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Manifestaciones pulmonares en pacientes con sida
Autores: Cristina Afione, Alejandra Della Sala, Laura Frank
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Resumen:
El HIV produce una infección crónica que conduce a
una severa inmunodepresión. El individuo infectado
desarrolla un HIV sintomáticos que, sin tratamiento,
progresa a sida, con una alta incidencia de infecciones
oportunistas (IO) o enfermedades malignas agregadas.
El pulmón es uno de los órganos más afectados en el
huésped inmunocomprometido por causas infecciosas
o neoplásicas.
El tipo de afección pulmonar que desarrollarán estos
pacientes depende del estadio de la enfermedad, el
cual se determina, por lo general, sobre la base del
recuento de linfocitos CD4.
La introducción de una terapia combinada de antiretrovirales
y antibióticos profilácticos ha producido
cambios que se manifiestan en la reducción del número
de infecciones por agentes patógenos comunes más
virulentos y un aumento simultáneo de la morbilidad
debido a agentes menos virulentos.
Para realizar un diagnóstico más certero del tipo de
enfermedad es importante tener en cuenta los factores
de riesgo del paciente y el medio por el que se adquirió
la infección por HIV.
Las imágenes, siempre basadas en la clínica, son una
herramienta fundamental en el diagnóstico de las
enfermedades pulmonares en pacientes con sida sintomático.
Permiten reconocer el patrón radiográfico que
suelen tener las diferentes IO y neoplasias, hacer el
diagnóstico diferencial de las patologías posibles y
monitorear la respuesta al tratamiento.
Se muestran radiografías simples y Tomografía
Computada (TC) de las siguientes patologías: neumonía
y bronquitis bacterianas; infecciones por nocardia,
rodococcus equi, bartonella henselae, micóticas, micobacterianas,
virales y parasitarias; neoplasias y enfermedades
no infecciosas ni malignas.
Palabras clave:
Pacientes inmunocomprometidos,
HIV, neumonía bacteriana, bronquitis bacteriana,
infecciones virales, citomegalovirus, infecciones micóticas,
Pneumocystis jiroveci, TBC, nódulos pulmonares
en HIV, sarcoma de Kaposi, linfoma
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Abstract
Pulmonary manifestations in patients with AIDS
The HIV virus causes a chronic infection that leads to severe
immunosuppression. The infected individual develops
symptomatic HIV, which, untreated, progresses to AIDS,
with a high incidence of associated opportunistic infections
(OI) or malignancies.
The lung is one of the most affected organs in the immunocompromised
host, for infectious or neoplastic causes.
The type of pulmonary condition to be developed by AIDS
patients will depend on the stage of disease, which is generally
determined based on the CD4 lymphocyte count.
The introduction of combination anti-retroviral therapy and
the use of prophylactic antibiotics have resulted in changes
that are evidenced by a reduction in the number of infections
caused by more virulent traditional pathogens and a simultaneous
increase in morbidity due to less virulent organisms.
In order to make an accurate diagnosis of the type of disease
it is important to consider the patient’s risk factors and how
the patient has acquired HIV infection.
Imaging, always based on clinical information, is an essential
tool in the diagnosis of pulmonary diseases in patients
with symptomatic AIDS. It makes it possible to recognize
the radiographic pattern of the various OIs and neoplasms,
to make a differential diagnosis of potential diseases and to
monitor the response to treatment.
Plain radiographs and computed tomography (CT) scans of
the following conditions are shown: bacterial pneumonia
and bronchitis; infections caused by nocardia, rodococcus
equi, bartonella henselae; fungal, mycobacterial, viral and
parasitic infections; neoplasms, and non-infectious and nonmalignant
diseases.
Key Words:
Immunocompromised patient, HIV, bacterial
pneumonia, bacterial bronchitis, viral infection,
cytomegalovirus, fungal infection, Pneumocystis jiroveci
pneumonia, pulmonary tuberculosis, pulmonary nodules in
HIV, Kaposi sarcoma, lymphoma.
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Cuantificación del signo de la arteria cerebral
media hiperdensa con TCMD
Autor: Francisco Meli, Javier Vallejos, Claudia Álvarez, Carlos Capuñay, Patricia Carrascosa
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Resumen:
Objetivos. Obtener una cuantificación absoluta y relativa
de la densidad en el signo de la arteria cerebral
media (ACM) con el fin de lograr un valor objetivo
para el diagnóstico temprano de isquemia cerebral
aguda con TCMD.
Materiales y Métodos. Se incluyeron 40 pacientes, 20
con sospecha de isquemia cerebral aguda (edad media
73,4 años) y 20 pacientes controles (edad media 71,2
años, p=0,63), que se realizaron TC cerebral con un
equipo de 64 filas de detectores. La cuantificación
absoluta se realizó midiendo la densidad en UH en el
segmento de la ACM visualmente de mayor densidad.
También se midió la densidad en el mismo segmento
de la ACM contralateral para calcular la diferencia
entre ambas arterias (cuantificación relativa).
Resultados. En pacientes casos, la densidad media de
la ACM afectada (62,5 UH, IC 99%: 46,2-78,7) fue
mayor que la de la ACM contralateral (39,3 UH, IC
99%: 33,3-45,3) (p=0,0004) y también fue mayor en
comparación con la ACM en pacientes controles (44,7
UH, IC 99%: 37,4-52) (p=0,0045).
En la cuantificación relativa, la diferencia media entre
la densidad de la ACM afectada y la de ACM contralateral
en los pacientes casos fue de 23,2 UH (IC 95%:
11,7-34,7), mientras que, en pacientes controles, la diferencia
media entre la densidad de la ACM derecha y la
ACM izquierda fue 5,2 UH (IC 95%: 2,4-8,4) (diferencia:
17,8 UH, p=0,0032, IC 95%: 6,8-28,8).
Conclusión. Mostramos diferencias significativas
(absolutas y relativas) en la densidad de la ACM en
pacientes con sospecha de isquemia cerebral aguda en
comparación con sujetos normales.
Palabras clave:
Accidente cerebro vascular. Arteria
cerebral media. Tomografía computada multidetector.
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Abstract
Quantification of hyperdense middle cerebral artery
sign by multidetector computed tomography (MDCT).
Purposes. To obtain absolute and relative quantification
values of density in the middle cerebral artery (MCA) sign,
in order to obtain an objective value for an early diagnosis of
acute ischemic stroke using MDCT.
Material and Methods. Forty adult patients, 20 with suspected
diagnosis of acute ischemic stroke (mean age: 73.4
years) and 20 controls (mean age: 71.2 years, p=0.63),
underwent brain CT scans with a 64-row multi-detector
scanner (Brilliance 64; Philips Medical Systems). Absolute
quantitative analysis was assessed by tracking tissue density
of the MCA segment using region of interests. For relative
quantification, density in the same segment of the contra-
lateral MCA was measured to calculate the difference
between both arteries.
