OBJECTIVE: We aimed to evaluate whether human immunodeficiency virus (HIV)-positive patients with and without clinically significant memory deficits and healthy control participants differ on in vivo hydrogen-1 magnetic resonance spectroscopy (H-MRS) in the posterior cingulate gyri. MATERIALS AND METHODS: In total, 21 HIV-positive patients with memory deficit (HIV+wMD) were compared with 15 HIV-positive patients without memory deficit (HIV+wOMD) and 22 sex-, age-, and education-matched control participants. Memory impairments were classified based on the participants’ performance on the Rey Auditory Verbal Learning Test. Short echo time (30 ms), single-voxel H-MRS was performed using a 1.5-T magnetic resonance scanner. RESULTS: The HIV+wMD and HIV+wOMD groups had higher choline/creatine ratio in the posterior cingulate gyri than the control group. There were no significant metabolite ratio differences between the HIV+wMD and HIV+wOMD groups. CONCLUSION: HIV-positive patients with and without memory deficits had significantly higher choline/creatine ratios than controls in the posterior cingulate gyri, which may reflect cerebral inflammation, altered cell membrane metabolism, microgliosis, and/or astrocytosis.

Keywords: HIV; Memory deficit; Posterior cingulate gyrus; Magnetic resonance spectroscopy.

OBJECTIVE: To evaluate the effect of acromial inferolateral tilt on subacromial impingement syndrome. MATERIALS AND METHODS: The acromial inferolateral tilt was retrospectively quantified by two researchers on 346 shoulder magnetic resonance images using the glenoacromial (between the inferior proximal acromial surface and the glenoidal face) and acromioclavicular (between the axis of the proximal acromion and distal clavicle) angles. RESULTS: The glenoacromial angle was associated with subacromial impingement syndrome (p < 0.001) and complete supraspinatus tendon rupture (p < 0.001), and the acromioclavicular angle was associated with partial or complete supraspinatus tendon rupture (p = 0.003). The area under the receiver operating characteristic curve (AUC), best cut-off angle, and odds ratio (OR) of the glenoacromial angle for impingement syndrome were 0.579 (95% confidence interval [CI]: 0.508–0.649; p = 0.032), 72°, and 2.1 (95% CI: 1.136–4.053), respectively. For complete supraspinatus tendon rupture, the AUC, best cut-off angle, and OR of the glenoacromial angle were 0.731 (95% CI: 0.626–0.837; p = 0.001), 69°, and 8.496 (95% CI: 2.883–28.33), respectively. For partial or complete supraspinatus tendon rupture, the AUC, best cut-off angle and OR of the acromioclavicular angle were 0.617 (95% CI: 0.539–0.694; p = 0.002), 17°, and 3.288 (95% CI: 1.886–5.768), respectively. Interobserver agreement found for the glenoacromial and acromioclavicular angles were 0.737 (95% CI: 0.676–0.787; p < 0.001) and 0.507 (95% CI: 0.391–0.601; p = 0.001), respectively. CONCLUSION: Inferolateral acromial tilt may have some impact on subacromial impingement syndrome; however, the best quantification method identified (glenoacromial angle) showed a moderate interobserver agreement and a fair performance to assess the risk of complete supraspinatus tendon rupture.

Keywords: Shoulder impingement syndrome; Inferolateral acromial tilt; Magnetic resonance imaging.

OBJECTIVE: To establish the prevalence of patellar chondropathy using 3T magnetic resonance imaging (MRI) and to correlate the findings with individual features such as gender, age, and body mass index. MATERIALS AND METHODS: Data consisted of collecting 3T MRIs of patients’ knees obtained between October 2016 and September 2017, comprising a period of 12 months. These MRIs were assessed by an experienced musculoskeletal radiologist who confirmed the presence of patellar chondropathy and, when present, rated the finding into the four grades ascribed by the International Cartilage Repair Society. RESULTS: A total number of 291 patients were assessed during the period with 389 MRI scans. Of those patients, 308 (79.2%) were diagnosed with patellar chondropathy, while 81 (20.8%) were not. Chondropathy was more prevalent in the female gender, in subjects above 40 years of age, and in obese patients. When the results were weighed in International Cartilage Repair Society classification, the milder grades (1 and 2) were seen in younger men (< 30 years of age), while the more severe grades (3 and 4) were mostly present in females, those above 40 years of age, and in obese patients. CONCLUSION: There was a high prevalence of patellar chondropathy in patients who had undergone high-field knee MRIs (79.2%), being highest in the female gender and in subjects above 40 years of age. The most prevalent group was graded as 4 by the International Cartilage Repair Society classification.

