AbSTrAcTS of ScIENTIfIc PAPErS - Sociedade Paulista de Radiologia

Transcription

30 de abril a 3 de maio
Transamerica Expo Center - São Paulo - Brasil
IMAGE GENTLY, IMAGE WISELY
Diagnóstico por Imagem na dose certa
Abstracts of
Scientific Papers
Collaboration
Support
www.jpr2015.org.br
summary
PA – Scientific Papers......................................................................... 4
1 - Abdominal / Digestive Tract............................................................ 4
2 - Abdominal / Genitourinary Tract..................................................... 7
3 - Head and Neck............................................................................... 10
4 - Cardiovascular .............................................................................. 11
5 - Physics / Quality Control............................................................... 13
6 - IT / Management / Education........................................................ 14
7 - Intervention ................................................................................... 16
8 - Breast............................................................................................. 23
9 - Fetal Medicine............................................................................... 25
10 - Nuclear Medicine........................................................................ 26
11 - Musculoskeletal System.............................................................. 29
12 - Neuroradiology............................................................................ 33
13 - Pediatrics..................................................................................... 36
14 - PET-CT........................................................................................ 40
16 - Chest............................................................................................ 41
17 - Ultrasonography.......................................................................... 46
PD – Scientific Papers – Digital Presentation................................. 48
1 - Abdominal / Digestive Tract.......................................................... 48
2 - Abdominal / Genitourinary Tract................................................... 61
3 - Head and Neck............................................................................... 69
4 - Cardiovascular .............................................................................. 76
5 - Physics / Quality Control............................................................... 80
6 - IT / Management / Education........................................................ 81
7 - Intervention ................................................................................... 81
8 - Breast............................................................................................. 84
9 - Fetal Medicine............................................................................... 87
10 - Nuclear Medicine........................................................................ 88
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45ª São Paulo Radiological Meeting • 1º Brasil - Iberia Meeting
11 - Musculoskeletal System.............................................................. 91
12 - Neuroradiology.......................................................................... 104
13 - Pediatrics................................................................................... 119
15 - Radiological Techniques............................................................ 124
16 - Chest.......................................................................................... 125
17 - Ultrasonography........................................................................ 136
TL – Scientific Papers – Oral Presentation................................... 140
1 - Abdominal / Digestive Tract........................................................ 140
2 - Abdominal / Genitourinary Tract................................................. 141
3 - Head and Neck............................................................................. 142
4 - Cardiovascular............................................................................. 143
7 - Intervention.................................................................................. 144
8 - Breast........................................................................................... 145
10 - Nuclear Medicine...................................................................... 145
11 - Musculoskeletal System............................................................ 146
12 - Neuroradiology.......................................................................... 148
14 - PET-CT...................................................................................... 151
16 - Chest.......................................................................................... 152
Abstracts of papers published in the following pages were enrolled and approved for presentation at
the 45th Sao Paulo Radiological Meeting (JPR’2015), and 1º Brasil - Iberia Meeting held on Abril,
30 - May, 3, 2015, at the Transamerica Expo Center in Sao Paulo, SP, Brazil.
Authors have full responsibility on the data contained in this publication such as quotes from institutions, company names
or authorship.
It is expressly understood that the Radiological and Diagnostic Imaging Society of São Paulo is not
civilly or criminally
liable for copyrights possibly inserted in this book.
SPR, Scientific Paper Committee
Abstracts of Scientific Papers
3
PA – Scientific Papers
1 - Abdominal / Digestive Tract
PA.01.005
WATER ENEMA TC: LOCAL STAGING OF COLO-RECTAL CANCER.
Study type: Pictorial Essay
Authors: RAICHHOLZ GA., GIMENEZ SL., SAÑUDO JL.,
FROULLET C., BROUVER DE KONING H., PEREZ MC.
Institution: Diagnostico Junin, Santa fe, Santa Fe, Argentina.
Author responsible: Gustavo Raichholz
Email: [email protected]
Introduction: The water enema TC is an hybrid technique
that combines the endorectal administration of a negative
contrast agent (water), with high resolution tomographic images. Is an excellent diagnostic method of colorectal cancer.
Our objective is to demonstrate the value of water enema TC
local staging of colorectal cancer.
Methods Involved: The technique involves to administrate 1
to 1.5 liters of warm water through an endorectal 24 F Foley
probe. Subsequently a venous portal series is acquired in 70 seconds after the administration of intravenous nonionic contrast.
Discussion: The visualization of colorectal tumor and its
environment is significantly improved with the use of negative endoluminal contrast substance (water) and intravenous
contrast. The sensitivity and specificity for differentiating between early local stages (T1 / T2) of advanced (T3) is high
with values of 88.46% and 75% respectively. Differentiation
between stages T3 and T4 shows a specificity of 98.14% and
a sensivity of 100%.
Conclusion of the presentation: Water enema CT has proved
to be a very high diagnostic method with high sensitivity and
specificity values for differentiating colorectal cancer in early
stages of locally advanced.
PA.01.006
Evaluation of the pancreatic parenchyma in Diabetes Mellitus through quantitative Magnetic Resonance Imaging (MRI)
techniques
Study type: Original Works
Authors: UYENO, F.A.; ITO, N.A.; ARAUJO, I.M.; CARVALHO, A.L.; PAULA, F.J.A.; MUGLIA, V.F.; ELIAS, J.Jr.
Institution: HOSPITAL DAS CLÍNICAS DE RIBEIRÃO
PRETO (USP), RIBEIRÃO PRETO, SÃO PAULO, BRASIL
Author responsible: Fabio Akira Uyeno
Brief description of the purpose of the study: To compare,
through quantitative MRI techniques, the pancreatic fat fraction in healthy and diabetic (type 1 and 2) individuals. Secondarily, we’ve tried to identify differences in ADC (diffusion) values in the pancreatic parenchyma.
Methods: A retrospective study, with review, by two radiologists, of abdominal MR images of 89 subjects (56 controls;
33 diabetics). Three sequences have been used: T1-GRE inphase and out-of-phase; diffusion (ADC map). Fat fractions
and average values of the ADC in pancreatic parenchyma
have been calculated and compared.
Main results: We observed significant differences between
pancreatic fat fractions of diabetics type 2 (DM2) and healthy
and diabetic type 1 (DM1) individuals, with p values of 0.01
and 0.02 for men and 0.02 and 0.01 for women, with good
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interobserver reliability (intraclass correlation coefficients >
0.8). There was also a significant difference in ADC values
between DM2 and DM1 and healthy individuals (p: 0.02 and
0.03 in males; p: 0.002 and 0.001 in females), lower in DM2.
Conclusion of the presentation: We observed significantly
higher pancreatic fat fractions in DM2, when compared to
healthy and DM1 individuals. This finding favors the hypothesis of fatty infiltration of the organ as an associated causal
factor to the pancreatic beta cells failure.
PA.01.007
Role of MDCT Enterography in the evaluation of small intestine in Peutz-Jeghers
syndrome. Pictorial essay.
Authors: FERNANDEZ ME, FRANGELLA J, GIURBINO
A, CASEROTTO A, CADENAS OLIVA MJ, MICHELONI
L, FRANK L.
Institution: HOSPITAL FERNANDEZ, CIUDAD DE BUENOS AIRES. ARGENTINA.
Author responsible: Julia Frangella
Introduction: MDCT enterography allows non-invasive
good-quality assessment of well-distended bowel loops and
the adjacent soft tissues. It displays the thickness and enhancement of the entire bowel wall. Peutz-Jeghers syndrome (PJS)
is an autosomal dominant disease and is characterized by the
development of benign hamartomatous polyps in the gastrointestinal tract. PJS is associated with a high risk for adenocarcinoma, mainly of the gastrointestinal tract. The aim of this
presentation is to describe the characteristic MDCT enterography findings of small-bowel abnormalities in PJS.
Methods Involved: In this pictorial essay we describe MDCT
enterography findings of small-bowel abnormalities in PJS.
Discussion: Regular smallbowel surveillance is performed to
reduce the risks associated with PJS (acute gastrointestinal
bleeding, intussusception and bowel obstruction, gastrointestinal and extra-digestive cancer). Surveillance allows for
the detection of large polyps and the consequent referral of
selected patients for endoscopic enteroscopy or surgery. The
characteristic CT findings are multiple, small-bowel regular
polyps with various sizes and shapes, presenting a homogeneous enhancement.
Conclusion of the presentation: MDCT enterography have
an important role in the management of patients suffering
from PJS, being a useful tool for the detection of the majority
of polyps. Missed polyps are mostly less than 10 mm in size
and aren´t considered to be clinically significant.
PA.01.008
COLITIS’ DIFFERENTIAL DIAGNOSIS IN COMPUTED TOMOGRAPHY
Authors: OLIVEIRA, V.S.; PAIVA, G.G.; LIBÂNIO, B.B.;
DUTRA, M.S.B.G.; BOLINELLI, A.P.; VALENTE, M.
Institution: Hospital Estadual Vila Alpina - Seconci-SP, São
Paulo, São Paulo, Brasil
Author responsible: Victor Santos Oliveira
Introduction: Computed tomography (CT) is widely used in
the evaluation of patients with colitis. The objective of this
work is to show, through images, features that can guide the
differential diagnosis in these instances.
Methods Involved: CT images will be shown with characteristics that suggest the differential diagnosis of Ulcerative
colitis, Crohn\’s disease, Pseudomembranous colitis and
Neutropenic colitis.
Discussion: The diagnosis suspect of colitis is clinically,
but computed tomography may aid in a differential diagnosis. Some radiological nuances are very important to suggest some differential diagnosis. Ulcerative colitis, Crohn\’s
Disease, Pseudomembranous colitis and Neutropenic colitis
have a classic important pattern of involvement, region most
affected or degree of colonic wall thickening, together with
the clinic patient and laboratory tests, to enter into an etiologic diagnosis of colitis.
Conclusion of the presentation: CT scans can provide characteristics that contribute for the differential diagnosis of
colitis a case, assisting in the evaluation of the patient.
PA.01.010
THE ACUTE ISCHEMIC BOWEL – THE CT AND MRI
IMAGING FINDINGS: PICTORIAL ESSAY
Authors: FIGUEIREDO, J.R.P.; BRITTO NETO, L.A.;
SILVA, M.M.A.; LUZ, D.C.; MARTINS, A.N.; ISHIKAWA,W.Y.; TACHIBANA, A.; FUNARI, M.B.G.;
Institution: Departamento de Diagnóstico por Imagem, Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brasil
Author responsible: Joana Rayane Pinheiro de Figueiredo
Introduction: Bowel ischemia is an abdominal emergency
that accounts for approximately 2% of gastrointestinal illnesses. That represents a process of insufficient blood supply of the
small or large bowel with the consequences ranging from transient, totally reversible attack to a lethally catastrophic event.
CT angiography and MR angiography are the main techniques
for the noninvasive diagnosis of mesenteric ischemia. Describe through case studies the role and major CT and MRI
findings of acute mesenteric ischemia in various conditions.
Methods Involved: Describe through case studies the role
and major CT and MRI findings of AMI.
Discussion: The ischemic bowel condition may result directly from arterial occlusion, hypotension or vasoconstrictive
medications, may also be associated with impaired venous.
The CT and MRI imaging findings include bowel wall thickening with or without the target sign, intramural pneumatosis,
mesenteric or portal venous gas, and mesenteric arterial or
venous thromboembolism.
Conclusion of the presentation: It is important for any radiologist to know which major findings fo the acute ischemic
bowel in the CT and MRI and important points that must be
described in the report. Early diagnosis is useful to ensure a
correct therapeutic approach.
PA.01.012
Bowel wall thickening assessment on
computed tomography
Authors: Negri,R.V.; Dadalto, R.V.; Leite, E.A.V; Costa,
A.S.; Fassbender, C.P.B; Guedes, V.H.C.C.; Souza, E.C.F;
Barros, E.G.
Institution: HSPE/FMO, São Paulo - SP, Brasil
Author responsible: Rodrigo Valadao Negri
Introduction: Computed tomography (CT) of the abdomen
became a useful tool in the initial evaluation of patients with
acute onset abdominopelvic pain or trauma. Generally the
focus is placed on the peritoneal cavity, mesentery and solid
organs, taking little attention in the evaluation of the gastro-
intestinal (GI) tract. The purpose of this essay is to familiarize the reader with patterns of abnormal attenuation and wall
thickening of TGI and associated diagnoses.
Methods Involved: Using contrast enhanced CT images we illustrate and discuss the major causes of bowel wall thickening.
Discussion: Normal variants as well as abnormal conditions
may cause thickening of the bowel wall, thus, using criteria
such as attenuation pattern, degree of bowel wall thickening;
circumferential symmetric thickening versus asymmetric thickening; focal, segmental, or diffuse involvement; and associated
perienteric abnormalities we are able to differentiate them.
Conclusion of the presentation: Careful analysis of parietal thickening of GI tract on CT, besides avoiding “pitfalls\”,
will strengthen the diagnostic possibilities among conditions
such: inflammatory and infectious conditions, neoplastic
disease, fat deposition, intestinal pneumatosis, submucosal
hemorrhage, edema, infarction and radiation injury.
PA.01.013
Evaluation of a Screening Dixon (SD) algorithm in comparison to quantitative reference standards (RS) for the detection
of iron/ fat deposition in the liver
Authors: SANCHES-ROCHA LG; STRECKER RM; KANNENGIESSER S; ZHONG X; BARONI RH; FUNARI MG
Institution: Departamento de Imagem, Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brasil
Author responsible: Liana Guerra Sanches da Rocha
Brief description of the purpose of the study: Assess the
performance of an SD algorithm for automated liver disease detection.
Methods: 85/98 abdominal MRIs were analyzed retrospectively, 13 were excluded from final analysis due to artifacts.
Proton density fat fraction was calculated applying non-linear
fitting of a seven peak fat model (Hamilton) with T1 correction
to 4-echo GRE2d ROI data in Matlab. T2* was determined by
an exponential ROI fit to 12-echo GRE2d data. A threshold of
PDFF=5,6% and a T2*=15ms were applied to separate iron/
fat from normal. Results were compared to the SD report generated inline (results: normal, iron, fat, combined).
Main results: SD detected 52 patients as normal, 10 with
fat, 17 with iron deposition and 6 with combined disease (fat
and iron). RS confirmed all 55 as normal, 7 with fat, 10 with
iron deposition and 0 with combined disease. 13 of the SD
positives were normal, 2 showed combined disease. No false
negative was detected by SD.
Conclusion of the presentation: SD shows excellent agreement and high sensitivity/ specificity with the RS in the detection of iron and/or fat deposition.
PA.01.015
Beyond acute appendicitis: unusual lesions of the appendix.
Authors: YAMAUCHI FI., (AUTOR PRINCIPAL) / AMOEDO CDM., (CO-AUTORA) / SAMESHIMA YT., (REVISÃO
E IMAGENS) / LUZ DC., (ELABORAÇÃO E IMAGENS)
/ CORADAZZI KRS., (ELABORAÇÃO E IMAGENS) /
BARONI RH., (COORDENAÇÃO) RACY MCJ., (REVISÃO BIBLIOGRÁFICA) FUNARI MBG., (REVISÃO)
Author responsible: Daniel Calich Luz
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Introduction: Although acute appendicitis is by far the most
common disease of the appendix detected on imaging exams,
there are many other conditions that can involve the appendix. We will discuss and illustrate unusual appendix lesions
on ultrasound (US), computed tomography (CT) and magnetic resonance (MR).
Methods Involved: We performed a retrospective search
from our files that resulted in epithelial tumors, carcinoid
tumors, lymphoma, Goblet cell carcinoid and other non-neoplastic conditions such as endometriosis, diverticulitis, volvulus and intussusception of the appendix.
Discussion: Several conditions rather than acute inflammation may involve the appendix. Clinical presentation is often
non-specific with lower abdominal pain and imaging exams
play a key role in this setting.
Conclusion of the presentation: Differentiation between all
these entities may be difficult on imaging exams, and most of
the times is not possible to make a specific diagnosis. However, knowledge of these conditions may help radiologist to
identify an unusual lesion and help surgeons to determine the
best management.
PA.01.017
CT findings in not traumatic Acute Abdomen
Authors: Bôas, RMV.; Távora, DGF.; Torres, RVA.; Timbó, PS.
Institution: Hospital Geral de Fortaleza (HGF), Fortaleza,
Ceará, Brasil
Author responsible: Rafaela Magalhães Villas Bôas
Introduction: The acute abdomen is defined as a syndrome
characterized by diffuse abdominal pain of sudden onset, which
needs urgent medical or surgical intervention. Computed tomography (CT) is a diagnostic method that provides non-invasive
and rapid detection of the etiology of acute abdomen, which significantly reduces the morbidity and mortality rates. The present
pictorial essay aims to discuss and illustrate some classic signs
of the most common causes of non-traumatic acute abdomen.
Methods Involved: The theme will be divided into three
major groups (inflammatory, obstructive and vascular) and
will be addressed through tomographic images, as well as by
figures and schematic drawings.
Discussion: The findings of classical radiological signs such
as parietal bowel thickening and the portal venous gas in
mesenteric ischemia, allows a more precise etiologic diagnosis in acute abdomen.
Conclusion of the presentation: CT is a method that provides accuracy as the differential diagnosis in acute abdomen
and becoming a important tool in the decision to conduct the
emergency. It is important that radiologist should be familiar
with the main signs of this syndrome.
TL.01.008
MR ELASTOGRAPHY: PRELIMINARY ANALYSIS
OF 105 PATIENTS WITH AND WITHOUT DIFFUSE
LIVER DISEASE
Authors: Coradazzi, K.R.S., Mello-Amoedo, C.D., Reis,
M.A.C.R., Baroni, R.H., Funari, M.B.G.
Author responsible: Klaus Rizk Sthur Coradazzi
Brief description of the purpose of the study: Magnet-
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ic resonance elastography (MRE) is a noninvasive method
for quantification of tissue stiffness measured in kilopascals
(kPa). Studies have been conducted to verify its clinical application in vivo, especially in the liver diseases. The study
objective was to determine and compare the values of liver
stiffness in patients with and without liver disease, and correlate them with liver function laboratory tests (AST, ALT,
GGT, bilirubin and albumin).
Methods: From June to November / 2014, 105 patients underwent ERM. Of these 37 had previous diagnosis of liver
disease (based on clinical and laboratory criteria) and the other had no known liver disease (controls). The values of liver
stiffness were measured in the right hepatic lobe avoiding
focal lesions and caliber hepatic vessels.
Main results: The average value of liver stiffness in patients
without liver disease was 2.44 kPa (1.32 to 4.32) and in patients with liver disease, 7.05 kPa (3.04 to 12.87). The average value of liver stiffness was 7.96 kPa (4.51 to 12.8) in
patients with pronounced laboratory abnormalities and 5.75
kPa (3.40 to 8.18) in patients with mild alterations.
Conclusion of the presentation: The initial results of this
study corroborate the use of the ERM for screening patients
with diffuse liver diseases.
TL.01.010
Semi-automatic quantification in Digital
Defecography: Software validation \”QAD
-b 1.0\” (Qualitative and quantitative Analisys of Defecography-bial).
Authors: SALA MAS; LIGABO ANSG; GONZAGA BMF;
INDIANI JMC; MARTIN MF; MARQUES EM; ALVES RT;
LELLIS LS; CAPPABIANCO FAM; NACIF MS.
Institution: URC Diagnóstico, São José dos Campos, São
Paulo, Brasil
Author responsible: Marco Aurélio Sousa Sala
Brief description of the purpose of the study: Semiautomatic quantitative analysis using the QAD-b 1.0 software,
developed by us, evaluating intra- and inter-observer variations and correlates them with manual analysis to quantify
lengths and angles in digital defecography.
Methods: Analyzing of 30 digital Defecography exams realized between March 2012 and October 2014. The protocol
was performed at rest, contraction, valsalva, and evacuation.
We used the anorectal angle measurements, length of puborectalis muscle, descending perineum, anal canal length
ando opening and post-evacuation emptying. Two radiologists (observer 1 and 2), independently and blind to each
other, performed the measurements at three-week intervals.
Pearson correlation was used to compare the quantification of
the results obtained by the semi-automated method (QAD-b
1.0) and the manual. We also performed the \”t\” test of Student paired two-tailed to identify significant differences in
the sample (p <0.05).
Main results: 504 measurements were made by the observer
1 using the semi-automatic method and manual with excellent correlation between them (r = 92, p <0.001). The results
were not statistically different (p> 0.05). All measures had
excellent correlation when comparing inter- and intra-observer analysis (r = 0.98; p <0.001).
Conclusion of the presentation: The semi-automatic analysis using the QAD-b 1.0 software obtained statistically similar results with excellent correlation when compared to the
manual method.
2 - Abdominal/Genitourinary Tract
PA.02.002
EVALUATION OF MAGNETIC RESONANCE PARTICULARS OF PELVIS FEMALE IN A CANCER CENTER USING THE CRITERIA OF THE AMERICAN
COLLEGE OF RADIOLOGY.
Authors: RODRIGUES, D.P; SILVA, O.A.C; BELTRANI, F.H; SILVA, L.U.M.A; MELO, R.A.B; LIMA, R.M.L;
BOAVENTURA, C.S; BITENCOURT, A.G.V; MENDES,
G.G; CHOJNIAK, R.
Institution: A.C CAMARGO CANCER CENTER, SAO
PAULO, SP, BRASIL.
Author responsible: Camila Silva Boaventura
Brief description of the purpose of the study: To evaluate
and discuss the MRI indications (MRI) of the female pelvis
in a cancer center.
Methods: Retrospective single center study, conducted by
reviewing medical records and imaging reports. We included
1060 patients who underwent MRI of the female pélvis from
January 2013 to June 2014, at a cancer ceenter. Indications
of the exam were classified according to the criteria of the
American College of Radiology (ACR).
Main results: The mean age of patients was 52.6 ± 14.8
years, with 49.8% in the peri- or postmenopausal. The majority (63.9%) had a history of cancer, including 29.5% gynecological and 34.4% non gynecological. Of patients with
clinical complaints (44%), the most common symptoms were
pelvic pain (11.5%) and bleeding (9.8%). 34.7% of patients
had abnormal finfinds in prior ultrasound. Most patients
(76.7%) had adequate indication for the examination, according to the ACR criteria. The main indications were: evaluation of tumor recurrence after surgical resection (25.9%),
detection and staging of gynecological neoplasms (23.3%)
and evaluation of pelvic pain or mass (17.1%).
Conclusion of the presentation: The majority of exams
showed adequate indication according to the ACR criteria.
The main indication was local recurrence after surgical treatment of pelvic malignancies, which is compatible with a cancer center routine.
PA.02.003
Multiparametric MRI Prostate. Pictorial
essay focusing on the most prevalent
changes.
Authors: Barros, AP; Abizaid, WJM; Dutra, BL; Amaral, F;
Galvão, BS; Vilela, VM.
Institution: Clínica Magnescan, Juiz de Fora, Minas Gerais, Brasil
Author responsible: Vagner Moysés Vilela
Introduction: multiparametric MRI of the prostate is a study
that has been gaining increasing acceptance in the current
scenario. Our goal is to demonstrate the primary findings to
the study, in an attempt to familiarize radiologists, urologists
and radiation oncologists with the new method.
Methods Involved: We reviewed all examinations of magnetic
resonance prostate made in branch unit of the clinic during the
years 2012 to 2014, in order to raise relevant imaging findings
and illustrative of the primary findings in routine evaluation.
Discussion: Its main function has been to direct biopsies in
patients with elevated PSA and negative results of random bi-
opsies, raising the positivity of the method and improving the
correlation with the Gleason score. The method provides also
local staging quite accurate, clearly demonstrating invasion
of neighboring structures.
Conclusion of the presentation: This type of study although
recent, has promoted significant increase in the evaluation of the
prostate gland and adjacent structures denoting increasing need
to become familiar with the method by the academic community.
PA.02.027
Herlyn-Werner-Wunderlich
syndrome:
imaging aspects in RM
Authors: RODRIGUES, M.A.S.; ROCHA, M.A.; MELLO-AMOEDO, C. D.; COÊLHO, C.R.; YAMAUCHI, F.I.;
BARONI, R.H.; FUNARI, M.B.G.
Institution: Hospital Israelita Albert Einstein, São Paulo,
São Paulo, Brasil.
Author responsible: Mariana Athaniel Silva Rodrigues
Introduction: This study was developed to spread knowledge
about Herlyn-Werner-Wunderlich Síndrome (HWWS): the association of müllerian anomalies with renal dysplasia / agenesis.
Methods Involved: Two cases will be described, with emphasis on magnetic ressonace imaging aspects.
Discussion: Patient 1: 41years old, during treatment of infertility. MR depicted didelphic uterus and left hemivagina
obstruction associated with ipsilateral renal agenesis and
Gartner’s duct cyst. Patient 2: 45 years old, primipara, under investigation of endometriosis, because of chronic pelvic pain. MR depicted bicornuate bicollis uterus and vaginal
duplicity associated with right renal agenesis, Gartner’s duct
cyst and deep pelvic endometriosis. Müllerian duct anomalies affects 7-10% of women and should be considered in the
imaging investigation of infertility, with special attention to
other associated anomalies. Early and correct diagnosis is essential to treatment planning and to improve prognosis.
Conclusion of the presentation: During investigation of infertility and endometriosis, knowledge of Müllerian anomalies and possible associated conditions, such as those observed in HWWS, is essential to avoid incomplete diagnosis.
PA.02.029
Perianal fistulas: practical guide to
evaluation by MRI
Authors: Bezerra, ROF; Araujo, DAP; Siqueira, LTB;
Menezes, MR; Cerri, GG
Institution: Hospital Sírio Libanês, São Paulo, São Paulo,
Brasil
Author responsible: Regis Otaviano França Bezerra
Introduction: Perianal fistulas are inflammatory conditions
that affect the region of the anal canal, causing significant
morbidity due to high rate of recurrence and often requiring
multiple surgical treatments. We will describe MRI protocol
for perianal fistulas; anatomy of the sphincter complex; the
main imaging findings / classification of fistula; discuss the
impact of MRI in the evaluation/clinical management and
post treatment / recurrence changes
Methods Involved: Magnetic Resonance
Discussion: Radiological evaluation of perianal fistulas is
critical because it allows surgeons to define the best surgical
approach, showing the location of fistulous tracks, secondary fistulas, complex fistulas or association with abscesses.
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Involvement of inter / transphincteric spaces, the levator ani
muscle and anal canal integrity is also crucial to describe,
since treatment can result in varying degrees of fecal incontinence. In addition, MRI has a role in follow-up after treatment
and may demonstrate fibrocicatricial changes or reccurrence.
Conclusion of the presentation: MRI is the imaging technique of choice for evaluation of perianal fistulas, providing a
highly accurate, fast and non-invasive way to define the best
surgical strategy and, therefore, reducing treatment morbidity.
PA.02.032
PI-RADS: HOW AND WHY TO USE
Authors: SILVESTRE, C.C.; GALVES JR., R.R.; OLIVEIRA, C.K.S; PINHEIRO, L.A.
Institution: Hospital Alemão Oswaldo Cruz, São Paulo, São
Paulo, Brasil
Author responsible: Carlos Cezar Silvestre
Introduction: Published in 2012 by the European Society of
Urogenital Radiology (ESUR), the PI-RADS (Prostate imaging reporting and data system) is a systematization of the multiparametric MRI prostate report. Although this new strategy
improves the detection of clinically significant cancer, it is not
widely used. Our aim is to show how to apply this systematic
assessment to improve the detection of prostate cancer.
Methods Involved: We included all prostate MRI that was
performed in our institution between January 2013 and December 2014 in patients with biopsy-proven diagnosis of
prostate cancer. Analyses of all MRI tests were performed by
two radiologists. The PI-RADS was applied as recommended
by ESUR guidelines.
Discussion: The PI-RADS arises as a method to prepare the
structured the multiparametric MRI prostate report in prostate lesions. Divided into five distinct categories according to
the presence and degree of suspicion of lesions, their proper
interpretation makes the report more objective and provides
better communication between the requesting physician and
the radiologist, resulting in optimization of the assessment.
Conclusion of the presentation: The use of PI-RADS improves the accuracy of the report of MRI in cases of prostate
cancer, with its use can impact the management of this highly
prevalent disease.
PA.02.033
Evaluation of BOLD (blood-oxygen-leveldependent) 3 Tesla MRI (3T) to differentiate acute tubular necrosis and acute rejection in kidney transplant patients.
Authors: MENDES, G.F., CORADAZZI, K.S.C., STRECKER, R., BARONI, R.H., FUNARI, M.B.G.
Institution: Hospital Israelita Albert Einsntein, São Paulo,
São Paulo, Brasil
Brief description of the purpose of the study: BOLD MR
imaging uses the R2* relaxivity rates to assess tissue oxygen
content and has been studied in various tissues and pathologies. The purpose of this study is to evaluate whether BOLD
is able to differentiate between acute tubular necrosis (ATN)
and acute rejection (AR) in renal grafts.
Methods: 20 patients of the kidney transplant program at our
institution and a control group of 12 volunteers had BOLD
MR exams. All patients had graft dysfunction less than four
8
weeks after surgery, AR (n=4) and ATN (n=9) were confirmed by biopsy results. Three R2* measures in kidney cortical (CR2*) and medullary (MR2*) were performed by two
radiologists, both blinded to the results of renal biopsy.
Main results: The CR2* values were significantly higher in
the ATN group compared to the control group and the AR
group. The MR2* values were lowest in the AR group, and
higher in the ATN group compared with the control group.
Conclusion of the presentation: Our preliminary results
show that 3T BOLD MRI shows effective in assessing tissue
oxygen renal of grafts and thus might help differentiate between AR and ATN in kidney transplantations.
PA.02.034
Syndrome of testicular vein: a rare cause of ureteral obstruction.
Study type: Case Report
Authors: AZEVEDO FILHO, L.F.; ANDERSON, P.A.V.
Institution: HOSPITAL SÃO JOSÉ DO AVAÍ
Author responsible: Luiz Fernando Azevedo Filho
Brief description of the purpose of the report: Testicular
vein syndrome (SVT) is a rare cause of ureteral obstruction.
Only 6 cases have been reported in the literature so far, and
there are no reviews on this subject. The study by Uro-CT is
essential for the diagnosis
Medical History: We reviewed the literature related to clarify when you can suspect this uncommon condition. In addition, we report the seventh case of SVT, this was a man
of 54 years old, with a history of chronic low back pain and
hematuria, with USG showing pielo-caliceal left dilation.
Diagnosis: Mellin et al in 1975 reported the first case in a
male patient, where an enlarged right testicular vein with an
atypical course was the cause of hidroureteronefrose. Two
years later, Kretkowski et al similarly described another
case in which the left testicular vein due to increased size
thrombophlebitis was found as the cause of proximal ureteral
obstruction. Ureteral obstruction due to compression by the
testicular vein usually presents with common symptoms of
dull and intermittent low back pain, with or without microscopic hematuria.
Discussion and summary of the case: TVS is an extremely
rare entity, which should be considered as an exclusion diagnosis in chronic cases.
PA.02.035
GYNECOLOGICAL EMERGENCIES: COMPUTED TOMOGRAPHY AND MAGNETIC RESONANCE FINDINGS
Authors: CAVALCANTE, F.A; BASTOS, B.B; MELLO
AMOEDO, C.D; YAMAUCHI, F.I; BARONI, R.H; FUNARI, M.B.G
Institution: HOSPITAL ISRAELITA ALBERT EINSTEIN,
SÃO PAULO - SP, BRASIL
Author responsible: Francisco de Assis Cavalcante Junior
Introduction: Acute gynecological conditions represent
common cause of care in emergency departments and account
for a large number of conditions that require, in most cases,
rapid therapeutic approach. The clinical diagnosis is often
complicated by nonspecific or overlapping presentations of
other diseases (including non-gynecological), requiring complementary imaging evaluation. This study aims to disseminate the computed tomography (CT) and magnetic resonance
(MR) imaging findings of some gynecological emergencies.
Methods Involved: Pictorial essay based on cases of acute
gynecological pathologies evaluated in a tertiary hospital. We
will illustrate cases of inflammatory pelvic disease, complicated ovarian cyst, ovarian, tubal and uterine fibroids torsion, ectopic and heterotopic pregnancy and ruptured endometrioma.
Discussion: Although ultrasound is the method of choice and
the most widely available for this purpose, it is not unusual that
the diagnosis of a gynecological emergency is initially suggested by CT (often incidentally) or only possible after performing
MR due to inconclusive results provided by other studies.
Conclusion of the presentation: Imaging diagnosis of gynecologic emergencies can be challenging. Therefore, it is
extremely important that the radiologist is familiar with its
findings on CT and MR studies.
PA.02.036
RM IN THE STAGING OF PENIS NEOPLASIA: WHAT
RADIOLOGIST NEED TO KNOW?
Authors: ABREU MFB. Idealização, levantamento bibliográfico e revisão de texto, GOMES KFM. Idealização,
levantamento bibliográfico e revisão de texto, MOTA MI.
Idealização, levantamento bibliográfico e revisão de texto ,
BATISTA AKC. Idealização, levantamento bibliográfico e
revisão de texto, MOTA FF. Levantamento bibliográfico e de
casos, FONSECA JM. Levantamento de casos
Institution: HOSPITAL DILSON GODINHO, MONTES
CLAROS, MINAS GERAIS, BRASIL.
Author responsible: Maria Fernanda Borges Abreu
Introduction: Magnetic resonance (MR) has become an essential tool in assessing local extent of penile cancer (NP)
due ineffectiveness of clinical staging.
Methods Involved: Conducted study with review of MR aspects essential for staging, prognosis and treatment planning
through tests performed in referral center for oncology.
Discussion: The size, tumor site and its relation to the spongy
body and corpus cavernosum, and violation of hypointense on
T2 line of tunica albuginea must be investigated to evaluate the
possibility of conservative resection. The desirable oncologic
safety margin is 2.0 cm, so tumors of the proximal third or invasion of the urethra indicate penectomy total. Thus, the base
of the penis or invasion of extension beyond the boundaries of
the penis and pelvic perineal wall portion should be reported, as
emasculation and radiotherapy may be required. Half of patients
with lymphadenopathy inguinal NP is palpable, not necessarily
metastatic, PET and CT diagnosis indicated in metastatic.
Conclusion of the presentation: MR is a noninvasive method of choice in the evaluation of penile lesions. The radiological report based on oncological surgeon’s needs allows
appropriate surgical planning, safe resection margins, minimizing unnecessary radical surgery and morbidity.
PA.02.037
Acute Scrotum Pictorial Essay
Authors: CAIXETA, F.H. ; BARRETO, R.L.M. ; CORTEZ,
J.G. ; FORTES, S.M.
Institution: Conjunto Hospitalar do Mandaqui, São Paulo,
São Paulo, Brasil
Author responsible: Fernando Henrique Caixeta Souza
Introduction: Acute Scrotum is defined by diseases of various etiologies that share common signs and symptoms, such
as inflammatory / infectious diseases ( orchitis and orchi-
epididymitis ) and testicular torsion, all that with different
treatment and diagnosis. The early diagnosis is important so
that the right treatment is ensured, increasing the testicular
viability. This essay objectives are to demonstrate the ultrasound image aspects, in the acute scrotum cases, correlating
with the onset of the symptoms, and how to make differential
diagnosis of the major diseases.
Methods Involved: Ultrasound images of acute scrotum
cases, using high-frequency transducers (7,5 - 10 MHz), B
mode, color and power Doppler
Discussion: Ultrasound imaging has a major role in acute
scrotum differential diagnosis. Especially in the surgical
emergencies, such as torsions, in which the early diagnosis
may avoid irriversible testicular damage.
Conclusion of the presentation: Ultrasonography is the
imaging method of choice for testicular assessment of
both acute and non- acute diseases, having decisive role
in former cases, allowing better characterization and
differentiation between diseases with similar clinical
signs and symptoms, highlighting those requiring immediate treatment.
PA.02.038
2000 Prostate Magnetic Resonance Imaging in 3 Tesla equipment: what has changed since the first exam
Authors: Martins, T; Mussi, TC; Baroni, RH; Funari, MBG
Institution: Hospital Israelita Albert Einstein, São Paulo, SP,
Brasil
Author responsible: Thais Caldara Mussi de Andrade
Introduction: Evaluate the different protocols in 3T prostate MRI in time, analyzing the improvement that allowed
increasing the appliance in the clinical practice, showing the
best implications and exams results.
Methods Involved: We evaluate retrospectively 2000 patients
that performed prostate MRI without endorectal coil in 3T scanner between the period o January 2007 and December 2014.
Discussion: The group had median age of 62 years old, medium PSA levels of 6.0 ng/mL. Initially, most of mpMRI were
performed for prostate tumor staging, what is very different
from nowadays statistics, which most of the exams are for
detection of clinically significant prostate cancer prior biopsy.
Since the beginning the sequence post-contrast perfusion was
performed, and in 2009 the diffusion sequence was included in the protocol. Nowadays, prostate mpMRI, without endorectal coil is the method of choice to evaluate the prostate,
and in our institution we do not use the rectal coil anymore.
The report was also improved over time, adopting, nowadays,
classification as PI-RADS/Likert wih the aim to standardize
the reports results, with optimizing the clinical conducts.
Conclusion of the presentation: Some changing’s in the
prostate mpMRI protocol allowed best results with the method with excellent results and consequent increasing the number of exams.
PA.02.039
PENILE FRACTURE: UNUSUAL EVENT, TYPICAL
FINDINGS
Authors: Figueiredo, J.R.P.; Cavalcante, F.A.; Rahal JR, A.;
Baroni, R.H.; Racy, M.C.J., Funari, M.B.G.
9
Introduction: Penile fracture usually occurs by an external
force applied to the erect penis. Most cases result from vigorous sexual intercourse. The most common presentation is
rupture of the tunica albuginea (TA) of the corpus cavernosum. We will describe relevant anatomical landmarks and
typical findings of the main presentations of penile trauma
for the purpose of increasing knowledge about this entity,
facilitating the imaging diagnosis, with emphasis on ultrasonography (US) and magnetic resonance imaging (MRI).
Methods Involved: Pictorial essay based on cases of penile
fracture evaluated at a tertiary hospital. We will present cases
of TA rupture of the cavernous and spongy bodies and chronic ruptures with fibrosis.
Discussion: Although the US is the initial examination in
most cases of acute penile fracture, MRI plays an important role in the evaluation of this condition, a highly accurate
method for identification of fractures and TA lacerations . The
imaging location and extent of the fracture is important to the
successful staging of the lesions and treatment planning.
Conclusion of the presentation: Although unusual, penile
fractures require correct diagnosis and specific action (often
immediate). The radiologist plays an important role in the diagnosis and aid the urologist in assessing the extent of the
injuries and definition of this conduct.
3 - Head and Neck
PA.03.002
Picture essay: Identification of the normal cranial nerve anatomy and spectrum
of diseases: analysis on the basis of 3D
fast imaging employing steady-state acquisition and Contrast-Enhanced 3D Fast
Imaging
Authors: PINCERATO, RCM; AYRES, AS; PINHO, PC;
ALVES, CAPF
Institution: Hospital Samaritano, São Paulo, São Paulo, Brasil
Author responsible: Rita de Cassia Maciel Pincerato
Introduction: The purpose of this study was to assess how
well the anatomy of cranial nerve and spectrum of diseases
could be displayed by MR imaging using a 3D fast imaging employing steady-state acquisition sequence and a Contrast-Enhanced 3D Fast Imaging
Methods Involved: Total of 14 patients underwent MR imaging
by 3D fast imaging employing steady-state acquisition sequence
and Contrast-Enhanced 3D Fast Imaging used to identify each
cranial nerve in relation to these anatomic landmarks and to assess the involvement of cranial nerves in various diseases.
Discussion: Routine MR imaging sequences are not always
successful for visualizing the lower cranial nerves and incomplete visualization of these nerves is partly due to their
close proximity and partly due to the lower resolution power of routine MR imaging sequences. The use of 3D fast imaging employing steady-state acquisition sequence provides
the best assessment of nerves anatomy and the MR imaging
with contrast enhancement is a valuable tool for detecting and
characterizing their involvement in various pathologies such
as neurogenic tumors, leptomeningeal disease (inflammatory
and metastatic diseases), infeccion disease, postinfectious e
demyelinating disorders, granulomatous inflammatory pro-
10
cess and neurovascular compression.
Conclusion of the presentation: We review the MR appearance of normal cranial nerves and their involvement in various pathologies.
PA.03.004
The ligaments of the ossicular chain: a
computed tomography analysis
Authors: ARAUJO JR, DAA; SUMI, DV; SOARES, CR; GARCIA, MRT; GOMES, RLE; DANIEL, MM; FUNARI, MBG.
Author responsible: David Alves de Araujo Junior
Introduction: The middle ear presents a chain of three ossicles supported by ligaments which are located in specific
sites of the tympanic cavity. The aim of this study is to review the anatomy of the main components and ligaments of
the ossicular chain, as well as major anatomical variations of
radiological relevance.
Methods Involved: From our didactic files of temporal
bones CTs, the most illustrative cases of ossicular ligaments
were selected.
Discussion: The tympanic cavity contains three auditory ossicles: the malleus, the incus and the stapes, which are supported by ligaments in specific sites. The malleus is supported by
the tensor tympani muscle, the anterior, lateral and superior
malleal ligaments and its articulation with the incus. The incus is supported by: the posterior, lateral, medial and superior
incudal ligaments. The annular ligament, which connects the
stapes footplate to the oval window, cannot be reliably separated from the footplate even on high-resolution CT studies.
Conclusion of the presentation: The anatomy of the middle
ear is complex. The detailed knowledge of the structures of
this region allows for more accurate diagnoses when evaluating cases of hearing loss involving the ossicular chain.
PA.03.006
Temporal bone fracture in patients with
polytrauma: correlation between critical findings and prognosis.
Authors: GONÇALVES FILHO, A.L.M.; ZUPPANI, H.B.;
TOYAMA, C.; SILVA, C.J.
Institution: Serviço de Diagnóstico por Imagem da Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo,
São Paulo, Brasil
Author responsible: Augusto Lio da Mota Gonçalves Filho
Introduction: To demonstrate temporal bone fractures in
patients with polytrauma depicted by computed tomography
(CT), with further clinical correlation.
Methods Involved: In our digital files, we retrospectively
collected 1226 CTs of temporal bones, from December 2010
to December 2014. Among those, we collected the examinations with traumatic temporal bone fractures. We reviewed
the classification and the description of the critical findings,
with further clinical correlation and prognosis.
Discussion: We found 47 patients with 50 temporal bone
fractures. The oblique fractures were the most frequent
(42%), followed by the longitudinal (34%), transverse (18%),
and mixed (6%) types. However, the identification of injury
to critical structures is more important than the description of
the main axis of the fracture itself. Among the patients with
post-trauma sequelae, 77,78% had good clinical correlation
with the CT findings.
Conclusion of the presentation: Identification of injury to critical structures is more important to guide further management
and predict prognosis than to simply classify the type of temporal bone fractures. Temporal bone CT allows accurate prediction of clinical outcome and complications, and it helps guide
the correct medical treatment of patients with polytrauma.
PA.03.009
Anatomy of the mouth floor and sublingual space and its leading conditions.
Authors: Negri,R.V.; Dadalto, R.V.; Carvalho, R.S.; Melo,
D.M; Camilo, M.L.; Zangiacomo, R.N.; Fassbender, C.P.B;
Barros, E.G.
Institution: HSPE/FMO, São Paulo, SP - Brasil
Introduction: Due to the wide spectrum of lesions involving
the floor of the mouth anatomical knowledge is imperative for
the correct analysis of its imaging. In this essay we will detail
the anatomy imaging of this region through different methods. The goal is to facilitate the identification of anatomical
variations and major diseases besides to optimize the indication of the imaging method to evaluate specific complaints.
Methods Involved: Through images of different methods illustrate and describe the characteristics of each method.
Discussion: The floor of the mouth is the horizontally aligned
U-shaped space on the oral cavity that is located under the
tongue. It lies between the mucosal surface and the mylohyoid muscle sling and contains connective and fat tissue,
salivary glands and ducts (Rivinus, Bartholin and Wharton),
nerves (lingual, hypoglossal and glossopharyngeal) and
lingual vessels. from it arises several lesions as: cystic, inflammatory (infection, stenosis or obstruction of main gland
duct), congenital and developmental abnormalities, vascular,
pseudotumoral, benign and malignant neoplasms.
Conclusion of the presentation: Although small, it is a space
that can be home to several conditions. The anatomy and its
variants should be well recognized and evaluated since may
potentially be confused with diseases.
PA.03.010
Anatomy of the floor of the mouth and
sublingual space
Authors: Negri,R.V.; Dadalto, R.V.; Carvalho, R.S.; Alves,
G.S.P; Guilherme, F.A; Souza, E.C.F;, Zangiacomo, R.N.;
Maciel, F.C.
Introduction: Although small, the floor of the mouth - and
the sublingual space (ESL) - is home to a variety of diseases. Intimacy with glandular anatomy, vascular and nervous
is imperative for the correct image analysis. Here we detail
the anatomy imaging of this region through different methods. The objective is to facilitate the identification of normal
anatomy and variations through images of different methods
illustrate and describe the characteristics of each method in
the anatomical evaluation.
Methods Involved: Through images of different methods illustrate and describe the characteristics of each method in the
anatomical evaluation.
Discussion: The floor of the mouth is the horizontally aligned
U-shaped space on the oral cavity that is located under the
tongue. It lies between the mucosal surface and the mylohyoid muscle sling and contains connective and fat tissue,
salivary glands and ducts (Rivinus, Bartholin and Wharton),
nerves (lingual, hypoglossal and glossopharyngeal) and lingual vessels. Evaluation through ultrasound, computed tomography or magnetic resonance can translates different levels anatomical details characteristic of each method.
Conclusion of the presentation: ESL is a potencial space
that lies on the floor of the mouth. Anatomy and its variants
should be recognized because it could be potencially mistaken with some diseases
4 - Cardiovascular
PA.04.001
Lipomatous hypertrophy of the interatrial septum: what you need to know? - a
case report
Authors: ANTUNES, L.O.; RIBEIRO, B. N.F.; SALATA,
T.M.; RIBEIRO, R.N.F.
Institution: HOSPITAL CASA DE PORTUGAL/3D DIAGNÓSTICO POR IMAGEM, RIO DE JANEIRO, RIO DE
JANEIRO, BRASIL.
Author responsible: Livia Antunes
Brief description of the purpose of the report: We present a
case of lipomatous hypertrophy (LH) of the interatrial septum
(IAS), documented by computed tomography (CT), highlighting the image of typical features associated with a brief bibliographic review. Our purpose is to familiarize the radiologist
with a little known change, which although benign, can create
confusion in the clinical management of patients.
Medical History: Patient female, 74 years, with a significant
history of weight loss in recent months, with no other associated complaints, is under investigation for neoplasia.
Diagnosis: The LH of the IAS is a benign condition, relatively infrequent, characterized by unencapsulated fat infiltration
in the IAS, usually an incidental finding without clinical implication. Presented in TC as mass with fat density and magnetic resonance imaging (MRI) with hyperintense signal on
T1-weighted sequences and T2 and signal loss in sequence
with fat suppression.
Discussion and summary of the case: The LH of the IAS
is a benign condition, reserving surgery for rare and specific cases, once located in an area of difficult access. The
typical CT standard of knowledge allows diagnosis, distinguishing it from other lesions, reducing costs with other
complementary methods of image and avoiding unnecessary treatments.
PA.04.002
Aorto-Retro-Aortic Left Renal Vein Fistula: A Rare Complication of Abdominal
Aortic Aneurysm
Authors: SAVARESE, L.G. ; TRAD, H.S. ; JOVILIANO,
E. E. ; KOENIGKAM-SANTOS, M. ; MUGLIA, V.F. ;
ELIAS-JUNIOR, J.
Institution: Hospital das Clínicas da Faculdade de Medicina
de Ribeirão Preto da Universidade de São Paulo; Ribeirão
Preto; São Paulo; Brasil.
11
Author responsible: Leonor Garbin Savarese
Brief description of the purpose of the report: We report a
case of surgically confirmed aorto-retro-aortic left renal vein
fistula secondary to an abdominal aortic aneurysm (AAA),
treated with endovascular repair. Incidence, pathophysiology,
and surgical management of this condition are discussed.
Medical History: A 63 year-old man presented with abdominal pain, left-sided varicocele, hematuria and acute renal
failure. A computed tomography (CT) scan revealed a 7,8 cm
infrarenal AAA associated with an unenhanced left kidney
and a retroaortic left renal vein, with simultaneous contrast
enhancement of the aneurysm, the vena cava and the left renal vein, suggesting the presence of a fistula. After endovascular repair, normal renal function was restored.
Diagnosis: Abdominal aortic aneurysm with spontaneous
aorto-left renal vein fistula is a rare but well-described clinical entity usually with abdominal pain, hematuria and a nonfunctioning left kidney. Literature review shows only about
30 other such cases. Aorto-left renal vein fistula is often seen
in patients with retroaortic left renal vein.
Discussion and summary of the case: To the best of our
knowledge, this is the sixth case reported in which an endovascular repair has been attempted in this type of fistula. Aorta–left renal vein fistula caused by an AAA is an extremely
rare entity and clinical examination and imaging are essential
for detection.
PA.04.003
ABDOMINAL VASCULAR COMPRESSION SYNDROMES - TIPS AND TRAPS
Authors: SILVA, M.M.A; SARAIVA, T.V.; MARTINS, A.
N.; ISHIKAWA, W.Y.; TACHIBANA, A.; FUNARI, M.B.G.
Author responsible: Murilo Marques Almeida Silva
Introduction: Vascular structures in the abdomen and pelvis
may be compressed by adjacent anatomic structures or they
may cause compression of adjacent hollow viscera. Compression of the proximal celiac artery, transverse duodenum,
left common iliac vein, left renal vein, ureteropelvic junction
(UPJ) and ureter can occur due to their close anatomic relationship to adjacent ligaments or vascular structures. Such
compressions may be asymptomatic or symptomatic. The
objective of this paper is to review and illustrate key features
in different imaging modalities of the most important abdominal vascular compression syndromes.
Methods Involved: A compilation of multiple cases of abdominal vascular compression syndromes performed in our
institution and an extensive literature review were done.
Discussion: When symptomatic, vascular compression can
result in a variety of syndromes in the abdomen and pelvis,
including median arcuate ligament syndrome, MayThurner
syndrome, nutcracker syndrome, superior mesenteric artery
syndrome, UPJ obstruction, ovarian vein syndrome and other
forms of ureteral compression. The diagnosis of these syndromes cannot be based only on imaging findings.
Conclusion of the presentation: The identification of signs
of abdominal vascular compression syndromes are very important for the radiologist, especially in symptomatic patients
, leading to accurate diagnosis and appropriate treatment ,
thus avoiding serious complications.
12
PA.04.004
Improvement of multiplanar and threedimensional reconstructions (3D) cardiac
performed on devices 320 detectors with
volumetric acquisitions through the stitching tool in revascularized patients.
Authors: Takeda, K.A.; Rosado, W.M.B.; Augusto, F.; Szarf,
G.; Silva, E. F.; Funari, M. G.
Author responsible: Welton Moacir Brito Rosado
Brief description of the purpose of the study: Shows the
result of three-dimensional multiplanar reconstructions employing stitching tool by comparing images with and without
the use thereof.
Methods: Material: are used revascularized images of five
patients, each of which were obtained two volumes of images
using 320 MDCT equipment. Method: from above volumetric acquisitions were made two reconstructions per patient.
One without the use of stitching, and the other using the
stitching.
Main results: : It is an easy method to be employed in
the routine where the reconstruction does not impact negatively with time increase and adds aesthetic quality to the
documentation of the studies. Mainly provides visible improvement in the quality of multiplanar and three-dimensional reconstructions.
Conclusion of the presentation: We conclude that the use
of this tool allows three-dimensional reconstructions with top
quality, due to the elimination of the \”step\” formed by the
junction of two or more volumes of acquisition.
PA.04.005
Aortic Computed Tomography Angiography(CTA) - What the Vascular Surgeon and
the Intervencional Radiologist want
to know
Authors: Araujo, DGL, Araujo, AG, Cerqueira, JR
Institution: Hospital Santa Mônica, Vila Velha, Espírito Santo, Brasil
Author responsible: Daniel Gonçalves Leal Araújo
Introduction: Most of times the referent physician wants
only a summarized, objective report in order to prepare and
select the adequate material to do either open surgery or endovascular surgery. They don\’t need to know about all the
details the radiologists like to write in a report. The objective
of this paper is to show all the measurements and pictures that
will effectively help the referent physician in the patient care.
Methods Involved: This work was developed in a duoslice
CT (GE Healhtcare), with patients refered to the hospital either outpatients or internee patients.
Discussion: Radiologists many times, or most of the times,
tend to be prolix, and write down in a report everything
that is possible, and, sometimes, in a poetic, indecipherable
fashion. But this is not what our coleagues want to receive,
want to read in a busy day. The Vascular Surgeon and the
Interventional Radiologist demand a report that says only
the necessary to the treatment, and other findings only if
strictly important.
Conclusion of the presentation: Objectivity is a major challenge in a radiologist labor. Selecting the main measurements
and pictures, we can help the referent coleagues and do not
obligate them to decode a prolix report.
PA.04.006
Prevalence of aortic aneurysm rupture
in patients undergoing CT angiography in
a referral hospital in Sao Paulo.
Authors: CASTRO, R.N.C., MELO, E.R.; NOMURA, C.H.,
SANTOS, M.G., OLIVEIRA, D.S., ZANGIACOMO, R.N.
Institution: Instituto do Coração do HCFMUSP - INCOR,
São Paulo, São Paulo, Brasil
Author responsible: Rafaela
Brief description of the purpose of the study: To determine the prevalence of aortic aneurysm rupture in patients
undergoing CT angiography (CTA) in a referral hospital in
Sao Paulo.
Methods: Prevalence retrospective study conducted through
collection from electronic medical record of all patients undergoing aortic CTA from august to october 2013th, in a reference hospital in São Paulo.
Main results: The sample consisted of 218 patients with a
mean age of 54.7 years old. The maximum size of the aorta
was 111 mm, with a mean of 37.6 mm. The rupture of the
aneurysm was observed in one patient (0.4 %), who died.
Conclusion of the presentation: Aortic diseases are closely
related to increases of life expectancy, poor eating habits and
smoking, accounting for 14,000 deaths per/year in the state
of Sao Paulo, being the 30th most common cause of death.
Early surgical intervention is imperative. Elective surgery
is indicated in diameters larger than 60 mm, recent growth
(greater than 10 mm/year), compression of neighboring organs, embolization and hypertensive patients difficult to control. CTA of aorta plays an important role in prognosis assessing the need for surgical intervention, reducing morbidity and
mortality related to disease progression.
TL.04.002
Prognostic value of myocardial scintigraphy with attenuation correction
with IQ SPECT technique.
Authors: REZENDE, MF; AZEVEDO, JC; SANTOS, TV;
VERAS, MF; CORREA, NL; BARBIRATO, GB; COTRADO, AYC; KER, W; AGUIAR, WKM; BARLETE, AV; VIANNA, BSL; VOLSCHAN, A; MESQUITA, CT
Institution: Hospital Pró-Cardíaco, Rio de Janeiro, Rio de
Janeiro, Brasil; Programa de Pós-Graduação em Ciências
Cardiovasculares, Universidade Federal Fluminense - UFF,
Niterói, Rio de Janeiro, Brasil;
Author responsible: Maria Fernanda
Brief description of the purpose of the study: Normal
SPECT scans are associated with benign prognosis. Recently,
multifocal collimators were introduced with dedicated reconstruction software, named IQ-SPECT. The aim of our study
was to evaluate the prognostic value of IQ SPECTin patients
undergoing myocardial scintigraphy.
Methods: Analysis of a scintigraphic examinationsdatabase
of myocardial perfusion, consecutive, held in hybrid SPECTCT equipment(Symbia T2). Minimum follow-up carried out
in 12 months, by telephone, to measure outcomes: nonfatal
myocardial infarction and cardiovascular death.
Main results: 1426 tests included. Follow-up done in
254(December / 2011 and February / 2012) and succeeded
in 219.Mean age of 63.1 years (+/- 12.6), and 70.8% were
male. Mean follow-up time was 960 days. Of the 219 patients, 39 (17.8%) had cardiac events, of these, 31 (79.5%)
had ischemia. Adverse events were observed in patients with
a family history, previous PTCA andmyocardial ischemia (p
<0.05). The only predictor of major adverse cardiac events
was ischemia on SPECT (odds ratio = 13.5, 95% CI = 5.4 to
33.5; p = 0.00001).
Conclusion of the presentation: IQ SPECT is useful
in determiningthe prognosis of patients who undergoexamination of myocardial perfusion scintigraphy with
correction of attenuation to determine the outcomes: cardiovascular death, non-fatal myocardial infarction and
myocardial revascularization.
TL.04.004
Evaluation of myocardial parameters
using new T1 mapping sequences by magnetic resonance imaging
Authors: Cardoso APT., Freitas FAM., Mazzo PE., Parga
JR., Ávila LF.,
Institution: Hospital Sírio Libanês, São Paulo, São
Paulo, Brasil
Author responsible: Ana Paula Toniello Cardoso
Brief description of the purpose of the study: Recent development of new MRI sequences have allowed evaluation
of T1, T2 and T2* relaxation. Native T1 mapping evaluates
myocardial parameters without contrast agents and T2* mapping evaluates iron overload. The aim of the study was describe T1 mapping results in different cardiomyopathies vs.
control group.
Methods: T1 mapping was acquired in left ventricle short
axis without contrast agents, and values directly obtained
from images automatically.
Main results: Twenty seven individuals (36.7±18.3 years, 18
men) between December 2013 and June 2014 were selected
for the study. Patients with left ventricular dysfunction (n=6)
had higher native T1 values vs. controls (9) (1096.3±29.8 vs.
1033.2±71.7, p=0.04). There was an inverse relation between
native T1 and ejection fraction (r=0.55, p=0.02). Higher T1
mapping values were found in patients with hemochromatosis vs. controls (994±36.4 vs. 1033.2±71.7, p=0.03), despite
normal ejection fraction (64% vs. 68%, p=0.16) and normal
T2* (T2*>20ms).
Conclusion of the presentation: New MRI T1 mapping sequences are fast and may evaluate early myocardial burden
in patients with hemochromatosis, and additionally, show
differences between patients with left ventricular dysfunction
vs. controls.
5 - Physics / Quality Control
PA.05.001
COMPARISON OF THE ATTENUATION OF DIFFERENT PROTECTIVE APRONS
Authors: LIMA,N.W., SILVA, L.M., LYKAWKA, R.,
ANÉS, M., BACELAR, A.
Institution: Hospital de Clínicas de Porto Alegre, Porto
Alegre, Rio Grande do Sul, Brasil
Author responsible: Alexandre Bacelar
13
Brief description of the purpose of the study: Portaria 453
establishes the use of protection for occupationally exposed
individuals. Besides, the aprons should be according to national regulation ABNT NBR IEC 61331-1, which evaluates
the radiation shielding of materials. The purpose of this study
is to compare the shielding of national lead aprons, an imported lead apron and an imported lead-free apron.
Methods: Five aprons were utilized for shielding evaluation. The method to calculate radiation shielding is described in Zuguchi et al. The shielding was measured at
tree points of the aprons. Two experimental layouts were
arranged: one to measure shielding for direct exposure,
and other for scattered exposure. On both arrangements, a
fluoroscopy equipment Shimadzu Sonialvision was used
and 20 centimeters of PMMA were placed at the table.
Has been used an ionization chamber Radcal 10X5-6 and
Radcal 10x5-1800. All the aprons were also measured
and weighted.
Main results: The radiation shielding presented by the
aprons was superior to 90% in both experimental layouts.
All aprons presented the recommended values of shielding
according to Portaria 453. Imported aprons presented higher
shielding values, lower fluctuation of shielding and a lower
weight/surface relation
Conclusion of the presentation: Imported aprons had a superior performance than the national ones.
PA.05.002
THE IMPORTANCE OF TECHNICAL IGRT IN PROSTATE CANCER TREATMENT
Authors: SILVA, C.M., BARROS, G., NUNES, T., PAVAN,
G., ALVES, A.
Institution: UNINIGRANRIO & COI; RIO DE JANEIRO;
BRASIL
Author responsible: Adriana Alves
Brief description of the purpose of the study: objective
of this work was through a retrospective analysis to evaluate the adequate preparation of the rectum and bladder in
patients with early stage prostate adenocarcinoma using
IGRT tool: OBI Varian Medical Systems, as well as relate
the daily movements of these patients with PTV margin
used for treatment.
Methods: This work was conducted in two stages. In the first
stage was defined the criterion of choice, which divided the
patients into two groups: patients with this prostatectomy and
prostate. In a second stage, of the 24 patients CBCT images
were used for rectal and bladder design, using the Eclipse
planning system from Varian.
Main results: The IGRT technique was paramount in the
analysis of bladder volumes, the rectum and preparation of
patients. It has been found that patients of the two groups
can not replicate such volume. Regarding the rectum, the
volumes varied randomly showing the great difficulty controlling that body. The presence of gases is also a problem
and it can displace the prostate its natural position.
Conclusion of the presentation: The IGRT technique was
paramount in the analysis of bladder volumes, the rectum and
preparation of patients.
6 - IT / Management / Education-
14
PA.06.001
PRÉ-MEDICAÇÃO COMO PRÁTICA EM PACIENTES ALÉRGICOS AO CONTRASTE IODADO: O
OLHAR DA ENFERMAGEM
Study type: Literature Review
Authors: DIAS WLV, BARROS TP, GRILLO FPS
Institution: Escola Bahiana de Medicina e Saúde Pública,
Salvador, Bahia, Brasil
Author responsible: Washington Luiz vieira dias
Brief description of the purpose of the Review of Literature: Demonstrate the duties of nurses regarding the use of
pre-medication for prevention of adverse reactions to iodinated contrast
Description (s) condition (s), method (s) or technique (s):
Integrative review character exploratory and descriptive, in
order to understand the main features of the contribution of
Nurses experiences of the use of iodinated contrast media
Conclusion: The use and effectiveness of premedication
is quite controversial, as they were still unclear etiology of
the adverse reactions or to contrast and standardization of
pre-treatment regimen. Studies have shown that the primary indication of the use of premedication with antihistamines
and / or corticosteroids, patients are targeted to the important
risk factors for the development of a reaction. The administration of corticosteroids and antihistamines requires careful
evaluation by the nursing and medical staff. In this regard, it
is noteworthy that, if administered in error there is no reduction of possible adverse reactions to contrast but the worsening of the patient\’s condition.
Brief discussion of the case The administration of iodinated
contrast media, as well as pre-medication regimen, are responsibility of the nursing team. Thus, it is necessary to have
full knowledge about the physicochemical properties, pharmacokinetics and pharmacodynamics, generating subsidies
for professional prevent, identify and implement actions to
reverse possible adverse reactions
PA.06.002
HUMANIZATION PROVIDED BY THE PROFESSIONAL SERVICE INVOLVED WITH TECHNICAL RADIOLOGICAL
Authors: NASCIMENTO , ACO.;BARROS, IC.; SOUSA,
JCO.; IBIAPINA, FGSB.
Institution: IFPI,TERESINA,PIAUÍ ,BRASIL
Author responsible: Joyce Caroline
Brief description of the purpose of the study: Humanize is
guarantee or ensure respect and individuality and subjectivity of
each patient during the service provided. The objective of this
work is to observe the technical actions and relates them to the
humane practice guided by the Unified Health System (SUS) in
the care provided by professional radiological techniques.
Methods: The study was conducted with 21 participants
(conclusive travel technology in radiology and radiology professionals) who had direct contact with pct.Aplicou a questionnaire containing questions about the practiced routine and
its relation to the procedures adopted in a humanized care.
Main results: It was found that the vast majority of respondents associated the practice of the concept of humanization, to an experience of interpersonal relationships tackling an courteous service and that prizes by
the ratio of personal respect to the patient but without
identifying any specific technique within this relation-
ship. This amounts to group 17 of the total of 21 participants addressed.
Conclusion of the presentation: The concept of health promotion distributed by the Ministry of Health goes far beyond
not present pathological picture. Insert it up the concept
where the promotion of well-being is closely associated. That
said should be taken in the light of all the concepts of humanized and techniques to achieve it.
PA.06.003
ANALYSIS OF ABDOMINAL COMPUTED TOMOGRAPHY EXAMS PERFORMED AT THE EMERGENCY ROOM IN A PRIVATE HOSPITAL IN SÃO PAULO.
Authors: MELINSK, M.; BITENCOURT, A.G.; BARRIO,
A.B.; BARONI, M.A.G.; CAPPI, S.B.; ARRUDA, M.J.C.;
MATHIAS, P.C.; MOREIRA, F.A.
Institution: Hospital Paulistano, São Paulo, São Paulo, Brasil
Author responsible: Monica Melinsk
the indications and results of abdominal computed tomography (CT) exams performed in the emergency room of a private hospital in São Paulo.
Methods: Retrospective single center study conducted by
reviewing medical records and imaging reports. 494 abdominal CT scans performed in the emergency room from June to
November 2014 were evaluated.
Main results: Patients’ mean age was 45 years, range 15 to
93 years, being 52.4% female and 47.6% male. The most
common indications were: renal colic (36.2%), suspected appendicitis (14.2%) and diverticulitis (13.6%). 59.5% of the
exams had positive results, which includes 73.3% for patients
with renal colic, 41.8% for patients with diverticulitis and
37.1% for patients with appendicitis. There was no significant difference in the percentage of positive results in relation
to age group.
Conclusion of the presentation: Most abdominal CT scans
showed positive results in this study, suggesting that these
tests were well indicated. The study of the indications and
results of abdominal CT scans allows the evaluation of the
situations in which the test is more or less likely to have a
positive outcome and thereby rationalize the use of this tool
in the emergency room.
PA.06.004
ANALYSIS OF BRAIN COMPUTED TOMOGRAPHY
EXAMS PERFORMED AT THE EMERGENCY ROOM
IN A PRIVATE HOSPITAL IN SÃO PAULO.
Authors: MELINSK, M.; BITENCOURT, A.G.; BARRIO,
A.B.; BARONI, M.A.G.; CAPPI, S.B.; ARRUDA, M.J.C.;
MATHIAS, P.C.; MOREIRA, F.A.
Institution: Hospital Paulistano, São Paulo, São Paulo, Brasil
Author responsible: Monica Melinsk
the indications and results of brain computed tomography
(CT) exams performed in the emergency room of a private
hospital in São Paulo.
Methods: Retrospective single center study conducted by reviewing medical records and imaging reports. 790 brain CT
scans performed in the emergency room from June to November 2014 were evaluated.
Main results: Patients’ mean age was 51 years, range 13 to
96 years, being 60.5% female and 39.5% male. The most
common indications were: traumatic brain injury (TBI) / hematoma (29.5%), headache (24.1%) and transient ischemic
attack (TIA) / stroke (17.7%). 34.4% of the exams had positive results, which includes 36.9% for patients with TBI /
hematoma, 26.3% for patients with headache and 31.4% for
patients with TIA / stroke. The number of positive results was
lower in the age group below 60 years (24.9%) when compared to those older than 60 years (42.8%).
Conclusion of the presentation: The study of the indications and results of CT scans performed allows the evaluation
of the situations in which the test is more or less likely to have
a positive outcome and thereby rationalize the use of this tool
in the emergency room.
PA.06.005
Automated Scanometric Report
Authors: Kitamura, F.C.; Alves, A.M.A.; Regacini, R.;
Lederman, H.M.
Institution: Departamento de Diagnóstico por Imagem da
Escola Paulista de Medicina da Universidade Federal de São
Paulo, São Paulo, São Paulo, Brasil
Author responsible: Felipe Campos Kitamura
Brief description of the purpose of the study: Radiography
is still the most accurate method for assessing size difference
between lower limbs. The most common methods are Farill,
Bell-Thompson, panoramic radiography and CT scout. We
propose a computer application capable of generating a report of scanometric measurements obtained by any of the
methods listed above.
Methods: A prototype application for Windows Vista/7/8 was
developed in C# language. The proposed program is a tool
that automatically performs the scanometry’s report, after being supplied with the necessary measurements. Pathological
cases of patients who underwent scanometric exams in the
Department of Diagnostic Imaging XXXX are being collected since the first half of 2013, to be submitted to a statistical
analysis in order to compare the report made by a radiologist
and the report automatically generated by the program.
Main results: Until now, equivalent results were observed
between manual and application’s reports.
Conclusion of the presentation: The described application
is capable of generating scanometric reports equivalent to
those created manually. At this time, the intention is to present this tool, in order to share it later.
PA.06.006
DWI Made Simple with Color Encoded
Imaging
Authors: Kitamura, F.C.; Tibana, L.A.T.; Abdala, N.
Brief description of the purpose of the study: Diffusion-weighted imaging was created for use in brain imaging,
but its use in other anatomical sites has gained wide acceptance due to its undeniable diagnostic contribution. The most
common use of these sequences is to analyze images with
high \’b\’-values and compare them with its corresponding
ADC map. We propose a diagnostic tool capable of providAbstracts of Scientific Papers
15
ing diffusion and ADC map information in a single image, in
order to simplify MRI reading.
Methods: A script was written in Matlab® to analyze the
signal intensities in diffusion and ADC map of a given MRI
exam and generate an image that assigns a default color for
each of the four possibilities (diffusion, facilitation, T2 shinethrough and blackout).
Main results: The program generates a new color image in
which, by convention, restriction appears in white, facilitation in black, T2 shine-through in blue and the blackout effect
in yellow. Proper windowing is necessary to accentuate distinction between colors.
Conclusion of the presentation: Images generated
reached the objective to differentiate in a single image, diffusion, facilitation, T2 shine-through and blackout effect.
At this time, the intention is to present this tool, in order
to share it later.
PA.06.007
TELERADIOLOGY: A NEW DATE FOR VETERINARY RADIOLOGY.
Authors: ALVES, K.R.M.; ALMEIDA, A.; RUIZ, R. P.;
SILVA, T.H.; LOPES, D. L.; ROCUMBACK, J.C.
Institution: Centro Universitário SENAC - Tiradentes, São
Paulo, SP - Brasil
Author responsible: Kayc Roberto Martins Alves
Brief description of the purpose of the study: The research
investigates the increasing use of teleradiology geared for the
veterinary area and its applicability, featuring the integration
of clinical and veterinary diagnostic hospitals with tele veterinary reports companies.
Methods: Survey of two private companies tele award in
veterinary radiology in the capital of São Paulo. Issues that
vision explore the operation of services and activities performed. Divided into four blocks: business, procedure, tools
and staff.
Main results: Companies are placed on the market a short
time and already have expertise to report the main types of
diagnostic imaging and supports Brazil. Company \”A\” has
a team of professionals specializing in different types of tests
while the \”B\” company is a pioneer in reports for computed tomography. The two companies have support for small
and medium-sized domestic animals, only the enterprise performs diagnosis in large animals because the company \”B\”
laudar only Computed tomography and the gantry does not
support larger animals.
Conclusion of the presentation: Smaller cities that do not
have a direct support for diagnostic imaging report using this
feature enabling the expansion of the enterprise and increasing demand for services.
7 - Intervention
PA.07.001
Intraprostatic Collections: Interventional Radiology Approach
Authors: Rostom, L.; Ajzen, S.; Castro, H.A.S.; De Nicola,
H.; Fornazari, V.A.V.; Rostom, P.P.T.; Solha, R.; Szejnfeld, D.
Institution: Hospital São Paulo da Universidade Federal de
São Paulo - UNIFESP, São Paulo, São Paulo, Brasil
Author responsible: Lucas Rostom
16
Brief description of the purpose of the report: Demonstrate the role of interventional radiology (IR) in addressing
the intraprostatic collections (IPC), referred to the IR service
in a reference hospital, showing an effective alternative to
surgical treatment.
Medical History: Two cases where there was clinical suspicion of IPC. The patients showed significant change in quality of life and were referred to the IR sector to assessment
and treatment.
Diagnosis: The IPC are usually symptomatic and clinically
significant and may, when infected, progress to sepsis; when
a quick and efficient therapeutic approach is necessary. The
diagnosis tends to be clinical, and the transrectal ultrasound
(TRUS) tend to be the imaging method of choice for diagnostic confirmation and in the hands of an interventional radiologist provides the treatment to be performed at diagnosis. In
patient A, the material collected was clear and easy to draw.
The subsequent laboratory analysis diagnosed sterile collection. In patient B, the material collected was purulent and
thick, but it was possible to emptying the IPC.
Discussion and summary of the case: The approach guided
by the USTR of the IPC allows a quick diagnosis, often curative and guiding specific antibiotic therapy when needed.
Associated with a low cost and reduced complication rate;
this procedure is confirmed as the preferred method for diagnosis and treatment.
PA.07.003
INCIDENCE OF ADVERSE EVENTS IN MINIMALLY
INVASIVE GUIDED PROCEDURES FOR IMAGE IN A
MEDICAL CENTER INTERVENTIONIST
Authors: Abatepaulo FM., Gattis, Oliveira PG., Vieira FAC.,
Mendes GF., Queiroz, MRG., Garcia RG
São Paulo, Brasil
Author responsible: Fernanda Marques Abatepaulo
Brief description of the purpose of the study: To determine
the incidence of adverse events (AE) in minimally invasive
interventional procedures guided by Image (ultrasound/CT)
in an Interventional Medical Center (CMI).
Methods: We prospectively followed patients undergoing
minimally invasive interventional procedures between January-November / 2014 to complications during, 24 hours
and in prostate biopsies also seven days after the procedure.
These data were reviewed to determine the incidence of EA.
The degree classification followed common terminology criteria for EA, published by the Department of Health and Human Services of the US National Health Institute.
Main results: Of the 4741 procedures, there were 31 EA
(0.66%) 4 events grade 2, 22 grade 3, 4 grade 4 and 1 Grade
5 with death (high risk of comorbidity). The rest had not had
mild event or events, ranked Grade 1. The pneumothorax was
more frequent, and its incidence among all EA 10 pneumothorax / 31 events (32%). 130 thoracic procedures were performed, and the incidence of pneumothorax was 10 pneumothorax / 130 thoracic procedures (6.9%).
Conclusion of the presentation: The incidence of AEs was
low (1: 153 procedures), the most frenquente pneumothorax
(1:13 lung procedures), with this index (6.9%) lower than the
literature data. These data can be used in drawing up protocols aimed at patient safety.
PA.07.004
CELIAC PLEXUS SCLEROSIS GUIDED BY COMPUTED TOMOGRAPHY FOR CONTROL OF CHRONIC
ABDOMINAL PAIN
Authors: Rostom, L.; Ajzen, S.; Castro, H.A.S.; De Nicola, H.; Fornazari, V.A.V.; Santos, R.M.; Solha, R.; Souza,
A.C.P.; Szejnfeld, D.
Introduction: Technique also called ablation, neurolysis or
nerve block. The method is a good choice for the control of
chronic abdominal pain (CAP) related to the celiac plexus
(CP). We aim to highlight the effectiveness and importance of
the technique via retrocrutal, illustrating the method through
cases of our service.
Methods Involved: The whole procedure was guided by computed tomography (CT). The sclerotic agent was the absolute
alcohol. The approach of choice was the classic retrocrural
via in prone position. There was sedation assisted by expert
professional. Two interventional radiologists performed the
procedure at the same time each approached one side of the
patient. The length of the procedure was less than an hour and
the patients were discharged 24 hours after the procedure.
Discussion: Although there are no studies showing statistically significant difference in pain control, when comparing
the use of oral opioids and the sclerosis of the nerve plexus;
There is undoubtedly a great improvement in the quality of
life of patients when they make use of intravenous drugs.
Conclusion of the presentation: The CT-guided sclerosis is
an easy and safe method with a high success and low complication rates for the relief of CAP related to celiac ganglia.
PA.07.005
CISTO ADRENAL GIGANTE: ALCOOLIZAÇÃO
PERCUT NEA
H.; Fornazari, V.A.V.; Leite, L.C.; Solha, R.; Szejnfeld, D.
Brief description of the purpose of the report: We aim
emonstrate the role of interventional radiology (IR) in addressing the cystic lesions of the adrenal glands (AG), illustrated by a case of our service.
Medical History: Patient with debilitating pain in the left
flank. Ultrasonography (USG) from another service characterized a cystic lesion in close contact with the left kidney.
Extensive cyst in the left adrenal glad evidenced by computed tomography (CT). We chose to proceed with percutaneous
ethanol sclerotherapy (PEI).
Diagnosis: Adrenal cysts are rare and classified as: true cysts
and pseudocysts. The whole procedure guided by USG. First
we perform a fine needle aspiration (citrus material and easy
aspiration collected). Followed with passage drainage catheter Type Pig Tail 8Fr. After emptying the contents of the lesion 100ml absolute alcohol were infused. The patient was
submitted to position change on its own axis for 45 minutes
and all the alcohol was aspirated. After two months the TC
control did not show lesion with significant volume and the
patient did not report any pain.
Discussion and summary of the case: PEI of true adrenal
cysts is a safe, effective, minimally invasive, inexpensive,
well tolerated procedure and with satisfactory results.
PA.07.006
Correlation between the Prevalence of
Prostate Adenocarcinoma and Transrectal
Ultrasound Characteristics of Focal Lesions in the Peripheral Zone of the Prostate
H.; Fornazari, V.A.V.; Rodrigues, M.A.A.; Santos, R.M.; Solha, R.; Szejnfeld, D.
Brief description of the purpose of the study: Correlation
between the Prevalence of Prostate Adenocarcinoma and
Transrectal Ultrasound Characteristics of Focal Lesions in
the Peripheral Zone of the Prostate
Methods: We selected 25 focal lesions in the peripheral zone
of the prostate (in 23 patients). Prostate biopsies yielded standard and focal lesion samples, all of which were submitted
to histopathological analysis. We attempted to determine
whether the prevalence of prostate cancer correlated with focal lesion volume, echogenicity, or border type, as well as
with patient age, prostate volume, or prostate-specific antigen
(PSA) density. We also determined the degree of similarity
between the histopathological features of the focal lesions
and those of the prostate as a whole.
Main results: Of the 25 focal lesions evaluated, 18 had
well-defined borders and 18 were characterized as hypoechoic. Histopathological analysis of the 25 focal lesions revealed
stroma without atypia in 14, high-grade prostatic intraepithelial neoplasia in 4, and prostate adenocarcinoma in 7. Only
PSA density, as well as other studies, correlated significantly
with the prevalence of prostate adenocarcinoma.
Conclusion of the presentation: Focal lesion characteristics
(volume, echogenicity, and border type) do not appear to correlate significantly with the prevalence of prostate adenocarcinoma when histopathology is used as a reference.
PA.07.007
RADIOFREQUENCY THERMAL ABLATION OF
BONE TUMORS
Authors: SILVA, M.M.A.; BRITTO NETO, L.A.; RAHAL
JR. A.; QUEIROZ M.R.G.; VIEIRA F.A.C.; KIHARA FILHO E.N.; ROSEMBERG, L.A.; GARCIA R.G.
Institution: Centro de Medicina Intervencionista, Hospital
Israelita Albert Einstein, São Paulo, São Paulo, Brasil
Introduction: Radiofrequency thermal ablation (RFTA)
is considered the treatment of choice for osteoid osteomas.
Other benign conditions can also be treated by this technique.
RFTA ablation is also an option for the palliation of localized, painful osteolytic metastatic and myeloma lesions. The
reduction in pain improves the quality of life of patients with
cancer, who often have multiple morbidities and a limited life
expectancy. This paper intent to review the principles, indications, techniques, outcomes, complications, truths and lies of
radiofrequency thermal ablation of bone tumors.
Methods Involved: A compilation of multiple cases of raAbstracts of Scientific Papers
17
diofrequency thermal ablation of bone tumors performed in
our institution and an extensive literature review were done.
Discussion: Several ablation techniques are available to treat
bone tumors. They are minimally invasive, allow targeted tumor destruction and have a low rate of complications. RFTA
of bone tumors is appropriate when there is a clear advantage
over surgery or when surgery would not be feasible.
Conclusion of the presentation: The outcomes are excellent and superior to the results of conventional management.
Further indications are now emerging, with reports of good
outcomes in treating other primary bone tumors.
PA.07.009
ARTIFICIALLY INDUCED PNEUMOTHORAX FOR
RADIOFREQUENCY ABLATION OF TUMORS IN
THE HEPATIC DOME
Authors: ROCHA, R.D.; FALSARELLA, P.M.; RAHAL.
JR.; A, SILVERIO P.R.B.; MARIOTTI, G.C.; SOCOLOWSKI L.R.;, GARCIA, R.G..
SÃO PAULO-SP, BRASIL
Author responsible: Rafael Dahmer Rocha
Brief description of the purpose of the report: Ablative
therapies have become a great alternative to surgical treatment of hepatic nodules. However, some technical difficulties may negatively influence the effectiveness of these lesions, for example when located close to the diaphragm. The
purpose of this paper is to describe the technique of a controlled induced pneumothorax in order to allow proper ablation probe positioning, improving the success of the method.
Medical History: A male patient presenting hepatocellular carcinoma, measuring 1.8 cm, in the highest portion of segment IV. It
was decided to perform a radioablation associated with a induced
pneumothorax, which allowed the right lung collapse. Guided by
computed tomography, a 6F drain was inserted into the right anterior pleural space, where were injected 700 cc of air. Then, the
ablation probe was positioned through transpleural access.
Diagnosis: Artificially induced pneumothorax was first described
in 2005. It presents itself as an excellent choice in nodules near
the diaphragm. The risk of complications is low, because there is
no damage to the visceral pleura and lung parenchyma.
Discussion and summary of the case: Artificially induced
pneumothorax appears to be useful and safe for CT-guided
radiofrequency ablation of liver dome tumors.
PA.07.010
GIANT UTERINE HEMANGIOMA: PERCUTANEOUS
SCLEROTHERAPY AS AN EFFECTIVE TREATMENT
Authors: ROCHA, R.D.; DE FINA, B.; GALASTRI, F.L.; AFFONSO B,B.; RIBEIRO, J.A.; MESSINA, M.L.; NASSER, F..
Brief description of the purpose of the report: The purpose
is to demonstrate an effective alternative treatment for symptomatic pelvic hemangiomas.
Medical History: A 28 year-old patient, complaining of dyspareunia and metrorrhagia. She was submitted to a magnetic
resonance that demonstrated an expansive lesion suggestive
of hemangioma involving the cervix and the vaginal fornix.
A minimally invasive treatment was indicated. An ultrasound/
18
fluoroscopy-guided embolization was performed. A 18-gauge
needle was introduced in the lesion through endovaginal access, where iodinated contrast was injected. Then, a sclerotherapy with 2% polidocanol was done. A partial response of the
symptons and in the size of the lesion was seen in the follow-up
Diagnosis: Uterine hemangioma is a extremely rare condition. Usually, the initial symptoms are refractory cervix
bleeding and/or dyspareunia. Like other hemangiomas, estrogen seems to be a predictor factor. Hemangiomas sclerotherapy for hemangiomas is well established, however no reports
was find for uterine lesions treatment.
Discussion and summary of the case: The sclerotherapy
with polidocanol for pelvic hemangiomas seems to be safe
and effective. An association of the images methods provides
a better evaluation of the tumor characteristics and the treatment area.
PA.07.012
Use of rTPA in thick collections: main indications, technique and early results
Authors: Falsarella, P.M. Rocha, R.D. Rahal Jr, A. Vieira,
F.A.C Mendes, G.F. Andrade, J.R. Garcia, R.G.
Author responsible: Priscila Mina Falsarella
Brief description of the purpose of the study: The advancement of minimally invasive image guided procedures
runs with increase of percutaneous drainage of collections.
The major limitation to the success of minimallyu invasive
drainage currently resides in thick, chambered, with coarse
clots or capsulated collections. In this context emerges the
possibility of fibrinolytic agent injection within the collections to amend the viscosity os drainage products, facilitating
the flow through the lumen of the various tubular drains. Objective: present the main indications and technique of rTPA
injectionin thick collections, as well as the evolution of patients undergoing this approach.
Methods: will be displayed ultrasound and tomographic, pre
and post drainage images before and after use rtPA in these
collections, as well as evolution of the patient data, including
recovery time, drainage volume, final costs and drainage time.
Main results: Studies in patients with loculated collections
submitted to injection of intracavitary fibrinolytic showed
safety in use, with no observed change in coagulation or bleeding complications. Also that it is an effective technique in reducing overall treatment time and faster clinical improvement.
Conclusion of the presentation: The use of rTPA in thick
collections proved to be effective as a complementary percutaneous drainage method, enhancing their success.
PA.07.014
Laser ablation of benign thyroid nodules: results from 33 patients.
Authors: Falsarella, P.M. Rocha, R.D. Rahal Jr, A. Queiroz,
M.R.G. Andrade, J.R. Hidal, J. Garcia, R.G.
Brief description of the purpose of the study: Thyroid nodules are very prevalent in the population with a low incidence
of malignancy. The approach of malignant lesions is well es-
tablished; however the approach of benign lesions remains
controversial. Indication for treatment in benign nodules depends on the lesion volume, leading to compressive symptoms and aesthetic issues. Among the therapeutic modalities,
we highlight hormone suppression, surgical and minimally
invasive therapies as alcoholization, however all with some
degree of side effects. In this scenario percutaneous application of laser is inserted as minimally invasive local ablative
therapy, alternative in the treatment of benign thyroid lesions.
Objectives: To present the results of experimental laser ablation of benign thyroid nodules in 33 patients.
Methods: will be presented images of the procedure stages,
the technical description and materials used.
Main results: The laser application induces necrosis and
complete tissue destruction in a predictable area, leading
to lesion volume reduction. The follow-up of these patients
showed 50% reduction in the volume of addressed nodes in
the first year, preserving the thyroid function. The complications of the method are rare and minor.
Conclusion of the presentation: Laser ablation of benign
thyroid nodules proved to be safe and effective as minimally
invasive therapy and may be included among the treatment
options for this pathology.
PA.07.015
2003 - 2013: MEDIUM AND LONG TERM RESULTS
OF LIVER NODULES RADIOABLATION
Authors: Falsarella, P.M. Rocha, R.D. Rahal J, A. Vieira,
F.A.C. Queiroz, M.R.G. Andrade, J.R. Garcia, R.G.
Brief description of the purpose of the study: Liver resection corresponds to the standard treatment of primary and
secondary hepatic nodules. However many patients are not
candidates for curative resection at diagnosis. In this scenario,
ablative therapies are gaining more attention as an alternative
to surgical therapies. The radiofrequency is widely used for his
safety, excellent results, better recovery and reasonable cost.
Objectives: To present the results of medium and long-term
radioablation of primary and metastatic liver nodules.
Methods: will be listed images pre and post liver radioablation, as well as medium and long term follow-up of the treated cases.
Main results: radioablation is part of the thermal ablative
methods arsenal, acting through the high frequency alternating current energy release, promoting coagulation necrosis of
the treated tissue. Among the main advantages, the preservation of the adjacent parenchyma, not limiting future treatment
options, and the low morbidity are the main. Larger or multiple lesions, active infection, coagulopathy refractory and
terminal cancer are limiting factors to the method. Related
complications such as bleeding and lesions of the biliary tract
are rare and manageable.
Conclusion of the presentation: radioablation of hepatic
nodules proved to be safe and effective as curative and palliative treatment for primary and secondary cancer over 10
years of experience of our group.
PA.07.016
2003 - 2013: MEDIUM AND LONG TERM RESULTS
OF RENAL NODULES CRYOABLATION
Authors: Falsarella, P.M. Rocha, R.D. Rahal Jr, A. Mendes,
G.F. Queiroz, M.R.G. Andrade, J.R. Garcia, R.G.
Brief description of the purpose of the study: Cryoablation of small renal tumors is a well established treatment modality in selected cases, with their main indications in small
incidental lesions, patients with advanced age or not candidates for surgery, single primitive or kidney graft, indolent
tumor growth. Sepsis, vascular invasion and central tumor
can be listed among the contraindications to the procedure.
Objectives: To present the results of medium and long-term
patients undergoing cryoablation of renal nodules in interventional medicine center of our institution.
Methods: images before the procedure, stages of ablation
and the evolution process will be presented and most relevant
clinical data.
Main results: Recent studies of the literature show it is a
safe and effective technique. The mechanisms of cell death
induced by cryoablation are necrosis and apoptosis inducing
directly acute cell damage and subacute vascular vasoconstriction. The advantages of this mode is reduction of pain
symptoms compared with other therapies, lower risk of collecting system injury, however, for not being a method that
promotes coagulation necrosis, has higher bleeding rates.
Conclusion of the presentation: The results of medium and
long term qualify cryoablation of renal nodules as safe and
effective minimally invasive therapy.
PA.07.017
THE WAYS OF RECENT ABLATIVE THERAPIES:
Electroporation
Authors: Falsarella, P.M. Rocha, R.D. Rahal Jr, A. Socolowski, L.R. Vieira, F.A.C. Andrade, J.R. Garcia, R.G.
Brief description of the purpose of the Review of Literature: The thermal ablative methods such as radioablation,
cryoablation and microwave evolved in recent years, contributing to the advancement of loco-regional oncologic
therapies. However, such techniques present significant challenges as a possible risk of thermal injury to adjacent organs
and loss of efficacy by the heat sink effect. In this scenario,
electroporation, the technology used in the food industry for
sterilization, appears as a minimally invasive alternative for
tumor ablation. The first applications of this technology in
tumor ablation date 2007.
The electroporation is a non thermal technique that promotes
opening cellular pores by high intensity electric field application, leading to electric charge change of the cell membrane.
At least two antennas are positioned with a distance less than
2 cm, varying with the size of the lesion to be treated. The
electrical change permanently opens pores in the cell membrane, leading to cell lysis and death.
Conclusion: Among the advantages, lack of energy loss by
dissipation or injury to adjacent structures by thermal damage
is the main.
Brief discussion of the case Initial results showed safety and efficacy of the method, however multicenter studies of long-term
follow-up for survival rate and quality of life are not yet available.
19
PA.07.019
Correlation of elastography and FNA in
thyroid nodules: results of the last five
years
Authors: Falsarella, P.M. Mendes, G.F. Rahal Jr, A. Socolowski, L.R. Silverio, P.R.B. Garcia, R.G. Francisco Neto,
M.J.F. Funari, M.B.G.
Brief description of the purpose of the study: Thyroid
nodules affect approximately 40% of the population, most
of these are benign. In recent years many imaging methods
have been developed in an attempt to predict the likelihood of
malignancy of the nodules, as its morphological features the
ultrasound study and the vascularization pattern with Doppler mapping. Elastography applied to the investigation of
thyroid nodules has been used in recent years to increase the
accuracy of prediction of malignancy of these nodules. Objectives: To demonstrate the correlation between the results
of elastography and fine needle aspiration cytology (FNA)
under BETHESDA scale.
Methods: the ultrasound images in B mode, Doppler and
Elastography of patients undergoing FNA of thyroid nodules,
and the correlation between the cytological and elastographic
data of these patients will be presented.
Main results: elastography analyzes the deformity of tissues
and indicates the degree of stiffness of them, comparing the
nodular area with normal parenchyma, characterized as elasticity index. Based on the concept that cancer has generally
more cell concentration, a smaller deformity capacity is observed in relation to the normal gland.
Conclusion of the presentation: The thyroid elastography
has proved to be an important diagnostic tool increasing the
accuracy of research when added to other diagnostic methods.
PA.07.020
WHERE TO GO? - alternative access routes
in the percutaneous approach
Authors: Falsarella, P.M. Rocha, R.D. Rahal Jr, A. Mariotti,
G.C. Socolowski, L.R. Queiroz, M.R.G. Garcia, R.G.
Brief description of the purpose of the Review of Literature: Percutaneous biopsy and collections drainage are safe,
effective and widely used procedures. However, some lesions
and collections are a challenge in percutaneous approach.
In such cases, alternative approaches should be reminded and
can mean the difference between making or not minimally
invasively procedure.
Conclusion: Collections and lesions in the upper abdomen
in the absence of access can be handled safely using the organs transfixation such as liver and stomach, for portal vein
and vena cava and peripancreatic access respectively. Other
possibilities are trans-aortic access in celiac plexus alcoholization, trans-renal percutaneous nephrostomy and proximal
ureter biopsy. The pelvis aproach includes certain barriers
given the presence of various structures interposed, as traditional routes, such as the front or side are used. Among alter-
20
natives to the pelvis, we can include transvaginal, transrectal
and transgluteal access, mainly used in the deep pelvis. Mediastinal lesions are another challenge, because the risk of
pneumothorax and injury of important structures. Techniques
vary with the area being addressed, anterior and middle mediastinum can be accessed through parasternal and transsternal
path, posterior mediastinal and subcarinal by paravertebral
and upper mediastinum trough suprasternal route.
Brief discussion of the case Knowledge of unusual access,
advantages and disadvantages represent valuable technical
gain to the interventionist.
PA.07.021
Transvaginal access in the pelvic collections approach: how, when and why
Authors: Falsarella, P.M. Rocha, R.D. Rahal Jr, A. Mendes,
G.F. Vieira, F.A.C. Queiroz, M.R.G. Garcia, R.G.
Brief description of the purpose of the Review of Literature: Abdominal collections percutaneous drainage is a
well-established treatment option. However, collections located in the deep pelvis are traditionally addressed surgically.
Despite the success and effectiveness, surgical treatment is
related to longer hospital stays, and increased morbidity and
mortality. In this scenario, the transvaginal aacess for pelvic
collections drainage is a safe and effective minimally invasive alternative in the management of these patients.
The indications of transvaginal pelvic drainage include gynecological or not gynecological conditions, such as tubo-ovarian simple or complex abscess, postoperative abscesses, and
complicated diverticulitis. The advantages are direct access
to the site of collection, without transfix bowel, uterus or
bladder. To perform the procedure the patient is in the lithotomy position, after mapping the pelvic structures with transvaginal US probe. After the collection location and local anesthesia, the drainage is performed through the techniques of
Tandem-Trocar or Seldinger.
Conclusion: A possible complication related to access is the
superinfection of previously sterile collection, because it is a
semi-sterile path.
Brief discussion of the case The use of transvaginal access
to drain collections in deep pelvis has low complication rates,
and is a quick and inexpensive way.
PA.07.022
Transgluteal access: Indications, Technique and Keypoints
F.A.C. Socolowski, L.R. Julio, T. Garcia, R.G.
Brief description of the purpose of the Review of Literature:
Lesions biopsy and collections drainage located in the deep pelvis pose a challenge to percutaneous approach, since often the
transabdominal approach is limited by bowel or other viscera
interposition. In such cases, the transgluteal access proves to be
advantageous and effective alternative in the pelvis approach.
The transgluteal access is generally used to assess subsequent
pelvic deep lesions in the sciatic foramen level as drainage
collections, biopsy of pre-sacral, perirectal, posterior or posterior-lateral to the bladder lesions and adnexal masses. The
transgluteal approach requires anatomical knowledge of the
region for safety and also preventing complications. Typically the transgluteal access is performed with the patient in the
prone, oblique-prone or lateral decubitus. The optimal site of
catheter insertion is closer to the sacrum, in the sacral spinous
ligament-level, since at this level the sciatic nerve and sacral
plexus vessels has more buttocks side topography.
Conclusion: Among the possible complications of this access, pain is the most common, however bleeding, nerve
damage can also occur less frequently.
Brief discussion of the case The transgluteal access is effective and safe for low pelvic percutaneous approach and
should be known and considered, by who indicates and performs the intervention.
PA.07.023
Percutaneous alcoholization in minimally invasive management of intractable cancer pain
F.A.C Mendes, G.F. Queiroz, M.R.G. Garcia, R.G.
Introduction: Abdominal and pelvic oncologic pain is a
chronic, progressive and debilitating medical condition, affecting sometimes aggressively the quality of life of patients
with advanced malignancies. Treatment of this condition is
complex, often requiring high doses of opioids. However,
many patients have refractory pain despite analgesic optimization, or significant side effects to the drug treatment. In this
context of intractable pain, minimally invasive interventional
therapies emerges to control visceral oncologic pain, as sympathetic plexus alcoholization
Methods Involved: detail the technical and main access, as
well as related complications of visceral sympathetic plexus alcoholization.
Discussion: Recent publications of the literature show it is a
safe and effective technique in the management of abdominal and pelvic intractable oncologic pain, with considerable
improvement in the quality of life of these patients. Transient
diarrhea and hypotension are among the major side effects
related to the procedure.
Conclusion of the presentation: visceral plexus alcoholization proved to be an effective and safe option in the control of intractable oncologic pain with medication, should
be considered in patients with abdominal and / or advanced
pelvic cancer, with a view to improving the quality of life of
this population.
PA.07.025
Proximal ureteral trans-renal biopsy
associated with percutaneous nephrostomy: how we do
Authors: falsarella, P.M.; Rocha, R.D. Andrade, J.R. Rahal
JR. A. Vieira F.A.C. Queiroz M.R.G. Garcia R.G.
Brief description of the purpose of the report: Biopsies
from retroperitoneal lesions may present a challenge to percutaneous access. The objective of this report is to demonstrate a safe alternative to percutaneous biopsy in the proximal ureter.
Medical History: A female patient who is 79 years with
hematuria in outpatient investigation for the last 2 weeks,
went to emergency room with abdominal pain and bulging.
Subjected to abdominal and thoracic tomography, with the
presence of a heterogeneous and hypervascular mass in the
proximal segment of the right ureter, extending to the renal
pelvis and collecting system dilatation upstream. After an unsuccessful attempt to upward pigtail pass for collecting system decompression, the patient undergone to percutaneous
nephrostomy and peri-ureteral mass biopsy through trans-renal access guided by ultrasound and CT. Pos procedure image showed no complications. Pathology demonstrate an
urothelial carcinoma. Patient evolved with improvement of
abdominal pain, remaining in the care of urology and oncology teams to treatment planning.
Diagnosis: The trans-renal access is a safe alternative to
proximal ureter and adrenal lesions biopsy. Bleeding is associated with major complication and can be avoided through
the puncture in the Brodel line, a less vascularized area of
the kidney.
Discussion and summary of the case: the trans-renal access
is a safe and effective minimally invasive option in retroperitoneal injuries
PA.07.027
PERCUTANEOUS CT–GUIDED CRYOABLATION AN
OPTION TO THE TREATMENT FOR A EXTENSIVE
PELVIC BONE GIANT CELL TUMOR : ORIGINAL
CASE REPORT
Authors: PANIZZA, P.S.B.; CAVALCANTI, C.F.A. ; YAMAGUCHI, N.; LEITE, C.C.; CERRI, G.C.; MENEZES, M.R.
Paulo, Brasil
Author responsible: Pedro Sergio Brito Panizza
Brief description of the purpose of the report: The giant
cell tumor of bone (GCT) is an intermediate grade neoplasia, locally aggressive that represents 5% of primary bone
tumors. Despite advances in surgical and clinical treatment,
cases located in the spine and pelvic bones remain a significant challenge. We report the use o percutaneous CT guided
cryoablation as alternative treatment option for giant cell tumor of pelvic bone.
Medical History: A 45 years old male with lumbar pain, presented on image studies a lytic expansile locally aggressive
lesion, with well-defined and sclerotic borders, centered on
right ischiopubic branch. After the clinical failure with the
use of denosumab and refusal of the patient to the surgical
procedure of hemipelvectomy, two cryoablation procedures
were performed with successful results.
Diagnosis: In this case percutaneous cryoablation presents
as an alternative treatment option for a GCT with extensive
involvement of pelvic bones, with structural and functional
preservation of the pelvic bones involved and low morbidity
and mortality related to the procedure associated with early
rapid postoperative recovery.
Discussion and summary of the case: Percutaneous
21
CT-guided cryoablation in this case presented as minimally
invasive, safe and effective alternative treatment for curative
intent option in a giant cell tumor of pelvic bones.
PA.07.028
Adrenal tumors ablation: what interventional radiology has to say?
Authors: LUZ DC., (ELABORAÇÃO E REVISÃO BIBLIOGÁFICA) / CAVALCANTE FA., (ELABORAÇÃO E REVISÃO
BIBLIOGÁFICA) / RAHAL JRA., (AUTOR PRINCIPAL) /
MARIOTTI GC., (REVISÃO) / ANDRADE JR (SELEÇÃO
DOS TRABALHOS) / QUEIROZ MRG., (SELEÇÃO DOS
TRABALHOS) / GARCIA RG (COORDENAÇÃO)
Brief description of the purpose of the Review of Literature: Historically, open or laparoscopic surgery has been the
modality of choice to treat adrenal tumors. With the increasing experience in percutaneous ablation techniques, interventional radiology plays an important role in a selective group
of patients with adrenal tumors. As a treatment option, radiologists should be familiarized with indications, technique and
complications of percutaneous ablation of adrenal tumors.
Description (s) condition (s), method (s) or technique (s): A
brief review of literature will be performed, discussing the main
indications, imaging aspects, techniques and the most common
complications of percutaneous ablation of adrenal tumors. Our
experience in technical aspects will be also discussed.
Conclusion: Many imaging-guided ablation modalities
have been described to treat adrenal tumors: radiofrequency,
cryoablation, microwave, and chemical ablation. Virtually all
adrenal tumors can be treated by percutaneous techniques.
The major described complications are: hematoma and hypertensive crisis.
Brief discussion of the case Percutaneous treatment of adrenal tumors may be an effective alternative to open / laparoscopic surgery. Multidisciplinary is an optimal approach.
Literature lacks on large studies and expanded follow-ups
to establish evidence of this modality as an option to surgical approach.
PA.07.029
HOW WE PERFORM THE CT-GUIDED FACET
JOINT INFILTRATION ?
Authors: BRITTO NETO, L.A.; SILVA, M.M.A.; CAVALCANTE, F.A.; KIHARA FILHO, E.N.; RAHAL, JR.A.;
MARIOTTI G.C.; ROSEMBERG, L.A.; GARCIA, R.G.
Institution: Hospital Israelita Albert Einsetin, São Paulo,
SP, Brasil
Author responsible: Lelivaldo Antonio de Britto Neto
Introduction: Low back pain (LBP) is common problem that
affect most individuals at some time during their lives. That
has assumed endemic proportions, with an annual prevalence
of 5–20% in the industrialized world. 1% of the population
is permanently disabled by LBP at any given point, with another 1%-2% temporarily disabled from their occupation.
15–45% of patients the pain was due to pathology of the facet joints and only in 13–20% was the pain due to herniated
discs. An alternative method for longer lasting pain relief is
CT-guided intrarticular infiltration of facet joints (FJI) with
22
local anaesthetics and cortisone. Describe through cases the
technique in the CT-guided FJI.
Methods Involved: Describe through case how we perform
the CT-guided FJI.
Discussion: With the realization by surgeons that not all
backache is a ‘disc’ and not all patients with LBP will respond to surgery, there is increasing awareness of the role of
percutaneous injection techniques in the nonoperative management of chronic LBP. The use of image-guidance with fluoroscopy or CT scan has increased the precision and safety of
these procedures.
Conclusion of the presentation: In selected cases of LBP,
FJI is a relatively simple, low cost, safe, and minimally invasive procedure that can be a valuable adjunct in the treatment.
PA.07.030
Image fusion in prostate biopsy : Where
are we now? How far can we go?
Authors: BARROS, R.M.; MARIOTTI, G.; MUSSI, T. C.;
QUEIROZ, M.R.G.; BARONI, R.H.; GARCIA, R.G.
Author responsible: Rodolfo Martins de Barros
Introduction: The transrectal prostate biopsy remains the
only minimally invasive method for the diagnosis of prostate
cancer. Recently, MRI has contributed for the presumptive
diagnosis of this type of cancer, detecting possible disease
foci in the gland. The fusion of MRI images with real-time
US enables the sampling of these lesions. The aim of this
study is to describe the technique, advantages and features of
the prostate biopsy with US/ MRI fusion.
Methods Involved: Presentation of prostate biopsy with US/
MRI fusion technique, accompanied by illustrative images
and explanatory texts of cases performed by our service.
Discussion: The transrectal prostate US may lead to both
false positive or negative cases whereas the RM has great
accuracy. Allying both techniques allows to diagnose tumors
that would not be sampled by random biopsy technique.
Conclusion of the presentation: The US/MRI fusion prostate biopsy is a technique that, although promising, requires
full knowledge of the techniques involved and proper training for it to reach its full potential.
PA.07.031
Endoscopic ultrasound guided biopsy : technique and indications
Authors: BARROS, R.M.; RAHAL JR., A.; ANDRADE, J.;
VIEIRA, F.; QUEIROZ, M.R.G.; GARCIA, R.G.
Introduction: Endoscopic ultrasonography ( EUS ) is a relatively new method to access hollow organs and their adjacencies , allowing tissue sampling through the fine needle aspiration ( FNA ) method . The aim of this study is to identify
in which situations is more advantageous to make use of this
modality and what is the right technique to apply it .
Methods Involved: Presentation of cases where teh endoscopic ultrasound guided biopsy was essential for the correct
diagnosis, using illustrative images and explanatory texts .
Discussion: Endoscopic ultrasound technique allows the
study of organs inaccessible to some conventional methods
of percutaneous biopsy , such as those located in the retroperitoneum and mediastinum, like the pancreas and lymph
nodes . Even if these organs can be accessed by techniques
percutaneous biopsy, the endoscopic approach offers a often
safer path and therefore with lower risk of complications .
Conclusion of the presentation: The EUS technique is a
minimally invasive method , accurate and low morbidity.
However , because it is little available technical and cost still
relatively high, it is necessary to correct evaluation of each
case so that it is clearly indicated and performed securely.
8 - Breast
PA.08.001
DEVELOPING ASYMMETRY
Authors: Feres, R.; Silva, M. M. A.; Bo, M. B.; Moraes, P.
C.; Shimizu, C.; Funari, M. B. G.
SP, Brasil
Author responsible: Renata Feres
Brief description of the purpose of the Review of Literature: Review the definition, management, imaging findings
and pathologic findings of developing asymmetries.
The terminology used to describe breast asymmetries changed
in 2013 with the publication by the American College of Radiology of the fifth edition of the BI-RADS® (Breast Imaging Reporting and Data System) lexicon. According to the
new edition, asymmetries are divided into: asymmetry, global asymmetry, focal asymmetry and developing asymmetry.
The term developing asymmetry has never been described
in the previous four BI-RADS® editions and refers to focal
asymmetry not present on a previous mammographic examination or one that has increased in size or conspicuity.
Conclusion: It is an unusual finding, with few data on its
frequency in the literature. Sickles reported incidence of
0.16 and 0.11% in screening and diagnostic mammograms,
respectively, in a retrospective study. Approximately 15% of
developing asymmetries are found to be malignant (invasive
carcinoma and/or in situ carcinoma), so these cases warrant
further imaging evaluation and eventual biopsy. The absence
of sonographic correlation should not avert biopsy. The usefulness of MRI for these cases has not been established.
Brief discussion of the case Developing asymmetry is an
uncommon finding, but the likelihood of malignancy is high
enough to justify recall and biopsy.
PA.08.002
Ultrasound guided core biopsy of breast
microcalcifications with a new image
processing technique: A pictorial assay
Authors: SILVA CB; GRAZIANO L; BITENCOURT AGV;
PALUDO J; BOAVENTURA CS; GUATELLI CS; SOUZA
JA; POLI MRB; MARQUES EF
Institution: AC CAMARGO CANCER CENTER, SÃO
PAULO, SÃO PAULO, BRASIL
Author responsible: Caroline Baptista da Silva
Introduction: The pre-operative diagnosis of suspicious microcalcifications usually requires stereotactic needle biopsy.
Mammography is reference standard for evaluation of breast
microcalcifications. However, in selected cases stereotactic
biopsy is not possible, such as deep or superficial lesions, or
patients with small breasts. Recent advances in ultrasound
(US) have improved the detection of these lesions. The purpose of this pictorial essay is to demonstrate that a new commercial image processing technique (MicroPure) can be used
to detect microcalcifications and therefore enable its biopsy
under direct US guidance.
Methods Involved: We discuss and illustrate the radiologic
findings of breast clustered microcalcifications detected by
US performed using gray scale and MicroPure techniques,
and mammographic correlation.
Discussion: MicroPure is an image processing function that is
designed to improve the visualization of microcalcifications. It
combines nonlinear imaging and speckle suppression to mark
suspected calcifications as white spots in a blue overlay image.
Although screen-film mammography remains the imaging
modality of choice for detecting and characterizing microcalcifications, this technique can enable procedures of microcalcifications in selected cases, avoiding unnecessary surgeries.
Conclusion of the presentation: US MicroPure examination can be an effective method for identifying and localizing
breast microcalcifications, being an alternative to guide biopsy in some patients with suspected breast cancer.
PA.08.004
IMAGE ISSUES IN LOCOREGIONAL RECURRENCE
BREAST CANCER – PICTORIAL ESSAY.
Authors: BOAVENTURA, C.S; PALUDO, J; SILVA, C.B;
BITENCOURT, A.G.V; GRAZIANO, L; GUATELLI, C;
SOUZA, J; POLI, M; MARQUES, E.
Institution: A.C Camargo Cancer Center, Sao Paulo,
SP, Brasil
Introduction: The risk of locoregional recurrence (RLR) of
breast cancer after curative surgery is about 2.5% per year in
the first 2-6 years. Imaging methods have functional role in
early detection and evaluation of RLR in patients treated for
breast cancer.
Methods Involved: Mammography, Ultrasound and Magnetic Resonance Imaging (MRI).
Discussion: The RLR of breast cancer can occur in the surgical bed, skin, chest wall and lymph node. Most cases is detectable on physical examination, but about 1/3 are only identified
by image. In mammography, tumor recurrence is presented by
accentuation of skin edema, development or increased asymmetry, distortion or suspicious calcifications in the surgical
bed. In ultrasound, the appearance of a new lesion or increase
of architectural distortion should be considered suspect. Findings suggestive of recurrence on MRI include irregular or extensive injury; enhancement segment; washout kinetic curve;
and any lesions larger than 5 mm near the surgical site. Other
imaging methods such as computed tomography (CT) and
PET-CT may be useful in the evaluation of RLR.
Conclusion of the presentation: The interpretation of imaging findings after treatment of breast cancer requires an understanding of postoperative changes and tumor recurrence
characteristics in the multiple methods used in practice.
PA.08.005
SPECTRUM OF TUMORS FIBROEPITHELIAL BREAST: PICTORIAL ESSAY.
23
Authors: BOAVENTURA, C.S; SILVA, C.B; PALUDO, J;
BITENCOURT, A.G.V; GUATELLI, C; GRAZIANO, L;
SOUZA, J; POLI, M; MARQUES, E.
Institution: A.C CAMARGO CANCER CENTER, SAO
PAULO, SP, BRASIL.
Introduction: Benign breast tumors represent up to 80%
of palpable lesions. Among them, the fibroepitelias tumors
stand out, resulting from the biphasic stromal-epithelial proliferation and its spectrum includes fibroadenomas and its
variants, benign mesenchymal tumors (hamartomas and adenomas) and tumor phyllodes.
Methods Involved: Differentiation of injuries by the correlation of radiological and pathological findings through a
review cases.
Discussion: The clinical history is essential to differentiate
fibroepithelial tumors. In mammography they usually present
as an iso/hyperdense circumscribed mass and varied formats.
The presence of fat is characteristic of hamartomas. Popcorn-like calcifications suggest fibroadenoma, however its
variants may have atypical aspect. In ultrasound, generally
the appearance is an iso/hypoechogenic mass, with or without
cysts, septa and posterior acoustic enhancement. In MRI, the
signal intensity and the enhancement depends on the amount
of hyalinization, which may have high or low signal on T2.
The impregnation is usually homogeneous, unless septa or
cystic areas are present. Most injuries can be treated conservatively, however juvenile fibroadenomas and phyllodes
tumors may require surgical resection to control symptoms.
Conclusion of the presentation: The radiological and pathological correlation of fibroepithelial tumors spectrum enables
the physician familiar with the findings, contribute to the better management of these benign lesions.
PA.08.006
COMPLICATIONS CAUSED BY AESTHETIC SUBSTANCES USED IN BREAST. LITERATURE REVIEW
AND CASE REPORT.
Authors: COLOMBO, E.C.E.; GRAZIANO, L.; SOUZA,
J.A.; BITTENCOURT, A.V.; GUATELLI, C.S.; MARQUES,E.F.; POLI,M.; PALUDO,J.
Institution: AC Camargo Cancer Center, São Paulo,
S.P., Brasil.
Author responsible: Elizabeth Cristina Elias Colombo
Introduction: The use of substances in the breast for cosmetic purposes and repairers have been increasingly frequent in
our midst. However, complications are not well publicized.
This work has the purpose of conducting a literature review
about the complications of application of body aesthetic
substances, illustrate and describe aspects mammographic,
sonographic and magnetic resonance intramammary liquid
silicone, the polymethylmethacrylate (PMMA) in the sternal
region and mammary screen, and its complications.
Methods Involved: Review of breast imaging findings in patients with complications after the use of cosmetic substances.
Discussion: The damage may be early (necrosis and infection) or late, as the migration of the product through the lymphatic system, venous and also through the force of gravity.
Another aspect is the difficulty in elucidating an importante
diagnosis, such as breast cancer.
Conclusion of the presentation: Imaging methods are used
to evaluate the substances introduced into the breast for cos-
24
metic purposes and repairers and should be known by the radiolologyst because these substances may confuse the interpreting imaging finds, hindering cancer screening. Therefore,
the history and past history of the patient are fundamental to
aid the interpretation of imaging findings.
PA.08.007
PSEUDOANGIOMATOUS STROMAL HYPERPLASIA
OF THE BREAST: IMPORTANCE OF RADIOLOGIC
-PATHOLOGIC CORRELATION
Authors: PALUDO, J; BOAVENTURA, C.S; SILVA, C.B;
FRANÇA, L.K.L; BITENCOURT, A.G.V; GUATELLI, C;
GRAZIANO, L; SOUZA, J.A; POLI, M; MARQUES, E.
Institution: A.C. CAMARGO CANCER CENTER; SÃO
PAULO; SÃO PAULO; BRASIL
Author responsible: Jociana Paludo
Introduction: Pseudoangiomatous Stromal Hyperplasia
(PASH) is a benign entity, commonly found in breast biopsy, either alone or associated with other histological findings.
The objective of this study is to evaluate the PASH features
in the imaging methods.
Methods Involved: The imaging findings of cases with histological diagnosis of PASH were reviewed.
Discussion: PASH may present as an incidental finding in
breast biopsy, palpable nodule or occult lesion. Radiological findings of PASH are nonspecific, however usually has
features suggestive of benignity. In mammography, the most
common findings are circumscribed nodule or asymmetric
density. Calcifications are uncommon, but may be related to
other associated lesions. At ultrasound, it usually presents as a
solid circumscribed, hypoechoic mass, which may have cystic
areas. MRI may present as a mass or non-mass enhancement.
PASH is not associated with an increased risk of malignancy.
However, in the presence of suspicious imaging findings, it is
necessary to rule out associated malignant lesions.
Conclusion of the presentation: Since there is no specific
radiological findings of PASH, it is essential that the radiologist know to correlate imaging findings and histology for an
adequate management of these lesions.
PA.08.009
The basics of accessory breast tissue embryology, multi-modality imaging and
management: pictorial essay.
