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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bookPart Estudo por imagem das vias biliares(2017) OLIVEIRA, Thobias Nóbrega de; SAITO, Osmar de Cássio; CHAMMAS, Maria Cristina; CERRI, Giovanni Guido- Can contrast-enhanced ultrasound with second-generation contrast agents replace computed tomography angiography for distinguishing between occlusion and pseudo-occlusion of the internal carotid artery?(2015) VENTURA, Carlos Augusto Pinto; SILVA, Erasmo Simao da; CERRI, Giovanni Guido; LEAO, Pedro Puech; TACHIBANA, Adriano; CHAMMAS, Maria CristinaOBJECTIVE: The purpose of this study was to evaluate the effectiveness of contrast-enhanced ultrasound with a second-generation contrast agent in distinguishing between occlusion and pseudo-occlusion of the cervical internal carotid artery, comparing it with that of conventional Doppler ultrasound and the gold standard, computed tomography angiography. METHOD: Between June 2006 and June 2012, we screened 72 symptomatic vascular surgery outpatients at a public hospital. Among those patients, 78 cervical internal carotid arteries were previously classified as occluded by Doppler ultrasound (without contrast). The patients were examined again with Doppler ultrasound, as well as with contrast-enhanced ultrasound and computed tomography angiography. The diagnosis was based on the presence or absence of flow. RESULTS: Among the 78 cervical internal carotid arteries identified as occluded by Doppler ultrasound, occlusion was confirmed by computed tomography angiography in only 57 (73.1%), compared with 59 (77.5%) for which occlusion was confirmed by contrast-enhanced ultrasound (p>0.5 vs. computed tomography angiography). Comparing contrast-enhanced ultrasound with Doppler ultrasound, we found that the proportion of cervical internal carotid arteries classified as occluded was 24.4% higher when the latter was used (p<0.001). CONCLUSIONS: We conclude that, in making the differential diagnosis between occlusion and pseudo-occlusion of the cervical internal carotid artery, contrast-enhanced ultrasound with a second-generation contrast agent is significantly more effective than conventional Doppler ultrasound and is equally as effective as the gold standard (computed tomography angiography). Our findings suggest that contrast-enhanced ultrasound could replace computed tomography angiography in this regard.
conferenceObject LOWLEVEL LASER THERAPY CAN IMPROVE THE THYROID VASCULARIZATION IN PATIENTS WITH CHRONIC AUTOIMMUNE THROIDITIS(2012) HOEFLING, Danilo; CHAVANTES, Maria Cristina; JULIANO, Adriana; CERRI, Giovanni; KNOBEL, Meyer; YOSHIMURA, Elisabeth; CHAMMAS, Maria CristinaBackground: Chronic autoimmune thyroiditis (CAT) frequently alters thyroid vascularization, likely as a result of the autoimmune process. Therefore, the objective of this study was to evaluate the effects of low-level laser therapy (LLLT) on the thyroid vascularization of patients with hypothyroidism induced by CAT using color Doppler ultrasound parameters. Study: A randomized clinical trial was conducted from 2006 to 2009 at the Hospital das Clínicas, University of Sao Paulo Medical School. Forty-three patients who underwent levothyroxine replacement for CAT-induced hypothyroidism were randomly assigned to receive either 10 sessions of LLLT (L group, n=23) or 10 sessions of a placebo treatment (P group, n=20). Color Doppler ultrasounds were performed before and 30 days after the end of the interventions. All of the patients in both groups continued taking their previous levothyroxine doses for the duration of the study. To verify the vascularization of the thyroid parenchyma, power Doppler was performed. The systolic peak velocity (SPV) and resistance index (RI) in the superior and inferior thyroid arteries were measured by pulsed Doppler. Results: All of the patients completed the study. The frequency of normal