Coronariografía mediante tomografía computarizada con sincronización prospectiva. Comparación de la calidad de imagen y dosis de radiación con equipos de 128 detectores de fuente única y doble fuente

Objective

To compare the image quality and radiation dose in a group of patients undergoing coronary CT angiography using a 128-slice dual source helical CT scanner with high pitch alto and prospective acquisition with those in a group of patients with similar clinical characteristics undergoing coronary CT angiography using a 128-slice single-source CT scanner with prospective sequential acquisition.

Material and methods

We included 80 patients with heart rates ≤65 beats/min: 40 underwent sequential 128-slice single source CT with prospective synchronization and the other 40 underwent 128-slice dual source helical CT with high pitch and prospective synchronization. Two radiologists independently assessed the quality of the images of the coronary arteries on the 80 coronary CT angiograms: image quality was classified on a four-point scale in which 1 represented excellent and 4 deficient. The effective dose of radiation was also calculated.

Results

The clinical characteristics of the patients in the two groups were similar. The image quality obtained with dual source CT was significantly better than that obtained with single source CT (P=0.006). The mean effective dose of radiation in the group undergoing dual source CT was 36% lower than in the group undergoing single source CT (1.4±0.6 mSv vs. 2.2±0.9 mSv; P<0.01).

Conclusion

Although both sequential 128-slice single source CT with prospective acquisition and 128-slice dual source helical CT with high pitch and prospective acquisition provide good image quality and low effective doses of radiation, 128-slice dual source helical CT with prospective acquisition provides better image quality and results in a lower effective dose of radiation.     

Energía dual y angioTC de carótidas: calidad,eliminación de hueso y dosis de radiación de 80/140 kV frente a 100/140 kV

Objective

To study the differences in vascular image quality, bone subtraction, and dose of radiation of dual energy CT angiography of the supraaortic trunks using different tube voltages.

Material and methods

We reviewed the CT angiograms of the supraaortic trunks in 46 patients acquired with a 128-slice dual source CT scanner using two voltage protocols (80/140 kV and 100/140 kV). The “head bone removal” tool was used for postprocessing. We divided the arteries into 15 segments. In each segment, we evaluated the image quality of the vessels and the effectiveness of bone removal in multiplanar reconstructions (MPR) and in maximum intensity projections (MIP) with each protocol, analyzing the trabecular and cortical bones separately. We also evaluated the dose of radiation received.

Results

Of the 46 patients, 13 were studied using 80/140 kV and 33 with 100/140 kV. There were no significant differences between the two groups in age or sex. Image quality in four segments was better in the group examined with 100/140 kV. Cortical bone removal in MPR and MIP and trabecular bone removal in MIP were also better in the group examined with 100/140 kV. The dose of radiation received was significantly higher in the group examined with 100/140 kV (1.16 mSv with 80/140 kV vs. 1.59 mSv with 100/140 kV).

Conclusion

Using 100/140 kV increases the dose of radiation but improves the quality of the study of arterial segments and bone subtraction.     

Medición del T2* hepático y cardíaco en la hemocromatosis secundaria

Objective

To determine whether there is iron overload by calculating the T2* value in the liver and myocardium in patients with secondary haemochromatosis. To analyse the correlation of the values obtained with the iron levels in blood, with the liver iron concentration (LIC) calculated using magnetic resonance (MR) imaging, and the correlation between them.

Material and methods

A total of 16 patients (13 males, 3 females), with a mean age of 61 years, were included and evaluated in the years 2008 and 2009. Fifteen of them had received multiple transfusions, and one was diagnosed with hereditary sideroblastic anaemia.The measurements included, blood ferritin, LIC by MRI, cardiac function using MRI and the T2* value by means of multi-echo sequences in the liver (TR/TE1/ΔTE/No of echos/α: 21/1,18/1.0/20/35°) and myocardium (26/1.04/0.8/30/60°). A correlation-regression analysis was performed by comparing the cardiac and liver T2* values with the ferritin, LIC and between each of them.

