Radiologia Brasileira最新文献

Objective: To assess the diagnostic success rate and complications of computed tomography (CT)-guided percutaneous biopsy in pulmonary nodules < 10 mm in diameter.

Materials and methods: This was a retrospective, single-center study involving the review of medical records, images, and chest CT reports related to 115 patients who underwent percutaneous CT-guided biopsy of < 10 mm pulmonary nodules between July 2015 and January 2019.

Results: Nodule diameter on the longest axis ranged from 4 mm to 9 mm, with a mean size of 7.7 mm. The mean age of the patients at the time of the procedure was 61 years, and 54.7% were women. Of the 115 nodules evaluated, 77 (67.0%) were solid and 55 (47.8%) were located in the lower lobes. The mean distance traversed by the needle in the lung parenchyma was 20 mm (range, 0-70 mm), and, in most cases, the biopsy was not performed with the patient in the biopsy-side-down lateral position. The diagnostic success rate was 93.0%. The most common complications were alveolar hemorrhage (in 36.5% of cases) and pneumothorax (in 24.3%).

Conclusion: The data suggest that CT-guided percutaneous biopsy of < 10 mm pulmonary nodules has a high diagnostic success rate and an acceptable rate of complications.

The aim of the present study was to investigate whether nutritional status and changes in muscle and adipose tissue determined by computed tomography are predictors of mortality in hospitalized patients. This was a prospective cohort study involving patients ≥ 20 years of age hospitalized in a public hospital. Sociodemographic and clinical variables were collected from electronic medical records. Nutritional variables were determined. All patients were followed prospectively until the hospital outcome, which could be discharge or death. Body composition was defined from computed tomography images, with the identification of myopenia, myosteatosis, and myopenic obesity. The sample comprised 542 patients. The mortality rate was 10.7% (95% CI: 6.4-15.0%). The independent predictors of mortality were malnutrition, assessed with the subjective global assessment (hazard ratio: 4.18; 95% CI: 1.01-17.22; p = 0.047), and myopenic obesity (hazard ratio: 2.82; 95% CI: 1.11-7.20; p = 0.029). The findings of the present study add to the limited evidence in the literature that body composition is associated with outcomes in hospitalized patients.

Objective: To analyze longitudinal changes between two brain magnetic resonance imaging (MRI) exams performed one year apart in symptomatic infants with congenital Zika syndrome (CZS) and normocephalic infants exposed to the Zika virus (ZIKV) prenatally.

Materials and methods: This was a prospective observational study. Infants born to women who tested positive for ZIKV on reverse transcription-quantitative polymerase chain reaction during pregnancy were classified into two groups: symptomatic infants with CZS and asymptomatic infants. All of the infants underwent brain MRI at presentation and after one year of follow-up. All MRI scans were evaluated independently by a pediatric radiologist and a pediatric neuroradiologist, and the infants underwent clinical monitoring by a pediatric neurologist.

Results: The sample included 36 infants exposed to ZIKV perinatally. Therefore, a total of 72 MRI scans were evaluated. Among the 36 infants included a diagnosis of CZS was made in 25 (69.4%), of whom 18 presented with a combination of classic findings (including reduced brain volume, subcortical calcifications, brainstem hypoplasia, malformations of the corpus callosum, malformations of cortical development, and ventriculomegaly), as well as atypical findings such as hyperintense foci in the white matter on T2-weighted sequences. Of those same 25 infants, seven presented with mild lesions. Of the 11 normocephalic patients, five (13.9%) had atypical findings such as hyperintense foci in the white matter on T2-weighted sequences and no other manifestations of CZS, although there was mild neurological involvement. Six (16.6%) of the 36 patients had completely normal MRI scans with no neurological changes. No disease progression was observed during follow-up.

Conclusion: In infants exposed to ZIKV perinatally, the frequency of classic and atypical findings on brain MRI seems to be associated with the neurological status. Brain MRI is an important diagnostic tool in the evaluation and monitoring of patients with congenital infection, because intracranial changes other than microcephaly can occur.

Objective: To explore the feasibility of two magnetic resonance imaging (MRI) sequences-high-resolution T2-weighted (HR T2) and Look-Locker T1 (LL T1) relaxometry-for the investigation focal lung lesions (FLLs). As a secondary objective, we analyzed the diagnostic accuracy of these sequences.

Materials and methods: This was a prospective observational study involving 39 subjects with FLLs scanned in a 1.5-T MRI system with LL T1 relaxometry and HR T2 sequences focused on the FLL region, in addition to a conventional protocol. All images were evaluated by two radiologists, working independently, who were blinded to other findings.

