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A 65-year-old man, with unremarkable previous medical history, presented to the emergency department with symptoms of anorexia, jaundice and fever. The serum total bilirubin level was 7.5 mg/dL and direct bilirubin was 5.4 mg/dL. Abdominal ultrasound detected generalised and irregular dilatation

Congenital extrahepatic portosystemic shunts are a rare cause of lower gastrointestinal bleeding in children. They result from the connection of a systemic vessel with the portomesenteric vasculature before the division of the main portal vein. Herein, we report a case of a congenital extrahepatic portosystemic shunts type II in a 4-year-old male diagnosed by Doppler ultrasonography during the investigation of abdominal pain and recurrent hematochezia, later confirmed by computed tomography. Conventional angiography with a balloon occlusion test revealed patent intrahepatic portal branches not depicted by previous imaging techniques. Successful shunt closure was achieved by endovascular approach with an Amplatzer Septal Occluder without complications.

Ovarian cancer is the most fatal gynecologic malignancy. The incidence of ovarian cancer among female-to-male transsexuals receiving treatment with testosterone is unknown, and few cases have been reported in the literature. We report a recent case in our institution, a 23-year-old female-to-male transsexual patient who received testosterone supplementation. The patient underwent a pelvic magnetic resonance imaging to study an ovarian complex cyst that revealed the presence of a bilateral ovarian tumor with imaging features of borderline serous tumor. These masses were surgically removed and the pathology report confirmed the diagnosis associated with noninvasive peritoneal implants and the presence of numerous androgen receptors in the tumor cells. Although there is still insufficient data to validate a direct correlation between hormonotherapy and ovarian cancer in these patients, this case may reinforce previous reports on this association and highlights the relevance of radiological follow-up and bilateral salpingo-oophorectomy as part of gender reassignment surgery.

A diabetes é uma doença crónica muito frequente na população portuguesa, sendo a sua prevalência estimada de 13,6% nos adultos. A melhor preparação e os riscos associados à realização de exames de imagem em pessoas com diabetes são frequentemente objeto de dúvidas. Neste artigo, pretendemos rever as principais precauções e sugerir um protocolo de atuação, de forma a reduzir os riscos e otimizar a sensibilidade destes exames nesta população. Revemos também a necessidade de suspensão de metformina após a administração de contraste iodado endovascular, pelo risco de acidose láctica, as precauções em pessoas com diabetes insulinotratadas ou sob fármacos que apresentam maior risco de hipoglicemia na realização de exames de imagem que obriguem a jejum, e a influência da hiperglicemia e da terapêutica anti-diabética na sensibilidade da PET-FDG. Com a revisão deste tema e apresentação de um protocolo de atuação pretendemos desmistificar a orientação dos indivíduos com diabetes que vão ser submetidos a exames de imagem, tornando mais simples a sua gestão.

OBJECTIVES Atherosclerotic plaque molecular imaging with F-sodium fluoride (NaF) PET with computed tomography (PET-CT) may identify active unstable microcalcification. We sought to explore renal arteries calcification activity in a group of high cardiovascular (CV) risk subjects without manifest CV disease. METHODS High CV risk hypertensive individuals from a single centre were prospectively scanned with F-NaF-PET-CT in major vascular territories. Renal arterial wall activity was retrospectively analysed and expressed as the ratio between maximum standard uptake value in the lesion and mean blood pool activity in the superior vena cava [tissue-to-background ratio (TBR)]. We explored renal artery wall F-NaF activity's association to CV risk factors and renal function. RESULTS Mean age was 64 ± 8.6 years, 56% male, 96% Caucasian and 24% had chronic kidney disease (CKD) (n = 25). Six individuals (24%) showed renal artery wall radiotracer uptake (TBR 1.4 ± 0.4); these subjects were heavier, had higher triglycerides, high-sensitivity C-reactive protein and predicted CV risk (SCORE) compared to the remaining cohort (P < 0.05 for all comparisons). There was a trend toward higher F-NaF uptake in other major vessels and increased thoracic fat volume in subjects with renal artery wall uptake. Glomerular filtration rate (GFR) was lower in subjects with positive renal plaques (93.0 ± 29.7 vs. 65.0 ± 19.7 ml/min, P = 0.04). Renal artery radiotracer uptake and eGFR were inversely correlated (r = -0.42, P = 0.04). CONCLUSION In a high CV risk group without manifest CV disease, higher renal artery wall F-NaF activity is associated with superior predicted CV risk and lower GFR.

Resumo Fundamento A cardiomiopatia hipertrófica (CMH) e a hipertrofia ventricular esquerda (HVE) secundária à hipertensão arterial sistêmica (HAS) podem estar associadas a anormalidades funcionais do átrio esquerdo (AE). Objetivos Caracterizar a mecânica do AE na CMH e na HAS e avaliar qualquer correlação com a extensão da fibrose ventricular esquerda medida por ressonância magnética cardíaca (RMC) em pacientes com CMH. Métodos A função longitudinal do AE derivada do ecocardiograma bidimensional com speckle tracking foi adquirida a partir de cortes apicais de 60 pacientes com CMH e 34 indivíduos controles, pareados por idade. Pacientes com CMH também foram submetidos à RMC, com medida da extensão do realce tardio por gadolínio. A associação com parâmetros de strain do AE foi analisada. Valores p < 0,05 foram definidos como estatisticamente significativos. Resultados A média da fração de ejeção do ventrículo esquerdo não foi diferente entre os grupos. A razão E/e’ estava comprometida no grupo CMH e preservada no grupo controle. A mecânica do AE estava significativamente reduzida na CMH em comparação aos pacientes com HAS. O strain rate do AE nas fases de reservatório (SRrAE) e na fase contrátil (SRctAE) foram os melhores parâmetros de discriminação de CMH com uma área sob a curva (AUC) de 0,8, seguido do strain do AE na fase de reservatório (SrAE) (AUC 0,76). O SRrAE e o SRctAE apresentaram elevada especificidade (89% e 91%, respectivamente), e o SrAE apresentou sensibilidade de 80%. Um decréscimo de 2,79% no strain rate do AE na fase de condução (SRcdAE) foi preditor de um aumento de 1 cm na extensão do RT pelo gadolínio (r2=0,42, β 2,79, p=0,027). Conclusões O SRrAE e o SRctAE foram os melhores fatores de discriminação de HVE secundária à CMH. O SRcdAE foi preditor do grau de fibrose ventricular esquerda avaliada por RMC. Esses achados sugerem que a mecânica do AE pode ser um potencial preditor de gravidade de doença na CMH. Abstract Background Hypertrophic cardiomyopathy (HCM) and left ventricular hypertrophy (LVH) secondary to systemic hypertension (HTN) may be associated with left atrial (LA) functional abnormalities. Objectives We aimed to characterize LA mechanics in HCM and HTN and determine any correlation with the extent of left ventricular (LV) fibrosis measured by cardiac magnetic resonance (CMR) in HCM patients. Methods Two-dimensional speckle tracking-derived longitudinal LA function was acquired from apical views in 60 HCM patients, 60 HTN patients, and 34 age-matched controls. HCM patients also underwent CMR, with measurement of late gadolinium enhancement (LGE) extension. Association with LA strain parameters was analyzed. Statistical significance was set at p