Authors: MORAES PC., (AUTOR PRINCIPAL) / LUZ DC.,
(ELABORAÇÃO E IMAGENS) / LEAO LRS., (ELABORAÇÃO E IMAGENS) / RAULINO DMR., (CORDENAÇÃO) / LYRIO CAC., (REVISÃO BIBLIOGRÁFICA
) / MUNIZ NETO FJ., (ESTRUTURAÇÃO GRÁFICA) /
FIGUEIREDO, J.R.P., (ELABORAÇÃO E IMAGENS) /
FUNARI MBG., (COORDENAÇÃO)
Introduction: Accessory Breast Tissue (ABT) is a normal variant and can be found in up to 6% of population. It is well know
that the same spectrum of breast disease can occurs in ABT. We
will discuss the embryology, imaging findings and management
of ATB to help radiologist to better evaluate this condition.
Methods Involved: Mammographic, sonographic, tomographic and magnetic resonance imaging of ABT will be dis-
cussed, with didactically illustration from our files. A brief
review of literature of the “milk line” embryology, screening,
benign disease and cancer of ABT will be performed.
Discussion: On multi-modality imaging, accessory breast
tissue has the same appearance as the normal glandular parenchyma. It is defined as residual breast embryological tissue and it is usually located at the “milk line”, embryological
ectoderm structure that runs bilaterally along anterior axillary
to inguinal folds. Others uncommon locations also have been
described. Most patients are asymptomatic and symptomatic
should be operated.
Conclusion of the presentation: Radiologists should
promptly recognize ABT by the most common radiology modalities since is a common imaging finding. We have to keep
on mind that any breast disease can also occur in the ABT.
PA.08.010
Evaluation of the nipple-areolar complex using MRI in breast cancer
Authors: MARQUES, EF; FRANÇA, LKL; PALUDO, J;
SILVA, CB; PEREIRA, NP; POLI, MRB; GUATELLI, CM;
GRAZIANO, L; BITTENCOURT, AGV; SOUZA, JA;
Institution: AC CAMARGO CANCER CENTER, SAO
PAULO, SP, BRASIL
Author responsible: Luciana Karla Lira França
Brief description of the purpose of the Review of Literature: In this review we discuss the benefit of breast MRI and
some imaging findings that sugest nipple-areolar complex
(NAC) involvement, supporting the surgeon’s decision.
Literature review of articles related to the NAC involvement
of in breast cancer
Conclusion: The development of new surgical techniques
to treat breast cancer, such as nipple-sparing mastectomy
(NSM), intensified the efforts to distinguish tumors extention
and its relation with the NAC, allowing safe completion of a
NSM, without increasing local recurrence. NAC involvement
is defined as ductal carcinoma in situ, invasive carcinoma or
paget cells within 10 mm of the NAC. There are some cases
that the tumor is identified in the histopatholical study without imaging findings relevant. So the evaluation of specific
morphological characteristics of the tumor, its relations and
NAC’s features are important to increase the sensitivity of
the studies.
Brief discussion of the case To proceed with new surgical
techniques it is important to explore all the diagnostic possibilities in order to exclude tumor extension that contraindicate the procedure, favoring the success of treatment.
9 - Fetal Medicine
PA.09.001
THE IMPORTANCE OF ULTRASOUND IN PRENATAL AND INJURIES FOLLOWING CYSTIC LUNG:
CASE REPORT
Authors: IACOVENKO JR, R.A.K.; NETO, O.G.; ZANFORLIN, S.; PIRES, C.;
Institution: CETRUS, São Paulo, São Paulo, Brasil
Author responsible: Ricardo Antonio Kachuko Iacovenko
Junior
Brief description of the purpose of the report: Description
of the importance of prenatal ultrasonographic evaluation of
fetus with pulmonary injury hyperechoic (LPH).
Medical History: To report a case of congenital lung malformations in the fetus of pregnant woman with 31 years old, diagnosed in prenatal ultrasound at 26 weeks of gestational age.
Diagnosis: Congenital lung malformations are a heterogeneous group of disease that has been diagnosed early due
to the advancement of new techniques for diagnostic tests,
especially ultrasound, the easy access and lower cost. The
estimated incidence of LPH range of 1: 10.000 to 1: 35.000
pregnancies. About a third of the fetuses develop hydrops,
principal of perinatal death risk predictor. The line will be
determined by the CVR (Cystic adenomatoid malformation
Volume Ratio), which is calculated by dividing the volume of
the LPH (estimated by the ellipse volume formula) for head
circunference. In cases where the CVR is higher than 1.6 the
risk of developing hydrops is increased. Thus, it\’s prenatal
follow-up with ultrasound control or corticosteroid administration to reverse the hidropsy. Your prenatal diagnosis is important because newborns may have symptoms that require
prompt diagnosis and treatment.
Discussion and summary of the case: The ultrasound study
plays an important role in the screening of congenital lung
malformations, for better management fetal and postnatal.
PA.09.002
Congenital Cardiac Tumors: A Pictorial
Test.
Authors: SANTOS, G.S.; ANDRADE, C.A.; ZANFORLIN
FILHO, S.M.; PIRES, C.R.; CATELÃO, L.C.
Author responsible: Géssyka Sousa dos Santos
Introduction: To develop an organizational chart to assist
the medical sonographer in his/her research and conduct of
intra-cardiac masses in the pre and post-natal phases.
Methods Involved: A literature review on congenital cardiac tumors was performed using MEDLINE and LILACS as sources.
Discussion: Studies have shown that cardiac tumors are very
rare in infants and children, but are a major cause of morbidity and mortality. Cardiac tumors may be primary or secondary. About 90% of these tumors are of benign etiology, where
the rhabdomyoma is the most prevalent, followed by fibroma,
teratoma, myxoma and hamartoma. Each has striking features that aid in the differential diagnosis between them, such
location, uni-multicentric, echo texture and association with
other morphological findings.
Conclusion of the presentation: Ultrasound, by cutting visualization of the four heart chambers, associated with fetal
morphological examination, allows the production of a guiding organizational chart in the diagnosis of these neoplasms,
especially in the prenatal period, in which the early diagnosis
helps provide appropriate management of birth labor, monitoring and perinatal treatment.
PA.09.003
DEFORMITY CONGENITAL OF LOWER: agenesis
BILATERAL FEMORAL TWO CASES REPORT
Authors: ABREU MFB. Idealização, revisão de texto, levantamento bibliográfico e de casos, GOMES KFM. Idealização, levantamento bibliográfico e revisão de texto, MOTA
MI. Idealização, levantamento bibliográfico e revisão de texAbstracts of Scientific Papers
25
to, BATISTA AKC. Idealização, levantamento bibliográfico
e revisão de texto, MOTA FF. Levantamento bibliográfico,
CORDEIRO L. Levantamento de casos, VALADARES LC.
Levantamento de casos, CORDEIRO LB. Revisão de texto
Institution: HOSPITAL DILSON GODINHO, MONTES
CLAROS, MINAS GERAIS, BRASIL.
Author responsible: Maria Fernanda Borges Abreu
Brief description of the purpose of the report: Bilateral femoral agenesis (ABF) is a rare congenital deformity of the lower limbs, and may appear as isolated ABF or associated with
other abnormalities such as facial changes, which possibly fall
into the femoral Facial Syndrome (SFF). Thus, the study aims
to report two rare cases of congenital malformation.
Medical History: Both cases were diagnosed by chance in
routine ultrasonography in pregnant women of the 34th and
20th weeks of gestation, respectively. Imaging tests were
performed in a private image service in the city of Montes
Claros, Minas Gerais.
Diagnosis: Evidence suggests that gestational diabetes appears to be the main risk factor for the SFF and this would be
more prevalent in female patients. However, chromosomal
changes were not dismissed as genetic cause, being appointed an autosomal dominant inheritance as a causal factor. In
routine ultrasound identified two cases of ABF, one female
and one male. Both cases do not present, in addition to the
femoral abnormalities, abnormalities compatible with the
SFF, making it even more obscure.
Discussion and summary of the case: This publication describes two rare cases of bilateral agenesis of isolated femur
in newborns of women and men, without associated pregnancy complications, in northern Minas Gerais/Brazil.
PA.09.004
MAGNETIC RESONANCE AND COMPUTED TOMOGRAPHY IN GESTATIONAL TROPHOBLASTIC DISEASE - THE EXPERIENCE OF A MAJOR HOSPITAL
IN RIO DE JANEIRO
Authors: TRIGO, S. G; NEVES, A.L.E.N, NEVES, R.
Institution: Hospital Estadual Adão Pereira Nunes, Rio de
Janeiro, Rio de Janeiro, Brasil
Author responsible: Silvana Guimarães Trigo
Introduction: Cases of Gestational Thophoblastic Disease
(GTD) evaluated ina a major public hospital in Rio de Janeiro are presented, highlighting the importance of Computed
Tomography (CT) and Magnetic Resonance . GTD includes
hydatidiform mole, invasive mole and choriocarcinoma,
characterized by neoplastic proliferation of gestational trophoblastic tissue. In invasive mole there\’s diferente levels
of uterine wall invasion, rarely metastize. Choriocarcinoma
is the most aggressive form and can origin distant metastasis
Methods Involved: It has been performed T2 weighted
(T2W) and T1 weighted (T1W) sequences of pelvic region
and sometimes of superior abdominal region too, in axial,
sagital and coronal planes, with gadolinium administration.
CT has been performed to search for distant metastasis in cases of persistente Beta-HCG levels.
Discussion: In MR hydatidiform mole is a heterogeneous
intrauterine mass, with low T1W signal and high T2W signal, and avid contrast enhancement. Invasive moles invade
myometrium, parametria or vaginal vault and have the same
signal bahavior as hydatidiform mole. Choriocarcinoma appears on MR as a low signal T1W, high signal T2W tumor ,
with contrast enhancement
26
Conclusion of the presentation: Both CT and MR play a
importante role in evaluation of GTD and are available in
major public hospitals, allowing more people to achieve the
best tratment and cure opportunity.
PA.09.005
MAGNETIC RESONANCE ASPECTS IN PLACENTA
ACCRETA SPECTRUM - THE EXPERIENCE OF A
MAJOR PUBLIC HOSPITAL IN RIO DE JANEIRO
Authors: TRIGO, S.G.; NEVES, A.L.E.; NEVES, R.
Institution: HOSPITAL ESTADUAL ADÃO PEREIRA
NUNES, DUQUE DE CAXIAS, RIO DE JANEIRO, BRASIL
Author responsible: Silvana Guimarães Trigo
Introduction: Cases of placenta accreta spectrum evaluated in a major public hospital in Rio de Janeiro State are presented, highlighting the importance of Magnetic Resonance
(MR). Defects in placental development allow abnormal
penetration of chorionic villi to or into uterine wall. The
abnormality is called placenta accreta, increta or percreta,
regarding the level of placental parietal uterine invasion
and can result in intrapartum hemorrhage and emergent
hysterectomy.
Methods Involved: It was performed T2 weighte(T2W) sequences in axial, coronal and sagital planes, related to placental axis. T1 weighted (T1W)sequences were used as a parameter to exclude possible hemorragic foci and gadolinium
is given in equivocal and postpartum cases.
Discussion: MR is used in placenta accreta spectrum when ultrasound is equivocal or placenta has a posterior implantation.
The findings include: uterine bulging,, signs of myometrial
and uterine serosa invasion and invasion of adjacent organs.
Conclusion of the presentation: The use of MR to evaluate
the placenta accreta spectrum can contribute to reduce perinatal mortality and morbidity related to these pathologies.
Increasing use of MR for diagnostic perinatal purposes, speacially in public hospitals, give the opportunity to more people
to achieve the proper treatment and cure.
10 - Nuclear Medicine
PA.10.002
Pyrophosphate myocardial scintigraphy in the evaluation of acute myocardial infarction in a patient with renal
cronic disease.
Authors: Veras MF, Azevedo JC, Rezende MF, Vianna BSL,
Santos TV, Barlete AV, Volschan A, Correa NL, Cotrado
AYC, Aguiar WKM, Ker W, Mesquita CT.
Institution: Hospital Pró-Cardiaco, Rio de Janeiro, Rio de
Janeiro, Brasil
Author responsible: Mariana Ferreira Veras
Brief description of the purpose of the report: Although
the fact troponin is used as a marker for diagnosis of ACS,
it´s elevation may occur in other diseases. Myocardial perfusion imaging with 99mTechnetium labeled pyrophosphate
(99mTc-PYP) is able to visualize areas of necrosis.
Medical History: Man, 70 years with chronic renal failure and gastritis, admitted with fever, dyspnea and chest/
abdominal pain. The ECG showed BRE, the echocardiogram showed dyskinesia of left ventricular apex and car-
diac troponins were high on admission. Sepsis protocol
was enroled due to pulmonary infiltrate image. Myocardial
scintigraphy with 99mTc-PYP demonstrated high uptake in
basal lateral segment and scintigraphy 99mTc-Sestamibi
(99mTc-MIBI) for myocardial perfusion showed low uptake in the same segment.
Diagnosis: Troponin elevation may not be related to ACS,
for example sepsis, renal failure and LBBB. Ischemia
leads to changes in phospholipidic membrane with an increase in permeability to calcium uptake and to phosphonated agent (PYP).
Discussion and summary of the case: Patient couldn´t be
submited to contrast studies due to chronic renal disease. The
high uptake of the radiotracer 99mTc PYP in basal lateral
segment was consistent with the low myocardial uptake of
the radiotracer 99mTc MIBI in the same region and it strongly suggests recent transmural, defining conduct.
PA.10.003
Imunocintilografia with 99mTc- besilesomab in helping to Fusarium detection in
patients with relapsed AML : a case report
Authors: MORAES, EC; BACHA, RP; PESSÔA, FFS; NASCIMENTO, NL; ANANIAS, FL
Institution: DIMEN/SP HOSPITAL BANDEIRANTES
Author responsible: Elizabeth Campos de Moraes
Brief description of the purpose of the report: Emphasize
the importance of nuclear medicine in the characterization of
infection an effective and non-invasive method.
Medical History: Female patient, 32 years old, diagnosed
with AML hospitalized with unknown origin fever, dyspnea,
nausea, myasthenia, abdominal pain and diarrhea. On physical examination, port- o- cath without signs of inflammation ,
exulcerated injury in abdominal and subcutaneous nodules in
upper and lower limbs.
Diagnosis: A CT scan of the chest showed extensive area of
ground-glass attenuation in the middle lobe, tending to the
consolidation and bilateral nodular opacities scattered, with
halo -glass appearance and suggested that inflammatory / infectious process of fungal etiology. The 99mTc - besilesomab
( Scintimun® ) identified focal infectious processes, scattered
by skin / subcutaneous tissue, predominantly in the upper and
lower limbs. In hemolcultura grew Fusarium sp.
Discussion and summary of the case: Inflammatory and infectious diseases can be divided into acute or chronic inflammation and infection. The radiological imaging techniques has,
with the exception of functional magnetic resonance imaging,
high sensitivity and low specificity. Nuclear medicine exams,
allow the in vivo detection of early pathological and physiological phenomena, even before anatomical changes occur.
PA.10.004
Comparative analysis of left ventricular dyssynchrony in patients with and
without left bundle branch block
Authors: Wiefels, CC; Vignoli, L; Nunes, THP; Batista,
LA; Wanderley, APB; Camilo, TGN; Ferreira, SG; Serrão,
J; Mesquita, CT
Institution: Hospital Universitário Antonio Pedro, Niterói,
Rio de janeiro, Brasil
Author responsible: Christiane Wiefels
Brief description of the purpose of the study: Left bundle
branch block (LBBB) causes beside an electric dyssynchrony, a mecanic dyssinchrony. The objective of this study was
to compare the parameters of dyssynchrony in patients with
LBBB to subjects with normal electrocardiogram.
Methods: We analyzed 19 studies of myocardial perfusion
scintigraphy (gated-SPECT) in patients with LBBB at rest
and 28 studies of patients without LBBB. The ECToolbox
was used for phase analysis. The dyssynchrony parameters
evaluated were (PeakPhase, Standard Deviation (SD), Bandwidth (BW). The values of ejection fraction (EF) and the end
systolic and diastolic volumes (ESV and EDV, respectively)
were also compared. We used the Student t test (p <0.05) and
Pearson’s correlation for comparison.
Main results: The t test showed significant differences in SD
and BW indicating the presence of dyssynchrony in patients
with LBBB. EF, EDV and ESV in patients with LBBB is significantly different from the normal, indicating LV dysfunction in this group. The Pearson correlation between BW and
EF was negative (-0.72), indicating an inverse relationship
between the two parameters.
Conclusion of the presentation: Patients with LBBB have
higher ventricular dyssynchrony, smaller EF and larger ventricular volumes compared to normal patients.
PA.10.005
Hypertrophic cardiomyopathy: Finding
of interventricular septum hypertrophy
in myocardial perfusion scintigraphy.
Authors: FREITAS SS; LOURENCO MBS; SANTOS ACF;
BARRAL CM; RODRIGUES NR; SANCHES SMD; MARINO VSP
Institution: Hospital das Clínicas da Universidade Federal
de minas Gerais
Author responsible: Stephanie Saliba de Freitas
Brief description of the purpose of the report: Hypertrophic
cardiomyopathy presents itself as symmetric or asymmetric ventricular walls hypertrophy. This report illustrates interventricular
septum hypertrophy in myocardial perfusion scintigraphy.
Medical History: Male, 71 years-old, coronary artery disease,
coronary artery surgery and angioplasty. Septal hypertrophy
by echocardiography (sigmoid septum). Asymptomatic, myocardial scintigraphy performed to evaluate the treatment.
Diagnosis: Post-stress images showed low uptake in the anterior wall of the left ventricle (LV) and septal wall thickening,
causing distortion at the intersection with the right ventricle
(RV). Similar pattern in rest. Fixed defect was interpreted as
artifact by septal hypertrophy. The septal predominance in
asymmetric hypertrophic cardiomyopathy is the most frequent. It presents different thickness in contiguous portions
of the LV walls and abrupt transitions. There may be diastolic
disfunction and increased walls stiffness. Echocardiography
is the most used exam in the assessment of hypertrophic cardiomyopathy, being LV hypertrophy a characteristic finding.
Diagnosis is difficult because of pathological and physiological conditions that mimic the disease.
Discussion and summary of the case: Although scintigraphy isn´t indicated for the diagnosis, we must be alert to the
standard scintigraphic pattern, avoiding interpretation errors
resulting from artifacts caused by the asymmetric hypertrophy. In diastolic dysfunction, this pattern also helps directioning for the echocardiographic diagnosis.
27
PA.10.006
Metastatic osteosarcoma: false-positive
lesion exclusion of PET / CT-18F-Fluoride
using PET / CT-18F-FDG
Authors: PANTOJA L.O., VON GRAPP II A., RIBEIRO
A.M., CONRADO J.L.F.A., LIMA E.N.P., TORRES I.C.G.,
MARTINEZ I., CAVICCHIOLI M., NAKAGAWA S.A.
Institution: A.C. CAMARGO CANCER CENTER, SÃO
PAULO, SP, BRASIL
Author responsible: Luiz Otávio Pantoja
Brief description of the purpose of the report: To report
a case of metastatic osteosarcoma with positive injury to
18F-Fluoride and negative to 18F-FDG
Medical History: HS, 15y, m, treated osteosarcoma of the right
distal femur and relapsed after 7 years with bone lesion in the
metaphyseal region of the left femur. Directed systemic bone restaging with 18F-fluoride, showing up area of intense concentration in the distal femur and still new hyper-concentration area in
T10. In order to determine the metabolic activity characteristics
of the new lesion a study was performed with 18F-FDG, with
SUV=10,9 evidenced in femoral lesion and no significant concentration at T10. The biopsy showed the presence of hemangioma at T10, confirming the negative findings of 18F-FDG.
Diagnosis: Osteosarcoma is the most common primary bone
tumor in children and adolescents and with high probability of metastatic spread. The PET-CT with 18F-Fluoride was
recently introduced as a substitute for bone scintigraphy due
to their sensitivity and the possibility of correlation with CT;
but, like the bone scan, is not specific for tumors.
Discussion and summary of the case: The described case
demonstrates the need for an association of metabolic information of 18F-FDG for the correct differentiation of suspicious lesions observed at 18F-Fluoride.
PA.10.007
PET / CT 18F-FDG IN PATIENT WITH LARYNGEAL
TUBERCULOSIS : CASE REPORT
Authors: MARÇAL FILHO, E.F.L.; MOSCI, C.; LIMA,
M.C.L.; AMORIM, B.J.; SANTOS A.O.; ETCHEBEHERE
E.C.S.C.; CHONE, C. T.; RAMOS, C.D.
Institution: Hospital de Clínicas da Unicamp, Campinas,
São Paulo, Brasil.
Author responsible: Eduardo Flávio de Lacerda Marçal Filho
Brief description of the purpose of the report: Tuberculosis
is an infectious disease caused by the Mycobacterium tuberculosis that recently presented with a change in its epidemiological profile, with higher incidence of extra-pulmonary forms.
Medical History: 48 years-old man, with dysphonia and involuntary weight loss of 4 kg in the last 3 months. Reported
smoking and alcohol use for 15 years and denied other comorbidities. He was in regular condition in physical exam,
a 1 cm cervical lymph node and diminished breath sounds
globally were observed. A laryngoscopy was requested and
detected a supra-glottis diffuse lesion, suspicious for malignancy. An 18F-FDG PET/CT showed hypermetabolic lesions
in: glottis, multiple cervical, mediastinal and abdominal
lymphadenopathy and lung nodules. Subsequently. the result
of laryngeal biopsy revealed chronic granulomatous process
and mycobacteria in sputum was also positive, confirming
the diagnosis of tuberculosis. Patient confirmed 2 household
contacts with tuberculosis.
28
Diagnosis: The most common form of tuberculosis in the
head and neck is lymph node involvement. However, other sites such as middle ear, nasal cavity, pharynx and larynx
may be involved. Hypermetabolic lesions on PET/CT may
represent inflammatory/infectious process or neoplasms.
Discussion and summary of the case: In PET/CT, the differential diagnosis between neoplasia and granulomatous diseases should always be considered, especially in areas with
high prevalence of the latter.
PA.10.008
Neoadjuvant use of 177Lu-Octreotate in
Metastatic Adenocarcinoid Tumor of Pancreas: A Case Report
Authors: MARCIANO, F.R.; LOBO, G.H.; SOUTO, J.F.M.;
GOMES, G.V.; FURTADO, R.G.; GOMES, M.V.; ARRATIA, J.I.C.; ANJOS, D.A.; GOMES, E.F.;
Institution: Nucleos - Centro de Medicina Nuclear, Brasília,
Distrito Federal, Brasil
Author responsible: Flávia Ribeiro Marciano
Brief description of the purpose of the report: to report
a case of neoadjuvant therapy with 177Lu-octreotate that
allowed complete resection of a pancreatic adenocarcinoid
tumor with liver metastasis.
Medical History: JSM, female, 38, with epigastric pain.
Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) identified a pancreatic mass lesion and nonspecific hepatic nodules. The Chromogranin A was high. The removal of the lesions was contraindicated during laparotomy.
Scintigraphy with 99mTc-octreotide showed marked concentration in the pancreatic mass and heterogeneous liver uptake.
The patient underwent 177Lu-octreotate therapy, according
to Rotterdam protocol. Nine months later, CT revealed reduction of lesions allowing complete excision of them. Four
years after surgery, the 99mTc-octreotide, CT and Chromogranin A studies were normalized.
Diagnosis: the treatment of metastatic and inoperable neuroendocrine tumors with 177Lu-octreotate is well established.
Literature shows reduction of tumor volume in 46% of the
patients, stability in 35% and progression in the rest of them.
In this case, the treatment caused reduction in pancreatic and
liver lesions enabling curative surgery.
Discussion and summary of the case: this case showed the
efficacy of neoadjuvant therapy with 177Lu-octreotate in a patient with an initially inoperable metastatic pancreatic tumor.
PA.10.009
Progressive Metabolic Response of a Neuroendocrine Tumor 33 Months After 177Lu
-Octreotate Therapy: Case Report
Authors: LOBO, G.H.; MARCIANO, F.R.; SOUTO, J.F.M.;
GOMES, G.V.; FURTADO, R.G.; GOMES, M.V.; ARRATIA, J.I.C.; ANJOS, D.A.; GOMES, E.F.
Institution: Nucleos - Centro de Medicina Nuclear, Brasília,
Author responsible: Gabriela el Haje Lobo
Brief description of the purpose of the report: to report an
unusual case of neuroendocrine tumor treated with 177Lu-octreotate that presented progressive metabolic response after
almost three years of follow-up.
Medical History: IVO, 74, female, with history of a med-
ullary thyroid carcinoma, showing numerous metastases involving the orbit, mediastinum, lungs, pancreas and femurs.
Directed treatment with 177Lu-octreotate using Rotterdam
protocol that showed complete clinical and laboratory responses and partial anatomical response. Scintigraphy with
99mTc-octreotide revealed progressive metabolic response in
a 33 month follow-up.
Diagnosis: according to a publication of the Rotterdam group,
a small percentage of patients with stable disease or minimal
response after therapy with 177Lu-octreotate obtained additional response between 6 and 12 month follow-up. In the
case illustrated, it was characterized progressive remission of
the tumor after 33 months, remaining only two areas of mild
uptake seen at the scintigraphy: one in the mediastinum and
another in the pancreas.
Discussion and summary of the case: we found no reports in
the literature supporting that neuroendocrine tumors continue
to respond after therapy with 177Lu-octreotate for more than
12 months. Therefore, this benefit was characterized in this
case by serial evaluations with metabolic functional images.
PA.10.010
Oncologic patients with amoebic abscess
diagnosed by PET/CT-18F-FDG
Authors: CONRADO J.L.F.A.;PANTOJA L.O., VON
GRAPP II A., RIBEIRO A.M., LIMA E.N.P., TORRES
I.C.G., MARTINEZ I., CAVICCHIOLI M.
Institution: A. C. Camargo Cancer Center, São Paulo, São
Paulo, Brasil
Author responsible: Jorge Luis Fonseca de Acioli Conrado
Brief description of the purpose of the report: Pointing out
the need of correlation with the history and clinical developments in the differential diagnosis of lymphoma.
Medical History: LFBS, 34th, diagnosed with mediastinal
Hodgkin lymphoma, already treated , and with clinical suspicion of recurrence due to persistent fever for 30 days, pain in the
right upper quadrant , asthenia , weight loss, mild leukocytosis
and elevation of CRP. During the evaluation of recurrence, underwent scintigraphy with Gallium-67 citrate observing anomalous hyper-concentration in right thoraco-abdominal transition. PET/CT-18F-FDG observed extensive heterogeneous
lesion with hypodense central area , with peripheral anomalous
concentration of 18F- FDG with SUV = 11.6 and absence of
abnormal concentrations in ganglionic chains or other organs,
which led us to consider abscess . Confirmation was made by
ultrasound-guided percutaneous drainage followed by antibiotic therapy with complete remission of symptoms .
Diagnosis: Carriers lymphoma and immunocompromised
patients facilitate access of opportunistic infections ; including to infectious and parasitic as Entamoeba histolytica, a
producer of unique liver abscess near phrenic dome.
Discussion and summary of the case: Gallium-67 and
18F-FDG , used for the diagnosis of lymphomas are also positive in infectious processes and can potentially lead to misdiagnosis, that is why we should always consider this feature
in cancer interpretation.
PA.10.013
Metastatic Insulinoma managed with radiolabeled Somatostatin analog
Authors: COSTA, R.; COSTA, R.; BACCHI, C. E.; ALMEIDA, P.; CARVALHO, L.V.; ALMEIDA, C.
Institution: Real Hospital Português de Beneficência - PE
Author responsible: Lucas Vieira de Carvalho
Brief description of the purpose of the report: The case
described here aims to present a successful case of treatment
of insulinoma by somatostatin analog use, inserting a real and
effective alternative to combat this pathology.
Medical History: The patient was a 32-year-old female, admitted with unexplained hypoglycemia and altered mental
status. She was brought to the Emergency Department for
further evaluation. She had recurrent episodes of hypoglycemia despite numerous intravenous glucose infusions which
led to a work up for a possible pancreatic tumor. An ultrasound of the abdomen was performed showing a large pancreatic mass measuring 10.7?cm in the largest diameter.
Diagnosis: Histopathology and immunohistochemistry results were consistent with low-grade neuroendocrine neoplasia. The patient received 2 infusions of radiolabeled
somatostatin analog lutetium (177LU). By the second administration of the radiopharmaceutical, Octreoscan SPECT/
CT had already shown objective metabolic and radiologic
response to treatment.
Discussion and summary of the case: The management of
insulinomas is challenging and requires a multidisciplinary
approach. Unresectable metastatic insulinomas may present
as a major therapeutic challenge for the treating physician.
For Octreoscan-positive tumors, radiolabeled somatostatin
analog lutetium (177LU) may represent an option for glycemic and systemic disease control, as shown in the case presented here.
11 - Musculoskeletal System
PA.11.002
Different aspects of musculoskeletal
calcifications in systemic sclerosis
Authors: NAGAYA, E.M.; JOJIMA, F.T.; CAMPOS, F.H.;
FERREIRA, D.L.
Institution: Instituto de Radiologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo,
São Paulo – SP, Brasil.
Author responsible: Erina Megumi Nagaya
Introduction: Systemic sclerosis (SS) is a systemic autoimmune disease characterized by inflammation and hyperreactivity of micro and macro vascular circulation associated with
excessive deposition of collagen in the tissues, with subsequent fibrosis, including the skin and internal organs. It is a
rare disease of unknown etiology, with female predominance
(3:1). The aim of this study is to list the different aspects of
calcifications in SS, which are quite varied and can help in
its diagnosis.
Methods Involved: It was performed a survey of the cases
cited in the literature and seen in our service.
Discussion: Calcinosis, abnormal calcium deposits, present
in 25% of patients with SS, occur in periarticular regions, fingertips, elbow, pre-patellar bursa and extensor surface of the
forearm, can occur in different ways: massive, dystrophic,
focus, associated or not to connective tissue retraction. It can
lead to local inflammation, skin ulceration and drainage of
calcified material, which predisposes to infection. The main
differential diagnoses are myositis ossificans, dermatomyositis, systemic lupus erythematosus, among others.
29
Conclusion of the presentation: Thus, although not specific, it is important to the radiologist keep in mind the various
forms of SS calcifications to aid the diagnosis.
PA.11.004
Injuries of the extensor carpi ulnaris
(ECU) subsheath: an under-recognized
diagnostic by radiologists
Authors: MUNIZ NETO, F.J.; OLIVEIRA JUNIOR, L.G.;
VALIM, A.C.; ALVARENGA, D.; LIMA, G.A.F.; SANTOS,
D.C.B.; FUNARI, M.B.G.
Author responsible: Francisco Julio Muniz Neto
Introduction: The tendon of extensor carpi ulnaris (ECU)
crosses a fibro-osseous tunnel at the distal ulna, which is
formed by a bony groove and a connective tissue band, referred as subsheath, which is responsible for tendon stability.
Clinical features of the subsheath injury are non-specific and
consist of ulnar-sided pain and painful snapping. Injury confirmation by magnetic resonance (MR) can be challenging,
therefore, the radiologist must have high suspicion. The objective of this study is to illustrate the main MR patterns of
ECU subsheath injury.
Methods Involved: This pictorial essay demonstrates the
normal anatomy and the main patterns of ECU subsheath injury on MR studies.
Discussion: Although repetitive stress can precede subsheath
injuries, most patients report an acute traumatic event, typically during supination, ulnar deviation and flexion of the
wrist. The most commonly related sporting activities are
tennis and golf. Subsheath injuries may cause subluxation /
dislocation of the ECU tendon, resulting in chronic instability
with tendinopathy and tenosynovitis, culminating in rupture.
Conclusion of the presentation: The radiologist must know
the unique anatomy of the ECU subsheath and should have
high suspicion of its injury for a proper diagnosis and clinical
/ surgical management.
PA.11.007
Radiographic findings in ochronosis:
case report
Authors: SALINA, A.C.I.; SOARES, D.X.; GADELHA,
C.M.C.
Institution: HOSPITAL UNIVERSITÁRIO WALTER
CANTÍDIO, FORTALEZA, CEARÁ, BRASIL
Author responsible: Andrea Carolina Inácio Salina
Brief description of the purpose of the report: We report
the case of a patient with ochronosis, in order to conduct a
review of typical radiographic findings of this disorder, also
known as alkaptonuria, which often, due to its rarity, is not
known by radiologists.
Medical History: We report the case of a man of the fifth
decade who presents clinically with knees joint pain and
chronic low back pain with darkened blue spots on the skin
and ear. Radiographically, the thoracic and lumbar spine have
multiple calcified intervertebral discs, while the knees exhibit
meniscal chondrocalcinosis and osteoarthritis signals.
Diagnosis: These clinical and radiographic features, along
with the homogentisic acid presence in the urine, leading to
diagnosis of ochronosis, a disorder whose incidence is rare
30
(1-4 in 1.000.000) and consisting of an innate error of phenylalanine and tyrosine’s metabolism. This disorder results
from a complete deficiency of the enzyme homogentisic acid
oxidase, causing accumulation of homogentisic acid on the
tissues, which causes the dark blue pigmentation in the skin
and ochronotic arthropathy.
Discussion and summary of the case: Thus, due to the relevance of radiographic ochronosis features for diagnosis suspicion, it is of great importance for the radiologist it’s study
and recognition.
PA.11.008
Cervical Radiculopathy Caused by Vertebral Artery Loop Formation
Authors: RODRIGUES, F.M.; TAKAKI, M.H.; MASSAKI, A.N.
Institution: Santa Casa de Misericórdia, Votuporanga, São
Paulo, Brasil.
Author responsible: Fernando Mansano Rodrigues
Brief description of the purpose of the report: Vertebral artery (VA) loop formation is a rare anatomical variant capable
of causing bony erosion, encroachment on cervical neural foramen, neurovascular compression, or vertebrobasilar insufficiency. It may be congenital or acquired, usually detected incidentally as part of investigation for trauma or cervical pain.
Medical History: Various symptoms can occur depending
on the level of the anomaly. If anomalies are at higher levels of the VA, the clinical presentation may be dysphagia,
glossopharyngeal neuralgia, Horner’s syndrome and neurogenic hypertension. Anomalies at the lower levels can cause
symptoms of cervicobrachial neuralgia produced by vascular
compression, presented as paraesthesia and dysaesthesia of
the fingers.
Diagnosis: Although VALF (Vertebral Artery Loop Formation) is a rare cause of cervical radiculopathy, clinicians
should keep this diagnosis in mind, especially when the plain
radiograph or the computed tomography scan of the cervical spine shows enlargement of the intervertebral foramen. If
suspected, magnetic resonance imaging can confirm the diagnosis as a signal void / vascular structure within the widened
foramen.
Discussion and summary of the case: Therefore, the objective of this case report aims to raise the awareness of both
clinicians and radiologists of this rare cause of cervical radiculopathy.
PA.11.009
INJURIES LIPOMATOUS MUSCULOSKELETAL :
INTEGRATED EVALUATION BY OTHER METHODS
OF IMAGE
Authors: SILVEIRA,YMA; KOBAYASHI,MTT; CHAGAS NETO, FA; GREGIO JUNIOR,E; ENGEL,EE; BARBOSA MHN
de Ribeirão Preto, Ribeirão Preto, São Paulo, Brasil
Author responsible: Ylana
Introduction: Introduction and Objectives : lipomatous lesions involving the musculoskeletal system are often found ,
although the specific diagnosis of these entities can be challenging .In this test demonstrated the most common imaging
findings in various types of lipomatous lesions that affect the
musculoskeletal system focusing on core features allow us to
suggest a better differentiation of each type of lesio
Methods Involved: Methods: A retrospective study was performed where typical cases of lipomatous lesions were selected and analyzed their characteristics in the various methods.
Discussion: Results: lipomatous lesions have variable presentation on ultrasound , and its nonspecific findings . Computed tomography has the drawback of using ionizing radiation
and a contrasting soft tissue resolution lower than the MRI.
Therefore , MRI , for their high tissue differentiation capacity
can demonstrate findings suggest that more aggressive lesion
, especially: presence and thickness of intralesional septa ,
nodular areas of non adipose tissue , lesion composition and
intensity enhancement after administration contrast
Conclusion of the presentation: Conclusions: The radiologist
must be prepared and aware of the different usual and atypical presentations of lipomatous lesions of the musculoskeletal
system in order to propose strategies that can lead to better
diagnostic investigation and the specific patient\’s therapy
PA.11.012
Association of Intramyocellular (IMCL)
Lipid Content with Insulin Resistance in
Obese Adolescents
Authors: MARUICHI, M.D.; BONFITTO, A.J.; LYRA, A.;
FERREIRA, A.B.; COTRIM, N.G.; LONGUI, C.A.; MONTE, O.; KOCHI, C.; HERNANDEZ FILHO, G.
Institution: Irmandade de Misericórdia da Santa Casa de São
Paulo, SP, Brasil
Author responsible: Marcelo Damaso Maruichi
anthropometric, laboratory and intramyocellular lipid content
data in obese adolescents.
Methods: 66 pubertal overweight patients, 25 boys and 41
girls, were evaluated. The study included: weight, height,
waist circumference(WC), percentage of fat, total cholesterol(TC) and fractions, glucose oral tolerance test with measurement of glycemia and insulin. The WC/Height, triglyceride/
HDL-C, HOMA-IR ratios were evaluated. Intramyocellular
and extramyocelullar lipid content ratings were obtained by
magnetic resonance spectroscopy.
Main results: The mean BMI SDS was +2.5(0.7), the WC/
height0.6(0.05) and the percentage of body fat37.8%(6.3).
We found the inadequacy values of36.4% of TC, 75.7%of
HDL, 34.8% of LDL and 53%of TG. The mean of fasting
insulin was 19.1(10.8) and IMCL=4.6(4.7). We found a positive correlation of IMCL with HOMA-IR(r=0.339,p<0.005);
IMCL with triglyceride/HDLc(r=0.251,p<0.042) and with
IMCL/EMCL ratio and HOMA-IR(r=0.513,p<0.001).
Conclusion of the presentation: We found a high percentage of inadequacy of the lipid profile, suggesting that this
population may be at cardiovascular risk. There was a positive association between ectopic fat assessed by the presence
of IMLC content with higher levels of insulin and the TG/
HDL-c, suggesting the importance of ectopic fat in the pathophysiology of insulin resistance. We suggest that the analysis
of IMCL lipid content may be useful on the assessment of the
metabolic risk in overweight patients
PA.11.013
Superficial Soft Tissue Lesions : Imaging
Findings and Systematic Approach
Authors: SAVARESE, L.G.; HERNANDES, M.A.; SIMÃO,
M.N.; YAMASHITA, M.E.A.S.; GAVA, N.F.; ENGEL, E.E.;
NOGUEIRA-BARBOSA, M.H.
Preto; São Paulo; Brasil.
Author responsible: Leonor Garbin Savarese
Introduction: Superficial soft-tissue lesions are frequently
encountered by radiologists in everyday clinical practice. Imaging findings of some lesions, such as lipomas, usually enable a definitive diagnosis. However, the imaging features of
many superficial soft-tissue lesions may be nonspecific. The
aim of this study is to illustrate a systematic approach that can
help the diferential diagnosis of superficial soft-tissue lesions.
Methods Involved: Review the imaging findings of superficial soft-tissue lesions, including pathology-proven cases.
Radilogic-pathologic correlation is made in selected cases.
Discussion: Superficial soft-tissue lesions can be categorized
into lesions that arise in the cutaneous tissue (epidermis/dermis), subcutaneous or in the fascia overlying the muscle. In
addition to location, by sistematically using the lesion imaging characteristics, the patient’s age and clinical history, the
radiologist may narrow the differential diagnosis for lesions
with indeterminate characteristics, or achieve a definitive diagnosis for lesions that have characteristic features.
Conclusion of the presentation: Superficial soft-tissue lesions are manifestations of a wide variety of benign and malignant processes. With a systematic approach, the radiologist
can develop an appropriate differential diagnosis list. Biopsy
is frequently needed to confirm the diagnosis.
PA.11.014
Arthrotomography and magnetic resonance imaging in the evaluation of internal injuries of the knee - a pictorial essay
with arthroscopic correlation
Authors: Chagas Neto, F.A.; de Oliveira Neto, S.R.O.; Araripe Neto, M.A.; Ferreira, J.S.S.; Silveira C.R.S.; Nogueira-Barbosa M.H.;
Institution: São Carlos Imagem, Fortaleza, Ceará, Brasil
Author responsible: Sabino Rodrigues de Oliveira Neto
Introduction: Knee imaging is fundamental in preoperative planning, and magnetic resonance imaging is the method of choice. However, there are cases in which the use of
arthrotomography is relevant. In this essay we illustrate the
most common meniscus, ligament and chondral knee injuries
through magnetic resonance imaging (MRI) and arthrotomography with arthroscopic correlation.
Methods Involved: Consecutive cases were selected and
illustrative of the main types of knee internal injuries of patients who underwent MRI, arthrotomography and arthroscopy in our service. The pre-operative images were then correlated with the arthroscopic findings.
Discussion: MRI is the method of choice for assessing internal disorders of the knee, however, there are cases where
arthrotomography can be used as a supplement or alternate
method. This paper illustrates some of these situations, correlating with the arthroscopic findings.
Conclusion of the presentation: MRI is the method of choice
for preoperative evaluation of the knee internal disorders, however, there are cases where the use of arthrotomography to supplement or alone may provide important and accurate information, requiring the radiologist to be familiar with this method.
31
PA.11.015
Tumoral Calcinosis: Presentation of Two
Cases And Literature Review
Authors: JOJIMA F T; NAGAYA E M; CAMPOS, F H;
FERREIRA D L.
Institution: InRad - Instituto de Radiologia do Hospital
das Clínicas da Universidade de São Paulo, São Paulo, São
Paulo, Brasil
Author responsible: Fabio Tadafumi Jojima
is to present two cases of Tumoral Calcinosis, comparing radiologic features in three imaging methods (simple radigraphy, computadorized tomography scan, and magnectic ressonance imaging)
Medical History: There are presented the cases of K. M., 37
years old, female, and R. L. S., 31 years old, male, both with
periarticular mild pain.
Diagnosis: There are presented two cases of tumoral calcinosis, with a brief literature review. Tumoral calcinosis is a rare
hereditary disease, caracterized by a set of periarticular calcifications. The soft tissue lesions determined by this disease
are usually lobulated and wel delimited. Generally affects the
extensor faces of large joints, but it seldom involves the knee.
The associated bone is normal. Clinically, it may present pain,
but usually it is not observed. It admits differential diagnoses
like hyperparathyroidism, calcinosis (chronic renal disease,
universal, circumscribed), calcificant tendinitis, synovial osteochondromatosis, synovial sarcoma, osteosarcoma, myositis ossificans, gouty tophus, and calcific myonecrosis.
Discussion and summary of the case: Tumoral calcinosis shows alterations in the methods of radiography, computadorized tomography scan, and magnetic ressonance
imaging, and the radiologist has a important role in its diagnose investigation.
PA.11.016
ABERRANT ANTERIOR TIBIAL ARTERY: COMPUTED TOMOGRAPHY ANGIOGRAPHY EVALUATION
Authors: ROSSI, C.S.; SILVA, J.C.A.; FILHO, G.H.
Institution: Irmandade da Santa Casa de Misericórdia de São
Author responsible: Carolina da Silva Rossi
Brief description of the purpose of the study: Describe and
evaluate the incidence of aberrant anterior tibial artery, an
anatomic variant, using computed tomography angiography
(angio-CT) of the lower limbs.
Methods: A retrospective database of angio-CT studies of
the lower limbs from 2011 to 2014 was evaluated. All imaging was performed on multisection spiral CT (6 or 64 section) scanners.
Main results: A retrospective database of 297 consecutive
angio-CT studies of the lower limbs from 2011 to 2014 was
evaluated, and 6 cases of aberrant anterior tibial artery were
present, an incidence of 2,0%. The low-rate incidence and
lack of knowledge of this anatomic variant, can be related
to risk of injury of this artery during common orthopaedic
operations, and potentially lead to complications of inadvertent laceration such as hemorrhage, compartment syndrome,
necrosis, and even-lower limb amputation.
Conclusion of the presentation: The aberrant anterior tibial
artery is an important anatomic variant of the popliteal region
32
that can be recognized in Angio-CT exams of the lower limb,
with results similar to the literature.
PA.11.018
MAGNETIC RESONANCE IMAGING FINDINGS OF
FEMORAL CONDYLES OSSIFICATION PATTERNS
IN SCHOLAR AGE CHILDREN
Authors: OLIVEIRA JUNIOR L.G.; RODRIGUES J.C.;
TANEJA A.K.; SILVA W.J.P.M.; MIRANDA F.C.; HARTMANN L.G.C.; ROSENBERG L.A.; SANTOS D.C.B.; FUNARI M.B.G.
Author responsible: Luiz Gonçalves de Oliveira Junior
Brief description of the purpose of the study: The objective of this study is to provide information about prevalence
and MRI features related to the skeletal maturation process of
the femoral condyles.
Methods: Study approved by the Ethics Committee in Research. We reviewed 135 knee magnetic resonance imaging
studies (MRI) from 125 patients (age, 5-10 years). Imaging
readings were performed independently by two musculoskeletal radiologists, being graded for signal intensity and thickness of the cartilage, subchondral bone changes, and location
on the femoral condyle. Biometric data and limb side were
also tabulated. Statistical analysis was performed for interobserver agreement (Kappa).
Main results: In sum, 66 MRI from the left knee and 69 MRI
from the right knee were analyzed (bilateral in 10 subjects).
Initial results demonstrated chondral signal changes in 85.6%
and subchondral bone changes in 58.4% of the cases. Findings were more prevalent in the posterior condylar segment
and in males. There was no chondral thickness abnormality.
Statistical analysis resulted in good inter-observer agreement.
Most representative images will be shown.
Conclusion of the presentation: The high prevalence of
subchondral bone and chondral signal intensity changes related to the femoral condyles maturation process makes its
recognition by the radiologist essential for proper differentiation with osteochondral diseases, avoiding unnecessary
medical treatments and complementary studies.
PA.11.021
Increase of intramyocellular (IMCL) and
extramyocellular (EMCL) lipid content
assessed by magnetic resonance spectroscopy (MRI) in adolescents with overweight.
Authors: MARUICHI, M.D.; BONFITTO, A.J.; LYRA, A.;
FERREIRA, A.B.; COTRIM, N.G.; LONGUI, C.A.; MONTE, O.; KOCHI, C.; HERNANDEZ FILHO, G.
Institution: Irmandade de Misericórdia da Santa Casa de
São Paulo
Author responsible: Marcelo Damaso Maruichi
anthropometric data and IMCL and EMCL lipid content in
overweighted pubertal adolescents.
Methods: 77 obese adolescents were evaluated, 31 boys
and 46 girls, and 11 adolescents control. The study assessed
weight, height, waist circumference (WC), body mass index
(BMI, expressed as z scores - zIMC) and relation CA/height.
The measures of IMCL and EMCL lipids were obtained by
MRI spectroscopy, with subsequent measurement of the area
and the peak of these metabolites.
Main results: Positive correlations were observed between
zIMC and the variables: IMCL peak (r=0.306, p<0.001);
IMCL area (r=0.234, p<0.001); EMCL peak (r=0.240,
p<0.001) and EMCL area (r=0,261,p<0.001). Also, there
were positive correlations between IMCL peak (p=0.016);
EMCL peak (p=0.029) and EMCL area (p=0.003), when
these metabolites were compared to the control group.
Conclusion of the presentation: There was an increase in
the IMCL peak and EMCL peak and EMCL area in obese
adolescents, when compared to the control group. There was
also a positive correlation between zIMC and the values obtained by spectroscopy. Thus, we suggest that the analysis
of IMCL and EMCL lipids can be a useful tool in assessing
the metabolic profile in obese patients, since the presence of
ectopic fat is associated with increased cardiovascular risk.
12 - Neuroradiology
PA.12.001
Study of brain’s structural differences
by diffusion tensor images in literate
and illiterate individuals.
Authors: SILVA RE, 1; AMARO JR., 1; NITRINI R.2
Institution: 1 - Departamento de Radiologia, Faculdade de
Medicina da Universidade de São Paulo; 2 - Departamento de Neurologia, Faculdade de Medicina da Universidade
de São Paulo.
Author responsible: Rafael Emídio da Silva
Brief description of the purpose of the study: In this study,
we aim to compare structures of brain tissue regions using
diffusion tensor imaging data (apparent diffusion coefficient
- ADC), from literate and iliterate subjects.
Methods: We used diffusion tensor images acquired at 3T magnetic resonance image (MRI) system, adquired in a short time
after death (postmortem interval=13.39±1.99). 2D. Were included 6 subjects, with a mean age of 61.50±19.66 years divided
into 2 groups: group A ( n=3; age=68.33±17.50) - illiterate individuals / without schooling; group B (n=3; age=70.00±26.89)
- literate (years of study=10.67±0.58) formal.
Main results: ADC values observed at cortical regions
from group A were reduced in relation to group B at: right
hippocampus (7.08%, p=0.100); left hippocampus (7.27%,
p=0.100); right superior frontal cortex (12:40%; p=0.200);
left superior frontal cortex (15.73%, p=0.100) and left angular gyrus (5.35%, p=0.200). At white matter regions, ADC
values from group A were shown to be increased - 7.08%
(p=0626) at right hemisphere and 8.08% (p=0.519) at left
hemisphere - in relation to the group B.
Conclusion of the presentation: Results allow us to infer
that subjects with higher levels of education tend to present
less tissue diffusivity, which may be related to the higher concentration of neuropil at analyzed brain regions.
PA.12.002
Stroke in a young adult caused by meningovascular neurosyphilis.
Authors: PINCERATO, RCM; PINHO, PC; FREUA, F;
ALVES, CAPF; AYRES, AS; RABELLO GD
Institution: HOSPITAL SAMARITANO, SÃO PAULO,
SP, BRASIL
the radiologic findings in one patient with meningovascular
neurosyphilis, that had the brain stroke as the first manifestation clinic.
Medical History: A 31-years-old man with no medical antecedents presented at the emergency department with headache, right hemiparesis and comprehension aphasia that progressed over one day.
Diagnosis: Brain MRI showed acute ischemic lesions in multiple and border vascular territories in the left cerebral hemisphere. Magnetic resonance angiography (MRA) demonstrated stenosis of the left supraclinoid carotid, proximal
anterior and middle cerebral arteries. Serology was positive
for HIV and Syphilis. Cerebrospinal fluid analysis disclosed
a linfomonocytic pleocytosis and positive Syphilis reactions.
Syphilis may involve the central nervous system (CNS) and
develops in about 5% of untreated patients. With the recent
increase in the incidence of primary syphilis and recurrent
infeccion, a recrudescence of the CNS forms of the disease
has occurred. The menigovascular type, accounting for a minority of all cases of neurosyphilis, may manifest as an acute
stroke syndrome. Arteritis, the most common form, affects
large and medium-sized arteries and these changes may result
in vessel occlusion, with secondary infarction.
Discussion and summary of the case: The diagnosis of meningovascular syphilis should be considered in patients presenting with vasculitis of uncertain etiology.
PA.12.003
Cranial hypotension secondary to CSF
fistula: recognizing the spectrum of findings in the various imaging methods to
reduce the initial underdiagnosis
Authors: PINCERATO, RCMP; PINHO, PC; AYRES, AS;
ALVES, CAPF; RIMKUS, C; PINTO, LF; CALDERARO,
M; RABELLO, GD.
Institution: HOSPITAL SAMARITANO, SÃO PAULO,
SP, BRASIL
Brief description of the purpose of the Review of Literature: Radiologic evaluation of CSF leaks is a diagnostic
challenge that often involves multiple imaging studies. We
aimed to assess the imaging spectrum of CSF leaks and intracranial hypotension to minimize initial underdiagnosis.
Total of 7 patients with clinically proved CSF leak syndrome
underwent imaging examination. Three patients underwent a
MR imaging, one underwent a computed tomographic myelography, one underwent a MRI and CTM, and two underwent a magnetic resonance myelography.
Conclusion: The CSF epidural collection was visible in 6.
Spinal meningeal diverticula were present in 2 patient e dilatation of the venous plexus were observed in 4. Brain MR
imaging findings of intracranial hypotension were present in
3 patients. Intracranial hypotension syndrome is a rare cause
of headache mostly originating from a dural CSF leak and an
initial misdiagnosis is common. Several imaging techniques
are available to confirm the diagnosis and to detect the location of the dural leakage, including spinal MR imaging, CT
myelography and MR myelography.
33
Brief discussion of the case We report a set of radiographic
manifestations that can help in the detection of CSF leaks
reducing initial misdiagnosis in patients with symptoms of
intracranial hypotension
PA.12.005
CLINICAL APPLICATIONS OF BRAIN MRI AUTOMATIC SEGMENTATION
Authors: Dal-Bó, M.B.; Santos, M.S.; Leão, L.R.S.; Dalaqua, M.; Barbosa Júnior, A.A.; Funari, M.B.G.
Author responsible: Marielli Benedet dal Bó
Introduction: Automatic segmentation using MRI has been
routinely performed to quantify brain atrophy in the context
of dementia. Our software is approved by FDA and measures
volumes of hippocampi, ventricles and remaining structures,
comparing the results to an FDA-approved database of healthy
north-americans regarding age, gender and total brain volume.
The aim is to describe how it works, its physical principles,
most common artifacts and main clinical applications.
Methods Involved: Review of literature and retrospective
analysis of MRI exams of patients with dementia in a private
quaternary hospital in São Paulo.
Discussion: Automatic segmentation and volumetric analysis
of brain structures aim to reduce subjectivity and increase accuracy in the differential diagnosis of dementia, considering
hippocampal atrophy is a biomarker of Alzheimer\’s disease.
It can also be useful for assessing the progression of hippocampal atrophy, contributing to the diagnosis of mesial temporal sclerosis and monitoring patients with multiple sclerosis.
Conclusion of the presentation: Automatic segmentation
and volumetric analysis of brain structures reduce subjectivity of the observer. Motion and technical artifacts can influence processing of data and its results, so neuroradiologists
should be familiar with these details. We emphasize the need
for a brazilian database for comparison.
PA.12.010
PROCESS OF NORMAL NEWBORN AND INFANT
MYELINATION: MAGNETIC RESONANCE ATLAS
Authors: UTIDA, HM.; MAHFOUZ, K.; KELLER, DFH.;
DE CARVALHO NETO, A.; BERTHOLDO, DB.
Institution: Hospital de Clínicas da UFPR , Curitiba, Paraná,
Brasil
Author responsible: Hellen Mariko Utida
Introduction: The normal myelination process can simulate
diseases in magnetic resonance imaging (MRI). We develop
an atlas with MRI images to demonstrate the normal pattern
of myelination.
Methods Involved: Normal brain MRI of children under
two years old performed at our institution in the last 4 years
were cataloged .
Discussion: MRI is a useful tool to investigate white matter diseases, due to high sensitivity to detect lesions. It also
does not use ionizing radiation. During the neonatal period
and early childhood major changes occur in the neurological
system, almost weekly. So many changes in such a fast pace
make the interpretation of MRI challenging to the radiologist with no experience in pediatric neurology. We assembled
an atlas with illustrative cases of normal myelination from 0
34
to 2 years old. It allows the analysis and comparison of the
white matter maturation stages and demonstrates myelination
in chronological and spatial order, the MRI techniques used
and its pitfalls.
Conclusion of the presentation: MRI of the infant brain has
given an enormous insight into the maturational processes
evaluation. It reveals detail changes that are not possible on
other methods. Therefore, it is important to recognize them to
avoid diagnostic errors and unnecessary investigations.
PA.12.012
Recurrent glioblastoma multiforme
(GBM) and treatment-related lesions:
qualitative evaluation of dynamic contrast enhanced (DCE) graphics.
Authors: AYRES, AS., PASSOS, UL., HIRATA, FC., ZUPPANI, HB., LUCATO, LT., LEITE, CC., GARCIA, MRT.
Institution: Icesp - Instituto do Câncer do Estado de São
Author responsible: Aline Sgnolf Ayres
Introduction: Concurrent chemotherapy and radiation therapy (CCRT) has become an important therapeutic adjunct to
surgical resection for patients with GBM. However, this therapy can lead to treatment-related lesions which can appear
as progressive contrast enhancement at follow-up magnetic
resonance (MR) imaging. We reviewed the utility of DCE in
distinguishing treatment-related changes from recurrent disease in GBM patient.
Methods Involved: The DCE graphics of patients with GBM
and increased enhancement after or during CCRT were evaluated and correlated with clinical and radiological results or
pathological results.
Discussion: The differentiation of therapy-induced necrosis from recurrent tumor is challenging. Functional imaging
techniques have been developed to the assessment of tumour
angiogenesis, such DCE. DCE is used to estimate vascular
permeability by measuring contrast medium leakage through
the blood-brain barrier (BBB). In clinical practice, softwares
for evaluation of the transfer constant (Ktrans) are not widely available, requiring the qualitative assessment of the DCE
graphics in patients follow up. A very rapid increase in signal
intensity following the gadolinium injection, compatible with
a leaky BBB from vascular lesion is seen in recurrent tumor.
A slow increase in signal is compatible with a leaky BBB
compatible with radiation necrosis.
Conclusion of the presentation: DCE graphics could help distinguishing treatment related changes from recurrent tumour.
PA.12.013
EXPERIENCE WITH THE USE OF PORTABLE CT
SCANNER IN A HIGH COMPLEXITY HOSPITAL
Authors: SARAIVA, T.V.; MARTINS, R.S.; FUKUMORI,
B.; SILVA, E.F.; DALAQUA, M.; HANDFAS, B.W.; TACHIBANA, A.; BARBOSA JR., A.A.
SÃO PAULO, SP, BRASIL
Author responsible: Thiago de Vasconcelos Saraiva
Introduction: Head CT is an aider for medical decisions in
critically ill patients, many of those hemodynamically unstable, monitored and at risk of complications during transport
to the radiology department, such as accidental removal of
ventilation apparatus and decubitus change. To minimize
these potential complications, a specialized team is needed
for transportation every time, which increases costs. Portable
head CT scanning (pCT) is performed at bedside, avoiding
transportation, turning into an advantage in this scenario.
Methods Involved: Review of records and pCT images of a
high complexity hospital in São Paulo.
Discussion: pCT reduces complications and costs associated
to transportation. pCT may also offer financial benefits by increasing the number of exams to be performed in the routine
of radiology department. This report discusses peculiarities
of radiation protection, dose, diagnostic accuracy and difficulties in carrying out exams at bedside.
Conclusion of the presentation: Despite inherent difficulties of this method, which should be acknowledged by the
multidisciplinary team, use of pCT is beneficial for the patient and for the hospital.
PA.12.014
WHAT YOU NEED TO KNOW ABOUT THE DIAGNOSIS OF CEREBRAL HEMIATROPHY
Authors: G,G. Paiva; Oliveira, V.S.; Libânio, B.B.; Bolinelli, A.P.; Valente, M.; Esteves, A. D.
Author responsible: Gledson Garcia de Paiva
Introduction: Cerebral hemiatrophy is related to several
syndromes including: Dyke-Davidoff-Manson Syndrome,
Stuge-Weber syndrome, Rasmussen\’s encephalitis, Hemimagalencefalia, among others that may have occasional cerebral
hemiatrophy, as tuberous sclerosis. The review of clinical and
radiological associations, the correlation with signs of skull
radiological examinations and laboratory tests are essential
for the diagnosis.
Methods Involved: The cases were selected by a search toll
designed to find images and reports from June 2010 to December 2014. The radiological findings were peer-reviewed and
compared retrospectively with clinical data of the same period.
Discussion: The etiology of hemiatrophy can be classified
into two groups: congenital or primary and acquired or secondary. Distinct types relate to vascular insults at different
phases of embryonic development. The main etiological factors are trauma, infection, cerebrovascular changes. The association of clinical/evolutionary data with imaging findings
described in head exams and the correlation of them with imaging studies of other systems support in clinical diagnosis.
Conclusion of the presentation: Signs of cerebral hemiatrophy and cranial imaging studies using traditional sequences
refer to a range of differential diagnoses, which combined
with specific image signals of complementary methods support in clinical diagnosis.
PA.12.015
Erdheim- Chester disease : case report
and literature review
Authors: FIGUEIREDO, MAP; LEAL, NL; FERNANDEZ,
C; OLIVAL, LD; NETO, WA; SIQUEIRA, CCG; SOUBHIA,
HR; WALCZAK, TGR; ORLANDI, JLM; GAVINO, JF; SOUZA, EZ; SALGADO, AABO; SINISGALLI JUNIOR, CA
Institution: Hospital São Luiz, São Paulo, São Paulo, Brasil
Author responsible: Maria Augusta Pacheco Figueiredo
Brief description of the purpose of the report: The objective is to present a patient with clinical and typical findings of
Erdheim-Chester disease and discuss the clinical and radiological findings based on literature review.
Medical History: Male patient, 50 years old, came to our
hospital after a sudden episode of imbalance and paresis in
the right leg. Referred to as personal background diabetes,
myopia and bilateral glaucoma. The MRI showed extra-axial
neoplastic expansive processes with wide base located in the
interhemispheric sickle and in the posterior fossa. There were
still expansive lesions in the retro-ocular regions, intra-conal
situation, determining exophthalmos, but with optic nerves
and extrinsic muscles preserved. The MRI also detected bone
lesions characterized by significant change with infiltrative
aspect signal of bone marrow, with contrast-enhanced heterogeneous enhancement. Patient underwent neurosurgery and
immunohistochemical analysis showed positivity for CD68
(PG- M1) and CD1a (negative MTB1) .
Diagnosis: The findings were consistent with the diagnosis of
Erdheim-Chester disease, histiocytosis rare non- Langerhans
cells of unknown etiology, affecting multiple organ system.
Discussion and summary of the case: We conclude that, despite this is a rare disease, the radiologist should be familiar
with set of findings that suggest the diagnosis.
PA.12.016
Central nervous system and advanced
magnetic resonance imaging techniques
Authors: MOREIRA BL, GRUNEWALD T, VILAS BOAS
TV, PEREIRA JUNIOR IC, GARCIA LAL, FREITAS LF,
MARUSSI VHR, CAMPOS CMS, LOPES BSC, AMARAL LLF
Institution: Hospital Beneficência Portuguesa - Med Imagem, São Paulo, São Paulo, Brasil
Author responsible: Bruno Lima Moreira
Brief description of the purpose of the Review of Literature: The aim of this study is to review the imaging features
of central nervous system (CNS) lymphoma, focusing on the
use of advanced magnetic resonance imaging (MRI) techniques, especially diffusion-weighted imaging, spectroscopy,
perfusion and permeability. We use histologically proven cases from our digital archieve to illustrate these topics.
The incidence of CNS lymphoma is increasing in the last
decades. Although the conventional imaging techniques are
useful for identifying and diagnosing brain tumors, there is
an overlapping in their features. Advanced MRI techniques
have been identifying findings in CNS lymphoma that are
useful for this differentiation.
Conclusion: In general, CNS lymphomas usually demonstrate restricted diffusion, elevated lipid (lip) peaks in solid
component and high coline/creatine (Cho/Cr) ratio, lower relative cerebral blood volume and flow (rCBV e rCBF) compared with glioblastomas and higher volume transfer constant (Ktrans) and flux rate constant (Kep) values compared
with glioblastomas.
Brief discussion of the case The use of advanced MRI techniques increases the accuracy of CNS lymphoma diagnosis
and may also be useful in evaluation of therapeutic response.
PA.12.019
Using the
35
Authors: PEREZ JA, EIFER DA, LONGO MG, SALVIO L,
ISOLAN GR, PITREZ EH, VEDOLIN L
Institution: HOSPITAL DE CLINICAS DE PORTO
ALEGRE, PORTO ALEGRE, RIO GRANDE DO SUL,
BRASIL
Author responsible: Maria Gabriela Longo
Brief description of the purpose of the Review of Literature: This study aims to conduct a manual review of references, for the last studies published about the use of the technique
”feed-and-sleep” to carry out magnetic resonance imaging
(MRI) in neonates and compare the literature results with the
experience of a tertiary hospital in the Southern Brazil.
To perform the MRI by the technique of ”feed-and-sleep”,
newborns are breastfed minutes before the test to induce sleep
and placed in a restraint device without anesthesia.
Conclusion: In our service, from November of 2011 to November of 2012, 87 MRIs were performed with the ”feedand-sleep” technique. In 10 cases (11%) could not take the
study due to patient agitation, requiring the use of chloral hydrate in 8 cases (9%) and general anesthesia in 2 cases (2%).
These results are similar those described in the literature.
Brief discussion of the case The use of general anesthesia
for MRI in the neonatal population comes exams with high
technical quality. However, its risks, infrastructure, time and
costs required are relevant. In this context, a noninvasive
technique as \”feed-and-sleep\” can be considered as an alternative, providing good results with minimum risk.
PA.12.021
Critical analysis of diffusion tensor image in evaluating the parenchyma adjacent to intracranial tumors
Authors: FRAGOSO, D.C.; ROCHA, A.J.; MAIA JR, A.C.
Author responsible: Diego Cardoso Fragoso
Brief description of the purpose of the study: Quantitatively evaluate the ability of the diffusion tensor image (DTI)
to differentiate high-grade glial neoplasms (infiltrative) of
metastases and meningiomas (not infiltrative) and conduct a
literature review.
Methods: A number of cases were selected based on the data
available in the digital archiving system. An experienced
neuroradiologist compared the derived values of DTI in the
perilesional hyperintense areas in T2 / FLAIR and normal
appearing white matter between infiltrative and non-infiltrative tumors. The results of this series of cases were compared
with available data in the literature.
Main results: There is no consensus in the literature regarding the differences in the values derived from the DTI in the
regions of interest between infiltrative and not infiltrative tumors. The results of this series of cases showed no differences between those regions.
Conclusion of the presentation: The DTI is a promising
technique for microstructural evaluation, although there are
conflicting results in the literature. Additional studies are
needed to validate this technique in order to reliably distinguish vasogenic edema from peritumoral infiltration.
13 - Pediatrics
36
PA.13.001
STANDARDIZATION OF THE HEAD ULTRASONOGRAPHY AND ITS USUAL AND NOT USUAL
APPLICATIONS
Authors: Dal-Bó, M.B; Silva, M.M.A; Sameshima, Y.T.; Yamanari, M.G.I.; Neto, M.J.F.; Funari, M.B.G.
Author responsible: Marielli Benedet dal Bó
Introduction: The head ultrasonography is the method of
choice for initial evaluation of the newborn brain. It can be
performed at the bedside, without ionizing radiation. We
emphasize in this work the importance of standardized documentation showing the main levels of \”sonographic slices\” and the main brain pathologies of prematurity, such as
periventricular leukomalacia, hemorrhage in the germinal
matrix / intraventricular and periventricular hemorrhagic infarction. Unusual applications such as in obstetrics traumas,
craniostenosis and scalp disorders will also be illustrated.
Methods Involved: Presentation of selected cases from 2006
to 2014 period in the neonatal ICU of a quaternary private
hospital in Sao Paulo to illustrate the main brain diseases in
premature infants.
Discussion: Advanced technology nowadays used in neonatal ICU allows for higher survival of extremely preterm
infants and/or weighing less than 1500 g and, as a direct consequence, occurs an increase in the incidence of prematurity
encephalopathy that may lead to attention, socialization and
behavioral changes, cognitive deficits, and even large motor
deficits such as cerebral palsy .
Conclusion of the presentation: Standardized documentation of the head ultrasound is of paramount importance to
the systematization and interpretation of premature´s brain
pathologies and for subsequent controls.
PA.13.002
RADIOGRAPHIC PREDICTORS OF THE WORST
PROGNOSIS IN NEWBORNS WITH NECROTIZING
ENTEROCOLITIS
Authors: SANTOS, I.G.G.; MEZZACAPPA, M.A.M.S.;
ALVARES, B.R.
Institution: Centro de Atenção Integral à Saúde da Mulher-CAISM, Universidade Estadual de Campinas-UNICAMP, Campinas, São Paulo, Brasil
Author responsible: Isabela Gusson Galdino dos Santos
Brief description of the purpose of the study: To investigate clinical and radiological risk factors for the worst
prognosis of newborns with necrotizing enterocolitis (NEC):
death, perforation and intestinal stenosis.
Methods: The study analysed radiological exams and records of 66 infants with NEC who presented intestinal pneumatosis, associated or not with air in portal system (APS).
Clinical and radiological variables were evaluated. Statistical
analysis was performed by Chi-square test, Mann-Whitney
and Logistic Regression (p<5%).
Main results: 7 cases presented APS, 15 evolved to perforation, 16 to stenosis and 12 to death. Bivariate analysis
revealed variables associated with death: perforation, pneumatosis in large and small intestines, APS, higher gestational
age, longer periods of mechanical ventilation until identification of pneumatosis and longer periods until discharge/death.
Multivariate regression did not identify any variable associated with perforation or stenosis and the following variables
remained as predictors of death: APS (OR=69.7; p=0.003),
perforation (OR=23.2; p=0.009) and pneumatosis in small
and large intestines (OR=12.4; p=0.035).
Conclusion of the presentation: This study identified as major risk factors for death during NEC: intestinal pneumatosis
associated with APS, intestinal perforation and pneumatosis
location. These variables were not significant for the outcomes perforation and stenosis.
PA.13.003
Interrupted aortic arch in pediatric age
group: rare condition, image features
and investigation
Authors: MUNIZ NETO, F.J; CAVALCANTE, F.A.;
SAMESHIMA, Y.T; YAMANARI, M.G; FRANCISCO
NETO, M.J; FUNARI, M.B.G.
Author responsible: Francisco Julio Muniz Neto
is to review the literature and report a new case of interrupted
aortic arch (IAA).
Medical History: Eight day-old newborn underwent a routine
ultrasound and diagnosed with aortic arch anomaly, and complemented with a chest CT angiography for the correct preoperative planning and diagnosis of type B IAA. The patient
underwent cardiac surgical correction with a good follow-up.
Diagnosis: IAA is an anatomical and luminal discontinuity
between the ascending and descending aorta, which may be
complete or remain connected by fibrous tissue. IAA is rare
condition, less than 1.5% of congenital heart malformations,
which results due to a failure in the development of the aortic
arch between the 5th to 7th weeks of intrauterine life. It is
often associated with DiGeorge syndrome and patent ductus
arteriosus. It can be classified as: type A - there is the interruption distal the left subclavian artery (42%); type B - interruption occurs between the left common carotid artery and
the subclavian artery (53%); and C-type - segment is interrupted between the innominate artery and the left common
carotid artery (4%). The main differential diagnosis is severe
aortic coarctation.
Discussion and summary of the case: The main diagnostic
criterion is the absence of the aortic arch visualization in different imaging modalities.
PA.13.004
Solitary Infantile Myofibroma on the
chest wall: report of a rare disease
Authors: MACIEL, M.S; CONSORTI,L; RYDZ, P.P.S;
ALMEIDA B.G.L; SOUZA, A.S; PORTUGAL, A.C.G
Author responsible: Mateus Maciel e Sousa
Brief description of the purpose of the report: Infantile
fibromatosis is responsible for 35% of all soft tissue tumors
present in newborns; the miofibroma is one of its subtypes,
with an estimated incidence of 1: 400,000 live-births.
Medical History: Newborns with bulging soft tissue in the
chest wall. Initially assessed by conventional radiography
and ultrasound of the chest, it was decided to continue the
investigation by computed tomography (CT), performed with
low-dose protocol, demonstrating expanding tumor with soft
tissue density in the chest wall with signs of remodeling of
adjacent ribs and heterogeneous impregnation through contrast). After five months new chest CT, showed increased
damage (proportional to the growth of the child), with components possibly related to lipid tissue.
Diagnosis: A solitary chest Infantile Myofibroma. There are
two forms of childhood fibromatosis, the solitary that most
often affects the head and neck, and multicentric, noticed
in soft tissues, bones and viscera. Spontaneous resolution
is described in most cases of myofibroma without visceral
involvement. In cases where there is visceral involvement,
there is typically a poor prognosis.
Discussion and summary of the case: Although rare, Infantyle Myofibroma should be considered in pediatric evaluation of solitary lesions in soft tissues, particularly during the
neonatal period or infancy.
PA.13.005
Incomplete Superior Sternal Cleft.
Authors: PEREIRA P.A.P.; SANTANA P.R.P.; TEIXEIRA
E.M.; FURLANETTO G.; GOMES A.C.P.
Author responsible: Pedro Annovazzi Paulo Pereira
Brief description of the purpose of the report: To demonstrate the characteristic imaging findings of this subtype of sternal cleft, which are crucial for diagnosis and treatment planning.
Medical History: Female patient, 28 days of life, term delivery, referred for computed tomography (CT) of the chest,
to evaluate a chest wall deformity in the upper sternal region, providing pulmonary protrusion during expiration.
There were no associated comorbidities or other findings on
physical examination. CT performed with low dose protocol, showed incomplete discontinuity in the middle line of
the sternum in the upper portion, featuring sternal cleft. Early
surgical correction was performed.
Diagnosis: Incomplete superior sternal cleft. Sternal Cleft
is a rare congenital chest deformity often associated with
other malformations, classified according to their length in
complete or incomplete, which can be superior or inferior.
Its isolated form is even less common and has only few
cases described in the literature. The diagnosis is usually
postnatal, through clinical examination and imaging tests,
especially CT because of its higher availability, lower cost
and high spatial resolution. Most authors recommend early
surgical correction.
Discussion and summary of the case: The knowledge
of this abnormality by the radiologist is very important,
since imaging studies are essential for diagnosis and surgical planning.
PA.13.007
PALBABLE ABDOMINAL MASS IN PEDIATRIC PATIENTS: WILMS TUMOR VERSUS NEUROBLASTOMA
Authors: OLIVEIRA, V.S.; PAIVA, G.G.; LIBÂNIO, B.B.;
DUTRA, M.S.B.G.; BOLINELLI, A.P.; VALENTE, M.
Author responsible: Victor Santos Oliveira
37
Brief description of the purpose of the Review of Literature: In front of a child with a palpable abdominal mass,
two pathologies must always be in the differential diagnosis:
Wilms Tumor and Neuroblastoma. The study aims to highlight and illustrate the main image features that distinguish
these two entities.
Scientific articles were analyzed as well as cases of a health
service and medical literature, seeking to describe image features that help in the differential diagnosis between Wilms
Tumor and Neuroblastoma.
Conclusion: Both the Wilms tumor as Neuroblastoma primarily involves infants, as a large abdominal mass which is
related to the kidney, not always being possible the differentiation of their site of origin. It is extremely important to
try distinguish them and some radiological findings can help.
The Neuroblastoma tends to have calcifications, touch vascular structures without invading them, are poorly circumscribed and can raise the aorta contralateral to the column.
The Wilms tumor rarely has calcification, is well circumscribed, extend to the renal vein and inferior vena cava. All
these findings can help, when they are present, in the differential diagnosis between these two entities.
Brief discussion of the case There are some radiological nuances that may primarily suggest a diagnosis of Wilms Tumor
and Neuroblastoma, contributing to early treatment.
PA.13.008
Prognosis of necrotizing enterocolitis
(NEC) through radiological examinations
Authors: BRITO, M.L.C.B.; COSTA, R.S.; SOUSA, M.M.;
BORGES, L.C.; DIAS, E.N.
Institution: Instituto Tocantinense Presidente Antonio Carlos - ITPAC, Araguaína, Tocantins, Brasil
Author responsible: Maria Lucia Carneiro de Brito
Brief description of the purpose of the Review of Literature: This review aims to describe the relevant points of
discussion about the prognosis of necrotizing enterocolitis
(NEC) through radiological examinations.
The NEC is a multifactorial disease which pathogenesis is
not well understood, the main hypothesis are related to intestinal isquemia and aberrant bacterial colonization. It affects
more preterm infants, in these patients the mortality rate can
reach 50%. The prognosis depends mostly of early detection
and appropriate surgical indication, then, the definition of the
most sensitivity method is very important.
Conclusion: The method of assessment most described is
the abdominal radiography which the radiographic findings are included in Bell’s staging system (initial evaluation and prognosis). Other radiological exams are the
ultrasound (US) (which allows the evaluation of echogenicity, peristalsis, the wall thickness and the perfusion,
the latter through the doppler of mesenteric artery and
celiac trunk), and the computerized tomography (CT) of
the abdomen, which is more sensitive to detect pneumatosis intestinalis.
Brief discussion of the case The abdominal radiography is
the principal method described in relation to prognosis, however it shows less sensitive than the US (which is a trend by
providing earlier diagnosis) and CT.
38
PA.13.009
Primary bilateral adrenal leiomyosarcoma in a pediatric patient with AIDS
Authors: MUÑOZ GE.,ROJAS AM.,POLO DE.,FLORES CM.
Institution: HOSPITAL NACIONAL ALBERTO SABOGAL SOLOGUREN,LIMA,PERU
Author responsible: Gabriela Muñoz Orihuela
Brief description of the purpose of the report: We describe
a case of primary adrenal leiomyosarcoma bilateral(PAL) an
uncommon immunosuppression-associated tumor studied by
radiological, histopathological and immunohistochemical
techniques.
Medical History: 10 year old female patient, HIV (+),Ig G
positive for Epstein Barr virus (EBV) and lymph node tuberculosis with three weeks of abdominal pain and diarrhea
and normal endocrine tests. Ultrasonography: heterogeneous
mass in the upper pole of both kidneys, with Doppler evidence of vascularization . Tomography: Bilateral adrenal
masses with soft tissue density and heterogeneous enhancement, 6 cm (right) and 3 cm(left).Magnetic Resonance:in
both adrenal glands neoformative heterogeneous lesions
,with mass effect but without local invasion.Adrenelectomy
was performed bilaterally.
Diagnosis: Histopathology: low-grade leiomyosarcoma. Immunohistochemistry positive for smooth muscle markers:
Actin(+), vimentin(+), CD68 (+/-), S100 (-).The PAL is a rare
malignant tumor associated with EBV infection in HIV patients. It is of mesenchymal origin, vascular smooth muscle.
Of silent growth it may produce symptoms by local compression.Without definitive serological markers, and radiologically unspecific, although > 6cm adrenal mass is malignant
in 85% of cases. The diagnosis is made by histopathology,
and the treatment is surgical removal. Generally they have a
poor prognosis.
Discussion and summary of the case: Include the PAL in
the differential diagnosis of adrenal tumors in patients with
HIV and EBV.
PA.13.010
Doppler ultrasonography study for umbilical cord catheterization evaluation
in neonates: ultrasonographic anatomy
and complications
Authors: CAVALCANTE, F.A; MUNIZ NETO, F.J;
SAMESHIMA, Y.T; YAMANARI, M.G.L; NETO, M.J.F;
FUNARI, M.B.G
São Paulo, Brasil
Introduction: Our aim is to expand the radiologists knowledge on umbilical catheterization evaluation. Since vascular
catheters introduction and the use of umbilical catheters for
exchange transfusions in 1947, umbilical catheterization has
been used routinely as an intravenous accesses to support
premature neonate.
Methods Involved: Presentation of anatomical landmarks
and main complications related to umbilical catheterization,
emphasizing the role of ultrasound and Doppler. We will describe these features with our institutional archives.
Discussion: Catheters misplacement may occur in many
different vascular structures, for instance, left atrium, and
also outside the vascular space, which may result in death.
Another common complication is the portal vein thrombosis
that might be initially asymptomatic then evolve with serious complications. Radiography, Doppler and B-mode ultrasound and angiography are often used to evaluate catheters
placement and its related complications.
Conclusion of the presentation: Ultrasonography is a valuable method for screening umbilical vein catheterization, as
well as evaluating its potential complications and the portal
vein perviousness. In this scenario, radiologists play an important role in the catheterization evaluation and detection
of complications.
PA.13.011
Many Faces of Neuroblastoma: Sites of
Manifestation and Outcomes
Authors: CAVALCANTE, F.A; MUNIZ NETO, F.J;
SAMESHIMA, Y.T; YAMANARI, M.G.L; NETO, M.J.F;
FUNARI, M.B.G
São Paulo, Brasil
Brief description of the purpose of the Review of Literature: We will present the main characteristics of imaging
findings of neuroblastomas (NBM), its various sites of involvement, emphasizing main aspects of diagnosis, staging
and follow-up of this pathology, considered challenging by
many studies.
Description (s) condition (s), method (s) or technique
(s): Neuroblastoma is the most common type of extracranial solid malignant tumor in children. Its cells originate
from the neural crest and migrate to the adrenal medulla and sympathetic nervous system. NBM has extremely
variable behavior, as it may regress spontaneously, progress to benign ganglioneuromas or evolve to a fatal outcome. We will illustrate various forms of presentation and
behavior of this neoplasm from cases evaluated by multiple imaging modalities.
Conclusion: These tumors may originate in various locations
and metastasize to various sites. About two third of primary neuroblastomas arises in the abdomen, among these, two
third is from the adrenal glands. When the tumor originates
from the Zuckerkandl bodies, the child may present bowel or
bladder compression symptoms .
Brief discussion of the case Both radiology and nuclear
medicine, with their various modalities, take a fundamental
role in the diagnosis, staging and follow-up procedures of patients, including as definers of therapeutic conduct.
PA.13.012
PANCREATITIS IN CHILDHOOD: FROM DIFFERENT VIEWPOINT OF ADULT PANCREATITIS
Authors: LEAO, L.R.S.; SAMESHIMA, Y.T. ; YAMANARI,
M.G.I.; BRINGEL, B.B ; LUZ, D.C ; FIGUEIREDO, J.R.P;
FRANCISCO NETO, M.J; FUNARI, M.B.G
Author responsible: Layra Ribeiro de Sousa Leao
Brief description of the purpose of the Review of Literature: This study aims to describe the spectrum of pancreatitis
in childhood.
It was carried out a systematic review of MEDLINE and
SciELO databases in the last 5 years on acute and chronic
pancreatitis in children, as well as consultation of relevant
references on the articles obtained.
Conclusion: The most common causes of pancreatitis in children are idiopathic, trauma, drugs and congenital anomalies.
Nearly a quarter of children with pancreatitis will develop a
complication, namely, pseudocyst, necrosis, vascular thrombosis and abscess, while the mortality rate is approximately
4%. The widely used imaging methods are abdominal ultrasound and computed tomography (CT). Although CT has
been the main method for imaging of the pancreas, this modality is limited in the pediatric population because of poorly
developed retroperitoneal fat planes and the use of potentially
harmful ionizing radiation. The magnetic resonance imaging
with cholangiopancreatography provides superior soft-tissue
resolution and improved visualization of ductal anatomy, and
avoiding exposure to radiation.
Brief discussion of the case The knowledge of specific features of pancreatitis in children have shown important role in
control of the disease. The use of ultrasound as the method
of choice avoids unnecessary exposure to ionizing radiation
following the ALARA principles.
PA.13.013
Wernicke\’s encephalopathy secondary
to pancreatic trauma in a pediatric patient: case report and literature review.
Authors: COLOMBO, E.C.E; SZEJNFELD, D; VOLPATO,
M.M; OLIVEIRA, P.S; LOPES, M.; SALEH, N.M; SILVA, M.G.
São Paulo, Brasil
Author responsible: Elizabeth Cristina Elias Colombo
Brief description of the purpose of the report: Wernicke\’s
encephalopathy is a rare neurological disorder caused by thiamine deficit. The authors report a case even more unusual of
a three years old boy. The objective of this work is to study
this potentially misdiagnosed situation.
Medical History: He was hospitalized due to blunt abdominal trauma and underwent laparotomy with splenectomy
and liver and pancreas suture. He progessed with pancreatic abscess and underwent reoperation. At the fiftieth day
of hospitalization progressed with nystagmus and altered
mental status.
Diagnosis: The head tomography scan, cerebrospinal-fluid analysis and infective serologies were inconclusive.
Magnetic resonance imaging showed bilateral increased
T2 and FLAIR signal with restricted diffusion on putamen,
caudate-nuclei heads, medial thalamus, periaquedcutal
area and fourth ventricle floor. The diagnosis was then
suspected, and there was full recovery after thiamine replacement therapy.
Discussion and summary of the case: The clinical hallmark
is ataxia, nystagmus and altered mental status triad, and is
more common in chronic alcohol abuse. Therefore it is also
known as alcoholic encephalopathy, but this seems to be a
misnomer since it is a nutritional deficit that may affect critically ill patients. The review of indexed literature showed no
report of Wernicke\’s encephalopathy and pancreatic trauma
association in children. A feasible hypothesis is that pancreatic trauma triggered this nutritional complication.
39
14 - PET-CT
PA.14.001
Detection of Distant Metastases in
Patients with Primary Breast Cancer:
Is 18FDG-PET/CT Better Than Conventional Imaging?
Authors: CUNHA, R. R.; CONRADO, J. L. F. A.; BITENCOURT, A. G. V.; ANDRADE, W. P.; LIMA, E. N. P.
Paulo, Brasil
Author responsible: Rodrigo Rodrigues da Cunha
Brief description of the purpose of the study: To compare
18-FDG PET/CT and conventional imaging tests for the detection of distant metastases in patients with breast cancer.
Methods: We retrospectively evaluated 81 patients with
breast cancer that were submitted to 18FDG-PET/CT before
treatment. 18FDG-PET/CT and conventional imaging findings were compared with findings on biopsy, subsequent imaging, or clinical follow-up. Conventional imaging included:
bone scintigraphy; chest X-ray (14.5%) or CT (85.5%); and
abdomen ultrasound (10.8%), CT (87.8%) or MRI (1.4%).
Main results: Patient’s mean age was 44.9 ± 12.0 years
(range, 24-73 years). The size of the primary breast tumor
varied from 19 to 150 mm (mean 55.8 ± 24.5 mm). Distant
metastases were observed in 9 patients (11.1%). 18-FDG
PET/CT and conventional imaging identified distant metastases in 8 patients each (9.8%), demonstrating the same
sensibility (88.9%). Conventional imaging did not show metastases to mediastinal lymph nodes and sternum that were
identified on 18FDG-PET/CT in on patient. 18FDG-PET/CT
did not demonstrate a bone metastasis in one patient that was
evident on bone scintigraphy.
Conclusion of the presentation: There was no difference in
the sensibility of 18FDG-PET/CT and conventional imaging
(in our series most cases performed chest and abdomen CT
+ bone scintigraphy for staging) for the detection of distant
metastasis in patients with primary breast cancer.
PA.14.002
18F-FDG PET/CT brain and Magnetic Ressonance Imaging in a Patient Diagnosed with
Creutzfeldt Jakob’s disease
Authors: CAMACHO, M.R.F.; COSTA, T.O.; RIGON,
B.G.S.; MARTINS, M.P.; CARDOSO, T.A.M.O.; SANTOS,
A.O.; LIMA, M.C.L.; ETCHEBEHERE, E.C.S.C.; MOSCI,
C.; SOUZA ,T.F.; RAMOS, C.D.; AMORIM, B.J.
Institution: Departamento de Radiologia da Faculdade de
Ciências Médicas da Unicamp, Campinas, São Paulo, Brasil
Author responsible: Mariana Ramos Fernandes Camacho
Brief description of the purpose of the report:
Creutzfeldt-Jakob’s disease (CJD) is a rare and lethal neurodegenerative prionic condition. The aim of this study is to
show how 18F-FDG PET/CT can aid in diasease’s diagnosis.
Medical History: A 56 year-old man admitted with excessive
sleepiness, asthenia, aphasia, apraxia and ataxia. The symptoms started a month and worsened 13 days before admission. Considering the quickly development of the symptoms,
the hypothesis of CJD was considered. A brain 18F-FDG
PET/CT was performed, showing diffuse hypometabolism in
40
both cerebral and cerebellar hemispheres, more intense in parietal-occipital region, suggesting CJD. Initial Magnetic Ressonance Imaging (MRI) demonstrated mild and non-specific
changes. The electroencephalogram suggested CJD and the
protein 14.3.3 in the CSF was positive, enhancing CJD diagnosis. The patient had rapid progression of the symptoms,
becoming bedridden, no communication and tube feeding
only 1 month after hospitalization. A new MRI showed progression of the alterations, being suggestive of CDJ.
Diagnosis: In this case report, 18F-FDG brain PET/CT
showed changes that were compatible with CJD, as described
in the literature, being more sensitive and bringing to light
earlier and more evident changes comparing to MRI.
Discussion and summary of the case: 18F-FDG brain PET/
CT may be an alternative method in the diagnosis of CJD, a
rare, fast progressive and severe disease.
PA.14.003
Monitoring of treatment with Radium-223
(223 Ra) in prostate cancer.
Authors: RIBEIRO, A. M. B., PANTOJA, L. O., CONRADO, J. L. F. A., VON GRAPP II, A., MARTINEZ, I. C. C.,
TORRES, I. C.G., CAVICCHIOLI, M., LIMA, E. N. P.
Paulo, Brasil
Author responsible: André Marcondes Braga Ribeiro
Brief description of the purpose of the report: Present aspects of Radium-223 management in the treatment of bone
metastases of prostate cancer.
Medical History: G.T.S., male, 59, prostate hormone refractory cancer diagnosed in 2011, evolving with osteolytic metastases and painful episodes of difficult control being
referred for treatment with Radium-223. Restaging, perform
PET / CT with 18F-fluoride to characterize the target bone lesions with 18F-FDG to determine the degree of basal activity
of the lesions on the SUV and its possible reduction during
treatment. The 18F-fluoride identified multiple
Diagnosis: The new alpha emitting therapeutic don´t generate images and thus involves the need for adequate control
of the course of treatment. The simultaneous application of
the two techniques described can provide information on the
appropriateness of treatment and simultaneously monitor the
metabolic changes, quantifying the answer.
Discussion and summary of the case: Our initial experience indicates the potential use of this combined technique
for monitoring of treatment with Radium-223
PA.14.004
Added value of 18FDG-PET/CT in the staging
and restaging of esophageal cancer to
allow assessment of the skeleton
Authors: JAIMEZ, F.D; GONZALEZ, C. J.; BRUNO, G.;
TINETTI, C. ; BUSTOS, N. D.; TRAVERSO, S. OSORIO, A.
Institution: Fundación Centro Diagnóstico Nuclear, Buenos
Aires, Argentina
Author responsible: Fernando Damian Jaimez
Brief description of the purpose of the study: Routinely
conventional diagnostic methods accepted by International Consensus for esophageal cancer, are not considered for
the specific evaluation of the skeleton bones. The aim of
our study is to evaluate the value of 18-fluorodeoxyglucose
Positron Emission Tomography/Computed Tomography
(18FDG-PET/CT) in staging and restaging of esophageal
cancer, mainly to enable the detection of bone involvement
Methods: We evaluated retrospectively 124 patients with confirmed esophageal cancer who underwent 18-FDG-PET/CT.
Visual parameters and the determination of maximum Standardized Uptake Value (SUVmax) was taken into account. Validation
of bone lesions was carried out with biopsy, clinical follow-up,
conventional imaging methods and new 18FDG-PET/CT study
Main results: Of the124 patients evaluated, 16 (12.9%) had
bone metastases. SUVmax of the lesions oscillated between
3.6 and 17.1 (average 8.1 ± 4 g/ml). Of the 16 patients, 13
showed structural alterations on CT and the remaining 3
(18.7%) didn’t show any morphological findings
Conclusion of the presentation: 18FDG-PET/CT seems to
improve staging and restaging of esophageal cancer since it
has the added value to evaluate the whole body in a single
scan, favoring the detection of bone metastases, which are
often unexpected, mainly in asymptomatic patients, leading
to changes in therapeutic conducts in many cases.
PA.14.005
Evaluation of a case of malignant histiocytosis by PET-CT
Authors: ALBUQUERQUE LF; MOURA JAC; MOURA
DS; MENEZES MCA; ROCHA ACMA
Institution: Clínica SOM diagnóstico , Belém, Pará, Brasil
Author responsible: Lhorem Fernandes Albuquerque
Brief description of the purpose of the report: This report describes a case of malignant histiocytosis evaluated
with PET-CT.
Medical History: JLMA patient, male, 41 years old, brown,
coming from Belém that the diagnosis had multiple lymphadenopathy, splenomegaly and weight loss. Performed biopsies of
lesions in 2002 with histopathological compatible with malignant histiocytosis. Established chemotherapy and radiotherapy
with complete response and is then maintained with periodic
follow-up oncologic PET-CT of the entire body. Currently the
patient presents with axillary and cervical lymphadenopathy
and PET-CT demonstrating lymph node involvement (lymphadenopathy) and pulmonary (excavated nodules).
Diagnosis: Malignant histiocytosis is characterized by a systemic proliferation of atypical histiocytes, causing hepatosplenomegaly, lymphadenopathy and systemic symptoms of
fever and cachexia. These symptoms result from the infiltration of malignant cells of the reticuloendothelial system affecting various organs. Most patients are young adult, male and
the majority is found in stages I and II, while a smaller portion
present as the more extensive disease patients in this study.
Discussion and summary of the case: The PET-CT stands out
as an important aid in the proper evaluation of diffuse activity
and therapeutic response of patients with this rare disease.
PA.14.012
PET / CT in non-Hodgkin Mantle Cell
lymphoma
Authors: Cosenza N.N.; Ferrari, R.J.R.; Mosci, C.; Lima,
M.C.L., Amorim, B.J.; Santos A.O.; Souza, T.F.; Etchebehere
E.C.S.C; Ramos, C.D.
Author responsible: Nathalia Novaes Cosenza
Brief description of the purpose of the study: The mantle
cell lymphomas (MCL) is a relatively rare disease, accounting for 7% of non-Hodgkin lymphomas. It can be behave as
an aggressive or indolent tumor. We evaluated the role of
18F-FDG-PET/CT in this disease.
Methods: We evaluated 13 patients with MCL between
July/2013 and September/2014 (10 male, between 37 and 80
years, mean: 60 years) who underwent 19 PET/CT-18F-FDG.
Five studies were for staging, 7 for restaging and 7 for treatment response evaluation. The number of lesions detected by
computed tomography (CT) without contrast was determined.
Then, we analyzed additional lesions found in PET/CT. Finally, we evaluated the SUVmax (Standard Uptake Value) of
all lesions. The results were compared with clinical outcome.
Main results: We found 72 lesions in CT. On the PET it was
identified 14 additional lesions (lymph nodes, spleen, colon
and epididymis). Nine other lesions identified on CT and with
no uptake on PET were considered benign (lymphadenopathy and lung nodules). The mean SUVmax was 6.79 + - 4.71.
Conclusion of the presentation: PET/CT-18F-FDG increases the detection of lesions in LCM compared to CT without
contrast and allows a better characterization of lesions identified on CT. The intensity of uptake measured by SUVmax is
relatively high, considering the mixed pattern of this disease.
16 - Chest
PA.16.003
UTILIDAD DE LA ANGIO-TCMD EN ESTUDIO DEL
PACIENTE CON HEMOPTISIS PREVIO AL TRATAMIENTO DE EMBOLIZACION
Authors: FRANGELLA MJ, GIURBINO A, CASEROTTO
AM, SALCEDO JI, FERNANDEZ E, MUÑOZ F, DELLA
SALA A, FRANK L.
Institution: HOSPITAL JUAN A. FERNANDEZ. BUENOS
AIRES. ARGENTINA.
Author responsible: Julia Frangella
Brief description of the purpose of the Review of Literature: Analysis of the usefulness of Angio-MDCT - previous
to embolization using angiogram- to study the patient presenting hemoptysis. To make a revision of the literature and
to present images from 5 cases.
16–detector row scanner. Image Acquisition: craniocaudal
direction from the base of the neck to L2. Multi– detector
row systems. Injection of 120 mL of contrast material at a
rate of 4 mL/ sec.
Conclusion: There are many options to studying hemoptysis.
Angio-MDCT is a noninvasive, accurate and rapid method to
evaluate the severity, localization of bleeding, to detect causes
of hemoptysis, and to determine the origin, courses, and communication with adjacent structures of the vessels responsible
for bleeding which are prone to embolization – bronchial, systemic, or pulmonary. As a result, it is possible to selectively
direct embolization by performing an angiogram, thus, reducing the procedure´s length and avoiding new embolization
caused by unnoticed hypertrophied vessels. Potential complications as a result of embolization - for existing anastomoses
among coronary and bronchial arteries, accidental embolization of spinal artery with the resulting paraplegia - may be
voided by information obtained from Angio-TCMD.
41
Brief discussion of the case Angio-MCDT is an essential
tool to diagnose a patient with the specific cause of hemoptysis, plan and guide embolization.
PA.16.004
Chondromesenchymal hamartoma
Authors: Simbrón R, L; Latorre Z, A J
Institution: Hospital Nacional Edgardo Rebagliati Martins,
Lima, Perú
Author responsible: Lourdes Simbrón Ribbeck
Brief description of the purpose of the report: A very rare
and benign tumor is presented in a neonate, who developed severe respiratory distress due to large size of the lesion. Surgical
treatment was incomplete and tumor experimented new growth.
Medical History: A neonate was referred presenting an anterior chest wall tumor of 10 cm and severe respiratory distress inmediately after birth. Imaging showed a large and expansile mass arising from second to fourth ribs, with coarse
and amorphous calcifications, extension to extrapleural soft
tissues, distortion of other ribs and deviation of the mediastinum to the right. The tumor was partially excised in order to
preserve the rib cage; however, recurrence was noted, requiring a second intervention with total excision.
Diagnosis: Chondromesenchymal hamartoma is a rare, benign primary bone tumor that typically arise from rib cage
of neonates and young children. Definitive diagnosis needs
histopathologic confirmation, usual findings are solid areas
composed of natural bone elements in a haphazard arrangement and cystic areas with haemorragic component, resembling aneurismatic bone cyst. Tomography and magnetic resonance are useful to identify fluid-fluid levels in this lesions.
Definitive treatment is complete excision of the tumor.
Discussion and summary of the case: Chondromesenchymal hamartoma is a benign tumour with unusual radiologic
and histopathologic features, often causing diagnostic problems, especially with agressive neoplasms.
PA.16.006
Primary pericardial tumors: review of
imaging aspects
Authors: PORTELA MF; PORTELA JR, HJ; PORTELA
ACF
Institution: Hospital EMCOR, Nova Iguacu, Rio de Janeiro,
Brasil
Author responsible: Mariana Portela
Brief description of the purpose of the Review of Literature: Describe briefly the imaging findings of primary pericardial tumors in Computed Tomography and Magnetic Resonance, clinical and differential diagnosis in adults.
Literature review of 46 articles was carried out in the period
2000-2014, with the key words: Primary pericardial tumors,
Pericardial tumors, Pericardial and Cardiac tumors.
Conclusion: Primary cardiac tumors are rare with a prevalence of about 0.02 to 0.056 %, and the pericardial involvement is much more infrequent , with about 6.7 to 12.8 %
prevalence among these. It should be noted that the pericardium is a sac-like, avascular training, in the middle mediastinum. For its central location, the lesions which affect should
be carefully analyzed. Examples of benign tumors, stand out:
pericardial cyst, lipoma, lymphangioma, lipoblastoma, para-
42
ganglioma, germ cell tumors, hemangioma and fibroma. But
among the malignant mesothelioma, sarcoma, lymphoma,
and primitive neuroectodermal tumor are other examples.
Brief discussion of the case Pericardial tumors are rare.
As benign pericardial primary tumor the highlight was
pericardial cyst and mesothelioma stands out as the most
common malignant.
PA.16.007
Central bronchial carcinoid tumor
Authors: de SANTANA, D.B.F.; VALENTIM, M.V.;
MELGES, G. C; ARAÚJO, T.R; ROQUE, D.
Institution: Documenta, ribeirão preto, SP, Brasil
Author responsible: Danilo Santana
Brief description of the purpose of the report: The report
describes a typical but very illustrative case of a bronchial
carcinoid, showing altogether findings widely discussed in
the literature, discussing from the initial radiographic semiology to the tomographic characteristics that must be recognized by radiologists.
Medical History: Female, 23 years, with new-onset asthma
worsened progressively, nonsmoker, no other comorbidities
Diagnosis: Chest X-ray showing atelectasis of the medial segment of the left lower lobe partially obscured by heart attenuation. CT workup suggested. Chest CT with and without contrast showing a central endoluminal mass with great extension
to the parenchyma (iceberg tip signal), parenchymal calcifications and high enhancement, highly suggestive of bronchial
carcinoid. Suspicion confirmed histopathologically.
Discussion and summary of the case: The findings, while
rare altogether are described in the literature as highly suggestive of pulmonary carcinoid and this case portrays the
features that represent the most common pulmonary tumor
of childhood and adolescence, emphasizing the clinical signs
and initial radiographic findings that suggest further evaluation and also findings that allow a safe assumption of a diagnosis, considering also the differential diagnoses.
PA.16.008
Lymphoma simulating pulmonary tuberculosis
Authors: SILVA IC; CAMILO FB; OLIVEIRA RGS; ALBUQUERQUE FA; EL HADJ SAA; PEREIRA SAC.
Institution: UFV, VIÇOSA, MINAS GERAIS, BRASIL
Author responsible: Iuri Camargo Silva
Brief description of the purpose of the report: Case report
of secondary anaplastic large cell pulmonary lymphoma with
clinical and imaging findings compatible with pulmonary tuberculosis, endemic disease in Brazil.
Medical History: Male patient, 38 years, with weight loss
(30 kg), night sweats and dry cough for eight months. Radiography and computed tomography showed extensive consolidation in the right upper lobe with mediastinal lymph
node enlargement, with some presenting necrotic core, consistent with the diagnosis of pulmonary tuberculosis. Radiological control in the course of specific therapy showed progression of the findings, and then suggested endobronchial
biopsy which featured high-grade malignancy with diffuse
expression of CD30 compatible with the diagnosis of anaplastic large cell lymphoma.
Diagnosis: Lymphomas can rarely be diagnosed as prima-
ry lung disease. However, not unusually, they secondarily
invade the lungs, by hematogenous dissemination or direct
invasion of lymph nodes, particularly in Hodgkin\’s disease.
Discussion and summary of the case: Anaplastic large cell
lymphoma has a high propensity for extranodal invasion and
rarely to the lung. Patient is usually asymptomatic, and when
symptoms occur, they are often non-specific, making diagnosis difficult. The radiological features are also multiple and
can mimic many diseases, including tuberculosis.
PA.16.009
Cutaneous metastatic angiosarcoma of
the lung: spectrum of CT findings
Authors: SANTOS, R.M.; LEITE, L.C.; PINETTI, R.Z.;
MISSRIE, I.; SANTIAGO, I.B.; KITAMURA, F.C.
Author responsible: Ramón Moura dos Santos
Brief description of the purpose of the report: Vascular
neoplasms are rare. The most common is the angiosarcoma,
which represents less than 2% of all sarcomas. Usually it manifests as skin lesions in the head and neck. Metastases occur
more frequently to the lung, liver, bone and lymph nodes. The
case reports of two patients with metastases aim to assist the
radiologist in the differential diagnosis of pulmonary nodules.
Medical History: An 82-year-old female, with primary lesion on the scalp. Staging: multiple pulmonary nodules with
cavitation and ground-glass halo. An 72-year-old male, with
hemoptysis and primary tumors in the lower abdomen and
left shoulder blade. Staging: multiple pulmonary solid nodules with ground-glass halo.
Diagnosis: These cases had histopathological diagnosis of
angiosarcoma. In the first patient, it is believed that cavitation occurs through the discharge necrotic material from a
injury nodular solid. The ground-glass halo, secondary to
perilesional hemorrhage. The second patient had more frequent image pattern and ground-glass halo, also secondary to
alveolar hemorrhage .
Discussion and summary of the case: Angiosarcoma is a
rare malignant tumor originating from endothelial cells. Pulmonary metastases may present an variety of radiological
findings , but mainly bilateral multiple solid nodular lesions,
not calcified . The radiologist should include as differential
diagnoses hypervascular metastases.
PA.16.010
Scimitar syndrome: Radiological Diagnosis and Treatment
Authors: BRITO, M.L.C.B.; NASCIMENTO, L.C.; MORAIS, L.D.S.; TEIXEIRA, V.M.; COSTA, E.S.
Institution: Instituto Tocantinense Presidente Antônio Carlos, Araguaína, Tocantins, Brasil.
Brief description of the purpose of the Review of Literature: Executing a literature review on the topic relating the
anatomy and physiology to its radiological findings and also
the main issues involved in the treatment.
The Scimitar Syndrome (SS) is a partial change in the venous
drainage of the right lung to the inferior vena cava, followed
by the right pulmonary hypoplasia (HPD), abnormality in the
bronchial tree and dextrocardia. Searching was made in the
major databases such as MEDLINE and LILACS, where it
were collected the most relevant articles on the topic.
Conclusion: The SS can be classified as: children form,
which usually present with pulmonary hypertension resulting in poor prognosis, and the adult form which most often
appears asymptomatic. The diagnosis is done by simple chest
radiography, which emphasizes HPD, mediastinal shift to
the right and scimitar\’s signal is tortuous tubuliforme image
projection of the right hemithorax. The most effective treatment is not well established. Surgical indication is given with
shunt greater than 50% ED, pulmonary infections, hemoptysis, heart defects and infant SS.
Brief discussion of the case The SC is rare and there are
many misconceptions regarding your diagnosis. This is very
important especially in its infant form since it courses with
pulmonary hypertension.
PA.16.011
Follicular dendritic cell sarcoma in
the mediastinum.
Authors: RIBEIRO F°, C.G.; ALMEIDA, A.H.S; ANDRADE, F.P.; EL KADRI, T.N. JR;
Institution: SANTA CASA DE VOTUPORANGA, VOTUPORANGA, SAO PAULO, BRASIL
Author responsible: Aires Henrique Schadeck de Almeida
Brief description of the purpose of the report: Report a rare
case of follicular dendritic cell sarcoma ( FDCS ) mediastinal
anterior with pemphigus as first presentation of this disease.
Medical History: A 46-year- old man with a history of two
months of ulcerative lesions of the oral and genital mucosa.
Rest of normal physical examination. Presented progressive
dyspnea . Image study (X-rays , CT scans and chest resonance ) revealed left perihilar lung mass . Left lower radical
lobectomy was performed with removal of the lesion. Pathological examination confirmed the diagnosis of follicular
dendritic cell sarcoma.
Diagnosis: The FDCS is a rare neoplasm of immune accessory cells , occurring mainly in lymph nodes. Diagnosis and
treatment of this disease remain a challenge . In our case,
we featured a left perihilar mass with well defined limits
and homogeneous enhancement, without infiltration signs of
adjacent structures. There are few mediastinal involvement
reports of the disease and with not well defined imagin features yet. Here, we discuss the main radiological findings described in the literature and some differential diagnoses.
Discussion and summary of the case: FDCS is a tumor
that, although rare with few cases reported in the mediastinum, can be considered in the differential diagnosis of mediastinal masses . Diagnosis and treatment of this disease
remains challenging.
PA.16.012
\”Aspects and differential diagnosis of
cavitary nodules on chest CT\”
Authors: BARROS,E.G.; VERGILIO,F.S.; STEINWANDTER,R.; SILVA,R.H.G.F.; FASSBENDER,C.P.B.;
COSTA,A.S.; MELO,D.M.;ZANGIACOMO, R.N.
Institution: Hospital do Servidor Público do Estado de São
Paulo (IAMSPE), São Paulo, SP, Brasil
Author responsible: Elisa Giraldez Barros
43
Introduction: Cavitary nodules are present in both benign
and malignant conditions. The goal of this paper is to present and discuss tomographic aspects of the pathologies where
these nodules are characterized.
Methods Involved: We present cases from our institution
where cavitary nodules were characterized by means of
computed tomography images and the underlying cause was
pathologically confirmed.
Discussion: Benign cavitary nodules may be present in:
rheumatoid arthritis (nodules that can cavitate), Wegener\’s
granulomatosis (present in 50% of patients and more commonly in nodules larger than 2 cm), septic embolism (several
stages of cavitation), tuberculosis (cavitation and necrotic
center) and angioinvasive aspergillosis (air crescent sign).
Malignant cavitary nodules may be present in: lung cancer
(central cavitation in 15% of nodules larger than 3 cm), cavitary pulmonary metastasis (frequency of 4%; more commonly in squamous cell carcinoma - 67%) and solitary pulmonary
nodules (cavitations with thickened and irregular walls).
Conclusion of the presentation: Cavitary nodules are easily
recognized and knowledge of their possible causes, as well as
clinical and pathological data, is of great importance for the
radiologist, helping towards more accurate diagnoses.
PA.16.013
THE IMPORTANCE OF SIGNALS IN THE DIAGNOSIS OF PULMONARY THROMBOEMBOLISM (PTE)
Authors: Paiva, G.G; Oliveira, V.S.; Libânio, B.B.; Bolinelli, A.P.; Paiva, D.H.; Valente, M.
Author responsible: Gledson Garcia de Paiva
Introduction: Thromboembolism has heterogeneous clinical
presentation, from asymptomatic frames to fatal situations.
The PTE and deep vein thrombosis represent the spectrum of
the same pathology, the venous thromboembolism. Chronic
PTE is characterized as embolism that remains at least three
months after an acute episode. Differentiation by radiological
signs is important for the therapeutic direction.
Methods Involved: The cases were selected by a search toll
designed to find images and reports from June 2010 to December 2014. The radiological findings were reviewed by
experts and compared retrospectively.
Discussion: The PTE effects are primarily hemodynamic.
Large or multiple emboli abruptly increase the pressure in the
pulmonary artery to levels not tolerated by the right ventricle,
the patient may present with syncope / hypotension due to
low cardiac output. Imaging methods such as angio-tomography of the chest may indicate suggestive signs of chronic
PTE, such as eccentric location of pulmonary emboli, abrupt
narrowing of the arterial diameter and besides other important signals for the diagnosis / therapy support.
Conclusion of the presentation: PTE signals by chronic angio tomography are important for clinical follow-up.Iit is for
the radiologist to recognize them and suggest the diagnosis
when evidenced.
PA.16.016
CT scan findings in vasculitis
Authors: Bargi L. , Miura T.Y., Jardim L.C., Rosa B.G.,
Câmara G.V., Paixão N.C.F, Vergilio F.S.
44
Author responsible: Leonardo Bargi Marchiori
Brief description of the purpose of the Review of Literature: familiarization of the main patterns of thoracic affections in vasculitis of a large public hospital
Description (s) condition (s), method (s) or technique (s): a
survey was conducted of patients with vasculitis in the 20082014 period and assessed their radiological images
Conclusion: Pulmonary vasculitis result from a recurrent
inflammatory process involving the pulmonary vasculature from major pulmonary vessels to the capillary level, and that often leads to destruction of the vascular wall
leading to ischemic injury of lung tissue. Most of these comorbid evolves with nonspecific clinical signs and symptoms, making the binomial laboratory and radiology indispensable today, both for diagnosis and for the definition of
the action to be taken. The images obtained by computed
tomography (CT) are considered to be the gold standard in
the management of these comorbidities and should therefore, the thoracic radiologist be familiar with the various
forms of presentations, as vasculitis do not follow a single
pattern of thoracic involvement. In the 2008-2014 period a survey of all types of vasculitis with lung involvement
was made in a large public hospital in order to clarify and
help to identify such patterns, especially for less experienced radiologists.
Brief discussion of the case This review serves as a way to
guide the study of vasculitis.
PA.16.017
Pulmonary thromboembolism beyond
filling defects . From acute to chronic .
From diagnosis to prognosis
Authors: Verrastro CGY, Eyer AAR, Missrie I, Pinetti RZ,
Yanaguizawa T, Teles MS, Lederman HM, Szarf G
Institution: UNIFESP-EPM, São Paulo, SP, Brasil
Author responsible: Carlos Gustavo Yuji Verrastro
Introduction: Pulmonary embolism is a potentially fatal
disease that requires rapid and accurate diagnosis and treatment. For many years, pulmonary angiography was considered the gold standard, despite its invasive nature . CT
angiography has emerged as a noninvasive alternative , and
technical advances , allowed more rapid tests , thinner slices
and with lower radiation doses . The objective is to illustrate
all changes related to acute and chronic PTE and the role of
CTangiography as predictor of prognosis and helping treatment choice .
Methods Involved: We will illustrate with cases the cardiovascular and parenchymal abnormalities found in patients
with PTE and some prognostic criteria.
Discussion: There is much more than filling defects in the
pulmonary CT angiography . Parenchymal abnormalities ,
airway disease, pulmonary hypertension and cardiac morphological and functional changes are some examples of
information that can also be obtained. In patients with pulmonary hypertension due to chronic PTE CT angiography
allows to identify surgically accessible thrombi .
Conclusion of the presentation: Pulmonary CTangiography
not only allows the diagnosis of acute and chronic PTE as can
predict prognosis. In chronic cases allows to identify patients
eligible for endarterectomy.
PA.16.018
Carcinoid tumor of the lung: review of
imaging findings based on series of cases.
Authors: Negri,R.V.; Dadalto, R.V.; Vergílio,F.S.; Alves,
G.S.P; Rosa, B.G.; Souza, E.C.F; Zangiacomo, R.N.;
Introduction: Carcinoids tumors occur most frequently in the
gastrointestinal tract but also can arise from lung, thymus, biliarytract, and ovary. Bronchial carcinoids are rare and responsible for only 1%–2% of all lung tumors and affect patients at
mean age of 45 years, are the most frequent primary pulmonary
neoplasm in childhood and there is no association with smoking or carcinogens inhalation. Our goal is to show the tomographic apearance and key findings the suggest this diagnose.
Methods Involved: We show three enhaced CT exams of
confirmed cases carcinoid tumors of lung.
Discussion: Typical and atypical bronchial carcinoids have
the same radiologic features. About 80% are centrally located. Shows characteristically highly vascular. Radiologic findings include hilar and perihilar masses, endobronchial nodules, findings related to bronchial obstruction and peripheral
nodules. May be mediastinal lymphadenopathy associated.
Conclusion of the presentation: Since there is similarity
between typical and atypical lesions at gross anathomy and
imaging methods, detailed description of CT findings in the
radiologic report leads to an acurate diagnosis and to optimized surgical planning.
PA.16.019
Pulmonary impairment in Paracoccidiodomicose: image methods in diagnostics
and monitoring
Authors: BRITO, M.L.C.B.; MEDEIROS, J.A.; MENEZES,
M.C.C.
Brief description of the purpose of the Review of Literature: Demonstrating the pulmonary impairment in
Paracoccidiodomicose through simple radiography as well
as define the importance of radiological methods in diagnosis approach and routine outpatient follow-up of patients
with Paracoccidiodomicose.
The literature review were done in the databases PubMed and
Lilacs, with the keyword: \”Paracoccidiodomicose\”. The
most relevant articles published between 2004 and 2014, in
Portuguese or English, were selected.
Conclusion: Among the clinical forms of Paracoccidiodomicose the one that stands out is the chronic form. In these cases
the pulmonary manifestations are present in 90% of patients.
Radiological studies should be done every 6 months, or in
a smaller period if there is no satisfactory clinical response
or if any indicative of laboratory activity changes appear.
Pulmonary fibrosis were described by image in about 50%
of patients with chronic infection of this organ. Radiological
changes considered moderate and severe are present mainly
in patients with obstructive functional framework.
Brief discussion of the case The accumulation of collagen
and the formation of fibrosis can lead to functional and ana-
tomical changes of the affected organs during the PCM, particularly the lungs. The radiological examination is important
in evaluating pulmonary impairment in PCM as well as being
a relevant criteria of cure.
