Valoración del grado de resección de los macroadenomas hipofisarios en la resonancia magnética posquirúrgica inmediata / Assessment of the extent of pituitary macroadenomas resection in immediate postoperative MRI

Objetivo. Comprobar si es posible determinar el grado de resección de macroadenomas hipofisarios en la resonancia magnética (RM) hipofisaria posquirúrgica inmediata. Material y métodos. Se revisaron las RM hipofisarias de pacientes intervenidos desde enero de 2010 hasta octubre de 2014. Se incluyeron aquellos que tenían RM diagnóstica, RM posquirúrgica inmediata y al menos un control posterior. Se comprobó si los hallazgos entre la RM posquirúrgica inmediata y las RM posteriores eran concordantes. Se excluyeron los casos sin controles evolutivos y las reintervenciones por recidivas. El grado de resección tumoral lo dividimos en grupos: resección total, resección parcial y dudoso. Los estudios se realizaron en una máquina de 1.5 Tesla siguiendo el mismo protocolo de secuencias: una parte morfológica, otra dinámica con contraste intravenoso y otra con contraste tardío. Resultados. De 73 casos incluidos, la RM posquirúrgica inmediata se interpretó como resección total en 38 casos y resto tumoral en 28 casos, habiendo dudas en 7 casos. En los controles evolutivos se determinó resección total en 41 casos y resto tumoral en 32. Se obtuvo una sensibilidad para detección de restos tumorales de 0,71, una especificidad de 0,82, un valor predictivo positivo de 0,89 y un valor predictivo negativo de 0,85 en la RM posquirúrgica inmediata respecto a los controles evolutivos. Conclusión. La RM posquirúrgica inmediata de macroadenomas hipofisarios es útil para valorar el grado de resección tumoral y es un buen predictor del grado de resección real definitivo al comparar con las RM posteriores, permitiendo plantear el tratamiento adecuado de forma precoz (AU)

Objective. To evaluate if it is possible to determine the extent of pituitary macroadenomas resection in the immediate postoperative pituitary magnetic resonance imaging (MRI). Material and methods. MRI of patient with pituitary macroadenomas from January 2010 until October 2014 were reviewed. Those patients who had diagnostic MRI, immediate post-surgical MRI and at least one MRI control were included. We evaluate if the findings between the immediate postsurgical MRI and the subsequent MRI were concordant. Cases which didn’t have evolutionary controls and those who were reoperation for recurrence were excluded. The degree of tumor resection was divided into groups: total resection, partial resection and doubtful. All MRI studies were performed on a1.5T machine following the same protocol sequences for all cases. One morphological part, a dynamic contrast iv and late contrast part. Results. Of the 73 cases included, immediate postoperative pituitary MRI was interpreted as total resection in 38 cases and tumoral rest in 28 cases, uncertainty among rest or inflammatory changes in 7 cases. Follow- up MRI identified 41 cases total resection and tumoral rest in 32. Sensitivity and specificity of 0.78 and 0.82 and positive and negative predictive value (PPV and NPV) 0.89 and 0.89 respectively were calculated. Conclusion. Immediate post-surgery pituitary MRI is useful for assessing the degree of tumor resection and is a good predictor of the final degree of real resection compared with the following MRI studies. It allows us to decide the most appropriate treatment at an early stage (AU)

Assessment of the extent of pituitary macroadenomas resection in immediate postoperative MRI. / Valoración del grado de resección de los macroadenomas hipofisarios en la resonancia magnética posquirúrgica inmediata.

