OBJECTIVE: To evaluate fetal nuchal translucency, ductus venosus, nasal bone and maternal age > 35 years by means of aneuploidy screening between the 12th and 14th gestational weeks in a high-risk population. MATERIALS AND METHODS: Prospective, observational study involving 92 pregnant women at 12-14 gestational weeks, who were submitted to chorionic villus sampling because of high risk for trisomy 21 based on the measurement of nuchal translucency thickness (17.4%) or on maternal age > 35 years (78.3%). Before the chorionic villus sampling, fetal nuchal translucency thickness was measured, ductus venosus flow was evaluated and the nasal bone was identified. Sensitivity, specificity, positive predictive value and negative predictive value were calculated for tests in parallel and in sequence. RESULTS: Chromosomal abnormalities were found in 12 fetuses (13.5%); 7 (58.3%) were positive for trisomy 21. The nasal bone was present in all cases with chromosomal abnormalities. Isolated nuchal translucency, ductus venosus or maternal age showed low sensitivity (41.67-58.33%) and low positive predictive value (10-45.45%). Combined nuchal translucency + ductus venosus + maternal age showed the best results (100% sensitivity; 6.49% specificity; 14.29% positive predictive value; 100% negative predictive value). CONCLUSION: In pregnant women with >35 years of age, combined nuchal translucency + ductus venosus have showed the highest sensitivity as an indication for invasive procedure.

Keywords: Nuchal translucency measurement, Ductus venosus, Nasal bone, Maternal age, Trisomy

OBJECTIVE: To describe changes of the biliary tree demonstrated by magnetic resonance cholangiography (MRC) in patients with the hepatosplenic presentation of schistosomiasis mansoni, and evaluating the interobserver agreement in the detection of schistosomal cholangiopathy. MATERIALS AND METHODS: Prospective, cross-sectional study involving 24 patients with hepatosplenic schistosomiasis and 6 healthy patients (control group) submitted to biliary tree evaluation by MRC. The following changes of the biliary tree were considered: distortion, thinning, stenosis, dilation and irregularity. The interobserver agreement in the detection of biliary tree changes was calculated with the McNemar's test and the kappa index of agreement (κ). RESULTS: The interobserver agreement in the detection of distortion and thinning of the biliary tree was almost perfect (κ = 0.867; confidence interval [CI] 95% [0.512-1.0] and κ = 0.865; CI 95% [0.51-1.0], respectively). There was a substantial agreement for stenosis (κ = 0.78; CI 95% [0.424-1.0]), moderate agreement for dilation (κ = 0.595; CI 95% [0.247-0.942]) and mild agreement for thinning (κ = 0.229; CI 95% [0.095-0.552]). CONCLUSION: In a decreasing order of frequency, the changes of the biliary tree were observed: distortion, thinning, stenosis, dilation and irregularity. The interobserver agreement for signs of schistosomal cholangiopathy was almost perfect for distortion and thinning, and substantial for stenosis.

Keywords: Schistosomiasis mansoni, Magnetic resonance imaging, Cholangiography, Biliary ducts

We present a case of a 27-year-old male patient submitted to computed tomography and magnetic resonance imaging for the evaluation of a renal tumor. The radiological features of the mass suggested the diagnosis of a malignant renal tumor of parenchymatous origin. However, the histological findings proved to be a benign solitary fibrous tumor within the pelvis and caliceal portion of the right kidney.

Keywords: Neoplasia, Fibrous tumor, Kidney, Mesothelioma, Computed tomography, Magnetic resonance imaging

The melanotic neuroectodermal tumor of infancy, also known as progonoma, is a rare benign disease of neural crest origin that occurs within the first year of life and affects mainly the maxilla. The authors report a case of a 10-month-old child presenting with this uncommon tumor in the maxilla, emphasizing the diagnostic findings on computed tomography, and present a literature review.