vascularization of the thyroid lobes observed in the post-intervention power Doppler examination was significantly higher in the L than in the P group (P=0.023). The pulsed Doppler examination revealed an increase in the SPV of the inferior thyroid arteries in the L group compared with the P group (P=0.016), whereas no significant difference in the SPV of the superior thyroid arteries was found between the groups. There was also no significant difference in the RI between the groups. Conclusion: These results suggest that LLLT can ameliorate thyroid parenchyma vascularization and increase the SPV of the inferior thyroid arteries of patients with hypothyroidism caused by CAT.- Safety and Efficacy of Low-Level Laser Therapy in Autoimmune Thyroiditis: Long-Term Follow-Up Study(2018) HOFLING, Danilo Bianchini; CHAVANTES, Maria Cristina; BUCHPIGUEL, Carlos Alberto; CERRI, Giovanni Guido; MARUI, Suemi; CARNEIRO, Paulo Campos; CHAMMAS, Maria CristinaIntroduction. A randomized clinical trial (RCT) was performed to evaluate the efficacy of low-level laser therapy (LLLT) for hypothyroidism induced by chronic autoimmune thyroiditis (CAT). Objective. The objective was to assess the safety and actions of LLLT 6 years after completion of the RCT. Materials and Methods. Forty-three participants were invited to participate in this study 6 years after completion of the RCT. Twenty-five were subjected to LLLT (group L), and 18 were subjected to placebo (group P). Primary outcome measure: frequency of thyroid nodules, which were subjected to fine-needle aspiration biopsy. Secondary outcome measures: dose of levothyroxine required to treat hypothyroidism, thyroid peroxidase antibodies (anti-TPO), and anti-thyroglobulin antibodies (anti-Tg). Results. In group L, a nodule was observed in three patients, who all had a Bethesda II classification. In group P, a nodule was also observed in three patients, with two classified as Bethesda II and one as Bethesda III. The levothyroxine dose required by group L was significantly lower than that required by group P (P = 0 002). The anti-TPO and anti-Tg levels did not differ between the groups. Conclusion. LLLT, by the methods described, has been shown to be safe for the treatment of hypothyroidism resulting from CAT.
- The End-Diastolic Velocity of Thyroid Arteries Is Strongly Correlated with the Peak Systolic Velocity and Gland Volume in Patients with Autoimmune Thyroiditis(2017) HOFLING, Danilo Bianchini; MARUI, Suemi; BUCHPIGUEL, Carlos Alberto; CERRI, Giovanni Guido; CHAMMAS, Maria CristinaBackground. The end-diastolic velocity (EDV) of thyroid arteries reflects peripheral blood flow resistance. Objective. The aim was to evaluate EDV correlations with other Doppler sonography parameters and with clinical and biochemical variables in a sample of patients with hypothyroidism caused by chronic autoimmune thyroiditis (CAT). Methods. A sample of 48 CAT hypothyroid patients receiving treatment with stable doses of levothyroxine was selected. The participants underwent clinical evaluation and measurement of serum thyrotropin (TSH), total triiodothyronine (T3), total thyroxine (T4), free T4, thyroid peroxidase antibodies (anti-TPO), and antithyroglobulin antibodies (anti-Tg) and Doppler sonography. Results. The EDV of the inferior thyroid arteries (ITA-EDV) was strongly and positively correlated with the peak systolic velocity of the inferior thyroid arteries (ITA-PSV, r = 0.919), thyroid volume (r = 0.711), and thyroid visual vascularization pattern (TVP, r = 0.687). There was no correlation between ITA-EDV and the clinical variables, hormones, anti-TPO, or anti-Tg. Conclusion. The strong correlation of ITA-EDV with ITA-PSV, TVP, and volume suggests that increased vascularization in CAT may be associated with a reduction in thyroid blood flow resistance, possibly due to an angiogenesis-induced increase in the total vascular cross-sectional area of the parenchyma.
