USE OF 125IODINE SEEDS (ROLLIS) FOR INTRA-OPERATIVE LOCALIZATION OF NONPALPABLE BREAST LESIONS: ANALYSIS OF THE IMPLANT OF 338 SEEDS IN 284 PATIENTS / Uso de sementes de iodo-125 (ROLLIS) para localização intraoperatória de lesões impalpáveis da mama: análise do implante de 338 sementes em 284 pacientes

Objective: To analyze the feasibility, efficacy and results of the use of 125Iodine seeds for intra-operative localization of nonpalpable breast lesions. Method: Retrospective review of 284 patients, referred by various breast specialist surgeons, with radiologically detected but clinically nonpalpable microcalcifications or nodules, submitted to pre-operatory 125Iodine seed implant, between July 2012 and September 2016. A total of 338 seeds were implanted in ordinary radiologic departments, supported by ultrasonography or mammography exams, chosen according to the morphologic aspect of the lesion. Radioguided surgical procedure took place on the same day or few days after the implant of the seeds, with the help of a radiation detector called Gamaprobe, which directs the surgeons towards the radioactive seeds and to the lesion to be resected. Results: All implants were performed as outpatient procedures, with patients immediately returning to their daily activities. No complications such as pain, bleeding, infeccion and haematoma were recorded. Pathologists had no difficulty in preparing the surgical specimens for histopathologic analysis. Surgical safety margins were considered adequate in all pathologic reports, with no need for re-operations. The healing process was not jeopardized by radiation, and the surgeons were pleased with the improvement on intraoperative lesions localizations and shortening on operatory time. Cosmetic results were well accepted by the patients. Conclusion: The 125Iodine seed implant is an effective alternative method for intraoperative localization of radiologically detectable and clinically nonpalpable breast lesions.

Objetivo: Avaliar a exequibilidade e a eficácia do método de implante de sementes de 125Iodo (ROLLIS) para localização intraoperatória de lesões impalpáveis da mama. Método: Trata-se de um estudo retrospectivo, incluindo 284 pacientes com nódulos ou microcalcificações mamárias, visíveis na mamografia e/ou ultrassonografia, porém, clinicamente impalpáveis, submetidas a implantes de sementes de 125Iodo, de julho de 2012 a setembro de 2016, sendo implantado um total de 338  sementes. As  pacientes foram encaminhadas por diversos mastologistas que executaram cirurgias radioguiadas com auxílio de detector de radiação denominado Gamaprobe, realizadas no mesmo dia do implante ou vários dias após, seguindo a agenda do centro cirúrgico, da equipe médica e a conveniência da paciente. Resultados: Os implantes foram realizados em regime ambulatorial, com imediato retorno das pacientes às atividades cotidianas, não sendo registrada qualquer complicação como dor, hemorragia, infecção ou hematoma. Os patologistas não constataram prejuízo no processamento do espécimen cirúrgico. O processo cicatricial se efetuou normalmente, obtendo-se plena satisfação por parte dos cirurgiões, que referiram maior facilidade na localização intraoperatória das lesões e diminuição no tempo operatório. O resultado cosmético também foi beneficiado, sendo bem aceito pelas pacientes. As margens cirúrgicas foram consideradas adequadas em todos os casos, graças à avaliação feita pelo patologista e às ampliações executadas no momento da cirurgia, dispensando re-excisões. Conclusão: O implante de sementes de 125Iodo (ROLLIS) é uma técnica segura e eficaz para localização intraoperatória de lesões radiologicamente visíveis, porém clinicamente impalpáveis, da mama.

Endovascular therapeutic options for the treatment of aortoiliac aneurysms / Opções terapêuticas endovasculares para o tratamento dos aneurismas aortoilíacos

ABSTRACT About 20% of patients with abdominal aortic aneurysms have associated iliac aneurysms. Distal sealing during the endovascular treatment of aortic-iliac aneurysms is a challenge that has led to the emergence of several technical options to achieve this goal over the years. Internal iliac artery embolization is associated with the risk of ischemic complications, such as gluteal necrosis, lower limb neurological deficit, colonic ischemia, impotence and gluteal claudication. This article summarizes the technical options for endovascular treatment of aortoiliac aneurysms with different approaches to preserving the patency of internal iliac arteries.

