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Lesiones gangliobasales y talámicas bilaterales en el adulto: Diagnóstico diferencial
Autor: Tatiana Wozniak, Osmar Telis, Nicolás Sgarbi
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Resumen:
Las lesiones gangliobasales y tálamicas bilaterales en el paciente
adulto son relativamente frecuentes en la práctica clínica y la lista de posibles diagnósticos diferenciales es muy amplia.
El análisis del patrón lesional básico tanto en tomografía computada como en resonancia magnética es fundamental a la hora de
poder comenzar con el razonamiento diagnóstico. Es asimismo importante correlacionar estos hallazgos con la presentación clínica así como también el perfil evolutivo de las lesiones siendo necesario en la mayor parte de los pacientes contar con informació adicional de estudios de laboratorio.
Dentro de las patologías más frecuentes encontramos las lesiones vasculares, infecciosas, metabólicas y tumorales, siendo de gran jerarquía
los aportes de la resonancia magnética e incluso de técnica funcionales como la difusión y espectroscopía.
Es nuestro objetivo revisar la forma de presentación de las patologías más frecuentes que pueden dar este patrón lesional destacando los elementos
fundamentales para poder establecer los diagnósticos diferenciales.
Palabras clave: gangliosbasales, tálamo, resonancia magnética,
tumores cerebrales. magnética.
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Abstract:
Bilateral gangliobasal and thalamic lesions in adult patients are relatively
common in clinical practice with a large list of possible differential
diagnosis. The analysis of the basic injury pattern both Computed Tomography and Magnetic Resonance Imaging is essential to be able to start with
the diagnostic reasoning. It is also important to correlate these findings with the clinical presentation as well as the evolving profile of injuries being needed in the majority of patients with additional information from laboratory
studies. Among the most frequent pathologies we found lesions, vascular, infectious, metabolic and tumor, being of great hierarchy the contributions
of Magnetic Resonance Imaging and Functional sequences such as Diffusion and Spectroscopy techniques. Our goal is to review the presentation of the most frequent pathologies that may cause these lesions pattern highlighting the most important imaging features to make the better diagnostic approach.
Keywords: basal ganglia, thalamus, magnetic resonance, brain
tumors.
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Hallazgos imagenológicos del acretismo placentario
Autores: Daniela Stoisa, Norberto O. Sánchez, Roberto L. Villavicencio
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El acretismo placentario (AP) resulta de una placentación anormal
caracterizada por la invasión de las vellosidades trofoblásticas más
allá de la decidua. El ultrasonido y la resonancia magnética son
métodos imagenológicos útiles para la detección y caracterización
de esta patología la que ha demostrado un incremento en su incidencia
debido al alto número de cesáreas. Los hallazgos imagenológicos
incluyen afinamiento o ausencia del miometrio, pérdida
del plano de clivaje uterino-vesical, irregularidad de la pared vesical,
vascularización anómala miometrioplacentaria y heterogeneidad
placentaria por lagunas venosas y depósitos de fibrina. Por lo tanto,
el propósito de este trabajo es mostrar los hallazgos ecográficos y
en resonancia magnética relacionados al acretismo placentario.
Palabras clave: acretismo placentario, ecografía, resonancia
magnética.
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Placenta accreta is the result of an abnormal placentation characterized
by invasion of chorionic villi beyond decidua basalis.
Ultrasound and Magnetic Resonance are useful diagnostic tools for
detection and characterization of this entity, which have shown increasing
incidence due to the higher cesarean section rate.
Imagenologic findings include reduced myometrium thickness, loss
of uterine –bladder cleavage, Irregular bladder wall, anomalous
myometrium and placental vascularity, presence of lacunae and fibrin,
etc.
The purpose of this article is to show ultrasonographic and Magnetic
Resonance findings in placenta accreta.
Key Words:placenta accreta, ultrasound, MRI.
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Biópsia percutânea de massas pancreáticas guiada
por tomografia computadorizada com pneumodissecção
Autores: Chiang Jeng Tyng, Almir Galvão Vieira Bitencourt, Maria Fernanda Arruda Almeida, Paula Nicole
Vieira Barbosa, Eduardo Bruno Lobato Martins, João Paulo Kawaoka Matushita Junior, Rubens
Chojniak, Felipe José Fernandez Coimbra
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Resumo:
Objetivo: Descrever a técnica de biópsia percutânea de tumores pancreáticos guiada por tomografia computadorizada com pneumodissecção. Materiais e Métodos: No período de junho de 2011 a maio de 2012, foram realizadas sete
biópsias percutâneas de tumores pancreáticos guiadas por tomografia computadorizada utilizando a manobra de pneumodissecção
em nossa instituição. Todas as biópsias foram realizadas utilizando pistola de disparo automático e sistema
coaxial, com agulhas Tru-core. As amostras colhidas foram submetidas a avaliação histológica. Resultados: Para todos
os casos, não havia um acesso direto seguro pela tomografia computadorizada para atingir o tumor pancreático sem
atravessar órgãos e estruturas importantes. A injeção de ar foi capaz de deslocar as estruturas adjacentes e criar uma
nova rota de acesso, permitindo um trajeto seguro da agulha coaxial até a lesão, e a biópsia foi realizada com sucesso
em todos os casos. Todas as biópsias forneceram material suficiente para análise histológica. Conclusão: Esta técnica
é segura, barata e tecnicamente fácil, podendo auxiliar na realização de biópsias percutâneas de tumores pancreáticos
guiadas por tomografia computadorizada de casos selecionados em que não existe acesso direto à lesão.
