Objective: To evaluate the retrospective accuracy of the Vesical Imaging-Reporting and Data System (VI-RADS) in detecting muscle invasion in bladder cancer. Materials and Methods: We investigated patients who underwent pelvic magnetic resonance imaging and were submitted to transurethral resection of a bladder tumor between 2015 and 2018. Thirty cases were reviewed by radiologists blinded to the final clinical stage. The VI-RADS score was applied and compared with the histopathological findings in the surgical specimen. Results: Of the 30 patients with suspicious bladder lesions, 5 (16.6%) had benign histopathological findings, 17 (56.6%) had non-muscle-invasive bladder cancer, and 8 (26.6%) had muscle-invasive bladder cancer. The optimal criterion to detect muscle-invasive bladder cancer was a final VI-RADS score > 3, for which the sensitivity and specificity were 100% (95% CI: 56.0-100%) and 90.9% (95% CI: 69.3-98.4%), respectively. Conclusion: The VI-RADS appears to estimate correctly the degree of muscle invasion in suspicious bladder lesions. However, prospective studies evaluating larger samples are needed in order to validate the method.

Objective: Prostate cancer has a high prevalence and mortality, being the most diagnosed urologic cancer. Prostatic magnetic resonance imaging showed high sensitivity in the detection of clinically significant neoplasia and agreement with the Gleason score. Therefore, we attempted to evaluate the diagnostic accuracy of the prostate imaging reporting and data system, using biopsy and prostatectomy as the reference standard. The secondary goal of correlating prostatic magnetic resonance imaging findings and anatomopathological samples is obtained. Materials and Methods: We retrospectively analyzed seventy-nine 1.5 Tesla prostatic magnetic resonance imaging scans in patients aged 31 to 86 years, performed at the Clinical Hospital of the Federal University of Paraná between January 2015 and February 2018. Results: Considering all 79 patients, prostatic magnetic resonance imaging was able to diagnose tumor in 47 patients (59.4%). Considering the peripheral zone, the prostatic magnetic resonance imaging had a sensitivity of 75.0% (95% confidence interval: 52.1%–98.0%), specificity of 89.5% (95% confidence interval: 66.0%–100%), 94.4% positive predictive value (95% confidence interval: 71.0%–100%), 66.7% negative predictive value (95% confidence interval: 43.0%–69.0%), 83.8% Positive Likelihood Ratio (PVR) (95% confidence interval: 60.0%–100%), 27.9% Negative Likelihood Ratio (RVN) (95% confidence interval: 5.0%–50.0 %), and accuracy of 86.3% (95% confidence interval: 63.0%–100%). The receiver operating characteristic curve obtained demonstrated the sensitivity variation according to the prostate imaging reporting and data system score of the patients, obtaining an area under the curve of 84.8 for a prostate imaging reporting and data system cutoff of 3. Conclusion: The use of the prostate imaging reporting and data system score is useful for the screening and classification of prostate cancer, due to its easy reproducibility, even in a population with an unknown prostate cancer prevalence, which can be easily correlated with biopsy studies and/or radical prostatectomy.

Splenosis, one type of manifestation of ectopic spleen tissue, 1,2 is a heterotopic autotransplantation of splenic tissue after abdominal trauma or surgical intervention (Figures 1). Hepatic splenosis is very rare, usually asymptomatic and cannot be distinguished from hepatic malignancies because of lack of significant radiological features. 2,3 Therefore, suspicion is an important step for diagnosis and invasive procedures are usually necessary to establish a definitive diagnosis. An important differentiation is made with hepatic adenomas, which are generally benign and, if smaller than 5 cm and asymptomatic, do not require surgical treatment, but if they are larger, they should be resected, due to the risk of hemorrhage or malign transformation. 4 This was the initial suspicion in the presented clinical case and, therefore, the patient underwent surgical resection. Splenosis is a benign entity, but with several differential diagnoses and need for clinical correlation and images for correct definition .4-8 In patients with cirrhosis the most important differential diagnosis is with hepatocellular carcinoma and invasive procedures may be necessary for the definition. 4,9 In this article we describe a clinical case of hepatic splenosis, its differential diagnoses and review of imaging methods for diagnostic definition. Case presentation Male, 47 years old, with an incidental finding of hepatic lesion, during investigation of nephrolithiasis. Previous history of splenectomy after abdominal trauma due to automobile accident 20 years ago. Hypertensive in use Olmesartan, denied other pathologies and surgeries. On physical examination: good general condition, anicteric, painless abdomen, without palpable masses. Laboratory tests: Hb 14g/dL (13,5-17,5), Hct 44,4% (39-55), Platelets 268,000/ mm3 (150.000-400.000), creatine 0,9mg/dL (1,5), INR 0,8, CEA 1,33 ng/mL (<3,0), CA 19-9 20U/mL (<37), AFP 1,5ng/dl (<7,22), albumin 4,19g/dL (3,4-4,8), AST 20U/L (17-55), ALT 18U/L (21-71), GGT 54U/L (15/73), AP 48U/L (38-126), total bilirrubin 0,57mg/ dL (0,2-1,3). MRI showed nodular hepatic lesion, 42x41x28mm, slight hyperintense in T2, with contrast enhancement and washout in late phase, in segment II, without dilatation of biliary tract (Figures 2). The initial diagnosis was hepatic adenoma. Proceeded with hepatic segmentectomy, with good evolution. The surgical specimen referred to pathological anatomy and revealed hepatic splenosis (Figures 1).

Os autores apresentam o caso de paciente do sexo masculino, 62 anos de idade, com emagrecimento há quatro meses e diminuição da força muscular associada a parestesias em membros inferiores há dois dias. Foi submetido a mielotomografia, que demonstrou massa no mediastino posterior com destruição dos corpos vertebrais e invasão do canal medular, além de espessamento irregular das paredes do esôfago. Na evolução, foi submetido a estudo contrastado do esôfago, que demonstrou falha de enchimento irregular. A biópsia confirmou a presença de carcinoma de células escamosas. Este é o primeiro relato na literatura latino-americana (Lilacs) de carcinoma de esôfago com invasão de canal medular e manifestação inicial de síndrome de compressão medular.