Low-dose chest CT for preoperative screening for SARS-CoV-2 infection.

INTRODUCTION: This study aimed to evaluate the role of chest computed tomography (CT) in complementing reverse transcription polymerase chain reaction (RT-PCR) in asymptomatic candidates for elective surgery in the context of the COVID-19 pandemic. MATERIAL AND METHODS: We prospectively included 464 asymptomatic patients who underwent a triple screening workup for SARS-CoV-2 infection (health questionnaire, RT-PCR, and low-dose chest CT) during the 48 h prior to undergoing elective surgery. A positive RT-PCR and/or CT findings suggestive of COVID-19 (CO-RADS 4/5) were considered diagnostic criteria for SARS-CoV-2 infection. RESULTS: Most patients (64.7%) underwent otorhinolaryngology surgery. No patients had positive RT-PCR results or symptoms suggestive of SARS-CoV-2 in the health questionnaire. Only 22 (4.7%) had signs compatible with lung infection; in 20 of these, the CT findings were atypical or indeterminate for COVID-19 (CO-RADS 2/3) and in 2 they were compatible with COVID-19 pneumonia in resolution. In the immediate postoperative period, no cases of SARS-CoV-2 infection were confirmed. CONCLUSION: In our series of asymptomatic patients, low-dose CT did not add any value to the results of RT-PCR and a health questionnaire in preoperative screening for SARS-CoV-2.

TC torácica de baja dosis de radiación como técnica de cribado preoperatorio de infección por SARS-CoV-2 / Low-dose chest CT for preoperative screening for SARS-CoV-2 infection

Introducción: El objetivo del presente estudio fue evaluar el papel de la tomografía computarizada (TC) de tórax complementaria a la prueba de la reacción en cadena de la polimerasa con transcripción inversa (RT-PCR) en pacientes asintomáticos candidatos a cirugía electiva en el contexto de la pandemia de COVID-19. Material y métodos: Se incluyeron, de forma prospectiva, 464 pacientes asintomáticos que se sometieron a una triple estrategia de cribado de infección por SARS-CoV-2 (cuestionario de salud, prueba de RT-PCR y TC torácica de baja dosis) durante las 48 horas previas a la realización de una cirugía electiva. Un resultado positivo en la prueba de RT-PCR y/o la identificación de hallazgos tomográficos sugestivos de neumonía COVID-19 (categorías CO-RADS 4 y 5) fueron considerados criterios diagnósticos de infección por SARS-CoV-2. Resultados: La mayor parte de los pacientes se sometieron a cirugías de otorrinolaringología (64,7%). Ningún paciente presentó un resultado positivo en la prueba de RT-PCR ni síntomas sugestivos de infección por SARS-CoV-2 en el cuestionario de salud. Únicamente 22 (4,7%) mostraron signos compatibles con infección pulmonar; 20 de ellos atípica o indeterminada para COVID-19 (CO-RADS 2, 3) y 2 compatibles con neumonía COVID-19 en resolución. Durante el postoperatorio inmediato no se confirmó ningún caso positivo para SARS-CoV-2. Conclusión: En nuestra serie, la realización de una TC torácica de baja dosis de radiación en pacientes asintomáticos para el cribado preoperatorio de infección por SARS-CoV-2 no proporcionó un valor diagnóstico adicional a la RT-PCR y el cuestionario de salud.(AU)

Introduction: This study aimed to evaluate the role of chest computed tomography (CT) in complementing reverse transcription polymerase chain reaction (RT-PCR) in asymptomatic candidates for elective surgery in the context of the COVID-19 pandemic. Material and methods: We prospectively included 464 asymptomatic patients who underwent a triple screening workup for SARS-CoV-2 infection (health questionnaire, RT-PCR, and low-dose chest CT) during the 48hours prior to undergoing elective surgery. A positive RT-PCR and/or CT findings suggestive of COVID-19 (CO-RADS 4 / 5) were considered diagnostic criteria for SARS-CoV-2 infection. Results: Most patients (64.7%) underwent otorhinolaryngology surgery. No patients had positive RT-PCR results or symptoms suggestive of SARS-CoV-2 in the health questionnaire. Only 22 (4.7%) had signs compatible with lung infection; in 20 of these, the CT findings were atypical or indeterminate for COVID-19 (CO-RADS 2 / 3) and in 2 they were compatible with COVID-19 pneumonia in resolution. In the immediate postoperative period, no cases of SARS-CoV-2 infection were confirmed. Conclusion: In our series of asymptomatic patients, low-dose CT did not add any value to the results of RT-PCR and a health questionnaire in preoperative screening for SARS-CoV-2.(AU)