RESUMO Cerca de 20% dos pacientes com aneurismas de aorta abdominal apresentam aneurismas ilíacos associados. A obtenção do selamento distal, durante o tratamento endovascular dos aneurismas aortoilíacos, constitui-se em um desafio que suscitou, ao longo dos anos, o surgimento de diversas opções técnicas para alcançar esse objetivo. A embolização da artéria ilíaca interna é associada ao risco de desenvolvimento de complicações isquêmicas, tais como: necrose glútea, déficit neurológico dos membros inferiores, isquemia colônica, impotência e claudicação glútea. Esse artigo resume as opções técnicas de tratamento endovascular dos aneurismas aortoilíacos com diferentes formas de abordagem de preservação da perviedade das artérias ilíacas internas.

Prognostic Value of Real Time Myocardial Contrast Echocardiography after Percutaneous Coronary Intervention.

Real time myocardial contrast echocardiography (RTMCE) is a cost-effective and simple method to quantify coronary flow reserve (CFR). We aimed to determine the value of RTMCE to predict cardiac events after percutaneous coronary intervention (PCI). We have studied myocardial blood volume (A), velocity (ß), flow indexes (MBF, A × ß), and vasodilator reserve (stress-to-rest ratios) in 36 patients with acute coronary syndrome (ACS) who underwent PCI. CFR (MBF at stress/MBF at rest) was calculated for each patient. Perfusion scores were used for visual interpretation by MCE and correlation with TIMI flow grade. In qualitative RTMCE assessment, post-PCI visual perfusion scores were higher than pre-PCI (Z = -7.26, P < 0.01). Among 271 arteries with TIMI flow grade 3 post-PCI, 72 (36%) did not reach visual perfusion score 1. The ß- and A × ß-reserve of the abnormal segments supplied by obstructed arteries increased after PCI comparing to pre-PCI values (P < 0.01). Patients with adverse cardiac events had significantly lower ß- and lower A × ß-reserve than patients without adverse cardiac events. In the former group, the CFR was ≥ 1.5 both pre- and post-PCI. CFR estimation by RTMCE can quantify myocardial perfusion in patients with ACS who underwent PCI. The parameters ß-reserve and CFR combined might predict cardiac events on the follow-up.

Endovascular therapeutic options for the treatment of aortoiliac aneurysms.

About 20% of patients with abdominal aortic aneurysms have associated iliac aneurysms. Distal sealing during the endovascular treatment of aortic-iliac aneurysms is a challenge that has led to the emergence of several technical options to achieve this goal over the years. Internal iliac artery embolization is associated with the risk of ischemic complications, such as gluteal necrosis, lower limb neurological deficit, colonic ischemia, impotence and gluteal claudication. This article summarizes the technical options for endovascular treatment of aortoiliac aneurysms with different approaches to preserving the patency of internal iliac arteries.

99m-Technetium binding site in bone marrow mononuclear cells.

INTRODUCTION: The increasing interest in 99m-technetium ((99m)Tc)-labeled stem cells encouraged us to study the (99m)Tc binding sites in stem cell compartments. METHODS: Bone marrow mononuclear cells were collected from femurs and tibia of rats. Cells were labeled with (99m)Tc by a direct method, in which reduced molecules react with (99m)Tc with the use of chelating agents, and lysed carefully in an ultrasonic apparatus. The organelles were separated by means of differential centrifugation. At the end of this procedure, supernatants and pellets were counted, and the percentages of radioactivity (in megabecquerels) bound to the different cellular fractions were determined. Percentages were calculated by dividing the radioactivity in each fraction by total radioactivity in the sample. The pellets were separated and characterized by their morphology on electron microscopy. RESULTS: The labeling procedure did not affect viability of bone marrow mononuclear cells. Radioactivity distributions in bone marrow mononuclear cell organelles, obtained in five independent experiments, were approximately 38.5 % in the nuclei-rich fraction, 5.3 % in the mitochondria-rich fraction, 2.2 % in microsomes, and 54 % in the cytosol. Our results showed that most of the radioactivity remained in the cytosol; therefore, this is an intracellular labeling procedure that has ribosomes unbound to membrane and soluble molecules as targets. However, approximately 39 % of the radioactivity remained bound to the nuclei-rich fraction. To confirm that cell disruption and organelle separation were efficient, transmission electron microscopy assays of all pellets were performed. CONCLUSIONS: Our results showed that most of the radioactivity was present in the cytosol fraction. More studies to elucidate the mechanisms involved in the cellular uptake of (99m)Tc in bone marrow cells are ongoing.

