OBJECTIVE: To investigate the accuracy of magnetic resonance imaging (MRI) in classifying sonographically indeterminate ovarian and adnexal masses.
MATERIALS AND METHODS: This was a retrospective cross-sectional study of the unenhanced pelvic MRI scans of 243 patients with a collective total of 336 adnexal and ovarian masses.
RESULTS: Unenhanced MRI showed a sensitivity of 97.7%, a specificity of 86.4%, and an accuracy of 93.8%. The area under the ROC curve was 0.944 (95% CI: 0.913–0.974).
CONCLUSION: Our results show that an unenhanced MRI protocol can be used to classify adnexal masses, especially in clinical settings in which the intravenous administration of gadolinium-based contrast is not safe and should be avoided.

Keywords: Ovarian neoplasms; Adnexal diseases; Magnetic resonance imaging; Contrast media; Gadolinium DTPA; Ultrasonography.

OBJECTIVE: To assess the frequency of unrecognized myocardial infarction and identify additional ischemic conditions, as well as to evaluate the efficacy of cardiac magnetic resonance imaging (CMRI) in risk groups, comparing the imaging findings with electrocardiographic (ECG) and laboratory data in patients with stage 5 chronic kidney disease, also known as end-stage renal disease.
MATERIALS AND METHODS: This was a prospective single-center study involving 20 patients who were referred to our radiology department to undergo CMRI between June 2010 and December 2011. Resting left ventricular functions and (early and late) myocardial contrast enhancement were assessed in all patients. Laboratory tests and ECG were conducted on all individuals. The mean duration of clinical follow-up was 18 ± 4 months.
RESULTS: Pathological results were seen in six (30%) of the patients in our study sample. Scar tissue was identified as a high-risk factor in three patients (15%), and myocardial hibernation was shown to pose a moderate risk in three patients (15%). In the remaining 14 cases, no pathology was identified, and the risk was therefore categorized as low. A statistically significant disparity in mortality rates was observed between the high- and low-risk groups (p < 0.05). There were no statistically significant differences between the two groups in terms of the ECG and cardiac biomarkers.
CONCLUSION: Our findings indicate that CMRI is effective in accurately categorizing risk groups and detecting ischemic conditions, even when such events are not evident on ECG or laboratory tests.

Keywords: Magnetic resonance imaging/methods; Kidney failure, chronic; Contrast media/metabolism; Myocardial infarction/diagnosis.

OBJECTIVE: To use shear wave elastography (SWE) in the evaluation of salivary glands in patients with ankylosing spondylitis (AS) who present with sicca symptoms.
MATERIALS AND METHODS: This was a prospective controlled study of patients diagnosed with AS and exhibiting sicca symptoms (study group) and of healthy volunteers (control group). The levels of antinuclear, anti-Ro, and anti-La antibodies were determined in blood samples. In both groups, parotid and submandibular glands were evaluated by ultrasound and tissue stiffness was determined by SWE. Intraclass correlation coefficients were used in order to assess reliability. The differences between the two groups were assessed by statistical methods, and a ROC curve analysis was performed to determine the predictive values.
RESULTS: A total of 66 patients with AS and 71 healthy volunteers were included in the study. There were no significant differences between the groups in terms of age or sex (p > 0.05). The intra- and inter-rater reliability of SWE were good for the parotid gland (0.81–0.85 and 0.80, respectively) and for the submandibular gland (0.85–0.88 and 0.80, respectively). Statistically significant differences were found. Tissue stiffness in the parotid and submandibular glands, as determined by SWE, was significantly greater in the study group than in the control group (p < 0.05).
CONCLUSION: Although there was no histopathological correlation in the parotid and submandibular salivary glands of patients with AS and sicca symptoms compared with the healthy volunteers, quantitative measurements showed greater tissue stiffness in the former group. In patients with AS, SWE guides salivary gland biopsy, which is the gold standard for diagnosing Sjögren’s syndrome.

Keywords: Spondylitis, ankylosing/diagnostic imaging; Inflammation; Salivary glands/physiopathology; Ultrasonography/methods; Elasticity imaging techniques/methods.

OBJECTIVE: To determine the accuracy of diffusion-weighted imaging (DWI) for the diagnosis of cervical lymph node metastasis from oral cancer.
MATERIALS AND METHODS: This was a cross-sectional study conducted in the Radiology Department of the Mayo Hospital, in the city of Lahore, Pakistan. We included 150 patients diagnosed with oral cancer. Ages ranged from 18 to 60 years of age. During the study period, all of the patients included underwent magnetic resonance imaging, including a DWI sequence, in a 1.5-T scanner with a phased-array head and neck coil. Patients with contraindications to magnetic resonance (aneurysm, a pacemaker, clips, plates, a prosthetic valve, or claustrophobia) were excluded. In the DWI sequence, the area scanned included the lymph nodes from suprasternal notch to the base of the skull. Histopathology of the lymph nodes was employed as the gold standard.
RESULTS: The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of DWI for the diagnosis of oral cancer metastasis to cervical lymph nodes, with histopathology as the gold standard, was 90.57%, 91.75%, 94.68%, 90.57%, and 91.33%, respectively.
CONCLUSION: Our findings indicate that DWI is fairly accurate for detecting metastases in the cervical lymph nodes of patients with oral cancer.

Keywords: Lymph nodes/pathology; Mouth neoplasms; Head and neck neoplasms; Lymphatic metastasis; Diffusion magnetic resonance imaging; Sensitivity and specificity.

OBJECTIVE: To determine the prevalence of incidentally detected pancreatic cystic lesions (PCLs) in adult patients undergoing magnetic resonance imaging (MRI).
MATERIALS AND METHODS: We included radiological records of consecutive adult patients who underwent MRI at our institution during a one-year period (January to December of 2023). We collected clinical and radiological data, including the presence or absence of cysts in the liver and kidneys.
RESULTS: A total of 1,211 MRI records were included. We identified PCLs in 138 patients, corresponding to a prevalence of 11.4%. That prevalence was 9.51% in men and 12.52% in women (p = 0.112). The patients with incidental PCLs (64.57 ± 13.15) were significantly older than were those without (mean age, 64.57 ± 13.15 years vs. 51.01 ± 15.27 years; p < 0.001). Of the 138 patients with PCLs, 53 (38.41%) had at least one liver cyst and 83 (60.14%) had at least one kidney cyst. In 69 patients (50.0%), the radiological diagnosis of the incidental cysts was intraductal papillary mucinous neoplasm. In the univariate analysis, the presence of PCLs was associated with age, liver cysts, and kidney cysts, although it was associated with only age and kidney cysts in the multivariate analysis.
CONCLUSION: In our study sample, the prevalence of incidentally detected PCLs was 11.4%. That prevalence increased significantly with age but did not differ by sex.

