RESUMEN
AIM: To assess the frequency of malignancy in lesions characterized as benign [Breast Imaging-Reporting and Data System (BI-RADS) 2] on breast MRI. MATERIALS AND METHODS: In this institutional review board-approved retrospective single-centre study, 1265 consecutive patients (mean age 50 ± 13 years), undergoing dynamic contrast-enhanced MRI (1.5 T) of the breast during a 6 year time period, were eligible. This study investigated the MRI characteristics and frequency of malignancy in 192 of these patients with breast lesions classified as BI-RADS 2. Examinations were read during clinical practice and classified according to the MRI BI-RADS lexicon. Based on the patient's and referring physician's preferences, lesions were either histopathologically verified or were subjected to both clinical and imaging follow-up of at least 2 years (range 2-9 years). Descriptive statistical metrics were calculated. RESULTS: According to the standard of reference, 0 of 192 (0%) lesions classified as BI-RADS 2 were malignant. Histopathology was available in 67 (34.9%) lesions and revealed benign findings exclusively. The remaining 125 (65.1%) lesions did not exhibit changes during the follow-up period and were, therefore, considered negative for malignancy. CONCLUSIONS: The frequency of malignancy in breast lesions classified as BI-RADS 2 is zero. As a consequence, breast biopsies are unnecessary in these cases.
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Neoplasias de la Mama/diagnóstico , Imagen por Resonancia Magnética/métodos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias de la Mama/clasificación , Neoplasias de la Mama/patología , Diagnóstico Diferencial , Femenino , Humanos , Persona de Mediana Edad , Estudios Retrospectivos , Sensibilidad y Especificidad , Adulto JovenRESUMEN
Pigmented villonodular synovitis (PVNS) is a rare proliferative lesion that can affect synovial membranes, tendon sheaths, and bursae. It is usually a monarticular disease of the lower extremities, and so far fewer than 30 cases of spinal involvement have been reported in the literature. We describe a patient with progressive lumbar pain and spinal claudication, in whom a CT scan of the lumbar spine revealed destruction fo facet joints L3 to L5. An open biopsy was performed, which led to the diagnosis fo PVNS. The patient underwent successful surgical resection of the tumour mass and stabilization of segments L3 to S1. Two years after surgery the patient has no signs of recurrence. Differential diagnosis of erosive vertebral joint disease is discussed.
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Discitis/cirugía , Desplazamiento del Disco Intervertebral/cirugía , Inestabilidad de la Articulación/cirugía , Sinovitis Pigmentada Vellonodular/diagnóstico , Sinovitis Pigmentada Vellonodular/cirugía , Discitis/diagnóstico , Discitis/etiología , Humanos , Desplazamiento del Disco Intervertebral/diagnóstico , Desplazamiento del Disco Intervertebral/etiología , Inestabilidad de la Articulación/etiología , Vértebras Lumbares/diagnóstico por imagen , Vértebras Lumbares/patología , Vértebras Lumbares/cirugía , Masculino , Persona de Mediana Edad , Radiografía , Fusión Vertebral , Sinovitis Pigmentada Vellonodular/complicaciones , Resultado del TratamientoAsunto(s)
Neoplasias Cardíacas , Micosis Fungoide , Neoplasias Cutáneas , Cardiomiopatía Dilatada/diagnóstico , Cardiomiopatía Dilatada/diagnóstico por imagen , Diagnóstico Diferencial , Neoplasias Cardíacas/diagnóstico , Neoplasias Cardíacas/diagnóstico por imagen , Neoplasias Cardíacas/mortalidad , Humanos , Inmunohistoquímica , Masculino , Persona de Mediana Edad , Micosis Fungoide/diagnóstico , Micosis Fungoide/mortalidad , Micosis Fungoide/patología , Radiografía Torácica , Piel/patología , Neoplasias Cutáneas/diagnóstico , Neoplasias Cutáneas/mortalidad , Neoplasias Cutáneas/patología , Factores de Tiempo , Tomografía Computarizada por Rayos X , UltrasonografíaAsunto(s)
Anticuerpos Monoclonales/uso terapéutico , Granulomatosis con Poliangitis/tratamiento farmacológico , Meningitis/tratamiento farmacológico , Vasculitis del Sistema Nervioso Central/tratamiento farmacológico , Adulto , Humanos , Infliximab , Imagen por Resonancia Magnética , Masculino , Factor de Necrosis Tumoral alfa/antagonistas & inhibidoresAsunto(s)
