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Estudio PET/TC en patología inflamatoria-infecciosa
Autores: Cecilia Carrera, Silvina De Luca, Laura Tisser, Mariana Jakubowicz, Emilia Casalini Vañek,
Eduardo Eyheremendy
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Resumen:
Propósito.Demostrar la utilidad del examen PET/TC
en patología inflamatoria-infecciosa.
Materiales y Métodos. Evaluación retrospectiva (enero de 2009 - mayo de 2011) de los exámenes de tomografía por Emisión de Positrones/ Tomografía Computada (PET/TC), realizados en nuestra institución con un equipo híbrido SIEMENS-BIOGRAPH 16 (Siemens, Erlangen, Alemania). Se seleccionaron 5 pacientes.
Resultados. Caso 1: paciente de 68 años de edad con
fiebre de 6 meses de duración, fatiga y pérdida de peso. El examen reumatológico demostró disminución en pulsos radiales sin otros síntomas asociados. La paciente fue sometida a biopsia de arteria temporal. Ésta confirmó una arteritis de la arteria temporal y el estudio PET/TC demostró hipermetabolismo en la aorta torácica y ramas principales. Caso 2: paciente de 85 años con fiebre de origen desconocido (FOD) y sospecha de osteomielitis de cadera. En contraposición, el PET/TC demostró un foco ávido de celulitis glútea y neumopatía. Caso 3: paciente de 35 años con fiebre vespertina. El PET/TC mostró múltiples adenomegalias ávidas por fluorodexosiglucosa (FDG) en mediastino, axilas y retroperitoneo, y compromiso difuso esplénico asociado a calcificaciones. Se confirmó infección por citomegalovirus por inmuno-globulina G y M. Caso 4: paciente de 39 años con infección por HIV que consultó por hipercalcemia. El PET/TC mostró implantes de silicona en glúteos con proceso inflamatorio ávido asociado. Se confirmó por la biopsia de uno de ellos. Caso 5: paciente de 45 años con historia de cáncer de mama en control presentó en los últimos estudios tomográficos aumento del tamaño de los ganglios supraclaviculares y mediastínicos, y compromiso esplénico multifocal difuso. Estos resultaron ávidos en el examen PET/TC. Se confirmó el diagnóstico de sarcoidosis por el estudio anatomopatológico de un ganglio supraclavicular.
Conclusión.El PET/TC es un método no invasivo de
utilidad para el diagnóstico y seguimiento de pacientes con FOD. Cambia la conducta en la vasculitis sin necesidad de realizar una biopsia y es considerado el método Gold Standard. Además, es útil en el monitoreo del tratamiento y seguimiento en la sarcoidosis.
Palabras clave. Infección. Inflamación. PET/TC.
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Abstract
PET/CT in infectious and inflammatory pathology.
Purpose.To demonstrate the utility of PET/CT in infectious and inflammatory diseases.
Materials and Methods.We evaluated retrospectively five patients with infectious and inflammatory pathology, by PET/CT scan (hybrid SIEMENS-BIOGRAPH 16, Siemens, Erlangen, Germany) in the period between january 2009 and may 2011.
Results.Case 1: a 68-year-old woman presented with a 6- months duration fever, fatigue, and weight loss. The rheumatologic examination showed a decrease in both radial pulses with no other associated symptoms. She underwent a temporal artery biopsy, which confirmed temporal arteritis. A PET/CT scan showed significant uptake in the thoracic aorta and major branches. Case 2: An 85-year-old patient with fever of unknown origin (FUO) was studied suspecting osteomyelitis of the hip, but on the contrary, PET/CT demonstrated an avid enhancement indicative of gluteal cellulitis and pneumonia, ruling out bone infection. Case 3: a 35-year-old woman with evening fever. PET/CT scan showed enlarged multiple FDG-avid mediastinal, axillary and retroperitoneal lymph nodes, as well as diffuse involvement of the spleen with multiple calcifications. Diagnosis of cytomegalovirus infection was confirmed by positive immunoglobulin G and M. Case 4: a 39-year-old patient with HIV-infection presented with hypercalcemia. PET/CT scan showed buttocks silicone
implants with associated avid inflammatory process, confirmed by biopsy. Case 5: a 45-year-old female with previous history of breast cancer under follow-up presented in recent CT scans enlarged mediastinal and supraclavicular lymph nodes, as well as diffuse multifocal splenic involvement, all of them avid on PET / CT examination. Sarcoidosis was confirmed by a supraclavicular node excision biopsy.
