49th Sao Paulo Radiological Meeting 1st Interventional Radiology Meeting May 2-5, Sao Paulo, Brazil
Abstracts of Scientific Papers
ORGANIZATION SUPPORT SUMMARY
ABDOMINAL / DIGESTIVE TRACT...... 4 PHYSICS / QUALITY CONTROL ...... 36 Original Paper...... 4 Original Paper...... 36 Posters (PI)...... 4 Digital Presentation (PD)...... 36 Digital Presentation (PD)...... 4 Oral Presentation (TL)...... 5 IT / MANAGEMENT ...... 37 Pictorial Essay...... 6 Original Paper...... 37 Posters (PI)...... 6 Posters (PI)...... 37 Digital Presentation (PD)...... 7 Digital Presentation (PD)...... 37 Literature Review...... 12 Oral Presentation (TL)...... 38 Posters (PI)...... 12 INTERVENTION...... 39 Case Report...... 12 Original Paper...... 39 Digital Presentation (PD)...... 12 Oral Presentation (TL)...... 39 ABDOMINAL / GENITOURINARY TRACT ...... 15 Pictorial Essay...... 40 Posters (PI)...... 40 Original Paper...... 15 Digital Presentation (PD)...... 15 Literature Review...... 41 Oral Presentation (TL)...... 16 Posters (PI)...... 41 Digital Presentation (PD)...... 41 Pictorial Essay...... 16 Posters (PI)...... 16 Case Report...... 42 Digital Presentation (PD)...... 17 Digital Presentation (PD)...... 42 Literature Review...... 19 MAMA...... 45 Posters (PI)...... 19 Original Paper...... 45 Case Report...... 20 Posters (PI)...... 45 Digital Presentation (PD)...... 20 Oral Presentation (TL)...... 45 Pictorial Essay...... 47 HEAD AND NECK...... 21 Posters (PI)...... 47 Pictorial Essay...... 21 Digital Presentation (PD)...... 49 Posters (PI)...... 21 Literature Review...... 51 Digital Presentation (PD)...... 22 Digital Presentation (PD)...... 51 Literature Review...... 29 Case Report...... 52 Posters (PI)...... 29 Digital Presentation (PD)...... 52 Case Report...... 29 Digital Presentation (PD)...... 29 FETAL MEDICINE ...... 54 Pictorial Essay...... 54 CARDIOVASCULAR...... 30 Digital Presentation (PD)...... 54 Pictorial Essay...... 30 Literature Review...... 54 Digital Presentation (PD)...... 30 Digital Presentation (PD)...... 54 Case Report...... 31 Digital Presentation (PD)...... 31 NUCLEAR MEDICINE ...... 55 Original Paper...... 55 TEACHING...... 33 Posters (PI)...... 55 Original Paper...... 33 Digital Presentation (PD)...... 55 Digital Presentation (PD)...... 33 Oral Presentation (TL)...... 56 Oral Presentation (TL)...... 34 Pictorial Essay...... 56 Literature Review...... 34 Posters (PI)...... 56 Posters (PI)...... 34 Case Report...... 57 Case Report...... 35 Digital Presentation (PD)...... 57 Digital Presentation (PD)...... 35
2 49th Sao Paulo Radiological Meeting NEURORADIOLOGY...... 59 RADIOLOGICAL TECHNIQUES...... 96 Original Paper...... 59 Original Paper...... 96 Posters (PI)...... 59 Digital Presentation (PD)...... 96 Digital Presentation (PD)...... 59 Oral Presentation (TL)...... 97 Oral Presentation (TL)...... 61 Pictorial Essay...... 98 Pictorial Essay...... 61 Posters (PI)...... 98 Posters (PI)...... 61 Digital Presentation (PD)...... 99 Digital Presentation (PD)...... 63 Literature Review...... 100 Literature Review...... 69 Posters (PI)...... 100 Posters (PI)...... 69 Digital Presentation (PD)...... 101 Case Report...... 70 Digital Presentation (PD)...... 70 CHEST...... 103 Original Paper...... 103 PEDIATRICS...... 74 Digital Presentation (PD)...... 103 Oral Presentation (TL)...... 104 Original Paper...... 74 Posters (PI)...... 74 Pictorial Essay...... 106 Digital Presentation (PD)...... 106 Pictorial Essay...... 74 Posters (PI)...... 74 Literature Review...... 109 Digital Presentation (PD)...... 78 Digital Presentation (PD)...... 109 Literature Review...... 80 Case Report...... 111 Digital Presentation (PD)...... 80 Digital Presentation (PD)...... 111 Case Report...... 80 ULTRASONOGRAPHY...... 113 Digital Presentation (PD)...... 80 Original Paper...... 113 PET-CT...... 84 Posters (PI)...... 113 Oral Presentation (TL)...... 113 Original Paper...... 84 Posters (PI)...... 84 Pictorial Essay...... 114 Posters (PI)...... 114 Case Report...... 84 Digital Presentation (PD)...... 117 Digital Presentation (PD)...... 84 Literature Review...... 119 Posters (PI)...... 119 MUSCULOSKELETAL SYSTEM...... 86 Posters (PD)...... 120 Original Paper...... 86 Oral Presentation (TL)...... 86 VETERINARY RADIOLOGY...... 120 Pictorial Essay...... 86 Case Report...... 120 Posters (PI)...... 86 Digital Presentation (PD)...... 120 Digital Presentation (PD)...... 88 Literature Review...... 93 BASIC / PRECLINICAL RESEARCH...... 121 Digital Presentation (PD)...... 93 Original Paper...... 121 Case Report...... 94 Posters (PI)...... 121 Digital Presentation (PD)...... 94 Oral Presentation (TL)...... 121
Abstracts of papers published in the following pages were enrolled and approved for presentation at the 49th Sao Paulo Radiological Meeting (JPR 2019), on 2 – 5 May, 2019, 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 ABDOMINAL / DIGESTIVE TRACT ORIGINAL PAPER DIGITAL PRESENTATION (PD)
PD.01.053 POSTERS (PI) QUANTITATIVE EVALUATION OF THE LIVER IRON CONCENTRATION BY MAGNETIC RESO- PI.01.001 NANCE IMAGING Authors: SANTIAGO, R.A.; PACHECO, B.O.; LEITE, EVALUATION OF DWI BY MAGNETIC RESONANCE M.O.; ZACARIAS, M.S.; PUCHNICK, A.; VELLONI, F.G.; IMAGING IN THE CHARACTERIZATION OF HE- BLASBALG, R. PATIC LESIONS IN PATIENTS WITH HEPATOCEL- Institution: DASA-SP LULAR CARCINOMA A brief description of the objective(s): Determinate T2* Authors: SILVA, M.G; ARRUDA M.F.; GUIMARÃES M.D. and R2* values in the population without known predispos- Institution: A C CAMARGO CÂNCER CENTER ing factors to liver iron overload. Determine the confidence A brief description of the objective(s): The Magnetic Reso- intervals to liver iron overload. Correlate and compare the nance Imaging (MRI) weighted by diffusion-weighted imag- results obtained with the different calibration curves for liver ing (DWI) is a technique of great potential for the diagnosis iron concentration (LIC) calculation. and survival of patients with cancer of the liver, because it differentiates the hepatic parenchyma tumor healthy to eval- Material(s) and method(s): We retrospectively evaluated uate the restriction of movements of water molecules and 303 magnetic resonances of the upper abdomen in patients quantificativa provides an analysis of the liver tissue through without history of liver iron overload. The examinations the calculation of the coefficient of apparent DWI (ADC). were performed on two devices: Optima MR450w GEM The objective of this study was to correlate the findings of 1,5T, (GE Healthcare, USA) and Magnetom Skyra 3,0T DWI WITH LI-RADS classification and evaluate radiologi- (Siemens Healthcare, Germany). The R2* values mea- cal profile of suspicious lesions for HCC. surements were performed on maps acquired through com- Material(s) and method(s): This study was be unicen- plex sequences (IDEAL-IQ, GE Healthcare; and Liverlab trico, retrospective, quantitative and qualitative study Q-Dixon, Siemens Healthcare). The measurements were through the analysis of MRI examinations of the abdomen made with a minimum 250 mm2 ROI (region of interest) in the period from 2015 to 2018, totaling 51 lesions sug- area, in the right hepatic lobe, avoiding intrahepatic bile gestive of HCC. The quantitative analysis of the lesion was ducts, focal lesions and artifacts regions. The T2* and R2* performed in b 600 and b 200 through the measurement of normality hypothesis was confirmed using Shapiro-Wilk the cdas with 3 ROIs identical measuring 50% lesion. The test; the comparison of statistical approaches were per- first 50% ROI quantified from the area of the lesion, the formed using the Wilcoxon-Mann-Whitney test and the second was placed in adjacent tissue is the third quantified Student`s t-test. the paravertebral tissue. Results and discussion: The mean and standard deviation at Results and discussion: The mean restriction on the dis- T2* values were respectively 30.6 ms and 8.1 ms, with con- semination for LI-RADS 4 and LI-RADS 5 were respective- fidence interval between 14.67 and 46.53 ms. The mean and ly (1.32 ± 2.33 x10-3mm2/s and 1.36± 2.40 x10-3mm2/s). standard deviation at R2* values were respectively 35.5 Hz Similar to other results found in the literature with radio- and 12.5 Hz, with confidence interval between 11.02 to 60.09 logical profile to this work (1.31 ±0, Abdominal / Digestive Hz. The values found presents correlation with the calibra- Tract× 10 -3 mm2 /s 1.35 ± 0.38 x 10-3mm2/s). The average tion curve proposed by Garbowski et al. of the cut-off point was 1.Nuclear Medicine x 10-3mm2/s, Conclusion: MRI is a consolidated and non-invasive tool for AUC 82% with rates of 86% sensitivity and specificity of liver iron quantification. Our study proposed to establish T2 43%. And the average of the cut-off point found in other * and R2 * normality values in the population without liver studies similar to this was 1.Breast x 10-3mm2/s with rates iron overload risk factors, since the studies performed to cal- of sensitivity of 88.5% and specificity of 43.8%, demonstrat- ibrate T2* and R2* values to LIC values were performed in ing that the DWI determines good rates of sensitivity and patients with known iron overload. The calibration curve specificity for HCC that most closely approximates our results is that proposed Conclusion: The sequence DWI was able to characterize by Garbowski et al., being our recommendation to estimate focal hepatic lesions of high probability for malignancy (LI- LIC values. RADS 4 and 5). For lesions LI-RADS 4 and 5 predominated, Responsible Author: Rafael Andrade Santiago hyperintense signal on T2, arterial enhancement, washout, Email: [email protected] pseudocápsula and restriction on DWI with an average size of 4.5 cm in the largest axis. In the present study the DWI Keyword: LIVER IRON CONCENTRATION,MAGNETIC showed AUC of 82% with a rate of 86% sensitivity and 43% RESONANCE IMAGING,LIVER IRON OVERLOAD specificity Responsible Author: Melissa Gonçalves Silva Email: [email protected] Keyword: Hepatocarcinoma; LI-RADS; Ressonância Mag- nética; DWI; ADC.
4 49th Sao Paulo Radiological Meeting ORAL PRESENTATION (TL) A brief description of the objective(s): This article aims to analyze the population profile of patients who underwent magnetic resonance imaging, as well as their main findings TL.01.001 and diagnostic imaging. ACCURACY OF A MR PROTOCOL SUMMARIZED Material(s) and method(s): A retrospective and descriptive IN THE SCREENING OF HEPATOCELLULAR CAR- study based on a database, in which 36 magnetic resonance CINOMA IN CIRRHOTIC LIVERS imaging examinations were performed from January 2017 to Authors: NOSCHANG, J.; TRIDENTE, C.F.; MUSSI, T.C.; LUZ, October 2018. Patients were assessed for age, gender and di- D.C.; NUNES, L.M.A.O.; BARONI, R.B.; YAMAUCHI, F.I. agnoses. The study describes the sequence of interpretation Institution: HOSPITAL ISRAELITA ALBERT EINSTEIN of the examination, with analysis of the anatomy of the pelvis A brief description of the objective(s): To evaluate the per- and its dysfunctions, including quantifications through the formance of an abbreviated MRI protocol (MRI),without pubococcygeal lines, H-line, M-line and anorectal angle. intravenous contrast, for the hepatocellular carcinoma (HCC) Results and discussion: Of the 36 patients studied, 33 had screening in at-risk patients. radiological alterations, most of them female (93,94%). Age Material(s) and method(s): Institutional review board and ranged from 20 to 79 years, with a mean age of 50.58 years. ethics comitee approved retrospective study. The study in- Twenty-five patients were 40 years of age or older and11 cluded upper abdominal MRI examinations performed for were less than 40. The most frequent diagnoses were rec- the evaluation of chronic liver disease, from January 2015 tocele (44,44%), cystocele (41,67%), enterocele (27,78%), to December 2015. We excluded studies of patients with a rectal prolapse (19,44%) and increased perineal decrease history of HCC treated (surgical resection, radiofrequency (25,0%). Seven patients had insufficient rectal emptying ablation, embolization and / or liver transplantation) and (19,4%). The less frequent findings included pelvic floor subsequent studies of the same patient. Three radiologists flaccidity (11,11%), focal parietal thickening (inflammation) (2,78%), anism (2,78%), tricompartmental prolapse (2,78%) with different levels of abdominal MR imaging (LI-RADS) and peritoniocele (2,78%). agreed to participate in this study: two radiologists special- Conclusion: The accuracy of the defecoRM in the character- ized in abdominal imaging (one more experienced and one ization of soft parts allows the diagnosis and even the grad- with intermediate experience) and a fellowship in abdominal uation of several causes of pelvic floor disorder according to radiology (less experienced) . Thirty-nine studies of MRI of their compartments, benefiting from young patients up to 40 the upper abdomen were interpreted with a summary proto- years of age. col, consisting only of the T2, T2 FAT SAT, diffusion and Responsible Author: Ester Ruiz de Oliveira chemical shift sequences. The standard of reference used Email: [email protected] were the same MR studies performed in the routine of the Keyword: Defecorressonância; Constipação intestinal; Re- service (including the post-contrast sequences), previously tocele; Prolapso retal. analyzed with the LI-RADS categorization. The accuracy of the detection of HCC, k-coefficient and analysis agreement was evaluated. TL.01.004 Results and discussion: 139 patients were included for anal- UTILITY OF CONVENTIONAL DIXON METHOD ysis composed of 38 women and 101 men. The analysis of FOR ASSESSING FAT DEPOSITION IN THE LIV- HCC suspicious nodules detection was obtained using two ER IN A GROUP OF NASH PATIENTS, COMPARED possible cutoff points: positive those categorized in the refer- WITH PDFF ANALYSIS. ence standard as LR-5 and positive including LR-4 and LR-5. Authors: LEAO-FILHO, H; BELMONTE, D; MIRANDA, The sensitivity, specificity and accuracy when considered as T; BORDINI, A; FABIANA, L; CLARK, P; CHUA-ANU- positive only the LR-5 was 93.2%, 68.4%, 76.3% (most ex- SORN, W; ROCHA, M perienced reader), 93.2%, 71.6% 78.4% ( intermediate expe- Institution: HOSPITAL DAS CLÍNICAS DA UNIVERSI- rience), 95.5%, 68.4%, 77.0% (less experienced), respective- DADE DE SÃO PAULO ly. The sensitivity, specificity and accuracy of LR-4 and LR-5 A brief description of the objective(s): Proton Density Fat was 88.3%, 77.2%, 82.0% (most experienced reader), 85.0%, Fraction (PDFF) is the most accurate way to quantify ste- 78.5% , 81.3% (intermediate experience), 85.0%, 73.4%, atosis, but isn't available in most scanners. 3DGRE Dixon 78.4% (less experienced), respectively. There was moderate sequences are available, and can be used to quantify steatosis, degree of interobserver agreement in the detection of LR-4 with the problem of R2* influence. Our purpose is compare and LR-5 lesions. a conventional Dixon sequence with the PDFF technique in Conclusion: The proposed MRI summary protocol (shorter NASH patients, analysing the impact of R2* values. time and lower cost) demonstrated high sensitivity for HCC Material(s) and method(s): We analyse 102 NASH patients screening in high-risk patients. with biopsy (done within 6 months). A 3TMRI was used for Responsible Author: Julia Noschang determining fat-fraction(FF) and water-R2*(R2*W) with Email: [email protected] PDFF. We used a 3DGREDixon sequence. We included 14 Keyword: LI-RADS,carcinoma-hepatocelular,rastreamen- volunteers without liver disease and normal ferritin. A ROI to,protocolo-RM encompassing the whole liver area in a slice was chosen in the PDFF maps, with a similar ROI in Dixon images. Fat deposition(FD) in the Dixon sequence were: FD=100x((IN- TL.01.002 Phase-OutPhase)/(2 x InPhase)) DEFECOGRAPHY BY MAGNETIC RESSONANCE: Results and discussion: FF mean value:14.4%(SD=9.2/ EXPERIENCE IN CLINICAL PRACTICE Min=4.1%/Max=54.8%). -FF from PDFF had a high cor- Authors: OLIVEIRA, E. R.; GONCALVES, A. N. S.; NACIF, relation coefficient (CC) with the conventional Dixon M. S.; MARTIN, M. F.; INDIANI, J. M. C; SALA, M. A. S.; (CC=0.96/p<0.01) -R2*W mean value: 67.5s-1(SD=42.0/ Institution: UNIDADE DE RADIOLOGIA CLÍNICA Min=34.5s-1/Max = 384s-1). The threshold for detection of LTDA. siderosis was 6
Abstracts of Scientific Papers 5 Conclusion: - The FF estimated from PDFF is very similar PICTORIAL ESSAY to the 3D Dixon technique in this NASH patients evaluated in a 3T machine - The Correlation Coefficient between the techniques is only lower when the R2* is >69.9 s-1. Responsible Author: Hilton Leao Filho POSTERS (PI) Email: [email protected] Keyword: Ressonância, Esteatose, Dixon, PDFF, R2*, Fígado, NASH PI.01.003 IMAGING PRESENTATION OF EXTRAPELVIC TL.01.005 SITES IN DEEP ENDOMETRIOSIS Authors: BARBISAN, C.C.; MEDEIROS,A.K.; LIBANIO, EVALUATION OF HEPATIC HYPERECHOGENIC B.B.; GOMES,N.B.; TORRES, L.R.; ABRAO,M.S.; RA- NODULES IDENTIFIED ON ULTRASONOGRAPHY CY,D.J. AND CORRELATION WITH MAGNETIC RESO- Institution: BENEFICÊNCIA PORTUGUESA DE SÃO NANCE IMAGING PAULO Authors: ELIAS, L. A. R. ; YAMAUCHI, F. I. ; BARONI, R. Introduction and objective(s): Extra-pelvic endometriosis is H. ; FRANCISCO NETO, M. J. ; defined as the occurrence of endometriosis outside the pelvis, Institution: SOCIEDADE BENEFICENTE ISRAELITA a rare condition (only 8.9%) and with a wide variability of BRASILEIRA HOSPITAL ALBERT EINSTEIN clinical and radiological presentations, which makes its diag- A brief description of the objective(s): Evaluate the effi- nosis a challenge. This study aims to review the main imaging cacy of ultrasonography (US) in the prediction of hepatic findings of extrapelvic endometriosis. hemangiomas, using magnetic resonance imaging (MRI) as Method(s): Imaging studies of the medical files of patients di- gold standard. agnosed with extrapelvic deep endometriosis were evaluated. Material(s) and method(s): Retrospective study of hepatic Discussion: Endometriosis is an enigmatic disease char- hyperechogenic nodules identified in the US and the correla- acterized by the development of functioning endometrial tion with sectional study of MRI, with definitive hemangio- tissue and glands outside the uterine cavity, reaching up to ma criteria. approximately 2-11% of women of reproductive age, gener- Selected men and women submitted to US of upper and total ating a broad impact on the quality of life of these patients, abdomen at Hospital X, in São Paulo, from January 2016 to who often present chronic pelvic pain and infertility. The December 2017 who had MRI also from this period. extrapelvic locations are diverse, often unusual and of vari- Characteristics analyzed from the image to the US: hyper- able presentations, the most common sites being the gas- echogenic lesion size, homogeneity / heterogeneity, multi- trointestinal tract (32.3%); urinary tract (5.9%); and other plicity, presence or not of steatosis, reinforcement / posterior sites (61.8%) including lung, umbilical scar, liver, gallblad- acoustic shadow and calcification. der, pancreas, pelvic nerves, inguinal region and abdominal Results and discussion: A retrospective analysis of the total wall, among others. of 201 selected cases of US abdomen revealed the presence Conclusion: Since extrapelvic endometriosis is a rare con- of a hepatic hyperechogenic nodule in 88. Of these 88 cas- dition with a variable presentation, whose clinical diagnosis es, 69 hemangioma was confirmed in MRI, 40 women and is not easy, it is oftenly up to the radiologist have attention 29 men, ranging in age from 24 to 85 years and lesion size to the clinical picture of female patients, especially in fertile between 0.4 and 5.3 cm. Positive predictive value of 78.4%. age, in order to correlate it with the imaging findings, which Of the confirmed cases of hemangioma, 40 presented asa may occur through subtle changes. single nodule in the US and 59 as a homogeneous nodule. Responsible Author: Cinthia Callegari Barbisan No calcification or sound beam attenuation artifact (posteri- Email: [email protected] or reinforcement / shadow) was observed. Of the total cases Keyword: endometriose,extrapélvica,ressonancia,ultrasso- of hemangioma, 65 had no fatty liver infiltration, 68 were nografia,atípicos not hepatopathic, and 67 had no cancerous history. Of the 14 cases of hepatic hyperechogenic nodule that did not confirm PI.01.006 hemangioma, 5 cases had no ultrasonographic findings on ABDOMINAL VACULAR EMERGENCIES: A RADIO- MRI and 9 cases had different diagnoses of hemangioma. Of LOGICAL APPROACH these 9 cases, 2 were confirmed as adenoma, 1 as focal nodu- Authors: VIDAL, B.P.C., FERREIRA, C.F, PENACHIM, lar hyperplasia, 3 as focal steatosis area, 1 if hepatocarcinoma T.J., LAHAN, D.M., PRANDO, A., RODSTEIN, M.A.M. was confirmed and in 2 the nodule corresponded to the area Institution: HOSPITAL VERA CRUZ - CENTRO RADI- previously treated with radioablation (one due to hepatocar- OLÓGICO CAMPINAS cinoma and another due to colorectal metastasis). See Tables Introduction and objective(s): Emergencial evaluation of 1 and 2 attached. the various imaging acquisition methods is becoming more Conclusion: From the above it was confirmed that hepatic frequent in the radiologist’s practice, due to the fact that hyperechogenic nodule is virtually diagnosed of hemangio- complimentary exam’s demand in emergency rooms is con- ma in a patient without hepatic steatosis. stantly growing, as well as technology advances that lead to Responsible Author: Laís Antonina Ribeiro Elias higher diagnostic sensitivity of current imaging techniques, Email: [email protected] which are increasingly available. The present study aims to Keyword: Nódulo,hiperecogênico,hepático,hemangioma demonstrate, schematically and through illustrative images the subgroups of abdominal emergency vascular patholo- gies, their main examples and respective image findings. Method(s): Computed tomography (CT) and magnetic reso- nance imaging (MRI) will be used as diagnostic techniques, as well as their multiplanar and three-dimensional (3D) refor-
6 49th Sao Paulo Radiological Meeting matting. The images used in this study were acquired in a hos- native management. Hence, rising awareness of less common pital of high complexity and personal archives of the authors. appendix pathologies and appendicitis mimickers is of utmost Discussion: Current imaging methods, especially multislice importance for radiologists since, in some cases, it may avoid computed tomography (CT), allowing shorter volumetric unnecessary hospital admission and surgical intervention. scanning, combined with softwares that provide multiplanar Responsible Author: LARISSA DE ANDRADE DEFENDI and three-dimensional (3D) reformatting, are an important Email: [email protected] tool in the diagnosis and surgical programming, since they al- Keyword: apendicite,apendagite,mucocele,volvo low non-invasive accurate angiographic evaluation. The etiol- ogies of emergent abdominal vascular conditions are diverse, and may occur as a result of traumatic events or as a result of aneurysmal ruptures, arterial dissections, thromboembolism, torsions, or even iatrogenic (post-procedures). Conclusion: Although it does not represent a high percent- DIGITAL PRESENTATION (PD) age of emergency room visits, abdominal vascular emer- gencies deserve special attention due to the risk of adverse outcome, if no adequate and immediate evaluation is made. PD.01.025 Current imaging methods are an important tool in the diag- THE ROLE OF IMAGING IN THE PREOPERATIVE nosis and surgical programming, so it is up to the radiologist EVALUATION OF HEPATIC MALIGNANCES: HEPA- to identify and provide the precise diagnosis to the referring TOCELLULAR CARCINOMA, CHOLANGIOCARCI- physician in order to optimize the patient's management in NOMA AND COLORECTAL LIVER METASTASIS the hospital environment. Authors: LEITE, C.B.F.; ALVES, I.S.; CAMERIN, G.R.; Responsible Author: Bruno Prado Cortizo Vidal OLIVEIRA, C.V.; GUERREIRO, N.F.C.; CERRI, G.G; VI- Email: [email protected] ANA, P.C.; PEREIRA, A.M.A.; LEITE, C.C.; HORVAT, N.; Keyword: emergencias,vasculares,abdominais,infarto,dis- Institution: HOSPITAL SÍRIO-LIBANÊS seccao,tromboembolia,iatrogenia Introduction and objective(s): The different imaging mo- dalities are very important in the preoperative evaluation of PI.01.008 the main hepatic malignances. Each modality has its own role BEYOND APPENDICITIS: UNUSUAL APPENDIX in screening, diagnosis, follow up and managing of these con- PRESENTATIONS AND APPENDICITIS MIMICKERS ditions, and they are all complementary. The aim of this study IN THE EMERGENCY DEPARTMENT is to review didactically the role of each imaging modality in Authors: DEFENDI, L.A.; REIS-FILHO, AJ.S; ZANONI, the evaluation of these tumors, focusing on the preoperative B.B.; SAVOIA P.; RAHAL JR. A.; CRUZ SANTOS A.R.; approach, highlighting the main aspects to be reported to the FRANCISCO-NETO M.J.; FUNARI M.B.G. multidisciplinary team. Institution: HOSPITAL ISRAELITA ALBERT EINSTEIN Method(s): A pictorial essay of cases diagnosed and fol- Introduction and objective(s): Appendicitis associated to lowed in our service will be conducted, emphasizing what the the presence of appendicolith represents the most common radiologist needs to know and report, showing the alterations cause of acute abdominal pathology. Nonetheless, many oth- identified in the different methods. We will also review of er pathologic conditions of the appendix or adjacent organs essential anatomical concepts, important surgical techniques can mimic appendicitis: primary appendiceal neoplasms, and the main guidelines and protocols recommended for the appendicitis within a hernia, appendiceal diverticulosis and diagnosis and management of these pathologies. diverticulitis, intussusception, intraluminal foreign bodies Discussion: Hepatocellular carcinoma (CHC) is the most appendiceal lipomatosis and epiploic appendagitis. The pur- common primary malignant neoplasm of the liver. Its main pose of this essay is to review appendiceal pathology besides risk factors are viral hepatitis (B and C), alcoholism and acute appendicitis and describe the corresponding findings on non-alcoholic fatty liver disease, and more than 80% of the multimodality imaging. diagnosed cases already have cirrhosis. HCC screening is per- Method(s): A retrospective review of circa 10-years radiol- formed through ultrasonography (with or without alpha-fe- ogy department records was conducted. Ultrasound (US), toprotein dosage) in cirrhotic patients or with chronic viral computed tomography (CT) and magnetic resonance (MR) hepatitis. When a suspected mass is identified, a computed to- images were obtained and organized into separate cases mography (CT) or magnetic resonance imaging (MRI) is re- according to the appendix condition: neoplasms (epithelial quested to confirm the diagnosis. Cholangiocarcinoma (CC) / carcinoid); endometriosis; diverticulitis and volvulus. Ac- is the second most common primary neoplasm. Its risk factors companying the images, a brief explanation of pathogenic are: parasitic infection, choledochal cyst, primary sclerosing basis and management of each case can be found. cholangitis and recurrent pyogenic cholangitis. Peri-hilar Discussion: Right lower quadrant pain can be indicative of cholangiocarcinomas represent the majority of tumors (70%) a vast list of differential diagnoses. A variety of less com- and can be classified according to vascular, biliary and met- mon conditions arise primarily from the appendix or sec- astatic involvement. Liver metastases from colorectal cancer ondarily from the small bowel, colon, epiploic appendages, are the most common malignant neoplasm of the liver and omentum or adjacent right lower quadrant organs. Clinical also the most common type of metastasis for this organ. Some signs and symptoms of these entities are usually nonspe- surgical procedures performed in two stages were recently cific, and can overlap with symptoms of acute appendicitis proposed to increase the ressecability of these tumors and is or mimic other pathology. TC has high accuracy in the rec- based on the ligature or embolization of a branch of the portal ognition of appendicitis and other less common appendix vein to induce hypertrophy of the lobe of interest. conditions, emerging as the imaging method of choice in Conclusion: The knowledge of the main imaging modali- evaluating acute abdominal pain. ties of the liver is essential for the management of the main Conclusion: In comparison to the frequency of acute appen- malignant hepatic tumors. These complementary modalities dicitis, other appendix entities are rare, but often require alter- present, each, their advantages and disadvantages.
Abstracts of Scientific Papers 7 Responsible Author: Cristyano Bismark Ferreira Leite patients with known or suspected CHC, with studies of com- Email: [email protected] puted tomography (CT), magnetic resonance imaging (MRI) Keyword: CHC,colangiocarcinoma,tumores,figado and / or contrast-enhanced ultrasound (CEUS) in most cases sufficient to diagnose this tumor, avoiding biopsies and com- PD.01.028 plications related to it. Multiple standardized imaging and structured imaging systems have been developed to address MUCINOUS RECTAL TUMOR - MAIN CHALLENGES the need for accurate diagnosis and staging of CHC, with Authors: MIRANDA, J. A.; HORVAT, N. M.; OLIVEIRA, the most conspicuous being the Liver Imaging and Report- B.C; CERRI, G.G. ing Data System (LI-RADS) with the most recent version in Institution: HOSPITAL SÍRIO-LIBANÊS 2018 (v2018). This study aims to review the LI-RADS v2018 Introduction and objective(s): Colorectal cancer (CRC) is and to organize a didactic practical guide of application, with the third most common cancer in men and the second most presentation of some cases challenge for training. common in women worldwide. It is also the second leading Method(s): We will illustrate through this pictorial essay, us- cause of cancer death. Rectal Magnetic Resonance Imaging ing images acquired at our institution through CT, MRI and (MRI) plays a pivotal role in the pretreatment and posttreat- CEUS, the following aspects of LI-RADS v2018: indications ment assessment of rectal cancer, assisting the multidisci- for its application, technical recommendations, diagnostic plinary team in tailoring treatment. This presentation aims to and therapeutic response categories, criteria for differenti- illustrate some pathological and genetic aspects of the muci- ation of HCC from other hepatic neoplasms, management nous neoplasms of the rectum (mucinous adenocarcinoma, options after categorization, and structured report example. signet ring cells, mucinous degeneration after neoadjuvant Discussion: The creation and use of standardized systems for treatment and acellular mucin), to review the imaging find- image acquisition and reporting are increasing in radiology, ings of mucinous neoplasms, including computed tomogra- since they allow greater reliability in the interpretation of the phy (CT), MRI and positron emission tomography (PET-CT) findings, high interobserver reproducibility, besides - facil and demonstrate image challenges and its limitations in both itating the communication of the radiologist with the other initial staging and restaging. medical specialties. LI-RADS has been widely used and rec- Method(s): We will illustrate the different imaging findings ognized for these purposes with the radiologist adding value of mucinous neoplasms of the rectum, including CT, MRI in the therapeutic decisions and follow-up of HCC patients. and PET-CT, in a pictorial essay based on cases using images Conclusion: It is important to train radiologists to use LI- acquired at our institution. RADS, contributing to an integrated and efficient care of pa- Discussion: Mucinous adenocarcinoma of the rectum is tients with diagnosed or suspected CHC. characterized by abundant mucus production, which com- Responsible Author: Nicolau Faria Correia Guerreiro prises at least 50% of the total tumor volume. Compared with Email: [email protected] non-mucinous adenocarcinoma, mucinous adenocarcino- Keyword: LI-RADS,CARCINOMA,HEPATOCELU- ma is more commonly diagnosed at an advanced stage. The LAR,HCC,CHC evaluation of mucin within the tumor is challenging and can present in other scenarios, such as signet ring cell carcinoma PD.01.035 of the rectum, and mucin degeneration and acellular mucin after treatment. There are some important pitfalls related do BEYOND PANCREATIC ADENOCARCINOMA: “BY- mucinous rectal tumour, furthermore, it carries a poor prog- THE-BOOK” CASES OF NON-ADENOCARCINOMA nosis. Therefore, the radiologist must familiar with this type LESIONS of rectal tumor. Authors: COELHO, F.M.A., PANIZZA, P.S.B.P., SANTOS, Conclusion: In the current era of rectal cancer management, J.M.M.M., VELLONI, F.G., BLASBALG,R. the multidisciplinary approach is of utmost importance for Institution: GRUPO DASA improving patient outcome. The emergence of rectal MR Introduction and objective(s): Pancreas imaging assess- imaging has played a key role in local staging and identify- ment usually demonstrates diseases with typical features. ing risk factors for local and distant recurrence, which helps However, the recognition of these patterns can be a challeng- tailor treatment and improve patient outcome. The imaging ing. A multimodality imaging approach helps on complex pitfalls and helpful tips described in this presentation will cases, resulting in adequate management of patients. Com- help radiologists relative to diagnosis of rectal cancer, par- puted tomography (CT) and magnetic resonance (MR) im- ticularly mucinous adenocarcinoma using MRI in routine aging are useful for accurate study of pancreas and them are clinical practice. complementaries in some cases. Responsible Author: Júlia Azevedo Miranda To purpose of this essay is to review the main non-adenocar- Email: [email protected] cinoma pancreatic lesions, emphasizing an approach of key Keyword: reto,neoplasia,estadimento,reestadiamento,res- cross-sectional imaging features that distinguish the different sonância,magnética types of neoplastic and nonneoplastic disorders. Method(s): Illustrative cases from our department were col- lected and classified according to these pattern types. Clin- PD.01.032 ical and radiology presentations, differential diagnosis, and DEMYSTIFYING LI-RADS: PRACTICAL GUIDE teaching points were also described. FOR 2018 VERSION Discussion: Non-adenocarcinoma lesions range from a Authors: SCHOEN, K; GUERREIRO, NFC; LEITE, CBF; tumor-like anatomic variant to a malignant disease. They OLIVEIRA, BC; COSTA, FLS; PEREIRA, AMA; HORVAT, N. can be broadly classified as neoplastic, such as solid and Institution: HOSPITAL SÍRIO-LIBANÊS cystic tumors, or nonneoplastic, like pancreatitis-relat- Introduction and objective(s): Hepatocellular carcinoma ed disorders, systemic diseases and tumor-mimicking le- (HCC) is the second leading cause of cancer death in the sions. Neoplastic lesions include serous cystic neoplasm, world, and the most common primary hepatic malignancy. mucinous cystic neoplasm, intraductal papillary mucinous Imaging methods play a key role in conducting decisions in neoplasm (IPMN), pseudopapillary solid neoplasm (Frantz
8 49th Sao Paulo Radiological Meeting tumor), acinar neoplasm, neuroendocrine tumor (NET), PD.01.040 neural crest tumors, metastatic lesions, and lymphoprolif- APPLICATIONS OF MAGNETIC RESONANCE IM- erative tumors. Nonneoplastic conditions involve pancre- AGING IN THE EVALUATION OF ACUTE ABDOM- atitis-related lesions (pseudocyst and walled off pancreatic INAL PAIN necrosis), systemic diseases (IgG-4 related disease, Erde- Authors: MENEZES, D.C.; FARIAS, L.P.G.; HANS, heim-Chester, Langerhans cell histiocytosis, cystic fibrosis) M.O.M; FERREIRA, R.H.Q; RAIMUNDO, E.C.R; SAN- and tumor-mimicking lesions, such as anatomic variants, TANA, P.G.; FRANCA, A.H.; GUEDES, M.S. intrapancreatic accessory spleen. Institution: HOSPITAL ALVORADA, AMERICAS Conclusion: Knowledge of key imaging features is import- SERVIÇOS MÉDICOS, SÃO PAULO/SP ant for accurate characterization and differentiation of pan- Introduction and objective(s): Acute abdominal pain is one creatic lesions. of the most frequent reasons for admission to the emergency Responsible Author: fernando morbeck almeida coelho room, sometimes demonstrating challenging clinical presen- Email: [email protected] tations with a wide range of differential diagnoses, including Keyword: Pâncreas,Neoplasia,Tomografia,Ressonância those potentially fatal conditions that can lead to emergency surgeries. This study aims to demonstrate, through high field PD.01.038 magnetic resonance imaging (MRI), the imaging aspects of the main diagnoses of acute abdominal pain. DIFFUSE PANCREATIC LESIONS: AN OVERVIEW Method(s): Literature review and a retrospective analysis of WITH AN EMPHASIS ON CLINICAL DECISION the cases of patients admitted to the emergency department MAKING of a tertiary hospital with acute abdominal pain that were car- Authors: ARAUJO, P. N. B. D.; NOGUEIRA, G. F.; FER- ried out and evaluated using high field MRI. REIRA, F. R.; TAVARES, R. R. F. M.; BEZERRA, R. O. F. Discussion: Abdominal pain presents a wide differential di- B.; ROCHA, M. D. S. D. agnosis, which encompasses multiple systems and organs, Institution: INSTITUTO DO CÂNCER DO ESTADO DE and may therefore represent a significant diagnostic chal- SÃO PAULO ‘OCTAVIO FRIAS DE OLIVEIRA’ – ICESP, lenge for the emergency physician. Although MRI is typical- SÃO PAULO, SÃO PAULO, BRASIL. ly reserved for pediatric populations, pregnant patients and Introduction and objective(s): Pancreatic lesions may pres- those with some degree of renal insufficiency, it has gained ent morphologically with solitary, multifocal or diffuse pat- increasing space in this type of evaluation, due to a proven tern. Diffuse involvement is observed in both neoplastic and history of being frequently diagnostic, non-use of ionizing non-neoplastic lesions. The objectives of this pictorial essay radiation and ability to provide excellent tissue contrast, and are to identify and describe the imaging characteristics that sometimes can be performed without the use of contrast me- distinguish the different causes of diffuse pancreatic lesions dium. However, MRI is not easily accessible due to its high and to report clinical information that may aid in the differen- cost and time to acquire images, requiring patient coopera- tial diagnosis and conduct. tion, which can be difficult in critically ill patients. The main Method(s): We selected cases illustrative of our department causes of acute abdominal pain include: inflammatory pro- and classified according to the different etiologies of diffuse cesses, infectious diseases, vascular conditions, neoplasias pancreatic involvement: non neoplastic (acute pancreatitis, and other diverse conditions. chronic pancreatitis and immunoglobulin G4 related disease) Conclusion: Although MDCT and USG are the methods of and neoplastic (primary or secondary lymphoma, adenocar- choice in the initial assessment of patients with acute abdom- cinoma with diffuse involvement pattern, neuroendocrine tu- inal pain due to their accessibility and convenience, MRI mors, neoplasia serous cystic and metastases). Radiological has been increasingly used in selected populations, as well presentations were also described, emphasizing differential as providing excellent tissue contrast, do not use Iodinated diagnoses and teaching points. intravenous contrast can even be performed without the use Discussion: Pancreatic lesions may manifest as solitary, of the contrast medium. The potential risks associated with multifocal or diffuse lesions, with diffuse involvement exposure to ionizing radiation, especially in those with large being a rare form of presentation. The radiological char- cumulative doses, have also increased their employability in acteristics, such as pancreatic parenchyma morphology, the emergency scenario. post-contrast enhancement pattern, evaluation of the main Responsible Author: Lucas de Pádua Gomes de Farias pancreatic duct, changes in adjacent planes, vascular inva- Email: [email protected] sion and characterization of lymph node enlargement are Keyword: Emergências,Abdominais,Ressonância,Aguda fundamental for the diagnosis of different etiologies. As well as clinical and laboratory alterations, such as pain, PD.01.041 weight loss, history of similar previous events, personal "CINEMATIC RENDERING" IN ABDOMINOPEL- history of syndromic pictures, elevation of pancreatic en- VIC PATHOLOGIES - HOW THIS NOVEL TOOL zymes and serum immunoglobulins. CAN HELP Conclusion: The radiologist should be familiar with the var- Authors: ROMAO, DS; SILVA, CFG; RODRIGUES, FV; ious etiologies that lead to diffuse pancreatic involvement. PEREIRA, AMA; HORVAT, N; VIANA, PCC; CERRI, GG. Knowledge of the main imaging aspects associated with rel- Institution: HOSPITAL SÍRIO-LIBANÊS - SÃO PAULO, evant clinical and laboratory information is essential for the SP, BRASIL characterization and differentiation of the main causes of dif- Introduction and objective(s): Cinematic rendering (CR) is fuse pancreatic lesions. a new 3D rendering technique that generates images based on Responsible Author: Pedro Naime Barroso de Araujo a new lighting model, much more complex than traditional Email: [email protected] Volume Rendering (VR), being able to produce photoreal- Keyword: Diffuse pancreatic lesions,neoplastic and istic images that have potential to illustrate more details of non-neoplastic lesions a complex anatomy. This exhibit aims to: describe the Cine-
Abstracts of Scientific Papers 9 matic Rendering technique for 3D visualization of Computed Responsible Author: Karen Consuegra Alves Tomography (CT) image data compared to traditional VR Email: [email protected] method; illustrate challenging cases of abdominopelvic pa- Keyword: Abdomen,Pelvis,CT,MR,Education,Education thologies using CR images; describe the potential role of CR and training,Tissue characterisation,Nervous system,neo- in abdominopelvic imaging; describe current limitations and plasms,Retroperitoneal space,adrenal future opportunities for CR. Mthod(s): Examinations were performed with a dual-source PD.01.047 CT system (Somatom Definition Flash, Siemens Healthcare). THE GALLBLADDER BEYOND THE STONES For cinematically rendered reconstructions, datasets were Authors: LOPES, PGM; VELLONI, FG; OLIVEIRA, RAS; processed in a workstation equipped with proper software (syngo.via Frontier, Siemens Healthcare). A literature review BLASBALG, R was also performed, based on recent articles which described Institution: DIAGNÓSTICOS DAS AMÉRICAS SA the use of this novel technique. (DASA) Discussion: Cinematic Rendered images give a more natural Introduction and objective(s): The main function of the and clearer depiction of anatomic structures illustrating in a gallbladder is to reserve the bile produced by the liver. Its better way the anatomy, being useful on anatomy teaching, most common complications are related to the formation patient education, pre and post-operative assessment and bet- of stones and include symptomatic cholelithiasis, acute and ter detection of disease in some situations. It is important to chronic cholecystitis and adenocarcinoma. However, with note that CR uses a more complex algorithm compared to the increasing use of imaging methods, other less frequent VR and requires higher computational power, which increas- diseases can be visualized, sometimes asymptomatic and pre- es post-processing time. senting diagnostic challenges to radiologists. The purpose of Conclusion: The preliminary observations show potential this study was to exemplify some of these situations, high- application of CR to abdominopelvic imaging. However, lighting their clinical relevance and radiological aspects rendering speed and processing still require considerable Method(s): Computed tomography (CT) and magnetic res- improvement to make the cinematic rendering technique onance imaging (MRI) of gallbladder diseases not related to feasible in clinical practice. Cinematic Rendering is still a gallstones were shown. The clinical evolution, as well as the prototype only available as a research tool and further stud- results of new imaging or anatomopathological studies were ies are needed to determine its actual diagnostic utility when also demonstrated, highlighting the main teaching points re- compared with VR lated to each case. Responsible Author: Davi dos Santos Romao The following cases were included: agenesis, ectopic and Email: [email protected] duplicated gallbladder, gangrenous cholecystitis, gallbladder Keyword: Cinematic, Rendering, Pós-processamento, post-pro- lymphangioma, adenomyomatosis, vascular anomalies, etc. cessing, 3d, rendering Discussion: It is important for the radiologist to be aware of the imaging aspects related to the gallbladder diseases, so PD.01.045 that the management can be correctly oriented. Conclusion: Imaging studies play a fundamental role in eval- MAJOR IMAGING FINDINGS OF ABDOMINAL NEU- uating the structures morphology and in detecting and char- ROGENIC TUMOR acterizing lesions in general. The combined analysis of clin- Authors: ALVES, K. C.; MONTEL, D.B.; SANTOS, L. ical, epidemiological, radiological and evolutionary aspects C.;BASSO, G. B.; DI FERREIRA, G. F. S. C.; SAAD, L. S.; may help in the correct interpretation of gallbladder diseases, FIOROT, V. C. R.; RANGEL, D. A.; LEWIN, F. avoiding unnecessary examinations and procedures. Institution: IRMANDADE DA SANTA CASA DE MI- Responsible Author: Paulo Gustavo Maciel Lopes SERICÓRDIA DE SÃO PAULO Email: [email protected] Introduction and objective(s): The neurogenic tumors in Keyword: galbladder,diseases,review the abdomen and pelvis are uncommon neoplasms that share similar clinical and imaging features, therefore the location, composition and shape are crucial to differentiate them. They PD.01.057 commonly involve the sympathetic ganglia in the paraspi- DUAL ENERGY CT IN PANCREATIC DISEASES - nal retroperitoneum or arise from the adrenal gland. These TECHNIQUE AND APPLICATION tumors are usually asymptomatic, unless they grow large Authors: MIRANDA, J. A; BRENTANO. V.B.; ALVES, enough to determinate compression of adjacent structures. I.S.; HORVAT, N. M; VIANNA, P.C.C.; CERRI, G.G. Computed tomography (CT) and magnetic resonance imag- Institution: HOSPITAL SÍRIO-LIBANÊS ing (MRI) findings are important to differentiate the benign Introduction and objective(s): Dual energy CT (DECT) is a from the malignant lesions and to chose the best approach. technology that is gaining widespread acceptance, particular- Method(s): Pictorial study with original cases. ly for its abdominopelvic applications. Pancreatic pathologies Discussion: The abdominal neurogenic tumors can be classi- are an ideal application for the many advantages offered by fied from its origin such as ganglion cell (ganglioneuromas, dual energy post-processing. This article reviews the current ganglioneuroblastomas, neuroblastomas), paraganglionic sys- literature on dual energy CT pancreatic imaging, specifically tem (pheochromocytomas, paragangliomas), or nerve sheath in the evaluation of pancreatic adenocarcinoma, neuroendo- (neurilemmomas, neurofibromas, neurofibromatosis, malig- crine tumors, small cystic lesions and other obscure tumors. nant nerve sheath tumors). There are several key findings in CT Method(s): We will illustrate in a pictorial essay based on and MRI that can narrow the differential diagnosis or even sug- cases, using images acquired at our institution through com- gest a specific diagnosis, and also distinguishing benign from puted tomography and dual energy technique, the different malignant tumors, and showing signs of invasion or metastasis. applications of this method in various pancreatic pathologies, Conclusion: To acknowledge the imaging findings and ex- as well as a review of its basic concepts. tension of the abdominal neurogenic tumors is important, be- Discussion: DECT is a complementary diagnostic tool with cause the main approach for these tumors is surgical resection. potential to analyze the material composition through image
10 49th Sao Paulo Radiological Meeting acquisition at to different energy levels. It demonstrates po- lesions. Despite the fact that tailgut cyst has a malignant po- tential in pancreatic imaging by enabling generation of vir- tential, many surgeons choose for active surveillance, given tual monoenergetic low kV images to enhance contrast and its surgical comorbidities. A dedicated magnetic resonance iodine overlay images to better characterize enhancement imaging pelvic floor protocol may help the surgeon planning from a single-phase acquisition. This allows for potential the best surgical approach. dose reduction by avoiding multiple scan phases and may Responsible Author: vicente bohrer brentano also be used to decrease contrast usage. Pancreatic patholo- Email: [email protected] gies are of great clinical significance, and yet are often subtle Keyword: cyst,MRI,tailgut cyst,retrorectal cystic lesion and difficult to detect on conventional CT. Many pancreatic lesions are detected incidentally during CT imaging for other PD.01.088 reasons. Furthermore, many pancreatic lesions are incom- JELLY-LIKE TUMORS: MUCINOUS TUMORS OF pletely characterized on a conventional single portal venous THE BODY IN CT AND MRI phase acquisition and additional dedicated pancreatic CT Authors: D HERQUINIGO, MD; A E PIZARRO, MD; M and/or MRI are often necessary. This presents an optimal tar- CASTRO ,MD; A. FUENTEALBA MD; P ALMARZA, get for application of DECT to enable easier detection and MD;F J CERDA, MD. better characterization of many lesions, such as pancreatic Institution: UNIVERSIDAD ANDRÉS BELLO, DEPAR- adenocarcinoma, obscured pancreatic tumors, neurondocrine TAMENTO DE IMAGENOLOGÍA, CLÍNICA INDISA. tumors and small cystic lesions of the pancreas. Introduction and objective(s): Mucinous tumors (MT) pro- Conclusion: Dual energy CT provides information about duce mucin and may be found in any organ of the human how substances behave at different energies. This and other body that has an epithelium. Imaging features depends on the capabilities are promising for improved detection and char- quantity of mucin, but overall MT are quite similar in most acterization of lesions in the abdomen and pelvis, particularly parts of the body because mucin (almost) always show the pancreatic pathologies. same imaging features in US, CT and MR . • Review the Responsible Author: Júlia Azevedo Miranda basic pathology of the mucinous tumors / • Learn the radio- Email: [email protected] logic findings in the most common mucinous tumors in the Keyword: tomografia,computadorizada,dupla,energia,pâncreas human body Method(s): Image review from the findings in CT & MRI. PD.01.073 Discussion: Mucinous Tumors can be founded in any or- MAGNETIC RESONANCE IMAGING OF TAILGUT gan of the human body that has an epithelium. The most CYSTS: SURGICAL IMPLICATIONS common mutation of these injuries is KRAS. In this work Authors: BRENTANO V. B.; CAMERIN G. R.; VIEIRA T. we will review the presentation of this tumor in breasts, D. R.; BEZERRA R. O.; PEREIRA A. M. A.; CERRI G. G. lungs, liver, bile duct, pancreas, ovary and rectum. The Institution: HOSPITAL SÍRIO-LIBÂNES principal characteristic of this tumors is that they produce Introduction and objective(s): Tailgut cysts are rare con- mucine, the appearance of mucine is similar in US, TC & genital lesions with variable clinical and radiological pre- MRI; except when the secreted content is more proteic and sentation. Tailgut cyst usually present as multilocular cystic thick, in those cases the imaging is: US: Hypoechoic with masses in presacral space, predominantly in women in fourth fine internal echoes or complex echogenicity / TC: Hyper and fifth decades of life. Surgical approach is challenging due dense cyst / MRI: hyper intense on T1W and hypo intense to complex anatomy of the lesser pelvis and depends upon on T2 weighted images, compared to water. on a detailed radiological evaluation. Coccygectomy is of- Conclusion: The mucinous tumors are generated in the ten performed, however total extension depends on rectal in- epitheliums and they have similar genetic mutations. Imag- volvement and evidence of malignancy. Magnetic Resonance ing features depends of the mucine amount , but generally imaging is the modality of choice for anatomical evaluation, they are very similar between them. The treatment and the differential diagnosis and follow up. prognosis of the mucine tumor depends of the location of Method(s): It was selected cases of magnetic resonance imag- the first tumor ing of pre and postoperative of presacral cysts to illustrate the Responsible Author: PAMELA ALMARZA SALAS importance of the knowledge of this pathologies and the essen- Email: [email protected] tials aspects to the surgeon, as well the postoperative findings. Keyword: mucinosos,tumores_mucinosos,mucina Discussion: The magnetic resonance imaging is the choice method to evaluate the cystic presacral lesions, therefore it is necessary to understand the anatomy of the presacral space, or retrorectal space. The relationship of a retrorectal lesion with the adjacent structures is an important aspect for the decision of the optimal surgical approach, that can be anterior (abdom- inal), posterior (perineal) and combined (abdominoperineal) . There is a broad differential diagnosis of cystic retrorectal lesions, both benign and malignant, and the tailgut cyst is a common cystic lesion of this location. The most common complications of this cystic lesions are the infection and the malignant degeneration, each one with distinct imaging as- pects, however they can overlap. The radiologist also needs to know the possible postoperative complications and the usual postoperative findings after the resection of this lesions. Conclusion: Tailgut cyst is a rare congenital lesion found in presacral space. The knowledge of the differential diagno- sis is crucial to prevent over or under treatment of pre-sacral
Abstracts of Scientific Papers 11 PESSOA, B.M; ARGOLO, T.A; GOMES, C.E.S.M; RACY, D.J. LITERATURE REVIEW Institution: BP - A BENEFICÊNCIA PORTUGUESA DE SÃO PAULO A brief description of the objective(s): The right accessory POSTERS (PI) hepatic notch (Rouvière sulcus / accessory cleft of Gans) is an important anatomical repair, first described by Henri Rouvière. The Rouvière sulcus was rarely characterized in open surgeries PI.01.007 in the past due to the difficulty of access, but, with the advent GOSSYPIBOMA: DESPITE THE IMPORTANCE, A laparoscopic surgeries, it became clearly noticeable. LITTLE KNOWN TERM Description of the disease(s), method(s) and/or tech- Authors: SANO, A. C. P. G.; SANO, E. O.; TAKAKI, L. nique(s): To help recognice the Rouvière sulcus / accessory A.; CRUZ, L. C.; FORTUNATO, B. S.; EGASHIRA, G. I.; cleft of Gans using sectional image methods, avoiding wrong LALIER, R. T. L.; SANO, RE. S.; SANO, RU. S.; CRUZ, T. M. reporting and over staging oncologic patients. Institution: CDI - CENTRO DE DIAGNÓSTICO POR IM- Discussion: We analyzed cases of oncologic patients diagnosed AGEM DE FERNANDÓPOLIS / SP or in control / treatment from the disease using imaging sectional A brief description of the objective(s): The first case report methods that were interpreted by experienced radiologists with of an intraabdominal foreign object after laparotomy dates to expertise in abdomen and oncologic radiology. 1884. Despite all the precautions of surgeons, other special- Conclusion: the radiologic literature about this topic is ists and the various preventive measures adopted, postoper- scarce, citations are found almost exclusively in works pub- ative retention of intracavitary foreign bodies is a relatively lished in surgical journals. In studies directed to radiology, frequent event. In this context, radiologists must know the few references were found. imaging aspects of gossypibomas, which represent a reckless Responsible Author: Marcelo Oliveira Coelho problem in medicine, because in addition to complications for Email: [email protected] the patient, their impacts on the doctor-patient relationship Keyword: Fissura de Gans, Anatomia, Sulco, Rouvière, and medical-legal implications are feared. Estadiamento Description of the disease(s), method(s) and/or tech- nique(s): The term gossypiboma is used to describe a mass formed from a cotton matrix surrounded by an inflammatory reaction. The word is derived from the latin gossypium (cot- ton) and the kiswahili boma (place of conceal, hide). Frequent sites of gossypiboma formation include: cavity thoracic (pleu- CASE REPORT ral and pericardial) and abdominal. The main predisposing factors of abdominal gossypibomas are: emergency surgery, unexpected changes in the surgical act, two or more different DIGITAL PRESENTATION (PD) surgical teams involved in the operation, change of nursing staff during surgery, obesity and intraoperative hemorrhage. Discussion: The diagnosis of a gossypiboma can be ex- PD.01.012 tremely challenging for the radiologist because of its vari- CASE REPORT: THE ROLE OF RADIOLOGY IN able presentation and usually results from the investigation COMBATING DRUG TRAFFICKING of complaints such as abdominal pain, palpable mass, intes- Authors: JABOUR, V. A. ; BOLINELLI, A. P. ; OLIVEIRA, tinal obstruction, fistula, or as part of routine postoperative V. S. ; BIANCO, G. A. ; BARRETO, V. O. ; WANDERLEY, imaging exams. Other times, they result in an incidental find- M. C ; SANTOS, R. V. ; MORAIS, A. E. Q. ing, years after an abdominal surgical intervention. Conven- Institution: HOSPITAL ESTADUAL VILA ALPINA tional radiology is the most commonly used imaging meth- A brief description of the objective(s): To present a case od in the postoperative period for the detection of retained report and discuss the best diagnostic method, its tools and gossypibomas. The US allows the identification of virtually the main signs, to identify a Body Packers (BP) as early as all types of gossypibomas, as well as providing information possible. In addition, the main features of different drugs in about their anatomical relationships. At CT, gossypibomas the different imaging methods, as well as the possible com- are generally identified as a well-defined mass, with soft-tis- plications that BP are subject to. sue density, high density, or even mixed, and may contain Clinical History: Eight patients referred from the provision- air bubbles and a hyperdense capsule that has post-contrast al detention center of Guarulhos, who denied having ingested enhancement. drug capsules, underwent a CT scan. This test evidenced the Conclusion: The imaging findings of gossypibomas have a presence of multiple capsules in the gastrointestinal tract of variable presentation, but may be suggested when there is the eight suspects. correlation with history of previous surgery, and should be Discussion and diagnosis: The transportation of the prod- considered among the differential diagnoses of the masses / ucts that drive the drug trade can be done in different ways. collections. One of the most common is the Body Packer (BP) or mule, Responsible Author: Ana Carolina Pimenta Grecco Sano in which a person ingests capsules or packets of a illicit drug Email: [email protected] in order to conceal their presence. Early identification of BP Keyword: cirurgia,complicações,massa,abdominal,gossipi- is essential, since the rupture of a single capsule can be fatal. boma,corpo,estranho Conclusion: Knowing that Brazil is the main route of traf- ficking in Latin America, that one of the main means to trans- PI.01.011 port illicit drugs is done by the BP and that the rupture of only ROUVIÈRE SULCUS: A FORGOTEN ANATOMICAL one capsule can be fatal, we suggest that CT is the best diag- LANDMARK? nostic method due to speed and security, as well as ensuring Authors: ARAÚJO, E. M; LIBÂNIO, B. B, COELHO, M.O; the integrity of the suspects.
12 49th Sao Paulo Radiological Meeting Responsible Author: Victor Arantes Jabour Institution: HOSPITAL DAS CLÍNICAS DA FACUL- Email: [email protected] DADE DE MEDICINA DE BOTUCATU (UNESP) Keyword: BODYPACKERS;,DROGAS,TRAFICO,TO- A brief description of the objective(s): To present a MOGRAFIA,RAIOX rare case of epiploic appendagitis mimicking acute ap- pendicitis in a young adult patient with undiagnosed in- PD.01.018 testinal malrotation. Clinical History: A 20-year-old male with two days of right OSTEOCLAST-LIKE GIANT CELL TUMOR OF THE lower quadrant pain associated with nausea and inappetence. PANCREAS WITH UNDIFFERENTIATED CARCINO- No signs of peritonitis on physical examination and leukocy- MA: CASE REPORT tosis of 16,400 cells / mm³. The acute appendicitis hypothesis Authors: SOUZA, L.P.; CONCEICAO, D.M.S.; PEDRO- was considered and the investigation with imaging study was SO, M.H.N.I.; ABUD, C.P. performed. Institution: BP MEDICINA DIAGNÓSTICA, HOSPITAL Discussion and diagnosis: Computed tomography (CT) of BP, SÃO PAULO/SP the abdomen showed intestinal malrotation characterized by A brief description of the objective(s): The report aims the presence of the cecum on the left lower quadrant and lack to demonstrate a case of undifferentiated osteoclastic giant of crossing of the third portion of the duodenum on the mid- cell carcinoma, a variant of ductal adenocarcinoma and cor- line, besides an oval image with fat attenuation next to the responding to less than 1% of exocrine pancreatic tumors. sigmoid colon, which presented redundancy passing through The existence of few reports and clinical experience has the the right lower qudrant, the normal cecal appendix was char- consequence of its extreme rarity. acterized in the left lower quadrant. The CT suggested the Clinical History: A 51-year-old male patient with massive diagnosis of epiploic appendagitis and the patient was treated complex pancreatic lesion, as well as three suspicious hepat- conservatively, presenting complete resolution of the clinical ic lesions for secondary involvement identified in computed symptoms in five days. Intestinal malrotation is a congenital tomography and magnetic resonance imaging studies of the anatomic anomaly caused by incomplete rotation and anoma- abdomen. Biopsy and histological analysis of the irregular, lous fixation of the primitive small bowel during embryonary whitish brown tissue fragment were performed, showing atyp- period. It usually presents in the first months of life, but can ical cell proliferation, rich in giant cells of the osteoclast type, remain silent and cause difficulties and diagnostic errors in associated with areas of fibrosis and fibrin deposition of un- adult patients with acute abdominal pain. Epiploic append- certain biological behavior. The immunohistochemical study agitis is a benign, self-limiting clinical condition resulting revealed giant cell positivity for CD68, TP53 and Ki-67. The from torsion or venous thrombosis of the epiploic appendix, set of findings was compatible with the osteoclastic giant cell usually presents with pain in the left lower quadrant and has tumor of the pancreas as the main etiological diagnosis. conservative treatment. Discussion and diagnosis: Undifferentiated giant cell-like os- Conclusion: In adults, the incidence of intestinal malrotation teoclast carcinoma is a rare neoplasm of the exocrine pancreas is extremely low (around 0.2%). In patients with abdominal and is commonly seen as a large cystic neoplasm with varying abnormalities not directly related to intestinal malrotation, al- degrees of hemorrhage and necrosis. The parts of the head and tered anatomy may result in atypical clinical presentations and body of the pancreas tend to be involved. It has been observed make it difficult for the clinician and / or surgeon to diagnose, that they can occur in the parotid gland, thyroid, kidney and so imaging studies are paramount for diagnostic accuracy. breast. However, the pancreas seems to have the greatest pre- Responsible Author: Faissal Matsubara Saad dilection for this pathological lesion. The presence of giant Email: [email protected] neoplastic cells similar to osteoclasts is the histological feature Keyword: Malrotação,Intestinal,Apendagite,Epiplóica of this tumor. They rarely express epithelial markers, but show staining for histomonocytic markers (CD68). The differential PD.01.022 diagnosis of undifferentiated pancreatic giant cell carcinoma with osteoclast-like giant cells includes cystic lesions such as ANEURYSM OF THE PORTAL VEIN, A RARE CLINI- serous and mucinous cystic tumors, pancreatic pseudocysts and CAL ENTITY OF UNKNOWN ETIOLOGY. solid pancreatic tumors, such as ductal pancreatic carcinomas Authors: RIBEIRO, F.A.; TSUNO, M.Y.; TSUNO, N.S.G. or neuroendocrine tumors. Although there is a limited progno- Institution: EXAME IMAGEM E LABORATÓRIO, sis, recent studies suggest that this subtype of tumor may have DASA, BRASÍLIA-DF a better prognosis than classic ductal adenocarcinoma. A brief description of the objective(s): Promote and share Conclusion: Undifferentiated giant-cell carcinoma of the knowledge about portal vein aneurysms. osteoclast-like pancreas is a rare neoplasm. This tumor may Clinical History: A 78-year-old female patient underwent a present several imaging characteristics and its definitive di- routine total abdominal ultrasound at another service and an agnosis is based on histopathological analysis with immuno- anechoic structure was identified in the topography of the liv- histochemistry. er and the diagnosis of a simple hepatic cyst was made and di- Responsible Author: Livia Passarelli de Souza agnostic complementation was suggested with a tomography Email: [email protected] study with the use of the intravenous contrast medium. Keyword: carcinoma,osteoclastos,pancreas Discussion and diagnosis: The examination detected the presence of a massive aneurysm in the trunk of the portal vein, with no signs of associated thrombosis, measuring up PD.01.020 to 60 mm in diameter. Aneurysms in the splenoportomesen- EPIPLOIC APPENDAGITIS MIMICKING ACUTE AP- teric system are a rare clinical entity of unknown etiology, PENDICITIS IN AN ADULT WITH UNDIAGNOSED having as contributing factors portal hypertension, chronic INTESTINAL MALROTATION liver disease and trauma, among others. The etiology of these Authors: SAAD, F. M.; NEVES, G. B; ROÇA, C. T.; RO- aneurysms is unknown, and may be congenital or acquired. DRIGUES, L. P.; BASSO, C. F.; VELOSO, J. C. V.; DINIZ, L. They may be asymptomatic and lead to severe conditions V.; ANTUNES, P. E. H.; JUNIOR, L. A. J.; WAJSMAN, V. Z. such as colicky abdominal pain, jaundice, and upper gastro-
Abstracts of Scientific Papers 13 intestinal bleeding secondary to portal hypertension. Chronic the caliber of the cecum measuring 9.2 cm, without evidence liver disease, portal hypertension, trauma or inflammation of intestinal ischemia or pneumoperitoneum. are contributing factors in the case of secondary aneurysms. Discussion and diagnosis: Initially described in 1948 by Weakening of vessel wall following trauma, inflammatory Heneage Ogilvie, there is no clear cause, but factors such conditions such as pancreatitis or local degenerative changes as history of orthopedic surgery, heart disease, infections, were also implicated in the genesis. The diagnosis is usually neurological disorders, antidepressant and morphine-derived made by ultrasonography (B mode or color Doppler), tomog- drugs are related to the onset of the syndrome. raphy and magnetic resonance imaging. Invasive procedures Conclusion: Although it is a rare syndrome, it is expected such as venous-phase mesenteric arteriography or splenopor- that, with these cases, a better understanding will occur, tography may be helpful in diagnosis. The choice of treat- making possible a rapid diagnostic decision for the appro- ment (conservative or surgical) depends on several factors. In priate treatment. the case of portal hypertension, the most accurate treatment Responsible Author: Aristócles Hitallo Bezerra seems to be the placement of a portosystemic shunt tube. The controversy appears in cases without portal hypertension, Email: [email protected] similar to our case, in which expectant management can be Keyword: Síndrome de Ogilvie,Pseudo-obstrução intesti- performed, with image and clinical controls. nal,Tomografia Computadorizada Conclusion: It is important to remember this rare clinical en- tity of unknown etiology in the differential diagnosis of vas- PD.01.043 cular diseases of the portal venous system, avoiding incorrect ILIAC VEIN COMPRESSION SYNDROME (COCK- procedures and treatments. ETT MAY-THURNER) IN PATIENT WITH CHRONIC Responsible Author: Fabiano Arantes Ribeiro VENOUS THROMBOSIS OF LEFT LOWER MEMBER Email: [email protected] Authors: RIBEIRO, F.A; TSUNO, M.Y; TSUNO, N.S.G. Keyword: aneurisma,veia,porta Institution: EXAME IMAGEM E LABORATÓRIO-DA- SA-BRASÍLIA DF PD.01.026 A brief description of the objective(s): To promote and to ACUTE COLONIC PSEUDO-OBSTRUCTION (OGIL- share the knowledge about the Syndrome of compression of VIE'S SYNDROME): REPORT OF 3 CASES the iliac vein through a study of computerized angiotomog- Authors: BEZERRA, A. H.; MARANHÃO, F. L. L.; SILVA, raphy. F. J.; XAVIER, H. A. F. R.; VIDAL, J. C. S.; SOUSA; J. C. Clinical History: A 53-year-old female patient with a history O.; ARAÚJO, J. M.; ARAÚJO, R. M. of venous insufficiency of the left lower limb and episodes Institution: HOSPITAL EMERGÊNCIA E TRAUMA DOM of thrombosis associated with treatment. The patient also LUIZ GONZAGA FERNANDES reported the appearance of superficial varicose veins in the FACULDADE DE CIÊNCIAS MÉDICAS DE CAMPINA vulvar region. The patient was asked by the attending phy- GRANDE - FCM-CG sician to computed angiotomography of the abdominal aorta A brief description of the objective(s): Ogilvie syndrome is a rare condition characterized by signs, symptoms, and find- and iliac vessels with arterial and venous phases. ings of radiological images of marked non-mechanical dila- Discussion and diagnosis: The examination showed signif- tation of the colon, usually involving hospitalized patients. icant compression of the left common iliac vein by the right Progressive distension may culminate with perforation of the common iliac arteries and also by the left in this case, de- cecum, in addition to gangrene of the cecum and ascending termining exuberant collateral circulation in the pelvis, with colon, and abdominal sepsis, common complications of the formation of pelvic varices and varicose veins in the vulvar syndrome. The objective of this study was to report 3 cases of region. Compression syndrome of the left common iliac vein this syndrome in order to relate clinical findings to radiologi- (also known as Coccket May-Thurner Syndrome) is a clinical cal images, aiming at an early intervention capable of reduc- situation in which the right common iliac artery extrinsically ing the morbidity and mortality of these patients. compresses the left common iliac vein. There is a predomi- Clinical History: First patient, male, 68 years old, with Alz- nance of young women between the second and fourth de- heimer's disease, was admitted to the emergency room after cades of life. Taking into account the potential complications falling from his own height, which resulted in subarachnoid of this syndrome, it should be recognized, diagnosed and hemorrhage, after one day of hospitalization he started with treated in symptomatic patients, before it causes irreversible abdominal distension, constipation, nausea and vomiting , the changes in the patient's venous system. Noninvasive methods Computed Tomography (CT) revealed diffuse aerial disten- such as Doppler ultrasound can be used, but angiotomogra- sion of the colonic segments, with a cecum measuring up to phy and angioresonance are more reliable. The method of 8.7 cm in transverse diameter, with a greater accumulation choice for diagnostic confirmation consists of phlebography, of feces in the rectal ampulla. The second patient, female, 54 in multiple incidences, with blood pressure gradients. En- years old, on treatment for depression with fluoxetine, pre- dovascular treatment is safe and effective, and may replace sented sudden pain and abdominal distension, associated with open surgical reconstruction and / or isolated anticoagulation. nausea, vomiting and diarrhea. CT presented intestinal pseu- do-obstruction pattern with colonic aerofecal distension, with Conclusion: Before labeling patients as having primary val- formation hydroaeal level, particularly affecting the cecum, vular insufficiency, such syndrome should always be remem- ascending and sigmoid colon, with cecum reaching up to 10 bered in the differential diagnosis of venous insufficiency of cm of transverse diameter. The third patient, female, 62 years, the left lower limb, with or without the presence of associated admitted with acute myocardial infarction, after 48 hours of thrombotic episodes for early diagnosis and treatment, thus hospitalization presented pain and abdominal distension, be- avoiding future complications. ing referred for CT examination, which demonstrated diffuse Responsible Author: Fabiano Arantes Ribeiro hyperdistension of the colon from the rectum to the cecum , Email: [email protected] with no evidence of obstructive factor to the method, being Keyword: Cockett,May-Thurner
14 49th Sao Paulo Radiological Meeting PD.01.055 cinoma, whose diagnostic criteria are the components of the STAUFFER'S SYNDROME: CASE REPORT association observed in the patient. Histopathological exam- Authors: ROMAN, S. M.; GUIMARÃES, R. B.; CHO- ination of the hepatic nodule was compatible with hemangi- oma and the surgical specimen of nephrectomy with renal JNIAK, R.; MELO, R. A. B. cell carcinoma (RCC), clear cell type. Four months after Institution: A.C.CAMARGO CANCER CENTER surgery, laboratory and imaging tests were repeated, which A brief description of the objective(s): Describe and dis- demonstrated normalization of anemia and levels of platelets, cuss a case of Stauffer syndrome and contribute to the un- alkaline phosphatase and gamma-GT, as well as resolution derstanding of this paraneoplastic syndrome, accelerating the of radiological signs of diffuse liver disease, thus evidencing accurate diagnosis and proper treatment. reversibility after the surgery, which confirmed the hypothe- Clinical History: Patient, male, 41 years old, was admitted sis of Stauffer's syndrome. Such syndrome is characterized to the service for investigation of liver nodules and staging by hepatic dysfunction triggered by a malignant neoplasm. of renal neoplasm. He showed fatigue and significant weight About 10 to 20% of the RCCs develop hepatic dysfunction, loss over the past year. The laboratorial exams then requested whose main manifestations are fever, fatigue and weight loss. showed anemia with plaquetose and high levels of alkaline Approximately 60-70% of these patients develop normaliza- phosphatase and gamma-GT, without other relevant findings. tion of liver function after surgery. Liverspecific gadoxetic acid-enhanced magnetic resonance Conclusion: The recognition of liver disease as a paraneo- imaging showed a mass in the upper pole of the left kidney plastic syndrome is fundamental to the suspicion of hidden with a high score on the R.E.N.A.L. Nephrometry Scoring neoplasms in patients without known risk factors for liver System, nonspecific liver nodules and liver with blunt edges dysfunction, as well as to your differentiation of metastatic and parenchyma with diffusely heterogeneous signal intensi- lesions. The knowledge and the appropriate differentiation of ty, signs suggestive of liver disease. these entities accelerates the correct diagnosis and interferes Discussion and diagnosis: Due to the association of renal directly in the prognosis. mass with diffuse hepatopathy in the absence of hepatic me- Responsible Author: Stefânia Maria Roman tastasis, the hypothesis of Stauffer's syndrome, an unusual Email: [email protected] paraneoplastic syndrome associated mainly to renal cell car- Keyword: SINDROME,STAUFFER,PARANEOPLASICA
ABDOMINAL / GENITOURINARY TRACT ORIGINAL PAPER lector system in CT scan. Stones were analyzed for laterality, location, size and density by CT, with these parameters being tested for prediction in TA formation. Results and discussion: 27 patients were included with 187 DIGITAL PRESENTATION (PD) renal calculi in CT scans. Sensitivity, specificity, positive pre- dictive value and negative predictive value were respectively PD.02.012 38.5% (CI 95%: 31.5% to 45.9%), 11.1% (CI 95%: 0.3% to 48.2%), 7.0% (CI 95%: 5.3% to 9.2%) and 51.0% (CI 95%: THE EFFECT OF THE USE OF TWINKLING ARTI- FACT ON ULTRASOUND ACCURACY IN DIAGNO- 14.0% to 86.9%) to a hyperechoic focus; 24.1% (CI 95%: 18.1% SIS OF THE INTRARENAL CALCULI to 30.8%), 77.8% (CI 95%: 40.0% to 97.2%), 15.8% (CI 95%: Authors: SARRIS, A.B.; CANDIDO, F.J.F.; SOBREIRO, 5.1% to 39.6%), and 85.5% (CI 95%: 80.5% to 89.4%) to a B.P.; DREWECK, M.O. hyperechoic focus with acoustic shadow and 21.9% (CI 95%: Institution: UNIVERSIDADE ESTADUAL DE PONTA 16.2% to 28.5%), 100.0% (CI 95%: 66.4% to 100.0%), 100.0% GROSSA and 88.1% (CI 95%: 87.2% to 88.8%) to a hyperechoic focus A brief description of the objective(s): To compare the ac- with TA. Regarding the parameters tested for the prediction of curacy of B-mode ultrasound (US) and sonographic color TA formation, no difference was observed between the stones Doppler twinkling artifact (TA) in the detection of intrarenal without and with the TA for laterality (p= 0.808), and about intra- calculi evaluated by computed tomography (CT) and to veri- renal location (p=0.007), size (p<0.001) and density (p<0.001) fy if the formation of TA is influenced by laterality, location, there were differences between the stones without and with TA. size and density of urinary stones. Conclusion: The main effect on the diagnostic accuracy ob- Material(s) and method(s): Following approval of the in- served with the TA was the increase in specificity when com- stitutional review board and informed consent requirement, pared to other sonographic findings in the characterization of patients older than 18 years who were referred for an abdomi- nal CT scan suspected of having urinary calculi was included renal calculi. Intrarenal location, size and density of kidney and submitted to US and color Doppler US to kidney evalua- stones were shown as predictive variables for formation of tion. The ultrasonographic criteria used were: 1) hyperecho- TA in color Doppler US. ic focus, 2) hyperechoic focus with acoustic shadow and 3) Responsible Author: Marcelo Dreweck hyperechoic focus with TA. The reference standard used to Email: [email protected] nephrolithiasis characterization was a calcification in the col- Keyword: twinkling artifact,kidney calculi,ultrasound
Abstracts of Scientific Papers 15 ORAL PRESENTATION (TL) PICTORIAL ESSAY
TL.02.001 BIPARAMETRIC VERSUS MULTIPARAMETRIC POSTERS (PI) MAGNETIC RESONANCE IN THE DETECTION OF CLINICALLY SIGNIFICANT PROSTATE LESIONS Authors: RACY, D.J.; GOMES, N. B. N. ; LIBANIO, B. B.; PI.02.004 ALBUQUERQUE, K.S.; BARBISAN, C.C.; TORRES, L.R.; "TIME IS KIDNEY": A REVIEW OF RENAL INFARC- Institution: HOSPITAL BENEFICÊNCIA PORTUGUESA TION IMAGING DE SP (BP). Authors: VIDAL, B.P.C.; PRANDO, A.; RODSTEIN, A brief description of the objective(s): Prostate cancer is M.A.M. the most common type of cancer in the male population, Institution: HOSPITAL VERA CRUZ - CENTRO RADI- with the exception of non-melanoma skin cancers, and ranks OLÓGICO CAMPINAS third in mortality. Magnetic Resonance (MR) is currently Introduction and objective(s): Acute abdominal pain is a the most recommended method for the detection and staging very frequent symptom in clinical practice, often leading the of neoplastic prostatic lesions and is expected to become primary physician to request imaging studies, which are ex- the chosen procedure for screening for potentially malignant tremely important for diagnostic elucidation. For this reason, lesions that is currently placed by invasive biopsy methods. the radiologist should be prepared to recognize the main dif- In this context, the biparametric method emerges as an inno- ferential diagnoses that occur with abdominal pain, from the vative, more economical and accessible alternative for the most common to the least frequent, but not less important, early diagnosis of prostate cancer in high-risk men. In this such as renal infarction. The present study aims to highlight context, the goal of this study is to determine the diagnostic the importance of early diagnosis of renal infarction and its accuracy of the biparametric MR protocol in the detection radiological signs, correlating them with the main etiologies, of clinically significant neoplastic lesions compared to the in order to optimize the patient's management and treatment. multiparametric protocol. Method(s): Computed tomography (CT) and magnetic res- Material(s) and method(s): The research was retrospec- onance imaging (MRI) scans, as well as their multiplanar tive, cross - sectional, observational and analytical of a and three-dimensional (3D) reformations will be used. The series of cases, being done through data collection of im- images used in this study were acquired in a hospital of high age exams in the year 2017 of a hospital. Three observ- complexity and personal archives of the authors. ers performed the analysis of the lesions according to the Discussion: In case of acute abdominal pain, especially located PIRADS (version 2) criteria and the findings were com- in the flanks, either unilateral or bilateral, the possibility of an pared with the anatomopathological results. Sensitivity, ischemic renal event should be considered. Often this diagnosis specificity, positive predictive value, negative predictive is late or even unidentified, making it an important cause of re- value and accuracy for all readers and both methods (mul- nal function loss and consequent cardiovascular consequences. tiparametric MR and biparametric MR) were calculated. Renal infarctions can be caused by reduction or disruption to Finally, interobserver agreement was made for the two blood flow, either arterial or venous, being arterial involvement, prostate MR protocols. more frequent. Focal renal infarctions tend to be caused by ob- Results and discussion: We selected 30 patients with pros- struction of small arterial or venous segments or sub-segments, tatic adenocarcinoma, with a mean age of 63 years old, four while global infarcts are related to larger caliber vascular ob- of them were submitted to the post-contraction phase directed structions, as in the case of renal artery dissection, for exam- to the upper abdomen and because of it have been excluded. ple. Bilateral manifestation tends to be related to inflammatory The sensitivity, specificity and accuracy for the mutipara- causes (vasculitis), or to cardiogenic thromboembolism. The metric RM and biparametric RM were: 88% and 92%; 40% main radiological findings will be described throughout the and 37% and 74% and 71%. The interobserver agreement study and demonstrated by their own case images. in the interpretation by biparametric image was moderate Conclusion: Since it is not a very frequent entity, the diag- (k = 0.50). nosis of renal infarction is sometimes not addressed, thus im- Conclusion: The biparametric MR allows the detection of pairing the proper management and treatment of the patient, clinically significant lesions with diagnostic accuracy similar as well as preservation of their renal function. It is up to the to those of the complete multiparametric protocol with con- radiologist to correlate the clinical and laboratory data pres- trast injection. ent with the imaging findings, in order to optimize the diag- Responsible Author: Natália Borges Nunes nosis and management of this condition. Email: [email protected] Responsible Author: Bruno Prado Cortizo Vidal Keyword: próstata;,diagnosticoporimagem,programasdera- Email: [email protected] streamento Keyword: Infarto,renal,dor,abdominal,tomografia,computa- dorizada
PI.02.006 GESTATIONAL TROPHOBLASTIC DISEASE KNOW THE FINDINGS USING COMPUTED TOMOGRAPHY & MAGNETIC RESONANCE Authors: HERQUIÑIGO D, PIZARRO A, CASTRO M, ALMARZA P. Institution: UNIVERSIDAD ANDRÉS BELLO, DEPAR- TAMENTO DE IMAGENOLOGÍA, CLÍNICA INDISA. Introduction and objective(s): Gestational trophoblastic
16 49th Sao Paulo Radiological Meeting disease (GTD) is an abnormal trophoblastic proliferation Discussion: For many years the diagnosis of DE was made composed by a huge diseases spectrum, beginning with be- through clinical and physical examination, followed by nign hydatid form mole, although pre malignant (partial or laparotomy or laparoscopy with diagnostic and therapeutic complete), up to an aggressive invasive mole, choriocarcino- functions. Today the imaging tests were incorporated into ma and placental site trophoblastic tumor (PSTT). Gestation- the routine of the evaluation of DE, and the USTV was a al trophoblastic neoplasia (GTN) is referred to the aggres- method with good accuracy for the diagnosis of intestinal DE sive subset that includes invasive mole, choriocarcinoma and and with high specificity for prediction of non-intestinal DE, PSTT. Know the findings using computed tomography (CT) being considered the first line examination. It may also be & magnetic resonance (MRI) and classify the advance in ges- used for evaluation of the anterior compartment (bladder and tational trophoblastic disease ureters). The main limitation of USTV is the restricted field Method(s): Image review from the findings in CT & MRI of vision and the difficulty of detecting lesions outside the Dscussion: The gestational trophoblastic disease (GTD) pelvis. To broaden the field of vision, we included the initial is composed by a set of benign & malign process in the abdominal evaluation. USTV can also be supplemented with trophoblastic fetal tissue, their own characteristic could be MRI in cases of lesions difficult to access by the US, such as differenced in images. Hydatid form mole could present in extensive pelvic adhesions. the CT as lesions in the heterogeneous endometrial cavity Conclusion: Every radiologist who is properly trained and in reticular pattern with hypo dense vesicles and partitions familiar with the steps and characteristics of the US examina- that enhance with the contrast. In invasive mole, the myo- tion can make a difference in this context. metrium is compromised. In MRI are isointense lesions in Responsible Author: Alan Hummel the myometrium in T1 and T2 hyper intensity of the vesi- Email: [email protected] cles that distend the cavity, partitions between the vesicles Keyword: Ultrassonografia, Endometriose that capture gadolinium in the case of the mole, in the in- complete mole fetal parts are identified and in the invader the patient’s myometrium is compromised. Choriocarcino- ma is a malignant tumor that in CT is seen as a myometri- um mass that may or may not have endometrial component, heterogeneous enhancement with prominent blood vessels DIGITAL PRESENTATION (PD) and in MRI a myometrium-endometrial mass is identified, signal voids representing prominent blood vessels, hetero- geneous enhancement, hyper intense in T1 and T2 with PD.02.004 respect to the myometrium. Placental site tumor is a rare COMPUTERIZED TOMOGRAPHY AND MAGNET- variant of choriocarcinoma, where the images are similar IC RESONANCE IN THE THREE-DIMENSIONAL to choriocarcinoma. BRAHCHERAPY PLANNING IN THE INITIAL AND Conclusion: Recognize MRI & CT finding help with the pre- LOCATED UTERINE COLON NEOPLASIA cise diagnose, therefore the correct handling of the disease Authors: SOUSA, J.C.O ; RÊGO,J.C.M;VIDAL,J,C.S Responsible Author: PAMELA ALMARZA SALAS Institution: NÚCLEO DE PESQUISA CIENTIFICA E Email: [email protected] ACADÊMICA DE RADIOLOGIA (NPCAR) Keyword: enfermedad trofoblástica gestacional (ETG),mo- Introduction and objective(s): In initial and localized cer- la_hidatiforme,coriocarcinoma,tumor_del_sitio_placentario vical neoplasia, radiotherapy using brachytherapy or internal radiation therapy is one of the most effective clinical ther- PI.02.007 apeutics; brachytherapy using three-dimensional (3D) plan- ENDOMETRIOSIS WITHOUT MYSTERIES - ALL THE ning reduces the uncertainties of the doses administered and STEPS OF ULTRASONOGRAPHIC EVALUATION ensures the correct positioning of gynecological radiation Authors: BISOLO, L; HUMMEL, A, D.; PASQUINI-RAI- applicators. Computed tomography (CT) and magnetic res- ZA L.C.; RAHAL JR. A.; SAVOIA P.; CRUZ-SANTOS onance imaging (MRI) imaging exams are essential for 3D A.R., FRANCISCO-NETO M.J.; FUNARI M.B.G. brachytherapy planning in the initial cervical neoplasia and Institution: HOSPITAL ISRAELITA ALBERT EINSTEIN localized because they permit the volumetric reconstruc- Introduction and objective(s): Endometriosis is a fre- tion of tumor and organs of risk (OARs). This study aims quent gynecological condition, and can be found in up to to demonstrate and discuss the performance of CT and MRI 5% of women. Ultrasonography (US) is considered the images in 3D planning of brachytherapy in the initial and lo- first-line, and most accessible, examination for the eval- calized cervical neoplasia. uation of deep endometriosis (DE). Our study aims to de- Method(s): Pictorial Trial with CT and MRI images of 3D scribe the step-by-step ultrasonographic research for DE brachytherapy planning in patients with initial and localized and to illustrate didactically images of US findings in the cervical neoplasia. A literature review will also be carried out various abdominal compartments. on the relevant conceptual thematic. Method(s): US images were performed using protocols di- Dscussion: The therapeutic modalities used in cervical neo- rected to the research of DE, using the terms proposed by plasias should treat the tumor area with: high and effective the International Deep Endometriosis Analysis (IDEA) con- dose; minimization of doses in adjacent healthy tissues or sensus. The evaluation consists of four steps, according to organs at risk, and reduction of side effects. In uterine cervix the IDEA consensus: 1st step - evaluation of the urinary sys- neoplasia (including the initial and localized), brachythera- tem (bladder and distal ureters) and uterus and its annexes py is highlighted as a therapeutic modality chosen for neo- by abdominal and transvaginal; 2nd step - evaluation of the plastic combat. The 3D planning in brachytherapy in initial relation of the organs of the pelvis to each other looking for and localized cervical neoplasia allows the dose adequacy to signs of adhesions; Step 3 - analysis of uterine mobility; Step the tumor volume and knowledge of the dose received in the 4 - search for foci of deep endometriosis in the anterior and volumes of the adjacent OARs. The images of CT and MRI posterior pelvic compartments. are extremely relevant for the construction of 3D planning
Abstracts of Scientific Papers 17 in brachytherapy in neoplasias of the initial and localized Email: [email protected] cervix because they guarantee: tumor reconstruction; defini- Keyword: Ovário,GI-RADS,Ultrassom,TC,RM tion of tumor contour; better tissue visualization and tumor differentiation. PD.02.014 Conclusion: In the initial and localized cervical neoplasms GYNECOLOGICAL SARCOMAS: A PICTORIAL ESSAY the use of 3D planning of brachytherapy increases the possi- Authors: FILHO, M. V. L.; SEMIONE, M. M.; TORRES, bility of saving OAR by allowing the volumetric evaluation L. R.; PEDROSO, M. H. N. I.; SILVA, M. C.; LEWIN, F.; of the doses received. In relation to the evaluated OARs, the FOREST, A. F.; HOUAT, C. R. S. use of CT or MRI images of the uterine cervix in 3D planning Institution: REAL E BENEMÉRITA BENEFICÊNCIA brachytherapy allows real visualization of the punctual doses applied in the tumor region as well as to guarantee the dosi- PORTUGUESA DE SAO PAULO metric optimization. Introduction and objective(s): Gynecological sarcomas Responsible Author: Joyce Caroline (GS) are rare pelvic tumors, accounting for approximately Email: [email protected] 1,5-2% of all gynecological malignancies, being the uter- Keyword: THREE-DIMENSIONAL BRAHCHERAPY us the most prevalent site of almost all common sarcomas PLANNING ;,UTERINE COLON NEOPLASIA;,BRAH- subtypes. Leiomyosarcoma (LMS), endometrial stromal sar- CHERAPY ; coma (EES) and adenosarcoma (AS) are the most prevalent uterine histological subtypes. Imaging studies play a critical role in the diagnosis and staging of pelvic tumors, especially PD.02.013 with the advent of minimally invasive surgery. This pictorial ALL YOU NEED TO KNOW ABOUT OVARIAN LESIONS essay discusses the use of imaging, especially magnetic res- Authors: OLIVEIRA, B.C; OLIVEIRA, C. V.; HORVAT, onance imaging (MRI), in the investigation of GS, focusing N.; PANIZZA, P.S.B.; CERRI G.G.; VIANA P.C.C. on uterine involvement, their main differential diagnosis and Institution: HOSPITAL SÍRIO-LIBANÊS E HOSPITAL patterns of recurrence. DAS CLÍNICAS DA FACULDADE DE MEDICINA DA Method(s): The cases were included from a retrospective UNIVERSIDADE DE SÃO PAULO database of our Tertiary Cancer Center. We discuss and illus- Introduction and objective(s): Adnexal cysts cause con- trate radiologic findings with pathologic correlation of GS, siderable anxiety in women due to the fear of malignancy, their differential diagnosis and patterns of recurrence, focus- once ovarian cancer frequently appears as a complex cystic ing on MRI findings. mass. However, the vast majority of adnexal cysts are be- Discussion: LMS usually presents as a massive uterine en- nign. Our objectives are to suggest a diagnostic approach of largement with hypointensity on T1 and intermediate-to-high ovarian cystic masses, reviewing the Gynecologic Imaging signal intensity on T2-weighted images, with central hyper- Report and Data System (GI-RADS) classification, as well as intensity indicative of extensive necrosis. clinical and radiologic features that help to differentiate neo- ESS are a heterogenous group ranging from relatively in- plastic from non-neoplastic lesions and can suggest specific dolent lesions (low grade ESS) to lesion with much more histological subtypes. aggressive course and a poorer prognosis (ESS undifferen- Method(s): Illustrated teaching cases from our department tiated). AS is a slow-growing tumor, that most commonly emphasizing imaging features on ultrasound (US), comput- presents as a large well-demarcated polypoid mass arising ed tomography (CT), magnetic resonance (MR) and positron within the endometrial cavity and protruding through the emission tomography (PET) that the radiologist should con- cervical canal. Smooth uterine muscle of uncertain malig- sider in the management of adnexal cystic lesions. nant potential (STUMP) is a group of uterine tumors that Discussion: Didactic systematic approach of relevant clinical cannot be diagnosed unequivocally as benign (leiomyoma) and imaging findings that help differentiate neoplastic from or malignant (LMS), and has been only sporadically de- non-neoplastic adnexal lesions and suggest specific histolog- scribed in the imaging literature given their rareness. Car- ical subtypes, including: - Patient's risk group (age, menstrual cinosarcoma (CCS) is a highly malignant biphasic tumour status, surgical history etc); - Symptomatic versus incidental with both carcinomatous and sarcomatous components, lesions; - Role of imaging methods, emphasizing practical currently classified as carcinoma, that remains a differen- outcomes, such as follow-up and surgery indications; - Im- tial diagnosis of GS. aging pearls for interpretation of suspicious ovarian lesions, Conclusion: GS are an aggressive heterogeneous group of reviewing the GI-RADS classification and highlighting the tumors that have a broad differential diagnosis ranging from information that must be present in the report; - Non-ovarian benign neoplasms (atypical leiomyomas), STUMP to ma- lesions: Lymphocele, lymphangioma, hydrosalpinx, peri- lignant neoplasms with high morbidity and mortality (carci- toneal inclusion cyst, paraovarian cysts, extra-ovarian en- nosarcomas). Enhancement, borders, T1 and T2 signal and dometrioma, ectopic pregnancy, appendiceal mucocele and diffusion weighted images could offer some clues to the diag- leiomyoma cystic degeneration; - Ovarian lesions: Funcional nosis of GS on MRI, which is also an useful tool for staging, cysts, hemorrhagic cyst, tubo-ovarian abscess, endometrio- guidance of treatment and follow-up. ma, mature cystic teratoma, fibroma, fibrotecoma, Brenner Responsible Author: marcela de mello semione tumor, ovarian fibromatosis and cystoadenofibroma; - Asso- Email: [email protected] ciated syndromes: Ovarian hyperstimulation syndrome and Keyword: Sarcoma,ginecológico polycystic ovarian disease/syndrome. Conclusion: In the management of patients with adnexal cysts, a multifactorial evaluation must be made, considering PD.02.028 clinical and radiological aspects. The radiologists must be OVARIAN ENDOMETRIOSIS: WHEN THINK ABOUT aware of the imaging features that suggests benign and ma- MALIGNANT TRANSFORMATION lignant lesions, in order to avoid unnecessary procedures or Authors: GONCALVES, F.C.; GONCALVES, V.C.; SILVA, recommend further investigation. L.N.M.; ABRAO, M.S.; DE MATTOS, L.A.; GONCALVES, Responsible Author: Brunna Oliveira M.O.C.