[Low-dose chest CT for preoperative screening for SARS-CoV-2 infection]. / TC torácica de baja dosis de radiación como técnica de cribado preoperatorio de infección por SARS-CoV-2.

Introduction: This study aimed to evaluate the role of chest computed tomography (CT) in complementing reverse transcription polymerase chain reaction (RT-PCR) in asymptomatic candidates for elective surgery in the context of the COVID-19 pandemic. Material and methods: We prospectively included 464 asymptomatic patients who underwent a triple screening workup for SARS-CoV-2 infection (health questionnaire, RT-PCR, and low-dose chest CT) during the 48 hours prior to undergoing elective surgery. A positive RT-PCR and/or CT findings suggestive of COVID-19 (CO-RADS 4 / 5) were considered diagnostic criteria for SARS-CoV-2 infection. Results: Most patients (64.7%) underwent otorhinolaryngology surgery. No patients had positive RT-PCR results or symptoms suggestive of SARS-CoV-2 in the health questionnaire. Only 22 (4.7%) had signs compatible with lung infection; in 20 of these, the CT findings were atypical or indeterminate for COVID-19 (CO-RADS 2 / 3) and in 2 they were compatible with COVID-19 pneumonia in resolution. In the immediate postoperative period, no cases of SARS-CoV-2 infection were confirmed. Conclusion: In our series of asymptomatic patients, low-dose CT did not add any value to the results of RT-PCR and a health questionnaire in preoperative screening for SARS-CoV-2.

Chest computed tomography findings in different phases of SARS-CoV-2 infection. / Hallazgos en la tomografía computarizada de tórax en las fases evolutivas de la infección por SARS-CoV-2.

OBJECTIVE: To compare the findings on chest computed tomography (CT) in patients with COVID-19 during different phases of the disease and to evaluate the reproducibility of a visual radiologic score for estimating the extent of lung involvement. METHODS: We retrospectively reviewed chest CT studies from 182 patients with RT-PCR findings positive for SARS-CoV-2. Patients were classified according to the time elapsed from the onset of symptoms, as follows: early (0-4 days), intermediate/progressive (5-9 days), or advanced (≥10 days). We analyzed the frequency of each radiologic finding, as well as the pattern, appearance, and predominant distribution of lung involvement. A visual tomographic score (range, 0-25) was used to estimate the extent of involvement in each lobe and in the total lung volume. RESULTS: The predominant CT finding was the ground-glass pattern (n=110; 60.4%), the most common distribution was peripheral (n = 116; 66.7%), and the most prevalent appearance was typical (n=112; 61.5%). The halo sign was seen most frequently in the early phase (25%), whereas ground-glass opacities were more common in the intermediate/progressive and advanced phases. The median severity score was 10 (IQR: 5-13), and the scores increased as the disease progressed. The interobserver agreement (kappa) was 0.92 for the appearance, 0.84 for the distribution, 0.70 for the predominant pattern, and 0.89 for the visual score. CONCLUSION: The CT findings in patients with COVID-19 vary with the course of the infection. The proposed visual radiologic score is a simple, reproducible, and reliable tool for assessing lung involvement in COVID-19 pneumonia.

[Chest computed tomography findings in different phases of SARS-CoV-2 infection]. / Hallazgos en la tomografía computarizada de tórax en las fases evolutivas de la infección por SARS-CoV-2.

