Cribado del cáncer de pulmón

Lung cancer is a very important disease, curable in early stages. There have been trials trying to show the utility of chest x-ray or computed tomography in Lung Cancer Screening for decades. In 2011, National Lung Screening Trial results were published, showing a 20% reduction in lung cancer mortality in patients with low dose computed tomography screened for three years. These results are very promising and several scientific societies have included lung cancer screening in their guidelines. Nevertheless we have to be aware of lung cancer screening risks, such as: overdiagnosis, radiation and false positive results. Moreover, there are many issues to be solved, including choosing the appropriate group to be screened, the duration of the screening program, intervals between screening and its cost-effectiveness. Ongoing trials will probably answer some of these questions. This article reviews the current evidence on lung cancer screening.     

Valoración de los factores pronósticos radiopatológicos del cáncer de mama triple negativo y análisis del carcinoma in situ como factor pronóstico

ObjectivesTo analyze what factors in magnetic resonance imaging (MRI) and histological study of triple-negative breast cancers are related to tumor recurrence and to shorter disease-free survival. To analyze survival and recurrence in function of the presence of an in situ component.Material and methodsThis was a retrospective study of MRI staging examinations in 122 women with triple-negative breast cancer done from 2007 through 2014. In the MRI, we evaluated morphological variables (size, margins, morphology, internal signal in T2-weighted sequences) and dynamic variables (perfusion and diffusion). In the histological study, we evaluated Ki67, p53, CK5/6, nuclear grade, and Scarff-Bloom grade, as well as the presence of an in situ component and tumor grade (high grade or not high grade). We compared the variables between patients with tumor recurrence and those without, and we conducted a survival analysis.ResultsNon-nodular enhancement was more common in patients with tumor recurrence (p  = 0.038) and was associated with shorter disease-free survival (p = 0.023). Neither diffusion restriction (p = 0.079) nor ki67 (p = 0.052) was associated with a worse prognosis. An in situ component was detected in 44% of triple-negative tumors, and a greater proportion of patients in the group with tumor recurrence had an in situ component; however, the presence of an in situ component was not associated with shorter survival (p = 0.185).ConclusionNon-nodular enhancement was associated with a worse prognosis. Diffusion restriction, ki67, and the presence of an in situ component were not associated with shorter disease-free survival.     

¿Son los sistemas de inteligencia artificial una herramienta útil para los programas de cribado de cáncer de mama?

Population-based breast cancer screening programs are efficacious in reducing the mortality due to breast cancer. These programs use mammography to screen the women who are invited to participate. Digital mammography makes it possible to develop computer-assisted diagnosis (CAD) systems that promise to reduce the workload of radiologists participating in screening programs. However, various studies have shown that CAD results in a high rate of false positive diagnoses. Systems based on artificial intelligence are being more widely implemented, and studies have shown that these systems have better diagnostic performance than traditional CAD systems.This article explains the fundamentals of artificial intelligence systems and an overview of possible applications of these systems within the framework of breast cancer screening programs.     

Imagen por resonancia magnética en la estadificación y planificación del tratamiento del cáncer de cérvix

ObjectiveTo review the key points that are essential for the correct staging of cervical cancer by magnetic resonance imaging.ConclusionMagnetic resonance imaging is the method of choice for locoregional staging of cervical cancer. Thorough evaluation of prognostic factors such as tumor size, invasion of adjacent structures, and the presence of lymph node metastases is fundamental for planning appropriate treatment.     

Resonancia magnética en el cáncer de mama tratado con neoadyuvancia: correlación radiopatológica de la respuesta y supervivencia libre de enfermedad en función del subtipo molecular

