Intestinal intussusception in adults: Location, causes, symptoms, and therapeutic management.

OBJECTIVE: Intestinal intussusception is difficult to diagnose in adults because the symptoms are nonspecific. However, most have structural causes that require surgical treatment. This paper reviews the epidemiologic characteristics, imaging findings, and therapeutic management of intussusception in adults. MATERIALS AND METHODS: This retrospective study identified patients diagnosed with intestinal intussusception who required admission to our hospital between 2016 and 2020. Of the 73 cases identified, 6 were excluded due to coding errors and 46 were excluded because the patients were aged <16 years. Thus, 21 cases in adults (mean age, 57 years) were analyzed. RESULTS: The most common clinical manifestation was abdominal pain, reported in 8 (38%) cases. In CT studies, the target sign yielded 100% sensitivity. The most common site of intussusception was the ileocecal region, reported in 8 (38%) patients. A structural cause was identified in 18 (85.7%) patients, and 17 (81%) patients required surgery. The pathology findings were concordant with the CT findings in 94.1% of cases; tumours were the most frequent cause (6 (35.3%) benign and 9 (64.7%) malignant). CONCLUSIONS: CT is the first-choice test for the diagnosis of intussusception and plays a crucial role in determining its aetiology and therapeutic management.

Invaginaciones intestinales en el adulto: localización, etiología, sintomatología y manejo terapéutico / Intestinal intussusception in adults: location, causes, symptoms, and therapeutic management

Objetivo: Las invaginaciones intestinales en adultos son de difícil diagnóstico debido a la inespecificidad de los síntomas. Sin embargo, la mayoría tienen una causa estructural que requiere tratamiento quirúrgico. El objetivo de este estudio es revisar sus características epidemiológicas, hallazgos en imagen y manejo terapéutico. Materiales y métodos: Estudio retrospectivo de las invaginaciones intestinales que precisaron ingreso hospitalario diagnosticadas en nuestro hospital entre 2016 y 2020. De un total de 73 casos fueron excluidos errores de codificación (n=6) y pacientes menores de 16 años (n=46), resultando 21 invaginaciones en adultos. Resultados: La edad media fue de 57 años, y el dolor abdominal fue la manifestación clínica más frecuente en el 38% de los casos (n=8). El diagnóstico mediante tomografía computarizada (TC), con la presencia “del signo de la diana”, alcanzó una sensibilidad del 100%, siendo la región ileocecal la localización más frecuente en un 38% de los pacientes (n=8). Un 85,7% de los casos (n=18) tenían una causa estructural y el 81% (n=17) requirió cirugía. Los resultados anatomopatológicos fueron concordantes con la TC en un 94,1%, siendo la etiología más frecuente la neoplásica: 35,3% benignas (n=6) y 64,7% malignas (n=9). Conclusiones: La TC es la prueba de elección en el diagnóstico de las invaginaciones intestinales y resulta determinante a la hora de identificar la etiología y decidir el manejo terapéutico.(AU)

Objective: Intestinal intussusception is difficult to diagnose in adults because the symptoms are nonspecific. However, most have structural causes that require surgical treatment. This paper reviews the epidemiologic characteristics, imaging findings, and therapeutic management of intussusception in adults. Materials and methods: This retrospective study identified patients diagnosed with intestinal intussusception who required admission to our hospital between 2016 and 2020. Of the 73 cases identified, 6 were excluded due to coding errors and 46 were excluded because the patients were aged<16 years. Thus, 21 cases in adults (mean age, 57 y) were analyzed. Results: The most common clinical manifestation was abdominal pain, reported in 8 (38%) cases. In CT studies, the target sign yielded 100% sensitivity. The most common site of intussusception was the ileocecal region, reported in 8 (38%) patients. A structural cause was identified in 18 (85.7%) patients, and 17 (81%) patients required surgery. The pathology findings were concordant with the CT findings in 94.1% of cases; tumors were the most frequent cause (6 (35.3%) benign and 9 (64.7%) malignant). Conclusions: CT is the first-choice test for the diagnosis of intussusception and plays a crucial role in determining its etiology and therapeutic management.(AU)

Intestinal intussusception in adults: location, causes, symptoms, and therapeutic management. / Invaginaciones intestinales en el adulto: localización, etiología, sintomatología y manejo terapéutico.