Objective: To compare the findings on chest computed tomography (CT) in patients with COVID-19 during different phases of the disease and to evaluate the reproducibility of a visual radiologic score for estimating the extent of lung involvement. Methods: We retrospectively reviewed chest CT studies from 182 patients with RT-PCR findings positive for SARS-CoV-2. Patients were classified according to the time elapsed from the onset of symptoms, as follows: early (0-4 days), intermediate/progressive (5-9 days), or advanced (≥10 days). We analyzed the frequency of each radiologic finding, as well as the pattern, appearance, and predominant distribution of lung involvement. A visual tomographic score (range, 0-25) was used to estimate the extent of involvement in each lobe and in the total lung volume. Results: The predominant CT finding was the ground-glass pattern (n=110; 60.4%), the most common distribution was peripheral (n = 116; 66.7%), and the most prevalent appearance was typical (n=112; 61.5%). The halo sign was seen most frequently in the early phase (25%), whereas ground-glass opacities were more common in the intermediate/progressive and advanced phases. The median severity score was 10 (IQR: 5-13), and the scores increased as the disease progressed. The interobserver agreement (kappa) was 0.92 for the appearance, 0.84 for the distribution, 0.70 for the predominant pattern, and 0.89 for the visual score. Conclusion: The CT findings in patients with COVID-19 vary with the course of the infection. The proposed visual radiologic score is a simple, reproducible, and reliable tool for assessing lung involvement in COVID-19 pneumonia.

Isquemia mesentérica aguda: revisión de las principales técnicas y signos radiológicos / Acute mesenteric ischemia: a review of the main imaging techniques and signs

La isquemia mesentérica aguda constituye una urgencia abdominal con elevada mortalidad, debido al escaso tiempo que transcurre desde la disminución del flujo vascular a las asas intestinales hasta la instauración de una necrosis intestinal irreversible. Esta disminución del flujo puede deberse a diferentes causas, objeto de revisión de este estudio (arteriales, venosas y estados de bajo gasto). Las pruebas de imagen tienen un importante papel en su diagnóstico, ya que ni los síntomas ni las pruebas de laboratorio son específicos. La tomografía computarizada multidetector (TCMD) es la técnica de imagen inicial de elección para el diagnóstico de sospecha de la isquemia mesentérica aguda y permite excluir otras causas de dolor abdominal agudo. Es importante conocer los signos radiológicos típicos de esta enfermedad, ya que resulta imprescindible su reconocimiento precoz para evitar la progresión de la enfermedad a necrosis intestinal, que puede poner en riesgo la vida del paciente

Acute mesenteric ischemia is an abdominal emergency because reduced blood flow to bowel loops rapidly leads to irreversible necrosis and death. This paper reviews the different conditions (arterial, venous, low-flow states) that can result in reduced blood flow to bowel loops. Since the clinical and laboratory findings are nonspecific, imaging tests play an important role in the diagnosis of mesenteric ischemia. Multidetector computed tomography is the first-choice technique for the initial workup in cases of suspected acute mesenteric ischemia because it can rule out other causes of acute abdominal pain. It is important to know the characteristic radiological signs of this entity, because early diagnosis is essential to prevent progression to life-threatening intestinal necrosis

Acute mesenteric ischemia: a review of the main imaging techniques and signs. / Isquemia mesentérica aguda: Revisión de las principales técnicas y signos radiológicos.

Acute mesenteric ischemia is an abdominal emergency because reduced blood flow to bowel loops rapidly leads to irreversible necrosis and death. This paper reviews the different conditions (arterial, venous, low-flow states) that can result in reduced blood flow to bowel loops. Since the clinical and laboratory findings are nonspecific, imaging tests play an important role in the diagnosis of mesenteric ischemia. Multidetector computed tomography is the first-choice technique for the initial workup in cases of suspected acute mesenteric ischemia because it can rule out other causes of acute abdominal pain. It is important to know the characteristic radiological signs of this entity, because early diagnosis is essential to prevent progression to life-threatening intestinal necrosis.

