Cuantificación de la concentración del iodo con TC de doble energía en pacientes con pancreatitis aguda / Quantification of iodine concentration by dual-energy CT in patients with acute pancreatitis

OBJETIVO: Determinar si existen diferencias en la concentración de iodo cuantificada con TC de doble energía en el páncreas de pacientes con pancreatitis aguda y pacientes sin signos analíticos ni en imagen de patología pancreática. MATERIAL Y MÉTODOS: Se estudian 27 casos de pancreatitis aguda a los que se realizó una TC con energía dual a las 48-72 horas del inicio de los síntomas, realizada con contraste intravenoso y una sola fase con un retraso de 55 segundos. Se compara con un grupo control de 11 pacientes con una TC realizada con el mismo protocolo, pero sin datos radiológicos de pancreatitis y amilasa y lipasa normales. Mediante posprocesado se obtienen reconstrucciones con mapa de iodo y se realizan tres regiones de interés en cabeza, cuerpo y cola pancreática para obtener los valores de concentración de iodo (mg/ml) y se comparan entre ambos grupos. Se hace un segundo cálculo normalizando la densidad de iodo con la aorta. RESULTADOS:En las pancreatitis, el valor medio de densidad de iodo es 2,5mg/ml. En el grupo de los controles es de 3,65mg/ml (p = 0,02). Hay tres casos con necrosis glandular en los que la densidad de iodo es 1,53mg/ml. CONCLUSIONES: Existen diferencias significativas en la concentración de iodo del páncreas medida en TC con energía dual entre pacientes con pancreatitis aguda en fases iniciales y pacientes sin signos analíticos ni en imagen de patología pancreática

OBJECTIVE: To determine whether pancreatic iodine concentrations quantified by dual-energy CT differ between patients with acute pancreatitis and those without imaging or laboratory findings indicative of pancreatic disease. MATERIAL AND METHODS: We compared findings on single-phase dual-energy CT images acquired 55seconds after the intravenous administration of contrast material in 27 patients with acute pancreatitis who underwent the examination 48 to 72hours after the onset of symptoms versus in 11 patients (controls) with no imaging findings suggestive of pancreatic disease and normal amylase and lipase who underwent the examination with the same protocol for other purposes. Imaging postprocessing included the generation of iodine maps. Three regions of interest were selected (pancreatic head, body, and tail) to obtain iodine concentrations (mg/ml) to compare between groups. Iodine concentrations were also calculated a second time by normalizing the density of iodine with the aorta. RESULTS: The mean density of iodine was 2.5mg/ml in patients with pancreatitis vs. 3.65mg/ml in controls (p = 0.02). In three patients with glandular necrosis, the density of iodine was 1.53mg/ml. CONCLUSIONS: The concentration of iodine in the pancreas measured with dual-energy CT differs significantly between patients with initial-stage acute pancreatitis and those without imaging or laboratory findings indicative of pancreatic disease

Perforación gastrointestinal por espina de pescado. Hallazgos radiológicos en tomografía computarizada en 58 pacientes / Gastrointestinal perforation caused by ingested fish bone. Computed tomography findings in 58 patients

CONTEXTO Y OBJETIVO: Las espinas de pescado son los cuerpos extraños que con más frecuencia se ingieren accidentalmente y a su vez los que más a menudo causan perforación. El diagnóstico clínico-radiológico es difícil dado que los síntomas son inespecíficos y el paciente no recuerda dicho antecedente. Por ello, en la mayoría de los casos suele ser un diagnóstico laparoscópico o quirúrgico. Nuestro objetivo es describir los signos radiológicos de alarma en tomografía computarizada (TC) para sospechar perforación por espina de pescado y así buscarla y diagnosticarla. MATERIAL Y MÉTODOS: Estudio retrospectivo en el que se examinan 58 pacientes con diagnóstico radiológico de perforación gastrointestinal por espina de pescado. Se seleccionan aquellos pacientes con una TC de abdomen con espina localizada más allá del esófago, todas confirmadas mediante cirugía, estudio endoscópico o control radiológico, desde el año 2007 hasta 2017. Se realiza un análisis descriptivo y se analiza la localización de la perforación y los signos radiológicos sospechosos, como la presencia de un cuerpo extraño lineal hiperdenso, desdibujamiento de la grasa, burbujas de aire extraluminal y complicaciones. Se compara con los hallazgos descritos en la literatura científica. RESULTADOS: De los 58 pacientes, 39 eran hombres y 19 mujeres, con una media de edad de 70 años. La localización más frecuente fue el íleon (20 pacientes). En el 100% existía desdibujamiento de la grasa, el 98% presentaba imagen de cuerpo extraño, el 45% tenía engrosamiento mural y solo el 20% mostraba pequeñas burbujas de aire extraluminal. Quince pacientes presentaban abscesos (tres hepáticos) y sólo cinco tenían neumoperitoneo franco. CONCLUSIONES: La afectación de la grasa alrededor del segmento intestinal perforado por espina de pescado es el hallazgo más frecuente. Por ello, ante un estudio abdominal con afectación aislada de la grasa, es importante que el radiólogo busque la presencia de un cuerpo extraño

