OBJECTIVE: To describe changes of the biliary tree demonstrated by magnetic resonance cholangiography (MRC) in patients with the hepatosplenic presentation of schistosomiasis mansoni, and evaluating the interobserver agreement in the detection of schistosomal cholangiopathy. MATERIALS AND METHODS: Prospective, cross-sectional study involving 24 patients with hepatosplenic schistosomiasis and 6 healthy patients (control group) submitted to biliary tree evaluation by MRC. The following changes of the biliary tree were considered: distortion, thinning, stenosis, dilation and irregularity. The interobserver agreement in the detection of biliary tree changes was calculated with the McNemar's test and the kappa index of agreement (κ). RESULTS: The interobserver agreement in the detection of distortion and thinning of the biliary tree was almost perfect (κ = 0.867; confidence interval [CI] 95% [0.512-1.0] and κ = 0.865; CI 95% [0.51-1.0], respectively). There was a substantial agreement for stenosis (κ = 0.78; CI 95% [0.424-1.0]), moderate agreement for dilation (κ = 0.595; CI 95% [0.247-0.942]) and mild agreement for thinning (κ = 0.229; CI 95% [0.095-0.552]). CONCLUSION: In a decreasing order of frequency, the changes of the biliary tree were observed: distortion, thinning, stenosis, dilation and irregularity. The interobserver agreement for signs of schistosomal cholangiopathy was almost perfect for distortion and thinning, and substantial for stenosis.

Keywords: Schistosomiasis mansoni, Magnetic resonance imaging, Cholangiography, Biliary ducts

OBJECTIVE: To evaluate the inter-observer agreement between Doppler ultrasonography and magnetic resonance imaging in the quantification of portal blood flow in healthy individuals, as well as evaluating the reproducibility of both methods. MATERIALS AND METHODS: A prospective, transverse, observational and self-paired study was developed evaluating 20 healthy volunteers whose portal blood flow was measured by means of Doppler ultrasonography and magnetic resonance imaging performed by two independent observers. Interobserver and intermethod agreements were calculated using the intraclass and Pearson's correlation coefficients. RESULTS: The agreement between Doppler ultrasonography and magnetic resonance imaging was low (intraclass coefficient: 1.9%-18.2%; Pearson's coefficient: 0.1%-13.7%; p=0.565). Mean values for the portal blood flow measured by Doppler ultrasonography and magnetic resonance imaging were respectively 0.768 l/min and 0.742 l/min. Interobserver agreement for quantification of the portal blood flow by Doppler ultrasonography and magnetic resonance imaging was respectively reasonable (intraclass coefficient: 43.3%; Pearson's coefficient: 43.0%) and excellent (intraclass coefficient: 91.4%; Pearson's coefficient: 93.4%). CONCLUSION: In the present study, magnetic resonance imaging demonstrated to be a reliable method for quantifying the portal blood flow, with a higher interobserver agreement than Doppler ultrasonography. The intermethod agreement was low.

Keywords: Portal blood flow, Magnetic resonance imaging, Ultrasonography

OBJECTIVE: To evaluate the reproducibility of Doppler ultrasonography in the measurement of portal blood flow volume in schistosomal patients. MATERIALS AND METHODOS: Prospective, transversal, observational and self-paired study evaluating 21 patients with hepatosplenic schistosomiasis submitted to Doppler ultrasonography performed by three independent observers for measurement of portal blood flow. Pairwise interobserver agreement was calculated by means of the intraclass correlation coefficient, paired t-test and Pearson's correlation coefficient. RESULTS: Interobserver agreement was excellent. Intraclass correlation ranged from 80.6% to 93.0% (IC at 95% [65.3% ; 95.8%]), with the Pearson's correlation coefficient ranging between 81.6% and 92.7% with no statistically significant interobserver difference regarding the mean portal blood flow volume measured by Doppler ultrasonography (p = 0.954 / 0.758 / 0.749). CONCLUSION: Doppler ultrasonography has demonstrated to be a reliable method for measuring the portal blood flow volume in patients with portal hypertension secondary to schistosomiasis, with a good interobserver agreement.

Keywords: Portal flow, Measurement, Doppler ultrasonography, Reproducibility, Portal hypertension

The iliopsoas compartment, a posterior boundary of the retroperitoneum, is comprised of the psoas major, psoas minor and iliac muscles. The symptoms picture in patients presenting with pathological involvement of this compartment may show a wide range of nonspecific clinical presentations that may lead to delayed diagnosis. However, in the search of an etiological diagnosis, it is already known that inflammation, tumors, and hemorrhages account for almost all the lesions affecting the iliopsoas compartment. By means of a retrospective analysis of radiological studies in patients with iliopsoas compartment lesions whose diagnosis was confirmed by anatomopathological evaluation or clinical follow-up, we have reviewed its anatomy as well as the main forms of involvement, with the purpose of identifying radiological signs that may help to narrow down the potential differential diagnoses. As each lesion is approached we will discuss the main radiological findings such as presence of gas in pyogenic abscesses, bone destruction and other bone changes of vertebral bodies in lesions secondary to tuberculosis, involvement of fascial planes in cases of neoplasms, and differences in signal density and intensity of hematomas secondary to hemoglobin degradation, among others. So, we have tried to present cases depicting the most frequent lesions involving the iliopsoas compartment, with emphasis on those signs that can lead us to a more specific etiological diagnosis.

