OBJECTIVE: To describe and compare imaging methods and clinical findings of cerebral venous thrombosis in four full-term neonates without brain damage, admitted to a neonatal intensive care unit. MATERIALS AND METHODS: Ten-year review of four cases diagnosed with cerebral venous thrombosis by transfontanellar ultrasonography associated with Doppler fluxometry and confirmed by magnetic resonance imaging/magnetic resonance angiography in correlation with clinical findings and neurological progression. RESULTS: Ultrasonography presented normal results in 75% of cases and magnetic resonance imaging in 100%. Doppler fluxometry and magnetic resonance angiography were abnormal in 100% of cases. Hypoxia (100%) and early seizures (100%) were predominant among clinical findings with evoked potential changes in 50% of cases. In the assessment of the neurodevelopment all the areas remained within normality parameters up to the conclusion of the present study. CONCLUSION: Ultrasonography in association with Doppler can identify changes related to cerebral venous thrombosis and should be complemented with magnetic resonance imaging that is the gold standard for diagnosis in these cases.

Keywords: Cerebral venous thrombosis, Full-term neonates, Magnetic resonance imaging, Magnetic resonance angiography, Ultrasonography and Doppler

OBJECTIVE: To evaluate the diameter, perimeter and area of atrioventricular valves as well thickness of ventricular walls and diameter of ventricular cavity of fetal hearts. MATERIALS AND METHODS: Twenty fetal hearts at gestational age between 28 and 36 weeks were dissected. A paquimeter with 1/10 mm accuracy was utilized for the following morphological measurements: anteroposterior and transverse diameters, mitral and tricuspid valves areas and perimeters. RESULTS: Anteroposterior and transverse diameters of the left atrioventricular valve measured 10.35 ± 1.62 mm and 9.90 ± 1.79 mm, respectively; and anteroposterior and transverse diameters of the right atrioventricular valve measured 10.98 ± 1.90 mm and 9.51 ± 1.81 mm, respectively. Mitral valve area and perimeter were, respectively, 84.06 ± 25.09 mm² and 29.87 ± 3.96 mm. Tricuspid valve area and perimeter were, respectively, 84.49 ± 26.79 mm² and 28.44 ± 3.85 mm. The thicknesses of the anterior and posterior right ventricular walls were, respectively, 5.00 ± 1.70 mm and 3.83 ± 0.91 mm. The thicknesses of the anterior and posterior left ventricular walls were, respectively, 4.25 ±0.87 mm and 4.14 ± 0.89 mm. The thickness of the interventricular septum measured 4.10 ± 1.13 mm. The anteroposterior diameter of the right ventricle was 9.25 ± 0.85 mm, and the transverse diameter was 8.24 ± 0.42 mm. The anteroposterior diameter of the left ventricle measured 9.95 ± 0.37 mm, and transverse diameter measured 9.20 ± 0.40 mm. CONCLUSION: The role of morphometric data of fetal atrioventricular valves is highly significant in the echocardiographic diagnosis of possible congenital cardiac malformations.

Keywords: Fetal echocardiography, Fetal circulation, Cardiac malformation, Heart

OBJECTIVE: To establish reference values for fetal nasal bone length measurements between 11 and 15 gestational weeks in a Brazilian population. MATERIALS AND METHODS: A cross-sectional study was developed with 171 normal pregnant women between their 11th and 15th gestational weeks. The fetal nasal bone was measured by means of transabdominal ultrasound in all of the cases. The 5th and 95th percentiles for the nasal bone length were calculated by the formula: mean ± 1.645 standard deviation. The Spearman correlation coefficient with 95% confidence interval was utilized to correlate the nasal bone length with fetal anthropometric parameters. RESULTS: The nasal bone could be measured in all of the cases with the mean length ranging between 1.69 mm and 2.94 mm. Nasal bone length demonstrated to be strongly correlated with all of the fetal anthropometric parameters (p < 0.001) and with the gestational age (R² = 0.59). CONCLUSION: Despite the preliminary character of the present study, a reference range of fetal nasal bone length was established.

Keywords: Fetal biometry, Nasal bone, Normality range, Ultrasound

Cardiac tumors constitute a rare condition, affecting 0.17-28/10,000 of the general population. Rhabdomyomas represent the most frequently found type of tumor in the prenatal period. The present report describes the case of a 31-week fetus presenting with a large intracardiac tumor with severe clinical repercussions.

Keywords: Prenatal diagnosis, Ultrasonography, Fetal masses, Fetal tumors

OBJECTIVE: To determine a reference curve for the peak systolic velocity of fetal middle cerebral artery. MATERIALS AND METHODS: The authors developed a cross-sectional study with 143 healthy pregnant women between the 23rd and 35th gestational weeks. A bidimensional axial scan of the fetal skull was performed, including the thalami and pellucid septum. Subsequently, the middle cerebral artery was visualized with the color Doppler mode. The pulsed-wave Doppler transducer was positioned over the origin of this vessel, at < 20° insonation angle. The correlation between the peak systolic velocity of the middle cerebral artery and gestational age was evaluated by means of the Pearson's correlation coefficient (r). Regression models were utilized in the construction of a table with multiples of the medians of the middle cerebral artery peak systolic velocity for each gestational age. Additionally, reference values for this variable were determined. RESULTS: A strong correlation was observed between the middle cerebral artery peak systolic velocity and gestational age (r = 0.70; p < 0.001). Values of middle cerebral artery peak systolic velocity were calculated for the following multiples of the medians: 1.0, 1.29, 1.5, 1.55. The 2.5th and 97.5th percentiles were determined for the middle cerebral artery peak systolic velocity ranging between 24.33 cm²/s and 78.36 cm²/s. CONCLUSION: A nomogram for the fetal middle cerebral artery peak systolic velocity during the second half of pregnancy was generated.

