Objective: We aimed to determine if multidetector-row computed tomography angiography is an effective and non-invasive method for diagnosing anomalous pulmonary venous drainage. Materials and methods: We performed a retrospective review of 2,905 cases from July 2003 to November 2007 in which cardiac multidetector-row computed tomography angiography was used. Of the cases, 393 evaluated congenital cardiopathy, with the others (2,512) evaluating the coronary arteries. Results: Anomalous pulmonary venous drainage was found in 21 cases, with 7 (33.3%) from total anomalous pulmonary venous drainage (3 supracardiac, 3 infracardiac and 1 cardiac), and 14 (66.7%) from partial anomalous pulmonary venous drainage. Conclusion: Multidetector-row computed tomography angiography can be useful for diagnosing the described anomalies because of its non-invasiveness, and its ability to evaluate intra- and extra-cardiac structures. The technique allows a thorough study of the thoracic anatomy and contributes to surgical conduct, consequently improving patient prognosis, in particular by allowing the diagnosis of clinically unsuspected malformations.

Keywords: Anomalous drainage; Pulmonary veins, Congenital abnormalities; Multidetector-row computed tomography.

Objective: To evaluate the agreement between Doppler ultrasonography and magnetic resonance imaging as well as the interobserver reproducibility of both methods in the measurement of portal blood flow in schistosomal patients. Materials and methods: A cross-sectional, observational, self-paired study evaluated 21 patients with schistosomiasis mansoni submitted to measurement of portal blood flow with phase-contrast magnetic resonance imaging and Doppler ultrasonography. Results: A poor intermethod agreement was observed (intraclass correlation coefficient: 34.5% [CI 95%]). On the other hand, the interobserver reproducibility was excellent in the evaluation by magnetic resonance imaging (intraclass correlation coefficient: 99.2% [CI 95%] / Pearson’s correlation coefficient: 99.2% / portal blood flow = 0.806) and by Doppler ultrasonography (intraclass correlation coefficient: 80.6 to 93.0% [CI 95%] / Pearson’s correlation coefficient: 81.6% to 92.7% / portal blood flow = 0.954, 0.758 and 0.749). Conclusion: There is a poor intermethod agreement in the measurement of portal blood flow. Nevertheless, contrastphase magnetic resonance imaging and Doppler ultrasonography demonstrated to be reproducible methods presenting excellent interobserver agreement in the quantification of portal blood flow in patients with hepatosplenic schistosomiasis-related portal hypertension.

Keywords: Portal blood flow; Magnetic resonance imaging; Doppler ultrasonography; Reproducibility; Portal hypertension.

Objective: The present study was aimed at evaluating the role of diffusion tensor imaging for the assessment of different patterns of white matter involvement in patients with brain tumors and the utility of this technique for differential diagnosis of such neoplasms. Materials and methods: Forty-four patients with brain tumors, including low-grade gliomas, anaplastic astrocytomas, glioblastomas multiforme and metastases, were studied with conventional and diffusion tensor magnetic resonance imaging. White matter tracts around the tumors were characterized as displaced, disrupted, infiltrated and edematous. Results: A significant overlap was observed between patterns of white matter involvement on diffusion tensor images as the displaced pattern was seen in all the types of tumor. Disrupted and infiltrated patterns were found in glioblastomas multiforme and anaplastic astrocytomas. The edematous pattern was found in the cases of metastases. Conclusion: Diffusion tensor imaging patterns of white matter involvement assists in the mapping of tracts adjacent to tumors, providing significant data about tumors extent; however, they cannot distinguish low-grade and high-grade gliomas from metastases.

Keywords: Diffusion tensor imaging; White matter; Brain tumors.

