Actualización de los tumores cartilaginosos según la clasificación de la OMS de 2020 / Update of cartilaginous tumours according to the WHO classification 2020

Los tumores cartilaginosos son un grupo amplio y heterogéneo de neoplasias caracterizadas por la presencia de una matriz condroide que presenta crecimiento lobular y patrones de calcificación en arcos y anillos o en palomitas de maíz. En RM destaca su hiperintensidad en las secuencias potenciadas en T2, y en las imágenes poscontraste, un relace lobulado o septal. En la clasificación de 2020 de la OMS, los tumores de estirpe condral se clasifican en benignos, intermedios o malignos. A pesar de los avances tecnológicos, siguen suponiendo un reto tanto para el radiólogo como para el patólogo, siendo la principal dificultad la diferenciación entre los tumores benignos y malignos, razón por la que requieren un abordaje multidisciplinar. Este trabajo recoge los principales cambios introducidos en la actualización de 2020, describe las características de imagen de los principales tumores cartilaginosos y proporciona las claves radiológicas para diferenciar entre tumores benignos y malignos.(AU)

Cartilaginous tumours are a large and heterogeneous group of neoplasms characterised by the presence of a chondroid matrix, with lobular growth and arcuate, ring-like or popcorn-like calcification patterns. MRI shows hyperintensity in T2-weighted sequences and a lobulated or septal relief in postcontrast images. In the WHO 2020 classification, chondral tumours are classified as benign, intermediate or malignant. Despite technological advances, they continue to pose a challenge for both the radiologist and the pathologist, being the main difficulty the differentiation between benign and malignant tumours, which is why they require a multidisciplinary approach. This paper describes the main changes introduced in the 2020 update, describes the imaging characteristics of the main cartilaginous tumours and provides the radiological keys to differentiate between benign and malignant tumours.(AU)

Update of cartilaginous tumours according to the WHO classification 2020.

Cartilaginous tumours are a large and heterogeneous group of neoplasms characterised by the presence of a chondroid matrix, with lobular growth and arcuate, ring-like or popcorn-like calcification patterns. MRI shows hyperintensity in T2-weighted sequences and a lobulated or septal relief in postcontrast images. In the WHO 2020 classification, chondral tumours are classified as benign, intermediate or malignant. Despite technological advances, they continue to pose a challenge for both the radiologist and the pathologist, being the main difficulty the differentiation between benign and malignant tumours, which is why they require a multidisciplinary approach. This paper describes the main changes introduced in the 2020 update, describes the imaging characteristics of the main cartilaginous tumours and provides the radiological keys to differentiate between benign and malignant tumours.

Adenomatosis hepática múltiple con captación de 18F-FDG: una manifestación rara de una entidad poco frecuente / Multiple liver adenomatosis with 18F-FDG uptake: a rare manifestation of an infrequent entity

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18F-FDG PET-CT imaging in the neoadjuvant setting for stages II-III breast cancer: association of loco­regional SUVmax with classical prognostic factors.

AIM: Classical prognostic and predictive factors serve to predict outcome and response to neoadjuvant treatment in stage II and III breast cancer. The purpose is to determine the relation between the SUVmax of the locoregional disease with these classical prognostic factors. METHODS: A prospective study including 43 stage II and III breast cancer patients was performed. In all the patients, two 18F-FDG PET-CT studies were performed before and after neoadjuvant chemotherapy. After this treatment, surgery and adjuvant treatment were carried out. To combine the information of the locoregional disease, the SUVmax of the lesion (tumor or abnormal lymphnodes) with the highest uptake was used. SUVmax and prognostic factors were studied with the Kruskal-Wallis non-parametric test and with the Mann-Whitney U. RESULTS: A statistically significant association between elevated SUVmax value and absence of estrogen receptors (ER) expression (16 vs.. 10; P<0.019) was found. Locorregional disease with positive HER2 phenotype had a statistically significant SUVmax value greater than Luminal A (estrogen and/or progesterone positive receptors with Ki67<15%) and B (estrogen and/or progesterone positive receptors with Ki67≥to 15%) (13.4 vs. 7.9 and 8.9; P<0.022 and P<0.024, respectively). Triple negative phenotype disease had higher SUVmax than Luminal A and B (15.4; P<0.030 and P<0.038). Positive correlation between the percentage of the Ki67 Proliferation Index and SUVmax (P<0.007) was demonstrated. High grade disease had a higher SUVmax than low grade (P<0.004). CONCLUSION: Locorregional SUVmax is associated to prognostic and predictive factors and reaffirms the utility of PET-CT as a tool in the common clinical practice.

