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Resonancia magnética de alta resolución
en el cáncer de recto
Autor: Adriana Dieguez
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Resumen:
La Resonancia Magnética de alta resolución (RM AR)
es el mejor método para demostrar la relación del tumor rectal con el potencial margen circunferencial de resección quirúrgico. Por esta razón es considerada en la actualidad el método de elección en la estadificación local del cáncer de recto. La cirugía primaria del cáncer
rectal es la escisión total del mesorrecto (ETM), cuyo plano de disección está formado por la fascia mesorrectal que envuelve la grasa del mesorrecto y al recto. Esta fascia es la que determinará el margen circunferencial de resección (MCR). Asu vez, la RM AR permite
una adecuada identificación preoperatoria de importantes factores pronósticos de riesgo, mejorando la selección e indicación de la terapia para cada paciente. Esta información incluye, además del MCR, la estadificación tumoral y ganglionar, la invasión vascular extramural y la descripción de tumores de recto inferior. Todos ellos deberán ser descriptos minuciosamenteen el informe, siendo parte importante de la discusión
en el equipo multidisciplinario (EMD), ámbito en el cual se tomarán las decisiones que involucren alpaciente con cáncer de recto. El objetivo de este trabajo es aportar la información necesaria para entender el uso de la RM AR en la identificación de los factores pronósticos de riesgo en elcáncer de recto. Se describirán los requerimientos técnicos para la realización de este estudio y el informe estandarizado, como así también los reparos anatómicos de importancia para la ETM, que como hemos dicho es la cirugía de elecciónen el cáncer de recto.
Palabras clave: Cáncer de recto; Resonancia Magnética de alta resolució; Margen circunferencial de resección; Equipo multidisciplinario; Factores pronósticos
de riesgo.
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Abstract:
High-Resolution MRI in Rectal Cancer High-resolution MRI is the best method of assessing the relation of the rectal tumor with the potential circumferential resection margin (CRM). Therefore it is currently considered the method of choice for local staging of rectal cancer. The primary surgery of rectal cancer is total mesorectal excision (TME), which plane of dissection is formed by the mesorectal fascia surrounding mesorectal fat and rectum. This fascia will determine the circumferential margin of resection. At the same time, high resolution MRI allows adequate pre-operative identification of important prognostic risk factors, improving the selection and indication of therapy for each patient. This information includes, besides the circumferential margin of resection, tumor and lymph nodestaging, extramural vascular invasion and the description of lower rectal tumors. All these should be described in detail in the report, being part of the discussion in the multidisciplinary team, the place where the decisions involving the patient with rectal cancer will take place. The aim of this
study is to provide the information necessary to understand the use of high resolution MRI in the identification of prognostic
risk factors in rectal cancer. The technical requirements and standardized report for this study will be describe, as well as the anatomical landmarks of importance for the total mesorectal excision (TME), as we have said is
the surgery of choice for rectal cancer.
Key Words: Rectal cancer; High - resolution magnetic resonance
imaging; Circumferential resection margin; Multidisciplinary team; Prognostic risk factors
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Neuroimágenes estructurales y funcionales en la
caracterización del linfoma del SNC
Autores: Cristina Besada, Pablo Schvartzman, Lisandro Paganini, Daniela Santa Cruz, Jorge Funes
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Resumen Objetivo: Mostrar los hallazgos en imágenes del compromiso primario o secundario del Sistema Nervioso Central (SNC) por el linfoma, haciendo énfasis en el
aporte de la espectroscopía. Material y Métodos: Se estudiaron en forma retrospectiva con un equipo de resonancia magnética (RM) de 1.5T 25 casos (16 hombres y 9 mujeres) con diagnóstico histológico de linfoma no Hodgkin y compromiso del SNC. Se destacaron los distintos tipos de presentación en imágenes convencionales con contraste y funcionales en espectroscopía. Se utilizaron técnicas multivoxel
con tiempos de eco intermedio y corto.