Unitermos: Neoplasias pancreáticas; Biópsia por agulha; Tomografia computadorizada.
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Abstract
Objective: To describe the technique of computed tomography-guided percutaneous biopsy of pancreatic tumors with
pneumodissection. Materials and Methods: In the period from June 2011 to May 2012, seven computed tomographyguided
percutaneous biopsies of pancreatic tumors utilizing pneumodissection were performed in the authors’ institution.
All the procedures were performed with an automatic biopsy gun and coaxial system with Tru-core needles. The biopsy
specimens were histologically assessed. Results: In all the cases the pancreatic mass could not be directly approached
by computed tomography without passing through major organs and structures. The injection of air allowed the displacement
of adjacent structures and creation of a safe coaxial needle pathway toward the lesion. Biopsy was successfully performed
in all the cases, yielding appropriate specimens for pathological analysis. Conclusion: Pneumodissection is a safe,
inexpensive and technically easy approach.
Keywords: Pancreatic neoplasms; Needle biopsy; Computed tomography.s
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Trauma dos ossos temporais e suas complicações: aspectos
na tomografia computadorizada
Autores: Ana Maria Doffémond Costa, Juliana Oggioni Gaiotti, Caroline Laurita Batista Couto, Renata
Lopes Furletti Caldeira Diniz, Emília Guerra Pinto Coelho Motta, Natália Delage Gomes
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Resumo:
A maioria das fraturas dos ossos temporais resulta de traumas cranianos bruscos, de alta energia, estando muitas
vezes relacionadas a outras fraturas cranianas ou a politraumatismo. As fraturas e os deslocamentos da cadeia ossicular,
na orelha média, representam umas das principais complicações das injúrias nos ossos temporais e, por isso,
serão abordadas de maneira mais profunda neste artigo. Os outros tipos de injúrias englobam as fraturas labirínticas,
fístula dural, paralisia facial e extensão da linha de fratura ao canal carotídeo. A tomografia computadorizada tem papel
fundamental na avaliação inicial dos pacientes politraumatizados, pois é capaz de identificar injúrias em importantes
estruturas que podem causar graves complicações, como perda auditiva de condução ou neurossensorial, tonturas e
disfunções do equilíbrio, fístulas perilinfáticas, paralisia do nervo facial, lesões vasculares, entre outras.
Unitermos:Trauma do osso temporal; Injúrias ossiculares; Trauma ossicular.
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Most temporal bone fractures result from high-energy blunt head trauma, and are frequently related to other skull fractures
or to polytrauma. Fractures and displacements of ossicular chain in the middle ear represent some of the main
complications of temporal bone injury, and hence they will be more deeply approached in the present article. Other
types of injuries include labyrinthine fractures, dural fistula, facial nerve paralysis and extension into the carotid canal.
Computed tomography plays a fundamental role in the initial evaluation of polytrauma patients, as it can help to identify
important structural injuries that may lead to severe complications such as sensorineural hearing loss, conductive hearing
loss, dizziness and balance dysfunction, perilymphatic fistulas, facial nerve paralysis, vascular injury and others.
Keywords: Temporal bone trauma; Ossicular injuries; Ossicular trauma.
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Osteocondroma: diagnóstico radiológico, complicaciones
y variantes
Autores: Dres. Marco Cañete P, Elena Fontoira M, Begoña Gutiérrez San José, Slavina Mancheva M.
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Conocer el espectro de apariencias del osteocondroma es importante, ya que representa lesión
pseudotumoral más frecuente del hueso y posee unas características radiológicas patognomónicas
evidenciables con los distintos métodos de imagen disponibles actualmente. El reconocimiento de estas
características radiológicas, de sus posibles complicaciones y variantes permite establecer el diagnóstico
correcto, identificar las posibles complicaciones y guiar el manejo terapéutico de los casos no concluyentes.
Palabras clave: Displasia, Exostosis, Neurológicas, Osteocondroma, Tumores óseos.
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Understanding and recognising the spectrum of appearances of osteochondroma is important
because it represents the most frequent pseudotumoral bone lesion. There are pathognomonic radiological
features that are evident with the currently available imaging methods. The recognition of these features
and their potential complications and variants, enables a correct diagnosis to be made, the identification
of possible complications and is a guide for the therapeutic decisions of non-conclusive cases.