Use of (99m)Tc-anti-TNF-α scintigraphy in a patient with non-radiographic axial spondyloarthritis.

The aim of this study was to describe the use of (99m)Tc-anti-TNF-α scintigraphy for detecting inflammation of the sacroiliac joints in a patient with non-radiographic axial spondyloarthritis. A 47-year-old female patient, non-smoker and non-drinker, complained of a low back pain inflammation, which began 4 years before her condition have exacerbated to morning stiffness and anterior uveitis in the last 6 months. Initially diagnosed as mechanical low back pain, she irregularly took non-steroidal anti-inflammatory drugs and corticosteroids, without significant long-lasting results. Radiographic findings were negative. There was increased uptake of (99m)Tc-anti-TNF-α in an area corresponding to the topography of ileum and sacroiliac right joint upon (99m)Tc-anti-TNF-α scintigraphy. Magnetic resonance imaging (MRI), the most used image diagnosis tool, showed minimum impregnation of gadolinium in the right sacroiliac joint and at the iliac face of the inferior third of the right sacroiliac joint. We suggest that (99m)Tc-anti-TNF-α can facilitate early diagnosis of patients with non-radiographic axial spondyloarthritis. More studies are now ongoing.

A new method for intraoperative localization of epilepsy focus by means of a gamma probe / Um novo método para a localização intraoperatória de foco de epilepsia mediante utilização de gamaprobe

Objective To evaluate the utility of a new multimodal image-guided intervention technique to detect epileptogenic areas with a gamma probe as compared with intraoperative electrocorticography. Materials and Methods Two symptomatic patients with refractory epilepsy underwent magnetic resonance imaging, videoelectroencephalography, brain SPECT scan, neuropsychological evaluation and were submitted to gamma probe-assisted surgery. Results In patient 1, maximum radioactive count was initially observed on the temporal gyrus at about 3.5 cm posteriorly to the tip of the left temporal lobe. After corticotomy, the gamma probe indicated maximum count at the head of the hippocampus, in agreement with the findings of intraoperative electrocorticography. In patient 2, maximum count was observed in the occipital region at the transition between the temporal and parietal lobes (right hemisphere). During the surgery, the area of epileptogenic activity mapped at electrocorticography was also delimited, demarcated, and compared with the gamma probe findings. After lesionectomy, new radioactive counts were performed both in the patients and on the surgical specimens (ex-vivo). Conclusion The comparison between intraoperative electrocorticography and gamma probe-assisted surgery showed similarity of both methods. The advantages of gamma probe include: noninvasiveness, low cost and capacity to demonstrate decrease in the radioactive activity at the site of excision after lesionectomy. .

