The Spanish Society of Emergency Radiology (SERAU), the Spanish Society of Neuroradiology (SENR), the Spanish Society of Neurology through its Cerebrovascular Diseases Study Group (GEECV-SEN) and the Spanish Society of Medical Radiology (SERAM) have met to draft this consensus document that will review the use of computed tomography in the stroke code patients, focusing on its indications, the technique for its correct acquisition and the possible interpretation mistakes.
Radiology , Stroke , Humans , Consensus , Stroke/diagnostic imaging , Tomography, X-Ray Computed , Societies, Medical
Traumatic injuries can be severe and complex, requiring the coordinated efforts of a multidisciplinary team. Imaging tests play a fundamental role in rapid and accurate diagnosis. In particular, whole-body computed tomography (CT) has become a key tool. There are different CT protocols depending on the patient's condition; whereas dose-optimized protocols can be used in stable patients, time/precision protocols prioritizing speed at the cost of delivering higher doses of radiation should be used in more severe patients. In unstable patients who cannot be examined by CT, X-rays of the chest and pelvis and FAST or e-FAST ultrasound studies, although less sensitive than CT, enable the detection of situations that require immediate treatment. This article reviews the imaging techniques and CT protocols for the initial hospital workup for patients with multiple trauma.
Multiple Trauma , Humans , Multiple Trauma/diagnostic imaging , Tomography, X-Ray Computed/methods , Radiography , Ultrasonography , Review Literature as Topic
Acute appendicitis is the most common indication for emergency abdominal surgery throughout the world and a common reason for consultation in emergency departments. In recent decades, diagnostic imaging has played a fundamental role in identifying acute appendicitis, helping to reduce the rate of blind laparotomies and hospital costs. Given the results of clinical trials supporting the use of antibiotic therapy over surgical treatment, radiologists need to know the diagnostic criteria for complicated acute appendicitis to be able to recommend the best treatment option. This review aims not only to define the diagnostic criteria for appendicitis in different imaging modalities (ultrasonography, computed tomography, and magnetic resonance imaging), but also to explain the diagnostic protocols, atypical presentations, and other conditions that can mimic appendicitis.
Appendicitis , Humans , Appendicitis/diagnostic imaging , Appendicitis/surgery , Appendectomy , Abdomen , Ultrasonography , Tomography, X-Ray Computed , Acute Disease
La Sociedad Española de Radiología de Urgencias (SERAU), la Sociedad Española de Neurorradiología (SENR), la Sociedad Española de Neurología a través de su Grupo de Estudio de Enfermedades Cerebrovasculares (GEECV-SEN) y la Sociedad Española de Radiología Médica (SERAM) se han reunido para redactar este documento de consenso que repasará el uso de la tomografía computarizada en el código ictus, centrándose en sus indicaciones, la técnica para su correcta adquisición y las posibles causas de error en su interpretación (AU)
The Spanish Society of Emergency Radiology (SERAU), the Spanish Society of Neuroradiology (SENR), the Spanish Society of Neurology through its Cerebrovascular Diseases Study Group (GEECV-SEN) and the Spanish Society of Medical Radiology (SERAM) have met to draft this consensus document that will review the use of computed tomography in the stroke code patients, focusing on its indications, the technique for its correct acquisition and the possible interpretation mistakes (AU)
Tomography, X-Ray Computed/methods , Stroke/diagnostic imaging , Computed Tomography Angiography , Consensus Development Conferences as Topic , Societies, Medical , Spain
OBJECTIVE: To analyze the evolution of the use of imaging tests (ultrasonography and computed tomography (CT)) in the diagnosis of acute appendicitis. To determine the positive predictive value of these tests and the percentage of negative and complicated appendectomies. MATERIAL AND METHODS: This retrospective study compared adults who underwent appendectomy for suspected acute appendicitis at our tertiary hospital during 2015 versus similar patients at our center during 2007. RESULTS: A total of 278patients were included. The rate of negative appendectomies descended to 5%. The positive predictive value of ultrasonography increased to 97.4% in 2015, and the positive predictive value of CT and combined CT and ultrasonography was 100%. The rate of complicated appendicitis increased (23% in 2015). CONCLUSIONS: The use of imaging tests increased, and the rate of "blind" laparotomies decreased. Nevertheless, the rate of complicated appendicitis increased.
