La PET-TC en la estadificación ganglionar prequirúrgica del carcinoma de pulmón de células no pequeñas: implicación de los falsos negativos y falsos positivos / PET-CT in presurgical lymph node staging in non-small cell lung cancer: the importance of false-negative and false-positive findings

Objetivo. Valorar las implicaciones de los falsos negativos (FN) y de los falsos positivos (FP) de la tomografía computarizada (TC) y la tomografía por emisión de positrones (PET) con fluorodesoxiglucosa (18F-FDG) en nuestro medio en la estadificación ganglionar mediastínica de pacientes operados de carcinoma de pulmón de células no pequeñas (CPCNP). Material y métodos. Estudio retrospectivo de 113 pacientes consecutivos con 120 CPCNP operados; 22 pacientes recibieron tratamiento neoadyuvante. Se compararon los resultados obtenidos en la 18F-FDG PET-TC prequirúrgica con los patológicos. Se analizaron el tamaño ganglionar y del tumor primario en la TC, y su valoración cualitativa y semicuantitativa (SUVmáx) en la PET. Resultados. Se encontraron ganglios metastásicos en el 21,7% de los 120 tumores y en el 7,7% de las 528 estaciones ganglionares analizadas. La 18F-FDG PET-TC en el estudio por tumor mostró una sensibilidad del 53,8%, una especificidad del 76,6%, un valor predictivo positivo del 38,9%, un valor predictivo negativo del 85,7% y una precisión diagnóstica del 71,7%. La tasa de FN fue del 14,2%. El análisis multivariable mostró que un grado de diferenciación moderado del tumor primario (p = 0,005) y una SUVmáx del tumor primario >4 (p = 0,027) eran los factores asociados con los FN. La tasa de FP fue del 61,1% y el tamaño ganglionar >1cm era el factor asociado con los FP (p <0,001). Conclusiones. La 18F-FDG PET-TC en la estadificación ganglionar mediastínica de pacientes con CPCNP mejora la especificidad y el valor predictivo negativo, y ayuda al clínico a seleccionar los pacientes que se beneficiarán de la cirugía. Dada la elevada tasa de FP, es recomendable que, antes de excluir a pacientes de la cirugía, se confirmen histológicamente los casos positivos (AU)

Objective. To assess the importance of false-negative and false-positive findings in computed tomography (CT) and 18F-FDG positron emission tomography (PET) in mediastinal lymph node staging in patients undergoing surgery for non-small cell lung cancer (NSCLC). Material and methods. This retrospective study included 113 consecutive patients and 120 resected NSCLCs; 22 patients received neoadjuvant treatment. We compared the findings on preoperative 18F-FDG PET-CT studies with the postoperative pathology findings. Lymph node size and primary tumor size were measured with CT, and lymph nodes and primary tumors were evaluated qualitatively and semiquantitatively (using standardized uptake values (SUVmax)) with PET. Results. Metastatic lymph nodes were found in 26 (21.7%) of the 120 tumors and in 41 (7.7%) of the 528 lymph node stations analyzed. 18F-FDG PET-CT yielded 53.8% sensitivity, 76.6% specificity, 38.9% positive predictive value, 85.7% negative predictive value, and 71.7% diagnostic accuracy. The false-negative rate was 14.2%. Multivariable analysis found that the factors associated with false-negative findings were a moderate degree of differentiation in the primary tumor (p = 0.005) and an SUVmax of the primary tumor >4 (p = 0.027). The false-positive rate was 61.1%, and the multivariable analysis found that lymph node size >1cm was associated with false-positive findings (p < 0.001). Conclusions. In mediastinal lymph node staging in patients with NSCLC, 18F-FDG PET-CT improves the specificity and negative predictive value and helps clinicians to select the patients that will benefit from surgery. Given the high rate of false positives, histological confirmation of positive cases is recommendable (AU)

PET-CT in presurgical lymph node staging in non-small cell lung cancer: the importance of false-negative and false-positive findings. / La PET-TC en la estadificación ganglionar prequirúrgica del carcinoma de pulmón de células no pequeñas: implicación de los falsos negativos y falsos positivos.

