Showing papers in "Radiologia Brasileira in 2016"

Intestinal perforation by an ingested foreign body

Abstract: Objective: To identify the computed tomography findings suggestive of intestinal perforation by an ingested foreign body. Materials and Methods: This was a retrospective study of four cases of surgically proven intestinal perforation by a foreign body, comparing the computed tomography findings with those described in the literature. Results: None of the patients reported having ingested a foreign body, all were over 60 years of age, three of the four patients used a dental prosthesis, and all of the foreign bodies were elongated and sharp. In all four patients, there were findings indicative of acute abdomen. None of the foreign bodies were identified on conventional X-rays. The computed tomography findings suggestive of perforation were thickening of the intestinal walls (in all four cases), increased density of mesenteric fat (in all four cases), identification of the foreign body passing through the intestinal wall (in three cases), and gas in the peritoneal cavity (in one case). Conclusion: In cases of foreign body ingestion, intestinal perforation is more common when the foreign body is elongated and sharp. Although patients typically do not report having ingested such foreign bodies, the scenario should be suspected in elderly individuals who use dental prostheses. A computed tomography scan can detect foreign bodies, locate perforations, and guide treatment. The findings that suggest perforation are thickening of the intestinal walls, increased mesenteric fat density, and, less frequently, gas in the peritoneal cavity, often restricted to the point of perforation.

Clinical and radiological correlations in patients with gestational trophoblastic disease

Abstract: Gestational trophoblastic disease is an abnormality of pregnancy that encompasses a group of diseases that differ from each other in their propensity for regression, invasion, metastasis, and recurrence. In the past, it was common for patients with molar pregnancy to present with marked symptoms: copious bleeding; theca lutein cysts; uterus larger than appropriate for gestational age; early preeclampsia; hyperemesis gravidarum; and hyperthyroidism. Currently, with early diagnosis made by ultrasound, most patients are diagnosed while the disease is still in the asymptomatic phase. In cases of progression to trophoblastic neoplasia, staging-typically with Doppler flow studies of the pelvis and chest X-ray, although occasionally with computed tomography or magnetic resonance imaging-is critical to the choice of an appropriate antineoplastic therapy regimen. Because it is an unusual and serious disease that affects women of reproductive age, as well as because its appropriate treatment results in high cure rates, it is crucial that radiologists be familiar with gestational trophoblastic disease, in order to facilitate its early diagnosis and to ensure appropriate follow-up imaging.

Diagnostic performance of 3D TSE MRI versus 2D TSE MRI of the knee at 1.5 T, with prompt arthroscopic correlation, in the detection of meniscal and cruciate ligament tears

Abstract: Objective: To compare the diagnostic performance of the three-dimensional turbo spin-echo (3D TSE) magnetic resonance imaging (MRI) technique with the performance of the standard two-dimensional turbo spin-echo (2D TSE) protocol at 1.5 T, in the detection of meniscal and ligament tears. Materials and Methods: Thirty-eight patients were imaged twice, first with a standard multiplanar 2D TSE MR technique, and then with a 3D TSE technique, both in the same 1.5 T MRI scanner. The patients underwent knee arthroscopy within the first three days after the MRI. Using arthroscopy as the reference standard, we determined the diagnostic performance and agreement. Results: For detecting anterior cruciate ligament tears, the 3D TSE and routine 2D TSE techniques showed similar values for sensitivity (93% and 93%, respectively) and specificity (80% and 85%, respectively). For detecting medial meniscal tears, the two techniques also had similar sensitivity (85% and 83%, respectively) and specificity (68% and 71%, respectively). In addition, for detecting lateral meniscal tears, the two techniques had similar sensitivity (58% and 54%, respectively) and specificity (82% and 92%, respectively). There was a substantial to almost perfect intraobserver and interobserver agreement when comparing the readings for both techniques. Conclusion: The 3D TSE technique has a diagnostic performance similar to that of the routine 2D TSE protocol for detecting meniscal and anterior cruciate ligament tears at 1.5 T, with the advantage of faster acquisition.

Rhombencephalitis: pictorial essay.