Hallazgos ecográficos transitorios y normales en el postoperatorio inmediato del trasplante hepático / Normal and transitory ultrasonography findings in the immediate postoperative period after liver transplantation

OBJETIVO: El trasplante hepático es uno de los tratamientos de la hepatopatía crónica en estadios avanzados y pacientes seleccionados con tumores hepáticos. La ecografía es la técnica de imagen de elección para su evaluación. En este trabajo se revisan la técnica quirúrgica, la anatomía del trasplante hepático y los hallazgos ecográficos normales en el postoperatorio inmediato, que servirán de referencia para evaluaciones posteriores. CONCLUSIÓN: Las complicaciones vasculares tempranas (arteriales y portales) pueden suponer una amenaza para el injerto o el paciente. Tras el trasplante hepático existe un periodo de adaptación del injerto al nuevo medio y de recuperación posquirúrgica en el que podemos observar alteraciones parenquimatosas o hallazgos en el estudio Doppler que difieren de los habituales y se pueden considerar como normales en esta situación; generalmente son transitorios. Su conocimiento e interpretación es clave para detectar o excluir complicaciones

OBJECTIVE: Liver transplantation is one of the treatments for patients with advanced stage chronic liver disease and for selected patients with hepatic tumors. Ultrasonography is the first-choice imaging technique to evaluate liver transplants. This article reviews the surgical technique, anatomy, and normal findings on ultrasonography in the immediate postoperative period in patients who have undergone liver transplantation, which will be used as a reference in follow-up studies. CONCLUSION: Early vascular (arterial and portal) complications can represent a threat for the graft or the patient. During the period after liver transplantation, the patient is recovering from surgery and the transplanted organ is adapting to its new environment. In this period, ultrasonography can show alterations in the parenchyma or Doppler findings that would be considered abnormal in other situations; these findings are usually transitory. Knowing how to interpret them is key to detecting or ruling out complications

Reacciones adversas inmunomediadas como predictoras de respuesta en pacientes oncológicos en tratamiento con inmunoterapia / Immune-related adverse events as predictors of response in cancer patients undergoing immunotherapy

OBJETIVO: Identificar la incidencia de reacciones adversas inmunomediadas (irAE, immune related adverse events), con y sin manifestaciones radiológicas, y correlacionarla con la respuesta al tratamiento inmunoterápico. MATERIAL Y MÉTODOS: Se reclutaron retrospectivamente 79 pacientes con carcinomas de pulmón (n=24), renal (n=11) y melanoma (n=44) en estadio IV que fueron tratados con fármacos inmunoterápicos. Se valoró la aparición de irAE, sus manifestaciones radiológicas y el tipo de patrón de respuesta de acuerdo con los criterios de respuesta a la inmunoterapia (irRC). Se relacionó la presencia de irAE con el patrón de respuesta al tratamiento. RESULTADOS: El 27,8% de los pacientes sufrieron irAE. Estas reacciones fueron más frecuentes en pacientes con melanoma (40,9% de los pacientes). Más de la mitad de las reacciones (59,1%) presentaron manifestaciones radiológicas a modo de neumonitis, colitis, hipofisitis, tiroiditis y miocarditis. La neumonitis fue la irAE con expresión radiológica más frecuente, incluso en pacientes asintomáticos. En la población estudiada, la tasa de respuesta a la inmunoterapia fue significativamente mejor en pacientes que desarrollaron irAE (68,2% frente a 38,6%, χ2=5,58; p = 0,018). La tasa de respuesta favorable en los pacientes con y sin manifestaciones radiológicas de las irAE fue de 84,6% y 44,4%, respectivamente (p = 0,023). CONCLUSIONES: La presencia de reacciones adversas inmunomediadas se asocia, de forma significativa, con una mejor respuesta a la inmunoterapia. La asociación con respuesta favorable es incluso mayor en pacientes con manifestaciones radiológicas de las irAE

