Repeated stereotactic radiosurgery for recurrent brain metastases: An effective strategy to control intracranial oligometastatic disease.

Due to improvements in systemic therapies and longer survivals, cancer patients frequently present with recurrent brain metastases (BM). The optimal therapeutic strategies for limited brain relapse remain undefined. We analyzed tumor control and survival in patients treated with salvage focal radiotherapy in our center. Thirty-three patients with 112 BM received salvage stereotactic radiosurgery (SRS) or fractionated stereotactic radiotherapy (FSRT) for local or regional recurrences. Local progression was observed in 11 BM (9.8 %). After 1 year, 72 % of patients were free of distant brain failure, and the 2-year overall survival (OS) was 37.7 %. No increase in toxicity or neurologically related deaths were observed. The 2- and 3-year whole brain radiation therapy free survival (WFS) rates were 92.9 % and 77.4 %, respectively. Hence, focal radiotherapy is a feasible salvage of recurrent BM in selected group of patients with limited brain disease, achieving a maintained intracranial control and less neurological toxicity.

Infratentorial hygroma secondary to decompressive craniectomy after cerebellar infarction.

We present a case of expansive CSF collection in the cerebellar convexity. The patient was a 74 years old lady who one month before had suffered a cerebellar infarct complicated with acute hydrocephalus. She had good evolution after decompressive craniectomy without shunting. Fifteen days after surgery, the patient started with new positional vertigo, nausea and vomiting and a wound CSF fistula that needed ventriculoperitoneal shunt (medium pressure) because conservative treatment failed. After shunting, the fistula closed, but the patient symptoms worsened. The MRI showed normal ventricular size with a cerebellar hygroma, extending to the posterior interhemispheric fissure. The collection had no blood signal and expanded during observation. A catheter was implanted in the collection and connected to the shunt. The patient became asymptomatic after surgery, and the hygromas had disappeared in control CT at one month. This case shows an infrequent problem of CSF circulation at posterior fossa that resulted in vertigo of central origin. A higroma-ventricle-peritoneal shunt solved the symptoms of the patient.

[Usefulness of maximum intensity projections in low-radiation multislice CT lung cancer screening]. / Utilidad de la reconstrucción de proyección de máxima intensidad para la lectura de los estudios realizados en un programa de detección precoz de cáncer de pulmón por tomografía computarizada multicorte de baja dosis de radiación.

OBJECTIVE: To evaluate the diagnostic accuracy of non-overlapping 10-mm-thick axial maximum intensity projections (MIP) in the detection of pulmonary nodules in subjects participating in a lung cancer screening program (LCSP) using multislice computed tomography (MSCT) with a low dose of radiation. MATERIAL AND METHODS: We evaluated 52 consecutive low-radiation MSCT studies in asymptomatic smokers included in an LCSP (1.25 mm axial images). Axial MIPs with 10mm slice thickness (30 images) were performed and evaluated retrospectively; readers were blind to the initial radiological report. All nodules detected were considered, regardless of their size or consistency. The standard of reference was determined by double reading and consensus for each nodule. RESULTS: A total of 162 pulmonary nodules (mean size: 3.9 mm, sd: 1.7) were detected. MIP reconstruction detected 150 nodules (S = 92.6%). The initial radiological evaluation detected 108 nodules (S = 66.7%). MIP reconstruction detected 54 (33.3%) nodules that were not reported initially (mean size: 3.4 mm; sd: 1.2) but failed to detect 12 (7.4%) of the nodules reported initially (mean size: 2.91 mm; sd: 0.8). MIP detected all 35 nodules > or = 5 mm, (S =100), whereas the initial radiological evaluation only detected 27 (S = 77%). MIP reconstruction enabled more of the nodules to be detected than the 1.25-mm conventional axial slices (p < 0.01). CONCLUSION: The introduction of non-overlapping 10-mm-thick axial MIP reconstructions in a low-radiation LCSP using MSCT enabled nodules more accurate and faster detection of pulmonary nodules in comparison with 1.25 mm conventional axial slices.

[Quantification of ventricular mass and function using real-time free-breathing SSFP sequences]. / Cuantificación de la función y masa ventricular con secuencias SSFP en tiempo real y respiración libre.