PA.16.020
Typical manifestation of a rare disease,
description of two cases
Authors: SASDELLI NR., (AUTOR PRINCIPAL) / LUZ
DC., (ELABORAÇÃO E IMAGENS) / LEAO LRS.,
(ELABORAÇÃO E IMAGENS) / FIGUEIREDO J.R.P.,
(ELABORAÇÃO E IMAGENS) / CHATE RC., (REVISÃO
BIBLIOGRÁFICA) / TELES GBS., (REVISÃO DAS IMAGENS) / FUNARI MBG ., (COORDENAÇÃO)
Brief description of the purpose of the report: Primary choriocarcinoma of the mediastinum is rare and affects
mainly young men. It is aggressive and has a poor prognosis.
Computed tomography (CT) imaging findings are non specific, but some clues can help radiologists. We will discuss two
cases with a focus on the characteristics of the mediastinal
mass, pulmonary metastases and hemorrhagic complications.
Medical History: Patient 1, 23 years-old men, presented to
emergency room with dyspnea and thoracic pain. Patient 2,
21 years-old men, came with a mediastinal mass incidentally
find. Laboratorial analysis reveals high levels of beta-human
chorionic gonadotropin and lactate dehydrogenase. Both patients have been subjected to a CT-guided mediastinal biopsy.
Diagnosis: CT findings shows, in both cases, anterior mediastinal masses, heterogeneous, with close contact with adjacent structures, diffuse pulmonary nodules, some of them
with ground-glass halo. The first patient developed hemorrhagic brain metastases and the second patient developed
signs of pulmonary hemorrhage and hemopericardium.
Discussion and summary of the case: Because it is a rare
and aggressive neoplasm, radiologists must know imaging
findings that suggests the possibility of choriocarcinoma and
others aggressive germ cell tumors. In young male patient,
the presence of anterior mediastinal mass, pulmonary nodules with ground-glass halo and hemorrhagic complications
are suggestive of choriocarcinoma.
PA.16.022
Fundamental patterns on HRCT Chest
Authors: Torres, RVA.; Costa NSS.; Bôas, RMV.; Costa,
LS.; Barbosa, RFM.
Institution: Hospital Geral de Fortaleza (HGF), Fortaleza,
Ceará, Brasil
Author responsible: Roberto Vitor Almeida Torres
Introduction: The clinical evaluation of patients with diffuse lung disease can set a challenge for the assistant medical
team, with fundamental imaging methods essential for proper
conduct. In this context, the study of the chest tomography,
especially with the use of computed tomography techniques
of high resolution (HRCT), may provide a better anatomical
detailing of pulmonary structures and accurate characterization of pathological findings. In this scenario, we developed
a pictorial essay in order to illustrate the classic patterns of
presentation of diffuse lung disease on HRCT.
45
Methods Involved: We analyzed chest CT scans of own cases from a referral hospital for chest.
Discussion: The radiologists and pulmonologists need to be
accustomed to the classic HRCT patterns, for proper monitoring and diagnostic investigation of patients. Illustrative cases
in HRCT are presented as air trapping standards, cysts, emphysema, \”ground glass\” attenuation, consolidation, paving
\”mosaic\”, centrilobular nodular pattern, perilymphatic nodular pattern, miliary nodular pattern, pattern of \”tree bud \”, position-pending opacity, linear opacities, among other findings.
Conclusion of the presentation: The study of HRCT patterns is a vast and complex subject and it is essential your review. periodically to greater familiarity with the subject and
better formulation of differential diagnoses.
PA.16.023
Erasmus syndrome: A rare association between systemic sclerosis and exposure
to silica.
Authors: ARAUJO FILHO, J.A.B., CASTRO, R.N.C.,
REISER, C.S., PAIVA, A.F.L., OLIVEIRA, D.S., SANTOS,
M.G., CHATE, R.C., FUJITA, C.L., NOMURA, C.H.
Brief description of the purpose of the report: To describe
two cases of occupational exposure to silica leading to the development of systemic sclerosis (SS), also known as Erasmus
Syndrome (ES).
Medical History: Male, 60 years-old, exposured to silica for
35 years, without pulmonary symptoms, diagnosed with SS
ten years ago, has esophageal dysmotility, cutaneous thickening proximal to the metacarpophalangeal joints.
Diagnosis: Performed chest CT, negative to the classical findings of silicosis, with chronic fibrosing interstitial infiltrate
symmetric distributed through the periphery and basal predominance, suggestive of nonspecific interstitial pneumonia.
Discussion and summary of the case: The association between exposure to silica and ES is rare and occurs on average 15 years after exposure and can occur with or without
associated pulmonary silicosis. A CT scan is valuable in the
diagnosis and evolution of the SE in describing the findings
of associated entities that characterize the syndrome.
PA.16.024
Pulmonary
alveolar
microlithiasis:
computed tomography findings
Authors:
MARANGON-MACHADO,J.C.;CAMARGO,M.V.;
Institution: HOSPITAL DE BASE, FAMESP,BAURU,SAO
PAULO,BRASIL
Author responsible: Joana Cruz Marangon Machado
Brief description of the purpose of the report: Pulmonary
alveolar microlithiasis is a rare, familial disease of chronic
evolution that affects young adults and frequently the imaging pattern is pathognomonic.More than half of all patients are
asymptomatic at the time of diagnosis. The disease remains silent for a long period, with subsequent occurrence of dyspnea,
chest pain, and dry cough. Objectives: Describe the changes in
x-rays and CT scan and monitor the development of the image
correlating with signs a clinical presentation of the patient.
46
Medical History: Patient, female, 38 years, with progressive
dyspnea for 1 year
Diagnosis: The findings were very characteristic radiological
introducing opacities ground-glass attenuation, subpleural calcifications, calcification along the interlobular septa, nodular
cissures, subpleural nodules among others. The correlation of
images with the clinical evolution of the patient was evident.
Discussion and summary of the case: The pulmonary alveolar microlithiasis presents radiological aspects that are highly suggestive of the disease, and even in some cases eliminating the need to perform a lung biopsy
PA.16.025
Acupuncture needles fragments identified in chest X-rays and PET/CT scan
Authors: LIMA, FL; SANTANA, PRP; TANAKA, SW;
BROTTO, MPD; FERNANDES, GSS; GOMES, ACP
Institution: MEDIMAGEM, SÃO PAULO, SP, BRASIL
Author responsible: Lilian Fonseca Lima
Brief description of the purpose of the report: We report a
case of a 75-year-old male patient whose chest x-ray showed
small metal images in the dorsal subcutaneous tissue, which
had similar sizes but in different ways, some of them linears
and others with some curvature degree.
Medical History: The patient had no chest symptoms and
there was also performed PET-CT scan in our service to investigation of lymphoid neoplasms, showing the same images.
Diagnosis: These findings are consistent with acupuncture
needles fragments. Traditional Chinese acupuncture involves
inserting needles into the subcutaneous tissue, which remain
for 15 minutes and are completely removed after that. Hari
acupuncture is a specific subtype where the needles are inserted into the subcutaneous tissue, and then broken off at the
skin. The remaining fragments are permanently held providing neurological continuous stimulation.
Discussion and summary of the case: Usually the fragments do not cause complications, they are found incidentally on imaging studies and can be confused with metal sutures. Occasionally these structures can form foreign body
granulomas and even migrate especially in patients with little
subcutaneous fat.
17 - Ultrasonography
PA.17.002
SÍNDROMES DE ROUBO VASCULAR – ENTENDENDO
AS DOENÇAS PARA UM DIAGNÓSTICO ACURADO
Authors: SILVA, M.M.A.; BRITTO NETO, L.A.; VENTURA, C.A.P.; NETO, M.J.F.; FUNARI, M.B.G;
Introduction: Vascular steal syndromes are a symptom complex that occurs whenever there are extensive anastomosis
between two vascular beds, and the arterial supply to one of
the beds is stenosed/occluded, resulting in diversion of blood
to other vascular bed. There are many types of vascular steal
syndromes, each one with specific clinical findings, symptoms, complications and treatment. Ultrasound is a dynamic
diagnostic method and has an important role in diagnosis and
graduation of the disease with the advantage of to define the
blood flow direction, providing a complete comprehension of
the steal phenomenon. The objective of this paper is to review
and illustrate the physiopathology, etiologies and diagnosis of
many types of vascular steal syndromes by ultrasonography.
Methods Involved: A compilation of cases of vascular steal
syndromes diagnosed in our institution and an extensive literature review were done.
Discussion: We describe and illustrate ultrassonography
changes in different types of steal syndromes, including complete external carotid steal syndrome, subclavian steal syndrome, brachiocephalic trunk steal, partial subclavian steal
syndrome and dialysis-access syndrome.
Conclusion of the presentation: Ultrasound is a dynamic
method and has a main role in the diagnosis and graduation
of many types of vascular steal syndromes, providing information that are used to guide further diagnostic and therapeutic procedures.
PA.17.003
PRIAPISM IN EMERGENCY UNIT . HOW CAN USDOPPLER HELP?
Authors: SILVA, M.M.A.; BRITTO NETO, L.A.; RAHAL
JR. A.; VIEIRA F.A.C.; QUEIROZ M.R.G.; FRANCISCO
NETO M.J.; FUNARI M.B.G.
Introduction: Priapism is a painful, generally and potentially
serious medical condition in which there is involuntary, prolonged, unrelated to sexual stimulation and persistent penile
erection, even after ejaculation. As many medical emergencies, time is important and early intervention allows a better
chance of functional recovery. The objective of this pictorial
essay is to illustrate and review the key points and the main
findings of the ultrasonography and Doppler of the penis in
patients with priapism.
Methods Involved: Compilation of several cases of penile
ultrasound diagnosed in our institution and an extensive literature review were done.
Discussion: Priapism can be classified as low-flow (ischemic) and high flow (non-ischemic). The low flow subtype is
the most common and occurs due to obstruction os output of
the venous flow. High flow priapism is a rare disease caused
by a pathological influx of blood to the corpora cavernosa,
usually related to traumatic mechanisms.
Conclusion of the presentation: The radiologist plays an
important role in cases of priapism. The penile ultrasonography and Doppler allow accurate diagnosis of the priapism
subtype, guiding the best treatment, and also may be useful in
evolutive control of cases.
PA.17.004
Abdominal pregnancy: a case report and
literature review.
Authors: SANTOS, R.C; LIBANIO, B.B; PAIVA, G.G; OLIVEIRA, V.S.; BOLINELLI, A.P
Institution: Universidade Federal de Alfenas, Alfenas,
Minas Gerais, Brasil
Author responsible: Bruna Brandão libanio
Brief description of the purpose of the Review of Lit-
erature: A case report of abdominal pregnancy at an advanced stage (16 ½ weeks) and live embryo with sonographic diagnosis.
BJ, 33, G2P1A0C1. Admitted to the gestation period (BHCG
+) with chronological age of 16 weeks and 4 days, abdominal
tenderness, vomiting and diarrhea 20 days ago, mild abdominal distension, no fever.
Conclusion: Transabdominal ultrasound shows empty
womb, net free abdominal cavity and background Douglas
bag, presence of gestational sac and placenta, are noted in fetal movements and heart rate the same. 16 ½ weeks gestation
outside the womb, juxtaposed outside the posterior wall of
the uterus. Performed exploratory laparotomy, lysis of adhesions, freeing the gestational sac ruptured during the act, ligation of vessels pelvic infundibulum right, with removal of the
uterine right attachment and cauterization of site deployment
by the womb. There was no wall invasion (myometrium), or
sigmoid colon. After two years, held repeat caesarian and
tubal ligation the left uneventfully.
Brief discussion of the case A rare case of development
with deployment outside of the uterus and the fallopian tube.
Fundamental importance, precise and definitive diagnosis of
ultrasound in obstetrics, especially in the most rare diseases
when the clinical diagnosis is more complex, difficult and
time consuming.
PA.17.005
Gastric Ultrasound Imaging for peri-operative aspiration risk assessment
Authors: NAVES, A. A.; MARTINS, F.M.B. B.; BENTO,
F. B. D. S.
Institution: Universidade Federal do Triângulo Mineiro,
Uberaba, Minas Gerais, Brasil.
Author responsible: Aline de Araújo Naves
Brief description of the purpose of the Review of Literature: General anesthesia or deep sedation blunt the physiologic mechanisms that protect the upper airway from
aspiration of gastric contents. Volume and gastric content
assessment is a new point-of-care ultrasound application that
can help determine aspiration risk.
This systematic review summarizes the current literature on
bedside ultrasound assessment of gastric content and volume
relevant to anesthesia practice.
Conclusion: The appearance of the gastric antrum makes
the correlation with gastroscopically measured fluid volume. An empty stomach (Grade 0) carries a negligible risk
of peri-operative aspiration, while aspiration of solid or thick
particulate content has been associated with particularly poor
patient outcomes. In the grade 1 antrum we have no fluid in
supine position, but it is present in the right lateral decubitus. A mean gastric has upper limit of normal of about 1.5
mL/kg (approximately 100 mL for an average adult) without
significant aspiration risk. In grade 2 we have fluid in both
positions, volume?is upper than > 1.5mL/kg and the risk of
aspiration is high.
Brief discussion of the case The implementation of gastric
ultrasound in the preoperative evaluation emergency surgery
establishing preventive and intubation techniques that limit
or eliminate the risk of pulmonary aspiration, reducing hospital stay and mortality measures.
47
PA.17.006
PA.17.008
Sonographic ribs evaluation: when the
pain is closer than we think
Authors: LUZ DC., (ELABORAÇÃO E IMGENS) / DIAS-DA-SILVA PS., (ELABORAÇÃO E IMAGENS) /RAHAL JRA., (AUTOR PRINCIPAL) / JULIO T (REVISÃO)/
FRANCISCO NETO MJF., (IMAGENS)/ QUEIROZ MRG.,
(REVISÃO)/ FUNARI MBG., (COORDENAÇÃO)
Introduction: Ultrasonography examination in emergency
is generally focused on the main patient symptoms. It is
not common assessing the ribs during routine abdominal
exams, especially at emergency department. Ultrasound is
a safe, non-ionizing, fast and available method to access
the ribs.
Methods Involved: The purpose of this panel is to show
the importance of rib ultrasound in the context of chest
wall and upper abdominal pain and summarize anatomical and abnormal findings, helping radiologist to familiarize with the normal and the typical findings of rib disease by ultrasound.
Discussion: Some papers reveal that ultrasound is better than
radiography to detect rib fracture. The evaluation of rib cartilage and costochondral junction is another advantage, like in
the Tietze´s syndrome. We also describe a case of abdominal
pain caused by thyroid rib metastasis at a middle age men
first detected by abdominal ultrasound.
Conclusion of the presentation: Ultrasound evaluation of
ribs is probably useful to access fractures and others causes
that can mimic upper abdominal pain. It is important know
how to do ribs ultrasound and be familiarized with the most
common causes of rib pain.
The importance of sonographic evaluation for identifying the Polycystic
Ovary Syndrome.
Authors: LOPES, GF, LIMA, JF
Institution: Tomovale - Centro de Diagnóstico por Imagem,
São José dos Campos, São Paulo, Brasil
Author responsible: Gabriela Ferraz Lopes
Introduction: The Polycystic Ovary Syndrome (PCOS) is
a complex endocrine disease characterized by hyperandrogenism and chronic anovulation. Its symptoms are menstrual irregularities or amenorrhea and a wide variety of
conditions caused by hyperandrogenism such as hirsutism,
acne and alopecia. Pelvic ultrasound (mainly transvaginal)
shows increased ovarian volume, stromal hypertrophy and
infracentimetric cysts close to the cortex.
Methods Involved: For diagnosing this disease it is necessary that the hyperandrogenism or chronic anovulation is
clinically proven via laboratory tests along with these imaging findings.
Discussion: PCOS is associated to different levels of infertility, increased risk of endometrial cancer, cardiovascular
diseases and metabolic disorders such as diabetes mellitus
caused by hyperandrogenism.
Conclusion of the presentation: The proper sonographic evaluation is very important, since it helps the diagnosis
process and outpatient treatment of patients with this widely
common syndrome that may cause the severe comorbidities
previously mentioned.
PA.17.007
Diagnostic imaging for endometrial
polyp.
Brief description of the purpose of the report: Most
endometrial pathologies depend on hormones, with a
hyperechoic appearance in ultrasounds. The endometrial polyp is the prototype of these pathologies. The best
period for identifying it is during the first phase of the
menstrual cycle, since the endometrium is hypoechoic,
offering higher contrast for a more efficient evaluation.
Medical History: Endometrial polyps are benign injuries
with low malignant rates. During the reproductive period, the
diagnosis is based on patients’ symptoms such as abnormal
uterine bleeding and infertility.
Diagnosis: After menopause, there are practically no symptoms, but there might be abnormal bleeding in approximately
one third of cases. Furthermore, there is an increased risk
of endometrial cancer, which makes the diagnosis very important.
Discussion and summary of the case: Transvaginal gynecologic ultrasonography is the gold standard diagnosis method
and is crucial for providing an appropriate treatment.
48
PD – Scientific Papers – Digital
Presentation
PD.01.001
Imaging findings of gallbladder carcinoma
Authors: PRAIA J; DIAS R; ALBUQUERQUE J
Institution: Centro Hospitalar Barreiro Montijo, Barreiro,
Setúbal, Portugal
Author responsible: João Praia
Brief description of the purpose of the Review of Literature: Overview of the epidemiology, histology and biology
of gallbladder carcinoma (GC). Description and discussion of
the imaging findings of GC.
GC is the most common primary hepatobiliary cancer, the
fifth most common cancer of the gastrointestinal tract, and
predominantly affects people over 65 years with long duration cholecystolithiasis, affecting predominantly females. It is
a disease with poor prognosis. An etiological hypothesis suggests that mucosal irritation by the gallbladder stones causes
chronic inflammation which, followed by repetitive epithelial
repair, can cause malignant transformation. It takes about 15
years for dysplasia to progress to invasive carcinoma. Imaging techniques, such as Computerized tomography (CT) and
ultrasound (US) complement each other in regards of imaging
of the different stages of the natural history of this tumour.
Conclusion: GC manifests in most patients as a heterogeneous mass replacing the gallbladder. The focal or diffuse wall
thickening is common (25% of patients), and is best identified
by US. Pre-malignant conditions, most notably cholelitiasis/
chronic cholecystitis, can also be identified by imagiology.
Brief discussion of the case GC is a disease with dire prognosis and imaging plays a vital role on not only the early
diagnosis and staging but also holds promise on identifying
pre-malignant characteristics that may allow timely screening and intervention.
PD.01.006
Videodeglutogram and Robbins classification: pictorial essay
Authors: AMANCIO CT, PANIZZA PSB, PAIXÃO TSA,
LIMA TC, SHENG PY, DOMENICIS JR O , COSTACURTA MA, LEITE CC, CERRI GG.
Institution: Hospital Sírio Libanês, São Paulo, SP, Brasil
Author responsible: Camila Trolez Amancio
Introduction: Videodeglutogram is considered the gold standard test for swallowing disorders evaluation, more frequent
related to populacional aging. It is a dynamic videofluoroscopy method to evaluate the swallowing process by eating
foods of different consistencies associated with barium or
iodinated contrast. Robbins classification standardizes videodeglutogram findings contributing even in the follow up after
treatment . The objective is to present the relevant anatomy,
dynamically exemplifying Robbins classification, emphasizing the most important radiological images for interpretation
of videodeglutogram.
Methods Involved: Pictorial essay presenting videodeglutograms snippets, conducted from August to December 2014,
demonstrating the Robbins classification.
Discussion: Aspiration is defined as the pharyngeal content
entry into the airway below the level of the vocal folds, being
directly related to bronchopneumonic processes, very common in the elderly. Robbins classification stratifies videodeglutogram findings in grades 1-8, according to severity, which
grade 1 is normal and grade 8 is silent aspiration with residue.
Conclusion of the presentation: The use of Robbins Classification in videodeglutogram is a very useful tool for the
diagnosis and subsequent control of the treatment of swallowing disorders.
PD.01.010
Unusual presentation of Extraosseous
Ewing’s Sarcoma / Primitive Neuroectodermal Tumor as large intraperitoneal
mass: Case Report
Authors: PEDRO, M.S.; HOFFMANN, J.; TESTONI, N.M.;
SANDRINI, H.V.
Institution: HOSPITAL SANTA ISABEL - ECOMAX,
BLUMENAU, SANTA CATARINA, BRASIL
Author responsible: Jaqueline
Brief description of the purpose of the report: Report a
case of a patient with large intraperitoneal heterogeneous
mass with cystic areas, well-defined, lobulated margins, with
local mass effect.
Medical History: Male, 24 years, with progressive abdominal pain.
Diagnosis: The Extraosseous Ewing’s Sarcoma (ESS) and the
Primitive Neuroectodermal Tumor (PNET) belong Ewing’s
Sarcoma Family of Tumors, which includes the Askin tumor
and Osseous Ewing’s Sarcoma. Histologically, this family of
tumors is characterized by primitive neuroectodermal cells,
that depending on the degree of cellular differentiation, give
rise to Ewing’s Sarcoma or PNET. ESS/PNET are rare entities that predominantly affect adolescents and young adults.
They usually arise from soft tissues of the trunk and extremities, but any part of the body may be affected. At CT examination EES/PNET usually appear as homogeneous masses
when they are small and heterogeneous masses when they are
large, with presence of foci of cystic degeneration, necrosis
and hemorrhage, and enhancement after contrast medium.
Discussion and summary of the case: SEE/PNET although
rare should be considered in the differential diagnosis of patients with soft tissue mass of the trunk or extremities, especially in adolescents and young adults.
PD.01.013
The arcuate ligament syndrome: relevants radiological findings
Authors: LABBATE, M.R.C.;CALDAS, A.L.C.; GARCIA,
A.A.; CARVALHO, M.Q.; SANTOS, R.M.; ARMELIN,
P.L.A.; MONTEIRO, R.C.D.; BORGES, A.P.
Institution: Próton Diagnósticos, Campinas, São Paulo, Brasil
Author responsible: Maria Renata Coelho Labbate
Brief description of the purpose of the Review of Literature: Describe significant radiological findings in the diagnosis of arcuate ligament syndrome by multidetector computed
tomography angiography (MDCTA).
Literature review of the median arcuate ligament syndrome
imaging findings with MDCTA in the last 10 years, illustrated with clinical cases from our institution. The extrinsic
compression syndrome of celiac trunk by the median arcuate
ligament is a rare disease characterized by postprandial abdominal pain, weight loss, nausea, vomiting and murmur in
the epigastric region.
Conclusion: The imaging methods most suitable for diagnosis include ultrasound, MDCTA and angiography. Although
the gold standard for diagnosis is angiography, MDCTA with
thin slices and 3D reformatting, allow similar diagnostic accuracy in a noninvasively way. In addition, MDCTA allows
a better evaluation of the local anatomy, organs involved, the
degree of involvement and possible complications.
Brief discussion of the case The compression of the celiac
trunk by the arcuate ligament can be seen in healthy patients,
but only few have symptoms that characterize the Syndrome.
The MDCTA allows the early diagnosis of the condition, its
different forms of presentation, also providing input for treatment planning and prevention of complications.
PD.01.015
Evaluation of the preparations for enterography CT in patients with Crohn’s
disease
Authors: RENOSTO, F.L.; DORNA, M.S.; BARROS, J.R.;
SIBIA, C.; MARRONE, S.; ANTUNES, P.E.; BAIMA, J.P.;
SASSAKI, L.Y.; HOSSNE, R. S.
Institution: Faculdade de Medicina de Botucatu - Unesp,
Botucatu, São Paulo, Brasil
49
Author responsible: FERNANDA LOFIEGO RENOSTO
Brief description of the purpose of the Review of Literature: The purpose of this review is to present several studies
enterography tomography (Entero-CT) with different protocols via oral, demonstrating their effectiveness in tomographic findings.
Crohn\’s disease (CD) is a chronic inflammatory disease that
can affect any segment of the gastrointestinal tract. The most
common symptoms are abdominal pain, weight loss, chronic diarrhea, fistulas formation and intestinal obstruction.
The confirmation of the diagnosis of the disease correlates
clinical manifestation with the findings of laboratory tests,
histological, endoscopic and radiological. The Entero-CT allows to evaluate each intestinal segment without overlapping
handles, the degree of wall thickening, provides information
about the mesentery, perientérica fat, identifies fistulae, abscesses, stenosis.
Conclusion: Several studies have shown the effectiveness of
Entero-CT in the diagnosis and staging of DC, so the proper preparation of the examination is considered a key factor
for the quality and therefore the correct diagnosis. The inadequate preparation leads to higher costs, increased radiation
exposure and inconvenience to patients and service because
there is a need to repeat the exam.
Brief discussion of the case However, the standardization of
oral preparation is a key factor for obtaining an appropriate
assessment of changes caused by the disease and thus help,
evolution, prognosis and even new approaches to treatment.
PD.01.018
Tomographic Aspects in Acute Colonic
Pseudobstruction and The Use of Vincristine in Non-Hodgkin Lymphoma: Case Report
Authors: PESSÔA F.M.C.; AFONSO F.B.; MELO A.S.A.;
BITTENCOURT L.K.; SANTOS A.A.S.M.D
Institution: HOSPITAL UNIVERSITÁRIO ANTONIO PEDRO - UFF, NITEROI, RIO DE JANEIRO, BRASIL
Author responsible: Fernanda Miraldi Clemente Pessôa
Brief description of the purpose of the Review of Literature: Acute Colonic Pseudobstruction (Ogilvie\’s Syndrome)
is a disorder of gastrointestinal motility, with gross dilatation
of the cecum and colon in the absence of mechanical obstruction. Its etiology is not well understood and may be relate to
chemotherapy. We describe a case occurred after use of vincristine, highlighting their clinical and tomographic features.
Female, 33 years, Non-Hodgkin Lymphoma and recent chemotherapy cycle termination (rituximab, cyclophosphamide,
doxorubicin, vincristine and prednisone) presented intestinal
obstruction syndrome with painful decompression. Computed tomography (CT) of abdomen showed left pleural effusion, colic proximal descending obstruction adjacent to the
splenic flexure, without evident occlusive lesions, with dilatation of the ascending and transverse colon, cecum (14 cm).
There was gas distending the rectal ampulla. The exploratory
laparotomy showed no obstructive material. Excluded from
metabolic causes, traumatic and inflammatory, pseudobstruction was confirmed and conservative therapy was chosen
with satisfactory response.
Conclusion: Colonic pseudobstruction is a potentially surgical entity. Predisposing factors vary from trauma to chemotherapy drugs. Among them, vincristine which acts in the
50
high turn-over cells, causing intestinal motility imbalance.
Brief discussion of the case This condition should be suspected in patients in chemotherapy and the tomographic diagnosis bears distal colonic dilatation considering transition
zone features, always searching for perfuration signs.
PD.01.019
Quantification of hepatic steatosis with
heterogeneous distribution: Evaluation
of different strategies measured by MRI.
Authors: NOGUEROL, E.C.; ALVES, P.H.M.; ARAÚJO,
I.M.; CARVALHO, A. L.; PAULA, F. J. A.; MUGLIA, V.F.;
ELIAS JR., J.
de Ribeirão Preto, Ribeirão Preto, São Paulo, Brasil
Author responsible: Eloá C. Noguerol
Brief description of the purpose of the study: MRI is a
well-established method for quantification of liver fat. The
simplest way is to obtain the calculation of the fat fraction
by GRE technique of chemical shift. However, no studies
demonstrating the best way to measure the signal intensity
for this calculation.
Methods: A retrospective study with a convenience sample of
74 MRI examinations showing steatosis, reviewed by two radiologists, and evaluation of three different measurement strategies to hepatic fat quantification in two groups, diffuse steatosis
(n = 37) and heterogeneous (n = 37 ), matched for age and sex.
Main results: In heterogeneous steatosis group, the ROI of
use of 1cm2 to measure the signal intensity in the most altered area showed significant variations in the quantification,
while the average of four ROIs of 1cm2 or representative target area in axial section did not vary significant. In diffuse
hepatic steatosis, any strategy used showed no significant difference. The intraclass correlation coefficient ranged between
0.96 and 0.99, with 95% of 0.93-0.99.
Conclusion of the presentation: The quantification of liver
fat by MRI using only one ROI is less representative, especially in heterogeneous steatosis. There was no significant
difference between getting the average of 4 ROIs and the representative area of segmentation parenchyma.
PD.01.021
Granulomatous Diseases with biliopancreatic involvement mimicking neoplasm
Authors: Souza, P.M.; Barbosa, R.C.B.; Araujo, T.A.; Schulte,
AC.Q.;Silva, M.M.; Pereira K.G.;Ferreira, CL. S.;Dias, C.S.
Institution: Hospital Federal de Bonsucesso, Rio de Janeiro,
RJ, Brasil
Author responsible: Priscilla Morgado e Souza
Brief description of the purpose of the Review of Literature: This article aims to report two cases of granulomatous
diseases (tuberculosis and paracoccidioidomycosis) with biliopancreatic involvement with clinical course of cholestasis
and initial radiographic findings consistent with cancer. We
emphasize these infectious causes of abdominal pain that
may mimic malignancy and, although rare, are part of a spectrum of etiologic agents of high prevalence in our country.
PVA, 48 years, presented heartburn and postprandial fullness, elevated serum amylase and evening fever. Computed tomography and endoscopic ultrasound revealed a mass
in the head and uncinate process of the pancreas. EZD, 57
years, presented jaundice and elevated alkaline phosphatase.
Computed tomography revealed hypodense material, heterogeneous and infiltrating adjacent to the hepatic hilum, with
dilatation of the intrahepatic bile ducts and cholecystitis.
Conclusion: Submitted to laparotomy, the histopathological study showed Mycobacterium tuberculosis and P. brasiliensis, respectively, and led to clinical improvement after
starting treatment. The pathogenesis of these granulomatous
diseases is not well known and its signs / symptoms are nonspecific, making its diagnosis difficult.
Brief discussion of the case Paracoccidioidomycosis and
tuberculosis are not always considered as differential diagnoses in the investigation of cholestatic syndromes, which may
delay the diagnosis of curable diseases, due to the similarity
with neoplasms biliodigestivo system.
PD.01.023
BILIARY ASCARIASIS: what every radiologist needs to know and how to report.
Authors: FUDO, C.M.K; MARCHI, S.E.N.; NASSAR,
S.A.; CALVI, C.A.; FURLAN, B.J.; MIZOBUCHI, F.C.;
PUTY,R.C.; RODRIGUES,M.P., MORAES, D.C.;
Institution: Centro Médico Diagnósticos, Sorocaba, São
Paulo, Brasil
Author responsible: Camila Mineyo Kasae Fudo
Brief description of the purpose of the report: Describe a
case of hepatobiliary ascariasis, and its findings on magnetic resonance cholangiopancreatography (MRCP) and ultrasound (US),performing an updated review of its conditions
and complications.
Medical History: J.S.C., 29 years old, history of pain in the
right hypochondrium, epigastric pain , nausea and vomiting.
Previous history of cholecystectomy. MRCP was performed
in search of residual gall stones in the bile ducts.
Diagnosis: MRCP showed tubular structure with low signal
on T2-weighted sequences, located in the duct bile near the
sphincter Oddi , causing obstruction and dilatation of the upper bile ducts. US showed echogenic tubular structure with
hypoechoic central portion, motionless. Retrograde cholangiopancreatography endoscopy, through which the tubular
structure was removed, thus confirming the presence of ascaris lumbricoides which caused the obstruction. Ascaris
lumbricoides is the leading cause of helminth infestation in
humans. Occasionally some reach the ampulla of Vater and
the pancreatic duct. Differential diagnosis includes: presence
of foreign body , bleeding, gall stones and pus that will be discussed in detail in order to differentiate between them.
Discussion and summary of the case: MRCP and US are
important non-invasive diagnostic instruments to detect the
helminth in biliary tree. Therefore, the clinical knowledge of
disease and imaging findings are of fundamental importance
to radiologists and sonographers .
PD.01.025
Syndrome Trenaunay and radiological
findings
Authors: WALCZAK, T.G.R; SALGADO, A.A.B.O; ZANETTI, E.S; GAVINO, J.F; ORLANDI, J.L.M; SOUBHIA,
H.R; NETO, W.A; SIQUEIRA, C.C.G; LEAL, N.L; FERNANDEZ, C; FIGUEIREDO, M.A.P; OLIVAL, L.D, SINISGALLI JR, C.A
Author responsible: Aline Almeida Baptista de Oliveira
Salgado
Brief description of the purpose of the report: To discuss
the radiological findings that can be found in individuals with
underlying disease of the patient. This is a very rich syndrome in imaging findings, with a significant morbidity and
complications.
Medical History: RAM , female, 30 years, with low back pain
over one day. HMP : Klippel Trenaunay Weber syndrome .
Diagnosis: Renal colic in a patient with Klippel Trenaunay
Weber Syndrome Triad characterized by port-wine stains ,
varicose veins, bone and soft tissue hypertrophy of one end.
Usually unilateral, affecting more often lower limbs. Most
are sporadic, with an incidence of 1:100,000, with no gender
preference . Vascular malformations may also affect visceral structures such as the gastrointestinal and genitourinary
tract , spleen and adrenal glands, generating several possible
imaging findings. Complications include thrombophlebitis,
thromboembolism , gastrointestinal or genitourinary bleeding , coagulopathy consumption , among others.
Discussion and summary of the case: It is important to the
professional become familiar about ways of involvement in
the disease, to make a better assessment of each case, with
improvement of the description and characterization of the
possible complications .
PD.01.026
Magnetic Resonance Elastography (MRE):
A Novel Technique for Evaluation of Liver Disease
Authors: COSTA-SILVA, L.; FERRARI,T.C.A.; LIMA,
A.S.; FEROLLA, S.; AMBROSIO,A.M.; SILVEIRA,M.C.;
FIGUEIREDO, E.
Institution: Instituto Hermes Pardini; Faculdade de Medicina da UFMG, Belo Horizonte-MG, Brasil
Author responsible: Luciana Costa Silva
Introduction: MRE is an emerging MRI technology that
provides semi-quantitative assessment of liver stiffness. The
most promising clinical application is the assessment of liver
stiffness as a surrogate marker of liver disease and fibrosis.
Methods Involved: MRE employs phase contrast MR sequences which are sensitive to the direction and amplitude
of tissue motion. In patients with chronic liver disease, as the
liver tissue becomes stiffer, the wavelength of the pressure
waves becomes longer. This can be visualized in color-coded
images, and specialized image analysis software can measure the wavelengths and provide quantitative estimates of
tissue stiffness. We will discuss the applications, weakness
and strengths of MRE and present a series of clinical and
research cases.
Discussion: Management of patients with liver disease
such as chronic viral hepatitis or NAFLD involves careful
monitoring for the development and progression of liver inflammation, fibrosis, and cirrhosis. This is usually achieved
through a combination of physical exam, laboratory testing,
and imaging. However, all of these tests may remain normal
during the early stages of liver disease. Therefore, in patients
with potential early disease, liver biopsy is often used, but it
is an invasive procedure with associated risks.
Conclusion of the presentation: MR elastography is a
promising technique to evaluate liver disease.
51
PD.01.028
Non-Neoplastic Uses of Diffusion-Weighted MRI in Abdomen
Authors: AFONSO, F.B.;PESSÔA, F.M.C;BIZZO, B.C.;VARELLA, R.;BITTENCOURT, L.K.
Institution: Departamento de Radiologia, Hospital universitário Antonio Pedro, Niterói, Rio de Janeiro, Brasil
Author responsible: Felipe Batista Afonso
Brief description of the purpose of the Review of Literature: This study aims to present a review of diffusion use in
non-neoplastic abdominal diseases.
(s): The diffusion-weighted MRI characterizes tissue based
on the Brownian motion of water molecules. Particularly in
non-contrast resonance imaging, diffusion provides an alternative to characterize and identify diseases. A literature review was conducted of the current applications of diffusion
sequence in non-neoplastic disease associated with collection
of the best representative cases during the last year. All images were obtained of devices with1.5 and 3.0 Tesla.
Conclusion: The inflammation causes increased migration
of leukocytes and plasma transudation into the interstitial
spaces of the affected tissues. This infiltration changes the
diffusion of water molecules in place, observed restriction to
diffusion in tissues with high cell density. Diffusion provides
information at the cellular level. Its main applications are the
acute and chronic inflammatory diseases, detection of complications in cysts, thrombosis and ischemic, inflammatory
bowel disease, assessment of liver fibrosis and renal function,
including post transplant.
Brief discussion of the case The diffusion-weighted MRI is
a much promising sequence for non-neoplasms abdominal
applications, as well as providing qualitative information also
presents quantitative data without the need of contrast medium.
PD.01.029
Apêndice Cecal- Ênfase em ultrassonografia e tomografia Computadorizadaanatomia e técnica de exame
Authors: Rodrigues LD, Aguiar APZ, Begot LRC, Hirose
MA, Portilho LC, Cavalcante B, Grassi DC, Lotte FM, FerreiraVFL, Francisco Neto MJ
Institution: Transduson Medicina Diagnóstica, Carapicuíba,
São Paulo, Brasil
Author responsible: Ana Patricia Zednik de Aguiar
Introduction: The appendix has been increasingly studied
by ultrasound examination and CT and the knowledge of
their anatomy and examination technique has its importance
increasingly pronounced in the current scenario, particularly in emergency medicine, for acute appendicitis is the main
cause of acute abdomen.
Methods Involved: Analysis of US and CT studies performed in our hospital, with emphasis on exam technique and
anatomy of the appendix.
Discussion: The examination technique in this context must
be known with the definition, protocols and basic cuts and
plans to be analyzed including cecum, ileocecal valve and
iliac vessels.
Conclusion of the presentation: Ultrasonography and computed tomography, have shown excellent method to study
antomia and diagnosis of various conditions that affect the
52
appendix. In daily practice, the use of transducers with high
frequency and millimeter resolution, greatly assist the application of ultrasound study in the evaluation of cecal apêncie.
Computed tomography with multidetector technique has reduced the acquisition time and allows the study of appendicular anatomy in many more biotypes. Thus, knowledge of
the art and the study protocol, and the field of appendicular
anatomy, are fundamental to the doctor imagenologista, in
the study of the appendix, particularly in the medical internist
and emergency room.
PD.01.030
Contribution of imaging in the differential diagnosis of splenomegalies
Authors: LIMA, TC; LEAO RV; VIANA PC; AMANCIO
CT; PANIZZA, PSB; PAIXAO TSA; LEITE CC; CERRI
GG; YAMANARI TR; ZATTAR, LC; SANTOS JR, VR;
DUQUE, DS.
Institution: Sociedade Beneficente de Senhoras Hospital
Sírio Libanês, São Paulo, São Paulo, Brasil
Author responsible: Thais Carneiro Lima
Introduction: Splenomegaly is characterized, radiologically,
by a spleen volume exceeding 470 cm3. This excessive volume
may originate from,congesti ve, inflammatory , hematologic ,
infiltrative or tumor sources . This essay aims describe and illustrate the main imaging findings in splenomegaly and its other
associated findings that contribute to the differential diagnosis.
Methods Involved: The image files of all patients admitted were
reviewed between January 2012 and December 2014. Those patients were submitted abdominal computed tomography (CT ).
Only splenomegaly cases were select. The etiologic diagnosis
was confirmed by information obtained from patient charts.
Discussion: Splenomegaly may be found in several diseases. Among them we can highlight congestive splenomegaly
due to portal hypertension, in which the features associated
as signs of liver disease , expansion of the splenic vein and
corpuscles Gamma- Gandy help define the diagnosis.Conglomerates in mesenteric lymph node chains and associated
retroperitoneal speak in favor of splenomegaly by lymphoma
. Among the infiltrative esplenomegalias stands out Gaucher
disease is associated with bone enlargement and cortical thinning with impaired bone concavity.
Conclusion of the presentation: Splenomegaly is a non-specific radiological finding, but the associated aspects guide the
radiologist for a more accurate diagnosis .
PD.01.031
Gadoxetic Acid–enhanced Magnetic Resonance Imaging of the Liver: Differential
Diagnosis of Hyperintense Lesions in Hepatobiliary Phase Images
Authors: LIMA, V.B.R.; EIRAS ARAUJO, A.L.; OLIVEIRA NETO, J.A.; ALVES, C.V.M.; HEMING, C.A.M.;
PEREIRA, R.C.R; VEZZANI, R.B.; PARENTE, D.B.
Institution: Fleury - Labs A+, Rio de Janeiro, RJ, Brasil.
Author responsible: Cinthia Vanessa Mendonça Alves
Introduction: To review the utility of Gadoxetic Acid-enhanced MR Imaging of the Liver and to illustrate the imaging
appearance of different types of lesions that are hyperintense
to the surrounding liver parenchyma in hepatobiliary phase
images, in both cirrhotic and non cirrhotic liver.
Methods Involved: Retrospective evaluation of gadoxetic
Acid–enhanced MR Imaging of the Liver in the last 5 years
and characterization of the imaging appearance of hyperintense lesions in hepatobiliary phase.
Discussion: Research has shown that gadoxetic acid can be
valuable in characterization of focal liver lesions. In cirrhotic liver, regenerative and dysplastic nodules are usually isointense or hyperintense in the hepatobiliary phase. However
well or moderately differentiated HCC can be also iso or hyperintense. In non cirrhotic liver, focal nodular hyperplasia
is the most common cause of hyperintense lesion in hepatobiliary phase, but nodular regenerative hyperplasia and other
rarer lesions can also present with hyperintensity. We characterize imaging features of histologically proven and/or radiologically proven iso or hyperintense lesions in hepatobiliary
phase images.
Conclusion of the presentation: Radiologists must be aware
of the typical features of Gadoxetic Acid-enhanced MR Imaging of the Liver to provide appropriate diagnosis. This pictorial essay reviews the most common hyperintense lesions in the
hepatobiliary phase and discusses the pitfalls and limitations.
PD.01.032
GASTROINTESTINAL STROMAL TUMOR :COMMON AND UNCOMMON PRESENTATION
Authors: LAGO, EAD; LAHAN, D; PENACHIM, TJ; YUMIOKA, A; BARROS, RH; CASERTA, NMG
Author responsible: Nelson Caserta
Introduction: Gastrointestinal stromal tumor (GIST) is the
most common mesenchymal neoplasm of the gastrointestinal
tract and may show a wide spectrum of presentation. We present some frequent and other uncommon aspects of this entity.
Methods Involved: From the archive of our instituition, we
have selected different manifestation of this neoplasm.
Discussion: We demonstrate cases of GIST with different sizes and localization, including large lesions with complications
such as hemorrhage and intestinal obstruction (intussusception).
Stomach is the most common location for GIST, but we show
other sites as colon, duodenum and extraintestinal presentation.
We also present GIST associated with type I neurofibromatosis.
Conclusion of the presentation: GIST may show a variety
of appearences and anatomic location. It is important for the
radiologist to be aware of the most common and also some
uncommon aspects of this neoplasm.
PD.01.033
ULTRASOUND FINDINGS OF RICHTER HERNIA
Authors: MANARA, L.M.; NESI, R.S.; WANDERLEY, M.;
YUHARA, E.Y.; ODELI, J.T.; DUARTE, E.C.; FERREIRA
NETO, B.J.
Institution: Hospital Universitário - UFSC, Florianópolis,
Santa Catarina, Brasil
Author responsible: Luiza Maes Manara
Introduction: Herniation of the bowel antimesenteric wall
through an intra-abdominal defect is called Richter hernia.
The presence of narrow herniary ring compromises the blood
flow, without obstructing the intestinal transit, therefore delaying diagnosis and allowing complications, like strangulation. The diagnostic by imaging studies can be decisive for a
positive outcome, and ultrasonography can be superior to CT
in the evaluation of this entity, besides it is a cheaper method,
easily available.
Methods Involved: Pictorial essay of CT and ultrasound imaging.
Discussion: The sonographic findings of rounded intestinal
loop, motionless, liquid filled, with free fluid in the herniary
ring, forming an image of circle inside circle, can be seen
in Richter hernia, and the differential diagnosis is incarcerated hernia. These aspects are more characteristic than the
CT findings, however there are few articles in the literature
about this topic.
Conclusion of the presentation: Richter hernia diagnosis
may be suspected by characteristic sonographic findings,
allowing early treatment and preventing the progression to
necrosis and perforation.
PD.01.034
Descending mesocolon defect with internal hernia: a rare complication of
open nephrectomy.
Authors: NESI R.S., MANARA L.M., WANDERLEY M.,
YUHARA E.Y., ODELI J.T., DUARTE E.C., CARVALHO
R.O.M.
Author responsible: Rafael da Silva Nesi
rare case of internal hernia after open nephrectomy.
Medical History: Masculine, 50 years old, 25 days after
open transperitoneal left nephrectomy, complaining of epigastric pain radiating to flank and left lumbar region for
two days.
Diagnosis: Internal hernias can be classified into congenital
and acquired, the last by postsurgical cause or traumatic defects. Nephrectomy can be performed by transperitoneal or
retroperiteneal approach. The transperitoneal aproach presents complications that are common in abdominal surgery,
like small bowel obstruction by adhesions. However, the
obstruction by a descending mesocolon defect is unusual in
laparoscopic surgery and even more unusual in open surgery.
In this case an abdominal CT scan was performed, showing
small bowel dilatation in the left flank, bowel wall thickening
and vascular engorgement. Surgical report described a mesocolon defect in the splenic flexure with internal hernia and
reversible intestinal ischemia in a small segment of the small
intestine, confirming the diagnosis of descending mesocolon
defect with internal hernia.
Discussion and summary of the case: Although it is unusual, radiologists should be aware of this complication.
PD.01.035
PETERSEN HERNIA – TYPICAL FINDINGS IN COMPUTED TOMOGRAPHY
YUHARA, E.Y.; ODELI, J.T.; DUARTE, E.C.; CARVALHO, R.O.M.
Introduction: With the popularity of bariatric surgery comes
53
the need for the radiologist to be familiar with tomographic
aspects of each type of surgery and the most common complications. Gastric bypass with Roux-en-Y, also used in gastrectomy, is one of the surgeries with the best results, but internal
hernias are possible complications. The most common is the
bowel herniation in the posterior potential space to the gastrojejunostomy, called Petersen hernia.
Methods Involved: Pictorial essay with computed tomography images of patients with Petersen hernia diagnosis, surgically proven.
Discussion: The rotation of mesenteric vessels, also known
as whirl sign is one of the most classic signs. Other typical findings are herniated intestinal loop segment above
the gastric level, displacement of Treitz angle, downward
course of middle-distal ileum and bowel distension in the
upper abdomen.
Conclusion of the presentation: The complications associated with the late diagnosis of Petersen hernia include volvulus, obstruction and intestinal ischemia. Therefore, the early
recognition of Petersen hernia typical findings is imperative.
PD.01.036
Melanoma metastasis to the gallbladder.
Authors: LOPEZ, A.M.; SANCHEZ, D.; RODRIGUEZ,
C.E.; ESTEBAN, E.M
Institution: HOSPITAL UNIVERSITARIO INFANTA
CRISTINA, BADAJOZ, ESPAÑA
Author responsible: Ana Lopez
Brief description of the purpose of the report: The aim
of this report is to describe and ilustrate a case of malignant
melanoma (MM) metastasis (M1) to the gallbladder.
Medical History: Man 50 year old, diagnosed with melanoma in left breast, stage IV Clark and Breslow 5 mm. Surgical
removal of the lesion and the sentinel node (where the pathology showed invasion) is performed. In extension study is
diagnosed with cerebral M1. Likewise, in computed tomography (CT) scan a nodule within the gallbladder, which ultrasound is displayed as a hypervascular polypoid lesion and
PET-CT coincides with a hypermetabolic focus is observed,
suggesting vesicular metastases as first possibility diagnostic.
Diagnosis: Metastasis to the gallbladder is rare and malignant melanoma is the tumor that most often metastatizes to
this site (50-65 % of all metastatic gallbladder).
Discussion and summary of the case: Metastases to the
gallbladder is a rare entity, but to consider in patients with
MM known to have biliary injuries clinic or different gallbladder stones in a test image. In both situations, ultrasonography is an ideal diagnostic method, being a vascularized
polypoid lesion the most common finding.
PD.01.037
ACUTE PANCREATITIS: HOW TO REPORT? - THE
REVISED ATLANTA CLASSIFICATION
Authors: YAMANARI, TR; VIANA, PCC; ZATTAR-RAMOS, LC; LEAO, RV;RIBEIRO-DOS-SANTOS JR., V;
LEITE, CC; CERRI, GG.
Institution: HOSPITAL SIRIO LIBANES, SAO PAULO,
SP, BRASIL
Author responsible: Tássia Regina Yamanari
Introduction: Acute pancreatitis (AP) is a common disease
and there have been important changes in its definitions and
54
stages since the Atlanta classification from 1992. The revised
classification divides the phases as early and late; stratifies
the severity as mild, moderate or severe; and defines the morphology of pancreatic and peripancreatic collections as complications of AP. This study ilustrate the differents phases and
severity of AP and the complications.
Methods Involved: We demonstrate the revised Atlanta classification with computed tomography images of patients with
AP, from the digital archive of our institution.
Discussion: In the first week (acute phase), clinical parameters determine treatment, and after the first week (later
phase), the treatment is determined on the basis of clinical
and CT parameters. The severity is defined by the presence
of transient or persistent organ failure (> 48 hours), local
complications or exacerbation of co-morbidities. Local complications are peripancreatic fluid collections, pancreatic and
peripancreatic necrosis (sterile or infected), pseudocyst and
walled-off necrosis (sterile or infected). The revised classification facilitates standardized reporting of imaging findings
and objective assessment of treatment.
Conclusion of the presentation: Radiologic imaging has become increasingly important in staging and treating AP and
the radiologist has to familiarize with these classification in
their clinical practice.
PD.01.040
WHAT WE CAN DETECT AT VIRTUAL COLONOSCOPY?
Authors: Maranhão CPM, Farias LPG, Padilha IG, França
DM, Miranda CMNR
Institution: Clínica de Medicina Nuclear e Radiologia de
Maceió - MedRadiUs, Maceió, Alagoas, Brasil
Author responsible: Igor Gomes Padilha
Introduction: Colon cancer is an important cause of morbidity and mortality. In most cases, it develops from pre-existing
adenomatous polyps. Virtual colonoscopy, CT Colonography
or CT Pneumocolon, has been considered a major advance
diagnosis and can be used in screening for cancer, evaluatig
colon above the occluded segment and after endoscopic colonoscopy without success. This paper aims to demonstrate, by
CT Colonography, several aspects related to the diagnosis of
benign and malignant lesions of the colon.
Methods Involved: Literature review, retrospective analysis and demonstration of various conditions detected by
CT Colonography.
Discussion: Screening is considered the best strategy for the
control of colorectal cancer. The endoscopic colonoscopy is
the gold standard, but it is invasive, with risks and patiet need
to be sedated. CT Colonography diagnoses and evaluates
tumor extension, synchronous tumors, extra-colonic lesions
and benign lesions such as polyps/diverticula. In order to
perform its diagnostic abilities, it is necessary to clean and
distended colon with air, but with no patient sedated.
Conclusion of the presentation: CT Colonography is a
non-invasive, safe and well tolerated medical test, with high
efficacy for the study colonic and can demonstrate various
benign and malignant pathologies, besides the great potential
for its use in colorectal cancer screening.
PD.01.045
TUMOR FRANTZ
Authors: Ramos, L C; DE SOUZA, C S ; CEDRO, P M A
Institution: MULTIMAGEM, ILHEUS, BAHIA, BRASIL
Author responsible: Lister Cedro Ramos
Brief description of the purpose of the report: THE REPORT
OF A TYPICAL TOMOGRAPHIC PATHOLOGY RARE
Medical History: IMAGENS DE TC , COM INJEÇÃO
ENDOVENOSA DO CONTRASTE REALIZADA EM
01/04/2014.
Diagnosis: The Frantz tumor is a pancreatic cancer rare,
occurring in approximately 0.17% -2.7% of non-endocrine
tumors of the pancreas. Recently, there has been the aumento
its incidence. A possible explanation is the greater knowledge
of the disease. Clinical findings are vague. It is rare invasion
of vascular or biliary structures, which makes surgical resection the best treatment .
Discussion and summary of the case: The Frantz tumor
should be included in the diagnosis of rare neoplasms of
the pancreas, once diagnosed it is chosen by radical surgical
treatment with curative intent, which is often not possible in
cases of adenocarcinoma.
PD.01.046
Carcinoid tumor of the appendix
Authors: ORLANDI, J.L.M; SALGADO, A.A.B.O; ZANETTI, E.S; GAVINO, J.F; WALCZAK, T.G.R; SOUBHIA,
H.R; NETO, W.A; SIQUEIRA, C.C.G; LEAL, N.L; FERNANDEZ, C; FIGUEIREDO, M.A.P; OLIVAL, L.D, SINISGALLI JR, C.A
Author responsible: Aline Almeida Baptista de Oliveira
Salgado
Brief description of the purpose of the report: The purposal of this report is to demonstrate the essential role of the
radiologist in the diagnosis, being the images methods are the
most important for diagnostic, and scintigraphy the primary
method, with accuracy higher than 80%.
Medical History: Female, 22 year old, with diffuse abdominal pain for 08 days and diarrhea. CT scan showed appendix
with increased caliber in distal portion, with maximum transverse diameter of 1.2 cm and homogeneous enhancement
after contrast. Patient undergoing appendectomy, improving
disease and pathology confirmed the diagnosis.
Diagnosis: Carcinoid Tumor Carcinoid tumor are neoplasms
of the diffuse neuroendocrine system with an incidence of 0.7
cases per 100 thousand inhabitants. Patients have an average
age of 50 years and the most frequent site is located in the
gastrointestinal tract. The appendix is the second most affected site on gastrointestinal tract. The diagnosis has increased
due to better methods available. The treatment of most cases
consists on appendectomy, depending on the stage of the tumor at diagnosis.
Discussion and summary of the case: The carcinoid tumor
symptoms of the appendix are usually nonspecific. The classic carcinoid syndrome with hot flashes, flushing and diarrhea, have low incidence (3-5%), making the imaging methods, keystone for elucidation of the diagnosis.
PD.01.047
Primary Hepatic Arteriovenous Fistulae:
a case report
Authors: KUPSKE, A.; PEDROLLO, I.M.; WAINSTEIN,
B.; FARENZENA, M.; GAZZONI, M.F.; DE MOURA,
G.G.R; FOLADOR, L.; GAZZONI, F.F.
Alegre, RS, Brasil
Author responsible: Ivan Morzoletto Pedrollo
of liver arteriovenous fistulae (AVF), discovered by chance
during cholecystitis research.
Medical History: 67-year-old woman, with heart failure,
presents to the emergency room with pain in the right hypochondrium.
Diagnosis: Abdominal ultrasonography showed ectatic and
tortuous vascular structures in the hepatic parenchyma, with
marked flow in the color Doppler study , with prominence
of hepatic, portal and splenic veins. The gallbladder had thin
walls and was filled with stones. The cholangiopancreatography magnetic resonance showed no signs of acute cholecystitis
or dilatation of the common bile duct. Computed Tomography
angiography identified bulky shunts between the right hepatic
artery and the middle and right hepatic veins, with marked increase in vessel caliber in the parenchyma and adjacent areas
of perfusion disorder. The celiac artery and hepatic artery had
greatly increased caliber. These AVF were confirmed in arteriography. The patient was investigated for other malformations and vascular hereditary syndromes, all negative.
Discussion and summary of the case: Based on imaging
and clinical data, we performed the diagnosis of primary liver
telangiectasia that had a direct relationship with the patient
heart failure . The patient was referred for cholecystectomy
and cardiac monitoring.
PD.01.048
Non-traumatic acute abdomen: Correlation between plain radiography and computerized tomographic findings
Authors: JARDIM, L.C.; ROSA, B.G.; VERGÍLIO, F.S.;
TONIN, C.L.; DE AZEVEDO, M.M.; PEREIRA, P.P.; HO,
F.; ZANGIACOMO, R.N.
Author responsible: Leonardo Castanheira Jardim
Introduction: Acute abdomen is the term used to define a
clinical syndrome which includes abdominal pain and requires emergency care. Acute abdominal pain is one of the
main symptoms that account for consultation in emergency
services. The objective of this study is to correlate the image
findings of non-traumatic acute abdomen cases in plain radiography (X-ray) and computerized tomography (CT).
Methods Involved: Pictorial essay of acute abdomen cases correlating X-ray and CT findings, obtained from the digital data
bank of a public hospital, reference in emergency medical care.
Discussion: Abdominal CT has been playing a major role on
abdominal pain approach, leaving X-ray a secondary role,
with a few exceptions. Either by the advantages of the method or the increase in number of equipment available, the CT
use has increased. However, X-ray and CT findings are correlated, in several occasions. A good evaluation and knowledge of these findings can clarify several cases.
Conclusion of the presentation: Planning and correct indication of the imaging method as well as indicating a diagnostic hypothesis can optimize the sensibility. In the context
of an emergency condition such as acute abdomen, the evaluation of the imaging exam has played a central role in promoting early and accurate diagnosis, reflecting in reduction
of mortality.
55
PD.01.049
Pelvic lipomatosis: a case report
Authors: KUPSKE, A.; KRUGER, M.S.; PEDROLLO, I.M.;
WAINSTEIN, B.; MULLER, A.S.; GRAZZIOTIN, R.U.
Alegre, RS, Brasil.
of an incidentally discovered bulky pelvic mass with lipomatous aspect.
Medical History: A 47-year-old man, presents in the emergency with nonspecific complaints and a palpable mass in the
lower abdomen on the physical examination. In the abdominal ultrasound (US), in addition to chronic liver disease signs,
was observed anterior and superior bladder displacement,
without being possible to identify its cause by the method.
Computed tomography (CT) showed a marked prominence
of perivesical fat planes with abundant vascularization and
discrete density, determining stretching of the floor and neck
of the bladder , with its cranial displacement. These findings
are related to massive pelvic lipomatosis.
Diagnosis: Pelvic lipomas present as nonencapsulated fatty
mass, symmetrically surrounding pelvic organs. It can cause
cranial displacement of pelvic structures, and important compression symptoms when they are large.
Discussion and summary of the case: The patient did not
complain of compressive symptoms. We decided on radiological follow-up. US can be useful in identifying this type of
injury, confirming their appearance at CT. Follow-up should
be done to monitor the behavior of the lesion and possible
vascular, urinary and intestinal complications.
PD.01.050
Arteriovenous fistula caused by firearm
projectile - Case report
Authors: VALADARES, L.C.; ANTUNES, R.V.B.; CAVALCANTI, J.P.L.; MATOS, B.P.; FARIA, R.N.; CARDOSO,
H.C.C.; NOGUEIRA, R.A.M.; LIMA, F.G.; VON ATZINGEN, A.C.
Institution: Hospital das Clínicas Samuel Libânio, Pouso
Alegre, Minas Gerais, Brasil
Author responsible: Bárbara Pessoa de Matos
Brief description of the purpose of the report: The arteriovenous fistula is a type of traumatic vascular injury that can
be caused by firearm projectile, and, in most cases, found in
peripheral vessels.
Medical History: We report the case of a male patient of
44 years old with clinical diagnosis of acute abdominal pain,
colic type, located in the left upper quadrant and a history
of congestive heart failure and injury by firearm in the right
inguinal region. The abdominal ultrasonography confirmed
hepatosplenomegaly, increased vena cava diameter and lower hypoechoic image in the spleen without the doppler color
flow, partially defined limits. The computerized tomography
observed an area of splenic infarction, hepatosplenomegaly,
cardiomegaly and increased vena cava diameter and iliac vessels right due fistula between artery and right femoral vein.
Diagnosis: Arteriovenous fistulas in central vessels are highly lethal, with late clinical manifestations present with cardiac decompensation at variable intervals between the trauma
and the diagnosis of high output fistula.
56
Discussion and summary of the case: The importance of
this case report is to improve the knowledge about this rare
condition and bibliography update.
PD.01.051
Gastrointestinal stromal tumor as uncommon cause of small bowel intussusception : A Case Report
Authors: BEDUSCHI, G.; VALENTIM, L.; CAMARGO,
L.F.S.;ZIMMERMANN, A.L, HOFFMANN, J.
Institution: Hospital Santa Isabel - Ecomax, Blumenau, Santa Catarina, Brasil
Brief description of the purpose of the report: Gastrointestinal Stromal Tumors (GIST ) are the most common mesenchymal neoplasms of the gastrointestinal tract, with varied
clinical manifestations. This case illustrates an atypical ileum
GIST leading to intestinal blockage by intussusception.
Medical History: 54, male, with high intestinal obstruction
syndrome frame. Computed enterotomography showing
well-defined mass related to the ileum segment, which functioned as head of intussusception associated with dilation of
the small upstream . At exploratory laparotomy, exophytic tumor in the proximal segment of ileum wall was found, being
dry, diagnosed with GIST confirmed by pathology.
Diagnosis: GIST affects middle-aged individuals, both male
and female. Can occur throughout the gastrointestinal tract ,
and 20 to 30% arise in the small intestine ( ileum location is
unusual ). Prone to exophytic growth , usually does not cause
intestinal obstruction. The lesions vary in size from incidentalomas to masses, that the CT scan are shown clearly defined
and hypervascular tumors.
Discussion and summary of the case: Small bowel GIST
is a rare condition with variable clinical picture, and usually
do not progress to intestinal obstruction, but eventually, as in
this case, can cause intestinal obstruction.
PD.01.052
ABDOMINAL REPERCUSSIONS AFTER FISH BONE
INGESTION: PICTORIAL ESSAY
Authors: LEAO RV; AZAMBUJA RL; VIANA PCC;
SIQUEIRA LTB; BEZERRA ROF; YAMANARI TR;
DUQUE DS; ZATTAR-RAMOS LC; RIBEIRO-DOS-SANTOS JR V; LEITE CC.
Institution: HOSPITAL SIRIO LIBANES, SAO PAULO-SP, BRASIL
Author responsible: Renata Vidal Leao
Introduction: Unintentional ingestion of a fishbone (FB) is
a common clinical problem. It is known that at least 1% of
ingested FBs perforate the bowel and it tends to occur in regions of acute angulation. This article tends to illustrate the
potential clinic and cirurgic complications of FB ingestion e
its importance in acute abdomen cases.
Methods Involved: The medical records of all patients admitted to the emergency department of the institution and
submitted to abdominal computer tomography (CT) between
January 2011 and December 2014. We selected the cases of
ingestion and perforation by FB.
Discussion: An amount of 11 patients were selected. Three of
them presented duodenum perforation by FB, two in jejuno,
one at the stomach, one at the sigmoide and in one case there
were multiples sites of perforation, including jejunum and ileum. The remaining patients were asymptomatic.
Conclusion of the presentation: The main limitation of CT
in the detection of FB perforations is a lack of suspicion by
the radiologist, since this finding may be easily confused with
other structures, such as blood vessels. Therefore, it is crucial
to understand this entity and its possible clinical presentations,
in order to provide an accurate diagnosis for the clinician.
PD.01.053
MR Enterography - preparation and
appropriate protocol for the assessment
of Crohn\’s disease (CD).
Authors: FALCONE, D.D.D.M.; HOLLANDA, E.S.; BITTENCOURT, L.K.; SABANEEFF, N.; FALCONE, B.R.;
VAZ, C.L.
Institution: CDPI - Clínica de Diagnóstico por Imagem, Rio
de Janeiro, Rio de Janeiro, Brasil
Author responsible: Dafne Daniela Dias Melquiades
Introduction: Demonstrate through a pictorial study the
preparation and proposed protocol in exams of MR enterography in our institution.
Methods Involved: Illustrative cases from our digital file
will be used to demonstrate the preparation, protocol, main
findings and artifacts in exams of MR enterography.
Discussion: The CD is one of the main indications for this
exam. It is a chronic granulomatous inflammatory disease of
the gastrointestinal tract, evolving with periods of remission
and relapse, and can affect any segment of the gastrointestinal tract, most commonly the terminal ileum. For the proper
study of this disease, there is a necessity to distend the bowels
and to use a specific image acquisition protocol.
Conclusion of the presentation: The study carried out by
MR enterography method has demonstrated satisfactory efficacy and accuracy for the characterization of activity and
detection of complications of CD, thus determining a better
management of these patients.
PD.01.054
FAT ABDOMINAL NECROSIS SIMULATING ACUTE
ABDOMEN IN THE EMERGENCY DEPARTMENT : A
PICTORIAL ESSAY
Authors: LEAO, R.V; AZAMBUJA, R.L; SIQUEIRA,
L.T.B; BEZERRA, R.O.F; YAMANARI, T.R; DUQUE, D.S;
ZATTAR-RAMOS, L.C; RIBEIRO-DOS-SANTOS JR, V;
LEITE, C.C.
Introduction: Fat abdominal necrosis (FAN) is a common
finding in abdomen computed tomography (CT) and can
cause abdominal pain, simulating acute abdomen. The objective of this essay is to illustrate cases of FAN simulating acute
abdomen in the emergency department (ED).
Methods Involved: There were selected the confirmed cases
of FAN admitted in this hospital between January 2010 and
December 2014. Through the patients records we registered
the initial suspicion of the clinician, prior to the adominal
CT. We selected the cases in which the FAN was initially suspected to be an appendicitis, diverticulitis, cholecystitis, pancreatitis, gastritis, kidney stones, cystitis and pyelonephritis.
Discussion: Common processes that result in FAN are torsion of the epiploic appendix, greater omentum and FAN related to trauma or pancreatitis. Typical CT findings are small
oval area with fat attenuation surrounded by a soft tissue ring
and densification of the adjacent tissues.
Conclusion of the presentation: The FAN is a diagnosis that
should be readily recognized by the radiologist, as it is a frequent finding, which often presents as an acute abdomen. The
correct identification of this entity is crucial to avoid unnecessary surgical interventions.
PD.01.057
INFLAMMATORY BOWEL DISEASE: PICTORIAL
ESSAY
Authors: PANIZZA, P.S.B.; YAMANARI, T.R.; ORTEGA,
C.D.; COSTACURTA, M.A.; MARCELINO, A.S.Z; LEITE,
C.C.; CERRI, G.C.;
Institution: Hospital Sírio Libanês, São Paulo, São Paulo,
Brasil
Introduction: Inflammatory bowel disease (IBD) is comprised
of two major conditions: ulcerative colitis (UC) and Crohn disease (CD). These disorders have both distinct and overlapping
clinical, radiological and pathologic characteristics. This study
intend to illustrate and characterize the radiological presentation of IBD by using different imaging methods.
Methods Involved: We will demonstrate with images of
barium studies of the gastrointestinal tract, computed tomography (CT), magnetic resonance imaging (MRI) and ultrasonography (US), typical findings for the diagnosis of UC and
CD, as well as the imaging findings related to complications
of confirmed cases of IBD in our service.
Discussion: Radiology has always played a major role in the
diagnosis and evaluation of IBD. Coupled to barium studies,
especially small-bowel barium examination and barium enema, in the last decade significant improvements in the field
of cross-sectional imaging (US, CT and MRI), even more increased the relevance of the radiologist in this context.
Conclusion of the presentation: Becomes fundamental to
radiologists the knowledge regarding the different image
patterns in these conditions, for early diagnosis and active
research of possible complications.
PD.01.058
Rare Tumors of the Colon and Rectum
Authors: Caiado, AHM; Warmbrand, G; Chamie, LP; Meirelles, GP; Tiferes, DA; Matsumoto, CA, Caldana, RP.
Institution: Fleury Medicina e Saúde, São Paulo, SP, Brasil.
Author responsible: Angela Hissae Motoyama Caiado
Introduction: To know the epidemiology and clinical behavior of uncommon neoplasms of the colon and rectum, as well
as, to recognize their imaging characteristics.
Methods Involved: CT, MRI and PET CT.
Discussion: Adenocarcinomas account for about 90% of colorectal neoplasms. However, there is a small group of tumors
of other cell lines, such as hemangiomas, neuroendocrine tumors, gastrointestinal stromal tumors (GISTs), leiomyomas,
sarcomas, lymphomas and squamous cell carcinoma, which
have imaging features, epidemiology and distinct clinical behavior. Despite the relatively rare occurrence, it was observed
in the last decade an increased incidence of some tumors in
57
this group, highlighting neuroendocrine tumors, lymphomas
and squamous cell carcinoma.
Conclusion of the presentation: Our aim is to present an
overview of the epidemiology, clinical behavior and imaging
characteristics of these relatively rare, but, progressively increasing group of tumors.
PD.01.059
Diseases involving the cecum that mimic
Crohn’s disease: CT and MRI findings
Authors: FREITAS, E.T., FIGUEIRA, D.M.B., NASCIMENTO, B.L., OLIVEIRA, P.A.G., BITTENCOURT, L.K.,
MELO, A.S.A., NEVES, D.G.
Institution: HUAP-UFF, NITERÓI, RJ, BRASIL
Author responsible: Daniel
Introduction: The evaluation of the cecum on CT and MRI
is a routine in abdominal scans, and usually determines a diagnostic challenge upon the presence of an abnormal finding.
A number of conditions may be confounded with Crohn’s
Disease (CD), being either infectious, neoplastic or vascular.
Our objective is to discuss the main differential diagnoses of
CD in the cecum and terminal ileum.
Methods Involved: we have included four illustrative cases
from our teaching file, with the following diagnoses: intestinal paracoccidioidomicosis, pseudomembranous colitis, cecal lymphoma and perforated cecal ischemia.
Discussion: the illustrative cases were evaluated for the type
and extension of wall thickening, extramural and mesenteric
abnormalities, as well as other features that may aid in differential diagnosis.
Conclusion of the presentation: Despite CD being a common cause of ileocecal wall thickening, other rarer diseases
should be considered in the differential diagnosis.
PD.01.060
CT and MR-enterography in Crohn’s Disease - Typical presentations and potencial
complications
Authors: MARTINS LRA; SOARES MV; NUNES PHT;
MOURA FM; GATTO YP; OLIVEIRA RFR
Institution: HOSPITAL UNIVERSITÁRIO DE BRASÍLIA,
BRASÍLIA, DF, BRASIL
Author responsible: Fernanda Moura
Introduction: Crohn’s disease (CD) is a highly prevalent intestinal inflamatory disease (IID), with unknown etiology. It
can occur in any part of the intestine, with a discontinuous
and transmural presentation. Moreover, extraintestinal sites
also can be compromised. The main purpose of this presentation is to illustrate diferent manifestations and complications
of this disease.
Methods Involved: Patients with CD were selected from our
database, who underwent CT ou MR-enterography. Various
findings associated with the main phenotypes of Crohn’s disease were illustrated, comprising inflammatory, stenosing, and
penetrating-fistulizing forms. Associated features commonly
found in this particular scenario were also illustrated, like
vascular turgency, fat mesenteric proliferation and regional
lymphadenopathy. Other complications, such as obstruction,
fistula and/or abdominal abscess formation, venous mesentery
thrombosis, intestinal tumour development and other associated hepatic and osseous diseases were also depicted.
58
Discussion: Considering the different forms of CD’s presentation and its similarity to other conditions, early diagnosis
can be a challenge. Undoubtfully, imaging exams are highly
helpful on the differential diagnosis.
Conclusion of the presentation: We can conclude that the
knowledge of the various imaging possible presentations of CD
is extremely important as it can help to define a correct diagnosis and to avoid late recognition of potential complications.
PD.01.062
Esophagogram: the current state of an
ancient art.
Authors: ROCKENBACH, M.A.B.C.; PEDROLLO, I.M.;
KUPSKE, A.; WAINSTEIN, B.; MACIEL, A.C.
Alegre, RS, Brasil
Introduction: The initial assessment of symptoms such as
dysphagia, heartburn and epigastric pain, extremely prevalent, is still held by the esophogram, an old method, but still
widely used. This paper proposes to review, in an objective
and illustrated form, exam techniques, current indications
and to demonstrate the findings and more prevalent diseases.
Methods Involved: A review of the exams performed in a
tertiary hospital in 2013 was made, and the main diagnostic
findings were listed. The tests ranged from diagnostic, follow-ups and pre-and postoperative esophagograms of upper
GI tract surgeries. Correlation of findings with other imaging
methods will also be explored.
Discussion: Of the 542 tests carried out in 2013, the most
frequent findings were stenosis, post-surgical changes and
changes resulting from achalasia. The most common associated diagnosis were gastric hernia, tumors and diverticula. The
most classic and most prevalent findings will be demonstrated
as well as the conditions related to them. Also, the advantages
of ECC compared to other methods will be discussed.
Conclusion of the presentation: The ECC is a method that
provides basic information about diseases of the upper gastrointestinal tract and has not been superseded by any other
diagnostic test. Therefore, it is crucial that all radiologists
should be familiar with its main findings.
PD.01.063
LI-RADS: A pictorial essay
Authors: PEREIRA RCR; ARAUJO ALE; OLIVEIRA-NETO JA; HEMING CAM; VEZZANI R; LIMA VB; ALVES
CVM; PARENTE DB
Institution: LABS A+ FLEURY, RIO DE JANEIRO, RIO
DE JANEIRO, BRASIL
Author responsible: Rita Pereira
Introduction: HCC is the fifth most common cancer in men.
Patients at risk of HCC have to submit TC and MR imaging
control to increases the early detection of HCC. In order to
standardize the descriptions between the radiologists, the
ACR develop a system for interpretation, reporting, and data
collection for CT and MRI examinations in patients at risk for
HCC - Liver Imaging Reporting and Data System (LI-RADS).
The aim of this exhibit is to review the version 2013 LI-RADS
in comprehensive way and to illustrate the new terminology in
order to category hepatic imaging in these patients.
Methods Involved: Brief review of the importance of the
LI-RADS classification. In order to illustrate the LI-RADS
categories, it was done a screnning of a Internal Medicine
clinical reference database of Rio de Janeiro
Discussion: Based in this system, there are five categories to rate
the HCC risk cases observations, in crescent suspicion order.
Conclusion of the presentation: The LI-RADS classification has demonstrated high interobserver reliability and high
specificity in the detection of HCC. Moreover, the standardization of description enables better tracking of cases and
evaluation of their evolution.
PD.01.065
ACUTE CHOLECYSTITI AND PERICHOLECYSTIC
HEPATIC RIM : AN IMPORTANT MULTIMODALITY
IMAGING SIGN.
Authors: LAGO EAD, YUMIOKA A, MORITA D, FERNANDES DA, MARTINS DL, PENACHIM TJ, CASERTA NMG
Institution: Departamennto de Radiologia da FCM da Unicamp, Campinas , SP
Author responsible: Nelson Caserta
Introduction: Acute cholecystitis (AC) is a common cause of
hospitalization. Ultrasonography is usually used for this characterization but computed tomography (CT), magnetic resonance
(MR) and scintigraphy (DISIDA) are helpful when findings are
equivocal. Due to the spread of inflammation from the gallbladder to the liver, more activity, active hyperemia and enhancement
can be detected surrounding the gallbladder. Our purpose is to
demonstrate this important sign in different imaging modalities
Methods Involved: From our personal archives and that
from our instituition, we selected examples of this sign in
US, CT, MR and DISIDA, in patients with AC.
Discussion: This is a very sensitive sign of AC due to transient focal increased attenuation of the liver adjacent to the
inflammed gallbladder. This appearance can be observed in
different imaging modalities.
Conclusion of the presentation: This is a sign considered
to be very specific for acute cholecystitis . It is important for
the radiologist to know about this appearance that can help to
obtain the correct diagnosis.
PD.01.066
PADRÕES DE CRESCIMENTO E DISSEMINAÇÃO
DO CARCNINOMA HEPATOCECLULAR NA TOMOGRAFIA COMPUTADORIZADA E RESSONÂNCIA
MAGNÉTICA
Authors: AMORIM F.C.S.; COSTA M.M.; GUIMARAES C.T.S.; OLIVEIRA A.C.;TORRES L.R.; FERREIRA
M.P.F.D
Institution: MEDIMAGEM-BENEFICENCIA PORTUGUESA, SAO PAULO, SAO PAULO, BRASIL
Author responsible: Allan Constantino de Oliveira
Introduction: Carcinoma hepatocelular (HCC) é a lesão maligna primária mais comum do fígado e apresenta alta taxa
de mortalidade. O comprometimento extra-hepático do HCC
ocorre predominantemente nos casos de doença localmente
avançada e pode acometer qualquer local do corpo através
de diversos mecanismos de disseminação. O objetivo deste
estudo é ilustrar os principais padrões de crescimento e disseminação do HCC.
Methods Involved: Imagens de Tomografia Computador-
izada (TC) e Ressonância Magnética (RM) de exemplos de
HCC para ilustrar os principais padrões de crescimento e disseminação tumoral.
Discussion: O principal mecanismo de disseminação ocorre
por via hematogênica, acometendo pulmão, suprarrenais e
os ossos. O segundo mecanismo mais comum é através do
sistema linfático para os linfonodos locorregionais como os
retroperitoniais, peri-hepáticos e peripancreáticos. A invasão
direta pelo tumor e a disseminação peritoneal está geralmente
relacionada ao rompimento de tumor exofítico. Os padrões
de realce das lesões secundárias assemelham-se aos da lesões
primárias, destacando-se a TC multifásica e a RM como métodos diagnósticos para pesquisa destas lesões.
Conclusion of the presentation: O conhecimento dos mecanismos e das características das metástases é de extrema
importância para adequada avaliação do paciente e elaboração de um tratamento apropriado.
PD.01.069
Different findings related to portal venous thrombosis in the resonance
Authors: SILVESTRE, C.C.; ALBUQUERQUE, A.S.;
FONSECA, L.E.P.; PINHEIRO, L.A.; OLIVEIRA, C.K.S.
Institution: Hospital Alemão Oswaldo Cruz, São Paulo, São
Paulo, Brasil
Author responsible: Carlos Cezar Silvestre
Introduction: Portal vein thrombosis is commonly related to
chronic liver disease or cancer. Early diagnosis can improve
the prognosis. Our goal is to show cases of portal thrombosis
in different phases and discuss the radiological findings and
patterns of presentations magnetic resonance imaging (MRI).
Methods Involved: We retrospectively reviewed all patients
with diagnosis of portal vein thrombosis in our institution between January 2008 and December 2014. A total of seven
cases were included, and the RM different radiological aspects could be contemplated.
Discussion: MRI with contrast is highly accurate in characterizing the obstruction, duration and distinguishing both
subtypes, if clot or mural thrombus. Moreover, it can show
other associated changes, complications and the etiologic
factor. The appropriate interpretation of findings related to
portal thrombosis may impact the prognosis, as it allows the
installation of appropriate therapy for both the underlying
disease and the own portal thrombosis.
Conclusion of the presentation: The use of MRI in the evaluation of portal thrombosis provides important information
for the diagnosis, characterization and, also, identification of
the underlying disease, providing data for better management
of this condition.
PD.01.073
Sclerosing cholangitis primary: magnetic resonance cholangiography image in
diagnosis pictorial essay.
Authors: Silva, RR ; Neto, JAO
Institution: Hospital Quinta D`or - Rio de Janeiro/RJ, Brazil
Author responsible: Rodolfo Rodrigues Silva Quero
Brief description of the purpose of the study: The aim of
this pictorial essay is to illustrate the most common imaging
findings of sclerosing cholangitis primary (SCP) in the magnetic ressonance cholangiopancreatography (MRCP).
59
Methods: The exams analysis was performed in patients
with SCP performed at our institution over the past two years.
The examinations were performed with volumetric sequences with respiratory control and thick cuts in apnea. Additional sequence diffusion, contrast and dynamic study were held
whenever necessary.
Main results: The image of typical findings consist of alternating segmental stenosis with dilatation, and in later stages
there is the loss of bile ducts view. It is more likely the involvement of intrahepatic bile ducts, followed by intrahepatic and
extrahepatic involvement and being rare extrahepatic unique
changes. The most frequent complications are infectious cholangitis, the abscess and the evolution to cholangiocarcinoma.
Conclusion of the presentation: The MRCP is an excellent
noninvasive tool of diagnosis and evaluation of complications in patients with SCP.
TL.01.002
ARFI Elastography performed exclusively on the left hepatic lobe on patients
with Hepatitis C. Analysis of 10 cases.
Authors: Schmillevitch J, Gomes R, Mincis R, Mincis
M, Gorski A
Institution:
Author responsible: Joel Schmillevitch
Brief description of the purpose of the study: Evaluate the
results of ARFI Elastography in 10 patients with Hepatitis C,
which could not be evaluated on the right hepatic lobe, but
only on the left.
Methods: Prospective study on 10 patients carrying Hepatitis C, between March and October 2014, with ARFI Elastography, which could not be evaluated on the right hepatic
lobe, for diverse causes; partial Hepatectomy on the right,
right portal vein chemoembolization, Down Syndrome with
Sprengel deformity and having juxtahepatic subcutaneous
adipose tissue over 3.0cm thick
Main results: On 10 patients, the ARFI Elastography
achieved satisfactory results, with good technical quality, informing the degree of liver fibrosis.
Conclusion of the presentation: The ARFI Elastography
may be performed on the left hepatic lobe on patients carrying the Hepatitis C virus who cannot be evaluated on the
right lobe.
TL.01.003
Liver ARFI Elastography on patients with
morbid obesity; is the limiting factor
the body mass index or the subcutaneous
adipose tissue thickness?
Authors: Schmillevitch J, Gomes R, Mincis R, Mincis M,
Gorski A
Institution:
Author responsible: Joel Schmillevitch
Brief description of the purpose of the study: Analyze the
results among the ARFI elastography, the Body Mass Index
(BMI), the juxtahepatic subcutaneous adipose tissue thickness,
and the liver fibrosis levels on patients with morbid obesity.
Methods: Were analyzed 30 patients between January 2012
and August 2014 who were submitted to bariatric surgery,
weighting between 116 and 165 kilograms, and BMI between
35 and 48. The patients went through a liver ARFI elastog-
60
raphy, with fibrosis level quantification, and measurement of
the juxtahepatic subcutaneous adipose tissue.
Main results: Of the 30 patients, 14 presented inconclusive
ARFI elastography or with falsely elevated values. The 14
cases presented juxtahepatic subcutaneous adipose tissue
thickness over 3.0 cm. On the remaining 16 patients, with
Metavir classification F0, F1 and F2, the correlation between
the ARFI elastography and the anathomical-pathological
study was of 92%.
Conclusion of the presentation: On patients with morbid
obesity, the juxtahepatic subcutaneous adipose tissue thickness was decisive to the ARFI elastography results.
TL.01.004
Transient Arterial Phase Respiratory Motion–related Artifact in MR Imaging of
the Liver: Comparison Between Gadoxetic Acid versus Gadodiamide
Authors: COSTA-SILVA, L; NATANAEL, E.R.; SILVEIRA, M.C.; MARQUES, R.F.; AMBROSIO, A.M.
Institution: Instituto Hermes Pardini, Belo Horizonte, Minas
Gerais, Brasil
Brief description of the purpose of the study: To compare
frequency of arterial phase respiratory motion–related artifact following administration of gadoxetate disodium or gadodiamide in liver MR.
Methods: Forty patients underwent gadoxetic acid–enhanced
abdominal magnetic resonance (MR) between september and
december 2014 and were matched to 40 patients who were
administered the gadodiamide as contrast media in the same
period. The exams were ranked as absence (0) or presence
(1) of artifacts. Statistical analysis was done (McNemar test).
Main results: In group 1, 82.5% of patients were female
with a mean age of 44.58 +/- 14.70 years (21-81 years) in
group 2, 52.5% were of this gender, mean age 50.50 +/- 15.48
years (26-91 years). There were no significantly differences
between matched populations. Gadoxetate acid was associated with significantly higher incidence of arterial phase respiratory motion–related artifact compared with gadodiamide
(52.5% vs 20%, P=.0004). In group 1, the frequency of respiratory artifact was significant higher in arterial phase than in
hepatobiliary phase (52.5% vs 10%, P= .000015).
Conclusion of the presentation: Arterial phase respiratory
motion–related artifact occurs significantly more often at
arterial phase in patients after receiving gadoxetic acid than
after receiving gadodiamide as contrast media.
TL.01.005
Test-Retest Repeatabiliy of MR Elastography in healthy volunteers: assessment of liver stiffness in fasting state,
before and after repositioning at the
magnet, and after a caloric meal
Authors: COSTA-SILVA, L.; AMBROSIO,A.M.; SILVEIRA,M.C., MARQUES, R.M.; NARCISO,J.A.; FIGUEIREDO, E
Institution: Instituto Hermes Pardini, Belo Horizonte, Minas
Gerais, Brasil
Brief description of the purpose of the study: To Assess
liver stiffness measured by magnetic resonance elastography
(MRE) in healthy volunteers with no history of liver disease.
Methods: Repeatability study (test-retest) was conducted
in five healthy volunteers with no history of liver disease
or alcohol intake. The subjects were scanned three times on
the same day: first acquisition fasting, second acquisition 10
minutes after repositioning and third after a caloric meal. In
all tests, MRE sequences were acquired with 60 Hz mechanical frequency emitted by acoustic driver, using commercially
available equipment (MR-Touch, GE Healthcare). The tests
were processed using specific software for elastography, with
region of interest (ROI) obtained with free hand. Liver stiffness was measured in four slices and the mean score for each
acquisition was calculated per pacient. Statistical analysis
was performed using the intraclass correlation coefficient
(ICC) and Friedman test.
Main results: The healthy volunteers had a mean elasticity
of 2.61kPa in the first acquisition, 2.49kPa after repositioning and 2.50kPa after feeding. The ICC was 0.841, with p =
0.014. The Friedman test also showed that there were no statistically significant differences in hepatic elasticity between
acquisitions (p = 0.449).
Conclusion of the presentation: MRE is a reproducible
method to assess liver stiffness in healthy subjects.
TL.01.006
Hepatic Iron Content Quantification:
Comparison between MR Relaxometry
with R2* mapping and Signal Intensity Ratio Imaging
Authors: COSTA-SILVA, L.; SILVEIRA,M.C., AMBROSIO,A.M.; FERRARI,T.C.A., LIMA,A.S.; FEROLLA, S.;
NARCISO,J.A.
Institution: Instituto Hermes Pardini e Faculdade de Medicina da UFMG, Belo Horizonte-MG, Brasil
Brief description of the purpose of the study: To evaluate the relationship between R2* relaxometry mapping and
Signal Intensity Ratio (SIR) methods for liver iron content
(LIC) quantification.
Methods: 61 subjects, including patients with non-alcoholic
steatohepatitis (NASH) and healthy volunteers were included.
They underwent MR examination, in a research protocol, in
the same day, and it was acquired R2* mapping relaxometry
sequences and Signal Intensity Ratio Imaging with multiple
TEs(Rennes University protocol) for LIC quantification. Results were respectively calculated in specific website (Rennes
University) and parametric maps automatically generated
by specific software (Starpmap). The statistical analysis was
done using Student t test with paired samples and Intraclass
correlation (ICC) – SPSS v20 for Mac.
Main results: SIR systematically derives higher hepatic
content (30,32+/-17,74 micromol/g) than relaxometry techniques (21,92+/-3,80 micromol/g), p<0,001 (IC=95%). In all
subjects, R2* mapping was normal, but using SIR imaging
21 participants had LIC higher than 36 micromol/g. SIR also
has a higher standard deviation than R2* methods, which in
patients with borderline measurements could be a problem,
as some would be misclassified as having liver iron overload.
Conclusion of the presentation: SIR and relaxometry methods give statistical significantly different results in the same
subjects who underwent MRI in the same day and, in borderline liver iron content, patients could be misclassified.
TL.01.009
Liver perfusion computed tomography
apparatus with 320 detectors in pre hepatic transplant patients with chronic liver disease (cirrhosis): initial experience.
Authors: Rosado, W.M.B.; Takeda, K.A.; Augusto, F.; Tachibana, A.; Silva, E.F.; Funari, M. B.G.
Author responsible: Welton Moacir Brito Rosado
Brief description of the purpose of the study: Assess hepatic perfusion rates of pre-transplant patients for chronic
liver diseases by CTP
Methods: 29 patients will be analyzed in line liver transplant after the liver dynamic volumetric acquisition, using
an MDCT 320 equipment. These volumes will be post-processed in the Body Perfusion software Toshiba Medical System, the values being measured blood perfusion, portal and
HPI of the right and left lobe.
Main results: Preliminary analysis showed that: Arterial
flow (AF) 80%High and 20% normal. Portal flow (PF) 60%
high, 20% down and 20% normal. Hepatic perfusion index
(HPI) 80% Down and 20% normal. Analysis of different
measures of hepatic perfusion index were made between the
right and left lobes were no differences between these measures: AF around 3%. Better in the left lobe. PF 11.28% higher in the left lobe and HPI 1.92% higher in the left lobe. There
is agreement with the literature, where the liver with chronic
injuries AF presents high and low HPI. However, there is disagreement of data regarding the PF been reported as low in
these liver diseases.
Conclusion of the presentation: There perfusion difference
in liver disease, with an increase in AF and decreased HPI,
demonstrating the effectiveness of the method as an aid to the
diagnosis of liver diseases.
PD.02.002
LINFOMA RENAL PÓS TRANSPLANTE
Authors: LOPES, A.K.B.F.; OLIVEIRA, J.W.A.; LINS,
C.F.; OLIVEIRA, M.V.N; MELO, A.F.; PINTO, E.M.
Institution: IMIP, Recife, Pernambuco, Brasil
Author responsible: Ana Karina Brizeno Ferreira Lopes
Brief description of the purpose of the report: Lymphoproliferative Post Transplant Disease (PTLD) is a serious complication of patients undergoing solid organ transplantation.
The risk of developing lymphoma in the first year post renal
transplantation is 20 times higher than in the general population and increases over the years. Objective of this report
is to present the case of a post renal transplant patient who
developed lymphoma graft.
Medical History: Female, 59 years old,with chronic renal
disease, undergoing kidney transplant in 2012, evolving asymptomatic. Ultrasonography in October/2014 showed nodular lesion in the upper pole of the graft and in the tomography, there were a solid hiperatenuated lesion with moderate
enhancement. Also, in the positron emission tomography
showed large lesion, occupying almost all the kidney, with
marked glycolytic hypermetabolism, witch was consistent
61
with lymphoproliferative disease activity. Histopathology
study showed diffuse proliferation of atypical cells suggestive of PTLD.
Diagnosis: PTLD differs from the common population lymphoma in histopathological findings by a greater extranodal
involvement, poor response to conventional therapies and
more aggressive clinical course. Immunosuppression is a
fundamental factor in the pathogenesis of PTLD, as well as
the presence of Epstein- Barr virus.
Discussion and summary of the case: Thus, it is essential to
have adequate knowledge of PTLD, aiming diagnosis/early
therapy, to increase survival of these patients.
PD.02.003
Keys in the diagnosis of granulomatous
diseases with involvement in the genitourinary system.
Authors: LOPEZ, A.M.; COLOMBO, J.J.; MURILLO, J.;
ESTEBAN, E.M.
Introduction: Describe the radiographic findings in granulomatous diseases with involvement of the genitourinary system, which constitute a true diagnostic challenge to be true
neoplasms simulators.
Methods Involved: We review and illustrate the key radiological findings in granulomatous diseases with genitourinary involvement, such as testicular sarcoidosis and genitourinary tuberculosis.
Discussion: Sarcoidosis in 30% of patients have extrapulmonary involvement, including the genitourinary system.
When the masses are in patients with confirmed sarcoidosis,
sarcoidosis testicular possible should always be considered,
because it can prevent unnecessary orchiectomies. Genitourinary tuberculosis is an important but unusual location,
but is the second form of extrapulmonary tuberculosis. Diagnosis is difficult and often delayed because tuberculosis
can mimic many other diseases. Imaging studies are very
useful to detect the presence of tuberculosis and to monitor
response to treatment.
Conclusion of the presentation: Granulomatous diseases with genitourinary involvement are rare and may mimic
many of the diseases that affect the urinary tract, which will
pose a diagnostic challenge for the radiologist, which will
require knowledge of the key findings of these entities .
PD.02.005
PI-RADS v2.0 - An Atlas and Illustrated Manual
Authors: de Hollanda, E.S; Falcone, D.D.D.M; Sabaneeff,
N.; Purysko, A.S.; Bittencourt, L.K.
Institution: Clínica CDPI, Rio de Janeiro, RJ, Brasil e
Cleveland Clinic, Cleveland, OH, EUA
Author responsible: Leonardo Kayat Bittencourt
Introduction: The joint efforts of the RSNA and ESUR for
the standardization of the interpretation and communication
of multiparametric prostate MR (mpMR) findings have culminated on the development of the second version of the PIRADS criteria, that were released in Dec/2014. Our objective
is to illustrate the typical imaging findings in each assessment
category, underscoring the main changes over the previous
62
version, and helping on the application of the criteria in clinical practice.
Methods Involved: A pictorial essay with typical cases obtained from our teaching file, based on the official PI-RADS
v2.0 document, in association to recently published evidence.
Discussion: The main change that was introduced in PIRADS v2.0 was the adoption of a “dominant” parameter
for each zonal compartment of the prostate, corresponding
to DWI for the peripheral zone and T2WI for the transition
zone. The means to obtain a final category of assessment
also obeys certain rules, which will be here illustrated in a
didactic scheme.
Conclusion of the presentation: The PI-RADS criteria are
already in clinical use since 2012 in most mpMR reference
centers. Urogenital radiologists should thus be aware of its’
most recent installment.
PD.02.011
ENDOMETRIOSIS IN ATYPICAL SITES: A PICTORIAL ESSAY
Authors: ALVES, C.V.M.; ARAUJO, A.L.E.; MARCHIORI, E.; HEMING, C.A.M.; PEREIRA, R.C.R; LIMA, V.B.R;
OLIVEIRA NETO, J.A.; PARENTE, D.B.
Institution: FLEURY- RJ LABS A +
Introduction: 1. Present a comprehensive review of the
deep endometriosis. 2. Describe the role of pelvic MR imaging in the investigation of endometriosis. 3. Illustrate
the MR imaging features of various atypical anatomic sites
of endometriosis.
Methods Involved: - Comprehensive literature review was
performed using as a basis the Pubmed platform and radiology scientific journals. - MR images of patients with confirmed diagnosis of atypical endometriosi were selected , was
used the digital archive of our instiituição and personal file
of the authors.
Discussion: 1. Review of atypical sites of deep endometriosis:
Clinical, MR imaging, Histopathological aspects 2. Describe
MR imaging protocol 3. Discuss and illustrate MR imaging
appearances of atycal endometriosis and the extension of disease: Thorax, Liver, Levator ani muscle, Bladder and ureter,
Anterior pelvic wall, Retosigmoid, Appendix, Cecum.
Conclusion of the presentation: - Endometriosis in atypical
locations are challenging diagnoses both clinically and radiologically. - Clinical symptoms associated with MR imaging
findings in the appropriate patient population is helpful to
reach the correct diagnosis. - Accurate preoperative assessment of the extension endometriotic disease can be used as a
map road for surgical planning.
PD.02.013
DESAFIO DIAGNÓSTICO: LINFANGIECTASIA RENAL– RELATO DE CASO E REVISÃO DE LITERATURA
Authors: ARAUJO, R.G.; MELO, A.F .de; COSTA E SILVA, E.J.; LEITE A.A.;PEREIRA R.O.; ARAUJO, L.B.T.F. de
Institution: IMIP, Recife, Pernambuco, Brasil
Author responsible: Rosana Araújo
Brief description of the purpose of the report: Renal
lymphangiectasia is rare benign entity, characterized by cysts
in parenchyma and/or sinus of the kidney, or even around the
perinephric space. The etiology remains unclear, however the
most possible hypothesis is an acquired or congenital abnormalities of renal lymphatic drainage system. The aim of this
paper is to conduct a literature review, focusing the imaging
aspects of this disease, in order to guide the radiologist on the
diagnostic hypothesis formulation.
Medical History: LGA 9 year old presented postoperative orthopedic surgery, clinical and laboratory evidence
of hyperparathyroidism. During investigation, ultrasound was performed, showing renal cystic images with
increased parenchymal echogenicity in both kidneys.
The main diagnosis, at the time, was hiperpatireoidismo
secondary to chronic kidney disease / polycystic. The
patient was admitted to IMIP with progressive worsening of renal function and high blood pressure. Were then
ordered new imaging tests, the first of which ultrasound
and subsequently suggested computed tomography and
magnetic resonance.
Diagnosis: Together with clinical and laboratory findings, imaging findings pointed to the diagnosis of renal
lymphangiectasis.
Discussion and summary of the case: Because it is rare
entity, it is necessary the knowledge of their radiological
characteristics for the diagnosis, guide treatment and prevent
possible complications, requiring distinguish it from other
diseases that mimic cystic kidney diseases.
PD.02.016
ACUTE PELVIC PAIN IN THE YOUNG FEMALE PATIENT: COMMON FINDINGS AND DIFFERENTIAL
DIAGNOSIS IN COMPUTED TOMOGRAPHY
Authors: LIMA, M.R.; STRIEDER, D.L.; RIBEIRO, G.J.;
SIECK, G.G.; SCORTEGAGNA, F.A.; PEREZ, J.A.
Institution: Hospital São Lucas da PUCRS, Porto Alegre,
Rio Grande do Sul, Brasil
Author responsible: Marjana Reis Lima
Introduction: Acute pelvic pain is a common complaint in
emergency departments, specially among young females. As
it is an unspecific symptom that usually comes in association
with other unspecific symptons and also unespecific clinical
examination, the diagnostic imaging evaluation becomes
primordial for a precise diagnosis. We will expose the most
common differential diagnosis of acuete pelvic pain, reviewing its main imaging aspects.
Methods Involved: Presentation of several acute pelvic pain
etiologies by demonstrating Computed Tomography (CT)
images, pointing out its main characteristics and possible
supporting findings that can ease the diagnsosis.
Discussion: The differential diagnosis comprehend mostly gynecological, urinary and gastrointestinal etiologies,
with inflammatory, neoplastic or obstructive origins, for
example. Many of them have unique presentations at CT,
which eases the etiologic diagnosis, especially when ultrassonography (US) is not able to solve the case alone.
Secondary complimentary findings, when present, help to
confirm diagnostic suspicions, making it easier to come
through the diagnosis.
Conclusion of the presentation: CT is a fast-acquiring imaging method, but less available than US, used mostly as a
complimentary tool in the evaluation of patients with acute
pelvic pain, being able to elucidate cases when there are diagnostic doubts.
PD.02.017
Ureteroinguinal hernia as an occasional
finding during ambulatory aortic dissection follow-up.
Authors: Pedrollo, I.M.; Kupske, A.; Wainstein, B.; Rockenbach, M.A.B.C; Eifer, D.A.; Gazzoni, F.F.
Alegre, RS, Brasil
of ureteroinguinal hernia causing obstructive uropathy.
Medical History: A 68 year-old man, asymptomatic, smoker,
hypertensive, with history of type B aortic dissection, performed a routine abdominal tomography (CT scan). The CT
scan showed left hydronephrosis, due to obstruction by an
ureteroinguinal hernia.
Diagnosis: Ureteroinguinal hernias are quite rare, with few
cases reported in the literature. Two types of were described:
the paraperitoneal, where the ureter slides into the inguinal
canal adhered to the peritoneal sac wall, usually by traction or
adhesions; and the extraperitoneal, containing only the ureter
and fat. A few cases were reported for other types of ureteral
hernias, as the femoral or sciatic. In our case, the patient presented a left paraperitoneal hernia, which extended to the scrotum, well demonstrated through the pathognomonic loop sign
in tomographic reconstructions and scintigraphy performed.
Discussion and summary of the case: The radiologist’s role
in describing this type of abnormality is extremely valuable
to the surgeon, as there is risk of iatrogenic ureteral rupture
during surgery. Treatment of ureteroinguinal hernias are surgical, especially when there are secondary complications
such as hydronephrosis.
PD.02.018
Dynamic UrethroMR: a new diagnostic
approach to urethral lesions.
Authors: ARAUJO, JR., C.M.C.; COUTINHO, JR., A.C.M;
CAVALCANTI, A.G.L.C.; FIEDLER, G.; OLIVEIRA, R.V.;
BITTENCOURT, L.K.
Author responsible: Carlos Martins Carneiro de Araujo Junior
Introduction: In this article, we describe the protocol and
the main findings of dynamic UrethroMR, while reviewing
the appearance of urethral strictures secondary to changes
related to surgical procedures and STDs, demonstrating its
importance in characterizing espongiofibrosis.
Methods Involved: Images were acquired in a Siemens
Aera 1.5-T Scanner, with multiplanar T1 and T2-weighted
sequences, T2 with urographic effect by technical MIP obtained at rest and during voiding effort, SPACE, T1 fat-sat
before and after administration of gadolinium.
Discussion: MR is a noninvasive imaging method with high
spatial resolution, which allows multiplanar evaluation and
good tissue characterization. Furthermore, it is highly accurate in the diagnosis of urethral strictures, enabling the identification of lesions that are often underestimated in voiding
uretrocistography, and allowing the physician a more accurate surgical plan. MRI also allows complete assessment of
the peri-urethral compartments, identifying risk factors and
the presence of associated complications.
63
Conclusion of the presentation: UrethroMRI is a new imaging modality that shows potential to identify and quantify
urethral strictures, for which surgery remains the best treatment option, and the preoperative evaluation is crucial for
success therapy in these patients.
PD.02.019
MR Defecography: A Comprehensive Review of the Pelvic Floor Anatomy. How to
do it and what to look for!
Authors: HEMING, C.A.M.; EIRAS ARAUJO, A.L.; OLIVEIRA NETO, J.A.; VEZZANI, R.B.; ALVES, C.V.M.;
PEREIRA, R.C.R; LIMA, V.B.R.; PARENTE, D.B.
Institution: Fleury - LabsA+, Rio de Janeiro, RJ, Brasil
Introduction: Pelvic floor dysfunction represents a variety
of alterations and symptoms that affects mainly women, and
has a high morbidity. Clinical examination may not diagnose
all associated dysfunctions. Magnetic Ressonance (MR)
defecography is a simple execution method that allows dynamic evaluation of pelvic floor dysfunction in all compartments. Objectives: Review pelvic floor normal anatomy and
landmarks; Describe how to perform, what to look for, and
how to interpret MR defecography; Illustrate the different
pathologies of the pelvic floor (pictures and videos) and their
grading system; Discuss the common pitfalls and limitations,
and the proper reporting method.
Methods Involved: MR Protocols: Anatomic and Dynamic
Study (Rest, Sphincter contraction, Valsalva maneuver, Defecation). Pelvic floor anatomy: anterior, middle and posterior
compartments, muscles, ligaments, fasciae. Important landmarks: pubococcygeal line, H line, M line, anorectal angle.
Examples of different pathologies in all compartments. Discussion: Different complex muscular and fascial lesions occur in pelvic floor dysfunction. An adequate exam execution
and interpretation is essential for the correct diagnosis of all
alterations.
Conclusion of the presentation: The anatomical approach
alone is not enough. Knowledge of the anatomy and a complete dynamic study are essential for the diagnosis of pelvic
floor pathologies. Multiple compartment dysfunctions are
common and its recognition changes the treatment.
PD.02.020
PI-RADS version 2: An illustrated review.
Authors: HEMING, C.A.M.; EIRAS ARAUJO, A.L.; OLIVEIRA NETO, J.A.; VEZZANI, R.B.; ALVES, C.V.M.;
PEREIRA, R.C.R; LIMA, V.B.R.; PARENTE, D.B.
Institution: Fleury - LabsA+, Rio de Janeiro, RJ, Brasil
Introduction: The American College of Radiology (ACR)
published a new version of Prostate Imaging and Reporting
and Data System (PI-RADS), using a new point scale for grading the likelihood of significant prostate cancer based on multiparametric Magnetic Ressonance Imaging (mpMRI) findings.
The aims of this review are to: - Introduce the reader to the
PI-RADS version 2 (v2) reporting system. - Discuss the sequences and the scoring system. - Provide illustrated examples
from our clinical practice. - Discuss the pitfalls and limitations.
Methods Involved: The scoring systems for each of the following will be described 1. High-resolution T2-weighted se-
64
quences 2. Diffusion-weighted MRI 3. Dynamic contrast-enhanced MRI Illustrated examples from our clinical practice
calculating Pi-RADS score.
Discussion: PI-Rads v2 aims to promote global standardization and reduce variation in the acquisition, interpretation,
and reporting of prostate mpMRI examinations.
Conclusion of the presentation: PI-RADS v2 system uses
a new point scale, simplified and easier to use in the clinical
practice, with different specifications for the transition and
peripheral zones. PI-RADS v2 allow better communication
to the referring physicians.
PD.02.021
Pelvic changes after intravesical BCG: a
pictorial essay based on MRI
Authors: SETTA, M. L. ; SABANEEFF, N. ; BITTENCOURT, L. K. ; BERNAL, S. O.
Author responsible: Maria Leticia Araujo Dutra da Silva
Setta
Introduction: This pictorial essay aims to show the most
common alterations observed on magnetic resonance imaging, that affect the lower urinary tract in patients on adjuvant
therapy with instillation of BCG for intravesical urothelial
tumor treatment.
Methods Involved: Will be presented illustrative cases of
pelvic MRI, from our didactic file, reporting changes promoted by adjuvant intravesical BCG therapy
Discussion: The most common findings are: cystitis, bladder
shrinkage, prostatitis and epididymitis granulomatous, urethritis and tumor recurrences. Granulomatous prostatitis is
the most common change and can simulate prostate tumor.
Presents with low signal in T2, the constraint diffusion and
highlight by contrast, being difficult to differentiate with primary malignancies. In most cases requiring dosage of PSA
and biopsy to reach the diagnosis. Cystitis is the most frequent cause of stopping treatment. It manifests as parietal
thickening, sometimes mimicking tumor recurrence focal. In
these cases, is new RM after treatment of cystitis to assess
whether there has been satisfactory answer .
Conclusion of the presentation: The adverse findings of
BCG therapy are typically observed just after induction or
up to six months of treatment. Its recognition is important,
since it can simulate tumors, causing damage to the kidney
function, or even infertility.
PD.02.023
Extraskeletal Ewing’s Sarcoma: Case
Report
Authors: STRIEDER, D.L; LIMA, M.R.; SIECK, G.G;
SCORTEGAGNA, F.A; RIBEIRO, G.J; STELLA, S.F;
MAURER, M.N
Author responsible: Débora Lunkes Strieder
Brief description of the purpose of the report: Ewing’s
Sarcoma (ES) is the second most common primary osseous
neoplasm in children. However, extraskeletal type is rare,
originated mostly from soft tissues of trunk and extremities.
We’ll report a case of retroperitoneal ES diagnosed in our
department, reviewing its major concepts.
Medical History: Female, 17 years old, left arm pain for 2
months. Requested shoulder radiograph showed an osteolytic lesion in the proximal humerus. Follow up investigation
identified several other osteolytic lesions and bulky periaortic
retroperitoneal mass.
Diagnosis: The retroperitoneal lesion was resected, and the
immunohistochemstry panel was compatible with ES. The
osseous biopsies were compatible with metastatic lesions.
Retroperitoneal ES is a rare (10-15% of the soft tissue sarcomas in children) peripheral Primitive Neuroectodermal
Tumor (PNET) that composes the heterogeneous with small
round cells mesenchymal tumor group. The main differential diagnoses are lymphoma, neuroblastoma and other soft
tissue sarcomas. Immunohistochemical analysis is imperative for accurate diagnosis, specially CD-99, FLI-1 protein,
neuron-specific enolase and vimentin. It has a poor prognosis
depending on whether the lesion is resectable or not and if
there’s disseminated disease at presentation.
Discussion and summary of the case: The systematic and
sequential learning through case reports of less common or
atypical-presenting diseases is crucial for radiologists to
consolidate and expand its differential diagnosis knowledge.
PD.02.024
It does not belong to you anymore ! Umbilical remnants abnormalities in the abdomen and pelvis : a pictorial essay
Authors: Hollanda, E.S.; Falcone, D.D.M.; Torres, U.S.; Bittencurt, L.K.; Sabaneeff, N.; Oliveira, R.V.
Author responsible: Erick Sabbagh de Hollanda
Introduction: Meckel’s diverticulum and the remnant of the
urachus are abnormalities of the umbilical remnant, specifically the vitelline duct (omphalomesenteric ) and the allantois
. These abnormalities may present as diverticular formations
, patent ducts, cystic formations , infections and even neoplasm. The clinic is often nonspecific and may even develop
into acute abdomen . In suspected cases of these conditions
, you should keep in mind the anatomy of these structures
, and for this is necessary to understand their embryologic
development.
Methods Involved: Case Review from our data, with illustrative images of major lesions and complications of umbilical remnants, based on CT scans , MRI and ultrasound.
Discussion: Although uncommon , these abnormalities ,
must always be taken as differential diagnoses by radiologists
in several abdominal and genitourinary complaints.
Conclusion of the presentation: Imaging methods are most
often diagnostic, and for the correct diagnosis, the radiologists should be familiar with the embryological development
of the umbilical structures, mainly due to the typical locations of these diseases.
PD.02.025
Proximal ureterocutaneous fistula after nephrectomy.
Authors: WANDERLEY, M.; NESI, R.S.; MANARA, L.M.;
YUHARA, E.Y.; ODELI, J.T.; DUARTE, E.C.; KOCH, M.C.
Institution: HU/UFSC
Author responsible: Mark Wanderley
Brief description of the purpose of the report: The report
aims to highlight the importance of the complete medical
history for the targeting of imaging and optimization of diagnostic accuracy, particularly in changes related to surgical procedures.
Medical History: VGA, female, 62, with right nephrectomy
8 years ago for nephrolithiasis, is accepted by the Gastroenterology Department for performing retrograde endoscopic
cholangiopancreatography to manage residual cholelithiasis
secundary to prior cholecystectomy. It was noticed a incisional hernia on the right flank associated with drainage of fluid
secretion in the adjacency of the injury. After looking at medical records and to surgical history, as to the initial images,
contrast medium was administered via probe through the drain
hole, clearly demonstrating communication with the proximal
right ureteral stub. The patient was referred to the service of
urology for appropriate clinical/surgical manegement.
Diagnosis: Ureteral fistulas are uncommon, being more frequent in women, secondary to iatrogenic lesion in gynecological surgeries. The proximal ureteral fistulas are rare, particularly with drainage to the skin. Clinical suspicion is based
mainly in the surgical history, particularly when it involves
nephrectomy and spontaneous secretion drainage.
Discussion and summary of the case: The imaging diagnosis has growing role but remain as a complementary method.
Clinical and surgical histories persist as pillars supporting the
image diagnostic hypotheses.
PD.02.026
Totally RAD! The pictorial review on BI
-RADS, PI-RADS, LI-RADS, and the many RADS
in RADiology today.
Authors: Hollanda, E.S.; Falcone, D.D.M.; Campos, G.C.P.;
Sabaneeff, N.; Bernal, S.O.; Bittencurt L.K.; Purysko, A.S.
Author responsible: Erick Sabbagh de Hollanda
Introduction: The BI-RADS (Breast Imaging Reporting and
Data System), actually a consensus in imaging reports, facilitated the communication between radiologists and attending
physicians. Due to the wide acceptance of the BI-RADS were
launched other types of classifications based on the same system, however adapted to other organs such as the prostate
(PI-RADS), thyroid (TI-RADS), liver (LI-RADS), etc.
Methods Involved: Presentation of the Reporting and Data
Systems (RADS) through illustrative images, tracing the
main features, differences and similarities between them.
Discussion: This type of standardization prevents the omission
of important findings in imaging reports, or even a misunderstood interpretation by the attending physicians. Scoring systems also allow better conduct each specific condition. These
systems are constantly being updated, either by inclusion of
new diagnostic methods, or even reclassifying the lesions.
Conclusion of the presentation: The \”RADS\” are intended to standardize the reporting of imaging studies, making
the communication easier between radiologists and attending
physician, thus assisting in the conduct.
PD.02.031
Ureteral metastasis from prostate adenocarcinoma - Case report
65
Authors: ANTUNES, R.V.B.; VALADARES, L.C.; MATOS, B.P.; CAVALCANTI, J.P.L.; JUNIOR, H.C.C.; FARIA,
R.N.; NETTO, J.D.J.; FONSECA, T.F.M.; VON ATZINGEN, A.C.
Institution: Hospital das Clínicas Samuel Libânio, Pouso
Alegre, Minas Gerais, Brasil
Author responsible: Bárbara Pessoa de Matos
Brief description of the purpose of the report: The ureter is
a rare location of metastasis from primary tumors of any kind
and prostatic origin is the rarest.
Medical History: We report the case of a male patient ,55
years old, referring dysuria and hematuria during the last
year. Already known as carrier of prostate tumor diagnosed
by transrectal ultrasound guided biopsy. Computerized tomography for tumor staging confirmed diffuse thickening of
the bladder wall, multiple osteoblastic lesions in the pelvis
and spine, moderate hydronephrosis with a dilated left ureter
and hyperdense content in the middle third and distal ipsilateral ureter, highlighted by intravascular contrast ,compatible
with secondary implant
Diagnosis: The ureter is a rare location of metastases. The
most common primary tumors origin are the breast, stomach and colorectal. Only 43 cases of prostate adenocarcinoma metastases to the ureter have been described in the
last century.
Discussion and summary of the case: The importance of
this case report is to improve the knowledge about this rare
condition and bibliography update.
PD.02.032
Findings in the multiparametric prostate MR in the evaluation of tumor recurrence in the postoperative period
and post-radiotherapy of prostate cancer (PCa).
OLIVEIRA, R.V.
Institution: CDPI, Rio de Janeior, RJ, Brasil
Introduction: To demonstrate that the multiparametric pelvis MR adds relevant information in the diagnosis of the PCa
recurrence.
Methods Involved: Cases from our didactic archive of
multiparametric pelvis MR will be presented, illustrating
the main related findings in the local and long-distance
PCa recurrence.
Discussion: Different studies have proven that the multiparametric prostate MR has high accuracy in the diagnosis and
the evaluation of the PCa recurrence. In the evaluation post
prostatectomy local recurrence and/or residual tumor, the areas of recurrence often present themselves as a tissue with
mild hyperintense signal on T2 weighted images and show
early contrast enhancement, while in the analysis of post-radiotherapy patients changes in the dynamic contrast enhancement and in the diffusion weighted images, are usually seen
in recurrence/residual lesions.
Conclusion of the presentation: The multiparametric pelvis
MR has its well-defined role in the research for the PCa recurrence, and should be used in this cases, in the appropriate
clinical context.
66
PD.02.033
Multiparametric prostate MR in the local staging of prostatic adenocarcinoma (PCa): local identification, extracapsular extension and seminal vesicles
invasion.
BERNAL, S. O.
Institution: CDPI, Rio de Janeiro, RJ, Brasil
Introduction: Demonstrate through a pictorial study that
multiparametric prostate MR can assists in a relevant way in
the preoperative local staging of PCa.
Methods Involved: Cases from our file didactic of multiparametric prostate MR will be presented illustrating the
main findings related to PCa staging. It will also be briefly discussed the role of PI-RADS criteria for detection, and
even in disease’s the staging.
Discussion: The presence of extracapsular extension is related to the dimensions and the Gleason score of greater identified lesion (lesion index). The main clinical signs suggestive
of extracapsular extension in T2 are: the nervous vascular
bundle asymmetry, tumor involvement of nervous, focal
bulging in prostate contour, irregularity in prostate contour,
obliteration of the rectus-prostate angle, capsular retraction,
contact of the tumor with the prostatic capsule bigger than 1,0
cm, and signs of capsule rupture with direct tumor extension
to the periprostatic fat.
Conclusion of the presentation: Multiparametric prostate
MR already presents itself as a fundamental method in the
prostate cancer study. The tumor staging is one its main indications, and currently presents better accuracy than any other
noninvasive diagnostic method.
PD.02.034
Using the PI-RADS® rating in the detection
and evaluation of Prostate Cancer (CAP)
with multiparametric MRI (MRI-MP) in RM
ultra high field (3T): A Pictorial study.
