OBJECTIVE: To evaluate the prevalence and appearance of incidental paranasal sinuses abnormalities in children with no clinical evidence of rhinosinusitis using CT scans. MATERIALS AND METHODS: CT scans of the head or orbits of children between 0 and 18 years of age performed due to problems not related to rhinosinusitis were studied. RESULTS: Sixty-four children were included (mean age 5.7 years; standard deviation = 3.9). Incidental sinuses abnormalities were found in 46 cases (72%). In most cases the abnormalities were mild (25/46) and mucosal thickening was the most common finding. Complete opacification and fluid levels occurred in 12 children. More than one cavity was affected in 33 patients and abnormalities were most frequently seen in maxillary sinuses, followed by ethmoid sinuses. Bilateral and symmetric findings were common. The prevalence and intensity of abnormalities were higher in children below three years of age. CONCLUSION: Incidental abnormalities are highly prevalent and tend to be mild in children without symptoms of rhinosinusitis. The most prevalent abnormality was mucosal thickening. Moderate and severe abnormalities occur in children below three years of age.

Keywords: Computed tomographic scans, Rhinosinusitis, Incidental abnormalities, Paranasal sinuses, Radiology, Pediatrics

OBJECTIVE: To evaluate the clinical benefit of pre-ablation scanning in patients with differentiated thyroid carcinoma. MATERIALS AND METHODS: We assessed scannings and serum thyroglobulin (Tg) measurements before the first ablative therapy in 100 patients with hypothyroidism submitted to total thyroidectomy. Scanning was considered clinically significant when it showed resectable metastases or which were treated with higher doses than the initially proposed one (100 mCi of 131I), in addition to cases with no uptake and Tg levels < 5 ng/ml not requiring radioiodine therapy. RESULTS: Scanning showed uptake corresponding to lymph node metastases in 10 patients (10%), distant metastases in 5 (5%), uptake only in the thyroid bed in 76 (76%), and was negative in 9 (9%). The procedure was considered clinically relevant in 18% of the patients (indicating the need of surgery, dose increase or discontinuation of radioiodine therapy). In patients with Tg > 10 ng/ml, scanning influenced therapeutic management in 41% of the cases due to detection of metastases, while in patients with Tg < 10 ng/ml scanning influenced therapeutic management in only 10% of the patients, most of which did not receive radioiodine therapy. CONCLUSION: Scanning provides clinically significant data (presence of metastases) in many patients with Tg levels > 10 ng/ml and, therefore, should be used in these cases.

Keywords: Thyroid cancer, Scanning, Ablative therapy

OBJECTIVE: To assess the usefulness of MRI as a diagnostic method in patients with rheumatoid arthritis, and to evaluate the frequency of changes in the hip in symptomatic and asymptomatic patients. MATERIALS AND METHODS: Forty patients (17 symptomatic and 23 asymptomatic) were evaluated by 1.5 T magnetic resonance imaging (MRI) after intravenous contrast media injection. MRI findings were divided in inflammatory, degenerative, combined (inflammatory and degenerative) and extra-articular changes. RESULTS: The most frequent findings seen were degenerative and extra-articular changes (22.5% each). Inflammatory changes were seen in only five (12.5%) symptomatic patients, four of them with degenerative findings associated (10%). CONCLUSION: The use of MRI of the hip allowed the evaluation of the main articular abnormalities seen in patients with rheumatoid arthritis. The most frequent findings were degenerative and extra-articular changes. Inflammatory findings were seen in only five patients, four of them with degenerative changes associated.

Keywords: Magnetic resonance imaging, Hip, Rheumatoid arthritis, Adult

OBJECTIVE: A marked impact on the splanchnic circulation is seen in liver cirrhosis. Doppler ultrasonography (DUS) was performed in a group of patients with end-stage liver cirrhosis before, during and after orthotopic liver transplantation (OLT) in order to investigate the hemodynamic changes in portal vein flow velocity. MATERIALS AND METHODS: Fifty-four patients submitted to OLT and intraoperative DUS were prospectively studied from January 2002 to July 2003. Seventeen patients were excluded because of missing data due to either technical difficulties to obtain the measurements or early patient death. All 37 patients included in the analysis had liver cirrhosis mainly associated with hepatitis C virus infection and alcoholic disease. Patients were submitted to DUS just before OLT, intraoperatively after graft reperfusion, and in the postoperative period (1st and 7th postoperative days). Mean flow velocity was measured at main, right and left portal veins. Statistical analysis was performed using paired t test. Differences were significant when p < 0.05. RESULTS: The mean pre-OLT velocity in the portal vein was 16.0 cm/s. Intraoperative measurements obtained few minutes after graft reperfusion showed an increase in portal vein velocity to 84.09 cm/s. Portal flow velocity was 71.0 cm/s and 58.5 cm/s in the 1st and 7th postoperative days, respectively. Intraoperative and postoperative mean flow velocity in the portal vein was significantly higher than in pre-OLT period (p < 0.001). On the 7th postoperative day, the mean flow velocity in the portal vein decreased significantly compared to intraoperative values (p < 0.05). CONCLUSION: In liver transplantation, there is a significantly increase in mean flow velocity in the portal vein immediately after graft reperfusion when compared to pre-OLT data. Likewise, after this initial peak flow there is a significant and progressive decrease in mean flow velocity in the portal vein, which tends to normalize on the 7th postoperative day.

