SARS-CoV-2: what it is, how it acts, and how it manifests in imaging studies. / SARS-CoV-2: cómo es, cómo actúa y cómo se expresa en la imagen.

COVID-19 is a disease with many clinical, biochemical, and radiological signs that has a predilection for the lungs, probably because of the high number of ACE-2 receptors in this organ. The infection of cells activates proinflammatory substances, causing diffuse alveolar damage, which is the histopathological basis of ARDS. The exudative phase would manifest as ground-glass opacities and consolidation, and the proliferative phase would manifest as a tendency toward a more linear morphology. Both CT and PET/CT findings support the inflammatory character of the lung lesions in the initial phase of the disease and in patients with mild-moderate disease. Severe cases have pulmonary hypoperfusion that is likely due to abnormal alveolar ventilation and perfusion. On the other hand, a prothrombotic state increases the risk of thromboembolic disease through the activation of coagulation and platelet pathways with the production of fibrin degradation products (D-dimer) and consumption of platelets.

SARS-CoV-2: cómo es, cómo actúa y cómo se expresa en la imagen / SARS-CoV-2: what it is, how it acts, and how it manifests in imaging studies

La COVID-19 es una enfermedad con una gran semiología clínica, bioquímica y radiológica, que tiene una afectación preferente por el pulmón, probablemente debido a un mayor número de receptores ECA-2. La infección celular activa sustancias proinflamatorias y provoca un daño alveolar difuso, que es la base histopatológica del distrés respiratorio del adulto. La fase exudativa explicaría las imágenes "en vidrio deslustrado" y consolidación, mientras que la tendencia hacia una morfología más lineal representa la fase proliferativa. Tanto la tomografía computarizada (TC) como la tomografía por emisión de positrones/ tomografía computarizada (PET/TC) apoyan el carácter inflamatorio de las lesiones pulmonares cuando la enfermedad está en fase inicial o es leve-moderada. Los casos graves muestran una hipoperfusión pulmonar que se explicaría por una alteración de la ventilación-perfusión alveolar (V/Q). Por otro lado, un estado protrombótico conlleva mayor probabilidad de enfermedad tromboembólica por la activación de la vía de la coagulación y plaquetaria, con la producción de sustancia de degradación de la fibrina (dímero D) así como el consumo de plaquetas

COVID-19 is a disease with many clinical, biochemical, and radiological signs that has a predilection for the lungs, probably because of the high number of ACE-2 receptors in this organ. The infection of cells activates proinflammatory substances, causing diffuse alveolar damage, which is the histopathological basis of ARDS. The exudative phase would manifest as ground-glass opacities and consolidation, and the proliferative phase would manifest as a tendency toward a more linear morphology. Both CT and PET/CT findings support the inflammatory character of the lung lesions in the initial phase of the disease and in patients with mild-moderate disease. Severe cases have pulmonary hypoperfusion that is likely due to abnormal alveolar ventilation and perfusion. On the other hand, a prothrombotic state increases the risk of thromboembolic disease through the activation of coagulation and platelet pathways with the production of fibrin degradation products (D-dimer) and consumption of platelets

Función sistólica del ventrículo izquierdo: cómo comprenderla y analizarla / Left ventricular systolic function: How to understand it and analyze it

En los estudios de resonancia magnética cardíaca, la función sistólica del ventrículo izquierdo suele calcularse automáticamente. Entender cómo se obtiene cada parámetro de la función y el por qué de las diferencias que pueden existir entre los valores obtenidos con dos técnicas, por ejemplo ecografía y resonancia magnética, es fundamental para comprenderlas e interpretarlas adecuadamente. En este artículo se detalla el análisis habitual de la función sistólica desde un punto de vista cuantitativo y cualitativo, y se explican otros métodos que no requieren un software específico. Hemos diseñado (y lo aportamos para que pueda usarse libremente) un fichero que, empleando el programa Microsoft Excel®, permite analizar la función sistólica sencilla e intuitivamente (AU)

In cardiac magnetic resonance imaging studies, left ventricular systolic function is usually calculated automatically. To understand and interpret parameters of left ventricular systolic function correctly, it is fundamental to understand how each parameter is obtained and why values obtained with different techniques, for example, ultrasonography and magnetic resonance imaging, can differ. This article provides details about the usual analysis of systolic function from the quantitative and qualitative points of view; it also explains other methods that do not require specific software. Moreover, we provide a file that we designed for use with Microsoft Excel® to enable simple, intuitive analysis of systolic function. Readers can use this file freely (AU)

[Left ventricular systolic function: how to understand it and analyze it]. / Función sistólica del ventrículo izquierdo: cómo comprenderla y analizarla.

