OBJECTIVE: The purpose of this study was to describe the tomographic findings of gastric gastrointestinal stromal tumor. MATERIALS AND METHODS: Fourteen patients with histopathologically and immunohistochemically confirmed gastric gastrointestinal stromal tumors, who had already been submitted to computed tomography scans before the treatment, were evaluated in the period between January 1999 and December 2006. The following tomographic variables were analyzed: lesion topography, size/dimensions, homogeneity, contour, margins, morphology, pattern and intravenous contrast-enhancement intensity, growth pattern, invasion of adjacent organs, presence of ulceration, fistula, calcifications, mesenteric fat infiltration, lymphadenomegaly and presence of distant metastasis. RESULTS: Tumors were found in the body (57.1%) or in the gastric fundus (42.9%), with sizes ranging between 6.0 cm and 23.0 cm (mean, 11.5 cm). Predominantly extraluminal growth was observed in 57.1% of cases and intra/extraluminal in 35.7%. Subtle contrast-enhancement was observed in 50%, moderate in 50%, and heterogeneous in 64.3% of cases. Additionally, central hypodensity was observed in 64.3%, invasion of adjacent organs in 42.9%, and hepatic metastasis in 7.2% of cases. CONCLUSION: In the present study, the majority of tumors were found in the gastric body, with an average size of 11.5 cm, presenting with central hypodensity, heterogeneous contrast-enhancement and predominantly extraluminal growth.

Keywords: Gastrointestinal stromal tumors, Stomach neoplasms, Spiral computed tomography

OBJECTIVE: To investigate and describe clinical, radiologic and pathologic findings of gastrointestinal stromal tumors. MATERIALS AND METHODS: In the period between December 2000 and March 2006, 16 patients were submitted to surgery for gastrointestinal stromal tumors in our institution. The following variables were taken into consideration: sex and age, signs and symptoms at presentation, tumor site and size, radiological and pathological features, and presence of metastasis. RESULTS: The study population was constituted by nine men and seven women. The primary tumor sites of origin were: stomach (n = 5), rectum (n = 4), small bowel (n = 3), mesentery (n = 3), and colon (n = 1). Mean primary tumor size was 9 cm. Computed tomography was the main radiological method utilized. Circumscribed, lobulated and heterogeneously contrast-enhanced mass was the main image finding. Metastasis was found in nine patients (56% of cases) at presentation or tumor recurrence was observed during the follow-up period (mean = 32 months). CONCLUSION: Gastrointestinal stromal tumor occurs in middle-age adults and the elderly, and must be taken into consideration as differential diagnosis for abdominal masses. Early diagnosis, adequate therapy, and rigorous follow-up are essential, considering the high probability of malignancy of these neoplasms as demonstrated by the present study.

Keywords: Gastrointestinal stromal tumor, Gastrointestinal neoplasms, Gastrointestinal diseases, Sarcoma

OBJECTIVE: The present study was aimed at evaluating radiological findings of delayed postoperative upper gastrointestinal series in patients submitted to Fobi-Capella surgery. MATERIALS AND METHODS: Radiological studies of 41 patients, six to nine months following the surgery. RESULTS: The following pathological alterations have been found: hiatal hernia (17%), gastroesophageal reflux disease (19.5%) and sliding of the silastic ring (4.8%). Least frequent findings have been the following: enterocutaneous fistula (2.4%), stenosis of the gastric pouch outlet (2.4%), bezoar (2.4%), and non-visualization of the silastic ring caused by its removal due to patient intolerance (2.4%). Anatomical alterations resulting from the surgery have been clearly demonstrated. CONCLUSION: The present study could demonstrate anatomical alterations and complications resulting from Fobi-Capella surgery.