Results. In cases, mean density of affected MCA (62.5 HU,
99% CI: 46.2 – 78.7) was greater than that of the contra-lateral
MCA segments (39.3 HU, 99% CI: 33.3-45.3)
(p < 0.0004) and also greater than that of controls (44.7 HU,
99% CI: 37.4-52) (p=0.0045).
In relative quantification, the mean difference between density
of the affected MCA and that of contra-lateral MCA in
cases was 23.2 HU (95% CI: 11.7-34.7), while in controls
the mean difference between the right MCA density and the
left MCA density was 5.2 HU (95% CI: 2.4-8.4) (difference:
17.8 HU, p = 0.0062, 95% CI: 6.8-28.8).
Conclusion. We showed significant (relative and absolute)
differences in MCA density in patients with suspected acute
ischemic stroke as compared to normal subjects.
Key Words:
Middle cerebral artery. Multidetector computed
tomography. Stroke.
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Cancerização de lóbulos: correlação de achados mamográficos
e histológicos
Autores: Alberto Domingues Vianna, Taísa Davaus Gasparetto, Gisela Costa Torres, José Carlos Saddy,
Edson Marchiori
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Resumo:
Objetivo: Caracterizar os aspectos mamográficos de cancerização de lóbulos associados a carcinoma ductal in situ
(CDIS), por meio de correlação entre achados de imagem e histológicos.
Materiais e Métodos: O presente estudo
retrospectivo foi baseado em uma revisão de laudos histopatológicos de 135 pacientes submetidas a biópsia de mama.
O diagnóstico de cancerização de lóbulos associada a CDIS foi confirmado em 12 das pacientes. Dois casos foram
excluídos porque os cortes histopatológicos não estavam disponíveis para correlação da patologia com a mamografia.
Todas as imagens mamográficas foram retrospectivamente analisadas às cegas quanto aos resultados histológicos e
classificados por dois experientes radiologistas especializados em mama.
Resultados: Nove casos (90%) apresentavam
microcalcificações redondas agrupadas e um (10%) apresentava calcificações lineares. A distribuição das calcificações
foi definida como lobular em todos os casos. A análise histopatológica demonstrou quatro casos de CDIS
cribriforme, dois casos de comedocarcinoma, um caso de CDIS sólido, um caso de CDIS cribriforme associado com
sólido e um caso de CDIS cribriforme associado com sólido e comedocarcinoma. No caso em que havia calcificações
redondas e lineares, o subtipo histológico era de CDIS cribriforme. Com relação ao número de microcalcificações, nove
casos apresentavam mais do que 20 e apenas um caso apresentava menos do que 10 microcalcificações.
Conclusão:
Na presente coorte, a avaliação mamográfica de pacientes com CDIS apresentando cancerização de lóbulos
demonstrou agrupamentos de microcalcificações redondas com distribuição lobular. Embora agrupamentos de calcificações
redondas sejam normalmente associados a um processo benigno, a cancerização de lóbulos por CDIS pode
produzir um padrão similar, mimetizando, assim, uma condição benigna.
Unitermos:
Mamografia; Carcinoma ductal in situ; Microcalcificações.
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Cancerization of lobules: correlation between mammography
and histological findings
Abstract
Objective: To characterize the mammographic appearance of cancerization of lobules by ductal carcinoma in situ (DCIS),
by correlating imaging and histological findings.
Materials and Methods: This retrospective study was based on a
review of the histopathological reports of 135 patients who underwent breast biopsy. A diagnosis of cancerization of
lobules by DCIS was confirmed in 12 patients. Two cases were excluded because the histopathological sections were
not available to correlate pathological and mammographic findings. All mammograms were retrospectively reviewed
and categorized by two experienced breast radiologists, with no knowledge of the histological findings.
Results: Nine
cases (90%) presented clusters of round microcalcifications, and one (10%) had round and linear calcifications. The
distribution of the calcifications was defined as lobular in all the cases. Histopathological study showed four cases of
cribriform DCIS, two cases of comedo DCIS, one case of solid DCIS, one case of cribriform associated with solid DCIS,
and one case of cribriform associated with solid and comedo DCIS. In the case showing round and linear calcifications,
the histological subtype was cribriform DCIS. With respect to the number of microcalcifications, nine cases presented
more than 20, and only one case showed less than 10 microcalcifications.
Conclusion: In our cohort, the mammographic
evaluation of patients with DCIS presenting cancerization of lobules demonstrated clusters of microcalcifications in a
lobular distribution. Although clusters of round calcifications are typically associated with a benign process, cancerization
of lobules by DCIS may produce a similar pattern, thus mimicking a benign condition.
Key Words:
Mammography; Ductal carcinoma in situ; Microcalcifications.
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Espessamento parietal da vesícula biliar no exame
ultrassonográfico: como interpretar?
Autores: Aldo Benjamim Rodrigues Barbosa, Luis Ronan Marquez Ferreira de Souza, Rogério Silva
Pereira, Giuseppe D’Ippolito
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Resumo:
O objetivo desta revisão é fornecer auxílio na interpretação correta do espessamento das paredes da vesícula biliar e
seus possíveis diagnósticos diferenciais. O espessamento da vesícula biliar é um achado frequente em exame de ultrassonografia
e um tema de grande interesse, por ter sido considerado durante muito tempo como sinal específico de
colecistite aguda, apesar de se reconhecer que ocorre em uma série de outras situações clínicas. A adequada caracterização
e interpretação desse achado é de grande importância, pois o diagnóstico correto tem impacto direto no
tratamento, que em alguns casos inclui intervenção cirúrgica. Neste artigo procuramos apresentar um conjunto de
sinais ultrassonográficos que, associados ao quadro clínico e laboratorial do paciente, permitem restringir as alternativas
diagnósticas e estabelecer, com maior precisão, a causa do espessamento parietal da vesícula biliar, através de
uma avaliação racional dos dados obtidos.
Unitermos:
Vesícula biliar; Ultrassonografia; Inflamação; Neoplasia.
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Gallbladder wall thickening at ultrasonography: how to interpret it?
Abstract:
The present review was aimed at providing help for correct interpretation of gallbladder wall thickening and differential
diagnosis at ultrasonography. Gallbladder wall thickening is a frequent sonographic finding and has been subject of
great interest for being considered as a hallmark feature of acute cholecystitis, despite the fact that such a finding is
observed in a number of other medical conditions. An appropriate characterization and interpretation of this finding is
of great importance, considering that the correct diagnosis has a direct impact on the treatment that in some cases
includes surgery. In the present article, the authors describe a set of sonographic signs that, in association with clinical
and laboratory findings can reduce the number of diagnostic hypotheses allowing a more accurate establishment of
the cause for gallbladder wall thickening through a rational data evaluation.
Key Words:
Gallbladder; Ultrasonography; Inflammation; Neoplasm.