Keywords: Incidental findings; Pancreatic cyst/diagnostic imaging; Magnetic resonance imaging; Kidney diseases, cystic; Liver diseases; Cysts/diagnostic imaging.

Hepatic cysts are quite common in the daily practice of radiologists and are generally described as simple cysts or as cystic lesions sparsely distributed throughout the parenchyma, often without the discrimination they merit. Simple cysts have, by definition, thin walls, one or two thin septa, and homogeneous fluid content. Such cysts include congenital epithelial cysts, biliary hamartomas, and peribiliary cysts, as well as those representing Caroli’s disease or polycystic liver disease. Complex cysts have variable walls, septa, and contents. They also have various etiologies. A detailed assessment of the clinical history and imaging characteristics can assist in making the diagnosis and choosing a course of clinical management. In this review, hepatic cysts are divided, for educational purposes, into five categories: congenital, traumatic, neoplastic, inflammatory, and miscellaneous.

Keywords: Liver; Cystadenoma, mucinous; Echinococcosis, hepatic; Caroli disease; Liver abscess.

OBJECTIVE: To investigate and identify the main abdominal ultrasound findings in patients with biliary atresia (BA).
MATERIALS AND METHODS: This was a retrospective study of the ultrasound images of 44 patients with neonatal cholestasis. We excluded 18 patients in whom a final diagnosis of BA was not confirmed or who were lost to clinical follow-up. The main ultrasound findings evaluated were gallbladder length and morphology; triangular cord thickness; hepatic artery enlargement; hepatic subcapsular flow; cysts in the porta hepatis; presence of a distinct triangular cord with linear, tubular, or round hypoechoic portions; and polysplenia syndrome.
RESULTS: Abnormal gallbladder morphology and triangular cord thickening were the main ultrasound findings in the patients with BA. Gallbladder abnormalities were present in all patients. Hepatic artery enlargement was the third most common finding, present in 19 (73%) patients. Six patients (23%) had subcapsular arterial flow and four (15%) had cysts in the porta hepatis. Hypoechoic or cystic portions of the triangular cord were present in three patients (11%), and we found that BA was accompanied by polysplenia syndrome in three patients (11%).
CONCLUSION: Ultrasound is the examination of greatest diagnostic relevance in the investigation of cholestasis in newborns and infants; it enables the establishment of BA suspicion and the indication for laparotomy with intraoperative cholangiography.

Keywords: Diagnosis; Abdomen/physiopathology; Gallbladder/physiopathology; Ultrasonography/methods; Biliary atresia/diagnostic imaging; Pediatrics

OBJECTIVE: To investigate the feasibility of performing magnetic resonance fingerprinting (MRF) of the bladder and quantify the T1 and T2 relaxation times of the bladder wall in healthy female volunteers, before and after voiding.
MATERIALS AND METHODS: Volunteers without lower urinary tract symptoms underwent pelvic MRF. Five axial MRF slices of the bladder were obtained before and after voiding. Regions of interest were annotated on MRF T1 maps: one on the anterior bladder wall, and one on a lateral wall. Annotations made on T1 maps were subsequently copied to coregistered T2 maps. Student’s t-tests for paired samples were employed to compare the T1 and T2 values obtained before voiding with those obtained after voiding.
RESULTS: Eight volunteers were included. The mean pre- and post-void T1 relaxation times were 1,575 ± 93 ms and 1,476 ± 138 ms, respectively. The mean pre- and post-void T2 relaxation times were 55 ± 21 ms and 53 ± 8 ms, respectively. The mean T1 relaxation times were 6% lower after voiding than before (p = 0.035).
CONCLUSION: The use of MRF to quantify T1 and T2 relaxation times in the bladder appears to be feasible. Our results can serve as a reference for studies investigating T1 and T2 relaxation times in patients with malignant or nonmalignant bladder disorders.

Keywords: Healthy volunteers; Magnetic resonance imaging; Urinary bladder.

OBJECTIVE: To evaluate the false-negative rate in the diagnosis of superior labrum anterior to posterior (SLAP) lesions on unenhanced 1.5-T magnetic resonance imaging (MRI).
MATERIALS AND METHODS: This was a retrospective analysis of the medical records of 24 patients who regularly engaged in physical activity and underwent surgery for reconstruction of the rotator cuff or for glenohumeral instability, comparing the result of the MRI examination with the intraoperative findings.
RESULTS: Eighteen patients (75%) were male and six (25%) were female. False-negative results for SLAP lesions were observed in 83% of the MRI examinations.
CONCLUSION: For SLAP-type lesions, MRI has low diagnostic sensitivity. Arthroscopy appears to be the most efficient tool for the diagnosis of such lesions.

Keywords: Shoulder injuries/diagnosis; Magnetic resonance imaging; Data accuracy.

OBJECTIVE: To develop a deep learning system to classify non-small cell lung cancer (NSCLC) by histologic subtype—adenocarcinoma or squamous cell carcinoma (SCC)—from computed tomography (CT) images in which the tumor regions were segmented, comparing our results with those of similar studies conducted in other countries and evaluating the accuracy of automated classification by using data from the Instituto Nacional de Câncer, Brazil.
MATERIALS AND METHODS: To develop the classification system, we employed a 2D U-Net neural network for semantic segmentation, with data augmentation and preprocessing steps. It was pretrained on 28,506 CT images from The Cancer Image Archive, a private database, and validated on 2,015 of those images. To develop the classification algorithm, we used a VGG16-based network, modified for better performance, with 3,080 images of adenocarcinoma and SCC from the Instituto Nacional de Câncer database.
RESULTS: The algorithm achieved an accuracy of 84.5% for detecting adenocarcinoma and 89.6% for detecting SCC, with sensitivities of 91.7% and 90.4%, respectively, which are considered satisfactory when compared with the values obtained in similar studies.
CONCLUSION: The system developed appears to provide accurate automated detection, as well as tumor segmentation and classification of NSCLC subtypes of a local population using deep learning networks trained using public image data sets. This method could assist oncological radiologists by improving the efficiency of preliminary diagnoses

Keywords: Carcinoma, non-small-cell lung; Image processing, computer-assisted/methods; Segmentation; Semantics; Carcinoma/classification; Deep learning.