OBJECTIVES: To compare real-time free-breathing steady-state free precession (SSFP) sequences with conventional breath-hold segmented SSFP sequences on the quantification of ventricular mass and function. MATERIAL AND METHODS: Cardiac function and mass were assessed in 15 consecutive patients with cardiopathies who underwent MRI for diverse indications. Sequences were planned in the short axis to include the area from the base to the apex of the ventricle. Two sequences were used: 1) a conventional breath-hold segmented SSFP sequence with 7-mm-thick slices and 3-mm gap between slices and 2) a real-time free-breathing SSFP sequence with 10-mm-thick slices. The systolic and diastolic volumes (VTD, VTS) and ejection fraction (EF) of both ventricles were evaluated and the mass of the left ventricle (LVM) was measured. The correlation between the different sequences was studied for each variable. RESULTS: An excellent correlation was observed between the two sequences on the quantification of cardiac parameters in both ventricles (0.9; p < 0.01). The mean differences for EF, VTD, VTS, and stroke volume (VTD-VTS) were 2.5% (2.1), 5.6 ml (14.2), -0.8 ml (6.4), 6.4 ml (9.4), respectively, for the left ventricle and 1.7% (3.1), 1.8 ml (18.7), -1.9 ml (9.8), 3.7 ml (10.8), respectively, for the right ventricle. The mean difference between the LVM was 4.8 g (6.3). CONCLUSIONS: The real-time free-breathing SSFP sequence is useful for the quantification of ventricular mass and function. The correlation with conventional SSFP is excellent. Both sequences allow the cardiac parameters to be precisely quantified and the results are reproducible.

Cuantificación de la función y masa ventricular con secuencias SSFP en tiempo real y respiración libre / Quantification of ventricular mass and function using real-time free-breathing SSFP sequences

Objetivos. Comparar la cuantificación de la función y masa ventricular en estudios de resonancia magnética (RM) cardíaca realizados con una secuencia SSFP en tiempo real y respiración libre (SSFP-RL) con respecto a la secuencia SSFP segmentada convencional (SSFP-apnea). Material y métodos. Se analizó la función y masa cardíaca en 15 pacientes consecutivos con cardiopatía a los que se realizó RM por diversas indicaciones. Las secuencias se planificaron en plano eje corto, incluyendo desde la base hasta el ápex ventricular. Se emplearon dos secuencias: secuencia segmentada SSFP convencional en apnea, de 7 mm de grosor de corte e intervalo de 3 mm y secuencia SSFP en tiempo real y respiración libre de 10 mm de grosor de corte. Se evaluaron los volúmenes (volumen telediastólico [VTD] y volumen telesistólico [VTS]) y fracción de eyección (FE) de ambos ventrículos y la masa ventricular izquierda (MVI). Se estudió la correlación entre las distintas secuencias para cada variable. Resultados. Se observó una correlación excelente entre las dos secuencias realizadas para la cuantificación de parámetros cardíacos en ambos ventrículos (0,9; p < 0,01). Las diferencias medias para la FE, VTD, VTS y volumen latido fueron 2,5% (2,1); 5,6 ml (14,2); -0,8 ml (6,4); 6,4 ml (9,4) para el ventrículo izquierdo y 1,7% (3,1); 1,8 ml (18,7); -1,9 ml (9,8); 3,7 ml (10,8) para el ventrículo derecho. La diferencia media de la masa ventricular izquierda (MVI) fue de 4,8 g (6,3). Conclusiones. La secuencia SSFP en tiempo real y respiración libre es útil para cuantificar la función y masa ventricular. La correlación es excelente con respecto a la secuencia SSFP convencional. Ambas secuencias permiten la cuantificación de los parámetros cardíacos de forma exacta y reproducible

Objectives. To compare real-time free-breathing steady-state free precession (SSFP) sequences with conventional breath-hold segmented SSFP sequences on the quantification of ventricular mass and function. Material and methods. Cardiac function and mass were assessed in 15 consecutive patients with cardiopathies who underwent MRI for diverse indications. Sequences were planned in the short axis to include the area from the base to the apex of the ventricle. Two sequences were used: 1) a conventional breath-hold segmented SSFP sequence with 7-mm-thick slices and 3-mm gap between slices and 2) a real-time free-breathing SSFP sequence with 10-mm-thick slices. The systolic and diastolic volumes (VTD, VTS) and ejection fraction (EF) of both ventricles were evaluated and the mass of the left ventricle (LVM) was measured. The correlation between the different sequences was studied for each variable. Results. An excellent correlation was observed between the two sequences on the quantification of cardiac parameters in both ventricles (0.9; p < 0.01). The mean differences for EF, VTD, VTS, and stroke volume (VTD-VTS) were 2.5% (2.1), 5.6 ml (14.2), -0.8 ml (6.4), 6.4 ml (9.4), respectively, for the left ventricle and 1.7% (3.1), 1.8 ml (18.7), -1.9 ml (9.8), 3.7 ml (10.8), respectively, for the right ventricle. The mean difference between the LVM was 4.8 g (6.3). Conclusions. The real-time free-breathing SSFP sequence is useful for the quantification of ventricular mass and function. The correlation with conventional SSFP is excellent. Both sequences allow the cardiac parameters to be precisely quantified and the results are reproducible

[Radiologic diagnosis of Erdheim-Chester disease. A case report]. / Diagnóstico radiológico de la enfermedad de Erdheim Chester. A propósito de un caso.