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Signo de “rueda de carreta” en los nódulos tiroídeos.
¿Sinónimo de benignidad?
Autores: Drs. Eleonora Horvath, Felipe González I, Claudio Silva F, Álex Castro M, Sergio Majlis D, Juan P. Niedmann
E, Carolina Whittle P, Daniel Gaete D.
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Resumen:
La patología nodular tiroidea es altamente prevalente. La mayoría de los nódulos son asintomáticos
y solo identificados en imágenes. Hemos establecido la relación entre una morfología especial del nódulo en
“rueda de carreta” e histología benigna. Se realizó una revisión de la base de datos de nódulos puncionados
bajo US y estudiados histológicamente entre 2003 y 2011. Criterios de selección: nódulos mixtos/sólidos,
redondos/ovales, rodeados por un halo, presentando estructuras convergentes hacia un punto central con o
sin calcificaciones y vasos periféricos con otros orientados hacia el centro del nódulo. De 3.204 nódulos puncionados
79 (2,5%) presentaron el signo. Tamaño promedio: 28,3 mm. Cincuenta y ocho resultaron nódulos
coloideos benignos en PAAF. El resto fueron informados como lesiones foliculares (4 operados benignos, 7
en seguimiento y estables, 10 sin información).
Este signo es poco frecuente, pero puede ser un elemento más que colabore en la discriminación ecográfica
de benignidad/malignidad, especialmente en nódulos tiroideos de gran tamaño.
Palabras Clave:
Benignidad, Nódulos tiroídeos, Rueda de carreta, Ultrasonido.
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The “spoke wheel” sign in thyroid nodules: Synonym of benignity?
Abstract:
Thyroid nodular disease is a highly prevalent condition. Most nodules are asymptomatic and only identifiable on images. We have established a relationship between the particular “spoke wheel” pattern of thyroid masses and a benign histology. A review of our institutional database of thyroid punctured under ultrasound
guidance, histologically studied between 2003 and 2011, was performed. Node selection criteria included: mixed /solid, round /oval, surrounded by a halo, with radial structures converging toward a central point, with or without calcifications, and with peripheral vessels along with others oriented toward the center of the thyroid masses. Seventy-nine (2.5%) out of 3.204 punctured masses exhibited this sign.
Average size: 28.3 mm. Fifty-eight masses were benign colloid nodules as diagnosed on FNA biopsy. Remaining masses corresponded to Lesion Follicular (4 benign, surgically treated; 7 under follow-up, stable; 10 with no information). Despite being a rare radiologic finding, the “spoke wheel” sign may be another element contributing
to ultrasonographic discrimination between benignity and malignancy, especially in large thyroid masses.
Key Words:
Benignity, “Spoke wheel” sign, Thyroid masses, Ultrasound.
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Procedimientos intervencionales guiados por ultrasonido
en radiología musculoesqueléticaAutores: Drs. Julio Rosales L, Sebastián Butrón M, Christian Linderman R, Marcos Verdugo P, Giancarlo Schiappacasse F,
Roberto Yañez D.
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Resumen:
El ultrasonido es una modalidad imaginológica útil para el estudio de múltiples estructuras,
tales como tejidos subcutáneos, tendones, músculos, articulaciones y nervios. Tiene un bajo costo, amplia
disponibilidad y alta resolución. Estas ventajas hacen del ultrasonido una excelente modalidad en
procedimientos intervencionales tales como biopsias de tejidos de partes blandas, aspiración de quistes
y otras colecciones y también en el tratamiento de calcificaciones sintomáticas, tales como depósitos de
cristales de hidroxiapatita de calcio en el manguito rotador. Este artículo desea mostrar la experiencia de los
autores en la realización de procedimientos intervencionales musculoesqueléticos guiados por ultrasonido.
Palabras Clave:
Musculoesquelético, Procedimientos Intervencionales, Ultrasonido.
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Ultrasound guided interventional procedures in musculoskeletal
radiology
Abstract:
Ultrasound is a useful diagnostic modality to study many structures such as subcutaneous
tissue, tendons, muscles, joints, and nerves. It has low cost, wide availability and high resolution. These
advantages make ultrasound a good modality in interventional procedures like soft tissue tumors biopsy,
aspiration of cysts and other collections, and also in treating symptomatic calcifications like deposition of
hidroxiapatite crystals in the rotator cuff, among other indications. Our objetive is to present the experience
of the authors in performing musculoskeletal interventional procedures by ultrasound.
Key Words:
Interventional procedures, Musculoskeletal, Ultrasound.
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Detección de hiperplasia
de paratiroides por
ultrasonografía y correlación
con signos clínicos y de
laboratorio en pacientes con
enfermedad renal crónica
Autores: César Augusto Restrepo Valencia,
David Santacruz Pacheco,
Campo Elías Castillo Pinilla,
José Arnoby Chacón Cardona
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Resumen:
Objetivo: Determinar la correlación entre la hiperplasia de paratiroides detectada
por ecografía de alta resolución y variables clínicas y de laboratorio en pacientes con
hiperparatiroidismo secundario a enfermedad renal crónica (ERC) estadio 5 en terapia
dialítica en RTS Ltda, sucursal Caldas, Hospital Santa Sofía, Hospital Infantil.
Métodos: A los
pacientes detectados se les practicó ultrasonografía de tiroides y paratiroides con un equipo
de alta resolución. Se analizaron variables como etiología, duración de la ERC, tiempo en
terapia dialítica, tipo de diálisis, presencia de síntomas relacionados con hiperparatiroidismo
(dolor óseo, fracturas, prurito) y las variables de laboratorio PTH intacta, calcio, fósforo,
producto calcio por fósforo y fosfatasa alcalina.
Resultados: De 403 pacientes evaluados,
92 cumplieron con los criterios de inclusión y se realizó ultrasonografía en 86. En este
grupo de pacientes la causa más común de ERC fue nefroesclerosis hipertensiva, con un
tiempo promedio en diálisis de 61,4 ± 36,6 meses. De los pacientes, 37 se encontraron en
diálisis peritoneal y 49 en hemodiálisis. La correlación entre las variables de laboratorio y
la presencia de hiperplasia de paratiroides no demostró significancia estadística cuando se
comparó contra el grupo sin documentación ecográfica de crecimiento glandular paratiroideo.
Conclusión: La hiperplasia de paratiroides puede estar presente en cualquier paciente con
ERC estadio 5 y valores de PTH intacta mayores a 400 pg/ml, independientemente de
sus variables clínicas y de laboratorio. Es necesario practicarle ultrasonografía a todos los
pacientes con cifras altas de PTH, con el fin de asignarles una terapia eficiente.
