Diagnostic accuracy of lumbar CT and MRI in the evaluation of chronic low back pain without red flag symptoms.

BACKGROUND: Low back pain (LBP) is one of the most frequent reasons for medical consultation. Most of the patients will have nonspecific LBP, which usually are self-limited episodes. It is unclear which of the diagnostic imaging pathways is most effective and costeffective and how the imaging impacts on patient treatment. Imaging techniques are usually indicated if symptoms remain after 6 weeks. Magnetic resonance imaging (MRI) is the diagnostic imaging examination of choice in lumbar spine evaluation of low back pain; however, availability of MRI is limited. OBJECTIVES: To evaluate the diagnostic accuracy of computed tomography (CT) with MRI (as standard of reference) in the evaluation of chronic low back pain (LBP) without red flags symptoms. To compare the results obtained by two radiologists with different grades of experience. MATERIALS AND METHODS: Patients with chronic low back pain without red flags symptoms were retrospectively reviewed by two observers with different level of experience. Patients included had undergone a lumbar or abdominal CT and an MRI within a year. Once the radiological information was collected, it was then statistically reviewed. The aim of the statistical analysis is to identify the equivalence between both diagnostic techniques. To this end, sensitivity, specificity and validity index were calculated. In addition, intra and inter-observer reliability were measured by Cohen's kappa values and also using the McNemar test. RESULTS: 340 lumbar levels were evaluated from 68 adult patients with chronic low back pain or sciatica. 63.2% of them were women, with an average age of 60.3 years (SD 14.7). CT shows high values of sensitivity and specificity (>80%) in most of the items evaluated, but sensitivity was low for the evaluation of density of the disc (40%) and for the detection of disc herniation (55%). Moreover, agreement between MRI and CT in most of these items was substantial or almost perfect (Cohen's kappa-coefficient > 0'8), excluding Modic changes (kappa = 0.497), degenerative changes (kappa0.688), signal of the disc (kappa = 0.327) and disc herniation (kappa = 0.639). Finally, agreement between both observers is mostly high (kappa > 0.8). Foraminal stenosis, canal stenosis and the grade of the canal stenosis were overdiagnosed by the inexperienced observer in the evaluation of CT images. CONCLUSIONS AND SIGNIFICANCE: CT is as sensitive as lumbar MRI in the evaluation of most of the items analysed, excluding Modic changes, degenerative changes, signal of the disc and disc herniation. In addition, these results are obtained regardless the experience of the radiologist. The rising use of diagnostic medical imaging and the improvement of image quality brings the opportunity of making a second look of abdominal CT in search of causes of LBP. Thereby, inappropriate medical imaging could be avoided (2). In addition, it would allow to reduce MRI waiting list and prioritize other patients with more severe pathology than LBP.

Percutaneous management of bone metastases: State of the art.

Interventional radiology is playing an increasingly important role in the local treatment of bone metastases; this treatment is usually done with palliative intent, although in selected patients it can be done with curative intent. Two main groups of techniques are available. The first group, centered on bone consolidation, includes osteoplasty/vertebroplasty, in which polymethyl methacrylate (PMMA) is injected to reinforce the bone and relieve pain, and percutaneous osteosynthesis, in which fractures with nondisplaced or minimally bone fragments are fixed in place with screws. The second group centers on tumor ablation. tumor ablation refers to the destruction of tumor tissue by the instillation of alcohol or by other means. Thermoablation is the preferred technique in musculoskeletal tumors because it allows for greater control of ablation. Thermoablation can be done with radiofrequency, in which the application of a high frequency (450 Hz-600 Hz) alternating wave to the tumor-bone interface achieves high temperatures, resulting in coagulative necrosis. Another thermoablation technique uses microwaves, applying electromagnetic waves in an approximate range of 900 MHz-2450 MHz through an antenna that is placed directly in the core of the tumor, stimulating the movement of molecules to generate heat and thus resulting in coagulative necrosis. Cryoablation destroys tumor tissue by applying extreme cold. A more recent, noninvasive technique, magnetic resonance-guided focused ultrasound surgery (MRgFUS), focuses an ultrasound beam from a transducer placed on the patient's skin on the target lesion, where the waves' mechanical energy is converted into thermal energy (65 °C-85 °C). Treatment should be planned by a multidisciplinary team. Treatment can be done with curative or palliative intent. Once the patient is selected, a preprocedural workup should be done to determine the most appropriate technique based on a series of factors. During the procedure, protective measures must be taken and the patient must be closely monitored. After the procedure, patients must be followed up.

Sobrediagnóstico por imagen / Overdiagnosis in imaging

El sobrediagnóstico, más que un fallo en el diagnóstico, es un fallo en el pronóstico. Ignoramos qué consecuencias tendría para la vida del paciente que algunas de las lesiones que diagnosticamos por imagen no recibiesen tratamiento. Mientras no sea posible diferenciar por imagen siempre qué lesiones tendrán un curso indolente y cuáles van a tener un comportamiento agresivo, existirá sobrediagnóstico. Las técnicas de imagen médica avanzadas, la radiómica y la radiogenómica en alianza con la inteligencia artificial prometen avances en este sentido. Mientras tanto, es prioritario que los radiólogos vigilemos que solo se realicen las pruebas de imagen estrictamente necesarias. Además, debemos participar en la toma multidisciplinar de decisiones diagnósticas y clínicas, compartida con el paciente. Y, por supuesto, hemos de seguir contribuyendo al avance tecnológico y científico de nuestra profesión, para continuar mejorando el diagnóstico y la detección precoz, en particular de las alteraciones que precisen tratamiento

