OBJECTIVE: To determine uterine artery resistance index (RI) and pulsatility index (PI) during the first and second trimesters of pregnancy. MATERIALS AND METHODS: The authors developed a prospective longitudinal study with 44 healthy women at their 8th-12th and 22nd gestational weeks. Doppler velocimetry was utilized for evaluating RI and PI of both uterine arteries, with a sample volume of 1 to 2 mm, a 50-70 Hz filter, and an insonation angle < 60°. RESULTS: At 8th-12th gestational weeks, the uterine artery RI and PI were higher than at the 22nd gestational week. At the first trimester uterine artery RI and PI were, respectively, 0.83 ± 0.07 and 2.32 ± 0.79 with a notch, and 0.71 ± 0.16 and 1.61 ± 0.78, without a notch. At the second trimester, uterine artery RI and PI were, respectively, 0.59 ± 0.09 and 1.03 ± 0.32 with a notch, and 0.44 ± 0.09 and 0.63 ± 0.19 without a notch. CONCLUSION: Reference values for uterine arteries RI and PI at the first and second trimesters of pregnancy were established.

Keywords: Doppler effect, Uterine artery, Preeclampsia

OBJECTIVE: To evaluate the uterine cervix length with magnetic resonance imaging in comparison with findings at transvaginal ultrasonography. MATERIALS AND METHODS: Twenty pregnant women between the 19th and 30th gestational weeks underwent magnetic resonance imaging and transvaginal ultrasonography for evaluation of their uterine cervix. Measurements by means of magnetic resonance imaging were performed by two specialists in imaging diagnosis for calculating the interobserver variability of the method. RESULTS: Calculation of the Pearson's correlation coefficient between measurements of the cervical length demonstrated a significant correlation between the results of both methods (r=0.628; p<0.01). The paired t test demonstrated no statistically significant difference between measurements obtained by transvaginal ultrasonography and magnetic resonance imaging (p=0.068). Interobserver agreement in cervical measurements by magnetic resonance imaging was high (a=0.96), demonstrating the reliability of the method. CONCLUSION: The comparison between both imaging methods in the evaluation of cervical biometry showed no statistically significant difference thus reinforcing the utilization of ultrasonography. However, in some cases where transvaginal ultrasonography is contraindicated, magnetic resonance imaging can be alternatively utilized for measurement of the cervical length.

Keywords: Uterine cervix, Pregnancy, Magnetic resonance imaging

Uterine malformations are unusual findings in the clinical practice of gynecology. Statistics regarding this abnormality are flawed, and there is a lack of standardization of the pertinent terminology, besides difficulty in the diagnosis. Starting in the 1980's, ultrasound became a procedure indispensable to the clinical practice in the field of tocogynecology, modifying concepts and procedures, and bringing an important contribution to this specialty. The advent of endocavitary transducers, amplitude and spectral color Doppler, as well as the increasing improvement in the imaging quality, has contributed to this progress. Over the last ten years, much has been studied, published and discussed about the role of the three-dimensional ultrasonography. The authors review the topic and emphasize the importance of this method as a diagnostic modality.

Keywords: Uterine malformations, Müllerian malformations, Three-dimensional ultrasonography

OBJECTIVE: To estimate which is the best period to realize uterine artery Doppler for the prediction of pregnancy complications. MATERIALS AND METHODS: A prospective study was conducted with 45 women without a history of chronic diseases and in their first pregnancy. The uterine artery Doppler was performed between the pregnancy weeks 18-20, 24-26, 28-30 and 34-36, with determination of the resistance index, the pulsatility index, the A/B ratio and presence or absence of notch on the flow velocity waveform, as well as the result of the pregnancy. RESULTS: The Doppler index showed decrease in the course of the pregnancy, more pronounced in the normal pregnancies in comparison with the complicated pregnancies. This was most noticed in the examinations performed between the weeks 24-26. The best sensitivity/specificity relation for detecting pregnancy complications was achieved in the examination performed in this same period. CONCLUSION: The best period to perform uterine artery Doppler for prediction of pregnancy complications is between weeks 24-26 of gestation.

