Publications by authors named "Dario Ariel Tiferes"

5 Publications

  • Page 1 of 1

The many faces of primary and secondary hepatic lymphoma: imaging manifestations and diagnostic approach.

Radiol Bras 2019 Sep-Oct;52(5):325-330

Department of Diagnostic Imaging, Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil.

Hepatic lymphoma can be divided into its primary and secondary forms. To be classified as primary hepatic lymphoma, the disease should be limited to the liver and hilar lymph nodes, with no distant involvement (to the bone marrow or other sites). Primary hepatic lymphoma is quite rare, accounting for less than 1% of all cases of non-Hodgkin lymphoma, whereas secondary hepatic lymphoma affects nearly half of such cases. Familiarity with the imaging features of hepatic lymphoma is important for its early diagnosis and appropriate management. In this essay, we aim to review the roles of computed tomography and magnetic resonance imaging in identifying and monitoring hepatic lymphomas, using sample cases to describe and illustrate the wide spectrum of imaging findings in the primary and secondary forms of this disorder.
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http://dx.doi.org/10.1590/0100-3984.2018.0013DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6808615PMC
October 2019

Common and Uncommon Benign Pancreatic Lesions Mimicking Malignancy: Imaging Update and Review.

Semin Ultrasound CT MR 2018 Apr 26;39(2):206-219. Epub 2017 Oct 26.

Grupo Fleury, São Paulo, Brazil; Department of Imaging, Universidade Federal de São Paulo, São Paulo, Brazil.

There is a broad range of inflammatory, pseudotumoral, and benign lesions that may masquerade as pancreatic malignancies, often representing a challenge to the radiologist. Unawareness of these entities can lead to inadequate differential diagnoses or misdiagnosis, with important prognostic and therapeutic consequences. The purpose of this article is to revisit a spectrum of lesions, varying from common to exceedingly rare nonmalignant, that may mimic malignant pancreatic neoplasms on imaging, identifying relevant features that may contribute to reaching the correct diagnosis. Representative cases include focal fatty replacement, intrapancreatic accessory spleen, pancreatic lobulation, lipoma, autoimmune pancreatitis, focal pancreatitis, eosinophilic pancreatitis, groove pancreatitis, hemangioma, intrapancreatic aneurysm, tuberculosis, and Castleman's disease.
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http://dx.doi.org/10.1053/j.sult.2017.10.002DOI Listing
April 2018

CT colonography: the value of this method in the view of specialists.

Radiol Bras 2014 May-Jun;47(3):135-40

Professor, Department of Imaging Diagnosis, Escola Paulista de Medicina - Universidade Federal de São Paulo (EPM-Unifesp), MD, Laboratório Fleury-São Paulo, São Paulo, SP, Brazil.

Objective: To map the view of surgeons on the role played by computed tomography colonography (CTC).

Materials And Methods: An electronic questionnaire was sent to members of the Brazilian College of Surgeons. The questionnaire consisted of 16 multiple-choice questions about demographics and general knowledge about CTC.

Results: The authors obtained 144 responses; 90.3% of the specialists were men, 60% with less than 30 years from graduation, 77.1% were gastrointestinal surgeons, 22.9% were general surgeons, 53.5% were involved in academic activity, and 59.7% had their professional activity in cities with more than 500,000 inhabitants. As regards the knowledge about CTC, 84.7% of the respondents knew the method, 70.8% knew how it is performed, 56.9% reported knowing the bowel preparation used for the procedure, 31.3% used the method, and 53.5% knew some CTC service in their city. About half of the respondents did not know the precise indication of the method. The method is most frequently known and used by professionals working in cities with more than 500,000 inhabitants (p < 0.005). There was a tendency of a more frequent use of the method by the professionals pursuing an academic career.

Conclusion: Despite its infrequent use in Brazil, CTC is a well known method, particularly in large urban centers and in the academic environment.
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http://dx.doi.org/10.1590/0100-3984.2013.1837DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4337144PMC
March 2015

Using computed tomography colonography in patients at high risk of colorectal cancer - a prospective study in a university hospital in South America.