Conclusion.PET/CT is a noninvasive diagnostic tool useful for the diagnosis and follow-up of patients with FUO. Especially in patients with vasculitis, it may change decisions without needing a diagnostic biopsy, as it is considered the gold standard procedure for diagnosing these entities. It is also a useful technique for follow-up and treatment monitoring in patients with sarcoidosis.
Keywords. Infection. Inflammation. PET/TC.
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Signo de la hoja de malvón y meningiomas en
Resonancia Magnética
Autor: Martín Aguilar, Rosana Salvático
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Resumen:
Los meningiomas son los tumores endocraneanos primarios más frecuentes en el adulto. Constituyen
muchas veces un hallazgo y no revisten demasiadas
dificultades en su diagnóstico por su comportamiento
típico en Resonancia Magnética (RM) y Tomografía Computada (TC). La descripción de este signo, basado en la similitud morfológica de este tumor con la hoja de malvón, pretende ser una herramienta útil para aquellos casos en los que la presentación atípica o la falta de secuencias adecuadas puedan dificultar su caracterización.
Palabras clave:
Malvón. Meningioma. Signo.
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Abstract
Similarity of meningiomas with geranium leaf on
Magnetic Resonance Imaging
Similarity between meningiomas and geranium leaf
on Magnetic Resonance Imaging. Meningiomas are the most frequent primary intracranial tumors in adults. They are often a not difficult to diagnose finding, given their typical behavior on magnetic resonance
imaging (MRI) and computed tomography (CT). The description of this sign, based on the morphologic resemblance of this tumor to the geranium leaf, aims to be a useful tool for those cases where either the atypical presentation or the lack of appropriate sequences could hinder their characterization.
Key Words:
Geranium leaf. Meningioma. Sign
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Aspectos comuns e pseudolesões na colonografia
por tomografia computadorizada: ensaio iconográfico
Autores: Augusto Castelli von Atzingen, Dario Ariel Tiferes, Carlos Alberto Matsumoto, Thiago Franchi
Nunes, Marcos Vinicius Alvim Soares Maia, Giuseppe D’Ippolito
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Resumo:
A colonografia por tomografia computadorizada é um método minimamente invasivo para rastreamento de pólipos e do câncer colorretal, com complicações extremamente incomuns, sendo cada vez mais utilizada na prática clínica. Na última década, a evolução no preparo intestinal, na aquisição das imagens e no treinamento dos examinadores determinou um aumento significativo na sensibilidade do método. A interpretação das imagens é realizada por meio da análise combinada das imagens fontes bidimensionais e de diversos tipos de reconstruções tridimensionais, com sensibilidade ao redor de 96% na detecção de lesões com dimensões iguais ou maiores que 10 mm, quando analisadas
por radiologistas experientes. Neste ensaio pictórico selecionamos exemplos ilustrativos das doenças e pseudolesões mais frequentemente observadas neste tipo de exame. Apresentamos exemplos de lesões polipoides e planas, benignas e malignas, moléstia diverticular dos cólons, entre outras afecções, bem como pseudolesões, entre as quais aquelas relacionadas a preparo inadequado e interpretação equivocada.
Unitermos: Colonografia; Tomografia computadorizada; Câncer colorretal; Pólipos do colo
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Common findings and pseudolesions at computed tomography colonography: pictorial essay
Abstract
Computed tomography colonography is a minimally invasive method for screening for polyps and colorectal cancer, with extremely unusual complications, increasingly used in the clinical practice. In the last decade, developments in bowel preparation, imaging, and in the training of investigators have determined a significant increase in the method sensitivity. Images interpretation is accomplished through a combined analysis of two dimensional source images and several types of three-dimensional renderings, with sensitivity around 96% in the detection of lesions with dimensions equal or greater than 10 mm in size, when analyzed by experienced radiologists. The present pictorial essay includes examples of diseases and pseudolesions most frequently observed in this type of imaging study. The authors present examples of flat and polypoid lesions, benign and malignant lesions, diverticular disease of the colon, among other conditions, as well as pseudolesions, including those related to inappropriate bowel preparation and misinterpretation.