Keywords: Doppler, Uterine artery, Preeclampsia, Intrauterine growth restriction

The measurement of cervical length utilizing transvaginal ultrasound is of help for pregnant women screening for premature labor, the shortening of the cervix being a predictor of higher risk of preterm delivery. Traditional methods for evaluating the uterine cervix during pregnancy are limited and unsatisfactory. Digital examination of cervix, considered as the standard method, demonstrates large variation among different examiners; on the other hand, transvaginal sonography is an effective method of examination during pregnancy. Recently, three-dimensional ultrasound has been used in the clinical practice including the study of uterine cervix. The three-dimensional technology allows acquisition and storage of a large volume of data. Such stored information can be reformatted and analyzed through an unlimited number of planes. The three-dimensional transvaginal ultrasound is the unique imaging method capable of obtaining a true coronal plane by direct correlation of the views in a multiplanar display. This method seems to offer a diagnostic potential because of the cervical ultrasonography increased accuracy.

Keywords: Uterine cervix, Pregnancy, Three-dimensional ultrasonography

OBJECTIVE: To assess the rate of geographic miss on conventional radiotherapy planning of patients with cervical cancer, using magnetic resonance imaging. MATERIALS AND METHODS: Thirty-two patients with squamous cell carcinoma of the uterine cervix were studied. Magnetic resonance imaging of the pelvis was performed after clinical staging. Magnetic resonance imaging findings were compared with the classic fields described for the "box" technique. Target volume within less than 1 cm margins of the fields' limits was considered as geographic miss. RESULTS: Classical radiation field limits were inadequate in 24 cases (75%), all in the anterior (46%) or posterior (40%) border of the lateral fields. CONCLUSION: Magnetic resonance detected a high probability of geographic miss on conventional radiotherapy planning in this population, both in initial and advanced stages of the disease.

Keywords: Uterine cervix cancer, Radiotherapy, Magnetic resonance imaging

We present the preliminary results of testing and acceptance of a method for displaying medical images that employs simple computer freewares that can be run in unsophisticated computational platforms, which are commonly underutilized. This method allows easy and accessible visualization, printing, documenting, archiving, consulting and electronic transmission of a wide range of medical images without the need of expensive, complex and difficult to learn softwares.

Keywords: Medical images, Freeware, Ultrasound

OBJECTIVE: To present the process of implementation of toolkits for visualization of medical images using DICOM and to review the basis and characteristics of this protocol. In this paper we present a VDTApplication for visualization of local and remote images, and a VDTApplet that allows the visualization of images on a web browser. MATERIALS AND METHODS: The toolkits were implemented using Java programming language. For the development of this toolkit we considered the different version of the DICOM protocol, creating a generic system capable of reading and opening images generated by different modalities of different manufacturers. The tools were evaluated qualitatively by doctors taking into account the system's interface, image quality and image adjustment. RESULTS: The evaluation score ranged from 1 (very poor ) to 5 (very good) for each item, with the following results: 5 for system interface, 4 for image quality and 3 for the image adjustment. Based on the scores obtained we concluded that the tools can be considered good. CONCLUSION: These results allowed us to conclude that these tools are practical, user friendly and should be added to the PACS (picture archiving and communication system) of "Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto - Universidade de São Paulo", Ribeirão Preto, SP, Brazil.

Keywords: Medical images, DICOM, Filmless radiology, Medical images visualization

PURPOSE: To report the initial clinical experience after the treatment of 100 women suffering of symptomatic fibroids who were submitted to uterine artery embolization as the main form of treatment. We also present an extensive review of literature on the subject in order to determine the indications and contra-indications, and the possible complications of this method.
MATERIAL AND METHOD: One hundred patients with symptomatic fibroids were submitted to uterine artery embolization as the main form of treatment. The main symptoms that justified the intervention were increased menstrual flow in 79 patients and pain related to the fibroids in 21 patients. Diagnosis was made using ultrasound alone in 75 patients and ultrasound and magnetic resonance imaging in 25 patients. The mean uterine volume measured using these imaging methods was 487cm³. The procedure was performed in two Institutions: 56 procedures in a public Institution in patients attended by the public health system, and 46 patients with health insurance treated in a private clinic. Seventy-six patients were followed clinically during 12 weeks after uterine embolization.
RESULTS: The procedure was done with success in 97% of cases using a conventional technique. Clinical follow-up after 12 weeks showed symptomatic improvement in over 90% of the patients. Reductions of the uterine volume of up to 52% were also observed. No relevant technical and/or clinical complications were seen.
CONCLUSION: Uterine artery embolization for the treatment of symptomatic fibroids is a simple, efficient and safe procedure.

Keywords: Fibroids; Uterine embolization; Gynecologic neoplasm; Menorrhagia.