18 49th Sao Paulo Radiological Meeting Institution: DASA (DIAGNÓSTICO DA AMÉRICA) demonstrate, through high field MRI, the imaging aspects Introduction and objective(s): Endometriosis is a disease of the main alterations of the penis. that affects about 10% of women in reproductive age, being Method(s): Literature review and retrospective analysis of the ovarian endometriosis very frequent and a marker of deep cases of patients with penile abnormalities, obtained through infiltrating disease. Endometriosis may be a risk factor for MRI, of experience and/or of the authors' own files. The im- ovarian cancer, especially the subtypes: endometrioid ade- aging characteristics will be demonstrated by means of an- nocarcinoma and clear cells. Endometriosis associated with atomical sections, multiplanar reconstructions, volumetric ovarian cancer usually affects women 10-20 years younger acquisition and simplified pictorial schemes, sometimes com- than those without endometriosis, and early detection it is plemented by USG and retrograde uretrocistography. important for the best prognosis and possible preservation Discussion: The penis consists of paired corpora cavernosa of fertility. This study aims to demonstrate the various pre- dorsally, that attach to the ischial tuberosities, and a midline sentations of ovarian endometrioses with malignant transfor- corpus spongiosum ventrally, all enveloped by a strong fas- mations in transvaginal ultrasound and magnetic resonance cial sheath, the tunica albuginea. The corpora cavernosa are imaging, as well as discuss how to differentiate them from composed of venous sinusoids whose fill with blood during atypical benign conditions. erection, and the corpus spongiosum that surrounds the penile Method(s): Typical and atypical characteristics of ovarian urethra, forming the glans distally. At MRI, all these tissues endometriosis will be analyzed on ultrasound and magnet- have characteristic signal intensity, becoming an adjuvant in ic resonance, determining which findings are indicative of the evaluation of pathologies that affect the penis, in addi- malignant transformation or associated to benign conditions. tion to having become more available and widely accepted by Cases from our group, with more than 10 years of experience urologists. MRI has been shown to be superior in the locore- in the study of endometriosis, will be exposed from typical gional staging of neoplasms, as well as in the evaluation of ovarian endometriosis to those associated with cancer. albuginea tunica integrity and inflammatory / infectious con- Discussion: Typical ovarian endometrioses presents at ditions. In this study, we propose the mnemonic "PENIS T" ultrasound as cysts with thick content, fine dotted, being – P (prosthesis), E (stenosis), N (neoplasia), I (inflammation homogeneous (“frosted glass” aspect) or heterogeneous. and infection), S (sexuality), T (trauma, thrombosis and vas- When heterogeneous, there may be atypical findings such as cular disorders) – in order to establish a practical approach projections, thick septum or mural nodules. In these cases, for early diagnosis and possible differentials. we should think on malignant transformation, but discard- Conclusion: MRI in penile evaluation characterizes a high- ing benign conditions that may have a similar appearance, ly accurate and non-invasive method, providing a precise such as clots or infection. Color Doppler provides addition- definition of its anatomy, malignant neoplastic conditions al information in this differentiation. In magnetic resonance and benign alterations that affect it. Adequate positioning imaging, typical ovarian endometrioses presents as hyper- of the patient and standardized imaging protocols, as well signal cysts, relatively homogeneous, in T1 and hyposig- as radiologists’ familiarity, are imperative in obtaining di- nal ("shade") in T2 sequences, without enhancement by the agnostic images. paramagnetic contrast media. Atypical findings in ovarian Responsible Author: Lucas de Pádua Gomes de Farias endometrioses such as solid projections or mural nodules, Email: [email protected] enhanced by paramagnetic contrast media and restricted to Keyword: Pênis,Ressonância,Mnemônico water molecules diffusion, best observed in the subtraction sequences, should always be valued for the risk of associ- ated neoplasia. Conclusion: Imaging studies in patients with endometriosis are essential for early diagnosis and better prognosis. In the case of ovarian endometrioses, the radiologist must always LITERATURE REVIEW be attentive to the imaging findings in in order to detect neo- plasms in the early stages, allowing a more effective and less invasive treatment. POSTERS (PI) Responsible Author: Fernanda Gonçalves Email: [email protected] Keyword: Endometriosis,Ovarian,Cancer PI.02.003 PEYRONIE'S DISEASE: WHICH METHOD SHOULD PD.02.037 WE USE? MAGNETIC RESONANCE IMAGING OF THE Authors: TORRES, L.; HOHGRAEFE NETO,G.; BAR- PENIS: UNDERSTANDING THE METHOD AND TELS, R. ITS APPLICATIONS Institution: HOSPITAL MOINHOS DE VENTO - PORTO Authors: FARIAS, L.P.G.; MENEZES, D.C.; SANTOS, ALEGRE/RS J.M.M.M.; GUEDES, M.S., ARANHA, A.S. A brief description of the objective(s): We will report six Institution: HOSPITAL ALVORADA, AMERICAS cases of Peyronie's disease, with a brief review of its clinical SERVIÇOS MÉDICOS, SÃO PAULO/SP issues and imaging features, correlating radiography, ultra- Introduction and objective(s): The penis is a superficial sonography (US) and magnetic resonance imaging (MRI). organ in which many diseases can be seen or palpated and Additionally, we will discuss the differences between these is readily imaged at high resolution with ultrasonography imaging methods in the evaluation of Peyronie's disease and (US). Due to its excellent soft tissue contrast resolution, the main advantages of each. magnetic resonance imaging (MRI) is highly accurate in Description of the disease(s), method(s) and/or tech- the characterization of benign penile lesions and in the nique(s): Peyronie disease is a chronic inflammatory condi- staging of penile cancer, aiding in planning for conserva- tion that leads to fibrosis and focal thickening of the tunica tive management or surgical approach. This study aims to albuginea, being the most frequent cause of painful penile
Abstracts of Scientific Papers 19 induration, occurring in around 3% of males. The indurated heterogeneous signal suggesting bleeding. Both cases were area results in varying degrees of penile deformity with an confirmed by surgical biopsy. erection. Diagnosis is based on the medical history and a clin- Discussion and diagnosis: Hepatic adenomas are rare ical examination with plaque palpation. Imaging is often re- benign neoplasms, more common in women between 15 quired to evaluate the extension of the plaques, involvement and 45 years old and strongly associated with the use of of the penile septum and the relationship between the plaques oral contraceptives. HA is defined as the presence of ten and the penile vasculature. or more hepatic adenomas. Unlike solitary adenoma, this Discussion: Plaques from Peyronie disease are usually pal- condition may occur in the absence of predisposing factors pable and are visible on both US and MRI in the majority of and are related to a higher risk of complications such as cases. They may or may not calcify; if calcified, the plaque hemorrhage (63%) or malignant transformation in hepa- may also be visible on radiography and computerized to- tocellular carcinoma (HCC) (10%). In 50% of the cases, mography. In a recent study comparing US with MRI in 57 the patients are asymptomatic. In symptomatic patients, patients with palpable plaques, 68% of plaques were detect- the most common complaints are abdominal pain, palpable ed on the US and 61% on the MRI, although the difference mass, elevated liver enzymes and intraperitoneal hemor- was not significant. MRI is at least as sensitive as the US rhage. The differential diagnosis includes well differenti- in demonstrating extension of plaques and their relationships ated HCC with multiple hepatic metastases, hypervascular with adjacent structures. However, MRI has two potential metastases and hepatic epithelioid hemangioendothelia. roles in this setting. The first one is for detection of impalpa- Lesions are circumscribed, well defined, but not encapsu- ble plaques and the main indication is the accurate depiction lated, and can measure up to 20 cm. Treatment depends on of deformity, tunic thickness, plaque position, and cavernosal the symptoms, on imaging findings and on the number of diameter in cases in which surgery may be complex. For this adenomas. Symptomatic adenomas can be treated surgical- purpose, MRI is clearly superior to the US. Another benefit of ly or with ablation. MRI is the use of gadolinium-based contrast material to show Conclusion: HA is a rare condition that can evolve with active inflammation. complications such as hemorrhage and in more severe cases, Conclusion: Studies have been suggesting that MRI not malignant transformation into HCC. Asymptomatic patients only depicts the localization and extent of fibrous plaques should undergo follow up imaging to assess the stability of in patients with Peyronie's disease but also reveals the pres- old lesions and the appearance of new ones. ence of inflammation, making MRI the technique of choice Responsible Author: ALINE SERFATY for planning therapy and for evaluating the response to con- Email: [email protected] servative treatment. Keyword: adenomatose,RM,CHC Responsible Author: Louise Torres Email: [email protected] PD.02.038 Keyword: Genital system male,MRI,Ultrassonography,Ra- CASE REPORT: MAYER-ROKITANSKY-KUSTER- diography,Peyronie'sDisease HAUSER (MRKH) SYNDROME IN YOUR WAY ATYPICAL OR TYPE II Authors: OLIVEIRA, L.T.; MENEGASSI, D.; NETO, A. R.; FREITAS, R. P; BRAGA, F. D. C. B. Institution: FACULDADE DE MEDICINA DE SÃO JOSÉ CASE REPORT DO RIO PRETO (FAMERP) - HOSPITAL DE BASE A brief description of the objective(s): Describe the case of Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome in your way atypical or type II. DIGITAL PRESENTATION (PD) Clinical History: Female patient, 15 years, attended to the ER complaining of abdominal pain in the epigastrium for 4 days, progressive and moderate intensity associated PD.02.032 with oliguria and vomiting. During anamnesis, primary HEPATIC ADENOMATOSIS: DIAGNOSIS BY MAG- amenorrhoea was reported and, on physical examination, NETIC RESONANCE IMAGING AND REPORT OF presence of secondary sexual characters and the absence TWO CASES. of vaginal canal. The ultrasound showed hematometra and Authors: NETO, A. A. M.; SERFATY, A.; ANTUNES, E.; right kidney with signs of chronic nephropathy, not pos- FONSECA, C. F.; MENDES, R. M.; MARTINS, E. M. L. sible to characterize the cervix, the upper portion of the Institution: MEDSCANLAGOS vaginal canal and the left kidney. The MRI showed right A brief description of the objective(s): To demonstrate two kidney with signs of chronic neuropathy, hematometra, cases of hepatic adenomatosis (HA) in young patients and to haematosalpinx, unicornuate uterus, and absence of vag- discuss the magnetic resonance (MR) imaging aspects of this inal canal and left kidney. Echocardiogram with atrial rare condition. septal defect (ASD) communication type ostium secun- Clinical History: Patient 1: female, 38 years old, with dum and dilation of the coronary sinus. Chest radiograph no relevant previous pathological history, presenting with showed failure of fusion of the posterior elements on the abdominal pain in the right flank and normal physical ex- cervical vertebra C7. amination. Patient 2: female, 40 years old, presenting right Discussion and diagnosis: The absence of vaginal canal flank pain radiating to the back. She underwent ultrasonog- and the renal agenesis associated to Müllerian duct anom- raphy that showed multiple hepatic nodules. Both patients alies, vertebral and cardiac changes led to the diagnosis of underwent abdominal MRI that demonstrated multiple dif- MRKH type II. The MRKH is an unusual condition and fuse hypervascular nodular lesions (more than ten in case occurs at a ratio of 1:4500–5000 female neoborn, be- 1 and more than 20 in case 2), with early and persistent ing the second most frequent cause of primary amenor- contrast enhancement. Patient 1 also presented lesions with rhea. There are two subtypes of MRKH syndrome: Type
20 49th Sao Paulo Radiological Meeting I, with isolated uterine absence and type II, wich have Conclusion: The MRKH is a condition that must be known association with other gynecological abnormalities and by radiologists and ultrasonographers for a patient with pri- non-gynecological and incidence of 1:50.000 births. Re- mary amenorrhoea and secondary sexual characters, enabling nal malformations found involve unilateral agenesis, renal the search of that diagnosis or your replacement. hypoplasia, horseshoe kidney, ectopic kidney and hydro- Responsible Author: Letícia Tomaz Oliveira nephrosis. Bone malformations occur mainly on the ver- tebrae, being more common anomalies of segmentation. Email: [email protected] Cardiac and digital abnormalities, as syndactyly and poly- Keyword: Mayer-Rokitansky-Kuster-Hauser syndrome;,- dactyly, are rare. type II,Müllerian duct anomalies
HEAD AND NECK PICTORIAL ESSAY Conclusion: Our work demonstrates that "usual" H&N osse- ous lesions knowledge, with its peculiar image findings and the main differential diagnoses, is fundamental and necessary for the radiological practice. In addition, we emphasize the POSTERS (PI) importance of a detailed description of the potential func- tional repercussions, since they are fundamental for adequate clinical or surgical management on a case-by-case basis. PI.03.002 Responsible Author: Pedro Henrique Pereira Rocha "USUAL" HEAD AND NECK OSSEOUS LESIONS - A Email: [email protected] PICTORIAL REVIEW Keyword: Osteomas,síndrome de McCune-Albright,sín- Authors: ROCHA, P.H.P.; FRAGOSO, D.C.; REALI, R.M.; drome de Gardner,displasia fibrosa,excrecências ósseas JUNHO, F.F.; SARPI, M.; SOUZA, S.A.; GARCIA, M.R.T. Institution: DIAGNÓSTICOS DAS AMÉRICAS PI.03.005 Introduction and objective(s): Head and neck (H&N) bone ANATOMICAL VARIANTS OF THE PARANA- lesions are common in radiological practice. The purpose SAL SINUSES AND NASAL CAVITIES BY CT – of this paper is to review the "usual" H&N osseous le- A PICTORIAL ESSAY sions, describing the histological types with their imaging Authors: FRAGOSO, D.C.; GONÇALVES FILHO, A.L.M.; characteristics, sites (usual and sometimes infrequent), as- SCOPPETTA, T.L.P.D.; GARCIA, L.L.; MAIA JUNIOR, sociated syndromes and functional repercussions. A.C.M.; DA SILVA, C.J, TOYAMA, C. Method(s): We performed a pictorial study of selected cas- Institution: FLEURY MEDICINA DIAGNOSTICA es from our institution's database between 2016 and 2018. Introduction and objective(s): To review the sinonasal "Usual" H&N osseous lesions were defined as those com- anatomy and illustrate the main anatomical variants, em- monly observed in the radiological practice and usually do phasizing those with clinical and surgical relevance. not require a surgical approach due to their low biological ag- Method(s): A pictorial essay was carried out based on select- gressiveness, except when there was functional impairment. ed cases from our institution's database. The CT scans were Afterwards, we conducted a literature review with the key- evaluated for the presence of anatomical variants of the sin- words "osseous lesions" and "head and neck" in the digital onasal cavities. The prevalence as well as the main related library PubMed in the period of the last decade or attributed complications of each anatomical variation was Discussion: H&N osseous lesions represent a variety of verified through literature review. pathological processes. The most frequent causes, called Discussion: The paranasal sinuses present innumerable ana- "usual" in this pictorial study, were osteoma and fibrous dys- tomical variations, some of which are so common that they plasia (FD). According to the literature, osteoma is the most are most likely found in the majority of the population. It is frequent benign tumor, and can be observed in all parana- important to recognize and describe some anatomical varia- sal sinuses, nasal fossae and also in the other H&N skeletal tions due to the potential clinical (mainly as a complicating structures. Although of a "benign" nature, functional reper- factor of rhinosinuspathies) and surgical relevance, such as cussions of the drainage pathways may occur and should be sphenoethmoidal cells (Onodi), pneumatization of anterior readily recognized and described by radiologists. When mul- clinoid processes, supraorbital and infraorbital ethmoidal tiple, the possibility of Gardner's syndrome should be consid- cells (Haller), the pneumatization of the dorsum sellae, an- ered. FD may have a monostotic or polyostotic presentation, terior ethmoidal artery canal, and dehiscence of the lamina with the maxilla and mandible being the most affected sites. papyracea, especially in cases of surgical planning, since they The McCune-Albright syndrome is characterized by the tri- are related to a higher rate of intraoperative complications. ad polyostotic FD, precocious puberty and cafe au-lait spots. Conclusion: We briefly reviewed the sinonasal anatomy The mandibular, maxillary and palatine torus are densely by CT and illustrated anatomical variations with clinical mineralized bone excretions frequently observed in imaging and surgical relevance. The radiologist must be familiar examinations. Although they may determine functional re- with the complex sinonasal anatomy in order to mini- percussion, such as eating and drinking, they usually occur in mize potential complications. asymptomatic individuals. Responsible Author: Diego Fragoso
Abstracts of Scientific Papers 21 Email: [email protected] Introduction and objective(s): Ultrasonography (USG), Keyword: Seios da face,variações anatômicas,TC contrast X-ray (Sialography), multidetector computed to- mography (MDCT) and high field magnetic resonance im- PI.03.007 aging (MRI). The aspects of abnormalities and pathological conditions of the salivary glands, notably parotid and sub- INJURIES OF THE OCULAR GLOBE LAYERS: AN mandibular glands, were correlated with the sialo-resonance APPROACH TO DIFFERENTIAL DIAGNOSIS technique (Sialo-MR). Authors: PFLUCK, BPM.; YAMASHITA, HK.; WOLOS- Method(s): Retrospective analysis of cases with salivary KER AMB; BORRI ML; ABDALA N. gland alterations, with examination techniques and MRI Institution: UNIVERSIDADE FEDERAL DE SÃO PAULO. findings. A standard Sialo-RM series is based on the high in- DEPARTAMENTO DE DIAGNÓSTICO POR IMAGEM. trinsic signal of the most weighted T2-weighted sequences, Introduction and objective(s): Auto-immune, inflammato- called "hydrographic", of the fluid not inside the glandular ry, infectious and tumoral diseases can alter any of the three ducts. One strategy to increase the quality of the study and layers that compose the ocular globe. Most of the diagnosis allow a dynamic evaluation is the use of salivary stimulant in this context are usually based on clinical-ophthalmology (sialogogo), usually using citric acid (lemon juice). assessment. With the exception of B-scan ultrasonography, Discussion: Numerous pathologies determine the sensory current imaging methods for diagnosing and monitoring and functional changes of the salivary glands, infectious, are predominately non-radiologic. However, the radiolo- neoplastic and mainly obstructive. The focus on sialo-MR gists unfamiliarity with the main aspects of ocular injuries should be made to the new type of evaluation, the method on cross-sectional studies may lead to misdiagnosed cases. is non-invasive, non-user dependent, non-ionizing, with- Thickening and/or enhancement of the uveoscleral tract out the need for intravascular contrast, use of a saturated on computed tomography (CT) and magnetic ressonance assessment of glandular drainage ducts and when associ- (MR) can be an important clue to this pathologies. The pur- ated as conventional sequences, allows an evaluation of pose of this exhibit is to develop a practical approach for the parenchyma. differential diagnosis of the ocular globe layers injuries. Conclusion: Sialo-MR is a complementary method to the Method(s): We selected CT and MR images with abnormal- treatment, reinforcing the need for a radiologist to respond to ities of the retina and uveoscleral tract and correlated with their needs with the objective of contributing with adequate clinical, surgical and pathological correspondent database. diagnostic and conductive elucidation. Literature review were also performed. Responsible Author: Isadora Carvalho Queiroz Discussion: The globe consists of three primary layers: the Email: [email protected] sclera and cornea, the outer layer which protects the eye and Keyword: Sialo-RM;,Sialografia maintain its shape and pressure; the uveal tract, the middle vascular layer, which contains the choroid, ciliary body, and iris; and the retina, the sensory inner layer. Those layers are PD.03.011 difficult to distinguish at imaging, especially CT. On MRI, the COCHLEAR IMPLANT: WHAT THE RADIOLOGIST retina is in close apposition to the choroid and cannot be dis- SHOULD KNOW cerned separately, unless there is a detachment; the uveal tract Authors: TAMES, H.L.V.C.; OLIVETTI, B. C.; SARPI, M. appears hyperintense on T1 and hypointense on T2 images O.; GOMES, R.L.E.; GEBRIM, E.M.M.S. and the sclera and cornea, both composed of collagen, appear Institution: HOSPITAL DAS CLINICAS DA FACUL- hypointense on T1. As the uvea is the vascular coat of the eye, DADE DE MEDICINA DA USP there is normal physiologic enhancement with the adminis- Introduction and objective(s): The cochlear implant is a de- tration of intravenous contrast, particularly of the choroid. In- vice that processes sound in electric impulses and stimulates stead, a scleral enhancement is always abnormal. Uveoscleral directly the cells in the cochlea, being considered one of the layer injuries can range from uveitis, scleritis, endophthalmi- treatment options for moderate to profound deafness. The ob- tis, choroidal metastasis and choroidal melanoma. jectives of this poster are to review the anatomy relevant to Conclusion: The knowledge of the various etiologies related cochlear implant placement surgery and to demonstrate the to injuries of the ocular globe layers and its images character- expected post surgical findings, as well as the complications istics is important to avoid misdiagnosis and to allow precise of the surgical procedure. clinical evaluation. Method(s): Retrospective evaluation of computed tomogra- Responsible Author: BÁRBARA PEÑA MUJICA PFLUCK phy and magnetic resonance of patients that underwent sur- Email: [email protected] gery for cochlear implantation in our institution. Keyword: ocular,retina,esclera,uvea,TC,RM Discussion: The cochlear implant consists of an external component that composed of a sound processor and an in- ternal component formed by the electrodes. The surgery for cochlear implantation consists of a wall-up mastoidectomy DIGITAL PRESENTATION (PD) and cochleostomy with subsequent progression of the elec- trode through the turns of the cochlea for direct stimulation of organ of Corti cells. Imaging evaluation of the temporal PD.03.008 bone with a cochlear implant may be difficult due to beam EVALUATION OF SALIVARY GLANDS CORRELAT- hardening artifacts in CT and susceptibility artifacts in MR. ING THE TRADITIONAL METHODS WITH MR / SI- It is important to the radiologist to be familiarized with this ALRO-MR. type of exam to detect possible complications such as malpo- Authors: QUEIROZ, I.C; FAE, I.S.; FERREIRA, R.H.Q.;- sitioning of the electrode. FARIAS, L.P.G.; SALES, T.S.; MENEZES, D.C; RAIMUN- Conclusion: Cochlear implant is one of the treatment op- DO, E.C.; GUEDES, M.S. tions for moderate to profound hearing loss. Knowledge of Institution: HOSPITAL ALVORADA - AMÉRICAS the cochlear implant components, the surgical procedure SERVIÇOS MÉDICOS for cochlear implantation and the adequate positioning of
22 49th Sao Paulo Radiological Meeting the implant is important for the radiologist in the post sur- and traction. We intend to review and discuss some causes gical evaluation. of enophthalmos with typical CT and MR imaging findings. Responsible Author: Hugo Tames Method(s): We retrospectively selected CT and MR images Email: [email protected] of some patients with enophthalmos of our institutions de- Keyword: implante,coclear,temporal,ouvido scribing the main findings that might help to the etiologic diagnosis. PD.03.014 Discussion: Enophthalmos may present with variable signs and symptoms, but it is not always clinically evident. Patients LARYNGEAL CANCER STAGING: REVIEW OF complain of both cosmetic and functional issues, including CRUCIAL POINTS AND TOPOGRAPHIC ANATOMY asymmetric position of the eyes, deep superior sulcus, pseu- CORRELATION WITH ILLUSTRATIONS doptosis, diplopia, and dry eyes. Trauma is the most common Authors: ARAÚJO, A.I.R..; SARPI, M. O.; PETTENGIL, cause of structural changes, while other causes include: silent A.L.M., FRAGOSO, D.C., CINTRA, M.B., SOUZA, S. A.; sinus syndrome and congenital or iatrogenic defects in the GARCIA, M. R. T. greater wing of the sphenoid. Fat atrophy can occur in cases Institution: GRUPO DASA of senile enophthalmos, orbital varix, scleroderma with Par- Introduction and objective(s): Laryngeal neoplasms are ry-Romberg Syndrome (PRS), post-radiation, and lipodystro- among the most frequent head and neck cancers (almost phy (e.g. HIV-infected patients). Enophthalmos can also be 25%), especially squamous cell carcinomas (SCC), which caused by posterior traction, a mechanism seen in some or- represent more than 90%. These neoplasms usually affect pa- bital metastases. There are various conditions that frequently tients between 50-70 y/o, smokers and alcohol users, with a present as enophthalmos and it is very important to rule out higher prevalence in males. pseudoenophthalmos before investigation by measuring the The main objective of this pictorial essay is to demonstrate axial length of the globe. The approach to enophthalmos in- the laryngeal anatomy emphasizing the correlation between cludes a medical history, a complete ophthalmic and system- involvement of its structures to the cancer staging and to de- ic examination, as well as laboratory and imaging analysis. pict spread patterns of the disease. CT and MR are the most useful imaging tools to evaluate Method(s): Schematic drawings, computed tomography (CT) enophthalmos, providing a detailed view of the orbital anato- and magnetic resonance (MR) images of exams performed in my and structural abnormalities. Imaging also allows an ob- our service and stored in our digital archive will be used to illus- jective assessment and a more precise measurement of the trated the larynx anatomy and neoplasms stages. enophthalmos. Discussion: The majority of laryngeal neoplasms (notably Conclusion: We reviewed and discussed typical CT and MR SCC) are readily identified by endoscopy, and sectional im- imaging findings that helped in the correct etiologic diagnosis aging studies (CT and MR) contribute to the evaluation of of enophthalmos. The knowledge of the many possible caus- submucosal dissemination, loco-regional extent, nodal dis- es of enophthalmos and their respective imaging patterns is ease, systemic metastasis, synchronous tumors and recurrent crucial for the correct etiologic diagnosis. disease, leading to correct staging of the disease and prop- Responsible Author: Rafael Dais da Rocha er treatment management. CT and mainly MR studies with Email: [email protected] dedicated protocols can diagnose and assess extension of la- Keyword: Enophthalmos,Orbital trauma,Orbital varix- ryngeal neoplasms, and assist in the therapeutic planning of ,Parry-Romberg Syndrome,Orbital metastases,Silent sinus these patients. Some parameters such as tumor volume and syndrome,Magnetic Resonance Imaging,Computed tomog- cartilage abnormalities are useful in predicting use of radio- raphy,Enoftalmia,Trauma orbital,Variz orbital,Síndrome de therapy or surgery. In addition, imaging studies play an im- Parry Romberg,Metástases orbitais,Síndrome do seio portant role in follow-up during and after treatment. Conclusion: CT and MRI have an important complementary PD.03.017 role to the endoscopic study in laryngeal neoplasm staging. The detailed anatomical knowledge of laryngeal structures, ANOMALIES AND ANATOMICAL VARIANTS their correlation with neoplasm extension, as well as the use OF THE AORTIC ARCH AND ORIGIN OF THE of specific examination protocols are essential for an accurate NECK VESSELS staging and diagnosis of laryngeal neoplasms, contributing Authors: PEREIRA, M.F.P.;RAIMUNDO, E.C.; FARIAS, to the therapeutic management and definition of prognosis. L.D.P.G.D.; QUEIROZ, I.C.; FERREIRA, R.H.Q.; PEDRI, Responsible Author: Alan Iuno Rios Araújo A.F.; SALES, T.S.D.; FRANCA, A.H.; GUEDES, M.D.S. Email: [email protected] Institution: HOSPITAL ALVORADA / AMÉRICAS Keyword: Estadiamento,laringe,neoplasia SERVIÇOS MÉDICOS Introduction and objective(s): Anomalies and congenital variants of the aortic arch and its branches are relatively PD.03.016 frequent finding in the evaluation of imaging exams of the IMAGING OF ENOPHTHALMOS: A PICTORIAL ESSAY thorax and neck. They are usually incidental radiological Authors: ROCHA, R.D.; BAE, S.M.B.; OLIVETII, B.C.; finding, but they may present unspecific symptoms such as PASSOS, U.L.; GEBRIM, E.M.M.S.; DA SILVA, C.J; chest pain and dysphagia. Their diagnosis plays an import- TOYAMA, C. ant role in the evaluation of multiple diseases like vascular Institution: GRUPO FLEURY - HOSPITAL SÍRIO-LI- rings, congenital heart diseases, and chromosomal abnor- BANÊS malities. This study aims to demonstrate the embryology Introduction and objective(s): Enophthalmos is a posterior and anatomy of the aortic arch and its branches, the main displacement of a normal-sized globe in relation to the bony types of anomalies and congenital variants through Mul- orbital margin. It comes to the attention when unilateral, when tidetector Computed Tomography (MDCT) and Magnetic a difference of more than 2 mm between the two eyes can Resonance Imaging (MRI) angiography, highlighting the be considered diagnostic. Enophthalmos can be produced by main three-dimensional post-processing techniques, as three main mechanisms: structural abnormality, fat atrophy well as other less common malformations in this spectrum.
Abstracts of Scientific Papers 23 Method(s): Imaging features of the main types of anomalies Authors: PADILHA, I.G.; COSTA, E. A. V.; SOUZA, S. A.; and congenital variants of the aortic arch and its branches, SARPI, M. O.; GARCIA, M. R. T. including a rarer case in the literature, will be demonstrated Institution: DIAGNOSTICOS DA AMERICA (DASA) through MDCT and MRI angiography, three-dimensional Introduction and objective(s): The temporomandibular reconstructions and simplified pictorial schemes. joint (TMJ) is a synovial joint formed by the head of the Discussion: Congenital aortic arch malformations present a mandible, temporal eminence and articular fossa, with a large spectrum of variations and anomalies that originated complex rotation and translation dynamic. The set of clinical from disordered embryogenesis of branchial arches. These alterations is called temporomandibular dysfunction (TMD). variations result from abnormal persistence or involution of Internal disarrangement occurs in 28% of the population, es- embryonic vascular segments. pecially related to joint disc displacement. Conditions such These anomalies are relatively frequent findings in chest and as arthropathies and neoplasm may also affect TMJ. neck imaging studies. They are usually incidental radiologi- Method(s): Iconographic essay was performed including il- cal findings in asymptomatic patients but may present vague lustrative cases from our digital files in order to review and symptoms such as chest pain and dysphagia. illustrate temporomandibular joint (TMJ) anatomy and its Conclusion: Familiarity with the anatomy of the aortic arch disorders in different imaging methods (CT and MRI); Set and its main branches, congenital variants, and anomalies in up a practical approach (DIAGNOSE mnemonic) to improve chest and neck imaging is essential for accurate diagnosis and early diagnosis and differentials, therapeutic planning and classification, as it directly influences the prognosis and ap- prognosis. propriate management of the treatment. The new techniques Discussion: The integrity of TMJ is the result of a balanced (MDCT and MRI) allows that valuation type, without digital interaction of soft tissue and bone structures. Despite their angiography need. daily exposure to continuous use, severe changes in TMJ are Responsible Author: MARIA FERNANDA PINTO PEREIRA rare. What makes this joint unique is that the joint surfac- Email: [email protected] es are covered by fibrocartilage instead of hyaline cartilage. Keyword: arco,aórtico,anomalias,variantes,anatômicas,to- Internal disturbance is the most prevalent TMJ disease, and mografia,ressonância its pathophysiology is due to ligament relaxation associated with disc injuries. The most common pattern of disc dis- PD.03.019 placement is anterior and anterolateral, representing more than 80% of these. Many differentials must be included such KEEP YOUR MOUTH OPEN: IMAGING EVALUA- as neoplastic, inflammatory and, metabolic disorders. MRI TION OF DENTAL CONDITIONS is the method of choice for assessing presumed internal de- Authors: REALI, R.M.; AMANCIO, C.T.; JUNHO, F.F.; rangement and inflammatory arthritis and CT is indicated in TAMES H.L.V.C.; GARCIA, M.R.T; SOUZA, S.A.; SARPI, cases of trauma. M.O.; ROCHA, P.H.P. Conclusion: Detailed knowledge of the anatomy of TMJ is a Institution: DIAGNÓSTICOS DA AMÉRICA S.A. - DASA 'sine qua non' condition, for the radiologist to recognize the Introduction and objective(s): Dental affections are often most prevalent related conditions. It is necessary to know observed in the radiological routine of the general radiolo- the protocols of studies in MRI and CT, to direct the most gist and more commonly in the head and neck specialist and appropriate examination, according to the clinical suspicion, neuroradiologist. The purpose of this paper is to review the allowing the diagnosis of a faster and safer way for the pa- anatomy and illustrate common and uncommon cases of as- tient. It is essential to know the different bone, meniscal, lig- ymptomatic or severe dental conditions. ament, synovial and adipose changes that can occur in TMJ Method(s): A pictorial study of cases of dental affections, lesions, and are often subtle. The lack of valuation of the grouping them according to their etiology, such as develop- findings is the main responsible for the great clinical-radio- mental changes, inflammatory / infectious processes, focal logical discrepancy. lesions (sclerotic or lytic), post-traumatic lesions and after Responsible Author: Igor Gomes Padilha surgical procedures, including common surgical materials Email: [email protected] used for dental treatment. Illustrative and didactic schemes Keyword: ATM,MRI,TC will be included addressing the dental anatomy, as well as its counting in adult and childhood. PD.03.022 Discussion: Dental injuries, when not explicitly severe or symp- tomatic, are routinely ignored and not reported in the radiolog- MANY FACES OF GRANULOMATOUS LESIONS OF ical report. The ability to recognize and describe dental condi- HEAD AND NECK tions allows early referral to a dental specialist and appropriate Authors: LÔBO, C.F.T; DALPRÁ, F.A.R; GONCALVES, treatment in order to avoid pain and possible complications. V.T.; MURAKOSHI, R.W.; SARPI, M. DE O.; GOMES, Conclusion: Knowledge and recognition of dental injuries, R.L.E.; GEBRIM, E.M.M.S. as well as possible complications of surgical procedures, are Institution: INSTITUTO DE RADIOLOGIA DA FACUL- essential for an adequate radiological diagnosis and clinical DADE DE MEDICINA DA UNIVERSIDADE DE SÃO management. PAULO Introduction and objective(s): Granulomas are the con- Responsible Author: Raphael Reali sequence of an organized protective response of the or- Email: [email protected] ganism to persistent particulate stimuli, such as infections, Keyword: Alterações dentárias,Dentes,Imagem dos foreign bodies, neoplasms and inflammation. The spec- dentes,Anatomia dentária trum of clinical manifestations of granulomatous diseases (GDs) is variable, as they can affect different organs and PD.03.020 systems. The objectives of the presentation are: - Illus- BEYOND THE TEMPOROMANDIBULAR JOINT ( trate and discuss the most frequent radiological findings A JAW-DROPPING REVIEW) – ANATOMY, DISOR- of GDs affecting the head and neck, through an anatomical DERS AND POSTOPERATIVE FEATURES. approach; - Highlight the importance of the identification
24 49th Sao Paulo Radiological Meeting of the possibility of a GD by the radiologist, avoiding in- maneuver promotes hipopharynx distension and better visu- appropriate treatment. alization of the mucosa. Method(s): The authors present illustrative cases involving Conclusion: This pictorial essay will first detail the anatomy GDs of head and neck, with computed tomography and mag- of the hypopharynx and its particularities in different axial netic resonance imaging. imaging methods, explaining the modified Valsalva maneu- Discussion: Some of the diseases illustrated and discussed ver that is useful for a better evaluation of this region. Then are: - Sinonasal cavity: granulomatosis with polyangiitis, we will review the epidemiology, main features and staging paracoccidioidomycosis, invasive fungal infections, leish- (including the new 8th TNM classification of AJC) of the maniasis and Churg-Strauss syndrome. - Orbits: sarcoidosis, most common lesion of the hypopharynx, the squamous cell relapsing polychondritis and granulomatosis with polyangii- tumor, illustrated by CT and MRI cases of our service. Fi- tis - Temporal bone and base of the cranium: tuberculosis, nally, it will show some unusual lesions of the hypopharynx myiasis, candidiasis, granulomatosis with polyangiitis and to increase the diagnostic possibilities during the radiologists relapsing polychondritis. - Aerodigestive tract: granuloma- evaluation of hypopharynx diseases. tosis with polyangiitis, relapsing polychondritis, tuberculo- Responsible Author: Júlia Scomparin Magalhães sis, leishmaniasis, sarcoidosis, paracoccidioidomycosis and Email: [email protected] actinomycosis (jaw) - Lymph nodes: tuberculosis, paracoc- Keyword: Hipofaringe,HYPOPHARYNX,Modified Valsal- cidioidomycosis, cat scratch disease and sarcoidosis Some va maneuver,Tumor de células escamosas,Manobra de Val- miscellaneous disorders that involve granuloma formation salva modificada,Squamous cell tumor,Anatomia da hipofar- are also described, such as Rosai-Dorfman granuloma. Also, inge,Anatomy of the hypopharynx differential diagnosis of nasal septal perforation is illustrated. Conclusion: GDs are frequent considering head and neck pa- PD.03.027 thologies. The diagnosis involves the conjunction of clinical history, laboratory exams and imaging findings, which may PATHOLOGIES RELATED TO THIRD MOLARS: overlap, but some are more specific and may help the diagnosis. WHAT THE RADIOLOGIST SHOULD KNOW Responsible Author: Carlos Felipe Teixeira Lobo Authors: LOUREIRO, R. M.; RIBEIRO, S. P. P.; SUMI, D. Email: [email protected] V.; MURAKOSHI, R. W.; DALPRA, F. A. R.; LEMOS, M. Keyword: granuloma,cabeça,pescoço D.; TAMES, H. L. V. C.; SOARES, C. R.; GOMES, R. L. E; DANIEL, M. M. Institution: HOSPITAL ISRAELITA ALBERT EINSTEIN PD.03.025 Introduction and objective(s): Several pathologies related UNCOMPLICATING THE HYPOPHARYNX - ANAT- to third molars are observed in clinical practice, whose imag- OMY, LESIONS, AND STAGING ing findings may be challenging to radiologists unfamiliar to Authors: MAGALHÃES, J.S.; TAMES, H.; GARCIA, the subject. This pictorial essay aims to illustrate the imaging M.R.T.; SILVA, C. J.; OLIVETTI, B.; MURAKOSHI, R.; findings of multiple pathologies related to third molars. GOMES, R.; GEBRIM, E.M.M.S. Method(s): Review of the institution's digital file in search of Institution: INSTITUTO DE RADIOLOGIA DO HOSPI- affections related to third molars. TAL DAS CLÍNICAS DA FACULDADE DE MEDICINA Discussion: The most common pathologies related to third DA UNIVERSIDADE DE SÃO PAULO molars include developmental anomalies, inflammatory and Introduction and objective(s): The purpose of this exhibit infectious processes, cysts and tumors, trauma and postoper- is: 1. To detail the anatomy of the hypopharynx and its rela- ative complications. tion to adjacent structures. 2. To show imaging characteristics The third molar is the tooth most related to a failed eruption, of the hypopharyngeal squamous cell carcinoma through se- dentigerous cysts, compression of the inferior alveolar nerve, lected images of computed tomography (CT) and magnetic indication for extraction and development of pericoronitis. resonance (MRI). 3. To review the staging of hypopharyn- The location of its roots' apices, inferiorly to the milo-hyoid geal squamous cell carcinoma. 4. To make the radiologist line, allows the direct dissemination of periapical infectious familiarized to some uncommon lesions so they can be in- processes directly into the submandibular space. In addition, cluded among the diagnostic possibilities during the imaging the "puffed cheek" maneuver is useful to better characterize evaluation of hypopharynx diseases. the alterations in the soft parts adjacent to the teeth. Method(s): Selected cases of normal anatomy and cancer of Conclusion: Knowledge of the imaging findings of diseases the hypopharynx extracted from our institution database will related to third molars is fundamental for accurate diagnosis be presented. and correct management of these patients. Discussion: The hypopharynx is a part of the digestive Responsible Author: Rafael Maffei Loureiro tract that lies between the plane of the hyoid bone and the Email: [email protected] cricopharyngeal muscle, communicating inferiorly with the Keyword: dente,pericoronarite,exodontia,molar,dentígero esophagus. It is constituted by two pyriform sinus, post- cricoid area and posterior wall. Squamous cell carcinoma (SCC) is the most common tumor of the hypopharynx, and PD.03.029 its most frequent location is in the pyriform sinus. The prog- WHY DO I NEED TO KNOW THAT? A PRATICAL nosis of epidermoid carcinomas of the hypopharynx is poor, APPROACH TO EXTERNAL, MIDDLE AND INNER with early lymph node metastases and distant metastases EAR ANATOMY in 20-40% of cases at diagnosis. Tumors originating from Authors: TAMES, H. L. V. C.; SUMI, D. V.; LOUREIRO, minor salivary glands, lymphomas, sarcomas, lipomas, pap- R. M.; MURAKOSHI, R. W.; LEMOS, M. D.; DALPRA, F. illomas and leiomyomas may be found at a lower frequency. A. R.; SOARES, C. R.; GOMES, R. L. E.; DANIEL, M. M. The hypopharynx is usually collapsed. We should look at Institution: HOSPITAL ISRAELITA ALBERT EINSTEIN the intramural fat planes that surround the mucosal surface, Introduction and objective(s): To review the anatomy and the obliteration of these plans may suggest infiltrative of the external, middle and inner ear, using a practical ap- injury. The acquisition of images with the modified Valsalva proach on how different anatomic structures can be involved,
Abstracts of Scientific Papers 25 demonstrating the relevancy of anatomic knowledge in the memorize the preoperative evaluation of otosclerosis. diagnosis of multiple diseases. Responsible Author: Ramón Moura dos Santos Method(s): Retrospective evaluation of computed tomogra- Email: [email protected] phy and magnetic resonance of patients that underwent tem- Keyword: otosclerosis,imaging,treatment,complications poral bone exams in our institution. Discussion: The ear presents a complex anatomy and is di- PD.03.034 vided in external, middle and inner ear, which presents further UNCOMMON LESIONS OF THE EXTERNAL AUDI- subdivisions. The external ear is composed by the auricular pavilion and the external auditory canal, divided in fibrocar- TORY CANAL: A PICTORIAL ESSAY tilaginous and osseous portions. The middle ear is subdivided Authors: OLIVETII, B.C.; DA SILVA, C.J.; TOYAMA, C.; in epitympanum, mesotympanum and hypotympanum, and DUTRA, B.G. contains the ossicular chain. The inner ear is formed by the Institution: FLEURY MEDICINA E SAÚDE otic capsule, that contains the membranous labyrinth. Knowl- Introduction and objective(s): The external auditory canal edge of the anatomy is relevant for the adequate description is a structure that extends from the auricle to the tympanic of involved structures in a disease and also to perform the membrane, divided in two portions: a fibrocartilaginous (1/3 best diagnostic hypothesis. lateral) and an osseous (2/3 medial), and measuring 2-3 cm Conclusion: Temporal bone anatomy can be challenging in length and 0,7-1 cm in diameter. Congenital, inflammato- for the general radiologist due to the small dimensions of its ry, neoplastic, vascular and traumatic lesions can affect the structures. Knowledge of the normal anatomy is crucial for EAC. In this study, we will show uncommon and rare lesions the radiologist to be able to identify what is altered. affecting the EAC. Responsible Author: Hugo Tames Method(s): We collected several cases from the archives of Email: [email protected] the authors' institution to this pictorial essay. Keyword: temporal,cabeça,pescoço,orelha Discussion: Most of the ECA lesions can be diagnosed clinically; however imaging is useful to evaluate the ex- tent of the pathology, make differential diagnosis, rule out PD.03.032 complications and pre surgery work-up. The EAC is a very IMAGING EVALUATION OF OTOSCLEROSIS: infrequent location of schwannomas, but schwannomas rep- WHAT THE OTOLOGIST NEEDS TO KNOW resent 25 to 45% of the head and neck tumors, mostly from Authors: SANTOS, R. M.; GONÇALVES, V. T.; MORE- the vestibulococlear nerve. Cappilary hemangioma is a vas- NO, R. A.; SOUZA, J. C. R.; TOYAMA, C.; GOMES, R. L. cular tumor more common in young children that progres- E.; GEBRIM, E. M. S. sively disappears before the ages of 5-6 years, but they are Institution: INSTITUTO DE RADIOLOGIA (INRAD) very rare in the ECA. When they occur in temporal bone, is DO HOSPITAL DAS CLÍNICAS (HC) DA FACULDADE generally in the fifth decade, and are twice more common DE MEDICINA DA UNIVERSIDADE DE SÃO PAULO in males than in females. Temporal bone osteoradionecrosis (FMUSP) is an uncommon but severe complication of radiotherapy, Introduction and objective(s): Otosclerosis is an osteo- and radiologists should define the extent of temporal bone dystrophic disorder of the otic capsule and is a cause of con- involvement, that can be very subtle in the beginning, while ductive, mixed or sensorineural hearing loss. It is believed evaluating for potential complications. Barotrauma is due to originate in cartilaginous remnants within the endochon- a subtle change in pressure, and can occur in diving sports, dral layer of the otic capsule. The objectives of this presen- aviation and hyperbaric-oxygen therapy. Imaging studies tation will be describe the imaging findings of fenestral and are mandatory to differentiate two common lesions of the retrofenestral otosclerosis, discuss post-treatment compli- EAC, that can occur together, the malignant otitis externa cations of stapes prosthesis and orientate the radiologist in and carcinoma. what the otologist needs to know in CT and MRI of patient Conclusion: Imaging studies are often indicated for sever- with otosclerosis. al pathologies of the external auditory canal, and radiologist Method(s): This is a retrospective study with some patients should evaluate the extent of the pathology, make differential retrieved from our database diagnosed with otosclerosis be- diagnosis and rule out complications. tween January 2013 and December 2018. The images were Responsible Author: Bruno Casola Olivetti obtained on magnetic resonance imaging (MRI) and mult- Email: [email protected] slice computed tomography (CT) scanner. Keyword: Conduto,auditivo,externo,CAE,ossos,temporais,- Discussion: Imaging has an important role in the diagno- mastoide sis and postsurgical management of otosclerosis. Thin-sec- tion CT of the temporal bone is the modality of choice for assessment of the bone labyrinth. MRI has limited appli- PD.03.037 cation, but it is important in the evaluation of the disease AN UPDATE IN PARATHYROID IMAGING activity. The treatment of fenestral otosclerosis is primarily Authors: TAMES, H.; SOUZA, S.A.; SARPI, M.O.; GAR- surgical with stapes reconstruction. Familiarity with the CIA, M.R.T. imaging findings of otosclerosis and post-treatment com- Institution: DASA plications of stapes prosthesis will enable the radiologist to Introduction and objective(s): To review the anatomy and assist the otologist in identifying patients in whom revision embriology of the parathyroid glands, the causes of prima- surgery is most appropriate. ry hyperparathyroidism and to provide an update in imaging Conclusion: Imaging is essential in the management of oto- evaluation of the lesions of these glands that promote hyper- sclerosis by the otologist. CT of the temporal bone is the parathyroidism. modality of choice and plays a role in the diagnosis and ex- Method(s): Analysis of computed tomography clusion of similar clinical situations. In the stapes surgery fail- and magnetic resonance of patients with primary ure, it assists in the identification of complications and leads hyperparathyroidism. to retreatment options. We propose the mnemonic FROGS to Discussion: The ultrasound and scintigraphy are consolidat-
26 49th Sao Paulo Radiological Meeting ed methods of primary hyperparathyroidism evaluation. This Method(s): CT and MRI scans of patients with CS lesions disease evaluation through 4D CT is importante, specially in were retrospectively analyzed. CS lesions were didatically cases of negative exams or post-surgical patients. classified into neoplasic, inflammatory/infectious, vascular Conclusion: There is not yet a stabilished algorithm for and miscellaneous. Important clinical and epidemiological evaluation of primary hyperparathyroidism. With increase of data were also collected in the diagnostic elucidation. Some these exams and advancement of minimally invasive surgery, radiological aspects are similar in several lesions or even it is important for the radiologist to familiarize with the dif- nonspecific, so the most characteristic aspects were empha- ferent methods of evaluation of this entity. sized to narrow the spectrum of differential diagnoses. Responsible Author: Hugo Tames Discussion: CS is located around the pituitary gland and the Email: [email protected] body of the sphenoid bone, between the endosteal and menin- Keyword: paratireoide,pescoço geal layers of the dura mater. It expands from the orbital apex to the petrous apex. The CS transmits multiple cranial nerves PD.03.040 to the superior orbital fissure and round foramen, in addition to containing vital vascular structures, such as the internal SKIN TUMORS OF THE HEAD AND NECK - PICTO- carotid artery. The main neoplasic pathologies include me- RIAL ESSAY tastases, which may be hematogenic or perineural dissemi- Authors: GONCALVES, V.T.; MORENO, R.A.; KASE, M.; nation; neural sheath lesions, such as the schwannomas, es- SARPI, M.O.; GARCIA, M.R.T.; SILVA, C.J.; GEBRIM, pecially of the trigeminal; meningiomas and hemangiomas. E.M.M.S.; GOMES, R.L.E. The vascular lesions addressed are CS thrombosis, carot- Institution: INSTITUTO DE RADIOLOGIA (INRAD) - id-cavernous fistulas and lesions originating from the internal HOSPITAL DAS CLINICAS DA FACULDADE DE ME- carotid artery, such as aneurysms. Inflammatory / infectious DICINA DA USP (HCFMUSP) diseases include a wide differential diagnosis, including fun- Introduction and objective(s): Cutaneous and subcutaneous gal, bacterial and viral infections (such as herpes zoster), as lesions are extremely frequent in clinical practice and many well as granulomatous diseases. The disease related to IgG4 of them are incidentally identified in imaging studies. In was classified in the miscellaneous group because it does not some cases, the imaging characteristics allow the definitive have the etiological mechanism totally clarified. Finally, we diagnosis, but in many cases its appearance is not specific. emphasize the importance of recognizing the other pathol- Nevertheless, the correlation of the imaging findings with ogies that mimic diseases originating in CS, such as those the clinical data may narrow the diagnostic possibilities. The originating in structures that contiguous with CS. purpose of this pictorial essay is to demonstrate the appear- Conclusion: It is important to report the type of CS injury, its ance of some skin tumors and to discuss the radiologist's role relation to neurovascular structures and its extension to ad- in the evaluation of these lesions. The new TNM classifica- jacent tissues. These findings are essential in the therapeutic tion (8th Edition) regarding Merckel cell carcinoma and mel- decision as microsurgery, radiotherapy, drug treatment and anoma will also be discussed. surgical planning. Method(s): Computed tomography (CT) and magnetic reso- Responsible Author: Camila Vilela de Oliveira nance (MR) images from our institution will be used to illus- Email: [email protected] trate cases of skin tumors of the head and neck. Keyword: cavernoso,cavernous,head,neck,schwannom- Discussion: Radiologists often deal with skin lesions, both in- a,meningioma,hemangioma,igg4 cidentally and in dedicated studies for diagnostic investigation of involvement of deep planes and adjacent structures, as well PD.03.042 as staging malignant neoplasms. Some of the skin tumors may have important specific findings on imaging. In addition, imag- HEAD AND NECK MANIFESTATIONS OF RELAPS- ing methods play an important role not only in diagnosis, but ING POLYCHONDRITIS. also in the therapeutic planning and follow-up of these patients. Authors: MORENO, R.A.; GONÇALVES, V.T.; SANTOS, Conclusion: It is essential that radiologists recognize pat- R.M.; SARPI, M.; TOYAMA, C.; MURAKOSHI, R.W.; terns of skin tumors to adequately assess these head and neck GOMES, R.L.L.; GEBRIM, E.M.M. lesions and provide relevant information in the reports, given Institution: INSTITUTO DE RADIOLOGIA DO HOSPI- the role of radiology in the management of these patients. TAL DAS CLÍNICAS DA FMUSP Responsible Author: Vinícius Trindade Gonçalves Introduction and objective(s): Relapsing polychondritis Email: [email protected] (PR) is a rare multi-systemic disease, characterized by recur- Keyword: neoplasia,dermatologia rent inflammation of cartilaginous and proteoglycan-rich structures, probably with an autoimmune etiology. Diverse head and neck organs are essentially cartilaginous, so most PD.03.041 of the clinical manifestations of PR could manifest on those PRACTICAL GUIDE TO CAVERNOUS SINUS LESIONS anatomical sites. In addition, five of the six Mac Adam di- Authors: OLIVEIRA, C. V.; VIEIRA, A. P. F.; PASSOS, U. agnostic criteria compromise head and neck structures, as L.; GODOY, L. F. S.; LEITE, C. C.; GEBRIM, E. M. S. known: bilateral auricular chondritis, nasal chondritis, ocular Institution: HOSPITAL SÍRIO-LIBANÊS, SÃO PAULO - inflammation, superior respiratory tract chondritis and ves- BRASIL. tibulocochlear dysfunction. Introduction and objective(s): Cavernous sinus (CS) le- The aim of this presentation is to review and illustrate the sions include a heterogeneous group of pathologies in which main imaging findings of the intra-orbital, nasal, auricular, early detection and diagnosis are often challenging in medi- external auditory canal, pharynx, larynx and vestibulocochle- cal practice. In order to facilitate the recognition of the main ar system of PR manifestations. diseases that affect SC, the objective of this study was to per- Method(s): The included patients were retrospectively se- form a systematic imaging approach, using anatomical and lected from our digital archive and had a confirmed diagnosis radiological aspects, through cases that are representative of of PR, either clinically and/ or by laboratory and / or histo- the main CS lesions. pathological analysis. Illustrative images are high resolution
Abstracts of Scientific Papers 27 computed tomography (CT) and / or magnetic resonance im- PD.03.044 aging (MRI) of 1.5 or 3 tesla (T). THE ROLE OF IMAGING AND THEIR RECENT AD- Discussion: According to reports, about 50% of patients VANCES IN THE DIFFERENTIAL DIAGNOSIS OF present auricular chondritis or systemic arthropathy; how- THE MAIN INFLAMMATORY AND INFECTIOUS ever, with disease progression, most of them develop about ORBITAL CONDITIONS. four of the six diagnostic criteria. PR may also manifest Authors: MORENO, R.A.; GONÇALVES, V.T.; SANTOS, by nonspecific symptoms, commonly observed in another R.M.; TOYAMA, C.; OLIVETTI, B.C.; GARCIA, M.R.T.; high prevalent conditions. For example, cases of odyno- GOMES, R.L.L.; GEBRIM, E.M.M. phagia related to Eustachian tubes and adjacent structures Institution: INSTITUTO DE RADIOLOGIA DO HOSPI- inflammation in PR may mimicks a viral tonsillitis. TAL DAS CLÍNICAS DA FMUSP Conclusion: Therefore, it is imperative that radiologists must Introduction and objective(s): Orbit and the surrounding be familiar with the main manifestations of PR, especially tissues may be affected by five major types of pathophys- on its initial phases. One should include PR as a differen- iological processes, distinctly or combined: inflammatory tial diagnosis of another common diseases, in order to direct / infectious diseases; structural abnormalities (acquired or the rest of the complementary investigation and to optimize congenital); vascular lesions; degenerative processes and treatment, reducing permanent damage rates. Inadequate storage diseases. Inflammatory / infectious processes ac- treatment may lead to permanent cartilage destruction and count for about 60% of the primary orbital diseases and can severe dysfunction. manifest in the acute setting, in the emergency context; in- Responsible Author: RAQUEL ANDRADE MORENO sidiously or chronically. This presentation aims to highlight Email: [email protected] the main findings in computed tomography (CT) and mag- Keyword: policondrite,recidivante,cabeça,e,pescoço,auric- netic resonance imaging (MRI) of each orbital inflamma- ular chondritis,nasal chondritis,ocular inflammation,superior tory and infectious diseases, according to their etiology and respiratory tract chondritis,vestibulocochlear dysfunction. anatomical affected site. Method(s): We reviewed the main acute and subacute infec- tious processes (pre and post septal cellulitis, endophthalmitis, PD.03.043 scleritis, uveitis, dacryocystitis) and diverse etiological inflam- PATTERNS OF MUSCULAR DENERVATION IN THE matory processes (idiopathic orbitopathies, pseudotumor orbital, HEAD AND NECK - PICTORIAL ESSAY Wegner's granulomatosis, sarcoidosis, Vogt- Konayagi-Harada, Authors: GONCALVES, V.T.; KASE, M.; MORENO, R.A.; optic neuritis, relapsing polychondritis). OLIVETTI, B.C.; MURAKOSHI, R.W.; GARCIA, M.R.T.; Discussion: Imaging play a key role in the characterization GOMES, R.L.E.; GEBRIM, E.M.M.S. of the main orbital inflammatory and infectious diseases Institution: INSTITUTO DE RADIOLOGIA (INRAD) - collaborating for the etiological elucidation and appropriate HOSPITAL DAS CLINICAS DA FACULDADE DE ME- treatment of them, together with the clinical data. DICINA DA USP (HCFMUSP) The recent use of advanced techniques, especially in mag- Introduction and objective(s): Many diseases of the head netic resonance imaging (MRI), has increased the accuracy and neck occur with involvement of cranial nerves, which can of such methods, with analysis of diffusion and volumetric result in muscular denervation. Muscles that undergo dener- sequences (3D CISS) essential for acurate diagnosis. vation process have a predictable sequence of changes on im- Conclusion: Radiologists must be familiar with the specific- aging, especially in MRI. The objective of this pictorial essay ities of each condition of the broad spectrum of inflammatory is to demonstrate the image appearance of the patterns of mus- and infectious orbital diseases, collaborating on narrowing cular denervation in the head and neck and to review import- the differential diagnosis and for the rapid onset of the most ant anatomical concepts for the recognition of these patterns. appropriate treatment. Method(s): Magnetic resonance (MR) and computed tomog- Responsible Author: RAQUEL ANDRADE MORENO raphy (CT) images of patients from our institution's digital Email: [email protected] archive will be used to illustrate cases of muscular denerva- Keyword: processos,inflamatórios,infecciosos,das,estrutu- tion secondary to cranial nerve dysfunction. ras,intraorbitárias Discussion: The recognition of muscular denervation pat- terns is fundamental in the diagnostic reasoning, since they denote involvement of the neural pathway, aiding in the de- tection of lesions and in the evaluation of perineural dissem- ination of tumors and inflammatory processes. In addition, it LITERATURE REVIEW helps to reduce diagnostic errors, since the process of mus- cular denervation, especially in the acute phase, can simulate other muscular abnormalities. POSTERS (PI) Conclusion: It is critical that radiologists recognize the anat- omy of cranial nerves and muscle denervation patterns in or- der to adequately assess lesions that affect neural pathways PI.03.001 and to provide relevant information in the reports, given the DUAL-ENERGY COMPUTED TOMOGRAPHY FOR role of radiology in the evaluation of these lesions. LARYNGEAL CANCER STAGING Responsible Author: Vinícius Trindade Gonçalves Authors: HONDA, N.B.; FURLAN, M.V.; GRAVINATTI, Email: [email protected] M.C.; MELLO, S.M.B. Keyword: Denervação,Atrofia Institution: HOSPITAL BENEFICÊNCIA PORTUGUESA DE SÃO PAULO (MED IMAGEM) A brief description of the objective(s): The aim of this re- view is to demonstrate the use of dual-energy (DE) comput-
28 49th Sao Paulo Radiological Meeting ed tomography (CT) for laryngeal cancer staging in patients ing of the brain revealed a mucosal thickening in the pe- with nonossified thyroid cartilage. ripheral aspect with T2 hypointense centre in the right con- Description of the disease(s), method(s) and/or tech- cha bullosa and no enhancement on T1-weighted images. nique(s): We analyzed three cases of patients who underwent The histopathological examination reported a fungal infec- DECT for laryngeal cancer staging. tion (aspergillosis). Discussion: The evaluation of nonossified thyroid cartilage Discussion and diagnosis: Concha bullosa is the pneuma- invasion with conventional CT can be very challenging for tization of the concha and is one of the most common vari- radiologists, as iodine-enhanced tumor and nonossified car- ations of the sinonasal anatomy. Fungus balls are non-inva- tilage may have the same CT values and therefore indistin- sive accumulations of dense fungal concretions that generally guishable shades of grey. The importance of this distinction affect healthy individuals and exhibit a female predominance. involves choosing the appropriate treatment strategy, as Fungus balls are usually found as an isolated collection in when there is thyroid cartilage invasion (T4a stage), total one sinus. In the sinonasal region, they occur most frequently laryngectomy is indicated. TCDE allows the distinction in the maxillary sinus. Although paranasal sinus involvement of materials with different molecular composition, based with mycotic infection is well known, a fungus ball in the on the principle that materials behave differently when concha bullosa is unusual, with only a few reported cases. CT exposed to x-rays photons with different energies. Scans is the most common method of diagnosing fungal infections, were obtained using a dual-source CT and post-processing as it is for other types of sinonasal pathology. The most com- techniques were applied, so weighted-average images (WA) mon CT appearance of fungus balls is partial or complete, are reconstructed and thereafter images with a color-coded heterogeneous opacification of the involved sinus, often with iodine distribution (IO) are created. After a lesion has been calcified material. This aspect was similar to that observed in evaluated as positive for cartilage invasion on WA images, the presented case. the iodine distribution on the IO images is examined to de- Conclusion: Although rare, fungus balls should be con- rive a final classification of either positive or negative. It is sidered in the differential diagnosis of middle turbinate pa- considered positive when IO images show a corresponding thology. Fungal balls may be suspected in a concha bullosa area of tumor cartilage invasion as a red-colored area and it that presents hyperdense content with central calcifications, is considered negative when there is no corresponding area marked hypointense on T2 and no enhancement by contrast. on IO images. Responsible Author: JORGE TOMIO TAKAHASHI Conclusion: Combined analysis of WA and IO images can Email: [email protected] improve the diagnostic performance in laryngeal cancer Keyword: BOLA,FÚNGICA,CONCHA,BOLHOSA,SI- staging over conventional CT, as it allows the distinction NUSITE between iodine- enhanced tumor and nonossified thyroid cartilage, which was illustrated in the cases analyzed in this PD.03.010 study. Since treatment is decided according to the tumor TEMPOROMANDIBULAR ARTHROSIS, A RARE extension, imaging plays a crucial role in the management CAUSE OF MIDDLE CRANIAL FOSSA EPIDURAL of these patients. EFFUSION. Responsible Author: Natasha Benitah Honda Authors: ROCHA, R.D.; BAE, S.M.B.; FRAGOSO, D.C.; Email: [email protected] SCOPPETTA, T.L.P.D.; DA SILVA, C.J, TOYAMA, C. Keyword: Laryngeal cancer,dual-energy CT,staging Institution: GRUPO FLEURY A brief description of the objective(s): To describe epi- dural effusion at the base of the middle cranial fossa sec- ondary to temporomandibular arthrosis with joint effusion in two patients. CASE REPORT Clinical History: Female, 76 years old, presenting with right retroauricular region and temporomandibular joint (TMJ) pain. Female, 67 years old, with left ear pain irradiated to the frontal region. Both cases showed unilateral epidural fluid DIGITAL PRESENTATION (PD) collection at the base of the middle cranial fossa demonstrat- ed by magnetic resonance imaging (MRI), characterized by T1 hyposignal, T2 hypersignal, no diffusion restriction and PD.03.009 peripheral gadolinium enhancement, associated with degen- AN UNUSUAL CASE OF FUNGUS BALL IN CONCHA erative changes, synovitis and joint effusion in the underlying BULLOSA TMJ. Temporal bone discontinuities were depicted in both Authors: TAKAHASHI, J. T.; FERNANDES JR, W. R.; LEM- cases by MRI or computed tomography. OS, M. D.; ALVES, H. C. B. R.; DA SILVA, C. J., TOYAMA, C. Discussion and diagnosis: Temporomandibular joint dys- Institution: FLEURY function (TMD) arises from a set of disorders affecting the A brief description of the objective(s): We report the im- TMJ, a common condition attributed to abnormal interaction agings characteristics of an unusual case of a fungus ball in of the articular disc, condyle, mandibular fossa and articular the concha bullosa, without involvement of the paranasal si- tubercle. Associated clinical features include joint pain and nuses. clicking. TMJ aseptic effusion, with intracranial extension Clinical History: A 66-year-old woman presented with through temporal bone discontinuity (TBD) is rare according complaints of headache and nasal obstruction. The patient to our literature review. Differential diagnosis which should had a history of recurrent sinusitis. Computed tomography be ruled out is epidural empyema. Clinical picture and diffu- (CT) of the paranasal sinuses demonstrated a polypoid hy- sion restriction are the main elements for the differentiation perdense lesion with slight central microcalcifications in the between these conditions. The identification of an epidural right middle turbinate. The lesion was expansible with no effusion at the base of the cranial fossa, associated with TMJ bone lysis or demineralization. Magnetic resonance imag- arthrosis and joint effusion were the determining signs for
Abstracts of Scientific Papers 29 TBD suspicion, being even determinant for a complementary marked pneumolabyrinth. Second patient: a 56 year-old tomographic study request for one of the patients, which pre- man with right hearing loss and vertigo. He reports trauma cisely demonstrated the bone discontinuity. with cotton swab in childhood. Temporal bone CT images Conclusion: We describe two patients with epidural effu- showed stapes crura within the vestibule. sion at the base of the middle cranial fossa secondary to TMJ Results and discussion: Ossicular injuries represent a com- arthrosis with joint effusion. Temporal bone discontinuity plication of temporal trauma, and the ossicular chain may be search, including with supplementary CT scan if necessary, interrupted at various sites. In patients with temporal trauma, should be actively sought, this being the main clue to deter- mine a cause-and-effect relationship between the TMJ arthro- conductive hearing loss is the most common consequence of sis and the epidural effusion. this type of injury. Dislocations are more frequent than ossic- Responsible Author: Rafael Dais da Rocha ular fractures. There are five types of dislocation: incudoe- Email: [email protected] stapedial joint, incudomalleolar joint, incus, incudomalleolar Keyword: Temporomandibular joint,Temporomandibular complex, and stapediovestibular joint dislocations. Ossicu- joint arthrosis,Middle cranial fossa Effusion,Magnetic reso- lar fractures are uncommon. Stapediovestibular dislocation nance imaging,Computed tomography,Articulação temporo- is rare because the annular ligament firmly attaches the sta- mandibular,Artrose da articulação temporomandibular,E- pes to the oval window. Penetrating insults from the external fusão da fossa craniana média,Ressonância magnét auditory canal (cotton swab trauma) can displace the stapes through the oval window into the vestibule (internal disloca- PD.03.023 tion). The symptoms are usually vestibulocochlear, such as TRAUMATIC STAPEDIOVESTIBULAR DISLOCA- sensorineural hearing loss, tinnitus and vertigo. The precise TION SECONDARY TO COTTON SWAB USE diagnosis is important for clinical and surgical treatment. Authors: FERNANDES JUNIOR, W. R.; TAKAHASHI, J.T.; Conclusion: Direct trauma caused by cotton swab in the ex- LEMOS, M.D.; FILHO, A.L.M.G.; SILVA, C.J.; TOYAMA, C. ternal auditory canal is a cause of stapediovestibular disloca- Institution: FLEURY MEDICINA E SAUDE tion, which can be diagnosed by CT. Pneumolabyrinth may A brief description of the objective(s): We describe the im- be associated. aging findings of stapediovestibular dislocation secondary to cotton swab trauma in two patients. Responsible Author: WILSON RODRIGUES FER- Clinical History: First patient: a 23 year-old man with NANDES JUNIOR dizziness, headache and left hearing loss after cotton swab Email: [email protected] trauma 3 weeks ago. Temporal bone CT images showed Keyword: TRAUMA,STAPEDIOVESTIBULAR,DISLO- dislocation of the stapes into the vestibule associated with CATION
CARDIOVASCULAR PICTORIAL ESSAY ditions of the IVC using multidetector computed tomography (MDCT) and high field magnetic resonance imaging (MRI). Method(s): Literature review and retrospective analysis of patients with congenital anomalies and pathological condi- DIGITAL PRESENTATION (PD) tions of the IVC evaluated by MDCT and/or high field MRI, including new techniques, such as the injection of the con- trast medium by the pedis veins, allowing a venous system PD.04.007 evaluation of the lower limbs. NEW IMAGES IN THE EVALUATION OF THE INFE- Discussion: IVC is divided into hepatic, suprarenal, renal RIOR VENA CAVA: STATE OF THE ART and infrarenal segments, which have different embryological Authors: FARIAS, L.P.G; MENEZES, D.C; FAÉ, I.S.; origins (right vitelline, right subcardinal, right supracardinal PEREIRA, M.F.P; PEDRI, A.F.; QUEIROZ, I.C.; GALON, and posterior cardinal veins) established from a sequence of M.V.; GUEDES, M.S. vascular formations, anastomoses and regressions between Institution: HOSPITAL ALVORADA, AMERICAS the 4th and 8th weeks gestation. Most anomalies are inciden- SERVIÇOS MÉDICOS, SÃO PAULO/SP tal findings, but may be associated with other abnormalities Introduction and objective(s): Congenital anomalies and and clinical syndromes. The most common spectrum of vari- anatomical variations of the IVC are relatively infrequent, ants can be classified as pre-renal (continuation of IVC with varying from 0.07% to 8.4%, when associated with left renal the azygos / hemiazygos-system), renal (retroaortic left and vein variations. Changes in its embryogenesis have clinical renal circumaortic vein) and post-renal (circumcaval ureter, and surgical relevant implications, and its important recog- transposition or left IVC and duplication of IVC), and IVC nition avoid misinterpretation and aid interventional vascular absence which is considered the most extreme form of these procedures. This study aims to demonstrate the imaging as- anomalies. Among the described pathological conditions and pects of the main congenital anomalies and pathological con- pitfalls we can find: platelet and tumor thrombi, tumor in-
30 49th Sao Paulo Radiological Meeting vasion, leiomyosarcoma, membranes, fistulas, spontaneous CASE REPORT shunts, stents and filters, artifactual pseudolesions and retro- grade opacification. Conclusion: Conventional venography, previously consid- ered a gold standard in the assessment of IVC, has been re- DIGITAL PRESENTATION (PD) placed by MDCT and MRI, which have high spatial resolu- tion, volumetric reconstructions in several anatomic planes, PD.04.004 and the evaluation of adjacent organs, with conventional ve- BILATERAL ANEURISM OF THE ARTERY nography being more indicated for therapeutic interventions. POPLÍTEA - CASE REPORT Responsible Author: Lucas de Pádua Gomes de Farias Authors: CARVALHO, T. M.; VIDAL, J. C. S.; SOUSA, Email: [email protected] J.C.O; ARAÚJO, J. M.; ARAÚJO, R. M Keyword: Cava,Inferior,Tomografia,Ressonância,Técnicas Institution: UNIFACISA - HOSPITAL DE EMERGÊNCIA E TRAUMA DE CAMPINA GRANDE PD.04.013 A brief description of the objective(s): To discuss the clini- cal presentation and the findings of the imaging examination CAD-RADS: PROS AND CONS OF AN UNUSUAL used to facilitate the identification and diagnosis of bilateral CLASSIFICATION AMONG RADIOLOGISTS popliteal artery aneurysm. Authors: GUERREIRO, NFC; ARAÚJO, JAB; COSTA, Clinical History: Patient, female, 67 years, admitted with FLS; TORRES, RVA; MORAIS, TC; HORVAT, N PARGA, pain in the lower limbs, edema and cyanosis of the right foot. JR, AVILA, LFR; NOMURA, CH. From the computerized angiotomography of lower limb ves- Institution: HOSPITAL SÍRIO-LIBANÊS sels using computerized tomography techniques obtained in Introduction and objective(s): The Coronary Artery Dis- a multislice apparatus, after intravenous infusion of nonionic iodinated contrast, multiplanar reformation was performed, ease Reporting and Data System (CAD-RADS) classifica- in which the main aspects observed were aneurysms in both tion is a recent attempt to standardize reports of coronary popliteal arteries with extensive wall thrombi (filling fail- angiotomography through a per-patient based analysis (the ure), to the right measuring 4.7x4.1 cm (longitudinal exten- score is defined according to the worst lesion found in the sion of 8.0 cm) and to the left measuring 3.2x3.0 cm (with exam, among all the coronary segments studied). The grad- longitudinal extension of 7.4 cm); in the right lower limb the uation is based on the degree of luminal stenosis, ranging anterior tibial artery has signs of occlusion in the proximal from 0 (absence of stenosis) to 5 (total occlusion). This third of the leg. study aims to review and discuss the tomographic criteria Discussion and diagnosis: Popliteal artery aneurysm used in structured CAD-RADS reports, focusing on its ad- (AAP) is the most common peripheral aneurysm, but it is vantages and limitations, aiming to disseminate this classifi- still rare. It usually affects men over 65 and in 50% of cas- es they are bilateral. Its most frequent etiology, although cation among radiologists. multifactorial, is atherosclerosis; clinical diagnosis is only Method(s): We will illustrate in a pictorial essay based made when arterial dilatation reaches large proportions or on cases, using images acquired at our institution through when ischemic complications appear in the limb.Clinical coronary angiotomography the following aspects of CAD- manifestations of AAP include acute arterial thrombosis, RADS: technical recommendations, diagnostic categories distal embolization, venous and / or nerve compression, options of conduct after categorization, example of struc- and rupture. The presence of AAP may be suspected by tured report, and the advantages and disadvantages of using physical examination when there is increased pulsatility in this classification. the popliteal fossa. Angiotomography is one of the best ex- Discussion: This classification innovates by system- aminations for surgical planning, in order to evaluate the atizing and objectifying CT findings in coronary dis- proximal and distal arteries. The technique for the treatment of popliteal artery aneurysm involves ligation of the aneu- ease in different clinical settings, providing suggestions rysm, to prevent embolization associated with the graft, and for clinical management, the need for additional tests to restore arterial continuity. and therapeutic options at each of its levels. Howev- Conclusion: The treatment consists of excluding the aneu- er, some of its main limitations are associated with the rysm with a size larger than 2 cm that presents mural throm- fact that the location and extent of the lesions, as well bus, bilateral frames should be treated due to complication as the existence of associated coronary anomalies, rates. Endovascular surgery is a therapeutic alternative to are not considered. treatment because it presents advantages over open treat- Conclusion: Despite some limitations, the CAD-RADS ment, such as shorter recovery time and hospitalization. classification can facilitate the communication between Responsible Author: Taiara Miranda Carvalho radiologists and clinicians by standardizing findings and Email: [email protected] Keyword: Aneurysm; Popliteal artery; Endovascular Procedures, behaviors in the complex clinical scenario of coronary dis- Aneurisma; Artéria Poplítea; Procedimentos Endovasculares. ease. However, it must be continually improved and still used with caution, and the diffusion of its use is a central PD.04.011 element in this process. Responsible Author: Nicolau Faria Correia Guerreiro RIGHT AORTIC ARCH ASSOCIATED WITH KOM- MERELL'S DIVERTICULUM AND ABERRANT LEFT Email: [email protected] SUBCLAVIAN ARTERY. Keyword: CAD-RADS,Coronary,Angiotomography Authors: CARVALHO, G.L.N.F.; NETO, W.R.T.; COR- DEIRO, A.H.L.; GUEDES, A.T.L.; FREITAS, L.S.; AM- ORIM, L.L.N.L.; FILHO, R.M.N.
Abstracts of Scientific Papers 31 Institution: CAMPIMAGEM- CENTRO DE DIAGNÓSTI- window with eccentric thrombus, compatible with a coro- CO POR IMAGEM DE CAMPINA GRANDE- PARAÍBA. nary graft aneurysm. A brief description of the objective(s): Case report of a Discussion and diagnosis: Aneurysmal dilatation of a patient with right aortic arch associated with aberrant left bypass graft requiring surgical correction is generally re- subclavian artery and Kommerell's diverticulum, showing garded as exceeding 2 cm True aneurysms typically arise aspects of image on chest radiography and computed angio- more than 5 years after bypass and occur in the body of tomography. the graft. The dominant mechanism is related to accelerated Clinical History:A 64-year-old female patient undergoing atherosclerosis . Pseudoaneurysms more commonly occur progressive dysphagia. At first, upper gastrointestinal endos- within 6 months after surgery, although they may also arise copy was performed, which showed postero-anterior pulsa- several years later. Pseudoaneurysms arise at either proxi- tile bulging of the esophagus, questioning extrinsic vascular mal or distal anastomotic sites. Earlier-onset cases may be compression. It was subsequently performed a chest radiog- related to wound infection or to tension at the anastomo- raphy which showed a right aortic arch, being after request- sis that leads to suture rupture; the pathogenesis of later ed a computed angiotomography of the thoracoabdominal pseudoaneurysms most likely involves progressive athero- aortic, which identified Kommerell's diverticulum associated sclerosis. Less common graft body pseudoaneurysms have on origin of aberrant left subclavian artery, determining com- been reported secondary to host vessel degeneration and pressive effect and displacing the esophagus anteriorly. technical factors. Discussion and diagnosis: Kommerell's diverticulum is a Conclusion: Graft aneurysms are often first identified as a rare condition that was initially described as aneurysmal mediastinal or hilar mass at chest radiography. Contrast-en- dilatation in the origin of an aberrant right subclavian ar- hanced CT and magnetic resonance imaging usually demon- tery with left aortic arch and later described as associated strate the vascular nature of the structure, as well as its extent with the right aortic arch with anomalous origin of the left and local mass effect. subclavian artery. The final conformation of the aortic arch Responsible Author: guilherme henrique naves de oliveira and its branches takes place after the migration and regres- Email: [email protected] sion of the branchial arches, around the seventh week of Keyword: aortocoronary graft,aneurysm,myocardial revas- prenancy, and their bad formations are due to defects in this cularization surgery mechanism. The aortic arch on the right is the result of the dissolution of the left dorsal aorta root instead of the right PD.04.014 one. The anomalous origin of the subclavian artery is at- QUANTITATIVE PARAMETERS IN CORONARY tributed to the abnormal regression of the fourth primitive ARTERIAL DISEASE: CORRELATION BETWEEN aortic arch during embryologic development. Kommerell's MORPHOMETRIC AND FUNCTIONAL DATA BY diverticulum is clinically relevant because of increased CORONARY ANGIOTOMOGRAPHY AND CARDIAC mortality associated with its rupture, morbidity caused by CATHETERISM compression of mediastinal structures and the complexity Authors: MORAIS, T.C.; SILVA, C.F.G.; BERTOLAZZI, P.; of surgical treatment. The vascular alterations of the aortic CARDOSO, A.P.T.; JUNIOR, A. N. A.; TORRES, R. V. A.; arch can be diagnosed by several image modalities, includ- FILHO, J. R. P; ÁVILA, L. F. R.; NOMURA, C. H. ing chest radiography, bronchoscopy, study of barium swal- Institution: HOSPITAL SÍRIO LIBANÊS/ SIEMENS lowing, echocardiography, computed angiotomography and HEALTHINEERS magnetic angioresonance. A brief description of the objective(s): The clinical man- Conclusion: Computed angiotomography and magnetic agement of symptomatic chronic coronary artery disease angioresonance play a key role in determining prognosis, (CAD) should be guided by stratification of cardiovascular pre-surgical evaluation and control of patients with aortic risk and follow a strategy based on anatomical or function- arch abnormalities. al evaluation. In the functional approach, the search for Responsible Author: GABRIELA LIRA NÓBREGA FAL- ischemia through fractional invasive flow reserve (FFRi) CONI DE CARVALHO by cardiac catheterization remains the gold standard. In Email: [email protected] the anatomical approach, coronary computed tomography Keyword: Kommerell,compressão,disfagia,angiotomografia (CCT) has demonstrated a significant reduction in cardio- vascular mortality rates, but it overestimates the severity PD.04.012 of the lesions, and sometimes the significant visual luminal ANEURYSMAL DILATATION OF A BYPASS GRAFT : reduction does not translate to the presence of ischemia. In CASE REPORT this context, CCT functions as a "hybrid" diagnostic tool, Authors: OLIVEIRA, G. H. N.; MAIA, D.F.; BARROS, with anatomical and functional information, through the F.C.; REIS, G.L.L. noninvasive quantification of FFRct. Recent data indicate Institution: HOSPITAL MADRE TEREZA an accuracy of 78%, with positive and negative predic- A brief description of the objective(s): To report a case of tive value increase, sensitivity of 82% and specificity of a patient with mediastinal mass who during the investigation 76% of FFRct compared to FFRi. We propose a compar- revealed that it was aortocoronary graft aneurysm. To discuss ison between the FFRct and FFRi values ??in cases of the concept and main radiological findings in the aortocoro- symptomatic CAD referred to CCT in our service, which nary graft aneurysm. subsequently underwent catheterization in an interval not Clinical History:A 67-year-old male patient, 7 years after exceeding 30 days. myocardial revascularization surgery; perfomrs conven- Clinical History:: Reported in the attached figures. tional radiography showing left mediastinal mass. Comput- Discussion and diagnosis: CCT plays a large role in exclud- ed tomography without contrast showed hypodense forma- ing coronary disease because of its high negative predictive tion in the middle mediastinum, in close contact with the value, but in the presence of intermediate lesions it is prudent left ventricle of undetermined etiology. Contrast CT shows to continue the investigation with functional tests or catheter- dilated sacculate coronary vessel near the aortopulmonary ization. However, of the patients referred to the catheteriza-
32 49th Sao Paulo Radiological Meeting tion, 40% are not submitted to revascularization procedures. Conclusion: The cardiovascular image is one of the pillars of When we associate a functional method with the anatomical the diagnosis of CAD. New software applied to CCT allows one, in the intermediate / doubtful lesions, it would be possi- to make estimates of FFR until then possible only through ble to reduce the number of patients who were referred to the catheterization, will facilitate decision making, especially in catheterization unnecessarily. A non-commercial software patients with doubtful or intermediate lesions, reducing the prototype for evaluation of FFRct was launched by Siemens, indication of unnecessary invasive exams. called "cFFR", which has not yet been validated for use in Responsible Author: Pâmela Bertolazzi clinical practice, but several studies have shown a good cor- Email: [email protected] relation with FFRi. Keyword: FFRct,FFRi,Coronary,ComputedTomography
TEACHING ORIGINAL PAPER abdomen (30.8%); thorax (5.5%). The main clinical justifica- tions were: abdominal pain (23.3%); headache (12.8%),%); paranasal sinos disease (11.2%); low back pain (9.2%); chest pain (5.6%, dyspnea (5.6%), and urinary complaints (5.3%). DIGITAL PRESENTATION (PD) Conclusion: Audit, justification of exams and directed train- ing with validated protocols allowed improvement in quality and patient safety. The Choosing Wisely campaign can be PD.05.010 applied in emergency sectors promoting benefits to patients, IMPLEMENTATION OF CHOOSING WISELY CAM- physicians and institutions, using protocols validated by spe- PAIGN IN THE INDICATION OF RADIOLOGICAL cialty medical societies with international consensus. In the EXAMS IN THE EMERGENCY SECTION OF PRI- future process this study will be applying educational training VATE HOSPITAL. through virtual activity to the doctors and will be extending Authors: BERNARDO, M. O; SANTOS, A. A. S. M. D; the campaign until 2020. NEVES, G.R; CUNHA, M. A. B. G; VIEIRA, X. G.; BEL- Responsible Author: Mônica Oliveira Bernardo LEGARD, L. M.; BARROS, M.F.F.; ALMEIDA, F. A. Email: [email protected] Institution: FACULDADE DE CIÊNCIAS MÉIDAS E DA Keyword: Proteção Radiologia;,radiografia,Tomografia SAÚDE PUC-SP Computadorizada por Raios X,Prática Clínica Baseada em A brief description of the objective(s): Alignment of indi- Evidências,Assistência ao Paciente cation of radiological exams in the emergency sector accord- ing to the Choosing Wisely campaign. PD.05.012 Promote awareness of the risks and benefits and rational use THE APPLICABILITY AND OMISSIONS OF THE of radiological exams to health professionals and patients. AMERICAN COLLEGE OF RADIOLOGY APPRO- Material(s) and method(s): A retrospective and prospective PRIATENESS CRITERIA IN IMAGING REQUEST IN study with educational intervention in the emergency sector A UNIVERSITY HOSPITAL of a private hospital; 140 thousand users; 8500 monthly adult Authors: HAMATI, C.; OLIVEIRA, R.S.; SZESZ, A.B.R.; medical attendance; 6500 pediatric attendance. Protocols LIMA, D.V.G.; MAIA, C.O.; DREWECK, M.O. proposed by the Choosing Wisely is going to be used promot- Institution: UNIVERSIDADE ESTADUAL DE PONTA ing conversations between clinicians and patients by helping GROSSA choose patient care that is: supported by evidence, not dupli- A brief description of the objective(s): To verify the applica- cative of other tests or procedures already received, free from bility of the American College of Radiology (ACR) Appropri- harm, truly necessary, engaging patients and doctors. The ation Criteria (AC) for image examination requests sent to a project is being applied in the adult emergency service (N = diagnostic imaging center of a university hospital and describe 55 physicians) and pediatric (N = 45 pediatricians); period major causes of the requests classified as non-applicable. from May to December 2018. Currently, 3100 radiographs Material(s) and method(s): We retrospectively reviewed the and 500 tomography are performed monthly. Retrospective requests for imaging examinations sent to the imaging center analysis of 10 mostly common indications of radiological of a university hospital, which was available for analysis be- examinations, protocols review, justification of exams su- tween January 2016 and February 2017. Applicability were pervised by group of experts according to Choosing Wisely, classified into two groups: an applicable and partially applica- medical educational activity, monthly analysis of percentages ble group and another group of not applicable with the major of radiological examinations. causes to non-applicability been reorted according to the cor- Results and discussion: Initial results showed a mean total respondence with the clinical variables present in the ACR AC. reduction of 27.2% in total radiological exams; 40.7% age Results and discussion: 1271 requests were analyzed, of range from 0 to 4 years; 37.6% (5 to 16 years) and 22.3% (16 which 471 (37.1%) were excluded and 800 (62.9%) requests years of age). A high number of exams were identified in the were included, 629 (78.6%) were classified as applicable or age group 0 to 4 years. The most requested radiological exams partially applicable (A group) and 171 (21.4%) were classi- were chest radiography (41.1%); paranasal sinus (17.5%); ab- fied as non-applicable (NA group). The NA group was formed domen (5.1%); computed tomography of the brain (45.1%); by requests that ACR AC could not applied because informa-
Abstracts of Scientific Papers 33 tion was not sufficient to be classified (85 cases, 10.65%) and Authors: DE SANTI, G.F.; IUNES, L.R.; TIBANA,T.K.; the ACR AC omission requests (86 cases, 10.75%). The ma- GRUBERT,R.M.; NUNES,T.F. jor omission causes were: control after fixation of fractures Institution: UNIVERSIDADE FEDERAL DE MATO (2.5%), facial trauma (1.2%), postoperative controls (1.1%), GROSSO DO SUL - UFMS abdominal hernias (0.9%), consumptive syndrome (0.9%) A brief description of the objective(s): To evaluate the lev- and neonatal anoxia (0.4%). el of knowledge of medical students from the 1st to the 6th Conclusion: The ACR AC can be considered a useful tool year on interventional radiology as a specialty, and to analyze in the request of imaging examinations in a university hos- whether there is an interest in having this subject or specialty pital with high applicability and a minority of omission cas- inserted in the academic curriculum. es which can be solved with educational actions and new Material(s) and method(s): Participants were invited to approaches by panels of experts from the American College respond a questionnaire with different questions related to of Radiology. interventional radiology, which addressed questions related Responsible Author: Marcelo Dreweck to the level of knowledge of the specialty, medical training Email: [email protected] required, procedures performed and the need to insert this Keyword: Diagnóstico por imagem,hospitais de ensino, specialty in the curriculum of academic training. registros médicos Results and discussion: One hundred and eighty-seven academics answered the survey 57 (30.48%) of the 1st or 2nd period, 110 (58.82%) 3rd or 4th and 20 (10.7%) 5th or ORAL PRESENTATION (TL) 6th years). Most students said they knew terms related to interventional radiology. Regarding the intervention area of TL.05.001 radiology, 109 (58.29%) signaled the diagnosis and treat- ment. Eighty-three participants (44.39%) stated that the WICH FORMAT OF RADIOLOGICAL REPORT IS procedures use all imaging methods and 70 (37.43%) did PREFERRED BY REQUESTING PHYSICIANS: PRO- not know what methods interventional radiology uses. Less SPECTIVE ANALYSIS IN A MEDICAL POPULATION than 50% of participants recognize the procedures that can OF A UNIVERSITY HOSPITAL be performed by the specialty. The vast majority (95.19%) Authors: CAMILO, D.M.R.; ADORNO, I.F.; TIBANA, of the students agreed that the insertion of more information T.K.; KLAESENER, C.; SANTI, G.F.; NUNES, T.F. about the area during the graduation would be of great value Institution: HOSPITAL UNIVERSITARIO - UFMS in the academic formation. A brief description of the objective(s): To improve the Conclusion: Medical students have poor knowledge about communication between assistant physicians and interventional radiology, however they are extremely posi- radiologists, defining which information should be included tive in their desire to have this subject inserted in the curricu- in radiological report and which format is preferred by appli- lum of medical school. cants from a university hospital. Responsible Author: Gabriel Franchi de Santi Material(s) and method(s): Participants were asked to Email: [email protected] choose the preferred option between reports with different Keyword: radiologia intervencionista; estudantes de medici- formats and levels of detail of 3 hypothetical cases and ques- na; faculdade de medicina. tioned whether characteristics commonly found in a radio- logical report are appropriate or not for inclusion. To assign the absolute order of preference of the different reports, the Kemeny-Young method was used. Results and discussion: Ninety-nine physicians answered the questionnaires (40.4% resident physicians, 31.3% precep- LITERATURE REVIEW tors of residency programs and 28.3% of medical professors). Structured reports with impression or comment were selected in situations of normal ultrasonography by 54% of partici- POSTERS (PI) pants, altered ultrasound by 59% and computed tomography by 53%. The informations that should be included according to the applicants was the quality of the image (92%), details PI.05.002 of the clinical scenario (91%), diagnostic impression (89%), DOCTOR-PATIENT RELATIONSHIP IN INTERVEN- examination technique (72%), information about contrast TIONAL ACTION: CONCEPT OF PERSONALIZED (68%). Opinions on follow-up and radiological or non-radio- INTERVENTION logical investigation were important. Authors: PINHEIRO K.; BARBOSA O.L.; GILBERTO Conclusion: Structured reports with impression or comment G.M., RAHAL JR. A.; FALSARELLA P.M.; QUEIROZ of a radiologist are preferred. Information such as quality of M.R.G.; GOBBO-GARCIA. R. examination, contrast used and follow-up suggestions and Institution: HOSPITAL ISRAELITA ALBERT EINSTEIN additional investigation are valued by requesting physicians. A brief description of the objective(s): Comprehensive Responsible Author: THIAGO NUNES analysis of main issues engaged in the development of a pos- Email: [email protected] itive doctor-patient relationship and the way it could directly Keyword: laudo radiológico; tomografia computadorizada; interfere in the success of the interventional treatment. Re- ultrassonografia. garding the fact that a significant number of interventionist professionals presently working come from radiologic train- TL.05.002 ing, it is of utmost importance to shape the doctor-patient re- INTERVENTIONAL RADIOLOGY AND MEDICAL lationship differences between radiologists and intervention- STUDENTS IN BRAZIL: A RESEARCH OF KNOWL- ists, making such differences clear for the applicants to the EDGE AND INTERESTS IN A PUBLIC UNIVERSITY interventional career.
