Magnetic resonance spectroscopy imaging in the diagnosis of prostate cancer: initial experience

OBJECTIVE: To report an experiment involving the introduction of a protocol utilizing commercially available three-dimensional 1H magnetic resonance spectroscopy imaging (3D 1H MRSI) method in patients diagnosed with prostatic tumors under suspicion of neoplasm. MATERIALS AND METHODS: Forty-one patients in the age range between 51 and 80 years (mean, 67 years) were prospectively evaluated. The patients were divided into two groups: patients with one or more biopsies negative for cancer and high specific-prostatic antigen levels (group A), and patients with cancer confirmed by biopsy (group B). The determination of the target-area (group A) or the known cancer extent (group B) was based on magnetic resonance imaging and MRSI studies. RESULTS: The specificity of MRSI in the diagnosis of prostate cancer was lower than the specificity reported in the literature (about 47%). On the other hand, for tumor staging, it corresponded to the specificity reported in the literature. CONCLUSION: The introduction and standardization of 3D 1H MRSI has allowed the obtention of a presumable diagnosis of prostate cancer, by a combined analysis of magnetic resonance imaging and metabolic data from 3D 1H MRSI.OBJETIVO: Demonstrar a experiência na implantação de um protocolo de espectroscopia por ressonância magnética do 1H tridimensional (3D 1H MRSI), disponível comercialmente, aplicando-o em pacientes com suspeita de neoplasia prostática e com diagnóstico estabelecido de tumor prostático. MATERIAIS E MÉTODOS: Estudo realizado de forma prospectiva, em 41 pacientes com idades entre 51 e 80 anos (média de 67 anos). Dois grupos foram formados: pacientes com uma ou mais biópsias negativas para câncer e antígeno prostático específico elevado (grupo A) e pacientes com câncer confirmado por biópsia (grupo B). Procurou-se, a partir dos resultados da ressonância magnética e espectroscopia por ressonância magnética, determinar a área-alvo (grupo A) ou a extensão do câncer conhecido (grupo B). RESULTADOS: No diagnóstico de câncer de próstata a espectroscopia por ressonância magnética apresentou especificidade abaixo da descrita pela literatura, cerca de 47%. Já para o estadiamento do tumor diagnosticado, houve correspondência com a literatura. CONCLUSÃO: A implantação e padronização da espectroscopia por ressonância magnética permitiram a obtenção de informações importantes para o diagnóstico presuntivo da existência de câncer de próstata, combinando as imagens por ressonância magnética com os dados metabólicos da espectroscopia por ressonância magnética.Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Universidade Federal de São Paulo (UNIFESP) Escola Paulista de MedicinaUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de Diagnóstico por ImagemUniversidade Federal do AmazonasUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Hospital São PauloUNIFESP, EPM, Depto. de Diagnóstico por ImagemUNIFESP, EPM, Hospital São PauloSciEL

Prevalence of Incidental Pancreatic Cysts on 3 Tesla Magnetic Resonance

ObjectivesTo ascertain the prevalence of pancreatic cysts detected incidentally on 3-Tesla magnetic resonance imaging (MRI) of the abdomen and correlate this prevalence with patient age and gender; assess the number, location, and size of these lesions, as well as features suspicious for malignancy; and determine the prevalence of incidentally detected dilatation of the main pancreatic duct (MPD).MethodsRetrospective analysis of 2,678 reports of patients who underwent abdominal MRI between January 2012 and June 2013. Patients with a known history of pancreatic conditions or surgery were excluded, and the remaining 2,583 reports were examined for the presence of pancreatic cysts, which was then correlated with patient age and gender. We also assessed whether cysts were solitary or multiple, as well as their location within the pancreatic parenchyma, size, and features suspicious for malignancy. Finally, we calculated the prevalence of incidental MPD dilatation, defined as MPD diameter >= 2.5 mm.ResultsPancreatic cysts were detected incidentally in 9.3% of patients (239/2,583). the prevalence of pancreatic cysts increased significantly with age (p= 5 mm in size; 12.1% were suspicious for malignancy. An estimated 2.7% of subjects had a dilated MPD.Universidade Federal de São Paulo UNIFESP, Escola Paulista Med, Dept Imaging Diag, São Paulo, SP, BrazilUniversidade Federal de São Paulo UNIFESP, Escola Paulista Med, Dept Imaging Diag, São Paulo, SP, BrazilWeb of Scienc

Metabolic changes in HIV-infected children and adolescents from São Paulo city, Brazil

Universidade Federal de São Paulo UNIFESP EPM, São Paulo, BrazilUniversidade Federal de São Paulo UNIFESP EPM, São Paulo, BrazilWeb of Scienc

Congenital microcephaly: Case definition & guidelines for data collection, analysis, and presentation of safety data after maternal immunisation.