OBJECTIVE: To assess the importance of false-negative and false-positive findings in computed tomography (CT) and 18F-FDG positron emission tomography (PET) in mediastinal lymph node staging in patients undergoing surgery for non-small cell lung cancer (NSCLC). MATERIAL AND METHODS: This retrospective study included 113 consecutive patients and 120 resected NSCLCs; 22 patients received neoadjuvant treatment. We compared the findings on preoperative 18F-FDG PET-CT studies with the postoperative pathology findings. Lymph node size and primary tumor size were measured with CT, and lymph nodes and primary tumors were evaluated qualitatively and semiquantitatively (using standardized uptake values (SUVmax)) with PET. RESULTS: Metastatic lymph nodes were found in 26 (21.7%) of the 120 tumors and in 41 (7.7%) of the 528 lymph node stations analyzed. 18F-FDG PET-CT yielded 53.8% sensitivity, 76.6% specificity, 38.9% positive predictive value, 85.7% negative predictive value, and 71.7% diagnostic accuracy. The false-negative rate was 14.2%. Multivariable analysis found that the factors associated with false-negative findings were a moderate degree of differentiation in the primary tumor (p = 0.005) and an SUVmax of the primary tumor >4 (p = 0.027). The false-positive rate was 61.1%, and the multivariable analysis found that lymph node size >1cm was associated with false-positive findings (p < 0.001). CONCLUSIONS: In mediastinal lymph node staging in patients with NSCLC, 18F-FDG PET-CT improves the specificity and negative predictive value and helps clinicians to select the patients that will benefit from surgery. Given the high rate of false positives, histological confirmation of positive cases is recommendable.

Resonancia magnética cardíaca prequirúrgica y de seguimiento en pacientes candidatos a endoventriculoplastia / Preoperative and follow-up cardiac magnetic resonance imaging of candidates for surgical ventricular restoration

Objetivo. Valorar con resonancia magnética cardíaca (RMC) el resultado de la endoventriculoplastia y compararlo con los hallazgos prequirúrgicos en pacientes con miocardiopatía dilatada isquémica y aneurisma ventricular. Material y métodos. Revisamos retrospectivamente 21 pacientes consecutivos con miocardiopatía dilatada isquémica sometidos a endoventriculoplastia entre enero de 2007 y marzo de 2013. En 12 de ellos se realizó RMC pre- y posquirúrgica. En las RMC diagnóstica y posquirúrgica se hizo un análisis cuantitativo de la fracción de eyección (FEVI), volúmenes telediastólico (VTDVI) y telesistólico (VTSVI) del ventrículo izquierdo indexados, y se valoraron las valvulopatías y trombos intracavitarios. El tiempo transcurrido entre la intervención quirúrgica y los estudios de control con RMC osciló entre 3 y 24 meses. Resultados. La FEVI y los VTDVI y VTSVI pre- y posquirúrgicos fueron significativamente diferentes. La mediana de la FEVI aumentó el 10% (rango intercuartílico: 2-15) (p = 0,003); la mediana del VTDVI disminuyó 38 ml/m2 (rango intercuartílico: 18-52) (p = 0,006), y la mediana del VTSVI disminuyó 45 ml/m2 (rango intercuartílico: 12-60) (p = 0,008). La reducción del volumen posquirúrgico fue mayor en pacientes con VTSVI basal > 110 ml/m2 (59 ml/m2 y 12 ml/m2, p = 0,006). Conclusión. En pacientes con cardiopatía isquémica candidatos a endoventriculoplastia, la RMC es una técnica incruenta, reproducible y fiable para estudiar la cicatriz miocárdica antes de la intervención y los volúmenes ventriculares y su evolución tras la endoventriculoplastia (AU)

