Objective: To evaluate the correlation between right hepatic vein Doppler flowmetry and degree of steatosis, inflammation and fibrosis at biopsy in nonalcoholic fatty liver disease. Materials and Methods: Doppler ultrasonography was performed in 80 patients divided into two groups as follows: 40 patients diagnosed with nonalcoholic fatty liver disease and also submitted to biopsy, and a control group including 40 healthy adults with no risk factor for nonalcoholic fatty liver disease. The Doppler waveform patterns of right hepatic vein were classified into triphasic, biphasic and monophasic. Biopsy specimens were classified according to the degree of steatosis, inflammation and fibrosis. Results: Triphasic flow was observed in 38 (95%) patients of the control group and in nine (56%) patients with mild steatosis, whereas in patients with severe steatosis, the pattern was monophasic in 60%. A statistically significant difference was observed in the distribution of Doppler patterns (p < 0.01). A significant negative correlation between the Doppler waveform pattern of right hepatic vein and steatosis degree was observed (r = 0.57; p < 0.01). Conclusion: An abnormal Doppler waveform pattern of right hepatic vein in patients with nonalcoholic fatty liver disease may suggest the presence of decreased vascular compliance caused by fatty infiltration.

Keywords: Fatty liver; Hepatic steatosis; Ultrasonography; Doppler flowmetry; Hepatic vein; Liver biopsy.

Objective: To investigate the correlation between frontal regions cortical thickness measured by magnetic resonance imaging of HIV-positive patients and their performance on instruments for assessing executive functions. Materials and Methods: The present study included 22 HIV-positive patients in the age range from 45 to 65, schooling ranging between three and 20 years, with executive functions deficit and undergoing antiretroviral therapy. Magnetic resonance imaging was performed with conventional T1-weighted, 3D sequences and the images were processed with the Freesurfer software to measure cortical thickness. The following instruments were utilized to evaluate the patients' executive functions: Trail Making, Wisconsin, Hayling, working memory (WAIS-III), verbal fluency and Stroop tests. The Pearson's correlation coefficient was utilized in the data statistical analysis. Results: Significant correlations were found between: Wisconsin scores and the thickness of the right pre-central, lateral and left pre-central orbitofrontal regions; Trail Making scores and thickness of right pre-central and left anterior caudal cingulate areas; and Hayling Test scores and thickness of the left lateral orbitofrontal area. Conclusion: Correlations between cortical thickness measurements by magnetic resonance imaging and cognitive performance suggest that the executive function deficit in HIV-positive patients are related to a reduction in the thickness of the frontal cortex.

Keywords: Magnetic resonance imaging; Cortical thickness; Frontal lobe; Neuropsychological; Executive functions; HIV.

Objective: The present study is aimed at describing computed tomography findings pulmonary tuberculosis in adult AIDS patients assisted at a radiology unit of a reference infectious diseases hospital, in an attempt to establish the association between such findings and CD4 count. Materials and Methods: Forty-five patients were evaluated by chest computed tomography over a four-year period. Results: Mediastinal and/or hilar lymph node enlargement was found in 31 (68.8%) cases, pleural effusion in 29 (64.4%), centrilobular nodules with segmental distribution in 26 (57.7%), consolidation in 24 (53.3%), confluent micronodules in 17 (37.7%), poorly defined nodules with centrilobular distribution in 16 (35.5%), tree-in-bud pattern in 13 (28.9%), bronchial wall thickening in 12 (26.6%), thick-walled cavity in 10 (22.2%), miliary nodules in 9 (20%), and cylindrical bronchiectasis in 6 (13.3%). Among the 45 patients, 35 (77.8%) presented CD4 count < 200 cel/mm³ and 10 (22.2%) presented CD4 count > 200 cel/mm³. Conclusion: Differently from reports in the literature, the authors conclude that mediastinal and/or hilar lymph node enlargement and consolidation were significantly most frequent in patients with CD4 count > 200 cel/mm³. However, lymph nodes with hypodense center were most often observed in severely immunosuppressed patients with CD4 count < 200 cel/mm³.

