Radiologic assessment of abdominal aortic calcifications, atherosclerotic burden levels and statistical bias affecting the reliability.

INTRODUCTION: AAC-8 and AAC-24 are two widely used scales to evaluate abdominal aortic calcification (AAC) on X-ray images. Levels of ≥3 (AAC-8) and ≥5 points (AAC-24) are of high relevance since they are associated with greater risk of cardiovascular events. Given that it is unknown, our aim was to determine the reliability of both scales at those levels of atherosclerotic burden. METHODS: The sample (93 subjects, 67.3 ± 9.7 years, BMI 28.8 ± 3.8, 57.6% smokers, 64.1% with hypertension) was classified according to quartiles of calcification. Six clinicians evaluated AAC independently with both scales on lateral lumbar spine X-ray images. We analyzed inter-rater agreement with the intraclass correlation coefficient (ICC) and the Bland-Altman scatterplots. RESULTS: We assessed 15 pairs of raters. Scores in both scales were significantly correlated with cardiovascular risk (r = 0.31 and r = 0.32; p < 0.005). Agreement was very high in the first quartile and moderate in the rest (p < 0.05). At cut-off points, ICC = 0.70 (95%CI, 0.54-0.86) and ICC = 0.68 (95%CI, 0.60-0.85) with AAC-8 and AAC-24. With the Bland-Altman method, mean of the differences ranged between 0 and 0.4 (AAC-8), and between 0.2 and 1 (AAC-24), while 95% limits of agreement showed values between 2.9 and 4.4 (AAC-8), and between 6 and 11.2 (AAC-24). Analyzing entire scales, ICC = 0.97 (95%CI, 0.97-0.98) and ICC = 0.98 (95%CI, 0.97-0.98) for AAC-8 and AAC-24, respectively. CONCLUSION: Both scales presented only moderate reliability at levels of atherosclerotic burden. Analyzing quartiles with ICC and the Bland-Altman plot showed concordant results. High global ICC values traditionally reported with both scales are likely biased. IMPLICATIONS FOR PRACTICE: AAC predicts subsequent vascular morbidity and mortality and should implicate evaluation of cardiovascular risk. Optimal visualisation of AAC and its correct assessment are mandatory in order to maximize patient care.

Ultrasonography of subcutaneous foreign bodies: differences depending on their nature, complications, and potential diagnostic errors. / Ecografía de los cuerpos extraños subcutáneos: diferencias según naturaleza, complicaciones y potenciales errores diagnósticos.

Patients with penetrating wounds with suspected foreign bodies retained in the wound are often seen in emergency departments. Imaging studies are necessary to rule out the presence of retained foreign bodies. Plain-film X-rays, however, are only useful when the foreign bodies contain radiopaque material (metal, glass, stone, and some plastics). In cases with strong diagnostic suspicion and negative plain films, other imaging tests are necessary. Ultrasonography has proven useful in the identification and location of both radiopaque and radiotransparent foreign bodies. Ultrasonography enables excellent assessment of adjacent anatomical structures (muscles, tendons, ligaments, and neurovascular structures) and of associated lesions. The different materials found in foreign bodies have characteristic ultrasonographic patterns that are useful for diagnosis. Finally, it is important to be familiar with the diagnostic pitfalls to avoid false positives.

Fiabilidad en la evaluación radiológica de la calcificación aórtica abdominal mediante la escala de 24 puntos / Reliability of radiologic evaluation of abdominal aortic calcification using the 24-point scale

Objetivo. La calcificación de la aorta abdominal se asocia a un incremento en el riesgo de morbilidad cardiovascular, y disponer de un método de cuantificación de la misma es clínicamente trascendente. La escala de 24 puntos (AAC-24) es el método estándar para su evaluación en la radiología simple lateral de columna lumbar. El objetivo del estudio ha sido conocer el nivel de acuerdo intra e interobservador que aporta esta escala, teniendo en cuenta la heterogeneidad de la distribución de las calcificaciones en el diseño del análisis estadístico. Material y métodos. Se analizó la concordancia intraobservador (sobre radiografías de 81 pacientes, con una separación de 4 años) y la concordancia interobservador (sobre radiografías de 100 pacientes, con tres evaluadores), utilizando simultáneamente la correlación intraclase y el método gráfico de Bland-Altman. Resultados. El coeficiente de correlación intraclase fue de 0,93 (intervalo de confianza al 95% [IC95%]: 0,6-0,9) y 0,91 (IC95%: 0,8-0,9), intra e interobservador, respectivamente, con un incremento del coeficiente en el tercil de mayor discrepancia. La diferencia de medias osciló entre 0,3 y-1,2 puntos. La amplitud entre los límites de acuerdo, entre 4,7 y 9,4 puntos. Se observó un aumento significativo de las diferencias en relación con el aumento progresivo de la calcificación. Conclusiones. La valoración de la calcificación de la aorta abdominal en radiología simple lateral de columna lumbar mediante la escala AAC-24 es un método fiable y reproducible, observándose un mayor grado de concordancia intra e interobservador en las fases iniciales de la calcificación (AU)

