Resumen:

Abstract:

Classification and epidemiology of orbital fractures diagnosed by computed tomography.

Purpose: To characterize the cases of orbital fractures diagnosed by computed tomography (CT) during a time period of one year at our Radiology Department.
Materials and Methods: A cross-sectional descriptive study was performed. All cases of orbital fracture diagnosed during a period of one year (from June 2011 to June 2012) were identified. The analyzed variables were: patient age and sex, mechanism of fracture production, fracture location, and need for surgical management. EpiDat 3.1 was used for the statistical processing of data.
Results: Orbital fractures were diagnosed in 25 of the 167 patients who underwent orbital computed tomography during that period: 5 were female (20%) and 20 male (80%). The mean age of the injured patients was 31 years (range 1 to 63 years). The fracture mechanisms were: falls (32%), physical aggression (44%), car accidents (8%), and other causes (16%). Fifteen cases (60%) required surgical management. As regards fracture distribution, 10 of them (40%) were isolated (just one orbital wall involved), while 15 (60%) were combined (2 or more orbital walls involved). Right orbital fractures were found in 11 cases (44%), while left and bilateral fracture locations were detected in 12 (48%) and 2 cases (8%), respectively.
Conclusion: The most common types of isolated orbital fractures found in our study were those of the orbital floor and the medial orbital wall, which could be associated with their known anatomical weakness. Mean age and gender distribution of lesions were consistent with those reported by other studies.

Keywords: Orbital fracture. Classification. Epidemiology. Computed tomography.

Resumen:

Introducción: La angiografía carotídea se utiliza para confi rmar la presencia de estenosis de la bifurcación carotídea (BC). Sin embargo, dado que este método resulta invasivo y presenta cierta morbimortalidad, existe un creciente interés en los métodos no invasivos, como la angiografía por resonancia magnética con gadolinio (ARM-Gd) y la ecografía Doppler color (EDC). El objetivo de este trabajo es determinar la correlación que existe entre la ecografía Doppler color y la angiografía por resonancia magnética con gadolinio en la determinación del grado de estenosis.
Materiales y métodos: Se analizaron por ecografía Doppler color y angiografía por resonancia magnética con gadolinio 100 estudios de la bifurcación carotídea, realizados entre enero de 2009 y agosto de 2011 en el Sanatorio Allende. Se determinó el coefi ciente de concordancia Kappa, evaluando por ecografía Doppler color el porcentaje de estenosis carotídea según la reducción del diámetro y la velocidad sistólica máxima (VSM) y por angiografía por resonancia magnética con gadolinio la reducción de la luz visualizada. En ambos métodos se empleó el criterio de NASCET. También se analizó la superfi cie de la placa.
Resultados: Se obtuvo una muy buena correlación entre la ecografía Doppler color y la angiografía por resonancia magnética con gadolinio, con un coefi ciente de concordancia Kappa de 0,90 y un intervalo de confi anza (IC) de 95% (0,786-0,99). Sin embargo, existió una discordancia para valorar la superfi cie de la placa, que dejó en evidencia la superioridad de la angiografía por resonancia magnética con gadolinio para defi nir la superfi cie irregular y/o ulcerada.
Conclusión: El avance de la tecnología y el creciente número de estudios que demuestran la fi abilidad y correlación diagnóstica de los métodos no invasivos hacen suponer que en un corto plazo estos reemplazarán a la angiografía en el diagnóstico y valoración de la patología carotídea.

