No abstract

No abstract

-Context: Low-grade astrocytomas are intracerebral lesions of relatively high frequency in the under-18 pediatric population. They often present indolent behaviour, and complete surgical resection is the choice treatment. In cases where the surgery is not possible, chemotherapy and radiotherapy may be used. Medical reports do not recommend examination of the spinal cord at diagnosis or during treatment, since the risk of dissemination of the lesion to the spine is minimal according to medical experience. We describe here four cases of children with low-grade astrocytoma with aggressive dissemination to the neuroaxis.KEY WORDS: astrocytomas, pilocytic astrocytoma, brainstem tumor, brain neoplasms, children. padrões incomuns de disseminação dos astrocitomas de baixo grau na infânciaResumo -Contexto: Gliomas de baixo grau de malignidade são lesões intracerebrais relativamente freqüentes na população pediátrica menor de 18 anos de idade. Eles freqüentemente são indolentes em seu comportamento e a ressecção cirúrgica completa é o tratmento de eleição. Nos casos em que a cirurgia não é possível, a quimioterapia e a radioterapia podem ser utilizadas. Relatos da literatura não recomendam a avaliação radiológica da coluna espinhal ao diagnóstico ou durante o tratamento, desde que o risco de disseminação destas lesões para a coluna é considerado mínimo. Descrevemos aqui quatro casos de crianças com gliomas de baixo grau de malignidade com disseminação agressiva para o neuroeixo. PALAVRAS-CHAVE: astrocitomas, astrocitoma pilocítico, tumor de tronco cerebral, tumor cerebral, criança.

Visualization of the abdominal organs was satisfactory even in patients who had only fasted and received water. The use of laxative and antiflatulent preparations is not required before routine abdominal ultrasound examinations.

Objective To evaluate the diagnostic accuracy of elastography for breast cancer identification in patients with indeterminate lesions on ultrasound. Methods This prospective, descriptive study included patients with indeterminate breast lesions in the ultrasound and with indication for percutaneous or surgical biopsy. The elastography was evaluated by qualitative analysis and by two methods for the semi quantitative analysis. Results We evaluated 125 female patients with 159 lesions, with a mean age of 47 years, and a range of 20-85 years. Ultrasound has shown to be a method with good sensitivity (98.1%), but with a lower specificity (40.6%). On the elastography qualitative analysis, the specificity and accuracy were of 80.2% and 81.8% respectively. The mean size of the lesions showed no difference in classification by elastography. For the semiquantitative elastography, the mean values of the malignant lesions were statistically higher when compared with the subcutaneous tissue or the adjacent fibroglandular tissue. The analysis of the receiver operating characteristic (ROC) curves for these two semiquantitative methods showed that both are considered satisfactory, with an area under the curve above 0.75 and statistical significance (p < 0.0001). The best results were obtained when using the findings of combined conventional ultrasound and qualitative elastography, with 100% sensitivity and 63.2% specificity. Conclusions Elastography can be a useful complementary method, increasing the specificity and diagnostic accuracy of conventional ultrasound for the diagnosis of breast cancer in patients with indeterminate breast lesions. ResumoObjetivo Avaliar a acurácia diagnóstica da elastografia para identificação do câncer de mama em pacientes com lesões indeterminadas por ultrassom. Métodos Estudo prospectivo, descritivo, com pacientes com lesões mamárias indeterminadas no ultrassom e indicação de biópsia percutânea ou cirúrgica. A elastografia foi avaliada por análise qualitativa e dois métodos de análise semiquantitativa.

Historically, radiology has developed in a way that has increasingly distanced the radiologist from the patient. Currently, diagnostic imaging results are predominantly communicated through written reports. Written communication is not considered sufficient, verbal communication being essential for the performance of the modern radiologist to be considered satisfactory. However, a lack of preparation on the part of the radiologist when communicating the diagnosis, especially when it is not favorable (as is often the case in a cancer hospital), makes that conversation quite challenging. Studies conducted in other countries have demonstrated that there are a variety of opinions on the part of requesting physicians and patients regarding radiologist-patient communication, which can be explained by cultural differences. Although there is no rule regarding the best way to accomplish such communication, there are definitely incorrect ways. To bridge the gap between radiologists and patients and improve radiologist-patient communication, preparation of radiologists during their medical residency is fundamental. Therefore, it is important to address this question in Brazil. The objective of this study was to identify deeper discussions about the topic in the scientific literature. This analysis could help us map those involved and plan strategies to improve the ethical behavior of radiologists toward their patients.

No abstract

No abstract