Keywords: Portal vein, Mean velocity, Transplantation, Hemodynamics

OBJECTIVE: To describe the clinical, imaging and pathological findings of SAPHO syndrome and to point out that although considered rare this syndrome may be under-diagnosed by clinicians and radiologists, probably due to unfamiliarity with its features. MATERIALS AND METHODS: A retrospective study of six cases diagnosed in the last six years, with emphasis on clinical findings (age, sex and symptoms) and imaging findings (bone scintigraphy, conventional x-ray, computed tomography and magnetic resonance imaging) was conducted. RESULTS: The initial clinical presentation in all patients was pain in the upper anterior chest wall for at least four months. Imaging findings of all these patients indicated inflammatory process and/or hyperostosis and osteitis in the joints of the upper anterior chest wall. Skin manifestations of the syndrome, such as palmoplantar pustulosis, were identified in five of the patients. In none of the cases the diagnosis was suggested either at the initial clinical medical appointment or after imaging assessment by radiologists not specialized in musculoskeletal system. CONCLUSION: Our clinical and imaging findings are in line with the ones described in the literature. This diagnosis must be considered for each patient presenting with pain in the upper anterior chest wall associated with skin lesions and/or osteitis.

Keywords: Acquired hyperostosis syndrome, Sternocostoclavicular hyperostosis, Psoriasis, Osteitis

OBJECTIVE: To use skeletal scintigraphy to detect mandibular growth through the analysis of bone metabolism in individuals with normal craniofacial growth, and to compare the findings with those seen in individuals with excessive craniofacial growth. MATERIALS AND METHODS: Forty-seven male and female patients between 18 to 28 years of age were divided in two groups - class I, control (n = 13), and class III, case (n = 34). Images were obtained two hours after intravenous injection of 99mTc-MDP (200 µCi/kg). Right and left side views of the mandible were obtained as well as a posterior view of the lumbar spine. The count rate was determined by the mean values of the count of the condyles and of the fourth lumbar vertebra, using a total of 300,000 counts. RESULTS: No asymmetrical condyle uptake was observed in both groups, and in spite of the absence of statistically significant differences, the mean condylar uptake values were higher in class III group. CONCLUSION: The increased mean uptake indicated higher condylar bone metabolism in class III individuals suggesting residual mandibular growth. Further studies are presently ongoing to increase our sample size.

Keywords: Bone scintigraphy, Mandibular condyle, Mandibular growth, Temporomandibular joint

OBJECTIVE: To evaluate the biosafety aspects and the working conditions of radiology department professionals and to make recommendations with respect to necessary modifications to be implemented in these departments in order to comply with national regulations. MATERIALS AND METHODS: Interviews with the professionals were carried out as well as observation of their activities in the working premises including processing of radiographic films inside the dark rooms, average time inside the dark rooms, preparation of chemical solutions for automatic processors and the type of help given to patients during radiographic examinations. The efficiency of the exhausting systems in the dark rooms was also measured. The ergonomic adequacy of the accessories inside the dark rooms was analyzed. With respect to electrical safety, the location and number of fire extinguishers as well as the grounding of the electrical equipment was evaluated to check if they were in accordance with the Brazilian legislation. RESULTS: The exhaustion systems were insufficient, professionals did not wear protective clothes/devices when preparing the chemical solutions, the ergonomic aspects were not in accordance with national recommendations, and the workers presented related stress. CONCLUSION: Based on these results, risk maps were drawn for each sector of the radiology department to be used in the implementation of improvements in each sector.

