Cervical spine trauma.

Cervical spine trauma encompasses a wide of injuries, ranging from stable, minor lesions to unstable, complex lesions that can lead to neurologic sequelae or vascular involvement. The Canadian C-Spine Rule and the NEXUS criteria aim to identify individuals with a low risk of cervical spine trauma who can safely forgo imaging tests. In high-risk patients, an imaging test is indicated. In adult patients the imaging test of choice is multidetector computed tomography. Complementary imaging tests such as CT angiography of the supra-aortic vessels and/or magnetic resonance imaging are occasionally necessary. It can be challenging for radiologists to diagnose and classify these lesions, because some of them can be subtle and difficult to detect. This paper aims to describe the most important imaging findings and the most widely used classification systems.

Radiologic diagnosis of patients with COVID-19. / Diagnóstico radiológico del paciente con COVID-19.

The pandemia caused by the SARS-CoV-2 virus has triggered an unprecedented health and economic crisis. Although the diagnosis of infection with SARS-CoV-2 is microbiological, imaging techniques play an important role in supporting the diagnosis, grading the severity of disease, guiding treatment, detecting complications, and evaluating the response to treatment. The lungs are the main organ involved, and chest X-rays, whether obtained in conventional X-ray suites or with portable units, are the first-line imaging test because they are widely available and economical. Chest CT is more sensitive than plain chest X-rays, and CT studies make it possible to identify complications in addition to pulmonary involvement, as well as to suggestive alternative diagnoses. The most common radiologic findings in COVID-19 are airspace opacities (consolidations and/or ground-glass opacities), which are typically bilateral, peripheral, and located primarily in the lower fields.

Neutrophil-to-lymphocyte ratio and mesenteric ischemia: can it predict the etiology of mesenteric ischemic at computed tomography?

OBJECTIVES: To assess the usefulness of the neutrophil-to-lymphocyte ratio (NLR) as a predictive factor of acute mesenteric ischemia (AMI) in patients presenting at the emergency department (ED) with acute abdominal pain. METHODS: This is a retrospective case-control study of patients older than 16 years admitted to the ED with acute abdominal pain with CT and histologic confirmation. The study group corresponded to patients with abdominal CT with radiological signs of AMI. The control group corresponded to patients with non-AMI findings in abdominal CT. Association measurements of NLR with radiological signs were compared with a paired-sample t test, and multivariate regression performed to analyze potential correlations. To assess the diagnosis capacity of NLR, ROC curves were calculated. RESULTS: A total of 61 patients were included (32 cases and 29 controls). The cases of AMI showed higher mortality (43.8% vs 6.9%, p < 0.01) and higher NLR on the limit of statistical significance (13.8 vs 8.7, p = 0.053). Patients with AMI due to occlusion of the superior mesenteric artery (SMA) showed a higher NLR (8.3 vs 22.3, p < 0.001). The area under the curve (AUC) of the NLR for AMI due to occlusion of the SMA was 0.88 (95% CI 0.7-1.0, p = 0.001). No patient with NLR < 5 presented AMI due to occlusion of the SMA. An NLR of 12.8 showed a sensitivity of 92% and a specificity of 74% for AMI due to occlusion of SMA. CONCLUSIONS: The NLR is a useful parameter of AMI of arterial origin due to occlusion of the SMA; it can help the clinician to raise suspicion of this diagnosis and the interpreting radiologist in the acquisition protocol for the CT study and would alert for an early surgical treatment.

Traumatic Injury of the Petrous Part of the Temporal Bone: Keys for Reporting a Complex Diagnosis. / Patología traumática de peñascos, un diagnóstico complejo. Claves para el informe.

Fractures of the petrous part of the temporal bone are a common lesion of the base of the skull; most of these fractures result from high-energy trauma. In patients with multiple trauma, these injuries can be detected on CT scans of the head and neck, where the direct and indirect signs are usually sufficient to establish the diagnosis. It is important to these fractures because the temporal bone has critical structures and the complexity of this region increases the risk of error unless special care is taken. This article reviews the key anatomical points, the systematization of the imaging findings, and the classifications used for temporal bone fracture. We emphasize the usefulness of identifying and describing the findings in relation to important structures in this region, of looking for unseen fractures suspected through indirect signs, and of identifying anatomical structures that can simulate fractures. We point out that the classical classifications of these fractures are less useful, although they continue to be used for treatment decisions.