Palabras clave: Estenosis. Arteria carótida interna. Ultrasonido. Doppler color. Angiografía por resonanciamagnética con gadolinio

Abstract:
Noninvasive assessment of carotid stenosis in relation to atherosclerosis: correlation between color Doppler ultrasound and magnetic resonance angiography with gadolinium

Introduction: Carotid angiography is used to confi rm carotid bifurcation (CB) stenosis. However, it is an invasive method that involves some morbidity. For this reason there is growing interest in non-invasive methods for the evaluation of carotid stenosis, including magnetic resonance angiography with gadolinium (MRAG) and color Doppler ultrasound (USDC). The aim of this study is to determine the correlation between the color Doppler ultrasound and magnetic resonance angiography with gadolinium in the evaluation of the degree of stenosis.
Materials and methods: One hundred carotid bifurcations were studied by color Doppler ultrasound and magnetic resonance angiography with gadolinium between January 2009 and August 2011 in Sanatorio Allende. The level of agreement was determined using the Kappa coeffi cient, analyzing the percentage of carotid stenosis with color Doppler ultrasound according to the maximum systolic speed and the stenosis seen by magnetic resonance angiography with gadolinium, using the NASCET criteria for both methods.
Results: An excellent correlation was obtained between Doppler ultrasound and magnetic resonance angiography with gadolinium, with a Kappa coeffi cient of 0.90 (95% CI: 0.786-0.99). There was disagreement between the two methods in assessing the plaque surface, showing that magnetic resonance angiography with gadolinium was better for detecting an irregular surface and / or ulcerated plaque.
Conclusion: The technological improvement and the increase in reliable studies that have a good diagnostic correlation with non-invasive methods, it could be assumed that, in a short period of time, Doppler ultrasound will gradually replace angiography in the diagnosis of carotid pathology.

Key Words: Stenosis. Internal carotid artery. Color Doppler ultrasound. Magnetic resonance angiography with gadolinium

Resumen:

La patología escrotal aguda constituye una situación clínica de urgencia que requiere un rápido diagnóstico para instalar un tratamiento precoz. Las causas más frecuentes de patología escrotal aguda son traumáticas, infecciosas y vasculares. Debido a que todas estas patologías tienen una sintomatología similar, caracterizada por el dolor y la tumefacción, el uso de la ecografía como método de imagen, inocuo y accesible, proporciona una gran ventaja para el diagnóstico preciso y posterior manejo terapéutico.

Palabras clave: escroto. agudo. ecografía

Abstract:
Acute scrotal pathology is a clinical emergency that requires rapid diagnosis to install an early treatment. The most frequent causes of acute scrotal pathology are traumatic, infectious and vascular. Because all these conditions have similar symptoms characterized by pain and swelling, the ultrasound is a safe and accessible method that provides a great advantage for the accurate diagnosis and subsequent therapeutic management.

Key Words: scrotal. acute. ultrasound

Resumen:

Las glándulas suprarrenales son el asiento de numerosas patologías y un nódulo adrenal puede ser descubierto incidentalmente. Las imágenes de alta resolución han modificado el algoritmo diagnostico ante una patología adrenal. La tomografía computada sin contraste endovenoso es el estudio de primera línea para la evaluación adrenal. Una densidad espontanea menor a 10 UH confirma la naturaleza benigna. Cuando las lesiones no pueden ser caracterizadas, la tomografía computada postcontraste o imágenes de RM, puede permitir el diagnostico.

Palabras clave: incidentaloma adrenal. tomografía computada.

Abstract
Abdominal fat necrosis may cause pain, mimic findings of acute abdomen, or be asymptomatic and accompany other pathophysiologic processes. Common processes that are present in fat necrosis include torsion of an epiploic appendage (a self-limited inflammation of the appendices epiploicae), infarction of the greater omentum (a hemorrhagic infarction resulting from vascular compromise), encapsulated fat necrosis (traumatic or ischemic insult that causes fat degeneration), fat saponification and pancreatitis and heterotopic ossification in surgical incisions of the abdomen (represent a subtype of traumatic myositis ossificans in which osseous, cartilaginous, and, occasionally, myelogenous elements forms within a surgical incision).

Key Words: necrosis. fat. abdominal.

