OBJECTIVE: To compare sonographic parameters related to the urethrovesical junction and proximal urethra in cured and not cured patients surgically treated with the Burch technique, for establishing a possible correlation with prognostic factors. MATERIALS AND METHODS: Thirty female patients were selected and divided into two groups: 15 patients considered as clinically cured and 15 not cured. The patients were submitted to preoperative transvulvar ultrasonography, with the examination being repeated at the 30th and 180th postoperative days. RESULTS: At the preoperative examination, the proximal urethra displacement was largest in the cured patients (15.87 ± 4.55 mm × 12.47 ± 3.52 mm - p < 0.05). At the postoperative examination, with strain, the vertical distance of the urethrovesical junction and the proximal urethra were largest in the cured patients (12.87 ± 5.80 mm × 5.13 ± 6.55 mm - p < 0.01; and 13.07 ± 6.44 mm × 6.20 ± 6.14 mm - p < 0.01), and the vertical displacement of the urethrovesical junction and proximal urethra was largest in the not cured patients (8.47 ± 3.98 mm × 5.13 ± 2.36 mm - p < 0.001; and 8.33 ± 4.54 mm × 5.20 ± 2.90 mm - p < 0.05). CONCLUSION: Ultrasonography of the urethrovesical junction and proximal urethra can be considered as an effective method for evaluating prognostic parameters in the surgical management of women with stress urinary incontinence.

Keywords: Transvulvar ultrasonography, Perineal ultrasonography, Urethrovesical junction, Stress urinary incontinence, Burch surgery

OBJECTIVE: The present study is aimed at comparing the quality of sonographic abdominal images obtained in fasting and non fasting children. MATERIALS AND METHODS: This is a prospective study including children aged up to 12 years sequentially evaluated by two sonographers. The images were classified according to a score as follows: 1 (non-visualized or partially visualized, inappropriate for diagnosis); 2 (sufficient for diagnosis); or 3 (excellent). Images were also classified into "diagnostic" or "non diagnostic". RESULTS: Seventy-seven patients (47 boys and 30 girls) with ages ranging between 0 and 12 years (median = 1 year) were evaluated. Fasting proved a statistically significant advantage only for evaluating the gallbladder by only one of the observers (p = 0.032). Once the images were classified into either "diagnostic" or "non diagnostic" no difference was observed between the two groups. CONCLUSION: The authors conclude that fasting did not affect significantly the quality of abdominal sonographic images in children.

Keywords: Ultrasonography, Children, Abdominal, Fasting

OBJECTIVE: The aim of this study was to describe the role of transvulvar ultrasonography in the assessment of anatomical changes following fascia lata sling or tension-free vaginal tape procedures. MATERIALS AND METHODS: Forty women in the age range between 30 and 60 years had fascia lata sling (20 patients) or tension-free vaginal tape (20 patients) placement for treating stress urinary incontinence. Transvulvar ultrasonography was utilized, both pre- and post-operatively, as the main investigational tool in these cases for evaluating the urethrovesical junction vertical and horizontal distances, pubo-urethral distance and proximal urethra length. RESULTS: The urethrovesical junction vertical distance did not vary significantly after the fascia lata sling surgery (p > 0.10). Both the pubo-urethral distance and the proximal urethra length became shorter (p < 0.003), and the urethrovesical junction horizontal distance was reduced only at rest (p = 0.03). The tension-free vaginal tape procedure resulted in a reduction of the urethrovesical junction vertical distance (p = 0.0005) and of the proximal urethra length (p = 0.02). CONCLUSION: Transvulvar ultrasonography was of utmost importance in the demonstration that both the fascia lata sling and tension-free vaginal tape surgical procedures elongate the proximal urethra, even though the fascia lata sling technique does it more effectively. The fascia lata sling technique is more focused on shortening the pubo-urethral distance, and the tension-free vaginal tape, on the correction of the vertical displacement of the urethrovesical junction.

Keywords: Transvulvar ultrasound, Perineal ultrasound, Urethrovesical junction, Stress urinary incontinence, Tension-free vaginal tape, Sling procedure