Objective. Calcification of the abdominal aorta is associated with increased cardiovascular morbidity, so a reliable method to quantify it is clinically transcendent. The 24-point scale (AAC-24) is the standard method for assessing abdominal aortic calcification on lateral plain films of the lumbar spine. The aim of this study was to determine the intraobserver and interobserver agreements for the AAC-24, taking into account the heterogeneity of the distribution of the calcifications in the design of the statistical analysis. Material and methods. We analyzed the intraobserver agreement (in plain films from 81 patients, with a four-year separation between observations) and the interobserver agreement (in plain films from 100 patients, with three observers), using both intraclass correlation and Bland-Altman plots. Results. The intraobserver intraclass correlation coefficient was 0.93 (95% confidence interval [CI95%]: 0.6-0.9), and the interobserver intraclass correlation coefficient was 0.91 (CI95%: 0.8-0.9) with an increase in the coefficient in the tercile with the greatest discrepancy. The difference in means ranged from 0.3 to 1.2 points, and the distance between the limits of agreement ranged from 4.7 to 9.4 points. These differences increased significantly as the calcification progressed. Conclusions. Using the AAC-24 on lateral plain films of the lumbar spine is a reliable and reproducible method of assessing calcification of the abdominal aorta; both intraobserver and interobserver agreement are higher during the initial phases of calcification (AU)

Reliability of radiologic evaluation of abdominal aortic calcification using the 24-point scale.

OBJECTIVE: Calcification of the abdominal aorta is associated with increased cardiovascular morbidity, so a reliable method to quantify it is clinically transcendent. The 24-point scale (AAC-24) is the standard method for assessing abdominal aortic calcification on lateral plain films of the lumbar spine. The aim of this study was to determine the intraobserver and interobserver agreements for the AAC-24, taking into account the heterogeneity of the distribution of the calcifications in the design of the statistical analysis. MATERIAL AND METHODS: We analyzed the intraobserver agreement (in plain films from 81 patients, with a four-year separation between observations) and the interobserver agreement (in plain films from 100 patients, with three observers), using both intraclass correlation and Bland-Altman plots. RESULTS: The intraobserver intraclass correlation coefficient was 0.93 (95% confidence interval [CI95%]: 0.6-0.9), and the interobserver intraclass correlation coefficient was 0.91 (CI95%: 0.8-0.9) with an increase in the coefficient in the tercile with the greatest discrepancy. The difference in means ranged from 0.3 to 1.2 points, and the distance between the limits of agreement ranged from 4.7 to 9.4 points. These differences increased significantly as the calcification progressed. CONCLUSIONS: Using the AAC-24 on lateral plain films of the lumbar spine is a reliable and reproducible method of assessing calcification of the abdominal aorta; both intraobserver and interobserver agreement are higher during the initial phases of calcification.

[The contribution made by neurophysiological and ultrasound imaging studies to the diagnosis of carpal tunnel syndrome. Surgical correlation]. / Aportación de los estudios neurofisiológico y ecográfico al diagnóstico del síndrome del túnel carpiano. Correlación quirúrgica.

INTRODUCTION: Electrophysiological study has been for long time the elected approach for the diagnosis and clinical evaluation of carpal tunnel syndrome (CTS). More recently, echography and other imaging techniques have been introduced in current medicine for their potential in the anatomical evaluation of the neural compression. To asses the usefulness of both diagnostic procedures we have compared the findings obtained by electrophysiological and echographic approaches in a group of 60 CTS patients with different degrees of the disease. PATIENTS AND METHODS: In all patients the conduction velocity was evaluated in the median and cubital nerves using surface electrodes. For echography lineal transductors of 5-10 Hz and 5-12.5 MHz were employed. RESULTS: The patients were distributed for each test on a scale depending of the severity of the alterations detected by the corresponding technique and both files were subsequently compared by regression analysis, Pearson test and paired-test. No correlation was detected in any of the statistical test. CONCLUSIONS: The lack of correlation between the results of both proofs emphasizes the usefulness of the two diagnostic approaches in CTS. While electrophysiological study provides information about nerve function, ecography unravels the morphological alterations accounting for the syndrome, therefore being non-excluding complementary approaches.

Aportación de los estudios neurofisiológico y ecográfico al diagnóstico del síndrome del túnel carpiano. Correlación quirúrgica / The contribution made by neurophysiological and ultrasound imaging studies to the diagnosis of carpal tunnel syndrome. Surgical correlation