Keywords: Neoplasia, Neural crest, Maxilla, Infancy, Computed tomography

OBJECTIVE: To test the hypothesis that the application of ductus venosus Doppler velocimetry between 10--14 weeks gestation may serve as a screening tool for the detection of fetuses with Down syndrome and estimate a new criteria of risk. PATIENTS AND METHODS: 491 fetuses were studied consecutively. In 132 cases a cytogenetic study was performed on material obtained from a biopsy of the chorionic villus, and in 359 cases the postnatal phenotype was used as a basis for the result. In addition to the routine ultrasonographic examination, all the fetuses were submitted to measurement of the nuchal translucency thickness. T "student" and ANOVA tests were used for the statistical analysis. The sensitivity, specificity, positive and negative predictive values, true-positive probability and likelihood ratio were calculated. RESULTS: There were 21 cases of Down syndrome. On these 21 fetuses the ductus venosus blood flow during atrial contraction was either absent (n = 3) or reversed (n = 17) - sensitivity = 95.2%. In the chromosomally normal fetuses (n = 470) only 8 had abnormal Doppler findings in the ductus venosus (specificity = 98.2%, positive and negative predictive values = 71.4% and 99.8%, respectively, and positive and negative likelihood ratio = 56 and 0.1, respectively). CONCLUSION: Our preliminary results suggest that the presence of Down syndrome may be strongly suspected when there is reverse or absent flow in the ductus venosus Doppler velocimetry during atrial contraction. We speculate the possibility of a new criteria to calculate the new risk of Down syndrome based on Doppler examination of the ductus venosus. Using the program of the Fetal Medicine Foundation to assess the baseline risk, a multiplying factor of approximately 0.1 (negative predictive value) is applied for normal ductus whereas a multiplying factor of 50 is applied in case of reverse or absent ductus, thus establishing a new adjusted risk factor.

Keywords: Doppler velocimetry, Ductus venosus, Down syndrome, Prenatal diagnosis

The authors review the use of intraoperative ultrasonography (IOUS) in the management of biliary-pancreatic disease. The methodology of IOUS used for the examination of the biliary-pancreatic ductal system as well as the most important findings and pitfalls of image interpretation are described. Additionally, some ultrasonography findings in pancreatic tumors, pancreatitis, bile duct tumors and bile duct stones are presented. The authors emphasize the importance of understanding this ultrasonographic method due to the increasingly use of IOUS in biliary-pancreatic surgery.

Keywords: Intraoperative ultrasonography, Pancreas, Biliary ductal system

The authors describe the main applications of endoscopic ultrasonography for the management of diseases of the gallbladder and biliary ductal system. In addition, some ultrasound findings of benign and malignant diseases affecting these structures of the digestive tract are presented, emphasizing the diagnostic importance of endoscopic ultrasonography.

Keywords: Ultrasonography, Endoscopic ultrasonography, Digestive tract, Gallbladder, Biliary system

OBJECTIVE: The aim of this prospective study was to investigate the feasibility of using a negative oral contrast agent to null the bowel signal during magnetic resonance cholangiopancreatography. MATERIAL AND METHOD: Fifteen healthy volunteers with no previous history of pancreaticobiliary disease or surgery were imaged with a single-shot fast spin-echo pulse sequence, using a magnetic resonance imaging system operating at 1.0 T. Data acquisition was started before and after administration of oral contrast agent. Using the magnetic resonance images obtained before and after administration of oral contrast agent, the common bile duct, pancreatic duct and papilla were assessed and graded by two radiologists. The frequency of adverse effects and the tolerance of the contrast were also evaluated. RESULTS: All patients that found negative oral contrast agent unpleasant (73% of the cases) tolerated well the oral contrast agent. Adverse effects as abdominal pain and diarrhea were noted in 30% of the patients. In all patients the high signal intensity from the intestinal fluid was completely suppressed. The depictions of the common hepatic duct were slightly improved, whereas the depictions of the choledochus, papilla and pancreatic duct were markedly improved by the negative oral contrast agent administration. CONCLUSION: Negative oral magnetic resonance contrast agent can be an effective and safe contrast media in eliminating signal intensity of the gastrointestinal tract, thus improving the depiction of the biliary system in magnetic resonance cholangiopancreatography.

Keywords: Magnetic resonance imaging, Biliary system, Pancreatic duct, Contrast media

The authors describe the case of a young female patient with primary amenorrhea and normal secondary sexual characteristics. The diagnostic investigation demonstrated the occurrence of Mayer-Rokitansky-Kuster-Hauser’s syndrome.

Keywords: Paramesonephric (Müllerian) ducts; Abnormalities.

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.

