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

Currently, computed tomography is the method of choice for assessment of paranasal sinuses, nasal fossae and their anatomical variations. Presumably, these variations may induce osteal obstruction, preventing mucus drainage and predisposing to chronic rhinosinusitis. However, this concept is still controversial and the presence of any anatomic variation does not necessarily establish an etiology for rhinosinusitis. Among three subtypes of concha bullosa, just the bulbous type seems to be strongly associated with symptoms. Size and obliteration of osteomeatal complex drainage pathways may be relevant as well. Variations and tomographic signs of sinusal disease occurring on the same side reinforce the likelihood of interference with the mucus drainage process. Computed tomography offers detailed study of anatomical variations and is an invaluable tool for managing clinical decisions and planning surgical strategies. Imaging assessment must be based on identification of variants, definition of their dimensions, as well as on their association with obstruction of drainage ostia and tomographic signs of sinus disease.

Keywords: Anatomical variations, Paranasal sinuses, Sinusitis, Computed tomography

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

We conducted a retrospective analysis of 71 selected pediatric patients, aged 1 to 7 years, which were submitted to helical computed tomography examination of the paranasal sinuses in the period between March, 1997 and April, 1998 due to recurrent acute sinusitis and chronic sinusitis. Clinical and helical computed tomography findings were compared by evaluating the pneumatization of the paranasal sinuses, ostiomeatal complexes, anatomic variants, the status of mucosal surface and lesion extension. The most common CT findings were total or partial opacification of one or more paranasal cavities (92.9%), followed by mucosal thickening (67.6%). In the majority of cases there was association between sinusitis and ostiomeatal obstruction. Anatomic variants were identified from the age of one year. The most common anatomic variant was septonasal deviation (14.1%) that was associated to sinusitis in about 71% of the patients.

Keywords: Helical computed tomography, Paranasal sinuses, Radiology

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.

The knowledge of meniscal anatomic variants and of the normal perimeniscal structures is essential to understand magnetic resonance imaging studies of the knee, both for the diagnosis of meniscal lesions and to avoid potential interpretation pitfalls. The present article reviews anatomic variants that change the size, shape and stability of the menisci, including the different types of discoid menisci, other less frequent meniscal malformations and the meniscal ossicle. Additionally, the anatomy of perimeniscal structures, particularly those including the meniscocapsular, intermeniscal, meniscofemoral ligaments and other menisco-ligamentous structures is reviewed.

Keywords: Knee; Discoid meniscus; Anatomic variants; 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.

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.

Mucoceles are cystic masses that generally affect the sinuses. It occurs as a result from obstruction of the ostium of a sinus and consequential accumulation of mucus. Frontal and ethmoid sinuses are mostly affected. Usually, the clinical symptoms are insidious, varying with the extent of the affected region. The treatment is surgical and endoscopic surgery is the method of choice in most cases. The present study is aimed at describing the main characteristics of paranasal sinuses mucoceles, demonstrating and illustrating a series of atypical presentations with emphasis on imaging findings.

Keywords: Paranasal sinuses; Mucocele; Presentation; Atypical.

Conventional angiography is still considered the gold standard for the study of the anatomy and of vascular diseases of the abdomen. However, the advent of multidetector computed tomography and techniques of digital image reconstruction has provided an alternative means of performing angiography, without the risks inherent to invasive angiographic examinations. Therefore, within the field of radiology, there is an ever-increasing demand for deeper knowledge of the anatomy of the regional vasculature and its variations. Variations in the renal vascular system are relatively prevalent in the venous and arterial vessels. For various conditions in which surgical planning is crucial to the success of the procedure, knowledge of this topic is important. The aim of this study was to familiarize the general radiologist with variations in the renal vascular system. To that end, we prepared a pictorial essay comprising multidetector computed tomography images obtained in a series of cases. We show patterns representative of the most common anatomical variations in the arterial blood supply to the kidneys, calling attention to the nomenclature, as well as to the clinical and surgical implications of such variations.

Keywords: Anatomic variation; Renal artery; Multidetector computed tomography.

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.

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.