Authors: GABRIELE HAA., ROSAS G.; MELO HJF.;
SZEJNFELD J.
Institution: CURA IMAGEM E DIAGNÓSTICO, São Paulo - SP, Brasil e ESCOLA PAULISTA DE MEDICINA, São
Paulo - SP, Brasil
Author responsible: Homero José de Farias e Melo
Introduction: The authors will present the theoretical and
illustrative images of the morphological criteria , diffusion
and perfusion MRI performed in 3T equipment without endoretal coil, in the detection and staging of CAP by MRI-MP.
The use of MRI-MP has been increasingly in the detection of
CAP in patients with clinical laboratory abnormalities (elevation of PSA and rectal examination suspect) indicative of
suspected CAP.
Methods Involved: The multiparametric assessment is based
on observation of prostate morphology, judged primarily on
the sequences Fat_Sat T2 and T2 in response to the movement of water molecules in the diffusion ADC map with review diffusivity coefficient values (b) between 800 and 1400
mm / s2 and perfusion curves obtained by the use of paramagnetic contrast.
Discussion: The value of this systematic review has been
recognized and carried out in the main centers of diagnostic
imaging. The standardization of technical parameters minimum acceptable for achieving MR-MP contributes to calculation of technical efficiency, comparison of results and
effectiveness of each parameter and their combination.
Conclusion of the presentation: The PI-RADS® criteria
were developed and described to reduce the evaluation subjectiveness levels.
PD.02.035
Herlyn-Werner-Wunderlich syndrome
Authors: MAIA JR, L. O. F.; HASSAN, A. P. M.; VIANA
NETO, E. M.; MASSOTE, A. G.; MALACARNE, T. S.; NASCIMENTO, I. N. C.
Institution: Hospital Mater Dei, Belo Horizonte, Minas
Gerais, Brasil
Author responsible: Luiz Otavio Freitas Maia Junior
Brief description of the purpose of the report: The purpose of
this case and provide early diagnosis and to reduce future risks.
Medical History: E. S. P. V., 29 years old, menarche at 12, with
recurrent episodes of abdominal pain since then, and irregular
menstrual cycles. Searched image service to assess changes in
tumor marker CA 15.3; being observed on ultrasound of the
abdomen/pelvis: vaginal septum, bicornuate uterus and absence of right kidney, supplemented with CT and MRI.
Diagnosis: The Herlyn-Werner-Wunderlich syndrome was
first described in 1971 the presence of renal agenesis and
hemivagina blind ipsilateral to a patient. Wunderlich in 1976,
described right renal aplasia association with simple Bicornuate uterus and vagina in the presence of isolated hematocérvice. The hematocérvice was the result of lack of communication between the right hemiútero and the vagina. The
HWWS characterized by the presence of hemivaginal septum
ipsilateral didelphic uterus and kidney agenesis. In fact, the
addition of HWWS is described last two syndromes with
similar clinical presentations.
Discussion and summary of the case: Is an anomalous formation of the genitourinary tract originating in the müllerian
ducts. Its early diagnosis can prevent several medical complications that invariably happen during adolescence. The diagnosis before menarche is a challenge and can be performed if
a high degree of suspicion.
PD.02.038
Cesarean Section Scar Diverticulum –
Appearance on Magnetic Resonance Imaging and Computed Tomography
Authors: ALBINO, D.J. (autor principal, idealizador, levantamento bibliográfico, elaborador/relator); VOLPATO, R.
(médico radiologista responsável pelo caso, revisão final);
PINHO, M.A. (levantamento bibliográfico; segunda revisão,
tradução do resumo)
Institution: HUCAM-UFES, VITORIA, ESPIRITO SANTO, BRASIL
Author responsible: Diogo Jose Albino de Souza
Brief description of the purpose of the report: Cesarean
section scar diverticula are rare post-surgical complications
and poorly reported as well in the medical literature. They occur due to the fragility of the uterine wall at the site of surgical incision, forming a sac-like protrusion at that topography.
Medical History: In this paper, we report the case of a female
patient aged 44 years with hypogastric pain for 2 years, associated with abdominal mass. Her past medical history includes
arterial hypertension, two cesarean sections and tubal ligation.
Diagnosis: Magnetic Resonance Imaging (MRI) of the pelvis
and Computed Tomography (CT) of the abdomen and pelvis scans were taken, showing a diverticular formation (hypodense on CT, hyperintense T1 and subtle hypointense T2
on MRI) at the anterior uterin wall, between the body and
the cervix, without contrast enhancement, compatible with
cesarean section scar diverticulum.
Discussion and summary of the case: With the increasing
number of cesarean surgery, the risk of postoperative complications also rises, including rare ones such as cesarean section scar diverticulum, and it is important for the radiologist
to recognize its appearance on CT scan and MRI.
PD.02.039
Acute Scrotum Pictorial Essay
Authors: CAIXETA, F.H. ; BARRETO, R.L.M. ; CORTEZ,
J.G. ; FORTES, S.M.
São Paulo, Brasil
Author responsible: Fernando Henrique Caixeta Souza
Introduction: Acute Scrotum is defined by diseases of
various etiologies that share common signs and symptoms, such as inflammatory / infectious diseases ( orchitis and orchiepididymitis ) and testicular torsion, all that
with different treatment and diagnosis. The early diagnosis is important so that the right treatment is ensured,
increasing the testicular viability. This essay objectives
are to demonstrate the ultrasound image aspects, in the
acute scrotum cases, correlating with the onset of the
symptoms, and how to make differential diagnosis of the
major diseases.
Methods Involved: Ultrasound images of acute scrotum cases, using high-frequency linear transducers (7,5 - 10 MHz),
in B mode, color and power Doppler.
Discussion: Ultrasound imaging has a major role in acute
scrotum differential diagnosis. Especially in the surgical
emergencies, such as torsions, in which the early diagnosis
may avoid irriversible testicular damage.
Conclusion of the presentation: Ultrasonography is the
imaging method of choice for testicular assessment of both
acute and non- acute diseases, having decisive role in former
cases, allowing better characterization and differentiation
between diseases with similar clinical signs and symptoms,
highlighting those requiring immediate treatment
PD.02.041
Kidney transplant complications: radiological aspects with emphasis on CT angiography.
Authors: NEVES DG, FOSSE JR. AM, MENEZES PA,
MELO ASA, SANTOS AASMD, NACIF MS, BITTENCOURT LK.
Institution: Universidade Federal Fluminense, Niterói, Rio
de Janeiro, Brasil
Author responsible: Daniel Neves
Introduction: To review vascular and urological complications of kidney transplantation, detected by imaging studies,
67
with emphasis on computed tomography (CT) angiography.
Methods Involved: Fifteen patients who had undergone CT
angiography to evaluate kidney graft complications between
march of 2013 and december of 2014. Selected cases were
evaluated by magnetic resonance (MR), ultrasonography or
scintigraphy.
Discussion: Renal transplantation techniques are well established and its complications well known. During the period of
the study the following urological and vascular complications
were observed: renal vein thrombosis, arterial post-transplant
stenosis, pseudoaneurysms, and urinomas. Selected patients
couldn’t receive iodinated contrast due to acute renal injury,
being evaluated through other methods.
Conclusion of the presentation: CT angiography has been
solidified as one the best alternatives for evaluation of renal
transplant complications due to its speed and good spatial
resolution. Its limitations include: iodine alergy and kidney
failure, two contraindications to iodinated contrast. In cases
of urinoma and acute kidney injury, scintilographic studies
have good acuracy without compromising kidney function.
In instances of alergies, MR angiography have been shown
as an emergent technique were high field machines are available, due to its good spatial resolution.
PD.02.042
Advanced testicular cancer: beyond retroperitoneal lymph nodes
Authors: Bezerra, ROF; Leal, NL; Figueiredo MAP; Garcia,
MR: Menezes, MR
Author responsible: Regis Otaviano França Bezerra
Introduction: Testicular tumor is the most common cancer
in male between 20 and 34 years, with the majority of germ
cells (90%). The spread occurs predominantly via the lymphatic vessels into the retroperitoneum and the liver / lung
when there is hematogenous metastasis. Among the germ cell
tumors (seminoma vs. non-seminoma), there are great differences in prognosis, imaging findings and treatment. The goal
is to demonstrate the complexity in the presentation of metastatic lesions, as well as the role of image in the definition of
the clinical / surgical procedures
Methods Involved: CT, MRI and PET / CT
Discussion: We demonstrate patterns of lymphatic and hematogenous spread, imaging evaluation after neoadjuvant
chemotherapy, residual lesions with surgical x follow-up
treatment, role of PET / CT in clinical management, surgical planning in patients with disseminated residual teratoma,
cases with atypical behavior and surgical complications of
advanced lesions
Conclusion of the presentation: Advanced testicular tumors
represent an agressive disease in young individuals, whose
clinical management is highly dependent on the imaging
findings and the radiologist expertise
PD.02.068
Rectovesical and Rectouterine Excavations: Markers That Really Matter
Authors: PESSÔA F.M.C.; AFONSO F.B.; BABY D.D.;
MATTOS F.A.C.; BITTENCOURT L.K.
Institution: HOSPITAL UNIVERSITÁRIO ANTONIO PEDRO - UFF, NITEROI, RIO DE JANEIRO, BRASIL
68
Brief description of the purpose of the Review of Literature: This study aims to present a spectrum of imaging findings of pathological conditions, considering the anatomy variations of the pelvis and peritoneal cavity between genders.
The pelvic peritoneal space is a common location for fluid,
pelvic malignancies and abscesses. It consists of the inferior reflection of the peritoneal over the urinary bladder and
the rectum at the junction of its middle and lower thirds. In
females we can observe the uterovesical excavation and the
rectouterine excavation (pouch of Douglas or cul-de-sac);
in males, the rectovesical excavation. From 2009 to 2014,
we selected the best representative cases of rectovesical and
rectouterine pouch pathological involvement. All images
were obtained from MRI of the pelvis, acquired from 1.5 and
3.0 Tesla scanners (sequences: T1, T1 FS Gad, T2, DWI).
Conclusion: Our cases included inflammatory pseudotumor,
pelvic inflammatory disease, diverticulitis, appendicitis, peritoneal tuberculosis, peritoneal carcinomatosis, sarcomatosis,
pseudomyxoma peritonei, contiguous tumor extension, endometriosis, iatrogenic causes, peritoneal inclusion cyst, vascular malformations and neurofibroma.
Brief discussion of the case MRI is a highly accurate method to evaluate different pathologic conditions of rectovesical
and rectouterine excavation. We have shown different representative lesions of these regions and discussed through correlation with local features and anatomy, highlighting some
life threatening conditions.
TL.02.004
Others prostatic tumors beyond adenocarcinomas on multiparametric prostate MRI
Authors: Mussi, TC; Martins, T; Queiroz, MR; Gobbo, R;
Baroni RH
SP, Brasil
Brief description of the purpose of the study: To describe
the imaging findings of non-usual prostatic tumors diagnosed
with biopsy with imaging fusion US/MRI.
Methods: Retrospective study of 200 patients that performed
prostate mpMRI followed for biopsy with imaging fusion
US/MRI. Medium PSA was 4.9 ng/mL. All patients submitted to prostate mpMRI in a 3T scanner without endorectal
coil, including T2, ADC and perfusion sequences.
Main results: 83 biopsies (41.5%) were negatives and 117
(58.5%) were positives for neoplasia. Of 117 positives cases, 113 (96.6%) were acinar adenocarcinomas, one (0.008%)
was stromal tumor of uncertain malignancy potential
(STUMP) and tree (0.02%) were leiomyomas. STUMP was
characterized as well-defined and heterogeneous nodule in
the peripherical zone, with diffusion restriction and hypervascularization. Leiomyomas were characterized as homogeneous expansive lesions, with marked diffusion restriction
and hypervascularization.
Conclusion of the presentation: Prostate tumors non-adenocarcinomas are rare, although can mimic adenocarcinomas. Radiologists, pathologists and urologists must know the
imaging findings of those lesions to choose the best conduct.
TL.02.005
Are unenhanced CT and excretory urography necessary for the evaluation of
acute pyelonephritis?
Authors: Taniguchi L.S., Torres L.R., D\’Ippolito G.
Institution: Laboratórios Fleury/Hospital São Luiz e Universidade Federal de São Paulo - UNIFESP
Author responsible: Lucas Rios Torres
Brief description of the purpose of the study: This study
aims to determine the accuracy of the nephrographic phase
for signs of acute pyelonephritis (PNA) and urolithiasis.
Methods: A total of 100 patients (200 kidneys; 11 male, 89
female, between 18 and 80 years old with a mean age of 35.5)
with clinical and laboratory indications of APN, who underwent triphasic CT of the abdomen (without contrast, nephrographic and excretory), were evaluated between 09/2012 and
02/2014. Two abdominal radiologists (with 3-5 years’ experience) independently evaluated the exams in the nephrographic phase only. Following this, they were asked to give further
diagnosis from the unenhanced and excretory phases. A third
radiologist, with 26 years’ experience in abdominal imaging,
reviewed each patient’s triphasic CT and the diagnosis was
used as a benchmark. Interobserver agreement (k Value) and
accuracy were measured.
Main results: Interobserver agreement was almost perfect
for the diagnosis of APN (k=0.80) and substantial for the diagnosis of urolithiasis. Accuracy for the diagnosis of APN
and urolithiasis ranged from 88% to 93% (95% IC: 2.68 –
2.89) and 95% to 97% (95% IC: 2.29 – 2.96) respectively.
Conclusion of the presentation: It is possible to evaluate
indications of APN and and the presence of nephrolithiasis
using the nephrographic phase alone, without unenhanced
CT and excretory urography.
3 - Head and Neck
PD.03.001
Anatomical variations of the paranasal
sinuses by Computed Tomography: pictorial essay.
Authors: FASSBENDER CPB., COSTA AS., CAMILO
ML., MELO D M., NEGRI RV., BARROS EG., VERGILIO
CS., CARVALHO RS.
Author responsible: Cecília Peçanha Bogado Fassbender
Introduction: Paranasal sinuses are filled extensions of air
that develop as expansions of the nasal cavities, promoting
erosion of the bone around. The endonasal surgery is the procedure of choice for the diagnosis and treatment of various
sinus disease. Computed tomography (CT) is considered the
gold standard for evaluation of this region. In order to prevent iatrogenic injuries, it is essential that the surgeon has the
mapping of bone structures (nasal cavity, paranasal sinuses
and drainage pathways) and their anatomical variations.
Methods Involved: Pictorial essay of CT cases performed
in patients with anatomical variations of paranasal sinuses
obtained from the digital file of a public reference hospital in
the head and neck.
Discussion: In the imaging study of paranasal sinuses, it
must be considered that some anatomical variations may be
present, predisposing to sinusopathy, constituting high-risk
regions for complications during surgical procedures, particularly: the nasal septum alterations; variations of: the uncinate processes, the middle nasal turbinate, the ethmoid cells,
the frontal and maxillary sinuses, the cribriform plate and
extent of pneumatization of the paranasal sinuses.
Conclusion of the presentation: CT plays a key role in the
diagnosis of anatomic variations of the paranasal sinuses,
promoting a better clinical and surgical treatment planning of
injuries that affect this region.
PD.03.002
Dacryocystography in the evaluation of
lacrimal system obstruction- Iconographic Essay
Authors: LOPES, A.K.B.F..; OLIVEIRA, J.W.A.; LINS,
C.F.; OLIVEIRA, M.V.N; SILVA, E.B.; RIBEIRO, S.C.
Institution: BORIS & Hospital das Clínicas, Recife, PE, Brasil
Author responsible: Ana Karina Brizeno Ferreira Lopes
Introduction: Dacryocystography (DCG) is a major imaging methods that allows the anatomical study of the lacrimal system (VVLL). It allows to define precisely the point
of obstruction of VVLL, being quite useful when surgical
treatment is the choice. This essay aims to demonstrate the
main imaging findings of obstructions of VVLL using as a
diagnostic method the DCG.
Methods Involved: The selected cases were obtained in
the database of our service of patients undergoing DCG to
assess the level of obstructive of VVLL, in the period of
November 2012 to November 2014, with obstruction in the
various valves.
Discussion: The imaging findings are usually nasolacrimal
obstruction, and low obstruction is the most frequent point,
but may find patent VVLL, without dilatation, despite the
complaint. Therefore, it is clear the importance of the examination for the exclusion of functional obstruction and not anatomical, avoiding unnecessary surgical procedure.
Conclusion of the presentation: Thus, there is the didactic
and educational value of this essay, enabling the identification of the main imaging findings in VVLL obstructions, allowing adequate surgical planning.
PD.03.005
ORBITAL DEVICES AND MATERIALS: ICONOGRAPHIC ESSAY
Authors: ARAUJO JR, DAA; MUNIZ NETO, FJ; SUMI,
DV; SOARES, CR; GOMES, RLE; GARCIA, MRT; DANIEL, MM; FUNARI, MBG.
São Paulo, Brasil
Introduction: Currently, several materials have been used in
orbital implants, more commonly glass, silicone and acrylic.
These inert materials cause minimal immune response in the
host, forming a pseudocapsule, which prompts a partitioning
of the implant. In this pictorial essay, we will show the most
common uses of imaging methods, especially CT and MRI,
in the follow-up of orbital implants and other devices / surgical materials in the orbital cavity, and also in the evaluation
of complications related to the use of these elements.
69
Methods Involved: Series of illustrative images of orbital
devices and materials from our service.
Discussion: The imaging follow-up of bio-inert implants is
essential in the evaluation of complications, such as migration and extrusion. The drainage implants are part of the therapeutic arsenal used in the management of glaucoma. They
allow for a new route for the outflow of aqueous humor, decreasing the intraocular pressure.
Conclusion of the presentation: Given the advances in the
development of surgical materials in the orbit, whether inert
or integrated, the imaging studies play a key role in the detection and management of complications.
Discussion: The 6 branchial arches give rise to 5 clefts. The
range of anomalies can include either a cyst, fistula or sinus. The cysts are considered most common, although some
anomalies can occur in combination.
Conclusion of the presentation: The knowledge of the
Branchial cleft anomalies becomes important in the differential diagnosis of various benign, malignant and infectious
cervical lesions.
PD.03.010
Granulomatous Diseases of the Head
and Neck
Authors: DALPRA F.A.R; GOMES R.L.E; CEVASCO F.I.;
DANIEL M.M.; GARCIA M.R.T.; SARPI M.O.; GEBRIM
E.M.S.
Institution: InRad - Instituto de Radiologia do Hospital das
Clínicas da Universidade de São Paulo, São Paulo, São Paulo, Brasil
Author responsible: Fábio Augusto Ribeiro Dalprá
The intent of this panel is to review the imaging findings of the
main granulomatous diseases affecting the head and neck.
Inflammatory / infectious granulomatous diseases may have
the following causes : - Infectious : Bacterial Fungal Parasitic -Unknown etiology of inflammatory diseases - Autoimmune diseases / vasculitis
Conclusion: Granulomatous diseases are a heterogeneous
group of diseases that share a common finding : granuloma
formation . Usually these conditions are described in a general way , but a deeper understanding of its possible etiologies
combined with clinical data can enable the radiologist to narrow the diagnostic possibilities , and thus assist in therapeutic
practice , avoiding unnecessary additional procedures .
Brief discussion of the case Despite being a large group of
diseases that cause a common immune response, the formation of granulomas, knowledge of the involvement of features and developments in imaging tests granulomatous diseases allow a narrowing of their differential diagnoses.
Uremic Leontiasis Ossea - Classic findings
of this rare form of renal osteodystrophy
Authors: BAPTISTA, R.M.; SOUZA, D.J.A.; PESSANHA,
L.B.; FERREIRA, L.F.R.; PINHO, M.A.; TEIXEIRA, R.R.G
Institution: Universidade Federal do Espírito Santo - UFES,
Vitória, Espírito Santo - Brasil
Author responsible: Rodrigo de Melo Baptista
Brief description of the purpose of the report: Renal osteodystrophy is a spectrum of skeletal disorders in patients
with chronic renal failure (CRF), due to disturbance in mineral metabolism, mainly of calcium and phosphate. It can be associated with both high and low bone \”turn over\”, resulting
in disorders such as brown tumors, “rugger- jersey“ spine,
salt and pepper pattern in skull, osteopenia, among others. In
the present study, we report the case of a rare form of renal
osteodystrophy, the uremic leontiasis ossea.
Medical History: Male patient aged 35 years, with CRF and
secondary hyperparathyroidism, who presented facial, trunk
and limbs dimorphism, with characteristic tomographic findings of uremic leontiasis ossea, and concomitant fibrous osteitis, fibro-osseous dysplasia and brown tumors findings.
Diagnosis: Facial bone abnormalities by secondary hyperparathyroidism in CRF can take three radiological patterns: cystic
fibrous osteitis, fibrous dysplasia and, most rarely, uremic leontiasis ossea. That last one displays a combination of quirky
findings, consisting of hypertrophy of the jaw, serpiginous tunneling in the bone marrow and undefined cortical bone.
Discussion and summary of the case: Skeletal changes for
renal osteodystrophy are several, yet well characterized by
the image, and tomographic and radiography studies associated with the clinical data are the key to an accurate diagnosis
in rare cases such as uremic leontiasis ossea.
PD.03.007
PD.03.011
Branchial cleft anomalies: pictorial essay
Authors: CARVALHO JR., L.J.P; LOPES, L.D.P; BASTOS,
B.B; MARTINS, L.R; MESQUITA, A.B.G; MIRANDA,
A.M.M; BRAGA, A.G.C; CRUZ, P.A.
Institution: UDI 24 HORAS, TERESINA, PIAUI, BRASIL
Author responsible: Luiz Judeci Pereira de Carvalho Junior
Introduction: Branchial cleft anomalies comprise of a spectrum of congenital defects that occur in the head and neck.
The anomalies result from branchial apparatus (6 arches)
which are the embryologic precursors of the ear and the muscles, blood vessels, bones, cartilage, and mucosal lining of
the face, neck, and pharynx. Being important to know the
main anomalies through imaging methods.
Methods Involved: In this pictorial essay selected for the
knowledge, illustrative examples of the main anomalies of
gill slit.
Pictorial Essay of neural sheath lesions
of the posterior fossa - schwannomas
beyond VIII pair
Authors: Ferreira, C.S; Ventura, N; Pitta, P; Niemeyer B;
Emery L; Abdalla G; Carvalho D; Fagundes, J; Gasparetto, E.
Institution: INSTITUTO ESTADUAL DO CÉREBRO
PAULO NIEMEYER - IEC /RJ
Author responsible: Emerson Leandro Gasparetto
Introduction: Among the tumors of nerve sheath posterior fossa schwannomas of the eighth nerve are the most frequently diagnosed, followed less frequently by the V nerve. Our objective
is to demonstrate through a pictorial essay, cases in our file with
lesions of these nerves and other more unusual in daily practice.
Methods Involved: We retrospectively reviewed cases of
schwannomas of the posterior fossa with radiological diagnosis and / or surgical confirmation.
PD.03.006
70
Discussion: Schwannomas of the posterior fossa can develop
from any cranial nerve, from the V to XII. Non vestibular
tumors have the same characteristics in common with the
other schwannomas in computed tomography and magnetic
resonance imaging (MRI), but often they are distinguished by
clinical symptoms at the presentation and its relationship to
the cranial nerves and the foramen base the skull.
Conclusion of the presentation: Regardless of location, in
most cases of schwannomas radiological features, remodeling and the clinical picture allow indicate the diagnosis even
in the case of unusual lesions such as the VII pair and low
cranial nerves.
Methods Involved: Cases of abscesses, ischemic neuropathy, petrous apex lesions, SCC, lymphomas, necrotic tumors,
among others were analyzed.
Discussion: DWI plays a role in tissue characterization distinguishing malignant from benign lesions, differentiating
squamous cell carcinoma and lymphoma based on cellularity
and Brownian motion of the tissue, that can be quantitative
measured by ADC values. DWI might also predict tumor response and evaluate recurrence.
Conclusion of the presentation: DWI and ADC threshold
values are very useful in the evaluation of diseases of the
head and neck.
PD.03.014
PD.03.017
Lethal midline granuloma syndrome - a
diagnostic dilemma - Pictorial Essay
Authors: SALATA, T.M.; ANTUNES, L.O.; RIBEIRO, B.N.F.
Institution: HOSPITAL CASA DE PORTUGAL / 3D DIAGNÓSTICO POR IMAGEM, RIO DE JANEIRO, RIO DE
JANEIRO, BRASIL
Author responsible: Tiago
Introduction: The lethal midline granuloma syndrome
(LMGS) is presented as destructive lesions of the midline of the
face, covering wide range of diseases, with little specific imaging findings, making diagnosis difficult by radiological methods. The objective of this study is to demonstrate the findings of
images acquired by computed tomography (CT) and magnetic
resonance imaging (MRI) of the main differential diagnosis of
lesions in the midline of the face, with analysis of the values of
the apparent diffusion coefficient map (ADC) of some lesions.
Methods Involved: We gathered the last five years the cases of
the syndrome in this service, all with diagnostic confirmation.
Discussion: The rare LMGS appears as changes in the midline of the face, which evolve as ulcerative / vegetative injury
and induce to destruction of the nasal region. Diagnosis is
difficult because of the variety of diseases listed as probable hypothesis, the main are: squamous cell carcinoma, nasal
lymphoma and Wegener\’s granulomatosis.
Conclusion of the presentation: The CT and MRI are effective in the evaluation and characterization of LMGS, with
some favoring findings of the diagnosis, and the value of the
ADC useful in this differentiation, restricting the diagnostic
hypotheses and shortening the start of treatment.
Parathyroid 4D-computed tomography:
series of cases with image findings and
correlation with post-surgical diagnosis
Authors: MAHFOUZ, K; CAVALHEIRO, D.D.S.;
BACARIN, J.V., KELLER, D.F.H.; SANTOS, G.R.; COELHO, L.O.M.; BERTHOLDO, D.B.
Institution: Hospital de Clínicas da Universidade Federal do
Paraná, Curitiba, Paraná, Brasil
Author responsible: Kassia Mahfouz
Introduction: The characterization of parathyroid lesions is
difficult because of its location and dimensions. Usually ultrasound and Tc-99m sestamibi scintigraphy are used. The
4D-computed tomography (4D-CT) for parathyroid has been
an important tool, increasing diagnostic sensitivity and assisting in surgical planning. We correlated imaging findings of 4DCT with post-surgical diagnosis and reviewed the literature.
Methods Involved: Fourteen patients with hyperparathyroidism were submitted to 4D-CT and 13 had suspicious findings for parathyroid adenoma. So far three were submitted to
surgery and histological analysis. Imaging findings of 4D-CT
were correlated with post-surgical diagnosis.
Discussion: Multidimensional tomography, or 4D-CT, has
emerged as an useful imaging modality to detect parathyroid
lesions causing primary hyperparathyroidism. 4D-CT obtain
additional information about the parathyroid lesion from imaging in two or more contrast-enhanced phases, providing
precise anatomic information, localizing small adenomas,
and differentiating adenoma form other mimics.
Conclusion of the presentation: Interpretation of 4D-CT
images is challenging because of ectopic glands, multiglandular disease, and lesion mimics such as thyroid nodules and
lymph nodes. The radiologist’s ability to detect and characterize a suspected lesion can be increased with 4D-CT.
PD.03.015
Diffusion weighted imaging in head and
neck: A pictorial essay
Authors: Olivetti, B.C.; Filho, A.P.M.M; Gomes, R.L.E.;
Sarpi, M.; Cevasco, F.K.I.; Daniel, M.M.; Passos, U.L.; Garcia, M.R.T; Gebrim, E.M.S.
Institution: Instituto de Radiologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo,
São Paulo, Brasil
Author responsible: Bruno Casola Olivetti
Introduction: DWI (diffusion weighted imaging) can provide improvement of head and neck diagnostics, in ischemic,
infectious and neoplastic lesions. The aim of this study is to
demonstrate that DWI can be used with high accuracy for
distinguishing various head and neck lesions and to predict
malignancy and recurrence tumor. ADC threshold values can
be used in this evaluation too.
PD.03.019
Nasal polypoid masses: main differential
diagnoses
Authors: LACERDA, L.S.; GARCEZ, D.C.; PEÇANHA,
A.S.; CAMILO, G.B.; MACHADO, D.C.; CHAGAS, L.A.;
OLIVEIRA, C.E.; PINTO, H.E.; SPIVAK, M.
Institution: Hospital Universitário Pedro Ernesto - UERJ,
Rio de Janeiro, Rio de Janeiro, Brasil
Author responsible: Letícia da Silva Lacerda
Introduction: The nasal polypoid masses are common findings in sinus exams, having many causes, from inflammatory
to neoplastic. The purpose of this essay is to review the image
spectrum of these lesions.
71
Methods Involved: We selected cases documented by
computed tomography (CT) and/or magnetic resonance imaging (MRI), from a university hospital, with histopathological confirmation.
Discussion: The most common cause of these masses is the
nasal polyps, chronic inflammatory disease, related to asthma
or cystic fibrosis. The angiomatous and antrochoanal polyps,
have typical radiological features such as the intense vascularization and the peculiar location, respectively. Inverted
papilloma is a rare benign nasal tumor, and it is usually unilateral, with risk of malignancy. The nasoangiofibroma is a
benign tumor, rare, which mainly affects adolescent males,
characterized as polypoid mass, well-vascularized, with its
epicenter in the pterygopalatine fossa. Among the imaging,
CT allows the evaluation of extension and invasion of adjacent structures, mainly bone damage, while MRI is superior
in the visualization of soft tissues, allowing differentiation
between tumor mass and secretions.
Conclusion of the presentation: Despite the wide spectrum
of nasal pathological processes with polypoid aspect, the imaging findings associated with clinical history and otorhinolaryngological examination, allow for increased specificity in
the diagnosis.
PD.03.020
Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) of Lower Cranial
Nerves (IX, X, XI and XII): A Pictorial Essay
Authors: Lyra, T.G.; Oliveira, D.J.L.; Noujaim, S.E.; Forsyth, A.; L N Silva, L.N.; Godoy, L.F.S.; Gebrim, E.M.S.
Institution: Hospital Sírio Libanês, São Paulo - SP - Brasil
Author responsible: Tatiana Goyanna Lyra
Introduction: The lower cranial nerves are involved in pharyngeal and laryngeal function as well as in movements of the
neck and tongue. Damage usually manifests as problems with
speech and swallowing. The authors will discuss the normal
anatomy of the lower cranial nerves and several pathologic
conditions will be presented with emphases on imaging findings and differential diagnosis.
Methods Involved: The authors will discuss the normal
anatomy of the lower cranial nerves and their relationship
with the corresponding anatomic structures. It will include
practical review of the jugular fossa and the hypoglossal canal using original drawings, CT and MRI images. Several
pathologic conditions will be presented with emphases on
imaging findings and differential diagnosis.
Discussion: Pathologic conditions to be presented include, but
not limited to: primary and extrinsic tumors (schwannoma, neurofibroma, paraganglioma, meningioma, metastasis), jugular
fossa syndrome (Vernet’s syndrome), acute and chronic vocal
cord paralysis, denervation atrophy, perineural tumor spread,
infectious (Lyme’s disease), Wallenberg syndrome, carotid artery dissection, glossopharyngeal neurovascular conflict.
Conclusion of the presentation: It is very important that
radiologist knows the low cranial nerves anatomy and recognizes the main pathologic conditions.
PD.03.021
Cisto do ducto tireoglosso e seus principais diagnósticos diferenciais
Authors: Raphoul J., Silva MQP, Nunes L., Tuffi, Veiga V.T.
Institution: Webimagem São Paulo
72
Author responsible: Marcelo de Queiroz Pereira da Silva
Introduction: Cisto do ducto tireoglosso é a lesão cística
mais comum do pescoço.Eles geralmente estão localizados
na linha média e são a massa cervical da linha média mais comum em pacientes jovens.Seus principais diagnósticos diferenciais são cisto da fenda branquial, cisto epidermóide, cistos
de tireóide, laringocele, ranula e adenoma de paratireoide.O
objetivo deste trabalho é salientar para os radiologistas as
principais características do cisto do ducto tireoglosso e seus
principais diagnósticos diferenciais
Methods Involved: Pesquisar nos principais sites e livros de
radiologia sobre o assunto em questão para auxílio no diagnóstico dos radiologistas
Discussion: Por representar 70% de todas as anomalias congênitas do pescoço, devemos expor com clareza suas principais características anatômicas e radiológicas e de seus principais diagnósticos diferenciais.Por exemplo , cisto do ducto
tireoglosso estão comumente localizados na linha média na
região infra hioide, possuem baixo sinal em T1 e tipicamente
alto sinal em T2.Em T1 pós contraste não apresenta realce em
cistos não complicados.
Conclusion of the presentation: Características anatômicas
e radiológicas( seja qual for o método utilizado), são essenciais para explorar patologias da região cervical e facilitar o
trabalho dos radiologistas no dia a dia.
PD.03.022
Rare Lytic lesion of the jaw. Miofibromatosis
Authors: PAESE, H.N.Z. ; SUASSUNA, G.
Author responsible: Henrique Nunes Zagnoli Paese
of a rare lytic lesion of the jaw and its differentials
Medical History: Child, male, 9 years old , presenting with
toothache, the panaromic radiograph of the maxillary showed
a sclerotic radioluscent image with poorly defined edges with
some intramedullary extension and exophytic bone, located
in the right horizontal branch of the jaw
Diagnosis: A CT was performed and showed a expansive lesion with soft parts density and periosteal reaction associated
with bone erosion and some calcified foci within the mass, affecting the the angle and the horizontal branch of the jaw.Due
to the characteristics of the lesion in addition with the patients
age, osteossarcoma and desmoplastic fibroma were our first
hypothesis. Two bone biopsies were performed, both of then
came with the result of normal tissue. Another biopsy was made
in the soft tissue mass and came positive for myofibromatosis.
Discussion and summary of the case: Myofibroma is the
most common benign fibrous tumor in infants. Approximately one-third of myofibromas arise in the head and neck, most
commonly in the tongue, mandible, maxilla, or mastoid bone.
Boys tend to have solitary lesions (myofibroma), whereas
multicentric lesions (myofibromatosis) are more common in
girls. At imaging, the lesions appear round and may be well
or ill defined.
PD.03.024
Nasopharyngeal carcinoma with skull
secondary invasion
Authors: Dias, A.G.; Dantas, G.C.; Natal, M.R.C.;
Institution: Hospital de Base do Distrito Federal (HBDF),
Brasília, Distrito Federal, Brasil
Author responsible: Alberto Guerra Dias
Brief description of the purpose of the report: Discussion
about nasopharyngeal tumor with aspects of their natural
history and image through CT scans and MRI of the patient
and literature.
Medical History: Patient with longstanding headache report
recently worsened.
Diagnosis: The nasopharyngeal carcinoma is one of the worst
prognoses among tumors of the head and neck due to the natural anatomy and tumor aggressiveness. Accounts for about
2% of tumors of the head and neck is very relevant and survival can reach only 10% in 5 years. Early diagnosis is necessary, therefore, imaging studies are essential in the diagnosis.
This case shows a large expansive lesion originating from the
nasopharynx with invasion of the skull middle fossa through
the foramen ovale and the sphenoid bone destruction associated with large tumor component in the middle fossa and
determining compression and invasion of the temporal lobe.
Discussion and summary of the case: The nasopharyngeal
carcinoma has a high mortality and comorbidity, becoming
needed a quick diagnosis for effective treatment with good
prognosis to the patient. The CT and MRI are essential in this
respect as far as the knowledge of the nature of the disease
and local anatomy by the radiologist.
PD.03.025
GRANULOMA REPARATIVO DE CÉLULAS GIGANTES DO ETMOIDE: RELATO DE UM CASO
Authors: Chagas LA, Lacerda LS, Machado DC, Camilo
GB, Oliveira CE, Peçanha AS, Junior CB, Sá LCB, Moreira
VG, Garcez DC.
Institution: Chagas LA, Peçanha AS: Médico residente do
segundo ano de radiologia do Hospital Universitário Pedro
Ernesto. Lacerda LS, Machado DC, Camilo GB, Oliveira CE:
Médico residente do terceiro ano de radiologia do Hospital
Universitário Pedro Ernesto Junior CB: Médico residente do
terceiro ano de otorrinolaringologia do Hospital Universitário Pedro Ernesto. Sá LCB: Médico serviço de otorrinolaringologia do Hospital Universitário Pedro Ernesto Moreira
VG: Médico serviço de patologia do Hospital Universitário
Pedro Ernesto Garcez DC.: Médico serviço de radiologia do
Hospital Universitário Pedro Ernesto
Author responsible: Lucia Antunes Chagas
Brief description of the purpose of the report: The giant
cell reparative granuloma (GCRG) is a rare benign lesion, of
unknown etiology, most common in young women.
Medical History: We present the case of a male patient, 34
years, with recurrent epistaxis and nasal obstruction for 4
months. Cranial and facial computadorized tomography (CT)
and magnetic resonance imaging (MRI) revealed solid expansive formation centered in the right ethmoidal bone, with
cystic/necrotic degeneration areas, measuring 6,5x2,5x4,5cm
(L x T x AP) extending to the left ethmoid cells, determining remodeling of bone blades, insinuating in right orbit and
anterior cranial fossa. The patient underwent embolization
of the right maxillary artery, nasal endoscopic resection and
bifrontal craniotomy for removal of intracranial component
of the lesion. Histopathology revealed reparative giant cell
granuloma (GCRG).
Diagnosis: The GCRG is located more frequently in the
mandible, and the ethmoid bone is an atypical location. The
most common symptoms are epistaxis, nasal obstruction and
local deformity. The differential diagnosis is giant cell tumor
and brown tumor depends on clinical and histopathological
findings, since radiological aspects are similar.
Discussion and summary of the case: Despite several imaging features, CT and MRI are essential to correctly locate the
lesion and determine its relationship to adjacent structures.
PD.03.026
Perfusion in head and neck: How, When
and Why?
Authors: GARCIA, MRT; CASERTA, GC; PASSOS, UL; ZUPPANI, HB; DANIEL, MM; GOMES, RLE; GEBRIM, EMS.
Author responsible: Marcio Ricardo Taveira Garcia
Introduction: Computed Tomography (CT) and Magnetic
Resonance (MR) anatomical images are limited in the treatment planning and monitoring patients with head and neck
tumors. Perfusion is a dynamic functional study that evaluates the tissue angiogenesis. We will discuss indications,
techniques, findings, and applications of perfusion studies in
clinical management of patients with head and neck tumors.
Methods Involved: CT and MR perfusion of head and neck
region with different devices, highlighting the acquisition
hot-topics. Describe the acquisition of parametric maps and
mathematical variables: blood flow (BF), blood volume
(BV), traffic mean time (MTT) and capillary permeability
(CP). Techniques and the main findings will be illustrated
with own service cases.
Discussion: Perfusion studies in head and neck have clinical applications yet, as narrowing diagnostic hypotheses
in parotid nodes, detection and delineation of primary and
secondary tumors, biopsy guide, biomarker in predicting and
monitoring response to chemotherapy and radiotherapy.
Conclusion of the presentation: Head and Neck radiologists
need to be familiar with perfusion studies on CT and MRI,
because these can bring important information to treatment
plan and evolution of patients with neoplasms of this region.
PD.03.027
FUNGAL SINUSITIS - IMAGING FINDINGS AND IMPORTANCE OF EARLY DIAGNOSIS
Authors: MELO, D.M.; CARVALHO, R.S.; FASBENDER,
C.P.B.; SOUZA, E.C.F.; CAMILO, M.L.; ZANGIACOMO,
R.N.; NEGRI, R.V.; BARROS, E.G.
Author responsible: Danilo Monteiro de Melo Henklain
Introduction: The fungal sinusitis (FS) usually affects the
elderly, immunocompromised patients and diabetics decompensated and mortality up to 80%. The study was intended to
describe the imaging findings of SF.
Methods Involved: Literature review was performed in
PubMed database (last 10 years) and a pictorial study of suspected cases of FS in large hospital in Sao Paulo (last 05 years).
Discussion: FS is divided into invasive forms (acute, chronic, granulomatous) and noninvasive (allergic and fungal
ball). The acute invasive most lethal in mortality between
50% and 80%. Computed tomography (CT) was observed in
the cases that reported in the literature: mucosal thickening
73
of the breasts, which may erode / bone sclerosis. Hyperattenuating material in the sinus can match the extremely thick
secretions, fungal sinusitis and blood. Acute form may cause
cavernous sinus thrombosis, occlusion and pseudoaneurysm
of the internal carotid. Magnetic resonance imaging (MRI)
better show the orbital extension and central nervous system,
with involvement of the muscles and orbital fat, and periantral, and meningeal enhancement.
Conclusion of the presentation: Early diagnosis and treatment of fungal infections are essential because of the risk of
infectious complications, intracranial extension and mortality
of up to 80%.
PD.03.029
IMPORTANCE OF RADIOLOGIC ANATOMY IN SURGICAL PLANNING FOR TUMORS OF THE TONGUE
Authors: SOUZA E.C.F., CARVALHO R.S., VERGILIO
C.S., MELO D.M., STEINWANDTER R., NEGRI R.V.,
CAMILO M.L., GUEDES V.H.C.C
Author responsible: Erika
Introduction: The tongue is divided into two parts and there
are different patterns of tumor involvement of the tongue
muscles and their behavior will determine different forms of
therapeutic approach.
Methods Involved: We conducted a literature review and
pictorial essay with cases of tongue tumors studied by means
of magnetic resonance imaging and computed tomography
at a large hospital in the last 5 years and correlated with the
anatomical involvement.
Discussion: The anterior two-thirds of the tongue correspond
to the oral portion and the posterior third, the base of the
tongue. The tongue is composed by intrinsic (superior longitudinal, inferior longitudinal, transverse and vertical) and
extrinsic muscles (genioglossus, hyoglossus, styloglossus
and palatoglossus). We found different patterns of anatomical
involvement of the tongue by tumors, which guided surgical
planning (partial and/or total glossectomy, hemiglossectomy). The most common histological subtype among the analyzed cases was squamous cell carcinoma.
Conclusion of the presentation: The different patterns of
tumor involvement of the tongue muscles guide the surgical
approach. Thus knowledge and anatomical description of this
region is essential for the radiologist.
PD.03.030
RHINOGENIC CEREBROSPINAL FLUID FISTULA:
DIAGNOSTIC CHALLENGE ON COMPUTED TOMOGRAPHY (CT)
Authors: SOUZA E.C.F., CARVALHO R.S., VERGILIO
C.S., STEINWANDTER R., MELO D.M., CAMILO M.L.,
GUEDES V.H.C.C., ZANGIACOMO R.N.
Author responsible: Erika
Introduction: Rhinogenic cerebrospinal fluid fistula is the
abnormal communication between the subarachnoid space
and the superior paranasal sinuses and its topographic diagnosis is relevant for the risk of central nervous system infection. There are different definitions and classifications for
74
these fistulas in the literature, utilizing different imaging modalities, such as CT, magnetic resonance (MR), CT or MR
cisternography, among others. This study aims to find the image through the site of the fistula.
Methods Involved: Pictorial essay of cases with suspected
rhinogenic cerebrospinal fluid fistula investigated by means
of CT with multiplanar reconstruction in a large hospital over
the past 5 years.
Discussion: The suspected sites for fistulas were the cribriform plate and ethmoid roof and difficulty in determining the
topographic diagnosis was noted.
Conclusion of the presentation: The diagnosis of rhinogenic cerebrospinal fluid fistulas is difficult, demanding multiple
imaging modalities in most cases. On CT, adequate study
technique and correlation with clinical and laboratory data
are essential for the diagnosis.
PD.03.031
Lemierre\’s Syndrome: a case report
Authors: Kitamura, F.C.; Lages, R.B.; Cardarelli-Leite, L.;
Santos, R.M.; Santiago, I.B.; Abdala, N.
Brief description of the purpose of the report: It was in a
1936 that André Lemierre described the syndrome that was
later named after him: anaerobic infection of the pharynx,
leading to cervical abscesses and septic emboli. We present
the case of a previously healthy young who suffered from
Lemierre syndrome.
Medical History: A 18-year old male was brought to the
Emergency Department complaining of severe left-sided
neck pain, soar throat, malaise and shortness of breath, which
begun 6 days before. On examination, severe pain on palpation of the left neck and hyperaemia of the pharynx were
noted. Cervical ultrasound showed thrombosis of the left internal jugular vein and CT scan of the chest revealed multiple consolidations, ground-glass nodules and small bilateral
pleural effusion.
Diagnosis: Lemierre\’s Syndrome typically begins with oropharyngeal infection caused by Fusobacterium. Primary infection is followed by invasion of the internal jugular vein
(IJV), causing septic thrombophlebitis. As occurred with our
patient, pulmonary involvement is extremely common. The
gold-standard for diagnosis of septic thrombophlebitis of the
IJV is contrasted neck CT, although Doppler ultrasonography
can also be used.
Discussion and summary of the case: Depicting jugular
vein thrombophlebitis is often the first diagnostic clue and a
high degree of suspicion in the appropriate clinical setting is
essential for diagnosis.
PD.03.032
Postoperative image findings in laryngeal SCC: conservative and radical surgery
Authors: PASSOS, UL; MEDEIROS, DC; GEBRIM,
EMMS; RAMOS, DM; GOMES, RLE; ZUPPANI, HB;
GARCIA, MRT
Institution: INRAD/ICESP - HCFMUSP
Author responsible: Ula Lindoso Passos
Introduction: The goal of treatment of Espino Cell Carcinoma (SCC) of the larynx is the tumor cure associated with
an attempt to preserve the functions of the organ whenever
possible. The radiologist often faced with different post-surgical findings of laryngectomy, and therefore it is our aim to
illustrate the main surgical techniques used in the treatment
of primary laryngeal cancer.
Methods Involved: Illustrations , CT scans, MRI and PETCT of the main post-surgical findings after laryngeal SCC.
Discussion: In an attempt to preserve swallowing functions,
speech and breathing, head and neck surgeons use different
surgical techniques in the treatment of laryngeal SCC. The
choice of technique to be used depends on the extent of the
lesion , the staging of the disease and acceptance of the patient for surgery. Besides the total laryngectomy, conservative surgery as chordectomy can be performed, vertical partial laryngectomy, horizontal supraglottic laryngectomy with
cricohioidopexia or cricohyoidoepiglottopexy, or the almost
total laryngectomy. The appearance imaging these different
surgical techniques may eventually simulate injuries
Conclusion of the presentation: Knowledge of laryngeal
anatomy and surgical techniques used in laryngeal SCC treatment is essential for the radiologist can differentiate postoperative changes of possible remaining or recurrent lesions.
PD.03.033
OTOSCLEROSIS: KEY FINDINGS AT MULTISLICE
COMPUTED TOMOGRAPHY
Authors: Rosa DT, Padilha IG, Farias LPG, Miranda CMNR
Introduction: Otosclerosis is a condition that usually comes accompanied by tinnitus, which has several differential diagnoses.
Patients are subjected to numerous tests, such as contrast tests,
totally unnecessary for diagnosis. With the advent of multislice
computed tomography (TCMS), the diagnosis became more precise and its evolutionary monitoring more effective. This paper
aims to demonstrate changes related to otosclerosis at TCMS.
Methods Involved: Literature review, retrospective analysis
and demonstration of various otosclerosis aspects at TCMS.
Discussion: The main computed tomography findings seen in
otosclerosis are represented by small irregularities and attenuation changes, branches of the stirrup inserts, irregularities
in stapedial base, scattered foci of calcification within the cochlea, tiny pockets of previous otospongiosis the oval window ,
coarse focus of otospongiosis in various regions of the cochlea
and cochlear demineralization rings, which are often easier diagnosis. Using some multiplanar reformatting, the diagnosis of
this clinical entity can be more accurate and also earlier.
Conclusion of the presentation: TCMS is a non-invasive
diagnostic imaging with high efficiency for the diagnosis of
otosclerosis and can provide an early diagnosis in order to
enable the use of appropriate treatment.
PD.03.034
Medullary plasmacytoma extra head
and neck metastatic
Authors: RAMOS, L.C; SOUZA, C.S; CEDRO, P.M.A
Institution: Multimagem. Ilheus, Bahia, Brasil
Author responsible: Lister Cedro Ramos
Brief description of the purpose of the report: Report typical radiological findings of a very rare metastatic lesion
Medical History: Imagens de TC e RM realizadas no período de 07/2014 a 09/2014
Diagnosis: The extramedullary plasmacytoma, next to the
bone marrow aspiration, is one of the performances of the localized plasma cell neoplasms, multiple myeloma that has as
its main representative. Its incidence among these neoplasms
is 4.5 to 7, 2% having the head and neck as the most frequent.
The differential diagnosis includes plasma cell granuloma,
pseudolymphoma, undifferentiated carcinoma and metastases.
The prognosis is related to the location of the tumor, bone destruction and cartilage, and regional lymph node involvement.
Discussion and summary of the case: Extramedullary plasmacytoma should be considered in the differential diagnosis
of rare tumors of the head and neck. It is essential after the
diagnosis of multiple myeloma research and a \”follow up\”
appropriate.
PD.03.036
Orbital Rabdiomyossarcoma: a case
report
Authors: DANTAS, G.C.; JALES JR., M.D. ; MENEZES,
A.L.P. ; VIEIRA, J.F.; NATAL, M.R.C.; RIBEIRO, G.M.R.
Institution: Hospital de Base do Distrito Federal, Brasília,
Author responsible: George Caldas Dantas
Brief description of the purpose of the report: Describe
and illustrate a case about Orbital Rabdiomyossarcoma.
Medical History: ERS, female, 6 years, complaining of left
proptosis for 1 month and that worsed 1 week ago. Computed
tomography (CT) and magnetic ressonance imaging (MRI)
revealed homogeneous mass, with intense enhancement by
contrast media, without bone destruction, located in superolateral region of the left orbit.
Diagnosis: The diagnosis was rhabdomyosarcoma which is
the most prevalent malignancy orbital extraocular in children, occurring in the first decade of life, between 6-8 years
with a slight preference for boys (5: 3). Most common histological type is embryonic. Aggressive tumor grows quickly,
often invading bone and soft tissue tissues, manifesting with
progressive ptosis. In the images of CT and MRI is seen as a
homogeneous mass, isodense / isointense in T1-weighted sequences and hyperintense on T2 may have calcification, necrosis and hemorrhage, with emphasis variable. Differential
diagnosis includes capillary hemangioma, lymphoma, and
neuroblastoma metastases. Treatment is surgery, radiotherapy and chemotherapy. 5-year survival of 90%.
Discussion and summary of the case: It is essential to perform imaging exams for the diagnosis and staging of orbital
tumor lesions, as in our case.
PD.03.038
Lesions of the Cervical Carotid Space
Authors: SHIMADA, B. J.; SOTTANO, F. F.; VALE, R.I.C.;
NOGUEIRA, A.B.; OLIVEIRA, G.S.; ROSSI, T.G.; SILVA,
H.C.; BAAKLINI, R.E.;
Institution: Faculdade de Medicina de Marília (Famema),
Marília- SP, Brasil.
Author responsible: Bruno Junji Uwada Shimada
Introduction: The carotid space is defined between the base
75
of the skull through the jugular foramen and extends to the
arch of the aorta. The most common lesions located in this
space are: pseudotumor, inflammatory lesions, benign and
malignant tumors. The purpose of this study is to conduct a
review of the most common injuries and discuss the importance of imaging methods for diagnosis.
Methods Involved: MRI is the method that best characterizes the tissues of the aforementioned space, but showing some
disadvantages on the TC, as higher cost, lower sensitivity,
among others.
Discussion: The pseudotumors, it can mention anatomical
variations as tortuosity, some dilatation of the common and
internal carotid artery. Inflammatory Lesions are infections,
fibromuscular dysplasia, takayasu arteritis and arterial dissections. Benign tumors are divided into neurogenic tumors
(schwannomas and neurofibromas), paragangliomas, meningiomas and teratomas, as Schwannoma, the most prevalent.
Malignant tumors are mostly the lymph node for non-Hodgkin lymphoma, which are the second most common malignant tumor of the head and neck, carcinomas metastases
Squamous Cells of nasal or throat, and metastases from infraclavicular tumors (breast, lung, kidney, etc).
Conclusion of the presentation: The association of clinical
and radiological findings allows most accurate preoperative
diagnosis of this lesions.
PD.03.039
The aid image in the diagnosis of orbital
trauma
Authors: MIYADA, W.S.; VILLA, P.P.O.; VALE, R.I.C.;
SHIMADA, B.J.U.; REZENDE, R.C.; SOARES, C.S.; SILVA, H.C.; BAAKLINI, R.E.; MORO, F.A.S.; LOBO, G.R.
Institution: Faculdade de Medicina de Marília, Marília, São
Paulo, Brasil
Author responsible: Williene dos Santos Miyada
Introduction: Most ocular traumatic injuries is usually related car accident or sports. About 3 % of all emergency calls
and eye 40% of uniocular blindness associated with trauma.
Knowledge of the main types of traumatic injuries associated with imaging findings are essential for accurate and rapid
diagnosis. The objective of this study is to correlate imaging
findings with the types of lesions found in orbital trauma.
Methods Involved: Imaging tests used in these cases include
radiography, ultrasound if there is no eye break, magnetic
resonance imaging ( MRI) and computed tomography (CT)
, the former being more used to evaluate bone parts . MRI is
usually not recommended for initial assessment , the method
of choice when there is suspicion of eye injury is CT .
Discussion: Ocular lesions are grouped according to their location, being divided into anterior chamber of injury, injury
to the crystalline, ocular perforation , fracture of the eye wall,
the extrinsic muscles injuries , foreign bodies , eye protrusion, carotid cavernous fistula and nerve injury optical .
Conclusion of the presentation: The early and accurate detection of eye injuries through the various imaging methods
is essential if there is immediate intervention when necessary
and avoid irreversible damage .
TL.03.006
Mastoid air cells pneumatization in the
newborn: a radioepidemiological study
Authors: ARAUJO JR, DAA; MUSA-AGUIAR, P; SUMI,
76
DV; SOARES, CR; GOMES, RLE; GARCIA, MRT; DANIEL, MM; FUNARI, MBG.
Brief description of the purpose of the study: The mastoid air cells have several functions, among which vibration,
isolation, as an air reservoir, acoustic dissipation, protection
against traumatic injuries, and reduction of the weight of the
skull. The chronology of the mastoid cells aeration process
is not well established in the literature. The aim of this study
is to measure the degree of mastoid cells pneumatization at
birth, as well as to evaluate the presence of concomitant sinus disease.
Methods: We analyzed CT and/or MRI exams of 87 newborn
patients and infants, aged up to 90 days.
Main results: Pneumatization of the mastoid cells at birth
was found in 85% of the cases. 33% of the patients presented
some degree of sinus disease. The affected sinuses were the
maxillary sinus (32%) and the ethmoidal cells (5%).
Conclusion of the presentation: The normal imaging pattern tends to aeration of the mastoid cells in the majority of
the neonates, suggesting that their opacification should warrant further evaluation.
4 - Cardiovascular
PD.04.001
Radiología del pericardio: el gran desconocido.
Authors: LOPEZ, A.M.; FERNADEZ, L.; ESTEBAN,
E.M.; ARENAS, S.
Introduction: • Check the normal anatomy and the anatomic pitfalls. • Define the usefulness of imaging techniques in
the evaluation of the pericardium. • Describe the pericardial
disease.
Methods Involved: We discuss and illustrate radiologic findings in pericardial disease with emphasis on their common
radiologic features.
Discussion: The pericardium is a two-layered membrane that
envelops all four cardiac chambers and the origins of the great
vessels. The pericardial structures are usually readily demonstrated with Computed Tomography (CT), even if chest CT is
performed for evaluation of noncardiac structures. However,
radiologists are expected to evaluate all structures on an image, and incidental findings are common. Radiologists must
first be familiar with the pericardial recesses to avoid mistaking them for pathologic processes. In the evaluation of pericardial disease, CT and Magnetic Resonance (MR) imaging
traditionally have been used as adjuncts to echocardiography.
However, CT and MR imaging provide excellent delineation
of the pericardial anatomy and can aid in the precise localization and characterization of various pericardial lesions.
Conclusion of the presentation: Infection, neoplasm, injury,
and congenital disease all may affect the pericardium. CT and
MR should be used when findings at echocardiography are
difficult to interpret or conflict with clinical findings.
PD.04.003
Aortic Regurgitation Quantification
using Cardiac Magnetic Resonance. What
is the best imaging plane for flow quantification? A single center clinical trial.
Authors: TRAD, HS; GALI, AMAS; KOENIGKAM-SANTOS, M; BRAGGION-SANTOS, MF; VOLPE, GJ; MACIEL, BC; SCHMIDT, A.
Preto; São Paulo; Brasil
Author responsible: Henrique Simão Trad
Brief description of the purpose of the study: Precise quantification of aortic regurgitation (AR) is central to surgical
planning. In routine clinical practice, the imaging plane for
flow analysis using phase contrast (PC) technique is the sinotubular junction (STJ). However, this plane is not suitable in
some cases. The other two planes of use are the ascending
aorta (Ao) and the left ventricle outflow tract (LVOT), but
these are said to respectively, overestimate and underestimate
the measures. Our objective was to compare the volumes of
three different planes of measure in the Ao, JST and LVOT,
in different degrees of AR.
Methods: all patients underwent cardiac magnetic resonance
with PC through-plane flow quantification. Pearson correlations and paired t-Student tests were performed with the different planes measures, with a significance level of 5 %.
Main results: 95 patients with AR were analyzed. Significant
correlation (p<0.0001) was present between forward and regurgitante flow, and the regurgitante fraction throughout the
series, with r values of 0.83 to 0.96. In the evaluation of volumes, a significant difference was present between forward
flow in the Ao and STJ (111±42 ml vs. 108±43ml,p=0.006).
Conclusion of the presentation: In AR patients, flow quantification similarities suggests that, when the usual plane of
analysis is impaired, reliable measures can be obtained in
different planes.
PD.04.004
MYCOTIC ANEURISM OF THE ABDOMINAL AORTA ASSOCIATED WITH SPONDYLODISCITIS
YUHARA, E.Y.; ODELI, J.T.; DUARTE, E.C.; THOMAZ, F.B.
Brief description of the purpose of the report: Most abdominal aortic aneurysms are infrarenal and fusiform, and
the most usual etiology is atherosclerosis, but other possible
causes are trauma, vasculitis or infection. The presence of
abdominal aortic aneurysm with atypical or unusual location
should alert to the possibility of infectious origin.
Medical History: Male, 75 years old, with consumptive
syndrome, back pain and a pulsatile mass in the upper abdomen. Imaging studies have demonstrated massive suprarenal
saccular aneurysm, and evidence of spondylodiscitis L2-L3,
with paraspinal abscess formations. The patient underwent
empirical treatment with antibiotics and antituberculosis
drugs, showing significant reduction in ESR, but due to his
comorbidities, the palliative treatment was chosen.
Diagnosis: Mycotic aneurysm secondary to lumbar spondy-
lodiscitis. Most mycotic aneurysms occurs by hematogenous
dissemination, but in some cases it may occur by contiguity.
Spondylodiscitis is a rare infection, whose most common etiologic agents are bacteria or mycobacteria. Development of
contiguous mycotic aneurysm is a rare complication.
Discussion and summary of the case: The patient symptoms should be valued and proper investigation by imaging
studies allow early diagnosis of spondylodiscitis, avoiding
complications and dramatic outcomes as reported.
PD.04.006
Myocardial late gadolinium enhancement is not related to the severity of
aortic regurgitation. Cardiac Magnetic
Resonance clinical trial.
Authors: TRAD, HS; GALI, AMAS; KOENIGKAM-SANTOS, M; BRAGGION-SANTOS, MF; VOLPE, GJ; MACIEL, BC; SCHMIDT, A.
Preto; São Paulo; Brasil
Author responsible: Henrique Simão Trad
Brief description of the purpose of the study: Myocardial
fibrosis detected by late gadolinium enhancement (LGE) has
been linked to adverse prognosis in several cardiovascular
pathologies. In aortic stenosis, LGE has been linked to worse
systolic function and prognosis. In aortic regurgitation (AR),
LGE has only been described in small experimental and clinical trials. Objectives: evaluate the presence of LGE, it’s relation to left ventricular function and volumes, and the severity
of AR in a cohort of patients.
Methods: 99 patients with AR underwent cardiac magnetic
resonance (CMR) with specific sequences to evaluate cardiac size and function, aortic flow quantification and LGE.
Descriptive statistical analysis and Fisher’s exam test were
performed, to identify LGE related factors.
Main results: LGE was present in 16 patients (16.2 %). In
relation to morphologic and functional parameters (end diastolic dimension, ejection fraction, end systolic and end diastolic volumes, and AR severity), there was no statistical difference between groups with and without LGE. Only patient
age was significantly higher in patients with LGE (64.3±10.5
vs.52.6±17.4,p=0.01).
Conclusion of the presentation: Myocardial fibrosis detected by LGE is not uncommon in patients with AR, although
it’s apparently related to age and not to the severity o AR or
it’s functional consequences.
PD.04.008
The MRI Heart contribution in the diagnosis and monitoring of dysplasia Arrhythmogenic Right Ventricular.
Authors: FERREIRA,LR; LEMOS LA; REIS,GLL; ROCHA CMV; SOARES AGS; VALADARES, RD; BARRETO, AS, VELOSO, G; MELO, ST;DIAS, RFS; SANTOS,MS; AMARAL, FG
Institution: Hospital Madre Teresa, Belo Horizonte, Minas
Gerais, Brasil
Author responsible: Flavia Gontijo
Brief description of the purpose of the report: Arrhythmogenic right ventricular dysplasia (ARVD) is a myocardial
77
disorder of primarily the right ventricle (RV).This desease is
not common but can be seen more frequently in young adults,
and clinical manifestations range from no symptoms to lethal
arrhythmia and sudden death.
Medical History: female patient with 21-year-old started 1
year ago framework of palpitations associated with episodes
of syncope. Echocardiogram showed aneurysmal formations
dense echogenic contrast RV and electrocardiogram with
atrial flutter signals. Requested RM heart that showed significant increase in RV dimensions and the ipsilateral lobby
highlighting various areas of akinesia and dyskinesia of the
RV free wall, confirming the diagnosis of ARVD.
Diagnosis: Because MR imaging depicts both functional
and structural abnormalities, positive MR imaging findings
should be used as important additional criteria in the clinical
diagnosis of ARVD.
Discussion and summary of the case: MR imaging appears
to be the optimal technique for detection and follow-up of
clinically suspected ARVD.
PD.04.010
Coronary artery anomaly originating
from a single trunk with inter-arterial
course
Authors: CALDAS, A.L.C.; GARCIA, A.A.; LABBATE,
M.R.C.;SANTOS, R.M.; CARVALHO, M.Q.; MONTEIRO,
R.C.D.; ARMELIN, P.L.A.; COELHO-FILHO, O.R.
Institution: PRÓTON DIAGNÓSTICOS, CAMPINAS,
SÃO PAULO, BRASIL
Author responsible: Ana Luiza de Carvalho Caldas
Brief description of the purpose of the report: Reporting
a rare case of a coronary artery (CA) anomaly, with the right
coronary artery (RCA) and the left main (LM), originating
from a single trunk. This anomaly is rare and studies indicate
increased risk of sudden death, especially in young adults.
Medical History: Forty five year-old asymptomatic male,
without risk factors for coronary artery disease, with abnormal exercise test, referred for evaluation of CA by multidetector computed tomography angiography (MDCTA).
Diagnosis: MDCTA revealed single origin of the coronary
tree, with both RCA and the LM originating from a common
trunk emerging from directly the aorta above the left Valsalva
sinus (VS), showing inter-arterial course (between the aorta
and the pulmonary artery) with moderate luminal reduction
by extrinsic compression. The LM demonstrated an extensive
intrasseptal course. This is a rare disorder with an incidence
between 0.02% to 0.06%. The patient underwent surgery,
with re-implantation of the single trunk in right VS associated with correction of intrasseptal LM path.
Discussion and summary of the case: The AMDCT is a
noninvasive diagnostic method that allows outstanding visualization of the coronary tree, allowing the correct diagnosis
and treatment planning.
PD.04.011
Atrial myxoma giant
Authors: CALDAS, A.L.C.; GARCIA, A.A.; LABBATE,
M.R.C.; SANTOS, R.M.; CARVALHO, M.Q.; MONTEIRO,
SÃO PAULO, BRASIL
Author responsible: Aline de Almeida Garcia
78
Brief description of the purpose of the report: Report an
unusual myxoma giant filling 70 % of the left atrium
Medical History: Female patient, 49 years old, asymptomatic,
referred for investigation of atrial left mass, visualized in routine transthoracic echocardiogram, underwent Cardiac Magnetic Resonance Image (CMR) to investigate such findings.
Diagnosis: CMR exam, with tissue characterization and late
gadolinium enhancement (LGE), demonstrated a giant mass
filling 70 % of the left atrial, adhered to the fossa ovales in
the atrial septum, presenting mobility during the cardiac cycle, close to the mitral leaflets, however without causing obstruction of the left ventricule (LV) input or of the pulmonary
veins. The mass showed moderate hyperintensity sinal on T1
and T2 images, associate to heterogeneous LGE. Collectively
these findings are compatible with giant atrial myxoma. The
patient was referred for open surgery, confirming the diagnosis of giant atrial myxoma.
Discussion and summary of the case: Atrial myxoma is the
most common primary benign cardiac tumor. However, rarely
these tumors have dimensions and fill the left atrial as reported. One of the possible complications of giant tumors in the
left atrium is obstruction of left ventricular inflow tract. CMR
with its high resolution and outstanding tissue characterization is considered the method of choice for cardiac tumors.
PD.04.012
Characterization of a pedunculated
mass on the right ventricle (RV) by Cardiac Magnetic Resonance (CMR )
Authors: LABBATE, M.R.C.; GARCIA, A.A.; CALDAS,
A.L.C.; SANTOS, R.M.; CARVALHO, M.Q.; MONTEIRO,
Institution: Próton Diagnósticos, Campinas, São Paulo, Brasil
Author responsible: Aline de Almeida Garcia
Brief description of the purpose of the report: : Report
an unusual case of a pedunculated mass attached to the RV,
assessed by CMR, with features suggestive of thrombus, confirmed after anticoagulation for six months.
Medical History: Female patient, 52 years old, asymptomatic, referred for investigation of a mass in the RV, visualized
on routine transthoracic echocardiogram, underwent CMR
for investigation.
Diagnosis: CMR exam, with tissue characterization and late
gadolinium enhancement (LGE), demonstrated an isointense
mass to the myocardium on T1 and T2-weighted images, partially adhered to the moderator band and the free wall of the
RV, presenting mobility during the cardiac cycle, showing
pedunculated pattern. The perfusion study indicated absence
of tissue perfusion. On the LGE, the structure did not show
contrast enhancement even with high inversion time, also suggesting thrombus. The clinical team decided to keep anticoagulation for 6 months, and a new CMR exam demonstrated
complete abscence of the mass, confirming the CMR findings.
Discussion and summary of the case: Masses located in the
RV may have various etiologies, including metastatic tumors
of malignant lineage. In this case, CMR strongly suggested
the presence of thrombus, confirming that this is a diagnostic
method of excellence for anatomical definition, assessment
and involvement of extracardiac structures, tumor tissue
characterization and treatment planning.
PD.04.013
MRI EVALUATION OF MAY THURNER SYNDROME: STATE OF ART
Authors: COSTA Y.B.; MARTINS A.N.; TACHIBANA A.;
FUNARI M.B.G.
Author responsible: Yves Bohrer Costa
Introduction: The May Thurner syndrome (MTS) occurs
when the left common iliac vein is compressed by the right
common iliac artery , classically presents persistent edema of
the left leg , with or without signs of deep venous thrombosis
associated. However, this entity remains controversial. Due
to the exponential increase in the use of imaging methods ,
the left common iliac vein compression by the right common
iliac artery have been commonly observed in asymptomatic
patients. When we consider the significant compression?
Methods Involved: We chose illustrative cases of patients with MTS who underwent MRI at 3T field, including sequence Time Resolved Imaging of Contrast Kinetics
( TRICKS).
Discussion: Recently, multislice CT and venous angiography
have been advocated for the diagnosis of MTS , including to
remove differential diagnoses , such as compression pelvic
masses . In MTS , MRI allows the observation of the compression of the left common iliac vein, but special attention
should also be given the for venous collateral branches.
Conclusion of the presentation: In order to perform early
diagnosis and avoid serious complications, radiologist should
know the direct and indirect signs of MTS. MRI also helps in
the treatment planning of venous stents or surgical approach,
when needed.
PD.04.014
Hypertrophic cardiomyopathy evaluation Imaging methods: role of magnetic
Resonance
Authors: EYER, AAR. VERRASTRO, CGY. SZARF, G.
UELLENDHAL, M. ABDALA, N
Author responsible: Alfredo Augusto Eyer Rodrigues
Introduction: Hypertrophic cardiomyopathy is a disease of
broad spectrum phenotype. MRI is the imaging method for assessing disease severity and risk of secondary complications.
Methods Involved: cases will be displayed showing the
phenotypes of hypertrophic cardiomyopathy and myocardial
fibrosis aspects of this way it is possible to exemplify the
great variability
Discussion: Hypertrophic cardiomyopathy and the large
phenotypic variation still bears several factors that determine
risk and possibility of complications, is the assessment of
myocardial mass by quantitative assessment of myocardial
thickness, the morphological evaluation of fibrosis withe the
gadolinium late enhancement so that the sum these factors
implies progressive increase in risk for ventricular arrhythmia and sudden death
Conclusion of the presentation: MRI is the imaging method
of choice in the imaging evaluation of patients with known
or suspected hypertrophic cardiomyopathy. This essay will
show through clinical cases for identification of different
phenotypes with subsequent risk stratification
PD.04.015
Coronary CT Angiography in Emergency
Room: Epidemiological Data from Single
Center Retrospective Study compared
with Multicenter Studies
Authors: Sasdelli Neto, R; Nomura, CH; Szarf, G; Ishikawa, WY; Sandoval, AC; Bianco, DP; Teles, GBS; Shoji, HK;
Sawamura, MVY; Santana Netto,PV; Chate, RC; Passos,
RBD; , Funari, M.B.G.
Author responsible: Roberto Sasdelli Neto
Brief description of the purpose of the study: Patients with
chest pain presenting in emergency room (ER) may stay in
the ER from 2 to 24 hours, to exclude acute coronary syndrome (ACS). The latest international guidelines in Cardiovascular CT established that it may be used in patients at low/
intermediate risk for coronary artery disease (CAD) by clinical scores, with atypical acute chest pain. The negative predictive value of the Coronary CTA is used to exclude SCA in
this group of patients, reducing the in-hospital length-of-stay
and health system costs. The aim of this retrospective study is
to demonstrate the epidemiological data of the patients who
underwent Coronary CTA at ER, comparing them with the
multicenter studies.
Methods: 60 patients presented to ER and had Coronary
CTA examinations between January and September 2012. 44
males; mean age of 55 y/o (22-87 y/o); mean body mass index (BMI) was 27.2 kgm2 (19.95 - 35.53).
Main results: The comparison with multicenter studies demonstrates similarities in patient’s age and the predominance of systemic hypertension and dyslipidemia as risk factors for CAD.
Differences included predominance of males and non-smokers.
In-hospital length-of-stay was similar (7,6 hours).
Conclusion of the presentation: Coronary CTA can help the
management of patients presenting to the ER with atypical
chest pain, reducing the in-hospital length-of-stay.
PD.04.016
Total Anomalous Pulmonary Venous Drainage: Case Report
Authors: GARCIA, M.M.; MEDEIROS, S.I.C.; BAPTISTA, L.P.S; GOSPOS, M.; SILVA, M.L.; MELLO, M.A.R.
Institution: Hospital Alvorada, São Paulo, São Paulo, Brasil
Author responsible: Marcelo Motta Garcia
Brief description of the purpose of the report: This work
aims at reporting a case of total anomalous pulmonary venous drainage ( TAPVD ) , with emphasis on their clinical
suspicion and peculiarities in diagnostic imaging.
Medical History: Newborn, male , full-term , with central
cyanosis and respiratory distress at birth. Holosystolic murmur at the left sternal border .
Diagnosis: TAPVD is a rare disease , accounting for approximately 2 % of all congenital heart diseases, being the infracardiac variant less frequent . Although rare, has a high
mortality : 80 % in the first year of life , without specific
therapy. Thus, the clinical suspicion , early diagnosis and surgical intervention are key to survival. After clinical suspicion
of cyanotic congenital heart disease , the patient was assessed
by echocardiography , which showed no connection between
the pulmonary veins and the left atrium, with common pulAbstracts of Scientific Papers
79
monary vein protruding distally beyond the diaphragm. Computed Tomography Angiography (CTA) study showed connection to the mesenteric- portal system.
Discussion and summary of the case: Despite technological advances in diagnostic imaging , the TAPVD remains a challenge.
Although echocardiography has key role in diagnosis, being often
the only preoperative necessary exam, some cases of greater anatomical complexity and especially the infracardiac variant need
additional study with CTA, allowing better surgical planning.
PD.04.018
HOW TO MEASURE THE HEART? A PRATICAL AND
EVIDENCE-BASED APPROACH ON HEART CHAMBERS EVALUATION BY CARDIOVASCULAR MAGNETIC RESONANCE IMAGING (CMRI)
Authors: Sasdelli Neto, R; Nomura, CH; Szarf, G; Ishikawa, WY; Sandoval, AC; Bianco, DP; Teles, GBS; Shoji, HK;
Sawamura, MVY; Santana Netto,PV; Chate, RC; Passos,
RBD; , Funari, M.B.G.
Author responsible: Roberto Sasdelli Neto
Brief description of the purpose of the Review of Literature: The measurements of the heart chambers are used for
morphological and functional evaluation of the heart. In addition, they are also necessary to ensure the proper classification of some heart diseases, such as dilated and hypertrophic
cardiomyopathies. Transthoracic Doppler-echocardiography
is the imaging method initially used for this analysis, due
to its availability, short examination time, lack of contrast
media or ionizing radiation. However, its accuracy is operator-dependent. Cardiovascular magnetic resonance imaging
(CMRI) allows comprehensive evaluation of the heart. It’s
possible to obtain volumetry, morphology and function of the
heart chambers and the analysis of the myocardium and some
valves in a single CMR examination. As a cross-sectional
imaging method and its measurements are semi-automated,
CMRI is more reproducible, due to lesser operator dependence. Nowadays, a standardization based on age, gender and
body surface area (BSA) has improved this evaluation, because these reference values for size of the cardiac chambers
and function of the ventricles turn the CMRI more individualized for each patient.
Description (s) condition (s), method (s) or technique (s): The
aim of this review it’s to demonstrate how to do the measurements
in CMRI, based on specialized literature recommendations.
Conclusion: Literature review
Brief discussion of the case CMRI provides individualuzed
heart chambers evaluation by age, gender and BSA with evidence-based reference values.
PD.04.021
Prevalence of coarctation of aorta in
patients undergoing CT angiography in a
referral hospital in Sao Paulo.
Authors: CASTRO, R.N.C., MELO, E.R.; NOMURA, C.H.,
SANTOS, M.G., OLIVEIRA, D.S., ZANGIACOMO, R.N.
80
the prevalence of aortic coarctation in patients undergoing
CT angiography (CTA) in a referral hospital in Sao Paulo.
Methods: Prevalence retrospective study conducted through
collection from electronic medical records of all patients undergoing aortic CTA from august to october 2013th, in a reference hospital in São Paulo.
Main results: The sample consisted of 218 patients. Coarctation of the aorta was observed in 26 pacients, seventeen
(65.4%) males and 9 (34.6%) females.
Conclusion of the presentation: Coarctation of the aorta is
a commom cardiovascular malformation, accounting for 5 %
to 8% of general cardiopathies, predominantly in males, in
a ratio of 3: 1. The obstructive change locates in the union
between the aortic arch with the descending aorta (isthmic
region - from the left subclavian arteries and the ductus arteriosus or its remaining) and can involve the aortic arch itself.
Angiotomography is important to set the location, extension
of the obstruction, severity and aspects of collateral circulation that are relevant to operatory strategy.
5 - Physics / Quality Control
PD.05.002
Quality Control in the Indirect Computed Radiography Agfa system.
Authors: PACIFICO, L.C., AUGUSTO, F.M.
Institution: Instituto Nacional de Câncer, Rio de Janeiro,
Rio de Janeiro, Brasil
Author responsible: Leonardo de Castro Pacifico
Brief description of the purpose of the study: Develop a
quality control protocol for indirect computed radiography
Agfa system.
Methods: It was used image plates (IPs) of different sizes to
reach a testing protocol. A fixed x ray machine was used to
expose the IPs, as well as a radiation meter, and other relevant
materials. The images were analyzed on a proper workstation
and in the ImageJ program.
Main results: The elaborate tests were satisfactory, and so
the Protocol.
Conclusion of the presentation: Based on these tests, it is
possible to follow the life of IPs and the reader thereof, allowing the institution to program for any replacements of IPs,
and ensure a quality image.
TL.05.001
Dose reduction protocol application in
Multi-detectors CT (MDCT): Comparison of
Hospital and Private Clinic
Authors: Cunha, B.M.R.; Seidel, K.A.; Teixeira, I.C.R.;
Sala, M.A.S.; Indiani, J.M.C.; Martin, M.F.; Nacif, M.S.
Institution: Unidade de Radiologia Clínica (URC) e no Hospital Vivalle, São José dos Campos, SP, Brasil
Author responsible: Beatriz Morais e Rodrigues da Cunha
Brief description of the purpose of the study: Identify radiation dose in millisievert (mSv), before and after the dose
reduction protocol application, comparing percentage of
dose reduction in the MDCT studies in a private Hospital
and Clinic.
Methods: 60 total abdominal CT scans were analyzed before the change of protocols for dose reduction and compared
with abdominal CT 60 after the change of protocols such in
hospital as in the clinic. The groups were divided by age. Percentage, mean and standard deviation were evaluated, considering p <0.05 as statistically significant.
Main results: We observed a significant reduction of approximately 15% in radiation dose on exams performed in hospitals and 9% in elective patients (private clinic), both p <0.05.
The age group that had more benefit from this reduction was
young adult.
Conclusion of the presentation: This study confirms the
importance of always act in attempt to reduce radiation in
MDCT exams maintaining the diagnostic capability of the
method. With this we believe reduce future impacts of radiation exposure.
6 - IT / Management / Education
PD.06.001
Demonstration for expenditures for implementation of a clinical ultrasound
small in the Northern Region of the State of Ceará.
Authors: PALHETA MS, SANTOS FRC, MARTINS RMS
Institution: CLÍNICA MICHEL PALHETA, SOBRAL
CEARÁ, BRASIL
Author responsible: Michel Santos Palheta
Brief description of the purpose of the study: This paper aims to demontrate for the expenses for the implementation of a clinical ultrasound small in the northern
state of Ceará
Methods: To that end, we realized price quotes, with several companies, suppliers in the state of Ceará and in other
states of Brazil, working in the field of diagnostic imaging.
The quotes were intended to raise spending on goods and
services (equipment, furniture and fixtures, various materials
and products used, hand labor, taxes, social contributions and
other) relevant to a clinical ultrasound
Main results: As a result of our analyzes, we note that, in
addition to its social role, the clinical ultrasound in the State
of Ceará can be characterized as a profitable activity.
Conclusion of the presentation: As a result of our analyzes,
we note that, in addition to its social role, the clinical ultrasound in the State of Ceará can be characterized as a profitable activity.
PD.06.002
Multislice tomography for evaluation
of bone structures of the Skulls of Sea
Animals with educational goal
Authors: Tacara S., Domit C., Silva L., Vitola M.L.A.,
Awamura Y., Nakano I.T, Kochinski K., Oliveira J.M.
Institution: UFPR CEM,CLINICA SUGISAWA IMAGEM,
Curitiba, Paraná, Brazil
Author responsible: Irene Tomoko Nakano
Introduction: Imaging methods have also revolutionized
the assessment of marine animals in the diagnosis and
treatment of diseases. The objective of this paper is the
study of bone anatomy by multislice computed tomography skull of marine animals with the production of educational material.
Methods Involved: Multislice CT scanner 64 channels with
processing of images with multiplanar reformatting and 3D
reconstruction of marine animals skulls.
Discussion: The purpose of this study is the correlation of CT
images with the anatomical bone structures of marine animal
skulls. There are few educational materials available in the
literature on the subject demonstrating the CT and anatomic correlation of these animals. Technological advances in
imaging methods and the integration of different specialties
allow great benefits to marine animals, improving their rehabilitation and survival.
Conclusion of the presentation: Multislice CT scan allowed
the acquisition of images of skulls of marine animals with
excellent anatomic correlation.
TL.06.001
New requisites for teleradiology: am i
using the the appropriate tools?
Authors: Santos IRM, Julio T
Author responsible: Igor Rafael Martins dos Santos
Brief description of the purpose of the study: Working in
teleradiology is relatively new in our market. It shows as a reliable alternative for the majority of radiologists and may be
the only or best alternative for solutioning specific demands,
as remote areas attending, 24/7 support, and high complexity exams (for example, specialists serving small businesses).
Recently, Brazil\’s Conselho Federal de Medicina (CFM)
published a new specific resolution (Nº 2107/2014), that defines and normatizes teleradiology practice. The resolution
specifics technical pre-requisites relatives to the way how images are stored and visualized, that aims warrant information
quality and security. Although specified on the normatives,
the majority of radiologists are unwared. Therefore, we will
demonstrate the main hardware and software concepts, necessary to teleradiology image interpretation.
Methods: Based on CFM\’s resolution Nº 2.107/2014, that
revoke the former resolution Nº 1890/09, and on ACR Technical Standard for Electronic Practice of Medical Imaging,
we analysed the key technical concepts necessary to teleradiology good practice.
Main results: Several portion of basic technical knowledge
related to this working practice aren\’t well propagated in
our enviroment.
Conclusion of the presentation: It\’s crucial that these technical concepts may be part of radiologist\’s expertise.
7 - Intervention
PA.07.008
CHYLOUS LEAK: PERCUTANEOUS TREATMENT
GUIDED BY COMPUTED TOMOGRAPHY
Authors: ROCHA, R.D.; FALSARELLA, P.M.; RAHAL.
JR., A; JULIO, T.; MARIOTTI, G.C.; RIBEIRO, J.A.;,
GARCIA, R.G..
81
is to highlight the importance of Interventional Radiology in
the treatment of this pathological condition of high mortality.
Medical History: Female, 35 years-old, presenting high-output chylotorax refractory to conservative, surgical and radiation treatments. A percutaneous embolization guided by
computed tomography was performed. Polidocanol, cyanoacrilate and ethiodol were injected in the fistulous path
mapped by iodated contrast. After the procedure the debit
has become progressively smaller and the drain could be removed 10 days later.
Diagnosis: Chylous leak is mainly caused by iatrogenic surgeries. Chronic chylothorax can induce loss of protein and
lymphocytes, increasing susceptibility to infections. Therapeutic options include conservative treatment and surgical
or interventional radiology procedures. The technique used
was effective and showed a nice alternative when the thoracic duct cannot be catheterized or when the fluoroscopy is
not available. A three-dimensional view of the fistula could
be easily demonstrated by the computed tomography. The
incidence of complications is low, mainly characterized by
chronic diarrhea and lower limbs edema.
Discussion and summary of the case: Percutaneous embolization of the thoracic duct is considered the first-line treatment in patients with chylous leaks.
PA.07.011
RADIOFREQUENCY ABLATION OF HEPATIC TUMORS ADJACENT TO THE GALLBLADDER: PROTECTION BY CONTINUOUS IRRIGATION THROUGH CHOLECYSTOSTOMY
Authors: ROCHA, R.D.; FALSARELLA, P.M.; JULIO,
T.; MARIOTTI, G.C.; SILVERIO P.R.B.; RIBEIRO, J.A.;,
GARCIA, R.G..
Brief description of the purpose of the report: Ablative
therapies have become a great alternative to surgical treatment of hepatic nodules. However, some technical difficulties
may decrease the effectiveness, for example, lesions adjacent
to the gallbladder. The purpose of this paper is to describe the
technique of profilatic cholecystostomy with continuous irrigation while performing a radiofrequency ablation, intending
to minimize the complication risks.
Medical History: A 48 year-old patient, presenting with
multiple liver metastases after a history of a uterine sarcoma
3 years before. A radiofrequency ablation of the hepatic tumors was indicated after neoadjuvant chemotherapy. Two of
the hepatic nodules were located adjacent to the gallbladder.
Therefore, the gallbladder was catheterized and a continuous
irrigation by cold solution was performed during the ablation.
Complications were not seen.
Diagnosis: The ablation of hepatic lesion adjacent to the gallbladder is safe. The complications are usually self-limited,
highlighting pain, fever and vomit. Cholecystitis, in turn, is
the most feared. To avoid this complication it is recommended to not cross the gallbladder during the access; avoid umbrella-shaped probes; and perform continuous irrigation of
the gallbladder.
Discussion and summary of the case: The continuous irrigation of the gallbladder during radiofrequency hepatic tumors ablation is an excellent method to decrease complications induced by high-temperature.
82
PA.07.026
Ytrium-90 Radioembolization: Case Report
Authors: falsarella, P.M.; Fina, B.D.; Galastri, F.L.; Affonso,
B.B.; Cavalcante, R.N.; Leal Filho, J.M.M.; Yamaga, L.Y.;
Garcia, R.G.; Nasser, F.
Brief description of the purpose of the report: The incidence of hepatocellular carcinoma (HCC) is increasing in
recent years. Most patients present outside the ressectability
criteria. Radioembolization is a locoregional therapy whose
principle is transarterial embolization of microparticles loaded with Ytrium-90.
Medical History: Male patient, 55, cryptogenic cirrhosis
with multinodular hepatocellular carcinoma, 2 nodes respectively in liver segments II (3.2 cm) and VI (2.5 cm). Patient
underwent two sessions of DEB-TACE, persisting with stable
disease (mRECIST). Mapping of the lesions with intra-arterial injection of macroaggregate, which excluded pulmonary
shunt, was carried out, and followed by infusion of radioactive sphere superselective catheterization of the corresponding arterial branch was performed. The immediate follow-up
by Pet-CT showed concentration of radioactive sphere in the
damaged area. The 120 follow-up, post treatment showed
partial response to treatment with necrosis greater than 90%.
Diagnosis: This new technology has been shown to be particularly promising for refractory patients to other therapies.
The technical complexity and multidisciplinary method requires its implementation in centers of excellence.
Discussion and summary of the case: the report of this case
illustrates the execution of this therapy in Brazil with good
results, allowing a therapeutic option for patients with inadequate response to DEB-TACE.
PD.07.003
EVALUATION OF SAFETY AND EFFICACY OF RETROPERITONEAL BIOPSIES GUIDED BY COMPUTED TOMOGRAPHY (CT)
Authors: AMANCIO CT, DIAS LTP, LEITE CC, VIANA
PCC, CERRI GG, MENEZES MR
Institution: Hospital Sírio Libanês, São Paulo, SP, Brasil
Author responsible: Camila Trolez Amancio
Brief description of the purpose of the study: Image-guided biopsy is a procedure widely accepted in current medical
practice, due to its excellent results and low complication
rate. Retroperitoneal tumors represent a possible target to this
procedure, ranging from benign to malignant lesions. The
objective is to evaluate safety and efficacy of retroperitoneal
biopsies guided by computed tomography (CT).
Methods: Cross-sectional, retrospective analysis of medical
records of patients who underwent retroperitoneal biopsy
guided by CT between 2007 and 2014. Safety was assessed
by complications rate and efficacy by pathological conclusive diagnosis.
Main results: There were 130 patients with a mean age of
61 years. There were no complications in 97% of cases, with
3 hematomas after procedure without needing medical intervention. The procedure was effective with pathological conclusive diagnosis in 99 % of cases. Of these, 33 % represented
metastasis and 24% lymphoma. Access to the retroperitone-
um by percutaneous procedure sometimes is considered unsafe due to the presence of vessels and ureter. However, there
are few reports in the literature on this subject, with usually
small samples.
Conclusion of the presentation: Retroperitoneal biopsy
guided by CT was shown to be safe and effective.
PD.07.004
Pleurodesis by Percutaneous Access –
Drainage Technical, Main Agents, Results
and Complications
Authors: CAVALCANTE, F.A; BRITTO NETO, L.A; LUZ,
D.C; RAHAL JR. A; QUEIROZ M.R.G; LUCIO, J.F.F;
GATTIS, P; GARCIA R.G.
Institution: HOSPITAL ISRAELITA ALBER EINSTEIN,
Brief description of the purpose of the Review of Literature: We will describe the relevant points about the indications
and mainly from the technical procedure guided by image.
Pleurodesis is the merger between the visceral and parietal
layers of the pleura in order to avoid accumulation of air or
fluid in the pleural space. Its main indications are malignant
pleural effusion, recurrent pleural effusion benign and pneumothorax. The choice of sclerosing agent is variable, and the
most appropriate imaging method to guide the procedure and
the selection of patients are still controversial. The clinical
imaginologic follow up these patients is of paramount role
in this context. We will illustrate our work with patients who
underwent pleurodesis in a tertiary hospital.
Conclusion: Recurrent effusions of malignant origin are the
most common indication and with better results for pleurodesis in clinical practice, especially of patients with cancer
advanced disease. This procedure can also be used in benign conditions, and pneumothorax the most frequent. There
is still little information about the mechanisms that lead to
pleural symphysis or the factors that influence the outcome
of pleurodesis.
Brief discussion of the case The performance of pleurodesis
by percutaneous access, minimally invasive, is an affordable,
effective, safe and low cost, should be considered among the
therapeutic options.
PD.07.005
RADIOABLAÇÃO DE OSTEOMA OSTEÓIDE: UM
ENSAIO PICTOGRÁFICO
Authors: SANTOS, LCM., PEIXOTO, TV., NOGUEIRA,
VH., ZÍLIO, MB., BARBOSA, PNV., CHOJNIAK, R.,
TYNG, CJ.
Institution: AC CAMARGO CANCER CENTER, SÃO
PAULO, SP , BRASIL
Author responsible: Thiago Peixoto
Introduction: The osteoid osteoma (OO) is a benign bone
tumour radiographically caracterized by a circumscribed
lucent region with sclerotic margins, that may or not be associated with periosteal reaction. Clinically, it manifests by
moderate to severe pain, that worsens at night and is relieved
by salicilates. Chronic use of salicilates is one of the primary
reasons for the indication of this treatment option. Objective:
To demonstrate how this procedure is conducted in a oncol-
ogy cancer center.
Methods Involved: In this study, we selected patients
with OO who underwent radiofrequency ablation (RFA)
guided by Computed Tomography (CT). Images from
those cases were chosen to illustrate this minimally invasive treatment technique.
Discussion: The classic treatment consists in wide ressection
of the nidus by open surgery. This method is associated with
high rates of morbidity in the post-operative period and by a
long recovery time. RFA is a minimally invasive treatment
in which ablation needles are used to destroy the nidus. This
procedure presentes low rates of morbidity and the patient
may return to their usual activities in a short period of time.
Conclusion of the presentation: RFA guided by CT may be
considered an excelent treatment option for the OO, since it’s
a safe, effective and minimaly invasive technique.
TL.07.002
CT-guided lung biopsy: a cancer center experience
Authors: PEIXOTO, TV; TYNG, CJ; BARBOSA, PNV;
NOGUEIRA, VHV; ZILIO, MB; SANTOS, LCM; CAMPORINI, MM ; CHOJNIAK, R
Institution: AC CAMARGO CANCER CENTER, SAO
PAULO-SP, BRASIL
Author responsible: Thiago Peixoto
Brief description of the purpose of the study: A computed tomography (CT)-guided lung biopsy has been used as a
method of obtaining material for histopathological and microbiological study for decades. The objective of the study
was to evaluate the efficacy of the procedure in a Cancer Center, its complications and associated variables.
Methods: It was collected data from biopsies performed in
this Interventional Radiology (IR) service in 2014
Main results: 323 lung biopsies were performed. The mean
age of patients was 60.5 years. In 119 (36%) procedures occurred pneumothorax, and 11 of them thoracic drainage was
necessary, providing a drainage rate of 9% of the pneumothorax. In the histopathological findings of the fragments, it was
found that 216 (66.9%) were malignant, and 107 (33.1%)
were benign. The mean diameter of lesions was 28 mm and
the average distance between the lesion and the pleura was
20mm. The Department of Pathology has considered 11 samples (3.4%) unsatisfactory, giving an efficiency of 96.6%.
These data are consistent with the literature, presenting variations related to the epidemiological profile and experience
of each Service.
Conclusion of the presentation: CT-guided lung biopsy performed with proper technique has low rates of serious complications and high efficiency, making this method an important tool in the treatment of cancer patients
TL.07.003
Comparison between incidences of complications after prostate biopsy with and
without the use of Image Fusion US / MRI
Brief description of the purpose of the study: Recently ,
prostate MRI emerged as an important ally for the detection
of lesions suspicious for cancer, particularly in the central
83
gland , a region seldom sampled by randomic prostate biopsy
. With the advent of US / MRI fusion techniques , the central zone ( CZ ) and transition ( TZ ) became more sampled.
However, since they are more vascularized regions , there is a
theoretical risk that their biopsy entail a greater morbidity for
the procedure. The aim of this study is to compare the rates of
complications between the randomic and fusion techniques.
Methods: Retrospective evaluation of cases of prostate biopsies performed with the above techniques , comparing the
most frequent complications .
Main results: Our observations have shown a greater incidence of adverse events in the US / MRI fusion biopsy group,
the most frequent of these being hematuria . Despite of this
result , these events were mostly mild and did not require any
aditional care .
Conclusion of the presentation: Although prostatic biopsy
with US / MRI fusion leads to an increased risk of complications , these are vastly self- limited. Furthermore , the benefits of diagnosing a tumor which would otherwise have been
missed outweigh this risk .
TL.07.005
It is worth sampling the transition zone
in a random prostate biopsy ?
Brief description of the purpose of the study: The transrectal prostate biopsy is the only minimally invasive method
for the definitive diagnosis of prostate adenocarcinoma. The
technique of random biopsy is to sample the peripheral zone
( PZ ) in sextants, where most of the tumors are found. However , a few lesions are located in the transitional zone (TZ) ,
which is not always sampled. For this reason, many services
biopsy the ZT as an integral part of their random prostate biopsies. The purpose of this study is to access the true impact
of additional sampling of ZT.
Methods: Systematic review of random prostate biopsies
made in our service, observing how many fragments were
positive and in which regions.
Main results: Our observations have shown that in only a minority of cases the ZT had cancer and, even in those cases,
the finding did not change the diagnosis or degree of disease.
Given the increased risk of complications, the additional fragments from the ZT might not be justified based on these results.
Conclusion of the presentation: The impact of additional
sampling of the ZT in a random prostate biopsy proved to be
small in our series. More studies are needed to evaluate the real
need and the cost-effectiveness for the sampling of this region.
TL.07.012
INTERVENTIONAL PROCEDURES DIFFICULTIES
IN CRITICAL PATIENTS
Authors: ZANGIACOMO, R.N.; OLIVEIRA, D.S.; FORNAZARI, V.A.V.; DSZEJNFELD, D.
Author responsible: Renato Norberto Zangiacomo
84
aims to familiarize with the difficulties faced by interventional during procedures in patients in critical care units.
Methods: In this prospective study we selected ten patients
admitted to the critical unit with a diagnosis of intra-abdominal abscesses in a large hospital. The images were reviewed
from the digital archive (PACS) by two radiologists with at
least three years of experience regarding the diagnosis, location and feasibility of drainage procedure by ultrasound.
Main results: A total seven of the ten patients was considered
viable procedure performed and the drainage of intra-abdominal abscesses without complications, followed by clinical
improvement according to the clinical and laboratory parameters. Two procedures had complications related to bleeding
and perforation of hollow viscera. And one has been declared
impossible procedure, due to restraint in bed. So the most
difficulties encountered in this study were: blood dyscrasias;
surgical procedures such as ileostomy, colostomy and flanges; position of the patient; and uremia.
Conclusion of the presentation: Thus, with the increase in
minimally invasive procedures in critical units, it is necessary
that the interventionists be aware of the difficulties faced, to
optimize patient therapy, reducing the hospitalization period
that desonerate the public health system.
8 - Breast
PD.08.001
Knowing what is normal: the first step
in the imaging evaluation of breast implants
Authors: LYRIO,C.A.C.; SHITARA, F.I.; SILVA,L.F.D.;
RACY, A.C.S.; FUNARI M.B.G.; RIBEIRO R.L.M.
Author responsible: Carla Andries Crês
Introduction: Nowadays there are several types of breast implants; many of them with some specific anatomical findings
which have correlate in different imaging methods. The goal
is to demonstrate the most common types of implants, especially the main anatomical features, correlating with findings
in different imaging methods, both in vitro and in vivo.
Methods Involved: We selected 10 types of implants used in
plastic surgery from different manufacturers. These implants
were analyzed in vitro, evaluating the main characteristics
including specific features. Subsequently the implants underwent mammography, sonography and MRI and the findings
were correlated with in vitro implants and with images obtained from patients with implants, selected from our database.
Discussion: Breast implants have characteristics and anatomical peculiarities which have correlate in diagnostic imaging methods. When these peculiarities are not evaluated
correctly, they can become pitfalls, frequently misinterpreted
as structural abnormalities. Through an in vitro and in vivo
comparative study, we recognized the main features of implants helping in the interpretation of normal findings in regular patients.
Conclusion of the presentation: The correct interpretation
of normal findings in diagnostic imaging is crucial, preventing misinterpretations and is the first step for the detection
and interpretation of abnormalities in breast implants.
PD.08.002
Radiologic Complete Response (RCR) case
series characterized by magnetic resonance imaging (MRI) in Breast Cancer after neoadjuvant chemotherapy use (NAC).
Authors: Badan, GM; Roveda JR., D; Fleury, EFC; Ferreira CAP; Campos, MSDA; Maragno, B; Leao RMA; Ferreira, FAT
Institution: Santa Casa de São Paulo, São Paulo, Brasil
Author responsible: Gustavo Machado Badan
Introduction: For patients undergoing NAC, imaging tests
are intended to monitor the radiological response. The joint
accuracy based on physical examination, mammography and
ultrasound is less than 50%. MRI is the method of choice and
the new therapeutic options, there was an increase in RCR,
reaching 30% in the early stages. Objectives: To present a
case series of RCR characterized by resolving all areas of abnormal enhancement, lump / mass or architectural distortion
on MRI performed after NAC, emphasizing the immunohistochemical profile and correlation with pathologic complete
response (PCR).
Methods Involved: Report 5 patients with breast carcinoma
clinical stages II and III confirmed by core biopsy, undergoing NAC. Underwent breast MRI with specific protocol before and after the end of NAC.
Discussion: The PCR is defined as the absence of invasive
carcinoma surgical pathological examination. According to
the literature, the immunohistochemical profile more associated with RCR is HER2. However, even negative MRI may
underestimate residual lesions in 30% of cases.
Conclusion of the presentation: Currently the presence or
absence of residual tumor on MRI helps to define the surgical setting. However, avoid surgery for certain patients with
RCR remains a future goal.
PD.08.003
BREAST PLASMACYTOMA: REPORT OF A EXTRAMEDULLARY RARE CASE WITH RELATIVELY BENIGN RADIOLOGICAL FEATURES
Authors: Badan, GM; Roveda JR., D; Fleury, EFC; Ferreira
CAP; Campos, MSDA; Maragno, B; Leao RMA; Ferreira, FAT
São Paulo, Brasil
Brief description of the purpose of the report: Introduce a
rare case of extramedullary plasmacytoma breast, emphasizing its radiological features.
Medical History: Patient 53 years old, female, diagnosed with multiple myeloma 2 months ago and undergoing chemotherapy for one month. She reported bilateral
palpable breast masses. Performed mammography and
breast ultrasound that showed multiple breast masses
circumscribed bilaterally.
Diagnosis: Performed core needle biopsy (core biospy) guided by ultrasound with histological diagnosis of plasmacytoma. The extramedullary plasmacytomas may occur in 5% of
the cases and usually affect the region of the head and neck.
They may occur in other locations, such as skin, lung and
gastrointestinal tract, but in the breast are extremely rare. Although primary plasmacytomas have been described in the
breast, they are not included in primary breast tumors according to the World Health Organization classification. Their radiological characteristics are not well established, but most
of them are described as relatively well-circumscribed mass
and may have the longest axis perpendicular to the skin or as
a focal asymmetry ill-defined to mammography.
Discussion and summary of the case: The breast extramedullary plasmocytomas although extremely rare should be
considered in patients with a history of multiple myeloma,
even in the presence of relatively benign radiological features
of the masses.
PD.08.004
DUCTAL CARCINOMA IN SITU (DCIS): MORPHOLOGICAL AND KINETIC CHARACTERISTICS IN
MAGNETIC RESONANCE (MRI).
Authors: Badan, GM; Roveda JR., D; Fleury, EFC; Ferreira
CAP; Campos, MSDA; Maragno, B; Leao RMA; Ferreira, FAT
Introduction: With the widespread mammographic screening the incidence of DCIS has increased from 2% to 20% of
all diagnosed cases and contributed to the decrease the mortality from breast cancer. However, not all calcify and mammographic sensitivity ranges from 27 to 80%. The limitations
of mammography have raised interest in the use of other
methods to better diagnostic accuracy. Some series of studies
have shown that MRI has a sensitivity for the detection of
DCIS, ranging from 20 to 95%. This study has the objective
of evaluate the different patterns of DCIS presentations to the
examination of breast MRI.
Methods Involved: Selected 20 consecutive cases of DCIS
from January 2013 to December 2014 undergoing MRI and
analyzed their morphological characteristics, according to
the BI-RADS lexicon.
Discussion: The DCIS may present with variables morphological characteristics in the MRI, and the non-nodular
enhancement it’s the most frequent manifestation. It may
also present as masses, and in these cases usually as irregular. The most common internal enhancement pattern is the
\”clumped\” followed by heterogeneous.
Conclusion of the presentation: The DCIS has a wide variety of imaginological features to MRI and is crucial to be able
to recognize them.
PD.08.006
THE FALSE-NEGATIVE MAMMOGRAM. HOW TO
FIX IT?
Authors: SILVA, M.M.A; SHIMIZU, C.; MORAES, P.C.;
RIBEIRO, R.L.M.; FUNARI, M.B.G.
Introduction: Mammography has proved to be an effective
tool for detecting both clinically occult and palpable breast
cancers. However, a small number of even palpable carcinomas may not be evident at mammography. The rate of
false-negative mammograms has been reported to be 4%34%. In general, failure to detect or correctly characterize
breast cancer can be attributed to one of four main factors: inAbstracts of Scientific Papers
85
herent limitations of mammography, inadequate radiographic
technique, subtle or unusual lesion characteristics and detection or interpretation errors. The objective of this paper is to
review and illustrate the main factors related to false negative
mammograms and also to discuss many ways to improve the
accuracy of the mammography.
Methods Involved: A compilation of multiple mammographic cases performed in our institution and an extensive literature review were done.
Discussion: Some inherent limitations of mammography and
lesions characteristics may lead to a false-negative mammogram. Interpretation errors are also very important and include many conditions that can be controlled. Recognition
of these various factors should help decrease the rate of
false-negative mammograms.
Conclusion of the presentation: Recognition of the unavoidable diagnostic difficulties (inherent limitations of
mammography, subtle or unusual lesion characteristics), optimization of radiographic technique, and minimization of
interpretation errors should help reduce the rate of false-negative mammograms.
PD.08.007
Squamous Cell-Type Metaplastic Breast
Carcinoma: A Case Report
Authors: ASSIS, RS.; LEITE, SCB; OLIVEIRA, PAG.,
GONCALVES, T.; REGO, SJF.
Institution: Universidade Federal Fluminense, Niterói, Rio
de Janeiro, Brasil
Author responsible: Renata Silva Assis
Brief description of the purpose of the report: The purpose of this report is to illustrate a rare case of metastatic
metaplastic carcinoma, with squamous differentiation, in a
young patient.
Medical History: A 30-year-old female patient, with negative family history, presented a palpable nodule in the left
breast. The follow up with breast ultrasound showed a cystic
lesion in the lower inner quadrant, with progressive enlargement of its size during the next six months. Weekly puncture
of the cyst showed a serosanguineous fluid, with citopatologic benign findings. Further, she was submitted to Ressonance
Magnetic (RM) and Computed Tomography (CT) scans,
showing an expansive, infiltrative, manly cystic lesion, with
thick walls and contrast-enhanced vegetations, with no plane
cleavage with the major pectoralis muscle.
Diagnosis: Squamous cell-type metaplastic breast carcinoma
represents less than 0,1% of all breast carcinomas, with higher
prevalence above 50-years-old. Clinical presentation is usually a palpable mass with increased growth rate and no involvement of lymph nodes. Macroscopically, they are well-defined
and may origin from cysts. The main sites of metastasis are
pleura and lungs, followed by bones and viscera.
Discussion and summary of the case: The case in discussion matches the literature, however, it stands out because of the early age diagnosis and precocious presentation of metastasis.
PD.08.008
BREAST CARCINOMAS: PRESENTATION TO MAGNETIC RESONANCE (RM) WITH LITTLE / NO
ENHANCEMENT TO CONTRAST PARAMAGNETIC
Authors: FLEURY, E.F.C; BADAN, G.M; ROVEDA JR,
86
DECIO; CAMPOS, M.S.D.A.; FERREIRA, C.A.P.; FERREIRA, F.A.T., MARAGNO, BIANCA; LEAO, R.M.A.
Institution: SANTA CASA DE SAO PAULO, SAO PAULO, SAO PAULO, BRASIL
Author responsible: Bianca Maragno
Introduction: Mammography and ultrasound are choice examinations to the diagnosis of breast cancer, although with specific limitations. Currently, RM imaging (MRI) has proved to be a
method with better diagnostic accuracy . MRI has better performance with the use of gadolinium for differentiating benign breast
lesions of malignant because the pattern of impregnation. Our
goal is to show atypical cases where the enhancement by contrast
does not occur in cases of malignancies, including ductal carcinoma in situ, invasive ductal carcinoma and lobular carcinoma.
Methods Involved: We selected cases of breast carcinomas
that showed little/ no enhancement by paramagnetic contrast
through January 2014 to December 2014.
Discussion: Neoangiogenesis may explain the fact that malignant lesions become impregnated more intensely when compared with normal breast tissues. Despite the high sensitivity, the low specificity of breast MRI may give false-positive
diagnoses, as well as the difficulty in making the differential
diagnosis in some cases of benign and malignant diseases.
In contrast, no enhancement cases can cause false-negative.
Conclusion of the presentation: Breast carcinomas may
show no enhancement to the paramagnetic contrast in the
atypical form to MRI and should not be ruled out suspected
by only the enhancement pattern, but on an combined analysis with lesion morphology.
PD.08.009
Male Breast Disease: Literature Review
and Radiologic-Pathologic Correlation
Authors: ROSA, B.G.; DE FREITAS, A.G.; DADALTO,
R.V.; JARDIM, L.C.; ZANGIACOMO, R.N.; ; NEGRI,
R.V.; FASSBENDER, C.P.B.; CAMILO, M.L.
Institution: Hospital do Servidor Público Estadual - IAMSPE, São Paulo, São Paulo, Brasil
Author responsible: Bruno Galvani Rosa
Brief description of the purpose of the Review of Literature: Male and female breast are identical at birth, but as
boys develop, testosterone levels cause significant involution
and duct atrophy in the male breast. In this study, we review
the imaging and pathologic features of a gamut of benign and
malignant processes involving the male breast.
Literature review on male breast disease with cases obtained
from the digital databank from a public hospital reference in
pathologies of the breast.
Conclusion: Specific topics discussed are gynecomastia,
male breast cancer, benign breast neoplasms, and benign
nonneoplastic breast conditions. Emphasis is placed on male
breast cancer, with a discussion of its epidemiology, characteristic imaging features, and initial management.
Brief discussion of the case Most breast conditions in men
are benign, many of which have characteristic imaging features that allow differentiation from malignancy. The appropriate use of mammography, US, and , when necessary,
magnetic resonance imaging will enable the radiologist to
identify the subset of patients who require further investigation, usually by biopsy. Familiarity with the features may
allow accurate imaging interpretation and avoid unnecessary
and often invasive treatments.
PD.08.010
Breast dermatofibrosarcoma protuberans: report of 2 cases, in both male and
female patients
Authors: MALDONADO, J.P.R.; GIANINI, A.C.C.; VAZ,
N.D.; AZEVEDO, F.C.; ASSIS, P.E.Z.; SALOMÃO, W.R.S.;
FLEURY, E.F.C.
Institution: Instituto Brasileiro de Controle do Câncer, São
Paulo, SP, Brasil.
Author responsible: Ana Claudia Camargo Gianini
Brief description of the purpose of the report: Presenting
two breast dermatofibrosarcoma protuberans cases, analyzed
through computed tomography (CT) and magnetic resonance
imaging (MRI).
Medical History: Patient A.J.O.J., male, 44-year-old, tumor
in the left breast, affecting the skin and subcutaneous tissue,
measuring approximately 8.5 cm. Histological and immunohistochemical analysis showed a dermatofibrosarcoma protuberans relapse. Subjected to CT. Patient A.T.B.M., female,
42-year-old, skin and subcutaneous tumor, in the intermammary cleft, with biopsy revealling dermatofibrosarcoma protuberans. Subjected to MRI.
Diagnosis: Dermatofibrosarcoma protuberans is an uncommon malignant mesenchymal tumor that rarely affects the
breast. It arises from the dermis and can invade the subcutaneous and soft tissue. Usually manifest on adult or young
adult, as an erythematous subcutaneous nodule, hardened,
firm to the touch and slow growth. It usually affects males,
and the global incidence is 5 cases/1 million per year. Local
recurrence rate varies from 0% to 60%, while regional and
distant metastases rates vary from 1% to 4% and 4% and 5%,
respectively. The diagnosis is one of exclusion
Discussion and summary of the case: The dermatofibrosarcoma protuberans is a malignant tumor, locally invasive,
slow growth, however, it has a high local recurrence rate.
PD.08.012
Outcomes after surgery for early-stage breast cancer women with heterogeneously dense and dense breasts staged
with preoperative breast magnetic ressonance imaging (MRI).
Authors: FAERMANN, R; CHEPELEV, L; WEIDENFELD, J; SCOTT-MONCRIEFF, A; VERMA, R; PEDDLE,
S; DOHERTY, G; LAU, J; ARNAOUT, A; WATTERS, J;
SEELY, J.
Institution: THE OTTAWA HOSPITAL/UNIVERSITY OF
OTTAWA, OTTAWA, ONTARIO, CANADA
Author responsible: Renata Faermann
Brief description of the purpose of the study: Due to
MRI’s high sensitivity in assessing disease extent, it was
thought that it would lower rates of re-excision, local recurrence, and improve disease-free survival. Results from studies were, however, conflicting. Trials evaluating these outcomes have not matched patients by density of breast tissue.
We are performing a retrospective study in order to compare
surgical and long-term outcomes in women with early stage
breast cancer who underwent preoperative breast MRI and
breast conservation therapy or mastectomy, with women who
received the same treatment but who did not undergo staging MRI, while classifying them by breast tissue density. Our
hypothesis is that outcomes will be improved in women with
preoperative MRI in denser breasts.
Methods: Breast biopsies from 2004 to 2009 are being reviewed, and two case-control groups are being built: patients
who underwent preoperative breast MRI (case) vs patients
which did not undergo preoperative breast MRI (control),
with stratification of breast density primarily determined by
mammography (dense vs non-dense breasts), with 5-years
follow up.
Main results: 1210 patients underwent preoperative MRI
staging and 1223 did not. Data analysis is currently ongoing.
Conclusion of the presentation: Preoperative MRI is an
important tool that can help improve surgical outcomes and
long-term survival, when used in select patient populations.
9 - Fetal Medicine
PD.09.001
Pulsatile umbilical vein in fetus with severe hypoxia
Authors: LANDIM B.D; SILVA G.S.B.V; PONARA S.J;
ZANFORLIN M.S;PIRES R.C
Institution: CETRUS, São Paulo, Sp, Brasil.
Author responsible: Jaqueline Sakie Ponara
of a primigravida diagnosed with preeclampsia, whose fetus
had high-growth restriction, severe oligohydramnios and persistent signs of hypotony.
Medical History: Patient S.L.N., 32 years old, primigravida,
attended the service with 24 weeks and 4 days. On examination, showed increased blood pressure (160x110 mmHg),
signs of restriction intrauterine growth, fetal weight 400g, absolute oligoamnios and signs of hypotonia. The Doppler study
revealed uterine arteries with bilateral protodiastolic notch,
pulsatility index above the 95th percentile and ophthalmic artery suggestive of severe preeclampsia. Umbilical artery with
reversed diastolic flow, ductus venosus with reverse wave A
, pulsatility index greater than 2, umbilical vein with clearly
pulsatile aspect in intra-abdominal segment. Ultrasound examination of control in a week showed fetal death.
Diagnosis: The pulsatile umbilical vein has been described
as signal Doppler predictor of prognosis ominous associated
with multiple fetal conditions such as twin-twin transfusion
syndrome, severe intrauterine growth restriction, congenital
cardiac lesions or cardiomyopathy by severe asphyxia.
Discussion and summary of the case: The Doppler study of
the umbilical vein is easy to evaluate and the pulsatile pattern
is a late marker of severe fetal tissue hypoxemia.
PD.09.002
Brainstem anomalies evaluation by fetal
MRI: pictorial essay.
Authors: OLIVEIRA, P.S.; CASAGRANDE, J.L.M.; ASSIS, C.R.; ABDALA, N.
Institution: Departamente de Diagnóstico por Imagem da
Universidade Federal de São Paulo/Escola Paulista de Medicina, São Paulo, SP, Brasil.
Author responsible: João Luiz Marin Casagrande
Introduction: The brainstem and the cerebellum have a
common embryonic origin, and different genes are responAbstracts of Scientific Papers
87
sible for the developmental events of each one of these strtuctures. Recently a new classification of the malformations
of the brainstem and cerebellum have been proposed, based
upon embryology and genetics. The objective of this study is
to show the imaging features of the brainstem malformations
diagnosed through Fetal MRI, and review the main genetic
and embryological events involved in the normal and abnormal development of the brainstem.
Methods Involved: We made a literature review of the normal and abnormal development of the brainstem and illustrate the most common conditions through cases diagnosed
in our Service.
Discussion: The accurate brainstem evaluation by ultrasound
is difficult. The fetal MRI, on the other hand, is a very important tool and enables the morphological evaluation of not only
the brainstem, but all the other cranial structures, making it
easier for the physicians to adequately diagnose and classify
the developmental abnormalities, which is essential for the
management and prognosis of the gestation.
Conclusion of the presentation: It is very important for the
radiologist to know the embryological development of the
brainstem so one can accurately diagnose the malformations
of these structures.
PD.09.003
Differential diagnoses in obstetric ultrasound of intracerebral cystic cavity.
Authors: Castro CR., Silva VSA., Castro CHR., Castro LR.,
Cardim VR., Castro CH.
Institution: bahia
Author responsible: Caroline Rodrigues Castro
Brief description of the purpose of the report: The objective consists of the possible differential diagnoses of brain
cystic disease in the fetus on ultrasound examination series.
Medical History: Pregnant women in the second quarter,
25, smoker, primigravida, held routine ultrasound examination, which was visualized the absence of the cerebral hemispheres, and these replaced by a cystic cavity. The brain stem,
cerebellum, and thalamus are apparently preserved.
