OBJECTIVE: To compare the intraobserver reproducibility of real three-dimensional ultrasonography (3DUS) with virtual ultrasonography using multiplanar and volumetric reformations. MATERIALS AND METHODS: A total of 132 blocks from 44 evaluations of 26 conceptuses were prospectively examined. The gestational age determined by echography ranged from eight weeks and eight weeks and six days in 18 conceptuses and ten weeks and ten weeks and six days in 26 conceptuses. The following structures were analyzed by 3DUS: crown-rump length, gestational sac, amniotic sac, nuchal translucency, omphalomesenteric duct, vitellin vesicle, upper limbs, lower limbs, head-thorax distinction, lateral view of the face, coronal view of the face, ear implantation, lateral view of the spine, coronal view of the spine, and closed abdominal wall. Three blocks were obtained from each conceptus for virtual ultrasonography. Student's t test, McNemar test and kappa statistics were used for the statistical analysis. RESULTS: In group I, real multiplanar 3DUS versus 3D virtual multiplanar ultrasonography, the analysis of continuous variables showed significant differences for all variables. The analysis of categorical variables showed no significant differences in any of the variables. In group II, real volumetric 3DUS versus virtual volumetric ultrasonography, showed significant differences only for ear implantation. The results of the analyses of categorical variables were consistent for most of the variables analyzed in both groups. CONCLUSION: We concluded that there is intraobserver reproducibility of virtual ultrasonography using multiplanar and volumetric reformations.

Keywords: Virtual ultrasonography, Three-dimensional ultrasonography, First trimester

OBJECTIVE: To evaluate and compare existing ultrasound findings in women with Rh-alloimmunized pregnancies with diagnosis of fetal anemia by spectrophotometric analysis of amniotic fluid or Doppler ultrasound of the fetal middle cerebral artery. MATERIALS AND METHODS: This was an observational descriptive study involving 99 patients evaluated between January 1995 and January 2004. Patients were divided into two groups: 74 Rh-isoimmunized women submitted to spectrophotometry of the amniotic fluid (group S) and 25 Rh-isoimmunized women submitted to Doppler ultrasound of fetal middle cerebral artery (group D) to evaluate fetal anemia. Ultrasound findings in the two groups were compared. RESULTS: Placental anomalies, mainly placentomegaly and textural irregularities were more frequently seen in pregnant women followed up with spectrophotometry of the amniotic fluid compared to those followed up with Doppler ultrasound (64% X 32%, p = 6,294). CONCLUSION: The frequency of abnormal ultrasound findings was 2-fold higher in pregnancies evaluated with spectrophotometry of the amniotic fluid compared to those followed up with Doppler ultrasound.

Keywords: Red blood cell isoimmunization, Fetal anemia, Middle cerebral artery, Doppler ultrasonography, Isoantibodies, Fetal erythroblastosis

OBJECTIVE: To describe a technique for measuring gastric emptying in children. MATERIALS AND METHODS: Gastric emptying time was measured in 14 healthy volunteer children aged between 2 to 11. The children were asked to drink modified milk in proportion of 200 ml/m² of body surface. The antral area was measured before the injection of contrast media and at 60, 90, 120 and 150 minutes after the injection. RESULTS: The diet was well tolerated by most patients. In the majority (85%) of the children total gastric emptying occurred 150 minutes after the ingestion of the solution. CONCLUSION: Ultrasound is a safe and low cost alternative for the assessment of gastric emptying.

Keywords: Ultrasound, Gastric motility, Gastric emptying

OBJECTIVE: To evaluate the occurrence and the correlation between pulmonary embolism (PE) and deep venous thrombosis (DVT) using a single CT angiography protocol. MATERIALS AND METHODS: This was a prospective study performed at Hospital Copa D'Or, Rio de Janeiro, Brazil from July 2003 to June 2004. We analyzed 116 CT angiography examinations of patients with clinical suspicion of PE. After an interval of approximately three minutes, venous phase images from the diaphragm to the knees were acquired without additional contrast injection in order to determine the presence of DVT. RESULTS: From the 116 patients studied, 23 (19.8%) had PE, 24 (20.7%) had DVT, 15 (12.9%) had both PE and DVT and 9 (7.8%) had DVT alone. Among the 23 cases of PE, 15 (65.2%) had concomitant DVT whereas 8 (34.8%) had only PE. Among the 24 cases of DVT, 15 (62.5%) had associated PE and 9 (37.5%) had DVT alone. CONCLUSION: The results showed a strong relationship between PE and DVT, as well as the importance of investigating DVT in cases with suspected PE and the benefits of performing indirect CT venography after pulmonary CT angiography as a single examination alternative method for simultaneous investigation of PE and DVT.