Objective: To evaluate the intra- and interobserver reproducibility of three-dimensional power Doppler sonography (3D power Doppler) in the assessment of fetal brain blood flow in the middle cerebral artery territory. Materials and methods: A cross-sectional study was developed with 20 healthy pregnant women between 26 and 34 gestational weeks. The middle cerebral artery territory closest to the transducer was scanned and the blood flow volume was calculated with the method Virtual Organ Computer-aided AnaLysis. The following 3D power Doppler indices were later obtained: vascularization index (VI), flow index (FI) and vascularization-flow index (VFI). The intraclass correlation coefficient (ICC) and Bland-Altman plots were utilized for calculating the intra- and interobserver variability. Results: A good intra- and interobserver agreement was observed, with ICC > 0.90 for all the 3D power Doppler indices: VI [ICC = 0.992 (CI 95%: 0.981–0.997)], FI [ICC = 0.999 (CI 95%: 0.998–0.999)], VFI [ICC = 0.995 (CI 95%: 0.987–0.998)]. Interobserver reproducibility: VI [ICC = 0.988 (CI 95%: 0.970–0.995)], FI [ICC = 0.999 (CI 95%: 0.997– 1.000)], VFI [ICC = 0.994 (CI 95%: 0.994–0.998)]. Conclusion: 3D power Doppler has shown to be a practical and easy method in the assessment of fetal brain blood flow, with good intra- and interobserver reproducibility. The FI presented the best intra- and interobserver agreement.

Keywords: Reproducibility of results; Prenatal ultrasonography; Fetal brain flow; Power Doppler; Threedimensional sonography.

Objective: The present study was aimed at evaluating the reliability of the qualitative visual assessment of brain abnormalities using conventional brain MRI in extremely preterm infants. Materials and methods: A cohort of 45 consecutive infants with gestational age of 30 weeks or less (median of 27 weeks, ranging from 25 to 30 weeks) was enrolled in this study. Two independent, experienced neuroradiologists blindly reviewed MRI studies of the infants’ brain for diffuse and excessive high-signal intensity (DEHSI), dilated lateral ventricles, intracranial hemorrhage, areas of abnormal signal in the basal ganglia and cortex, cyst-like areas, ventricular deformities, enlargement of subarachnoid spaces, early leukoencephalomalacia, and cortical abnormalities. Results: Forty-one patients (91.1%) presented abnormalities at MRI. The most common findings were DEHSI in the white matter (75.6%) and ventricular dilatation (42.2%). The interobserver agreement was high (κ > 0.60) for most of the abnormal MRI findings. The kappa statistic values were moderate for enlargement of the subarachnoid space (κ = 0.52) and was only low for DEHSI in the white matter (κ = 0.39). Conclusion: Conventional MRI seems to be a reliable method for evaluating the most common brain abnormalities in extremely premature infants; however, the presence of DEHSI in the white matter demonstrated to be is a less reliable finding.

Keywords: Preterm; Brain; Magnetic resonance imaging; Imaging; Hypoxia.

Objective: To evaluate the cervical length by means of transvaginal ultrasonography in a population of healthy pregnant women, developing a normality curve in the period between the 20th and 34th gestational weeks. Materials and methods: Cross sectional study involving 145 healthy singleton pregnancies with healthy fetuses between 20 and 34 weeks of gestation, evaluated at the units of ultrasonography of Hospital Universitário Júlio Müller and of a private center. Each pregnant woman underwent a single transvaginal ultrasonography study, with measurement and recording of the cervical length. Exclusion criteria were: preterm labor, preterm premature rupture of membranes, placenta previa, use of tocolytics and/or progesterone, cerclage or any surgical intervention prior to pregnancy. The association between cervical length and gestational age was evaluated by linear regression analysis. Results: The cervical length presented a progressive decrease (0.8 mm/week) as the gestational age progressed (r = –0.351; p < 0.001). The women with cervical funneling presented shorter cervix (p = 0.001). Interpolation of the 5th, 50th and 95th percentiles provides a graph to be used as a reference. Conclusion: The mean cervical length decreases about 0.8 mm per week in the period between the 20th and 34th gestational weeks.

Keywords: Cervical length measurement; Ultrasonography; Cervix uteri; Preterm labor.

Objective: To describe the MR imaging features of hepatic hemangioma with perilesional enhancement. Materials and methods: A search was performed of the MRI section database to identify all cases of hepatic hemangioma with perilesional enhancement between March 2008 and July 2009. All patients underwent MR examinations including precontrast T1- and T2-weighted images and postgadolinium dynamic images. On MR images, characteristics of the hemangioma and perilesional enhancement were evaluated. Results: Seven hemangiomas in seven patients (five men, two women; age range, 41–69 years; mean, 57 years) were included in this study. Lesion size ranged from 7 to 20 mm (mean, 12.4 mm). On hepatic arterial dominant phase, all seven hemangiomas exhibited wedge-shaped perilesional enhancement which faded on two minutes postgadolinium images. Four of these lesions demonstrated adjacent capsular enhancement. Conclusion: All hepatic hemangiomas with perilesional enhancement were < 2 cm capsulebased lesions. This location suggests that these hemangiomas may conscript capsular vessels to account for the perilesional enhancement.

