OBJECTIVE: To evaluate the performance of computed tomography (CT)-guided percutaneous biopsy of abdominal lesions. MATERIALS AND METHODS: This retrospective, single-center study evaluated patients submitted to CT-guided percutaneous biopsy of abdominal lesions at a cancer center, between January 2014 and June 2015. The images and patient medical records were reviewed using a standardized data collection form. RESULTS: We included 225 procedures performed in 212 patients, of whom 143 (63.5%) had a prior diagnosis of cancer. Of the 225 lesions biopsied, 88 (39.1%) had a suspected primary origin and 137 (60.9%) were suspected metastatic lesions. Complications occurred in only 14 (6.2%), the most common being self-limited bleeding, which occurred in 12 (85.7%) of the 14. The occurrence of complications was not found to be significantly associated with the lesion location, age of the patient, presence of comorbidities, use of a supplementary technique, vascularization pattern, or proximity of the lesion to large vessels. The pathology findings were sufficient for making the diagnosis in 202 cases (89.8%), and the diagnosis was consistent with the clinical suspicion in 132 (58.6%). CONCLUSION: The procedure demonstrated a high (approximately 90%) rate of providing a sufficient sample for the diagnosis and a low complication rate, the most common complication being self-limiting bleeding.

Keywords: Tomography, X-ray computed; Image-guided biopsy; Abdominal neoplasms/diagnostic imaging.

OBJECTIVE: To describe the preoperative localization of musculoskeletal lesions with the radioguided occult lesion localization (ROLL) technique. MATERIALS AND METHODS: In all cases, computed tomography-guided injection of technetium-99m sulfur colloid was performed, directly into or near the suspicious lesion, up to 36 hours before the surgical procedure. Lesions were detected intraoperatively with a gamma probe. RESULTS: We report the cases of six patients submitted to radioguided surgery, including three patients with bone lesions suspicious for metastasis, two patients suspected of recurrent sarcoma, and one patient with no previous diagnosis who had a nodular lesion on the left leg. Patients tolerated the procedure well, and no complications were associated with the puncture. All marked lesions were easily identified intraoperatively and were excised with clear margins. CONCLUSION: The ROLL technique was effective in the intraoperative localization of occult musculoskeletal lesions, demonstrating that it is a feasible and promising technique for the surgical exploration of selected cases.

Keywords: Nuclear medicine; Gamma cameras; Medical oncology; Musculoskeletal system; Minimally invasive surgical procedures.

OBJECTIVE: To show the initial (first-year) experience with ⁶⁸Ga-PSMA PET/CT at a clinic in Brazil. MATERIALS AND METHODS: Over a one-year period, 96 examinations with ⁶⁸Ga-PSMA PET/CT (85 related to prostate cancer and 11 related to kidney cancer) were performed in 90 patients. RESULTS: In the prostate and kidney cancer patients alike, the main clinical indication for ⁶⁸Ga-PSMA PET/CT was suspicion of recurrence during follow-up (in 65.8% and 63.0% of the cases, respectively). Among the prostate cancer patients, 38.5% of those with a prostate specific antigen (PSA) < 0.5 ng/mL tested positive for recurrence on ⁶⁸Ga-PSMA PET/CT, compared with 71.0% of those with a PSA of 0.5–0.99, 85.7% of those with a PSA of 1.0–1.99, and 92.6% of those with a PSA > 1.99. CONCLUSION: Although ⁶⁸Ga-PSMA PET/CT is a technique that has only recently been applied in clinical settings, despite its high cost, ⁶⁸Ga-PSMA PET/CT shows great promise as a tool in the clinical management of patients with kidney and prostate cancer, especially in those with prostate cancer whose PSA levels are elevated even after treatment.

Keywords: Prostate cancer; Kidney cancer; PET/CT; ⁶⁸Ga-PSMA.