Results

A total of 13 patients had ferritin values greater than 1000 ng/ml (median/minimum/maximum: 1762/294/3785 ng/ml). An increased LIC greater than 80 μmol/g (median/minimum/maximum: 125.4/41.2/241.5 μmol/g) was observed in 13 patients. In all cases cardiac function was conserved, and in 15 cases the liver T2* value was less than 6.3 ms. The myocardium T2* value was less than 20 ms. in only one case. A high correlation was observed between the liver T2* values and the LIC (r: -0.912). The correlation was statistically significant between the liver T2* value and ferritin (r: -0.541). The correlations between myocardium T2* and ferritin, myocardium T2* and LIC, and myocardium T2* and liver T2* were not statistically significant.

Conclusions

The liver T2* showed a high correlation with LIC and a statistically significant correlation with ferritin. No association was observed between the myocardium T2* values and ferritin in blood, the LIC or the liver T2* value.     

Embolización selectiva como tratamiento de la hemorragia obstétrica

Objective

To describe cases of obstetric hemorrhage that have called for selective intra-arterial embolization and the different embolization techniques used. To assess the clinical outcomes and postprocedural fertility.

Material and methods

We studied 27 women with obstetric hemorrhage. In 24 patients, embolization was performed by catheterizing both uterine arteries and in 2 patients only one uterine artery was catheterized (pseudoaneurysm). The materials used for embolization consisted of Spongostan in 17/27, particles in 9/27, and coils in 1/27. Clinical follow-up included an analysis of early and late complications and of postprocedural fertility.

Results

Hemorrhage was classified as primary (25/27) or secondary (2/27).The cause of bleeding was vaginal delivery (20), cesarean sections (5), abortion (1), and cervical ectopic pregnancy (1).The initial technical success rate was 100% and the clinical success rate was 92.6% (25 of the 27 patients).Bleeding ceased and the outcome was satisfactory in 25 patients. During clinical follow-up ranging from one to seven years, 23 patients had normal menstruation and 6 patients completed 7 full-term pregnancies.

Conclusion

Intra-arterial embolization for obstetric hemorrhage leads to good outcomes and few complications and it preserves fertility.     

El síndrome congestivo pélvico. Resultados tras la embolización con espirales

Objective

To study the clinical manifestations and findings at venography in patients with pelvic congestion syndrome and to evaluate the outcome after percutaneous embolization using coils.

Materials and methods

We studied 34 women referred to the vascular radiology unit from the vascular surgery department for clinical suspicion of pelvic congestion syndrome. All patients underwent venography to assess the competence of the ovarian veins and to detect other varicose pelvic veins. When pelvic varicose veins were detected, they were embolized with coils. Clinical outcomes were recorded after reviewing the clinical history and administering a questionnaire over the phone.

Results

In 22 of the 34 patients, signs of pelvic venous insufficiency were found. The symptoms were mainly pelvic and perineal heaviness (20/22) and pelvic pain (18/22). The technical success of venography and embolization was 100%, with three minor complications that did not require hospitalization. Pelvic heaviness improved in 14 patients (in 13 it was completely eliminated). Pain disappeared in 11 patients and was partially alleviated in another 2.

Conclusion

In patients with pelvic congestion syndrome, the embolization of insufficient pelvic veins achieves clinical improvement with short hospital stays and few complications.     

Los elementos decorativos ambientales en el Área de Imagen Médica mejoran la percepción de agradabilidad del paciente

Objectives

To evaluate the sensation of pleasantness perceived by patients attended in the radiology department in response to decorative elements hung on the walls in the waiting rooms and in the hallways of the imaging area.

Material and methods

The material resources comprised works of art in the form of “magic windows” representing scenes from nature installed on the ceilings and walls of the waiting area and hallways of the imaging area. Patients were given a brief questionnaire with general data and questions (sadness-cheerfulness, coldness-warmth, darkness-light, and pessimism-optimism) about their perception of the decorative elements.

Results

Of the 150 questionnaires collected, 142 were filled out correctly. The overall health of these patients was good in 84 (56%), not bad in 58 (39%), and poor in 8 (5%). The idea seemed very good to 70 patients (47%), good to 58 (39%), not bad to 8 (5%), indifferent to 11 (7%), bad to 1 (1%), and very bad to 2 (1%). As far a patients’ mobility, 119 patients (79%) walked into the department, 18 (12%) were wheeled in on beds, and 13 (9%) needed wheelchairs.