Resultados: Se detectaron 3 patrones principales de presentación de esta patología: parenquimatosa, meníngea y de pares craneanos. Además, se destacaron algunos hallazgos característicos, como compromiso
de los espacios perivasculares. La resonancia magnética convencional no fue concluyente en la caracterización del tumor en varios de los
casos. En dichos pacientes, el aporte de la espectroscopía fue de gran utilidad. El hallazgo más significativo
tanto para los linfomas primarios como para los secundarios fue el aumento de los picos de lípidos y colina. El pico de lípido fue en algunos casos identificado como el metabolito dominante, especialmente en tiempos de eco (TE) corto. No se encontraron diferencias en el patrón
espectroscópico entre linfomas primarios y sistémicos.
Conclusión: La afectación del SNC por los linfomas
presenta una gran variedad de manifestaciones radiológicas,con diferentes patrones de presentación.
Esta característica hace difícil la correcta caracterización de estos tumores en forma prequirúrgica sólo con RM convencional. La espectroscopía por RM puede ser de
gran utilidad en estas situaciones, demostrando la presencia del pico de lípido. Este hallazgo, presente en un tumor sólido intraxial con realce post contraste sugiere la posibilidad de un linfoma y podría promover la modificación de la estrategia terapéutica y quirúrgica.
Palabras clave: Sistema Nervioso Central; Linfoma; Resonancia Magnética; Espectroscopía; Lípidos; Tumor sólido.
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Abstract
Structural and functional imaging for the characterizationof CNS lymphomas
Purpose: To show the imaging patterns of primary or secondary involvement of the Central Nervous System (CNS) in cases of lymphoma with emphasis in the contribution of spectroscopy.
Material and methods: 25 cases (16 males and 9 females) were retrospectively reviewed using a 1.5T magnetic resonance unit. The patients had a histological diagnosis of Non- Hodgkins lymphoma with CNS involvement. The
cases were studied with conventional MR with contrast and functional images were obtained with spectroscopy through a multivoxel
technique using intermediate and short echo sequences
Results: Three main patterns of presentation were identified:
parenchymal, meningeal and cranial nerve involvement. Additionally some characteristic findings were detected such as the involvement of perivascular spaces. Conventional MRI was not conclusive in the characterization of several tumors. In such patients spectroscopy proved to be
very useful. The most significant findings both in the primary tumors as well as in the secondary lesions were the lipid and choline peaks. The choline peak was in some cases identified as the dominant metabolite, particularly in the short TE echo
sequences. No differences were found between the spectroscopic pattern of primary and systemic lymphomas.
Conclusion: CNS lymphomas are tumors with a wide range of radiological patterns. This characteristic creates difficulties to characterize them correctly during the pre-surgical phase with conventional MRI alone. MR Spectroscopy may be useful in such cases by demonstrating the lipid peak.
This finding only seen in deep intra-axial tumours demonstrated by contrast enhancement supports the presumption
of lymphoma and may lead to changes in therapeutic or surgical strategy.
Key words: Central Nervous System; Lymphoma; Magnetic Resonance Imaging; Spectroscopy; Lipids; Solid
enhancing tumor.
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Aspectos ultrassonográficos e hemodinâmicos
da esquistossomose mansônica: avaliação
pela ultrassonografia Doppler em áreas endêmicas
Sonographic and hemodynamic findings of schistosomiasis mansoni: Doppler sonography
assessment in endemic areas
Autores: Leticia Martins Azeredo, Leonardo Campos de Queiroz, Carolina Coimbra Marinho, Maria Cristina Carvalho do Espírito Santo, Maria Cristina Chammas, Raiza Ruiz-Guevara, Aluizio Prata, Carlos Mauricio Figueiredo Antunes, José Roberto Lambertucci, Giovanni Guido Cerri
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Resumo Objetivo:
Este estudo de campo objetivou identificar as alterações ultrassonográficas e hemodinâmicas indicativas da morbidade da esquistossomose mansônica em áreas endêmicas.
