GIOVANNI GUIDO CERRI
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Radiologia, Faculdade de Medicina - Docente
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina
LIM/44 - Laboratório de Ressonância Magnética em Neurorradiologia, Hospital das Clínicas, Faculdade de Medicina - Líder
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina
LIM/44 - Laboratório de Ressonância Magnética em Neurorradiologia, Hospital das Clínicas, Faculdade de Medicina - Líder
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- Effects of Prostatic Artery Embolization on the Dynamic Component of Benign Prostate Hyperplasia as Assessed by Ultrasound Elastography: A Pilot Series(2019) ASSIS, Andre Moreira de; MOREIRA, Airton Mota; CARNEVALE, Francisco Cesar; MARCELINO, Antonio Sergio Zafred; CERRI, Luciana Mendes de Oliveira; ANTUNES, Alberto Azoubel; SROUGI, Miguel; CERRI, Giovanni GuidoPurposeTo determine the effects of prostatic artery embolization (PAE) on prostaticelasticity as assessed by Ultrasound Elastography (US-E), as well as to describe the feasibility and role of US-E as a novel tool in both pre- and post-PAE evaluation.Materials and MethodsThis is a prospective, single-center investigation that included eight patients undergoing PAE for treatment of lower urinary tract symptoms (LUTS) attributed to benign prostate hyperplasia (BPH). Baseline and 3-month follow-up evaluations were performed and included prostate-specific antigen (PSA), uroflowmetry, pelvic magnetic resonance imaging and clinical assessment using the International Prostate Symptom Score (IPSS) questionnaire and the IPSS-Quality of life (QoL) item. US-E with measurement of the prostatic Elastic Modulus (EM) was performed before PAE and at 1-month follow-up.ResultsAfter PAE, US-E showed a significant reduction of prostatic EM as assessed in kPa (33.14 vs. 47.24, -29.8%, p=0.002) and in m/s (3.75 vs. 4.63, -19.0%, p<0.001). Also, the transitional/peripheral zone ratio was significantly reduced by 45.36% (0.53 vs. 0.97, p<0.05). All eight patients presented with significant LUTS improvement after PAE (p<0.05 for IPSS, QoL, prostate volume, peak urinary flow rate and PSA).ConclusionsFindings described in this study suggest that PAE significantly reduces prostaticEM, leading to a positive effect on BPH dynamic component related to prostatic elasticity. Also, it features US-E as an additional tool for pre- and post-PAE evaluation, describing a novel indication for this technology.
- Infusion of Recombinant Human Tissue Plasminogen Activator Through the Superior Mesenteric Artery in the Treatment of Acute Mesenteric Venous Thrombosis(2011) LEAL FILHO, Joaquim Mauricio da Motta; SANTOS, Aline Cristine Barbosa; CARNEVALE, Francisco Cesar; SOUSA JR., Wilson de Oliveira; GRILLO JR., Luiz Sergio Pereira; CERRI, Giovanni GuidoAcute mesenteric venous thrombosis is an uncommon condition that is usually treated with systemic anticoagulation. Catheter-directed thrombolysis through the superior mesenteric artery may be a viable adjunct to treat this morbid condition. In the present article, we have described a case of superior mesenteric venous thrombosis treated with catheter-directed infusion of tissue plasminogen activator through the superior mesenteric artery.