34 49th Sao Paulo Radiological Meeting Description of the disease(s), method(s) and/or tech- close monitoring of severe cases, supervision of those under nique(s): The present scenario of interventional radiology professional development and appropriate register of conclu- increasingly includes clinical expertise with focus on the pa- sions and outcomes. Regarding difficulties, studies indicate tient. Personalized intervention is more and more referred to. advantages of exposing young professionals to a friendly and Such scenario, significantly different from that valid for most safe intellectual collaboration environment, which would radiology branches, is continuously enhanced, being consid- contribute to both their training and their assistance to the pa- ered essential for the maintenance and growth of interven- tient. In order to evaluate this topic, twenty articles have been tions in our work environment. In order to evaluate this topic, compiled, which were published between 2007 and 2018 and twenty articles have been compiled, which were published retrieved from the plataform PUBMED through searches between 2004 and 2018 and retrieved from the plataform using the following key-words: meeting OR discussion OR PUBMED through searches using the following key-words: multi-disciplinary conferences AND interventional radiology doctor-patient relationship OR shared decision-making AND AND trainee. interventional radiology. Discussion: Multi-disciplinary conferences are an effective Discussion: There is a global trend in medical sciences to fo- strategy regarding case discussion, aiming at knowing and cus on the diseased and not the disease which overreaches the planning treatment options available in order to trace a coor- interventional radiology field. In the last few years, the evo- dinated, optimized and safe practice for the management of lution of interventional techniques brought about the need for the diseased. The immersion of young professionals in such longitudinal monitoring of the diseased, which would include meetings seeks to improve their generalist training, broaden- the development of ambulatory aspects of the expertise. Some ing their scientific and clinic knowledge. In addition, when of the essential characteristics of the current interventionist they are inserted in an environment of multiple experiences, doctor are reliability, communicability and empathy. A new the professionals interact with other experts, building criti- tool aimed at strengthening the doctor-diseased relation is the cal thinking and developing an empathic attitude towards the shared decision-making process. To that end the intervention- other fields of expertise. ist acts as the facilitator, making disease and treatment, as Conclusion: In the face of the benefits listed above, it is clear well as good and bad outcomes, understandable for the pa- that such meetings represent a priceless demand for the train- tient, who then becomes able to participate in the decisions. ing interventionist. Therefore, a relation of co-responsibility and cooperation is Responsible Author: Kátia Pinheiro de Souza established among the involved individuals. Another recent Email: [email protected] study is the impact the internet has on interpersonal relations, Keyword: multi-disciplinary meetings;,interventional ra- including that among doctors and the diseased. diology,trainee,multi-disciplinary conferences Conclusion: In light of the foregoing, the growing impor- tance of care in respect to the doctor-patient relation within the concept of interventional radiology becomes clear, in or- der to build medical therapy strategy which weighs the pa- tient's values and priorities, broadening chances of success. Responsible Author: Kátia Pinheiro de Souza CASE REPORT Email: [email protected] Keyword: doctor-patient relationship,shared decision-mak- ing,interventional radiology. DIGITAL PRESENTATION (PD) PI.05.003 PARTICIPATION IN MULTI-DISCIPLINARY MEET- PD.05.011 INGS: WHY SHOULD WE STIMULATE THE NEW RADIOLOGICAL APPROACH TO NON-TRAUMAT- INTERVENTIONIST? IC ACUTE ABDOMEN MANAGEMENT - EXPERI- Authors: PINHEIRO K.; LEMBRANÇA L.; BARBOSA ENCE REPORT O.L.; ANDRADE J.R.; RAHAL JR A.; VALLE L.G.M.; Authors: ANDRADE, M.G.S.; JUCÁ, C.S.; CUNHA, C.A.; GOBBO GARCIA R. SANCHO, L.S.; PORTUGAL, M.M.; TANIGUCHI, T.M.; Institution: HOSPITAL ISRAELITA ALBERT EINSTEIN OLIVEIRA, P.B.; LINS, C.F. A brief description of the objective(s): To argue about the Institution: ESCOLA BAHIANA DE MEDICINA E importance of multi-disciplinary meetings in the learning SAÚDE PÚBLICA (EBMSP) process of new specialists and also in the construction of pro- FACULDADE DE MEDICINA DE RIBEIRÃO PRETO DA fessionals who have not only scientific knowledge but also a UNIVERSIDADE DE SÃO PAULO (FMRP-USP) critical eye allied to flexible postures, being able to manage DELFIN MEDICINA DIAGNÓSTICA challenging situations. Moreover, an interventionist's phys- A brief description of the objective(s): There is a lack in ical and intellectual availability in meetings of other fields the literature on a standardized radiological approach in the is an unambiguous connection among new cases inside an management of acute non-traumatic abdominal pain in the intervention center. context of the Choosing Wisely initiative. Thus, was created Description of the disease(s), method(s) and/or tech- the course Non-traumatic Abdominal Pain in the Emergency, nique(s): The growing culture of regular multi-disciplinary aiming to improve medical training of interns and residents meetings is a strategy which requires human and financial of general surgery on radiological approach in the non-trau- resources, having as a main aim the provision of a scientif- matic acute abdomen. ically based discussion among the many experts involved Clinical History: The course was organized by radiolog- in the assistance of a given case in order to elaborate a co- ical anatomy monitors and their mentor (a radiologist), ordinated management plan. Many benefits arise from this in a way the classes were divided into three stages: 1) a action, such as professionals' time optimization, exchanges 30-minute lesson on basic physical principles (image ac- of experience, reduced therapeutic decision-making time, quisition and radiological nomenclature) of radiography,
Abstracts of Scientific Papers 35 ultrasonography (USG), computed tomography (CT) and to incorporate knowledge about the conscious use of radio- magnetic resonance imaging (MRI), presented by a student logical imaging methods in the non-traumatic acute abdomen monitor; 2) five classes on radiological anatomy and appli- syndromic types. As a result, they gained more confidence in cation of the exams on acute abdomen: simple abdomen understanding, interpretation and identification of pathologi- radiography, abdomen USG, transvaginal USG, abdomen cal changes, as well as learning the main indications of each CT and abdomen MRI, each lasting 20 minutes and also imaging examination in non-traumatic acute abdomen. taught by student monitors; 3) a class on the main patho- Conclusion: After the course, the participants demonstrated logical aspects of imaging examinations in the five acute to be more confident about clinical-radiological reasoning abdomen syndromes (Inflammatory, Obstructive, Perforat- of non-traumatic acute abdomen. This knowledge allows ing, Hemorrhagic and Vascular) within the context of the application of the Choosing Wisely initiative and is useful Choosing Wisely initiative and based on the presentation for optimizing emergency room care and making it more fi- of clinical cases to be discussed by all participants, last- nancially viable. ing three hours. It is important to note that each student Responsible Author: Carolina Freitas Lins monitor prepared their class, but there was training with Email: [email protected] guidance from the radiologist before the course, to remove Keyword: Abdome agudo,choosing wisely,radiologia doubts and improve the content. Discussion and diagnosis: From this experience, the student monitors, interns and residents of general surgery were able
PHYSICS / QUALITY CONTROL ORIGINAL PAPER regions highlighted by the user in the stack of images, pro- viding its volume automatically. To validate the methodology applied in this study the volume calculated for the phantom was compared with reference values: 1040 cm³ obtained by DIGITAL PRESENTATION (PD) Louise Giansante at “Aplicação de Métodos de Segmentação de Imagens para Mapeamento dos Órgãos de um Phantom Antropomórfico Pediátrico”, 1047cm³ obtained with au- PD.06.004 tomated software Vitrea® (Canon, Japan) and 1000cm³ PULMONARY VOLUME ESTIMATES FROM PEDI- proposed by ICRP 89 as a standard pulmonary volume for ATRIC PATIENTS USING COMPUTED TOMOGRA- a five-year-old child. To enable a comparison between the PHY IMAGES patient’s biotypes and the phantom it was utilized the concept Authors: GUERRA, V. H; NERSISSIAN, D. Y; SAWAMU- of effective diameter. RA, M. M; TOMAL, A; COSTA, P. R. Results and discussion: The results found in this study Institution: IFUSP/INRAD-FMUSP/IFGW-UNICAMP where a 946cm³ average pulmonary volume for a five-year- A brief description of the objective(s): The goal of the old child and 1035cm³ for the phantom pulmonary volume, study is to provide estimates of the average pulmonary vol- detecting a 10% difference between them. Between the effec- ume of a five-year-old child using CT scans from their chests tive diameter of the phantom and the average for five-year- for future estimation of the absorbed organ dose. The results old children, a 6% difference is noticeable. Conclusion: The results obtained confirmed a good - cor were compared to the pulmonary volume of an anthropomor- relation with the reference values: 1% difference from the phic simulator equivalent to a five-year-old patient and three pulmonary value obtained with the automatic software from reference values. the phantom and 0.5% difference from the pulmonary value Material(s) and method(s): Chest CT scans from an ATOM obtained with the segmentation method from the phantom. pediatric anthropomorphic “phantom” model 705 (CIRS Finally, it is expected that these results will be used in the INC., USA) and from eight pediatric patients – with ages be- estimation of absorbed dose and that this methodology can tween three and five years – were analyzed with a volumet- be replicated for evaluation of the volume of other organs of ric measurement tool from the IntelliSpace® PACS (Philips, the phantom. Holland) visualization and manipulation software. This tool Responsible Author: Vivian Heidorne Guerra works in a semi-automated mode, where the user must draw Email: [email protected] the relevant region in the stack of images. The software cre- Keywords: Volume-pulmonar,Tomografia-Computadoriza- ates a 3D reconstruction of the structure from the selected da,Diâmetro-efetivo,Dose-absorvida
36 49th Sao Paulo Radiological Meeting IT / MANAGEMENT ORIGINAL PAPER DIGITAL PRESENTATION (PD)
PD.07.001 POSTERS (PI) STUDY REGARDING TO CYBER SECURITY IN MEDICAL EQUIPMENT: VULNERABILITIES AND PI.07.002 MITIGATION METHODS Authors: DAVOGLIO, P. M. V. M.; LOPES, T. N.; SILVA A. APPLICATION OF RISK-BASED ASSET MANAGE- C. L.; GIBERTONI JUNIOR, A.; CARDOSO, K. MENT ON A PORTABLE X-RAY Institution: SOCIEDADE BENEFICENTE ISRAELITA Authors: PETAGNA, M; TRANOULIS, E.; SOARES, M; BRASILEIRA ALBERT EINSTEIN FARIAS, W. A brief description of the objective(s): The study aims to Institution: SOCIEDADE BENEFICENTE ISRAELITA evaluate vulnerabilities in medical equipment connected to BRASILEIRA ALBERT EINSTEIN (SBIBAE) , UNIVER- data network regarding to possibility of cyber invasion, and SIDADE DE SÃO PAULO (USP) propose methods to mitigate such vulnerabilities. A brief description of the objective(s): This work aims to Material(s) and method(s): It was performed a cyber-at- perform the analysis of the management of the active porta- tack simulation to 183 different models of medical equip- ble X-ray, based on the concepts of ISO 55000, aiming at a ment (323 equipment in total) connected to the data net- better use of the available resources and greater availability work of a large hospital, coming from internal network, of the assets and in order to elaborate an optimized manage- using a real and controlled scenario. It was possible to ver- ment plan. ify the risks and vulnerabilities found when regarding to a Material(s) and method(s): For the development of the cyber-invasion to medical equipment and data recorded in study, the ISO 55000, ISO 55001 and ISO 55002 standards these. After evaluating the results and based on the stan- were used, the concepts of risk-based asset management and dards IEC80001-1 and IEC 27001, it was verified methods reliability centered, as well as the Failure Modes and Effects that can mitigate such vulnerabilities. Analysis, FRACAS (Failure Reporting, Analysis and Analy- Results and discussion: The simulation demonstrated a sis Corrective Action Systems); AMSAA (US Army Materi- great fragility for the unauthorized access for the most of al Systems Analysis Activity) and LCC (Life cycle cost). It the medical devices studied. Among the main vulnerabili- was considered 18 equipment with records between 2005 and ties, the possibility of remote control of Computed Tomog- 2017 in the management system used as database. Results and discussion: Initially, to evaluate the main- raphy, Magnetic Resonance and Mammography equipment tenance methodology, a survey of all equipment failures stands out. The tests shown these medical equipment has was performed and, applying AMSAA methodology, a ß many logic ports without restriction of access, allowing re- (beta) value of 0.802 was obtained, indicating that there mote access to patient data and their exams, manipulation is a tendency to increase the time between especially after of calibration data and deletion of these data too. Mali- 2015 when it was decided to prioritize the labor force for cious software such as Ramsonware can be easily installed preventive maintenance, which increased overall avail- through a remote attack, encrypting the data of the equip- ability from 24% to 58%. For the determination of parts ment and rendering it useless. Based on these vulnerabili- to be kept in stock, a risk analysis was performed and con- ties and their causes, it was possible identify opportunities sidered that, of the parts that failed the most, the arm has to make the equipment safer regarding to cyber-attacks a non-tolerable risk, the collimator, moderate, the trigger, through modifying the physical structure of the data net- moderate and the brake, not tolerable, it being economi- work and using other methods. cally interesting to keep 1 lamp for the collimator and 1 Conclusion: Medical data has a high monetary value and is trigger in stock. The study was performed to exchange exposed to attacks like any other computerized system. It was the equipment and, based on the calculation of Present proved the data structure used in medical equipment is fragile Value, it was considered feasible a useful life of 20 years, and very susceptible to cyber-attacks. It is evidenced a risk man- however it is feasible the exchange with 10, due to the agement focused to a computerized healthcare systems is need- technological advances. ed to reduce risks and losses and to improve the patient´s safety. Conclusion: The application of the concepts of ISO 55000 Responsible Author: Petrick Marcellus de Victorio Men- was possible for a better management of the asset, as well donça Davoglio as verifying that actions already taken, such as the prior- Email: [email protected] itization of preventive maintenance, were really advanta- Keywords: CYBER-SECURITY,VULNERABILITY,SE- geous both operationally and financially for the institution. CURITY The cost studies, useful life, equipment replacement time and spare parts can be applied immediately to other assets of the institution. Responsible Author: Manuela Petagna Email: [email protected] Keywords: ISO55000,FRACAS,gestão-de-ativos
Abstracts of Scientific Papers 37 ORAL PRESENTATION (TL) TL.07.002 AUTOMATION OF THE ACR MRI LOW-CONTRAST RESOLUTION TEST USING MACHINE LEARNING TL.07.001 Authors: JHONATA E. RAMOS, HAE YONG KIM, F. B. AUTOMATIC CAD-RADS CONTENT EXTRACTION TANCREDI FROM CORONARY ANGIOTOMOGRAPHY REPORTS Institution: UNIVERSIDADE DE SÃO PAULO Authors: REIS, E.P.; NASCIMENTO, F. B. P. ; SECOL, F. HOSPITAL ISRAELITA ALBERT EINSTEIN ; FELIX, M.M.; SZARF, G.; A brief description of the objective(s): Magnetic Resonance Institution: HOSPITAL ISRAELITA ALBERT EINSTEIN Imaging (MRI) is a powerful, widespread and indispensable A brief description of the objective(s): This work aims to medical imaging modality. The American College of Ra- the application of natural language processing (NLP) in the diology (ACR) recommends weekly acquisition of phantom automation of CAD-RADS content extraction from coronary images to assess the quality of scanner. Usually, these imag- angiotomography reports for the construction of a structured es must be analyzed by experienced technicians. Automatic database for cardiology research. analysis of these images would reduce costs and improve re- Material(s) and method(s): Two hundred coronary angiot- peatability. Some automated methods have been proposed, omography reports were obtained from the institution PACS but the automation of two of the ACR image quality tests system between 01/01/2015 and 01/02/2015. All the reports remains open problem. Reports on the high- and low-contrast were then reviewed and annotated with the CAD-RADS find- resolution tests are scarce and so far none of the proposed ings described in the report for each cardiac artery, result- methods produce results robust enough to allow replacing hu- ing in a table with the structured data. Subsequently, natural man work. We use Machine Learning to emulate, with high language processing techniques such as Regular expression accuracy, the detection of 120 low-contrast structures of ACR (REGEX) and Named Entity Recognition (NER) were used phantom by an experienced professional. to automate the extraction and construction of the database. Material(s) and method(s): We used a database with 620 Results and discussion: A high correlation was achieved in sets of ACR phantom images that were acquired on scan- the comparison between manual extraction and automatic ners of different vendors, fields and coils, totaling 74,400 techniques, even using simple techniques such as REGEX. low-contrast structures. Technicians with more than 10 years We also identify that highly structured radiological reports al- of experience labeled each structure as ‘detectable’ or ‘unde- tectable’. Machine learning algorithms were fed with image low a better content extraction with simpler techniques such features extracted from the structures and their surroundings. as REGEX. However, more complex NLP techniques, such Results and discussion: Among the five methods we tested, as Named Entity Recognition (NER), enable a better general- Logistic Regression yielded the largest area under the ROC ization of the algorithm and to address free texts. curve (0.878) and the highest Krippendorff’s alpha (0.995). The next steps include comparing the performance of differ- The results achieved in this study are substantially better than ent NLP models in performing this task. those previously reported in the literature. They are also bet- Conclusion: Natural language processing tools can be used ter than the classifications made by junior technicians (with to extract coronary angiotomography reports for the con- less than 5 years of experience) struction of a database with good accuracy results. Factors, Conclusion: Our results indicate that the ACR MRI low- such as variability of terms, structure and organization of sen- contrast resolution test may be automated using Machine tences, influence the results and may determine the choice of Learning. The results achieved are better than junior techni- different methods for the algorithm development. cians analysis and than those previously reported in literature. Responsible Author: Eduardo Pontes Reis Responsible Author: Jhonata Emerick Email: [email protected] Email: [email protected] Keywords: Natural language processing,CAD-RADS,An- Keywords: MRI, Quality Assurance, Visual Perception, Machine giotomografia de coronárias,NLP Learning.,MRI,Quality,MachineLearning,VisualPerception
38 49th Sao Paulo Radiological Meeting INTERVENTION ORIGINAL PAPER neal structures. The patients were placed in ventral decubitus, left paravertebral approach with a Chiba 21G needle, which transfixed the aorta in posterior and anterior wall, and the tip of the needle located in the preaortic space. Confirmation of ORAL PRESENTATION (TL) correct positioning of the needle tip was made with the injec- tion of 5 ml of solution containing iodinated contrast and an- esthetic. The injection of 20 mL of absolute alcohol (100%) TL.08.001 was executed. THE ROLE OF PERCUTANEOUS TRANSHEPATIC Results and discussion: Four patients aged 36 to 60 years CHOLANGIOBIOPSY IN DIAGNOSIS OF PATIENTS diagnosed with locally invasive pancreatic cancer were eval- WITH OBSTRUCTIVE JAUNDICE: INITIAL EXPE- uated. All patients had abdominal pain that was difficult to RIENCE control with opioids. Celiac plexus neurolysis was indicated Authors: TIBANA, T.K.; GRUBERT, R.M.; NEVES, for pain relief. The access chosen was the transaortic route T.M.H.; SANTI, G.F.; NUNES, T.F. due to the anatomical aspects and the lesion itself. Three Institution: HOSPITAL UNIVERSITÁRIO - UFMS patients underwent a single-session of alcohol (100%) in- A brief description of the objective(s): To evaluate the ac- jection, except one of the patients in who was submitted to curacy of percutaneous transhepatic cholangiobiopsy in pa- two sessions, with the approximate range of 15 days, the first tients with suspected biliary obstruction. being neurolysis by the anterior route. None of the patients Material(s) and method(s): Retrospective analysis of eigh- presented technical complications and only one presented di- teen patients with obstructive jaundice underwent percuta- arrhea as an expected complication of the procedure. neous transhepatic biopsy. In each patient, three to ten frag- Conclusion: Celiac plexus neurolysis, by transaortic route, ments were collected from the lesion. The final diagnosis was is an infrequent route for the therapeutic approach of patients confirmed by anatomopathological report. Laboratory analy- with pancreatic cancer with abdominal pain difficult to con- sis before the procedure, Bismuth classification, clinical out- trol clinically. Despite being considered a risky route, it has come, intercurrences during the procedure, access route and proven to be a safe and objective route that uses a smaller materials used were also recorded. volume of drug than in the usual procedures. Results and discussion: Percutaneous transhepatic cholan- Responsible Author: Aline Oliveira Domingos giobiopsy showed technical success in 100% of the cases. 18 Email: [email protected] patients clinically diagnosed with bile stenosis, 17 received Keywords: Bloqueio do plexo celíaco,Neurólise do plexo a positive pathological diagnosis. In one case the patholog- celíaco,Abordagem guiada por imagem,Radiologia interven- ical findings were considered false-negative. Cholangiocar- cional,Manejo da dor,Cuidado paliativo,Câncer de pâncreas cinoma was the predominant tumor (50%). Sixteen (88.9%) procedures were performed without intercurrences. Transient TL.08.003 hemobilia occurred in 1 case and cholangitis in another iso- ARE LUNG BIOPSY SAMPLES USING 20G NEEDLE lated case. ENOUGH TO GENETIC ANALYSIS? Conclusion: Percutaneous transhepatic cholangiobiopsy is Authors: LEMBRANÇA, L.; LIMA, C. A.;GILBER- a safe, viable and simple technique with a high rate of true TO G.M.; CARVALHO, V.O.; MARTINS R. B.; VALLE positives for the definitive diagnosis of obstructive jaundice. L.G.M.; FALSARELA, P. M.; RAHAL JR. A.; ANDRADE, Responsible Author: THIAGO NUNES J. R.; MENDES, G. F.; QUEIROZ, M.R.G.; GOBBO-GAR- Email: [email protected] CIA, R. Keywords: icterícia obstrutiva,colangiobiópsia,percutânea Institution: HOSPITAL ISRAELITA ALBERT EINSTEIN A brief description of the objective(s): The purpose is to TL.08.002 verify if the sample volume obtained with semi-automatic CELIAC PLEXUS NEUROLYSIS BY TRANSAORTIC 20G cutting needle is able to provide sufficient material for ROUTE: AN UNUSUAL APPROACH EXPERIENCE tumor genetic analysis Authors: DOMINGOS, A.O.; VENTURA, L.M.; CARDO- Material(s) and method(s): The samples were collected SO, M.S.; CASTRO, L.A. through CT-guided lung biopsy and for genecit analysis we Institution: HOSPITAL DE AMOR DE BARRETOS, use the tests: Oncoscreen and FoundationONE. We evatued FUNDAÇÃO PIO XII. BARRETOS, SP. the amount and quality of material and the need to resam- A brief description of the objective(s): Celiac plexus neu- ple. For Oncoscreen if was necessary to perform more than rolysis is an interventional procedure in the palliative treat- one extraction of DNA and RNA due to the small amount ment of patients with upper abdominal neoplasia, especial- of material the sample were suboptimal. The extraction of ly the ones with pancreatic origin, which are refractory to DNA and RNA is performed at the same time with a single kit clinical treatment of pain or that suffer side effects related and, in cases of small samples, DNA extraction may be im- to high doses of opioids for visceral pain control. The poste- paired, requiring further extraction by another technique. For rior and bilateral percutaneous approach of retroperitoneum FoundationONE, the criterion used to classify the material as is the main access route, but in specific cases, it may be less sub-optimal (Qualified) was that the quality or quantity of the efficient or difficult to execute, increasing intrinsic method sample received. risks. The aim of this work is to report an alternative route, Results and discussion: Of the 97 cases biopsied, only 22 the transaortic access, which is unusual and potentially risky. cases submitted for analysis (Oncoscreen - 14; Foundatio- Material(s) and method(s): The procedures were performed nONE - 8). In the cases of Oncoscreen test, 85% had ade- by computed tomography for the precise location of the celi- quate sample, 1 insufficient sample and 1 sub-optimal sam- ac plexus, the abdominal aorta, its branches and retroperito- ple. Of the 8 cases sent to FoundationONE, 50% presented
Abstracts of Scientific Papers 39 adequate material and the remaining sub-optimal material. PICTORIAL ESSAY The extraction of DNA and RNA is performed at the same time with a single kit and, in cases of small samples, DNA extraction may be impaired, requiring further extraction by another technique. There was only one case submitted to ge- POSTERS (PI) netic analysis by the Oncoscreen test that was not possible to perform it due to insufficient amount of material. PI.08.005 Conclusion: Despite the small number of cases, we obtained INTERVENTIONAL RADIOLOGY IN THE TERRI- a high success rate and it was able to perform the genetic TORY OF THE HEAD AND NECK - BEYOND TO FNA analysis through the fragments obtained with a 20-gauge OF THYROID needle biops Authors: CAVALCANTE JR, F.A.; FALSARELLA, P.M.; Responsible Author: Lucas Lembrança Pinheiro MELO, R.A.B; SEGUTI, D.T.; ZANGIACOMO, R.N.; Email: [email protected] MONARIM, M.A.S; SIQUEIRA, L.T. Keywords: Despite the small number of cases, we obtained a Institution: REDE D'OR high success rate and it was able to perform the genetic anal- Introduction and objective(s): The region of the head and neck presents a high density of noble structures such as ves- ysis through the fragments obtained with a 20-gauge needle sels that irrigate the brain, airways, spinal cord and numer- biopsy,lung,biopsy,genetics,analysis ous nerves. It has a complex anatomy that is often ''dreaded '' by general radiologists and doctors of other specialties. We TL.08.004 aim to expand knowledge in the medical community, espe- PREDICTIVE FACTORS OF COMPLETE RESPONSE cially between head and neck surgeons and radiologists, on OF HEPATIC TRANSARTERIAL CHEMOEMBO- the possibilities of minimally invasive and safe approaches in this territory. LIZATIONS WITH DRUG ELUTING BEADS IN PA- Method(s): We will demonstrate the possibility of safe and TIENTS WITH HEPATOCELLLULAR CARCINOMA resolutive approaches with cases of interventional radiology Authors: LEMBRANÇA, L.; LIMA, C. A.; GILBERTO service of a tertiary hospital in the city of São Paulo-SP. G.M.; CARVALHO, V.O.; MARTINS, R. B.; DA MOT- Discussion: The minimally invasive approaches guid- TA-LEAL-FILHO, J. M.; FALSARELLA, P. M.; VALLE ed by images, in their different modalities (tomography, L.G.M.; GALASTRI, F. L.; AFFONSO, B. B.; NASSER, F PET-CT, scopia and ultrasonography), have been gaining Institution: HOSPITAL ISRAELITA ALBERT EINSTEIN more and more space among the doctors of the various A brief description of the objective(s): To evaluate the exis- specialties. They allow high resolution capability with tence of radiological factors predictors of complete response low metabolic insult to the patient, effective and safe way, often using only local anesthesia. It is possible to include in hepatic hepatocellular carcinoma (HCC) nodules, submit- bedside and outpatient approaches. Among these proce- ted to transarterial chemoembolization dures we can mention: aspiration puncture with fine nee- Material(s) and method(s): A retrospective, unicentric dle; biopsy with thick needle; drainage of superficial col- study involving 123 patients, a total of 166 nodules, in pa- lections and deep cervical spaces; thermal and chemical tients from the institutional liver transplantation program, ablations of thyroid nodules; preoperative marking of le- submitted to hepatic chemoembolization with Drug-eluting sions; preoperative transarterial embolization of lesions; Beads (DEB-TACE), with indication criteria for downstaging palliative embolizations, administration of botulinum tox- or bridging to transplant, between April 2011 to June 2014. in in salivary glands, procedures for the treatment of pain The nodules were divided into 3 groups according to the di- (foraminal, facet, temporomandibular joint infiltrations) ameter: group 1 (nodules up to 2 cm); group 2 (nodules be- among other indications. Conclusion: The familiarization of the medical communi- tween 2 and 5 cm); group 3 (nodules greater than 5 cm). Di- ty with the various possibilities of minimally invasive ap- ameter and necrosis rate were assessed by contrast enhanced proaches in this area, whether in the diagnostic, palliative magnetic resonance or computed tomography, performed 30- or therapeutic scope, allows to increase the quality of care 45 days after treatment and then every 3 months. provided to patients. Providing them minimal tissue damage, Results and discussion: When comparing the size reduction resolving, hospital discharge often precocious, in addition to and the mean size of all nodules, we observed a reduction of cost reduction. the size up to the fifth control (150 to 210 days) post-chemo- Responsible Author: FRANCISCO JUNIOR embolization in relation to the pre-treatment measurement, Email: [email protected] and later evolving with stability in size (p <0.001). Among Keywords: Interventional Radiology,Minimally Invasive,- the 166 nodules analyzed, 49 presented recurrence during Head and Neck,Safe follow-up. Comparing the size of the nodules in relation to recurrence in the three groups, we observed that the mean diameter in the nodules that presented recurrence was higher than those that maintained complete necrosis Conclusion: nodules with complete necrosis present with reduction of diameter until approximately 200 days after the Chemoembolization with spheres carrier (DEB-TACE). Responsible Author: Lucas Lembrança Pinheiro Email: [email protected] Keywords: deb-tace, quimioembolização, hcc, hepatocarcinoma
40 49th Sao Paulo Radiological Meeting LITERATURE REVIEW tric tube (NGT). Currently, most gastrostomies in Brazil are by endoscopy. However, in other countries, the percutaneous route, performed by the interventional radiologist predom- inates, since it presents fewer infectious complications and POSTERS (PI) fewer positioning failures, due it is performed more safely, avoiding the hepatic left lobe, transverse colon and thin loops in previously operated patients.The purpose of this summa- PI.08.004 ry is to expose and disseminate percutaneous, CT guided or BROADENING HORIZONS - PORT-O-CAT CATHETER: scopic technique. INDICATIONS, TECHNIQUE AND COMPLICATIONS Material(s) and method(s): The gastrostomy/percutaneous Authors: CAVALCANTE JR, F.A.; FALSARELLA, P.M.; jejunostomy method is safe, effective and non-invasive in ob- MELO, R.A.B; SEGUTI, D.T.; ZANGIACOMO, R.N.; taining the definitive enteral diet, and can be performed with MONARIM, M.A.S; SIQUEIRA, L.T. mild sedation and even with local anesthesia if necessary. In Institution: REDE D'OR the procedure the gastric distension is performed after the A brief description of the objective(s): To disclose among passage of NGT, followed by its pexia against the abdominal the interventional radiologists the indications and techniques wall in 3 or 4 points with a specific KIT of easy use, followed of implantation of the Port-o-cat catheter in order to position by puncture with 18g needle and stiff guidewire 0.035. The the specialty also in this invasive minimane procedure, now- dilatation and the enteral nutrition tube are performed. The adays performed mainly by surgeons. technical success is close to 100% for gastrostomy and be- Material(s) and method(s): Central venous catheters play tween 85-95% for jejunostomy (CT guided preferably). an important role in the management of cancer patients. The Results and discussion: Regarding the surgical and en- objective of the present study is to present the technique, doscopic technique, the percutaneous procedure is less advantages and complications associated with the implant invasive, has a lower rate of complications and does not and use of the catheter of port o cath, under the optics of require general anesthesia, which in this patient profile the interventional radiologist the catheter of port o cath is a (elderly, demented, with cerebrovascular accidents) is of central venous catheter totally implantable that allows the great value. The procedure takes about 20 minutes. The administration of medicines in central vein of great caliber, main contraindications are intractable coagulopathy and reducing the toxic effects to the endothelium when compared gastric varices. Ascites is a partial contraindication. The to the administration in the peripheral veins. It consists of main complication is extravasation of enteric contents into a reservoir and a catheter. Its implantation should be per- the abdominal cavity, which studies describe occur in ap- formed in a surgical center or interventional radiology room, proximately 1% of procedures. performing venipuncture of the internal jugular vein guided Conclusion: In this panel will be exposed different tech- by ultrasound and intraoperative radioscopy for the proper niques performed by interventional radiology, aiming to stim- positioning of the catheter. Subsequently, the shop is made ulate the specialty to expand its performance in gastrostomies to implant the reservoir in the subcutaneous and connection as a safer alternative than the endoscopic technique. between the items. Responsible Author: MARLON AUGUSTO SCHIOC- Results and discussion: Possible complications include CHET MONARIM vascular injury, thrombosis, pneumothorax, hemothorax, Email: [email protected] infection, hematoma, nerve damage, gas embolism and Keywords: Gastrostomia,jejunostomia,intervencionista,per- wound dehiscence. cutânea,enteral,radiologia Conclusion: The indications, implant technique and the rec- ognition and management of potential complications should be known to the interventional radiologist, aiming at ampli- fying the performance of the professionals of the specialty in the universe of the oncological intervention. Responsible Author: FRANCISCO JUNIOR DIGITAL PRESENTATION (PD) Email: [email protected] Keywords: intInterventional radiologists,Port-o-cat,invasive minimane procedure,oncological intervention. PD.08.003 PROSTATE BIOPSY IN THE MULTIPARAMETRIC PI.08.006 MRI: WHERE DO WE STAND. IMAGE-GUIDED GASTROSTOMY AND JEJUNOS- Authors: SETUGUTI, DANIEL T.; ZANGIACOMO TOMY: BROADENING OUR HORIZONS! R.Z.;VALLE L.G.M.; FALSARELLA P.M.; MELO R.A.B.; Authors: MONARIM, M. A. S; FALSARELLA, P. M.; VAL- CAVALCANTE JR F.A.; MONARIM M.A.S.; SIQUEIRA LT LE, L. G.; SEGUTTI, D. T.; MELO, R. A. B.; CAVALCAN- Institution: REDE D'OR TE, JR. F. A.; ZANGIACOMO, R. N.; SIQUEIRA, L. T. B. A brief description of the objective(s): Review the ba- Institution: REDE D`OR sics of prostate biopsy incorporating new trends and evi- A brief description of the objective(s): Gastrostomy/jeju- dence-based updates. nostomy is aimed at the implantation of a definitive prolonged Material(s) and method(s): Literature review in the Pubmed pathway for enteral nutrition. They are mainly indicated in database and current guidelines. patients with chronic diseases. The main diseases in this sce- Results and discussion: The first prostate biopsy per nee- nario are neurological (advanced dementia, cerebrovascular dle was performed by Ferguson in 1930, since new tech- accidents), neck and esophagus carcinomas, dysphagia, ste- niques and technologies were being employed to increase nosis/obstruction of the upper gastrointestinal tract, among its accuracy. The multiparametric MRI of the prostate is others. There are also obstructed oncology patients who may one of these evolutions and is consolidating as a watershed receive gastrostomy for drainage by replacing the nasogas- in the way we perform the biopsy today. Therefore, it is
Abstracts of Scientific Papers 41 extremely important that the interventional radiologist is CASE REPORT updated to act on the decision to indicate and conduct the various scenarios in which the patients present themselves, as well as knowing how to handle possible complications DIGITAL PRESENTATION (PD) inherent in the procedure. Conclusion: Prostate biopsy is among the oldest procedures performed by interventional radiology and also one of the PD.08.001 most sought after. Although often trivialized, it is essential PERCUTANEOUS BILIARY SOLUTIONS FOR POOR- to be up to date and use the new resources that come up each day to offer the best result for the patient. LY POSITIONED COATED STENTS: A CASE SERIES Responsible Author: daniel setuguti AND LITERATURE REVIEW Email: [email protected] Authors: TIBANA, T.K.; ARAUJO, T.A.; ANDRADE, Keywords: biópsia,próstata,ressonância,magnética,multi- G.H.D.; FORNAZARI, V.A.V.; ZUSTRASSEN, C.E.; paramétrica,fusão,pirads NUNES, T.F. Institution: HOSPITAL UNIVERSITARIO - UFMS PD.08.004 A brief description of the objective(s): Failure of bili- RADIOGUIDED SURGERY WITH 99 M TC - SESTA- ary stents may be due to fracture, migration, occlusion, or MIBI IN THE PARATHYROID ADENOMA malposition. A dysfunctional stent left in the biliary tract Authors: SOUSA, J.C.O may act as a nidus and cause recurrent and persistent chol- Institution: NÚCLEO DE PESQUISA CIENTIFICA E angitis. It may also lead to additional vascular complica- ACADÊMICA DE RADIOLOGIA (NPCAR) tions. In cases of malposition of biliary endoprostheses, a A brief description of the objective(s): Parathyroid Adeno- percutaneous transhepatic technique should be performed ma refers to a tumor of benign nature of the parathyroid gland for restoring biliary flow and avoiding additional damage. that results in the exponential increase of the parathyroid tis- Clinical History: We report two cases of dysfunctional en- sues responsible for the high parathyroid (PTH) production doprostheses, including description of the techniques used rate. The choice of parathyroid adenoma therapy is correlated to the following factors: tumor size; location; and its diffu- for restoring biliary patency and imaging demonstration. sion or not to other tissues. The therapeutic modalities for Discussion and diagnosis: Case 1: A 71-year-old man combating parathyroid adenoma reside in surgery and radio- with chronic liver disease presented with symptoms of ob- therapy. 99m Tc-Sestamibi Radioguided Surgery is indicated structive jaundice. Endoscopic retrograde cholangiopan- in the parathyroid adenoma because it is minimally invasive creatography was performed two times with placement and results in: a smaller incision; less surgical trauma, and of a coated biliary metallic prosthesis. However, the ob- shorter surgery time. This study aims to discuss the use of struction did not improve, and laboratory parameters were 99m Tc-Sestamibi Radioguided Surgery in the parathyroid poorer. CT scan revealed an endoprosthesis placed in the adenoma describing this modality of intervention, reviewing left bile duct and increased bile duct dilation in the right anatomical aspects of the parathyroid and emphasizing the lobe. Percutaneous external drainage was performed in benefits for the patient. the right bile duct, and the patient returned for removing Material(s) and method(s): Review study of literature con- gregated in pictorial essay. The literature review for the the- the external drain and introducing a RUPS kit. Case 2: An oretical approach of the subject gathered scientific sources 80-year-old woman with pancreatic head adenocarcinoma from the SCIELO and PUBMED databases: written in Portu- presented with cholangitis. She underwent an endoscopic guese and English; correlated with the study objectives; and procedure for implantation of a Wallflex stent, showing without established temporal cut. A pictorial essay was ad- improvement. After two weeks, jaundice worsened. CT opted encompassing images related to the theme. scan showed marked dilation of intrahepatic bile ducts Results and discussion: The ability of 99mTc-sestamibi to to the left because of malposition of a selective biliary perform a greater marking of the neoplastic tissue to the nor- prosthesis in the right hepatic duct. During the new endo- mal, allows its use in the parathyroid adenoma; this capacity scopic procedure there was a fracture in the ring and the may be related to affinity for tumor cells and to correlate with coating of the stent, which did not move. The common the function of metabolic activity (tumor cells have a greater amount of mitochondria present). In the parathyroid adeno- bile duct was pre-dilated using a Mustang balloon catheter ma, the use of 99mTc-sestamibi radio-guided surgery resides: of 6 x 60 mm, the introducer sheath was replaced and a na facilitating the distinction between normal parathyroid Viabil 10 x 100 mm biliary stens was implanted. and thyroid parathyroid neoplastic tissue; high precision; to Conclusion: Cases of dysfunctional PTBD catheters are rare. the fact that it is much less invasive; to the numerous benefits The percutaneous approach should come into consideration to the patient (correlated to lower postoperative pain and bet- if endoscopic intervention or reintervention fails. Howev- ter aesthetic results, among others). er, there is no consensus on a single method suitable for all Conclusion: 99mTc-sestamibi radioguided surgery is ex- clinical situations, which means that understanding different tremely relevant in parathyroid adenoma because of its high percutaneous techniques, including snare catheter and bal- efficiency and the range of benefits it provides to the patient loon catheter, is useful. The interventional radiologist should including: minimally invasive approach; shorter surgery be familiar with different techniques and know that all these time; reduction of anesthesia and hospitalization, lower total cost; among others. techniques can be performed with high success and low com- Responsible Author: Joyce Caroline plication rates. Email: [email protected] Responsible Author: THIAGO NUNES Keywords: Parathyroid Adenoma, Radioguided Surgery, Email: [email protected] Parathormone. Keywords: interventional radiology, stent, obstruction, bile duct.
42 49th Sao Paulo Radiological Meeting PD.08.006 Institution: HOSPITAL ISRAELITA ALBERT EINSTEIN IMAGE FINDINGS AND REDUCTION OF THE HE- A brief description of the objective(s): Our objective is to PATIC HEMANGIOMA AFTER 90Y RADIOEMBOLI- report a case of symptomatic Rendu-Osler-Weber Syndrome treated by endovascular method with success. ZATION. Clinical History:Patient, 22 years old, male. Stroke with 4 Authors: MARTINS, R. B.; LEMBRANÇA, L.; GILBER- years old. Mother states that the patient presented in the evo- TO, G. M.; FALSARELLA, P. M.; VALLE, L. G. M.; GA- lution of the treatment of stroke a brain abscess, treated with LASTRI, F. L.; AFFONSO, B. B.; NASSER, F. prolonged antibiotic therapy. He had Rendu-Osler-Weber's Institution: CENTRO DE MEDICINA INTERVENCIONI- family history in the family. On admission, he was in good STA - HOSPITAL ISRAELITA ALBERT EINSTEIN general condition, with dysarthria and gait altered. During the A brief description of the objective(s): Many liver-direct- diagnostic investigation, Angio CT(Computed tomography) ed therapies have been developed to control liver metastases was performed in the chest, with a finding of bilateral pulmo- or primary liver cancer. Selective internal radiation therapy nary AVM. In view of the clinical picture, AVM was indicat- (SIRT), also known as radioembolization delivers a single, ed as the etiological factor of hemorrhagic stroke and cere- measured, targeted radiation dose to liver tumors via injec- bral abscess due to paradoxical embolism, and the closure of tion into the hepatic artery. Yttrium-90 (90Y)–labeled resin AVM was indicated to reduce the risk of new events. Initially, microspheres (SIR-Spheres®) have a median diameter of it was chosen the AVM with more volume for embolization, 32.5 mm, considerably smaller than the particles of other followed by AVM embolization in the contralateral lung in liver-directed therapies such as transarterial chemoemboliza- a second moment, in order to minimize pulmonary and in- tion, which enables the microspheres to lodge distally within fectious risks. Procedure performed under general anesthe- the microvascular plexus of tumors. Indeed, several authors sia, in horizontal dorsal decubitus, in a Hemodynamic room. have described SIRT as a form of liver-directed brachyther- Antibiotic prophylaxis was performed by the risk reported in apy. Although there are larger studies with HCC and MCR, the post-procedure Pneumonia literature. Access carried out few studies have been done with other tumors, and today ra- in the Right Common Femoral Artery, with supersselective dioembolization is a way to treat different tumors and liver catheterization of the arterial branch of the AVM. Performed metastases. This report is about an incidental finding of ra- Embolization with Amplatzer3mm plug (St. Jude Medical). diological alterations of Hemangioma after Radioemboliza- Control arteriography did not identify contrast in the territory tion in a patient with NET(Neuroendocrine tumors) metasta- of AVM, with a well-positioned plug. sis of terminal ileum Discussion and diagnosis: Rendu-Osler-Weber syndrome Clinical History: MCGSMB, female, with antecedent of may present in a dramatic way, with high morbidity to the NET (Neuroendocrine tumor), resected in 08/11/17 because patient. When symptomatic, it should be treated in order to gastrointestinal obstruction. In the follow up, patient pre- reduce episodes of acute bleeding and to preserve visceral sented Carcinoid Syndrome (Diarrhea and flushing). Bilobar function to the maximum extent. liver metastases were identified. Initiated systemic treatment Conclusion: Thus, Endovascular treatment, through the em- with Lanreotide with partial improvement of the symptoms. bolization of AVM, appears as a minimally invasive method Due to absence of control of symptoms, extent, location and of great utility in the treatment. Through the techniques em- number of metastases, opted for treatment with Radioembo- ployed, it is possible to control bleeding foci with low com- lization. Magnetic Ressonance image (MRI) pre-TARE esti- plication rates, and it can be repeated when necessary and mated tumor mass in 15% of hepatic volume and identified avoiding a morbidity procedure. hepatic hemangioma with 2.2cm in Segment VII. Responsible Author: Rafael Birelo Martins On 09/27/18, TARE was performed. Embolized previously Email: [email protected] the cystic artery. The hepatopulmonary shunt was estimated Keywords: RENDU-OSLER-WEBER,MALFORMAÇÃO,- at 8% and total administered dose of 1.06 GBq in the right EMBOLIZAÇÃO hepatic artery and 0.22GBq in the left hepatic artery. Discussion and diagnosis: The radiological control post- PD.08.008 TARE performed on 11/07/18 observed reduction of second- ary hepatic lesions, areas of hypovascularization and reduc- ABLATIONS IN UNCOMON INJURIES - WHEN THE tion of 85% in size of the hepatic hemangioma. UNLIKELY SUCEEDED Conclusion: This case confronts us about the possibility of Authors: GILBERTO, G.M.; LEMBRANÇA, L.P.; PIN- using Radioembolization with Y90 as a treatment form in pa- HEIRO, K.; RAHAL JUNIOR, A.; FALSARELA, P.M.; tients with symptomatic hepatic Hemangioma. In the present NASSER,F.; ANDRADE, J.R.; GOBBO-GARCIA, R.. case, the finding of reduction of hemangioma was an inciden- Institution: HOSPITAL ISRAELITA ALBERT EINSTEIN tal finding and was not the patient's goal of treatment, but this A brief description of the objective(s): A series of cases finding opens the door for a new interrogation and possible in which curative ablative treatment was indicated, but the new use of SIRT in benign hepatic diseases. location or the number of lesions were challenges to the pro- Responsible Author: Rafael Birelo Martins cedure. With proper planning and use of adequate techniques, Email: [email protected] good results were obtained. Keywords: Hemangioma,Radioembolização,Radioemboli- Clinical History:Three patients with malignant liver lesions; zation the first was a young male with multiple metastases of col- orectal cancer, being indicated joint treatment with surgical team to approach the whole liver with curative purpose. PD.08.007 Radiofrequency ablation (RFA) of multiple lesions was per- ENDOVASCULAR TREATMENT OF PULMONARY formed, followed by contralateral hepatectomy, with optimal ARTERIOVENOUS MALFORMATION IN REN- results. Patient evolved with significant decrease of the tu- DU-OSLER-WEBER SYNDROME mor marker, maintained for three years after the treatment, Authors: MARTINS, R.B.; FALSARELLA, P.M.; VALLE, still following-up. The second and third had hepatocellular L.G.M.; GALASTRI, F.L.; AFFONSO, B.B.;NASSER, F. carcinoma (HCC) in difficult-to-approach sites. One of them
Abstracts of Scientific Papers 43 was located in the left lobe, in close contact with the stomach. PD.08.012 RFA was indicated, and hydrodissection was first attempted, FIDUCIAL MARKING GUIDED BY IMAGE - PARTNER- with no success. Percutaneous mechanical withdrawal of SHIP SURGERY + INTERVENTIONAL RADIOLOGY the stomach was performed using two 18G Turner needles. Authors: GILBERTO, G.M; LEMBRANÇA, L.P.; MAR- The last patient presented a lesion adjacent to the gallblad- TINS, R.B.; RAHAL JUNIOR, A.; VALLE, L.G.M.; AF- der. Faced with the risk of injury, we decided to use cryoab- FONSO, B.B.; MARIOTTI, G.C.; GOBBO-GARCIA, R.. lation to better determine the margins of the ablation area. Institution: HOSPITAL ISRAELITA ALBERT EINSTEIN After unsuccessful hydrodissection, mechanical withdrawal A brief description of the objective(s): Demonstrate the with Turner 18G was performed. The patients evolved well, partnership of surgical and interventional teams, resulting in in hospital discharge conditions the day after the procedure. benefits to patients such as reduction of morbidity and high Discussion and diagnosis: Several protective techniques in surgical success. Patients with biochemical recurrence of order to avoid non-target organ damage are described in the prostatic cancer were previously treated with systemic thera- literature, and mechanical withdrawal is possible and feasi- py, but with development of Positron Emission Tomography ble. In these cases we use Turner 18G needles with little blunt and Computed Tomography with Prostate-Specific Mem- tip. Often we face challenges in the practice of interventional brane Antigen (PET-PSMA) it is now possible to detect small radiology, whether due to difficult cases or the risk of compli- metastatic lesions, especially in pelvis. Currently, these pa- cations. In this way, the interdisciplinary discussion and the tients undergo surgical treatment, but the small dimensions of careful planning of the approaches are essential, aiming the these lesions make it difficult to excision them to the naked best results with the lowest morbidity for the patients. eye, with the radiology team marking the essential role. Conclusion: Challenging cases, because of the high risk of Clinical History: Two patients presenting biochemical re- complication or difficulty of access, require a great diversity currence after radical prostatectomy with high uptake in of techniques and experience of the operator to make the pro- small lymph nodes detected in PET-PSMA. They were sub- cedure safe and viable. mitted to preoperative marking with carbon and radiopaque Responsible Author: Guilherme Moratti Gilberto fiducial, and then referred to surgery. Email: [email protected] Results and discussion: Finding small intraoperative le- Keywords: interventional,radiology,ablation,radiofrequen- sions, usually small lymph nodes in unusual topographies, is cy,crioablation,liver,oncology challenging for urologists, even for those more experienced. With the development of PET-PSMA detection of these le- PD.08.010 sions by image became possible, creating a new paradigm: how to approach them? INTERVENTIONAL RADIOLOGY APROACH IN A Fiducial marking followed by surgical approach, or even POST LIVER TRANSPLANT PORTAL STENOSIS - A percutaneous ablation in some cases, have been the methods CASE REPORT used in our service to treat patients with these small lesions, Authors: KOCHI, A.T.; SZEJNFELD, D.; MONARIM, with great effectiveness. This type of treatment requires mul- M.A.S.; FERREIRA, D.M.; FORNAZARI, V.A.V.; PORTO, tidisciplinary work, especially with the urological and oncol- D.D.S.; JESUS, G.A.B.; PAIVA, G.G.; AZEVEDO FILHO, ogy teams, usually in clinical meetings with case discussions. L.F.; FERRARESI, I.M. The presence of the interventional radiologist in these meet- Institution: UNIFESP / HOSPITAL SÃO PAULO ings is essential, as well as being able to work as a team and A brief description of the objective(s): The objective is to respect the limits of each specialty. report the interventional radiology approach in a case of por- Conclusion: Fiducial marking assists the surgeon for com- tal stenosis after pediatric hepatic transplantation. plete treatment of the target lesion and optimizes the surgical Clinical History: Male patient, 18 years old, liver trans- outcome. plant at 12 caused by Budd-Chiari. Electivelly admited for Responsible Author: Guilherme Moratti Gilberto investigation of elevation of canalicular enzymes. Cholan- Email: [email protected] giorassonance demonstrating the finding of choledocholi- Keywords: Fiducial;,interventional-radiology,prostate,can- thiasis and intrahepatic portal vein ectasia, splenomegaly, cer,oncology retroperitoneal collateral circulation with splenorenal shunt. Performed ERCP with extraction of calculi, but remaining with elevation of enzymes. Secondly the endovascular ap- proach confirms the portal stenosis, that was treated with angioplasty and stent placement. Resulting in liver laborato- ry markers improvement. Discussion and diagnosis: Vascular complications may oc- cur with a certain frequency after hepatic transplantation. The hepatic parenchyma congestion, described in this case, probably caused repercussion in the portal triad, impairing hepatic function and elevating, even if slightly, the canalic- ular enzymes. Conclusion: Interventional radiology is a specialty that also has its role in the vascular area, aiding the diagnostic and treatment of complications after hepatic transplantation. Responsible Author: ANDERSON KOCHI Email: [email protected] Keywords: RADIOLOGIA, INTERVENÇÃO, INTERVEN- CIONISTA, VASCULAR, ENDOPRÓTESE, TRANSPLAN- TE, HEPÁTICO, HIPERTENSÃO, PORTAL, ESTENOSE
44 49th Sao Paulo Radiological Meeting MAMA ORIGINAL PAPER ORAL PRESENTATION (TL)
TL.09.001 POSTERS (PI) MRI PATTERNS OF RESPONSE FOR BREAST CAN- CER AFTER NEOADJUVANT CHEMOTHERAPY: DIFFERENCES BETWEEN MOLECULAR SUBTYPES PI.09.009 AND TUMOR PHENOTYPES PRE TREATMENT IMPORTANCE OF ULTRASONOGRAPHY AND Authors: NEGRAO, E.M.S.; BITENCOURT, A. G. V.; MAGNETIC RESSONANCE IMAGING IN THE AX- SOUZA, J.A.; MARQUES, E. F.; GUATELLI, C. S.; GRA- ILLARY EVALUATION IN PATIENTS WITH BREAST ZIANO, L.; ALBUQUERQUE, M.L.L.; CANCER Institution: AC CAMARGO CANCER CENTER - SÃO Authors: PEIXOTO, M.P.; FURTADO, R. S. O. P.; FONSE- PAULO - SP - BRASIL CA, E. K. U. N.; LUPINACCI, F.A.S.; RIBEIRO, R. L. M.; A brief description of the objective(s): To compare tumor response and regression patterns in magnetic resonance im- FEDERICCI, E. E. F. aging after chemotherapy for breast cancer between molecu- Institution: HOSPITAL ISRAELITA ALBERT EINSTEIN lar subtypes and pre-treatment resonance lesion phenotypes A brief description of the objective(s): To demonstrate the Material(s) and method(s): We selected 219 cases with negative predictive value of ultrasonography and magnetic pre-MRI and post neoadjuvant chemotherapy for breast can- resonance imaging (MRI) in the evaluation of axillary lymph cer. The lesions were classified by the phenotype as nodule, nodes in breast cancer patients. enhancement (non nodular lesion) or mixed, in addition to Material(s) and method(s): The axilla of 305 patients single or multiple lesions, multicentric or multifocal disease. who underwent ROLL / needling of their breast lesions per- Response patterns were compared between molecular sub- formed in a quaternary hospital during the year 2017 were types of tumors and among pre-treatment lesion phenotypes retrospectively evaluated. The inclusion criteria were: patient Results and discussion: The predominant finding in MRI with diagnosis of breast cancer; pathological results of sen- pre-treatment was mass (68%) and single lesion (62%). In tinel lymph nodes and available US and / or MRI scans. The MRI post-treatment the predominant residual finding was anatomopathological results of the sentinel lymph node sur- non-mass, focus or both (70%). Considering the molecular gical biopsies were evaluated and compared with their char- subtype, in the luminal and luminal Her2 (n = 132) tumors, acteristics in the ultrasonographic and MRI images. the mass finding in the pre-QTN MRI occurred in 60% and the non-mass residual lesion (non-mass enhancement) pre- Results and discussion: Of those cases, 122 were within the dominated in 59%. In superexpressed Her-2 tumors (n = 43), inclusion criteria. Of these, 16 axilla had altered lymph nodes the pre-QTN MRI mass in 72% and in the post-MRI, non- in the imaging studies (US and MRI). In imaging studies, 4 mass lesion in 50%. In the triple-negative (n = 69) mass in had up to 2 lymph nodes affected by metastasis, 6 had more MRI pre 72% and in MRI post, non-mass lesion in 44%, but than 2 lymph nodes affected and 6 were reactional. 106 cases in this subtype mass lesion after QTN reached a higher pro- presented axillas with preserved lymph nodes in the imaging portion (42%) compared to the other subtypes (Luminal 25% studies, 13 cases presented metastatic involvement in the ax- and Her2 37%). Regarding the initial finding, in the cases illary lymph nodes. 10 cases of that had up to 2 lymph nodes that presented as mass, the finding in the posttreatment ex- affected, 3 cases with more than 2 lymph nodes affected. The amination was mass in 39%, whereas of those that presented remaining 93 cases of negative axilla in the imaging methods initially as non-mass or both, was 9%. showed no signs of secondary involvement. Conclusion: The present study reinforces the classification Conclusion: Taking ACOZOG Z0011 as reference, we con- of MR response patterns of QTN tumors and residual patho- clude: axillla positive to the USG and / or MRI, 37.5% pre- logical tumor patterns. Residual imaging patterns after QTN sented metastatic involvement and negative axilla only pre- were similar to the patterns of tumor retraction in MRI previ- sented 2.8% relevant metastatic involvement in image. Thus, ously suggested by other Responsible Author: Erika Marina Solla Negrao although the positivity of the lymph nodes in the imaging Email: [email protected] studies did not always indicate significant metastatic involve- Keywords: Ressonancia,mama,quimioterapia,cancer ment in the sentinel evaluation, its negativity showed a good correlation with absence of involvement in the sentinel eval- uation. TL.09.002 Responsible Author: Milena Rocha Peixoto STUDY OF TRIPLE NEGATIVE BREAST CANCER Email: [email protected] MORPHOLOGY AND ANGIOGENESIS THROUGH ULTRASSONOGRAPHY Keywords: linfonodo,axilar,cancer,mama Authors: RODRIGUES, L. P.; VELOSO, J. C. V.; LIMA, P. H. P.; SILVA, C. P.; DINIZ, L. V.; MIRANDA, G. M.; WAJS- MAN, V. Z.; BASSO, C. F.; RIBEIRO, S. M.; PESSOA, C. P. K. C.; PESSOA, E. C. Institution: UNIVERSIDADE ESTADUAL PAULISTA - FACULDADE DE MEDICINA DE BOTUCATU A brief description of the objective(s): Breast cancer is an heterogenous disease and was divided in three groups after gene expression analysis that reflect the biological behav-
Abstracts of Scientific Papers 45 ior of the tumours: luminal, HER and triple negative (bas- analyze the angiogenesis of different mammary carcinomas al). This study uses immunohistochemistry to classify the classified by immunohistochemistry using Power Doppler tumours, once genomic testing was unavailable. Luminal ultrasonography. tumours express nuclear hormone receptors, HER tumours Material(s) and method(s): This is a prospective study, express HER2 receptors and triple negative tumours do not which evaluated 1080 breast tumours submitted to percuta- express these receptors. Triple negative lesions are more ag- neous biopsy from 2012 to 2017. Out of these lesions, 459 gressive, tipically have undifferentiated cells, high histolog- mammary carcinomas were selected and classified by immu- ic grade and mitotic index, resulting in greater relapse rate nohistochemistry in three groups: luminal, HER2 and triple and smaller survival rate. This study analyzes the morpho- negative. All tumors were submitted to Power Doppler (PD) logical and angiogenic features of triple negative tumours ultrasonography. The presence or absence of vessels, number through ultrasonography. of vessels and their spectral wave data were evaluated, such Material(s) and method(s): Out of 1180 mammary tumours as Maximum Systolic Velocity (Vmax), Resistance Index submitted to percutaneous biopsy and ultrasonography as a (RI) and Pulsatility Index (PI). part of a prospective study between the years of 2012 and Results and discussion: The mean patient’s age was 57,9 2017, 129 lesions with imunohistochemistry profile of triple years and tumour average size was 2.5cm. Of all lesions, negative tumours were selected. Shape, margin, posterior 59,3% were classified as luminal, 28,1% triple negative and acoustic effect, surrounding tissue, lesion boundaries, inter- 12,6% HER2. Mean patient’s age was 60 years in luminal nal calcifications, presence or absence of vessels, resistance group, 55,7 years in basal group and 53,6 years in HER2 index (IR), pulsatility index (IP) and maximum velocity of group. The mean lesion size was 2,2 cm in luminal tumours, flow (Vmax) were annalyzed. 2,9 cm in triple negative tumours and 3,2 cm in HER2 ones. Results and discussion: Mean patient’s age was 56 years Vessels representing tumor angiogenesis were observed in and mean tumour size was 3,2cm. Round tumours were 11% 63% of triple negative group, 60% of HER2 group and 46% of all lesions, oval lesions were 56% and irregular lesions of luminal ones with p <0.001 (chi-square test). No differ- were 33%. It was observed that only 3,8% of all lesions had ences were observed between the groups concerning spectral spiculated margins, 45,7% were microlobulated and 27,1% wave data or number of vessels. The Vmax was 20cm/s in were circumscribed. Posterior acoustic shadowing was seen luminal lesions, 19cm/s in triple negative lesions and 17cm/s in 14% of tumours and posterior acoustic enhancement in in HER2 ones. The mean RI was 0.7 and the mean IP was 1.5 38%. Most of the lesions didn’t have internal calcifications in all three groups. (92%) or hyperechoic surrounding halo (89%), they had Conclusion: Tumoral angiogenesis appears more frequently abrupt boundaries and 85% had normal surrounding tissue. in triple negative and HER2 tumours, which are biologically The mean IR was 0,7, the mean IP was 1,5 and the mean more aggressive. However, once flow is detected within the Vmax was 19,7cm/s, considering that 63% of all tumours had lesion, there is no difference in flow parameters between tu- blood flow on Doppler ultrasonography. mors classified by immunohistochemistry. Conclusion: Morphological patterns founded on the basal Responsible Author: Camila de Paula Silva tumours can help determining the genomic feature of the Email: [email protected] tumour through ultrasonography. Most of these tumours Keywords: Power Doppler ultrasonography,breast cancer,- showed round or oval form, normal surrounding tissue, mi- Angiogenesis,Immunohistochemistry crolobulated or circumscribed margins and rarely display internal calcifications. These qualities suggest rapid tumour TL.09.004 growth, resulting in regular form, smooth margins, absent STUDY OF 948 MAMMARY TUMOURS USING POW- halo and high cellularity, often associated with central necro- ER DOPPLER ULTRASOUND sis and posterior acoustic enhancement. Authors: VELOSO, J. C. V.; RODRIGUES, L. P.; SILVA, Responsible Author: Lucas Padilha Rodrigues C. P.; DINIZ, L. V.; LIMA, P. H. P.; MIRANDA, G. M.; Email: [email protected] WAJSMAN, V. Z.; BASSO, C. F.;DESSIMONI, M. C.; YA- Keywords: Breast cancer,luminal,HER,triple negative,ultra- MASHITA, S.; PESSOA, C. P. K. C.; PESSOA, E. C. sonography,Doppler Institution: UNIVERSIDADE ESTADUAL PAULISTA JÚLIO DE MESQUITA FILHO (UNESP) TL.09.003 A brief description of the objective(s): Tumoral angiogen- STUDY OF ANGIOGENESIS IN DIFFERENT TYPES esis is necessary for the outgrowth of mammary cancer. It OF MAMMARY CARCINOMAS THROUGH POWER also has a secondary role in benign lesions. Magnetic Reso- DOPPLER ULTRASONOGRAPHY nance Imaging (MRI) studies show important differences be- Authors: SILVA, C. P. RODRIGUES, L. P. VELOSO, J. C. tween vascularization within benign and malignant mamma- V. DINIZ, L. V. WAJSMAN, V. Z. MIRANDA, G. M. BAS- ry lesions. Benign tumours have a simpler vascular network, SO, C. F. LIMA, P. H. P. TRINDADE, A. P. PEREIRA, G. A. without high flow or arteriovenous shunts, unlike malignant PESSOA, E. C. PESSOA, C. P. K. C lesions. Few recent studies assess the variation in angiogen- Institution: FACULDADE DE MEDICINA DE BOTUCA- esis of mammary tumours. This study suggests analyzing TU-FMB (UNESP) malignant and benign lesions angiogenesis through power A brief description of the objective(s): Analysis of gene doppler ultrasound. expression in breast cancers allowed classifying them into Material(s) and method(s): This is a prospective study in three groups, which reflect their biological behavior: lumi- which 1080 mammary tumours were evaluated, all of them nal group, HER2 group and basal group, also called triple submitted to percutaneous biopsy between the years of 2012 negative group. Using immunohistochemistry, an attempt is and 2017. Carcinomas in situ, atypia, inflammatory process- made to approximate the genomic classification. Tumoral an- es, and malignancies other than carcinoma were excluded giogenesis is an important factor for development of breast from the sample, resulting in 984 tumours. These tumours cancer and its hemodynamic changes provide the basis for were analyzed with power doppler ultrasound (PD) regarding study of the lesions in Doppler. The purpose of this study is to the presence or absence of vessels, maximum systolic veloc-
46 49th Sao Paulo Radiological Meeting ity (Vmax), resistance index (RI) and pulsatility index (PI). Responsible Author: Erika Marina Solla Negrao Results and discussion: Out of the 984 tumours, 489 were Email: [email protected] benign lesions and 495 were malignant. About benign tu- Keywords: mamografia,benigno,rastreamento mours, the patient’s mean age was 45,8 years, the mean size of the tumour was 1,7cm and 14,5% of these lesions had ves- PI.09.007 sels (p< 0,01). On the other hand, in malignant tumours, the PSEUDOANGIOMATOUS STROMAL HYPERPLASIA mean patient’s age was 58 years, the mean sizeof the tumour (PASH) AS BREAST IMAGING CHAMELON was 2,6cm and 52,7% of these lesions had flow on PD. On Authors: GOMES, A.I.; PONTE, M. P. T. R.; PEIXOTO, M. benign lesions, the average RI was 0,6, the average PI was R.; RIBEIRO, R. L. D. M.; FRANÇOLIN, E.E.; DUBINCO, 0,9 and the mean Vmax was 13,9cm/s. On malignant lesions, A.; FURTADO, R.S.O.P. the average RI was 0,73, the mean PI was 1,4 and the average Institution: HOSPITAL ISRAELITA ALBERT EINSTEIN Vmax was 19,4cm/s. ROC curve showed a RI cutoff of 0,65, (HIAE) with 77% sensibility and specificity and a PI cutoff of 1,1 Introduction and objective(s): Pseudoangiomatous stro- with 80% sensibility and specificity. mal hyperplasia (PASH) is a benign proliferation of breast Conclusion: Tumoral angiogenesis is more frequent in ma- stromal cells with a possible hormonal etiology, although lignant tumours and once flow is detected, pulsatility and re- pathophysiology isn’t yet fully understood. Women in the sistance indeces are greater in carcinomas. reproductive age and elderly women with estrogen replace- Responsible Author: JULIA DE CASTRO VIEIRA VELOSO ment therapy are the most affected group. It is frequently an Email: [email protected] incidental histologic finding in breast biopsies performed to Keywords: breast cancer,ultrasound,Power Doppler,Dop- investigate other benign or malignant lesions and has been pler,angiogenesis,malignant tumours,benign tumours reported in 23% of patients. It rarely presents as a painless breast mass (nodular PASH), found at only 0,4% of breast biopsies. This iconographic essay proposes a practical ap- proach to recognize the broad spectrum of PASH in different imaging modalities, bringing togheter some differential diag- PICTORIAL ESSAY noses, highlighting possible pitfalls and imaging limitations. Method(s): The study consists in a review of the multiple imaging findings of more than 50 breast lesions depicted in POSTERS (PI) our Breast Imaging Center which had PASH as their final pathological diagnosis. 1. Irregular mass on ultrasound (US); 2. Segmental enhancement on magnetic resonance imaging PI.09.001 (MRI); 3. Solid oval mass with small cysts on US; 4. Focal asymmetry on mammography (MMG); 5. Oval circumscribed BENIGN FINDINGS ON MAMMOGRAPHY, BUT UN- mass on US and MRI; 6. Developing asymmetry on MMG. USUAL. HOW TO IDENTIFY THEM? Discussion: The most common presentation of PASH Authors: NEGRAO, E.M.S.; SABINO, S. M. P. S.; WATA- on imaging modalities is a well-circumscribed mass on NABE, A. P. H. U., MAUAD, E. C.; SAITO, M. M.; PI- MMG and a hypoechoic, slightly heterogeneous mass with CONE, J. C. S. S.; ONARI, N. or without cystic spaces on US, but there are many other Institution: HOSPITAL DO CÂNCER DE BARRETOS - presentations. It is important to recognize that clinically, BARRETOS - SP - BRASIL PASH is a potential mimicker of fibroadenoma, while on Introduction and objective(s): Benign findings found and histology it can be misdiagnosed as a low-grade angiosar- reported on mammography should be classified as such, coma. To proceed the diagnosis a core-needle biopsy is re- which in this category determines essentially 100% chance quired in almost all cases. Further management depends on of being benign. Calcified fibroadenomas, multiple secretory concordant imaging findings, the histologic diagnosis and calcifications, fat-containing lesions (oil cyst, lipomas, galac- the patient’s choice. The differentiation between PASH and tocells and hamartomas of mixed densities), cutaneous neu- angiosarcoma is essential for the prognosis and treatment. rofibromas, intramammary lymph nodes and sebaceous cysts The second one is a malignant lesion, highly vascular and are classic examples. Although less common, other findings, usually requires wide local excision and chemotherapy. if correctly identified and classified, determine benign classi- Conclusion: Correct identification of PASH has import- fication. Examples of foreign body, anatomical variants, and ant treatment implications for the patient and frequently a unusual or very large skin lesions that must be properly iden- good prognosis. The radiologic findings should raise the tified so that they are not mistakenly classified as suspicious. suspicion of PASH, but the current imaging studies are not Method(s): We describe a series of cases of uncommon be- specific enough to make a definite diagnosis, therefore, nign findings in mammography, which can simulate suspi- the final diagnosis rests on histological confirmation and cious lesions in case of misinterpretation. immunohistochemistry. Discussion: Considering that no change is expected in the Responsible Author: Andressa Inácio Gomes follow-up interval of tests with benign findings, the radiolo- Email: [email protected] gist should be able to recognize and classify these findings, Keywords: Breast,Mammography,Ultrasound,Diagnostic even if uncommon, to mention them as a definitive benign procedure,Connective tissue disorders,MRI,PASH lesion. Due to the lack of familiarity with certain findings, the analysis can be difficult and possibly interpreted as uncertain or suspicious. PI.09.012 Conclusion: The knowledge of typically benign findings BREAST LYMPHOMAS - WHAT RADIOLOGISTS is important for the recognition and proper interpretation SHOULD KNOW? of a definite benign finding, thus avoiding later errors of Authors: SOUZA, J. A.; SILVA, C. O.; MEIRELES, L. L.; interpretation. MATTIONI, M.; FREITAS, J. S.
Abstracts of Scientific Papers 47 Institution: AC CAMARGO CANCER CENTER four cases of different causes followed in our service from Introduction and objective(s): Breast cancer is the most 2014 to 2017, due to metastasis of breast neoplasm, tattoo common malignant neoplasm in women and the leading cause pigment deposit and pseudocalcifications associated with sil- of cancer mortality in women in Brazil. More than 95% of icone implants, illustrating the findings of each case in differ- breast cancers are carcinomas. Occasionally, other malignan- ent imaging methods. cies may develop in the breast tissue, and breast lymphomas, Discussion: The calcification of axillary lymph nodes is an although uncommon, are a diagnostic possibility to be con- uncommon finding in the mammographic evaluation, with sidered. The aim of this pictorial essay is to contribute to the multiple possible etiologies. The clinical history, the relevant knowledge of radiologists regarding mammary lymphomas, antecedents and the imaging aspects in mammography may presenting illustrative images of the main forms of presenta- help in this distinction, which in some cases is only possible tion of the disease in different imaging methods. through the anatomopathological study. In clinical practice, Method(s): A review of the literature and analysis of cases the knowledge of the main causes and their characteristics in diagnosed in a referral center was carried out through mam- the image helps in the differentiation between the benign and mography, ultrasonography, magnetic resonance imaging malignant causes, directly reflecting in the morbimortality. and PET-CT. Among the benign causes, granulomatous diseases, the pres- Discussion: Breast lymphomas can originate in the breast ence of tattoos, the use of medications based on gold salts, (primary) or involve it as a result of dissemination from fatty necrosis and silicone deposits. Calcifications secondary other sites (secondary). Both forms of presentation are rare, to malignant processes, which constitute the smallest part of accounting for about 0.8 to 2.2% of extranodal lymphomas the cases, often represent metastases of breast neoplasms, with and 0.1 to 0.5% of primary breast neoplasms. Primary breast other primary sites being extremely uncommon. lymphomas are mostly non-Hodgkin diffuse large B-cell Conclusion: The calcification of the axillary lymph nodes is type, followed by follicular and MALT types.They are usu- an uncommon mammographic finding due to several caus- ally single, painless and well delimited tumors and exhibit es. The distinction between benign and malignant causes is elastic consistency and rapid growth. There may be nipple essential and should consider the clinical history, relevant retraction and skin involvement, including breast ulceration. antecedents, stability and appearance of calcifications, espe- Breast enlargement and edema may be present, simulating in- cially its morphology, although in many cases anatomopatho- flammatory carcinoma. A subtype of primary lymphoma that logical study is indispensable. has been gaining evidence in recent years is the breast im- Responsible Author: Gabriel Laverdi Beraldo plant-associated anaplastic large cell lymphoma. This entity Email: [email protected] has two predominant clinical presentations: a) more frequent Keywords: Mamografia,Linfonodos,Mammography,Calcifi- and indolent, in which a fluid containing tumor cells accu- cations,Calcificação,BI-RADS mulates between the prosthesis and the fibrous capsule; b) less frequent and more aggressive, presenting a mass, usually PI.09.018 accompanied by seroma. Mammography, ultrasonography, SILICONE IMPLANT MICROTRANSPONDER: magnetic resonance imaging and PET-CT are imaging meth- WHAT HEALTHCARE PROVIDERS NEED TO KNOW ods that may help in diagnosis. Authors: DUBINCO, A.; GOMES A.I.; PEIXOTO, M.R.; Conclusion: Imaging findings in breast lymphoma are not FRANÇOLIN, E.; RACY, A. C. S.; RIBEIRO, R.L.D.M. definitive and may be indistinguishable from other lesions. Institution: HOSPITAL ISRAELITA ALBERT EINSTEIN Although the histological evaluation is most necessary for Introduction and objective(s): The microtransponder is a the final diagnosis, the imaging methods are important in its small device attached to the silicone implant capsule, that detection and characterization. use radiofrequency to transmit some vital information on the Responsible Author: Mateus Mattioni implant to a portable scanner, such as: serial number, size, Email: [email protected] shape, position, surface, year of fabrication, among other. Keywords: Lymphoma,Breast Neoplasms Once the microtransponder is still an unusual device to be seen on daily practice, this study has as objectives: make a re- PI.09.016 view about the silicone implants microtransponder and their CALCIFIED AXILLARY LYMPH NODES: WHAT functions; discuss about how the microtransponder appears COULD THEY MEAN? on different modalities of imaging exams; analyze the mag- Authors: BERALDO, G. L.; AMARAL, L. T. W.; JARRY, V. netic susceptibility artifact produced on breast MRI. M.; RAEDER, M. T. L.; BISINOTTO, H. S.; ALMEIDA, O. J. Method(s): This study shows our experience with the sili- Institution: UNIVERSIDADE ESTADUAL DE CAMPI- cone implant microtransponder over several modalities of NAS - UNICAMP imaging exams. Introduction and objective(s): During the mammographic Discussion: On mammography and chest radiography (fig- evaluation, we occasionally encounter abnormalities of the ax- ures 1 and 2), the microtransponder appears projected on the illary lymph nodes, either due to changes in density, size, mor- implant capsule wall as a small, linear object, with a metallic phology, loss of usual fatty hilum or presence of calcifications. density. On chest CT it appears as a small metallic artifact Among these, axillary lymph node calcifications are uncom- (figure 3). To analyze the silicone implant on MRI, our ser- mon in clinical practice and in the literature, without mention vice protocol includes an axial STIR. The classic finding is in the BI-RADS® classification. The objective of this study is the “black hole” artifact (figure 4), that is a single void and to review the main causes of calcified axillary lymph nodes and usually larger than the actual implant. That´s an important their aspects in the different imaging modalities, establishing topic of discussion, as it is one of the greatest disadvantages in findings that favor benign and malignant etiologies, with the its use. A study performed using one of the silicone implants purpose of helping to interpret this finding in clinical practice. with microtransponder (Motiva Implants), calculated that the Method(s): We discuss the main etiologies of calcification void area was approximately 15 cm2, that is equivalent to 20 of axillary lymph nodes, establishing the typical findings that mm – 30 mm. The void artifact raises concerns about the abil- favor benign and malignant etiologies. Finally, we describe ity to detect breast cancer – routine screening or even during
48 49th Sao Paulo Radiological Meeting the search of local recurrences – and for that the manufactur- Conclusion: Mammary scintigraphy is an effective tech- ers recommend using sequences without fat suppression, such nique for the detection of mammary carcinomas; however, as Turbo Spin Echo, T1 or T2 weighted. it should be emphasized that the accuracy of the method is Conclusion: Health care providers, including radiologists influenced by the size, histological type, degree and location and breast surgeons, should be able to recognize this device of tumors, but it is independent of mammary density or place- on different modalities of imaging exams. ment of prostheses Microtransponder is safe for use during breast MRI scans, al- Responsible Author: Joyce Caroline though produces susceptibility artifact (black hole) and may Email: [email protected] reduce detection of silicone rupture and adjacent small breast Keywords: Breast Screening; Mammography; Breast Carcinoma lesions. Alternative sequences are being studied over the last few years, Dual-Echo Dixon for example, to reduce the arti- PD.09.009 fact volume area. MAMMOGRAPHY BY ISSUE OF POSITRONS (PEM) Responsible Author: André Dubinco IN THE BREAST CANCER STUDY: ICONOGRAPHIC Email: [email protected] TEST AND LITERATURE REVIEW Keywords: Implante,Silicone,Microtransponder,RFID,Ar- Authors: SOUSA, J.C.O tefato,MRI,RM Institution: NÚCLEO DE PESQUISA CIENTIFICA E ACADÊMICA DE RADIOLOGIA (NPCAR) Introduction and objective(s): Currently, breast cancer is the most common malignant neoplasm in women world- wide. Early detection together of timely therapeutic choice DIGITAL PRESENTATION (PD) results in a marked reduction in morbidity and mortality in the world due to breast cancer. Diagnostic imaging methods that contribute to the early diagnosis of breast cancer fall into PD.09.007 categories: anatomical (resulting in images only of structure MAMARY CINTILOGRAPHY AS A DIAGNOSTIC or anatomical changes that are associated with pathology) and functional (produce images resulting from the capture of METHOD IN MAMMARY CARCINOMA physiology of the body, or functional and metabolic changes Authors: SOUSA, J.C.O. associated with pathology). Positron emission mammography Institution: NÚCLEO DE PESQUISA CIENTIFICA E (PEM) is a functional imaging technique for the detection of ACADÊMICA DE RADIOLOGIA (NPCAR) breast cancer, facilitating the acquisition of information in Introduction and objective(s): The prognosis of breast spite of the metabolic processes that occur within the tumor. carcinoma is intrinsically related to: early diagnosis; tumor accurate way contributing to the knowledge of breast tumor dimension; lymph node metastasis; presence of distant met- behavior. This research seeks to explain important aspects of astatic foci. Mammary Scintigraphy acts as a non-invasive PEM in breast cancer: list the advantages and disadvantages; method capable of differentiating benign and malignant le- enumerate the indications and contraindications of the meth- sions in the breast region, contributing satisfactorily to the od: to illustrate the indications by means of clinical cases. detection of tumoral areas, complementing mammography Method(s): This is an iconographic essay combining multi- and breast ultrasonography. This study proposes to report in ple images of clinical cases of patients with suspected breast mammary carcinoma the contribution of mammary scintigra- cancer submitted to PEM. In order to further enhance the phy emphasizing the technical description and using images scientific relevance of this study we used the literary review from clinical cases to demonstrate the indications of this pro- of scientific publications written in Spanish and Portuguese cedure in the aforementioned neoplasia. referring to the theme for the constitution of the theoretical Method(s): Pictorial study of clinical cases of breast carcino- content of this study. ma submitted to mammary scintigraphy, combined with the Discussion: In breast cancer, positron emission mammog- literary review of conceptual aspects relevant to the subject. raphy (PEM) works by evaluating tumor metabolic activity All the theoretical contextualization of the subject encom- through a high resolution study of molecular images of the passed scientific publications of methodological scope of: mammary gland. PEM has the ability to detect breast cancer case reports; field surveys; Masters dissertation; and litera- by combining image sensitivity at high spatial resolution, it is ture review articles. Images of the pictorial essay were used emphasized that this technique does not appear to be adverse- with the consent of patients previously notified of the purpos- ly affected by breast density, hormone replacement therapy es of teaching and scientific practice of this research. or menopause. Discussion: Mammary scintigraphy is a highly accurate, Conclusion: PEM specifically in breast cancer: produces non-invasive diagnostic imaging method capable of detecting much more accurate images of small breast lesions; deter- mammary carcinomas in the following situations involving mines the exact location of tumor areas; assisting in the es- patients with: inconclusive mammography; dense breasts; ar- tablishment of neoplastic extension due to the high level of chitectural distortion; breast implants; among others. Among precision and excellent spatial resolution. the various radiopharmaceuticals used in this procedure, Responsible Author: Joyce Caroline sestamibi-99m Tc is the most used because it distributes in Email: [email protected] the tissues through the blood flow and penetrates the cells Keywords: Mammography by Positron Emission by passive diffusion due to the difference in transmembrane (PEM);,Breast Cancer;,Mammary Injuries; potential. Among the indications of mammary scintigraphy in mammary carcinoma are: diagnosis and evaluation of ma- lignancy; predictive factor of response to chemotherapy; to PD.09.030 correlate the imaging findings with the immunohistochem- TRIPLE NEGATIVE BREAST CANCER (TNBC): WHAT ical subtypes; classify prognostic groups; suggest adjuvant IS IT? HOW DOES IT SHOW? WHAT TO EXPECT? therapies; etc. Authors: OLIVEIRA, T. M. G. ; SOUZA, B. N. C. ; BAR-
Abstracts of Scientific Papers 49 ROS, R. V. ; FIGUEIREDO, P. C. the skin / subcutaneous, ducts and stroma, vessels and nerves. Institution: HOSPITAL DAS CLÍNICAS USP RIBEIRÃO Gynecomastia is the ductal and stromal proliferation of breast PRETO. tissue with typical imaging features in mammography. Its Introduction and objective(s): Triple negative tumors do mammographic classification in nodular, dendritic and dif- not express hormone receptors (for estrogen and progester- fuse is correlated to histological correlation and time of evo- one) and the human epidermal growth factor of receptor 2 lution. On ultrasonography study the irregular and hypoecho- (HER2). Although conceptually different, they are often used ic mammary tissue can be vascularized at Doppler and lead as a synonym for basal tumors, a molecular subtype. TNBC to misinterpretations. Retroareolar location, lack of associat- presents specific characteristics that allow the presumptive ed secondary findings, and correlation with mammography diagnosis by image and represent a group of neoplasias with may aid in the diagnosis of benignity. Other benign lesions aggressive behavior and worse prognosis. The objective of of the breast can be found in the male patient: simple cysts, this study is to review the epidemiology, imaging characteris- lipomas / fibrolipomas, papillomas, abscesses, hematomas, tics, response to neoadjuvant chemotherapy and the systemic steatonecrosis, pseudo-angiomatous stromal hyperplasia, metastasis pattern of this tumor subtype. among others, with imaging finding similar to that found in Method(s): Patients with a diagnosis of TNBC with imaging women. The invasive carcinoma of the male breast presents examinations at our institution from 2010 to 2018 were re- as an irregular, spiculate and eccentric nodule to the papilla. viewed and selected. Often thickening and / or retraction of the skin and ipsilateral Discussion: TNBCs represent 15% of invasive breast carci- axillary lymph node disease are present and calcifications are nomas and affect younger women, and are particularly relat- less prevalent. In up to 20% of the cases the breast neoplasm ed to genetic cancer, being diagnosed in 70% of patients with shows round / oval shape and circumscribed margin. Magnet- breast cancer with BRCA1 mutation. In the vast majority of ic resonance imaging (MRI) can be used for clinical staging, cases it presents as a single oval or round nodule, relative- especially for evaluation of chest wall invasion. ly well circumscribed. Its high mitotic index and cellularity Conclusion: Male breast abnormalities comprise a broad correlate with tumor necrosis. In Ultrasonography studies spectrum of pathologies. Knowledge of the most repre- common findings are posterior acoustic reinforcement and sentative images of these breast changes and the role of the presence of a cystic component. In magnetic resonance each method in the radiological investigation help in the imaging (MRI) the annular enhancement with kinetic pattern correct diagnosis. in washout is the most prevalent, with diffusion restriction Responsible Author: Rafael Vasconcelos Barros and low ADC values. These carcinomas present a high rate of Email: [email protected] complete response to neoadjuvant chemotherapy (34%) with Keywords: male,breast,cancer,gynecomastia classic centripetal reduction of lesions in partial response cases. MRI is the exam of choice for evaluation of response PD.09.035 to neoadjuvant chemotherapy with high negative predictive SECOND LOOK ULTRASOUND IN THE EVALUA- value (high prediction of complete response). Patients with TION OF INJURIES SUSPICIOUS TO THE RESO- TNBC have lower overall survival and disease-free survival, NANCE EXAMINATION with a higher risk for visceral metastasis, especially brain and Authors: VENDRAMINI,D.F.V; DOCEMA, M.F.L; BAS- lung, arising early, around 3 years after treatment. TREGHI,R.C; COSTENARO,M.A.; MOYSES, L.A.J; Conclusion: TNBCs present imaging characteristics, neo- DOCEMA, M.F.L SACCARELLI, C.R.; TEIXEIRA,P.A.C.; adjuvant chemotherapy response pattern, final prognosis and OMURA,V.L.N; GIANNOTTI,D.G., LEITE, CC. specific systemic dissemination. The knowledge of those Institution: HOSPITAL SÍRIO LIBANÊS aspects makes the radiological assessment of these patients Introduction and objective(s): Breast magnetic resonance more accurate. imaging (MRI) has a high sensitivity in the diagnosis of breast Responsible Author: Rafael Vasconcelos Barros cancer. It also plays an important role in preoperative planning, Email: [email protected] post-treatment evaluation, and screening of high-risk patients, Keywords: breast,cancer,triple-negative,CDI among others. However, due to the availability, the high cost and the long examination time, the ultrasound (US) second PD.09.033 look became a useful tool after detection of suspicious MRI le- RECOGNIZING THE IMAGE ASPECTS OF MAJOR sions, and the probability of malignancy in any lesion is greater ALTERATIONS OF MALE BREAST. if it is also observed in the US. This pictorial essay aims to fa- Authors: OLIVEIRA, T. M. G. ; SOUZA, B. N. C. ; BAR- cilitate and guide the radiologist how to perform the second US ROS, R. V. ; FIGUEIREDO, P. C look, and will review and illustrate the main imaging findings Institution: HOSPITAL DAS CLÍNICAS USP RIBEIRÃO in MRI and US of suspected lesions. PRETO Method(s): The main findings in both MRI and US second Introduction and objective(s): Breast alterations in males look will be illustrated and reviewed in a case-based pictorial are predominantly benign. The imaging aspects of gyneco- essay using images acquired at our institution, and guide and mastia, the main abnormality of the male breast, can mim- assist in how to improve the evaluation by the US second look ic neoplasia and lead to unnecessary biopsies. On the other Discussion: Several pathologies can affect the breast, and hand, breast cancer in men, which comprises only 1% of all the role of the radiologist is to recognize the main radiologi- breast cancers, presents a late diagnosis and a worse progno- cal characteristics that allow differentiation between benign sis than in women. The objective of this study is to discuss the and malignant pathologies and assist when to indicate the re- main pathologies of the male breast identifying the most rel- search and the best method to be used. MRI of the breast is evant aspects of the image for the correct diagnosis, pointing one of the main tools for both the mastologist and the special- out the indications and limitations of each imaging method. ist in breast imaging, however due to the difficulty of access Method(s): We retrospectively selected the cases of male pa- by the great majority of the population and because there are tients with breast complaints who underwent our institution. more accessible methods, the US second look deserves to be Discussion: Changes in the male breast can originate from highlighted and better understood on the part of radiologists,
50 49th Sao Paulo Radiological Meeting since a lesion seen in MRI if well directed can be found, even has helped in the management of mammary adenocarcinoma if small, in a second reading. since it makes it possible to determine predictors of lymph Conclusion: The detection of lesions in the US second look node involvement. Radioguided surgery is based on the ad- is improved when directed by the location of them based on ministration of a radiotracer (Tc99m + Phytate) by means of the MR images of the breast and recognizing the different 4 intradermal applications around the areola with subsequent presentations of these lesions. The understanding of the main detection of gamma radiation by means of the use of a probe characteristics of the lesion to the different methods allows and identification of the sentinel lymph node. the radiologist the correct correlation, contributing to an ap- Conclusion: The sentinel lymph node tracking by radiogu- proach and better management of the patient. ided surgery works to complement lymphatic mapping with Responsible Author: daniela ferreira vieira vendramini vital dye and helps in the identification of possible mammary Email: [email protected] metastases and lymph node involvement. Keywords: resonance imaging,suspicious lesions,,ultra- Responsible Author: Joyce Caroline sound second look,radiologist,ressonância magnética,lesões Email: [email protected] suspeitas,ultrassom second look,radiologista Keywords: Radioguided surgery;,Infiltrating adenocarci- noma,Breast carcinoma
PD.09.029 FIBROEPITELIAL DISEASES OF BREAST: WHAT LITERATURE REVIEW THE RADIOLOGIST SHOULD KNOW TO DIFFER- ENTIATE THEM Authors: CASTRO, H. F. B.; DIAS, G. P. F.; PAGOTO, A. A. O.; TOGNI FILHO, P. H. A.; MAIA, M.H.V. DIGITAL PRESENTATION (PD) Institution: CENTRO UNIVERSITÁRIO PADRE ALBINO A brief description of the objective(s): The present study PD.09.004 aims to analyze in an objective and succinct way the fibroepi- thelial tumors of the breast, with focus on phyloid tumors and CONTRIBUTION OF RADIOGUIDED SURGERY fibroadenoma, as well as diagnosis, clinical-imaging correla- WITH 99MTC IN THE EFFECTIVE RECOGNITION tion of the same. OF SENTINEL LYMPHONOD IN ADENOCARCINO- Description of the disease(s), method(s) and/or tech- MA INFILTRANT OF BREAST nique(s): Fibroepithelial tumors of the breast include a broad Authors: SOUSA, J.C.O ; DA SILVA,F.F; RÊGO, J.C.M.; spectrum of presentations, ranging from fibroadenomas of VIDAL,J.C.S benign behavior to phyloid tumors that may manifest more Institution: NÚCLEO DE PESQUISA CIENTIFICA E aggressively, including metastases. Fibroadenomas represent ACADÊMICA DE RADIOLOGIA (NPCAR) the most common benign neoplasms of the breast, notably A brief description of the objective(s): The infiltrating ad- in young women (younger than 35 years). Histologically enocarcinoma corresponds to the most common histological they are characterized by containing glandular mammary type of mammary carcinoma and is characterized by initial tissue and stromal tissue. Phyllodes tumors account for less development in the lactic ducts with growth in the mammary than 1% of total breast neoplasms and about 2% of breast adipose tissue. In most cases of infiltrating breast adenocar- fibroepithelial neoplasms. They are presented as well-defined cinoma with the presence of a clinically detectable palpable voluminous masses, with tendency to local recurrence. Histo- mass the possibility of axillary lymph node metastases is ob- logically they are characterized by leaf-like lobulations, with served. Indications of lymph node dissemination are deter- cellular stroma in greater quantity, when compared to fibro- minant in the prognosis and choice of neoplastic therapies. adenoma. Scientific articles from the last 10 years (2009 to The sentinel node is related to the first lymph node to receive 2019) were analyzed by accessing PUBMED, LILACS, Sci- the cancer cells through the lymph. Performing sentinel node ELO and MEDLINE databases. Keywords: Phyllodes tumor, biopsy and radioguided surgery allows the identification of Fibroadenoma, Fibroepithelial, Breast neoplasms, Radiology. a possible neoplastic mammary cell dislocation. This study Discussion: The differentiation between fibroadenomas and aims to demonstrate the efficacy of the method of identifica- filoid tumors through imaging is essential for correct man- tion of sentinel lymph node in mammary infiltrating adeno- agement and better prognosis of patients. Differentiating carcinoma by radioguided surgery. these tumors becomes challenging to the radiologist, mainly Description of the disease(s), method(s) and/or tech- because of the similarity of presentation between some cas- nique(s): This is a literature review based on the integrative es. The mammographic study showed a similar presentation format of 9 publications originated from electronic search between the two, standing out as well defined masses. At in the following databases: Google academic, SCIELO, BI- ultrasound examination, the predominant morphology was REME by means of the conjunction of the following DeCS rounded images, with smooth or lobed margins, with hypoe- (Descriptors in Health Science): "radioguided surgery" , chogenicity and heterogeneity of the parenchyma, cystic foci "Sentinel lymph node", "mammary adenocarcinoma. The sci- of permeation and absence of microcalcifications. The find- entific publications were selected after a careful reading in the ing of posterior acoustic reinforcement was more frequent in summary and adaptation to the inclusive criteria determined phyllodes tumors than in fibroadenomas. The diagnosis of by the authors: Portuguese or English; relation to the theme; mammary neoplasias, as well as pharyngeal tumors, depends free availability and contributory relevance to the study. on the biopsies performed through thick needle puncture Discussion: Infiltrating adenocarcinoma constitutes about guided by imaging methods. Other variables involved are the 70% to 80% of cases of mammary carcinomas; when the experience of radiologist physicians and pathologists respon- cancerous cells cross the latic duct and spread through the sible for the acquisition and analysis of harvested material. In lymphatic system, neoplastic dissemination occurs. The iden- some cases immunohistochemistry may be useful to arrive at tification of the sentinel lymph node by radioguided surgery the correct diagnosis.
Abstracts of Scientific Papers 51 Conclusion: Fibroepithelial tumors are prevalent among Clinical History: N.S., female, 72 years old, with bilateral mammary pathologies and constitute a challenge for radiol- subglandular breast implant for 12 years, with palpable mass ogists to differentiate these lesions for correct management. in the left breast growing for two years. On clinical examina- Responsible Author: HELLEN FABIANA BATISTA DE tion, there was an increase in volume, hardening and hyper- CASTRO emia of the left breast. Email: [email protected] Discussion and diagnosis: The patient underwent mam- Keywords: Phyllodes tumor,Fibroadenoma,Fibroepitheli- mography, ultrasonography and magnetic resonance imaging al,Breast neoplasms,Radiology.,Radiology (MRI) of the breast evidencing a small collection associat- ed with periprosthetic solid masses, contained by the fibrous PD.09.041 capsule. The lesions were coalescent, heterogeneous, circum- scribed, with power Doppler vascularization and heteroge- BREAST INCIDENTALOMAS ON PET-CT AND neous enhancement after gadolinium. Percutaneous biopsy WHOLE BODY MRI EXAMS with ultrasound-guided auto-trigger revealed nonspecific Authors: PAULA I.B, PEREIRA I. M. F, CAMPOS A. M., proliferative breast changes, a result that was discordant to RODRIGUES F. M.W, FERNANDES P. C. S. L. the imaging aspect. The implants were removed bilaterally Institution: HOSPITAL FELICIO ROCHO - BELO HOR- with capsulotomy and excision of the solid lesions of the left IZONTE breast. The evaluation of the surgical specimen showed fi- A brief description of the objective(s): Sistematic review brous tissue associated with non-specific chronic inflamma- and case series of suspicious breast lesions on PET-CT and tory process and granulation tissue with hemosiderin foci. WBMRI (whole body MRI) that were not breast cancer. Solid lesions associated with breast implants are rare late Description of the disease(s), method(s) and/or tech- complications. Among the differential diagnoses it is nec- nique(s): PET-CT has been used in management of several essary to consider granulomatous inflammatory process, types of neoplasia, including breast cancer, as inicial asses- fibromatosis and neoplasia, especially sarcomas and breast sement, evaluation of chemotherapy response and in cases anaplastic large-cell and, more remotely, invasive carcinoma of systemic recurrence. Whole body MRI is used as an im- of the breast. There are few reports in the literature of the portant screening tool in mutated patients, specially those formation of periprosthetic reactive granulomas induced by with the TP53 mutation, more suceptible to development of chronic hematoma or silicone gel bleed. radioinduced tumors. Although these exams are designed The imaging aspect of the different pathologies may be sim- to evaluate the whole body, breast lesions distinct from the ilar to mammography and ultrasonography. Magnetic reso- surrounding tissue are frequently detected, with suspicious nance imaging allows a better evaluation of the extent of the features, called incidentalomas. Our study presents 4 patients lesion and characterization of hemorrhagic foci (hemosider- with suspicious breast mass on PET-CT and WBMRI exams, in), aiding in diagnosis and that were not breast cancer, but papillar lesion, fat necrosis, Conclusion: Solid lesions associated with implants are un- lymphoma and surgical scar. common late complications. Differential diagnosis and im- Discussion: This study illustrate that PET-CT and WBMRI aging aspects must be known for correct histopathological can have false positives in breast evaluation. Although breast correlation and treatment. incidentalomas are more frequently malignant compared to Responsible Author: LORENA SARAIVA DE ALENCAR incidentalomas in other sites (42%), benign breast lesions can Email: [email protected] uptake the FDG or restrict the diffusion as does breast cancer. Keywords: Breast mass,Breast implants,Breast MRI Conclusion: Although PET-CT and WBMRI can depict sus- picious breast lesions, this evaluation and final assessment should be done using dedicated breast imaging exams and PD.09.003 according to the BI-RADS. UNUSUAL CALCIFICATIONS IN AXILLARY AND Responsible Author: IVIE BRAGA DE PAULA INTRAMAMMARY LYMPH NODES ON MAMMOG- Email: [email protected] RAPHY: RARE PRESENTATION OF SEROUS OVAR- Keywords: falso-positivos,PET-CT,WBMRI,cancer,mama IAN TUMOR Authors: NEGRAO, E.M.S.; CAPUCI, M.; BARRETO, G. B.; SABINO, S. M. P. S.; WATANABE, A. P. H. U.; SAITO, M. M.; PICONE, J. C. S. S.; ONARI, N.; MAUAD, E. C.. Institution: HOSPITAL DO CÂNCER DE BARRETOS - CASE REPORT BARRETOS - SÃO PAULO A brief description of the objective(s): Presentation of an unusual finding in mammography of calcifications of axillary and intramammary lymph nodes submitted to biopsy with an DIGITAL PRESENTATION (PD) unusual diagnosis of ovarian serous tumor implantation. Clinical History: A 45-year-old female patient underwent screening mammography with amorphous and heteroge- PD.09.002 neous calcifications of axillary lymph nodes and -intrama EXPANSIVE LESION RELATED TO BREAST mmary lymph nodes. A history of ovarian tumor treated for IMPLANT. more than 5 years in another institution. Authors: OLIVEIRA, T. M. G.; SOUZA, B. N. C.; Discussion and diagnosis: The finding of lymph node calci- ALENCAR, L. S. fications is uncommon in screening mammography and most Institution: HOSPITAL DAS CLÍNICAS DE RIBEIRÃO have benign causes. Calcifications, when suspected, most PRETO often result from metastatic implantations of primary breast A brief description of the objective(s): To evaluate the main tumors. In the case reported, the secondary cause was unex- imaging findings and to establish differential diagnoses for pected because of the context of the resolution of the ovarian masses associated with breast implants or prosthesis. pathology and because it is a breast cancer screening test.