Hepatopatías/diagnóstico por imagen , Radiografía Torácica , Sarcoidosis Pulmonar/diagnóstico por imagen , Sarcoidosis/diagnóstico por imagen , Enfermedades del Bazo/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Adulto , Antiinflamatorios/administración & dosificación , Antiinflamatorios/uso terapéutico , Líquido del Lavado Bronquioalveolar , Broncoscopía , Femenino , Estudios de Seguimiento , Humanos , Prednisolona/administración & dosificación , Prednisolona/uso terapéutico , Sarcoidosis Pulmonar/tratamiento farmacológico , Sarcoidosis Pulmonar/patología , Factores de TiempoRESUMEN
BACKGROUND: We assessed the usefulness of helical computed tomography (CT) with a negative oral contrast material for detecting Crohn disease. METHODS: Thirty-eight patients with proven Crohn disease were examined. We administered a large volume of a new negative oral contrast material (Mucofalk suspended in water) and then proceeded with helical CT scanning. This technique is an alternative to CT and conventional enteroclyses that use a nasojejunal tube. Two radiologists interpreted the scans, and patients were interviewed about their tolerance of the procedure. We created multiplanar reformatted images in all cases. Potential of small bowel distention by Mucofalk was evaluated by two observers on a three-point scale, and interobserver agreement was calculated with kappa statistics. RESULTS: All patients who underwent enteroclysis stated that CT was the more comfortable method, the taste of the peroral contrast medium was considered good by 52.6% and acceptable by 47.4%. Small bowel distention was excellent in 55% of cases, moderate in 26%, and poor in 19%, with an interoberserver agreement of 78%. CT findings correlated with enteroclysis in 27 patients who underwent both methods. Analysis of CT versus enteroclysis showed a sensitivity of 89% for CT versus 78% for small bowel enteroclysis. CONCLUSION: Mucofalk CT is a simple, rapid, noninvasive, and accurate method of evaluating extramucosal manifestations of Crohn disease. The tubeless procedure improved patients' comfort and decreased time, cost, and radiation exposure.
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Enfermedad de Crohn/diagnóstico por imagen , Yohexol/análogos & derivados , Tomografía Computarizada Espiral , Administración Oral , Adulto , Medios de Contraste , Femenino , Humanos , Intestino Delgado/diagnóstico por imagen , Masculino , PsylliumAsunto(s)
Abdomen Agudo/etiología , Obstrucción Intestinal/diagnóstico por imagen , Epiplón , Enfermedades Peritoneales/diagnóstico por imagen , Radiografía Abdominal , Tomografía Computarizada por Rayos X , Adulto , Humanos , Obstrucción Intestinal/complicaciones , Obstrucción Intestinal/cirugía , Masculino , Enfermedades Peritoneales/complicaciones , Enfermedades Peritoneales/cirugía , Anomalía TorsionalRESUMEN
We present the MRI and CT findings in a 43-year old patient with bilateral orbital pseudotumour due to Ormond's disease.
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Imagen por Resonancia Magnética , Seudotumor Orbitario/diagnóstico , Fibrosis Retroperitoneal/diagnóstico , Tomografía Computarizada por Rayos X , Adulto , Humanos , Seudotumor Orbitario/diagnóstico por imagen , Seudotumor Orbitario/cirugía , Fibrosis Retroperitoneal/diagnóstico por imagen , Fibrosis Retroperitoneal/cirugíaRESUMEN
Our objective was to assess the practicability and accuracy of a computer-assisted multislice CT-guided frameless electromagnetic tracking for endoscopic sinus surgery. Eighty-two patients with various paranasal sinus diseases were evaluated. Prior to surgery, axial multislice spiral-CT scans with 2.5-mm collimation, 0.8-mm reconstruction increment, and a pitch of 3 were acquired. After Ethernet transfer of the CT data set to the guidance system, coronal and sagittal images were reconstructed. For intraoperative navigation the Insta Trak System (Visualization Technology, Boston, Mass.) was used. Navigational procedures are described in detail in the paper. Accuracy was assessed by means of visual landmarks which could be clearly identified endoscopically as well as on CT images. A second parameter for accuracy was calculated by the system itself as the root mean square (RMS). The system was able to display the position of the aspirating tip relative to anatomical structures with an average accuracy of 0.70 +/- 0.40 mm. Root mean square values showed a mean value of 0.40 +/- 0.20 mm. During surgical procedures the Insta Trak System provides the surgeon with additional image-based information to the endoscopic view. The device accuracy is high and the system proves to be practicable and efficient in ENT surgery.