OBJECTIVE: To present the results of a series of outpatient renal biopsies performed with a tangential approach, as well as to conduct an analysis focusing on patient safety and the frequency with which sufficient material was obtained.
MATERIALS AND METHODS: This retrospective observational study examined the pathology results and evolution of 244 patients referred for ultrasound-guided renal biopsy at a single center. In each biopsy, the needle was advanced in the cortex just below the renal capsule. The pathologist examined the fragments, counting the viable glomeruli obtained; additional punctures were performed if necessary, as long as Doppler ultrasound showed no bleeding. The patients remained at rest at the clinic, being discharged after a follow-up ultrasound evaluation and contacted one week later to investigate late adverse events.
RESULTS: Ten patients were excluded from the analysis, leaving a sample of 234 patients. The material obtained for diagnosis was considered sufficient in 95.73% of the procedures, partially adequate in 3.42%, and not very representative in 0.85%. Two patients (0.85%) had bleeding greater than 50 cm³ and were referred to the hospital emergency department. Both of those patients had a favorable evolution: one required only a period at rest, and the other required a blood transfusion, being discharged 48 h after the procedure.
CONCLUSION: The tangential approach to renal biopsy, with its high rates of safety and efficacy, representing a reliable diagnostic tool for renal and systemic diseases, should be the method of choice for obtaining adequate pathological specimens.

Keywords: Image-guided biopsy; Kidney diseases; Ambulatory care; Ultrasonography, interventional.

OBJECTIVE: To investigate computed tomography (CT) features of pneumonia that does not respond to empirical therapy in patients with hematologic diseases.
MATERIALS AND METHODS: This was a retrospective analysis of all patients with hematologic disease who were diagnosed with pneumonia between 2017 and 2023, did not respond to empirical therapy for the infection, and underwent bronchoalveolar lavage and CT within a week of each other. The distribution and CT pattern of pulmonary abnormalities were assessed, as was the presence of lymphadenopathy, pleural effusion, and pericardial effusion.
RESULTS: Forty-nine patients (30 males; mean age, 61 years) were included. We identified Gram-negative bacteria in 45 patients, Gram-positive bacteria in 13, and fungi in three. Pulmonary abnormalities were bilateral in 73% of the patients in the sample, and there was no difference in prevalence between the upper and lower lung fields in 53%. Common alterations were consolidation, in 73% of the patients, bronchial wall thickening, in 71%, bronchiectasis, in 55%, and nodules, in 53%; extrapulmonary findings were less common, being identified in ≤ 27%. Pulmonary findings were typically bilateral and without a predominance between the upper and lower lung fields (p < 0.05). Common associations were between consolidation and bronchiectasis, between nodules and bronchial wall thickening, and between bronchiectasis and bronchial wall thickening (p < 0.05 for all).
CONCLUSION: The CT manifestations of pneumonia in patients with hematologic diseases not responding to empirical therapy can resemble those of lobular pneumonia with airway inflammation. For that reason, as well as because multiple pathogens can be present in the same patient, examination of bronchoalveolar lavage fluid can be necessary.

Keywords: Pneumonia; Drug resistance; Hematologic neoplasms; Tomography, X-ray computed; Bronchoalveolar lavage.

OBJECTIVE: To evaluate the frequency of the typical computed tomography (CT) pattern in individuals with coronavirus 2019 (COVID-19), comparing those who were vaccinated with those who were unvaccinated.
MATERIALS AND METHODS: This was a retrospective study of the medical records of patients with clinical suspicion of COVID-19 between August 2021 and February 2022. The vaccination status was classified as absent/incomplete (0 or 1 dose) or complete (2 or more doses). The pattern seen on the first chest CT was defined as typical, atypical, indeterminate, or normal, the last three patterns being combined to form what was designated the non-typical group.
RESULTS: Binary logistic regression analysis showed that individuals with a complete vaccination status were less likely to present with the typical CT pattern than were those with an absent/incomplete vaccination status (adjusted OR = 0.19, 95% CI: 0.06–0.60).
CONCLUSION: This information is important because it demonstrates that the frequency of the CT pattern considered typical of COVID-19 is currently lower than it was before the vaccines became available. Therefore, the typical CT pattern is no longer expected.

Keywords: Tomography, X-ray computed; Thorax; COVID-19; Vaccines.

OBJECTIVE: To determine the proportion of men with completely negative multiparametric magnetic resonance imaging (MRI) scans and which individual sequence—T2-weighted imaging (T2WI) or diffusion-weighted imaging (DWI)—best predicts an overall negative examination result.
MATERIALS AND METHODS: This was a single-center retrospective study evaluating 492 MRI scans compliant with Prostate Imaging Reporting and Data System (PI-RADS), version 2.1. Radiology reports described the absence of lesions or suspicious lesions with PI-RADS scores of 3–5, signifying positive T2WI or DWI results. Positivity on a dynamic contrast-enhanced (DCE) study was determined by early or simultaneous focal enhancement consistent with lesions on T2WI or DWI. All scans reported as negative were prospectively reviewed to ensure that each sequence truly met the criteria for negativity according to the PI-RADS guidelines. Descriptive statistics were employed to summarize the data, and the chi-square test was employed to assess the relationship between a negative T2WI result and a negative DWI/DCE result, as well as that between a negative DWI result and a negative DWI/DCE result, with logistic regression models identifying predictors of such combined results.
RESULTS: Among the patients evaluated, approximately one-third of those with suspected prostate cancer and 10% of those with known cancer could have concluded their examination after a single negative sequence. A negative T2WI result predicted negative DWI/DCE findings in 62.4% of scans (95% CI: 55.3–68.9), with an odds ratio of 245.3 (p < 0.001). Similarly, a negative DWI result predicted negative T2WI/DCE findings in 88.9% of scans (95% CI: 83.1–92.7) with an odds ratio of 76.4 (p < 0.001). These associations remained robust after adjustment for age, prostate-specific antigen level, prostate-specific antigen density, cancer status, and radiologist.
CONCLUSION: Findings from T2WI or DWI may serve as preliminary indicators for the subsequent diagnostic yield of other sequences, with DWI appearing to hold a slight advantage. Although the accuracy of this approach is not yet sufficient for clinical implementation, these results are promising and merit further investigation.

Keywords: Prostate/diagnostic imaging; Prostatic neoplasms; Magnetic resonance imaging/methods.

OBJECTIVE: To characterize the main causes of the reversed halo sign (RHS) on computed tomography (CT) of the chest and its imaging features.
MATERIALS AND METHODS: This was a retrospective study reviewing all chest CT scans for which the report contained the term "reversed halo sign" among those performed between 2015 and 2020 at a tertiary care hospital.
RESULTS: A total of 286 cases were identified, and the corresponding CT images and clinical data were reviewed. In this population, the most common cause of an RHS was pulmonary infarction (in 42%), followed by cryptogenic organizing pneumonia (in 17%) and bacterial pneumonia (in 16%). In addition, the CT characteristics of the RHS were identified in various conditions, such as pulmonary thromboembolism with pulmonary infarction, in which the RHS was typically smooth-walled and solitary with a peripheral distribution.
CONCLUSION: The RHS can be observed in many contexts, and its CT characteristics, in combination with the clinical picture, can help narrow the differential diagnosis.

