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Abandonment of agricultural lands promotes the global expansion of secondary forests, which are critical for preserving biodiversity and ecosystem functions and services. Such roles largely depend, however, on two essential successional attributes, trajectory and recovery rate, which are expected to depend on landscape-scale forest cover in nonlinear ways. Using a multi-scale approach and a large vegetation dataset (843 plots, 3511 tree species) from 22 secondary forest chronosequences distributed across the Neotropics, we show that successional trajectories of woody plant species richness, stem density and basal area are less predictable in landscapes (4 km radius) with intermediate (40-60%) forest cover than in landscapes with high (greater than 60%) forest cover. This supports theory suggesting that high spatial and environmental heterogeneity in intermediately deforested landscapes can increase the variation of key ecological factors for forest recovery (e.g. seed dispersal and seedling recruitment), increasing the uncertainty of successional trajectories. Regarding the recovery rate, only species richness is positively related to forest cover in relatively small (1 km radius) landscapes. These findings highlight the importance of using a spatially explicit landscape approach in restoration initiatives and suggest that these initiatives can be more effective in more forested landscapes, especially if implemented across spatial extents of 1-4 km radius.

PET/CT is widely used for the evaluation of patients with thoracic malignancies. Although the levels of 18 F-fluorodeoxyglucose (FDG) uptake are usually high in neoplastic diseases, they can also be physiological, due to artifacts. In addition, FDG uptake can occur in benign conditions such as infectious, inflammatory, and iatrogenic lesions. Furthermore, some malignant tumors, such as adenocarcinoma in situ (formerly known as bronchoalveolar carcinoma) and carcinoid tumors, may not show FDG uptake. Here, we illustrate the main pitfalls and artifacts in the interpretation of the results of oncologic PET/CT of the chest, outlining strategies for avoiding misinterpretation.

Objective: To evaluate radiologist agreement on the quantification of bronchiectasis by high-resolution computed tomography (HRCT)., Materials and Methods: The HRCT scans of 43 patients with bronchiectasis were analyzed by two radiologists, who used a scoring system to grade the findings. Kappa (κ) values and overall agreement were calculated., Results: For the measurement and appearance of bronchiectasis, the interobserver agreement was moderate (κ = 0.45 and κ = 0.43, respectively), as was the intraobserver agreement (κ = 0.54 and κ = 0.47, respectively). Agreement on the presence of mucous plugging was fair, for central distribution (overall interobserver agreement of 68.3% and κ = 0.39 for intraobserver agreement) and for peripheral distribution (κ = 0.34 and κ = 0.35 for interobserver and intraobserver agreement, respectively). The agreement was also fair for peribronchial thickening (κ = 0.21 and κ = 0.30 for interobserver and intraobserver agreement, respectively). There was fair interobserver and intraobserver agreement on the detection of opacities (κ = 0.39 and 71.9%, respectively), ground-glass attenuation (64.3% and κ = 0.24, respectively), and cysts/bullae (κ = 0.47 and κ = 0.44, respectively). Qualitative analysis of the HRCT findings of bronchiectasis and the resulting individual patient scores showed that there was an excellent correlation between the observers (intraclass correlation coefficient of 0.85 and 0.81 for interobserver and intraobserver agreement, respectively)., Conclusion: In the interpretation of HRCT findings of bronchiectasis, radiologist agreement appears to be fair. In our final analysis of the findings using the proposed score, we observed excellent interobserver and intraobserver agreement.

Objective: The aims of this study were to assess the concordance between high-resolution computed tomography (HRCT) diagnostic hypotheses (DH) and final diagnosis in patients with diffuse lung disease and to evaluate whether clinical data or the radiologist's degree of certainty influence concordance., Methods: Concordances between first and any one of radiologists' DH and final diagnosis were assessed before and after access to clinical data, with study of importance of degree of certainty in the DH formulated., Results: Concordances of HRCT DH and final diagnosis were 48% and 76%, respectively, considering first or any of the DH without access to clinical data. Accessing clinical data improved concordance especially for hypersensitivity pneumonitis. Diagnostic hypotheses formulated with high degree of confidence were correct in 69% of cases., Conclusions: First HRCT DH was concordant with final diagnosis in approximately half of cases, increasing to approximately 75% when considering any 1 of the 3 DH. Radiologists' knowledge of clinical data or increased degree of certainty improved concordance of HRCT DH and the final diagnosis.