Background Congenital extrahepatic portosystemic shunts (CEPS) are rare shunts connecting the extrahepatic portal system with the inferior vena cava. Shunt dimensions and the risk of portal hypertension determines the closure strategy. Endovascular treatment is indicated for single stage occlusion of longer length shunts, whereas the remaining shunt types are preferentially surgically occluded. Herein we describe the technical details of a novel endovascular treatment for short length CEPS. Case presentation A 15-years-old male with a short length CEPS complicated with multinodular liver disease was submitted to a multistage closure, as indicated by the high portal pressure values during shunt balloon occlusion venography. Initially a transjugular intrahepatic portosystemic shunt (TIPS) was created and the CEPS occluded with an atrial septal defect occluder. In a second procedure the TIPS was embolized with a flow reductor stent and an amplatzer vascular plug II. At a 1 year follow up the liver nodules size reduced, the patient remains asymptomatic, and the shunt adequately closed. Conclusion This paper outlines the potential use of a TIPS and an atrial septal defect occluder combination in complex CEPS, supporting its usage as an alternative to the standard surgical treatment. Level of Evidence: Level 4, Case report.

Diabetes is a very common chronic disease in the Portuguese population, with an estimated prevalence of 13.6% in the adults. Doubts often arise regarding the best preparation and the risks associated with doing imaging tests in these patients. In this article we intend to review the main precautions in imaging tests in people with diabetes and to suggest a guideline to reduce the risks and optimize the sensitivity of these tests in this population. The main topics addressed in this article are the need to suspend metformin after the administration of endovascular iodinated contrast due to the risk of lactic acidosis, the precautions in insulin-treated patients or those taking medicines with a higher risk of hypoglycemia when performing imaging tests that require fasting, and the influence of hyperglycemia and of anti-diabetic therapy on the sensitivity of PET-FDG. With this review and the presentation of a guideline, we intend to demystify and simplify the management of individuals with diabetes who are undergoing imaging tests.A diabetes é uma doença crónica muito frequente na população portuguesa, sendo a sua prevalência estimada de 13,6% nos adultos. A melhor preparação e os riscos associados à realização de exames de imagem em pessoas com diabetes são frequentemente objeto de dúvidas. Neste artigo, pretendemos rever as principais precauções e sugerir um protocolo de atuação, de forma a reduzir os riscos e otimizar a sensibilidade destes exames nesta população. Revemos também a necessidade de suspensão de metformina após a administração de contraste iodado endovascular, pelo risco de acidose láctica, as precauções em pessoas com diabetes insulinotratadas ou sob fármacos que apresentam maior risco de hipoglicemia na realização de exames de imagem que obriguem a jejum, e a influência da hiperglicemia e da terapêutica anti-diabética na sensibilidade da PET-FDG. Com a revisão deste tema e apresentação de um protocolo de atuação pretendemos desmistificar a orientação dos indivíduos com diabetes que vão ser submetidos a exames de imagem, tornando mais simples a sua gestão.

Background Three-dimensional (3D) models are increasingly used to help surgeons, guiding them through the complex hepatic vasculobiliary anatomy. The biliary tract is a relatively untapped territory with only a few case reports described in medical literature. Our aim is to present an innovative 3D reconstruction methodology for biliary imaging and surgical planning, applied to a case of iatrogenic biliary stricture, with fusion of segmented CT and MRI images. Case presentation A selected case of Bismuth type III iatrogenic biliary stenosis for 3D planning. CT and MR studies were acquired with dedicated protocols for segmentation. Two radiologists performed segmentation and 3D model post-processing, fusing both imaging techniques to faithfully render the anatomical structures. Measurements of anatomical landmarks were taken in both the CT/MRI and the 3D model to assure its accuracy and differences in measurement were calculated. The 3D model replicates anatomical structures and pathology with high accuracy, with only 2.2% variation between STL, CT and MRI measurements. The model was discussed with the surgical team and used in the surgical planning, improving confidence in this delicate procedure, due to the detailed prior knowledge of the patient's anatomy. Conclusion Three-dimensional reconstructions are a rapidly growing area of research with a significant impact in the personalized and precision medicine. The construction of 3D models that combine vascular and biliary anatomy, using different imaging techniques, respectively CT and MRI, will predictably contribute to a more rigorous planning of complex liver surgeries.

Purpose The purpose of this study was to compare metallic coils and glue (n-butyl-2 cyanoacrylate) for varicocele embolization, regarding immediate technical and clinical success, procedure time, complications and recurrence rates. Materials and methods A retrospective analysis of a consecutive series of varicocele embolization procedures performed between July 2012 and July 2015 was undertaken. A total of 129 procedures were performed, 26 using glue (20.2%; 26 men with a mean age of 32.6 years) and 103 using coils (79.8%; 103 men with a mean age of 32.3 years). Demographic data, indications, technique, procedure time, complications and outcomes were compared. Results A total of 89 procedures (69%) were motivated by infertility (glue = 20, coils = 69) and 40 (31%) by testicular pain (glue = 6, coils = 34). The mean procedure time was 35.58 ± 13.44 (SD) min for glue and 45.97 ± 17.46 (SD) min for coils ( P = 0.0054). Immediate technical success rate was 100% using glue and 99% using coils ( P = 1.0000). A single minor complication was observed after coil embolization (0.97%). Both materials showed significant improvement of semen parameters, with similar clinical success rates. For patients referred for testicular pain, clinical success rate was 66.67% using glue and 88.24% using coils ( P = 0.2147). Recurrence rate was 11.54% with glue and 5.83% with coils ( P = 0.4000). Procedure time was significantly shorter with glue ( P = 0.0054). Conclusion Glue and coils are both safe and effective for varicocele embolization. However, the use of glue yields shorter procedure time.