Objective: To comparatively evaluate the effectiveness of transvaginal ultrasonography (TVUS) and sonohysterography (SHG) in the assessment of endometrial diseases in women with abnormal uterine bleeding. Materials and Methods: Cross-sectional study with 30 patients, aged from 29 to 71 years, 21 (70%) of them premenopausal and 9 (30%) postmenopausal. Saline solution (at 9%) was utilized as contrast agent for SHG. The MacNemar test was utilized for comparison of diagnostic studies. Results: Hysteroscopy diagnosed 18 cases (60%) of intracavitary alterations, and 10 polyps (33.3%). TVUS demonstrated 83.3% sensitivity and specificity, and SHG showed 94.4% sensitivity and 91.6% specificity. The MacNemar test showed similar sensitivity (p = 0.500) and specificity (p = 1.000) between TVUS and SHG in the detection of endometrial diseases. In the diagnosis of polyp, SHG showed the highest sensitivity (90.9% vs. 27.3%; p = 0.016) with similar specificity (89.5% vs. 94.7%; p = 1.000). Conclusion: SHG and TVUS present a good predictive value for endometrial diseases in patients with abnormal uterine bleeding. SHG and TVUS present similar sensitivity and specificity in the detection of such diseases, but SHG is more sensitive in the detection of polyps.

Keywords: Transvaginal ultrasonography; Sonohysterography; Hysteroscopy; Abnormal uterine bleeding.

Objective: To evaluate the possible repercussions of the previous cesarean scar at uterine arteries Doppler velocimetry between the 26th and 32nd gestational weeks. Materials and Methods: Prospective cross-sectional study including 45 women between 11 and 14 weeks of gestation, divided into three groups: 17 pregnant women with uterine scar resulting from a previous elective cesarean section (group A); 14 with uterine scar resulting from a previous cesarean section performed during labor (group B); and 14 pregnant women with a single previous vaginal delivery (group C). Uterine arteries Doppler velocimetry was performed with transabdominal approach. Means, medians and standard deviation (SD) were calculated for each group in the study. The groups comparison regarding pulsatility index was performed with the non-parametric Kruskal-Wallis test. Results: In group A, the pulsatility index ranged from 0.60 to 1.60 (mean: 0.90; SD: 0.29), in group B, from 0.53 to 1.43 (mean: 0.87; SD: 0.24), and in group C, from 0.65 to 1.65 (mean: 1.01; SD: 0.37); with p = 0.6329. Conclusion: No repercussion of previous cesarean scar was observed at uterine arteries Doppler velocimetry performed in the period between the 26th and 32nd gestational weeks.

Keywords: Pregnancy; Uterine scar; Previous cesarean section; Uterine arteries Doppler velocimetry.

Objetivo: A principal utilidade da tomografia por emissão de pósitrons com 18-fluordeoxiglicose (FDG-PET) está no estadiamento do câncer de pulmão. Porém, ela também pode ser utilizada para diferenciar lesões pulmonares indeterminadas, mas seu impacto na ressecção cirúrgica de lesões benignas é desconhecido. O objetivo deste estudo foi comparar a prevalência de lesões benignas em toracotomias feitas por suspeição de câncer de pulmão, antes e após a introdução do FDG-PET, em um centro de referência de cirurgia torácica. Materiais e Métodos: Os autores analisaram, prospectivamente, uma base de dados cirúrgicos de todos os pacientes consecutivos submetidos a toracotomia por câncer de pulmão suspeito ou comprovado e compararam a prevalência de lesões benignas em dois grupos ao longo de dois anos consecutivos, respectivamente antes (grupo I) e depois (grupo II) da introdução da FDG-PET. Resultados: Ressecção cirúrgica foi feita em 1.233 pacientes durante o período do estudo. A prevalência de lesões benignas na cirurgia nos grupos I e II foi similar (44/626 e 41/607, ambas correspondendo a 7%), e também no grupo II, entre aqueles submetidos a FDG-PET e os restantes (21/301 e 20/306 respectivamente, ambos correspondendo a 7%). No grupo II, dos 21 pacientes com lesões benignas submetidos a FDG-PET, 19 tiveram um estudo falso-positivo (valor médio padrão de captação 5.3 [faixa 2.6–12.7]). Desses, respectivamente 13 e 4 pacientes tiveram broncoscopia não diagnóstica e biópsia transtorácica percutânea de pulmão antes da toracotomia. Não houve diferença na proporção de lesões benignas diferentes ressecadas entre o grupo I e aqueles submetidos a FDG-PET no grupo II. Conclusão: A introdução da FDG-PET não alterou a proporção de pacientes submetidos a toracotomia por lesões benignas, principalmente devido à avidez pelo isótopo de algumas lesões não malignas. Tais resultados falsos-positivos devem ser considerados nos casos em que se contempla a possibilidade de ressecção cirúrgica em pacientes com câncer de pulmão não confirmado.