OBJECTIVE: To determine the influence of intraabdominal pressure in the ultrasonographic evaluation of the urethrovesical junction (UVJ) and proximal urethra (PU) in patients with stress urinary incontinence (SUI). MATERIALS AND METHODS: A prospective, cross-sectional study was conducted at the Urinary Incontinence Research Unit of "Universidade Federal de Pernambuco", Brazil, from January 2002 to January 2005. Perineal ultrasounds of the UVJ and PU were performed in thirty-six women complaining of SUI with the bladder virtually empty (< 50 ml); simultaneous measurement of the intraabdominal pressure was also performed. An ultrasound machine with a computer chip and a high-resolution photographic camera connected to a 7 MHz vaginal probe was used for the evaluation. In order to measure the intraabdominal pressure, an urodynamic equipment with a 10fr rectal catheter connected to a pressure sensitive balloon was used. RESULTS: The age of the patients ranged from 25 to 69 years (mean 46.4 ± 10.2 years). On Valsava maneuver, the intra-abdominal pressure ranged from 7 to 193 cmH2O (mean: 99.3 ± 51.8 cmH2O; median: 99.5 cmH2O). Eight out of 31 (25.8%) patients with UVJ hypermobility had an intraabdominal pressure lower than 60 cmH2O. There was no statistically significant association between intraabdominal pressure and the ultrasound parameters studied. CONCLUSION: There is a specific urethral pressure index for each woman with SUI. However, there is no significant association between increase in intraabdominal pressure and increase of UVJ and UP hypermobility in women with clinical SUI.

Keywords: Stress urinary incontinence, Abdominal pressure, Perineal ultrasound, Urethrovesical junction

OBJECTIVE: To investigate the influence of bladder volume on perineal ultrasound assessments of the urethrovesical junction (UVJ) mobility and proximal urethral (PU) length in women with stress urinary incontinence (SUI). MATERIALS AND METHODS: Women with SUI were submitted to perineal ultrasound assessments of UVJ mobility and PU length with both full and practically empty (< 50 ml of urine) bladder. RESULTS: The means, in millimeters, of the measured parameters with a practically empty and full bladder were as follows: at rest: UVJ vertical distance (UVJVD) = 15 and 13.5 (p = 0.3347), UVJ horizontal distance (UVJHD) = 14 and 15 (p = 0.3767), pubourethral distance (PUD) = 13 and 13 (p = 0.8065), PU = 15 and 14 (p = 0.8011); on strain: UVJVD = 0 and 4 (p = 0.0281), UVJHD = 21 and 19.5 (p = 0.7501), PUD = 18.5 and 15 (p = 0.1592), PU = 0 and 4 (p = 0.0479); the resulting movements: UVJVD = 16 and 15 (p = 0.0047), UVJHD = 6 and 5 (p = 0.3542), PUD = 7 and 5.5 (p = 0.1789), PU = 12 and 8 (p = 0.0496). CONCLUSION: The comparison of UVJ parameters using perineal ultrasound with the bladder practically empty as well as full showed that vertical movement of the UVJ and PU length and their status on strain were significantly increased in patients with a practically empty bladder.

Keywords: Urethrovesical junction, Stress urinary incontinence, Perineal ultrasound

OBJECTIVE: To determine and compare the efficacy of image-guided percutaneous needle aspiration (PNA) versus percutaneous catheter drainage (PCD) in the treatment of intra-abdominal liquid collections. MATERIALS AND METHODS: A prospective study involving 52 patients referred to our service for percutaneous treatment of abdominal liquid collections was carried out. Sixteen of these patients had intra-abdominal liquid collections (six patients with simple localized collections and ten patients with complex, multiseptated or multiple, collections). The volume of the collections ranged from 40 to 1,200 ml (median, 200 ml). PCD was performed in ten (62.5%) collections and PNA in six (37.5%) collections. Successful treatment was defined as complete resolution of the collection with both clinical and laboratorial recovery. RESULTS: Success was achieved in 75% of cases. The success rate was 100% and 60% in the groups submitted to PNA and PCD, respectively. Successful treatment was observed in 50% of the patients submitted to PCD with collections £ 200 ml, and in 75% of the patients with larger collections. Complete resolution with PCD was obtained in 33.3% of complex, 42.9% of infected and 100% of simple or sterile collections. Only two minor complications (transient bacteremia and cutaneous infection) due to the procedures were observed. CONCLUSION: Our results showed that PCD and PNA are safe and effective in the treatment of intra-abdominal collections. In this study, needle aspiration was more effective than drainage, particularly for smaller collections.

Keywords: Intra-abdominal collections, Percutaneous needle aspiration, Percutaneous catheter drainage

OBJECTIVE: To review the abdominal ultrasound findings in patients with serologically proven dengue fever and to compare the results with data from the literature. MATERIALS AND METHODS: Thirty-eight patients with serologically proven dengue fever, 25 female and 13 male, mean age of 35 years, were submitted to abdominal ultrasound. The ultrasound findings were compared with data from the literature. RESULTS: The most relevant ultrasound findings were diffuse gallbladder wall thickening in 18 cases (47.4%), abdominal and/or pelvic free fluid in 12 (31.6%), splenomegaly in 11 (28.9%), hepatomegaly in 10 (26.3%) and perivesicular fluid in 10 (26.3%). Twenty-six percent of the patients had normal abdominal ultrasound. CONCLUSION: Abdominal sonography is a useful additional diagnostic tool for the confirmation of suspected cases of dengue hemorrhagic fever and for the evaluation of severity and progression of the disease. The knowledge of the ultrasound possible findings in patients with dengue fever is of extreme importance for the radiologist.