Lymphadenopathy is a common radiological finding in many thoracic diseases and may be caused by a variety of infectious, inflammatory, and neoplastic conditions. This review aims to describe the patterns of mediastinal and hilar lymphadenopathy found in benign diseases in immunocompetent patients. Computed tomography is the method of choice for the evaluation of lymphadenopathy, as it is able to demonstrate increased size of individual nodes, abnormalities of the interface between the mediastinum and lung, invasion of surrounding fat, coalescence of adjacent nodes, obliteration of the mediastinal fat, and hypo- and hyperdensity in lymph nodes. Intravenous contrast enhancement may be needed to help distinguish nodes from vessels. The most frequent infections resulting in this finding are tuberculosis and fungal disease (particularly histoplasmosis and coccidioidomycosis). Sarcoidosis is a relatively frequent cause of lymphadenopathy in young adults, and can be distinguished from other diseases - especially when enlarged lymph nodes are found to be multiple and symmetrical. Other conditions discussed in this review are silicosis, drug reactions, amyloidosis, heart failure, Castleman's disease, viral infections, and chronic obstructive pulmonary disease., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Amyloidosis is a constellation of disease entities characterized by abnormal extracellular deposition and accumulation of protein and protein derivatives, which show apple-green birefringence when stained with Congo red and viewed under polarized light. Amyloid can infiltrate virtually all organ systems and can display multiple and diverse imaging findings. Pathologically, respiratory involvement occurs in 50 % of patients with amyloidosis, and its clinical signs and symptoms vary depending on whether the disease is systemic or localized. The four main patterns of respiratory tract involvement are tracheobronchial, nodular parenchymal, diffuse alveolar septal, and lymphatic. Imaging findings of amyloidosis are nonspecific and vary in each pattern; knowledge about the disease impairment type is thus very important, and amyloidosis should be considered in the differential diagnosis of other very common diseases, such as infectious diseases, neoplasms, and vasculitis. This literature review describes the main clinical and imaging manifestations of amyloidosis, focusing on respiratory tract involvement and differential diagnosis.

Background: Chest radiography (CXR) is inferior to Thin-section computed tomography in the detection of asbestos related interstitial and pleural abnormalities. It remains unclear, however, whether these limitations are large enough to impair CXR´s ability in detecting the expected reduction in the frequency of these asbestos-related abnormalities (ARA) as exposure decreases., Methods: Clinical evaluation, CXR, Thin-section CT and spirometry were obtained in 1418 miners and millers who were exposed to progressively lower airborne concentrations of asbestos. They were separated into four groups according to the type, period and measurements of exposure and/or procedures for controlling exposure: Group I (1940-1966/tremolite and chrysotile, without measurements of exposure and procedures for controlling exposure); Group II (1967-1976/chrysotile only, without measurements of exposure and procedures for controlling exposure); Group III (1977-1980/chrysotile only, initiated measurements of exposure and procedures for controlling exposure) and Group IV (after 1981/chrysotile only, implemented measurements of exposure and a comprehensive procedures for controlling exposure)., Results: In all groups, CXR suggested more frequently interstitial abnormalities and less frequently pleural plaques than observed on Thin-section CT (p<0.050). The odds for asbestosis in groups of decreasing exposure diminished to greater extent at Thin-section CT than on CXR. Lung function was reduced in subjects who had pleural plaques evident only on Thin-section CT (p<0.050). In a longitudinal evaluation of 301 subjects without interstitial and pleural abnormalities on CXR and Thin-section CT in a previous evaluation, only Thin-section CT indicated that these ARA reduced as exposure decreased., Conclusions: CXR compared to Thin-section CT was associated with false-positives for interstitial abnormalities and false-negatives for pleural plaques, regardless of the intensity of asbestos exposure. Also, CXR led to a substantial misinformation of the effects of the progressively lower asbestos concentrations in the occurrence of asbestos-related diseases in miners and millers.

Objective: The aim of this study was to analyze chest CT scans of patients with thoracic textiloma., Methods: This was a retrospective study of 16 patients (11 men and 5 women) with surgically confirmed thoracic textiloma. The chest CT scans of those patients were evaluated by two independent observers, and discordant results were resolved by consensus., Results: The majority (62.5%) of the textilomas were caused by previous heart surgery. The most common symptoms were chest pain (in 68.75%) and cough (in 56.25%). In all cases, the main tomographic finding was a mass with regular contours and borders that were well-defined or partially defined. Half of the textilomas occurred in the right hemithorax and half occurred in the left. The majority (56.25%) were located in the lower third of the lung. The diameter of the mass was ≤ 10 cm in 10 cases (62.5%) and > 10 cm in the remaining 6 cases (37.5%). Most (81.25%) of the textilomas were heterogeneous in density, with signs of calcification, gas, radiopaque marker, or sponge-like material. Peripheral expansion of the mass was observed in 12 (92.3%) of the 13 patients in whom a contrast agent was used. Intraoperatively, pleural involvement was observed in 14 cases (87.5%) and pericardial involvement was observed in 2 (12.5%)., Conclusions: It is important to recognize the main tomographic aspects of thoracic textilomas in order to include this possibility in the differential diagnosis of chest pain and cough in patients with a history of heart or thoracic surgery, thus promoting the early identification and treatment of this postoperative complication.

