[Analysis of the management of occult fractures of the scaphoid through early magnetic resonance imaging]. / Análisis del manejo de fracturas ocultas de escafoides mediante la realización precoz de resonancia magnética.

INTRODUCTION: We aimed to evaluate the usefulness of magnetic resonance imaging (MRI) in the diagnosis of occult fractures of the scaphoid and to determine the advantages and cost in comparison with the traditional follow-up protocol. MATERIAL AND METHOD: The traditional approach at our center consisted of immobilization and periodic clinical and radiological follow-up (plain-film X-rays and computed tomography in the final phase of the process). The new protocol called for a limited MRI study consisting of coronal T1- and T2-weighted fat suppression sequences if the findings at plain-film X-rays continued to be negative at the first follow-up examination with the traumatologist (10 days after trauma). We evaluated the MRI findings, the time the patient was immobilized, the cost of each protocol, and the dose of radiation received. RESULTS: We included 33 cases of patients with clinically suspected fractures of the scaphoid and negative findings on plain-film X-rays. In 13 patients, the MRI findings were negative. In 12 patients, the MRI findings confirmed the diagnosis of a fracture of the scaphoid, which was associated with other pathology in 6 cases. In 8 patients, another pathological process was diagnosed. The cost of the new protocol was €131.06 per patient; the cost of the traditional protocol was €114.41 or €151.06 per patient, depending on the follow-up studies required. The new protocol reduced the dose of radiation by eliminating successive radiologic studies. CONCLUSIONS: The new protocol improved the management of these patients, reducing the time of immobilization, improving joint rigidity, and reducing the time off work. The limited MRI study makes it possible to diagnose other radiologically occult lesions. The cost of the new protocol is similar to that of the traditional protocol and even lower in some cases. The new protocol results in a reduction in the dose of radiation.

[An audit of breast cancer screening mammograms and the variability of radiological practice]. / Auditoría de la mamografía de cribado del cáncer de mama y variabilidad de la práctica radiológica.

OBJECTIVE: To audit the breast cancer screening mammograms performed in a general hospital and to assess the variation in medical practice in the diagnostic process. MATERIAL AND METHODS: A review was carried out on the screening mammograms performed between 1 May 2010 and 30 April 2011, with clinical follow up for two years, and a comparison with the published standards. RESULTS: Of the 3,878 women examined, 368 (9.48%) were called back to complete the study (97 [16.1%] in the initial screening and 271 [8.2%] in revisions). Forty three biopsies (1.1%) were indicated, of which 24 were diagnosed with cancer. The positive predictive value (PPV) in screening studies (PPV1) was 6.52%. For the recommended biopsy (PPV2) it was 55%, with a sensitivity of 100%, a specificity of 91% and a cancer detection rate of 6.1/1,000. There were no false negatives. Twenty tumours were invasive; with no axillary lymph node infiltration was observed 15 of them. In 6 cases, the size of the tumour was less than or equal to 10mm, and in 17 it was less than 15mm. There were a higher percentage of new appointments by two radiologists (12% and 17.2% versus 7.3%) (P<.001). In 217 cases (58.96%; P<.001) only one radiologist indicated new appointments. Of this group, 73% were discharged in the first visit, compared to 47.6% in the non-discrepant group (P<.001). Four of the cancers were detected in these 217 patients. CONCLUSIONS: The observed results are adjusted to the reference values. The discordant data are the new appointments rate, both in the initial screening and in the review, with a significant variation depending on the radiology reader.

[Noninvasive diagnosis of cerebral venous thrombosis]. / Diagnóstico de trombosis venosas cerebrales mediante técnicas no invasivas.

OBJECTIVES: Cerebral venous thrombosis (CVT) is an uncommon condition. Its variable, unspecific clinical presentation causes delays in diagnosis. We analyze the validity of different neuroimaging techniques, including CT, MRI, MR angiography, and conventional angiography in the diagnosis of CVT. MATERIAL AND METHODS: We review the imaging findings of 12 patients with the final diagnosis of CVT. All 12 patients underwent CT as the initial imaging test; all 12 underwent MRI; 11 underwent MR angiography; and 4 underwent conventional angiography. Visualization of the thrombus or filling defects in the affected vessel were considered direct signs of CVT, whereas findings compatible with venous infarction were considered indirect signs. RESULTS: Of the 12 CT examinations, 4 showed direct signs, 2 indirect signs, and 6 only normal findings. Indirect signs of CVT were seen on follow-up CT in three of the patients with normal initial CT examination. CT failed to show the real extent of the process except in one case in which a cortical vein was affected. MRI detected thrombi in the affected territory in 6 cases; the empty delta sign was seen in 2 and signs of venous infarction in 8. MRI failed to diagnose CVT in one case. MR angiography showed direct signs of CVT in all cases, even without intravenous contrast, and the results were similar to those seen at conventional angiography. More than two locations were affected in 11 patients. CONCLUSIONS: At CT, indirect signs of CVT are seen, although sometimes not immediately. Direct signs can be so subtle that they can only be interpreted with experience. Furthermore, CT does not show the real extent of the process. Nevertheless, given its availability, contrast-enhanced CT should be the primary imaging test, both to rule out other possibilities and to indicate other neuroimaging studies, in this case MRI and MR angiography. The results obtained when these two techniques are performed simultaneously, even without contrast administration, are sufficient for diagnosis and are comparable to those at conventional angiography, but without the risks entailed and without exposing the patient to ionizing radiation.