Magnetic resonance imaging findings in placenta accreta spectrum disorders: pictorial essay.

Placenta accreta spectrum disorders are characterized by abnormal adhesion of the placenta that can be subdivided into three categories according to degree of invasion: placenta accreta (passing through the decidua basalis and adhering to the myometrium); placenta increta (penetrating the myometrium); and placenta percreta (invading the uterine serosa or adjacent tissues or organs). The incidence of placenta accreta has increased significantly in recent decades, mainly because of an increase in the rates of cesarean section, which is its main risk factor. Accurate prenatal identification makes it possible to institute the ideal treatment with a multidisciplinary team, significantly minimizing maternal morbidity and mortality. The examinations of choice are ultrasound and magnetic resonance imaging (MRI). When the ultrasound evaluation is inconclusive, as well as when the patient has risk factors for the condition or the placenta is in a posterior location, MRI is indicated. In cases of placental invasion of the adjacent pelvic organs, MRI is also preferable because it provides a broader field of view, which improves surgical planning. Numerous features of placenta accreta spectrum disorders are discernible on MRI, including dark intraplacental bands, uterine bulging, and heterogeneous placenta. Knowledge of these findings and the combination of two or more of them increase confidence in the diagnosis.

Acretismo placentário é uma condição caracterizada pela implantação anormal da placenta, que pode ser subdividida em três espectros de acordo com o seu grau de invasão: placenta acreta (ultrapassa a decídua basal e adere ao miométrio), placenta increta (penetra o miométrio) e placenta percreta (invasão da serosa uterina ou de tecidos/órgãos adjacentes). A incidência de acretismo placentário aumentou significativamente nas últimas décadas, principalmente em função da elevação das taxas de cesarianas, sendo este o seu principal fator de risco. A sua identificação pré-natal precisa permite um tratamento ideal com equipe multidisciplinar, minimizando significativamente a morbimortalidade materna. Os exames de escolha são a ultrassonografia e a ressonância magnética (RM), sendo a RM um método complementar indicado quando a avaliação ultrassonográfica é duvidosa, para pacientes com fatores de risco para acretismo placentário ou quando a placenta tem localização posterior. A RM é preferível também para avaliar invasão de órgãos adjacentes, oferecendo um campo de visão mais amplo, o que melhora o planejamento cirúrgico. Diversas características na RM são descritas no acretismo placentário, incluindo bandas hipointensas em T2 intraplacentárias, protuberância uterina anormal e heterogeneidade placentária. O conhecimento desses achados e a combinação de mais de um critério aumentam a confiabilidade do diagnóstico.

Achados na ressonância magnética do espectro do acretismo placentário: ensaio iconográfico / Magnetic resonance imaging findings in placenta accreta spectrum disorders: pictorial essay

Resumo Acretismo placentário é uma condição caracterizada pela implantação anormal da placenta, que pode ser subdividida em três espectros de acordo com o seu grau de invasão: placenta acreta (ultrapassa a decídua basal e adere ao miométrio), placenta increta (penetra o miométrio) e placenta percreta (invasão da serosa uterina ou de tecidos/órgãos adjacentes). A incidência de acretismo placentário aumentou significativamente nas últimas décadas, principalmente em função da elevação das taxas de cesarianas, sendo este o seu principal fator de risco. A sua identificação pré-natal precisa permite um tratamento ideal com equipe multidisciplinar, minimizando significativamente a morbimortalidade materna. Os exames de escolha são a ultrassonografia e a ressonância magnética (RM), sendo a RM um método complementar indicado quando a avaliação ultrassonográfica é duvidosa, para pacientes com fatores de risco para acretismo placentário ou quando a placenta tem localização posterior. A RM é preferível também para avaliar invasão de órgãos adjacentes, oferecendo um campo de visão mais amplo, o que melhora o planejamento cirúrgico. Diversas características na RM são descritas no acretismo placentário, incluindo bandas hipointensas em T2 intraplacentárias, protuberância uterina anormal e heterogeneidade placentária. O conhecimento desses achados e a combinação de mais de um critério aumentam a confiabilidade do diagnóstico.

Abstract Placenta accreta spectrum disorders are characterized by abnormal adhesion of the placenta that can be subdivided into three categories according to degree of invasion: placenta accreta (passing through the decidua basalis and adhering to the myometrium); placenta increta (penetrating the myometrium); and placenta percreta (invading the uterine serosa or adjacent tissues or organs). The incidence of placenta accreta has increased significantly in recent decades, mainly because of an increase in the rates of cesarean section, which is its main risk factor. Accurate prenatal identification makes it possible to institute the ideal treatment with a multidisciplinary team, significantly minimizing maternal morbidity and mortality. The examinations of choice are ultrasound and magnetic resonance imaging (MRI). When the ultrasound evaluation is inconclusive, as well as when the patient has risk factors for the condition or the placenta is in a posterior location, MRI is indicated. In cases of placental invasion of the adjacent pelvic organs, MRI is also preferable because it provides a broader field of view, which improves surgical planning. Numerous features of placenta accreta spectrum disorders are discernible on MRI, including dark intraplacental bands, uterine bulging, and heterogeneous placenta. Knowledge of these findings and the combination of two or more of them increase confidence in the diagnosis.

