OBJECTIVE: To evaluate positron emission tomography/computed tomography (PET/CT) and conventional imaging tests for the detection of distant metastases in patients with locally advanced breast cancer. MATERIALS AND METHODS: We included 81 patients with breast cancer who had undergone ¹⁸F-fluorodeoxyglucose (FDG) PET/CT before treatment. Conventional imaging included the following: bone scintigraphy; chest X-ray (in 14.5%) or CT (in 85.5%); and abdominal ultrasound (in 10.8%), CT (in 87.8%), or magnetic resonance imaging (in 1.4%). Histopathology and clinical/imaging follow-up served as reference. RESULTS: Distant metastases were observed in nine patients (11.1%). On patient-based analysis, conventional imaging identified distant metastases in all 9 patients. In one patient, the initial ¹⁸F-FDG PET/CT failed to demonstrate bone metastases that was evident on bone scintigraphy. In two patients, the CT scan failed to show extra-axillary lymph node metastases that were identified on ¹⁸F-FDG PET/CT. There was no significant difference between ¹⁸F-FDG PET/CT and conventional imaging in terms of their sensitivity for the detection of distant metastases in patients with locally advanced breast cancer. CONCLUSION: This study showed that ¹⁸F-FDG PET/CT and conventional imaging with CT scans had similar sensitivity for the diagnosis of distant metastases in patients with locally advanced breast cancer. ¹⁸F-FDG PET/CT can add information about extra-axillary lymph node involvements.

Keywords: Breast neoplasms; Positron-emission tomography; ¹⁸F-fluorodeoxyglucose.

OBJECTIVE: The purpose of this study was to compare two short-tau inversion recovery (STIR) sequences, Cartesian and radial (BLADE) acquisitions, for breast magnetic resonance imaging (MRI) examinations. MATERIALS AND METHODS: Ninety-six women underwent 1.5 T breast MRI exam (48 Cartesian and 48 BLADE). Qualitative analysis including image artifacts, image quality, fat-suppression, chest-wall depiction, lesion detection, lymph node depiction and overall impression were evaluated by three blinded readers. Signal to noise ratios (SNRs) were calculated. Cronbach’s alpha test was used to assess inter-observer agreement. Subanalyses of image quality, chest-wall depiction and overall impression in 15 patients with implants and image quality in 31 patients with clips were correlated using Pearson test. Wilcoxon rank sum test and t-test were performed. RESULTS: Motion artifacts were present in 100% and in 0% of the Cartesian and the BLADE exams, respectively. Chemical-shift artifacts were present in 8% of the Cartesian exams. Flow artifacts were more frequent on BLADE. BLADE sequence was statistically superior to Cartesian for all qualitative features (p < 0.05) except for fat-suppression (p = 0.054). In the subanalysis, BLADE was superior for implants and clips (p < 0.05). SNR was statistically greater for BLADE (48.35 vs. 16.17). Cronbach ranged from 0.502 to 0.813. CONCLUSION: BLADE appears to be superior to Cartesian acquisition of STIR imaging as measured by improved image quality, fewer artifacts, and improved chest wall and lymph node depiction.

Keywords: Breast MRI; BLADE sequence; Cartesian sequence; Image quality.

OBJECTIVE: To assess the feasibility of contrast-enhanced spectral mammography (CESM) of the breast for assessing the size of residual tumors after neoadjuvant chemotherapy (NAC). MATERIALS AND METHODS: In breast cancer patients who underwent NAC between 2011 and 2013, we evaluated residual tumor measurements obtained with CESM and full-field digital mammography (FFDM). We determined the concordance between the methods, as well as their level of agreement with the pathology. Three radiologists analyzed eight CESM and FFDM measurements separately, considering the size of the residual tumor at its largest diameter and correlating it with that determined in the pathological analysis. Interobserver agreement was also evaluated. RESULTS: The sensitivity, specificity, positive predictive value, and negative predictive value were higher for CESM than for FFDM (83.33%, 100%, 100%, and 66% vs. 50%, 50%, 50%, and 25%, respectively). The CESM measurements showed a strong, consistent correlation with the pathological findings (correlation coefficient = 0.76–0.92; intraclass correlation coefficient = 0.692–0.886). The correlation between the FFDM measurements and the pathological findings was not statistically significant, with questionable consistency (intraclass correlation coefficient = 0.488–0.598). Agreement with the pathological findings was narrower for CESM measurements than for FFDM measurements. Interobserver agreement was higher for CESM than for FFDM (0.94 vs. 0.88). CONCLUSION: CESM is a feasible means of evaluating residual tumor size after NAC, showing a good correlation and good agreement with pathological findings. For CESM measurements, the interobserver agreement was excellent.

Keywords: Mammography/methods; Breast neoplasms/diagnosis; Magnetic resonance imaging; Neoadjuvant therapy/methods.

