Hallazgos posoperatorios esperables en cirugías de aorta torácica ascendente con angiotomografía computada multicorte: todo lo que un médico radiólogo debe conocer / Expected postoperative findings in ascending thoracic aortic surgeries with multislice angiotomography: Everything a radiologist should know

Resumen Para la reconstrucción y el tratamiento de anomalías que comprometen la aorta torácica pueden emplearse diversas técnicas quirúrgicas abiertas, las cuales estarán determinadas por la patología que presente el paciente. La angiotomografía computada multicorte (ATCMC) es el método de elección para su control y seguimiento. El médico radiólogo debe estar familiarizado con las técnicas quirúrgicas empleadas (Wheat, Bentall de Bono, Cabrol, entre otras), con las reparaciones estructurales que se realizan y con los materiales protésicos utilizados con el fin de evitar una interpretación errónea de las imágenes. El fieltro espontáneamente hiperdenso, los conductos protésicos y sus anastomosis, tanto con la aorta como con los grandes vasos, puede generar errores en el informe final y en el diagnóstico.

Abstract Multiple surgical techniques can be used for the reconstruction and treatment of abnormalities that compromise the thoracic aorta, which will be determined by the patient’s pathology. Multislice computed tomography angiography is the method of choice for their control and monitoring. The radiologist should be familiar with the surgical techniques used (Wheat, Bentall de Bono, and Cabrol, among others), as well as with the structural repairs that are performed and the prosthetic materials used in order to avoid an erroneous interpretation of the images. Spontaneously hyperdense felt, the prosthetic ducts and their anastomosis, both with the aorta and the large vessels, can generate pitfalls in the final report and error in the diagnosis.

Utilidad de la tomografía computarizada multicorte para la estimación de la composición del derrame pericárdico / Usefulness of computed tomography densities to estimate the composition of pericardial effusion

Resumen El derrame pericárdico (DP) es una entidad frecuente en la práctica diaria, que puede ocurrir por un amplio rango de patologías. Los métodos por imágenes constituyen una herramienta diagnóstica clave en la evaluación del pericardio. El ecocardiograma transtorácico (ETT) se considera de primera línea por su costo-efectividad. La tomografía computarizada multicorte (TCMC), por su parte, representa un valioso complemento ante limitaciones del ETT y en la evaluación de urgencia del paciente con sospecha de DP. El objetivo del trabajo es mostrar la utilidad y rol de la TCMC, mediante la medición de densidades, para estimar la etiología del DP, ilustrado con casos de nuestra institución.

Abstract Pericardial effusion (PE) is a common entity in daily practice, which can occur due to a wide range of conditions. Imaging methods are a key diagnostic tool in the evaluation of the pericardium. Transthoracic echocardiogram (TTE) is the first line imaging method because of its cost-effectiveness. Multi-slice Computed Tomography (MSCT), on the other hand, represents a valuable complement to the limitations of TTE and in emergency evaluation of the patient with suspected PE. The objective of this review is to show the usefulness and role of the MSCT —through the measurement of densities— to estimate the etiology of PE, illustrated with cases of our Institution.

Use of Chest Imaging in the Diagnosis and Management of COVID-19: A WHO Rapid Advice Guide.

The World Health Organization (WHO) undertook the development of a rapid guide on the use of chest imaging in the diagnosis and management of coronavirus disease 2019 (COVID-19). The rapid guide was developed over 2 months by using standard WHO processes, except for the use of "rapid reviews" and online meetings of the panel. The evidence review was supplemented by a survey of stakeholders regarding their views on the acceptability, feasibility, impact on equity, and resource use of the relevant chest imaging modalities (chest radiography, chest CT, and lung US). The guideline development group had broad expertise and country representation. The rapid guide includes three diagnosis recommendations and four management recommendations. The recommendations cover patients with confirmed or who are suspected of having COVID-19 with different levels of disease severity, throughout the care pathway from outpatient facility or hospital entry to home discharge. All recommendations are conditional and are based on low certainty evidence (n = 2), very low certainty evidence (n = 2), or expert opinion (n = 3). The remarks accompanying the recommendations suggest which patients are likely to benefit from chest imaging and what factors should be considered when choosing the specific imaging modality. The guidance offers considerations about implementation, monitoring, and evaluation, and also identifies research needs. Published under a CC BY 4.0 license. Online supplemental material is available for this article.

