Resumen:

Abstract

Ultrasonography measurement of carotid intima-media
thickness in pediatric patients with obesity, familial
hypercholesterolemia and type 1 diabetes.

Purpose. To evaluate by ultrasonographic images carotid intima-media thickness (IMT) as an early marker of cardiovascular risk (CVR) in patients with clinical and laboratory diagnosis of familial hypercholesterolemia (FHC), type 1 diabetes (DBT-1) and Obesity (OB), compared to a healthy control group.
Materials and Methods. A prospective, descriptive, and cross-sectional study. We evaluated the IMT of common carotid (cc) arteries and included in a single dichotomic variable other structural modifications of the wall (atheromatous plaques and intima irregularities). US was blinded to the blood tests results (as recommended by the 2007 Mannheim consensus) from 121 patients (aged 6 to 18 years): 24 FHC, 40 DBT-1, 43 OB, and 14 controls. Patients with other diseases that could alter the arterial wall were excluded. Variables were analyzed using the Statistix 8 program.
Results. The three groups had a higher IMT than the control group, with these differences being statistically significant. Mean IMT (mm) were 0.59 (0.31-2.15), p: 0.006, CI 0.06 to 0.36 in FHC; 0.48 (0.3-0.85), p: 0.001, CI 0.06-0.14 in obesity; and 0.46 (0.25-0.65), p: 0.0004, CI 0.03-0.13 in
DBT-1. Control group: 0.37 (0.30-0.45). The major difference was observed in FHC patients. No association was found between LDL-C value and IMT. Upon the examination, 62.5% were receiving pharmacotherapy. In DBT-1 no association was found between IMT and the levels of HbA1c and lipids. In the OB group there was no association between IMT and BMI Z-score. Atheromatous plaques and intima irregularities were found in 31% of FHC patients, 8% of DBT-1 patients, and 6% of OB patients.
Conclusion. Ultrasonographic IMT measurements demonstrated that patients with chronic diseases and increased CVR at adulthood presented early changes in the carotid intima-media at childhood. This allows clinical prevention strategies and therapeutic guidance.

Keywords. Cardiovascular Risk. Children. Type 1
Diabetes. Familial Hypercholesterolemia. Intimal-Medial Thickness. Obesity. Ultrasound.

Resumen:

Abstract
One-step MR angiography and urography in the evaluation of potential renal living donors.

Purposes. To evaluate diagnostic accuracy of renal MRangiography (MRA) and MR- urography (MRU) in the assessment of normal anatomy and renal vascular pathology in potential renal living donors compared with surgical findings.
Material and Methods.Evaluation of 55 potential living donors performing one-step MR angiography and MR urography in a 1.5 T magnet. MRA evaluated the presence of anatomic variants or arterial or venous pathologic conditions. MRU depicted renal parenchyma anatomy and collector system. These results were compared with surgical findings.
Results.MRA and MRU findings were actually compared with surgical findings in 42 effective donors. MRA specificity was 94 % and diagnostic accuracy was 93 %. Anatomic variants and arterial structural abnormalities were detected in 29 % of patients. Venous and excretory surgical findings were consistent in 100 % of cases.
Conclusion.One-step MRA and MRU constitutes an accurate method for pre-operative assessment of renovascular and excretory anatomy in potential living donors.

Key Words:
Angiography. Living donor. MR. Renal arteries. Urography

Resumo:

Imaging findings of abdominal gossypibomas

Abstract

Gossypiboma is a term utilized to describe a mass developed from a matrix of cotton fibers surrounded by inflammatory granulomatous reaction. Its incidence is estimated at 0.15% to 0.2% of laparotomies. A foreign body within the abdominal
cavity may provide a niche for proliferation of microorganisms, acting as primary focus for development of an abscess and peritonitis. Several studies have demonstrated the relevance of clinical correlation with the findings of different imaging methods (conventional radiography, ultrasonography, computed tomography and magnetic resonance imaging) in the diagnosis of gossypibomas. The present pictorial essay is aimed at demonstrating a series of typical cases of abdominal gossypibomas and illustrating the several presentations of such mass, with emphasis on the findings at different imaging methods in order to familiarize radiologists with this entity and with the main differential diagnosis.

Keywords: Gossypiboma; Abdominal; Imaging diagnosis.