Keywords: Colonography; Computed tomography; Colorectal neoplasm; Colonic polyps.
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Punção aspirativa com agulha fina guiada pelo ultrassom
em nódulos de tireoide: avaliação do número ideal de punções
Autores: Sandro Ceratti, Paula Giannini, Ricardo Antenor de Souza e Souza, Orlando Fermozelli
Rodrigues Junior
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Resumo:
Objetivo:Determinar o número de punções aspirativas necessárias para o diagnóstico citológico de nódulos tireoidianos com segurança.
Materiais e Métodos: Estudo transversal com enfoque diagnóstico. A amostra foi composta por 94 pacientes. Resultados: A idade média dos participantes do estudo foi de 52 anos (desvio-padrão = 13,7), dos quais 90,4% eram do sexo feminino. Considerando cada punção como um evento independente, a primeira punção apresentou resultado conclusivo em 78,7% dos casos, a segunda punção mostrou resultado conclusivo em 81,6% dos casos e a terceira punção mostrou resultado conclusivo em 78,1% dos casos. Considerando-se a chance de se
obter o diagnóstico conclusivo a cada nova punção, tem-se que com duas punções obteve-se 89,5% de resultados conclusivos e com três punções, 90,6% apresentaram pelo menos um resultado conclusivo. Analisando-se todos os resultados obtidos, identificaram-se 70,2% de nódulos benignos, 5,3% de nódulos malignos, 17,0% de resultados indeterminados e 7,4% de amostras não diagnósticas.
Conclusão:Duas punções permitiram a realização do diagnóstico de nódulos de tireoide em 89,5% dos casos, na amostra estudada, sugerindo que não há necessidade de múltiplas punções para se obter o diagnóstico de nódulos tireoidianos com segurança.
Unitermos: Nódulo de tireoide; Punção aspirativa por agulha fina; Punção aspirativa guiada por ultrassom.
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Ultrasound-guided fine-needle aspiration of thyroid nodules: assessment of the ideal number of punctures
Abstract:
Objective:To determine the number of punctures in fine-needle aspiration biopsies required for a safe cytological analysis of thyroid nodules.
Materials and Methods:Cross-sectional study with focus on diagnosis. The study population included 94 patients.
Results: The mean age of the patients participating in the study was 52 years (standard-deviation = 13.7) and 90.4% of them were women. Considering each puncture as an independent event, the first puncture has showed conclusive results in 78.7% of cases, the second, in 81.6%, and the third, in 71.8% of cases. With a view to the increasing chance of a conclusive diagnosis at each new puncture, two punctures have showed conclusive results in 89.5% of cases, and three punctures, in 90.6% of cases with at least one conclusive result.
Conclusion:Two punctures in fine-needle aspiration biopsies of thyroid nodules have lead to diagnosis in 89.5% of cases in the study sample, suggesting that there is no need for multiple punctures to safely obtain the diagnosis of thyroid nodules.
Keywords: Thyroid nodules; Fine-needle aspiration biopsy; Ultrasonography-guided fine-needle aspiration.
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¿Es concordante el tamaño tumoral medido en resonancia
magnética mamaria y el de la biopsia quirúrgica en
pacientes con cáncer de mama, tratadas con quimioterapia
neoadyuvante?
Autores: Drs. Marcela Uchida S, Daniel Grudsky P, Felipe Vergara D, Miguel A. Pinochet T, Eleonora Horvath,
Heriberto Wenzel K, Eduardo Soto N.