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Procesamiento de Imagen Asistido por Computador/instrumentación , Senos Paranasales/cirugía , Cirugía Asistida por Computador/instrumentación , Tomografía Computarizada por Rayos X/instrumentación , Adolescente , Adulto , Anciano , Endoscopía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Cirugía Asistida por Computador/métodos , Cirugía Asistida por Computador/normasAsunto(s)
Granuloma de Cuerpo Extraño/diagnóstico por imagen , Enfermedades Pulmonares Intersticiales/diagnóstico por imagen , Abuso de Sustancias por Vía Intravenosa/diagnóstico por imagen , Talco/efectos adversos , Tuberculosis Pulmonar/diagnóstico por imagen , Adulto , Diagnóstico Diferencial , Femenino , Humanos , Aumento de la Imagen , Pulmón/diagnóstico por imagen , Radiografía , Abuso de Sustancias por Vía Intravenosa/complicacionesRESUMEN
Accurate knowledge of age-related development and pneumatisation of the paranasal sinuses has become an important issue in diagnosing paranasal sinus diseases in infants and young adults. Magnetic resonance imaging (MRI) has the potential to assess bone marrow conversion and pneumatisation of the paranasal sinuses. We retrospectively reviewed 800 children aged 0-14 years undergoing brain MRI for various indications. T1-weighted sagittal and T2-weighted axial scans were evaluated for bone marrow conversion and development of pneumatisation of the sphenoid sinus. The sphenoid sinus had a uniformly low signal intensity on T1-weighted images in all children less than four months old. Signal intensity began to change to hyperintense marrow at the age of four months. Onset of pneumatisation was observed in 19% at the age of 12-15 months. Pneumatisation was complete in all patients older than 10 years. In conclusion, these data can be used as baseline standards of normal age-related development of the sphenoid sinus and can be of great value for the diagnostic and therapeutic management of pathologic conditions of the child's sphenoid sinus and its surrounds.
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Imagen por Resonancia Magnética , Seno Esfenoidal/anatomía & histología , Adolescente , Médula Ósea/anatomía & histología , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Estudios RetrospectivosRESUMEN
RATIONALE AND OBJECTIVES: The purpose of this study was to compare gadolinium-enhanced magnetic resonance (MR) angiography with contrast material-enhanced computed tomography (CT) for the detection of small (4-5-mm) pulmonary emboli (PE), with a methacrylate cast of the porcine pulmonary vasculature used as the diagnostic standard. MATERIALS AND METHODS: In 15 anesthetized juvenile pigs, colored methacrylate beads (5.2 and 3.8 mm diameter-the size of segmental and subsegmental emboli in humans) were injected via the left external jugular vein. After embolization, MR angiographic and CT images were obtained. The pigs were killed, and the pulmonary arterial tree was cast in clear methacrylate, allowing direct visualization of emboli. Three readers reviewed CT and MR angiographic images independently and in random order. RESULTS: Forty-nine separate embolic sites were included in the statistical analysis. The mean sensitivity (and 95% confidence intervals) for CT and MR angiography, respectively, were 76% (68%-82%) and 82% (75%-88%) (P > .05); the mean positive predictive values, 92% (85%-96%) and 94% (88%-97%) (P > .05). In this porcine model, PE were usually seen as parenchymal perfusion defects (98%) with MR angiography and as occlusive emboli (100%) with CT. CONCLUSION: MR angiography is as sensitive as CT for the detection of small PE in a porcine model.