Keywords: Liver; Liver hemangioma; Liver perfusion; Liver contrast enhancement.

Objective: To evaluate endothelial function in patients with risk factors for atherosclerosis by measuring brachial artery flow-mediated dilatation (BAFMD) and intima-media thickness (IMT) of carotid and brachial arteries. Materials and methods: A cross-sectional, case-control study in which endothelial function was evaluated by measurement of BAFMD and IMT of carotid and brachial arteries and presence or absence of risk factors in 112 patients distributed as follows: women with risk factors (n = 49), women control group (n = 24), men with risk factors (n = 21), men control group (n = 18). Results: BAFMD was significantly compromised in the group with risk factors as compared with the control group, regardless of sex: in women, 15.2 Χ 25.3 (p < 0.01); in men, 11.8 Χ 16.8 (p < 0.02). On the other hand, IMT was not significant both for the carotid and brachial arteries, regardless of sex: brachial artery in women, 0.3 Χ 0.3 (p < 0.06); brachial artery in men, 0.36 Χ 0.23 (p < 0.07); carotid artery in women, 0.6 Χ 0.4 (p < 0.07); carotid artery in men, 0.85 Χ 0.38 (p < 0.08). The significance level was set at 5% (p < 0.05). Conclusion: Measurement of BAFMD was effective for detecting endothelial impairment in a population with risk factors for atherosclerosis.

Keywords: Atherosclerosis; Endothelial dysfunction; Brachial artery flow-mediated dilatation; Intima-media complex of the carotid and brachial arteries.

Objective: To compare data regarding dosimetry and photons fluence in different breast phantoms, discussing constancy tests and dosimetry applied to mammography. Materials and methods: Different homogeneous breast phantoms and one anthropomorphic voxel phantom were developed for collection of data regarding total absorbed dose in the phantom, absorbed dose in the glandular tissue material-equivalent, absorbed dose and photons fluence at different depths in the phantoms. A simulated ionization chamber collected the entrance skin kerma. Target-filter combinations (Mo-30Mo and Mo-25Rh) were studied for different accelerating potentials of 26 kVp to 34 kVp. Results: As compared with the voxel phantom, the normalized glandular dose resulted in differences from –15% to –21% for RMI, –10% for PhantomMama, and 10% for the Barts and Keithley models. The half-value layer variation was generally < 10% for all the sensitive volumes. Conclusion: The phantom proposed by Dance is recommended for evaluating the glandular dose and normalized glandular dose in a standard breast. Homogeneous phantoms should be utilized for constancy tests in dosimetry, but they are not appropriate for estimating dosimetry in actual patients.

Keywords: Mammography; Dosimetry; Monte Carlo simulation; Geant4.

Dengue virus infection is endemic in tropical and subtropical areas. Symptomatic dengue infection is classified into dengue fever or dengue hemorrhagic fever with a tendency to develop shock syndrome. Dengue hemorrhagic fever is characterized by hemorrhagic manifestations, thrombocytopenia and increased capillary permeability. Dengue shock syndrome presents findings of dengue hemorrhagic fever with hypotension. Many sonographic findings have been described, including pleural effusion, ascites, gallbladder wall thickening and pericardial effusion. The aim of the present review is to describe sonographic findings and to demonstrate the role of ultrasonography in the assessment of children with suspected dengue hemorrhagic fever.

Keywords: Dengue; Dengue hemorrhagic fever; Dengue shock syndrome; Pleural effusion; Ultrasonography.

Biliary hamartomas, also known as von Meyenburg complex, are typically benign lesions that may mimic metastases at imaging studies. The present study reports a case of von Meyenburg complex and discusses the imaging diagnosis, the association with adult polycystic disease and the malignant potential of this finding currently considered and frequently ignored, which raises the necessity of follow-up.

Keywords: Hamartoma; Intrahepatic bile ducts; Cholangiocarcinoma; Polycystic kidney; Imaging diagnosis; Ultrasonography.