CONTEXT AND OBJETIVE: Fish bones (FB) are the most commonly ingested objects and the most common cause of foreign body perforation of the GI tract. Patients present with varied and nonspecific clinical presentations. The inability to obtain a history of FB ingestion and its wide spectrum of nonspecific clinical presentations makes dietary FB perforation extremely difficult to diagnose, being a laparoscopic or surgical diagnosis. The aim of our study is to describe radiological features in CT that will alert you to look for the FB and then make an accurate presurgical diagnosis. MATERIALS AND METHODS: All patients (n=58) with radiological diagnosis of gastrointestinal perforation caused by fish bone detected by CT between 2007 to 2017 were retrospectively reviewed. Inclusion criteria were: fish bone located beyond the esophagus, radiological diagnosis by CT and confirmation by surgery, endoscopy or radiological control. Descriptive analysis was made. Radiological features were studied including radioopaque foreign body, mural thickness, fatty infiltration or extraluminal air bubbles. Also potential complications were assessed. RESULTS: There were 58 patients, 39 men and 19 women, with an average age of 70. Ileon was the most frequent site of perforation (20 patients). 100% showed regional fatty infiltration, 98% included foreign body, 45% had mural thickening and 20% localized extraluminal air bubbles. 15 abscess were found (3 in the liver) and just 5 showed pneumoperitoneum. CONCLUSION: Fatty infiltration is the feature more common. Therefore, if fatty infiltration is seen in isolation radiologist should look for foreign body

Manejo actual de las masas renales pequeñas / Current management of small renal masses

Una de las consecuencias derivadas del uso creciente de las técnicas de diagnóstico por imagen ha sido el notable incremento en la detección de masas renales pequeñas que presumiblemente corresponden a tumores localizados, potencialmente curables con tratamiento quirúrgico. Ante el hallazgo de una masa renal pequeña incidental se deben plantear varias cuestiones: si es un tumor; si es benigno o maligno y si es maligno a qué subtipo pertenece, y finalmente cómo debe ser manejado, si con tratamiento quirúrgico, con técnicas ablativas o, por el contrario, con actitud expectante mediante vigilancia activa. En la actualidad, las masas renales pequeñas constituyen una nueva entidad clínica de manejo diferente al establecido hasta ahora para los carcinomas de células renales clásicos. En este escenario, los radiólogos tienen que asumir su importante papel, ya que están implicados en todos los aspectos del manejo de estos tumores, incluido el diagnóstico, el tratamiento y el seguimiento

One of the consequences of the growing use of diagnostic imaging techniques is the notable growth in the detection of small renal masses presumably corresponding to localized tumors that are potentially curable with surgical treatment. When faced with the finding of a small renal mass, radiologists must determine whether it is benign or malignant, and if it is malignant, what subtype it belong to, and whether it should be managed with surgical treatment, with ablative techniques, or with watchful waiting with active surveillance. Small renal masses are now a clinical entity that require management different from the approaches used for classical renal cell carcinomas. In this scenario, radiologists are key because they are involved in all aspects of the management of these tumors, including in their diagnosis, treatment, and follow-up

Gastrointestinal perforation caused by ingested fish bone. Computed tomography findings in 58 patients. / Perforación gastrointestinal por espina de pescado. Hallazgos radiológicos en tomografía computarizada en 58 pacientes.

CONTEXT AND OBJETIVE: Fish bones (FB) are the most commonly ingested objects and the most common cause of foreign body perforation of the GI tract. Patients present with varied and nonspecific clinical presentations. The inability to obtain a history of FB ingestion and its wide spectrum of nonspecific clinical presentations makes dietary FB perforation extremely difficult to diagnose, being a laparoscopic or surgical diagnosis. The aim of our study is to describe radiological features in CT that will alert you to look for the FB and then make an accurate presurgical diagnosis. MATERIALS AND METHODS: All patients (n=58) with radiological diagnosis of gastrointestinal perforation caused by fish bone detected by CT between 2007 to 2017 were retrospectively reviewed. Inclusion criteria were: fish bone located beyond the esophagus, radiological diagnosis by CT and confirmation by surgery, endoscopy or radiological control. Descriptive analysis was made. Radiological features were studied including radioopaque foreign body, mural thickness, fatty infiltration or extraluminal air bubbles. Also potential complications were assessed. RESULTS: There were 58 patients, 39 men and 19 women, with an average age of 70. Ileon was the most frequent site of perforation (20 patients). 100% showed regional fatty infiltration, 98% included foreign body, 45% had mural thickening and 20% localized extraluminal air bubbles. 15 abscess were found (3 in the liver) and just 5 showed pneumoperitoneum. CONCLUSION: Fatty infiltration is the feature more common. Therefore, if fatty infiltration is seen in isolation radiologist should look for foreign body.

