OBJECTIVE: To evaluate immediate and mid-term outcomes in a series of patients submitted to endovascular repair of infrarenal abdominal aortic aneurysm in a reference center for cardiovascular medicine. MATERIALS AND METHODS: The present retrospective study included a series of patients treated in the period from January 2009 to July 2010, and evaluated demographic characteristics, technical success, therapeutic success, morbimortality, immediate complications and perioperative reintervention rate in a one-year follow-up. RESULTS: The authors evaluated 102 consecutive patients with a mean age of 72 ± 9 years (79% were men). Technical success was observed in 97.1% of cases, and therapeutic success, in 81%. Perioperative mortality was 0.9% and one-year mortality rate was 7.8%. Reintervention was necessary in 18.8% of the patients during follow-up. CONCLUSION: The outcomes observed in the present study justify performing such a procedure in patients with suitable anatomy.

Keywords: Aneurysm; Vascular graft; Atherosclerosis.

OBJECTIVE: To evaluate the incidence and imaging findings of lymphoma after liver transplantation in children. MATERIALS AND METHODS: The authors reviewed records and imaging studies of children submitted to liver transplantation in the period between 2000 and 2008 in a single institution. RESULTS: Among 241 children submitted to liver transplantation, with a mean follow-up period of 41.4 ± 26.4 months, 16 (6.6%) had lymphoma. The mean age of the patients who developed lymphoma at the moment of transplantation was lower than in children who did not develop malignancy (23.9 ± 18.9 versus 38.0 ± 48.9 months; p = 0.02). The time interval between liver transplantation and the diagnosis of lymphoma ranged from 6 to 103 months. Clinical and radiological presentation was variable and the abdomen was the most common location of the tumor (n = 13; 81.3%), followed by chest and head and neck (n = 4; 25.0% each). Imaging findings included adenopathy, mediastinal, pulmonary and mesenteric masses, bowel wall thickening and hepatic and renal nodules. Four children (25.0%) died because of complications of lymphoma. CONCLUSION: Lymphomas are relatively uncommon and potentially fatal complications that may occur any time after pediatric liver transplantation, presenting different clinical and imaging findings.

Keywords: Lymphoma; Hepatic transplantation; Pediatrics; Imaging diagnosis; Postoperative complications.

OBJECTIVE: To describe the clinical and imaging findings that may aid in correctly diagnosing osteoid osteoma of the elbow. MATERIALS AND METHODS: The authors have retrospectively evaluated seven patients diagnosed with osteoid osteoma of the elbow histologically confirmed by bone biopsy. The patients’ medical records and imaging studies were reviewed. RESULTS: Among the 142 patients with osteoid osteoma identified in the archives of the institutions, 4.9% had the lesion in the elbow, predominantly in men (2.5:1), with a mean age of 25 years. Pain and limitation of movement were the most common symptoms. Five of the patients (71.4%) had previously received a different clinical diagnosis. The mean duration of symptoms was 21 months. Radiography did not demonstrate the nidus in 42.8% of cases. Computed tomography and magnetic resonance imaging clearly demonstrated the nidus. Joint effusion was a constant finding. The histological findings corresponded to the ones usually observed in such cases. Surgical resection has brought relief of symptoms and/or functional improvement in all of the cases. CONCLUSION: It is important to consider the possibility of osteoid osteoma in young adult patients with pain, limitation of movement and signs of synovitis in the elbow refractory to conservative treatment. The detection of bone sclerosis, cortical thickening and/or periosteal reaction at radiography allows directing computed tomography towards the accurate identification of the nidus.

Keywords: Osteoid osteoma; Intra-articular; Elbow; Synovitis; Imaging; Biopsy.