Keywords: Tomography, X-ray computed/methods; Respiratory tract infections/diagnostic imaging; Pulmonary embolism/diagnostic imaging; Lung diseases, interstitial/diagnostic imaging.

OBJECTIVE: The purpose of this study was to evaluate the agreement between and reproducibility of specific two-dimensional (2D) and three-dimensional (3D) ultrasound methods in assessing cervical volume in pregnant women in their second trimester.
MATERIALS AND METHODS: This was a prospective cross-sectional study of 48 asymptomatic pregnant women at 20–24 weeks of gestation. All cervical volumes were determined by transvaginal ultrasound, with a 2D method employing a geometric formula {π * [(anteroposterior diameter + transverse diameter) * ¼] * length}, where π = 3.14, and a 3D method employing a virtual organ computer-aided analysis. Intraobserver and interobserver reliability was analyzed by calculating the intraclass correlation coefficient (ICC).
RESULTS: The mean maternal age and timing of the ultrasound examination were 26 ± 6 years and 21 ± 1 weeks of gestation, respectively. The mean cervical volumes measured by the 2D and 3D ultrasound methods were 27.71 ± 9.27 cm³ and 35.21 ± 8.85 cm³, respectively. Cervical length and volume showed a positive correlation with both methods—r = 0.77 (p < 0.001) and r = 0.70 (p < 0.001), respectively. Intraobserver reliability was excellent for both methods, with ICCs of 0.92 and 0.93 for the 2D and 3D methods, respectively. Interobserver reliability was good (ICC: 0.81) for the 3D method, whereas it was poor (ICC: 0.37) for the 2D method. Reproducibility of the transverse diameter measurement was low, with an intraobserver ICC of 0.41 and an interobserver ICC of 0.48.
CONCLUSION: Cervical volume measurements obtained with 2D and 3D ultrasound methods seem to show satisfactory agreement and good intraobserver reliability. In our study sample, the 2D ultrasound method showed low interobserver reliability, whereas the 3D ultrasound method was more reliable, with good intraobserver and interobserver reliability.

Keywords: Pregnancy; Cervical length measurement; Cervix uteri/embryology; Pregnancy trimester, second; Ultrasonography, prenatal/methods; Reproducibility of results.

OBJECTIVE: To perform an agreement analysis between volBrain and HIPS software for measuring hippocampal volume and its associated asymmetry index.
MATERIALS AND METHODS: We evaluated volumetric T1-weighted magnetic resonance imaging scans from radiologically normal subjects (n = 50; age range, 25–75 years). Correlation and Bland-Altman plots were generated. The Pearson correlation coefficient (r) and the intraclass correlation coefficient of absolute agreement between volBrain and HIPS software were calculated for each measurement.
RESULTS: For each hippocampus and its combined volume, a very high correlation was found between the methods (r ≥ 0.96 for absolute values and r ≥ 0.93 for relative values), along with a systematic bias (primarily additive). Consistently, HIPS (with the Kulaga-Yoskovitz protocol) reported smaller volumes than did volBrain. The average difference ranged from 8.2% to 9.1% for absolute values and from 7.9% to 8.7% for relative values. The asymmetry index exhibited a strong correlation (r = 0.82) with no significant bias, although 14% of cases showed opposite signs. The average asymmetry index difference was 32.7%. The intraclass correlation coefficient of absolute agreement ranged from 0.61 to 0.83, reflecting moderate to good agreement overall.
CONCLUSION: Our results indicate that the two methods are not interchangeable for evaluating hippocampal volume and its associated asymmetry index.

Keywords: Hippocampus; Magnetic resonance imaging; Alzheimer disease; Image processing, computer-assisted; Reproducibility of results.

OBJECTIVE: To evaluate the association between first-trimester screening for fetal growth restriction (FGR) and the effect of aspirin use as prophylaxis for this condition, as well as its effect on adverse maternal and perinatal outcomes. A secondary objective was to evaluate the association between a high risk of FGR and adverse perinatal outcomes.
MATERIALS AND METHODS: This was a retrospective cohort study of pregnant women who did or did not undergo first-trimester screening for FGR. Screening for FGR involved the evaluation of maternal characteristics, mean arterial pressure, and the results of uterine artery Doppler. Pregnancies with an estimated risk ≥ 1:155 were categorized as high risk, whereas those with an estimated risk < 1:155 were categorized as low risk.
RESULTS: We evaluated 499 pregnant women who did not undergo first-trimester screening for FGR (unscreened group) and 615 who did (screened group). The risk of gestational hypertension was lower in the screened group, as evidenced by an adjusted odds ratio (aOR) of 0.24 (95% CI: 0.14—0.39; p < 0.001), as was the risk of spontaneous preterm birth at < 37 weeks of gestation (aOR: 0.22; 95% CI: 0.10—0.45; p < 0.001). The risk of delivery at < 32 weeks was higher in the screened group (aOR: 8.25; 95% CI: 1.05—65.71; p < 0.045) as was the risk of delivery at < 37 weeks (aOR: 5.91; 95% CI: 2.62—13.31; p < 0.001). Among all of the pregnancies at high risk of FGR (in both groups), there was an increased risk of delivery at < 32 weeks (3.1% vs. 0.2%; OR: 16.20; 95% CI: 2.20—190.90; p = 0.004), and at < 37 weeks (10.7% vs. 1.4%; OR: 8.41; 95% CI: 3.60—22.10; p < 0.0001). The use of aspirin was associated with a greater prevalence of gestational hypertension (8.0% vs. 2.1%; OR: 4.1; 95% CI: 1.77—10.10; p = 0.0014) and of a birth weight < 2,500 g (14.5% vs. 7.3%; OR: 2.14; 95% CI: 1.25—3.71; p = 0.009).
CONCLUSION: First-trimester screening for FGR seems to be associated with a higher risk of preterm birth (at < 32 and < 37 weeks). Pregnancies that are at high risk of FGR appear to also be at a higher risk of adverse perinatal outcomes. Aspirin use seems to be associated with a greater prevalence of developing gestational hypertension and of a birth weight < 2,500 g.

Keywords: Pregnancy trimester, first; Mass screening/methods; Fetal growth retardation/epidemiology; Pregnancy outcome/epidemiology; Aspirin/adverse effects.

