OBJECTIVE: To evaluate the interobserver reproducibility of vascular indices obtained with three-dimensional power Doppler (3D power Doppler) ultrasonography at the first trimester of gestation. MATERIALS AND METHODS: The present reproducibility study involved 32 healthy pregnant women with 7 to 10 weeks and 6 days of gestation. The VOCAL (Virtual Organ Computer-aided AnaLysis) method was utilized to calculate embryos volume, with a 12° rotational angle. Subsequently, the software automatically displayed three 3D power Doppler vascular indices: vascularization index (VI), flow index (FI) and vascularization and flow index (VFI). In order to calculate the interobserver variability, an investigator performed a second blind measurement of the 32 embryos, and another investigator performed a third blind measurement of the same volumes. The interclass correlation coefficient (ICC) and Bland-Altman plots were utilized for statistical analysis. RESULTS: A good interobserver reproducibility was observed in relation to the three vascular indices. The VI presented ICC = 0.9 and mean difference between measurements = -1.1. For the FI, the ICC was 0.9 and mean difference = -0.5. The VFI presented ICC = 0.9 and mean difference = -1.1. CONCLUSION: The vascular indices, particularly the FI, obtained with 3D power Doppler ultrasonography at the first trimester of gestation demonstrated a high reproducibility.

Keywords: First trimester of gestation, Color Doppler ultrasonography, Reproducibility of results, Three-dimensional imaging

OBJECTIVE: To determine reference values for placental volume at 7 to 10 + 6 weeks of gestation by means of three-dimensional ultrasonography with the XI VOCAL (eXtended Imaging Virtual Organ Computer-aided Analysis) method. MATERIALS AND METHODS: A cross-sectional study was developed with 70 pregnant women at 7 to 10 + 6 weeks of gestation. The XI VOCAL method with ten sequential adjacent planes was utilized in the volume calculations. Means, medians, standard deviation, minimum and maximum values for placental volume were calculated. A scatter plot adjusted by the determination coefficient (R²) was constructed to correlate placental volume and gestational age. RESULTS: Mean placental volume ranged from 4.6 cm³ (2.6-8.6 cm³) to 28.9 cm³ (11.4-66.9 cm³). The placental volume (PV) has shown to be highly correlated with the gestational age (GA) and the best fit equation was [PV = exp(0.582 × GA + 0.063); R² = 0.82]. CONCLUSION: Reference values for placental volume in the first gestational trimester were determined with the XI VOCAL method.

Keywords: Early placental phase, First trimester of pregnancy, Gestational age, Organ volume, Three-dimensional imaging

OBJECTIVE: To evaluate the correlation between the yolk sac volume measured by three-dimensional ultrasonography with gestational age at 7-10 weeks. MATERIALS AND METHODS: A cross-sectional study involving 72 healthy pregnant women at 7th-10th gestational weeks. The multiplanar method with 1.0 mm intervals was utilized. Regression models were constructed to analyze the correlation between yolk sac volume and gestational age, adjusted by the determination coefficient (R²). Mean, median, standard deviation, maximum and minimum values for yolk sac volume were calculated for each gestational age. RESULTS: A poor correlation was observed between yolk sac volume (YSV) and gestational age (GA). The quadratic regression was the model that best expressed this correlation: YSV = 0.9757 - 0.2499 × GA + 0.0172 × GA² (R² = 0.234). Mean yolk sac volume ranged from 0.07 cm³ (0.02-0.11) to 0.20 cm³ (0.02-0.74) between the 7th and 10th weeks (mean, 0.11 cm³, ± 0.10 cm³). CONCLUSION: There was a poor correlation between yolk sac volume and gestational age.

Keywords: Yolk sac, First trimester of pregnancy, Gestational age, Prenatal ultrasonography, Three-dimensional imaging

OBJECTIVE: To compare the intraobserver reproducibility of real three-dimensional ultrasonography (3DUS) with virtual ultrasonography using multiplanar and volumetric reformations. MATERIALS AND METHODS: A total of 132 blocks from 44 evaluations of 26 conceptuses were prospectively examined. The gestational age determined by echography ranged from eight weeks and eight weeks and six days in 18 conceptuses and ten weeks and ten weeks and six days in 26 conceptuses. The following structures were analyzed by 3DUS: crown-rump length, gestational sac, amniotic sac, nuchal translucency, omphalomesenteric duct, vitellin vesicle, upper limbs, lower limbs, head-thorax distinction, lateral view of the face, coronal view of the face, ear implantation, lateral view of the spine, coronal view of the spine, and closed abdominal wall. Three blocks were obtained from each conceptus for virtual ultrasonography. Student's t test, McNemar test and kappa statistics were used for the statistical analysis. RESULTS: In group I, real multiplanar 3DUS versus 3D virtual multiplanar ultrasonography, the analysis of continuous variables showed significant differences for all variables. The analysis of categorical variables showed no significant differences in any of the variables. In group II, real volumetric 3DUS versus virtual volumetric ultrasonography, showed significant differences only for ear implantation. The results of the analyses of categorical variables were consistent for most of the variables analyzed in both groups. CONCLUSION: We concluded that there is intraobserver reproducibility of virtual ultrasonography using multiplanar and volumetric reformations.

