Multicentric infantile myofibromatosis with extensive involvement limited to bone.

Infantile myofibromatosis (IM) is the most common benign fibrous tumor of infancy, characterized by the development of single or multiple nodules in the skin, soft tissues, bone, and/or viscera. Multicentric forms are less frequent and can affect different tissues simultaneously and their prognosis depends on their extension and visceral involvement. Rarely, these forms are limited to the skeleton, in which case the absence of extraosseous lesions makes it difficult to suspect this entity. We present the case of an infant with multiple radiolucent lesions involving the skull, ribs, spine, and long bones, discovered in a radiological study performed after a minor trauma. A broad differential diagnosis was considered based on the osteolytic and polyostotic nature of the lesions on imaging studies. This report details and illustrates the typical radiological findings in bony involvement of IM, which suggest this disorder over other diagnostic options.

Is There a Relationship between the Elasticity of Brain Tumors, Changes in Diffusion Tensor Imaging, and Histological Findings? A Pilot Study Using Intraoperative Ultrasound Elastography.

Intraoperative ultrasound elastography (IOUS-E) is a novel image modality applied in brain tumor assessment. However, the potential links between elastographic findings and other histological and neuroimaging features are unknown. This study aims to find associations between brain tumor elasticity, diffusion tensor imaging (DTI) metrics, and cell proliferation. A retrospective study was conducted to analyze consecutively admitted patients who underwent craniotomy for supratentorial brain tumors between March 2018 and February 2020. Patients evaluated by IOUS-E and preoperative DTI were included. A semi-quantitative analysis was performed to calculate the mean tissue elasticity (MTE). Diffusion coefficients and the tumor proliferation index by Ki-67 were registered. Relationships between the continuous variables were determined using the Spearman ρ test. A predictive model was developed based on non-linear regression using the MTE as the dependent variable. Forty patients were evaluated. The pathologic diagnoses were as follows: 21 high-grade gliomas (HGG); 9 low-grade gliomas (LGG); and 10 meningiomas. Cases with a proliferation index of less than 10% had significantly higher medians of MTE (110.34 vs. 79.99, p < 0.001) and fractional anisotropy (FA) (0.24 vs. 0.19, p = 0.020). We found a strong positive correlation between MTE and FA (rs (38) = 0.91, p < 0.001). A cubic spline non-linear regression model was obtained to predict tumoral MTE from FA (R2 = 0.78, p < 0.001). According to our results, tumor elasticity is associated with histopathological and DTI-derived metrics. These findings support the usefulness of IOUS-E as a complementary tool in brain tumor surgery.

Comparison of Intraoperative Ultrasound B-Mode and Strain Elastography for the Differentiation of Glioblastomas From Solitary Brain Metastases. An Automated Deep Learning Approach for Image Analysis.

BACKGROUND: The differential diagnosis of glioblastomas (GBM) from solitary brain metastases (SBM) is essential because the surgical strategy varies according to the histopathological diagnosis. Intraoperative ultrasound elastography (IOUS-E) is a relatively novel technique implemented in the surgical management of brain tumors that provides additional information about the elasticity of tissues. This study compares the discriminative capacity of intraoperative ultrasound B-mode and strain elastography to differentiate GBM from SBM. METHODS: We performed a retrospective analysis of patients who underwent craniotomy between March 2018 to June 2020 with glioblastoma (GBM) and solitary brain metastases (SBM) diagnoses. Cases with an intraoperative ultrasound study were included. Images were acquired before dural opening, first in B-mode, and then using the strain elastography module. After image pre-processing, an analysis based on deep learning was conducted using the open-source software Orange. We have trained an existing neural network to classify tumors into GBM and SBM via the transfer learning method using Inception V3. Then, logistic regression (LR) with LASSO (least absolute shrinkage and selection operator) regularization, support vector machine (SVM), random forest (RF), neural network (NN), and k-nearest neighbor (kNN) were used as classification algorithms. After the models' training, ten-fold stratified cross-validation was performed. The models were evaluated using the area under the curve (AUC), classification accuracy, and precision. RESULTS: A total of 36 patients were included in the analysis, 26 GBM and 10 SBM. Models were built using a total of 812 ultrasound images, 435 of B-mode, 265 (60.92%) corresponded to GBM and 170 (39.8%) to metastases. In addition, 377 elastograms, 232 (61.54%) GBM and 145 (38.46%) metastases were analyzed. For B-mode, AUC and accuracy values of the classification algorithms ranged from 0.790 to 0.943 and from 72 to 89%, respectively. For elastography, AUC and accuracy values ranged from 0.847 to 0.985 and from 79% to 95%, respectively. CONCLUSION: Automated processing of ultrasound images through deep learning can generate high-precision classification algorithms that differentiate glioblastomas from metastases using intraoperative ultrasound. The best performance regarding AUC was achieved by the elastography-based model supporting the additional diagnostic value that this technique provides.