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Angiografía por Resonancia Magnética , Embolia Pulmonar/diagnóstico , Tomografía Computarizada por Rayos X , Animales , Medios de Contraste , Femenino , Gadolinio DTPA , Valor Predictivo de las Pruebas , Embolia Pulmonar/epidemiología , Sensibilidad y Especificidad , Porcinos , Ácidos TriyodobenzoicosRESUMEN
Peripheral primitive neuroectodermal tumour in the kidney is a rare entity with high malignant potential. The distinctive demographic, clinical and radiological findings, as described in the present case, should suggest this aggressive tumour in the differential diagnosis of renal neoplasms in adolescents.
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Neoplasias Renales/diagnóstico por imagen , Tumores Neuroectodérmicos Periféricos Primitivos/diagnóstico por imagen , Adolescente , Terapia Combinada , Diagnóstico Diferencial , Femenino , Humanos , Neoplasias Renales/patología , Neoplasias Renales/terapia , Tumores Neuroectodérmicos Periféricos Primitivos/patología , Tumores Neuroectodérmicos Periféricos Primitivos/terapia , Tomografía Computarizada por Rayos XRESUMEN
OBJECTIVE: Our objective was to evaluate the CT appearance of talcosis associated with IV abuse of oral medications and to compare the findings of talcosis related to methylphenidate with those findings seen with other drugs. MATERIALS AND METHODS: The CT scans of 12 patients with talcosis (seven men, five women), 33-54 years old (mean age, 44 years), were analyzed retrospectively. Seven patients had abused methylphenidate; five patients had no history of abuse. The diagnosis of talcosis was made histologically in 11 patients and at funduscopy in one patient. CT was performed with 1- to 1.5-mm collimation (n = 10 patients) or 5- to 10-mm collimation (n = 2). RESULTS: The predominant abnormalities seen on CT consisted of a diffuse fine nodular pattern (n = 2), a combination of nodules and lower lobe panacinar emphysema (n = 3), and ground-glass attenuation (n = 2). Emphysema was the only abnormality seen in the remaining five patients (lower lobe panacinar, n = 4; upper lobe centrilobular, n = 1). No significant difference in the prevalence of nodules and ground-glass attenuation was seen between the methylphenidate and non-methylphenidate groups. Lower lobe panacinar emphysema was more common in methylphenidate abusers (six [86%] of seven patients) than in non-mnethylphenidate drug abusers (one [20%] of five, p<0.05, Fisher's exact test). CONCLUSION: The CT manifestations of talcosis consist of a fine micronodular pattern, ground-glass attenuation, and emphysema. A significantly increased prevalence of lower lobe panacinar emphysema is seen in IV drug addicts who abuse methylphenidate.
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Estimulantes del Sistema Nervioso Central , Reacción a Cuerpo Extraño/diagnóstico por imagen , Granuloma de Cuerpo Extraño/diagnóstico por imagen , Drogas Ilícitas , Enfermedades Pulmonares/diagnóstico por imagen , Metilfenidato , Abuso de Sustancias por Vía Intravenosa/diagnóstico por imagen , Talco , Tomografía Computarizada por Rayos X , Adulto , Diagnóstico Diferencial , Femenino , Humanos , Masculino , Persona de Mediana Edad , Enfisema Pulmonar/diagnóstico por imagen , Estudios RetrospectivosRESUMEN
OBJECTIVE: The aim of the study was to compare the radiographic and the high-resolution CT findings of Mycoplasma pneumoniae pneumonia. MATERIALS AND METHODS: The chest radiographs and 1.5-mm collimation CT scans obtained in 28 patients with serologically proven M. pneumoniae pneumonia were retrospectively reviewed. The radiographs and CT scans were analyzed independently by two observers. RESULTS: The most common finding on radiography was the presence of air-space opacification (n = 24), which was patchy and segmental (n = 9) or nonsegmental (n = 15) in distribution. On high-resolution CT, areas of ground-glass attenuation were seen in 24 patients (86%) and air-space consolidation in 22 (79%). In 13 patients (59%), the areas of consolidation had a lobular distribution evident on CT. Nodules were seen more commonly on high-resolution CT (25 of 28 patients, 89%) than on radiography (14 patients, 50%) (p < 0.01, chi-square test). In 24 (86%) of the 28 patients, the nodules had a predominantly centrilobular distribution on CT. Thickening of the bronchovascular bundles was identified more commonly on CT (23 of 28 patients, 82%) than on radiography (five patients, 18%) (p < 0.01, chi-square test). CONCLUSION: The lobular distribution, centrilobular involvement, and interstitial abnormalities in M. pneumoniae pneumonia are often difficult to recognize on radiography but can usually be seen on high-resolution CT.