Background and aims Atherosclerotic plaque molecular imaging with 18 F-sodium fluoride (NaF) in positron emission tomography with computed tomography (PET-CT) provides potential discrimination between active unstable microcalcification and established dormant calcification. We aimed to study 18 F-NaF atherosclerotic plaque uptake in high cardiovascular (CV) risk participants and its associations with CV risk factors, coronary calcium score and thoracic fat volume. Methods High CV risk hypertensive individuals from a single centre were prospectively scanned with 18 F-NaF-PET-CT in the coronary, aortic and carotideal arteries. Atherosclerotic plaque 18 F-NaF uptake was expressed as Corrected Uptake per Lesion (CUL): maximum standard uptake value in each vascular territory subtracted by mean blood pool activity. Results Mean age was 64 years, 56% male and 96% Caucasian (n = 25). Ninety six per cent of the subjects showed 18 F-NaF uptake in the aorta (CUL 0.9 ± 0.3), 40% in the carotid arteries (median CUL 0.0, IQR 0.0–0.7) and 64% in the coronary arteries (0.4, IQR 0.0–0.6). Individuals with ≥ five risk factors (60%) had increased overall 18 F-NaF uptake (1.1 ± 0.3 vs . 0.7 ± 0.3, p p = 0.01). There was no correlation between 18 F-NaF uptake in the coronary arteries and calcium score ( p = 0.87). Thoracic fat was moderately correlated with overall CUL (r = 0.41, p = 0.04). Conclusions In a high CV risk group, 18 F-NaF atherosclerotic plaque uptake was related to the burden of CV risk factors and thoracic fat volume, but there was no association between coronary uptake and calcium score.

Primary cardiac involvement in systemic sclerosis is common, often subclinical, and is associated with significant mortality. We report the case of a patient who developed autoimmune myocarditis at an early stage of systemic sclerosis, who completely recovered from cardiac dysfunction under optimal medical therapy for heart failure and immunosuppression. This challenging case aims at increasing awareness around the fact that the heart is a target organ of scleroderma disease. It also highlights the importance of screening and early diagnosis of cardiac involvement, because a timely treatment may impact the quality of life of these patients and improve their prognosis.

BACKGROUND : Hypertrophic cardiomyopathy (HCM) and left ventricular hypertrophy (LVH) secondary to systemic hypertension (HTN) may be associated with left atrial (LA) functional abnormalities. We aimed to characterize LA mechanics in HCM and HTN and determine any correlation with the extent of fibrosis measured by cardiac magnetic resonance (CMR) in HCM patients. METHODS: Two-dimensional speckle tracking-derived longitudinal LA function was acquired from apical views in 60 HCM patients, 60 HTN patients, and 34 age-matched controls. HCM patients also underwent CMR, with measurement of late gadolinium enhancement (LGE) extension. Association with LA strain parameters was analyzed. RESULTS: The mean LV ejection fraction did not differ across groups. The E/e’ ratio was only preserved in the control group and significantly impaired in the HCM group. LA mechanics were significantly reduced in HCM, compared to the HTN group. LA strain rate in systole (LA-SRs) and late diastole (LA-SRa) were the best discriminators of HCM, with an area under the curve (AUC) of 0.8, followed by LA strain in systole (LA ɛsys) (AUC 0.76). LA-SRs and LA-SRa had high specificity (89% and 91%, respectively) and LA ɛsys had sensitivity of 80%. LA strain rate in early diastole (LA-SRe) was moderately correlated with the extension of LGE (r 2 0.42, p=0.027) CONCLUSIONS: LA-SRs and LA-SRa were the best discriminators for LVH secondary to HCM. LA-SRe was best correlated with the degree of fibrosis assessed by CMR. These findings suggest that LA mechanics can be potential predictors of disease severity in HCM.

18F-sodium fluoride (18F-NaF) has been used to evaluate aortic stenosis. It is know that its uptake is related with microcalcification. The purpose of this study is to assess the relationship between 18F-NaF uptake by the aortic valve and by the main arterial vessels and cardiovascular risk. Twenty-five hypertensive patients without known cardiovascular disease or aortic stenosis underwent PET-CT with 18F-NaF. Cardiovascular risk was assessed through the ASCVD risk calculator. The patients had a mean age of 64.0±8.6 years and 56% were males. The mean ASCVD risk was of 28.8±19.0 (IQR: 10–48.5). The uptake of 18F-NaF assessed through the corrected uptake per lesion (CUL = max SUV – mean blood-pool SUV) was of 0.49±0.14 (IQR: 0.44–0.57) and the mean uptake in the aortic, coronary and carotid territories was of 0.66±0.21 (IQR: 0.53 - 0.76).The patients were classified according to the ASCVD: Group A: patients with a risk above the 50thpercentile of the ASCVD risk distribution (50thpercentile=25), 12 patients) and Group B: patients with a risk under or equal to the 50thpercentile of the ASCVD risk distribution, 13 patients. The uptake of 18F-NaF in the aortic valve (AoV)and in the main vascular territories (VT) were evaluated in both groups: A vs B: AoV CUL = 0.57±0.09 vs 0. 42±0.14, p=0.005; VT= 0.78±0.16 vs 0.54±0.20, p=0.003. We also evaluate the relation between AoV uptake and VT uptake and they were significantly related (r=0.69, p=0.0001). In conclusion on this study microcalcification of the aortic valve and in the main vessels, evaluated through 18F-NaF uptake, were related between them and with cardiovascular risk reinforcing the importance of cardiovascular risk prevention in aortic valve degeneration and vascular atherosclerosis.

An asymptomatic 45-year-old man, with no relevant medical history, underwent an abdominal ultrasound that revealed a markedly hypoechoic focal liver lesion in S4b. Contrast-enhanced multidetector CT (MDCT) was performed for further characterisation. The nodule displayed heterogeneous enhancement

Whipple’s disease is a rare and difficult-to-diagnose infectious disease, related to infection by gram-positive bacillum Tropheryma whipplei. Clinical manifestations are very variable, but the classic form usually begins with recurring arthritis, followed several years later by non-specific abdominal symptoms, leading to late diagnosis. We present the case of a 52-year-old man who was admitted in the emergency department with an insidious clinical picture characterised by weight loss, abdominal pain, diarrhoea and arthralgias. An abdominal ultrasound was performed, showing findings suggestive of Whipple’s disease, which, in conjunction with the clinical and laboratory findings, allowed the diagnosis to be correctly addressed. Upper endoscopy with duodenal biopsy revealed findings compatible with Whipple’s disease, and the diagnosis was also confirmed through PCR techniques of blood. The patient was given antibiotic therapy, with rapid and substantial clinical improvement.