Clinics (Sao Paulo) 2014 Nov;69(11):723-30

Division of Abdominal Imaging, Department of Diagnostic Imaging, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil.

Objectives: The purpose of our study was to report the results of the implementation of computed tomography colonography in a university hospital setting serving a Brazilian population at high risk of colorectal cancer.

Methods: After creating a computed tomography colonography service in our institution, 85 patients at high risk of colorectal cancer underwent computed tomography colonography followed by a same-day optical colonoscopy from September 2010 to May 2012. The overall accuracy of computed tomography colonography in the detection of lesions ≥6 mm was compared to that of optical colonoscopy (direct comparison). All colonic segments were evaluated using quality imaging (amount of liquid and solid residual feces and luminal distension). To assess patient acceptance and preference, a questionnaire was completed before and after the computed tomography colonography and optical colonoscopy. Fisher's exact test was used to measure the correlations between colonic distension, discomfort during the exam, exam preference and interpretation confidence.

Results: Thirteen carcinomas and twenty-two lesions ≥6 mm were characterized. The sensitivity, specificity and accuracy of computed tomography colonography were 100%, 98.2% and 98.6%, respectively. Computed tomography colonography was the preferred method of investigation for 85% of patients. The preparation was reported to cause only mild discomfort for 97.6% of patients. According to the questionnaires, there was no significant relationship between colonic distension and discomfort (p>0.05). Most patients (89%) achieved excellent bowel preparation. There was a statistically significant correlation between the confidence perceived in reading the computed tomography colonography and the quality of the preparation in each colonic segment (p≤0.001). The average effective radiation dose per exam was 7.8 mSv.

Conclusion: It was possible to institute an efficient computed tomography colonography service at a university hospital that primarily assists patients from the public health system, with high accuracy, good acceptance and effective radiation doses. Our results seem to be comparable to other centers of excellence and fall within acceptable published guidelines, showing that a successful computed tomography colonography program can be reproduced in a South American population screened in a university hospital.
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http://dx.doi.org/10.6061/clinics/2014(11)03DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4255077PMC
November 2014

Comparison between ultrasound and noncontrast helical computed tomography for identification of acute ureterolithiasis in a teaching hospital setting.

Sao Paulo Med J 2007 Mar;125(2):102-7

Diagnostic Imaging Department, Universidade Federal de São Paulo - Escola Paulista de Medicina, São Paulo, Brazil.

Context And Objective: Recent studies have shown noncontrast computed tomography (NCT) to be more effective than ultrasound (US) for imaging acute ureterolithiasis. However, to our knowledge, there are few studies directly comparing these techniques in an emergency teaching hospital setting. The objectives of this study were to compare the diagnostic accuracy of US and NCT performed by senior radiology residents for diagnosing acute ureterolithiasis; and to assess interobserver agreement on tomography interpretations by residents and experienced abdominal radiologists.

Design And Setting: Prospective study of 52 consecutive patients, who underwent both US and NCT within an interval of eight hours, at Hospital São Paulo.

Methods: US scans were performed by senior residents and read by experienced radiologists. NCT scan images were read by senior residents, and subsequently by three abdominal radiologists. The interobserver variability was assessed using the kappa statistic.

Results: Ureteral calculi were found in 40 out of 52 patients (77%). US presented sensitivity of 22% and specificity of 100%. When collecting system dilatation was associated, US demonstrated 73% sensitivity, 82% specificity. The interobserver agreement in NCT analysis was very high with regard to identification of calculi, collecting system dilatation and stranding of perinephric fat.

Conclusions: US has limited value for identifying ureteral calculi in comparison with NCT, even when collecting system dilatation is present. Residents and abdominal radiologists demonstrated excellent agreement rates for ureteral calculi, identification of collecting system dilatation and stranding of perinephric fat on NCT.
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http://dx.doi.org/10.1590/s1516-31802007000200007DOI Listing
March 2007
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