OBJECTIVE: To determine the incidence of immune-mediated adverse reactions with and without radiologic manifestations and to correlate them with the response to immunotherapy. MATERIAL AND METHODS: We retrospectively included 79 patients with stage IV lung carcinomas (n=24), renal carcinomas (n=11), or melanoma (n=44) treated with immunotherapy. We evaluated the occurrence of immune-mediated adverse reactions, their radiologic manifestations, and the response pattern according to the immune-related response criteria (irRC). We correlated the presence of immune-mediated adverse reactions with the response pattern. RESULTS: Immune-mediated adverse reactions occurred in 27.8%, being most common in patients with melanoma (40.9%). In 59.1% of patients with adverse reactions, there were radiologic manifestations such as pneumonitis, colitis, hypophysitis, thyroiditis, or myocarditis. Pneumonitis was the most common radiologic manifestation of immune-mediated adverse reactions, even in asymptomatic patients. The rate of response to immunotherapy was higher among patients who developed immune-mediated adverse reactions than in those who did not (68.2% vs. 38.6%, respectively, χ2 5.58; p = 0.018). The rate of favorable responses was higher in patients with radiologic manifestations of immune-mediated adverse reactions than in those without radiologic manifestations (84.6% vs. 44.4%, respectively; p = 0.023). CONCLUSIONS: The presence of immune-mediated adverse reactions is associated with a better response to immunotherapy. The association with a favorable response is even stronger in patients with radiologic manifestations of the immune-mediated adverse reactions

Immune-related adverse events as predictors of response in cancer patients undergoing immunotherapy. / Reacciones adversas inmunomediadas como predictoras de respuesta en pacientes oncológicos en tratamiento con inmunoterapia.

OBJECTIVE: To determine the incidence of immune-mediated adverse reactions with and without radiologic manifestations and to correlate them with the response to immunotherapy. MATERIAL AND METHODS: We retrospectively included 79 patients with stage IV lung carcinomas (n=24), renal carcinomas (n=11), or melanoma (n=44) treated with immunotherapy. We evaluated the occurrence of immune-mediated adverse reactions, their radiologic manifestations, and the response pattern according to the immune-related response criteria (irRC). We correlated the presence of immune-mediated adverse reactions with the response pattern. RESULTS: Immune-mediated adverse reactions occurred in 27.8%, being most common in patients with melanoma (40.9%). In 59.1% of patients with adverse reactions, there were radiologic manifestations such as pneumonitis, colitis, hypophysitis, thyroiditis, or myocarditis. Pneumonitis was the most common radiologic manifestation of immune-mediated adverse reactions, even in asymptomatic patients. The rate of response to immunotherapy was higher among patients who developed immune-mediated adverse reactions than in those who did not (68.2% vs. 38.6%, respectively, χ2 5.58; p=0.018). The rate of favorable responses was higher in patients with radiologic manifestations of immune-mediated adverse reactions than in those without radiologic manifestations (84.6% vs. 44.4%, respectively; p=0.023). CONCLUSIONS: The presence of immune-mediated adverse reactions is associated with a better response to immunotherapy. The association with a favorable response is even stronger in patients with radiologic manifestations of the immune-mediated adverse reactions.

Normal and transitory ultrasonography findings in the immediate postoperative period after liver transplantation. / Hallazgos ecográficos transitorios y normales en el postoperatorio inmediato del trasplante hepático.

OBJECTIVE: Liver transplantation is one of the treatments for patients with advanced stage chronic liver disease and for selected patients with hepatic tumors. Ultrasonography is the first-choice imaging technique to evaluate liver transplants. This article reviews the surgical technique, anatomy, and normal findings on ultrasonography in the immediate postoperative period in patients who have undergone liver transplantation, which will be used as a reference in follow-up studies. CONCLUSION: Early vascular (arterial and portal) complications can represent a threat for the graft or the patient. During the period after liver transplantation, the patient is recovering from surgery and the transplanted organ is adapting to its new environment. In this period, ultrasonography can show alterations in the parenchyma or Doppler findings that would be considered abnormal in other situations; these findings are usually transitory. Knowing how to interpret them is key to detecting or ruling out complications.