OBJECTIVE: Intestinal intussusception is difficult to diagnose in adults because the symptoms are nonspecific. However, most have structural causes that require surgical treatment. This paper reviews the epidemiologic characteristics, imaging findings, and therapeutic management of intussusception in adults. MATERIALS AND METHODS: This retrospective study identified patients diagnosed with intestinal intussusception who required admission to our hospital between 2016 and 2020. Of the 73 cases identified, 6 were excluded due to coding errors and 46 were excluded because the patients were aged<16 years. Thus, 21 cases in adults (mean age, 57 y) were analyzed. RESULTS: The most common clinical manifestation was abdominal pain, reported in 8 (38%) cases. In CT studies, the target sign yielded 100% sensitivity. The most common site of intussusception was the ileocecal region, reported in 8 (38%) patients. A structural cause was identified in 18 (85.7%) patients, and 17 (81%) patients required surgery. The pathology findings were concordant with the CT findings in 94.1% of cases; tumors were the most frequent cause (6 (35.3%) benign and 9 (64.7%) malignant). CONCLUSIONS: CT is the first-choice test for the diagnosis of intussusception and plays a crucial role in determining its etiology and therapeutic management.

CT findings of pulmonary cysts.

Pulmonary cysts are thin-walled radiolucent lesions that may appear in a variety of uncommon disorders known as diffuse cystic lung diseases (DCLD) that essentially includes lymphangioleiomyomatosis (LAM), Langerhans cell histiocytosis (LCH), lymphocytic interstitial pneumonia (LIP), Pneumocystis jiroveci pneumonia (PJP), and Birt-Hogg-Dubé syndrome (BHDS). Moreover, they have been reported in several cases of coronavirus disease 2019 (COVID-19). The purpose of this review is to provide a practical approach for evaluating lung cysts when encountered on CT. We describe the imaging findings of DLCD emphasising their differences in terms of shape and distribution of the cysts, as well as their association with other findings such as nodules or ground-glass opacities, which may help in making a confident diagnosis. We also discuss the link between pulmonary cysts and COVID-19.

A multidisciplinary consensus on the morphological and functional responses to immunotherapy treatment

The implementation of immunotherapy has radically changed the treatment of oncological patients. Currently, immunotherapy is indicated in the treatment of patients with head and neck tumors, melanoma, lung cancer, bladder tumors, colon cancer, cervical cancer, breast cancer, Merkel cell carcinoma, liver cancer, leukemia and lymphomas. However, its efficacy is restricted to a limited number of cases. The challenge is, therefore, to identify which subset of patients would benefit from immunotherapy. To this end, the establishment of immunotherapy response criteria and predictive and prognostic biomarkers is of paramount interest. In this report, a group of experts of the Spanish Society of Medical Oncology (SEOM), the Spanish Society of Medical Radiology (SERAM), and Spanish Society of Nuclear Medicine and Molecular Imaging (SEMNIM) provide an up-to-date review and a consensus guide on these issues (AU)

Imaging acute pancreatitis. / Pancreatitis aguda en imágenes.

OBJECTIVES: Acute pancreatitis is common; the clinical course of this potentially severe condition varies widely. This paper aims to review the role of different imaging techniques in the management of acute pancreatitis, describe the main imaging findings for this entity, and explain the terms and criteria used to classify them. CONCLUSIONS: Imaging techniques play a key role in the management of acute pancreatitis, from diagnosis and staging to identifying and treating complications, as well as in determining the underlying causes of the condition. For these reasons, radiologists should know the advantages and limitations of each imaging technique in the evaluation of acute pancreatitis, be familiar with the wide spectrum of imaging findings associated with it, and how to use the specific terminology derived from the Atlanta classification to ensure the standardization and quality of reports.

A multidisciplinary consensus on the morphological and functional responses to immunotherapy treatment.