Need for developing case definitions and guidelines for data collection, analysis, and presentation for congenital microcephaly as an adverse event following maternal immunisation Congenital microcephaly, also referred to as primary microcephaly due to its presence in utero or at birth, is a descriptive term for a structural defect in which a fetus or infant’s head (cranium) circumference is smaller than expected when compared to other fetuses or infants of the same gestational age, sex and ethnic background

Zika Virus: What Have We Learnt Since the Start of the Recent Epidemic?

Zika is a viral disease transmitted mainly by mosquitoes of the genus Aedes. In recent years, it has expanded geographically, changing from an endemic mosquito-borne disease across equatorial Asia and Africa, to an epidemic disease causing large outbreaks in several areas of the world. With the recent Zika virus (ZIKV) outbreaks in the Americas, the disease has become a focus of attention of public health agencies and of the international research community, especially due to an association with neurological disorders in adults and to the severe neurological and ophthalmological abnormalities found in fetuses and newborns of mothers exposed to ZIKV during pregnancy. A large number of studies have been published in the last 3 years, revealing the structure of the virus, how it is transmitted and how it affects human cells. Many different animal models have been developed, which recapitulate several features of ZIKV disease and its neurological consequences. Moreover, several vaccine candidates are now in active preclinical development, and three of them have already entered phase I clinical trials. Likewise, many different compounds targeting viral and cellular components are being tested in in vitro and in experimental animal models. This review aims to discuss the current state of this rapidly growing literature from a multidisciplinary perspective, as well as to present an overview of the public health response to Zika and of the perspectives for the prevention and treatment of this disease

Neuroimaging in congenital zika virus syndrome: from diagnosis to monitoring of neurologic sequelae

