Radiologia最新文献

{"title":"Improvement in the management of suspected acute aortic syndrome in the emergency room through a clinical algorithm and study of predictive factors","authors":"B. Lumbreras-Fernández ,&nbsp;A. Vicente Bártulos ,&nbsp;B.M. Fernandez-Felix ,&nbsp;J. Corres González ,&nbsp;J. Zamora ,&nbsp;A. Muriel","doi":"10.1016/j.rxeng.2022.03.007","DOIUrl":"10.1016/j.rxeng.2022.03.007","url":null,"abstract":"<div><h3>Background and objective</h3><p><span>Acute aortic syndrome<span> (AAS) is uncommon and difficult to diagnose, with great variability in clinical presentation. To develop a computerized algorithm, or clinical decision support system (CDSS), for managing and requesting imaging in the </span></span>emergency department<span>, specifically computerized tomography<span> of the aorta (CTA), when there is suspicion of AAS, and to determine the effect of implementing this system. To determine the factors associated with a positive radiological diagnosis that improve the predictive capacity of CTA findings.</span></span></p></div><div><h3>Materials and methods</h3><p>After developing and implementing an evidence-based algorithm, we studied suspected cases of AAS. Chi-squared test was used to analyze the association between the variables included in the algorithm and radiological diagnosis, with 3 categories: no relevant findings, positive for AAS, and alternative diagnoses.</p></div><div><h3>Results</h3><p><span><span>130 requests were identified; 19 (14.6%) had AAS and 34 (26.2%) had a different acute pathology. Of the 19 with AAS, 15 had been stratified as high risk and 4 as intermediate risk. The probability of AAS was 3.4 times higher in patients with known </span>aortic aneurysm </span><em>(P</em><span> = .021, 95% CI 1.2–9.6) and 5.1 times higher in patients with a new aortic regurgitation murmur </span><em>(P</em><span> = .019, 95% CI 1.3–20.1). The probability of having an alternative severe acute pathology was 3.2 times higher in patients with hypotension or shock </span><em>(P</em> = .02, 95% CI 1.2–8.5).</p></div><div><h3>Conclusion</h3><p>The use of a CDSS in the emergency department can help optimize AAS diagnosis. The presence of a known aortic aneurysm and new-onset aortic regurgitation were shown to significantly increase the probability of AAS. Further studies are needed to establish a clinical prediction rule.</p></div>","PeriodicalId":94185,"journal":{"name":"Radiologia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41180175","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"MRI for detection, staging, and follow-up of prostate cancer: Synthesis of the PI-RADS v2.1, MET-RADS, PRECISE, and PI-RR guidelines","authors":"J.C. Vilanova ,&nbsp;V. Catalá-Sventzetzky ,&nbsp;J. Hernández-Mancera","doi":"10.1016/j.rxeng.2022.12.005","DOIUrl":"10.1016/j.rxeng.2022.12.005","url":null,"abstract":"<div><p>Prostate cancer<span> is very common among men. Radiology, mainly through MRI, plays a key role in the different stages of prostate cancer: diagnosis, staging and treatment assessment. The correct management of MRI requires knowledge and proper use of the different guidelines developed for the acquisition, interpretation and reporting of MRI in diagnosis (PI-RADS guide), whole body staging (MET-RADS guide), active surveillance (PRECISE guide) and local recurrence (PI-RR guide) in prostate cancer. The objective of this article is to show an update and synthesis of the most relevant aspects of these MRI guidelines for an optimal use and thus providing a more effective management of prostate cancer.</span></p></div>","PeriodicalId":94185,"journal":{"name":"Radiologia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41159941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"European Diploma in Radiology (EDiR) Clinical Cases. Clinically Oriented Reasoning Evaluation (CORE)","authors":"Editorial Board of Radiology","doi":"10.1016/j.rxeng.2023.09.003","DOIUrl":"10.1016/j.rxeng.2023.09.003","url":null,"abstract":"","PeriodicalId":94185,"journal":{"name":"Radiologia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41170724","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Update on meningioma: Clinical-radiological and radio-pathological correlation","authors":"A. Navarro-Ballester ,&nbsp;M. Aleixandre-Barrachina ,&nbsp;S.F. Marco-Doménech","doi":"10.1016/j.rxeng.2023.09.002","DOIUrl":"10.1016/j.rxeng.2023.09.002","url":null,"abstract":"<div><p><span><span>Meningiomas are tumors that