Appendicitis , Humans , Adult , Appendicitis/diagnostic imaging , Appendicitis/surgery , Retrospective Studies , Predictive Value of Tests , Ultrasonography , Tomography, X-Ray Computed/methods , Acute Disease
Objetivo: Analizar la evolución del uso de pruebas de imagen (ecografía y tomografía computarizada [TC]) en el diagnóstico de apendicitis aguda, el valor predictivo positivo (VPP) y determinar el porcentaje de apendicectomías negativas y complicadas. Material y métodos: Estudio retrospectivo que incluye a los pacientes adultos con apendicectomía por sospecha de apendicitis aguda en 2015 en un hospital terciario. Se compara con los del 2007 publicados previamente. Resultados: La muestra incluye 278 pacientes. La tasa de apendicectomías negativas descendió a un 5%. El VPP de la ecografía aumentó a 97,4% en 2015 y el VPP de la TC y del uso combinado de la ecografía y la TC fue del 100%. El porcentaje de apendicitis complicadas se incrementó (23% en 2015). Conclusiones: Se observó un aumento en el empleo de pruebas de imagen y una disminución de laparotomías en blanco. No obstante, las apendicitis complicadas se han incrementado.(AU)
Objective: To analyze the evolution of the use of imaging tests (ultrasonography and computed tomography (CT)) in the diagnosis of acute appendicitis. To determine the positive predictive value of these tests and the percentage of negative and complicated appendectomies. Material and methods: This retrospective study compared adults who underwent appendectomy for suspected acute appendicitis at our tertiary hospital during 2015 versus similar patients at our center during 2007. Results: A total of 278 patients were included. The rate of negative appendectomies descended to 5%. The positive predictive value of ultrasonography increased to 97.4% in 2015, and the positive predictive value of CT and combined CT and ultrasonography was 100%. The rate of complicated appendicitis increased (23% in 2015). Conclusions: The use of imaging tests increased, and the rate of blind laparotomies decreased. Nevertheless, the rate of complicated appendicitis increased.(AU)
Humans , Male , Female , Appendicitis/diagnosis , Ultrasonography , Tomography, X-Ray Computed , Predictive Value of Tests , Appendicitis/classification , Radiology , Radiology Department, Hospital , Diagnostic Imaging , Retrospective Studies
OBJECTIVE: Puerperium is the period during which the physiological changes that have taken place during pregnancy revert and the uterus involutes until it reaches its normal size. This is a period of intense systemic changes, and diagnosing complications in this period is a challenge for both gynecologists and radiologists. This paper reviews the complications that can occur during puerperium, classifying them according to the pathophysiological mechanisms involved: the prothrombotic state, hemodynamic and hormonal changes, rapid uterine growth, changes associated with endothelial damage (preeclampsia, eclampsia, and HELLP syndrome), and postoperative complications in patients undergoing cesarean sections. CONCLUSION: Puerperal complications represent a diagnostic challenge. Understanding the pathophysiological mechanisms underlying these complications is fundamental for choosing the most appropriate imaging technique to ensure the correct diagnosis in each case.
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.
COVID-19/diagnostic imaging , Radiography, Thoracic , Tomography, X-Ray Computed , Humans
INTRODUCTION: SARS-CoV-2, the virus responsible for the current pandemic, predominantly affects the respiratory tract, and a growing number of publications report the predisposition of patients with COVID-19 to develop thrombotic phenomena. OBJECTIVE: To determine the prevalence of pulmonary embolism in patients with COVID-19; to determine the possible relationship between the severity of pulmonary involvement and D-dimer levels; to analyze the location of pulmonary embolisms in patients with COVID-19 and to compare it with the location in patients without COVID-19. METHODS: This retrospective study analyzed all CT angiograms of the pulmonary arteries done in patients with suspected pulmonary embolisms between March 15 and April 30, 2020 and compared them with studies done in the same period one year earlier. RESULTS: We included 492 pulmonary CT angiograms (342 (69.9%) in patients with COVID-19 and 147 (30.1%) in patients without COVID-19). The prevalence of pulmonary embolisms was higher in patients with COVID-19 (26% vs. 16.3% in patients without COVID-19, p=0.0197; relative risk=1.6). The prevalence of pulmonary embolisms in the same period in 2019 was 13.2%, similar to that of the group of COVID-19-negative patients in 2020 (p=0.43). There were no significant differences in D-dimer levels or the location of pulmonary embolisms between the two groups. CT showed moderate or severe pulmonary involvement in 78.7% of the patients with COVID-19. CONCLUSIONS: Patients with COVID-19 have an increased prevalence of pulmonary embolisms (26%), and most (78.7%) have moderate or severe lung involvement on CT studies. The location of pulmonary embolisms and the degree of elevation of D-dimer levels does not differ between patients with COVID-19 and those without.