Abstract: The term rhombencephalitis refers to inflammatory diseases affecting the hindbrain (brainstem and cerebellum). Rhombencephalitis has a wide variety of etiologies, including infections, autoimmune diseases, and paraneoplastic syndromes. Infection with bacteria of the genus Listeria is the most common cause of rhombencephalitis. Primary rhombencephalitis caused by infection with Listeria spp. occurs in healthy young adults. It usually has a biphasic time course with a flu-like syndrome, followed by brainstem dysfunction; 75% of patients have cerebrospinal fluid pleocytosis, and nearly 100% have an abnormal brain magnetic resonance imaging scan. However, other possible causes of rhombencephalitis must be borne in mind. In addition to the clinical aspects, the patterns seen in magnetic resonance imaging can be helpful in defining the possible cause. Some of the reported causes of rhombencephalitis are potentially severe and life threatening; therefore, an accurate initial diagnostic approach is important to establishing a proper early treatment regimen. This pictorial essay reviews the various causes of rhombencephalitis and the corresponding magnetic resonance imaging findings, by describing illustrative confirmed cases.

Low-level laser therapy for the prevention of low salivary flow rate after radiotherapy and chemotherapy in patients with head and neck cancer.

Abstract: Objective: To determine whether low-level laser therapy can prevent salivary hypofunction after radiotherapy and chemotherapy in head and neck cancer patients. Materials and Methods: We evaluated 23 head and neck cancer patients, of whom 13 received laser therapy and 10 received clinical care only. An InGaAlP laser was used intra-orally (at 660 nm and 40 mW) at a mean dose of 10.0 J/cm2 and extra-orally (at 780 nm and 15 mW) at a mean dose of 3.7 J/cm2, three times per week, on alternate days. Stimulated and unstimulated sialometry tests were performed before the first radiotherapy and chemotherapy sessions (N0) and at 30 days after the end of treatment (N30). Results: At N30, the mean salivary flow rates were significantly higher among the laser therapy patients than among the patients who received clinical care only, in the stimulated and unstimulated sialometry tests (p = 0.0131 and p = 0.0143, respectively). Conclusion: Low-level laser therapy, administered concomitantly with radiotherapy and chemotherapy, appears to mitigate treatment-induced salivary hypofunction in patients with head and neck cancer.

Solitary pulmonary nodule and (18)F-FDG PET/CT. Part 1: epidemiology, morphological evaluation and cancer probability.

Abstract: Solitary pulmonary nodule corresponds to a common radiographic finding, which is frequently detected incidentally. The investigation of this entity remains complex, since characteristics of benign and malignant processes overlap in the differential diagnosis. Currently, many strategies are available to evaluate solitary pulmonary nodules with the main objective of characterizing benign lesions as best as possible, while avoiding to expose patients to the risks inherent to invasive methods, besides correctly detecting cases of lung cancer so as the potential curative treatment is not delayed. This first part of the study focuses on the epidemiology, the morfological evaluation and the methods to determine the likelihood of cancer in cases of indeterminate solitary pulmonary nodule.

Contribution of the Unified Health Care System to mammography screening in Brazil, 2013

Abstract: Objective: To estimate the coverage of opportunistic mammography screening performed via the Brazilian Sistema Unico de Saude (SUS, Unified Health Care System), at the state and regional level, in 2013. Materials and Methods: This was an ecological study in which coverage was estimated by determining the ratio between the number of mammograms performed and the expected number of mammograms among the population of females between 50 and 69 years of age. The number of mammograms performed in the target population was obtained from the Outpatient Database of the Information Technology Department of the SUS. To calculate the expected number of mammograms, we considered 58.9% of the target population, the proportion that would be expected on the basis of the recommendations of the Brazilian National Cancer Institute. Results: In 2013, the estimated national coverage of mammography screening via the SUS was 24.8%. The mammography rate ranged from 12.0% in the northern region to 31.3% in the southern region. When stratified by state, coverage was lowest in the state of Para and highest in the state of Santa Catarina (7.5% and 35.7%, respectively). Conclusion: The coverage of mammography screening performed via the SUS is low. There is a significant disparity among the Brazilian states (including the Federal District of Brasilia) and among regions, being higher in the south/southeast and lower in the north/northeast.

Vascular loops in the anterior inferior cerebellar artery, as identified by magnetic resonance imaging, and their relationship with otologic symptoms.

Abstract: Objective: To use magnetic resonance imaging to identify vascular loops in the anterior inferior cerebellar artery and to evaluate their relationship with otologic symptoms. Materials and Methods: We selected 33 adults with otologic complaints who underwent magnetic resonance imaging at our institution between June and November 2013. Three experienced independent observers evaluated the trajectory of the anterior inferior cerebellar artery in relation to the internal auditory meatus and graded the anterior inferior cerebellar artery vascular loops according to the Chavda classification. Kappa and chi-square tests were used. Values of p < 0.05 were considered significant. Results: The interobserver agreement was moderate. Comparing ears that presented vascular loops with those that did not, we found no association with tinnitus, hearing loss, or vertigo. Similarly, we found no association between the Chavda grade and any otological symptom. Conclusion: Vascular loops do not appear to be associated with otoneurological manifestations.