Materiais e Métodos: Foram examinados pela ultrassonografia Doppler 554 pacientes esquistossomóticos em três áreas com níveis distintos de endemicidade: baixa endemicidade (n = 109); média endemicidade (n = 255) e alta endemicidad (n = 190). Para o estudo ultrassonográfico foi utilizado o protocolo da Organização Mundial da Saúde (Niamey Working Group, 2000). Pelo Doppler foram avaliados: vasos portais, artérias hepática
e esplênica, veias hepáticas e vasos colaterais. Resultados: Houve correlação significativa entre a frequência das alterações ultrassonográficas e o nível de endemicidade das áreas, exceto a hipertrofia do lobo esquerdo.
As veias hepáticas apresentaram padrão de fluxo alterado em 23,7% dos casos, alteração esta relacionada à presença e à intensidade de espessamento periportal. A artéria hepática não apresentou alterações
nos parâmetros avaliados. Os vasos colaterais foram identificados apenas na área de alta endemicidade.
A artéria esplênica apresentou alterações (aumento do calibre, da velocidade e do índice de resistência)
mais frequentes na área de alta endemicidade, com diferença significativa entre os grupos.
Conclusão: A ultrassonografia Doppler mostrou-se ferramenta auxiliar importante no estudo da morbidade relacionada à esquistossomose mansônica, contribuindo para definição mais precisa do perfil da doença nas áreas endêmicas.
Unitermos: Esquistossomose mansônica; Ultrassonografia Doppler.
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Abstract Objective:
The present field research was aimed at identifying sonographic and hemodynamic findings
indicative of the presence of schistosomiasis mansoni in endemic areas.
Materials and Methods: Doppler
sonography was performed in 554 patients with schistosomiasis in three areas with different endemicity
levels: low (n = 109), medium (n = 255) and high endemicity (n = 190). The World Health Organization
(Niamey Working Group, 2000) protocol was adopted for sonographic evaluation. Doppler study included portal
vessels, hepatic and splenic arteries, hepatic veins and collateral vessels.
Results: A significant correlation
was observed between the frequency of sonographic findings, except for left lobe hypertrophy, and the areas endemicity levels. Altered hepatic
veins flow pattern was observed in 23.7% of cases, such abnormality being related to the presence and intensity of periportal thickening. Hepatic arteries did not present any alteration as related to the evaluated parameters. Collateral vessels were identified only in the patients from
the high-endemicity area. The splenic artery presented alterations (increase in caliber, flow velocity and resistive
index), most frequently in the high-endemicity area, with significant difference between groups.
Conclusion: Doppler sonography has shown to be a relevant auxiliary tool in the study of the morbidity related to
schistosomiasis mansoni, contributing for a more accurate description of the disease profile in endemic areas.
Key Words: Schistosomiasis mansoni; Doppler sonography.
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PET-RM neurológico com FDG-18F: ensaio iconográfico
Brain 18F-FDG PET-MRI coregistration: iconographic essay
Autores: José Leite Gondim Cavalcanti Filho, Léa Mirian Barbosa da Fonseca, Romeu Côrtes
Domingues, Roberto Côrtes Domingues, Luiz Souza de Machado Neto, Emerson Leandro Gasparetto
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Resumo:
A integração da tomografia por emissão de pósitrons (PET) com a ressonância magnética (RM) tem sido alvo de diversos estudos nos últimos anos. O PET é a modalidade de imagem mais sensível e específica na detecção de alterações metabólicas, entretanto, apresenta limitada resolução espacial.
Por outro lado, a RM apresenta importante resolução espacial, além de avaliar estruturas com intensidade de sinal de partes moles com excelente contraste. O objetivo deste estudo é demonstrar, na forma de ensaio iconográfico, as potenciais aplicações clínicas da fusão de imagens de PET e RM. Os exames foram realizados em aparelho PET dedicado utilizando como radiofármaco a fluordeoxiglicose-18F (FDG) e corregistrados com RM de 1,5 T ou 3 T do encéfalo. A fusão por programa de imagens do cérebro tem acurácia já bem estabelecida.
