Conjoined twins are rare malformations and a challenge for both radiologists and pediatric surgeons. Antenatal evaluation is essential for the identification of anatomic fusions and other associated abnormalities, which will enable an adequate surgical planning and the assessment of fetal prognosis. The authors present the clinical and imaging findings of thoracopagus twins, joined by the anterior portion of the thorax, sharing the heart and the liver. Diagnosis was made by ultrasonography and confirmed with fetal magnetic resonance imaging.

Keywords: Pregnancy twins, Conjoined twins, Imperfect twinning

OBJECTIVE: Approximately 35% of the patients with acute appendicitis have a doubtful or incorrect preoperatory diagnosis, particularly in pregnant women and children. Ultrasonography has demonstrated to be an important means of diagnosis due to its low cost and easy access. This study is intended to show the main imaging findings of the many phases of appendicitis, thus helping the ultrasonographist to establish an early diagnosis. MATERIALS AND METHODS: From January to June 2001, 14 patients with acute abdominal pain were submitted to abdominal ultrasound using 3.5 MHz and 7.5 MHz transducers. RESULTS: The ultrasound findings when perforation had not occurred demonstrated a noncompressible appendix, thickening and focal lack of definition of the walls. After perforation had occurred the appendix could no longer be visualized at ultrasonography. Secondary changes such as mass effect, phlegmous changes, liquefaction and abscess formation, and gas bubbles within a collection were identified. CONCLUSION: An early diagnosis of appendicitis is essential in order to minimize morbidity that is high when perforation occurs. Atypical presentations result in misdiagnosis and treatment delay. The main diagnostic challenges are retrocecal, focal or perforated appendicitis.

Keywords: Appendicitis, Ultrasonography, Computed tomography

The purpose of this study is to review the anatomical structures, ultrasonography examination technique and imaging findings in patients with musculotendinous lesions of the shoulder with the aim of helping the radiologist in the differential diagnosis of these lesions. We performed ultrasonography examinations of the shoulder using high-resolution probes (7.5-10 MHz) in 34 patients from January to December, 2001. The examination was normal in eight patients (23%) whereas 26 patients presented abnormalities: eight patients had total rotator cuff tears (30%), five had partial rotator cuff (19%), ten had tendinopathy (38%), one had calcified tendinopathy (3%), one had biceps tendinitis, one had biceps tendon luxation (3%) and one had tendinopathy associated to crystal arthropathy (3%). The lack of experience and the insufficient knowledge about the main diseases of the shoulder are limiting factors for the diagnosis of these lesions. Therefore, a comprehensive study of the abnormalities of the shoulder should be carried out.

Keywords: Shoulder, Ultrasonography, Rotator cuff

Gastric cancer frequently presents intraperitoneal spread. Distant metastases are rare. The authors describe a case of a 47-year-old white man, long-term cigarette smoker, who had a right upper lobe mass seen on plain films and computed tomography of the chest. A gastric adenocarcinoma was concomitantly diagnosed by endoscopic examination. A bronchoscopy guided biopsy showed that the lung mass was in fact a metastasis from gastric adenocarcinoma. In this article, the imaging findings of gastric cancer and the patterns of dissemination to other organs are reviewed.

Keywords: Gastric cancer, Lung metastasis, Bone metastasis, Computed tomography

OBJECTIVE: To present the current recommendations for breast cancer screening in Brazil, as devised by the Brazilian College of Radiology and Diagnostic Imaging, the Brazilian Breast Disease Society, and the Brazilian Federation of Gynecological and Obstetrical Associations. MATERIALS AND METHODS: We analyzed scientific studies available in the Medline and Lilacs databases. In the absence of evidence, the recommendations reflected the consensus of a panel of experts. RECOMMENDATIONS: Annual mammography screening is recommended for women 40–74 years of age. Among women ≥ 75 years of age, annual mammography screening should be reserved for those with an expected survival > 7 years. Complementary ultrasound should be considered for women with dense breasts. Complementary magnetic resonance imaging is recommended for women at high risk. When available, an advanced form of mammography known as tomosynthesis can be considered as a means of screening for breast cancer.

Keywords: Breast cancer screening; Mammography; Ultrasound; Magnetic resonance imaging.

Breast cancer is the most common malignancy among women in Brazil and the leading cause of cancer-related death in the female population of the country. Despite advances in treatment and the implementation of mammography screening programs, mortality rates have continued to rise. This increase is particularly evident among women under 50 years of age and those 70 years of age or older, groups that account for a substantial proportion of diagnosed cases and registered deaths in the country. Until recently, these age groups were not included in the screening guidelines established by the Brazilian National Ministry of Health, although consistent scientific evidence demonstrates significant benefits of early detection in these populations, including reduced mortality, a higher proportion of early-stage diagnoses, and less aggressive therapeutic interventions. This article analyzes epidemiological data, the socioeconomic impacts of breast cancer, and the scientific evidence regarding mammography screening, discussing the outcomes and limitations of national programs in Brazil. On the basis of that analysis, we advocate for the revision and expansion of public breast cancer screening policies to include women 40–49 and ≥ 70 years of age, as an essential strategy to reduce mortality, improve clinical outcomes, and promote greater equity in access to diagnosis and treatment of breast cancer in Brazil.

Keywords: Breast neoplasms; Mammography; Mass screening; Brazil; Middle aged; Aged.

The assessment of response to neoadjuvant systemic therapy (NST) is a critical pillar in defining the multidisciplinary therapeutic strategy in breast cancer. This consensus aimed to establish national guidelines for imaging assessment of NST, based on the best scientific evidence adapted to the Brazilian context. To this end, a panel of experts was formed, composed of breast radiologists, breast surgeons, oncologists, onco-radiotherapists and breast pathologists. The methodology was based on a systematic literature review, followed by face-to-face discussions and rounds of virtual voting (adapted Delphi method), defining consensus when agreement was ≥75%. As a result, radiological response criteria were standardized, and accuracy, false-negative, and positive rates were determined, as well as the role of mammography, ultrasound, magnetic resonance imaging, and tomosynthesis, stratified by molecular subtypes. Additionally, recommendations were established for marking the breast lesion and axillary lymph nodes before the start of treatment. Finally, the role of other imaging techniques, such as contrast-enhanced mammography and positron-emission tomography/computed tomography, was discussed, as well as the impact of artificial intelligence as tools for evaluating the response to SNRT.

Keywords: breast neoplasm; neoadjuvant systemic therapy; imaging assessment; breast magnetic resonance imaging