COVID-19/complications , Pulmonary Embolism/epidemiology , Pulmonary Embolism/etiology , Adult , Aged , Aged, 80 and over , Computed Tomography Angiography , Female , Fibrin Fibrinogen Degradation Products/analysis , Humans , Male , Middle Aged , Prevalence , Pulmonary Embolism/blood , Pulmonary Embolism/diagnostic imaging , Retrospective Studies , Severity of Illness Index , Tertiary Care Centers
La pandemia por el virus SARS-CoV-2ha desencadenado una crisis económica y sanitaria sin precedentes. Aunque el diagnóstico es microbiológico, las técnicas de imagen tienen un papel importante para apoyar el diagnóstico, graduar la gravedad de la enfermedad, guiar el tratamiento, detectar posibles complicaciones y valorar la respuesta terapéutica. La afectación es principalmente pulmonar. La radiografía de tórax en sala convencional o portátil es el primer método de imagen por su amplia disponibilidad y bajo coste. La tomografía computarizada torácica tiene una mayor sensibilidad que la radiografía de tórax y permite valorar tanto la afectación pulmonar como posibles complicaciones, además de proporcionar diagnósticos alternativos. Los hallazgos radiológicos más frecuentes son las opacidades del espacio aéreo en forma de consolidaciones y/u opacidades en vidrio deslustrado, con distribución típicamente bilateral, periférica y de predominio en los campos inferiores
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
Humans , Aged , Aged, 80 and over , Coronavirus Infections/diagnostic imaging , Pneumonia, Viral/diagnostic imaging , Pandemics , Severity of Illness Index , Tomography, X-Ray Computed , Sensitivity and Specificity , Risk Factors , Radiography
OBJECTIVE: To analyze the evolution of the use of imaging tests (ultrasonography and computed tomography (CT)) in the diagnosis of acute appendicitis. To determine the positive predictive value of these tests and the percentage of negative and complicated appendectomies. MATERIAL AND METHODS: This retrospective study compared adults who underwent appendectomy for suspected acute appendicitis at our tertiary hospital during 2015 versus similar patients at our center during 2007. RESULTS: A total of 278 patients were included. The rate of negative appendectomies descended to 5%. The positive predictive value of ultrasonography increased to 97.4% in 2015, and the positive predictive value of CT and combined CT and ultrasonography was 100%. The rate of complicated appendicitis increased (23% in 2015). CONCLUSIONS: The use of imaging tests increased, and the rate of "blind" laparotomies decreased. Nevertheless, the rate of complicated appendicitis increased.
Una fístula aortoentérica (FAE) es una comunicación aberrante entre la aorta y la pared del tubo digestivo. Se trata de una entidad rara pero con alta mortalidad que requiere, por tanto, un diagnóstico certero y precoz. Se clasifica como primaria si se desarrolla sobre una aorta nativa no intervenida previamente o como secundaria cuando ocurre en un contexto de complicación posquirúrgica de reparación vascular. Todo radiólogo debería saber reconocer los signos directos e indirectos que pudieran sugerir la existencia de una FAE. En este artículo se revisan los tipos de FAE y su correlación clínico-fisiopatológica, así como el algoritmo diagnóstico exponiendo los hallazgos radiológicos típicos en tomografía computarizada
An aortoenteric fistula is an abnormal communication between the aorta and the gastrointestinal tract wall. The high mortality associated with this rare entity means it requires early accurate diagnosis. Aortoenteric fistulas are classified as primary when they develop on a native aorta that has not undergone an intervention and as secondary when they develop after vascular repair surgery. All radiologists need to be able to recognize the direct and indirect signs that might suggest the presence of an aortoenteric fistula. This article reviews the types of aortoenteric fistulas and their clinical and pathophysiological correlation, as well as the diagnostic algorithm, illustrating the most characteristic findings on multidetector computed tomography
Humans , Male , Middle Aged , Aged , Aged, 80 and over , Aortic Diseases/diagnostic imaging , Digestive System Fistula/diagnostic imaging , Vascular Fistula/diagnostic imaging , Angiography , Tomography, X-Ray Computed
An aortoenteric fistula is an abnormal communication between the aorta and the gastrointestinal tract wall. The high mortality associated with this rare entity means it requires early accurate diagnosis. Aortoenteric fistulas are classified as primary when they develop on a native aorta that has not undergone an intervention and as secondary when they develop after vascular repair surgery. All radiologists need to be able to recognize the direct and indirect signs that might suggest the presence of an aortoenteric fistula. This article reviews the types of aortoenteric fistulas and their clinical and pathophysiological correlation, as well as the diagnostic algorithm, illustrating the most characteristic findings on multidetector computed tomography.