Keywords: Pulmonary embolism, Deep venous thrombosis, Computed tomography angiography, Lungs

OBJECTIVE: To evaluate the development of children with vertically transmitted HIV infection by comparing two methods for bone age assessment. MATERIALS AND METHODS: A total of 100 children aged between 4 years and two months and 11 years and 9 months were studied. The hands and wrists of the children were X-rayed using standard techniques and the films were subsequently analyzed according to the Greulich & Pyle (1959) and by Eklöf & Ringertz (1967) methods. RESULTS: The results showed statistically significant differences between the two methods, with the Eklöf & Ringertz method being distinguished by higher sensitivity (p < 0.05). In the group of female patients statistically significant differences were seen between control and HIV+ cases (seven cases) when assessed using this method (p < 0.05). CONCLUSION: The study showed that HIV influenced skeletal development in this group of patients.

Keywords: Skeletal age, HIV infection, Children, Eklöf & Ringertz, Greulich & Pyle

OBJECTIVE: To standardize a method and determine normal values for absolute renal uptake of 99mTc-DMSA in children with normal creatinine clearance. MATERIALS AND METHODS: Twenty-two children (between 7 months and 10 years of age; mean 4.5 years) without clinical evidence of renal disease were studied using 99mTc-DMSA scintigraphy. Eighteen had normal renal ultrasonography, micturating urethrocystography, creatinine clearance and visual interpretation of the scintigraphy with 99mTc-DMSA. Four children were excluded, one with incomplete creatinine clearance and three due to reduction in the creatinine clearance. Absolute renal uptake of 99mTc-DMSA (DMSA-Abs) was expressed as the fraction of the administered dose retained by each kidney six hours after administration of the radiopharmaceutical. RESULTS: DMSA-Abs was 21.8 ± 3.2% for the right kidney and 23.1 ±3.3% for the left kidney. There was no correlation between renal uptake and the age groups studied, although there was a tendency to an increase in the creatinine clearance with age. CONCLUSION: Normal values of DMSA-Abs can be used as an additional parameter for the initial diagnostic evaluation and during follow-up of renal diseases, mainly when bilateral impairment of renal function is suspected or in a patient with a single functioning kidney (in which renal differential function is of limited value).

Keywords: Renal function, Quantification, 99mTc-DMSA, Children, Scintigraphy

OBJECTIVE: To report the results of the treatment of patients with small-cell lung cancer with limited disease (SCLC-LD) in a single institution during a 10-year period, for quality assurance and comparison with data from the literature. MATERIALS AND METHODS: Between January 1992 and December 2002, 101 patients with SCLC-LD completed treatment at our institution. The outcomes were reviewed and included chemotherapy, radiotherapy, the sequence of the two treatments, and the use of prophylactic cranial irradiation. Radiation was delivered with a median dose of 45 Gy in 1.8 to 2 Gy per fraction. The median dose of the prophylactic cranial irradiation was 25 Gy in 10 fractions. RESULTS: Average follow-up was of 50.6 months and the average age of the patients was 63 years. There were 85 confirmed deaths, 5 patients were lost to follow up and 11 patients were alive. The median survival time was 11 months, the overall survival at 2 and 5 years was 25.5% and 10% respectively. There were no significant difference in overall survival at 2 or 5 years according to the age and sex of the patients. In addition, there were no statistical difference in overall survival among patients who had prophylactic cranial irradiation or not, or who were treated in two different periods (1997-2002 vs. 1992-1996). CONCLUSION: The results of the treatment of SCLC-LD patients in our institution reflect the constant changes in the management of SCLC. The 2-year's 25.5% overall survival seen in our institution is similar to reports published from other single institution, but lower than the 47% to 54% recently published results from cooperative groups.

Keywords: Small-cell lung cancer, Limited disease, Radiotherapy, Chemotherapy

OBJECTIVE: In order to simplify the use of the corresponding tables for the quality factors of International Atomic Energy Agency TRS-398, the cross-calibration of parallel chambers is performed by comparison with a cylindrical chamber calibrated at a quality electron beam Qcross; an intermediate and random energy Qint is introduced in which the parallel chamber will be calibrated. The objective of this study is to evaluate the selection of this intermediate energy. MATERIALS AND METHODS: A parallel chamber from Scanditronix, model NACP-02 and a PTW Markus chamber were calibrated in two linear accelerators from Varian, Clinac 2100C and Clinac 23EX, in the energies of 16 and 20 MeV respectively. A Nuclear Enterprises chamber, model 2571 previously calibrated in terms of Dw at "Instituto de Pesquisas Energéticas e Nucleares", São Paulo, Brazil, for a 60Co beam was used as reference. RESULTS: The calibration factors N D,w thus obtained show a variation of 0.07% that can be considered negligible. The absorbed dose values in water determined at Clinac 2100C for a Qint of 16 MeV present a variation of 0.04% for the smallest energy (4 MeV) and of 2.6% for the largest energy (16 MeV), in relation to the TRS-381 protocol. For a Qint of 20 MeV, the observed variations are of 1.3% and 3.5%, respectively. On the other hand, the doses obtained in Clinac23EX for Qint of 16 MeV and of 20 MeV are of 1.9% and 2.0% and of 2.8% and 3.0% respectively. CONCLUSION: The choice of Qint is not so critical, particularly when no electron beams which have a R50value exactly equal to 7.5 g.cm-2 are available.