OBJECTIVE: Macroporous cement with mechanical properties similar to cancellous bone may improve the treatment of large bone defects in relation to solid acrylic cement. The aim of this study was to compare physical and mechanical characteristics of a polymethyl methacrylate (PMMA) based porous cement with cancellous bone. METHODS: Compressive strength and pore size, interconnectivity, and distribution of cylindrical porous PMMA cement samples containing 10% (G1), 20% (G2) or 30% (G3) effervescent components were analyzed. Results were compared to bovine cancellous bone (G4) and solid PMMA (G5) samples. RESULTS: Scanning electron microscopy (SEM) of all experimental samples (G1 - G3) revealed a random distribution and a wide size variation of pores ranging from 50 µm to 3 mm. Micro-CT showed that G2 have high porosity and lower interconnectivity of pores. No significant differences in yield strength and Young's modulus were observed among G1, G2 and G3. G4 samples were slightly stronger and less elastic than the other groups. Solid PMMA is extremely strong and inelastic. CONCLUSIONS: PMMA based porous cement met the expected characteristics. High porosity with large and interconnected pores may allow for bone ingrowth. Strength and elasticity similar to cancellous bone may enhance mechanical stimuli to bone remodeling. Observational Descriptive Study.

We report the imaging findings of an uncommon coronary vascular termination anomaly, with fistula to the pulmonary artery.This 70 year old female patient presented unstable angina, showing a coronary artery fistula depicted in coronary angiogram from the left coronary to the pulmonary artery, with no significant atherosclerotic pathology.Due to development of ventricular tachycardia in stress echocardiogram examination, she was proposed for coronary fistula closure.Coronary CT was performed for procedure planning and allowed the identification of a second unsuspected fistula from the right coronary to the right pulmonary artery.Congenital coronary anomalies are a possible cause of symptomatic coronary pathology in patients of any age. In older patients, coronary artery fistulas are rare, especially when symptomatic. Adequately performed CT examinations, using its post processing capabilities, with 3D and MIP reconstructions are invaluable in delineating coronary anatomy, essential for further treatment planning. Keywords: Coronary anomalies, Coronary fistula, Angiogram, Computer tomography

Editor: This report was granted exemption from institutional review board approval. The authors report a case of endovascular recanalization and stent placement in the right hepatic vein (HV) by using a collateral loop-guided approach through a caudate-lobe patent accessory HV. A 9-year-old boy presented with a 2-month history of abdominal distension, left thigh pain, and claudication. Blood tests revealed erithrocytosis, γ-glutamyl transpeptidase level of 143 U/L, and lactate level of 2,30 mmol/L. Coagulation, thrombophilia studies, and copper levels were normal. Autoantibody screens were negative, and autoimmune lymphoproliferative syndrome was excluded by flow cytometry. Genetic analysis showed a nonspecific JAK2 gene polymorphism. Doppler ultrasound (US) demonstrated narrowed HVs with decreased flow (10 cm/s), and thrombosis of the confluence of the right, middle, and left HVs (Fig 1). A tortuous caudate lobe vein was identified. The portal vein had antegrade flow with normal velocity (33 cm/s). The hepatic artery had normal resistive indices. Hepatomegaly (liver length at the midclavicular line of 15 cm) and ascites were noted. Computed tomographic (CT) angiography confirmed the HV obstruction and demonstrated caudate lobe hypertrophy with retrohepatic vena cava compression (3 mm). The caudatelobe accessory HV draining into the inferior vena cava (IVC) was identified (Fig 2). The patient was referred to our institution for angiographic evaluation and, if possible, retrograde recanalization of the HVs. The venography and endovascular treatment were performed through a right transjugular approach. A 6-F, 11-cm-long sheath introducer (Boston Scientific, Natick, Massachusetts) was inserted into the right jugular vein, through which a 65-cm-long, 5-F multipurpose 0.038-inch catheter (Cordis, Warren

Resumo: Introdução: A ressonância magnética cardíaca (RMC) tem vindo a adquirir grande relevância na avaliação diagnóstica de um espectro cada vez mais amplo de cardiomiopatias, incluindo as que apresentam potencial arritmogénico. Objetivo: Avaliação do valor acrescentado da RMC no diagnóstico etiológico de arritmias ventriculares, quando a investigação convencional inicial com outros métodos complementares de diagnóstico não é conclusiva. Métodos: Estudaram-se retrospetivamente os doentes que realizaram RMC para esclarecimento da etiologia de arritmias ventriculares, entre 2005-2011 (n = 113). Foram incluídos apenas doentes com arritmias ventriculares documentadas. Constituíram critérios de exclusão a obtenção de diagnóstico definitivo por exame complementar, de diagnóstico realizado previamente e a presença de história prévia sugestiva de doença coronária (antecedentes de síndrome coronária aguda ou história de angor típico, de elevação de biomarcadores de necrose miocárdica ou teste de isquemia positivo, quando realizado). Os resultados da RMC foram considerados relevantes quando sugeriram um diagnóstico provável. Resultados: Dos 113 doentes incluídos, 57,5% eram homens. A idade média foi 41,7 ± 16,2 anos. Quanto à arritmia documentada, 38,1% dos doentes foram referenciados por taquicardia ventricular/fibrilhação ventricular (FV/TV mantida) e 61,9% por extrassistolia ventricular com menor complexidade (ESV). A RMC mostrou alterações sugestivas de um diagnóstico específico em 42,5% dos doentes, foi totalmente normal em 36,3% e mostrou alterações inespecíficas nos restantes. Nos casos de referenciação por FV/TV mantida a RMC foi diagnóstica em 60,4% dos casos, enquanto nos casos de ESV foi-o em 31,4%.Os diagnósticos prováveis mais frequentes foram displasia arritmogénica do ventrículo direito, não compactação ventricular e miopericardite. Assinala-se que, apesar da ausência de evidências clínicas sugestivas pelos critérios atrás referidos, 6,2% dos doentes apresentaram áreas de realce tardio com distribuição e características atribuíveis a doença coronária obstrutiva. Conclusão: A RMC proporciona valor acrescentado no diagnóstico etiológico de arritmias ventriculares quando exames mais acessíveis ou realizados previamente não são conclusivos. A percentagem de doentes em que foi conclusiva foi de 42,5% (60,4% nos casos de referenciação por FV/TV mantida) e em que foi totalmente normal foi de 36,3%. Abstract: Introduction: Cardiac magnetic resonance (CMR) imaging is increasingly important in the diagnostic work-up of a wide range of heart diseases, including those with arrhythmogenic potential. Objective: To assess the added value of CMR in etiological diagnosis of ventricular arrhythmias after an inconclusive conventional investigation. Methods: Patients undergoing CMR between 2005 and 2011 for investigation of ventricular arrhythmias were included (n=113). All had documented arrhythmias. Those with a definite diagnosis from a previous investigation and those with evidence of coronary artery disease (acute coronary syndrome, typical angina symptoms, increase in biomarkers or positive stress test) were excluded. CMR results were considered relevant when they fulfilled diagnostic criteria. Results: Of the 113 patients, 57.5% were male and mean age was 41.7±16.2 years. Regarding the initial arrhythmia, 38.1% had ventricular fibrillation/sustained ventricular tachycardia (VF/VT) and 61.9% had less complex ventricular ectopy. CMR imaging showed criteria of a specific diagnosis in 42.5% of patients, was totally normal in 36.3%, and showed non-specific alterations in the remainder. In VF/VT patients, specific criteria were found in 60.4%, and in 31.4% of those with less complex ectopy.The most frequent diagnoses were arrhythmogenic right ventricular dysplasia, ventricular non-compaction and myopericarditis. It is worth noting that, although there was no evidence of previous coronary artery disease, 6.2% of patients had a late gadolinium enhancement distribution pattern compatible with myocardial infarction. Conclusion: CMR gives additional and important information in the diagnostic work-up of ventricular arrhythmias after an inconclusive initial investigation. The proportion of patients with diagnostic criteria was 42.5% (60.0% in those with VF/VT), and CMR was completely normal in 36.6%. Palavras-chave: Ressonância magnética cardíaca, Etiologia de arritmias ventriculares, Substrato arritmogénico, Keywords: Cardiac magnetic resonance, Diagnosis of ventricular arrhythmias, Arrhythmogenic substrate

