OBJECTIVE: To evaluate and measure the scapular positioning, and establishing its correlation with functional postural analysis and degree of upper extremities disability in sonographers. MATERIALS AND METHODS: Eighteen physicians divided into two groups - symptomatic individuals with pain for more than six months, and asymptomatic individuals - were interviewed and submitted to physical assessment with application of the Brazilian version of the DASH questionnaire. Functional measurements of scapular inclination angles and upper limbs positioning were obtained during the ultrasound scanning. The Mann-Whitney U test was utilized for analyzing the disability questionnaires; the t-Student test, for upper limbs positioning; ANOVA, for scapular inclination angles, and the Spearman's test for correlation between the functional upper limbs positioning and disability degree. RESULTS: A significant difference between symptomatic and asymptomatic groups was observed in the first 30 items of the DASH questionnaire as well as in the four study-related questions. Measurements of scapular positioning presented significant differences between the groups in the frontal plane at 90° and 120°. No significant difference was found for the analysis of functional upper limbs positioning. CONCLUSION: Changes in the scapular positioning may result in upper limbs dysfunction, and the application of the DASH questionnaire can indicate the level of pain and disability of an individual.

Keywords: Biomechanics, Shoulder joint complex, Scapular positioning, Scapulohumeral rhythm, Sonographer

OBJECTIVE: The present study was aimed at evaluating the frequency and types of anatomical variants of the ostiomeatal complex. MATERIALS AND METHODS: Computed tomography studies of 200 patients evaluated for clinical suspicion of sinusopathy were reviewed. RESULTS: Two or more types of anatomical variants were observed in 83.5% of the patients. The most frequent anatomical variants involved the middle turbinate (84%) and the nasal septum (34%). Other common variants found were the presence of pneumatized agger nasi cells and infraorbital ethmoid cells (Haller cells). CONCLUSION: The prevalence of anatomical variants in the ostiomeatal complex is high, the most frequent ones involving the middle turbinate and the nasal septum.

Keywords: Computed tomography, Ostiomeatal complex, Paranasal cavities, Anatomy, Drainage

OBJECTIVE: To describe the high-resolution computed tomography findings in the lung of patients with systemic sclerosis, independently of the respiratory symptoms. MATERIALS AND METHODS: Seventy-three high-resolution computed tomography scans of 44 patients with clinical diagnosis of systemic sclerosis were reviewed and defined by the consensus of two radiologists. RESULTS: Abnormalities were seen in 91.8% (n = 67) of the scans. The most frequent findings were reticular pattern (90.4%), ground-glass opacities (63%), traction bronchiectasis and bronchiolectasis (56.2%), esophageal dilatation (46.6%), honeycombing pattern (28.8%) and signs of pulmonary hypertension (15.6%). In most cases the lesions were bilateral (89%) and symmetrical (58.5%). The lesions were predominantly located in the basal (91.2%) and peripheral (92.2%) regions. CONCLUSION: In the majority of the patients, progressive systemic sclerosis can cause pulmonary fibrosis mainly characterized by reticular pattern with basal and peripheral distribution on high-resolution computed tomography.

Keywords: High-resolution computed tomography, Progressive systemic sclerosis, Reticular pattern

Sonographic presentation of bile duct hamartomas is variable. It is important to recognize their different forms of presentation in order to be included in the differential diagnosis of multiple focal hepatic lesions. Herein the authors report a case of bile duct hamartomas that was identified as multiple diffuse hyperechogenic liver nodules with the largest measuring 1.6 cm, without posterior acoustic reverberation.

Keywords: Liver, Bile duct hamartomas, von Meyenburg complex, Ultrasonography

The recognition and identification of benign liver tumors is important since most of these tumors do not require any intervention. The authors report the ultrasonography findings in 16 patients with bile duct hamartomas (von Meyenburg complex) that were evaluated prospectively by an active search of eight years. Multiple lesions with size equal or less than 0.8 cm were identified in 14 patients. Two other patients had only two lesions measuring 0.4 cm to 1.3 cm. The most common ultrasonographic pattern was that of multiple small hyperechogenic lesions (with or without posterior acoustic reverberation) with irregular margins (14 patients). A less common finding (two patients with two lesions each) was the "target" pattern with echogenic center and well defined limits.

Keywords: Liver, Bile duct hamartomas, von Meyenburg complex, Ultrasonography, Intraoperative ultrasonography

Objective: To evaluate endothelial function in patients with risk factors for atherosclerosis by measuring brachial artery flow-mediated dilatation (BAFMD) and intima-media thickness (IMT) of carotid and brachial arteries. Materials and methods: A cross-sectional, case-control study in which endothelial function was evaluated by measurement of BAFMD and IMT of carotid and brachial arteries and presence or absence of risk factors in 112 patients distributed as follows: women with risk factors (n = 49), women control group (n = 24), men with risk factors (n = 21), men control group (n = 18). Results: BAFMD was significantly compromised in the group with risk factors as compared with the control group, regardless of sex: in women, 15.2 Χ 25.3 (p < 0.01); in men, 11.8 Χ 16.8 (p < 0.02). On the other hand, IMT was not significant both for the carotid and brachial arteries, regardless of sex: brachial artery in women, 0.3 Χ 0.3 (p < 0.06); brachial artery in men, 0.36 Χ 0.23 (p < 0.07); carotid artery in women, 0.6 Χ 0.4 (p < 0.07); carotid artery in men, 0.85 Χ 0.38 (p < 0.08). The significance level was set at 5% (p < 0.05). Conclusion: Measurement of BAFMD was effective for detecting endothelial impairment in a population with risk factors for atherosclerosis.

