Reconstrucción cinemática en imagen cardiovascular / Kinematic reconstruction in cardiovascular imaging

Objetivo: El avance en aplicaciones clínicas en tomografía computarizada se ha acompañado de mejoras en herramientas de posproceso avanzado. Además de las reconstrucciones multiplanares, planares curvas, de proyección de máxima intensidad y de las reconstrucciones volumétricas, muy recientemente se ha desarrollado la reconstrucción cinemática como técnica que, basada en modelos matemáticos que simulan la de propagación de los haces de luz a través de un volumen de datos, permite obtener imágenes tridimensionales de gran realismo. En este trabajo se ilustran y comparan ejemplos de reconstrucciones cinemáticas respecto a reconstrucciones volumétricas clásicas en pacientes con patología cardiovascular, de manera que se pueden establecer fácilmente las diferencias entre ambos tipos de reconstrucción. Conclusión: la reconstrucción cinemática es un nuevo modo de representar la imagen tridimensional, que facilita la explicación y la comprensión de los hallazgos

Objective: Advances in clinical applications of computed tomography have been accompanied by improvements in advanced post-processing tools. In addition to multiplanar reconstructions, curved planar reconstructions, maximum intensity projections, and volumetric reconstructions, very recently kinematic reconstruction has been developed. This new technique, based on mathematical models that simulate the propagation of light beams through a volume of data, makes it possible to obtain very realistic three dimensional images. This article illustrates examples of kinematic reconstructions and compares them with classical volumetric reconstructions in patients with cardiovascular disease in a way that makes it easy to establish the differences between the two types of reconstruction. Conclusion: Kinematic reconstruction is a new method for representing three dimensional images that facilitates the explanation and comprehension of the findings

Kinematic reconstruction in cardiovascular imaging. / Reconstrucción cinemática en imagen cardiovascular.

OBJECTIVE: Advances in clinical applications of computed tomography have been accompanied by improvements in advanced post-processing tools. In addition to multiplanar reconstructions, curved planar reconstructions, maximum intensity projections, and volumetric reconstructions, very recently kinematic reconstruction has been developed. This new technique, based on mathematical models that simulate the propagation of light beams through a volume of data, makes it possible to obtain very realistic three dimensional images. This article illustrates examples of kinematic reconstructions and compares them with classical volumetric reconstructions in patients with cardiovascular disease in a way that makes it easy to establish the differences between the two types of reconstruction. CONCLUSION: Kinematic reconstruction is a new method for representing three dimensional images that facilitates the explanation and comprehension of the findings.

Obstrucción del drenaje venoso hepático tras trasplante: resultados del tratamiento con endoprótesis autoexpandibles / Hepatic venous outflow obstruction after transplantation: outcomes for treatment with self-expanding stents

Objetivos. Evaluar la seguridad y permeabilidad del tratamiento de la obstrucción del drenaje venoso hepático tras trasplante ortotópico con endoprótesis autoexpandibles. Valorar las diferencias en la respuesta en pacientes con obstrucción precoz y tardía. Material y métodos. Análisis retrospectivo de 16 pacientes trasplantados con obstrucción del drenaje venoso hepático tratados con endoprótesis (1996-2011). El seguimiento se realizó mediante venografía/manometría, ecografía, TC y pruebas de laboratorio. Se realizó análisis estadístico descriptivo de supervivencia de pacientes e injertos, éxito técnico y clínico, recurrencia y complicaciones del total de la muestra, así como inferencial para comparar las diferencias entre pacientes con obstrucción precoz y tardía. Resultados. La media de seguimiento fue de 3,34 años (21-5.331 días). La tasa de éxito técnico fue del 93,7%, y la de éxito clínico, del 81,2%. La tasa de complicaciones fue del 25%. La tasa de supervivencia para pacientes fue de 87,5%, y para injertos, de 92,5%. La tasa de recurrencia fue del 12,5%. La tasa de permeabilidad primaria a los 3, 6, 12 y 60 meses fue de 0,96 (IC 95% 0,91-1), 0,96 (IC 95% 0,91-1), 0,87 (IC 95% 0,73-1) y 0,87 (IC 95% 0,73-1), respectivamente. No hubo diferencias significativas entre los pacientes con obstrucción precoz o tardía, aunque las tasas de permeabilidad primaria mostraron tendencia a ser significativamente superiores en el grupo precoz (p = 0,091). Conclusiones. El tratamiento con endoprótesis autoexpandibles en obstrucciones del drenaje venoso hepático tras trasplante ortotópico es efectivo, duradero y seguro. No hay diferencias significativas entre pacientes con obstrucción precoz y tardía (AU)