In cardiac magnetic resonance imaging studies, left ventricular systolic function is usually calculated automatically. To understand and interpret parameters of left ventricular systolic function correctly, it is fundamental to understand how each parameter is obtained and why values obtained with different techniques, for example, ultrasonography and magnetic resonance imaging, can differ. This article provides details about the usual analysis of systolic function from the quantitative and qualitative points of view; it also explains other methods that do not require specific software. Moreover, we provide a file that we designed for use with Microsoft Excel(®) to enable simple, intuitive analysis of systolic function. Readers can use this file freely.

[Painful incomplete third-nerve palsy caused by an internal carotid-communicating posterior artery aneurysm]. / Parálisis dolorosa incompleta del III nervio causada por un aneurisma de la carótida interna-comunicante posterior.

CLINICAL CASE: A 38-year-old woman presented acute-onset, painful incomplete third-nerve palsy caused by an internal carotid-posterior communicating artery (IC-PC) aneurysm. We describe the differential diagnosis with Tolosa-Hunt syndrome and the results after endovascular treatment. DISCUSSION: The presence of pupil-sparing third-nerve palsy may not exclude the presence of an IC-PC aneurysm and orbital magnetic resonance imaging and/or computed tomography imaging must be performed in these cases. The prompt recovery after endovascular treatment is consistent with previous reports.

Parálisis dolorosa incompleta del III nervio causada por un aneurisma de la carótida interna-comunicante posterior / Painful incomplete third-nerve palsy caused by an internal carotid-communicating posterior artery aneurysm

Caso clínico: Mujer de 38 años que presentó de forma aguda una parálisis incompleta y dolorosa del III par causada por un aneurisma de la carótida interna-comunicante posterior (CI-CP). Describimos el diagnóstico diferencial con el Síndrome Tolosa-Hunt y los resultados tras tratamiento endovascular. Discusión: La presencia de una parálisis del III par sin afectación pupilar no excluye la presencia de un aneurisma de la CI-CP. La realización de una resonancia nuclear magnética orbitaria y/o angio-tomografía axial computerizada es obligada en estos casos. La rápida recuperación tras tratamiento endovascular es consistente con otros trabajos previos

Clinical case: A 38-year-old woman presented acute-onset, painful incomplete third-nerve palsy caused by an internal carotid-posterior communicating artery (IC-PC) aneurysm. We describe the differential diagnosis with Tolosa-Hunt syndrome and the results after endovascular treatment. Discussion: The presence of pupil-sparing third-nerve palsy may not exclude the presence of an IC-PC aneurysm and orbital magnetic resonance imaging and/or computed tomography imaging must be performed in these cases. The prompt recovery after endovascular treatment is consistent with previous reports (Arch Soc Esp Oftalmol 2009; 84: 43-46)

[MR-arthrography of the shoulder. Description and evaluation of the technique using a US-guided pediatric spinal needle]. / RM-artrografía de hombro. Descripción y valoración de la técnica guiada con ecografía y utilizando una aguja espinal infantil.

OBJECTIVE: To describe the technique of US-guided shoulder arthrography using a pediatric needle (modified Valls- Melloni technique) and to assess its efficacy. MATERIAL AND METHODS: Descriptive study of articular puncture for 48 magnetic resonance imaging arthrographs of the shoulder in 48 consecutive patients. The puncture was performed by a radiologist without prior experience in the technique. We used an anterior approach to the shoulder, guiding the puncture using US according to the Valls-Melloni technique; however, we used a pediatric spinal needle (Yale spinal; 22G: 0.7 x 40 mm). The efficacy of the technique was evaluated using the following variables: time employed, number of attempts, extravasation of contrast outside the joint, pain reported by the patient (on a scale from 0 to 10), and immediate or late complications of the technique. RESULTS: The time required for the procedure was 15.2+/-2.6 min (mean+/-standard deviation). A single puncture sufficed in 45 patients (94%); two attempts were necessary in two patients (4%) and three in one patient (2%). Contrast extravasation outside the joint occurred only in two patients (4%). The mean pain reported was 3.6 points (confidence interval: 3.1-4). Three patients (6%) had a vasovagal reaction. No late complications were observed. CONCLUSION: US-guided shoulder arthrography using a pediatric spinal needle is fast, simple, and safe; it can be performed by any radiologist, even without prior experience in the technique.