Quantification of iodine concentration by dual-energy CT in patients with acute pancreatitis. / Cuantificación de la concentración del iodo con TC de doble energía en pacientes con pancreatitis aguda.

OBJECTIVE: To determine whether pancreatic iodine concentrations quantified by dual-energy CT differ between patients with acute pancreatitis and those without imaging or laboratory findings indicative of pancreatic disease. MATERIAL AND METHODS: We compared findings on single-phase dual-energy CT images acquired 55seconds after the intravenous administration of contrast material in 27 patients with acute pancreatitis who underwent the examination 48 to 72hours after the onset of symptoms versus in 11 patients (controls) with no imaging findings suggestive of pancreatic disease and normal amylase and lipase who underwent the examination with the same protocol for other purposes. Imaging postprocessing included the generation of iodine maps. Three regions of interest were selected (pancreatic head, body, and tail) to obtain iodine concentrations (mg/ml) to compare between groups. Iodine concentrations were also calculated a second time by normalizing the density of iodine with the aorta. RESULTS: The mean density of iodine was 2.5mg/ml in patients with pancreatitis vs. 3.65mg/ml in controls (p = 0.02). In three patients with glandular necrosis, the density of iodine was 1.53mg/ml. CONCLUSIONS: The concentration of iodine in the pancreas measured with dual-energy CT differs significantly between patients with initial-stage acute pancreatitis and those without imaging or laboratory findings indicative of pancreatic disease.

Current management of small renal masses. / Manejo actual de las masas renales pequeñas.

One of the consequences of the growing use of diagnostic imaging techniques is the notable growth in the detection of small renal masses presumably corresponding to localized tumors that are potentially curable with surgical treatment. When faced with the finding of a small renal mass, radiologists must determine whether it is benign or malignant, and if it is malignant, what subtype it belong to, and whether it should be managed with surgical treatment, with ablative techniques, or with watchful waiting with active surveillance. Small renal masses are now a clinical entity that require management different from the approaches used for classical renal cell carcinomas. In this scenario, radiologists are key because they are involved in all aspects of the management of these tumors, including in their diagnosis, treatment, and follow-up.

Valor de la enterografía por tomografía computarizada con doble energía en el análisis de segmentos intestinales patológicos en pacientes con enfermedad de Crohn / Value of dual-energy CT enterography in the analysis of pathological bowel segments in patients with Crohn's disease

Objetivo: Analizar si existen diferencias significativas en los parámetros cuantitativos obtenidos en el posprocesado de estudios con enterografía por tomografía computarizada (entero-TC) de doble energía entre segmentos intestinales con signos radiológicos de enfermedad de Crohn (EC) y segmentos radiológicamente normales. Material y métodos: Estudio retrospectivo en el que se analizan 33 pacientes con EC conocida (16 hombres y 17 mujeres), con una media de edad de 54 años. Se seleccionan aquellos con una entero-TC con protocolo de doble energía. Todas las exploraciones están realizadas con una solución de sorbitol oral y contraste intravenoso en fase portal. Mediante técnicas de posprocesado de las imágenes adquiridas con doble energía se obtienen mapas de color (mapas de yodo). Sobre estos mapas de color, mediante la realización de regiones de interés se cuantifican en cada paciente la densidad de yodo (mg/ml) y la fracción de grasa (%) de la pared de un segmento intestinal patológico con signos radiológicos de EC y de un segmento sano, y se analiza si existen diferencias entre ambos. Resultados: La cuantificación de yodo en los segmentos sanos es 1,8 (± 0,4) mg/ml, y en los segmentos enfermos es 3,7 (± 0,9) mg/ml (p <0,05). La fracción de grasa presente en la pared de los segmentos sanos es del 32,42% (± 6,5), y en los segmentos afectados es del 22,23% (± 9,4) (p <0,05). Conclusión: Existen diferencias significativas en la cuantificación de la densidad de yodo y la fracción de grasa entre segmentos intestinales con signos radiológicos de EC y segmentos radiológicamente normales

Objective: To analyze whether there are significant differences in the objective quantitative parameters obtained in the postprocessing of dual-energy CT enterography studies between bowel segments with radiologic signs of Crohn's disease and radiologically normal segments. Material and methods: This retrospective study analyzed 33 patients (16 men and 17 women; mean age 54 years) with known Crohn's disease who underwent CT enterography on a dual-energy scanner with oral sorbitol and intravenous contrast material in the portal phase. Images obtained with dual energy were postprocessed to obtain color maps (iodine maps). For each patient, regions of interest were traced on these color maps and the density of iodine (mg/ml) and the fat fraction (%) were calculated for the wall of a pathologic bowel segment with radiologic signs of Crohn's disease and for the wall of a healthy bowel segment; the differences in these parameters between the two segments were analyzed. Results: The density of iodine was lower in the radiologically normal segments than in the pathologic segments [1.8 ± 0.4mg/ml vs. 3.7 ± 0.9mg/ml; p<0.05].The fat fraction was higher in the radiologically normal segments than in the pathologic segments [32.42% ± 6.5 vs. 22.23% ± 9.4; p<0.05]. Conclusion: There are significant differences in the iodine density and fat fraction between bowel segments with radiologic signs of Crohn's disease and radiologically normal segments

Value of dual-energy CT enterography in the analysis of pathological bowel segments in patients with Crohn's disease. / Valor de la enterografía por tomografía computarizada con doble energía en el análisis de segmentos intestinales patológicos en pacientes con enfermedad de Crohn.