Palabras clave: Hiperplasia,
Ultrasonografía,
Hiperparatiroidismo secundario,
Fallo renal crónico
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Abstract
ULTRASOUND DETECTION OF
PARATHYROID HYPERPLASIA AND
CORRELATION WITH CLINICIAL AND
LABORATORY FINDINGS IN PATIENTS
WITH CHRONIC KIDNEY DISEASE
Objective: To determine whether there is any correlation between parathyroid hyperplasia,
as detected by high-resolution ultrasound, and clinical and laboratory variables in patients with
hyperparathyroidism secondary to stage-5 chronic kidney disease (CKD) on hemodialysis.
Design: Descriptive. Location: RTS Ltda. Renal Unit in Caldas, Santa Sofía Hospital and
Children’s Hospital. Patients: All patients, 18 years of age, with stage – 5 CKD who were
on dialysis therapy (hemodialysis or peritoneal dialysis), and with PTH levels greater than
400 pg / ml. Methods: After giving their written consent to participate in the study, all patients
underwent high-resolution thyroid and parathyroid ultrasound (Phillips Team Enviisor CHD - 12
MHz transducer) performed by a medical specialist in radiology. Variables such as etiology,
duration of the CKD, time on dialysis therapy, type of dialysis, presence of symptoms related
to hyperparathyroidism (bone pain, fractures, pruritus),and laboratory variables like an intact
PTH, calcium, phosphorus, calcium x phosphorus, and alkaline phosphatase were analyzed
in order to determine if there was a significant correlation between the variables and the
detection of parathyroid hyperplasia documented by high resolution ultrasound. Results: Of
403 patients evaluated, 92 met the inclusion criteria, 86 were scanned and 6 were excluded.
In these patients, the most common cause of CKD was hypertensive nephrosclerosis. Thirtyseven
patients were on peritoneal dialysis and 49 on hemodialysis, with an average time on
dialysis of 61.4 ± 36.6 months. The average levels of PTH in pg / mL were 829,465 ± 473,631.
The most prevalent clinical symptom was bone pain, found in 52.2% of patients. Ultrasound
showed enlarged parathyroid glands in 30 patients (34.88%), with single-gland hyperplasia in
23 (26.74%), two-gland hyperplasia in 4 (4.65%) and three-gland hyperplasia in 3 (3.48%). The
correlation between laboratory variables and the presence of parathyroid hyperplasia showed
no statistical significance when compared with the group without ultrasound documentation
of enlarged parathyroid glands. Conclusion: Parathyroid hyperplasia may be present in any
patient with stage-5 CKD and intact PTH levels greater than 400 pg/ml, regardless of the
clinical and laboratory variables. Ultrasound should be performed in all patients with high
PTH values in order to refer them to the appropriate therapy. Key words: Hyperplasia
Ultrasonography
Hyperparathyroidism, secondary
Kidney failure, chronic
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Orina particulada: ¿se
correlaciona con infección
urinaria?
Autores: Catalina Wilches,
Andrea Gallo,
Ángela Moreno,
Óscar Rivero,
Javier Romero
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Resumen:
Introducción: La infección de las vías urinarias (IVU) es una entidad frecuente en los
servicios de urgencias que requiere diagnóstico y manejo oportuno para evitar posibles
complicaciones. En su diagnóstico, el uroanálisis es el estudio empleado en urgencias.
La ecografía de vías urinarias se utiliza para descartar complicaciones y variantes
anatómicas que predispongan a IVU y no para el diagnóstico de la entidad, que se hace
fácilmente con la clínica y los hallazgos de laboratorio. Objetivo: Evaluar si el aspecto
particulado de la orina identificado en la ecografía de vías urinarias se relaciona con IVU.
Métodos: Se realizó un análisis descriptivo de variables como edad, diagnóstico inicial
y diagnóstico final, determinando su relación y estableciendo características operativas
(sensibilidad, especificidad, valores predictivos y razones de probabilidad). Resultados: El
70% de los pacientes con IVU eran los mayores de 65 años; el 56,5% de los que presentaban
orina de aspecto particulado en la ultrasonografía tenían IVU y el 34% no presentaba orina
particulada en el ultrasonido y cursaban con IVU. Conclusión: En el ultrasonido es frecuente
el reporte del aspecto particulado de la orina. Ello sugiere correlación con uroanálisis por
parte del radiólogo para descartar IVU; sin embargo, la literatura no refiere este hallazgo
como indicativo de infección. En esta serie de casos, la orina particulada presenta baja
especificidad y sensibilidad intermedia, lo cual indica que el hallazgo de “orina particulada”
en el ultrasonido no es criterio diagnóstico de IVU.
Palabras clave: Orina,
Ultrasonografía,
Enfermedades urológicas,
Sistema urinario
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Abstract
PARTICULATE ECHOES WITHIN
THE BLADDER: DOES THIS
FINDING CORRELATE WITH
URINARY TRACT INFECTION?
Urinary tract infection (UTI) is a common disorder in the emergency department,
requiring timely diagnosis and appropriate management to avoid potential complications.
Urinalysis is used in the emergency department for diagnosis. Renal and urinary tract ultrasound
is used to rule out complications and anatomic variants that may predispose to UTI, yet not for
diagnosis, considering that a urinary tract infection is better identified on the basis of clinical and
laboratory findings.
Objective: To determine whether particulate echoes found on urinary tract
ultrasound correlate with urinary tract infection. Methods: Descriptive analysis of variables such
as age, initial diagnosis and final diagnosis of patients presenting to the emergency department
between January and May 2010. The relationship between the variables was determined and
the operational characteristics (sensitivity, specificity, predictive values and likelihood ratios)
were established. Results: Seventy per cent of the patients with UTI were older than 65 years;
56.5% of patients with a finding of particulate echoes in the bladder on ultrasound had urinary
tract infection; and 34% had a urinary tract infection but did not show particulate echoes.
Conclusion: Particulate echoes within the bladder are frequent in ultrasound reports and they
should be correlated with urinalysis results in order to rule out a UTI. However, in the literature,
this finding is not considered as an indication of infection. In our case series, particulate urine
had low specificity and intermediate sensitivity, indicating that this finding is not an adequate
diagnostic criterion for UTI.
Key words:Urine
Ultrasonography
Urologic diseases
Urinary tract
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Utilidad de la resonancia magnética en el cáncer de próstata
Autores: J.C. Vilanovaa, J.Comet, R.Garcia-Figueiras, J.Barceló y M.Boada
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Resumen:
Los avances técnicos de la resonancia magnética (RM) en la última década hacen que se considere la técnica de elección en el manejo global del paciente con sospecha o diagnóstico de cáncer de próstata. La RM permite combinar información morfológica y funcional al mismo tiempo mediante la aplicación de secuencias como la espectroscopia, difusión y secuencias dinámicas con contraste endovenoso en el mismo estudio. La RM permite no solo focalizar el estudio en la glándula sino valorar también la extensión regional a toda la pelvis o a todo el cuerpo dependiendo de la indicación clínica, en menos de 1 hora de exploración. Las principales indicaciones clínicas de la RM de próstata son: a) estadificación local, regional o a distancia; b) detección o guía para biopsia diagnóstica ante la sospecha clínica o resultado negativo en biopsias previas; y c) monitorización terapéutica. Es preciso conocer los distintos protocolos con secuencias específicas en RM de próstata, dependiendo de las diferentes indicaciones clínicas, para su correcta realización e interpretación. Este artículo pretende ser una actualización en la utilización de la RM de próstata en el manejo del cáncer de próstata, describiendo un enfoque útil que permita aplicar la información morfológica y funcional en la práctica clínica.
