OBJECTIVE: To evaluate the olfactory fossae depth according to the Keros' classification and determine the incidence and degree of asymmetry in the height and contour of the ethmoid roof. MATERIALS AND METHODS: Retrospective analysis of 200 coronal computed tomography studies of paranasal sinuses performed in the period between August and December, 2006. RESULTS: According to the Keros' classification, olfactory fossae type II was most frequently found in 73.3% of cases followed by type I in 26.3% and type III in 0.5% of cases. Asymmetry in the ethmoid roof height was found in 12% of cases (24 computed tomography studies), and contour asymmetry was found in 48.5% (97 computed tomography studies), with flattening of the ethmoid roof on one of the sides. CONCLUSION: As regards the olfactory fossae depth, the Keros' type II was most frequently found. In most of cases, the ethmoid roof asymmetry was related to angulation of the lateral lamella of the cribriform plate.

Keywords: Anatomy, Nose, Nasal cavity, Computed tomography, Fovea ethmoidalis, Olfactory fossa

Retrospective study of two cases of atypically localized cerebral hemorrhage among 777 newborns admitted to the neonatal intensive care unit at Casa de Saúde São José, Rio de Janeiro, RJ, Brazil. Clinical findings and imaging diagnoses were evaluated. The diagnostic effectiveness of ultrasonography was established by correlation with magnetic resonance imaging findings. Multifactorial etiology was observed, besides silent clinical presentation independently from localization. So far the neurological evaluation has satisfactorily progressed although the patients are still too young to allow a definite neurological evaluation.

Keywords: Brain, Newborn, Atypical hemorrhage, Posterior fossa hemorrhage, Ultrasonography, Magnetic resonance imaging

OBJECTIVE: In the pediatric group, the radiological diagnosis of bone tumors of the hip is difficult and presents some peculiarities, but reviewed literature does not approach this specific problem. The objective of the present study was to investigate the existence of reliable radiological patterns for the differential diagnosis of these tumors. MATERIALS AND METHODS: Radiological findings of bone tumors of the hip in ten patients in the age range between 8 and 19 years have been reviewed. RESULTS: Bone reaction (sclerosis or lysis), periosteal reaction (lamellar with single or multiple layers, or radial), tumor extent in the bone and level of soft tissues invasion have presented low specificity. Soft tissue calcifications, when considered as a whole, were non-specific. However, when those calcifications with varied shapes and sizes, nearby the affected bone (pattern I) were separated from those, thin and amorphous, away from the bone (pattern II), we have observed that the pattern I was totally non-specific, and the pattern II was found in the three cases of osteosarcoma (100%) and in only one case of Ewing's sarcoma (16.6%). CONCLUSION: In the present study, pattern II calcifications have shown a 100% sensitivity and 90% specificity for osteosarcoma. However, their importance may be not limited to the radiological diagnosis. Pattern II calcifications indicate probably ideal sites for biopsy.

Keywords: Bone tumors, Ilium, Hip, Pelvis, Pediatrics, Computed tomography

OBJECTIVE: To distinguish healthy from pathological tissues in pediatric patients with posterior cranial fossa tumors using calculated textural parameters from magnetic resonance images. MATERIALS AND METHODS: We evaluated 14 pediatric patients with posterior cranial fossa tumors using the software MaZda to define the texture parameters in selected regions of interest representing healthy and pathological tissues based on T2-weighted magnetic resonance images. RESULTS: There was a statistically significant difference between normal and tumoral tissues as well as between supposedly normal tissues adjacent and distant from the tumoral lesion. CONCLUSION: Magnetic resonance textural evaluation is an useful tool for determining differences among various tissues, including tissues that appear apparently normal on visual analysis.

Keywords: Magnetic resonance imaging, Textural evaluation, Posterior cranial fossa tumors, Pediatric patients, MaZda software

Vascular tumors encompass a spectrum of lesions, which may vary from benign hemangiomas to malignant angiosarcomas. Hemangioendotheliomas can be considered intermediary between these two types of lesions. We report a case of hepatic hemangioendothelioma in a newborn female and review the most important aspects of this disease.