OBJECTIVE: The purpose of this study was to determine whether chemical-shift magnetic resonance imaging (MRI) could be useful in the diagnosis of osteoid osteoma when clinical and radiological tumor features are inconclusive. MATERIALS AND METHODS: This retrospective study included 17 patients who underwent chemical-shift MRI for the evaluation of osteoid osteoma. For all patients, two musculoskeletal radiologists independently recorded signal intensities on in-phase and out-of-phase images in the nidus of the tumor, in abnormal-intensity bone marrow surrounding the lesion, and in normal-appearing bone marrow. For each region, relative signal intensity ratios were calculated by dividing out-of-phase by in-phase values. Relative ratios > 1 were considered indicative of neoplastic lesions. Statistical analysis was carried out to analyze the sample. Inter-observer and intra-observer agreement for each imaging method were assessed using intraclass correlation coefficients according to the Fleiss method and a value > 0.65 was considered to indicate substantial agreement. RESULTS: The mean relative signal intensity ratios were 1.2 (range, 0.9-1.4) for the nidus and 0.35 (range, 0.11-0.66) for the surrounding tissue; these values differed significantly from the relative signal-intensity ratios for normal-appearing bone marrow (p < 0.05). CONCLUSION: Chemical-shift MRI is useful for the diagnosis and evaluation of osteoid osteoma.

Keywords: Osteoma, osteoid; Magnetic resonance imaging; Neoplasms, bone tissue.

OBJECTIVE: To analyze the perception of the relevance of introducing bilingual (Portuguese-English) musculoskeletal imaging education into radiology and diagnostic imaging residency programs, describing the method used. MATERIALS AND METHODS: To evaluate the relevance of incorporating the bilingual study of musculoskeletal imaging into medical residency programs, we administered a questionnaire, consisting of several multiple-choice questions and one subjective question, to 21 radiology residents at a private tertiary hospital. The residents completed the questionnaire voluntarily and anonymously. RESULTS: Integrating English teaching into radiology training was considered important by 95.2% of the residents. Approximately 90% of residents believe that the method applied at their institution is suitable for learning. CONCLUSION: The introduction of the English language into the teaching of musculoskeletal imaging in the radiology residency program was perceived positively by the residents, and the preceptors effectively supported those activities.

Keywords: Multilingualism; Education, medical; Radiology; Musculoskeletal system/diagnostic imaging.

OBJECTIVE: The aim of this study was to identify radiological and clinical risk factors for death in newborns with necrotizing enterocolitis. MATERIALS AND METHODS: This was a retrospective cohort study, based on radiological examinations and medical charts of 66 infants with necrotizing enterocolitis, as confirmed by a finding of intestinal pneumatosis (stage IIA, according to modified Bell’s staging criteria). Radiological and clinical variables were evaluated. RESULTS: Of the 66 infants evaluated, 14 (21.2%) presented pneumatosis in the large and small bowel; 7 (10.6%) presented air in the portal system; and 12 (18.2%) died. Bivariate analysis revealed that the following variables were associated with death: bowel perforation; pneumatosis in the large and small bowel; air in the portal system; earlier gestational age; longer time on mechanical ventilation before the identification of pneumatosis; and longer time on mechanical ventilation before discharge or death. In the multivariate regression, the following variables remained as predictors of death: pneumatosis in the large and small intestines (odds ratio [OR] = 12.4; 95% confidence interval [95% CI] = 1.2-127.4; p = 0.035), perforation (OR = 23.2; 95% CI = 2.2-246.7; p = 0.009), and air in the portal system (OR = 69.7; 95% CI = 4.3-[not calculated]; p = 0.003). CONCLUSION: The set of factors most strongly associated with death in infants with necrotizing enterocolitis comprised extensive pneumatosis, pneumoperitoneum, and air in the portal system. Our findings confirm the importance of radiological imaging in the diagnosis and monitoring of necrotizing enterocolitis.

Keywords: Enterocolitis, necrotizing/diagnosis; Infant, premature; Premature birth; Perinatal death.

