OBJECTIVE: Vesicovaginal and ureterovaginal fistulas are unusual complications secondary to pelvic surgery or pelvic diseases. The therapeutic success in these cases depends on an appropriate preoperative evaluation for diagnosis and visualization of the fistulous tract. The present study is aimed at demonstrating the potential of magnetic resonance urography for the diagnosis of vesicovaginal and ureterovaginal fistulas as well as for defining the fistulous tracts. MATERIALS AND METHODS: Seven female patients clinically diagnosed with vesicovaginal or ureterovaginal fistulas had their medical records, radiological and magnetic resonance images retrospectively reviewed. Magnetic resonance urography included 3D-HASTE sequences with fat saturation. RESULTS: Six patients presented vesicovaginal fistulas and, in one patient, a right-sided ureterovaginal fistula was diagnosed. Magnetic resonance urography allowed the demonstration of the fistulous tract in six (85.7%) of the seven patients evaluated in the present study, without the need of bladder catheterization or contrast injection. CONCLUSION: This study demonstrates both the potential and applicability of magnetic resonance urography in the evaluation of these types of fistulas.

Keywords: Urinary fistula, Vesicovaginal fistula, Urological diagnostic techniques, Magnetic resonance imaging, Vaginal fistula - diagnosis

OBJECTIVE: To implement a protocol for correction of images acquired by videofluoroscopy based on the mathematical model described by Baltzopoulos (1995) and to evaluate the magnitude of error in the linear and non-linear calibration methods. MATERIALS AND METHODS: The images were acquired using a Axion Siemens Iconos R100 videofluoroscope from one individual during knee extension exercise. A non-linear calibration pattern was used for the correction of the images. Data was processed using a Silicon Graphics 320 capture plate and subsequently analyzed using the Matlab software. RESULTS: In order to demonstrate the method's applicability, the deformation of the patellar ligament was evaluated. The use of a linear calibration pattern produced a maximum error of 0.086 mm, while the non-linear calibration pattern reached a maximum value of 0.019 mm. According to the mean error, the linear calibration was 0.024 mm, and the non-linear presented a value of 0.007 mm. CONCLUSION: The results show the need to use a non-linear calibration procedure.

Keywords: Videofluoroscopy, Images calibration, Patellar ligament, Knee

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: The aim of this study is to obtain an alternative angiographic diagnostic method which can be used in patients at a high risk for the use of iodine contrast medium. MATERIALS AND METHODS: Twenty-six patients with chronic renal failure whose fistulas were assessed by digital angiography were first evaluated using iodine contrast medium. Subsequently, carbon dioxide was used as contrast medium, and the images were printed in angiographic film. The angiographic studies were evaluated for opacification, radiological diagnosis and vessel diameter by two independent vascular surgeons; the author performed a comparative analysis of the measurement of the artery and the vein, and respiratory frequency before and after contrast injection. RESULTS: The results obtained with the statistical analysis using kappa coefficient showed agreement between the two doctors and were 0.3217 for opacification, 0.5583 for radiological diagnosis and of 0.4298 for the analysis of vessel diameter. For the carbon dioxide technique, no significant difference was seen in the comparative analysis of the measures of the artery (p = 0.3657) and vein (p = 0.2041), in the position measurements and dispersion; the analysis of the position measurements and dispersion for respiratory frequency showed no significant difference. CONCLUSION: We concluded that this method can be used as an alternative for angiographic study in patients with history of allergy or risk of nephrotoxicity.

Keywords: Angiography using carbon dioxide, Renal failure, Arteriovenous fistula

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

The authors report two cases of gastrocolic fistula caused by chronic therapy with indometacin in patients with Bartter's syndrome followed at the outpatients clinic of "Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo", Brazil. The diagnosis was suggested by a barium meal that showed a gastrocolic fistula between the greater curvature of the stomach and the transverse colon. Treatment was surgical in the both cases.