Conclusions

We found a high level of satisfaction with the decorative elements.     

Clasificación y características del cáncer de intervalo en el programa de detección precoz de cáncer de mama en el Principado de Asturias

Objective

To review and classify the interval cancers found in the Principality of Asturias's Breast Cancer Screening Program (PDPCM). A secondary objective was to determine the histological characteristics, size, and stage of the interval cancers at the time of diagnosis.

Material and methods

We included the interval cancers in the PDPCM in the period 2003-2007. Interval cancers were classified according to the breast cancer screening program protocol, with double reading without consensus, without blinding, with arbitration. Mammograms were interpreted by 10 radiologists in the PDPCM.

Results

A total of 33.7% of the interval cancers could not be classified; of the interval cancers that could be classified, 40.67% were labeled true interval cancers, 31.4% were labeled false negatives on screening, 23.7% had minimal signs, and 4.23% were considered occult. A total of 70% of the interval cancers were diagnosed in the year of the period between screening examinations and 71.7% were diagnosed after subsequent screening. A total of 76.9% were invasive ductal carcinomas, 61.1% were stage II when detected, and 78.7% were larger than 10 mm when detected.

Conclusions

The rate of interval cancers and the rate of false negatives in the PDPCM are higher than those recommended in the European guidelines. Interval cancers are diagnosed later than the tumors detected at screening. Studying interval cancers provides significant training for the radiologists in the PDPCM.     

El esquema de biopsia transrectal puede predecir la gradación histológica incorrecta del cáncer de próstata

Objective

To identify factors that might explain why a prostate with a Gleason score (GS) <7 in the biopsy specimen can turn out to have a GS ≥7 in the surgical specimen.

Material and methods

We compared the GS of biopsy specimens with the GS of surgical specimens in 185 patients who underwent surgery for prostate cancer. We calculated the sensitivity, specificity, and predictive values for the GS of the biopsy specimens. We used Cohen's kappa to determine the degree of concordance between a GS of <7 and ≥7 for the biopsy specimen and the surgical specimen. Age, a family history of prostate cancer, total prostate-specific antigen (tPSA), digital rectal examination, prostate structure and volume, and the number of biopsy cores (biopsy scheme) were analyzed using multivariable logistic regression.

Results

Histological study of biopsy specimens yielded high sensitivity (98%) but low specificity (49%) for GS ≤6 and low sensitivity (35, 26%) and high specificity (93, 99%) for GS=7 and GS ≥7, respectively. Cohen's kappa for the GS from the biopsy and surgical specimens was 0.43 (95% CI=30-56%). The biopsy scheme was the only predictor of discordance in the GS between the two techniques. Among the other variables included in the model, only tPSA showed a slightly significant association. Taking a scheme with less than 7 cores as a reference, we found no difference with 8 to 9 cores but we did find a difference with 10 to 11 cores and with 12 or more cores, with a prevalence ratio of 0.138 (95% CI=0.030-0.513) and 0.277 (95% CI=0.091-0.806), respectively.

Conclusion

The GS of the biopsy depends on the scheme. This factor must be taken into account when choosing a treatment option in patients with low tumor grade in biopsy specimens.     

Reproducibilidad y exactitud en la cuantificación morfométrica y mecánica del hueso trabecular a partir de imágenes de resonancia magnética de Tesla

Objective

We used an animal model to analyze the reproducibility and accuracy of certain biomarkers of bone image quality in comparison to a gold standard of computed microtomography (μCT).

Material and methods

We used magnetic resonance (MR) imaging and μCT to study the metaphyses of 5 sheep tibiae. The MR images (3 Teslas) were acquired with a T1-weighted gradient echo sequence and an isotropic spatial resolution of 180 μm. The μCT images were acquired using a scanner with a spatial resolution of 7.5 μm isotropic voxels. In the preparation of the images, we applied equalization, interpolation, and thresholding algorithms. In the quantitative analysis, we calculated the percentage of bone volume (BV/TV), the trabecular thickness (Tb.Th), the trabecular separation (Tb.Sp), the trabecular index (Tb.N), the 2 D fractal dimension (D^2D), the 3 D fractal dimension (D^3D), and the elastic module in the three spatial directions (Ex, Ey and Ez).