Objective: The purpose of this study was to evaluate the clinical and radiological features of patients with fungal infection mimicking thoracic malignancy and to establish a diagnostic approach for both clinicians and radiologists to avoid misdiagnosis., Methods: In this retrospective study, we reviewed clinical and computed tomography (CT) findings from 27 patients who presented with suspicion of thoracic malignancy who were ultimately diagnosed with fungal disease., Results: Patients' median age was 55.7 (range 31-78) years. The most common clinical findings were cough (48.1 %), expectoration (33.3 %), chest pain (25.9 %), weakness (25.9 %), weight loss (18.5 %), and hemoptysis, dyspnea, and fever (7.4 % each). The median lesion size was 35.5 (range 10-85) mm. CT findings included a solid nodule (51.9 %), solid mass (37 %), or both (11.1 %). Nodule and mass margins were lobulated in 9 (33.3 %) patients, ill-defined in 5 (18.5 %), spiculated in 4 (14.8 %), and smooth in 4 (14.8 %) patients. Additional findings included consolidation in 4 (14.8 %) patients, cavitation in 3 (11.1 %), pleural effusion in 2 (7.4 %), and lymphadenopathy in 11 (40.7 %) patients. In all patients, specific diagnoses were made and confirmed by histopathology; final diagnoses were histoplasmosis (25.9 %), coccidiomycosis (22.2 %), cryptococcosis (22.2 %), aspergillosis (14.8 %), North American blastomycosis (7.4 %), mucormycosis (3.75 %), and paracoccidioidomycosis (3.75 %)., Conclusions: Fungal infection can present with clinical and radiological features that are indistinguishable from thoracic malignancy, such as lung nodules or masses. Because the management and outcomes of fungal infection and malignancy are entirely distinct, the establishment of a specific diagnosis is critical to provide appropriate therapy.

In the elderly (conventionally defined as individuals ≥ 60 years of age), it is often difficult to establish what normality is, because of the numerous anatomical and physiological modifications that occur during the aging process. As a result, the greatest challenge is to differentiate between the normal aging process and the onset of disease. Healthy elderly people commonly present borderline findings on chest imaging. We systematically reviewed the medical literature on the subject, covering the period between 1950 and 2011, including articles in Portuguese, English, French, Italian, and Spanish. We searched the PubMed, LILACS, and SciELO databases, using the search terms "age", "aging", "lung", "thorax", "chest", "X-ray", "radiography", "pulmonary", and "computed tomography"-as well as their corresponding translations-in various combinations. We included only original or review articles on aging-related chest imaging findings. In broad terms, aging results in physiological modifications that must be recognized so as not to be erroneously interpreted as pathological.

Bronchioloalveolar carcinoma has various presentations and a wide spectrum of imaging patterns, as does adenocarcinoma with a bronchioloalveolar component. The objective of this essay was to describe and illustrate the CT findings that are most characteristic of these tumors. Three presentations are described: solitary pulmonary nodule, consolidation, and diffuse pattern. The last two should be included in the differential diagnosis, together with infectious diseases. Knowledge of the various presentations and the use of proper diagnostic procedures are crucial to early diagnosis and to improving survival.

Objective: To compare the clinical, high-resolution computed tomography (HRCT) and pathological findings of primary alveolar proteinosis (PAP) and silicoproteinosis., Material and Methods: The study included 15 patients with PAP (6 women, 9 men, mean age 31 years) and 13 with silicoproteinosis (13 men, mean age 29.5 years). PAP was diagnosed by lung biopsy in 13 and bronchoalveolar lavage in two patients and silicoproteinosis by bronchoalveolar lavage in 10 and autopsy in three cases. HRCT images were reviewed by two chest radiologists with consensus for the presence, extent and distribution of ground-glass opacities, septal thickening, consolidation and nodules. Radiological-pathological correlation was performed by one radiologist and one chest pathologist., Results: Seven (46%) patients with PAP were asymptomatic; the remainder presented slowly progressive dyspnea and dry cough. All silicoproteinosis patients had dry cough and rapidly progressive dyspnea. The most common HRCT finding on PAP was the crazy-paving pattern (93%). All cases had areas of geographic sparing in the affected lung. The most common finding in silicoproteinosis (92%) was dependent consolidation with calcification in 83%. Centrilobular nodules were common (85%). On pathology, both diseases demonstrated intra-alveolar accumulation of PAS material, thickening of interlobular septae and alveolar walls and no evidence of fibrosis. A few silica particles were seen in silicoproteinosis., Conclusion: Despite the pathological similarities, PAP and silicoproteinosis have distinct clinical and imaging features and prognosis. Bilateral crazy-paving pattern with areas of geographic sparing is characteristic for PAP. Silicoproteinosis presents with bilateral dependent consolidation often with areas of calcification. The crazy-paving pattern is not seen in silicoproteinosis., (Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.)

Collagen vascular diseases are a diverse group of immunologically mediated systemic disorders that often lead to thoracic changes. The collagen vascular diseases that most commonly involve the lung are rheumatoid arthritis, progressive systemic sclerosis, systemic lupus erythematosus, polymyositis and dermatomyositis, mixed connective tissue disease, and Sjögren syndrome. Interstitial lung disease and pulmonary arterial hypertension are the main causes of mortality and morbidity among patients with collagen vascular diseases. Given the broad spectrum of possible thoracic manifestations and the varying frequency with which different interstitial lung diseases occur, the interpretation of thoracic images obtained in patients with collagen vascular diseases can be challenging. The task may be more difficult in the presence of treatment-related complications such as drug toxicity and infections, which are common in this group of patients. Although chest radiography is most often used for screening and monitoring of thoracic alterations, high-resolution computed tomography can provide additional information about lung involvement in collagen vascular diseases and may be especially helpful for differentiating specific disease patterns in the lung. General knowledge about the manifestations of thoracic involvement in collagen vascular diseases allows radiologists to provide better guidance for treatment and follow-up of these patients., (© RSNA, 2012.)