ObjectivesTo evaluate the radiologic and pathologic responses to neoadjuvant chemotherapy and their correlation in the molecular subtypes of breast cancer and to analyze their impact in disease-free survival.Material and methodsWe included 205 patients with breast cancer treated with neoadjuvant chemotherapy. We evaluated the radiologic response by comparing MRI images acquired before and after chemotherapy. The pathologic response was classified on the Miller and Payne scale. For each subtype (HER2+, TN, luminal A, luminal B HER2–, and luminal B HER2+), we used the χ² test, Student's t-test, ANOVA, and Kendall's Tau-b to evaluate the radiologic response and the pathologic response, the radiologic-pathologic correlation, and the disease-free survival.ResultsThe subtypes HER2+ (62.1%) and TN (45.2%) had higher rates of complete radiologic response. The pathologic response was 65.5% in the HER2+ subtype, 38.1% in the TN subtype, 2.6% in the luminal A subtype, 8.2% in the luminal B HER2– subtype, and 31% in the luminal B HER2+ subtype. The rate of radiologic-pathologic correlation was significant in all subtypes, higher in TN and HER2 (Tau-b coefficients 0.805 and 0.717, respectively). Disease-free survival was higher in HER2+ (91.9 ± 3.3 months) and lower in TN (69.5 ± 6.3 months), with significant differences between the cases with poor and good radiologic responses (P=.040). Survival was greater in cases with good radiologic response, except in cases with luminal A subtype.ConclusionMRI can be a useful tool that provides information about the evolution of breast cancer treated with neoadjuvant chemotherapy, which varies with the immunohistochemical subtype.     

El Dr. Hyacinthe Guilleminot y los primeros sistemas de sincronización respiratoria y cardíaca para obtención de imagen radiológica

In an era when it was not possible to achieve quality x-rays with short exposure times, the need to obtain chest images without movement led the French doctor Emré Hyacinthe Guilleminot to construct a machine that repeatedly emitted x-rays only when desired during the respiratory cycle. His aim was to create a satisfactory radiograph from multiple short bursts performed at the moment of inhalation or exhalation, based on Charles Bouchard's research on heart disease. He extended his idea to radiography of the heart, creating a system that enabled images to be obtained disassociating the phases of heartbeat. This article seeks to explain the basic functioning of these mechanisms, and to recover previous research papers that led to their creation. We will also retrieve biographical and personal data of the two people involved – one directly, the other indirectly – in these novel inventions.     

Neurolinfomatosis de los nervios ciático y mediano como presentación inicial del linfoma de linfocitos B

Neurolymphomatosis (NL) is the infiltration of cranial nerves or nerves and roots from the peripheral nervous system by lymphoma, usually by B-cell non-Hodgkin's lymphoma. It is uncommon as initial presentation of the disease and can lead to extremely heterogeneous clinical manifestations. We report the case of a 72-year old male who presented with numbness of the right hand, progressive weakness in both lower limbs and weight loss. 18F-FDG PET/CT showed bilateral hypermetabolic adrenal masses, gastric ulcer, small hypermetabolic adenopathies, multiple focal bone marrow uptake and intense uptake in both sciatic nerves and right median nerve. A node and gastric biopsy confirmed diffuse large-B-cell lymphoma, activated B cell type, with posterior resolution of peripheral nerves uptake after beginning chemotherapy.     

Cáncer de mama: determinación del perfil genético a partir de la biopsia percutánea ecoguiada diagnóstica

ObjectivesTo evaluate the possibility of determining the genetic profile of primary malignant tumors of the breast from specimens obtained by ultrasound-guided percutaneous biopsies during the diagnostic imaging workup.Material and methodsThis is a retrospective study in 13 consecutive patients diagnosed with invasive breast cancer by B-mode ultrasound-guided 12 G core needle biopsy. After clinical indication, the pathologist decided whether the paraffin block specimens seemed suitable (on the basis of tumor size, validity of the sample, and percentage of tumor cells) before sending them for genetic analysis with the MammaPrint® platform.ResultsThe size of the tumors on ultrasound ranged from 0.6 cm to 5 cm. In 11 patients the preserved specimen was considered valid and suitable for use in determining the genetic profile. In 1 patient (with a 1 cm tumor) the pathologist decided that it was necessary to repeat the core biopsy to obtain additional samples. In 1 patient (with a 5 cm tumor) the specimen was not considered valid by the genetic laboratory. The percentage of tumor cells in the samples ranged from 60% to 70%. In 11/13 cases (84.62%) it was possible to do the genetic analysis on the previously diagnosed samples.ConclusionIn most cases, regardless of tumor size, it is possible to obtain the genetic profile from tissue specimens obtained with ultrasound-guided 12 G core biopsy preserved in paraffin blocks.     

Utilidad del artefacto Doppler de centelleo de color (twinkle) en la detección ecográfica de microcalcificaciones mamarias

Objective

To determine whether the twinkling artifact on Doppler ultrasound imaging corresponds to microcalcifications previously seen on mammograms and to evaluate the usefulness of this finding in the ultrasound management of suspicious microcalcifications.