Keywords: Hemangioendotheliomas, Hepatic tumors, Vascular tumors, Computed tomography

The authors interviewed 211 medical residents from 44 health care institutions in which Residency in Radiology programs were accredited or had projects recognized by the National Committee of Medical Residency. During these interviews, positive and negative aspects of medical residence in radiology programs were presented along with suggestions of improvement. The residents pointed out the number of exams performed and the diversity of diseases diagnosed as the most relevant features of these programs. One of the negative features appointed by the residents was the excessive number of damaged or obsolete equipment and the lack of some equipment. The most important suggestions pointed out were the interchange of residents among health institutions and the possibility of specific radiology residency activities in scientific meetings. We hope that the aspects and suggestions presented in this paper may contribute for the improvement of Medical Residency in Radiology programs in Brazil.

Keywords: Medical Residency, Radiology, Programs evaluation

The authors report a case of a 40-year-old male patient with sickle cell disease who presented with intra-thoracic extramedullary hematopoiesis and paravertebral expansive lesions that appeared as soft tissue density masses on conventional x-ray films. A computed tomography of the chest demonstrated soft tissue density masses in the lower third of the paravertebral spaces. These masses presented well-defined limits, lobulated edges and were heterogeneous due to areas of interposed adipose and soft density tissues. The lung parenchyma had no abnormalities. Computed tomography of the abdomen revealed diffuse hiperdensity and enlargement of the liver that was attributed to hemosiderosis, and an atrophic and calcified spleen due to repeated episodes of infarction.

Keywords: Intrathoracic extramedullary hematopoiesis. Computed tomography. Sickle cell anemia. Posterior mediastinum.

The literature reports only rare cases of urinary ascites, usually secondary to rupture of the bladder and not to renal calyx rupture. The present report describes an uncommon case of posterior urethral valve in a newborn with ascites caused by the rupture of a renal calyx that, to our knowledge, was diagnosed for the first time by ultrasonography.

Keywords: Newborn; Urinary ascites; Renal calyx rupture; Posterior urethral valve; Ultrasonography.

Disc herniation with posterior epidural migration is a rare and often symptomatic entity. Multiple are the natural barriers that prevent this pattern of migration. Enhanced magnetic resonance imaging is the diagnostic modality of choice in these cases. The diagnostic dilemma in this case was the contraindication to the use of contrast since the patient was known to have chronic renal failure.

Keywords: Lumbar hernia; Complication; Epidural space; Posterior; Magnetic resonance imaging; Contrast.

OBJECTIVE: To evaluate the performance of diagnostic centers in the classification of mammography reports from an opportunistic screening undertaken by the Brazilian public health system (SUS) in the municipality of Goiânia, GO, Brazil in 2010. MATERIALS AND METHODS: The present ecological study analyzed data reported to the Sistema de Informação do Controle do Câncer de Mama (SISMAMA) (Breast Cancer Management Information System) by diagnostic centers involved in the mammographic screening developed by the SUS. Based on the frequency of mammograms per BI-RADS^®category and on the limits established for the present study, the authors have calculated the rate of conformity for each diagnostic center. Diagnostic centers with equal rates of conformity were considered as having equal performance. RESULTS: Fifteen diagnostic centers performed mammographic studies for SUS and reported 31,198 screening mammograms. The performance of the diagnostic centers concerning BI-RADS classification has demonstrated that none of them was in conformity for all categories, one center presented conformity in five categories, two centers, in four categories, three centers, in three categories, two centers, in two categories, four centers, in one category, and three centers with no conformity. CONCLUSION: The results of the present study demonstrate unevenness in the diagnostic centers performance in the classification of mammograms reported to SISMAMA from the opportunistic screening undertaken by SUS.

Keywords: Breast cancer; Screening programs; Mammography; Information systems; Health services.