The implementation of immunotherapy has radically changed the treatment of oncological patients. Currently, immunotherapy is indicated in the treatment of patients with head and neck tumors, melanoma, lung cancer, bladder tumors, colon cancer, cervical cancer, breast cancer, Merkel cell carcinoma, liver cancer, leukemia and lymphomas. However, its efficacy is restricted to a limited number of cases. The challenge is, therefore, to identify which subset of patients would benefit from immunotherapy. To this end, the establishment of immunotherapy response criteria and predictive and prognostic biomarkers is of paramount interest. In this report, a group of experts of the Spanish Society of Medical Oncology (SEOM), the Spanish Society of Medical Radiology (SERAM), and Spanish Society of Nuclear Medicine and Molecular Imaging (SEMNIM) provide an up-to-date review and a consensus guide on these issues.

La radiología en tiempos de distopías y cisnes negros: reflexiones desde el confinamiento COVID-19 / Radiology in times of dystopia and black swans: reflections during the COVID-19 lockdown

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Consensus document on the progression and treatment response criteria in gastroenteropancreatic neuroendocrine tumors

Purpose: Gastroenteropancreatic neuroendocrine tumors are a heterogeneous group of low incidence neoplasms characterized by a low proliferative activity and slow growth. Their response to targeted therapies is heterogeneous and often does not lead to tumor shrinkage. Thus, evaluation of the therapeutic response should differ from other kind of tumors. Methods: To answer relevant questions about which techniques are best in the assessment of progression or treatment response a RAND/UCLA-based consensus process was implemented. Relevant clinical questions were listed followed by a systematic search of the literature. The expert panel answered all questions with recommendations, combining available evidence and expert opinion. Recommendations were validated through a questionnaire and a participatory meeting. Results: Expert recommendations regarding imaging tools for tumor assessment and evaluation of progression were agreed upon. Available imaging techniques were reviewed and recommendations for best patient monitoring practice and the best way to evaluate treatment response were formulated

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Imagen funcional de la patología pancreática / Functional imaging in pancreatic disease

El constante avance tecnológico de las técnicas de imagen basadas fundamentalmente en la tomografía computarizada y la resonancia magnética ha permitido, además de la clásica valoración morfológica de la patología pancreática, su evaluación cuantitativa funcional y molecular. Esta información basada en la imagen conlleva en muchos casos un sustancial cambio en el manejo de los pacientes y podría ser una herramienta fundamental en el desarrollo de biomarcadores. El objetivo de este artículo es revisar el papel de las técnicas emergentes funcionales y moleculares basadas en la tomografía computarizada y la resonancia magnética, para la valoración de la patología pancreática

In addition to the classical morphological evaluation of pancreatic disease, the constant technological advances in imaging techniques based fundamentally on computed tomography and magnetic resonance imaging have enabled the quantitative functional and molecular evaluation of this organ. In many cases, this imaging-based information results in substantial changes to patient management and can be a fundamental tool for the development of biomarkers. The aim of this article is to review the role of emerging functional and molecular techniques based on computed tomography and magnetic resonance imaging in the evaluation of pancreatic disease

Valoración mediante Dixon modificado de las lesiones suprarrenales incidentales en RM 3T / Using the modified Dixon technique to evaluate incidental adrenal lesions on 3T MRI

Objetivo: Cuantificar mediante secuencia mDIXON-Quant la fracción grasa (FG) de las lesiones suprarrenales encontradas incidentalmente en estudios de TC. Analizar la relación de la caída de señal entre las secuencias potenciadas en T1 en fase y fase opuesta con la FG en mDIXON-Quant. Comparar la sensibilidad y especificidad de ambos métodos para caracterizar las lesiones suprarrenales. Material y métodos: Se realizó un estudio prospectivo descriptivo que incluyó a 31 pacientes con lesiones suprarrenales incidentales evaluados mediante RM 3T con las secuencias T1 en fase y fase opuesta y mDIXON-Quant. Se midió la FG de las lesiones suprarrenales mediante mDIXON-Quant y la intensidad de señal en secuencias T1 en fase y fase opuesta, calculando su porcentaje de pérdida de señal (PPS). Resultados: El PPS medio fue significativamente mayor en el grupo adenoma (61,3% ± 20,4%) que en el no adenoma (5,1% ± 5,8%) (p < 0,005). La FG media de los adenomas también fue significativamente mayor (26,9% ± 10,8% vs. 3,4% ± 3,0%) (p < 0,005). El área bajo la curva ROC fue 0,99 (0,96-1,00) para el PPS y 0,98 (0,94-1,00) para la FG. El punto de corte obtenido fue de 24,42% para el PPS y de 9,2% para la FG. Los valores diagnósticos fueron iguales para los dos métodos: sensibilidad del 96% (79,6-99,9), especificidad del 100% (39,8-100,0), valor predictivo positivo del 100% (85,8-100,0) y valor predictivo negativo del 80% (28,4-99,5). Conclusión: La FG obtenida mediante técnica Dixon modificada es capaz de diferenciar adenomas de no adenomas con la misma sensibilidad y especificidad que la PPS