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Abstract

The present study aimed to review high resolution computed tomography findings in patients with H1N1 influenza A infection. The most common tomographic findings include ground-glass opacities, areas of consolidation or a combination of both patterns. Some patients may also present bronchial wall thickening, airspace nodules, crazy-paving pattern, perilobular opacity, air trapping and findings related to organizing pneumonia. These abnormalities are frequently bilateral, with subpleural distribution. Despite their nonspecificity, it is important to recognize the main tomographic findings in patients affected by H1N1 virus in order to include this possibility in the differential diagnosis, characterize complications and contribute in the follow-up, particularly in cases of severe disease.

Keywords:Influenza A (H1N1). Pulmonary infection. Pulmonary viruses. Computed tomography.

Resumo:

Tomographic diagnosis and relevant aspects of otosclerosis



Abstract: A literature review and pictorial essay were developed to discuss the importance of knowing the main findings and locations of otosclerosis at multidetector computed tomography (MDCT). The authors performed a retrospective review of cases of otosclerosis diagnosed in their institution by means of high resolution multidetector computed tomography. Otosclerosis corresponds to otic capsule dysplasia characterized by metabolic derangement of its endochondral layer. Such condition constitutes a relevant cause of sensorineural hearing loss, affecting about 7% to 10% of the general population. The diagnosis is usually clinical, but imaging methods play a significant role in the anatomical detailing, differential diagnosis, surgical planning and evaluation of postoperative complications. Among such methods, the relevance of MDCT is highlighted. Radiologists should be familiar with the MDCT findings of otosclerosis, as well as with the temporal bone anatomy to assist in the appropriate clinical management of this disease.

Keywords: Otosclerosis. Otospongiosis. Sensorineural hearing loss. Multidetector computed tomography.

Resumen:

Abstract:

Multiple sclerosis (MS) is a common demyelinating disease that involves the central nervous system causing focal lesions in the brain and spinal cord causing diverse neurological development deficits, many of them severe and irreversible, affecting and invaliding a large percentage of young productive-aged patients. MRI exams have improved diagnostic capability compared to computed tomography, but in this decade the development of new magnets, coils and software have allowed the development of quantitative neuroradiology which achieves the evaluation of parameters such as total brain volume, of each of its structures, as well as semi-automated or automated counting of the lesion load, allowing better monitoring of each individual patient in relation to a particular event such as a new neurological deficit in an outbreak of the disease, a previously undetected cognitive impairment or in related to a given treatment. We will show our local experience using the FreeSurfer software in our habitual practice, as well as other post-processing software, this being the first experience of its use in multiple sclerosis published in our country.

Keywords: Brain volume. FreeSurfer. Magnetic resonance imaging. MIPAV software. Multiple sclerosis. Lession load,

Resumen:

Lower limb asymmetry: Imaging evaluation in children

Abstract:

Limb length discrepancy or anisomelia has long been objectified with imaging.The biomechanical implications for patients with a developing skeleton are more relevant than the cosmetic aspects, both in treatment and in follow-up. The aim of this publication is to review the most common causes of lower limb asymmetry in children, with emphasis on imaging findings, which are of great importance for clinical management. A retrospective review was performed on patients younger than 15 years, who required evaluation at our center for lower limb asymmetry, using simple X-ray, CT scan and /or MRI. The anatomical findings and morphometric analysis were recorded for each case. The causes of limb length discrepancy are many, including congenital and sequelae conditions. A knowledge and proper assessment of the imaging findings helps to improve and standardize the radiology report.

Keywords: Anisomelia. Asymmetry. Lower extremities.

Resumen:

Abstract

Non-Ionizing Biological Effects and Security Issues in Magnetic Resonance

Objective: To review the deterministic biological effects of static, dynamic and dependent magnetic fields used in clinical magnetic resonance imaging (MRI).
Methods: The suggested limits are referenced depending on the different MRI applications, as well as their possible biological effects. In addition, safety aspects which must be taken into account when areas that include this diagnostic technique are shown. Lastly, a short description of the important items for the regulatory authorities to consider when facing these types of test with non-ionizing radiation is discussed.
Conclusions: Even though there is no agreement in the literature about the biological risks, risks do exist due to the presence of high magnetic fields. Specific precautions should be taken in terms of proper facilities and qualified personnel, as well as an appropriate legislation which does not exist in Colombia.