Objectives. To evaluate the safety and patency of self-expanding stents to treat hepatic venous outflow obstruction after orthotopic liver transplantation. To evaluate differences in the response between patients with early obstruction and patients with late obstruction. Material and methods. This is a retrospective analysis of 16 patients with hepatic venous outflow obstruction after liver transplantation treated with stents (1996-2011). Follow-up included venography/manometry, ultrasonography, CT, and laboratory tests. We did a descriptive statistical analysis of the survival of patients and stents, technical and clinical success of the procedure, recurrence of obstruction, and complications of the procedure. We also did an inferential statistical analysis of the differences between patients with early and late obstruction. Results. The mean follow-up period was 3.34 years (21-5,331 days). The technical success rate was 93.7%, and the clinical success rate was 81.2%. The rate of complications was 25%. The survival rates were 87.5% for patients and 92.5% for stents. The rate of recurrence was 12.5%. The rate of primary patency was 0.96 (95% CI 0.91-1) at 3 months, 0.96 (95% CI 0.91-1) at 6 months, 0.87 (95% CI 0.73-1) at 12 months, and 0.87 (95% CI 0.73-1) at 60 months. There were no significant differences between patients with early and late obstruction, although there was a trend toward higher rates of primary patency in patients with early obstruction (P = .091). Conclusions. Treating hepatic venous outflow obstruction after orthotopic transplantation with self-expanding stents is effective, durable, and effective. There are no significant differences between patients with early obstruction and those with late obstruction (AU)

Hepatic venous outflow obstruction after transplantation: outcomes for treatment with self-expanding stents.

OBJECTIVES: To evaluate the safety and patency of self-expanding stents to treat hepatic venous outflow obstruction after orthotopic liver transplantation. To evaluate differences in the response between patients with early obstruction and patients with late obstruction. MATERIAL AND METHODS: This is a retrospective analysis of 16 patients with hepatic venous outflow obstruction after liver transplantation treated with stents (1996-2011). Follow-up included venography/manometry, ultrasonography, CT, and laboratory tests. We did a descriptive statistical analysis of the survival of patients and stents, technical and clinical success of the procedure, recurrence of obstruction, and complications of the procedure. We also did an inferential statistical analysis of the differences between patients with early and late obstruction. RESULTS: The mean follow-up period was 3.34 years (21-5,331 days). The technical success rate was 93.7%, and the clinical success rate was 81.2%. The rate of complications was 25%. The survival rates were 87.5% for patients and 92.5% for stents. The rate of recurrence was 12.5%. The rate of primary patency was 0.96 (95% CI 0.91-1) at 3 months, 0.96 (95% CI 0.91-1) at 6 months, 0.87 (95% CI 0.73-1) at 12 months, and 0.87 (95% CI 0.73-1) at 60 months. There were no significant differences between patients with early and late obstruction, although there was a trend toward higher rates of primary patency in patients with early obstruction (P=.091). CONCLUSIONS: Treating hepatic venous outflow obstruction after orthotopic transplantation with self-expanding stents is effective, durable, and effective. There are no significant differences between patients with early obstruction and those with late obstruction.

Knee lymphocutaneous fistula secondary to knee arthroplasty.

Lower limb lymphorrhea secondary to a surgical procedure is a rare but difficult-to-solve complication. In lower limb, this entity is frequently associated with vascular procedures around the inguinal area. We report on a case of a knee lymphocutaneous fistula secondary to a knee revision arthroplasty. To our knowledge, no previous reports regarding this complication have been published.

