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To compare the position and shape of the temporomandibular joint (TMJ) articular disc among the sagittal and vertical skeletal patterns in Angle Class III, Class III subdivision malocclusion and normal occlusion. The null hypothesis was that there was no difference in disc position and shape in different (1) malocclusions and (2) skeletal patterns.This cross-sectional observational study evaluated 105 patients divided into 3 groups: Class III (33, 9.39 ± 1.96 years), Class III subdivision (45, 9.51 ± 1.59 years) and a normal occlusion (27, 10.24 ± 0.87 years) was included as healthy control. Severity of the maxilla-mandibular anteroposterior discrepancy and vertical facial pattern were determined using 2D cephalometry, and the position and shape of the articular discs were evaluated in magnetic resonance images. Statistical parametric and non-parametric tests and Kappa analysis for intra-observer and inter-observer assessment were used (p ≤ .05).Significant between-group differences were found in articular disc position. In the normal occlusion group, all the articular discs were well positioned. In Class III and Class III subdivision, the discs were displaced in 30.3% and 12.2% of the TMJs, respectively. Sagittal and vertical skeletal patterns did not affect the findings significantly. The Class III subdivision malocclusion group is probably different from the other groups, showing 97.7% of biconcave discs in both TMJs.The longitudinal follow-up of this sample becomes relevant as the two groups with malocclusion in the pre-peak phase of pubertal growth showed differences in the prevalence of displacement and form of the articular disc, with no association with their vertical facial characteristics.

Objective: To emphasize the most appropriate magnetic resonance imaging (MRI) diffusion protocol for the detection of lesions that cause transient global amnesia, in order to perform an accurate examination, as well as to determine the ideal time point after the onset of symptoms to perform the examination. Materials and Methods: We evaluated five patients with a diagnosis of transient global amnesia treated between 2012 and 2015. We analyzed demographic characteristics, clinical data, symptom onset, diffusion techniques, and radiological findings. Examination techniques included a standard diffusion sequence (b value = 1000 s/mm2; slice thickness = 5 mm) and a optimized diffusion sequence (b value = 2000 s/mm2; slice thickness = 3 mm). Results: Brain MRI was performed at 24 h or 36 h after symptom onset, except in one patient, in whom it was performed at 12 h after (at which point no changes were seen) and repeated at 36 h after symptom onset (at which point it showed alterations in the right hippocampus). The standard and optimized diffusion sequences were both able to demonstrate focal changes in the hippocampi in all of the patients but one, in whom the changes were demonstrated only in the optimized sequence. Conclusion: MRI can confirm a clinical hypothesis of transient global amnesia. Knowledge of the optimal diffusion parameters and the ideal timing of diffusion-weighted imaging (> 24 h after symptom onset) are essential to improving diagnostic efficiency. Resumo Objetivo: Enfatizar o protocolo de difusão mais adequado para detecção de lesões da amnésia global transitória, a fim de realizar um exame preciso, em tempo ideal, após o início dos sintomas. Materiais e Métodos: Foram analisados cinco pacientes com diagnóstico de amnésia global transitória atendidos entre 2012 e 2015, considerando-se dados demográficos, clínicos, tempo do início dos sintomas, técnicas de difusão e achados radiológicos. As técnicas incluíram uma sequência de difusão padrão (b = 1000 s/mm2; espessura do corte = 5 mm) e uma sequência de difusão otimizada (b = 2000 s/mm2; espessura de corte = 3 mm). Resultados: A ressonância magnética de encéfalo foi realizada após 24 ou 36 horas do início dos sintomas, exceto em um paciente, em que foi realizada após 12 horas (sem alterações) e repetida após 36 horas (mostrando alterações hipocampais). Em todos os pacientes foram demonstradas alterações focais na difusão no hipocampo em ambas as técnicas, exceto em um paciente, em que as alterações foram demonstradas apenas na sequência otimizada. Conclusão: A ressonância magnética é capaz de confirmar a hipótese clínica de amnésia global transitória. O conhecimento dos parâmetros ótimos da técnica de difusão e o melhor tempo para a detecção das alterações (> 24 horas) são essenciais para aprimorar a eficiência diagnóstica.

Objective: To use magnetic resonance imaging to identify vascular loops in the anterior inferior cerebellar artery and to evaluate their relationship with otologic symptoms. Materials and Methods: We selected 33 adults with otologic complaints who underwent magnetic resonance imaging at our institution between June and November 2013. Three experienced independent observers evaluated the trajectory of the anterior inferior cerebellar artery in relation to the internal auditory meatus and graded the anterior inferior cerebellar artery vascular loops according to the Chavda classification. Kappa and chi-square tests were used. Values of p < 0.05 were considered significant. Results: The interobserver agreement was moderate. Comparing ears that presented vascular loops with those that did not, we found no association with tinnitus, hearing loss, or vertigo. Similarly, we found no association between the Chavda grade and any otological symptom. Conclusion: Vascular loops do not appear to be associated with otoneurological manifestations. Resumo Objetivo: O objetivo deste estudo foi avaliar e analisar, por ressonância magnética, a presença e o tipo de alça vascular da artéria cerebelar anteroinferior e sua associação com sintomas otológicos. Materiais e Métodos: Selecionamos 33 adultos com queixas otológicas que realizaram ressonância magnética em nosso serviço, entre junho e novembro de 2013. Três observadores experientes, independentes, avaliaram o trajeto da artéria cerebelar anteroinferior e sua relação com o conduto auditivo interno, classificando os tipos de alça vascular segundo a classificação de Chavda. Os testes de kappa e de qui-quadrado foram utilizados e o índice de significância adotado foi p < 0,05. Resultados: O coeficiente kappa entre diferentes observadores demonstrou concordância moderada. Comparando as orelhas que apresentavam alça vascular com as que não apresentavam, não encontramos associação com zumbido, hipoacusia ou tontura. Semelhantemente, comparando os diferentes graus da classificação de Chavda com os sintomas relatados, não encontramos associação estatisticamente significante. Conclusão: Concluímos que não há associação entre a presença ou o tipo de alça vascular e sintomas otoneurológicos.

Purpose To evaluate the clinical and radiologic response of patients with Graves' ophthalmopathy given low-dose orbital radiotherapy (RT) with a protracted fractionation. Methods and Materials Eighteen patients (36 orbits) received orbital RT with a total dose of 10 Gy, fractionated in 1 Gy once a week over 10 weeks. Of these, 9 patients received steroid therapy as well. Patients were evaluated clinically and radiologically at 6 months after treatment. Clinical response assessment was carried out using three criteria: by physical examination, by a modified clinical activity score, and by a verbal questionnaire considering the 10 most common signs and symptoms of the disease. Radiologic response was assessed by magnetic resonance imaging. Results Improvement in ocular pain, palpebral edema, visual acuity, and ocular motility was observed in all patients. Significant decrease in symptoms such as tearing ( p p = 0.008), conjunctival hyperemia ( p = 0.002), and ocular grittiness ( p = 0.031) also occurred. Magnetic resonance imaging showed decrease in ocular muscle thickness and in the intensity of the T2 sequence signal in the majority of patients. Treatments were well tolerated, and to date no complications from treatment have been observed. There was no statistical difference in clinical and radiologic response between patients receiving RT alone and those receiving RT plus steroid therapy. Conclusion RT delivered in at a low dose and in a protracted scheme should be considered as a useful therapeutic option for patients with Graves' ophthalmopathy.