Key words: Magnetic resonance imaging. Abnormalities radiationinduced. Non ionizing radiation Equipment safety

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Abstract

Applications of Conventional Radiology in the Medical Forensic Field

Introduction: The field of forensics is an unexplored field of radiology in Colombia. However, it has many applications of great importance. These applications help solve crimes and therefore, assist in the administration of justice. Radiology is applied in forensic medicine in areas such as: study of deaths from air accidents and disasters, documentation of injuries in traffic accidents, medical-legal autopsies in mechanical suffocation deaths, study of deaths associated from accidents with firearm projectiles, diagnosis of child abuse, verifying the authenticity of physical evidence, identification of corpses, examination of fetal deaths, personal injuries, age determination, examination of skeletal remains and virtual autopsy (virtuopsia), among others.
Objectives: To present the reader with the most important applications of radiology in the forensic field through illustrations of medical-legal cases obtained from the National Institute of Legal Medicine and Forensic and Academic Sciences at the University Hospital San Ignacio.
Materials and Methods: We performed a literature search in PubMed, ScienceDirect and MDConsult, with MESH words and free text from 1985 where 114 articles were obtained. 59 of these articles were selected due to their relevance. Conclusions: Different radiological imaging modalities can be applied in the area of forensics. The radiologist doctor plays a key role in the implementation, interpretation and reporting of radiological studies aimed at solving legal problems for the proper administration of justice.

Key words:Radiology. Forensic medicine. Cadaver. Victims identification. Forensic anthropology

Resumen:

Structural magnetic resonance imaging in epilepsy

Abstract:
Magnetic resonance imaging is the main structural imaging in epilepsy. In patients with focal seizures, detection (and characterization) of a structural lesion consistent with electroclinical data allows therapeutic decisions without having to resort to other more expensive or invasive diagnostic procedures. The identification of some lesions may provide prognostic value, as in the case of Mesial Temporal Sclerosis (MTS) or may contribute to genetic counseling, as in the case of some Malformations of Cortical Development (MCD). The aim of this paper is to review the current state of structural MRI techniques, propose a basic protocol of epilepsy and mention the indications for structural MRI. Also, review the semiology of the main causes of epilepsy, with emphasis on MTS and MCD, by its highest frequency and by the special impact that MRI has shown in dealing with these entities.

Keywords: Magnetic resonance. Epilepsy. Mesial Temporal. Sclerosis. Focal Cortical Dysplasia

Resumen:

Diagnosis and management of adrenal incidentaloma

Abstract:

The growing demand for imaging tests and the progressive aging of the population have led to a progressive increase in the detection of indeterminate adrenal lesions. Once an adrenal incidentaloma is detected, clinical and hormone tests together with a battery of imaging techniques (CT, MRI, PET/CT. . .) make it possible to determine the cause in most cases. In this article, we discuss the advantages and limitations of each technique.We show the imaging characteristics of the most common adrenal lesions and propose a diagnostic algorithm to enable their diagnosis.

Key Words:Adrenal incidentaloma. Computed tomography. Magnetic resonance imaging. Positron emission tomography/ computed tomography. Algorithm

Resumen:

Abstract:

Gallbladder cancer is the most common malignancy of the biliary tract. The progress and development of imaging methods in recent decades has led to a marked improvement in the preoperative diagnosis of this pathology, this being essential in the therapeutic management and prognosis. Also, many series report an increased number of incidental findings obtained with multislice CT scanners, which sometimes represent early-stage tumors. However, the signs and symptoms associated with cancer of the gallbladder (abdominal pain, jaundice, anorexia, nausea and vomiting), are insidious and unspecific, therefore, in most cases, the detection is performed in advanced stages of disease. This determines that it is a malignancy with poor prognosis and lower overall survival rate (less than 5% at 5 years).

