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 Breast Imaging Reporting and Data System (BI-RADS™) from the American College of Radiology is a system designed to standardize mammographic reporting, reduce confounding factors in breast imaging interpretation, and to simplify the management of the final result. OBJECTIVE: To identify how the system is being used, providing information to help the Brazilian College of Radiology to develop strategies to improve its use. MATERIALS AND METHODS: Data were collected in the City of Goiânia, GO, Brazil. Each woman submitted to the examination in the service between January and June, 2003 was asked to provide previous reports and films. Examinations performed between 1/7/2001 and 30/6/2003 were included in the analysis. RESULTS: A total of 104 previous reports done by 40 radiologists from 33 different services were collected for analysis; 77% (n = 80) used the BI-RADS™. From these, only 15% (n = 12) were concise, none followed the recommendations suggested by the system, 98.75% (n = 79) were not in conformity with the lexicon terminology and in 65% (n = 51) there was no reference to pertinent recommendations. CONCLUSION: Although largely used, BI-RADS™ was not recognized as a system designed to standardize the reports and it was used almost exclusively to a final categorization of the exams.

Keywords: Mammography, Breast neoplasms, Detection

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

The purpose of this work was to evaluate the action of the vitamin E as a radioprotective agent in the process of tissue reparation in rats submitted to a surgical procedure, which consisted of a wound done in the fore dorsal area. The animals were divided into five groups: group C (controls) - wound; group VE - previous treatment with vitamin E (90 UI); group IR - wound and irradiation of the borders three days after surgery; group VEIR - previous treatment with 90 UI of the vitamin E and irradiation of the borders three days after the surgery; group OIR - previous treatment with olive oil and irradiation of the borders three days after surgery. The radioprotective effect of the vitamin E was evaluated using hematoxylin-eosin stained specimens in order to identify granulation tissue, at 4, 7, 14 and 21 days after the surgical procedures. The results showed that 6 Gy of electron irradiation with a beam of 6 MeV caused retardation of the tissue repairing process and that vitamin E was effective as a radioprotective agent.

Keywords: Vitamin E, Radioprotective, Free radicals, Ionizing radiation, Tissue reparation

Pseudomyxoma peritonei is rare tumor that presents insidious evolution and is characterized by mucinous ascites or implants in the peritoneal cavity. The origin of this tumor is frequently the appendix or the ovaries. Diagnosis can be established by fine needle aspiration cytology, ultrasonography, computed tomography or magnetic resonance imaging . The authors report three cases of patients with pseudomyxoma peritonei arising from the ovary that were submitted to computed tomography and magnetic resonance imaging examinations of the abdomen. This paper emphasizes the importance of these imaging methods that permit greater spatial resolution, multiplanar images and different types of sequences (magnetic resonance imaging), and allow better evaluation of these lesions. Computed tomography examinations showed lobulated low-density masses with well defined limits causing "scalloping" of the hepatic and splenic borders due to extrinsic compression by adjacent peritoneal implants. Invasion of the liver and spleen was not observed. Magnetic resonance imaging examinations revealed expansive peritoneal lesions with low-intensity signal on T1-weighted images and high-intensity signal on T2-weighted images, adjacent to the hepatic and splenic borders.

Keywords: Pseudomyxoma peritonei. Computed tomography. Magnetic resonance imaging.

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 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.

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.

Sclerosing encapsulating peritonitis is a rare and frequently severe entity characterized by total or partial involvement of small bowel loops by a membrane of fibrous tissue. The disease presents with nonspecific clinical features of intestinal obstruction, requiring precise imaging diagnosis to guide the treatment. The present report emphasizes the importance of computed tomography in the diagnosis of this condition and its confirmation by surgical correlation.

Keywords: Peritonitis; Peritoneal fibrosis; Sclerosing encapsulating peritonitis; Computed tomography.

Sclerosing encapsulating peritonitis, a rare cause of bowel obstruction, was described as a complication associated with peritoneal dialysis which is much feared because of its severity. The authors report a case where radiological findings in association with clinical symptoms have allowed for a noninvasive diagnosis of sclerosing encapsulating peritonitis, emphasizing the high sensitivity and specificity of computed tomography to demonstrate the characteristic findings of such a condition.

Keywords: Sclerosing encapsulating peritonitis; Peritoneal dialysis; Peritoneal fibrosis; Intestinal obstruction; Computed tomography; Chronic renal failure.

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.

OBJECTIVE: To determine the most common imaging features of pseudomyxoma peritonei (PMP), as well as the histologic subtypes of the primary tumors. MATERIALS AND METHODS: We reviewed 30 cases of women with pathologically confirmed PMP. Only computed tomography scans were available. All cases were retrospectively studied by four radiologists, working independently. We identified the most common imaging findings, the predominant primary site of the disease, and the growth pattern. The most common sites of recurrence were also analyzed. RESULTS: The most common computed tomography finding was peritoneal/omental nodules (including “omental caking”), followed by visceral scalloping and non-mucinous ascites. The most common site of the primary tumor was the appendix (in 63.3%), followed by the ovaries (in 16.6%), and 16.6% of the tumors were of undetermined origin. There was one case of synchronous appendiceal and ovarian tumors. Low-grade mucinous neoplasm was the most common histologic subtype, accounting for 84.2% of the appendiceal tumors and 40% of the ovarian tumors. CONCLUSION: Although PMP is a relatively rare entity, radiologists must be aware of its possible imaging findings, common locations, and possible patterns of recurrence. The origin of the primary tumor should also be investigated. Future studies are needed in order to determine which preoperative imaging findings predict surgical outcomes and to characterize the main findings of radiological recurrence.

Keywords: Pseudomyxoma peritonei; Tomography, X-ray computed; Neoplasms, cystic, mucinous, and serous/pathology.

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.

Mucoceles of the appendix are rare and can have quite variable imaging and clinical presentations, sometimes mimicking an adnexal mass. The underlying cause can be neoplastic or non-neoplastic. The typical imaging appearance of a mucocele of the appendix is that of a cystic structure with a tubular morphology. This structure is defined by having a blind-ending and being contiguous with the cecum. Radiologists should be familiar with key anatomical landmarks and with the various imaging features of mucoceles of the appendix, in order to provide a meaningful differential diagnosis of a lesion in the right lower abdominal quadrant. In addition, a neoplastic mucocele can rupture, resulting in pseudomyxoma peritonei, which will change the prognosis dramatically. Therefore, prompt diagnostic imaging is crucial.

Keywords: Mucocele/diagnostic imaging; Appendiceal neoplasms/diagnostic imaging; Adenocarcinoma, mucinous/diagnostic imaging; Cystadenoma, mucinous/diagnostic imaging; Pseudomyxoma peritonei/etiology.