Results: Most of the examinations (31 of the LL T1 relaxometry sequences and 36 of the HR T2 sequences) were of adequate diagnostic quality. Nondiagnostic examinations were considered so mainly because of limited coverage of the sequences. Of the FLLs studied, 19 were malignant, 17 were benign, and three were excluded from the accuracy analysis because there was no definitive diagnosis. Although LL T1 relaxometry could not distinguish between benign and malignant lesions, the signal intensity at its first inversion time (160 ms) differed between the two groups. The HR T2 sequence was considered the best sequence for assessing specific morphological characteristics, especially pseudocavities and pleural tags. We found that MRI showed better accuracy than did computed tomography (86% vs. 74%).

Conclusion: Both MRI sequences are feasible for the evaluation of FLLs. Images at 160 ms of the LL T1 relaxometry sequence helped distinguish between benign and malignant lesions, and the HR T2 sequence was considered the best sequence for evaluating specific morphological characteristics.

Objective: To determine the correlation of conventional and diffusion-weighted imaging findings on magnetic resonance imaging (MRI) of the brain, based on Visually AcceSAble Rembrandt Images (VASARI) criteria, with the histopathological grading of gliomas: low-grade or high-grade.

Materials and methods: Preoperative MRI scans of 178 patients with brain gliomas and pathological confirmation were rated by two neuroradiologists for tumor size, location, and tumor morphology, using a standardized imaging feature set based on the VASARI criteria.

Results: In the univariate analysis, more than half of the MRI characteristics evaluated showed a significant association with the tumor grade. The characteristics most significantly associated with the tumor grade were hemorrhage; restricted diffusion; pial invasion; enhancement; and a non-contrast-enhancing tumor crossing the midline. In a multivariable regression model, the presence of enhancement and hemorrhage maintained a significant association with high tumor grade. The absence of contrast enhancement and restricted diffusion were associated with the presence of an isocitrate dehydrogenase gene mutation.

Conclusion: Our data illustrate that VASARI MRI features, especially intratumoral hemorrhage, contrast enhancement, and multicentricity, correlate strongly with glial tumor grade.

The superficial musculoaponeurotic system (SMAS) is a complex fibrous network connecting facial muscles to the dermis, with varying morphological characteristics across different facial regions. Recent studies have identified five distinct types of SMAS morphology, highlighting the need for region-specific interventions in facial rejuvenation. This pictorial essay explores ultrasound imaging of the SMAS using ultra-high frequency (24-33 MHz) probes, known as U-SMAS. Analysis of 186 full-face U-SMAS scans revealed consistent patterns in the facial and neck layers, with regional variations aligning with the Sandulescu classifications: type I (preparotideal); type II (chin and lip); type III (eyelid); type IV (temporal and parotideal); and type V (cervical). Understanding these morphological differences is crucial for accurate interpretation of ultrasound images and for optimizing pre-procedural assessments to ensure that aesthetic treatments are safe and effective. Knowledge of the SMAS architecture enhances the ability to visualize facial and neck anatomy accurately, particularly through U-SMAS imaging, ensuring comprehensive patient care in rejuvenation procedures.

Objective: To compare costs between treatment strategies employed prior to and after prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA PET/CT) via the Brazilian Unified Health Care System and their impact on the therapeutic management of biochemical recurrence of prostate cancer.

Materials and methods: The referring physicians were surveyed on their treatment intentions (strategies) at two different time points: prior to and after PSMA PET/CT. Cost comparison results are presented as median (IQR) for each of the two strategies. The shift in therapeutic management after PSMA PET/CT was also analyzed.

Results: The study sample included 59 patients (mean age: 65.9 years). The PSMA PET/CT result was considered positive in 38 patients (64.4%) and was found to have an impact on the treatment strategy in for 36 patients (61.0%). Prior to PSMA PET/CT, salvage therapy (i.e., treatment with curative intent) was the intended treatment for most patients, and that was significantly less so after the examination (76.3% vs. 45.8%; p < 0.001). Conversely, a strategy involving systemic (i.e., palliative) therapy became more common after PSMA PET/CT (23.7% vs. 54.2%; p < 0.001). The after-PSMA PET/CT strategy presented higher overall costs than did the before-PSMA PET/CT strategy, in all scenarios evaluated. In all scenarios, nearly half of this cost difference was related to the cost of the PSMA PET/CT itself, the remainder being related to the new treatment choices that stemmed from knowledge of the PSMA PET/CT findings.

Conclusion: For patients treated within the Brazilian Unified Health Care System, PSMA PET/CT presented higher costs in comparison with conventional imaging methods. Adding PSMA PET/CT to the workflow had an impact on therapeutic management, mainly representing a shift from futile curative treatments to systemic palliative ones. The amount of funds that could potentially be saved by not providing such futile treatments would suffice to evaluate roughly two patients with PSMA PET/CT scans for each futile treatment strategy avoided.