Introducción. El estudio neurofisiológico (ENF) como técnica de elección para el diagnóstico del síndrome del túnel carpiano (STC) ha demostrado repetidamente su utilidad y eficacia. Más recientemente se han incorporado técnicas de imagen como la ecografía (ECO), que aporta valiosos datos en cuanto a la morfología normal del nervio mediano en el canal carpiano y sus cambios patológicos. Nuestro objetivo ha sido comparar los resultados de ambos estudios, ENF y ECO, en un número reducido de pacientes de nuestra casuística con el fin de comprobar su diferente utilidad en el diagnóstico del síndrome. Pacientes y métodos. 60 pacientes diagnosticados de STC, en los que se estudió la conducción nerviosa de ambos nervios medianos y cubital mediante electrodos de superficie, así como estudio ecográfico de ambas muñecas mediante transductores lineales 5-10 Hz y 5-12,5 MHz. Resultados. Según el grado de afectación se utilizaron escalas de gravedad para ambas pruebas y los resultados se compararon estadísticamente mediante análisis de regresión, test de Pearson y test t pareado, que demostraron una ausencia de correlación entre ambas pruebas. Conclusión. La falta de correlación evidenciada entre ambas pruebas en los diferentes estudios estadísticos utilizados indica que ambas son herramientas útiles en el diagnóstico de STC. Los datos neurofisiológicos aportan información acerca de la funcionalidad del nervio y la ECO, por su parte, informa de sus alteraciones morfológicas en condiciones patológicas y las posibles lesiones o variantes anatómicas causantes del síndrome, por lo que consideramos que ambas pruebas no son excluyentes, sino complementarias

Introduction. Electrophysiological study has been for long time the elected approach for the diagnosis and clinical evaluation of carpal tunnel syndrome (CTS). More recently, echography and other imaging techniques have been introduced in current medicine for their potential in the anatomical evaluation of the neural compression. To asses the usefulness of both diagnostic procedures we have compared the findings obtained by electrophysiological and echographic approaches in a group of 60 CTS patients with different degrees of the disease. Patients and methods. In all patients the conduction velocity was evaluated in the median and cubital nerves using surface electrodes. For echography lineal transductors of 5-10 Hz and 5-12.5 MHz were employed. Results. The patients were distributed for each test on a scale depending of the severity of the alterations detected by the corresponding technique and both files were subsequently compared by regression analysis, Pearson test and paired-test. No correlation was detected in any of the statistical test. Conclusions. The lack of correlation between the results of both proofs emphasizes the usefulness of the two diagnostic approaches in CTS. While electrophysiological study provides information about nerve function, ecography unravels the morphological alterations accounting for the syndrome, therefore being non-excluding complementary approaches

[Castleman's disease: isolated retroperitoneal mass. Report of a case]. / Enfermedad de Castleman: masa única retroperitoneal. A propósito de un caso.

OBJECTIVE: To describe a rare case of vascular hyaline variant of Castleman's disease presenting as a solitary mass, with special reference to the radiological findings and differential diagnosis. The literature is briefly reviewed. METHODS/RESULTS: A 48-year-old male presented with nonspecific pain in the left flank. Routine analyses were unremarkable. Sonographic and CT studies showed a well-defined, highly vascularized, 3.3 x 3.6 x 4 cm retroperitoneal mass. The risk of hemorrhage made a preoperative biopsy impracticable and the mass was removed surgically. The pathological analysis of the surgical specimen showed a localized retroperitoneal angiofollicular lymphoid hyperplasia (vascular hyaline variant). CONCLUSIONS: Castleman's disease can rarely present as a solitary retroperitoneal mass, which must be distinguished from primary retroperitoneal masses that are usually malignant. Imaging techniques are not conclusive. Definitive diagnosis is based on the postoperative pathological findings.

Intraductal placement of a Kopans spring-hookwire guide to localize nonpalpable breast lesions detected by galactography.

PURPOSE: To evaluate a new procedure for locating intraductal breast lesions detected by galactography, using the technique of intraductal placement of a Kopans spring-hookwire guide. MATERIAL AND METHODS: A catheter (0.7 mm) with a Kopans hookwire guide inside it was placed in 34 patients in whom an intraductal growth had been detected by galactography. The catheter was introduced through the discharging duct, with one hand holding the catheter and the other hand gently pushing the Kopans guide until it was anchored in the duct. The correct position of the guide was confirmed with new galactograms. RESULTS: A precise excision of the lesion was satisfactorily executed in 29 of 34 patients (85%) who underwent this procedure. In 5 patients the method was unsuccessful because the Kopans guide was dislodged. CONCLUSION: This method is effective in removing intraductal lesions because it ensures a precise ductal excision and enables the pathologist to find the lesion more easily.

[Computerized axial tomography (CAT) and echography (US) of multilocular cystic nephroma]. / Estudio mediante tomografía axial computerizada (TAC) y ecografía (US) del nefroma quístico multilocular.

OBJECTIVES: To determine the sensitivity and specificity of computed tomography and ultrasound in the diagnosis of multilocular cystic nephroma. METHODS: Four cases with a pathologically confirmed diagnosis of cystic nephroma were reviewed. RESULTS: These four cases had a predominantly cystic mass with thin walls located in the lower pole of the kidney. Both techniques had a sensitivity of 100% for renal masses but a low specificity since they failed to distinguish multilocular cystic nephroma from other cystic lesions. CONCLUSIONS: A presumptive diagnosis of multilocular cystic nephroma can be made on the findings of these noninvasive diagnostic imaging techniques. The definitive diagnosis, however, is by anatomopathology.