OBJECTIVE: The authors have established a methodological approach to evaluate head and neck squamous cell carcinoma aiming at identifying and distinguishing high metabolic activity inside the lesion, combining in a single examination, functional, metabolic and morphological data simultaneously acquired by means of different non-dedicated positron emission tomography (PET)-computed tomography (CT) device. MATERIALS AND METHODS: The study population included 17 patients with head and neck squamous cell carcinoma submitted to a non-dedicated 18F-FDG-PET imaging at Department of Diagnostic Imaging of Hospital do Câncer, São Paulo, SP, Brazil. CT and 18F-FDG-PET images were simultaneously acquired in a non-dedicated device. The original data were transferred to an independent workstation by means of the Entegra 2 NT software to generate PET-CT imaging fusion. RESULTS: The findings were defined as positive in the presence of a well defined focal area of increased radiopharmaceutical uptake in regions not related with the normal biodistribution of the tracer. CONCLUSION: The fusion of simultaneously acquired images in a single examination (18F-FDG-PET and CT) has allowed the topographic-metabolic mapping of the lesion as well as the localization of high metabolic activity areas inside the tumor, indicating recidivation or metastasis and widening the array of alternatives for radiotherapy or surgical planning.

Keywords: Squamous cell carcinoma, Computed tomography, Positron emission tomography, Face

Objective: The present study is aimed at describing the experience of an oncology center with computed tomographyguided core-needle biopsy of pulmonary lesions. Materials and Methods: Retrospective analysis of 97 computed tomography-guided core-needle biopsy of pulmonary lesions performed in the period between 1996 and 2004 in a Brazilian reference oncology center (Hospital do Câncer – A.C. Camargo). Informations regarding material appropriateness and the specific diagnoses were collected and analyzed. Results: Among 97 lung biopsies, 94 (96.9%) supplied appropriate specimens for histological analyses, with 71 (73.2%) cases being diagnosed as malignant lesions and 23 (23.7%) diagnosed as benign lesions. Specimens were inappropriate for analysis in three cases. The frequency of specific diagnosis was 83 (85.6%) cases, with high rates for both malignant lesions with 63 (88.7%) cases and benign lesions with 20 (86.7%). As regards complications, a total of 12 cases were observed as follows: 7 (7.2%) cases of hematoma, 3 (3.1%) cases of pneumothorax and 2 (2.1%) cases of hemoptysis. Conclusion: Computed tomography-guided coreneedle biopsy of lung lesions demonstrated high rates of material appropriateness and diagnostic specificity, and low rates of complications in the present study.

Keywords: Needle; Biopsy; Lung; Cancer; Computed tomography.

Computed tomography-guided needle biopsy has been widely utilized as an effective and safe diagnostic procedure in many clinical settings. In the lungs, transthoracic needle biopsy has become one of the primary choices to investigate nodules and mass lesions. The procedure versatility allows access to either peripheral or central lesions at almost any site, even in cases of small nodules. In this article, indications, technical aspects of the procedure, expected success and complication rates of computed tomography-guided transthoracic needle biopsy of pulmonary nodules and masses are discussed.

Keywords: Needle biopsy; Pulmonary nodules; Computed tomography.

Objective: To evaluate and discuss the indications for breast magnetic resonance imaging in an oncology reference center. Materials and Methods: Retrospective study approved by the Committee for Ethics in Research of the institution and developed through a review of patients’ records and clinical reports. All the breast magnetic resonance studies performed in the period from July 2008 to July 2009 (n = 529) were included. Results: Mean patients’ age was 49 years, ranging from 17 to 86 years. Family history of breast and/or ovarian cancer was present in 162 patients (30.6%). Most common indications for breast magnetic resonance imaging included inconclusive mammographic/sonographic findings (48.8%), evaluation of tumor recurrence/surgical scar after breast surgery (15.1%), disease staging/surgical planning (11.7%) and screening in high-risk patients (8.5%). Conclusion: In spite of inconclusive findings at conventional imaging studies being the most common indication for breast magnetic resonance imaging, there is no evidence in the literature supporting such a conduct. Because of its high sensitivity and high rate of false positive results, magnetic resonance imaging should be appropriately indicated in order to avoid unnecessary procedures. Once such method is appropriately indicated, it may contribute in the decision making process, constituting an essential tool in the assessment of breast lesions.

Keywords: Magnetic resonance imaging; Breast neoplasms; Early detection of cancer.