Diagnosis: The main differential diagnoses include: hydrocephalus, alobar holoprosencephaly and brain atrophy. The
differential diagnosis with severe hydrocephalus is difficult
even after birth. The most important sign for the differentiation of diseases is the presence of the brainstem.
Discussion and summary of the case: Congenital malformations may have etiologies as the embriogenéticos processes
malformations, fetal circulatory encephalopathy and injuries
suffered during intrauterine life, such as smoking maternal
and congenital infections examples. The serial ultrasound
examinations are of great importance for early knowledge
of the pathology and the aftercare. However the test is not
entirely specific and necessary to pathologic evaluation to
confirm the diagnosis.
PD.10.001
O uso do SPECTCT em um Paciente com Suspeita de Embolia Pulmonar
Authors: VIANNA BSL, VERAS MF, CORREA NL, AZEVEDO JC, KER W, REZENDE MF, COTRADO AAC, SAN-
88
TOS TV, BARLETE AV, AGUIAR WKM, VOLSCHAN A,
MESQUITA CT
Janeiro, Brasil
Author responsible: Bernardo Sanches Lopes Vianna
perfusion scintigraphy is used for the diagnosis of pulmonary embolism. SPECT images increases the sensitivity for
detection of pulmonary embolism because there is a better
visualization of the segments medially design with highest
accuracy. The SPECT / CT can compare anatomical with
scintigraphic findings with negative predictive value of up to
97%. We describe of suspect pulmonary embolism.
Medical History: Women, 69 year old with dyspnea for
about 2 months and history of sarcoidosis. Pulmonary Function Test demonstrated moderate obstructive ventilatory disorder. SPECT inhaled images shows reduced uptake of the
radiotracer in the alveolar and vascular beds in both lungs,
mainly in the left one.
Diagnosis: SPECTCT shows volumetric reduction of the left
lung, vicarious right lung, reducing the vascular tree especially in the left lung, hilar lymphnode enlargement, calcified
bilaterally, especially on the left, that would justify the perfusion / ventilation changes. There was septal thickening interlobular, groundglass opacities and small nodular opacities
consistent with diffuse the pattern of Sarcoidosis, that ruled
out pulmonary embolism. The patient follow up in drug therapy improved breathing pattern.
Discussion and summary of the case: Nuclear medicine
has no good resolution of your images, while the CT ?s was
Using SPECT CT results in an exam with better diagnostic
quality.
PD.10.002
Gastrointestinal bleeding difficult diagnostic definition: SPECT / CT Application
Authors: VIANNA BSL, VERAS MF, CORREA NL, AZEVEDO JC, COTRADO AAC, REZENDE MF, AGUIAR
WKM, SANTOS TV, BARLETE AV, KER W, VOLSCHAN
A, MESQUITA CT
Janeiro, Brasil
Brief description of the purpose of the report: Scintigraphy with labeled red blood cells is a high accuracy technique
for grastrintestinal bleeding research, but without SPECT CT
it ?s difficult to locate the site of We report a case in wich
SPECT CT was crucial for surgical therapy.
Medical History: Female, 71 years old with melena, recurrent anemia since 2010, when endoscopy showed no active
bleeding colonoscopy and endoscopy (EDA) that showed
mild gastritis enanthematous. In 2012, presented a new
episode of gastrointestinal bleeding and EDA showed mild
bleeding in the third duodenal portion, requiring transfusion
of red blood cells. After this episode, there were two more
others and scintigraphy with labeled red blood cells findings
were negative. The patient was told to look for a nuclear medicine service when clinical signs of bleeding appears, wich
occured after one year.
Diagnosis: SPECTCT at the time was positive in the projection of the colon ?s splenic flexure; then, underwent
partial left colectomy, that angiodysplasia. In Follow up,
remains asymptomatic.
Discussion and summary of the case: Scintigraphy with
SPECT CT defined the anatomical location of the bleeding
source. It ?s that gastrointestinal bleeding is intermittent and persistent research allowed guided surgery by SPECTCT findings.
PD.10.004
Non-coronary perfusional findings in
myocardial perfusion scintigraphy
Authors: MONTEIRO, P.H.S.; HUBER, F.Z.T.; ALMEIDA,
A.W.C.; ALEXANDRE, L.M.; OLIVEIRA, M.A.C.; SMANIO, P.E.P.
Institution: Instituto Dante Pazzanese de Cardiologia, São
Author responsible: Paulo Henrique Silva Monteiro
Introduction: Myocardial Perfusion scintigraphy with 99mTc sestamibi(MPS) primarily evaluates coronary ischemic
disease. Our objective is to demonstrate several non-coronary
diseases with fixed and reversible perfusional defects, to describe the physiopathology involved by literature review, and
to present images and cases from our institution.
Methods Involved: We will present MPS images of non-coronary etiologies correlated with other imaging modalities, including sarcoidosis, hypertrophic cardiomyopathy(HCM), chagasic
cardiomyopathy(CCM), pacemaker, LBBB, valvulopathies,
myocardial bridge, myocarditis, dilated cardiomyopathy, noncompaction cardiomyopathy and congenital cardiomyopathies.
Discussion: The cases presented are exemples of differential diagnoses of non-coronary perfusion findings, relatively
frequent in specialized cardiologic services. Not recognizing
these conditions may lead to false-positive studies for coronariopathy and to unnecessary interventions and invasive
treatments. An important example is HCM, which may present typical findings of severe coronariopathy, emulating multivessel disease, with transmural ischemia, transient ischemic
dilation and a drop in ejection fraction. However, suspecting
HCM in MPS is important, for it causes sudden death. Another example is fibrosis from CCM which may be confused
with a prior ischemic event on a MPS requisitioned to investigate the etiology of dilated cardiomyopathy.
Conclusion of the presentation: Non-coronary findings in
MPS must always be remembered by the nuclear medicine
physician, demanding attentiveness to anamnesis and knowledge of differential diagnoses.
PD.10.005
Arm lymphatic flow variation following
sentinel lymph node biopsy in breast cancer
Authors: MORIGUCHI SM, SARRI AJ, VIEIRA RAC,
GONÇALVES MCP, ANDRADE CELC, TINOIS E, DIAS
DS, KOGA KH CAÇÃO PHM, FERREIRA VC, DIAS R
Institution: Faculdade de Medicina de Botucatu, UNESP Universidade Estadual Paulista, Botucatu, São Paulo Brasil
Author responsible: Sônia Marta Moriguchi
early variations in lymphatic circulation of the arm pre and
post-SLNB and whose relationship with age, time post surgery (TPS), body mass index (BMI), number of lymph nodes
removed (NLNR) and immediate oncoplastic surgery (IOS)
Methods: 15 patients who performed the LPS before and after the SLNB, total of 30 studies. LPS before and after the
SLNB of each patient were paired and compared to each other,
evaluating two variables: the site of lymph flow into the lymphatic vessels and the number of lymph nodes identified and
those were classified into decreased, sustained or increased
after pairing the images. Only two subgroups were formed
for statistical analysis purposes: patients with decreased (DG)
versus patients with sustained/increased (SIG). Mann-Whitney’s Test, Spearman’s Rho Correlation and Fisher’s Exact
Test. A 5% significance level was assumed for all analyses.
Main results: SIG=7, DG=8. Significant difference regarding
the lymph flow and lymphnodes visualized and TPS, Albeit
in an inverse relationship: the longer the period is, the smaller
the site of the lymphatic flow will be, indicating a gradual decrease of lymphatic flow post-SLNB (p=0.002, Rho=-0.623;
p=0.013 ). Three patients underwent IOS showed lymph flow
incresead (p=0.070).More patients are needed.
Conclusion of the presentation: Arm lymphatic flow gradually decreased after SLNB.
PD.10.006
Lymphoscintigraphy with SPECT / CT in the
investigation of the cause of chylothorax in children: Report of two cases
Authors: Ribeiro, M.P.; Mosci, C.; Grotta, M.B.; Lima,
M.C.L.; Amorim, B.J.; Santos A.O.; Souza, T.F.; Etchebehere
E.C.S.C.; Ramos, C.D.
Institution: Serviço de Medicina Nuclear do Departamento
de Radiologia da Faculdade de Ciências Médicas da Universidade Estadual de Campinas (UNICAMP), Campinas, São
Paulo, Brasil
Author responsible: Mariana Paixao Ribeiro
Brief description of the purpose of the report: Chylothorax is a rare condition characterized by the accumulation of
chylous in the pleural space with a significant morbimortality.
Lymphoscintigraphy is an alternative study to identify the origin of lymphatic leakage and the combined use with the single
photon emission tomography /computed tomography (SPECT/
CT) improves the sensitivity and gives a more precise location.
Medical History: We reported two cases of chylothorax in
children: 7 years-old girl and a 7 days-newborn boy, both with
extensive chylous pleural effusion, confirmed by the presence
of high levels of triglycerides. Both performed chest tomography that didn’t show any apparent cause. Lymphoscintigraphy of the lower limbs with 99mTc-dextran complemented
with SPECT/CT of the chest and abdomen was ordered and
the study confirmed radiotracer flow to the topography of the
thoracic duct bilaterally and uptake in the right pulmonary
hilum in the first and second patient, respectively.
Diagnosis: The lymphoscintigraphy with SPECT/CT not
only identified the locations of possible leakage of chylous,
but also helped to clarify the diagnosis: post trauma lesion after multiple vomiting episodes and congenital malformation
in the first and second case, respectively.
Discussion and summary of the case: Lymphoscintigraphy is a non-invasive study with low dose of radioactivity,
presenting an important role in the management of children
with chylothorax.
PD.10.007
Frequency of osteoporosis/osteopenia in
patients with spinocerebellar ataxia.
Authors: Farias, AMS; França Jr, MC; Appenzeller, S; Mosci, C.; Lima, M.C.L., Amorim, B.J.; Souza, T.F., Etchebehere
89
E.C.S.C; Ramos, C.D; Santos, AO;
Institution: Unicamp
Author responsible: Aline Maria Santos Farias
Brief description of the purpose of the study: The spinocerebellar ataxia is the most common form of autosomal dominant ataxia. Osteoporosis is characterized by decreased bone
mass. Some of the risk factors for osteoporosis as prolonged
immobility and low sun exposure are common in patients
with ataxia. They also have high frequency of falls, that associated with bone fragility, increases the risk of fractures.
The objective of this study was to evaluate the frequency of
osteopenia and osteoporosis in patients with ataxia to define
the importance of bone densitometry incorporation into the
management of these patients.
Methods: Twenty-three patients (13 women) with cerebellar
ataxia were submitted to bone densitometry.
Main results: The mean age was 50 years and mean disease
duration time was 12 years. Ten patients had normal spine
BMD (43.5%) (T-score ? -1.0), 6 (26,1%) showed osteopenia
(between -1.1 and -2.5) and 7 (30,4%), osteoporosis. In the
femur, 10 patients (43,5%) had normal BMD, 11 (47,8%) had
osteopenia and 2 (8,7%), osteoporosis.
Conclusion of the presentation: There was a high frequency
of osteoporosis/osteopenia in patients with cerebellar ataxia.
This shows the importance of performing bone densitometry
in these patients and select those with bone mass loss for early treatment in order to prevent fractures.
PD.10.009
Spontaneous intracranial hypotension:
SPECT-CT role in Mieloscintigraphy
Authors: Veras MF, Cotrado AYC, Vianna BSL, Rezende
MF, Santos TV, Barlete AV, Aguiar WK, Correa NL, Ker W,
Volschan A, Azevedo JC, Mesquita CT
Janeiro, Brasil
Author responsible: Mariana Ferreira Veras
Brief description of the purpose of the report: Spontaneous intracranial hipotension is a cause of persistent postural headache. Clinical presentation, measurement of cerebrospinal fluid pressure (CSF) and the radiological/scintygraphic
study determines diagnosis. We report a case of a patient with
spontaneous intracranial hipotension.
Medical History: Woman, 36yo, with migraine associated
with nausea, blurred vision, diplopia and vomiting worsened in
the standing position. Lumbar puncture showed a reduced pressure (4 mm H20), MRI showed enhancement by paramagnetic
agent in thoracic spine and posterior epidural CSF collection in
cervical and lumbosacral. Mielocintilografia with SPECT-CT
demonstrates radiotracer accumulation in L1 / L2, L4 / L5 and
L5 / S1, C6 / C7, suggestive of cervical and lumbosacral
Diagnosis: The syndrome has many migraine standards,
and many other possible symptoms associated. The associated clinical determination of low CSF opening pressure
(?60mmHg) and scintigraphic/radiological images show the
presence of meningeal diverticula, seals the diagnosis of this
rare syndrome.
Discussion and summary of the case: Mieloscintigraphy
with SPECT-CT is a powerful tool in the diagnosis and precisely locates the cerebrospinal fluid leakage allowing the
definition of the therapeutic strategy safely. The association
of the findings can be nonspecific, so mielocintilografia is
crucial in the diagnosis.
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TL.10.001
Desempenho do SPECT/CT na Cintilografia
de Leucócitos Marcados com 99mTc-Besilesomab.
Authors: VIANNA B.S.L., ALVES J.G., CORREA N.L.,
AZEVEDO J.C., COTRADO A.A.C., REZENDE M.F.,
BARLETE A.V., SANTOS T.V., VERAS M.F., AGUIAR
W.K.M., KER W., MESQUITA C.T.
Janeiro, Brasil
evaluated the effect of the of imaging on 99mTc-Besilesomab-labeled leukocyte scintigraphy.
Methods: Labeled leukocyte scans of 47 patients performed
between 15 months were reviewed. The technique used was:
whole body and SPECT / CT 3-6 hours after injection. Clinical
finding, Scintigraphic images and follow-up were analysed.
Main results: The mean age was 65.4 ± 19 years and 58.4%
were women. Clinical indications were: 14 patients of fever
of unknown origin, 13 with suspected osteomyelitis, 6 with
abdominal conditions, 4 with unkown origin for sepsis, 3
with suspected prostatitis, 3 with suspected encephalitis, 2
with suspected endocarditis and 2 with suspected mediastinitis. Scintigraphic findings were positive in 49% of cases.
Of the 23 patients who tested positive for infectious focus 14
cases, were in use of antibiotics at the time of scintigraphy.
There were 8 surgeries guided by scintigraphy findings.There
was a change in medical management of 29 of 49 patients
after performing scintigraphy.
Conclusion of the presentation: Conclusions: Hybrid SPECT/
CT 99mTc-Besilesomab-labeled leukocyte scintigraphy is very
useful in patients with suspected infection. In spite of the use of
antibiotics we observed a good diagnostic accuracy.
TL.10.002
The importance of doing three diferent
sites assessment for the osteoporosis
evaluation and diagnosis.
Authors: Santana João AM, Santana Sara MM, Leal Ângela
CGB, Barbosa Rita AA e Doria LS.
Institution: Serviço de Densitometria Clínica da Climedi. Av. Barão de Maruim, 570. Aracaju-Se. Brasil. Email:
[email protected]
Author responsible: João Antonio Macedo Santana
Brief description of the purpose of the study: A retrospective review of 705 females patients that performed the bone
density measurements not only in the two standard lumbar
spine and femoral sites recommended by WHO, IOF and
ISCD, but, including also, the forearm site in the evaluation
and diagnosis of osteoporosis.
Methods: The tests were performed on equipment Hologic
Discovery W and GE Prodigy showing proper readings for
the mentioned sites. 646 patients over 50 years of age were
selected and the prevalence of osteoporosis according to age
group was also determined.
Main results: RESULTS: 26% normal, 40% to 34% with
osteopenia and osteoporosis. Of the 34% with osteoporosis,
the results show that the addition of the forearm region determines an increase of more than 9% for the diagnosis of osteoporosis, meaning that of 100 patients nine would not be diag-
nosed. The prevalence of osteoporosis in aged 50 to 59 years
was 21%, from 60 to 69 years 33% and 70 years on 55%.
Conclusion of the presentation: Conclusions: This study
leads to the conclusion by the importance of the inclusion of
the forearm in the evaluation and diagnosis of patients with
suspicion and diagnosis of osteoporosis and that the prevalence of osteoporosis occurs with increasing age, according
to data from literature.
TL.10.004
How to plan a Nuclear Medicine facility
under the legal aspects in Brazil ?
Authors: KUBO, TTA; BARBIRATO, GB; KER, W;
REZENDE, MF; COSTA, MNA; SILVA, MAM; AZEVEDO, FSR; SILVA, FR; ARELYS ,A; SANTOS, MVJ; MESQUITA, CT
Institution: HOSPITAL DAS AMERICAS, RIO DE JANEIRO, RIO DE JANEIRO, BRASIL
Author responsible: Tadeu Takao Almodovar Kubo
Brief description of the purpose of the Review of Literature: In 2014, ANS approved new clinical indications which
provides an increase in demand for exams and thus the emergence of new nuclear medicine services (NMS). The aim of
this study is to guide the work teams to elaborate a NMS.
The documents of the Brazilian National Commission of Nuclear Energy (CNEN), Board Resolution (RDC) and international publications to define steps and functions of working
teams in the NMS project.
Conclusion: The teams were divided into architecture, nuclear medicine physicians and medical physics, to obtain the
authorization documentation for construction and operation.
Critical steps: number of patients, location of rooms, patient
flow and shielding calculation for hybrid equipment were
analyzed in a multidisciplinary way. The average time for
NMS preparation was 50 hours. The difficulties in this project were: structural layout, patient flow and receipt of NM
equipments and radioactive sources.
Brief discussion of the case The strategic planning for the
NMS ally to areas that belongs to a different regulators, promotes an adequate and effective operational flow to obtain
the approval of all necessary licenses. The feasibility of conducting this process online and easy access to the facility
manager were key to a fast conclusion.
PA.11.005
Osteoclastoma: Unusual Sites
Authors: BRANT R M C; MARRETTO R A S; PHILIP
D.R.S. ; SERNIK R A; FERREIRA D L; YAMASHITA R. S.
Institution: Hospital Bandeirantes, sao paulo sp Brasil
Author responsible: Ronaldo Brant
Brief description of the purpose of the report: Brief description of the purpose of the report: Case report of osteoclastoma, describing some unusual disease sites and
comparing picture radiological aspects (radiography and
computed tomography).
Medical History: Patient B.C.B. 31, female with chronic renal failure presenting osteoclastomas in unusual places
Diagnosis: Discussion summary of the case: report a case
of osteoclastoma, placing emphasis on unusual sites along
with a brief review of the literature. The osteclastoma or
brown tumor is a benign bone lesion secondary to primary
or secondary hyperparathyroidism. The secondary form is a
common complication of chronic renal failure (CRF), mainly
affecting the hands, feet, skull, jaw and cheekbone and rarely
other skeletal sites. It is expressed through a solitary lesion,
lithic, expansive and can extend for extra adjacent bone tissue. Your diagnosis is clinical radiological and its treatment
is accomplished by correction of hyperparathyroidism, which
can result in tumor regression.
Discussion and summary of the case: Radiological examinations are important for diagnostic investigation, preventing the patient from invasive investigations of this non-neoplastic lytic lesion.
PA.11.017
Osteopoikilosis as an incidental finding
in a patient with a diagnosis of immature
ovarian tumor with peritoneal carcinomatosis : Case report
Authors: FALONE, VBG; BATISTA, MG; MOTA, MMS;
PAULA JR, CRV; SANTOS, EF; PALMEIRA NETO, JS;
PEREIRA, CFF; SOUZA, SWD; ABREU, AM; RIZZUTO, MS
Institution: Hospital Santa Marcelina, São Paulo, São Paulo,
Brasil
Author responsible: Virgínia Batista Gusmão Falone
case of osteopoikilosis diagnosed by computed tomography
as a differential diagnosis of metastasis.
Medical History: Female patient , 21 years old, in research
of a pelvic mass . She was underwent to a bilateral oophorectomy and omental biopsy , which the histopathological report
evidenced immature tumor at both ovaries. She underwent
chemotherapy and is currently up in palliative care . One year
later, the patient was hospitalized for intestinal obstruction
and was submitted to chest X-ray and abdominal, pelvic and
chest C.T. where it was found additional multiple osteoblastic
lesions on pelvic bones , glenohumeral joint and hips, raising
the suspicion of secondary proceedings
Diagnosis: After analysing images, it was concluded that the
injuries were consistent with osteopoikilosis. Osteopoikilosis
is a rare bone injurie, hereditary, autossomic dominant asymptomatic, characterized radiologically by multiple round
or oval radiopaque images of diferent sizes and are more
common in periarticular regions. The differential diagnosis
must be done mainly with osteoblastic metastases
Discussion and summary of the case: The osteopoikilosis
is usually an incidental finding on imaging studies. There is
not any clinical importance , but can be confused with diffuse
osteoblastic metastases . For this reason, it should always be
considered in the differential diagnosis to avoid iatrogenic.
PA.11.019
The importance of radiological findings
in diagnosis of Langerhans cells histiocytosis (LCH): a case report.
Authors: CHOJNIAK, R; MELO, RAB; CARVALHO, SC;
FERNANDES, ACO
Institution: AC Camargo, São Paulo, Brasil
Author responsible: Rayssa Araruna Bezerra de Melo
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Brief description of the purpose of the report: The radiological findings of LCH, a rare disease with incidence of 5:
1000000, are essential for its diagnosis. The \’\’flat vertebra\’\’ is specific for the diagnosis. We’ll discuss the clinical
and radiological spectrum of this entity.
Medical History: Patient, male, 11 years old, from Cubatão-SP, presented pain in the right arm a month ago, x-ray
showed osteolytic lesion, areas of cortical disruption and thinning, lamellar periosteal reaction in the proximal humerus. It
was identified lesions in the right acetabulum and flat thoracic
vertebra, with intense uptake in bone scintigraphy.
Diagnosis: HCL has three presentations, all part of the same
pathological substrate of granulomatous proliferation of reticular cells. Eosinophilic granuloma (EG), the most characteristic form, is a rare disease of unknown etiology, affecting
mainly male children, it affects bones of the skull, pelvis,
vertebrae and long bones. In the spine, vertebral collapse, the
\’flat vertebra’\’ is characteristic of the disease. Bone lesions
may be unilateral or multifocal, lytic, with continuous or discontinuous periosteal reaction.
Discussion and summary of the case: EG is among the differential diagnosis of lytic lesions. Additional bone findings,
such as flat vertebra are fundamental for the diagnosis, so it
should be recognized by the radiologist.
PA.11.020
Radiological results in skeletal complications of sickle cell anemia
Authors: BRITO, M.L.C.B.; BORGES, L.C.; DIAS, E.N.;
COSTA, R.S.; SOUSA, M.M.
Brief description of the purpose of the Review of Literature: This review is about the radiologic results of skeletal
complications on sickle cell anemia (SCA), especially those
found in the spine.
The SCA skeletal complications include lifelong preservation
and expansion of red bone marrow, bone infarction and osteomyelitis.
Conclusion: The majority of red bone marrow presents itself
to magnetic resonance imaging (MRI) as a diffuse osseous
medullary hypointense signal on T1-weighted sequences,
where one would expect a hypersignal from fatty tissue. In
the spine, bone infarction areas can achieve the central portions of the vertebral plateaus with subsequent adjacent portions of overgrowth. This entails a characteristic deformity of
affected vertebral bodies (\”H- vertebrae\”), with central depression of plateaus, which is easily identified on simple radiography. However MRI has greater sensitivity, being able to
identify abnormalities within few days after ischaemic event.
Imaging methods alone still does not allow reliable and accurate differentiation between infarction and ostheothemyelitis,
however they are essential in monitoring this complication.
Brief discussion of the case The diagnostic imaging methods are important particularly in the evaluation of frequent
skeletal complications of SCA. The simple radiography
shows advanced complications; on the other hand MRI has
great value in early detection of this complications, and also
contribute to monitoring and follow-up of infections.
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PD.11.001
Avulsion fractures in adolescents. What
the radiologist needs to know.
Authors: REBECHI F; DADALTO, R.V; REBECHI G;
STEINWANDTER, R.
Institution: HOSPITAL DO SERVIDOR PÚBLICO ESTADUAL - SÃO PAULO - SÃO PAULO - BRASIL
Author responsible: Fernando Rebechi
Introduction: Fraturas por avulsão são comuns entre os participantes de esportes, especialmente entre os adolescentes.
Os recursos de imagem são úteis para avaliar lesões agudas
e crônicas das principais localizações acometidas e também
para ajudar a diferenciar essas lesões de processos de doenças
mais graves, como neoplasias e infecções.
Methods Involved: Evaluation studies (RX, CT and MRI)
of adolescents with a history of injury after sports practice.
Discussion: Avulsion fractures acute may be associated with
bone fragments, while subacute lesions can have an aggressive appearance with areas of lysis and sclerosis. Chronic
lesions i.e., those resulting from repetitive micro trauma or
excessive use may be associated with a mass and may be likened to a neoplastic or infectious process.
Conclusion of the presentation: It is very important for
radiologists be aware of the main places of avulsion fractures and know how to differentiate them from other aggressive processes.
PD.11.002
Bone imaging and joint complications of
solitary osteochondroma and in the hereditary multiple exostosis
Authors: CUNHA JR., A.L.C.; COTTA, A.C.S.; MELLO,
C.M.; NAVARRO, M.M.N.;
Institution: Rede SARAH de Hospitais de Reabilitação –
Belo Horizonte – Minas Gerais. Brasil.
Author responsible: Antonio Lopes Cunha Jr
the contribution of imaging for the evaluation of osteochondromas and to compare the complication’s frequency of solitary osteochondroma (SO) and hereditary multiple exostosis
(HME).
Methods: It’s an observational study of a historical cohort
of patients with osteochondromas evaluated by plain radiographs, computed tomography (CT), magnetic resonance
imaging (MRI) and histology analysis when lesions were
surgically removed.
Main results: There were 67 patients with osteochondromas
in the sample, 56 with HME (84%) and 11 with SO (16%). In
the MES, there was impaired growth (13%); occurred malignancy (4%); and the following deformities were found: bowing of the forearms (42%); genuvalgus (28%) and caxavalga
(19%); tibiofibular deformity (86%); radioulnar shortening
(64%), compression (21%), fusion (3%) and dislocation
(13%) of radius and ulna; tibiofibular compression (74%)
and tibiofibular fusion (23%) . There was SO in the knees
(64%), in the ankles (18%) and in the forearms (18%); and its
complications were tibiofibular compression (50%) and bowing of forearms (100%); there was no impairment of growth
(short stature), malignancy or other deformities.
Conclusion of the presentation: If an osteochondroma is diagnosed, it should be checked whether the lesion is solitary
or multiple, which have prognostic and therapeutic implications. There was a greater number of deformities and malignancy in HME.
PD.11.003
The role of MRI on diagnosing post-sternotomy injuries of the brachial plexus
Authors: CONCATTO, NH; ALVES, GRT; HOCHHEGGER, B; MARCHIORI, E; LANGER, FW; MCCANN, C;
HARRINGTON, D; IRION, KL.
Institution: Liverpool Heart and Chest Hospital, Liverpool
- England.
Author responsible: Natália Henz Concatto
Brief description of the purpose of the report: Brachial
plexus injuries (BPI) are potential complications of cardiac
surgery, especially in those who have undergone sternotomy.
Magnetic resonance imaging (MRI) is the modality of choice
for diagnosis.
Medical History: A 56-year-old man started, 6 weeks after
cardiac surgery, with numbness in the ulnar distribution of
his left hand and reduced power for extending his fourth and
fifth left fingers. Moreover, he showed reduced sensation in
the distribution of C8 territory. MRI revealed the presence of
a hyperintense signal in T2-weighted sequence, affecting the
left C8 root.
Diagnosis: The brachial plexus is a crucial structure that provides most of the upper limbs sensitive and motor functions.
Various mechanisms are involved with the pathogenesis of
post-operative symptoms or signs. Symptoms may pass undetected, with mild sensory dysfunction and asymmetrical
upper limb weakness, or may be more obvious, making diagnosis. MRI may demonstrate the site and the extent of the
brachial plexus lesion, and also predisposing factors.
Discussion and summary of the case: Although the symptoms resulting from minor injuries tend to decline, other consequences may be permanent. Treatment of BPI consists mainly of rehabilitation measures and/or reconstructive surgery.
However, more effort should be taken for primary prevention.
PD.11.004
Spectrum of Bone Manifestations of Hematologic Diseases - Iconographic Essay
Authors: LINS, CF; LOPES, AKBF; SANTOS WGD
Institution: CLÍNICA DELFIN IMAGEM, SALVADOR,
BAHIA, BRASIL/ INSTITUTO DE MEDICINA INTEGRAL PROFESSOR FERNANDO FIGUEIRA (IMIP),
RECIFE, PERNAMBUCO, BRASIL/ ESCOLA BAHIANA
DE MEDICINA E SAÚDE PÚBLICA, SALVADOR, BAHIA, BRASIL
Author responsible: Carolina Freitas Lins
Introduction: Hematologic diseases can be divided into
three major groups: anemia, coagulation disorders and proliferative / infiltrative diseases. These diseases may manifest
themselves simulating primary joint diseases, later leading to
extensive and articular changes in structures osteocartilaginous. This paper aims to demonstrate the spectrum of musculoskeletal manifestations / complications of blood disorders,
using radiography, computed tomography (CT) and magnetic
resonance imaging (MRI).
Methods Involved: The selected cases were obtained in the
image file of our Service, involving sickle cell anemia, he-
mophilia, multiple myeloma, lymphoma, myelodysplastic
disease and idiopathic thrombocytopenic purpura.
Discussion: There are significant associations between blood
disorders and musculoskeletal involvement. Pathognomonic
patterns of joint involvement of hemophilia, as well as differentiation between osteomyelitis and bone infarction in
sickle cell anemia are some highlighted topics. In addition,
description of bone involvement in multiple myeloma and
myelodysplastic disease are other issues approached in this
study. Thus, the understanding of many hematologic diseases
requires understanding of articular pathology, which may be
the principal place of morbidity.
Conclusion of the presentation: Thus, the didactic and educational value of this job is the identification of the main
imaging findings in diagnosis and detection of osteo-articular
complications / involvement of hematologic diseases through
different imaging methods (X-ray, CT and MRI).
PD.11.005
Eosinophilic fasciitis (Shulman syndrome) - Case Report
Authors: LINS, CF; TRINDADE, RMC; LOPES, AKBF;
SANTOS, WGD
BAHIA, BRASIL/ INSTITUTO DE MEDICINA INTEGRAL PROFESSOR FERNANDO FIGUEIRA (IMIP),
RECIFE, PERNAMBUCO, BRASIL/ ESCOLA BAHIANA
DE MEDICINA E SAÚDE PÚBLICA, SALVADOR, BAHIA, BRASIL
Brief description of the purpose of the report: Eosinophilic fasciitis (EF) or Shulman\’s syndrome is a rare inflammatory disease of unknown etiology, affecting the deep fascia. It
is generally associated with peripheral eosinophilia, hypergammaglobulinemia and high erythrocyte sedimentation rate. It
usually involves the lower limbs. The aim of this study is to
describe a case of FE, reporting the main clinical findings and
correlation with magnetic resonance imaging (MRI).
Medical History: Man 66 years, complaining of swelling
and stiffness joints and pain in muscles of the upper and lower
members of right-side for approximately 8 months. First MRI
showed swelling and thickening of fascial planes diffusely in
the right leg, without data laboratory tests. Six months later,
a second MRI of right-side forearm and thigh showed similar
findings, but associated with peripheral eosinophilia (782 /
microl). Deep muscle biopsy of thigh showed findings suggesting FE.
Diagnosis: Few studies approach MRI findings for FE, however, they show the usefulness of this method in imaginologic
diagnosis of FE. Key features include fascial thickening with
high signal intensity on T1 and T2, associated with post-contrast enhancement of the fascia, especially the superficial one.
Discussion and summary of the case: Thus, FE generally
has good prognosis, highlighting the importance of MRI in
diagnosis, biopsy site selection and evaluation of therapeutic response.
PD.11.006
Imaging Manifestations of Neurofibromatosis - Magnetic Resonance Imaging
Approach
Authors: LINS, CF; LOPES, AKBF; SANTOS WGD
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BAHIA, BRASIL/ INSTITUTO DE MEDICINA INTEGRAL PROFESSOR FERNANDO FIGUEIRA (IMIP), RECIFE, PERNAMBUCO, BRASIL/ ESCOLA BAHIANA DE
MEDICINA E SAÚDE PÚBLICA, SALVADOR, BAHIA,
BRASIL
Introduction: Neurofibromatosis is an autosomal dominant
disease that can affect almost any organ or system. Can be
divided into: type 1 (characterized by the presence of numerous neurofibromas, multiple café-au-lait spots, freckles in axillary region and Lisch nodules) and type 2 (whose diagnosis
is based on presence of benign tumors in the auditory nerve,
tumors of cranial nerves and spinal roots, and cutaneous
manifestations, these less frequent than in neurofibromatosis
1). This paper aims to demonstrate the spectrum of the main
imaging findings in neurofibromatosis types 1 and 2, using
magnetic resonance imaging (MRI).
image file of our Service, showing MRI dural ectasia cases,
bone dysplasia, meningocele, plexiform neurofibromas in
various locations and bilateral schwannomas of acoustic.
Discussion: Affected patients should be monitored regularly,
due to variation in clinical expression of the disease, the risk
for developing cancer, with consequent unpredictable evolution. Thus, imaging methods play an important role in the
control and management of these individuals.
Conclusion of the presentation: Thus, we can see the didactic and educational value of this test, enabling the identification of the main MRI findings in the diagnosis of neurofibromatosis and differentiation of their types.
PD.11.007
Peroneal-cuboid syndrome: case series
and review the literature in an unusual
pathology
Authors: Duarte, M.L.; Silva A.Q.P.; Mallmann, R.; Alvarenga, S.B.; Prado, J.L.M.A.; Scoppetta, L.C.D.
Institution: Hospital São Camilo, São Paulo, São
Paulo, Brasil
Author responsible: Márcio Luís Duarte
Brief description of the purpose of the Review of Literature: Made review of the most relevant studies of this very
rare disease.
Ankle tendons can change direction around bony prominences, who occasionally act as pulleys and are subject to friction and mechanical stress. Morrison et al. postulate that the
edema occurs in adjacent friction places the tendon sheaths
hyperemia, with evident between the cuboid bone and the
peroneus longus tendon. Also found that the swelling patterns
of bone marrow subtendinous are present in a high proportion
of patients with chronic pain in ankle.
Conclusion: Edema and erosion of the cuboid bone simulating a bone injury (\”pseudotumor\” cuboid) may be caused
by adjacent peroneus longus tendinopathy. It is essential to
be aware of this entity to avoid unnecessary biopsy. Made
review of the most relevant studies according to the AJR,
Skeletal and Radiology using keywords peroneal-cuboid syndrome and magnetic resonance imaging.
Brief discussion of the case Patients with chronic ankle
pain must undergo magnetic resonance imaging. The swelling of the cuboid bone marrow, although uncommon, is to be
94
searched, then, may be a marker for the location of symptoms,
and therefore the peroneus longus tendinopathy, easy to resolve pathology, however, often presenting delay in diagnosis.
PD.11.008
Knee intraarticular nodular fasciitis: A
diagnosis that requires a multidisciplinary team
Authors: Duarte, ML; Nóbrega RR, Alvarenga SB; Prado
JLMA; Scoppetta LCD.
Institution: Hospital São Camilo, São Paulo, São Paulo,
Brasil
rare form of nodular fasciitis, being reported just 14 intra -articular knee cases.
Medical History: Boy with three years of life, referring
\”lump\” in the left knee which increases size for the last two
years. Denies pain and functional limitation . Denies Allergies and Other pathologies. Healthy parents.
Diagnosis: The magnetic resonance imaging showed a nodular mass lesion, intra-articular, well defined, with sign near to
cartilage in all as sequences, with a slight contrast enhancement. The anatomopathological study reported up dense
hyaline connective tissue with extensive areas of myxoid
degeneration without atypia. After a joint assessment of the
radiological study with histological, concluded the diagnosis
of intra-articular nodular fasciitis of the knee. Intra-articular
lesions have morphological characteristics similar to other
cases of nodular fasciitis, with the safeguard that stromal hyalinization and deposition of hemosiderin adjacent are common, probably due to the friction or trauma at this location.
Myxoid matrix is already seen in early stages of injury.
Discussion and summary of the case: Patients with mechanical limitation of knee extension and a mass lesion inside the knee joint after the completion of MRI should have
a wide possibility of differential diagnoses, including intraarticular nodular fasciitis.
PD.11.010
Linfranc pediatric fracture: a literature review with two illustrative cases of
a commonly overlooked diagnosis
Authors: Duarte, M.L.; Campozana NS, Silva AQP, Johnsson J, Reis LM, Barreto LE, Prado JLMA, Scoppetta LCD.
Paulo, Brasil
Brief description of the purpose of the Review of Literature: Made review of the most relevant studies according to
the AJR and Pediatrics of an commonly overlooked fracture.
Radiographs in PA, lateral and oblique views have some specific standards, but may be inconclusive. When radiography
does not detect the fracture, the computed tomography (CT
scan) demonstrated to be an effective method for diagnosis.
Made review of the most relevant studies according to the
AJR and Pediatrics using the keywords \”bunk bed fracture\”
and pediatric Linsfranc fracture.
Conclusion: The bunk bed fracture is the pediatric equivalent of adult Lisfranc tarsal-metatarsal dislocation fracture.
Patients with this type of injury typically lame and walks
supporting the outside of the foot, with mild swelling and
bruising associated tissues. It is a common pediatric fracture
and that is often not remembered. Falls are the most common
mechanism of injury, followed by jumps.
Brief discussion of the case In suspected cases of pediatric
Lisfranc fracture, if radiography is inconclusive, as commonly, CT scan should be performed. However, the suspicion of
the attending physician must be reported in the medical application, already in radiography, guiding the patient positioning and evaluation of images for proper fracture diagnosis.
PD.11.012
Fabela Syndrome: Literature review
with illustrative case of bilateral involvement.
Authors: Duarte, M.L.; Silva A.Q.P.; Prado, J.L.M.A.; Scoppetta, L.C.D.
Institution: Hospital São Camilo, São Paulo, São Paulo,
Brasil
Brief description of the purpose of the report: Report the
diagnosis of a rare syndrome, especially when bilateral.
Medical History: Woman with 63 years old, referring chronic pain in both knees. Physical examination with pain from
physical tests.
Diagnosis: Magnetic resonance imaging (MRI) of the knees
showed bilateral fabella syndrome. Fabella is a small sesamoid bone located in the posterolateral aspect of the knee,
the proximal portion of the lateral gastrocnemius tendon, articulating with the lateral femoral condyle. The fabella syndrome is recognized by a sharp pain and tenderness, stepped
in fabella region with full knee extension. Ultrasound may
provide valuable information regarding knee posterolateral
structures including the presence of fabella and can perform
the injection of anesthetic for surgery. Knee X-ray imaging
and MRI are able to reveal the position of fabella to the lateral femoral condyle.
Discussion and summary of the case: The incidence of
fabela is highly variable in the population, although it is
more common in people who practice or practiced sports.
When present, the posterior aspect of the lateral femoral
condyle should be carefully evaluated, especially when the
patient\’s complaint is that topography. The presence of
edema and osteochondral lesions at this location features
the fabela syndrome.
PD.11.014
Chondroma of Hoffa\’s Fat Pad - Case Report and Image Correlation Methods
Authors: LINS, CF; LOPES, AKBF; PEIXOTO, MCG;
SANTOS WGD
BRASIL
Brief description of the purpose of the report: Hoffa’s fat
pad is an intra-articular structure and extra-synovial in the an-
terior knee compartment, with unusual cartilage / bone nodular lesions inside. The intracapsular chondroma is considered
by some authors as end-stage of Hoffa\’s disease, usually
resulting from acute trauma / repetitive microtrauma, with
subsequent chondroid metaplasia / endochondral ossification
of Hoffa’s fat pad. The aim of this job is to describe a case
of chondroma of Hoffa’s fat pad, reporting the main clinical findings and correlation with chest radiography (Rx) and
magnetic resonance imaging (MRI).
Medical History: Female patient, 75 years, with pain in the
anterior aspect of the left knee for six years, associated with
mild restriction of range of motion, without evidence of trauma. He denied previous surgical interventions. Physical examination revealed painful compression of the infrapatellar
region, with flexion-extension restriction.
Diagnosis: The radiographic diagnosis only occurs later,
after ossification. MRI allows the evaluation of inflammatory changes in the acute and chronic edema / hemorrhage
(acute phase); fibrocicatricial tissue, areas of chondroid
transformation and endochondral ossification (chronic
phase). At all stages can occur contrast uptake, resulting
from inflammation.
Discussion and summary of the case: Thus, we emphasize
knowledge importance of chondroma of Hoffa\’s fat pad,
allowing early diagnosis, appropriate therapeutic conduct,
avoiding unnecessary morbidity.
PD.11.015
Musculoskeletal involvement and Staging in Gout – From Radiography to Magnetic Resonance Imaging
Authors: LINS, CF; LOPES, AKBF; PEIXOTO, MCG;
SANTOS WGD
BRASIL
Introduction: Gout is a metabolic disease classically presents with acute arthritis (often monoarticular); intercritical
period and chronic tophaceous gout. After several bouts of
acute arthritis, some patients may develop chronic synovitis and polyartropathy that can be confused with rheumatoid
arthritis. This paper aims to demonstrate the main musculoskeletal involvement imaging findings in gout, using radiography, computed tomography (CT) and magnetic resonance
imaging (MRI).
image file of our Service, showing joint, synovial, bursal and
subcutaneous tissue involvement at gout in various segments
of the body and using various imaging modalities.
Discussion: In the acute phase of gout, the diagnosis is usually clinical, with laboratory and imaging methods considered
unnecessary. However, in the chronic form, imaging methods
play a key role in the staging of osteochondral and involvement of soft tissues in the evaluation of effusion / synovial
proliferation and commitment of muscles and ligaments.
Conclusion of the presentation: Thus, we can see the didactic and educational value of this job, enabling the identification of the main imaging findings on the involvement and
staging of gout arthropathy by different methods (X-ray, CT
and MRI).
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PD.11.017
Interosseous posterior branch neuropathy associated with lipomatous lesion:
Case report with clinical, functional,
radiologic and anatomopathological
correlation
Authors: Aita, A. A; Carvalho,F.G.A;Torres, K.B;Monteiro, A.
Institution: Hospital Sarah Kubistchek, Brasília, Distrito
Federal, Brasil
Author responsible: Alessandro Amorim Aita
Brief description of the purpose of the report: The posterior interosseous branch or deep branch of radial nerve emerges in the elbow plane, courses between the superficial and
deep portions of the supinator muscle, deeply in the arcade
Frohse. It represents an usual site of various etiologies of
compressive neuropathy.
Medical History: 55 years-old patient , with pain in the right
forearm .Physical examination showed inability to active
wrist extension and IV/V fingers, with a fibroelastic tumor in
the posterolateral compartiment of the forearm. Electroneuromiography showed reduced motor amplitude of the radial
nerve. MRI demonstrated lipomatous lesion with discret uptake in the muscle plans between the supinator and ulnar extensor carpal and signs of desnervation in the digital extensor.
Diagnosis: Histopathologic diagnostic was lipomatous tumor with pseudocapsule without signs of malignancy. The
interosseous nerve courses between the superficial and deep
portions of supinator muscle and it is the motor branch of the
radial nerve.
Discussion and summary of the case: It is important to recongnize the signs of desnervation in the territory of the deep
branch of the radial nerve with neuropathy of the posterior
interosseous, allowing the topographic diagnostic, and the
etiologic diagnosis with clinical, functional, radiologic and
anatompathological correlation
PD.11.019
Dual-energy
computed
tomography
(DECT) assessing bone marrow edema
Authors: DAMASCENO R.S.; BIZETTO E.B.; CORREA
M.F.P.; AMARAL D.T.; CAVALCANTI C.F.A.; BORDALO-RODRIGUES M.; LEITTE C.C.; CERRI G.G.
Paulo, Brasil
Author responsible: Rodrigo Sanford Damasceno
Introduction: DECT allows the evaluation of the chemical
composition of structures according to its differential x-ray
attenuation at two different energy levels. That said, the main
objective of this study is to present and illustrate the feasibility of DECT in identifying bone marrow edema in patients
with a trauma context.
Methods Involved: Using imaging from cases of ours institution data base, we will demonstrate the applicability of
DECT as a valid tool to assess bone marrow edema in patients with a history of trauma.
Discussion: Using imaging from cases of ours institution
data base, we will demonstrate the applicability of DECT as
a valid tool to assess bone marrow edema in patients with a
history of trauma.
Conclusion of the presentation: Assessing bone marrow
edema in DECT emerges as a powerful additional tool to
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identity other subtle findings in patients within a trauma context that could pass otherwise unnoticed in conventional CT
scans. That said, it is mostly important that all the radiologists
are aware of such method, especially those with particular
interest in musculoskeletal radiology.
PD.11.020
Solid Variant of Aneurysmal Bone Cyst:
Case Report
Authors: DIAS, G.M.; CUPOLILO, E.N.; DELGADO, N.J.;
BRESSAN, C.A.V.; GOMES, B.M.
Institution: UFJF, JUIZ DE FORA, MG, BRASIL
Author responsible: Guilherme Moreira Dias
case of solid variant of aneurysmal bone cyst (ABC), a rare
tumor accounting for 5% to 7,5% of all aneurysmal bone
cysts. Although it is a benign disorder, their appearance can
simulate malignant lesions, making your definitive diagnosis
important in order to elect the appropriate therapy.
Medical History: An 30 years old female presented with a
history of pain in the left knee a year ago, associated with
increased volume in the region and claudication. She was
subject to radiography, computed tomography (CT) and magnetic resonance imaging (MRI) for investigation.
Diagnosis: It was identified medullary osteolitic lesion with
soft tissue density, without calcified matrix, excentric in the
distal femoral metaphysis, destroying the cortical bone and
invading adjacent soft tissues with aggressive aspect. Biopsy identified spindle cells without atypia permeated by blood
gaps, compatible with solid variant of ABC.
Discussion and summary of the case: Expansive lytic bone
lesions, eccentric, well-defined, with thin sclerotic margins
and liquid-liquid levels at MRI affecting long bone metaphysis in patients up to the age of twenty years, are quite suggestive of COA. But in the solid variant of ABC these features
are not seen, making its diagnosis more challenging. The
main differential diagnoses include teleangiectasic osteosarcoma, condroblastoma and giant cell tumor.
PD.11.022
Unusual tarsal coalitions: pictorial essay
Authors: LEITE MCNA; JESUS CLM; CASTRO FD; ;
GAIOTTI JO; BELUSSO L; GUIDORIZZI HP
Institution: DASA - Delboni Auriemo, São Paulo, São Paulo, Brasil
Author responsible: Maíra C N A Leite
Introduction: Tarsal coalition is an important cause of feet
pain specially in young patients (prevalence up to 2%). The
aim of this paper is to present magnetic resonance imaging
(MRI) and computed tomography (CT) images, illustrating
cases of coalitions less frequently found in the population.
Methods Involved: MRI and CT images performed at our institution of patients with unusual tarsal coalitions were selected.
Discussion: Tarsal coalition is a congenital disease in which
there is an abnormal fusion (bone, cartilage or fibrous tissue) between two or more bones. The most frequent fusions
are talocalcaneal and calcaneonavicular, but there are reports
in classic papers of other rarer types, involving: the subtalar posterior facet, the cuboid and navicular bones, talus and
navicular, navicular and cuneiform, calcaneus and cuboid,
between the tarsal bones and metatarsals etc. Treatment in-
volves use of painkillers and non hormonal anti-inflammatories, or/and even surgery (resection of the coalition).
Conclusion of the presentation: Tarsal coalitions are commonly identified on imaging studies. The radiologist must
be familiar with less frequent coalition sites and the imaging
findings to make an accurate diagnosis.
PD.11.024
PICTORIAL ESSAY: A SYSTEMATIZED APPROACH
FOR THE EVALUATION OF THE SPINAL COLUMN
DEGENERATIVE DISEASE
Authors: ZATTAR-RAMOS, L.C.; DAMASCENO, R.S.;
CAVALCANTI, C.F.A.; BORDALO-RODRIGUES, M.;
AMARAL, D.T.; LEITE, C.C.; CERRI, G.G.
Institution: Hospital Sírio-Libanês - São Paulo, SP, Brasil.
Author responsible: Luciana C. Zattar
Introduction: By the age of 60 virtually all individuals will
have spinal degenerative changes, mainly in the lumbosacral
or cervical segments. Criteria for the diagnosis of degenerative disease includes: the presence of clinical symptoms and
a correct evaluation by imaging studies. This paper aims to
demonstrate the systematic evaluation of the spine, illustrating the main degenerative changes found and highlighting the
imaging findings.
Methods Involved: Spinal MRI and CT images were selected from digital archive of our institution, to illustrate the major degenerative disease findings.
Discussion: Degenerative diseases of the spine are defined as
a spectrum of pathological changes that led to varied degrees
of discs, vertebral plateaus or interapophyseal / uncovertebral
joint compromise. Pain is the predominant symptom. Each of
its components should be evaluated by a systematic approach
by analyzing the morphology and alignment of the vertebral
bodies, the plateaus, the intervertebral discs, the uncovertebral / interapophyseal joints and adjacent muscle planes.
Conclusion of the presentation: Degenerative findings in
spine include: alterations in physiological curvature of spine,
Schmorl’s nodes, Modic changes, discopathies, arthrosis and
foraminal or spinal canal stenosis, which comprise a spectrum of degenerative diseases, a leading cause of disability in
Brazil and around the world.
PD.11.025
RESONANCE OF BONE MARROW: HOW TO INTERPRET
Authors: MARTINI, M.A.L. ; LOPES, S. ; TRANQUILINI, F. ; FRANÇA, S.M. ; GARCIA, D.A.L. ; NASCENTES,
L.D.B. ; HACHUL M. T.
Institution: Hospital São Joaquim - Beneficência Portuguesa
de São Paulo - MedImagem, São Paulo, São Paulo, Brasil
Author responsible: Mauricio Martini
Introduction: The bone marrow composition varies according to fat conversion of red marrow with advancing age, determining various presentations on the magnetic resonance
imaging (MRI).The objective is to recognize the different
MRI presentations of bone marrow, illustrating the variations
of normality, differentiating pathological processes.
Methods Involved: MRI studies with different presentations
of the bone marrow, using T1 and T2 weighted sequences in
1.5T and 3.0T machine.
Discussion: The different proportions in the bone marrow
composition determine the variation in the MRI signal intensity. This diagnostic method helps to distinguish between
normal and pathological processes patterns, whether benign
or malignant, avoiding misinterpretation.
Conclusion of the presentation: MRI plays a fundamental
role in the evaluation of bone marrow, allowing with good accuracy the appropriate recognition of different image patterns.
PD.11.026
Congenital Vertical Talus - a case report.
Authors: DE TONI, G.S.; TESTONI, N.M.; HOFFMANN,
J.; SANDRINI, H.V.S.; CAMARGO, L.F.S.
Brief description of the purpose of the report: This paper
aims at describing a case of congenital vertical talus and literature review.
Medical History: K.S., female, 9 months, research deformity on the right foot. Radiographs demonstrated a flatfoot secondary to change the morphology and position of the talus,
known as congenital vertical talus or flatfoot valgus convex.
Diagnosis: This is a rare congenital disease that affects as a flat
foot, rigid, presenting radiologically as talus in plantar flexion
with flattened head and neck and deflected medially and a shift
dorsolateral dislocation of the navicular bone, associated with
numerous muscle contractures and dislocation of tendons.
Many etiological theories are suspected, among the most important increased intrauterine pressure resulting tendon contracture, failure foot desnvoldimento between the seventh and
twelfth weeks of gestation and idiopathic. If untreated, can
develop into a foot rigid plan and painful, weak to generate
energy during march, significantly impairing walking.
Discussion and summary of the case: In conclusion, it is a
case of vertical talus congêntio and emphasize the need for
early diagnosis of the disease in order to prevent further injury sequelae for walking.
PD.11.029
New concepts of preoperative evaluation
for unstable shoulder imaging: What the
orthopedist wants to know.
Authors: RIBEIRO, EJS; LOPES, AA; RODRIGUES, RN;
MACHADO, VB; SANTOS, FML; FRANÇA, FO; FREITAS, JMA; GODINHO, AC; GODINHO, PC; GODINHO, GG.
Institution: Axial Medicina Diagnóstica, Belo Horizonte,
Minas Gerais, Brasil.
Author responsible: Elísio José Salgado Ribeiro
Introduction: Post surgical recurrence of traumatic anterior
instability of the shoulder is multi factorial. One of the predisposing factors is the concomitant finding of significant bone
injuries, such as large Hill- Sachs defects and glenoid bone loss
(inverted pear lesion). The size of these lesions is directly related to the risk of recurrence. Our objective is to describe measurement techniques of these lesions by multislice computed
tomography and magnetic resonance imaging, which should
be included in the preoperative evaluation of these patients and
the introduction of new concepts to the practice of radiologists.
Methods Involved: Illustrative clinical cases of primary
repair or surgical intervention for traumatic anterior shoulder instability.
97
Discussion: There are several predisposing factors of recurrent anterior glenohumeral dislocation, either after a single
episode, whether postoperative and preventing recurrence
corresponds to the orthopedic surgeon’s major goal. In this
context, it’s essential to know the dimensions of those lesions
in order to choose the best technique to be adopted, whether
arthroscopic with or without “remplissage” or open approach
with Latarget-Patte technique, both described in this panel.
Conclusion of the presentation: Radiologists have a crucial
role regarding the treatment of instability, providing critical
information in the pre and post surgical handling of patients.
PD.11.031
THORACIC OUTLET SYNDROME: IMAGING FEATURES AND A SUGGESTED MAGNETIC RESONANCE STANDARD PROTOCOL
Authors: BIZETTO EL; LEAO RV; DAMASCENO RS;
CORREA, MFP; CAVALCANTI, CFA; FERNANDES, RY;
KURIMORI, CO; COSTA, HP; AMARAL, DT; BORDALO
RODRIGUES, M; CERRI, GG.
Paulo, Brasil
Author responsible: Eduardo Luis Bizetto
Introduction: The thoracic outlet comprises three compartments: the interscalene triangle and costoclavicular and retropeitoral minor spaces by which crosses structures such as
the brachial plexus and subclavian artery and vein. The term
thoracic outlet syndrome (TOS) refers to a heterogeneous
group of disorders which have in common the compression
of one or more neurovascular elements at some point within
the thoracic outlet.
Methods Involved: First, anatomical and functional aspects
of normal thoracic outlet will be demonstrated. Next, we specify the suggested protocol used in our institution for investigation of TOS. Finally, we illustrate some cases through images
of magnetic resonance obtained from our digital archives.
Discussion: TOS includes congenital and acquired abnormalities predisposing to dynamic compression of neurovascular
structures triggered by arm elevation. The most common abnormalities include cervical rib, C7 elongated transverse process, development and traumatic anomalies in the first rib and
clavicle. Anatomical variations of the scalene muscles, fibrous
bands and post-surgical changes are also associated causes.
Conclusion of the presentation: Application of an appropriate MRI investigation protocol is a key factor for this syndrome diagnosis, increasing the sensitivity detection of its
compressive causes and allowing the physician to determine
an appropriate treatment.
PD.11.032
Calcific tendinitis of the pectoralis major insertion associated with cortical
bone erosion
Authors: NAPOLI A., CHOBADINDEGUI R., LUERCHO
E., MARTIN E., BRUNO C.H.
Institution: Fundación Cientifica del Sur, Diagnóstico por
Imágenes Adrogué, Buenos Aires, Argentina
Author responsible: Eugenia Luercho
Brief description of the purpose of the report: We present a
case of calcific tendinitis of the pectoralis major insertion with
cortical involvement, and we describe the CT and MRI findings.
98
Medical History: A 51 year old woman presented with three
months history of spontaneous pain in the proximal third of
the right upper arm, there was no history of trauma or other
diseases. Make swimming. \0
Diagnosis: The calcareous tendinitis is a self-limited inflammatory disorder characterized by hydroxyapatite crystals deposit in tendons and periarticular soft tissues. The shoulder
is the most common location. Involvement of the pectoralis
major insertion is a less-common location. \0The pathogenesis
is unclear. These deposits generated inflammation, causing a
local hypervascularization, leading to bone resorption at the
site of tendon attachment. Together with mechanical forces
result in bone changes. CT scan demonstrated a intracortical
calcified mass with periosteal reaction at the humerus. MRI
evidence a intracortical round image at the humerus, with
marrow edema and soft tissue involvement the pectoralis major tendon insertion. DX: Calcific tendinitis of the pectoralis
major insertion associated with cortical bone erosion. \0
Discussion and summary of the case: Cortical involvement
can be associated with calcific tendinitis, so the knowledge
of these case, compromising the pectoralis major humeral insertion, becomes important to avoid unnecessary diagnostic
biopsies. \0
PD.11.033
Carpal boss syndrome: os styloideum fused to the trapezoid.
Authors: NICOLODI, G.C.; TRIPPIA, C.R.; CABOCLO,
M.F.; TERAZAKI, C.R.; MILLER, W.P.; CASTRO, F.G.;
LIMA, R.R.; RINALDI, F.; ZUKOVSKI, C.
Institution: Hospital São Vicente - FUNEF, Curitiba, Paraná,
Brasil
Author responsible: Gabriel Clève Nicolodi
Brief description of the purpose of the report: We present
a symptomatic case of carpal boss with styloideum fused to
trapezoid, setting the rarest form of carpal boss syndrome,
correlating the imaging findings, and a brief literature review.
Medical History: Female, 29 years old, caucasian, with
chronic pain on dorsiflexion of the right hand, had painful
swelling on the basis of the second and third metacarpals.
Diagnosis: Os styloideum is an accessory ossicle located
dorsally at the wrist (anatomical variant). Its association with
wrist pain sets carpal boss syndrome. The main obstacle at
its recognition lies in the lack of specific symptoms, often
attributed to dorsal cysts, since both share very similar location. The present case is the rarest form of this unusual disorder, wherein the os styloideum presents fused with trapezoid
(0.5%). Generally it occurs fused to the base of the second
and third metacarpals (94%), isolated (2%) or fused to the
capitate (3.5%). Its etiology is based on the persistence of an
accessory ossification center during the embryogenesis.
Discussion and summary of the case: The knowledge of
the pathology and imaging findings are essentials to set the
correct diagnosis and exclude main differential diagnoses
(synovial cysts, fractures, osteoarthritis, exostosis, bone and
soft tissue tumors).
PD.11.034
IMAGING FEATURES OF POLYMYALGIA RHEUMATICA: CASE REPORT AND LITERATURE REVIEW
Authors: BIZETTO, EL; DAMASCENO, RS; AMARAL,
DT; FERNANDES, RY; CORREA, MFP; KURIMORI, CO;
CAVALCANTI, CFA; CALICH, I; CALICH, AL; BORDALO RODRIGUES, M; CERRI, GG.
Paulo, Brasil
Author responsible: Eduardo Luis Bizetto
Brief description of the purpose of the report: Polymyalgia rheumatica is an inflammatory disease that affects people
over 50 years, characterized by pain and morning stiffness of
shoulder and pelvic girdle. May present alone or associated
with giant cell arteritis. The diagnosis is mainly clinical. The
image patterns identified through different methods are nonspecific and scarce in the literature.
Medical History: The authors report a clinical case, female,
68, with neck pain and movement limitation. Shoulders and
cervical spine MRI was performed showing craniovertebral
pericapsular edema and in interspinous ligaments besides tenosynovitis of the long head of the biceps. PET / CT showed
periarticular inflammatory changes in the hips.
Diagnosis: In polymyalgia rheumatica, ultrasonography and
magnetic resonance imaging can identify bursitis subacromial - subdeltoid, cervical, trochanter, and tenosynovitis of
the long head of the biceps. The interspinous involvement in
the cervical and lumbar spine is also described. PET-CT is
useful to demonstrate the association between polymyalgia
rheumatic and vasculitis.
Discussion and summary of the case: Imaging methods,
although non-specific help in the diagnosis and contribute
to the exclusion of the main differentials diagnostics such as
rheumatoid arthritis and inflammatory osteoarthritis. In addition, guide treatment and evolution of disease activity.
PD.11.035
Childhood accidental spiral tibial fracture (Toddler´s fracture): a case report
Authors: MARTINS DLN, GUERRA LFA, PESSANHA
LB, RONDINA RG, SOUZA RSM, MELLO RAF
Institution: Hospital Universitário Cassiano Antonio de Moraes - Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brasil
Author responsible: Diego Lima Nava Martins
a case in a 3 year old child whose initial tibia radiography
was frustrating , having the fracture been diagnosed by CT
and MRI , noting importance of including Toddler’s fracture
in the differential diagnosis of traumatic tibial lesions with
innocent radiography .
Medical History: 3 year old boy with acute pain in the left
leg , without direct trauma on the site.
Diagnosis: Plain radiographs showed no significant changes
. CT and MRI showed spiral fracture of the distal third of
the tibia .
Discussion and summary of the case: Although tibial fractures are common in children who are starting to walk , the
diagnosis can be difficult because the trauma of history is often frustrating . The diagnosis of Toddler’s fractures was easier in recent years due to the use of digital x-rays , which were
more accurate than conventional, but the rate of detection of
fractures depends on the radiologist’s experience in using the
method. The “Toddler’s fracture” is an entity that should be
remembered by radiologists in cases of child with a history of
trauma and foil tibial pain.
PD.11.036
Fungal Ankle Infection( Mycetoma): Case
report with clinical, radiological and
pathological correlation.
Authors: Aita, A.A; Lopes, C.S; Sadala, F. ; Martins, B.J;Batista,K.T.;Bosi,T.C.
Institution: Hospital Sarah Kubistchek, Brasília, Distrito
Federal, Brasil
Author responsible: Alessandro Amorim Aita
two cases of mycetoma in the ankle, enphasizing the radiological findings and the pathologic correlation.
Medical History: Both patients male with 31 and 36
years-old,presenting with indolent pain and nodulation. In
MRI and CT, there were osteolytic tubular and oval hyperintense areas, confluent , associated with adjacent marrow
and soft tissues edema and contraste enhancement . The oval
lesions presented a hypointense central focus( \”dot-in-circle
sign\”). Histopathological study confirmed chronic inflammatory process and fungal granules.
Diagnosis: Mycetoma is a granulomatous fungal infection,
indolent afeccting the soft tissues and presentign as a nodule,
that may extend to skin and bone( osteomyelite)The mycetoma is formed by aglomeration of granules of the microorganisms which are found in the abscesses surrounded by
granulation tissue. The appearance of the MRI is due to this,
with small clusteres of hyperintense lesions (2-5 mm) representing granulation tissue surrounded by a ring representing
hypointense fibrous septa.
Discussion and summary of the case: We emphasizes the
importance of inclunding mycetoma in the diagnosis of bone
and soft tissue lesions in the ankle, the radiologic typical aspects and findings that allow the diagnosis and the clinical,
radiological and anatomopathological correlation.
PD.11.039
Treatment of developmental dysplasia
of the hip (DDH) with Pavlik harness: ultrasound evaluation
Authors: PACHECO, E.M.B; DERTKIGIL, S.; CASERTA,
NMG.
Institution: Faculdade de Ciências Médicas da Universidade Estadual de Campinas (UNICAMP), Campinas, São
Paulo, Brasil
Author responsible: Elisa Maria de Brito Pacheco
Introduction: Ultrasound examination satisfactorily evaluates
the relationship of the femoral head to the acetabulum during
treatment of DDH with Pavlik harness and has been performed
in our service since 1990. The aim of this study is to describe
the protocol used in this evaluation, making a critical analysis
of the findings that may influence treatment decisions.
Methods Involved: The children were initially examined in
the supine position with the Pavlik harness, to investigate the
reduction of the hip. Then, the Pavlik harness was removed
and the hip was examined using the Graf’s method. The dynamic evaluation of hip stability was performed when requested by the orthopedic surgeon.
Discussion: Pavlik harness use requires close clinical, ultrasound and radiographic monitoring since its prolonged use,
without the appropriate reduction of the hip, is potentially
harmful. The findings detected by ultrasonography, which are
99
important in analyzing the effectiveness of the treatment, will
be emphasized.
Conclusion of the presentation: Ultrasonography is effective
in evaluating the hip of infants treated with Pavlik harness.
PD.11.040
Magnet resonance imaging in runnners:
ankle and foot lesions
Authors: COUTINHO, A.R.; SALOMAO, R.P.; GARCIA,
D.A.L.; FRANÇA, S.M.; NASCENTES, L.D.B.; HACHUL, M.T.
Author responsible: Amanda Ribeiro Coutinho
Introduction: The study of stress injuries is extremely important for radiologists owing to the increasing number of
people who practice impact physical activities. This paper
aims to illustrate the main findings in magnetic resonance
imaging (MRI) of the ankle and foot stress injuries.
Methods Involved: Pictorial essay with MRI in runners with
stress injuries of the ankle and foot.
Discussion: Tendon lesions represent the most stress injuries
and typically occur when there is a change in frequency or
intensity of training. Meanwhile, bone lesions are represented by contusions and changes in osseous remodeling, predisposing to stress fractures. Other stress injuries affecting the
ankle and foot to be reported are impact syndromes, plantar
fasciitis and tarsal tunnel syndrome.
Conclusion of the presentation: Plain radiography and ultrasonography have limited role in diagnosis of stress injuries
in an early stage, which makes the recognition of these lesions in MRI to be extremely important for radiologists in order to contribute to the appropriate diagnosis and treatment.
PD.11.042
Main slips on diagnosing spondylodiscitis – Pictorial essay
Authors: DAMASCENO R.S.; BIZETTO E.L.; AMARAL D.T.; CAVALCANTI C.F.A.; CORREA M.F.P.;
FERNANDES R.Y.; KURIMORI C.O.; BORDALO-RODRIGUES M.; LEITTE C.C.; CERRI G.G.
Paulo, Brasil
Author responsible: Rodrigo Sanford Damasceno
Introduction: The early diagnosis of spondylodiscitis is the
key for therapeutic success. Thus, as the modality which first
identifies signs of spondylodiscitis, magnetic resonance (MR)
plays a fundamental role. Therefore, it is of major importance
that the radiologists are aware of the main slips committed in
interpreting these exams. The objective of this presentation
is to demonstrate the findings that help to narrow the differential diagnosis and to better fallow the outcome of patients
with spondylodiscitis.
Methods Involved: With images from cases of ours institution data base, we will illustrate the key findings to be interpreted in spondylodiscitis.
Discussion: Some signs found in MRI are crucial for the early diagnosis and follow up of patients with spondylodiscitis.
Therefore, the key-points of the interpretation have to be remembered, in order to avoid slips that can lead to failures
in the cases conduction. Some of these key-points are: - Acquiring contrast-enhanced sequences when spondylodiscitis
100
is suspected; - Differentiate bacterial infections from fungal
or granulomatous origin; - Track the dissemination pathways;
- Evaluate therapeutic failures.
Conclusion of the presentation: Identifying the findings on
MRI concerning spondylodiscitis is important to the adequate
conduction of such cases. Therefore this has to be mastered
by the radiologists, especially those with interest in musculoskeletal radiology.
PD.11.043
Multicentric plasmocytoma: case report and literature review.
Authors: NESI R.S., MANARA L.M., WANDERLEY M.,
YUHARA E.Y., ODELI J.T., DUARTE E.C., PIONER G.G.,
NOBRE L.F.,
Author responsible: Rafael da Silva Nesi
case of multicentric plasmacytoma involvement of jaw, humerus, skull, ribs and lumbar spine.
Medical History: A 52 year old male with an expansive lesion in the left jaw.
Diagnosis: Plasmacytomas are usually solitary bone lesions
with monoclonal plasma cell proliferation that progresses to
systemic disease, multiple myeloma, in most patients. The average age is 55 years old, 10 years less than multiple myeloma, and predominates in males. In this case radiographs and
computed tomography scans where performed and showed
bone lesions with aggressive behavior in jaw, humerus, skull,
ribs and lumbar spine. Bone marrow and mandibular lesion
biopsies showed infiltration by plasma cells in the mandibular
lesion with normal bone marrow, confirming the diagnosis.
Discussion and summary of the case: The imaging findings
in this case are different from the commonly observed in cases of plasmacytoma, which are usually solitary.
PD.11.047
The association between posture, morphology and presence of fatty infiltration in the paraspinal musculature
Authors: BONUGLI, G.P; REIS R.M; SALMON, C.E.G;
NOGUEIRA-BARBOSA, M.H
Institution: FMRP-USP Ribeirãp Preto, São Paulo, Brasil
Author responsible: Gustavo
Brief description of the purpose of the study: Assessment
a possible correlation between the spinopelvic alignment and
the presence of fatty infiltration in the paraspinal musculature
Methods: MRI was performed (Acquisitions Axial T1 and
In-Phase / Out-Phase) and panoramic radiograph (PR) in profile in 46 subjects without low back pain (21.54 ± 5.0 years).
Subjects were grouped according to the sacral slope (IS):
group 1 (IS <35 °) and group 2 (IS> 35 °). Two previously
trained examiners performed the segmentations of the multifidus muscles, erector and psoas in MR images and measured
the lordosis angles, pelvic incidence, pelvic tilt and sacral
slope in RP
Main results: The t test showed that the pelvic incidence
and lordosis were different between the groups. However not
identified differences in muscle volume nor in the percentage
of fat infiltration between groups. The presence of muscle
asymmetries were observed in the multifidus muscles and
erector in individuals with sacral slope greater than 35 ° and
the psoas in less than 35 °.
Conclusion of the presentation: Our results suggest that
posture does not predictive influence on muscle trophism and
presence of fatty infiltration in asymptomatic young adults.
PD.11.048
Avaliação da Placa Plantar do Hálux ( PPH
) por Ressonância Magnética : descrição
anatômica e patológica
Authors: Lopes, A.A; Rodrigues, R.N; Ribeiro, E.J.S.; Rabelo, B.C.S.; Araujo, R.O.D.; Baumfeld, D.S.;Torres,J.M.
Author responsible: Alexia Moura Abuhid Lopes
Introduction: Injuries in the hallux metatarsophalangeal
joint in athletes are not uncommon. With technological advancement, the capsuloligamentar injuries has been more
recognized both from a clinical point of view, as per image.
The knowledge of the anatomy of the glenosesamoid complex by MRI helps orthopedic surgeons and radiologists in
the diagnosis and treatment of lesions. The study aimed to
demonstrate the standard regional anatomy of the hallux
metatarsophalangeal, the mechanism of injury and the injury
spectrum found in MR.
Methods Involved: MRI Evaluation of 9 patients (athletes
and non-athletes) with description of normal and pathological anatomy of the hallux metatarsophalangeal capsuloligamentous complex.
Discussion: Due to the anatomical complexity, there are
many types and variations in the presentation of the PPH
lesions, which may be missed by the radiologist, often misdiagnosed in generalized terms since “sesamoiditis” to degenerative first ray lesions. The knowledge of the degree of
injury guides the approach to be adopted by the orthopedist,
especially in athletes with high-grade lesions and joint instability that do not respond to conservative treatment.
Conclusion of the presentation: The MRI is a high value
tool in the evaluation of hallux metatarsophalangeal pain and
dysfunction, assuming key role in the diagnosis and management of these lesions.
PD.11.049
Hands and wrists fractures – Aspects in
X-Ray
Authors: PAIXÃO, N.C.F.; CÂMARA, G.V.; JARDIM,
C.C.; ROSA, B.G.; AZEVEDO, M.M.; TONIN, C.L.;
VERGÍLIO, F.S.
Institution: INSTITUTO DE ASSISTÊNCIA MÉDICA AO
SERVIDOR PÚBLICO ESTADUAL, SÃO PAULO, SÃO
PAULO, BRASIL
Author responsible: Nicelly Cristina Ferreira da Paixão
Introduction: Considered as a functional unit, the wrist and
the hand are the places with highest lesion incidence in the
skeletal system. Hand and wrist fractures result from traumas
of different origins, present variable prognosis depending on
the fracture characteristics and instituted treatment, what can
determine significant functional limitations to the patient.
The present work aims to demonstrate the observed images
in hand and wrist fractures in simple radiograph (X-ray).
Methods Involved: An X-ray pictorial essay was carried out
with patients with wrists or hands fractures, using images
obtained from a large hospital digital archive located in São
Paulo city.
Discussion: In most circumstances, the anamnesis and physical examination provide valuable information in which are
possible to substantiate a diagnostic suspicion. However, radiological findings from simple radiograph are essential to
determine a specific lesion diagnosis in these places.
Conclusion of the presentation: : It is the radiologist job to
recognize the images and early promote the diagnosis of hand
and wrist fractures, in order to help the orthopedist to choose
the best therapeutic option, decreasing thereby the probability of functional complications.
PD.11.050
Application of magnetic resonance imaging in the evaluation of sacroiliitis.
Authors: SANTOS J.C.; BRAUN R.; FERNANDES E.;
MELO H.J.F.
Institution: CURA IMAGEM E DIAGNÓSTICO, São Paulo, SP- Brasil Centro Universitário São Camilo, São Paulo,
SP- Brasil Universidade Federal de São Paulo, São Paulo,
SP- Brasil
Brief description of the purpose of the Review of Literature: It is known that magnetic resonance imaging (MRI)
plays a fundamental role in the study and diagnosis of diseases of the musculoskeletal system.
In view of this, we evaluated the accuracy of sequences percentage T1-weighted STIR and dissemination in sacroiliitis
analysis and pointed out the main assessment protocols recommended in the literature through systematic review.
Conclusion: Spondyloarthropathies (set of heterogeneous
disorders with similar characteristics) often affect the sacroiliac joints and are related to genetic predisposition linked
to the histocompatibility antigen HLA-B27. The ASAS /
OMERACT group was the first to include diagnostic criteria for sacroiliitis MRI using readily reproducible methods,
showing that weighted sequences in T1 are sufficient to detect structural damage. Have the Spondyloarthritis Research
Consortium of Canada (SPARCC) has different criteria for
evaluating active lesions which enables the monitoring of
the disease and response to treatment.
Brief discussion of the case Diffusion weighted imaging
(DWI) are potentially useful to show the degree of inflammatory activity as STIR sequences, which truly non-specific inflammatory changes as opposed to mechanical injury.
PD.11.052
LIPOMATOUS TUMOURS: A PICTORIAL REVIEW
Authors: LOUREIRO, A.L .; MAGALHÃES, M.; DUARTE, A.L.; PEREIRA, P.; ABRANTES, C.; MARQUES, C.
Institution: INSTITUTO PORTUGUÊS DE ONCOLOGIA
DE LISBOA, FRANCISCO GENTIL; LISBOA; PORTUGAL
Author responsible: Ana Luisa Loureiro
Introduction: • To describe the spectrum of lipomatous tumours, benign and malign. • To review and illustrate the specific imaging findings on magnetic resonance of several lipomatous tumours. • To emphasize specific features that may aid
101
in the differentiation of benign from malignant lesions.
Methods Involved: • The authors will introduce the radiological spectrum of lipomatous lesions, ranging from simple lipomas to atypical lipomas to frankly malignant liposarcomas.
• The subtypes of liposarcomas, based on the World Health
Organization (WHO) classification, will be discussed and
examples will be presented. • Other lipomatous lesions like
lipoblastoma, hibernoma and lipomatosis will be reviewed.
Discussion: Lipomatous tumors are common mesenchymal
neoplasms of lipogenic differentiation. They can be either benign or malignant with a wide range of histologic subtypes.
The appearance of lipomatous tumors on MRI reflects the
degree of differentiation. The diagnostic accuracy of the biopsy it’s limited by the possibility of sampling error. MRI is
capable of evaluating the whole tumoral mass and is superior
to other imaging modalities in distinguishing lipomas, lipoma
variants, and well-differentiated liposarcomas.
Conclusion of the presentation: Recognition of the spectrum lipomatous tumours improves the radiologic assessment
of the lesion and this is vital for optimal patient management.
PD.11.053
MRI findings of knee cysts lesions: a vast
differential diagnosis
Authors: MOURA FM; FONSECA DR; SILVA PMF;
FRANÇA C; REGATTIERI NAT
Introduction: A wide variety of cystic lesions may be identified during magnetic resonance imaging (MRI) of the knee,
ranging from benign cysts to complications of diseases such
as infectious or inflammatory arthritis, and malignant lesions.
The aim of this pictorial essay is to illustrate aspects of cystic
lesions around the knee, including popliteal, meniscal, ganglion cysts among others.
Methods Involved: Based on cases of knee MRI performed
in our department between January/2006 and July/2012, a
literature review on cysts around the knee and its main differential diagnoses was carried out.
Discussion: MRI is an excellent imaging method to detect
and characterize cystic lesions in the knee and adjacent structures. The knee cystic lesions include popliteal, meniscal and
ganglion cysts, bursae, for example anserine, pre-patellar and
supra patellar bursitis, as well as other lesions that mimic
cysts, such as articular recesses, vascular aneurysms, hematomas and tumors, among others.
Conclusion of the presentation: Knee cystic lesions are a
frequent finding on MRI. Radiologists should be able to recognize, characterize and properly locate the cystic lesions, so
that the correct diagnosis and appropriate therapy are possible.
PD.11.054
PERIPATELLAR FAT IMPINGEMENT: BEYOND
CHONDROMALACIA
Authors: MENDES FH, F.A.A; SOUZA, G.L; MARTINS,
M.M; GARCIA, D.A.L; FRANÇA, S.M.; NASCENTES,
L.D.B; HACHUL, M.T
Institution: MedImagem - Hospital Beneficência Portuguesa
de São Paulo, São Paulo, São Paulo, Brasil
Author responsible: Fernando Augusto de Albuquerque
Mendes Filho
102
Introduction: Anterior knee pain is a common clinical compliant specially amongst active individuals, whether caused
by traumatic or non-traumatic mechanisms. The anterior
supra-patellar, posterior supra-patellar and infra-patellar fatpads play an important role in regional biomechanical stability and are sites of well described affections with clinical
repercussion. The present study claims to elucidate normal
knee fat pads anatomy and discuss some imaging features
observed in peri-patellar fat impingement, correlating them
with the literature.
Methods Involved: Pictorial essay of multimodality selected
cases, with emphasis on magnetic resonance (MR).
Discussion: Anterior knee pain is a common presentation in
orthopedic environment. Primary non-traumatic affections that
reduce the patellotibial or patellofemoral spaces are implied
in the predisposal to peripatellar fat impingement. Repetitive
micro-traumas due to regional overload are also described on
impact physiopathology. The imaging assessment of knee fat
pads helps to uncover some regional pathologic mechanisms.
Conclusion of the presentation: Imaging assessment of
patellotibial and patellofemoral biomechanics, as well as acquaintance with peri-patellar fat impingement, assist on differential diagnose of anterior knee pain.
PD.11.055
SACOIDOSIS MYOSISTIS: CASE REPORT
Authors: LEAO, R.V; AMARAL, D.T; FERNANDES, R.Y;
CORREA, M.F.P; CALICH, I; RODRIGUES, M.B; CAVALCANTE, C.F.A; MENDES, A.A.M; BIZETTO, E.L
Brief description of the purpose of the report: Sarcoidosis is a granulomatous inflammatory disease that affects
muscles, joints and bones. The muscle involvement occurs in
1.4% of cases and is manifested as granulomatous nodules,
myositis, myopathy or acute. Sarcoidosis Myositis (SM) is a
few studied entity that presents many differentials. This study
reports a case of SM and illustrate its image patterns.
Medical History: Male patient, 23, maestro, presented a
hardening and increased volume of the extensor surface of
the forearm and anterolateral compartment of the leg, without
limitation of labor activities or pain. He developed swelling
in the anterior and distal surface of the right thigh. Denied
trauma. Magnetic resonance imaging showed no nonspecific
findings and there were no chest or lymph node changes.
Diagnosis: A muscle biopsy was suggested and demonstrated
granulomas. Only after a 6 months follow-up the pattern of
myositis with diffuse interstitial edema evolved into a nodular pattern, compatible with the classic finding described in
muscle sarcoidosis.
Discussion and summary of the case: The case presented an acute myositis without respiratory symptoms, chest
or lymphnodes changes. Despite the fact that the definitive
diagnosis is made through a biopsy demonstrating noncaseating granulomas, the image pattern must be recognized by
the radiologist.
PD.11.056
Radiological evaluation of Osteochondrosis: a pictorial essay
Authors: PAIXAO T.S.A.; DAMASCENO R.S.; LIMA T.C.;
AMANCIO C.T.; PANIZZA P.S.B.; ARAUJO E.P.; CERRI
G.G.; LEITTE C.C.
Paulo, Brasil
Author responsible: Tassia Soraya Araujo Paixao
Introduction: Osteochondrosis represent a group of diseases that affect the ossification nuclei due to ischemia durind
childhood and early youth. This condition is relatively common and according to the bone committed it usually gets an
eponym. That said, the purpose of this paper is to illustrate
the most relevant radiographic aspects of the most frequent
osteochondromatous entities.
Methods Involved: We will present six cases from our institution’s data base that comprise different osteochondromatous conditions, with particular emphasis on the most illustrative images.
Discussion: Osteochondrosis represent a group of diseases that affect the ossification nuclei due to ischemia durind
childhood and early youth. This study demonstrates the most
typical radiologic findings concerning the most commonly
committed bones by osteochondromatosis, such as LeggCalvé-Perthes disease, a condition most commonly found in
male children. The early diagnosis and accurate treatment are
extremely important to prevent deformities, pain and joint
malfunction.
Conclusion of the presentation: Being a relatively common
condition that can lead to severe deformities, it is mostly
important that all radiologists are able to recognize the most
typical radiological aspects os the osteochondrosis.
PD.11.057
FIBRODYSPLASIA
OSSIFICANS
PROGRESSIVA: FIRST CASE REPORT IN THE STATE OF
ACRE – BRAZIL
Authors: PEREIRA RCR; MELO WAL; RIBEIRO BFR;
PEREIRA SBAV; PAIVA IB, GINDRI FH; MORAES FHP;
BARBOSA GV
Institution: UFAC, RIO BRANCO, ACRE, BRASIL
Author responsible: Rita Pereira
Brief description of the purpose of the report: This study
aims to report the first case of Fibrodysplasia ossificans progressiva (FOP) diagnosed in Acre and the importance of image studies to characterize the disease. FOP is an autosome
dominant disorder of connective tissue, disabling, with malformations of the first toes and progressive heterotopic ossification. The global prevalence is 1 / 2,000,000.
Medical History: D.C.F.A, 2 years and 8 months old, female, born in Rio Branco-AC. At 13 months of age showed
increased volume of the cervical and thoracic region, with
limitation of axial skeleton. Radiographs: bilateral hallux valgus. Ultrasound: Increased volume of the back muscles and
parenchymal calcifications. MDP scintigraphy with 99mTc -:
multiple areas of uptake of the radiopharmaceutical varying
from moderate to severe, located in the posterior region of
thoracic soft tissue.
Diagnosis: The diagnosis of FOP is clinical, but complementary image help in the differential diagnosis. Image findings
include ectopic ossification, abnormalities in short bones (hallux valgus) and vertebral abnormalities. On CT is possible to
check the early process of calcification of soft tissues. In MRI
detection at an early and at late Stages. In bone scintigraphy
radiotracer uptake occurs at sites of ectopic ossification.
Discussion and summary of the case: Imaging studies are
essential to confirm the diagnosis and monitoring of disease progression.
PD.11.058
METAL IMPLANTS AND MAGNETIC SUSCEPTIBILITY ARTIFACTS: APPLICABILITY OF SEMAC / VAT
Authors:
PANIZZAPANIZZA,
P.S.B.;
RIBEIRO-DOS-SANTOS, V.; PAIXÃO, T.S.A.; AMANCIO,
C.T.; LIMA, T.C.; DAMASCENO, R.S.; NASSER, G.E.;
CAVALCANTI, C.F.A.; LEITE, C.C.; CERRI, G.C.
Paulo, Brasil
Introduction: The use of metal prostheses has grown exponentially, especially in orthopedic surgery. In the postoperative period clinical and radiological follow-up is essential to
rule out complications, mainly related to infection and periprosthetic osteolysis. Magnetic resonance (MR) emerged as
valuable tool for this purpose and the aim of this study is to
illustrate the applicability of the slice encoding technique for
metal artifact correction (SEMAC) in the reduction of magnetic susceptibility artifacts.
Methods Involved: We will comparatively demonstrate imaging studies acquired by 1.5T field MRI, with and without
the use of SEMAC. Clinical situations experienced at our
service will be exhibited in which the application of the technique allowed diagnostic elucidation by the substantial correction of spatial distortion artifacts.
Discussion: The SEMAC allows metal artifact reduction for
being a two-dimensional (2D) view angle tilting (VAT)-spin
echo sequence, acquiring information from the periprosthetic
regions with minimization of inhomogeneities of the field induced by the metal, within a feasible scan time.
Conclusion of the presentation: It is possible to significantly improve the viewing of bone and soft tissue in the
vicinity of metal implants and produce diagnostic quality
images with the use of MRI coupled with modern artifacts
correction methods.
PD.11.065
Ultrasound Evaluation of Joints in Systemic Lupus Erythematosus: A Systematic
Review
Authors: LINS, CF; SANTIAGO, MB
BAHIA, BRASIL/ ESCOLA BAHIANA DE MEDICINA E
SAÚDE PÚBLICA (EBMSP), SALVADOR, BAHIA, BRASIL
Brief description of the purpose of the Review of Literature: Systemic lupus erythematosus (SLE) is an autoimmune
disease with musculoskeletal involvement more than 90% of
cases. Joint Ultrasonography (US) is not routine for SLE, but
may become an important tool in the management of arthritis
/ tenossinovitis in lupus. The aim of this job is to describe
scientific evidences regarding sonographic findings of joints
in SLE patients.
Seven databases were searched (PubMed, ScienceDirect,
Scopus, Cochrane, EMBASE, LILACS and SciELO), using keywords like: “lupus”, “ultrasonography”, “synovitis”,
103
“tenosynovitis”, “arthritis” and their corresponding terms in
Portuguese, in a period from 1950 to January/2015.
Conclusion: Twelve articles were included at final analysis.
In total, 610 SLE patients and 1124 joints were studied: 888
hands/ wrists, 154 ankles/feet, 56 knees and 26 elbows. Effusion was identified in 602 joints, synovitis in 213, tenosynovitis in 210, synovial hypertrophy in 150 and bone erosions
in 73 cases. The majority of the studies demonstrated higher
frequency of musculoskeletal abnormalities on US than those
observed on physical examination.
Brief discussion of the case US seems to be a valuable
tool to identify subclinical joint manifestations in SLE.
Prospective studies are necessary to determine if those patients with subclinical joint abnormalities have higher risk
for the development of chronic deformities as those seen in
Jaccoud’s Arthropathy.
TL.11.004
Comparison between the detection of
the dentate ligament in cervical spine by
means of volumetric sequence between
the magnetic resonance equipment of 1.5
Tesla and 3.0 Tesla.
Authors: Seragioli, R.; Simão, M.N.; Barbosa, M.H.N.;
Institution: Centro de Ciências das Imagens e Física Médica, Seção de Medicina Nuclear - Hospital das Clínicas de Ribeirão Preto - USP, Ribeirão Preto, São Paulo, Brasil
Author responsible: Rafael Seragioli
Brief description of the purpose of the study: The aim
of our study is to compare the identification of the dentate
ligaments in magnetic resonance imaging (MRI) equipment of 1.5 Tesla and 3.0 Tesla and assess the interobserver reproducibility.
Methods: A total of 115 MRI scans of the cervical spine
were selected during the periods of January 2011 and January 2012, tracked by the institution database. There were 64
scans in at 1.5 Tesla and 51 scans in the 3.0 Tesla equipment.
The identification of the dentate ligaments was evaluated using three-dimensional volumetric sequence of high spatial
resolution called COSMIC. The images review were made
by two radiologists, from C2 to C7 levels.
Main results: The mean age of patients was 49.75 years ,
with standard deviation of 14.60 years . Observer 1 detected
83% of the possible dentate ligaments (83% in the 1.5 Tesla
equipment and 83% in the 3.0 Tesla equipment). The observer 2 detected 84% of the possible dentate ligaments (81% in
the 1.5 Tesla equipment and 86% in the 3.0 Tesla equipment).
Conclusion of the presentation: The study shows good
detection capability of the dentate ligaments in the cervical
spine when evaluated by volumetric sequence. These ligaments are displayed similarly in both MRI equipment in the
various cervical levels.
TL.11.006
Evaluation of the labral periosteal attachment variations of the inferior glenohumeral ligament by magnetic resonance arthrography exam
Authors: KOBAYASHI, M.J.; HERNANDES, M.A.; SIMAO, M.N., NOGUEIRA-BARBOSA, M.H.
Institution: HOSPITAL DAS CLÍNICAS DE RIBEIRÃO
PRETO (USP), RIBEIRÃO PRETO, SÃO PAULO, BRASIL
104
Author responsible: Maximilian Jokiti Kobayashi
the anatomic variations of the insertion of the anterior band of
the inferior glenohumeral ligament (AB-IGHL) to the glenoid.
Methods: Retrospective review of 93 shoulder magnetic
resonance arthrography exams was performed using consensus by two radiologists. The AB-IGHL labral-periosteal
attachment pattern, distinguishing between two types, labral
or periosteal attachment, and its position on the anterior rim
of the glenoid were recorded. Abnormalities of the anterior
labrum fibrocartilage of the glenoid were recorded, including
degeneration and avulsion.
Main results: On 50 exams (53,8%) the AB-IGHL originated mostly from the labrum (type 1) and 43 exams (46,2%)
demonstrated a type 2 variation, meaning that its origin attached directly to the glenoid neck. The AB-IGHL emerged at
the 4 o’clock position on 58 cases (62,4%). Fourteen of them
(15%) from the 3 o’clock position and on 21 cases (22,6%)
from the 5 o’clock position. Anterior labrum avulsion was
identified on 55 patients (59,1%) and degeneration without
avulsion was seen in 23 cases (24,7%).
Conclusion of the presentation: Although the AB-IGHL
originating from the anteroinferior labrum is more frequent,
we found a high prevalence of the AB-IGHL emerging from
the periosteum of the glenoid neck. The AB-IGHL originated
between 3 and 5’o clock position, more frequently at 4 o’clock.
12 - Neuroradiology
PD.12.002
Multidetector computed tomography is
sovereign in predicting the mortality of
patients with traumatic brain injuries,
or the clinic is still sovereign?
Authors: ROSA JR., M.; MAIA JR., A.C.M.; ROCHA, A.J.
Author responsible: Marcos Rosa Junior
Brief description of the purpose of the study: It is very
large the number of cases of traumatic brain injury. Computed tomography has large space in this scenario, because it
is an available, cheap and fast examination. We studied the
mortality in this group of patients and whether the CT findings are more important than the clinical findings, in particular the Glasgow coma scale, in predicting mortality.
Methods: We studied 121 patients with traumatic brain injury who arrived at the hospital within 72 hours of the ictus
and underwent multidetector CT angiography to evaluate the
findings of the brain trauma. We compared the CT findings
with clinical data to know which one is more important in
predicting mortality.
Main results: The factors most related to mortality in the
multivariate logistic regression analysis were the Glasgow
Coma Scale (OR 95% CI = 15.2 to 2.90; 79.56), the volume
of hemorrhage (OR 95% CI = 8.8 - 1.10; 71.89) and the presence of spot sign (OR 95% CI = 3.4 to 1.12; 10.37).
Conclusion of the presentation: Despite the great advances
in computed tomography in recent decades the most important factor to predict mortality in patients with traumatic brain
injury is still the score of the Glasgow coma scale.
PD.12.003
Corpus Callosum: spectrum of congenital anomalies and acquired diseases.
Authors: Silva, P.M.F.S; Nunes, P.H.T.; Moura, F.M.; Coimbra, C.F.; Soares, M.V.; Regattieri, N.A.T.
Institution: Hospital Universitário de Brasília - UnB,
Brasília-DF, Brasil.
Author responsible: Paula Myllane Fernandes dos Santos
Silva
Introduction: The corpus callosum is the largest white matter commissure and plays an important role in inter-hemispheric brain connection and coordination. The purpose of
this study is to evidentiate the wide spectrum of lesions in the
corpus callosum, both congenital and acquired, through a retrospective analysis of XXX hospital database and to compare
statistical results with the population.
Methods Involved: The eligible criteria were review reports
of the head performed by Computed Tomography (CT) and
Magnetic Resonance Imaging (MRI) in the period between
June 2005 and October 2014 that mentioned \”corpus callosum\” . All reports were reviewed in order to classify them in
groups of diseases.
Discussion: There were 13,292 CT and MRI reports of head,
of which 1074 mention “corpus callosum”. 187 cases were
selected with the following results (‰): Congenital anomalies: 49-3.6 ‰; Vascular: 40 -3.0 ‰; Neoplasms: 29 -2.0 ‰;
Demyelinating: 22 -1.6 ‰ ; Trauma: 7-0.5 ‰; Postoperative:
7-0.5 ‰; Infectious: 6 -0.4; Hydrocephalus: 6 -0.4 ‰ ; Metabolic: 2 -0.1 ‰; Other: 19 -1.4 ‰.
Conclusion of the presentation: In the present study the
corpus callosum injuries spectrum were wide, with a higher
incidence than the general population. Familiarity with the
appearances of those injuries allows radiologist making the
appropriate diagnosis.
PD.12.004
Unusual intracranial hemorrhages caused by aneurysmal rupture: Beyond the HSA.
Authors: ALVES, C.A.P.; CARDOSO, E.O.A.; ROCHA, A.J.
Institution: Irmandade da Santa Casa de Misericórdia de
Santos, Santos, São Paulo, Brasil
Author responsible: Cesar Augusto Pinheiro Ferreira Alves
Introduction: The rupture of intracranial aneurysms has
as its main form of presentation subarachnoid hemorrhage
(SAH). However, there are atypical clinical and radiological
presentation described. The imaging findings of ruptures of
intracranial aneurysms have close correlation with bleeding
sites and the correct diagnosis can greatly interfere in the
conduct. We have reviewed the atypical radiological presentations of bleeding related to intracranial aneurysms to facilitate the correct diagnosis of its various forms.
Methods Involved: We evaluated the CT studies and intracranial CT angiography performed between 2011, january to
2014, december, in those patients with surgical confirmation
on digital angiography.
Discussion: The various presentations were exposed in a
didactic way and our results confronted with available literature data.
Conclusion of the presentation: Atypical presentations of
rupture of intracranial aneurysms are infrequent, despite this,
the radiologist plays a crucial role in the recognition of all
forms of this serious condition, whose prognosis depends directly on the early diagnosis and right conduct.
PD.12.005
Lhermitte-Duclos disease. Morphological and functional findings highlighted
the imaging methods, reviewed the subject of a case report.
Authors: Abizaid, WJM; Barros, AP; Dutra, BL; Amaral, F;
Galvão, BS ;Vilela, VM.
Institution: Clínica Magnescan, Juiz de Fora, Minas
Gerais, Brasil
a rare case of cerebellar gangliocytoma reviewing its main
morphological and functional imaging findings of computed
tomography and magnetic resonance, contrasting them with
the changes found in the main differential diagnosis.
Medical History: Male patient, 62, sent the magnetic resonance imaging of the brain to the right buzz evaluation.
On neurological examination, the patient had no significant
changes, nor of intracranial hypertension.
Diagnosis: Lhermitte-Duclos disease or cerebellar gangliocytoma is a rare lesion, which shows mixed findings between
hamartomatous line and low-grade tumor, showing an image
characteristics of both groups. We describe the details of the
image findings, always providing comparative data with desmoplastic medulloblastoma, its main differential diagnosis,
terminating poor prognosis.
Discussion and summary of the case: Although rare, the
characteristic imaging findings allow the diagnosis with a
high degree of certainty, saving the patient from an invasive
procedure, which justifies the knowledge about the disease
and the need to know the data to be extracted from the workup armed.
PD.12.006
Spectrum of pathological involvement
of the Brachial Plexus in MRI - Iconographic Essay
Authors: LINS, CF; MARIZ FILHO, PJ DA C; RIOS, GM;
LOPES, AKBF; SANTOS, WGD
BRASIL
Introduction: The brachial plexus provides sensory and motor innervation to the upper limbs, which can be involved by
trauma, inflammatory diseases, primary tumors, direct extension of tumor adjacent, metastasis or secondary to radiation
therapy. Symptoms of brachial plexopathy are commonly
nonspecific and its clinical evaluation is challenging, because
it is inaccessible to palpation, requiring additional tests for the
diagnosis. This paper aims to demonstrate the main forms of
pathological involvement of the brachial plexus with their corresponding findings in magnetic resonance imaging (MRI).
image file of our Service, involving primary or secondary tuAbstracts of Scientific Papers
105
mor involvement, actinic plexopathy, traumatic and inflammatory injuries in RM.
Discussion: The imaging evaluation of the brachial plexus is hampered by its complex anatomy and the possibility of involvement by various diseases. MRI plays a
significant role in the diagnosis of plexopathies, including the context of trauma, especially for differentiation
of lesions pre and post-ganglionic, critical to the management of the patient.
Conclusion of the presentation: Thus, we can see the didactic and educational value of this job, enabling the identification of the main imaging findings in the diagnosis of the most
common disorders of the brachial plexus.
PD.12.007
Differential diagnosis of anterior sacral meningocele during the evaluation
of post hysterectomy pelvic collections.
Authors: RONDINA, R.G. (autor principal, idealizador, levantamento bibliográfico, elaborador/relator); VOLPATO R.
(médico radiologista responsável pelo caso, revisão final);
BATISTA E.F.P. (levantamento bibliográfico; tradução do
resumo), MARTINS, D.L.N. (levantamento bibliográfico);
GUERRA, L.F.A. (levantamento bibliográfico); PESSANHA, L.B. (levantamento bibliográfico); OLIVEIRA JR., R.
(coleta dos dados clínicos).
Institution: Hospital Universitário Cassiano Antonio de Moraes - Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brasil
Author responsible: Ronaldo Garcia Rondina
case of an incidental anterior sacral meningocele (ASM)
which failure to diagnosis could have had disastrous consequences for the patient.
Medical History: Female, 34, underwent partial hysterectomy, developing with pain and fever
Diagnosis: Computed tomography scan performed on the
2nd day postoperative demonstrates a loculated and dense
collection, in the pelvic cavity, with small interposed air bubbles. There was another hypodense cystic image in pre-sacral
region, communicating with the spinal canal, dislocating the
rectum to the right. The diagnostic hypothesis of ASM was
later confirmed by magnetic resonance imaging. ASM is a
rare form of spinal disrafism, characterized by the herniation
of dural sac into the pre-sacral space. These lesions can occur
isolated or associated with other congenital abnormalities.
Because of its hidden nature, it is usually diagnosed during
the second or third decade. The diagnostic investigation can
be done by plain radiography, ultrasonography, CT and MRI,
the last two being better accuracy.
Discussion and summary of the case: In this case the diagnosis of ASM was especially important because the patient
underwent laparotomy for drainage of pelvic hemorrhagic
collections and a possible intervention in the meningocele
could have disastrous consequences.
PD.12.008
Neurological complications related to
the use of methotrexate: imaging findings
Authors: D J L Oliveira, Damasceno R S; T G Lyra; L F
Godoy, MD; Docema M F; D Delgado; Lee H. W; Martin M
G M; Cerri G.G; Leite C C.
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Institution: HOSPITAL SÍRIO LIBANÊS, SÃO PAULO SP, BRASIL
Author responsible: Diego José Leão de Oliveira
Introduction: Methotrexate is a chemotherapic agent used
systemically for a wide range of cancers, both in conventional doses and in high doses. It is also administered in adjuvancy to brain radiotherapy and intrathecally to treat leptomeningeal metastases and for prophylaxis in hematologic
malignancies.
Methods Involved: We will present patients with neurological complications secondary to methotrexate therapy, with
typical and atypical imaging findings on computed tomography (CT) and magnetic resonance (MR), including diffusion
techniques, perfusion and spectroscopy.
Discussion: The three major presentations for methotrexate
toxicity in the central nervous system are toxic leukoencephalopathy, a reversible lesion of the white matter; necrotizing
encephalopathy, which is more severe, with development of
necrotic areas in the white matter; and subacute combined
degeneration, indistinguishable from vitamin B12 deficiency.
Conclusion of the presentation: The onset of neurological
symptoms in a patient using methotrexate should promptly
alert the clinician to the possibility of the development of the
toxic effects of the drug in the central nervous system. Imaging techniques are essential to determine the form of involvement and especially the evolution of the findings.
PD.12.009
Urbach-Wiethe Syndrome (lipoid proteinosis): a case report.
Authors: CASAGRANDE, J.L.M.; TIBANA, L.A.T.;
ALVES, S.M.
Institution: Departamento de Diagnóstico por Imagem
da Universidade Federal de São Paulo/EPM, São Paulo,
SP, Brasil
Brief description of the purpose of the report: The lipoidoproteinosis (Urbach-Wiethe syndrome) is a recessive authossomic disorder caused by the deposition of hyaline material in many organs, of unknown ethiology. We describe a
case diagnosed in our service and review the most common
imaging findins in this condition.
Medical History: A 34-year-old female patient presented
with a 10-year-history of convulsive disorder, treated with
phenobarbital 100mg/day. She was also being treated for
generalized anxious disorder and mild depressive episode
with cytalopram and gabapentin. The physical examination
didn’t show any abnormalities other than hoarseness and papular skin lesions more proeminent on the eyelids, but also
present at other regions of the body. A CT scan of the head
showed bilateral symmetric cortical calcifications at the hippocampus head, amygdala and uncus.
Diagnosis: A skin biopsy showed deposition of hyaline material at the papillary dermis. The diagnosis of lipoidproteinosis (Urbach-Wiethe Syndrome) was made, a recessive
authossomic disorder caused by the deposition of hyaline
material in many organs, of unknown ethiology, causing a
myriad of symptons.
Discussion and summary of the case: This syndrome must
be considered when bilateral intracerebral calcifications are
found on CT examinations along with the presence of cutaneous lesions and other typical signs and symptoms.
PD.12.010
APPLICATION OF NUCLEAR MAGNETIC RESONANCE AT DIFFERENTIAL DIAGNOSIS BETWEEN
VESTIBULAR SCHWANNOMA AND MENINGIOMA
ON CEREBELLOPONTINE ANGLE
Authors: MELO, D.M.; CARVALHO, R.S.; VERGILIO,
C.S.; FASBENDER, C.P.B.; SOUZA, E.C.F.; BARROS,
E.G; GUEDES, V.H.C.C.; COSTA, A.S.
Author responsible: Danilo Monteiro de Melo Henklain
Introduction: Vestibular schwannomas (VS) and Meningiomas account for 85% and 15%, respectively, of the cerebellopontine angle lesions (PCA). The study was intended to
describe the imaging findings of these lesions.
Methods Involved: Literature review in PubMed database
(last 10 years) and pictorial study with magnetic resonance
imaging (MRI) of cases with the PCA lesions in large hospital in São Paulo (last 05 years).
Discussion: In the cases analyzed found was reported in the
literature. VS are small lesions intracanalicular with some
aspect \”ice ball\” and extension to APC, intense contrast enhancement, isosignal on T1 and hypersignal on T2. Spectroscopy demonstrates peak myoinositol and no alanima, with
the questionable diffusion and the minor relative cerebral
blood volume. Signal loss of the acoustic nerve in the volumetric sequences (FIESTA, CISS) support the diagnosis. Meningiomas of the APC simulate SV is ovoid form, but do not
extend the internal auditory canal, show tail and dural thickening (60%), isosignal T1, variable T2, restrict the diffusion
and hight perfusion. MRI features the obtuse angle with the
temporal bone (acute in VS) and infrequent intracanalicular
extension (80% in VS).
Conclusion of the presentation: MRI is essential for the differential diagnosis between VS and meningiomas on PCA.
PD.12.011
Cerebral bleeding during Brain MRI:
key findings
Authors: RODRIGUES DP., DALAQUA M., BASTOS
BB., BARBOSA JUNIOR AA., AMARO JUNIOR E., FUNARI MBG.
Author responsible: Diego Parga Rodrigues
Brief description of the purpose of the report: Illustrate
a case of hyperacute intracranial hemorrhage that occurred
during MR images acquisition.
Medical History: Puerpera complaining about acute severe
headache after normal delivery, with nausea and vomiting
and without papilledema. Brain MRI demonstrated signs of
subarachnoid hemorrhage and during the imaging acquisition
an intraparenchymal bleeding was noticed, with documented
progressive increase in pre- and post-contrast images, including the classic spot sign.
Diagnosis: Pregnant and postpartum women are predisposed
to several potentially serious and lethal neurological complications, especially the ones of cerebrovascular origin, particularly intracranial bleeding. Computed tomography (CT) is
the method of choice to search acute bleeding, but magnetic
resonance imaging (MRI) has the advantage of dating the
hemorrhages based on T1, T2, FLAIR and magnetic susceptibility sequences, and in cases of active bleeding, based on
progressive post-contrast sequences.
Discussion and summary of the case: The case documented the entire occurrence of hyperacute intracranial bleeding
during the MRI sequences acquisition, a rare complication
and diagnosed by an unusual method, since detection of such
finding is frequently made by CT, usually without contrast.
PD.12.012
Imaging findings in infectious meningoencephalitis
Authors: RODRIGUES DP., DALAQUA M., BARBOSA JUNIOR AA., DIAS GG., RODRIGUES MAS., FUNARI MBG.
Author responsible: Diego Parga Rodrigues
Introduction: The incidence of infections in the central nervous system has increased in the past years, mainly due to
the AIDS epidemic and the increasing use of immunosuppressive drugs. Meningitis is defined as inflammation of the
meninges and adjacent cerebrospinal fluid; it may be acute,
subacute or chronic, mainly of bacterial, viral or fungal etiology. Encephalitis corresponds to diffuse inflammation of
the brain parenchyma, mainly caused by viruses. To illustrate
and describe the main imaging findings of meningoencephalitis cases diagnosed and monitored in a quaternary hospital
in São Paulo, highlighted by their rarity or tragic outcome.
Methods Involved: To illustrate the different cases of meningoencephalitis will be used MR images obtained in Private Hospital in the city of SP.
Discussion: Patient´s with variable neurological impairment
underwent imaging studies, which demonstrated a pattern of
diffuse parenchymal and / or meningeal involvement, with
peculiar radiological findings that led to specific etiologies,
and subsequent detailed investigation. Clinical and especially
imaging findings were emphasized to characterize these etiologies, with illustration of the typical characteristics in each case.
Conclusion of the presentation: The correct diagnosis of
meningoencephalitis depends on the knowledge of their radiological patterns, highlighting its role in managing, excluding complications, therapeutic monitoring and prognosis.
PD.12.013
Vertigo and its diagnostic challenge computed tomography and magnetic resonance imaging findings - Pictorial Essay.
Authors: NIEMEYER, B.; ROSAS, H.B.; FERREIRA,
C.L.S.; PINTO, L.E.S.; ABREU, P.P.; VIANNA, G.A.G.;
WILNER, N.V.; GASPARETTO, E.L.
Institution: Instituto Estadual do Cérebro Dr Paulo Niemeyer, Rio de Janeiro, Rio de Janeiro, Brasil
Author responsible: Bruno Niemeyer de Freitas Ribeiro
Introduction: Vertigo is defined as body movement illusion or the environment, and this symptom one of the main
reasons for medical appointments and can occur in any age
group. The aim of our work is to present selected cases of
patients with vertigo, documents with computed tomography
(CT) and magnetic resonance imaging (MRI), making from
this, a brief review of current literature and highlighting the
key role of the radiologist to confirm the diagnosis .
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Methods Involved: We selected cases of vertigo, documented by CT and MRI in the last two years, all with diagnostic confirmation.
Discussion: The balance disorders are the result of the vestibular disorders paths (central and peripheral), cerebellar,
and various proprioceptive process of integration of these
with the rest of the central nervous system, each of these requiring a specific approach and treatment, making diagnosis
a challenge for doctor.
Conclusion of the presentation: During the investigation,
detailed medical history, physical examination and complete
evaluation of the vestibular system, for example, hearing
tests lead clinical reasoning toward the diagnosis. However, when suspected central amendment, performing imaging
evaluation with CT and MRI is irreplaceable.
PD.12.019
Practical
assessment
of
dementia
syndromes: what every radiologist
must know.
Authors: BARBOSA, DKG; OLIVEIRA,KA; CAMPOS,HCB; ROCHA,LM; BOMFIM,RC; OLIVEIRA FILHO,HB
Institution: HOSPITAL DO AÇUCAR- ANGIONEURO,
Maceió, Alagoas, Brasil
Author responsible: Danyella Karla Guedes Barbosa
Introduction: Dementia is defined as a clinical syndrome
characterized by the decline of cognitive functions, with inability to perform activities of daily living in a previously
competent individual. In syndromes dementias an imaging
evaluation is always mandatory, it will provide information
that will contribute substantially to the diagnosis with an
MRI being more sensitive in the evaluation. Describing the
imaging findings of the main dementia (Alzheimer\’s disease,
vascular dementia, dementia with Lewy bodies and frontotemporal lobar degeneration).
Methods Involved: This is a pictorial essay based on a database of MRI imaging study performed in our service, combined with brief literature review.
Discussion: In dementia the radiologist must keep two propositions: actively seek treatable causes and distinguish normal aging patterns of those associated with specific diseases.
Conventional and advanced techniques MRI allow a good
accuracy in the differentiation of the main dementia causes,
as specific areas of preferential involvement are observed for
each disease.
Conclusion of the presentation: Evaluation by MRI offers
good parameters in the differential diagnosis in the most
common causes of dementia and it is crucial in the diagnosis,
monitoring and clinical management of these patients.
PD.12.020
Practical assessment of Parkinsonian
Syndromes: what every radiologist
should know.
Authors: OLIVEIRA KA., BOMFIM RC., BARBOSA DKG.,
ROCHA LM., OLIVEIRA FILHO HB., CAMPOS HCB.,
Institution: DIRAD - Hospital Memorial Arthur Ramos,
Maceió, Alagoas, Brasil
Author responsible: Katharine
Introduction: Parkinsonian syndrome is a clinical syndrome characterized by lentification of beginning of volun-
108
teer movements, associated with at least one of the following: resting tremor, muscle stiffness or postural instability.
Among the main causes of parkinsonian syndromes include:
Parkinson\’s disease, corticobasal degeneration, and Parkinson\’s plus syndromes (Progressive Supranuclear Palsy and
Multiple System Atrophy). In this study, we intend to demonstrate the characteristic findings in the leading causes of Parkinsonian syndrome.
Methods Involved: This is a pictorial essay based on a database of Magnetic Resonance imaging study performed in our
service, combined with brief literature review.
Discussion: The differential diagnosis of parkinsonian syndromes has become a challenge, especially in its earliest stages. Evaluation by Magnetic Resonance conventional at this
early stage, offers good parameters in the differential diagnosis of the most common causes of Parkinsonian syndrome.
Conclusion of the presentation: Despite the RM in Parkinson\’s disease present nonspecific characteristics, the systematization in imaging assessment becomes fundamental in the
differential diagnosis of other causes of parkinsonian syndromes, as these have special features.
PD.12.022
Intracranial tumors and patterns of
spread: a useful tool in the radiological
differential diagnosis.
Authors: CASTRO, P.N.; ANDRADE, J.P.; NASCIMENTO, M.L.; QUEIROZ, V.O., BAPTISTA, L.C., MARCA,
P.G.C., ZEITOUNE, R.H., FRANCESCON, P.V.M.
Author responsible: Rachel Zeitoune Hertz
Introduction: Intracranial tumors present with well defined
patterns of spread according to the route of dissemination
and histologic grade. Our aim is to illustrate,through didatic schemes,hematogenous,periventricular,perineural and liquoric pathways of dissemination,and correlate with imaging
findings in MRI simplifying reach the differential diagnosis.
Methods Involved: Each topic below will be according discussed and illustrated: -Epidemiology and main causes of
each pattern of brain neoplasic lesions -MRI imaging protocol for brain neoplasic lesions evaluation -Simple didatic
schemes showing the pathways of neoplasic lesions inside
the brain,specially: perineural dissemination of cystic carcinoma adenomatoyd, periventricular/liquorical infiltration of
GBM, hematogenous metastasis of breast/pulmonary primary malignance -MRI imaging appearance of the most relevant
lesions and when to suspect the primary site according to:
hematogenous, through liquor, periventricular and perineural
pathways of dissemination.
Discussion: A thorough assessment of the spread and tumor
infiltration benefits the identification of dissemination standards, allowing further narrow the differential diagnosis.
Conclusion of the presentation: The pattern of dissemination of metastais within the brain may characterize the primary tumor.Through easy schemes we try to illustrate aspects
of imaging that characterize these routes of dissemination,
favouring the right diagnosis.
PD.12.023
Iron Evaluation in Patients with Multiple
Sclerosis using MRI: literature review
Authors: MELO, HJF.; KACIC,IC
Institution: Centro Universitário São Camilo, São Paulo,
São Paulo, Brasil
Brief description of the purpose of the Review of Literature: Discuss the importance of evaluation of iron deposits
in the brain tissue by magnetic resonance imaging (MRI ) in
patients with multiple sclerosis (MS ).
MS is a chronic progressive and neurological disease of central nervous system (CNS), whose mechanism is associated
with autoimmunity. MRI contributes to early diagnosis and
includes T2-weighted images, FLAIR and pre- and post- contrast T1. Recently importance has been given to studying the
increased iron deposition in the brain of patients with MS
mainly through magnetic resonance techniques (T2-Weighted Images, R2* Relaxometry, Susceptibility Weighted Imaging (SWI) and Magnetic Field Correlation), since excess
of iron can be harmful and can contribute, though oxidative
stress to neuronal death.
Conclusion: The increase in iron levels is observed in several phenotypes mainly in the gray matter , and may be related to physical disability and cognitive due to damage to the
gray matter . The source of iron may be oligodendrocytes
and myelin debris , iron concentrated in macrophages and
vascular damage.
Brief discussion of the case MRI is important to understand
the possible role that iron plays in the pathogenesis , search
possible therapeutic interventions , establish what stage the
iron accumulation occurs and study the possibility of using it
to predict progression.
PD.12.024
Connectivity of the Superior Longitudinal Fasciculus and Speech Disorders in Patients with Congenital Polymicrogyria
Authors: ANDRADE, C. S.; FIGUEIREDO, K. G.; VALERIANO, C.; MENDOZA, M.; VALENTE, K. D.; OTADUY,
M. C. G.; LEITE, C. C.
Institution: Faculdade de Medicina da Universidade de São
Paulo, São Paulo, São Paulo, Brazil
Author responsible: Celi Andrade
Brief description of the purpose of the study: Congenital
polymicrogyria (PMG) is commonly associated with language disorders. The superior longitudinal fasciculus (SLF)
is a major tract involved in language processing, as it connects the Broca’s area (speech production) with Wernicke’s
area (speech comprehension). Our purpose is to evaluate the
integrity of the SLF in a series of patients with PMG and to
correlate the findings with language skills.
Methods: Twelve patients with PMG and 12 matched controls were prospectively evaluated with MRI at 3.0T. The
SLF was virtually dissected with deterministic tractography.
DTI metrics included fractional anisotropy-FA, mean-MD,
axial-AD and radial-RD diffusivities. A smaller subset of patients (n=4) was evaluated to assess language abilities.