Consegue- se, assim, importante sinergia de um estudo funcional de PET com excelente detalhamento anatômico da RM. As aplicações clínicas mais atraentes dessa abordagem são a avaliação da zona epileptogênica em pacientes refratários ao tratamento medicamentoso, identificação dos pacientes com déficit cognitivo com maior risco de progressão para demência e distinção de demências e síndromes parkinsonianas.
Unitermos:
Fluordeoxiglicose; FDG; Tomografia por emissão de pósitrons; PET; Imagem por ressonância
magnética; Fusão; Neurologia.
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Abstract:
The combination of positron emission tomography (PET) with magnetic resonance imaging (MRI) has been
the subject of several studies in recent years. Positron emission tomography is the most sensitive and specific
imaging modality in the detection of metabolic changes, but presents limited spatial resolution. On the other
hand, MRI presents a significant spatial resolution, besides evaluating soft tissues signal intensity with excellent
contrast resolution. The present iconographic essay is aimed at demonstrating the potential clinical application
of PET/MRI coregistration. The studies were performed in a dedicated PET unit with 18F-fluorodeoxyglucose
(FDG) as radiopharmaceutical and coregistered with 1.5 T or 3 T brain MRI. The brain images fusion software
presents an already well-established accuracy, so a significant synergy between a functional PET study and
an excellent MRI anatomical detail is achieved. The most attractive clinical applications of this approach are
the following: epileptogenic zone assessment in patients refractory to drug therapy, identification of patients
with cognitive impairment at higher risk for progression to dementia and differentiation of dementias and
Parkinsonian syndromes.
Key Words:
Fluorodeoxyglucose; FDG; Positron emission tomography; PET; Magnetic resonance imaging;
Fusion; Clinical neurology.
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Amplio espectro de la enfermedad vascular hepática en imágenes
Autores: Juan Camilo Camacho, Adriana Márquez,Javier Romero, Diego Aguirre
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Resumen:
La enfermedad vascular hepática (EVH ) constituye un amplio espectro de entidades de baja prevalencia, pero con manifestaciones clínicas diversas que pueden llevar a la muerte. Una detección temprana y un tratamiento oportuno cambian el pronóstico. De ahí que las imágenes diagnósticas desempeñen un papel fundamental; sin embargo, hay que tener en cuenta el amplio diagnóstico diferencial. La tomografía computarizada de abdomen es una de las herramientas más útiles para el diagnóstico, sin olvidar otros métodos de imagen, como el ultrasonido Doppler y la resonancia magnética. La EVH puede clasificarse según la repercusión que se pueda derivar de ella, por lo que en términos prácticos puede dividirse en alteraciones venosas, portales, arteriales, sinusoidales y otras. El objetivo de esta revisión es describir la presentación más frecuente de la EVH y sus principales hallazgos y diagnósticos diferenciales, al tiempo que se reconoce su correlación con los mecanismos fisiopatológicos.
Palabras Clave: Enfermedades vasculares
; Circulación hepática;
Hígado
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Summary:
Hepatic vascular diseases (HVD) are a broad spectrum of entities of low prevalence but with different clinical manifestations that may even lead to death. Its early detection and timely treatment
may change the prognosis. Diagnostic imaging plays a key role and imaging findings may be typical. However, in most cases, radiologists must take into account a wide range of differential diagnosis. Computed tomography (CT) of the abdomen is one of the most useful tools for the diagnosis of HVD taking also into account the value of other imaging methods such as Doppler Ultrasound and
Magnetic Resonance Imaging (MRI).
HVD can be classified according to the compromised vascular structure and can be divided into
venous, portal, arterial, sinusoidal and others disorders. The objective of this review is to describe the
most common presentation HVD . The major imaging findings and differential diagnosis recognizing
its correlation with the pathophysiological mechanisms.