originate in the arachnoid villi and are the most common non-glial neoplasm in the central nervous system<span>. The clinical manifestations associated with meningioma depend, fundamentally, on its location. The location in the cerebral convexity is the most frequent, especially in the frontal lobes, manifesting with headache, </span></span>motor disturbances, </span>seizures<span> and even neurocognitive disorders. There are 15 histologic subtypes of meningioma and three histologic grades. Within these, grades two and three have a worse prognosis and a higher rate of recurrence, as well as a radiological behavior that is generally more aggressive. Although there are some imaging features that can suggest a specific subtype, the definitive diagnosis will always require histological/molecular confirmation.</span></p></div>","PeriodicalId":94185,"journal":{"name":"Radiologia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41177731","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Peer review and authorship disclosure","authors":"L. Martí-Bonmatí","doi":"10.1016/j.rxeng.2023.05.004","DOIUrl":"10.1016/j.rxeng.2023.05.004","url":null,"abstract":"","PeriodicalId":94185,"journal":{"name":"Radiologia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41157984","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radiological predictors of final infarct volume in patients with proximal vascular occlusion","authors":"M.J. Rodríguez,&nbsp;A. Graziani,&nbsp;J.S. Seoane,&nbsp;L. Di Napoli,&nbsp;M. Pérez Akly,&nbsp;C. Besada","doi":"10.1016/j.rxeng.2021.12.002","DOIUrl":"10.1016/j.rxeng.2021.12.002","url":null,"abstract":"<div><h3>Introduction</h3><p><span>Various clinical and radiologic variables impact the neurologic prognosis of patients with ischemic cerebrovascular accidents. About 30% of ischemic cerebrovascular accidents are caused by proximal obstruction of the anterior circulation; in these cases, systemic thrombolysis<span><span> is of limited usefulness. CT angiography<span> is indicated in candidates for endovascular treatment<span>. Various radiologic factors, including the grade of leptomeningeal collateral circulation, as well as the length, density, and extension of the </span></span></span>thrombus<span>, have been identified as predictors of neurologic prognosis after anterior ischemic cerebrovascular accidents due to proximal vascular obstruction<span>. Final infarct volume correlations with mortality and long-term functional outcome in these patients. This study aimed to determine the best predictors of final infarct volume on CT angiography </span></span></span></span>in patients with ischemic cerebral accidents due to proximal occlusion.</p></div><div><h3>Materials and methods</h3><p>This retrospective observational study included adults with ischemic cerebrovascular accidents due to obstruction of the anterior circulation diagnosed by CT angiography in the period comprising June 2009 through December 2019. We measured the length and density of the thrombus in unenhanced CT images, and we used the clot burden score to record the grade of leptomeningeal collateral circulation and the extension of the thrombus. Then we measured the final infarct volume on follow-up CT and analyzed the correlations among these radiologic factors in the infarct volume.</p></div><div><h3>Results</h3><p><span>We included 54 patients [mean age, 82 y; 41 (75%) women] with ischemic cerebrovascular accidents due to proximal occlusion. About 60% of the cerebrovascular accidents affected the right cerebral hemisphere, and the most commonly affected vessel was the M1 segment of the medial cerebral artery (40.7%). Final infarct volume correlated with the grade of leptomeningeal collateral circulation (</span><em>p</em> <!-->=<!--> <!-->0.03) and with the clot burden score (<em>p</em> <!-->=<!--> <!-->0.01). Neither the length nor the density of the thrombus correlated with final infarct volume.</p></div><div><h3>Conclusion</h3><p>The final infarct volume can be estimated on the initial CT angiogram. Nevertheless, we found no useful predictive factors<span> in unenhanced CT images. The best independent radiologic predictors of the final infarct volume are the grade of collateral circulation and the clot burden score, especially in patients who did not undergo mechanical thrombectomy, because mechanical thrombectomy improves outcomes. These factors are important for decision making in the management of patients with ischemic cerebrovascular accidents due to proximal occlusion.