Intraoperative Ultrasonographic Elastography: A Semi-Quantitative Analysis of Brain Tumor Elasticity Patterns and Peritumoral Region.

BACKGROUND: Ultrasonographic elastography imaging visualizes the elastic properties of tissues to distinguish pathologic and healthy areas. Real-time elastography measures relative tissue hardness by evaluating changes in local strain in response to external forces. OBJECTIVE: We aimed to determine the elastographic patterns of different brain tumor types and establish differences between their peritumoral regions. METHODS: We prospectively enrolled patients undergoing craniotomy along with intraoperative ultrasonographic elastography for supratentorial brain tumors in March 2018-May 2019. The elastograms were semi-quantitatively analyzed offline based on the mean tissue elasticity of the tumors, peritumoral regions, and healthy parenchyma. RESULTS: We examined 37 lesions in 36 patients. The pathologic diagnoses comprised 11 meningiomas (29.7%), 4 low-grade gliomas (LGGs; 10.8%), 16 high-grade gliomas (HGGs; 43.2%), and 6 metastases (16.2%). The median MTE values observed after manual segmentation of the whole tumor were as follows: meningiomas, 119.9 (36.6); HGGs, 77.9 (18.9); LGGs, 91 (19.5); metastases, 103.9 (35.6); tumor types significantly differed (H = 18.2; P < 0.001). The peritumoral MTE values were as follows: meningiomas, 120.1 (36.3); HGGs, 86.3 (20.9); LGGs, 94.8 (7.38); and metastases, 116.3 (22). The intergroup differences were significant (H = 17.43; P < 0.001). Using receiver operating characteristic curves, we obtained an optimal cutoff point of 92.22 (whole tumors) and 109.6 (peritumoral regions). Values below these cutoff points were correlated with a high probability of being a glioma. CONCLUSIONS: We objectively describe the elastographic patterns of different types of brain tumors (i.e., gliomas, metastases, and meningiomas). We have identified differences in both the tumors and the peritumoral areas of these histologic types.

Retrospective cohort study comparing endoscopic ultrasound-guided and percutaneous drainage of upper abdominal abscesses.

BACKGROUND AND AIM: Endoscopic ultrasonography (EUS)-guided drainage (EUS-D) has become the standard treatment for peripancreatic fluid collections. Its use in other intra-abdominal abscesses has been reported, although there is limited evidence. METHODS: We carried out a single-center retrospective cohort study comparing percutaneous drainage (PCD) and EUS-D of upper abdominal abscesses between January 2012 and June 2017. Pancreatic fluid collections and liver transplant recipients were excluded. Primary endpoints were technical and clinical success rates. RESULTS: We included 18 EUS-D (nine hepatic and nine intraperitoneal abscesses) and 62 PCD. There were no differences regarding age, gender and etiology. Size was larger in the PCD group (80 vs 65.5 mm, P = 0.04) and perivesicular location was more frequent in the PCD group (24.2% vs 11.1%, P = 0.003). In the EUS-D group, metal stents were deployed in 16 (88.9%) subjects (eight lumen-apposing metal stents and eight self-expandable metal stents), coaxial double-pigtail plastic stents in six (33.3%) and lavage/debridement was carried out in five (27.8%). There were no significant differences in technical success (EUS-D: 88.9%, PCD: 96.8%, P = 0.22) or clinical success (EUS-D: 88.9%, PCD: 82.3%, P = 0.50), with no relapses in the EUS-D group and 10 (16.1%) in the PCD group (P = 0.11). There were four (22.2%) adverse events in the EUS-D group, none of them severe, and 13 (21%) in the PCD group (P = 0.91). CONCLUSIONS: EUS-D is an alternative to PCD in the treatment of upper abdominal abscesses, reaching similar success, relapse and adverse events rates.

