International cooperation in radiology training: A multipronged approach.

INTRODUCTION: Medical imaging has undergone significant technical advancements in recent years, posing a considerable challenge for radiologists to stay up-to-date with emerging modalities and their applications in daily practice. This challenge is even more daunting in developing countries with limited resources compared to the US and other developed nations with greater economic assets. The collaboration between the United States and other advanced nations with radiological institutions in Latin America has been a significant achievement in the pursuit of new opportunities for continuous medical education. The aim of this study was to evaluate the effectiveness of international collaborations among Spanish-speaking Latin American institutions and radiologists through a survey. MATERIALS AND METHODS: A group of radiologists and institutions from various countries, including the USA, Spain, and Argentina, who have been working together for several years to improve Radiology education across Latin America, were selected. An online survey was conducted. The survey included questions about interest in the activities, participation, and impact of radiologic education during these educational efforts. RESULTS: The survey received responses from 166 participants, all of whom reported knowledge of at least one type of educational activity. The most well-known activity was ALAT Webinars. The primary motivators for participation were the quality of the content and the opportunity to learn new information. Additionally, improving local education in radiology and receiving expert advice on radiology issues were identified as priorities for participation in international collaborations. The Cronbach alpha coefficient was calculated for individual and global Likert questions, resulting in a global score of 0.96. CONCLUSION: The study confirms the significance of a multifaceted approach to address gaps in radiology education. While traditional models have relied on hosting international visitors or sending US teachers abroad, the results suggest that using a variety of methods will have a greater impact than relying on a single technique for those who benefit most from collaborative efforts.

Radiologic Clues to Cerebral Venous Thrombosis.

Cerebral venous thrombosis (CVT) is uncommon, representing approximately 0.5% of all cases of cerebrovascular disease worldwide. Many factors, alone or combined, can cause CVT. Although CVT can occur at any age, it most commonly affects neonates and young adults. CVT is difficult to diagnose clinically because patients can present with a wide spectrum of nonspecific manifestations, the most common of which are headache in 89%-91%, focal deficits in 52%-68%, and seizures in 39%-44% of patients. Consequently, imaging is fundamental to its diagnosis. MRI is the most sensitive and specific technique for diagnosis of CVT. The different MRI sequences, with and without the use of contrast material, have variable strengths. Contrast material-enhanced MR venography has the highest accuracy compared with sequences without contrast enhancement.Online supplemental material is available for this article.©RSNA, 2019.

How clinical imaging can assess cancer biology.

Human cancers represent complex structures, which display substantial inter- and intratumor heterogeneity in their genetic expression and phenotypic features. However, cancers usually exhibit characteristic structural, physiologic, and molecular features and display specific biological capabilities named hallmarks. Many of these tumor traits are imageable through different imaging techniques. Imaging is able to spatially map key cancer features and tumor heterogeneity improving tumor diagnosis, characterization, and management. This paper aims to summarize the current and emerging applications of imaging in tumor biology assessment.

Advanced Imaging Techniques in Evaluation of Colorectal Cancer.

Imaging techniques are clinical decision-making tools in the evaluation of patients with colorectal cancer (CRC). The aim of this article is to discuss the potential of recent advances in imaging for diagnosis, prognosis, therapy planning, and assessment of response to treatment of CRC. Recent developments and new clinical applications of conventional imaging techniques such as virtual colonoscopy, dual-energy spectral computed tomography, elastography, advanced computing techniques (including volumetric rendering techniques and machine learning), magnetic resonance (MR) imaging-based magnetization transfer, and new liver imaging techniques, which may offer additional clinical information in patients with CRC, are summarized. In addition, the clinical value of functional and molecular imaging techniques such as diffusion-weighted MR imaging, dynamic contrast material-enhanced imaging, blood oxygen level-dependent imaging, lymphography with contrast agents, positron emission tomography with different radiotracers, and MR spectroscopy is reviewed, and the advantages and disadvantages of these modalities are evaluated. Finally, the future role of imaging-based analysis of tumor heterogeneity and multiparametric imaging, the development of radiomics and radiogenomics, and future challenges for imaging of patients with CRC are discussed. Online supplemental material is available for this article. ©RSNA, 2018.

Advanced MR Imaging Techniques for Differentiation of Neuropathic Arthropathy and Osteomyelitis in the Diabetic Foot.

Diagnosis and treatment of foot disease in patients with diabetes is a common clinical-radiologic challenge, particularly the differentiation of neuropathic arthropathy from osteomyelitis. Conventional clinical tests and imaging techniques have limited accuracy for evaluation of the diabetic foot. The introduction of morphologic magnetic resonance (MR) imaging in these patients has provided a qualitative leap in diagnosis. The characteristics of soft-tissue and bone marrow edema and their patterns of distribution throughout the foot allow discrimination between both entities. However, in certain scenarios, the application of MR imaging to this problem is limited because of overlapping features between the two and the coexistence of infection and neuropathic changes. Recent technical advances in MR imaging sequences have increased the capability to add functional quantitative information to structural information. Diffusion-weighted imaging is useful to determine the presence and extension of osteomyelitis. Dynamic contrast-enhanced MR imaging may help to detect differences between the vascularization patterns of neuropathic arthropathy and osteomyelitis. MR angiography (with or without contrast material) is used in clinical practice to identify candidate distal vessels for revascularization. MR neurography, and especially diffusion-tensor imaging, provides quantitative information about neural damage. These new sequences may help in assessment of the different pathophysiologic conditions that occur in the diabetic foot. The physical basis of these techniques, their limitations, and their potential applications for diabetic foot assessment are detailed in this article. The introduction of advanced MR imaging multiparametric protocols, with the aim of enhancing the overall diagnostic accuracy of MR imaging, may help in treatment decision making and lead to improved patient outcomes. © RSNA, 2017.

