Update on imaging in Code Stroke.

"Code Stroke" is a multidisciplinary procedure designed to detect acute ischemic strokes and transfer patients for early reperfusion. Selecting these patients requires multimodal imaging with either CT or MRI. 1) Conventional studies without contrast material are obligatory to detect bleeding. Applying the ASPECTS scale, these studies can also identify and quantify areas of early infarction. 2) In candidates for mechanical thrombectomy, angiographic studies are necessary to identify stenoses and obstructions and to evaluate the collateral circulation. 3) Patients with known onset between 6 and 24h or with unknown onset require perfusion studies to distinguish between infracted tissue and recoverable ischemic tissue. Semi-automatic software facilitates diagnosis, but radiologists must interpret its output.

Aspectos radiológicos de la neumonía COVID-19: evolución y complicaciones torácicas / Radiologic aspects of COVID-19 pneumonia: outcomes and thoracic complications

Los pacientes con COVID-19 presentan una evolución muy variable: desde enfermos con síntomas leves de corta duración a pacientes con enfermedad grave que desarrollan un síndrome de distrés respiratorio agudo, con ingresos prolongados en unidades de críticos. Desde el punto de vista radiológico, la etapa inicial se caracteriza por una neumonía viral poco expresiva. No obstante, en algunos pacientes, con el inicio de la respuesta inmunitaria se produce un daño pulmonar agudo con patrones radiológicos de neumonía organizada y daño alveolar difuso. La enfermedad moderada-grave se asocia con una incidencia alta de tromboembolismo pulmonar, generalmente de distribución periférica y asociado al daño endotelial, encamamiento prolongado y coagulopatía de la enfermedad. Otras complicaciones relativamente frecuentes son: el neumotórax y el neumomediastino espontáneos por rotura de paredes alveolares, y el barotrauma en pacientes con ventilación mecánica. La sobreinfección es más frecuente en pacientes graves, generalmente de origen bacteriano y menos frecuente fúngico

Outcomes vary widely in patients with COVID-19. Whereas some patients have only mild symptoms of short duration, others develop severe disease that leads to acute respiratory distress syndrome requiring prolonged stays in intensive care units. Radiologically, the initial stage is characterized by viral pneumonia with mild expression. In some patients, however, the onset of the immune response results in acute lung damage with organizing pneumonia and diffuse alveolar damage. Moderate-severe disease is associated with a high incidence of pulmonary embolisms, generally peripherally distributed and associated with endothelial damage, prolonged stays in bed, and coagulopathy. Other relatively common complications are spontaneous pneumothorax and pneumomediastinum due to the rupture of alveolar walls and barotrauma in mechanically ventilated patients. Superinfection, generally bacterial and less commonly fungal, is more common in patients with severe disease

Papel del estudio radiológico multimodal en el código ictus / The role of multimodal imaging in stroke code patients

El estudio multimodal engloba distintas técnicas radiológicas utilizadas en el "código ictus". Incluye tomografía computarizada (TC) basal, resonancia magnética (RM) y RM por difusión, técnicas de perfusión con TC o RM y angiografía por TC o RM. Se emplean para descartar sangrado, confirmar oclusión arterial, establecer viabilidad tisular y ayudar a seleccionar a los candidatos a tratamiento endovascular lo antes posible. Se han publicado recientemente cinco relevantes ensayos clínicos que han demostrado la eficacia de la trombectomía mecánica en oclusiones arteriales proximales. Todos han utilizado diferentes estrategias de imagen para la selección de los pacientes. Analizando estos ensayos y la bibliografía científica actual concluimos que la TC convencional con valoración de la puntuación ASPECTS y la angiografía por TC o RM debe usarse siempre, con nivel de evidencia I y grado de recomendación A. Los estudios de perfusión por TC y RM tienen utilidad en situaciones específicas (AU)

In stroke code patients, multimodal imaging workup encompasses various imaging techniques, including baseline computed tomography (CT), magnetic resonance (MR) imaging, diffusion MR imaging, CT or MR perfusion studies, and CT or MR angiography, that are used to rule out bleeding, confirm arterial occlusion, establish tissue viability, and help select candidates for endovascular treatment as early as possible. Five recently published relevant clinical trials have demonstrated the efficacy of mechanical thrombectomy in proximal arterial occlusions; all these trials used different imaging techniques to select patients. Analyzing these trials and the scientific literature, we conclude that conventional CT interpreted with the Alberta Stroke Programme Computed Tomography Score (ASPECTS) and CT or MR angiography should always be used (level of evidence I, grade of recommendation A) and that CT and MR perfusion studies are useful in specific circumstances (AU)

The role of multimodal imaging in stroke code patients. / Papel del estudio radiológico multimodal en el código ictus.

In stroke code patients, multimodal imaging workup encompasses various imaging techniques, including baseline computed tomography (CT), magnetic resonance (MR) imaging, diffusion MR imaging, CT or MR perfusion studies, and CT or MR angiography, that are used to rule out bleeding, confirm arterial occlusion, establish tissue viability, and help select candidates for endovascular treatment as early as possible. Five recently published relevant clinical trials have demonstrated the efficacy of mechanical thrombectomy in proximal arterial occlusions; all these trials used different imaging techniques to select patients. Analyzing these trials and the scientific literature, we conclude that conventional CT interpreted with the Alberta Stroke Programme Computed Tomography Score (ASPECTS) and CT or MR angiography should always be used (level of evidence I, grade of recommendation A) and that CT and MR perfusion studies are useful in specific circumstances.

Neumonía organizante: Neumonía organizante criptogenética (NOC). Bronquiolitis obliterante con neumonía organizada (BONO) y neumonía organizante secundaria. A propósito de tres casos / Organizing pneumonia: Cryptogenetiuc organizing pneumonia (COP). Bronchiolitis obliterans organizing pneumonia (BOOP). Secondary organizing pneumonia: Report of a three cases

Las proliferaciones intraalveolares de tejido de granulación constituido por una mezcla de fi broblastos y miofi broblastos sobre matriz colágena sedenomina Neumonía organizante. Cuando la etiología es desconocida o que se relacione con determinadas causas la denominaremos Neumonía Organizante Criptogenéticas o secundaria

The presence in the distal air spaces of buds of granulation tissue progressing from fi brin exudates to loose collagen containing fi broblasts is defined as Organising pneumonia. It can be classifi ed as Cryptogenetic Organising Pneumonia (COP) if the cause is unknown and Secondary Organizing Pneumonia when there is a determined cause or in a specific context (AU)

Neumonía organizante: Neumonía organizante criptogenética (NOC). Bronquiolitis obliterante con neumonía organizada (BONO) y neumonía organizante secundaria. A propósito de tres casos / No disponible

Las proliferaciones intraalveolares de tejido de granulación constituidopor una mezcla de fi broblastos y miofi broblastos sobre matriz colágena sedenomina Neumonía organizante. Cuando la etiología es desconocida oque se relacione con determinadas causas la denominaremos NeumoníaOrganizante Criptogenéticas o secundaria(AU)

The presence in the distal air spaces of buds of granulation tissue progressingfrom fi brin exudates to loose collagen containing fi broblasts isdefi ned as Organising pneumonia. It can be classifi ed as CryptogeneticOrganising Pneumonia (COP) if the cause is unknown and SecondaryOrganizing Pneumonia when there is a determined cause or in a specifi ccontext(AU)