Ricardo Andrade Fernandes de Mello

Left atrial volume quantification using cardiac MRI in atrial fibrillation: comparison of the Simpson's method with biplane area-length, ellipse, and three-dimensional methods.

PURPOSE Left atrial volume is an important predictor of future arrhythmias, and it can be assessed by several different methods. Simpsons method is well accepted as a reference standard, although no standardization exists for cardiac magnetic resonance (CMR). We aimed to compare the estimations of left atrial volumes obtained by the Simpsons method with three other methods. MATERIALS AND METHODS Eighty-one consecutive patients referred for CMR imaging between February 2007 and May 2010 were included in the study (47 males; mean age, 59.4±11.5 years; body mass index, 26.3±3.7 kg/m(2)). Left atrial volume measurements were performed using the Simpsons, biplane area-length, ellipse, and three-dimensional methods. Results were correlated using a Bland-Altman plot and linear regression models and compared by two-tailed paired-sample t tests. Reader variability was also calculated. RESULTS Left atrial volume measurements using the biplane area-length technique showed the best correlation with Simpsons method (r=0.92; P < 0.001). Quantification values using the ellipse and three-dimensional methods were significantly different than values obtained using the Simpsons method (P < 0.05, for both). All methods showed excellent observer reliability (intra-class correlation coefficient >0.99). CONCLUSION The biplane area-length method can be used for left atrial volume measurement when the Simpsons method cannot be performed. If these two methods are not feasible, then all methods are highly reproducible and can be used, but should not be used interchangeably for follow-up studies.

Double-chambered left ventricle in an adult: diagnosis by CMRI.

Outpouching of the left ventricle is a rare condition with heterogeneous causes ranging from congenital abnormalities, such as diverticula or muscle bands, to complications secondary to myocardial infarction, such as aneurysm and pseudoaneurysm. Distinguishing among these etiologies is challenging but of great clinical importance given the wide range of risks and implications involved.1–3 Double chambered is a term that has been used to describe the subdivision of a ventricle as a result of anomalous septum or muscle bundle. Subdivision of the left ventricular cavity is a rare cardiac anomaly compared with subdivision of the right ventricle.3 Cardiac magnetic resonance imaging (CMRI) is useful in the assessment of associated conditions and to better understand the disease, characterizing the diagnosis. CMRI can demonstrate changes in the ventricular contractility, presence or absence of fibrosis and is useful in the follow-up of patients with double-chambered left ventricle (DCLV).3,4 We describe a case of DCLV, highlighting the importance of CMRI, clinical evolution, and outcome.

Seqüestro broncopulmonar intralobar: relato de caso

We report the case of a 49-year-old patient with repeated lung infections. Chest x-rays showed a mass in the posterior basal segment of the right lung. Angiotomography and 3D reconstructions showed a blood supply coming from the descending aorta. The analysis of the surgical specimen confirmed the occurrence of intralobar pulmonary sequestration with a cavitation filled with mucus.

Avaliação morfométrica do tendão de Aquiles por ultra-sonografia

OBJETIVO: Determinar os valores normais dos diâmetros ântero-posterior e transversal do tendao de Aquiles na nossa populacao e correlaciona-los com sexo, faixa etaria, cor da pele, grupo sanguineo ABO e indice de massa corporal. MATERIAIS E METODOS: Foi feita analise ultra-sonografica de 100 tendoes de Aquiles de 50 voluntarios sadios, visando a mensuracao dos diâmetros ântero-posterior e transversal desses tendoes. Todos os exames foram realizados pelo mesmo examinador, em aparelho de ultra-sonografia com transdutor linear com frequencia de 10 MHz. RESULTADOS: Dos 50 voluntarios estudados, 25 eram do sexo masculino e 25, do sexo feminino, com a faixa etaria variando de 20 a 52 anos (media de 33,9 anos). O valor medio do diâmetro transversal do tendao de Aquiles foi de 13,3 ± 1,0 mm para o sexo feminino e 14,4 ± 1,4 mm para o sexo masculino; em relacao ao diâmetro ântero-posterior, foi de 5,4 ± 0,5 mm para o sexo feminino e 5,6 ± 0,6 mm para o sexo masculino. Os diâmetros do tendao de Aquiles foram significativamente menores no sexo feminino (p < 0,05). Nao houve diferenca estatisticamente significativa entre os diâmetros ântero-posterior e transversal em relacao a faixa etaria, grupo sanguineo e cor da pele. O grupo com indice de massa corporal de sobrepeso apresentou diâmetro transversal do tendao de Aquiles significativamente maior que do grupo com indice de massa corporal normal. CONCLUSAO: Os valores medios encontrados na nossa casuistica foram discordantes em relacao a maioria dos estudos da literatura, demonstrando ser de grande importância a padronizacao e o emprego de tabelas proprias da nossa populacao na pratica clinica diaria.