- Prostatic Artery Embolization: Indications, Preparation, Techniques, Imaging Evaluation, Reporting, and Complications(2021) JR, Ubenicio Silveira Dias; MOURA, Mauricio Ruettimann Liberato de; VIANA, Publio Cesar Cavalcante; ASSIS, Andre Moreira de; MARCELINO, Antonio Sergio Zanfred; MOREIRA, Airton Mota; LEITE, Claudia Costa; CERRI, Giovanni Guido; CARNEVALE, Francisco Cesar; HORVAT, NatallyBenign prostatic hyperplasia (BPH) is a noncancerous growth of the transitional zone of the prostate, which surrounds the prostatic urethra. Consequently, it can cause lower urinary tract symptoms (LUTS) and bladder outlet obstruction symptoms that may substantially reduce a patient's quality of life. Several treatments are available for BPH, including medications such as alpha-blockers and 5 alpha-reductase inhibitors and surgical options including transurethral resection of the prostate and prostatectomy. Recently, prostatic artery embolization (PAE) has emerged as a minimally invasive treatment option for selected men with BPH and moderate to severe LUTS. Adequate pre- and postprocedural evaluations with clinical examinations and questionnaires, laboratory tests, and urodynamic and imaging examinations (particularly US, MRI, and CT) are of key importance to achieve successful treatment. Considering that the use of PAE has been increasing in tertiary hospital facilities, radiologists and interventional radiologists should be aware of the main technical concepts of PAE and the key features to address in imaging reports in pre- and postprocedural settings. An invited commentary by Lopera is available online. Online supplemental material is available for this article. (C) RSNA, 2021
- Anatomical Variants in Prostate Artery Embolization: A Pictorial Essay(2017) CARNEVALE, Francisco Cesar; SOARES, Guilherme Rebello; ASSIS, Andre Moreira de; MOREIRA, Airton Mota; HARWARD, Sardis Honoria; CERRI, Giovanni GuidoProstate artery embolization (PAE) has emerged as a new treatment option for patients with symptomatic benign prostatic hyperplasia. The main challenges related to this procedure are navigating arteries with atherosclerosis and anatomical variations, and the potential risk of non-target embolization to pelvic structures due to the presence of collateral shunts and reflux of microparticles. Knowledge of classical vascular anatomy and the most common variations is essential for safe embolization, good clinical practice, and optimal outcomes. The aim of this pictorial essay is to illustrate the pelvic vascular anatomy relevant to PAE in order to provide a practical guide that includes the most common anatomical variants as well as to discuss the technical details related to each.
- Role of Ultrasound Elastography in Patient Selection for Prostatic Artery Embolization(2021) ASSIS, Andre Moreira de; MOREIRA, Airton Mota; CARNEVALE, Francisco Cesar; MARCELINO, Antonio Sergio Zafred; ANTUNES, Alberto Azoubel; SROUGI, Miguel; CERRI, Giovanni GuidoPurpose: To determine the effects of prostatic artery embolization (PAE) on prostate elasticity as assessed using ultrasound elastography (US-E) and to describe baseline US-E's potential role in patient selection. Materials and Methods: This was a prospective investigation that included 20 patients undergoing PAE to treat lower urinary tract symptoms attributed to benign prostatic hyperplasia (BPH). US-E with measurement of the prostatic elastic modulus (EM) and shear wave velocity (SWV) was performed before PAE and at 1-month follow-up. Baseline, 3-month, and 1-year follow-up evaluations included prostate-specific antigen, uroflowmetry, pelvic magnetic resonance imaging, and clinical assessment using the International Prostate Symptom Score (IPSS) and quality of life (QoL) metrics. Results: Seventeen patients entered statistical analysis. US-E showed a significant reduction in mean prostatic EM (34.4 kPa vs 46.3 kPa, similar to 24.7%, P <.0001) and SWV (3.55 m/s vs 4.46 m/s, similar to 20.0%, P <.0001) after PAE. There were moderate positive correlations between baseline EM and 1-year IPSS (R = 0.62, P = .007) and between baseline SWVand 1-year IPSS (R = 0.68, P = .002). Baseline SWV >= 5.59 m/s and baseline EM >= 50.14 kPa were associated with suboptimal IPSS and QoL outcomes after PAE with high degrees of sensitivity (100%) and specificity (69-100%). Conclusions: PAE led to a positive effect on the BPH dynamic component related to prostatic elasticity. There was a moderate positive correlation between baseline prostatic elastographic parameters and 12-month IPSS. Measurement of baseline elastographic characteristics may become useful for the evaluation and selection of patients for PAE.