Hemangioendotelioma epitelioide hepático: Pesquisa em três centros universitários

Abstract: Objective: To determine common imaging findings of hepatic epithelioid hemangioendothelioma on magnetic resonance images. Materials and Methods: A search was made of three institutional databases between January 2000 and August 2012. Seven patients (mean age, 47 years; range, 21-66 years; 6 women) with pathology-confirmed diagnosis of hepatic epithelioid hemangioendothelioma who had undergone magnetic resonance imaging were identified. None of the patients had received any treatment for hepatic epithelioid hemangioendothelioma at the time of the initial magnetic resonance imaging examination. Results: Hepatic epithelioid hemangioendothelioma tumors appeared as focal masses in 7/7 patients, greater than 5 in number, with a coalescing lesion in 1/5, and peripheral localization in 6/7. Capsular retraction was present in 4/7, and was associated with peripherally located lesions. Early ring enhancement was appreciated in the majority of lesions in 7/7 patients. Centripetal progressive enhancement was shown in 5/7 patients on venous phase that exhibited a distinctive thick inner border of low signal on venous phase images, and a central core of delayed enhancement. Small lesions did not show this. Conclusion: The combination of multifocal round-configuration lesions that are predominantly peripheral and exhibit early peripheral ring enhancement and late appearance of an inner thick border of low signal and central core of high signal may represent an important feature for hepatic epithelioid hemangioendothelioma.

Diagnostic underestimation of atypical ductal hyperplasia and ductal carcinoma in situ at percutaneous core needle and vacuum-assisted biopsies of the breast in a Brazilian reference institution

Abstract: Objective: To determine the rates of diagnostic underestimation at stereotactic percutaneous core needle biopsies (CNB) and vacuum-assisted biopsies (VABB) of nonpalpable breast lesions, with histopathological results of atypical ductal hyperplasia (ADH) or ductal carcinoma in situ (DCIS) subsequently submitted to surgical excision. As a secondary objective, the frequency of ADH and DCIS was determined for the cases submitted to biopsy. Materials and Methods: Retrospective review of 40 cases with diagnosis of ADH or DCIS on the basis of biopsies performed between February 2011 and July 2013, subsequently submitted to surgery, whose histopathological reports were available in the internal information system. Biopsy results were compared with those observed at surgery and the underestimation rate was calculated by means of specific mathematical equations. Results: The underestimation rate at CNB was 50% for ADH and 28.57% for DCIS, and at VABB it was 25% for ADH and 14.28% for DCIS. ADH represented 10.25% of all cases undergoing biopsy, whereas DCIS accounted for 23.91%. Conclusion: The diagnostic underestimation rate at CNB is two times the rate at VABB. Certainty that the target has been achieved is not the sole determining factor for a reliable diagnosis. Removal of more than 50% of the target lesion should further reduce the risk of underestimation.

Ultrasound findings of the physiological changes and most common breast diseases during pregnancy and lactation

Abstract: Because of the physiological changes that occur during pregnancy and lactation, diagnostic ultrasound of the breast during these periods is a challenge for physicians. Therefore, a comprehensive understanding of imaging, anatomy, and physiology of the breast is important to effectively diagnosing diseases that can arise in women who are pregnancy or lactating. The aim of this article was to review the physiological changes that occur in the breasts during pregnancy and lactation, as well as to describe the main features of the breast diseases that occur most frequently during these periods.

Solitary pulmonary nodule and (18)F-FDG PET/CT. Part 2: accuracy, cost-effectiveness, and current recommendations.

Abstract: A solitary pulmonary nodule is a common, often incidental, radiographic finding. The investigation and differential diagnosis of solitary pulmonary nodules remain complex, because there are overlaps between the characteristics of benign and malignant processes. There are currently many strategies for evaluating solitary pulmonary nodules. The main objective is to identify benign lesions, in order to avoid exposing patients to the risks of invasive methods, and to detect cases of lung cancer accurately, in order to avoid delaying potentially curative treatment. The focus of this study was to review the evaluation of solitary pulmonary nodules, to discuss the current role of (18)F-fluorodeoxyglucose positron-emission tomography, addressing its accuracy and cost-effectiveness, and to detail the current recommendations for the examination in this scenario.