52 49th Sao Paulo Radiological Meeting Conclusion: Although mammography is indicated for the with emphasis on its imaging and differential diagnosis screening of breast cancer, it may also reveal systemic abnor- in this period. malities and secondary findings of extramammary tumors. Clinical History: E.A.T, 18, puerperal, with no family Responsible Author: Erika Marina Solla Negrao history of breast cancer, noted a significant increase in Email: [email protected] the left breast about 2 years ago during her first pregnan- Keywords: calcificações,mamografia,ovário cy. He did not breastfeed, so there was a decrease in size. The initial examination in our service was performed 12 PD.09.006 days after a second delivery, in which there was a new significant increase in the dimensions of this breast. DUCTAL CARCINOMA IN SITU WITHIN A FIBRO- Clinically it presented with great mammary asymmetry ADENOMA: REPORT OF A RARE CASE. and hyperemia of the affected breast, with no visible Authors: SILVA, M. M.; COSTA, F. M. S. N.; LOPES, M. F. lesions on the skin or nipple, without palpable axillary V.; LOPES, R. B. S. C.; PEREIRA, I. C. A. L.; MIRANDA, lymph nodes. She underwent mammography, ultrasound A. C. A. and magnetic resonance, which demonstrated mass mea- Institution: IMIP - INSTITUTO DE MEDICINA INTE- suring about 19.0 x 4.7 cm. We performed core biopsy GRAL PROFESSOR FERNANDO FIGUEIRA guided by ultrasonography, with histopathological result A brief description of the objective(s): To report the rare evidenced lactational adenoma. case of a ductal carcinoma in situ within a fibroadenoma and Discussion and diagnosis: The fibroadenoma presents to emphasize the importance of acurate ecographic control of with mixed, epithelial and stromal components, and may these nodules. present an increase in the dimensions due to hormonal Clinical History: Patient M.C.S.D, female, 44years, brown stimuli during pregnancy. The lactational adenoma con- and farmer was undergoing semiannual breast ultrasound tains only epithelial component, being filled by secretion, control of a hypoechoic, oval and circumscribed nodule, due to lobular proliferation more prominent than in the with calcifications in its interior, located at 10h, in the left adjacent mammary tissue. The adenoma is more common- breast. In 2015, a FNA was performed indicating a benign ly found as an oval mass, smaller than 5 cm, parallel to the non-specific cytology category. During ecographic fol- skin, circumscribed, homogeneous texture, with posterior low-up, it was observed an increase in the nodule’s size and acoustic shadow, similar to fibroadenoma. In the James the patient was referred to our department for a core biopsy, study, in a series of 14 cases, the dimension was 2.5 to which revealed a ductal carcinoma in situ within a fibroad- 3.5 cm, with the largest being 7.8 cm.Reeves reported the enoma. A total mastectomy was chosen and the patient was largest case in the literature, measuring 25x18 cm. The followed up. rapid increase in size may be due to infarction, however Discussion and diagnosis: The prevalence of ductal car- not described in this first one. The second largest reported cinoma in situ within a fibroadenoma is extremely rare ( case was 16x10x5 cm, described by Manipadam. In our about 0.02%). The histopathological diagnosis is based on case there was reduction of the dimensions in the puerpe- the criterion that the neoplastic cells are limited within the rium period, due to the non-breastfeeding. fibroadenoma and only extend in a focal way to the stroma Conclusion: Lactational adenoma is a rare tumor, usually of and adjacent ducts. The mean age of onset is around 44 years small dimensions, that should be remembered in the differen- and alert signs include fibroadenomas larger than 1cm and tial diagnosis of the lesions in this period. suspicious imaging features such as non-circumscribed mar- Responsible Author: AFRANIO JORGE DE ALBUQUER- gins and increased size since previous ecography. We also QUE MAGALHAES emphasize that FNA has high false negative indexes, with Email: [email protected] core-biopsy as the method of choice in cases with indication Keywords: ADENOMA,LACTACIONAL,GIANT,LAC- of investigation. TATING,BREAST Conclusion: In spite of the rare occurrence of ductal carcino- ma in situ within a fibroadenoma, we emphasize the impor- PD.09.023 tance of the radiologist in performing ultrasound control of probably benign nodules, especially in women over 40 years BREAST AMYLOIDOSIS EXPRESSED AS A SUS- of age. And always being alert to the warning signs, so that PECTED LESION IN MAMMOGRAPHY. early diagnosis is made to improve patient’s prognosis. Authors: POSSAGNOLO, D.T.; BARBOSA, F.R.; DWEK, Responsible Author: Marina Magalhães Silva F.F.M.; ALVES, A.C. Email: [email protected] Institution: GRUPO DASA Keywords: Fibroadenoma,carcinoma intraductal,carcinoma A brief description of the objective(s): The objective of this ductal in situ study is to report the diagnosis through breast percutaneous biopsy of a case of breast amyloidosis expressed in mam- mography only as clustered amorphous microcalcifications PD.09.012 (ACR BIRADS® category 4). We emphasize the importance GIANT LACTATING ADENOMA OF THE BREAST: of the accurate diagnosis of this benign pathology since it CASE REPORT may present as a suspected lesion for malignancy in imaging Authors: MAGALHÃES A.J.A; VIANA, F.O.F; LOPES, aspects. We will evaluate its main radiological and anatomo- A.K.B.F. pathological characteristics, complementary exams and dif- Institution: HOSPITAL DAS CLÍNICAS DA UNIVERSI- ferential diagnoses. DADE FEDERAL DE PERNAMBUCO- RECIFE/PE Clinical History: Female patient, 45 years old, asymptomat- A brief description of the objective(s): Some breast ic, came to our service for screening mammography, in which lesions are common in pregnancy and lactation, most of were identified clustered amorphous microcalcifications clas- them benign, such as puerperal mastitis, abscess and ga- sified as suspected for malignancy (ACR BIRADS® catego- lactocele. The objective of this study is to report a case of ry 4) and were not seen in her previous exams. The patient giant lactational adenoma during the gestational period, was submitted to percutaneous breast biopsy (Stereotactic
Abstracts of Scientific Papers 53 Vacuum-Assisted Breast Biopsy) with histopathological re- mogeneous pink appearance in traditional stains and birefrin- sult of amyloidosis. gence to Congo red staining under polarized light. Discussion and diagnosis: Primary amyloid disease accounts Conclusion: Breast amyloidosis is a rare and benign pa- for about 15% of the cases of amyloidosis and primary breast thology, but may exhibit clinical and radiological expres- amyloidosis accounts for only 0.5% of the cases. Breast amy- sion that mimics breast carcinoma. Thus, the definitive loidosis is a rare benign disease and is usually seen in elderly diagnosis is histopathological and it should be considered patients. It may be primary, related to systemic diseases, such as one of the differential diagnoses for patients with sus- as: rheumatoid arthritis and multiple myeloma or may also be picious breast lesions, in order to define precise treatment, associated with a concomitant carcinoma. follow-up and prognosis. In mammography it may present as single or multiple lumps, Responsible Author: Daniela Tavares Possagnolo with or without associated microcalcifications, asymmetry, Email: [email protected] or, rarely as clustered microcalcifications. The definitive di- Keywords: Breast amyloidosis,suspicious breast le- agnosis is histological and is characterized by amorphous sions,mammography,clustered microcalcifications, extracellular deposition of amyloid protein, presenting ho- breast biopsy
FETAL MEDICINE PICTORIAL ESSAY Conclusion: Radiologists must familiarize with the different placental pathological conditions, allowing adequate mater- nal and fetal follow-up and conduct. Responsible Author: Maria Inês Novis DIGITAL PRESENTATION (PD) Email: [email protected] Keywords: Ressonância, Magnética, Placenta, variações, anatômicas, alterações PD.10.004 PLACENTAL MAGNETIC RESONANCE IMAGING: NORMAL AND ABNORMAL APPEARANCES LITERATURE REVIEW Authors: NOVIS, M.I.; MOURA, A.P.C.; WATANABE, A.P.F.; CHOMA, G.; WARMBRAND, G. Institution: FLEURY MEDICINA E SAÚDE Introduction and objective(s): Although placental magnet- DIGITAL PRESENTATION (PD) ic resonance imaging (MRI) is reserved for cases of dubious ultrasonography, we have seen an increasing number of these PD.10.005 examinations, especially in Imaging Services located inside FETAL MAGNETIC RESONANCE IN VENTRICU- maternity hospitals. It is extremely important to the radiologist LOMEGALIA be familiar with normal placental findings, including anatom- Authors: SOUSA, J.C.O. ical variations, as well as the main pathologies, such as in- Institution: NÚCLEO DE PESQUISA CIENTIFICA E sertion abnormalities, placental adhesive disorders, neoplasias ACADÊMICA DE RADIOLOGIA (NPCAR) and retroplacental hemorrhages. Our objective is to illustrate A brief description of the objective(s): Ventriculomegaly different placental conditions through MRI examinations, re- corresponds to one of the most common fetal abnormalities viewing normal anatomy, concepts, terminologies, main pa- and is characterized by the excessive accumulation of cere- thologies and recommended protocols. brospinal fluid in the lateral ventricles. Fetal magnetic reso- Mthod(s): Retrospective review of at least 80 placental MRI nance imaging (RMF) has reached the threshold fundamental examinations performed at XXXXXX, located at Maternity and of relevant contribution in the analysis of the fetal central XXXXXX, since the year 2014. nervous system (CNS) and acts as a complementary study to Discussion: MRI scans have been increasingly performed to prenatal ultrasonography. This study seeks to provide perti- elucidate doubts of ultrasound examinations, with increasing nent explanations to RMF in cases of ventricumegalia. importance in obstetrics. Description of the disease(s), method(s) and/or tech-
54 49th Sao Paulo Radiological Meeting nique(s): Imaginary and theoretical study of: selected scien- good signal to noise ratio; The imaging pattern of ventric- tific publications in indexed databases (VHL and SCIELO), ulomegaly in RMF should demonstrate marker sulphates, printed and online books and international journals of neu- germ matrix / migration of neuroblasts, corpus callosum and rology, case reports and doctoral theses on the subject. The ventricles, and the systematic analysis of these regions is par- theoretical development was carried out with aspects of liter- amount for the interpretation of RMF exams. ature review previously chosen from November to December Conclusion: RMF like any technology has functional limita- 2017. The imaging study contemplated FMR examinations in tions related to artifacts due to fetal movement, however the the comparative aspects within normality and in the condition benefits provided in the early diagnosis of ventriculomegaly of ventriculomegaly. override any and all problems of performing the exam. The Discussion: At the ventriculomegaly, RMF acts as a comple- information provided by the FMR examination helps to mon- mentary method to fetal ultrasonography and is characterized itor fetal brain development, may contribute to the identifi- by a good accuracy in the analysis of the brain and / or fe- cation of alterations associated with ventriculomegaly and to tal spinal segments and in the cerebral maturation. Howev- act in the differential diagnosis of pathologies of the central er, FMR also acts in the early diagnosis of inappropriately nervous system. congenital anomalies analyzed or not detected by ultrasono- Responsible Author: Joyce Caroline graphic study. The standard RMF protocol at ventriculomeg- Email: [email protected] aly combines fast sequences for acquisition of images with Keywords: FETAL MAGNETIC RESONANCE;,VEN- short acquisition times, excellent contrast resolution and TRICULOMEGALIA;,NERVOUS SYSTEM;
NUCLEAR MEDICINE ORIGINAL PAPER associated with molecules present in our body from PET and a good spatial resolution that allows the recognition of ana- tomical structures of the soft parts with an excellent contrast from the MRI, thus a promising equipment in the contribution POSTERS (PI) for the diagnosis of metastases, mainly useful when the le- sions are very subtle. In addition, if associated with the ligand marker of prostate-specific membrane antigen (PSMA-68Ga) PI.11.001 a radiopharmaceutical that has a strong affinity for PSMA PET-RM WITH PSMA-68GA IN THE DIAGNOSIS OF binding and may enhance the ability to enhance the staging METASTASIS AND STAGING OF PROSTATE CAN- diagnosis in prostate cancer. CER: A SYSTEMATIC REVIEW Conclusion: Although PSMA-68Ga PET-RM can generate Authors: PAP, S.S.C.P; CAMELO, M.A artifacts such as the halo artifact, studies show that it has a Institution: CENTRO UNIVERSITÁRIO SÃO CAMILO greater precision and sensitivity when compared to PET-CT. A brief description of the objective(s): Conduct a system- Responsible Author: STEPHANE SANTOS DA atic review of the application of PET-MRI in the diagnosis CUNHA PAP and staging of prostate cancer, showing the advantages and Email: [email protected] disadvantages of this new technology as well as its progress Keywords: Câncer de Próstata. PET-RM. 68Ga-PSMA. Di- in relation to the PET-CT. agnóstico. Estadiamento. Material(s) and method(s): The content used for this sys- tematic review was obtained by searching the database with Bireme the keywords whose flowchart of the search is shown in Figure 1. The articles were read and selected according to its theme and arguments, and the fundamental criteria for the inclusion of the studies were: 1. Presence of members who had DIGITAL PRESENTATION (PD) primary, recurrent or metastatic prostate cancer; 2. Systemat- ics involving the use of PET-MRI with the 68Ga-PSMA radio- pharmaceutical in the investigation of prostate cancer; 3. Use PD.11.011 of PET-MRI for the diagnosis and staging of prostate cancer. WHAT IS THE REAL VALUE OF THE PREDITOR Results and discussion: Prostate cancer (CaP) has a very INDEX VALUE OF NEOADJUVANT CHEMOTHER- relevant epidemiological significance, where the number of APY RESPONSE IN BREAST SCINTIGRAPHY OF cases increases each year and therefore a fast and efficient ap- PATIENTS WITH BREAST CARCINOMA LOCALLY proach is necessary to avoid late diagnoses and development ADVANCED of possible recurrences and staging of the latter. [Blood tests Authors: CERIGATTO, L.C.T.; FERRASI, A.O.; for prostate specific antigen (PSA), biopsies, and multipara- MARQUES, M.E.A.; KOGA, K.H.; VESPOLI, H.M.L.; metric resonance (MPRM)] are indicated for the detection of PETROCELLI, D.; SANTOS, V.V.; CAVALLARI, H.H.; CaP. During the period of treatment and follow-up, new re- CACAO, P.H.M.; MORIGUCHI, S.M. searches are highlighting positron emission tomography asso- Institution: FACULDADE DE MEDICINA DE BOTUCA- ciated with magnetic resonance imaging (MRI-PET), which TU, UNIVERSIDADE ESTADUAL PAULISTA JULIO DE has a sensitivity of the injected radiopharmaceutical that is MESQUITA FILHO - UNESP
Abstracts of Scientific Papers 55 A brief description of the objective(s): This study aimed perform myocardial perfusion scintigraphy with a protocol to verify whether the predictive index of neoadjuvant che- for the evaluation of CFR (1 day - rest and pharmacologi- motherapeutic response, obtained by SMM with sestami- cal stress with dipyridamole). The study was performed on bi-99mTc proposed by Alonso and colleagues, is related to a Discovery NM 530c, with acquisitions in list-mode during the chemotherapeutic response, as shown by postoperative infusion of 99mTc-sestamibi by injection pump, in addition anatomopathological study of the breasts (AP), considered to GATED / SPECT images. The values of myocardial blood the gold standard, analyzing the isolated indices, early index flow and coronary flow reserve were obtained by INVIA® (EI) and late index (LI), and associated index (EI+LI). 4DM Corridor software. Material(s) and method(s): This was a transversal, observa- Results and discussion: The "dynamic" list-mode imag- tional and descriptive study, with retrospective data collected es performed during infusion of the tracer enable to evalu- from charts of patients who were carriers of LABC attended ate myocardial extraction. Estimated values of myocardial at this Institution in the period from 2012 to 2017, that were blood flow (in ml / min / g of tissue) were achieved after submitted to SMM, defining the values of isolated or com- rest and stress. With the values obtained, the relation between bined good response indices as EI>1.5 and LI>1.4, neoad- the stress and rest flow for the calculation of the CFR was juvant chemotherapy with AC-T scheme and posterior mas- performed. The values obtained with the coronary flow re- tectomy or quadrantectomy, with tumor size reduction >30% serve allow quantification of the degree of ischemia and its (G>30%) considered a good response to AP. The significance severity, before indicating an invasive procedure. The gold level was p<0.05 standard for the evaluation of CFR is PET / CT with perfu- Results and discussion: The sample was composed of 151 sion tracers, already with well-established protocols and ref- women with mean age of 54.00 ±10.71 years (26 to 77 years, erence values. With the evolution of dedicated CZT cardiac of which 72 were afflicted on the right side and 79 on the left detectors, researchers sought to adapt the PET/CT protocol side. The predominant histological type was ductal (n=141; to conventional Nuclear Medicine techniques, allowing, even 93.38%), followed by lobular (n=6; 3,97%), metaplastic with some limitations, the determination of CFR values, with (n=2; 1,32%) and papilliferous (n=2; 1,32%). Immunohisto- promising results and close to those obtained with the PET/ chemical classification evidenced predominance of luminal CT techniques, becoming a great alternative in places where type B (n=47, 32,41%), followed by the types triple-nega- the PET/CT is not wide available. CFR values above 2.0 rule tive (n=31; 21,38%), HER 2 positive (n=24; 16,55%), hy- out significant ischemia. brid (n=24; 16,55%), luminal A (n=18; 12,41%) and luminal Conclusion: CFR analysis with CZT detectors is a promising non-A non-B (n=1; 0.69%). The initial size of the tumors tool with accuracy close to PET/CT for the detection of isch- varied from 0.20 to 16.00 SB, with a mean of 3,40±2,26 SB. emia in patients with stable CAD. Its use in association with The final tumor size ranged from 0.00 to 11.00 SB, with a other anatomical imaging methods allows the identification mean of 1,63±2,01 SB. On average, the percentage reduc- of the type of disease (predominantly epicardial, microvascu- tion of tumor size was 51,72±58,46%, varying from -185.71 lar or mixed). Our initial experience has shown that the exam to 100%, since some tumors presented a progression of size. is reproducible and contributes with additional information There was no significant association between EI versus on the risk stratification of selected patients. Further studies, G>30% (p=0,8054); LI vs. G>30% (p=0,2097), and (EI+LI) patients and comparison with other methods to validate the vs. G>30% (p=0,1289). data are still necessary. Conclusion: Threre are not association between the predictive Responsible Author: Rafael Boratto Chaves indices of good response (EI, LI, EI+LI) described in SMM Email: [email protected] and the size reduction response observed in AP in LABC car- Keywords: coronary,flow,reserve,reserva,fluxo,coronari- riers treated with the AC-T chemotherapeutic scheme, not ano,czt,spect,gated justifying its application. New studies based on the immuno- histochemistry of breast carcinoma should be conducted. Responsible Author: Sonia Moriguchi Email: [email protected] Keywords: CANCERDEMAMA,QUIMIOTERAPIANEO- PICTORIAL ESSAY ADJUVANTE,INDICEPREDITOR,QUANTIFICAÇÃO
POSTERS (PI)
ORAL PRESENTATION (TL) PI.11.002 SPOTLIGHT ON BONES: SKELETAL PITFALLS IN 68GA-PSMA PET/CT TL.11.001 Authors: SOUZA, AR; OSAWA A; CASTRO, AA; FON- INITIAL EXPERIENCE IN CORONARY FLOW RE- SECA, EKUN; NUNES, LM; CUNHA, ML; BARONI, RH; SERVE STUDIES WITH CZT DETECTORS OLIVEIRA, JC; YAMAGA, L; SANTOS, DCB; WAGNER, Authors: CHAVES, R.B.; ALVES, A. S. F.; PRADO, L. F. J; ROSEMBERG, LA. M.; GROSSI, B. J.; SOBRINHO, A. B.; Institution: HOSPITAL ISRAELITA ALBERT EINSTEIN Institution: IMEB - DIAGNÓSTICO POR IMAGEM E Introduction and objective(s): Prostate cancer has a bio- MEDICINA NUCLEAR logical affinity to metastasize to bone. Enough evidence has A brief description of the objective(s): Initial experience been accumulated in literature regarding the usefulness of with the coronary flow reserve protocol (CFR) in CZT detec- 68Ga-PSMA PET/CT in prostate cancer. Knowledgment of tors dedicated to cardiac study. the possible non-malignant conditions of uptake in 68Ga-PS- Material(s) and method(s): We selected 13 patients to MA PET/CT is helpful to nuclear medicine physicians to
56 49th Sao Paulo Radiological Meeting minimize reporting fallacies. In according to this, this exhibt After scintigraphy, the patient underwent amagnetic reso- aims to: review the basic characteristics about PSMA PET/ nance imaging (MRI), which revealed chronic liver disease CT radiotracer; discuss potential causes of false-positive with signs of portal hypertension and extensive collateral findings on PSMA PET/CT in bones; illustrate the imaging circulation in the upper abdomen. The echocardiogram con- findings, including review of unfused CT images, for opti- firmed enlargement of the right chambers associated with mal skeletal evaluation when interpreting PSMA PET/CT. moderate tricuspid regurgitation. The association of the tests Method(s): This study is a pictoric essay with a review of led to the hypothesis of portal hypertension and pulmonary the literature through a series of cases of our service of the arterial hypertension and, after the diagnosis has been con- main musculoskeletal non-malignant conditions of uptake in firmed, the patient had treatment instituted. 68Ga-PSMA PET/CT. Discussion and diagnosis: Pulmonary hypertension (PH) is Discussion: The current pictoric essay addresses the follow- characterized by increased blood pressure in the pulmonary ing: 68Ga-PSMA PET/CT - physiology and normal biodis- artery, which may be secondary to several diseases.. Values tribution; sample cases and mimics comprehending habitu- greater than 25 mmHg at rest or al appearance and morphologic features, including review greater than 30 mmHg at exercise define this diagnosis. Re- of unfused CT images, bone windows, and multiple imag- gardless of etiology, HP leds to changes in the right ventricle ing planes; differential diagnosis of fractures, degenerative and has potentially fatal consequences. changes, benign tumors and tumorlike processes (as fibrous Mansonic schistosomiasis (MS) is one of most important dysplasia and Paget disease) and postoperative changes; fu- causes of PH in Brazil. The prevalence of HP in patients with ture directions and summary. MS in the hepatosplenic form can reach up to 30%. Conclusion: Benign bone and soft-tissue lesions can mimic Conclusion: Although CPM is not part of the exams in the malignancy, particularly if they are highly avid. Low-grade diagnosis of PH, the study provided the findings of right ven- malignancies with low PSMA uptake can be mistaken for tricular hypertrophy, which - associated with the previous benign lesions if the CT and radiographic characteristics of history of schistosomiasis - led to the correct diagnosis. the lesions are not closely studied. Musculoskeletal pitfalls Responsible Author: FLAVIA DORNELAS KURKOWSKI can be avoided as the physician becomes familiar with their Email: [email protected] appearance, understands their causes, and fully analyzes their Keywords: MYOCARDIAL PERFUSION CINTILOGRAPHY, morphologic features on unfused CT / MRI images. PULMONARY HYPERTENSION, ESCHYSOSOMOSIS Responsible Author: Adham do Amaral e Castro Email: [email protected] PD.11.013 Keywords: PET-CT,Sistema musculoesquelético THE IMPORTANCE OF CEREBRAL PERFUSION SCINTIGRAPHY IN MOYAMOYA DISEASE Authors: BECKMANN, G. A.; NEVES, B. C.; REIS, A. M.; KURKOWSKI, F. D.; SILVA, M. M.; BARRA, R. R.; TEIX- EIRA, E. P. A.; POEYS, F. C. T. CASE REPORT Institution: IMEB - IMAGENS MÉDICAS DE BRASÍLIA A brief description of the objective(s): To clarify the clini- cal use of cerebral perfusion scintigraphy in Moyamoya dis- ease. DIGITAL PRESENTATION (PD) Clinical History: Patient C.M.A.C, female, 42 years old, with history of Ischemic Stroke for 2 months with involve- ment of the middle cerebral artery. After the episode there PD.11.003 was loss of memory and difficulty in verbal communication. MYOCARDIAL PERFUSION CINTILOGRAPHY She was submitted to angiography of the skull and angiog- IN PULMONARY HYPERTENSION BY ESCHYSO- raphy that showed suspicious alterations of Moyamoya dis- SOMOSIS ease. Cerebral perfusion scintigraphy was then requested to Authors: KURKOWSKI, F.D.; REIS, A.M.; NEVES, B.C.; help elucidate the diagnosis. Brain SPECT showed heteroge- BECKMANN, G.A.; SILVA, M.M.; ALVES, A.S.F.; TEIX- neous superficial cerebral perfusion, with an extensive area EIRA, E.P.A.; POEYS, F.C.T. of absence of perfusion / activation involving the temporal, Institution: IMEB - IMAGENS MÉDICAS DE BRASÍLIA parietal and occipital lobes on the left, related to the previ- A brief description of the objective(s): Demonstrate the ous stroke. In addition to hypoperfusion / activation of the usefulness of myocardial perfusion scintigraphy (CPM) in ipsilateral frontal lobe. The nuclei of the base show perfusion the evaluation of coronary disease in a patient with pulmo- / activation maintained. nary hypertension due to schistosomiasis. Discussion and diagnosis: Moyamoya disease is a vascu- Clinical History: M.I.E., male, 43 years old, coming from lar stenosis in the Willis polygon, which occurs after several the northeast of the country, referring fatigue to great ef- ischemic vascular events of unknown etiology. It can usually forts a year ago, initially insidious and progressive evo- be diagnosed after angiography, which is the gold standard lution, with current limitations of sports practice. He re- method. The frontal lobe, some parts of the parietal lobe and ferred diagnosis of schistosomiasis five years ago, with no basal ganglia are most often affected because they are terri- other comorbidities. He was referred to Nuclear Medicine tories of the middle cerebral artery. Cerebral perfusion in the service, where CPM was performed with sestamibi-99mTc evaluation of cerebrovascular diseases is indicated in patients in dedicated equipment for cardiac study with CZT detec- with acute stroke, chronic cerebral ischemia and preoperative tor. The study evidenced persistent hypoperfusion in the assessment. Brain SPECT is being used more and more since interventricular septum without signs of myocardial isch- it is a noninvasive method capable of evaluating cerebral emia. However, there was significant radiotracer´s uptake perfusion, allowing in some cases to show that the extent of in the right ventricle suggesting meaningful right ventric- changes are greater than those detected by angiotomography. ular hypertrophy. Conclusion: Cerebral perfusion scintigraphy is a noninva-
Abstracts of Scientific Papers 57 sive complementary exam that can provide information about PD.11.016 regional cerebral blood flow. Thus, it is a useful method to as- EVALUATION OF CORONARY FLOW RESERVE sess the extent of the initial damage, evolution and prognosis WITH CZT DETECTORS – CASE REPORT of Moyamoya disease. Authors: CHAVES, R. B.; ALVES, A. S. F.; PRADO, L. F. Responsible Author: Gabriel Alvarenga Beckmann M.; GROSSI, B. J.; SOBRINHO, A. B. Email: [email protected] Institution: IMEB - DIAGNÓSTICO POR IMAGEM E Keywords: moyamoya,spect,cerebral,angiotomography,an- MEDICINA NUCLEAR giotomografia A brief description of the objective(s): To evaluate the im- portance of coronary flow reserve (CFR) study as an addi- PD.11.015 tional noninvasive tool in the risk stratification of patients THE ROLE OF BONE SCINTIGRAPHY IN THE DI- with coronary artery disease (CAD). AGNOSIS OF OSTEOPOIKILOSIS: CASE REPORT. Material(s) and method(s): M.P.C, 71 years old, female, Authors: BECKMANN, G. A.; POEYS, F. C. T.; SILVA, with hypertension, type 2 diabetes and dyslipidemia, with M. M.; ALVES, A. S. F.; VIVIANI, C. L. S.; BARRA, R. no prior history of CAD, was referred for myocardial perfu- R.; JUNIOR, L. M. P.; PRADO, L. F. M.; AMARAL, R. M.; sion scintigraphy to search for ischemia due to atypical chest MARINO, F. M.; SOBRINHO, A. B. pain. A one-day protocol (rest-stress with dipyridamole) was conducted for evaluation of CFR in a Discovery NM 530c. Institution: IMEB - IMAGENS MÉDICAS DE BRASÍLIA "Dynamic" images were acquired in list-mode, starting im- A brief description of the objective(s): Osteopoikilosis is a mediately prior to radiotracer injection (by continuous infu- rare, benign, usually asymptomatic bone disease. It is charac- sion pump), for calculating myocardial blood flow, as well as terized by the casual finding of dense, ovoid or circular bone GATED / SPECT images for evaluation of ventricular func- lesions, well defined, of uniform density, whose size varies tion and relative perfusion. from 2 to 20mm in diameter. It mainly affects male patients Discussion and diagnosis: Images of myocardial perfusion aged 15 to 30 years. scintigraphy did not show ischemia. However, GATED / Clinical History: D.R.T., female gender, 32 years old, un- SPECT showed discrete post-stress inferobasal hypomotility. derwent abdominal computed tomography (CT) for ovarian Analysis of myocardial blood flow and the relation between cancer staging, which evidenced sclerotic focal lesions in stress and rest (CFR) revealed a reduced value - CFR of 1.89 multiple lumbar and dorsal vertebrae. For a better charac- (normal> 2.0) - in the territory of the right coronary artery terization of the lesions, magnetic resonance imaging (MRI) (RCA). Therefore, the quantification of regional myocardial of the lumbosacral spine was performed, which showed le- blood flow allowed the detection of ischemia in the territory sions in L2, L3, L5, sacral and iliac wings and also chest irrigated by RCA, even without significant alterations in the CT, which evidenced multiple sclerotic lesions involving the images of relative perfusion, indicating continuation of the vertebral bodies, and differential diagnosis was osteoblastic investigation to define the best conduct in this case. metastases.. After these findings, the patient was referred to Conclusion: Imaging methods have been increasingly used the Nuclear Medicine service to perform bone scintigraphy, in the detection of ischemia in patients with CAD, no longer which showed physiological distribution of the radiopharma- based solely on the degree of arterial stenosis. The greatest ceutical, without evidence of abnormal areas of bone uptake, limitation of myocardial perfusion scintigraphy is to detect favoring the diagnosis of osteopoikilosis. balanced reduction of coronary flow in patients with mul- Discussion and diagnosis: Osteopoikilosis is a rare, he- tivessel disease. The evaluation of CFR, already well estab- reditary and autosomal dominant bone alteration, usually lished in the PET / CT studies, has been implanted in cameras without symptoms, radiologically characterized by multi- with CZT detectors with significant accuracy, becoming an- ple radiopaque images, rounded or oval, of varying dimen- other useful tool in this evaluation. However, further studies sions and which are common in the periarticular´s areas. are needed to validate the clinical protocols, in addition to The most frequently affected bones are those of the carpus comparing with other methods for better stratification and and tarsal and, to a lesser extent, in the ribs, vertebrae, clav- confirmation of the results. The values of myocardial blood icle, mandible, pelvis, skull and scapula. Characteristics flow reflect the physiological severity of coronary alterations, such as the symmetry of the lesions, the rare involvement either by atherosclerotic epicardial disease or by microvascu- of the diphysis and the absence of laboratory alterations lar diseases. contribute to the differential diagnosis with other pathol- Responsible Author: Rafael Boratto Chaves ogies. Another important feature is that in osteopoikilosis Email: [email protected] bone scintigraphy does not show radiotracer´s increased Keywords: CFR,reserva,fluxo,coronariano,perfusão,miocár- uptake in areas with radiological alterations. The main dica,CZT,coronary,flow,reserve differential diagnoses include osteoblastic osseous metas- tases – which present increased uptake to the scintigraphic PD.11.018 study – melorreostosis, enchondromatosis, mastocytosis DETECTION OF ATYPICAL METASTASES IN RARE and chondrodysplasia. CASE OF SUBMANDIBULAR SALIVARY GLAND Conclusion: Bone Scintigraphy presents an important role in CARCINOMA WITH 18F-FDG PET / CT the evaluation of osteoblastic lesions casually found in com- Authors: SILVA, M. T.; CAMPOS, A. L. M; BACHA, R. P.; puted tomography, especially in the face of the hypothesis of LIMA, T. C. osteopoikilosis, since this condition has as its main differen- Institution: DIMEN/HOSPITAL LEFORTE tial diagnosis osteoblastic metastases. A brief description of the objective(s): Demonstrate a rare Responsible Author: Gabriel Alvarenga Beckmann case of salivary gland carcinoma with muscular metastasis Email: [email protected] and the role of 18F-FDG PET in therapeutic decision: a case Keywords: osteopoikilosis,osteopoiquilose,scintigraphy,cin- report. tilografia,mri,ressonancia,osteoblastic,osteoblastica Clinical History: Male patient, 60 years old, painful nodule
58 49th Sao Paulo Radiological Meeting in the left submandibular region, submitted to left submandi- head and neck tumors, and among salivary gland tumors, mu- blectomy, showing high-grade mucoepidermoid carcinoma, coepidermoid carcinoma is the most common. They occur with vascular invasion and local invasion of the extrapa- predominantly in males around 60 years old, smoking and diet renchymal soft tissues. Local radiotherapy was performed. may be related to risk factors. Metastases usually occur local- Study control performed by Positron Emission Tomography ly, nerves, bones and skin. PET with 18F-Fluordeoxyglucose associated with Computed Tomography (PET / CT), in jan- (18F-FDG) has been shown to be superior to conventional uary 2018, a nodule was observed in the left gluteus muscle, imaging methods for diagnosing head and neck tumors. The performed surgical excision, the anatomopathological study sensitivity of 18F-FDG-PET to detect primary salivary gland confirmed that it was a metastatic lesion in relation tothe tumors is 91.2%, while CT is 79.4%, and to detect lymph primary tumor, carried out chemotherapy with carboplatin node disease PET has a sensitivity 20% higher than CT. and paclitaxel, three cycles, treatment was interrupted due to Conclusion: Although 18F-FDG PET is more sensitive than low spinal reserve. A new control study was performed in our other imaging methods in primary diagnosis of malignant service in november 2018, there was evidence of recurrence salivary gland tumors, it is not a substitute for anatomopatho- in the musculature of the left gluteus (confirmed by biopsy), logical study, but PET has great value in staging, evaluation as well as new nodules on the right biceps and calf muscles. of therapeutic response and re-staging by especially in the New cycles of chemotherapy were performed with cyclo- diagnosis of metastases and better establishment of therapeu- phosphamide, doxorubicin and cisplatin, but patient evolved tic management. with febrile neutropenia, then administered Granulokine. Responsible Author: Mayara Torres da Silva Discussion and diagnosis: Salivary gland carcinoma are rare, Email: [email protected] corresponding to <0.5% of all malignant tumors and <1% of Keywords: PET,submandibular,metastases,atypical
NEURORADIOLOGY ORIGINAL PAPER Statistical Parametric Mapping (SPM) software for evalua- tion of brain glucose metabolism and with Lesion Segmenta- tion Tool for SPM for quantification of white matter lesions. Results and discussion: [18F]FDG-PET analysis revealed POSTERS (PI) glucose hypometabolism in soccer players in both temporal lobes and corona radiata white matter, reaching statistical sig- nificance (p<0.001). There was also correlation of the global PI.12.014 volume of white matter lesions with lower glucose metabo- [18F]FDG-PET AND MORPHOMETRIC BRAIN lism in the cortex of the temporal lobes. ANALYSIS IN RETIRED SOCCER PLAYERS EX- Conclusion: Findings of glucose hypometabolism in tem- POSED TO LONG-TERM MILD TRAUMATIC BRAIN poral lobes are in accordance with previous reports. Our INJURIES work contributes significantly to CTE study field by confirm- Authors: ARANHA, M. R.; COUTINHO, A. M.; CARNEI- ing cortical metabolic alterations in soccer players and by RO, C. G.; MOREIRA, E. L. S.; PASTORELLO, B.; ANGH- demonstrating correlation between volume of white matter INAH, R.; IANOF, J.; BUCHPIGUEL, C. A.; LEITE, C. C. lesions and reduced cortical glucose metabolism. Institution: INSTITUTO DE RADIOLOGIA - HOSPITAL Responsible Author: MATEUS ROZALEM ARANHA DAS CLÍNICAS HCFMUSP, FACULDADE DE MEDICI- Email: [email protected] NA, UNIVERSIDADE DE SÃO PAULO, SÃO PAULO, Keywords: mTBI,trauma,[18F]FDG-PET,soccer,futebol,- SP, BR. / CENTRO DE MEDICINA NUCLEAR - HOS- jogadores,metabolismo PITAL DAS CLÍNICAS HCFMUSP, FACULDADE DE MEDICINA, UNIVERSIDADE DE SÃO PAULO, SÃO PAULO, SP, BR. / DISCIPLINA DE NEUROLOGIA - HOSPITAL DAS CLÍNICAS HCFMUSP, FACULDADE DE MEDICINA, UNIVERSIDADE DE SÃO PAULO, SÃO PAULO, SP, BR. DIGITAL PRESENTATION (PD) A brief description of the objective(s): Chronic traumat- ic encephalopathy (CTE) is mostly described in boxers and football players. Soccer players are exposed to repetitive mild PD.12.028 traumatic brain injuries (mTBI), however the prevalence and RELATIONSHIP OF EARLY CHANGES IN THE effects of CTE on these athletes remains elusive. This study QUANTITATIVE BRAIN MAGNETIC RESONANCE aims to evaluate regional brain glucose metabolism and vol- IMAGING TECHNIQUES OF HUMAN IMMUNO- ume of white matter lesions of retired soccer players com- DEFICIENCY VIRUS-INFECTED PATIENTS WITH pared to age-matched healthy controls. MEMORY DEFICIT Material(s) and method(s): Twenty retired soccer players Authors: CORRÊA, D. G.; VAN DUINKERKEN, E.; ZIM- and twenty age-matched controls were submited to brain MERMANN, N.; FONSECA, R. P.; LOPES, F. C. R.; GAS- [18F]FDG-PET and magnetic resonance imaging (MRI) with PARETTO, E. L. volumetric T1-weighted and FLAIR sequences in our 3T Institution: UNIVERSIDADE FEDERAL DO RIO PET/MR scanner. Images were processed and analysed with DE JANEIRO
Abstracts of Scientific Papers 59 A brief description of the objective(s): To evaluate potential idemiological (sex, age), clinical (Hunt-Hess scale) and ra- differences in the relationships between the quantitative brain diological (Fisher scale) variables and the Hunt-Hess and the magnetic resonance imaging (MRI) techniques in human im- Fisher scales were correlated with risk of death. munodeficiency virus (HIV) seropositive patients with and Results and discussion: The study of 46 cases of SAH evi- without memory deficit and healthy controls. denced major prevalence of this outcame in women (69,5%), Material(s) and method(s): Participants were submitted as well as in those between the ages of 51 and 60 (34,7%). to brain MRI in a 1.5 Tesla scanner, with T1-three-dimen- Regarding the scales, there was higher prevalence on the sional gradient-echo; diffusion tensor imaging (DTI); and graduations Fisher 4 and Hunt-Hess 2. The diseased that most resting-state functional MRI (RS-FMRI). Participants also evolved to death were women (76,4%) and those between the performed a battery of neuropsychological tests to determine ages of 61 to 70. the cognitive deficit profile. Thirteen HIV-positive patients Conclusion: Mortality was major on patients classified as with memory deficit were compared to nineteen HIV-posi- Fisher 3 and Hunt-Hess = 3 - however, since the majority tive patients without memory deficit and nineteen control of the sample was graduated as Hunt-Hess 1 or 2, this group subjects, matched for age, sex, education and deficits in other represented 53% of the deaths of this trial. cognitive domains. HIV-positive groups were also matched Responsible Author: Sarah Biguelini for known infection time and were under treatment. No par- Email: [email protected] ticipant had a history of other brain diseases. The evaluation Keywords: Subarachnoid Hemorrhage, Aneurysm, Prog- of the memory deficit was done through the Rey Auditory nostic,Hemorragia Subaracnoidea, Aneurisma, Prognósti- Verbal Learning Test. co.,Hemorragia Subaracnoidea, Aneurisma, Prognóstico. Results and discussion: RS-FMRI revealed increased con- nectivity in HIV-positive patients without memory deficit, PD.12.064 compared to controls, in the Wernicke area, in the language RESTING STATE FMRI OF RETIRED SOCCER network. No significant differences in connectivity were ob- PLAYERS COMPARED TO RETIRED RUNNERS served in the comparisons: HIV-positive with memory deficit Authors: DALPRÁ, FAR; AZEVEDO NT, R; PASTOREL- versus HIV-positive without memory deficit, and controls LO BF; AMARO JR, E; MARTIN, MGM; IANOF, JN; AN- versus HIV-positive with memory deficit, in the functional GHINAH, R; CERRI, GG; NITRINI, R; LEITE, CC. networks found. DTI revealed an increase in mean diffusiv- Institution: HOSPITAL DAS CLÍNICAS DA FACUL- ity and radial diffusivity in some white matter tracts in the DADE DE MEDICINA DA UNIVERSIDADE DE SÃO frontal lobes in HIV-positive patients with memory deficit, PAULO HC-FMUSP compared to controls. Cortical thinning was also observed A brief description of the objective(s): Cross-sectional in areas of the frontal lobes and in the Wernicke area, in study comparing resting state functional magnetic resonance HIV-positive patients with memory deficit, compared to con- imaging between retired soccer players and retired runners trols. No differences were found in diffusivity parameters (control group) to investigate the hypothesis that chronic and cortical thickness in the comparisons: HIV-positive with traumatic encephalopathy is associated with reduced cerebral memory deficit versus HIV-positive without memory deficit, connectivity of temporal mesial structures. and controls versus HIV-positive without memory deficit. Material(s) and method(s): A resting state functional mag- Conclusion: HIV-positive patients without memory deficits netic resonance imaging study was performed on 20 retired showed increased connectivity, probably to compensate the soccer players and 22 retired runners. The images were an- neuronal damage caused by the infection, with no changes in onymized and analyzed in CONN functional connectivity the structural MRI. HIV-positive patients with memory defi- software. Pre-processing included realignment, unwarpping; cit cannot compensate the neuronal damage caused by the slice-timing correction; outliner detection; segmentation, infection, presenting changes in cortical thickness and diffu- normalization and smoothing of functionl images; as well as sivity parameters, without changes in functional MRI. segmentation and normatization of structural images. First Responsible Author: Diogo Goulart Corrêa and second level analyzes were performed with regions of Email: [email protected] interest (seed regions) in three temporal mesial regions: hip- Keywords: HIV,Memória,RS-FMRI,DTI pocampal formations, parahippocampal gyrus and amygda- loid complexes - sites where changes are described in chronic PD.12.038 traumatic encephalopathy. Results and discussion: Three subjects were excluded due A CLINICAL-RADIOLOGICAL ANALYSIS OF SPONTA- to movement artifacts, being 2 of the control group and 1 of NEOUS SUBARACHNOID HEMORRHAGE VICTIMS the group of soccer players. Authors: ARAUJO JUNIOR, F. A.; BIGUELINI, S. E.; This analysis demonstrated: Reduced connectivity between HANNA, L, M, D, A. the right hippocampal formation and the inferior division of Institution: FACULDADES PEQUENO PRÍNCIPE the right lateral occipital cortex; between the left hippocam- HOSPITAL EVANGÉLICO UNIVERSITÁRIO pal formation and the posterior division of the left middle DE CURITIBA temporal gyrus; and between the right amygdala and the A brief description of the objective(s): The aim of this study precune cortex and the left temporal plane; There were no is to analyze the population and the early mortality rate (up to changes in the connectivity of the left amygdala and the par- thirty days) of patients victims of spontaneous subarachnoid ahippocampal gyrus. hemorrhage (SAH) according to the Hunt-Hess clinical scale Conclusion: Chronic traumatic encephalopathy is still poorly and the Fisher radiological scale. understood and, although initially reported in boxing athletes, Material(s) and method(s): A retrospective and transversal growing evidence suggests that they affect other athletes with study was carried out through analysis of 46 medical records less obvious brain traumas, such as soccer players. Our re- and computed brain tomographies of patients with SAH with- sults are in line with findings from other authors suggesting in the period of February 2014 to December 2017 admitted changes in brain connectivity in retired soccer players. This at an University Hospital in XXX. It has been evaluated ep- is the first result of the project that involves complete analysis
60 49th Sao Paulo Radiological Meeting of brain networks and regions and comparison with clinical Authors: MATOS, B. A.; NASCIMENTO, F. B. P.; FELIX, and neuropsychological data. M. M.; BARBOSA JR, A. A.; AMARO JR, E. Responsible Author: Fabio Augusto Dalpra Institution: HOSPITAL ISRAELITA ALBERT EINSTEIN Email: [email protected] A brief description of the objective(s): To evaluate the per- Keywords: Ressonância_funcional,encefalopatia_traumáti- formance of the Artificial Intelligence Software for classifi- ca_crônica,fmri cation of ASPECTS and its use in the routine of the Neurora- diologist in a Private Stroke Center in Brazil. Material(s) and method(s): A retrospective and randomized study of 200 “Stroke CT Protocol” cases (Brain CT without contrast plus cervical and intracranial angioCT in the absence of a contraindication to the use of iodinated contrast) between ORAL PRESENTATION (TL) 2008 and 2016. Unsatisfactory studies or non-follow-up CT or MRI examination in up to 72 hours were excluded. The report of the neuroradiologist (in training or young) was later TL.12.003 reviewed by the senior neuroradiologist - both had clinical in- BRAIN MAGNETIC RESONANCE SPECTROSCOPY formation transmitted by the neurologist - and was compared (MRS) AND BRAIN HEMORRHAGE IN RETIRED to the result of the software (commercial software), which an- SOCCER PLAYERS EXPOSED TO LONG-TERM alyzed the ASPECTS score and stratified by territory, without MILD TRAUMATIC BRAIN INJURY clinical data or arterial analysis. The reference standard was Authors: RESENDE L. L; OTADUY M; MARTIN, M. G. the follow-up CT or MRI study within 72 hours. Statistical M; CHAIM K.T; PASTORELLO B; ANGHINAH R; IANOF analysis included concordance / discordance between groups, J; LEITE C. C. error (final ASPECTS score other than control), impact error Institution: INRAD - HOSPITAL DAS CLÍNICAS DA (change of ASPECTS groups, <6 and > or = 6), and gross FACULDADE DE MEDICINA DA UNIVERSIDADE DE error (> or = 3 territories), considering statistical significance SÃO PAULO values of p <= 0.05. A brief description of the objective(s): Chronic traumatic Results and discussion: The software presented a higher encephalopathy (CTE) is a possible long term consequence number of errors (44% x 34%) and lower accuracy (62% x of consecutive mild traumatic brain injuries. There are re- 71%), with greater sensitivity that remained low, and less ports of soccer players diagnosed with CTE, however, its specificity. There were no significant differences between the prevalence and effects remain poorly understood. Neuroim- groups in the analysis of impact error (change of the group aging rules out others causes for the symptoms and shows of the final ASPECTS value, groups <6 and> or = 6) and typical abnormalities in patients chronically exposed to con- gross errors (difference of final score> or = 3 territories). The cussions. Our goal is to evaluate retired soccer players with groups showed high disagreement over the territories affect- magnetic resonance spectroscopy and quantitative suscepti- ed in relation to the control. bility-weighted imaging. Conclusion: The software for ASPECTS automated classifi- Material(s) and method(s): Twenty retired professional cation performed less than the neuroradiologist in this study, soccer players and fifteen age-matched healthy controls were maintaining low CT sensitivity for stroke detection and high assessed with brain magnetic resonance (MR). Single-vox- disagreement of the territories affected in relation to the con- el spectroscopy and volumetric T1-weighted images were trol, with no statistically significant difference in the analyzes obtained in 3T PET/MR scanner (SIGNA, GE Healthcare). of gross errors or impact error. Considered faster than neu- Quantitative Susceptibility Mapping (QSM) was used to ass- roradiologist, the software can be an important tool for stroke es and quantifies hemorrhages. Mean values of spectrosco- management, particularly in non-specialized centers. py metabolites ratio normalized per creatine were processed Responsible Author: Breno Matos with LCModel and compared between patients and controls. Email: [email protected] We considered a p value 0.05 as statistically significant. Keywords: Stroke,ASPECTS,Artificial Intelligence Results and discussion: MR spectroscopy concentration of N-acetylaspartate, glutamate, glutamine, choline, Myo-inosi- tol and lipids yielded no statistically significant differences between soccer players and controls. Quantification of hem- orrhagic lesions also showed no significant differences be- tween the two groups. PICTORIAL ESSAY Conclusion: This preliminary study have shown no statisti- cally significant differences in spectroscopy and brain hem- orrhagic lesions between retired soccer players and healthy POSTERS (PI) controls, suggesting that should not be a relationship between soccer practice and CTE. Responsible Author: Lucas Resende PI.12.001 Email: [email protected] SYSTEMIC LUPUS ERYTHEMATOSUS ON NER- Keywords: Spectroscopy,Brain,Trauma,Soccer,Hemorrhage VOUS CENTRAL SYSTEM: TYPICAL AND NOT SO TYPICAL CLINICAL PRESENTATIONS TL.12.005 Authors: MIRANDA, G. M.; DINIZ, L. V.; RODRIGUES, EVALUATION OF ARTIFICIAL INTELLIGENCE L. P.; MACHADO, J. C. M.; JORGE JUNIOR, L. A.; AN- SOFTWARE FOR AUTOMATED CLASSIFICATION TUNES, P. E. H.; NEVES, G. B.; SILVA, C. P; GALGA- OF ASPECTS IN THE ROUTINE OF THE NEURORA- RO, D. P. DIOLOGIST IN A PRIVATE STROKE CENTER IN Institution: FACULDADE DE MEDICINA DE BOTUCA- BRAZIL TU - UNESP
Abstracts of Scientific Papers 61 Introduction and objective(s): Systemic Lupus Erythema- cords and MRI of our digital archive, we illustrated a pictori- tosus (SLE) is an inflammatory autoimmune disorder that al essay on the radiological findings of the main etiologies of affects multiple organ systems and causes significant mor- primary viral encephalitis. bidity and mortality worldwide. There are no universally ac- Discussion: Clinical and imaging findings are often nonspe- cepted imaging criteria for the diagnosis of SLE, and not all cific in viral encephalitis, and the microbiological analysis SLE patients need imaging because many will present with of cerebrospinal fluid and serological tests can provide the systemic findings as well as laboratory abnormalities. Imag- etiological diagnosis of viral infection in only a minority of ing is often performed to determine the extent and severity of cases. The MRI of the brain plays a fundamental role, mainly the disease and to monitor the myriad of complications that because it allows the other differential diagnosis to be exclud- arise from the disease and its therapy. The purpose of this ed, but it can also contribute significantly to the suggestion presentation is to demonstrate in imaging a broad spectrum of the diagnosis of encephalitis and, in some cases, due to of SLE disease and to understand the main complications typical characteristics of image and involvement of specific that lead the patients with Lupus to the Emergency Room. sites in the brain, narrow the possible etiologic agents. Among Method(s): We have prepared a pictorial essay highlighting the typical radiological findings include the involvement of five clinical cases of SLE patients who have presented to the temporal lobe with the preservation of the lentiform nuclei in Emergency Room with neurological abnormalities, whose herpes simplex encephalitis; demyelinating disease without a diagnosis were based on careful evaluation of their imaging mass effect, edema or enhancement in progressive multifocal studies. leukoencephalopathy caused by reactivation of a human poly- Discussion: All patients were women aged 18 to 47, who omavirus (JC virus); ventriculoencephalitis by cytomegalovi- had a prior diagnosis of SLE and sometimes other diseases rus in a patient with congenital infection or AIDS. or complications of their treatments (such as anticoagula- Conclusion: Viral encephalitis can be fatal, and the correct tion and immunossuppresion). The clinical cases consisted diagnosis plays a decisive role in the therapeutic management of: one extensive subarachnoid and intraparenchymal hem- of patients. Radiological findings can identify the extent and orrhage on a patient under anticoagulants to treat a chronic severity of each case and in some cases point out the possible pulmonary embolism; a Candida cerebral abscess on a pa- etiological agents. tient undergoing therapeutic immunossuppresion; a central Responsible Author: Elissandra Melo Lima nervous system vasculitis presenting with multiple infarct Email: [email protected] foci on different vascular territories, stages and evolution Keywords: encefalite viral,herpes vírus,imagem por res- patterns; a longitudinally extensive transverse myelitis with sonância magnética extension from the T3 to T7 levels of the spinal cord; and a Posterior Reversible Encephalopathy Syndrome (PRES). PI.12.020 Conclusion: Many described diseases will never be pri- FINDINGS ON ANGIOTOMOGRAPHY IN marily thought of by the clinician as differential diagnoses. ISCHEMIC AVC Radiologists play a key role by knowing what the key indi- Authors: LIMA, A., N., A.; PIMENTEL, A., C., F.; OLIVEI- cators are for the disease and its treatment to suggest new RA, I., B.; GAMA, L., G.; PINHEIRO, D., O.; diagnostic possibilities. Institution: HOSPITAL GERAL DE FORTALEZA-HGF Responsible Author: Guilherme Marcelino de Miranda Introduction and objective(s): Acute stroke is an emergen- Email: [email protected] cy because acute-phase therapies can improve clinical out- Keywords: lupus,SLE,PRES,vasculitis,CNS,transverse,my- come. In this pathology, the most important task of angioto- elitis,candida,intraparenchymal,subarachnoid,hemorrhage mography (CT angiography) is to provide information about possible thrombosis or vascular occlusion. It has been shown PI.12.017 to be reliable in detecting or excluding thrombotic occlusion VIRAL ENCEPHALITIS: WHEN THE MAGNETIC of large intracranial vessels. This work has the purpose of RESONANCE IMAGING OF THE BRAIN CAN SUG- writing the main imaging findings in CT angiography of pa- GEST THE ETIOLOGY tients who had ischemic stroke. Authors: LIMA, E.M.; CASTRO, P. N.P.; PINTO, Method(s): We selected the images of patients who had a L.E.S.; SANTOS, R.Q.; GOMES, C.M.P.; ABREU, P.P; diagnosis of ischemic stroke from January to December 2018 MOREIRA,D.M. and evaluated the main findings that corroborate this diag- Institution: AMERICAS MEDICAL CITY nosis. Introduction and objective(s): Viral encephalitis represents Discussion: The role of CT angiography is to evaluate the a devastating neurological condition, which most often pres- major cervical and intracranial arteries and to help define the ents with a variable clinical picture and poorly specific im- site of occlusion, describe arterial dissection, determine col- aging characteristics, and it is difficult to identify the etio- lateral blood flow, and characterize atherosclerotic disease. logic agent. They can be divided into primary or secondary. This information helps to predict the extent and location of The primaries are caused by direct action of the virus in the the final infarction and is useful in providing guidance to the central nervous system (CNS), while the secondary ones are interventional neuroradiologist prior to intraarterial throm- related to the immune response determined by the viral in- bolysis. CT angiography is especially important for the de- fection. Among the primary viral encephalitis are included tection of vertebrobasilar system thrombosis, since this en- infections by herpes simplex virus type 1 and type 2, vari- tity is very difficult to detect on non-contrast-enhanced CT. cella-zoster virus, cytomegalovirus, Epstein-Barr virus, en- In addition, images of the carotid and vertebral arteries are terovirus, influenza virus, West Nile virus and arboviruses. obtained to better evaluate the morphological characteristics The objective of this work is to review the main magnetic (calcification, irregular surface, ulceration) of heterogeneous resonance imaging (MRI) findings of patients with primary plaques and quantification of the degree of stenosis. Appro- viral encephalitis, trying to correlate these findings with the priate interpretation of CT angiographic images requires most common etiologies. special attention to calcification of the vascular wall to an- Method(s): After a retrospective analysis of the medical re- alyze the presence or absence of luminal enhancement and,
62 49th Sao Paulo Radiological Meeting therefore, vessel permeability. Image analysis is required in LA,DVA various window configurations to detect or exclude flow in the vessel. The cavernous part of the carotid arteries should PD.12.008 also be assessed if there is hyperattenuation in the cavernous sinus. ANATOMY AND PATHOLOGY OF THE OPTIC Conclusion: CT angiography can describe the site of oc- NERVE: A PICTORIAL ESSAY clusion, help to grade the collateral blood flow, and help Authors: SOLDATELLI, M.D.; ARRUDA, B.; DA CON- characterize carotid atherosclerotic disease. The advantage CEIÇÃO, T.M.B.; CONCATTO, N.H.; EIFFER, D.A.; of CT angiography is the visualization of wall calcifications. CAMPOS, L.; LEIRIA, F.A.; PEREZ, J.A.; DUARTE, J.A. In addition, measurements of vessel diameters adjacent to Institution: HOSPITAL DE CLÍNICAS DE PORTO the stenosis may guide the choice of the ideal endoprosthe- sis diameter. ALEGRE (HCPA) Responsible Author: ANTONIA NAYANNE DE ALMEI- Introduction and objective(s): The main objectives of this DA LIMA pictorial essay are: - Briefly describe the optic nerve (ON) Email: [email protected] anatomy; - Illustrate the main findings and differential diag- Keywords: ANGIOTOMOGRAFIA,AVC nosis of ON pathologies on computed tomography (CT) and on magnetic resonance imaging (MRI). - Discuss the main etiologies: congenital, inflammatory/ infectious, neoplastic, vascular and others. Method(s): Data were reviewed and collected based on 10 DIGITAL PRESENTATION (PD) years of experience of our Neuroradiology service. We se- lected the images from well-documented cases with estab- PD.12.004 lished diagnosis based on an educational perspective. CEREBRAL VENOUS DRAINAGE DISORDERS Discussion: The ON is an extension of the central nervous Authors: ALLEGRO, B.B.; PADILHA, I.G.; PETTEN- system axons, thus, it's myelinated by oligodendrocytes. It GILL, A.L.M.; NUNES, R.H.; ROCHA, A.J. originates from the retina, is circumscribed by glial cells and Institution: SANTA CASA DE MISERICÓRDIA DE SÃO the three meningeal layers, measures 4mm in diameter and PAULO -SP / GRUPO DASA - SP approximately 5.0 cm in length. The ON is divided into four Introduction and objective(s): It is important to identify segments (figure 1): intraocular, intraorbital, intracanalicular usual and unusual imaging findings of cerebral venous anat- and intracranial/pre-chiasmatic. Differential diagnosis of ON omy and embryology to understand cerebral venous drainage abnormalities. The purposes of this exhibit are to review and pathology can be broadly divided into congenital, inflamma- illustrate anatomic and embryologic feature of the cerebral tory/infectious, neoplastic, vascular and others. Septo-optic venous drainage and to describe acquired and congenital dysplasia (SOD) is a congenital cause of ON hypoplasia, venous disorders, and their pathophysiological and genetic diagnosed when two or more are present: ON hypoplasia, features. pituitary hormone abnormalities and midline brain defects Method(s): In this exhibit, we study and discuss genetic dis- (figure 2). ON colobomas are congenital focal defects in eases related to venous abnormalities, duralarteriovenous fis- tula pathophysiology, typical and atypical associations with the posterior globe at the optic nerve head insertion and can developmental venous anomalies, hypotensive and hyper- be related to morning glory disc anomaly and peripapillary tensive syndromes related to venous drainage abnormalities staphyloma (figure 3). Optic neuritis can be infectious or and clinical radiologic thrombotic syndromes. We also dis- demyelinating, it shows unilateral ON swelling with a hy- cuss some new perspectives, especially the relation between perintense STIR/T2 WI signal and intense homogeneous inflammatory diseases and its repercussion to the linfatic/ enhancement. Chronically the nerve will appear atrophied liquoric system, as well as the venous impairment involved (figure 4). Similar findings can be found in ON sarcoidosis Discussion: Cerebral venous drainage abnormalities are com- mon disorders and range from congenital to acquired condi- (figure 5). Glioma is the most common neoplasia of the ON tions. Developmental venous anomalies (DVAs)are known (figure 6), followed by ON sheath meningioma (figure 7). disorders, but the reasons behind the tendency os some DVAs The ON can also be a site of metastasis and retinoblastoma to be associated withssymptons or to develop cavernomas are spread (figure 8). Idiopathic intracranial hypertension can be not fully understood. We also known all the clinical radiolog- suggested when flattening of the posterior sclera, intraocular ic thrombotic syndromes and that some genetic disorders can ON protrusion, enlarged sheath, a be associated to venous abnormalities. But little information is Conclusion: Clinical information, understanding of the available regarding pathophysiology of these conditions. Conclusion: The appropriate comprehension of the normal main imaging features, and knowledge in imaging methods venous drainage pattern and it normal variants is necessary and protocols can help radiologists to reach the most accu- for the pathophysiologic understanding and proper making rate diagnosis. decision diagnosis. Many congenital and acquired conditions Responsible Author: MATHEUS D. SOLDATELLI can be associated to venous abnormalities. Identifying spe- Email: [email protected] cific additional clinical and imaging findings can narrow the Keywords: neuroradiology,anatomy,optic,nerve,mri,ct,edu- diagnosis possibilities. Responsible Author: Bruna Allegro cation,radiology Email: [email protected] Keywords: VENOSO,CEREBRAL,TROMBOSE,FISTU-
Abstracts of Scientific Papers 63 PD.12.018 features of the different tumors, categorizing them accord- INTRACRANIAL CALCIFICATIONS: WHEN ing to the new classification of the World Health Organi- AND WHERE DO THEY APPEAR AND WHAT DO zation. THEY MEAN Discussion: In 2016, the WHO published a new classifica- tion of CNS tumors, characterizing a revolution in how these Authors: QUEIROZ, I.C.; SALES, T.S.; GALON, M.V.; neoplasms are categorized. RAIMUNDO, E.C.; GUEDES, M.S.; VALENTE,M. Traditionally, CNS tumors were classified according to their Institution: HOSPITAL ALVORADA - AMÉRICAS tumor lineages, histogenesis and microscopic features. In this SERVIÇOS MÉDICOS new classification, there is a rupture of the principle of di- Introduction and objective(s): Intracranial calcifications agnosing tumors only according to its morphological char- are part of the routine of the radiologist, as the patients can be acteristics, incorporating molecular and genetic parameters. of physiological or pathological origin, and sometimes this This adaptation may imply a better refinement of the entities, type of differentiation can be a challenge, even because they allowing a better prediction of the clinical parameters and are physiological calcifications, depending on the age group, prognosis of the different tumors. may correspond calcifications of another etiology. Anatomic Conclusion: It is very important for the radiologist to know location, distribution, dimensions and morphology of cal- the main modifications of the classification, as its new enti- cifications are the main factors associated with the clinical ties, variants and patterns, and to identify the main challenges history and age group that can help the radiologist in the dif- in the correlation of molecular characteristics and radiologi- ferential diagnosis. To demonstrate as multiple causes of in- cal images in the different imaging modalities. tracranial calcifications and their origins, correlating with the Responsible Author: Cristyano Bismark Ferreira Leite radiological pattern as entities, in order to provide a means of Email: [email protected] rapid consultation. Keywords: Tumores, SNC, Classificação, OMS, Gliomas, Method(s): To describe more than sixty cases of intracranial Glioblastomas calcifications of physiological and pathological etiology, in- cluding vascular, neoplastic, metabolic, infectious and neuro- cutaneous syndromes, among others. All cases were studied PD.12.037 through by Multidetectors Computed Tomography (MDCT) MAGNETIC RESONANCE IMAGING OF THE FE- and / or Magnetic Resonance Imaging (MRI) in a reference TAL BRAIN: PRACTICAL TIPS FOR RECOGNIZING hospital of the city of São Paulo - SP. MAIN PATHOLOGIES Discussion: Intracranial calcifications are a frequent presen- Authors: DALAQUA, M.; RIBEIRO, S.P.P.; ARAÚJO, L.; tation in numerous neurological imaging studies. As frequent HIRATA, F.; PIOVESAN, A.C.B.; BARBOSA JR, A.A. as they may be in imaging examinations and the physiolog- Institution: HOSPITAL ISRAELITA ALBERT EINSTEIN ical calcifications are well defined, depending on their pre- Introduction and objective(s): Magnetic resonance imag- sentation and the age group of presentation, the differential ing (MRI) of the fetal brain is an important tool for antenatal diagnosis can be extensive. diagnosis of congenital encephalic diseases, whose prognosis Conclusion: Imaging methods (MDCT and MRI) present can sometimes be improved by performing intrauterine pro- high sensitivity and specificity in the detection of intracranial cedures. The aim of this poster is to demonstrate the main calcifications. In the cases of our study, allowed a differentia- congenital brain anomalies, as well as to present practical tion between the physiological and pathological findings, and tips for the recognition of these malformations. In addition, in the pathological cases, allowed a good etiological evalu- a normal case was selected to illustrate the discussion about ation. Intracranial calcifications are related to several sug- the exam technique, maternal and fetal tailored sequences gestive etiologies and image patterns that sometimes over- and main anatomical landmarks that should be analyzed in a lap, however, reinforcing the radiologist's need to know the normal fetal brain. characteristics of these patterns to contribute to the diagnostic Method(s): We have selected fetal MRI exams performed for elucidation and clinical conduction. the investigation of malformations of the central nervous sys- Responsible Author: Isadora Carvalho Queiroz tem, performed without intravenous contrast between 2008 Email: [email protected] and 2018 in a 1.5T magnet. Keywords: Calcificações,Tomografia,Ressonância Discussion: In this poster, we will summarize the normal anatomy of the fetal brain in the T2 weighted sequences in 3 planes (axial, coronal and sagittal), as well as other se- PD.12.029 quences directed to the analysis of the brain and fetal spine THE NEW CLASSIFICATION OF CENTRAL NER- (FLAIR, diffusion, magnetic susceptibility and FIESTA). In VOUS SYSTEM TUMORS: WHAT HAS CHANGED? addition, we will accomplish a pictorial essay describing the Authors: LEITE, C.B.F.; PERDIZES, G.O.; DIAS JR, U.S.; VIE- main MRI findings of clinically relevant pathologies, with IRA, A.P.F.; OLIVEIRA, C.V.; LANCELLOTTI, C.L.P.; DOCE- tips for the recognition of these affections, namely: dysgen- MA, M.F.L.; GODOY, L.F.S.; CERRI, G.G.; LEITE, C.C.; esis of the corpus callosum (incidence 0.5 to 2/10000), an- Institution: HOSPITAL SÍRIO-LIBANÊS encephaly (incidence 1.2 / 10000), porencephaly (incidence Introduction and objective(s): Central nervous system 1/10000), microlisencephaly (undetermined incidence), (CNS) tumors are represent a diagnostic challenge of the ra- Chiari II malformation, before and after prenatal correction diologist's daily life. The objective of this study is to review, by fetoscopy (incidence 1/1000), Chiari III malformation in a didactic and illustrative way, the main changes of the (the rarest of Chiari malformations), myelomeningocele with new classification of the World Health Organization (WHO) closed neural tube (undetermined incidence), Dandy-Walker for CNS tumors, informing the main practical implications of malformation (incidence 1/30000), vein of Galen aneurysmal this important change, as well as highlighting its most char- malformation (corresponding to 30% of intracranial vascu- acteristic image aspects. lar malformations of childhood) and congenital infection by Method(s): A pictorial essay of cases diagnosed and fol- coxsackie virus with ventricular-amniotic shunt (indetermi- lowed in our service will be performed, showing the typical nate incidence).
64 49th Sao Paulo Radiological Meeting Conclusion: The value of magnetic resonance imaging INTRACRANIAL VESSEL WALL MRI: A PRAC- of the fetal brain for antenatal diagnosis of neurological TICAL GUIDE FOR RECOGNITION OF diseases has increased in recent years, due to the improve- MAJOR PATHOLOGIES ment of the technique and greater availability of the meth- Authors: DALAQUA M., RIBEIRO, S.P.P., LYRA T.C.B., od. It is crucial for the radiologist to recognize normal fe- ARCANJO-MARQUES T.L.M., IQUIZLI R., BARBOSA tal brain development, as well as to identify the main brain JR, A.A. malformations. Institution: HOSPITAL ISRAELITA ALBERT EINSTEIN Responsible Author: Mariana Dalaqua Introduction and objective(s): Intracranial vascular insults Email: [email protected] are usual in diagnostic imaging practice, and radiologists Keywords: Má-formação,encéfalo,fetal,ressonância sometimes face challenging differential diagnosis. This post- er aims to exhibit cases from our institution to illustrate a PD.12.042 practical guide on how to recognize the main pathologies of intracranial arteries (atherosclerosis, arterial dissection, vas- MAIN UNUSUAL NEOPLASMS OF THE CENTRAL culitis and vascular tone dysregulation), a task often impos- NERVOUS SYSTEM IN THE PEDIATRIC POPULA- sible using non guided and low resolution imaging. Accurate TION: ANALYSIS OF 7774 CASES diagnosis of different patterns of vascular diseases has sig- Authors: PEDRO, A.F.; FRANCA, A.H.; MENEZES, D.C.; nificant clinical magnitude and direct impact on therapeutic RAIMUNDO, E.C.; FAÉ, I.S.; QUEIROZ, I.C.; FARIAS, management. L.P.G; GALON, M.V.; PEREIRA, M.F.P.; SANTANA, P.G.; Method(s): We have selected cases in which intracranial ves- SALES, T.S.; GUEDES, M.S. sel wall MRI was performed between 2015 and 2018 in a 3T Institution: HOSPITAL ALVORADA, AMERICAS magnet, using intravenous contrast. SERVIÇOS MÉDICOS, SÃO PAULO/SP Discussion: Vessel wall imaging is a highly effective tool for Introduction and objective(s): Central nervous system evaluation of arterial walls, allowing accurate diagnosis of (CNS) tumors are the second most common group of pediat- vascular pathologies. ric cancers. They present varying symptoms, which basically The technique consists in the acquisition of high resolution depend on age and location at the time of presentation. There volumetric and sometimes two-dimensional images on a high are a large number of neoplastic histological types in the pe- magnetic field (3 Tesla), with suppression of intravascular diatric age group, almost all of them already well established blood and CSF signal, with sequences performed before and and described. However, there is a group of lesions that are after intravenous injection of a gadolinium-based contrast classified as unusual due to their low incidence in this group. agent. The following steps are proposed for systematic eval- This paper aims to describe the incidence and characteristics uation: 1) Identification of arteries and segments injured; 2) of the main unusual CNS tumors in children. Recognition of patterns of parietal thickening: eccentric or Method(s): Retrospective evaluation of 7774 cases in the concentric; 3) Interpretation of T1 and T2 intensities (iden- pediatric age group studied by Magnetic Resonance Imag- tification of methemoglobin, fibrous tissue, lipids andcal- ing (MRI) and / or Multidetector Computed Tomography cifications); 4) Recognition of patterns of enhancement; 5) (MDCT) of the CNS, from January 2011 to July 2018. Un- Identification of pitfalls; 6) Reversibility of the findings in usual tumors were defined as those whose the percentage of follow-up examinations. occurrence in the pediatric population is low, according to the Conclusion: Conventional MRI lacks in specificity for the literature, generally below 1 to 2%. diagnosis of vessel wall pathology due to its low spatial res- Discussion: From 7774 cases studied, 238 CNS tumors olution. Vessel wall imaging MRI (VWI-MRI) is based on were diagnosed, with a total incidence of 3.06% in our pop- high resolution imaging, contributing to distinguish the main ulation group. From 238 cases, 20 were considered unusu- pathologies that can affect these arteries. Recognition of spe- al, representing 8.4% of all cases: infantile astroblastoma cific patterns of diseases may assist the radiologist in achiev- (01), neural vacuolar multinodular tumor (01), nasal glio- ing the correct diagnosis. ma (01), pediatric oligodendroglioma (01), supratentorial Responsible Author: Mariana Dalaqua glioblastoma 02), brainstem ganglioglioma (01), neuro- Email: [email protected] blastoma (01), esthesioneuroblastomas (01), central neuro- Keywords: angiorresonância,dissecção,ateromatose,vaso- cytoma (01), schwannoma not related to neurofibromatosis constrição,MRI,VWI (01), hemangioblastoma (01), intracranial chordoma (01), rhabdomyosarcoma (02), primary lymphoma (02), menin- PD.12.046 gioma (02, with and without sarcomatous transformation) SCALP AND SKULL VAULT IMAGING: WHY DO and metastases (01). All cases have anatomopathological YOU LOOK BUT DO NOT SEE? confirmation. Authors: RAIMUNDO, E.C.; PEREIRA, M.F.P.; FARIAS, Conclusion: Due to the high incidence of CNS neoplasms L.D.P.G.D.; GUEDES, M.D.S.; SANTANA, P.G.; QUE- in the pediatric age group, the main histological and radio- IROZ, I.C.; GALON, M.V.; PEDRI, A.F.; FERREIRA, logical characteristics of this type of tumor are already well R.H.Q.; ROCHA, R.C.F. defined in the literature, however the radiologist should be Institution: HOSPITAL ALVORADA SÃO PAULO / aware of some types of unusual neoplasms in this population, AMÉRICAS SERVIÇOS MÉDICOS to broaden the spectrum of differential diagnoses, thereby as- Introduction and objective(s): Skull vault and scalp lesions sisting the requesting physician and avoiding misunderstand- are present in every day radiologist, but in many cases they ings in the treatment. go unnoticed and when detected generate a great diagnos- Responsible Author: Lucas de Pádua Gomes de Farias tic dilemma due to non-specificity and unfamiliarity with Email: [email protected] the findings. The present study intend to demonstrate the Keywords: Pediátrico,Encéfalo,Neoplasias multiple skull vault and scalp lesions, including anatomical variants, congenital, traumatic, inflammatory, neoplastic and PD.12.043 miscellaneous changes. To describe the radiological pattern.
Abstracts of Scientific Papers 65 To gather this information, which is scattered in the literature, control of vasculitis due to sarcoidosis has demonstrated sig- thus serving as a tool for the professional radiologist in the nificant reduction in the thickening and enhancement of the differential diagnosis of lesions in these topographies. vascular wall after immunosuppressive treatment. Mthod(s): Described more than fifty lesions and anatomical Conclusion: The 3D T1-weighted dark-blood sequence MR variations of the skull vault and scalp. All cases were con- Imaging study of the vascular wall is extremely useful in the firmed by biopsy or clinical follow-up. demonstration of inflammatory alterations of the vascular Discussion: The scalp is composed of five layers: skin; con- wall, enabling the accurate diagnosis of vasculitis against nective tissue; galea aponeurosis; loose connective tissue and noninflammatory vasculopathies. In addition, it may be use- periosteum. The skull vault can be divided into three layers: ful in the follow-up after immunosuppressive therapy. outer board, dipole and inner board. Therefore, due to this Responsible Author: Pedro Neves Paiva de Castro constitution, the radiological presentation can be quite var- Email: [email protected] ied, both in terms of topography and image. With the techno- Keywords: Vasculitis, Magnetic Resonance Imaging, Stroke, logical evolution and greater accessibility to the radiological Sarcoidosis examinations, the evaluation of these anatomical regions be- came more frequent and necessary. PD.12.068 Conclusion: Skull vault and scalp are sites of anatomical variations and lesions of the most diverse etiologies and NON-NEOPLASTIC INTRACRANIAL CYSTIC LE- with image patterns that sometimes overlap. Thus, the ra- SIONS - NOT ALL ARE ARACHNOID CYSTS diologist's knowledge of these standards and having an eas- Authors: ALMEIDA, L. B.; SIMEÃO, T. B.; HOLLANDA, ily accessible material for research are important for a more R.; PEREIRA, R. G.; NIEMEYER, B.; MUNIZ, B. C. accurate diagnosis. Institution: 3D DIAGNOSTICO / HOSPITAL REDE CASA Responsible Author: Enrique Caetano Raimundo Introduction and objective(s): Intracranial cysts are com- Email: [email protected] mon on computed tomography and magnetic resonance, and Keywords: Calota,Envoltórios,lesões,Variações most cases are found to be incidental in asymptomatic pa- tients. Arachnoid cysts are the most common intracranial cysts and correspond to approximately 1% of all intracranial PD.12.061 masses. They are usually located in the subarachnoid space VESSEL WALL MAGNETIC RESONANCE IMAG- and they are characterized as well circumscribed cysts, with ING: A NEW MILESTONE IN THE DIAGNOSIS OF an imperceptible wall, displacing adjacent structures, and CEREBRAL VASCULITIS following the hypodense pattern on computed tomography Authors: CASTRO, P. N. P.; PINTO, L. E. S.; SANTOS, R. and hyperintense on T2 with FLAIR suppression on mag- Q.; GOMES, C. M. P.; ABREU, P. P.; WAJNBERG, C. M. netic resonance. In this article will be presented the main G.; MOREIRA, D. M. radiological characteristics of non - neoplastic intracranial Institution: AMERICAS MEDICAL CITY cystic lesions, with the exception of the arachnoid cyst, in Introduction and objective(s): An accurate diagnosis of order to know and differentiate the diagnostic possibilities cranial vasculitis is crucial in therapeutic targeting. These based on their location and the signal characteristics in the vasculopathies are characterized by intense inflammatory different sequences. activity in the vascular wall. Conventional arterial 3D time- Method(s): It will be used images from our digital archive of-flight (TOF) MR angiography is useful for the evaluation of the last 5 years for the illustration of this pictorial essay, of the luminal flow but is nevertheless quite limited in the confirmed by imaging findings or by histopathological study. demonstration of the inflamed vascular wall. In this context, Discussion: Intracranial cystic lesions present a wide spec- an improved technique recently emerges with great promi- trum of pathology and imaging, and some require treatment, nence in the evaluation of the vessel wall. The 3D T1-weight- while most remain asymptomatic and do not require fol- ed dark-blood sequence enables the suppression of the flow low-up or intervention. However, the etiology of these le- inside the vascular lumen, what allows the study of its wall. sions changes, making the differential diagnosis a challenge. In the case of vasculitis, there are areas of concentric thicken- They can be divided into intra-axial and extra-axial and each ing and avid enhancement by the contrast agent of the vascu- in supra and infra-tentorial. The extra-axial ones can be di- lar wall. In non-inflammatory vasculopathies, the contrast en- vided in the lesions that affect or not the midline and the hancement is minimal or absent. Our goal is to demonstrate intra-axial ones in parenquimatosas and intraventricular. typical aspects of vasculitis imaging with emphasis on a 3D Conclusion: An extensive spectrum of diseases can cause T1-weighted dark-blood sequence. non-neoplastic intracranial cystic lesions resulting in a diag- Method(s): We reviewed the digital file of our institution and nostic challenge. The combination of imaging findings, such retrospectively assessed patients with a final diagnosis of vas- as signal intensity and location, associated with the patient's culitis, including sarcoidosis vasculitis, systemic collageno- clinical history and age are of paramount importance for the sis vasculitis, primary CNS arteritis and temporal arteritis. differential diagnosis. The patients underwent 3 Tesla (3T) MRI (Skyra, Siemens) Responsible Author: Leticia Baldez de Almeida with protocols that included a 3D T1-weighted dark-blood Email: [email protected] sequence after the intravenous administration of gadolinium. Keywords: Lesão cistica,Cistos não neoplásicos Discussion: The main findings were areas of avid enhance- ment and concentric thickening of the vascular wall, condi- tioning narrowing and luminal occlusion. Additional sequenc- PD.12.070 es for the evaluation of the cerebral parenchyma showed IT IS NOT ALWAYS MULTIPLE SCLEROSIS: THE ischemic and edematous changes in the affected regions. In DIFFERENTIAL DIAGNOSIS AND MAIN FEATURES addition, a case of temporal arteritis demonstrated severe tor- USING MAGNETIC RESONANCE IMAGING. tuosity, parietal thickening and enhancement of the temporal Authors: DE BEM, R.B. ; CASTRO, P. N. P. ; NETTO, artery involved. The vascular wall study may additionally E.C.C. ; CRUZ JR, L.C.H. be useful for monitoring therapeutic response. Evolutionary Institution: MULTI IMAGEM / IPANEMA - DASA RJ
66 49th Sao Paulo Radiological Meeting Introduction and objective(s): Multiple sclerosis (MS) is the Conclusion: Bilateral lesions of the thalamus have a wide most common CNS demyelinating disorder, however many variety of causes, with magnetic resonance being an essential inherited and acquired disorders could mimic MS, and they tool in the search for differential diagnoses. A detailed de- must be included in the differential diagnosis of multiple-scle- scription of imaging findings and associated clinical findings rosis-like lesions. When unusual features or "red flags" are can greatly narrow differential diagnoses, enabling better present, the exclusion of alternative diagnosis that can mimic clinical management of the patient and avoiding potentially MS is necessary, like other demyelinating diseases (as ADEM harmful biopsies. or NMO) and vascular, metabolic, toxic, genetic or tumor Responsible Author: Luciana Emery de Siqueira Pinto diseases. Idiopathic inflammatory-demyelinating diseases in- Email: [email protected] clude a broad spectrum of diseases, and the concomitant pres- Keywords: bitalamicas ence of MS-typical lesions is an important hint for differential diagnostic clarification, also being important to distinguish PD.12.078 them from tumors, avoiding unnecessary biopsies. PRIMARY CENTRAL NERVOUS SYSTEM LYMPHO- Method(s): The purpose is to present an archive of the last MA: CLINICAL AND RADIOLOGICAL ASPECTS IN five years, documented by magnetic resonance imaging IMMUNOCOMPETENT AND IMMUNOCOMPRO- (MRI) from our institution, through an iconographic essay, MISED showing a short review of current literature about the main Authors: BASSO, C. F.; DINIZ, L. V.; SAAD, F. M.; imaging features of several common and uncommon demye- NEVES, G. B; ROÇA, C. T.; RODRIGUES, L. P.; VELOSO, linating diseases, highlighting the importance of the radiolo- J. C. V ANTUNES, P. E. H.; JUNIOR, L. A. J. gist in the diagnostic elucidation. Institution: UNIVERSIDADE ESTADUAL PAULISTA - Discussion: Review of criteria consensus of CNS demye- FACULDADE DE MEDICINA DE BOTUCATU linating diseases. Discuss routine and advanced MRI. Re- Introduction and objective(s): Primary central nervous view atypical forms and mimics of demyelinating diseases: system lymphomas (PCNSL) are becoming increasingly MS; Acute disseminated encephalomyelitis (ADEM); Leigh common, accounting for the third most common primary syndrome; Neuromyelitis optica; Idiopathic inflammatory neoplasm of the CNS, behind meningiomas and tumors of demyelinating disorders; Others. Summary with the main glial origin. Most are B-cell non-Hodgkin type, and may MRI findings. be primary (exclusive CNS involvement) or secondary to Conclusion: It is essential to the radiologist recognize the systemic lymphoproliferative disease. Immunodeficiencies “red flags” in the MR imaging, being useful for the proper - whether primary (HIV-positive patients, for example) or ac- diagnostic evaluation of suspected cases of MS, which allows quired (post-transplant patients on immunosuppression, for the correct differential diagnosis by assessing the combined example) - greatly increase the risk of developing lymphop- imaging, clinical and laboratory information. roliferative neoplasms. The present work aims to illustrate Responsible Author: RODRIGO BEBER DE BEM the peculiarities of PCNSL in immunocompetent and immu- Email: [email protected] nocompromised individuals, in relation to epidemiological, Keywords: multiple sclerosis,differential diagnosis,magnet- clinical and radiological aspects. ic resonance imaging,esclerose múltipla,diagnóstico diferen- Method(s): A review of the literature on the subject was cial,imagem por ressonância magnética performed, exemplifying PCNSL cases from our service in the last 5 years. Clinical and epidemiological aspects were PD.12.071 collected in the electronic medical records and radiological BITALAMIC VIRAL ENCEPHALITIS: PRACTICAL aspects include the CT (Activision 16 and Optima 660) and APPROACH THROUGH MAGNETIC RESONANCE MRI studies (Verio 3T), including advanced sequences such IN SEARCH OF DIFFERENTIAL DIAGNOSES as diffusion, perfusion and spectroscopy. Within the group of Authors: PINTO, L.E.S; CASTRO, P.N.P; SANTOS, immunocompromised patients, cases of individuals with HIV R.Q; GOMES, C.M.P; ABREU, P.P; WAJNBERG, C.M.G; / AIDS infection and those transplanted with immunosuppres- MOREIRA, D.M; BRAGANÇA, E. sion, including the spectrum of post-transplant lymphoprolif- Institution: AMERICAS MEDICAL CITY erative disorders (PTLD), were presented. All patients present Introduction and objective(s): Acute viral encephalitis is histopathological study to confirm the diagnosis. getting more common these days in our society. They are the Discussion: The incidence of PCNSL is increasing in recent result of brain parenchymal infection by a number of differ- years due to the HIV / AIDS epidemic and the increase in the ent viruses, many of which have similar presentations and number of individuals transplanted in the immunosuppressive imaging features. MRI is the modality of choice to evaluate regimen. The exposure of the radiologist, especially those in all types of encephalitis and their differential diagnoses. The the training phase, to the different possible presentations of goal of this work is to describe and illustrate the findings of lymphoproliferative diseases is a fundamental task for the ex- bitalamic viral encephalitis and its differential diagnoses. pansion of differential diagnoses when evaluating CNS neo- Method(s): We selected cases of several pathologies that plasms. The role of advanced sequences in resonance studies involve the thalamus bilaterally and make a differential is paramount for differential diagnosis with other neoplasms diagnosis with bitalamic viral encephalitis. A brief review and opportunistic infections. of these pathologies and their pattern in the MRI study Conclusion: Despite the existence of overlapping radiolog- was performed. ical features, especially with other CNS tumors and oppor- Discussion: Bitalamic lesions are rare and have a limited tunistic infections, the radiographics features of lymphop- spectrum of differential diagnoses including metabolic and roliferative diseases can be evaluated with relative accuracy toxic processes, infections, vascular and neoplastic lesions. by the radiologist when using the MRI traditional and ad- The patient's history and imaging characteristics are very im- vanced sequences. portant in the evaluation of differential diagnoses. Magnet- Responsible Author: Caio Ferraz Basso ic resonance imaging is the choice modality in the study of Email: [email protected] these lesions. Keywords: PCNSL,CNS,SNC,Linfoma
Abstracts of Scientific Papers 67 PD.12.081 Method(s): We retrospectively selected the fetal CNS MR DIFFERENTIAL DIAGNOSIS AND EVALUATION OF exams of our institution with an abnormal report over the past THE SELLAR AND PARASELLAR LESIONS 10 years, describing the main findings that can help on the eti- Authors: DE BEM, R.B. ; CASTRO, F.S.P.; DE PINHO, L. ological diagnosis, correlating with the ultrasound changes. K. J.; GADELHA, M.R.; VENTURA, N. Discussion: The fetal MR of the CNS can be employed to Institution: INSTITUTO ESTADUAL DO CÉREBRO confirm and characterize cerebral abnormalities detected by PAULO NIEMEYER / RJ routine prenatal ultrasound, as well as help on the identifi- Introduction and objective(s): Tumor and tumor-like con- cation of occult US changes. The studies demonstrate that ditions may involve the sellar and parasellar region and its the fetal MR can detect inapparent anomalies on US in up anatomic localization is essential in the creation of differ- to 50% of the cases with a variety of indications. The role ential diagnosis. Magnetic resonance (MR) imaging is im- of fetal MR on the approach of CNS alterations, whether portant for complete characterization, including localization, verifying the absence of abnormalities, confirming detect- regional extension or invasion, and surveillance after medical ed abnormalities detected by US or discovering additional or surgical treatment. Computed tomography (CT) is com- abnormalities has shown to affect the clinical decision-mak- plementary to MR imaging for the depiction of bony chang- ing, with implications to the counseling of the patients and es. Vascular lesions, such as an aneurysm, may involve the changes in management during pregnancy and prognosis. sellar region. CT or MR angiography should be performed Besides exemplifying clinical cases, we highlight the impor- if suspected. On MR imaging, a sella protocol is necessary. tance of the image protocols, which, if not directed at the T2 sagittal and coronal as well as pre- and postcontrast T1 clinical hypothesis, can make it harder to detect or character- sagittal and coronal images with a slice thickness of 2.5 mm ize certain abnormalities. are the optimum planes to examine the region. Conclusion: We describe the typical fetal MR findings of the Method(s): The purpose is to present an archive of the last five CNS through illustrative cases, as well as the image proto- years, documented by magnetic resonance imaging from our in- col and its applications that help to narrow or confirm the stitution, through an iconographic essay, showing a short review diagnosis on certain malformations and destructive events of current literature about the main imaging features of common of the fetal CNS. A good comprehension of these possible and uncommon sellar and parasellar tumors, highlighting the abnormalities is fundamental for the correct diagnosis, with importance of the radiologist in the diagnostic elucidation. implications on the prenatal management and prognosis. discussion: Approach to analysis of sellar and parasellar pro- Responsible Author: Rafael Dais da Rocha cesses, for commom/uncommon regional pathologies. MR Email: [email protected] typical sellar protocol. Review of imaging findings: 1) Solid Keywords: CNS,Congenital CNS abnormality,Fetal Lesions: 1.1)Hypothalamic-chiasmatic / tuber cinereum ori- MRI,SNC,Anormalidade congênita do SNC,Ressonância gin: Glioma; Germinoma; Tuber cinereum hamartoma; Lang- magnética fetal erhans cell histiocytosis. 1.2) Lateral structures origin: Aneu- rysm; Meningioma. 1.3) Clivus origin: Chordoma 2) Cystic Lesions: Empty sella; Arachnoid Cyst; Rathke Cleft Cyst; PD.12.084 Craniopharyngioma. Summary with the main MRI findings AUTOIMMUNE ENCEPHALITIS: NOT ALWAYS on sellar and parasellar injuries. LIMBIC Conclusion: A host of pathologic processes may involve the Authors: SCOPPETTA, T.L.P.D.; NUNES, D.M.; LEITE, sellar and parasellar region, and knowledge of the anatomy C.C.; TOYAMA, C.; DA SILVA, C.J. and its main differential diagnosis, in addition to clinical in- Institution: HOSPITAL SÃO CAMILO, SCOPP DIAG- formation, essential for facilitating the correct diagnosis. NÓSTICOS, FLEURY MEDICINA E SAUDE, HOSPITAL Responsible Author: RODRIGO BEBER DE BEM DAS CLINICAS DA CIDADE DE SÃO PAULO. Email: [email protected] Introduction and objective(s): Autoimmune encephalitis Keywords: Sellar,parasellar,suprasellar,pituitary,Cavernous is a difficult clinical diagnosis due to the similarities in the sinus,MR imaging clinical, imaging and laboratory findings of many forms of autoimmune and infectious encephalitis. To describe a series PD.12.082 of cases of autoimmune encephalitis with clinical and imag- MAGNETIC RESONANCE (MR) EVALUATION OF ing extralimbic manifestations. THE FETAL CENTRAL NERVOUS SYSTEM (CNS): Method(s): We collected several cases from the archives of WHAT WE LEARNED IN THE LAST DECADE, IM- the authors institutions to this pictorial essay. AGE PROTOCOLS AND APPLICATIONS. Discussion: Autoimmune encephalitis is an important cause Authors: ROCHA, R.D.; BAE, S.M.B.; GARCIA, L. A. L.; MAIA of altered level of consciousness and syncope that has been JR., A. C. M.; FRAGOSO, D.C.; DA SILVA, C.J, TOYAMA, C. recognized recently in the medical literature. Limbal enceph- Institution: GRUPO FLEURY alitis is a common cause of classic paraneoplastic syndrome Introduction and objective(s): Fetal MR is an additional (approximately 70%). However, there are other imaging tool for the evaluation of the fetal CNS and has been used as patterns, such as impairment of the brainstem, cerebellum, a complement to the prenatal ultrasound (US). The increas- spinal cord, and white matter of the cerebral hemispheres. ing clinical use of this modality is due to the development of Recognition of non-common forms of presentation prevents ultrafast MR techniques, which produce multiplanar images delay in diagnosis and enables early treatment. in high resolution, allowing a better differentiation of the nor- Conclusion: The neuroradiologist should be familiar not just mal from the abnormal tissue and thus helping on the search with the common autoimmune limbic presentations, but also for abnormalities not identified on US. We pretend to discuss with the extra-limbic ones. image protocols, the applications of MR on the fetal CNS and Responsible Author: Thiago Luiz Pereira Donoso Scoppetta demonstrate our experience over the last 10 years through Email: [email protected] illustrative cases. Keywords: encefalite,auto-imune,cerebelite,limbica
68 49th Sao Paulo Radiological Meeting PD.12.088 are the main symptoms, a clinical history of subarachnoid GLIOBLASTOMA: A MULTIFORME TUMOR hemorrhage is often absent. In this scenario, imaging exams Authors: FONSECA, A.P.A.; PADILHA, I.G.; PETTEN- are fundamental not only to demonstrated hemosiderin depo- GILL; A.L.M.; PACHECO, F.T.; NUNES, R.H.; MAIA JR, sition but also to depict the bleeding source, even though in A.C.M.; ROCHA, A.J. some cases it is not identified with the available radiological Institution: IRMANDADE DA SANTA CASA DE MI- propaedeutic (brain and spine MR, CT myelography, MR an- SERICÓRDIA DE SÃO PAULO giography, and cerebrospinal angiography). It is imperative Introduction and objective(s): Glioblastoma (GBM) is to radiologists be trained to look after for potential common the most common adult primary intracranial neoplasm. and uncommon sources of bleeding (such as trauma, surgery, GBMs are aggressive, largely resistant to therapy, and have cerebral amyloid angiopathy, cortical and dural vein throm- a poor prognosis. The WHO classification has dropped bosis, duropathies, neoplasms and vascular pathologies). To the 'multiforme' and thus it is best to refer to these tumors simplify the differential diagnosis workout of SS, we intro- merely as glioblastomas. Although the term "multiforme" duce a diagnostic algorithms considering the age, SS location should not be used, this tumor presents multiple patterns and associated findings. of presentation and its recognition is essential in the early Conclusion: Superficial siderosis is not an uncommon imag- diagnosis and prognosis. ing finding in MR brain exams. Method(s): After reviewing our institution teaching files, It is imperative that radiologists know the potential causes we selected cases demonstrating GBM in different scenar- of SS and are able to cost-effectively screen imaging in each ios, including early diagnosis, patterns of involvement and particular case. The diagnostic algorithm can simplify the SS post-treatment aspects. Our purpose is to review and dis- differential diagnosis training. cuss the pattern of GBM imaging abnormalities correlating Responsible Author: Thiago Luiz Pereira Donoso Scoppetta to pathogenesis, classification, histological and molecular Email: [email protected] aspects. Furthermore describe through illustrative cases the Keywords: siderose,hipotensão,trombose,angiopatia,tu- scenarios to diagnose, including early onset glioblastoma, mor,malformação,duropatia and highlight the differential. Discussion: In 2016, the WHO released an update to the brain tumor classification. The glioma category has been significantly reorganized, with infiltrating gliomas now defined by genetic features. GBM is now subdivided on LITERATURE REVIEW the basis of the presence or absence of IDH mutation. It is likely that most of the previously recognized primary GBMs were IDH wild-type, and most of the secondary POSTERS (PI) GBMs were IDH mutant. The classic imaging manifesta- tion of GBM is a solitary ring-enhancing mass, but GBM can manifest as multifocal disease or with more unusual PI.12.012 imaging features. MULTINODULAR AND VACUOLATING NEURONAL Conclusion: Radiologist must be aware of the different im- TUMOR: FOUR CASES REPORT AND DISCUSSION aging scenarios to optimize imaging protocols to support ear- ABOUT THE NATURE OF THIS LESION ly and accurate GBM diagnosis, helping the treatment and Authors: BARTELS, R.; LIMA, M. R.; TORRES, L. follow-up. Institution: HOSPITAL MOINHOS DE VENTO Responsible Author: Ana Paula Alves Fonseca A brief description of the objective(s): We will present Email: [email protected] four cases of multinodular and vacuolating neuronal tumor Keywords: Glioblastoma;,Neoplasm (MVNT) depicted in Magnetic Resonance Imaging (MRI) studies with illustrative imaging findings. We will also dis- PD.12.089 cuss the nature and etiology of this lesion, whether it is mal- SUPERFICIAL SIDEROSIS: WHERE TO LOOK. formative or a true neoplasm, briefly reviewing its clinical Authors: SCOPPETTA, T.L.P.D.; FRAGOSO, D.C.; TOYA- issues, pathology and treatment strategies. MA, C.; DA SILVA, C.J. Description of the disease(s), method(s) and/or tech- Institution: FLEURY MEDICINA E SAUDE; HOSPITAL nique(s): MVNT was categorized by the World Health Orga- SÃO CAMILO; SCOPP DIAGNÓSTICOS nization (WHO) as a new central nervous system (CNS) neo- Introduction and objective(s): The objective of this picto- plasm entity in 2016. The most common presentation of this rial essay is to illustrate and describe the cause, physiopa- lesion is an incidentally discovered, typically asymptomatic, thology, natural history, and clinical and imaging presenta- cluster of variably sized discrete nodules along inner sur- tions of a series of pathologies that present with superficial face of cortex hyperintense on T2-weighted image (T2WI) siderosis (SS). / fluid-attenuated inversion recovery (FLAIR), without mass Method(s): Was conducted a retrospective and descriptive effect, diffusion-weighted imaging (DWI) restriction or con- study of brain and spine MRI scans performed in our insti- trast enhancement on MRI. Histologic evaluation reveals dis- tution. We will exhibit a number of pathologies that present crete nodules with prominent intracellular and stromal vacu- with SS focusing in depicting the source of the bleeding. We olation. Provided that MVNT is a clinically indolent benign also propose a diagnostic algorithm. nonaggressive CNS lesion, it has been categorized as a "leave Discussion: Superficial siderosis of the CNS is a rare clinical me alone" lesion, that is, no treatment is needed unless prov- entity that results from chronic hemosiderin deposition in the en to be epileptogenic. subpial layers of the brain and spinal cord that leads to grad- Discussion: Followed by MVNT description in 2013, a de- ual progressive neurologic deterioration. Although slowly bate about the nature of this lesion arose due to its benign progressive gait ataxia and sensorineural hearing impairment clinical and imaging features. Tumor cells typically express
Abstracts of Scientific Papers 69 glial and neuronal antigens such as synaptophysin, HuC/HuD CASE REPORT and Olig2, which is the reason why MVNT was initially de- scribed as a malfomative lesion. Conventional tumor immu- nomarkers could not help distinguish whether MVNT was a malformative lesion or a true clonal neoplasm. Recent re- DIGITAL PRESENTATION (PD) search analyzed archival tissue specimens from eight patients diagnosed with MVNT. It found genetic alterations that acti- vate the mitogen-activated protein kinase (MAPK) signaling PD.12.011 pathway similar to gangliogliomas, pilocytic astrocytomas, OPHTHALMOPLEGIC MIGRAINE: CASE REPORT and dysembyroplastic neuroepithelial tumors, but differing Authors: AMORIM, P.M.; CASTRO, C.E.S.; SOUZA, L.O. from each of these in some genetic way. Institution: HOSPITAL SANTA ISABEL - ASSOCIAÇÃO Conclusion: Recently described as a distinct neuronal lesion, CONGREGAÇÃO DE SANTA CATARINA MVNT is often an incidental finding in asymptomatic patients, A brief description of the objective(s): Report the case of a featuring typical and benign imaging and histological aspects. patient with Ophthalmoplegic Migraine (OM), emphasizing Characterized as a malformative lesion by some authors, recent the radiological manifestations of the disease. research suggests its neoplastic origin, although no treatment is Clinical History: A 36-year-old female patient with a history usually required because of its favorable prognosis. of migraine during adolescence, internal to investigate pul- Responsible Author: Rodrigo Bartels satile headache associated with left third cranial nerve palsy, Email: [email protected] evolving with complete spontaneous improvement of symp- Keywords: Multinodular and vacuolating neuronal tumor,- toms after 36 hours. A cranial magnetic resonance imaging Magnetic resonance imaging,Diffusion-weighted imaging (MRI) was performed, showing discreet thickening of the left oculomotor nerve in its cisternal segment, with hypersignal PI.12.016 in T2 / FLAIR and contrast enhancement. Discussion and diagnosis: Ophthalmoplegic migraine is a rare BEVACIZUMAB-RELATED IMAGE ABNORMALI- syndrome, characterized by the association of migraine-like TIES (BRIA) - CASE REPORTS AND LITERATURE headache and partial or complete paralysis of one or more ocu- REVIEW lar nerves (commonly the third nerve), in the absence of any oth- \Authors: KUSSANO, I.C.T; HIRATA, F.C.C; BARBO- er demonstrable intracranial lesion, except for MRI alterations SA-JUNIOR, A.A. ; SILVA, F.A.B; DO NASCIMENTO, of the affected nerve itself. The syndrome is more frequent in F.B.P. males. Recurrent crises may occur, and the first episode tends to Institution: HOSPITAL ISRAELITA ALBERT EINSTEIN occur even in childhood. Its etiology is uncertain, initially was A brief description of the objective(s): Case reports and considered a variant of migraine, however, many authors now review of the literature regarding image changes (magnetic consider that OM is more related to acute attacks of nervous resonance imaging) associated with the use of antiangiogen- demyelination or a form of inflammatory neuropathy. Cranial ic bevacizumab (BRIA) in patients undergoing treatment for MRI can demonstrate the presence of hypersignal, contrast en- high-grade glial tumors. hancement and thickening of the affected cranial nerve. These Description of the disease(s), method(s) and/or tech- radiological findings tend to resolve spontaneously. Diagnostic nique(s): We reviewed articles describing changes in images criteria include: headache with migraine characteristics, accom- related to the use of antiangiogenic and some cases observed panied or followed by palsy of one or more ocular nerves, and in our institution were described. exclusion, by appropriate investigation, of parasellar lesions, Discussion: Bevacizumab, marketed since 2004 on the name lesions in the orbital fissure or the posterior fossa. Avastin™, is a recombinant monoclonal antibody that in- Conclusion: MRI plays a fundamental role in the diagnosis hibits vascular endothelial growth factor A (VEGF-A) by of ophthalmoplegic migraine, helping in the differential diag- blocking angiogenesis in a number of diseases. A subgroup nosis with other causes of painful ophthalmoplegia, especial- of patients taking Bevacizumab for treatment of high-grade ly the Tolosa Hunt syndrome, being of fundamental impor- gliomas develop diffusion restriction areas, usually near the tance to recognize its radiological manifestations. surgical bed. These alterations, a priori interpreted as a hy- Responsible Author: Priscila Mara Amorim percellular tumor, have been described as areas of ischemia Email: [email protected] and atypical necrosis, which remain unchanged throughout Keywords: Ophthalmoplegic Migraine,Enxaqueca Oftalmo- the treatment. The mechanism for its occurrence has not yet plégica,Oftalmoplegia dolorosa,Paralisia do nervo oculomo- been determined but there are theories about chronic hypoxia tor,MRI,Neurorradiologia and vascular changes that hinder the free migration of macro- phages to the affected areas. Conclusion: The spectrum of changes associated with bev- PD.12.050 acizumab is studied in several high-grade glioma treatment ?-PROPELLER PROTEIN-ASSOCIATED NEURODE- services. However, since it is difficult to confirm histopa- GENERATION (BPAN): CHARACTERISTIC IMAG- thology, there is no consensus regarding its true incidence, ING FINDINGS IN CHILDHOOD AND ADULTHOOD pathophysiology and outcome. The great importance is its Authors: FERREIRA, A.F.; FREDDI, T.A.L; FERREIRA, differentiation of areas of true tumor progression, since this N.P.F.D.; DANTAS, F.D.G. influences the treatment and prognosis of these patients. Institution: HOSPITAL DO CORAÇÃO (HCOR) - There are reports in the literature that BRIA are related to bet- SÃO PAULO ter survival. This differentiation is often not easy, and tools A brief description of the objective(s): Report two cases such as advanced brain perfusion and proton spectroscopy of ß-propeller protein-associated neurodegeneration (BPAN) techniques and follow-up / follow-up may be used. with characteristic findings on magnetic ressonance imaging Responsible Author: Ivan Cesar Tanaka Kussano (MRI) in childhood and adulthood. Email: [email protected] Clinical History: Case 1: Female child, 2-years-old, present- Keywords: RM,DIFUSÃO,PERFUSÃO,BEVACIZUMAB ing with neuropsychomotor delay, including language, with
70 49th Sao Paulo Radiological Meeting a new episode of tonic-clonic seizure. Brain MRI revealed and the correlation with the previous history, the patient was T2-hyperintensity with mild swelling in the substantia nigra, diagnosed with an embolic ischemic vascular event with a globus pallidus and dentate nuclei. Genomic evaluation iden- projectile fragment. In order for the embalia to occur a small tified mutations in WDR45 gene, establishing the diagnosis caliber projectile or multiple fragments of large caliber weap- of BPAN. Case 2: Woman, 47-year-old, referred for parkin- ons is required provided that they have a low kinetic energy sonism evaluation started 3 year earlier. Brain MRI depicted when entering the wall of a vessel and the diameter of that bilateral and symmetric T2, FLAIR and SWI hypointensity in vessel is greater than the diameter of the projectile. Imag- the globus pallidus and substantia nigra, as well T1-hyperin- ing methods such as Simple Radiography and MDCT can tensity in the substantia nigra, besides marked brain atrophy. diagnose and evidence the topography of the projectile or Presumptive BPAN diagnosis was made. fragments of the same; however, MDCT is superior in this Discussion and diagnosis: ß-propeller protein-associated type of evaluation because it can determine the topography neurodegeneration (BPAN), originally termed static enceph- of the plunger, the region of the secondarily compromised alopathy (of childhood) with neurodegeneration in adulthood brain parenchyma, and information about the need for surgi- (SENDA) is a subtype of neurodegeneration with brain iron cal intervention. accumulation (NBIA). It is a X-linked hereditary disease, re- Conclusion: Although the intracranial embalia is a very rare sulting from the mutation of the WDR45 gene, responsible event, the radiologist must be aware of its existence, and can for the generation of ß-propeller protein, involved in regula- therefore confirm the diagnosis in patients suffering from tory mechanisms of intracellular autophagy. The MRI find- gunshot wounds with metallic attenuation fragment in vas- ings in adulthood are well-known, due to early iron deposit cular topography that are evolving or not with some neuro- in substantia nigra, resulting on typical symmetrical linear logical deficit. peripheral hyperintensity in T1 with a central band of hy- Responsible Author: Pedro Guimarães Santana pointensity. However the diagnosis suspicion on childhood Email: [email protected] was challenging until recent studies indicated that the T2-hy- Keywords: Embalia,projétil,êmbolo perintensity and swelling in the globus pallidus and substan- tia nigra were a characteristic sign. In our case we also found PD.12.063 signal abnormality in the dentate nuclei, not yet reported in MARCHIAFAVA-BIGNAMI DISEASE the literature. Authors: SOUSA, J. K. M.; MARIN, M. S.; DAVID, H. C.; Conclusion: Imaging findings in BPAN adult patients are DAN, V. J. L. well known, but only recently signal changes in globus palli- Institution: SANTA CASA DE VOTUPORANGA/SP dus and substantia nigra on affected children were described. A brief description of the objective(s): This report shows It is important to be aware of this signs for diagnostic suspi- the acute form of Marchiafava-Bignami disease (MBD), cion and early treatment. which is an infrequent condition of the central nervous sys- Responsible Author: Arthur de Freitas Ferreira tem, usually seen in the context of chronic alcoholism and Email: [email protected] malnutrition. It classically involves primary degeneration of Keywords: BPAN, SENDA ,NBIA., NEURODEGENERA- the corpus callosum with necrosis and demyelination. Most TION of the patients are middle-aged, male, with a history of al- coholism and malnutrition. It should be differentiated from PD.12.056 other alcoholic encephalopathies and, despite the difficult di- EMBALIA: REPORT OF A CASE OF ENCEPHALIC agnosis of certainty in the living patient, neuroimaging stud- VASCULAR ACCIDENT BY FRAGMENT OF FIRE- ies are essential. ARM PROJECTILE Clinical History: 33-year-old male patient, chronic alco- Authors: RAIMUNDO, E. C.; QUEIROZ, I. C.; GALON, M. holic, a street dweller, with a history of head trauma after V.; PEREIRA, M. F. P.; GUEDES, M. D. S.; SANTANA, P. G. falling from a bus, presented with lowering of consciousness Institution: HOSPITAL ALVORADA / AMÉRICAS level and convulsive crisis, strong ethylic odor, and under- SERVIÇOS MÉDICOS went orotracheal intubation (OTI). He was extubated, but A brief description of the objective(s): Embalia is the evolved the following morning with respiratory failure and term described for the embolism caused by a firearm pro- cardiorespiratory arrest (CRA), reversed with cardiorespira- jectile fragment far from the entrance site, an extremely tory resuscitation (CPR). Computed tomography (CT) of the rare phenomenon. In this report we describe a plunger case skull revealed hypodensity throughout the entire corpus cal- for the middle cerebral artery secondary to a cervical gun- losum and small hypoattenuating areas in the region of both shot wound. putamen, symmetric. Magnetic resonance imaging (MRI) Clinical History: JCL patient, male, 32 years, was admit- revealed probable bilateral and calosal putaminal necrosis, ted to the emergency room of the institution on 06/2017 with with areas of hemorrhagic transformation and halo of edema. headache complaint. It presents a history of firearm injury in He remained in the intensive care unit (ICU), with treatment the cervical region in 2015, with surgery at the time for remov- of pneumonia, multiple transfusions and the need of trache- al of the projectile / fragments. He subsequently progressed ostomy. On the thirteenth day of hospitalization, the patient with motor deficit. In the present hospitalization he was sub- started renal failure and anasarca, with indication of renal re- mitted to Multidetector Computed Tomography (MDCT) of placement therapy. He maintained clinical stability, but at the the neck, which demonstrated several metallic fragments in last session of hemodialysis he presented respiratory failure, deep and superficial cervical planes. He was submitted to the evolving with CRA, without response to CPR, and died. MDCT of the skull for a better characterization of the motor Discussion and diagnosis: There is no pattern for the clinical deficit and headache, which evidenced the embolic fragment picture of MBD, often manifesting initially with subtle clin- of the metallic projectile in the M1 segment of the left middle ical signs, such as reduced levels of consciousness, seizures, cerebral artery and encephalomalacia with gliosis in the ipsi- and other neurological changes. However, it can often evolve lateral lateral and subinsular nucleocapsular region. into coma and death. Its treatment is still controversial, with Discussion and diagnosis: Due to the radiological findings variable results. As nutritional factors are implicated, similar-
Abstracts of Scientific Papers 71 ly to Wernicke's encephalopathy, some authors recommend Email: [email protected] the replacement of B-complex vitamins. Keywords: Meningite,tuberculosa,menigotuberculose,neu- Conclusion: Until recently, the definitive diagnosis of BMD rotuberculose was confirmed at necropsy. However, with current neuroim- aging technology, it is possible to define it through a typical PD.12.073 clinical profile and the specific locations of lesions in the cor- pus callosum, demonstrated by means of CT and / or MRI. ADEM AFTER YELLOW FEVER VACCINATION : Responsible Author: VANDERSON JOSÉ LOPES DAN CASE REPORT Email: [email protected] Authors: BRINGEL, AMDG; BRINGEL, RFG; FIOROT, Keywords: Encefalopatias,Doença de Marchiafava-Bigna- LCR; IUTAKA, T; GABRIG, RC; LIMA, VF; CARVALHO, mi/diagnóstico,Alcoolismo/complicações,Imagem por res- RS; SOUSA AMS; ANDRADE, LSM; NASCIMENTO, DB sonância magnética,Relatos de casos Institution: INSTITUTO DE ASSISTÊNCIA MEDICA AO SERVIDOR PÚBLICO ESTADUAL DE SÃO PAULO- IAMSPE PD.12.066 A brief description of the objective(s): To report a case of CASE REPORT: HOW THE IMAGING DIAGNOSES acute disseminated encephalopathy, with focus on clinical CAN BE BROUGHT WITH NEUROTUBERCULOSIS approach, image findings and discussion about the topic. DIAGNOSIS. Clinical History: A 18 years old female patient, was ad- Authors: HOLANDA, K.G.,MEIRA, M.S.B.; SPERAN- mitted reporting tingling and cramps in lower limbs with DIO, V.A.; ZAMARIOLLI, G.S.; V.A.; FREITAS, J.S.; loss of balance, hypersensitivity in the thoracoabdominal TAKAMOTO, A.T.R.; GOMES, L.P.P.S.; ; AZEKA, A. H.; region and urinary incontinence 2 days after yellow fever EDUARDO, L.L.S.; ABE, D.G.; GRANDESO, C.; SZEJN- vaccination 4 weeks ago. During hospitalization, computer FELD, P.O.; SCHWARTZ, M.C.; Tomography (CT) showed right parietal corticosubcortical Institution: CONJUNTO HOSPITALAR DO MANDAQUI hypodense lesion. In brain Magnetic Resonance Imaging A brief description of the objective(s): To demonstrate a (MRI), we observed corticosubcortical frontal and right pa- case of tuberculous meningitis (MTB) and as the diagnosis rietal areas of T1 weighted imaging hyposignal in and T2 / by imaging, corroborated this hypothesis. FLAIR weighted imaging hypersignal, with ovoid morphol- Clinical History: L.S.R, male, 23 months, history of 1 ogy, without expansive or atrophic effect, with enhancement month of daily fever and use of 3 types of antibiotics, with and peripheral diffusion restriction of water molecules. In persistence of fever. He entered the service by febrile convul- cervical and thoracic MRI spine, was observed a spinal cord sion, on the third day of the last antibiotic, associated with focus of hypersignal on T2 and STIR in the levels of C2 and drowsiness and stiff neck. CSF analysis showed: cells 360 / D11, as well as spinal cord signal changes from C6 to D6 mm3 (mononuclear 69%), proteins 190 mg / dL and glucose without expansive effect. Therefore from the clinical data, 20 mg / dL, and ceftriaxone was started. Computed tomog- laboratory and sorological tests did not indicate another dis- raphy (CT) of the initial skull demonstrated supratentorial ease, the hypothesis of acute disseminated encephalomyeli- hydrocephalus with signs of intracranial hypertension and tis (ADEM) was done. After plasmapheresis there was clin- the ventricular shunt was performed. After 11 days of hospi- ical improvement. talization, there was a lowering of the level of consciousness. Discussion and diagnosis: ADEM is characterized by an Magnetic resonance imaging (MRI) was observed and hyper- inflammatory and demyelinating reaction in the central ner- tensive hydrocephalus, leptomeningeal enhancement, basal vous system (CNS) commonly preceded by viral infection ganglia and thalamus ischemia were observed. The MTB or vaccination. It mainly affects the pediatric population hypothesis was based on clinical, epidemiological and lab- starting a day or few weeks after immunological stimula- oratory findings. After one month of specific treatment, the tion, with nonspecific febrile prodromes, fast onset encepha- patient evolved with clinical improvement, laboratory diag- lopathy with multifocal neurologic deficits, meningeal signs nosis was confirmed and, despite neurological sequelae, he and fast progressive altered mental status. The diagnosis is was discharged from hospital. made through the patient's clinic and imaging findings. MRI Discussion and diagnosis: Tuberculous meningitis is caused may show focal subcortical asymmetric hyperintensities in by Mycobacterium tuberculosis and is usually secondary to T2 / FLAIR, or small periventricular, oval / rounded lesions hematogenous (pulmonary) spread. It has a peak incidence up to "cotton ball" lesions with ranging from multifocal, lin- in childhood (0 to 4 years) in areas of high prevalence, and ear or partial annular enhancement. Differential diagnosis of is more frequent in adolescents and adults in areas of low multiple sclerosis, neuromyelitis optica (NMO), encephali- prevalence. Clinically it is manifested by typical signs and tis, vasculitis, vascular collagen disease and neoplasia may symptoms of meningitis (headache, fever and nuchal rigidity) mimic ADEM. lasting from days to months. Radiologically it is manifested Conclusion: With the current outbreaks of previously extinct by: 1) meningitis with basilar exudate and intense leptomen- diseases and the return of macive vaccination, we have to ingeal enhancement; 2) Tuberculoma with ring or target en- look for adverse reactions appearance to improve adequate hancement, 3) abscess (rare). Complications: Hydrocephalus management of the patient and decrease morbimortality. and ischemia by arteritis. The diagnosis of MTB is challeng- Responsible Author: AMORA MARIA DUARTE BRINGEL ing because of difficulties in quickly identifying the agent Email: [email protected] in CSF samples. Empirical treatment with anti-tuberculosis Keywords: Febre amarela; encefalite; ADEM; vacinação drugs is the standard of care in presumptive cases with nega- tive CSF correlation. Conclusion: Tuberculous meningitis should be strongly con- PD.12.090 sidered in any patient presenting with signs and symptoms of METASTATIC PERITONEAL DISSEMINATION OF meningitis in regions endemic for tuberculosis and in high- HIGH-GRADE PONTINE GLIOMA VIA A VENTRIC- risk individuals in non-endemic regions. ULOPERITONEAL SHUNT CATHETER IN A PEDI- Responsible Author: Khatya Gonzales de Holanda ATRIC PATIENT.