OBJECTIVE: This study aimed to assess whether the evaluation of the central vein sign (CVS) and paramagnetic rim lesions (PRLs) using susceptibility-weighted magnetic resonance imaging (MRI) can distinguish multiple sclerosis (MS) from migraine.
MATERIALS AND METHODS: In this single-center observational study, we conducted a cross-sectional analysis of the CVS, determining the proportion of CVS-positive lesions per individual and absolute counts, using thresholds of 3 lesions (select3*) and 6 lesions (select6*), and of PRLs in participants with MS and in those with migraine, from 3.0-T MRI brain scans.
RESULTS: The study included 20 participants with MS, 20 with migraine, and 20 included as healthy controls. The proportion of participants with CVS-positive lesions was higher in the MS group than in the migraine group (61.8% vs. 10.4%), and PRLs were observed exclusively in the MS group. The presence of at least one PRL and the select6* criterion demonstrated the highest diagnostic accuracy within the study sample.
CONCLUSION: The detection of the CVS and of a PRL on 3.0-T MRI scans may serve as a reliable biomarker to differentiate MS from migraine.

Keywords: Cerebral veins/diagnostic imaging; Multiple sclerosis/diagnosis; Migraine disorders/diagnosis; Neuroimaging/methods; Magnetic resonance imaging/methods; Biomarkers/analysis.

OBJECTIVE: To evaluate the relationship between the mean thyroid lobe diameter (MTLD) and the transverse tracheal diameter (TTD), as determined by ultrasound, in order to validate its efficacy as a quantitative marker of goiter.
MATERIALS AND METHODS: Thyroid ultrasound images were analyzed. Standardized measurements included the MTLD [(transverse + anteroposterior diameter) ∕ 2], TTD, and thyroid volume [transverse diameter × anteroposterior diameter × length × 0.470]. Statistical correlation and regression analyses were employed to assess the interactions among those variables and their diagnostic utility in goiter detection.
RESULTS: A total of 300 thyroid ultrasound images (200 of adults and 100 of children/adolescents) were evaluated. We identified a significant correlation between the MTLD:TTD ratio and goiter. When the MTLD exceeded the normative TTD threshold (> 1.7 cm in adults; > 2.4 cm in children/adolescents), the mean thyroid volume was consistently elevated, in the adult patients—12.5 ± 2.1 mL (normal range, 7–10 mL)—and in the pediatric patients—18.3 ± 3.6 mL (normal range, 5.0–16.1 mL)—confirming goiter (p < 0.001). Regression analysis demonstrated a strong linear relationship between thyroid volume and the MTLD (R² = 0.82; β = 1.34; p < 0.001), with 89% sensitivity and 93% specificity for goiter prediction. An abnormal tracheal index (1.7–2.4 vs. the observed mean of 2.6 ± 0.3) was found to increase diagnostic accuracy (AUC = 0.94; 95% CI: 0.91–0.97).
CONCLUSION: The MTLD:TTD ratio is a reliable ultrasound biomarker for goiter detection, demonstrating strong diagnostic performance and volumetric correlation.

Keywords: Goiter; Thyroid gland; Trachea; Ultrasonography.

OBJECTIVE: To evaluate the relationship between the magnetic resonance imaging-derived proton density fat fraction (MRI-PDFF) and liver size in patients with metabolic dysfunction-associated steatotic liver disease (MASLD), as well as to explore the role of determining the craniocaudal diameter of the right hepatic lobe (CCDHL), measured at the midclavicular line, and liver volumetry as complementary tools in the assessment of hepatic steatosis.
MATERIALS AND METHODS: This was a single-center, cross-sectional, prospective study including 289 patients with MASLD who underwent multiparametric MRI for the evaluation of hepatic steatosis, which was categorized by the MRI-PDFF value. Liver size measurements included the CCDHL, liver volume from automated segmentation, and its difference from the total expected liver volume (eLV), calculated with the Vauthey formula.
RESULTS: A significant positive correlation was observed between the MRI-PDFF and liver size measurements, including the CCDHL (rs = 0.651; p < 0.001) and the eLV (rs = 0.568; p < 0.001). Patients with higher grades of steatosis showed a progressive increase in liver volume (p < 0.001). A receiver operating characteristic curve analysis demonstrated good diagnostic accuracy for the CCDHL and for the eLV in identifying moderate-to-severe steatosis (area under the curve: 0.76 and 0.83, respectively).
CONCLUSION: The integrated assessment of the MRI-PDFF and liver size appears to be effective for the diagnosis, stratification, and monitoring of steatosis in patients with MASLD.

Keywords: Fatty liver; Multiparametric magnetic resonance imaging; Biomarkers; Liver/diagnostic imaging; Liver/physiopathology.

OBJECTIVE: To evaluate the effect of saline hydration on contrast-induced acute kidney injury in a rat model of diabetes mellitus.
MATERIALS AND METHODS: This was a quantitative, preclinical experimental study. A total of 28 male Wistar rats were randomized into four groups: citrate (control); diabetes mellitus-only; diabetes mellitus + iodinated contrast (6 mL/kg iothalamate meglumine); and diabetes mellitus + iodinated contrast + saline (NaCl 0.9%, 12 mL/kg). Physiological parameters, renal hemodynamics, inulin clearance (as a proxy for renal function), urinary albumin, and oxidative injury were assessed. Statistical significance was set at p < 0.05.
RESULTS: In the diabetes mellitus-only group, there was sustained hyperglycemia, weight loss, polyphagia, polyuria, polydipsia, and renal hypertrophy, with significant differences in comparison with the control group. In the diabetes mellitus + iodinated contrast group (in comparison with the diabetes mellitus-only group), there was an additional reduction in the mean renal blood flow (2.1 ± 0.7 mL/min vs. 6.9 ± 0.8 mL/min), greater mean renal vascular resistance, lower mean inulin clearance (0.17 ± 0.02 mL/min vs. 0.85 ± 0.13 mL/min), and a higher mean level of urinary neutrophil gelatinase-associated lipocalin (318.1 ± 52.6 pg/mL vs. 42.2 ± 42.6 pg/mL), together with higher hydrogen peroxide concentrations, as well as elevated lipid peroxidation and thiol consumption in renal tissue. Pretreatment with saline hydration averted those changes (p < 0.05 for all).
CONCLUSION: Saline hydration attenuated the impairment of renal function and hemodynamics by reducing redox imbalance in contrast-induced acute kidney injury.

Keywords: Diabetes mellitus; Kidney/drug effects; Kidney diseases/chemically induced; Contrast media; Risk factors; Primary prevention.

Advances in cardiac magnetic resonance have promoted tissue characterization with high spatial and contrast resolution, and late gadolinium enhancement (LGE) sequences have improved the detection of myocardial fibrosis. The distribution pattern of LGE facilitates differentiation between ischemic and nonischemic etiologies and aids in refining diagnoses within nonischemic cardiomyopathies, suggesting specific etiological factors. A distinctive nonischemic LGE pattern that has recently gained prominence is the ring-like pattern, defined as a subepicardial or mid-wall circumferential or semi-circumferential enhancement, which involves at least three contiguous segments within the same short-axis slice. Initially identified as a diagnostic marker for desmoplakin and filamin C-related cardiomyopathies, the pattern has been reported in nongenetic conditions; nevertheless, it remains an uncommon finding in these diseases. In this article, we aim to present the differential diagnoses of ring-like LGE and its mimics. The combination of epidemiological, clinical, electrocardiographic, and additional features enables a focused refinement of the differential diagnosis associated with ring-like LGE.