Ultrasonografía endoscópica versus tomografía computarizada en la estadificación preoperatoria del cáncer gástrico / Endoscopic ultrasound versus multidetector computed tomography in preoperative gastric cancer staging

Introducción: la ultrasonografía endoscópica (USE) es la técnica de elección para la estadificación loco-regional del adenocarcinoma gástrico (ACG). Sin embargo, la introducción de la tomografía computarizada multidetector (TCMD) permite obtener estudios de muy alta calidad diagnóstica. Objetivo: nuestro objetivo fue comparar la rentabilidad diagnóstica de la USE frente a la TCMD en la estadificación loco-regional preoperatoria de los pacientes con ACG. Material y métodos: se realizó un estudio retrospectivo y comparativo entre pacientes intervenidos de ACG con estadificación preoperatoria mediante USE y TCMD de 64 filas, comparando en cada caso los resultados con el informe anatomopatológico final. Resultados: se analizaron 77 pacientes intervenidos de ACG, incluyéndose finalmente 42 que disponían de estadificación completa. Para la estadificación "T", la precisión diagnóstica (PD) global de USE fue superior a la de TCMD (62% vs. 50%). En un subanálisis entre estadios precoces (T1-2) y avanzados (T3-T4), la PD y sensibilidad (S) de la USE resultaron ser superiores a las de la TCMD (83,3% vs. 64,29% y 84,4% vs. 59,5% respectivamente), aunque sin alcanzarse niveles de significación estadística. Respecto al estadio N, la PD y S de la USE resultaron inferiores a las de la TCMD, aunque tampoco se alcanzaron diferencias estadísticamente significativas (57% vs. 64% y 29% vs. 55%). Conclusiones: en nuestra experiencia, la rentabilidad diagnóstica de la ecoendoscopia es similar a la de los nuevos TCMD en la estadificación preoperatoria T y N en pacientes con ACG. Sin embargo, ambas técnicas deberían considerarse complementarias hasta que estudios más extensos y aleatorizados puedan confirmar estos resultados (AU)

Introduction: Endoscopic ultrasonography (EUS) is the gold standard technique in loco-regional staging of gastric adenocarcinoma (GAC). Nevertheless, the introduction of multidetector-row computed tomography (MDCT) allows accurate studies to be performed. Objective: To compare the diagnostic yield of EUS and MDCT in loco-regional preoperative staging of gastric adenocarcinoma. Material and methods: This was a retrospective and comparative study of all surgical patients with GAC and preoperative staging by EUS and 64-row MDCT. The results for each case were compared with the histological data. Results: Seventy seven surgical patients with GAC were identified and forty two had a complete preoperative staging and were finally included in the study. With regard to overall accuracy of T staging, EUS was superior to MDCT (62% vs 50%). In a subanalysis of early stages (T1-T2) and advanced stages (T3-T4), accuracy and sensitivity (S) were higher for EUS than for MDTC (83.3% vs 64.29% and 84.4% vs 59.5% respectively), although this did not reach statistical significance. The overall accuracy and sensitivity of EUS for N staging was lower than that for MDCT, although neither comparison reached statistical significance (57% vs 64% and 29% vs 55%). Conclusion: EUS diagnostic yield is similar to new MDCT with regard to T and N preoperative staging of GAC. Nevertheless, both techniques should be considered as complementary until more extensive and randomized studies can confirm these results (AU)

Endoscopic ultrasound versus multidetector computed tomography in preoperative gastric cancer staging.