Objetivo Avaliar a utilidade de um novo método de intervenção multimodal guiado por imagem, permitindo a detecção de áreas epileptogênicas mediante utilização de gamaprobe em comparação à eletrocorticografia intraoperatória. Materiais e Métodos Dois pacientes sintomáticos com epilepsia refratária realizaram ressonância magnética, videoeletroencefalograma, SPECT cerebral, avaliação neuropsicológica e foram submetidos a neurocirurgia usando gamaprobe. Resultados No paciente 1 as contagens radioativas inicialmente estavam no máximo no giro temporal, cerca de 3,5 cm posterior à ponta do lobo temporal esquerdo. Após corticotomia, o gamaprobe apontou o ponto máximo na cabeça do hipocampo, de acordo com os achados de eletrocorticografia intraoperatória. No paciente 2 as contagens foram máximas na região occipital em sua transição com os lobos temporal e parietal (hemisfério direito). Na cirurgia, a área mapeada da atividade epileptogênica na eletrocorticografia foi também delimitada, demarcada e comparada aos dados do gamaprobe. Após a lesionectomia, procedeu-se uma nova radiocontagem no paciente e na peça cirúrgica (ex-vivo). Conclusão A comparação entre os métodos mostrou acurácia praticamente similar. As vantagens do gamaprobe foram a de não ser invasivo, ser de baixo custo e também ser relevante para mostrar a redução da atividade radioativa no local da exérese. .

99mTc-thymine scintigraphy may be a promising method in the diagnosis of breast cancer.

OBJECTIVE: Mammography has been established as the gold standard for the detection of breast cancer, and imaging techniques such as ultrasonography, magnetic resonance imaging, scintigraphy and positron emission tomography may be useful to improve its sensitivity and specificity. The objective of this study with breast scintigraphy was to evaluate the uptake of 99mTc-thymine in mammary lesions. METHODS: A total of 45 patients were included in this study. Thirty-three patients (73%) were subjected to surgery or percutaneous biopsy, providing histopathological data. The other 12 patients who remained under surveillance received clinical examinations and biannual mammography with a normal follow-up of at least three years, the data from which were used for comparison with the scintimammography results. RESULTS: The majority of patients (64.4%) had clinically impalpable lesions with a mammogram diagnosis of microcalcifications, impalpable nodules, or focal asymmetry. Of the studied lesions, 87% were smaller or equal to 20 mm in diameter, and 22% had malignant histopathological findings. Scintigraphy with 99mTc-thymine had a sensitivity of 70%, a specificity of 85.7%, positive and negative predictive values of 58.3% and 90.9%, respectively, and an accuracy of 82.2%. CONCLUSIONS: The results of this study are consistent with those previously reported by other authors. The good specificity and high negative predictive value of this technique and the absence of uptake in the heart indicate that it may be a promising complementary method in clinical practice and that it may contribute to reducing unnecessary benign biopsies.

The rise of cell therapy trials for stroke: review of published and registered studies.

Stroke is the second leading cause of death and the third leading cause of disability worldwide. Approximately 16 million first-ever strokes occur each year, leading to nearly 6 million deaths. Nevertheless, currently, very few therapeutic options are available. Cell therapies have been applied successfully in different hematological diseases, and are currently being investigated for treating ischemic heart disease, with promising results. Recent preclinical studies have indicated that cell therapies may provide structural and functional benefits after stroke. However, the effects of these treatments are not yet fully understood and are the subject of continuing investigation. Meanwhile, different clinical trials for stroke, the majority of them small, nonrandomized, and uncontrolled, have been reported, and their results indicate that cell therapy seems safe and feasible in these conditions. In the last 2 years, the number of published and registered trials has dramatically increased. Here, we review the main findings available in the field, with emphasis on the clinical results. Moreover, we address some of the questions that have been raised to date, to improve future studies.

99mTc-thymine scintigraphy may be a promising method in the diagnosis of breast cancer