Keywords: Bartter's syndrome, Gastrocolic fistula, Indometacin, Barium meal

OBJECTIVE: To report results of the application of endovascular techniques in the management of scalp cirsoid aneurysms. MATERIALS AND METHODS: Four patients diagnosed with cirsoid aneurysms were submitted to treatment by endovascular approach. All the four patients included in the present series had arteriovenous malformations and were treated solely by embolization. RESULTS: Three of the patients underwent endovascular treatment by transarterial embolization and one was treated by direct puncture of the venous segment. Both clinical and cosmetic outcomes were satisfactory in all of the patients. Clinical relapse was not observed along the follow-up period. CONCLUSION: The endovascular approach is safe and effective in the management of crisoid aneurysms. Although this technique can be used as an adjuvant or complement to surgery, particularly in cases where deep afferents are involved, complete resolution can be achieved only with endovascular treatment. The choice of treatment method should be based on a range of typical characteristics of the lesion, including angioarchitecture, size and clinical presentation.

Keywords: Arteriovenous fistula; Cirsoid aneurysm; Cerebral angiography; Embolization.

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.

Caroli's disease is a rare congenital malformation characterized by multifocal dilatation of intrahepatic bile ducts predisposing to cholestasis and recurrent cholangitis. The authors describe the case of a young patient with Caroli's disease diagnosed by magnetic resonance cholangiography and complicated with liver abscess, being submitted to surgical drainage.

Keywords: Caroli's disease; Magnetic resonance cholangiography; Liver abscess.

Rendu-Osler-Weber syndrome or hereditary hemorrhagic telangiectasia is an autosomal dominant vascular disease involving multiple systems whose main pathological change is the presence of abnormal arteriovenous communications. Most common symptoms include skin and mucosal telangiectasias, epistaxis, gastrointestinal, pulmonary and intracerebral bleeding. The key imaging finding is the presence of visceral arteriovenous malformations. The diagnosis is based on clinical criteria and can be confirmed by molecular biology techniques. Treatment includes measures for management of epistaxis, as well as surgical excision, radiotherapy and embolization of arteriovenous malformations, with emphasis on endovascular treatment. The present pictorial essay includes a report of three typical cases of this entity and a literature review.

Keywords: Rendu-Osler-Weber; Hereditary hemorrhagic telangiectasia; Arteriovenous fistula; Epistaxis.

The present study is aimed at describing scrotal collections observed at ultrasonography and magnetic resonance imaging. The authors describe the main features of hydrocele, hematocele and pyocele, as well as the most common causes, clinical manifestations and associated diseases, with a brief review of the embryology and anatomy of the scrotum. Collections are frequently found in the evaluation of the scrotum, which is often performed on an emergency basis, and in most cases can be differentiated by means of imaging studies. With the consolidation of magnetic resonance imaging as the method of choice complementary with ultrasonography, the authors also describe magnetic resonance imaging findings of scrotal collections as well as the situations where such method is indicated.

Keywords: Testis; Testicular hydrocele; Hematocele; Abscess; Ultrasonography: Magnetic resonance imaging.

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.

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.

Hepatic cysts are quite common in the daily practice of radiologists and are generally described as simple cysts or as cystic lesions sparsely distributed throughout the parenchyma, often without the discrimination they merit. Simple cysts have, by definition, thin walls, one or two thin septa, and homogeneous fluid content. Such cysts include congenital epithelial cysts, biliary hamartomas, and peribiliary cysts, as well as those representing Caroli’s disease or polycystic liver disease. Complex cysts have variable walls, septa, and contents. They also have various etiologies. A detailed assessment of the clinical history and imaging characteristics can assist in making the diagnosis and choosing a course of clinical management. In this review, hepatic cysts are divided, for educational purposes, into five categories: congenital, traumatic, neoplastic, inflammatory, and miscellaneous.

Keywords: Liver; Cystadenoma, mucinous; Echinococcosis, hepatic; Caroli disease; Liver abscess.