OBJETIVO: A ressonância magnética tem sido utilizada para avaliar as vias lacrimais, com vantagens em relação à dacriocistografia por raios-X. O objetivo deste trabalho é obter imagens de alta resolução utilizando bobinas de superfície microscópicas para avaliação de estruturas normais das vias lacrimais, comparando com o aspecto observado utilizando-se bobinas de superfície convencionais. MATERIAIS E MÉTODOS: Cinco voluntários assintomáticos, sem histórico de lacrimejamento, submeteram-se a ressonância magnética de alto campo, com bobinas de superfície (convencional e microscópica), com seqüência STIR após instilação de soro fisiológico. A identificação das estruturas anatômicas normais das vias lacrimais foi comparada utilizando-se as duas bobinas. Mediante uso de um sistema de escore, um valor médio de cada estrutura foi calculado por dois examinadores, consensualmente. RESULTADOS: Em 90% das vezes houve aumento do escore, atribuído à estrutura anatômica no estudo com a bobina microscópica. Em média, houve aumento de 1,17 ponto no escore, por estrutura anatômica visualizada, quando se utilizou a bobina microscópica. Observou-se, ainda, melhora subjetiva da relação sinal-ruído ao se utilizar a bobina microscópica. CONCLUSÃO: A dacriocistografia por ressonância magnética com bobinas microscópicas é um método adequado para o estudo das vias lacrimais, resultando em imagens de melhor qualidade quando comparada ao uso de bobinas de superfície convencionais.OBJECTIVE: Magnetic resonance imaging has been utilized in the evaluation of the lacrimal apparatus with some advantages over conventional dacryocystography. The present study was aimed at acquiring high-resolution images utilizing microscopic coils for evaluating typical structures of the lacrimal apparatus as compared with the findings observed with conventional surface coils. MATERIALS AND METHODS: Five asymptomatic volunteers with no history of epiphora were submitted to high-field magnetic resonance imaging with microscopic and conventional surface coils, and STIR sequence after instillation of saline solution. The definition of normal anatomic structures of lacrimal apparatuses was compared utilizing conventional and microscopic surface coils. Based on a consensual scoring system, the mean values for each structure were calculated by two observers. RESULTS: In 90% of cases, higher scores were attributed to images acquired with the microscopic coil. On average, a 1.17 point increase was observed in the scoring of anatomic structures imaged with the microscopic coil. Additionally, a subjective improvement was observed in the signal-to-noise ratio with the microscopic coil. CONCLUSION: Magnetic resonance dacryocystography with microscopic coils is the appropriate method for evaluating the lacrimal apparatus, providing images with better quality as compared with those acquired with conventional surface coils.

O nosso objetivo foi descrever e ilustrar aspectos incomuns do hemangioma hepático na ultra-sonografia (US), tomografia computadorizada (TC) e ressonância magnética (RM). A partir da análise retrospectiva de 300 casos de pacientes com diagnósticos de hemangioma hepático, por meio da análise combinada de exames de imagem, biópsia ou acompanhamento clínico, selecionamos aqueles com apresentação atípica em um ou mais métodos de imagem ou aqueles com evolução não usual, ilustrando os seus principais aspectos de imagem. Entre os casos apresentados, escolhemos pacientes com hemangiomas: hipoecogênicos na US; hipovasculares ou avasculares na TC e RM; com calcificações grosseiras; gigantes e medindo mais de 20 cm de diâmetro; predominantemente exofíticos; hipointensos em T2; promovendo defeito de perfusão; com cicatriz central e simulando hiperplasia nodular focal; com crescimento evolutivo. O hemangioma hepático é o tumor mais comum do fígado e geralmente tem apresentação típica. Porém, os seus diversos aspectos não usuais precisam ser conhecidos para auxiliar na orientação diagnóstica e conduta.In order to evaluate atypical aspects of hepatic hemangiomas at ultrasound (US), computed tomography (CT) and magnetic resonance imaging (MRI), we have retrospectively analyzed 300 cases of patients diagnosed with hepatic hemangiomas by means of combined imaging studies, clinical follow-up and/or biopsy results. Based on this analysis we have selected those cases with atypical findings at one or more imaging methods or those presenting an unusual evolution such as: hypoechoic nodules at US; giant, heterogeneous hemangiomas; rapidly filling hemangiomas; calcified hemangiomas; pedunculated hemangiomas; hypointense hemangiomas at T2-weighted images; causing perfusion defect; with central scar simulating focal nodular hyperplasia; hemangiomas with adjacent abnormalities such as arterial-portal venous shunt and capsular retraction as well as hemangiomas enlarging over time. The hepatic hemangioma is the most common benign tumor affecting the liver and usually presents typical aspect. However, atypical findings should be known aiming at supporting diagnosis guidance and clinical decisions.

O nosso objetivo foi descrever e ilustrar aspectos incomuns do hemangioma hepatico na ultra-sonografia (US), tomografia computadorizada (TC) e ressonância magnetica (RM). A partir da analise retrospectiva de 300 casos de pacientes com diagnosticos de hemangioma hepatico, por meio da analise combinada de exames de imagem, biopsia ou acompanhamento clinico, selecionamos aqueles com apresentacao atipica em um ou mais metodos de imagem ou aqueles com evolucao nao usual, ilustrando os seus principais aspectos de imagem. Entre os casos apresentados, escolhemos pacientes com hemangiomas: hipoecogenicos na US; hipovasculares ou avasculares na TC e RM; com calcificacoes grosseiras; gigantes e medindo mais de 20 cm de diâmetro; predominantemente exofiticos; hipointensos em T2; promovendo defeito de perfusao; com cicatriz central e simulando hiperplasia nodular focal; com crescimento evolutivo. O hemangioma hepatico e o tumor mais comum do figado e geralmente tem apresentacao tipica. Porem, os seus diversos aspectos nao usuais precisam ser conhecidos para auxiliar na orientacao diagnostica e conduta. Unitermos: Hemangioma; Figado; Aspectos atipicos; Ultra-sonografia; Tomografia computadorizada; Ressonância magnetica. Unusual presentations of hepatic hemangioma: an iconographic essay. In order to evaluate atypical aspects of hepatic hemangiomas at ultrasound (US), computed tomography (CT) and magnetic resonance imaging (MRI), we have retrospectively analyzed 300 cases of patients diagnosed with hepatic hemangiomas by means of combined imaging studies, clinical follow-up and/or biopsy results. Based on this analysis we have selected those cases with atypical findings at one or more imaging methods or those presenting an unusual evolution such as: hypoechoic nodules at US; giant, heterogeneous hemangiomas; rapidly filling hemangiomas; calcified hemangiomas; pedunculated hemangiomas; hypointense hemangiomas at T2-weighted images; causing perfusion defect; with central scar simulating focal nodular hyperplasia; hemangiomas with adjacent abnormalities such as arterial-portal venous shunt and capsular retraction as well as hemangiomas enlarging over time. The hepatic hemangioma is the most common benign tumor affecting the liver and usually presents typical aspect. However, atypical findings should be known