Palabras Claves: Neoplasia de próstata; Imagen por resonancia magnética; Espectroscopia; IRM difusión; Medio de contraste
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Usefulness of magnetic resonance imaging in prostate cancer
Abstract:
In the last decade, technical advances in magnetic resonance imaging (MRI) have made it the
technique of choice in the overall management of patients with suspected or confi rmed prostate
cancer. MR makes it possible to acquire information about morphology and function in the same
examination by using techniques like spectroscopy, diffusion, and dynamic sequences with
intravenous contrast material administration. Moreover, MRI enables both focused study of the
prostate gland and of regional and/or whole-body involvement, depending on the clinical
indications, in less than an hour. The main clinical indications for MRI of the prostate are a)
staging local, regional, and/or remote disease; b) detecting prostate cancer or guiding prostate
biopsy in cases of clinical suspicion or negative fi ndings in previous biopsy specimens; and c)
monitoring the response to treatment. It is important to know the different protocols with
specifi c MRI sequences for the prostate, depending on the different clinical indications, to
ensure that they are performed and interpreted correctly. This article provides up-to-date
information about the use of MRI for the study of the prostate to show how the morphological
and functional information can be used in clinical practice.
Palabras Claves: Prostate tumors;
Magnetic resonance
imaging;
Spectroscopy;
Diffusion MRI;
Contrast agent.
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Utilidad de la ecografía con contraste en la práctica clínica diaria.
Autores: C. Nicolau Molina, T.Fontanilla Echeveste, J.L.Del Cura Rodríguez, F.Cruz Villalón, T. Ripollés González, B.Baudet Naveros, Ma .J. Velasco Marcos, C. Garre Sánchez, R.Huertas Arroyo, L. Hernández García, S.J. Pitti Reyes, R.A. Gómez Rodríguez, Ma. J. Calvo López, A. Maroto Genover, G. Álvarez Bustos, M. Poch Zatarain y A. Talegón Meléndez
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Resumen:
Objetivos: El objetivo de este estudio multicéntrico ha sido evaluar si la ecografía con contraste
permite aumentar el rendimiento diagnóstico de la ecografía basal.
Material y métodos: En este estudio prospectivo multicéntrico realizado en 42 hospitales se
incluyeron 1.786 pacientes con estudios ecográf icos considerados como no concluyentes. El
84,9 % fueron ecografías abdominales (incluyendo estudios hepáticos, renales, esplénicos y de
otras localizaciones), el 6,2 % fueron estudios vasculares periféricos, el 4,3 % fueron estudios
mamarios y el 4,6 % fueron estudios de otras localizaciones. Se evaluó el tipo de ecografía con
contraste (Doppler color o método específico de contraste), el tipo de contraste, la dosis y el
número de dosis y el tipo de administración (en forma de bolo o infusión). Sobre los hallazgos
obtenidos en la ecografía con contraste se valoró si conseguía aumentar el rendimiento
diagnóstico de la ecografía basal y si permitía un diagnóstico concluyente.
Resultados: El 99,9 % de los estudios se realizó con SonoVue, con una dosis de contraste (84,8 %)
y en forma de bolo (98,5 %). En el 91,6 % de los casos la ecografía con contraste aumentó el
rendimiento diagnóstico de la ecografía basal, y en el 69,2 % permitió un diagnóstico de certeza.
El mayor rendimiento diagnóstico se obtuvo en los estudios de troncos supraaórticos con un
diagnóstico definitivo en el 95,4 % de los casos, seguido por el área abdominal con resultado
concluyente en el 72,6 % de los casos.
Conclusiones: El uso de la ecografía con contraste aumentó significativamente el rendimiento
diagnóstico de la ecografía basal, y se obtuvo un resultado concluyente en la mayoría de los
casos.
Palabras Claves:
Ecografía;
Medios de contraste;
Ecografía con
contraste
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Usefulness of contrast-enhanced ultrasonography in daily clinical practice: A multicenter study in Spain
Abstract:
Objectives: We aimed to determine whether the use of ultrasonographic contrast agents
improves the diagnostic accuracy of ultrasonography (US).
Material and methods: We carried out a prospective multicenter study in 42 hospitals. We
included 1786 patients with inconclusive US; 84.9 % of the inconclusive studies were abdominal
US (including studies of the liver, kidneys, spleen, and other sites), 6.2 % were studies of the peripheral vessels, 4.3 % were breast studies, and 4.6 % were other studies. We evaluated the
type of contrast-enhanced US (color Doppler or contrast-specifi c method), type of contrast
agent, dose and number of doses, and type of administration (bolus or infusion). We evaluated
whether the fi ndings at contrast-enhanced US improved the diagnostic accuracy of unenhanced
US and whether they enabled a conclusive diagnosis to be reached.
Results: The contrast agent SonoVue was used in 99.9 % of the studies; a single dose of contrast
agent was used in 84.8 %, and the contrast agent was administered in bolus in 98.5 %.
Contrast-enhanced US improved the diagnostic accuracy in 91.6 % of cases and enabled a
conclusive diagnosis in 69.2 %. The best diagnostic accuracy was obtained in the supraaortic
vessels, where a defi nitive diagnosis was reached in 95.4 % of cases, followed by the abdominal
area, with a conclusive diagnosis in 72.6 % of cases.
Conclusions: The use of contrast-enhanced US signifi cantly improved the diagnostic accuracy of
US and enabled a conclusive diagnosis in most cases.
Key Words:
Ultrasonography;
Contrast agents;
Contrast-enhanced
ultrasonography
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Lesiones benignas atípicas en mama
Autores: Mena Olmedo Glenn, PhD , Avalos Paulina, MD , Varela Sara MD, Trujillo Cecilia, MD Ortiz Malena MD, Quishpe Maritza, MD , Pérez Monica V. MD
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Resumen:
El motivo del presente trabajo fue la dificultad que se nos presenta cuando la imagen de algunas lesiones de la mama nos dan resultados histológicamente poco esperados sea por su frecuencia así como por su aspecto poco usual. Incluimos por tanto cinco casos de pacientes con Clasificación de BIRADS 4 A y B, en las que se realizo mamografía, ecografía y biopsia core, adjuntamos también la imagen histopatologica de cada una de ellas, la mayoría de ellas lesiones no proliferativas, únicamente la adenosis esclerosante fue catalogada como lesión proliferativa y por ende requiere un estricto seguimiento, ya que estas lesiones se han relacionado con un riesgo relativo de dos veces más que la población en general de presentar cáncer de mama.