Keywords: Chondromalacia patellae; Chondropathy; Magnetic resonance imaging.

OBJECTIVE: To determine whether evaluating the mean apparent diffusion coefficient (ADC) together with capsular contact (CC) adds value in the prediction of microscopic extracapsular extension (ECE) of prostate cancer. MATERIALS AND METHODS: Between January 2012 and December 2016, 383 patients underwent multiparametric magnetic resonance imaging (mpMRI) of the prostate. A total of 67 patients were selected for inclusion. Two radiologists (observers 1 and 2), working independently, performed qualitative and quantitative analyses of ECE, macroscopic ECE, and microscopic ECE. A third radiologist assessed the correlation with the clinical data, and two experienced pathologists reviewed all histopathological findings. RESULTS: Among the 67 patients, mpMRI showed lesions that were confined to the capsule in 44 (66.7%), had microscopic ECE in 12 (17.9%), and had macroscopic ECE in 11 (16.4%). There were no significant differences, in terms of the diagnostic accuracy, as measured by determining the area under the curve (AUC), of CC on T2-weighted images (CCT2), CC on diffusion-weighted imaging (CCDWI), and the mean ADC for the prediction of microscopic ECE, between observer 1 (AUC of 0.728, 0.691, and 0.675, respectively) and observer 2 (AUC of 0.782, 0.821, and 0.799, respectively). Combining the mean ADC with the CCT2 or CCDWI did not improve the diagnostic accuracy for either observer. There was substantial interobserver agreement for the qualitative evaluation of ECE, as demonstrated by the kappa statistic, which was 0.77 (0.66–0.87). The diagnostic accuracy (AUC) of the qualitative assessment for predicting microscopic ECE was 0.745 for observer 1 and 0.804 for observer 2, and the difference was less than significant. In a multivariate analysis, none of clinical or imaging parameters were found to be associated with ECE. CONCLUSION: For the detection of microscopic ECE on mpMRI, CC appears to have good diagnostic accuracy, especially if the observer has considerable experience. Adding the mean ADC to the CCT2 or CCDWI does not seem to provide any significant improvement in that diagnostic accuracy.

Keywords: Prostatic neoplasms; Diffusion magnetic resonance imaging; Magnetic resonance imaging; Neoplasm staging.

OBJECTIVE: To identify the main hemorrhagic complications after percutaneous nephrolithotomy, as well as the results obtained with transcatheter arterial embolization (TAE) at an interventional radiology center. MATERIALS AND METHODS: This was a retrospective analysis of patients undergoing TAE for the treatment of hemorrhagic complications after percutaneous nephrolithotomy. All patients underwent computed tomography angiography (CTA). RESULTS: We evaluated a total of nine patients. At emergency department readmission, the most common symptom was macroscopic hematuria, which was seen in five patients. Three patients had an isolated pseudoaneurysm, two had a pseudoaneurysm together with active bleeding (perirenal hematoma), and one had a pseudoaneurysm together with arteriocalyceal fistula. Arteriovenous fistula was diagnosed in three patients and was not seen in combination with other vascular lesions. We did not identify arteriocalyceal fistula in isolation. Five patients underwent TAE with 6 × 15 mm and 6 × 20 mm microcoils. Four patients underwent TAE with n-butyl-2-cyanoacrylate and ethiodized oil. Follow-up CTAs revealed no complications. CONCLUSION: Because of its high diagnostic accuracy, CTA provides the interventional radiologist with valuable data for individualized therapeutic planning. The TAE procedure is safe and effective. It can therefore be used as a first-line treatment for hemorrhagic complications resulting from percutaneous renal procedures.

Keywords: Nephrolithotomy, percutaneous; Aneurysm, false; Arteriovenous fistula; Embolization, therapeutic/methods; Radiology, interventional; Computed tomography angiography.

The objective of this article is to share the strategy we used in order to restructure the radiology and diagnostic imaging department of a referral institution during the coronavirus disease 2019 pandemic, on the basis of the current recommendations. It is essential to integrate the work of supervisors, preceptors, and residents, maintaining communication and sharing decisions, with mutual support, as well as to determine the best strategy to be adopted in this scenario of uncertainty and constant change, while also ensuring adequate emotional support for all parties.

Keywords: Pandemics; Radiology; Internship and residency.