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Resumen:
La quimioterapia neoadyuvante (QTNA) es un tratamiento usado en aquellos cánceres mamarios cuyo tamaño los hace inoperables al momento del diagnóstico y en cánceres mamarios operables, pero cuyo uso podría permitir una cirugía conservadora. Para evaluar la respuesta al tratamiento, se ha utilizado el examen clínico, la mamografía, el ultrasonido y la resonancia magnética mamaria, siendo ésta última la que mejor correlación tiene con el tamaño tumoral histológico. Quisimos evaluar la concordancia del tamaño tumoral medido en resonancia magnética con el de la biopsia quirúrgica, en cánceres mamarios tratados con QTNA. Dieciocho pacientes se realizaron resonancia magnética para monitorización de QTNA, en 15(83%) de ellas se obtuvo la biopsia definitiva. En este grupo observamos una muy buena correlación, con una diferencia promedio de 4 mm, entre el tamaño de la resonancia y el de la histología, lo que permitió en nuestro medio un adecuado manejo de las pacientes.
Palabras clave: Cirugía conservadora de la mama, Quimioterapia neoadyuvante, Resonancia magnética
mamaria.
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Is breast MRI concordant with pathologic tumor size in breast cancer patients treated with neoadjuvant
chemotherapy?
Abstract:
Neoadjuvant chemotherapy (NACT) is a treatment used in those breast cancers initially inoperable due to their size, and also in operable breast cancers where NACT could increase the rate of conservative breast surgery. To assess tumor response to treatment, clinical examination, mammography, ultrasound, and breast MRI are used, the latter being the modality that yields the best correlation with histologic tumor
volume. We evaluated the correlation of tumor sizes as measured by MRI versus surgical pathological specimen in breast cancers treated with NACT. Eighteen patients underwent MRI to monitor NACT; in 15 (83%) of them the final biopsy was obtained. In this group a very good correlation was observed, with a mean difference between MRI and histology of 4 mm regarding tumor volumen, which has allowed an
adequate management of patients in our daily practice.
Keywords: Breast MRI, Conservative breast surgery, Neoadjuvant chemotherapy
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Análisis cuantitativo de variables hemodinámicas de la
aorta obtenidas de 4D flowAutores: Ing. Julio Sotelo P, Rodrigo Salas F, Cristián Tejos N, Sterén Chabert1, Sergio Uribe A.
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Resumen:
Objetivo: Los parámetros hemodinámicos son de gran utilidad para realizar un adecuado diagnóstico. Sin embargo, debido a la gran cantidad de variables que pueden obtenerse, el análisis global de todas ellas puede ser complejo. Para facilitar esta tarea, nosotros proponemos crear un modelo que permita clasificar distintas variables hemodinámicas entre las pertenecientes a un individuo sano o a uno patológico. Para ello, usaremos técnicas de minería de datos que permitan identificar y encontrar relaciones entre distintos parámetros hemodinámicos de la aorta obtenidos a través de flujo multidimensional (4D flow) por resonancia magnética. Método: Una secuencia 4D flow de todo el corazón y los grandes vasos fue adquirida utilizando resonancia magnética en 19 voluntarios sanos y 2 pacientes (uno con una coartación aórtica y otro con una coartación aórtica reparada). Retrospectivamente, los datos fueron reformateados a lo largo de la aorta, originándose 3 cortes en los voluntarios y 30 cortes en cada paciente. En cada corte la aorta fue segmentada y distintos parámetros fueron cuantificados: área, velocidad máxima, velocidad mínima, flujo y volumen, calculándose en los cuatro últimos su valor máximo, promedio, desviación estándar, curtosis, sesgo, proporción de tiempo en alcanzar el valor máximo, entre otros. Teniendo un total de 26 variables por cada corte. Se aplicó la técnica de árboles de decisión tipo CART (por sus siglas en inglés) para clasificar los datos. Para validar el modelo, 2 cortes extras fueron
generados por cada voluntario y 20 cortes por cada paciente. Resultados: La técnica CART, mediante la
utilización de sólo 7 variables, puede clasificar las imágenes de los voluntarios y pacientes con una tasa
de error del 14,1%, una sensibilidad de 82,5% y una especificidad de 89.4%. Conclusiones: 4D flow provee
una gran cantidad de datos hemodinámicos que son difíciles de analizar. En este trabajo demostramos que al utilizar minería de datos se pueden clasificar imágenes a partir de parámetros hemodinámicos
relevantes y sus relaciones para apoyar el diagnóstico de alteraciones cardiovasculares.