Applicability of three-dimensional imaging techniques in fetal medicine

Abstract: Objective: To generate physical models of fetuses from images obtained with three-dimensional ultrasound (3D-US), magnetic resonance imaging (MRI), and, occasionally, computed tomography (CT), in order to guide additive manufacturing technology. Materials and Methods: We used 3D-US images of 31 pregnant women, including 5 who were carrying twins. If abnormalities were detected by 3D-US, both MRI and in some cases CT scans were then immediately performed. The images were then exported to a workstation in DICOM format. A single observer performed slice-by-slice manual segmentation using a digital high resolution screen. Virtual 3D models were obtained from software that converts medical images into numerical models. Those models were then generated in physical form through the use of additive manufacturing techniques. Results: Physical models based upon 3D-US, MRI, and CT images were successfully generated. The postnatal appearance of either the aborted fetus or the neonate closely resembled the physical models, particularly in cases of malformations. Conclusion: The combined use of 3D-US, MRI, and CT could help improve our understanding of fetal anatomy. These three screening modalities can be used for educational purposes and as tools to enable parents to visualize their unborn baby. The images can be segmented and then applied, separately or jointly, in order to construct virtual and physical 3D models.

Bilateral elastofibroma dorsi.

Abstract: A 76-year-old female patient with a previous history of surgically resected rectal cancer for seven years was admitted for diagnostic investigation of bilateral and symmetrical dorsal masses. She reported chronic pain in the thoracic spine. At clinical examination, the masses were solid, mobile, located subcutaneously and inferiorly to the scapulae (Figure 1A). Computed tomography (CT) showed the presence of bilateral soft tissue masses in the infrascapular region (Figures 1B and 1C). On the basis of the clinical findings and the images, the diagnosis of elastofibroma dorsi (ED) was established. ED is a slow growing soft tissue pseudotumor incidentally diagnosed during routine imaging studies, that may also cause chronic scapular pain. It is a benign fibroelastic tumor inferiorly located in the infrascapular region, between the scapula and the thoracic wall deeply to the serratus and latissimus dorsi muscles, possibly inserting into the periosteum of the posterior ribs. Coincidentally such type of tumor has been detected at CT in up to 2% of elderly patients. It is most frequently found in elderly women (female to male ratio 5:1) in the age range between 65 and 70 years at the moment of the diagnosis. Unilateral masses are slightly more prevalent at the right side, but up to 60% of EDs are bilateral. Other reported sites include deltoid muscle, axillae, ischial tuberosity, olecranon, hands and feet, among others. It is also characterized by symptoms absence at early phases. With the disease progression, there is an increase in the mass volume, possibly limiting the upper limb motion, principally in the upward movements of the arm which require sliding of the scapula in relation to the thoracic wall. Such a movement may cause pain. Macroscopically, ED is characterized by an ill defined mass with fibrous tissue and internal adipose tissue. Histopathological analysis demonstrates non-encapsulated hypocellular mass composed of benign fibroblasts, eosinophilic collagen bundles and apparently fragmented elastic fibers, with groups of interposed mature adipocytes. Although in most cases of thoracic investigation magnetic resonance imaging (MRI) is indicated to evaluate extrapulmonary lesions, and CT remains reserved for investigation of parenchymal diseases, CT may be diagnostic in cases where the lesion presents as an infrascapular or subscapular ill defined, nonencapsulated soft parts mass, isoattenuating to the muscles (fibrous tissue), interspersed with fat attenuation strips or lines. Homogeneity may be observed in cases of smaller masses. Bilateral elastofibroma dorsi

Comparison of power Doppler and thermography for the selection of thyroid nodules in which fine-needle aspiration biopsy is indicated.

Abstract: Objective: To compare two methods-power Doppler and thermography-for the analysis of nodule vascularization and subsequent selection of nodules to be biopsied. Materials and Methods: A total of 510 subjects with thyroid nodules were analyzed by power Doppler and submitted to fine-needle aspiration biopsy (FNAB). Thirty-seven patients were submitted to nodule excision (29 due to carcinoma or suspected carcinoma and 8 by patient choice). Among those patients, power Doppler had raised the suspicion of malignancy in 39 lesions, compared with 48 for FNAB. Another group, comprising 110 patients, underwent thermography, which raised the suspicion of malignancy in 124 thyroid nodules, as did FNAB. Malignant nodules were excised in all 110 of those patients (95 underwent nodulectomy and 15 underwent thyroidectomy), malignancy being confirmed by intraoperative examination of frozen biopsy samples. Results: In relation to the FNAB findings, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of power Doppler were 95.16%, 23.52%, 96.22%, 16.70%, and 89.51%, respectively, compared with 100%, 58.06%, 87.73%, 100%, and 89.51%, respectively, for thermography. Conclusion: Thermography was more precise than was power Doppler for the selection of thyroid nodules to be biopsied.

Cardiac magnetic resonance imaging and computed tomography in ischemic cardiomyopathy: an update.