OBJECTIVE: Mammography has been established as the gold standard for the detection of breast cancer, and imaging techniques such as ultrasonography, magnetic resonance imaging, scintigraphy and positron emission tomography may be useful to improve its sensitivity and specificity. The objective of this study with breast scintigraphy was to evaluate the uptake of 99mTc-thymine in mammary lesions. METHODS: A total of 45 patients were included in this study. Thirty-three patients (73%) were subjected to surgery or percutaneous biopsy, providing histopathological data. The other 12 patients who remained under surveillance received clinical examinations and biannual mammography with a normal follow-up of at least three years, the data from which were used for comparison with the scintimammography results. RESULTS: The majority of patients (64.4%) had clinically impalpable lesions with a mammogram diagnosis of microcalcifications, impalpable nodules, or focal asymmetry. Of the studied lesions, 87% were smaller or equal to 20 mm in diameter, and 22% had malignant histopathological findings. Scintigraphy with 99mTc-thymine had a sensitivity of 70%, a specificity of 85.7%, positive and negative predictive values of 58.3% and 90.9%, respectively, and an accuracy of 82.2%. CONCLUSIONS: The results of this study are consistent with those previously reported by other authors. The good specificity and high negative predictive value of this technique and the absence of uptake in the heart indicate that it may be a promising complementary method in clinical practice and that it may contribute to reducing unnecessary benign biopsies.

A FDG-18F na distinção de placa aterosclerótica: inovação em tecnologia PET/CT / FDG-18F in differentiating atherosclerotic plaque: innovation in PET/CT technology

A composição da placa aterosclerótica, em contrapartida ao grau de estenose arterial, parece ser o determinante crítico da vulnerabilidade e trombogenicidade da placa. O fluordesoxiglucose (FDG-18F), pode ser usado para obter imagensda atividade celular inflamatória de forma não invasiva através da tecnología PET. O objetivo principal do presente estudo foi averiguar a viabilidade da tecnologia FDG-18F PET na avaliação do processo inflamatório instalado nas placas ateroscleróticas, e, dessa forma, promover a distinção de placas ateroscleróticas através da relação entre acúmulo do radiofármaco e as características funcionais da lesão aterosclerótica. Estudo epidemiológico prospectivo, duplo cego randomizado, transversal foi realizado em cinco pacientes, seis controles e, os mesmos, foram submetidos ao exame diagnóstico FDG-18F PET/CT. Os valores de suv em artérias carótidas e veias jugulares do próprio paciente e o comparativo com o grupo controle foram correlacionados através de uma avaliação qualitativa do coeficiente de correlação de pearson. Através de um estudo descritivo comparativo inter-grupos na carótida direita observa-se que 64.9% da média dos valores de SUV corresponde aos pacientes em estudo. Na análise efetuada intra-grupo da carótida direita com a jugular direita dos pacientes em estudo, observou-se um valor médio de SUV 26.2% superior na artéria carótida. No grupo controle, a diferença entre os níveis médios de captação do FDG-18F foi inferior a 10%. Através da endarterectomia, foi possível realizar um estudo anátomo patológico e, dessa forma, identificar a presença de conteúdo inflamatórionas carótidas avaliadas, caracterizando assim placas instáveis. A tecnologia FDG-18F PET mostrou-se exequível favorecendo uma boa correlação histopatológica entre o processo inflamatório instalado nas placas ateroscleróticas e os níveis mensurados de SUV.

An ethological approach to the study of behavioral disorders provides key information on functionalaspects of behavior that characterize certain pathologies. The purpose of this study was to describe non-verbal behavioral units presented by a group of 14 women with social phobia (SP) and a control groupof 13 women during a clinical interview and to evaluate the possible differences between these twogroups. The 19 behavior units were selected with the index of concordance between the observers tauKendall = 0.795 (p = 0.000). People with SP supported the way they spoke with their hands and placedtheir hands on their legs, in comparison with the control group. People with SP nodded more often,touched their faces, pressed their lips, licked their lips and touched their hair more frequently than thecontrol group. The article suggests that a systematic evaluation of non-verbal behavior may be impor-tant in conducting a full evaluation of patients with SF in a clinical environment, and may contribute toevaluating the efficiency of the treatment.