Palabras clave: CART, Resonancia magnética cardíaca, 4D flow.
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Quantitative analysis of hemodynamic variables of the aorta by 4D flow MRI
Abstract:
Objective: Hemodynamic parameters are critical to perform a proper diagnosis. However, due to the large number of variables that can be obtained, overall analysis may represent a complex task. To facilitate this, we propose to create a model for classifying different hemodynamic variables between those belonging to a healthy individual and to a pathological patient. For this purpose, we employed data mining techniques to identify relationships among various aortic hemodynamic parameters obtained through multi-dimensional (4D flow) MR imaging. Method: A 4D flow sequence of whole heart and great vessels was acquired using MRI in 19 healthy volunteers and 2 patients (one with aortic coarctation and one with repaired coarctation of the aorta). Retrospectively, data were reformatted along the aorta; three MRI acquisitions were performed for volunteers and 30 sequences for each patient. In each slice the aorta was segmented and various parameters were quantified: area, maximum velocity, minimum velocity, flow and volumen, with following values being calculated for last four parameters: maximum, average, standard deviation, kurtosis, skewness, proportion of time to reach the maximum value, among others. A total of 26 variables for each acquisition were obtained. In order to classify data, the CART Technique (Classification and Regression Trees) was applied. To validate the model, two extra projections were generated per each volunteer and 20 slice per each patient. Results: By using only 7 variables, the CART Technique allows discrimination between images performed either on volunteers or patients with an error rate of 14.1%, a sensitivity of 82.5%, and a specificity of 89.4%. Conclusions: 4D flow MR imaging provides a wealth of hemodynamic data that can be difficult to analyze. In this paper we demonstrate that by using data mining techniques it is possible to classify images from relevant hemodynamic parameters and their relationships in order to support the diagnosis of cardiovascular disorders.
Keywords: Cardiac magnetic resonance, CART technique, 4D flow.
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Ecografía torácica vs. tomografía multicortes en el diagnóstico del hemotórax retenido postraumático
Autores: Tatiana Suárez Poveda, Carlos Hernando Morales Uribe, Jakeline Restrepo Loaiza, Édgar Hernán Orozco Hurtado, Álvaro Enrique Sanabria, Jimmy Paul León Rodríguez, Andrés Mauricio Valencia Delgado
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Resumen:
Introducción: Entre el 5% y 30% de los pacientes con trauma de tórax desarrollan hemotórax retenido, que requiere una intervención para evacuarlo y prevenir el desarrollo de empiema, fibrotorax y/o atrapamiento pulmonar. El método diagnóstico recomendado es la
tomografía con medio de contraste. El ultrasonido ha sido utilizado ampliamente para evaluar la cavidad pleural. El propósito de este estudio fue evaluar el desempeño diagnóstico de la ecografía en pacientes con sospecha de hemotórax retenido traumático, en comparación con la tomografía con medio de contraste.
Materiales y método: Estudio prospectivo
de evaluación de dos pruebas diagnósticas en el Hospital Universitario San Vicente de Paúl (Medellín, Colombia). Un total de 68 pacientes con sospecha de hemotórax retenido postraumático se evaluaron con ultrasonido de tórax y tomografía multicorte torácica. El resultado de las ecografías y tomografías multicortes de tórax se comparó con los hallazgos quirúrgicos de los pacientes intervenidos o con el seguimiento clínico.
Resultados: Se incluyeron en el estudio 68 pacientes. Se confirmó hemotórax retenido en 47 pacientes (69,1%) y se descartó en 21 (30,9%). La ecografía pleural tuvo una sensibilidad de 72,3%, especificidad de 95,24%, VPP de 97,14%, VPN de 60,61%, cociente de probabilidades positivo 15,19 y cociente de probabilidades negativo 0,29. La tomografía de tórax tuvo una sensibilidad de 70,21%, especificidad de 52,38%, VPP 76,74%, VPN de 44%, cociente de probabilidades positivo 1,47 y cociente de probabilidades negativo 0,57 en el diagnóstico de hemotórax retenido.
Conclusiones: La ecografía torácica tuvo un mejor desempeño diagnóstico que la tomografía con medio de contraste en pacientes con sospecha de hemotórax retenido.