Keywords: Virtual ultrasonography, Three-dimensional ultrasonography, First trimester

The authors report a case of a 24 year-old female patient with a three-month history of pain and enlargement of the left halux. Ultrasound showed a heterogeneous, hypoechoic solid soft tissue mass with cystic areas and calcification in the dorsum of the left halux. A tendinous structure was identified within the lesion but no evidence of involvement of adjacent osseous structures was found. Doppler ultrasound revealed central and peripheral hypervascularization of the lesion. Magnetic resonance imaging demonstrated a solid soft tissue mass containing a tendinous structure. The lesion appeared as an intermediate signal intensity structure on T1 images, high signal intensity on T2 images, and showed marked enhancement after intravenous administration of gadolinium. No osseous lesions were identified. The patient was submitted to surgical resection of the lesion in the dorsum of the left halux and the pathology results revealed a monophasic fibrous synovial sarcoma.

Keywords: Synovial sarcomas, Soft-tissue tumors, Ultra-sonography, Magnetic resonance imaging

Objective: To evaluate the intra- and interobserver reproducibility of three-dimensional power Doppler sonography (3D power Doppler) in the assessment of fetal brain blood flow in the middle cerebral artery territory. Materials and methods: A cross-sectional study was developed with 20 healthy pregnant women between 26 and 34 gestational weeks. The middle cerebral artery territory closest to the transducer was scanned and the blood flow volume was calculated with the method Virtual Organ Computer-aided AnaLysis. The following 3D power Doppler indices were later obtained: vascularization index (VI), flow index (FI) and vascularization-flow index (VFI). The intraclass correlation coefficient (ICC) and Bland-Altman plots were utilized for calculating the intra- and interobserver variability. Results: A good intra- and interobserver agreement was observed, with ICC > 0.90 for all the 3D power Doppler indices: VI [ICC = 0.992 (CI 95%: 0.981–0.997)], FI [ICC = 0.999 (CI 95%: 0.998–0.999)], VFI [ICC = 0.995 (CI 95%: 0.987–0.998)]. Interobserver reproducibility: VI [ICC = 0.988 (CI 95%: 0.970–0.995)], FI [ICC = 0.999 (CI 95%: 0.997– 1.000)], VFI [ICC = 0.994 (CI 95%: 0.994–0.998)]. Conclusion: 3D power Doppler has shown to be a practical and easy method in the assessment of fetal brain blood flow, with good intra- and interobserver reproducibility. The FI presented the best intra- and interobserver agreement.

Keywords: Reproducibility of results; Prenatal ultrasonography; Fetal brain flow; Power Doppler; Threedimensional sonography.

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.

OBJECTIVE: To assess the degree of acceptance of patients undergoing computed tomography colonography (CTC) in comparison with colonoscopy in the screening of colorectal disease. MATERIALS AND METHODS: Fifty patients with suspected colorectal disease underwent CTC and colonoscopy. Questionnaires were administered before and after the performance of the CTC and after the colonoscopy. The discomfort expected and experienced before and after the performance of both procedures as well as the patients’ preference for each method were evaluated. RESULTS: As regards CTC, before the procedure, 18% of the patients reported expecting little discomfort, 78%, mild discomfort, and 4%, a lot of discomfort. After the procedure, 72% of the patients reported little discomfort, 26%, mild discomfort, and only one (2%) of the patients reported a lot of discomfort. Upon completion of the colonoscopy, 86% of the patients reported their preference for CTC. The degree of colonic distention and residual amount of fluid had no influence on the patients’ preference. Conclusion: CTC was preferred to colonoscopy, with no statistical relationship with the degree of colonic distention at CTC and efficiency of bowel preparation.

Keywords: Colonoscopy; Virtual colonoscopy; Computed tomography colonography; Computed tomography; Patients’ preference; Patients’ satisfaction.

