Inmunoterapia en oncología: un nuevo desafío radiológico / Immunotherapy in oncology: a new challenge for radiologists

Objetivo: La inmunoterapia en oncología se ha establecido como una terapia alternativa o complementaria al tratamiento tradicional (cirugía, radioterapia y quimioterapia). La inmunoterapia disponible actualmente se divide en dos categorías: pasiva y activa. La respuesta activa refuerza el sistema inmune para responder frente a las células tumorales activando tanto la inmunidad humoral como la celular, utilizando la respuesta adaptativa. El objetivo de este trabajo es valorar los patrones radiológicos de respuesta al tratamiento inmunológico mediante los criterios de respuesta relacionados con la inmunidad (inmune related response criteria [irRC]) y describir los principales efectos adversos asociados. Conclusión: Las pruebas de imagen tienen un papel fundamental en el seguimiento y valoración de la respuesta al tratamiento en pacientes oncológicos. La inmunoterapia es un desafío en el enfoque radiológico tanto para la valoración de la respuesta al tratamiento como para la correcta detección de los efectos adversos asociados

Objective: In patients with oncologic disease, immunotherapy has become established as an alternative or complementary therapy to traditional treatment options (surgery, radiotherapy, and chemotherapy). Currently available immunotherapy modes can be divided into two types: passive and active. The active type strengthens the immune system's response to tumor cells by activating both humoral immunity and cell-mediated immunity, using the adaptive response. This article aims to analyze the radiologic patterns of the response to immunotherapy through immune-response-related criteria and to describe the main adverse effects associated with this treatment approach. Conclusion: Imaging tests play a fundamental role in the follow-up of oncologic patients and in the assessment of their response to treatment. Immunotherapy represents a challenge for radiologists both in the evaluation of the response to immunotherapy and in the detection of the adverse effects associated with this treatment approach

Immunotherapy in oncology: a new challenge for radiologists. / Inmunoterapia en oncología: un nuevo desafío radiológico.

OBJECTIVE: In patients with oncologic disease, immunotherapy has become established as an alternative or complementary therapy to traditional treatment options (surgery, radiotherapy, and chemotherapy). Currently available immunotherapy modes can be divided into two types: passive and active. The active type strengthens the immune system's response to tumor cells by activating both humoral immunity and cell-mediated immunity, using the adaptive response. This article aims to analyze the radiologic patterns of the response to immunotherapy through immune-response-related criteria and to describe the main adverse effects associated with this treatment approach. CONCLUSION: Imaging tests play a fundamental role in the follow-up of oncologic patients and in the assessment of their response to treatment. Immunotherapy represents a challenge for radiologists both in the evaluation of the response to immunotherapy and in the detection of the adverse effects associated with this treatment approach.

Defectos de perfusión en el mapa de iodo pulmonar: causas y semiología / Perfusion defects in pulmonary perfusion iodine maps: causes and semiology

Objetivo: Describir la utilidad de la tomografía computarizada con energía dual (TCED) en la obtención de mapas de perfusión pulmonar para aportar información morfológica y funcional en el tromboembolismo pulmonar (TEP). Revisar la semiología de los defectos de perfusión debidos a TEP y diferenciarlos de los defectos no debidos a TEP que son alteraciones que quedan fuera del rango utilizado en el mapa de iodo y están causados por otras enfermedades del parénquima pulmonar o por artefactos. Conclusión: La angiografía por TC de las arterias pulmonares es la técnica de elección en el diagnóstico de TEP. Las nuevas TC con energía dual son útiles para detectar defectos de perfusión secundarios a obstrucción completa o parcial de las arterias pulmonares, y tiene su mayor utilidad en la detección de TEP en ramas subsegmentarias

Objective: to describe the usefulness of dual-energy CT for obtaining pulmonary perfusion maps to provide morphological and functional information in patients with pulmonary embolisms. To review the semiology of perfusion defects due to pulmonary embolism so they can be differentiated from perfusion defects due to other causes: alterations outside the range used in the iodine map caused by other diseases of the lung parenchyma or artifacts. Conclusion: CT angiography of the pulmonary arteries is the technique of choice for the diagnosis of pulmonary embolisms. New dual-energy CT scanners are useful for detecting perfusion defects secondary to complete or partial obstruction of pulmonary arteries and is most useful for detecting pulmonary embolisms in subsegmental branches

Utilidad de la tomografía computarizada de energía dual en la reducción del artefacto metálico generado por clips y coils intracraneales / The utility of dual-energy CT for metal artifact reduction from intracranial clipping and coiling