72 49th Sao Paulo Radiological Meeting Authors: ASSUNCAO, F.B; CAMARGO, K. K. J. A.; nystagmus and falling back with latency when she closes her SCOPPETTA, T. L. P. D. eyes. All had lesions in the periventricular and subcortical Institution: HOSPITAL SÃO CAMILO; FLEURY ME- white matter in the cerebral parenchyma, brainstem, middle DICINA E SAUDE cerebellar peduncles, and dentate nuclei characterized by A brief description of the objective(s): To describe a case of high signal on FLAIR, some of those hypointense on T2 with high grade pontine glioma with peritoneal and hepatic meta- diffusion restriction, exhibiting nodular enhancement and static dissemination via a ventriculoperitoneal shunt catheter perilesional edema. All patients had bilateral obliteration of in a pediatric patient. the perirenal fat and diaphyseal and metaphyseal sclerosis. Clinical History: A 4-year-old female patient with a histo- Two of them had marked hypointense sinus mucosal thicken- ry of pontine brain tumor, whose histopathological analysis ing on T2. The diagnosis was confirmed by histopathological determined the diagnosis of pontine glioma with histone and immunohistochemical studies. H3K27m positive mutation. Patient developed hydroceph- Discussion and diagnosis: ECD is a rare form of non-Lang- alus, and ventriculoperitoneal shunt was required after a erhans histiocytosis. It is characterized by a variable clinical month of diagnosis. He also started, in this period, specific course, which depends on the extent of the disease and the cancer treatment with chemoradiotherapy. Approximately affected organ. It affects the central nervous system (CNS) one year after diagnosis, the patient started abdominal pain in less than 50% of the cases. The most common sites are and distension, and was then evaluated by computed tomog- the hypothalamic-pituitary region and the encephalic paren- raphy of the abdomen, which revealed multiple peritoneal chyma, often with a perivascular punctate pattern. Other neu- lesions, predominating at the extremity of the catheter, as- rological manifestations include meningeal, venous sinuses, sociated with moderate volume ascites. The histopathologi- choroid plexus, calvarial, and periarterial infiltration. Neu- cal analysis confirmed the presence of metastases with glial rologic symptoms occur in less than a third of patients and histogenesis. usually present with diabetes insipidus, panhypopituitarism, Discussion and diagnosis: Extra-cranial metastatic dis- exophthalmia, and ataxia. When the neurological symptoms semination of cerebral gliomas is extremely rare due to the open the clinical course, the diagnosis of ECD is challeng- presence of the blood-brain barrier and the absence of lym- ing, especially in patients without hypothalamic-pituitary and phatic system in the central nervous system, which hinders meningeal involvement, since the imaging pattern admits dif- the migration of neoplastic cells out of the cranial compart- ferentials with lymphoproliferative diseases, demyelinating ment. Several hypotheses explain the appearance of extra- diseases and vasculitis. The identification of sinus mucosal cranial glioma metastases, such as surgical interventions, thickening with low signal on T2, bilateral perirenal fibrosis migration of neoplastic cells through ventriculoperitoneal and diaphyseal and metaphyseal sclerosis leads the suspicion catheters, or invasion of the dura mater and skullcap by the of ECD and guides the best location for biopsy. neoplastic process. The description of peritoneal metastat- Conclusion: We described the neurologic and systemic im- ic implants from neoplastic dissemination of high grade aging manifestations of our 3 patients with ECD. The CNS pontine glioma via a ventricular lead catheter is rare, ac- involvement has non-characteristic imaging findings, but cording to our literature review. The identification of signs systemic manifestations such as bilateral perirenal, sinus of lesions with secondary characteristics in the abdomen, and bony involvement, among others, guide the diagnostic associated to the patient's clinical and surgical history, were suspicion. the determinant signs for the suspicion of this complication Responsible Author: Rafael Dais da Rocha evidenced in this patient. Email: [email protected] Conclusion: We describe a rare case of a pediatric patient Keywords: Erdheim-Chester disease,Brain magnetic res- with high grade pontine glioma who developed secondary onance imaging,Computed tomography,Doença de Erd- peritoneal lesions, histopathologically confirmed as lesions heim-Chester,Ressonância magnética do crânio,Tomografia of glial origin. computadorizada Responsible Author: Thiago Luiz Pereira Donoso Scoppetta Email: [email protected] Keywords: glioblastoma,GBM,alto,grau,metastase,dissemi- nação,peritonio
PD.12.093 ERDHEIM-CHESTER DISEASE WITH ENCEPHAL- IC INVOLVEMENT: SERIES OF CASES Authors: ROCHA, R.D.; BAE, S.M.B.; VIEIRA, A.P.F.; GODOY, L.F.S.; BORRI, M.L.; MARTIN, M.G.M; LEE, H.W.; LEITE, C.C.; TOYAMA, C.; DA SILVA, C.J. Institution: GRUPO FLEURY, HOSPITAL SÍRIO-LI- BANÊS, HOSPITAL SÃO LUIZ, HOSPITAL ALEMÃO OSWALDO CRUZ A brief description of the objective(s): To describe the neu- rologic and systemic imaging manifestations of 3 patients with Erdheim-Chester disease (ECD). Clinical History: Male patient, 48 years-old, presented left hemifacial paresthesia. Female patient, 50 years-old with ataxia and slight weakness in the limbs. Female patient, 49 years-old with diplopia, facial paresthesia, multidirectional
Abstracts of Scientific Papers 73 PEDIATRICS ORIGINAL PAPER patients with suspected appendicitis. In the pediatric popu- lation, early diagnosis is essential for a good outcome, with a reduction in the risk of complications. The diameter of the cecal appendix is ??one of the main parameters evaluated POSTERS (PI) in the ultrasound diagnosis of acute appendicitis and, there- fore, the knowledge of the normal diameter of the appendix is ??important for the recognition of possible abnormalities. PI.13.007 There are few bibliographic data on the normal diameter of ASSOCIATION OF CHILDHOOD OBESITY WITH the cecal appendix in the pediatric population in our country. THE CENTRAL NERVOUS SYSTEM: STUDY OF DIF- The aim of this study was to evaluate the normal cecal appen- FUSION TENSOR IMAGING (DTI) dix diameter profile, using ultrasonography, in the pediatric Authors: BERTOLAZZI,P.; DURÁN, F.; NEVES, T.; CAL- population attended at Hospital XXXX, from 2008 to 2015. FAT, E.; COSTA, N.A.; UCHIDA, R.R. Material(s) and method(s): Retrospective evaluation of the Institution: UNIVERSIDADE DE SÃO PAULO (HOSPI- normal cecal appendix diameter in patients aged 0 to 15 years TAL DAS CLÍNICAS/ SANTA CASA DE MISERICÓRDIA) in the period from 2008 to 2015, using the analysis of the A brief description of the objective(s): Childhood obesity images stored in the PACS (Picture Archiving and Commu- is a subject of great clinical importance and presents data of nication System) of the Hospital XXXX. The data search was ascent from 10 to 40% of the last 10 years in most countries. done from the BI-Laudos system of the hospital, obtaining Previous studies have pointed to obesity as a risk factor for the diameter reported in reports of ultrasound examinations neurodegenerative disorders through DTI. Therefore, the ob- in children without the diagnosis of appendicitis. The search jective of this work is to investigate the influence of child- term between the reports was "normal cecal appendix". hood obesity on changes in brain connectivity using magnetic Results and discussion: The study group consisted of 102 resonance imaging (MRI). In this way, we investigate previ- patients, aged 0 to 15 years (mean age 7.8 years). The evalu- ous or early cerebral changes in obesity. ation of the anteroposterior diameter, in centimeters, resulted Material(s) and method(s): The images were obtained on in an average diameter of 0.42 cm, with a standard devia- Achieva 3T Phillips Magnetic Resonance. The sample for tion of approximately 0.09 cm and a median of 0.43 cm. The statistical analysis consisted of 120 subjects: 59 obese adoles- highest value found was 0.65cm, and the lowest was 0.06cm. cents and 61 healthy adolescents, aged 12 years to 16 years, There was no significant difference in cecal appendix diame- and matched regarding gender, age, and schooling. The im- ter according to age group. ages were processed with the FSL-Tbss (Tract Based Spatial Conclusion: The results found in the population sample de- Statistics) program and analyzed statistically by the same scribed in the Hospital XXXX are compatible with the liter- program with Randomize. ature data for the pediatric population. There was no signif- Results and discussion: The statistical and exploratory anal- icant difference in the anteroposterior diameter of the cecal ysis of 339350 voxels showed a reduction of the FA (Frac- appendix according to the age group. The mean diameter tional Anysotropy) values in obese patients when compared found was 0.42 cm, with a standard deviation of 0.09 cm and to the control group in regions located in the body of the cor- a median of 0.43 cm. pus callosum (pfwe <0.001; figure 1), splenius of the corpus Responsible Author: Pedro Andrade Alencar Luna callosum (pfwe <0.017) and mean orbital spin (pfwe <0.044). Email: [email protected] There was no region with increased FA in obese patients Keywords: apêndice,cecal compared to the control group. Conclusion: The data reveal a pattern of involvement in important regions in the control of appetite and emotions. Important regions for impulse control, rewards and pleasure in eating and autonomic control of appetite also showed a reduction in FA. Further studies need to be performed to elu- PICTORIAL ESSAY cidate whether, in fact, obesity is a consequence of structur- al changes in the brain, and with this, DTI may represent a marker prior to obesity, avoiding the complications associat- POSTERS (PI) ed with this condition. Responsible Author: Pâmela Bertolazzi Email: [email protected] PI.13.001 Keywords: Obesidade,Pediatria,DTI,MRI,SNC POINT-OF-CARE LUNG ULTRASONOGRAPHY IN THE NEONATAL INTENSIVE CARE UNIT: A PROM- PI.13.008 ISING AND CONTROVERSIAL TOOL ULTRASOUND EVALUATION OF CECAL APPEN- Authors: FURTADO, R.S.O.P.; SAMESHIMA, Y.T.; DIX DIAMETER IN A PEDIATRIC POPULATION OF GOMES, A.I.; YAMANARI, M.G.I.; NETO, M.J.F.; FU- HOSPITAL XXXX NARI, M.B.G. Authors: LUNA, P. A. A. ; NETO, M. J. F. ; JR, A. R. ; DE- Institution: HOSPITAL ISRAELITA ALBERT EINSTEIN FENDI, L. A. ; YAMANARI, M. Y. ; SAMESHIMA, Y. T. ; Introduction and objective(s): Chest ultrasound is an avail- DA SILVA, P. S. S. able imaging modality without ionizing radiation that can Institution: HOSPITAL ISRAELITA ALBERT EINSTEIN be performed quickly and safely at the bedside with mini- A brief description of the objective(s): Ultrasound exam- mal manipulation of the neonate. It contributes with import- ination is one of the main tests for the initial evaluation of ant information on lung aeration status in preterm (pre and
74 49th Sao Paulo Radiological Meeting post-surfactant administration) and term newborns. It is very gradually in early adult life. They are defined as patent by useful in detecting pneumothorax and to check diaphragmat- the presence of a hypoechoic gap between two hyperecho- ic mobility. It can also guide procedures and evaluate the me- ic bone edges. The metopic suture usually closes during the diastinum locating central lines. This iconographic essay pro- first 4–9 months of age, with the earliest evidence of closure poses a practical approach to the normal lung aeration pattern was reported at 3 months of age. A “normal” metopic suture and main neonatal lung diseases, reinforcing the role of chest includes either patency (hypoechoic gap) or the absence of ultrasonography in the neonatal intensive care unit (NICU). hypoechoic gap with no ridging of the sutures in children Method(s): We selected cases from the Pediatric Radiolo- older than 3 months. Overriding sutures (echogenic calvarial gy group of our Department demonstrating different sono- plates overlapping one another) is frequently seen in benign graphic patterns of main neonatal lung diseases: 1. Neonatal positional plagiocephaly and can also be well demonstrated respiratory distress syndrome (NRDS) - Hyaline membrane on US. When premature suture closure is identified, CT with disease; 2. Transient tachypnea of the newborn (TTN); 3. 3-dimensional reconstruction (3D-CT) confirms the US find- Pneumothorax; 4. Pneumonia; 5. Pleural effusion. ings. Discussion: Once restricted to the evaluation of pleural ef- Conclusion: Given its lack of ionizing radiation and no need fusions, chest ultrasonography has emerged as an invalu- for sedation, cranial US could be considered a safe first line able tool for pulmonary parenchyma evaluation, even in the diagnostic tool when craniosynostosis is suspected. 3D-CT NICU. Its understanding is based on the study of normal ar- may be restricted to positive US, as a second level examina- tefactual lines and their various pathologic patterns that had tion just for preoperative planning. been already well characterized in pediatric lung diseases. Responsible Author: LARISSA DE ANDRADE DEFENDI Radiologists involved in the NICU point-of-care should not Email: [email protected] only recognize the normal lung sonographic patterns but also Keywords: craniossinostoses,suturas,braquicefalia,dolico- adequately characterize the main alterations related to the cefalia,trigonocefalia neonatal lung diseases, such as ultrasonographic ground glass pattern (white lung) and subpleural consolidations in NRDS PI.13.004 and the "Double lung point" in TTN. DECISION MAKING FLOWCHART FOR PEDIAT- Conclusion: Due to its lack of ionizing radiation, portability, RIC HEAD TRAUMA AND BIRTH RELATED HEAD and diagnosis in real time, chest ultrasound is an important, INJURIES: ULTRASONOGRAPHY OR COMPUTED promising and controversial tool in the NICU. It not only pro- TOMOGRAPHY? vides information on the lung aeration status but also allows Authors: GOMES, A.I.; SAMESHIMA, Y.T.; FURTADO, monitoring of different neonatal lung diseases. R.S.O.P.; YAMANARI, M.G.I.; NETO, M.J.F.; FUNARI, Responsible Author: renata silveira olimpio de paula furtado M.B.G. Email: [email protected] Institution: HOSPITAL ISRAELITA ALBERT EINSTEIN Keywords: ultrassonografia, point-of-care, torax,- (HIAE) taquipneia,transitoria,membrana,hialina,derrame, pleural, Introduction and objective(s): Pediatric head trauma (PHT) pediatria,derramepleural,ttn,dmh,nrds,ttrn,sdrn and birth related head injuries (BRHI) are very common and a source of great concern for the parents and physicians. Al- PI.13.003 though many patterns of pediatric head injury are similar to ULTRASONOGRAPHIC EVALUATION OF CRA- adults, the imaging findings of head injury in children are NIAL SUTURES IN CHILDREN WITH SUSPECT- more complex due to the developing brain and calvarium. ED CRANIOSYNOSTOSIS: MAIN FINDINGS AND Computed tomography (CT) has been used as the main im- TECHNIQUE aging modality in emergency department as physicians are Authors: DEFENDI, L.A.; SAMESHIMA, Y.T.; FURTA- unaware about the role of the cranial ultrasound (CUS) for DO, R.S.O.P.; YAMANARI, M.G.I; NETO, M.J.F.; FU- PHT evaluation. US has emerged as the method of choice for NARI, M.B.G. head trauma initial screening in children with open fontanelle Institution: HOSPITAL ISRAELITA ALBERT EINSTEIN for been free of ionizing radiation, portable and real time di- Introduction and objective(s): Computed Tomography agnostic tool. This iconographic essay proposes a decision (CT), a technique that involves ionizing radiation exposure making flowchart for diagnostic management after PHT or and sedation, is still proposed as the first-line imaging choice BRHI, focusing on the role of US as an initial diagnostic tool. for evaluating premature closure of cranial sutures. As an Method(s): We selected cases from the Pediatric Radiology alternative to CT, cranial ultrasound (US) could be consid- group of our Department demonstrating the main sonograph- ered an adequate screening tool to rule out craniosynostosis ic findings in PHT and BRHI cases: caput succedaneum, in children with abnormal head shape. The purpose of this cephalohematoma, subgaleal, subdural, subarachnoid and essay is: to present anatomic and physiological basis required epidural hemorrhages and cranial fracture. for the sonographic assessment of cranial sutures; to clarify Discussion: CUS has other indications besides lesions relat- the technique of ultrasound study of the sutures; to depict the ed to prematurity such as in PHT and BRHI investigation for main features of some craniosynostosis and their differential which it shows high sensitivity and specificity in the diagno- diagnoses. sis of cranial fractures and hematomas. Therefore in children Method(s): Children referred for radiographic evaluation with open fontanelles we should always think CUS to begin due to skull deformity were examined by an experienced the investigation. In the absence of significant intra or ex- pediatric sonographer. Cranial US were performed using a traparenchymatous hematomas (without deviation of midline 12-MHz linear high frequency transducer. The sagittal, cor- brain structures) and patient’s clinical stability, management onal, lambdoid and metopic sutures, besides the fontanelles, could be done with observation. If there is a significant hema- were evaluated. Abnormal findings are discussed based on toma, the next step is to perform a CT to identify intracranial ultrasonographic images of three cases and sometimes with injuries that may require immediate treatment. In children volumetric CT and radiographic correlation. with closed fontanelles, CT should be the method of choice Discussion: Sagittal, coronal and lambdoid sutures close for initial evaluation.
Abstracts of Scientific Papers 75 Conclusion: PHI and BRHI continue to represent an import- PI.13.006 ant source of morbidity and mortality. The primary role of THE IMPORTANCE OF USING THE ACR-TIRADS the radiologist is to identify and characterize the type of head (AMERICAN COLLEGE OF RADIOLOGY - THY- injury to guide patient management. Therefore, it is important ROID IMAGING REPORTING AND DATA SYSTEM) to know the indications of CUS in order to reduce the patient's CLASSIFICATION IN PEDIATRICS exposure to ionizing radiation. This flowchart becomes very Authors: KOSHIMURA, E.T.; SAMESHIMA, Y.T.; LU- useful in making decisions in these cases of head trauma. PINACCI, F.S.; YAMANARI, M.G.I.; NETO, M.J.F.; FU- Responsible Author: Andressa Inácio Gomes NARI, M.B.G. Email: [email protected] Institution: HOSPITAL ISRAELITA ALBERT EINSTEIN Keywords: pediatric,head,trauma,ultrasound,CT Introduction and objective(s): The thyroid nodule is a com- mon finding in the radiologist's routine. These nodules are PI.13.005 found in the pediatric population in a much smaller number ULTRASOUND EVALUATION OF GASTROESOPHA- than in adults (rates between 0.05% and 5.1%), but with a GEAL REFLUX IN CHILDREN: A REVIEW OF THE much higher malignancy rate (around 25%). Numerous TECHNIQUE guidelines have been developed to determine which of these Authors: DEFENDI, L.A.; SAMESHIMA, Y.T.; YA- nodules should be investigated through fine needle aspiration MANARI, M.G.I; NETO, M.J.F.; FUNARI, M.B.G. biopsy (FNA), considering factors that could predict malig- Institution: HOSPITAL ISRAELITA ALBERT EINSTEIN nancy. The 2017 American College of Radiology - Thyroid Introduction and objective(s): Gastroesophageal reflux can Imaging Reporting and Data System (ACR-TIRADS) classi- be a physiological process. When troublesome symptoms or fication stratifies the risk of malignancy of thyroid nodules, complications are associated, it characterizes GER disease using a score based on ultrasound imaging characteristics: (GERD). Clinical history seems the most important diag- composition, echogenicity, shape, margin and hyperechogen- nostic information, but is less reliable in pediatric practice, ic foci. The main of this study is to apply the ACR-TIRADS mainly under 2 years old. Diagnostic tests are needed to doc- classification in the pediatric cases of thyroid nodules and ument the presence of GER(D) and exclude associated con- demonstrate it in a pictorial essay, with the respective imag- ditions. Although not universally available, the combination ing findings. of 24-hour pH measurement and intraluminal impedance test Method(s): We retrospectively selected cases of thyroid nod- is considered the gold standard in GERD diagnosis. Gastro- ules in children of our service, with different ACR-TIRADS esophageal ultrasonography (US) is a widely available, non- classifications. invasive and sensitive method that provides morphological Discussion: Since the introduction of ACR-TIRADS in and functional information. We review the ultrasonographic adults, little has been studied in children. technique employed to evaluate the presence of reflux and We must pay attention to the proper classification of thyroid the morphology of the gastroesophageal junction. nodules in children because, even though rare, thyroid cancer Method(s): A 3.5-5.0 MHz curved or linear (5-15 MHz) in this group may have a higher recurrence and a higher rate probe is used. The antrum and pyloric morphology is exam- of metastasis. Some known risk factors are history of radia- ined after a 3-4 hours fasting period to exclude gastric outlet tion, chronic inflammatory diseases, and some genetic syn- obstruction. After a liquid feed, the evaluation is performed in dromes. Although it does not consider the dimensions of the the supine position. Reflux episodes are documented during a nodule, ACR-TIRADS suggests FNA only from specific di- 10-15 minutes period. Finally, abdominal esophageal length mensions. However, due to the biological behavior of thyroid and His angle are measured. cancer in children, this indication can be surveyed, and FNA Discussion: The passage of a gastric fluid column into the is recommended in suspicious nodules, regardless of its size. abdominal esophagus and esophageal clearance by peristal- Two cases of classification nodules ACR-TIRADS 5 follow sis can be seen as moving echogenic spots. US allows direct as examples. The first one of a 4-year-old girl and the second correlation of symptoms (coughing, vomiting) with the so- of an 8-year-old boy. Fortunately, the results were not malig- nographic evidence of reflux, can detect nonacid events and nant in both cases. They were focal lymphocytic thyroiditis exclude several non-GER causes of vomiting and weight loss and thymic intrathyroidal nodule, respectively. (hiatus hernia, hypertrophic pyloric stenosis and abdominal Conclusion: The ACR-TIRADS classification was demon- masses). Sonographic assessment of abdominal esophageal strated as we proposed. Ultrasonography remains the method length and gastroesophageal angle provides important diag- of choice for the investigation of thyroid nodules and radiol- nostic indicators of reflux and its degree. ogists should be skilled in the application of ACR-TIRADS Conclusion: Gastroesophageal US, when performed with in the pediatric group. suitable device by a skilled operator, besides noninvasive Responsible Author: erika tae koshimura is informative. Morphological and functional data, not Email: [email protected] available through other techniques - with high sensitivity Keywords: tireoide,ultrassonografia,tirads,pediatria and positive predictive values for GERD - are obtained rapidly and without patient discomfort and radiation. It PI.13.009 is a simple and reliable screening approach for high-risk CAT SCRATCH DISEASE: DIFFERENT CLINICAL GERD infants younger than 2 years of age. Nonetheless, PRESENTATION AND ITS MAIN SONOGRAPHIC there is still a need for procedure standardization and FINDINGS definite diagnostic criteria. Authors: GOMES, A.I.; SAMESHIMA, Y.T.; KOSHIMU- Responsible Author: LARISSA DE ANDRADE DE- RA, E.T.; DUBINCO, A.; YAMANARI, M.G.I.; NETO, FENDI M.J.F.; FUNARI, M.B.G. Email: [email protected] Institution: HOSPITAL ISRAELITA ALBERT EINSTEIN Keywords: refluxo,gastroesofágico,ultrassonografia, pedi- (HIAE) atria Introduction and objective(s): Cat scratch disease is typi-
76 49th Sao Paulo Radiological Meeting cally a self-limiting infectious condition, often presenting in are very different from the adult patient, ATS, in conjunc- children, because of children’s increased levels of uninhibit- tion with the Pathology Cooperative Group and ChILD Re- ed interaction with pets compared with adults. It appears as a search Co-operative, divided childhood interstitial lung dis- benign regional lymphadenitis that results from a cat scratch eases initially into three major groups: 1) diseases prevalent or bite involving the distal upper extremity. The initial trau- in childhood, 2) non-specific diseases of childhood and 3) ma results in inoculation with Bartonella henselae, which can non-classifiable lung diseases. The first group is further sub- cause cutaneous lesions, such as a papule or pustule at the divided into four other categories: pulmonary developmental site of inoculation and subsequent regional lymph node en- abnormalities, pulmonary growth abnormalities, disorders largement, most commonly the medial epitrochlear region, related to surfactant dysfunction, and diseases of unknown but may also appear in the axilla, head and cervical region. etiology. In the second group, interstitial diseases are present In approximately 5-10% of patients, there is dissemination of in the context of other systemic diseases, in the immunosup- disease affecting multiple organs (liver, spleen, brain, eyes, pressed child, in the child without previous lung disease, and bones). Imaging evaluation of the palpable mass is often con- also in systemic situations that simulate interstitial lung in- sidered in order to differentiate cat scratch disease from sar- volvement. The understanding of this division is extremely coma, lymphoma and metastatic disease. This iconographic important for the adequate correlation of tomographic find- essay proposes a review of the main ultrasonographic find- ings with the clinical context of the patient, which in turn ings in local and disseminated type of cat scratch disease. has a great impact on the diagnosis and management of the Method(s): We selected cases from the Pediatric Radiology patients affected. group of our Department demonstrating the main ultraso- Conclusion: Typical radiological manifestations of intersti- nographic findings in cat scratch disease, including cases tial lung diseases in childhood are poorly understood by the of the localized form and a more severe case of the dissem- pediatric radiologis. Recognizing and highlighting the radio- inated form. logical findings of these diseases is essential for proper diag- Discussion: Ultrasound (US) is the initial modality used in nosis, follow-up, and prognostic evaluation of these patients. pediatric population to evaluate lymph node enlargement, Responsible Author: Gabriela Alencar Bandeira which is the main finding in localized cat scratch disease. US Email: [email protected] shows enlarged lymph nodes, with irregularly thickened cor- Keywords: doença interticial pulmonar na criança,hiperpla- tices, central hyperemia by color Doppler and, eventually, a sia de células neuroendócrinas,doença de niemann pick hypoechoic center that suggests liquefaction. But these find- ings are non-specific and can be found in several pathological PI.13.012 conditions. Therefore, the definitive diagnosis depends on the PULMONARY SEQUESTRATION: IMAGING FIND- history of scratching, physical examination and appropriate INGS BY CT ANGIOGRAPHY IN PEDIATRIC PA- serological tests. Cat scratch disease involving the liver and TIENTS spleen can develop several weeks after inoculation and cause Authors: PARENTE, J.G., BARROSO, L. M., NUNEZ, E., abdominal pain and organ enlargement. The key imaging find- BEVILACQUA, C.T, HAGEMEYER, R. ing is the presence of abscesses and granulomas, which may Institution: HOSPITAL PEDIÁTRICO PRO CRIANÇA appear as multiple small hypoechoic nodular lesions on US. JUTTA BATISTA Conclusion: A broad differential diagnosis for cat scratch Introduction and objective(s):Pulmonary sequestration is disease exists, which can delay treatment or lead to erroneous a rare disease characterized by a mass of non-functioning management. Therefore, knowing the main imaging findings lung tissue that has no connection to the bronchial tree or of this disease is important in accurate diagnosis and man- pulmonary arteries. It can be classified into intralobar and ex- agement, although the definitive diagnosis depends on sero- tralobar according to its relation with the pleura. The imaging logical tests. findings are heterogeneous and vary according to the type of Responsible Author: Andressa Inácio Gomes sequestration and presence of a superimposed infection or as- Email: [email protected] sociated malformations. This work aims to review the main Keywords: Cat scratch disease,localized,disseminated,pedi- imaging features in the pulmonary sequestration by CT angi- atric,ultrasound ography in pediatric patients through a pictorial essay. Method(s): We will illustrate in a pictorial essay based on PI.13.010 cases using images acquired at our institution by CT angiog- INTERSTITIAL LUNG DISEASE IN CHILDREN: raphy, the main characteristics of images of pulmonary se- CLASSIFICATION AND CASE REVIEWS. questration in pediatric patients. Authors: BANDEIRA,G.A.;VIANA,J.A.; FORTALEZA, Discussion: Pulmonary sequestration is an uncommon bron- E.; FRASSEI, J.S.; GUERRINI,R.M.; STRAUS,M.T.; SU- chopulmonary malformation, characterized by a mass of ZUKI,L.; SAWAMURA,M.V.Y.;OLIVEIRA, L.A.N nonfunctioning pulmonary tissue that has no connection to Institution: HC- FMUSP : HOSPITAL DAS CLINICAS DA the bronchial tree or pulmonary arteries. It is vascularized by FACULDADE DE MEDICINA DA USP - SP an aberrant systemic artery usually derived from the thoracic Introduction and objective(s): Interstitial lung diseases of aorta, celiac trunk, or intercostal arteries. There are two types: childhood are rare and poorly understood when compared intralobar sequestration, which represents the majority and to adults. Although rare, they are associated with high infant is presented later in childhood with recurrent infections and morbidity and mortality. This work aims to review the main extralobar sequestration, less common and usually present in interstitial lung diseases found in the pediatric population. the neonatal period with respiratory discomfort, cyanosis, or Method(s): We have screened, through selected cases from infection. The two types of sequestration are similar in their our service, the main radiological findings of pediatric inter- relationship to the bronchial tree and arterial supply/venous stitial lung diseases, based on the ATS (American Thoracic drainage, but differ in their relationship to the pleura. Over- Society) classification of 2013. all, sequestration preferentially affects the lower lobes. The Discussion: aking into account that the pathophysiology and tomographic aspects are varied and it can be observed from natural history of pediatric pulmonary interstitial diseases the presence of homogeneous mass to cystic formations. CT
Abstracts of Scientific Papers 77 angiography can reliably demonstrate the origin and course PD.13.007 of systemic anomalous vessels, especially after the advent of TRANSPERINEAL ULTRASOUND IN YOUNG GIRLS helical equipment. WITH CONGENITAL ADRENAL HYPERPLASIA: Conclusion: Imaging findings are important for differen- ANATOMY, TECHNIQUE AND FINDINGS. tial diagnosis of pulmonary malformations. The definitive Authors: TAKAHASHI, M. S.; MOREIRA, M. T.; MOTTA, diagnosis of pulmonary sequestration depends on the exact G. B.; GUAL, F.; SOARES, J. K.; GASPARETTO, T. D. visualization of the vessels that nourish and drain the seques- Institution: DIAGNÓSTICO DA AMÉRICA (DASA) tration, a condition essential for surgical planning and appro- Introduction and objective(s): Girls with congenital adre- priate treatment. nal hyperplasia can present with a wide variety of urogenital Responsible Author: Julia Gomes Parente malformations. Understanding these malformations and the Email: [email protected] anatomical relations between the Keywords: sequestro,pulmonar,angiotomografia,torax pelvic structures is paramount for surgical planning. Imaging of these patients can be done by various methods such as gen- itography, magnetic resonance or endoscopy. More recently some authors have begun to propose perineal ultrasound as an alternative for imaging of these patients for pre-operative planning. The objective of this study is to detailed the normal DIGITAL PRESENTATION (PD) anatomy and main findings of the genitourinary tract in these patients as well as illustrate the main ultrasound findings. PD.13.006 Method(s): In this educational poster we will use perineal ultrasound images and detailed illustrations to: 1) Review the LANDMARKS, LINES AND ANGLES: UNDERSTAND- spectrum of genital and lower urinary tract malformations ING AND AVOIDING THE COMMON PITFALLS IN related to congenital adrenal hyperplasia in girls. 2) Explain THE GRAF METHOD FOR ULTRASOUND EVALUA- the transperineal ultrasound technique and normal anatomy. TION OF HIP DEVELOPMENT DYSPLASIA. 3) Explain the transperineal ultrasound findings and utility in Authors: TAKAHASHI, M. S; MOTTA, G. B.; MOREIRA, girls with congenital adrenal hyperplasia. M.T.; SOARES, J.K.; GUAL, F.; GASPARETTO, T.D. Discussion: The majority of girls with diagnosis of congeni- Institution: DIAGNÓSTICO DA AMÉRICA (DASA) tal adrenal hyperplasia that present with some degree of gen- Introduction and objective(s): Developmental dyspla- itourinary malformation will need a detailed anatomical eval- sia of the hip is the most common orthopaedic condition in uation of the pelvic region, specially those who will undergo newborn patients, and when timely diagnosis is missed and surgical procedures. Ultrasound is an ideal method for the treatment is delayed may lead to premature articular degen- evaluation of these patients, allowing for a safe and non-inva- eration in adult life with significative impact over quality of sive method that can depict with excellent spatial resolution life. Among the many radiologic methods for hip evaluation not the anatomical structures but also their relation with other of the newborn hip, the one proposed by Graf stands out as important anatomical landmarks. one of the most utilized and accepted. The objective of this Conclusion: Transperineal ultrasound is a dafe, readily study is to present with detailed illustrations and ultrasound available and very effective method for evaluation the lower images not only the anatomy and landmarks used in the ade- urinary and genital tract in girls with congenital adrenal hy- quate interpretation of the neonatal hip examination but also perplasia. Understanding the exam technique, local anatomy to present and explain how to identify and avoid the most and spectrum of expected alterations is paramount so that the common mistakes in this kind of exam. radiologista my elucidate the degree of malformation, the an- Method(s): Detailed illustrations and ultrasound images of atomical relation between the structures and help in guiding the neonatal hip will be utilized in order to exemplify: 1) the therapeutic approach. Graf´s Method 1) a)What is the standard plane b)Anatomical Responsible Author: Marcelo Straus Takahashi identification and usability checklists; c) How are measure- Email: [email protected] ments done and classification. 2) Common pitfalls and mis- Keywords: hiperplasia,congenita,adrenal,pediatria,ultras- takes: a)Positioning mistakes; b)Tilting effects; c)Landmark som,genitourinario and anatomical identification mistakes; d)Lines and angles mistakes; e) Classification mistakes PD.13.009 Discussion: Graf´s method is already established as one of EMBLEMATIC IMAGING FEATURES (AND OTH- the main techniques for evaluation developmental hip dys- ERS NOT THAT MUCH) OF NEUROTUBERCULOSIS plasia in newborns and infants. As a relatively straightfor- IN PEDIATRIC PATIENTS: A PICTORIAL ESSAY ward and simple technique small errors such as anatomic Authors: WAGNER L. F.; REISER C. S.; PELETTI A. B.; interpretation mistakes or image acquisition mistakes can DORA M. D.; MATIOTTI S. B.; KEFFER C. P.; ARAÚJO M. A. have a significant impact on results. Understanding and be- Institution: HOSPITAL DA CRIANÇA CONCEIÇÃO DE ing able to identify these kind of flaws is less likely to make PORTO ALEGRE - GRUPO HOSPITALAR CONCEIÇÃO these mistakes. Introduction and objective(s): The involvement of the cen- Conclusion: Knowing and understanding the mains pit- tral nervous system (CNS) accounts for only 2 to 5% of all falls and mistakes in the Graf´s method for evaluating de- tuberculosis (TB) infections, but it is among the most dev- velopmental hip dysplasia is paramount for a good prac- astating. Neurotuberculosis affects all ages, however 60 to tice, avoiding diagnostic mistakes and ascertaining exam 70% of cases occur during the first two decades of life. It reproducibility is usually caused by hematogenous dissemination of an ex- Responsible Author: Marcelo Straus Takahashi tracranial infection, most frequently pulmonary. Gastrointes- Email: [email protected] tinal tract, genitourinary tract, musculoskeletal system and Keywords: pediatria,quadril,ultrassom,displasia lymph nodes are less common sources. Purpose: Review and
78 49th Sao Paulo Radiological Meeting discuss, through pictorial essay and literature review, typical strate that there is a great delay in the diagnosis of the disease, and atypical findings of CNS infection by Mycobacterium which in turn leads to a great impact in the management and tuberculosis. prognosis of the affected patients. From the clinical suspi- Method(s): Illustrative imaging exams were selected from cion, radiographic investigation is mandatory. The initial digital imaging archive of children hospitalized due to My- radiological evaluation protocol of these patients generally cobacterium tuberculosis CNS infection in a public pediatric includes: skull x-rays, thorax, hip, thoracic spine x-ray, long tertiary hospital. bones, and extremity x-rays . The main findings were: corti- Discussion: CNS TB has several manifestations. Acute / sub- cal bone of thick skull, “J-shaped sella “; scarlet, short jaw, acute tuberculous meningitis accounts for 80-90% of cases. odontoid process dysplasia, flattened vertebrae, oar-shaped An inflammatory reaction with a mixture of exudative, prolif- ribs, acetabular dysplasia, short diaphysis and slightly hypo- erative, and necrotizing components in the arachnoid cister- plastic epiphyses. nae is the typical finding. TB meningitis has a predilection for Conclusion: Conventional radiography remains a useful di- the basal cisterns. The second most common manifestation agnostic tool in the evaluation of mucopolysaccharidoses. of neurotuberculosis is the focal infection of the parenchyma with central caseous necrosis, the called tuberculoma, which The radiologist should be familiar with the normal bone anat- is a lesion of granulomatous tissue with an expansive ef- omy for the pediatric age group and with the main radiologi- fect. This lesion may be solitary, multiple or miliary and can cal findings in this setting , in order to contribute to the early be seen anywhere in the cerebral parenchyma, being more diagnosis , specially in the unsuspected cases ,and future ge- common in the frontal and parietal lobes. The least common netic counseling. manifestation of neurotuberculosis is an abscess. As it gener- Responsible Author: Gabriela Alencar Bandeira ally does not contain pus with neutrophils, most "abscesses" Email: [email protected] from tuberculosis are more correctly called pseudoabscesses. Keywords: mucopolissacaridose,displasia esquelética The most common complication of tuberculous meningitis is communicating hydrocephalus, which is caused by the block- PD.13.019 age of the basal cisterns by inflammatory exudate. Ischemic CAKUT - PICTORIAL REVIEW infarctions are also a common complication, seen in 20-40% of patients, resulting from occlusion and compression of Authors: MATOS, I. A ; KATEKARU, D. small vessels. Institution: INSTITUTO NACIONAL DE SALUD DEL Conclusion: Neurotuberculosis can appear in very differ- NIÑO - SAN BORJA - LIMA PERU ent ways. It is important that radiologists are familiar with Introduction and objective(s): The congenital malforma- the aspects that this infection can take in order to make tion of the kidneys and the urinary tract is very frequent in the the diagnosis as accurate and early as possible and, con- pediatric population and has been grouped under the acronym sequently, reduce the morbidity and mortality of this often CAKUT. An accurate radiological diagnosis is important for annihilating disease. proper management, surgical planning and prognosis. This Responsible Author: Liana Franciscatto Wagner document aims to review the embryogenesis and pathophysi- Email: [email protected] ology of the most important congenital malformations of the Keywords: tuberculosis,brain,pediatrics kidney and urinary tract in children and correlate the findings between the different radiological techniques used. PD.13.011 Method(s): We collect images of patients with CAKUT from RADIOGRAPHIC BONE CHANGES IN MUCOPO- the PACS system of our institution and select the most rep- LYSACCHARIDOSIS: WHAT THE RADIOLOGIST resentative images of the different modalities used for the NEEDS TO KNOW. diagnosis. Authors: BANDEIRA,G.A.; FRASSEI,J.S.; STEPHAN, Discussion: The following renal and urinary tract abnormal- B.O.,SOUZA, S.A.;SAKAMOTO,F. ; SUZUKI,L.; OL- ities were found: Unilateral and bilateral renal agenesis, re- IVEIRA,L.A.N.; KIM,CHONG.AE ; STRAUSS,M.T.; nal cystic diseases, horseshoe kidney, fused and non-fused Institution: HCFMUSP: HOSPITAL DAS CLÍNICAS DA crossed renal ectopia, stenosis of the ureteral junction, uret- FACULDADE DE MEDICINA DA USP - SP eropelvic junction stenosis, complete and incomplete ureteral Introduction and objective(s): Mucopolysaccharidoses duplication, ureterocele, Hutch's diverticulum, urachal anom- (MPS) represent a heterogeneous group of hereditary lyso- alies, valve posterior urethral and double bladder. We also de- somal storage diseases. The accumulation of scribe common complications such as lithiasis and infections non-degraded glycosaminoglycans (GAGs) in the affected and frequent associations. patients leads to progressive damage in several tissues, es- Conclusion: The different renal and urinary tract congenital pecially in the musculoskeletal system. Although advanced diseases grouped under the acronym CAKUT are prevalent in sectional methods have gained prominence in recent years, the pediatric age and it is necessary to be familiar with these conventional radiography persists as a fundamental exam entities to provide an assertive diagnosis for the correct man- in the diagnostic propaedeutics and in the follow - up of agement and adequate prognosis of these patients. these patients. The objective is to review the main bone al- Responsible Author: Irma Aracelly Matos Rojas terations found in conventional radiographs in patients with Email: [email protected] mucopolysaccharidosis. Keywords: CAKUT,kidney,urinary-tract,paediatric,ultra- Method(s): Through selected cases of our service we will illustrate the systematized evaluation of the main bone find- sound,urotomography,MRI ings in conventional radiography that occur in patients with mucopolysaccharidosis. Discussion: Most children with MPS are normal at birth, and may start manifesting the first signs and symptons in early childhood. The few available studies in this scenario demon-
Abstracts of Scientific Papers 79 LITERATURE REVIEW in more robust techniques for this quantification grew, with many other methods being published thereafter, includings qualitative, manual quantitative and more recently automated quantitative methods. The objective of this study is to review DIGITAL PRESENTATION (PD) and illustrate the main techniques used in measuring the de- gree of lung disease in patients with cystic fibrosis, highlight- ing their strengths and limitations. PD.13.016 Description of the disease(s), method(s) and/or tech- ULTRASOUND FOR DEVELOPMENTAL HIP DYS- nique(s): We will review the importance of radiologic tho- PLASIA: ONE PATHOLOGY AND MANY METHODS. racic imaging in patients with cystic fibrosis and the utiliza- Authors: TAKAHASHI, M.S.; RODRIGUES, L. B. Q.; tion of chest CT as a surrogate marker. Detailed illustrations MATSUOKA, M.W.; GUAL, F.; ROCHA, J.P.R.S.; MASSA, and chest ct images of patients with cystic fibrosis will be B. S. F.; ROCHA, S.M.S.; ALMEIDA, G.C; SUZUKI, L. used in order to exemplify and explain the main techniques Institution: INSTITUTO DA CRIANÇA - HOSPITAL DAS in lung burden quantification, including: 1) Swachman and CLINICAS DA FACULDADE DE MEDICINA DA UNI- Kulczycki score; 2) Bhalla score; 3) Brody´s score; 4) Loev- VERSIDADE DE SÃO PAULO E DIAGNÓSTICO DA e´s score; 5) PRAGMA-CF score; 6) Artery-airway score and AMERICA (DASA) 7) Automated methods. automatizados. A brief description of the objective(s): Ultrasound is the Discussion: THe radiologic evaluation of lung disease in best imaging method for evaluating developmental hip dys- cystic fibrosis is a very useful tool, with many studies demon- plasia in newborns and infants and there are currently many strating that chest CT is more sensitive then clinical param- different examination methods described for this goal. Un- eters in quantifying disease progression as well as early dis- fortunately there is no universal consensus on which method ease. As cystic fibrosis is a chronic disease, follow-up is a is best suited each situation and different groups use differ- key point in the management of these patients, and the use of ent approaches. The objective of this study is to review the radiologic quantification methods allow this to be done in a main ultrasound techniques utilized in evaluating the neo- consistent, reproducible and clinically feasible way. natal hip. Conclusion: With the understating of these techniques and Description of the disease(s), method(s) and/or technique(s): with the appropriate tools the radiologist can interpret in a Detailed illustrations and ultrasound images of the neonatal hip more objective and reproducible fashion the lung imaging will be used in order not only to demonstrate the normal hip findings in patients with cystic fibrosis. This precise informa- anatomy and the displasic hip anatomy but also to exemplify tion is very useful for the referring clinician, as it can lead to the following methods: 1) Graf´s method; 2) Harcke´s method; a better and more precise patient care. Téguier´s method and 4) Terjensen´s method. Responsible Author: Marcelo Straus Takahashi Discussion: There is a great variety of ultrasound methods for Email: [email protected] newborn hip evaluation. The radiologist must be versed in these Keywords: torax,fibrose,cistica,tomografia,computadoriza- main methods not only to be able to perform a complete exam- da,radiografia,quantificaçao ination but also to enable an effective communication with the requisitioning physician, who may in some cases be familiar- ized with only a specific method and not with the others. Conclusion: There are many ultrasound techniques utilized in the evaluation of the developmental hip dysplasia, and de- spite being focused on the same pathology, they are based on CASE REPORT different aspects of the hip articulation. The knowledge of these methods is important not only to ensure a detailed hip evaluation but also to guarantee that communication between DIGITAL PRESENTATION (PD) the radiologist and requisitioning physicians is effective. Responsible Author: Marcelo Straus Takahashi Email: [email protected] PD.13.002 Keywords: DISPLASIA, QUADRIL, PEDIATRIA, UL- NEOPLASTIC DISSEMINATION BY PERITONEAL TRASSOM VENTRICLE BYPASS CATHETER Authors: MAIA, D.F.; SILVA, C.B.; FERREIRA, R.C.S; RI- PD.13.020 BEIRO, J.H.A.; OLIVEIRA, G.H.N.; RADIOLOGIC QUANTIFICATION OF CYSTIC FI- Institution: SANTA CASA DE BELO HORIZONTE BROSIS: A REVIEW OF THE DIFFERENT METHODS A brief description of the objective(s): The aim of this Authors: TAKAHASHI, M.S., KANASHIO, J. S.; GUAL, study is the description of neoplastic spread by an unusual F, MOREIRA, M. T.; SILVA FILHO, L. V. R. F.; VASCON- route, the peritoneal ventricle bypass catheter. CELOS, L. M.; GASPARETTO, T. D. Clinical History: Male patient, five years old, with pine- Institution: DIAGNOSTICO DA AMERICA (DASA) aloblastoma without oncologic treatment, with peritoneal INSTITUTO DA CRIANCA DO HOSPITAL DAS CLINI- ventricle bypass catheter, presenting intestinal constipa- CAS DA FACULDADE DE MEDICIAN DA UNIVERSI- tion. After requesting intra-hospital Ultrasonography (US), DADE DE SAO PAULO pelvic mass was clarified. Computed tomography (CT) A brief description of the objective(s): The use of radiol- revealed a large expansive lesion and multiple similar le- ogy as an auxiliary tool to measure the lung burden of pa- sions in the patient's abdomen and pelvis: Large, partially tients with cystic fibrosis is not novel, with the first report on defined, expansive formation with lobulated contours, with this area made in 1958 with the use of a clinical-radiologic heterogeneous impregnation by contrast, showing areas of scoring system. WIth the advent of computer tomography, necrosis of permeation, measuring approximately 11.5 x that started a revolution on lung disease diagnosis, interest 8.2 x 12.8 cm. Such an injury compresses the distal ureters,
80 49th Sao Paulo Radiological Meeting conditioning moderate hydroureteronephrosis upstream, as tiocytosis and hypothalamic hamartoma. As the lymphoma is well as compressing the rectum, but without intestinal ob- a rare intracranial malignant neoplasm in immunocompetents structive signs. of patient's age, the radiological findings, reflecting their his- Multiple lesions with similar appearance to the aforemen- topathologic characteristics, were essential in establishing tioned, maintaining close relationship with the parietal leaflet the diagnosis, despite the atypical clinical scenario. of the peritoneum, some without cleavage planes with the Responsible Author: Stefânia Maria Roman abdominal wall, notably perihepatic, in the right paracolic Email: [email protected] space and in the mesentery, at the mesogastrium level, the Keywords: LINFOMA,PRIMÁRIO,NERVOSO,CENTRAL most prominent in these two last sites, measuring about 3.7 cm and 2.7 cm in their largest axial axes. There are also other PD.13.005 peri-gastric implants at the level of the umbilical scar, adja- cent to the splenic hilum, adjacent to the left perirenal and NEONATAL ARTERIAL HYPERTENSION WITH UN- bilateral retrocural fascia. FAVORABLE OUTCOME: A CASE REPORT. Discussion and diagnosis: Although rare in the literature, Authors: LUPINACCI FAS, DUBINCO,A, SAMESHIMA there was evidence of neoplastic dissemination by the cathe- YT, YAMANARI MG, NETO MJF, FUNARI MBG. ter in the patient, and this possibility should always appear in Institution: HOSPITAL ISRAELITA ALBERT EINSTEIN the differential diagnosis in oncologic patients. A brief description of the objective(s): To report the case Conclusion: Although rare in the literature, there was evi- of a bivitelinic twin with the diagnosis of neonatal systemic dence of neoplastic dissemination by the catheter in the pa- arterial hypertension that presented an unfavorable outcome, tient, and this possibility should always appear in the differ- with loss of renal function, presenting characteristics of the ential diagnosis in oncologic patients. imaging findings that aided in the etiological diagnosis, as Responsible Author: DANILO FERREIRA MAIA well as a review of the image findings in the stenoses of the Email: [email protected] renal artery. Keywords: PEDIATRIA, ONCOLOGIA, DISSEMINAÇÃO, Clinical History: A couple of bivitelinic twins, post-fertil- DVP ization in vitro, term births with low birth weight, the girl had to be hospitalized at the neonatal ICU for six days and was discharged home. Seven days after birth, it presented PD.13.004 septic shock and systemic arterial hypertension of about 132 PRIMARY LYMPHOMA OF CENTRAL NERVOUS x 77 mmHg, and the investigation of the cause of hyperten- SYSTEM WITH ATYPICAL PRESENTATION: CASE sion was started. Once the critical infectious condition was REPORT resolved, the right kidney exclusion was diagnosed due to Authors: GUIMARÃES, R. B.; ROMAN, S. M.; CHO- critical stenosis of the right renal artery and significant ste- JNIAK, R.; MELLO, R. A. B. nosis in the left renal artery. The brother, asymptomatic, was Institution: A.C.CAMARGO CANCER CENTER also investigated from the diagnosis of the sister, and bilateral A brief description of the objective(s): Describe and discuss stenosis of the renal arteries was also visualized, to a lesser a case of primary lymphoma of the central nervous system extent. With the evolution of the stenosis, the girl presented (CNS) in a immunocompetent patient of pediatric age. in addition to the renal exclusion to the right, renal necrosis Clinical History: Patient, male, 12 years, featured intense to the left, being submitted to bilateral nephrectomy, now be- sleepiness and polydipsia in the 15 days prior to hospital ad- ing in the period of peritoneal dialysis. His brother also had mission and evolved with depressed level of consciousness a infaction and complete loss of the right kidney, but the left and mental confusion on the last day. Admission examination kidney preserved the function. showed the Glasgow Coma Scale ranging from 9 to 13, with Discussion and diagnosis: Neonatal hypertension is a rare no other relevant findings. It was requested laboratory tests that event, with incidence varying from 0.2 - 3%. Even infre- showed polyuria, hyposthenuria, hypernatremia, hypothyroid- quent, there are several causes of this condition, from renal ism and hypocortisolism, allowing to establish the syndromic causes such as renal artery stenosis, into poisonings such as diagnosis of panhypopituitarism with diabetes insipidus. pancuronium use or drug use, such as cocaine and heroin by Discussion and diagnosis: Cranial computed tomography the mother. The prognosis of this entity is usually good and without contrast confirmed a hyperdense expansive lesion is often a transient condition and only requires follow-up on in the hypothalamus. Then, magnectic ressonance imag- the cardiovascular risk of these patients. However, depending ing was performed and showed injury of the hypothalamus on the etiology of the hypertensive condition, the prognosis with bi-hemispheric extension with butterfly wing aspect, may not be favorable and may have severe consequences for hypointense signal on T1 and T2, intense homogeneous en- the patient. hance by contrast media and restriction of diffusion. Biopsy Conclusion: Neonatal hypertension is a rare event, but it can was performed and the histopathological examination was have severe consequences for the child, and the radiologist compatible with diffuse large B-cell lymphoma. Primary must be prepared to identify his signs and perform the diag- CNS lymphoma is a rare extranodal non-Hodgkin's Lym- nosis correctly. phoma of B cells form and correspond to 6% of intracranial Responsible Author: felipe lupinacci malignant neoplasms. It presents primarily around the sixth Email: [email protected] decade of life among immunocompetent patients. These tu- Keywords: hipertensão,neonatal,estenose mors are characterized by high cellularity and elevated nu- cleocytoplasmic relationship, resulting in typical restriction on diffusion. They exhibit good response to corticotherapy PD.13.008 and chemotherapy and the evolution of their treatment can be DENYS-DRASH SYNDROME: A RARE CASE REPORT clearly monitorized. Authors: SOUZA, J.P.D.; SILVA, T.A.; FERREIRA, M.B.; Conclusion: Due to the epidemiological characteristics of the SANTOS, T.; SANTIN, L.A.; BAVARESCO, A.P.; TEIXEI- case were initially proposed different diagnostic hypotheses, RA, R.; VIEGAS, T.F. as germinoma, chiasmatic glioma, pilocytic astrocytoma, his- Institution: HOSPITAL GERAL DE CAXIAS DO SUL
Abstracts of Scientific Papers 81 A brief description of the objective(s): To describe a Denys sus prior to surgery. In cases where surgery should be post- Drash Syndrome (DDS) case, which is a rare disease charac- poned, prolonged use of the medication may lead to bone terized by the association of Wilms Tumor (WT), progressive and soft tissue changes, such as diffuse periosteal reaction renal failure that begins within the first few months of life and and pre-tibial edema and soft tissues at the extremities. male pseudohermaphroditism resulting from mutations in the The percentage of infants who develop periosteal reaction TWI suppressor gene located on chromosome 11 p 13. by the use of prostaglandin increases with the duration of Clinical History: INM, one-year and eight-month-old, with treatment, ranging from 42% with <30 days to 100% with> ambiguous external genitalia in outpatient follow-up with 60 days. These changes may appear early, from 9 to 11 nephrologist and endocrinologist due to nephrotic syndrome days after the drug treatment was instituted. The evolution and male pseudohermaphroditism (46,XY karyotype). The is benign, being reversible upon discontinuation of (PGE). patient presented abdominal pain, vomiting and watery diar- The differential diagnosis should be made with physiolog- rhea. Three days after first symtoms, an ultrasonography was ical periostitis, metabolic diseases, congenital infectious performed and showed a renal mass on the left. The child diseases (TORCH), notably syphilis, Caffey's disease, was referred to our hospital to diagnosis, where the tomo- osteomyelitis, reparative fractures and hereditary pachy- graphic exam confirmed the existence of a large expansive dermoperiostitis. The symmetrical, painless and unaltered lesion with probable neoplastic origin in the lower pole of involvement of the cortical bone helps in its differentiation. the left kidney, measuring about 6.6 x 9.3 x 5.4 cm, with In this study, we present two cases of infants with congeni- heterogeneous density and presenting a discrete contrast en- tal heart disease, in prolonged use of prostaglandin causing hancement, first considering the possibility of Wilms tumor, diffuse periosteal reaction and a review of the literature. and images suggestive of lymph node enlargement in the left Conclusion: Patients in continuous use of prostaglandins lateral para-aortic chain. Subsequently, genetic testing con- in addition to common side effects such as apnea, edema firmed Denys Drash Syndrome. and fever should be considered periosteal reaction so there Discussion and diagnosis: The prevalence of DDS is un- is no confusion with other diagnoses such as syphilis and known. People with Denys-Drash syndrome have an es- osteomyelitis. timated 90 percent chance of developing this rare form of Responsible Author: Henrique Abrão Fróes de Moraes kidney cancer known as Wilms tumor. Approximately 5% of Email: [email protected] WT are associated with known constitutional predisposition Keywords: reação,periosteal,literatura,prostaglandina syndromes. Germline aberration of WT1 is clearly associated with increase in bilateral disease as the overall rate of bilat- PD.13.013 eral WT is 5% whereas patients with DDS show incidence of MULTILOCULAR THYMIC CYST: A RARE CAUSE 20%. As most tumors are large at presentation and are treated OF CERVICAL MASS IN CHILDREN with nephrectomy, the role of imaging is primarily in pre- Authors: REISER C.S.; WAGNER L.F.; PELETTI A.B.; operative planning and evaluation for metastatic disease, in DORA M.D.; KEFFER C.P.; MATIOTTI S.B.; ARAUJO M.A. addition to providing initial disease staging information and Institution: HOSPITAL DA CRIANÇA NOSSA SENHORA a presumptive diagnosis to guide therapy. Ultrasonography is DA CONCEIÇÃO - GRUPO HOSPITALAR CONCEIÇÃO, usually the initial imaging examination. PORTO ALEGRE/RS Conclusion: Making a diagnosis for a genetic or rare disease A brief description of the objective(s): To describe the clin- can often be challenging. Knowledge of the clinical-patholog- ical and tomographic findings of the multilocular thymic cyst ic features and some distinctive imaging features of renal neo- and their embriological causes; plasms in young children can allow the radiologist to provide To enlighten radiologists to consider this diagnosis in the dif- information with a potential impact on patient management. ferential of cervical cystic lesions in pediatrics. Responsible Author: João Paulo Dalazen de Souza Clinical History: We describe the case of a 15-year-old boy, Email: [email protected] with a tumor in the right cervical region of sudden onset and Keywords: DENYS-DRASH, TUMOR, WILMS, SYN- rapid growth. Patient in good general condition, afebrile, DROME with stable vital signs, presenting right cervical mass, of firm and painless consistency, without phlogistic signs, without PD.13.010 determining stridor, hoarseness or dysphagia. He brought an PERIOSTEAL REACTION INDUCED BY THE PRO- external ultrasonography (images not available) describing a LONGED USE OF PROSTAGLANDINES IN INFANT cystic septate lesion, extending from the angle of the mandi- PATIENTS: CASE PRESENTATION AND LITERA- ble to the upper mediastinum. The CT study performed for TURE REVIEW diagnostic elucidation and extension evaluation demonstrat- Authors: SANTOS, J. E. M; RODRIGUES, A. A. E; MO- ed a multiloculated fluid density lesion with enhancing septae RAES, H. A. F; MACHADO. P. R.;MENDONCA, V. C; in the right parapharyngeal space, extending from the level of BITTENCOURT,G. R; BARROS, L. F; VIEIRA, J. B; mandible (anteromedially to the sternocleidomastoid muscle LEAO. F.I; AUGUSTO,B.M and anterior to the carotid sheat) to the superior mediastinum. Institution: HOSPITAL SEPACO Patient submitted to elective surgery with complete excision A brief description of the objective(s): To present 2 cases of the lesion, which presented a thick capsule and was closely of periosteal reaction in infants in prolonged use of prosta- adhered to the mediastinal thymus. The anatomopathological glandin. revealed a multilocular thymic cyst. Clinical History: Male patients, with 3 months of life and Discussion and diagnosis: The thymus develops from the diagnosis of cyanotic congenital heart disease, in prolonged third and fourth branchial pouches and during its embryolo- use of prostaglandins, presenting diffuse and symmetrical gy separates from the pharynx and migrates caudally to the periosteal reaction. anterior mediastinum. The persistence of parts of the embry- Discussion and diagnosis: Prostaglandin (PGE) is the onic thymus or the thymopharyngeal duct in its downward drug of choice in the treatment of cyanotic congenital heart path can cause thymic cystic lesions or ectopic thymic tis- disease, for a short time, to maintain patent ductus arterio- sue. Cervical thymic cysts represent less than 1% of cervical
82 49th Sao Paulo Radiological Meeting masses in children. Usually painless and fast growing, they PD.13.015 are more common in boys, younger than 10 years old and FIBROMYXOID SARCOMA OF THE PANCREAS IN A on the left side. Unilocular types are more common, caused PEDIATRIC PATIENT: CASE REPORT by persistence of the thymofaringeal duct, whereas the de- Authors: SOARES, D. R.; SUNADA, A. M.; ADATIHARA, generation of Hassall's corpuscles in ectopic cervical thymic J. M.; DOLÇAN, K. S.; STEIN, V. S.; SOARES, T. R. tissue forms the rarer multilocular cysts, as in our case. The Institution: ASSOCIAÇÃO CONGREGAÇÃO DE SANTA main differential diagnoses include branchial cleft cysts, thy- CATARINA HOSPITAL SANTA ISABEL roglossal cyst and lymphangiomas. A brief description of the objective(s): The present study Conclusion: Cervical thymic cysts are rare and often over- aims to report a case of fibromyxoid sarcoma of the pancreas looked causes of cervical masses in children that radiologists in a pediatric patient, reviewing its main imaging findings. must be familiar in order to includ them in differential of cer- Clinical History: A 10 years old male patient complaining vical cystic lesions in children. of abdominal pain. Magnetic Resonance Imaging (MRI) of Responsible Author: Carolina Sander Reiser the abdomen was performed, showing an expansive lesion, Email: [email protected] with well defined limits, presenting heterogeneous signal in Keywords: cisto,tímico,multilocular,thymic,cyst,cervical T1- and T2-weighted sequences, areas of restricted diffusion interspersed by areas of facilitated diffusion, and early and PD.13.014 heterogeneous enhancement after intravenous injection of contrast medium, located in the right abdomen, related to the KAPOSIFORM HEMANGIOENDOTHELIOMA WITH pancreatic head, determining alteration of its morphology. KASABACH-MERRITT SYNDROME This lesion compresses the distal segment of the common bile Authors: ROMAN, S.M; TACCA, A; SEDA, G.V; CHO- duct, with upstream dilatation of the same and of the intra- JNIAK, R; AMOEDO, M. K hepatic bile ducts. Compressive effect on the right kidney is Institution: AC CAMARGO CÂNCER CENTER also observed. This lesion was resected, and the results of the A brief description of the objective(s): Describe and dis- anatomopathological and immunohistochemical studies were cuss a case of kaposiform hemangioendothelioma complicat- compatible with low-grade fibromyxoid sarcoma. ed with Kasabach-Merritt syndrome, contextualizing it in the Discussion and diagnosis: Pancreatic neoplasms can be di- diagnosis and approach of vascular tumors. vided into epithelial and non-epithelial. The latter comprise Clinical History: ARD, female, 82 days old, referred to only about 2% of all, being represented mainly by mesenchy- the hospital for investigation of left cervico-facial mass mal tumors. Pancreas related sarcomas less commonly orig- that rapidly evolves with consumption coagulopathy. The inate from the pancreatic tissue itself, with the fibromyxoid imaging exams showed a massive mass centered in the left subtype being among the rarest. The histological variability of cervical region, solid, heterogeneous and infiltrative, hy- the different types of sarcoma manifests into imaging exams, pervascular, with hyposignal on T1 and hypersignal on T2. with findings that also depend on the type of sarcoma, which Anatomopathological and immunohistochemical examina- may be non-specific or aid in the diagnostic differentiation. In tion were performed after percutaneous biopsy and con- general, unlike pancreatic adenocarcinoma, sarcomas appear firmed kaposiform hemangioendothelioma. She received as bulky and heterogeneous masses, with frequent central corticoid and immunosuppressive treatment (rapamune) necrosis and hemorrhage. Low-grade fibromyxoid sarcoma that led to the clinical resolution of the syndrome, partial usually presents heterogeneous on MRI images, with areas volume decrease, color change and mass consistency. of low signal intensity on both T1- e T2-weighted sequences, Discussion and diagnosis: Kaposiform hemangioendothe- representing fibrous tissue. Solid-cystic appearance is also lioma is a rare tumor (100 cases described) and is aggressive usually found. Conclusion: Non-epithelial pancreatic tumors represent a because of high mortality in the absence of correct treat- diagnostic and therapeutic challenge because of their rarity ment. It presents association with lymphangiomatosis and and clinical and imaging characteristics, and fibromyxoid Kasabach-Merritt syndrome, characterized by consump- sarcoma is very rarely reported. However, it is important to tion coagulopathy and presence of giant vascular lesion in consider and, when possible, differentiate them from epithe- young infants. In the case of Kassabach Merrit Syndrome, lial neoplasms, due to the great difference in treatment and the differential diagnosis is made with rapidly involutive prognosis between them. congenital hemangiomas. Congenital hemangiomas can be Responsible Author: Diego Roberto Soares classified as rapidly involutive (RICH), partially involutive Email: [email protected] (PICH) or non-involutive (NICH). The main differential di- Keywords: low-grade fibromyxoid sarcoma,MRI,pancreatic agnosis of congenital hemangioma is the infantile hemangi- neoplasms,pediatrics oma, which is much more common, but not associated with Kassabach Merrit syndrome. Conclusion: It was report a case of Kaposiform Hemangio- endothelioma complicated by Kassabah-Merritt syndrome, whose correct diagnosis and treatment directly interfere with the patient's evolution and prognosis due to its high associ- ated mortality. Responsible Author: Stefânia Maria Roman Email: [email protected] Keywords: Hemangioendotelioma, Kaposiforme, Kassabah, Merritt
Abstracts of Scientific Papers 83 PET-CT ORIGINAL PAPER CASE REPORT
POSTERS (PI) DIGITAL PRESENTATION (PD)
PI.14.002 PD.14.006 PET / CT IN THE EVALUATION OF PULMONARY INCIDENTAL PANCREATIC MALIGNANT NEO- NODULES WITH INTERMEDIATE PRE-TEST PLASM DIAGNOSED AT 68GA-PSMA PET/CT RISK FOR MALIGNANCY IN A PRIVATE HOSPI- Authors: CAMPOS, A.L.; SILVA, M.T.; PALMA, G.L.; SE- TAL IN BRAZIL GUNDO NETO, E.M.V.; QUAGLIATO, P.C.; COURA, G.B. Authors: KUSSANO, I.C.T.; TELES, G.B.S.; SHOJI, H.; Institution: A. C. CAMARGO CANCER CENTER, SãO CHATE, R.C.; SZARF, G.; FUNARI, M.B.G. PAULO, SãO PAULO, BRASILADVANCED IMAGING Institution: HOSPITAL ISRAELITA ALBERT EINSTEIN ASSOCIATES, FREMONT, CALIFORNIA, USAAN- A brief description of the objective(s): Evaluate the diag- GIO VASCULAR MEDICINE CONSULTING ROOMS, nostic accuracy of 18F-FDG PET / CT in the characteriza- BELGRADE, SERBIAANGIORAD, RECIFE, PERNAM- tion of pulmonary nodules between benign or malignant in BUCO, BRASILAPROFE, AMBATO, TUNGURAHUA, patients with intermediate pre-test risk in a private hospital ECUADORAPROFE, BABAHOYO, LOS RíOS, ECUA- in Brazil. DORAPROFE, GUAYAQUIL, GUAYAS, ECUADORA- Material(s) and method(s): A retrospective analysis of SIAN MEDICAL CENTER, SEOUL, REPUBLIC OF KO- 18F-FDG PET / CT examinations performed between Jan- REAASSOCIAçãO HOSPITALAR BENEFICENTE SãO uary 2015 and December 2016 for the evaluation of solitary VICENTE DE PAULO, PASSO FUNDO, RIO GRANDE pulmonary nodules was performed in a private hospital in DO SUL, BRASILAXIAL CENTRO DE IMAGEM DI- Brazil. The lesions were evaluated for size, location, density, AGNóSTICO SC LTDA., BELO HORIZONTE, MINAS presence of spiculation and 18f-FDG maximum Standardized GERAIS, BRASILBAYERO UNIVERSITY, KANO, NI- Uptake Value (SUVmax). Pulmonary nodules were included GERIABENEFICIêNCIA PORTUGUESA DE SãO PAU- between 8 and 30 mm, solids or subsolids with a solid com- LO, SãO PAULO, SãO PAULO, BRASILBEYTEPE MIL- ponent greater than 8 mm, with an intermediate pre-test risk ITARY HOSPITAL, ANKARA, TURKEYBIO MASTER (5 to 65%) calculated by the Mayo Clinic model. Patients MEDICINA DIAGNóSTICA, SãO PAULO, SãO PAULO, with a history of active neoplasia in the last 5 years were BRASILBOSTON UNIVERSITY SCHOOL OF MED- excluded. The definitive diagnosis was established by histo- ICINE, BOSTON, MASSACHUSETTS, EUABREAST pathological confirmation or clinical-radiological follow-up CENTER, NATIONAL TAIWAN UNIVERSITY HOSPI- for a minimum period of 24 months. TAL, TAIPEI, TAIWANBUDDHIST TZU CHI GENERAL Results and discussion: The exams of 226 patients were HOSPITAL, TAIPEI BRANCH, TAIWANBUSAN PAIK evaluated, and 52 nodules met the inclusion criteria. Of these, HOSPITAL INJE UNIVERSITY, BUSAN, SOUTH KO- 25 nodules (48%) presented the diagnosis of malignancy (ad- REACARDIOLOGY RESEARCH COMPLEX, MOSCOW, enocarcinoma was the most common histological subtype in RUSSIACASA DE SAúDE SANTA MARCELINA, SãO 60% of cases) and 27 (52%) were benign (9 of them related PAULO, SãO PAULO, BRASILCASA DE SAúDE SãO to granulomatous disease). Using the SUV value of 2.5, 15 JOSé, RIO DE JANEIRO, RIO DE JANEIRO, BRASIL- false-positive results and 3 false-negative results (2 lepidic CDB - CENTRO DE DIAGNóSTICOS BRASIL, SãO adenocarcinomas and 1 mucinous adenocarcinoma) were PAULO, SãO PAULO, BRASILCDE DIAGNóSTICO found. This same cutoff point showed sensitivity of 88%, POR IMAGEM, CAMPINAS, SãO PAULO, BRASILCDI - specificity of 44%, positive predictive value of 59%, negative CENTRO DE DIAGNóSTICO POR IMAGEM, VITóRIA, predictive value of 80% and accuracy of 65%. ESPíRITO SANTO, BRASILCDPI - CLíNICA DE DIAG- Conclusion: PET / CT scan with 18F-FDG is a non-inva- NóSTICO POR IMAGEM, RIO DE JANEIRO, RIO DE JA- sive alternative that combines morphological and metabol- NEIRO, BRASILCEBRAMEN - CENTRO BRASILEIRO ic parameters in the characterization of pulmonary nodules, DE MEDICINA NUCLEAR E IMAGEM MOLECULAR, being widely accepted in the diagnostic evaluation of suspi- GOIâNIA, GOIáS, BRASILCEDIMA - CENTRO DE ES- cious nodules for malignancy. However, recent studies have demonstrated limitations of this method in regions with en- TUDOS DE DIAGNóSTICO POR IMAGEM PROFES- demic pulmonary infectious diseases, where there is a reduc- SOR WALDIR MAYMONE, PRESIDENTE PRUDENTE, tion in PET / CT specificity and accuracy values. Our study SãO PAULO, BRASILCEDIMAGEM, JUIZ DE FORA, confirms reduced specificity, PPV and accuracy of this test in MINAS GERAIS, BRASILCEDIMEN - CENTRO DE DI- a private hospital in Brazil, despite the use of restricted selec- AGNóSTICO EM MEDICINA NUCLEAR, SãO PAULO, tion criteria, including only nodules with a solid component SãO PAULO, BRASILCEDIRP - CENTRAL DE DIAG- above 8 mm and with an intermediate pre-test risk. NóSTICO RIBEIRãO PRETO, RIBEIRãO PRETO, SãO Responsible Author: Ivan Cesar Tanaka Kussano PAULO, BRASILCEGYR, CIUDAD AUTóNOMA DE Email: [email protected] BUENOS AIRES, ARGENTINACENTRO DE ATENçãO Keywords: 18F-FDG, PET/CT, TÓRAX, NÓDULO, INTEGRAL à SAúDE DA MULHER-CAISM, UNIVERSI- SOLITÁRIO DADE ESTADUAL DE CAMPINAS-UNICAMP, CAMPI- NAS, SãO PAULO, BRASILCENTRO DE CIêNCIAS DAS IMAGENS E FíSICA MéDICA, SEçãO DE MEDICINA NUCLEAR - HOSPITAL DAS CLíNICAS DE RIBEIRãO
84 49th Sao Paulo Radiological Meeting PRETO - USP, RIBEIRãO PRETO, SãO PAULO, BRASIL UNIVERSITáRIO CLEMENTINO FRAGA FILHO - UFRJ, CENTRO DE DESENVOLVIMENTO DA TECNOLO- RIO DE JANEIRO, RIO DE JANEIRO, BRASILCLIMAG, GIA NUCLEAR, BELO HORIZONTE, MINAS GERAIS, TIMóTEO, MINAS GERAIS, BRASILCLIM BRASILCENTRO DE DIAGNóSTICO DR. ENRIQUE A brief description of the objective(s): Demonstrate that ROSSI, BUENOS AIRES, ARGENTINACENTRO DE 68Ga-PSMA can have uptake in extra-prostatic tissues and DIAGNóSTICO SCHMILLEVITCH, SãO PAULO, SãO diagnose diseases unrelated to prostate cancer. PAULO, BRASILCENTRO DE ENSINO E PESQUISA Clinical History: Patient AR, male, 70 years old, referred DO HOSPITAL PRO CARDIACO/PROCEP, RIO DE JA- to our service for evaluation with Ga68-PSMA PET/CT for NEIRO, RIO DE JANEIRO, BRASILCENTRO DE ESTU- a prostate adenocarcinoma Gleason 6 (3 + 3) under follow DOS MEDIMAGEM FEIRA DE SANTANA, FEIRA DE up for 1 year, with no history of radical prostatectomy and SANTANA, BAHIA, BRASILCENTRO DE MEDICINA currently with increased levels of serum PSA. In the image INTERVENCIONISTA, HOSPITAL ISRAELITA ALBERT analysis, in addition to the nodular formation in the prostate, EINSTEIN, SãO PAULO, SãO PAULO, BRASILCENTRO an increased expression of prostate-specific membrane anti- DE MEDICINA NUCLEAR DA GUANABARA, RIO DE gen was observed in a nodular formation in the uncinate pro- JANEIRO, RIO DE JANEIRO, BRASILCENTRO DE ME- cess of the pancreas, determining pancreatic duct dilation and DICINA NUCLEAR DO HOSPITAL DAS CLíNICAS DA parenchyma atrophy of pancreatic head, body and tail. It was FACULDADE DE MEDICINA DA UNIVERSIDADE DE then suggested to continue investigation, with confirmation SãO PAULO, SãO PAULO, SãO PAULO, BRASILCEN- of pancreatic disease and total pancreatectomy, resulting in a TRO DE MEDICINA NUCLEAR DO INSTITUTO DE primary malignant tumor of the pancreas. RADIOLOGIA DO HOSPITAL DAS CLíNICAS DA FAC- Discussion and diagnosis: Prostate-specific membrane an- ULDADE DE MEDICINA DA UNIVERSIDADE DE SãO tigen (PSMA) is hyperexpressed in prostate cancer. Its ex- PAULO, SãO PAULO, SãO PAULO, BRASILCENTRO DE pression progressively increases with tumor aggressiveness, RADIOTERAPIA RIO DE JANEIRO, DUQUE DE CAX- metastatic disease, and castration-refractory prostate cancer IAS, RIO DE JANEIRO, BRASILCENTRO DE REABIL- and can be used for diagnosis, staging, and re-staging. How- ITAçãO E READAPTAçãO DR. HENRIQUE SANTILLO, ever, there may be false positives in extra-prostatic tissues GOIâNIA, GOIáS, BRASILCENTRO DE TECNOLOGIA that should be evaluated with caution, because they may be DA INFORMAçãO RENATO ARCHER, CAMPINAS, SãO not related to the prostatic disease. Our case represents a rare PAULO, BRASILCENTRO DIAGMED DE RADIOTERA- case of pancreatic nodule uptake, which has been shown to PIA, CAMPINAS, SãO PAULO, BRASILCENTRO DIAG- be a primary pancreatic malignant tumor after total pancre- NóSTICO LUCILO ÁVILA JR, RECIFE, PERNAMBUCO, atectomy. BRASILCENTRO EDUCACIONAL ETIP, SãO PAULO, Conclusion: In addition to be a fundamental tool in the SãO PAULO, BRASILCENTRO ESTADUAL DE DIAG- follow-up of biochemical recurrence of Prostate Cancer, NóSTICO POR IMAGEM (CEDI/SES-RJ), RIO DE JA- 68Ga-PSMA PET / CT has shown extra-prostatic tissues up- NEIRO, RIO DE JANEIRO, BRASILCENTRO INFANTIL take unrelated to the prostatic disease, helping in the diagno- BOLDRINI, CAMPINAS, SãO PAULO, BRASILCENTRO sis of other primary tumors. MéDICO DIAGNóSTICOS, SOROCABA, SãO PAULO, Responsible Author: Ana Luiza Campos BRASILCENTRO RADIOLóGICO CAMPINAS - HOSPI- Email: [email protected] TAL VERA CRUZ, CAMPINAS, SãO PAULO, BRASIL- Keywords: PSMA,cancer,pancreas,prostata,PET/CT,68Ga CENTRO RADIOLóGICO CAMPINAS - UNIFESP, CAMPINAS, SãO PAULO, BRASILCENTRO UNIVER- SITáRIO ESTáCIO-FIB, SALVADOR, BAHIA, BRASIL- CENTRO UNIVERSITáRIO SANT'ANNA, SãO PAULO, SãO PAULO, BRASILCENTRO UNIVERSITáRIO SãO CAMILO, SãO PAULO, SãO PAULO, BRASILCENTRUS DIAGNóSTICOS POR IMAGEM, CAMPINAS, SãO PAULO, BRASILCEPEM - CENTRO DE ESTUDOS E PESQUISAS DA MULHER, RIO DE JANEIRO, RIO DE JANEIRO, BRASILCETAC - DIAGNóSTICO POR IMA- GEM, CURITIBA, PARANá, BRASILCETRUS, SãO PAU- LO, SãO PAULO, BRASILCEU DIAGNóSTICOS, BELO HORIZONTE, MINAS GERAIS, BRASILCEUSPE - CEN- TRO ESPECIALIZADO EM ULTRASSONOGRAFIA, SãO LUíS, MARANHãO, BRASILCHA GUMI MEDICAL CENTER, CHA UNIVERSITY, GUMI, REPUBLIC OF KO- REACHANG GUNG UNIVERSITY COLLEGE OF MED- ICINE, KAOHSIUNG, TAIWANCHARITé - UNIVERSI- TäTSMEDIZIN BERLIN, BERLIN, GERMANYCHENG HSIN GENERAL HOSPITAL, TAIPEI CITY, TAIWAN- CHILDREN’S HOSPITAL OF CHONGQING MEDICAL UNIVERSITY, CHONGQING, CHINACHILDREN'S MEMORIAL HEALTH INSTITUTE, INSTITUTE OF MOTHER AND CHILD, WARSAW, POLANDCHINESE PLA GENERAL HOSPITAL, BEIJING, NEIJING, CHIN- ACHS, SOROCABA, SãO PAULO, BRASILCHUNGNAM NATIONAL UNIVERSITY HOSPITAL, DAEJEON, RE- PUBLIC OF KOREACIRURGIA VASCULAR HOSPITAL
Abstracts of Scientific Papers 85 MUSCULOSKELETAL SYSTEM ORIGINAL PAPER TL.15.003 TOTAL HIP ARTHROPLASTY: DO SURGICAL FIND- INGS CORRELATE WITH MR IMAGING STUDY? Authors: VALDUGA, S. G. ; BALDISSEROTTO, M.; ORAL PRESENTATION (TL) FORTE, G. C.; ANDRADE, R. G. F.; SODER, R. B.; STUKER, G.; FIORENTINI, L. F. TL.15.001 Institution: PONTIFÍCIA UNIVERSIDADE CATÓLICA DO RIO GRANDE DO SUL / HOSPITAL SÃO LUCAS MEASUREMENT AND TOPOGRAPHIC ANALYSIS (PUCRS/HSL) OF SUBCHONDRAL BONE EDEMA IN SACROILIAC A brief description of the objective(s): To evaluate the cor- MRI OF PATIENTS WITH SACROILIITIS OR DE- relation of magnetic resonance imaging (MRI), using the SE- GENERATIVE CHANGES MAC sequence, with findings of surgical revision in patients Authors: RODRIGUES, J. C.; ENGE JR, D. J.; HEY- with total hip prosthesis. MANN, R. E.; QUARESMA, M. R.; ROSEMBERG, L. A.; Material(s) and method(s): This retrospective cross-sec- SANTOS, D. C. B. tional HIPPA-compliant study was approved by the institu- Institution: HOSPITAL ISRAELISTA ALBERT EINSTEIN tional review board. MRI and surgical descriptions of 22 pa- A brief description of the objective(s): The primary ob- tients who underwent hip arthroplasty revision surgery were jective is to compare the measurement and topography of evaluated. MR imaging was performed with convencional subchondral bone edema in sacroiliac MRI and identify dif- and SEMAC sequences in a 1,5 T scanner. The six major ferences between patients with sacroiliitis or degenerative surgical findings were considered as gold standard criteria: changes. synovitis, pseudotumor, osteolysis, metallosis, scar tissue Material(s) and method(s): In this retrospective study, and loosening. We correlated the surgical data with both the ASAS criteria identified patients with inflammatory sacroilii- MR reports and the review of the images made by two mus- tis or degenerative changes based on clinical and laboratory culoskeletal radiologists (reviewer I and reviewer II). Cor- relation between MRI and surgical findings was measured findings. Two radiologists, blinded to the ASAS criteria, read using Cohen’s Kappa (k). the MRI images independently. They divided each face of Results and discussion: There were a poor correlation be- the sacroiliac joints (sacral and iliac) into parts (upper, mid- tween the surgical data and both MR reports and the second dle and lower thirds and anterior, central and posterior thirds) evaluation of the images by the revisors for synovitis, oste- and examined the frequency of the subchondral bone ede- olysis, metallosis, scar tissue and loosening. There was rea- ma according to this regions. The measurement of the most sonable correlation for pseudotumor at the same conditions. significant focus of subchondral edema in each face of the Conclusion: MRI with SEMAC sequence does not show a sacroiliac joint (sacral and iliac) was made in three dimen- good correlation with the surgical findings of patients under- sions (lateromedial, anteroposterior and craniocaudal) and going revision of hip arthroplasty. registered in centimeters. Hypothesis tests, depending on the Responsible Author: Guilherme Stüker nature and distribution of the data, investigated associations Email: [email protected] among ASAS criteria, bone edema in MRI, and patients char- Keywords: Hip, arthroplasty, surgical, findings, mri, acteristics. SPSS program performed the analysis consider- correlation ing a significance level of 5%. Results and discussion: Thirty-six patients (19 women, 17 men, average age 36,4 years) full filled the inclusion criteria (low back pain lasting equal or more than three months, the onset of symptoms before 45 years of age, who were referred PICTORIAL ESSAY for MRI). In this sample, the ASAS criteria classified 16 pa- tients with sacroiliitis and 20 with degenerative change. The variable topography showed a difference in between groups with the edema distribution predominating in the anteri- POSTERS (PI) or sacroiliac region of the middle third in the degenerative group. The location of the edema in the sacroiliitis group PI.15.001 had a more widespread distribution affecting other areas as X-RAY STEREORADIOGRAPHY: TWO YEARS NA- well. The measurement of edema was also different between TIONAL EXPERIENCE groups with larger dimensions in the sacroiliitis group. Authors: ZORZENONI, F.O.; CARNEIRO, B.C.; YA- Conclusion: Despite the advances in the introduction of MRI MASHITA, S.R.; SILVA, I.P.; GUIMARAES, J.B.; SILVA, for the early diagnosis of sacroiliitis, bone edema is quite F.D.; PASTORE, D.; FILHO, A.G.O.; STUMP, X.M.G.R.G.; common in degenerative changes and may confuse the di- NICO, M.A.C. agnosis, reaching high false-positive rates. The measurement Institution: GRUPO FLEURY MEDICINA & SAÚDE and topography of subchondral bone edema in MRI may help Introduction and objective(s): The multidimensional ste- differentiate patients with inflammatory sacroiliitis or degen- reoradiography X-ray system is a recent biplanar imaging erative changes. system that uses low dose ionizing radiation and produces Responsible Author: joao rodrigues quality images in the orthostatic position, providing valu- Email: [email protected] able informations into the understanding of spinopelvic and Keywords: sacroiliitis,sacroiliac,degenerative lower limb relationships. This work aims to illustrate the ex-
86 49th Sao Paulo Radiological Meeting perience of 2 years with this technology by demonstrating intramuscular or subcutaneous fat grafting, intramuscular or the functioning of the system and its indications, as well as subfascial implants and injection of absorbable or non-ab- its didactic analysis, also presenting practical cases of how sorbable intradermal material. The complications are of the system can aid in the diagnosis and surgical planning diverse etiologies and frequencies, such as seromas, dehis- of various pathologies, going beyond the basic information cences, infections, hidradenitis, embolism, rupture and rota- provided by conventional radiography and tomography. tion of prostheses. However, the injection of illegal exoge- Method(s): Retrospective analysis of stereoradiography nous materials constitutes the greatest diagnostic challenge studies of whole-body, pelvis and lower limbs in the period for the radiologist, since the clinical history is often poor and between 2017 and 2018, demonstrating the main findings and imaging findings can be confused especially with infections illustrative cases. and neoplasms. In cases of injection of exogenous material, Discussion: The images are acquired simultaneously in the the findings are presented by nodular images with a varied frontal and sagittal planes, which allows, after post-pro- topography, and may be located in the subcutaneous, intra- cessing, measurements in the axial plane and three-di- muscular or subfascial areas. It is necessary to identify pos- mensional modeling in the weight-bearing position. It also sible collections, abscesses, reactional lymphonodes, fistulas allows the reduction of 85% of the radiation dose, which, and continuity with vascular and nerve structures, as well as together with its axial measurement capacity, makes it the associated inflammatory processes. These findings may also method of choice in the evaluation and follow-up of sco- be indications of infection in cases of rupture and rotation of liosis. By allowing the evaluation of the whole-body in a gluteal prostheses. single acquisition, it allows a better understanding of the interrelations between the spine, pelvis and lower limbs, Conclusion: Thus, it is important to know the surgical tech- whose unbalance can be a source of pain, therapeutic fail- niques and to be familiar to the most varied spectrum of ures or post-surgical complications. Its use in the pre and post-surgical images of the gluteal region, in order to iden- postoperative evaluation of hip arthroplasties has become tify possible complications and avoid misunderstandings in interesting due to the idea of ??the pelvis as a pelvic ver- the diagnosis. tebra, as well as the relation of the spatial positioning of Responsible Author: Marcelo Maruichi the acetabulum to the position of the patient and the distur- Email: [email protected] bances of the spine. It also provides axial measurements of Keywords: GLUTEOPLASTIA,ESTETICA,COMPLI- the lower limbs and adds precision in angular and length CAÇÕES,PÓS-OPERATÓRIAS measurements in complex deformities, as well as does not exclude the feet of their analysis. PI.15.005 Conclusion: X-ray stereoradiography is a single system that ASPECTS IN MAGNETIC RESONANCE AFTER SUR- uses a low dose of radiation and allows global assessment of GICAL REPAIR OF THE KNEE CARTILAGE: PIC- the individual in the orthostatic position, providing valuable TORIC ESSAY. information on the knowledge of spinopelvic and lower limbs Authors: SOUZA, AR; CASTRO, AA; FONSECA, EKUN; relationships, an essential comprehension in the understand- NUNES, LM; BAPTISTA, E; HARTMANN, LGC; SAN- ing of pain, musculoskeletal system disturbances and in ther- apeutic planning. TOS, DCB; ROSEMBERG, LA. Responsible Author: Fernando Ometto Zorzenoni Institution: HOSPITAL ISRAELITA ALBERT EINSTEIN Email: [email protected] Introduction and objective(s): Radiologists should be fa- Keywords: estereorradiografia, equilíbrio, sagital, modelização, miliar with the main techniques of surgical repair of the knee tridimensional, incidência, pélvica, balaço cartilage and the imaging methods available for their evalu- ation, in order to optimize the postoperative follow-up of the PI.15.002 patient. The present study aims to illustrate the main surgi- cal techniques applied to knee cartilage repair, as well as the POSTOPERATIVE COMPLICATIONS OF AESTHET- magnetic resonance techniques usually used in the postoper- IC GLUTEOPLASTIES. WHAT DOES THE RADIOL- ative evaluation and the relevant radiological findings OGIST NEED TO KNOW? Method(s): This is a pictorial essay study with literature Authors: VASCONCELOS, R.C.; NETO, O.L.A.; MARUI- review through a series of cases of our service to illustrate CHI, M.D.; GODOY, I.R.B; HEHN, B.J.; YAMADA, A.F.; the main surgical techniques applied to knee cartilage re- FILHO, G.H.; NETO, L.P.; IKAWA, M.H.; LUNDBERG, pair, as well as the magnetic resonance techniques usually J.S.; SILVA, J.J.; SKAF, A.Y. used in the postoperative evaluation and the relevant radio- Institution: HOSPITAL DO CORAÇÃO - HCOR logical findings. Introduction and objective(s): Aesthetic procedures in- volving the buttocks are common and grow exponentially in Discussion: We reviewed and illustrated cases contemplating Brazil. It can be realized by diverse techniques and have a the surgical techniques of microperforation, mosaicoplasty, variety of complications. Often in radiological practice, the repair by regeneration through stem cells, surgical fixation of physician is faced with examinations without adequate clini- chondral fragment and biomembrane. cal and surgical history, and in addition, the injection of ille- Conclusion: Radiologists should be familiar with the main gal substances by disqualified professionals further increases techniques and imaging of cartilage repairs, which have been the diagnostic challenge. Thus, this pictorial essay aims to demonstrated in the present study through an illustrative re- cite the main surgical techniques and show a series of cases view of didactic cases of surgical techniques, MRI sequences of postoperative complications in gluteoplasties. and imaging aspects of each case through conventional ex- Method(s): We selected magnetic resonance imaging of the aminations and through complementary diagnostic imaging gluteal region of patients who underwent postoperative com- techniques (T2 map). plications of aesthetic gluteoplasties from 2013 to 2018. Responsible Author: Adham do Amaral e Castro Discussion: Several techniques can be used in the aesthet- Email: [email protected] ic procedures of the gluteal region, including lipoaspiration, Keywords: joelho; cartilagem; ressonância magnética.