Aortitis: Hallazgos radiológicos en relación a sus diversas etiologías / Aortitis: Radiological Findings in Relation to its Various Etiologies

Resumen La inflamación de la aorta (aortitis) es una patología poco frecuente, con etiología infecciosa (pseudoaneurisma micótico, sífilis) y no infecciosa (arteritis, aortitis idiopática, espondilitis anquilosante, entre otras) de difícil diagnóstico clínico y variable pronóstico. Por esa razón, la utilización de diversos métodos por imágenes, tales como la tomografía computada multidetector (TCMD), la tomografía computada por emisión de positrones (PET-TC), la resonancia magnética (RM) y ultrasonido (US) facilitan la identificación, seguimiento y tratamiento de esa entidad. El siguiente trabajo tiene como objetivo realizar una revisión y actualización bibliográfica acerca de la aortitis y sus diversas etiologías, ejemplificando con casos de nuestra institución.

Abstract Aortic inflammation (aortitis) is a rare pathology, with infectious (fungal pseudoaneurysm, syphilis) and noninfectious etiology (arteritis, idiopathic aortitis, ankylosing spondylitis, among others), it has a difficult clinical diagnosis and a variable prognosis. The use of various imaging methods such as multidetector computed tomography (MDCT), magnetic resonance imaging (MRI), positron emission tomography-computed tomography (PET-CT) and ultrasound (US) facilitate the identification, monitoring and treatment of this entity. The following paper aims to perform a literature review and update about aortitis and its various etiologies, exemplifying cases of our institution.

Validation of an informatics tool to assess resident's progress in developing reporting skills.

BACKGROUND: Diagnostic radiology residency programs pursuits as main objectives of the development of diagnostic capabilities and written communication skills to answer clinicians' questions of referring clinicians. There has been also an increasing focus on competencies, rather than just education inputs. Then, to show ongoing professional development is necessary for a system to assess and document resident's competence in these areas. Therefore, we propose the implementation of an informatics tool to objectively assess resident's progress in developing diagnostics and reporting skills. We expect to found decreased preliminary report-final report variability within the course of each year of the residency program. RESULTS: We analyzed 12,162 evaluations from 32 residents (8 residents per year in a 4-year residency program) in a 7-month period. 73.96% of these evaluations belong to 2nd-year residents. We chose two indicators to study the evolution of evaluations: the total of discrepancies over the total of preliminary reports (excluding score 0) and the total of likely to be clinically significant discrepancies (scores 2b, 3b, and 4b) over the total of preliminary reports (excluding score 0). With the analysis of these two indicators over the evaluations of 2nd-year residents, we found a slight decrease in the value of the first indicator and relative stable behavior of the second one. CONCLUSIONS: This tool is useful for objective assessment of reporting skill of radiology residents. It can provide an opportunity for continuing medical education with case-based learning from those cases with clinically significant discrepancies between the preliminary and the final report.

Pneumo-PET-CT: Initial Results of This Novel Technique on the Evaluation of Esophageal and Gastric Tumors with Anatomic-Surgical Correlation.

We present the initial results of a novel hybrid scanning-based technique that combines pneumo-computed tomography (PNCT) with positron emission tomography (PET) using 2-(fluorine-18) fluoro-2-deoxy-D-glucose (FDG). We denominate it pneumo-PET-CT. The focus of our discussion will be on the description of the pneumo-PET-CT technique and the interpretation criteria with emphasis on its benefits and applications in the presurgical and postneoadjuvant therapy evaluation of esophageal, esophagogastric junction (EGJ), and gastric tumors.

Bilateral Anatomic Variation of Anterolateral Thigh Flap in the Same Individual.