Sistemas de registro automático de pacientes en instalaciones de radiología digital. Historial dosimétrico / Automatic registration of patients in digital radiology facilities: Dosimetric record

Actualmente, existe consenso en la comunidad internacional, tanto en la necesidad como en los beneficios del registro sistemático y planificado de los indicadores de dosis a los pacientes en las exposiciones médicas con radiación ionizante, con principal interés en el registro y seguimiento de las técnicas y procedimientos que pueden implicar un mayor riesgo para los pacientes derivado del uso de la radiación. Este registro debe ser planificado con la estructura y herramientas necesarias para que se tenga en cuenta la seguridad radiológica del paciente, permitiendo al médico solicitante del estudio acceder a la información más relevante del registro, con el objeto de justificar adecuadamente la petición de los nuevos estudios a realizar. Asimismo, debería considerarse una prioridad el establecimiento de niveles de referencia diagnósticos para las distintas magnitudes que se definan en función de la modalidad y prestación a realizar, siendo de gran interés el conocimiento de esta información por el personal involucrado en la realización de los procedimientos con radiaciones ionizantes (AU)

There is a consensus in the international community regarding both the need for and benefits of systematic registration and planning of the dosage indicators in patients exposed to ionizing radiation. The main interest is in the registration and follow-up of the techniques and procedures that can involve the greatest risk from exposure to radiation. This register should be planned to include the structure and tools necessary to take the radiological safety of the patients into account, enabling the physicians requesting the studies to access the most important information in the register so they can appropriately justify the request for additional studies. Likewise, it should be considered a priority to establish diagnostic reference levels for the different magnitudes that are defined in function of the modality and techniques used; this information is useful for the staff involved in procedures that use ionizing radiation (AU)

[Automatic registration of patients in digital radiology facilities: dosimetric record]. / Sistemas de registro automático de pacientes en instalaciones de radiología digital. Historial dosimétrico.

There is a consensus in the international community regarding both the need for and benefits of systematic registration and planning of the dosage indicators in patients exposed to ionizing radiation. The main interest is in the registration and follow-up of the techniques and procedures that can involve the greatest risk from exposure to radiation. This register should be planned to include the structure and tools necessary to take the radiological safety of the patients into account, enabling the physicians requesting the studies to access the most important information in the register so they can appropriately justify the request for additional studies. Likewise, it should be considered a priority to establish diagnostic reference levels for the different magnitudes that are defined in function of the modality and techniques used; this information is useful for the staff involved in procedures that use ionizing radiation.

Prevalence of fenestrated basilar artery with magnetic resonance angiography: a transversal study.

Fenestration of the basilar artery (BA) is a rare anatomical variation in comparison to those of the other intracranial arteries constituting the cerebral arterial circle. The incidence is difficult to ascertain and data vary according to type of series and modalities of detection. Basilar artery fenestration (BAF) has been reported in association with arteriovenous malformations, vascular variants, other developmental anomalies and neurovascular conflicts as a consequence of relations between the arterial branches of the BA and the nerves and other structures in the posterior cranial fossa. However, the real clinical interest of BAF is due to the possible formation of an aneurysm at the junction of the fenestrated segment and less frequently to the thrombosis of the vessels. With the aim to establish the prevalence of BAF in our population, we made a transversal pilot study of the first 200 MR angiographies performed on patients attending for the first time to control their base pathology (vascular or not). We have described three patients with this condition (representing a prevalence of 1.5 % on MR angiography) to shed additional light on this anomaly, two cases located at 1/3 proximal end (type 1-BAF) and one case located at joint 1/3 medium-1/3 distal end, locating distal to the anterior inferior cerebellar artery (type 4-BAF). In neither case was any other lesion found (i.e. aneurysm, infarctions, ischemia or thromboembolism). The pertinent clinical anatomy and embryological basis for this variation are reviewed, and the possible clinical implications and associated findings are discussed.

Calidad diagnóstica y repercusión del empleo de contrastes en los estudios de tomografía computarizada de exploraciones con tomografía por emisión de positrones en combinación con tomografía computarizada / The impact on diagnostic quality of using contrast media in PET-CT studies