A trajetória do Zika vírus, desde sua origem na isolada Floresta Zika até se tornar um patógeno com impacto profundo na saúde mundial, ilustra a dinâmica complexa das doenças infecciosas emergentes e a necessidade de vigilância constante, pesquisa e cooperação internacional para enfrentar desafios que transcendem fronteiras. Em face dos desafios impostos pela síndrome congênita do Zika, a necessidade de pesquisa contínua é evidente. Esta tese investiga o papel da neuroimagem no diagnóstico e acompanhamento dos pacientes acometidos pelo Zika vírus, através de estudos desenvolvidos pelo grupo de pesquisa, cujo objetivo geral foi caracterizar as alterações morfológicas relacionadas a infecção congênita pelo vírus Zika e os objetivos específicos foram: caracterizar os aspectos de imagem das alterações do desenvolvimento fetal; descrever as características das imagens pós-natais com foco nas anomalias cranioencefálicas; correlacionar os aspectos morfológicos radiológicos com as alterações histopatológicas nos casos de autópsia; e correlacionar achados morfológicos com alterações do neurodesenvolvimento das crianças expostas à infecção congênita pelo vírus Zika. O resultado é demonstrado através da compilação dos nove artigos desenvolvidos pelo nosso grupo de pesquisa: 1) investigou a associação entre a infecção pelo vírus Zika e a microcefalia fetal, confirmando a transmissão vertical e descrevendo os aspectos de imagem através da avaliação por ultrassonografia de dois fetos acometidos pela infecção congênita, 2) documentou os achados de imagem característicos da infecção congênita pelo vírus Zika, tanto no período pré-natal quanto pós-natal através de uma abordagem multimodal, 3) descreveu a evolução pré-natal e os resultados perinatais através de uma abordagem clínica e radiológica completa do desenvolvimento e danos neurológicos associados à infeção pelo vírus Zika, 4) analisou a ativação imune no líquido amniótico de gestantes infectadas pelo vírus Zika, 5) revisão das alterações radiológicas do sistema nervoso central associados à infecção congênita pelo vírus Zika, utilizando diferentes métodos de imagem e a correlação destas com a fisiopatologia e mecanismo de ação, 6) investigou e detalhou os efeitos neuropatológicos do vírus Zika no sistema nervoso central através da avaliação post-mortem de neonatos infectados intraútero, 7) demonstrou os resultados da avaliação clínica de crianças em idade pré-escolar com síndrome congênita do Zika, identificando os principais sintomas neurológicos, suas correlações funcionais e comorbidades associadas, 8) abordou os resultados obstétricos e perinatais da coorte de pacientes gestantes cujos fetos foram acometidos pela síndrome congênita do Zika, observando as implicações clínicas da infecção pelo vírus Zika durante a gestação e no período perinatal, e 9) investigou e demonstrou os resultados de uma segunda gestação em mulheres que foram infectadas pelo vírus Zika em gestação prévia e cujos filhos anteriores nasceram com síndrome congênita do vírus Zika. O grupo de pesquisa foi o responsável pelo alerta mundial da transmissão vertical e o pioneiro na descrição dos dois primeiros casos de Zika congênita diagnosticados ainda na vida intrauterina, também propôs o termo "síndrome congênita do Zika", além de contribuições importantes como o estudo de neuropatologia com o maior número de neonatos avaliados post-mortem e o estudo dedicado a avaliação multimodal de neuroimagem com a descrições minuciosas do espectro de alterações radiológicas.The trajectory of the Zika virus, from its origins in the isolated Zika Forest to becoming a pathogen with profound global health impact, illustrates the complex dynamics of emerging infectious diseases and the need for constant surveillance, research and international cooperation to tackle challenges that transcend borders. In light of the challenges posed by Zika congenital syndrome, the need for ongoing research is evident. This thesis investigates the role of neuroimaging in the diagnosis and follow-up of patients affected by the Zika virus, through studies conducted by the research group, the overall aim was to characterize the morphological alterations related to congenital Zika virus infection, with the specific objectives being: to characterize imaging aspects of fetal development abnormalities; to describe postnatal imaging features focusing on cranioencephalic anomalies; to correlate radiological morphological aspects with histopathological changes in autopsy cases; and to relate morphological findings with neurodevelopmental alterations in children exposed to congenital Zika virus infection. The results are demonstrated through the compilation of nine articles developed by our research group: 1) investigated the association between Zika virus infection and fetal microcephaly, confirming vertical transmission and describing the imaging aspects through ultrasound evaluation of two fetuses affected by congenital infection; 2) documented the characteristic imaging findings of congenital Zika virus infection, both prenatal and postnatal, using a multimodal approach; 3) described the prenatal evolution and perinatal outcomes through a comprehensive clinical and radiological approach to development and neurological damage associated with Zika virus infection; 4) analyzed immune activation in the amniotic fluid of pregnant women infected with Zika virus; 5) reviewed the radiological changes in the central nervous system associated with congenital Zika virus infection, utilizing different imaging methods and correlating them with pathophysiology and mechanisms of action; 6) investigated and detailed the neuropathological effects of Zika virus on the central nervous system through post-mortem evaluation of intrauterine-infected neonates; 7) demonstrated the results of clinical evaluations of preschool-aged children with congenital Zika syndrome, identifying the main neurological symptoms, their functional correlations and associated comorbidities; 8) addressed obstetric and perinatal outcomes of the cohort of pregnant patients whose fetuses were affected by congenital Zika syndrome, observing the clinical implications of Zika virus infection during pregnancy and the perinatal period; and 9) investigated and demonstrated the outcomes of a second pregnancy in women who were infected with Zika virus in a previous pregnancy and whose earlier children were born with congenital Zika syndrome. The research group was responsible for the worldwide alert on vertical transmission and was pioneering in the description of the first two cases of congenital Zika diagnosed still in utero. Additionally, proposed the term "congenital Zika syndrome" and made significant contributions, including the neuropathology study with the largest number of post-mortem evaluated neonates and a dedicated multimodal neuroimaging study with detailed descriptions of the spectrum of radiological changes.Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brasil (CAPES