Keywords: Middle cerebral artery, Doppler, Ultrasonography, Nomogram, Fetus

Pathological processes of the testis are very frequently found, and include non-tumoral and tumoral lesions. Ultra-sonography performed with a high-frequency transducer has become the imaging modality of choice for examination of these organs. This method is of help to improve intratesticular lesions characterization, and in many instances the findings suggest a more specific diagnosis, especially in the presence of similar clinical manifestations such as pain, swelling and local increase in volume. Color Doppler is an invaluable tool for demonstrating anomalous patterns of testicular perfusion and aids in the diagnosis of acute clinical conditions. In the present iconographic essay, the authors summarize the most frequent clinical, pathological findings as well as the main diagnostic features of benign intratesticular lesions such as microlithiasis, simple cysts, spermatocele, varicocele, tubular ectasia of the rete testis, orchitis, hematomas and more rare conditions. Familiarity with clinical and sonographic features is essential for the correct diagnosis and starting of the most effective therapy, as necessary.

Keywords: Testis, Benign testicular lesions, Ultrasonography, Color Doppler

OBJECTIVE: To evaluate and compare existing ultrasound findings in women with Rh-alloimmunized pregnancies with diagnosis of fetal anemia by spectrophotometric analysis of amniotic fluid or Doppler ultrasound of the fetal middle cerebral artery. MATERIALS AND METHODS: This was an observational descriptive study involving 99 patients evaluated between January 1995 and January 2004. Patients were divided into two groups: 74 Rh-isoimmunized women submitted to spectrophotometry of the amniotic fluid (group S) and 25 Rh-isoimmunized women submitted to Doppler ultrasound of fetal middle cerebral artery (group D) to evaluate fetal anemia. Ultrasound findings in the two groups were compared. RESULTS: Placental anomalies, mainly placentomegaly and textural irregularities were more frequently seen in pregnant women followed up with spectrophotometry of the amniotic fluid compared to those followed up with Doppler ultrasound (64% X 32%, p = 6,294). CONCLUSION: The frequency of abnormal ultrasound findings was 2-fold higher in pregnancies evaluated with spectrophotometry of the amniotic fluid compared to those followed up with Doppler ultrasound.

Keywords: Red blood cell isoimmunization, Fetal anemia, Middle cerebral artery, Doppler ultrasonography, Isoantibodies, Fetal erythroblastosis

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.

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 investigate whether breastfeeding influence the cerebral blood-flow velocity. MATERIALS AND METHODS: The present study included 256 healthy term neonates, all of them with appropriate weight for gestational age, 50.8% being female. Pulsatility index, resistance index and mean velocity were measured during breastfeeding or resting in the anterior cerebral artery, in the left middle cerebral artery, and in the right middle cerebral artery of the neonates between their first 10 and 48 hours of life. The data were analyzed by means of a paired t-test, Brieger's f-test for analysis of variance and linear regression, with p < 0.01 being accepted as statistically significant. RESULTS: Mean resistance index decreased as the mean velocity increased significantly during breastfeeding. Pulsatility index values decreased as much as the resistance index, but in the right middle cerebral artery it was not statistically significant. CONCLUSION: Breastfeeding influences the cerebral blood flow velocities.

Keywords: Cerebral blood flow; Breastfeeding; Doppler ultrasonography; Neonates.

Neurocysticercosis is a disease characterized by the involvement of the central nervous system by the intermediate larval stage of the parasite Taenia solium. The larva degeneration process and the inflammatory reaction of the body cause clinical symptoms. The authors report a case of clinical and radiological reactivation of nodular calcified neurocysticercosis in a patient who was asymptomatic for more than 20 years. Antiparasitic treatment showed a good response.

Keywords: Neurocysticercosis; Reactivation; Cerebral calcifications.

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 functional assessment of the fetal heart has been incorporated into cardiac ultrasound screening as a routine procedure, encompassing fetuses with and without structural heart diseases. It has long been known that various cardiac and extracardiac conditions, such as fetal growth restriction, fetal tumors, twin-to-twin transfusion syndrome, fetal anemia, diaphragmatic hernia, arteriovenous fistula with high cardiac output, and congenital heart diseases (valvular regurgitation and primary myocardial disease), can alter hemodynamic status and fetal cardiac function. Several ultrasound and Doppler echocardiographic parameters of fetal cardiovascular disease have been shown to correlate with perinatal mortality. However, it is still difficult to identify the signs of fetal heart failure and to determine their relationship with prognosis. The aim of this study was to review the main two-dimensional Doppler ultrasound parameters that can be used in the evaluation of fetal cardiac function, with a focus on how to perform that evaluation and on its clinical applicability.

Keywords: Fetal heart; Ultrasonography, Doppler; Echocardiography, Doppler; Echocardiography/methods.

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.