Pancreatic collision tumor: mucinous cystadenoma and celar cell renal cell carcinoma metastasis

We present a clinical, radiological, surgical, and pathological correlation case of a 49-year-old woman with a prior nephrectomy due to a clear cell renal cell carcinoma, who was then diagnosed with a multilocular cystic lesion in the pancreatic tail after a routine ultrasound. Computed tomography and magnetic resonance cholangiopancreatography showed a multilocular cystic lesion with a hypervascular wall nodule in the pancreas. The patient underwent a distal pancreatectomy and had a final diagnosis of pancreatic mucinous cystadenoma with an associated component of clear cell renal cell carcinoma (collision tumor of the pancreas). (AU)

Evaluation of Interobserver Agreement in the Diagnosis of Posterior Pelvic Ring Lesions Using Plain Radiography.

Objective To evaluate the interobserver agreement of a radiologist, two hip specialist orthopedists with experience in the treatment of pelvic and acetabulum fractures, two general orthopedists, two orthopedics residents and two radiology residents regarding the diagnosis of posterior pelvic ring injuries using plain radiography. Method A cross-sectional study conducted in September 2017. The exams of 20 patients who had been treated for traumatic lesions of the posterior pelvic ring were randomly selected.. A total of nine examiners from different medical fields evaluated the plain pelvic radiographs; those were compared with computed tomography, scans, which are considered a confirmatory diagnostic criterion. Interobserver agreement was assessed using the Kappa test ( κ ) and 95% confidence intervals (95%CIs). Results A total of 28 lesions were found by computed tomography (23%; 95%CI: 16-32%) among all of the cases evaluated. The interobserver agreement between plain radiography and computed tomography was moderate among physicians with more experience: a radiologist ( κ = 0.461; 95%CI: 0.270-0.652), hip specialists 1 and 2 ( κ = 0.534; 95%CI: 0.348-0.721 and κ = 0.431; 95%CI: 0.235-0.627 respectively), and general orthopedists 1 and 2 ( κ = 0.497; 95%CI: 0.307-0.686 and κ = 0.449; 95%CI: 0.254-0.645 respectively). Among the orthopedics and radiology residents, the interobserver agreement was considered poor. High false negative values were found among all of the examiners, especially regarding posterior iliac fractures and sacrum fractures. Conclusion Professionals with greater experience in the field have a better ability to identify posterior pelvic ring lesions by plain radiography, but we emphasize that plain pelvic radiography was susceptible to false negative evaluations among all of the professionals assessed.

Evaluation of Interobserver Agreement in the Diagnosis of Posterior Pelvic Ring Lesions Using Plain Radiography / Avaliação da concordância interobservador no diagnóstico de lesões do anel pélvico posterior usando radiografia simples

Abstract Objective To evaluate the interobserver agreement of a radiologist, two hip specialist orthopedists with experience in the treatment of pelvic and acetabulum fractures, two general orthopedists, two orthopedics residents and two radiology residents regarding the diagnosis of posterior pelvic ring injuries using plain radiography. Method A cross-sectional study conducted in September 2017. The exams of 20 patients who had been treated for traumatic lesions of the posterior pelvic ring were randomly selected.. A total of nine examiners from different medical fields evaluated the plain pelvic radiographs; those were compared with computed tomography, scans, which are considered a confirmatory diagnostic criterion. Interobserver agreement was assessed using the Kappa test (κ) and 95% confidence intervals (95%CIs). Results A total of 28 lesions were found by computed tomography (23%; 95%CI: 16-32%) among all of the cases evaluated. The interobserver agreement between plain radiography and computed tomography was moderate among physicians with more experience: a radiologist (κ = 0.461; 95%CI: 0.270-0.652), hip specialists 1 and 2 (κ = 0.534; 95%CI: 0.348-0.721 and κ = 0.431; 95%CI: 0.235-0.627 respectively), and general orthopedists 1 and 2 (κ = 0.497; 95%CI: 0.307-0.686 and κ = 0.449; 95%CI: 0.254-0.645 respectively). Among the orthopedics and radiology residents, the interobserver agreement was considered poor. High false negative values were found among all of the examiners, especially regarding posterior iliac fractures and sacrum fractures. Conclusion Professionals with greater experience in the field have a better ability to identify posterior pelvic ring lesions by plain radiography, but we emphasize that plain pelvic radiography was susceptible to false negative evaluations among all of the professionals assessed.