Introduction: Cardiac magnetic resonance (CMR) imaging is increasingly important in the diagnostic work-up of a wide range of heart diseases, including those with arrhythmogenic potential. Objective: To assess the added value of CMR in etiological diagnosis of ventricular arrhythmias after an inconclusive conventional investigation. Methods: Patients undergoing CMR between 2005 and 2011 for investigation of ventricular arrhythmias were included (n=113). All had documented arrhythmias. Those with a definite diagnosis from a previous investigation and those with evidence of coronary artery disease (acute coronary syndrome, typical angina symptoms, increase in biomarkers or positive stress test) were excluded. CMR results were considered relevant when they fulfilled diagnostic criteria. Results: Of the 113 patients, 57.5% were male and mean age was 41.7±16.2 years. Regarding the initial arrhythmia, 38.1% had ventricular fibrillation/sustained ventricular tachycardia (VF/VT) and 61.9% had less complex ventricular ectopy. CMR imaging showed criteria of a specific diagnosis in 42.5% of patients, was totally normal in 36.3%, and showed non-specific alterations in the remainder. In VF/VT patients, specific criteria were found in 60.4%, and in 31.4% of those with less complex ectopy.The most frequent diagnoses were arrhythmogenic right ventricular dysplasia, ventricular non-compaction and myopericarditis. It is worth noting that, although there was no evidence of previous coronary artery disease, 6.2% of patients had a late gadolinium enhancement distribution pattern compatible with myocardial infarction. Conclusion: CMR gives additional and important information in the diagnostic work-up of ventricular arrhythmias after an inconclusive initial investigation. The proportion of patients with diagnostic criteria was 42.5% (60.0% in those with VF/VT), and CMR was completely normal in 36.6%. Resumo: Introdução: A ressonância magnética cardíaca (RMC) tem vindo a adquirir grande relevância na avaliação diagnóstica de um espectro cada vez mais amplo de cardiomiopatias, incluindo as que apresentam potencial arritmogénico. Objetivo: Avaliação do valor acrescentado da RMC no diagnóstico etiológico de arritmias ventriculares, quando a investigação convencional inicial com outros métodos complementares de diagnóstico não é conclusiva. Métodos: Estudaram-se retrospetivamente os doentes que realizaram RMC para esclarecimento da etiologia de arritmias ventriculares, entre 2005-2011 (n = 113). Foram incluídos apenas doentes com arritmias ventriculares documentadas. Constituíram critérios de exclusão a obtenção de diagnóstico definitivo por exame complementar, de diagnóstico realizado previamente e a presença de história prévia sugestiva de doença coronária (antecedentes de síndrome coronária aguda ou história de angor típico, de elevação de biomarcadores de necrose miocárdica ou teste de isquemia positivo, quando realizado). Os resultados da RMC foram considerados relevantes quando sugeriram um diagnóstico provável. Resultados: Dos 113 doentes incluídos, 57,5% eram homens. A idade média foi 41,7 ± 16,2 anos. Quanto à arritmia documentada, 38,1% dos doentes foram referenciados por taquicardia ventricular/fibrilhação ventricular (FV/TV mantida) e 61,9% por extrassistolia ventricular com menor complexidade (ESV). A RMC mostrou alterações sugestivas de um diagnóstico específico em 42,5% dos doentes, foi totalmente normal em 36,3% e mostrou alterações inespecíficas nos restantes. Nos casos de referenciação por FV/TV mantida a RMC foi diagnóstica em 60,4% dos casos, enquanto nos casos de ESV foi-o em 31,4%.Os diagnósticos prováveis mais frequentes foram displasia arritmogénica do ventrículo direito, não compactação ventricular e miopericardite. Assinala-se que, apesar da ausência de evidências clínicas sugestivas pelos critérios atrás referidos, 6,2% dos doentes apresentaram áreas de realce tardio com distribuição e características atribuíveis a doença coronária obstrutiva. Conclusão: A RMC proporciona valor acrescentado no diagnóstico etiológico de arritmias ventriculares quando exames mais acessíveis ou realizados previamente não são conclusivos. A percentagem de doentes em que foi conclusiva foi de 42,5% (60,4% nos casos de referenciação por FV/TV mantida) e em que foi totalmente normal foi de 36,3%. Keywords: Cardiac magnetic resonance, Diagnosis of ventricular arrhythmias, Arrhythmogenic substrate, Palavras-chave: Ressonância magnética cardíaca, Etiologia de arritmias ventriculares, Substrato arritmogénico