Key Words: Gallbladder Cáncer. Computed Tomography.

Resumen:

Abstract:
Epilepsy is a frequent neurological disease being one of the most common reasons for application of magnetic resonance (MR) in our hospital. While the majority of patients achieve adequate control of the disease, nearly 30% fail to respond to therapeutic setting, being called refractory epilepsy. The possibility of finding a focal lesion responsible for the clinical picture increases significantly in patients with refractory epilepsy which gives importance to imaging studies. We show the findings in a group of patients with refractory epilepsy studied in the epilepsy program highlighting the features of each case in MR images and the importance of a proper protocol.

Key Words: epilepsy. cortical malformations. magnetic resonance. temporomesial sclerosis.

Resumen:

Abstract:

Purpose: To determine whether the addition of arterial phase computed tomography (CT) to the standard combination of portal venous and delayed phase imaging increases sensitivity in the diagnosis of active hemorrhage and/or contained vascular injuries in patients with splenic trauma.
Materials and Methods: The institutional review board approved this HIPAAcompliant retrospective study; the requirement to obtain informed consent was waived. The study included all patients aged 15 years and older who sustained a splenic injury from blunt or penetrating trauma and who underwent CT in the arterial and portal venous phases of image acquisition during a 74-month period (September 2005 to November 2011). CT scans were reviewed by three radiologists, and a consensus interpretation was made to classify the splenic injuries according to the American Association for the Surgery of Trauma splenic injury scale. One radiologist independently recorded the presence of contained vascular injuries or active hemorrhage and the phase or phases at which these lesions were seen. Clinical outcome was assessed by reviewing medical records. The relationship between imaging findings and clinical management was assessed with the Fisher exact test.
Results: One hundred forty-seven patients met the inclusion criteria; 32 patients (22%) had active hemorrhage and 22 (15%) had several contained vascular injuries. In 13 of the 22 patients with contained injuries, the vascular lesion was visualized only at the arterial phase of image acquisition; the other nine contained vascular injuries were seen at all phases. Surgery or embolization was performed in 11 of the 22 patients with contained vascular injury.
Conclusion: The arterial phase of image acquisition improves detection of traumatic contained splenic vascular injuries and should be considered to optimize detection of splenic injuries in trauma with CT.

Abstract:

Abstract:

Actinomycosis is a chronic suppurative bacterial infection caused by Actinomyces species. Actinomyces israelii is the organism most commonly found in human disease. Actinomycosis usually manifests with abscess formation, dense fibrosis, and draining sinuses. The disease is further characterized by the tendency to extensively spread beyond normal fascial and connective tissue planes. Actinomycosis occurs most commonly in the cervicofacial region (50%–65%), followed by the thoracic (15%–30%) and abdominopelvic (20%) regions, but rarely involves the central nervous system. Most cases of cervicofacial actinomycosis are odontogenic in origin. In the acute form, cervicofacial disease can manifest with soft-tissue swelling, a painful pyogenic abscess, or a mass lesion. In the subacute to chronic form, a painless indurated mass can spread to the skin, leading to draining sinus tracts. Thoracic manifestations include parenchymal, bronchiectatic, and endobronchial actinomycosis. At computed tomography, pulmonary actinomycosis usually appears as chronic segmental airspace consolidation containing necrotic low-attenuation areas with peripheral enhancement. Abdominopelvic actinomycosis preferentially involves the ileocecal region, ovary, and fallopian tube. The imaging findings favoring abdominopelvic actinomycosis include strong enhancement in the solid portion of the mass after contrast material administration, small rim-enhancing abscesses within the mass, and extensive inflammatory extensions. Actinomycosis in the central nervous system may produce brain abscess, meningitis, subdural empyema, actinomycetoma, and spinal and cranial epidural abscess. In general, actinomycosis responds well to antibiotic therapy, but long-term follow-up after treatment is needed because of frequent relapses.