- Ultrasonographic study and Doppler flow velocimetry of maternal kidneys and liver in low-risk pregnancy(2015) DAHER, Cibele Helena; GOMES, Andrea Cavalanti; KOBAYASHI, Sergio; CERRI, Giovanni Guido; CHAMMAS, Maria CristinaAbstract Objective: Longitudinal study with B-mode ultrasonography and Doppler ultrasonography of maternal kidneys and liver in low-risk pregnancy, to establish and quantify normality parameters, correlating them with physiological changes. Materials and Methods: Twenty-five pregnant women were assessed and selected to participate in the study, each of them undergoing four examinations at the first, second, third trimesters and postpartum. Results: Findings during pregnancy were the following: increased renal volume, pyelocaliceal dilatation with incidence of 45.4% in the right kidney, and 9% in the left kidney; nephrolithiasis, 18.1% in the right kidney, 13.6% in the left kidney. With pyelocaliceal dilatation, mean values for resistivity index were: 0.68 for renal arteries; 0.66 for segmental arteries; 0.64 for interlobar arteries; 0.64 for arcuate arteries. Without pyelocaliceal dilatation, 0.67 for renal arteries; 0.64 for segmental arteries; 0.63 for interlobar arteries; and 0.61 for arcuate arteries. Portal vein flow velocities presented higher values in pregnancy, with mean value for maximum velocity of 28.9 cm/s, and 22.6 cm/s postpartum. The waveform pattern of the right hepatic vein presented changes persisting in the postpartum period in 31.8% of the patients. Cholelithiasis was observed in 18.1% of the patients. Conclusion: Alterations in renal volume, pyelocaliceal dilatation, nephrolithiasis, cholelithiasis, changes in portal vein flow velocity, alterations in waveform pattern of the right hepatic vein, proved to be significant.
conferenceObject LONG-TERM FOLLOW-UP OF PATIENTS WITH HYPOTHYROIDISM INDUCED BY AUTOIMMUNE THYROIDITIS SUBMITTED TO LOW-LEVEL LASER THERAPY(2017) HOFLING, Danilo; CHAVANTES, M. Cristina; BUCHPIGUEL, Carlos Alberto; CERRI, Giovanni Guido; CARNEIRO, Paulo Campos; MARUI, Suemi; CHAMMAS, Maria Cristina- Can Doppler or contrast-enhanced ultrasound analysis add diagnostically important information about the nature of breast lesions?(2014) STANZANI, Daniela; CHALA, Luciano F.; BARROS, Nestor de; CERRI, Giovanni G.; CHAMMAS, Maria CristinaOBJECTIVES: Despite evidence suggesting that Doppler ultrasonography can help to differentiate between benign and malignant breast lesions, it is rarely applied in clinical practice. The aim of this study was to determine whether certain vascular features of breast masses observed by duplex Doppler and color Doppler ultrasonography (before and/or after microbubble contrast injection) add information to the gray-scale analysis and support the Breast Imaging-Reporting and Data System (BI-RADS) classification. METHODS: Seventy solid lesions were prospectively evaluated with gray-scale ultrasonography, color Doppler ultrasonography, and contrast-enhanced ultrasonography. The morphological analysis and lesion vascularity were correlated with the histological results. RESULTS: Percutaneous core biopsies revealed that 25/70 (17.5%) lesions were malignant, while 45 were benign. Hypervascular lesions with tortuous and central vessels, a resistive index (RI)> 0.73 before contrast injection, and an RI > 0.75 after contrast injection were significantly predictive of malignancy (p < 0.001). CONCLUSION: The combination of gray-scale ultrasonography data with unenhanced or enhanced duplex Doppler and color Doppler US data can provide diagnostically useful information. These techniques can be easily implemented because Doppler devices are already present in most health centers.
