OBJECTIVE: The present study is aimed at comparing the quality of sonographic abdominal images obtained in fasting and non fasting children. MATERIALS AND METHODS: This is a prospective study including children aged up to 12 years sequentially evaluated by two sonographers. The images were classified according to a score as follows: 1 (non-visualized or partially visualized, inappropriate for diagnosis); 2 (sufficient for diagnosis); or 3 (excellent). Images were also classified into "diagnostic" or "non diagnostic". RESULTS: Seventy-seven patients (47 boys and 30 girls) with ages ranging between 0 and 12 years (median = 1 year) were evaluated. Fasting proved a statistically significant advantage only for evaluating the gallbladder by only one of the observers (p = 0.032). Once the images were classified into either "diagnostic" or "non diagnostic" no difference was observed between the two groups. CONCLUSION: The authors conclude that fasting did not affect significantly the quality of abdominal sonographic images in children.

Keywords: Ultrasonography, Children, Abdominal, Fasting

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

Many reports in the literature have described findings of gossypibomas at conventional radiography and computed tomography. However, magnetic resonance imaging findings are still to be completely known. The purpose of the present study was to describe imaging findings of gossypibomas in a patient with previous history of brain surgery, presenting fever and mental confusion.

Keywords: Magnetic resonance imaging, Brain, Granuloma, Gossypiboma

OBJECTIVE: To utilize ultrasonography for evaluating the esophageal transit time as well as the esophagus capability of differentiating among non-solid substances ingested (water and yoghurt). MATERIALS AND METHODS: Twenty-two young adults of both sexes with no gastric or esophageal complaint were evaluated, with a B-mode 3.5 MHz, convex transducer placed over the epigastric area. The esophageal transit time was determined by means of a chronometer activated when the deglutition was initiated (glottic movement), and stopped upon visualization of the bolus through the intra-abdominal esophagus. RESULTS: The mean esophageal transit time for water was 6.64 ± 1.83 sec, and 8.59 ± 2.70 sec for yoghurt. The comparative statistical analysis by a t-paired test has demonstrated statistically significant differences between the mean esophageal transit times for the two substances. CONCLUSION: This new experimental method for evaluating the esophageal transit time by ultrasonography demonstrates significant differences in the time required for a determined liquid or pasty food passing through the esophagus, elucidating clinical suspicions and allowing a more precise indication for further, more complex clinical studies.

Keywords: Ultrasonography, Esophageal transit time, Abdominal esophagus

OBJECTIVE: To review the abdominal ultrasound findings in patients with serologically proven dengue fever and to compare the results with data from the literature. MATERIALS AND METHODS: Thirty-eight patients with serologically proven dengue fever, 25 female and 13 male, mean age of 35 years, were submitted to abdominal ultrasound. The ultrasound findings were compared with data from the literature. RESULTS: The most relevant ultrasound findings were diffuse gallbladder wall thickening in 18 cases (47.4%), abdominal and/or pelvic free fluid in 12 (31.6%), splenomegaly in 11 (28.9%), hepatomegaly in 10 (26.3%) and perivesicular fluid in 10 (26.3%). Twenty-six percent of the patients had normal abdominal ultrasound. CONCLUSION: Abdominal sonography is a useful additional diagnostic tool for the confirmation of suspected cases of dengue hemorrhagic fever and for the evaluation of severity and progression of the disease. The knowledge of the ultrasound possible findings in patients with dengue fever is of extreme importance for the radiologist.

Keywords: Dengue, Ultrasound, Abdominal findings

OBJECTIVE: To evaluate the contribution of abdominal ultrasound in the follow-up of a group of post-treatment breast cancer patients. MATERIAL AND METHODS: We retrospectively studied the findings of abdominal ultrasound examinations of 100 patients treated for primary breast cancer. These patients were attended from January to December of 1997 at the Ultrasound Sector, Division of Radiology of the Department of Clinical Medicine of the "Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo", SP, Brazil. Information such as age, histological type, staging, number of examinations and ultrasound findings were rated and analyzed. RESULTS: Abdominal ultrasound was normal in 70% of the patients whereas liver metastases were diagnosed in 3% of the patients. CONCLUSION: The majority of the abnormalities identified were not directly related to complications of breast cancer.

Keywords: Breast cancer, Abdominal ultrasound, Follow-up

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 utilize intra-abdominal esophagus ultrasonography to evaluate esophageal transit time for water and yogurt in orthostatic position, and to evaluate the influence of gender and body mass index. Materials and Methods: The present study included 89 young adults [40 women (mean age, 20.13 ± 1.62 years) and 49 men (mean age, 20.43 ± 2.17 years)] who did not show upper gastrointestinal tract disorder. Esophageal transit time was measured with the patient in orthostatic position during water and yogurt swallowing. Results: Esophageal transit time for women and men was, respectively, 5.84 ± 1.60 seconds versus 6.66 ± 1.68 seconds with water, and 9.12 ± 1.96 seconds versus 9.28 ± 1.70 seconds with yogurt. No difference between genders was observed in spite of the lower body mass index in women. Conclusion: Data regarding esophageal transit time for liquid (water) and pasty (yogurt) food swallowed by young adults in the orthostatic position did not demonstrate any difference between genders even in women with lower body mass index as compared with men.

Keywords: Ultrasonography; Intra-abdominal esophagus; Body mass index.