La urografía intravenosa ha muerto, viva la tomografía computarizada / Intravenous urography is died. Long live the computerized tomography

Durante la última mitad del siglo xx se han producido cambios muy importantes en el campo de la imagen genitourinaria, de forma que para la mayor parte de las históricas indicaciones de la urografía intravenosa la tomografía computarizada (TC) es ahora la técnica de elección. El objetivo de este trabajo es realizar una actualización del correcto uso de las pruebas de imagen, con especial enfoque en la TC, en la patología urológica del adulto revisando las entidades más frecuentes: litiasis, hematuria, infecciones, tumores, controles de cirugía y pielectasia. Hacemos un breve recorrido histórico por las pruebas de imagen utilizadas en urología a través de los años, haciendo hincapié en sus fundamentos físicos. En la segunda parte revisamos las diferentes patologías urológicas y el papel que desempeñan la radiografía simple, la ecografía, la TC y la resonancia magnética, analizando su sensibilidad y su especificidad. Por último, hacemos una breve reflexión acerca de las dosis de radiación de los diferentes métodos radiológicos (AU)

Very important changes have happened in the field of the genitourinary image during the last half of the 20th century, so that for most of the historical intravenous urography indications, nowadays the computerized tomography (CT) is technique of choice. The aim of this report is to perform an update in the correct use of the imaging techniques in the adult-related most frequent urological pathology, including: urolithiasis, haematuria, infections, tumours, surgery follow-up and pyelectasis, specially focused in CT. A brief historical review of the urological imaging techniques is performed, emphasizing the physical principles. In the second part, the role played by plain X-ray, ultrasound, CT and MR in the different urological pathologies are reviewed, discussing the sensibility and specificity of each technique. A brief reflection is finally carried out over of the radiation doses (AU)

[Intravenous urography is died. Long live the computerized tomography!]. / La urografía intravenosa ha muerto, ¡viva la tomografía computarizada!

Very important changes have happened in the field of the genitourinary image during the last half of the 20th century, so that for most of the historical intravenous urography indications, nowadays the computerized tomography (CT) is technique of choice. The aim of this report is to perform an update in the correct use of the imaging techniques in the adult-related most frequent urological pathology, including: urolithiasis, haematuria, infections, tumours, surgery follow-up and pyelectasis, specially focused in CT. A brief historical review of the urological imaging techniques is performed, emphasizing the physical principles. In the second part, the role played by plain X-ray, ultrasound, CT and MR in the different urological pathologies are reviewed, discussing the sensibility and specificity of each technique. A brief reflection is finally carried out over of the radiation doses.

Función, volúmenes y masa ventricular izquierda por resonancia magnética en estudios realizados en un modelo animal con secuencias SSFP y FLASH: comparación de los resultados / Left ventricular function, volumes, and mass in MRI studies using SFPP versus FLASH sequences in an animal model

Objetivo Comparar la exactitud de 2 secuencias cine eco de gradiente para cuantificar función, volúmenes y masa ventricular izquierda en un modelo animal. Material y métodosSe estudiaron 10 cerdos miniatura tipo Goettingen (7 machos, 3 hembras; peso medio: 49,8±10,65kg; rango: 35¿65kg) en un equipo 1,5 Tesla con secuencias precesión libre en estado estacionario (SSFP) y eco de gradiente convencionales (FLASH) en respiración libre. Se utilizaron imágenes de 8mm de grosor obtenidas en el eje corto para cuantificar los parámetros del ventrículo izquierdo. Se calcularon la fracción de eyección (FE), volúmenes (volumen telediastólico [VTD], volumen telesistólico [VTS], volumen latido [VL]), masa ventricular y la relación señal ruido (RSR) con cada secuencia. Se estudiaron la correlación y concordancia entre las distintas secuencias para cada variable. ResultadosUtilizando la secuencia SSFP, la FE media estimada fue 77,35±3,13%; VTD medio 61,55±8,64ml; VTS medio 13,83±1,92ml; VL medio 47,72±7,78ml y la masa miocárdica media calculada fue de 75,87±11,44g. Mediante la secuencia FLASH se calculó una FE media de 81,87±2,22%; VTD medio 55,4±8,08ml; VTS medio 10,03±1,87ml; VL medio 45,38±6,83ml, y masa miocárdica media 87,74±15,21g. Se demostró una correlación excelente entre SSFP y FLASH para cuantificar VTD, VL y masa miocárdica (r>0,8) y moderada para VTS y FE (r>0,4). La RSR que se obtuvo con la secuencia SSFP fue significativamente superior a la estimada con la secuencia FLASH (diferencia media 120,94±42,94). ConclusionesCon la secuencia SSFP se obtienen volúmenes ventriculares ligeramente superiores y masa ventricular izquierda ligeramente inferior a los calculados con la secuencia FLASH probablemente por su mayor RSR (AU)