Main results: In comparison to controls, patients exhibited
significant decrease of FA (patients: mean±SD=0.43±0.01;
controls: 0.45±0.02, p=0.003) in addition to increase of RD
(patients: mean±SD=0.58±0.02; controls: 0.55±0.02, p=0.03)
in the right SLF. Patients also had increase of MD in the left
SLF (patients: mean±SD=0.76±0.02; controls: 0.74±0.02,
p=0.04). All 4 patients with neuropsychological evaluation
had compromised lexical-semantic and prosodic skills. Two
of the patients with the worst scores exhibited severe disruption of the SLF.
Conclusion of the presentation: DTI and tractography
demonstrated that the SLF was severely disrupted, providing
an anatomical in vivo substrate for language impairment in
patients with PMG.
PD.12.025
Rinorréia secundária a Ecchordosis physaliphora (EP)
Authors: SAKAMOTO S; RIBEIRO DH; VERGILIO CS;
TIBANA LAT; IDAGAWA MH; ABDALA N.
Author responsible: Sylvia Sakamoto
Brief description of the purpose of the report: EP is a rare,
benign, hamartomatous, congenital lesion arising from notochord. Usually is asymptomatic. That tissue is located at the
midline of the craniospinal axis, reaching from the dorsum
sellae to the sacrococcygeal region. Intracranial EP is typically found intradurally in the prepontine cistern where it
is attached to the dorsal surface of the clivus. We describe
a case particularly unusual of such a lesion with extension
through to the sphenoid sinus and consequently rhinorrhea.
Medical History: A 47-years-old woman presented with
a 5-day history of clear, watery, rhinorrhea exacerbated by
leaning forward. No trauma history. On CT bony dissolution of the posterior wall of the left sphenoid sinus/clivus,
communicating it with the liquoric space, evidenced liquid
attenuation filling the sphenoid sinus. On MRI an oval lesion
hyperintense in T2, located posteriorly to the sphenoid sinus/
clivus, with no contrast enhancement.
Diagnosis: Ecchordosis physaliphora associated with fracture and liquoric fistula
Discussion and summary of the case: Knowledge of the
imaging features of EP is useful for the differential diagnosis.
Studies with thin-section images, such as CT and specially
MRI, facilitates the detection and its precise location.
PD.12.026
Ischemic stroke: early signs of CT to MRI.
Authors: SILVA, RR;SALES,LAM
Institution: Hospital Quinta D`or - Rio de Janeiro/RJ, Brasil
Author responsible: Rodolfo Rodrigues Silva Quero
Brief description of the purpose of the study: Ischemic
stroke is a sudden neurological event and medically inaccurate by up to 20% of cases. Imaging methods are essential for
the rapid screening among patients with ischemic event, those
with bleeding accidents. The identification of early CT signs
will be key to the treatment and prognosis of these patients.
The purpose of this essay is to describe the early signs of
ischemic stroke and its correlacção with magnetic resonance.
Methods: We performed analysis of computed topography scans of the brain in patients with a clinical diagnosis
of stroke performed at our institution in the year 2014. The
CT scans were performed with and without intravenous contrast. The MRI used diffusion-weighted sequences, ADC and
FLAIR map.
Main results: The observed signs were tomographic sign
of dense ACM or signal \”point\”, deletion and blurring the
109
interface between the white and gray matter, a sign of \”insular track\”, signal \’disappearance of the basal ganglia. \”The
main finding in the resonance magnetic was the restriction to
difusibilidadade water.
Conclusion of the presentation: Early signs of early ischemic stroke were correlated and confirmed by MRI.
PD.12.027
Demyelination Is Not Always Multiple
Sclerosis
Authors: VENTURA N, FERREIRA C, PITTA P, NIEMEYER B, EMERY L, RUEDA F, ABDALLA G, BAHIA PR,
HYGINO DA CRUZ LC, GASPARETTO EL
Institution: CDPI - Clínica de Diagnóstico por Imagem,
IECPN - INSTITUTO ESTADUAL DO CÉREBRO PAULO NIEMEYER, UFRJ - UNIVERSIDADE FEDERAL DO
RIO DE JANEIRO, RIO DE JANEIRO, RJ, BRASIL
Introduction: Although multiple sclerosis (MS) is the most
known and studied demyelinating disease, demyelinating
processes involving the CNS are related to a wide range of
etiologies, including primary and secondary causes. This exhibit aims to illustrate the main secondary causes of demyelination processes, focusing in the MRI findings that help the
Methods Involved: We selected cases of secondary demyelinating disorders and presented their main MRI findings, such as:
o Acute disseminated encephalomyelitis o HIV encephalitis o
Progressive multifocal leucoencephalitis o Creutzfeldt–Jakob
encephalitis o Osmotic demyelination o Wernicke encephalopathy o Marchiafava–Bignami o Posterior reversible encephalopathy syndrome o Cerebral autosomal dominant arteriopathy
with subcortical infarcts and leucoencephalopathy (CADASIL)
Discussion: Demyelinating processes can be caused by primary and secondary etiologies. The classic example of primary demyelination is MS. However, secondary processes
represent an important group of demyelinating diseases, including infectious, metabolic etiologies, among others.
Conclusion of the presentation: Since the imaging findings
of both groups can be similar, radiologist should be aware of
the special features that favor secondary causes.
PD.12.029
The relationship between cerebellar
activacion and the cerebral cortex and
their connection pathways. Functional
neuroimaging analysis of the normal
patterns.
Authors: Granados AM, Orejuela JF, Baena GP, Rodriguez SY
Institution: Fundación Valle de Lili, Cali, Valle del Cauca,
Colombia
Author responsible: Ana Maria Granados
the normal patterns of cerebellar activation of specific functions (motor, language, memory and visual) and its relationship with the cerebral cortex through connection pathways by
fMRI and DTI.
Methods: Between February 2013 and April 2014, 25
healthy subjects, 17 male and 8 female between 16 and 64
years old, 22 right-handed, 2 left-handed and 1 ambidextrous
were evaluated by fMRI with language, memory, motor and
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visual tasks and DTI with 20 directions in a 1.5 T MRI scanner with a 32-channel antenna. FSL libraries were used for
image processing.
Main results: It was able to characterize a distribution of the
cerebellar activation associated with specific functions and a
relationship with cortical areas through connection and association pathways was demonstrated.
Conclusion of the presentation: The knowledge of the normal activation patterns of the cerebellum and the connection
pathways are important for the clinician and the radiologist in
order to evaluate patients with cerebellar pathology.
PD.12.030
SWI- Phase imaging – Practical applications and pitfalls
Authors: NUNES, R.H.; ABELLO, A.L.; CASTILLO, M.
Institution: UNIVERSITY OF NORTH CAROLINA,
CHAPEL HILL, NORTH CAROLINA, USA
Author responsible: Renato Hoffmann Nunes
Introduction: Susceptibility-weighted phase imaging (SWPI) is generated from the previously acquisition of SW imaging processing after submitted to a filtering process. Deoxyhemoglobin and ferritin are paramagnetic and produce strong
susceptibility effects, while calcium is diamagnetic, showing
a lower susceptibility effect than iron. SWI-PI may exploit the
properties of these components aiming to differentiate them.
Methods Involved: After reviewing our institution teaching files from 2009 through 2014, we selected examples that
aim to address how the phase shift induced by calcification
is opposite to that found with paramagnetic substances like
deoxyhemoglobin, methemoglobin, hemosiderin and ferritin.
Discussion: There are some several conditions in which SWPI is a useful tool in clinical practice. The most relevant are
the differentiation of microcalcifications from micro-bleeds
from small vascular lesions and to identify the calcium components or bleeds in tumors. However, it is important to be
aware of its artifacts, especially, aliasing, which limits the
visualization of large calcified areas and hematomas.
Conclusion of the presentation: We present the utility and
limitations of SW–PI demonstrating its potential as a powerful
imaging tool in the detection, characterization and differentiation of paramagnetic and diamagnetic components in the brain.
PD.12.031
Espontaneous calcium cerebral embolism.
Authors: LOPEZ, A.M.; RODRIGUEZ, C.E.; SANCHEZ,
D.; PALACIOS, R.
Brief description of the purpose of the report: We present
a rare case of cerebral calcium embolism diagnosed in our
center, only 48 cases up to date.
Medical History: A man 79 years old, with no background
of interest, presents himself to emergency with symptoms of
stroke. CT was performed, in which, the only thing noteworthy, was a calcium density image in the left middle cerebral
artery (MCA). After fibrinolysis execution, a control CT was
performed, noticing this image in the same location, although
smaller and associated to another calcium density image in
distal left middle cerebral artery. Magnetic resonance im-
aging (MRI) confirmed the existence of an acute ischaemic
injury on the left MCA territory. The echocardiogram and
carotid doppler were normal.
Diagnosis: The cerebral embolisms are rare. The diagnosis is
established by neuroimaging, mainly through CT and MRI,
although often unnoticed.
Discussion and summary of the case: Calcium cerebral embolisms are exceptional but potentially deadly, it is fundamental the knowledge of the radiologic findings for early an
accurate diagnosis.
PD.12.032
Neurofibromatosis type 1 - Findings in
Computed Tomography and Magnetic Resonance - pictorial essay
Authors: ANTUNES, L.O.; RIBEIRO, B. N.F.; SALATA, T.M.
Institution: HOSPITAL CASA DE PORTUGAL/3D DIAGNÓSTICO POR IMAGEM, RIO DE JANEIRO, RIO DE
JANEIRO, BRASIL.
Author responsible: Livia Antunes
Introduction: Neurofibromatosis type 1 (NF1) also known as
Von Rocklinghausen’s disease, is a more common autosomal
dominant neurocutaneous syndrome, without predilection for
ethnic or racial group. The NF1 gene (17q11.2) is located on
the long arm of chromosome 17. However, the phenotypic
expression is extremely varied. The aim of our work is to
present a personal file with different cases documented by
computed tomography (CT) and magnetic resonance imaging
(MRI), making from this, a brief review of current literature
and highlighting the key role of the radiologist for diagnosis.
Methods Involved: NF1 cases were selected from the personal file of the authors, documented by CT and MRI, dated
between 2010 and 2015.
Discussion: NF1 is a neurocutaneous syndrome that affects
multiple cell types and organ system, with wide range of expression and unpredictable behavior. In clinical practice the
diagnosis is made through characterization of a set of changes that make internationally accepted criteria.
Conclusion of the presentation: NF1 is a complex disease
for the radiologist knowledge of this entity and forms of presentation, for diagnostic confirmation.
PD.12.035
Split Notochord Syndrome: a rare condition
Authors: SOUSA, C.S.M.; BASTOS, B.B.; CASTRO, B.B.;
VELOSO, L.R.M.
Institution: Med Imagem, Teresina, Piauí, Brasil
Author responsible: Camila Soares Moreira de Sousa
late diagnosis of a rare congenital condition.
Medical History: M.A.C.O., female, 36, attended at the
radiology service complaining of paresthesia in his left leg.
The patient had a history of myelomeningocele surgically
corrected at 7 years age. The CT lumbosacral spine revealed
a congenital morphostructural change, compatible with split
notochord syndrome (SNS).
Diagnosis: SNS is a rare congenital malformation, occurring
in both sexes and involving the central nervous system, spinal column, and, sometimes, the gastrointestinal tract. Exact
etiology has not yet established, but it is believed that it is
the result of change in the development of the notochord,
neurenteric canal and paraxial mesoderm, with persistent
connection of endoderm and ectoderm, leading to division or
deviation of the notochord. Condition, in general, diagnosed
in the first months of life or intrauterine, however, in the case
described, there was a delay in diagnosis by precarious health
care in his municipality. The prognosis is poor, but depends
on the approach of associated conditions.
Discussion and summary of the case: The reported case
brings to light the discussion of a rare syndrome, sometimes
serious, but if diagnosed early with investigation of associated conditions, it is possible to improve the overall prognosis.
PD.12.040
Imaging findings and clinical significance of perineural spread of other different tumors of head and neck tumors
Authors: Pereira ML, Abdalla G, Ventura N, Fagundes J
Institution: Instituto Estadual do Cérebro, Rio de Janeiro,
RJ; Clínica de Radiologia Ultrimagem , Juiz de Fora, Minas
Gerais, Brasil
Author responsible: Mariana Leite Pereira
Introduction: The perineural spread of tumors of the head
and neck is a form of known metastatic disease, but other
tumors can spread through the way and is of fundamental
importance to pay attention to the clinical and image data.
Perineural spread implies tumor extension into areas not contiguous along the nerves. Clinical evidence is often lacking
or non-specific, as many patients are initially asymptomatic, hence the importance of constant evaluation. Several tumors may affect such a route, for example, breast cancer and
lymphoproliferative disease.
Methods Involved: Literature review from different literary
sources.
Discussion: Both CT as MRI can help in early detection, although this is the elected. CT findings include enlargement
and foraminal destruction; have the nerve is best evaluated
in MRI T1-weighted fat suppressed. Other findings include
obliteration of fat plane in foraminal openings, neuropathic
atrophy, enlargement of the cavernous sinus and replacement
of the tank trigeminal by soft tissue.
Conclusion of the presentation: The perineural spread pathway is predictable with anatomical knowledge and radiological
appearance, so it is imperative to be familiar beyond become
constant evaluation of these structures to better characterize
the perineural extension and consequent disease staging.
PD.12.043
The Use Of Conventional And Advanced
Magnetic Resonance Imaging Techniques
For The Evaluation Of Dysembryoplastic
Neuroepithelial Tumors
Authors: VENTURA N, FERREIRA C, PITTA P, NIEMEYER B, EMERY L, ABDALLA G, RUEDA F, BAHIA PR,
GASPARETTO EL
IECPN- INSTITUTO ESTADUAL DO CEREBRO PAULO NIEMEYER, UFRJ - UNIVERSIDADE FEDERAL DO
RIO DE JANEIRO, RJ, RJ, BRASIL
Introduction: DNETs are benign, focal, intracortical masses,
commonly superimposed on a background of cortical dysAbstracts of Scientific Papers
111
plasia. Conventional MRI techniques have been successfully used for diagnosing typical lesions. However, advanced
MRI techniques are essencial in the differencial diagnosis,
when the lesion presents atypical features. This exhibit aims
to illustrate the most common MRI findings in DNETs, with
emphasis to the advanced MRI features that can help in the
Methods Involved: We have collected imaging data of several
cases of DNETs, and presented the main clincal issues, the most
common imaging findings, using convencional and advanced MRI
techniques and main differential diagnosis, such as: Cortical dysplasia Ganglioglioma Pleomorphic xanthoastrocytoma Gliomas.
Discussion: DNETs represent approximately 1-2% of primary brain tumors in patients under 20 years and are an important cause of longstanding partial complex seizures. Advanced
MRI findings are helpful in defining the differential diagnosis
when the lesions present atypical features, such as pronouced
contrast enhancement.
Conclusion of the presentation: Radiologist should be
aware of the main imaging features, as well as the main differential diagnosis, since cortical lesions have different treatment strategies and prognosis.
PD.12.044
Toxic /metabolites brain injuries
Authors: VENTURA N, PITTA P, FERREIRA C, FAGUNDES J, NIEMEYER B, EMERY L, ABDALLA G, HYGINO
DA CRUZ LC, GASPARETTO EL
RIO DE JANEIRO, Rio de Janeiro, Rio de Janeiro, Brasil
Introduction: Several toxins and metabolites can cause brain
damage in a wide spectrum of presentation. Some typical imaging patterns can be high specific and help narrowing the
differential diagnosis. This exhibit aims to illustrate the most
common imaging findings related to brain toxicity.
Methods Involved: We selected cases of toxic brain injuries
and ther main differential diagnosis and MRI features: • Drug
abuse: alcohol, cocaine, and marijuana. • Vitamin deficiency:
B12, tiamine. • Gas toxicity: carbon monoxide • Metabolic
encephalopathies: hypoglycemia, hepatic encephalopathy, osmotic pontine myelinolysis, global hypoxic-ischemic injury.
Discussion: Drug abuse, gas toxicity, vitamin deficiency and
metabolic encephalopathies are the main causes of toxic/metabolic brain damage. MRI can often show the damage at both
early and delayed phases of the disease and plays a vital role
in detection and characterization of these disorders.
Conclusion of the presentation: Familiarity with the main
imaging findings of several toxic injuries to the brain may help
narrow the differential diagnosis in cases of acute encephalopathies. Some mentioned disorder such as drug abuse and vitamin deficiency should prompt the radiologist to search for coexisting pathologic conditions, which may alter management.
PD.12.046
Initial assessment of PET/MRI in patients
with neurofibromatosis type 1
Authors: NUNES, R.H.; RAMALHO, J.; LEE, Y.; CASTILLO, M.
112
Brief description of the purpose of the study: Neurofibromatosis type 1 (NF1) patients are commonly imaged to
assess disease progression. Our purpose is to assess whole
body FDG PET/MRI sensitivity for detection of plexiform
neurofibromas and optic pathway gliomas, its sensitivity for
FDG avid lesions localization and compare its results with
those of conventional MRI studies.
Methods: Using whole body PET/MRI NF1 patients from a
single institution were evaluated. Whole body MRI was performed and dedicated sequences through the optic pathways
were additionally acquired. Fused MR/PET images were analyzed and maximum standardized uptake value was recorded for all lesions. The MR images were also correlated with
conventional MR images obtained previously.
Main results: 11 patients were included (4 with recently
local pain). All lesions were demonstrated comparing with
the previous conventional MRI and were enough to assess
location and extension. No uptake of FDG in any lesions in
the asymptomatic patients was revealed, while in the symptomatic patients, it demonstrated one tumor with FDG uptake
and also areas with uptake restricted to muscles surrounding
the tumors, suggesting that the pain did not originate from
the tumors.
Conclusion of the presentation: Whole body PET/MRI
study was sufficient to assess the structural and metabolic behavior of the NF1 lesions, providing better comprehension of
the clinical manifestations.
PD.12.047
Non-neoplastic intracranial cystic lesions: pictorial essay
Authors: FASSBENDER CPB., COSTA AS., MELO D M.,
ZANGIACOMO RN., GUEDES VHCC., SOUZA ECF.,
VERGILIO CS., CARVALHO RS.
Author responsible: Cecília Peçanha Bogado Fassbender
Introduction: Several cystic lesions can be identified in the
brain imaging studies. The etiology and histopathologic spectrum of these lesions are variable, covering a wide range of
differential diagnoses. Some are incidental and without clinical significance. Others can cause life-threatening symptoms.
Methods Involved: Pictorial Essay of cases of computed tomography and magnetic resonance imaging performed on patients with intracranial cysts obtained from a digital file from
a reference hospital in neurology.
Discussion: The most used division of intracranial cysts is
based on its location and the histology of its walls. The exact location of an intracranial cystic lesion is essential for diagnostic definition. Among them, stand out: arachnoid cyst,
dermoid cyst, epidermoid cyst, pineal cyst, choroid plexus
cyst,ependimary cyst, neuroglial cyst, prominent vascular
spaces, parasitic cysts, porencephalic cyst, neuroenteric cyst
and after radiotherapy cysts. In addition, some cystic lesions
may be associated with extra-axial tumors, as meningiomas
or schwannomas.
Conclusion of the presentation: The various intracranial
cystic lesions represent a diagnostic challenge. Combined
with clinical data, such as patient age, magnetic resonance
imaging and computed tomography play a key role on its diagnosis by identifying its location and main imaging features.
PD.12.048
SWI Hot Topics: Clinical Applications In
Brain And Spine
Authors: VENTURA N, FERREIRA C, PITTA P, NIEMEYER B, EMERY L, ABDALLA G, FAGUNDES J, HYGINO
DA CRUZ LC, BAHIA PR, RUEDA F, GASPARETTO EL
RIO DE JANEIRO, Rio de Janeiro, Rio de Janeiro, Brasil
Introduction: The susceptibility-weighted phase MR imaging (SWI) is a recently described sequence that has an exquisite sensitivity to the venous vasculature, blood products and
calcification. This sequence can be widely used to help the
differential diagnosis among brain and spine disorders. This
exhibit aims to discuss the main applications of SWI underlying brain and spinal cord conditions.
Methods Involved: We reviewed the principles of SWI imaging, presented our imaging protocol and main clinical applications of SWI, such as: - in the brain: Traumatic brain injury; Vascular malformations; Cerebral micro bleeds ; Stroke;
Brain tumors - in the spine: Trauma;Vascular malformations.
Discussion: Abnormal vasculature, blood products deposits and calcification are features that can be histologically
demonstrated in many brain and spinal cord lesions and their
demonstration within SWI sequences can help the differential
diagnosis. SWI is more sensitive than T2*-weighted gradient
echo for demonstrating blood products deposits and calcification and Susceptibility-weighted MR phase imaging can help
in the differentiation between both of them. Tumors, trauma,
vascular abnormalities and cerebral micro bleeds are the main
clinical application for SWI of the brain and spinal cord.
Conclusion of the presentation: Radiologist should be
aware of the main clinical application of this recently described sequence in order to improve diagnosis.
PD.12.049
INTRACRANIAL MENINGIOMAS - THE PLEOMORFISM AND THE RARE ASPECTS OF A COMMON TUMOR
Emery L; Abdalla G.; Gasparetto, E.
Institution: Instituto Estadual do Cérebro Paulo Niemeyer
- IEC / RJ
Introduction: Demonstrate the less common aspects in the
presentation of meningiomas, correlating with histologic
types identified and the importance of recognizing radiological aspects in the diagnosis of these tumors in spite of its
location and demographic characteristics.
Methods Involved: We retrospectively reviewed all cases of
meningiomas diagnosed in our department, with histopathological confirmation, and selected those with unusual presentations in young, non-syndromic multiple lesions and those
involving the posterior fossa.
Discussion: Meningiomas are tumors derived from meningothelial cells and account for about 25-33% of intracranial
primary tumors. Although they may have any location, predominate in the supratentorial compartment. These tumors
are classically diagnosed in middle-aged or elderly patients,
with a peak incidence between the 6th and 7th decades. They
tend to be unique when outside the context of the neurofibromatosis type II syndrome.
Conclusion of the presentation: Although extremely prevalent tumors in daily radiology practice, especially at a neurossurgical center, meningiomas have an extreme pleomorphism
at presentation. Unlike the literature, the cases presented
demonstrate the unusual aspects of this very frequent tumor,
correlating with histologic types identified and demonstrating
the importance of radiological features in diagnosis despite
possible unusual presentations.
PD.12.052
Multifocal Dysembryoplastic Neuroepithelial Tumour– a rare presentation Case Report and literature review
Abdalla, G.; Emery L; Gasparetto, E.
Institution: Instituto Estadual do Cérebro - IEC / RJ
case of multifocal dysembryoplastic neuroepithelial tumour
(DNET) presentation and late diagnosis and review the literature of this rare form of presentation.
Medical History: IRS, 28 performed magnetic resonance
imaging (MRI) for intractable epilepsy investigation.
Diagnosis: MRI showed a cortical lesion suggestive of
DNET in the right frontal lobe. Two other similar lesions
were identified on the base of the left frontal lobe and ipsilateral convexity. The DNET is a cortical and supratentorial
benign tumor grade I, WHO (2007) classification. Usually
affects young people, often observed in the temporal lobe and
is a recognized cause of intractable epilepsy. Due to its location and signal characteristics on MRI studies, in general the
presumptive diagnosis with high margin of safety is possible.
In our case, due to the difficulty of clinical control of the seizures, it was opted for the removal of the epileptogenic lesion
in the multidisciplinary evaluation.
Discussion and summary of the case: Since its description
in 2007 the WHO classification, the DNET\’s have been diagnosed presumptively on MRI studies increasingly and with
high safety margin, however, reports of multicentric lesions,
as in the case reported, remain to be extremely rare.
PD.12.056
Comparison of cerebral blood volume
and plasma volume values in untreated
brain lesions
Authors: NUNES, R.H.; BAZYAR, S.; RAMALHO, J.;
FRANCESCHI, A.M.; LEE, Y.; CASTILLO, M.
Brief description of the purpose of the study: Cerebral
blood volume (CBV) and plasma volume (Vp) allow the
noninvasive assessment of the brain’s microvasculature, representing related vascular spaces. However its acquisition
utilizes significantly different approaches and modeling assumptions. Our purpose was to examine the equivalence of
CBV and Vp, and its potential for distinguishing different
types of intracranial lesions.
113
Methods: Patients were scanned with a standard clinical protocol that included both dynamic contrast enhancement and
dynamic susceptibility contrast. Our study population included 27 histologically proven untreated newly diagnosed brain
tumor patients: 6 grade IV gliomas, 7 meningiomas 14 and
metastasis. ROIs were measured in all lesions, in a standard
manner. Rational regional CBV (rrCBV) and Vp were calculated based ROIs accessed. Statistical analyses were performed with Pearson and Spearman correlations.
Main results: rrCBV and Vp correlation was better in meningioma (Pearson correlation=0.859, Spearman correlation
coefficient=0.641, P <0.01), than in gliomas (Pearson correlation=0.546, Spearman correlation coefficient=0.649, P
<0.01). This relation was not significant in metastatic lesions.
Conclusion of the presentation: Vp and rrCBV represent
more significantly different vascular processes than their
definitions would initially suggest. Furthermore, examining
the relationship between rrCBV and Vp may help differentiate these entities.
PD.12.058
X-Linked adrenoleukodystrophy MRI:
A pictorial essay to emphasize unusual
patterns.
Authors: ALVES, H.C.B.R.; NUNES, R.H.; AMARAL,.L.F.; ROCHA, A.J.
São Paulo, Brasil
Author responsible: Heitor Castelo Branco Rodrigues Alves
Introduction: X-Linked adrenoleukodystrophy (X-ALD) is
a peroximal disorder that has a wide range of clinical manifestations. Usually, X-ALD presents with bilateral symmetric involvement of the parieto-occipital white matter (WM).
However, different MR imaging patterns have been described
that do not conform to the typical pattern. To review the pathophysiology of X-Linked adrenoleukodystrophy (X-ALD) To
review recognizable neuroimaging patterns of X-ALD Emphasizing atypical brain patterns in X-ALD using conventional MRI. Reviewing the role of advanced MR techniques
to better comprehend in vivo X-ALD pathophysiology.
Methods Involved: Our current aim was to study a selected
series of X-ALD patients (n=12) with unusual MR findings to
didactically list recognizable features, including topography
and Gd-enhancement patterns. Frontal lobe (anterior pattern),
exclusive unilateral (infra or supratentorial disease) and also,
either diffuse bilateral, posterior or anterior asymmetrical
WM lesions were all scrutinized.
Discussion: Advanced MR techniques, including DTI, tractography and MRS, were useful to show involved structures and
also to detect early T2/FLAIR unsuspected WM involvement.
Conclusion of the presentation: Radiologists must be aware
to recognize X-ALD based on both conventional and advanced MR techniques, in its typical or atypical presentations
of this rare disease.
PD.12.060
CHIARI MALFORMATIONS: SUBTYPES, PRESENTATIONS TYPICAL AND VARIATIONS IN COMPUTED TOMOGRAPHY AND MAGNETIC RESONANCE.
Authors: CAMILO, ML; VERGILIO, CS; CARVALHO,
RS; GUEDES, VHCC; MELO, DM; RV;ZANGIACOMO,
114
RN; COSTA, AS; FASSBENDER, CPB;
Author responsible: Matheus Lobo Camilo
Introduction: Introduction: The Chiari malformations (MCH)
were initially described as a group of posterior fossa malformations associated with hydrocephalus and divided into three
main groups: Chiari I, II and III with different findings.
Methods Involved: MATERIALS AND METHODS: a pictorial study in cases with suspected HCM in a large hospital
undergoing CT and MRI was performed in the last 5 years.
Discussion: Currently some authors have included some
variants described as Chiari 0, 1.5, 4 and 5. The diagnosis can
be performed by computed tomography (CT) and Magnetic
Resonance Imaging (MRI).
Conclusion of the presentation: RESULTS: The various
types of MCH are sometimes difficult differential diagnosis,
requiring careful analysis to their proper classification. Keywords: Chiari malformations, New variants.
PD.12.061
GANGLIOGLIOMA INTRAVENTRICULAR WITH
CSF DISSEMINATION: CASE REPORT.
Authors: PITTA, P; FERREIRA, CS; VENTURA, N; NIEMYER, B; EMERY, L; ABDALLA G; FAGUNDES, J;
GASPARETTO, E.
Institution: INSTITUTO ESTADUAL DO CÉREBRO
a case of intraventricular ganglioglioma a 26 year old patient
with a history of seizures , headache and blurred vision with
further spread via CSF.
Medical History: Female patient of 26 years with a history
of generalized tonic-clonic seizures , headache and blurred
vision with mass lesion in the third ventricle extending to the
left lateral ventricle and fourth ventricle , and hydrocephalus.
Resection of the lesion with resolution of hydrocephalus was
performed . Was subsequently performed lumbar puncture and
MRI neuraxial which spread via CSF tumor signs were seen .
Diagnosis: Histopathologic diagnosis was ganglioglioma
grade I of WHO. Gangliogliomas glioneuronal tumors are
often associated with seizures. The most frequent location of
these lesions is cortical in the temporal lobes , but can be
found in any location in the central nervous system , with
an intraventricular location with consequent hydrocephalus
quite unusual with few reports in the literature. Neoplasms
are commonly benign but in some cases may undergo malignant transformation and spread via CSF .
Discussion and summary of the case: Gangliogliomas are
mixed neoplasms often located in the temporal lobes of young
adults with seizures . We report a case of intraventricular gangliglioma , an atypical location, with CSF spread signals.
PD.12.063
Central Nervous System Neoplasms associated with Neurocutaneous Syndromes:
pictorial essay
Authors: LIMA, M.R.; STRIEDER, D.L.; RIBEIRO, G.J.;
SIECK, G.G.; SCORTEGAGNA, F.A.; PEREZ, J.A.
Introduction: Neurocutaneous syndromes, also known as
phakomatoses, are a group of congenital diseases that present with neurological, cutaneous and ocular manifestations.
Their prevalence is variable and many can develop Central
Nervous System (CNS) neoplasms. The goal of this essay is
to present the main syndromes that present CNS neoplasms
as one of its aspects, highlighting the most prevalente types
and its imaging characteristics.
Methods Involved: Review of the most frequent neurocutaneous syndromes, pointing out the CNS neoplasms that
commonly develop in association, illustrated by Magnetic
Resonance Imaging images in order to discuss its leading
morphologic characteristics e secondary findings that can
help the diagnosis.
Discussion: The most common neurocutaneous syndromes
are Neurofibromatosis Type I, Neurofibromatosis Type II,
Tuberous Sclerosis complex and von-Hippel-Lindau Disease.
All of them are usually associated with CNS neoplasms like
plexiform neurofibroma, astrocytoma, meningioma, ependymoma and hemangioblastoma. Specific association between
the tumor type and CNS supporting findings allow an accurate etiologic diagnosis.
Conclusion of the presentation: Phakomatosis normally
present specific association with some CNS neoplasms. Aknowledgement of this lesions’ and the complimentary findings’ imaging characteristics, specially at MRI, allow a precise disease definition and an appropriate clinical follow up
for the patients.
PD.12.064
Otogenic Spontaneous pneumocephalus:
case report
Authors: DE TONI, F.S.; SANDRINI, H.V.; TESTONI,
N.M.; HOFFMANN, J.
Brief description of the purpose of the report: Pneumoencephalus detection in CT skull from young man, with no
history of trauma, surgery or ear disease.
Medical History: 35 year old man with history of pulsatile
headache for 15 days associated with nausea and vomiting.
Medical past of HIV +, without treatment, alcoholism, smoking, drug user.
Diagnosis: Pneumocephalus is caused by trauma, tumor, radiation therapy, infection and, rarely, spontaneous reasons. The
latter includes mastoid hyperpneumatization. Only 14 cases of
spontaneous pneumocephalus associated with mastoid hyperpneumatization have been described in the literature. We believe
this may be the fifteenth case. Usually occurs in patients between 20 – 78 years and the first symptom was headache after
performing the Valsalva maneuver. Neurologic alterations such
as aphasia, hemianopsia, otogenic cerebrospinal fluid leakage,
and hemiparesis have been described in isolated cases. Auditory symptoms such as aural fullness and tinnitus were rare.
Discussion and summary of the case: Spontaneous pneumocephalus is rare and not well described in the literature.
Has been associated with temporal bone defects and mastoid
hyperpneumatization. Auditory symptoms are rare. Headache related to pressure variations and the Valsalva maneuver
is a common and valuable finding in the diagnosis and management of neurologic manifestations and complications.
PD.12.065
Intraventricular tumors - differential
diagnosis and pictorial essay
Authors: ABDALLA G.; VENTURA, N; FAGUNDES,
J; FERREIRA, C.S.; PEREIRA ML; PITTA P; EMERY L;
NIEMEYER B;GASPARETTO, E.
Institution: IECPN - INSTITUTO ESTADUAL DO CÉREBRO PAULO NIEMEYER, RIO DE JANEIRO, RJ, BRASIL
Introduction: The objective of this paper is to show the image aspect of the main tumors affecting the ventricular system.
Methods Involved: The key images for a accurate diagnosis
among the diagnostic possibilities of intraventricular tumors
were separated from exams available in our database.
Discussion: Intraventricular tumors are not rare, but it is
extremely important to differentiate between the diagnostic
possibilities, by the methods of images to a suitable therapeutic and surgical planning. Tumors in this paper are meningioma, ependymoma, papilloma, the neurocytomas, oligodendroglioma, among others.
Conclusion of the presentation: It is important for the radiologist knowledge of imaging features the major intraventricular
tumors, for a pre-surgical assistance and appropriate therapy.
PD.12.068
PYLOCYTIC CEREBELLAR ASTROCYTOMA: WHICH IMAGING ASPECTS SHOULD THE RADIOLOGY
CONSIDER?
Authors: Figueiras, FN; Duarte,ML; Villar,AA; Ferreira,CBA; Ferreira,JBA
Institution: Irmandade da Santa Casa de Misericórdia de
Santos, Santos, São Paulo, Brasil
Author responsible: Felipe Nunes Figueiras
Brief description of the purpose of the Review of Literature: Compare radiological aspects of a typical cerebral neoplasia, contrasting to its main differential diagnosis.
Primary brain tumors represents the most common solid mass
in children, comprising approximately 20% of all pediatric
neoplasias. Typically, it affects the posterior fossa. The most
frequent tumors in this location are: Pilocytic astrocytoma,
medulloblastoma and ependymoma. Headache and nausea
are the most frequent symptoms presented, due to hydrocephaly secondary to ventricular obstruction. Imaging methods,
particularly computadorized tomography and magnetic resonance imaging have high sensitivity and accuracy to diagnose
this condition, as well as its main differential diagnosis. A literature review was performed, comparing the main radiological aspects; Radiographics, Pubmed, Scielo and Cochrane
database were analyzed using the keywords Pilocytic astrocytoma, medulloblastoma, ependymoma, computadorized
tomography and diagnose.
Conclusion: It is important to recognize the typical imaging
aspect of an aggressive pylocitic astrocytoma, which may
lead to some misdiagnosis. Rarely an astrocytoma suffers a
malignant transformation, in which case it is known as an
anaplasic pylocitic astrocytoma.
Brief discussion of the case Even considering the benign
evolution of this neoplasia, the follow up with imaging studies, particularly with MRI, is essential to the prognosis of
this disease.
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PD.12.069
Cerebral Chagas Disease in cardiac
transplant patient mimicking Posttransplant Lymphoproliferative Disease (PTLD)
Authors: LANDEIRA, FLF; AMARAL, LLF; GARCIA,
LAL; CAMPOS, CMS; LOPES, BSC; MARUSSI, VHR;
FREITAS, LL; SANTOS, APSD
Institution: HOSPITAL BENEFICENCIA PORTUGUESA
DE SAO PAULO, SAO PAULO, BRASIL
Author responsible: Felipe Landeira
illustrating Chagas Disease as an important differential diagnosis of tumor-like brain lesions in immunosupressed patients, and literature review.
Medical History: We present the case of a 65-year-old woman presenting with sudden left hemifacial paresthesia and
paresis. In use of immunosupressants due to chagasic cardiomyopathy and cardiac transplantation.
Diagnosis: Magnetic resonance imaging of the brain showed
multiple subcortical brain convexity ring-enhancing lesions,
and spectrometry findings suggesting chronic inflammation.
Histopathological analysis after brain biopsy diagnosed T.
cruzi infection. It is estimated that eighteen million people
are infected worldwide with T. cruzi, most in Latin America,
leading to 50000 deaths each year. Immunosupression states
may lead to disease reactivation, mainly in nervous system
(70-85%), being meningoencephalitis its most common presentation , as tumor-like lesions that resemble Toxoplasma
encephalitis. Radiological images alone are insufficient for
a definitive diagnosis, so brain biopsy and histopathological
findings of T. cruzi infection are usually required.
Discussion and summary of the case: Chagas disease should
be included in the differential diagnosis of cerebral lesions in
immunosupressed patients, particularly in those in whom lesions are not responsive to antitoxoplasmosis treatment.
PD.12.073
Giant myxopapillary ependymomas of
the sacrum - case report and literature
review.
Authors: SCOPPETTA, T.L.P.D.; NUNES, R.H.; ROCHA, A.J.
São Paulo, Brasil
Author responsible: Thiago Luiz Pereira Donoso Scoppetta
Brief description of the purpose of the report: Myxopapillary ependymomas(MPEs) are a benign slow-growing
tumor, which arise from the ependymal glia of the filum
terminale, and, thus, are tipically intradural. However, rarely presents as expansive sacral lesion with extensive bone
destruction, being included in the differential diagnosis of
primary sacral tumors.
Medical History: A 29-year-old man presented with 3-year
history of back pain with radiation to the lower limbs and urinary incontinence. Radiologic investigation depicted a massive osteolytic sacral lesion with intradural extension from
the conus medullaris to the sacrum.
Diagnosis: The pathological diagnosis was MPE, a benign
tumor classified as grade I by WHO. The clinical picture is
indolent and nonspecific, often presenting as back pain and
116
neurological deficit. The MPE occurs almost exclusively in
the conus level, representing 83% of the tumors in this region. A rare form of presentation is when it gets large dimensions and is located near the sacrum and may determine bone
destruction and mimic primary or secondary sacral tumors.
This presentation is very rare, and the case described confronted with fewer than 50 reports in the international literature, supporting the diagnosis.
Discussion and summary of the case: Radiologist must be
aware of the differents forms of presentation of the MPRs,
witch can mimic primary or metastatic tumors of the sacrum.
PD.12.075
Imaging findings correlation between
transfontanellar US and brain MRI in
newborn encephalopathy
Authors: RODRIGUES M.A.S.; RODRIGUES D.P.; YAMANARI M.G.I.; DALAQUA M.; ;BARBOSA JR. A.A;
SAMESHIMA Y.T.; FRANCISCO NETO M.J.; FUNARI
M.B.G.
São Paulo, Brasil
Introduction: The most common etiology of non progressive encephalopathy is of hypoxicischemic origin, however
severe neurological deficits in the prenatal and neonatal period may be triggered by other causes. This study aims to correlate imaging findings of transfontanellar ultrasonography
(US) and magnetic resonance imaging (MRI) in meningoencephalitis, ischemic infarcts and of germinal matrix hemorrhage cases, focusing on changes of image and known poor
prognostic factors, such as involvement of the posterior limb
of the internal capsule and its association with motor deficits.
Methods Involved: Review of medical records and images.
Discussion: The evaluated US and MRI methods proved to
be complementary, in which both are important in the assessments of complications and detecting characteristic patterns
of brain lesions, which correlated well with severity, prognosis, and degree of brain maturity at the time of injury. Those
factors correlated with worse outcomes such as diffusion restrictions, involvement of the perirolandic cortex, posterior
limb of internal capsule and thalamus were also evaluated.
Conclusion of the presentation: The best method that
achieves better neurological impairment diagnosis in neonatology is the one that respects the severity of the patient, is
promptly available, and is capable to draw an accurate distinction between normal and abnormal imaging findings.
PD.12.076
Transient cerebral arteriopathy as cause of ischemic stroke in children
Authors: RODRIGUES M.A.S.; VAZOLLER M.R.; YAMANARI M.G.I.; DALAQUA M.; SAMESHIMA Y.T;
BARBOSA JR. A.A; .; FRANCISCO NETO M.J.; FUNARI
M.B.G.
São Paulo, Brasil
Introduction: Cerebral infarction is an important cause of
neurological disability in children, for which prognosis relies
on the extent of involvement and associated diseases.This
study was developed in order to better understand this disease in childhood, which is rare and not as clear as in adults.
Methods Involved: We evaluated three cases of stroke in the territory of middle cerebral artery: two related to infection (chickenpox and mycoplasma), and one idiopathic. Patients were
evaluated by transfontanellar ultrasonography (US), computed
tomography (CT) and magnetic resonance imaging (MRI).
Discussion: Correct assessment of damage extension and imaging patterns in these patients helps to narrow differential
diagnosis, estimate their severity and prognosis and provide
valuable data for treatment planning.
Conclusion of the presentation: MRI identified and better
defined anatomy of infarcted areas and allowed its functional
analysis by depicting diffusion-perfusion mismatches. Transfontanellar US had strong correlation with MRI findings in
the case of varicella vasculitis, was helpful for follow-up
analysis in those with meningoencephalitis, and also adequate for detecting subtle initial findings.
PD.12.078
TUMORS MENINGOTHELIAL: SUBTYPES, TYPICAL AND ATYPICAL PRESENTATIONS IN COMPUTED TOMOGRAPHY AND MRI.
Authors: CAMILO, ML; VERGILIO, CS; BARROS, EG;
GUEDES, VHCC;NEGRI, RV;ZANGIACOMO, RN; COSTA, AS; FASSBENDER, CPB;
Author responsible: Matheus Lobo Camilo
Introduction: . Introduction: menigoteliais tumors (TME)
originates in the meninges and are the most common intracranial tumors. They are divided into three levels by the World
Health Organization (WHO), benign meningioma, atypical
meningioma and anaplastic meningiomas which are respectively stages I, II and III.
Methods Involved: MATERIALS AND METHODS: We
conducted a pictorial study in cases suspected of TME in a
large hospital underwent computed tomography (CT) and
magnetic resonance imaging (MRI) in the last five years.
Discussion: Are extra axial tumors that originated in meningothelial cells of the arachnoid being found in different locations and with different aspects of image.
Conclusion of the presentation: RESULTS: The TME normally present location and appearance of typical images and
sometimes are in unusual locations and simulating tumors of
different origins. Diagnostic CT and MRI are of great importance and good accuracy. Keywords: meningioma, extra axial
tumors, atypical presentations.
PD.12.079
POSTERIOR REVERSIBLE ENCEPHALOPHATY
SYNDROME ASSOCIATED WITH HENOCH-SCHÖNLEIN PURPURA: CASE REPORT AND LITERATURE
REVIEW
Authors: LANGER, F.W.; DOS SANTOS, D.; ALVES,
G.R.T.; DOS SANTOS, T.; NETO, W.T.P.
Institution: UNIVERSIDADE LUTERANA DO BRASIL,
CANOAS, RIO GRANDE DO SUL, BRASIL
Author responsible: Giordano Rafael Tronco Alves
an unusual case of posterior reversible encephalopathy syn-
drome (PRES) in a young female patient with Henoch-Shönlein purpura (HSP).
Medical History: A seven-year-old female patient with HSP
was admitted to our hospital with a one-week history of abdominal pain, vomiting and inappetence. On physical examination, multiple purpuric eruptions were noted on her skin.
Five days after admission, she presented acute kidney failure,
seizures, hypertension, headache and blindness. Findings of
magnetic resonance imaging (MRI) detected an image compatible with PRES. Clinical symptoms improved few hours
after antihypertensive and anticonvulsant therapies. She presented complete clinical recovery, being asymptomatic one
year after the episode.
Diagnosis: HSP is the most common vasculitis of childhood,
characterized by cutaneous, intestinal, articular and renal involvement. Neurological complications are uncommon, and
cases of PRES secondary to HSP were rarely described in the
literature. MRI is considered the main imaging modality to
diagnose PRES. Blood pressure control and monitoring of
kidney function are the cornerstones of treatment in patients
with HSP and PRES.
Discussion and summary of the case: PRES is a potentially fatal condition, and radiological examination should be
prompted early. Although rare, clinicians should be aware of
PRES as a possible complication of HSP.
PD.12.080
Moebius syndrome: report of two cases
and literature review.
Authors: BARRETO, L.E.; REIS, L.M.; BRITO, M.C.B.;
NOBREGA, R.R.; BARHUM, R.S.; PRADO, J.L.M.A.;
SCOPPETTA, T.L.D; SCOPPETTA, L.C.D.
Paulo, Brasil
Author responsible: Luiz Eduardo Barreto
a case of Moebius syndrome, a rare congenital neurological
disorder, discussing their clinical and radiological findings.
Medical History: Case 1: Newborn, extremely premature
(31 weeks), with strabismus, facial diparesis, dysphagia and
bilateral congenital clubfoot. Imaging studies showed punctate calcifications in the topography of the nuclei of the VI
and VII cranial nerves and lack of facial nerves bilaterally.
Case 2: Newborn with bilateral facial palsy signs. Mother
reported use of misoprostol during pregnancy. Computed tomography showed punctate calcifications in the topography
of the VI and VII cranial nerves bilaterally.
Diagnosis: Moebius syndrome is characterized by paresis or
paralysis of the facial muscles, and ophthalmoplegia by damage to the abducens nerves. Mainly VI and VII cranial nerves
are involved, but other nerves may also be affected. Other findings are deformities in the feet, hands, jaw and chest wall. Most
patients have intelligence and normal cognitive development.
Discussion and summary of the case: Two cases of Moebius syndrome, with description of the clinical and radiological
findings.
PD.12.081
Only the Spot Sign accurately predicts
risk of expansion in primary Intracerebral hemorrhage ?
Authors: ROSA JR., M.; MAIA JR., A.C.M.; ROCHA, A.J.
117
Institution: Santa Casa de São Paulo, São Paulo, SP, Brasil
Author responsible: Marcos Rosa Junior
Brief description of the purpose of the study: The active
extravasation of contrast (spot sign) within the intracerebral
hemorrhage (ICH) has been extensively studied as a predictor of expansion in primary and secondary hemorrhage and
in traumatic brain injuries. We aimed to study the group of
patients without the presence of spot sign (in primary ICH),
if any factor could also predict the expansion of the volume
of the hemorrhage.
Methods: We studied 124 patients with primary ICH during the
period 2011-2013, with multidetector computed tomography
and separate those who did not presented spot sign (73 patients).
Main results: We found some factors that can be predictors
of hemorrhage expansion in this particular group of patients,
in particular the form and the attenuation of HIC.
Conclusion of the presentation: In the absence of the sign
spot, there are other factors that can be used to predict the risk
of ICH expansion in patients with primary ICH, principally
attenuation of hemorrhage.
the study of the central nervous system and aid in detection of
neurofibromatosis are computed tomography (CT) and magnetic resonance imaging (MRI).
Discussion: The aim of this study is to formulate and review
briefly , by exposing selected cases of our service , the neurofibromatosis on CT and MRI.
Conclusion of the presentation: Knowledge of typical appearances of central nervous system abnormalities provides a
more reliable and accurate diagnosis, as well as the classification of neufibromatosis and their differential diagnoses; and
also better targeting of therapeutic procedures and ultimately
improve the bottom line.
PD.17.022
Differential diagnosis of lesions with tumoral appearance in the cavernous sinus.
Authors: Ferraciolli, SF; Leite, CC; Lucato, LT; Santos, GT.
Institution: InRad - FMUSP - São Paulo -São Paulo
Author responsible: Suely Fazio Ferraciolli
Introduction: The cavernous sinuses are affected by various
types of lesions because of its relationship with different anatomical structures such as the skull base , sella turcica, orbit,
vessels and cranial nerves.
Methods Involved: A retrospective study from the university neuroradiology file, selecting computed tomography
and magnetic resonance imaging of cases with predominant involvement of the cavernous sinus. Performed a literature review.
Discussion: Vascular lesions will not be addressed in this
study. Our focus will be the lesions with tumoral appearance,
as perineural spread of facial tumors, extension of nasopharyngeal tumors, dural metastases, meningiomas, lymphomas
and pseudotumors.
Conclusion of the presentation: Recognize and differentiate these tumors and pseudotumors is useful for the correct
diagnostic interpretation, with consequent improvement in a
better clinical management of the case.
Brain involvement on Whipple disease:
magnetic resonance findings and review
of the literature
Authors: MAHFOUZ, K; SANTOS, G.R.; MARTINS,
J.E.V.; UTIDA, H.M; WENDLING, L.U.; TORRES, L.F.B;
BERTHOLDO, D.B.
Institution: Hospital de Clínicas da Universidade Federal do
Paraná , Curitiba, Paraná, Brasil
Author responsible: Kassia Mahfouz
Brief description of the purpose of the report: Approximately 33% of patients with Whipple disease (WD) present
with neurological symptoms. Magnetic resonance imaging
(MRI) findings of brain involvement in WD are still under-reported. We aimed to report a case of this variant of WD, describe the MRI findings and review the literature.
Medical History: Woman, 26 yo, started eight years ago
with tremor in the left upper limb, progressing to cephalic
tremor, gait and speech abnormalities. Brain MRI showed lesions in the white matter, thalamus, midbrain, pons and cerebellar peduncles. Periventricular lesions were similar to multiple sclerosis lesions. However, the extensive midbrain and
thalamic lesions and the clinical history were not consistent
with this diagnosis. Due to theses imaging findings, WD was
suspected. Duodenal biopsy was positive for WD.
Diagnosis: The diagnosis of WD is established by histological or molecular methods such as polymerase chain reaction
(PCR). Antibiotic therapy may have significant impact on
morbidity and mortality.
Discussion and summary of the case: Imaging findings of WD
are not specific, but it is important that the radiologist familiarizes
with imaging presentation of this disease, guiding the correct diagnosis and resulting in earlier treatment and better survival rates.
PD.12.084
TL.12.006
Neurofibromatosis : a pictorial essay of
selected cases of our service
Authors: Ferreira, V.T.R.; Oliveira, G.S.; Miyada, W.S.; Rossi, T.G; Soares, C.S.; Villa, P.P.O.; Silva, H.C.; Baaklini, R.E.
Institution: Faculdade de Medicina de Marília, Marília, São
Paulo, Brasil
Author responsible: Vinicius Tadeu Rodrigues Ferreira
Introduction: Considering the prevalence and incidence, as
well as its relevant aspect in neuroradiologic study, the diagnosis of neurofibromatosis becomes a challenge, requiring the
doctor radiologist in-depth knowledge of normal anatomy and
variants, as well as the conditions and differential diagnoses.
Methods Involved: Non-invasive imaging methods enable
Comparative Analysis for Subarachnoid
Hemorrhage by CT. Methods Fisher and Hijdra: Angiographic Vasospasm and Prognosis
Authors: Alves C.A, Maia A.C.J, Rocha A.J,
São Paulo, Brasil
Brief description of the purpose of the study: Proper Graduation for subarachnoid hemorrhage is essential to predict
risk of vasospasm and prognosis thereby allowing for secondary prevention strategies. We studied two classifications
proposed for graduation aneurysmal SAH by CT : Fisher and
PD.12.083
118
Hijdra, comparing the accuracy to predict angiographic vasospasm and prognosis.
Methods: We included 50 patients with clinical suspicion of
SAH < 72 hours and after applied exclusion criteria. Rating I:
Graduation SAH using the criteria already published by analysis of the unenhanced CT. Rating II: The control study was
analyzed during the critical period(3-10 days). The statistical
analysis used the study of qualitative variables, considering
statistically significant result when p< 0.05.
Main results: The Hijdra method with value cut off> 15 had sensitivity and specificity (46 and 87%, respectively ) when compared to the Fisher method with value cut off> 2 (80 % and 38
% , respectively) to predict vasospasm in the critical period. Only
Fisher method was statistically significant for the evaluation of
poor prognosis, with sensitivity 82.3 % and specificity 74.7 % .
Conclusion of the presentation: Our data indicate that the
combined use of Hidjra and Fisher methods increase the reliability in the stratification of imaging studies of aneurysmal
SAH , with greater allowance for the clinical management
and secondary prevention .
TL.12.010
Multiparametric Computed Tomography in the Complementary Evaluation to
Diagnose Brain Death: Tips and Pitfalls.
Authors: Nunes, DM; Rocha, AJ; Maia Jr, ACM; Boni, RC.
Author responsible: Douglas Mendes Nunes
Brief description of the purpose of the study: The international experience confirms multiparametric computed tomography (MCT) as a complementary alternative to diagnose brain
death (BD). There are many conditions that simulate brain
circulation, even when the BD diagnosis is confirmed, with a
potential misinterpretation of MCT. We described the patterns
of brain circulation in a case series with BD, undergoing MCT.
Methods: We performed an observational and transverse study
in 48 patients (older than 2 years) with confirmed BD undergoing MCT (perfusion and angiography computed tomography).
Main results: The main arterial pitfalls were enhancement
of M1 to M3 branches (33/48 – 68,75%), spontaneous hyperdensity of the brain circulation resulting of hemoconcentration (1/48 – 2,08%) and subarachnoid haemorrhage (5/48 –
10,41%). The main venous pitfalls were parcial enhancement
of the venous sinuses (30/48 – 62,5%), due to venous reflux
and/or filling of the emissary veins.
Conclusion of the presentation: Intracranial arterial and venous pitfals must be recognized during the exams evaluation.
This study demonstrated the importance of the MCT analises
(perfusion and angiography computed tomography) to reduce
the misinterpretation in BD diagnosis.
13 - Pediatrics
PD.13.001
Bilateral ureterocele with calculi complicated with urinary tract infection in
pediatric patient
Authors: CASTRO, M.A.; MIAMAE, L.M.; PARREIRA,
P.L.; CAVALCANTE, I.O.; QUEIROZ, A.P.; CASTRO,
M.A.; TEIXEIRA, K.I.S.S.; EDELHOFF, V.N.G.
Institution: Departamento de Radiologia e Diagnóstico por
Imagem do Hospital das Clínicas da Universidade Federal de
Goiás, Goiânia, Goiás, Brasil
Author responsible: Murilo Antunes de Castro
Brief description of the purpose of the report: Report bilateral ureterocele containing lithiasis and urinary tract infection (UTI) in pediatric patient, relevant by the incidence and
association with unfavorable outcomes.
Medical History: Male, 2 year-old, fever, abdominal pain,
leukocytosis, leukocyturia and hematuria. Ultrasonography:
bilateral ureterocele, containing calculus on the left, complicated with bilateral hidroureteronefrose. Findings confirmed
in excretory urography. Cystourethrography retrograde and
voiding without vesicoureteral reflux (VUR).
Diagnosis: Ureterocele is a cystic dilatation of the intramural
portion of the distal ureter, unilateral or bilateral, resulting
from congenital anomaly with stenosis of the ureteral meatus
and subsequent hyperplastic response. It is estimated incidence of 1: 4000 live births. It is observed orthotopic form
with normally positioned ureteral orifice, and ectopic form
with ureter inserted inferiorly. It is often associated with duplication of the collecting system, more common in ectopic
ureterocele and female. May be asymptomatic or present ITU
recurrent/persistent, lithiasis, urinary disorder and renal failure, if not diagnosed and treated properly. Ultrasonography
is the initial screeningmethod in symptomatic children, although excretory urography and voiding cystourethrography,
in selected cases, may add information on renal function and
association with VUR and other urinary malformations.
Discussion and summary of the case: Image exams are
valuable tools in pediatric ITU approach, showing congenital urinary anomalies that can be corrected, reducing adverse developments.
PD.13.003
RETROPERITONEUM AND MEDIASTINUM GANGLIONEUROMA
Authors: HUAPAYA J.
Institution: INSTITUTO NACIONAL DE ENFERMEDADES NEOPLASICAS,
Author responsible: Janice Huapaya Torres
Brief description of the purpose of the report: Ganglioneuromas are tumors derived from the neural crest, are the
source of the adrenal medulla and sympathetic ganglia. Are
presented in children and adolescents. Benign tumors are
slow growing and asymptomatic. The locations are the posterior mediastinum (41%), retroperitoneum (37%) and adrenal
gland (21%) still extremely rare its multiple submission.
Medical History: Male patient of 4 years old, native of San
Martin - Perú. Symptoms: 3 months of progressive tumor
growth on left flank, not painful. Laboratory: Standard. TC:
Large solid lesion located in the retroperitoneum. Lesion with
similar characteristics located in the retrocrural region. RM:
Neoformativa heterogeneous solid lesion in Intra-abdominal
cavity, above and in front of kidney heterogeneously captures
the dye. A right paravertebral lesion level other similar features. There is s right paravertebral lesion with similar features.
Diagnosis: He was operated on two occasions both outcomes
resulting pathologically ganglioneuroma, initially in the retroperitoneum and then in the posterior mediastinum.
Discussion and summary of the case: Despite being rare,
the diagnosis of ganglioneuroma should be considered when
we have a retroperitoneal mass. The locations more frequenAbstracts of Scientific Papers
119
cies are the posterior mediastinum and retroperitoneum after
being extremely rare its multiple submission.
PD.13.004
ULTRASOUND GUIDED INTESTINAL INVAGINATION REDUCTION – HOW DO WE DO?
Authors: MUSA-AGUIAR, P. ; SAMESHIMA Y.T.; YAMANARI, M.; BRANDAO, A. . MIGUEL NETO, F.; FUNARI, M.G.
Author responsible: Paula Musa Aguiar
Brief description of the purpose of the Review of Literature: Intestinal invagination is a medical urgency and is defined as invagination of intestinal segment into the adjacent
lumen. Sonographically guided hydrostatic reduction should
be the method of choice in the management of this pathology.
The patient must be clinically stable. Insert the Foley catheter
in the rectum with the patient placed in left lateral decubitus
and inflate the balloon. Transfer the patient to supine position. Elevate the enema bag about 90 cm above the bed (80
mmHg of hydrostatic pressure) and initiate the saline solution
instillation. Follow the solution flow to the level of the intussusception until its complete reduction (main criteria is the
visualization of fluid reflux from the cecum into the terminal
ileum through the ileocecal valve). Gentle movements on the
abdomen can be made to assist reduction. Immediately interrupt the procedure if bowel perforation is suspected.
Conclusion: Nonsurgical treatment based on ultrasound
guided hydrostatic reduction is the method of choice for the
reduction of ileocecal intussusception, for its low cost, high
successful outcome rate and especially for its lack of ionizing
radiation exposure, in accordance to the ALARA principle.
Brief discussion of the case High successful outcome rates
and the aim to eliminate ionizing radiation exposure should
encourage the use of this technique.
PD.13.005
Liver Tumors in Children: Differential
Diagnosis
Authors: PAIVA, L.S.; CAVALCANTE, C.E.; SOUZA,
F.M.P; LOPES, L.F.
Institution: Hospital do Cancer de Barretos
Author responsible: Lara Sa de Paiva
Brief description of the purpose of the report: Five
case report of liver tumors in children highlighting the imaging findings .
Medical History: Met children in the Children\’s Hospital
of Barretos Cancer in 2013, with a diagnosis of liver tumor.
Diagnosis: Diagnostic confirmation: rhabdomyosarcoma of
the biliary tract, hepatoblastoma, hamartoma, hepatocellular
and carcinoma Fibrolamellar.
Discussion and summary of the case: Differential diagnosis
of liver tumors in children and their imaging findings.
PD.13.006
Association between choledochal cyst and
congenital cytomegalovirus infection
Authors: PARREIRA, P.L.; CASTRO, M.A.; CARNEIRO,
120
D.B.V.; MIAMAE, L.M; CASTRO, M.A.; SANTANA JR,
P.J.; EDELHOFF, V.N.G.; TEIXEIRA, K.I.S.S.
imagem da Universidade Federal de Goiás, Goiânia, Goiás.
Author responsible: Poliana Lopes Parreira
Brief description of the purpose of the report: Discuss
the association between neonatal cholestasis, represented by
choledochal cyst, and cytomegalovirus (CMV) infection, besides complications related to that disease, especially if the
diagnosis is delayed.
Medical History: Female, 1 month and 16 days, with neonatal cholestasis. Soropositive for cytomegalovirus (IgM +).
Ultrasound demonstrated a large cystic mass with regular
contours and well-defined limits, located on topography of
the porta hepatis, communicating with intrahepatic bile ducts
and associated with mild dilatation of them. Magnetic resonance cholangiography confirmed cystic dilatation of the
common bile duct (Todani Ia). Head ultrasonography showed
calcification focus adjacent to the fourth ventricle.
Diagnosis: The occurrence of choledochal cyst in neonates is
relatively infrequent. This is one of the presentations of childhood obstructive cholangiopathy, which can result from an
injury to liver tissue and bile ducts, probably of viral origin.
CMV is a virus related to that entity due to apparent affinity
for biliary epithelium.
Discussion and summary of the case: Image exams are important for early diagnosis of cystic dilatation of the common
bile duct, allowing therapeutic intervention at the right time
and reducing the rate of complications such as cholangitis,
cyst rupture, biliary cirrhosis, among others and thus reducing morbidity and mortality associated with disease.
PD.13.007
Anterior Encephalocele: A Pictorial Essay
Authors: Morimoto TP, Lozano TM, Campi CC
Institution: Faculdade de Medicina do ABC - Hospital Estadual Mário Covas, Santo André, São Paulo, Brasil
Author responsible: Tauy Pereira Morimoto
Introduction: The encephalocele are herniation of brain tissue by a congenital or acquired skull defect. The birth defect
is due to a neural tube defect attributed to an interaction of
several genes and environmental factors. Prenatal diagnosis
can be made showing herniation of brain parenchyma by
ultrasound. Computed tomography (CT) and magnetic resonance imaging (MRI) studies are used to evaluate the encephalocele in the postnatal period. The objectives are to illustrate
and review some aspects of the anterior encephalocele, to
complement the study of this rare presentation.
Methods Involved: The pictorial essay is based on cases of
anterior encephalocele in newborns diagnosed in Hospital
XXX documented by CT and MRI and review of the literature in electronic journals.
Discussion: The encephalocele are neural tube defects, with
no gender preference and frequency estimated at 1: 4000 live
births, with approximately 15% in the frontal region. Are often associated with other malformations. Anterior encephalocele are classified according to their anatomical location.
Conclusion of the presentation: Although rare anterior encephalocele has significant impact on survival of newborns,
becoming necessary to recognize antenatal and postnatal
evaluation. The objective of the study was to illustration that
entity, its main aspects and classification.
PD.13.008
Meningoencephalocele: Case Report
Authors: DUARTE, E.C.; ODELI, J.T.; SANTOS, I.W.;
WANDERLEY , M.; NESI, R.S.; YUHARA, E. Y.; NETO,
R.G.C.; MANARA, L. M.; GALUZZO, R.N.
Author responsible: Evilasio Carsten Duarte
Brief description of the purpose of the report: Imaging
evaluation of a case meningoencephalocele during pregnancy
and neonatal period.
Medical History: Pregnant women in monitoring fetal medicine service where he was diagnosed that the fetus had a frontal encephalocele by ultrasound examination at 29 weeks\’
gestational age. Also held fetal MRI which confirmed the
diagnosis of frontal encephalocele. After birth, computed tomographic and magnetic resonance imaging to better study
the deformity and help in the treatment planning were performed. These studies showed a great defect formation of
the frontal bones especially the right with protrusion of the
anterior frontal lobe segment duty associated their meninges.
Diagnosis: Diagnosis: front meningoencephalocele. Discussion: encefomeningocele is defined as a protrusion of the
brain and / or meninges through the skull bones. Embryologically occurs for failure to closure of the rostral neuropore
these being classified as primary; there are also secondary
that occur after trauma or postoperative. Primaries are subdivided according to their location in sincipital, basal and
occipital.Os signs and symptoms are dependent on your location. In this case the diagnosis was made during the prenatal
and confirmed in the neonatal period.
Discussion and summary of the case: Imaging tests are essential for the correct diagnosis of encefalomeningoceles.
PD.13.009
Revisiting the patterns of hypoxic-ischemic brain injury of neonatal MRI.
Authors: Abizaid, WJM; Abizaid, TK; Abizaid, MK; Barros,
AP; Amaral, F; Dutra, BL; Vilela, VM.
Institution: Clínica Magnescan, Juiz de Fora, Minas Gerais,
Brasil
Introduction: Hypoxic-ischemic brain injury is a serious
cause of morbidity and mortality, sometimes hustling severe
forms of developmental delay. The correct identification of
these changes, allows to safely identify, in most cases the exact timing of fetal development that damage has occurred,
estimating the severity of the injury and allowing the best
individualized approach to each situation.
Methods Involved: We reviewed every case of brain MRIs
of pediatric patients in our institution, in order to assess the
primary findings in the central nervous system and demonstrate the most frequent and relevant image patterns according to the current literature.
Discussion: Appropriate radiological diagnosis of ischemic
hypoxic injury requires familiarity with many image manifestations of this injury. Factors such as maturity of the brain,
type and timing, duration and severity of the insult, all influence the results of imaging findings.
Conclusion of the presentation: MRI remains the gold standard for detection and characterization of brain injuries that
occur during the perinatal period. Due to the high prevalence
of the problem even today, the need for accurate recognition
of these changes remains imposing.
PD.13.012
Importance of transfontanelar ultrasound in the monitoring of neonates undergoing therapeutic hypothermia.
Authors: ANDRADE, C.A. ; SANTOS, G.S. ; ZANFORLIN FILHO, S.M. ; PIRES, C.R.
Author responsible: Cibele Alvarenga Andrade
To review the use of ultrasound and Doppler velocimetry transfontanelar in the evaluation of newborns with hypoxic-ischemic encephalopathy, undergoing therapeutic hypothermia.
Literature review through consultation of scientific papers
selected from Medline and Lilacs sources published over the
last decade. The hypoxic-ischemic encephalopathy is a prevalent entity in neonates and entails significant personal, social
and economic costs. The therapeutic hypothermia is carried
out by subjecting the newborn, who suffered from hypoxia,
at reduced temperatures during the first days of life, for the
purpose of reducing brain damage.
Conclusion: The ultrasound examinations should be performed in early periods in order to investigate other etiological
factors and following up the findings. The association of the
Doppler velocimetric study with ultrasound shows that the reduction of resistance rates in patients undergoing therapeutic
hypothermia, had a positive predictive value (PPV) lower when
compared to PPV of patients under normothermia in evolutionary prediction. This type of treatment has benefits supported by
studies that show its great importance in improving the prognosis and survival of the newborn who suffered from hypoxia.
Brief discussion of the case Ultrasound plays an important
auxiliary function in the monitoring of newborns undergoing
therapeutic hypothermia regime.
PD.13.013
Persistent vitelline vein aneurysm with
portal vein thrombosis and early cavernomatous transformation
Authors: BASTOS BB., SAMESHIMA YT., YAMANARI MGI., FRANCISCO NETO MJ., FUNARI
MBG., OTONI NC.
Author responsible: Bruna Bringel Bastos
and illustrate a rare case of persistent vitelline vein aneurysm
thrombosis extending to the portal system, and early cavernomatous transformation in a full-term newborn (FN) admitted to
a neonatal intensive care unit of a private hospital in São Paulo.
Medical History: FN with suspected umbilical cord varix
seen on a fetal US was submitted to an US on the first day
of life, which showed PVV with aneurysmatic dilatation and
thrombosis spreading into the portal vein. Heparinization and
surgical resection of the dilated thrombosed vein was indicated. The portal thrombosis persisted and evolved with early
cavernomatous transformation.
121
Diagnosis: The portal vein drains blood from vitelline veins
and an abnormal involution patterns result in anomalies of
the venous system such as persistence of the vitelline vein
(PVV), umbilical vein varix and portal system aneurysms. In
these cases Doppler ultrasonography (US) is the method of
choice for diagnosis. The prevalence of PVV is approximately 0.43% which is characterized as an aneurysmatic vessel
that communicates directly to the portal vein trunk.
Discussion and summary of the case: The prompt diagnosis
of the PVV, especially in cases of thrombosis, is a determinant factor in good prognosis of neonates, in which the surgery is mandatory on those cases of thrombosis.
PD.13.014
Congenital intrahepatic portosystemic
shunt: A case report
Authors: BASTOS BB., SAMESHIMA YT., YAMANARI
MGI., FRANCISCO NETO MJ., FUNARI MBG., FIGUEIREDO JRP.
and illustrate a rare case of congenital intrahepatic portosystemic shunt in a full-term newborn (FN) admitted to neonatal
intensive care unit of a private hospital in SP.
Medical History: FN with a history of IUGR and episodes of
neonatal hypoglycemia underwent Doppler US on the sixth
day of life that showed abnormal communication between the
left portal branch and the left hepatic vein, featuring a CPS.
Diagnosis: Congenital portosystemic shunts (CPS) are a
rare vascular malformations characterized by abnormal
communication between portal branch and hepatic vein
(or vena cava) with caliber greater than 1 mm. Classified
as intra- or extrahepatic, CPS may be asymptomatic, but
more commonly present complications such as intrauterine
growth retardation (IUGR), hyperammonemia and hepatic
neoplasms. Doppler US is considered the method of choice
to diagnose the SPC, but CT and MRI are required for better anatomical characterization. SPC may be associated with
other vascular malformations such as aorta coarctation and
splenic artery aneurysm.
Discussion and summary of the case: Because of its potential severity, SPC should be diagnosed as early as possible
and, in symptomatic or large caliber shunts cases, occlusion
of the fistula should be immediately performed to avoid irreversible consequences.
PD.13.015
Canal of Nuck: Anatomical review and
curious pathologies
Authors: BASTOS BB., SAMESHIMA YT., YAMANARI
MGI., FRANCISCO NETO MJ., FUNARI MBG., RODRIGUES DP.
Introduction: The processus vaginalis (PV) originates as
a fetal peritoneal evagination. Depending on the sex, PV is
accompanied by the testis or round ligament of the uterus,
which passes through the inguinal canal and reaches the
122
scrotum or labia majora. In girl, the PV is relatively short
and usually regresses during intrauterine life, but if it fails to
obliterate, the patent open pouch is called the canal of Nuck
(CN). Our aim is to make a brief pictorial review of the entities involving the CN.
Methods Involved: To illustrate different pathologies of the
CN, some quite rare, the US images obtained in a private
hospital in São Paulo will be used.
Discussion: The main anomalies associated with the CN are
hydrocele and hernia. The CN hernia may contain any of the
intra-abdominal structures. In 20% of cases herniation of the
ovary occurs with or without the fallopian tube and rarely with
the uterus. The US is considered the method of choice to differentiate the pathologies of the CN, with nearly 100% accuracy.
Conclusion of the presentation: The CN conditions are rare,
but their recognition, as well as the knowledge of local anatomy, the US examination allows for accurate diagnosis and
proper treatment.
PD.13.016
Case report: Abdominal lipoblastoma associated with intussusception in child
Authors: Figueiredo, J.R.P.; Bastos, B.B.; Leão, L.R.S; LUZ,
D.C.; SAMESHIMA, Y.T.; YAMANARI, M.G.I; FRANCISCO NETO, MJF; FUNARI, M.B.G.
and illustrate a rare case of lipoblastoma associated with intussusception in10 month-old baby.
Medical History: A 10 month-old male infant presenting
bloating, constipation, vomiting and fever for two days.
Abdominal ultrasound revealed a large hyperechoic mass
occupying entire right hemiabdomen and a hepatomegaly
with signs of periportal edema. It also revealed diffuse liquid
distension of small intestine in the hypochondrium and on
left side presenting obstructive pattern, wall thickening and
moderate amount of free fluid in the abdominal cavity. The
child underwent surgery with resection of tumor and intestinal segment ,which was suffering from volvulus. The surgery
confirmed the diagnosis of lipoblastoma and intestinal ischemia by volvulus.
Diagnosis: The lipoblastoma is an adipocytic, mesenchymal,
rare and benign tumor, composed of embryonic fat-cell, with
main incidence in infancy as a progressively growing mass.
Therefore the identification of a mass with mainly fat content
during childhood would suggest the diagnosis of lipoblastoma.
Discussion and summary of the case: The awareness of this
condition is important as the lipoblastoma delimitation is not
always easily achieved as its fat component can be masked
by intestinal gas content. In the reported case, there was a surgical emergency due to the association of lipoblastoma with
intestinal volvulus.
PD.13.017
Sonographic findings of cat-scratch disease
Authors: Figueiredo, J.R.P.; Cavalcante, F.A.; Sameshima,
Y.T.; Yamanari, M.G.I.; Francisco Neto, M.J.; Funari M.B.G.
Introduction: Cat-scratch disease (CSD) is an infectious disease characterized by regional and self limited lymphadenopathy. Abdomen, central nervous system and ocular manifestations may also occur. It is caused by Bartonella henselae and
has been reported worldwide. Cats are the natural bacterium
reservoir, which is usually transmitted by scratch and bites.
The purpose of this pictorial essay is to show radiological
lymph node findings of cat-scratch disease and alert to include this disease in differential diagnosis of enlarged inflammatory lymphadenopathy.
Methods Involved: CSD sonographic findings of patients
from our institution since 2009 are discussed.
Discussion: The cat-scratch disease is one of the most common causes of bacterial lymphadenopathy in arms, head and
neck of children. Classically CSD diagnosis is made on clinical course and immunological laboratorial analysis. Radiologist should always ask the patient or the parents about the
contact with cat, often absent on clinical history.
Conclusion of the presentation: Ultrasonography with
Doppler plays an important role in diagnosis and follow-up
of this condition due to its safety, non invasiveness, reliability
and non ionizing radiation method, very important in pediatric population.
PD.13.018
Barium Enema findings of Hirschsprung
Disease: pictorial essay
Authors: STRIEDER, D.L; LIMA, M.R.; SIECK, G.G;
SCORTEGANGA, F.A.; RIBEIRO, G.J, COSTA, J.G.;
Author responsible: Débora Lunkes Strieder
Introduction: Hirschsprung Disease (HD) is the absence of
submucosal and myenteric ganglionar cells in a colon segment, resulting from defective migration. Is a common condition affecting boys more than girls. It manifests in the first
few weeks with abdominal distention and retarded meconium
elimination. Diagnostic evaluation benigs with abdominal radiograph and Barium Enema (BE). Therefore, the radiologist
must be familiarized with this methods.
Methods Involved: Review HD diagnosis with BE, its classification and description of the main imaging findings, illustrated by our service’s studies.
Discussion: BE show: 1. Definite Transition Zone; 2. Peculiar contractions; 3. Non-demarcated ganglionic/aganglionic
zones; 4. Normal colon; 5. Bands (persistent spasms). The
Rectosigmoid Ratio (the normal diameter rectum/sigmoid
ratio must be bigger than 1) is useful for evaluation. The
classification depends on the aganglionosis extent: 1. Short
segment; 2. Long segment; 3. Total Colonic Aganglionosis;
4. Ultrashort Segment. The differential diagnosis is wide and
depends on the patient’s age.
Conclusion of the presentation: Because HD is highly prevalent and BE is an important tool in the early diagnosis, the
radiologist must be familiar with the leading imaging finding
of this disease in order to provide useful information both for
diagnostic complementation as for surgical approach.
PD.13.019
Case Report: Interruption Aortic
Authors: PAIVA D.H.R.;FRANÇA S.R.N.; CAMARGO
M.V.; JUNIOR L.A.J.; MASSELI V.B.; POSSES F.P.; VIEIRA FILHO W.R.; PAIVA G.G.; RIBEIRO S.M.
Institution: Faculdade de Medicina de Botucatu - Unesp,
Botucatu, São Paulo, Brasil
Author responsible: Douglas Henrique Rodrigues de Paiva
Brief description of the purpose of the report: The discontinuity between the ascending and the descending portion of
the aorta is known as aortic interruption. It’s a rare condition
accounting for about 1% of congenital heart disease.
Medical History: Female, newborn, with severe cianosis
after birth requiring intensive care. Investigated by echocardiography and computed tomography showed aortic interruption between the left common carotid artery and the left
subclavian artery, and a large ventricular septal defect and
pulmonary arterial hypertension.
Diagnosis: The aortic interruption is usually diagnosed
during the neonatal period. Overall survival at 16 years varies
between 59-70%. Echocardiography, computed tomography
and magnetic resonance imaging are the exams indicated for
diagnosis. The classification according to Celoria-Patton, is
divided into type A, which the interrupt is distal to the left
subclavian artery (42%), the type B, between the left common carotid artery and the left subclavian artery (53%) and
type C, between the brachiocephalic trunk and the left common carotid artery (4%). The definitive treatment is surgical,
restoring the continuity of the aorta.
Discussion and summary of the case: The aortic disruption
is a rare congenital heart disease whose prognosis depends on
the correct early diagnosis for satisfactory surgical correction
and increasing survival.
PD.13.021
Focal fibrocartilaginous dysplasia as a
cause of unilateral Tibia Vara : a case report
Authors: HUGUENIN F.G.S. , CASTRO P. N. P. , MAYMONE W. H. , MOGAMI R.
Author responsible: Fellipe Huguenin
Brief description of the purpose of the report: Reporting rare
and underdiagnosed cause of deformity of the proximal tibia.
Medical History: MNM , 1 year and 7 months of age , presented painless stick curvature of the right tibia perceived For
parents while learning to walk. What made ??Imaging examinations showed proximal metaphyseal defect and medial
cortical thickening of the right tibia. The Magnetic resonance
imaging (MRI ) showed cortical thickening with low signal
intensity on all sequences and focal cartilaginous areas with
high signals .
Diagnosis: The clinical history and typical radiographic findings determined the diagnosis of focal fibrocartilaginous dysplasia . This rare condition results of stress in the insertion of anserine pes and overload in the proximal medial cortex of the tibia.
The condition presents complete and spontaneous resolution in
1-4 years and radiological findings are so typical that make unnecessary diagnostic biopsies or surgical manipulations .
Discussion and summary of the case: The Focal fibrocartilaginous dysplasia is a rare and under diagnosed cause of
tibia vara unilateral . Radiologists , orthopedists and pediatricians should be familiar to clinical and radiological findings
this condition and avoid unnecessary surgical manipulations .
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PD.13.022
Recurrent spontaneous pneumothorax
by Langerhans Cell Histiocytosis
Authors: MARCA, P.G.C.; ZEITOUNE, R.H.; PECANHA,
A.S.; NASCIMENTO, M.L.; BAPTISTA, L.C., QUEIROZ,
V.O., VIANA, N.J.; SALOMAO, H.L.; FIRMIDA, M.C.;
LOBO, G.P.
Author responsible: Rachel Zeitoune Hertz
Langerhans cell histiocytosis is a disease of unknown etiology, characterized by destructive granulomatous lung lesions.
We report a serious pediatric case with strictly pulmonary involvement and recurrent spontaneous pneumothorax.
Medical History: L.A.T.A.P., twelve years old, male, white.
diagnosed with diabetes insipidus four years , with thickening
of the pituitary stalk in magnetic resonance imaging (MRI )
of the head . Three months ago, episode of sudden dyspnea
for spontaneous pneumothorax . Computed tomography (CT)
of the chest revealed multiple diffuse bizarre cysts and subpleural bullae bilaterally. In pleural and scalp biopsies were
diagnosed Langerhans cells histiocytosis . Even after the start
of treatment , occurred episodes of spontaneous pneumothorax with difficult therapeutic management.
Diagnosis: In children is uncommon the clinical form limited to the lungs of Langerhans cell histiocytosis , observing
worse prognosis when diagnosis occurs in young or elder
people, persistent systemic symptoms , recurrent pneumothorax , and the presence of diffuse cystic lesions on CT.
Discussion and summary of the case: Langerhans cell histiocytosis include various manifestations , from forms of individual involvement to multiorgan such as Hand- Schuller
- Christian syndrome. Thus , CT lung excels in follow-up,
while MRI to characterize other associated changes.
PD.13.023
Revisiting the Graf method
Authors: Abizaid, TK; Abizaid, MK; Barros, GN; Barros,
CN; Vilela, VM.
Institution: Clínica Magnescan, Juiz de Fora, Minas
Gerais, Brasil
Introduction: Graf method developed in 2006, remains
to the present day as the main evaluation tool of pediatric
hip. We aim to bring the method to the fore, with a view to
emphasize the technical parameters of the examination and
demonstrate the main changes of each subtype classified by
the author.
Methods Involved: We evaluated the studies conducted by
the method that has been stored in our system, the demand for
relevant and illustrative cases to be reported here, enriching
the knowledge on the subject.
Discussion: The analysis of pediatric hip can be performed
by different methods proposed by different renowned schools.
However, the methodology adopted by Graf, has become the
most popular for its simplicity of implementation, method
reproducibility, less variability within and between observer
and better correlation with surgical findings.
Conclusion of the presentation: Analysis of pediatric hip
performed by the Graf method has wide acceptance and val-
124
idation by the academic community, and is considered standard by renowned institutions and therefore needs to be understood thoroughly by assistant doctors and examiner.
15 - Radiological Techniques
PD.15.001
Pearls and Pitfalls in Computed Tomography angiography of Lower Limbs
Authors: GARCIA, A.A.; CALDAS, A.L.C.; LABBATE,
MONTEIRO, R.C.D.; M.R.C.;SANTOS, R.M.; CARVALHO, M.Q.; ARMELIN, P.L.A.; Borges, A.P.
SÃO PAULO, BRASIL
Author responsible: Ana Luiza de Carvalho Caldas
Brief description of the purpose of the Review of Literature: The study aimed to address technical aspects of image
acquisition , contrast injection protocols and relevant reconstruction tools and demonstrates how to avoid pitfalls during
the reconstruction of images.
There were selected the most relevant cases from 302 studies
in our department between June 2012 and December 2014 .
Conclusion: Computed tomography angiography of Lower
Limbs ( ATCMI ) can be used as an alternative in the diagnostic evaluation of acute or chronic ischemia of the lower
limbs . But there are several steps ranging from choosing the
right acquisition protocol to the post-processing data that can
generate a wrong diagnosis .
Brief discussion of the case Being familiar with the acquisition protocol and the main pitfalls in imaging post-processing
is fundamental to make the correct diagnosis in ATCMI, leading to better management and treatment of these patients .
PD.15.004
Radiological examinations to diagnose
the odontoid process fractures: a literature review
Authors: DE CASTRO,J.C.S., DE CASTRO,M.S., VIEIRA,M.P.M.M., BANDEIRA,C.K.
Institution: Instituto Federal do Paraná, Curitiba,
Paraná, Brasil
Author responsible: Caroline Kretezel Bandeira
Brief description of the purpose of the Review of Literature: Radiological examinations are requested to diagnose
the odontoid process fractures, given that it is necessary to
execute maneuvers during the positioning of the patient,
which are important to demonstrate possible lesions and to
avoid artifacts in the image, requiring special care to prevent
further possible preexisting injuries. The objective of this review is to identify which radiological examination is the best
exam to diagnose fractures of the odontoid process.
Fractures of the odontoid process are diagnosed using radiographs in anteroposterior, lateral and transoral incidences.
Investigations by computed tomography and magnetic resonance imaging are performed to better evaluation of the cervical region or if the general clinical condition of the patient
does not allow the acquisition of radiographic images.
Conclusion: The literature review identified that convention-
al radiography executed properly presents the best cost-effective because it allows diagnostic efficiency with lower cost
and radiation dose.
Brief discussion of the case The transoral incidence executed
properly allows to diagnose fractures of the odontoid process,
without the need to perform more complex exams which require greater cost, time and radiation dose. The radiology professional performs an important role for diagnose of this type
of lesion and for the radiological protection of other health
care professionals involved in emergency room visits.
TL.15.002
Use of intravenous low-to-isosmolar Iodinated contrast media for CT exams and
the risk of acute kidney injury: a systematic review and meta-analysis of controlled studies
Authors: LONGO MG, ROCKENBACH MABC, EIFER
DA, REICHERT R, TORRES FS.
Institution: HOSPITAL DE CLINICAS DE PORTO
ALEGRE, PORTO ALEGRE, RIO GRANDE DO SUL,
BRASIL
Author responsible: Maria Gabriela Longo
Brief description of the purpose of the study: Purpose: to
conduct a systematic review with meta-analysis of controlled
studies evaluating the incidence of acute kidney injury (AKI)
and other outcomes in patients exposed to intravenous (IV)
nonionic iodinated contrast for computed tomography (CT).
Methods: Methods: we performed a systematic search of databases (MEDLINE, Cochrane Library and LILACS), in addition to manual review of references, for studies published
until December 2014, in which the incidence of AKI, defined
as a change in serum creatinine in the first 48-72 hours after
exposure to nonionic (iso or low-osmolar) iodinated IV contrast, was directly compared to those unexposed. Odds Ratio
(OR) was calculated using random-effects model.
Main results: Results: among 1024 identified studies, 17
studies (1.7%; 65,822 patients) were selected. Exposure to
iodinated IV contrast was not associated with an increased
risk of AKI (OR=0.85; 95% CI: 0.71-1.02; p <0.01), dialysis (OR=0.89; 95% CI: 0.62-1.30; p = 0:27) or mortality
(OR=0.92; 95% CI: 0:55 to 1:53; p = 0.4). This pattern was
similar in patients with chronic renal failure, regardless of the
degree of renal dysfunction.
Conclusion of the presentation: Conclusion: in controlled
studies, the use of nonionic iodinated IV contrast for CT
scans was not associated with an increased risk of AKI, dialysis or mortality.
16 - Chest
PD.16.001
Pitfalls in Interpretation of Oncologic
Thoracic PET/CT
Authors: Meirelles, G.S.P; Capobianco, J.; Oliveira, M.A.C.
Institution: Fleury, São Paulo, SP, Brasil
Author responsible: Gustavo Meirelles
Introduction: PET/CT is an integral part of the management
of patients with thoracic neoplasms, improving staging, therapy control and prognostic assessment. However, pitfalls can
be seen on the examination, like normal variants, physiologic
areas of FDG uptake, acquisition or reconstruction artifacts,
false-positive and false-negative findings.
Methods Involved: The main teaching points of this exhibit
are to illustrate the main pitfalls in the interpretation of oncologic thoracic PET/CT examinations, including false-negative and
false-positive findings, and to present strategies for avoiding
misinterpretation of oncologic thoracic PET/CT examinations.
Discussion: The authors will illustrate the physiologic uptake of FDG, normal variants, artifacts (misregistration, truncation, FDG embolism and extravasation), potential pitfalls,
like brown-fat FDG uptake, lipomatous hipertrophy of the
interatrial septum, pleural uptake related to talc pleurodesis,
radiation-induced injuries, iatrogenic causes of FDG uptake,
muscular FDG uptake, FDG uptake induced by G-CSF and
EPO, false-negative results (small lesions, mucinous tumors,
adenocarcinomas in situ and minimally invasive tumors) and
false-positive findings, such as infectious processes, atherosclerosis and granulomatous diseases (like sarcoid).
Conclusion of the presentation: Awareness of FDG normal
distribution, physiological uptake and variants is mandatory
before interpreting oncologic thoracic PET/CT examinations.
False-positive and false-negative findings can be avoided
with knowledge of their main aspects and by careful interpretation of CT and PET findings.
PD.16.002
Imaging of Lymphoma: Applications for
Staging, Response Evaluation, Prognostic
Assessment and Detection of Relapse
Authors: Capobianco, J.; Meirelles, G.S.P.
Institution: Fleury, São Paulo, SP, Brasil
Author responsible: Gustavo Meirelles
Introduction: Hodgkin and non-Hodgkin`s lymphomas are
a wide group of neoplasms, whose treatment and prognosis
rely on accurate staging and prognosis. The purpose of this
exhibit is to assist interpreting radiologists in becoming familiar with the role of imaging methods for staging, response
evaluation, prognostic assessment and detection of relapse in
patients with lymphoma.
Methods Involved: The authors will illustrate the main aspects
of Hodgkin and non-Hodgkin`s lymphomas, with emphasis on
the roles and limitations of imaging methods for staging aggressive and low-grade lymphomas, evaluation of Richter`s
transformation in indolent lymphomas, bone marrow evaluation and differentiating fibrosis from tumor in residual masses.
Discussion: The reader should be able to distinguish pitfalls
and false-positive findings and to discuss the roles of imaging
methods for response evaluation after treatment with chemotherapy, radiation therapy or surgery. The main prognostic
indicators in patients with lymphomas will also be discussed.
Conclusion of the presentation: Imaging methods, especially PET/CT, are very accurate for baseline staging, prognostic
assessment, response control and restaging of patients with
lymphomas, yielding important information for determining
the most appropriate treatment for these neoplasms.
PD.16.004
Thoracic splenosis
Authors: GOMES P.M.M. (idealização, levantamento bibliográfico, levantamento de caso, autora); BORGES M.( levantamento de caso, revisão de texto); VARELLA R.(revisão de texto).
125
Institution: Hospital Central da Polícia Militar- Rio de Janeiro - RJ - Brasil
Author responsible: Paula Medina Maciel Gomes
Brief description of the purpose of the report: Make radiologists aware of the effectiveness of imaging methods in
making definitive diagnosis, without the need of invasive
procedures. Therefore, it is required from the professional a
high level of suspicion with regards to the disease in question, and an appropriate choice of radiological techniques.
Medical History: 46 years old patient, without complaints,
with a mass in the posterior basal segment of the lower lobe
of the left lung. The patient was submitted to an abdominal
surgery 28 years ago, because of a gun’s projectile.
Diagnosis: Thoracic splenosis is a heterotopic autograft viable
splenic tissue, that appears after traumatic events, with lapse
of time varying from 2 to 42 years between trauma and the
discovery of the lesion. The lesion is benign, asymptomatic,
predominant in young men and is, generally, find by chance
in routine exams. The most common location of the lesion is
intra-abdominal. With an imaging analysis, it presents the same
density, signal strength, and echogenicity of the spleen. Scintigraphy is the gold standard. Resection must be avoided, except
for cases where there are severe symptoms or complications.
Discussion and summary of the case: It is possible to reach
the correct diagnosis with a high quality anamnesis and an
appropriate imaging analysis, avoiding invasive methods.
PD.16.005
Computed tomographic pulmonary changes in patients with chronic rhinosinusitis
Authors: ALVES, G.R.T.; NIN, C.S.; AMARAL, R.H.;
CONCATTO, N.H.; IRION, K.L.; MARCHIORI, E.; HOCHHEGGER, B.
Institution: Departamento de Radiologia da Universidade
Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brasil
Brief description of the purpose of the study: To investigate whether patients with a diagnosis of chronic rhinosinusitis (CRS) show characteristic pulmonary changes on chest
computed tomography (CT) compared with a control group
without sinusopathy.
Methods: This prospective, observational study included patients with and without CRS, who underwent CT examination
of the lungs between 2012 and 2014. Two radiologists, who
were blinded for the presence of CRS, reviewed the images
independently. The chi-squared test was used for correlative
analysis, with a significance level of 0.05.
Main results: A total of 123 scans (51.2% male, mean age
41±16 years) were reviewed, including 59 (48%) patients
with a diagnosis of CRS. Patients with CRS were more likely than the control group to exhibit atelectasis, bronchiolectasis, centrilobular nodules, and ground-glass opacities (all
P<0.001), with a significant predilection for middle lobe and
lingular involvement observed (P<0.001). Other abnormalities, such as bronchial wall thickening and air trapping, did
not differ between groups.
Conclusion of the presentation: Atelectatic changes, groundglass opacities and centrilobular nodules are the most frequent
abnormalities associated with CRS, with peculiar middle lobe
and lingular involvement observed on chest CT examinations.
Although eminently clinical, the diagnosis of CRS could be
reinforced in the presence of these radiological findings.
126
PD.16.006
Solitary lung cavities: computed tomographic findings in malignant and non
-malignant diseases
Authors: ALVES, G.R.T.; NIN, C.S.; AMARAL, R.H.;
CONCATTO, N.H.; IRION, K.L.; MARCHIORI, E.; HOCHHEGGER, B.
Institution: Departamento de Radiologia da Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de
Janeiro, Brasil
Brief description of the purpose of the study: To assess
the computed tomographic findings of solitary excavated pulmonary lesions that could potentially aid in differentiating
malignant from non-malignant lung diseases.
Methods: A retrospective study of patients diagnosed with a
solitary lung cavity at computed tomography (CT) between
June 2012 and April 2014, was performed. Lesions were
evaluated for maximum diameter, maximum wall thickness
and associated findings. Statistical analyses and a receiver operating characteristic (ROC) curve was also designed
to select the most accurate cutoff values for malignant and
non-malignant lesions.
Main results: Records from 96 patients were reviewed. Significant differences (p<0.05) were found between malignant
and non-malignant cases when comparing the averages of
maximum wall thickness (15.2mm vs 7.8mm) and maximum
diameter (51mm vs 35mm, respectively). The presence of
either perilesional consolidation or centrilobular nodules favored the diagnosis of non-malignant conditions (p<0.05). At
ROC curve, maximum wall thicknesses thresholds of ?7mm
or ?24mm were the most accurate in suggesting non-malignant and malignant etiologies, respectively.
Conclusion of the presentation: Malignant and non-malignant solitary lung cavities differ significantly at CT. Non-malignant lesions tend to exhibit thinner walls, but more perilesional consolidations and centrilobular nodules than
malignant ones. Our results reveal that maximum wall thicknesses of ?7mm or ?24mm are indicative of non-malignant
and malignant diseases, respectively.
PD.16.007
Tomographic patterns of pulmonary parenchymal cystic diseases - Pictorial Essay
.Study type: Pictorial Essay
Authors: GUEDES, VHCC; VERGILIO, FS; CAMILO,
ML; ZANGIACOMO, RN; MELO, DM; COSTA, AS; SOUZA, ECF; NEGRI, RV
Institution: HOSPITAL DO SERVIDOR PÚBLICO ESTADUAL, SÃO PAULO-SP
Author responsible: Victor Guedes
Introduction: Lung cysts are characterized by rounded areas
and confined with thin walls , typically <3 mm thick. Computed tomography (CT) are identified as areas of low attenuation coefficient in the lung parenchyma . Usually contains
air, but may contain any liquid or solid material. The cystic
pattern on CT , refers to the presence of multiple cysts , well
defined and of varying sizes. The aim of this study is to evaluate the differential diagnosis of pulmonary cystic diseases .
Methods Involved: Evaluation of high-resolution CT and
description of tomographic patterns of the differential diagnosis of pulmonary cystic diseases .
Discussion: The most important causes of diseases in patients
with pulmonary cystic pattern by CT are usual interstitial pneumonia, pneumocystosis , lymphangioleiomyomatosis , pulmonary Langerhans cell histiocytosis, lymphocytic interstitial
pneumonia, hypersensitivity pneumonitis and Birt- Hogg - Dubé
syndrome. The differential diagnosis of these lesions is caused by
the sex and age of the patient , medical history , predominant distribution of cysts and association with other pulmonary findings .
Conclusion of the presentation: CT shows a method with
confidence for the characterization of pulmonary cysts and
diagnostic support for the possibility of identifying the predominant distribution of cysts and association with other pulmonary findings .
PD.16.008
FINDINGS OF FREQUENT AND UNUSUAL Pneumocystis jiroveci IN COMPUTED TOMOGRAPHY
Authors: PANITRUR, ASA. DELUCCAS V, VARELA CN.
Institution: Departamento de Radiología Clínica Dávila,
Facultad de Medicina Universidad Mayor, Santiago , Chile
Author responsible: Alvaro Pañitrur
Introduction: Chest radiography is usually the initial imaging
test performed for patients with suspected pneumonia. However, radiographic findings by pneumocystis jiroveci Pneumonia
(PJP) are nonspecific, and up to one third of infected patients
may have normal radiographic findings. The high-resolution
computed tomography (HRCT) must be indicated in the evaluation of immunocompromised patients with radiographic findings of normal or near normal thorax, and the results may be
indicative of PJP in the appropriate clinical setting.
Methods Involved: Set by computed tomography, the frequency of common and uncommon findings in Pneumocystis
pneumonia jiroveci.
Discussion: The findings on CT are highly variable at more
frequent than others, identifying classic patterns described in
the literature, and other rare but recurrent. Among the patterns
described we highlight. Patchy pattern: bilateral, patchy mosaic appearance, asymmetrical. ground-glass pattern: bilateral, symmetric diffuse distribution. Interstitial pattern: bilateral, symmetrical or asymmetrical, with reticular commitment.
Abnormal airspaces with pneumatoceles, subpleural blebs,
thin-walled cysts, pneumothorax, lymphadenopathy, pleural
effusion. Pulmonary nodules and cavitated mass formation.
Conclusion of the presentation: Recognition of frequent
and infrequent patterns in chest CT PJP is essential.
PD.16.009
The role of CT pulmonary densitovolumetry in the evaluation of patients with
advanced emphysema
Authors: CONCATTO, NH; MOHAN, K; SCHAKCLOTH,
M; ALVES,GRT; IRION, KL.
Institution: Liverpool Heart and Chest Hospital, Liverpool
- England
Author responsible: Natália Henz Concatto
Brief description of the purpose of the report: The computed tomography (CT) pulmonary densitovolumetry is a
technique of post-processing of images that allows the quantification of emphysema areas. Currently, it is the modality
of choice in evaluating patients with advanced emphysema.
Medical History: A 65-year old male with a diagnosis of se-
vere bilateral pulmonary emphysema was assessed with CT
for therapy planning. The densitovolumetry revealed a total
lung volume (TLV) of 6.4L, with an emphysema volume (EV)
of 1.6L (emphysema index – EV/TLV: 25%). Unilateral endobronchial valve implantation was thus selected as the most
appropriate interventional option. Post-operative CT scans
confirmed a substantial reduction of emphysematous areas
(TLV of 5.1L, EV of 0.9L, and emphysema index of 17%).
Diagnosis: The technique of CT pulmonary densitovolumetry is applied by segmentation of the structures according
to their density, therefore enabling a differentiation between
normal and adjacent emphysematous areas. In addition to
this, such post-processing tool provides three-dimensional
views that are useful in assisting thoracic surgeons.
Discussion and summary of the case: The CT pulmonary
densitovolumetry is a useful tool in monitoring patients with
emphysema, moreover, should be included in the preoperative evaluation of patients referred for volume reduction surgery of the lungs.
PD.16.010
Tomographic Aspects of Bronchial Asthma: A Study Review
Authors: PESSÔA F.M.C.; AFONSO F.B.; MELO A.S.A.;
BITTENCOURT L.K.; SANTOS A.A.S.M.D
Institution: Departamento de Radiologia, Hospital Universitário Antonio Pedro - UFF, Niteroi, Rio de Janeiro, Brasil
Brief description of the purpose of the Review of Literature: This review aims to describe the main tomographic
findings of asthma and its complications, considering the
most important differential diagnosis conditions.
The asthma is a chronic inflammatory disease characterized
by reversible airflow obstruction. The pathogenesis involves
mechanisms of hyperreativity, leading to airway remodeling
in some cases, which may induce pulmonary complications.
Beyond structural evaluation of airway, computerized tomography scan allows to analyze the occurrence of complications
and to infer possible differential diagnosis. Confirmed cases of asthma, with and without complication, were selected
from our institucional data. All images were obtained from a
64-channel multi-detector CT scan. Additionally, we included cases of chronic eosinofilic pneumonia, allergic bronchopulmonary aspergillosis and bronchiolitis obliterans as differential diagnosis to illustrate.
Conclusion: The imaging findings of asthma included bronchial wall thickening, mosaic attenuation, air trapping and
bronchiectasis. In very few cases, cysts and pneumomediastinum were evidenced as well.
Brief discussion of the case Tomographic evaluation of asthma is based on the assessment of airway structure and permits
to infer its relationship to lung fucntion. Therefore, it is possible to show airway damage that might become irreversible
throughout the years. Also, it is reliable to establish differential diagnosis and evaluate the presence of complications.
PD.16.011
A rare case of pulmonary and intestinal
lymphangiectasia.
Authors: OLIVEIRA, L.A.N.; SUZUKI, L.; VALENTE, M.;
SILVEIRA, J.P.; HONORATO NETO, A.; UEZATO, S..
127
Institution: Instituto da Criança do Hospital das Clínicas da
Faculdade de Medicina da Universidade de São Paulo, São
Paulo, São Paulo, Brasil/ Departamento de Radiologia e Diagnóstico por Imagem do Hospital Estadual de Vila Alpina
- HEVA, São Paulo, São Paulo, Brasil.
Author responsible: Simone Uezato
Brief description of the purpose of the report: To describe
clinical and radiological presentation of a case of pulmonary
and intestinal lymphangiectasia.
Medical History: Female patient, 9 years old, with successive hospitalizations, since her birth, due to diarrhea, bloating, edema and pneumonia. She was referred from another
hospital, where was admitted with dyspnea, chest pain and
edema in the face, limbs and genitals. Past medical and family history without peculiarities. Chest X-ray shows Kerley
B lines (interlobular septal thickening on chest computed
tomography). Abdominal magnetic resonance reveals extensive infiltrative lesion with intermediate signal on T1 and T2weighted images, affecting the mesentery and causing bowel
displacement peripherally.
Diagnosis: Edema of extremities, bowel displacement and interlobular septal thickening could be explained by idiopathic dilated lymphatic system, because her heart function was normal
and there were not obvious obstructive factors in the lymphatic
system. Duodenal biopsy confirmed the diagnosis of intestinal
lymphangiectasia. High Resolution Computed Tomography diagnoses pulmonary lymphangiectasia with high accuracy. The
relationship with Hennekam syndrome is under investigation.
Discussion and summary of the case: Knowing the clinical
and radiological presentation of lymphangiectasia implies
early multidisciplinary therapeutic support.
PD.16.012
Differential Diagnosis of Pulmonary Excavations: Pictorial Assay
Authors: AFONSO F.B.; PESSÔA F.M.C.; MELO A.S.A.;
BITTENCOURT L.K.; SANTOS A.A.S.M.D.
Institution: Departamento de Radiologia, Hospital Universitário Antonio Pedro - UFF, Niteroi, Rio de Janeiro, Brasil
Introduction: Excavation is defined as a gas-filled space,
seen as a lucency or low-attenuation area, within pulmonary
consolidation, a mass or a nodule produced by the drainage
of a necrotic part of the lesion via the bronchial tree. The
presence of an excavation supports early diagnosis and is
related to a huge amount of malignant, infectious and non
infectious conditions. This pictorial assay aims to describe
the main tomographic and clinical aspects during pulmonary
excavations investigation.
Methods Involved: Cases with pulmonary excavation observed in computerized tomography (CT) scan were obtained
from our institucional data. These were analyzed considering
clinical features and literature.
Discussion: The main differential diagnosis are neoplasm,
Wegener’s granulomatosis, mycobacteriosis, necrotizing
etiologypneumonia and fungal diseases. The tomographic
aspects can support etiology investigation . The main topics
to analyze include excavation wall evaluation (thickness and
the presence of nodes and/or septa), number and localization
of lesions, underlying lung disease and associated lymphadenopathy. Clinical and epidemiologic data include onset of
disease, alcohol abuse, illicit drugs, diabetes, smoking and
immunocompromised hosts.
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Conclusion of the presentation: Pulmonary excavation
bears an extensive differential diagnosis list. However, a
great number of etiologies are related to specific risk factors
and conditions. The use of CT scan permits a reliable diagnostic investigation.
PD.16.014
CHEST WALL PATHOLOGIES
Authors: ZANGIACOMO, R.N.; OLIVEIRA, D.S.;
FASSBENDER, C.P.B.; SOUZA, E.C.F.; CAMILO, M.L.;
GUEDES, V.H.C.C.; NEGRI, R.V.; VERGILIO, F.S.;
Author responsible: Renato Norberto Zangiacomo
Brief description of the purpose of the Review of Literature: A wide variety of disorders affecting the chest wall
and many of these have a characteristic feature that allows
radiological diagnosis. This study aims to familiarize these
radiological findings to facilitate diagnosis and optimize patient treatment.
Description (s) condition (s), method (s) or technique (s): A
literature review and digital file of a large hospital on the most
common diseases affecting the chest wall was performed.
Conclusion: Pathological processes involving the chest wall
range from congenital and development anomalies, as infectious and inflammatory diseases, and bone and soft tissue tumors. A systematic approach based on patient age, clinical
history, lesion location and characteristic imaging findings
often helps limit the differential diagnosis. Computed tomography and magnetic resonance imaging have fundamental
role in the assessment of these diseases, they provide useful
information such as the location, extent and composition of
the lesion allowing to reach a diagnosis. Among these diseases, were encompassed, Poland’s Syndrome, pectus excavatum, ostiomielite, hematoma, elatofibroma, metastases,
lipoma, osteochondroma, chondrosarcoma, desmoid tumor
and plasmacytoma.
Brief discussion of the case Thus, the improvement of diagnostic imaging methods, it’s necessary to have knowledge
of these features in order to identify and direct the diagnosis
from the differential.
PD.16.016
CT findings in interstitial lung diseases
related to smoking - Pictorial Essay.
Authors: GUEDES, VHCC; VERGILIO, FS; CAMILO,
ML; FASSBENDER, CPB; MELO, DM; COSTA, AS; SOUZA, ECF; NEGRI, RV
Institution: HOSPITAL DO SERVIDOR PÚBLICO ESTADUAL, SÃO PAULO - SP
Author responsible: Victor Guedes
Introduction: During the last decades the control of cigarette
smoking was configured as one of the greatest public health
challenges. The extent to which smokers increase their exposure to numerous toxic substances, respiratory, cardiovascular and neoplastic diseases develop. Pulmonary interstitial
lung diseases are a heterogeneous group of diseases characterized by dyspnea, parenchymal abnormalities and restrictive pulmonary function. The aim of this study is to evaluate
and describe the principal tomographic findings in interstitial
lung diseases related to smoking.
Methods Involved: High Resolution Computed tomography
(HRCT) of the chest evaluation of patients with significant
history of smoking, showing the various related lung diseases.
Discussion: Smoking is related to the emergence of various
interstitial lung diseases. Among them, we highlight the respiratory bronchiolitis-associated interstitial lung disease,
desquamative interstitial pneumonia, Langerhans cells histiocytosis , idiopathic pulmonary fibrosis and pulmonary emphysema combined with pulmonary fibrosis.
Conclusion of the presentation: HRCT is a good method to
characterize the findings in interstitial lung diseases related
to smoking, however the differential diagnosis may be hampered by overlapping findings of these diseases in some cases.
PD.16.017
Magnetic resonance imaging in pulmonary embolism: diagnostic accuracy of
unenhanced
steady-state-free-precession sequence and its effect on mortality rates
Authors: ALVES, G.R.T.; NIN, C.S.; AMARAL, R.H.; IRION, K.L.; MARCHIORI, E.; HOCHHEGGER, B.
Janeiro, Brasil
the effectiveness of unenhanced angiographic magnetic resonance imaging (MRI) sequences for pulmonary embolism
(PE) diagnosis in symptomatic patients.
Methods: This prospective investigation included 98 patients (62F:36M) with suspect of pulmonary embolism. All
patients underwent unenhanced steady-state-free-precession
(SSFP) on a 1.5-T unit, in addition to CTA (CT angiography).
Two independent readers evaluated each MR study, with subsequent obtention of consensus. CT angiography results were
analyzed by a third reviewer, who retrospectively recorded presence of emboli using the same format; these results
served as the reference standard. Sensitivity, specificity, predictive values were calculated. Evidence for death from PE
within the 1 year of follow-up was further assessed.
Main results: There were 98 exams performed with 97.9%
(96/98) of diagnostic quality. We found 88% MR exams negative for PE. During the 1-year follow-up period, seven patients die and there were no diference between MR and CT
embolism detection. MR sequences has sensitivity of 95%,
specificity was 94.4% and accuracy was 94,5% . Inter-observer agreement was high (?=0.87).
Conclusion of the presentation: Compared with contrast-enhanced CT, unenhanced MR sequences demonstrate
good accuraccy and no differences in mortality rates in 1 year
were detected.
PD.16.018
Thoracic imaging findings related to
breast cancer
Authors: Nishiyama, KH; Soares GMT; Teles MS; Pavani
AVB; Garcia MRT
Author responsible: Katia Hidemi Nishiyama
Introduction: Breast cancer is the most common malignant
cancer in women and it is the first cause of death in Brazilian women. Breast masses and nodules may be incidentally
found in chest imaging and staging and follow-up exams are
very common at radiologist’s routine. The main objective of
this presentation is to illustrate these imaging findings.
Methods Involved: Illustrative cases of thoracic imaging findings related to breast cancer: primary tumor, typical and atypical
metastasis, manifestations related to treatment (such as postsurgical findings, complications of radiation and chemotherapy).
Discussion: Metastasis from breast cancer and manifestations related to its therapy are very common in chest, and
sometimes, it may be a diagnostic challenge. Familiarity with
these radiologic findings may avoid misdiagnosis.
Conclusion of the presentation: The high incidence of
breast cancer leads to increase of number of exams related to
it at radiologist’s routine. Thoracic imaging findings are very
common and its knowledge allows proper image interpretation and patient’s follow up.
PD.16.021
Phagocytes, the “cops without bullets”:
a case report of Chronic Granulomatous
Disease.
Authors: SANTOS, G.R.; MAHFOUZ, K.; WENDLING, L.U.;
NORONHA, L.; BERTHOLDO, D.B.; ESCUISSATO, D.L.
Institution: Universidade Federal do Paraná - Hospital de
Clínicas, Curitiba, Paraná, Brasil
Author responsible: Gustavo Rengel dos Santos
Brief description of the purpose of the report: Primary disorders of the immune system occur by different mechanisms.
An inherited gene defect interfering in oxygen radical production by the phagocytes compromises the microorganism
killing capacity, resulting in recurrent infections and formation of multiple granulomas. That disease is known as chronic granulomatous disease (CGD).
Medical History: A 4-year-old male patient was in investigation for chronic anemia, low weight gain, and recurrent respiratory infections. Chest x-Ray demonstrated bilateral lung
opacities. At computed tomography (CT), enlarged mediastinal nodes were present associated with nodules with a halo of
ground glass attenuation (GGA) and multiple pulmonary micronodules in random distribution. Open lung biopsy showed granulomatous pneumonitis with focal hyalohyphomycosis, and the
specific tests for neutrophil function were positive for CGD.
Diagnosis: Recurrent infections with development of multiple granulomas are typical in CGD. The chest is the main
affected site, but there is little information about the thoracic
radiological manifestations of CGD. Case series demonstrated variable patterns, including multiple nodules in random
distribution and consolidation with GGA areas. Hematopoietic stem-cell transplantation has significant impact in clinical outcome, even in chronic infected patients.
Discussion and summary of the case: CGD is a peculiar
immunodeficiency syndrome with little known information
about radiological findings; however, more studies may improve diagnosis suspicion.
PD.16.024
Applicability of magnetic resonance
imaging in the evaluation of the pleural
lesions: Initial Experience.
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Authors: FIFUEIREDO, C.B.; COUTINHO, A.R.; AMBROS, L.S.; SANTANA, P.R.P.; GOMES, A.C.P.
Author responsible: Caio Barros Figueiredo
Introduction: The diagnostic workflow of pleural lesions
involves many different diagnostic imaging modalities such
as conventional radiography, ultrasonography and computed tomography, which are widely used and with a well-defined role in diagnostic procedures. In recent years the use
of magnetic resonance imaging (MRI) of the chest is moving
forward with several applicability already well established.
The objective of this work is to illustrate the applicability of
MRI in the diagnosis of pleural lesions, describing the main
imaging findings.
Methods Involved: Pictorial essay with Chest MRI exams
selected from the medical files of patients with pleural diseases and its correlation with other methods.
Discussion: Despite the important role that Chest MRI may
provide in some situations for the diagnosis of inflammatory and infectious pleural disease, including pleural effusions
and empyema, or benign and malignant pleural tumors especially mesothelioma, MRI remains underutilized.
Conclusion of the presentation: Knowledge of imaging
findings on MRI of inflammatory and infectious pleural diseases, as well as primary and secondary malignancies, especially mesothelioma, may help guide treatment decisions and
possible surgical planning.
PD.16.025
Intrathoracic Computed Tomography
Findings in Rheumatoid Arthritis
Authors: AMBROS L.E; FIGUEIREDO C.B; MACEDO.
M.A.P, SANTANA P.R.P; LIMA A.P.S, FERNANDES
G.S.S, BROTTO M.P.D, TANAKA S.W, GOMES A.C.P
Author responsible: Luciana Estacia Ambros
Introduction: Rheumatoid arthritis (RA) is a common collagen vascular disease that affects 2% of population. There
is some extra-articular involvement in almost 50% of RA
patients, mainly in the chest. Pulmonary involvement is the
second most common cause of death (18%) in these patients,
after infection. The objective of this study is to demonstrate
the variability of Computed Tomography (CT) findings in RA
thoracic involvement, aiming to familiarize the radiologist
with possible findings.
Methods Involved: In this pictorial essay study, chest CT
examinations of known RA patients were selected from the
medical files to illustrate the main intrathoracic findings of
the disease
Discussion: There are many ways of RA thoracic involvement, such as pleural effusion, interstitial lung disease, airway disease or pulmonary nodules. Since other conditions
may produce similar findings, the knowledge of these findings has fundamental importance to the radiologist.
Conclusion of the presentation: Rheumatoid arthritis is a
common collagen disease with frequent and variable forms of
intrathoracic involvement. The radiologist should be familiar with the main findings, in order to recognize and include
them among the possible differential diagnosis.
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PD.16.027
Patterns of lung metastases , literature
review of the main tomographic presentations
Authors: OLIVEIRA, D.S. ; CASTRO, R.N.C. ; CASTRO,
P.H. ; ZANGIACOMO, R.N. ; LIMA, M.S. ; LACK N.F.P. ;
VALESE B.G. ; NOMURA, C.H.
Author responsible: Daniel Simões de Oliveira
Brief description of the purpose of the Review of Literature: The incidence of metastases, from extrathoracic primary source, to the lung,, can reach 50 % . The frequency
varies depending on the type and stage of the disease, being
extremely common certain imaging standards. Surgical resection of pulmonary metastases is a well established therapeutic option and key in patient survival. Computed tomography is the method of choice for morphological analysis of
this condition.
In general , pulmonary metastases may develop by hematogenous dissemination , lymphatic , through the pleural space,
airways or by contiguity . Their CT patterns vary according
to the following characteristics : Cavitation , calcification
, confluence , halo sign , single or multiple , distribution ,
shape and size .
Conclusion: Although most cases of lung metastases can be
diagnosed based on typical findings , knowledge of atypical
presentation is essential to differentiate metastatic disease ,
primary lung cancer and benign lung synchronous conditions.
Brief discussion of the case It is essential for the radiologist
to know the main patterns of typical and atypical pulmonary
metástases, because, besides having high incidence and the
frequency characteristics in the study, help in the diagnose of
oncologic patient .
PD.16.029
Evaluation by CT angiography in patients
with suspected acute pulmonary thromboembolism with low volume of intravenous contrast and low radiation dose .
Authors: OLIVEIRA, D.S. ; CASTRO, R.N.C. ; CASTRO,
P.H. ; ZANGIACOMO, R.N. ; LIMA, M.S. ; SANTOS,
M.V.B. ; SCOPPETTA, L.R.P.D. ; NOMURA, C.H.
Brief description of the purpose of the report: The TEP
is the third leading cause of cardiovascular death worldwide
. Over the past decade , the contribution of CT angiography
(CTA) for the diagnosis of pulmonary embolism (PE ) increased dramatically as a result of the great advantages of
this test , becoming the method of choice for this indication.
A major drawback of the ATC is its risks (contrast/radiation),
especially for kidney disease patients , young people , pregnant women and others , creating a framework in which a
considerable portion of suspected patients with PE ends up
damaging during the investigation, moving to other less effective methods.