Resumo:

Incidence and imaging findings of lymphoma after liver transplantation in children

Abstract:


Objective: To evaluate the incidence and imaging findings of lymphoma after liver transplantation in children.
Materials and Methods: The authors reviewed records and imaging studies of children submitted to liver transplantation in the period between 2000 and 2008 in a single institution.
Results: Among 241 children submitted to liver transplantation, with a mean follow-up period of 41.4 ± 26.4 months, 16 (6.6%) had lymphoma. The mean age of the patients who developed lymphoma at the moment of transplantation was lower than in children who did not develop malignancy (23.9 ± 18.9 versus 38.0 ± 48.9 months; p = 0.02). The time interval between liver transplantation and the diagnosis of lymphoma ranged from 6 to 103 months. Clinical and radiological presentation was variable and the abdomen was the most common location of the tumor (n = 13; 81.3%), followed by chest and head and neck (n = 4; 25.0% each). Imaging findings included adenopathy, mediastinal, pulmonary and mesenteric masses, bowel wall thickening and
hepatic and renal nodules. Four children (25.0%) died because of complications of lymphoma.
Conclusion: Lymphomas are relatively uncommon and potentially fatal complications that may occur any time after pediatric liver transplantation,
presenting different clinical and imaging findings.

Keywords: Lymphoma; Hepatic transplantation; Pediatrics; Imaging diagnosis; Postoperative complications.

Resumen:

Characterization of lesions associated with microcalcifications BI-RADS 4A over a 11-year period of stereotactic breast biopsies

Abstract:

Substantial advances in breast imaging techniques, especially developments in digital mammography,
have led to early detection of breast cancer. It is well-known that microcalcifications are present in approximately 55% of nonpalpable breast malignancies and are responsible for the detection of 85-90% of cases of ductal carcinoma in situ (DCIS) through mammographic screening. We evaluated the types of associated lesions and the percentage of malignancy in BI-RADS 4A subcategory (low suspicion of malignancy), by performing a database review of stereotactic biopsies of microcalcifications categorized as BI-RADS 4A, between September 1999 and January 2011, which accounted for 21.4% of biopsied microcalcifications in a total of 159 women. Histological findings corresponded to benign lesions in 43.5%, high-risk lesions in 46.5%, and malignant tumors in 10%. Concerning the latter (16 biopsies), 81.3% were DCIS and 18.7% corresponded to infiltrating ductal carcinoma (IDC). The PPV of BI-RADS 4 A category was 13%, a value consistent with that described in the literature. Microcalcifications BI-RADS 4A exhibit low suspicion of malignancy, since they mostly correspond to benign lesions (90%). Subcategory 4A constitutes an important ancillary diagnostic tool for a more accurate assessment of lesions suspicious for malignancy; therefore, we strongly recommend its use.

Keywords: BI-RADS 4A, Microcalcifications, Stereotactic biopsy.

Resumen:

Imaging studies in early diagnosis of childhood leukemia

Abstract:

Leukemia is the most commonly encountered cancer in children under the age of 15 and accounts for approximately 35-40% of all cancers at that age. Acute lymphoblastic leukemia (ALL) is the most common type of leukemia affecting young children between the ages of 2 and 5 years; it accounts for around 80 % of all childhood leukemia cases. Initial clinical and laboratory findings may be non-specific. Imaging studies in patients with bone pain and extramedullary involvement may provide the clinician with valuable supplementary information when the first symptoms result from tissue infiltration and haematological series show a discrete and asymptomatic involvement. The purpose of this work is to review the initial radiological manifestations of leukemia in children. Given the systemic nature of this disease, the goal is to identify the key elements found in the study of the different affected organs, in order to facilitate an early diagnosis of this condition. Late-stage alterations or treatment complications, such as osteonecrosis, infections by opportunistic pathogens, graft-versus-host disease, etc. –where magnetic resonance imaging (MRI) and computed tomography (CT) play a fundamental role– will not be reviewed.

Keywords: Child, Imaging, Leukemia, Pediatrics.