INTRODUCTION: Endoscopic ultrasonography (EUS) is the gold standard technique in loco-regional staging of gastric adenocarcinoma (GAC). Nevertheless, the introduction of multidetector-row computed tomography (MDCT) allows accurate studies to be performed. OBJECTIVE: To compare the diagnostic yield of EUS and MDCT in loco-regional preoperative staging of gastric adenocarcinoma. MATERIAL AND METHODS: This was a retrospective and comparative study of all surgical patients with GAC and preoperative staging by EUS and 64-row MDCT. The results for each case were compared with the histological data. RESULTS: Seventy seven surgical patients with GAC were identified and forty two had a complete preoperative staging and were finally included in the study. With regard to overall accuracy of T staging, EUS was superior to MDCT (62% vs 50%). In a subanalysis of early stages (T1-T2) and advanced stages (T3-T4), accuracy and sensitivity (S) were higher for EUS than for MDTC (83.3% vs 64.29% and 84.4% vs 59.5% respectively), although this did not reach statistical significance. The overall accuracy and sensitivity of EUS for N staging was lower than that for MDCT, although neither comparison reached statistical significance (57% vs 64% and 29% vs 55%). CONCLUSION: EUS diagnostic yield is similar to new MDCT with regard to T and N preoperative staging of GAC. Nevertheless, both techniques should be considered as complementary until more extensive and randomized studies can confirm these results.

Hipervitaminosis B12 y cáncer de recto / B12 hypervitaminosis and rectum cancer

Niveles elevados de vitamina B12 pueden ser relacionados con un alto riesgo de desarrollo de cáncer debido a una alteración de la integridad del ADN, como consecuencia del metabolismo anómalo de la cobalamina. Esto es importante para tener en cuenta la vitamina B12 como marcador tumoral inespecífico en el desarrollo de neoplasias sólidas, una vez descartadas otras patologías serias como enfermedades hematológicas, hepáticas y renales. Se presenta el caso de un paciente con hipervitaminosis B12 y cáncer de recto (AU)

High extreme values of B12 vitamin could be linked with high risk cáncer development throughout the DNA integrity distress because a cobalamine disfunctional metabolism. It's vital to understand the role of B12 vitamin as inespecific tumoral marker in the development of solid neoplasm when other many serious diseases as blood, liver and kidney diseases are rejected. We report a patient case about B12 hypervitaminosis and rectum cáncer (AU)

Assessment of left ventricular diastolic function with cardiovascular MRI: what radiologists should know.

Diastolic dysfunction is a common entity and the predominant cause of heart failure in 40%-50% of patients. Diagnosis of diastolic dysfunction is clinically relevant and associated with a poor prognosis. The aim of this essay was to review the pathophysiology and different grades of diastolic dysfunction and to provide an overview on the role of cardiovascular magnetic resonance imaging in the assessment of diastolic function.

Left ventricular apical diseases.

There are many disorders that may involve the left ventricular (LV) apex; however, they are sometimes difficult to differentiate. In this setting cardiac imaging methods can provide the clue to obtaining the diagnosis. The purpose of this review is to illustrate the spectrum of diseases that most frequently affect the apex of the LV including Tako-Tsubo cardiomyopathy, LV aneurysms and pseudoaneurysms, apical diverticula, apical ventricular remodelling, apical hypertrophic cardiomyopathy, LV non-compaction, arrhythmogenic right ventricular dysplasia with LV involvement and LV false tendons, with an emphasis on the diagnostic criteria and imaging features. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s13244-011-0091-6) contains supplementary material, which is available to authorized users.

Takotsubo cardiomyopathy: assessment with cardiac MRI.