Abstracts of Scientific Papers 87 PI.15.006 the main contributory factor for morbidity and mortality in MAFFUCCI SYNDROME - A PICTORIAL ESSAY this patients. Clinically can be classified in two forms: acute, Authors: ROSAS, C.H.S.; VERZA, L.; GÓES A.C.A.; LIMA, when appears before 100 days after the transplantation and A.O.; MESQUITA, F.N.B.; PORTO, .G.C.L.M.; BARBOSA, chronic when it manisfests after 100 days. The chronic form P.N.P.;CERQUEIRA, W.S.; BITENCOURT, A.G.V. is not always preceeded by the acute GVHD. Musculoskel- Institution: FUNDAÇÃO ANTONIO PRUDENTE - HOS- etal manifestations are rare in GVHD. The chronic form PITAL A.C.CAMARGO CANCER CENTER (cGVHD) is the most common and includes inflammatory Introduction and objective(s): Introduction and objectives: and fibrosing manifestations. Maffucci Syndrome (MS) is a rare entity with only few cases Mthod(s): The objective of this study is to illustrate through reported in literature, characterized by diffuse enchondroma- a case based review, image patterns of musculoskeletal find- tosis associated with vascular anomalies, including hemangi- ings in GVHD. Familiarize the radiologist with the different oma and lymphangioma. This study aims to review imaging imaging aspects and forms of GVHD. aspects related to the syndrome and based on the cases seen Discussion: The incidence of cGVHD (after 100 days in our service. of BMT) has been increasing due to several factors, Method(s): Methods: We performed a review of medical re- among them the expansion of the HLA donor network cords and imaging of patients with suspected MS in a refer- and the increase in the number of procedures. Muscu- ence cancer center. loskeletal involvement is an important cause of wors- Discussion: Discussion: Maffucci syndrome manifests early ening of the patient's quality of life and functional in life, usually before the age of 5 years, and is characterized status, being classified as cutaneous and subcutaneous by fractures, cutaneous vascular lesions and bone deformi- involvement (predominating sclerosing pattern), fasci- ties due to asymmetric enchodromas, with a predilection for itis (thickening and edema, uni or multicompartimet- involvement of the long tubular bones. Patients with MS are al), polymyositis / myositis, and joint involvement. at increased risk of developing different kinds of malignant The familiarity of the particularities of the imaging tumors, such as pancreatic adenocarcinoma, glioma and sar- findings and the possible pathologies in these patients coma, which is typically develop from the long and tubular is of great importance due to the early and specific bones (like chondrosarcoma). The main differential diagno- clinical management with immunosuppressants and sis is Ollier disease, characterized by multiples enchondro- corticosteroids. mas without vascular lesions. The most frequent sites of en- Conclusion: The number of allogenic bone marrow trans- chondromas are the metaphysis, less commonly the diaphysis plantations performed worldwide has increased exponen- and rarely the epiphysis. Radiographs and computed tomog- tially since the 80s, as well as the complications involved. raphy shows round lesions, with narrow zone of transition, Radiologists must be aware of the different image patterns of may have osseous expansile remodeling, chondroid calcifi- musculoskeletal GVHD involvement. cations with "arc-and-ring" appearance, without periosteal Responsible Author: Raul Omena Martins reaction or soft tissue mass. When located in the phalanges, Email: [email protected] enchondromas are usually purely lytic. MR imaging presents Keywords: Graft-versus-host,Transplant,Fasciitis,Polymyo- low to intermediate signal intensity on T1WI, high signal on sitis,BMT T2WI (can be focal regions of signal drop out where calci- fication present) and variable contrast enhancement. The malignant transformation into chondrosarcomas is suspected when there are new lytic lesions without chondroid calcifica- tions or destruction of this area. Conclusion: Conclusion: MS is a rare syndrome, with high DIGITAL PRESENTATION (PD) morbidity to the patients and presents risk for malignant transformation. The radiologist should know suggestive PD.15.001 findings of MS for early diagnosis and for recognition of "FINGER'S LIGAMENT AND TENDON STRUC- signs of sarcomatous degeneration. TURES": REVISION OF ANATOMY AND THE MAIN Responsible Author: Carlos Henrique de Sousa Rosas LESIONS WITH EMPHASIS ON THE EVALUATION Email: [email protected] BY ULTRASONOGRAPHY AND MAGNETIC RESO- Keywords: SÍNDROME DE MAFFUCCI,Encondromatose NANCE IMAGING. Authors: LOURENÇO M.R.; AGNOLLITTO P.M.; SIMÃO PI.15.008 M.N.; LINS C.F.; NOGUEIRA-BARBOSA M.H. MUSCULOSKELETAL MANIFESTATION OF Institution: HOSPITAL DAS CLÍNICAS DA FACUL- CHRONIC GRAFT-VERSUS-HOST DISEASE DADE DE MEDICINA DE RIBEIRÃO PRETO - USP. Authors: MARTINS, R.O.; FERNANDES, R.B.P.; ROCHA, Introduction and objective(s): Tendon and ligament inju- S.R.R.; DIAS JR, U. S.; LEAO, R.V.; CORREA, M.F.P; HE- ries of the fingers are among the main sports and occupa- LITO, P.V.P.; BORDALO-RODRIGUES; M. tional diseases found today. The fingers’ anatomy can be ex- Institution: HOSPITAL SÍRIO LIBANÊS, SÃO PAULO tensively studied by magnetic resonance imaging (MRI) and Introduction and objective(s): Allogenic or autologous he- ultrasound (US). Our goal with this panel is to review fingers' matopoietic stem cells transplant became a key therapeutic anatomy with emphasis on US and MRI assessment, as well option of various malignancies and plays an important role as illustrate the major lesions involving their ligament and in the management of bone marrow failure.Graft-versus host tendon components. disease (GVHD) occurs when immunologically competent Method(s): Illustrative images of MR and US were selected cells engrafted onto a foreign host attack the tissues of that with the main anatomical references, as well as typical and host. GVHD is the most common complication after allo- didactic examples involving the main tendinous and ligament geneic hematopoietic stem cell transplant (HSCT) and is injuries of the hands.
88 49th Sao Paulo Radiological Meeting Discussion: The tendon and ligament injuries of the fingers, partial volume effect, making it difficult to identify. It is im- whether they are occupational or related to sports, are fre- portant to note that ALL may be important in maintaining the quent in the medical routine. normal rotational limits of knee movement, controlling the Among this broad spectrum of pathologies, the ones that des- internal rotation of the tibia and preventing its anterior trans- serve to be highlighted by their prevalence are: avulsions and lation. Thus, in cases of association with ACL injury, it could tendinous ruptures, capsular-ligamentous lesions, especially be responsible for some findings in physical examination: ro- those involving volar plaques and the disorders involving tational loosening after isolated intra-articular reconstruction pulleys, especially stenosing tenosynovitis ("trigger finger" ). of the ACL, detachment of the meniscus lateral border (ALL In this context, MRI and US are considered effective meth- insertion site, according to some studies), or even to avoid ods, each one with their advantages and limitations. The MRI excessive anterior tibial translation after knee arthroplasty. has high contrast resolution, is reproductible, but requires Conclusion: Thus, it is important that radiologists acknowl- dedicated protocols and specific coils. edge this anatomical structure and image patterns of the main On its In turn US is a low cost and widely available method lesions, as well as other associated alterations, facilitating diag- that allows dynamic evaluation of structures, but which re- nosis and allowing the appropriate treatment of each situation. sults are directly related to the operator's experience. Responsible Author: Carolina Freitas Lins Conclusion: The evaluation of the fingers' tendon and liga- Email: [email protected] ment injuries can be challenging due to the anatomical and Keywords: ligamento,anterolateral,joelho,anatomia biomechanical complexity of these structures. The radiolo- gist plays a essential role in the diagnosis of these lesions, PD.15.005 either in the interpretation or optimization of the acquisition CLINICAL-RADIOLOGICAL EVALUATION OF SAC- of the MRI and US images. ROILIITIS IN THE CONTEXT OF SPONDYLOAR- Responsible Author: Mateus Repolês Lourenço THRITIS Email: [email protected] Authors: LINS, C. F.; TENÓRIO, L. P.; PEIXOTO, M. C. Keywords: Finger,tendons,ligaments,injuries,ultrasound,MRI G.; MARTINEZ, M. L. A.; SARMENTO, C. A.; SIMÃO, M. N.; AGNOLLITTO P. M.; NOGUEIRA-BARBOSA, M. H. PD.15.004 Institution: FACULDADE DE MEDICINA DE RIBEIRÃO ANTEROLATERAL LIGAMENT OF THE KNEE - AN- PRETO (USP), RIBEIRÃO PRETO – SP – BRASIL; DEL- ATOMICAL REVIEW, MAJOR INJURIES AND CLIN- FIN MEDICINA DIAGNÓSTICA, SALVADOR - BA - ICAL IMPORTANCE BRASIL. CEDIRP - CENTRAL DE DIAGNÓSTICO RI- Authors: LINS, C. F.; SIMÃO, M. N.; AGNOLLITTO P. M.; BEIRÃO PRETO, RIBEIRÃO PRETO – SP – BRASIL; TENORIO, L. P.; PEIXOTO, M. C. G.; NOGUEIRA-BAR- ESCOLA BAHIANA DE MEDICINA E SAÚDE PÚBLI- BOSA, M. H. CA, SALVADOR - BA – BRASIL. Institution: FACULDADE DE MEDICINA DE RIBEIRÃO Introduction and objective(s): Spondyloarthritis constitute PRETO (USP), RIBEIRÃO PRETO – SP – BRASIL; a group of inflammatory rheumatologic diseases with prima- CEDIRP - CENTRAL DE DIAGNÓSTICO RIBEIRÃO ry involvement of the spine and axial skeletal joints, espe- PRETO, RIBEIRÃO PRETO – SP – BRASIL; DELFIN ME- cially the sacroiliac. Sacroiliitis is considered to be an early DICINA DIAGNÓSTICA, SALVADOR - BA - BRASIL. manifestation of spondyloarthritis, and it is incorporated as ESCOLA BAHIANA DE MEDICINA E SAÚDE PÚBLI- a diagnostic criterion by ASAS (International Assessment of CA, SALVADOR - BA – BRASIL. Spondyloarthritis Society), mainly in the evaluation by mag- Introduction and objective(s): Anterolateral ligament netic resonance imaging (MRI). The purpose is to character- (ALL) of the knee originates in the prominence of lateral ize changes in spondyloarthrites in various imaging methods. femoral epicondyle, anterior to the origin of lateral collater- Method(s): The cases were selected from the image file al ligament, with oblique path, inserting in the anterolateral to illustrate the involvement of ankylosing spondyli- aspect of the proximal tibia and lateral meniscus, involving tis, spondylarthritis related to psoriatic and enteropathic the lateral inferior geniculate artery and vein. It is believed arthritis. Typical findings of sacroiliitis in the acute in- to be an intracapsular ligament with intima relationship to flammatory phase (active) and in post-inflammatory in- synovial tissue, which can be viewed by magnetic resonance volvement (chronic structural changes), with examples in imaging (MRI), helping to control internal tibial rotation and radiography, computed tomography (CT) and MRI imag- pivot-shift phenomenon, being associated with the biome- es will be demonstrated. chanical function of anterior cruciate ligament (ACL). Thus, Discussion: Sacroiliac joints are usually affected early in the it is intended to demonstrate in MR images: anatomy of this course of spondyloarthritis. Radiographic involvement of sac- ligament, as well as the main lesions, emphasizing its impor- roiliitis shows post-inflammatory damage and chronic struc- tance in clinical practice. tural impairment (bone erosions, subchondral sclerosis and Method(s): The selected cases were obtained in the image reduction of joint space/ankylosis). MRI is the most sensitive archive of our Institutions. They will be illustrated by MRI method, providing detection of active inflammation by the images showing normal appearance, acute (partial/complete) identification of subchondral bone marrow edema, but also and chronic healed lesions, as well as associated alterations, allows to characterize post-inflammatory structural damage, such as ACL lesion, correlating them with knee anatomy and including areas of fatty replacement. Enthesitis, capsulitis clinical picture of the patient. and synovitis do not fall into the ASAS criteria for diagnosis Discussion: MRI corresponds to the gold-standard imaging of disease activity, but can be identified by MRI. Image eval- method for visualization and evaluation of ALL, and it is nec- uation of spine may help in the diagnosis of spondyloarthritis essary to identify it in axial and coronal planes for correct in- in some cases, however, its findings are not included in ASAS terpretation of lesions. However, its characterization by MRI criteria. When applying the diagnostic criteria for sacroiliitis is not always possible due to the presence of adjacent struc- in pediatric patients, it is necessary to recognize potential di- tures, such as popliteal tendon, lateral collateral ligament, agnostic traps, such as the confusion between immature bone anterolateral capsule and iliotibial band, which may cause and subchondral bone edema, as well as unmelted ossifica-
Abstracts of Scientific Papers 89 tion nuclei and bone erosions. It is important to emphasize Authors: OTONI, J; CASTRO, AA; LUPINACCI, FAS; the tendency to use new MRI sequences in evaluation of sac- FONSECA, EKUN; SANTOS, DCB; ROSEMBERG, LA. roiliitis (DIXON, for example), and publications that support Institution: HOSPITAL ISRAELITA ALBERT EINSTEIN intravenous contrast protocol for ASAS. Introduction and objective(s): Conventional magnetic res- Conclusion: The pictorial essay illustrates the approach of onance imaging (MRI) of the shoulder has high accuracy in sacroiliitis with emphasis on MRI, involvement in pediatric the diagnosis of labral lesions. Magnetic resonance arthrogra- patients and clinical correlation. The study emphasizes the phy studies (arthro-MRI) have an even greater sensitivity and importance of correct radiological diagnosis, an efficient tool specificity when compared to MRI, but it is an invasive pro- in the prevention of chronic joint impairment. cedure and therefore has limited acceptance. Therefore, it is Responsible Author: Carolina Freitas Lins fundamental that the radiologist is familiar with the imaging Email: [email protected] findings related to labral lesions. The present study correlated Keywords: SACROILIÍTE,ESPONDILOARTRITE,CLINI- images in both exams with the objective of reviewing and il- CO-RADIOLÓGICO lustrating the main types of labral lesions that can be detected by both methods. PD.15.017 Method(s): A pictorial study with a review of the literature through a series of cases from our service of labral lesions BONE LESIONS OF THE VERTEBRAL COLUMN: and their findings on MRI and arthro-MRI. PICTORIAL ESSAY AND STEP-BY-STEP GUIDE FOR Discussion: Labral lesions have been widely diagnosed by THE DIFFERENTIAL DIAGNOSIS imaging examinations, which is mainly due to better knowl- Authors: PADIAL, MB; CASTRO, AA; FONSECA, EKUN; edge of lesions and the development of techniques for non- SANTOS DCBS; ROSEMBERG LA invasive diagnosis. However, the diagnosis of labral lesions Institution: HOSPITAL ISRAELITA ALBERT EINSTEIN may represent a challenge for the radiologist due to the wide Introduction and objective(s): The vertebral column is an variety in their presentations, as well as anatomical variations important axis of corporal sustentation and constitutes the of the glenoid labrum. communication between the central and peripheral nervous Cases of anatomic variants (sublabral recess, sublabral fo- system. Vertebral bone lesions may have a challenging ramen and Buford complex), anteroinferior labral lesions diagnosis, especially those of isolated presentation. The (Bankart, ALPSA, Perthes and GLAD), posteroinferior labral present pictoric essay is a guide that emphasizes the main lesions (reverse Bankart, POLPSA and GLAD) and SLAP le- imaging parameters, which, together with the clinical and sions were reviewed and illustrated. epidemiological data of the patients, are useful to determine Conclusion: The glenoid labrum is an important anatomical or to narrow the differential diagnosis of these lesions. structure in the shoulder joint and may be the site of multiple Method(s): This study is a pictoric essay with a review of injuries causing instability. Although the arthro-MRI study is the literature through a series of cases of our service of the more accurate than conventional MRI, especially in subtypes main bone lesions affecting the spine with image data and of partial labral lesions, it is an invasive and less accepted clinical data to narrow their differential diagnoses. The ob- method than conventional MRI, which also has high sensi- jective of completing the study of this exposition is to ad- tivity and specificity, especially in the equipment of 3.0 T. equately evaluate the image characteristics in the vertebral The present study reviewed the main types of labral lesions lesions in order to determine or narrow the differential diag- and their anatomical variations and illustrated through didac- nosis according to the location (cervical, thoracic or lumbar tic cases their findings in both imaging modalities through a spine and vertebral body or posterior elements), character- pictorial essay. istics (age, symptoms and previous diseases) and presenta- Responsible Author: Adham do Amaral e Castro tion (isolated or diffuse lesions) of each type of lesion. Email: [email protected] Discussion: Among the lesions addressed in the present Keywords: diagnóstico por imagem,sistema muscu- study, the following stand out: hemangioma, osteonecrosis, loesquelético.,ombro chordoma, spondylolysis, aneurysmal bone cyst, osteoblas- toma, metastasis, solitary plasmocytoma, multiple myeloma, PD.15.019 Paget's disease, vertebral body osteomyelitis, osteoid osteo- ma, chondrosarcoma and pedicles hypoplasia. PRINCIPAL PERIPHERAL NEUROPATHIES OF THE Conclusion: Vertebral bone lesions may have a challeng- UPPER LIMB: PICTORIAL ESSAY ing diagnosis, especially those with isolated presentation. Authors: BASTOS, AA; CASTRO, AA; FONSECA, For this reason, the correct analysis of the available imaging EKUN; SANTOS, DCB; ROSEMBERG, LA. tests allows to determine or narrow the differential diagno- Institution: HOSPITAL ISRAELITA ALBERT EINSTEIN sis, in order not to delay the diagnosis, to reduce unnecessary Introduction and objective(s): Compression neuropathies procedures and to anticipate the treatment and to contribute may present with pain and functional deficit with an expected greatly to the health of the patient. The main bone lesions profile for the affected nerve. There are anatomical regions affecting the vertebral bodies were reviewed in the present in which segments of peripheral nerves are vulnerable or study, through illustrative didactic cases. predisposed to become trapped or suffer chronic compres- sion. Neural compression occurs especially in osteofibrous Responsible Author: Adham do Amaral e Castro tunnels, but may occur at points of passage of the peripheral Email: [email protected] nerve through the muscles, along with a band of fibrous tissue Keywords: coluna vertebral, doenças da coluna vertebral, or even extrinsic compressions. The present study reviewed diagnóstico por imagem, sistema musculoesquelético. in an illustrative way the main causes of neuropathies of the upper limb, exemplified by means of a collection of cases of PD.15.018 our service. LABRAL LESIONS OF THE GLENOID: COMPARA- Method(s): This study is a pictorial essay with a review of TIVE PICTORIAL ESSAY OF LESIONS DETECTED the literature through a series of cases from our service of the BY CONVENTIONAL MRI AND ARTHRO-MRI. main neuropathies of the upper limb.
90 49th Sao Paulo Radiological Meeting Discussion: Neuropathies of the main nerves of the upper PD.15.034 limb were reviewed and illustrated: suprascapular nerve, DIFFERENTIAL DIAGNOSIS OF EPIDURAL CYSTIC axillary nerve, radial nerve, median nerve and ulnar nerve. MASSES OF THE SPINE: PICTORIAL ESSAY. Conclusion: Neuropathies of the upper limb may cause sen- Authors: NETO,I.A.C., PESSOA, C.N.G.; OLIVEIRA, sory changes and functional limitation, being the understand- M.F.; JUNIOR, M.A.F.S.; FILHO,P.J.C.M.; LINS, C.F. ing of the anatomy, function, clinical aspects and the findings Institution: DELFIN MEDICINA DIAGNÓSTICA of the radiologist's knowledge image. The present icono- Introduction and objective(s): Spinal epidural cistic masses graphic essay illustrated its main related conditions through are prevalent and easily identified lesions in magnetic res- imaging examinations, focusing on MRI studies. onance imaging (MRI). The differential diagnosis includes: Responsible Author: Adham do Amaral e Castro synovial cysts, cysts of ligamentum flavum, cysts related to Email: [email protected] knterspinous bursitis, arachnoid cysts and discal cysts. This Keywords: diagnóstico por imagem; extremidade superior; pictorial essay discusses the imaging aspects and character- sistema nervoso. istics of the most frequent epidural cystic masses with the utilizations of MRI. PD.15.027 Method(s): Some cases of MRI of the spine of our ULTRASONOGRAPHIC EVALUATION OF THE CAR- service were selected to demonstrate the differ- TILAGINOUS INFANTILE PATELLA, WITH EMPHA- ential diagnosis of epidural cysts, reviewing the SIS ON AGENESIS AND PATELLAR HYPOPLASIA main aspects of imaging and complications of the most Authors: TENÓRIO, L. P.; LINS, C. F.; NOGUEIRA-BAR- frequent situations. BOSA, M. H. Discussion: These lesions represent one of the causes Institution: FACULDADE DE MEDICINA DE RIBEIRÃO for vertebral canal stenosis and lumbar sciatic pain. The PRETO DA UNIVERSIDADE DE SÃO PAULO (FM- recognition of these findings is information that provides RP-USP), ESCOLA BAHIANA DE MEDICINA E SAÚDE specificity to the diagnostic suspicion. Synovial cysts are PÚBLICA (EBMSP) usually related to osteoarthrosis of the interapophysiary, Introduction and objective(s): The absence or hypoplasia more frequently in lower lumbar levels. MRI may present of the patella are rare congenital anomalies that may occur a hypointense capsule in T2 due to calcifications or hemor- alone or as part of some specific syndromes or chromosomal rhages and exhibit peripheral enhancement by gadolinium disorders. Ultrasonography is an efficient tool to evaluate the (Gd) together with the joint. In the context of Baastrup's anatomy of the patella and its changes in neonates. The aim disease, some patients may have interspinous bursitis and of this study is to illustrate the examination protocol and pa- the fluid collections sometimes extends into the postero- tellar abnormalities found in neonates. central epidural space resulting in the cyst. Cysts of liga- Method(s): Retrospective case series selected from the mentum flavum are rare and arise from the anterior margin keywords present at the conclusion of reports of ultrasound of this ligament, resulting from degenerative alterations examinations. Subsequently the images were obtained from or spondylolisthesis. They also exhibit peripheral contrast the digital archive, being selected the most didactic cases enhancement and should be distinguished from synovial and with good documentation of the changes of the patella cysts by topography. The disc cyst is another extremely demonstrated by the ultrasonographic images. rare situation, with few reports in the literature, most com- Discussion: Accurate data on the prevalence of agenesis or monly in men, usually communicating with the interver- patellar hypoplasia in live births are not available and are dif- tebral disc and presenting variable signal in T1, usually ficult to obtain because the patella is completely cartilaginous hypointense, with peripheral contrast enhancement. Final- at birth and its ossification only occurs from the end of the ly, arachnoid cysts result from the dural defect allowing second year. Agenesis / hypoplasia of the patella is mainly the arachnoid membrane and CSF to herniate through the due to developmental defects, but lack of mobility may also dural layer. In MRI the walls are difficult to characterize be involved in its genesis. Patellar malformations may oc- and there is no contrast enhancement. cur soon after birth with external rotation of the tibia, genu Conclusion: There are a variety of distinct cystic formations valgus and flexion contracture. However, in some cases, the in the epidural space, which should be remembered as caus- diagnosis can be postponed until early childhood and, in less es of low back pain and radiculopathy. Thus, the radiologist severe cases, in which the function may be little impaired, should be familiar with the spectrum imaging findings in the diagnosis tends to be even more delayed occurring in late MRI, a method of fundamental importance for the identifica- childhood, adolescence, or even in adulthood. Early diagno- tion, location and characterization of these lesions, narrowing sis in the neonatal phase is important because associated with the differential diagnosis. other changes may increase suspicion for some genetic syn- Responsible Author: IVO ALVES dromes. In addition, early start of treatment may improve the Email: [email protected] Keywords: RessonânciaMagnética,cistosaracnoideos,Dor- development of the knee joint, reducing or avoiding the set Lombar,ColunaVertebral,LigamentoAmarelo,Bursite,Cisto- of late sequelae. Surgical intervention should be timely and Sinovial appropriate to ensure high levels of patient activity. Conclusion: The pictorial essay illustrates the approach of ultrasonographic evaluation of the patella in the neonatal pe- PD.15.036 riod and its clinical correlation. It contributes to the famil- SPINAL EPIDURAL SPACE LESIONS iarization of radiologists with possible patellar ultrasound Authors: DIAS JR, U.S., FERNANDES, R.P., PERDIZES, abnormalities, important for early and correct diagnosis. G.O., MARTINS, R.O., MENEZES, R.S.A.A., MOURA Responsible Author: Leila Pereira Tenório FILHO, J.P., LEITE, C.B.F., ALVES, I.S., CAMERIN, G.R., Email: [email protected] LEITE, C.C., HELITO, P.V.P., BORDALO-RODRIGUES, M. Keywords: PATELA, ULTRASSONOGRAFIA, AGENESIA, Institution: HOSPITAL SÍRIO LIBANÊS HIPOPLASIA Introduction and objective(s): The spinal epidural space
Abstracts of Scientific Papers 91 extends from the foramen magnum to the sacral canal at S2/ changes in staging, treatment, and prognosis. The objective S3 levels. It presents as internal limit the spinal dura mater of this paper is to demonstrate the main characteristics that and as external border several structures that constitute the help us differentiate benign and malignant fractures in the walls of the vertebral canal. main imaging methods - CT, MRI, PET / CT, with pitfalls The objective of this study is to describe the radiological and and propose an algorithm to facilitate this differentiation. anatomopathological aspects of the main differential diagno- Method(s): We will perform an updated review of the imag- ses that affect this space. ing aspects that allow the differentiation between benign and Method(s): A pictorial essay will be carried out on the cases malignant fractures in CT, MRI and PET / CT demonstrated at our service, describing the specific findings and, if it is through our service cases. possible, radio-pathological correlation. Discussion: Imaging methods are fundamental in the distinc- Discussion: The epidural space can be affected by several tion between benign and malignant compression fractures, pathologies, such as hematomas, tumors, infections / ab- with MR being the method of choice with the use of morpho- scesses, degenerative and traumatic lesions, lipomatosis and logical characteristics, signal intensity, enhancement patterns postoperative changes. The correct diagnosis implies in early and the DWI sequences for differentiation. treatment and better surgical and clinical results, as well as Among the aspects that speak in favor of benignity is the oc- the decrease of complications secondary to disease progres- currence of multiple fractures, convex aspect of the posterior sion. The epidural hematomas occur more frequently due wall and areas of medullary preservation. In the pathological to spontaneous venous bleeding. It is important to consider fracture are suggestive findings the presence of soft parts, re- the use of anticoagulants and hemorrhagic disorders. Other striction to diffusion and involvement of posterior elements. causes include trauma, vascular malformations, tumors, and Conclusion: Knowledge of the main imaging characteristics iatrogenic conditions. Several primary tumors and metastases helps us to differentiate between benign and malignant frac- affect the vertebral canal and may extend into the epidural tures, with impact on the diagnosis, treatment and prognosis space. We highlight bone lesions with epidural extension, of the patient. lymphomas and granulocytic sarcoma (chloroma). Responsible Author: RAONNE SOUZA ALMEIDA Degenerative or traumatic lesions, such as fractures, hernias, ALVES MENEZES and disc sequestration happens in higher frequency in the el- Email: [email protected] derly people, leading to painful and debilitating conditions. Keywords: fraturas, benignas, malignas, neoplasia, coluna, Infections / abscesses of the epidural space can lead to rap- vertebral id clinical deterioration due to inflammation and spinal cord compression. Emergency surgery is often a necessary proce- PD.15.055 dure. The access route of the infection occurs by contigui- TRIBUTE TO THE CORONAL: THE IMPORTANCE ty, iatrogenic inoculation and hematogenous dissemination. OF THIS ADDITIONAL SEQUENCE IN THE RESO- Discitis / osteomyelitis causes 80% of cases. Lipomatosis is NANCE OF LUMBAR SPINE the accumulation of fat in the epidural space. It is associated Authors: MOURA FILHO, J.P.; MENEZES, R. S.A.A.; HE- with long-term use of glucocorticoids, Cushing's syndrome LITO, P.V.; LEAO, R.V.; CORREA, M.F.P; BORDALO, M.; and obesity. The involvement AMARAL, D.T.; Conclusion: The knowledge of the main differential diag- Institution: HOSPITAL SÍRIO-LIBANÊS noses that affect the epidural space, and their respective pre- Introduction and objective(s): Back pain with or with- sentations and radiological specificities is essential to a more out radiation into lower limbs is a common problem. accurate diagnosis of these pathologies. Because of the increasing availability of magnetic res- Responsible Author: Ubenicio Silveira Dias Júnior onance imaging (MRI) scanning, patients are more fre- Email: [email protected] quently referred for MRI of the lumbar spine as a first- Keywords: LESÕES, ESPACO, EPIDURAL, COLUNA, line investigation. Despite minimal impact on overall VERTEBRAL acquisition time, routine MRI protocols at many institu- tions do not include coronal imaging, and diagnostically PD.15.046 significant information in a small percentage of patients HOW TO DIFFERENTIATE BENIGN AND MALIG- can be missed. The aim of this study is to demonstrate the NANT VERTEBRAL FRACTURES? range of additional pathologic findings on coronal short Authors: MENEZES, R. S. A. A.; LEÃO, R. V.; ZATTAR, L. tau inversion recovery (STIR) sequences as part of a rou- C.; ALVES, I. S.; FERNANDES, R.P.; CAMERIN, G. R.; FIL- tine MRI protocol of the lumbar spine in patients referred HO, J. P. M.; DIAS JR, U. S.; TAVEIRA, R. B. R.; YAMACHI- for lumbar pain syndrome. RA, V. S.; CORREA, M.F.; CAVALCANTI, C.F.; AMARAL, Method(s): The main pathologies and imaging findings only D.T.; LEITE, C. C.; BORDALO-RODRIGUES, M. seen or best depicted on coronal sequence will be illustrated Institution: HOSPITAL SÍRIO-LIBANÊS and discussed, in the form of presentation of clinical cases Introduction and objective(s): Compressive spine fractures attended at our institution. are common in elderly patients, even without trauma. Oste- Discussion: Addition of coronal STIR imaging to lumbar oporosis is the leading cause of fracture in this age group, spine imaging protocol can depict important findings and about half of them in the vertebral body. The reduction of provide a panoramic abdominal and pelvic view. The major bone mass progresses with age and leads to a fragile bone, extraspinal causes of lumbar pain detectable only on coronal predisposed to fractures. In patients below 50 years of age, plane are most commonly related to sacrum and sacro-iliac trauma is the main cause of vertebral compressive fractures. joints, such as bilateral or unilateral sacroiliitis, sacro-iliac On the other hand, the skeletal system is also the second ma- joint degenerative changes and sacral stress/insufficiency jor metastasis and the spine accounts for 39% of all bone me- fractures. Another causes of back and buttock pain, which tastases, which can result in a pathological fracture. Differen- can be diagnosed with coronal STIR imaging, are coxofemo- tiation between benign and malignant spinal fractures can be ral disease, such as subchondral fractures, coxofemoral joints a diagnostic challenge, especially in older patients, implying degeneration and femoral head osteonecrosis; muscle sprain,
92 49th Sao Paulo Radiological Meeting especially in gluteal muscles; or even conditions evolving ab- Email: [email protected] dominopelvic organs. Keywords: Nômina,Anatomica,Relatorios,Radiologia Conclusion: Coronal STIR sequence, acquired in a lumbar spine MR imaging protocol to investigate lumbar pain, allows PD.15.021 the assessment of musculoskeletal and abdominopelvic imag- THE ANATOMICAL NOMENCLATURE: STANDARD- ing findings relate not included on routine sagittal and axial ISATION OF ANATOMICAL TERMS IN RADIOLOGI- planes. It can provide important information, which can be CAL REPORTS. PART II: LOWER LIMBS useful in early diagnosis and institution of correct treatment. Authors: GUIMARAES, J; RIBEIRO, E; NICO, M; OR- Responsible Author: Jucelio Pereira Moura Filho MOND, A; SANTOS, C; STUMP, X. Email: [email protected] Institution: GRUPO FLEURY; UNIVERSIDADE FEDER- Keywords: coronal,stir,spine AL DE SAO PAULO, ESCOLA PAULISTA DE MEDICINA A brief description of the objective(s): The objective of this panel is to call attention to the standardisation of the anatom- ical terms, following what was established for the latest an- atomical nomenclature of the main parts of musculoskeletal LITERATURE REVIEW system of the lower limbs, and thus making a guide of the correct and standardised anatomical nomenclature enabling adequate descriptions of the anatomical structures in radiol- DIGITAL PRESENTATION (PD) ogy reports. Description of the disease(s), method(s) and/or tech- nique(s): Since a radiological report is a universal document, PD.15.020 it is advocated that the correct and standardised anatomical terms should be used, following the anatomical nomenclature THE ANATOMICAL NOMENCLATURE: STANDARD- of 1997. ISATION OF ANATOMICAL TERMS IN RADIOLOGI- Discussion: In over a century of meetings, many changes CAL REPORTS. PART I: UPPER LIMBS have been discussed and approved, and Brazil has also partic- Authors: GUIMARAES, J; RIBEIRO, E; NICO, M; OR- ipated in standardising the anatomical terms. Brazilian anat- MOND, A; EZZEDDINE, O; STUMP, X. omists participated on the subject during the XIII meeting in Institution: GRUPO FLEURY; UNIVERSIDADE FEDER- 1989 in Rio de Janeiro and in 1997 in São Paulo, with Liber- AL DE SAO PAULO, ESCOLA PAULISTA DE MEDICINA ato Di Dio, considered the father of the anatomical nomen- A brief description of the objective(s): The objective of this clature, having the utmost importance in the changes made to panel is to call attention to the standardisation of the anatom- the terminology. Although many attempts have been made, ical terms, following what was established for the latest an- the changes are not well embraced by the healthcare profes- atomical nomenclature of the main parts of musculoskeletal sionals and the reason for this may be due to the fact that system of the upper limbs, and thus making a guide of the the changes were made during anatomy meetings and most correct and standardised anatomical nomenclature enabling of the healthcare professionals, radiologists included, do not adequate descriptions of the anatomical structures in radiol- keep up to date. This causes terminology discrepancies to be ogy reports. a common finding in radiological reports, thus negatively im- Description of the disease(s), method(s) and/or tech- pacting the communication between colleagues from differ- nique(s): Since a radiological report is a universal document, ent areas. it is advocated that the correct and standardised anatomical Conclusion: The anatomical nomenclature is a universal terms should be used, following the anatomical nomenclature document elaborated in order to try and unify the anatomical of 1997. terms, thus enhancing the description and function of each Discussion: In over a century of meetings, many changes and every part of the human body, making it easier for doc- have been discussed and approved, and Brazil has also par- tors from different medical areas to speak the same language, ticipated in standardising the anatomical terms. Brazilian specially in a country the size of Brazil. anatomists participated on the subject during the XIII meet- Responsible Author: Julio Guimaraes ing in 1989 in Rio de Janeiro and in 1997 in São Paulo, with Email: [email protected] Liberato Di Dio, considered the father of the anatomical Keywords: Nomina,Anatomica,Relatorio,Radiologia nomenclature, having the utmost importance in the chang- es made to the terminology. Although many attempts have been made, the changes are not well embraced by the health- PD.15.022 care professionals and the reason for this may be due to the THE ANATOMICAL NOMENCLATURE: STANDARD- fact that the changes were made during anatomy meetings ISATION OF ANATOMICAL TERMS IN RADIOLOGI- and most of the healthcare professionals, radiologists in- CAL REPORTS. PART III: HIPS AND SPINE cluded, do not keep up to date. This causes terminology dis- Authors: GUIMARAES, J; RIBEIRO, E; NICO, M; OR- crepancies to be a common finding in radiological reports, MOND, A; ARRUDA, P; STUMP, X. thus negatively impacting the communication between col- Institution: GRUPO FLEURY; UNIVERSIDADE FEDER- leagues from different areas. AL DE SAO PAULO, ESCOLA PAULISTA DE MEDICINA Conclusion: The anatomical nomenclature is a universal A brief description of the objective(s): The objective of this document elaborated in order to try and unify the anatomical panel is to call attention to the standardisation of the anatom- terms, thus enhancing the description and function of each ical terms, following what was established for the latest an- and every part of the human body, making it easier for doc- atomical nomenclature of the main parts of musculoskeletal tors from different medical areas to speak the same language, system of the hips and spine, and thus making a guide of the specially in a country the size of Brazil. correct and standardised anatomical nomenclature enabling Responsible Author: Julio Guimaraes adequate descriptions of the anatomical structures in radiol-
Abstracts of Scientific Papers 93 ogy reports. began 2 weeks af-ter seeking medical attention. The pain was Description of the disease(s), method(s) and/or tech- associated with edema and reduced range of motion. A physi- nique(s): Since a radiological report is a universal document, cal examination showed mild fever, reduction of passive, and it is advocated that the correct and standardised anatomical active right thigh movement, with increased temperature of terms should be used, following the anatomical nomenclature the limb, close to the knee joint. The patient’s medical history of 1997. was collected with his father and did not include neoplastic Discussion: In over a century of meetings, many changes disease or prior surgery. have been discussed and approved, and Brazil has also partic- Discussion and diagnosis: Magnetic resonance imaging ipated in standardising the anatomical terms. Brazilian anat- (MRI) findings of acute osteomyelitis vary from non-spe- omists participated on the subject during the XIII meeting in cific bone marrow edema to more reliable signs such as 1989 in Rio de Janeiro and in 1997 in São Paulo, with Liber- bone destruction,periosteal reaction, and sequestrum. In ato Di Dio, considered the father of the anatomical nomen- some cases, imaging features could overlap with oth- clature, having the utmost importance in the changes made to er conditions such as trauma and bone tumors. Intra and the terminology. Although many attempts have been made, extramedullary fat globules are a helpful MRI marker for the changes are not well embraced by the healthcare profes- osteomyelitis, as shown in this case report. The main im- sionals and the reason for this may be due to the fact that aging findings of our patient on MRI were bone marrow the changes were made during anatomy meetings and most edema, with intra-medullary fat globules, and subperioste- of the healthcare professionals, radiologists included, do not al collection with extra-medullary fat globules. There was keep up to date. This causes terminology discrepancies to be also an increase in local soft tissues and small joint effusion a common finding in radiological reports, thus negatively im- with associated synovitis. After MRI the patient underwent pacting the communication between colleagues from differ- medial arthrotomy of the knee, with partial synovectomy ent areas. resulting from culture positive for enterococci, confirming Conclusion: The anatomical nomenclature is a universal the diagnosis of infection. document elaborated in order to try and unify the anatomical Conclusion: The presence of intramedullary and extramed- terms, thus enhancing the description and function of each ullary fat globules has been described as a radiological signal and every part of the human body, making it easier for doc- that although rare, when present in an adequate clinical con- tors from different medical areas to speak the same language, text, corroborates the diagnosis of infection. specially in a country the size of Brazil. Responsible Author: LIVIA SANTANA OLIVEIRA Responsible Author: Julio Guimaraes Email: [email protected] Email: [email protected] Keywords: FAT GLOBULES,acute osteomyelitis,infec- Keywords: nomina,anatomica,radiologia,relatorio tion.,bone PD.15.008 OSTEOARTICULAR MANIFESTATIONS IN MUCO- POLYSACCHARIDOSES: CASE REPORTS AND LIT- CASE REPORT ERATURE REVIEW Authors: OLIVEIRA, E. K.; TENORIO, L. P.; PESSOA, C. N. G.; ROCHA, C. A.; BARBOSA, C. A. S.; ALVES, V. O.; LINS, C. F. DIGITAL PRESENTATION (PD) Institution: HOSPITAL GERAL ROBERTO SANTOS - BAHIA CLINICA DELFIN - BAHIA PD.15.003 A brief description of the objective(s): As rare genetic INTRA AND EXTRAMEDULLARY FAT GLOBULES diseases, mucopolysaccharidoses (MPS) are caused by AT MRI AS A RADIOLOGY SIGN FOR ACUTE OS- the deficiency of enzymes involved in the degradation of TEOMYELITIS DIAGNOSIS glycosaminoglycans (GAG), promoting their intralisosom- Authors: OLIVEIRA,L.S.; GODOY,I.R.B.; YAMADA,A.F.; al accumulation. Thus, accumulation of GAG occurs in LUNDBERG,J.S.; MARUICHI,M.D.; SKAF,A. several organs, leading to chronic degeneration of cells, Institution: DEPARTMENT OF RADIOLOGY, HOSPITAL especially the skeletal system, liver, spleen, heart, eyes DO CORAÇÃO (HCOR) AND TELEIMAGEM, 53, 7TH and central nervous system. The objective of this work is FLOOR. CEP 04004-030, SÃO PAULO, SP BRAZIL to show the main results of MPS evaluation through radi- A brief description of the objective(s): Osteomyelitis ography and magnetic resonance imaging (MRI), through usually affects the end of the long bones of children and literature review. adolescents due to their low blood flow, which leads to in- Clinical History: Male patient, 6 years old, with syndromic fection. The differential diagnosis between osteomyelitis characteristics such as dwarfism, kyphosis, hand deformity and bone tumor, especially in the pediatric age group, can and macrocrania was in outpatient investigation with geneti- be challenging for the radiologist. The presence of intra- cist, who requested radiographies from axial skeleton, pelvis, medullary and extramedullary fat globules on magnetic hips, hands, knees and skull. The other patient is male, 15 resonance imaging (MRI) are suggestive signs of acute years old, with a diagnosis of MPS type VI, attending to the osteomyelitis in a suitable clinical setting. The objective reduction of the motor capacity and movement of upper and of this study is to report a case of acute osteomyelitis with lower limbs, besides sleep apnea. intramedullary and extramedullary fat globules on mag- Discussion and diagnosis: The first case showed the most netic resonance imaging as a radiological signal of acute evident radiographic changes in platispondilia with anterior osteomyelitis. tapering of vertebral bodies, enlarged ribs in oar, rounded Clinical History: A 15-year-old young man presented with iliac wings with lower tapering, valga thigh, short and wide intense pain in the right lower limb, mainly in the thigh, that metacarpuses with pointed proximal ends, having a diagno-
94 49th Sao Paulo Radiological Meeting sis of Mucopolysaccharidosis, confirmed by the geneticist. PD.15.043 In the second case, abnormalities such as odontoid hypo- BONE PARACOCCIDIOIDOMYCOSIS WITH PUL- plasia, thickening of the periodontoid tissue, platibasia, MONARY INVOLVEMENT SIMULATING A PRIMA- basilar invagination and stenosis of the spinal canal with RY METASTATIC BONE TUMOUR: A CASE REPORT spinal compression were identified by MRI. MPS are rare Authors: DA SILVA, T.P.F; MEIRA, M.S.; PARASKEVO- diseases, most of them autosomal recessive. Several types POULOS, D.K.S.; BARBOSA, P.N.V.P. Institution: A.C. CAMARGO CANCER CENTER of the disease are differentiated through enzyme deficiency, A brief description of the objective(s): To report and dis- affected gene and phenotypic characteristics. Radiography cuss a case of bone paracoccidioidomycosis with pulmonary and MRI are important to characterize the osteoarticular involvement, which simulated a high-grade primary bone tu- and neurological manifestations, helping to establish the mour with possible lung metastasis. The particularities of the diagnosis, as well as its complications early. The role of case were correlated with information gathered from current MRI of the cervical spine is highlighted because it allows literature on the topic. Clinical History: A 15 year-old male patient from the coun- the diagnosis of life threatening conditions such as canal tryside of São Paulo reported to the hospital with the com- stenosis, compression of the respiratory center and reduc- plaint of ankle pain, cervical adenomegaly and weight loss tion of the cavum aerial column. for a month, with the recent onset dyspnea. Past medical re- Conclusion: Thus, it is important that radiologists recognize the cords were unremarkable. imaging findings in MPS, facilitating their diagnosis and ade- Discussion and diagnosis: Diagnostic workup was per- quate therapeutic behavior, avoiding unnecessary morbidity. formed with multiple modality imaging; including plain ra- Responsible Author: Emilie Kruschewsky Oliveira diography, bone scintigraphy (BS), computed-tomography scan (CT-scan) and magnetic resonance imaging (MRI). The Email: [email protected] set of radiological findings suggested high grade bone pa- Keywords: MUCOPOLISSACARIDOSE, MUSCU- thology, extending to adjacent soft tissues and including the LOESQUELÉTICO, RADIOGRAFIA, RESSONÂNCIA possibility of secondary lung involvement, characterized by multiple pulmonary parenchymal nodules. Bone biopsy was PD.15.038 then required to bring clarification to the case, and revealed granulomatous inflammatory process; histological analysis REGIONAL MIGRATORY OSTEOPOROSIS: A RE- of the sample was diagnostic to the infection by Paracoccus VIEW ILLUSTRATED BY ONE CASE. brasiliensis. Follow-up after adequate therapy showed com- Authors: OLIVEIRA, G. H. N.; SOARES, A.R.G. plete clinical response and gradual resolution of the radio- Institution: HOSPITAL MADRE TERESA logical findings. A brief description of the objective(s): The radiological Conclusion: Skeletal lesions in paracoccidioidomy- features of the disease obtained by conventional radiogra- cosis are among the less common presentations of the disease. When present, the majority of reports in the phy, CT, MRI and radionuclide scintigraphy are illustrated current medical literature describe it as a osteolytic, by means of one case report. well defined lesion with low-grade radiological aggres- Clinical History: A 60-year-old male patient started with sivity features. In the presented case, regional and dis- right ankle pain three years ago. Magnetic Resonance (MR) tant organ involvement by the fungal disease demanded evidenced an important bone edema in distal aspect of the further investigation with interventional procedure to right ankle. After two years, there was pain in the left ankle exclude the possibility of a primary bone tumour with secondary involvement. and in MR, significant bone edema was noted in the talus. Responsible Author: THIAGO PEREIRA FERNANDES After two months, new complaining, now in left forefoot. DA SILVA MRI showed important bone edema at the base and proximal Email: [email protected] region of the first, second and third metatarsal bodies. One Keywords: Paracoccidioidomicose,osteomielite,doença fún- year ago, there was pain in the left inguinal region and func- gica,biópsia óssea.,Paracoccidioidomycosis,osteomyelitis,- tional limitation. At MR, there was exuberant bone edema fungal disease,bone biopsy in femoral head region, extending distally to the neck and intertrochanteric region of the proximal femur. PD.15.057 Discussion and diagnosis: Regional migratory osteoporosis KNEE ARTHROPATHY RELATED TO RELAPSING is an uncommon disorder that predominantly affects mid- POLYCHONDRITIS: A DIAGNOSTIC CHALLENGE. Authors: SILVA JUNIOR C. L.; COIMBRA, B. M.; CUPO- dle-aged males, presenting as migrating arthralgia involving LILO N. E.; CAMPOS, C. L.; MARTINS M. M.; ALCAN- the lower extremities. It is a transient condition that involves TARA, G. G. R.; MARCOS N. V. joints without preexisting disease and resolves spontaneously Institution: HOSPITAL UNIVERSITÁRIO DA UNI- without long-term sequelae. VERSIDADE FEDERAL DE JUIZ DE FORA - MINAS Conclusion: We describe a classic of Regional migratory os- GERAIS, BRASIL. teoporosis of long duration, which was during the follow-up A brief description of the objective(s): The objective of this period, it was possible to establish this diagnosis. study is to report a case of knee arthropathy related to redi- cidal polychondritis, which is quite infrequent in the disease. Responsible Author: guilherme henrique naves de oliveira To date, we have found only one similar case reported in the Email: [email protected] literature. Keywords: Regional migratory osteoporosis,Magnetic Res- Clinical History: Male patient, 18 years old, admitted with onance,bone edema recurrent respiratory symptoms. On physical examination,
Abstracts of Scientific Papers 95 auricular deformities, nasal bridge collapse and glaucoma with oligo or polyarticular distribution, and should be con- were observed. Computed tomography of the initial thorax sidered as differential diagnoses among the causes of acute demonstrated parietal calcifications of the trachea and bron- oligo/monoatrites in young patients. Conventional radiogra- chi, sparing its posterior wall, as well as calcifications in the phy may be normal at the beginning of the disease. RM can cricoid and thyroid cartilages. At follow-up, the patient de- evaluate the inflammation of the perichondral ring, consid- veloped recurrent arthralgia in the knees. The simple x-ray ered one of the most characteristic alterations of the relapsing of the knees showed a morphostructural alteration of the polychondritis, as it was presented by the patient. condyles and tibial plateaus. The magnetic resonance (MRI) Conclusion: Recurrent polychondritis is a disease with difficult di- study characterized the presence of inflammatory changes in agnosis due to the variety of manifestations and the low incidence the perichondral ring topographies and chondroepiphysial in clinical practice. Knee arthropathy related to polychondritis is a regions of the distal and proximal tibiae. There was no evi- rare finding, proving to be a diagnostic challenge, even for special- dence of joint effusion or significant synovitis. Laboratory tests revealed negative infectious serologies, as ists in musculoskeletal radiology. MRI has an important role in the well as non-reactive rheumatoid factor and antinuclear factor. diagnosis of this case, once it is able to identify perichondral and Discussion and diagnosis: Two of the six original diagnostic chondroepiphysial inflammation (a characteristic finding in this criteria described pertain to findings that can be identified by disease), and the radiologist must be aware of such image patterns. the radiologist: arthropathy and respiratory tract chondritis Responsible Author: CILMARIO LEITE DA SILVA JÚNIOR Arthritis in polychondritis has been described as episodic, Email: [email protected] seronegative, non-erosive, non-deforming and asymmetric, Keywords: Relapsing polychondritis,MRI,Child
RADIOLOGICAL TECHNIQUES ORIGINAL PAPER CareDose 4D activated and triggered in the total acquisition. In protocol B, the trigeminal phase, which covers the entire thoracic aorta, was used with 120kV and 160 mAs (ref) with activated 4D CareDose and a second acquisition that covers DIGITAL PRESENTATION (PD) the abdominal aorta, without trigger, with the same reference dose and with CareDose 4D activated. Results and discussion: The data demonstrated a reduction PD.16.011 of approximately 50% of effective dose of ionizing radiation REDUCTION OF IONIZING RADIATION DOSE IN with mean of DLP of 2327.30 in protocol A, totaling 34.9 COMPUTED TOMOGRAPHY EXAMINATIONS FOR mSv and 1115.28 in protocol B with 16.72 mSv, with mean TRIPLE RULE OUT WITH EXTENSION FOR AB- of density of 429 and 431 HU, respectively. DOMINAL AORTA Conclusion: The optimized protocol provides a considerable Authors: BERTOLAZZI, P.; SILVA, C.F.G.; OLIVEIRA, dose reduction, maintaining image quality in CT studies for F.F.; VIANA, P.C.C. triple rule out with extension to the abdominal aorta accord- Institution: HOSPITAL SIRIO LIBANÊS/ SIEMENS ing to the radiologists involved. HEALTHINEERS Responsible Author: Pâmela Bertolazzi A brief description of the objective(s): The triple rule out Email: [email protected] examination is a diagnostic option in Computed Tomography Keywords: TriploDescarte,TC,RadiaçãoIonizante (CT), which can provide relevant information for the screen- ing of patients with acute chest pain, including pulmonary, PD.16.013 coronary and aortic arteries, with the consequent exclusion of acute coronary syndromes, aorta and pulmonary embolism, ADDITIONAL FINDINGS OF MAGNETIC RESO- leading to a differential diagnosis. Also in this context, eval- NANCE IN PATIENTS WITH BREAST CANCER uation of the abdominal aorta is also necessary to character- Authors: SOUSA, J.C.O ;VIEIRA,S.C. ize the extent of eventual aortic dissection. The rational use Institution: NÚCLEO DE PESQUISA CIENTIFICA E of ionizing radiation is in increasing discussion, according to ACADÊMICA DE RADIOLOGIA (NPCAR) ALARA principles. Therefore, this prospective study aims to A brief description of the objective(s): Imaging methods compare different techniques of CT acquisition for triple rule are essential in the screening and diagnosis of breast cancer. out with extension to the abdominal aorta as the effective dose Magnetic resonance imaging (MRI) corresponds to a com- of ionizing radiation and diagnostic quality of tomographic plementary noninvasive mammary propaedeutic method image. that works satisfactorily in breast cancer to: discrimination Material(s) and method(s): Between January 2018 and June between different subtypes; evaluation of the effectiveness 2018, all patients who had previous exams of the same mo- of applied neoplastic therapies; the collection of tumor mor- dality with the conventional protocol (Protocol A) within a phological information, and the determination of data on the maximum of 5 previous years and had no exclusion criteria anatomical areas adjacent to the tumor, among others. This were included. Therefore, the sample number is 55 patients, study aims at listing and discussing the series of additional 36 men and 19 women, aged 36 to 84 years. The examina- data that magnetic resonance imaging makes available in the tions were performed in the 128-channel single source scan- evaluation of breast cancer. ner. In protocol A, 120kV and 210 mAs (ref) were used with Material(s) and method(s): This is a retrospective study of the
96 49th Sao Paulo Radiological Meeting electronic medical record and images of 100 breast tumors in an Keywords: modelo,computacional,tórax,pediátrico,fantoma oncological diagnosis clinic between October and November of 2018. Patients older than 30 years of age who were given MRI to gather the largest amount of information possible despite mam- ORAL PRESENTATION (TL) mary tumors. In order to constitute a study of greater scientific relevance, MRI data were associated with findings clinical and laboratory. TL.16.001 Results and discussion: The mean age of the patients was HUMANIZED PROTOCOL IN THE IMPLEMENTA- 50 years of age, ranging from 33 to 70 years. The ductal TION OF MAMMOGRAPHY: PROTOTYPE CON- infiltrating carcinoma was predominant in 95 cases (90% STITUTION AND CONTRIBUTION FOR INTERPER- of the sample) and with the HER2-positive sample. With SONAL AND INTERSETORIAL IMPROVEMENTS the application of paramagnetic contrast, the MR allowed Authors: SOUSA, J.C.O ;VIDAL,J.C.S. the determination of the tumor diameter: the presence of tu- Institution: NÚCLEO DE PESQUISA CIENTIFICA E mors of 1.5 cm (90 cases). It was observed that MRI identi- ACADÊMICA DE RADIOLOGIA (NPCAR) fied additional and multiple lesions in 53 patients (53%), 34 A brief description of the objective(s): Health and emotions in the same breast and 19 in the opposite breast. The iden- are closely linked. Performing a mammogram presents a po- tification of additional lesions by MRI allowed: elucidation tentially disturbing situation and biopsychosocial reactions can of malignancy or not; indication of biopsy or not; and the disrupt the performance of the examination. Biopsychosocial alteration of the therapeutic plan to be implanted with the reactions may interfere with the quality of the mammography patients of the sample. However, it should be noted that the examination, making diagnosis difficult. Mammography is additional lesions identified by MRI were not previously still referred to as a painful and uncomfortable situation re- visualized on mammography. lated to the physical context and examination procedures. The Conclusion: It was concluded from the study that breast MRI health professional must consider that each person is unique was more accurate than conventional examinations in assess- and unequaled, with all its biological, psychological, social, ing the size of the main tumor and the ability to identify ad- intellectual and emotional aspects that make up and that at no ditional lesions. time can be forgotten. The elaboration of a clinical protocol Responsible Author: Joyce Caroline acts in the restructuring of the health services and guarantees Email: [email protected] integral care to the patient and this research aims to develop Keywords: ADDITIONAL FINDINGS;,MAGNETIC RES- a prototype clinical protocol contemplating the humanization ONANCE;,BREAST CANCER; and the well being of the patient submitted to mammography as a guiding question and main focus of this protocol . PD.16.015 Material(s) and method(s): The study contemplates two methodological pathways: integrative review (BVS and SCI- PEDIATRIC CHEST COMPUTATIONAL MODELS ELO publications selected by health descriptors: "humaniza- FOR RADIATION DOSIMETRY APPLICATION tion" and "mammography") and development research that Authors: VIEIRA, M. P. M. M.; BANDEIRA, C. K. consists of the elaboration of a prototype clinical protocol Institution: INSTITUTO FEDERAL DO PARANÁ - IFPR performed in December 2017.A elaboration of the prototype UNIVERSIDADE TECNOLÓGICA FEDERAL DO protocol for humanization in mammography contemplated PARANÁ - UTFPR theories of the National Humanization Policy (PNH), reports A brief description of the objective(s): Virtual phantoms of experience and scientific articles on humanization in health have been shown to be of great value for estimating doses re- services. ceived by patients in radiological procedures and also for the Results and discussion: Structurally, the protocol brings to- simulation of radiographic images. In this context, the aim of gether a series of actions to be carried out by the radiodiag- this work is to develop pediatric thorax computational mod- nostic professional during mammography previously related els comprising the age range between neonate and ten years, in flowcharts of interrelated axes distributed: identification of which will serve as the basis for the development of pediatric the profile of the patient / behavior of the professional, char- chest computational phantoms. acterization of mammography, humanized practices. Material(s) and method(s): The pediatric chest computa- Conclusion: The adoption of humanistic practice in mam- tional models were constructed in the free software Blender mography favors the establishment of an interpersonal re- 3D from primitive geometric forms consisting of mesh sur- lationship between the radiodiagnosis professional and the faces. The technique used was blueprint and the images used patient. The development of a protocol prototype for human- were obtained from pediatric anatomical atlases. ization during mammography should be considered: it is pos- Results and discussion: The developed models consist of two sible to measure the need for reinforcement of the guidelines lungs, heart, thymus, trachea, bronchi, esophagus, costal arches educational services to clients and care staff; practical expe- and skin surface. Each structure was modeled from a different rience of SUS principles; establishment and redirection of ac- primitive, but in the same virtual environment, so that the mod- tions of health intervention and evaluation of public policies els had the same scale. The image rendering feature available related to women (when necessary). in the software made it possible to simulate radiographic imag- Responsible Author: Joyce Caroline es to verify the position of the elaborated structures. Email: [email protected] Conclusion: The anatomical structures modeled are compatible Keywords: Mammography;,Biopsychosocial Reactions;,Patient; with those of individuals in the age range from zero to ten years. This computational model of the thorax has potential to be used as phantom, from the application of algorithms that can allow TL.16.002 the simulation of radiographic images and estimation of doses PERCUTANEOUS NEPHROSTOMY VERSUS ANTE- received by pediatric patients in radiological examinations. GRADE DOUBLE-J STENT PLACEMENT IN THE Responsible Author: Caroline Kretezel Bandeira TREATMENT OF MALIGNANT OBSTRUCTIVE Email: [email protected] UROPATHY: A COST-EFFECTIVENESS ANALYSIS
Abstracts of Scientific Papers 97 FROM THE PERSPECTIVE OF THE BRAZILIAN of images. To demonstrate the contribution of tomographic PUBLIC HEALTH SERVICE reconstruction algorithms to the quality of CT images. Authors: TIBANA, T.K.; GRUBERT, R.M.; NEVES, Method(s): It is a basic, exploratory, bibliographical and T.M.H.; SANTI, G.F.; KLAESENER, C.; NUNES, T.F. qualitative approach. The research took place in two distinct Institution: HOSPITAL UNIVERSITARIO - UFMS phases: literature review and pictorial review. The literature A brief description of the objective(s): To compare the review for the theoretical basis of the study. The pictorial cost-effectiveness of two percutaneous techniques used in the review included CT images from clinical cases submitted treatment of obstructive uropathy - antegrade double-J stent to reconstruction for association of practice and theory as a (JJ) placement versus percutaneous nephrostomy (PN) - from learning mechanism. the perspective of the Brazilian public health system Discussion: The quality of CT images depends on two types Material(s) and method(s): In this cost-effectiveness anal- of interrelated parameters: dose-related parameters and pa- ysis by decision analytic modeling, material costs were cal- rameters that are related to the processing and visualization culated from 2017 factory prices listed by the Brazilian Drug of the tomographic image. Digital image processing on CT Market Regulation Chamber (for medicines) and published aims to improve the characteristics of an image and covers a in Revista Simpro (for medical devices). Procedure-related wide range of hardware, software and theoretical foundations. costs and technical and clinical success rates were evaluated. Tomographic reconstructions act as image processing mecha- These measures were then used as inputs for a cost-effective- nisms and allow: reconstructing, projecting images in different ness analysis comparing the two procedures. planes; (MPR), Maximum, Minimum and Average Intensity Results and discussion: The sample consisted of 41 patients, of Projection (MIP / MiniP / Average) and the use of 3D images. whom 16 underwent 26 antegrade JJ placement procedures and This technique allows the visualization of internal details of 10 underwent 15 percutaneous nephrostomies. Patient records, the patient without surgery. The tomographic reconstruction radiology reports, and expense reports of the interventional techniques are fundamentally of three groups: Multiplanar radiology service of the public hospital where the study was Reconstruction (three-dimensional view). The MPR technique conducted were retrospectively analyzed. There were no signif- allows reconstructing images for other viewing planes from a icant complications; one patient had low back pain and one had single series contributing to the visualization of the structures a transient retroperitoneal hematoma. The mean procedure time in three-dimensional form. The MIP / mIP / Medium technique was 24 minutes, and clinical success (improvement in serum allows applying intensity attenuation to structures to manip- creatinine and resolution of hydronephrosis) was achieved in ulate images of TC, and 3D provides the three-dimensional 100% of cases. The average cost of JJ placement (US$159.00) view of the area or body segment under study. was significantly lower than that of PN (US$536.00) Conclusion: The importance of tomographic reconstructions Conclusion: In the absence of any clinical contraindications, as a mechanism to improve CT image quality by promoting antegrade JJ stent placement is a suitable alternative to both qualitative improvements in the images and facilitating the PN and retrograde stenting in patients with dilated renal col- observation of anatomical structures with high resolution. lecting systems secondary to malignant ureteric obstruction, Responsible Author: Joyce Caroline providing significant cost savings and high success rates. Email: [email protected] Responsible Author: THIAGO NUNES Keywords: Digital Image;,Tomographic Reconstruction;,- Email: [email protected] Computed tomography. Keywords: Análise custo-efetividade; radiologia interven- cionista; nefrostomia percutânea; stent. PI.16.007 THE IMPACT OF CHANGES IN PARAMETERS IN KNEES MAGNETIC RESONANCE: A PICTORIAL ESSAY Authors: BUGES, C. B.; OTANI, L. H.; BORGES, J. Institution: UNICESUMAR PICTORIAL ESSAY Introduction and objective(s): Currently, magnetic reso- nance imaging (MRI) is considered the examination of choice for investigation of images of the knee joint. This study aims to review the literature and demonstrate with images the im- POSTERS (PI) pact of the isolated change of each of the parameters on the final image obtained in the MRI of the knee. Method(s): Individual changes were made in each of the dif- PI.16.004 ferent parameters of a knee MRI, each variation of the image TOMOGRÁFICAS RECONSTRUÇÕES AS IMPROVE- obtained were compared to others and to the control sequence MENT OF THE QUALITY OF IMAGES IN COMPUT- in order to observe the changes obtained. The modified pa- ERIZED TOMOGRAPHY: PICTÓRICO TEST AND rameters were the field of view (FOV), thickness, matrix LITERATURE REVIEW and number of excitations (NEX). The repetition time and Authors: SOUSA, J.C. O; VIDAL,J,C.S.; RÊGO,J.C.M. echo-time (TR and TE) were not changed. The device used is Institution: NÚCLEO DE PESQUISA CIENTIFICA E manufactured by GE, model Optima 450w, with 1.5 Tesla of ACADÊMICA DE RADIOLOGIA (NPCAR) power. The sequence chosen for demonstration was Coronal Introduction and objective(s):The quality of the digital im- T2 with fat saturation. We selected a voluntary patient, 33 age has a direct influence on the ability to identify and delin- years old, male, asymptomatic and with no surgical history in eate the structures important for the diagnosis establishment. the joint, he was placed in dorsal decubitus with slight exter- The processing of digital images in Computed Tomography nal rotation of the right knee (about 5 degrees), and the knee (CT) aims to improve the characteristics of an image for bet- coil was used. ter visualization and human interpretation. The tomographic Discussion: The optimal fit of the parameters of each se- reconstructions correspond to algorithms of image processing quence is dependent on the anatomical structure to be ana- that promote the optimization of the operations of treatment lyzed in the examination, since the adjustment in one fac-
98 49th Sao Paulo Radiological Meeting tor alters another. In the sagittal or coronal planes of a knee Conclusion: Because of the importance of UroTc for the examination, the cut thickness of 4 mm or less is required diagnosis and precocity of UroTc, in order to avoid worse to demonstrate subtle pathologies of the meniscus, finer cuts complications, it is necessary to deepen the UroTc differen- may be advantageous for detailed analyzes of other struc- tial role in Xanthogranulomatous Pyelonephritis. tures, such as articular cartilage. As a result of this decrease Responsible Author: Juan carlos Soares Vidal vidal in the thickness of the cut, it is necessary to resort to alter- Email: [email protected] ations of other parameters, aiming to maintain the quality of Keywords: XANTOGRANULOMATOSA, PIELONEFRITE, the image, since thinner cuts bring reduction of signal noise UROTOMOGRAFIA, CÁLCULO, HIDRONEFROSE ratio. Increasing FOV, reducing the Matrix, or increasing the NEX may mitigate this. Conclusion: The knowledge of the parameters that affect the image quality in the MR exam, as well as its choice is fundamental to obtain the best possible image according to the structure to be analyzed, resulting in a more satisfactory DIGITAL PRESENTATION (PD) diagnosis and treatment. Responsible Author: Carolina Buges Email: [email protected] PD.16.014 Keywords: Ressonância Magnética,Articulação do joel- DYNAMIC PROTOCOL OF COMPUTERIZED TO- ho,Parâmetros,Artefatos MOGRAPHY OF HYPOPHYSIS FOR THE ASSESS- MENT OF MICRODENOMAS OF SELA TÚRCICA: PI.16.016 PICTÓRICO TEST ALLIANCE THE LITERARY RE- VIEW OF ANATOMIC CONCEPTS THE IMPORTATION OF THE NO DIAGNOSTIC Authors: SOUSA,J.C.O;BOAS,C.A.A.V.;BOAS,A.G.V.;VI UROTOMOGRAPHY OF PIELONEFRITE XANTO- GRANULOMATOSA "PATA DE URSO" SIGN. DAL,J.C.S. Authors: VIDAL, J.C.S.; SOUSA, J.C.O.; SILVA, A.M.L.; Institution: NÚCLEO DE PESQUISA CIENTIFICA E GREGORIO, J.L.; GREGORIO, D.L.; RIBEIRO, M.S.S.N. ACADÊMICA DE RADIOLOGIA (NPCAR) Institution: HOSPITAL DE EMERGÊNCIA E TRAUMA Introduction and objective(s): The region of the túrcica DON LUIZ GONZAGA FERNANDES saddle can be affected by tumors of primary nature empha- NÚCLEO DE PESQUISA CIENTIFICA E ACADÊMICA sizing the pituitary adenomas. Pituitary adenomas are rela- DE RADIOLOGIA ( NPCAR) tively common benign and incipient tumors; the importance Introduction and objective(s): Xanthogranulomatous py- of the imaging exams for the previous classification based on elonephritis (PNX) is an uncommon chronic inflammatory the tumor dimensions in microadenomas or macroadenomas process that occurs in the kidney, leading to a destruction of is emphasized. Dynamical computed tomography of the pi- the renal parenchyma, being more recurrent. This pathology tuitary gland predominates in the suspicion of microadeno- can be caused by recurrent obstructions of the pielocalicial mas because it provides information such as: bone limit of system, infections or inflammations, being more frequent the túrcica saddle; evaluation of deformities or of solutions in women. The presence of fistulas and kidney stones is a of continuity in the sealing floor. This study aims to elicit trigger for the development of this benign condition, which knowledge despite the performance of CT in the diagnosis can be confused with malignant diseases, such as renal cell of pituitary microadenomas to discuss the dynamic protocol carcinoma. Objective: This study aims to discuss the clinical of the pituitary gland and perform the anatomical review of findings of the imaging study used in the case to facilitate the terms related to the topic. diagnosis of other patients. Method(s): Pictorial study contemplating an imaging ex- Method(s): Men, 40 years admitted with abdominal pains, amination of a patient submitted to a dynamic CT scan of the fever, weight loss with episodes of hematuria. Urotomogra- pituitary gland to establish a diagnosis of possible pituitary phy (Uro Tc) was the method chosen for diagnostic investi- microadenomas. The review of anatomical terminologies gation of the kidneys. Nephrographically (90 seconds) and for previous insertion in the field of study was discussed. excretory (5minutes), together with its reconstructions, it was Discussion: Pituitary microadenomas are characterized by tu- possible to observe the corneal calculus in the right kidney mor size less than 10 mm correlated to: hormonal activity; type associated to the important hydronephrosis (xanthogranulo- of hormone produced; and degree of extension in the turkish matous pyelonephritis) with an important inflammatory pro- saddle. Dynamic CT of the pituitary gland is performed with cess in the retroperitoneum, evidencing mass effect by com- the patient in dorsal decubitus (DD) and face up (Head First / pressing and moving the liver, aorta, inferior vena cava and Face UP) with acquisition of the images in: without contrast pancreas to the left. and post administration of the contrast in sequences of du- Discussion: PNX was first described in 1916 by Schlagen- ration in seconds: 0, 30 , 60, 90, 120 and 180 (known as dy- haufer and is characterized as chronic and granulomatous namic phases), this will allow the visualization of the pituitary renal inflammation, accompanied by leukocytosis and ane- microadenomas by means of a three dimensional image and mia. The disease can be divided into focal, segmental or will allow the evaluation of the turcica saddle through the pre- diffuse. UroTc is the gold standard for the diagnosis of this vious analysis of its dimensions in the skeletal class: sagittal comorbidity, and it is also important to differentiate it from and coronal plane (multiplying the length, depth, width and other pathologies. Findings such as dilated non-operant kid- dividing by two: (C x P x L) \ 2). In routine CT images with ney, central calculus in contracted renal pelvis, expansion contrast, pituitary microadenomas are often indistinguishable of calyces, and inflammatory changes in perinephric fat are from pituitary tissue due to isoatention. suggestive of PNX. For patients with focal PNX, treatment Conclusion: Dynamic CT of the pituitary gland effective- is restricted to the use of antibiotics; in cases of diffuse or ly acts in the identification of pituitary microadenomas by segmental PNX with advanced pictures, the nephrectomy listing information from the pituitary gland and allowing the procedure is indicated. distinction of pituitary tissue from alleged lesions.
