Maria Lucia Borri

Apresentações incomuns do hemangioma hepático: ensaio iconográfico

O nosso objetivo foi descrever e ilustrar aspectos incomuns do hemangioma hepatico na ultra-sonografia (US), tomografia computadorizada (TC) e ressonância magnetica (RM). A partir da analise retrospectiva de 300 casos de pacientes com diagnosticos de hemangioma hepatico, por meio da analise combinada de exames de imagem, biopsia ou acompanhamento clinico, selecionamos aqueles com apresentacao atipica em um ou mais metodos de imagem ou aqueles com evolucao nao usual, ilustrando os seus principais aspectos de imagem. Entre os casos apresentados, escolhemos pacientes com hemangiomas: hipoecogenicos na US; hipovasculares ou avasculares na TC e RM; com calcificacoes grosseiras; gigantes e medindo mais de 20 cm de diâmetro; predominantemente exofiticos; hipointensos em T2; promovendo defeito de perfusao; com cicatriz central e simulando hiperplasia nodular focal; com crescimento evolutivo. O hemangioma hepatico e o tumor mais comum do figado e geralmente tem apresentacao tipica. Porem, os seus diversos aspectos nao usuais precisam ser conhecidos para auxiliar na orientacao diagnostica e conduta. Unitermos: Hemangioma; Figado; Aspectos atipicos; Ultra-sonografia; Tomografia computadorizada; Ressonância magnetica. Unusual presentations of hepatic hemangioma: an iconographic essay. In order to evaluate atypical aspects of hepatic hemangiomas at ultrasound (US), computed tomography (CT) and magnetic resonance imaging (MRI), we have retrospectively analyzed 300 cases of patients diagnosed with hepatic hemangiomas by means of combined imaging studies, clinical follow-up and/or biopsy results. Based on this analysis we have selected those cases with atypical findings at one or more imaging methods or those presenting an unusual evolution such as: hypoechoic nodules at US; giant, heterogeneous hemangiomas; rapidly filling hemangiomas; calcified hemangiomas; pedunculated hemangiomas; hypointense hemangiomas at T2-weighted images; causing perfusion defect; with central scar simulating focal nodular hyperplasia; hemangiomas with adjacent abnormalities such as arterial-portal venous shunt and capsular retraction as well as hemangiomas enlarging over time. The hepatic hemangioma is the most common benign tumor affecting the liver and usually presents typical aspect. However, atypical findings should be known

Menkes disease: case report of an uncommon presentation with white matter lesions

Menkes disease is a rare X-linked disorder related to a defect in the copper metabolism. According to the current literature, the most frequent neuroimaging findings are cortical atrophy, chronic subdural effusion or hygroma, and vascular abnormalities. White matter lesions may be present before other features of the disease and may evolve into atrophy. We hereby report a case of Menkes disease with typical history and progression, and an early phase imaging study with important white matter abnormalities, which could have lead to diagnostic difficulties.

O valor da tomografia computadorizada helicoidal sem contraste na avaliação de pacientes com dor no flanco

Our purpose was to evaluate the accuracy of unenhanced helical computed tomography in the diagnosis of ureteral lithiasis, to establish the frequency of the main computed tomography findings, and to assess and compare the interobserver agreement with the results of conventional intravenous urography. A prospective double-blind study was carried out in 25 patients referred for unenhanced helical computed tomography and conventional intravenous urography due to nephretic colic. Both methods were employed to evaluate the size of the kidneys, hydronephrosis and the size and location of ureteral stones. Perirenal hyperdensities, periureteral edema and the halo sign were also assessed by unenhanced helical computed tomography. In 23 of the 25 unenhanced helical computed tomography examinations (92%) and in 17 of the 25 conventional intravenous urography examinations (68%) there was agreement on the results of the two observers. In 21 of the 25 patients, there was agreement between the results of both methods. We concluded that unenhanced helical computed tomography is as efficient as conventional intravenous urography in the evaluation of patients with nephretic colic, is a reproducible method, and avoids the discomfort of the use of intravenous contrast.