</span></p></div>","PeriodicalId":94185,"journal":{"name":"Radiologia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41172307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lung infection with nontuberculous mycobacteria","authors":"C. Cano Rodríguez ,&nbsp;E. Castañer González ,&nbsp;M. Andreu Magarolas ,&nbsp;X. Gallardo Cistare ,&nbsp;A. González López ,&nbsp;Ó. Cuevas Lobato ,&nbsp;M. Gallego Díaz","doi":"10.1016/j.rxeng.2023.09.001","DOIUrl":"10.1016/j.rxeng.2023.09.001","url":null,"abstract":"<div><h3>Objective</h3><p>To describe the epidemiology<span> and CT<span> findings for nontuberculous mycobacterial lung infections and outcomes depending on the treatment.</span></span></p></div><div><h3>Material and methods</h3><p><span>We retrospectively studied 131 consecutive patients with positive cultures for nontuberculous mycobacteria between 2005 and 2016. We selected those who met the criteria for nontuberculous mycobacterial lung infection. We analysed the epidemiologic data; clinical, microbiological, and </span>radiological findings; treatment; and outcome according to treatment.</p></div><div><h3>Results</h3><p><span>We included 34 patients (mean age, 55 y; 67.6% men); 50% were immunodepressed (58.8% of these were HIV+), 20.6% had COPD<span>, 5.9% had known tumors, 5.9% had cystic fibrosis, and 29.4% had no comorbidities. We found that 20.6% had a history of tuberculosis and 20.6% were also infected with other microorganisms. </span></span><em>Mycobacterium avium</em><span> complex was the most frequently isolated germ (52.9%); 7 (20.6%) were also infected with other organisms. The most common CT findings were nodules (64.7%), tree-in-bud pattern (61.8%), centrilobular nodules (44.1 %), consolidations (41.2%), bronchiectasis<span> (35.3%), and cavities (32.4%). We compared findings between men and women and between immunodepressed and immunocompetent patients. Treatment was antituberculosis drugs in 67.6% of patients (72% of whom showed improvement) and conventional antibiotics in 20.6% (all of whom showed radiologic improvement).</span></span></p></div><div><h3>Conclusion</h3><p>The diagnosis of nontuberculous mycobacterial lung infections is complex. The clinical and radiologic findings are nonspecific and a significant percentage of pateints can have other, concomitant infections.</p></div>","PeriodicalId":94185,"journal":{"name":"Radiologia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41166740","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dual-energy CT in the differentiation between adrenal adenomas and metastases: Usefulness of material density maps and monochromatic images","authors":"R. Cano Alonso ,&nbsp;A. Álvarez Vázquez ,&nbsp;C. Andreu Vázquez ,&nbsp;I.J. Thuissard Vasallo ,&nbsp;A. Fernández Alfonso ,&nbsp;M. Recio Rodríguez ,&nbsp;V. Martínez de Vega","doi":"10.1016/j.rxeng.2021.10.006","DOIUrl":"10.1016/j.rxeng.2021.10.006","url":null,"abstract":"<div><h3>Objective</h3><p>To evaluate the behavior of adrenal adenomas<span><span> and metastases with dual-energy </span>CT, analyzing the attenuation coefficient in monochromatic images at three different levels of energy (45, 70, and 140 keV) and the tissue concentrations of fat, water, and iodine in material density maps, with the aim of establishing optimal cutoffs for differentiating between these lesions and comparing our results against published evidence.</span></p></div><div><h3>Materials and methods</h3><p>This retrospective case-control study included oncologic patients diagnosed with adrenal metastases in the 6–12 months prior to the study who were followed up in our hospital between January and June 2020. For each case (patient with metastases) included in the study, we selected a control (patient with an adrenal adenoma) with a nodule of similar size. All patients were studied with a rapid-kilovoltage-switching dual-energy CT scanner, using a biphasic acquisition protocol. We analyzed the concentration of iodine in paired water−iodine images, the concentration of fat in the paired water–fat images, and the concentration of water in the paired iodine–water and fat–water images, in both the arterial and portal phases. We also analyzed the attenuation coefficient in monochromatic images (at 55, 70, and 140 keV) in the arterial and portal phases.