The authors report a case where a quantitative assessment of the apparent diffusion coefficient (ADC) of liver metastasis in a patient undergoing chemotherapy has shown to be an effective early marker for predicting therapeutic response, anticipating changes in tumor size. A lesion with lower initial ADC value and early increase in such value in the course of the treatment tends to present a better therapeutic response.

Keywords: Magnetic resonance imaging; Diffusion; Liver metastases; Breast cancer; Chemotherapy; Therapy monitoring.

In the investigation of tumors with conventional magnetic resonance imaging, both quantitative characteristics, such as size, edema, necrosis, and presence of metastases, and qualitative characteristics, such as contrast enhancement degree, are taken into consideration. However, changes in cell metabolism and tissue physiology which precede morphological changes cannot be detected by the conventional technique. The development of new magnetic resonance imaging techniques has enabled the functional assessment of the structures in order to obtain information on the different physiological processes of the tumor microenvironment, such as oxygenation levels, cellularity and vascularity. The detailed morphological study in association with the new functional imaging techniques allows for an appropriate approach to cancer patients, including the phases of diagnosis, staging, response evaluation and follow-up, with a positive impact on their quality of life and survival rate.

Keywords: Cancer imaging; Magnetic resonance imaging; Oncology; Neoplasia; Functional imaging; Diffusion.

Gastrostomy is indicated for patients with conditions that do not allow adequate oral nutrition. To reduce the morbidity and costs associated with the procedure, there is a trend toward the use of percutaneous gastrostomy, guided by endoscopy, fluoroscopy, or, most recently, computed tomography. The purpose of this paper was to review the computed tomography-guided gastrostomy procedure, as well as the indications for its use and the potential complications.

Keywords: Gastrostomy; Radiology, interventional; Tomography, X-ray computed.

OBJECTIVE: To evaluate the accuracy of chest computed tomography (CT) in patients with suspected severe acute respiratory syndrome-related coronavirus-2 (SARS-CoV-2) infection at a cancer center. Materials and METHODS: This retrospective single-center study selected 91 patients who had chest CT and real-time polymerase chain reaction (RT-PCR) test collected at the same day. CT results were classified in negative, typical, indeterminate or atypical findings. Diagnostic accuracy, sensitivity and specificity were calculated for two different scenarios: in the first, only typical findings on CT were considered positive; in the second, both typical and indeterminate findings were considered positive. RESULTS: Mean patients’ age was 58.2 years, most were male (60.4%) and had prior diagnosis of cancer (85.7%). CT showed typical findings in 28.6%, indeterminate findings in 24.2% and atypical findings in 26.4%. RT-PCR results were positive for SARS-CoV-2 in 27.5%. The sensitivity, specificity and accuracy in the first and second scenarios were respectively 64.0%, 84.8% and 79.1%, and 92.0%, 62.1% and 70.3%. CONCLUSION: CT has a high accuracy for the diagnosis of SARS-CoV-2 infection. Different interpretation criteria can provide either high sensitivity or high specificity. CT should be integrated as a triage test in resource-constrained environments during the pandemic to assist in the optimization of PCR-tests, isolation beds and intensive care units.

Keywords: Computed tomography; Severe acute respiratory syndrome; Coronavirus infections; Cancer.

OBJECTIVE: To profile the use of educational materials by radiologists and radiology residents in Brazil. MATERIALS AND METHODS: This was a cross-sectional, descriptive, observational study in which an electronic questionnaire was sent via email to physicians working in the field of radiology. The questionnaire contained questions regarding the profile, education, and place of work of the physicians, as well as their access to educational resources and the types of educational materials they used most. RESULTS: The questionnaire was completed by 265 physicians. The mean age of the respondents was 38.2 years. Of the 265 respondents, 212 (80.0%) worked with ultrasound, 206 (77.7%) worked with computed tomography, 170 (64.2%) were board-certified, 166 (62.6%) were male, 174 (65.7%) worked at private facilities, and 167 (63.0%) had no academic affiliation. The mean weekly total study time was 9.6 h (median, 6 h), being higher among physicians in training, among those who worked at public facilities, and among those who worked at teaching hospitals. Regarding the device employed in order to access educational materials, there was a trend toward greater use of computers, which were employed by 65.3%. The majority of the respondents (61.9%) chose to access educational materials that were free of charge, the most common sources being websites, eBooks, and online journals. CONCLUSION: Electronic and digital resources are the main means of access to educational materials used by radiologists in Brazil, the most commonly used resources being web sites, eBooks, and online journals.

Keywords: Radiology; Teaching materials; Education, continuing; Multimedia.