Primary staging of rectal cancer on MRI: an updated pictorial review with focus on common pitfalls and current controversies.

Magnetic resonance imaging (MRI) plays a pivotal role in primary staging of rectal cancer, enabling the determination of appropriate management strategies and prediction of patient outcomes. However, inconsistencies and pitfalls exist in various aspects, including rectal anatomy, MRI protocols and strategies for artifact resolution, as well as in T- and N-staging, all of which limit the diagnostic value of MRI. This narrative and pictorial review offers a comprehensive overview of factors influencing primary staging of rectal cancer and the role of MRI in assessing them. It highlights the significance of the circumferential resection margin and its relationship with the mesorectal fascia, as well as the prognostic role of extramural venous invasion and tumor deposits. Special attention is given to tumors of the lower rectum due to their complex anatomy and the challenges they pose in MRI staging. The review also addresses current controversies in rectal cancer staging and the need for personalized risk stratification. In summary, this review provides valuable insights into the role of MRI in the primary staging of rectal cancer, emphasizing key aspects for accurate assessment to enhance patient outcomes.

[Intracranial dural sinus hypodensity as a sign of acute thrombosis: an unusually atypical radiological manifestation]. / Hipodensidad de senos durales intracraneales como signo de trombosis aguda: una manifestación radiológica extraordinariamente atípica.

TITLE: Hipodensidad de senos durales intracraneales como signo de trombosis aguda: una manifestación radiológica extraordinariamente atípica.

Imaging of low-energy vertebral fractures.

Low-energy vertebral fractures pose a diagnostic challenge for the radiologist due to their often-inadvertent nature and often subtle imaging semiology. However, the diagnosis of this type of fractures can be decisive, not only because it allows targeted treatment to prevent complications, but also because of the possibility of diagnosing systemic pathologies such as osteoporosis or metastatic disease. Pharmacological treatment in the first case has been shown to prevent the development of other fractures and complications, while percutaneous treatments and various oncological therapies can be an alternative in the second case. Therefore, it is necessary to know the epidemiology and typical imaging findings of this type of fractures. The objective of this work is to review the imaging diagnosis of low-energy fractures, with special emphasis on the characteristics that should be outlined in the radiological report to guide a specific diagnosis that favours and optimizes the treatment of patients suffering of low energy fractures.

Epidemiology, clinical and imaging features of rhombencephalitis caused by L. monocytogenes. A retrospective observational study. / Epidemiología, clínica y resultados de imagen de rombencefalitis causada por L. monocytogenes. Un estudio observacional.

INTRODUCTION: To date, few studies have explored the specific risk factors of patients with listeriosis who develop rhombencephalitis, and there is insufficient information regarding imaging findings and clinical symptoms in patients with this disease. This work aimed to analyze the imaging findings associated with L. monocytogenes rhombencephalitis in a cohort of patients with listeriosis. MATERIALS AND METHODS: We conducted a retrospective observational study of all declared cases of listeriosis in a tertiary hospital from Granada, Spain, from 2008 to 2021. Risk factors, comorbidities, and clinical outcomes were collected for all patients. In addition, clinical symptoms and magnetic resonance imaging (MRI) findings were included for those patients who developed rhombencephalitis. Descriptive and bivariate analyses were performed using SPSS statistical software (IBM SPSS, version 21). RESULTS: Our cohort comprised 120 patients with listeriosis (41.7% women, mean age: 58.6 ± 23.8 years), of which 10 (8.3%) had rhombencephalitis. The most frequent MRI findings in patients with confirmed rhombencephalitis were T2-FLAIR hyperintensity (100%), T1 hypointensity (80%), scattered parenchymal enhancement (80%), and cranial nerve enhancement (70%), while the most frequent anatomical involvement were pons, medulla oblongata, and cerebellum. Complications occurred in 6 patients (abscess in 4, hemorrhage in 2, hydrocephalus in 1). CONCLUSIONS: Rhombencephalitis is associated with an increased in-hospital mortality in patients with listeriosis. The anatomical distribution and imaging characteristics of neurolisteriosis could be useful to suggest the diagnosis. Future studies with greater sample size should explore the association between anatomical location, imaging patterns, and associated complications (e.g., hydrocephalus, hemorrhage), and clinical outcomes.

