OBJECTIVE: The purpose of this study was to evaluate the interobserver variability of ultrasound in the measurement of subcutaneous, visceral and perirenal fat through standard technique. MATERIALS AND METHODS: From November 2006 to January 2007, 50 patients were evaluated. The subcutaneous fat thickness was measured with a 7.5 MHz linear transducer transversely positioned 1 cm above the umbilical scar. For the visceral fat, a 3.5 MHz transducer was also positioned 1 cm above the umbilical scar, considering the distance between the internal surface of the abdominal rectus muscle and the posterior aortic wall in the abdominal midline. The perirenal fat was measured in the middle third of the right kidney, with the transducer positioned at the axillary midline. RESULTS: The t-Student test was utilized to analyze the interobserver reproducibility with significance level of 95%. No statistically significant difference was observed among mean values for subcutaneous, visceral and perirenal fat (p = 0.7141, 0.7286 and 0.6368, respectively). Mean and standard deviation corresponded to 2.64 ± 1.37 for subcutaneous thickness, 6.84 ± 2.38 for visceral fat, and 4.89 ± 2.6 for perirenal fat. CONCLUSION: Ultrasound presented a good interobserver reproducibility in the evaluation of abdominal fat based on measurement of subcutaneous, visceral and perirenal fat as parameters.

Keywords: Abdominal fat, Ultrasound, Metabolic syndrome

Elongated styloid process or Eagle's syndrome is a multifactorial disease with unspecific characteristics on clinical and imaging examinations. The use of imaging methods in combination with the signs and symptoms are valuable in the confirmation of the diagnosis since they show the extension of the styloid complex, the muscles and ligaments, and adjacent structures. The diagnosis can be established when there is an association of clinical information and imaging findings. The authors report two cases of elongated styloid process including the imaging findings, mainly obtained using computed tomography.

Keywords: Eagle's syndrome, Diagnosis, Computed tomography

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

Tracheobronchomegaly is a rare condition of uncertain etiology characterized by marked dilatation of the trachea and main bronchi, bronchiectasis and recurrent respiratory tract infections. Clinical presentation is nonspecific and the diagnosis is usually made by imaging methods. We report a case of a patient with tracheobronchomegaly. Diagnosis was confirmed by plain x-ray films and computed tomography of the chest.

Keywords: Tracheobronchomegaly, Mounier-Kuhn syndrome, Computed tomography

We report the radiographic findings in the long bones of a newborn with confirmed diagnosis of congenital syphilis and discuss the differential diagnosis with battered child syndrome. The radiographic findings in the long bones from birth to the fourth month of life are presented. Clinical and laboratory data, the serial x-ray films and the characteristic radiological signs were essential to establish the correct diagnosis.

Keywords: Congenital syphilis, Battered child syndrome, Bone fractures

The author reports the radiological findings in two siblings with mucopolysaccharidosis type VI (mucopolysaccharide VI). Conventional radiographs of the skeleton and magnetic resonance imaging examination of the central nervous system were performed. Skeletal abnormalities in patients with mucopolysaccharidosis type VI have already been well described by other authors and are generally similar to other mucopolysaccharides. Magnetic resonance imaging of the central nervous system may be helpful in the differential diagnosis, assessment of extension, and follow-up of these diseases.

Keywords: Mucopolysaccharidoses, Maroteaux-Lamy syndrome, Gargoylism

Short bowel syndrome is defined as the small bowel functional absorptive surface inability to provide adequate nutrition, leading to intestinal failure and chronic malnutrition. In adult individuals the main etiologies for short bowel syndrome are related to extensive or multiple surgical bowel resections secondary to mesenteric ischemia, Crohn’s disease and actinic enteritis. Besides evaluating the transit time through the large bowel, barium follow through may be utilized in the measurement of bowel remnants length as well as in the follow-up of structural adaptation phenomena of small bowel and colonic loops. In patients with short bowel syndrome, structural small bowel adaptation consists in hyperplasia of villi and mucosal folds, which become more numerous, deeper and larger in diameter, as well as remnant segment dilation. Such morphological findings are more prominent and best established in the ileal loops, whose remarkable adaptive capacity has been well documented. Therefore, the knowledge of imaging findings regarding morphological and adaptive characteristics of the small bowel is extremely relevant in the multidisciplinary approach to short bowel syndrome.

Keywords: Short bowel syndrome; Radiology; Adaptation.

The present report describes the case of a 43-year-old diabetic patient with facial pain, protruding eyes, nasal congestion and decreased right vision (involvement of the ipsilateral cranial nerves III, IV and V). Computed tomography showed diffuse sinusitis at right, cribriform plate erosion and presence of a hypodense collection in the frontal lobe with peripheral enhancement. Magnetic resonance imaging confirmed the presence of a cerebral abscess. Samples were collected from the lesion, confirming hyphae compatible with mucormycosis.

Keywords: Syndrome; Cavernous sinus; Mucormycosis.

Heterotaxy syndrome is defined as an abnormal arrangement of some organs and vessels in association with dysmorphism. The authors describe the case of a patient with heterotaxy syndrome with poliesplenia incidentally diagnosed during imaging evaluation (computed tomography and small bowel barium study) of unrelated pathological condition.

Keywords: Heterotaxy syndrome; Polysplenia; Disorders of intestinal rotation; Partial inferior vena cava agenesis; Dorsal pancreas agenesis.