BACKGROUND: Anterolateral thigh flap has gained popularity for its use as a soft-tissue flap for reconstruction of regional and distal defects. There is discrepancy between the predominant skin vessels-musculocutaneous or septocutaneous. The purpose of this study was to demonstrate anatomic variation of bilateral anterolateral thigh flap vasculature in the same individual. METHODS: We performed an observational retrospective case series study in 11 patients and an observational prospective study in 7 cadavers to confirm our findings. RESULTS: We found bilateral anatomic variation in the main cutaneous branch of the descendent branch of the lateral circumflex femoral artery between both thighs in the same individual. In 72.2% of cases, we observed that the main cutaneous branch was septocutaneous in 1 thigh and musculocutaneous in the contralateral thigh; in 16.7%, the main cutaneous branches were musculocutaneous in both thighs, and in 11.1%, the main cutaneous branches were septocutaneous in both thighs. CONCLUSIONS: Significant anatomic variation exists between the right and the left cutaneous branches of deep circumflex femoral arteries. Hence, preoperative imaging by computed tomography angiography (CTA) aids in determination of the vascular anatomy of the descending branch of the lateral circumflex femoral artery and in selection of septocutaneous branches, thereby reducing operative time.

Early experience with the AMPLATZER vascular plug IV for the occlusion of pulmonary arteriovenous malformations.

The recent generation of AMPLATZER Vascular Plug (AVP; ie, the AVP IV) was used for the occlusion of eight pulmonary arteriovenous malformations (PAVMs) in five patients. A treatment was considered successful when there was a reduction or disappearance of the aneurysmal sac. At a mean follow-up of 20.1 months, no recanalization of PAVMs was observed on multidetector computed tomographic angiography. This shows the AVP IV to be safe and effective as an embolic device to occlude PAVMs.

Pneumo-CT assessing response to neoadjuvant therapy in esophageal cancer: Imaging-pathological correlation.

Pneumo-computed tomography (PnCT) is a technique primarily developed and used to study stenotic lesions of the esophagus, gastroesophageal junction and stomach for pre-surgical planning. It helps to define both upper and lower borders of neoplasms located in the aforementioned areas. It achieves maximum lumen distension with CO2 highlighting thickened areas of the esophageal wall, thus allowing an accurate quantification of their extents. Although there are other alternatives for distension (oral contrast agents, water and effervescent granules), they may be suboptimal. Patients with locally advanced esophageal cancer have a dismal prognosis despite surgical resection. Therefore, neoadjuvant treatment strategies using radiation therapy and chemotherapy were developed to improve survival. Neoadjuvant therapy improves esophageal tumor prognosis in a substantial proportion of patients, and the use of imaging techniques is mandatory to detect their response. PnCT combined with virtual endoscopy and multiplanar reconstruction enhances morphologic details in esophageal cancer, and thus would allow an improved assessment of response to neoadjuvant treatment. Therefore, more information could be provided to assess the efficacy of pre-surgical treatment. We describe the potential use of PnCT to assess the response to neoadjuvant therapy in esophageal cancer with an imaging pathologic correlation.

Nódulos pulmonares subsólidos en tomografía computada multicorte. Características y diagnósticos diferenciales con el adenocarcinoma de pulmón / Subsolid pulmonary nodules at multislice computed tomography. Characteristics and differential diagnosis with lung adenocarcinoma

En el último tiempo se ha incrementado la detección de nódulos pulmonares, debido al uso de la tomografía computada multicorte (TCMC) y a la implementación de métodos de cribado de cáncer de pulmón mediante el uso de la tomografía computada (TC) de baja dosis. Esto ha despertado especial interés en los nódulos de tipo subsólido por su probabilidad de tener una etiología maligna, en particular el adenocarcinoma (ADC). Con el análisis minucioso de las imágenes adquiridas en la tomografía computada multicorte se pueden identificar las características morfológicas de cada nódulo y realizar una correlación en forma aproximada con su probable anatomía patológica. La evaluación, junto con el contexto clínico-epidemiológico del paciente, hace posible un diagnóstico presuntivo y un pronóstico aproximado, permitiendo determinar las conductas terapéuticas o los planes de seguimiento...