Medical History: Patient with dyspnea on efforts , controlled
renal function and positive D- dimer .
Diagnosis: In this case report , the patient DB, 74 years, with
clinical suspicion of PE , did ATC held in two stages , one using
low dose / volume and the other according to the usual protocol
, and then were qualitatively compared the two acquisitions.
Discussion and summary of the case: The objective of this
report was , by reducing the possible adverse effects related
to ionizing radiation and / or volume of contrast commonly
used, improve the quality of diagnostic investigation for patients with suspected acute pulmonary embolism
PD.16.030
Aspergilose invasiva disseminada para
mama e pele
Authors: Wainstein, B; Ferreira, EV, Silva, RW, Pedrollo,
IM, Klaes, AINM, Kruger, MS, Indrusiak, FS
Author responsible: Eleci Vaz Ferreira
of immunocompromised patient with Aspergillus fumigattus
infection in its invasive and disseminated form, affecting less
common sites such as skin and breast.
Medical History: Female patient with a diagnosis of bone
marrow aplasia and inadequate response to treatment, presented with fever and productive cough The chest computed
tomography showed findings consistent with invasive aspergillosis. In the hospitalization, palpable breast and skin
lesions appeared. The patient underwent mammography, sequential ultrasound studies and whole body magnetic resonance imaging.
Diagnosis: Invasive aspergillosis is a condition that occurs
more frequently in neutropenic patients. Breast and skin infection are rare and occur by direct invasion through local
trauma or by hematogenous spread. In our case, the patient
presented hematogenous spread of the fungus, from a pulmonary condition, which led to the involvement of the skin and
breast. The diagnosis of the infection is made by histological
analysis of the lesions.
Discussion and summary of the case: After confirmation
of the diagnosis, the patient received systemic anti-fungal
treatment, performed breast setorectomia and was discharged
with symptomatic improvement and presenting stability of
the skin lesions in examinations performed subsequently. The
combination of findings in multiple imaging modalities, confirm the important role of the radiologist in the diagnosis of
this disease.
PD.16.031
PULMONARY COMPLICATIONS IN MALIGNANT
HEMATOLOGIC DISEASES: A PICTORIAL ESSAY
Authors: YAMANARI, TR; BACHION, GH; AUAD, RV.;
LEE, HJ; CANTONI, STO; LEITE, CC; CERRI, GG.
Institution: HOSPITAL SIRIO LIBANES, SAO PAULO,
SP, BRASIL
Author responsible: Tássia Regina Yamanari
Introduction: Pulmonary diseases are among the most common complications in patients with hematologic malignancies. They may be related to infection, pulmonary infiltration
of malignant cells, drug toxicity, and immunodeficiency related to the disease or the treatment. This study reviews and
illustrates the pathology and frequent imaging findings in
computed tomography of pulmonary complications in hematologic patients.
Methods Involved: We demonstrate with CT images from
the digital file of the institution, and with relevant clinical
data, cases of malignant hematologic diseases with pulmonary complications.
Discussion: Pulmonary complications in patients with hematologic malignancies can be a diagnostic and therapeutic
challenge for radiologists and hematologists. Despite the imaging findings in these conditions are often non-specific and
varied, the diagnosis can be suspected by imaging patterns,
based also on clinical and laboratory data.
Conclusion of the presentation: It is important for radiologists the knowledge about the different image patterns in
these conditions to suspect the diagnosis and direct to appropriate treatment.
PD.16.032
Granulomatous-lymphocytic
intersticial lung disease (GLILD): Case Report
Authors: NICOLODI, G.C.; TRIPPIA, C.R.; CABOCLO,
M.F.; TERAZAKI, C.R.; RINALDI, F.; MILLER, W.P.;
CASTRO, F.G.; LIMA, R.R.; ZUKOVSKI, C.
Institution: Hospital São Vicente - FUNEF, Curitiba, Paraná,
Brasil
Author responsible: Gabriel Clève Nicolodi
Brief description of the purpose of the report: Common
variable immunodeficiency (CVID) is characterized by hypogammaglobulinemia and reduced/absent antibodies production. GLILD is the most common form of non-infectious
pulmonary complications in patients with CVID, thus its important the differential diagnosis of sarcoidosis and lymphoproliferative disorders to avoid inappropriate treatment. To
this end, we propose to correlate imaging findings, complementar exams and brief literature review.
Medical History: Female, 26 years, reports chronic dry
cough, recurrent skin lesions and retroperitoneal lymphadenopathy visualized in previous ultrasound. Refers hypothyroidism without other comorbidities. Magnetic resonance
imaging of the abdomen was perfomed for investigation
of retroperitoneal lymphadenopathy, and found retroperitoneal and mediastinal lymphadenopaty, splenomegaly,
and interstitial involvement of displaying portions of the
lungs. Computed tomography of the chest noticed bilateral
and diffuse interlobular septal and intralobular interstitial
irregular thickening, and to a lesser extent the peribronchial
vascular interstitium.
Diagnosis: GLILD is a non-infectious pulmonary complication occuring in 10 to 15% of patients with CVID, characterized by non-necrotic granulomas, lymphocitic interstitial pneumonitis, diffuse lymphadenopathy, splenomegaly
and extra-pulmonary granulomatous disease non caseating.
Pathological examination in combination with imaging studies and laboratory diagnoses GLILD.
Discussion and summary of the case: Recognition of
GLILD is of paramount importance, since the specific therapy
dramatically reduces the morbidity and mortality of patients.
PD.16.033
PULMONARY INVOLVEMENT IN GAUCHER’S DISEASE
Authors: Maranhão CPM, Farias LPG, Padilha IG, Soares
131
MLL, Miranda CMNR
Brief description of the purpose of the report: This paper
aims to demonstrate a case of Gaucher disease (GD) with
bilateral lung involvement, evaluated by chest X-ray and
multidetector computed tomography (MDCT), which show
bilateral interstitial pulmonary and mosaic attenuation patterns, respectively.
Medical History: Female patient, 02 years and 09 months
old, second daughter of consanguineous parents (first
cousins) and GD diagnosed, is sent to MDCT service with
tachydyspnea above two weeks, without fever or overall
poor health.
Diagnosis: Gaucher’s disease is caused by a hereditary deficiency of the enzyme glucocerebrosidase, which results in
the accumulation of glucocerebroside inside the phagocytes
from monocyte/macrophage system. Pulmonary involvement
is rare, but it has frequently been identified although there are
no reports of epidemiological statistics. There is still a lack of
standardization in its forms of radiological presentation due
to multifactorial involvement with multiple patterns of tissue
infiltration by Gaucher cells.
Discussion and summary of the case: Diffuse involvement
of GD lung reflects a systemic disease condition. MDCT is
an important tool for initial evaluation and follow-up of these
patients, and lung biopsy may not be necessary if CT findings
demonstrate a classic pattern in a suitable clinical and epidemiological context.
PD.16.034
UNVEILING THORACIC LYMPH NODE MAP FOR
STAGING OF LUNG CANCER
Authors: Silva, A.M., Fiorot, V.C.R., Rangel, D.A.
São Paulo, Brasil
Author responsible: Vinícius Castro de Rezende Fiorot
Brief description of the purpose of the Review of Literature: Review and illustrate in a practical way the current
lymph node anatomical map recommended by the International Association for the Study of Lung Cancer (IASLC)
for the staging of lung câncer, as well as to review the normal range in the literature for tomographic measurement of
lymph nodes in the thoracic groups, since those are primal
information for the accurate staging for lung cancer.
(s): We used the graphics adapted from the latest version of
lymph node map recommended by the IASLC and reviewed
the literature in order to obtain data for the correct tomographic measurement of lymph nodes and its normal range in
each thoracic group.
Conclusion: Accurate staging for lung cancer is primal for
optimal treatment planning and improved outcome. Part of
this staging requires assessment of lymph node metastases
and a consistent and reproducible regional lymph node designation. However, the data of the usual size of lymph nodes
are scarce and often confused in the literature.
Brief discussion of the case Lymph node evaluation based
on their size and the radiologist familiarity with the lymph
node map recommended by IASCL is primal to accurate tomographic staging of lung cancer.
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PD.16.035
Pulmonary infarction in Pulmonary
Thromboembolism Acute: radiological
features
Authors: COSTA A.S.; VERGILIO F.S.; CAMILO M.L.;
ZANGIACOMO R.N.; GUEDES V.H.C.C.; NEGRI R.V.;
MELO D.M.; SOUZA E.C.F.
Institution: IAMSPE, SAO PAULO, SP, BRASIL
Author responsible: Andrea Sousa Costa
Introduction: Pulmonary embolism (PE) has a high morbidity and mortality and corresponds to the third most common
acute cardiovascular events after acute myocardial infarction
and stroke, and early diagnosis is very important. The purpose of this essay is to describe the main radiological findings
in pulmonary infarction in acute pulmonary embolism.
Methods Involved: Will be done from CT angiography analysis of patients with suspected of this entity.
Discussion: Among the diagnostic methods for the PE, chest
computed tomography angiography is well established as a
method of choice because it was shown by meta-analyzes
a sensitivity of 53% -100% and specificity of 83% -100%.
There are signs angiotomographic well established for the diagnosis of acute pulmonary embolism: filling defects not obstructive or central eccentric and complete obstruction with
focal increase in the diameter of the affected vessel. There are
also indirect signals including oligemia and areas of pulmonary infarction. Specific characteristics of pulmonary infarction areas were described as subpleural consolidations with:
triangular shape, no air bronchogram, large vessel reaching
the summit and central lucências / signal \”reversed halo\”.
The signal \”reversed halo\” showed 98% specificity.
Conclusion of the presentation: Knowledge of these findings have shown a significant applicability in the practice of
the radiologist to obtain early diagnosis.
PD.16.036
Pleural abnormalities: radiological
aspects
Authors: COSTA A.S.; VERGILIO F.S.; CAMILO M.L.;
ZANGIACOMO R.N.; FASSBENDER C.P.B.; NEGRI R.V.;
MELO D.M.; SOUZA E.C.F.
Institution: IAMSPE, SÃO PAULO, SP, BRASIL
Author responsible: Andrea Sousa Costa
Introduction: The pleura is a serous membrane lining divided into parietal (lines the cavity) and visceral (lining the gut).
Radiological recognition of pleural normal aspect distinguishes pathological changes as plate and diffuse thickening,
and help differentiate malignant from benign conditions. The
objective of this study is to describe and illustrate the main
pleural radiological changes.
Methods Involved: Will be held graphic documentation and
description of the radiological findings from chest CT with
pleural changes.
Discussion: The main changes are described: focal espesssamento the pleura (pleural plaques, fibrous tumor of the pleura, lipoma and liposarcoma), diffuse thickening (malignant
by secondary tumors, malignant mesothelioma, asbestos related diffuse, diffuse unrelated to asbestos), pleural effusion,
hemothorax and pneumothorax. Pleural plaques is the most
common manifestation of asbestos, usually bilateral, more
common left with posterolateral predominance. The fibrous
tumor of the pleura is a primary neoplasm of slow growth
and accounts for less than 5% of pleural tumors. Lipoma is
often asymptomatic, benign, with fat density on computed
tomography (CT) and magnetic resonance imaging while liposarcoma is larger, infiltrative, symptomatic and heterogeneous on CT.
Conclusion of the presentation: The importance of identifying the main radiological findings interfere in the diagnosis
and subsequent treatment correct.
PD.16.037
Cystic lung diseases: tomographic
features
Authors: MOURA FM; MARTINS LRA; FONSECA DR;
SOARES MV; DINIZ WP
Introduction: Pulmonary cysts are not an infrequent finding
on computed tomographic (CT) imaging and may be caused
by a large number of diseases. Recognising its pattern and
differentiating from other entities, such as emphysema, is
extremely important to a correct diagnosis. The aim of this
pictorial essay is to review and exemplify the main clinical
and radiologic characteristics of pulmonary cystic diseases.
Methods Involved: For this pictorial essay a brief review of
literature about pulmonary cystic diseases and its main differential diagnosis was made, as well as assortment of cases
of illustrative pulmonary cystic diseases of CT performed at
our service.
Discussion: Lung cysts are described as a parenchymal
well-described, low-attenuating, usually containing air, thinwalled lesions. Pulmonary cystic disease may be caused by
a large variety of congenital or acquired diseases, which can
be separated in two main groups according to its distribution:
diffuse (e.g.: Langerhans’ cell histiocytosis and lymphangioleiomyomatosis) and focal or multifocal (e.g.: Lymphocytic
and Desquamative interstitial pneumonias).
Conclusion of the presentation: The detection of a cystic
pulmonary disease on CT, describing its characteristics and
distribution, along with the clinical presentation, often is
diagnostic and requires no complementary investigation or
limits the differential diagnosis.
PD.16.038
Aortic coarctation: what the thoracic
radiologist need to know
Authors: OLIVEIRA FILHO, S. B.; ZORZENONI, F. O.;
SILVA, A. M.
Author responsible: Sergio Barreto de Oliveira Filho
Brief description of the purpose of the Review of Literature: Demonstrate the imaging findings associated with aortic coarctation and carry out a literature review focusing on
the main points that the radiologist should know.
Aortic coarctation is a narrowing of the descending aorta that
mostly involves the arterial ligament region, distal to the left
subclavian artery. Accounts for about 7% of congenital heart
disease and occurs as a solitary lesion in 82% of cases. We
reviewed current literature and used images obtained from
digital files of our hospital to illustrate the findings described.
Conclusion: The main radiological findings of aortic coarctation are the narrowing of aortic isthmus and the presence of
collateral circulation through the internal thoracic, intercostal
and scapular arteries. Chest radiography may show erosions
on the inferior surface of the ribs and increased aortic arch
forming an inverted three image with the middle arch. Computed tomography angiography depicts both the aortic stenosis as collaterals, and when associated with multiplanar and
three-dimensional reconstructions is sensitive enough to the
diagnosis next to 100%.
Brief discussion of the case The knowledge of the characteristic imaging features of aortic coarctation and the main
aspects to be reported is essential in the practice of thoracic
radiologist, and is also fundamental for defining the prognosis and appropriate therapy.
PD.16.039
Erasmus syndrome: A rare association between systemic sclerosis and exposure
to silica.
Authors: ARAUJO FILHO, J.A.B. ; REISER, C.S. ; PAIVA,
A.F.L. ; OLIVEIRA, D.S. ; CASTRO, R.N.C. ; DOS SANTOS, M.G. ; CHATE, R.C. ; FUJITA, C.L. ; NOMURA, C.H.
the cases of patient with a occupational history of exposure
to sílica, who developed systemic sclerosis (SSc) , featuring
Erasmus Syndrome (ES).
Medical History: Male, 40 years, with exposure to silica for
20 years and recent complaint of arthralgia, dysphagia, and
Raynaud’s phenomenon (clinical diagnosis of SSc ). Computed tomography (CT) of the chest showed micronodular
infiltrate , mediastinal lymphnode enlargement (probably related to silicosis ), esophageal dilation and reticular opacities
in frosted glass with peripheral and basal predominance, suggesting fibrogenic interstitial lung disease associated.
Diagnosis: The association between exposure to silica and
ES is rare and occurs on average 15 years after exposure,
and can occur with or without associated pulmonary silicosis.
Discussion and summary of the case: A CT scan is valuable in the diagnosis and evolution of the ES in describing
the findings of the involvement of associates that characterize the syndrome.
PD.16.040
The various forms of pulmonary aspergillosis in a pictorial essay .
Authors: Verrastro CGY, Missrie I, Pinetti RZ, Yanaguizawa
T, Teles MS, Colombo A, Lederman HM, Bergamasco MD,
Szarf G
Institution: UNIFESP-EPM, São Paulo, SP, Brasil
Author responsible: Carlos Gustavo Yuji Verrastro
Introduction: The Aspergillus is a hyaline filamentous fungi
that have universal distribution in nature. The main form of
human infection is caused by inhalation of conidia . Aspergillosis includes a broad spectrum of clinical presentations ,
depending on the inlet port , presence or absence of structural
133
changes in the pulmonary parenchyma and the host immune
status (in particular neutropenia and T-cell immunosuppression) or asthma. The objective is to present the various forms
of pulmonary aspergillosis .
Methods Involved: We will illustrate with cases and literature review the major changes in imaging tests caused by the
different forms of pulmonary aspergillosis .
Discussion: Atopic or asthmatic patients can develop allergic
sinusitis and ABPA . Patients with structural changes in lung parenchyma , such as cavities, and bronchiectasis caused by TB ,
NTM , sarcoidosis , may present with colonization and progressive chronic lung disease. Representing the most rapidly fatal
form of aspergillosis , we have the occurrence of invasive pulmonary disease , with the potential spread to other organs, this
clinical form is documented in immunocompromised patients.
Conclusion of the presentation: The various forms of pulmonary aspergillosis have different characteristics on imaging studies
PD.16.041
Cystic lung diseases: a practical approach to the differential diagnosis.
Authors: PADILHA IG, BIANCHINI APAP, SOLINO ACD,
REIS JUNIOR CG, SILVA AM.
Institution: Serviço de Diagnostico por Imagem, Irmandade
Santa Casa de Misericórdia de São Paulo, São Paulo, Brasil.
Introduction: Several diseases can present pulmonary cysts
during its natural history. This presentation aims to demonstrate the main diagnostic possibilities in the spectrum of pulmonary cystic diseases, according to age, in order to make
practical and accurate the clinical-radiological investigation.
Methods Involved: We performed literature review of pulmonary cystic diseases, illustrated by computed tomography
and chest radiography images from our service. We built a
flowchart that allows a practical approach to the differential
diagnosis of these diseases for the radiologists.
Discussion: Several diseases can manifest as pulmonary cyst,
being lymphangioleiomyomatosis and Langerhans cells histiocytosis most common in the adult. In children, there are
congenital causes such as the airways malformations, and the
acquired ones, as post-infectious cystic changes. Congenital
diseases are a major cause of acute respiratory failure requiring
the diagnosis as soon and accurate as possible to the favorable
evolution of the patient. In adults, the association of clinical and
radiological findings allows an objective and practical approach
to the correct diagnosis, also positively affecting the prognosis.
Conclusion of the presentation: The knowledge of the characteristic imaging findings of pulmonary cystic diseases and
the main aspects to be reported is essential in radiologist\’s
practice being the correct diagnosis crucial to defining the
prognosis and appropriate therapy.
PD.16.042
Dendriform pulmonary ossification. Main
tomographic findings and differential
diagnoses.
Authors: DELGADO, N. J. ; PEREIRA, M. L. ; DIAS, G.
M. ; BRESSAN, C. A. V. ; GOMES, B. M.
Institution: UNIVERSIDADE FEDERAL DE JUIZ DE
FORA (UFJF), JUIZ DE FORA, MINAS GERAIS, BRASIL
Author responsible: Natalia Juste Delgado
134
Brief description of the purpose of the Review of Literature: The purpose of this article is to identify the essential
tomographic findings of Dendriform pulmonary ossification,
comparing them with the imaging findings of its main differential diagnoses.
Dendriform pulmonary ossification is a rare diffuse form of
pulmonary ossification of unknown pathogenesis, in which
there is metaplastic bone dendritic appearance in the lung parenchyma. The disease is more common in middle-aged men.
It is usually asymptomatic and is incidentally found on imaging studies. Tomographic findings may suggest the diagnosis
and help to rule out other diseases. The article consists of a
literature review based on different literary sources.
Conclusion: Dendriform pulmonary ossification is rare desease and difficult to diagnose. In conventional radiography,
the findings are subtle and indistinguishable from other conditions, however, in HRCT scans, although features are still
discrete, it is possible to infer the diagnosis. Imaging studies
show reticular infiltrates of calcified density along the bronchovascular distribution, commonly interpreted as scars, fibrosis or bronchiectasis, or multiple subpleural calcifications.
It is predominant in the lower lobes.
Brief discussion of the case Although Dendriform pulmonary ossification does not have specific imaging findings
on CT, the combination of multiple aspects together with
their anatomical distribution can assist in achieving a proper diagnosis.
PD.16.044
SAPHO: Recognizing the syndrome through chest CT findings
Authors: FREITAS ET, NASCIMENTO BL, FIGUEIRA
DMB, VIANNA JAS, MELO ASA, BITTENCOURT LK
Institution: Departamento de Radiologia, Hospital Universitário Antonio Pedro, Niterói, Rio de Janeiro, Brasil
Author responsible: Bruna Lício do Nascimento
Introduction: SAPHO syndrome is a rare clinical condition,
mostly underdiagnosed, with an unknown pathogenesis, first
described in 1987, being more common in young and middle
aged female adults. It is characterized by five clinical-radiological findings: synovitis, acne, palmoplantar pustulosis,
hyperostosis and osteitis. It is a chronic disease with acute
episodes, often accompanied by pain and local edema. The
anterior chest wall, especially the sternocostoclavicular region, is the most frequently affected site (70%-90%). Our
objective is to describe the main osteoarticular findings involving the anterior thoracic wall in this syndrome.
Methods Involved: Three cases of this syndrome were presented from our digital teaching file, with illustration, description and comparison of the most prevalent osteoarticular
findings involving the anterior chest wall by CT.
Discussion: In two patients, we observed the sternal-notch
joint involvement, with bone neoformation, osteophytes,
sclerosis and subcondral erosions, associated with joint space
irregularity. The same tomographic findings were also present in the third patient, however, this time at the sterno-clavicular and costo-sternal joints.
Conclusion of the presentation: In this presentation, we
demonstrate the importance to recognize the radiological
finding of SAPHO syndrome and connect them with the clinical signs of the disease, so we can improve the number and
precision of diagnostses of this syndrome.
PD.16.045
Retrocrural lymphoma
Authors: ALBUQUERQUE LF; MOURA DS; ROGÉRIO
RM; MOURA JAC
Institution: CLINICA SOM DIAGNÓSTICO, BELÉM,
PARÁ, BRASIL
Author responsible: Lhorem Fernandes Albuquerque
Brief description of the purpose of the report: This report
describes the case of a CD10 positive B lymphoma immunophenotype of retrocrural location.
Medical History: ATC, 62, female, coming of Belém do
Pará, in clinical research by pain in the dorsal region for two
months, no other complaints or clinical findings. Subjected to
magnetic resonance dorsal column in which there was expasiva training lobulated, well-defined, heterogeneous, located
in retrocrural space, with intermediate signal on T1, high T2
signal and with predominantly peripheral enhancement after
paramagnetic contrast.
Diagnosis: The lesion biopsy was performed and the evaluation of immunohistochemical profile that was consistent with
immunophenotype Lymphoma, B, CD10 positive with extensive areas of cell necrosis. The retrocrural space is a small
triangular region in the posterior and inferior mediastinum
bordered by the two crura diaphragm. Normal structures in
this region include the aorta, nerves, azygos and hemiazygos
veins, the chyle cistern with the thoracic duct, fat and lymph
nodes. Lymphomas comprise a diverse group of lymphoid
neoplastic processes that are characterized by cause lymph
nodes increased in retrocrural involvement.
Discussion and summary of the case: Both Hodgkin\’s disease and non-Hodgkin\’s lymphoma may involve and retrocrural space, but this is a rare location diseases.
PD.16.046
Cutaneous and Pulmonary extramedullary plasmocytoma: case report.
Authors: CASAGRANDE, J.L.M.; SANTOS, R.M.; MISSRIE, I.
Institution: Departamento de Diagnóstico por Imagem
da Universidade Federal de São Paulo/EPM, São Paulo,
SP, Brasil
Brief description of the purpose of the report: The aim of
this study is to describe a case of cutaneous and pulmonary
extramedullary plasmocytoma.
Medical History: A 62-year-old male patient presented with
a 20 days history of progressive dyspnea and nodular skin
lesions on the neck and chest. Splenomegaly was noted on
physical examination and pancytopenia on the laboratory
work-up. Chest CT showed multiple bilateral pulmonary
nodules, some showing ground-glass halo and a coalescent
configuration, with some areas of ground-glass parenchymal
opacities, mediastinal and axillary lymph nodes enlargement
and subcutaneous nodules also being noticed. The bone marrow biopsy showed no signs of neoplastic infiltration.
Diagnosis: The skin and pulmonary nodules biopsy showed
plasmocytoma with a lambda light chain restriction. The final diagnosis was extramedullary plasmocytoma of the skin and lung.
Discussion and summary of the case: Extramedullary plasmacytomas form a small percentage of plasma cell tumors,
and 80-90% occur in the head and neck, involving submuco-
sal lymphoid tissues of the nasopharynx and paranasal sinuses without bone marrow involvement, being the pulmonary
and skin plasmacytomas found to be a very uncommon clinical entity. So, this condition may be frequently overlooked,
being important to be considered every time one finds pulmonary parenchimal nodules, consolidations and ground-glass
opacities at chest CT in a patient with a suspected hematological condition.
PD.16.047
PARACOCCIDIOIDOMYCOSIS PULMONARY: PICTORIAL ESSAY
Authors: GUERRA LFA; PESSANHA LB; MARTINS
DLN; GARCIA RR; BAPTISTA RM; MOLL RSS; ANDRADE RMF
Institution: Universidade Federal do Espírito Santo (UFES),
Vitória, Espírito Santo, Brasil
Author responsible: Luiz Felipe Alves Guerra
Introduction: Paracoccidioidomycosis (PCM) is the most
common systemic mycosis in Latin America. In approximately 75% of cases the lungs are affected and high resolution computed tomography (HRCT) of the chest is the best
method of choice to evaluate the pulmonary PCM patients.
This study has the objective to identify the main tomographic
findings of the chest this disease.
Methods Involved: Patients diagnosed with pulmonary
PCM Were submitted chest HRCT and the main findings
were analyzed.
Discussion: The PCM is caused by Paracoccidioides brasiliensis, which is not limited to epithelial surfaces of the body,
deeper invading it with predominant pulmonary and cutaneous-mucous affection. The disease affects men more prevalent, rural workers, usually between 30 and 50 years, who inhale fungal spores, occurring primarily lung injury and later
spread linfoematogênica with involvement of other organs.
Conclusion of the presentation: The main CT findings
identified in our sample were nodules and micronodules
centrilobular, opacities branched with standard tree-in-bud,
interlobular septal thickening scattered throughout the parenchyma, peribronchovascular interstitial thickening, irregular
increase airspace (scar-related emphysema). Ground-glass
opacities and consolidation occur in up to 30% of patients.
PD.16.049
Atypical presentations tomographic of
pulmonary metastases of osteosarcoma
Authors: BOECHAT M; ALVES P; BOECHAT P; ARCOVERDE R
Institution: Instituto Nacional do Câncer - INCA, Rio de Janeiro, Rio de Janeiro, Brasil
Author responsible: Marianna Nunes Boechat
Introduction: Osteosarcoma is a malignant neoplasm of
long bones, characterized by the production of osteoid tissue
and immature bone that proliferates through the cell stroma.
It mainly affects young adults and has high incidence of metastases, preferably lung, bone and brain. The most prevalent
metastases are lung, and it manifest classically as nodules
with soft tissue density and calcification. The aim of this pictorial essay is to demonstrate the presentations on computed
tomography (CT) of atypical osteosarcoma lung metastasis.
Methods Involved: Chest CT scans of patients in follow-up
135
of pulmonary metastases from osteosarcoma were analyzed,
highlighting their atypical presentations.
Discussion: Lung metastases commonly result in the formation of nodules. When multiple pulmonary nodules are identified, there are two main hypotheses diagnostic: metastatic
tumors and granulomatous lesions (tuberculomas, fungal infections). The differential diagnosis of benign conditions, especially in small nodules, sometimes is difficult, particularly
with infectious diseases.
Conclusion of the presentation: While most cases of lung
metastases may be diagnosed with based on typical findings,
knowledge of atypical presentation is essential for the differentiation between metastatic disease, synchronous primary
lung cancer and benign pulmonary conditions.
17 - Ultrasonography
PD.17.001
Sonographic findings in pediatric patient
with warning signs of Dengue
Authors: CASTRO, M.A.; CARNEIRO, D.B.V.; PARREIRA, P.L.; REZENDE, F.M.; QUEIROZ, A.P.; TEIXEIRA,
K.I.S.S.; EDELHOFF, V.N.G.
sonographic findings in pediatric patient with warning signs
of dengue, emphasizing on its importance on stratification of
severity and on prognostic value.
Medical History: Female, 10 years old, was diagnosed as
dengue and evolved with vomiting and intense abdominal
pain about the third day of illness. Laboratory exams showed
elevated hematocrit, severe thrombocytopenia and hypoalbuminemia. Abdominal ultrasonography revealed gallbladder with thickening and diffuse parietal delamination, small
amount of liquid pericholecystic, moderate ascites and laminar bilateral pleural effusion. Patient was treated as severe
dengue and recovered well.
Diagnosis: The plasma leakage is a major complication of
dengue and this precedes the shock of dengue, a potentially
fatal medical condition if not treated properly. Abdominal ultrasound is a useful tool to detect the plasma extravasation and
predict progression to dengue shock. Comparative study of
clinical, laboratory and sonographic parameters pointed ultrasound as the best method of tracking severe cases of dengue.
Pleural effusion, thickening of the gallbladder wall, ascites
and hepatosplenomegaly are the most frequent findings and
may precede clinical manifestations and laboratorial changes.
Discussion and summary of the case: Knowledge of possible sonographic findings in patients with dengue is extremely
important in early identification of severe cases or dengue
complications, which impact the prognosis of the disease.
PD.17.002
Heterotopic Gestation after Natural
Conception
Authors: CASTRO, M.A.; MIAMAE, L.M.; PIRES, R.D.S.;
PARREIRA, P.L.; QUEIROZ, A.P.; CASTRO, M.A.; TEIXEIRA, K.I.S.S.
136
Brief description of the purpose of the report: Heterotopic pregnancy is a rare condition, whose incidence has increased with growing access to assisted reproduction, thus,
the knowledge of the forms of presentation is essential.
Medical History: Female, 28, G4P2A1, gestational age:
9w2d, intense diffuse abdominal pain, Blumberg +, vaginal
bleeding small amount, closed cervix, afebrile. Ultrasound:
pelvic mass in the right adnexal region, intrauterine gestation
with 9w3d, small trophoblastic detachment, large amount of
fluid with debris in the abdominal cavity, especially in Douglas
pouch. Laparotomy with salpingectomy. Pathology confirmed
ovular remains. Evolved with embryonic death and curettage.
Diagnosis: Heterotopic pregnancy is ectopic pregnancy simultaneously with intrauterine gestation. In the past, the incidence was 1:30.000. Acsses to assisted reproduction techniques, increased to 1: 100-500. The most common location
of ectopic implantation is the uterine tube. Risk factors associated with this complication: pelvic inflammatory disease,
uterine malformations, advanced age, smoking, previous
pelvic surgery, infertility and assisted reproduction, which
were not found in this patient.The surgical approach through
laparotomy or laparoscopy is the treatment of choice for tubal
ectopic pregnancy.
Discussion and summary of the case: Heterotopic pregnancy rate has increased, especially with assisted fertilization, it
is fundamental to consider this diagnosis in abdominal pain
in the first quarter pregnancy. Early diagnosis influences the
evolution of the topic gestation.
PD.17.003
ARFI: Standardization of the avaluation
technique of liver elastography and
determination of normal values in healthy adults.
Authors: SOUZA, M.T.P, FERNANDES, F.S, OLIVER,
F.A, JUNIOR, J.E, SOUZA, F.T, MUGLIA, V.F, MARTINELLI, A.L.C,
Institution: FACULDADE DE MEDICINA DE RIBERÃO
PRETO, RIBEIRÃO PRETO, SÃO PAULO, BRASIL.
Author responsible: Marina Taliberti Pereira de Souza
Brief description of the purpose of the study: The objectives of this study were to establish the normal values of liver
elastography by ARFI (Acoustic Radiation Force Impulse)
method in a control group of our population, assess the possible conflicting factors that may affect the accuracy of the
method and establish a standardization of the technique in
order to achieve the best possible reproduction.
Methods: This is a prospective study, that included healthy
volunteers. Two areas of interest in liver were evaluated, VIII
segment and II segment, being used 20 measures of VIII segment and 10 measures of II segment. We consider the median
as a representative measurement of the elasticity of liver for
each individual. Were considered IQR/median < 30%.
Main results: The overall median segment 8 (10 measures)
of the 50 patients was 0.96. When comparing the median values of the VIII segment between the sexes, age group and
groups with higher BMI or less than 25 realized that there
was no statistical difference between the groups.
Conclusion of the presentation: The ARFI is a reproducible
technique for evaluation of liver elastography, where 10 measurements were sufficient for the applicability of the method
and the values obtained in the VIII segment can be used as
reference for healthy adults in our population.
PD.17.004
Distension of the sternocleidomastoid
muscle: Case report and literature review
Authors: Duarte, ML.
Institution: Santos Medical Group - Vila Rica, Santos, São
Paulo, Brasil
sonographic diagnosis of a muscle injury in an unusual region.
Medical History: A 48- year-old policeman complaining of
pain in the right cervical region after dodging an attack. Physical examination shows neck pain with mobilization.
Diagnosis: The ultrasonographic study showed mild edema
and disruption of the muscle fibers of the right sternocleidomastoid, featuring muscle strain grade I. Excessive use,
for example, poring over wheel for many hours can trigger
muscle tension. Even simple situations like reading in bed or
teeth grinding can stretch the neck muscles. Ultrasonography
is a convenient, practical and inexpensive method to evaluate
mainly a variety of musculoskeletal disorders affecting the
patient, and it can show changes in muscle structural relations that occur with movement, and compare easily, in different planes, symptoms and the contralateral side. Strengthening exercises increase muscle capacity in different ways,
reducing the incidence of muscle strains, as in the case of
this report.
Discussion and summary of the case: Although uncommon,
the muscle strain of the sternocleidomastoid may be the cause
of pain in patients with a history of physical exertion or trauma
to the neck and is detected on ultrasound, without the need for
more complex studies such as magnetic resonance imaging.
PD.17.005
Spontaneous Pneumobilia: Unusual complication and potentially underdiagnosed
Authors: ASSIS B.M; PONARA S.J; FIGUEIREDO C.P;
ZANFORLIN M.S; CZAPKOWSKI A.; PIRES R.C.
Author responsible: Jaqueline Sakie Ponara
Brief description of the purpose of the report: Pneumobilia
is a rare disease and is difficult to interpret on the ultrasound
method. It is characterized by the presence of air in the biliary
tract usually related by the anomalous communication between the gastrointestinal at biliary tract. Among the non-surgical causes, obstructive cholelithiasis, cholecystitis emphysematous and endoscopic interventions are the most common.
Medical History: Case report of a female patient of 76 years
with chronic pain in the epigastric region and right upper
quadrant initiated after diagnosis of gastric ulcer 10 years
ago. On abdominal ultrasound was identified ectasia of the
extrahepatic bile duct associated with the presence of hyperechoic mobile intraluminal image with posterior acoustic reverberation throughout the intra and extrahepatic biliary tract
. The gallbladder had gallstones.
Diagnosis: Pneumobilia is characterized on the ultrasound
by mobile hyperechoic images and producing subsequent
artifacts in biliary tracts. Attention should be given to this
diagnosis on patients with a history of cholelithiasis, peptic
ulcers and biliodigestive derivations.
Discussion and summary of the case: Although tomography is considered the best method, ultrasonography remains a
good screening option for its high sensitivity in the detection
of gas in the biliary tract.
PD.17.006
Encephalocele frontoethmoidal: Ultrasonography findings.
Authors: MARCUCCI. M.B.; PONARA. S.J.; FILHO.
M.Z.S.; PIRES.C.; LUMINOSO.D.
Author responsible: Barbara M Marcucci
Brief description of the purpose of the report: Ultrasound
fetal case report of frontoethmoidal encephalocele and severe
bilateral ventriculomegaly.
Medical History: Primigravida, JMSL , 24 years, without
previous comorbidity with 26 weeks was visualized bilateral
cerebral ventriculomegaly, frontal facial vegetating lesion,
renal left cysts and liver cyst on ultrasound obstetric. Performed cordocentesis at 28 weeks for karyotype (46, XY).
Cesarean elective was performed at 40 weeks and 3 days and
confirmed encephalocele frontoethmoidal.
Diagnosis: Encephalocele is a herniation of intracranial
structures through a cranial defect containing brain tissue. It
usually occurs in the midline in the occipital region (75%),
frontal (13%) and parietal (12%). They appear as isolated lesions or associated with other anomalies. At ultrasonography
encephalocele manifests as mass in the cranial surface. The
confirmation occurs by the presence of brain tissue, herniated
by the bone defect. Chromosomal abnormalities are observed
in 14-18% of cases, mainly trisomy 18 and 13. Neonatal mortality is around 44% of cases and cognitive disorder affects
40% to 91% of survivor.
Discussion and summary of the case: Ultrasonography is
an effective method for the diagnosis of encephalocele and
determining their location, size and affected structures.
PD.17.010
Pleural and lung ultrasound at the bedside in the intensive care unit: a pictorial
essay and literature review.
Authors: TAVARES, M.A.; OLIVEIRA, R.R.; OLIVEIRA
FL, W.; LIPPI, M.M.; MATOS, A.M.
Institution: UNIVERSIDADE FEDERAL DO AMAZONAS (UFAM), MANAUS, AM, BRASIL
Author responsible: Michel de Araujo Tavares
Introduction: Ultrasonography is fast and affordable method for hemodynamic evaluation, pleural and lung, cardiac,
periferal vascular at intensive care unit (ICU). This study
aims is show the aplications and interpretation of pleura and
lung ultrasonography exams in critical care patiets at ICU.
Methods Involved: Pleural and lung ultrasound images will
be analyzed with the main applicability in critical care patients.
Discussion: Pleural effusions seen by transthoracic ultrasound as anechoic collections in the pleural space, common
in costophrenic angles. It has higher sensitivity to chest
X-ray, identifying smaller quantities than 20ml. In pneumothorax there is the loss of the physiological sliding of visceral
137
and parietal pleura flyers, sensitivity finding of 95.3% and
specificity of 91.1% and a negative predictive value of 100%.
Pulmonary point at which prevents an incomplete pneumothorax lung sliding a region adjacent to an area without
pneumothorax, in which there is normal slip also has a high
specificity. Alveolar and intesticial liquid can be seen by the
presence of lines B.
Conclusion of the presentation: Medical education should be
intensified in this method because it is inexpensive, safe, affordable, provide relevant information, defining conduct in ICU.
PD.17.011
Vascular ultrasound to guide vascular
procedures in the intensive care unit: a
pictorial essay and literature review.
Authors: TAVARES, M.A.; OLIVEIRA, R.R.; OLIVEIRA
FL, W.; LIPPI, M.M.; MATOS, A.M.
Institution: UNIVERSIDADE FEDERAL DO AMAZONAS (UFAM), MANAUS, AM, BRASIL
Author responsible: Michel de Araujo Tavares
Introduction: Peripheral arterial and central venous puncture is routine in the intensive care unit (ICU). Ultrasonography (US) is a method used to guide puncture of the internal
jugular vein (IJV), axillary vein and femoral vein, brachial
artery, reducing the risk of complications. This study aimed
to demonstrate the importance of US as a method for vascular
invasive procedures in the ICU.
Methods Involved: US images will be analyzed as a guide
for vascular catheterization procedures in ICU patients.
Discussion: Critical patients require central venous access
for measuring pressure, central venous saturation, vasoactive
agents and highly concentrated solutions, dialysis catheter
installation. The PVC made blind is more likely to lead to a
pneumothorax, not compressible bleeding. Ultrasonography
as a guide provides direct visualization of the structure to
be punctured, reducing complications. Provides preliminary
study of the structure to be punctured, giving the examiner to
choose the best site for the puncture.
Conclusion of the presentation: It should be emphasized
the improvement of ultrasound in the ICU, making their routine practice during vascular procedures, aiming minor complications to critical patients.
PD.17.012
ACUTE PELVIC PAIN IN THE YOUNG FEMALE PATIENT: COMMON FINDINGS AND DIFFERENTIAL
DIAGNOSIS IN ULTRASONOGRAPHY
Authors: LIMA, M.R.; STRIEDER, D.L.; SIECK, G.G.;
SCORTEGAGNA, F.A.; RIBEIRO, G.J.; PEREZ, J.A.
Introduction: Acute pelvic pain is a common complaint at
emergency departments, specially among young female patients. Once pelvic pain is an unspecific symptom and usually comes in association with other unspecific ones, complimentary imaging studies play a leading role in accurate
diagnosis. This essay will show some possible differential
diagnosis for acute pelvic pain, pointing out the main imaging characteristics.
Methods Involved: Review of several etiologies of acute
138
pelvic pain illustrated by Ultrassonography (US) images,
pointing out their most important aspects and possible supporting findings that can ease the diagnosis.
Discussion: The differentials are many and include mostly
gynecological, urinary and gastrointestinal causes. Some of
them have distinct presentations at US, allowing a proper diagnosis by this examination. Still, there are complimentary findings that corroborate the diagnosis and help the
study’s interpretation.
Conclusion of the presentation: US is a cheap and accessible method, that guarantees a fast and proper evaluation of
the patients with acute pelvic pain at emergency. Many diagnosis can be achieved based on clinical setting in addition to
ultrassnographic aspects, but in some cases, specially related
to the method’s limitations, complimentary imaging studies
might be necessary.
PD.17.013
The importance of ultrasound in the
pre-surgical evaluation of imperforate
anus: case report
Authors: FIGUEIREDO C.A.P; VIOLATO L.M; COPPO
S.R; ZANFORLIN M.S; PIRES R.C
Institution: CETRUS, SAO PAULO, SAO PAULO,
BRASIL
Author responsible: Marcio Luiz Violato
Brief description of the purpose of the report: Description
of the evaluation of ultrasonography of neonatal performed in
a patient with imperforate anus.
Medical History: Newborn male with 38.5 weeks gestational age with imperforate anus diagnosed in the delivery room.
Diagnosis: The anorectal malformations is an important
cause of obstruction of the gastrointestinal tract determining
high rate of morbidity and mortality. It’s estimated incidence
is 1 for every 5000 newborn. Prenatal diagnosis of this isolated anomaly is usually difficult because there is no other
malformations associated to aid in the clinical suspicion. The
sonographic evaluation performed with high frequency transducer allows the characterization of the distance from the terminal stump of the digestive tract to the skin level, as well as
research fistula and anal sphincter. These data are extremely
important for surgical planning.
Discussion and summary of the case: The ultrasound study
takes an important function in the preoperative planning of
neonates with imperforate anus.
PD.17.014
Transthoracic echocardiography and
inferior vena cava ultrasound in the intensive care unit: a pictorial essay and
literature review.
Authors: OLIVEIRA, R.R.; OLIVEIRA FL, W.; TAVARES,
M.A.; MATOS, A.M.; LIPPI, M.M.
Institution: Universidade Federal do Amazonas, Manaus,
Amazonas, Brasil.
Author responsible: Rodrigo Ribeiro de Oliveira
Introduction: Among the applications of ultrasonography
in intensive care unit (ICU), stand out echocardiography and
evaluation of the inferior vena cava (IVC). There is the possibility of assessing shock differential diagnosis, hemodynamic
instability, measuring cardiac output, and size of the inferior
vena cava. This study will demonstrate the applicability of
this method in these segments.
Methods Involved: Echocardiography and IVC ultrasound
images will be analyzed in ICU critical care patients.
Discussion: By transthoracic echocardiography, the intensivist can evaluate qualitative data on the segmental dysfunction, global, interventricular communication. Indicate
inotropic drugs. Measure the right and left cardiac chambers for diagnosis of right ventricular failure associated with
acute respiratory distress syndrome, mechanical ventilation
and pulmonary thromboembolism. Diagnosis of pericardial
effusion, cardiac tamponade. Provides cardiac output noninvasively, multiplying the transverse area ventricular outflow
tract (LVOT), the integral of the flow rate with LVOT pulsed
doppler, with heart rate. The IVC is evaluated in the right
atrium entry in the subcostal window, measure its diameter in
expiration and inspiration in M mode, telling us the need for
volume replacement and central venous pressure.
Conclusion of the presentation: Since there accessibility
and great information obtained in using this method in ICU,
it is important to emphasize their continuing education.
PD.17.015
Sonographic findings in the glenohumeral ligaments injuries
Authors: SILI,T.J.M; BRANDÃO, A.T.; SILVA,M.R.C.;
TANAKA,R.M.;
FRANCISCO
NETO,M.J;
FUNARI,M.B.G.
Author responsible: Tárik José Moura Sili
Introduction: The instability and adhesive capsulitis are
common pathologies in the shoulder. The glenohumeral ligaments are frequently damaged structures in these diseases.
The purpose of this paper is to review the anatomy and the
changes of these ligaments in some patients.
Methods Involved: Shoulder ultrassonography in patients
with shoulder instability.
Discussion: The shoulder stability depends on bone and soft
tissue structures. The glenohumeral ligaments are important in
this role. They are constituted by thickening of the joint capsule. In unstable shoulder can be found in some patients (who
are not obese and do hyperextension with abduction of the
arm), by ultrasound, ligament injuries. The adhesive capsulitis
is a fibrosing inflammation that causes pain and limitation of
shoulder movement. Glenohumeral ligament thickening can
eventually be observed on ultrasound in this disease.
Conclusion of the presentation: Although MRI is the standard for the diagnosis of these entities, ultrasound is a method
of easy access and can offer a dynamic evaluation of the joint.
In some patients, it is also possible to evaluate the glenohumeral ligaments. It is important to the radiologist know the
correct maneuver to evaluate the glenohumeral ligaments in
seeking changes to these structures, which can help in the
treatment planning of the patient.
PD.17.017
Sonographic findings of ankle ligaments
injuries
Authors: RODRIGUES M.A.S.; ELIAS L.N.; TANAKA
R.M.; BRANDÃO A.T.;SILVA M.R.C.S.; FRANCISCO
NETO M. J.; FUNARI M.B.G.
São Paulo, Brasil
Introduction: Ankle and lateral or plantar faces pain of the
foot are common symptoms and have several causes. Clinical
evaluation of the tendons may be limited by compensatory
mechanisms of adjacent muscles. Ultrasonography is a good
method to the assessment of the ankle: safe, efficient, has
good cost benefit relation and is effective in the diagnosis of
ligament injuries. Our objective in this study is to conduct a
review of the cases with abnormalities in malleolar ligaments
and their sonographic findings.
Methods Involved: Review of cases submitted to ankle ultrasonography in our files.
Discussion: The success of ultrasound of the musculoskeletal system has been the subject of several studies, their
success depends on the knowledge of normal anatomy, their
pathological changes and the suitable probe positioning
during the procedure.
Conclusion of the presentation: The ultrasound study was
appropriate to set ligament injuries ankle, showing to be
reproducible and illustrative, in its various manifestations,
when performed by a professional trained in the method.
Thickening, echogenicity changes, partial discontinuity and
complete rupture were the main findings associated with ligament injuries.
PD.17.018
LYMPH NODES: TYPICAL AND NOT TYPICAL FINDINGS ON ULTRASOUND
Authors: TONIN, C.L; AZEVEDO, M.M; HO, F; PEREIRA, P.P; COSTA, A.S; VERGÍLIO, F.S; MARCHIORI, L.B;
MIURA, T.Y.
Author responsible: Carla Luisa Tonin
Introduction: The lymph nodes are oval structures, measuring 0,1 cm to 2,5 cm, and when altered help to differentiate
the disease pattern - benign (reaction) or malignant (neoplastic). This study – pictorial essay – comprises the main ultrasound methods to classify lymph nodes in typical and not
typical and emphasize the importance of this method as tool
to establish the need for further study.
Methods Involved: Use of ultrasound images performed in
mode B and mode doppler obtained from the literature and
radiology files of a public Hospital.
Discussion: The ultrasonography (US) allows for detailed study
of lymph node in relation to its size, shape, number, presence of
hilum, enhanced cortex, calcification, spread of autbreaks extracapsular and vascularization. These criteria, which have different
degrees of relevance, contribute to the multifatorial assessment
of lymph node and their degree of suspicion as malignancy.
Conclusion of the presentation: The US proved to be a
great method to distinguish benign and malignant nature of
the lymph node, thereby assisting the professional health in
diagnosing pathological and contributing to the indication of
the histological study.
PD.17.019
Sonographic findings of elbow ligaments injuries
139
Authors: RODRIGUES M.A.S.; CAMARA L.R.A; TANAKA R.M.; BRANDÃO A.T.;SILVA M.R.C.S.; FRANCISCO
NETO M. J.; FUNARI M.B.G.
São Paulo, Brasil
Introduction: Ultrasonography is a good method for the
evaluation of ligament injuries of the elbow: safe, effective
and has a good cost / benefit ratio. Our objective in this study
conduct a review of the cases of changes in the elbow ligaments and their sonographic findings.
Methods Involved: Educational files review of the elbow
ultrasound exams, analysis of the images of the normal anatomy of the ligaments and cases demonstrating injuries.
Discussion: The success of ultrasound of the musculoskeletal system depends on proper positioning in the procedure,
knowledge of anatomy and sonographic changes.
Conclusion of the presentation: The ultrasound study was appropriate to demonstrate ligament injuries of the elbow, and proved
to be reproducible and illustrative, when performed by a professional trained in the method. Thickening, echogenicity changes,
partial discontinuity and complete rupture were the main findings.
PD.17.021
The importance of sonographic evaluation for identifying the Polycystic
Ovary Syndrome.
Introduction: The Polycystic Ovary Syndrome (PCOS) is
a complex endocrine disease characterized by hyperandrogenism and chronic anovulation. Its symptoms are menstrual
irregularities or amenorrhea and a wide variety of conditions caused by hyperandrogenism such as hirsutism, acne
and alopecia. Pelvic ultrasound (mainly transvaginal) shows
increased ovarian volume, stromal hypertrophy and infracentimetric cysts close to the cortex.
Methods Involved: For diagnosing this disease it is necessary that the hyperandrogenism or chronic anovulation is
clinically proven via laboratory tests along with these imaging findings.
Discussion: PCOS is associated to different levels of infertility, increased risk of endometrial cancer, cardiovascular
diseases and metabolic disorders such as diabetes mellitus
caused by hyperandrogenism.
Conclusion of the presentation: The proper sonographic evaluation is very important, since it helps the diagnosis
process and outpatient treatment of patients with this widely
common syndrome that may cause the severe comorbidities
previously mentioned.
PD.17.023
Ultrasonographic aspects of hollow viscera lesions
Authors: Ho F. , Pereira P.P. , Sasaki F.V. , Marchiori L.B. ,
Miura T.Y. , Paixão N.C.F , Câmara G.V. ;
Author responsible: Fábio Ho
140
Introduction: Considering the great number of patients
with acute abdominal pain in Emergency Units, it´s adequate
choosing a low cost method, widely available and that is quite
accurate to help diagnosis and adequate immediate action. In
this scenario, high frequence transducer technology evolution and consequent upgrade in image quality enable better
hollow viscera evaluation. Therefore, that´s the chosen method for initial examination in these cases. This study evaluates
ultrasonography accuracy in identifying these diseases.
Methods Involved: Elaborating a pictorial essay comparing ecographic results with tomographic ones compatible
with the most common hollow viscera diseases seen in our
institution´s Emergency Unit ( appendicitis, diverticulitis,
neoplasms ). Retrospective analysis of cases which diagnosis
were made by tomographic findings was performed. Previous
ecographic findings were studied to establish comparison.
Discussion: Comparison of both methods results points to great
efficiency of Ultrasound in despite of its lower accuracy when
compared with computed tomography. This fact confirms the
necessity of correlation of its findings with clinic information
in order to exclude diagnosis or indicate another tests.
Conclusion of the presentation: In spite of its lower accuracy, ultrasound is extremely useful as a first complementary
exam to diagnose hollow viscera lesions.
TL – Scientific Papers –
Oral Presentation
TL.01.001
ARFI Elastography and fibrosis serum
markers on patients with Hepatitis C
Authors: Schmillevitch J, Gomes R, Mincis R, Mincis
M, Gorski A
Institution: XXX
Author responsible: JOEL SCHMILLEVITCH
Brief description of the purpose of the study: Comparing
the ARFI Elastography, fibrosis serum markers and liver biopsy on patients carrying Hepatitis C.
Methods: Prospective study between January 2012 and
March 2014 on 112 non-treated patients (HC) with biological
tests (APRI, Forms, King and FIB-4) and liver biopsy. The
cut-off values were determined by the AUROC curve and the
Metavir classification was used.
Main results: The best result to predict significant fibrosis (F
? 2) was the elastography with AUROC of 90% and for liver
cirrhosis was ARFI with AUROC of 0.98
Conclusion of the presentation: The ARFI elastography
presented excelent accuracy on the quantification of liver
fibrosis levels and showed to be more effective than serum markers
TL.01.007
CT Enterography: A Comparison of Image
Quality and Dose Reduction between Routine-Standard Radiation Dose with Filtered Back Projection and Low-Dose with
Iterative Reconstruction in a 128-channel MDCT
Authors: SILVEIRA,M.C.; AMBROSIO, A.M.; COSTA-SILVA,L.
image quality in patients who underwent CT Enterography
(CTE), using two different reconstruction algorithms: (a)
Standard radiation dose and reconstruction based on filtered
back projection (FBP), (b) low radiation dose and reconstruction based on iterative reconstruction (IR). The second aim
is to estimate the amount of dose reduction in second group.
Methods: 198 patients, mean age 43.3y/o, 61 male, underwent CTE, in a 128-channel MDCT, were retrospectively
evaluated. From January-June/2013, 111 patients underwent
CT with FBP/standard radiation dose and between July-December, 87 patients used IR/reduced radiation dose. All exams were performed with automatic tube current modulation. Blinded to scan technique, one abdominal radiologist
reviewed the images in random order. The image quality was
evaluated based on a 5 point-score, considering the following aspects: adequacy for bowel imaging; ability to identify
small vessels and to evaluate the liver; overall quality of the
study; and whether there was image noise that might obscure
pathologic findings.
Main results: Considering the statistical findings, the estimated dose reduction between the protocols was 40%. All
exams were scored above 3/5points.
Conclusion of the presentation: New techniques allow
low-dose CT maintaining image quality. Using IR, the image
quality compares well or even better with that of conventional reconstruction algorithms in CTE.
TL.01.011
Fibrosis in nonalcoholic fatty steatohepatitis: noninvasive assessment with MR
elastography: Preliminary Results
Authors: COSTA-SILVA, L.; FERRARI, T.C.A.; LIMA,
A.S.; FEROLLA, S.; AMBROSIO,A.M.; SILVEIRA,M.C.;
FIGUEIREDO, E.
the diagnostic accuracy of magnetic resonance elastography
(MRE) as a method to help diagnose fibrosis in patients with
nonalcoholic steatohepatitis (NASH).
Methods: This prospective study was institutional review
board approved. Informed consent was obtained. This study
was conducted in patients with NASH, who were identified
by laboratory tests and biopsy and in healthy volunteers,
with no history of liver disease or alcohol intake. All of them
underwent MR elastography (MRE) and liver stiffness was
calculated. Non-parametric and parametric tests were used
to compare the MRE stiffness to the fibrosis noted on liver
biopsy and on volunteers.
Main results: Analysis included 42 subjects (28 patients
with NASH and 14 healthy volunteers). MRE median liver
stiffness measurements increased per histologic liver fibrosis
stage (one-way ANOVA p<0.001), with significant correla-
tion between increasing fibrosis stage and stiffness values.
Median MRE for control group (2.50kPa±0.62kPa) was significantly lower than for patient group (3.48kPa±1.38kPa)
(p=0.04). Significantly, higher median stiffness was seen
with increasing severity of fibrosis: F0:2.50kPa, F1:3.70kPa,
F2:3.50kPa, F3:5,40kPa and F4:7.76 kPa.
Conclusion of the presentation: Our analysis supports previous findings that MRE is a non-invasive and effective method
for detection and assessment of liver fibrosis and may represent a valuable tool to discern hepatic fibrosis non-invasively.
TL.02.002
MRI-US fusion prostate biopsy: initial experience at a single center and comparison with standard 12-core TRUS biopsy in
the same procedure
Authors: Bittencourt, L.K.; Mostardeiro, T.; Purysko, A.S.
Institution: Cleveland Clinic, Cleveland, OH, EUA e Universidade Federal Fluminense (UFF) - Rio de Janeiro,
RJ, Brasil
Author responsible: Leonardo Kayat Bittencourt
Brief description of the purpose of the study: The aim of
this retrospective study is to compare the detection rates of
clinically significant (CS) prostate cancer (PCa) by MRI-US
fusion biopsy and standard 12-core Transrectal US guided
(TRUS) biopsy.
Methods: 72 men underwent both MRI-US fusion biopsy
(Uronav, InVivo), with targets identified on preceding MPMRI performed on a 3 Tesla scanner. These patients also underwent systematic 12-core TRUS biopsy in the same procedure, and the results of both methods were compared.
Main results: Both biopsy techniques combined detected
PCa in 66.7% of the patients, including 38.9% patients with
CS disease. There was no statistically significant difference
in the number of PCa detected by MRI/US fusion biopsy
(34/72) compared to standard TRUS biopsy (37/72) (p 0.79),
and no difference in the number of patients diagnosed with
CS disease (20 patients for each method) (p 0.81). There were
8 cases in which CS was detected on standard biopsy but not
on MR-US fusion biopsy, and 8 cases in which CS was detected only on MR-US fusion biopsy.
Conclusion of the presentation: MRI-fusion biopsy may
improve detection of CS PCa, but in the early phase of implementation of this technique, it may be important to continue
to perform standard TRUS biopsy to ensure the detection of
CS disease.
TL.02.003
Multiparametric Magnetic Resonance
Imaging for Detection of Central Gland
Prostate Cancer Prior to Biopsy
Authors: Mussi, TC; Martins, T; Queiroz, MR; Gobbo, R;
Baroni, RH
SP, Brasil
Brief description of the purpose of the study: To compare suspicious imaging findings on multiparametric MRI
141
for screening of clinically significant prostate cancer with
biopsy results.
Methods: Retrospective analyses of patients that performed
mpMRI followed biopsy using US/MRI imaging fusion in
a period of 17 months. Inclusion criteria were presence of
suspicious lesions in the central gland (PI-RADS 3 to 5) in
patients referred for screening of clinically significant prostate cancer, with a maximum interval of 6 months between
procedures. mpMRI included T2 weighted-images, DWI and
perfusion in a 3T magneto without endorectal coil.
Main results: The final group was composed of 32 patients
(median age: 63.5 years old, median PSA: 5.5 ng/mL and median time between procedures: 23.5 days). Fifteen patients
were classified as PI-RADS 3 (equivocal), seven patients as
PI-RADS 4 (clinically significant cancer likely present) and
10 patients as PI-RADS5 (clinically significant cancer highly likely present). Overall positivity for clinically significant
cancers was 40% (7% of PI-RADS 3, 28% of PI-RADS 4 and
100% of PI-RADS 5).
Conclusion of the presentation: Tumors in the central gland
of the prostate remain a challenging diagnosis. mpMRI prior
to biopsy helps in the detection of lesions and in guidance
of focused sampling during the procedure, especially when a
high suspicion pattern is observed (PI-RADS 5).
TL.02.009
Dynamic voiding UrethroMR: description
of the technique and initial experience
of 15 cases.
Authors: ARAUJO, JR., C.M.C.; COUTINHO, JR., A.C.M;
CAVALCANTI, A.G.L.C.; FIEDLER, G.; PURYSKO, G.;
BITTENCOURT, L.K.
Author responsible: Carlos Martins Carneiro de Araujo Junior
Brief description of the purpose of the study: Describe the
examination for protocol Dynamic voiding UrethroMR that
we have developed in our service, reporting the main findings
in an initial experience of 15 patients.
Methods: Images were acquired in the Siemens Aera 1.5-T
after the lidocaine gel administration via urethral, with standard protocol including axial T1-weighted sequences of the
pelvis, axial and sagittal T2, coronal SPACE, T1 fat-sat sagittal pre and post gadolinium, and MRI techniques with urographic effect obtained at rest and during voiding effort. The
first 15 patients were studied for the examination indication,
number, location and extent of stenosis.
Main results: All patients were referred for suspected urethral stenosis, 60% for sexually transmitted diseases, 26.7%
postoperative status, 6.7% related to hypospadias and 6.7%
with nonspecific dysuria. here was satisfactory opening of the
bladder neck during the voiding phase in 53.3% of patients.
60% of patients had single stenosis, while 40% of patients
had multiple stenoses, being more common in the bulbar
urethra (53.3%), followed by penile (33.3%). The average
length of stenosis was 2.4 ± 2,8cm. There was only one case
of post-procedure complications, related to self-limiting urethral bleeding.
Conclusion of the presentation: Dynamic voiding UrethroMR is an elegant method, simple to implement,
provinding useful information for the management of urethral strictures.
142
3 - Head and Neck
TL.03.007
Cochlear and vestibular hyperintensity
on 3D-fluid-attenuated inversion recovery (3D-FLAIR) sequence in Vogt-Koyanagi-Harada disease: a new imaging finding.
Authors: LEITE M.A.; DUTRA B.G.; TOYAMA C.; ZUPPANI H.B.; SILVA C.J.
São Paulo, Brasil
Author responsible: Marco Antônio Leite
Brief description of the purpose of the study: Describe
cochlear and vestibular hyperintensity on 3D-fluid-attenuated inversion recovery (3D-FLAIR) in four patients with
Vogt-Koyanagi-Harada (VKH) disease with clinical and audiometric correlation.
Methods: Four patients classified as incomplete VKH disease by the Revised Diagnostic Criteria presented mild headache, blurring vision and ocular hyperemia, three of them
with symptomatic hypoacusia, were submitted to magnetic
resonance (MR) evaluation. We analyzed the MR findings on
3D-FLAIR sequence and correlated them with further clinical and audiometric data.
Main results: We depicted sensory hearing loss on audiometric examinations, as well as cochlear and vestibular hyperintensity on 3D-FLAIR in all four VKH patients, three of them with symptomatic hypoacusia. There
is a high incidence of cochlear and vestibular end-organ
involvement in patients with VKH disease and the adequacy and timing of treatment has a significant effect on
the disease outcome. As far as we know, this is the first
report of labyrinthine signal abnormality on 3D-FLAIR
in this setting.
Conclusion of the presentation: MR imaging has been a
helpful complementary examination in the diagnosis of VKH
disease and the 3D-FLAIR sequence may be an additional
tool for clinical and subclinical evaluation of sensory hearing
loss in this setting, contributing for early diagnosis and adequate treatment.
TL.03.008
Correlation between ecographic features of thyroid nodules and cytological
exam for neoplasia risk stratification.
Evaluation of the conformity of two TIRADS in the classification of 1986 nodular
lesions submitted to fine-needle aspiration guided by ultrasonography
Authors: CARDOSO, E.O.A.; MAIA JR., A.C.M.
Author responsible: Erica Oliveira Alves Cardoso
Brief description of the purpose of the study: Compare
two TIRADS systems published in the literature which intend
to evaluate nodules submitted to fine needle aspiration guided
by ultrasound(FNA-US).
Methods: 1864 thyroid nodules were submitted to FNA-US
and stratified according to the systems published by Horvath
et al. (called TIRADS A) and Kwak et al. (called TIRADS B)
and correlated with the cytological results. The nodules classified as Bethesda II and III were grouped as \”non-surgical\”
and the ones classified as nodules Bethesda IV, V or VI were
named \”surgical\”.
Main results: From the sample, 1745 nodules (93.6%) were
classified as non-surgical and 119 (6.4%) as surgical. Was
found a statistical significant association between with surgical
indication and microcalcifications (OR=34.1; CI13,9-83,8;p
<0.001), also with not parallel to skin orientation (OR=3.2;
CI1,9-5,5;p<0.001) and with presence of halo, whether thick
(OR=35; CI11,8-103,7;p<0.001) or thin (OR=14.1; CI5,536,1;p<0.001). The sensitivity, specificity, PPV, NPV, and
accuracy between the two methods were respectively TIRADS A97.5%,79.7%, 23.8%,99.8% and 80.8%; TIRADS B
94.2%,79.4%, 22.9%,99.5% and80.3%. The possibility of aggressiveness could be excluded in the absence of echographic
risk predictors signs on 99,9% of the cases.
Conclusion of the presentation: The two systems had a satisfatory risk stratification of thyroid nodules, especially when
used to exclude surgical indication, with no statistical difference between them
4 - Cardiovascular
TL.04.001
Risk Factors and Coronary Calcium Score in the elderly.
Authors: DARIO, C.F.R; SZARF, G; NOMURA, C.H;
ISHIKAWA, W.Y; SANTANA-NETTO, P.V; SASDELLI,
R.N; FUNARI,M.B.G.
Author responsible: Gilberto Szarf
Brief description of the purpose of the study: To analize
cardiovascular risk factors and coronary calcium score in a
group of people of 65 years or older.
Methods: We studied the patients 65 years or older that
underwent computed tomography to detect coronary artery
calcification (coronary calcium score) between 2013 April
to 2014.
Main results: 661 patients were evaluated. Zero score was
found in 119 (18%), 192 (29%) presented scores between 1
and 100, 134 (20%) between 101 and 300, and 216 (32%)
scores over 300. Sixty nine patients were smokers (10%) and
234 (35%) former smokers. Diabetes was mentioned in 168
of them (25%). Total cholesterol levels were known in 343
(52%) of the patients, with levels above the normal range in
67 patients (20% of the patients with known cholesterol levels). Three hundred seventy nine (57%) patients were treated
for hypertension.
Conclusion of the presentation: In an elderly group, the distribution of coronary calcium score and the cardiovascular risk
were evaluated. Advanced age not necessarily correlated to the
presence of exuberant amount of calcified coronary plaque.
TL.04.003
Comparison of Coronary CT Angiography
with Intravascular Ultrasound in the qualitative assessment of coronary plaques
Authors: Cardoso APT., Bierrenbanch AL., Parga JR., Ávila
LFR., Falcão BAA., Lemos PA., Kalil R.
Paulo, Brasil
Author responsible: Ana Paula Toniello Cardoso
Brief description of the purpose of the study: Coronary CT
angiography (CCTA) is a noninvasive method that has the
ability to assess coronary plaque characteristics.Intravascular
Ultrasound(IVUS) is the invasive gold standard for assessment of plaque composition and progression in clinical studies.However,few studies have compared CCTA with IVUS
in order to determine its diagnostic accuracy.The aim of the
study was the demonstration of diagnostic accuracy of CCTA
X IVUS.
Methods: Patients who were referred to the Hospital for
coronary artery disease investigation and underwent CCTA
and IVUS from January 2011 to May 2013 were selected
for the study. Dedicated software for each exam evaluated
minimal lumen area (MLA), percentage stenosis(AS),plaque
burden(PB%),and composition(calcified (C), mixed (M) or
non-calcified(NC).
Main results: Ninety patients underwent both CCTA
and IVUS(125 arteries) were enrolled in the study.CCTA
and IVUS results showed a MLA of 4.4±0.18and4.7±0.2
mm;AS(%)of 50±0.8 and 55±0.9%;PB(%) of 59±0.8 and
62±1.8%,respectively. There were 21%,62% and16% of
C, M and NC plaques.IVUS showed 28%,54% and 16% of
C, M and NC plaques.There was 84% agreement between
both methods in plaque composition.There was non-significant differences between CCTA and IVUS (MLA p=0.64),
PB (%) p= 0.14). Significant differences were found in
AS(p<0.001).
Conclusion of the presentation: CCTA has shown excellent
concordance with IVUS in the qualitative assessment of coronary plaques.
TL.04.005
Main clinical and radiological findings
of celiac trunk isolated arteritis and its
branches, a rare cause of abdominal pain,
with or without dissection.
Authors: CORADAZZI, K.R.S., ROCHA, M.A., MARTINS, A.N., TACHIBANA, A., FUNARI, M.B.G.
Brief description of the purpose of the study: The study
objective is establish the frequency of clinical and radiological findings of celiac trunk isolated arteritis (CTIA) with or
without dissection. Treatments and clinical outcome of each
case were also analyzed.
Methods: A retrospective study of CTIA with or without dissection, in the base of our service data, was made. In this
population, frequencies of radiological findings, symptoms,
clinical data and the proposed treatment, were studied. 26
cases were selected from the digital archive, 19 underwent
follow-up (average 19 months).
Main results: There was a male predominance (5.5:1) with
a mean age of 57 years (44-80). Most frequent symptoms
were: diffuse abdominal pain (10/38.5%), epigastric pain
(7/26.9%), melena (1/3.8%) and asymptomatic (8/30.8%).
Radiological findings were obliteration of fatty plans adjacent to the celiac trunk (14/53.8%), intimal flap of the vessel (13/50.0%) and dissection extending to the branches
(9/34.6%). Treatments used are analgesics and non-steroidal
143
anti-inflammatory (13/50%), corticosteroids (7/26.9%), anti-coagulants (4/15.4%) and endovascular surgery (2/7.7 %).
Four cases that began as arteritis evolved to dissection.
Conclusion of the presentation: The CTIA is rare and had
variable evolution. This condition can develop complications
such as dissection and ischemia. It´s important to know the
imaging findings for their identification and follow-up, leading to improve treatment for each case.
TL.04.006
Cardiac CT angiography for congenital
heart disease (CHD) evaluation using ultra-low dose of radiation in dual source
and high pitch equipment: initial experience in a reference center.
Authors: MELO, C.A.,DIAS, M.I., SIQUEIRA, M.E.,
GRAVINATTI, M.C. , GABURE,L.A.G. , CATTANI,
C.A.M.
Institution: Med Imagem, São Paulo, São Paulo, Brasil
Author responsible: Cíntia Acosta Melo
Brief description of the purpose of the study: To demonstrate the initial experience with ultra-fast acquisition equipment with low radiation dose protocol in the evaluation of
patients with CHD.
Methods: From Jul/14 to Jan/15, 57 exams were performed
using high pitch (3.2-3.4) in dual source equipment, using
low voltage and tube current. Demographic data and technical procedures were collected.
Main results: Thirty-three males (58%) with a median age
and weight of 8,4 months (0-339) and 7.3 kg (2.4-64), respectively. The average scan time was 0.5 ± 0.1seconds.
Exams without apnea were done in 48 patients (34 with inhalation sedation without intubation, 8 newborns without
sedation and movement restraint, 6 patients were already
intubated). The other 9 patients had ability to perform spontaneous apnea. The median radiation was 0,16 mSv (0.050.77mSv) and contrast was 1.3 ml / kg (0.9 to 2.4). The diagnostic quality was considered adequate in all exams.
Conclusion of the presentation: Exams performed on the
equipment with ultra-fast acquisition showed good diagnostic quality with significantly lower radiation dose in this
initial group of patients, similar to previous literature data.
Studies with more patients need to be carried out to confirm
this statement in our reality.
TL.04.007
Use of Cardiac CT angiography in pre and
post-operative evaluation in hypoplastic
left heart syndrome (HLHS): experience
of a reference center
Authors: MELO, C.A.,DIAS, M.I., SIQUEIRA, M.E.,
GRAVINATTI, M.C. , GABURE,L.A.G. , CATTANI,
C.A.M.
Institution: Med Imagem, São Paulo, São Paulo, Brasil
Author responsible: Cíntia Acosta Melo
Brief description of the purpose of the study: Demonstrate
the use of cardiac CT angiography in the evaluation of HLHS.
Methods: Retrospective analysis of medical records of a
series of patients with HLHS who underwent cardiac CT
angiography. We collected demographic and technical data
(age, weight, sex and surgical stage, contrast volume and ra-
144
diation) related to the procedure. Were also analyzed clinical
relevance data.
Main results: From Nov/10 to Aug/14, 101 patients underwent 128 exams, 79 male (78%). The median age and weight
were 4.7 months (0.1 to 123) and 5.5 kg (2.7 to 30). The
median contrast and radiation dose were 8 ml (4-45) and 1
mSv (0.2 to 2.9). Sixty were post-Norwood, 46 post-Glenn
and 16 post-Fontan. The others were hybrid procedure or
without surgery before exam. The most frequent diagnoses
were pulmonary artery stenosis (33.6%) or in the RV / PA
conduit (24.2%), significant systemic-pulmonary collateral
circulation (21%), aortic coarctation (19%) and hypoplastic
pulmonary arteries (15.6%). Good repair was considered in
15% of cases.
Conclusion of the presentation: Cardiac CT angiography
proved to be an excellent method for HLHS structural assessment, adding relevant information, mainly in the evaluation
of the pulmonary arteries and aorta. The radiation dose is not
negligible, but new generation equipment can drastically reduce these rates.
7 - Intervention
PA.07.019
Authors: Falsarella, P.M. Mendes, G.F. Rahal Jr, A. Socolowski, L.R. Silverio, P.R.B. Garcia, R.G. Francisco Neto,
M.J.F. Funari, M.B.G.
Brief description of the purpose of the study: Thyroid
nodules affect approximately 40% of the population, most
of these are benign. In recent years many imaging methods
have been developed in an attempt to predict the likelihood of
malignancy of the nodules, as its morphological features the
ultrasound study and the vascularization pattern with Doppler mapping. Elastography applied to the investigation of
thyroid nodules has been used in recent years to increase the
accuracy of prediction of malignancy of these nodules. Objectives: To demonstrate the correlation between the results
of elastography and fine needle aspiration cytology (FNA)
under BETHESDA scale.
Methods: the ultrasound images in B mode, Doppler and
Elastography of patients undergoing FNA of thyroid nodules,
and the correlation between the cytological and elastographic
data of these patients will be presented.
Main results: elastography analyzes the deformity of tissues
and indicates the degree of stiffness of them, comparing the
nodular area with normal parenchyma, characterized as elasticity index. Based on the concept that cancer has generally
more cell concentration, a smaller deformity capacity is observed in relation to the normal gland.
Conclusion of the presentation: The thyroid elastography
has proved to be an important diagnostic tool increasing the
accuracy of research when added to other diagnostic methods.
TL.07.001
Development of an experimental model
of Cone-Beam Computed Tomography
(CBCT)-guided vertebral cryoablation
in swine
Authors: FREITAS RMC; ANDRADE CS; CALDAS
JGMP; TSUNEMI MH; FERREIRA LB; ARANA-CHAVEZ
VE; CURY PM.
Institution: InRad - Instituto de Radiologia do Hospital das
Clínicas da Universidade de São Paulo, São Paulo, São Paulo, Brasil
Author responsible: Ricardo Miguel Costa de Freitas
Brief description of the purpose of the study: To present
the feasibility of a CBCT-guided percutaneous vertebral
cryoablation in a swine model in vivo.
Methods: The institutional animal care committee approved
this study. Twenty-two vertebral cryoablations were performed
in eight pigs, under protective measures to neural structures.
Clinical and radiological data were correlated with light (n=20)
or transmission electron (n=2) microscopic analyses.
Main results: CBCT/fluoroscopic-guided cryoprobe positioning and CO2 epidural injection were successful in all procedures. No major complications were observed in seven animals (87.5 %). A minor complication was observed in one pig
(12.5 %). The cryoprobe-spinal canal (Cp-Sc) distance was
the most efficient parameter to categorize spinal canal temperatures lower than 19oC (logistic regression model analysis; p<0.004). Ablation zones encompassed pedicles and the
posterior wall of the vertebral bodies. Light microscopy did
not depict inflammatory infiltrate in the surrounding neural
structures. Ultrastructural analyses evidenced myelin sheath
disruption in some large nerve fibers, although neurological
deficits were not observed.
Conclusion of the presentation: CBCT-guided vertebral
cryoablation of the porcine spine is feasible under a combination of a short freezing protocol and protective measures
to the surrounding nerves. Ultrastructural analyses may be
helpful to assess the early modifications of the nerve fibers.
8 - Breast
TL.08.001
Evaluation of breast lesions with compression elastography
Authors: Graziano L., Bitencourt A., Guatelli C., Poli M.,
Marques E., Souza J. , Pecora M.
Institution: A C Camargo Cancer Center, São Paulo,
SP, Brasil
Author responsible: LUCIANA GRAZIANO
Brief description of the purpose of the study: To evaluate the diagnostic accuracy of elastography compression
(”strain”) for breast cancer identification in patients with indeterminate lesions on ultrasound (US).
Methods: After approval by the Research Ethics Committee, patients were evaluated with indeterminate lesions in the
US and indication for percutaneous or surgical biopsy, from
August to November 2014. The elastography was performed
through qualitative analysis (Itoh criteria) and semi-quantitative, the correlation of the hardness of the lesions compared
to subcutaneous tissue and adjacent tissue. The ROC curve
was used to evaluate the accuracy of elastográficos criteria.
Main results: We evaluated 56 breast lesions, most nodules (85.7%) with a mean diameter of 16 mm (5-42 mm).
Histological evaluation showed that 40 (71%) benign and 16
(28.6%) malignant. Malignant lesions had higher degrees of
hardness to benign lesions in both analyzes. The accuracy of
semiquantitative evaluation was higher than for the qualitative diagnosis of malignancy. There was no significant difference in the accuracy of semi-quantitative analysis in the
tissues evaluated for correlation (adjacent subcutaneous tissue or tissue).
Conclusion of the presentation: Elastography is a promising method with low cost, painless and affordable in additional analysis of indeterminate breast lumps, which can
reduce the number of biopsies and anxiety of patients.
TL.08.002
Breast Cancer Screening Using Tomosynthesis in Combination with Digital Mammography.
Authors: Aguillar, VLN; Ferreira, VCCS, Dequi, CB,
Costenaro, MA, Cerri, GG
Paulo, Brasil
Author responsible: Vera Lucia Nunes Aguillar
Brief description of the purpose of the study: Determine
the performance of breast tomosynthesis combined to digital
mammografphy in breast cancer screening.
Methods: Retrospective study over 03 years of data collection (from 09/2011 to 08/2014), in private single center.
4,314 mammograms were performed with 2D followed by
tomosynthesis, both with two views (craniocaudal and mediolateral oblique). Equipment: Dimensions, Hologic. The interpretation of these studies was sequential reading (first 2D
then 3D) by dedicated breast imagers with, at least, 5 years
of experience and trained in tomosynthesis interpretation.
Mammographic density was visually estimated according to
the classification of BI-RADS.
Main results: Of the 4,314 tests performed, 72 were classified as BI-RADS 4 or 5 of which 27 had positive results (in
situ or invasive carcinoma). The breast cancer detection rate
was 4.9 / 1000, with digital mammography only and 6.2/1000
adding tomosynthesis. This means an increase of 28.3%.
Considering only invasive carcinomas, an increase of 55% in
the detection rate was noted. (6 carcinomas displayed only by
tomosynthesis, all as architectural distortion).
Conclusion of the presentation: Breast tomosynthesis digital mammography combined with increased cancer detection
rate, especially invasive cancers.
TL.10.002
The importance of doing three diferent
sites assessment for the osteoporosis
evaluation and diagnosis.
Authors: Santana João AM, Santana Sara MM, Leal Ângela
CGB, Barbosa Rita AA e Doria LS.
Institution: Serviço de Densitometria Clínica da Climedi. Av. Barão de Maruim, 570. Aracaju-Se. Brasil. Email:
[email protected]
Author responsible: João Antonio Macedo Santana
Brief description of the purpose of the study: A retrospective review of 705 females patients that performed the bone
density measurements not only in the two standard lumbar
spine and femoral sites recommended by WHO, IOF and
145
ISCD, but, including also, the forearm site in the evaluation
and diagnosis of osteoporosis.
Methods: The tests were performed on equipment Hologic
Discovery W and GE Prodigy showing proper readings for
the mentioned sites. 646 patients over 50 years of age were
selected and the prevalence of osteoporosis according to age
group was also determined.
Main results: RESULTS: 26% normal, 40% to 34% with
osteopenia and osteoporosis. Of the 34% with osteoporosis,
the results show that the addition of the forearm region determines an increase of more than 9% for the diagnosis of
osteoporosis, meaning that of 100 patients nine would not
be diagnosed. The prevalence of osteoporosis in aged 50 to
59 years was 21%, from 60 to 69 years 33% and 70 years
on 55%.
Conclusion of the presentation: Conclusions: This study
leads to the conclusion by the importance of the inclusion of
the forearm in the evaluation and diagnosis of patients with
suspicion and diagnosis of osteoporosis and that the prevalence of osteoporosis occurs with increasing age, according
to data from literature.
TL.10.003
Utility of brain SPECT with 99mTc-TRODAT-1
in evaluating striatal dopamine function
in Hereditary Spastic Paraplegia with
Thin Corpus Callosum
Authors: ARAUJO, MLCM; FABER, I; SANTOS, AO;
LIMA, MCL; MOSCI, C; ETCHEBEHERE, ECSC;
SOUZA, TF; FRANÇA JR, MC ; RAMOS, CD; AMORIM, BJ.
Institution: SERVIÇO DE MEDICINA NUCLEAR, DEPARTAMENTO DE RADIOLOGIA DO HOSPITAL DE
CLÍNICAS DA UNIVERSIDADE ESTADUAL DE CAMPINAS, CAMPINAS, SAO PAULO, BRASIL
Author responsible: Maidane Luisi Costa Maia Araujo
Brief description of the purpose of the study: Hereditary
Spastic Paraplegia with Thin Corpus Callosum (HSPTCC)
is part of a group of genetic disorders known as hereditary
spastic paraplegias, which are characterized by spasticity
and paraplegia. HSPTCC patients may present with dopa-responsive parkinsonism with difficult clinical diagnosis. Brain
SPECT with 99mTc-TRODAT-1 allows invivo evaluation of
nigrostriatal function.
Methods: Brain SPECT with 99mTc-TRODAT-1 was performed in 8 patients with HSPTCC. All had history of longstanding and slowly progressive spastic paraplegia. Brain
MRI revealed thinning of the corpus callosum in all patients.
The exam was also performed in 3 healthy controls.
Main results: The visual and quantitative analysis of the images of the control subjects had the expected parameters of
normality (right striatum: 1.09±0.08; left: 1.17±0.04; reference value: 1.1±0 25). Almost all patients (7/8) had reduced
bilateral striatal uptake on both visual and quantitative analysis (right striatum: 0.59±0.30; left: 0.64±0.22).
Conclusion of the presentation: Individuals with HSPTCC
presented reduced striatal 99mTc-TRODAT-1 uptake. This
low uptake is observed even in patients without clear symptoms of parkinsonism, suggesting that the nigrostriatal dopaminergic terminals are an important site of onset of disease and that dopaminergic agents could be useful in their
medical management.
146
PD.11.047
The association between posture, morphology and presence of fatty infiltration in the paraspinal musculature
Authors: BONUGLI, G.P; REIS R.M; SALMON, C.E.G;
NOGUEIRA-BARBOSA, M.H
Institution: FMRP-USP Ribeirão Preto, São Paulo, Brasil
Author responsible: Gustavo
Brief description of the purpose of the study: Assessment
a possible correlation between the spinopelvic alignment and
the presence of fatty infiltration in the paraspinal musculature
Methods: MRI was performed (Acquisitions Axial T1 and
In-Phase / Out-Phase) and panoramic radiograph (PR) in profile in 46 subjects without low back pain (21.54 ± 5.0 years).
Subjects were grouped according to the sacral slope (IS):
group 1 (IS <35 °) and group 2 (IS> 35 °). Two previously
trained examiners performed the segmentations of the multifidus muscles, erector and psoas in MR images and measured
the lordosis angles, pelvic incidence, pelvic tilt and sacral
slope in RP
Main results: The t test showed that the pelvic incidence
and lordosis were different between the groups. However not
identified differences in muscle volume nor in the percentage
of fat infiltration between groups. The presence of muscle
asymmetries were observed in the multifidus muscles and
erector in individuals with sacral slope greater than 35 ° and
the psoas in less than 35 °.
posture does not predictive influence on muscle trophism and
presence of fatty infiltration in asymptomatic young adults.
TL.11.001
Ultrasound evaluation on carpal tunnel syndrome before and after bariatric
surgery
Authors: CASTRO, A.A.; SKARE, T.L.; NASSIF, P.A.N.;
SAKUMA, A.K.; ARIEDE, B.L.; BARROS, W.H.
Institution: Hospital Evangélico do Paraná, Curitiba,
Paraná, Brasil
Author responsible: Adham do Amaral e Castro
the prevalence of carpal tunnel syndrome (CTS) in candidates
for bariatric surgery comparing with the non-obese population and verify the results on it after bariatric treatment.
Methods: Three groups of individuals were studied: waiting
for the bariatric surgery (preoperative); already undergoing
the procedure (postoperative); and control group. Were collected demographic and clinical data of CTS. Ultrasound examination was done to measure median nerve cross sectional
area to diagnose the CTS. Was considered significant p value
less than or equal to 5%.
Main results: Were included 329 individuals (114 in the
preoperative group, 90 in the postoperative group and 125
controls). There was a higher prevalence of paresthesias
(p=0.0003) and positive clinical tests (p=0.0083) when
preoperative group was compared to controls (p<0.00001).
There was decrease in paresthesias (p=0.0002) and median
nerve area (p=0.04) in postoperative patients but with no sig-
nificant difference in general. Difference was found between
the preoperative and postoperative groups (p=0.05) in those
who performed non-manual work.
Conclusion of the presentation: There was a higher prevalence of CTS between the preoperative group compared to
control, but no significant difference was observed between the
pre and postoperative groups in general. Difference was found
between pre and postoperative groups for non-manual workers.
TL.11.003
Common peroneal nerve injury in acute
and subacute posterolateral corner lesion: a retrospective MRI evaluation
Authors: Marconi, G.F; Simão, M.N.; Nogueira-Barbosa,
M.H.
Institution: Centro de Ciências das Imagens e Física Médica, Seção de Medicina Nuclear - Hospital das Clínicas de Ribeirão Preto - USP, Ribeirão Preto, São Paulo, Brasil
Author responsible: Gustavo Felix Marconi
Brief description of the purpose of the study: Purpose 1)
evaluate MRI identification criteria to determine common
peroneal nerve (CPN) lesion in patients with acute/subacute posterolateral corner (PLC) lesion 2) assess whether
there are correlation between injured structures and risk of
nerve damage.
Methods: Included retrospectively 38 patients submitted to
MRI and diagnosed with acute or subacute injury to the PLC.
Other 38 patients with normal knee MRI were used as the
control group. Nerve damage was classified as neurapraxia,
axonotmesis or neurotmesis. Measured signal intensity in the
CPN, tibial nerve (TN) and a superficial vein (SV), and calculated ratios (CPN/TN, CPN/SV).
Main results: Radiologist A found changes in CPN in 14
cases (36.8%): 9 neurapraxia, 5 axonotmesis and 0 neurotmesis. Radiologist B found changes in CPN in 15 cases (39.4%):
8 neurapraxia, 7 axonotmesis and 0 neurotmesis. Kappa test
showed high interobserver agreement. ROC curve demonstrated high specificity (93.3%) with CPN/NT ratio using
cut-off value of 1.39 and with CPN/SV ratio (81.3%) using
cut-off value of 0.41.
Conclusion of the presentation: Changes in the CPN in PLC
injuries are highy detectable by MRI, with good interobserver agreement. Using signal intensity ratio with tibial nerve
and a superficial vein increase nerve damage confidence.
TL.11.005
Desempenho diagnóstico de STIR e T2 com
supressão de gordura na detecção de sacroiliíte em atividade: Um estudo comparativo utilizando sequências T1 com gadolínio como padrão de referência.
Authors: DALTO, VF; ASSAD, RL; LORENZATO, MM;
LOUZADA-JUNIOR P; NOGUEIRA-BARBOSA MH
Institution: FMRP-USP, RIBEIRAO PRETO, SP, BRASIL
Author responsible: Vitor Faeda Dalto
Brief description of the purpose of the study: The STIR
technique has been considered the reference for diagnosing
sacroiliitis in the rheumatologic literature, but we found no
scientific evidence of superiority of STIR compared to other
fluid sensitive techniques. The aim was to compare the diagnostic performance of STIR and fat-suppressed (FS)T2 tech-
niques in the detection of sacroiliitis, using gadolinium-enhanced sequences as the reference.
Methods: We retrospectively included 69 patients with clinical suspicion of inflammatory sacroiliitis. All patients evaluated with 1.5T MRI protocol which included a coronal STIR,
coronal FS-T2-weighted and a coronal and axial GE-FS-T1weighted sequences. Two musculoskeletal radiologists (R1
and R2) evaluated each sequence and classified them as positive or negative for sacroiliitis according to the Assessment of
Spondyloarthritis International Society criteria. The diagnostic performance of techniques was achieved using GE-FS-T1
sequences as reference.
Main results: The FS-T2 technique showed a sensitivity
(St) of 1.0(95%CI 0.8, 1.0) and specificity (Sp) of 0.94(0.84,
0.98) for R1 and 0.94(0.69, 0.99) and 0.94(0.83, 0.98) respectively for R2. The STIR technique showed a St of 0.94(0.69,
0.99) for both readers and Sp of 0.86(0.73, 0.93) for R1 and
0.90(0.78, 0.96) for R2.
Conclusion of the presentation: Our results do not support
the STIR technique as being superior in the detection of bone
marrow edema in inflammatory sacroiliitis.
TL.11.007
Comparison between a semi-quantitative
and a quantitative method for evaluation of bone involvement in Gaucher’s disease
Authors: Rodrigues, R.N.; Rabelo, B.R.C.; Abuhid, A.M.L;
Strecker, R.; Mota, R.V.; Taranto, D.O.L.
Brief description of the purpose of the study: The purpose
of this study was to correlate the semi-quantitatively determined MRI-based bone marrow burden(BMB) score with a
quantitative method obtained by a 3D T2* -corrected Dixon
sequence in a cohort of adult patients with Gaucher’s disease.
Methods: MRI was performed in femurs and lumbar spine of
30 type 1 Gaucher patients. The images were analyzed separately by three radiologists .The BMB score was determined
and compared to fat fraction measurements at five spots of
both femurs and at three spots of the lumbar spine. A pattern
was created with anatomical references to make the measurements close to the same spot and with the same size at each
topography. The fat fraction measures were summed and correlated with the total BMB score. The correlation was calculated by using two-tailed pearson correlation test.
Main results: The mean BMB score were 11,46 (95%CI,
9.83-13.1) while the mean value for the sum of the fat fraction values were 680,63 (95%CI, 612.57-748.7). A strong
correlation was found between those two variables (r=0,82).
Conclusion of the presentation: In contrast with quantitative methods which are not widely available, BMB score can
be used with normal MRI technology and our results showed
a strong correlation with a quantitative method.
TL.11.009
Assessment of fatty degeneration of the
gastrocnemius and soleus muscles in patients with achillodynia using MRI: Reliability of the Goutallier classification system.
147
Authors: Rabelo, B.R.C.; Rodrigues, R.N.; Abuhid, A.M.L.;
Ribeiro, E.J.S.; Torres, J.M.; Baumfeld, D.S.
Brief description of the purpose of the study: The purpose of
this study was to quantify the reliability of the Goutallier classification for assessing fatty degeneration of the gastrocnemius
and soleus muscles in patients with achillodynia from MRI.
Methods: MRI of the calf of 22 patients with achillodynia
were evaluated independently by 3 musculoskeletal radiologists. The degree of fatty infiltration was scored as a set for
the gastrocnemius and soleus muscles on both legs using the
Goutallier classification system which was compared with a
gold standard qualitative method using the ImageJ software
for analyzing intensity distribution on both muscles. Interobserver reliability was determined and accuracy was assessed
by comparing readers scores with the gold standard method.
Main results: The gold standard method mean fat content
was 11.4% (95% CI, ± 9.8%) for the affected leg and 6.5%
(95% CI, ± 2.9%) for the asymptomatic leg. The agreement
with the gold standard method and the Goutallier classification for readers 1, 2 and 3 was 0,79, 0,84 and 0,76 respectively for the affected leg and 0,86,0,84 and 0,81 for the asymptomatic leg. Mean interobserver agreement for the Goutallier
classification was 0,84.
Conclusion of the presentation: Our results show that the
Goutallier classification is a reliable method for quantifying
fat infiltration in the gastrocnemius and soleus muscles.
12 - Neuroradiology
TL.12.001
Longitudinal Voxelwise Analysis of White Matter Integrity with Diffusion Tensor Imaging in Patients with Traumatic
Diffuse Axonal Injury
Authors: ANDRADE, C. S.; ZANINOTTO, A. L. C.; CONCEIÇÃO, D. M.; FIGUEIREDO, K.G.; MACRUZ, F. B. C.;
FELTRIN, F. S.; OTADUY, M. C. G.; LEITE, C. C.
Institution: Faculdade de Medicina da Universidade de São
Paulo, São Paulo, São Paulo, Brazil
Author responsible: Celi Andrade
Brief description of the purpose of the study: Traumatic
diffuse axonal injury (DAI) is an important cause of severe
disability and mortality. The main goal of this study is to longitudinally assess white matter (WM) integrity with diffusion
tensor imaging (DTI) in patients with DAI. Correlations with
clinical and cognitive parameters will also be held.
Methods: Twenty adults with moderate to severe DAI were
evaluated with a 3.0T magnetic resonance imaging in the
acute (t1<3 months), subacute (6<t2<t3
Main results: In comparison to controls, patients exhibited one
large cluster with lower FA values (p < 0.001) at all stages, but
the number of affected voxels decreased gradually by 2% at t2
and 7.2% at t3. Patients also exhibited significant increases in
MD, RD and AD. Patients’ performances on cognitive measures
were suboptimal at all stages, but also improved over time.
WM damage in DAI patients are not stationary and may reverse to some extent, likewise partial cognitive improvement.
148
TL.12.002
Imagens de Transferência de Magnetização na Avaliação da Integridade do
Parênquima Cerebral em Pacientes com
Lesão Traumática Cerebral Moderada
a Severa
Authors: MACRUZ, F.B.C ; FELTRIM, F. ; GUIRRADO,
V. ; ZANINOTTO, A.L. ; ANDRADE, C. ; LEITE, C.C.
Institution: Instituto de Radiologia do Hospital da Clínicas
da Faculdade de Medicina da Universidade de São Paulo,
São Paulo, SP, Brasil
Author responsible: Fabiola Bezerra de Carvalho Macruz
Brief description of the purpose of the study: Diffuse axonal injury (DAI) is underestimated by structural MRI images,
not only in the acute phase of the trauma, but also in delayed
stages. New quantitative methods, such as Magnetization
Transfer Sequences, are required to allow a more reliable
estimation of cerebral lesion\’s extension, focusing in the
white- matter involvement.
Methods: A prospective study was conducted in 28 patients
with DAI and in 28 healthy control subjects, with three MRIs
performed, 2, 6 and 12 months after the trauma in the group
of patients, and only once in the group control. T2-weighted, FLAIR, T1 FSPGR and magnetization transfer sequences
obtained and comparison of the magnetization transfer ratio
(MTR) was done between groups and amog the sequencial
studies of each patient.
Main results: The mean MTR in the white-matter was lower
in the group of patients than in control group, in all MRIs performed after the trauma and showed a progressive decreased
over time.
Conclusion of the presentation: These findings are consistent with previous observations that the real extension in
the cerebral white matter is greater than the one shown in
the structural MRI sequences, involving the apparently preserved parenchyma and showing a progressive character over
time, in spite of the patients rehabilitation treatment.
TL.12.003
CT Angiography Clot Burden Score and
Collateral Score: Correlation with Clinical and Radiologic Outcomes in Acute
Middle Cerebral Artery Infarct
Authors: ALVES, H.C.B.R.; SCOPPETTA, T.L.P.D.,
DUTRA, B.G.; PACHECO, F.T.; ROCHA, A.J.
São Paulo, Brasil
Author responsible: Thiago Luiz Pereira Donoso Scoppetta
Brief description of the purpose of the study: Different imaging methods have been proposed to predict the prognosis
of patients with ischemic stroke. We evaluated the correlation
between the clot location and collateral integrity through CT
angiography (CTA) with the prognosis of these patients.
Methods: Two hundred and nineteen patients with ischemic
stroke presenting were reviewed of which 108 had diagnostic
confirmation. Death or final core infarction volume> 100cm3
were considered poor prognosis. The clot location was evaluated by the clot burden score (CBS), while the collateral
supply by the collateral score (CS), being scored on a scale
of 0-10 and 0-4 respectively. Malignant profile of ischemic
stroke was classified with CBS?6 and absent or reduction of
collateral supply in > 50% of the M2 territory (score of 0 or 1).
Main results: Our data show a tendency that CBS?6 represents poorer outcome of the ischemic stroke(p = 0.06),
while the CS showed an accuracy of 73.8%(p = 0.004). The
simultaneous analysis of these scores, with at least one of
them showing malignant profile, reached an accuracy of
74.5%(p <0.001) to predict an unfavorable outcome.
Conclusion of the presentation: The clot extension and the
CS are useful markers to the ischemic stroke study as poor
outcome predictors, mainly when they are used together.
TL.12.004
Correlation between the collateral
score and perfusion maps in acute ischemic stroke.
Authors: ALVES, H.C.B.R.; SCOPPETTA, T.L.P.D.;
DUTRA, B.G.; PACHECO, F.T.; ROCHA, A.J.
São Paulo, Brasil
Author responsible: Heitor Castelo Branco Rodrigues Alves
Brief description of the purpose of the study: Collateral circulation has been considered an important predictor of
outcome in acute ischemic stroke. We assessed the relationship between CT angiogram (CTA) data and CT perfusion
(CTP) parameters.
Methods: A total of 109 patients were subjected to stroke
protocol with CTA and CTP. We analyzed the CTP studies
using Olea medical software to quantify core (dual threshold
of rCBF less than 30% and Tmax >6 sec ), critically hypoperfused volumes (Tmax >6 sec) and mismatch ratios. Collateral
grade on CTA before were assessed on a 5-point scale. Student t test correlation test was used to measure the strength
of association.
Main results: Patients with higher collateral score (2-4) had
smaller ischemic cores (p=0,02) and hypoperfused volumes
(p=0,03) and higher mismatch ratios (p=0,02). Our data suggest
that collateral score is associated with the CTP data severity.
Conclusion of the presentation: Multiparametric tomography is an important non-invasive method for collateral circulation evaluation. Higher collateral scores are associated with
smaller cores, hypoperfused volmes and higer mismatch ratio.
TL.12.005
Filling time delay quantification of insular branches based on Computed Tomography Perfusion Imaging of the brain:
a method that may predict the clinical
and radiological outcomes in acute ischemic stroke
Authors: ALVES, H.C.B.R.; DUTRA, B.G.; SCOPPETTA,
T.L.P.D.; PACHECO, F.T.; ROCHA, A.J.
São Paulo, Brasil
Author responsible: Bruna Garbugio Dutra
Brief description of the purpose of the study: Collateral score (CS) has already being used to predict clinical and
radiological outcomes in acute ischemic stroke. This study
aims to estimate indirectly the presence of collateral’s pattern
through the filling time delay of the insular branches.
Methods: There were 108 patients with acute ischemic
stroke in the territory of middle cerebral artery. The filling
time delay (?T) of the insular branches were evaluated between the cerebral hemispheres using perfusion imaging, by
computing the average of time to peak (TTP) of both hemispheres. Collateral’s pattern was estimated through the CS
(0-4), based on computed tomography angiography (CTA),
correlating the filling time delay with the CS and with the
clinical and radiological outcomes, considered poor when
core>145ml or death.
Main results: A larger filling time delay of the insular
branches was associated with a low CS and, consequently,
poor clinical and radiological outcomes. Our study showed
a higher ?T with a low CS (0 or 1) and a poor outcome, with
an average of 4.54 seconds (p = 0.001) and 5.2 seconds(p =
0.026), respectively.
Conclusion of the presentation: The assessment of filling
time delay of the insular branches in acute ischemic stroke
can predict the prognosis of these patients, being directly related to the collateral score.
TL.12.007
Findings on Brain Computed Tomography
and Magnetic Resonance Imaging in Infarction of the Corpus Callosum in patients of a Tertiary Hospital
Authors: Campos, LG; Menegatti, RS; Koltermann, T; Filho, HLM; Leiria, FA; Perez, JA; Duarte, JA; Vedolin, L.
Author responsible: Lillian Gonçalves Campos
Brief description of the purpose of the study: Describe the
pattern of changes observed on computed tomography and /
or magnetic resonance imaging in patients with involvement
of the corpus callosum in ischemic stroke, including correlation with the etiology (TOAST).
Methods: Cross-sectional study, retrospective, of patients
evaluated in the emergency room and, with clinically suspected ischemic stroke, between 2011-2013. Out of 150 stroke
patients, we identified 10 patients with corpus callosum infarction. The images were reviewed by two neuroradiologists.
Main results: The etiology was variable, being atherothrombotic in five cases and of these, three, had involvement of the
body. Six patients showed involvement of other brain structures beyond the corpus callosum. In the two patients that
had the exclusive involvement of the corpus callosum, the
possibility of lymphoma was initially considered. The body
was involved in six patients and splenium was also involved
in six patients, some with simultaneous involvement.
Conclusion of the presentation: The equally frequent involvement of the corpus callosum body and splenium contradicts literature data that consider the splenium infarction
most common. Half of the patients presented atherothrombotic etiology, representing the majority of the cases, without
correlation with any corpus callosum portion.
TL.12.008
Database of patients with neurogenetic
disease: preliminary experience in a reference center
Authors: Menegatti, RS; Campos, LG; Leiria, FA; Perez,
149
JA; Duarte, JA; Vedolin, L.
Author responsible: Lillian Gonçalves Campos
Brief description of the purpose of the study: Specialized
centers in neurogenetic are fundamental for the diagnosis and
treatment of high complexity diseases. The image database
can assist the management e research of these diseases. The
objective of this study is to characterize the imaging findings
and correlate with demographics, molecular tests and therapeutic interventions.
Methods: During six months, three researchers reviewed the
imaging findings in patients with known or suspected neurogenetic disease (inborn error of metabolismo and congenital
malformations) through databases of department of Genetics
and Radiology of a tertiary hospital. The examinations were
compared with demographic and genetic data and classified into
three groups: (A) genetically confirmed, (B) characteristic image of a disease but without definitive molecular diagnosis and
(C) non-specific image, not specific molecular tests or available.
Main results: 220 cases were analyzed and 80% was group
A, group B 18% and 2% of group C. The most common metabolic diseases were adrenoleukodystrophy and mucopolysaccharidosis. Malformations of the posterior fossa and holoprosencephaly were the most common malformations.
Conclusion of the presentation: In this preliminary study,
the most prevalent diseases represent the institution\’s research groups and do not reflect the prevalence of population
studies of literature.
TL.12.011
Análise de 100 aneurismas consecutivos da
artéria comunicante anterior tratados
por via endovascular: volume aneurismático, grau de preenchimento com espiras
e repermeabilizacão aos 6 e 18 meses
Authors: Baptista T; Nunes J; Gomes B; Fragata I; Ribeiro
C; Reis J
Institution: Centro Hospitalar de Lisboa Central,
Lisboa, Portugal
Author responsible: Tiago Baptista
Brief description of the purpose of the study: Our purpose
was to review a series of 100 consecutive ACoA aneurysms
and evaluate the relation between aneurysm volume, coil packing and immediate and long term follow up occlusion results.
Methods: We retrospectively analysed 100 consecutive
coiled ACoA aneurysms between January 2009 and January
2013, and reviewed follow up results at 6 and 18 months. We
calculated aneurysm volumes and coil packing results using
AngioCalc ® software.
Main results: Mean aneurysm volume was 100± 143 mm3
(range 4,19 – 921,53 mm3). A mean packing volume of 28,1±
15% was achieved. Immediate posttreatment angiography
revealed complete occlusion (Raymond 1) of 67 aneurysms
(67%). Follow-up data at 6 months was available for 63 patients (63%); 44 (71%) aneurysms showed complete occlusion, 16 (26%) had a residual neck, and 2 (3%) showed residual filling. Larger volume aneurysms had worse immediate
occlusion results (p<0,05). Partially recanalized aneurysms
at 6-month were found to have higher mean volumes and less
coil packing.
Conclusion of the presentation: A mean packing volume of
approximately 28% was related to aneurysm stability. Small-
150
er aneurysms and higher packing densities tend to have better
occlusion results on follow-up.
TL.12.012
The role of cerebrospinal fluid flow
study using phase contrast MR imaging
in diagnosing intracranial hypertension
and hydrocephalus in Mucopolysaccharidoses
Authors: DALLACORTE, A.; VEDOLIN, L.M.; SOUZA,
C.F.M.; VAIRO, F.; ANÉS, M.; FERREIRA, M.M.; AGUZZOLI, A.A.G.; PERRONE, S.G.P.; FEDERHEN, A.; GIUGLIANI, R.;
Author responsible: Amauri Dalla Corte
Brief description of the purpose of the study: The study
purpose is to distinguish hypertensive ventriculomegaly from
atrophy in mucopolysaccharidosis (MPS) patients and characterize hydrocephalus by using cerebrospinal fluid (CSF)
lumbar pressure manometry and aqueductal CSF flow magnetic resonance imaging (MRI) study.
Methods: We performed a CSF flow study by phase-contrast
MRI followed by a standart lumbar puncture with the CSF
opening pressure assessment in 19 MPS patients.
Main results: The most frequent MRI findings were dilated
perivascular spaces in 14 patients, white matter changes in
14 patients, ventricle enlargement in 8 patients and craniovertebral junction stenosis in 8 patients. Of the 8 patients
with radiological signs of hydrocephalus, hyperdynamic aqueductal CSF flow was obtained in 2 of them and 4 patients
showed CSF lumbar pressure values above 200 mm H2O. On
the other hand, in 7 patients with no typical ventriculomegaly
elevated CSF pressure values were obtained.
Conclusion of the presentation: Aqueductal CSF flow measurement seems to be little specific for helping diagnosis
and therapy planning of hydrocephalus and high intracranial pressure in MPS patients. CSF opening pressure showed
better correlation with typical findings of hydrocephalus and
with CSF flow restriction across the craniocervical junction.
TL.12.013
High signal intensity in the dentate nucleus and globus pallidus on T1: Relationship with the chemical structure of
the gadolinium-based contrast material.
Authors: NUNES,R.H.; RAMALHO, J.; RAMALHO, M.;
ALOBAIDY, M.; SEMELKA, R.C.; CASTILLO, M.
Brief description of the purpose of the study: Recently
high T1 signal intensity on globus pallidus (GP) and dentate
nucleus (DN) were related to the number of gadolinium administrations. We aimed to explore any correlation between
the type of gadolinium-based contrast material (GD) and high
signal intensity (SI) in the DN and GP on T1.
Methods: 75 patients who had undergone brain MRI were
selected based on strict inclusion and exclusion criteria. For
each patient, the number of consecutive gadolinium-enhanced MRI scans performed with an ionic linear GD and
a non-ionic linear GD was assessed. Quantitative analysis
was conducted by using the unenhanced T1 images with
ROI measurements of mean SI. The DN-to-middle cerebellar
peduncle and the GP-to-thalamus SI ratios were calculated.
Stepwise regression analysis was undertaken in the consecutive patient group to detect any relationship between both SI
ratio and previous GD administration or other factors.
Main results: The SI ratios showed a significant correlation
with the number of previous GD administrations and with the
use of non-ionic linear GD, what might be explained by the
fact that ionic agents are more stable than non-ionic ones.
Conclusion of the presentation: High SI on unenhanced T1
images may be related to the number of previous GD administrations and to the chemical stability of the GD.
TL.12.014
Angio-CT: Method for Vasospam Detection
and Predictor for Delayed Cerebral Ischemia in the Context of Aneurysmal Subarachnoid Hemorrhage
Authors: Alves, C.A.P; Brito, D.S; Maia, A.C.J; Rocha, A.J
Brief description of the purpose of the study: The aneurysmal subarachnoid hemorrhage is a common and serious
condition. Vasospasm in its critical period (3-10days after the
ictus) is consider a relevant find for the poor prognosis. The
present study evaluated the accuracy of CT angiography for
vasospasm detection in its critical period and the incidence of
cerebral ischemia.
Methods: The study included 40 patients with CT or laboratorial diagnosis of aneurysmal SAH<72 hours after applied
exclusion criteria. CT control study performed in the critical
period were subsequent correlated with digital angiography
as the gold standard method. The first CT exam was evaluated by two neuroradiologists which later also evaluated the
control CT. The neuroradiologists were unaware about digital
angiography. Comparative analysis was performed between
the methods for vasospasm diagnosis and determined the incidence of delayed ischemic stroke.
Main results: Were diagnosed 26 cases of vasospasm (70%),
with agreement between the methods presented 90 % specificity for CT angiography. The presence of ischemic stroke
resulting from the delayed vasospasm is demonstrated in six
patients (23%).
Conclusion of the presentation: Our data indicate that CT
angiography is highly specific for the diagnosis of vasospasm. As an additional finding was observed a incidence of
ischemic stroke of 23% (6 patients).
14 - PET-CT
TL.14.001
QUANTIFICATION ANALYSIS OF 18F-FDG BRAIN
PET/CT IN EXTRATEMPORAL LOBE EPILEPSY PATIENTS: IS IT POSSIBLE LATERALIZE?
Authors: MENDES COELHO VC; MARÇAL FILHO EFL;
SANTOS AO; LIMA MCL; ETCHEBEHERE E.C.S.C;
MOSCI C; SOUZA TF; RAMOS CD; MORITA ME;
CENDES F; AMORIM BJ
Institution: Faculdade de Ciências Médicas da Universidade Estadual de Campinas (UNICAMP), Campinas, São Paulo, Brasil
Author responsible: Vanessa Cristina Mendes
Brief description of the purpose of the study: INTRODUCTION:drug refractory epilepsy the image methods have
a fundamental role to search for the epileptogenic focus,
which enable a surgical treatment. The 18F-FDG PET/CT
has been efficient in these cases, suggesting the diagnosis and
allowing the treatment, however, its sensitivity is still low.
OBJECTIVE: Analyze the applicability of Syngo Scenium®
quantification software in patients with extra-temporal epilepsy who performed 18F-FDG PET/CT.
Methods: Thirty-eight patients with refractory extra-temporal epilepsy were analyzed retrospectively. All patients underwent 18F-FDG PET/CT. It was performed visual and quantitative analysis in Syngo Scenium® software. The results
were compared with the clinical, serial routine electroencephalography and long-term-video- electroencephalography.
Main results: The sensitivity for epileptogenic focus detection with quantification was 55% and the sensitivity of visual
analysis was 38%.
Conclusion of the presentation: Quantification tools help identifies the epileptogenic focus in 18F-FDG PET/CT. The quantification software Syngo Scenium® was fast and easy to use in
clinical routine. In the present study, it was observed increased
sensitivity in epileptogenic focus localization as compared with
the visual analysis. More prospective study comparing its sensitivity to post-surgical outcome is necessary to confirm these data.
TL.14.002
Comparison between PET/CT-18F-FDG and
PET/CT-fluoride-18F in patients with inconclusive bone scintigraphy.
Authors: Brito, A.E.T; Souza, T.F.; Mosci, C.; Lima, M.C.L.;
Amorim, B.J.; Santos A.O.; Ramos, C.D.
Author responsible: Ana Emília Teixeira Brito
Brief description of the purpose of the study: The PET/
CT- FDG- 18F is estabilished for detect distant metastases
and literature asserts be more sensitive than conventional
bone scintigraphy (BS) for diagnostic of lytic metastases.
The correlation between PET/CT-FDG-18F and bone PET/
CT-fluoride-18F it ins\’t well defined in the evaluation of
bone metastases. Objective: Compare PET/CT-18F-CT and
PET/CT-fluoride-18F in detection of bone metastases in patientes with inconclusive BS.
Methods: Thirteen patients (11 female), in follow-up for
breast, prostate and kidney cancer, with inconclusive findings in BS for bone metastases were studied. All had PET/
CT-18F-FDG and PET/CT-fluoride-18F peformed, 0,12mCi/
kg, whole body images, one hour after injection. The mean
interval between the exams was 18 +/- 15 days.
Main results: The 13 patients had 39 inconclusive lesions
on BS. After both PET/CT exams, bone metastases were excluded in 2 patientes, 34 lesions were confirmed and 16 new
were found. The PET/CT-fluoride-18F detected 100% of lytic, blast and mixed lesions and 88% of lesions without anatomical changes on the CT. The PET/CT-18F-FDG detected
75% of lytic lesions, 58% of blast, 54% of mixed and 58% of
lesions without anatomical changes on TC.
Conclusion of the presentation: PET/CT-fluoride-18F appears to be more sensitive than PET/CT-18F-FDG in the diAbstracts of Scientific Papers
151
agnosis of bone metastases in patients with inconclusive BS,
even for lytic lesions.
TL.14.003
Radiotherapy planning with PET/CT in
lung cancer associated with atelectasis.
Authors: Zuliani, A.C; Casagrande, R.C.; Brito, A.E.T.; Silva, V.M.; Pereira, E.B.; Mosci, C.; Lima, M.C.L., Amorim,
B.J.; Santos A.O.; Souza, T.F.; Ramos, C.D.
Author responsible: ANA EMÍLIA TEIXEIRA BRITO
Brief description of the purpose of the study: Compare
the treatment volumes between conformal radiotherapy
planned with CT without contrast to the radiotherapy guided
by PET/CT for non-small cell lung cancer stage III associated with atelectasis.
Methods: From March 2014, our institution has performed
19 conformal radiotherapy treatments with PET/CT fusion
for non-small cell lung cancer stage III patientes. Of these, 4
patientes had significant atelectasis associated with the tumor
(3 males/ 1 female, age 70.5 + -5.68). For the present study,
their plans were redone and reviewed by 3 experience radiation oncologists in planning radiotherapy of lung cancer, with
no access to income planning with PET/CT, based solely on
non-contrast computerized tomography. The average of the
planned treatment volume (PTV) with and without PET/CT
fusion were compared by paired T test.
Main results: The mean volume of PTV for treatment without PET/CT fusion was 2202.65 cm3 (SD: 211,5) and using
PET/CT was 1045.6 cm3 (SD: 236,7), two-tailed P = 0.0109,
average reduction 52.5% of the PTV.
Conclusion of the presentation: Radiotherapy planning using
PET/CT images significantly reduces the trated volume in patients with non-small cell lung cancer stage III with atelectasis.
TL.14.005
Comparison of 18F-FDG PET/CT with elevated versus suppressed TSH levels in patients with dedifferentiated thyroid
cancer.
Authors: ARAUJO, MLCM; SANTOS, AO; MOSCI, C;
LIMA, MCL; AMORIM, BJ; SOUZA, TF; RAMOS, CD;
ETCHEBEHERE, ECSC
Institution: Serviço de Medicina Nuclear do Departamento
de Radiologia do Hospital de Clínicas da Univesidade Estadual de Campinas, Campinas, São Paulo, Brasil
Author responsible: Maidane Luisi Costa Maia Araujo
Brief description of the purpose of the study: Positron emission tomography/computed tomography with 18F-fluordeoxiglicose (PET/CT ) is a well established method for diagnosing
residual disease in patients with dedifferentiated thyroid cancer
(dDTC) . However, it is not well established whether these patients should perform the examination under elevated or suppressed TSH levels. Fifteen patients with dDTC were studied.
Methods: All patients underwent PET/CT under levothyroxin intake and 30 days after hormonal withdrawal.
Main results: Three patients had both tests negative. Under
TSH stimulation, there was a trend towards increasing the highest Maximum Standard Uptake Value (SUVmax), although it
was not statistically significant (p = 0.0505). Four patients pre-
152
sented new sites of lesions in the stimulated study and in eight
patients, the number of lesions remained the same. There was
no change in the clinical management of any of the patients.
Conclusion of the presentation: It is possible that in larger
studies, we may observe a statistically significant increase in
the highest SUVmax. However, as there was no clinical impact even in patients who presented new lesions, these findings may lead us to rethink the role of hormonal withdrawal
in these patients. Studies with larger series are necessary to
confirm this hypothesis.
