Recommendations for radiological diagnosis and assessment of treatment response in lung cancer: a national consensus statement by the Spanish Society of Medical Radiology and the Spanish Society of Medical Oncology.

The last decade has seen substantial progress in the diagnostic and therapeutic approach to lung cancer, thus meaning that its prognosis has improved. The Spanish Society of Medical Radiology and the Spanish Society of Medical Oncology have therefore produced a national consensus statement to make recommendations for radiological diagnosis and assessment of treatment response in patients with lung cancer. This expert group recommends multi-detector computed tomography as the technique of choice for investigating this disease. The radiology report should include a full assessment by the TNM staging system. Lastly, when the patient is on immunotherapy, response evaluation should employ not only response evaluation criteria in solid tumours, but also immune-related response criteria.

[Recommendations for radiological diagnosis and assessment of treatment response in lung cancer: a national consensus statement by the Spanish Society of Medical Radiology and the Spanish Society of Medical Oncology]. / Recomendaciones para el diagnóstico radiológico y la valoración de la respuesta terapéutica en el cáncer de pulmón. Consenso nacional de la Sociedad Española de Radiología Médica y la Sociedad Española de Oncología Médica.

The last decade has seen substantial progress in the diagnostic and therapeutic approach to lung cancer, thus meaning that its prognosis has improved. The Spanish Society of Medical Radiology (SERAM) and the Spanish Society of Medical Oncology (SEOM) have therefore produced a national consensus statement in order to make recommendations for radiological diagnosis and assessment of treatment response in patients with lung cancer. This expert group recommends multi-detector computed tomography (MDCT) as the technique of choice for investigating this disease. The radiology report should include a full assessment by the TNM staging system. Lastly, when the patient is on immunotherapy, response evaluation should employ not only Response Evaluation Criteria in Solid Tumours (RECIST 1.1) but also Immune-Related Response Criteria (irRC).

[Imaging findings in catamenial pneumothorax]. / Neumotórax catamenial.Hallazgos radiológicos.

OBJECTIVE: To show the presentation and imaging findings of catamenial pneumothorax. MATERIAL AND METHODS: We reviewed the imaging tests (plain-film radiography, computed tomography [CT], magnetic resonance [MR]) performed in six women aged between 28 and 44 years with recurrent pneumothorax associated to menstruation. All patients underwent videothoracoscopic surgery and thoracotomy was necessary in three due to the recurrence of the pneumothorax. RESULTS: CT was performed in three cases and found pleural nodules in two; one of these was confirmed at MR. Pleural endometriosis was only demonstrated at histological examination in one case. Diaphragmatic blebs and bullae were found in five of the six patients. DISCUSSION: The most common symptoms of catamenial pneumothorax are chest pain, dyspnea, and hemoptysis. The right side is affected in 90% of cases. The radiological findings are pneumothorax, hemothorax, or hydropneumothorax. CT and MR can help to identify the pleural lesions that are not visible on plain-film radiographs and are a very common finding at surgery. CONCLUSION: The diagnosis of catamenial pneumothorax should be suspected in fertile-aged women with a history of recurrent pneumothorax coinciding with menstruation. CT and MR can help to identify lesions suspicious of endometriosis.

Hydatid disease: radiologic and pathologic features and complications.

Hydatid disease primarily affects the liver and typically demonstrates characteristic imaging findings. However, there are many potential local complications (eg, intrahepatic complications, exophytic growth, transdiaphragmatic thoracic involvement, perforation into hollow viscera, peritoneal seeding, biliary communication, portal vein involvement, abdominal wall invasion). Furthermore, secondary involvement due to hematogenous dissemination may be seen in almost any anatomic location (eg, lung, kidney, spleen, bone, brain). Ultrasonography (US) is particularly useful for the detection of cystic membranes, septa, and hydatid sand. Computed tomography (CT) best demonstrates cyst wall calcification and cyst infection. CT and magnetic resonance (MR) imaging may demonstrate cyst wall defects as well as the passage of contents through a defect. Chest radiography, US, CT, and MR imaging are all useful in depicting transdiaphragmatic migration of hydatid disease. CT is the modality of choice in peritoneal seeding. US and CT demonstrate rupture in most cases that involve wide communication. Indirect signs of biliary communication include increased echogenicity at US and fluid levels and signal intensity changes at MR imaging. CT allows precise assessment of osseous lesions, whereas MR imaging is superior in demonstrating neural involvement. Familiarity with atypical manifestations of hydatid disease may be helpful in making a prompt, accurate diagnosis.