Resumen:

Abstract

Usefulness of the Negative Multidetector CT Angiography in Patients with Suspected Pulmonary Embolism

Objective: The aim of the study is to evaluate alternative findings in pulmonary CT angiography using MDCT reported as negative in patients with suspected pulmonary embolism.
Material and method: Cross sectional study with 178 patients. We recognized other findings reported in pulmonary CT angiography using MDCT whose result was negative. Subsequently these findings were classified into six different categories of clinical relevance and their association with clinical scenario was analyzed.
Results: From November 2004 to June 2007 we requested 231 pulmonary CT angiography using MDCT in patients with 3402 Utilidad del angio-TC multidetector negativo en pacientes con sospecha de tromboembolismo pulmonar. Holguín A., Lombana M., Collazos G., Bravo H., Abella J. suspected pulmonary embolism. 217 patients were included in the final analysis. Of these, 39 (185) were positive for
pulmonary embolism. The 178 remaining negative studies, 8.43% were normal, 53.37% were classified as category A, 20.79% category B, 14.04% category C; category D 1.12% and 2.25% were not interpretable. The most frequent diagnoses were pneumonia, interstitial lung disease and cardiogenic pulmonary edema. It was less likely to find a
normal report whether the study was requested in the hospital department in emergency patients (OR = 0.38 95% 0.16 to 0.88, p = 0.0007). No differences were found in other categories or between patients younger or older than 65 years (p = 0.436). Conclusion: Pulmonary CT angiography as first line imaging tool in patients with suspected pulmonary embolism is useful, offering alternative diagnoses in hospitalized and emergency room patients, regardless of their age and clinical findings.

Key words:Pulmonary embolism, Tomography, X–ray computed Diagnosis

Resumen:

Abstract

SONOGRAPHIC EVALUATION OF THE TRASPLANTED
LIVER: VASCULAR COMPLICATIONS

The number of liver transplants has increased during the last decade and a significant amount of transplants are currently being performed in our country. This trend requires that radiologists have a basic knowledge of the technical aspects of the surgery, as well as its main complications and the imaging criteria used to routinely evaluate grafts. Orthotopic cadaveric donor and living donor transplants are possible at present because of advances in surgical technique, which are based on the understanding of hepatic and vascular surgical anatomy. The most feared complications during the early postoperative period are those of vascular
origin, mainly hepatic artery or portal thrombosis, as they can rapidly induce an irreversible damage of the liver graft and hence require immediate medical and/or surgical intervention. Doppler ultrasonography should always be included in the evaluation of the graft during the postoperative period to evaluate the vascular anastomoses periodically and allow a prompt diagnosis of any complication. Therefore, this review includes the main vascular complications after liver transplantation and the fundamental aspects that the radiologist should consider during the routine postoperative evaluation.

Key words:Liver transplant, Ultrassonografia Doppler, Vascular diseases

Resumen:

Breast Magnetic Resonance Imaging: State of the art and clinical applications

Abstract:
Breast magnetic resonance imaging is a modality that is being progressively integrated into the breast radiologist’s daily clinical practice. There is consensus on the minimal technical requirements that a breast MR exam should have in order to attain diagnostic quality. Diagnostic criteria are mainly based on the American College of Radiology’s BI-RADS magnetic resonance imaging categories. Breast cancer staging is a main clinical application, but it is not universally accepted. Other applications are: response evaluation in patients treated with chemotherapy, screeening in high-risk patients, cancer of unknown origin, assessment of a possible relapse and breast implant evaluation.

Keywords: Breast Neoplasms; Diagnosis; Magnetic Resonance Imaging

Resumen:

Extrahepatic vessels depending on the hepatic artery. Identification and management

Abstract:

Patients with malignant liver tumors, whether primary tumors or metastases, that are not candidates for surgical treatment can benefit from different endovascular treatments with proven efficacy in local control of the disease. Correct treatment requires a careful angiographic technique and precise knowledge about the vascular anatomy afferent to the lesion. Occasionally, lesions considered relapse are actually areas that were untreated because the afferent pedicle was not adequately detected. On the other hand, some of the complications of endovascular treatments are related with material passing into non-hepatic vessels.

Key Words:Anatomy; Angiography; Hepatic artery;
Embolization; Chemoembolization; Radioembolization

Resumen:

ECTOPIC THYROID IN RELATION OF TWO CASES

Abstract:

Two cases of patients presented: one of them was 3 years and 5 months old and the other 3 years and 3 months old. Both showed a mass in the neck that was listed as adenopathy. Imaging examinations were performed which showed that it was thyroid tissue, ectopic thyroid diagnosed. 