ObjectiveTo compare the accuracy of two cine-gradient-echo sequences to quantify left ventricular function, volumes, and mass in an animal model. Material and methodsWe studied ten Gottingen miniature pigs (seven male, three female; mean weight 49.8±10.65kg; range: 35¿65kg) with a 1.5 Tesla MRI scanner using free-breathing SSFP and FLASH sequences. We used 8-mm short-axis images to estimate left ventricular ejection fraction (EF), volumes (end-diastolic (EDV), end-systolic (ESV), and stroke volume (SV)), mass, and signal-to-noise ratio (SNR) on SSFP and FLASH sequences. We analyzed the correlation and concordance of the two sequences for each variable. ResultsUsing the SSFP sequence, the mean estimated EF was 77.35±3.13%; mean EDV 61.55±8.64ml; mean ESV 13.83±1.92ml; mean SV 47.72±7.78ml; and mean myocardial mass 75.87±11.44g. Using the FLASH sequence, the mean EF was 81.87±2.22%; mean EDV 55.4±8.08ml; mean ESV 10.03±1.87ml; mean SV 45.38±6.83ml; and mean myocardial mass 87.74±15.21g. The correlation between SSFP and FLASH to quantify EDV, SV, and myocardial mass was excellent (r>0.8) and moderate (r>0.4) for quantifying ESV and EF. The SNR in the SSFP sequence was significantly higher than in the FLASH sequence (mean difference 120.94±42.94). ConclusionsIn the SSFP sequence, ventricular volumes are slightly higher and ventricular mass is slightly lower than in the FLASH sequence, probably because of the higher SNR on SSFP sequences (AU)

[Left ventricular function, volumes, and mass in MRI studies using SFPP versus FLASH sequences in an animal model.]. / Función, volúmenes y masa ventricular izquierda por resonancia magnética en estudios realizados en un modelo animal con secuencias SSFP y FLASH: comparación de los resultados.

OBJECTIVE: To compare the accuracy of two cine-gradient-echo sequences to quantify left ventricular function, volumes, and mass in an animal model. MATERIAL AND METHODS: We studied ten Gottingen miniature pigs (seven male, three female; mean weight 49.8+/-10.65kg; range: 35-65kg) with a 1.5 Tesla MRI scanner using free-breathing SSFP and FLASH sequences. We used 8-mm short-axis images to estimate left ventricular ejection fraction (EF), volumes (end-diastolic (EDV), end-systolic (ESV), and stroke volume (SV)), mass, and signal-to-noise ratio (SNR) on SSFP and FLASH sequences. We analyzed the correlation and concordance of the two sequences for each variable. RESULTS: Using the SSFP sequence, the mean estimated EF was 77.35+/-3.13%; mean EDV 61.55+/-8.64ml; mean ESV 13.83+/-1.92ml; mean SV 47.72+/-7.78ml; and mean myocardial mass 75.87+/-11.44g. Using the FLASH sequence, the mean EF was 81.87+/-2.22%; mean EDV 55.4+/-8.08ml; mean ESV 10.03+/-1.87ml; mean SV 45.38+/-6.83ml; and mean myocardial mass 87.74+/-15.21g. The correlation between SSFP and FLASH to quantify EDV, SV, and myocardial mass was excellent (r>0.8) and moderate (r>0.4) for quantifying ESV and EF. The SNR in the SSFP sequence was significantly higher than in the FLASH sequence (mean difference 120.94+/-42.94). CONCLUSIONS: In the SSFP sequence, ventricular volumes are slightly higher and ventricular mass is slightly lower than in the FLASH sequence, probably because of the higher SNR on SSFP sequences.