Keywords: Ergonomics, Biosafety, Map risks, Stress, Protective devices

OBJECTIVE: Exposure to high levels of radioactive radon gas can cause lung cancer, therefore, it is important to measure the concentration levels of this gas in indoor environments in order to provide radiological protection for the general population. In this study, passive and time-integrated radon monitoring was performed in different types of indoor environments in Baixada Santista, São Paulo, Brazil including tunnels, fertilizer shops, shopping malls, ceramics shops and houses to evaluate the actual radon levels in these locations. MATERIALS AND METHODS: Radon concentration measurements were performed using the alpha particle track registration technique in plastic foils of Makrofol E, employing the closed cup method. RESULTS: Concentration levels of radon measured in the indoor environments studied ranged from 17 to 263 Bq/m³, which is in accordance with the values reported in the literature by other authors for similar environments. CONCLUSION: In general, the results obtained were below the maximum limits recommended by the International Commission on Radiological Protection (ICRP) and thus, intervention actions for the these locations were not necessary.

Keywords: Radon, Uranium, Environment, Nuclear track detectors

Currently, mammography is the most effective method for an early diagnosis of breast cancer. In 85% to 90% of the cases, a high quality mammography allows the visualization of a tumor more than two years before the occurrence of lymph nodes involvement in women over 50 years of age. The radiological appearance of a normal and a sick tissue is very similar, therefore, a high quality of the scan is essential to obtain high contrast resolution to allow distinguishing them. Strict and preestablished protocols must be followed during mammography in order to reach high quality standards. Artifacts are defects occurred during film processing that interfere in the quality of the final image and can result in loss or masked information. Several types of artifacts from different sources can occur during image acquisition. These can be caused by the processor, the radiology technician, the mammography unit or the patient, and all result in degradation of the image acquired. The aim of this study is to review the effective methods that can be used in the quality control of mammography and to analyze the most important artifacts occurring in the daily practice, showing illustrations and suggestions on how to avoid them.

Keywords: Breast cancer, Breast radiology, Artifact

The author presents a critical analysis of the recently published BI-RADS TM system. The first recommendation is to always determine if BI-RADS TM is being used for mammography, ultrasound or magnetic resonance by using the term BI-RADS TM-US or a similar term. The advantages of using the BI-RADS TM-US including reproducibility, standardization, auditing, basis of echogenicity are also considered. In addition, some drawbacks of the system are identified: the omission of statistically significant proven descriptors such as marked hypoechogenicity and number of lobulations, the use of non-recognized descriptors such as the Cooper ligament, and the lack of data on the positive predictive value of some very common breast lesions such as hypoechoic nodules. Finally, a suggestion is presented: to classify the descriptors according to its importance as predictors in order to determine the positive predictive value of the lesions.

Keywords: BI-RADS™, Mammography, Breast cancer

The authors report two cases of pulmonary artery sling diagnosed by three-dimensional reconstruction of images of the tracheobronchial tree and the esophagus acquired using magnetic resonance imaging or helical computer tomography. The typical clinical findings of this congenital abnormality, which may not be as rare as previously believed, include those related to severe tracheobronchial obstruction, although asymptomatic or mild symptomatic cases have been reported. Early diagnosis of this anomaly is extremely important, since in most cases immediate surgical correction is indicated due to its high lethality. The use of three-dimensional reconstruction allows simultaneous identification of the associated tracheobronchial and cardiovascular malformations, in addition to a clear visualization of the anomaly. Thus, the diagnosis can usually be established non-invasively, avoiding the use of the selective angiocardiography, considered the gold-standard.

Keywords: Pulmonary artery sling, Anomalous left pulmonary artery, Tracheal stenosis, Vascular ring, Left pulmonary artery variants

A choking patient was admitted with dyspnea, cyanosis, and loss of consciousness, which initially improved after suction of the airways. The patient presented worsening of the clinical parameters until the introduction of supportive treatment, after which she rapidly recovered. Chest x-ray taken on day of hospitalization showed bilateral diffuse alveolar filling pattern, and computed tomography showed ground glass areas. The aim of this paper is to show the radiological features of this syndrome.

Keywords: Mendelson syndrome, Chest x-ray, Computed tomography

We present a case of a 27-year-old male patient submitted to computed tomography and magnetic resonance imaging for the evaluation of a renal tumor. The radiological features of the mass suggested the diagnosis of a malignant renal tumor of parenchymatous origin. However, the histological findings proved to be a benign solitary fibrous tumor within the pelvis and caliceal portion of the right kidney.

Keywords: Neoplasia, Fibrous tumor, Kidney, Mesothelioma, Computed tomography, Magnetic resonance imaging

The authors report a case of a patient with a progressive-growing mass in the left subaxillary region, since childhood. Chest x-ray and computed tomography showed a well-defined low attenuation mass with irregular calcifications contiguous with the left fifth rib. Histological findings were consistent with parosteal lipoma, a rare slow-growing benign tumor.

Keywords: Parosteal lipoma, Rib, Soft tissue tumor