- Management and treatment of decompensated hepatic fibrosis and severe refractory Schistosoma mansoni ascites with transjugular intrahepatic portosystemic shunt(2022) SANTO, Maria Cristina Carvalho do Espirito; GRYSCHEK, Ronaldo Cesar Borges; FARIAS, Alberto Queiroz; ANDRAUS, Wellington; CARVALHO, Noemia Barbosa; LEITE, Olavo Henrique Munhoz; CASTRO, Felipe Correa; CERRI, Giovanni Guido; HYPOLITTI, Gustavo Henrique; CARNEVALE, Francisco Cesar; ASSIS, Andre Moreira deThis study aimed to report the first case of a patient with hepatosplenic schistosomiasis mansoni, refractory ascites and portal vein thrombosis treated with a transjugular intrahepatic portosystemic shunt (TIPS), at the Instituto de Radiologia, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Brazil. After the procedure, the patient recovered favorably and progressed with portal pressure reduction and no deterioration of the liver function. Endovascular shunt modification is a conservative medical approach that often helps in reducing symptoms significantly, making it a less invasive and a safer alternative to liver transplantation for the treatment of schistosomiasis with portal hypertension.
- Pediatric Liver Transplant: Techniques and Complications(2017) HORVAT, Natally; MARCELINO, Antonio Sergio Zafred; HORVAT, Joao Vicente; YAMANARI, Tassia Regina; ARAJO-FILHO, Jose de Arimateia Batista; PANIZZA, Pedro; SEDA-NETO, Joao; FONSECA, Eduardo Antunes da; CARNEVALE, Francisco Cesar; CERRI, Luciana Mendes de Oliveira; CHAPCHAP, Paulo; CERRI, Giovanni GuidoLiver transplant is considered to be the last-resort treatment approach for pediatric patients with end-stage liver disease. Despite the remarkable advance in survival rates, liver transplant remains an intricate surgery with significant morbidity and mortality. Early diagnosis of complications is crucial for patient survival but is challenging given the lack of specificity in clinical presentation. Knowledge of the liver and vascular anatomy of the donor and the recipient or recipients before surgery is also important to avoid complications. In this framework, radiologists play a pivotal role on the multidisciplinary team in both pre-and postoperative scenarios by providing a road map to guide the surgery and by assisting in diagnosis of complications. The most common complications after liver transplant are (a) vascular, including the hepatic artery, portal vein, hepatic veins, and inferior vena cava; (b) biliary; (c) parenchy-mal; (d) perihepatic; and (e) neoplastic. The authors review surgical techniques, the role of each imaging modality, normal posttransplant imaging features, types of complications after liver transplant, and information required in the radiology report that is critical to patient care. They present an algorithm for an imaging approach for pediatric patients after liver transplant and describe key points that should be included in radiologic reports in the pre-and postoperative settings. (C) RSNA, 2017
- A Review of Adverse Events Related to Prostatic Artery Embolization for Treatment of Bladder Outlet Obstruction Due to BPH(2017) MOREIRA, Airton Mota; ASSIS, Andre Moreira de; CARNEVALE, Francisco Cesar; ANTUNES, Alberto Azoubel; SROUGI, Miguel; CERRI, Giovanni GuidoMinimally invasive procedures have gained great importance among the treatments for benign prostate hyperplasia (BPH) due to their low morbidity. Prostate artery embolization has emerged as a safe and effective alternative for patients with large volume BPH, not suited for surgery. Low adverse events rates have been reported following prostate artery embolization and may include dysuria, urinary infection, hematuria, hematospermia, acute urinary retention and rectal bleeding. Although most complaints are reported as side effects, complications can also be superimposed. The prostate gland is the most common source of complaints following PAE, where the inflammatory process can create a large variety of localized symptoms. Periprostatic organs and structures such as bladder, rectum, penis, seminal vesicle, pelvis, bones and skin may be damaged by nontarget embolization, especially due to the misidentification of the normal vascular anatomy and variants or due to inadvertent embolic reflux. Radiodermatitis may also happen in case of small vessel size, atherosclerosis, the learning curve and long procedure or fluoroscopy times. Regarding safety, it is pivotal to understand the pathophysiology of adverse events following PAE and their standardized reporting. The aim of this article is to discuss adverse events, their management and to review the current literature.