Keywords: Bone tumors, Dysplasia, Exostosis, Osteochondroma.
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Correlación entre score de calcio coronario, esteatosis
hepática y síndrome metabólicoAutores: Dres. Karina Hermosilla M, Daniela Pivcevic C, Julia Alegría B, Claudio Silva F.
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Objetivos:
Objetivos. Demostrar la correlación que existe entre presencia o no de enfermedad coronaria
establecida (medida a través del índice de Agatston) y esteatosis hepática en los segmentos visualizados del
hígado al momento de realizar el score de calcio. Material y Métodos:Estudio retrospectivo que incluyó 229
pacientes con factores de riesgo para enfermedad coronaria a los que se les realizó tomografía computada
multicorte de arterias coronarias o score de calcio. Se evaluó la presencia de enfermedad ateromatosa en
arterias coronarias y aorta torácica y atenuación hepática en los segmentos visualizados del hígado. El análisis
estadístico incluyó modelos de regresión lineal, estudio por asociación de múltiples variables y modelo CART.
Resultados: 229 pacientes, 78% de sexo masculino y 22% femenino, con edad promedio 56 años. Se demostró
asociación estadísticamente significativa entre mayor nivel de score de calcio y menor atenuación hepática, en
pacientes de mayor edad y sexo masculino. Se logró definir dos tipos de pacientes con score de calcio elevado,
un grupo con hipertensión arterial - esteatosis hepática y otro grupo con hipertensión arterial y diabetes tipo 2;
los pacientes solamente obesos no tenían mayores niveles de score de calcio. Conclusiones: Existe asociación
entre ateromatosis calcificada y esteatosis hepática. Los pacientes con esteatosis hepática como parte de un
síndrome metabólico, tienen mayor riesgo de ateroesclerosis. Puede ser útil incorporar la evaluación de esteatosis
hepática en la estratificación de riesgo cardiovascular.
Palabras clave: Ateromatosis, Esteatosis, Hepática, Score de calcio, Síndrome metabólic.
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Objectives:
To demonstrate the correlation between the presence or absence of established coronary
disease (as measured by the Agatston index) and hepatic steatosis visualized in liver segments when calculating
calcium score. Material and Methods: Retrospective study that included 229 patients with risk factors for coronary
disease who underwent multislice computed tomography of coronary arteries or calcium score. We evaluated the
presence of atherosclerotic disease in coronary arteries and thoracic aorta and liver attenuation in visualized liver
segments. Statistical analysis included linear regression models, association studies of multiple variables and
CART model. Results: 229 patients, 78% male, average age 56 years. It values statistically significant association
was found between higher levels of calcium score and lower hepatic attenuation in older patients and males.
We were to define two types of patients with high calcium score, a group with hypertension – hepatic steatosis
and another groups with hypertension and type 2 diabetes; patients that were only obese did not have higher
levels of calcium score. Conclusions A relationship exists between calcified atheromatosis disease and hepatics
steatosis. Patients with hepatics steatosis as part of a metabolic syndrome are at increased risk of atherosclerosis.
It may be useful to incorporate the assessment of hepatics steatosis in cardiovascular risk stratification.
Key words: Atheromatosis, Calcium score, Hepatic steatosis, Metabolic syndrome.
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Aspergilosis pulmonar por tomografía computarizada en el paciente pediátrico. Pulmonary Aspergillus in Pediatric Pa tient by CT
Autores: Arturo Vives Hurtado, David Palau Pérez, Liliana Henao Gómez, Luz Ángela Moreno Gómez, Lina Eugenia Jaramillo Barberi
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Resumen:
La aspergilosis pulmonar es una micosis con un espectro variable de manifestaciones
que dependen del estado inmunológico. El propósito de esta revisión es mostrar las
diferentes modalidades de la aspergilosis en los niños, en las que el radiólogo cumple un
papel importante, especialmente para la detección temprana de las formas invasivas en
inmunosupresión, debido a sus implicaciones pronósticas.
Palabras clave: Aspergilosis, Tomografía, Pulmón |
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Summary: Pulmonary aspergillosis is a mycotic disease with many manifestations which depend on the
immunological state. The purpose of this article is to show the different forms of aspergillosis in
children. The radiologist plays an important role, especially in early detection with the invasive
forms of immunosuppression, due to prognostic implications.