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BREAST ATYPICAL BENIGN LESIONS
Abstract:
The motive of this study was the difficulty we face when the image of some breast lesions histologically give us some expected results evidenced by its frequency as well as its unusual appearance. Therefore included five cases of patients with BIRADS Rating 4 A and B, in which mammography, ultrasound and core biopsy, histopathological image also attached to each of them, most of them non-proliferative lesions, only adenosis sclerosing lesion was classified as proliferative and thus requires close monitoring, because these lesions have been associated with a relative risk of two times the general population of breast cancer.
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Zonificación de la próstata para la biopsia randomizada
guiada por ecografía.
Autores: Mena Olmedo, Glenn, Zúñiga, Marcia, Anrango, Selenita, Pérez de Rocha, Mónica, Pontón, Patrícia, Diaz, Miriam.
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Introducción:
La ecografía transrectal ha cambiado desde el concepto anatómico ( Fig 1) , propuesto por McNeal, hasta la toma de biopsias, mejorando la comprensión de la disposición espacial y la localización de las lesiones . La Tomografía computada multicorte ( TCM) así como la imagen por Resonancia Magnética (RM) se orientan más al estadiaje de las lesiones infiltrativas, mención especial merece la biopsia “virtual” no invasiva por RM realizada por espectroscopia , con el mismo principio utilizado a nivel cerebral. Es una biopsia no invasiva, que permite diferenciar tejido prostático sano del tejido de una neoplasia maligna. Los metabolitos presentes en la próstata, son el citrato, que es el metabolito más abundante y el indicador de una célula prostática normal. ( 4 ) . El tradicional modelo de Mac Neal ( 5 ) dividiendo a la próstata ( PR) en zona periférica, de transición, de las glándulas periuretrales, central y fibromuscular anterior asociado a la ecografía transrectal presenta muchos beneficios; mas aún si se encuentra potencializada por el Angio Doppler, Armónicas (1 ) , 3D y 4D ( fig 3D ) que nos auxilian en el momento de decidir los lugares más adecuados a ser biopsiados. En el Instituto de Diagnóstico Alpha de Quito Ecuador, zonificamos a la glándula en 22 regiones que nos ha permitido randomizar la toma de muestras de una manera organizada y con excelente correlación histopatologíca , además permite encontrar adenocarcinoma “oculto”a la ecografía cuando no los valores de PSA son sugestivos y en los hallazgos prostáticos no encontramos signos que sugieran malignidad. Este último concepto lo estamos realizando actualmente en un proyecto prospectivo con la finalidad de definir la utilidad de la biopsia randomizada, su costo/ beneficio y su potencial utilidad en el descubrimiento de adenocarcinomas incipientes que podría o no a futuro ser o no causa de patología en los pacientes, esa perspectiva aún se encuentra en discusión.
Si bien ya se realiza toma de biopsias múltiples descritas en la literatura ( varias publicaciones) , nosotros proponemos un mapa zonificado para la toma de las biopsia múltiples y que permita una estandarización del método así como una reproductibilidad en otros Institutos u Hospitales, lo que favorecería la orientación de los Urológos y Patológos.
Objetivos:
1) Presentar un mapa anatómico ecográfico de la próstata para la toma de biopsias randomizadas guiadas por ecografía.
2) Comunicar los beneficios encontrados con la utilización de un mapa preestablecido y los resultados obtenidos.
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PROSTATE ZONING FOR RANDOMIZED BIOPSY GUIDED BY ULTRASOUND
Abstract:
Introduction: The transrectal ultrasound has changed from the anatomic view (Fig. 1) proposed by McNeal, to the biopsy sample taking, improving the comprehension of spatial arrangement and lesions location. Multidetector computer tomography (MCT) as well as the Magnetic Resonance Imaging (MRI) are oriented mostly to infiltrative lesions staging, the non-invasive “virtual” biopsy performed through spectroscopy deserving special mention with same principle utilized at brain level. It is a non-invasive biopsy which permits to distinguish healthy prostatic tissue from malign neoplasia. Metabolites present in the prostate are citrate which is the most abundant metabolite and indicator of a normal prostatic cell (4). The McNeal’s traditional model (5) dividing prostate (PR) into peripheral, transition, periurethral glands, and anterior fibro-muscular areas, associated to transrectal ultrasound presents many benefits, moreover if powered by Angio Doppler, Harmonics (1), 3D, and 4D (Fig. 3D) which assist us at the time of deciding the most suitable places for biopsy. At the Alpha diagnostic Institute, Quito, Ecuador the gland was zoned in 22 regions which has let us randomize sample taking in an organized way with excellent histopathological correlation, besides permitting to find adenocarcinoma “hidden” to ultrasound when PSA values are not suggestive and in prostatic findings no malignity suggesting signs were found. This latter concept is being actually realized in a prospective project with the aim of defining the usefulness of randomized biopsy, cost/benefit, and its use in finding incipient adenocarcinomas which, in the future could or not be cause for pathology in patients. That perspective is still under discussion. While multiple biopsy sample taking is already being carried out as described in the literature(several publications), we propose a zoned map for multiple biopsies taking which lets method standardization as well as replying at other Institutes or Hospitals, which would favor orientation to Urologists and Pathologists.
Objectives: 1) Present a prostate ultrasound anatomic map for randomized biopsies taking, ultrasound guided. 2) Let to be known benefits found through the use of a preset map and results obtained.
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Complicaciones de la cirugía hepatobiliar:
Valoración por colangio RM.
Autores: Dibarboure Luis, Braggio Viviana, Fernández Adriana.
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Resumen:
INTRODUCCIÓN
La colangio RM ha surgido como una técnica reciente en nuestro
medio que permite una adecuada valoración anatómica de la vía
biliar, de gran utilidad en esta patología.
OBJETIVO
Determinar su utilidad en pacientes con sospecha de
complicaciones postoperatorias de cirugía hepatobiliar.
MATERIAL Y MÉTODOS
Se evaluaron 25 colangio RM consecutivas derivadas a nuestro
servicio, realizadas a 22 pacientes con sospecha de complicaciones
postoperatorias de cirugía hepatobiliar, en el período
comprendido entre junio de 2008 y julio de 2009.
Los procedimientos quirúrgicos previos a los exámenes realizados
fueron 15 transplantes hepáticos, 5 anastomosis biliodigestivas y 5
colecistectomías.
Se correlacionaron los hallazgos de la colangio RM con la
evolución clínica, parámetros humorales, colangiografía
convencional (en los que se les realizó) y hallazgos quirúrgicos.