In the current pandemic, caused by infection with severe acute respiratory syndrome coronavirus 2, ultrasound has played a fundamental role in patients who develop the resulting disease, designated coronavirus disease 2019 (COVID-19). In this study we present ultrasound images of the lungs of neonates with a suspected or confirmed diagnosis of COVID-19, distinguishing between the changes related to COVID-19 and those unrelated to the disease. Ultrasound examinations were performed by a pediatric sonographer. A total of 27 neonates were evaluated. Among those who presented no respiratory symptoms, some tested negative for COVID-19 and others tested positive. All of those who were pulmonary symptomatic, negative for COVID-19 presented transient tachypnea of the newborn and respiratory distress syndrome. Lung ultrasound images obtained in COVID-19-negative neonates showed, in some cases, a normal pattern (with A lines, few B lines, a thin, linear pleural line, and no pleural effusion), whereas in others showed coalescent B lines and areas of opacity. In two of the COVID-19-positive neonates, lung ultrasound examination showed several coalescent B lines, pleural thickening, and areas of opacity. Lung ultrasound in the neonatal period appears to be applicable within the context of the current pandemic, allowing efficient evaluation of COVID-19-related changes in neonates, as well as of pathologies inherent to the neonatal period.

Keywords: Ultrasonography; Lung/diagnostic imaging; Coronavirus infections/diagnostic imaging; Coronavirus; Infant, newborn.

Pregnancy and lactation constitute states of intense hormonal variation with secretory and structural changes in the breast parenchyma. These changes translate into important features on breast imaging, as well as the emergence of specific benign and malignant lesions. This literature review aims to discuss the safety of the use of breast imaging methods (mammography, ultrasound, and magnetic resonance imaging) during the pregnancy-lactation cycle, and to present the expected physiological changes and imaging appearance of the main breast diseases that may occur in this period, such as galactocele, lactating adenoma, fibroadenoma, puerperal mastitis, and pregnancy-associated breast cancer.

Keywords: Pregnancy; Lactation; Breast; Imaging diagnosis.

As they are asymptomatic or have a nonspecific, anatomical variations of the ribs are usually detected as incidental findings on imaging studies. They may be isolated changes or can be related to anomalies or clinical syndromes. Such variations are easily overlooked on conventional radiography and computed tomography if they are not actively investigated, mainly because most indications for a chest X-ray studies aim to evaluate the lung parenchyma and mediastinal structures. The objective of this pictorial essay was to use multislice computed tomography images to illustrate the imaging aspects of the main anatomical variations and congenital anomalies of the ribs.

Keywords: Ribs; Anatomical variation; Multislice computed tomography.

Primary bone lymphoma is a rare neoplasm that can initially present as local pain, a palpable mass, and pathologic fracture. It can also be discovered as an incidental finding on an imaging examination. It is defined as a bone marrow tumor with no involvement of other sites, lasting at least six months. The diagnosis is confirmed by biopsy and immunohistochemical analysis. Although the imaging characteristics are nonspecific, there are certain findings that, when correlated with clinical and epidemiological aspects, can increase the level of suspicion of primary bone lymphoma. The classic imaging aspect is a bone lesion with a soft-tissue component that preserves the cortical layer more than would be expected given the invasive nature of the lesion. Magnetic resonance imaging is the best imaging method to evaluate the extent of involvement of adjacent compartments, whereas computed tomography depicts the cortical layer in greater detail, as well as being an important tool for biopsy guidance. Other imaging modalities are also discussed, such as X-ray, ultrasound, bone scintigraphy, and positron emission tomography/computed tomography. The aim of this paper is to describe the most common findings obtained with the various imaging methods used in patients with a confirmed diagnosis of primary bone lymphoma.

Keywords: Bone neoplasms/diagnostic imaging; Lymphoma/pathology; Radiology; Magnetic resonance imaging.

Portal vein thrombosis refers to complete or partial obstruction of the portal venous system, in the intrahepatic or extrahepatic venous tract or even in the splenic or superior mesenteric veins. This common and potentially fatal condition can develop in various clinical contexts, especially those of liver cirrhosis, hepatocellular carcinoma, and other solid tumors. Certain characteristics, such as the time since the onset of the thrombus (acute or chronic), its biology (hematic or tumoral), the presence of collateral vessels, and the magnetic resonance imaging aspects, are important components of a thorough, careful analysis, as well as informing decisions regarding the appropriate therapeutic strategy. Here, we present a brief review of the anatomy of the portal venous system and a systematic approach to analyzing the condition, using a mnemonic (ABCD, for age, biology, collaterals, and diffusion). We discuss the various imaging methods and illustrate our discussion with images selected from the case files archived at our facility.

Keywords: Portal vein; Venous thrombosis; Hypertension, portal; Collateral circulation; Magnetic resonance imaging.