Objective: The purpose of this article is to describe diseases that may present with the reversed halo sign on high-resolution CT. We emphasize the tomographic features most frequently associated with this sign and correlate them with histologic findings., Conclusion: A wide spectrum of infectious and noninfectious diseases may present with the reversed halo sign on chest CT. The nonspecific nature of this sign should not cloud an otherwise fairly straightforward diagnosis, especially when associated background findings are typical. Although a rigorous analysis of associated CT findings may help with the differential diagnosis, histologic assessment is often needed for a definitive determination of the cause.

Objective: The purpose of this article is to illustrate and describe various CT manifestations of swine-origin influenza A (H1N1) viral infection., Conclusion: The imaging findings seen in patients with H1N1 infection include consolidations, ground-glass opacities, interlobular septal thickening, small nodules, and findings suggestive of small airways disease, among others. Definitive diagnosis is based on correlation of the CT findings with the clinical symptoms and laboratory test results.

Physical inactivity is a determinant of clinical disorders and psychological problems in patients with chronic kidney disease patients. In two satellite clinics, a program of physical activity (PA) was offered to 86 patients undergoing hemodialysis. Of those, 49 patients entered the PA program spontaneously and 37 remained inactive. After six months, a satisfaction self-reported questionnaire and the Modified Mini-Mental State (3MS) Examination for assessment of cognitive function were applied. Cognition was compared between inactive patients and those participating in the PA program for at least three months. Regardless of age and duration of dialysis, patients showed a cognitive deficit greater than expected. In the general group, better cognitive function was observed in active patients as compared to the inactive ones (p < 0.05). When separated by age groups, active patients over the age of 60 years had better results than the inactive ones (p < 0.05). We concluded that patients with better cognitive responses are more physically active and/or physical activity contributes to better cognitive function.

Purpose: To compare the diagnostic and prognostic value of [(18)F] fluorodeoxyglucose positron emission tomography (FDG-PET) and bone scans (BS) in the assessment of osseous lesions in patients with progressing prostate cancer., Experimental Design: In a prospective imaging trial, 43 patients underwent FDG-PET and BS prior to experimental therapies. Bone scan index (BSI) and standardized uptake value (SUV) on FDG-PET were recorded. Patients were followed until death (n = 36) or at least 5 years (n = 7). Imaging findings were correlated with survival., Results: Osseous lesions were detected in 39 patients on BS and 32 on FDG-PET (P = 0.01). Follow-up was available for 105 FDG-positive lesions, and 84 (80%) became positive on subsequent BS. Prognosis correlated inversely with SUV (median survival 14.4 versus 32.8 months if SUVmax > 6.10 versus ≤ 6.10; P = 0.002) and BSI (14.7 versus 28.2 months if BSI > 1.27 versus < 1.27; P = 0.004). Only SUV was an independent factor in multivariate analysis., Conclusion: This study of progressive prostate cancer confirms earlier work that BSI is a strong prognostic factor. Most FDG-only lesions at baseline become detectable on follow-up BS, suggesting their strong clinical relevance. FDG SUV is an independent prognostic factor and provides complementary prognostic information., (©2010 AACR.)

Objective: The aim of this study was to assess the high-resolution computed tomography (HRCT) findings at presentation in patients diagnosed with Influenza A (H1N1) virus-associated pneumonia., Materials and Methods: We reviewed the HRCT findings from 20 patients diagnosed with Influenza A (H1N1) and compared their HRCT scans with chest radiographs, obtained on the same day. The imaging studies were obtained 4-9 days after the onset of symptoms. The patients included 11 men and 9 women (ages 24-62 years; mean 42.7 years). All patients had a body temperature greater than 100.4 degrees F (>38 degrees C), tachypnea, and cough. Other common symptoms included diarrhea (60%) and sore throat (30%). The radiographs and HRCT scans were reviewed independently by two observers who reached a consensus decision., Results: The predominant HRCT findings consisted of bilateral ground-glass opacities (n=12), bilateral areas of consolidation (n=2), or a mixed bilateral pattern of ground-glass opacities and areas of consolidation (n=6). The abnormalities were bilateral in all of the 20 patients, had a predominantly sub-pleural distribution in 13 patients, and had a random distribution in the remaining 7 patients. The predominant radiographic findings were consolidations. Normal radiographs were found in 4 out of the 20 patients., Conclusion: HRCT may reveal parenchymal abnormalities in patients with Influenza A (H1N1) infection who have normal findings on radiographs. The predominant HRCT findings were bilateral, peripheral, ground-glass opacities and/or bilateral areas of consolidation. The patients who presented consolidations had more severe clinical course., (Copyright (c) 2010 Elsevier Ireland Ltd. All rights reserved.)