OBJECTIVE: To analyze whether there are significant differences in the objective quantitative parameters obtained in the postprocessing of dual-energy CT enterography studies between bowel segments with radiologic signs of Crohn's disease and radiologically normal segments. MATERIAL AND METHODS: This retrospective study analyzed 33 patients (16 men and 17 women; mean age 54 years) with known Crohn's disease who underwent CT enterography on a dual-energy scanner with oral sorbitol and intravenous contrast material in the portal phase. Images obtained with dual energy were postprocessed to obtain color maps (iodine maps). For each patient, regions of interest were traced on these color maps and the density of iodine (mg/ml) and the fat fraction (%) were calculated for the wall of a pathologic bowel segment with radiologic signs of Crohn's disease and for the wall of a healthy bowel segment; the differences in these parameters between the two segments were analyzed. RESULTS: The density of iodine was lower in the radiologically normal segments than in the pathologic segments [1.8 ± 0.4mg/ml vs. 3.7 ± 0.9mg/ml; p<0.05]. The fat fraction was higher in the radiologically normal segments than in the pathologic segments [32.42% ± 6.5 vs. 22.23% ± 9.4; p<0.05]. CONCLUSION: There are significant differences in the iodine density and fat fraction between bowel segments with radiologic signs of Crohn's disease and radiologically normal segments.

Tomografía computarizada de pitch alto en estudios de triple descarte: dosis de radiación y calidad de la imagen comparada con la de la tomografía computarizada multidetector / High pitch CT in triple rule-out studies: radiation dose and image quality compared to multidetector CT

Objetivo. Comparar la calidad de imagen y dosis de radiación de la TC de doble fuente (128-TCDF) con pitch alto y la adquisición retrospectiva con TC de 64 filas de detectores (64-TCMD) en estudios de triple descarte. Material y métodos. Estudiamos retrospectivamente 60 pacientes con dolor torácico agudo: 30 con una adquisición ECG-retrospectiva con 64-TCMD y 30 con 128-TCDF y pitch alto. Analizamos cuantitativamente la calidad de la imagen calculando la densidad vascular (DV), densidad muscular (DM), ruido y cocientes densidad vascular/ruido (CDVR) y contraste/ruido (CCR). Valoramos cualitativamente los artefactos en la vena cava, aorta y coronarias. Calculamos la dosis de radiación efectiva estimada (DRE) con el producto dosis-longitud. Resultados. No hubo diferencias significativas en la DV. Con 128-TCDF los CDVR y CCR fueron mayores en la aorta (CDVR: 28,9 ± 11,7 y 20 ± 5,5; CCR: 24,4 ± 10,9 y 16,8 ± 5,4; p < 0,01), arterias pulmonares (CDVR: 25,5 ± 10 y 20,6 ± 6,5; CCR: 24,5 ± 5,4 y 17,4 ± 6,4; p < 0,01) y coronarias (CDVR: 25,9 ± 8,2 y 18,9 ± 4,9; CCR: 24,9 ± 8,2 y 15,6 ± 4,6; p < 0,01). Los artefactos coronarios (3 y 34 segmentos no diagnósticos p < 0,001) y la DRE (13,77 ± 4 y 2,77 ± 0,6 mSv; p < 0,001) fueron menores con 128-TCDF. Conclusión. El pitch alto en el triple descarte disminuye la dosis de radiación y mejora la calidad de la imagen con respecto a la adquisición retrospectiva con 64-TCMD (AU)