Resumen:

Abstract:

Deep venous thrombosis (DVT) of lower limbs is
frequent in emergency services. Clinical presentation
is very evident in cases of extensive DVT, but not in
cases of infrapatellar location or  partially obstructive
thrombosis.
Confirmation requires doppler examination to make
a positive diagnosis and mislead potential differential
diagnoses. Processes that may mimic DVT are multiple,
cellulite and postphlebitic syndrome are the most
common.
The objectives of this study are: to review the
indications of emergency ecodoppler ordered to rule
out DVT in patients with clinical suspicion, evaluate
the results of these studies and review the differential
diagnosis.
Between March and September 2009 60 patients from
Emergency and inpatient services of the Hospital with
clinically suspected DVT were prospectively evaluated.
They were sent to Radiology department for lower
limb venous Doppler ultrasound.
Doppler ultrasound was performed on pathological
lower limb with B-mode, spectral and color doppler,
exploring the deep and superficial venous system.
Compression maneuver was performed every 2 cm
on the venous axis and distal compression maneuver
except in obvious acute DVT.
Data were completed: medical history and results of
paraclinical previous studies.
The results of Doppler ultrasound were classified as
normal and pathological.
In the case of proven DVT was classified in stage: acute,
subacute and chronic and  extent of thrombosis was
indicated.
The most frequent Differential diagnosis found were:
thrombophlebitis,  IVC,  Baker  cyst,  hematoma,
postphlebitic syndrome, erysipelas, cellulitis and causes
of generalized edema and heart failure.
Of a total of 60 patients referred for clinical suspicion of
DVT, only 12 patients (20%) confirmed this diagnosis.
Of the 48 patients who did not have thrombosis 28 were
undiagnosed, 8 patients were diagnosed as chronic
venous insufficiency, heart failure in 5 patients, 2 patients
erysipelas and the remaining 5 other causes of edema.
Doppler ultrasound in Emergency reduces the cost of
hospitalization of patients with clinical suspicion of DVT,
confirms or rules out this diagnosis and identifies other
pathologies. The low percentage of patients with DVT in
this series of patients suggests to adjust the indications of
Doppler.

Key Words:
Deep vein thrombosis, Venous doppler,
Differential diagnosis of DVT

Resumen:

Abstract:

As computed tomography (CT) technology has evolved, multidetector CT has become an integral part of the initial assessment of many injured patients, and the spine is easily included in the total body screening performed in patients with severe blunt polytrauma. Despite all the advantages of multidetector CT, clearing the spine in which injury is suspected continues to be a daily challenge in
clinical practice. The purpose of this review is to present the evidence and the controversies surrounding the practice of imaging in patients suspected of having spine injury. The discussion is centered on the increasing reliance on multidetector CT in the work-up of these patients but also considers the important contributions of clinical trials
to select patient for appropriate imaging on the basis of risk and probability of injury. Available protocols, injury classification systems, and issues awaiting future research are addressed.

Abstract:

Abstract:

There is a broad spectrum of primary pelvic retroperitoneal masses in adults that demonstrate characteristic epidemiologic and histopathologic
features and natural histories. These masses may be classified into five distinct subgroups using a pattern-based approach that takes anatomic distribution and certain imaging characteristics into account, allowing greater accuracy in their detection and characterization and helping to optimize patient management. The five groups are cystic (serous and mucinous epithelial neoplasms, pelvic lymphangioma, tailgut cyst, ancient schwannoma), vascular or hypervascular (solitary fibrous tumor, paraganglioma, pelvic arteriovenous malformation, Klippel-Trénaunay-Weber syndrome, extraintestinal GIST [gastrointestinal stromal tumor]), fat-containing (lipoma, liposarcoma, myelolipoma, presacral teratoma), calcified (calcified lymphocele, calcified rejected transplant kidney, rare sarcomas), and myxoid (schwannoma, plexiform neurofibroma, myxoma).Cross-sectional imaging modalities help differentiate the more common gynecologic neoplasms from more unusual masses. In particular, the tissue-specific multiplanar capability of high-resolution magnetic resonance imaging permits better tumor localization and internal characterization, thereby serving as a road map for surgery.