16 - Chest
PD.16.017
Authors: ALVES, G.R.T.; NIN, C.S.; AMARAL, R.H.; IRION, K.L.; MARCHIORI, E.; HOCHHEGGER, B.
Janeiro, Brasil
the effectiveness of unenhanced angiographic magnetic resonance imaging (MRI) sequences for pulmonary embolism
(PE) diagnosis in symptomatic patients.
Methods: This prospective investigation included 98 patients (62F:36M) with suspect of pulmonary embolism. All
patients underwent unenhanced steady-state-free-precession
(SSFP) on a 1.5-T unit, in addition to CTA (CT angiography).
Two independent readers evaluated each MR study, with subsequent obtention of consensus. CT angiography results were
analyzed by a third reviewer, who retrospectively recorded presence of emboli using the same format; these results
served as the reference standard. Sensitivity, specificity, predictive values were calculated. Evidence for death from PE
within the 1 year of follow-up was further assessed.
Main results: There were 98 exams performed with 97.9% (96/98)
of diagnostic quality. We found 88% MR exams negative for PE.
During the 1-year follow-up period, seven patients die and there
were no diference between MR and CT embolism detection. MR
sequences has sensitivity of 95%, specificity was 94.4% and accuracy was 94,5% . Inter-observer agreement was high (?=0.87).
Conclusion of the presentation: Compared with contrast-enhanced CT, unenhanced MR sequences demonstrate
good accuraccy and no differences in mortality rates in 1 year
were detected.
TL.16.001
Mediastinal fat necrosis: imaging findings and follow-up for a conservative
approach
Authors: SHOJI, H.; SZARF, G.; ISHIKAWA, W.Y.;
DARIO, C.F.R.; SANTANA NETTO, P.V.; CHATE, R.C.;
TELES, G.B.S.T.; BIANCO, D.P.; MACEDO, A.C.S.; PASSOS, R.B.D.; FUNARI, M.B.G.
Author responsible: Hamilton Shoji
Brief description of the purpose of the study: Mediastinal
fat necrosis (MFN) is a rare cause of acute chest pain that can
be mistaken for serious conditions such as acute coronary or
aortic syndromes and pulmonary embolism. Literature data
suggest that clinical and CT findings can be enough to choose
for a conservative approach with imaging follow-up. We
present our experience with a series of cases.
Methods: Between 03/10/2011 and 08/12/2014, 16 patients
received the diagnosis of MFN based on both clinical and CT/
MRI findings. Twelve of those cases had a prior or later cross
sectional imaging study that could be used for comparison.
Five of them had a prior study . Seven of them had an imaging
study as follow-up; four patients had no control studies.
Main results: Among the seven patients with imaging follow-up, all have documented resolution (or near resolution)
of the imaging findings. Among the other nine patients, five
clinically had an uneventful evolution, becoming asymptomatic, and the other four were lost on follow up.
Conclusion of the presentation: This is the largest series
of MFN cases with documented resolution in the literature,
and reinstates the previous impression that CT findings can
be sufficient for a conservative approach when this diagnosis
is suggested.
153
Author Index
A
Abatepaulo FM. PA.07.003
Abdala, N. PA.06.006, PD.03.031
ABDALA N. PD.12.025
ABDALA, N PD.04.014
ABDALA, N. PD.09.002
Abdalla G PD.03.011, PD.12.040
Abdalla G. PD.12.049
Abdalla, G. PD.12.052
ABDALLA G PD.12.027, PD.12.043, PD.12.044,
PD.12.048, PD.12.061
ABDALLA G. PD.12.065
ABELLO, A.L. PD.12.030
Abizaid, MK PD.13.009, PD.13.023
Abizaid, TK P
D.13.009, PD.13.023
Abizaid, WJM PA.02.003, PD.12.005, PD.13.009
ABRANTES, C. PD.11.052
ABREU, AM PA.11.017
ABREU MFB PA.02.036, PA.09.003
ABREU, P.P. PD.12.013
Abuhid, A.M.L TL.11.007
Abuhid, A.M.L. TL.11.009
ADAZZI, K.R.S. TL.04.005
Affonso, B.B. PA.07.026
AFFONSO B,B. PA.07.010
AFONSO F.B. PD.01.018, PD.02.068, PD.16.010,
PD.16.012
AFONSO, F.B. PD.01.028
Aguiar APZ PD.01.029
Aguiar WK PD.10.009
Aguiar WKM PA.10.002
AGUIAR W.K.M. TL.10.001
AGUIAR WKM PD.10.001, PD.10.002
AGUIAR, WKM TL.04.002
AGUZZOLI, A.A.G. TL.12.012
Aita, A. A P
D.11.017
Aita, A.A PD.11.036
Ajzen, S. PA.07.001, PA.07.004, PA.07.005, PA.07.006
ALBINO, D.J PD.02.038
ALBUQUERQUE, A.S. PD.01.069
ALBUQUERQUE FA PA.16.008
ALBUQUERQUE J PD.01.001
ALBUQUERQUE LF PA.14.005, PD.16.045
ALEXANDRE, L.M. P
D.10.004
ALMEIDA, A. PA.06.007
ALMEIDA, A.H.S PA.16.011
ALMEIDA, A.W.C. P
D.10.004
ALMEIDA B.G.L PA.13.004
ALMEIDA, C. PA.10.013
ALMEIDA, P. PA.10.013
ALOBAIDY, M. TL.12.013
ALO RODRIGUES, M PD.11.034
ALVARENGA, D. PA.11.004
Alvarenga SB PD.11.008
Alvarenga, S.B. PD.11.007
ALVARES, B.R. PA.13.002
ALVES, A. PA.05.002
Alves, A.M.A. PA.06.005
154
Alves C.A TL.12.006
Alves, C.A.P TL.12.014
ALVES, C.A.P. PD.12.004
ALVES, CAPF PA.03.002, PA.12.002, PA.12.003
ALVES CVM PD.01.063
ALVES, C.V.M. PD.01.031, PD.02.011, PD.02.019,
PD.02.020
ALVES, G.R.T. PD.12.079, PD.16.005, PD.16.006,
PD.16.017
ALVES, GRT PD.11.003
ALVES,GRT PD.16.009
Alves, G.S.P P
A.03.010, PA.16.018
ALVES, H.C.B.R. PD.12.058, TL.12.003, TL.12.004
ALVES J.G. TL.10.001
ALVES, K.R.M. PA.06.007
ALVES P P
D.16.049
ALVES, P.H.M. PD.01.019
ALVES RT TL.01.010
ALVES, S.M. PD.12.009
AMANCIO C.T. PD.11.056
AMANCIO CT PD.01.006, PD.01.030, PD.07.003
AMANCIO, C.T. PD.11.058
AMARAL D.T. PD.11.019, PD.11.042
AMARAL, D.T PD.11.055
AMARAL, D.T. PD.11.024
AMARAL, DT PD.11.031, PD.11.034
Amaral, F P
A.02.003, PD.12.005, PD.13.009
AMARAL, FG PD.04.008
AMARAL,.L.F. P
D.12.058
AMARAL LLF PA.12.016
AMARAL, LLF P
D.12.069
AMARAL, R.H. PD.16.005, PD.16.006, PD.16.017
AMARO JR. PA.12.001
AMARO JUNIOR E. PD.12.011
AMBROSIO, A.M. TL.01.004, TL.01.007
AMBROSIO,A.M. PD.01.026, TL.01.005, TL.01.006,
TL.01.011
AMBROS L.E P
D.16.025
AMBROS, L.S. PD.16.024
AMOEDO CDM. PA.01.015
Amorim, B.J. P
A.14.012, PD.10.006, PD.10.007,
TL.14.002, TL.14.003
AMORIM BJ TL.14.001
AMORIM, B.J. PA.10.007, PA.14.002
AMORIM, BJ TL.14.005
AMORIM, BJ. TL.10.003
AMORIM F.C.S. PD.01.066
ANANIAS, FL PA.10.003
ANDERSON, P.A.V. PA.02.034
ANDRADE, C. TL.12.002
ANDRADE, C.A. PA.09.002, PD.13.012
ANDRADE CELC P
D.10.005
ANDRADE CS TL.07.001
ANDRADE, C. S. PD.12.024, TL.12.001
ANDRADE, F.P. PA.16.011
ANDRADE, J. PA.07.031
ANDRADE, J.P. PD.12.022
Andrade, J.R. P
A.07.012, PA.07.014, PA.07.015,
PA.07.016, PA.07.017, PA.07.025
45a Jornada Paulista de Radiologia • 1o Encontro Brasil - Península Ibérica
ANDRADE JR PA.07.028
ANDRADE RMF PD.16.047
ANDRADE, W. P. PA.14.001
ANÉS, M. PA.05.001, TL.12.012
ANJOS, D.A. PA.10.008, PA.10.009
ANTUNES, L.O. PA.04.001, PD.03.014, PD.12.032
ANTUNES, P.E. PD.01.015
ANTUNES, R.V.B. PD.01.050, PD.02.031
Appenzeller, S P
D.10.007
ARANA-CHAVEZ VE TL.07.001
Araripe Neto, M.A. P
A.11.014
Araujo, AG PA.04.005
ARAUJO ALE PD.01.063
ARAUJO, A.L.E. PD.02.011
Araujo, DAP PA.02.029
Araujo, DGL PA.04.005
ARAUJO E.P. PD.11.056
ARAUJO FILHO, J.A.B. PA.16.023, PD.16.039
ARAUJO, I.M. PA.01.006
ARAÚJO, I.M. PD.01.019
ARAUJO, JR., C.M.C. PD.02.018, TL.02.009
ARAUJO JR, DAA PA.03.004, PD.03.005, TL.03.006
ARAUJO, L.B.T.F. de PD.02.013
ARAUJO, MLCM TL.10.003, TL.14.005
ARAUJO, R.G. PD.02.013
Araujo, R.O.D. PD.11.048
Araujo, T.A. PD.01.021
ARAÚJO, T.R PA.16.007
ARCOVERDE R PD.16.049
ARELYS ,A TL.10.004
ARENAS, S. PD.04.001
ARIEDE, B.L. TL.11.001
ARMELIN, P.L.A. P
D.01.013, PD.04.010, PD.04.011,
PD.04.012, PD.15.001
ARNAOUT, A PD.08.012
ARRATIA, J.I.C. PA.10.008, PA.10.009
ARRUDA, M.J.C. PA.06.003, PA.06.004
ASSAD, RL TL.11.005
ASSIS B.M PD.17.005
ASSIS, C.R. PD.09.002
ASSIS, P.E.Z. PD.08.009
ASSIS, RS. PD.08.007
AUAD, RV. PD.16.031
Augusto, F. P
A.04.004, TL.01.009
AUGUSTO, F.M. PD.05.002
Ávila LF. TL.04.004
Ávila LFR. TL.04.003
Awamura Y. P
D.06.002
AYRES, AS PA.03.002, PA.12.002, PA.12.003
AYRES, AS. PA.12.012
AZAMBUJA RL PD.01.052
AZAMBUJA, R.L PD.01.054
AZEVEDO, F.C. P
D.08.009
AZEVEDO FILHO, L.F. P
A.02.034
AZEVEDO, FSR TL.10.004
Azevedo JC PA.10.002, PD.10.009
AZEVEDO J.C. TL.10.001
AZEVEDO JC PD.10.001, PD.10.002
AZEVEDO, JC TL.04.002
AZEVEDO, M.M PD.17.018
AZEVEDO, M.M. P
D.11.049
B
Baaklini, R.E. P
D.12.084
BAAKLINI, R.E. P
D.03.038, PD.03.039
BABY D.D. PD.02.068
BACARIN, J.V. PD.03.017
BACCHI, C. E. P
A.10.013
BACELAR, A. PA.05.001
BACHA, RP PA.10.003
BACHION, GH PD.16.031
Badan, GM P
D.08.002, PD.08.003, PD.08.004
BADAN, G.M PD.08.008
Baena GP PD.12.029
BAHIA PR P
D.12.027, PD.12.043, PD.12.048
BAIMA, J.P. PD.01.015
BANDEIRA,C.K. PD.15.004
BAPTISTA, L.C. PD.12.022, PD.13.022
BAPTISTA, L.P.S PD.04.016
BAPTISTA RM PD.16.047
BAPTISTA, R.M. PD.03.010
Baptista T TL.12.011
BARBIRATO, GB TL.04.002, TL.10.004
BARBOSA DKG. PD.12.020
BARBOSA, DKG PD.12.019
BARBOSA GV PD.11.057
BARBOSA JR. A.A PD.12.075
BARBOSA JR. A.A. PD.12.076
BARBOSA JR., A.A. PA.12.013
BARBOSA JUNIOR AA. PD.12.011, PD.12.012
Barbosa Júnior, A.A. PA.12.005
Barbosa, M.H.N. TL.11.004
BARBOSA MHN PA.11.009
BARBOSA, PNV TL.07.002
BARBOSA, PNV. PD.07.005
Barbosa, R.C.B. P
D.01.021
Barbosa, RFM. P
A.16.022
Barbosa Rita AA TL.10.002
Bargi L. P
A.16.016
BARHUM, R.S. PD.12.080
Barlete AV P
A.10.002, PD.10.009
BARLETE A.V. TL.10.001
BARLETE AV P
D.10.001, PD.10.002
BARLETE, AV TL.04.002
BARONI, M.A.G. PA.06.003, PA.06.004
Baroni RH TL.02.004
Baroni, R.H. P
A.02.039, TL.01.008
Baroni, RH P
A.02.038, TL.02.003
BARONI RH PA.01.013
BARONI RH. PA.01.015
BARONI, R.H PA.02.035
BARONI, R.H. PA.02.027, PA.02.033, PA.07.030,
TL.07.003, TL.07.005
BARRAL CM PA.10.005
BARRETO, AS PD.04.008
Barreto LE P
D.11.010
BARRETO, L.E. PD.12.080
BARRETO, R.L.M. PA.02.037, PD.02.039
BARRIO, A.B. PA.06.003, PA.06.004
Barros, AP PA.02.003, PD.12.005, PD.13.009
Barros, CN P
D.13.023
Barros, E.G. P
A.01.012, PA.03.009
BARROS EG. P
D.03.001
BARROS, E.G P
D.12.010
BARROS, E.G. P
D.03.027
Resumos de Painéis e Temas Livres
155
BARROS, EG PD.12.078
BARROS,E.G. PA.16.012
BARROS, G. PA.05.002
Barros, GN PD.13.023
BARROS, IC. PA.06.002
BARROS, J.R. PD.01.015
BARROS, RH PD.01.032
BARROS, R.M. PA.07.030, PA.07.031, TL.07.003,
TL.07.005
BARROS TP PA.06.001
BARROS, W.H. TL.11.001
Bastos, B.B. PD.13.016
BASTOS BB. PD.12.011, PD.13.013, PD.13.014,
PD.13.015
BASTOS, B.B PA.02.035, PD.03.007
BASTOS, B.B. PD.12.035
BATISTA AKC PA.02.036, PA.09.003
BATISTA E.F.P. P
D.12.007
Batista,K.T. P
D.11.036
Batista, LA P
A.10.004
BATISTA, MG PA.11.017
Baumfeld, D.S. PD.11.048, TL.11.009
BAZYAR, S. PD.12.056
BEDUSCHI, G. PD.01.051
Begot LRC P
D.01.029
BELTRANI, F.H P
A.02.002
BELUSSO L PD.11.022
BENTO, F. B. D. S. PA.17.005
Bergamasco MD PD.16.040
Bernal, S.O. PD.02.026
BERNAL, S. O. PD.02.021, PD.02.033
BERTHOLDO, D.B. P
D.03.017, PD.16.021, PD.17.022
BERTHOLDO, DB. P
A.12.010
Bezerra, ROF PA.02.029, PD.02.042
BEZERRA ROF PD.01.052
BEZERRA, R.O.F P
D.01.054
BIANCHINI APAP PD.16.041
Bianco, DP PD.04.015, PD.04.018
BIANCO, D.P. TL.16.001
Bierrenbanch AL. TL.04.003
Bitencourt A. TL.08.001
BITENCOURT, A.G. PA.06.003, PA.06.004
BITENCOURT AGV PA.08.002
BITENCOURT, A. G. V. PA.14.001
BITENCOURT, A.G.V PA.02.002, PA.08.004, PA.08.005,
PA.08.007
BITTENCOURT, AGV PA.08.010
BITTENCOURT, A.V. PA.08.006
Bittencourt, L.K. P
D.02.005, TL.02.002
BITTENCOURT L.K. PD.01.018, PD.02.068, PD.16.010,
PD.16.012
BITTENCOURT LK PD.02.041, PD.16.044
BITTENCOURT, L. K. PD.02.021
BITTENCOURT, L.K. PD.01.028, PD.01.053, PD.01.059,
PD.02.018, PD.02.032, PD.02.033,
TL.02.009
Bittencurt L.K. P
D.02.026
Bittencurt, L.K. P
D.02.024
BIZETTO E.B. P
D.11.019
BIZETTO E.L. P
D.11.042
BIZETTO EL P
D.11.031
BIZETTO, E.L P
D.11.055
BIZETTO, EL P
D.11.034
156
BIZZO, B.C. P
D.01.028
Bôas, RMV P
A.01.017
Bôas, RMV. P
A.16.022
BOAVENTURA CS PA.08.002
BOAVENTURA, C.S PA.02.002, PA.08.004, PA.08.005,
PA.08.007
BOECHAT M P
D.16.049
BOECHAT P P
D.16.049
Bolinelli, A.P. P
A.12.014, PA.16.013
BOLINELLI, A.P PA.17.004
BOLINELLI, A.P. P
A.01.008, PA.13.007
Bo, M. B. P
A.08.001
BOMFIM RC. PD.12.020
BOMFIM,RC PD.12.019
BONFITTO, A.J. PA.11.012, PA.11.021
Boni, RC TL.12.010
BONUGLI, G.P PD.11.047
BORDALO RODRIGUES, M PD.11.031
BORDALO-RODRIGUES M. PD.11.019, PD.11.042
BORDALO-RODRIGUES, M. PD.11.024
Borges, A.P. P
D.15.001
BORGES, A.P. PD.01.013
BORGES, L.C. P
A.11.020, PA.13.008
BORGES M P
D.16.004
Bosi,T.C. PD.11.036
BRAGA, A.G.C PD.03.007
BRAGGION-SANTOS, MF PD.04.003, PD.04.006
BRANDAO, A. PD.13.004
BRANDÃO A.T. PD.17.017, PD.17.019
BRANDÃO, A.T. PD.17.015
BRANT R M C PA.11.005
BRAUN R. P
D.11.050
BRESSAN, C. A. V. PD.16.042
BRESSAN, C.A.V. PD.11.020
BRINGEL, B.B PA.13.012
Brito, A.E.T. TL.14.003
Brito, D.S TL.12.014
BRITO, M.C.B. PD.12.080
BRITO, M.L.C.B. PA.11.020, PA.13.008, PA.16.010,
PA.16.019
BRITTO NETO, L.A PD.07.004
BRITTO NETO, L.A. PA.01.010, PA.07.007, PA.07.029,
PA.17.002, PA.17.003
BROTTO M.P.D PD.16.025
BROTTO, MPD PA.16.025
BROUVER DE KONING H. PA.01.005
BRUNO C.H. PD.11.032
BRUNO, G. PA.14.004
BUSTOS, N. D. PA.14.004
C
CABOCLO, M.F. PD.11.033, PD.16.032
CAÇÃO PHM PD.10.005
CADENAS OLIVA MJ PA.01.007
Caiado, AHM PD.01.058
CAIXETA, F.H. PA.02.037, PD.02.039
Caldana, RP P
D.01.058
CALDAS, A.L.C. PD.01.013, PD.04.010, PD.04.011,
PD.04.012, PD.15.001
CALDAS JGMP TL.07.001
CALDERARO, M P
A.12.003
CALICH, AL PD.11.034
CALICH, I PD.11.034, PD.11.055
CALVI, C.A. PD.01.023
CAMACHO, M.R.F. PA.14.002
Câmara G.V. P
A.16.016, PD.17.023
CÂMARA, G.V. PD.11.049
CAMARA L.R.A PD.17.019
CAMARGO, L.F.S. PD.01.051, PD.11.026
CAMARGO M.V. PD.13.019
CAMARGO,M.V. PA.16.024
CAMILO FB PA.16.008
Camilo GB P
D.03.025
CAMILO, G.B. PD.03.019
Camilo, M.L. P
A.03.009
CAMILO M.L. PD.03.029, PD.03.030, PD.16.035,
PD.16.036
CAMILO ML. PD.03.001
CAMILO, M.L. PD.03.027, PD.08.009, PD.16.014
CAMILO, ML PD.12.060, PD.12.078, PD.16.007,
PD.16.016
Camilo, TGN P
A.10.004
Campi CC P
D.13.007
CAMPORINI, MM TL.07.002
CAMPOS CMS PA.12.016
CAMPOS, CMS PD.12.069
CAMPOS, F H PA.11.015
CAMPOS, F.H. PA.11.002
Campos, G.C.P. P
D.02.026
CAMPOS HCB. PD.12.020
CAMPOS,HCB PD.12.019
Campos, LG TL.12.007, TL.12.008
Campos, MSDA PD.08.002, PD.08.003, PD.08.004
CAMPOS, M.S.D.A. PD.08.008
Campozana NS PD.11.010
CANTONI, STO PD.16.031
Capobianco, J. PD.16.001, PD.16.002
CAPPABIANCO FAM TL.01.010
CAPPI, S.B. PA.06.003, PA.06.004
Cardarelli-Leite, L. P
D.03.031
Cardim VR. PD.09.003
Cardoso APT. TL.04.003, TL.04.004
CARDOSO, E.O.A. PD.12.004, TL.03.008
CARDOSO, H.C.C. PD.01.050
CARDOSO, T.A.M.O. PA.14.002
CARNEIRO, D.B.V. PD.13.006, PD.17.001
CARVALHO, A. L. PD.01.019
CARVALHO, A.L PA.01.006
Carvalho D PD.03.011
Carvalho,F.G.A PD.11.017
CARVALHO JR., L.J.P PD.03.007
CARVALHO, L.V. PA.10.013
CARVALHO, M.Q. PD.01.013, PD.04.010, PD.04.011,
PD.04.012, PD.15.001
CARVALHO R.O.M. PD.01.034
CARVALHO, R.O.M. PD.01.035
Carvalho, R.S. PA.03.009, PA.03.010
CARVALHO R.S. PD.03.029, PD.03.030
CARVALHO RS. PD.03.001, PD.12.047
CARVALHO, R.S. PD.03.027, PD.12.010
CARVALHO, RS PD.12.060
CARVALHO, SC PA.11.019
CASAGRANDE, J.L.M. PD.09.002, PD.12.009,
PD.16.046
Casagrande, R.C. TL.14.003
CASEROTTO A PA.01.007
CASEROTTO AM PA.16.003
CASERTA, GC PD.03.026
CASERTA NMG PD.01.065
CASERTA, NMG PD.01.032
CASERTA, NMG. PD.11.039
CASTILLO, M. P
D.12.030, PD.12.046, PD.12.056,
TL.12.013
CASTRO, A.A. TL.11.001
CASTRO, B.B. P
D.12.035
Castro CH. PD.09.003
Castro CHR. PD.09.003
Castro CR. PD.09.003
CASTRO FD PD.11.022
CASTRO, F.G. PD.11.033, PD.16.032
Castro, H.A.S. P
A.07.001, PA.07.004, PA.07.005,
PA.07.006
Castro LR. P
D.09.003
CASTRO, M.A. PD.13.001, PD.13.006, PD.17.001,
PD.17.002
CASTRO, P.H. PD.16.027, PD.16.029
CASTRO, P.N. PD.12.022
CASTRO P. N. P. PD.13.021
CASTRO, R.N.C. P
A.04.006, PA.16.023, PD.04.021,
PD.16.027, PD.16.029, PD.16.039
CATELÃO, L.C. P
A.09.002
CATTANI, C.A.M. TL.04.006, TL.04.007
Cavalcante B P
D.01.029
CAVALCANTE, C.E. P
D.13.005
CAVALCANTE, C.F.A PD.11.055
Cavalcante, F.A. P
A.02.039, PD.13.017
CAVALCANTE FA. PA.07.028
CAVALCANTE, F.A PA.02.035, PA.13.010, PA.13.011,
PD.07.004
CAVALCANTE, F.A. PA.07.029, PA.13.003
CAVALCANTE, I.O. PD.13.001
Cavalcante, R.N. P
A.07.026
CAVALCANTI, A.G.L.C. PD.02.018, TL.02.009
CAVALCANTI C.F.A. PD.11.019, PD.11.042
CAVALCANTI, C.F.A. PA.07.027, PD.11.024, PD.11.058
CAVALCANTI, CFA PD.11.031, PD.11.034
CAVALCANTI, J.P.L. PD.01.050, PD.02.031
CAVALHEIRO, D.D.S. PD.03.017
CAVICCHIOLI M. PA.10.006, PA.10.010
CAVICCHIOLI, M. PA.14.003
CEDRO, P M A P
D.01.045
CEDRO, P.M.A PD.03.034
CENDES F TL.14.001
Cerqueira, JR PA.04.005
CERRI, G.C. P
A.07.027, PD.01.057, PD.11.058
Cerri G.G P
D.12.008
Cerri, GG PA.02.029
CERRI G.G. PD.11.019, PD.11.042, PD.11.056
CERRI GG P
D.01.006, PD.01.030, PD.07.003
CERRI, G.G. P
D.11.024
CERRI, GG P
D.01.037, PD.11.031, PD.11.034, PD.16.031
CEVASCO F.I. PD.03.006
Cevasco, F.K.I. P
D.03.015
Chagas LA P
D.03.025
CHAGAS, L.A. PD.03.019
Chagas Neto, F.A. P
A.11.014
CHAGAS NETO, FA PA.11.009
Chamie, LP P
D.01.058
157
Chate, RC P
D.04.015, PD.04.018
CHATE RC. P
A.16.020
CHATE, R.C. P
A.16.023, PD.16.039, TL.16.001
CHEPELEV, L PD.08.012
CHOBADINDEGUI R. PD.11.032
CHOJNIAK, R PA.11.019, TL.07.002
CHOJNIAK, R. PA.02.002, PD.07.005
CHONE, C. T. PA.10.007
COÊLHO, C.R. PA.02.027
COELHO-FILHO, O.R. PD.04.010, PD.04.011, PD.04.012
COELHO, L.O.M. P
D.03.017
Coimbra, C.F. P
D.12.003
Colombo A P
D.16.040
COLOMBO, E.C.E P
A.13.013
COLOMBO, E.C.E. P
A.08.006
COLOMBO, J.J. PD.02.003
CONCATTO, N.H. PD.16.005, PD.16.006
CONCATTO, NH PD.11.003, PD.16.009
CONCEIÇÃO, D. M. TL.12.001
CONRADO J.L.F.A. PA.10.006, PA.10.010
CONRADO, J. L. F. A. PA.14.001, PA.14.003
CONSORTI,L PA.13.004
COPPO S.R PD.17.013
Coradazzi, K.R.S. TL.01.008
CORADAZZI KRS. PA.01.015
CORADAZZI, K.S.C. PA.02.033
CORDEIRO L PA.09.003
CORDEIRO LB PA.09.003
CORREA M.F.P. PD.11.019, PD.11.042
CORREA, M.F.P P
D.11.055
CORREA, MFP PD.11.031, PD.11.034
Correa NL PA.10.002, PD.10.009
CORREA N.L. TL.10.001
CORREA NL PD.10.001, PD.10.002
CORREA, NL TL.04.002
CORTEZ, J.G. PA.02.037, PD.02.039
Cosenza N.N. PA.14.012
Costa, A.S. PA.01.012
COSTA A.S. PD.16.035, PD.16.036
COSTA AS. PD.03.001, PD.12.047
COSTA, A.S PD.17.018
COSTA, A.S. PD.12.010
COSTA, AS PD.12.060, PD.12.078, PD.16.007, PD.16.016
COSTA,A.S. PA.16.012
COSTACURTA MA PD.01.006
COSTACURTA, M.A. PD.01.057
COSTA, E.S. PA.16.010
COSTA E SILVA, E.J. PD.02.013
COSTA, HP PD.11.031
COSTA, J.G. PD.13.018
Costa, LS. PA.16.022
COSTA M.M. PD.01.066
COSTA, MNA TL.10.004
Costa NSS. PA.16.022
COSTA, R. PA.10.013
COSTA, R.S. PA.11.020, PA.13.008
COSTA-SILVA, L TL.01.004
COSTA-SILVA, L. PD.01.026, TL.01.005, TL.01.006,
TL.01.011
COSTA-SILVA,L. TL.01.007
COSTA, T.O. PA.14.002
COSTA Y.B. PD.04.013
COTRADO A.A.C. TL.10.001
158
COTRADO AAC PD.10.001, PD.10.002
Cotrado AYC P
A.10.002, PD.10.009
COTRADO, AYC TL.04.002
COTRIM, N.G. P
A.11.012, PA.11.021
COTTA, A.C.S. PD.11.002
COUTINHO, A.R. PD.11.040, PD.16.024
COUTINHO, JR., A.C.M PD.02.018, TL.02.009
CRUZ LC PD.12.048
CRUZ, P.A P
D.03.007
Cunha, B.M.R. TL.05.001
CUNHA JR., A.L.C. PD.11.002
CUNHA, R. R. PA.14.001
CUPOLILO, E.N. P
D.11.020
CURY PM TL.07.001
CZAPKOWSKI A. PD.17.005
D
Dadalto, R.V. P
A.01.012, PA.03.009, PA.03.010, PA.16.018
DADALTO, R.V PD.11.001
DADALTO, R.V. PD.08.009
Dalaqua, M. P
A.12.005
DALAQUA M. PD.12.011, PD.12.012, PD.12.075,
PD.12.076
DALAQUA, M. PA.12.013
Dal-Bó, M.B P
A.13.001
Dal-Bó, M.B. P
A.12.005
DALLACORTE, A. TL.12.012
DALPRA F.A.R PD.03.006
DALTO, VF TL.11.005
Damasceno R S PD.12.008
DAMASCENO R.S. PD.11.019, PD.11.042, PD.11.056
DAMASCENO RS PD.11.031
DAMASCENO, R.S. PD.11.024, PD.11.058
DAMASCENO, RS PD.11.034
Daniel, M.M. P
D.03.015
DANIEL M.M. PD.03.006
DANIEL, MM PA.03.004, PD.03.005, PD.03.026,
TL.03.006
Dantas, G.C. P
D.03.024
DANTAS, G.C. PD.03.036
DARIO, C.F.R TL.04.001
DARIO, C.F.R. TL.16.001
D Delgado P
D.12.008
DE AZEVEDO, M.M. PD.01.048
DE CARVALHO NETO, A. PA.12.010
DE CASTRO,J.C.S. PD.15.004
DE CASTRO,M.S. PD.15.004
DE FINA, B. P
A.07.010
DE FREITAS, A.G. PD.08.009
de Hollanda, E.S P
D.02.005
DELGADO, N. J. PD.16.042
DELGADO, N.J. PD.11.020
DELLA SALA A PA.16.003
DELUCCAS V P
D.16.008
DE MOURA, G.G.R PD.01.047
De Nicola, H. P
A.07.001, PA.07.004, PA.07.005,
PA.07.006
de Oliveira Neto, S.R.O. P
A.11.014
DERTKIGIL, S. PD.11.039
de SANTANA, D.B.F. PA.16.007
DE SOUZA, C S PD.01.045
DE TONI, F.S. PD.12.064
DE TONI, G.S. PD.11.026
Dias, A.G. PD.03.024
Dias, C.S. PD.01.021
DIAS-DA-SILVA PS. PA.17.006
DIAS DS PD.10.005
DIAS, E.N. PA.11.020, PA.13.008
DIAS GG. PD.12.012
DIAS, G. M. PD.16.042
DIAS, G.M. PD.11.020
DIAS LTP PD.07.003
DIAS, M.I. TL.04.006, TL.04.007
DIAS R PD.01.001, PD.10.005
DIAS, RFS PD.04.008
DIAS WLV PA.06.001
DINIZ WP PD.16.037
D’Ippolito G. TL.02.005
D J L Oliveira P
D.12.008
Docema M F PD.12.008
DOHERTY, G PD.08.012
DOMENICIS JR O PD.01.006
Domit C. PD.06.002
Doria LS TL.10.002
DORNA, M.S. PD.01.015
DOS SANTOS, D. PD.12.079
DOS SANTOS, M.G. PD.16.039
DOS SANTOS, T. PD.12.079
DSZEJNFELD, D. TL.07.012
DUARTE, A.L. PD.11.052
DUARTE E.C. PD.01.034, PD.11.043
DUARTE, E.C. PD.01.033, PD.01.035, PD.02.025,
PD.04.004, PD.13.008
Duarte, JA TL.12.007, TL.12.008
Duarte, M.L. PD.11.007, PD.11.010, PD.11.012
Duarte, ML PD.11.008
Duarte, ML. PD.17.004
Duarte,ML PD.12.068
DUQUE DS PD.01.052
DUQUE, D.S PD.01.054
DUQUE, DS PD.01.030
DUTRA B.G. TL.03.007
DUTRA, B.G. TL.12.003, TL.12.004
Dutra, BL PA.02.003, PD.12.005, PD.13.009
DUTRA, M.S.B.G. PA.01.008, PA.13.007
E
EDELHOFF, V.N.G. PD.13.001, PD.13.006, PD.17.001
Eifer, D.A. PD.02.017
EIFER DA PA.12.019, TL.15.002
EIRAS ARAUJO, A.L. PD.01.031, PD.02.019, PD.02.020
EL HADJ SAA PA.16.008
ELIAS, J.Jr. PA.01.006
ELIAS JR., J. PD.01.019
ELIAS-JUNIOR, J. PA.04.002
ELIAS L.N. PD.17.017
EL KADRI, T.N. JR PA.16.011
ELLENDHAL, M. P
D.04.014
Emery L P
D.03.011, PD.12.049, PD.12.052
EMERY L P
D.12.027, PD.12.043, PD.12.044, PD.12.048,
PD.12.065
EMERY, L PD.12.061
ENGEL, E.E. PA.11.013
ENGEL,EE PA.11.009
ESCUISSATO, D.L. PD.16.021
ESTEBAN, E.M P
D.01.036
ESTEBAN, E.M. P
D.02.003, PD.04.001
Esteves, A. D. PA.12.014
Etchebehere E.C.S.C P
A.14.012, PD.10.007
Etchebehere E.C.S.C. P
D.10.006
ETCHEBEHERE E.C.S.C TL.14.001
ETCHEBEHERE E.C.S.C. P
A.10.007
ETCHEBEHERE, E.C.S.C. P
A.14.002
ETCHEBEHERE, ECSC TL.10.003, TL.14.005
Eyer AAR PA.16.017
EYER, AAR. PD.04.014
F
FABER, I TL.10.003
FAERMANN, R PD.08.012
Fagundes J P
D.12.040
Fagundes, J P
D.03.011
FAGUNDES J PD.12.044, PD.12.048
FAGUNDES, J PD.12.061, PD.12.065
Falcão BAA. TL.04.003
FALCONE, B.R. PD.01.053, PD.02.032, PD.02.033
Falcone, D.D.D.M P
D.02.005
FALCONE, D.D.D.M. PD.01.053, PD.02.032, PD.02.033
Falcone, D.D.M. P
D.02.024, PD.02.026
FALONE, VBG PA.11.017
falsarella, P.M. P
A.07.025, PA.07.026
Falsarella, P.M. P
A.07.012, PA.07.014, PA.07.015,
PA.07.016, PA.07.017, PA.07.019,
PA.07.020, PA.07.021, PA.07.022,
PA.07.023
FALSARELLA, P.M. P
A.07.008, PA.07.009, PA.07.011
FARENZENA, M. PD.01.047
FARIA, R.N. PD.01.050, PD.02.031
Farias, AMS PD.10.007
Farias LPG P
D.01.040, PD.03.033, PD.16.033
FASBENDER, C.P.B. PD.03.027, PD.12.010
Fassbender, C.P.B P
A.01.012, PA.03.009
FASSBENDER C.P.B. PD.16.036
FASSBENDER CPB. PD.03.001, PD.12.047
FASSBENDER, C.P.B. PD.08.009, PD.16.014
FASSBENDER, CPB PD.12.060, PD.12.078, PD.16.016
FASSBENDER,C.P.B. PA.16.012
FEDERHEN, A. TL.12.012
FELTRIM, F. TL.12.002
FELTRIN, F. S. TL.12.001
Feres, R. P
A.08.001
FERNADEZ, L. P
D.04.001
FERNANDES, ACO PA.11.019
FERNANDES DA PD.01.065
FERNANDES E. P
D.11.050
FERNANDES, F.S PD.17.003
FERNANDES G.S.S PD.16.025
FERNANDES, GSS PA.16.025
FERNANDES R.Y. PD.11.042
FERNANDES, R.Y PD.11.055
FERNANDES, RY PD.11.031, PD.11.034
FERNANDEZ, C P
A.12.015, PD.01.025, PD.01.046
FERNANDEZ E P
A.16.003
FERNANDEZ ME P
A.01.007
FEROLLA, S. P
D.01.026, TL.01.006, TL.01.011
Ferraciolli, SF P
D.12.083
159
Ferrari, R.J.R. PA.14.012
FERRARI, T.C.A. TL.01.011
FERRARI,T.C.A. PD.01.026, TL.01.006
FERREIRA, A.B. PA.11.012, PA.11.021
FERREIRA C PD.12.027, PD.12.043, PD.12.044,
PD.12.048
Ferreira CAP PD.08.002, PD.08.003, PD.08.004
FERREIRA, C.A.P. P
D.08.008
Ferreira,CBA PD.12.068
Ferreira, CL. S. PD.01.021
FERREIRA, C.L.S. P
D.12.013
Ferreira, C.S PD.03.011, PD.12.049, PD.12.052
FERREIRA, C.S. PD.12.065
FERREIRA, CS PD.12.061
FERREIRA D L PA.11.005, PA.11.015
FERREIRA, D.L. PA.11.002
Ferreira, EV P
D.16.030
Ferreira, FAT P
D.08.002, PD.08.003, PD.08.004
FERREIRA, F.A.T. PD.08.008
Ferreira,JBA PD.12.068
Ferreira, J.S.S. PA.11.014
FERREIRA LB TL.07.001
FERREIRA, L.F.R. P
D.03.010
FERREIRA,LR PD.04.008
FERREIRA, M.M. TL.12.012
FERREIRA M.P.F.D PD.01.066
FERREIRA NETO, B.J. PD.01.033
Ferreira, SG PA.10.004
FERREIRA VC PD.10.005
FerreiraVFL PD.01.029
Ferreira, V.T.R. P
D.12.084
FIEDLER, G. PD.02.018, TL.02.009
FIFUEIREDO, C.B. P
D.16.024
FIGUEIRA DMB PD.16.044
FIGUEIRA, D.M.B. PD.01.059
Figueiras, FN PD.12.068
FIGUEIREDO C.A.P PD.17.013
FIGUEIREDO C.B PD.16.025
FIGUEIREDO C.P PD.17.005
FIGUEIREDO, E TL.01.005
FIGUEIREDO, E. PD.01.026, TL.01.011
Figueiredo, J.R.P. P
A.02.039, PD.13.016, PD.13.017
FIGUEIREDO J.R.P. PA.16.020
FIGUEIREDO JRP. PD.13.014
FIGUEIREDO, J.R.P PA.13.012
FIGUEIREDO, J.R.P. PA.01.010, PA.08.009
FIGUEIREDO, K. G. PD.12.024
FIGUEIREDO, K.G. TL.12.001
Figueiredo MAP P
D.02.042
FIGUEIREDO, M.A.P PD.01.025, PD.01.046
FIGUEIREDO, MAP PA.12.015
Filho, A.P.M.M P
D.03.015
FILHO, G.H. PA.11.016
Filho, HLM TL.12.007
FILHO. M.Z.S. PD.17.006
Fina, B.D. PA.07.026
Fiorot, V.C.R. P
D.16.034
FIRMIDA, M.C. PD.13.022
Fleury, EFC P
D.08.002, PD.08.003, PD.08.004
FLEURY, E.F.C P
D.08.008
FLEURY, E.F.C. P
D.08.009
FLORES CM. PA.13.009
FOLADOR, L. PD.01.047
160
FONSECA DR PD.11.053, PD.16.037
FONSECA JM PA.02.036
FONSECA, L.E.P. PD.01.069
FONSECA, T.F.M. PD.02.031
Fornazari, V.A.V. P
A.07.001, PA.07.004, PA.07.005,
PA.07.006
FORNAZARI, V.A.V. TL.07.012
Forsyth, A. PD.03.020
FORTES, S.M. P
A.02.037, PD.02.039
FOSSE JR. AM PD.02.041
Fragata I TL.12.011
FRAGOSO, D.C. PA.12.021
FRANÇA C P
D.11.053
França DM P
D.01.040
FRANÇA, FO PD.11.029
França Jr, MC P
D.10.007
FRANÇA JR, MC TL.10.003
FRANÇA, L.K.L PA.08.007
FRANÇA, LKL PA.08.010
FRANÇA, S.M. PD.11.025, PD.11.040, PD.11.054
FRANÇA S.R.N. PD.13.019
FRANCESCHI, A.M. PD.12.056
FRANCESCON, P.V.M. PD.12.022
Francisco Neto MJ P
D.01.029
Francisco Neto, M.J. P
D.13.017
FRANCISCO NETO M. J. PD.17.017, PD.17.019
FRANCISCO NETO M.J. PA.17.003, PD.12.075,
PD.12.076
FRANCISCO NETO MJ. PD.13.013, PD.13.014,
PD.13.015
FRANCISCO NETO, M.J PA.13.003, PA.13.012
FRANCISCO NETO,M.J PD.17.015
Francisco Neto, M.J.F. P
A.07.019
FRANCISCO NETO MJF. PA.17.006
FRANCISCO NETO, MJF PD.13.016
FRANGELLA J PA.01.007
FRANGELLA MJ PA.16.003
FRANK L PA.16.003
FRANK L. P
A.01.007
FREITAS ET PD.16.044
FREITAS, E.T. PD.01.059
Freitas FAM. TL.04.004
FREITAS, JMA PD.11.029
FREITAS LF PA.12.016
FREITAS, LL PD.12.069
FREITAS RMC TL.07.001
FREITAS SS PA.10.005
FREUA, F P
A.12.002
FROULLET C. PA.01.005
FUDO, C.M.K PD.01.023
FUJITA, C.L. PA.16.023, PD.16.039
FUKUMORI, B. PA.12.013
Funari M.B.G. P
D.13.017
Funari, M. B. G. P
A.08.001
Funari, M. B.G. TL.01.009
Funari, M.B.G. P
A.02.039, PA.07.019, PA.12.005,
PA.13.001, PD.04.015, PD.04.018,
TL.01.008
Funari, MBG P
A.02.038
FUNARI M.B.G. PA.11.018, PA.17.003, PD.04.013,
PD.08.001, PD.12.075, PD.12.076,
PD.17.017, PD.17.019
FUNARI MBG PA.16.020
FUNARI MBG.
PA.01.015, PA.08.009, PA.17.006,
PD.12.011, PD.12.012, PD.13.013,
PD.13.014, PD.13.015
FUNARI, M.B.G PA.02.035, PA.13.010, PA.13.011,
PA.13.012, PA.17.002
FUNARI, M.B.G. PA.01.010, PA.02.027, PA.02.033,
PA.04.003, PA.11.004, PA.13.003,
PD.08.006, PD.13.016, TL.04.005,
TL.16.001
FUNARI, MBG PA.03.004, TL.03.006
FUNARI, MBG. PD.03.005
FUNARI,M.B.G. PD.17.015, TL.04.001
Funari, M. G. PA.04.004
FUNARI MG PA.01.013
FUNARI, M.G. PD.13.004
FURLAN, B.J. PD.01.023
FURLANETTO G. PA.13.005
FURTADO, R.G. PA.10.008, PA.10.009
G
GABRIELE HAA. P
D.02.034
GABURE,L.A.G. TL.04.006, TL.04.007
GADELHA, C.M.C. PA.11.007
GAIOTTI JO PD.11.022
Galastri, F.L. P
A.07.026
GALASTRI, F.L. P
A.07.010
GALI, AMAS PD.04.003, PD.04.006
GALUZZO, R.N. PD.13.008
Galvão, BS PA.02.003, PD.12.005
GALVES JR., R.R. PA.02.032
Garcez DC PD.03.025
GARCEZ, D.C. PD.03.019
GARCIA, A.A. PD.01.013, PD.04.010, PD.04.011,
PD.04.012, PD.15.001
GARCIA, D.A.L PD.11.054
GARCIA, D.A.L. PD.11.025, PD.11.040
GARCIA LAL PA.12.016
GARCIA, LAL PD.12.069
GARCIA, M.M. PD.04.016
Garcia, MR PD.02.042
Garcia MRT P
D.16.018
Garcia, M.R.T P
D.03.015
GARCIA M.R.T. PD.03.006
GARCIA, MRT PA.03.004, PD.03.005, PD.03.026,
PD.03.032, TL.03.006
GARCIA, MRT. PA.12.012
Garcia R.G. PA.07.025
Garcia RG PA.07.003
Garcia, R.G. PA.07.012, PA.07.014, PA.07.015, PA.07.016,
PA.07.017, PA.07.019, PA.07.020, PA.07.021,
PA.07.022, PA.07.023, PA.07.026
GARCIA R.G. PD.07.004
GARCIA RG PA.07.028
GARCIA, R.G. PA.07.008, PA.07.009, PA.07.011,
PA.07.029, PA.07.030, PA.07.031,
TL.07.003, TL.07.005
GARCIA RR PD.16.047
Gasparetto, E. P
D.03.011, PD.12.049, PD.12.052
GASPARETTO, E P
D.12.061, PD.12.065
GASPARETTO EL PD.12.027, PD.12.043, PD.12.044,
PD.12.048
GASPARETTO, E.L. P
D.12.013
Gattis, Oliveira PG. P
A.07.003
GATTIS, P P
D.07.004
GATTO YP P
D.01.060
GAVA, N.F. PA.11.013
GAVINO, J.F PD.01.025, PD.01.046
GAVINO, JF PA.12.015
Gazzoni, F.F. P
D.02.017
GAZZONI, F.F. P
D.01.047
GAZZONI, M.F. PD.01.047
GEBRIM, EMMS P
D.03.032
Gebrim, E.M.S. P
D.03.015, PD.03.020
GEBRIM E.M.S. P
D.03.006
GEBRIM, EMS P
D.03.026
G,G. Paiva P
A.12.014
GIANINI, A.C.C. PD.08.009
GIMENEZ SL. P
A.01.005
GINDRI FH PD.11.057
GIUGLIANI, R. TL.12.012
GIURBINO A PA.01.007, PA.16.003
Gobbo, R TL.02.003, TL.02.004
GODINHO, AC PD.11.029
GODINHO, GG. PD.11.029
GODINHO, PC PD.11.029
Godoy, L.F.S. P
D.03.020
GOMES A.C.P PD.16.025
GOMES A.C.P. PA.13.005
GOMES, A.C.P. PD.16.024
GOMES, ACP PA.16.025
Gomes B TL.12.011
GOMES, B. M. PD.16.042
GOMES, B.M. PD.11.020
GOMES, E.F. P
A.10.008, PA.10.009
GOMES, G.V. PA.10.008, PA.10.009
GOMES KFM PA.02.036, PA.09.003
GOMES, M.V. PA.10.008, PA.10.009
GOMES P.M.M. PD.16.004
Gomes R TL.01.001, TL.01.002, TL.01.003
Gomes, R.L.E. P
D.03.015
GOMES R.L.E P
D.03.006
GOMES, RLE P
A.03.004, PD.03.005, PD.03.026,
PD.03.032, TL.03.006
GONÇALVES FILHO, A.L.M. PA.03.006
GONÇALVES MCP PD.10.005
GONCALVES, T. PD.08.007
GONZAGA BMF TL.01.010
GONZALEZ, C. J. P
A.14.004
Gorski A TL.01.001, TL.01.002, TL.01.003
GOSPOS, M. PD.04.016
Granados AM PD.12.029
Grassi DC PD.01.029
GRAVINATTI, M.C. TL.04.006, TL.04.007
Graziano L. TL.08.001
GRAZIANO L PA.08.002
GRAZIANO, L PA.08.004, PA.08.005, PA.08.007,
PA.08.010
GRAZIANO, L. P
A.08.006
GRAZZIOTIN, R.U. P
D.01.049
GREGIO JUNIOR,E PA.11.009
GRILLO FPS P
A.06.001
Grotta, M.B. P
D.10.006
GRUNEWALD T PA.12.016
Guatelli C. TL.08.001
GUATELLI, C P
A.08.004, PA.08.005, PA.08.007
161
GUATELLI, CM P
A.08.010
GUATELLI CS P
A.08.002
GUATELLI, C.S. P
A.08.006
Guedes, V.H.C.C. P
A.01.012
GUEDES V.H.C.C PD.03.029
GUEDES V.H.C.C. PD.03.030, PD.16.035
GUEDES VHCC. PD.12.047
GUEDES, V.H.C.C. PD.12.010, PD.16.014
GUEDES, VHCC PD.12.060, PD.12.078, PD.16.007,
PD.16.016
GUERRA LFA PD.11.035, PD.16.047
GUERRA, L.F.A. PD.12.007
GUIDORIZZI HP PD.11.022
Guilherme, F.A P
A.03.010
GUIMARAES C.T.S. PD.01.066
GUIRRADO, V. TL.12.002
H
HACHUL M. T. PD.11.025
HACHUL, M.T PD.11.054
HACHUL, M.T. PD.11.040
HANDFAS, B.W. PA.12.013
HARRINGTON, D PD.11.003
HARTMANN L.G.C. PA.11.018
HASSAN, A. P. M. PD.02.035
HEMING CAM PD.01.063
HEMING, C.A.M. PD.01.031, PD.02.011, PD.02.019,
PD.02.020
HERNANDES, M.A. PA.11.013, TL.11.006
HERNANDEZ FILHO, G. PA.11.012, PA.11.021
Hidal, J. PA.07.014
HIRATA, FC. PA.12.012
Hirose MA PD.01.029
HOCHHEGGER, B PD.11.003
HOCHHEGGER, B. PD.16.005, PD.16.006, PD.16.017
Ho F. PD.17.023
HO, F PD.17.018
HO, F. P
D.01.048
HOFFMANN, J. PD.01.010, PD.01.051, PD.11.026,
PD.12.064
Hollanda, E.S. P
D.02.024, PD.02.026
HOLLANDA, E.S. PD.01.053, PD.02.032, PD.02.033
HONORATO NETO, A. PD.16.011
HOSSNE, R. S. PD.01.015
HUAPAYA J. PD.13.003
HUBER, F.Z.T. PD.10.004
HUGUENIN F.G.S. PD.13.021
HYGINO DA PD.12.048
HYGINO DA CRUZ LC PD.12.027, PD.12.044
I
IACOVENKO JR, R.A.K. PA.09.001
IBIAPINA, FGSB. PA.06.002
IDAGAWA MH PD.12.025
Indiani, J.M.C. TL.05.001
INDIANI JMC TL.01.010
Indrusiak, FS PD.16.030
IRION, K.L. PD.16.005, PD.16.006, PD.16.017
IRION, KL PD.11.003, PD.16.009
Ishikawa, WY P
D.04.015, PD.04.018
ISHIKAWA, W.Y TL.04.001
162
ISHIKAWA, W.Y. PA.04.003, TL.16.001
ISHIKAWA,W.Y. PA.01.010
ISOLAN GR PA.12.019
ito, A.E.T TL.14.002
ITO, N.A. PA.01.006
J
JAIMEZ, F.D P
A.14.004
JALES JR., M.D. PD.03.036
JARDIM, C.C. PD.11.049
Jardim L.C. P
A.16.016
JARDIM, L.C. P
D.01.048, PD.08.009
JESUS CLM P
D.11.022
Johnsson J PD.11.010
JOJIMA F T PA.11.015
JOJIMA, F.T. PA.11.002
JOVILIANO, E. E. PA.04.002
Julio T TL.06.001
Julio, T. P
A.07.022
JULIO T PA.17.006
JULIO, T. PA.07.008, PA.07.011
Junior CB P
D.03.025
JUNIOR, H.C.C. PD.02.031
JUNIOR, J.E PD.17.003
JUNIOR L.A.J. PD.13.019
K
KACIC,IC P
D.12.023
Kalil R. TL.04.003
KANNENGIESSER S PA.01.013
KELLER, D.F.H. P
D.03.017
KELLER, DFH. P
A.12.010
Ker W PA.10.002, PD.10.009
KER W PD.10.001
KER W, P
D.10.002
KER W. TL.10.001
KER, W TL.04.002, TL.10.004
KIHARA FILHO, E.N. PA.07.029
Kitamura, F.C. P
A.06.005, PA.06.006, PD.03.031
KITAMURA, F.C. PA.16.009
Klaes, AINM PD.16.030
KOBAYASHI, M.J. TL.11.006
KOBAYASHI,MTT PA.11.009
KOCHI, C. P
A.11.012, PA.11.021
Kochinski K. P
D.06.002
KOCH, M.C. PD.02.025
KOENIGKAM-SANTOS, M PD.04.003, PD.04.006
KOENIGKAM-SANTOS, M. PA.04.002
KOGA KH PD.10.005
Koltermann, T TL.12.007
Kruger, MS P
D.16.030
KRUGER, M.S. PD.01.049
KUBO, TTA TL.10.004
Kupske, A. PD.02.017
KUPSKE, A. PD.01.047, PD.01.049, PD.01.062
KURIMORI C.O. PD.11.042
KURIMORI, CO PD.11.031, PD.11.034
L
LABBATE, MONTEIRO, R.C.D. P
D.15.001
LABBATE, M.R.C. P
D.01.013, PD.04.010, PD.04.011,
PD.04.012
Lacerda LS P
D.03.025
LACERDA, L.S. PD.03.019
LACK N.F.P. PD.16.027
Lages, R.B. PD.03.031
LAGO EAD PD.01.065
LAGO, EAD PD.01.032
LAHAN, D PD.01.032
LANDEIRA, FLF P
D.12.069
LANDIM B.D PD.09.001
LANGER, F.W. P
D.12.079
LANGER, FW PD.11.003
Latorre Z, A J P
A.16.004
LAU, J PD.08.012
Leal Ângela CGB TL.10.002
Leal Filho, J.M.M. PA.07.026
Leal, NL P
D.02.042
LEAL, N.L PD.01.025, PD.01.046
LEAL, NL PA.12.015
LEAO LRS. PA.08.009, PA.16.020
LEAO, L.R.S. PA.13.012
Leão, L.R.S P
D.13.016
Leão, L.R.S. P
A.12.005
Leao RMA PD.08.002, PD.08.003, PD.08.004
LEAO, R.M.A. PD.08.008
LEAO RV PD.01.030, PD.01.052, PD.11.031
LEAO, R.V P
D.01.054, PD.11.055
LEAO, RV PD.01.037
Lederman HM PA.16.017, PD.16.040
Lederman, H.M. PA.06.005
LEE, HJ PD.16.031
Lee H. W P
D.12.008
LEE, Y. P
D.12.046, PD.12.056
Leiria, FA TL.12.007, TL.12.008
LEITE A.A. PD.02.013
Leite C C P
D.12.008
Leite, CC P
D.12.083
LEITE CC P
D.01.006, PD.01.030, PD.01.052, PD.07.003
LEITE, C. C. P
D.12.024, TL.12.001
LEITE, C.C. P
A.07.027, PD.01.054, PD.01.057,
PD.11.024, PD.11.058, TL.12.002
LEITE, CC P
D.01.037, PD.16.031
LEITE, CC. P
A.12.012
Leite, E.A.V P
A.01.012
Leite, L.C. P
A.07.005
LEITE, L.C. P
A.16.009
LEITE M.A. TL.03.007
LEITE MCNA PD.11.022
LEITE, SCB P
D.08.007
LEITTE C.C. P
D.11.019, PD.11.042, PD.11.056
LELLIS LS TL.01.010
LEMOS LA PD.04.008
Lemos PA., TL.04.003
L F Godoy, MD PD.12.008
LIBANIO, B.B PA.17.004
Libânio, B.B. P
A.12.014, PA.16.013
LIBÂNIO, B.B. PA.01.008, PA.13.007
LIGABO ANSG TL.01.010
LIMA A.P.S P
D.16.025
LIMA, A.S. PD.01.026, TL.01.011
LIMA,A.S. TL.01.006
LIMA E.N.P. P
A.10.006, PA.10.010
LIMA, E. N. P. P
A.14.001, PA.14.003
LIMA, F.G. P
D.01.050
LIMA, FL PA.16.025
LIMA, G.A.F. PA.11.004
LIMA, JF P
A.17.007, PA.17.008, PD.17.021
Lima, M.C.L. P
A.14.012, PD.10.006, PD.10.007,
TL.14.002, TL.14.003
LIMA MCL TL.14.001
LIMA, M.C.L. P
A.10.007, PA.14.002
LIMA, MCL TL.10.003, TL.14.005
LIMA, M.R. P
D.02.016, PD.02.023, PD.12.063,
PD.13.018, PD.17.012
LIMA, M.S. P
D.16.027, PD.16.029
LIMA,N.W. P
A.05.001
LIMA, R.M.L PA.02.002
LIMA, R.R. P
D.11.033, PD.16.032
LIMA T.C. PD.11.056
LIMA TC PD.01.006
LIMA, T.C. PD.11.058
LIMA, TC PD.01.030
LIMA VB PD.01.063
LIMA, V.B.R P
D.02.011
LIMA, V.B.R. P
D.01.031, PD.02.019, PD.02.020
LINS, C.F. P
D.02.002, PD.03.002
LINS, CF P
D.11.004, PD.11.005, PD.11.006, PD.11.014,
PD.11.015, PD.11.065, PD.12.006
LIPPI, M.M. P
D.17.010, PD.17.011, PD.17.014
LOBO, G.H. P
A.10.008, PA.10.009
LOBO, G.P. PD.13.022
LOBO, G.R. P
D.03.039
LONGO MG PA.12.019, TL.15.002
LONGUI, C.A. PA.11.012, PA.11.021
Lopes, A.A PD.11.048
LOPES, AA PD.11.029
LOPES, A.K.B.F. PD.02.002, PD.03.002
LOPES, AKBF PD.11.004, PD.11.005, PD.11.006,
PD.11.014, PD.11.015, PD.12.006
LOPES BSC P
A.12.016
LOPES, BSC P
D.12.069
Lopes, C.S P
D.11.036
LOPES, D. L. P
A.06.007
LOPES, GF P
A.17.007, PA.17.008, PD.17.021
LOPES, L.D.P P
D.03.007
LOPES, L.F. P
D.13.005
LOPES, M. P
A.13.013
LOPES, S. P
D.11.025
LOPEZ, A.M. PD.01.036, PD.02.003, PD.04.001,
PD.12.031
LORENZATO, MM TL.11.005
Lotte FM P
D.01.029
LOUREIRO, A.L. PD.11.052
LOURENCO MBS PA.10.005
LOUZADA-JUNIOR P TL.11.005
Lozano TM P
D.13.007
Lucato, LT P
D.12.083
LUCATO, LT. PA.12.012
LUCIO, J.F.F PD.07.004
LUERCHO E. PD.11.032
LUMINOSO.D. PD.17.006
LUZ DC. P
A.01.015, PA.07.028, PA.08.009, PA.16.020,
PA.17.006
163
LUZ, D.C PA.13.012, PD.07.004
LUZ, D.C. PA.01.010, PD.13.016
LYKAWKA, R. PA.05.001
LYRA, A. PA.11.012, PA.11.021
Lyra, T.G. P
D.03.020
LYRIO CAC. PA.08.009
LYRIO,C.A.C. PD.08.001
M
MACEDO, A.C.S. TL.16.001
MACEDO. M.A.P PD.16.025
Machado DC PD.03.025
MACHADO, D.C. PD.03.019
MACHADO, VB PD.11.029
MACIEL, A.C. PD.01.062
MACIEL, BC PD.04.003, PD.04.006
Maciel, F.C. P
A.03.010
MACIEL, M.S PA.13.004
MACRUZ, F. B. C. TL.12.001
MACRUZ, F.B.C TL.12.002
MAGALHÃES, M. PD.11.052
MAHFOUZ, K PD.03.017, PD.17.022
MAHFOUZ, K. PA.12.010, PD.16.021
Maia A.C.J TL.12.006
Maia, A.C.J TL.12.014
MAIA JR, A.C. PA.12.021
Maia Jr, ACM TL.12.010
MAIA JR., A.C.M. PD.12.002, PD.12.081, TL.03.008
MAIA JR, L. O. F. PD.02.035
MALACARNE, T. S. PD.02.035
MALDONADO, J.P.R. PD.08.009
Mallmann, R. P
D.11.007
MANARA L.M. PD.01.034, PD.11.043
MANARA, L. M. PD.13.008
MANARA, L.M. PD.01.033, PD.01.035, PD.02.025,
PD.04.004
Maragno, B PD.08.002, PD.08.003, PD.08.004
MARAGNO, BIANCA PD.08.008
MARANGON-MACHADO,J.C. PA.16.024
Maranhão CPM PD.01.040, PD.16.033
MARÇAL FILHO EFL TL.14.001
MARÇAL FILHO, E.F.L. PA.10.007
MARCA, P.G.C. PD.12.022, PD.13.022
MARCELINO, A.S.Z PD.01.057
MARCHIORI, E PD.11.003
MARCHIORI, E. PD.02.011, PD.16.005, PD.16.006,
PD.16.017
Marchiori L.B. P
D.17.023
MARCHIORI, L.B PD.17.018
MARCHI, S.E.N. PD.01.023
MARCIANO, F.R. PA.10.008, PA.10.009
Marconi, G.F TL.11.003
MARCUCCI. M.B. PD.17.006
MARINO VSP PA.10.005
MARIOTTI, G. PA.07.030, TL.07.003, TL.07.005
Mariotti, G.C. P
A.07.020
MARIOTTI G.C. PA.07.029
MARIOTTI GC. PA.07.028
MARIOTTI, G.C. PA.07.008, PA.07.009, PA.07.011
MARIZ FILHO, PJ DA C PD.12.006
MARQUES, C. PD.11.052
Marques E. TL.08.001
164
MARQUES, E P
A.08.005
MARQUES, E. P
A.08.004, PA.08.007
MARQUES EF PA.08.002
MARQUES, EF PA.08.010
MARQUES,E.F. PA.08.006
MARQUES EM TL.01.010
MARQUES, R.F. TL.01.004
MARQUES, R.M. TL.01.005
MARRETTO R A S PA.11.005
MARRONE, S. PD.01.015
MARTIN E. PD.11.032
MARTINELLI, A.L.C PD.17.003
MARTINEZ I. PA.10.006, PA.10.010
MARTINEZ, I. C. C. PA.14.003
MARTINI, M.A.L. PD.11.025
Martin, M.F. TL.05.001
MARTIN MF TL.01.010
Martin M G M P
D.12.008
MARTINS A.N. PD.04.013
MARTINS, A. N. PA.04.003
MARTINS, A.N. PA.01.010, TL.04.005
Martins, B.J P
D.11.036
MARTINS DL PD.01.065
MARTINS DLN PD.11.035, PD.16.047
MARTINS, D.L.N. PD.12.007
MARTINS, F.M.B. B. PA.17.005
MARTINS, J.E.V. PD.17.022
MARTINS, L.R PD.03.007
MARTINS LRA PD.01.060, PD.16.037
MARTINS, M.M PD.11.054
MARTINS, M.P. PA.14.002
MARTINS RMS PD.06.001
MARTINS, R.S. PA.12.013
Martins, T PA.02.038, TL.02.003, TL.02.004
MARUICHI, M.D. PA.11.012, PA.11.021
MARUSSI VHR PA.12.016
MARUSSI, VHR PD.12.069
MASSAKI, A.N. PA.11.008
MASSELI V.B. P
D.13.019
MASSOTE, A. G. PD.02.035
MATHIAS, P.C. PA.06.003, PA.06.004
MATOS, A.M. PD.17.010, PD.17.011, PD.17.014
MATOS, B.P. PD.01.050, PD.02.031
Matsumoto, CA P
D.01.058
MATTOS F.A.C. PD.02.068
MAURER, M.N PD.02.023
MAYMONE W. H. PD.13.021
Mazzo PE. TL.04.004
MCCANN, C PD.11.003
MEDEIROS, DC P
D.03.032
MEDEIROS, J.A. PA.16.019
MEDEIROS, S.I.C. P
D.04.016
Meirelles, GP P
D.01.058
Meirelles, G.S.P P
D.16.001
Meirelles, G.S.P. P
D.16.002
MELGES, G. C P
A.16.007
MELINSK, M. P
A.06.003, PA.06.004
Mello-Amoedo, C.D. TL.01.008
MELLO AMOEDO, C.D PA.02.035
MELLO-AMOEDO, C. D. PA.02.027
MELLO, C.M. P
D.11.002
MELLO, M.A.R. P
D.04.016
MELLO RAF P
D.11.035
MELO, A.F. PD.02.002
MELO, A.F .de PD.02.013
MELO A.S.A. PD.01.018, PD.16.010, PD.16.012
MELO ASA PD.02.041, PD.16.044
MELO, A.S.A. PD.01.059
MELO, C.A. TL.04.006, TL.04.007
Melo, D.M PA.03.009
MELO D M. PD.03.001, PD.12.047
MELO D.M. PD.03.029, PD.03.030, PD.16.035,
PD.16.036
MELO, D.M. PD.03.027, PD.12.010
MELO, DM PD.12.060, PD.16.007, PD.16.016
MELO,D.M. PA.16.012
MELO, E.R. PA.04.006, PD.04.021
MELO H.J.F. P
D.11.050
MELO HJF. P
D.02.034
MELO, HJF. P
D.12.023
MELO, R.A.B PA.02.002
MELO, RAB PA.11.019
MELO, ST PD.04.008
MELO WAL PD.11.057
MENDES, A.A.M PD.11.055
MENDES COELHO VC TL.14.001
MENDES FH, F.A.A PD.11.054
Mendes GF. PA.07.003
Mendes, G.F. PA.07.012, PA.07.016, PA.07.019,
PA.07.021, PA.07.023
MENDES, G.F. PA.02.033
MENDES, G.G PA.02.002
MENDOZA, M. PD.12.024
Menegatti, RS TL.12.007, TL.12.008
MENEZES, A.L.P. P
D.03.036
MENEZES MCA PA.14.005
MENEZES, M.C.C. P
A.16.019
Menezes, MR PA.02.029, PD.02.042
MENEZES MR PD.07.003
MENEZES, M.R. PA.07.027
MENEZES PA P
D.02.041
MESQUITA, A.B.G PD.03.007
Mesquita CT P
A.10.002, PD.10.009
Mesquita, CT P
A.10.004
MESQUITA C.T. TL.10.001
MESQUITA CT PD.10.001, PD.10.002
MESQUITA, CT TL.04.002, TL.10.004
MESSINA, M.L. PA.07.010
MEZZACAPPA, M.A.M.S. PA.13.002
MIAMAE, L.M PD.13.006
MIAMAE, L.M. PD.13.001, PD.17.002
MICHELONI L PA.01.007
MIGUEL NETO, F. PD.13.004
MILLER, W.P. P
D.11.033, PD.16.032
Mincis M TL.01.001, TL.01.002, TL.01.003
Mincis R TL.01.001, TL.01.002, TL.01.003
MIRANDA, A.M.M PD.03.007
Miranda CMNR PD.01.040, PD.03.033, PD.16.033
MIRANDA F.C. PA.11.018
Missrie I PA.16.017, PD.16.040
MISSRIE, I. PA.16.009, PD.16.046
Miura T.Y. PA.16.016, PD.17.023
MIURA, T.Y. PD.17.018
Miyada, W.S. PD.12.084
MIYADA, W.S. PD.03.039
MIZOBUCHI, F.C. PD.01.023
MOGAMI R. PD.13.021
MOHAN, K PD.16.009
MOLL RSS PD.16.047
Monteiro, A. PD.11.017
MONTEIRO, P.H.S. PD.10.004
MONTEIRO, R.C.D. P
D.01.013, PD.04.010, PD.04.011,
PD.04.012
MONTE, O. P
A.11.012, PA.11.021
MORAES, D.C. PD.01.023
MORAES, EC P
A.10.003
MORAES FHP PD.11.057
Moraes, P. C. P
A.08.001
MORAES PC. PA.08.009
MORAES, P.C. PD.08.006
MORAIS, L.D.S. PA.16.010
MOREIRA BL PA.12.016
MOREIRA, F.A. PA.06.003, PA.06.004
Moreira VG PD.03.025
MORIGUCHI SM PD.10.005
Morimoto TP P
D.13.007
MORITA D PD.01.065
MORITA ME TL.14.001
MORO, F.A.S. PD.03.039
Mosci, C. P
A.14.012, PD.10.006, PD.10.007, TL.14.002,
TL.14.003
MOSCI C TL.14.001
MOSCI, C TL.10.003, TL.14.005
MOSCI, C. P
A.10.007, PA.14.002
Mostardeiro, T. TL.02.002
MOTA FF PA.02.036, PA.09.003
MOTA MI PA.02.036, PA.09.003
MOTA, MMS PA.11.017
Mota, R.V. TL.11.007
MOURA DS PA.14.005, PD.16.045
Moura, F.M. P
D.12.003
MOURA FM PD.01.060, PD.11.053, PD.16.037
MOURA JAC PA.14.005, PD.16.045
MUGLIA, V.F PD.17.003
MUGLIA, V.F. PA.01.006, PA.04.002, PD.01.019
MULLER, A.S. PD.01.049
MUNIZ NETO FJ. PA.08.009
MUNIZ NETO, F.J PA.13.003, PA.13.010, PA.13.011
MUNIZ NETO, F.J. PA.11.004
MUNIZ NETO, FJ PD.03.005
MUÑOZ F PA.16.003
MUÑOZ GE. PA.13.009
MURILLO, J. P
D.02.003
MUSA-AGUIAR, P TL.03.006
MUSA-AGUIAR, P. PD.13.004
Mussi, TC PA.02.038, TL.02.003, TL.02.004
MUSSI, T. C. PA.07.030, TL.07.003, TL.07.005
N
Nacif, M.S. TL.05.001
NACIF MS PD.02.041, TL.01.010
NAGAYA E M PA.11.015
NAGAYA, E.M. PA.11.002
NAKAGAWA S.A. PA.10.006
Nakano I.T PD.06.002
NAPOLI A. PD.11.032
NARCISO,J.A. TL.01.005, TL.01.006
NASCENTES, L.D.B P
D.11.054
165
NASCENTES, L.D.B. P
D.11.025, PD.11.040
NASCIMENTO , ACO. PA.06.002
NASCIMENTO BL PD.16.044
NASCIMENTO, B.L. PD.01.059
NASCIMENTO, I. N. C. PD.02.035
NASCIMENTO, L.C. PA.16.010
NASCIMENTO, M.L. PD.12.022, PD.13.022
NASCIMENTO, NL PA.10.003
NASSAR, S.A. PD.01.023
Nasser, F. P
A.07.026
NASSER, F. PA.07.010
NASSER, G.E. PD.11.058
NASSIF, P.A.N. TL.11.001
Natal, M.R.C. PD.03.024
NATAL, M.R.C. P
D.03.036
NATANAEL, E.R. TL.01.004
NAVARRO, M.M.N. PD.11.002
NAVES, A. A. PA.17.005
Negri,R.V. P
A.01.012, PA.03.009, PA.03.010, PA.16.018
NEGRI R.V. P
D.03.029, PD.16.035, PD.16.036
NEGRI RV. P
D.03.001
NEGRI, R.V. P
D.03.027, PD.08.009, PD.16.014
NEGRI, RV PD.12.078, PD.16.007, PD.16.016
NESI R.S. PD.01.034, PD.11.043
NESI, R.S. PD.01.033, PD.01.035, PD.02.025, PD.04.004,
PD.13.008
Neto, JAO PD.01.073
Neto, M.J.F. PA.13.001
NETO, M.J.F PA.13.010, PA.13.011
NETO, M.J.F. PA.17.002
NETO, O.G. PA.09.001
NETO, R.G.C. PD.13.008
NETO, W.A PD.01.025, PD.01.046
NETO, WA PA.12.015
NETO, W.T.P. PD.12.079
NETTO, J.D.J. PD.02.031
NEVES, A.L.E. PA.09.005
NEVES, A.L.E.N PA.09.004
NEVES DG PD.02.041
NEVES, D.G. PD.01.059
NEVES, R. PA.09.004, PA.09.005
NICOLODI, G.C. PD.11.033, PD.16.032
Niemeyer B P
D.03.011, PD.12.049, PD.12.052
NIEMEYER B PD.12.027, PD.12.043, PD.12.044,
PD.12.048, PD.12.065
NIEMEYER, B. PD.12.013
NIEMYER, B PD.12.061
NIN, C.S. PD.16.005, PD.16.006, PD.16.017
Nishiyama, KH PD.16.018
NITRINI R. PA.12.001
NOBREGA, R.R. PD.12.080
Nóbrega RR PD.11.008
NOBRE L.F. P
D.11.043
NOGUEIRA, A.B. PD.03.038
Nogueira-Barbosa M.H. P
A.11.014
Nogueira-Barbosa, M.H. TL.11.003
NOGUEIRA-BARBOSA MH TL.11.005
NOGUEIRA-BARBOSA, M.H PD.11.047
NOGUEIRA-BARBOSA, M.H. PA.11.013, TL.11.006
NOGUEIRA, R.A.M. PD.01.050
NOGUEIRA, VH. PD.07.005
NOGUEIRA, VHV TL.07.002
NOGUEROL, E.C. P
D.01.019
166
Nomura, CH P
D.04.015, PD.04.018
NOMURA, C.H TL.04.001
NOMURA, C.H. PA.04.006, PA.16.023, PD.04.021,
PD.16.027, PD.16.029, PD.16.039
NORONHA, L. PD.16.021
Noujaim, S.E. P
D.03.020
Nunes, DM TL.12.010
Nunes J TL.12.011
Nunes L. P
D.03.021
Nunes, P.H.T. P
D.12.003
NUNES PHT PD.01.060
NUNES, R.H. PD.12.030, PD.12.046, PD.12.056,
PD.12.058, PD.12.073
NUNES,R.H. TL.12.013
NUNES, T. PA.05.002
Nunes, THP PA.10.004
O
ODELI J.T.
ODELI, J.T.
PD.01.034, PD.11.043
PD.01.033, PD.01.035, PD.02.025,
PD.04.004, PD.13.008
OLI,M. P
A.08.006
OLIVAL, L.D P
D.01.025, PD.01.046
OLIVAL, LD P
A.12.015
OLIVEIRA A.C. PD.01.066
Oliveira CE P
D.03.025
OLIVEIRA, C.E. P
D.03.019
OLIVEIRA, C.K.S P
A.02.032
OLIVEIRA, C.K.S. P
D.01.069
Oliveira, D.J.L. P
D.03.020
OLIVEIRA, D.S. P
A.04.006, PA.16.023, PD.04.021,
PD.16.014, PD.16.027, PD.16.029,
PD.16.039, TL.07.012
OLIVEIRA FILHO HB. P
D.12.020
OLIVEIRA FILHO,HB P
D.12.019
OLIVEIRA FILHO, S. B. P
D.16.038
OLIVEIRA FL, W. P
D.17.010, PD.17.011, PD.17.014
Oliveira, G.S. P
D.12.084
OLIVEIRA, G.S. P
D.03.038
Oliveira J.M. P
D.06.002
OLIVEIRA JR., R. P
D.12.007
OLIVEIRA JUNIOR L.G. PA.11.018
OLIVEIRA JUNIOR, L.G. PA.11.004
OLIVEIRA, J.W.A. PD.02.002, PD.03.002
OLIVEIRA KA. P
D.12.020
OLIVEIRA,KA P
D.12.019
OLIVEIRA, L.A.N. P
D.16.011
Oliveira, M.A.C. P
D.16.001
OLIVEIRA, M.A.C. P
D.10.004
OLIVEIRA, M.V.N PD.02.002, PD.03.002
OLIVEIRA NETO, J.A. PD.01.031, PD.02.011,
PD.02.019, PD.02.020
OLIVEIRA-NETO JA PD.01.063
OLIVEIRA, P.A.G. PD.01.059
OLIVEIRA, PAG. PD.08.007
OLIVEIRA, P.S PA.13.013
OLIVEIRA, P.S. PD.09.002
OLIVEIRA RFR P
D.01.060
OLIVEIRA RGS P
A.16.008
OLIVEIRA, R.R. P
D.17.010, PD.17.011, PD.17.014
Oliveira, R.V. P
D.02.024
OLIVEIRA, R.V. P
D.02.018, PD.02.032
Oliveira, V.S. P
A.12.014, PA.16.013
OLIVEIRA, V.S. PA.01.008, PA.13.007, PA.17.004
OLIVER, F.A P
D.17.003
Olivetti, B.C. P
D.03.015
Orejuela JF PD.12.029
ORLANDI, J.L.M PD.01.025, PD.01.046
ORLANDI, JLM PA.12.015
ORTEGA, C.D. PD.01.057
OSORIO, A. PA.14.004
OTADUY, M. C. G. PD.12.024, TL.12.001
OTONI NC. PD.13.013
P
PACHECO, E.M.B; P
D.11.039
PACHECO, F.T. TL.12.003, TL.12.004
PACIFICO, L.C. PD.05.002
Padilha IG PD.01.040, PD.03.033, PD.16.033
PADILHA IG PD.16.041
PAESE, H.N.Z. PD.03.022
PAIVA, A.F.L. PA.16.023, PD.16.039
Paiva, D.H. PA.16.013
PAIVA D.H.R. PD.13.019
Paiva, G.G PA.16.013
PAIVA G.G. PD.13.019
PAIVA, G.G PA.17.004
PAIVA, G.G. PA.01.008, PA.13.007
PAIVA IB PD.11.057
PAIVA, L.S. PD.13.005
Paixão N.C.F PA.16.016, PD.17.023
PAIXÃO, N.C.F. PD.11.049
PAIXAO T.S.A. PD.11.056
PAIXAO TSA PD.01.030
PAIXÃO TSA PD.01.006
PAIXÃO, T.S.A. PD.11.058
PALACIOS, R. PD.12.031
PALHETA MS PD.06.001
PALMEIRA NETO, JS PA.11.017
PALUDO J PA.08.002
PALUDO, J PA.08.004, PA.08.005, PA.08.007, PA.08.010
PALUDO,J. PA.08.006
PANITRUR, ASA PD.16.008
PANIZZAPANIZZA, P.S.B. PD.11.058
PANIZZA P.S.B.
PANIZZA PSB PD.01.006
PANIZZA, P.S.B. PA.07.027, PD.01.057
PANIZZA, PSB PD.01.030
PANTOJA L.O. PA.10.006, PA.10.010
PANTOJA, L. O. PA.14.003
PARENTE DB P
D.01.063
PARENTE, D.B. P
D.01.031, PD.02.011, PD.02.019,
PD.02.020
Parga JR. TL.04.003, TL.04.004
PARREIRA, P.L. PD.13.001, PD.13.006, PD.17.001,
PD.17.002
Passos, RBD PD.04.015, PD.04.018
PASSOS, R.B.D. TL.16.001
Passos, U.L. PD.03.015
PASSOS, UL PD.03.026, PD.03.032
PASSOS, UL. PA.12.012
PAULA, F. J. A. PD.01.019
PAULA, F.J.A. PA.01.006
PAULA JR, CRV PA.11.017
PAVAN, G. PA.05.002
Pavani AVB P
D.16.018
PECANHA, A.S. PD.13.022
Peçanha AS PD.03.025
PEÇANHA, A.S. PD.03.019
Pecora M. TL.08.001
PEDDLE, S P
D.08.012
Pedrollo, I.M. P
D.02.017
Pedrollo, IM P
D.16.030
PEDROLLO, I.M. P
D.01.047, PD.01.049, PD.01.062
PEDRO, M.S. PD.01.010
PEIXOTO, MCG PD.11.014, PD.11.015
PEIXOTO, TV TL.07.002
PEIXOTO, TV. P
D.07.005
PENACHIM TJ PD.01.065
PENACHIM, TJ PD.01.032
PEREIRA, CFF P
A.11.017
Pereira, E.B. TL.14.003
PEREIRA JUNIOR IC P
A.12.016
Pereira K.G. P
D.01.021
Pereira ML P
D.12.040
PEREIRA ML PD.12.065
PEREIRA, M. L. P
D.16.042
PEREIRA, NP P
A.08.010
PEREIRA, P. P
D.11.052
PEREIRA P.A.P. PA.13.005
Pereira P.P. P
D.17.023
PEREIRA, P.P P
D.17.018
PEREIRA, P.P. PD.01.048
PEREIRA RCR P
D.01.063, PD.11.057
PEREIRA, R.C.R P
D.01.031, PD.02.011, PD.02.019,
PD.02.020
PEREIRA R.O. P
D.02.013
PEREIRA SAC P
A.16.008
PEREIRA SBAV P
D.11.057
Perez, JA TL.12.007, TL.12.008
PEREZ JA P
A.12.019
PEREZ, J.A. P
D.02.016, PD.12.063, PD.17.012
PEREZ MC. P
A.01.005
PERRONE, S.G.P. TL.12.012
PESSANHA LB PD.11.035, PD.16.047
PESSANHA, L.B. PD.03.010
PESSÔA, FFS PA.10.003
PESSÔA F.M.C. PD.01.018, PD.02.068, PD.16.010,
PD.16.012
PESSÔA, F.M.C PD.01.028
PHILIP D.R.S. PA.11.005
PINCERATO, RCM PA.03.002, PA.12.002
PINCERATO, RCMP PA.12.003
Pinetti RZ P
A.16.017, PD.16.040
PINETTI, R.Z. P
A.16.009
PINHEIRO, L.A. P
A.02.032, PD.01.069
PINHO, M.A. PD.02.038, PD.03.010
PINHO, PC PA.03.002, PA.12.002, PA.12.003
PINTO, E.M. PD.02.002
PINTO, H.E. PD.03.019
PINTO, L.E.S. PD.12.013
PINTO, LF PA.12.003
PIONER G.G. PD.11.043
PIRES, C. P
A.09.001
PIRES.C. P
D.17.006
PIRES, C.R. P
A.09.002, PD.13.012
PIRES R.C P
D.09.001, PD.17.013
167
PIRES R.C. PD.17.005
PIRES, R.D.S. PD.17.002
PITREZ EH PA.12.019
Pitta, P PD.03.011, PD.12.049, PD.12.052
PITTA P PD.12.027, PD.12.043, PD.12.044, PD.12.048,
PD.12.065
PITTA, P PD.12.061
Poli M. TL.08.001
POLI, M PA.08.004, PA.08.005, PA.08.007
POLI MRB PA.08.002
POLI, MRB PA.08.010
POLO DE. PA.13.009
PONARA S.J PD.09.001, PD.17.005
PONARA. S.J. PD.17.006
PORTELA ACF PA.16.006
PORTELA JR, HJ PA.16.006
PORTELA MF PA.16.006
Portilho LC P
D.01.029
PORTUGAL, A.C.G PA.13.004
POSSES F.P. PD.13.019
Prado JLMA PD.11.008, PD.11.010
Prado, J.L.M.A. PD.11.007, PD.11.012
PRADO, J.L.M.A. PD.12.080
PRAIA J PD.01.001
Purysko, A.S. PD.02.005, PD.02.026, TL.02.002
PURYSKO, G. TL.02.009
PUTY,R.C. P
D.01.023
Q
QUEIROZ, A.P. P
D.13.001, PD.17.001, PD.17.002
Queiroz, MR TL.02.003, TL.02.004
Queiroz M.R.G. PA.07.025
Queiroz, M.R.G. PA.07.014, PA.07.015, PA.07.016,
PA.07.020, PA.07.021, PA.07.023
Queiroz, MRG. PA.07.003
QUEIROZ M.R.G P
D.07.004
QUEIROZ M.R.G. P
A.17.003
QUEIROZ MRG. PA.07.028, PA.17.006
QUEIROZ, M.R.G. P
A.07.030, PA.07.031, TL.07.003,
TL.07.005
QUEIROZ, V.O. PD.12.022, PD.13.022
R
RABELLO GD PA.12.002
RABELLO, GD PA.12.003
Rabelo, B.C.S. PD.11.048
Rabelo, B.R.C. TL.11.007, TL.11.009
RACY, A.C.S. PD.08.001
Racy, M.C.J. PA.02.039
RACY MCJ. PA.01.015
Rahal J, A. PA.07.015
Rahal Jr, A. PA.07.012, PA.07.014, PA.07.016, PA.07.017,
PA.07.019, PA.07.020, PA.07.021, PA.07.022,
PA.07.023
Rahal JR, A. PA.02.039
Rahal JR. A. PA.07.025
RAHAL JR. A PD.07.004
RAHAL JR. A. PA.07.007, PA.17.003
RAHAL JR., A. PA.07.031
RAHAL JRA. PA.07.028, PA.17.006
RAHAL, JR.A. PA.07.029
168
RAHAL. JR., A PA.07.008
RAHAL. JR.; A PA.07.009
RAICHHOLZ GA. PA.01.005
RAMALHO, J. PD.12.046, PD.12.056, TL.12.013
RAMALHO, M. TL.12.013
Ramos, C.D P
D.10.007
Ramos, C.D. P
A.14.012, PD.10.006, TL.14.002, TL.14.003
RAMOS CD TL.14.001
RAMOS, C.D. PA.10.007, PA.14.002
RAMOS, CD TL.10.003, TL.14.005
RAMOS, DM PD.03.032
Ramos, L C PD.01.045
RAMOS, L.C P
D.03.034
Rangel, D.A. P
D.16.034
Raphoul J P
D.03.021
RAULINO DMR. PA.08.009
REBECHI F PD.11.001
REBECHI G P
D.11.001
Regacini, R. P
A.06.005
Regattieri, N.A.T. P
D.12.003
REGATTIERI NAT P
D.11.053
REGO, SJF. PD.08.007
REICHERT R TL.15.002
REISER, C.S. P
A.16.023, PD.16.039
REIS,GLL PD.04.008
Reis J TL.12.011
REIS JUNIOR CG PD.16.041
Reis LM PD.11.010
REIS, L.M. P
D.12.080
Reis, M.A.C.R. TL.01.008
REIS R.M P
D.11.047
RENOSTO, F.L. PD.01.015
REZENDE, F.M. P
D.17.001
Rezende MF PA.10.002, PD.10.009
REZENDE M.F. TL.10.001
REZENDE MF P
D.10.001, PD.10.002
REZENDE, MF TL.04.002, TL.10.004
REZENDE, R.C. PD.03.039
RIBEIRO A.M. PA.10.006, PA.10.010
RIBEIRO, A. M. B. PA.14.003
RIBEIRO BFR PD.11.057
RIBEIRO, B. N.F. P
A.04.001, PD.12.032
RIBEIRO, B.N.F. P
D.03.014
Ribeiro C TL.12.011
RIBEIRO DH P
D.12.025
RIBEIRO-DOS-SANTOS JR V PD.01.052
RIBEIRO-DOS-SANTOS JR, V PD.01.054
RIBEIRO-DOS-SANTOS JR., V PD.01.037
RIBEIRO-DOS-SANTOS, V. PD.11.058
Ribeiro, E.J.S. P
D.11.048, TL.11.009
RIBEIRO, EJS P
D.11.029
RIBEIRO F°, C.G. P
A.16.011
RIBEIRO, G.J P
D.02.023, PD.13.018
RIBEIRO, G.J. P
D.02.016, PD.12.063, PD.17.012
RIBEIRO, G.M.R. P
D.03.036
RIBEIRO, J.A. P
A.07.008, PA.07.010, PA.07.011
Ribeiro, M.P. P
D.10.006
RIBEIRO R.L.M. P
D.08.001
RIBEIRO, R.L.M. P
D.08.006
RIBEIRO, R.N.F. P
A.04.001
RIBEIRO, S.C. P
D.03.002
RIBEIRO S.M. P
D.13.019
RIGON, B.G.S. PA.14.002
RIMKUS, C PA.12.003
RINALDI, F. P
D.11.033, PD.16.032
RIOS, GM PD.12.006
RIZZUTO, MS PA.11.017
ROCHA ACMA PA.14.005
Rocha A.J TL.12.006
Rocha, A.J TL.12.014
Rocha, AJ TL.12.010
ROCHA, A.J. PA.12.021, PD.12.002, PD.12.004,
PD.12.058, PD.12.073, PD.12.081,
TL.12.003, TL.12.004
ROCHA CMV PD.04.008
ROCHA LM. PD.12.020
ROCHA,LM PD.12.019
ROCHA, M.A. PA.02.027, TL.04.005
Rocha, R.D PA.07.012
Rocha, R.D. PA.07.014, PA.07.015, PA.07.016, PA.07.017,
PA.07.020, PA.07.021, PA.07.022, PA.07.023,
PA.07.025
ROCHA, R.D. PA.07.008, PA.07.009, PA.07.010,
PA.07.011
Rockenbach, M.A.B.C P
D.02.017
ROCKENBACH MABC TL.15.002
ROCKENBACH, M.A.B.C. PD.01.062
ROCUMBACK, J.C. PA.06.007
RODRIGUES D.P. PD.12.075
RODRIGUES DP PD.12.012
RODRIGUES DP. PD.12.011, PD.13.015
RODRIGUES, D.P PA.02.002
RODRIGUES, F.M PA.11.008
RODRIGUES J.C. PA.11.018
Rodrigues LD PD.01.029
Rodrigues, M.A.A. PA.07.006
RODRIGUES M.A.S. PD.12.075, PD.12.076,
PD.17.017, PD.17.019
RODRIGUES MAS. PD.12.012
RODRIGUES, M.A.S. PA.02.027
RODRIGUES, M.B PD.11.055
RODRIGUES,M.P. PD.01.023
RODRIGUES NR PA.10.005
Rodrigues, R.N PD.11.048
Rodrigues, R.N. TL.11.007, TL.11.009
RODRIGUES, RN PD.11.029
RODRIGUEZ, C.E. P
D.01.036, PD.12.031
Rodriguez SY PD.12.029
ROGÉRIO RM PD.16.045
ROJAS AM. PA.13.009
RONDINA RG PD.11.035
RONDINA, R.G. PD.12.007
ROQUE, D. PA.16.007
Rosa B.G. PA.16.016
Rosa, B.G. PA.16.018
ROSA, B.G. PD.01.048, PD.08.009, PD.11.049
Rosado, W.M.B. PA.04.004, TL.01.009
Rosa DT PD.03.033
ROSA JR., M. PD.12.002, PD.12.081
ROSAS G. PD.02.034
ROSAS, H.B. PD.12.013
ROSEMBERG, L.A. P
A.07.029
ROSENBERG L.A. P
A.11.018
ROSSI, C.S. PA.11.016
Rossi, T.G PD.12.084
ROSSI, T.G. PD.03.038
Rostom, L. P
A.07.001, PA.07.004, PA.07.005, PA.07.006
Rostom, P.P.T. P
A.07.001
Roveda JR., D P
D.08.002, PD.08.003, PD.08.004
ROVEDA JR, DECIO PD.08.008
RUEDA F P
D.12.027, PD.12.043, PD.12.048
RUIZ, R. P. P
A.06.007
RYDZ, P.P.S PA.13.004
S
Sabaneeff, N. P
D.02.005, PD.02.024, PD.02.026
SABANEEFF, N. PD.01.053, PD.02.021, PD.02.032,
PD.02.033
Sadala, F. P
D.11.036
SAKAMOTO S PD.12.025
SAKUMA, A.K. TL.11.001
Sala, M.A.S. TL.05.001
SALA MAS TL.01.010
SALATA, T.M. PA.04.001, PD.03.014, PD.12.032
Sá LCB PD.03.025
SALCEDO JI P
A.16.003
SALEH, N.M P
A.13.013
SALES,LAM P
D.12.026
SALGADO, A.A.B.O PD.01.025, PD.01.046
SALGADO, AABO PA.12.015
SALINA, A.C.I. PA.11.007
SALMON, C.E.G PD.11.047
SALOMAO, H.L. PD.13.022
SALOMAO, R.P. PD.11.040
SALOMÃO, W.R.S. PD.08.009
SALVIO L PA.12.019
Sameshima, Y.T. P
A.13.001, PD.13.017
SAMESHIMA Y.T PD.12.076
SAMESHIMA Y.T. PD.12.075, PD.13.004
SAMESHIMA YT. PA.01.015, PD.13.013, PD.13.014,
PD.13.015
SAMESHIMA, Y.T PA.13.003, PA.13.010, PA.13.011
SAMESHIMA, Y.T. PA.13.012, PD.13.016
SANCHES-ROCHA LG PA.01.013
SANCHES SMD PA.10.005
SANCHEZ, D. P
D.01.036, PD.12.031
Sandoval, AC PD.04.015, PD.04.018
SANDRINI, H.V. PD.01.010, PD.12.064
SANDRINI, H.V.S. PD.11.026
Santana João AM TL.10.002
SANTANA JR, P.J. PD.13.006
Santana Netto,PV P
D.04.015, PD.04.018
SANTANA NETTO, P.V. TL.16.001
SANTANA-NETTO, P.V TL.04.001
SANTANA P.R.P PD.16.025
SANTANA P.R.P. PA.13.005
SANTANA, P.R.P. PD.16.024
SANTANA, PRP PA.16.025
Santana Sara MM TL.10.002
Santiago, I.B. P
D.03.031
SANTIAGO, I.B. PA.16.009
SANTIAGO, MB PD.11.065
SANTOS A.A.S.M.D PD.01.018, PD.16.010
SANTOS A.A.S.M.D. PD.16.012
SANTOS AASMD PD.02.041
SANTOS ACF PA.10.005
Santos A.O. PA.14.012, PD.10.006, TL.14.002, TL.14.003
Santos, AO PD.10.007
169
SANTOS A.O. PA.10.007
SANTOS AO TL.14.001
SANTOS, A.O. PA.14.002
SANTOS, AO TL.10.003, TL.14.005
SANTOS, APSD PD.12.069
SANTOS D.C.B. PA.11.018
SANTOS, D.C.B. PA.11.004
SANTOS, EF PA.11.017
SANTOS, FML PD.11.029
SANTOS FRC PD.06.001
SANTOS, G.R. PD.03.017, PD.16.021, PD.17.022
SANTOS, G.S. PA.09.002, PD.13.012
Santos, GT PD.12.083
SANTOS, I.G.G. PA.13.002
Santos IRM TL.06.001
SANTOS, I.W. PD.13.008
SANTOS J.C. PD.11.050
SANTOS JR, VR PD.01.030
SANTOS, LCM TL.07.002
SANTOS, LCM. PD.07.005
SANTOS, M.G. PA.04.006, PA.16.023, PD.04.021
Santos, M.S. PA.12.005
SANTOS,MS PD.04.008
SANTOS, M.V.B. PD.16.029
SANTOS, MVJ TL.10.004
SANTOS, R.C PA.17.004
Santos, R.M. PA.07.004, PA.07.006, PD.03.031
SANTOS, R.M PA.16.009
SANTOS, R.M. PD.01.013, PD.04.010, PD.04.011,
PD.04.012, PD.15.001, PD.16.046
Santos TV PA.10.002, PD.10.009
SANTOS T.V. TL.10.001
SANTOS TV PD.10.001, PD.10.002
SANTOS, TV TL.04.002
SANTOS WGD PD.11.004, PD.11.006, PD.11.014,
PD.11.015
SANTOS, WGD PD.11.005, PD.12.006
SAÑUDO JL. PA.01.005
SARAIVA, T.V. PA.04.003, PA.12.013
Sarpi, M. PD.03.015
SARPI M.O. PD.03.006
SARRI AJ PD.10.005
Sasaki F.V. P
D.17.023
Sasdelli Neto, R P
D.04.015, PD.04.018
SASDELLI NR. PA.16.020
SASDELLI, R.N TL.04.001
SASSAKI, L.Y. PD.01.015
SAVARESE, L.G. PA.04.002, PA.11.013
Sawamura, MVY P
D.04.015, PD.04.018
SCHAKCLOTH, M PD.16.009
SCHMIDT, A PD.04.006
SCHMIDT, A. PD.04.003
Schmillevitch J TL.01.001, TL.01.002, TL.01.003
Schulte, AC.Q. PD.01.021
Scoppetta LCD P
D.11.008, PD.11.010
Scoppetta, L.C.D. P
D.11.007, PD.11.012
SCOPPETTA, L.C.D PD.12.080
SCOPPETTA, L.R.P.D. PD.16.029
SCOPPETTA, T.L.D PD.12.080
SCOPPETTA, T.L.P.D. PD.12.073, TL.12.003, TL.12.004
SCORTEGAGNA, F.A PD.02.023
SCORTEGAGNA, F.A. PD.02.016, PD.12.063, PD.17.012
SCORTEGANGA, F.A. PD.13.018
170
SCOTT-MONCRIEFF, A PD.08.012
SEELY, J P
D.08.012
Seidel, K.A. TL.05.001
SEMELKA, R.C. TL.12.013
Seragioli, R. TL.11.004
SERNIK R A PA.11.005
Serrão, J P
A.10.004
SETTA, M. L. PD.02.021
SHENG PY PD.01.006
SHIMADA, B. J. PD.03.038
SHIMADA, B.J.U. PD.03.039
Shimizu, C. P
A.08.001
SHIMIZU, C. P
D.08.006
SHITARA, F.I. PD.08.001
SHOJI, H. TL.16.001
Shoji, HK P
D.04.015, PD.04.018
SIBIA, C. P
D.01.015
SIECK, G.G P
D.02.023, PD.13.018
SIECK, G.G. P
D.02.016, PD.12.063, PD.17.012
SILI,T.J.M PD.17.015
Silva, A.M. PD.16.034
SILVA AM PD.16.041
SILVA, A. M. PD.16.038
Silva A.Q.P. P
D.11.007, PD.11.012
Silva AQP PD.11.010
SILVA CB P
A.08.002
SILVA, C.B PA.08.004, PA.08.005, PA.08.007
SILVA, CB PA.08.010
SILVA C.J. TL.03.007
SILVA, C.J. PA.03.006
SILVA, C.M. PA.05.002
SILVA, E.B. P
D.03.002
Silva, E. F. P
A.04.004
Silva, E.F. TL.01.009
SILVA, E.F. PA.12.013
SILVA, FR TL.10.004
SILVA G.S.B.V PD.09.001
Silva, H.C. P
D.12.084
SILVA, H.C. PD.03.038, PD.03.039
SILVA IC P
A.16.008
SILVA, J.C.A. PA.11.016
Silva L. P
D.06.002
SILVA,L.F.D. PD.08.001
SILVA, L.M. PA.05.001
Silva, L.N P
D.03.020
SILVA, L.U.M.A PA.02.002
SILVA, MAM TL.10.004
SILVA, M.G. PA.13.013
SILVA, M.L. PD.04.016
Silva, M.M. P
D.01.021
Silva, M. M. A. PA.08.001
Silva, M.M.A P
A.13.001
SILVA, M.M.A PA.04.003, PD.08.006
SILVA, M.M.A. PA.01.010, PA.07.007, PA.07.029,
PA.17.002, PA.17.003
Silva MQP P
D.03.021
SILVA,M.R.C. PD.17.015
SILVA M.R.C.S. PD.17.017, PD.17.019
SILVA, O.A.C PA.02.002
SILVA PMF PD.11.053
Silva, P.M.F.S P
D.12.003
SILVA RE P
A.12.001
SILVA,R.H.G.F. PA.16.012
Silva, RR PD.01.073
SILVA, RR PD.12.026
Silva, RW P
D.16.030
SILVA, T.H. PA.06.007
Silva, V.M. TL.14.003
Silva VSA. PD.09.003
SILVA W.J.P.M. PA.11.018
Silveira C.R.S. P
A.11.014
SILVEIRA, J.P. PD.16.011
SILVEIRA, M.C. TL.01.004
SILVEIRA,M.C. PD.01.026, TL.01.005, TL.01.006,
TL.01.007, TL.01.011
SILVEIRA,YMA PA.11.009
Silverio, P.R.B. P
A.07.019
SILVERIO P.R.B. PA.07.009, PA.07.011
SILVESTRE, C.C. P
A.02.032, PD.01.069
SIMAO, M.N. TL.11.006
Simão, M.N. TL.11.003, TL.11.004
SIMÃO, M.N. PA.11.013
Simbrón R, L PA.16.004
SINISGALLI JR, C.A PD.01.025, PD.01.046
SINISGALLI JUNIOR, CA PA.12.015
SIQUEIRA, C.C.G PD.01.025, PD.01.046
SIQUEIRA, CCG PA.12.015
Siqueira, LTB P
A.02.029
SIQUEIRA LTB P
D.01.052
SIQUEIRA, L.T.B PD.01.054
SIQUEIRA, M.E. TL.04.006, TL.04.007
SKARE, T.L. TL.11.001
SMANIO, P.E.P. PD.10.004
SOARES AGS PD.04.008
SOARES, CR PA.03.004, PD.03.005, TL.03.006
Soares, C.S. PD.12.084
SOARES, C.S. PD.03.039
SOARES, D.X. PA.11.007
Soares GMT PD.16.018
Soares MLL PD.16.033
Soares, M.V. P
D.12.003
SOARES MV PD.01.060, PD.16.037
Socolowski, L.R. PA.07.017, PA.07.019, PA.07.020,
PA.07.022
SOCOLOWSKI L.R. P
A.07.009
Solha, R. PA.07.001, PA.07.004, PA.07.005, PA.07.006
SOLINO ACD PD.16.041
SOTTANO, F. F. PD.03.038
SOUBHIA, H.R PD.01.025, PD.01.046
SOUBHIA, HR PA.12.015
SOUSA, C.S.M. PD.12.035
SOUSA, JCO. PA.06.002
SOUSA, M.M. PA.11.020, PA.13.008
SOUTO, J.F.M. PA.10.008, PA.10.009
Souza, A.C.P. P
A.07.004
SOUZA, A.S PA.13.004
SOUZA, C.F.M. TL.12.012
SOUZA, C.S PD.03.034
SOUZA, D.J.A. PD.03.010
Souza, E.C.F PA.01.012, PA.03.010, PA.16.018
SOUZA E.C.F. P
D.03.029, PD.03.030, PD.16.035,
PD.16.036
SOUZA ECF. P
D.12.047
SOUZA, E.C.F. P
D.03.027, PD.12.010, PD.16.014
SOUZA, ECF PD.16.007, PD.16.016
SOUZA, EZ PA.12.015
SOUZA, F.M.P PD.13.005
SOUZA, F.T PD.17.003
SOUZA, G.L PD.11.054
Souza J. TL.08.001
SOUZA, J PA.08.004, PA.08.005
SOUZA JA P
A.08.002
SOUZA, J.A PA.08.007
SOUZA, J.A. PA.08.006
SOUZA, JA PA.08.010
SOUZA, M.T.P PD.17.003
Souza, P.M. P
D.01.021
SOUZA RSM PD.11.035
SOUZA, SWD PA.11.017
Souza, T.F. P
A.14.012, PD.10.006, PD.10.007,
TL.14.002, TL.14.003
SOUZA ,T.F. PA.14.002
SOUZA TF TL.14.001
SOUZA, TF TL.10.003, TL.14.005
SPIVAK, M. PD.03.019
STEINWANDTER R. P
D.03.029, PD.03.030
STEINWANDTER, R P
D.11.001
STEINWANDTER,R. P
A.16.012
STELLA, S.F P
D.02.023
Strecker, R. TL.11.007
STRECKER, R. PA.02.033
STRECKER RM P
A.01.013
STRIEDER, D.L PD.02.023, PD.13.018
STRIEDER, D.L. P
D.02.016, PD.12.063, PD.17.012
SUASSUNA, G. PD.03.022
SUMI, DV PA.03.004, PD.03.005, TL.03.006
SUZUKI, L. P
D.16.011
Szarf G P
A.16.017, PD.16.040
Szarf, G P
D.04.015, PD.04.018
Szarf, G. P
A.04.004
SZARF, G TL.04.001
SZARF, G. P
D.04.014, TL.16.001
Szejnfeld, D. P
A.07.001, PA.07.004, PA.07.005, PA.07.006
SZEJNFELD, D P
A.13.013
SZEJNFELD J. P
D.02.034
T
Tacara S. PD.06.002
Tachibana, A. TL.01.009
TACHIBANA A. PD.04.013
TACHIBANA, A. PA.01.010, PA.04.003, PA.12.013,
TL.04.005
TAKAKI, M.H. PA.11.008
Takeda, K.A. P
A.04.004, TL.01.009
TANAKA R.M. PD.17.017, PD.17.019
TANAKA,R.M. PD.17.015
TANAKA S.W PD.16.025
TANAKA, SW PA.16.025
TANEJA A.K. PA.11.018
Taniguchi L.S TL.02.005
Taranto, D.O.L. TL.11.007
TAVARES, M.A. PD.17.010, PD.17.011, PD.17.014
Távora, DGF. P
A.01.017
TEIXEIRA E.M. P
A.13.005
Teixeira, I.C.R. TL.05.001
TEIXEIRA, K.I.S.S. P
D.13.001, PD.13.006, PD.17.001,
PD.17.002
TEIXEIRA, R.R.G P
D.03.010
171
TEIXEIRA, V.M. P
A.16.010
Teles, GBS PD.04.015, PD.04.018
TELES GBS. PA.16.020
TELES, G.B.S.T. TL.16.001
Teles MS PA.16.017, PD.16.018, PD.16.040
TERAZAKI, C.R. PD.11.033, PD.16.032
TESTONI, N.M. PD.01.010, PD.11.026, PD.12.064
T G Lyra P
D.12.008
THOMAZ, F.B. P
D.04.004
Tibana, L.A.T. P
A.06.006
TIBANA LAT P
D.12.025
TIBANA, L.A.T. PD.12.009
Tiferes, DA PD.01.058
Timbó, PS. PA.01.017
TINETTI, C. PA.14.004
TINOIS E PD.10.005
TONIN, C.L PD.17.018
TONIN, C.L. PD.01.048, PD.11.049
TORRES FS TL.15.002
TORRES I.C.G. PA.10.006, PA.10.010
TORRES, I. C.G. PA.14.003
Torres, J.M. TL.11.009
Torres,J.M. PD.11.048
Torres, K.B PD.11.017
TORRES, L.F.B PD.17.022
Torres L.R. TL.02.005
TORRES L.R. PD.01.066
Torres, RVA. P
A.01.017, PA.16.022
Torres, U.S. PD.02.024
TOYAMA C. TL.03.007
TOYAMA, C. PA.03.006
TRAD, H.S. PA.04.002
TRAD, HS PD.04.003, PD.04.006
TRANQUILINI, F. PD.11.025
TRAVERSO, S. PA.14.004
TRIGO, S. G PA.09.004
TRIGO, S.G. PA.09.005
TRINDADE, RMC PD.11.005
TRIPPIA, C.R. PD.11.033, PD.16.032
TSUNEMI MH TL.07.001
Tuffi, Veiga V.T PD.03.021
TYNG, CJ TL.07.002
TYNG, CJ. PD.07.005
U
UEZATO, S. PD.16.011
UTIDA, H.M PD.17.022
UTIDA, HM. PA.12.010
UYENO, F.A. PA.01.006
V
VAIRO, F. TL.12.012
VALADARES LC PA.09.003
VALADARES, L.C. PD.01.050, PD.02.031
VALADARES, RD PD.04.008
VALENTE, K. D. P
D.12.024
Valente, M. P
A.12.014, PA.16.013
VALENTE, M. P
A.01.008, PA.13.007, PD.16.011
VALENTIM, L. P
D.01.051
VALENTIM, M.V. PA.16.007
VALERIANO, C. PD.12.024
172
VALE, R.I.C. P
D.03.038, PD.03.039
VALESE B.G. P
D.16.027
VALIM, A.C. P
A.11.004
VARELA CN P
D.16.008
VARELLA R. P
D.16.004
VARELLA, R. P
D.01.028
VAZ, C.L. P
D.01.053
VAZ, N.D. PD.08.009
VAZOLLER M.R. P
D.12.076
Vedolin, L. TL.12.007, TL.12.008
VEDOLIN L PA.12.019
VEDOLIN, L.M. TL.12.012
VELOSO, G P
D.04.008
VELOSO, L.R.M. P
D.12.035
VENTURA, C.A.P. PA.17.002
Ventura N P
D.12.040
Ventura, N P
D.03.011, PD.12.049, PD.12.052
VENTURA N P
D.12.027, PD.12.043, PD.12.044,
PD.12.048
VENTURA, N P
D.12.061, PD.12.065
Veras MF P
A.10.002, PD.10.009
VERAS M.F. TL.10.001
VERAS MF PD.10.001, PD.10.002
VERAS, MF TL.04.002
VERGILIO C.S. P
D.03.029, PD.03.030
VERGILIO CS P
D.12.025
VERGILIO CS. P
D.03.001, PD.12.047
VERGILIO, C.S. P
D.12.010
VERGILIO, CS P
D.12.060, PD.12.078
Vergilio F.S. P
A.16.016
VERGILIO F.S. P
D.16.035, PD.16.036
VERGILIO, F.S. P
D.16.014
VERGILIO, FS P
D.16.007, PD.16.016
VERGILIO,F.S. P
A.16.012
Vergílio,F.S. P
A.16.018
VERGÍLIO, F.S P
D.17.018
VERGÍLIO, F.S. P
D.01.048, PD.11.049
VERMA, R P
D.08.012
Verrastro CGY P
A.16.017, PD.16.040
VERRASTRO, CGY. PD.04.014
VEZZANI R P
D.01.063
VEZZANI, R.B. P
D.01.031, PD.02.019, PD.02.020
VIANA NETO, E. M. PD.02.035
VIANA, N.J. PD.13.022
VIANA PC PD.01.030
VIANA PCC PD.01.052, PD.07.003
VIANA, PCC PD.01.037
Vianna BSL P
A.10.002, PD.10.009
VIANNA B.S.L. TL.10.001
VIANNA BSL PD.10.001, PD.10.002
VIANNA, BSL TL.04.002
VIANNA, G.A.G. PD.12.013
VIANNA JAS PD.16.044
VIEIRA, F. P
A.07.031
Vieira F.A.C. P
A.07.025
Vieira FAC. PA.07.003
Vieira, F.A.C P
A.07.012, PA.07.023
Vieira, F.A.C. P
A.07.015, PA.07.017, PA.07.021,
PA.07.022
VIEIRA F.A.C. P
A.17.003
VIEIRA FILHO W.R. P
D.13.019
VIEIRA, J.F. P
D.03.036
VIEIRA,M.P.M.M. PD.15.004
VIEIRA RAC PD.10.005
Vignoli, L P
A.10.004
VILAS BOAS TV PA.12.016
Vilela, VM PA.02.003, PD.12.005, PD.13.009, PD.13.023
Villa, P.P.O. P
D.12.084
VILLA, P.P.O. PD.03.039
Villar,AA P
D.12.068
VIOLATO L.M P
D.17.013
Vitola M.L.A. P
D.06.002
VOLPATO, M.M PA.13.013
VOLPATO R. PD.12.007
VOLPATO, R. PD.02.038
VOLPE, GJ PD.04.003, PD.04.006
Volschan A P
A.10.002, PD.10.009
VOLSCHAN A PD.10.001, PD.10.002
VOLSCHAN, A TL.04.002
VON ATZINGEN, A.C. PD.01.050, PD.02.031
VON GRAPP II A. PA.10.006, PA.10.010
VON GRAPP II, A. PA.14.003
W
Wainstein, B P
D.16.030
Wainstein, B. P
D.02.017
WAINSTEIN, B. PD.01.047, PD.01.049, PD.01.062
WALCZAK, T.G.R PD.01.025, PD.01.046
WALCZAK, TGR PA.12.015
Wanderley, APB P
A.10.004
WANDERLEY , M. P
D.13.008
WANDERLEY M. P
D.01.034, PD.11.043
WANDERLEY, M. P
D.01.033, PD.01.035, PD.02.025,
PD.04.004
Warmbrand, G P
D.01.058
WATTERS, J P
D.08.012
WEIDENFELD, J PD.08.012
WENDLING, L.U. PD.16.021, PD.17.022
Wiefels, CC P
A.10.004
WILNER, N.V. P
D.12.013
Yanaguizawa T P
A.16.017, PD.16.040
YUHARA E.Y. PD.01.034, PD.11.043
YUHARA, E. Y. PD.13.008
YUHARA, E.Y. PD.01.033, PD.01.035, PD.02.025,
PD.04.004
YUMIOKA A PD.01.065
YUMIOKA, A PD.01.032
Z
ZANETTI, E.S P
D.01.025, PD.01.046
ZANFORLIN FILHO, S.M. PA.09.002, PD.13.012
ZANFORLIN M.S PD.09.001, PD.17.005, PD.17.013
ZANFORLIN, S. PA.09.001
Zangiacomo, R.N. P
A.03.009, PA.03.010, PA.16.018
ZANGIACOMO R.N. PD.03.030, PD.16.035, PD.16.036
ZANGIACOMO RN. PD.12.047
ZANGIACOMO, R.N. PA.04.006, PA.16.012, PD.01.048,
PD.03.027, PD.04.021, PD.08.009,
PD.16.014, PD.16.027, PD.16.029,
TL.07.012
ZANGIACOMO, RN PD.12.060, PD.12.078, PD.16.007
ZANINOTTO, A.L. TL.12.002
ZANINOTTO, A. L. C. TL.12.001
ZATTAR, LC P
D.01.030
ZATTAR-RAMOS LC P
D.01.052
ZATTAR-RAMOS, L.C P
D.01.054
ZATTAR-RAMOS, L.C. P
D.11.024
ZATTAR-RAMOS, LC P
D.01.037
ZEITOUNE, R.H. PD.12.022 P
D.13.022
ZHONG XPA.01.013
ZILIO, MBTL.07.002
ZÍLIO, MB. P
D.07.005
ZIMMERMANN, A.L PD.01.051
ZORZENONI, F. O. P
D.16.038
ZUKOVSKI, C. PD.11.033 PD.16.032
Zuliani, A.CTL.14.003
ZUPPANI H.B.TL.03.007
ZUPPANI, H.B.PA.03.006
ZUPPANI, HB PD.03.026 P
D.03.032
ZUPPANI, HB.PA.12.012
Y
Yamaga, L.Y. P
A.07.026
YAMAGUCHI, N. PA.07.027
YAMANARI, M. PD.13.004
YAMANARI, M.G PA.13.003
Yamanari, M.G.I. P
A.13.001, PD.13.017
YAMANARI M.G.I. PD.12.075, PD.12.076
YAMANARI MGI. PD.13.013, PD.13.014, PD.13.015
YAMANARI, M.G.I PD.13.016
YAMANARI, M.G.I. PA.13.012
YAMANARI, M.G.L PA.13.010, PA.13.011
YAMANARI TR PD.01.030, PD.01.052
YAMANARI, T.R PD.01.054
YAMANARI, T.R. PD.01.057
YAMANARI, TR PD.01.037, PD.16.031
YAMASHITA, M.E.A.S. PA.11.013
YAMASHITA R. S PA.11.005
YAMAUCHI FI. PA.01.015
YAMAUCHI, F.I PA.02.035
YAMAUCHI, F.I. PA.02.027
173

AbSTrAcTS of ScIENTIfIc PAPErS - Sociedade Paulista de Radiologia

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