O objetivo deste trabalho foi descrever e ilustrar aspectos incomuns do hepatocarcinoma na tomografia computadorizada e ressonância magnética. A partir da análise retrospectiva de 100 casos de pacientes com hepatocarcinoma diagnosticado por análise combinada de exames de imagem, dosagem de alfa-feto-proteína, biópsia percutânea ou ressecção cirúrgica, selecionamos aqueles com apresentação atípica em um ou mais métodos de imagem ou aqueles com evolução não usual, ilustrando os seus principais aspectos de imagem. Entre os casos apresentados, escolhemos pacientes com hepatocarcinomas císticos, hemorrágicos, rotos e causando hemoperitônio, calcificados, com regressão espontânea, exofíticos, hipovasculares, gigantes e com disseminação não usual. O hepatocarcinoma é o tumor maligno mais comum do fígado e freqüentemente tem apresentação típica e associada à cirrose hepática. Porém, em alguns casos, apresentações atípicas podem retardar o seu diagnóstico.In order to evaluate atypical aspects of hepatocellular carcinoma at computed tomography and magnetic resonance imaging, we have retrospectively evaluated 100 patients with diagnosed hepatocellular carcinoma, based on combined imaging studies, laboratory results, biopsy and surgery. We have selected those cases with atypical findings at computed tomography or magnetic resonance imaging, including cystic lesions, bleeding tumors, with calcifications, with spontaneous regression, pedunculated tumors, hypovascular lesions, giant hepatocellular carcinomas, and those with unusual local invasiveness. The hepatocellular carcinoma is the most usual primary malignant lesion of the liver and usually it has a typical aspect and is associated with hepatic cirrhosis. However, in a significant number of cases, some uncommon findings can be responsible for a delayed diagnosis.

O objetivo é apresentar uma técnica recente para a avaliação de obstruções arteriais dos membros inferiores por ressonância magnética em um único momento e com a utilização de dose dupla do meio de contraste paramagnético administrado de forma lenta através de bomba injetora. O método baseia-se em um "software" e "hardware" denominado Mobitrak, disponível nos aparelhos de alto campo de ressonância da Philips, que permite a avaliação de uma grande extensão vascular a partir de aquisições de alta resolução, segmentares e contínuas. A seqüência utilizada é um gradiente eco (FFE) que permite a programação de três segmentos simultaneamente, com pequena sobreposição nas intersecções desses segmentos. Essa seqüência dinâmica é obtida em duas fases, uma previamente ao contraste e outra durante a injeção lenta deste, com subtração do sinal dos tecidos adjacentes e reconstruções em 3D. O método apresenta vários benefícios, como: melhor visualização dos segmentos tibiofibulares, estudo de toda a aorta e o membro inferior em uma única visita do paciente, com baixo volume de meio de contraste.

PURPOSE: Inspite of the long experience with the treatment of intermittent claudication, little is known about the natural history of stenotic lesions in the iliac segment. With the advent of endovascular treatment, this knowledge has become important. METHODS: Fifty-two stenosis, diagnosed using arteriography, in 38 claudicant patients were analyzed. After a minimum time interval of 6 months, a magnetic resonance angiography was performed to determine whether there was arterial occlusion. The primary factors that could influence the progression of a stenosis were analyzed, such as risk factors (smoking, hypertension, diabetes, sex, and age), compliance with clinical treatment, initial degree of stenosis, site of the stenosis, and length of follow-up. RESULTS: The average length of follow-up was 39 months. From the 52 lesions analyzed, 13 (25%) evolved to occlusion. When occlusion occurred, there was clinical deterioration in 63.2% of cases. This association was statistically significant (P = .002). There was no statistically significant association of the progression of the lesion with the degree or site of stenosis, compliance with treatment, or length of follow-up. Patients who evolved to occlusion were younger (P = .02). The logistic regression model showed that the determinant factors for clinical deterioration were arterial occlusion and noncompliance with clinical treatment. CONCLUSIONS: The progression of a stenosis to occlusion, which occurred in 25% of the cases, caused clinical deterioration. Clinical treatment was important, but it did not forestall the arterial occlusion. Prevention of occlusion could be achieved by early endovascular intervention or with the development of drugs that might stabilize the atherosclerotic plaque.OBJETIVO: Apesar da longa experiência com o tratamento da Claudicação Intermitente, pouco se sabe sobre a evolução natural das estenoses nas artérias ilíacas. Com o advento do tratamento endovascular, esse conhecimento tornou-se importante. MÉTODOS: Foram avaliadas cinqüenta e duas estenoses, diagnosticadas por arteriografia, em 38 pacientes com claudicação intermitente acompanhados clinicamente. Após um intervalo de tempo mínimo de 6 meses, os pacientes foram submetidos a uma angioressonância para determinar se houve oclusão arterial. Principais medidas de avaliação: Foram avaliados os principais fatores que poderiam influenciar a progressão da estenose, como os fatores de risco (tabagismo, hipertensão, diabete, sexo, idade), a aderência ao tratamento clínico,o grau de estenose inicial, sua localização e o tempo de observação. RESULTADOS: O período médio de observação foi de 39 meses. Das 52 lesões analisadas, 13 (25%) evoluíram para oclusão. Quando houve oclusão, ocorreu piora clínica na maioria dos casos (63,2%), sendo esta associação estatisticamente significante (p=0,002). O grau de estenose inicial, sua localização, a aderência ao tratamento e o tempo de observação não apresentaram relação com a progressão da lesão. Os pacientes que evoluíram para oclusão eram mais jovens (p=0,02). Pelo teste de regressão logística, os fatores determinantes da piora clínica foram a oclusão do vaso e a não aderência ao tratamento clínico. CONCLUSÕES: A progressão da estenose para oclusão, que ocorre em 25% dos casos, gera piora clínica. O tratamento clínico, apesar de importante, não preveniu a oclusão arterial, que poderá ser alcançada com o desenvolvimento de drogas que possam estabilizar a placa aterosclerótica ou com intervenções endovasculares precoces.

Our purpose was to evaluate the accuracy of unenhanced helical computed tomography in the diagnosis of ureteral lithiasis, to establish the frequency of the main computed tomography findings, and to assess and compare the interobserver agreement with the results of conventional intravenous urography. A prospective double-blind study was carried out in 25 patients referred for unenhanced helical computed tomography and conventional intravenous urography due to nephretic colic. Both methods were employed to evaluate the size of the kidneys, hydronephrosis and the size and location of ureteral stones. Perirenal hyperdensities, periureteral edema and the halo sign were also assessed by unenhanced helical computed tomography. In 23 of the 25 unenhanced helical computed tomography examinations (92%) and in 17 of the 25 conventional intravenous urography examinations (68%) there was agreement on the results of the two observers. In 21 of the 25 patients, there was agreement between the results of both methods. We concluded that unenhanced helical computed tomography is as efficient as conventional intravenous urography in the evaluation of patients with nephretic colic, is a reproducible method, and avoids the discomfort of the use of intravenous contrast.