Keywords: Aspergillosis, Tomography, Lung
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Ecografia Doppler en la evaluación de trasplante del hígado
Autores: Beatriz Molinares Arévalo, Martín Ochoa Escudero, Carlos Mario González Vásquez, Juan Sebastián Toro Gutiérrez, Sergio Álvarez Vallejo
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Resumen:
El trasplante de hígado es un método terapéutico efectivo para el tratamiento de múltiples
enfermedades hepáticas terminales irreversibles, tanto agudas como crónicas. Los avances
en la terapia inmunosupresora, la técnica quirúrgica y el cuidado perioperatorio han mejorado
el pronóstico de los pacientes sometidos a este procedimiento. La ecografía con evaluación
Doppler es el método de imagen más utilizado para valorar a estos pacientes, tanto en la
etapa inicial como en el seguimiento a largo plazo. Tiene como ventajas estar ampliamente
disponible, la posibilidad de volverse portátil, no generar efectos secundarios y no asociarse
con efectos por radiación ionizante. Permite realizar una valoración anatómica en escala de
grises y funcional con la evaluación del flujo de las diferentes anastomosis vasculares. Es el
método diagnóstico ideal ante la sospecha de complicaciones vasculares. Las complicaciones
más comunes y con más importancia clínica son las vasculares: trombosis arterial, trombosis
venosa, estenosis, fístulas. También se encuentran complicaciones de la anastomosis biliar,
las colecciones, las neoplasias y el rechazo. En este artículo se revisan los hallazgos normales
y anormales en el Doppler de los pacientes sometidos a trasplante de hígado.
Palabras clave: Ecografía
Ultrasonografía Doppler en color, Trasplante de hígado. |
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Abstract
Summary: Liver transplantation is an effective therapeutic method for treatment of multiple irreversible
terminal liver disease, both acute and chronic. Advances in immunosuppressive therapy, surgical
technique and post-surgical care have improved the prognosis of patients undergoing this procedure.
The ultrasound with Doppler assessment is the image method which is most commonly used to
assess these patients, both in the initial phase and during long-term follow-up. The advantages of
ultrasound Doppler are the following: It is widely available, it can be portable, it does not cause sideeffects,
and it is not associated with ionizing radiation effects. In addition, it also allows an anatomical
assessment of grey and functional scales, with flow evaluation of different vascular complications. The
most common complications during liver transplantation, as well as the ones with the highest clinical
importance are vascular complications: arterial thrombosis, venous thrombosis, stenosis, fistulas.
In addition, one can find complications of biliary anastomosis, as well as collections, neoplasms
and rejection. Normal and abnormal Doppler findings in patients undergoing liver transplantation
are reviewed in this article.
Keywords:Ultrasound Ultrasonography, Doppler,
color, Liver transplant.
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Entero-resonancia magnética: revisión de la técnica para el estudio de la enfermedad de Crohn
Autores: L. Herraiz Hidalgo, E. Alvarez Moreno, J. Carrascoso Arranz,
R. Cano Alonso y V. Martínez de Vega Fernández
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La enfermedad de Crohn es una enfermedad crónica de curso imprevisible que
requiere numerosos estudios radiológicos durante la vida. Afecta frecuentemente a pacientes
jóvenes, más vulnerables a los efectos nocivos de las exploraciones repetidas con radiaciones
ionizantes. La precisión diagnóstica de la enterografía por RM es similar a la de la tomografía
computarizada por su alta resolución tisular, sin el inconveniente de la radiación. Los índices
clínicos de valoración de la enfermedad son poco precisos y subjetivos por lo que las técnicas
enterográficas de imagen se están incorporando cada vez más a la práctica clínica como medios
objetivos de control de la gravedad de la enfermedad. En este artículo, describimos nuestra
técnica enterográfica en RM para la valoración de la enfermedad de Crohn. Revisaremos los
hallazgos más relevantes por imagen y los subtipos de la enfermedad, la literatura científica
relacionada y los índices por RM en la valoración de la gravedad de la enfermedad.
Palabras Claves: Enfermedad de Crohn
Resonancia magnética, Cine-RM Gadolinio Resumen
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Abstract: Crohn’s disease is a chronic disease with an unpredictable course. Patients with
Crohn’s disease will have to undergo numerous imaging tests. Crohn’s disease often affects
young people, who are more vulnerable to the harmful effects of repeated exposure to ionizing
radiation. The high resolution of tissues on MR enterography give it a diagnostic accuracy similar
to that of CT; however, MR enterography does not have the drawback of ionizing radiation.
The clinical indices used to assess Crohn’s disease are subjective and not very accurate; thus,
enterographic techniques are becoming more common in clinical practice as a means to follow
up patients objectively. In this article, we describe the MR enterography technique we use to
evaluate Crohn’s disease. We illustrate the most relevant imaging findings, and we review the subtypes of the disease, the related scientific literature, and the MR indices used to assess the
severity of Crohn’s disease.