Objective. To compare the image quality and radiation dose from high pitch dual source CT (128-DSCT) versus those from retrospective acquisition with 64-row multidetector CT (64-MDCT) in triple rule-out studies. Material and methods. We retrospectively studied 60 patients with acute chest pain: 30 with a retrospective EKG acquisition with 64-MDCT and 30 with high pitch 128-DSCT. We quantitatively analyzed the image quality by calculating the vascular density, muscular density (DM), noise, vascular density/noise ratio (VDNR), and contrast/noise ratio (CNR). We qualitatively evaluated the artifacts in the vena cava, aorta, and coronary arteries. We estimated the effective dose (ED) of radiation by means of the dose-length product. Results. There were no significant differences between 128-DSCT and 64-MDCT in the vascular density. The VDNR and CNR were higher on 128-DSCT than on 64-MDCT in the aorta (VDNR: 28.9 ± 11.7 vs. 20 ± 5.5; CNR: 24.4 ± 10.9 vs. 16.8 ± 5.4; P < .01), in the pulmonary arteries (VDNR: 25.5 ± 10 vs. 20.6 ± 6.5; CNR: 24.5 ± 5.4 vs. 17.4 ± 6.4; P < .01), and in the coronary arteries (VDNR: 25.9 ± 8.2 vs. 18.9 ± 4.9; CNR: 24.9 ± 8.2 vs. 15.6 ± 4.6; P < .01). There were fewer artifacts in the coronary arteries on 128-DSCT than on 64-MDCT (3 vs. 34 nondiagnostic segments; P < .001), and the ED in 128-DSCT was lower than in 64-MDCT (13.77 ± 4 vs. 2.77 ± 0.6 mSv; P < .001). Conclusion. In triple rule-out studies, high pitch 128-DSCT delivers a lower dose of radiation and provides better image quality than retrospective acquisition with 64-MDCT (AU)

High pitch CT in triple rule-out studies: Radiation dose and image quality compared to multidetector CT.

OBJECTIVE: To compare the image quality and radiation dose from high pitch dual source CT (128-DSCT) versus those from retrospective acquisition with 64-row multidetector CT (64-MDCT) in triple rule-out studies. MATERIAL AND METHODS: We retrospectively studied 60 patients with acute chest pain: 30 with a retrospective EKG acquisition with 64-MDCT and 30 with high pitch 128-DSCT. We quantitatively analyzed the image quality by calculating the vascular density, muscular density (DM), noise, vascular density/noise ratio (VDNR), and contrast/noise ratio (CNR). We qualitatively evaluated the artifacts in the vena cava, aorta, and coronary arteries. We estimated the effective dose (ED) of radiation by means of the dose-length product. RESULTS: There were no significant differences between 128-DSCT and 64-MDCT in the vascular density. The VDNR and CNR were higher on 128-DSCT than on 64-MDCT in the aorta (VDNR: 28.9 ± 11.7 vs. 20 ± 5.5; CNR: 24.4 ± 10.9 vs. 16.8 ± 5.4; P<.01), in the pulmonary arteries (VDNR: 25.5 ± 10 vs. 20.6 ± 6.5; CNR: 24.5 ± 5.4 vs. 17.4 ± 6.4; P<.01), and in the coronary arteries (VDNR: 25.9 ± 8.2 vs. 18.9 ± 4.9; CNR: 24.9 ± 8.2 vs. 15.6 ± 4.6; P<.01). There were fewer artifacts in the coronary arteries on 128-DSCT than on 64-MDCT (3 vs. 34 nondiagnostic segments; P<.001), and the ED in 128-DSCT was lower than in 64-MDCT (13.77 ± 4 vs. 2.77 ± 0.6 mSv; P<.001). CONCLUSION: In triple rule-out studies, high pitch 128-DSCT delivers a lower dose of radiation and provides better image quality than retrospective acquisition with 64-MDCT.

Comparación de la calidad de imagen y dosis de radiación en angio-tomografía computarizada de arterias periféricas con 80 y 100 kV / Comparison of image quality and radiation dose in computed tomography angiography of the peripheral arteries using tube voltage of 80 kV versus 100 kV

Objetivo. Comparar la calidad de imagen y la dosis de radiación en 2 grupos de pacientes a los que se realiza angio-TC de extremidades inferiores con 80 y 100 kV. Material y métodos. Se realizó angio-TC de miembros inferiores a 60 pacientes con sospecha de enfermedad arterial periférica aleatorizados en 2 grupos, en uno la TC se realizó con 80 kV y en el otro con 100 kV. Los demás parámetros de adquisición se mantuvieron constantes. Se analizaron las imágenes cuantificando la densidad vascular (DV) y el ruido (R), y se calcularon los cocientes densidad vascular/ruido (CDVR) y contraste/ruido (CCR). Dos radiólogos evaluaron independientemente la calidad subjetiva de las imágenes. Se calculó la dosis efectiva estimada (DEE) basada en el producto dosis-longitud (DLP). Resultados. El grupo de 80 kV presentó valores significativamente más elevados de la DV (462,5 UH ± 95,6 vs. 372 UH ± 100,9; p < 0,001) y del CDVR (241,9 ± 48,1 vs. 194,3 ± 49,6; p < 0,001) y diferencias no significativas del R (21,3 UH ± 13 vs. 16,3 UH ± 3,5; p = 0,098) y el CCR (21,4 ± 12,1 vs. 22,9 ± 9,1; p = 0,15). No hubo diferencias significativas en la calidad subjetiva de la imagen y la dosis efectiva fue significativamente menor en el grupo de 80 kV (4,73 mSv ± 1,1 vs. 9,6 mSv ± 2,2; p < 0,001). Conclusión. La utilización de 80 kV en el estudio de angio-TC de miembros inferiores disminuye la dosis de radiación sin afectar a la eficacia diagnóstica del estudio respecto a la utilización de 100 kV (AU)