Keywords: Atherosclerosis; Endothelial dysfunction; Brachial artery flow-mediated dilatation; Intima-media complex of the carotid and brachial arteries.

OBJECTIVE: To describe the clinical and imaging findings that may aid in correctly diagnosing osteoid osteoma of the elbow. MATERIALS AND METHODS: The authors have retrospectively evaluated seven patients diagnosed with osteoid osteoma of the elbow histologically confirmed by bone biopsy. The patients’ medical records and imaging studies were reviewed. RESULTS: Among the 142 patients with osteoid osteoma identified in the archives of the institutions, 4.9% had the lesion in the elbow, predominantly in men (2.5:1), with a mean age of 25 years. Pain and limitation of movement were the most common symptoms. Five of the patients (71.4%) had previously received a different clinical diagnosis. The mean duration of symptoms was 21 months. Radiography did not demonstrate the nidus in 42.8% of cases. Computed tomography and magnetic resonance imaging clearly demonstrated the nidus. Joint effusion was a constant finding. The histological findings corresponded to the ones usually observed in such cases. Surgical resection has brought relief of symptoms and/or functional improvement in all of the cases. CONCLUSION: It is important to consider the possibility of osteoid osteoma in young adult patients with pain, limitation of movement and signs of synovitis in the elbow refractory to conservative treatment. The detection of bone sclerosis, cortical thickening and/or periosteal reaction at radiography allows directing computed tomography towards the accurate identification of the nidus.

Keywords: Osteoid osteoma; Intra-articular; Elbow; Synovitis; Imaging; Biopsy.

OBJECTIVE: To compare automatic and manual measurements of intima-media complex (IMC) in common carotid, common femoral and right subclavian arteries of HIV-infected patients in relation to a control group, taking into consideration the classical risk factors for atherosclerosis. MATERIALS AND METHODS: The study sample comprised 70 HIV-infected patients and 70 non-HIV-infected controls paired according sex and age. Automatic (gold standard) and manual measurements of IMC were performed in the carotid arteries. Manual measurements were also performed in common femoral and right subclavian arteries. Bland-Altman graphs were utilized in the comparison and the adopted level significance was 5%. RESULTS: Intima-media complex alterations were not observed in any of the individuals as the mean automatic measurement in the right common carotid (RCC) artery was considered as the gold standard. As the gold standard was compared with the manual measurements (mean, maximum and minimum), no clinically significant alteration was observed. As the gold standard was compared with other sites, the difference was statistically and clinically significant at the origin of right subclavian artery (RCC: 0.51 mm vs. 0.91 mm) (p < 0.001). CONCLUSION: HIV-infected individuals are not at higher risk for atherosclerosis than the control population.

Keywords: Atherosclerosis; Intima-media complex; Automatic; Subclavian; Femoral.

OBJECTIVE: To develop a simulator for training In fluoroscopy-guided facet joint Injections and to evaluate the learning curve for this procedure among radiology residents. MATERIALS AND METHODS: Using a human lumbar spine as a model, we manufactured five lumbar vertebrae made of methacrylate and plaster. These vertebrae were assembled in order to create an anatomical model of the lumbar spine. We used a silicon casing to simulate the paravertebral muscles. The model was placed into the trunk of a plastic mannequin. From a group of radiology residents, we recruited 12 volunteers. During simulation-based training sessions, each student carried out 16 lumbar facet injections. We used three parameters to assess the learning curves: procedure time; fluoroscopy time; and quality of the procedure, as defined by the positioning of the needle. RESULTS: During the training, the learning curves of all the students showed improvement in terms of the procedure and fluoroscopy times. The quality of the procedure parameter also showed improvement, as evidenced by a decrease in the number of inappropriate injections. CONCLUSION: We present a simple, inexpensive simulation model for training in facet joint injections. The learning curves of our trainees using the simulator showed improvement in all of the parameters assessed.

Keywords: Zygapophyseal joint; Injections, intra-articular; Injections, spinal; Learning curve; Models, anatomic; Radiology, interventional.

OBJECTIVE: To evaluate the anatomical variations of the attachment of the inferior glenohumeral ligament (IGHL) to the anterior glenoid rim. MATERIALS AND METHODS: This was a retrospective review of 93 magnetic resonance arthrography examinations of the shoulder.Two radiologists, who were blinded to the patient data and were working independently, read the examinations. Interobserver and intraobserver agreement were evaluated. The pattern of IGHL glenoid attachment and its position on the anterior glenoid rim were recorded. RESULTS: In 50 examinations (53.8%), the glenoid attachment was classified as type I (originating from the labrum), whereas it was classified as type II (originating from the glenoid neck) in 43 (46.2%). The IGHL emerged at the 4 o’clock position in 58 cases (62.4%), at the 3 o’clock position in 14 (15.0%), and at the 5 o’clock position in 21 (22.6%). The rates of interobserver and intraobserver agreement were excellent. CONCLUSION:Although type I IGHL glenoid attachment is more common, we found a high prevalence of the type II variation. The IGHL emerged between the 3 o’clock and 5 o’clock positions, most commonly at the 4 o’clock position.

Keywords: Shoulder; Ligaments, articular/anatomy & histology; Magnetic resonance imaging.