Abstract: Ischemic cardiomyopathy is one of the major health problems worldwide, representing a significant part of mortality in the general population nowadays. Cardiac magnetic resonance imaging (CMRI) and cardiac computed tomography (CCT) are noninvasive imaging methods that serve as useful tools in the diagnosis of coronary artery disease and may also help in screening individuals with risk factors for developing this illness. Technological developments of CMRI and CCT have contributed to the rise of several clinical indications of these imaging methods complementarily to other investigation methods, particularly in cases where they are inconclusive. In terms of accuracy, CMRI and CCT are similar to the other imaging methods, with few absolute contraindications and minimal risks of adverse side-effects. This fact strengthens these methods as powerful and safe tools in the management of patients. The present study is aimed at describing the role played by CMRI and CCT in the diagnosis of ischemic cardiomyopathies.

Pulmonary infection caused by Mycobacterium kansasii: findings on computed tomography of the chest

Abstract: Objetivo: Descrever os achados tomograficos de pacientes com diagnostico de infeccao pulmonar pelo Mycobacterium kansasii. Materiais e Metodos: Estudo retrospectivo dos exames de tomografia computadorizada do torax de 19 pacientes com infeccao pulmonar pelo M. kansasii. Resultados: Dos 19 pacientes avaliados, 10 (52,6%) eram do sexo masculino e 9 (47,4%) eram do sexo feminino. A media de idade do grupo foi 58 anos, com variacao entre 33 e 76 anos. As alteracoes encontradas nos exames de tomografia computadorizada foram distorcao arquitetural em 17 pacientes (89,5%), opacidades reticulares e bronquiectasias em 16 (84,2%), cavidades em 14 (73,7%), nodulos centrolobulares em 13 (68,4%), pequenas consolidacoes em 10 (52,6%), atelectasias e grandes consolidacoes em 9 (47,4%), bolhas subpleurais e enfisema em 6 (31,6%) e linfonodomegalias em 1 paciente (5,3%). Conclusao: Houve predominio de cavidades e do padrao de acometimento de pequenas e grandes vias aereas. A doenca de vias aereas foi caracterizada por bronquiectasias e bronquiolites que se manifestaram como nodulos centrolobulares.

High-resolution computed tomography and histopathological findings in hypersensitivity pneumonitis: a pictorial essay

Abstract: Hypersensitivity pneumonitis is a diffuse interstitial and granulomatous lung disease caused by the inhalation of any one of a number of antigens. The objective of this study was to illustrate the spectrum of abnormalities in high-resolution computed tomography and histopathological findings related to hypersensitivity pneumonitis. We retrospectively evaluated patients who had been diagnosed with hypersensitivity pneumonitis (on the basis of clinical-radiological or clinical-radiological-pathological correlations) and had undergone lung biopsy. Hypersensitivity pneumonitis is clinically divided into acute, subacute, and chronic forms; high-resolution computed tomography findings correlate with the time of exposure; and the two occasionally overlap. In the subacute form, centrilobular micronodules, ground-glass opacities, and air trapping are characteristic high-resolution computed tomography findings, whereas histopathology shows lymphocytic inflammatory infiltrates, bronchiolitis, variable degrees of organizing pneumonia, and giant cells. In the chronic form, high-resolution computed tomography shows traction bronchiectasis, honeycombing, and lung fibrosis, the last also being seen in the biopsy sample. A definitive diagnosis of hypersensitivity pneumonitis can be made only through a multidisciplinary approach, by correlating clinical findings, exposure history, high-resolution computed tomography findings, and lung biopsy findings.

Predictive performance of BI-RADS magnetic resonance imaging descriptors in the context of suspicious (category 4) findings.

Abstract: Objective: To determine the positive predictive value (PPV) and likelihood ratio for magnetic resonance imaging (MRI) characteristics of category 4 lesions, as described in the Breast Imaging Reporting and Data System (BI-RADS®) lexicon, as well as to test the predictive performance of the descriptors using multivariate analysis and the area under the curve derived from a receiver operating characteristic (ROC) curve. Materials and Methods: This was a double-blind review study of 121 suspicious findings from 98 women examined between 2009 and 2013. The terminology was based on the 2013 edition of the BI-RADS. Results: Of the 121 suspicious findings, 53 (43.8%) were proven to be malignant lesions, with no significant difference between mass and non-mass enhancement (p = 0.846). The PPVs were highest for masses with a spiculated margin (71%) and round shape (63%), whereas segmental distribution achieved a high PPV (80%) for non-mass enhancement. Kinetic analyses performed poorly, except for type 3 curves applied to masses (PPV of 73%). Logistic regression models were significant for both patterns, although the results were better for masses, particularly when kinetic assessments were included (p = 0.015; pseudo R2 = 0.48; area under the curve = 90%). Conclusion: Some BI-RADS MRI descriptors have high PPV and good predictive performance-as demonstrated by ROC curve and multivariate analysis-when applied to BI-RADS category 4 findings. This may allow future stratification of this category.