A FDG-18F na distinþÒo de placa aterosclerótica: inovaþÒo em tecnologia PET/CT / FDG-18F in differentiating atherosclerotic plaque: innovation in PET/CT technology

A composiþÒo da placa aterosclerótica, em contrapartida ao grau de estenose arterial, parece ser o determinante crítico da vulnerabilidade e trombogenicidade da placa. O fluordesoxiglucose (FDG-18F), pode ser usado para obter imagensda atividade celular inflamatória de forma nÒo invasiva através da tecnología PET. O objetivo principal do presente estudo foi averiguar a viabilidade da tecnologia FDG-18F PET na avaliaþÒo do processo inflamatório instalado nas placas ateroscleróticas, e, dessa forma, promover a distinþÒo de placas ateroscleróticas através da relaþÒo entre acúmulo do radiofármaco e as características funcionais da lesÒo aterosclerótica. Estudo epidemiológico prospectivo, duplo cego randomizado, transversal foi realizado em cinco pacientes, seis controles e, os mesmos, foram submetidos ao exame diagnóstico FDG-18F PET/CT. Os valores de suv em artérias carótidas e veias jugulares do próprio paciente e o comparativo com o grupo controle foram correlacionados através de uma avaliaþÒo qualitativa do coeficiente de correlaþÒo de pearson. Através de um estudo descritivo comparativo inter-grupos na carótida direita observa-se que 64.9% da média dos valores de SUV corresponde aos pacientes em estudo. Na análise efetuada intra-grupo da carótida direita com a jugular direita dos pacientes em estudo, observou-se um valor médio de SUV 26.2% superior na artéria carótida. No grupo controle, a diferenþa entre os níveis médios de captaþÒo do FDG-18F foi inferior a 10%. Através da endarterectomia, foi possível realizar um estudo anátomo patológico e, dessa forma, identificar a presenþa de conteúdo inflamatórionas carótidas avaliadas, caracterizando assim placas instáveis. A tecnologia FDG-18F PET mostrou-se exequível favorecendo uma boa correlaþÒo histopatológica entre o processo inflamatório instalado nas placas ateroscleróticas e os níveis mensurados de SUV. (AU)

An ethological approach to the study of behavioral disorders provides key information on functionalaspects of behavior that characterize certain pathologies. The purpose of this study was to describe non-verbal behavioral units presented by a group of 14 women with social phobia (SP) and a control groupof 13 women during a clinical interview and to evaluate the possible differences between these twogroups. The 19 behavior units were selected with the index of concordance between the observers tauKendall = 0.795 (p = 0.000). People with SP supported the way they spoke with their hands and placedtheir hands on their legs, in comparison with the control group. People with SP nodded more often,touched their faces, pressed their lips, licked their lips and touched their hair more frequently than thecontrol group. The article suggests that a systematic evaluation of non-verbal behavior may be impor-tant in conducting a full evaluation of patients with SF in a clinical environment, and may contribute toevaluating the efficiency of the treatment.(AU)

99mTc-Anti-TNF-α scintigraphy: a new perspective within different methods in the diagnostic approach of active Graves ophthalmopathy.

Different imaging methods applied in the evaluation of a patient with unilateral active Graves ophthalmopathy (GO) are shown in the present paper. 99mTc-Anti-TNF-α scintigraphy is proposed as a promising method, not yet described, for the diagnosis of active ocular disease. It consists of labeling a human monoclonal antibody directed against TNF-α molecule (adalimumab) with technetium (99mTc). The method is based on the demonstration of TNF-α as one of the cytokines enrolled in the initial active phase of GO development. The method may give the perspective to link diagnosis and therapy, including new target-based modalities.

Iodine-123 metaiodobenzylguanidine cardiac imaging as a method to detect early sympathetic neuronal dysfunction in chagasic patients with normal or borderline electrocardiogram and preserved ventricular function.