Palabras clave:Traumatismos torácicos
Hemotórax
Tomografía computarizada
por rayos X Ultrasonografia
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Abstract
Chest Ultrasonography versus Chest CT for
Diagnosis of Posttraumatic Residual Hemothorax
Introduction: Between 5% and 30% of patients who with a hemothorax develop a clotted hemothorax. An intervention is required to evacuate the clotted hemothorax and prevent the development of an empyema, a fibrothorax and/or pulmonary entrapment. Contrasted tomography is recommended as the best diagnostic method. An ultrasonography has been widely used to evaluate the pleural cavity. The purpose of this study was to assess the diagnostic performance of chestultrasonography in comparison with CT in patients suspected of having posttraumatic clotted hemothorax.
Material and method:A prospective study to assess two diagnostic tests in San Vicente de Paúl University Hospital (Medellín, Colombia). A total of 68 patients who were suspected to have posttraumatic clotted hemothorax were assessed with a chest ultrasonography and a multi slice CT. The findings of the ultrasonography and the multi slice CT were compared with the surgical findings of the patients or with clinical monitoring.
Results:We recruited a total of 68 patients. Of
these patients, 47 patients (69.1%) had clotted hemothorax. The chest ultrasonography had a sensitivity of 72.3% and a specificity of 95.2%, a VPP of 77.14%, a VPN of 60.61%, a positive probability ratio of 15,19 and a negative probability ratio of 0.29. The chest CT had a sensitivity of 70.21%, a specificity of 52.38%, a VPP of 76.74%, VPN of 44%, a positive probability ratio of 1.47 and a negative probability ratio of 0.57 in the diagnosis of clotted hemothorax.
Conclusion:Chest ultrasonography had a better diagnostic performance than CT in patients suspected of having posttraumatic clotted hemothorax.
Key words:Thoracic injuries, Hemothorax, Tomography, X-ray computed, Ultrasonography
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Estrategias diagnósticas dirigidas al seguimiento de los pacientes con cáncer tratados con nuevas terapias moleculares
Autores: Juan Camilo Camacho Vásquez, Javier Romero Enciso
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Resumen:
La evaluación objetiva de la respuesta a la terapia anticáncer es muy importante. La estandarización y la utilización de un lenguaje común es fundamental para poder comparar las terapias en diferentes escenarios. Se puede afirmar que existía una relación directa entre tamaño tumoral y la respuesta, axioma derivado de los criterios de la OMS desde 1979. Debido a las limitaciones de estos criterios, los criterios RECIST fueron creados en el 2000; ahora se reconoce que las imágenes diagnósticas son el pilar en el seguimiento de los pacientes con cáncer. Sin embargo, con la aparición de nuevas tecnologías ha llevado a
nuevos criterios, como los RECIST 1.1 y los PERCIST, una vez se reconoció la deficiencia de aquellos creados en el 2000. Mientras tanto, se han diseñado nuevas terapias anticáncer con mecanismos de acción molecular, lo cual ha demostrado que la evaluación anatómica no es actualmente el único parámetro y se debe correlacionar con técnicas de perfusión y
de función, como Doppler, resonancia magnética o TA C y la inclusión de nuevos criterios de seguimiento por PET (PERCIST). El principal objetivo de este artículo de revisión es reconocer de manera suficiente los estándares actuales en términos de criterios RECIST, su aplicación práctica, las limitaciones actuales y cómo los radiólogos oncólogos están progresando en la
evaluación de los tumores según su comportamiento biológico y la terapia que el paciente esté recibiendo.