Purpose. To assess pre and post-operative cardiac MRI (CMR) findings in patients with left endoventriculoplasty repair for ventricular aneurysm due to ischemic heart disease. Material and methods. Data were retrospectively gathered on 21 patients with diagnosis of ventricular aneurysm secondary to ischemic heart disease undergoing left endoventriculoplasty repair between January 2007 and March 2013. Pre and post-operative CMR was performed in 12 patients. The following data were evaluated in pre-operative and post-operative CMR studies: quantitative analysis of left ventricular ejection fraction (LVEF), left ventricular end-diastolic (LVEDV) and end-systolic (LVESV) volume index, presence of valvular disease and intracardiac thrombi. The time between surgery and post-operative CRM studies was 3-24 months. Results. Significant differences were found in the pre and post-operative LVEF, LVEDV and LVESV data. EF showed a median increase of 10% (IQR 2-15) (p = 0.003). The LVEDV showed a median decrease of 38 ml/m2 (IQR 18-52) (p = 0.006) and the LVESV showed a median decrease of 45 ml/m2 (IQR:12-60) (p = 0.008). Post-operative ventricular volume reduction was significantly higher in those patients with preoperative LVESV >110 ml/m2 (59 ml/m2 and 12 ml/m2, p = 0.006). Conclusion. In patients with ischemic heart disease that are candidates for left endoventriculoplasty, CMR is a reliable non-invasive and reproducible technique for the evaluation of the scar before the surgery and the ventricular volumes and its evolution after endoventricular surgical repair (AU)

[Preoperative and follow-up cardiac magnetic resonance imaging of candidates for surgical ventricular restoration]. / Resonancia magnética cardíaca prequirúrgica y de seguimiento en pacientes candidatos a endoventriculoplastia.

PURPOSE: To assess pre and post-operative cardiac MRI (CMR) findings in patients with left endoventriculoplasty repair for ventricular aneurysm due to ischemic heart disease. MATERIAL AND METHODS: Data were retrospectively gathered on 21 patients with diagnosis of ventricular aneurysm secondary to ischemic heart disease undergoing left endoventriculoplasty repair between January 2007 and March 2013. Pre and post-operative CMR was performed in 12 patients. The following data were evaluated in pre-operative and post-operative CMR studies: quantitative analysis of left ventricular ejection fraction (LVEF), left ventricular end-diastolic (LVEDV) and end-systolic (LVESV) volume index, presence of valvular disease and intracardiac thrombi. The time between surgery and post-operative CRM studies was 3-24 months. RESULTS: Significant differences were found in the pre and post-operative LVEF, LVEDV and LVESV data. EF showed a median increase of 10% (IQR 2-15) (p=0.003). The LVEDV showed a median decrease of 38 ml/m(2) (IQR 18-52) (p=0.006) and the LVESV showed a median decrease of 45 ml/m(2) (IQR:12-60) (p=0.008). Post-operative ventricular volume reduction was significantly higher in those patients with preoperative LVESV >110 ml/m(2) (59 ml/m(2) and 12 ml/m(2), p=0.006). CONCLUSION: In patients with ischemic heart disease that are candidates for left endoventriculoplasty, CMR is a reliable non-invasive and reproducible technique for the evaluation of the scar before the surgery and the ventricular volumes and its evolution after endoventricular surgical repair.

Los patrones de vascularización pulmonar en la radiografía simple de tórax / Patterns of pulmonary vascularization on plain-film chest X-rays

La radiografía de tórax no es solo una prueba radiológica fundamental, sino que es una herramienta básica en el ejercicio de la medicina. La aparente sencillez de la radiografía de tórax nos hace a veces olvidar que interpretarla correctamente puede aportar información muy valiosa, sobre todo si la lectura se apoya en datos clínicos clave. Para interpretar una radiografía de tórax es importante prestar atención a la vascularización pulmonar. En este artículo se revisa la forma y la distribución normal de los vasos pulmonares en la radiografía de tórax y los principales patrones vasculares patológicos que podemos encontrar, el de la hipertensión pulmonar, la hiperemia, hipovascularización, y el patrón de vascularización vicariante (AU)

Plain chest films are a fundamental tool in the practice of medicine. The apparent simplicity of plain chest films sometimes leads us to forget that interpreting them correctly can provide very valuable information, especially if the interpretation is grounded in key clinical information. To interpret a plain chest film, it is important to pay attention to the pulmonary vascularization. This article reviews the normal shape and distribution of the pulmonary vessels on plain chest films and the most common pathologic vascular patterns, including those seen in pulmonary hypertension, hyperemia, hypovascularization, and alternative perfusion (AU)

[Patterns of pulmonary vascularization on plain-film chest X-rays]. / Los patrones de vascularización pulmonar en la radiografía simple de tórax.