- Audiovisual Sexual Stimulation Improves Diagnostic Accuracy of Penile Doppler Ultrasound in Patients With Erectile Dysfunction(2020) CARNEIRO, Felipe; NASCIMENTO, Bruno; MIRANDA, Eduardo P.; CURY, Jose; CERRI, Giovanni G.; CHAMMAS, Maria CristinaIntroduction: Although penile Doppler ultrasound (PDU) is a useful tool in evaluating erectile dysfunction (ED), an optimal erectile response might be limited because of an increased sympathetic discharge. Audiovisual sexual stimulation (AVSS) has been suggested to help improving PDU performance. Aim: To evaluate the use of AVSS as a tool to improve diagnostic accuracy of PDU studies. Methods: A total of 40 men (mean age: 61.8 +/- 10.2 years) with ED were enrolled. PDU sessions were performed in a randomized fashion as follows: session A under intracavernous injection (ICI) alone and session B under ICI and AVSS with 7-day interval between sessions. Peak systolic velocity (PSV), end-diastolic velocity (EDV), and resistive index (RI) were measured 5, 10, 15, and 20 minutes after ICI. Main Outcome Measure: Comparisons between PSV, EDV, and RI values were performed with and without AVSS. Univariable and multivariable analyses including clinical and demographic parameters were performed to evaluate predictors of an abnormal PDU. Results: 23 patients performed the first session without AVSS, and 17 performed the first session with AVSS. EDV and RI were better in AVSS session (p = 0.022 and 0.019). PSV was not influenced by AVSS (p = 0.768). The proportion of patients whose diagnosis was changed because of the AVSS was 4 of 40 (10.0%, 95% confidence interval [CI]: 2.8-23.7%). Of 12 patients with venous leak observed on the PDU without AVSS, 3 turned into normal after AVSS (25.0%, 95% CI: 5.5-57.2%). Of 4 men with arterial insufficiency observed on the PDU on ICI alone, 1 became normal after AVSS (25.0%, 95% CI: 0.6-80.6%). International Index of Erectile Function-5 scores were lower in patients with abnormal PDU (6.3 +/- 3.3 vs 12.0 +/- 5.8, p=0.003). On multivariable analysis, DM and International Index of Erectile Function-5 scores were the only independent predictors of abnormal PDU studies. Clinical Implications: False diagnoses of venous leak during PDU with ICI could be a result of an increased adrenergic discharge during the examination. Routine AVSS may be helpful to avoid error in diagnosis. Strength & Limitations: The study has randomized the use of AVSS in different session orders. Only one previously published study has used this strategy to control the accommodation effect in repeat studies, a common source of bias in the PDU literature. The main limitation is the absence of a rigidity assessment and a redosing protocol. Conclusion: Adding AVSS during PDU improves ICI response and may help clinicians evaluate penile hemodynamics more accurately.
- Low-level laser in the treatment of patients with hypothyroidism induced by chronic autoimmune thyroiditis: a randomized, placebo-controlled clinical trial(2013) HOEFLING, Danilo B.; CHAVANTES, Maria Cristina; JULIANO, Adriana G.; CERRI, Giovanni G.; KNOBEL, Meyer; YOSHIMURA, Elisabeth M.; CHAMMAS, Maria CristinaChronic autoimmune thyroiditis (CAT) is the most common cause of acquired hypothyroidism, which requires lifelong levothyroxine replacement therapy. Currently, no effective therapy is available for CAT. Thus, the objective of this study was to evaluate the efficacy of low-level laser therapy (LLLT) in patients with CAT-induced hypothyroidism by testing thyroid function, thyroid peroxidase antibodies (TPOAb), thyroglobulin antibodies (TgAb), and ultrasonographic echogenicity. A randomized, placebo-controlled trial with a 9-month follow-up was conducted from 2006 to 2009. Forty-three patients with a history of levothyroxine therapy for CAT-induced hypothyroidism were randomly assigned to receive either 10 sessions of LLLT (830 nm, output power of 50 mW, and fluence of 707 J/cm(2); L group, n = 23) or 10 sessions of a placebo treatment (P group, n = 20). The levothyroxine was suspended 30 days after the LLLT or placebo procedures. Thyroid function was estimated by the levothyroxine dose required to achieve normal concentrations of T-3, T-4, free-T-4 (fT(4)), and thyrotropin after 9 months of postlevothyroxine withdrawal. Autoimmunity was assessed by measuring the TPOAb and TgAb levels. A quantitative computerized echogenicity analysis was performed pre- and 30 days postintervention. The results showed a significant difference in the mean levothyroxine dose required to treat the hypothyroidism between the L group (38.59 +/- 20.22 mu g/day) and the P group (106.88 +/- 22.90 mu g/day, P < 0.001). Lower TPOAb (P = 0.043) and greater echogenicity (P < 0.001) were also noted in the L group. No TgAb difference was observed. These findings suggest that LLLT was effective at improving thyroid function, promoting reduced TPOAb-mediated autoimmunity and increasing thyroid echogenicity in patients with CAT hypothyroidism.