RM-artrografía de hombro. Descripción y valoración de la técnica guiada con ecografía y utilizando una aguja espinal infantil / MR-arthrography of the shoulder. Description and evaluation of the technique using a US-guided pediatric

Objetivo. Describir la técnica de artrografía de hombro guiada con ecografía utilizando una aguja espinal infantil (técnica modificada de Valls y Melloni) y verificar su eficacia. Material y métodos. Estudio descriptivo de la técnica de punción articular en 48 artrografías de hombro mediante resonancia magnética, realizadas en 48 pacientes consecutivos. La punción la realizó un radiólogo sin experiencia previa en esta técnica. Se empleó un abordaje anterior del hombro guiando la punción mediante ecografía según la técnica de Valls y Melloni, pero utilizando una aguja espinal infantil (Yale spinal; 22G: 0,7 × 40 mm). La eficacia de la prueba se valoró mediante las variables: tiempo empleado, número de intentos, extravasación del contraste fuera de la articulación, dolor referido por el paciente (escala de 0 a 10) y complicaciones inmediatas o tardías de la técnica. Resultados. El tiempo del procedimiento fue de 15,2 ± 2,6 min (media ± desviación estándar). Se precisó una sola punción en 45 pacientes (94%); dos intentos en dos pacientes (4%) y tres en un paciente (2%). Solamente en dos pacientes existió extravasación del contraste fuera de la articulación (4%). La media del dolor referido fue de 3,6 puntos (intervalo de confianza: 3,1-4). Tres pacientes (6%) sufrieron una reacción vaso-vagal. No hubo complicaciones tardías. Conclusión. La artrografía de hombro guiada por ecografía y usando una aguja espinal infantil es una técnica rápida, sencilla y segura, que puede ser realizada por cualquier radiólogo, incluso sin experiencia previa en la técnica

Objective. To describe the technique of US-guided shoulder arthrography using a pediatric needle (modified Valls- Melloni technique) and to assess its efficacy. Material and methods. Descriptive study of articular puncture for 48 magnetic resonance imaging arthrographs of the shoulder in 48 consecutive patients. The puncture was performed by a radiologist without prior experience in the technique. We used an anterior approach to the shoulder, guiding the puncture using US according to the Valls-Melloni technique; however, we used a pediatric spinal needle (Yale spinal; 22G: 0.7 × 40 mm). The efficacy of the technique was evaluated using the following variables: time employed, number of attempts, extravasation of contrast outside the joint, pain reported by the patient (on a scale from 0 to 10), and immediate or late complications of the technique. Results. The time required for the procedure was 15.2 ± 2.6 min (mean ± standard deviation). A single puncture sufficed in 45 patients (94%); two attempts were necessary in two patients (4%) and three in one patient (2%). Contrast extravasation outside the joint occurred only in two patients (4%). The mean pain reported was 3.6 points (confidence interval: 3.1-4). Three patients (6%) had a vasovagal reaction. No late complications were observed. Conclusion. US-guided shoulder arthrography using a pediatric spinal needle is fast, simple, and safe; it can be performed by any radiologist, even without prior experience in the technique

Complicaciones respiratorias en el trasplante de progenitores hematopoyéticos. ¿Qué aporta la radiología? / Respiratory complications in blood progenitor cell transplantation. What does radiology add?