Apresentações incomuns do hepatocarcinoma: ensaio iconográfico

In order to evaluate atypical aspects of hepatocellular carcinoma at computed tomography and magnetic resonance imaging, we have retrospectively evaluated 100 patients with diagnosed hepatocellular carcinoma, based on combined imaging studies, laboratory results, biopsy and surgery. We have selected those cases with atypical findings at computed tomography or magnetic resonance imaging, including cystic lesions, bleeding tumors, with calcifications, with spontaneous regression, pedunculated tumors, hypovascular lesions, giant hepatocellular carcinomas, and those with unusual local invasiveness. The hepatocellular carcinoma is the most usual primary malignant lesion of the liver and usually it has a typical aspect and is associated with hepatic cirrhosis. However, in a significant number of cases, some uncommon findings can be responsible for a delayed diagnosis.

Gadolinium Magnetic Angioresonance in the Study of Aortoiliac Disease

There is a need for noninvasive methods for the early identification of patients with intermit tent claudication who need surgical treatment. Newer magnetic resonance angiography (MRA)- techniques allow detailed study of the arterial tree with image quality similar to that of conven tional arteriography. From April 1997 to January 2001, 30 patients with intermittent claudica tion of the lower limbs were studied with both imaging methods. In each case, the MRA images were examined first and the arteriographic images were examined 15 days later. Examiners interpreting the arteriographic images were blinded to the results of the corresponding MRA images. After each examination (MRA and arteriography), a vascular surgeon suggested a surgical plan. MRA showed results similar to those of arteriography, although with inferior image quality. No patient had an allergic reaction or side effects due to administration of contrast material. There was total agreement between MRA and arteriography in regard to the morphologic analysis and proposed surgical plans in every case. In conclusion, MRA is a feasible, useful, and less invasive alternative for the morphologic evaluation of the aortofemoral area in patients with intermittent claudication of lower limbs.

Angio-RM das artérias carótidas e vertebrais: análise de diferentes técnicas de volume e diluição de contraste em aparelho de 1,0 t e gradiente de 15 mt/m

PURPOSE: To evaluate the carotid and vertebral arteries by magnetic resonance angiography, using different contrast volumes and dilution techniques. SUBJECTS AND METHODS: Prospective study of 15 patients, which included the evaluation of 30 common carotid arteries, 30 internal carotid arteries, 30 external carotid arteries and 30 vertebral arteries, using different gadolinium (Gd-DTPA) volumes and dilutions: group I - single-dose (14 ml of Gd-DTPA); group II - double-dose (28 ml of Gd-DTPA); group III - single-dose, dilution at 50%. Gd-DTPA was administered using a power injector at 2 ml/sec (group I) and 3 ml/sec (groups II and III). A qualitative assessment was performed for each arterial segment. Three radiologists, who judged the quality of depiction of the arteries, vascular signal intensity and contours delineation, performed a consensus analysis. RESULTS: All evaluated features showed better performance in group II (complete depiction of the arteries, good vascular signal intensity and well defined contours). In group I, there was adequate depiction of the arteries, but inadequate vascular signal intensity and contours delineation. Group III showed the poorest results, with inadequate parameters for all evaluated features. CONCLUSION: Among the tested Gd-DTPA dilutions and volumes, double-dose contrast injection allowed better evaluation of the carotid and vertebral arteries. The studies with dilution of Gd-DTPA showed the poorest results.

Expansão rápida da maxila: análise da densidade radiográfica da sutura palatina mediana e sua correlação nos estágios de neoformação óssea, por meio de imagem digitalizada

AIM: To evaluate the new bone formation of the midpalatal suture in different phases of the rapid maxillary expansion procedure by means of the scanned image and to compare the radiographic density of the different selected areas along this suture in predetermined periods. METHODS: The sample consisted of 23 individuals, aged from 9 to 12 years who underwent rapid maxillary expansion in accordance with a protocol which consisted initially of a full turn on the screw, followed by ¼ turn by morning and ¼ turn at night for two weeks. Were obtained 69 occlusal radiographs at different phases of the procedure, which passed through the scanning process via scanner and then were subjected to the software Digora for Windows 5.6, to perform the readings of radiographic density. RESULTS: In all phases of the procedure, the values of gray levels were, on average, different from each other, showing partial bone healing of the midpalatal suture. CONCLUSIONS: The results revealed that are necessary more than three months for complete sutural recovery after the rapid maxillary expansion and that the method used to read the densities proved to be trustworthy, because of its ability to display details. Therefore, it can be concluded that the expander should be removed only after full sutural bone recovery in order to avoid relapses.