Objective. To compare the image quality and dose of radiation in two groups of patients undergoing CT angiography of the lower limbs, one with tube voltage of 80 kV and the other with tube voltage of 100 kV. Material and methods. We performed CT angiography of the lower limbs in 60 patients with suspected peripheral arterial disease. Patients were randomly assigned to one of two groups; in one group, CT angiography was performed using a tube voltage of 80 kV, whereas in the other it was performed using 100 kV. The remaining acquisition parameters were the same in both groups. The images were analyzed by quantifying vascular density (VD) and noise (N) and by calculating the quotients density/noise (QVDN) and contrast/noise (QCN). Two radiologists working independently evaluated the subjective quality of the images. We calculated the estimated effective dose (EED) based on the dose-length product (DLP). Results. In the group studied at 80 kV, VD was significantly higher (462.5 UH ± 95.6 vs. 372 UH ± 100.9; P <. 001), QVDN was significantly higher (241.9 ± 48.1 vs. 194.3 ± 49.6; P < .001), and there were trends toward higher N (21.3 UH ± 13 vs. 16.3 UH ± 3.5; P = .098) and toward higher QCN (21.4 ± 12.1 vs. 22.9 ± 9.1; P = .15). No significant differences were found in the subjective quality of the images. The EED was significantly lower in the group studied at 80 kV (4.73 mSv ± 1.1 vs. 9.6 mSv ± 2.2; P <. 001). Conclusion. Using 80 kV instead of 100 kV for CT angiography of the lower limbs reduces the dose of radiation without affecting the diagnostic efficacy of the study (AU)

[The administration of intravenous contrast agents: extravasations]. / Administración de contrastes intravenosos: las extravasaciones.

Local extravasation of intravenous contrast material is a relatively common complication that radiologists need to know about. The risk of extravasation is greater in children, the elderly, and unconscious patients. Although most extravasations are mild and do not lead to further complications, some can result in severe lesions that require surgery, especially in cases that are associated with compartment syndrome. We describe the main characteristics of extravasations, comment on different treatments, and propose a protocol for dealing with them.

Energía dual y angioTC de carótidas: calidad, eliminación de hueso y dosis de radiación de 80/140 kV frente a 100/140 kV / Dual energy CT angiography of the carotid arteries: quality, bone subtraction, and radiation dosage using tube voltage 80/140 kV versus 100/140 kV

Objetivo: Estudiar las diferencias en la calidad de imagen vascular, la capacidad de eliminar el hueso y la dosis de radiación de la angio-TC de troncos supraaórticos con la técnica de energía dual utilizando dos diferentes potenciales del tubo. Material y métodos: Se revisaron retrospectivamente los estudios de angio-TC de troncos supraaórticos realizados a 46 pacientes con un equipo de TC de doble fuente de 128 cortes, tilizando 2 protocolos de voltaje diferente (80/140 kV y 100/140 kV). El posproceso se hizo con la herramienta «head bone removal». Las arterias se dividieron en 15 segmentos. En ellos se evaluó la calidad de los vasos y la capacidad de eliminar el hueso en imágenes multiplanares (MPR) y de proyección de máxima intensidad (MIP) con cada protocolo, analizando de forma separada los huesos trabecular y cortical. También se evaluó la dosis de radiación recibida. Resultados: Se realizaron 13 estudios con 80/140 kV y 33 con 100/140 kV, sin diferencias significativas entre los grupos en edad y sexo. Las diferencias fueron significativas en la calidad de los vasos en 4 segmentos, mayor en el grupo de 100/140 kV. También en este grupo fue mejor la eliminación automática de hueso cortical en MPR y MIP, y del trabecular en las imágenes MIP. La dosis de radiación (1,16 mSv con 80/140 kV y 1,59 mSv con 100/140 kV) fue significativamente mayor en el grupo de 100/140 kV. Conclusión: El potencial 100/140 kV incrementa la dosis de radiación, pero también mejora la calidad del estudio por segmentos arteriales y la eliminación de hueso (AU)

Objective: To study the differences in vascular image quality, bone subtraction, and dose of radiation of dual energy CT angiography of the supraaortic trunks using different tube voltages. Material and methods: We reviewed the CT angiograms of the supraaortic trunks in 46 patients acquired with a 128-slice dual source CT scanner using two voltage protocols (80/140 kV and 100/140 kV). The ‘‘head bone removal’’ tool was used for postprocessing. We divided the arteries into 15 segments. In each segment, we evaluated the image quality of the vessels and the effectiveness of bone removal in multiplanar reconstructions (MPR) and in maximum intensity projections (MIP) with each protocol, analyzing the trabecular and cortical bones separately.We also evaluated the dose of radiation received. Results: Of the 46 patients, 13 were studied using 80/140 kV and 33 with 100/140 kV. There were no significant differences between the two groups in age or sex. Image quality in four segments was better in the group examined with 100/140 kV. Cortical bone removal in MPR and MIP and trabecular bone removal in MIP were also better in the group examined with 100/140 kV. The dose of radiation received was significantly higher in the group examined with 100/140 kV (1.16 mSv with 80/140 kV vs. 1.59 mSv with 100/140 kV). Conclusion: Using 100/140 kV increases the dose of radiation but improves the quality of the study of arterial segments and bone subtraction (AU)