Key Words: Vascular diseases;
Diagnostic imaging
; Liver diseases
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Uso de entero-TC para evaluar patología del intestino delgado:
experiencias y hallazgos en 90 pacientes
Autores: Daniel Upegui Jiménez, Óscar Derek Mendoza Báez, Wilber Orlando Segura Cotrino, Fabián Mauricio Heredia Sánchez, Germán Galvis Ruiz, Jorge Enrique Fuentes
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Introducción:
La entero-TC o escanografía abdominal con protocolo especial para evaluar el intestino delgado se ha convertido en una valiosa herramienta en los pacientes con sospecha de patologías intestinales, a
partir de la combinación de un medio de contraste endovenoso y grandes volúmenes de medio de contraste neutro, administrado por vía oral, para distender la luz intestinal y obtener imágenes del lumen, así como del espesor y el patrón de realce de las paredes del intestino delgado.
Materiales y Métodos: Entre mayo de 2007 y febrero de 2009 se recolectaron de forma retrospectiva 90 casos de pacientes que consultaron en una clínica universitaria. Fueron preparados con dieta líquida sin residuo durante 24 horas y ayuno completo de cuatro horas previo al examen. Se administró un total de 2.000 cm3 de agua. Luego se complementó con 100 cm3 de medio de contraste endovenoso a una tasa de 4 cm3/segundo. Se realizó una fase arterial temprana a los 20 segundos y una fase
portal a los 60 segundos luego de iniciar la administración
del contraste.
Resultados: Los hallazgos más frecuentes fueron: enfermedad diverticular, lesiones quísticas, afectación neoplásica, enfermedad de Crohn, ileítis, obstrucción mecánica, hernia hiatal, colelitiasis, hemangiomas hepáticos, hernia interna, divertículo duodenal, poliposis, malrotación intestinal y sangrado activo.
Conclusiones: El entero-TC es un estudio útil y no invasivo para el diagnóstico de patologías de intestino delgado, que permite una distensión satisfactoria del intestino delgado en la mayoría de los casos sin la utilización de una sonda enteral avanzada.
Palabras Clave: Fracturas ocultas ; Rayos X;
Imagen por resonancia magnética
; Heridas y traumatismos.
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Summary
Introduction: Proper evaluation of the small intestine is achieved with the combination of intravenous contrast medium and large volume of neutral contrast medium administered orally
to stretch the intestinal lumen and produce images for the assessment of the lumen, thickness and pattern of enhancement of the small intestine walls.
Materials and Methods: Between May 2007 and February 2009 we retrospectively collected 90 cases of mainly outpatients who consulted our clinic. They were prepared taking a liquid diet for 24 hours that had no residue and complete fasting 4
hours prior to the examination. A total of 2000 cc of water was administrated orally (divided in 500 cc, 75, 65, 25 and 15 minutes prior to the examination). Then 100 cc of contrast medium (OptirayTM ) were administered intravenously, at a rate of 4 cc/sec. An early arterial phase was performed 20 seconds after injection, and a portal phase 60 seconds after IV contrast administration. The studies were performed in a 16 channels, General Electric® multidetector scanner, with 3.0 mm slices, with multiplanar reconstructions and MIP.
Results: The studies were interpreted by a group body imaging radiologists. The most frequent findings were: diverticular disease, cystic lesions, neoplasia, Crohn’s disease, ileitis, mechanical obstruction, hiatal hernia, cholelithiasis, hepatic hemangiomas, duodenal diverticulum, polyposis,
intestinal malrotation, and active bleeding.
Conclusions: CT enterography is a useful and noninvasive technique for
diagnosing small bowel disorders, allowing, in most cases, a satisfactory distension of the small bowel without the use
of an enteral tube.
Key Words: Tomography; X-ray computed;
Small intestine;
Crohn disease;
Inflammatory bowel diseases
Colitis; ulcerative
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Estudio de imágenes de articulación patelofemoral: ¿En qué estamos?