Unlabelled: The aim of this study was to develop a clinically applicable noninvasive method to quantify changes in androgen receptor (AR) levels based on (18)F-16beta-fluoro-5alpha-dihydrotestosterone ((18)F-FDHT) PET in prostate cancer patients undergoing therapy., Methods: Thirteen patients underwent dynamic (18)F-FDHT PET over a selected tumor. Concurrent venous blood samples were acquired for blood metabolite analysis. A second cohort of 25 patients injected with (18)F-FDHT underwent dynamic PET of the heart. These data were used to generate a population-based input function, essential for pharmacokinetic modeling. Linear compartmental pharmacokinetic models of increasing complexity were tested on the tumor tissue data. Four suitable models were applied and compared using the Bayesian information criterion (BIC). Model 1 consisted of an instantaneously equilibrating space, followed by a unidirectional trap. Models 2a and 2b contained a reversible space between the instantaneously equilibrating space and the trap, into which metabolites were excluded (2a) or allowed (2b). Model 3 built on model 2b with the addition of a second reversible space preceding the unidirectional trap and from which metabolites were excluded., Results: The half-life of the (18)F-FDHT in blood was between 6 and 7 min. As a consequence, the uptake of (18)F-FDHT in prostate cancer lesions reached a plateau within 20 min as the blood-borne activity was consumed. Radiolabeled metabolites were shown not to bind to ARs in in vitro studies with CWR22 cells. Model 1 produced reasonable and robust fits for all datasets and was judged best by the BIC for 16 of 26 tumor scans. Models 2a, 2b, and 3 were judged best in 7, 2, and 1 cases, respectively., Conclusion: Our study explores the clinical potential of using (18)F-FDHT PET to estimate free AR concentration. This process involved the estimation of a net uptake parameter such as the k(trap) of model 1 that could serve as a surrogate measure of AR expression in metastatic prostate cancer. Our initial studies suggest that a simple body mass-normalized standardized uptake value correlates reasonably well to model-based k(trap) estimates, which we surmise may be proportional to AR expression. Validation studies to test this hypothesis are underway.

Objective: To determine the interobserver and intraobserver agreement in the diagnosis of interstitial lung diseases (ILDs) based on HRCT scans and the impact of observer expertise, clinical data and confidence level on such agreement., Methods: Two thoracic radiologists and two general radiologists independently reviewed the HRCT images of 58 patients with ILDs on two distinct occasions: prior to and after the clinical anamnesis. The radiologists selected up to three diagnostic hypotheses for each patient and defined the confidence level for these hypotheses. One of the thoracic and one of the general radiologists re-evaluated the same images up to three months after the first readings. In the coefficient analyses, the kappa statistic was used., Results: The thoracic and general radiologists, respectively, agreed on at least one diagnosis for each patient in 91.4% and 82.8% of the patients. The thoracic radiologists agreed on the most likely diagnosis in 48.3% (kappa = 0.42) and 62.1% (kappa = 0.58) of the cases, respectively, prior to and after the clinical anamnesis; likewise, the general radiologists agreed on the most likely diagnosis in 37.9% (kappa = 0.32) and 36.2% (kappa = 0.30) of the cases. For the thoracic radiologist, the intraobserver agreement on the most likely diagnosis was 0.73 and 0.63 prior to and after the clinical anamnesis, respectively. That for the general radiologist was 0.38 and 0.42.The thoracic radiologists presented almost perfect agreement for the diagnostic hypotheses defined with the high confidence level., Conclusions: Interobserver and intraobserver agreement in the diagnosis of ILDs based on HRCT scans ranged from fair to almost perfect and was influenced by radiologist expertise, clinical history and confidence level.

Objective: To evaluate the main aspects on CT scans of six patients hospitalized in a bone marrow transplant ward, diagnosed with invasive pulmonary aspergillosis (IPA), during an in-hospital outbreak of the disease., Methods: We reviewed 10 chest CT scans of six neutropenic or immunocompromised patients hospitalized in the hematology and bone marrow transplant ward of the Hospital São Paulo, in the city of São Paulo, Brazil, who were diagnosed with IPA between April of 2007 and October of 2007. The diagnosis of IPA was confirmed by anatomopathological findings (in 2 cases), culture (in 3 cases) or appropriate treatment response (in 1 case)., Results: We evaluated the CT scans of three male and three female patients, ranging from 22 to 58 years of age. The most common tomographic findings were nodules (5/6 cases) and areas of consolidation (2/6 cases). The nodules were more often multiple (3/5 cases), with irregular contours (4/5 cases) and accompanied by the halo sign (3/5 cases). One case presented multiple, centrally distributed areas of consolidation, and another presented an isolated, peripheral area of consolidation. Areas of ground-glass attenuation and septal thickening were found in three and two patients, respectively. Bilateral pleural effusion occurred in three cases., Conclusions: Consolidation, nodules, septal thickening, pleural effusion and ground-glass opacities were the principal tomographic findings in the six patients hospitalized in the above mentioned ward during the IPA outbreak. The nodules were often (in 67% of the cases) accompanied by the halo sign, a classically described finding in patients with IPA.