In the investigation of tumors with conventional magnetic resonance imaging, both quantitative characteristics, such as size, edema, necrosis, and presence of metastases, and qualitative characteristics, such as contrast enhancement degree, are taken into consideration. However, changes in cell metabolism and tissue physiology which precede morphological changes cannot be detected by the conventional technique. The development of new magnetic resonance imaging techniques has enabled the functional assessment of the structures in order to obtain information on the different physiological processes of the tumor microenvironment, such as oxygenation levels, cellularity and vascularity. The detailed morphological study in association with the new functional imaging techniques allows for an appropriate approach to cancer patients, including the phases of diagnosis, staging, response evaluation and follow-up, with a positive impact on their quality of life and survival rate.

Keywords: Cancer imaging; Magnetic resonance imaging; Oncology; Neoplasia; Functional imaging; Diffusion.

OBJECTIVE: The present study was aimed at evaluating the contribution of transrectal prostate ultrasound in the screening for prostate neoplasias and in the guidance of prostate biopsies. MATERIALS AND METHODS: Prospective study developed over a one-year period. All the patients with indication for prostate biopsy were evaluated. Regardless of PSA values, the patients underwent ultrasound in order to identify suspicious nodules (confirmed by two observers). Sextant biopsy was subsequently performed. In cases of finding suspicious nodules, an additional puncture directed to such nodules was done. RESULTS: In a total of 155 cases the prevalence of malignancy was of 53%. Suspicious nodules were detected in 34 patients, and 25 where malignant (positive predictive value of 74%). The specificity and sensitivity for suspicious nodules were 88% and 31% respectively. Comparatively with the randomly obtained sextant specimens, the rate of findings of neoplasia was higher in the specimens obtained with puncture directed to the nodule (p = 0.032). No statistically significant difference was observed in the Gleason score for both types of specimens (p = 0.172). CONCLUSION: The high positive predictive value and the high rate of findings of neoplasia in specimens of suspicious nodules should be taken into consideration in the future. The authors suggest a biopsy technique similar to the one described in the present study (sextant biopsy plus puncture directed to the suspicious nodule).

Keywords: Prostatic neoplasia; Ultrasonography; Imaging-guided biopsy; Diagnostic techniques and procedures; Screening.

OBJECTIVE: To determine the rates of diagnostic underestimation at stereotactic percutaneous core needle biopsies (CNB) and vacuum-assisted biopsies (VABB) of nonpalpable breast lesions, with histopathological results of atypical ductal hyperplasia (ADH) or ductal carcinoma in situ (DCIS) subsequently submitted to surgical excision. As a secondary objective, the frequency of ADH and DCIS was determined for the cases submitted to biopsy. MATERIALS AND METHODS: Retrospective review of 40 cases with diagnosis of ADH or DCIS on the basis of biopsies performed between February 2011 and July 2013, subsequently submitted to surgery, whose histopathological reports were available in the internal information system. Biopsy results were compared with those observed at surgery and the underestimation rate was calculated by means of specific mathematical equations. RESULTS: The underestimation rate at CNB was 50% for ADH and 28.57% for DCIS, and at VABB it was 25% for ADH and 14.28% for DCIS. ADH represented 10.25% of all cases undergoing biopsy, whereas DCIS accounted for 23.91%. CONCLUSION: The diagnostic underestimation rate at CNB is two times the rate at VABB. Certainty that the target has been achieved is not the sole determining factor for a reliable diagnosis. Removal of more than 50% of the target lesion should further reduce the risk of underestimation.

Keywords: Breast neoplasia; Core needle biopsy; Vacuum-assisted biopsy; Diagnostic techniques and procedures; Noninvasive intraductal carcinoma.

Most tumors of the biliary tract are too small to have specific imaging characteristics or for percutaneous puncture to provide sufficient material for diagnosis. Percutaneous transhepatic biliary drainage, in addition to being a well-established technique in the treatment of obstructive jaundice, provides adequate access for sampling obstructive lesions. In cases of biliary lesions, percutaneous transhepatic biopsy of the biliary tract has proven to be a useful diagnostic technique, with a reported accuracy of over 90% at some referral centers.

Keywords: Bile duct neoplasms; Biliary tract; Biopsy/methods; Biopsy, needle/methods; Cholangiography.

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.