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.     

Tratamiento del hepatocarcinoma: ablación y embolización arterial

Percutaneous and endovascular techniques take an important role in the therapeutic management of patients with hepatocarcinoma. Different techniques of percutaneous ablation, especially indicated in tumors up to 2 cm diameter offer, at least, similar results to surgical resection. Taking advantage of double hepatic vascularization and exclusive tumor nutrition by the artery, several endovascular techniques of treating the tumor have been developed. Intra-arterial administration of embolizing particles, alone or charged with drug (chemoembolization), will produce ischemia and consequent necrosis with excellent results in selected patients. Certain types of particles may exclusively be carriers of a therapeutic agent when they incorporate a radioisotope that facilitates the direct intratumoral selective irradiation (radioembolization). This technique has demonstrated its efficacy in lesions not susceptible to be treated with other methods and should be considered, together with ablation and chemoembolization, in the therapeutic algorithms of hepatocarcinoma.     

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.     

Evaluación postratamiento locorregional y sistémico del carcinoma hepatocelular

Evaluating the response to different treatments is a decisive factor in the clinical management of patients with hepatocellular carcinoma because it can determine the efficacy of the treatment and because it can detect the recurrence of treated tumors or the appearance of new lesions that can be candidates for new treatments. When locoregional treatments that induce necrosis or molecular therapies are applied, the treated lesions usually change their behavior on imaging studies. It is important to point out that the size of the lesions does not usually decrease, at least initially, and some lesions can even appear to increase in size. For this reason, it is essential to know the mechanisms of action for each treatment applied and the spectrum of findings that these treatments can cause in the different imaging techniques used to assess the response.     

Adenocarcinoma gástrico: revisión del TNM y de las vías de diseminación

Gastric cancer is the fifth most common cancer in the world. The most common histologic subtype is adenocarcinoma. Gastric adenocarcinomas are staged using the American Joint Committee on Cancer's 8^th TNM classification. The perigastric ligaments, mesentery, omentum, and potential spaces between the parietal and visceral peritoneal linings are important structures for staging. The spread of disease is influenced by the location of the tumor within the stomach, as well as by the anatomy related to the ligaments and lymph vessels. CT is the imaging modality of choice for the preoperative clinical staging of gastric cancer, and it is essential for planning treatment. To be able to do an adequate imaging workup, radiologists need to know the different pathways through which gastric cancer can spread: lymphatic, subperitoneal, direct invasion, transperitoneal, hematogenous, and extramural venous invasion.     

Diagnóstico por imagen de anomalías en el número y localización del bazo

In imaging studies, some developmental anomalies such as perisplenic accessory spleen are easily recognizable due to their high incidence. However, other, less common anomalies such as intrapancreatic accessory spleen, splenopancreatic fusion, splenogonadal fusion, heterotaxy, and wandering spleen, as well as acquired conditions such as splenosis, can pose diagnostic difficulties. This aim of this review is to show the imaging diagnosis and differential diagnoses of these uncommon splenic anomalies.     

Estadificación mediante tomografía computarizada del carcinoma de páncreas

Pancreatic carcinoma is becoming more common in our environment; the mortality rate for this tumor has barely changed over the last 20 years.Early diagnosis and accurate staging are crucial to ensure an appropriate therapeutic approach, which should aim to improve survival in patients in whom complete resection is possible and to minimize surgical morbidity and mortality in those with a high risk of residual disease after the intervention.Various imaging techniques are used for tumor staging: multidetector computed tomography (CT), magnetic resonance imaging, positron emission tomography (PET)-CT, endoscopic ultrasound, and diagnostic laparoscopy. Currently, multidetector CT is the technique of choice for the study of pancreatic tumors; thus, this article aims to review the state of the art in staging adenocarcinoma of the pancreas, focusing mainly on the applications and limitations of this technique.     

Valoración del grado de resección de los macroadenomas hipofisarios en la resonancia magnética posquirúrgica inmediata

Objective

To evaluate if it is possible to determine the extent of pituitary macroadenomas resection in the immediate postoperative pituitary magnetic resonance imaging (MRI).

Valoración del carcinoma urotelial de vías superiores mediante ecografía con contraste

Aim

To describe the findings and behaviour of contrast-enhanced ultrasound in the study of upper tract urothelial tumours and to assess its usefulness for diagnosis.

Posibilidades del entorno virtual tridimensional Second Life® para la formación en radiología

Three-dimensional virtual environments enable very realistic ludic, social, cultural, and educational activities to be carried out online. Second Life^® is one of the most well-known virtual environments, in which numerous training activities have been developed for healthcare professionals, although none about radiology. The aim of this article is to present the technical resources and educational activities that Second Life^® offers for training in radiology based on our experience since 2011 with diverse training activities for undergraduate and postgraduate students. Second Life^® is useful for carrying out radiology training activities online through remote access in an attractive scenario, especially for current generations of students and residents. More than 800 participants have reported in individual satisfaction surveys that their experiences with this approach have been interesting and useful for their training in radiology.     

Conocimientos en materia de radioprotección en radiólogos del noroeste de España

Objectives

To estimate radiologist? level of knowledge of and their implication in radioprotection.

Función sistólica del ventrículo izquierdo: cómo comprenderla y analizarla

In cardiac magnetic resonance imaging studies, left ventricular systolic function is usually calculated automatically. To understand and interpret parameters of left ventricular systolic function correctly, it is fundamental to understand how each parameter is obtained and why values obtained with different techniques, for example, ultrasonography and magnetic resonance imaging, can differ. This article provides details about the usual analysis of systolic function from the quantitative and qualitative points of view; it also explains other methods that do not require specific software. Moreover, we provide a file that we designed for use with Microsoft Excel^® to enable simple, intuitive analysis of systolic function. Readers can use this file freely.     

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.     

Esclerosis hipocampal: evaluación volumétrica de las subestructuras del hipocampo utilizando resonancia magnética

Objective

The pathological classification of hippocampal sclerosis is based on the loss of neurons in the substructures of the hippocampus. This study aimed to evaluate these substructures in patients with hippocampal sclerosis by magnetic resonance imaging and to compare the usefulness of this morphological analysis compared to that of volumetric analysis of the entire hippocampus.

Cómo integrar la información cuantitativa en el informe radiológico del paciente oncológico

Nowadays, the images and information generated in imaging tests, as well as the reports that are issued, are digital and represent a reliable source of data. Reports can be classified according to their content and to the type of information they include into three main types: organized (free text in natural language), predefined (with templates and guidelines elaborated with previously determined natural language like that used in BI-RADS and PI-RADS), or structured (with drop-down menus displaying questions with various possible answers that have been agreed on with the rest of the multidisciplinary team, which use standardized lexicons and are structured in the form of a database with data that can be traced and exploited with statistical tools and data mining). The structured report, compatible with Management of Radiology Report Templates (MRRT), makes it possible to incorporate quantitative information related with the digital analysis of the data from the acquired images to accurately and precisely describe the properties and behavior of tissues by means of radiomics (characteristics and parameters). In conclusion, structured digital information (images, text, measurements, radiomic features, and imaging biomarkers) should be integrated into computerized reports so that they can be indexed in large repositories. Radiologic databanks are fundamental for exploiting health information, phenotyping lesions and diseases, and extracting conclusions in personalized medicine.     

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.     

Asociación entre patrones de llenado ventricular y extensión del realce tardío por resonancia magnética en pacientes con miocardiopatía hipertrófica

Objective

To explore the relationship between ventricular filling curves and the extent of late enhancement on cardiac magnetic resonance imaging (MRI) in patients with hypertrophic cardiomyopathy.

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.