ABSTRACT
"Code Stroke" is a multidisciplinary procedure designed to detect acute ischemic strokes and transfer patients for early reperfusion. Selecting these patients requires multimodal imaging with either CT or MRI. 1) Conventional studies without contrast material are obligatory to detect bleeding. Applying the ASPECTS scale, these studies can also identify and quantify areas of early infarction. 2) In candidates for mechanical thrombectomy, angiographic studies are necessary to identify stenoses and obstructions and to evaluate the collateral circulation. 3) Patients with known onset between 6 and 24h or with unknown onset require perfusion studies to distinguish between infracted tissue and recoverable ischemic tissue. Semi-automatic software facilitates diagnosis, but radiologists must interpret its output.
Subject(s)
Brain Ischemia , Stroke , Humans , Brain Ischemia/diagnosis , Tomography, X-Ray Computed/methods , Stroke/diagnostic imaging , Magnetic Resonance Imaging , SoftwareABSTRACT
OBJECTIVE: To review the main findings for anisakiasis in the different imaging tests that can be used to diagnose it, based on studies done at our center. CONCLUSION: The presence of Anisakis species in food consumed in Western countries is becoming more common. Patients with anisakiasis present with acute abdomen; there are no specific clinical signs or laboratory findings. Careful history taking is key to discovering exposure to Anisakis-contaminated food, but this task is hindered by unfamiliarity with the condition and lack of suspicion and is also confounded by the variable latency period after ingestion of Anisakis-contaminated food. Give the nonspecific presentation, patients with anisakiasis often undergo imaging tests to rule out other processes. Thus, radiologists need to be familiar with the spectrum of imaging findings that should lead to the inclusion of anisakiasis in the differential diagnosis, so they can guide clinicians toward directed history taking and specific tests.
Subject(s)
Abdomen, Acute , Anisakiasis , Anisakis , Animals , Anisakiasis/diagnostic imaging , Diagnosis, Differential , HumansABSTRACT
Objetivo: Revisar los principales hallazgos radiológicos de la anisakiasis en las diferentes pruebas de imagen que se pueden utilizar en su diagnóstico, basándonos en estudios realizados en nuestro centro. Conclusión: La contaminación alimentaria por Anisakis muestra una tendencia creciente en países occidentales. Habitualmente se presenta como un cuadro de patología abdominal aguda, sin datos clínicos o analíticos característicos. Una anamnesis cuidadosa es clave para descubrir el antecedente de exposición, pero se ve dificultada al ser un proceso poco conocido o sospechado y con un periodo de latencia variable. Al tratarse de cuadros poco específicos, a estos pacientes con frecuencia se les realizan pruebas radiológicas para descartar otros procesos. Por ello, es recomendable familiarizarse con los posibles hallazgos en imagen que permitan incluir la anisakiasis en el diagnóstico diferencial, lo que podría guiar al clínico hacia una anamnesis dirigida y pruebas específicas.(AU)
Objective: To review the main findings for anisakiasis in the different imaging tests that can be used to diagnose it, based on studies done at our center. Conclusion: The presence of Anisakis species in food consumed in Western countries is becoming more common. Patients with anisakiasis present with acute abdomen; there are no specific clinical signs or laboratory findings. Careful history taking is key to discovering exposure to Anisakis-contaminated food, but this task is hindered by unfamiliarity with the condition and lack of suspicion and is also confounded by the variable latency period after ingestion of Anisakis-contaminated food. Give the nonspecific presentation, patients with anisakiasis often undergo imaging tests to rule out other processes. Thus, radiologists need to be familiar with the spectrum of imaging findings that should lead to the inclusion of anisakiasis in the differential diagnosis, so they can guide clinicians toward directed history taking and specific tests.(AU)
Subject(s)
Humans , Animals , Anisakiasis/diagnostic imaging , Food Contamination , Nematoda , Abdominal Pain , Medical History Taking , Ultrasonography , Tomography, X-Ray Computed , Parasitic Diseases , Parasitic Diseases, Animal , Gastrointestinal Tract , RadiologyABSTRACT
El estudio multimodal engloba distintas técnicas radiológicas utilizadas en el "código ictus". Incluye tomografía computarizada (TC) basal, resonancia magnética (RM) y RM por difusión, técnicas de perfusión con TC o RM y angiografía por TC o RM. Se emplean para descartar sangrado, confirmar oclusión arterial, establecer viabilidad tisular y ayudar a seleccionar a los candidatos a tratamiento endovascular lo antes posible. Se han publicado recientemente cinco relevantes ensayos clínicos que han demostrado la eficacia de la trombectomía mecánica en oclusiones arteriales proximales. Todos han utilizado diferentes estrategias de imagen para la selección de los pacientes. Analizando estos ensayos y la bibliografía científica actual concluimos que la TC convencional con valoración de la puntuación ASPECTS y la angiografía por TC o RM debe usarse siempre, con nivel de evidencia I y grado de recomendación A. Los estudios de perfusión por TC y RM tienen utilidad en situaciones específicas (AU)
In stroke code patients, multimodal imaging workup encompasses various imaging techniques, including baseline computed tomography (CT), magnetic resonance (MR) imaging, diffusion MR imaging, CT or MR perfusion studies, and CT or MR angiography, that are used to rule out bleeding, confirm arterial occlusion, establish tissue viability, and help select candidates for endovascular treatment as early as possible. Five recently published relevant clinical trials have demonstrated the efficacy of mechanical thrombectomy in proximal arterial occlusions; all these trials used different imaging techniques to select patients. Analyzing these trials and the scientific literature, we conclude that conventional CT interpreted with the Alberta Stroke Programme Computed Tomography Score (ASPECTS) and CT or MR angiography should always be used (level of evidence I, grade of recommendation A) and that CT and MR perfusion studies are useful in specific circumstances (AU)
Subject(s)
Humans , Stroke/diagnostic imaging , Multimodal Imaging/methods , Radiography/methods , Critical Pathways/organization & administration , Tomography, X-Ray Computed/methods , Magnetic Resonance Spectroscopy/methods , Cerebral Infarction/diagnostic imaging , Diagnosis, DifferentialABSTRACT
In stroke code patients, multimodal imaging workup encompasses various imaging techniques, including baseline computed tomography (CT), magnetic resonance (MR) imaging, diffusion MR imaging, CT or MR perfusion studies, and CT or MR angiography, that are used to rule out bleeding, confirm arterial occlusion, establish tissue viability, and help select candidates for endovascular treatment as early as possible. Five recently published relevant clinical trials have demonstrated the efficacy of mechanical thrombectomy in proximal arterial occlusions; all these trials used different imaging techniques to select patients. Analyzing these trials and the scientific literature, we conclude that conventional CT interpreted with the Alberta Stroke Programme Computed Tomography Score (ASPECTS) and CT or MR angiography should always be used (level of evidence I, grade of recommendation A) and that CT and MR perfusion studies are useful in specific circumstances.
Subject(s)
Magnetic Resonance Imaging , Multimodal Imaging , Stroke/diagnostic imaging , Tomography, X-Ray Computed , HumansABSTRACT
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