Tomography patterns of lung disease in systemic sclerosis

Abstract: Currently, lung impairment is the leading factor responsible for the morbidity and mortality associated with systemic sclerosis. Therefore, the recognition of the various tomography patterns becomes decisive in the clinical management of these patients. In high-resolution computed tomography studies, the most common pattern is that of nonspecific interstitial pneumonia. However, there are other forms of lung involvement that must also be recognized. The aim of this study was to review the literature on the main changes resulting from pulmonary involvement in systemic sclerosis and the corresponding radiological findings, considering the current classification of interstitial diseases. We searched the Medline (PubMed), Lilacs, and SciELO databases in order to select articles related to pulmonary changes in systemic sclerosis and published in English between 2000 and 2015. The pulmonary changes seen on computed tomography in systemic sclerosis are varied and are divided into three main categories: interstitial, alveolar, and vascular. Interstitial changes constitute the most common type of pulmonary involvement in systemic sclerosis. However, alveolar and vascular manifestations must also be recognized and considered in the presence of atypical clinical presentations and inadequate treatment responses.

Chronic kernicterus: magnetic resonance imaging findings.

Abstract: 1. Documenta – Hospital São Francisco, Ribeirão Preto, SP, Brazil. Mailing address: Dr. Rodolfo Mendes Queiroz. Documenta – Centro Avançado de Diagnóstico por Imagem. Rua Bernardino de Campos, 980, Centro. Ribeirão Preto, SP, Brazil, 14015-130. E-mail: rod_queiroz@hotmail.com. structures, capable of detecting small UDs and identifying neoplasms. In T-2 weighted MRI sequences, UDs show hyperintense signals, although they can be hypointense if they have thick content. Solid tumor components present as vegetative lesions with intermediate signals on T1and T2weighted sequences, potentially restricting the diffusion, and show significant enhancement after intravenous administration of contrast.

Pulmonary paracoccidioidomycosis showing reversed halo sign with nodular/coarse contour

Abstract: Radiol Bras. 2016 Jan/Fev;49(1):56–64 59 http://dx.doi.org/10.1590/0100-3984.2015.0129 The Brazilian radiological literature has recently highlighted the relevant role played by MRI in the improvement of the diagnosis of central nervous system conditions. PRES is a clinical-radiological entity of varied etiology, generally occurring in the setting of severe arterial hypertension. In some cases, however, it may be associated with immunosuppressive therapy, and is rarely described in the literature after the use of immunoglobulin. Its physiopathogenesis is characterized by the presence of endothelial lesion and dysfunction of cerebral autoregulation mechanisms, leading to hypoperfusion and vasogenic edema. The clinical manifestations present acute/ subacute onset characterized by headache, decreased level of consciousness, visual alterations, tonic-clonic seizures and focal neurological signs. The symptoms are progressive. Complete regression is achieved provided the syndrome is appropriately treated; otherwise irreversible damages may occur. MRI findings are quite suggestive and characterized by hyperintense areas on T2-weighted and FLAIR sequences, in general affecting the white substance bilaterally and symmetrically, with predilection for the parieto-occipital region. It may also affect the frontal lobes, internal and external capsules, cerebellum and encephalic trunk. At early stages of the condition, diffusion MRI does not demonstrate any abnormalities, but inappropriate management may result in irreversible damages presented as diffusion restriction corresponding to cytotoxic edema. Recent studies by means of retrospective analysis, utilizing MRI and laboratory data, have demonstrated the association between PRES and albumin serum levels. There are evidences that significantly decreased albumin serum levels lead to a higher risk to develop vasogenic-type edema. This is due to the fact that, in conditions with endothelial damages caused by inflammatory processes, the decrease in the colloidosmotic pressure, directly related to the albumin levels, may facilitate the development of vasogenic edema. Thus, the early administration of human serum albumin might prevent ischemic damages and reduce possible sequelae. Finally, despite being rare after administration of immunoglobulin, PRES should be considered in cases where typical MRI findings are present. One should not wait until the onset of a hypertensive episode to take such a diagnostic possibility into consideration. REFERENCES

Imaging assessment of glenohumeral dysplasia secondary to brachial plexus birth palsy