Keywords: Morbid obesity, Gastroplasty, Upper gastrointestinal series, Bariatric surgery, Fobi-Capella

OBJECTIVE: To review upper gastrointestinal tract (UGI) contrast examinations in order to establish the main diagnoses and radiological findings, the actual benefits to the patients and the costs for the department of radiology. MATERIALS AND METHODS: This is a retrospective study of 270 UGI contrast examinations performed between 6/3/2001 and 12/4/2002 at the Department of Radiology of "Hospital Santa Cruz/Beneficência Portuguesa de Niterói", Niterói, RJ, Brazil. RESULTS: A total of 270 examinations were reviewed. Radiological findings (anatomical, congenital, acquired, peptic or surgery related findings) were seen in 115 (42.5%) examinations while 155 (57.5%) examinations were normal. The age range was 0-12 years in 197 (72.9%) patients whereas 73 (27.1%) patients were above 12 year-old. CONCLUSION: Due to the clear benefit to the patients, UGI contrast examinations should continue to be used as an important complementary method to study UGI diseases, particularly in children and surgical cases. Therefore, we should keep in mind that UGI contrast examinations and endoscopy are complementary methods of investigation when comparing its advantages and disadvantages. UGI contrast examination is a fast, simple, and relatively low cost procedure. In addition, it presents low risk to the patients.

Keywords: Upper gastrointestinal tract diseases, Contrast examination, Differential diagnosis

OBJECTIVE: To compare both qualitatively and quantitatively six T2-weigthed turbo spin-echo sequences varying the respiratory compensation technique, associating or not fat tissue suppression and using different types of coils. MATERIALS AND METHODS: We performed a prospective study of 71 consecutive patients that were submitted to MRI of the liver using a 1.5T magnet. The six following pulse sequences were used: 1) fat-suppressed respiratory triggered with conventional body coil; 2) breath-hold fat-suppressed with conventional body coil; 3) non-suppressed respiratory triggered with conventional body coil; 4) breath-hold non fat-suppressed with conventional body coil; 5) fat-suppressed respiratory triggered with phased-array multicoil; 6) breath-hold fat-suppressed with phased-array multicoil. Images were analyzed quantitatively by measuring the signal-to-noise ratios and qualitatively by evaluating the sharpness of hepatic contours, visibility of intrahepatic vessels and other segmental landmarks, and the presence of artifacts. RESULTS: The qualitative analysis showed that the mean values obtained with the six sequences were 7.8, 4.6, 7.9, 5.2, 6.7 and 4.6, respectively. The respiratory-triggered sequences were better than the breath-hold sequences in both qualitative and quantitative analysis (p < 0.001). No significant differences in the values of signal-to-noise ratios and in overall image quality rankings were found between the sequences with and without fat suppression (p > 0.05). The sequences using the body coil were similar in terms of image quality (p > 0.05) and better regarding signal-to-noise ratios than those obtained with the phased-array multicoil (p < 0.001). CONCLUSION: Our qualitative and quantitative results suggest that the best MRI sequences for the evaluation of the liver are the sequences with respiratory triggering using a conventional body coil, with or without fat suppression.

Keywords: Magnetic resonance imaging, Liver, Gastrointestinal diagnostic techniques, Imaging techniques

Objective: To determine the sensitivity of upper gastrointestinal (UGI) series, adopting the 24-h esophageal pH monitoring as the gold standard in the diagnosis of gastroesophageal reflux disease (GERD) in preterm newborns, besides describing the presence of anatomical abnormalities in the digestive tube. Materials and Methods: The present study included 41 neonates with average birth weight of 1,243.9 g, presenting signs/symptoms of GERD and abnormal 24-h esophageal pH monitoring (reflux index > 10%). The UGI series was performed as soon as the infants’ clinical conditions were considered sufficiently stable. Results: The 24-h pH monitoring and UGI series were performed respectively at 49.8 and 66.8 days of life. The UGI series sensitivity was of 39.0 (CI 95%: 25.7–54.3%). The reflux index was significant in 41.4%, moderate in 44.8%, and mild in 13.8% of the cases. Only one case of hiatus hernia was identified by UGI series. Conclusion: Upper gastrointestinal series has demonstrated low sensitivity in the diagnosis of GERD in preterm newborns and was not associated with the reflux severity as compared with pH monitoring. However, it is useful in the detection of anatomical abnormalities in the upper gastrointestinal tract.

Keywords: Gastroesophageal reflux disease; Upper gastrointestinal series; 24-h esophageal pH monitoring; Preterm newborns.