Palabras clave: Imágenes diagnósticas, Angiogénesis, Neoplasia residual, Metástasis de la neoplasia, Quimioterapia
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Abstract
Diagnostic Strategies Aimed to Monitor Cancer
Patients Treated with New Molecular Therapies
It is very important to have an objective evaluation of the response to cancer therapy. The standardization and use of a common language is essential in order to make a comparison of different therapies in different settings. It can be said that there was a direct relationship between tumor size and tumor response, comment derived from the WHO criteria, since
1979. Due to the limitations of these criteria, the RECIST criteria were created in 2000, where it is recognized that diagnostic images are the key point when monitoring cancer patients. However, with the emergence of new technologies, RECIST has evolved into new criteria such as RECIST 1.1 and PERCIST, once the limitations of the criteria created in 2000
were recognized. Meanwhile, new anti-cancer therapies are designed with mechanisms of action at the molecular level, which has shown that the current anatomical evaluation is not the only parameter and must be correlated with functional and perfusion techniques, such as Doppler, Magnetic Resonance or CT and the inclusion of new following criteria by PET (PERCIST). The main objective of this review article is to recognize the current standards in terms of RECIST criteria, RECIST practical implementation, and current limitations in a sufficient manner, so that the reader can recognize how radiologists are progressing in the evaluation of tumors according to their biological behavior and the specific therapy being received by the patient
Key words:Diagnostic imaging, Angiogenesis, Neoplasm, residual, Neoplasm metastasis, Drug therapy
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Diagnóstico de la esclerosis lateral amiotrófica: avances en RM
Autores: M.J. Álvarez-Uría Tejero, A. Sáiz Ayala, C. Fernández Rey, M.E. Santamarta Liébana,
S. Costilla García
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Resumen:
La esclerosis lateral amiotrófica es una enfermedad neurodegenerativa progresiva
crónica de etiología desconocida que afecta de forma selectiva a las motoneuronas tanto superior como inferior. Hoy en día, su diagnóstico se basa en hallazgos clínicos, electromiográficos y la exclusión de otras enfermedades con síntomas similares, no existiendo pruebas específicas ni marcadores biológicos que confirmen su diagnóstico.
En este artículo exponemos las nuevas técnicas de RM como la transferencia de magnetización, la espectroscopia por RM, la RM funcional, el tensor difusor o las técnicas volumétricas, que pueden contribuir tanto a la confirmación diagnóstica precoz como al seguimiento de esta enfermedad. Revisamos la utilidad de dichas técnicas según la bibliografía y discutimos sus posibles aplicaciones en la práctica clínica.
Palabras Claves: Esclerosis lateral
amiotrófica;
Espectroscopia;
Haz corticoespinal;
Motoneurona;
Neurodegeneración;
RM funcional;
Tensor de difusión;
Tractografía;
Transferencia
de magnetización
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Diagnosis of amyotrophic lateral sclerosis: advances in magnetic
resonance imaging
Abstract:
Amyotrophic lateral sclerosis is a chronic progressive neurodegenerative disease of unknown etiology. It selectively affects both upper and lower motor neurons. Nowadays, amyotrophic lateral sclerosis is diagnosed on the basis of clinical and electromyographic findings and by ruling out other diseases with similar symptoms. To date, there are no specific tests or biologic markers to confirm the diagnosis. This article discusses new MRI techniques like magnetization transfer imaging, MR spectroscopy, functional MRI, diffusion tensor imaging, and volumetric techniques that can contribute to early confi rmation of the diagnosis and to the follow-up of this disease. We review the usefulness of each of these techniques and discuss their possible applications in clinical practice.
Keywords: Amyotrophic lateral
sclerosis;
Spectroscopy;
Corticospinal bundle;
Motor neuron;
Neurodegeneration;
Functional MRI;
Diffusion tensor
imaging;
Tractography;
Magnetization
transfer imaging
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Intervencionismo guiado por ecografía en el sistema musculoesquelético
Autores: J.L. del Cura, R. Zabala, I. Corta
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Resumen:
La ecografía es la herramienta más adecuada para la realización de procedimientos intervencionistas en el sistema musculoesquelético (SME) si la lesión es visible ecográfi camente. Estas técnicas incluyen: biopsias, drenaje de abscesos, bursitis, hematomas o roturas musculares, tratamiento de lesiones quísticas, artrocentesis diagnóstica o terapéutica, inyección de
sustancias en articulaciones o lesiones, aspiración de depósitos cálcicos y extracción de cuerpos extraños.
