Maria José Noruegas

Hospitais da Universidade de Coimbra, Coímbra, Coimbra, Portugal

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Publications (7)8.39 Total impact

  • Catarina Oliveira · Alfredo Gil-Agostinho · Isabel Gonçalves · Maria José Noruegas ·
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    ABSTRACT: Benign liver tumours are uncommon in children, haemangiomas being the most frequent. Focal nodular hyperplasia (FNH) represents about 2% of paediatric liver tumours. In children, as in adults, a conservative approach is generally recommended. However, large lesions (greater than 5 cm) are more frequent in the paediatric age group, and in these cases, as well as in growing lesions, surgical removal may be advised. Transarterial embolisation (TAE) has been a successful alternative option described in older patients, especially in cases where surgical removal is not possible. This minimally invasive procedure may also become an option in the paediatric group. The authors report the case of a boy with a large FNH treated with TAE using microspheres. 2015 BMJ Publishing Group Ltd.
    Case Reports 07/2015; 2015. DOI:10.1136/bcr-2014-208879
  • Hugo Matos · Ana Trindade · Maria José Noruegas ·
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    ABSTRACT: Objectives: The objective of this study was to obtain a normal value for liver shear wave velocities (SWVs) in healthy paediatric patients and to investigate variations concerning age, sex, and different approaches, depths, and lobes of measurements. Methods: A total of 150 healthy children (2 months-17 years) were examined with acoustic radiation force impulse (ARFI) technology by an experienced paediatric radiologist, after receiving an informed consent. Measurements obtained were divided according to group age (n = 50, 0-5 years; n = 50, 6-11 years; n = 50, 12-17 years); sex (male-female); lobe (right-left lobe); approach (intercostal-subcostal), and depth of measurements (1-5 and 5-6 cm for the youngest group; 2-6 to 6-8 cm for the 2 other groups). Comparative analyses were performed with measurements obtained at right and left lobes, with different depths and approaches. Differences between age and sex were also analysed. Results: Mean SWV in the right liver lobe was 1.07 ± 0.10 m/s. No significant differences were found according to sex or among different probe locations. SWVs were, however, significantly higher within left lobe in comparison with right liver lobe (1.07 ± 0.10 m/s, right; 1.21 ± 0.16 m/s, left). Depth of measurements also influenced SWV values obtained, being slightly lower at deeper locations. Regarding the age significant differences were found for children <6 years old compared with other age groups. Conclusions: ARFI analysis seems to be influenced by age, depth, and lobe of measurements. A mean SWV value of 1.07 ± 0.10 m/s for healthy paediatric population with the possibility of reaching 1.12 m/s in the case of younger children was found. ARFI values were more consistently obtained analysing right liver lobe and depths lower than 5 to 6 cm.
    Journal of Pediatric Gastroenterology and Nutrition 08/2014; 59(6). DOI:10.1097/MPG.0000000000000539 · 2.63 Impact Factor
  • Luciana Barbosa · Manuel João Brito · Inês Balaco · Maria José Noruegas ·
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    ABSTRACT: We present a case of a 17-year-old boy who presented with a skin lesion with extension to the soft tissues of the left thigh. On ultrasound, a homogeneous and hypoechoic expansile formation in the subcutaneous tissue was found, measuring 6.5 × 5 × 3.5 cm, with scarce vascularization. Computed tomography showed a low attenuating neoformation with surrounding edema. An inflammatory disorder was the first diagnosis, but the absence of improvement with antibiotics led us to perform magnetic resonance imaging that showed a high signal lesion on T2-weighted imaging and low intensity signal on T1-weighted imaging and surrounding contrast uptake. Positron emission tomography and computed tomography showed uptake of 18F-fluorodeoxyglucose by the lesion. The final diagnosis was anaplastic cutaneous lymphoma.
    Journal of Radiology Case Reports 03/2014; 8(3):39-47. DOI:10.3941/jrcr.v8i3.1934