TITLE: Epidemiología, clínica y resultados de imagen de rombencefalitis causada por L. monocytogenes. Un estudio observacional.Introducción. Hasta la fecha, pocos estudios han explorado los factores de riesgo específicos de los pacientes con listeriosis que desarrollan rombencefalitis, y no hay suficiente información sobre los hallazgos de imagen y los síntomas clínicos en pacientes con esta enfermedad. El objetivo de este trabajo fue analizar los hallazgos de imagen asociados a la rombencefalitis por L. monocytogenes en una cohorte de pacientes con listeriosis. Materiales y métodos. Se realizó un estudio observacional retrospectivo de todos los casos declarados de listeriosis en un hospital terciario de Granada, España, desde 2008 hasta 2021. Se recogieron los factores de riesgo, las comorbilidades y los resultados clínicos de todos los pacientes. Además, se incluyeron los síntomas clínicos y los hallazgos de resonancia magnética (RM) de los pacientes que desarrollaron rombencefalitis. Se realizaron análisis descriptivos y bivariados utilizando el software estadístico SPSS (IBM SPSS, versión 21). Resultados. Nuestra cohorte incluyó a 120 pacientes con listeriosis (41,7%, mujeres; edad media: 58,6 ± 23,8 años), de los cuales 10 (8,3%) tenían rombencefalitis. Los hallazgos más frecuentes en la RM de los pacientes con rombencefalitis confirmada fueron hiperintensidad en T2-FLAIR (100%), hipointensidad en T1 (80%), realce parenquimatoso disperso (80%) y realce de los nervios craneales (70%), mientras que la afectación anatómica más frecuente fue en la protuberancia, la médula oblongada y el cerebelo. Se produjeron complicaciones en seis pacientes (absceso en cuatro, hemorragia en dos e hidrocefalia en uno). Conclusiones. La rombencefalitis se asocia a un aumento de la mortalidad intrahospitalaria en pacientes con listeriosis. La distribución anatómica y las características de imagen de la neurolisteriosis podrían ser útiles para sugerir el diagnóstico. Futuros estudios con mayor tamaño muestral deberían explorar la asociación entre la localización anatómica, los patrones de imagen y las complicaciones asociadas (por ejemplo, hidrocefalia y hemorragia), y los resultados clínicos.

Acute pulmonary embolism: Appropriateness of emergency department management according to clinical guidelines.

BACKGROUND AND AIMS: To 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 METHODS: This 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. RESULTS: We 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. CONCLUSIONS: The 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.

[Are secondary descriptors of headache useful in neuroimaging examinations? Results of a multicenter retrospective study of 1041 brain MRI studies]. / ¿Son útiles los descriptores secundarios de cefalea en las pruebas de neuroimagen? Resultados de un estudio retrospectivo multicéntrico de 1.041 resonancias magnéticas craneales.

INTRODUCTION: Headache is a common health problem in the general population. In clinical practice it is common to request neuroimaging examinations to rule out secondary headache, especially brain magnetic resonance imaging (MRI). The aim of this study is to analyze the secondary descriptors of headache-associated symptoms in brain MRI studies to assess their usefulness as predictors of potential intracranial structural abnormalities. MATERIALS AND METHODS: Retrospective observational study of brain MRI studies performed due to headache in 6 centers in Andalusia between January 1 and May 30, 2019. The studies were performed on MRI machines with similar technical characteristics and imaging protocols, and were subjected to double reading by two neuroradiologists. Uni- and bivariate analyses were performed on the variables of interest: age, sex, headache-associated symptoms, and imaging findings. RESULTS: A total of 1041 patients who underwent brain MRI were included -mean age: 38.6 years (range: 3-86); 69.9% women-. In 737 (70.80%) cases there were no headache-associated symptoms and in the remaining patients (304 cases, 29.20%) there were headache-associated symptoms, the most frequent being: visual alterations, paresthesia, and vertigo and dizziness. Bivariate analyses showed no significant differences between groups. CONCLUSIONS: The findings of this study suggest that symptoms accompanying headache are not associated with a greater or lesser detection of intracranial structural abnormalities in MRI. Prospective studies that overcome the limitations of the present work are needed to verify this hypothesis.

TITLE: ¿Son útiles los descriptores secundarios de cefalea en las pruebas de neuroimagen? Resultados de un estudio retrospectivo multicéntrico de 1.041 resonancias magnéticas craneales.Introducción. La cefalea es un problema de salud frecuente en la población general. En la práctica clínica es común solicitar pruebas de neuroimagen para descartar una etiología secundaria, especialmente una resonancia magnética (RM) craneal. El objetivo de este trabajo es analizar los descriptores secundarios de síntomas asociados a cefalea en estudios de RM craneal para valorar su utilidad como predictores de potenciales alteraciones orgánicas intracraneales. Materiales y métodos. Estudio retrospectivo observacional a partir de las RM de cráneo realizadas por cefalea en seis centros de Andalucía entre el 1 de enero y el 30 de mayo de 2019. Los estudios se realizaron en máquinas de RM de similares características técnicas y protocolos de imagen, y fueron sometidos a doble lectura por dos neurorradiólogos. Se realizaron análisis uni- y bivariantes de las variables de interés: edad, sexo, síntomas asociados a cefalea y hallazgos de imagen. Resultados. Se incluyó a 1.041 pacientes sometidos a RM craneal ­edad media: 38,6 años (rango: 3-86); 69,9% mujeres­. En 737 (70,8%) casos no existían síntomas asociados, y en los restantes pacientes (304 casos, 29,2%) sí, y los más frecuentes fueron: alteraciones visuales, parestesias, y vértigos y mareos. Los análisis bivariantes no mostraron diferencias significativas entre grupos. Conclusiones. Los hallazgos de este estudio sugieren que los síntomas acompañantes de cefalea no se asocian a una mayor o menor detección de alteraciones estructurales intracraneales en la RM. Es preciso realizar estudios prospectivos que superen las limitaciones del presente trabajo para verificar esta hipótesis.

