Radiologia Brasileira最新文献

Infantile hemangioma (IH) is a common benign vascular neoplasm with a characteristic pattern of progression: at birth, it is not fully developed; in the first days or weeks of life, it grows; and its growth peaks at around one year of age, after which there is spontaneous regression. Although most IHs are superficial and therefore obvious on physical examination, they can also affect deeper planes or other organs, in which case they are best assessed with imaging examinations. Methods such as ultrasound and magnetic resonance imaging can help differentiate IHs from vascular malformations, other benign tumors, and malignant tumors. The aim of this pictorial essay is to demonstrate the various presentations of IHs through illustrative cases, with an emphasis on imaging findings.

Objective: To investigate computed tomography (CT) features of pneumonia that does not respond to empirical therapy in patients with hematologic diseases.

Materials and methods: This was a retrospective analysis of all patients with hematologic disease who were diagnosed with pneumonia between 2017 and 2023, did not respond to empirical therapy for the infection, and underwent bronchoalveolar lavage and CT within a week of each other. The distribution and CT pattern of pulmonary abnormalities were assessed, as was the presence of lymphadenopathy, pleural effusion, and pericardial effusion.

Results: Forty-nine patients (30 males; mean age, 61 years) were included. We identified Gram-negative bacteria in 45 patients, Gram-positive bacteria in 13, and fungi in three. Pulmonary abnormalities were bilateral in 73% of the patients in the sample, and there was no difference in prevalence between the upper and lower lung fields in 53%. Common alterations were consolidation, in 73% of the patients, bronchial wall thickening, in 71%, bronchiectasis, in 55%, and nodules, in 53%; extrapulmonary findings were less common, being identified in ≤ 27%. Pulmonary findings were typically bilateral and without a predominance between the upper and lower lung fields (p < 0.05). Common associations were between consolidation and bronchiectasis, between nodules and bronchial wall thickening, and between bronchiectasis and bronchial wall thickening (p < 0.05 for all).

Conclusion: The CT manifestations of pneumonia in patients with hematologic diseases not responding to empirical therapy can resemble those of lobular pneumonia with airway inflammation. For that reason, as well as because multiple pathogens can be present in the same patient, examination of bronchoalveolar lavage fluid can be necessary.

Objective: To present the results of a series of outpatient renal biopsies performed with a tangential approach, as well as to conduct an analysis focusing on patient safety and the frequency with which sufficient material was obtained.

Materials and methods: This retrospective observational study examined the pathology results and evolution of 244 patients referred for ultrasound-guided renal biopsy at a single center. In each biopsy, the needle was advanced in the cortex just below the renal capsule. The pathologist examined the fragments, counting the viable glomeruli obtained; additional punctures were performed if necessary, as long as Doppler ultrasound showed no bleeding. The patients remained at rest at the clinic, being discharged after a follow-up ultrasound evaluation and contacted one week later to investigate late adverse events.

Results: Ten patients were excluded from the analysis, leaving a sample of 234 patients. The material obtained for diagnosis was considered sufficient in 95.73% of the procedures, partially adequate in 3.42%, and not very representative in 0.85%. Two patients (0.85%) had bleeding greater than 50 cm³ and were referred to the hospital emergency department. Both of those patients had a favorable evolution: one required only a period at rest, and the other required a blood transfusion, being discharged 48 h after the procedure.

Conclusion: The tangential approach to renal biopsy, with its high rates of safety and efficacy, representing a reliable diagnostic tool for renal and systemic diseases, should be the method of choice for obtaining adequate pathological specimens.

The sternum and the sternoclavicular joints can exhibit a wide range of anatomical variations and serve as sites for numerous diseases, many of which are diagnosed solely through imaging studies. Recognizing these variations and differentiating them from pathological conditions is essential for radiologists, because accurate identification helps prevent misdiagnoses and treatment delays. This study provides a comprehensive review of the sternal anatomy, addressing anatomical variations, as well as mechanical, inflammatory, and traumatic pathologies, discussing their radiographic characteristics across different imaging modalities. Thus, it provides an overview of the key radiological findings.

This study aimed to systematically review the highest-quality evidence regarding the cutoff value in kPa for the diagnostic accuracy of ultrasound-based liver elastography in comparison with reference standards, including magnetic resonance imaging (MRI), computed tomography, and liver biopsy. In addition, we assessed the presence of hepatocellular carcinoma (HCC) and its associated implications in clinical and diagnostic contexts. We conducted a search using Medical Subject Headings across PubMed, Embase, Cochrane Library, Web of Science, Scopus, and Lilacs for articles published up to June 6, 2024. Of 1,131 studies identified, 33 were eligible and 8 met the quality criteria, as evaluated with the "RTI Item Bank" and "QUADAS-2" tools, following the PICO strategy. The mean elasticity of the liver parenchyma among patients with confirmed HCC was 18.77 kPa (95% CI: 16.28-21.27), making ultrasound liver elastography useful as a predictor of the diagnosis by gold-standard methods such as MRI. Ultrasound elastography is a low-cost, accessible, and noninvasive diagnostic tool capable of estimating liver elasticity in patients with HCC. However, due to the heterogeneity of the articles included in this review, further prospective studies are needed in order to confirm and standardize a cutoff stiffness value for early HCC screening, which could improve patient outcomes, particularly in resource-limited settings.