Administración de contrastes intravenosos: las extravasaciones / The administration of intravenous contrast agents: Extravasations

La extravasación local del contraste intravenoso es una complicación relativamente común que el radiólogo debe conocer. Los niños, los ancianos y los pacientes inconscientes son los que presentan un riesgo más elevado de padecerla. Aunque la mayoría de las extravasaciones son leves y cursan sin complicaciones, algunos casos pueden provocar lesiones severas que requieran cirugía, sobre todo en los casos asociados a síndrome compartimental. Describimos las principales características de las extravasaciones, se comentan los distintos tratamientos y se propone un protocolo de actuación (AU)

Local extravasation of intravenous contrast material is a relatively common complication that radiologists need to know about. The risk of extravasation is greater in children, the elderly, and unconscious patients. Although most extravasations are mild and do not lead to further complications, some can result in severe lesions that require surgery, especially in cases that are associated with compartment syndrome. We describe the main characteristics of extravasations, comment on different treatments, and propose a protocol for dealing with them (AU)

Comparison of image quality and radiation dose in computed tomography angiography of the peripheral arteries using tube voltage of 80 kV versus 100 kV.

OBJECTIVE: To compare the image quality and dose of radiation in two groups of patients undergoing CT angiography of the lower limbs, one with tube voltage of 80 kV and the other with tube voltage of 100 kV. MATERIAL AND METHODS: We performed CT angiography of the lower limbs in 60 patients with suspected peripheral arterial disease. Patients were randomly assigned to one of two groups; in one group, CT angiography was performed using a tube voltage of 80kV, whereas in the other it was performed using 100 kV. The remaining acquisition parameters were the same in both groups. The images were analyzed by quantifying vascular density (VD) and noise (N) and by calculating the quotients density/noise (QVDN) and contrast/noise (QCN). Two radiologists working independently evaluated the subjective quality of the images. We calculated the estimated effective dose (EED) based on the dose-length product (DLP). RESULTS: In the group studied at 80 kV, VD was significantly higher (462.5 UH ± 95.6 vs. 372 UH ± 100.9; P<.001), QVDN was significantly higher (241.9 ± 48.1 vs. 194.3 ± 49.6; P<.001), and there were trends toward higher N (21.3 UH ± 13 vs. 16.3 UH ± 3.5; P=.098) and toward higher QCN (21.4 ± 12.1 vs. 22.9 ± 9.1; P=.15). No significant differences were found in the subjective quality of the images. The EED was significantly lower in the group studied at 80 kV (4.73 mSv ± 1.1 vs. 9.6 mSv ± 2.2; P<.001). CONCLUSION: Using 80 kV instead of 100 kV for CT angiography of the lower limbs reduces the dose of radiation without affecting the diagnostic efficacy of the study.

[Dual energy CT angiography of the carotid arteries: quality, bone subtraction, and radiation dosage using tube voltage 80/140 kV versus 100/140 kV]. / Energía dual y angioTC de carótidas: calidad, eliminación de hueso y dosis de radiación de 80/140 kV frente a 100/140 kV.

OBJECTIVE: To study the differences in vascular image quality, bone subtraction, and dose of radiation of dual energy CT angiography of the supraaortic trunks using different tube voltages. MATERIAL AND METHODS: We reviewed the CT angiograms of the supraaortic trunks in 46 patients acquired with a 128-slice dual source CT scanner using two voltage protocols (80/140 kV and 100/140 kV). The "head bone removal" tool was used for postprocessing. We divided the arteries into 15 segments. In each segment, we evaluated the image quality of the vessels and the effectiveness of bone removal in multiplanar reconstructions (MPR) and in maximum intensity projections (MIP) with each protocol, analyzing the trabecular and cortical bones separately. We also evaluated the dose of radiation received. RESULTS: Of the 46 patients, 13 were studied using 80/140 kV and 33 with 100/140 kV. There were no significant differences between the two groups in age or sex. Image quality in four segments was better in the group examined with 100/140 kV. Cortical bone removal in MPR and MIP and trabecular bone removal in MIP were also better in the group examined with 100/140 kV. The dose of radiation received was significantly higher in the group examined with 100/140 kV (1.16 mSv with 80/140 kV vs. 1.59 mSv with 100/140 kV). CONCLUSION: Using 100/140 kV increases the dose of radiation but improves the quality of the study of arterial segments and bone subtraction.