[Recurrent Bing-Neel syndrome with mixed intracranial involvement. A diagnostic challenge]. / Síndrome de Bing-Neel con afectación intracraneal mixta recidivante. Un reto diagnóstico.

TITLE: Síndrome de Bing-Neel con afectación intracraneal mixta recidivante. Un reto diagnóstico.

Percutaneous vertebroplasty versus conservative treatment and placebo in osteoporotic vertebral fractures: meta-analysis and critical review of the literature.

OBJECTIVES: To assess the current evidence regarding the efficacy of percutaneous vertebroplasty (PVP) over conservative treatment (CT) and placebo in osteoporotic vertebral fractures (OVFs) by performing a meta-analysis of randomized controlled trials (RCTs). MATERIALS AND METHODS: A systematic search was conducted on PubMed, EMBASE, and Cochrane databases. The main outcomes were pain relief, improvement of functional disability, and quality of life at different time points: short-term (1-2 weeks), medium-term (1-3 months), and long-term (≥ 6 months). Subgroup analyses based on time from fracture onset and sham procedure were also performed. RESULTS: A total of 14 RCTs were included in the meta-analysis. PVP showed significant benefits over CT in all outcomes, but slight-to-none clear differences over placebo. Subgroup analyses revealed that PVP performed in fractures < 6 weeks provided superior short-term pain relief than the control group (p = .02), and better quality of life in the medium-term (p = .03) and long-term (p = .006). Placebo based on infiltrating the skin alone was significantly inferior to PVP at most time points in all outcomes, but no significant differences between PVP and placebo were found when the sham procedure consisted of infiltrating both the skin and periosteum. CONCLUSIONS: PVP showed significant advantages over CT in terms of efficacy, but benefits were more limited when compared to placebo. In addition, benefits of PVP are more prominent in recent OVFs. Differences in the sham procedure or criteria regarding patient's selection/allocation seem to be the main causes of disparity in previous RCTs. KEY POINTS: • Previous RCTs showed significant advantages of PVP over CT in terms of efficacy, but benefits were more limited when compared to placebo. • Differences in patient allocation or in the sham procedure might explain the lack of benefits of PVP versus placebo found in previous RCTs. • Despite controversial opinions, PVP should be offered to patients with OVFs as an alternative option to conservative treatment.

Acute pulmonary embolism: appropriateness of emergency department management according to clinical guidelines. / Tromboembolismo pulmonar agudo: adecuación del manejo de pacientes según las guías de práctica clínica en el servicio de urgencias.

BACKGROUND AND AIMS: To 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 METHODS: This 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. RESULTS: We 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. CONCLUSIONS: The 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.

Aortic dissection class 3: a little-known entity. Presentation of 4 cases. / Disección aórtica de clase 3: una entidad poco conocida. Presentación de 4 casos.

Aortic dissection (AD) is the most common acute condition of the aorta and has a high mortality. Therefore, it is a radiological emergency of vital importance. Currently, five subtypes are distinguished, among which AD class 3 -also known as limited or subtle AD- is the less recognised. This type of dissection is infrequent and needs to be acknowledged radiologically in order not to go unnoticed. Regarding its imaging features, this entity is characterized by a small focal bulging of the aortic wall outline and/or a limited round dilation at the region affected by the intimal tear. Recently, the low familiarity of the radiologist with this condition has been emphasized. With the aim of illustrating the main imaging findings of this entity and reviewing its most relevant aspects, we present four cases of AD class 3 diagnosed in our hospital.

Hospitalisation by tick-borne diseases in the last 10 years in two hospitals in South Spain: analysis of tick exposure data collected in the Emergency Department.

Tick-borne diseases (TBDs) can sometimes cause severe symptoms and lead to hospitalisation, but they often go unnoticed in the Emergency Department (ED). The aim of this study was twofold: (i) to describe the profile of patients hospitalised by TBDs; and (ii) to evaluate the data collected in the medical records from the ED in order to analyse their potential clinical consequences. A total of 84 cases that included all TBD diagnoses registered in the ED records were identified and analysed. These corresponded to all the hospitalisations by TBDs in the last 10 years (2009-2019) in two tertiary hospitals in Granada, Spain. Statistical analyses were made using RStudio. Coinciding with the absence of patient's report of exposure to ticks, 64.3% of TBDs were not suspected in the ED. Intensive care unit admission was required in 8.3% of cases, and the mortality rate was 2.4%. Non-suspected cases showed longer hospital stay (P < 0.001), treatment duration (P = 0.02) and delay in the initiation of antibiotic treatment (P < 0.001). Our findings indicate that symptoms associated with TBDs are highly non-specific. In the absence of explicit information related to potential tick exposure, TBDs are not initially suspected. As a consequence, elective treatment administration is delayed and hospitalisation time is prolonged. In conclusion, our results highlight the importance of addressing potential exposure to ticks during the ED contact with patients presenting with febrile syndrome.