Autores: Drs. Edith Miranda V, Sara Muñoz Ch , Dra. Paola Paolinelli G, Claudia Astudillo A, Mauricio Wainer E,Jaime Duboy U
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Resumen: La disfunción patelofemoral (DPF) es causa frecuente de consulta clínica y se refiere, a grandes rasgos, a una patología en la cual la patela falla en la correcta entrada en la tróclea. Es un tema en el que la terminología suele ser ambigua y confusa, debido entre otras cosas a la discrepancia entre la clínica y la imaginología. Además, la etiología de la DPF es multifactorial, incluyendo factores anatómicos locales, rotacionales y dinámicos, no existiendo tampoco
claridad acerca de su real influencia.
Desde el punto de vista imaginológico, existen innumerables
publicaciones, con diferentes clasificaciones
y mediciones descritas para las distintas técnicas, sin
embargo, no hay un consenso amplio en relación a
cuáles son las alteraciones anatómicas o los valores
normales que el reporte imaginológico debiera incluir.
Se realiza una revisión de la literatura existente y
se propone para los pacientes con DPF, un estudio
radiológico que considera los factores etiológicos
anatómicos y un estudio tomográfico de segunda
línea, que incluye estudio rotacional de extremidades
inferiores, sistematizando las mediciones y puntos
relevantes en una plantilla de informe.
Palabras Clave: Disfunción patelofemoral, Factores
anatómicos, Factores dinámicos, Displasia troclear,
Subluxación patelar, Tilt patelar.
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Abstract: Patellofemoral dysfunction (PFD) is a common
cause for medical consultation and in a broad sense it refers to a condition in which the patella fails to engage securely in the trochlear groove. This is a topic in which terminology is often ambiguous and confusing due, inter alia, to the discrepancy between symptomatology,
imaging findings and physical examination. In addition,PFD has a multifactorial etiology that includes local anatomical, rotational and dynamic factors, with no certainty about its real influence. From the imaging point of view, there are countless publications proposing
different classifications and measurements obtained trough different imaging techniques; however, there is no consensus regarding what are the anatomical alterations or the normal values that imaging reports should include. A review of the existing literature is
performed and we propose that patients with PFD should undergo both a radiological study comprising etiologic and anatomic factors and a second-line tomographic exploration including lower extremity rotational profiles. From the radiological and clinical viewpoints, relevant issues to be considered as well as assessments performed should be systematized
and recorded in a report sheet.
Key Words: Anatomical factors, Dynamic factors, Patellar
subluxation, Patellar tilt, Patellofemoral dysfunction,
Trochlear dysplasia.
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Sarcoma de Kaposi extratorácico: Evidencias de una enfermedad multisistémica
Autores: Javier Willatt H, Int. Cristian Moyano N, Int. Camilo Apey R, Dr. Leonardo Lidid A
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Resumen: El sarcoma de Kaposi es un tumor vascular
de bajo grado, que manifiesta típicamente cuatro formas diferentes, siendo la epidémica (o relacionada con el SIDA) la más conocida de ellas. El compromiso pulmonar de esta enfermedad está bien descrito y se manifiesta principalmente por nódulos parenquimatosos bilaterales de morfología característica; sin embargo, esta neoplasia produce un compromiso multisistémico que no es ampliamente conocido. Debido a la creciente
incidencia y sobrevida de los pacientes con VIH y el hecho de que el sarcoma de Kaposi es una de sus complicaciones frecuentes, decidimos describir su estadificación y los principales hallazgos imaginológicos en tomografía computada, por la importancia de su conocimiento para el adecuado pronóstico y manejo de esta enfermedad.
Palabras Clave: Estadificación de neoplasias, Hígado, Sarcoma de Kaposi, SIDA, Sistema Musculoesquelético,
Tracto Gastrointestinal.