[Localization of lung nodules with CT-guided hookwire before videothoracoscopic surgery]. / Localización de nódulos pulmonares con arpón guiado por TC previa a cirugía videotoracoscópica.

PURPOSE: To localize peripheral lung nodules under CT guidance using hookwires, prior to video-assisted thoracic surgery (VATS). PATIENTS AND METHODS: Twenty-two pulmonary nodules were localized with a hookwire under CT guidance. The visceral pleura was stained with methylene blue. VATS was performed thereafter. RESULTS: All nodules were successfully localized and resected without significant complications. CONCLUSIONS: In select cases, localization of pulmonary nodules with hook wire and methylene blue allows the thoracoscopic resection of unaccessible lesions.

Transthoracic needle aspiration biopsy: value in the diagnosis of mycobacterial lung opacities.

The purpose of this study was to assess the value of transthoracic fine-needle aspiration in the diagnosis of mycobacterial infection as the cause of focal lung opacities. Six hundred twelve fine-needle aspiration biopsies were performed from 1985 to 1997 in 587 patients with solitary or multiple lung opacities. Initial procedures, including sputum analysis and bronchoscopy, had been nondiagnostic. Fluoroscopic or computed tomography guidance was used, and a pathologist was present. A diagnosis of mycobacterial infection was established when acid-fast bacilli were demonstrated in the aspirate. In 487 patients, a malignant cause was confirmed, and six other patients had carcinoid tumor. Of 94 nonmalignant opacities, 24 (26%) were determined to have a mycobacterial cause. Fine-needle aspiration biopsy detected acid-fast bacilli in 15 of 24 cases (sensitivity, 62.5%; specificity, 100%). Radiologic findings included upper lobe involvement (17 of 24 cases), single opacities (12 of 24 cases), satellite nodules (4 of 12 cases with single opacities), irregular borders (19 of 24), eccentric calcification (2 of 24), and cavitation (8 of 24). The authors conclude that fine-needle aspiration biopsy must be processed for acid-fast bacilli when nonmalignant cytologic findings result, even if the results of sputum smears, cultures, and bronchoscopy are negative.

Using gadolinium-enhanced three-dimensional MR angiography to assess arterial inflow stenosis after kidney transplantation.

OBJECTIVE: Our objective was to evaluate use of gadolinium-enhanced three-dimensional (3D) MR angiography in the assessment of suspected arterial inflow stenosis after kidney transplantation. SUBJECTS AND METHODS: Twenty-eight consecutive patients receiving kidney transplants (26 single-kidney transplants and two en block transplants) with suspected arterial inflow stenosis were examined with two MR angiography sequences: gadolinium-enhanced 3D fast spoiled gradient-recalled (SPGR) imaging and 3D phase-contrast imaging. Twenty-four of these patients then were examined using the gold standards: either digital subtraction angiography (DSA) (n = 23) or surgery (n = 1). MR angiography and DSA studies were independently and prospectively analyzed for the presence of arterial stenoses (mild [<50%], severe [50-90%], or critical [>90%]) in the iliac, anastomotic, and renal artery segments. Two independent observers retrospectively evaluated the MR angiography sequences for ability to detect or exclude significant (> or = 50%) arterial stenoses. RESULTS: In 22 single-kidney transplants, DSA showed eight significant stenoses in 66 arterial segments. MR angiograms adequately showed 66 of 66 segments (prospective observers) and 64 of 66 segments (each retrospective observer), which were subsequently evaluated. The sensitivity and specificity of MR angiography in revealing significant stenoses were 100% and 98% (prospective analysis), 88% and 98% (retrospective observer 1), and 86% and 100% (retrospective observer 2). Concordance between observers showed kappa values exceeding .85 for all comparisons except the analysis of phase-contrast series (kappa = .62). In one en block transplant, DSA showed that stenosis was greater than 90%, although it had been graded at less than 50% with MR angiography. CONCLUSION: Gadolinium-enhanced 3D MR angiography accurately evaluated arterial inflow in single-kidney transplants.