Fundamento. Determinar la incidencia de complicaciones respiratorias y sus manifestaciones radiológicas convencionales y en la tomografía computarizada de alta resolución (TCAR) en una serie de pacientes con trasplante de progenitores hematopoyéticos (TPH). Se pretende valorar si la imagen radiológica unida al tiempo postrasplante puede ser de utilidad a la hora de establecer el diagnóstico diferencial. Pacientes y métodos. Se realizó un estudio en el cual se incluyeron un total de 108 pacientes consecutivos que habían sido sometidos a un TPH durante un año; de ellos se seleccionaron aquellos que presentaron alguna complicación respiratoria durante el primer año post-TPH que fueron clasificadas en tres grupos distintos, según el tiempo transcurrido desde el trasplante (fases precoz, intermedia y tardía). Se analizaron las radiografías de tórax de cada uno de ellos y en 17 casos se completó el estudio con TCAR. Estos hallazgos se han correlacionado con el diagnóstico definitivo y con el tiempo transcurrido desde el TPH. La confirmación diagnóstica se obtuvo, según el caso, mediante: hemocultivo, cultivos de esputo, fibrobroncoscopia con lavados broncoalveolares o biopsia pulmonar, biopsia por otros métodos, autopsia o evolución clínica tras el tratamiento empírico. Resultados. De los 108 pacientes sometidos a un TPH, 33 presentaron alguna complicación respiratoria en el primer año. El patrón radiológico más frecuente tanto en la radiografía de tórax como en la TCAR fue la consolidación alveolar. Otros hallazgos fueron el patrón en vidrio deslustrado, el patrón intersticial, los nódulos pulmonares y el derrame pleural. El diagnóstico en relación con las distintas fases del trasplante fue: en la fase precoz aparecieron tres casos de insuficiencia cardíaca, dos de hemorragia alveolar, dos de aspergilosis pulmonar, tres de neumonías de etiología no filiada y tres complicaciones sin documentar. En la fase intermedia post-TPH se encontraron: cuatro neumonías por citomegalovirus, un caso de aspergilosis pulmonar, dos neumonías bacterianas y dos neumonitis no documentadas. En la fase tardía se diagnosticaron: cuatro neumonías documentadas bacteriológicamente, dos neumonitis sin identificación del germen, dos casos de enfermedad injerto contra huésped, un caso de aspergilosis pulmonar y dos complicaciones sin diagnóstico final. Conclusiones. La relación de los hallazgos radiológicos y del tiempo transcurrido desde el trasplante de progenitores hematopoyéticos es de gran ayuda para establecer el diagnóstico en las complicaciones pulmonares. La TCAR es útil para detectar lesiones no visibles en radiografía convencional y para el diagnóstico de la bronquiolitis obliterante y de algunas lesiones fúngicas. (AU)

[Respiratory complications in hematopoietic stem cell transplantation. What does radiology contribute?]. / Complicaciones respiratorias en el trasplante de progenitores hematopoyéticos. Qué aporta la radiología?

OBJECTIVE: To determine the incidence of respiratory complications and their manifestations in both conventional radiology and high-resolution computerized tomography (HRCT) in a series of patients who had undergone blood progenitor cell transplantation (BPCT). The objective was to evaluate whether the radiological findings associated with post-transplantation time can be useful for establishing the differential diagnosis. PATIENTS AND METHODS: A study was undertaken of a total of 108 consecutive patients who had undergone BPCT and were alive one year after; from these patients a selection was made of those who had some respiratory complications during the first year after transplantation. Complications were classified in three different groups on the basis of time elapsed since transplantation (early, intermediate, and late stages). Chest X-ray films of each patient were examined and in 17 cases the study was completed with HRCT. These findings were correlated with both definitive diagnosis and time elapsed since BPCT. The following procedures were useful for diagnostic confirmation: blood culture, sputum culture, fibrobronchoscopy with bronchoalveolar lavage or lung biopsy, biopsy by other methods, necropsy, or clinical course after empirical therapy. RESULTS: Thirty-three out of the 108 patients undergoing BPCT had some form of respiratory complication during the first year after transplantation. The most common radiological pattern both in the chest X-ray and in HRCT was alveolar consolidation. Other findings included ground-glass appearance, interstitial pattern, pulmonary nodules, and pleural effusion. The diagnoses in relation to the different stages of transplantation were: a) early stage: three cases of heart failure, two cases of alveolar hemorrhage, two cases of pulmonary aspergillosis and three cases of undocumented complications; b) intermediate stage: four cases of cytomegalovirus pneumonia, one case of pulmonary aspergillosis, two cases of bacterial pneumonia, and two cases of undocumented pneumonitis; c) late stage: four cases of bacteriologically documented pneumonia, two cases of pneumonitis with an unidentified agent, two cases of graft-versus-host disease, one case of pulmonary aspergillosis and two complications without established diagnosis. CONCLUSIONS: The relationship between radiological findings and time elapsed since transplantation of blood precursor cells is very useful for establishing the diagnosis of pulmonary complications. High resolution computerized tomography is useful for detecting unnoticed lesions in conventional X-ray, and for diagnosing bronchiolitis obliterans and some fungal lesions.