Keywords: Dengue, Ultrasound, Abdominal findings

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

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.

Objective: To utilize intra-abdominal esophagus ultrasonography to evaluate esophageal transit time for water and yogurt in orthostatic position, and to evaluate the influence of gender and body mass index. Materials and Methods: The present study included 89 young adults [40 women (mean age, 20.13 ± 1.62 years) and 49 men (mean age, 20.43 ± 2.17 years)] who did not show upper gastrointestinal tract disorder. Esophageal transit time was measured with the patient in orthostatic position during water and yogurt swallowing. Results: Esophageal transit time for women and men was, respectively, 5.84 ± 1.60 seconds versus 6.66 ± 1.68 seconds with water, and 9.12 ± 1.96 seconds versus 9.28 ± 1.70 seconds with yogurt. No difference between genders was observed in spite of the lower body mass index in women. Conclusion: Data regarding esophageal transit time for liquid (water) and pasty (yogurt) food swallowed by young adults in the orthostatic position did not demonstrate any difference between genders even in women with lower body mass index as compared with men.

Keywords: Ultrasonography; Intra-abdominal esophagus; Body mass index.

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.

OBJECTIVE: To evaluate sonographic measurements of visceral and subcutaneous fat in children, and to investigate the usefulness of preperitoneal fat (PF) and the abdominal wall fat index (AFI) as parameters to determine visceral fat and presence of nonalcoholic fatty liver disease (NAFLD) in obese children. MATERIALS AND METHODS: A case-control study of a sample including 44 children (22 cases and 22 controls) matched by sex and age. The Student t test and the Fisher exact test were utilized in the descriptive and bivariate analysis. RESULTS: The sonographic parameters evaluated - subcutaneous cell tissue, PF and intraperitoneal fat, and NAFLD - presented high statistical association with body mass index. NAFLD was observed in eight obese patients (36.36%), and PF and AFI were the variables with highest statistical significance, with p < 0.0001. CONCLUSION: Ultrasonography is useful tool in the differentiation and quantification of visceral and subcutaneous fat in children. The measures of PF and AFI are useful in the assessment of visceral fat and NAFLD in obese children.

Keywords: Ultrasonography; Child; Obesity; Fatty liver; Intra-abdominal fat.

OBJECTIVE: To evaluate the feasibility of quantifying visceral adipose tissue (VAT) on computed tomography (CT) and magnetic resonance imaging (MRI) scans, using freeware, as well as calculating intraobserver and interobserver reproducibility. MATERIALS AND METHODS: We quantified VAT in patients who underwent abdominal CT and MRI at our institution between 2010 and 2015, with a maximum of three months between the two examinations. A slice acquired at the level of the umbilicus was selected. Segmentation was performed with the region growing algorithm of the freeware employed. Intraobserver and interobserver reproducibility were evaluated, as was the accuracy of MRI in relation to that of CT. RESULTS: Thirty-one patients (14 males and 17 females; mean age of 57 ± 15 years) underwent CT and MRI (mean interval between the examinations, 28 ± 12 days). The interobserver reproducibility was 82% for CT (bias = 1.52 cm²; p = 0.488), 86% for T1-weighted MRI (bias = −4.36 cm²; p = 0.006), and 88% for T2-weighted MRI (bias = −0.52 cm²; p = 0.735). The intraobserver reproducibility was 90% for CT (bias = 0.14 cm²; p = 0.912), 92% for T1-weighted MRI (bias = −3,4 cm²; p = 0.035), and 90% for T2-weighted MRI (bias = −0.30 cm²; p = 0.887). The reproducibility between T1-weighted MRI and T2-weighted MRI was 87% (bias = −0.11 cm²; p = 0.957). In comparison with the accuracy of CT, that of T1-weighted and T2-weighted MRI was 89% and 91%, respectively. CONCLUSION: The program employed can be used in order to quantify VAT on CT, T1-weighted MRI, and T2-weighted MRI scans. Overall, the accuracy of MRI (in comparison with that of CT) appears to be high, as do intraobserver and interobserver reproducibility. However, the quantification of VAT seems to be less reproducible in T1-weighted sequences.

Keywords: Intra-abdominal fat; Image processing, computer-assisted/methods; Tomography, X-ray computed; Magnetic resonance imaging; Reproducibility of results.

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.