OBJECTIVE: The objective of this article is to show how MRI findings can be used to differentiate Takotsubo cardiomyopathy from acute coronary syndrome. CONCLUSION: Takotsubo cardiomyopathy is a disorder that mimics acute coronary syndrome. MRI can show not only edema in the ventricular wall, which is diffuse and without arterial territory distribution, but also motion abnormalities with typical akinesis in the apical and mid planes. Moreover, MRI can detect potential complications such as obstruction of the left ventricular outflow tract or thrombus in the left ventricular cavity.

Tomografía computarizada multidetectora en el estudio cardíaco / Cardiac imaging in multidetector row computed tomography

La aparición de la tomografía computarizada (TC) helicoidal en la década de los años noventa supuso el salto tecnológico para obtener imágenes en distintos planos del espacio. Esto se debió a la adquisición volumétrica, es decir, el tubo de rayos X mantenía la exposición mientras la mesa se movía de forma continua. La posibilidad de aumentar el número de detectores favorecía la rapidez al obtener varias imágenes (4, 16, 40 o 64) en cada giro del tubo. Así se estudia un volumen (tórax o abdomen) con mejor resolución espacial e imágenes muy finas: 0,5 mm. La resolución temporal, que es el tiempo para obtener una imagen, mejoró significativamente debido a la mayor velocidad en el giro del tubo. Sin embargo, en el estudio del corazón se precisa también la sincronización con el ciclo cardíaco para adquirir las imágenes en la zona telediastólica, lo que posibilita no sólo la visualización de las arterias coronarias, sino también la valoración de los bypass, stents, anomalías coronarias e incluso el estudio de la función ventricular (AU)

Helical computed tomography (CT) emerged during the 1990s and represented an advance in CT technology, allowing images to be visualized in different planes. This was due to volumetric acquisition, i.e. the X-ray tube is active while the table is moving into the gantry. The possibility of increasing the number of detectors allowed the procedure to be performed more rapidly as several images could be obtained in each tube rotation (4, 16, 40 or 64). Thus, volume (thorax or abdomen) could be studied with better spatial resolution and images of as little as 0.5mm of collimation. Temporal resolution, defined as the time required to obtain an image, markedly improved due to faster tube rotation. However, in cardiac evaluation, synchronization with the cardiac phase was required to acquire images in telediastole, allowing not only visualization of the coronary arteries but also evaluation of coronary artery bypass grafts, stents, coronary anomalies, and even ventricular function (AU)

Radiologic findings of segmental testicular infarction.

OBJECTIVE: Our objective was to describe the radiologic findings of segmental testicular infarction and to establish a proper diagnosis that can avoid orchiectomy. CONCLUSION: The presence of a triangular-shaped avascular intratesticular lesion on sonography or MRI and enhancement of the surrounding borders on enhanced MR images may suggest a presurgical diagnosis of segmental testicular infarction and therefore avoid a total orchiectomy in these patients.

[Attitude of the health care professionals toward hypertension in the health service area of Salamanca]. / Actitudes de los profesionales de atención primaria ante la hipertensión en el área de salud de Salamanca.

A survey was carried out in the ten Health Centers in Salamanca using a questionnaire about aspects related with hypertension, the material used, diagnostic methods, risk factors, therapeutic approach, and management of hypertensive paroxysms and emergencies. Participation was 59.5% and the median age 36 years. There was a definite male predominance (85.3%). The use of three blood pressure readings in successive visits for the diagnosis was preferred by the professionals with younger working age [Cl = 8.8 to 12.8 years; (p less than 0.05)]. Regarding the type of Center (rural, urban, semiurban), significant differences regarding the investigated issues could not be established. The most relevant conclusions were deficiencies such as inadequacy of cuffs (53.3%), lack of calibration of sphygmomanometers (41.9%), introduction of thestethoscope within the cuff (34.7%), use of beta-blockers in hypertensive diabetics (13.5%).