Metástases orbitárias de hepatocarcinoma (HCC) são raras. Os autores têm o objetivo de relatar o caso de um paciente que apresentou metástase orbitária como único achado de um HCC. Paciente masculino, 57 anos, apresentando massa em região temporal direita, associada à proptose, dor e hiperemia. Os exames de imagem revelaram volumosa massa em região temporal, estendendo-se para fossa temporal com destruição da parede orbitária e extensão intracraniana. A tomografia computadorizada de abdome demonstrou tumor primário no fígado. Foi realizada biópsia incisional através de uma orbitotomia anterior cujo estudo anátomo-patológico diagnosticou lesão metastática de hepatocarcinoma. O estudo imuno-histoquímico com marcador para CAM 5.2 e CEA foi positivo. A avaliação sistêmica não revelou outras lesões. O tumor evoluiu com rápido crescimento com óbito 15 meses após o diagnóstico. Metástases orbitárias do carcinoma hepatocelular são raras. Nosso caso foi relevante não só pela raridade desta lesão orbitária, como também pela ausência de outras lesões metastáticas e de sintomas sistêmicos.Orbital metastasis of hepatocellular carcinoma is rare. We report an unusual orbital metastatic lesion as the only finding in a case of hepatocellular carcinoma. A 57-year-old man presented with a 6-month history of orbital painful right orbital mass, associated with proptosis. Computed tomography of the orbits showed an orbital soft tissue mass leading to bone erosion and intracranial invasion. Computed tomography of the adbomen showed a focal perfusion abnormality in the left lobe of the liver. Incisional biopsy was performed and the histopathologic examination of the specimen confirmed the diagnosis. The patient died 15 months after the initial presentation. COMENTS: This is a rare case of orbital metastasis of hepatocellular carcinoma. There was no another metastatic lesion and the patient reported only ophthalmological symptoms.

The effects of radioiodine (131I) therapy for hyperthyroidism on the ocular process of Graves' disease is controversial. In order to evaluate the outcome of ophthalmopathy after radioiodine therapy for thyrotoxicosis we studied prospectively 30 Graves' hyperthyroid patients, 22 submitted to radioiodine (131I) treatment (group A) and 8 treated with antithyroid drugs (group B). All patients were evaluated by clinical ophthalmologic examination, and ocular proptosis (OP) was measured with both a Hertel exophthalmometer (HE) and computed tomography (CT) before and 4 to 7 months after therapy. No statistical difference was obtained between pre- and post-treatment OP measurements in each eye in either group, and we did not observe worsening in the ophthalmopathy of patients treated with drugs or radioiodine. After therapy, there was an improvement in the clinical signs of ophthalmopathy in 59% of group A and in 37.5% of group B patients. We found a significant correlation between OP measured by HE and by CT. CT findings showed an increase in orbital fat and/or muscle thickening in all patients at baseline, proving to be a useful procedure for ophthalmologic diagnosis in doubtful cases. No patient in either group developed hypothyroidism or elevated TSH levels during the study period; this may explain our good results in the evolution of Graves' ophthalmopathy after treatment with 131I and antithyroid drugs. Euthyroidism seems to be an important factor in the outcome of ophthalmopathy after therapy, whatever the mode of treatment chosen to achieve it.

The incidence of concomitant abdominal aortic aneurysm (AAA) and asymptomatic cholelithiasis is 5% to 6%.1 In such situations, isolated standard AAA repair is associated with acute cholecystitis in up to 18% of these concomitant cases,2 which justifies correcting these two diseases together. When a median route is used, it can lead to infection of the prosthesis. A good alternative for preventing this complication is the use of endovascular techniques that are rarely associated with perioperative cholecystitis3 or the use of two different surgical routes during the same operation.4 With the development of endovascular and videolaparoscopic techniques, a further possibility described in this case report enables correction of the two diseases in the same operation with the aim of diminishing the risk of infection: endovascular treatment of infrarenal AAA associated with laparoscopically assisted cholecystectomy.

OBJETIVO: A ressonância magnética tem sido utilizada para avaliar as vias lacrimais, com vantagens em relação à dacriocistografia por raios-X. O objetivo deste trabalho é obter imagens de alta resolução utilizando bobinas de superfície microscópicas para avaliação de estruturas normais das vias lacrimais, comparando com o aspecto observado utilizando-se bobinas de superfície convencionais. MATERIAIS E MÉTODOS: Cinco voluntários assintomáticos, sem histórico de lacrimejamento, submeteram-se a ressonância magnética de alto campo, com bobinas de superfície (convencional e microscópica), com seqüência STIR após instilação de soro fisiológico. A identificação das estruturas anatômicas normais das vias lacrimais foi comparada utilizando-se as duas bobinas. Mediante uso de um sistema de escore, um valor médio de cada estrutura foi calculado por dois examinadores, consensualmente. RESULTADOS: Em 90% das vezes houve aumento do escore, atribuído à estrutura anatômica no estudo com a bobina microscópica. Em média, houve aumento de 1,17 ponto no escore, por estrutura anatômica visualizada, quando se utilizou a bobina microscópica. Observou-se, ainda, melhora subjetiva da relação sinal-ruído ao se utilizar a bobina microscópica. CONCLUSÃO: A dacriocistografia por ressonância magnética com bobinas microscópicas é um método adequado para o estudo das vias lacrimais, resultando em imagens de melhor qualidade quando comparada ao uso de bobinas de superfície convencionais. OBJECTIVE: Magnetic resonance imaging has been utilized in the evaluation of the lacrimal apparatus with some advantages over conventional dacryocystography. The present study was aimed at acquiring high-resolution images utilizing microscopic coils for evaluating typical structures of the lacrimal apparatus as compared with the findings observed with conventional surface coils. MATERIALS AND METHODS: Five asymptomatic volunteers with no history of epiphora were submitted to high-field magnetic resonance imaging with microscopic and conventional surface coils, and STIR sequence after instillation of saline solution. The definition of normal anatomic structures of lacrimal apparatuses was compared utilizing conventional and microscopic surface coils. Based on a consensual scoring system, the mean values for each structure were calculated by two observers. RESULTS: In 90% of cases, higher scores were attributed to images acquired with the microscopic coil. On average, a 1.17 point increase was observed in the scoring of anatomic structures imaged with the microscopic coil. Additionally, a subjective improvement was observed in the signal-to-noise ratio with the microscopic coil. CONCLUSION: Magnetic resonance dacryocystography with microscopic coils is the appropriate method for evaluating the lacrimal apparatus, providing images with better quality as compared with those acquired with conventional surface coils.

Orbital metastasis of hepatocellular carcinoma is rare. We report an unusual orbital metastatic lesion as the only finding in a case of hepatocellular carcinoma. A 57-year-old man presented with a 6-month history of orbital painful right orbital mass, associated with proptosis. Computed tomography of the orbits showed an orbital soft tissue mass leading to bone erosion and intracranial invasion. Computed tomography of the abdomen showed a focal perfusion abnormality in the left lobe of the liver. Incisional biopsy was performed and the histopathologic examination of the specimen confirmed the diagnosis. The patient died 15 months after the initial presentation. COMENTS: This is a rare case of orbital metastasis of hepatocellular carcinoma. There was no another metastatic lesion and the patient reported only ophthalmological symptoms.

