Reference ranges for fetal brain fissure development on 3-dimensional sonography in the multiplanar mode.

OBJECTIVES: To determine reference ranges for measurements of fetal cerebral fissures by 3-dimensional (3D) sonography in the multiplanar mode and to evaluate the reliability and concordance of these measurements. METHODS: A cross-sectional study was conducted on 393 women with normal pregnancies at 22 weeks to 33 weeks 6 days. The distances between the internal bone plate of the fetal calvaria and the sylvian, parieto-occipital, hippocampal, and calcarine fissures were assessed. To obtain the distances for the first 3 fissures, a 3D sweep was made in the axial plane, at the level of the lateral ventricles. To obtain the distance for the calcarine fissure, a coronal sweep was used, at the level of the occipital lobes. To evaluate the correlation between the fissures and gestational age, polynomial regression was performed with adjustments using the coefficient of determination (R(2)). Reliability was determined with intraclass correlation coefficients and concordance with concordance limits. RESULTS: The mean distances ± SD to the sylvian, parieto-occipital, hippocampal, and calcarine fissures were 10.42 ± 2.28, 22.38 ± 3.23, 24.88 ± 4.67, and 21.19 ± 2.73 mm, respectively. These distances correlated with gestational age such that the best fit with the linear equation produced R(2) values of 0.582, 0.627, 0.860, and 0.458 for the sylvian, parieto-occipital, hippocampal, and calcarine fissures. Reliability analyses showed intraobserver and interobserver intraclass correlation coefficients of 0.90 to 0.95 and 0.85 to 0.97. The concordance limits were-1.33 to 1.30 and -2.38 to 2.28 mm for the intraobserver evaluation and -1.60 to 2.57 and -3.51 to 2.73 mm for the interobserver evaluation. CONCLUSIONS: Cerebral fissures can be measured by 3D sonography at 22 to 33 weeks of pregnancy with acceptable reliability and concordance. Reference ranges for this gestational period have thus been described.

Evaluation of the efficacy and reproducibility of cholangiopancreatography by magnetic resonance for detecting biliary complications following orthotopic liver transplantation / Estudo da eficácia e da reprodutibilidade da colangiopancreatografia por ressonância magnética na detecção das complicações biliares pós-transplantes hepáticos

PURPOSE: To evaluate the accuracy and reproducibility of magnetic resonance cholangiopancreatography (MRCP) in the detection of biliary complications in liver transplanted patients. METHODS: A study was conducted, with blinded review of 28 MRCP exams of 24 patients submitted to liver transplantation. The images were reviewed by two independent observers, at two different moments, regarding the degree of biliary tree visualization and the presence or absence of biliary complications. The MRCP results were compared, when negative, to at least 3 months of clinical and biochemical follow-up, and when positive, to the findings at surgery or endoscopic retrograde cholangiopancreatography (ERCP). RESULTS: The degree of intrahepatic biliary tree visualization was considered good or excellent in 78.6 percent and 82.1 percent of the exams by the two observers and visualization of the donor duct, recipient duct and biliary anastomosis was considered good or excellent in 100 percent of the exams, by both observers. Six biliary complications were detected (21.4 percent), all of them anastomotic strictures. Intra and interobserver agreement were substantial or almost perfect (kappa k values of 0.611 to 0.804) for the visualization of the biliary tree and almost perfect (k values of 0.900 to 1.000) for the detection of biliary complications. MRCP achieved 100 percent sensitivity, 95.45 percent specificity, 85.7 percent positive predictive value and 100 percent negative predictive value for the detection of biliary complications. CONCLUSIONS: MRCP is an accurate examination for the detection of biliary complications after orthotopic liver transplantation and it is a highly reproducible method in the evaluation of the biliary tree of liver transplanted patients.

OBJETIVO: Medir a acurácia e reprodutibilidade da colangiopancreatografia por ressonância magnética (CPRM) na avaliação da visibilização de complicações biliares em pacientes submetidos a transplantes hepáticos ortotópicos. MÉTODOS: Realizado estudo retrospectivo de 28 exames de CPRM de 24 pacientes submetidos a transplantes hepáticos. Os exames foram interpretados por dois observadores independentes, em dois momentos distintos, quanto ao grau de visibilização das estruturas estudadas e quanto à presença ou ausência de alterações nas vias biliares. Os resultados da CPRM foram comparados, nos casos de CPRM negativa, à evolução clínico-laboratorial por pelo menos 3 meses e, nos casos de CPRM alterada, aos achados de colangiopancreatografia retrógrada endoscópica (CPRE) e cirurgia, quando indicados. RESULTADOS: A visibilização das vias biliares intra-hepáticas foi considerada boa ou excelente em 78,6 por cento e 82,1 por cento dos exames pelos dois observadores. A visibilização da via biliar extra-hepática do doador e do receptor, bem como da anastomose biliar, foi considerada boa ou excelente em 100 por cento dos casos por ambos os observadores. Foram detectadas seis complicações biliares (21,4 por cento dos casos), todas elas estenoses anastomóticas. A concordância intra e intra-observador foi substancial ou quase perfeita (índices de kappa- k de 0,611 a 0,804) para a visualização das estruturas estudadas e quase perfeita (k de 0,900 a 1,000) para a detecção das complicações biliares. A CPRM apresentou sensibilidade de 100 por cento, especificidade de 95,45 por cento, valor preditivo positivo de 85,7 por cento e valor preditivo negativo de 100 por cento para a detecção de complicações biliares. CONCLUSÕES: A colangiopancreatografia por ressonância magnética (CPRM) é um exame acurado para a detecção de complicações biliares em pacientes submetidos a transplantes hepáticos ortotópicos por CPRM. Este exame configura-se como um método eficiente ...