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Abstract: Kaposi’s sarcoma is a low-grade vascular
neoplasm that typically manifests as one of four variants, being the epidemic (or AIDS-related) the best known of them. The pulmonary involvement of this disease is well described and is expressed mainly by bilateral parenchymal nodules of characteristic morphology; however, this tumor produces a multisystemic compromise that is not widely known. Due to the increasing incidence and survival rates of
patients with HIV, and the fact that Kaposi’s sarcoma is one of its frequent complications, we sought to describe its staging and major imaging findings in computed tomography, given the importance of timely recognition of this neoplasm for a proper prognosis and management of the disease.
Key Words: Kaposi’s Sarcoma, Neoplasm staging,
liver, gastrointestinal tract, musculoskeletal system,
AIDS.
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Imagen funcional tumoral - Parte I
Autores: R. García Figueirasa, A.R. Padhanib, J.C. Vilanovac,d,
V. Gohb y C. Villalba Martína
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Resumen: Los principales avances en el campo de las técnicas convencionales de imagen diagnóstica se habían centrado tanto en mejorar la resolución espacial y la velocidad de
adquisición de los datos como en la introducción de nuevos medios de contraste. Sin embargo,los tumores representan modelos biológicos tremendamente complejos,existiendo
una serie de características (hipoxia, metabolismo, celularidad, angiogénesis o funcionalismo de los ganglios linfáticos)de gran importancia en el campo de la
oncología y que no pueden ser estudiadas adecuadamente con estos métodos diagnósticos.En este trabajo se presenta la posible aportación de distintas técnicas de
imagen funcional basadas en el uso de la TC,la RM o la PET para obtener información de características y procesos biológicamente muy importantes para el diagnóstico,
estadificación, planificación terapéutica, valoración de respuesta o seguimiento evolutivo de los pacientes oncológicos; así como para el desarrollo de nuevos fármacos.
Palabras Clave: Neoplasias; Resonancia magnética; Funcional; Angiogénesis; Patológica; Hipoxia; Celular; Espectroscopia; Estudios de evaluación de
fármacos
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Summary:
Most advances in conventional diagnostic imaging techniques have focused on improving the spatial resolution and speed of acquisition of images or on new contrast agents. However,tumors are extremely complex biological models with a series of characteristics
like hypoxia, metabolism, cellularity, angiogenesis, and functionality of the lymph nodes that are very important in oncology but cannot be adequately studied with these diagnostic imaging methods. Inthisarticle, we discuss the possible contributions of
different functional imaging techniques based on computed tomography, magnetic resonance imaging,or positron emission tomography to obtain information about different
biological processes and characteristics that are very important for diagnosing, staging,
planning treatment,evaluating the response to treatment,and monitoring the evolution
of cancer patients, as well a sfor the development of new drugs.
Key Words: Tumors;
Magnetic resonance imaging; Functional; Angiogenesis; Pathological; Hypoxia; Cellular;
Spectroscopy; Drug evaluation studies
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La radiografía simple en el estudio del dolor de la columna vertebral
Autores: F. Ruiz Santiago, L.Guzmán Álvarez, M.Tello Moreno y P.J. Navarrete González
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Resumen: La introducción de las técnicas de imagen tomográficas, fundamentalmente la tomografía
computarizada (TC) y resonancia magnética (RM), ha con llevado una paulatina disminución
en las indicaciones de la radiología simple,tanto en el número de pacientes como en la
cantidad de proyecciones por paciente. Esto ha podido con llevar una menor atención al
estudio y conocimiento de la radiografía simple de la columna vertebral en condiciones
normales y patológicas.
Sin embargo,la radiografía simple aún sigue siendo ampliamente utilizada en atención
primaria y especializada. Por tanto,semantiene vigente el conocimiento de la anatomía
radiológica normal y de las manifestaciones radiológicas de los distintos procesos patológicos
que afectan a la columna vertebral y que pueden ser responsables del dolor vertebral.