  • OALib Journal 01/2014; 01(08):1-10. DOI:10.4236/oalib.1100916
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    ABSTRACT: Fibrosis, related to several causes, can be diagnosed in children and adolescent's liver grafts with more than 1 year old. Currently, liver biopsy is the gold-standard for assessing liver damage in the post-transplant setting. We aimed to evaluate the accuracy of non-invasive biomarkers of fibrosis, namely ARFI (acoustic radiation force impulse), APRI (aspartate-to-platelet ratio index) and AST/ALT (aspartate aminotransferase/alanine aminotransferase) ratio index, either alone or in combination, for predicting fibrosis in pediatric patients submitted to liver transplantation. We prospectively assessed liver fibrosis in 30 liver transplant children/adolescents through biopsy (liver transplant follow-up over 12 months). ARFI with Virtual Touch Software (Acuson 2000, Siemens) was performed, and blood samples were taken in order to determine liver function and platelet count. Two groups were analyzed according to the histopathologic stage of fibrosis, namely none/mild (F0-1) vs. significant fibrosis (F2-4). The mean age of the 30 patients was 11 years old (3-18 years old), with a mean post-transplant period of assessment of 6.5 years. Twenty-four patients (80%) presented stage F0-1 fibrosis and six patients (20%) presented stage F2-4. The area under the curve (AUC) using ROC analysis for ARFI, APRI and AST/ALT ratio index for significant fibrosis was 0.76 (p = 0.052), 0.74 (p = 0.066) and 0.69 (p = 0.162), respectively. Through multivariate logistic regression analysis, the only independent predictor of significant fibrosis was ARFI (OR = 10.7; CI 95%: 1.2-95.7; p = 0.045). The combination of ARFI and AST/ALT ratio index presented a good diagnostic accuracy of fibrosis (AUC of 0.83, p = 0.013). ARFI may serve as a potential method for assessing significant fibrosis in pediatric liver transplant patients, particularly in combination with AST/ALT ratio index.
    Journal of pediatric gastroenterology and nutrition 10/2013; 58(3). DOI:10.1097/MPG.0000000000000226 · 2.63 Impact Factor
  • Hugo Matos · Maria José Noruegas · Isabel Gonçalves · Conceição Sanches ·
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    ABSTRACT: Percutaneous liver biopsy (PLB) is an important procedure in the diagnosis and follow-up of paediatric liver disease. Its purpose is to obtain tissue for histopathological observation, in our case, with ultrasound (US) guidance. To evaluate the effectiveness and safety of US-guided PLB in children. A retrospective study over a period of 12 years, from January 1999 until December 2010, with a selection of US-guided PLB performed in children with focal liver lesions or diffuse hepatic disease and liver transplant (LT). A 16-gauge automatic needle was used and a maximum of three fragments of liver were collected. Contraindications were: bile duct dilatation (>3 mm) INR > 1.5 (reference range, 0.9 -- 1.2) and platelet count <50,000 (reference range, 150,000 -- 450,000). Analysis focused on complications and final diagnosis. A total of 513 biopsies were performed, 379 (73.9%) in children who had undergone orthotopic LT, 117 (22.8%) in children with liver disease of unknown cause and 17 (3.3%) in children with focal hepatic lesions. Histological diagnosis was obtained in 509 of 513 (99.3%) biopsies performed. Minor complications were registered in 38 patients (7.4%) and major complications occurred in 5 patients (1%). None needed a surgical intervention. US-guided PLB in children is a safe and efficient method to achieve a specific diagnosis in liver disease.
    Pediatric Radiology 08/2012; 42(11):1322-5. DOI:10.1007/s00247-012-2433-z · 1.57 Impact Factor
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    ABSTRACT: Acoustic radiation force impulse-imaging (ARFI) uses sound waves to interrogate the mechanical stiffness of a tissue. To determine the usefulness of ARFI for estimating liver fibrosis in children. A prospective masked study of children with chronic liver disease (CLD) and/or before liver transplant (LT) comparing ARFI with histopathological analysis. Children with no history of liver disease served as a control group. ARFI was performed with Virtual Touch software using ACUSON S2000. Share wave velocities (SWV) of several regions within the liver were measured. Fifty-two children were studied (mean age 8 years; range 1-16 years). The abnormal group included 10 children (31%) with CLD and 22 (69%) planned for LT. There were 20 normal controls. Mean SWV was 1.42 m/s in the abnormal group and 1.11 m/s [corrected] in the controls. For diagnosis of fibrosis stage ≥ F1, ≥F2 and F4, the areas under the receiver-operator characteristics curves were 0.834, 0.818 and 0.983, respectively. SWV is related to the degree of liver fibrosis in children, and may be a non-invasive alternative to biopsy.
    Pediatric Radiology 02/2012; 42(2):201-4. DOI:10.1007/s00247-011-2257-2 · 1.57 Impact Factor

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