</p></div><div><h3>Results</h3><p>In the monochromatic images, in both the arterial and portal phases, the attenuation coefficient at all energy levels was significantly higher in the group of patients with metastases than in the group of patients with adenomas. This enabled us to calculate the optimal cutoffs for classifying lesions as adenomas or metastases, except for the arterial phase at 55 KeV, where the area under the receiver operating characteristic curve (AUC) for the estimated threshold (0.68) was not considered accurate enough to classify the lesions. For the arterial phase at 70 keV, the AUC was 0.76 (95% CI: 0.663‒0.899); the optimal cutoff (42.4 HU) yielded 92% sensitivity and 60% specificity. For the arterial phase at 140 keV, the AUC was 0.94 (95% CI: 0.894‒0.999); the optimal cutoff (18.9 HU) yielded 88% sensitivity and 94% specificity). For the portal phase at 55 keV, the AUC was 0.76 (95% CI: 0.663‒0.899); the optimal cutoff (95.4 HU) yielded 68% sensitivity and 84% specificity. For the portal phase at 70 keV, the AUC was 0.82 (95% CI: 0.757‒0.955); the optimal cutoff (58.4 HU) yielded 80% sensitivity and 84% specificity. For the portal phase at 140 keV, the AUC was 0.9 (95% CI: 0.834‒0.987); the optimal cutoff (16.35 HU) yielded 96% sensitivity and 84% specificity. In the material density maps, in the arterial phase, significant differences were found only for the iodine–water pair, where the concentration of water was higher in the group with metastases (1018.8 ± 7.6 mg/cm³ vs. 998.6 ± 8.0 mg/cm³ for the group with adenomas, p &lt; 0.001). The AUC was","PeriodicalId":94185,"journal":{"name":"Radiologia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41127423","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Generalized lymphatic anomaly in adult patients: An eminently radiological diagnosis","authors":"J. Sainz Sánchez ,&nbsp;A. Aranaz Murillo ,&nbsp;E. Andrés Villares ,&nbsp;J. García Maroto","doi":"10.1016/j.rxeng.2022.08.004","DOIUrl":"10.1016/j.rxeng.2022.08.004","url":null,"abstract":"<div><p><span><span>Generalized lymphatic anomaly (GLA) is an uncommon congenital disease secondary to the proliferation of lymphatic vessels in any organ except the </span>central nervous system. GLA has a wide spectrum of clinical and radiological presentations, among which </span>osteolytic lesions<span><span> are the most widespread, being the ribs the most commonly affected bone. GLA is diagnosed mainly in children and young adults; nevertheless, on rare occasions it can remain asymptomatic and be detected incidentally in older patients. We present an unusual case of GLA in an asymptomatic 54-year-old man who had atypically distributed, purely cystic bone lesions on </span>CT<span>; measuring the Hounsfield (HU) of these lesions enabled us to suspect GLA. This suspicion was confirmed with MRI, PET/CT, CT-guided fine-needle aspiration biopsy, and fluoroscopy-guided percutaneous vertebral biopsy. After surgical resection of one of the lesions, histologic study provided the definitive diagnosis.</span></span></p></div>","PeriodicalId":94185,"journal":{"name":"Radiologia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41166669","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cerebral microbleeds. Utility of SWI sequences","authors":"L. Martínez Camblor,&nbsp;J.M. Peña Suárez,&nbsp;M. Martínez-Cachero García,&nbsp;E. Santamarta Liébana,&nbsp;J. Rodríguez Castro,&nbsp;A. Saiz Ayala","doi":"10.1016/j.rxeng.2022.12.006","DOIUrl":"10.1016/j.rxeng.2022.12.006","url":null,"abstract":"<div><h3>Objectives</h3><p>Define the concept of cerebral microbleeds (CMBs) and describe the most useful MRI sequences for detecting this finding.</p><p>Review the entities that most frequently present with CMBs and that may benefit from the use of susceptibility-weighted imaging (SWI) sequences.</p></div><div><h3>Conclusions</h3><p>SWI is a useful MRI sequence for the detection and characterization of microhemorrhages, venous structures and other sources of susceptibility in imaging.</p><p>SWI is particularly sensitive to local magnetic field inhomogeneities generated by certain substances and is superior to T2* GRE sequences for this assessment.</p><p>CMBs may be seen in different neurologic conditions, in certain infrequent clinical contexts and have a key role as a biomarker status in gliomas<span> (ITTS) and as a marker of inflammatory activity in multiple sclerosis.</span></p></div>","PeriodicalId":94185,"journal":{"name":"Radiologia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9886620","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}