Uso do contraste oral negativo em exames de colangiografia por ressonância magnética

OBJECTIVE: The aim of this prospective study was to investigate the feasibility of using a negative oral contrast agent to null the bowel signal during magnetic resonance cholangiopancreatography. MATERIAL AND METHOD: Fifteen healthy volunteers with no previous history of pancreaticobiliary disease or surgery were imaged with a single-shot fast spin-echo pulse sequence, using a magnetic resonance imaging system operating at 1.0 T. Data acquisition was started before and after administration of oral contrast agent. Using the magnetic resonance images obtained before and after administration of oral contrast agent, the common bile duct, pancreatic duct and papilla were assessed and graded by two radiologists. The frequency of adverse effects and the tolerance of the contrast were also evaluated. RESULTS: All patients that found negative oral contrast agent unpleasant (73% of the cases) tolerated well the oral contrast agent. Adverse effects as abdominal pain and diarrhea were noted in 30% of the patients. In all patients the high signal intensity from the intestinal fluid was completely suppressed. The depictions of the common hepatic duct were slightly improved, whereas the depictions of the choledochus, papilla and pancreatic duct were markedly improved by the negative oral contrast agent administration. CONCLUSION: Negative oral magnetic resonance contrast agent can be an effective and safe contrast media in eliminating signal intensity of the gastrointestinal tract, thus improving the depiction of the biliary system in magnetic resonance cholangiopancreatography.

Vascular loops in the anterior inferior cerebellar artery, as identified by magnetic resonance imaging, and their relationship with otologic symptoms

Objective To use magnetic resonance imaging to identify vascular loops in the anterior inferior cerebellar artery and to evaluate their relationship with otologic symptoms. Materials and Methods We selected 33 adults with otologic complaints who underwent magnetic resonance imaging at our institution between June and November 2013. Three experienced independent observers evaluated the trajectory of the anterior inferior cerebellar artery in relation to the internal auditory meatus and graded the anterior inferior cerebellar artery vascular loops according to the Chavda classification. Kappa and chi-square tests were used. Values of p < 0.05 were considered significant. Results The interobserver agreement was moderate. Comparing ears that presented vascular loops with those that did not, we found no association with tinnitus, hearing loss, or vertigo. Similarly, we found no association between the Chavda grade and any otological symptom. Conclusion Vascular loops do not appear to be associated with otoneurological manifestations.

Ressonância magnética das vias lacrimais: estudo comparativo entre bobinas de superfície convencionais e microscópicas

OBJETIVO: A ressonância magnetica tem sido utilizada para avaliar as vias lacrimais, com vantagens em relacao a dacriocistografia por raios-X. O objetivo deste trabalho e obter imagens de alta resolucao utilizando bobinas de superficie microscopicas para avaliacao de estruturas normais das vias lacrimais, comparando com o aspecto observado utilizando-se bobinas de superficie convencionais. MATERIAIS E METODOS: Cinco voluntarios assintomaticos, sem historico de lacrimejamento, submeteram-se a ressonância magnetica de alto campo, com bobinas de superficie (convencional e microscopica), com sequencia STIR apos instilacao de soro fisiologico. A identificacao das estruturas anatomicas normais das vias lacrimais foi comparada utilizando-se as duas bobinas. Mediante uso de um sistema de escore, um valor medio de cada estrutura foi calculado por dois examinadores, consensualmente. RESULTADOS: Em 90% das vezes houve aumento do escore, atribuido a estrutura anatomica no estudo com a bobina microscopica. Em media, houve aumento de 1,17 ponto no escore, por estrutura anatomica visualizada, quando se utilizou a bobina microscopica. Observou-se, ainda, melhora subjetiva da relacao sinal-ruido ao se utilizar a bobina microscopica. CONCLUSAO: A dacriocistografia por ressonância magnetica com bobinas microscopicas e um metodo adequado para o estudo das vias lacrimais, resultando em imagens de melhor qualidade quando comparada ao uso de bobinas de superficie convencionais.