Nódulos pulmonares subsólidos en tomografía computada multicorte. Características y diagnósticos diferenciales con el adenocarcinoma de pulmón / Subsolid pulmonary nodules at multislice computed tomography. Characteristics and differential diagnosis with lung adenocarcinoma

En el último tiempo se ha incrementado la detección de nódulos pulmonares, debido al uso de la tomografía computada multicorte (TCMC) y a la implementación de métodos de cribado de cáncer de pulmón mediante el uso de la tomografía computada (TC) de baja dosis. Esto ha despertado especial interés en los nódulos de tipo subsólido por su probabilidad de tener una etiología maligna, en particular el adenocarcinoma (ADC). Con el análisis minucioso de las imágenes adquiridas en la tomografía computada multicorte se pueden identificar las características morfológicas de cada nódulo y realizar una correlación en forma aproximada con su probable anatomía patológica. La evaluación, junto con el contexto clínico-epidemiológico del paciente, hace posible un diagnóstico presuntivo y un pronóstico aproximado, permitiendo determinar las conductas terapéuticas o los planes de seguimiento...(AU)

MDCT findings after hepatic chemoembolization with DC-beads: what the radiologist needs to know.

Transcatheter arterial chemoembolization with drug-eluting beads (TACE-DC-beads) is a new local treatment for primary or metastatic liver tumors. Despite technical efforts to achieve highly selective embolization of the tumor-supplying vessels, small, or large insults to the non-tumorous parenchyma are inevitably induced by the embolic materials or procedure itself. Parenchymal changes following TACE-DC-beads include bile duct injuries (bile duct dilatation, periportal edema, and bilomas), obliteration of intrahepatic portal vein branches, hypodense ill-defined areas, and perilesional parenchymal enhancement. The radiologist must be familiar with the changes induced by this treatment in order to distinguish therapeutic effect and collateral findings from complications and residual or recurrent tumor.

New surgical strategy to induce liver hypertrophy: role of MDCT-volumetry to monitor and predict liver growth.

BACKGROUND/AIMS: To describe the role of MDCT-volumetry to monitor and predict liver hypertrophy in a recently introduced surgical technique in patients needing hepatectomy. METHODOLOGY: This prospective study was approved by the local research and ethics committee and patient informed consent was obtained. Twelve consecutive patients were selected for associating liver partition and portal vein ligation for staged-hepatectomy procedure. The mean absolute the future-liver-remnant (FLR) and FLR/total liver volume (TLV) ratio was calculated before and after surgery to determine the degree of hypertrophy. Six days after surgery a new CT-examination was performed to determine the FLR-volume and FLR/TLV. If the enlargement of the FLR was the expected a second-step surgery was performed. Continuous variables are expressed as mean (range). A p<0.05 was considered significant. RESULTS: The mean pre-operative FLR-volume was 402 mL and the FLR/TLV was 27%. The mean post-operative FLR-volume 6 days after the first step was 702 mL (range 521-1030 mL) being the mean difference between preoperative and postoperative FLR volume 303 mL (p<0.0001). The mean volume increase was 80% ranged from 21-139%. At day six, FLR/TLV was 46.5% (range 33.5-67.7), morbidity was 41% and mortality 0%. CONCLUSIONS: MDCT-volumetry has a key role in decision-making, monitoring and predicting liver hypertrophy pre- and postoperatively.

Puesta al día: estadificación del carcinoma de células renales / Update on staging of renal cell carcinoma

El cáncer de células renales o adenocarcinoma renal es el tumor renal maligno más frecuente en adultos, con una incidencia mayor entre la cuarta y sexta décadas de la vida. Los hombres se afectan el doble que las mujeres. En Argentina, por año se calcula una incidencia de 6,1 casos por 100.000 habitantes, con una mortalidad anual de 3,4 casos por 100.000 habitantes.Para la estadificación se utiliza el sistema TNM de la American Joint Committee on Cancer (AJCC), actualizado en su séptima edición (2010). Allí se reflejan algunos cambios en el T, con subdivisión de la categoría T2 (T2a > 7 cm y < 10 cm y T2b > 10 cm). Asimismo, se considera T4 a la invasión por contigüidad de la glándula suprarrenal homolateral y T3a al compromiso de la vena renal. También se simplificó el N en N0 y N1...