Plain chest films are a fundamental tool in the practice of medicine. The apparent simplicity of plain chest films sometimes leads us to forget that interpreting them correctly can provide very valuable information, especially if the interpretation is grounded in key clinical information. To interpret a plain chest film, it is important to pay attention to the pulmonary vascularization. This article reviews the normal shape and distribution of the pulmonary vessels on plain chest films and the most common pathologic vascular patterns, including those seen in pulmonary hypertension, hyperemia, hypovascularization, and alternative perfusion.

Miocarditis: diagnóstico y seguimiento con resonancia magnética / Myocarditis: magnetic resonance imaging diagnosis and follow-up

La miocarditis consiste en la inflamación del miocardio, producida la mayoría de las veces por una infección viral. La confirmación diagnóstica en la práctica clínica habitual es difícil porque la historia clínica y la exploración física, las alteraciones en el electrocardiograma, la determinación de las enzimas cardiacas y el ecocardiograma ofrecen escasa precisión diagnóstica, y no es infrecuente que se plantee el diagnóstico diferencial con el infarto agudo de miocardio. La resonancia magnética (RM) cardiaca se ha convertido en el método de imagen de elección para el diagnóstico de la miocarditis. En este trabajo se describen los hallazgos de imagen en la RM en el momento del diagnóstico y en el seguimiento de los pacientes con miocarditis, el diagnóstico diferencial con otros procesos agudos como el infarto de miocardio, y los factores pronósticos estudiados mediante RM (AU)

Myocarditis, inflammation of the myocardium, is usually due to viral infection. Diagnostic confirmation in ordinary clinical practice is difficult because the findings on the clinical history, physical examination, electrocardiogram, and laboratory tests offer scant diagnostic accuracy, and the differential diagnosis is often done with acute myocardial infarction. Cardiac magnetic resonance imaging (CMR) has become the method of choice for the diagnosis of myocarditis. In this article, we describe the CMR findings at diagnosis and during the follow-up of patients with myocarditis, the differential diagnosis with other acute processes like myocardial infarction, and the prognostic factors studied with CMR (AU)

[Myocarditis: magnetic resonance imaging diagnosis and follow-up]. / Miocarditis: diagnóstico y seguimiento con resonancia magnética.

Myocarditis, inflammation of the myocardium, is usually due to viral infection. Diagnostic confirmation in ordinary clinical practice is difficult because the findings on the clinical history, physical examination, electrocardiogram, and laboratory tests offer scant diagnostic accuracy, and the differential diagnosis is often done with acute myocardial infarction. Cardiac magnetic resonance imaging (CMR) has become the method of choice for the diagnosis of myocarditis. In this article, we describe the CMR findings at diagnosis and during the follow-up of patients with myocarditis, the differential diagnosis with other acute processes like myocardial infarction, and the prognostic factors studied with CMR.

Amiloidosis nodular pulmonar / Nodular pulmonary amyloidosis

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Silicoantracosis: una forma de presentación clinicorradiológica excepcional simulando metástasis pulmonares / Anthracosilicosis: a rare clinical and radiological presentation simulating lung metastases

El caso que presentamos es el de un paciente asintomático con un diagnóstico clínico rradiológico inicial de metástasis pulmonares. Una vez efectuado el estudio anatomopatológico de las lesiones pulmonares, se realiza el diagnóstico final de silicoantracosis. Tras una exhaustiva revisión bibliográfica, se ha comprobado que el caso de silicoantracosis que se presenta tiene una forma de presentación excepcional, tanto en las manifestaciones radiológicas como en el largo período de latencia (unos 50 años) entre una breve exposición al polvo del carbón (de 6 años) y la expresión radiológica (AU)

We present the case of an asymptomatic patient with an initial clinical and radiological diagnosis of lung metastases in whom histological study diagnosed anthracosilicosis. A review of the literature shows that this presentation of anthracosilicosis is exceptional; our patient had atypical radiological findings and a very long latency period (over 50 years) after a brief (nearly 6 years) exposure to coal dust (AU)

[Anthracosilicosis: a rare clinical and radiological presentation simulating lung metastases]. / Silicoantracosis: una forma de presentación clinicorradiológica excepcional simulando metástasis pulmonares.