Müllerian anomalies represent a spectrum of congenital malformations of the female reproductive tract. Over the decades, various classifications have been developed to categorize these anomalies. Based on a classification proposed by Kaufmann and Jarcho in 1946, the classification devised by the American Fertility Society in 1988 was considered simple and practical; although it faced criticism for its subjectivity and limitations in classifying complex anomalies, it was widely adopted. In 2013, the European Society of Human Reproduction and Embryology and the European Society for Gynaecological Endoscopy introduced a more detailed classification, which, albeit more complex and with a risk of overdiagnosis, also included cervical and vaginal anomalies. In 2021, the American Society for Reproductive Medicine updated the classification with the aim of simplifying and improving diagnostic accuracy, expanding the categories, and defining more objective criteria. This new classification seeks to facilitate communication among professionals and enhance clinical management, emphasizing the importance of continuous updates to improve reproductive outcomes and the quality of life for patients affected by these anomalies. This article aims to discuss the strengths and limitations of each of these classifications, offering a critical analysis of their impact on the diagnosis and treatment of müllerian anomalies. It also seeks to highlight aspects that may be refined in future revisions to achieve greater diagnostic precision and clinical applicability.

Objective: To develop a deep learning system to classify non-small cell lung cancer (NSCLC) by histologic subtype-adenocarcinoma or squamous cell carcinoma (SCC)-from computed tomography (CT) images in which the tumor regions were segmented, comparing our results with those of similar studies conducted in other countries and evaluating the accuracy of automated classification by using data from the Instituto Nacional de Câncer, Brazil.

Materials and methods: To develop the classification system, we employed a 2D U-Net neural network for semantic segmentation, with data augmentation and preprocessing steps. It was pretrained on 28,506 CT images from The Cancer Image Archive, a private database, and validated on 2,015 of those images. To develop the classification algorithm, we used a VGG16-based network, modified for better performance, with 3,080 images of adenocarcinoma and SCC from the Instituto Nacional de Câncer database.

Results: The algorithm achieved an accuracy of 84.5% for detecting adenocarcinoma and 89.6% for detecting SCC, with sensitivities of 91.7% and 90.4%, respectively, which are considered satisfactory when compared with the values obtained in similar studies.

Conclusion: The system developed appears to provide accurate automated detection, as well as tumor segmentation and classification of NSCLC subtypes of a local population using deep learning networks trained using public image data sets. This method could assist oncological radiologists by improving the efficiency of preliminary diagnoses.

Objective: To evaluate the false-negative rate in the diagnosis of superior labrum anterior to posterior (SLAP) lesions on unenhanced 1.5-T magnetic resonance imaging (MRI).

Materials and methods: This was a retrospective analysis of the medical records of 24 patients who regularly engaged in physical activity and underwent surgery for reconstruction of the rotator cuff or for glenohumeral instability, comparing the result of the MRI examination with the intraoperative findings.

Results: Eighteen patients (75%) were male and six (25%) were female. False-negative results for SLAP lesions were observed in 83% of the MRI examinations.

Conclusion: For SLAP-type lesions, MRI has low diagnostic sensitivity. Arthroscopy appears to be the most efficient tool for the diagnosis of such lesions.

Objective: To investigate the feasibility of performing magnetic resonance fingerprinting (MRF) of the bladder and quantify the T1 and T2 relaxation times of the bladder wall in healthy female volunteers, before and after voiding.

Materials and methods: Volunteers without lower urinary tract symptoms underwent pelvic MRF. Five axial MRF slices of the bladder were obtained before and after voiding. Regions of interest were annotated on MRF T1 maps: one on the anterior bladder wall, and one on a lateral wall. Annotations made on T1 maps were subsequently copied to coregistered T2 maps. Student's t-tests for paired samples were employed to compare the T1 and T2 values obtained before voiding with those obtained after voiding.

Results: Eight volunteers were included. The mean preand post-void T1 relaxation times were 1,575 ± 93 ms and 1,476 ± 138 ms, respectively. The mean preand post-void T2 relaxation times were 55 ± 21 ms and 53 ± 8 ms, respectively. The mean T1 relaxation times were 6% lower after voiding than before (p = 0.035).

Conclusion: The use of MRF to quantify T1 and T2 relaxation times in the bladder appears to be feasible. Our results can serve as a reference for studies investigating T1 and T2 relaxation times in patients with malignant or nonmalignant bladder disorders.

This study involved a retrospective analysis of nine cases of neurocryptococcosis (eight from our institution and one from another institution) seen between May 2014 and May 2022, together with a systematic review of the literature indexed in the PubMed, Embase, and Lilacs databases. Clinical and radiological features of those cases were further refined via an additional comprehensive literature review. The following search string was employed: cryptococcosis AND central nervous system AND (magnetic resonance imaging OR X-ray computed tomography). The search was limited to articles published between July 1978 and May 2022. Two authors, working independently, searched for and selected studies that met the inclusion criteria, and another author reviewed conflicts in a blinded manner. We used Rayyan.ai software to organize the studies, and the review was structured in accordance with the 2020 Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Understanding the prevalence of different patterns of neurocryptococcosis is crucial for improving diagnosis and supporting decision-making in clinical practice. Our review of the literature demonstrated that imaging examinations are a valuable resource for early diagnosis, as well as for assessment of the initial extent and pattern of the disease.