Abstracts of Scientific Papers 99 Responsible Author: Joyce Caroline Responsible Author: Joyce Caroline Email: [email protected] Email: [email protected] Keywords: SELA TÚRCICA;,HYPOPHYSIS ;,DYNAMIC Keywords: DOSIMETRIC REDUCTION ;,COMPUTER- PROTOCOL ;,MICROADENOMAS; IZED TOMOGRAPHY:;,CLINICAL PROTOCOL;
PI.16.006 RAPID PROTOTYPING WITH COMPUTERIZED TO- MOGRAPHY IMAGES IN THE MEDICAL AREA LITERATURE REVIEW Authors: SOUSA, J.C.O ; RÊGO,J.C.M.;VIDAL,J.C.S;BAR- ROS,I. C. Institution: NÚCLEO DE PESQUISA CIENTIFICA E POSTERS (PI) ACADÊMICA DE RADIOLOGIA (NPCAR) A brief description of the objective(s): Rapid Prototyping is conceptualized as an additive and constructive process PI.16.005 where layer-by-layer overlap occurs, resulting in objects of ELABORATION OF A PROTOTYPE CLINICAL PRO- complex and solid shapes, the biomodels. The Rapid Proto- TOCOL DOSIMÉTRICA REDUCTION IN COMPUT- typing biomodels are biomedical prototypes originated from ERIZED TOMOGRAPHY: BASES AND PRESENTA- computed tomography (CT), magnetic resonance imaging TION OF PRACTICAL-THERMAL ELEMENTS and ultrasound imaging being used for: didactic purposes, Authors: SOUSA, J.C.O ;VIDAL,J.C.S.; RÊGO,J.C.M the manufacture of personalized prosthetic implants and the Institution: NÚCLEO DE PESQUISA CIENTIFICA E early diagnosis of pathologies. are two-dimensional images ACADÊMICA DE RADIOLOGIA (NPCAR) made up of pixels and have DICOM extension (representing A brief description of the objective(s): Computed tomog- the tissues evaluated through different gray intensities); how- raphy (CT) examination subjects the patient to a higher dose ever, these DICOM files can not be directly used by the rapid of radiation, however, it presents inherent risks and its use prototyping equipment and previous processing is necessary should weigh the cost and benefit of the procedure. The final in order to obtaining 3D representations through reconstruc- quality of the CT imaging produced must have a high amount tion programs. This study aims to discuss rapid prototyping of information the lowest possible dose deposited in the pa- encompassing: methods; the contribution of TC and applica- tient. The elaboration of a prototype of clinical protocol in CT tions in the medical field. that combines imaginative quality allied with the dosimetric Description of the disease(s), method(s) and/or tech- reduction will contribute to raise the level of safety in the care nique(s): The data obtained for this bibliographic review to the patient. The objective of this study was to elaborate a were collected from the electronic database: PUBMED, LI- protocol prototype in a CT (called PPRTC) with diagnostic LACS and SCIELO. When you finished the search on each guarantee and with plausible benefits to the patient. database, duplicate references were deleted. Scientific pub- Description of the disease(s), method(s) and/or tech- lications were selected in the English and Portuguese lan- nique(s): The study included 3 methodological courses: guages ??with the following descriptors: rapid prototyping; literary review (theoretical basis for BVS, BIREME and computed tomography; medicine used jointly or separately. The bibliographic scope included: scientific articles; field SCIELO publications selected by health descriptors: "radi- surveys; dissertations; among others published without es- ation dose" and "computed tomography"); and development tablished temporal cut. research (elaboration of a prototype clinical protocol) carried Discussion: For the use of CT images in the manufacture of out in May 2018. The elaboration of the PPRTC included medical prototyping biomodels it is necessary to possess the the theoretical constitution: camp surveys; articles of literary same: good quality and high spatial resolution. CT images are revision; doctoral theses and master's degrees, experimental processed with dedicated software, which allows the separa- studies with PHATOM (phantom) and documents and / or tion of the different tissues (epithelial, bone) and obtaining resolutions focused on radiological protection. The whole a file compatible with the existing technologies for manu- methodology seeks to associate theory with the daily practi- facturing biomodels. Rapid prototyping works effectively in cal reality of a TC sector. the medical field, contributing to the diagnosis, planning and Discussion: Computed tomography (CT) dosimetry involves simulation of surgeries. the determination of specific CT dosimetry quantities up to Conclusion: The rapid prototyping medical biomodels pro- the estimation of absorbed dose and effective dose. Struc- vide a series of benefits to the patient and to the health pro- turally, the PPRTC brings together a series of actions to be fessional: assisting in the diagnosis and surgical planning; in- performed by the radiodiagnostic professional during a relat- crease precision and speed in surgical procedures; reduction ed CT examination in interrelated baseline flowcharts: pro- of surgical risks; decrease in hospital time and costs; stimu- fessional, equipment and patient. The PPRTC's purpose is to late confidence and improvements in patient comfort. congregate: diagnostic quality, CT and patient benefits. Due Responsible Author: Joyce Caroline to the increase in the frequency of CT scans and the dose Email: [email protected] of radiation supplied, the execution and implantation of this Keywords: Rapid Prototyping;,Computed Tomography;, protocol prototype is justified. Pathologies; Conclusion: The development of a protocol prototype in TC allows: to measure the need for execution of radiological pro- tection practices aimed at patients and care staff; practical ex- PI.16.008 perience of the ALARA (As Low As Reasonably Achievable) APPLICATION OF MAGNETIC RESONANCE SPEC- principle and to initiate in the work environment the discus- TROSCOPY sion and implementation of measures capable of reducing the Authors: FILIPPI, E.R. dose of radiation in CT. Institution: UNICAMP
100 49th Sao Paulo Radiological Meeting A brief description of the objective(s): Nuclear Magnetic equipment (EPI), we have the food in our favor. To demon- Resonance Spectroscopy is a research technique that explores strate the benefits of vitamins and especially vitamin Ein the magnetic properties of certain atomic nuclei to determine our body as a radiological protective agent, reducing tissue the physical or chemical properties of the atoms or molecules damage and minimizing the deleterious effects of exposure in which they are contained. to ionizing radiation. Description of the disease(s), method(s) and/or tech- Description of the disease(s), method(s) and/or tech- nique(s): The Magnetic Resonance Spectroscopy (ERM) nique(s): This study was developed using the narrative re- technique allows to obtain chemical information of the tis- view method and had as materials 8 articles. sues based on the same physical principle of the conventional Discussion: The use of vitamin E as a radiological protector images. The resonance frequency of the hydrogen (proton) proved to be effective since it acts in conjunction with the depends on the intensity of the magnetic field to which it is cellular repair process. It is also able to inhibit the growth of subjected and its physicochemical interactions with the other malignant cells, and above all, it is an efficient antioxidant, atoms and contiguous molecules. Hydrogen protons bound which works in conjunction with other cellular antioxidants. to different particles have different resonance frequencies It is also noted that when worked with other vitamins brings according to the position of the hydrogen in this molecule. an even more effective result, since vitamin C regenerates lost Similarly, each metabolite will have a characteristic spectrum vitamin E, and vitamin A potentiates its antioxidant power. according to the resonance frequencies of its protons, which Conclusion: Although all articles studied have positive re- will allow its ready and unequivocal identification by the po- sults, the professionals' knowledge regarding this topic is still sition of the peaks in the graph, as in a "fingerprint" a true limited. And for this, it is necessary to research on the level spectroscopic "signature". of knowledge of the professionals on this subject, since, the Discussion: Proton spectroscopy analyzes three-dimension- daily consumption of vitamins is essential for the body, es- al samples (voxel). According to voxel, spectroscopy can be pecially for professionals engaged in radiological practices. divided into single voxel and multiple voxel. For a substance Responsible Author: Andressa Caron Brey to be detected by proton spectroscopy, its concentration must Email: [email protected] be greater than 0.5 -1.0 mmol / l. The metabolites identified Keywords: vitaminaE,radioprotetor,alimentação by the spectroscopy are: N-acetyl-aspartate, choline, total creatine, myo-inositol, glutamate / glutamine, lactate and lip- ids. To perform the metabolic reading, the voxel is positioned over the area of the tissue to be studied and subsequently processed, thus generating a graph with the values of each metallic present in the tissue in question. DIGITAL PRESENTATION (PD) Conclusion: Magnetic resonance spectroscopy (MRA) is a technique that has received increasing attention from radiol- ogists and in particular from neuroradiologists, neurologists PD.16.007 and psychiatrists. The main indications for central nervous EVALUATION OF CRANIOENCEPHALIC TRAUMA- system spectroscopy include: Subclinical hepatic enceph- TISM AND COMPUTERIZED TOMOGRAPHY alopathy and pre-transplantation evaluation, differential Authors: BARROS, E. P. S.; OLIVEIRA, D. G.; BARROS, diagnosis of dementia syndromes, neoplastic monitoring, N. M. neonatal hypoxia, inborn errors of metabolism, evaluation of Institution: FACULDADE SETE DE SETEMBRO ischemic cerebral vascular accidents, prognostic evaluation A brief description of the objective(s): Cranioencephalic of severe trauma, surgical planning of temporal lobe epilepsy, trauma (TBI) is an injury to the brain caused by external muscular diseases , HIV encephalitis. forces that can cause changes in the skull, brain or meninges, Differential diagnosis of white matter diseases, especially of a physical, behavioral or social order for an indeterminate multiple sclerosis, adrenoleukodystrophy, canavan and en- time. Among the causes are car accidents and sports caused cephalopathies related to HIV. by young people, being responsible for the high rate of mor- Responsible Author: Ederson Filippi bidity and mortality. It is estimated that its incidence ranges Email: [email protected] from 100 to 300 per 100,000 inhabitants, and that around Keywords: ressonancia,magnética 100,000 people have severe neurological sequelae resulting from TBI and is considered a public health problem. Tomog- PI.16.011 raphy is the imaging test performed in emergencies in vic- USE OF VITAMIN E AS RADIOPROTECTOR tims of head trauma, the tomographic images emitted pres- Authors: BRAGANÇA, R.S.S; SKROCK,N.R.; BOM- ent the changes that are usually related to the severity of the FIM,M.H.; BREY,A.C. lesion.The objective of this work is to discuss the evaluation Institution: SENAC-PR of TBI through the Glasgow Coma Scale and the importance A brief description of the objective(s): Both nowadays of performing Tomography in the identification of lesions. and in the past, professionals have been suffering from the Description of the disease(s), method(s) and/or tech- damage of ionizing radiation in their body. These effects nique(s): It is a narrative study, developed through a bib- are mainly mediated by free radicals, which are generated liographical review of contents between the years 2011 to by interaction with water. These oxidants are highly reactive 2018. The electronic search strategy was carried out in the and can cause cell death. Consequently, patients and profes- following databases Scientific Electronic Library Online sionals end up developing diseases and living without know- (SCIELO), LILACS (Latin American Literature and of the ing what to do to prevent this disease. For this, radiological Caribbean in Health Sciences) and Google Scholar, in Portu- protection standards were created in the radiology services, guese and English. and to expand this area, bringing to the professionals an ad- Discussion: CT is the most commonly used standard imag- dition to the radiological protection, several researches point ing test in emergency care for the rapid diagnosis of traumat- out that besides the correct use of the individual protection ic brain injury patients, being determinant for the choice of
Abstracts of Scientific Papers 101 therapeutic or surgical management, allowing the specific di- PD.16.016 agnosis, intervention measures and monitoring of the clinical USE OF DIFFUSION TECHNIQUE (DWI) AND MAP picture, besides the study of the encephalic anatomy, of the APPROACHES OF DIFFUSION APPROACH (ADC) lesions and their consequences deriving from the trauma. The OF MAGNETIC RESONANCE IN ENDOMETRIC CT provides sharp images and information on tissue density, CARCINOMA STABILIZATION displacement, cartilage and muscle, providing an apparatus Authors: SOUSA, J.C.O ;VIDAL,J.C.S.; RÊGO,J.C.M for the identification of brain lesions. Institution: NÚCLEO DE PESQUISA CIENTIFICA E Conclusion: Computed tomography is the most advanta- ACADÊMICA DE RADIOLOGIA (NPCAR) geous imaging test to be performed in cases of traumatic A brief description of the objective(s): Imaging methods brain injury, since it has low cost, wide availability, fast ex- have gained relevance in preoperative assessment and surgi- ecution and study, satisfactory results and sensitivity for the cal planning in EC. Magnetic resonance imaging (MRI) pro- detection of intracranial abnormalities, providing important vides pre-operative information of one of the most important diagnostic information and prognosis of patients with TBI, prognostic factors in EC: the depth of myometrial invasion. being extremely important to CT in hospital settings. The use of the diffusion technique (DWI) associated with Responsible Author: EVERTON PHILIPE DA SILVA the apparent diffusion coefficient map (ADC) in endometrial BARROS MRI allows the detection of peritoneal and ganglionic dis- Email: [email protected] semination of the neoplasia. It is intended to report how the Keywords: Escala de Glasgow; Tomografia Computadoriza- diffusion technique and MRI of MRI is relevant in the estab- da; Traumatismo Cranioencefalico. lishment of CE staging. Description of the disease(s), method(s) and/or tech- nique(s): It is a literature review of 10 scientific publications PD.16.009 originating in the databases SCIELO, BVS and PUBMED COMPARATIVE STUDY BETWEEN CONVENTION- from February to April, 2018. The descriptors used in the re- AL AND DIGITAL RADIOGRAPHIC SYSTEMS search were: Endometrial Staging associated with the term Authors: SANTOS, R. V.; BOLINELLI, A. P.; JABOUR, V. magnetic resonance. The bibliographic sample was estab- A.; MORAIS, A. E. Q. lished according to their inclusion in the following inclusion Institution: HOSPITAL ESTADUAL VILA ALPINA criteria: Portuguese language; contemplate the theme and A brief description of the objective(s): The emergence of meet the objectives of the study. digital radiology systems has provided many benefits to pa- Discussion: The magnetic resonance imaging (MRI) in the tients and professionals. Digital images can be stored and CE plays a determining role in the patient's risk stratification transferred via the internet and manipulated using computer and in the definition of the surgical protocol due to its high programs without the need to expose the patient to ionizing spatial resolution and contrast for the pelvic tissues and or- radiation again. These possibilities make the exams faster gans. In the CE, the DWI allows the mandatory application of and more efficient, with images visualization almost simul- intravenous contrast and acts in the detection of: very small taneous to the acquisition, when compared to conventional tumors at the initial stage with minimal endometrial thicken- radiology. Thus, this paper aims to clarify the main differ- ing and peritoneal dissemination (high reproducibility in the ences between conventional and digital radiology systems, to evaluation of muscle-tendon structures. acts prominently in determine the most efficient system, taking into account their the CE in the detection of ganglionar invasion and in obtain- respective advantages and disadvantages ing data on the degree of tumor differentiation and the depth Description of the disease(s), method(s) and/or tech- of myometrial invasion. nique(s): Scientific articles were analyzed through anex- Conclusion: MRI through the diffusion and mapping of ADC, although not officially incorporated by FIGO as a neo- haustive review of the literature for a detailed comparative plastic staging mechanism, is the best imaging in terms of ac- analysis between existing radiographic systems. curacy for: planning and therapeutic follow-up; lymph node Discussion: Some studies show that the doses absorbed by involvement and evaluation of tumor extension and volume the patients submitted to digital radiography - Thorax pro- in the EC due to its high sensitivity and specificity. cedure - are significantly higher than the doses in conven- Responsible Author: Joyce Caroline tional systems, and can reach a 288% increase in the Intake Email: [email protected] dose on the skin (DEP) of the patient. In the literature, it is Keywords: DIFFUSION;,MAP APPROACHES OF DIF- also observed in another study with patients performing the FUSION APPROACH (ADC) ;,MAGNETIC RESO- same incidence, that the conventional system increases the NANCE;,ENDOMETRIC CARCINOMA; DEP by up to 57.91% in relation to digital. However, the digital radiological system has more benefits for patients, professionals and the environment when compared to con- ventional radiology. Conclusion: Through the multi-center studies and analyzes of bibliographic databases, it was concluded that the digital radiological system presents more benefits to patients, pro- fessionals and the environment, when compared to conven- tional radiology. Responsible Author: ROMULO VIANA DOS SANTOS Email: [email protected] Keywords: Bisossegurança,radiologia,digital,convenciona- l,estudo,comparativo
102 49th Sao Paulo Radiological Meeting CHEST ORIGINAL PAPER PD.17.024 RADIOMICS IN THE EVALUATION OF SUBSOLID NODULES TO PREDICT TUMOR INVASIVENESS OF PULMONARY ADENOCARCINOMAS: INITIAL EX- DIGITAL PRESENTATION (PD) PERIENCE OF 10 CASES Authors: TELES, GBS; PAIVA, OA; FASSBENDER, CPB; PD.17.006 CHATE, RC; SZARF, G; FUNARI, MBG Institution: HOSPITAL ISRAELITA ALBERT EINSTEIN LUNG-RADS USED IN LUNG CANCER SCREEN- A brief description of the objective(s): To assess whether ING: DOES GRANULOMATOUS DISEASE MAKE A the use of Radiomics in the evaluation of subsolid lung nod- DIFFERENCE? INITIAL RESULTS AT A BRAZILIAN ules may complement the radiologist's subjective assessment CENTER. to differentiate invasive and pre-invasive (in situ and mini- Authors: GUIMARÃES, M.D.; CHULAM, T.C.; HADD- mally invasive) adenocarcinomas. AD, F.J.; BARBOSA, P.N.; BITTENCOURT, A.; TYNG, Material(s) and method(s): Anatomopathological reports of C.J.; NOSCHANG, J.; CHAVES, K.C.B.; FOLADOR, J.B.; all primary pulmonary adenocarcinomas with lepidic compo- GROSS, J.L. nent submitted to complete surgical excision between 2011 Institution: A.C. CAMAGO CANCER CENTER and 2018 in a private hospital were evaluated. Of these, 5 A brief description of the objective(s): The aim of this invasive adenocarcinomas and 5 pre-invasive adenocarcino- study was to analyze the outcomes of low-dose computed mas with chest CT or PET / CT performed at the institution tomography (LDCT) lung cancer screening using Lung CT up to 3 months before surgery were randomly selected. A Screening Reporting and Data System (Lung-RADS) at a thoracic radiologist with 15 years of experience, without the Brazilian cancer center. knowledge of anatomopathological diagnosis, evaluated the Material(s) and method(s): We retrospectively reviewed nodules in relation to their morphological characteristics and the medical records of patients submitted to baseline LDCT classified the lesions as invasive or pre-invasive. The nodules lung cancer screening program at XXX. The average effec- were segmented using the 3D Slicer software and Radiomics tive dose of 0.30 mSv and mean Dose Length Product (DLP) parameters were extracted using Python 3.6 programming of 21.3 mGy/cm2. The inclusion and exclusion criteria were language. Another radiologist without previous knowledge of the same as those for the National Lung Cancer Screening the cases performed the analysis of the parameters obtained. Trial (NLST). The criteria for image findings were those clas- Results and discussion: The mean nodule size was 1.6 cm in sified according to Lung Imaging Reporting and Data System both invasive adenocarcinomas and pre-invasive adenocarci- (Lung-RADS) assessment categories. nomas (2 adenocarcinomas in situ and 3 minimally invasive Results and discussion: From May 2016 to April 2017, adenocarcinomas). The radiologist correctly classified the 552 individuals submitted to baseline LCDT lung cancer nodules in 8 of the 10 cases (80%), and 2 invasive adeno- screening program. Of these individuals, 265 patients were carcinomas confirmed in the anatomopathological study were not included. The remaining 287 individuals matched the classified as pre-invasive in the subjective radiological eval- NLST inclusion and exclusion criteria, showing a mean age uation. Several radiometric parameters were able to correctly of 61.7 years. The proportion of current smokers was 99.6% differentiate the 10 nodules and it was possible to divide the (286 participants) with a mean of 45.3 pack-year. Most pa- cases into two groups with 100% accuracy in an unsuper- tients (n=207; 72.1%) had a negative screening CT (Lung- vised learning analysis. RADS categories 1 or 2). The remaining 80 individuals Conclusion: Radiological differentiation of subsolid pulmo- showed positive screening CT, considering 5.6% in Lung- nary nodules in invasive and pre-invasive adenocarcinomas RADS category 4A, 2.1% in category 4B and 1.0% in cate- is very important in the selection of patients who must un- gory 4X. The major findings were evaluated in 218 (75.9%) dergo surgery and the type of surgery to be performed. Sev- individuals, presenting solid (64.8%), part solid (2.7%) and eral morphological features of the nodules can be used for nonsolid nodules (8.3%). Patients in Lung-RADS catego- this purpose, but have limited accuracy and high variability ry 4A (n=9) had a CT follow-up and most of them (n=7) among observers. Radiomics analysis may help to noninva- showed stable findings and in two patient the nodules in- sively predict the heterogeneity and behavior of lung nodules. creased in size on follow-up LCDT. Histologic results con- Our pilot study showed that it seems possible to differentiate firmed lung cancer in 2 cases (prevalence of 0.7% ofall the nodules in invasive and pre-invasive using radiomic pa- screened patients). rameters. It will be necessary to include more cases to obtain Conclusion: LC prevalence in our study was compatible a quantitative model for lesion differentiation. with the literature. However, we had a higher prevalence of Responsible Author: Gustavo Teles Lung-RADS categories 3 and 4A than expected. This may be Email: [email protected] associated with a higher incidence of granulomatous disease, Keywords: nódulo,pulmonar,subsólido,radiomics,adenocar- especially tuberculosis, in the Brazilian population. cinoma Responsible Author: Karen Chaves Email: [email protected] Keywords: tomografia, computadorizada, câncer de pulmão, rastreamento
Abstracts of Scientific Papers 103 ORAL PRESENTATION (TL) TL.17.002 BRONCHIOLOCENTRIC INTERSTITIAL PNEUMO- NIA: CORRELATION WITH SIGNS OF ESOPHAGEAL TL.17.001 DISEASE AND POSSIBLE BRONCHOASPIRATION BRONCHIOLOCENTRIC INTERSTITIAL PNEUMO- Authors: LOURENÇO MR, MACHADO CVB, WADA DT, NIA: TOMOGRAPHIC PATTERNS OF BRONCHO- SANCHES IB, ALVES LR, CIPRIANO FEG, FABRO AT, PULMONARY ABNORMALITIES. MARTINEZ JAB, KOENIGKAM-SANTOS M. Authors: MACHADO C.V.B., LOURENÇO M.R., SANCH- Institution: HOSPITAL DAS CLÍNICAS DA FACUL- ES I.B., WADA D.T., PADUA A.I., NADAI T.R., BADDI- DADE DE MEDICINA DE RIBEIRÃO PRETO - UNIVER- NI-MARTINEZ J.A., FABRO A.T., KOENIGKAM-SAN- SIDADE DE SÃO PAULO. TOS M. A brief description of the objective(s): To describe the to- Institution: HOSPITAL DAS CLÍNICAS DA FACUL- mographic findings of esophageal disease in patients with DADE DE MEDICINA DE RIBEIRÃO PRETO - UNIVER- bronchiolocentric interstitial pneumonia (BIP), correlating SIDADE DE SÃO PAULO with clinical and laboratory data. A brief description of the objective(s): To describe the to- Material(s) and method(s): This was a retrospective obser- mographic findings in patients with bronchiolocentric inter- vational study of patients with pathological diagnosis of BIP, stitial pneumonia (BIP) and to correlate them with clinical evaluated by high resolution computed tomography (HRCT). data and multidisciplinary diagnosis. Signs of esophagopathy on HRCT (coronal diameter great- Material(s) and method(s): This was a retrospective ob- er than 1.0 cm in at least two thirds, or presence of liquid servational study of patients with pathological diagnosis of / alimentary stasis) and hiatal gastric hernia was evaluated BIP, evaluated by high resolution computed tomography by two experienced thoracic radiologists. Clinical complaints (HRCT). CT images were reviewed separately by 2 resi- related to dyspepsia, gastroesophageal reflux and aspiration, dent physicians and 2 experienced thoracic radiologists, results of upper gastrointestinal endoscopy (UGIE), pHmetry with final decision obtained by consensus. It was evaluated: and findings of peptic necrosis on pulmonary biopsies were classification according to ATS/ERS 2018 (usual interstitial reviewed. Tomographic findings on the lungs were reviewed pneumonia - UIP, probable or undetermined for UIP, alter- separately by 2 resident physicians and 2 experienced thorac- native diagnosis), if alternative diagnosis, which specific ic radiologists, with the final decision obtained by consensus. pattern (e.g. non-specific interstitial pneumonia - NSIP) or Results and discussion: 29 patients were included (17 men, uncharacteristic pattern; presence of ground-glass opacities, age 62 ± 7 years) and 22 had criteria for esophageal disease reticulations, honeycombing, consolidations, centrilobular on HRCT, characterized by esophageal dilation in 7, fluid / nodules, tree-in-bud opacities, mosaic attenuation, air trap- alimentary stasis in 1, gastric hiatal hernia in 4 or by the com- ping, “headcheese sign”, bronchial impactions, non-honey- bination of these findings in 10. Among this 22 patients, 50% combing cysts, bronchiectasis, “elongated bronchus sign”, had complaints of dyspepsia / dysphagia and 33% showed apex-basal gradient and intra- and inter-lung distribution. necrosis on pulmonary biopsy. Nine patients underwent Patients electronic records and registry of the multidisci- UGIE, which was positive for reflux and / or hiatal hernia in plinary discussions were reviewed. 22%. Among patients with normal UGIE, but with an import- Results and discussion: 29 patients were included (17 ant clinical suspicion, 3 were submitted to pHmetry that was men, age 62 ± 7 years), with 28 patients classified as "al- positive for gastroesophageal reflux. The group of patients ternative diagnosis", 26 of them showing an "uncharacter- with signs of esophageal disease on HRCT exhibited a higher istic" pattern. The most frequent findings observed in 3 or prevalence of abnormalities in lower lobes (46% versus 14%) more lobes were: mosaic attenuation, air trapping, ground and asymmetric pulmonary distribution (R x L) of findings glass opacities, reticulations and bronchiectasis. The sign (46% versus 0%). Bronchial impactions and small airway of the elongated bronchus was observed in 16 cases. Re- opacities were infrequent. garding to distribution, 17 had diffuse lung disease and 16 Conclusion: BIP is a form of fibrosing interstitial lung dis- had central and peripheral abnormalities. Twenty-eight pa- ease (ILD) with few studies that has been associated, among tients were discussed at a multidisciplinary meeting, with a others, with chronic bronchoaspiration and hypersensitivity variety of diagnoses, including: hypersensitivity pneumo- pneumonia. Among our patients, 76% showed tomograph- nia (HP), chronic bronchoaspiration, interstitial pneumonia ic signs of esophageal disease, considered a risk factor for with autoimmune features, drug toxicity and collagen-vas- aspiration. In these patients, bronchopulmonary abnormali- cular diseases. In only 8 patients, the multidisciplinary ties were more frequently inferior and asymmetric. The true team had reached a definitive diagnosis (higher degree of meaning of these findings in the context of ILD still needs to confidence), including 3 HP and 3 chronic bronchoaspira- be established. tion cases. Responsible Author: Mateus Repolês Lourenço Conclusion: BIP is a form of fibrosing interstitial lung Email: [email protected] disease with only a few studies, representing a diagnostic Keywords: BRONCHIOLOCENTRIC INTERSTITIAL challenge. In this study, the most characteristic tomograph- PNEUMONIA,ESOPHAGEAL DISEASE,BRONCHO- ic pattern was diffuse disease (upper and lower lobes), ASPIRATION involving central (peribronchial) and peripheral regions, with mosaic attenuation, ground glass opacities, reticu- TL.17.003 lations, bronchiectasis and air trapping at expiration. The MAIN IMAGING FINDINGS OF GRANULOMA- elongated bronchus sign may represent a characteristic of TOUS DISEASES IN PATIENTS WHO UNDERWENT high specificity. LUNG BIOPSY Responsible Author: Camila Vilas Boas Machado Authors: OLIVEIRA, C. V.; ROMÃO, D.; RASSI, M. B.; Email: [email protected] LEITE, C. B. F.; TESTAGROSSA, L. D. A.; CERRI, G. G.; Keywords: PIB,PH,TÓRAX,TOMOGRAFIA HORVAT, N.; CHI, C. K.; LEE, H. J.
104 49th Sao Paulo Radiological Meeting Institution: HOSPITAL SÍRIO-LIBANÊS, SÃO PAULO - stratified according to the risk for PE. PE was detected in BRASIL. 164 (16,5%) of the patients, but 61 patients of these were A brief description of the objective(s): Granulomatous lung excluded because of motion and breathing artifacts, unavail- diseases (GLD) comprise a broad spectrum of infectious and able non-enhanced volumetric acquisition or missing data. non-infectious diseases. The objective of this study is to de- Results were submited to statistical analysis, and were sig- termine the incidence and the main radiological patterns of nificant with P<0,05. each etiology in patients with biopsy proven GLD in our in- Results and discussion: Spontaneous perception of clots stitution. was recognized in 17 patients (17%), being high density clots Material(s) and method(s): This is a retrospective obser- in 13, low density clots in 4 patients, and one patient in the vational study, approved by the Research Ethics Committee, last group with a calcified clot. Pulmonary infarctions were which evaluated all patients with biopsy proven GLD be- observed in 9 patients (53%). Interlobar descending arteries tween January 2014 and December 2017 in a tertiary hospi- were more frequently involved, specially the right interlobar tal, totaling 88 cases . Those without chest CT prior to biopsy descending (76,4%) Bivariated statistical analysis showed were excluded, leaving 75 patients. Two radiologists, who significant correlation of spontaneous detection of clots and were blinded to the histopathological findings, evaluated the central trombi, pulmonary artery trunk diameter < 2,9 cm and images following a pre-established form, and in cases of dis- age < 49 years, but in multivariated analysis only the pres- agreement, a third expert radiologist re-evaluated the results ence of central clots persisted significative. to reach a consensus. The data were represented by absolute Conclusion: We concluded that, in a non negligible amount frequency (n) and relative frequency (%) and the contingency of patients, spontaneous visualization of clots in non-en- matrices were analyzed by Pearson's Chi-square test. hanced acquisitions may be feasible, that there is significative Results and discussion: Infectious etiologies were the most correlation of this finding and the presence of central clots, prevalent (47/75, 62.7%), led by Histoplasmosis (27/75, being more frequent in the right interlobar descending artery, 36%) and Tuberculosis (7/75, 9.3%). The non-infectious and may be present in patients without pulmonary infarction, causes totaled 13.3% (10/75) and the indeterminate by the bi- highlighting the importance of its identification. opsy added 24% (18/75). The main radiological pattern was Responsible Author: Pedro Paulo Teixeira e Silva Torres nodular in 65.3% of all cases of PGD (49/75), and in 92.6% Email: [email protected] of cases of histoplasmosis (25/27). The focal distribution is Keywords: tromboembolismo, pulmonar, tomografia, com- strongly associated with histoplasmosis (p <0.05), while the putadorizada centrilobular micronodular pattern and excavation favor tu- berculosis (p <0.05). TL.17.005 Conclusion: Infectious granulomatous lung diseases are en- EVALUATING THE CURRENT CLASSIFICATION demic in our country, represented mainly by the fungal and FOR PULMONARY CHANGES AFTER STEREO- mycobacterial etiologies. TACTIC BODY RADIATION THERAPY (SBRT) FOR In patients with low probability of malignancy, GLD should LUNG CANCER: IS BIOPSY REQUIRED TO PRE- be considered in the differential diagnosis, especially in cas- DICT PULMONARY ACTINIC CHANGES? es of solitary pulmonary nodule investigation, which was Authors: GUERREIRO, NFC; GIASSI, K; OLIVEIRA, strongly associated with histoplasmosis in our study. BSP; SCHOEN, K; HORVAT, N; LEE, HJ; CHI, CK; J; MI- Responsible Author: Camila Vilela de Oliveira RANDA, F; ABREU, CEV. Email: [email protected] Institution: HOSPITAL SÍRIO-LIBANÊS Keywords: Lung, Tórax, Tomografia, Tomography, Bióp- A brief description of the objective(s): To assess the repro- sia, Biopsy, Estatística, Statistics, Infecção, Infecction, In- ducibility of the current classification of post-SBRT pulmo- flamação, Inflammation, Granuloma nary changes and to compare the CT lung actinic changes between patients with lung cancer that were submitted to a TL.17.004 lung biopsy and those who did not have a lung biopsy before VISUALIZATION OF ARTERIAL CLOTS IN UNEN- the treatment with SBRT. HANCED TOMOGRAPHY IN PATIENTS WITH PUL- Material(s) and method(s): In this IRB-approved retrospec- MONARY THROMBOEMBOLISM: FREQUENCY, tive study, 98 patients treated with SBRT at our institution CHARACTERISTICS AND CORRELATION WITH from 2007 to 2018 were included. The exclusion criteria are PULMONARY INFARCTION VISUALIZATION displayed at the flowchart. Two blinded radiologists assessed Authors: TORES, PPTS; MANÇANO AD; RABAHI MF; the images (1 and 7 years of experience) at two time points MARCHIORI E. after SBRT: early follow-up (first 6 months), and late (= 6 Institution: MULTIMAGEM DIAGNÓSTICOS, RADIO- months). Findings were classified as expected CT changes LOGIA ANCHIETA after SBRT according the current classification or sugges- A brief description of the objective(s): Pulmonary em- tive of recurrence. Expected changes on early period (Figure bolism (PE) is a frequent condition, which may complicate 1): diffuse or patchy consolidation, diffuse or patchy GGO. with death and chronic hypertensive pulmonary embolism Expected changes on late period (Figure 2): modified con- (CHPE). Considering that clinical diagnosis is challenging, ventional pattern, scar-like or mass-like patterns of fibrosis. a number of patients may be referred to non-enhanced com- Recurrence findings (Figure 3): enlarging opacity, bulging puted tomography scans attempting to evaluate acute pulmo- margins, loss of air bronchogram. Patients were classified in nary conditions. Our goal is to evaluate how often clots can two groups: with and without a confirmed histology by biop- be spontaneously characterized in the non-enhanced CT scans sy. CT findings were assessed with the two groups compared as a part of a computed tomography pulmonary angiography by McNemar test, and the interobserver agreement was tested (CTPA) protocol, also describing its characteristics and cor- by Kappa and Wilcoxon statistics. relating it to the presence of pulmonary infarction. Results and discussion: In our preliminary results, 30 Material(s) and method(s): A total of 993 CTPA were per- women and 68 men with mean age of 75,3 (+ /- 8,9) years formed between January 2010 and December 2014 and were old were included. Total and per fraction SBRT doses were
Abstracts of Scientific Papers 105 5,060.5 (+/-570) cGy and 1,583.3 (+/-334) cGy. Kappa val- PICTORIAL ESSAY ues demonstrated a strong agreement (>0,85) between the readers, except for diffuse consolidation in the first period of evaluation (k =0,65). Findings are displayed in Table 1. CT findings demonstrated no difference between patients with or DIGITAL PRESENTATION (PD) without previous biopsy. Conclusion: The current pulmonary SBRT classification is easily reproducible by radiologist. Findings are consistent PD.17.008 with the current classification regardless the presence or ab- USUAL INTERSTITIAL PNEUMONIA – PICTORIAL sence of histology. SBRT is rising as an optimal lung cancer ESSAY treatment modality for patients with poor status performance, Authors: MAIA, D.F.; SILVA, C.B.; FERREIRA, R.C.S; RI- and the knowledge of these pulmonary changes by radiolo- BEIRO, J.H.A.; OLIVEIRA, G.H.N.; gists is indispensable. Institution: SANTA CASA DE BELO HORIZONTE Responsible Author: Nicolau Faria Correia Guerreiro Introduction and objective(s): Usual interstitial pneu- Email: [email protected] monia (UIP) is one of the morphological and patholog- Keywords: STEREOTACTIC, RADIOTHERAPY, LUNG, ical patterns of interstitial lung disease. On imaging, it TOMOGRAPHY, THORAX usually presents with a patchy craniocaudal gradient of peripheral septal thickening, bronchiectasis, and hon- TL.17.006 eycombing. The aim of this study is to characterize one of the types of pulmonary fibrosis, Usual Intersti- THORACIC CALCIFICATIONS ON MAGNETIC tial Pneumonia. RESONANCE IMAGING: CORRELATIONS WITH Method(s): The methogology adopted was a bibliographical COMPUTED TOMOGRAPHY survey and use of images of Hospital XXX. Authors: ZAMPIERI, J. F.; HOCHHEGGER, B.;SOARES Discussion: At Computed Tomography (CT), typical Usu- SOUZA, A.; FIORENTINI, L. F.; STUKER. G.; PEREIRA, al Interstitial Pneumonia (UIP) is present with honeycomb L. B. N.; PELLICIOLI, A. A. present, usually with an apicobasal gradient, associated with Institution: HOSPITAL SÃO LUCAS DA PUCRS; IR- a reticular pattern with bronchiectasis or traction bronchiolo- MANDADE DA SANTA CASA DE MISERICÓRDIA DE ectasis. Still, there should be no findings that suggest an alter- PORTO ALEGRE native diagnosis. In patients with UIP, areas of ground-glass A brief description of the objective(s): The purpose of this attenuation tend to increase in extent or progress to fibrosis study was to assess thoracic calcifications by magnetic res- despite treatment. In those with more active inflammation onance imaging (MRI) and describe correlations with their involving the pulmonary interstitium, there is a faster pro- features on computed tomography (CT). gression of honeycombing in long-term follow-up. The aver- Material(s) and method(s): We examined the MRI pre- age rate of progression of honeycombing in patients with id- sentation of 82 patients (54 females) with calcified thorac- iopathic usual interstitial pneumonia according to one study ic lesions detected by CT. Two radiologists analyzed MRI was 0.4% of lung volume per month. signal characteristics of these lesions in T1 and T2-weighted Conclusion: Thus, Usual Interstitial Pneumonia should be a sequences, using the paraspinal muscle as a reference. T (1 clear differential diagnosis for the radiologist and especially or 2) index = T(1 or 2) signal lesion/T(1 or 2) signal muscle. taught to residents. Diffusion-weighted/spinal cord index was calculated. Responsible Author: DANILO FERREIRA MAIA Results and discussion: Mean CT density was 1107 ± 435 Email: [email protected] Hounsfield Unit (HU). MRI analysis showed that the median Keywords: PIU,UIP,FIBROSE,PULMONAR,LUNG (interquartile range [IQR]) T1 index was 0.37 (0.08–0.66); the median (IQR) T2 index was 0.17 (0–0.73) and the me- PD.17.016 dian (IQR) diffusion index was 0.44 (0.32–0.71). T1 index IMAGING OF COLLAGEN VASCULAR DISEASES: exceeded the paraspinal signal in 22% of cases. Correlation SPECTRUM OF THE INTRATHORACIC MANIFES- coefficients between CT density and T1 and T2 indexes were TATIONS r = –0.753 and r = –0.574, respectively. The rate of radiolo- Authors: ANTUNES, VB; CAPOBIANCO, J; MEIRE- gist agreement was 94.05% (? = 0.730; 95% confidence in- LLES, GSP; MISSRIE, I; VERRASTRO, CGY; PAVANI, terval, 0.509–0.951). AVB; SZARF, G; SILVA, AM; LAJARIN, VS; FIGUE- Conclusion: Thoracic calcifications show variable MRI IREDO, CM. signal characteristics that are correlated with CT density. Institution: FLEURY MEDICINA E SAÚDE Calcified lesions of the lung occasionally appear bright on Introduction and objective(s): Collagen vascular diseases T1-weighted MR images. (CVD) are a spectrum of systemic autoimmune disorders, Responsible Author: Luís Fiorentini which commonly lead to thoracic changes. The frequency of Email: [email protected] intrathoracic manifestations and the patterns of abnormality Keywords: Thoracic calcifications,computed tomography,- are variable depending on the type of collagen vascular dis- magnetic resonance imaging ease and may involve: lung parenchyma, airways, pulmonary vessels, pericardium, and pleura. CVD that most frequently involve the lungs are rheumatoid arthritis (RA), systemic lu- pus erythematosus (LE), inflammatory idiopathic myopathies (polymyositis and dermatomyositis), Sjögren’s syndrome, systemic sclerosis (SScl), mixed connective tissue disease (MCD) and Interstitial pneumonia with autoimmune feature (IPAF). The aim of the study is to illustrate the imaging fea- tures of the intrathoracic manifestations of collagen vascular
106 49th Sao Paulo Radiological Meeting diseases with emphasis on high-resolution chest computed PD.17.021 tomography (HRCT). ADVERSE PULMONARY MANIFESTATIONS RE- Method(s): Radiographs and HRCT images of patients from LATED TO CHEMOTHERAPY. WHAT THE RADIOL- our institution with CVD were selected in order to illustrate OGIST SHOULD KNOW. the main imaging features. Authors: JUNIOR, C.C.; FILISBINO, M.M.; VAZ, N.D.; Discussion: Interstitial lung disease and pulmonary arterial FIOROT, V.C.R.; LEITE, D.O.; ORSINI, T.M.F. hypertension are the main causes of mortality and morbidity Institution: INSTITUTO BRASILEIRO DE CONTROLE among these patients. Intrathoracic involvement may also DO CÂNCER be secondary to the disease therapy, including drug toxicity Introduction and objective(s): It is estimated that the num- and infections, as a result of immunosuppression. Although ber of new cancer cases in the world in 2018 is 18.1 millions chest radiography is the imaging modality most frequently and the number of deaths around 9.6 millions. Chemotherapy used, especially for screening and monitoring of thoracic as a treatment is essential in a large number of cases because alterations, HRCT is the method of choice for assessment it interferes with cure rate, reducing the number of deaths. of pulmonary abnormalities, better differentiation of the in- However, about 10% of patients receiving chemotherapy terstitial patterns, prognosis, evaluation of progression and agents develop pulmonary toxicities and diagnosis of these adverse reactions is fundamental as it alters the clinical man- differential diagnosis. agement and may result in the suspension of the drug respon- Conclusion: Knowledge of the thoracic manifestations of sible. Thus the intention of the work is to present the patterns each type of collagen vascular disease and understanding of pulmonary alterations related to the main chemotherapeu- of the associated complications are crucial for radiologists tic drugs. to provide better guidance for treatment and follow-up of Method(s): Pictorial study containing aspects evaluated in these patients. the diagnosis by imaging of main toxicities resulting from Responsible Author: Viviane Antunes chemotherapy treatment, illustrated with cases selected from Email: [email protected] our service or with representative images. Keywords: Colagenoses, intersticiopatias, Hipertensãopul- Discussion: A wide variety of chemotherapeutic agents have monar, fibrose been associated with pulmonary toxicity. The clinical pre- sentation of many of these effects is similar and overlapping PD.17.018 with changes of other natures, such as edema, infections or the evolution of the underlying disease itself. The radiolo- CARDIAC INCIDENTAL FINDINGS ON ROUTINE gist plays a fundamental role because he may suspect a re- CHEST CT: WHAT RADIOLOGISTS SHOULD KNOW. action related to its use, influencing the outcome of the case. Authors: PEREIRA, H.A.C.; NISHIYAMA K.H.; PINETTI To facilitate diagnostic reasoning, we will present the most R.Z.; SILVA A.M.; ; MACIEL R.P.; SILVA V.C.; AUAD, common patterns of involvement and will illustrate with cas- R.V.; KUROKI, I.R.; DARIO, C.F.R.; BLASBALG, R. es, including ground glass attenuation, consolidation, septal Institution: DASA - DIAGNÓSTICOS DAS AMERICAS - thickening, non-cardiogenic pulmonary edema and pulmo- SAO PAULO, SP nary hemorrhage, as well as findings associated with pleural Introduction and objective(s): Advances in computed to- effusion and traction bronchiectasis. mography (CT) has decreased scanning time and cardiac ar- Conclusion: Lung has significant susceptibility to changes tifacts, leading to an increase in cardiac incidental findings associated with chemotherapy and its diagnosis is challeng- (CIFs) detected on non dedicated CT. ing, particularly as regards the differential diagnosis with OBJECTIVES - To review common and less common car- usual and atypical infections, as well as progression of neo- diac incidental findings (CIFs) in patients undergoing routine plastic disease. Establishing a causal relationship between the chest CT in our institution. - To discuss its imaging features pulmonary clinical / radiological change and the chemother- and possible implications on patient outcome. - To high- apeutic agent is difficult, since there is no definitive method. Thus, the diagnosis of cytotoxic lung injury usually depends light which CIFs should always be reported by radiologists. on compatible image changes and appropriate history, in ad- Method(s): We reviewed all chest CT performed in our insti- dition to the need to exclude other differentials. Therefore, tution between January 2016 and December 2018 and select- the radiologist plays a fundamental role in determining the ed those with CIFs. clinical management of these patients, being extremely im- Discussion: Although most of CIFs on chest CT do not need portant to know how to recognize and point out their diagnos- further investigation, few are life-threatening conditions tic possibilities through the image patterns. needing immediate intervention. Others, like coronary and Responsible Author: Carlos Chadi Junior valvar calcifications, may be useful for cardiovascular risk Email: [email protected] stratification and improving patient outcome, through prima- Keywords: Manifestações pulmonares adversas,Quimi- ry and secondary preventive efforts like smoke cessation and oterápicos,Toxicidade pulmonar lipid-lowering intervention. Radiologists should recognize CIFs and report at least those with potential impacts in pa- PD.17.022 tient`s quality of life. PULMONARY EMBOLISM: MUCH BEYOND DEEP Conclusion: Recently, advances in CT are increasing CIFs VENOUS THROMBOSIS EMBOLIZATION on routine chest CT. The report of CIFs, in special if poten- Authors: FURTADO, R. S. O. P. ; SHOJI, H. ; FONSECA, tially clinical relevant, is a good practice that may benefit E. K. U. N. ; GOMES, A. I. ; PASSOS , R. B. D. ; ISHIKA- the patient. WA, W. Y. ; CHATE, R. C. ; SZARF, G. ; FUNARI, M. B. G. Responsible Author: Helena Alves Costa Pereira Institution: HOSPITAL ISRAELITA ALBERT EINSTEIN Email: [email protected] Introduction and objective(s): Pulmonary thromboembo- Keywords: cardiac,incidental,finding,non-gated,chest,CT lism (PE) has an extremely variable clinical presentation,
Abstracts of Scientific Papers 107 from asymptomatic to shock, making its clinical diagnosis neuroendocrine, which need specific treatment. When these sometimes challenging and demanding a central role for im- proliferations take the form of malignant neoplasms, they aging studies. The present work proposes a review of several may exhibit variable biological behavior, ranging from low- classic as well as atypical forms of PE, highlighting its find- grade carcinoid tumors to highly malignant small cell lung ings on chest X-rays and computed tomography without con- carcinomas (SPPC) and large cell neuroendocrine lung car- trast, as well as alarm signals for hemodynamic repercussion cinomas (LCNEC). and cases of atypical embolism. Conclusion: The radiologist has a central role in the detec- Method(s): We selected cases from our didactic file on our tion and characterization of these abnormalities and may be PACS database, illustrating several radiological presenta- the first to suggest the diagnosis, continuing the investiga- tions of pulmonary thromboembolism, comprising: 1. Im- tion, being therefore fundamental to understand the changes aging findings in non-contrast and conventional radiology at the microscopic level to better understand the spectrum of exams 2. Massive embolism 3. Macroscopic and microscopic the imaging findings. fat embolism 4. Infectious Embolism 5. Autoimmune pulmo- Responsible Author: Andrea Folchini Forest nary embolism induced by pneumonia 6. Air Embolism 7. Email: [email protected] Vertebroplasty cement embolism 8. Catheter tip embolism 9. Keywords: Neuroendocrine tumors;,carcinoid tumors,small Projectile Embolism 10. Tumoral embolism cell lung carcinomas,large cell neuroendocrine lung carcinomas Discussion: It is already well established that computed to- mography angiogram exams are considered the gold standard PD.17.025 for the diagnosis of pulmonary thromboembolism. Howev- er, the role of the image goes far beyond the diagnosis: the NON-NEOPLASTIC DISEASES OF TRACHEA: WHAT radiologist should be able to suspect this condition even in THE RADIOLOGIST NEEDS TO KNOW. conventional chest X-ray examinations, as well as thoracoab- Authors: DI FERREIRA, G.F.S.C.; MONTEL, D. B.; BAS- dominal transition images and thoracic tomography without SO, G. B.; GONÇALVES, F.C.; SILVA, L.N.M.; COSTA, intravenous contrast. In addition, the alarm signals for hemo- M.F.S.; GRILL, J.A.T.; REIS JUNIOR, C.G.; LAJARIN, dynamic instability should be recognized and the attending V.S.; SILVA, A.M.; PEREIRA, H.A.C. physician notified. It is also essential to remember atypical Institution: IRMANDADE DA SANTA CASA DE MI- causes of pulmonary embolism that do not respond to anti- SERICÓRDIA DE SÃO PAULO CASA DE SÃO PAULO coagulation, such as fat embolism in the context of cosmetic FLEURY MEDICINA E SAÚDE surgery, embolism of vertebroplasty material, and iatrogenic Introduction and objective(s): The objective of this picto- massive gas embolism. rial study is to perform a review of the anatomy of the tra- Conclusion: Pulmonary thromboembolism is a severe and chea, to recognize the different patterns of involvement of very incident disease, being present recurrently in the routine the main non-neoplastic, focal and diffuse tracheal diseases, of every radiologist working in the emergency environment. helping the radiologist identify the main findings associated Thus, the knowledge of its different presentations in the vari- with each one. ous imaging modalities is extremely important in the practice Method(s): Demonstrate in a didactic way through the prop- of the radiologist. osition of illustrative models the main aspects of tracheal Responsible Author: renata silveira olimpio de paula furtado involvement, correlating the models to the tomographic find- Email: [email protected] ings observed in the main non-neoplastic, focal and diffuse Keywords: embolia, tromboembolismo, pulmonar, torax, diseases, that affect the trachea. CT, tomografia, computadorizada, contraste, emboliagasosa, Discussion: The diseases represented in this trial are: "Sa- emboliagordurosa ber-Sheath" trachea, tracheal stenosis, Wegener's Granulo- matosis, Amyloidosis, Osteochondroplastic Tracheobron- PD.17.023 chopathy, Relapsing Polychondritis, Tracheal Diverticulum, andr Tracheobronchomegaly (Mounier Syndrome). The main PULMONARY NEUROENDOCRINE NEOPLASMS alterations identified in the computed tomography and repro- AND PROLIFERATIONS: IMAGING ASPECTS duced in the illustrative models were the thickening of the Authors: MEDEIROS, A. K.; FOREST, A. F.; HOUAT, C. tracheal walls, with or without nodulations, the parietal cal- R. S.; SEMIONE, M. M.; FILHO, M. V. L.; SANTANA, P. cifications and the compromise or not of the posterior wall. R. P.; GOMES, A. C. P.; BARBISAN, C. C. Conclusion: Computed tomography allows the detection and Institution: BENEFICIÊNCIA PORTUGUESA DE SÃO characterizationof diseases of non-neoplastic trachea, allow- PAULO (BP DIAGNÓSTICA) ing the narrowing of diagnostic possibilities. However, it is Introduction and objective(s): Neuroendocrine tumors are important to remember the importance of the evolution of the tumors that can be found throughout the body, most common- clinical data, and a bronchoscopy with biopsy is still the most ly in the gastrointestinal tract, followed by the thorax. Neuro- important procedure for the diagnosis of tracheal lesions. endocrine cells normally occur in the bronchial and bronchi- Responsible Author: Gabriela Faria e Silva Costa Di Ferreira olar epithelium, being solitary or occurring in clusters. This Email: [email protected] pictorial essay has the primary objective of reviewing the en- Keywords: Thoracic diseases; Tracheal diseases; Tomog- tire spectrum of neuroendocrine neoplasms and proliferations raphy,X-ray computed; Trachea.,Thoracic diseases,Tracheal and their imaging aspects. diseases,Tomography,Trachea Method(s): Cases were selected from imaging exams per- formed at a referral hospital with an established diagnosis of neuroendocrine neoplasia. PD.17.038 Discussion: Pulmonary neuroendocrine cells may undergo a IMAGING FINDINGS OF CENTRAL VENOUS CATH- variety of proliferations that manifest with a broad spectrum ETERS RELATED COMPLICATIONS: A PICTORIAL of imaging abnormalities, so that radiologists should be fa- REVIEW. miliar with these various manifestations and should be able to Authors: COELHO, M.O.; OKI, G.C.R.; SANTANA, distinguish non-neoplastic cell proliferations from neoplasms P.R.P.; MOREIRA, B.L.; MEDEIROS, A.K.; VERRASTRO,
108 49th Sao Paulo Radiological Meeting C.G.Y.; MISSRIE, I.; MEIRELLES, G.S.; GOMES, A.C.P. Method(s): This study reviewed articles related to the topic Institution: BP - A BENEFICÊNCIA PORTUGUESA DE and CT scans of patients diagnosed with Tuberous Sclerosis. SÃO PAULO Discussion: Although not included in the criteria, other le- FLEURY MEDICINA DIAGNÓSTICA sions in the thoracic cavity, corroborate with the diagnosis Introduction and objective(s): Peripherally inserted central of ET, such as the presence of micronodular hyperplasia of catheter (PICC) and port-a-cath are common types of long- pneumocytes, characterized by nodules, well delimited and term central venous access used to deliver chemotherapy with distribution multicentric. There is also an increase in the and other medications. Secure and reliable venous access is incidence of cardiac neoplasms, with rhabdomyomas seen in a cornerstone in the care of hospitalized patients, as well as 50-65% of cases. When they occur in the myocardium they for a variety of outpatient situations. Its positioning, paten- are more commonly located in the right atrium, left ventricle cy and complications can be well evaluated by contrast-en- and interventricular septum. Another find heart disease is the hanced radiography and fluoroscopy. Eventually computed myocardial fatty foci, this does not confirm the diagnosis, but tomography (CT) may be necessary for further evaluation. when an incidental CT finding, the hypothesis ET should be There are many possible complications related to the cath- considered. In addition, sclerotic bone lesions have been de- eter placement. The most feared ones, although rare, are the scribed as part of the diagnosis of ET, being more frequent superior vena cava rupture, air embolism, and pericardial and numerous in patients with this condition. Pleural effusion rupture. The periprocedural complications are hematoma, is more frequent in female patients with LAM, and the dys- arterial puncture, pneumothorax, and pain at venotomy site. pnea is the most common symptom. Diffuse lipomatosis is a The delayed complications are related to port pocket infec- rare condition characterized by progressive growth of mature tion, catheter-related sepsis, deep venous thrombosis, wound adipose tissue involving structures of skeletal muscle, which dehiscence or skin necrosis with port exposure, presence of also may be associated with ET depending on the correlation fibrin sheath or thrombus, catheter migration, and catheter with other findings. rupture or disconnection. Conclusion: It is important to recognize the classic chest CT Method(s): We made a review of the available literature findings, since they may be associated with a risk of compli- about port-a-cath complications and its evaluation through cations such as pneumothorax and pleural effusion, but new contrast-enhanced radiography and fluoroscopy. We col- associated findings are described and provide more informa- lected cases from the routine of two institutions to illustrate tion on the pathogenesis and evolution of the disease, and imaging findings related to complications in which imaging therefore should also be recognized and studied. exams play a central role in the diagnosis. Responsible Author: Fernanda Gonçalves Discussion: With the large number of central venous cathe- Email: [email protected] ters placed every day, the fast recognition of its malfunction Keywords: LYMPHANGIOLEIOMYOMATOSIS,TUBER- is important and the contrast-enhanced radiography has a OUS,SCLEROSIS significant role in evaluating the catheter positioning, pa- tency, and complications. Early detection of catheter mal- functioning requires its replacement and failure to intervene may result in life-threatening complications (e.g. catheter fragmentation). Conclusion: Contrast-enhanced radiography and fluoro- LITERATURE REVIEW scopic evaluation of the central venous catheters are widely available imaging techniques, whose knowledge and correct interpretation are expected from any general radiologist. DIGITAL PRESENTATION (PD) These studies, and eventually CT, provide valuable informa- tion about correct positioning of the whole device, patency of the catheter and related complications thereby assisting the PD.17.009 physician to make prompt decisions about its management. ANATOMY OF PERICARDIAL RECESSES IN MUL- Responsible Author: Marcelo Oliveira Coelho TIDETECTOR CT: IMPLICATIONS FOR ONCOLOG- Email: [email protected] IC IMAGING Keywords: Central,Venous,Catheters,PICC,Port-a-cath Authors: ARAUJO, P. N. B. D.; PAVANI, A.V.B.; LUC- CHESI, F.R.; MEIRELLES, G.; GARCIA, M. R. T. PD.17.042 Institution: INSTITUTO DO CÂNCER DO ESTADO DE BEYOND LYMPHANGIOLEIOMYOMATOSIS: RE- SÃO PAULO OCTAVIO FRIAS DE OLIVEIRA – ICESP, VISITING THE THORACIC FINDINGS OF TUBER- SÃO PAULO, SÃO PAULO, BRASIL. OUS SCLEROSIS COMPLEX A brief description of the objective(s): The purpose of es- Authors: GONCALVES, F.C.; TAKITANI, P.A.S.; MON- say is to review of the normal and variant pericardial recess- TEL, D.B.; BASSO, G.B.; DI FERREIRA, G.F.S.C.; PEREI- es, and differentiating features from other common cystic RA, A.C.P; REIS JUNIOR, C.G.; GRILL, J.A.T.; SILVA, A.M. mediastinal masses and lymphadenopathy, essential informa- Institution: SANTA CASA DE MISERICORDIA DE SAO tion in oncologic patient. PAULO Description of the disease(s), method(s) and/or tech- Introduction and objective(s): Tuberous sclerosis (ET) is a nique(s): The pericardium encases the heart and superiorly rare neurocutaneous syndrome characterized by presence of envelops the origin of the superior vena cava, ascending aorta congenital tumor lesions in multiple organs. The most com- and the pulmonary trunk. Its function is to protect the heart mon thoracic manifestations are lymphangioleiomyomatosis and facilitate cardiac motion within the thoracic cavity. It is (LAM), and the cardiac rhabdomyomas, which are among the formed by an outer fibrous layer (fibrous pericardium) and an major diagnostic criterias. The aim of this pictorial study is inner serous sac (serous pericardium) composed of two thin to highlight other lesions that are frequently found and may membranes lined at their opposing margins by serosa and assist in the diagnosis of ET. filled with up to 50mL of serous fluid. The inner visceral lay-
Abstracts of Scientific Papers 109 er of the serous sac is reflected around the great vessels and Responsible Author: Pedro Naime Barroso de Araujo against the outer parietal layer forming the pericardial sinuses Email: [email protected] or recesses, which are visualized when distended with flu- Keywords: Lung metastasis,Radiofrequency ablation,radio- id. Illustrative cases from our department were collected and logical changes classified according to these different pattern types. Radiol- ogy presentations, differential diagnosis and teaching points PD.17.011 were also described. PRECISION CANCER THERAPIES IN LUNG CAN- Discussion: The pericardial recesses arise from either one of the two sinuses, the transverse sinus and oblique sinuses or CER: CURRENT STATUS AND ROLE OF THE IMAGE directly from the pericardium itself. There are several peri- Authors: ARAUJO, P. N. B. D; PAVANI, A. V. B.; GAR- cardial recesses that may be mistaken for lymphadenopathy: CIA, M. R. T. a) aortic recesses (inferior and superior); b) pulmonic recess- Institution: INSTITUTO DO CÂNCER DO ESTADO DE es (right and left); c) postcaval recess; d) pulmonary venous SÃO PAULO ‘OCTAVIO FRIAS DE OLIVEIRA’ – ICESP, recesses (right and left). SÃO PAULO, SÃO PAULO, BRASIL. Conclusion: Radiologist should be familiar with the expect- A brief description of the objective(s): The purpose of es- ed radiological of anatomy of pericardial recesses in order to say is to review, list, explain and demonstrating the variety of avoid incorrect radiological diagnosis or oncological staging of responses and adverse events related about the precision can- tumors, which could significantly change patient management. cer therapies, with which the radiologist should be familiar. Responsible Author: Pedro Naime Barroso de Araujo Description of the disease(s), method(s) and/or tech- Email: [email protected] nique(s): Illustrative cases from our department were col- Keywords: Anatomy,Recesses pericardial,Oncology lected to describe the different types of precision cancer ther- apy in lung cancer, the main immune-related adverse events and treatment response. PD.17.010 Discussion: Recent advances in understanding the molecular BRIEF REPORT ON RADIOLOGICAL CHANGES mechanisms of cancer have opened a new era of precision FOLLOWING RADIOFREQUENCY ABLATION OF medicine for cancer treatment, especially in lung cancer. LUNG METASTASIS: A PICTORIAL ESSAY Precision cancer therapies target specific molecules that are Authors: ARAUJO, P. N. B. D.; PAVANI, A. V. B.; GARCIA, responsible for cancer development and progression, and M.R.T.; ROSA, S.T.D.; JUNIOR, J; MOURA, M.R.L.D; VI- they achieve marked treatment benefits in specific cohorts of ANA, P.C.C patients. However, these therapies are also associated with a Institution: NSTITUTO DO CÂNCER DO ESTADO DE different response criteria and variety of complications that SÃO PAULO OCTAVIO FRIAS DE OLIVEIRA – ICESP, are often unique to specific groups of anticancer agents. SÃO PAULO, SÃO PAULO, BRASIL. Conclusion: Advancements in precision cancer therapies A brief description of the objective(s): The purpose of essay challenge the current imaging. To contribute to the current is to review the different radiological changes seen after ra- care of patients with cancer, radiologists must be keep abreast diofrequency ablation (RFA) in metastasis to lung and how to of the major advancements in treatment of cancer and knowl- distinguish it from residual or recurrent disease. edgeable about the atypical tumor response pattern and com- Description of the disease(s), method(s) and/or tech- mon adverse events seen with this novel class of drugs. nique(s): Distinctive patterns of early and late benign fibro- Responsible Author: Pedro Naime Barroso de Araujo sis are commonly observed after RFA for lung metastasis. Email: [email protected] These changes on computed tomography scans need to be Keywords: Immunotherapy,Targeted therapy,Immune-relat- distinguished from so-called high risk radiological features, ed adverse events,Treatment Response,Lung cancer which can be associated residual or recurrent disease. llus- trative cases from our department were collected and clas- sified according to these different pattern types. Radiology PD.17.013 presentations, differential diagnosis and teaching points WHAT THE RADIOLOGIST NEEDS TO KNOW were also described. ABOUT USUAL INTERSTICAL PNEUMONIA AND Discussion: Radiological changes following RFA of Lung NON-SPECIFIC INTERSTICAL PNEUMONIA. metastasis may present different forms on computed to- Authors: SOUSA, A.M.S.; ROCHA, B.P.; ANDRADE, mography (CT) scan: (1) acute radiological changes (dif- L.S.M.;NASCIMENTO, D.B.; CARDOZO, R.R.S; BRIN- fuse consolidation, patchy consolidation, diffuse ground GEL, A.M.D.G.; IUTAKA, T.; FIOROT, L.C.R. glass opacity (GGO), and patchy GGO); (2) late radio- Institution: HOSPITAL DO SERVIDOR PÚBLICO DO logical changes (fibrosis, scar-like fibrosis and mass-like ESTADO DE SÃO PAULO (IAMSPE) fibrosis); (3) high-risk radiological features of residual or A brief description of the objective(s): The Usual Intersticial recurrent disease (increasing contrast material uptake in Pneumonia(UIP) and Non Specific Intersticial Pneumonia(N- the ablation zone, nodular enhancement measuring more SIP) are part of the Idiopathic Interstitial Pneumonias(IIP), than 10 mm, any central enhancement greater than 15 HU; group of parenchymal lung diseases which are characterized growth of the RFA zone after 3 months (compared with by the presence of various degrees of inflammation and fi- baseline) and definitely after 6 months, peripheral nodu- brosis. Symptoms of both conditions are characterized by dry lar growth and change from ground-glass opacity to solid cough and progressive dyspnea, more subtle in NSIP patients. opacity, regional or distant lymph node enlargement, and The UIP is the most common type of IIP, affecting patients old- new intrathoracic or extrathoracic disease). er than 50 years old, mainly smokers. It has a poorer prognosis Conclusion: Radiologist should be familiar with the expect- ( 2,5 to 4 years after the diagnosis). The NSIP affects mostly ed radiological features associated with lung radioablation. non-smoker women and presents a 5 year survival rate in most Distinguishing benign changes on CT scans from possible pacients. In contrast to UIP, NSIP responds well to the use of recurrences will also avoid patient anxiety and minimize the high doses of corticosteroids. This work aims to discuss the risks of toxicity from unnecessary diagnostic procedures. differential diagnosis between UIP and NSIP.
110 49th Sao Paulo Radiological Meeting Description of the disease(s), method(s) and/or tech- studies of 18F-FDG PET/CT, the pooled estimate of sen- nique(s): In this paper, the scientific literature which refers sitivity and specificity was 0.83 (95% CI 0.54 to 0.95) and to this subject was consulted. Also a comparison between di- 0.93 (95% CI 0.87 to 0.96), respectively, compared with 0.92 agnosed cases in a specific service health. (95% CI 0.18 to 1.00) and 0.93 (95% CI 0.85 to 0.95) for Discussion: An accurate IIP diagnosis requires a thourough WB-MRI, and 0.78 (95% CI 0.46 to 0.93) and 0.91 (95% CI evaluation of clinical, histological and image data. The high 0.79 to 0.96) for WB-DWI. There is no significant difference resolution computed tomography (CT) is the state-of-the-art between the diagnostic odds ratio between the modalities, 62 of imaging evaluation of those conditions, representind a (95% CI 18 to 212) for WB-DWI, 117 (95% CI 3 to 4480) for non-invasive method beside good relation with the histolog- WB-MRI, and 62 (95% CI 18 to 212) for 18F-FDG PET/CT. ical findings. Regarding the UIP, the diagnosis requires the Conclusion: In summary, WB-MRI and the use of DWI se- presence of three criteria: reticular patterns and honeycomb- quences is an no radiation alternative method compared to ing with peripheral and basal predominance and absence of 18F-FDG PET/CT in M staging of NSCLC. More studies atypical findings. In the NSIP case, the opacities with ground- comparing WB-MRI and 18F-FDG PET/CT in the detection glass attenuation tend to be the pattern at the beggining stag- of metastasis are still needed. es of the disease. Furthermore, the presence of the reticular Responsible Author: Luís Fiorentini pattern overlaping to the groundglass attenuation is observed. Email: [email protected] This form of presentation varies over time and might resem- Keywords: positron emission tomography/computed tomog- ble to the described for UIP in advanced disease. raphy,PET/CT,whole body,magnetic resonance imaging,M- The dissemblance of radiological patterns of the most import- RI,lung cancer ant forms of IIP are vital to the evaluation of those patients. Conclusion: The differences between the therapeutical responses and the prognosis of the diseases studied in this paper make the histological pattern description important to the care of those patients. Thus, having the CT as the state- of-the-art exam, the radiologist physician have to know the CASE REPORT image features. The ultimate diagnosis also includes athou- rough clinical history evaluation and the analysis of histo- logic features. DIGITAL PRESENTATION (PD) Responsible Author: Andrea Meneses Soares de Sousa Email: [email protected] Keywords: TORAX, PNEUMONIA, INTERSTICIAL, ID- PD.17.003 IOPATICA, PIU, PINE, TCAR, LUNG, CHEST, UIP, NSIP, FIBROSING MEDIASTINITIS WITH SEVERE PUL- IIP, PII, FIBROSE, FIBROSIS MONARY ARTERY STENOSIS Authors: AMARAL, A. C.; GHISSI, A. C.; SAGGIN, G.; PD.17.041 GUIMARÃES, L. P. T.; ZARPELLON, R. J. 18F-FLUORODEOXYGLUCOSE (18F-FDG) POSITRON Institution: HOSPITAL SANTA CATARINA DE BLUME- EMISSION TOMOGRAPHY/COMPUTED TOMOG- NAU RAPHY (PET/CT) AND WHOLE-BODY MAGNETIC A brief description of the objective(s): The present study RESONANCE IMAGING (WB-MRI) DIAGNOSTIC aims to describe the clinical features of Fibrosing Medias- PERFORMANCE IN M STAGING NON-SMALL CELL tinitis, a condition still poorly understood, with a benign LUNG CANCER: A SYSTEMATIC REVIEW but often progressive and potentially fatal character, whose Authors: MEDEIROS, T. M.; HOCHHEGGER, B.; WATTE, evolution in this case determined pulmonary artery stenosis. G.; FIORENTINI, L. F.; STUKER. G.; PEREIRA, L. B. N.; Clinical History: Male patient, 58 years old, reporting epi- PAULA, L. S. sodes of dyspnea, palpitation, pallor and malaise for 30 days. Institution: HOSPITAL SÃO LUCAS DA PUCRS; IR- There is no evidence of previous granulomatous disease. MANDADE DA SANTA CASA DE MISERICÓRDIA DE Simple chest X-ray demonstrated enlargement of the upper PORTO ALEGRE mediastinum. Computed tomography of the chest showed A brief description of the objective(s): To evaluate the di- mass with soft tissue density in the mediastinum, reducing agnostic test accuracy of 18F-fluorodeoxyglucose positron the caliber of the trunk and the origin of the left pulmonary emission tomography/computed tomography (18F-FDG artery. Pulmonary arteriography confirmed the finding, de- PET/CT) and whole body magnetic resonance imaging (WB- scribing subocclusion of the right pulmonary artery and crit- MRI) for the detection of metastases in patients with non- ical stenosis of the left pulmonary artery, with severe hemo- small cell lung cancer (NSCLC). dynamic repercussion. Patient submitted to surgical resection Description of the disease(s), method(s) and/or tech- of the invading tissue, with confirmation of a fibrotic chronic nique(s):We searched MEDLINE, EMBASE and Cochrane inflammatory process, characterizing fibrosing mediastinitis. Library up until October 2018. We selected studies reporting Angioplasty was performed with stent placement in the pul- data that could be used to construct contingency tables that monary arteries, associated with immunosuppressive therapy, compared 18F-FDG PET/CT and WB-MRI, with or without with good clinical response. diffusion (WB-DWI). Two authors independently extracted Discussion and diagnosis: Fibrosing Mediastinitis is a rare data on study characteristics and measures of test accuracy condition characterized by anomalous proliferation of fi- and assessed studies methodological quality (QUADAS-2). brotic tissue in the mediastinum. In its granulomatous form, We generated forest plots of the sensitivity and specificity of it is related to histoplastomosis and tuberculosis, while the 18F-FDG PET/CT, WB-MRI, and WB-DWI and created a non-granulomatous form is associated with autoimmune summary receiver operating characteristic plot. disorders, drugs and radiation. The disease is insidious and Discussion: Four studies met our inclusion criteria, with a its morbidity is directly related to the compression of me- total of 564 patients, 559 lesions, being 233 metastases. In diastinal structures, especially vascular ones. Computed to-
Abstracts of Scientific Papers 111 mography is considered the method of choice for diagnosis, body. Due to its low incidence and wide spectrum of presenta- excluding malignancies and confirming the existence and the tions, the diagnosis can be challenging. The knowledge of the extent of the fibrotic process, often related to the presence of main clinical and radiological manifestations is fundamental calcifications. There is no curative therapy, and the manage- for the correct diagnosis and management of the patient. ment is performed with corticosteroids and immunosuppres- Responsible Author: Lucas Nakasone Matos da Silva sants, in addition to specific interventions such as dilatation Email: [email protected] of the airways and angioplasty with stenting. The prognosis Keywords: Síndrome,Proteus is variable, with the disease stabilizing or regressing in the majority of patients. PD.17.043 Conclusion: Fibrosing Mediastinitis is a rare, benign, chronic PULMONARY TUMOR THROMBOTIC MICROAN- inflammatory condition with remarkable potential for critical GIOPATHY: REPORT OF TWO CASES complications, such as pulmonary artery stenosis, described Authors: GUIMARÃES, R. B.; ROMAN, S. M.; CHO- in this case. Precise diagnosis through computed tomography JNIAK, R.; MELO, R. A. B. and arteriography, combined with rapid interventional thera- Institution: A.C.CAMARGO CANCER CENTER py, provided a satisfactory clinical response. A brief description of the objective(s): Discuss two cases Responsible Author: Artur Carsten Amaral of pulmonary tumor thrombotic microangiopathy (PTTM) Email: [email protected] and contribute to the recognition of this rare complication. Keywords: mediastinite,fibrosante,massa,mediastinal,radiologia Clinical History: Case 1: female, 28 years old, presented dry cough and progressive dyspnea. She had history of ovar- PD.17.019 ian metastasis of signet ring cell adenocarcinoma. Physical PROTEUS SYNDROME: CASE REPORTS AND LIT- examination showed bad general condition, tachycardia, ERATURE REVIEW tachypnea and respiratory auscultation with reduced breath Authors: SILVA, L. N. M.; MENDES, L. A.; ASSUNÇÃO. sounds and sparse wheezing. Laboratory tests showed ane- F. B.; GONÇALVES, F. C.; BASSO, G. B.; MONTEL, D. mia, respiratory alkalosis and hypoxemia with high D-Dimer. B.; DI FERREIRA, G. F. S. C.; JUNIOR, C. G. R.; GRILL, Chest computed angiotomography was held which excluded J. A. T.; PEREIRA, H. A. C.; LAJARIN, V. S.; SILVA, A. M. pulmonary thromboembolism and showed signs of overload Institution: IRMANDADE DA SANTA CASA DE MI- of right chambers with rectified interventricular septum and SERICÓRDIA DE SÃO PAULO; FLEURY MEDICINA E diffuse micronodular interstitial pattern with tree-in-bud. She SAÚDE evolved with clinical deterioration and it was opted for lung A brief description of the objective(s): This paper aims to biopsy. A day after the procedure, she was dead. Case 2: fe- describe two cases of Proteus Syndrome, reporting the main male, 14 years old, with history of mucinous signet ring cell findings of images through computed tomography (CT) and adenocarcinoma with metastasis to ovary. She evolved with magnetic resonance imaging (MRI), and review the literature fever, worsening of respiratory function and ends tremors on this subject. during hospitalization for venous catheter installation. It was Clinical History: Case 1: A 9-year-old male presented initiated a protocol for sepsis, whose laboratory tests showed bulging of the left anterior thoracic wall 5 years ago, with anemia and high CRP. Radiological examinations were car- progressive growth. Deny associated respiratory symp- ried out and showed similar pattern to the previous case. She toms. CT showed hypertrophy of the fat tissue with multi- was submitted to bronchoscopy and evolved with chest pain compartmental aspect, involving the left thoracoabdominal and cyanosis, with rapid clinical deterioration. On the seventh wall, extrapleural space and the abdominal cavity. Pulmo- day of hospitalization, in biopsy programming, she was dead. nary cysts were also observed. Case 2: A 15-year-old male Discussion and diagnosis: Histopathologic diagnosis of patient with a history of bulging in the right upper limb for the first case and assumed diagnosis of the second one were 13 years, progressively growing, extending to the ipsilat- compatible with PTTM, a rare form of tumor pulmonary em- eral shoulder and chest wall. Deny associated respiratory bolism in which small tumor emboli induce a fibrocelular symptoms. CT and MRI showed extensive hypertrophy of proliferation of intima of pulmonary arteries. This results in the fatty tissue of these regions, as well as the right ex- progressive precapillary pulmonary hypertension with acute/ trapleural space, maintaining contact with vascular struc- subacute cor pulmonale. Most cases are diagnosed post mor- tures and determining volumetric reduction of the ipsilater- tem and occurs in patients with metastatic carcinoma, being al lung. Hypertrophy of the 2nd and 3rd right costal arches the stomach the main primary site. The characteristic radio- is also observed. logical findings are those described in these cases, especially Discussion and diagnosis: Proteus Syndrome is a rare, muta- the overload of the right ventricle and the centrilobular bud- tion-related AKT1 gene, with an incidence of 1 in 1,000,000 in-tree pattern, since this is one of the few vascular causes. people. It has a broad spectrum of clinical and radiologi- Conclusion: The PTTM should be suspected in cancer pa- cal presentations characterized by the multicompartmental tients who develop respiratory deterioration in the absence of proliferation and asymmetric distribution of adipose tissue, pulmonary thromboembolism and bud-in-tree pattern in the asymmetry of the muscular planes, arteriovenous malfor- absence of infection. Early diagnosis prevents tragic mations, hyperostosis, vertebral anomalies and macrodac- evolution and interferes with the prognosis. tyly. The most common pulmonary manifestations are cysts Responsible Author: Stefânia Maria Roman and thromboembolism. Findings are usually not diagnosed Email: [email protected] at birth, progressing rapidly during childhood and stabiliz- Keywords: MICROANGIOPATIA, TUMORAL, TROM- ing until adolescence. The main differential diagnoses are BOTICA, PULMONAR hemihyperplasia-multiple lipomatosis syndrome and Kip- pel-Trenaunay syndrome. Conclusion: Proteus syndrome is a rare disease characterized by the progressive and asymmetric increase of fat, muscles, bones and blood vessels in multiple compartments of the
112 49th Sao Paulo Radiological Meeting ULTRASONOGRAPHY ORIGINAL PAPER ORAL PRESENTATION (TL)
TL.18.001 POSTERS (PI) CONTRIBUTION OF ULTRASONOGRAPHY AS A DIAGNOSTIC METHOD OF SUBUNGAL GLOMUS TUMORS PI.18.005 Authors: SILVA, V. R.; ZAVARIZ, J. D.; BOUER, M.; ASSOCIATION OF RADIOLOGIC FINDINGS IN SERNIK, R.; GABBI, T. V. B.; FILHO, A.M.A.; ORLANDI, PROSTATE ULTRASOUND WITH LOWER URINARY R.; NICO, M. M. S.; SANTOS, M. V. P. Q. TRACT SYMPTOMS Institution: INSTITUTO DE RADIOLOGIA DO HOSPI- Authors: SOUZA, J.P.D.; ROCHA, H.P.; BOTELHO, L.J; TAL DAS CLÍNICAS DA FACULDADE DE MEDICINA FILHO, A.F.N. DA UNIVERSIDADE DE SÃO PAULO Institution: HOSPITAL UNIVERSITÁRIO DA UNIVER- A brief description of the objective(s): Glomus tumor is a SIDADE FEDERAL DE SANTA CATARINA benign neoplasm of rare occurrence, but debilitating by pain A brief description of the objective(s): To evaluate the as- and with high recurrence after surgical excision due to the sociation of intravesical prostatic protrusion (IPP), prostate difficulty of visualization for complete removal. volume (PV), post-void residual (PVR) and bladder wall The purpose of this study was to evaluate the ultrasound ca- thickness (BWT) with lower urinary tract symptoms. pacity for diagnostic confirmation, correlating with post-sur- Material(s) and method(s): The population in this study gical anatomopathological results. Material(s) and method(s): This study was carried out ret- consisted of men that were submitted to an abdominal pros- rospectively, with a survey of suspected cases accompanied tate ultrasound in a radiology service, and agreed partici- at the Department of Dermatology of Hospital XXX, who un- pating in this study. There were not included patients with derwent ultrasound imaging at the Department of Radiology confirmed or suspect history of prostate cancer, or patients and surgical treatment studied between 2007 and 2018. Ultra- with a medical or neurological condition that could affect sonography of nail with high frequency transducer (18MHz) the lower urinary tract function, except for benign pros- was performed, in which characteristics of the lesion (s) were tate hyperplasia (BPH). All patients were evaluated using evaluated, such as shape, contours, echogenicity, dimensions, the international prostate symptom score (IPSS), score of vascularity pattern, location, pertinent distances and associ- quality of life related to urinary symptoms and abdominal ated alterations. ultrasound to assess the measurements. They were split into Results and discussion: In a preliminary analysis, there two groups, and normal and abnormal cutoff points were was a high concordance between the ultrasound diagnosis established for each measurement. of glomus tumor and the postoperative anatomical diagnosis Results and discussion: This work was conceived consid- of the nodules, compatible in about 75% of the results. In ering the clinical relevance of BPH, of the diagnostic utility about 15%, the ultrasonography identified the nodule, but that the US has in this population, of the need for standard- the appearance was not typical of glomus tumor and in one ization, uniformity and applicability of the results of this im- case of ultrasonography was false negative. Among the ul- aging method. 81 patients participated, with a mean age of trasound findings, a more recurrent pattern of nodules was 59.8±9.3 years old. The mean IPSS in the mild IPSS group observed: oval, hypoechogenic, with regular and well de- was 3.7 ± 2.1, and in the moderate-severe IPSS group was fined contours, vascularized at Doppler. Most located in the 18.6 ± 7.1. The mean IPP in the mild IPSS group was 3.6 ± nail matrix and with irregularity of the associated phalange- 4.24 and 8.4 ± 5.6 in the moderate-severe IPSS group (p < al bone surface. 0.001). It was noticed that 83.33% of the patients with IPP > Conclusion: The ultrasound study of the nail may be use- 10mm, 82.76% of the patients with BWT > 5mm, 88.24% of ful in the confirmation of glomus tumors even in cases of the patients with PV > 40 ml and 89.47% with PVR > 50cm³ doubtful clinical picture, since it has shown to be a highly sensitive and specific diagnostic method. It presents a pat- had moderate to severe symptoms. tern typical of the lesions in more than 70% of the cases, Conclusion: The measurements’ means showed a significant which facilitates their reproducibility. It has a much lower increase related to symptom’s severity. It was demonstrated cost in relation to Magnetic Resonance. It was effective in a statistically significant correlation between all of the mea- detecting lesions up to 2 mm in the smallest axis. The im- surements and the moderate-severe IPSS group, showing that portance also lies in the detailed description of the dimen- these measures may have important clinical utility and may sions and distances of the lesions to anatomical structures, serve as a tool for diagnosis and predict the need for treat- allowing better surgical programming of the excision, to ment and follow-up of the cases. We concluded the study sug- minimize the chance of recurrence. gesting the development of a radiologic score system that can Responsible Author: VIVIAN REGINA SILVA quantify these measurements and guide their use in a better Email: [email protected] way on the daily practice. Keywords: GLOMUS,TUMORS,SUBUNGUAL,ULTRA- Responsible Author: João Paulo Dalazen de Souza SONOGRAPHY,ULTRASOUND,DIAGNOSIS Email: [email protected] Keywords: Benign prostatic hyperplasia,ultrasound,Interna- tional Prostate Symptom Score,diagnostic