- Prostatic Artery Embolization for the Treatment of Lower Urinary Tract Symptoms Due to Benign Prostatic Hyperplasia: 10 Years' Experience(2020) CARNEVALE, Francisco Cesar; MOREIRA, Airton Mota; ASSIS, Andre Moreira de; ANTUNES, Alberto Azoubel; RODRIGUES, Vanessa Cristina de Paula; SROUGI, Miguel; CERRI, Giovanni GuidoBackground: Long-term experience with prostatic artery embolization (PAE) for benign prostatic hyperplasia remains limited. Purpose: To evaluate the efficacy, safety, and long-term results of PAE for benign prostatic hyperplasia. Materials and Methods: This retrospective single-center study was conducted from June 2008 to June 2018 in patients with moderate-to severe benign prostatic hyperplasia-related symptoms. International Prostate Symptom Score (IPSS), quality-of-life score, maximum urinary flow rate, postvoid residual volume, prostate-specific antigen (PSA), and prostate volume were assessed. PAE was performed with 100-500-mu m embolic microspheres. Mixed-model analysis of variance and Kaplan-Meyer method was accessed, as appropriate. Results: A total of 317 consecutive men (mean age 6 standard deviation, 65 years 6 8) were treated. Follow-up ranged from 3 months to 96 months (mean, 27 months). Bilateral and unilateral PAE was performed in 298 (94%) and 19 (6%) men, respectively. Early clinical failure occurred in six (1.9%) and symptom recurrence in 72 (23%) men at a median follow-up of 72 months. Mean maximum improvement was as follows: IPSS, 16 points +/- 7; quality-of-life score, 4 points +/- 1; prostatic volume reduction, 39 cm(3) +/- 39 (39% +/- 29); maximum urinary flow rate, 6 mL/sec +/- 10 (155% +/- 293); and postvoid residual volume, 70 mL +/- 6121 (48% +/- 81) (P < .05 for all). Unilateral PAE was associated with higher recurrence (42% vs 21%; P =.04). Baseline PSA was inversely related with recurrence (hazard ratio, 0.9 per nanograms per milliliter of PSA; 95% confidence interval [CI], 0.8, 0.9; P < .001). Embolization with combined particle sizes (100-500 mu m) did not relate to symptom recurrence (hazard ratio, 0.4; 95%CI: 0.2, 1.1 for 100-500-mu m group vs 300-500-mu m group and hazard ratio, 0.4; 95% CI: 0.1, 1.5 for 100-500-mu m group vs 100-300-mm group; P =.19). None of the patients presented with urinary incontinence or erectile dysfunction. Conclusion: Prostatic artery embolization was a safe and effective procedure for benign prostatic hyperplasia with good long-term results for lower urinary tract symptoms. (C) RSNA, 2020
- Recurrence of Lower Urinary Tract Symptoms Following Prostate Artery Embolization for Benign Hyperplasia: Single Center Experience Comparing Two Techniques(2017) CARNEVALE, Francisco Cesar; MOREIRA, Airton Mota; HARWARD, Sardis Honoria; BHATIA, Shivank; ASSIS, Andre Moreira de; SROUGI, Miguel; CERRI, Giovanni Guido; ANTUNES, Alberto AzoubelTo compare recurrence of lower urinary tract symptoms (LUTS) recurrence at 12 months following original prostate artery embolization (oPAE) or ""proximal embolization first, then embolize distal"" (PErFecTED) PAE for benign prostatic hyperplasia (BPH). 105 consecutive patients older than 45 years, with prostate size greater than 30 cm(3), International Prostate Symptom Score (IPSS) ae 8, quality of life (QoL) index ae 3, and refractory status or intolerance of medical management were prospectively enrolled between June 2008 and August 2013. The study was IRB-approved, and all patients provided informed consent. Patients underwent oPAE or PErFecTED PAE and were followed for at least 12 months. Technical success was defined as bilateral embolization and clinical success (non-recurrence) was defined as removal of the Foley catheter in patients with urinary retention, IPSS < 8 and QoL index < 3 at 12 months of follow-up. Nonparametric statistics were used to compare the study groups due to the size of the study population and distributions of clinical data. 97 patients had 12-month data and were categorized as oPAE without recurrence (n = 46), oPAE with recurrence (n = 13), PErFecTED without recurrence (n = 36), or PErFecTED with recurrence (n = 2). Recurrence was significantly more common in oPAE patients (chi (2), p = 0.026). Unilateral embolization was significantly associated with recurrence among patients who underwent oPAE (chi (2), p = 0.032). Both oPAE and PErFecTED PAE are safe and effective methods for treatment of LUTS, but PErFecTED PAE is associated with a significantly lower rate of symptom recurrence.