Results

The morphometric and mechanical quantification of trabecular bone by MR was very reproducible, with percentages of variation below 9% for all the parameters. Its accuracy compared to the gold standard (μCT) was high, with errors less than 15% for BV/TV, D^2D, D^3D, and E_appx, E_appy and E_appz.

Conclusions

Our experimental results in animals confirm that the parameters of BV/TV, D^2D, D^3D, and E_appx, E_appy and E_appz obtained by MR have excellent reproducibility and accuracy and can be used as imaging biomarkers for the quality of trabecular bone.     

Comparison of 3D two-point Dixon and standard 2D dual-echo breath-hold sequences for detection and quantification of fat content in renal angiomyolipoma

Purpose

To assess the utility of a 3D two-point Dixon sequence with water–fat decomposition for quantification of fat content of renal angiomyolipoma (AML).

Methods

84 patients underwent renal MRI including 2D in-and-opposed-phase (IP and OP) sequence and 3D two-point Dixon sequence that generates four image sets [IP, OP, water-only (WO), and fat-only (FO)] within one breath-hold. Two radiologists reviewed 2D and 3D images during separate sessions to identify fat-containing renal masses measuring at least 1 cm. For identified lesions subsequently confirmed to represent AML, ROIs were placed at matching locations on 2D and 3D images and used to calculate 2D and 3D SI_index [(SI_IP − SI_OP)/SI_IP] and 3D fat fraction (FF) [SI_FO/(SI_FO + SI_WO)]. 2D and 3D SI_index were compared with 3D FF using Pearson correlation coefficients.

Results

41 AMLs were identified in 6 patients. While all were identified using the 3D sequence, 39 were identified using the 2D sequence, with the remaining 2 AMLs retrospectively visible on 2D images but measuring under 1 cm. Among 32 AMLs with a 3D FF of over 50%, both 2D and 3D SI_index showed a statistically significant inverse correlation with 3D FF (2D SI_index: r = −0.63, p = 0.0010; 3D SI_index: r = −0.97, p < 0.0001).

Conclusion

3D two-point Dixon sequence may provide a reasonable alternative to 2D dual-echo sequence for detection of renal AML and may have additional value for quantification of fat content of these lesions given the observation that 3D FF, unlike 2D and 3D SI_index, is not limited by ambiguity of water or fat dominance. This may assist clinical management of AML given evidence that fat content predicts embolization response.     

Comparison of a single shot T1-weighted in- and out-of-phase magnetization prepared gradient recalled echo with a standard two-dimensional gradient recalled echo: preliminary findings

Purpose:

To compare in‐phase (IP) /out‐of‐phase (OP) single shot magnetization‐prepared gradient‐recalled‐echo (MP‐GRE) with a standard two‐dimensional gradient‐recalled‐echo (2D‐GRE), and to compare image quality of MP‐GRE in cooperative and noncooperative subjects.

Materials and Methods:

Ninety‐six consecutive subjects (52 males, 44 females; mean age, 53.2 ± 16.7 years), both cooperative (n = 73) and noncooperative (n = 23) subjects who had MRI examinations including precontrast T1‐weighted IP/OP MP‐GRE with or without IP/OP 2D‐GRE were included in the study. The sequences were independently qualitatively evaluated by two radiologists. Quantitative analysis of liver fat index, signal‐to‐noise ratio (SNR) and liver‐lesion contrast‐to‐noise ratio (CNR) was also performed. Data were subjected to statistical analysis.

Results:

The visual detection of the presence or absence of liver steatosis showed no differences between 2D‐GRE and MP‐GRE imaging (k = 1). Minor differences were observed on image quality between MP‐GRE and 2D‐GRE in cooperative subjects, and between MP‐GRE sequences performed in cooperative and noncooperative subjects. Liver fat index results were strongly positively correlated (r = .98; 95% confidence interval [CI] 0.97 to 0.98; P < .0001). Intercept (.14; 95% CI .13 to .15; P < .0001) and slope (.83; 95% CI .79 to .86; P < .0001) were statistically significant.