Aortic Diseases/diagnostic imaging , Intestinal Fistula/diagnostic imaging , Multidetector Computed Tomography , Vascular Fistula/diagnostic imaging , Aged , Aged, 80 and over , Aortic Diseases/diagnosis , Humans , Intestinal Fistula/diagnosis , Male , Middle Aged , Vascular Fistula/diagnosis
INTRODUCCIÓN: El coronavirus SARS-CoV-2, responsable de la pandemia actual, afecta preferentemente al tracto respiratorio, con un número creciente de publicaciones sobre su predisposición a fenómenos trombóticos. OBJETIVO: Conocer la prevalencia de tromboembolismo pulmonar (TEP) en pacientes con COVID-19; determinar su posible relación con la gravedad de la enfermedad pulmonar y los niveles de dímeros D, y analizar la localización del TEP en pacientes con COVID-19 comparándolos con los pacientes sin COVID-19. MÉTODO: Estudio retrospectivo de todas las angio-TC de arterias pulmonares realizadas por sospecha de TEP del 15 de marzo al 30 de abril de 2020. Se compara con las angio-TC realizadas durante el mismo periodo en 2019. RESULTADOS: Se incluyeron 492 angio-TC pulmonares, 342 (69,9%) de pacientes con COVID-19 y 147 (30,1%) de pacientes sin infección. La prevalencia de TEP fue del 26% en el grupo COVID-19 positivo y del 16,3% en el negativo (p = 0,0197), con un riesgo relativo de 1,6 veces. La prevalencia de TEP en el mismo período del año 2019 fue del 13,2%, similar a la del grupo COVID-19 negativo del año 2020 (p = 0,43). No hubo diferencias significativas en el nivel de dímeros D ni en la localización del TEP entre ambos grupos. El 78,7% de los pacientes con COVID-19 con TEP mostraron una extensión de la afectación pulmonar moderada o grave en la tomografía computarizada. CONCLUSIONES: Los pacientes con COVID-19 tienen una prevalencia aumentada de TEP (26%) y la mayoría (78,7%) presentan una extensión moderada o grave de afectación pulmonar en la tomografía computarizada. No hay diferencias significativas en la localización del material embólico ni en el grado de elevación de dímero-D respecto a los pacientes sin COVID-19
INTRODUCTION: SARS-CoV-2, the virus responsible for the current pandemic, predominantly affects the respiratory tract, and a growing number of publications report the predisposition of patients with COVID-19 to develop thrombotic phenomena. OBJECTIVE: To determine the prevalence of pulmonary embolism in patients with COVID-19; to determine the possible relationship between the severity of pulmonary involvement and D-dimer levels; to analyze the location of pulmonary embolisms in patients with COVID-19 and to compare it with the location in patients without COVID-19. METHODS: This retrospective study analyzed all CT angiograms of the pulmonary arteries done in patients with suspected pulmonary embolisms between March 15 and April 30, 2020 and compared them with studies done in the same period one year earlier. RESULTS: We included 492 pulmonary CT angiograms (342 (69.9%) in patients with COVID-19 and 147 (30.1%) in patients without COVID-19). The prevalence of pulmonary embolisms was higher in patients with COVID-19 (26% vs. 16.3% in patients without COVID-19, p = 0.0197; relative risk=1.6). The prevalence of pulmonary embolisms in the same period in 2019 was 13.2%, similar to that of the group of COVID-19-negative patients in 2020 (p = 0.43). There were no significant differences in D-dimer levels or the location of pulmonary embolisms between the two groups. CT showed moderate or severe pulmonary involvement in 78.7% of the patients with COVID-19. CONCLUSIONS: Patients with COVID-19 have an increased prevalence of pulmonary embolisms (26%), and most (78.7%) have moderate or severe lung involvement on CT studies. The location of pulmonary embolisms and the degree of elevation of D-dimer levels does not differ between patients with COVID-19 and those without
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Coronavirus Infections/epidemiology , Pulmonary Embolism/epidemiology , Severe acute respiratory syndrome-related coronavirus/pathogenicity , Severe Acute Respiratory Syndrome/epidemiology , Retrospective Studies , Tertiary Healthcare/statistics & numerical data , Pandemics/statistics & numerical data , Prevalence , Severe Acute Respiratory Syndrome/complications , Angiography/methods , Tomography, X-Ray Computed/methods , Pulmonary Artery/diagnostic imaging