Keywords: Tuberculosis; Tomography; Chest; HIV; AIDS; SIDA.

Objective: Lung radiographic findings were reviewed to evaluate the differences in the progression of findings along the follow-up of patients with chronic paracoccidioidomycosis treated with a novel second-generation triazole antifungal agent (voriconazole) as compared with patients treated with the drug of choice for treatment of such disease (itraconazole). Materials and Methods: A comparative, randomized study involved the review of chest radiographic images acquired before, during and after treatment of 39 patients divided into two groups: one receiving voriconazole and the other receiving itraconazole. The parameters adopted to describe and to measure lesions present on the radiographic images were based on an adaptation of the method used in cases of another diffuse pulmonary disease, the ILO (International Labour Office) classification of pneumoconioses, dividing the lesions into small and large opacities. Results: The results coincided with previous descriptions regarding lung radiographic findings, and the progression of such findings along the treatment was similar for both groups. Partial regression was observed in the small opacities while large opacities showed a tendency towards complete regression. Conclusion: The adapted ILO classification demonstrated to be useful in the radiographic follow-up along treatment of patients with chronic paracoccidioidomycosis.

Keywords: Paracoccidioidomycosis; Chest; Radiography; ILO classification; Voriconazole.

Objective: To compare the performance of the T1, T2, STIR and DWIBS (diffusion-weighted whole-body imaging with background body signal suppression) sequences in the staging and follow-up of pediatric patients with Hodgkin’s lymphoma in lymph node chains, parenchymal organs and bone marrow, and to evaluate interobserver agreement. Materials and Methods: The authors studied 12 patients with confirmed diagnosis of Hodgkin’s lymphoma. The patients were referred for whole body magnetic resonance imaging with T1-weighted, T2-weighted, STIR and DWIBS sequences. Results: The number of lymph node sites characterized as affected by the disease on T1- and T2-weighted sequences showed similar results (8 sites for both sequences), but lower than DWIBS and STIR sequences (11 and 12 sites, respectively). The bone marrow involvement by lymphoma showed the same values for the T1-, T2-weighted and DWIBS sequences (17 lesions), higher than the value found on STIR (13 lesions). A high rate of interobserver agreement was observed as the four sequences were analyzed. Conclusion: STIR and DWIBS sequences detected the highest number of lymph node sites characterized as affected by the disease. Similar results were demonstrated by all the sequences in the evaluation of parenchymal organs and bone marrow. A high interobserver agreement was observed as the four sequences were analyzed.

Keywords: Whole-body magnetic resonance imaging; Diffusion; Lymphoma; DWIBS.

Objective: To describe the correlation between the Glasgow Coma Scale, risk factors, age, sex and tracheal intubation with the cranial computed tomographic findings in patients with traumatic brain injury. Materials and Methods: A prospective, cross sectional study was developed with 102 patients who were given a Glasgow coma score and submitted to computed tomography at the first 12 hours following admission. Results: The mean age of the entire series was 37.77 ± 18.69 years, with prevalence of male patients (80.4%). The most common causes of head injury were: automobile accidents (52.9%), falls (20.6%), pedestrian injuries (10.8%), falls to the ground (7.8%) and aggression (6.9%). In the present study, 82.4% of patients had traumatic brain injury rated as mild, 2.0% as moderate and 15.6% as severe. Tomographic findings such as subgaleal hematoma, skull fractures, subarachnoid hemorrhage, cerebral contusion, extra-axial blood collection and diffuse cerebral edema were observed in 79.42% of the patients. Most of the findings of severe traumatic brain injury were observed in the patients above 50 years (93.7%) and in this group, all the patients required tracheal intubation. Conclusion: Statistical significance was observed in the correlation between the Glasgow Coma Scale, age > 50 years (p < 0.0001), need for tracheal intubation (p < 0.0001) and CT findings.