Conclusion:

IP/OP MP‐GRE and 2D‐GRE comparably demonstrate the presence or absence of hepatic steatosis. Image quality of MP‐GRE was also comparable to 2D‐GRE, and was not substantially adversely affected if subjects were unable to cooperate with breathholding instructions. J. Magn. Reson. Imaging 2011;33:1482–1490. © 2011 Wiley‐Liss, Inc.     

Técnicas de recanalización vertebrobasilar antes de la introducción de las endoprótesis recuperadoras: la reapertura no es sinónimo de buena evolución

Objectives

To evaluate the recanalization rate and clinical outcome three months after endovascular treatment for vertebrobasilar occlusion before the placement of stentrievers.

Material and methods

We reviewed all cases of basilar thrombosis treated with endovascular techniques at our center. We reviewed the clinical outcomes with the main objective of determining the recanalization rate and the secondary objective of evaluating the outcome using the modified Rankin scale (mRS) three months after treatment. We assessed clinical and angiographic variables and correlated them with outcome and complications.

Results

We reviewed a total of 27 consecutive patients (mean age, 58.1 ± 15.5 y; median National Institutes of Health Stroke Scale (NIHSS), 21, interquartile range, 18-29; median Glasgow coma score (GCS) 7, interquartile range, 4-9.5). The mean time between the onset of symptoms and endovascular treatment was 26.3 ± 41.7 hours. Complete or partial recanalization was achieved in 23 (85.1%) patients. Three months after treatment, 16 (59.2%) had died and 6 (22.2%) had good outcome (mRS ≤ 2).

Conclusion

Endovascular treatment achieved a high rate of recanalization of occlusions of the basilar artery. Nevertheless, a high percentage of the patients did not have a good outcome. New materials might improve the prognosis in these patients.     

Características en tomografía computarizada de la isquemia cecal aislada

Objective

The aims of this review are to describe the main characteristics for the CT diagnosis of isolated caecal ischaemia (ICA) and give details of the differential diagnosis with other conditions with a similar clinical picture.

Material and methods

A retrospective study was conducted to review the CT findings of 4 patients diagnosed with ICA in our hospital. The parameters recorded to analyse their characteristics in the CT were: maximum thickness of the caecum wall, the appearance of the peri-caecum fat, presence of free fluid, signs of caecal or portal pneumatosis, the appearance of the caecal appendix, and general signs of the presence of vasculopathy.

Results

In all cases it was recorded that there was a thickening of the walls of the blind loop with an abrupt transition between the caecal wall and the walls of the ascending colon wall. In all cases the caecal thickening had a characteristic image in the central area. Signs of caecal pneumatosis were observed in two cases. All of them had an appendix with normal characteristics.

Conclusions

The combination of caecal wall thickening with oedematous characteristics, with no changes in the appendix, ileum and colon, suggest the diagnosis of caecal ischaemia, particularly with the presence of pneumatosis.     

30-15 Intermittent Fitness Test et répétition de sprints

Introduction

The maximal running velocity (V_IFT) reached at the end of the 30-15 Intermittent Fitness Tests (30-15_IFT) is very well related to most physiologic determinants of team-sport performance: explosive power of lower limbs, speed, maximal aerobic power and the ability to recover between exercise bouts. Nevertheless, its relationship with repeated sprint ability (RSA) was unknown.

Synthesis of the facts

Present results in 84 team-sport athletes show that V_IFT is very well related to mean sprint time during a RSA test (p > 0.001).

Conclusion

We conclude that V_IFT is highly representative of most physiologic determinants of performance in team-sports, and could thus been used to monitor athletic performance of team-sport players.     

Tratamiento endovascular de estenosis intracraneales sintomáticas: resultados a corto y largo plazo de un único centro

Objectives

We present the short- and long-term results of a series of patients with symptomatic intracranial arterial stenoses treated with angioplasty and stenting.

Material and methods

We reviewed patients with symptomatic intracranial stenoses greater than 50% who were treated with angioplasty, stenting, or both. We recorded demographic data and risk factors (hypertension, diabetes, dyslipemia, ischemic heart disease). We classified all lesions treated according to their location, degree of stenosis, and length. The degree of stenosis was classified as moderate (50%-70%) or severe (>70%). In the follow-up, we assessed cerebrovascular accidents, episodes of ischemic heart disease, and deaths in the first 30 days and in later follow-up.