Aproximación diagnóstica al engrosamiento parietal del intestino delgado: más allá de la enfermedad de Crohn y el cáncer

Although small-bowel wall thickening is a common manifestation of Crohn's disease and tumors, many other entities can give rise to similar imaging findings. The small bowel is difficult to access by endoscopy, so radiologic imaging tests play an essential role in the diagnosis of conditions involving the small bowel. The main objectives of this paper are to explain the definition of small-bowel wall thickening, analyze the patterns of involvement seen in multidetector computed tomography (MDCT) with intravenous contrast administration, and provide an image-based review of the different causes of small-bowel wall thickening. The differential diagnosis must include many entities because wall thickening can result from immune-mediated, infectious, or vascular causes, as well as from toxicity and other lesser-known entities. As the imaging appearance of many of these conditions overlap, clinical and laboratory findings are necessary to support the imaging diagnosis.     

Evolución y tendencias de un programa de resonancia magnética cardiaca pediátrica en un hospital terciario durante 14 años

Objectives1. To review the activity in our hospital's pediatric cardiac magnetic resonance imaging (cMRI) program from its inception to the present. 2. To evaluate changes in the number of patients, in the number of studies done under anesthesia, in the number of studies done with contrast material (magnetic resonance angiography (MRA) and delayed enhancement), and in representative diseases studied. 3. To estimate trends in the parameters evaluated in objective 2.Material and methodsThe pediatric cMRI program at our hospital started on February 14, 2005. We assessed cMRI studies done between the inception of the program and December 31, 2018. The cases were entered in a calculation table that included sex, date of birth, date of examination, clinical presentation, radiologic diagnosis, sequences done, and anesthesia. For each year, we obtained data about patients’ age, studies done under anesthesia, contrast-enhanced MRA, delayed enhancement studies, and postoperative studies. We also evaluated the evolution of the number of patients studied for a group of representative diseases (coarctation of the aorta; tetralogy of Fallot; dextro-transposition of the great arteries; corrections of univentricular heart; hypoplastic left heart syndrome; anomalous pulmonary venous return; and cardiomyopathy). We analyzed these data with bar graphs, evolutions of means, and logarithmic trend curves.ResultsA total of 2606 cases were included. The number of cases per year increased gradually. The mean age of all patients was 12.5 years, and the age of the patients studied also increased during the 14-year period. Anesthesia was used in 42%. Contrast-enhanced MRA was done in 57.6% and delayed enhancement in 42.13%. The most common condition was aortic coarctation (16.39%), although the frequency of aortic coarctation and hypoplastic left heart syndrome decreased slightly during the period. By contrast, the frequency of cardiomyopathy (7.25% of cases) increased slightly, to the point where it represented 9.35% in 2018.ConclusionDuring the 14-year period in which pediatric cMRI has been done at our hospital, the conditions studied, the type of patients, and the techniques used has varied; the number of patients and patients’ age has increased, where as the frequency of MRA studies has decreased. The prevalence of the different conditions studied has also changed.     

Valor de la ecografía doppler en la disfunción de los accesos vasculares periféricos para hemodiálisis

ObjectiveThe main objectives of this study were to evaluate the sensitivity and specificity of duplex Doppler ultrasonography in the study of hemodialysis peripheral vascular access dysfunction and to analyze the resistance index and flow in the afferent artery.Material and methodsWe prospectively studied 178 patients with 178 peripheral vascular accesses that were dysfunctional in at least three consecutive hemodialysis sessions. Patients underwent duplex Doppler ultrasonography and clinical and laboratory follow-up for three months (provided angiography findings were negative). We calculated the sensitivity, specificity, predictive values, and coefficients of probability. We studied the morphology of the afferent artery, the arteriovenous anastomosis, and the efferent vein, and we measured the resistance index and the flow of the afferent artery, the diameter of the anastomosis, and the flow and peak systolic velocity in the efferent vein.ResultsThe final sample consisted of 159 patients. The sensitivity, specificity, positive and negative predictive values, and positive and negative coefficients of probability were 0,98 (95% CI: 0,88-1.00), 0,74 (95% CI: 0,66-0,81), 0,96, 0,82, 3.7, and 0,03, respectively. The resistance index was less than 0,5 in 78.5% of the peripheral vascular accesses with normal function and greater than 0,5 in 86.1% of the dysfunctional peripheral vascular accesses. We found aneurysms in 19 of the native peripheral vascular accesses and pseudoaneurysms in 7 of the prosthetic grafts. Inverted flow was seen in 57 peripheral vascular accesses.ConclusionDuplex Doppler ultrasonography is an efficacious method for detecting and characterizing stenosis and thrombosis in peripheral vascular accesses, and it provides information about the morphology and hemodynamics.     

