Henrique Donato

Liver MRI: From basic protocol to advanced techniques

Liver MR is a well-established modality with multiparametric capabilities. However, to take advantage of its full capacity, it is mandatory to master the technique and optimize imaging protocols, apply advanced imaging concepts and understand the use of different contrast media. Physiologic artefacts although inherent to upper abdominal studies can be minimized using triggering techniques and new strategies for motion control. For standardization, the liver MR protocol should include motion-resistant T2-w sequences, in-op phase GRE T1 and T2-w fast spin echo sequences with fat suppression. Diffusion-weighted imaging (DWI) is mandatory, especially for detection of sub-centimetre metastases. Contrast-enhanced MR is the cornerstone of liver MR, especially for lesion characterization. Although extracellular agents are the most extensively used contrast agents, hepatobiliary contrast media can provide an extra-layer of functional diagnostic information adding to the diagnostic value of liver MR. The use of high field strength (3T) increases SNR but is more challenging especially concerning artefact control. Quantitative MR belongs to the new and evolving field of radiomics where the use of emerging biomarkers such as perfusion or DWI can derive new information regarding disease detection, prognostication and evaluation of tumour response. This information can overcome some of the limitations of current tests, especially when using vascular disruptive agents for oncologic treatment assessment. MR is, today, a robust, mature, multiparametric imaging modality where clinical applications have greatly expanded from morphology to advanced imaging. This new concept should be acknowledged by all those involved in producing high quality, high-end liver MR studies.

Imaging Findings of Metaplastic Carcinoma of the Breast with Pathologic Correlation

Objectives: To review the imaging findings of a series of cases of metaplastic carcinoma of the breast, a rare and aggressive form of breast cancer with variable imaging features. Materials and methods: Retrospective review of multimodality imaging features of eleven cases of metaplastic carcinoma of the breast retrieved from a single hospital institution database. Clinical and pathologic data were also documented. Results: The median age of presentation was 65 years. Four cases had axillary lymphadenopathies, and two had distant metastases. An oval mass was the most common sonographic finding (7/11; 64%). Lesions displayed circumscribed/partially circumscribed margins (6/11; 55%) or non-circumscribed margins (5/11; 45%). Most lesions had a heterogeneous echo structure (9/11; 82%) and posterior acoustic enhancement (6/11; 55%). In nine patients, mammographies were available. An oval dense mass was the most common mammographic finding (5/9; 56%). The majority of cases had non-circumscribed margins (6/9; 67%), and nearly half displayed calcifications (4/9; 44%). Conclusions: Mammographic findings were not different from the usual features of more prevalent types of breast cancer, though the majority of metaplastic carcinoma of the breast showed possible distinctive sonographic features, such as circumscribed margins or complex echogenicity, reflecting the histologic background.

Symptomatic bilateral coronary artery fistula to pulmonary artery in elderly patient

We report the imaging findings of an uncommon coronary vascular termination anomaly, with fistula to the pulmonary artery. This 70 year old female patient presented unstable angina, showing a coronary artery fistula depicted in coronary angiogram from the left coronary to the pulmonary artery, with no significant atherosclerotic pathology. Due to development of ventricular tachycardia in stress echocardiogram examination, she was proposed for coronary fistula closure. Coronary CT was performed for procedure planning and allowed the identification of a second unsuspected fistula from the right coronary to the right pulmonary artery. Congenital coronary anomalies are a possible cause of symptomatic coronary pathology in patients of any age. In older patients, coronary artery fistulas are rare, especially when symptomatic. Adequately performed CT examinations, using its post processing capabilities, with 3D and MIP reconstructions are invaluable in delineating coronary anatomy, essential for further treatment planning.

Ecografia de Nervos Periféricos – Um Tutorial Guiado por Imagem para Iniciante

Avancos tecnicos na ecografia facilitou de forma fiavel a avaliacao de pequenas estruturas. Atualmente, a avaliacao de nervos perifericos depende ainda de dados clinicos suplementados por estudos eletrofisiologicos. A ultrassonografia pode ser aplicada na avaliacao de patologia de nervos perifericos, contribuindo para o diagnostico diferencial de patologias musculo-esqueleticas. O crescimento exponencial de publicacoes sobre esta tematica nos ultimos 10 anos foi fortemente fomentado pelo desenvolvimento de intervencao guiada por imagem, frequentemente utilizada em procedimentos analgesicos e anestesicos, tais como bloqueios nervosos. A Medicina da Dor e outro campo para a ecografia de nervos perifericos, onde a intervencao pode ser usada como forma de tratamento ou diagnostico. A ecografia e uma tecnica segura, embora fortemente dependente do utilizador, implicando firmes conhecimentos de anatomia. Elaborou-se uma revisao pictorica, assim como dos parâmetros e peculiaridades tecnicas utilizadas para otimizar a imagem obtida. Serao demonstrados os marcos anatomicos mais frequentes e reconheciveis no pescoco, membro superior, virilha, membro inferior, assim como a forma de colocacao da sonda. Sera efetuada uma breve revisao dos achados descritos em casos patologicos. Um firme conhecimento da ecografia dos nervos perifericos e um pre-requisito para os interessados na avaliacao destes. O papel da intervencao guiada por ecografia tem evoluido no campo da anestesia e no campo da medicina da dor. Os radiologistas estao em excelente posicao para relacionar a adequada tecnica e o conhecimento anatomico, permitindo expandir o papel dos procedimentos guiados por imagem.