OBJECTIVE: To evaluate if it is possible to determine the extent of pituitary macroadenomas resection in the immediate postoperative pituitary magnetic resonance imaging (MRI). MATERIAL AND METHODS: MRI of patient with pituitary macroadenomas from January 2010 until October 2014 were reviewed. Those patients who had diagnostic MRI, immediate post-surgical MRI and at least one MRI control were included. We evaluate if the findings between the immediate postsurgical MRI and the subsequent MRI were concordant. Cases which didn't have evolutionary controls and those who were reoperation for recurrence were excluded. The degree of tumor resection was divided into groups: total resection, partial resection and doubtful. All MRI studies were performed on a1.5T machine following the same protocol sequences for all cases. One morphological part, a dynamic contrast iv and late contrast part. RESULTS: Of the 73 cases included, immediate postoperative pituitary MRI was interpreted as total resection in 38 cases and tumoral rest in 28 cases, uncertainty among rest or inflammatory changes in 7 cases. Follow- up MRI identified 41 cases total resection and tumoral rest in 32. Sensitivity and specificity of 0.78 and 0.82 and positive and negative predictive value (PPV and NPV) 0.89 and 0.89 respectively were calculated. CONCLUSION: Immediate post-surgery pituitary MRI is useful for assessing the degree of tumor resection and is a good predictor of the final degree of real resection compared with the following MRI studies. It allows us to decide the most appropriate treatment at an early stage.

Study of survival in patients with malignant lung lesions treated with radiofrequency

OBJECTIVE: To report on the survival of a series of patients with primary and metastatic lung tumours treated with radiofrequency (RF). Four years ago we published our preliminary experience with the use of this technique. MATERIALS AND METHODS: For a period of 8 years we have treated 59 patients (by means of a total of 70 procedures) with primary or metastatic pulmonary neoplastic lesions, which fulfilled inclusion criteria to perform the technique. They were in all cases non-surgical lesions that had been either previously treated or not. The technique was performed in the radiology suite, under conscious analgo-sedation. We treated primary pulmonary lesions, neoplastic recurrences, or metastases with curative or palliative intention (pain management). RESULTS: Current global survival rate is 19 patients (32 %) with a mean of 26.61 ± 3.17 months (range: 20.38 ± 32.83) and a median of 16.00 ± 3.57 (range: 8.99-23.00). If we establish the difference between primary and metastatic tumours, mean survival is 27.62 ± 4.12 months in primary tumours (median: 16.00) vs. 24.65 ± 4.47 months in metastatic tumours (median: 16.00). When we studied the survival in those cases with a curative intent, mean survival in primary tumours was 30.97 ± 4.57 months (median: 21.00) vs. 25.14 ± 4.68 (median: 16.00) months in metastatic tumours. CONCLUSIONS: RF ablation of lung lesions is a minimally invasive procedure that is useful in primary tumours (especially in stage I) and metastatic ones. RF has proven its usefulness in the multidisciplinary treatment of this pathology due to the low incidence of serious complications and survival obtained, considering that patients are elderly with significant comorbidity (AU)

Study of survival in patients with malignant lung lesions treated with radiofrequency.

OBJECTIVE: To report on the survival of a series of patients with primary and metastatic lung tumours treated with radiofrequency (RF). Four years ago we published our preliminary experience with the use of this technique. MATERIALS AND METHODS: For a period of 8 years we have treated 59 patients (by means of a total of 70 procedures) with primary or metastatic pulmonary neoplastic lesions, which fulfilled inclusion criteria to perform the technique. They were in all cases non-surgical lesions that had been either previously treated or not. The technique was performed in the radiology suite, under conscious analgo-sedation. We treated primary pulmonary lesions, neoplastic recurrences, or metastases with curative or palliative intention (pain management). RESULTS: Current global survival rate is 19 patients (32 %) with a mean of 26.61 ± 3.17 months (range: 20.38 ± 32.83) and a median of 16.00 ± 3.57 (range: 8.99-23.00). If we establish the difference between primary and metastatic tumours, mean survival is 27.62 ± 4.12 months in primary tumours (median: 16.00) vs. 24.65 ± 4.47 months in metastatic tumours (median: 16.00). When we studied the survival in those cases with a curative intent, mean survival in primary tumours was 30.97 ± 4.57 months (median: 21.00) vs. 25.14 ± 4.68 (median: 16.00) months in metastatic tumours. CONCLUSIONS: RF ablation of lung lesions is a minimally invasive procedure that is useful in primary tumours (especially in stage I) and metastatic ones. RF has proven its usefulness in the multidisciplinary treatment of this pathology due to the low incidence of serious complications and survival obtained, considering that patients are elderly with significant comorbidity.