Keywords: Iliopsoas muscle, Psoas muscle, Computed tomography, Abscesses, Neoplasms

OBJECTIVE: To evaluate the reproducibility of magnetic resonance imaging and the agreement between ultrasound and magnetic resonance imaging in the classification of periportal fibrosis in patients with schistosomiasis based on Niamey's qualitative criteria. MATERIALS AND METHODS: A prospective, double-blinded study was conducted between February 2005 and June 2006 with 20 patients (10 men and 10 women, with ages ranging between 24 and 60 years, mean age 42.7 years) diagnosed with schistosomiasis mansoni. Both ultrasound and magnetic resonance images were independently evaluated by two experienced observers. Interobserver agreement was evaluated for findings of periportal fibrosis on magnetic resonance images and in a comparison between magnetic resonance and ultrasound images. RESULTS: The analysis of magnetic resonance images showed total interobserver agreement in 14 patients (70%). The comparison between ultrasound and magnetic resonance imaging showed agreement between images in only six cases (30%) by observer 1, and in eight cases (40%) by observer 2. CONCLUSION: Magnetic resonance imaging presents a good reproducibility in the evaluation of periportal fibrosis in later stages of schistosomiasis, however, the correlation between magnetic resonance imaging and ultrasound is poor.

Keywords: Schistosomiasis, Periportal fibrosis, Ultrasound, Magnetic resonance imaging

OBJECTIVE: To determine the intra- and interobserver agreement in the classification of periportal fibrosis, according to the criteria defined at the Niamey Workshop of 1996. MATERIALS AND METHODS: A prospective, observational and transverse study was developed in the period between February, 2005 and March, 2006, in 30 schistosomal patients with no other hepatic findings associated, submitted to abdominal ultrasound. Ultrasonographic studies were independently performed and reviewed by two radiologists at three different moments: the dynamic examination itself (first moment), 30 and 90 days later (second and third moments), by means of the images review performed in a workstation. Intra- and interobserver agreement was evaluated by means of the kappa test. RESULTS: Intraobserver agreement was 0.43 for the first, and 0.57 for the second observer. Interobserver agreement as regards the dynamic examination and images review was respectively 0.46 and 0.71. CONCLUSION: Ultrasonography demonstrated moderate to substantial reproducibility in the classification of periportal fibrosis according to the Niamey criteria.

Keywords: Ultrasonography, Reproducibility of results, Fibrosis, Schistosomiasis

OBJECTIVE: To define, by means of computed tomography, the level of ureteral implantation into de bladder. MATERIALS AND METHODS: We have measured the distances from the ureteral meatus to the acetabulum, and to the superior margin of the pubic symphysis, as well as the bladder volume, using contrast enhanced computed tomography of the pelvis in 46 patients (31 male and 15 female) in the age range between 18 and 45 years, with at least one of the ureteres filled with excreted contrast material. The Student t test has been applied to determine eventual statistically significant differences between groups. RESULTS: The level of ureteral implantation into the bladder was, on average, 10.6 ± 8.1 mm below the acetabular roof, and 29.7 ± 9.5 mm above the superior margin of the pubic symphysis. In patients with bladder repletion volume of < 200 ml and > 200 ml, the level of ureteral implantation into the bladder was, respectively, on average, 11.6 ± 7.3 mm and 10.2 ± 8.4 mm below the acetabular roof (p = 0.61), and 28.3 ± 7.3 mm and 30.3 ± 10.2 mm above the superior margin of the pubic symphysis (p = 0.52), and in male and female men patients, respectively, on average, 11.8 ± 8.0 mm and 8.3 ± 8.0 mm below the acetabular roof (p = 0.17), and 27.7 ± 9.2 mm and 33.9 ± 8.8 mm above the superior margin of the pubic symphysis (p = 0.34). CONCLUSION: Calcifications located < 3 cm below the acetabular roof and < 1.5 cm above the superior margin of the pubic symphysis probably do not represent ureteral calculi. Vesical repletion or sex have no significant influence on the ureteral meatus position.

Keywords: Calculus, Ureter, Ureteral obstruction, Lithiasis, X-ray computed tomography

Objective: To evaluate the agreement between Doppler ultrasonography and magnetic resonance imaging as well as the interobserver reproducibility of both methods in the measurement of portal blood flow in schistosomal patients. Materials and methods: A cross-sectional, observational, self-paired study evaluated 21 patients with schistosomiasis mansoni submitted to measurement of portal blood flow with phase-contrast magnetic resonance imaging and Doppler ultrasonography. Results: A poor intermethod agreement was observed (intraclass correlation coefficient: 34.5% [CI 95%]). On the other hand, the interobserver reproducibility was excellent in the evaluation by magnetic resonance imaging (intraclass correlation coefficient: 99.2% [CI 95%] / Pearson’s correlation coefficient: 99.2% / portal blood flow = 0.806) and by Doppler ultrasonography (intraclass correlation coefficient: 80.6 to 93.0% [CI 95%] / Pearson’s correlation coefficient: 81.6% to 92.7% / portal blood flow = 0.954, 0.758 and 0.749). Conclusion: There is a poor intermethod agreement in the measurement of portal blood flow. Nevertheless, contrastphase magnetic resonance imaging and Doppler ultrasonography demonstrated to be reproducible methods presenting excellent interobserver agreement in the quantification of portal blood flow in patients with hepatosplenic schistosomiasis-related portal hypertension.

Keywords: Portal blood flow; Magnetic resonance imaging; Doppler ultrasonography; Reproducibility; Portal hypertension.