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Neumonía por Mycoplasma/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Adolescente , Adulto , Anciano , Niño , Femenino , Humanos , Pulmón/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Estudios RetrospectivosAsunto(s)
Hamartoma/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Enfermedades de la Tráquea/diagnóstico por imagen , Adolescente , Adulto , Obstrucción de las Vías Aéreas/diagnóstico , Asma/diagnóstico , Broncoscopía , Calcinosis/diagnóstico por imagen , Calcinosis/patología , Cartílago/patología , Tejido Conectivo/patología , Diagnóstico Diferencial , Femenino , Hamartoma/patología , Humanos , Masculino , Recurrencia , Enfermedades de la Tráquea/patologíaRESUMEN
BACKGROUND: Image-guided surgery is increasingly acknowledged as useful technology also for endoscopic sinus surgery. For many years our department has been involved in the development and testing of devices for image-guided endoscopic sinus surgery. Since January 1997 we have been testing the "Insta Trak" System, which is based on electromagnetic tracking and was especially designed for use in endoscopic sinus surgery. METHODS: We tested practicability and accuracy of the system in a wide range of cases from standard sphenoethmoidectomies to tricky frontal sinus surgery, from endoscopic tumour surgery to endoscopic repair of CSF fistulas. System accuracy was assessed by means of visual landmarks which could be clearly identified endoscopically as well as via computer screen. Additionally we measured the time for setting up the system, total operating time and rating of the subjective surgeon's assessment of the system's usefulness in each particular case. RESULTS: We present the results according accuracy and practicability in 45 patients, who were operated on under computer-aided guidance. Our overall experience with the "Insta Trak" system was very positive. It was no longer the indeed promising, but still rather circumstantial and not always reliable technique we were used to. Operating the system was relatively easy and did not require excessive computer skills. We measured an average accuracy of 0.69 mm with a maximum deviation of 2 mm in a single test measurement. Incorrect use of the device, however, may significantly increase the possible weight of system errors. CONCLUSIONS: The system accuracy was high and "Insta Trak" proved to be practicable and efficient in daily clinical routine. Especially in complicated cases like revision surgery "Insta Trak" proved to be extremely helpful. Whether a system like "Insta Trak" will be definitely able to lower complication rates in FESS is still an open question. Certainly in the near future no such navigational device will become a substitute for the surgeon's understanding of anatomy. In our opinion and experience "Insta Trak" is a significant development in sinus surgery. However, one must be aware of the fact that it cannot be more than yet another and indeed helpful tool.
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Procesamiento de Imagen Asistido por Computador/instrumentación , Procesamiento de Imagen Asistido por Computador/tendencias , Senos Paranasales/cirugía , Terapia Asistida por Computador/instrumentación , Terapia Asistida por Computador/tendencias , Endoscopios , Endoscopía/tendencias , HumanosAsunto(s)
Enfermedades Bronquiales/diagnóstico por imagen , Enfermedades de la Tráquea/diagnóstico por imagen , Xantogranuloma Juvenil/diagnóstico por imagen , Adulto , Enfermedades Bronquiales/patología , Humanos , Masculino , Radiografía , Enfermedades de la Tráquea/patología , Xantogranuloma Juvenil/patologíaRESUMEN
Chronic spinal subdural haematoma is a uncommon. We describe the CT and MRI appearances of chronic spinal and intracranial subdural haematomas following minor trauma. The aetiology, pathogenesis and differential diagnosis are discussed.