We present the case of an asymptomatic patient with an initial clinical and radiological diagnosis of lung metastases in whom histological study diagnosed anthracosilicosis. A review of the literature shows that this presentation of anthracosilicosis is exceptional; our patient had atypical radiological findings and a very long latency period (over 50 years) after a brief (nearly 6 years) exposure to coal dust.

Paragangliomas mediastínicos: a propósito de 2 casos / Mediastinal paragangliomas: a report of 2 cases

Los paragangliomas son tumores neuroendocrinos derivados de las células cromafines del sistema simpático extraadrenal y representan una patología excepcional dentro del mediastino.Se exponen los hallazgos radiológicos en 2 pacientes diagnosticadas de paraganglioma aorticopulmonar no funcionante y de paraganglioma aorticosimpático funcionante localmente agresivo, tras la observación inicial de una masa mediastínica en la radiografía simple de tórax (AU)

Paragangliomas are neuroendocrine tumors derived from chromaffin cells of the extraadrenal sympathetic system; mediastinal paragangliomas are rare. We illustrate and describe the imaging findings in two cases of mediastinal paraganglioma, one nonfunctional aorticopulmonary paraganglioma and one locally aggressive functional aorticosympathetic paraganglioma first observed as a mediastinal mass on chest plain-film radiographs (AU)

Trombo cardíaco calcificado en un paciente con síndrome antifosfolípido / Calcified cardiac thrombus in a patient with antiphospholipid syndrome

El síndrome antifosfolípido es una entidad clínica poco frecuente que se manifiesta por fenómenos trombóticos de repetición en pacientes jóvenes sin factores de riesgo cardiovascular. Sus formas de presentación más habituales son los abortos de repetición y el accidente cerebrovascular. La afectación cardíaca es menos frecuente.Se presenta el caso de una mujer de 30 años, con un trombo cardíaco calcificado localizado en el ventrículo derecho con extensión a la arteria pulmonar, que fue diagnosticada de síndrome antifosfolípido. La paciente tenía antecedentes de abortos de repetición (AU)

Antiphospholipid syndrome is a rare clinical entity that manifests through repeated thrombotic events in young patients without cardiovascular risk factors. The most frequent clinical features are repeated fetal losses and acute cerebral ischemic events. Cardiac involvement is less frequent.We present the case of a calcified thrombus in the right ventricle with extension to the pulmonary artery in a 30-year-old woman with a history of recurrent miscarriage who was diagnosed with antiphospholipid syndrome (AU)

[Mediastinal paragangliomas: a report of 2 cases]. / Paragangliomas mediastínicos: a propósito de 2 casos.

Paragangliomas are neuroendocrine tumors derived from chromaffin cells of the extraadrenal sympathetic system; mediastinal paragangliomas are rare. We illustrate and describe the imaging findings in two cases of mediastinal paraganglioma, one nonfunctional aorticopulmonary paraganglioma and one locally aggressive functional aorticosympathetic paraganglioma first observed as a mediastinal mass on chest plain-film radiographs.

[Calcified cardiac thrombus in a patient with antiphospholipid syndrome]. / Trombo cardíaco calcificado en un paciente con síndrome antifosfolípido.

Antiphospholipid syndrome is a rare clinical entity that manifests through repeated thrombotic events in young patients without cardiovascular risk factors. The most frequent clinical features are repeated fetal losses and acute cerebral ischemic events. Cardiac involvement is less frequent. We present the case of a calcified thrombus in the right ventricle with extension to the pulmonary artery in a 30-year-old woman with a history of recurrent miscarriage who was diagnosed with antiphospholipid syndrome.