Keywords: Calibration of parallel chambers, Electron beams dosim, Dosimetry protocols

The use of unenhanced computed tomography has been frequently recommended for the initial assessment of patients with clinical suspicion of acute abdomen instead of other diagnostic methods. The authors present a review of the literature on the main aspects, advantages, limitations and efficacy of unenhanced computed tomography for the diagnosis of acute appendicitis, renal colic, diverticulitis, acute pancreatitis, primary epiploic appendicitis, pneumoperitoneum and small bowel obstruction. The advantages and limitations of this technique are also discussed.

Keywords: Appendicitis, Diverticulitis, Acute abdomen, Computed tomography, Contrast media

Breast reconstruction using myocutaneous flaps has been widely used in patients undergoing modified radical mastectomy for the treatment of breast cancer with significant improvement in esthetical results, which also helps to improve self-esteem of the patients as it minimizes the feeling of mutilation, without changing disease prognosis. Previously, it was believed that there was no risk of recurrence in the reconstructed breast due to the complete removal of breast tissue. However, histological studies have shown that a small amount of glandular tissue may remain after mastectomy, with a high potential for malignancy. Clinical follow-up of mastectomy patients is recommended as most recurring lesions occur at the flap margins and can be detected by palpation. In addition, the inclusion of mammographic and ultrasound monitoring has been proposed for the follow-up of patients as these methods may contribute to the diagnosis of recurrent lesions before they become palpable.

Keywords: Breast cancer, Mastectomy, Mammography, Ultrasound

Thoracic asymmetries characterized by increased radiolucency of the lungs are important causes of morbidity in infants and children. Evaluation of affected patients frequently requires multiple imaging methods to diagnose the abnormality and to plan the surgical correction. The authors review and illustrate the characteristics of both common and rare thoracic asymmetries with emphasis on the radiological findings. The usefulness of different imaging methods in the diagnosis and treatment of these conditions is evaluated. The differential diagnosis as well the pitfalls and diagnostic difficulties are also discussed.

Keywords: Thoracic diseases, Congenital cystic adenomatoid malformation, Congenital lobar emphysema, Congenital diaphragmatic hernia

Interstitial calcinosis is an uncommon condition in which there is either localized or widely disseminated deposition of calcium in the skin, subcutaneous tissues, muscles, and tendons. Calcinosis is often associated with collagen diseases, scleroderma and dermatomyositis. The authors report a case of interstitial calcinosis associated with dermatomyositis studied with conventional radiograph, ultrasound and magnetic resonance imaging, and correlate the imaging findings with the results of surgical pathology gross examination.

Keywords: Calcinosis, Interstitial calcinosis, Dermatomyositis, Conventional radiograph, Ultrasound, Magnetic resonance imaging

The authors report a case of a 38-year-old male patient who works as a driver, HIV positive for eight years and with no follow up since diagnosis presenting with productive cough with grayish secretion and intermittent attacks of dyspnea two weeks before hospital admission. He also reported two previous episodes of treated pulmonary tuberculosis (in 1983 and 2001). Chest X-ray showed nodular hypolucent areas and air bronchograms bilaterally. Computed tomography of the chest revealed many unspecific findings, including scattered areas of consolidation, cavitations, bronchial dilatation, ground glass opacities, interstitial thickening and air bronchograms. The bronchoalveolar lavage showed a number of hyphaes with rare bifurcated septa suggestive of Aspergillus sp. Cultures of Nocardia sp. and Mycobacterium tuberculosis were positive. Therefore, treatment with amphotericin B, trimethoprim-sulfamethoxazole and antiretroviral was started. The patient was discharged twenty days later without pulmonary symptoms. Fifteen days later, the patient returned to the hospital with diarrhea, fever, dysphagia and significant weight loss. The patient died five days later due to staphylococci sepsis.

Keywords: AIDS, Tuberculosis, Aspergillosis, Nocardiosis, Radiology