[Multiple coronary aneurysms in a young man. A diagnostic approach via different technics]. / Aneurismas coronarios múltiples en un varón joven. Aproximación diagnóstica mediante diferentes técnicas.

Coronary aneurysms are uncommon. The most frequent etiologies are atherosclerotic and congenital, although there are several other rare causes. Myocardial infarction and sudden death may be the initial manifestations which are usually a consequence of aneurysm complications such as rupture or distal embolization. Although coronariography is the gold standard diagnostic technique, coronary aneurysm may also be detected by non-invasive methods such as ultrasonography and nuclear magnetic resonance. We report the case of a young male with hypercholesterolemia who presented cardiac arrest as the first clinical manifestation. Ultrasonography and MRI revealed the presence of multiple coronary aneurysm. This case illustrates the usefulness of non-invasive techniques for the diagnosis of coronary aneurysm.

Natural history and serial morphology of aortic intramural hematoma: a novel variant of aortic dissection.

BACKGROUND: Acute aortic dissection is a cardiovascular emergency that requires prompt diagnosis and treatment. Transesophageal echocardiography is the current standard diagnostic imaging modality in many medical centers. Aortic intramural hematoma is a variant of aortic dissection whose natural history and prognosis have not been well studied. We performed transesophageal echocardiography in patients with aortic intramural hematoma to determine the echocardiographic characteristics and echocardiographic evolution of this lesion, impact on patient management, and patient outcome. METHODS AND RESULTS: Twenty-one consecutive patients with aortic intramural hematoma confirmed anatomically (four patients) or with an additional diagnostic imaging technique (17 patients) underwent a transesophageal echocardiographic examination. Fifteen patients with longstanding hypertension had chest or back pain, and the intramural hematoma was visualized in the ascending aorta (n = 4), along the whole aorta (n = 4), in the descending aorta (n = 6), or in the aortic arch (n = 1). The thickening of the aortic wall was crescentic. Patients with ascending aortic intramural hematoma had the following results: two patients died suddenly, three patients underwent surgery because of increased aortic wall thickening (one patient) or secondary intimal tear (two patients), and the remaining three patients had regression of the hematoma. Patients with hematoma confined to the descending aorta and the patient with aortic arch involvement (n = 7) had a different result: one patient died from aortic rupture and the remaining six patients did well. Six patients had a traumatic aortic injury, and the intramural hematoma was located along the descending thoracic aorta. The thickening of the aortic wall was circular in five patients and crescentic in one. Three of these patients had normalized thickness of the aortic wall on follow-up transesophageal echocardiographic studies. The other three patients died from multiorgan system failure. Aortography showed a reduction of the diameter of the aortic lumen in four patients; diameter in the remaining 17 patients was normal. CONCLUSIONS: Aortic intramural hematoma can be detected and monitored by transesophageal echocardiography but not by aortography. Two types of aortic intramural hematoma can be distinguished: (1) traumatic of good prognosis and (2) nontraumatic, which can be an early stage of the classic aortic dissection, with bad prognosis in cases involving the ascending aorta.

Computed tomography in abdominal Castleman's disease.

Three patients with abdominal Castleman disease studied by CT are presented. Two cases corresponded to localized mesenteric disease and the third to a systemic form of the process. The CT findings are nonspecific, although a dense enhancement of the lesions can be demonstrated sometimes on dynamic CT.

The value of computed tomography in the localization of undescended testes.

Eight patients with unilateral and four with bilateral (4) unpalpable testes were evaluated with CT for localization. All patients were later submitted to laparascopy and/or surgery and 13 cryptorchid testes and 3 atrophic or agenesic testes were found. CT detected correctly 11 of the cryptorchid testes - (85%) with one false positive and one false negative finding. In the three atrophic or agenesic testes, CT did not identify any image suspicious of being a testis, so there three were no false positive studies here. It is concluded that CT is an accurate noninvasive method for the preoperative detection of cryptorchid testes.