Keywords: Head injury; Glasgow Coma Scale; Epidemiology; Computed tomography.

Objective: The present study was aimed at analyzing the impact of enteral nutrition on the maintenance of body weight and on the necessity of replanning and/or interruption of treatment of head and neck cancer patients undergoing intensity-modulated radiotherapy (IMRT). Materials and Methods: Cases of patients submitted to IMRT in the period from January 2005 to October 2008 were retrospectively reviewed, and 83 of them were included in the study. Results: Median patients’ age was 58.6 years. Only five patients (6%) had their treatment interrupted for a period ranging from 4 to 18 days, and in 19 cases (23%) required replanning. Enteral nutrition was initiated before the radiotherapy in 16 patients (19%). Weight loss of > 5% was observed in 58 patients (70%), with a higher prevalence in the group of patients who had not received pre-radiotherapy enteral nutrition. No significant difference was observed between the groups regarding the necessity of radiotherapy replanning (25% versus 21%; p = 0.741) and necessity and duration of treatment interruption. Conclusion: Enteral nutrition is of a great value in the body weight maintenance, but no benefit was observed with the performance of endoscopic percutaneous gastrostomy as compared with radiotherapy interruption/replanning.

Objective: To establish the costs for quality control of [^99mTc]technetium radiopharmaceuticals in Brazilian nuclear medicine centers, in compliance with Agência Nacional de Vigilância Sanitária (National Health Surveillance Agency) resolutions RDC No. 38/2008 and No. 63/2009. Materials and Methods: Prices for consumables, equipment and labor involved in quality control procedures were calculated and the values were converted into units of volume, time or other appropriate units for use in mathematical formulas for determining unit prices. Results: Estimated investment for acquisition of consumables and equipment was R$ 35,500.00. The final unit cost for quality control of a [^99mTc]technetium radiopharmaceutical kit ranged from R$ 6.44 to R$ 7.80 per kit, depending on the product under analysis, on the methodology applied and on the qualification of the professional involved in the process. Such values may correspond to 0.5% to 10% of the amount received by the institution per diagnostic procedure. In practice the effective cost might be lower, considering that a single labeled kit can be fractionated into several doses. Conclusion: Considering the gains in quality and patients’ safety, the authors conclude that costs for implementing a quality control program for radiopharmaceuticals can be absorbed in the financial planning of nuclear medicine centers.

Keywords: Technetium; Radiopharmaceuticals; Quality control; Cost analysis; Nuclear medicine; National Health Surveillance Agency; Anvisa.

Systemic lupus erythematosus is an autoimmune disease involving multiple organ systems. Musculoskeletal involvement is one of the most frequent presentations of the disease, affecting bones, joints, muscles, tendons and ligaments, either as a primary manifestation or secondary to the treatment of the disease. In the present article, the authors review and illustrate the joint disorders and the most common musculoskeletal abnormalities seen in this disorder.

Keywords: Systemic lupus erythematosus; Arthropathy; Musculoskeletal abnormalities.

Transabdominal and transvaginal ultrasonography performed by a skilled and experienced investigator is currently considered as a highly accurate method in the differential diagnosis of adnexal masses. The authors set out a review based on sonographic images demonstrating the main presentations of adnexal masses, describing their characteristics and locations.

Keywords: Ultrasonography; Ovarian neoplasms; Adnexal diseases; Pelvis.

The literature reports only rare cases of urinary ascites, usually secondary to rupture of the bladder and not to renal calyx rupture. The present report describes an uncommon case of posterior urethral valve in a newborn with ascites caused by the rupture of a renal calyx that, to our knowledge, was diagnosed for the first time by ultrasonography.

Keywords: Newborn; Urinary ascites; Renal calyx rupture; Posterior urethral valve; Ultrasonography.