Metástasis única en los huesos carpianos como primera manifestación clínica de un hepatocarcinoma

Hepatocellular carcinoma is the most common primary tumor of the liver. Spreading outside the liver usually takes place in advanced stages of the disease, and bone is the third most common site of metastases. We present a case of hepatocellular carcinoma in which the first clinical manifestation was a single metastasis to the carpal bones. The interest of this case lies in the way this hepatocellular carcinoma manifested as well as in the unusual site of the metastasis.     

Resonancia magnética en la planificación de la braquiterapia intracavitaria para el tratamiento del cáncer de cérvix localmente avanzado

Cervical cancer is the third most common gynecological cancer. Its treatment depends on tumor staging at the time of diagnosis, and a combination of chemotherapy and radiotherapy is the treatment of choice in locally advanced cervical cancers. The combined use of external beam radiotherapy and brachytherapy increases survival in these patients. Brachytherapy enables a larger dose of radiation to be delivered to the tumor with less toxicity for neighboring tissues with less toxicity for neighboring tissues compared to the use of external beam radiotherapy alone. For years, brachytherapy was planned exclusively using computed tomography (CT). The recent incorporation of magnetic resonance imaging (MRI) provides essential information about the tumor and neighboring structures making possible to better define the target volumes. Nevertheless, MRI has limitations, some of which can be compensated for by fusing CT and MRI. Fusing the images from the two techniques ensures optimal planning by combining the advantages of each technique.     

Tromboembolismo pulmonar agudo: adecuación del manejo de pacientes según las guías de práctica clínica en el servicio de urgencias

Background and aimsTo evaluate the frequency of acute pulmonary embolism, the use of clinical probability scores, and the appropriateness of the management of patients for whom computed tomography angiography (CTA) was requested from the emergency department for suspected acute pulmonary embolism.Materials and methodsThis was a retrospective observational study of CTA studies requested from the emergency department to rule out acute pulmonary embolism. We analyzed clinical variables and the explicit use of clinical probability scores. We determined the appropriateness of management according to the Wells Score and Geneva Score and the simplified versions of these two scores, calculated retrospectively.ResultsWe included 534 patients (52.8% women; mean age, 73 years). The frequency of acute pulmonary embolism was 23.0% and the Wells Score was explicitly used in 15.2%. The appropriateness of the management varied depending on the clinical probability score used to assess it (54.5%-75.8%) and on whether the standard D-dimer or age-adjusted D-dimer was used.ConclusionsThe failure to use the Wells Scores in all cases does not necessarily imply inappropriate management, and the performance of global clinical judgment can be similar to that of clinical probability scores; however, specific studies are necessary to confirm this hypothesis.     

Revisión de los hallazgos clínicos y radiológicos del nuevo síndrome inflamatorio multisistémico pediátrico vinculado a la COVID-19

The World Health Organization defines the multisystem inflammatory syndrome in children (MIS-C) as a new syndrome reported in patients aged < 19 years old who have a history of exposure to SARS-CoV-2. The onset of this syndrome is characterized by persistent fever that is associated with lethargy, abdominal pain, vomiting and/or diarrhea, and, less frequently, rash and conjunctivitis. The course and severity of the signs and symptoms vary; in some children, MIS-C worsens rapidly and can lead to hypotension, cariogenic shock, or even damage to multiple organs. The characteristic laboratory findings are elevated markers of inflammation and heart dysfunction. The most common radiological findings are cardiomegaly, pleural effusion, signs of heart failure, ascites, and inflammatory changes in the right iliac fossa. In the context of the current COVID-19 pandemic, radiologists need to know the clinical, laboratory, and radiological characteristics of this syndrome to ensure the correct diagnosis.