[Normal anatomy, anatomical variants, and anomalies of the origin and course of the coronary arteries on multislice CT]. / Anatomía normal, variantes anatómicas y anomalías del origen y trayecto de las arterias coronarias por tomografía computarizada multicorte.

Cardiovascular disease is the leading cause of death in adults in developed countries. Conventional coronary angiography is the technique of choice for the detection of coronary disease; however, this technique is not without complications. Nowadays, a significant proportion of conventional coronary angiography examinations are performed solely for diagnostic purposes. Multislice CT enables noninvasive study of the coronary arteries. This technique involves many professionals from different specialties and is constantly evolving. This article aims to provide an initiation to the fundamentals of multislice CT coronary angiography. We describe the classification of coronary arteries, as well as the normal anatomy, anatomical variants, and anomalies of the origin and course of the coronary arteries in axial images, in maximum intensity reconstructions, and in volumetric reconstructions. We also describe the myocardial segments and their vascularization.

Anatomía normal, variantes anatómicas y anomalías del origen y trayecto de las arterias coronarias por tomografía computarizada multicorte / Normal anatomy, anatomical variants, and anomalies of the origin and course of the coronary arteries on multislice CT

Las enfermedades cardiovasculares constituyen la primera causa de muerte en adultos en los países desarrollados. La técnica de elección para diagnosticar enfermedad coronaria es la coronariografía convencional, un procedimiento no exento de complicaciones. Actualmente, un porcentaje significativo de las exploraciones anuales se realizan únicamente con fines diagnósticos. La tomografía computarizada multicorte (TCMC) permite estudiar las arterias coronarias de forma no invasiva. Se trata de una técnica en continuo desarrollo, que involucra un gran número de profesionales de distintas especialidades. Como aproximación básica inicial a la coronariografía por TCMC en este trabajo se describen la clasificación de las arterias coronarias, la anatomía normal de las arterias coronarias en imágenes axiales, reconstrucciones de proyección de máxima intensidad y reconstrucciones volumétricas, y las variantes anatómicas y las anomalías del origen y trayecto de las arterias coronarias. Se describen, además, los segmentos miocárdicos y su correspondiente vascularización (AU)

Cardiovascular disease is the leading cause of death in adults in developed countries. Conventional coronary angiography is the technique of choice for the detection of coronary disease; however, this technique is not without complications. Nowadays, a significant proportion of conventional coronary angiography examinations are performed solely for diagnostic purposes. Multislice CT enables noninvasive study of the coronary arteries. This technique involves many professionals from different specialties and is constantly evolving. This article aims to provide an initiation to the fundamentals of multislice CT coronary angiography. We describe the classification of coronary arteries, as well as the normal anatomy, anatomical variants, and anomalies of the origin and course of the coronary arteries in axial images, in maximum intensity reconstructions, and in volumetric reconstructions. We also describe the myocardial segments and their vascularization (AU)

[Intestinal pneumatosis and portomesenteric gas: a case review]. / Neumatosis intestinal y gas portomesentérico: a propósito de un caso.

Intestinal pneumatosis (presence of gas in the intestinal wall and in the portomeseteric veins) is an infrequent clinical situation that has been associated with extended bowel necrosis and fatal outcome. However, there are other reasons that can justify these findings without such an outcome. Recent advances in diagnostic imaging techniques, especially multislice computerized tomography (MSCT), have allowed precise and quick diagnosis of these entities. In this article, we review the MSCT radiological manifestations of intestinal pneumatosis, as well as the different diagnoses related with the findings observed in a patient diagnosed with esophageal carcinoma under chemotherapy treatment.

Detección y caracterización del nódulo pulmonar por tomografía computarizada / Detection and characterization of pulmonary nodules using multislice computed tomography

El nódulo pulmonar es un hallazgo frecuente en los estudios torácicos realizados durante la práctica clínica diaria. Aunque no existen datos clínicos o radiológicos patognomónicos que indiquen su naturaleza exacta, el contexto clínico y la caracterización adecuada del nódulo pulmonar permiten realizar el diagnóstico correcto en la mayoría de los casos. En este artículo se exponen los aspectos más relevantes de lautilidad de la tomografía computarizada multicorte (TCMC) para detectar y caracterizar los nódulos pulmonares de forma no invasiva

Pulmonary nodules are a common finding in routine chest studies. Although there are no pathognomic clinical or radiological signs that enable the exact nature of a pulmonary nodule to be determined, the clinical context and the appropriate characterization of the pulmonarynodule make it possible to reach the correct diagnosis in most cases. This article discusses the most important aspects involved in the use of multislice computed tomography in the noninvasive detection and characterization of pulmonary nodules (AU)

[Detection and characterization of pulmonary nodules using multislice computed tomography]. / Detección y caracterización del nódulo pulmonar por tomografía computarizada multicorte.