Keywords: Crohn’s disease,
Magnetic resonance imaging Cine MRI
Gadolinium
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Hemorragia digestiva: papel de la radiología
Autores: S. Quiroga Gómeza, M. Pérez Lafuentea, M. Abu-Suboh Abadiab y J. Castell Conesac
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Resumen:
La hemorragia digestiva (HD) supone un problema diagnóstico tanto en su forma de
presentación aguda, que requiere una rápida localización del punto de sangrado, como en la
crónica, que precisa de exploraciones repetidas para determinar su etiología. El diagnóstico y
tratamiento se basa en estudios endoscópicos, aunque los estudios radiológicos mediante angiografía
por tomografía computarizada (TC) en la hemorragia aguda y mediante TC enterografía
en la crónica son cada día más utilizados en la práctica clínica, a pesar de no estar incluidos
todavía en las guías clínicas de la HD. La TC puede ser una exploración diagnóstica de primera
elección en la hemorragia aguda masiva, sustituyendo a la angiografía, y una exploración diagnóstica
complementaria a la cápsula endoscópica y la gammagrafía en la hemorragia crónica o
recurrente cuando se sospecha un origen en el intestino delgado. La angiografía es actualmente
un método terapéutico complementario a la endoscopia en el manejo de esta afección.
Palabras Claves: Hemorragia digestiva; Angiografía por TC; TC enterografía; Arteriografía
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Abstract:
Gastrointestinal bleeding represents a diagnostic challenge both in its acute presentation,
which requires the point of bleeding to be located quickly, and in its chronic
presentation, which requires repeated examinations to determine its etiology. Although the
diagnosis and treatment of gastrointestinal bleeding is based on endoscopic examinations,
radiological studies like computed tomography (CT) angiography for acute bleeding or CT enterography
for chronic bleeding are becoming more and more common in clinical practice, even
though they have not yet been included in the clinical guidelines for gastrointestinal bleeding.
CT can replace angiography as the diagnostic test of choice in acute massive gastrointestinal
bleeding, and CT can complement the endoscopic capsule and scintigraphy in chronic or
recurrent bleeding suspected to originate in the small bowel. Angiography is currently used to
complement endoscopy for the treatment of gastrointestinal bleeding.
Key Words: Gastrointestinal bleeding; CT angiography; CT enterography; Angiography
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Histerosalpingografía virtual con TC, una nueva técnica
Autores: Walter Samaniego Dr., Eliana Arévalo Dra., Tatiana Angulo Dra
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Resumen:
Los recientes avances en medicina reproductiva han generado la demanda de métodos de imagen que cada vez sean más precisos para la identificación de una causa específica de la infertilidad femenina y otros trastornos ginecológicos. La histerosalpingografía virtual (HSG-V) es una modalidad donde la histerosalpingografía convencional se combina con la tecnología de tomografía computarizada multidetector (TC), para permitir una evaluación integral y de alta precisión, tanto del sistema reproductor femenino como de la anatomía de la pelvis en general. A diferencia del ultrasonido (US) y la resonancia magnética (RM), la TC multidetector es capaz de representar tanto las superficies externas e internas del útero, las trompas de Falopio y otros órganos pélvicos, proporcionando datos de alta resolución que son adecuados para reconstrucciones bidimensionales, tridimensionales y endoscópica virtual. Así, la HSG-V puede llegar a ser superior a otras modalidades no invasivas.
Palabras Clave:histerosalpingografía virtual, infertilidad femenina.
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Abstract:
Recent advances in reproductive medicine have created a demand for more imaging methods that are more accurate to identify the specific cause of female infertility and other gynecological disorders. Virtual hysterosalpingography (HSG-V) is a mode where the established technique of hysterosalpingography technology combined with multidetector computed tomography (CT) to allow a comprehensive evaluation and high precision, both the female reproductive system and pelvic anatomy in genera (1)l. Unlike ultrasound (US) and magnetic resonance imaging (MRI), multidetector CT is able to represent both the external and internal surfaces of the uterus, fallopian tubes and other pelvic organs, providing high-resolution data that are suitable for three-dimensional reconstructions and virtual endoscopic views. Thus, the HSG-V can be superior to other non-invasive assessment of tubal patency. Furthermore, compared with conventional hysterosalpingography, which may involve clamping cervical, HSG-V is painless. Because of the health risks associated with ionizing radiation, the use of another modality (RM and US), May be preferred if a focal lesion suspected uterine. However, the HSG-V CT can provide a diagnostic advantage in complex cases.
Key Words:virtual hysterosalpingography, female Infertility.