Objective: To present the findings of computed tomography (CT) scans of the chest in patients with laryngotracheobronchial papillomatosis., Methods: We retrospectively analyzed CT scans of eight patients, five males and three females, ranging from 5 to 18 years of age with a mean age of 10.5 years. Images were independently reviewed by two radiologists. In discrepant cases, a consensus was reached., Results: The most common CT findings were intratracheal polypoid lesions and pulmonary nodules, many of which were cavitated., Conclusions: In patients with laryngotracheobronchial papillomatosis, the most common tomographic finding was the combination of intratracheal polypoid lesions and multiple pulmonary nodules, many of which were cavitated.

A 41-year-old male presented to an outside institution complaining of a lump under the skin of his right abdomen. CT scan reported ill-defined densities with streaky inflammatory changes in the anterior abdominal wall. Excisional biopsy of the subcutaneous adipose tissues of the right anterior abdominal wall was consistent with subcutaneous panniculitis-like T-cell lymphoma. Flow cytometry demonstrated CD3+ and CD8+ population. On immunohistochemistry, most lymphoid cells were positive for CD3, CD45RO, CD5, and CD8 and negative for CD10, CD43, CD4, CD20, and CD56. The MIB-1 proliferative index was 30%. Bone marrow biopsy revealed no evidence of lymphomatous involvement.

Objective: To present findings on computed tomography scans of the chest indicative of extramedullary hematopoiesis in six patients., Methods: We retrospectively analyzed computed tomography scans of six adult patients - five males and one female - with a mean age of 36.5 years. Two radiologists independently reviewed the scans, and a consensus was reached in discrepant cases., Results: The most common finding in the scans was lower paravertebral masses with heterogeneous content (four patients). The scans of two patients showed a solitary parietal and pleural mass., Conclusions: There are findings in computed tomography scans that are highly suggestive of extramedullary hematopoiesis, especially when those findings correlate with underlying blood diseases. Such findings, in most of the cases, allow physicians to dispense with histopathological confirmation.

Purpose: This study was conducted to evaluate the clinical utility of a Positron Emission Tomography/Computed Tomography (PET/CT) analysis module of a picture archiving communication system (PACS) workstation in comparison to a dedicated PET/CT interpretation workstation., Materials and Methods: The study included 32 consecutive patients referred for an [(18)F] Fluro-2-Deoxy-D: -Glucose ((18)F-FDG) PET/CT at our institution. Images were reviewed at dedicated PET/CT and at PACS-integrated workstations. Mean standardized uptake values (SUVs) were calculated for the liver and the lung. Maximum SUVs were recorded for the bladder and an index lesion with the highest FDG uptake. The time spent for SUV measurements was recorded. Correlation of the SUV measurements was calculated with the Pearson coefficient., Results: Pearson coefficients between the workstations ranged from 0.96 to 0.99 for bladder and lesion maximum SUVs. For liver and lung average SUVs, the coefficients varied from 0.53 to 0.98. The mean time spent to perform the four SUV measurements was 122.6 s for the dedicated workstations and 134.6 s for the PACS-integrated system., Conclusion: The correlation of SUV measurements between dedicated PET/CT and PACS-integrated workstations is very good, especially for maximum SUVs. For routine reading of PET/CT scans, a PACS workstation with a PET/CT analysis module offers an excellent alternative to the use of a dedicated PET/CT workstation.

Unlabelled: Respiratory motion during PET/CT acquisition can cause misregistration and inaccuracies in calculation of standardized uptake values (SUVs). Our aim was to compare the detection and characterization of thoracic lesions on PET/CT with and without a deep-inspiration protocol., Methods: We studied 15 patients with suspected pulmonary lesions who underwent clinical PET/CT, followed by deep-inspiration breath-hold (BH) PET/CT. In BH CT, the whole chest of the patient was scanned in 15 s at the end of deep inspiration. For BH PET, patients were asked to hold their breath 9 times for 20-s intervals. One radiologist reviewed images, aiming to detect and characterize pulmonary, nodal, and skeletal abnormalities. Clinical CT and BH CT were compared for number, size, and location of lesions. Lesion SUVs were compared between clinical PET and BH PET. Images were also visually assessed for accuracy of fusion and registration., Results: All patients had lesions on clinical CT and BH CT. Pulmonary BH CT detected more lesions than clinical CT in 13 of 15 patients (86.7%). The total number of lung lesions detected increased from 53 with clinical CT to 82 with BH CT (P<0.001). Eleven patients showed a total of 31 lesions with abnormal (18)F-FDG uptake. BH PET/CT had the advantage of reducing misregistration and permitted a better localization of sites with (18)F-FDG uptake. A higher SUV was noted in 22 of 31 lesions on BH PET compared with clinical PET, with an average increase in SUV of 14%., Conclusion: BH PET/CT enabled an increased detection and better characterization of thoracic lesions compared with a standard PET/CT protocol, in addition to more precise localization and quantification of the findings. The technique is easy to implement in clinical practice and requires only a minor increase in the examination time.