PURPOSE: To investigate if colchicine is valuable in the treatment of Graves' ophthalmopathy (GO), we compared its effect with prednisone in 22 patients during the inflammatory phase of GO. METHODS: All patients, similar in age, sex and smoking habits, were euthyroid for at least 3 months and randomly divided into two groups, one treated with colchicine (1.5 mg/day) and the other treated with prednisone (0.75 mg/kg/day). They were monitored with ophthalmologic assessment (clinical activity score-CAS) and magnetic resonance imaging, using a signal intensity ratio (SIR) of the recti muscles in comparison to the cerebral substantia alba. RESULTS: Amelioration of CAS was seen in 68% of the orbits in both groups. SIR also had a significant reduction after treatment: the initial median of 1.14 in G1 and 1.27 in G2, evolved, after treatment, to 1.07 in G1 and 0.69 in G2. The variation between both groups after treatment was not significant (p=0.22). None of the patients treated with colchicine had side effects; on the other hand, side effects in G2 were weight gain, edema, gastric complaints, hirsutism, weakness, depression, and alterations in blood pressure. CONCLUSION: Colchicine had a beneficial effect on the inflammatory phase of GO without the side effects of prednisone. OBJETIVO: Investigar se a colchicina é eficaz no tratamento da oftalmopatia de Graves, nós comparamos o seu efeito com a prednisona em 22 pacientes tratados na fase inflamatória da doença. MÉTODOS: Todos os pacientes, similares quanto à idade, sexo e hábitos de tabagismo, estavam em eutiroidismo por pelo menos três meses e foram randomizados em dois grupos. O grupo 1 (G1) recebeu colchicina (1,5 mg/dia) e o grupo 2 (G2) foi tratado com prednisona (0,75 mg/kg/dia). Os pacientes foram acompanhados com avaliação oftalmológica (escore de atividade clínica - CAS) e de imagem por meio da ressonância magnética, usando a relação da intensidade de sinal (SIR) dos músculos reto em comparação com a substância alba cerebral. RESULTADOS: Diminuição no CAS de 68% foi notada em ambos os grupos. A SIR também apresentou redução significante após o tratamento: A mediana inicial do G1 de 1,14 e 1,27 do G2 diminui após o tratamento para 1,07 no G1 e 0,69 no G2. A variação entre os grupos após o tratamento não foi significante (p=0,22). Nenhum paciente tratado com colchicina apresentou efeito colateral; ao passo que os efeitos colaterais no G2 foram ganho de peso, edema, queixas gástricas, fraqueza, depressão e alteração na pressão arterial. CONCLUSÕES: A colchicina apresenta efeitos benéficos na fase inflamatória da oftalmopatia de Graves sem os efeitos colaterais da prednisona.

O objetivo deste trabalho foi descrever e ilustrar aspectos incomuns do hepatocarcinoma na tomografia computadorizada e ressonância magnética. A partir da análise retrospectiva de 100 casos de pacientes com hepatocarcinoma diagnosticado por análise combinada de exames de imagem, dosagem de alfa-feto-proteína, biópsia percutânea ou ressecção cirúrgica, selecionamos aqueles com apresentação atípica em um ou mais métodos de imagem ou aqueles com evolução não usual, ilustrando os seus principais aspectos de imagem. Entre os casos apresentados, escolhemos pacientes com hepatocarcinomas císticos, hemorrágicos, rotos e causando hemoperitônio, calcificados, com regressão espontânea, exofíticos, hipovasculares, gigantes e com disseminação não usual. O hepatocarcinoma é o tumor maligno mais comum do fígado e freqüentemente tem apresentação típica e associada à cirrose hepática. Porém, em alguns casos, apresentações atípicas podem retardar o seu diagnóstico.

PURPOSE: Inspite of the long experience with the treatment of intermittent claudication, little is known about the natural history of stenotic lesions in the iliac segment. With the advent of endovascular treatment, this knowledge has become important. METHODS: Fifty-two stenosis, diagnosed using arteriography, in 38 claudicant patients were analyzed. After a minimum time interval of 6 months, a magnetic resonance angiography was performed to determine whether there was arterial occlusion. The primary factors that could influence the progression of a stenosis were analyzed, such as risk factors (smoking, hypertension, diabetes, sex, and age), compliance with clinical treatment, initial degree of stenosis, site of the stenosis, and length of follow-up. RESULTS: The average length of follow-up was 39 months. From the 52 lesions analyzed, 13 (25%) evolved to occlusion. When occlusion occurred, there was clinical deterioration in 63.2% of cases. This association was statistically significant (P = .002). There was no statistically significant association of the progression of the lesion with the degree or site of stenosis, compliance with treatment, or length of follow-up. Patients who evolved to occlusion were younger (P = .02). The logistic regression model showed that the determinant factors for clinical deterioration were arterial occlusion and noncompliance with clinical treatment. CONCLUSIONS: The progression of a stenosis to occlusion, which occurred in 25% of the cases, caused clinical deterioration. Clinical treatment was important, but it did not forestall the arterial occlusion. Prevention of occlusion could be achieved by early endovascular intervention or with the development of drugs that might stabilize the atherosclerotic plaque.

Venous aneurysms are less common than arterial aneurysms in clinical practice, and the occurrence of isolated cases is a topic for publication. Aneurysms of the superior mesenteric vein are rare, and their origin is unknown. Many aneurysms are asymptomatic, and the diagnosis is established from radiologic findings. Others are diagnosed after complications such as gastrointestinal bleeding or thrombosis with associated abdominal pain. Because of the rarity of this disease and consequent absence of standard treatment, therapy must be adapted to fit each case. We present a case report of an aneurysm of the superior mesenteric vein. The diagnosis of this anomaly was made after investigation of abdominal pain. Computed tomography (CT) scans demonstrated the mass. Clinical treatment was administered, and no aneurysm growth was observed after 5 years of follow-up.

There is a need for noninvasive methods for the early identification of patients with intermit tent claudication who need surgical treatment. Newer magnetic resonance angiography (MRA)- techniques allow detailed study of the arterial tree with image quality similar to that of conven tional arteriography. From April 1997 to January 2001, 30 patients with intermittent claudica tion of the lower limbs were studied with both imaging methods. In each case, the MRA images were examined first and the arteriographic images were examined 15 days later. Examiners interpreting the arteriographic images were blinded to the results of the corresponding MRA images. After each examination (MRA and arteriography), a vascular surgeon suggested a surgical plan. MRA showed results similar to those of arteriography, although with inferior image quality. No patient had an allergic reaction or side effects due to administration of contrast material. There was total agreement between MRA and arteriography in regard to the morphologic analysis and proposed surgical plans in every case. In conclusion, MRA is a feasible, useful, and less invasive alternative for the morphologic evaluation of the aortofemoral area in patients with intermittent claudication of lower limbs.