Keywords: Tomografia por emissão de pósitrons; Tomografia computadorizada; Pulmão – lesões benignas ou congênitas; Câncer de pulmão – diagnóstico e estadiamento; Câncer de pulmão – cirurgia.

Objetivo: Avaliar a percepção de médicos residentes em radiologia de 4º ano sobre as melhores modalidades de imagem na investigação de neoplasias e trauma. Materiais e Métodos: Vinte e sete médicos residentes de 4º ano de quatro programas de residência em radiologia americanos participaram do estudo. Aos participantes foi perguntado sobre a melhor modalidade de imagem para se avaliar o cérebro e a coluna vertebral, pulmões, abdome e o sistema musculoesquelético. As modalidades de imagem disponíveis foram: RM, TC, ultrassonografia, PET e radiografia simples. Todos os achados foram comparados com os Critérios de Adequação de Exames de Imagem e Radioterapia do ACR. Resultados: A RM foi escolhida como melhor modalidade de imagem para se avaliar neoplasias encefálicas, espinhais, abdominais e musculoesqueléticas por 96,3%, 100%, 70,4% e 63% dos residentes, respectivamente. A TC foi escolhida por 88,9% dos residentes para avaliar neoplasias pulmonares. A modalidade de imagem ótima para se avaliar trauma foi a TC para lesões encefálicas (100%), espinhais (92,6%), pulmonares (96,3%), abdominais (92,6%) e grandes lesões traumáticas musculoesqueléticas (74,1%); a RM foi escolhida para lesões esportivas (96,3%). Observou-se concordância com os critérios de adequação do ACR. Conclusão: Houve concordância entre a percepção dos residentes sobre as melhores modalidades de imagem para avaliação de neoplasias e trauma e os critérios de adequação do ACR.

Keywords: Formação de residentes; Educação médica; Modalidades de imagem.

Os nervos cranianos representam extensões das estruturas funcionais do cérebro que cruzam a cabeça e o pescoço. Eles estão ligados a diferentes estruturas cranianas e se relacionam com diversas doenças. Uma compreensão profunda de sua complexa anatomia e aparência normal de imagem permite ao examinador identificar e caracterizar com mais precisão as anormalidades. A ressonância magnética com contraste é uma importante ferramenta para avaliar essas estruturas, especialmente as sequências tridimensionais de precessão livre de estado estacionário, que proporcionam alta resolução espacial e de partes moles, apesar da fina espessura dos nervos cranianos. Na maioria dos casos, os achados de imagem são inespecíficos, e uma anamnese completa, exame físico dirigido e testes laboratoriais são necessários para estreitar o diagnóstico diferencial. Este ensaio iconográfico ilustra e discute doenças congênitas, traumáticas e vasculares dos nervos cranianos, mostrando imagens em uma abordagem fisiopatológica.

Keywords: Neuroimagem/métodos; Radiologia/métodos; Ressonância magnética/métodos; Nervos cranianos/diagnóstico por imagem.

OBJECTIVE: To evaluate the safety and efficacy of using highly compressible calibrated microspheres in uterine artery embolization (UAE) for the treatment of uterine fibroids. MATERIALS AND METHODS: This was a prospective multicenter study. Thirty-two women with symptomatic uterine fibroids were selected for UAE between January 2019 and March 2020. The participants completed the Uterine Fibroid Symptom and Quality of Life (UFS-QOL) questionnaire, underwent contrast-enhanced pelvic magnetic resonance imaging (MRI), and were submitted to anti-Müllerian hormone measurement, subsequently undergoing UAE with Embosoft microspheres. After six months, the patients again completed the UFS-QOL questionnaire and underwent pelvic MRI. RESULTS: The most common symptoms were abnormal uterine bleeding (in 81.3% of the cases), pelvic pain (in 81.3%), and compression (in 46.9%). Of the 32 patients evaluated, 12 (37.5%) had anemia due to abnormal uterine bleeding. Thirty patients completed the study. Among those patients, we observed median reductions of 21.4% in uterine volume and 15.9% in dominant fibroid volume. We identified no adverse events that could be attributed to the material itself, although there were events attributed to the UAE procedure in general. CONCLUSION: For the treatment of uterine fibroids, UAE using Embosoft microspheres shows satisfactory results, providing reductions in uterine and dominant fibroid volumes, with a low rate of adverse events, and improving patient quality of life, as well as demonstrating safety and efficacy.

Keywords: Leiomyoma; Uterine artery; Uterine artery embolization; Microspheres.