El objetivo de este trabajo es realizar una revisión general de las manifestaciones en la
radiografía simple del amplio espectro de patologías que pueden ser responsables del dolor
generado en la columna vertebral.Este espectro abarca la patología congénita, traumática,
degenerativa, tumoral, inflamatoria e infecciosa.
Palabras Clave: Columna;
Radiografía simple;
Dolor de espalda;
Enfermedades de la
columna;
Curvatura espinal;
Osteofitos espinales
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Abstract:
The introduction of tomographic imaging techniques, fundamentally computed tomo -
graphy and magnetic resonance imaging, has led to a gradual decrease in the indications
for plain-film radiography, resulting in fewer patients studied and fewer projections for
each patient. Consequently, plain - film studies of the spine have received less attention
and radiologists are less familiar with the typical findings in normal and pathologic
conditions of the spine.
Nevertheless, plain - film radiography continues to be widely used in both primary and
specialized care. Thus,radiologists still need to be aware of the normal radiologic anatomy
of the spine and of the radiologic manifestations of the diverse pathological processes that
can affect the spinal columnand that can cause pain.
Key Words: Spine; Plain-film radiography; Back pain; Spinal diseases; Spinal curvature; Spinal osteophytes
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Microbubble - enhanced us in body imaging: what role?
Autores: Stephanie R. Wilson, MD and
Peter N. Burns, PhD
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Abstract:
Contrast agents for ultrasonography (US) comprise microscopic bubbles of gas in an encapsulating shell. They are unique in that they interact with the imaging process, oscillating in response to a low-intensity ultrasound field and disrupting in response to a high-intensity field. New contrast-specific imaging modes allow US to show exquisite vascularity and tissue perfusion in real time and with excellent spatial resolution. In Europe, Asia, and Canada, to name only the most obvious, characterization of focal liver masses is the first and best established use of contrast-enhanced (CE) US, allowing for the noninvasive diagnosis of commonly encountered liver masses with comparable accuracy to that of computed tomography and magnetic resonance studies. CE US is a preferred modality for the difficult task of diagnosis of liver nodules detected on surveillance scans in those at risk for hepatocellular carcinoma. Newer body applications include the guidance of ablative intervention, monitoring activity of bowel inflammation in Crohn disease, characterization of kidney masses, especially cystic renal cell carcinoma, diagnosis of prostate cancer, and monitoring the response of tumors to antivascular drug therapies. Microbubble contrast agents are easy to use and robust; their use poses no risk of nephrotoxicity and requires no ionizing radiation. CE US plays a vital and expanding role that improves management and patient care.
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Lung cancer staging essentials: The new TNM staging system and potential imaging pitfalls
Autores: Stacy J. UyBico, Carol C. Wu,
Robert D. Suh,
Nanette H. Le,
Kathleen Brown and
Mayil S. Krishnam
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Abstract:
Lung cancer is the leading cause of cancer-related deaths worldwide, with a dismal 5-year survival rate of 15%. The TNM (tumor-node-metastasis) classification system for lung cancer is a vital guide for determining treatment and prognosis. Despite the importance of accuracy in lung cancer staging, however, correct staging remains a challenging task for many radiologists. The new 7th edition of the TNM classification system features a number of revisions, including subdivision of tumor categories on the basis of size, differentiation between local intrathoracic and distant metastatic disease, recategorization of malignant pleural or pericardial disease from stage III to stage IV, reclassification of separate tumor nodules in the same lung and lobe as the primary tumor from T4 to T3, and reclassification of separate tumor nodules in the same lung but not the same lobe as the primary tumor from M1 to T4. Radiologists must understand the details set forth in the TNM classification system and be familiar with the changes in the 7th edition, which attempts to better correlate disease with prognostic value and treatment strategy. By recognizing the relevant radiologic appearances of lung cancer, understanding the appropriateness of staging disease with the TNM classification system, and being familiar with potential imaging pitfalls, radiologists can make a significant contribution to treatment and outcome in patients with lung cancer.
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