Abstract: Objetivo: Avaliar os parâmetros de imagem relacionados com a morfologia da articulacao glenoumeral em criancas com paralisia obstetrica do plexo braquial (POPB) unilateral, comparando-os com os observados em ombros saudaveis. Materiais e Metodos: Foi realizada uma busca retrospectiva de casos de POPB unilateral diagnosticados em nossa instituicao. Somente foram incluidos os pacientes com diagnostico clinico de POPB unilateral, e a amostra final do estudo consistiu em 10 pacientes consecutivos avaliados por meio de imagens transversais. Foram avaliados a retroversao da cavidade glenoide, a translacao da cabeca do umero e o grau de displasia glenoumeral. Resultados: A media do diâmetro da cabeca do umero foi 1,93 cm nos membros afetados e 2,33 cm nos membros normais. Em dois casos, nao houve deslocamento posterior significativo da cabeca do umero, cinco casos apresentaram subluxacao posterior da cabeca do umero, e os tres casos restantes apresentaram luxacao total da cabeca do umero. A media do ângulo de retroversao glenoide dos membros afetados (90-α) foi -9,6o, ao passo que a dos membros contralaterais normais foi +1,6o. Conclusao: As principais deformidades encontradas neste estudo foram retroversao da cavidade glenoide relacionada com POPB, atraso no desenvolvimento da cabeca do umero e translacao posterior da cabeca do umero.

Posterior reversible encephalopathy syndrome following immunoglobulin therapy in a patient with Miller-Fisher syndrome.

Abstract: Radiol Bras. 2016 Jan/Fev;49(1):56–64 58 http://dx.doi.org/10.1590/0100-3984.2014.0057 infarction, spontaneous or traumatic rupture, congestive heart failure, and Kasabach-Merritt syndrome. A correct diagnosis of the pedunculated lesion may be difficult, despite the typical radiological presentation, because of the limitation in define the origin of the mass, since a thin pedicle may be almost undetectable at images. The most used modalities of imaging in diagnosis include US, CT and MRI. At US, the image is typically hyperechoic, homogeneous, with well defined margins; and, in cases of giant lesions, central heterogeneity may be present. At CT, with a certain frequency, giant hemangiomas do not present with the typical pattern of hypoattenuating lesion with centripetal enhancement and homogenization at delayed sections, due to the presence of avascular areas of necrosis, fibrosis or hemorrhage. MRI is the most sensitive and specific (> 90%) diagnostic method. The lesions are well defined, homogeneous, with low signal intensity at T1-weighted sequences, and high signal intensity at T2-weighted sequences. Biopsy is not recommended in such cases, due to the risk of hemorrhage. There are reports in the literature describing pedunculated hemangiomas as gastric, adrenal tumor, retroperitoneal mass, other pedunculated liver tumors such as hepatocellular carcinoma, mesenchymal hamartoma, focal nodular hyperplasia or adenoma. Surgical treatment is reserved for cases of giant or symptomatic lesions, uncertain diagnosis, lesions with complications, and for cases of pedunculated hemangiomas due to their tendency to torsion. REFERENCES

Locally advanced hypopharyngeal squamous cell carcinoma: single-institution outcomes in a cohort of patients curatively treated either with or without larynx preservation.

Abstract: Objective: The present study was aimed at describing a single-institution experience in the curative treatment of patients diagnosed with locally advanced hypopharyngeal squamous cell carcinoma. Materials and Methods: Data concerning all patients treated for locally advanced hypopharyngeal squamous cell carcinoma between January 2006 and June 2012 were reviewed. Results: A total of 144 patients were included in the present study. The median follow-up period was 36.6 months. Median survival was 26 months, and 2-year and 5-year overall survival rates were, 51% and 30.5%, respectively. Median recurrence-free survival was 18 months and 2-year and 5-year recurrence-free survival rates were 42.8% and 28.5%, respectively. Conclusion: The outcomes in the present series are in line with the literature.

Hughes-Stovin syndrome: an unusual cause of pulmonary artery aneurysms

Abstract: Radiol Bras. 2016 Mai/Jun;49(3):199–204 202 http://dx.doi.org/10.1590/0100-3984.2015.0082 extraplexus nerve transfer techniques, the areas of activation mainly being located in the contralateral cortex. This study has some limitations. We presented the patient data only in comparison with those of a single control participant, rather than with a group of control, and both data sets were acquired at only one time point. In addition, the patient did not undergo a pre-operative fMRI scan.

