OBJECTIVE: To perform a quantitative analysis of the airways using automated software, in computed tomography images of patients with cystic fibrosis, correlating the results with spirometric findings. MATERIALS AND METHODS: Thirty-four patients with cystic fibrosis were studied—20 males and 14 females; mean age 18 ± 9 years—divided into two groups according to the spirometry findings: group I (n = 21), without severe airflow obstruction (forced expiratory volume in first second [FEV1] > 50% predicted), and group II (n = 13), with severe obstruction (FEV1 ≤ 50% predicted). The following tracheobronchial tree parameters were obtained automatically: bronchial diameter, area, thickness, and wall attenuation. RESULTS: On average, 52 bronchi per patient were studied. The number of bronchi analyzed was higher in group II. The correlation with spirometry findings, especially between the relative wall thickness of third to eighth bronchial generation and predicted FEV1, was better in group I. CONCLUSION: Quantitative analysis of the airways by computed tomography can be useful for assessing disease severity in cystic fibrosis patients. In patients with severe airflow obstruction, the number of bronchi studied by the method is higher, indicating more bronchiectasis. In patients without severe obstruction, the relative bronchial wall thickness showed a good correlation with the predicted FEV1.

Keywords: Cystic fibrosis; Tomography, X-ray computed; Airway remodeling/physiology.

OBJECTIVE: To identify and classify the radiographic patterns of megaesophagus in Chagas disease, as seen on esophagograms and chest X-rays. MATERIALS AND METHODS: This was a prospective study of 35 patients diagnosed with esophageal disease via manometry. The changes found on esophagograms were stratified according to Rezende's classification, divided into four categories (grades I through IV) determined by the degree of dilatation and impairement of esophageal motility. We subsequently correlated that ranking with the chest X-ray findings: gastric air bubble; air-fluid level; and mediastinal widening. RESULTS: Among the 35 patients, the esophageal disease was classified as grade I in 9 (25.7%), grade II in 3 (8.6%), grade III in 19 (54.3%), and grade IV in 4 (11.4%). None of the patients with grade I esophageal disease showed changes on chest X-rays. In two of the three patients with grade II disease, there was no gastric air-bubble, although there were no other findings in any of the grade II patients. Of the 19 patients with grade III disease, 15 had abnormal findings on X-rays. All four patients with grade IV disease showed abnormalities. CONCLUSION: The use of Rezende's classification is feasible, encompassing findings ranging from the subtle changes that characterize the initial phases of esophageal disease to the complete akinesia seen in dolicomegaesophagus. Chest X-ray findings are more common in patients with advanced stages of the disease and indicate the degree of esophageal involvement in Chagas disease.

Keywords: Esophageal achalasia/radiography; Esophagus/radiography; Radiography, thoracic.

OBJECTIVE: To assess the feasibility and reliability of apparent diffusion coefficient (ADC) measurements of normal adrenal glands. MATERIALS AND METHODS: This was a retrospective study involving 32 healthy subjects, divided into two groups: prepubertal (PreP, n = 12), aged from 2 months to 12.5 years (4 males; 8 females); and postpubertal (PostP, n = 20), aged from 11.9 to 61 years (5 males; 15 females). Diffusion-weighted magnetic resonance imaging (DW-MRI) sequences were acquired at a 1.5 T scanner using b values of 0, 20, 500, and 1000 s/mm². Two radiologists evaluated the images. ADC values were measured pixel-by-pixel on DW-MRI scans, and automatic co-registration with the ADC map was obtained. RESULTS: Mean ADC values for the right adrenal glands were 1.44 × 10^–3 mm²/s for the PreP group and 1.23 × 10^–3 mm²/s for the PostP group, whereas they were 1.58 × 10^–3 mm²/s and 1.32 × 10^–3 mm²/s, respectively, for the left glands. ADC values were higher in the PreP group than in the PostP group (p < 0.05). Agreement between readers was almost perfect (intraclass correlation coefficient, 0.84–0.94; p < 0.05). CONCLUSION: Our results demonstrate the feasibility and reliability of performing DW-MRI measurements of normal adrenal glands. They could also support the feasibility of ADC measurements of small structures.

Keywords: Adrenal glands; Diffusion magnetic resonance imaging; Magnetic resonance imaging.

OBJECTIVE: To determine the value of anterior displacement of the abdominal aorta, when present at any level or only at the level of the adrenal gland, contralateral to the mass, in diagnosing neuroblastoma on computed tomography or magnetic resonance imaging in children up to 7 years of age. MATERIALS AND METHODS: Imaging examinations of 66 patients were classified by consensus as for the presence of anterior aorta displacement and were compared with the pathology report. RESULTS: We found anterior abdominal aorta displacement in 26 (39.39%) of the 66 patients evaluated. Among those 26 patients, we identified neuroblastoma in 22 (84.62%), nephroblastoma in 3 (11.54%), and Burkitt lymphoma in 1 (3.85%). The positive predictive value was 84.62%, and the specificity was 88.24%. The displacement of the aorta was at the adrenal level, contralateral to the mass, in 14 cases, all of which were attributed to neuroblastoma. CONCLUSION: When the abdominal aorta is displaced at the level of the adrenal gland, contralateral to the mass, it can be said that the diagnosis is neuroblastoma, whereas abdominal aorta displacement occurring at other abdominal levels has a positive predictive value for neuroblastoma of approximately 85%.