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Cancer de mama en mujeres menores de 35 años. Correlación de los hallazgos radiológicos y patológicos. Resultados Preliminares
Autores: Castillo, Ana María MD; Arroyo, Dolly MD; Mena Olmedo, Glenn MD PhD; Segura, Alexandra G. MD, Wally, Mushtaq MD, Mejía, Carlos MD, Pacheco, Rosita
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Resumen:
Se realiza un estudio prospectivo inicial para identificar la incidencia del cáncer de mama en mujeres menores de 35 años diagnosticadas en el Hospital Eugenio Espejo. El objetivo es identificar los diferentes tipos de carcinoma de mama que se presenta en este grupo etario y correlacionar los hallazgos radiológicos con los resultados histopatológicos. Los resultados expresan que el 83.3% corresponde a carcinoma ductal con diferentes grados de severidad, el 72.2% de las lesiones se ubican en el Cuadrante Supero e externo, en el estudio mamográfico se identifica una masa en el 44.4% y con igual porcentaje la presencia de una asimetría focal, en el 38.8% se observa microcalcificaciones; en el estudio ecográfico el 94.4% de la lesiones corresponden a una masa hipoecogénica, en el 55,5% es homogénea y de alta resistencia al estudio doppler, En el 44.4% las lesiones malignas se asociaron a la presencia de adenomegalias. Por tanto, se menciona que el número de casos de cáncer de mama en mujeres jóvenes está en aumento, el diagnóstico se lo realiza generalmente ante la presencia de una masa, lo que desfavorece el pronóstico, por lo que se busca establecer nuevas estrategias de cribado y fomentar la prevención y diagnóstico temprano de esta patología.
Palabras Claves: cáncer de mama, mujeres jóvenes, mamografía, ecografía, patología
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Abstract:
We performed a prospective study to identify the initial incidence of breast cancer in women under 35 diagnosed in the Eugenio Espejo Hospital. The aim is to identify the different types of breastcarcinoma occurring in this age group and correlate radiological findings and histopathological findings. The results show that 83.3% are ductal carcinoma with different degrees of severity, 72.2% of lesions are located in Quadrant Supero and external, the studyidentifies a mass mammography in 44.4% and with the same percentage the presence a focal asymmetry in the observed 38.8%microcalcifications, in the ultrasound study 94.4% of the lesions correspond to a hypoechoic mass, in 55.5% homogeneous, high-resistance Doppler study, 44.4% in the malignant lesions were associated with the presence of lymphadenopathy. Therefore, it is mentioned that the number of cases of breast cancer in young women is increasing, the diagnosis was usually performed in the presence of a mass, which disfavors the
Key Words: breast cancer, young women, risk factors, mammography, ultrasound, pathology.
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Aportes de la espectroscopía por resonancia magnética en la diferenciación entre metástasis encefálica única y glioma de alto grado
Autores: Dres. Nicolás Sgarbi, Osmar Telis.
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Resumen:
La resonancia magnética es el método de elección en el estudio de las lesiones tumorales
del sistema nervioso central. Si bien su rendimiento global es excelente en algunas situaciones
específicas presenta limitaciones para establecer el diagnóstico final como sucede
en la diferenciación de metástasis encefálica única y glioma de alto grado.
Nuevas secuencias, utilizadas desde hace años en nuestro medio, aportan elementos
clave en el estudio de las lesiones tumorales si bien también presentan limitaciones.
La espectroscopía es una técnica que permite obtener mapeos metabólicos de forma no
invasiva con excelente rendimiento en el estudio de las lesiones tumorales.
Numerosos autores han planteado la utilidad de la espectroscopía para la diferenciación
de metástasis encefálica única y glioma de alto grado en el paciente adulto lo que es de
gran importancia en el manejo inicial del paciente con lesión tumoral única.
Es objetivo de nuestro trabajo establecer los aportes, alcances y limitaciones de la espectroscopía
por resonancia magnética en la diferenciación entre metástasis encefálica
única y glioma de alto grado en el paciente adulto.
Palabras Claves: metástasis cerebal, glioblastoma multiforme, espectroscopía.
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Abstract:
Magnetic resonance imaging is the gold standar in the study of tumoral lesions of the
central nervous system. While its overall performance is excellent in some specific
situations presents limitations to establish the final diagnosis as it happens in the
differentiation of solitary brain metastasis and high grade glioma.
New sequences contribute in the study of tumor lesions while they also have important
limitations.
Magnetic resonance spectroscopy is an imaging technique that allows to obtain noninvasive
metabolic mapping of multiple lesions with excellent performance in the study
of brain tumors.
Numerous authors have raised the usefulness of spectroscopy for the differentiation of
solitary brain metastasis and high-grade glioma in adult patients what is of great importance
in the initial management of patients.
The goal of our work is to establish the contributions, scope and limitations of magnetic
resonancia spectroscopy in differentiating between solitary brain metastasis and highgrade
glioma in adult patients.
Key Words: solitary brain metastasis, high-grade glioma, spectroscopy
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Imágenes hipermetabólicas del tubo digestivo en PET/CT. Diagnósticos diferenciales
Autores: Dras. Verónica Gigirey, Liliana Servente, Margarita García Fontes.