Objectives: To use the mDIXON-Quant sequence to quantify the fat fraction of adrenal lesions discovered incidentally on CT studies. To analyze the relation between the signal loss between in-phase and out-of-phase T1-weighted sequences and the fat fraction in mDIXON-Quant. To compare the sensitivity and specificity of the two methods for characterizing adrenal lesions. Material and methods: This prospective descriptive study included 31 patients with incidentally discovered adrenal lesions evaluated with 3T MRI using in-phase and out-of-phase T1-weighted sequences and mDIXON-Quant; the fat fraction of the adrenal lesions was measured by mDIXON-Quant and by calculating the percentage of signal loss between in-phase and out-of-phase T1-weighted sequences. Results: The percentage of signal loss was significantly higher in the group of patients with adenoma (61.3% ± 20.4% vs. 5.1% ± 5.8% in the group without adenoma, p<0.005). The mean fat fraction measured by mDIXON-Quant was also higher for the adenomas (26.9% ±10.8% vs. 3.4% ± 3.0%, p<0.005).The area under the ROC curve was 0.99 (0.96 - 1.00) for the percentage of signal loss and 0.98 (0.94 - 1.00) for the fat fraction measured by mDIXON-Quant. The cutoffs obtained were 24.42% for the percentage of signal loss and 9.2% for the fat fraction measured by mDIXON-Quant. The two techniques had the same values for diagnostic accuracy: sensitivity 96% (79.6 - 99.9), specificity 100% (39.8 - 100.0), positive predictive value 100% (85.8 - 100.0), and negative predictive value 80% (28.4 - 99.5). Conclusion: The fat fraction measured by the modified Dixon technique can differentiate between adenomas and other adrenal lesions with the same sensitivity and specificity as the percentage of signal loss between in-phase and out-of-phase T1-weighted sequences

Functional imaging in pancreatic disease. / Imagen funcional de la patología pancreática.

In addition to the classical morphological evaluation of pancreatic disease, the constant technological advances in imaging techniques based fundamentally on computed tomography and magnetic resonance imaging have enabled the quantitative functional and molecular evaluation of this organ. In many cases, this imaging-based information results in substantial changes to patient management and can be a fundamental tool for the development of biomarkers. The aim of this article is to review the role of emerging functional and molecular techniques based on computed tomography and magnetic resonance imaging in the evaluation of pancreatic disease.

Using the modified Dixon technique to evaluate incidental adrenal lesions on 3T MRI. / Valoración mediante Dixon modificado de las lesiones suprarrenales incidentales en RM 3T.

OBJECTIVES: To use the mDIXON-Quant sequence to quantify the fat fraction of adrenal lesions discovered incidentally on CT studies. To analyze the relation between the signal loss between in-phase and out-of-phase T1-weighted sequences and the fat fraction in mDIXON-Quant. To compare the sensitivity and specificity of the two methods for characterizing adrenal lesions. MATERIAL AND METHODS: This prospective descriptive study included 31 patients with incidentally discovered adrenal lesions evaluated with 3T MRI using in-phase and out-of-phase T1-weighted sequences and mDIXON-Quant; the fat fraction of the adrenal lesions was measured by mDIXON-Quant and by calculating the percentage of signal loss between in-phase and out-of-phase T1-weighted sequences. RESULTS: The percentage of signal loss was significantly higher in the group of patients with adenoma (61.3% ± 20.4% vs. 5.1% ± 5.8% in the group without adenoma, p<0.005). The mean fat fraction measured by mDIXON-Quant was also higher for the adenomas (26.9% ±10.8% vs. 3.4% ± 3.0%, p<0.005).The area under the ROC curve was 0.99 (0.96 - 1.00) for the percentage of signal loss and 0.98 (0.94 - 1.00) for the fat fraction measured by mDIXON-Quant. The cutoffs obtained were 24.42% for the percentage of signal loss and 9.2% for the fat fraction measured by mDIXON-Quant. The two techniques had the same values for diagnostic accuracy: sensitivity 96% (79.6 - 99.9), specificity 100% (39.8 - 100.0), positive predictive value 100% (85.8 - 100.0), and negative predictive value 80% (28.4 - 99.5). CONCLUSION: The fat fraction measured by the modified Dixon technique can differentiate between adenomas and other adrenal lesions with the same sensitivity and specificity as the percentage of signal loss between in-phase and out-of-phase T1-weighted sequences.