Unlabelled: The goal of this study was to describe our initial experience with the deep-inspiration breath-hold (DIBH) technique in combined PET/CT of the thorax. This article presents particular emphasis on the technical aspects required for clinical implementation., Methods: In the DIBH technique, the patient is verbally coached and brought to a reproducible deep inspiration breath-hold level. The first "Hold" period, which refers to the CT session, is considered as the reference. This is followed by 9- to 20-s independent breath-hold PET acquisitions. The goal is to correct for respiratory motion artifacts and, consequently, improve the tumor quantitation and localization on the PET/CT images and inflate the lungs for possible improvement in the detection of subcentimeter pulmonary nodules. A physicist monitors and records patient breathing during PET/CT acquisition using a motion tracker. Patient breathing traces obtained during acquisition are examined on the fly to assess the reproducibility of the technique., Results: Data from 8 patients, encompassing 10 lesions, were analyzed. Visual inspection of fused PET/CT images showed improved spatial matching between the 2 modalities, reduced motion artifacts especially in the diaphragm, and increased the measured standardized uptake value (SUV) attributed to reduced motion blurring, as compared with the standard clinical PET/CT images., Conclusion: The practice of DIBH PET/CT is feasible in a clinical setting. With this technique, consistent lung inflation levels are achieved during PET/CT sessions, as judged by both motion tracker and verification of spatial matching between PET and CT images. Breathing-induced motion artifacts are significantly reduced using DIBH compared with free breathing, enabling better target localization and quantitation. The DIBH technique showed an increase in the median SUV by 32.46%, with a range from 4% to 83%, compared with SUVs measured on the clinical images. The median percentage reduction in the PET-to-CT lesions' centroids was 26.6% (range, 3%-50%).

Primary pulmonary meningioma is very rare, with about 30 cases reported in the English literature. These lesions are usually benign, grow slowly, and have an excellent prognosis. However, they can mimic any other pulmonary tumor, as the most common presentation is as a solitary pulmonary nodule. We report a case of a primary pulmonary meningioma manifesting as a solitary lung nodule with a very high metabolic activity on the positron emission tomography, mimicking a primary lung cancer.

Objective: To assess the reproducibility of a new high-resolution computed tomography (CT) visual semiquantitative method for pleural plaques in asbestos-exposed workers., Material and Methods: We performed thin-section CT in 752 chrysotile asbestos mining workers and ex-workers. Institutional review board approval and signed written informed consent from subjects were obtained. Two readers independently evaluated the 752 CT scans and identified 57 workers (mean age +/- SD, 61.8 years +/- 8.1; range, 37 to 81 years) who had pleural plaques and no other pleural or parenchymal abnormality. Three independent radiologists then quantified the plaque burden in these 57 workers using a scoring system based on the evaluation of the maximum thickness of parietal pleural plaques and percentage of parietal pleural surface involvement. We also calculated the proportion between the number of CT slices with diaphragmatic plaques and the total number of slices in which the diaphragm was seen (pdiaph). The intraobserver and interobserver agreements were analyzed using weighted Kappa coefficient., Results: Interobserver agreements were good for the pleural plaque score (k = 0.61, 0.75, and 0.79) and ranged from good (k = 0.61) to excellent (k = 0.86) for the pdiaph. Intraobserver agreements ranged from good to excellent for the pleural plaque score (k = 0.79 and 1.00) and for the pdiaph (k = 0.79 and 0.93)., Conclusion: The method proposed for high-resolution CT pleural plaque quantification in asbestos-exposed workers has a high reproducibility.

This chapter consists of a review of the literature regarding radiographic and tomographic characteristics of the principal occupational respiratory diseases (silicosis and asbestosis). Special attention is given to the practical relevance of high-resolution computed tomography, which is the most sensitive and specific method of identifying and quantifying the extent of pleural and parenchymal lesions related to such diseases.

Pleural plaques (PP) are considered to be hallmarks of asbestos exposure. They constitute focal thickenings of the pleura and are commonly seen in patients without lung disease. They can involve parietal, diaphragmatic and mediastinal pleura. Chest x-ray is frequently used for PP diagnosis, but computed tomography, especially when used the high-resolution technique, is the imaging exam with the greatest sensibility and specificity. PP are almost always asymptomatic, but there are some controversial about their relationship with asbestos exposure indexes, pulmonary functional alterations and risk of neoplasias.

Pleural and pulmonary asbestos-related diseases range from benign conditions, like pleural effusion and pleural plaques, to some neoplasias, such as lung cancer and malignant mesothelioma. Pleural effusion is the earliest finding after asbestos exposure, but the imaging findings are not specific. Diffuse pleural thickening involves the visceral pleura and pleural plaques are considered to be hallmarks of exposure. Asbestosis is the pulmonary fibrosis due to asbestos. Rounded atelectasis is a peripheral lung collapse in these individuals, generally related to pleural disease. Some neoplasias, like lung carcinoma and pleural mesothelioma, are more prevalent in asbestos-exposed subjects. The aim of this essay is to illustrate the main imaging findings of asbestos-related diseases.