Abstracts of Scientific Papers 113 PICTORIAL ESSAY ACADÊMICA DE RADIOLOGIA (NPCAR) Introduction and objective(s): The use of minimally inva- sive therapies for prostate cancer (PCa) has gained promi- nence today due to the numerous consequences and biopsy- POSTERS (PI) chosocial impact that conventional therapies have on the quality of life of patients with PCa. Focal therapies (PCT) appear in PCP as minimally invasive therapies of intermedi- PI.18.001 ate potential between active follow-up and radical treatments EVALUATION PER IMAGE OF THE TRANSPLANT- (radical prostatectomy (PR), external radiotherapy (RT), ED KIDNEY : THE ROLE OF ULTRASONOGRAPHY brachytherapy (BT) and cryotherapy (CT). uniting cancer WITH DOPPLER STUDY control and reducing morbidity. High intensity focused ul- Authors: FURTADO, R. S. O. P. ; DUTENHEFNER, E. E. trasonography (HIFU) is the main form of TF that can be ; GOMES, A. I. ; PONTE, M. P. T. R. ; LANGE FILHO, R.; applied in PCa due to the possibility of applying it to the en- NETO, M. J. F. ; QUEIROZ, M. R. G.; FUNARI, M.B.G. tire extent of the prostate gland or even only partially (s) of it Institution: HOSPITAL ISRAELITA ALBERT EINSTEIN in an effectively noninvasive way (without tissue invasion). HOSPITAL MUNICIPAL VILA SANTA CATARINA The present study aims to report the performance of HIFU in Introduction and objective(s): The kidney transplant is prostate cancer using the description of the technical parame- the treatment of choice for most patients on a final stage ters and offering multiple images of this procedure in patients of chronic nephropathy caused by various morbidities, en- diagnosed with this neoplasm. abling a longer survival compared to dialytic techniques. Method(s): It is a bibliographical, descriptive and explor- Grafts have increasingly durability, due to the refinement of atory study allied to a pictorial essay. The literary review surgical techniques and the emergence of better immuno- brought together scientific articles; field surveys; disserta- suppressive drugs. In turn, also grow number post-surgical tions; theses without temporal cut of date of publication and complications, early and late. Therefore, the Ultrasonogra- writing in English and Portuguese. The pictorial test grouped phy Doppler plays a great role on these patients follow-up, images of both the technical procedure of HIFU and the use allowing detection of possible early and late complications. of HIFU in the CaP. The present study offers a selection of complications and Discussion: HIFU is a noninvasive approach that presents their image features, to help the radiologist on its detection. itself as an attractive curative therapy option making use of Method(s): We selected cases of our ultrasound group, precisely applied ultrasound energy to achieve tumor cell ne- demonstrating kidney graft complications, including: 1. Ob- crosis without radiation or surgical excision. HIFU is used structive uropathy, causing hydronephrosis and hydroureter/ clinically in the treatment of prostate cancer as follows: in 2. Collections (urinoma, hematoma, abscess, lymphocele) / the entire prostate; half of the prostate (hemi - HIFU) or even 3. Thrombosis/stenosis of the renal artery / 4. Thrombosis/ in "L"; (area of ??positivity of a biopsy and / or where tests stenosis of the renal vein / 5. Pseudoaneurysms / 6. Intrarenal point to a single area with disease). arteriovenous fistula. Conclusion: The contribution of HIFU to the quality of life Discussion: Renal transplantation includes placement of the of patients with PCa resides in the possibility of postponing graft into the iliac fossa, most commonly right. Anastomosis the need for invasive therapies associated with greater mor- of the renal artery is done with the renal artery in the case of bidity by providing a longer period without the risk of living a living donor, and with aortic segment grafting as a cadav- with treatment-related genitourinary side effects. eric donor. The venous anastomosis is done with the external Responsible Author: Joyce Caroline iliac vein. Finally, a ureteroneocystostomy or anastomosis is Email: [email protected] performed with the native ureter to reestablish urinary flow. Keywords: High Intensity Focused Ultrasound;,Focal Ther- Knowledge of the surgical technique increases the evaluation apy;,Prostate cancer quality. Ultrasonographic analysis of the grafted kidney be- gins in Mode B, observing the perirenal space, then evalu- PI.18.003 ating corticomedullary differentiation and renal size. At the ULTRASOUND EVALUATION OF URETERS: FAR Doppler mode, the patency of the renal artery and vein is BEYOND URINARY CALCULI evaluated, as well as discarding possible stenoses, especially Authors: HORIE, MKS; YONEKURA,I; FONSECA, in the anastomosis region. The expected parameters are flow EKUN; DUTENHEFNER, EE; LANGE FILHO, R; DIAS velocity less than 200 cm/sec. Intrarenal arteries are also eval- DA SILVA, PS; RAHAL JÚNIOR, A;QUEIROZ, MRG; uated, where we investigate the resistance index of these ves- FRANCISCO NETO, MJ; FUNARI, MBG sels. Larger values may characterize graft dysfunction. Institution: HOSPITAL ISRAELITA ALBERT EINSTEIN Conclusion: Ultrasonography emerges as accessible eval- HOSPITAL MUNICIPAL VILA SANTA CATARINA uation method and detection of complications, especially Introduction and objective(s): Ultrasonography is usually vascular, renal graft. The radiologist's knowledge about the the initial diagnostic imaging modality in abdominal pain, of- ultrasound characteristics and possible morbid changes of the ten with suspected renal origin. The evaluation of the kidneys graft is growing in importance. and urinary tract by ultrasonography usually focuses on the Responsible Author: renata silveira olimpio de paula furtado study of the renal parenchyma and urinary bladder, not al- Email: [email protected] ways detailing the ureters. However, such structures are often Keywords: ultrassonografia,doppler,transplante,renal also the site of various diseases. The present study combines a collection of cases that demonstrate the importance of the PI.18.002 detailed study of ureters, with several examples of diseas- HIGH INTENSITY FOCUSED ULTRASOUND (HIFU) es with involvement of the ureters, which were detected and AS FOCAL THERAPY IN PROSTATE CANCER detailed sonographically. We also illustrate some of our ex- Authors: SOUSA, J.C.O ; perience with dynamic assessment of the ureters in the study Institution: NÚCLEO DE PESQUISA CIENTIFICA E of vesicoureteral reflux and its peristalsis, correlating with
114 49th Sao Paulo Radiological Meeting conventional radiology. rapid growth. Gray-scale US can provide a correct diagnosis Method(s): We carried out an exhaustive review of the lit- in diffuse splenic disease which the main finding is the acute erature and selected several illustrative cases of ureter ultra- or chronic increase in the size of the organ. Splenomegaly can sonography, from impacted calculi to involvement of these be caused by infections, liver or blood diseases, problems with structures by granulomatous and neoplastic diseases, con- lymph system, or other conditions. genital affections and pitfalls in their evaluation. In addition, Conclusion: US plays a major role in the detection of diseases we present the technique of dynamic assessment of ureteral of the spleen and can be the method of choice for initial eval- reflux with correlation to radiographic studies. uation and follow-up. This makes the role of the radiologist in Discussion: Often forgotten in the ultrasound evaluation of the recognition of its typical patterns of imaging paramount, the urinary tract, ureters can be site of innumerable condi- allowing a more assertive diagnosis. Otherwise the appear- tions, and must be carefully studied, as illustrated by the dif- ance of splenic lesions is rather nonspecific, thefore, a through ferent cases that we have presented, which include diseases knowledge of the patient’s history and associated symptoms commonly encountered in sonographer´s daily practice, as may be of great importance in the differential diagnosis. well as some unusual manifestations and some rare diseas- Responsible Author: Andressa Inácio Gomes es that can affect these structures and should be known and Email: [email protected] recognized. We also highlight the use of the technique for dy- Keywords: spleen,lesions,focal,diffuse,ultrasound namic study in real time without the use of ionizing radiation in the characterization of vesicoureteral reflux. PI.18.006 Conclusion: The ultrasound study of the ureters allows vari- ULTRASONOGRAPHY OF CERVICAL ARTERIES - ous diagnoses, far beyond the simple evaluation of impacted STATE OF THE ART: EXAMINATION TECHNIQUE, calculus and consequent upstream dilatation. All sonogra- DOPPLER EVALUATION, POSTOPERATIVE STUDIES, phers, hence, should careful evaluation of these structures. CONTRAST-ENHANCED AND OTHER PATHOLOGIES Responsible Author: Eduardo Kaiser Ururahy Nunes Fonseca Authors: FONSECA, EKUN; HORIE, MKS; YONEKURA, I; Email: [email protected] VENTURA, CA; DUTENHEFNER, EE; LANGE FILHO, R; Keywords: ultrassonografia,ureter,Neoplasias Ureterais,Uret- QUEIROZ, MRG; FRANCISCO NETO, MJ; FUNARI, MBG erolitíase,tuberculose,leucemia,refluxo vesicoureteral Institution: HOSPITAL ISRAELITA ALBERT EINSTEIN HOSPITAL MUNICIPAL DA VILA SANTA CATARINA PI.18.004 Introduction and objective(s): Ultrasonography of the cer- DIFFUSE AND FOCAL SPLENIC LESIONS: HOW TO vical arteries is a noninvasive method to evaluate vascular INTERPRET ULTRASOUND FINDINGS patency and allows simultaneous flow analysis and morpho- Authors: GOMES, A. I.; DUTENHEFNER, E. E.; FURTA- logical evaluation, without dependence of nephrotoxic con- DO, R.S.O.P.; QUEIROZ, M.R.; NETO, M.J.F.; FUNARI, trast media or ionizing radiation, and is valuable both before M.B.G. and after treatment of stenoses. Institution: HOSPITAL MUNICIPAL VILA SANTA CA- The present study reviews from the basic principles as well TARINA as details the habitual and pathological postoperative changes Introduction and objective(s): A wide range of patholog- of the carotids and also illustrating other diseases that affect ic conditions can affect the spleen. They can be classified the neck arteries. into the following categories: congenital diseases (accessory Method(s): We carried out an exhaustive review of the liter- spleen, polysplenia, and asplenia); trauma; inflammation (ab- ature and selected several illustrative cases of cervical artery scess, tuberculosis, candidiasis, histoplasmosis, cytomegalo- ultrasonography, including the evaluation of atherosclerotic virus and sarcoidosis); vascular disorders (infarction, arterio- disease before and after surgical and endovascular treatment, venous malformation); benign tumors (cysts, hemangioma, the role of microbubble contrast, as well as other diseases and hamartoma); malignant tumors (sarcoma, lymphoma, of the such as carotid bulb tumors, inflammatory conditions, and metastases); and other disease processes that affect the dissections and aneurysms. spleen diffusely (portal hypertension, Gaucher disease and Discussion: The ultrasound study of the cervical arteries sickle cell disease) or focally (Gamna-Gandy nodules). Ul- allows great detailing of the carotids and vertebral arteries, trasonography (US) plays an importante role in diagnosis comprising both morphological and functional evaluation in since it has the capability of delineating distinct characteris- the same exam. In addition, the advent of contrast-enhanced tics of malignant and benign lesions. This iconographic essay ultrasonography allowed a greater degree of assertiveness in proposes a practical approach of pathologic conditions of the the differentiation between occlusions and subocclusions, spleen according to their etiology, bringing together some with a direct impact on the conduct and prognosis of these specific ultrasonographic features in order to guide their di- patients. It also presents high accuracy in the postoperative agnosis. assessment of carotid arteries, so that it becomes essential for Method(s): We selected cases from the Ultrasound group of the radiologist to know the normal postoperative aspect in our Department demonstrating the main splenic lesions on both B mode and in the Doppler study. US: 1. Polysplenia; 2. Accessory spleen; 3. Cyst; 4. It also characterizes other affections of these arteries such as Hemangioma; 5. Tuberculosis; 6. Candidiasis; 7. Abscess; 8. arteritis, carotidynia, subclavian steal syndrome and tumors Splenic infarction; 9. Sickle cell trait with splenic nodules of in the region of the carotid bulb. preserved parenchyma; 10. Lymphoma. Conclusion: Ultrasonography is the initial method of choice Discussion: US can analysys internal architecture of the lesion, for evaluation of the cervical arteries, especially in the con- depicting calcification (with suggests a long-standing pro- text of stenoses and atheromatous disease. Its applications, cess), gas within a lesion (usually due to bacterial infection), however, transcend such conditions by giving primary infor- perilesional edema (suggesting acute process), the patterns of mation to the postoperative evaluation and allowing the char- vascularization and it can detect other associated findings like acterization of innumerable other diseases of these vessels. lymphadenopathy. Malignant lesions especially metastasis are Therefore, the sonographer should not only know this initial more frequently multifocal, diffuse and ill-defined due to its evaluation but also how to identify the expected postopera-
Abstracts of Scientific Papers 115 tive changes, characterize other affections of these arteries Introduction and objective(s): Detection of small bone and be familiar with the use of microbubble contrast. fractures is often challenging for emergency room physicians, Responsible Author: Eduardo Kaiser Ururahy Nunes Fonseca clinicians, surgeons and also radiologists. In the last years, Email: [email protected] the development of linear transducers of excellent definition, Keywords: Microbolhas,Artérias Carótidas,Doenças das as well as the immersion of the radiologist inside the physical Artérias Carótidas,Endarterectomia das Carótidas,Estenose space of the emergency services, has led to the increasing das Carótidas use of ultrasonography in the detection of occult fractures, in an increasing number of places. Radiographs may have low PI.18.009 sensitivity for detecting fractures in some sites. The evalu- ation of X-rays by clinicians is increasingly limited, begin- FALSE NEGATIVE BREAST LESIONS: WHAT THEY ning with their formation. This work aims to teach the main CAN TEACH ultrasonographic aspects of fractures in different bone sites, Authors: HORIE, M.K.S.; FONSECA, E.K.U.N.; PEIXO- demonstrating where the sonographer made the difference. TO, M.; SHITARA, F.; YANO, L.; FEDERICCI,E.; RI- Method(s): Radiographic images (RX), ultrasound (US), to- BEIRO, R.L.M. mography (CT) and magnetic resonance imaging (MRI) of Institution: HOSPITAL ISRAELITA ALBERT EINSTEIN the patient admitted to the emergency room were used. Com- HOSPITAL MUNICIPAL DA VILA SANTA CATARINA pared results of other methods with those of ultrasonography. Introduction and objective(s): The screening with mam- Ultrasonography was performed using the 12 MHz linear mography has already proved to help reduce breast cancer transducer at the specific site of pain. mortality. Besides mammography, breast MRI is also used Discussion: The detection of occult fractures, less symptom- in screening programs for women with cumulative lifetime atic, in an emergency environment, is a permanent challenge. breast cancer risk. Recently, scientific papers have discussed In one hand simple radiographies turns out to be the simplest, issues related to errors in cancer diagnosis. Among the rea- low cost, with fair sensitivity for detection of more evident sons are the harms related to these errors and the fact that fractures, however with less sensitivity for small fractures. missed breast cancer was one of the most frequent cancer-re- On the other hand the RM that can be considered gold stan- lated diagnostic errors implicated in malpractice claims. The dard, despite the high cost. The US represents sensitive and purpose of this exhibit is to present the findings of false neg- specific examination in experienced hands. The sensitivity atives exams and to discuss the possible causes of mistakes for detecting fractures in the ribs may reach 90% in the US and how to learn from this cases to prevent similar errors in and 15% in the X-rays, both with specificity of 100% (PPV: the future. respectively 100% and 100% and VPN: 20% and 69%, re- Method(s): We carried out an exhaustive review of the lit- spectively) , as reported by GRIFFITH et al. In the present we erature and selected several illustrative cases of false nega- have brought fractures from different sites, some quite subtle. tive, missed lesions and misinterpreted lesions in breast can- Conclusion: Ultrasonographic evaluation of fractures can be cer screening exams. In addition, we will briefly discuss the used in a way that helps to diagnose occult fractures. Low importance of medical audit in a Breast Imaging Center and cost, sensitive, specific, and fully adapted to the needs of how to learn from these cases. emergency service units, promoting real-time diagnostics. Discussion: Trying to prevent these errors, one of the most Responsible Author: André Dubinco important actions is to have a comprehensive quality assess- Email: [email protected] ment program. This kind of program involves many steps Keywords: fraturas,ocultas,ultrassonografia,emergência and one of them is the evaluation of image interpretation ac- curacy. This is known as medical audit. Therefore, auditing PI.18.013 may be a very useful method to provide feedback to a breast radiology group about its success in meeting performance FINE ULTRASOUND ADJUSTMENTS FOR BEGGIN- benchmarks. ERS – STATE OF THE ART Conclusion: To improve the standard of care in any Breast Authors: NUNES, L.M.A.O.; DEFENDI, L.A.; ALCALA, Imaging Center it is mandatory to have a comprehensive J.M.; DUTENHEFNER, E.E.; RAHAL JR., A.; SAVOIA, P.; quality assessment program. In such program, some key per- FRANCISCO-NETO, M.J.; FUNARI, M.B.G. formance indicators must be measured. False negative cases Institution: HOSPITAL ISRAELITA ALBERT EINSTEIN are one of these indicators. It is important to know not only Introduction and objective(s): Among all imaging meth- the number of false negative exams, but also the reasons of ods, ultrassonography (US) is the most widely available those events to occur because among these lesions, missed and accessible. Due to its operator-dependance feature, it is cancers will be found. Knowing the causes of missed lesions unique between all imaging modalities. Such particularity will guide the corrective actions. is related not only to the specific training provided to image Responsible Author: MATHEUS KIYOSHI SIQUEIRA profissionals, or to the imaging findings and their interpreta- HORIE tion but also to appliance setting, gradually more complex Email: [email protected] and equipped with multiple tools. A lesion could be identified Keywords: Mama,Neoplasias da Mama,Falso-Negativas,M- or not depending on the specific appliance setting. The essay aims to introduce and discuss fundamental concepts in per- amografia,ressonância magnética forming B Mode US, Color Doppler, Pulsed Wave Doppler and Power Doppler, illustrating the impact of settings on ac- PI.18.012 quired images, focusing on beginner users. HIDDEN FRACTURES - IDENTIFYING THE FOCUS Method(s): A brief physics review will be conduct, including WITH ULTRASSOUND explanation regarding the probe choice. The pictorial essay Authors: HUMMEL A. D.; PONTE, M.P.T.R.; DUBINCO will cover images from various organs such as thyroid, ca- A. ; BISOLO L.; YONEKURA, I.; RAHAL JR., A.; FRAN- rotid, liver and kidney with and without the adequate pre- CISCO-NETO M.J.; FUNARI M.B.G. set, in a comparative manner. The specif setting adjustment Institution: HOSPITAL ISRAELITA ALBERT EINSTEIN will be discussed: focus, gain, depth, gray scale, sweep rate
116 49th Sao Paulo Radiological Meeting (B-Mode); PRF, WMF, angle correction and steer (Doppler). DIGITAL PRESENTATION (PD) Finally, the most prevalent conditions will be reviewed con- sidering the main settings to optimize their documentation. Discussion: The learning curve of US depends on familiar- PD.18.001 izing with the appliance and deepening in physics concepts EXTRA-GYNECOLOGICAL FINDINGS OF ENDO- of imaging formation. It is a continuous and not finite. For VAGINAL ULTRASONOGRAPHY better imaging identification, it is of utmost importance to Authors: VAZ, A.; GUSATTI, A. A.; REIFEGERSTE, C. P.; adequately operate the US equipament. TRIPPIA, C. R.; LINHARES, L. S. Conclusion: The improvement of apparatus-operator inter- Institution: HOSPITAL NOSSA SENHORA DAS face is of paramount importance for all radiologists. Partic- GRAÇAS, CURITIBA, PARANÁ, BRASIL ularly in ultrasound, beginners must to be trained intensely Introduction and objective(s): Endovaginal ultrasound is in the adjustment of US devices, fully dominating their po- an imaging modality with wide availability and acceptance tentialities. due to absence of ionizing radiation, low cost and easy ex- Responsible Author: Leticia Nunes ecution and interpretation by properly trained professionals. Email: [email protected] Its primary purpose is to evaluate gynecological organs; Keywords: Ultrassonografia,Ajuste,Parâmetros however, endovaginal ultrasound may depict alterations in adjacent structures. Therefore, the aim of this work is to il- PI.18.015 lustrate non-gynecological findings depicted by endovaginal ultrasonography. ELASTOGRAPHY OF THE THYROID: PRINCIPLES Method(s): A series of cases were selected from a image da- AND TECHNIQUES tabase of one of the authors. Intestinal changes (appendici- Authors: DEFENDI L.A.; KUSSANO, I.C.T; RAHAL tis, diverticulitis, polyp, colitis, colorectal adenocarcinoma), JR.A.; FALSARELLA P.M.; SAVOIA P.; VENTURA C.A.; urinary (pelvic kidney, ureterolithiasis, ureterocele, urethral CRUZ-SANTOS A.R.; FRANCISCO-NETO-M.J.; FUNARI M. diverticulum) and others (foreign body, peritoneal carcino- Institution: HOSPITAL ISRAELITA ALBERT EINSTEIN matosis) were included. Introduction and objective(s): Thyroid nodules are a com- Discussion: Incidental extra-gynecological pelvic abnor- mon finding with an estimated prevalence of 50%. Ultraso- malities and non-gynecological pathologies that mimic gy- nography (US) is the most sensitive imaging tool. For the last necological complaints may be detected by endovaginal ul- years, TI-RADS system has became important in the classi- trasound. fication of thyroid nodules, helping to differentiate between Conclusion: The knowledge of the imaging aspects of ex- those which can be followed and those that deserve further tra-gynecological findings favors the correct diagnosis and investigation. Fine-needle aspiration (FNA) plays a critical adequate referral of these patients. role in differentiating malign and benign nodules. Nonethe- Responsible Author: Anderson Azzolini less, it is invasive and involves high indeterminate outcomes. Email: [email protected] Since most malignant nodules are portrayed by the organi- Keywords: Pelvis,Obstetric and Gynecologic Diagnostic zation of their unusually firm stroma (desmoplasic reaction), Technics,Ultrasonography,nongynecologic pelvic findings,- ultrasound elastography (UE) emerges as a promising non-in- Gastrointestinal Diseases vasive tool for evaluating tissue stiffness. It has been applied for some years and shows good correlation with FNA. This PD.18.002 essay aims to review UE principles and techniques. US IMAGING OF SCROTAL TRAUMA: THE CLASSI- Method(s): Strain elastography (SE), shear wave elastogra- CAL AND UNUSUAL FINDINGS phy (SWE) or Sound Touch Elastography (STE) can be used. Authors: OLIVEIRA, T.F.T.; CALEGARI, M.C.; MARTINS, The last provides maps of tissue stiffness with the elastic ratio R.O.; MELO, F.G.; GOMES, V.A.; VASCONCELOS, R.A. (EI) and shear modulus (G) using the same ultrasound equip- Institution: INSTITUTO HOSPITAL DE BASE DO DIS- ment. Target lesion are examined in the B-mode, with volu- TRITO FEDERAL metry and TI-RADS classification. During the elastograms, Introduction and objective(s): To exhibit common and un- patients are asked to keep still in dorsal decubitus. common sonographic presentations of the scrotal trauma, Discussion: Elastography is a non-invasive method for assess- emphasizing the findings that define a conservative manage- ing mechanical qualities of tissues (elasticity and stiffness). ment or surgical intervention. The thyroid is a superficial gland and can be assessed by all Method(s): we evaluated a great number of scrotal trauma elastography techniques. Signal processing is used to evaluate cases, mostly subacute, demonstrating classic findings of le- stiffness and elasticity. Manufacturers have built their elas- sions such as hematoma, fractures and ruptures. We also iden- tography modules utilizing any of the methods (SE, SWE, tify extensive and complicated injuries of these conditions, STE) and their own particular annual innovations. Elastog- with anatomopathological and surgical correlation, as well as raphy helps to characterize primary lesions and structures like an accidentally detection of a seminoma of the testis. post-thyroidectomy residual tissue, thyroiditis pseudo-nodules Discussion: Testicular trauma is the third most common and parathyroid nodules that might mimic tyroid lesions. It can cause of acute scrotal pain and the ultrasound is the first- also be useful in the investigation of cervical adenopathy. line imaging modality for this condition. It provides a non- Conclusion: When its technique and interpretation is fully invasive evaluation that supports the clinical approach and understood, elastography can be integrated into the conven- identify associated complications. The method also enables a tional ultrasound examination without adding much time to secure follow-up of the patients, besides detecting accidental the procedure. tumors, which occurs in 10% of cases. Responsible Author: LARISSA DE ANDRADE DEFENDI Conclusion: The spectrum of scrotal trauma injuries includes Email: [email protected] not only the testis, but also the surrounding tissue. High-res- Keywords: tireoide,elastografia,TIRADS,PAAF olution ultrasound with Doppler represents the modality of
Abstracts of Scientific Papers 117 choice for the initial evaluation. As the early recognition and sound using a microbubble contrast media (CEUS) has al- therapeutic approach generally ensure good evolution of this ready been consolidated in the literature for several patholo- condition, preserving the functions of the structures involved, gies, mainly in the characterization of hepatocarcinoma. It is it is important for the radiologist to be well versed with the a low cost imaging method, with low morbidity and relatively appearance of each type of injuries along this spectrum. easy to perform with adequate training. It can be used as first Responsible Author: THAIS FIGUEIREDO TEODORO approach or even in patients with contraindication for CT or DE OLIVEIRA MRI examinations. Despite this, the CEUS is still little dif- Email: [email protected] fused and little known in our country, being considered com- Keywords: scrotal trauma,testicular trauma,ultrasound, plex by many radiologists due to lack of experience and lack of imaging contact with the method. The objective of this work is to help understand the mechanism of action of microbubble contrast PD.18.006 media, its use, its indications and its limitations, through se- lected cases to illustrate in a practical and simple way. As a sec- TI-RADS UPDATE: REVIEW AND TRAINING ondary objective we have the recognition of the multisystemic Authors: FIGUEIREDO, M.A.P.; NETO, M.J.F.; JUNIOR, role of CEUS, not only limited to its use in echocardiography A.R.; VIEIRA, F.A.C.; FUNARI, M.B.G. and hepatic lesions characterization, but also in several other Institution: HOSPITAL ISRAELITA ALBERT EINSTEIN pathologies for its characterization and diagnostic elucidation, Introduction and objective(s): Thyroid nodules are a fre- outlining a panel of CEUS future perspectives. quent finding on neck sonography. Most nodules are benign; Method(s): Illustrated teaching cases from our department therefore, many nodules are biopsied to identify the small reviewing the situations in which the CEUS is useful in clin- number that are malignant or require surgery for a definitive ical practice. diagnosis. Since 2009, many professional societies have pro- Discussion: ?CEUS ?Physical principles ?Ultrasound contrast posed ultrasound-based risk stratification systems to identi- agents ?Indications and limitations ?A STEP-BY-STEP PRAC- fy nodules that warrant biopsy or sonographic follow-up. In TICAL GUIDE TO CEUS ?How to perform CEUS: imaging 2012, the ACR convened TI-RADS committees to provide acquisition, phases, degree and timing of enhancement, device recommendations for reporting incidental thyroid nodules, parameters and artefacts. ?CLINICAL APPLICATIONS OF develop a set of standard terms (lexicon) for ultrasound re- CONTRAST-ENHANCED ULTRASOUND, INCLUDING: porting, and propose a TI-RADS on the basis of the lexicon. ?Screening and evaluation of focal masses in the liver ?Organ In 2017, the TI-RADS classification has been updated, so the transplantation ?Abdominal trauma ?Pancreatic masses ?Deter- user must score each node in five different categories which, mination of active inflammation in inflammatory bowel disease when added, determine the risk of TR1 to TR5. They are: ?Renal vascular, inflammatory and neoplastic diseases ?Evalua- composition, echogenicity, margins, position and presence of tion of adnexal disease ?Prostatic cancer screening ?Monitoring echogenic foci. The objective of this work is to present the aortic stent-graft ?CEUS–guided Intervention ?CEUS monitoring new TIRADS classification and, through interactive cases, to of response to tumor therapy ?FUTURE DIRECTIONS ?What provide a practical training for the congressmen. is on the horizon for CEUS ?Molecular imaging ?Target therapy Method(s): After a brief review of the literature, we will Conclusion: CEUS is an emerging important alternative mo- present exams performed at our institution, which were sub- dality to assess enhancement pattern of several conditions mitted to histological study. Through an interactive quizz, especially for patients with contraindication to CT or MRI, each node will have its five characteristics classified and then as well as in a bedside setting. Furthermore, it has a potential summed to determine the final TIRADS. role in molecular imaging and cancer therapy. Discussion: ACR, in its last update of TIRADS, greatly al- Responsible Author: Karla Schoen tered the methodology of classification of the thyroid nodules. Email: [email protected] Because it is a tool already adopted in several ultrasound ser- Keywords: CEUS,ultrasound,contrast,microbubble,ultras- vices in Brazil, due mainly to the ease of interpretation by the som,contraste,microbolhas requesting physician, it is fundamental to review and periodic training of radiologists and sonographers. PD.18.011 Conclusion: The ACR TI-RADS risk-stratification system allows practitioners to deter- mine whether thyroid nodules FIRST TRIMESTER BLEEDING: WHAT EVERY require biopsy, follow-up, or no further action based on their RADIOLOGIST NEEDS TO KNOW US appearance. Success demands close cooperation be- Authors: PERDIZES, O.G.; ALVES, I.S.; DIAS JR, U.S.; tween radiologists and sonographers, understanding of the LEITE, C.B.F.; CAMERIN, G.R.; OLIVEIRA, C.V.; HOR- nuances and pitfalls of feature assignments, and attention to VART,N.; KOBAYASHI, S. detail in reporting and making recommendations. Institution: HOSPITAL SÍRIO LIBANÊS. Responsible Author: MARIA AUGUSTA PACHECO Introduction and objective(s): Vaginal bleeding during FIGUEIREDO the first trimester of pregnancy is a common presentation in Email: [email protected] the obstetric emergency room. Approximately half of these Keywords: ATUALIZAÇÃO,TI-RADS,TREINAMENTO patients will lose the gestation. Its main causes are ectopic pregnancy, gestational trophoblastic disease, spontaneous abortion, subchorionic hematoma, anembryonic pregnancy PD.18.010 and spotting, caused by implantation of the fertilized egg in FROM MICROBUBBLES TO BURST: A PRACTICAL the endometrium. The clinical history and the physical ex- GUIDE TO CONTRAST ENHANCED ULTRASOUND amination play a limited role in the evaluation of its causes Authors: KARLA SCHOEN, K.; OLIVEIRA, B. C.; and outcomes. In this context, ultrasound plays an important MARCELINO A. S. Z.; ARAÚJO-FILHO, J. A. B.; HOR- role in the diagnosis, treatment and follow-up of these pa- VAT, N.; CERRI, L. M. O.; CERRI G. G. tients, being a fast, non-invasive method, with good accuracy Institution: HOSPITAL SÍRIO-LIBANÊS and without using of radiation. The objective of this study is Introduction and objective(s):: Contrast-enhanced ultra- to describe the milestones and findings of ultrasonographic
118 49th Sao Paulo Radiological Meeting images of the main causes of the first trimester bleeding, its and not exempt from the possibility of complications, some- complications, treatments and differential diagnoses. times severe. Elastography is the imaging method that adds to Method(s): We are going to illustrate, in a pictorial essay conventional B-mode and Doppler ultrasound the analysis of based on cases, the features and the detailed description of elasticity and tissue stiffness after application of a mechanical the radiological findings of the main causes of bleeding in stimulus. The examination was incorporated by the Unified the first trimester of pregnancy, using images acquired at our Health System from 2015, according to the "Clinical Protocol institution by means of ultrasonography. and Therapeutic Guidelines of chronic hepatitis C" established Discussion: Ultrasonography is an essential tool in the eval- by the Ministry of Health, thus making it essential to know its uation of the gestational first trimester bleeding, being able to bases for health professionals who patients with chronic hepati- perform an accurate and fast diagnosis and guide the various tis, especially intra-hospital ultrasonographers. therapies. In order to do this, it is necessary for the radiologist Conclusion: Hepatic elastography is a sensitive and specific to recognize and evaluate the main landmarks and findings method to distinguish patients with absent or minimal hepatic of obstetric ultrasound, paying special attention to the par- fibrosis (METAVIR F0 and F1) and severe hepatic fibrosis or ticularities of the images and its time of appearance, for the cirrhosis (METAVIR F3 and F4), denying the need for liver determination of the most appropriate approach. biopsy to diagnose fibrosis in these groups, except in cases Conclusion: As mentioned above, obstetric ultrasound is a where the procedure is indicated for other reasons. fundamental and widely used method in pregnancy first tri- Responsible Author: Ivan Cesar Tanaka Kussano mester bleeding scenario, playing a key role in its diagno- Email: [email protected] sis and management. Therefore, a didactic presentation of Keywords: ultrassonografia,fígado,elastografia,cirrose obstetric ultrasound concepts and the proper technique for performing it is fundamental for the radiologist, given the PI.18.008 importance and impact of a rapid and correct diagnosis to DEFINING CONDUCTS WITH ELASTOGRAPHY - determinate the best management for these patients. FOCUS ON EXTRA-HEPTIC CONDITIONS Responsible Author: Gregory de Oliveira Perdizes Authors: KUSSANO I.; RAHAL JR. A.; SAVOIA P.; Email: [email protected] SAMESHIMA Y.T.; QUEIROZ M.R.G.; FRANCISCO-NE- Keywords: Utrasound,first,trimester,bleeding TO M.J.; FUNARI M.B.G. Institution: HOSPITAL ISRAELITA ALBERT EINSTEIN A brief description of the objective(s): Review the current lit- erature regarding the use of ultrasonography with elastography for the evaluation of diseases and extrahepatic conditions, ana- LITERATURE REVIEW lyzing the applications and limitations of the method in different organs, increasing in our means the indications. Description of the disease(s), method(s) and/or tech- nique(s): Different articles from different databases describ- POSTERS (PI) ing the application of the examination to the breast, thyroid, prostate, kidneys, lymph nodes, muscles and other organs PI.18.007 have been consulted. Discussion: Elastography is an imaging method already validat- HEPATIC ELASTOGRAPHY - GROWING APPLICA- ed as a tool for assessing liver fibrosis. Its application, however, TION / STEP BY STEP / KEY POINTS is not restricted to the liver, since it can provide valuable infor- Authors: KUSSANO I.C.T; VENTURA C.A.; RAHAL JR. mation in the study of lesions in other organs. The application in A.; FRANCISCO-NETO M.J.; FUNARI M.B.G. breast exams already presents a very valuable use in practice to Institution: HOSPITAL ISRAELITA ALBERT EINSTEIN aid in the differentiation of lesions between benign and malig- A brief description of the objective(s): Review the current nant. Its use in other organs, such as thyroid and prostate, present literature regarding the application of elastography for the as- potential as an aid to indicate and guide invasive procedures, but sessment of liver diseases, focusing on the diagnosis of liver still do not have clear indications in practice. As far as the pros- cirrhosis using the different techniques available, and tech- tate is concerned, elastography is seen as the virtual rectal touch, nical details of the main devices. This review aims to break gaining more and more space. In the kidneys, it is possible to use the barrier between this relatively recent method and the vast the method as a non-invasive and non-invasive alternative to the majority of imaging professionals, often wary when asked to biopsy to determine the degree of fibrosis of the organ, but further perform this examination. studies will be necessary to determine its degree of reliability. Description of the disease(s), method(s) and/or tech- Conclusion: Ultrasonography associated with elastography nique(s): The different techniques available in the market is an examination that is relatively recent in its use, with including Transient Elastography, Point Shear Wave Elastog- some already consecrated applications, and new studies be- raphy (pSWE), and 2D Shear Wave Elastography (2D SWE) ing carried out to validate its use in the complementary eval- were analyzed comparing their differences, advantages and uation in several organs. The examination is promising in disadvantages. The main findings related to diffuse and focal several fields, not only in terms of the diagnostic accuracy of liver lesions have also been described. ultrasonography, but also as a defining potential of conduct Discussion: Hepatic fibrosis results from a series of events in- in certain situations. As the use of the method becomes more volving injury and scarring, representing the final state of vari- widespread, new consensuses related to its applicability are ous diseases that affect the organ. Its evaluation is important not being constructed, and the sonographer needs to be familiar only for the diagnosis of cirrhosis but also for guiding conducts with this methodology, incorporating it into its portfolio. and for the purpose of therapeutic follow-up of the diseases that Responsible Author: Ivan Cesar Tanaka Kussano cause it. Before the advent and dissemination of elastography, Email: [email protected] the only way to reliably determine the degree of liver fibrosis Keywords: Ultrassonografia, Elastografia, Mama, Tireoide, was through biopsy, an invasive procedure with greater costs Próstata, Rins, Baço
Abstracts of Scientific Papers 119 DIGITAL PRESENTATION (PD) published articles in the Google Books, Scielo, PubMed and Lilacs databases. We used for the production of this article 01 doctoral thesis, 01 master's thesis, 01 book and 07 scientific PD.18.004 articles. The inclusion criteria were: books, original papers, ASSOCIATION OF 3D PRINTING IN OBSTETRIC UL- case reports, meta-analyzes, bibliographic reviews and scien- TRASONOGRAPHY EXAMINATIONS tific research. Authors: BARROS, E. P. S.; SILVA, D. C. B.; OLIVEIRA, Discussion: This review highlighted the great advances made I. C. by ultrasound and three-dimensional impression in the obstet- Institution: Faculdade Sete de Setembro ric area through the development of virtual and physical mod- els of the anatomical structure of the fetus as an indispensable A brief description of the objective(s): Ultrasonography is instrument for the early diagnosis of pathologies. a noninvasive technique that allows images to be obtained Conclusion: Ultrasonography and 3D printing have been in- and displayed in the obstetric area quickly and without caus- creasingly used, providing the creation of a virtual and phys- ing risks in fetal formation. With the technological advance, ical model for a better knowledge of the fetus or for the study it is possible to perform three-dimensional (3D) ultrasound, of pathologies. Although it has several benefits, this tech- which allows the medical professional and the family to have nique has a relatively high cost, which makes it difficult for a real and precise detail of the fetus. Far below a simple the association to be a popular technique in society. There- prototype, the 3D impression of the fetus facilitates the ex- fore, studies such as this are indispensable for the populariza- planation of pathologies, as well as the decision making for tion of the 3D printer in the field of obstetrics, thus providing possible resolutions of these.The study aimed to analyze the a broad knowledge of this technique and thus greater attribu- available scientific evidence on the use of ultrasonography tions of it in the area of health, in addition, the growing study and 3D printing in obstetrics. may provide new techniques that present the cost benefiting Description of the disease(s), method(s) and/or tech- the entire population. nique(s): This is a bibliographical review of the narrative Responsible Author: EVERTON PHILIPE DA SILVA type, based on data collected through research using contents BARROS that deal with ultrasound and 3D printing, between 2005 and Email: [email protected] August 2018, available in books, dissertations, theses and Keywords: ULTRASSONOGRAFIA; OBSTETRICIA; DI- AGNÓSTICOS POR IMAGEM; IMPRESSÃO 3D
VETERINARY RADIOLOGY CASE REPORT tion of the bladder, around 3.5 cm x 3.0 cm, suggesting for- mation or intraluminal mass. An exploratory laparotomy and caudal partial cystectomy were performed, histopathological and immunohistochemical studies concluded as pleomorphic DIGITAL PRESENTATION (PD) rhabdomyosarcoma and chemotherapy with doxorubicin was performed. Eighteen months after the surgical intervention, the animal had a good general condition. PD.19.003 Discussion and diagnosis: The bladder is the most common PLEOMORPHIC RHABDOMYOSARCOMA IN THE site of canine urinary tract neoplasias, but less than 1% of URINARY BLADDER IN A YOUNG FEMALE DOG: A all tumors in dogs occur in it, and the absolute majority is CASE REPORT. transitional cell carcinomas (97% in dogs). According to Lip- Authors: GOMIDE, G. A.; LEPIANI, R. D.; TOMOKO, A. N. tak & Forrest (2007), rhabdomyosarcoma is locally invasive, Institution: UNIVERSIDADE ANHEMBI MORUMBI with low to moderate metastatic potential. Rhabdomyosar- A brief description of the objective(s): Rhabdomyosarco- comas occur in the bladder more commonly than elsewhere, mas are uncommon malignant mesenchymal tumors in dogs. comprising approximately 2/3 of the cases reported in dogs. This study aims to report a case of pleomorphic rhabdomyo- This tumor tends to occur in dogs of large breeds less than sarcoma in a young female bitch bladder. two years old and metastases are uncommon but have been Clinical History: A one year old Golden Retriever non-hyster- reported in several organs. As in humans, pleomorphic rhab- ectomized female dog was treated with hyporexia, oligodipsia domyosarcoma appears to be the least common form of this and dysuria with quick evolution, as well as severe hematuria tumor in animals. in the urinalysis. Ultrasound revealed diffuse thickening in Conclusion: Ultrasound and x-ray examinations provided the urinary bladder wall, as well as a hypoechoic image dis- relevant information regarding the lesion aspect and extent cretely heterogeneous in the caudal region of the bladder and of the involvement. Although the pleomorphic variant is ex- in continuity with the bladder wall, measuring approximately tremely rare and has an unfavorable prognosis, it showed 3.5 cm x 2.2 cm, accompanied by urethral dilatation. Color good evolution after chemotherapy treatment in the patient Doppler showed bladder wall vascularization in continuity to in question. bladder formation. The splenic parenchyma presented diffuse Responsible Author: Gabriela Abdalla Gomide gross ecotexture and discrete heterogeneous echogenicity Email: [email protected] and a slight increase of cranial mesenteric lymph nodes. In Keywords: canine,urinary bladder,rhabdomyosarcoma,Pleo- urethrocistography, dilation of the cranial third of the urethra morphic rhabdomyosarcoma,cães,bexiga urinária,neopla- was observed, and evident failure filling in the caudal- por sia,rabdomiossarcoma
120 49th Sao Paulo Radiological Meeting BASIC / PRECLINICAL RESEARCH ORIGINAL PAPER ORAL PRESENTATION (TL)
TL.20.001 POSTERS (PI) ROLE OF COMPUTED TOMOGRAPHY (CT) AT ON- COLOGIC EMERGENCIES AND URGENCIES- AN ONCOLOGICAL REFERRAL CENTER EXPERIENCE. PI.20.001 Authors: COSTA, R.S.; BASTOS, M.C.; BERTHOLATO, ROLE OF MAGNETIC RESONANCE IMAGING IN F.S.; NEVES FILHO, E.J.L.; PASSOS, D.K.; STROLIGO, THE EVALUATION OF EMERGENCIES AND ONCO- C.F.; STUTZ, C.L.; ALVES, P.L. LOGICAL EMERGENCIES Institution: INSTITUTO NACIONAL DE CÂNCER Authors: TEIXEIRA, D.F.D; BRAGA, J.C.D; GUIM- (INCA)- RIO DE JANEIRO ARÃES, M. D. A brief description of the objective(s): To describe the Institution: A.C.CAMARGO CANCER CENTER main indications and findings of computed tomography (CT) A brief description of the objective(s): Entrepreneurship, in urgent and emergency situations in an oncological referral the image of magnetic resonance imaging (MRI) is sought in center. To evaluate the proportion of positive or negative re- the emergency and emergency department at a cancer refer- sults in relation to clinical suspicion, in order to discuss the rational request for imaging examinations. ence center, raising its main indications, findings and impacts Material(s) and method(s): A descriptive, retrospective, on therapeutic conduct and decision making, correlating with single-center study which included data from all scan re- indications with hospital admission and mortality during hos- quests in context of urgency and emergency, in patients with pitalization. current or previous benign or malign neoplasia at National Material(s) and method(s): This is a retrospective study, ap- Cancer Institute from Brazil, from January to December pe- proved by the institution's Ethics and Research Committee, riod of 2018. conducted through the review of medical records and reports Results and discussion: We collected data from approxi- of patients from June 2017 to June 2018. The information mately 900 CT scans from the emergency departments (adult collected was exported to a database and the appropriate sta- and pediatric) - 41%, Inpatients -38%, Intensive Care Unit tistical tests applied. (ICU) -13%, and ambulatory care patients- 8%. Most of the Results and discussion: A total of 1334 MRI reports were patients (75%) were in the age range of 18-60 years, mainly collected so far, 156 of which were analyzed and 68 of them males (55%). The most frequent primary tumors were col- entered the inclusion criteria. The mean age was 59.8 years orectal carcinoma and non-Hodgkin's lymphoma. The main (24-89 years). Considering the main radiological indica- requests were in the areas of Neuroradiology (39%), with tions for MRI, 17 (25%) sought to investigate metastasis, 15 suspicion of hydrocephalus; followed by Internal Medicine (22.1%) pain, and 11 (16.2%) headache. The most frequently (36%), with suspicion of intra-abdominal collection and performed MRI scans were skull with 54.4%, column 23.5% thorax (21%) for infection investigation. In general, 55% and basal-hip-pelvis 7.4%. Based on the radiological indica- of the requested scans did not confirm the clinical suspicion, tions to perform the imaging exam, 50 (73.5%) of the MRIs with greater disagreement in the head scans, in which 65% performed were positive for the suspicion, confirming the of the exams did not present alterations, and in the internal initial indications and 18 (26.5%) presented negative results. medicine, with disagreement or negative findings in 55% of Based on the conclusions of the reports, the following ther- the cases. Conclusion: CT presents an important role in the evaluation apeutic measures were taken: 44 (64.7%) hospitalization, of cancer patients, considering the presence of several con- 17 (25%) clinical treatment and 7 (10.3%) %) surgery. Re- founding factors to routine clinical and laboratory exams. garding the evolution of these patients, 40 (58.8%) were dis- However, the large proportion of normal or discordant exam- charged from hospital, 22 (32.4%) remained hospitalized and inations of clinical suspicion raises the discussion about over- 6 (8.8%) were in palliative care. use of the method, with negative impacts related to too much Conclusion: The main indications of MRI in the emergency exposure to ionizing radiation and to the economic losses. room were: metastasis, pain and headache. The most request- Responsible Author: Rangel de Sousa Costa ed exams were skull and spine. Hospital admission was the Email: [email protected] most frequent conduct after MRI in the emergency and there Keywords: computed tomography, ONCOLOGICAL RE- were no cases of mortality during hospitalization. FERRAL CENTER, urgency and emergency Responsible Author: Diogo Fábio Dias Teixeira Email: [email protected] Keywords: Magnetic Resonance Imaging,oncology,urgen- cies and emergencies
Abstracts of Scientific Papers 121 AUTHORS INDEX ANGHINAH, R. • PI.12.014 ANTUNES, E. • PD.02.032 ANTUNES, P. E. H. • PD.01.020, PD.12.078, , PI.12.001 ANTUNES, VB • PD.17.016 A A. P. PEREIRA • TL.09.003 ABDALA N. • PI.03.007 ARANHA, A.S. • PD.02.028 ABE, D.G. • PD.12.066 ARANHA, M. R. • PI.12.014 ABRAO, M.S. • PD.02.028 ARAÚJO, A.I.R. • PD.03.014 ABRAO,M.S. • PI.01.003 ARAÚJO, E. M • PI.01.011 ABREU, CEV • TL.17.005 ARAÚJO-FILHO, J. A. B. • PD.18.010 ABREU, P. P. • PD.12.061 ARAÚJO, JAB • PD.04.013 ABREU, P.P • PD.12.071, PI.12.017 ARAÚJO, J. M. • PD.01.026, PD.04.004 ABUD, C.P. • PD.01.018 ARAUJO JUNIOR, F. A. • PD.12.038 ADATIHARA, J. M. • PD.13.015 ARAÚJO, L. • PD.12.037 ADORNO, I.F. • TL.05.001 ARAUJO M.A. • PD.13.013 A E PIZARRO, MD • PD.01.088 ARAÚJO M. A. • PD.13.009 AFFONSO, B. B. • PD.08.006, TL.08.004 ARAUJO, P. N. B. D • PD.17.011 AFFONSO, B.B. • PD.08.007, PD.08.012 ARAUJO, P. N. B. D. • PD.01.038, PD.17.009, PD.17.010 A. FUENTEALBA MD • PD.01.088 ARAÚJO, R. M • PD.04.004 AGNOLLITTO P. M. • PD.15.004, PD.15.005 ARAÚJO, R. M. • PD.01.026 AGNOLLITTO P.M. • PD.15.001 ARAUJO, T.A. • PD.08.001 ALBUQUERQUE, K.S. • TL.02.001 ARCANJO-MARQUES T.L.M. • PD.12.043 ALBUQUERQUE, M.L.L. • TL.09.001 ARGOLO, T.A • PI.01.011 ALCANTARA, G. G. R. • PD.15.057 ARRUDA, B. • PD.12.008 ALENCAR, L. S. • PD.09.002 ARRUDA M.F. • PI.01.001 ALLEGRO, B.B. • PD.12.004 ARRUDA, P • PD.15.022 ALMARZA P. • PI.02.006 ASSO, G. B. • PD.17.025 ALMEIDA, F. A. • PD.05.010 ASSUNCAO, F.B • PD.12.090 ALMEIDA, G.C • PD.13.016 ASSUNÇÃO. F. B. • PD.17.019 ALMEIDA, L. B. • PD.12.068 AUAD, R.V. • PD.17.018 ALMEIDA, O. J. • PI.09.016 AUGUSTO,B.M • PD.13.010 ALVES, A.C. • PD.09.023 AVILA, LFR • PD.04.013 ALVES, A. S. F. • PD.11.015, PD.11.016, TL.11.001 ÁVILA, L. F. R. • PD.04.014 ALVES, A.S.F. • PD.11.003 AZEKA, A. H. • PD.12.066 ALVES, H. C. B. R. • PD.03.009 AZEVEDO FILHO, L.F. • PD.08.010 ALVES, I. S. • PD.15.046 AZEVEDO NT, R. • PD.12.064 ALVES, I.S. • PD.01.025, PD.01.057, PD.15.036, PD.18.011 B ALVES, K. C. • PD.01.045 ALVES LR • TL.17.002 BACHA, R. P. • PD.11.018 ALVES, P.L. • TL.20.001 BADDINI-MARTINEZ J.A. • TL.17.001 ALVES, V. O. • PD.15.008 BAE, S.M.B. • PD.03.010, PD.03.016, PD.12.082, AMANCIO, C.T. • PD.03.019 PD.12.093 AMARAL, A. C. • PD.17.003 BALDISSEROTTO, M. • TL.15.003 AMARAL, D.T. • PD.15.046, PD.15.055 BANDEIRA, C. K. • PD.16.015 AMARAL, L. T. W. • PI.09.016 BANDEIRA,G.A. • PD.13.011, • PI.13.010 AMARAL, R. M. • PD.11.015 BAPTISTA, E • PI.15.005 AMARO JR, E. • PD.12.064, TL.12.005 BARBISAN, C. C. • PD.17.023 AMOEDO, M. K • PD.13.014 BARBISAN, C.C. • PI.01.003, TL.02.001 AMORIM, L.L.N.L. • PD.04.011 BARBOSA, C. A. S. • PD.15.008 AMORIM, P.M. • PD.12.011 BARBOSA, F.R. • PD.09.023 ANDRADE, G.H.D. • PD.08.001 BARBOSA JR, A. A. • TL.12.005 ANDRADE J.R. • PI.05.003 BARBOSA JR, A.A. • PD.12.037, PD.12.043 ANDRADE, J. R. • TL.08.003 BARBOSA-JUNIOR, A.A. • PI.12.016 ANDRADE, J.R. • PD.08.008 BARBOSA O.L. • PI.05.002, • PI.05.003 ANDRADE, L.S.M. • PD.17.013 BARBOSA, P.N. • PD.17.006 ANDRADE, LSM • PD.12.073 BARBOSA, P.N.P • PI.15.006 ANDRADE, M.G.S. • PD.05.011 BARBOSA, P.N.V.P. • PD.15.043 ANDRADE, R. G. F. • TL.15.003 BARONI, R.B. • TL.01.001 ANGHINAH R • TL.12.003 BARONI, R. H. • TL.01.005 ANGHINAH, R • PD.12.064 BARONI, RH • PI.11.002
122 49th Sao Paulo Radiological Meeting BARRA, R. R. • PD.11.013, PD.11.015 BRAGANÇA, R.S.S • PI.16.011 BARRETO, G. B. • PD.09.003 BRENTANO V. B. • PD.01.073 BARRETO, V. O. • PD.01.012 BRENTANO. V.B. • PD.01.057 BARROS, E. P. S. • PD.16.007, PD.18.004 BREY,A.C. • PI.16.011 BARROS, F.C. • PD.04.012 BRINGEL, A.M.D.G. • PD.17.013 BARROS,I. C. • PI.16.006 BRINGEL, AMDG • PD.12.073 BARROS, L. F • PD.13.010 BRINGEL, RFG • PD.12.073 BARROS, M.F.F. • PD.05.010 BUCHPIGUEL, C. A. • PI.12.014 BARROS, N. M. • PD.16.007 BUGES, C. B. • PI.16.007 BARROSO, L. M. • PI.13.012 BARROS, R. V. • PD.09.030, PD.09.033 BARTELS, R. • PI.02.003, • PI.12.012 C BASSO, C. F. • PD.01.020, PD.12.078, CACAO, P.H.M. • PD.11.011 TL.09.002, TL.09.004 CALEGARI, M.C. • PD.18.002 BASSO, G. B. • PD.01.045, PD.17.019 CALFAT, E. • PI.13.007 BASSO, G.B. • PD.17.042 CAMARGO, K. K. J. A. • PD.12.090 BASTOS, AA • PD.15.019 CAMELO, M.A • PI.11.001 BASTOS, M.C. • TL.20.001 CAMERIN G. R. • PD.01.073 BASTREGHI,R.C • PD.09.035 CAMERIN, G. R. • PD.15.046 BAVARESCO, A.P. • PD.13.008 CAMERIN, G.R. • PD.01.025, PD.15.036, PD.18.011 BECKMANN, G. A. • PD.11.013, PD.11.015 CAMILO, D.M.R. • TL.05.001 BECKMANN, G.A. • PD.11.003 CAMPOS, A.L. • PD.14.006 BELLEGARD, L. M. • PD.05.010 CAMPOS, A. L. M • PD.11.018 BELMONTE, D • TL.01.004 CAMPOS A. M. • PD.09.041 BERALDO, G. L. • PI.09.016 CAMPOS, C. L. • PD.15.057 BERNARDO, M. O • PD.05.010 CAMPOS, L. • PD.12.008 BERTHOLATO, F.S. • TL.20.001 CANDIDO, F.J.F. • PD.02.012 BERTOLAZZI, P. • PD.04.014, PD.16.011 CAPOBIANCO, J • PD.17.016 BERTOLAZZI,P. • PI.13.007 CAPUCI, M. • PD.09.003 BEVILACQUA, C.T • PI.13.012 CARDOSO, A.P.T. • PD.04.014 BEZERRA, A. H. • PD.01.026 CARDOSO, K. • PD.07.001 BEZERRA R. O. • PD.01.073 CARDOSO, M.S. • TL.08.002 BEZERRA, R. O. F. B. • PD.01.038 CARDOZO, R.R.S • PD.17.013 BIANCO, G. A. • PD.01.012 CARNEIRO, B.C. • PI.15.001 BIGUELINI, S. E. • PD.12.038 CARNEIRO, C. G. • PI.12.014 BISINOTTO, H. S. • PI.09.016 CARVALHO, G.L.N.F. • PD.04.011 BISOLO L. • PI.18.012 CARVALHO, RS • PD.12.073 BISOLO, L • PI.02.007 CARVALHO, T. M. • PD.04.004 BITENCOURT, A. G. V. • TL.09.001 CARVALHO, V.O. • TL.08.003, TL.08.004 BITENCOURT, A.G.V. • PI.15.006 CASTRO, AA • PD.15.017, PD.15.018, PD.15.019, , BITTENCOURT, A. • PD.17.006 PI.11.002, , PI.15.005 BITTENCOURT,G. R • PD.13.010 CASTRO, C.E.S. • PD.12.011 BLASBALG, R • PD.01.047 CASTRO, F.S.P. • PD.12.081 BLASBALG, R. • PD.01.053, PD.17.018 CASTRO, H. F. B. • PD.09.029 BLASBALG,R. • PD.01.035 CASTRO, L.A. • TL.08.002 BOAS,A.G.V. • PD.16.014 CASTRO M • PI.02.006 BOAS,C.A.A.V. • PD.16.014 CASTRO, P. N. P. • PD.12.061, PD.12.070 BOLINELLI, A. P. • PD.01.012, PD.16.009 CASTRO, P. N.P. • PI.12.017 BOMFIM,M.H. • PI.16.011 CASTRO, P.N.P • PD.12.071 BORDALO, M. • PD.15.055 CAVALCANTE JR F.A. • PD.08.003 BORDALO-RODRIGUES, M. • PD.15.036 CAVALCANTE JR, F.A. • PI.08.004, • PI.08.005 BORDALO-RODRIGUES; M. • PI.15.008 CAVALCANTE, JR. F. A. • PI.08.006 BORDINI, A • TL.01.004 CAVALCANTI, C.F. • PD.15.046 BORGES, J. • PI.16.007 CAVALLARI, H.H. • PD.11.011 BORRI ML • PI.03.007 CERIGATTO, L.C.T. • PD.11.011 BORRI, M.L. • PD.12.093 CERQUEIRA, W.S. • PI.15.006 BOTELHO, L.J • PI.18.005 CERRI G. G. • PD.01.073, PD.18.010 BOUER, M. • TL.18.001 CERRI G.G. • PD.02.013 BRAGA, F. D. C. B. • PD.02.038 CERRI, G. G. • TL.17.003 BRAGA, J.C.D • PI.20.001 CERRI, G.G. • PD.01.025, PD.01.028, PD.01.057, BRAGANÇA, E. • PD.12.071 PD.12.029, PD.12.064
Abstracts of Scientific Papers 123 CERRI, GG. • PD.01.041 DANTAS, F.D.G. • PD.12.050 CERRI, L. M. O. • PD.18.010 DAN, V. J. L. • PD.12.063 C. F. LIMA • TL.09.003 DARIO, C.F.R. • PD.17.018 CHAIM K.T • TL.12.003 DA SILVA, C. J. • PD.03.009 CHATE, R. C. • PD.17.022 DA SILVA, C.J • PD.03.010, PD.03.016, PD.12.082, , CHATE, R.C. • PI.14.002 PI.03.005 CHATE, RC • PD.17.024 DA SILVA, C.J. • PD.03.034, PD.12.084, PD.12.089, CHAVES, K.C.B. • PD.17.006 PD.12.093 CHAVES, R. B. • PD.11.016 DA SILVA,F.F • PD.09.004 CHAVES, R.B. • TL.11.001 DA SILVA, P. S. S. • PI.13.008 CHI, C. K. • TL.17.003 DA SILVA, T.P.F • PD.15.043 CHI, CK • TL.17.005 DAVID, H. C. • PD.12.063 CHOJNIAK, R • PD.13.014 DAVOGLIO, P. M. V. M. • PD.07.001 CHOJNIAK, R. • PD.01.055, PD.13.004, PD.17.043 DE BEM, R.B. • PD.12.070, PD.12.081 CHOMA, G. • PD.10.004 DEFENDI L.A. • PI.18.015 CHUA-ANUSORN, W • TL.01.004 DEFENDI, L. A. • PI.13.008 CHULAM, T.C. • PD.17.006 DEFENDI, L.A. • PI.01.008, • PI.13.003, • PI.13.005 CINTRA, M.B. • PD.03.014 CIPRIANO FEG • TL.17.002 DE MATTOS, L.A. • PD.02.028 CLARK, P • TL.01.004 DE PINHO, L. K. J. • PD.12.081 COELHO, F.M.A. • PD.01.035 DE SANTI, G.F. • TL.05.002 COELHO, M.O • PI.01.011 DESSIMONI, M. C. • TL.09.004 COELHO, M.O. • PD.17.038 D HERQUINIGO, MD • PD.01.088 COIMBRA, B. M. • PD.15.057 DIAS DA SILVA, PS • PI.18.003 CONCATTO, N.H. • PD.12.008 DIAS, G. P. F. • PD.09.029 CONCEICAO, D.M.S. • PD.01.018 DIAS JR, U. S. • PD.15.046, • PI.15.008 CORDEIRO, A.H.L. • PD.04.011 DIAS JR, U.S. • PD.12.029, PD.15.036, PD.18.011 CORRÊA, D. G. • PD.12.028 DI FERREIRA, G. F. S. C. • PD.01.045 CORREA, M.F. • PD.15.046 DI FERREIRA, G.F.S.C. • PD.17.025, PD.17.042 CORREA, M.F.P • PD.15.055, • PI.15.008 DINIZ, L. V. • PD.01.020, PD.12.078, , PI.12.001, COSTA, E. A. V. • PD.03.020 TL.09.002, TL.09.004 COSTA, FLS • PD.01.032, PD.04.013 DOCEMA, M.F.L • PD.09.035 COSTA, F. M. S. N. • PD.09.006 DOCEMA, M.F.L. • PD.12.029 COSTA, M.F.S. • PD.17.025 DOLÇAN, K. S. • PD.13.015 COSTA, N.A. • PI.13.007 DOMINGOS, A.O. • TL.08.002 COSTA, P. R. • PD.06.004 DO NASCIMENTO, F.B.P. • PI.12.016 COSTA, R.S. • TL.20.001 DORA M. D. • PD.13.009 COSTENARO,M.A. • PD.09.035 DORA M.D. • PD.13.013 COURA, G.B. • PD.14.006 DREWECK, M.O. • PD.02.012, PD.05.012 COUTINHO, A. M. • PI.12.014 DUARTE, J.A. • PD.12.008 C. P. K. C • TL.09.003 DUBINCO A. • PI.18.012 CRUZ JR, L.C.H. • PD.12.070 DUBINCO, A. • PI.09.007, • PI.09.018, • PI.13.009 CRUZ, L. C. • PI.01.007 DUBINCO,A • PD.13.005 CRUZ SANTOS A.R. • PI.01.008 DURÁN, F. • PI.13.007 CRUZ-SANTOS A.R. • PI.02.007, • PI.18.015 DUTENHEFNER, E. E. • PI.18.001, • PI.18.004 CRUZ, T. M. • PI.01.007 DUTENHEFNER, EE • PI.18.003, • PI.18.006 CUNHA, C.A. • PD.05.011 CUNHA, M. A. B. G • PD.05.010 DUTRA, B.G. • PD.03.034 CUNHA, ML • PI.11.002 DWEK, F.F.M. • PD.09.023 CUPOLILO N. E • PD.15.057 E D E. C. PESSOA • TL.09.003 DA CONCEIÇÃO, T.M.B. • PD.12.008 EDUARDO, L.L.S. • PD.12.066 DALAQUA M. • PD.12.043 EGASHIRA, G. I. • PI.01.007 DALAQUA, M. • PD.12.037 EIFFER, D.A. • PD.12.008 DALPRA, F. A. R. • PD.03.027, PD.03.029 ELIAS, L. A. R. • TL.01.005 DALPRA, F.A.R. • PD.12.064 ENGE JR, D. J. • TL.15.001 DALPRÁ, F.A.R • PD.03.022 EZZEDDINE, O • PD.15.020 DA MOTTA-LEAL-FILHO, J. M. • TL.08.004 DANIEL, M. M. • PD.03.027, PD.03.029
124 49th Sao Paulo Radiological Meeting F FONSECA, A.P.A. • PD.12.088 FONSECA, C. F. • PD.02.032 FABIANA, L • TL.01.004 FONSECA, E. K. U. N. • PD.17.022, • PI.09.009 FABRO A.T. • TL.17.001 FONSECA, E.K.U.N. • PI.18.009 FABRO AT • TL.17.002 FONSECA, EKUN • PD.15.017, PD.15.018, PD.15.019, FAE, I.S. • PD.03.008 PI.11.002, , PI.15.005, PI.18.003, FAÉ, I.S. • PD.04.007, PD.12.042 PI.18.006 FALSARELA, P. M. • TL.08.003 FONSECA, R. P. • PD.12.028 FALSARELA, P.M. • PD.08.008 FOREST, A. F. • PD.02.014, PD.17.023 FALSARELLA P.M. • PD.08.003, • PI.05.002, • PI.18.015 FORNAZARI, V.A.V. • PD.08.001, PD.08.010 FALSARELLA, P. M. • PD.08.006, • PI.08.006, TL.08.004 FORTALEZA, E. • PI.13.010 FALSARELLA, P.M. • PD.08.007, • PI.08.004, • PI.08.005 FORTE, G. C. • TL.15.003 FARIAS, L.D.P.G.D. • PD.03.017, PD.12.046 FORTUNATO, B. S. • PI.01.007 FARIAS, L.P.G • PD.04.007, PD.12.042 FRAGOSO, D.C. • PD.03.010, PD.03.014, PD.12.082, FARIAS, L.P.G. • PD.01.040, PD.02.028, PD.03.008 PD.12.089, PI.03.002, , PI.03.005 FARIAS, W. • PI.07.002 FRANCA, A.H. • PD.01.040, PD.03.017, PD.12.042 FASSBENDER, CPB • PD.17.024 FRANCISCO NETO, M. J. • TL.01.005 F. B. TANCREDI • TL.07.002 FRANCISCO NETO, MJ • PI.18.003, PI.18.006 FEDERICCI,E. • PI.18.009 FRANCISCO-NETO M.J. • PI.01.008, PI.02.007, FEDERICCI, E. E. F. • PI.09.009 PI.18.007, PI.18.008, FELIX, M. M. • TL.12.005 PI.18.012 FELIX, M.M. • TL.07.001 FRANCISCO-NETO-M.J. • PI.18.015 FERNANDES JR, W. R. • PD.03.009 FRANÇOLIN, E. • PI.09.018 FERNANDES JUNIOR, W. R. • PD.03.023 FRANÇOLIN, E.E. • PI.09.007 FERNANDES P. C. S. L. • PD.09.041 FRASSEI, J.S. • PI.13.010 FERNANDES, R.B.P. • PI.15.008 FRASSEI,J.S. • PD.13.011 FERNANDES, R.P. • PD.15.036, PD.15.046 FREDDI, T.A.L • PD.12.050 FERRARESI, I.M. • PD.08.010 FREITAS, J. S. • PI.09.012 FERRASI, A.O. • PD.11.011 FREITAS, J.S. • PD.12.066 FERREIRA, A.F. • PD.12.050 FREITAS, L.S. • PD.04.011 FERREIRA, C.F • PI.01.006 FREITAS, R. P • PD.02.038 FERREIRA, D.M. • PD.08.010 FUNARI M. • PI.18.015 FERREIRA, F. R. • PD.01.038 FUNARI M.B.G. • PI.01.008, PI.02.007, PI.18.007 FERREIRA, M.B. • PD.13.008 PI.18.008, • PI.18.012 FERREIRA, N.P.F.D. • PD.12.050 FUNARI MBG • PD.13.005 FERREIRA, R.C.S • PD.13.002, PD.17.008 FUNARI, M. B. G. • PD.17.022 FERREIRA, R.H.Q • PD.01.040 FUNARI, M.B.G. • PD.18.006, PI.13.001, PI.13.003, FERREIRA, R.H.Q. • PD.03.008, PD.03.017, PD.12.046 PI.13.004, PI.13.005, PI.13.006, FIGUEIREDO, CM • PD.17.016 PI.13.009, PI.14.002, PI.18.001, FIGUEIREDO, M.A.P. • PD.18.006 PI.18.004 FIGUEIREDO, P. C • PD.09.033 FUNARI, MBG • PD.17.024, PI.18.003, PI.18.006 FIGUEIREDO, P. C. • PD.09.030 FURLAN, M.V. • PI.03.001 FILHO, A.F.N. • PI.18.005 FURTADO, R. S. O. P. • PD.17.022, PI.09.009, PI.18.001 FILHO, A.G.O. • PI.15.001 FURTADO, R.S.O.P. • PI.09.007, PI.13.001, PI.13.003, FILHO, A.L.M.G • PD.03.023 PI.13.004, PI.18.004 FILHO, A.M.A. • TL.18.001 FILHO, G.H. • PI.15.002 FILHO, J. P. M. • PD.15.046 G FILHO, J. R. P • PD.04.014 GABBI, T. V. B. • TL.18.001 FILHO, M. V. L. • PD.02.014, PD.17.023 GABRIG, RC • PD.12.073 FILHO,P.J.C.M. • PD.15.034 GADELHA, M.R. • PD.12.081 FILHO, R.M.N. • PD.04.011 GALASTRI, F. L. • PD.08.006, TL.08.004 FILIPPI, E.R. • PI.16.008 GALASTRI, F.L. • PD.08.007 FILISBINO, M.M. • PD.17.021 GALGARO, D. P. • PI.12.001 FIORENTINI, L. F. • PD.17.041, TL.15.003, TL.17.006 GALON, M. V. • PD.12.056 FIOROT, L.C.R. • PD.17.013 GALON, M.V. • PD.04.007, PD.12.018, FIOROT, LCR • PD.12.073 PD.12.042, PD.12.046 FIOROT, V. C. R. • PD.01.045 GAMA, L., G. • PI.12.020 FIOROT, V.C.R. • PD.17.021 G. A. PESSOA • TL.09.003 F J CERDA, MD. • PD.01.088 GARCIA, L. A. L. • PD.12.082 FOLADOR, J.B. • PD.17.006 GARCIA, L.L. • PI.03.005
Abstracts of Scientific Papers 125 GARCIA, M. R. T. • PD.03.014, PD.03.020, PD.17.009, GRANDESO, C. • PD.12.066 PD.17.011 GRAVINATTI, M.C. • PI.03.001 GARCIA, M.R.T • PD.03.019 GRAZIANO, L. • TL.09.001 GARCIA, M.R.T. • PD.03.025, PD.03.037, PD.03.043, GREGORIO, D.L. • PI.16.016 PD.03.044, PD.17.010, , PI.03.002 GREGORIO, J.L. • PI.16.016 GASPARETTO, E. L. • PD.12.028 GRILL, J. A. T. • PD.17.019 GASPARETTO, T. D. • PD.13.007, PD.13.020 GRILL, J.A.T. • PD.17.025, PD.17.042 GASPARETTO, T.D. • PD.13.006 GROSSI, B. J. • PD.11.016, TL.11.001 GEBRIM, E.M.M. • PD.03.042, PD.03.044 GROSS, J.L. • PD.17.006 GEBRIM, E.M.M.S. • PD.03.011, PD.03.016, PD.03.022, GRUBERT, R.M. • TL.08.001, TL.16.002 PD.03.025, PD.03.040, PD.03.043 GRUBERT,R.M. • TL.05.002 GEBRIM, E. M. S. • PD.03.032, PD.03.041 GUAL, F • PD.13.020 GHISSI, A. C. • PD.17.003 GUAL, F. • PD.13.006, PD.13.007, PD.13.016 GIANNOTTI,D.G. • PD.09.035 GUATELLI, C. S. GIASSI, K • TL.17.005 GUEDES, A.T.L. • PD.04.011 GIBERTONI JUNIOR, A • PD.07.001 GUEDES, M. D. S. • PD.12.056 GILBERTO G.M. • PI.05.002, TL.08.003, TL.08.004 GUEDES, M.D.S. • PD.03.017, PD.12.046 GILBERTO, G. M. • PD.08.006 GUEDES, M.S. • PD.01.040, PD.02.028, PD.03.008, GILBERTO, G.M • PD.08.012 PD.04.007, PD.12.018, PD.12.042 GILBERTO, G.M. • PD.08.008 GUERRA, V. H • PD.06.004 G. M. BASSO • TL.09.003 GUERREIRO, N.F.C. • PD.01.025 GOBBO GARCIA R. • PI.05.003 GUERREIRO, NFC • PD.01.032, PD.04.013, TL.17.005 GOBBO-GARCIA, R. • PD.08.008, PD.08.012, GUERRINI,R.M. • PI.13.010 TL.08.003 GUIMARAES, J • PD.15.020, PD.15.021, PD.15.022 GOBBO-GARCIA. R. • PI.05.002 GUIMARAES, J.B. • PI.15.001 GODOY, I.R.B • PI.15.002 GUIMARÃES, L. P. T. • PD.17.003 GODOY,I.R.B. • PD.15.003 GUIMARÃES M.D. • PI.01.001 GUIMARÃES, M. D. • PI.20.001 GODOY, L. F. S. • PD.03.041 GUIMARÃES, M.D. • PD.17.006 GODOY, L.F.S. • PD.12.029, PD.12.093 GUIMARÃES, R. B. • PD.01.055, PD.13.004, PD.17.043 GÓES A.C.A. • PI.15.006 GUSATTI, A. A. • PD.18.001 GOMES, A. C. P. • PD.17.023 GOMES, A.C.P. • PD.17.038 H GOMES A.I. • PI.09.018 GOMES, A. I. • PD.17.022, PI.18.001, PI.18.004 HADDAD, F.J. • PD.17.006 GOMES, A.I. • PI.09.007, PI.13.001, PI.13.004, PI.13.009 HAE YONG KIM • TL.07.002 GOMES, C.E.S.M • PI.01.011 HAGEMEYER, R. • PI.13.012 GOMES, C. M. P. • PD.12.061 HAMATI, C. • PD.05.012 GOMES, C.M.P • PD.12.071 HANNA, L, M, D, A. • PD.12.038 GOMES, C.M.P. • PI.12.017 HANS, M.O.M • PD.01.040 GOMES, L.P.P.S. • PD.12.066 HARTMANN, LGC • PI.15.005 GOMES,N.B. • PI.01.003 HEHN, B.J. • PI.15.002 GOMES, N. B. N. • TL.02.001 HELITO, P.V. • PD.15.055 GOMES, R. • PD.03.025 HELITO, P.V.P. • PD.15.036, • PI.15.008 GOMES, R. L. E • PD.03.027 HERQUIÑIGO D • PI.02.006 GOMES, R. L. E. • PD.03.029, PD.03.032 HEYMANN, R. E. • TL.15.001 GOMES, R.L.E. • PD.03.011, PD.03.022, PD.03.040, HIRATA, F. • PD.12.037 PD.03.043 HIRATA, F.C.C • PI.12.016 GOMES, R.L.L. • PD.03.042, PD.03.044 HOCHHEGGER, B. • PD.17.041, TL.17.006 GOMES, V.A. • PD.18.002 HOHGRAEFE NETO,G. • PI.02.003 GOMIDE, G. A. • PD.19.003 HOLANDA, K.G. • PD.12.066 GONCALVES, A. N. S. • TL.01.002 HOLLANDA, R. • PD.12.068 GONCALVES, F.C. • PD.02.028, PD.17.042 HONDA, N.B. • PI.03.001 GONÇALVES, F. C. • PD.17.019 HORIE, M.K.S. • PI.18.009 GONÇALVES, F.C. • PD.17.025 HORIE, MKS • PI.18.003, • PI.18.006 GONÇALVES FILHO, A.L.M. • PI.03.005 HORVART,N. • PD.18.011 GONCALVES, M.O.C. • PD.02.028 HORVAT, N • PD.01.041, TL.17.005 GONCALVES, V.C. • PD.02.028 HORVAT, N. • PD.01.025, PD.01.032, PD.02.013, GONCALVES, V.T. • PD.03.022, PD.03.040, PD.03.043 PD.18.010, TL.17.003 GONÇALVES, V. T. • PD.03.032 HORVAT, N. M • PD.01.057 GONÇALVES, V.T. • PD.03.042, PD.03.044 HORVAT, N. M. • PD.01.028
126 49th Sao Paulo Radiological Meeting HORVAT, N PARGA, JR • PD.04.013 KUSSANO, I.C.T. • PI.14.002 HOUAT, C. R. S. • PD.02.014, PD.17.023 HUMMEL A. D. • PI.18.012 L HUMMEL, A, D. • PI.02.007 LAHAN, D.M. • PI.01.006 LAJARIN, V. S. • PD.17.019 I LAJARIN, V.S. • PD.17.025 IANOF J • TL.12.003 LAJARIN, VS • PD.17.016 IANOF, J. • PI.12.014 LALIER, R. T. L. • PI.01.007 IANOF, J.N. • PD.12.064 LANCELLOTTI, C.L.P. • PD.12.029 IKAWA, M.H. • PI.15.002 LANGE FILHO, R • PI.18.003, • PI.18.006 INDIANI, J. M. C • TL.01.002 LANGE FILHO, R. • PI.18.001 IQUIZLI R. • PD.12.043 LEAO. F.I • PD.13.010 ISHIKAWA, W. Y. • PD.17.022 LEAO-FILHO, H • TL.01.004 IUNES, L.R. • TL.05.002 LEAO, R.V. • PD.15.055, • PI.15.008 IUTAKA, T • PD.12.073 LEÃO, R. V. • PD.15.046 IUTAKA, T. • PD.17.013 LEE, H. J. • TL.17.003 LEE, HJ • TL.17.005 LEE, H.W. • PD.12.093 J LEIRIA, F.A. • PD.12.008 JABOUR, V. A. • PD.01.012, PD.16.009 LEITE, C. B. F. • TL.17.003 JARRY, V. M. • PI.09.016 LEITE, C.B.F. • PD.01.025, PD.12.029, PD.15.036, J. C. V. DINIZ • TL.09.003 PD.18.011 JESUS, G.A.B. • PD.08.010 LEITE, CBF • PD.01.032 JHONATA E. RAMOS • TL.07.002 LEITE C. C. • TL.12.003 LEITE, C. C. • PD.03.041, PD.15.046, , PI.12.014 J; MIRANDA, F • TL.17.005 LEITE, C.C. • PD.01.025, PD.12.029, PD.12.064, JORGE JUNIOR, L. A. • PI.12.001 PD.12.084, PD.12.093, PD.15.036 JR, A. R. • PI.13.008 LEITE, CC. • PD.09.035 JUCÁ, C.S. • PD.05.011 LEITE, D.O. • PD.17.021 JUNHO, F.F. • PD.03.019, • PI.03.002 LEITE, M.O. • PD.01.053 JUNIOR, A. N. A. • PD.04.014 LEMBRANÇA L. • PI.05.003 JUNIOR, A.R. • PD.18.006 LEMBRANÇA, L. • PD.08.006, TL.08.003, TL.08.004 JUNIOR, C.C. • PD.17.021 LEMBRANÇA, L.P. • PD.08.008, PD.08.012 JUNIOR, C. G. R. • PD.17.019 LEMOS, M. D. • PD.03.009, PD.03.027, PD.03.029 JUNIOR, J; MOURA, M.R.L.D • PD.17.010 LEMOS, M.D. • PD.03.023 JUNIOR, L. A. J. • PD.01.020, PD.12.078 LEPIANI, R. D. • PD.19.003 JUNIOR, L. M. P. • PD.11.015 LEWIN, F. • PD.01.045, PD.02.014 JUNIOR, M.A.F.S. • PD.15.034 LIBANIO, B. B. • TL.02.001 LIBANIO, B.B. • PI.01.003 K LIBÂNIO, B. B • PI.01.011 LIMA, A., N., A. • PI.12.020 KANASHIO, J. S. • PD.13.020 LIMA, A.O. • PI.15.006 KARLA SCHOEN, K. • PD.18.010 LIMA, C. A. • TL.08.003, TL.08.004 KASE, M. • PD.03.040, PD.03.043 LIMA, D.V.G. • PD.05.012 KATEKARU, D. • PD.13.019 LIMA, E.M. • PI.12.017 KEFFER C. P. • PD.13.009 LIMA, M. R. • PI.12.012 KEFFER C.P. • PD.13.013 LIMA, P. H. P. • TL.09.002, TL.09.004 KIM,CHONG.AE • PD.13.011 LIMA, T. C. • PD.11.018 KLAESENER, C. • TL.05.001, TL.16.002 LIMA, VF • PD.12.073 KOBAYASHI, S. • PD.18.011 LINHARES, L. S. • PD.18.001 KOCHI, A.T. • PD.08.010 LINS C.F. • PD.15.001 KOENIGKAM-SANTOS M. • TL.17.001, TL.17.002 LINS, C. F. • PD.15.004, PD.15.005, KOGA, K.H. • PD.11.011 PD.15.008, PD.15.027 KOSHIMURA, E.T. • PI.13.006, • PI.13.009 LINS, C.F. • PD.05.011, PD.15.034 KURKOWSKI, F. D. • PD.11.013 LÔBO, C.F.T • PD.03.022 KURKOWSKI, F.D. • PD.11.003 LOPES, A.K.B.F. • PD.09.012 KUROKI, I.R. • PD.17.018 LOPES, F. C. R. • PD.12.028 KUSSANO I. • PI.18.008 LOPES, M. F. V. • PD.09.006 KUSSANO I.C.T • PI.18.007 LOPES, PGM • PD.01.047 KUSSANO, I.C.T • PI.12.016, • PI.18.015 LOPES, R. B. S. C. • PD.09.006
Abstracts of Scientific Papers 127 LOPES, T. N. • PD.07.001 MATSUOKA, M.W. • PD.13.016 LOUREIRO, R. M. • PD.03.027, PD.03.029 MATTIONI, M. • PI.09.012 LOURENÇO M.R. • PD.15.001, TL.17.001 MAUAD, E. C. • PD.09.003 LOURENÇO MR • TL.17.002 M CASTRO ,MD • PD.01.088 L. P. VELOSO • TL.09.003 MEDEIROS, A. K. • PD.17.023 LUCCHESI, F.R. • PD.17.009 MEDEIROS, A.K. • PD.17.038 LUNA, P. A. A. • PI.13.008 MEDEIROS,A.K. • PI.01.003 LUNDBERG, J.S. • PI.15.002 MEDEIROS, T. M. • PD.17.041 LUNDBERG,J.S. • PD.15.003 MEIRA, M.S. • PD.15.043 LUPINACCI FAS • PD.13.005 MEIRA, M.S.B. • PD.12.066 LUPINACCI, F.A.S. • PI.09.009 MEIRELES, L. L. • PI.09.012 LUPINACCI, FAS • PD.15.018 MEIRELLES, G. • PD.17.009 LUPINACCI, F.S. • PI.13.006 MEIRELLES, G.S. • PD.17.038 LUZ, D.C. • TL.01.001 MEIRELLES, GSP • PD.17.016 L. V. WAJSMAN • TL.09.003 MELLO, R. A. B. • PD.13.004 LYRA T.C.B. • PD.12.043 MELLO, S.M.B. • PI.03.001 MELO, F.G. • PD.18.002 MELO R.A.B. • PD.08.003 M MELO, R. A. B. • PD.01.055, PD.17.043, , PI.08.006 MACHADO C.V.B. • TL.17.001 MELO, R.A.B • PI.08.004 MACHADO CVB • TL.17.002 MENDES, G. F. • TL.08.003 MACHADO, J. C. M. • PI.12.001 MENDES, L. A. • PD.17.019 MACHADO. P. R. • PD.13.010 MENDES, R. M. • PD.02.032 MACIEL R.P. • PD.17.018 MENDONCA, V. C • PD.13.010 MAGALHÃES A.J.A • PD.09.012 MENEGASSI, D. • PD.02.038 MAGALHÃES, J.S. • PD.03.025 MENEZES, D.C • PD.03.008, PD.04.007 MAIA, C.O. • PD.05.012 MENEZES, D.C. • PD.01.040, PD.02.028, PD.12.042 MAIA, D.F. • PD.04.012, PD.13.002, PD.17.008 MENEZES, R. S. A. A. • PD.15.046 MAIA JR, A.C.M. • PD.12.088 MENEZES, R. S.A.A. • PD.15.055 MAIA JR., A. C. M. • PD.12.082 MENEZES, R.S.A.A. • PD.15.036 MAIA JUNIOR, A.C.M. • PI.03.005 MESQUITA, F.N.B. • PI.15.006 MAIA, M.H.V. • PD.09.029 MIRANDA, A. C. A. • PD.09.006 MANÇANO AD • TL.17.004 MIRANDA, G. M. • PI.12.001, TL.09.002, TL.09.004 MARANHÃO, F. L. L. • PD.01.026 MIRANDA, J. A • PD.01.057 MARCELINO A. S. Z. • PD.18.010 MIRANDA, J. A. • PD.01.028 MARCHIORI E • TL.17.004 MIRANDA, T • TL.01.004 MARCOS N. V. • PD.15.057 MISSRIE, I • PD.17.016 MARIN, M. S. • PD.12.063 MISSRIE, I. • PD.17.038 MARINO, F. M. • PD.11.015 MONARIM M.A.S. • PD.08.003 MARIOTTI, G.C. • PD.08.012 MONARIM, M. A. S • PI.08.006 MARQUES, E. F. • TL.09.001 MONARIM, M.A.S • PI.08.004, • PI.08.005 MARQUES, M.E.A. • PD.11.011 MONARIM, M.A.S. • PD.08.010 MARTINEZ JAB • TL.17.002 MONTEL, D. B. • PD.17.019, PD.17.025 MARTINEZ, M. L. A. • PD.15.005 MONTEL, D.B. • PD.01.045 MARTIN, M. F. • TL.01.002 MORAES, H. A. F • PD.13.010 MARTIN, M. G. M • TL.12.003 MORAIS, A. E. Q. • PD.01.012, PD.16.009 MARTIN, M.G.M • PD.12.093 MORAIS, T.C. • PD.04.014 MARTIN, M.G.M. • PD.12.064 MORAIS, TC • PD.04.013 MARTINS, E. M. L. • PD.02.032 MOREIRA, B.L. • PD.17.038 MARTINS M. M. • PD.15.057 MOREIRA, D. M. • PD.12.061 MARTINS R. B. • TL.08.003 MOREIRA, D.M • PD.12.071 MARTINS, R. B. • PD.08.006, TL.08.004 MOREIRA,D.M. • PI.12.017 MARTINS, R.B. • PD.08.007, PD.08.012 MOREIRA, E. L. S. • PI.12.014 MARTINS, R.O. • PD.15.036, PD.18.002, , PI.15.008 MOREIRA, M. T. • PD.13.007, PD.13.020 MARUICHI, M.D. • PI.15.002 MOREIRA, M.T. • PD.13.006 MARUICHI,M.D. • PD.15.003 MORENO, R. A. • PD.03.032 MASSA, B. S. F. • PD.13.016 MORENO, R.A. • PD.03.040, PD.03.042, PD.03.043, MATIOTTI S. B. • PD.13.009 PD.03.044 MATIOTTI S.B. • PD.13.013 MORIGUCHI, S.M. • PD.11.011 MATOS, B. A. • TL.12.005 MOTTA, G. B. • PD.13.006, PD.13.007 MATOS, I. A • PD.13.019 MOURA, A.P.C. • PD.10.004
128 49th Sao Paulo Radiological Meeting MOURA FILHO, J.P. • PD.15.036, PD.15.055 O MOYSES, L.A.J • PD.09.035 OKI, G.C.R. • PD.17.038 MUNIZ, B. C. • PD.12.068 OLIVEIRA, B. C. • PD.18.010 MURAKOSHI, R. • PD.03.025 OLIVEIRA, B.C • PD.01.028, PD.02.013 MURAKOSHI, R. W. • PD.03.027, PD.03.029 OLIVEIRA, BC • PD.01.032 MURAKOSHI, R.W. • PD.03.022, PD.03.042, PD.03.043 OLIVEIRA, BSP • TL.17.005 MUSSI, T.C. • TL.01.001 OLIVEIRA, C. V. • PD.02.013, PD.03.041, TL.17.003 OLIVEIRA, C.V. • PD.01.025, PD.12.029, PD.18.011 N OLIVEIRA, D. G. • PD.16.007 OLIVEIRA, E. K. • PD.15.008 NACIF, M. S. • TL.01.002 OLIVEIRA, E. R. • TL.01.002 NADAI T.R. • TL.17.001 OLIVEIRA, F.F. • PD.16.011 NASCIMENTO, D.B. • PD.17.013 OLIVEIRA, G. H. N. • PD.04.012, PD.15.038 NASCIMENTO, DB • PD.12.073 OLIVEIRA, G.H.N. • PD.13.002, PD.17.008 NASCIMENTO, F. B. P. • TL.07.001, TL.12.005 OLIVEIRA, I., B. • PI.12.020 NASSER, F • TL.08.004 OLIVEIRA, I. C. • PD.18.004 NASSER, F. • PD.08.006, PD.08.007 OLIVEIRA, JC • PI.11.002 NASSER,F. • PD.08.008 OLIVEIRA, L.A.N • PI.13.010 NEGRAO, E.M.S. • PI.09.001, TL.09.001 OLIVEIRA,L.A.N. • PD.13.011 NERSISSIAN, D. Y • PD.06.004 OLIVEIRA,L.S. • PD.15.003 NETO, A. A. M. • PD.02.032 OLIVEIRA, L.T. • PD.02.038 NETO, A. R. • PD.02.038 OLIVEIRA, M.F. • PD.15.034 NETO,I.A.C. • PD.15.034 OLIVEIRA, P.B. • PD.05.011 NETO, L.P. • PI.15.002 OLIVEIRA, RAS • PD.01.047 NETO MJF • PD.13.005 OLIVEIRA, R.S. • PD.05.012 NETO, M. J. F. • PI.13.008, • PI.18.001 OLIVEIRA, T.F.T. • PD.18.002 NETO, M.J.F. • PD.18.006 OLIVEIRA, T. M. G. • PD.09.002, PD.09.030, PD.09.033 NETO, O.L.A. • PI.15.002 OLIVEIRA, V. S. • PD.01.012 NETO, W.R.T. • PD.04.011 OLIVETII, B.C. • PD.03.016, PD.03.034 NETTO, E.C.C. • PD.12.070 OLIVETTI, B. • PD.03.025 NEVES, B. C. • PD.11.013 OLIVETTI, B. C. • PD.03.011 NEVES, B.C. • PD.11.003 OLIVETTI, B.C. • PD.03.043, PD.03.044 NEVES FILHO, E.J.L. • TL.20.001 OMURA,V.L.N • PD.09.035 NEVES, G. B • PD.01.020, PD.12.078 ONARI, N. • PD.09.003, • PI.09.001 NEVES, G. B. • PI.12.001 ORLANDI, R. • TL.18.001 NEVES, G.R • PD.05.010 ORMOND, A • PD.15.020, PD.15.021 NEVES, T. • PI.13.007 ORSINI, T.M.F. • PD.17.021 NEVES, T.M.H. • TL.08.001 OSAWA A • PI.11.002 NICO, M • PD.15.020, PD.15.021, PD.15.022 OTADUY M • TL.12.003 NICO, M.A.C. • PI.15.001 OTANI, L. H. • PI.16.007 NICO, M. M. S. • TL.18.001 OTONI, J • PD.15.018 NIEMEYER, B. • PD.12.068 NISHIYAMA K.H. • PD.17.018 NITRINI R. • PD.12.064 P NOGUEIRA-BARBOSA M.H. • PD.15.001 PACHECO, B.O. • PD.01.053 NOGUEIRA-BARBOSA, M. H. • PD.15.004, PD.15.005, PACHECO, F.T. • PD.12.088 PD.15.027 PADIAL, MB • PD.15.017 NOGUEIRA, G. F. • PD.01.038 PADILHA, I.G. • PD.03.020, PD.12.004, PD.12.088 NOMURA, C. H. • PD.04.014 PADUA A.I. • TL.17.001 NOMURA, CH • PD.04.013 PAGOTO, A. A. O. • PD.09.029 NOSCHANG, J. • PD.17.006, TL.01.001 PAIVA, G.G. • PD.08.010 NOVIS, M.I. • PD.10.004 PAIVA, OA • PD.17.024 NUNES, D.M. • PD.12.084 PALMA, G.L. • PD.14.006 NUNES, LM • PI.11.002, • PI.15.005 P ALMARZA, MD • PD.01.088 NUNES, L.M.A.O. • TL.01.001 PANIZZA, P.S.B. • PD.02.013 NUNES, R.H. • PD.12.004, PD.12.088 PANIZZA, P.S.B.P. • PD.01.035 NUNES, T.F. • PD.08.001, TL.05.001, TL.08.001, PAP, S.S.C.P • PI.11.001 TL.16.002 PARASKEVOPOULOS, D.K.S. • PD.15.043 NUNES,T.F. • TL.05.002 PARENTE, J.G. • PI.13.012 NUNEZ, E. • PI.13.012 PASQUINI-RAIZA L.C. • PI.02.007
Abstracts of Scientific Papers 129 PASSOS, D.K. • TL.20.001 PINTO, L.E.S. • PI.12.017 PASSOS , R. B. D. • PD.17.022 PIOVESAN, A.C.B. • PD.12.037 PASSOS, U. L. • PD.03.041 PIZARRO A • PI.02.006 PASSOS, U.L. • PD.03.016 POEYS, F. C. T. • PD.11.013 PASTORE, D. • PI.15.001 PASTORELLO B • TL.12.003 POEYS, F.C.T. • PD.11.003 PASTORELLO, B. • PI.12.014 PONTE, M. P. T. R. • PI.09.007, • PI.18.001 PAULA I.B • PD.09.041 PONTE, M.P.T.R. • PI.18.012 PAULA, L. S. • PD.17.041 PORTO, D.D.S. • PD.08.010 PAVANI, A. V. B. • PD.17.010, PD.17.011 PORTO, .G.C.L.M. • PI.15.006 PAVANI, A.V.B. • PD.17.009 PORTUGAL, M.M. • PD.05.011 PAVANI, AVB • PD.17.016 POSSAGNOLO, D.T. • PD.09.023 PEDRI, A.F. • PD.03.017, PD.04.007, PD.12.046 PRADO, L. F. M. • PD.11.015, PD.11.016, TL.11.001 PEDRO, A.F. • PD.12.042 PRANDO, A. • PI.01.006, • PI.02.004 PEDROSO, M. H. N. I. • PD.02.014 PUCHNICK, A. • PD.01.053 PEDROSO, M.H.N.I. • PD.01.018 PEIXOTO, M. • PI.18.009 PEIXOTO, M. C. G. • PD.15.004, PD.15.005 Q PEIXOTO, M.P. • PI.09.009 QUAGLIATO, P.C. • PD.14.006 PEIXOTO, M. R. • PI.09.007 QUARESMA, M. R. • TL.15.001 PEIXOTO, M.R. • PI.09.018 QUEIROZ, I. C. • PD.12.056 PELETTI A. B. • PD.13.009 QUEIROZ, I.C • PD.03.008 PELETTI A.B. • PD.13.013 QUEIROZ, I.C. • PD.03.017, PD.04.007, PD.12.018, PELLICIOLI, A. A. • TL.17.006 PD.12.042, PD.12.046 PENACHIM, T.J. • PI.01.006 QUEIROZ, M.R. • PI.18.004 PERDIZES, G.O. • PD.12.029, PD.15.036 QUEIROZ M.R.G. • PI.05.002, • PI.18.008 PERDIZES, O.G. • PD.18.011 QUEIROZ, M. R. G. • PI.18.001 PEREIRA, A.C.P • PD.17.042 QUEIROZ, M.R.G. • TL.08.003 PEREIRA A. M. A. • PD.01.073 QUEIROZ, MRG • PI.18.003, • PI.18.006 PEREIRA, A.M.A. • PD.01.025 PEREIRA, AMA • PD.01.032, PD.01.041 PEREIRA, H. A. C. • PD.17.019 R PEREIRA, H.A.C. • PD.17.018, PD.17.025 RABAHI MF • TL.17.004 PEREIRA, I. C. A. L. • PD.09.006 RACY, A. C. S. • PI.09.018 PEREIRA I. M. F • PD.09.041 RACY, D.J. • PI.01.011, TL.02.001 PEREIRA, L. B. N. • PD.17.041 RACY,D.J. • PI.01.003 PEREIRA, M. F. P. • PD.12.056 RAEDER, M. T. L. • PI.09.016 PEREIRA, M.F.P • PD.04.007 RAHAL JR A. • PI.05.003 PEREIRA, M.F.P. • PD.03.017, PD.12.042, PD.12.046 RAHAL JR. A. • PI.01.008, • PI.02.007, • PI.05.002, • PEREIRA, R. G. • PD.12.068 PI.18.007, • PI.18.008, TL.08.003 PEREZ, J.A. • PD.12.008 RAHAL JR., A. • PI.18.012 PESSOA, B.M • PI.01.011 RAHAL JR.A. • PI.18.015 PESSOA, C. N. G. • PD.15.008 RAHAL JUNIOR, A. • PD.08.008, PD.08.012 PESSOA, C.N.G. • PD.15.034 RAHAL JÚNIOR, A • PI.18.003 PESSOA, C. P. K. C. • TL.09.002, TL.09.004 RAIMUNDO, E. C. • PD.12.056 PESSOA, E. C. • TL.09.002, TL.09.004 RAIMUNDO, E.C. • PD.03.008, PD.03.017, PD.12.018, PETAGNA, M • PI.07.002 PD.12.042, PD.12.046 PETROCELLI, D. • PD.11.011 RAIMUNDO, E.C.R • PD.01.040 PETTENGIL, A.L.M. • PD.03.014 RANGEL, D. A. • PD.01.045 PETTENGILL, A.L.M. • PD.12.004 RASSI, M. B. • TL.17.003 PETTENGILL; A.L.M. • PD.12.088 REALI, R.M. • PD.03.019, • PI.03.002 PFLUCK, BPM. • PI.03.007 RÊGO,J.C.M • PD.02.004, PD.16.016, , PI.16.005 P. H. P. TRINDADE • TL.09.003 RÊGO,J.C.M. • PD.09.004, • PI.16.004, • PI.16.006 PICONE, J. C. S. S. • PD.09.003, • PI.09.001 REIFEGERSTE, C. P. • PD.18.001 PIMENTEL, A., C., F. • PI.12.020 REIRA, L. B. N. • TL.17.006 PINETTI R.Z. • PD.17.018 REIS, A. M. • PD.11.013 PINHEIRO, D., O. • PI.12.020 REIS, A.M. • PD.11.003 PINHEIRO K. • PI.05.002, • PI.05.003 REIS, E.P. • TL.07.001 PINHEIRO, K. • PD.08.008 REISER C. S. • PD.13.009 PINTO, L. E. S. • PD.12.061 REISER C.S. • PD.13.013 PINTO, L.E.S • PD.12.071
130 49th Sao Paulo Radiological Meeting REIS-FILHO, AJ.S • PI.01.008 SALES, T.S.D. • PD.03.017 REIS, G.L.L. • PD.04.012 SAMESHIMA Y.T. • PI.18.008 REIS JUNIOR, C.G. • PD.17.025, PD.17.042 SAMESHIMA YT • PD.13.005 RESENDE L. L • TL.12.003 SAMESHIMA, Y. T. • PI.13.008 RIBEIRO, E • PD.15.020, PD.15.021, PD.15.022 SAMESHIMA, Y.T. • PI.13.001, • PI.13.003, • PI.13.004, RIBEIRO, F.A • PD.01.043 • PI.13.005, • PI.13.006, • PI.13.009 RIBEIRO, F.A. • PD.01.022 SANCHES I.B. • TL.17.001 RIBEIRO, J.H.A. • PD.13.002, PD.17.008 SANCHO, L.S. • PD.05.011 RIBEIRO, M.S.S.N. • PI.16.016 SANO, A. C. P. G. • PI.01.007 RIBEIRO, R. L. D. M. • PI.09.007 SANO, E. O. • PI.01.007 RIBEIRO, R.L.D.M. • PI.09.018 SANO, RE. S. • PI.01.007 RIBEIRO, R. L. M. • PI.09.009 SANO, RU. S. • PI.01.007 RIBEIRO, R.L.M. • PI.18.009 SANTANA, P. G. • PD.12.056 RIBEIRO, S. M. • TL.09.002 SANTANA, P.G. • PD.01.040, PD.12.042, PD.12.046 RIBEIRO, S. P. P. • PD.03.027 SANTANA, P. R. P. • PD.17.023 RIBEIRO, S.P.P. • PD.12.037, PD.12.043 SANTANA, P.R.P. • PD.17.038 ROÇA, C. T. • PD.01.020, PD.12.078 SANTIAGO, R.A. • PD.01.053 ROCHA, A.J. • PD.12.004, PD.12.088 SANTI, G.F. • TL.05.001, TL.08.001, TL.16.002 ROCHA, B.P. • PD.17.013 SANTIN, L.A. • PD.13.008 ROCHA, C. A. • PD.15.008 SANTOS, A. A. S. M. D • PD.05.010 ROCHA, H.P. • PI.18.005 SANTOS, C • PD.15.021 ROCHA, J.P.R.S. • PD.13.016 SANTOS, D. C. B. • TL.15.001 ROCHA, M • TL.01.004 SANTOS, DCB • PD.15.018, PD.15.019, , PI.11.002, , ROCHA, M. D. S. D. • PD.01.038 PI.15.005 ROCHA, P.H.P. • PD.03.019, • PI.03.002 SANTOS DCBS • PD.15.017 ROCHA, R.C.F. • PD.12.046 SANTOS, J. E. M • PD.13.010 ROCHA, R.D. • PD.03.010, PD.03.016, PD.12.082, SANTOS, J.M.M.M. • PD.01.035, PD.02.028 PD.12.093 SANTOS, L. C. • PD.01.045 ROCHA, S.M.S. • PD.13.016 SANTOS, M. V. P. Q. • TL.18.001 ROCHA, S.R.R. • PI.15.008 SANTOS, R. M. • PD.03.032 RODRIGUES, A. A. E • PD.13.010 SANTOS, R.M. • PD.03.042, PD.03.044 RODRIGUES F. M.W • PD.09.041 SANTOS, R. Q. • PD.12.061 RODRIGUES, FV • PD.01.041 SANTOS, R.Q • PD.12.071 RODRIGUES, J. C. • TL.15.001 SANTOS, R.Q. • PI.12.017 RODRIGUES, L. B. Q. • PD.13.016 SANTOS, R. V. • PD.01.012, PD.16.009 RODRIGUES, L. P. • PD.01.020, PD.12.078, , PI.12.001, SANTOS, T. • PD.13.008 TL.09.002, TL.09.004 SANTOS, V.V. • PD.11.011 RODSTEIN, M.A.M. • PI.01.006, • PI.02.004 SARMENTO, C. A. • PD.15.005 ROMAN, S. M. • PD.01.055, PD.13.004, PD.17.043 SARPI, M. • PD.03.042, • PI.03.002 ROMAN, S.M • PD.13.014 SARPI, M. DE O. • PD.03.022 ROMÃO, D. • TL.17.003 SARPI, M. O. • PD.03.011, PD.03.014, PD.03.020 ROMAO, DS • PD.01.041 SARPI, M.O. • PD.03.019, PD.03.037, PD.03.040 ROSAS, C.H.S. • PI.15.006 SARRIS, A.B. • PD.02.012 ROSA, S.T.D. • PD.17.010 SAVOIA P. • PI.01.008, • PI.02.007, • PI.18.008, • ROSEMBERG LA • PD.15.017 PI.18.015 ROSEMBERG, L. A. • TL.15.001 SAWAMURA, M. M • PD.06.004 ROSEMBERG, LA • PD.15.018, PD.15.019, , PI.11.002 SAWAMURA,M.V.Y. • PI.13.010 ROSEMBERG, LA. • PI.15.005 SCHOEN, K • PD.01.032, TL.17.005 SCHWARTZ, M.C. • PD.12.066 SCOPPETTA, T. L. P. D. • PD.12.090 S SCOPPETTA, T.L.P.D. • PD.03.010, PD.12.084, SAAD, F. M. • PD.01.020, PD.12.078 PD.12.089, , PI.03.005 SAAD, L. S. • PD.01.045 SECOL, F. • TL.07.001 SEDA, G.V • PD.13.014 SABINO, S. M. P. S. • PD.09.003, • PI.09.001 SEGUNDO NETO, E.M.V. • PD.14.006 SACCARELLI, C.R. • PD.09.035 SEGUTI, D.T. • PI.08.004, • PI.08.005 SAGGIN, G. • PD.17.003 SEGUTTI, D. T. • PI.08.006 SAITO, M. M. • PD.09.003, • PI.09.001 SEMIONE, M. M. • PD.02.014, PD.17.023 SAKAMOTO,F. • PD.13.011 SERFATY, A. • PD.02.032 SALA, M. A. S. • TL.01.002 SERNIK, R. • TL.18.001 SALES, T.S. • PD.03.008, PD.12.018, PD.12.042 SETUGUTI, DANIEL T. • PD.08.003
Abstracts of Scientific Papers 131 SHITARA, F. • PI.18.009 SOUSA, J.C. O • PI.16.004 SHOJI, H. • PD.17.022, • PI.14.002 SOUSA, J.C.O • PD.02.004, PD.04.004, PD.08.004, SILVA A. C. L. • PD.07.001 PD.09.004, PD.09.009, PD.16.013, SILVA A.M. • PD.17.018 PD.16.016, , PI.16.005, , PI.16.006, , SILVA, A. M. • PD.17.019 PI.18.002, TL.16.001 SILVA, A.M. • PD.17.025, PD.17.042 SOUSA, J.C.O. • PD.09.007, PD.10.005, , PI.16.016 SILVA, AM • PD.17.016 SOUSA,J.C.O • PD.16.014 SILVA, A.M.L. • PI.16.016 SOUSA; J. C. O. • PD.01.026 SILVA, C.B. • PD.13.002, PD.17.008 SOUSA, J. K. M. • PD.12.063 SILVA, C.F.G. • PD.04.014, PD.16.011 SOUZA, AR • PI.11.002, • PI.15.005 SILVA, CFG • PD.01.041 SOUZA, B. N. C. • PD.09.002, PD.09.030, PD.09.033 SILVA, C. J. • PD.03.025 SOUZA, J. A. • PI.09.012 SILVA, C.J. • PD.03.023, PD.03.040 SOUZA, J.A. • TL.09.001 SILVA, C. O. • PI.09.012 SOUZA, J. C. R. • PD.03.032 SILVA, C. P • PI.12.001 SOUZA, J.P.D. • PD.13.008, • PI.18.005 SILVA, C. P. • TL.09.002, TL.09.004 SOUZA, L.O. • PD.12.011 SILVA, C. P. RODRIGUES • TL.09.003 SOUZA, L.P. • PD.01.018 SILVA, D. C. B. • PD.18.004 SOUZA, S. A. • PD.03.014, PD.03.020 SILVA, F.A.B • PI.12.016 SOUZA, S.A. • PD.03.019, PD.03.037, PD.13.011, , SILVA, F.D. • PI.15.001 PI.03.002 SILVA FILHO, L. V. R. F. • PD.13.020 SPERANDIO, V.A. • PD.12.066 SILVA, F. J. • PD.01.026 STEIN, V. S. • PD.13.015 SILVA, I.P. • PI.15.001 STEPHAN, B.O. • PD.13.011 SILVA, J.J. • PI.15.002 STRAUS,M.T. • PI.13.010 SILVA JUNIOR C. L. • PD.15.057 STRAUSS,M.T. • PD.13.011 SILVA, L. N. M. • PD.17.019 STROLIGO, C.F. • TL.20.001 SILVA, L.N.M. • PD.02.028, PD.17.025 STUKER, G. • TL.15.003 SILVA, M. C. • PD.02.014 STUKER. G. • PD.17.041, TL.17.006 SILVA, M.G • PI.01.001 STUMP, X • PD.15.021 SILVA, M. M. • PD.09.006, PD.11.013, PD.11.015 STUMP, X. • PD.15.020 SILVA, M.M. • PD.11.003 STUMP, X.M.G.R.G. • PI.15.001 SILVA, M. T. • PD.11.018 STUTZ, C.L. • TL.20.001 SILVA, M.T. • PD.14.006 SUMI, D. V. • PD.03.027, PD.03.029 SILVA, T.A. • PD.13.008 SUNADA, A. M. • PD.13.015 SILVA V.C. • PD.17.018 SUZUKI, L. • PD.13.016 SILVA, V. R. • TL.18.001 SUZUKI,L. • PD.13.011, • PI.13.010 SIMÃO M.N. • PD.15.001 SZARF, G • PD.17.016, PD.17.024 SIMÃO, M. N • PD.15.005 SZARF, G. • PD.17.022, • PI.14.002, TL.07.001 SIMÃO, M. N. • PD.15.004 SZEJNFELD, D. • PD.08.010 SIMEÃO, T. B. • PD.12.068 SZEJNFELD, P.O. • PD.12.066 SIQUEIRA LT • PD.08.003 SZESZ, A.B.R. • PD.05.012 SIQUEIRA, L.T • PI.08.004 SIQUEIRA, L.T. • PI.08.005 T SIQUEIRA, L. T. B. • PI.08.006 SKAF,A. • PD.15.003 TACCA, A • PD.13.014 SKAF, A.Y. • PI.15.002 TAKAHASHI, J. T. • PD.03.009 SKROCK,N.R. • PI.16.011 TAKAHASHI, J.T. • PD.03.023 SOARES, A.R.G. • PD.15.038 TAKAHASHI, M. S • PD.13.006 SOARES, C. R. • PD.03.027, PD.03.029 TAKAHASHI, M. S. • PD.13.007 SOARES, D. R. • PD.13.015 TAKAHASHI, M.S. • PD.13.016, PD.13.020 SOARES, J. K. • PD.13.007 TAKAKI, L. A. • PI.01.007 SOARES, J.K. • PD.13.006 TAKAMOTO, A.T.R. • PD.12.066 SOARES, M • PI.07.002 TAKITANI, P.A.S. • PD.17.042 SOARES SOUZA, A. • TL.17.006 TAMES, H. • PD.03.025, PD.03.037 SOARES, T. R. • PD.13.015 TAMES H.L.V.C. • PD.03.019 SOBREIRO, B.P. • PD.02.012 TAMES, H. L. V. C. • PD.03.027, PD.03.029 SOBRINHO, A. B. • PD.11.015, PD.11.016, TL.11.001 TAMES, H.L.V.C. • PD.03.011 SODER, R. B. • TL.15.003 TANIGUCHI, T.M. • PD.05.011 SOLDATELLI, M.D. • PD.12.008 TAVARES, R. R. F. M. • PD.01.038 SOUSA AMS • PD.12.073 TAVEIRA, R. B. R. • PD.15.046 SOUSA, A.M.S. • PD.17.013 TEIXEIRA, D.F.D
132 49th Sao Paulo Radiological Meeting TEIXEIRA, E. P. A. • PD.11.013 VENTURA, L.M. • TL.08.002 TEIXEIRA, E.P.A. • PD.11.003 VENTURA, N. • PD.12.081 TEIXEIRA,P.A.C. • PD.09.035 VERRASTRO, C.G.Y. • PD.17.038 TEIXEIRA, R. • PD.13.008 VERRASTRO, CGY • PD.17.016 TELES, G.B.S. • PI.14.002 VERZA, L. • PI.15.006 TELES, GBS • PD.17.024 VESPOLI, H.M.L. • PD.11.011 TENORIO, L. P. • PD.15.004, PD.15.008 VIANA, F.O.F • PD.09.012 TENÓRIO, L. P. • PD.15.005, PD.15.027 VIANA,J.A. • PI.13.010 TESTAGROSSA, L. D. A. • TL.17.003 VIANA, P.C. • PD.01.025 TIBANA, T.K. • PD.08.001, TL.05.001, TL.08.001, VIANA P.C.C. • PD.02.013 TL.16.002 VIANA, P.C.C • PD.17.010 TIBANA,T.K. • TL.05.002 VIANA, P.C.C. • PD.16.011 TOGNI FILHO, P. H. A. • PD.09.029 VIANA, PCC • PD.01.041 TOMAL, A • PD.06.004 VIANNA, P.C.C. • PD.01.057 TOMOKO, A. N. • PD.19.003 VIDAL, B.P.C. • PI.01.006, • PI.02.004 TORES, PPTS • TL.17.004 VIDAL, J. C. S. • PD.01.026, PD.04.004 TORRES, L. • PI.02.003, • PI.12.012 VIDAL, J.C.S. • PI.16.016 TORRES, L. R. • PD.02.014 VIDAL,J,C.S • PD.02.004 TORRES, L.R. • PI.01.003, TL.02.001 VIDAL,J,C.S. • PI.16.004 TORRES, R. V. A. • PD.04.014 VIDAL,J.C.S • PD.09.004, • PI.16.006 TORRES, RVA • PD.04.013 VIDAL,J.C.S. • PD.16.014, PD.16.016, , PI.16.005, TOYAMA, C. • PD.03.009, PD.03.010, PD.03.016, TL.16.001 PD.03.023, PD.03.032, PD.03.034, VIEGAS, T.F. • PD.13.008 PD.03.042, PD.03.044, PD.12.082, VIEIRA, A. P. F. • PD.03.041 PD.12.084, PD.12.089, PD.12.093, , VIEIRA, A.P.F. • PD.12.029, PD.12.093 PI.03.005 VIEIRA, F.A.C. • PD.18.006 TRANOULIS, E. • PI.07.002 VIEIRA, J. B • PD.13.010 TRIDENTE, C.F. • TL.01.001 VIEIRA, M. P. M. M. • PD.16.015 TRIPPIA, C. R. • PD.18.001 VIEIRA,S.C. • PD.16.013 TSUNO, M.Y • PD.01.043 VIEIRA T. D. R • PD.01.073 TSUNO, M.Y. • PD.01.022 VIEIRA, X. G. • PD.05.010 TSUNO, N.S.G. • PD.01.022, PD.01.043 VIVIANI, C. L. S. • PD.11.015 TYNG, C.J. • PD.17.006 V. Z. MIRANDA • TL.09.003
U W UCHIDA, R.R. • PI.13.007 WADA D.T. • TL.17.001 WADA DT, SANCHES IB • TL.17.002 WAGNER, J • PI.11.002 V WAGNER L. F. • PD.13.009 VALDUGA, S. G. • TL.15.003 WAGNER L.F. • PD.13.013 VALENTE,M. • PD.12.018 WAJNBERG, C. M. G. • PD.12.061 VALLE, L. G. • PI.08.006 WAJNBERG, C.M.G • PD.12.071 VALLE L.G.M • PD.08.003 WAJSMAN, V. Z. • PD.01.020, TL.09.002, TL.09.004 VALLE L.G.M. • PI.05.003, TL.08.003, TL.08.004 WANDERLEY, M. C • PD.01.012 VALLE, L. G. M. • PD.08.006 WARMBRAND, G. • PD.10.004 VALLE, L.G.M. • PD.08.007, PD.08.012 WATANABE, A.P.F. • PD.10.004 VAN DUINKERKEN, E. • PD.12.028 WATANABE, A. P. H. U. • PD.09.003• PI.09.001 VASCONCELOS, L. M. • PD.13.020 WATTE, G. • PD.17.041 VASCONCELOS, R.A. • PD.18.002 WOLOSKER AMBPI.03.007 VASCONCELOS, R.C. • PI.15.002 VAZ, A. • PD.18.001 X VAZ, N.D. • PD.17.021 VELLONI, F.G. • PD.01.035, PD.01.053 XAVIER, H. A. F. R. • PD.01.026 VELLONI, FG • PD.01.047 VELOSO, J. C. V • PD.12.078 Y VELOSO, J. C. V. • PD.01.020, TL.09.002, TL.09.004 VENDRAMINI,D.F.V • PD.09.035 YAMACHIRA, V. S. • PD.15.046 VENTURA C.A. • PI.18.007, • PI.18.015 YAMADA, A.F.PI.15.002 VENTURA, CA • PI.18.006 YAMADA,A.F. • PD.15.003
Abstracts of Scientific Papers 133 YAMAGA, L • PI.11.002 YAMANARI MG • PD.13.005 YAMANARI, M.G.I • PI.13.003PI.13.005 YAMANARI, M.G.I. • PI.13.001PI.13.004PI.13.006 PI.13.009 YAMANARI, M. Y. • PI.13.008 YAMASHITA, HK. • PI.03.007 YAMASHITA, S. • TL.09.004 YAMASHITA, S.R.PI.15.001 YAMAUCHI, F. I. • TL.01.005 YAMAUCHI, F.I. • TL.01.001 YANO, L.PI.18.009 YONEKURA, I • PI.18.006 YONEKURA, I. • PI.18.012 YONEKURA,IP • I.18.003
Z ZACARIAS, M.S. • PD.01.053 ZAMARIOLLI, G.S. • PD.12.066 ZAMPIERI, J. F. • TL.17.006 ZANGIACOMO, R. N. • PI.08.006 ZANGIACOMO, R.N. • PI.08.004PI.08.005 ZANGIACOMO R.Z. • PD.08.003 ZANONI, B.B. • PI.01.008 ZARPELLON, R. J. • PD.17.003 ZATTAR, L. C. • PD.15.046 ZAVARIZ, J. D. • TL.18.001 ZIMMERMANN, N. • PD.12.028 ZORZENONI, F.O. • PI.15.001 ZUSTRASSEN, C.E. • PD.08.001
134 49th Sao Paulo Radiological Meeting 50th Sao Paulo Radiological Meeting 1st Meeting of Interventional Radiology April 30 to may 3, Sao Paulo – Brazil www.jpr2020.org.br
Radiology for the FUTURE
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