Objective Hürthle cell carcinomas (HCCs) of the thyroid have been recently reclassified as a separate entity due to their distinct clinical and molecular profiles. Few studies have assessed the ability of preoperative characteristics in differentiating HCCs from Hürthle cell adenomas (HCAs) due to the low prevalence of both lesions. This study aimed to compare the preoperative features of HCCs and HCAs and evaluate the diagnostic performance of ultrasound in distinguishing between both. Subjetcs and methods Retrospective study including 101 patients (52 HCCs and 49 HCAs) who underwent thyroid surgery from 2000 to 2016. Clinical, ultrasonographic, and histological data were reviewed. Diagnostic performance of suspicious sonographic features was analyzed in 51 cases (24 HCCs and 27 HCAs). Results Hürthle cell neoplasms were predominant in females. Subjects ≥ 55 years represented 58% of the cases of HCCs and 53% of those of HCAs. Carcinomas were significantly larger (p < 0.001), and a tumor size ≥ 4 cm significantly increased the risk of malignancy (odds ratio 3.67). Other clinical, cytologic, and sonographic data were similar between HCCs and HCAs. Among the HCCs, the lesions were purely solid in 54.2%, hypoechoic in 37.5%, and had coarse calcifications in 12.5%, microcalcifications in 8.3%, irregular contours in 4.2%, and a taller-than-wide shape in 16.7%. Predominantly/exclusive intranodular vascularization was observed in 52.6%. Overall, 58% of the HCCs were classified as TI-RADS 4 or 5 compared with 48% of the HCAs. TI-RADS 4 or 5 had a specificity of only 51.8% and a positive likelihood ratio of 1.21. Conclusions Apart from the lesion size, no other preoperative feature adequately distinguished HCCs from HCAs. Sonographic characteristics raising suspicion for malignancy, which are mostly present in papillary carcinomas, were infrequent in HCCs. New tools must be developed to improve preoperative diagnosis and deferral of surgery in cases of adenomas.

Coronary computed tomography angiography (coronary CTA) is a powerful non-invasive imaging method to evaluate coronary artery disease. Nowadays, coronary CTA estimated effective radiation dose can be dramatically reduced using state-of-the-art scanners, such as 320-row detector CT (320-CT), without changing coronary CTA diagnostic accuracy. To optimize and further reduce the radiation dose, new iterative reconstruction algorithms were released recently by several CT manufacturers, and now they are used routinely in coronary CTA. This paper presents our first experience using coronary CTA with 320-CT and the Adaptive Iterative Dose Reduction 3D (AIDR-3D). In addition, we describe the current indications for coronary CTA in our practice as well as the acquisition standard protocols and protocols related to CT application for radiation dose reduction. In conclusion, coronary CTA radiation dose can be dramatically reduced following the “as low as reasonable achievable” principle by combination of exam indication and well-documented technics for radiation dose reduction, such as beta blockers, low-kV, and also the newest iterative dose reduction software as AIDR-3D.

Introdução: O tumor sólido pseudopapilar do pâncreas (tumor de Frantz) é uma neoplasia sólido-cística de células exócrinas que corresponde a cerca 0,2-2,7% de todos os tumores pancreáticos. Trata-se de doença rara, com baixo potencial de malignidade, que acomete preferencialmente em mulheres jovens, com média de idade de 25 anos. A ressecção cirúrgica completa da lesão é o tratamento de escolha, e o prognóstico é excelente. Objetivo: Relatar um caso desafiador de tumor de Frantz com apresentação clínico-radiológica atípica, em que os exames de imagem tiveram importância fundamental para elucidação diagnóstica e no manejo terapêutico. Relato de Caso: Paciente do gênero feminino, 31 anos, apresentando anemia crônica, hematêmese, melena e hematoquezia. A endoscopia digestiva alta evidenciou úlcera em atividade no bulbo duodenal. A tomografia revelou massa expansiva localizada entre a cabeça pancreática e o duodeno, com sinais de ulceração. As principais hipóteses diagnósticas eram tumor estromal gastrointestinal (GIST) ou tumor de Frantz. A ressonância magnética caracterizou íntima relação da lesão com o tecido pancreático, deixando o diagnóstico de tumor de Frantz como a hipótese mais provável. A paciente foi submetida a duodenopancreatectomia total para ressecção e tratamento definitivo da lesão. A imunohistoquímica revelou células com citoplasma eosinofílico indistinto e núcleos hipercromáticos, por vezes com arranjos pseudopapilíferos, bem como expressão para betacatenina em padrão nuclear e positividade para CD10 e CD99, confirmando se tratar de um tumor sólido pseudopapilar do pâncreas. Conclusão: Observa-se a importância dos exames de imagem para caracterização e diagnóstico assertivo desse tipo de tumor, possibilitando a ressecção completa da lesão e perspectiva de cura da doença.

Acromegaly is an uncommon metabolic disorder, often diagnosed after a long delay. One symptom seen in many patients with acromegaly is arthralgia, a finding that calls for the use of conventional radiography, which can reveal subtle changes that can go unnoticed. The objective of this pictorial essay is to portray the radiographic aspects of acromegaly, seeking to demonstrate the importance of conventional radiography, which, despite its simplicity, can suggest the diagnosis, even in the early stages, thus altering the clinical course of the disease.

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