Keywords: Tomography, X-ray computed; Magnetic resonance imaging; Neuroblastoma; Aorta, abdominal; Pediatrics.

OBJECTIVE: The objective of this study was to profile patients who undergo defecography, by age and gender, as well as to describe the main imaging and diagnostic findings in this population. MATERIALS AND METHODS: This was a retrospective, descriptive study of 39 patients, conducted between January 2012 and February 2014. The patients were evaluated in terms of age, gender, and diagnosis. They were stratified by age, and continuous variables are expressed as mean ± standard deviation. All possible quantitative defecography variables were evaluated, including rectal evacuation, perineal descent, and measures of the anal canal. RESULTS: The majority (95%) of the patients were female. Patient ages ranged from 18 to 82 years (mean age, 52 ± 13 years): 10 patients were under 40 years of age; 18 were between 40 and 60 years of age; and 11 were over 60 years of age. All 39 of the patients evaluated had abnormal radiological findings. The most prevalent diagnoses were rectocele (in 77%) and enterocele (in 38%). Less prevalent diagnoses were vaginal prolapse, uterine prolapse, and Meckel's diverticulum (in 2%, for all). CONCLUSION: Although defecography is performed more often in women, both genders can benefit from the test. Defecography can be performed in order to detect complex disorders such as uterine and rectal prolapse, as well as to detect basic clinical conditions such as rectocele or enterocele.

Keywords: Defecography; Constipation; Rectocele; Rectal prolapse.

OBJECTIVE: To compare brain structures using volumetric magnetic resonance imaging with isotropic resolution, in T1-weighted gradient-echo (GRE) acquisition, with and without inversion recovery (IR). MATERIALS AND METHODS: From 30 individuals, we evaluated 120 blocks of images of the left and right cerebral hemispheres being acquired by T1 GRE and by T1 IR GRE. On the basis of the Naidich et al. method for localization of anatomical landmarks, 27 anatomical structures were divided into two categories: identifiable and inconclusive. Those two categories were used in the analyses of repeatability (intraobserver agreement) and reproducibility (interobserver agreement). McNemar's test was used in order to compare the T1 GRE and T1 IR GRE techniques. RESULTS: There was good agreement in the intraobserver and interobserver analyses (mean kappa > 0.60). McNemar's test showed that the frequency of identifiable anatomical landmarks was slightly higher when the T1 IR GRE technique was employed than when the T1 GRE technique was employed. The difference between the two techniques was statistically significant. CONCLUSION: In the identification of anatomical landmarks, the T1 IR GRE technique appears to perform slightly better than does the T1 GRE technique.

Keywords: Magnetic resonance imaging; Brain/anatomy & histology; Reproducibility of results.

Because of the physiological changes that occur during pregnancy and lactation, diagnostic ultrasound of the breast during these periods is a challenge for physicians. Therefore, a comprehensive understanding of imaging, anatomy, and physiology of the breast is important to effectively diagnosing diseases that can arise in women who are pregnancy or lactating. The aim of this article was to review the physiological changes that occur in the breasts during pregnancy and lactation, as well as to describe the main features of the breast diseases that occur most frequently during these periods.

Keywords: Pregnancy; Lactation; Breast; Ultrasonography.

In the appropriate clinical setting, certain aspects of extranodal abdominal lymphoma, as revealed by current cross-sectional imaging techniques, should be considered potentially diagnostic and can hasten the diagnosis. In addition, diagnostic imaging in the context of biopsy-proven lymphoma can accurately stage the disease for its appropriate treatment. The purpose of this article was to illustrate the various imaging aspects of extranodal lymphoma in the abdomen.

Keywords: Lymphoma; Abdomen; Tomography, X-ray computed.

We report an unprecedented case of ectopic thymoma in a young adult. A 33-year-old male presented with a 10-day history of non-productive cough and fever. Investigation revealed mediastinal widening without pulmonary involvement. Computed tomography showed a large mass—14.8 × 10.8 × 8.4 cm—in the mid-posterior mediastinum, and a biopsy obtained by video-assisted thoracoscopy indicated that the mass was a tumor. Immunohistochemistry showed combined thymoma type AB1. Because of the considerable proportions of the tumor and its close proximity to major structures, the patient was treated with chemotherapy.

Keywords: Thymoma; Middle mediastinum; Posterior mediastinum; Ectopic tumor.