Pulmonary nodules are a common finding in routine chest studies. Although there are no pathognomic clinical or radiological signs that enable the exact nature of a pulmonary nodule to be determined, the clinical context and the appropriate characterization of the pulmonary nodule make it possible to reach the correct diagnosis in most cases. This article discusses the most important aspects involved in the use of multislice computed tomography in the noninvasive detection and characterization of pulmonary nodules.

Neumatosis intestinal y gas portomesentérico: a propósito de un caso / No disponible

La neumatosis intestinal (presencia de gas en el interior de la pared intestinal y en el complejo venoso portomesentérico) es una situación clínica poco frecuente que ha sido característicamente relacionada con la isquemia intestinal y con un desenlace fatal. Existen otras causas que pueden justifi car estos hallazgos y cuya repercusión para el paciente no es inevitablemente trágica. Los avances recientes en técnicas de imagen, sobre todo en tomografía computarizada multicorte (TCMC), permiten un diagnóstico preciso fi able y precoz de estos hallazgos. En este artículo, repasamos las manifestaciones radiológicas de la neumatosis intestinal en TC así como las distintas causas relacionadas con esta entidad, en relación con los hallazgos presentes en un paciente diagnosticado de carcinoma de esófago y en tratamiento quimioterápico

Intestinal pneumatosis (presence of gas in the intestinal wall and in the portomeseteric veins) is an infrequent clinical situation that has been associated with extended bowel necrosis and fatal outcome. However, there are other reasons that can justify these fi ndings without such an outcome. Recent advances in diagnostic imaging techniques, especially multislice computerized tomography (MSCT), have allowed precise and quick diagnosis of these entities. In this article, we review the MSCT radiological manifestations of intestinal pneumatosis, as well as the different diagnoses related with the fi ndings observed in a patient diagnosed with esophageal carcinoma under chemotherapy treatment

[Mammographic findings in microcalcifications associated with breast cancer after neoadjuvant chemotherapy]. / Hallazgos mamográficos en las microcalcificaciones asociadas a cáncer de mama tras quimioterapia neoadyuvante.

OBJECTIVE: To evaluate the mammographic findings in microcalcifications associated with breast cancer after neoadjuvant chemotherapy. MATERIAL AND METHODS: From January 2000 to May 2005, a total of 99 breast cancer patients underwent neoadjuvant chemotherapy. Ten patients had microcalcifications on mammograms prior to treatment. We evaluated the evolution of the tumor and of the microcalcifications, correlating the imaging findings with the clinical and histological manifestations. RESULTS: Four different patterns of evolution were observed for the microcalcifications: the number of particles increased in two cases, remained stable in three, decreased in four, and in one patient the microcalcifications disappeared. The size of the tumor decreased in all cases. CONCLUSIONS: After neoadjuvant chemotherapy microcalcifications can evolve unpredictably and independently of tumor response.

Hallazgos mamográficos en las microcalcificaciones asociadas a cáncer de mama tras quimioterapia neoadyuvante / Mammographic findings in microcalcifications associated with breast cancer after neoadjuvant chemotherapy

Objetivo. Evaluar los hallazgos mamográficos en las microcalcificaciones asociadas al cáncer de mama tras el tratamiento con quimioterapia neoadyuvante (QTNA). Material y métodos. Desde enero de 2000 hasta mayo de 2005, un total de 99 pacientes con cáncer de mama se trataron con QTNA. De ellas, diez presentaban microcalcificaciones en las mamografías previas al tratamiento. Se estudió la evolución de la masa tumoral y de las microcalcificaciones, correlacionándola con las manifestaciones clínicas y anatomopatológicas. Resultados. Se observaron cuatro patrones en la evolución de las microcalcificaciones: el número de partículas aumentó en dos casos, permaneció estable en tres, disminuyó en cuatro y en uno las microcalcificaciones desaparecieron. La masa tumoral disminuyó en todos los casos. Conclusiones. Tras el tratamiento neoadyuvante las microcalcificaciones pueden evolucionar de manera impredecible e independiente de la respuesta tumoral