Erdheim-Chester disease is a rare disorder, belonging to the group of histiocytoses, in which diffuse infiltration of histiocytes affects various organs and systems. Bone involvement in Erdheim-Chester disease manifests as generalized sclerosis of the bone marrow and cortex of the long bones, and this peculiar radiologic characteristic differentiates it from other histiocytoses. Diagnostic suspicion of the disease derives from the pulmonary and bone radiologic findings as well as from the clinical findings. Histological study reveals histiocyte infiltration affecting the soft tissues, musculoskeletal system, and central nervous system. The definitive diagnosis is reached by immunohistochemistry. Like other histiocytoses, such as Langerhans cell histiocytosis, immunohistochemical techniques reveal lipid-laden histiocytes; however, unlike the other types, Erdheim-Chester histiocytes stain negatively for S 100 protein and do not contain Birbeck granules.

Diagnóstico radiológico de la enfermedad de Erdheim Chester. A propósito de un caso / Radiologic diagnosis of Erdheim-Chester disease. A case report

La enfermedad de Erdheim-Chester es una patología poco frecuente que pertenece al grupo de las histiocitosis. Se produce por una infiltración difusa de histiocitos que afecta a varios órganos y sistemas. La afectación ósea muestra una característica radiológica peculiar que la diferencia de otras histiocitosis, y es una esclerosis córtico-medular de huesos largos. La sospecha diagnóstica de la enfermedad se realiza tanto por los hallazgos clínicos como por los radiológicos pulmonares y óseos. En el estudio anatomopatológico se observa la infiltración por células histiocitarias que afecta tanto a tejidos blandos, sistema musculoesquelético, como al sistema nervioso central. El diagnóstico definitivo es inmunohistoquímico, donde se demuestran histiocitos cargados de lípidos, negativos a la proteína S 100 y sin gránulos de Birbeck, rasgo que la diferencia de otras histiocitosis como la de células de Langerhans

Erdheim-Chester disease is a rare disorder, belonging to the group of histiocytoses, in which diffuse infiltration of histiocytes affects various organs and systems. Bone involvement in Erdheim-Chester disease manifests as generalized sclerosis of the bone marrow and cortex of the long bones, and this peculiar radiologic characteristic differentiates it from other histiocytoses. Diagnostic suspicion of the disease derives from the pulmonary and bone radiologic findings as well as from the clinical findings. Histological study reveals histiocyte infiltration affecting the soft tissues, musculoskeletal system, and central nervous system. The definitive diagnosis is reached by immunohistochemistry. Like other histiocytoses, such as Langerhans cell histiocytosis, immunohistochemical techniques reveal lipid-laden histiocytes; however, unlike the other types, Erdheim-Chester histiocytes stain negatively for S 100 protein and do not contain Birbeck granules

[Endovascular therapeutic techniques]. / Técnicas terapéuticas endovasculares.

Percutaneous and endovascular techniques have shown their efficacy in the treatment of a great variety of pathologies. The advances in diagnostic imaging as well as the development of new materials have made it possible to carry out new procedures that were unthinkable not many years ago. The irruption of this new form of treating patients has had, is having, and will have a clear impact on the multidisciplinary approach to numerous diseases.

Técnicas terapéuticas endovasculares / Endovascular therapeutic techniques

Las técnicas percutáneas y endovasculares han demostrado su eficacia en el tratamiento de una gran variedad de patologías. Los avances en la imagen diagnóstica así como en el desarrollo de nuevos materiales han posibilitado la realización de nuevos procedimientos, impensables hace no mucho años. La irrupción de esta nueva forma de tratar a los pacientes ha tenido, tiene y tendrá, aún más, un claro impacto en el enfoque multidisciplinar de múltiples enfermedades

Percutaneous and endovascular techniques have shown their efficacy in the treatment of a great variety of pathologies. The advances in diagnostic imaging as well as the development of new materials have made it possible to carry out new procedures that were unthinkable not many years ago. The irruption of this new form of treating patients has had, is having, and will have a clear impact on the multidisciplinary approach to numerous diseases