Guía SEOM-SERAM-SEMNIM sobre el empleo de las técnicas de imagen funcional y molecular en el cáncer de pulmón no microcítico avanzado / SEOM-SERAM-SEMNIM guidelines on the use of functional and molecular imaging techniques in advanced non-small-cell lung cancer

En oncología, las técnicas de imagen son una herramienta esencial para el manejo de los pacientes, pero su potencial está enormemente infrautilizado. Cada una de las modalidades que se utilizan en el proceso diagnóstico ofrece, también, información funcional que puede ser relevante para el proceso de toma de decisiones en torno al tratamiento. Nuevos algoritmos y técnicas de imagen acentúan lo que ya sabemos del fenotipo del tumor y de su posible respuesta a diferentes tratamientos. Las modalidades de imagen funcional se definen como aquellas que ofrecen información más allá de los meros datos morfológicos e incluyen todas las técnicas que hacen posible medir funciones fisiológicas específicas del tumor, mientras que las modalidades de imagen molecular se refieren a técnicas que nos permiten medir cambios a nivel metabólico. Las técnicas funcionales y moleculares incluidas en el presente documento se basan en la tomografía computarizada (TC) multidetector, la tomografía por emisión de positrones con 18-fluorodesoxiglucosa (18F-FDG PET), la resonancia magnética (RM) y los equipos híbridos que integran la PET y la TC (PET/TC) o la PET y la RM (PET/RM). El cáncer de pulmón es uno de los tumores más comunes y letales que existen, aunque la supervivencia va en aumento gracias a los avances realizados en los métodos diagnósticos y a los nuevos tratamientos. Esta mayor supervivencia plantea retos en torno a un adecuado seguimiento y a las definiciones de respuesta y progresión de la enfermedad, tal y como ejemplifica la seudoprogresión de la enfermedad asociada a las terapias inmunológicas. En este documento de consenso abordamos el uso de las técnicas de imagen funcional y molecular a fin de poder explotar todo su potencial en la actualidad, y explorar futuras aplicaciones en el diagnóstico, evaluación de la respuesta al tratamiento y detección de la recurrencia del cáncer de pulmón no microcítico en fase avanzada

Imaging in oncology is an essential tool for patient management but its potential is being profoundly underutilized. Each of the techniques used in the diagnostic process also conveys functional information that can be relevant in treatment decision making. New imaging algorithms and techniques enhance our knowledge about the phenotype of the tumor and its potential response to different therapies. Functional imaging can be defined as the one that provides information beyond the purely morphological data, and include all the techniques that make it possible to measure specific physiological functions of the tumor, whereas molecular imaging would include techniques that allow us to measure metabolic changes. Functional and molecular techniques included in this document are based on multi-detector computed tomography (CT), 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET), magnetic resonance imaging (MRI), and hybrid equipments, integrating PET with CT (PET/CT) or MRI (PET-MRI). Lung cancer is one of the most frequent and deadly tumors although survival is increasing thanks to advances in diagnostic methods and new treatments. This increased survival poises challenges in terms of proper follow-up and definitions of response and progression, as exemplified by immune therapy-related pseudoprogression. In this consensus document, the use of functional and molecular imaging techniques will be addressed to exploit their current potential and explore future applications in the diagnosis, evaluation of response and detection of recurrence of advanced NSCLC