Keywords: Cardiomyopathies; Arrhythmogenic right ventricular cardiomyopathy; Magnetic resonance imaging; Gadolinium.

The aim of this article is to provide a comprehensive guide to image quality assessment in diagnostic radiology, emphasizing practical methodologies for radiologists. The goal is to improve diagnostic accuracy and patient care on the basis of the understanding and application of quantitative and qualitative metrics in clinical practice and research. We conducted a review of the literature in the PubMed, Scopus, Web of Science, and Embase databases. The search terms included “image quality in radiology”, “quantitative and qualitative assessment”, “modulation transfer function”, “signal-to-noise ratio”, “contrast-to-noise ratio”, “radiation dose optimization”, and “artificial intelligence in image quality assessment”. The review identified the main methodologies for image quality assessment. We analyzed these metrics for their applicability in clinical settings, highlighting their benefits and limitations. In addition, we discuss qualitative methods such as visual assessment, the assessment of contrast/density, and peer review. This guide fills a gap in the literature by providing accessible, practical knowledge for general radiologists. Ongoing research, education, and technological development are essential to advance the field and ensure high standards in radiology practice.

Keywords: Quality control; Image processing, computer-assisted; Radiology; Diagnostic imaging; Practice guideline.

Müllerian anomalies represent a spectrum of congenital malformations of the female reproductive tract. Over the decades, various classifications have been developed to categorize these anomalies. Based on a classification proposed by Kaufmann and Jarcho in 1946, the classification devised by the American Fertility Society in 1988 was considered simple and practical; although it faced criticism for its subjectivity and limitations in classifying complex anomalies, it was widely adopted. In 2013, the European Society of Human Reproduction and Embryology and the European Society for Gynaecological Endoscopy introduced a more detailed classification, which, albeit more complex and with a risk of overdiagnosis, also included cervical and vaginal anomalies. In 2021, the American Society for Reproductive Medicine updated the classification with the aim of simplifying and improving diagnostic accuracy, expanding the categories, and defining more objective criteria. This new classification seeks to facilitate communication among professionals and enhance clinical management, emphasizing the importance of continuous updates to improve reproductive outcomes and the quality of life for patients affected by these anomalies. This article aims to discuss the strengths and limitations of each of these classifications, offering a critical analysis of their impact on the diagnosis and treatment of müllerian anomalies. It also seeks to highlight aspects that may be refined in future revisions to achieve greater diagnostic precision and clinical applicability.

Keywords: Congenital abnormalities; Mullerian ducts; Classification; Diagnosis; Radiology; Diagnostic imaging.

This study aimed to systematically review the highest-quality evidence regarding the cutoff value in kPa for the diagnostic accuracy of ultrasound-based liver elastography in comparison with reference standards, including magnetic resonance imaging (MRI), computed tomography, and liver biopsy. In addition, we assessed the presence of hepatocellular carcinoma (HCC) and its associated implications in clinical and diagnostic contexts. We conducted a search using Medical Subject Headings across PubMed, Embase, Cochrane Library, Web of Science, Scopus, and Lilacs for articles published up to June 6, 2024. Of 1,131 studies identified, 33 were eligible and 8 met the quality criteria, as evaluated with the “RTI Item Bank” and “QUADAS-2” tools, following the PICO strategy. The mean elasticity of the liver parenchyma among patients with confirmed HCC was 18.77 kPa (95% CI: 16.28–21.27), making ultrasound liver elastography useful as a predictor of the diagnosis by gold-standard methods such as MRI. Ultrasound elastography is a low-cost, accessible, and noninvasive diagnostic tool capable of estimating liver elasticity in patients with HCC. However, due to the heterogeneity of the articles included in this review, further prospective studies are needed in order to confirm and standardize a cutoff stiffness value for early HCC screening, which could improve patient outcomes, particularly in resource-limited settings.

Keywords: Carcinoma, hepatocellular; Elasticity imaging techniques; Liver neoplasms/diagnostic imaging.

The sternum and the sternoclavicular joints can exhibit a wide range of anatomical variations and serve as sites for numerous diseases, many of which are diagnosed solely through imaging studies. Recognizing these variations and differentiating them from pathological conditions is essential for radiologists, because accurate identification helps prevent misdiagnoses and treatment delays. This study provides a comprehensive review of the sternal anatomy, addressing anatomical variations, as well as mechanical, inflammatory, and traumatic pathologies, discussing their radiographic characteristics across different imaging modalities. Thus, it provides an overview of the key radiological findings.

Keywords: Sternum; Manubrium; Xiphoid bone; X-Rays; Multidetector computed tomography; Magnetic resonance imaging.

This study involved a retrospective analysis of nine cases of neurocryptococcosis (eight from our institution and one from another institution) seen between May 2014 and May 2022, together with a systematic review of the literature indexed in the PubMed, Embase, and Lilacs databases. Clinical and radiological features of those cases were further refined via an additional comprehensive literature review. The following search string was employed: cryptococcosis AND central nervous system AND (magnetic resonance imaging OR X-ray computed tomography). The search was limited to articles published between July 1978 and May 2022. Two authors, working independently, searched for and selected studies that met the inclusion criteria, and another author reviewed conflicts in a blinded manner. We used Rayyan.ai software to organize the studies, and the review was structured in accordance with the 2020 Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Understanding the prevalence of different patterns of neurocryptococcosis is crucial for improving diagnosis and supporting decision-making in clinical practice. Our review of the literature demonstrated that imaging examinations are a valuable resource for early diagnosis, as well as for assessment of the initial extent and pattern of the disease.

Keywords: Cryptococcosis; Central nervous system; Magnetic resonance imaging.

