OBJECTIVE: To compare sonographic and magnetic resonance imaging findings in deep endometriosis with emphasis on intestinal involvement. MATERIALS AND METHODS: Eighteen women aged between 23 and 49 years with clinical suspicion and gynecological signs suggestive of deep endometriosis were submitted to ultrasonography and magnetic resonance imaging for correlation between findings. RESULTS: Ultrasonography detected 40 lesions while magnetic resonance imaging detected 53 lesions in the pelvis. A comparative study has not shown any statistically significant intermethod difference in the detection of lesions (respectively p > 0.19 and p > 0.14). In the rectosigmoid junction, magnetic resonance imaging has detected one (5.6%) lesion, while ultrasonography has detected four lesions (22.2%). In the rectum, ultrasonography has detected eight lesions (44.4%), and magnetic resonance imaging has detected seven lesions (38.9%). CONCLUSION: The intermethod agreement has not been good for lesions in the rectosigmoid junction, considering that ultrasonography has detected a higher number of lesions in this region, but a lower number of lesions in the pelvis as compared with magnetic resonance imaging. The global comparative analysis has demonstrated no statistically significant intermethod difference in the detection of lesions. Low cost, good tolerability and high availability make ultrasonography a valuable diagnostic tool in cases of deep endometriosis.

Keywords: Deep endometriosis, Diagnosis, Transvaginal ultrasonography, Magnetic resonance imaging

Endometriosis is characterized by the presence of normal endometrial tissue outside the uterine cavity. In patients with deep pelvic endometriosis, uterosacral ligaments, rectum, rectovaginal septum, vagina or bladder may be involved. Clinical manifestations may be variable, including pelvic pain, dysmenorrhea, dyspareunia, urinary symptoms and infertility. Complete surgical excision is the gold standard for treating this disease, and hence the importance of the preoperative work-up that usually is limited to an evaluation of sonographic and clinical data. Magnetic resonance imaging is of paramount importance in the diagnosis of endometriosis, considering its high accuracy in the identification of lesions intermingled with adhesions, and in the determination of peritoneal lesions extent. The present pictorial review describes the main magnetic resonance imaging findings in deep pelvic endometriosis.

Keywords: Magnetic resonance imaging, Endometriosis, Female pelvis, Infertility

OBJECTIVE: Early diagnosis of voiding dysfunction can minimize social and psychological repercussions and avoid renal lesions. The ureteric jet can be evaluated by color Doppler, and a good correlation has been observed between this method and patients' clinical data in the diagnosis of voiding dysfunction. This study was aimed at evaluating the interobserver agreement in the assessment of the ureteral jet in asymptomatic children. MATERIALS AND METHODS: Interobserver agreement was prospectively evaluated. A total of 41 patients were sequentially evaluated by two medical sonographers. For each patient, three consecutive Doppler waveforms were obtained from each of the two ureteral jets. The number of peaks on each wave was observed and classified. The maximum velocity of the highest peak of each waveform was also observed. Kappa coefficients (κ) were calculated. RESULTS: Moderate interobserver agreement was observed (κ = 0.48; 95% confidence interval: 0.36-0.60). Most frequently a plateau pattern was observed for the ureteric jet. Maximum velocities measured by the two observers were respectively 32.37 cm/s and 35.63 cm/s. CONCLUSION: Moderate interobserver agreement was observed in the evaluation of the ureteric jet by means of color Doppler.

Keywords: Ureter, Urination, Children

Endometriosis is defined as the presence of functional endometrial tissue outside the endometrial cavity and myometrium. Although this is a frequent disease with multifactorial causes, involvement of the lower urinary tract is rare. Magnetic resonance imaging is highly sensitive, specific and accurate in the diagnosis of endometriosis in the lower urinary tract, especially for allowing the identification of lesions obscured by adhesions or with subperitoneal extension. The present iconographic essay presents the main magnetic resonance imaging findings of the lower urinary tract involvement by endometriosis.

Keywords: Magnetic resonance imaging, Endometriosis, Infertility, Genitourinary tract, Bladder, Urethra

OBJECTIVE: To compare low-field (0.2 T) with high-field (1.5 T) magnetic resonance imaging in the assessment of pelvic endometriosis and adenomyosis. MATERIALS AND METHODS: Twenty-seven female patients with clinically suspected endometriosis were prospectively evaluated by means of high-field and low-field magnetic resonance imaging. The reading of the images was performed by a single radiologist, initiating by the low-field, followed by the high-field images. High-field magnetic resonance imaging was utilized as the golden-standard. RESULTS: Among the 27 patients included in the present study, 18 (66.7%) had some type of lesion suggesting the presence of endometriosis demonstrated at high-field images. In 14 of these patients the diagnosis was correctly established by low-field magnetic resonance imaging. Endometriomas, tubal lesions, and endometriotic foci > 7 mm identified at the high-field images were also identified at low-field images with 100% accuracy, sensitivity and specificity. Among the nine patients diagnosed with adenomyosis by high-field images, eight were correctly diagnosed by low-field images with 88.9% accuracy, specificity and sensitivity. CONCLUSION: Low-field magnetic resonance imaging demonstrated a low sensitivity in the detection of small endometriotic foci, high sensitivity in the detection of endometriomas and large endometriotic foci, and high accuracy in the detection of adenomyosis when compared with high-field magnetic resonance imaging.