OBJECTIVE: The aim of this study was to evaluate the high-resolution computed tomography (HRCT) findings in patients diagnosed with metastatic pulmonary calcification (MPC). MATERIALS AND METHODS: We retrospectively reviewed the HRCT findings from 23 cases of MPC [14 men, 9 women; mean age, 54.3 (range, 26–89) years]. The patients were examined between 2000 and 2014 in nine tertiary hospitals in Brazil, Chile, and Canada. Diagnoses were established by histopathologic study in 18 patients and clinical-radiological correlation in 5 patients. Two chest radiologists analyzed the images and reached decisions by consensus. RESULTS: The predominant HRCT findings were centrilobular ground-glass nodules (n = 14; 60.9%), consolidation with high attenuation (n = 10; 43.5%), small dense nodules (n = 9; 39.1%), peripheral reticular opacities associated with small calcified nodules (n = 5; 21.7%), and ground-glass opacities without centrilobular ground-glass nodular opacity (n = 5; 21.7%). Vascular calcification within the chest wall was found in four cases and pleural effusion was observed in five cases. The abnormalities were bilateral in 21 cases. CONCLUSION: MPC manifested with three main patterns on HRCT, most commonly centrilobular ground-glass nodules, often containing calcifications, followed by dense consolidation and small solid nodules, most of which were calcified. We also described another pattern of peripheral reticular opacities associated with small calcified nodules. These findings should suggest the diagnosis of MPC in the setting of hypercalcemia.

Keywords: Metastatic pulmonary calcification; Computed tomography; Metabolic diseases; Pulmonary diseases.

OBJECTIVE: To investigate the influence of bladder fullness on the diagnosis of urinary tract obstruction during dynamic renal scintigraphy with a diuretic stimulator. MATERIALS AND METHODS: We studied 82 kidneys in 82 patients submitted to dynamic renal scintigraphy with a diuretic stimulator. We compared the proportional elimination of the radiopharmaceutical ^99mTc-DTPA from the kidneys before and after bladder emptying in post-diuretic images, classifying each image as representing an obstructed, indeterminate, or unobstructed kidney. RESULTS: The overall elimination of ^99mTc-DTPA from the kidneys was 10.4% greater after bladder emptying than before. When the analysis was performed with a full bladder, we classified 40 kidneys as obstructed, 16 as indeterminate, and 26 as unobstructed. When the 40 kidneys classified as obstructed were analyzed after voiding, 11 were reclassified as indeterminate and 3 were reclassified as unobstructed. Of the 16 kidneys classified as indeterminate on the full-bladder images, 13 were reclassified as unobstructed after voiding. CONCLUSION: In dynamic renal scintigraphy with a diuretic stimulator, it is important to obtain images after voiding, in order to perform a reliable analysis of the proportional excretion of ^99mTc-DTPA from the kidneys, avoiding possible false-positive results for urinary tract obstruction.

Keywords: Dynamic renal scintigraphy; Urinary tract obstruction; ^99mTc-DTPA; Vesical repletion.

OBJECTIVE: To present the current recommendations for breast cancer screening in Brazil, as devised by the Brazilian College of Radiology and Diagnostic Imaging, the Brazilian Breast Disease Society, and the Brazilian Federation of Gynecological and Obstetrical Associations. MATERIALS AND METHODS: We analyzed scientific studies available in the Medline and Lilacs databases. In the absence of evidence, the recommendations reflected the consensus of a panel of experts. RECOMMENDATIONS: Annual mammography screening is recommended for women 40–74 years of age. Among women ≥ 75 years of age, annual mammography screening should be reserved for those with an expected survival > 7 years. Complementary ultrasound should be considered for women with dense breasts. Complementary magnetic resonance imaging is recommended for women at high risk. When available, an advanced form of mammography known as tomosynthesis can be considered as a means of screening for breast cancer.

Keywords: Breast cancer screening; Mammography; Ultrasound; Magnetic resonance imaging.

Parkinson’s disease is one of the most common neurodegenerative diseases. Clinically, it is characterized by motor symptoms. Parkinson’s disease should be differentiated from atypical parkinsonism conditions. Conventional magnetic resonance imaging is the primary imaging method employed in order to facilitate the differential diagnosis, and its role has grown after the development of advanced techniques such as diffusion-weighted imaging. The purpose of this article was to review the role of magnetic resonance imaging in Parkinson’s disease and in the differential diagnosis with atypical parkinsonism, emphasizing the diffusion technique.

Keywords: Parkinson disease; Parkinsonian disorders; Supranuclear palsy, progressive; Multiple system atrophy; Neurodegenerative diseases/physiopathology; Diffusion magnetic resonance imaging.

Diagnostic imaging is crucial to the diagnosis and monitoring of spondyloarthropathies. Magnetic resonance imaging is the most relevant tool for the early detection of sacroiliitis, allowing the institution of therapeutic strategies to impede the progression of the disease. This study illustrates the major criteria for a magnetic resonance imaging-based diagnosis of spondyloarthropathy. The cases selected here present images obtained from the medical records of patients diagnosed with sacroiliitis over a two-year period at our facility, depicting the active and chronic, irreversible forms of the disease. Although computed tomography and conventional radiography can also identify structural changes, such as subchondral sclerosis, erosions, fat deposits, and ankylosis, only magnetic resonance imaging can reveal active inflammatory lesions, such as bone edema, osteitis, synovitis, enthesitis, and capsulitis.

Keywords: Sacroiliitis; Magnetic resonance imaging; Spondyloarthropathies; Ankylosing spondylitis; Computed tomography; Radiography.

Only 5–10% of osteosarcomas arise from the craniofacial bones. We report the case of a 14-year-old female patient who presented with headache and a mass that had been growing in the left frontoparietal region for six months. We describe the findings on conventional radiography, computed tomography, and magnetic resonance imaging.

Keywords: Osteosarcoma; Neoplasms; Skull.