OBJECTIVE: To identify possible differences between endothelial dysfunction evaluated by brachial artery flow-mediated dilation and central hyperperfusion evaluated by dopplerfluxometry of ophthalmic artery in women with early- and late-onset preeclampsia. MATERIALS AND METHODS: Flow-mediated dilation testing and dopplerfluxometry of ophthalmic artery were performed in 81 patients (26 with early preeclampsia, 30 with late preeclampsia, and 25 normotensive pregnant women – control group). RESULTS: As compared with the control group, patients with preeclampsia presented lower values of flow-mediated dilation, both in cases of early preeclampsia (7.62 ± 5.42% × 14.12 ± 6.14%; p = 0.02) and in cases of late preeclampsia (5.83 ± 4.12% × 14.12 ± 6.14%; p = 0.00). No statistically significant difference was observed between early- and late-onset preeclampsia (7.62 ± 5.42% × 5.83 ± 4.12%; p = 0.09). Values for dopplerfluxometry of ophthalmic artery were significant lower in patients with preeclampsia as compared with the control group, both in cases of early preeclampsia (0.631 ± 0.024 × 0.737 ± 0.032; p = 0.01) and in cases of late preeclampsia (0.653 ± 0.019 × 0.737 ± 0.032; p = 0.03). Again, no statistically significant difference was observed between early- and late-onset preeclampsia (0.631 ± 0.024 × 0.653 ± 0.019; p = 0.12). Basically, the results demonstrate a decrease in values for dopplerfluxometry of ophthalmic artery in patients with early and late presentations of preeclampsia as compared with the control group, although with no statistically significant difference between the two presentations of the disease. CONCLUSION: The present results indicate the presence of endothelial dysfunction and central hyperperfusion in patients with early- and late-onset preeclampsia.

Keywords: Preeclampsia; Flow-mediated dilation; Ophthalmic arteries.

OBJECTIVE: To assess the degree of acceptance of patients undergoing computed tomography colonography (CTC) in comparison with colonoscopy in the screening of colorectal disease. MATERIALS AND METHODS: Fifty patients with suspected colorectal disease underwent CTC and colonoscopy. Questionnaires were administered before and after the performance of the CTC and after the colonoscopy. The discomfort expected and experienced before and after the performance of both procedures as well as the patients’ preference for each method were evaluated. RESULTS: As regards CTC, before the procedure, 18% of the patients reported expecting little discomfort, 78%, mild discomfort, and 4%, a lot of discomfort. After the procedure, 72% of the patients reported little discomfort, 26%, mild discomfort, and only one (2%) of the patients reported a lot of discomfort. Upon completion of the colonoscopy, 86% of the patients reported their preference for CTC. The degree of colonic distention and residual amount of fluid had no influence on the patients’ preference. Conclusion: CTC was preferred to colonoscopy, with no statistical relationship with the degree of colonic distention at CTC and efficiency of bowel preparation.

Keywords: Colonoscopy; Virtual colonoscopy; Computed tomography colonography; Computed tomography; Patients’ preference; Patients’ satisfaction.

OBJECTIVE: To evaluate the quality of primary and secondary displays of conventional radiography systems based on luminance measurements. The level of ambient lighting within the rooms was also measured. MATERIALS AND METHODS: Luminance measurements were performed with an Unfors Xi Light Detector in 23 primary and 22 secondary displays (six of them utilized in emergency departments) at five different institutions, and according to the method described on the American Association of Physicists in Medicine (AAPM) TG18 report. The level of ambient lighting was measured with Delta Ohm HD 9221 lux meter. RESULTS: In general, both the primary and secondary the displays were compliant with the AAPM guidelines. As regards ambient lighting, the primary workstation rooms were slightly above the recommended levels. As far as The Royal College of Radiologists (RCR) recommendations are concerned, the number of compliant displays corresponded to a minority, with no significant difference, though. CONCLUSION: Although most of the displays could not meet the strict RCR guidelines, in general, the results were satisfactory. The level of agreement between primary and secondary displays should be as high as possible in order to guarantee the image quality. Considering the key role played by diagnostic imaging systems, medical imaging displays must be regularly evaluated to assure that the quality of the imaging system is maintained.

Keywords: Quality control; Luminance; Illuminance.

OBJECTIVE: The present study was aimed at characterizing a diamond detector and observing its behavior. MATERIALS AND METHODS: The dosimetric characteristics of 6 MV photon beams were measured by utilizing an automatic PTW MP3 scanning system with a diamond detector, and compared with measurements performed with a PTW 31010 ion chamber. RESULTS: Measurements of dose linearity, dose rate dependence and depth dose distribution as well as dose profiles demonstrated the dosimetric characteristics of the diamond detector. CONCLUSION: Some measurements with diamond detector and ion chamber were validated with results published in the literature, demonstrating a good behavior of the diamond detector as compared with the ionization chamber that is widely utilized for dosimetry in radiotherapy, indicating that the diamond detector is a good choice for small field dosimetry.

Keywords: Diamond; Dosimetry; Radiotherapy.