OBJECTIVES: Asymptomatic left ventricular (LV) diastolic dysfunction is increasingly recognised as an important diagnosis. Our goal was to study the prevalence and gender differences in subclinical LV diastolic dysfunction, using cardiovascular magnetic resonance imaging (CMR) at 3 T. METHODS: We prospectively studied 48 volunteers (19 male and 29 female, mean age 49 ± 7 years) with no evidence of cardiovascular disease. We used CMR to measure left atrium (LA) and LV volumes, LV peak filling rate and transmitral flow. RESULTS: The overall prevalence of LV diastolic dysfunction in our cohort varied between 20 % (based on evaluation of LV filing profiles) and 24 % (based on the evaluation of the transmitral flow). The prevalence of diastolic dysfunction was higher in men than in women, independently of the criteria used (P between 0.004 and 0.022). Indexed LV end-diastolic volume, indexed LV stroke volume, indexed LV mass, indexed LA minimum volume and indexed LA maximum volume were significantly greater in men than in women (P

Resumo: Introdução e objectivos: A isquémia do miocárdio pode ser avaliada através da ressonância magnética de perfusão (RMp). O objetivo do trabalho foi avaliar o uso clínico da RMp no estudo da doença cardíaca isquémica (DCI). Métodos: Foram estudados 55 doentes através de RMp, num aparelho de 1,5 T (Siemens Symphony), através da injeção de quelato de gadolínio (0,10 mmol/kg), utilizando uma sequência IR-SSFP. O stress foi induzido pela adenosina (140 μg/kg/min durante 4 min). Os resultados foram comparados com os das coronariografias e das cintigrafias de perfusão do miocárdio. A concordância entre as variáveis qualitativas foi a avaliada através do coeficiente kappa. Foi considerada significância estatística a 95%. Efetuou-se um follow-up clínico mínimo de 12 meses. Resultados: Das 55 ressonâncias magnéticas (RM) efetuadas, em 19 (34,5%) não se detetou isquemia ou necrose do miocárdio, em 17 (30,9%) foi diagnosticada área de necrose sem isquemia, em 7 (12,7%) isquemia isolada e em 12 (21,8%) isquemia em doente com enfarte prévio. A comparação específica em função do território de irrigação coronária entre a RMp e a coronariografia foi muito boa: descendente anterior e coronária direita – k = 0,8571; intervalo 0,59-1, circunflexa – k = 0,8108; intervalo 0,59-1. Não se conseguiu obter qualquer razão de concordância entre as RMp e as cintigrafias realizadas. Conclusões: Numa população com elevada prevalência de doença coronária, a RMp mostrou ser um exame capaz de diagnosticar doença coronária significativa, através da identificação de isquemia do miocárdio. Abstract: Introduction and objectives: Myocardial ischemia can be assessed with cardiac magnetic resonance perfusion imaging (MRPI). This study aimed to analyze the clinical utility of MRPI in the diagnosis of significant coronary artery disease. Methods: Fifty-five patients were examined with a 1.5 T MR scanner (Siemens Symphony), with a first pass of 0.10 mmol/kg gadolinium chelate, at rest and during adenosine vasodilatation (140 μg/kg/min for 4 min) using an inversion recovery steady-state free precession sequence. The results were compared with coronary angiography and with SPECT myocardial perfusion images. Agreement for qualitative diagnosis was measured by the kappa coefficient, taking statistical significance as 95%. Minimum clinical follow-up was 12 months. Results: In 19 patients (34.5%) MRPI was negative for myocardial ischemia and necrosis, in 17 (30.9%) it was negative for ischemia but positive for necrosis, in 7 (12.7%) only ischemia was present and in 12 (21.8%) the ischemic area was larger than the necrotic area. The correlation between MRPI and coronary angiography for ischemia detection by coronary artery territory was very good: left anterior descending and right coronary – k=0.8571 (0.59-1), circumflex – k=0.8108 (0.59-1). By contrast, there was no correlation in terms of myocardial ischemia detection between MRPI and SPECT. Conclusions: MRPI is able to diagnose significant coronary disease in a high risk population, by detection of myocardial ischemia. Palavras-chave: Ressonância magnética, Perfusão, Doença coronária, Ressonância magnética de perfusão, Keywords: Magnetic resonance imaging, Perfusion, Coronary disease, Myocardial Perfusion Imaging

Introduction and objectives: Myocardial ischemia can be assessed with cardiac magnetic resonance perfusion imaging (MRPI). This study aimed to analyze the clinical utility of MRPI in the diagnosis of significant coronary artery disease. Methods: Fifty-five patients were examined with a 1.5 T MR scanner (Siemens Symphony), with a first pass of 0.10 mmol/kg gadolinium chelate, at rest and during adenosine vasodilatation (140 μg/kg/min for 4 min) using an inversion recovery steady-state free precession sequence. The results were compared with coronary angiography and with SPECT myocardial perfusion images. Agreement for qualitative diagnosis was measured by the kappa coefficient, taking statistical significance as 95%. Minimum clinical follow-up was 12 months. Results: In 19 patients (34.5%) MRPI was negative for myocardial ischemia and necrosis, in 17 (30.9%) it was negative for ischemia but positive for necrosis, in 7 (12.7%) only ischemia was present and in 12 (21.8%) the ischemic area was larger than the necrotic area. The correlation between MRPI and coronary angiography for ischemia detection by coronary artery territory was very good: left anterior descending and right coronary – k=0.8571 (0.59-1), circumflex – k=0.8108 (0.59-1). By contrast, there was no correlation in terms of myocardial ischemia detection between MRPI and SPECT. Conclusions: MRPI is able to diagnose significant coronary disease in a high risk population, by detection of myocardial ischemia. Resumo: Introdução e objectivos: A isquémia do miocárdio pode ser avaliada através da ressonância magnética de perfusão (RMp). O objetivo do trabalho foi avaliar o uso clínico da RMp no estudo da doença cardíaca isquémica (DCI). Métodos: Foram estudados 55 doentes através de RMp, num aparelho de 1,5 T (Siemens Symphony), através da injeção de quelato de gadolínio (0,10 mmol/kg), utilizando uma sequência IR-SSFP. O stress foi induzido pela adenosina (140 μg/kg/min durante 4 min). Os resultados foram comparados com os das coronariografias e das cintigrafias de perfusão do miocárdio. A concordância entre as variáveis qualitativas foi a avaliada através do coeficiente kappa. Foi considerada significância estatística a 95%. Efetuou-se um follow-up clínico mínimo de 12 meses. Resultados: Das 55 ressonâncias magnéticas (RM) efetuadas, em 19 (34,5%) não se detetou isquemia ou necrose do miocárdio, em 17 (30,9%) foi diagnosticada área de necrose sem isquemia, em 7 (12,7%) isquemia isolada e em 12 (21,8%) isquemia em doente com enfarte prévio. A comparação específica em função do território de irrigação coronária entre a RMp e a coronariografia foi muito boa: descendente anterior e coronária direita – k = 0,8571; intervalo 0,59-1, circunflexa – k = 0,8108; intervalo 0,59-1. Não se conseguiu obter qualquer razão de concordância entre as RMp e as cintigrafias realizadas. Conclusões: Numa população com elevada prevalência de doença coronária, a RMp mostrou ser um exame capaz de diagnosticar doença coronária significativa, através da identificação de isquemia do miocárdio. Keywords: Magnetic resonance imaging, Perfusion, Coronary disease, Myocardial perfusion imaging, Palavras-chave: Ressonância magnética, Perfusão, Doença coronária, Ressonância magnética de perfusão