Objective. To evaluate the mammographic findings in microcalcifications associated with breast cancer after neoadjuvant chemotherapy. Material and methods. From January 2000 to May 2005, a total of 99 breast cancer patients underwent neoadjuvant chemotherapy. Ten patients had microcalcifications on mammograms prior to treatment. We evaluated the evolution of the tumor and of the microcalcifications, correlating the imaging findings with the clinical and histological manifestations. Results. Four different patterns of evolution were observed for the microcalcifications: the number of particles increased in two cases, remained stable in three, decreased in four, and in one patient the microcalcifications disappeared. The size of the tumor decreased in all cases. Conclusions. After neoadjuvant chemotherapy microcalcifications can evolve unpredictably and independently of tumor response

Preoperative planning of deep inferior epigastric artery perforator flap reconstruction with multislice-CT angiography: imaging findings and initial experience.

BACKGROUND: Autologous breast reconstruction with abdominal tissue is one of the best options after mastectomy. Reconstruction with deep inferior epigastric perforator (DIEAP) flaps requires a precise location and preoperative evaluation of perforating vessels. The objective of this report is to demonstrate the usefulness of multislice-CT (MSCT) angiography for preoperative planning in patients undergoing DIEAP flap reconstruction. METHODS: Six consecutive women were considered for breast reconstruction with DIEAP flaps after previous mastectomy for breast cancer. Preoperative MSCT angiography was performed to localise the arterial perforators. Axial images, multiplanar reconstructions (MPR) and 3D volume-rendered images were analysed. Findings were correlated with surgery. Initial experience and imaging findings will be described. RESULTS: Accurate identification of the main perforators was achieved in all six patients with a very satisfactory concordance between MSCT angiography and surgical findings. No unreported vessels were found. Location, course, anatomical variations and relations of the superficial inferior epigastric artery were reported. The very small perforators, were equally evaluated and described. CONCLUSIONS: Preoperative evaluation of perforator arteries with MSCT angiography is feasible in patients undergoing breast reconstruction. This technique provides a noninvasive global approach of the vascular anatomy and the entire anterior abdominal wall. However, more patients need to be evaluated in order to clarify the potential aspects pointed in this report.

Síndrome de Dietl: dolor abdominal recurrente y estenosis pieloureteral intermitente por vaso polar / Dietl's syndrome: recurrent abdominal pain and intermittent ureteropelvic junction stenosis caused by a pole vessel

Introducción: Una de las múltiples causas de dolor abdominal recurrente (DAR) es la hidronefrosis intermitente por vaso polar aberrante o síndrome de Dietl. El objetivo de esta nota clínica es mostrar la importancia de esta enfermedad dentro del diagnóstico diferencial de un DAR de larga evolución, así como su diagnóstico y tratamiento quirúrgico definitivo. Caso clínico: Se trata de un varón de 13 años que acudió a consulta por DAR de 3 años de evolución. Tras el diagnóstico de imagen de hidronefrosis intermitente derecha coincidente con episodios de sobreingestión hídrica, se confirmó el hallazgo tras exploración quirúrgica y se siguió de corrección de la obstrucción mediante pieloplastia. Discusión: La clínica característica de crisis de dolor en un contexto de sobrecarga hídrica debe hacer pensar en un síndrome de Dietl. El diagnóstico se llevará a cabo mediante la conjunción de estudios de ecografía y de urografía excretora tras sobrecarga hídrica. El estudio de la funcionalidad renal se realizará con gammagrafía. Conclusiones: El síndrome de Dietl es una enfermedad importante dentro del diagnóstico del DAR y puede pasar inadvertido de no efectuarse una correcta anamnesis y estudio de imagen coincidente con las crisis de dolor. De la misma manera, su tratamiento será siempre quirúrgico (AU)