We report an unprecedented case of ectopic thymoma in a young adult. A 33-year-old male presented with a 10-day history of non-productive cough and fever. Investigation revealed mediastinal widening without pulmonary involvement. Computed tomography showed a large mass—14.8 × 10.8 × 8.4 cm—in the mid-posterior mediastinum, and a biopsy obtained by video-assisted thoracoscopy indicated that the mass was a tumor. Immunohistochemistry showed combined thymoma type AB1. Because of the considerable proportions of the tumor and its close proximity to major structures, the patient was treated with chemotherapy.

Keywords: Thymoma; Middle mediastinum; Posterior mediastinum; Ectopic tumor.

OBJECTIVE: To map the different methods for diagnostic imaging instruction at medical schools in Brazil. MATERIALS AND METHODS: In this cross-sectional study, a questionnaire was sent to each of the coordinators of 178 Brazilian medical schools. The following characteristics were assessed: teaching model; total course hours; infrastructure; numbers of students and professionals involved; themes addressed; diagnostic imaging modalities covered; and education policies related to diagnostic imaging. RESULTS: Of the 178 questionnaires sent, 45 (25.3%) were completed and returned. Of those 45 responses, 17 (37.8%) were from public medical schools, whereas 28 (62.2%) were from private medical schools. Among the 45 medical schools evaluated, the method of diagnostic imaging instruction was modular at 21 (46.7%), classic (independent discipline) at 13 (28.9%), hybrid (classical and modular) at 9 (20.0%), and none of the preceding at 3 (6.7%). Diagnostic imaging is part of the formal curriculum at 36 (80.0%) of the schools, an elective course at 3 (6.7%), and included within another modality at 6 (13.3%). Professors involved in diagnostic imaging teaching are radiologists at 43 (95.5%) of the institutions. CONCLUSION: The survey showed that medical courses in Brazil tend to offer diagnostic imaging instruction in courses that include other content and at different time points during the course. Radiologists are extensively involved in undergraduate medical education, regardless of the teaching methodology employed at the institution.

Keywords: Schools, medical; Education, medical/standards; Program evaluation/methods; Diagnostic imaging.

Ultrasound diagnosis of posterior fossa malformations in the prenatal period is a challenge, having major implications for the counseling and follow-up of pregnant women. The purpose of this study was to review aspects of the ultrasound evaluation of the fetal posterior fossa, as well as to describe the most relevant ultrasound findings of the main posterior fossa malformations that can affect the fetus in the prenatal period.

Keywords: Prenatal diagnosis/methods; Ultrasonography/methods; Cranial fossa, posterior/abnormalities; Cerebellum/embryology.

OBJECTIVE: We aimed to evaluate whether human immunodeficiency virus (HIV)-positive patients with and without clinically significant memory deficits and healthy control participants differ on in vivo hydrogen-1 magnetic resonance spectroscopy (H-MRS) in the posterior cingulate gyri. MATERIALS AND METHODS: In total, 21 HIV-positive patients with memory deficit (HIV+wMD) were compared with 15 HIV-positive patients without memory deficit (HIV+wOMD) and 22 sex-, age-, and education-matched control participants. Memory impairments were classified based on the participants’ performance on the Rey Auditory Verbal Learning Test. Short echo time (30 ms), single-voxel H-MRS was performed using a 1.5-T magnetic resonance scanner. RESULTS: The HIV+wMD and HIV+wOMD groups had higher choline/creatine ratio in the posterior cingulate gyri than the control group. There were no significant metabolite ratio differences between the HIV+wMD and HIV+wOMD groups. CONCLUSION: HIV-positive patients with and without memory deficits had significantly higher choline/creatine ratios than controls in the posterior cingulate gyri, which may reflect cerebral inflammation, altered cell membrane metabolism, microgliosis, and/or astrocytosis.

Keywords: HIV; Memory deficit; Posterior cingulate gyrus; Magnetic resonance spectroscopy.

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.