OBJECTIVE: The aim of this prospective study was to investigate the feasibility of using a negative oral contrast agent to null the bowel signal during magnetic resonance cholangiopancreatography. MATERIAL AND METHOD: Fifteen healthy volunteers with no previous history of pancreaticobiliary disease or surgery were imaged with a single-shot fast spin-echo pulse sequence, using a magnetic resonance imaging system operating at 1.0 T. Data acquisition was started before and after administration of oral contrast agent. Using the magnetic resonance images obtained before and after administration of oral contrast agent, the common bile duct, pancreatic duct and papilla were assessed and graded by two radiologists. The frequency of adverse effects and the tolerance of the contrast were also evaluated. RESULTS: All patients that found negative oral contrast agent unpleasant (73% of the cases) tolerated well the oral contrast agent. Adverse effects as abdominal pain and diarrhea were noted in 30% of the patients. In all patients the high signal intensity from the intestinal fluid was completely suppressed. The depictions of the common hepatic duct were slightly improved, whereas the depictions of the choledochus, papilla and pancreatic duct were markedly improved by the negative oral contrast agent administration. CONCLUSION: Negative oral magnetic resonance contrast agent can be an effective and safe contrast media in eliminating signal intensity of the gastrointestinal tract, thus improving the depiction of the biliary system in magnetic resonance cholangiopancreatography.

OBJETIVO: Avaliar as artérias cervicais (carótidas e vertebrais) por meio da angio-RM, utilizando-se diferentes dosagens e diluições de contraste paramagnético. MATERIAIS E MÉTODOS: Estudo prospectivo em 15 pacientes, com análise de 30 artérias carótidas comuns, 30 artérias carótidas internas, 30 artérias carótidas externas e 30 artérias vertebrais, utilizando-se diferentes volumes e dosagens de contraste paramagnético: grupo I - dose única (14 ml de Gd-DTPA); grupo II -dose dupla (28 ml de Gd-DTPA); grupo III - dose única e diluída a 50%. A injeção de contraste foi realizada com a utilização de bomba injetora e com velocidades de injeção de 2 ml/s (grupo I) e 3 ml/s (grupos II e III). Os segmentos arteriais foram analisados por três examinadores em consenso de forma subjetiva, avaliando-se o grau de visibilidade, intensidade de contrastação e definição de seus contornos. RESULTADOS: Em todos os itens analisados os pacientes do grupo II apresentaram melhor resultado (visibilização total, boa contrastação dos vasos e contornos bem definidos). No grupo I houve boa visibilização das artérias carótidas e vertebrais, porém a intensidade de contraste e a definição dos contornos apresentaram variabilidade qualitativa. O grupo III apresentou os piores resultados, com dificuldade de visibilização, intensidade de contrastação baixa e contornos mal definidos. CONCLUSÃO: Entre os grupos analisados, a técnica utilizando dose dupla de gadolínio é a que permite melhor avaliação das artérias cervicais. A utilização de contraste diluído prejudica a avaliação dos vasos do pescoço. PURPOSE: To evaluate the carotid and vertebral arteries by magnetic resonance angiography, using different contrast volumes and dilution techniques. SUBJECTS AND METHODS: Prospective study of 15 patients, which included the evaluation of 30 common carotid arteries, 30 internal carotid arteries, 30 external carotid arteries and 30 vertebral arteries, using different gadolinium (Gd-DTPA) volumes and dilutions: group I - single-dose (14 ml of Gd-DTPA); group II - double-dose (28 ml of Gd-DTPA); group III - single-dose, dilution at 50%. Gd-DTPA was administered using a power injector at 2 ml/sec (group I) and 3 ml/sec (groups II and III). A qualitative assessment was performed for each arterial segment. Three radiologists, who judged the quality of depiction of the arteries, vascular signal intensity and contours delineation, performed a consensus analysis. RESULTS: All evaluated features showed better performance in group II (complete depiction of the arteries, good vascular signal intensity and well defined contours). In group I, there was adequate depiction of the arteries, but inadequate vascular signal intensity and contours delineation. Group III showed the poorest results, with inadequate parameters for all evaluated features. CONCLUSION: Among the tested Gd-DTPA dilutions and volumes, double-dose contrast injection allowed better evaluation of the carotid and vertebral arteries. The studies with dilution of Gd-DTPA showed the poorest results.

RESUMO Histiocitose de células de Langerhans (HCL) é uma patologia benigna, geralmente com bom prognóstico. Relatamos um caso de HCL em uma criança que apresentou apenas comprometimento orbitário, de aparecimento rápido, com quadro clínico de proptose axial, indolor, sem sinais flogísticos. O diagnóstico foi realizado através de imagenologia e biópsia incisional da lesão, com exame histopatológico. O tratamento foi realizado inicialmente com corticoterapia sistêmica, com posterior introdução de quimioterapia. O curso clínico foi favorável.

Diferenças na espessura e regularidade da cartilagem da articulação temporomandibular (ATM) ocorrem como o resultado de áreas em crescimento ou em remodelamento. Esse aspecto dificulta a interpretação clínica das imagens e geralmente negligencia a presença da fibrocartilagem. O estudo, por meio da Ressonância Magnética utilizando bobinas microscópicas, possibilita uma melhor observação da cartilagem articular. Confirmamos essa evidência por meio do estudo que analisou 20 indivíduos (40 ATM), divididos em grupo sintomático (DTM) com 10 pacientes (20 ATM) apresentando queixa clínica e suspeita diagnóstica de DTM e, o grupo controle com 10 voluntários (20 ATM) assintomáticos ou que não apresentavam sinais e sintomas clínicos de DTM. As imagens de RM sagitais oblíquas ponderadas em DP SPIR da ATM foram capazes de mostrar a cartilagem com melhor evidência tanto na cabeça da mandíbula quanto na eminência articular proporcionado mensurações, as quais se apresentaram estatisticamente iguais entre os grupos e também a avaliação da regularidade com o mesmo comportamento entre os grupos e geralmente acompanhando a morfologia da cortical óssea. Em muitos casos, principalmente quando da presença de deslocamento para anterior do disco articular, a observação se torna mais difícil, requerendo mais prática para esse tipo de avaliação. Observamos que pacientes do grupo controle apresentaram deslocamento de disco. Dessa maneira, consideramos um exame muito útil como auxiliar no diagnóstico da DTM, e com o desenvolvimento de novas terapias para doenças degenerativas e traumas na cartilagem, as imagens de RM com o uso de bobina microscópica são de crescente importância clínica e poderão desempenhar um papel importante na avaliação da eficácia dessas terapias. Differences in thickness and regularity of the temporomandibular joints (TMJ) cartilage occur as the result of areas of growth or remodeling. This fact leads to misinterpretations on diagnosis and generally neglects the presence of fibrocartilage. The present study, using MRI microscopic coils, allows better observation of the articular cartilage. This evidence was confirmed by this study that examined 20 individuals (40 TMJ), divided into: symptomatic group with temporomandibular dysfunction (TMD) of 10 patients (20 TMJ) presenting clinical complaint and TMD diagnosis; and the control group of 10 volunteers (20 TMJ) that were asymptomatic or who had no clinical signs and symptoms of TMD. On both groups were measured cartilage thickness and if the cartilage was regular or not. The oblique sagital MR images of weighted SPIR protons density (PD\'s) TMJ were able to show the best cartilage images either in the mandibles head or on the articular eminence providing measurements. Both groups presented no statistically significant differences regarding to thickness and the evaluation of the regularity presented the same result. The regularity of the cartilage generally was similar to the morphology of the cortical bone. In many cases, especially when the presence of anterior articular disc displacement, the evaluation was more difficult, requiring practice. The control group with asymptomatic patients was found also to have disc displacements. Thus, we review a very useful tool in the diagnosis of TMD and its importance to evaluate the cartilage to development new therapies for degenerative diseases and trauma. The MRI images with the use of microscopic coil are of increasing clinical importance and might play an important role in assessing the effectiveness of these therapies.

