OBJECTIVE: To evaluate the accuracy of multidetector computed tomography with a stomach protocol in staging of gastric cancer. MATERIALS AND METHODS: We evaluated 14 patients who underwent computed tomography in a 16-channel scanner for preoperative staging of gastric adenocarcinoma between September 2015 and December 2016. All images were analyzed by the same radiologist, who had extensive experience in abdominal cancer imaging. The sensitivity, specificity, and accuracy of the method were calculated by comparing it with the pathology result. All patients underwent partial or total gastrectomy. RESULTS: The mean age was 61.5 years, and 53.8% of the patients were male. The gastric lesions were classified as T1/T2 in 35.7% of the cases, as T3 in 28.5%, and as T4 in 35.7%. Eleven patients (68.7%) had suspicious (N positive) lymph nodes. The accuracy of the T1/T2, T3, T4, and lymph node staging tests was 85%, 78%, 90%, and 78%, respectively. The respective sensitivity and specificity values were 71% and 100% for T1/T2, 66% and 81% for T3, 100% and 90% for T4, and 88% and 60% for lymph nodes. CONCLUSION: Multidetector computed tomography with a stomach protocol, used in conjunction with virtual gastroscopy, shows good accuracy in the tumor and lymph node staging of gastric adenocarcinoma.

Keywords: Stomach neoplasms; Multidetector computed tomography; Neoplasm staging.

OBJECTIVE: To analyze the prevalence of cystic lesions of the pancreas on imaging exams and their association with signs of malignancy risk. MATERIALS AND METHODS: This was an observational cross-sectional study, in which we evaluated 924 sequential computed tomography and magnetic resonance imaging scans of the abdomen. For all of the patients included in the study, we reviewed the demographic data available in the medical records and evaluated the images. RESULTS: Cysts were observed in 4.5% of patients, the prevalence of cysts being highest (7.6%) in patients over 60 years of age. Lesions were detected at higher rates on magnetic resonance imaging and in patients with pancreatic symptoms (6.1% and 42.9%, respectively). Signs of malignancy risk were observed in 26.3% of the patients, more frequently in those who were male and over 60 years of age. CONCLUSION: The prevalence of pancreatic cysts was 4.5%. Signs of malignancy risk were observed in 26.3% of the cystic neoplasms identified.

Keywords: Pancreas; Pancreatic cyst; Pancreatic neoplasms.

OBJECTIVE: To investigate the correlation between tracer uptake on bone scintigraphy and recovery time in patients with tibial stress fracture. MATERIALS AND METHODS: We evaluated two groups of athletes: those with clinical suspicion and a radiological diagnosis of tibial stress fracture (TSF group, n = 21); and those with no symptoms or evidence of fracture (control group, n = 10). All subjects underwent bone scintigraphy and magnetic resonance imaging with a maximum interval of 7 days between the assessments. RESULTS: Using the region of interest technique, we obtained a quantitative evaluation index, comparing affected and unaffected legs. The mean uptake of ^99mTc-MDP was significantly higher in the TSF group than in the control group (2.54 ± 0.77 vs. 1.05 ± 0.11; p < 0.001). CONCLUSION: In our sample of athletes, determining the bone scintigraphy uptake indices provided an objective method to estimate the appropriate recovery time after a tibial stress fracture.

Keywords: Tibial fractures; Athletes; Fractures, stress; Radionuclide imaging.

OBJECTIVE: To analyze the efficacy of recombinant tissue plasminogen activator (r-TPA) injection in the evolution of percutaneous drainage of thick collections. MATERIALS AND METHODS: This was a single-center study involving the retrospective analysis of hospitalized patients undergoing percutaneous drainage of thick (superficial or intracavitary) fluid collections, followed by injection of a fibrinolytic agent (r-TPA) into the affected space. RESULTS: A total of 53 percutaneous drainage procedures, with r-TPA injection, were performed in 51 patients. Abdominal and pelvic collections were the most common, being seen in 38 (73%) of the procedures; in 35 (66%), the etiology of the collection was attributed to postoperative complications. A total of 61 catheters were used in order to drain the 53 collections. Of those 61 catheters, 52 (85%) were large (12–16 Fr) and 9 (15%) were small (4–10 Fr). The mean r-TPA dose was 5.7 mg/collection per day, and the mean time from r-TPA injection to drain removal was 7.7 days. Percutaneous drainage in combination with r-TPA injection was successful in 96% of the cases. None of the patients showed coagulation changes during the study period. CONCLUSION: The use of once-daily, low-dose r-TPA for up to three consecutive days, as an adjunct to percutaneous drainage of thick collections, with or without loculation, appears to be an effective technique.