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Resumen:
La tomografía de emisión de positrones (PET)
utilizando 18 Fluor fluoro-deoxi-glucosa (18F-FDG)
ha sido implementada con éxito para la evaluación
de tumores malignos mostrando alta sensibilidad
para la detección de tumores del tubo digestivo pero
con baja especificidad debido a varios patrones
fisiológicos y patológicos de captación de la FDG
en el tubo digestivo. Con la fusión del PET y la
tomografía computada (PET/CT) podemos localizar
y caracterizar el foco de captación de FGD. Es
necesario familiarizarse con los patrones de captación
en el tubo digestivo para diferenciar los
hallazgos fisiológicos de los patológicos y dentro de
éstos poder discriminar las alteraciones inflamatorias
de las tumorales. Para ello nos planteamos los
siguientes objetivos:
1) Describir y caracterizar la captación fisiológica vs
patológica de la 18F-FDG en el tubo digestivo en los
estudios PET/CT.
2) Revisar los hallazgos en los estudios PET/CT con
18F-FDG realizados en el CUDIM a pacientes
oncológicos que presentan lesiones hipermetabólicas
en el tubo digestivo y su correlación
patológica.
La correlación con la TC y la combinación de PET/
CT puede a veces ayudar a identificar la causa del
incremento en la captación y se recomienda que
los focos de mayor captación en intestino sean
valorados con endoscopía.
Palabras Claves: Tubo digestivo, lesiones focales, FFDG,
PET/CT, oncología, pitfalls.
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Abstract:
Positron Emission Tomography (PET) using fluorine
18-deoxy-glucose has been implemented
succesfully for the evaluation of malignant tumors,
showing high sensibility for the detection of
gastrointestinal tumors but low specificity due to
various physiological and pathological patterns of
FDG uptake in the gastrointestinal tract.
With the fusion of PET and CT (PET-CT), we can
locate and characterize the focus of uptake of FDG.
It is necessary to get familiarity with the patterns of
uptake in the gastrointestinal tract in order to
differentiate physiological from pathological findings
and discriminate within these inflammatory changes
and tumoral lesions.
For this we propose the following objectives:
1) To describe and characterize the pathological
versus physiological uptake of FDG in the digestive
tract in PET CT studies.
2) To review the findings on PET-CT studies made in
CUDIM to oncologic patients with hypermetabolic
lesions in the gastrointestinal tract and pathologic
correlation.
Correlation with computed tomography and the
combination of PET CT can sometimes help identify
the cause of increase in the FDG uptake and it is
recommended that the foci of increased uptake in
the gastrointestinal tract should be evaluated
endoscopically.
Key Words: Gastrointestinal tract foci, 18F-FDG, PET/
CT, oncology, pitfalls.
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Diagnostic Reference Ranges for
Pediatric Abdominal CT¹
Autor: Marilyn J. Goske, MD, Keith J. Strauss, MS Laura P. Coombs, PhD Keith E. Mandel, MD Alexander J. Towbin, MD David B. Larson, MD
Michael J. Callahan, MD Kassa Darge, MD, PhD Daniel J. Podberesky, MD Donald P. Frush, MD Sjirk J. Westra, MD Jeffrey S. Prince, MD
Resumen:
Purpose: To develop diagnostic reference ranges (DRRs) and a method for an individual practice to calculate site-specific
reference doses for computed tomographic (CT) scans of the abdomen or abdomen and pelvis in children on the
basis of body width (BW). Materials and Methods: This HIPAA-compliant multicenter retrospective study
was approved by institutional review boards of participating institutions; informed consent was waived. In 939 pediatric patients, CT doses were reviewed in 499 (53%) male and 440 (47%) female patients (mean age, 10 years). Doses were from 954 scans obtained from September 1 to December 1, 2009, through Quality Improvement Registry for CT Scans in Children within the National Radiology Data Registry, American College of Radiology.
Size-specific dose estimate (SSDE), a dose estimate based on BW, CT dose index, dose-length product, and effective
dose were analyzed. BW measurement was obtained with electronic calipers from the axial image at the splenic
vein level after completion of the CT scan. An adult-sized patient was defined as a patient with BW of 34 cm. An appropriate dose range for each DRR was developed by reviewing image quality on a subset of CT scans through comparison with a five-point visual reference scale with
increments of added simulated quantum mottle and by determining DRR to establish lower and upper bounds for each range.
Results: For 954 scans, DRRs (SSDEs) were 5.8–12.0, 7.3–12.2, 7.6–13.4, 9.8–16.4, and 13.1–19.0 mGy for BWs less than 15, 15–19, 20–24, 25–29, and 30 cm or greater, respectively. The fractions of adult doses, adult SSDEs, used within the consortium for patients with BWs of 10,
14, 18, 22, 26, and 30 cm were 0.4, 0.5, 0.6, 0.7, 0.8, and 0.9, respectively.
Conclusion: The concept of DRRs addresses the balance between the patient’s risk (radiation dose) and benefit (diagnostic image
quality). Calculation of reference doses as a function of BW for an individual practice provides a tool to help develop site-specific CT protocols that help manage pediatric patient radiation doses.