PURPOSE: The indeterminate form of Chagas disease represents the most common chronic presentation. The aim of this study was to assess cardiovascular autonomic system function with I-123 metaiodobenzylguanidine (MIBG) scintigraphy in chagasic patients with normal or "borderline" electrocardiographic alterations and preserved left ventricular function evaluated by echocardiography. MATERIALS AND METHODS: A total of 40 chagasic patients and 19 control subjects were included in this study. Patients had normal echocardiogram and chest radiography; no arrhythmias or myocardial ischemia; and normal exercise performance for age, gender, and body mass index. I-123 MIBG scintigraphy was performed and the heart-to-mediastinum (H/M) uptake was used as the primary predictor in the present analysis. The data analysis was performed by using Nonparametric Regression Trees and the Survival Agreement Plot. We included only patients with preserved right and left ventricular function assessed by echocardiographic methods. RESULTS: Variables analyzed in the regression tree were age, sex, 20 minutes and 3 hours H/M uptake after injection of I-123 MIBG, washout rate, and single photon emission computed tomography imaging. The 3 hours H/M ratio was the only significant variable (P<0.001) and for 95% of chagasic patients, this value was less than 2.19. CONCLUSIONS: This study presents evidence that cardiac autonomic sympathetic modulation may be affected in chagasic subjects with preserved ventricular function evaluated by echocardiography, especially in those with "borderline" electrocardiogram.

Responsabilidade civil do radiologista no diagnóstico do câncer de mama através do exame de mamografia / Civil liability of the radiologist in the diagnosis of breast cancer through mammography

O objetivo deste trabalho foi analisar a responsabilidade civil por erro médico no que tange, especificamente, à conduta do radiologista no diagnóstico do câncer através do exame mamográfico. Foram analisadas, para exemplificar, decisões judiciais com o objetivo de mostrar o entendimento dos tribunais nacionais, dentre eles, o Supremo Tribunal Federal, a quem compete revisar, em grau de recurso, as decisões judiciais que afrontam a Constituição Federal, bem como o Superior Tribunal de Justiça, que tem a competência de julgar em grau de recurso as decisões violadoras das leis federais. O material utilizado demonstra a visão dos tribunais acerca do tema objeto desta pesquisa, revelando as consequências do erro do médico radiologista e dos serviços de radiologia no âmbito do direito civil, que possui a indenização monetária como consequência da existência de responsabilidade civil. Ou seja, o dever de indenizar decorre da constatação da existência da responsabilidade civil. Assim, afastada a responsabilidade civil, fica afastado o dever de indenizar. Indenização não se confunde com a responsabilidade civil, esta é fundamento daquela.

The present study was aimed at analyzing civil liability for medical errors specifically for a radiologist's errors in the mammographic diagnosis of breast cancer. As examples, Court decisions were analyzed with the aim of showing the understanding of the Brazilian Courts of Law, among them the Supreme Federal Court that is responsible for reviewing, on appeal, judicial decisions affronting the Brazilian Constitution, as well as the Superior Court of Justice, that is competent to judge on appeals against decisions violating Federal Laws. The reviewed material demonstrates the Courts' view on the subject discussed on the present article, describing the consequences of radiologists' and radiological centers' errors in the sphere of the civil law that establishes monetary indemnity as a consequence of the existence of civil liability. That is to say that the duty to indemnify arises from the testifying of the existence of civil liability. Thus, once the civil liability is removed, the duty to indemnify comes to an end. Indemnity should not be confused with civil liability; the latter is the foundation of the former.

PET/CT and vascular disease: current concepts.

Since its introduction in 2001, positron emission tomography associated to computed tomography (PET/CT) has been established as a standard tool in cancer evaluation. Being a multimodality imaging method, it combines in a single session the sensitivity granted by PET for detection of molecular targets within the picomolar range, with an underlying submilimetric resolution inherent to CT, that can precisely localize the PET findings. In this last decade, there have been new insights regarding the pathophysiology of atherosclerosis, particularly about plaque rupture and vascular remodeling. This has increased the interest for research on PET/CT in vascular diseases as a potential new diagnostic tool, since some PET molecular targets could identify diseases before the manifestation of gross anatomic features. In this review, we will describe the current applications of PET/CT in vascular diseases, emphasizing its usefulness in the settings of vasculitis, aneurysms, vascular graft infection, aortic dissection, and atherosclerosis/plaque vulnerability. Although not being properly peripheral vascular conditions, ischemic cardiovascular disease and cerebrovascular disease will be briefly addressed as well, due to their widespread prevalence and importance.