Palabras Claves: Sistema musculoesquelético; Ecografía; Intervencionista; Drenaje; Tendinitis; Artrocentesis
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Ultrasound-guided interventional procedures
in the musculoskeletal system
Abstract:
Ultrasonography is the most appropriate tool for interventional procedures in the musculoskeletal
system when the lesion is visible on ultrasonography. Procedures performed under ultrasonographic guidance include: taking biopsies; draining abscesses; bursitis; hematomas or muscle tears; treating cystic lesions; diagnostic or therapeutic arthrocentesis; injecting substances into joints or lesions; aspirating calcium deposits and extracting foreign bodies.
Although some of these procedures are often carried out without imaging guidance, ultrasonographic guidance improves their efficacy. Drainage can be performed with catheters or needles and makes it possible to avoid more aggressive treatments in most cases. Urokinase is useful for draining hematomas or fi brinous collections. Injecting corticoids is useful in the treatment of synovial cysts, Baker’s cyst, tendinitis, and non-infective arthritis. Calcifying tendinitis of the shoulder can be treated effectively with percutaneous calcium lavage.
Key Words:Musculoskeletal system; Ultrasonography; Interventional procedures; Drain; Tendinitis; Arthrocentesis
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MR Imaging Evaluation of
Cardiovascular Risk in Metabolic
Syndrome
Autor: Rutger W. van der Meer, MD, PhD, Hildo J. Lamb, MD, PhD, Johannes W. A. Smit, MD, PhD, Albert de Roos, MD, PhD
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:
Metabolic syndrome has become an important public
health problem and has reached epidemic proportions
globally. Metabolic syndrome is characterized by a cluster of metabolic abnormalities in an individual, with insulin resistance as the main characteristic. The major adverse consequence of metabolic syndrome is cardiovascular disease, which is often already present without clinical signs or symptoms. In this early stage of disease, interventions (eg, lifestyle intervention, medication) can be used to prevent further cardiovascular deterioration or even to reverse cardiovascular disease. Therefore, risk stratification on an individual basis and early detection of cardiovascular disease are essential. Magnetic resonance (MR) imaging is a powerful tool for demonstrating cardiovascular risk factors in metabolic syndrome, such as increased fat depots and arterial stiffening. Furthermore, MR imaging is an established modality for the assessment of myocardial function. This review provides a summary of the current MR applications in metabolic syndrome and discusses how these MR techniques can be used to identify subclinical cardiovascular damage.
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Genitourinary Schistosomiasis:
Life Cycle and
Radiologic-Pathologic
Findings
Autores: Haytham M. Shebel, MD • Khaled M. Elsayes, MD • Heba M. Abou El
Atta, MBBCh, PhD • Yehia M. Elguindy, MBBCh • Tarek A. El-Diasty, MD
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:
Genitourinary schistosomiasis is produced by Schistosoma haematobium, a species of fluke that is endemic to Africa and the Middle East, and causes substantial morbidity and mortality in those regions. It also may be seen elsewhere, as a result of travel or immigration. S haematobium, one of the five fluke species that account for most human cases of schistosomiasis, is the only species that infects the genitourinary system, where it may lead to a wide spectrum of clinical symptoms and signs. In the early stages, it primarily involves the bladder and ureters;
later, the kidneys and genital organs are involved. It rarely infects the colon or lungs. A definitive diagnosis of genitourinary schistosomiasis is based on findings of parasite ova at microscopic urinalysis. Clinical manifestations and radiologic imaging features also may be suggestive of the disease, even at an early stage: Hematuria, dysuria, and hemospermia, early clinical signs of an established S haematobium infection, appear within 3 months after infection. At imaging, fine ureteral calcifications that appear as a line or parallel lines on abdominopelvic radiographs and as a circular pattern on axial images from computed tomography (CT) are considered pathognomonic of early-stage schistosomiasis. Ureteritis, pyelitis, and cystitis cystica, conditions that are characterized by air bubble–like filling defects representing ova deposited in the ureter, kidney, and bladder, respectively, may be seen at intravenous urography, intravenous ureteropyelography, and CT urography. Coarse calcification, fibrosis, and strictures are signs of chronic or late-stage schistosomiasis. Such changes may be especially severe in the bladder, creating a predisposition to squamous cell carcinoma. Genital involvement, which occurs more often in men than in women, predominantly affects the prostate and seminal vesicles.
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