Resumo Objetivo Avaliar a concordância interobservador de radiologista, dois ortopedistas especialistas em quadril com experiência no tratamento de fraturas da pelve e acetábulo, dois ortopedistas gerais, dois residentes de ortopedia, e dois residentes de radiologia no diagnóstico de lesões do anel pélvico posterior usando radiografia simples. Método Estudo transversal, realizado em setembro de 2017. Foram selecionados retrospectivamente e de modo aleatório exames de 20 pacientes atendidos previamente com lesões traumáticas do anel pélvico posterior. Nove examinadores de diferentes áreas médicas avaliaram as radiografias simples de bacia, que foram comparadas com a tomografia computadorizada, considerada critério confirmatório de diagnóstico. A concordância interobservador foi analisada pelo teste de Kappa (κ), e com intervalos de confiança de 95% (IC95%). Resultados Foram encontradas pela tomografia computadorizada 28 lesões (23%; IC95%: 16-32%) em todos os casos avaliados. A concordância interobservador entre a radiografia simples e a tomografia computadorizada foi moderada nos médicos com mais experiência: o radiologista (κ = 0,461; IC95%: 0,270-0,652), os especialistas em quadril 1 e 2 (κ = 0,534; IC95%: 0,348-0,721; e κ = 0,431; IC95%: 0,235-0,627, respectivamente), e os ortopedistas gerais 1 e 2 (κ = 0,497; IC95%: 0,307-0,686; e κ = 0,449; IC95%: 0,254-0,645, respectivamente). Já com relação aos residentes de ortopedia e radiologia, a concordância interobservador foi considerada fraca. Nos diagnósticos de todos os examinadores, foram encontrados altos valores falso-negativos, principalmente nas fraturas da região posterior do ilíaco e nas fraturas do sacro. Conclusão Profissionais com mais experiência na área apresentam melhor capacidade de identificação de lesões do anel pélvico posterior por radiografia simples; porém, salienta-se que a radiografia simples de pelve esteve suscetível a avaliações falso-negativas da parte de todos os profissionais estudados.

PET/CT imaging in lung cancer: indications and findings.

The use of PET/CT imaging in the work-up and management of patients with lung cancer has greatly increased in recent decades. The ability to combine functional and anatomical information has equipped PET/CT to look into various aspects of lung cancer, allowing more precise disease staging and providing useful data during the characterization of indeterminate pulmonary nodules. In addition, the accuracy of PET/CT has been shown to be greater than is that of conventional modalities in some scenarios, making PET/CT a valuable noninvasive method for the investigation of lung cancer. However, the interpretation of PET/CT findings presents numerous pitfalls and potential confounders. Therefore, it is imperative for pulmonologists and radiologists to familiarize themselves with the most relevant indications for and limitations of PET/CT, seeking to protect their patients from unnecessary radiation exposure and inappropriate treatment. This review article aimed to summarize the basic principles, indications, cancer staging considerations, and future applications related to the use of PET/CT in lung cancer.

Superior Vena Cava Lipoma in an Asymptomatic Man.

A 58-year-old asymptomatic male smoker, underwent computed tomography of the chest for lung cancer screening. Unenhanced CT showed a hypodense elongated lesion with fat density within the superior vena cava (SVC). Magnetic resonance imaging was performed and confirmed the fatty nature of the lesion. Surgical resection of the lesion was performed and histopathological evaluation confirmed the diagnosis of SVC lipoma.

PET/CT imaging in lung cancer: indications and findings / PET/TC em câncer de pulmão: indicações e achados

The use of PET/CT imaging in the work-up and management of patients with lung cancer has greatly increased in recent decades. The ability to combine functional and anatomical information has equipped PET/CT to look into various aspects of lung cancer, allowing more precise disease staging and providing useful data during the characterization of indeterminate pulmonary nodules. In addition, the accuracy of PET/CT has been shown to be greater than is that of conventional modalities in some scenarios, making PET/CT a valuable noninvasive method for the investigation of lung cancer. However, the interpretation of PET/CT findings presents numerous pitfalls and potential confounders. Therefore, it is imperative for pulmonologists and radiologists to familiarize themselves with the most relevant indications for and limitations of PET/CT, seeking to protect their patients from unnecessary radiation exposure and inappropriate treatment. This review article aimed to summarize the basic principles, indications, cancer staging considerations, and future applications related to the use of PET/CT in lung cancer.

O uso de PET/TC na avaliação e manejo de pacientes com câncer de pulmão aumentou substantivamente durante as últimas décadas. A capacidade de combinar informações funcionais e anatômicas permite a PET/TC analisar diversos aspectos do câncer de pulmão, desde um estadiamento mais preciso da doença até a capacidade de prover dados úteis na caracterização de nódulos pulmonares indeterminados. Além disso, a acurácia de PET/TC tem se demonstrado maior do que a de modalidades convencionais em alguns cenários, tornando a PET/CT um valioso método não invasivo para a investigação de câncer de pulmão. Entretanto, a interpretação dos achados de PET/TC apresenta numerosas armadilhas e potenciais fatores de confusão. Portanto, é imperativo que pneumologistas e radiologistas familiarizem-se com as principais indicações e limitações desse método, com o intuito de proteger os pacientes da exposição desnecessária à radiação e de terapias inapropriadas. Este artigo de revisão objetivou sumarizar os princípios básicos, indicações, considerações sobre o estadiamento tumoral e futuras aplicações de PET/TC em câncer de pulmão.