Análise retrospectiva do trânsito do delgado em um serviço de radiologia de hospital geral

OBJETIVO: Os autores se propoem a revisar os exames de trânsito do delgado, a fim de demonstrar os principais diagnosticos e achados radiologicos, e o atual beneficio para o paciente. MATERIAIS E METODOS: Estudo retrospectivo e descritivo realizado a partir de levantamento de exames realizados no periodo de janeiro/2001 a junho/2002, no servico de radiologia do Hospital Santa Cruz da Beneficencia Portuguesa de Niteroi. RESULTADOS: Do total de 60 exames, 24 (40,0%) apresentaram alteracoes radiologicas (anatomicas, enterites, diverticulos, relacionadas a cirurgias e outras) e 36 (60,0%) foram normais. Observamos que 36 pacientes (60,0%) tinham entre 35 e 65 anos incompletos, apenas dois (3,32%) eram menores de 18 anos e o paciente mais idoso tinha 87 anos. CONCLUSAO: Apesar do advento da endoscopia para a avaliacao do trato gastrintestinal superior e inferior, o uso do estudo contrastado do intestino delgado se manteve como metodo de escolha para avaliacao do duodeno, jejuno e ileo. Sabe-se que o trânsito do delgado e a principal tecnica diagnostica para o estudo deste orgao e importante para o estudo das enterites, alem de ser um exame de facil execucao e de alta sensibilidade. Dessa forma, estamos reforcando a sua importância diagnostica e devemos ter em mente que o exame do trato gastrintestinal superior e complementar, devendo considerar suas limitacoes e vantagens.

Dactylolysis spontanea (ainhum)

Radiol Bras. 2015 Jul/Ago;48(4):263–270complications caused by clinically unsuspected ingested dietary foreignbodies: a case series emphasizing the use of volume rendering techniques.Radiol Bras. 2013;46:346–50.3. Tyng CJ, Bitencourt AGV, Almeida MFA, et al. Computed tomography-guided percutaneous biopsy of pancreatic masses using pneumodissec-tion. Radiol Bras. 2013;46:139–42.4. Elias Jr J. Imaging findings of unusual hepatic tumors: expanding thedifferential diagnosis. Radiol Bras. 2014;47(5):ix–x.5. Silva EJC, Silva GAP. Local behavior and lymph node metastases ofWilms’ tumor: accuracy of computed tomography. Radiol Bras. 2014;47:9–13.6. Torres LR, Timbo LS, Ribeiro CMF, et al. Multifocal and metastatichepatic hemangioendothelioma: case report and literature review. RadiolBras. 2014;47:194–6.7. Pedrassa BC, Rocha EL, Kierszenbaum ML, et al. Uncommon hepatictumors: iconographic essay – Part 1. Radiol Bras. 2014;47:310–6.8. Pedrassa BC, Rocha EL, Kierszenbaum ML, et al. Uncommon hepatictumors: iconographic essay – Part 2. Radiol Bras. 2014;47:374–9.Thiago Krieger Bento da Silva

Magnetic resonance imaging and BMB score in the evaluation of bone involvement in Gaucher's disease patients.

Objective To evaluate by magnetic resonance imaging changes in bone marrow of patients undergoing treatment for type I Gaucher’s disease. Materials and Methods Descriptive, cross-sectional study of Gaucher’s disease patients submitted to 3 T magnetic resonance imaging of femurs and lumbar spine. The images were blindly reviewed and the findings were classified according to the semiquantitative bone marrow burden (BMB) scoring system. Results All of the seven evaluated patients (three men and four women) presented signs of bone marrow infiltration. Osteonecrosis of the femoral head was found in three patients, Erlenmeyer flask deformity in five, and no patient had vertebral body collapse. The mean BMB score was 11, ranging from 9 to 14. Conclusion Magnetic resonance imaging is currently the method of choice for assessing bone involvement in Gaucher’s disease in adults due to its high sensitivity to detect both focal and diffuse bone marrow changes, and the BMB score is a simplified method for semiquantitative analysis, without depending on advanced sequences or sophisticated hardware, allowing for the classification of the disease extent and assisting in the treatment monitoring.

Multisystemic Langerhans Cell Histiocytosis with advanced lung involvement

Langerhans cell histiocytosis is a rare disease of unknown cause, characterized by the proliferation of histiocytic cells (Langerhans cells), that can sometimes be especially difficult to diagnose due to its wide clinical spectrum, ranging from a single lesion to a multisystemic disorder. Appropriate disease staging is fundamental, since treatment depends upon the severity of the disease, and imaging methods play a fundamental role not only in diagnosing and assessing the extent of Langerhans cell histiocytosis, as well as guiding the appropriate treatment for the patient and their monitoring.

Imaging paracoccidioidomycosis: A pictorial review from head to toe

Paracoccidioidomycosis is an infectious disease characterized primarily by pulmonary involvement and potential dissemination to other organs, mainly mucosa and skin; however, it can affect any organ in the body. Although difficult to diagnose purely based on imaging, imaging is important for diagnosis, follow-up, and assessment of disease-related complications. We provide a comprehensive review of the most notable imaging findings of paracoccidioidomycosis.

Discordance between clinical and imaging criteria: assessment by magnetic resonance imaging of the foot of patients with rheumatoid arthritis

Evaluation of the correlation between disease activity and joint involvement was assessed by MRI in the clinically dominant foot of patients with RA. We conducted a cross-sectional descriptive study of 55 patients with RA, who were subjected to clinical evaluation and MRI assessment. Imaging of the clinically dominant foot was performed, and both the Disease Activity Score 28 (DAS28-CRP) and the Health Assessment Questionnaire—Disability Index (HAQ-DI) were measured. The majority of patients classified as in clinical remission presented some degree of inflammatory activity upon MRI evaluation. Statistical analysis demonstrated no correlation between MRI findings and clinical scores. There is evidence of disease activity on MRI of the clinically dominant foot even in patients classified as in clinical remission according to the DAS28-CRP criteria.