Results

Between 2006 and 2010, we treated 26 patients (21 men and 5 women; age range, 44-79 years; mean age, 63 years) with 29 intracranial lesions. The endovascular procedure (angioplasty + stenting) was successfully performed in 23 cases (92.0%). In the first 30 days after the procedure, 3 (11.5%) patients had adverse effects of vascular origin: 1 stroke, 1 hemorrhage, and 1 death due to thrombosis of the stent. Long-term follow-up (5-46 months) in the 25 patients who survived more than 30 days detected no recurrence of symptoms.

Conclusion

Endovascular treatment of intracranial stenosis is technically feasible. Short-term complications are highly prevalent. No recurrence of symptoms was detected during long-term follow-up.     

Resonancia magnética de perfusión en astrocitomas de alto grado: el volumen sanguíneo cerebral,la altura del pico y el porcentaje de recuperación de intensidad de señal ¿pueden discriminar entre progresión y seudoprogresión?

Objectives

To study the usefulness of common MRI perfusion parameters for identifying pseudoprogression in high grade astrocytomas.

Material and methods

This retrospective case-control study compared the relative cerebral blood volume (rCBV), the relative percentage of signal intensity recovery (rPSR), and the relative peak height (rPH) recorded in a sample of 17 cases of anaplastic astrocytomas and gliomas considered to be undergoing pseudoprogression by biopsy or follow-up with those recorded in a sample of histologically similar tumors that were treated and considered to be undergoing progression by histologic study or follow-up. We evaluated the accuracy of these parameters and the correlations among them. Statistical significance was set at P<.05.

Results

The rCBV, rPSR, and rPH were significantly different between the two groups (P=.001). The cutoff values rPH=1.37, rCBV=0.9, and rPSR=99% yielded sensitivity (S)=88% and specificity (Sp)=82.2% for rPH, S=100% and Sp=100% for rCBV, and S=100% and Sp=70.6% for rPSR, respectively. We found negative correlations between rPRS and rPH (−0.76) and between rPRS and rCBV (−0.81) and a high positive correlation between rPH and rCBV (0.87).

Conclusion

The variables rPH and rCBV were useful for differentiating between pseudoprogression and true progression in our sample. The variable rPRS was also very sensitive, although the overlap in the values between samples make it less useful a priori.     

Administration de courte durée de prednisolone et sécrétion d'érythropoïétine

Introduction

The aim of the study is to assess the effects of a short-term therapeutical prednisolone intake on erythropoietin (EPO) secretion.

Synthesis

We studied, according to a double-blind, randomized cross-over protocol, the effects of a 7 day prednisolone intake (60 mg/day) in 10 healthy male subjects on hematocrit, EPO and hemoglobin concentrations. No significant change was found between the treatments (prednisolone/placebo) in the parameters investigated.

Conclusion

In view of the results obtained, short-term therapeutic glucocorticoid intake did not induce any enhancement of erythropoiesis via EPO stimulation that can result in ergogenic advantage during submaximal exercise.     

Estudio de coste-efectividad sobre la utilización de un tapón de hidrogel en las biopsias pulmonares guiadas por tomografía computarizada

Objective

Using a hydrogel plug decreases the number of cases of pneumothorax and reduces the need for pleural drainage tubes in CT-guided lung biopsies. We aimed to analyze the cost-effectiveness of using hydrogel plugs.

Qualités physiques requises pour la performance en sprint avec changements de directions types sports collectifs

Purpose

To explore qualities necessary to succeed in (swerve-sprinting) sprints with changes of direction.

Method

Two biometric measurements (body mass (MC); lean body mass (MM)) and three tests (20 m sprint two-point start 20 Da, 20 m swerve-sprint: 20Dc on track equipped with a force platform, and half squat) are carried out by nine players of team sports.

Results

The multiple linear regression shows that 44% of 20Dc performance are explained by relative maximum force (developed on the 20 Da) and the MM relative.

Conclusion

Coordination could represent 50% of unexplained 20Dc performance.