[Multiparametric MRI. The role of MRI techniques in the diagnosis, staging and follow up of prostate cancer]. / Resonancia magnética multiparamétrica. Papel de las técnicas de RM en el diagnóstico, estadiage y seguimiento del cáncer de próstata.

The current diagnosis of prostate cancer based on PSA values and systematic biopsy has limitations in its efficacy of detection and staging. Technical advances on imaging over the last decade, mainly MRI, enable improvements in the strategy of prostate cancer management in diagnosis, staging, follow up and therapy monitoring. MRI enables the combination of morphological (T2 sequences) and, at the same time, functional information by means of the application of sequences such as spectroscopy (SMRI), diffusion and dynamic intravenous contrast (CMRI) in the same study, giving the multiparametric MRI (mpMRI). Currently, it is not necessary to apply all sequences to obtain an mpMR study of optimal efficacy, so that a time shorter than 30 minutes is enough to obtain the necessary information depending on the clinical indication. The main clinical indications of prostatic MRI are a) local, regional or distance staging; b) Detection or guide for diagnostic biopsy for clinical risk suspicion or negative result in previous biopsies; c) active surveillance; and d) therapeutic monitoring. Furthermore, one of the most relevant features of prostate cancer, and a challenge for the mpMRI techniques is to be able to differentiate aggressive and non-significant neoplasias (latent). This update tries to review the current role of mpMRI in the management of prostate cancer using in combination the anatomical (T2) and functional (SMRI, DMRI and CMRI) information. We also describe the European prostate mpMRI guidelines, PI-RADS (Prostate imaging reporting data System).

Resonancia magnética multiparamétrica. Papel de las técnicas de RM en el diagnóstico, estadiage y seguimiento del cáncer de próstata / Multiparametric mri. the role of MRI techniques in the diagnosis, staging and follow up of prostate cancer

El diagnóstico actual del cáncer de próstata basado en las cifras de PSA y biopsia sistemática presenta limitaciones en la eficacia de su detección y estadiaje. Los avances técnicos de la imagen en la última década, especialmente la resonancia magnética (RM) permiten mejorar la estrategia en el manejo del cáncer de próstata en el diagnóstico, estadificación, seguimiento y monitorización terapéutica. La RM permite combinar información morfológica (secuencia T2) y funcional al mismo tiempo mediante la aplicación de secuencias como la espectroscopía (RME), difusión (RMD) y contraste endovenoso dinámico (RMC) en el mismo estudio, constituyendo la RM multiparamétrica (RMmp). En la actualidad no es necesario aplicar todas las secuencias para obtener un estudio de eficacia óptima en RMmp, con lo que en tiempo inferior a 30 minutos es suficiente para obtener la información necesaria dependiendo de la indicación clínica. Las principales indicaciones clínicas de la RM de próstata son: a) estadificación local, regional o a distancia; b) Detección o guía para biopsia diagnóstica ante sospecha de riesgo clínico o con resultado negativo en biopsias previas; c) seguimiento activo; y d) monitorización terapéutica. Además, uno de los aspectos más relevantes del cáncer de próstata y un reto de las técnicas en RMmp es poder diferenciar la neoplasia agresiva de la no significativa (latente). Esta actualización pretende revisar el papel actual de la RMmp en el manejo del cáncer de próstata utilizando de forma combinada la información anatómica (T2) y funcional (RME, RMD y RMC). Así mismo se describe la guía europea de la RMmp de próstata, PI-RADS (Prostate Imaging Reporting and Data System)

The current diagnosis of prostate cancer based on PSA values and systematic biopsy has limitations in its efficacy of detection and staging. Technical advances on imaging over the last decade, mainly MRI, enable improvements in the strategy of prostate cancer management in diagnosis, staging, follow up and therapy monitoring. MRI enables the combination of morphological (T2 sequences) and, at the same time, functional information by means of the application of sequences such as spectroscopy (SMRI), diffusion and dynamic intravenous contrast (CMRI) in the same study, giving the multiparametric MRI (mpMRI). Currently, it is not necessary to apply all sequences to obtain an mpMR study of optimal efficacy, so that a time shorter than 30 minutes is enough to obtain the necessary information depending on the clinical indication. The main clinical indications of prostatic MRI are a) local, regional or distance staging; b) Detection or guide for diagnostic biopsy for clinical risk suspicion or negative result in previous biopsies; c) active surveillance; and d) therapeutic monitoring. Furthermore, one of the most relevant features of prostate cancer, and a challenge for the mpMRI techniques is to be able to differentiate aggressive and non-significant neoplasias (latent). This update tries to review the current role of mpMRI in the management of prostate cancer using in combination the anatomical (T2) and functional (SMRI, DMRI and CMRI) information. We also describe the European prostate mpMRI guidelines, PI-RADS (Prostate imaging reporting data System)

Utility of MRI diffusion techniques in the evaluation of tumors of the head and neck.