New imaging techniques have been developed with the objective of obtaining not only a structural assessment, but also a metabolic and functional analysis of different organs and types of lesions. Among such tools perfusion computed tomography (PCT) has recently aroused the interest of many researchers in studying the applicability of such imaging modality in the evaluation of abdominal organs and diseases. Analysis of the biological behavior of healthy and diseased tissues, differentiation of inflammatory processes from tumors, and diagnosis of tumor recurrence after minimally invasive therapies can be mentioned as applications of such an imaging modality. The main features of PCT are related to its ability to characterize different perfusional behaviors reflecting biological changes of certain lesions and diseased tissues. Thus, the present study was aimed at carrying out a comprehensive literature review, describing the key techniques and protocols utilized in PCT imaging, main clinical applications, advantages and disadvantages of the method, besides proposing an imaging protocol that can be adopted by both private and public health services, with good reproducibility and easy implementation.

Keywords: Perfusion; Computed tomography; Biomarkers; Angiogenesis; Neoplasm; Contrast media.

Mammography is the best method for early detection of breast cancer. Nevertheless, approximately 10% to 30% of breast lesions are missed at screening due to limitations of human observers. Computer-aided detection (CAD) is a relatively new technology that has been implemented in some mammography services to allow a double reading of mammograms. Clinical studies have demonstrated that CAD increases the sensitivity by up to 21% in the detection of breast cancer by radiologists. A CAD system is useful in situations where there is a high interobserver variability, lack of trained observers, or impossibility to perform the double reading with two or more radiologists. The objective of the present review is based on the need to get the medical community acquainted with this tool as an auxiliary, quantitative and non-operator-dependent method, to improve the diagnosis of breast cancer.

Keywords: Breast cancer; CAD; Double reading.

Gossypiboma is a term utilized to describe a mass developed from a matrix of cotton fibers surrounded by inflammatory granulomatous reaction. Its incidence is estimated at 0.15% to 0.2% of laparotomies. A foreign body within the abdominal cavity may provide a niche for proliferation of microorganisms, acting as primary focus for development of an abscess and peritonitis. Several studies have demonstrated the relevance of clinical correlation with the findings of different imaging methods (conventional radiography, ultrasonography, computed tomography and magnetic resonance imaging) in the diagnosis of gossypibomas. The present pictorial essay is aimed at demonstrating a series of typical cases of abdominal gossypibomas and illustrating the several presentations of such mass, with emphasis on the findings at different imaging methods in order to familiarize radiologists with this entity and with the main differential diagnosis.

Keywords: Gossypiboma; Abdominal; Imaging diagnosis.

Biloma is defined as any collection of bile outside the biliary tree, usually resulting from surgery complications and abdominal trauma. Spontaneous occurrence of bilomas is rare, occasionally associated with choledocolithiasis. The present report describes a case of spontaneous biloma, whose diagnosis was radiologically confirmed. At laparotomy, the presence of a retroperitoneal biloma was observed. Intraoperative cholangiography has not demonstrated the presence of fistula. After drainage, the patient progressed well and was discharged.

Keywords: Biloma; Choledocolithiasis; Retroperitoneum.

The authors report a case of a patient with favorable outcome after diagnosis of osmotic demyelination syndrome (central pontine and extrapontine myelinolysis) confirmed by magnetic resonance imaging.

Keywords: Osmotic demyelination syndrome; Osmotic myelinolysis; Central pontine and extrapontine myelinolysis.

Hemobilia is a rare cause of gastrointestinal bleeding and uncommon complication in cases of liver trauma. It occurs due to communication between bile ducts and intrahepatic vessels. The authors describe the case of a patient victim of penetrating abdominal injury, who progressed after three months of liver suture with pain, jaundice and gastrointestinal bleeding. Angiography diagnosed right hepatic artery pseudoaneurysm, and embolization procedure was successfully performed.

Keywords: Penetrating hepatic trauma; Hemobilia; Angiography.

The authors report the case of a patient with a thyroid nodule with benign sonographic and cytopathological features that had presented a decrease of more than 50% in three years and changed its pattern during her pregnancy, being diagnosed as papillary carcinoma. It was concluded that pregnancy can either increase the risk for malignant transformation or accelerate the growth of a malignant thyroid nodule, corroborating pre-existing literature data.

Keywords: Pregnancy; Cancer; Thyroid; Carcinoma; Papillary.