OBJECTIVE: To investigate the learning about management of the technology (efficient use, acquisition and maintenance of imaging diagnosis equipment) in the radiology residency program of Escola Paulista de Medicina - Universidade Federal de São Paulo, with a view to improving the education of radiologists. MATERIALS AND METHODS: Exploratory research where residents, faculty staff and tutors of the program were quantitative and qualitatively approached with Likert scale questionnaires (46), and deepening with recorded interviews (18) and categorization based upon meaning units (thematic analysis). RESULTS: Among the participants, 66% agreed that they had the opportunity of learning about the use of radiological equipment; for 61% the program should include knowledge on the importance of acquiring equipment; and 72% emphasized the lack of learning about equipment management and maintenance. CONCLUSION: As the major moment in the education of specialists, the medical residency program provides residents with a favorable environment to the learning of the skills required to the future of their professional practice, but with limited emphasis on the management of the technology: efficient use, acquisition and mainly maintenance of equipment, still poorly explored. Both the investigated program and the medical residency in radiology should incorporate, whenever possible, the commitment with the training in supplementary skills related to equipment management, developing the competence of the future radiologists.

Keywords: Medical education; Medical residency; Health management; Radiologic technology; Radiology; Imaging diagnosis.

The present report is aimed at describing a rare case of cranial malformation - cloverleaf skull syndrome -, whose presence was noticed after the birth of a child with signs of abnormality. Imaging diagnosis methods such as computed tomography and conventional radiography were used to characterize the syndrome.

Keywords: Syndrome; Malformation; Computed tomography.

OBJECTIVE: To identify the computed tomography findings suggestive of intestinal perforation by an ingested foreign body. MATERIALS AND METHODS: This was a retrospective study of four cases of surgically proven intestinal perforation by a foreign body, comparing the computed tomography findings with those described in the literature. RESULTS: None of the patients reported having ingested a foreign body, all were over 60 years of age, three of the four patients used a dental prosthesis, and all of the foreign bodies were elongated and sharp. In all four patients, there were findings indicative of acute abdomen. None of the foreign bodies were identified on conventional X-rays. The computed tomography findings suggestive of perforation were thickening of the intestinal walls (in all four cases), increased density of mesenteric fat (in all four cases), identification of the foreign body passing through the intestinal wall (in three cases), and gas in the peritoneal cavity (in one case). CONCLUSION: In cases of foreign body ingestion, intestinal perforation is more common when the foreign body is elongated and sharp. Although patients typically do not report having ingested such foreign bodies, the scenario should be suspected in elderly individuals who use dental prostheses. A computed tomography scan can detect foreign bodies, locate perforations, and guide treatment. The findings that suggest perforation are thickening of the intestinal walls, increased mesenteric fat density, and, less frequently, gas in the peritoneal cavity, often restricted to the point of perforation.

Keywords: Intestinal perforation; Intestine, small; Foreign bodies; Abdomen, acute; Tomography, X-ray computed.

OBJECTIVE: To determine the accuracy of diffusion-weighted imaging (DWI) in identifying terminal ileitis in patients with Crohn’s disease. MATERIALS AND METHODS: This was a retrospective study of 38 consecutive patients with Crohn’s disease who underwent magnetic resonance enterography with DWI in a 3.0 T scanner. The patients were divided into two groups, on the basis of colonoscopy and biopsy findings: active inflammation; and inactive disease. Apparent diffusion coefficient (ADC) values were determined, as were the magnetic resonance index of activity (MaRIA) and the Clermont score. RESULTS: Of the 38 patients evaluated, 18 (47%) had active inflammation. The patients with active inflammation showed greater restricted diffusion, more pronounced mucosal edema, greater wall thickening, a higher MaRIA, and a higher Clermont score than did those with inactive disease. The level of interobserver agreement (intraclass correlation coefficient) was excellent for the MaRIA and the Clermont score, whereas it was substantial for the ADC values. For identifying colonoscopy-proven inflammation, the best ADC cut-off point was 2.1 × 10⁻³ mm²/s, which had a sensitivity of 88.8% and a specificity of 95.0%, whereas DWI presented an overall accuracy of 89.4%, with a sensitivity of 88.9% and a specificity of 90.0%. CONCLUSION: Visual analysis of the DWI sequence has good accuracy in detecting terminal ileitis in patients with Crohn’s disease. In addition, low ADC values have good sensitivity for detecting colonoscopy-proven inflammation.

Keywords: Crohn’s disease; Diffusion magnetic resonance imaging; Inflammation; Ileitis; Intestine, small; Magnetic resonance imaging.

The evaluation of inflammatory bowel activity in patients with Crohn’s disease has traditionally been a challenge, mainly because of the difficulty in gaining endoscopic access to the small bowel. Historically, barium-based contrast studies were the only option for the evaluation of inflammatory activity in Crohn’s disease. They were gradually replaced by cross-sectional imaging techniques, computed tomography enterography (CTE) and magnetic resonance enterography (MRE) now being the modalities of choice for such evaluations. Those two imaging methods have provided important information regarding intestinal wall involvement and extra-intestinal manifestations of Crohn’s disease, not only assessing lesion characteristics and complications but also quantifying inflammatory bowel activity. The objective of this article is to review the main technical aspects of CTE and MRE, together with their indications, contraindications, and limitations, as well as the CTE and MRE imaging characteristics of inflammatory activity in Crohn’s disease.

Keywords: Crohn disease; Magnetic resonance imaging; Tomography, X-ray computed; Inflammatory bowel diseases; Intestine, small.

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.