Incidental irradiation of internal mammary lymph nodes in breast cancer: conventional two-dimensional radiotherapy versus conformal three-dimensional radiotherapy

Abstract: Objective: To evaluate incidental irradiation of the internal mammary lymph nodes (IMLNs) through opposed tangential fields with conventional two-dimensional (2D) or three-dimensional (3D) radiotherapy techniques and to compare the results between the two techniques. Materials and Methods: This was a retrospective study of 80 breast cancer patients in whom radiotherapy of the IMLNs was not indicated: 40 underwent 2D radiotherapy with computed tomography for dosimetric control, and 40 underwent 3D radiotherapy. The total prescribed dose was 50.0 Gy or 50.4 Gy (2.0 or 1.8 Gy/day, respectively). We reviewed all plans and defined the IMLNs following the Radiation Therapy Oncology Group recommendations. For the IMLNs, we analyzed the proportion of the volume that received 45 Gy, the proportion of the volume that received 25 Gy, the dose to 95% of the volume, the dose to 50% of the volume, the mean dose, the minimum dose (Dmin), and the maximum dose (Dmax). Results: Left-sided treatments predominated in the 3D cohort. There were no differences between the 2D and 3D cohorts regarding tumor stage, type of surgery (mastectomy, breast-conserving surgery, or mastectomy with immediate reconstruction), or mean delineated IMLN volume (6.8 vs. 5.9 mL; p = 0.411). Except for the Dmin, all dosimetric parameters presented higher mean values in the 3D cohort (p < 0.05). The median Dmax in the 3D cohort was 50.34 Gy. However, the mean dose to the IMLNs was 7.93 Gy in the 2D cohort, compared with 20.64 Gy in the 3D cohort. Conclusion: Neither technique delivered enough doses to the IMLNs to achieve subclinical disease control. However, all of the dosimetric parameters were significantly higher for the 3D technique.

Radiological findings in megaesophagus secondary to Chagas disease: chest X-ray and esophagogram

Abstract: Objetivo: Identificar e classificar as alteracoes radiologicas no megaesofago chagasico no esofagograma e na radiografia simples de torax. Materiais e Metodos: Foram estudados 35 pacientes com diagnostico de esofagopatia na manometria. As alteracoes encontradas no esofagograma foram estratificadas segundo a classificacao de Rezende, dividida em quatro categorias, determinadas pelo grau de dilatacao e alteracao da motilidade do esofago. Tambem foi realizada correlacao desta classificacao com os achados na radiografia de torax: presenca ou ausencia de bolha gastrica, nivel liquido e alargamento do mediastino. Resultados: A distribuicao encontrada, segundo a classificacao de Rezende, foi: grau I - 25,7% (9/35); grau II - 8,6% (3/35); grau III - 54,3% (19/35); grau IV - 11,4% (4/35). Nenhum paciente grau I apresentou alteracoes na radiografia simples. No grau II, o unico achado foi a ausencia da bolha gastrica (2/3). No grau III, 15 dos 19 pacientes apresentaram achados anormais na radiografia. Ja no grau IV, em todos os quatro pacientes identificaram-se anormalidades no exame simples. Conclusao: A classificacao de Rezende e praticavel, encontrando-se desde achados sutis caracterizando os graus iniciais ate a completa acinesia do dolicomegaesofago. Os achados na radiografia de torax sao mais frequentes em pacientes com estagios avancados da doenca e podem fazer aventar o grau da esofagopatia chagasica.

Quantitative computed tomography analysis of the airways in patients with cystic fibrosis using automated software: correlation with spirometry in the evaluation of severity.

Abstract: Objective: To perform a quantitative analysis of the airways using automated software, in computed tomography images of patients with cystic fibrosis, correlating the results with spirometric findings. Materials and Methods: Thirty-four patients with cystic fibrosis were studied-20 males and 14 females; mean age 18 ± 9 years-divided into two groups according to the spirometry findings: group I (n = 21), without severe airflow obstruction (forced expiratory volume in first second [FEV1] > 50% predicted), and group II (n = 13), with severe obstruction (FEV1 ≤ 50% predicted). The following tracheobronchial tree parameters were obtained automatically: bronchial diameter, area, thickness, and wall attenuation. Results: On average, 52 bronchi per patient were studied. The number of bronchi analyzed was higher in group II. The correlation with spirometry findings, especially between the relative wall thickness of third to eighth bronchial generation and predicted FEV1, was better in group I. Conclusion: Quantitative analysis of the airways by computed tomography can be useful for assessing disease severity in cystic fibrosis patients. In patients with severe airflow obstruction, the number of bronchi studied by the method is higher, indicating more bronchiectasis. In patients without severe obstruction, the relative bronchial wall thickness showed a good correlation with the predicted FEV1.