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.

Gastrointestinal bleeding is a common cause of admission to emergency services. Hemorrhages originated from arteriovenous malformations in the stomach have been rarely described in the literature. Embolization offers a good chance for the control of bleeding. We describe the case of a patient with recurrent hematemesis and melena whose angiography identified arteriovenous malformations in the greater curvature of the stomach. The bleeding was treated by arterial embolization.

Keywords: Arteriovenous malformation; Gastrointestinal hemorrhage; Embolization.

Gastrointestinal bleeding represents a common medical emergency, with considerable morbidity and mortality rates, and a prompt diagnosis is essential for a better prognosis. In such a context, endoscopy is the main diagnostic tool; however, in cases where the gastrointestinal hemorrhage is massive, the exact bleeding site might go undetected. In addition, a trained professional is not always present to perform the procedure. In an emergency setting, optical colonoscopy presents limitations connected with the absence of bowel preparation, so most of the small bowel cannot be assessed. Scintigraphy cannot accurately demonstrate the anatomic location of the bleeding and is not available at emergency settings. The use of capsule endoscopy is inappropriate in the acute setting, particularly in the emergency department at night, and is a highly expensive method. Digital angiography, despite its high sensitivity, is invasive, presents catheterization-related risks, in addition to its low availability at emergency settings. On the other hand, computed tomography angiography is fast, widely available and minimally invasive, emerging as a promising method in the diagnostic algorithm of these patients, being capable of determining the location and cause of bleeding with high accuracy. Based on a critical literature review and on their own experience, the authors propose a computed tomography angiography protocol to assess the patient with gastrointestinal bleeding.

Keywords: Gastrointestinal hemorrhage; Computed tomography; Angiography; Multidetector computed tomography.

Abdominal vascular syndromes are rare diseases. Although such syndromes vary widely in terms of symptoms and etiologies, certain imaging findings are characteristic. Depending on their etiology, they can be categorized as congenital—including blue rubber bleb nevus syndrome, Klippel-Trenaunay syndrome, and hereditary hemorrhagic telangiectasia (Rendu-Osler-Weber syndrome)—or compressive—including "nutcracker" syndrome, median arcuate ligament syndrome, Cockett syndrome (also known as May-Thurner syndrome), and superior mesenteric artery syndrome. In this article, we aimed to illustrate imaging findings that are characteristic of these syndromes, through studies conducted at our institution, as well as to perform a brief review of the literature on this topic.

Keywords: Gastrointestinal tract; Venous thrombosis; Arteriovenous fistula; Hemangioma.

OBJECTIVE: To determine whether preoperative anthropometric and computed tomography (CT) measurements of body composition can predict postoperative morbidity and mortality in patients with gastric or esophageal cancer. MATERIALS AND METHODS: This was a retrospective study in which we reviewed the medical records and abdominal CT scans of patients with gastric or esophageal cancer who underwent surgery in 2015 at a cancer center. CT scans performed during routine preoperative evaluation were retrospectively assessed to measure the area of lean body mass at the level of the third lumbar vertebra, as well as the area of visceral and subcutaneous fat. RESULTS: Seventy patients were included in the study. The mean age was 59.9 years (range, 33–82 years), and 47 patients (67.1%) were men. The mean postoperative follow-up period was 14.9 months. Neither postoperative morbidity nor postoperative mortality correlated significantly with gender, age, the type of primary tumor, the presence of comorbidities, smoking status, body mass index, nutritional status, or visceral fat area. The survival rate was higher for patients with normal lean body mass than for those with low lean body mass (hazard ratio = 0.116; 95% confidence interval: 0.015–0.906; p = 0.040). CONCLUSION: Our data suggest that lean body mass can be a relevant prognostic factor in patients with gastric or esophageal cancer, and that CT measurements should be included in the routine preoperative evaluation, because it may provide information that aids nutritional and clinical care for these patients.

Keywords: Gastrointestinal neoplasms; Stomach neoplasms; Esophageal neoplasms; Body composition; Body fat distribution; Tomography, X-ray computed.

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.