Los vólvulos del tracto gastrointestinal constituyen una causa importante de abdomen agudo, no tanto por su frecuencia como por la gravedad de sus posibles complicaciones. Todos ellos tienen un mecanismo fisiopatológico común que consiste en una obstrucción intestinal en asa cerrada que provoca una isquemia. Las manifestaciones clínicas son inespecíficas por lo que el radiólogo tiene un papel muy importante para identificar precozmente los signos de torsión más comunes, como «el pico de pájaro» o «el remolino», y los signos de isquemia potencialmente reversible o irreversible. El tratamiento de elección en la mayoría de los casos es quirúrgico, bien para corregir las causas y preservar el órgano volvulado, o para resecarlo en caso de necrosis (AU)
Gastrointestinal volvuli cause processes that manifest as acute abdomen. Volvuli are important not because they are common, but rather because their possible complications can be severe. All types of volvuli share a common pathophysiology, which consists of intestinal obstruction in a closed loop that results in ischemia. The clinical manifestations are nonspecific, so radiologists play a very important role in the early identification of the most common signs of torsion. These include the «bird's beak sign», the «whirlpool sign», and signs of potentially reversible or irreversible ischemia. The treatment of choice in most cases is surgery, either to correct the torsion and save the organ or to resect it if it is necrotic (AU)
Female , Humans , Male , Stomach Volvulus/pathology , Stomach Volvulus , Intestinal Obstruction/complications , Intestinal Obstruction/pathology , Intestinal Obstruction , Magnetic Resonance Imaging/methods , Tomography , Colon, Sigmoid/pathology , Colon, Sigmoid , Stomach Volvulus/surgery , Diagnosis, Differential
Gastrointestinal volvuli cause processes that manifest as acute abdomen. Volvuli are important not because they are common, but rather because their possible complications can be severe. All types of volvuli share a common pathophysiology, which consists of intestinal obstruction in a closed loop that results in ischemia. The clinical manifestations are nonspecific, so radiologists play a very important role in the early identification of the most common signs of torsion. These include the "bird's beak sign", the "whirlpool sign", and signs of potentially reversible or irreversible ischemia. The treatment of choice in most cases is surgery, either to correct the torsion and save the organ or to resect it if it is necrotic.
Intestinal Volvulus/diagnostic imaging , Multidetector Computed Tomography , Stomach Volvulus/drug therapy , Humans , Intestinal Volvulus/complications , Radiography , Stomach Volvulus/complications
OBJECTIVE: The main objective of this study was to not only determine the most appropriate sequence for the analysis of white matter hyperintensities (WMH) on MRI but also to confirm the advantage of three-dimensional (3D) acquisition, as it has been suggested in previous studies, and to test the convenience of using maximum intensity projection (MIP) algorithms on 3D-fluid-attenuated inversion-recovery (FLAIR) images for a quicker evaluation of brain MR studies. METHODS: The number of WMH was compared in 40 patients and a control group of 10 volunteers using 4 different imaging modalities: two dimensional (2D)-FLAIR, 2D fast spin echo proton density (FSE PD), 3D-FLAIR and FLAIR MIP. Four experienced radiologists took part in the imaging analysis. All studies were performed on a 1.5-T whole-body MR unit. RESULTS: A statistically significant difference between the number of lesions detected on 3D acquisitions (FLAIR CUBE® or FLAIR MIP sequences) compared with those on 2D-FLAIR or 2D FSE PD was demonstrated. There is no significant difference between 3D-FLAIR and FLAIR MIP, therefore both of them can be used with similar results. CONCLUSION: 3D-FLAIR sequences should replace conventional 2D-FLAIR and/or FSE PD sequences in the MR acquisition protocol when WMH are suspected. MIP reformat algorithms are less time consuming, therefore these can also be used to simplify the detection. ADVANCES IN KNOWLEDGE: 3D sequences are superior for WMH depiction. Moreover, MIP algorithms allow easier analyses with similar results.
Brain/pathology , Imaging, Three-Dimensional/methods , Magnetic Resonance Imaging/methods , Adult , Algorithms , Female , Humans , Male , Middle Aged , Multiple Sclerosis/pathology , Observer Variation , Protons
Humans , Male , Aged , Tolosa-Hunt Syndrome/diagnosis , Tolosa-Hunt Syndrome/therapy , Headache/complications , Paresis/complications , Paresis/diagnosis , Granuloma, Giant Cell/complications , Granuloma, Giant Cell/diagnosis , Prednisone/therapeutic use , Tolosa-Hunt Syndrome/physiopathology , Tolosa-Hunt Syndrome , Granuloma, Giant Cell/physiopathology , Granuloma, Giant Cell