Keywords: Magnetic resonance imaging, Endometriosis, Adenomyosis, Diagnosis

OBJECTIVE: To evaluate endometrial alterations by means of transvaginal ultrasound and to correlate them with hysteroscopic and histological findings in patients under tamoxifen therapy. MATERIALS AND METHODS: The present study was developed in the period between January 2003 and December 2005, including patients under tamoxifen therapy for breast cancer, and presenting with endometrial thickening > 5 mm. The sonographic findings were correlated with hysteroscopic and anatomopathological results. RESULTS: Twenty-five patients, mean age 62.6 years, were selected. The mean time elapsed from the diagnosis of cancer was 4.3 years, and use of tamoxifen, three years. Twenty patients (80%) were asymptomatic, and five (20%) presented with bleeding. Ultrasound showed that 16% of patients had endometrial thickening ranging between 5 mm and 8 mm, 40% between 9 mm and 15 mm, and 44% above 15 mm. Hysteroscopy showed 40% of patients with atrophy, 16% with cystic atrophy, 28% with polyps and 16% with hyperplastic lesion. Anatomopathological study showed 35.2% of patients with normal results, 5.8% with atrophy, 29.4% with polyps and 11.7% with hyperplasia. One case of adenocarcinoma (5.8%) was observed. CONCLUSION: Combined ultrasound and hysteroscopy have proven to be important allies in the evaluation of patients under tamoxifen therapy. Ultrasonography presents low specificity for detecting endometrial thickening, while hysteroscopy is more accurate in the detection of polyps, hyperplasia and neoplastic alterations.

Keywords: Ultrasound, Hysteroscopy, Tamoxifen

OBJECTIVE: To define, by means of computed tomography, the level of ureteral implantation into de bladder. MATERIALS AND METHODS: We have measured the distances from the ureteral meatus to the acetabulum, and to the superior margin of the pubic symphysis, as well as the bladder volume, using contrast enhanced computed tomography of the pelvis in 46 patients (31 male and 15 female) in the age range between 18 and 45 years, with at least one of the ureteres filled with excreted contrast material. The Student t test has been applied to determine eventual statistically significant differences between groups. RESULTS: The level of ureteral implantation into the bladder was, on average, 10.6 ± 8.1 mm below the acetabular roof, and 29.7 ± 9.5 mm above the superior margin of the pubic symphysis. In patients with bladder repletion volume of < 200 ml and > 200 ml, the level of ureteral implantation into the bladder was, respectively, on average, 11.6 ± 7.3 mm and 10.2 ± 8.4 mm below the acetabular roof (p = 0.61), and 28.3 ± 7.3 mm and 30.3 ± 10.2 mm above the superior margin of the pubic symphysis (p = 0.52), and in male and female men patients, respectively, on average, 11.8 ± 8.0 mm and 8.3 ± 8.0 mm below the acetabular roof (p = 0.17), and 27.7 ± 9.2 mm and 33.9 ± 8.8 mm above the superior margin of the pubic symphysis (p = 0.34). CONCLUSION: Calcifications located < 3 cm below the acetabular roof and < 1.5 cm above the superior margin of the pubic symphysis probably do not represent ureteral calculi. Vesical repletion or sex have no significant influence on the ureteral meatus position.

Keywords: Calculus, Ureter, Ureteral obstruction, Lithiasis, X-ray computed tomography

Our purpose was to evaluate the accuracy of unenhanced helical computed tomography in the diagnosis of ureteral lithiasis, to establish the frequency of the main computed tomography findings, and to assess and compare the interobserver agreement with the results of conventional intravenous urography. A prospective double-blind study was carried out in 25 patients referred for unenhanced helical computed tomography and conventional intravenous urography due to nephretic colic. Both methods were employed to evaluate the size of the kidneys, hydronephrosis and the size and location of ureteral stones. Perirenal hyperdensities, periureteral edema and the halo sign were also assessed by unenhanced helical computed tomography. In 23 of the 25 unenhanced helical computed tomography examinations (92%) and in 17 of the 25 conventional intravenous urography examinations (68%) there was agreement on the results of the two observers. In 21 of the 25 patients, there was agreement between the results of both methods. We concluded that unenhanced helical computed tomography is as efficient as conventional intravenous urography in the evaluation of patients with nephretic colic, is a reproducible method, and avoids the discomfort of the use of intravenous contrast.

Keywords: Lithiasis. Ureter. Kidney. Computed tomography.

The involvement of the retroperitoneum by endometriosis occurs only sporadically. In the present report, emphasis will be given to the magnetic resonance imaging findings which raised the diagnostic suspicion of periureteral lesion in a patient undergoing tamoxifen therapy, presenting with left upper quadrant pain and hydronephrosis. Histopathological findings obtained by means of computed tomography-guided percutaneous biopsy revealed the diagnosis of periureteral endometriosis.

Keywords: Endometriosis; Ureter; Tamoxifen; Magnetic resonance imaging; Biopsy.

Endometriosis is characterized by the presence of endometrial tissue outside the uterus. When endometrial implants penetrate more than 5 mm into the peritoneum, the condition is referred to as deep pelvic endometriosis. Although laparoscopy is the gold standard test to establish a diagnosis of deep endometriosis, transvaginal ultrasound represents an alternative that can contribute to detection of the disease, because it is an accessible, low-cost, noninvasive examination that allows preoperative planning in cases requiring surgical treatment. However, in clinical practice, transvaginal ultrasound is still not widely used as the first-line examination in suspected cases of endometriosis. This essay describes the findings of deep endometriosis on transvaginal ultrasound, in order to disseminate knowledge of the utility of the technique for the diagnosis of this disease.

Keywords: Endometriosis/diagnostic imaging; Ultrasonography/methods; Diagnostic techniques and procedures.

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.