Here, we evaluate the anti-inflammatory and wound-healing effects of methanolic crude extract obtained from aerial parts (leaves and branches) of Rubus imperialis Chum. Schl. (Rosaceae) and the pure compound niga-ichigoside F1. Anti-inflammatory activity was determined in vivo and in vitro, and the healing effect was evaluated in surgical lesions in mice skin. The 1,1-diphenyl-2-picrylhydrazyl radical (DPPH) assay and H2O2-induced oxidative stress were used to determine antioxidant activity. The efferocytosis activity was also determined. The data obtained show that the extract of R. imperialis promote reduction in the inflammatory process induced by lipopolysaccharide (LPS) or carrageenan in the air pouch model; the effects could be reinforced by nitric oxide reduction in LPS-stimulated neutrophils, and an increase in the efferocytosis. The extract showed wound healing property in vitro and in vivo, scavenging activity for DPPH, and cytoprotection in the H2O2-induced oxidative stress in L929 cells. In addition, the compound niga-ichigoside F1 was able to reduce the NO secretion; however, it did not present wound-healing activity in vitro. Together, the data obtained point out the modulatory actions of R. imperialis extract on leukocyte migration to the inflamed tissue, the antioxidant, and the pro-resolutive activity. However, the R. imperialis anti-inflammatory activity may be mediated in parts by niga-ichigoside F1, and on wound healing do not correlated with niga-ichigoside F1.

We report the approach to a 29 year old patient presenting with the diagnosis of a Budd-Chiari Syndrome, with clinical deterioration after initial anticoagulation treatment.The patient was proposed to endovascular treatment.Through intra-hepatic shunting seen at angiography, and from a left to right liver lobe, a guide-wire was passed retrogadely and allowed sufficient support to perform hepatic vein angioplasty and stenting.The patient responded favourably and liver transplant was avoided. Keywords: Budd-Chiari, Angioplasty, Hepatic-vein, Interventional radiology

The aim of this study was to investigate the correspondence between the coronary arterial anatomy and the supplied myocardium based on the proposed American Heart Association (AHA) 17-segment model. Six human cadaveric hearts without signs of infarct were selectively injected with colored contrasted gelatin in the three major coronary arteries. After injection, the hearts were scanned by computed tomography (64-detector scanner LightSpeed VCT, GE Healthcare) with a collimation of 64 × 0.625 mm. Reconstructed image data were analyzed in order to evaluate the blood supply of each myocardial segment. Coronary artery territory varies due to anatomy variations. Left anterior descending coronary artery (LAD) was the main vessel responsible for the myocardium blood supply in 11 segments. LAD contributed to the blood supply of all apical segments. Left circumflex (LCx) was the main coronary artery for the infero-anterior wall. Right coronary artery (RCA) contributed in all hearts for the blood supply of infero-septal segments. There was an important overlap between LAD and RCA territories at the infero-septal region and between LAD and LCx territories at the antero-lateral region. In our experiment, LAD territory was larger than the AHA-proposed 17-segment model. The most specific segments were located at the anterior wall and supplied exclusively by LAD. No specific segment could be exclusively attributed to RCA or to LCx. Sometimes, LCx can be the most important artery for the blood supply of the inferior wall even if the origin of the posterior descending artery is the RCA.

Advances in surgical techniques are extremely demanding regarding the accuracy and level of detail expected for display of the vascular anatomy of the liver. Precise knowledge of the arterial, portal and hepatic vein territories are mandatory whenever a liver intervention is planned. Sectional anatomy can now be routinely performed on multidetector computed tomography (MDCT) with volumetric data and isotropic voxel display, by means of sub-millimetric slice thickness acquisition. The relevant vascular information can thus be gathered, reviewed and post-processed with unprecedented clarity, obviating the need for digital subtraction angiography. The scope of the present paper is to review the normal vascular liver anatomy, its most relevant variants including additional sources of vascular inflow. Apart from providing the surgeon with a detailed vascular and parenchymal roadmap knowledge of imaging findings may avoid potential confusion with pathologic processes.

Congenital anomalies of the thoracic veins are rare yet important developmental abnormalities, usually classified into systemic and pulmonary. They may be encountered incidentally; as such the radiologist must be aware of their imaging presentation and clinical relevance. Furthermore, to understand these anomalies, knowledge of the embryological development and of the normal anatomy of the thoracic veins is required. In the age of non-invasive imaging modalities, magnetic resonance is paramount for the characterization of these developmental abnormalities.