Objetivo: Evaluar la capacidad de la TC de energía dual (TCED) para reducir el artefacto metálico en pacientes con clips y coils intracraneales en estudios de angio-TC cerebral, y analizar el diferente impacto que dicha reducción tiene en función del tipo de dispositivo estudiado. Material y métodos: Se analizaron retrospectivamente 13 pacientes (6 clips, 7 coils). Se obtuvieron imágenes virtuales monoenergéticas (IVM) en un rango de 40 a 150 keV. Se midió el ruido dentro del área de máximo artefacto. La evaluación subjetiva del ruido fue realizada independientemente por dos radiólogos. Las diferencias encontradas se evaluaron mediante el test ANOVA. El test Mann-Whitney se utilizó para comparar las diferencias entre clips y coils. Se determinó el grado de concordancia interobservador (coeficiente κ). Resultados: El ruido fue más bajo en los niveles energéticos más altos (p < 0,05). El ruido fue mayor en pacientes con coils (p < 0,001). La correlación interobservador fue buena (κ = 0,72). Conclusiones: El uso de TCED con reconstrucciones virtuales monoenergéticas ayuda a minimizar el artefacto producido por clips y coils intracraneales en estudios de angio-TC cerebral. La reduccción del artefacto conseguida es mayor en el grupo de pacientes con clips que en el grupo de pacientes con coils

Objective: To assess the ability of dual-energy CT (DECT) to reduce metal-related artifacts in patients with clips and coils in head CT angiography, and to analyze the differences in this reduction between both type of devices. Materials and methods: Thirteen patients (6 clips, 7 coils) were selected and retrospectively analized. Virtual monoenergetic images (MEI) with photon energies from 40 to 150 keV were obtained. Noise was measured at the area of maximum artifact. Subjective evaluation of streak artifact was performed by two radiologists independently. Differences between noise values in all groups were tested by using the ANOVA test. Mann-Whitney U test was used to compare the differences between clips and coils. Cohen??s κ statistic was used to determine interobserver agreement. Results: The lowest noise value was observed at high energy levels (p<0,05). Noise was higher in the coil group than in the clip group (p<0.001). Interobserver agreement was good (κ=0.72). Conclusions: TCED with MEI helps to minimize the artifact from clips ands coils in patients who undergo head CT angiography. The reduction of the artifact is greater in patients with surgical clipping than in patients with endovascular coiling

The utility of dual-energy CT for metal artifact reduction from intracranial clipping and coiling. / Utilidad de la tomografía computarizada de energía dual en la reducción del artefacto metálico generado por clips y coils intracraneales.

OBJECTIVE: To assess the ability of dual-energy CT (DECT) to reduce metal-related artifacts in patients with clips and coils in head CT angiography, and to analyze the differences in this reduction between both type of devices. MATERIALS AND METHODS: Thirteen patients (6 clips, 7 coils) were selected and retrospectively analized. Virtual monoenergetic images (MEI) with photon energies from 40 to 150 keV were obtained. Noise was measured at the area of maximum artifact. Subjective evaluation of streak artifact was performed by two radiologists independently. Differences between noise values in all groups were tested by using the ANOVA test. Mann-Whitney U test was used to compare the differences between clips and coils. Cohens κ statistic was used to determine interobserver agreement. RESULTS: The lowest noise value was observed at high energy levels (p<0,05). Noise was higher in the coil group than in the clip group (p<0.001). Interobserver agreement was good (κ=0.72). CONCLUSIONS: TCED with MEI helps to minimize the artifact from clips ands coils in patients who undergo head CT angiography. The reduction of the artifact is greater in patients with surgical clipping than in patients with endovascular coiling.

Perfusion defects in pulmonary perfusion iodine maps: causes and semiology. / Defectos de perfusión en el mapa de iodo pulmonar: causas y semiología.

OBJECTIVE: to describe the usefulness of dual-energy CT for obtaining pulmonary perfusion maps to provide morphological and functional information in patients with pulmonary embolisms. To review the semiology of perfusion defects due to pulmonary embolism so they can be differentiated from perfusion defects due to other causes: alterations outside the range used in the iodine map caused by other diseases of the lung parenchyma or artifacts. CONCLUSION: CT angiography of the pulmonary arteries is the technique of choice for the diagnosis of pulmonary embolisms. New dual-energy CT scanners are useful for detecting perfusion defects secondary to complete or partial obstruction of pulmonary arteries and is most useful for detecting pulmonary embolisms in subsegmental branches.

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.