Systemic sclerosis (SSc) is a multifaceted autoimmune condition that leads to fibrosis in the skin and various internal organs, including the lungs. One of its most serious complications is interstitial lung disease (ILD), which has a profound impact on the prognosis and on patient quality of life. High-resolution computed tomography (HRCT) plays a critical role by offering detailed structural information, whereas positron-emission tomography/CT (PET/CT) provides a deeper understanding of disease activity by combining metabolic and anatomical data. Radiomics expands on those modalities, extracting subtle imaging features undetectable by visual analysis, thereby enabling superior diagnostic accuracy, staging, and prognostic accuracy. This review explores the current applications of radiomics in SSc-ILD, highlighting breakthroughs such as the integration of artificial intelligence for early ILD prediction and risk stratification. Studies have demonstrated that radiomics is efficacious in overcoming traditional diagnostic limitations, enhancing precision in identifying the patterns of usual interstitial pneumonia and monitoring disease progression. When applied to PET/CT, especially that using advanced tracers, radiomics can complement HRCT by identifying metabolic biomarkers of ILD activity, thus supporting personalized treatment strategies. Although radiomics holds significant transformative potential, its routine use in clinical practice still faces several obstacles, such as the need for standardization, validation, and consistency across institutions. Future efforts will be focused on combining radiomics with genetic and molecular data, developing artificial intelligence-driven longitudinal models, and adopting multimodal approaches to improve the management of SSc-ILD. These advances promise to drive a shift toward precision medicine, ultimately improving outcomes for patients with this complex disease.

Keywords: Radiomics; Scleroderma, systemic/diagnostic imaging; Lung diseases, interstitial; Connective tissue diseases/metabolism; Precision medicine.

OBJECTIVE: To assess the prevalence and type of residual lung abnormalities on chest computed tomography (CT) and pulmonary function testing (PFT) variables in patients with respiratory symptoms related to post-COVID-19 condition at 12 months of follow-up, and to analyze associations between CT findings and PFT parameters.
MATERIALS AND METHODS: The CT findings were evaluated by two radiologists, who calculated semiquantitative CT scores. The PFTs included spirometry, plethysmography, and the diffusing capacity of the lung for carbon monoxide.
RESULTS: Thirty-seven patients were included in the study. On CT scans of the chest acquired at 12 months of follow-up, 78.3% of the patients exhibited residual abnormalities, including reticular opacities, in 75.7%; traction bronchiectasis/bronchiolectasis, in 43.2%; and fibrosis-like findings, in 43.2%. The mean overall CT score was 9.30 ± 2.59. Patients with fibrosis-like findings had significantly lower total lung capacity (68.6% vs. 80.6% of the predicted value; p = 0.018). A moderate negative correlation was found between the overall CT score and total lung capacity (rs = −0.49; p = 0.003).
CONCLUSION: It seems that a significant proportion of patients with respiratory symptoms related to post–COVID-19 condition demonstrate residual lung abnormalities on chest CT at 12 months of follow-up, with a substantial prevalence of fibrosis-like findings. Such abnormalities are associated with restrictive lung disease.

Keywords: Post-acute COVID-19 syndrome; Tomography, X-ray computed; Pulmonary fibrosis; SARS-CoV-2; COVID-19/complications.

The objective of this systematic review and meta-analysis of observational studies was to estimate the prevalence of residual alterations in the lung parenchyma on computed tomography (CT) after coronavirus disease 2019 (COVID-19), correlating those alterations with the severity of the acute phase of the disease. We reviewed data related to adult patients evaluated at 3, 6, and 12 months after the diagnosis of moderate-to-critical COVID-19. We performed structured searches of 14 databases, encompassing works published between January 2020 and January 2024. Thus, 44 primary studies were selected. Data on mild cases of COVID-19 were excluded, as were those related to assessment of the acute phase of the disease. The results were analyzed descriptively, and meta-analyses were conducted to estimate prevalence. The estimated prevalence of altered CT scans at post-diagnosis months 3, 6, and 12 was 69.0% (95% CI: 60.0–77.6%; I² = 86%; p < 0.001), 62.0% (95% CI: 52.0–71.5%; I² = 77%; p < 0.001), and 54.0% (95% CI: 40.0–67.5%; I² = 88%; p < 0.001), respectively. There was no correlation between severity of the acute phase and the persistence of alterations on CT in general. Among the CT scans acquired at post-diagnosis month 3, alterations indicative of fibrosis were observed in 22% (95% CI: 13–30%; I² = 85%; p < 0.001), and no reduction in that prevalence was observed at the subsequent time points (rho-s = 0.952; p < 0.000). The severity of the acute phase showed a positive correlation with the presence of lesions indicative of pulmonary fibrosis on CT scans acquired at 3 months after the diagnosis of COVID-19.

Keywords: COVID-19; Tomography, X-ray computed; Post-acute COVID-19 syndrome; Thorax; Lung diseases/complications.

A typical approach for many cardiovascular surgical procedures is median sternotomy. Despite advances in surgical techniques and postoperative care, complications still occur in 0.5–5.0% of cases. Radiological assessment of the chest after sternotomy is a challenge, because normal findings resulting from surgical trauma can resemble complications. This pictorial essay aims to provide an overview of normal postoperative imaging findings and the spectrum of complications that can arise, including surgical material-related issues, hematomas, bone complications, and infections. Diagnosis and management require careful interpretation of imaging studies, considering the recovery timeline and clinical status of the patient. With the increasing number of cardiothoracic surgical procedures, this is essential knowledge for radiologists, allowing them to contribute to an accurate diagnosis and the appropriate management of patients.

Keywords: Sternotomy; Postoperative complications; Diagnostic imaging; Mediastinitis; Surgical wound infection.

Increasing tissue contrast for bone assessment on magnetic resonance imaging has been the aim of several recent studies, and various techniques have been proposed for that purpose, including ultrashort echo time sequences, zero echo time sequences, and gradient echo sequences in various acquisition forms. In this article, we discuss the fast field echo resembling a computed tomography using restricted echo-spacing (FRACTURE) sequence, which we have started to use routinely in our practice. The FRACTURE sequences are based on the acquisition of gradient echo sequences with different echo times and specific postprocessing. Gradient echo sequences are widely available on magnetic resonance imaging scanners, which is an advantage for the use of a FRACTURE sequence. However, being more susceptible to metal artifacts, a FRACTURE sequence is of limited utility in patients with metallic implants or medical devices. The aim of this article is to illustrate the use of FRACTURE sequences in various contexts, including osteoarticular infection, inflammatory arthropathy, bone tumors, fractures, and crystal deposition diseases.

Keywords: Magnetic resonance imaging; Multidetector computed tomography; Bone and bones; Joints.

For ultrasound-guided prostate biopsy, a transperineal approach is emerging as a superior alternative to the transrectal approach because the former is associated with a lower risk of infection. This pictorial essay aims to highlight the broader applications of transperineal ultrasound (i.e. , those beyond prostate biopsy). We demonstrate various diagnostic and therapeutic uses of transperineal ultrasound, including lymph node biopsies, abscess drainage, hydrogel spacer placement for radiotherapy, and penile biopsies. Details of the transperineal approach, including patient positioning and preparation, are described. In addition, the effectiveness and safety of the method are demonstrated. Our results underscore the versatility of transperineal ultrasound and its potential to enhance clinical practice, demonstrating its importance as a minimally invasive technique with significant clinical benefits in various medical contexts.