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Abstract:
Purpose: To develop diagnostic reference ranges (DRRs) and a
method for an individual practice to calculate site-specific
reference doses for computed tomographic (CT) scans of
the abdomen or abdomen and pelvis in children on the
basis of body width (BW)
Materials and
Methods:
This HIPAA-compliant multicenter retrospective study
was approved by institutional review boards of participating
institutions; informed consent was waived. In 939
pediatric patients, CT doses were reviewed in 499 (53%)
male and 440 (47%) female patients (mean age, 10 years).
Doses were from 954 scans obtained from September 1
to December 1, 2009, through Quality Improvement Registry
for CT Scans in Children within the National Radiology
Data Registry, American College of Radiology.
Size-specific dose estimate (SSDE), a dose estimate based
on BW, CT dose index, dose-length product, and effective
dose were analyzed. BW measurement was obtained
with electronic calipers from the axial image at the splenic
vein level after completion of the CT scan. An adult-sized
patient was defined as a patient with BW of 34 cm. An
appropriate dose range for each DRR was developed by
reviewing image quality on a subset of CT scans through
comparison with a five-point visual reference scale with
increments of added simulated quantum mottle and by
determining DRR to establish lower and upper bounds for
each range.
Results: For 954 scans, DRRs (SSDEs) were 5.8–12.0, 7.3–12.2,
7.6–13.4, 9.8–16.4, and 13.1–19.0 mGy for BWs less
than 15, 15–19, 20–24, 25–29, and 30 cm or greater,
respectively. The fractions of adult doses, adult SSDEs,
used within the consortium for patients with BWs of 10,
14, 18, 22, 26, and 30 cm were 0.4, 0.5, 0.6, 0.7, 0.8, and
0.9, respectively.
Conclusion: The concept of DRRs addresses the balance between the
patient’s risk (radiation dose) and benefit (diagnostic image
quality). Calculation of reference doses as a function
of BW for an individual practice provides a tool to help
develop site-specific CT protocols that help manage pediatric
patient radiation doses.
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Chronic Fibrosing Conditions
in Abdominal Imaging¹
Autores: Verghese George, MBBS, FRCR Varaha Sairam Tammisetti, MD
Venkateswar Rao Surabhi, MD Alampady K. Shanbhogue, MD
Abstract:
Chronic fibrosing conditions of the abdomen are relatively poorly understood
and involve varied and often multiple organ systems. At histopathologic
analysis, they share the unifying features of proliferative fibrosis and
chronic inflammation. Different conditions in this group are often found
in association with each other and with other fibrosing conditions outside
the abdomen. Some of the confusion about these conditions stems
from their complex nomenclature, which includes a gamut of alternate
terms and eponyms. Many of them can be categorized within two large
subgroups: the fibromatoses and immunoglobulin G4 (IgG4)–related
disorders. While many of these entities are of uncertain etiology, some,
especially the IgG4-associated conditions, appear to have an immunemediated
pathogenesis. Nephrogenic systemic fibrosis, sclerosing peritonitis,
and retroperitoneal fibrosis have iatrogenic associations, while some
of the fibromatoses are genetically inherited. Imaging differentiation of
these conditions is difficult due to considerable overlap in their radiologic
findings. However, certain conditions such as penile fibromatosis and
sclerosing peritonitis may have unique imaging features that can help the
radiologist make the diagnosis. Others such as deep fibromatoses and inflammatory
pseudotumor demonstrate fibroproliferative mass formation
and cannot be differentiated from neoplastic conditions at imaging. Thus,
histopathologic correlation is often required to confirm their diagnosis.
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Abstract:
Retained products of conception (RPOC) are a common and treatable complication after delivery or termination of pregnancy. The pathologic diagnosis of RPOC is made based on the presence of chorionic villi, which indicates persistent placental or trophoblastic tissue. In the setting of postpartum hemorrhage, however, distinguishing RPOC from bleedingrelated to normal postpartum lochia or uterine atony can be clinically challenging. Ultrasonographic (US) evaluation can be particularly helpful in these patients, and a thickened endometrial echo complex (EEC) or a discrete mass in the uterine cavity is a helpful gray-scale US finding that suggests RPOC. However, gray-scale US findings alone are inadequate for accurate diagnosis. Detection of vascularity in a thickened EEC or an endometrial mass at color or power Doppler US increases the positive predictive value for the diagnosis of RPOC. Computed tomography or magnetic resonance imaging may be helpful when US findings are equivocal and typically demonstrates an enhancing intracavitary mass in patients with RPOC. Diagnostic pitfalls are rare but may include highly vascular RPOC, which can be mistaken for a uterine arteriovenous malformation; true arteriovenous malformations of the uterus; invasive moles; blood clot; and subinvolution of the placental implantation site.
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