Gossypiboma is a term utilized to describe a mass developed from a matrix of cotton fibers surrounded by inflammatory granulomatous reaction. Its incidence is estimated at 0.15% to 0.2% of laparotomies. A foreign body within the abdominal cavity may provide a niche for proliferation of microorganisms, acting as primary focus for development of an abscess and peritonitis. Several studies have demonstrated the relevance of clinical correlation with the findings of different imaging methods (conventional radiography, ultrasonography, computed tomography and magnetic resonance imaging) in the diagnosis of gossypibomas. The present pictorial essay is aimed at demonstrating a series of typical cases of abdominal gossypibomas and illustrating the several presentations of such mass, with emphasis on the findings at different imaging methods in order to familiarize radiologists with this entity and with the main differential diagnosis.

Keywords: Gossypiboma; Abdominal; Imaging diagnosis.

OBJECTIVE: To evaluate the accuracy in the detection of abdominal aortic calcification by densitometry as compared with lateral spine radiography. MATERIALS AND METHODS: Study comprising 80 individuals, 50 of them with abdominal aortic calcification and 30 without calcification. Densitometry was performed once for each participant, with the patient in right lateral decubitus position. RESULTS:Both groups were similar in terms of age range and body mass index - mean age of 74.56 ± 10.55 years and 68.40 ± 10.80 years and mean body mass index of 28.94 ± 6.06 kg/m², and 26.84 ± 4.11 kg/m², respectively for the individuals with abdominal aortic calcification and for the individuals without calcification. A statistical comparison between densitometry and radiography demonstrates similar performances of the two methods in the detection of abdominal aortic calcification, with 100% specificity and positive predictive value, 94% sensitivity, 90.9% negative predictive value, and 96.3% accuracy. Qualitative equivalence in diagnosis was demonstrated by kappa correlation index of 0.922. CONCLUSION: The results obtained by radiography and densitometry were statistically equivalent, which endorses the indication of densitometry for investigating abdominal aortic calcification.

Keywords: Atherosclerosis; Abdominal aorta; Densitometry.

OBJECTIVE: To evaluate the feasibility of quantifying visceral adipose tissue (VAT) on computed tomography (CT) and magnetic resonance imaging (MRI) scans, using freeware, as well as calculating intraobserver and interobserver reproducibility. MATERIALS AND METHODS: We quantified VAT in patients who underwent abdominal CT and MRI at our institution between 2010 and 2015, with a maximum of three months between the two examinations. A slice acquired at the level of the umbilicus was selected. Segmentation was performed with the region growing algorithm of the freeware employed. Intraobserver and interobserver reproducibility were evaluated, as was the accuracy of MRI in relation to that of CT. RESULTS: Thirty-one patients (14 males and 17 females; mean age of 57 ± 15 years) underwent CT and MRI (mean interval between the examinations, 28 ± 12 days). The interobserver reproducibility was 82% for CT (bias = 1.52 cm²; p = 0.488), 86% for T1-weighted MRI (bias = −4.36 cm²; p = 0.006), and 88% for T2-weighted MRI (bias = −0.52 cm²; p = 0.735). The intraobserver reproducibility was 90% for CT (bias = 0.14 cm²; p = 0.912), 92% for T1-weighted MRI (bias = −3,4 cm²; p = 0.035), and 90% for T2-weighted MRI (bias = −0.30 cm²; p = 0.887). The reproducibility between T1-weighted MRI and T2-weighted MRI was 87% (bias = −0.11 cm²; p = 0.957). In comparison with the accuracy of CT, that of T1-weighted and T2-weighted MRI was 89% and 91%, respectively. CONCLUSION: The program employed can be used in order to quantify VAT on CT, T1-weighted MRI, and T2-weighted MRI scans. Overall, the accuracy of MRI (in comparison with that of CT) appears to be high, as do intraobserver and interobserver reproducibility. However, the quantification of VAT seems to be less reproducible in T1-weighted sequences.

Keywords: Intra-abdominal fat; Image processing, computer-assisted/methods; Tomography, X-ray computed; Magnetic resonance imaging; Reproducibility of results.

The rupture of an abdominal aortic aneurysm (AAA) is considered a high-risk surgical emergency, given the catastrophic consequences and high mortality rate. The objective of this pictorial essay is to illustrate the radiological signs that indicate rupture or imminent rupture. To that end, we describe cases treated at our facility and present a brief review of the literature on the topic. The clinical diagnosis of imminent AAA rupture can be difficult, because patients are usually asymptomatic or have nonspecific pain complaints. In the subsequent follow-up, it is possible to identify radiological signs that indicate instability or rupture itself and thus change the prognosis. Computed tomography is the modality of choice for evaluating an AAA and abdominal pain in the emergency setting. It is therefore essential that the radiologist immediately identify the imaging findings that indicate AAA rupture or the imminent risk of such rupture.

Keywords: Aortic aneurysm, abdominal/complications; Aortic aneurysm, abdominal/mortality; Aortic rupture/diagnostic imaging; Abdominal pain/diagnostic imaging; Tomography, X-ray computed/methods.

OBJECTIVE: To validate the use of a three-dimensional printing system for metric and volumetric analysis of the segments of an abdominal aortic aneurysm (AAA). MATERIALS AND METHODS: In patients scheduled to undergo endovascular AAA repair, the computed tomography angiography (CTA) measurements obtained during the preoperative assessment of the patients were compared with those obtained by computed tomography of individualized three-dimensional biomodels. RESULTS: The volumetric assessment showed a discrepancy of 3–12%, and the difference between the areas was 10–16%. CONCLUSION: Computed tomography measurements of 3D-printed biomodels of AAAs appear to be comparable to those of three-dimensional CTA measurements of the same AAAs, in terms of the metric and volumetric dimensions.

Keywords: Aortic aneurysm, abdominal/diagnostic imaging; Printing, three-dimensional; Aortic diseases; Biocompatible materials; Endovascular procedures; Blood vessel prosthesis implantation.

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.