Background: One of the major problems when evaluating dyspeptic patients at public hospitals is the large interval between the consultation and the endoscopy, leading to the prescription of antisecretory drugs, what can be responsible for false results on examinations., Aim: To evaluate changes in ultrarapid urease test and histopathological examination for Helicobacter pylori by antisecretory drugs., Methods: In a prospective double-blind study, 50 patients with dyspeptic complaints and endoscopic diagnosis of peptic ulcer, erosive gastritis, esophagitis or duodenitis with a positive urease test, were randomized to a 7-day course of treatment with either omeprazole 20 mg or ranitidine 300 mg a day. Before and after treatment, two biopsy specimens each were obtained from the antrum and corpus and an ultrarapid urease test and a histopathological examination for Helicobacter pylori were performed., Results: There were no significant changes in the results of ultrarapid urease test and histopathological examination for Helicobacter pylori after treatment with ranitidine. With omeprazole, we observed a decrease in positive results in ultrarapid urease test and histopathological examination for Helicobacter pylori in the antrum, but not in the corpus., Conclusion: Omeprazole, used for 7 days can lead to negative results in ultrarapid urease test and histopathological examination for Helicobacter pylori in the antrum, and should not be employed in patients before the endoscopy is performed.

Acute pancreatitis is one of the complications associated with severe primary and secondary hypertriglyceridemia. The frequency of hypertriglyceridemia in patients with pancreatitis ranges from 4 to 53%. The elevation in serum triglycerides probably induces the release of free fatty acids, responsible for the pancreatic damage. During a three year study, nine patients with acute pancreatitis due to hypertriglyceridemia were followed up at the University Hospital of Federal University and at the "Hospital Monte Sinai" (Juiz de Fora, MG, Brazil). Suggestive clinical manifestations, especially superior abdominal pain, nausea, vomiting and ileus, were found in all the patients; however, only three showed elevated serum amylase levels. All had triglyceride levels above 1000 mg/dl (11.3 mmol/L). The evolution after clinical treatment was good in eight patients (two needed parenteral nutrition). The only death observed was due to shock and acute respiratory distress, refractory to clinical management. The maintenance treatment aimed at withdrawing the predisposing conditions and reduction of the triglyceride levels prevented recurrence of acute pancreatitis episodes during the 23 months of follow-up.

The authors present their experience with the follow-up of 60 cases of Crohn's disease, from 1970 until 1998, in the city of Juiz de Fora, Minas Gerais state, a county of the Southeast region of Brazil, and analyse the epidemiology of disease to improve the understanding of its behaviour in the country. The incidence rates increased greatly in the last 28 years. In the group studied 53.3% were men, 90% white, 71.7% non-smokers, 93.3% non-alcoholics, and all, but two, lived in urban area; 58.3% had their symptoms started at the age between 11 and 30 years and 30% were in the second decade of life. Relatives with Crohn's disease were seen in 6.7%, and the most common symptoms observed at the beginning of disease were: abdominal pain (78.3%), diarrhea (68.3%), weight loss (26.7%) and small bowel obstruction or localized peritonitis (15%). The ileum was involved in 90% and five cases (8.3%) with lesions restricted to the colon were observed. Two patients died because they were non-responders despite any therapy schedule and had sepsis after surgery. The effect of several substances used in the treatment is described, being prednisone the most effective in controlling the active disease. Other drugs as aminosalicilates, metronidazol and immunomodulators are also considered to avoid the side-effects of long-term use of steroides. Comments are made about the clinical evolution, surgeries and response to many treatments adopted. The authors conclude that Crohn's disease is increasing its incidence rate in Brazil and probably in South America formerly considered as a region of low frequency.

Background and Aims: Dyspepsia is a common complaint that may signal the presence of diseases like cancer or peptic ulcer. The aim of our study was to assess if the clinical patterns of dyspepsia can be considered a valid guideline for the appropriate use of endoscopy., Methods: According to the symptomatological patterns, our 243 patients were defined as sufferers from: ulcer-like (93 patients), reflux-like (25) and dismotility-like dyspepsia (125). Erosive gastritis and erosive duodenitis were regarded as minor inflammatory lesions., Results: A negative endoscopy (normal or presenting minor inflammatory lesions) was found in 36.6% of ulcer-like dyspepsia patients: this rate was 52% in the reflux-like group, and 49.6% in the dismotility-like one. Duodenal ulcer was the most frequent abnormal lesion in the three groups. The frequency of negative endoscopies was significantly higher in dismotility-like than in ulcer-like (49.6% vs. 36.6%--P < 0.05) dyspepsia. In those patients with dismotility-like dyspepsia under 41 years, the rate of negative endoscopies was 72.7%, and neoplasms were not observed., Conclusion: Our data indicate that endoscopy could be considered inappropriate for patients under 41 years old with dismotility-like dyspepsia. These subjects account for 18.1% of the patients studied, what could lead to a good percentage of reduction in endoscopic service load.