Keywords: Abscess; Drainage; Fibrinolytic agents.

OBJECTIVE: The aim of this study was to evaluate the incidence of extravasation of iodinated contrast medium (ICM) at the site of intravenous injection in oncology patients submitted to computed tomography (CT). MATERIALS AND METHODS: This was a retrospective, descriptive, single-center study that evaluated all patients who underwent CT with ICM administration and presented ICM extravasation, at a cancer center, between January 2010 and December 2015. RESULTS: During the study period, we evaluated a total of 99,076 ICM injections and identified 199 cases of extravasation, the incidence rate therefore being 0.20%. Among the patients who presented extravasation, the mean age was 59.22 years and 60% were female. The extravasation was classified as mild in 94.10% of the patients and as moderate in 5.90%. There were no cases of severe extravasation in the sample. CONCLUSION: The incidence of ICM extravasation in cancer patients submitted to CT in the present study was similar to that reported for the general population, according to other studies in the literature. The vast majority of cases of extravasation were considered mild, and no severe cases were observed in the study sample.

Keywords: Tomography, X-ray computed; Contrast media; Extravasation of diagnostic and therapeutic materials; Medical oncology.

OBJECTIVE: To assess the feasibility of Facebook to promote a radiology education project and to expand it from our university community of medical students to a wider audience. MATERIALS AND METHODS: A group of 12 medical students created a Facebook page in June 2015, to contribute to radiology education in our university. From August 2015, clinical cases, including a brief explanation of clinical findings, along with different imaging modalities, were posted weekly and subscribers were encouraged to choose the most appropriate diagnosis. All cases were followed by the appropriate answer and an explanation to highlight imaging findings and diagnosis. Aiming to reach a larger audience, we also shared cases to a public Latin-American Facebook group, comprising a collective total of 28,182 physicians and medical students. Using the Facebook Insights tracking tool, we prospectively analyzed subscriber interaction with our page for 14 months. RESULTS: During the period analyzed, 35 cases were posted. The most common imaging modalities were X-ray (n = 15) and computed tomography (n = 13). Before we began posting the weekly cases, our page had 286 likes. By October 2016, that number had grown to 4244, corresponding to an increase of 1484% and eight times the size of the medical student community at our institution (n = 530). Medical students made up most (76%) of the subscribers, followed by radiology residents (6%). An excellent or moderate contribution to personal image interpretation skills was reported by 65.3% and 33.1% of the users, respectively. CONCLUSION: Creating a Facebook page and posting weekly clinical cases proved to be an effective method of promoting radiology education.

Keywords: Education, medical, continuing; Clinical medicine/education; Radiology/education; Social media.

Accessory ossicles are supernumerary and inconstant structures that are not caused by fractures. Derived from unfused ossification centers, accessory ossicles were first described by Vesalius in 1543. For centuries, they were believed to be asymptomatic. However, with advances in radiology techniques, many have been associated with painful syndromes. Although the original descriptions date from the sixteenth century, the subject is little discussed and, in some cases, controversial. The objective of this study was to describe the radiological aspects of a series of accessory ossicles and to review the evolution of their various descriptions, in order to revive discussion of the subject.

Keywords: Bone and bones; Anatomic variation; Magnetic resonance imaging; Tomography, X-ray computed; Radiology.

Ultrasound is an excellent method for the study of penis. In this article, using a critical review of the literature and teaching files, we present examples of the major findings in the ultrasound routine, focusing on trauma, priapism, Peyronie’s disease, and erectile dysfunction.

Keywords: Penis; Ultrasonography; Ultrasonography, Doppler, color; Ultrasonography, Doppler, duplex; Penile diseases.

The rheumatic diseases, which include systemic lupus erythematosus, rheumatoid arthritis, Behçet’s disease, scleroderma, and ankylosing spondylitis, are characterized by involvement of connective tissue, with multiple manifestations. In those diseases, there can be involvement of the peripheral or central nervous system, and that involvement can be primary, presenting as a major feature of the clinical presentation, or secondary, as an effect of the drugs used in order to control a given disease or its complications. Knowledge of the wide variety of imaging findings is crucial to the diagnosis of a rheumatic disease, especially in the early stages, enabling effective treatment and minimizing disability. This pictorial essay, presenting cases from the records of two tertiary teaching hospitals, encompasses cases of patients diagnosed with rheumatic disease and illustrates the neuroradiological findings on magnetic resonance imaging and computed tomography, in order to emphasize the importance of these methods for properly diagnosing rheumatic diseases.

Keywords: Lupus erythematosus, systemic; Arthritis, rheumatoid; Behçet syndrome; Scleroderma, systemic; Spondylitis, ankylosing.