Se trabajó con un equipo General Electric 1.5 Tesla Horizon,
Signa LX Echo Speed de 4 canales.
Los estudios fueron revisados por los autores en estación de trabajo
Advantage Windows 4.3.
RESULTADOS
Se logró una adecuada visualización de la vía biliar en 24 estudios
(96 %).
Se identificaron variantes anatómicas en 6 pacientes de los 22
estudiados (27.3 %). De los 20 pacientes con anastomosis biliar se
logró buena visualización en 16 (80 %). Se diagnosticó dilatación
de la vía biliar en 15 estudios, 12 por estenosis y 3 por litiasis y/o
barro biliar. En 15 casos se diagnosticó estenosis (12 con dilatación
biliar y 3 sin ella).
En los 5 casos con probable lesión quirúrgica se confirmó el
diagnóstico y se determinó el nivel de la misma.
CONCLUSIONES
La colangio RM es un método no invasivo de enorme valor en el
estudio de la vía biliar en pacientes con sospecha de complicaciones
derivadas de cirugía hepatobiliar.
Palabras Claves:
colangiografía por Resonancia Magnética,
cirugía hepatobiliar, anastomosis biliodigestivas, etenosis biliar.
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Abstract:
PURPOSE
To retrospectively assess the value of
magnetic resonance (MR) cholangiography
imaging for detection and
characterization of postsurgical lesions of
the biliary tract.
MATERIAL AND METHODS
25 MR cholangiography were performed
in 22 consecutive patients with suspected
biliary complications after hepatobiliary
surgery between June 2008 to July 2009.
Prior surgical procedures were liver
transplantation in 15 exams, biliary enteric
anastomosis in 5 and cholecystectomy in
5.
Examination was performed in a GE 1.5 T
Horizon Sigma LX Echo Speed and images
analyzed in an Advantage Window 4.3
workstation. Sequences included axial fat
sat T2WI, coronal single shot and 3D.
RESULTS
There was an appropriate visualization of
the biliary ductal system in 24 cases (96%).
Anatomical variants were diagnosed in 6
patients (27.3%). Biliary stenosis was
present in 15 cases, 12 with dilation and 3
without dilation. In the 15 cases with
dilation of the biliary ducts the cause was
due to stricture in 12 and to stones or
sludge in 3. Good demonstration of biliar
anastomosis was achieved in 16 of 20
patients (80%).
CONCLUSIONS
MR cholangiography is a useful method
for visualization of the biliary tract and
detection and characterization of
postsurgical lesions.
Key Words:
MR cholangiography,
hepatobiliary surgery, bilio digestive
anastomosis, biliar stenosis.
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Valor de la ecografía modo b
en el diagnóstico de sinusitis maxilar
en el paciente crítico.
Autores: Dres. Fernando Landó, Marcelo Espiñeira, Jorge Baraibar
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Resumen:
Objetivo: establecer el valor de la ecografía (modo B) en el
diagnóstico de sinusitis maxilar en pacientes internados en
cuidados intensivos (UCI). Se consideró diagnostico
imagenológico positivo de sinusitis maxilar la ocupación
liquida parcial o total de la cavidad sinusal.
Diseño del estudio: Estudio prospectivo comparativo y ciego
empleando a la tomografía computada como gold standard.
Material y método: Se incluyeron 50 pacientes adultos,
internados en las UCI de la ciudad de Tacuarembó (Hospital
Regional y Cooperativa Médica de Tacuarembó) que por su
patología de base requirieron valoración tomográfica (TC)
de cráneo, macizo facial o columna cervical. Las edades se
ubicaron entre 21 y 78 años (media 45), 36 eran hombres y
14 mujeres. Concomitantemente a la valoración TC solicitada
se efectuaron seis cortes axiales de los senos maxilares de
5mm de espesor y 8mm de intervalo.
Un único médico imagenólogo, desconociendo los resultados
tomográficos, realizó en forma sistematizada el estudio
ecográfico. Los hallazgos se clasificaron en primera instancia
y para cada seno como negativo (ausencia de signos
ecográficos de ocupación), positivo (visualización del sector
posterior del seno) y dudoso (imágenes no concluyentes).
Los casos dudosos fueron recategorizados por el imagenólogo
en positivo o negativo antes de finalizar la exploración
ecográfica. Posteriormente se efectuó análisis comparativo
entre los resultados ecográficos y los de la tomografía
computada ,considerada el gold standard, calculándose
sensibilidad, especificidad, valor predictivo positivo (VPP) y
valor predictivo negativo (VPN).
Resultado: Se exploraron 100 senos maxilares
correspondientes a 50 pacientes internados en UCI.
Ecográficamente se interpretaron como positivos 31 de ellos,
62 fueron negativos y 7 dudosos. Mediante tomografía fueron
positivos 37, negativos 67. Incluidos todos los senos (100
senos) la ecografía modo B mostro una sensibilidad 91%,
especificidad 92.5%, valor predictivo positivo 86% y valor
predictivo negativo 95%.
Conclusiones: la ecografía puede ser tenida en cuenta como
método de primera línea en el diagnóstico de sinusitis
maxilar dado su elevada eficacia diagnostica. Refuerza este
concepto la facilidad y rápido aprendizaje de la técnica en
senos maxilares, la disponibilidad, practicidad y costos de la
ecografía.
Palabras Claves:
sinusitis maxilar; ultrasonido; paciente
critico.
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Abstract:
Objective: to establish the value of ultrasound (mode B) for
the diagnosis of maxillary sinusitis in patients admitted to the
Intensive Care Unit (ICU). Partial or complete liquid filling
of the sinus cavity was considered as a positive image
diagnosis.
Design of the study: Prospective, comparative and blind
study using computed tomography as a gold standard.
Material and method: 50 adult patients, admitted to the
ICU in the city of Tacuarembó (Hospital Regional y
Cooperativa Medica de Tacuarembó), who required a head,
face or cervical spine CT scanning due to their main disease
were included. The ages varied from 21 to 78 years old
(mean 45), 36 were men and 14 women. As well as the
requested CT scanning six axial slices of the maxillary sinuses
5 mm width and 8 mm interval were performed.
A single imagenology physician, unaware of the tomographic
results, sistematically performed the ultrasound assesment.
The findings were initially classified for each sinus as negative
(lack of ultrasound signs of filling), positive (visualization of
the back area of the sinus) and uncertain (no conclusive
images). The uncertain cases were reassigned as positive or
negative by the physician before finishing the ultrasound
examination. Later, a comparative analysis between the
ultrasound results and the computed tomography results,
considered as the gold standard, calculating sensitivity,
specificity, positive predictive value (PPV) and negative
predictive value (NPV) was performed.
Result: 100 maxillary sinuses corresponding to 50 patients
admitted to the ICU were examined. 31 of them were
ecographically seen as positive, 62 were negative and 7
uncertain. Using tomography 37 were positive and 67
negative. Including all the sinuses (100) the ultrasound mode
B showed a 91% sensitivity, 92.5% specificity, 86% positive
predictive value and 95% negative predictive value.