¿Betabloqueante oral o intravenoso en coronariografía mediante tomografía computarizada? Un estudio prospectivo y aleatorizado / Oral versus intravenous beta-blockers for computed tomography coronary angiography? A randomized controlled trial

Objetivos. Estudiar si existen diferencias en los tiempos empleados en la atención al paciente, según se utilice la vía oral o intravenosa en la administración de betabloqueantes a pacientes ambulatorios sometidos a coronariografía mediante tomografía computarizada (TC). Material y métodos. Estudio prospectivo, analítico, aleatorizado y controlado. Se distribuye a 40 pacientes con frecuencia mayor de 65 latidos por minuto en 2 grupos. En el grupo 1 se administra el betabloqueante por vía oral y en el grupo 2 por vía intravenosa. Se mide el tiempo global transcurrido desde la entrada del paciente en Radiología hasta su marcha y el tiempo parcial de ocupación de sala desde que entra hasta que sale de la sala de TC. Variables secundarias: frecuencia cardíaca, tensión arterial y número de estudios concluyentes. Resultados. La mediana (rango intercuartílico) del tiempo global fue de 120 minutos (100-150) en los 19 pacientes betabloqueados por vía oral y de 35 minutos (27,5-67,5) en los 21 pacientes con medicación intravenosa (p<0,001). El tiempo parcial de ocupación de sala fue 10 minutos (6-15) en el grupo 1 y 10 minutos (9-20) en el grupo 2 (p=0,57). El descenso de la tensión arterial media es 10 mmHg con los betabloqueantes por vía intravenosa frente a 3,3 mmHg por la vía oral (p=0,01). No se hallaron diferencias significativas en la calidad diagnóstica de las exploraciones. Conclusiones. El tiempo de atención al paciente es significativamente menor con la administración intravenosa de betabloqueantes. No se demostraron diferencias en el tiempo de ocupación de sala ni en la calidad diagnóstica (AU)

Objectives. To determine whether the time employed in the radiological management of outpatients undergoing computed tomography (CT) coronary angiography varies in function of whether oral or intravenous beta-blockers are administered. Material and methods. This was a prospective, analytical, randomized controlled trial. A total of 40 patients with heart rates greater than 65 beats per minute were randomly assigned to one of two groups. Patients in group 1 were administered oral beta-blockers and patients in group 2 were administered intravenous beta-blockers. We measured the overall time from entry to the radiology department to exit from the CT examination room. We also measured heart rate, blood pressure, and the number of conclusive studies. Results. The median (interquartile range) overall time was 120 (100-150) minutes in the 19 patients who received oral beta-blockers compared to 35 (27.5-67.5) minutes in the 21 patients who received intravenous beta-blockers (p<0.001). The median time that patients were in the CT examination room was 10 (6-15) minutes in Group 1 and 10 (9-20) minutes in Group 2 (p=0.57). The decrease in mean arterial pressure was 10 mmHg after the administration of intravenous beta-blockers compared to 3.3 mmHg after the administration of oral beta-blockers (p=0.01). No significant differences were found in the diagnostic quality of the examinations. Conclusions. The time employed in the radiological management of patients undergoing CT coronary angiography is significantly lower when beta-blockers are administered intravenously. There was no difference in the time patients were in the CT examination room or in the diagnostic quality of the examinations (AU)

[Oral versus intravenous beta-blockers for computed tomography coronary angiography? A randomized controlled trial]. / ¿Betabloqueante oral o intravenoso en coronariografía mediante tomografía computarizada? Un estudio prospectivo y aleatorizado.

OBJECTIVES: To determine whether the time employed in the radiological management of outpatients undergoing computed tomography (CT) coronary angiography varies in function of whether oral or intravenous beta-blockers are administered. MATERIAL AND METHODS: This was a prospective, analytical, randomized controlled trial. A total of 40 patients with heart rates greater than 65 beats per minute were randomly assigned to one of two groups. Patients in group 1 were administered oral beta-blockers and patients in group 2 were administered intravenous beta-blockers. We measured the overall time from entry to the radiology department to exit from the CT examination room. We also measured heart rate, blood pressure, and the number of conclusive studies. RESULTS: The median (interquartile range) overall time was 120 (100-150) minutes in the 19 patients who received oral beta-blockers compared to 35 (27.5-67.5) minutes in the 21 patients who received intravenous beta-blockers (p<0.001). The median time that patients were in the CT examination room was 10 (6-15) minutes in Group 1 and 10 (9-20) minutes in Group 2 (p = 0.57). The decrease in mean arterial pressure was 10 mmHg after the administration of intravenous beta-blockers compared to 3.3 mmHg after the administration of oral beta-blockers (p = 0.01). No significant differences were found in the diagnostic quality of the examinations. CONCLUSIONS: The time employed in the radiological management of patients undergoing CT coronary angiography is significantly lower when beta-blockers are administered intravenously. There was no difference in the time patients were in the CT examination room or in the diagnostic quality of the examinations.