OBJECTIVE: The purpose of this study was to compare cardiac MRI-derived parameters of left ventricular (LV) diastolic function between uncomplicated type 2 diabetes mellitus (DM2) and normoglycemic control subjects and to evaluate whether these parameters of LV diastolic function are related to coronary atherosclerosis. SUBJECTS AND METHODS: We prospectively studied 41 subjects with DM2 and 21 normoglycemic control subjects (30 women and 32 men; mean age, 57.2 ± 7.1 [SD] years) with no evidence of overt cardiovascular disease. We used cardiac MRI to measure LV volumes, LV peak filling rate (PFR), and transmitral flow and CT to determine coronary artery calcium scores. RESULTS: Absolute values of the peak filling rate (PFR) were significantly lower in DM2 patients than in control subjects (mean ± SD, 293.2 ± 51.7 vs 375.7 ± 102.8 mL/s, respectively; p < 0.001). Mitral peak E velocities (mean ± SD, 42.8 ± 10.7 vs 48.8 ± 10.4 cm/s; p = 0.040) and peak E velocity-to-peak A velocity ratios (0.88 ± 0.3 vs 1.1 ± 0.3; p = 0.002) were also lower in DM2 patients compared with control subjects. DM2 patients with coronary artery calcification showed a lower PFR normalized to stroke volume (SV) (mean ± SD, 4.4 ± 1.0 vs 5.3 ± 1.4, respectively; p = 0.038) and lower mitral peak E velocities (40.1 ± 11.3 vs 48.0 ± 7.3 cm/s; p = 0.024) than DM2 patients without coronary calcification. PFR normalized to SV was independently associated with the presence of coronary artery calcification (β = -1.5, p = 0.005). CONCLUSION: DM2 decreases cardiovascular MRI-derived parameters of LV diastolic function. Patients with DM2 and coronary atherosclerosis show a more impaired LV diastolic function than patients without coronary atherosclerosis.

The left atrium (LA) modulates left ventricular filling through reservoir, conduit and booster pump functions. Only limited data exist on LA involvement in type 2 diabetes mellitus (DM2). This study sought to assess LA function in asymptomatic DM2 with cardiac MRI. We hypothesized that cardiac MRI can detect LA dysfunction in asymptomatic DM2. Forty-five patients with asymptomatic DM2 and 24 normoglycaemic controls were studied. MRI cine imaging was performed to measure LA maximal and minimal volumes. A flow-sensitive phase-contrast gradient-echo sequence was used for flow measurements perpendicular to the orifice of the mitral valve, to quantify active LA stroke volume. LA total, passive and active emptying volumes and fractions were calculated. LA reservoir function, namely LA total ejection fraction, was significantly greater in controls compared to patients with DM2 (62.2 ± 5.2 vs 57.0 ± 7.6 %, P = 0.004). LA passive ejection fraction was also greater in the controls (26.2 ± 9.5 vs 16.1 ± 11.0 %, P

Erdheim-Chester disease (ECD) is a rare, non-Langerhans cell histiocytosis with characteristic radiological and histological features. This entity is defined by a mononuclear infiltrate consisting of lipid-laden, foamy histiocytes that stain positively for CD68 and negatively for CD1a. Osseous involvement is constant and characteristic. Extra-osseous lesions may affect the retroperitoneum, lungs, skin, heart, brain and orbits. Both radiography and technetium-99m bone scintigraphy may reveal osteosclerosis of the long bones, which is a typical finding in ECD. For visceral involvement, computed tomography (CT) is most useful, while magnetic resonance (MR) imaging is more sensitive for cardiovascular lesions; 2-[fluorine-18] fluoro-2-deoxy-d-glucose (FDG) positron emission tomography (PET)/CT scanning is useful in assessing the extension of ECD lesions. The prognosis is extremely variable and is often worse when there is cardiovascular system involvement. Diagnosis is based on the combination of radiographic, CT, MR imaging and nuclear medicine features and a nearly pathognomonic immunohistochemical profile. The aims of this work are to perform a systematic review of Erdheim-Chester disease as seen on imaging of the chest, abdomen and musculoskeletal system and to discuss the diagnostic workup and differential diagnoses according to the imaging presentation. Teaching points • Bone involvement is usually present in patients, and the imaging findings are pathognomonic of ECD. • The circumferential periaortic infiltration may extend to its branches, sometimes becoming symptomatic. • Cardiac involvement—the pericardium, right atrium and auriculoventricular sulcus—worsens its prognosis. • Perirenal infiltration extending to the proximal ureter is highly suggestive of this disease.

Um dos obstáculos a uma utilização mais frequente e apropriada da ressonância magnética cardíaca (RMC) em Portugal tem sido a ausência de códigos específicos que descrevam adequadamente os exames tal como são efetuados actualmente. Este documento de consenso fornece recomendações para a atualização e uniformização dos códigos empregues na RMC. São igualmente feitas recomendações quanto às técnicas e códigos a utilizar nas indicações clínicas mais frequentes.

Renal artery aneurysms are a rare cause of secondary hypertension. Endovascular treatment with a polytetrafluoroethylene (PTFE)-coated stent can exclude aneurysms and treat hypertension. We report the case of a 23-year-old man with hypertension diagnosed three years earlier and in whom renal angiography revealed three aneurysms involving the right renal artery. A covered stent was implanted, resulting in successful exclusion of the aneurysm. Ten months after the procedure the patient is asymptomatic and with normal blood pressure without antihypertensive therapy. Resumo: Os aneurismas da artéria renal representam uma causa rara de hipertensão secundária. O tratamento endovascular com stent revestido por politetrafluoretileno (PTFE) consiste numa abordagem que permite excluir os aneurismas e tratar a hipertensão. Apresentamos o caso de um jovem de 23 anos, com o diagnóstico de hipertensão há três anos e cuja angiografia renal mostrou três aneurismas na dependência da artéria renal direita. Procedeu-se à implantação de um stent revestido por PTFE com a exclusão bem sucedida dos aneurismas. Dez meses após o procedimento o doente está assintomático e com valores normais de tensão arterial sem terapêutica anti hipertensora. Keywords: Renovascular hypertension, Renal artery aneurysm, Endovascular repair, Renal stent, Palavras-chave: Hipertensão renovascular, Aneurisma da artéria renal, Tratamento endovascular, Stent renal

Due to constant innovations in radiological and surgical techniques, more accurate results are expected in the diagnostic and therapeutic procedures related to hepatic pathology. The aim of this work was to demonstrate the normal hepatic vascular and biliary anatomy using cadaveric livers and CT scans of the affected livers. Furthermore, using the CT scans, the authors intended to illustrate the most common morphological variations of the vascular and biliary anatomy. Four human cadaveric livers were injected with colored silicone mixed with radiological contrast solution in the common bile duct, in the proper hepatic artery, in the portal vein and in the inferior vena cava near the ostia of the hepatic veins (only one of these structures was injected in each liver). After obtaining the CT scans, 3D rendered models were created, which demonstrated the normal hepatic anatomy of the vascular and biliary structures. The International Anatomical Nomenclature was used for their classification (based on Couinaud’s work). The 3D rendered CT models were also modified to illustrate the most common normal variations of the hepatic anatomy (found in the literature).