Conclusions: ultrasound can be taken into account as a first
line method for the diagnosis of maxillary sinusitis due to its
high diagnostic accuracy. This concept is enhaced by the
simplicity and quick learning of this technique in the maxillary
sinuses, the availability, feasibility and costs of ultrasound.
Key Words:
maxillary sinusitis; ultrasound; critic patient.
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Ileal Crohn Disease : Mural
Microvascularity Quantifi ed with
Contrast-enhanced US Correlates with
Disease Activity
Autor: Antonio De Franco , MD
Alessandra Di Veronica , MD
Alessandro Armuzzi , MD
Italia Roberto , MD
Manuela Marzo , MD
Barbara De Pascalis , MD
Italo De Vitis , MD
Alfredo Papa , MD
Enrico Bock , MD
Francesco M. Danza , MD
Lorenzo Bonomo , MD
Luisa Guidi , MD
Resumen:
Purpose:To evaluate the effectiveness of a staged ultrasonography (US) and computed tomography (CT) imaging protocol for the accurate diagnosis of suspected appendicitis in children and the opportunity for reducing the number of CT examinations and associated radiation exposure.
Method:This retrospective study was compliant with HIPAA, and a waiver of informed consent was approved by the institutional review board. This study is a review of all imaging studies obtained in children suspected of having appendicitis between 2003 and 2008 at a suburban pediatric emergency department. A multidisciplinary staged US and CT imaging protocol for the diagnosis of appendicitis was implemented in 2003. In the staged protocol, US was performed first in patients suspected of having appendicitis; follow-up CT was recommended when US findings were equivocal. Of 1228 pediatric patients who presented to the emergency department for suspected appendicitis, 631 (287 boys, 344 girls; age range, 2 months to 18 years; median age, 10 years) were compliant with the imaging pathway. The sensitivity, specificity, negative appendectomy rate (number of appendectomies with normal pathologic findings divided by the number of surgeries performed for suspected appendicitis), missed appendicitis rate, and number of CT examinations avoided by using the staged protocol were analyzed.
Results:
The sensitivity and specificity of the staged protocol were 98.6% and 90.6%, respectively. The negative appendectomy rate was 8.1% (19 of 235 patients), and the missed appendicitis rate was less than 0.5% (one of 631 patients). CT was avoided in 333 of the 631 patients (53%) in whom the protocol was followed and in whom the US findings were definitive.
Conclusion:
A staged US and CT imaging protocol in which US is performed first in children suspected of having acute appendicitis is highly accurate and offers the opportunity to substantially reduce radiation.
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Abstract:
Purpose: To quantitatively assess microvascular activation in the
thickened ileal walls of patients with Crohn disease (CD)
by using contrast-enhanced ultrasonography (US) and
evaluate its correlation with widely used indexes of CD
activity.
Materials and
Methods:
This prospective study was approved by the ethics committee,
and written informed consent was obtained from
all patients. The authors examined 54 consecutively enrolled
patients (mean age, 35.29 years; age range, 18–69
years; 39 men, 15 women) with endoscopically confi rmed
CD of the terminal ileum. Ileal wall segments thicker than
3 mm were examined with low-mechanical-index contrastenhanced
US and a second-generation US contrast agent.
The authors analyzed software-plotted time–enhancement
intensity curves to determine the maximum peak intensity
(MPI) and wash-in slope coeffi cient ( b ) and evaluated
their correlation with (a) the composite index of CD activity
(CICDA), (b) the CD activity index (CDAI), and (c) the
simplifi ed endoscopic score for CD (SES-CD, evaluated
in 37 patients) for the terminal ileum. Statistical analysis
was performed with the Mann-Whitney test, Spearman
rank test, and receiver operating characteristic (ROC)
analysis.
Results: MPI and b coeffi cients were signifi cantly increased in the
36 patients with a CICDA indicative of active disease ( P
, .0001 for both), the 33 patients with a CDAI of at least
150 ( P , .032 and P , .0074, respectively), and the 26
patients with an SES-CD of at least 1 ( P , .0001 and
P , .002, respectively). ROC analysis revealed accurate
identifi cation (compared with CICDA) of active CD with
an MPI threshold of 24 video intensity (VI) (sensitivity,
97%; specifi city, 83%) and a b coeffi cient of 4.5 VI/sec
(sensitivity, 86%; specifi city, 83%).
Conclusion: Contrast-enhanced US of the ileal wall is a promising
method for objective, reproducible assessment of disease
activity in patients with ileal CD.
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FIGO Staging System for Endometrial Cancer: Added Benefits of MR Imaging
Autores: Peter Beddy, FFRRCSI, FRCR • Ailbhe C. O’Neill, MB, BCh • Adam K. Yamamoto, MB, BS, MRCP • Helen C. Addley, MRCP, FRCR • Caroline Reinhold, MD, MSc • Evis Sala, MD, PhD, FRCR
Abstract:
The increasing use of imaging necessitates familiarity with a wide variety of pathologic conditions, both common and rare, that affect the fallopian tube. These conditions should be considered in the differential diagnosis for pelvic disease in the nonpregnant patient. The most common condition is pelvic inflammatory disease, which represents a spectrum ranging from salpingitis to pyosalpinx to tubo-ovarian abscess. Isolated tubal torsion is rare but is nevertheless an important diagnosis to consider in the acute setting. Hematosalpinx in a nonpregnant patient can be an indicator of tubal endometriosis; however, care should be taken to exclude tubal torsion or malignancy. Current evidence suggests that the prevalence of primary fallopian tube carcinoma (PFTC) is underestimated and that there is a relationship between PFTC and breast cancer. PFTC has characteristic imaging features that can aid in its detection and in differentiating it from other pelvic masses. Familiarity with fallopian tube disease and the imaging appearances of both the normal and abnormal fallopian tube is crucial for optimal diagnosis and management in emergent as well as ambulatory settings.
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Abstract:
Endometrial cancer is the most commonly diagnosed gynecologic malignancy
in the United States. This pathologic condition is staged with the International Federation of Gynecology and Obstetrics (FIGO) system. The FIGO staging system recently underwent significant revision,
which has important implications for radiologists. Key changes incorporated into the 2009 FIGO staging system include simplification
of stage I disease and removal of cervical mucosal invasion as a distinct stage. Magnetic resonance (MR) imaging is essential for the preoperative staging of endometrial cancer because it can accurately depict the depth of myometrial invasion, which is the most important morphologic prognostic factor and correlates with tumor grade, presence
of lymph node metastases, and overall patient survival. Diffusion-weighted MR imaging and dynamic contrast medium–enhanced MR imaging are useful adjuncts to standard morphologic imaging and may improve overall staging accuracy.
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