Evaluation of the efficacy and reproducibility of cholangiopancreatography by magnetic resonance for detecting biliary complications following orthotopic liver transplantation.

PURPOSE: To evaluate the accuracy and reproducibility of magnetic resonance cholangiopancreatography (MRCP) in the detection of biliary complications in liver transplanted patients. METHODS: A study was conducted, with blinded review of 28 MRCP exams of 24 patients submitted to liver transplantation. The images were reviewed by two independent observers, at two different moments, regarding the degree of biliary tree visualization and the presence or absence of biliary complications. The MRCP results were compared, when negative, to at least 3 months of clinical and biochemical follow-up, and when positive, to the findings at surgery or endoscopic retrograde cholangiopancreatography (ERCP). RESULTS: The degree of intrahepatic biliary tree visualization was considered good or excellent in 78.6% and 82.1% of the exams by the two observers and visualization of the donor duct, recipient duct and biliary anastomosis was considered good or excellent in 100% of the exams, by both observers. Six biliary complications were detected (21.4%), all of them anastomotic strictures. Intra and interobserver agreement were substantial or almost perfect (kappa k values of 0.611 to 0.804) for the visualization of the biliary tree and almost perfect (k values of 0.900 to 1.000) for the detection of biliary complications. MRCP achieved 100% sensitivity, 95.45% specificity, 85.7% positive predictive value and 100% negative predictive value for the detection of biliary complications. CONCLUSIONS: MRCP is an accurate examination for the detection of biliary complications after orthotopic liver transplantation and it is a highly reproducible method in the evaluation of the biliary tree of liver transplanted patients.

Fetal lung volume in fetuses with urinary tract malformations: comparison by 2D-, 3D-sonography and magnetic resonance imaging.

OBJECTIVE: To evaluate the concordance between two-dimensional ultrasonography (2DUS), three-dimensional ultrasonography (3DUS) and magnetic resonance imaging (MRI) in the assessment of lung volume in fetuses with urinary tract malformations (UTM). METHODS: This was a cross-sectional study involving 12 pregnancies between 19 and 34 weeks, with various fetal UTM. Pulmonary volume was obtained by 2DUS using the following equation: total lung volume = [right lung antero-posterior diameter (X) x transverse diameter (Y) x cranial-caudal diameter x 0.152 + left lung (X1) x (Y1) x (Z1) x 0.167]. Pulmonary volume by 3DUS was obtained using the virtual organ computer-aided analysis (VOCAL) method with a 30 degrees (VOL30), 18 degrees (VOL18) and 12 degrees (VOL12) rotation. A fast sequence of transverse lung section was also obtained by MRI. The intraclass correlation coefficient was used to evaluate the correlation between the three methods. The paired student t-test was used to compare the means. RESULTS: There was a strong correlation between the three methods, and the highest correlations were between MRI and VOL18 for the right (ICC = 0.913) and left (ICC = 0.947) lungs. A strong correlation was also found between the lung volumes obtained through MRI and VOL12 as well as VOL18 (p = 0.544 and 0.286, respectively). However, for the left lung there was only a correlation between MRI and VOL12 (p = 0.49). CONCLUSIONS: There is a good concordance between 3DUS (VOL12) and MRI in the evaluation of lung volume in fetuses with UTM.

Carcinoma em tecido mamário ectópica: aspectos de imagem (mamografia, ultra-sonografia e ressonância magnética) / Carcinoma in ectopic breast tissue: imaging aspects (mammography, ultrasonography and magnetic resonance imaging)

Nos últimos três anos foram realizadas 30.000 mamografias no Departamento de Diagnóstico por Imagem da Universidade Federal de São Paulo/Escola Paulista de Medicina, sendo que em 0,23% delas foi observado tecido mamário acessório. Relatamos um caso de paciente de 44 anos de idade, feminina, que apresentava nódulo endurecido, aderido ao subcutâneo, em topografia inframamária à direita. À ultra-sonografia observou-se imagem nodular sólida hipoecogênica, com contornos irregulares, medindo 1,4 cm. À ressonância magnética visualizou-se curva de realce tipo II (platô). Após biópsia, foi diagnosticado denocarcinoma mamário. O carcinoma nas mamas acessórias costuma apresentar aspecto histopatológico indiferenciado e disseminação mais precoce, determinando pior prognóstico. Por este motivo, é de fundamental importância sua detecção nos estágios iniciais, permitindo, dessa forma, a instituição precoce do tratamento e possibilitando maiores chances de cura.

Over the last three years 30,000 mammograms were performed in the Department of Diagnostic Imaging of Universidade Federal de São Paulo/Escola Paulista de Medicina. Accessory breast tissue was observed in 0.23% of the individuals. We report a case of a 44-year-old woman presenting a hard nodule adhered to the subcutaneous tissue in right inframammary topography. At ultrasonography, a hypoechogenic solid nodule with irregular contour measuring 1.4 cm was observed. Magnetic resonance imaging showed type II (plateau) dynamic curve. Breast adenocarcinoma was subsequently diagnosed by biopsy. Accessory breast carcinomas generally present with an ill-defined histopathological aspectand early dissemination. Early detection is essential to begin treatment in the initial stages, with better chances of cure.