OBJECTIVE: To present a quantitative system for assessing the quality of ultrasound examinations—SQUALUS—and to determine its reproducibility, taking into consideration the images on file, as well as the consistency between the images obtained and the final report. MATERIALS AND METHODS: The system includes questions related to the number of images; the appropriateness of images in relation to the protocol established; focus adjustment; depth; gain; and appropriateness of the measurements for B-mode examinations. For Doppler examinations, the system includes questions related to the appropriateness of color images, the spectral analysis, and correction of the insonation angle. To assess the quality of the report, the system includes questions related to the consistency between the images obtained and the contents of the report. An overall numerical score was assigned by averaging the scores for image quality and for the contents of the report. Two independent examiners, each blinded to the evaluation of the other, assessed 30 different types of ultrasound examinations. RESULTS: There was statistically significant agreement between the two examiners for 8 of the 10 questions related to image quality. For the questions related to the quality of the reports, the interexaminer agreement was almost perfect. CONCLUSION: The proposed quantitative system for assessing the quality of ultrasound examinations is a reproducible tool that can be used in audits and accreditation programs.

Keywords: Ultrasonography; Quality control; Quality improvement; Certification; Accreditation.

The accurate diagnosis of pulmonary thromboembolism is essential to reducing the morbidity and mortality associated with the disease. The diagnosis of pulmonary thromboembolism is challenging because of the nonspecific nature of the clinical profile and the risk factors. Imaging methods provide the definitive diagnosis. Currently, the imaging method most commonly used in the evaluation of pulmonary thromboembolism is computed tomography. The recent development of dual-energy computed tomography has provided a promising tool for the evaluation of pulmonary perfusion through iodine mapping. In this article, we will review the importance of diagnosing pulmonary thromboembolism, as well as the imaging methods employed, primarily dual-energy computed tomography.

Keywords: Pulmonary embolism; Tomography, emission-computed/methods; Tomography, X-ray computed/methods; Computed tomography, dual-energy scanned projection; Ventilation-perfusion ratio.

Although ultrasound is still the gold standard for the assessment of fetal malformations, magnetic resonance imaging (MRI) has gained great prominence in recent years. In situations in which ultrasound has low sensitivity, such as maternal obesity, abdominal scarring, and oligohydramnios, MRI has proven to be a safe and accurate method. Regarding fetal abdominal wall defects, MRI appears to be widely used in the prognostic assessment of gastroschisis with intestinal atresia or of complications of omphalocele, allowing better perinatal management and parental counseling. In addition, MRI allows the assessment of local invasion of fetal abdominal tumors, with significant prognostic value for the postnatal period. In this article, we review the main MRI findings in the evaluation of fetal abdominal wall defects and tumors.

Keywords: Fetus; Congenital abnormalities/diagnostic imaging; Abdomen/diagnostic imaging; Magnetic resonance imaging.

Emergencies involving the inguinal region and scrotum are common and can be caused by a plethora of different causes. In most cases, such conditions have nonspecific symptoms and are quite painful. Some inguinoscrotal conditions have high complication rates. Early and accurate diagnosis is therefore imperative. Ultrasound is the method of choice for the initial evaluation of this vast range of conditions, because it is a rapid, ionizing radiation-free, low-cost method. Despite the practicality and accuracy of the method, which make it ideal for use in emergency care, the examiner should be experienced and should be familiarized with the ultrasound findings of the most common inguinoscrotal diseases. On the basis of that knowledge, the examiner should also be able to make an accurate, direct, precise report, helping the emergency room physician make decisions regarding the proper (clinical or surgical) management of each case. Here, we review most of the inguinoscrotal conditions, focusing on the imaging findings and discussing the critical points for the appropriate characterization of each condition.

Keywords: Hernia, inguinal; Inguinal canal; Orchitis; Fournier gangrene; Ultrasonography.