The use of diffusion-weighted imaging in the head and neck is an increasingly used technique that requires adaptation of the acquisition parameters. Parallel imaging and emerging techniques such as IVIM are playing a new role. The main indications for performing DWI are tissue characterization, nodal staging and therapy monitoring. Lower apparent diffusion coefficients have been reported in this region for malignant lesions such as SCC, lymphoma and metastatic lymph node, as opposed to higher ADC in benign lesions and lymph nodes. Follow-up and early response to treatment are reflected in an ADC increase in both primary tumor and nodal metastasis.

Técnicas de imagen en la evaluación de las manifestaciones sistemáticas de las vasculitis / Imaging techniques for the evaluation of systemic manifestations of vasculitis

Las vasculitis provocan un proceso inflamatorio vascular que determina distintas manifestaciones orgánicas que dependen del calibre del vaso afectado y de su localización. Las técnicas de imagen desempeñan un papel importante en la caracterización y detección de las vasculitis de vasos grandes y medianos, pues son capaces de detectar el edema parietal y de monitorizar la respuesta para el tratamiento. En las vasculitis de vasos pequeños las técnicas de imagen son necesarias para estudiar las diferentes repercusiones orgánicas o sistémicas, ya que en el momento actual ninguna técnica de imagen tiene la resolución espacial suficiente para visualizarlos de forma directa (AU)

Vasculitides create a local inflammatory process in the vessel wall, which determines the different organic manifestations according to vessel size and location. Imaging techniques play a key role in the characterization and detection of large and medium size vessel vasculitides. Imaging is able to detect the vessel wall edema and to monitor the therapeutic response. In small vessel vasculitis, imaging can indirectly analyse the organic and/or systemic manifestations, because at present, none of the imaging techniques has the necessary spatial resolution to directly visualize small vessels (AU)

Estudio por imagen del hombro doloroso / Imaging studies in cases with painful shoulder

El hombro doloroso es un problema clínico frecuente en la enfermedad osteomuscular. Las pruebas de imagen desempeñan un papel importante en el diagnóstico etiológico. La radiografía convencional generalmente es la primera prueba realizada y en ocasiones es suficiente para el diagnóstico. Las calcificaciones tendinosas se ven con claridad y en el diagnóstico etiológico de las neoplasias óseas las técnicas tomográficas no la han sustituido. La patología tendinosa es la causa más frecuente de dolor en el hombro, y tanto la ecografía como la resonancia magnética (RM) son herramientas eficaces para su estudio. La RM es la técnica que mejor detecta cambios patológicos precoces. Asimismo, es fundamental en la valoración prequirúrgica del hombro y en la estadificación local de los tumores óseos y de las partes blandas (AU)

Painful shoulder is a frequent clinical problem in musculoskeletal pathology. Imaging plays an essential role in the etiologic diagnosis. Simple X-rays are usually the first performed diagnostic test, and on occasion, it is enough to establish a diagnosis. Tendinous calcifications are clearly depicted on plain radiographs, which are a first option modality in the evaluation of bone tumors. Tendinous pathology is the most common cause of shoulder pain. It may be analysed either by ultrasound or magnetic resonance (MR). MR is the most sensitive technique to detect early pathological changes. MR is usually used in the presurgical evaluation of the shoulder and in local staging of bone and soft tissue tumors (AU)

[Imaging studies in cases with painful shoulder]. / Estudio por imagen del hombro doloroso.

Painful shoulder is a frequent clinical problem in musculoskeletal pathology. Imaging plays an essential role in the etiologic diagnosis. Simple X-rays are usually the first performed diagnostic test, and on occasion, it is enough to establish a diagnosis. Tendinous calcifications are clearly depicted on plain radiographs, which are a first option modality in the evaluation of bone tumors. Tendinous pathology is the most common cause of shoulder pain. It may be analysed either by ultrasound or magnetic resonance (MR). MR is the most sensitive technique to detect early pathological changes. MR is usually used in the presurgical evaluation of the shoulder and in local staging of bone and soft tissue tumors.

[Imaging techniques for the evaluation of systemic manifestations of vasculitis]. / Técnicas de imagen en la evaluación de las manifestaciones sistemáticas de las vasculitis.

Vasculitides create a local inflammatory process in the vessel wall, which determines the different organic manifestations according to vessel size and location. Imaging techniques play a key role in the characterization and detection of large and medium size vessel vasculitides. Imaging is able to detect the vessel wall edema and to monitor the therapeutic response. In small vessel vasculitis, imaging can indirectly analyse the organic and/or systemic manifestations, because at present, none of the imaging techniques has the necessary spatial resolution to directly visualize small vessels.