O Músculo Pterigóideo Lateral (MPL) desempenha um papel importante nas Desordens Temporomandibulares (DTM), devido à íntima relação deste músculo com a Articulação Temporomandibular (ATM). No entanto, evidências de alterações patológicas dos músculos mastigatórios ainda parecem faltar nas pesquisas da DTM. Este estudo investigou o MPL por meio de Ressonância Magnética (RM) de 50 indivíduos com e sem DTM. Neste trabalho, das 100 ATM analisadas, 35 pacientes com DTM (70 ATM), prevalecendo o gênero feminino e 15 indivíduos sem sinais e sintomas clínicos de DTM (30 ATM) foram incluídos. O MPL foi observado e analisado em diferentes projeções. As imagens sagitais oblíquas e axiais da ATM foram capazes de mostrar os MPL claramente. Hipertrofia, atrofia e contratura do MPL foram as anomalias encontradas. Sinais de DTM, como hipermobilidade, hipomobilidade e deslocamento do disco articular puderam ser observados nas imagens de ATM. Com relação aos sintomas clínicos como dor, sons articulares, cefaléia e limitação nos movimentos mandibulares, foi possível observar que todos os pacientes com DTM apresentavam pelo menos um destes sintomas, sendo as queixas mais presentes dor e estalo; e os pacientes sem DTM também puderam mostrar alterações nas imagens de RM da ATM, como atrofia e contratura muscular, as mais observadas. O reconhecimento das alterações no MPL, podem levar a um diagnóstico mais específico e aumentar o entendimento dos sintomas clínicos e da fisiopatologia da DTM. Estudos futuros são necessários para se continuar avaliando o MPL por meio de RM. The Lateral Pterygoid Muscle (LPM) plays an important role in Temporomandibular Disorders (TMD), due to the close relation of this muscle with the Temporomandibular Joint (TMJ). However, evidence of pathological changes of the masticatory muscles still seems to be lacking in the TMD research. This study investigated the LPM by Magnetic Resonance Imaging (MRI) of 50 subjects with and without TMD. In this work, 100 Temporomandibular joints were analyzed, 35 subjects with TMD (70 TMJs), with the prevalence of female and 15 subjects without clinical signs and symptoms (30 TMJs) were included. The LPM was visible in different projections and analyzed. The oblique sagital and axial images of the TMJ were able to show the LPM clearly. Hipertrophy, atrophy and contracture of the LPM were the abnormalities found. TMD signs, such as hipermobility, hipomobility, disc displacement could be seem in the TMJ images. Related to clinical symptoms like pain, articular sounds, headache, and limitation of mandibular movements, it was possible to observed that all patients with TMD had at least one of these symptoms, pain and click being the most frequent complaint. Patients without TMD could also show alterations in the TMJ MRI, such as atrophy and contracture as the most common. The recognition of LPM alterations may lead to a more specific diagnosis and improvement of understanding of the clinical symptoms and pathophysiology of TMD. Further studies should be necessary to continue evaluating the LPM by MRI.

Introdução: Epífora corresponde ao hiperlacrimejamento decorrente de causa obstrutiva. Quase sempre se indica o tratamento cirúrgico, e a determinação do nível e da natureza da obstrução solicita exames de imagem. A ressonância magnética pode ser utilizada nesse contexto. Objetivos: Verificar a eficácia da dacriocistografia por RM, na avaliação de obstrução das vias lacrimais, correlacionando com o exame de imagem padrão-ouro, a dacriocistografia por RX. Métodos: A amostra compreendeu 32 indivíduos (26 mulheres e seis homens, com média de idade de 55,4 ± 21,5 anos) com tempo de sintomatologia oscilando entre três meses e vinte anos. Utilizaram-se seqüências de RM ponderadas em STIR T2 sem e com instilação de soro fisiológico e seqüência gradiente-eco ponderada em T1, após instilação de solução de gadolínio diluído (1:100). Os dados da RM foram correlacionados com o exame padrão-ouro (dacriocistografia por RX). A análise foi realizada por dois observadores. Foram calculados: a sensibilidade, a especificidade e os valores preditivos - positivo (VPP) e negativo (VPN) - de cada uma das seqüências de RM, para a detecção da presença de obstrução das vias lacrimais. Calculou-se, ainda, a concordância intra- e interobservador para os diagnósticos da presença e do nível da obstrução, obtidos em cada seqüência de RM, comparando-a com o padrão-ouro (DCG), utilizando-se o teste exato de Fischer e o índice Kappa (K), com nível de significância (p) < 0,001. Resultados: Quanto à detecção de obstrução das vias lacrimais, as seqüências de RM apresentaram sensibilidade entre 91,9% e 93,2%, especificidade entre 80,3% e 100%, VPP entre 88,7% e 100% e VPN entre 83,2% e 87,8%. O índice Kappa revelou concordâncias intra- e interobservadores bastantes elevadas (entre 0,716 e 1,000). Quanto à caracterização do nível da obstrução, houve diferenças entre os resultados de cada um dos observadores. Para o observador 1, apenas a seqüência STIR, com instilação de soro fisiológico, denotou concordância estatisticamente significante com a DCG (K = 0,582). Em contrapartida, para o observador 2, todas as seqüências de RM mostraram concordância estatisticamente significante com a DCG (K entre 0,404 e 0,623). Conclusões: A RM pode ser adotada como método de imagem para a avaliação dos pacientes com suspeita de obstrução das vias lacrimais, por apresentar elevada sensibilidade e especificidade para esse diagnóstico, além de elevados índices de concordância intra - e interobservadores. Nos casos em que as vias lacrimais se revelem não preenchidas por qualquer meio de contraste na RM, outros métodos de imagem poderão ser necessários para a diferenciação entre obstruções altas ou distúrbios funcionais Epiphora is the hyperlachrymation related to an obstruction of the lachrymal drainage system. In such cases, the treatment is frequently surgical and the definition of the nature and level of obstruction demands imaging methods. Magnetic Resonance Imaging (MRI) may play a role in this issue. Objectives: Evaluate the efficacy of MR dacryocystography in the obstruction of the lachrymal drainage system, comparing the results to the gold standard imaging method (X-ray dacryocystography - DCG). Methods: The study comprised 32 patients (26 women and 6 men, mean age 55.4 ± 21.5 years), with a time course of symptoms ranging from 3 months to 20 years. They were evaluated using a STIR T2 sequence, without and with the instillation of saline solution and a Gradient-echo T1 sequence after instillation of 1:100 diluted gadolinium. The MRI findings were compared to the DCG ones. Two different observers performed the analysis. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated for each MRI sequence, regarding the detection of the obstruction of the lachrymal apparatus. Intra and interobserver agreement were calculated for the detection of the obstruction and for the determination of the level of obstruction, using the Fischer exact test and Kappa index - K (statistical significance p < 0,001). Results: Regarding the detection of obstruction, MRI sequences presented sensitivity ranging from 91.9% to 93.2%, specificity ranging from 80,3% to 100%, PPV ranging from 88.7% to 100% and NPV ranging from 83.2% to 87.8%. Kappa index revealed high intra and interobserver values (ranging from 0.716 to 1.000). Regarding the determination of the level of obstruction, the results for each observer were different. For Observer 1, the STIR T2 sequence after instillation of saline solution was the only one to be statistically concordant to DCG (K = 0.582). Otherwise, for Observer 2, all MR sequences were statistically concordant to DCG (K ranging from 0.404 to 0.623). Conclusions: MRI may be considered in the radiological evaluation of patients with epiphora, due to its high sensitivity and specificity, as well as consistent intra and interobserver agreement rates. When the lachrymal drainage system is not filled with any kind of content in the MRI examination, other imaging modalities must be considered, for differentiation between upper system obstruction and functional disease