OBJETIVO: Avaliar a completude das fissuras, resposta radiológica ao tratamento e análise quantitativa por TC (AQTC) em população de pacientes com enfisema grave submetidos ao implante de valvas endobrônquicas (VEB). MATERIAIS E MÉTODOS: Foram estudados exames de TC multidetectores de 29 pacientes, realizados com protocolo de baixo dose, cortes finos, sem contraste. Dois radiologistas revisaram, retrospectivamente, os exames em consenso. A completude das fissuras foi estimada em escala de 5% e a resposta radiológica (atelectasia/perda volumétrica do lobo alvo) foi avaliada. AQTC foi realizada nos exames pré e pós-tratamento utilizando programa completamente automático. RESULTADOS: Resposta radiológica positiva foi vista em 16/29 pacientes. Os 13 pacientes sem resposta à TC apresentavam fissuras incompletas e completude média das fissuras obliquas de 72,8%, contra 88,3% no outro grupo. Os resultados mais significativos da AQTC mostraram redução do volume pulmonar (VP) total (média de 542 ml), VP tratado (700 ml) e volume de enfisema (331,4 ml) no grupo com resposta positiva, que também apresentou melhora nos testes funcionais. CONCLUSÃO: O benefício das VEB é maior em pacientes com fissuras completas e que desenvolvem atelectasia lobar. Nos pacientes sem resposta radiológica encontramos maior prevalência de fissuras incompletas e grau de incompletude das fissuras. Nossa AQTC automática detectou as alterações pós-tratamento, principalmente considerado a análise do pulmão tratado.

Keywords: Enfisema; Terapia de colapso pulmonar; Tomografia computadorizada.

The aim of this study was to compare virtual reality simulation with other methods of teaching interventional radiology. We searched multiple databases—Cochrane Library; Medline (PubMed); Embase; Trip Medical; Education Resources Information Center; Cumulative Index to Nursing and Allied Health Literature; Scientific Electronic Library Online; and Latin-American and Caribbean Health Sciences Literature—for studies comparing virtual reality simulation and other methods of teaching interventional radiology. This systematic review was performed in accordance with the criteria established by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the Best Evidence Medical Education (BEME) Collaboration. Eligible studies were evaluated by using the quality indicators provided in the BEME Guide No. 11 and the Kirkpatrick model of training evaluation. After the eligibility and quality criteria had been applied, five randomized clinical trials were included in the review. The Kirkpatrick level of impact varied among the studies evaluated, three studies being classified as level 2B and two being classified as level 4B. Among the studies evaluated, there was a consensus that virtual reality aggregates concepts and is beneficial for the teaching of interventional radiology. Although the use of virtual reality has been shown to be effective for skill acquisition and learning in interventional radiology, there is still a lack of studies evaluating and standardizing the employment of this technology in relation to the numerous procedures that exist within the field of expertise.

Keywords: Radiology, interventional; Virtual reality; Education, medical; Simulation training.

OBJETIVO: Avaliar os padrões tomográficos relacionados aos agentes etiológicos da pneumonia em pacientes durante o primeiro ano após transplante renal. MATERIAIS E MÉTODOS: Foram analisados dados de prontuários de 956 pacientes submetidos a transplante renal, no período de 2013 a 2018, em um centro transplantador renal do nordeste do Brasil. Nos pacientes que desenvolveram pneumonia, os agentes etiológicos foram classificados em bactérias piogênicas, micobactérias, fungos, vírus e pneumonia polimicrobiana, enquanto os padrões tomográficos foram classificados em consolidação, broncopneumonia, pneumonia intersticial e nódulos e massas. Para verificar associação estatística entre micro-organismos e padrões tomográficos, foi utilizado o teste exato de Fisher, com p < 0,001. RESULTADOS: Foram encontrados 101 casos de pneumonia, dos quais 60 (59,4%) tiveram agente etiológico identificado, sendo as bactérias piogênicas as mais frequentes, detectadas em 22 (36,7%) dos casos. Entre os pacientes com agente causal identificado, o padrão tomográfico predominante foi o de nódulos e massas, identificado em 25 (41,7%) casos. Foi observada associação entre bactérias piogênicas e o padrão de consolidação, fungos com nódulos e massas, bem como entre agentes virais e padrão intersticial. CONCLUSÃO: Foi demonstrada associação estatística entre micro-organismos causadores de pneumonia e padrões tomográficos, informação que pode contribuir para o planejamento da terapia de pacientes transplantados renais.

Keywords: Pneumonia; Transplante de rim; Tomografia computadorizada.