Keywords: Perineum/diagnostic imaging; Biopsy; Drainage; Radiotherapy; Hydrogels; Ultrasonography.

The anatomy of the sural nerve is highly variable, and the nerve can present injuries of various etiologies, including iatrogenic injury during surgery. Precise knowledge of the course and morphology of the sural nerve is valuable, and the ability to assess the nerve properly before surgery increases the postoperative success rate, as well as facilitating the execution of nerve conduction studies and biopsies. The purpose of this article is to describe and illustrate the anatomy of the sural nerve, as seen on ultrasonography, which is a practical and economical imaging method.

Keywords: Diagnosis; Sural nerve; Ultrasonography; Anatomy.

Infantile hemangioma (IH) is a common benign vascular neoplasm with a characteristic pattern of progression: at birth, it is not fully developed; in the first days or weeks of life, it grows; and its growth peaks at around one year of age, after which there is spontaneous regression. Although most IHs are superficial and therefore obvious on physical examination, they can also affect deeper planes or other organs, in which case they are best assessed with imaging examinations. Methods such as ultrasound and magnetic resonance imaging can help differentiate IHs from vascular malformations, other benign tumors, and malignant tumors. The aim of this pictorial essay is to demonstrate the various presentations of IHs through illustrative cases, with an emphasis on imaging findings.

Keywords: Hemangioma; Hemangioma, capillary; Infant; Ultrasonography; Magnetic resonance imaging.

Takotsubo cardiomyopathy is an important differential diagnosis for acute chest pain. Imaging tests, such as ventriculography, echocardiography, computed tomography of the heart, and cardiac magnetic resonance, are valuable tools for diagnostic confirmation in this context. This study reviews the literature and exemplifies the spectrum of typical and atypical cardiac magnetic resonance findings in this disease, on the basis of the experience of our facility. Recognition of these characteristics underscores the roles that radiologists and cardiologists play in the care of patients with acute chest pain, enabling an accurate diagnosis and appropriate treatment.

Keywords: Chest pain; Takotsubo cardiomyopathy; Cardiac magnetic resonance.

Pulmonary edema is a very prevalent condition, especially in the intensive care setting, and can have different origins and be caused by different mechanisms. Imaging tests, particularly computed tomography, are sometimes used in the diagnostic investigation of these patients, and may even help to elucidate the etiology. Therefore, it is essential that radiologists understand the dynamic nature of the changes associated with pulmonary edema and be able to recognize diagnostic clues that indicate possible etiologies, in addition to understanding the underlying mechanisms. This illustrated essay provides a concise review of the pathophysiology of pulmonary edema and highlights its main imaging findings, focusing on the clinical features that help to refine the etiological diagnosis.

Keywords: Diagnostic imaging; Chest radiology; Pulmonary edema.

Tarsal tunnel syndrome results from compression or damage to the tibial nerve or its branches as they pass through the tarsal tunnel beneath the flexor retinaculum. Diagnosing tarsal tunnel syndrome is challenging because of nonspecific symptoms that overlap with those of other lower limb pathologies. Vascular disorders are common causes but are often overlooked. High-resolution ultrasonography has emerged as a valuable diagnostic tool, offering advantages over other imaging methods. This technique allows real-time assessment, identifying the factors that cause vascular compression and improving diagnostic accuracy. Increased awareness of the vascular contributions to tarsal tunnel syndrome can promote early diagnosis and improve treatment outcomes.

Keywords: Ultrasonography; Tarsal tunnel syndrome; Tibial nerve; Vascular diseases.

OBJECTIVE: To investigate the relationship between spinopelvic alignment and vertebral fracture in postmenopausal women with osteoporosis.
MATERIALS AND METHODS: This was a retrospective cross-sectional study including 93 women diagnosed with osteopenia or osteoporosis by densitometry between June 2017 and March 2018. Using the software Surgimap to analyze lateral X-rays of the spine and pelvis, we measured the following spinopelvic parameters: pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), sagittal vertical axis (SVA), global tilt (GT), spinosacral angle (SSA), T1 pelvic angle (TPA), lumbar lordosis (LL), and thoracic kyphosis (TK). The spinopelvic parameters were assessed in relation to fracture occurrence by estimating prevalence ratios. Two groups (patients with and without fractures) were compared on the basis of their spinopelvic parameters. Vertebral fractures were graded by the Genant classification, and the spinal deformity index (SDI) was calculated as the sum of the grades. The SDI was found to correlate with spinopelvic parameters. Intraobserver and interobserver reliability for the measurement of the spinopelvic parameters was evaluated.
RESULTS: The GT correlated significantly with the presence of fractures; the incidence of fracture was found to increase by 2.1% for every 1-degree increase in the GT. The presence of fractures was not found to correlate significantly with the SS, PT, PI, LL, TK, SVA, or SSA. The GT was significantly greater in the group with fractures than in the group without fractures. The SDI correlated significantly with global sagittal balance, as measured by the GT.
CONCLUSION: Fractures seem to be more prevalent among women with a higher GT. The SDI appears to correlate well with global sagittal balance, as assessed by the GT.

Keywords: Spine; Radiography; Spinal fractures; Osteoporosis.

OBJECTIVE: To comprehensively and impartially analyze the scientific evidence available for establishing diagnostic reference levels (DRLs) in interventional radiology.
METHOD: This was a systematic review conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The search focused on studies related to interventional radiology and DRLs in PubMed/Medline and Embase. Studies involving computed tomography-guided procedures, studies with incomplete data, and systematic reviews were excluded. Two independent reviewers evaluated the studies, resolving discrepancies with a third reviewer. Articles were tabulated with information such as title, publication year, procedures, DRL values, and type of equipment used.
RESULTS: A total of 475 articles were identified. After duplicates had been excluded and eligibility criteria had been applied, the final sample comprised 30 articles. Most DRL values (73%) were reported at the local level, as defined by International Commission on Radiological Protection criteria, representing typical dose values from a sample within one or a few institutions. A total of 113 procedures were identified, with endovascular aneurysm repair and nephrostomy being the most frequently reported. We identified DRLs at national and regional scales, predominantly within Europe. Influencing factors included technology, operator experience, specific protocols, and optimization strategies. The analysis also identified a lack of longitudinal studies assessing changes over time. The use of dose management software emerged as an effective tool for facilitating data collection and DRL establishment.
CONCLUSION: The lack of standardized procedural terminology hindered direct DRL comparisons. Our findings highlight a predominance of European studies and emphasize the need for broader international efforts to improve DRL implementation.

Keywords: Diagnostic reference levels; Radiology, interventional; Radiation protection; Fluoroscopy.