Objetivo. Valorar la repercusión del uso de contrastes radiológicos en las exploraciones de tomografía por emisión de positrones en combinación con tomografía computarizada (PET-TC) utilizados en nuestro centro. Material y métodos. Los estudios se realizaron en un equipo PET-TC con una TC multidetector de 6 detectores. La población estudiada fueron pacientes oncológicos. Las indicaciones para realizar estos estudios fueron las incluidas en la ficha técnica de la 18F-2-fluoro-2-desoxi-D-glucosa. Se realizó un estudio retrospectivo observacional con el fin de valorar la calidad de los estudios PET-TC realizados con contrastes radiológicos y la presencia de artefactos generados por estos contrastes. Resultados. Entre febrero y junio de 2009 se han realizado 612 exploraciones PET-TC. Trescientas sesenta y nueve fueron en varones y 243 en mujeres. Se administró contraste iodado intravenoso en el 48% de los pacientes y oral en el 18%. La calidad diagnóstica se valoró como alta en el 93,5% de los estudios, como media en el 4,3% y como baja en el 2,2%. De las TC realizadas con contraste intravenoso se identificaron artefactos por contraste en el 8%, y en el 1,4% ocasionaron dudas diagnósticas en la PET. El contraste oral no produjo problemas diagnósticos en ninguna ocasión. Conclusiones. En el análisis de nuestros estudios hemos observado que el uso de contrastes radiológicos en las exploraciones PET-TC no deteriora la calidad diagnóstica ni altera el flujo de trabajo. Si a esto se añade que una TC de alta calidad diagnóstica puede mejorar la capacidad de detección de la PET-TC nos parece adecuado incluirla en los protocolos de exploración (AU)

Objective. To evaluate the impact of using radiologic contrast media on the quality of PET-CT studies at our center. Material and methods. This is a retrospective observational study to evaluate the quality of the PET-CT studies carried out with radiologic contrast media and the presence of artifacts due to these contrast agents. Oncologic patients in whom PET was indicated according to the manufacturer's specifications for FDG (18F-2-fluoro-2-deoxy-D-glucose) underwent PET-CT study on a PET-CT system with a six-detector-row CT scanner. Results. Between February 2009 and June 2009, we performed 612 PET-CT examinations in 369 male patients and 243 female patients. Iodinated contrast media were administered intravenously in 48% and orally in 18%. Diagnostic quality was considered high in 93.5% of the studies, intermediate in 4.3%, and low in 2.2%. In the CT studies performed using intravenous contrast agents, artifacts were identified in 8% and resulted in diagnostic uncertainty in the PET study in 1.4%. We found no diagnostic problems caused by oral contrast agents in any case. Conclusions. The use of radiologic contrast agents in PET-CT studies does not negatively affect diagnostic quality or workflow. Given that we can improve the ability of PET-CT to detect lesions by enhancing the diagnostic quality of the CT study, we consider it appropriate to include the administration of contrast agents in protocols for PET-CT studies (AU)

[The impact on diagnostic quality of using contrast media in PET-CT studies]. / Calidad diagnóstica y repercusión del empleo de contrastes en los estudios de tomografía computarizada de exploraciones con tomografía por emisión de positrones en combinación con tomografía computarizada.

OBJECTIVE: To evaluate the impact of using radiologic contrast media on the quality of PET-CT studies at our center. MATERIAL AND METHODS: This is a retrospective observational study to evaluate the quality of the PET-CT studies carried out with radiologic contrast media and the presence of artifacts due to these contrast agents. Oncologic patients in whom PET was indicated according to the manufacturer's specifications for FDG ((18)F-2-fluoro-2-deoxy-D-glucose) underwent PET-CT study on a PET-CT system with a six-detector-row CT scanner. RESULTS: Between February 2009 and June 2009, we performed 612 PET-CT examinations in 369 male patients and 243 female patients. Iodinated contrast media were administered intravenously in 48% and orally in 18%. Diagnostic quality was considered high in 93.5% of the studies, intermediate in 4.3%, and low in 2.2%. In the CT studies performed using intravenous contrast agents, artifacts were identified in 8% and resulted in diagnostic uncertainty in the PET study in 1.4%. We found no diagnostic problems caused by oral contrast agents in any case. CONCLUSIONS: The use of radiologic contrast agents in PET-CT studies does not negatively affect diagnostic quality or workflow. Given that we can improve the ability of PET-CT to detect lesions by enhancing the diagnostic quality of the CT study, we consider it appropriate to include the administration of contrast agents in protocols for PET-CT studies.

Callosal atrophy and associated electromyographic responses in Alzheimer's disease and aging.

Alzheimer's disease is a degenerative disorder characterised by cerebral atrophy with cortical and subcortical changes. Our objective is to investigate the patterns of atrophic changes in the corpus callosum in patients with Alzheimer's disease and healthy elderly subjects and to clarify the relations of callosal impairment and the presence of associated electromyographic responses. We compare cross-sectional area of the corpus callosum by age, group and associated electromyographic responses, using quantitative magnetic resonance imaging from 47 subjects (twenty four healthy subjects and twenty three Alzheimer's disease patients). The control population was selected by criteria of optimal health; medical, neurological or psychiatric illnesses were excluded. We find that the first anterior and medial-anterior corpus callosum areas show an atrophy in Alzheimer group patients. These sectors show a clear relationship with the presence of associated movements.