A aterosclerose é uma doença progressiva crônica. Embora segmentar, é generalizada e acomete as artérias carótidas, propiciando maior risco de acidente vascular cerebral. Utilizamos dois métodos diagnósticos, nesta avaliação, que foram a ultra-sonografia modo B em escala de cinza associada também a fluxo Doppler colorido, e a ressonância magnética (RM) com seqüências ponderadas em T1 e T2, ambas pelas técnicas \"black-blood\" (BB) e \"fat sat black-blood\" (FSBB), e angiografia por ressonância magnética \"time-of-flight\'\' tridimensional (3D TOF), com e sem a administração do contraste paramagnético. Objetivou-se a identificação de ateromas carotídeos em pacientes coronariopatas, comprovados por cateterismo cardíaco com indicação de terapia cirúrgica. Realizou-se a estimativa do grau de estenose das artérias carótidas internas, através de ultra-sonografia com fluxo Doppler colorido (UDC) e angiografia por ressonância magnética (ARM), comparando-se os métodos. Também foram feitas comparações entre a ecogenicidade das placas visualizadas através de ultra-sonografia (USG), com a intensidade de sinal adquirida pelos exames de ressonância magnética (RM). Foi realizada avaliação de qualidade de imagens e confiabilidade inter-observadores, nos exames de ressonância magnética. Houve alta incidência de aterosclerose carotídea, nos pacientes em estudo. Do total de 100 segmentos carotídeos analisados por ultra-sonografia, com fluxo Doppler colorido para estimativa do grau de estenose, 81% apresentaram algum tipo de estenose, sendo o grau leve (grau II) predominante, evidenciado em 59% dos casos. Avaliamos a associação entre o grau de estenose visualizado através de UDC e ARM, com e sem contraste, e houve reprodutibilidade marginal entre os métodos. Observaram-se alterações de intensidade de sinal das paredes vasculares nos exames de RM, nas seqüências ponderadas em T1-BB, T1-FSBB, T2-BB e T2-FSBB, entre 71% e 72%. O aumento da intensidade de sinal foi predominante. Nas 72 placas com ecogenicidade tipo 4, houve aumento da intensidade de sinal em 13,9% em 3D TOF, 59,7% em T1-BB, 65,3% em T1-FSBB, 62,5% em T2-BB e 66,7% em T2-FSBB. Nas placas com ecogenicidade tipo 2, houve aumento da intensidade de sinal em 42,9% em 3D TOF, 71,4% em T1-BB e T1-FSBB, 85,7% em T2-BB e 71,4% em T2-FSBB. Nas placas com ecogenicidade tipo 1, houve aumento da intensidade de sinal em 50,0%, nas seqüências ponderadas em 3D TOF, T1 e T2. Em 19 segmentos carotídeos, a USG foi considerada normal. Quando os mesmos segmentos foram avaliados através de RM, observou-se aumento da intensidade de sinal em 21,1% em 3D TOF, 47,4% em T1-BB, 57,9% em T1-FSBB, 52,6% em T2-BB e T2-FSBB. Não houve correlação entre os tipos de ecogenicidade das placas visualizadas através de USG, com as alterações de intensidade de sinal pela RM. A avaliação da qualidade de imagens dos exames de RM, com cortes no plano axial nas seqüências ponderadas em T1 e T2 (BB e FSBB), foi considerada ótima e, em 3D TOF, muito boa. A qualidade de imagem dos exames de ARM, com e sem contraste, foi considerada excelente. Notou-se ótima reprodutibilidade inter-observadores, com valores de índice Kappa acima de 0,71 Atherosclerosis is a chronic progressive disease. Although being segmental, atherosclerosis is systemic and attacks carotid arteries, propitiating a greater risk of cerebral vascular accident. In this assessment, we have applied two diagnostic imaging methods such as gray-scale B-mode ultrasound (US) in association with color flow Doppler (CFD-US) and T1 and T2-weighted magnetic resonance imaging (MRI) sequences, using black-blood (T1-BB and T2-BB) and black-blood with fat saturation (T1-FSBB and T2-FSBB) techniques, and magnetic resonance angiography (MRA) with and without paramagnetic contrast agent (three-dimensional time-of-flight, 3D TOF). Our objective was the identification of carotid atheromas in patients with coronary artery disease - as confirmed by cardiac catheterism, and referred to cardiac surgery. The degree of stenosis of the internal carotid arteries was estimated by CFD-US and by MRA, and the results from both methods were compared. The echogenicity of carotid plaques as seen by US and the signal intensity of MR images were also compared. Evaluation of image quality and inter-rater reliability of evaluation of MR images were also performed. There was a high incidence of carotid atherosclerosis in the patient population under study. From a total of one hundred (100) carotid artery segments analyzed by CFD-US for stenosis degree estimation, 81% showed some degree of stenosis, with a predominance of mild grade (grade II), which was detected in 59.0% of the cases. We have evaluated the association between the degree of stenosis visualized by CFD-US and by MRA with and without contrast agent and there was a marginal reproducibility between these methods. It was observed changes in artery wall signal intensity of 71% to 72%, in the T1-BB, T1-FSBB, T2-BB and T2-FSBB sequences of the MRI examinations. Increases in signal intensity were predominant. Among 72 plaques with echogenicity type 4, the signal intensity has increased 13.9% in 3D TOF, 59.7% inT1-BB, 65.3% in T1-FSBB, 62.5% in T2-BB and 66.7% in T2-FSBB. Among plaques with echogenicity type 2, the signal intensity has increased 42.9% in 3D TOF, 71.4% in T1-BB and T1-FSBB, 85.7% in T2-BB and 71.4% in T2-FSBB. Plaques with echogenicity type 1, showed signal intensity increase of 50.0% in the 3D TOF, T1 and T2 weighted MRI sequences. In 19 carotid artery segments, CFD-US was considered normal. When the same segments were evaluated by MRI, it was noted an increase of the image signal intensity in 21.1% in 3D TOF, 47.4% in T1-BB, 57.9% in T1-FSBB, 52.6% in T2-BB and T2-FSBB. There was no correlation between the types of plaque echogenicities seen by the CFD-US with the changes of signal intensity seen by MRI. The image quality and interobserver reliability of MR examinations were evaluated. The image quality of the T1 and T2-weighted axial MR images was considered excellent and for 3D TOF images, the quality was considered very good. The quality of the MRA images with and without paramagnetic contrast agent was considered excellent. It was noted an excellent interobserver reproducibility with values of Kappa index greater than 0.71