Overdiagnosis, more than an error regarding the diagnosis, is an error regarding the prognosis. We cannot know what consequences some lesions that we detect by imaging would have on our patients' lives if they were left untreated. As long as it is not possible for imaging techniques to differentiate between lesions that will have an indolent course from those that will have an aggressive course, there will be overdiagnosis. Advanced imaging techniques, radiomics, and radiogenomics, together with artificial intelligence, promise advances in this sense. In the meantime, it is important that radiologists be careful to ensure that only strictly necessary imaging tests are done. Moreover, we need to participate, together with patients, in making multidisciplinary decisions about diagnosis and clinical management. Finally, of course, we need to continue to contribute to the technological and scientific advance of our profession, so that we can continue to improve the diagnosis and early detection of abnormalities, especially those that require treatment

Lesión de Morel-Lavallée: diagnóstico y tratamiento con técnicas de imagen / Morel-Lavallée lesion: diagnosis and treatment with imaging techniques

Objetivo: Revisar las características de las lesiones de Morel-Lavallée y valorar su tratamiento. Material y métodos: Hemos revisado de forma retrospectiva 17 pacientes diagnosticados de lesión de Morel-Lavallée en dos servicios diferentes: 11 hombres y 6 mujeres, edad media 56,1 años, rango de edad 25-81 años. En todos se hizo un estudio con ecografía, en cinco se realizó tomografía computarizada y en nueve resonancia magnética. Trece fueron tratados de forma percutánea mediante aspiración con aguja fina o drenaje con catéter de 6-8 F, o con ambos procedimientos. Dos pacientes requirieron esclerosis percutánea con doxiciclina. Resultados: Todos los pacientes respondieron de forma adecuada al tratamiento percutáneo, aunque en cuatro hubo que repetir el procedimiento. Conclusiones: El radiólogo debe estar familiarizado con esta patología cuyo tratamiento percutáneo, cuando no está asociada a otras afecciones, puede realizarse con éxito en la sala de ecografía

Objectives: We aim to review the characteristics of Morel-Lavallée lesions and to evaluate their treatment. Material and methods: We retrospectively reviewed 17 patients (11 men and 6 women; mean age, 56.1 years, range 25-81 years) diagnosed with Morel-Lavallée lesions in two different departments. All patients underwent ultrasonography, 5 underwent computed tomography, and 9 underwent magnetic resonance imaging. Percutaneous treatment with fine-needle aspiration and/or drainage with a 6F-8F catheter was performed in 13 patients. Two patients required percutaneous sclerosis with doxycycline. Results: All patients responded adequately to percutaneous treatment, although it was necessary to repeat the procedure in 4 patients. Conclusions: Radiologists need to be familiar with this lesion that can be treated percutaneously in the ultrasonography suite when it is not associated with other entities

Overdiagnosis in imaging. / Sobrediagnóstico por imagen.

Overdiagnosis, more than an error regarding the diagnosis, is an error regarding the prognosis. We cannot know what consequences some lesions that we detect by imaging would have on our patients' lives if they were left untreated. As long as it is not possible for imaging techniques to differentiate between lesions that will have an indolent course from those that will have an aggressive course, there will be overdiagnosis. Advanced imaging techniques, radiomics, and radiogenomics, together with artificial intelligence, promise advances in this sense. In the meantime, it is important that radiologists be careful to ensure that only strictly necessary imaging tests are done. Moreover, we need to participate, together with patients, in making multidisciplinary decisions about diagnosis and clinical management. Finally, of course, we need to continue to contribute to the technological and scientific advance of our profession, so that we can continue to improve the diagnosis and early detection of abnormalities, especially those that require treatment.

Morel-Lavallée lesion: diagnosis and treatment with imaging techniques. / Lesión de Morel-Lavallée: diagnóstico y tratamiento con técnicas de imagen.

OBJECTIVES: We aim to review the characteristics of Morel-Lavallée lesions and to evaluate their treatment. MATERIAL AND METHODS: We retrospectively reviewed 17 patients (11 men and 6 women; mean age, 56.1 years, range 25-81 years) diagnosed with Morel-Lavallée lesions in two different departments. All patients underwent ultrasonography, 5 underwent computed tomography, and 9 underwent magnetic resonance imaging. Percutaneous treatment with fine-needle aspiration and/or drainage with a 6F-8F catheter was performed in 13 patients. Two patients required percutaneous sclerosis with doxycycline. RESULTS: All patients responded adequately to percutaneous treatment, although it was necessary to repeat the procedure in 4 patients. CONCLUSIONS: Radiologists need to be familiar with this lesion that can be treated percutaneously in the ultrasonography suite when it is not associated with other entities.

Musculoskeletal interventional radiology: ultrasound and CT. / Intervencionismo en musculoesquelético. Ecografía y tac.

We aim to describe imaging-guided (ultrasound and CT) interventional techniques in the musculoskeletal system that can be performed by general radiologists, whether in hospitals, primary care clinics, private offices, or other settings. The first requirement for doing these procedures is adequate knowledge of the anatomy of the musculoskeletal system. The second requirement is to inform the patient thoroughly about the technique, the risks involved, and the alternatives available in order to obtain written informed consent. The third requirement is to ensure that the procedure is performed in accordance with the principles of asepsis in relation to the puncture zone and to all the material employed throughout the procedure. The main procedures that can be done under ultrasound guidance are the following: fine needle aspiration cytology (FNAC), core needle biopsy (CNB), diagnostic and/or therapeutic arthrocentesis, drainage of juxta-articular fluid collections, drainage of abscesses, drainage of hematomas, treatment of Baker's cyst, treatment of ganglia, treatment of bursitis, infiltrations and treatment of plantar fasciitis, plantar fibrosis, epicondylitis, Achilles tendinopathy, and Morton's neuroma, puncture and lavage of calcifications in calcifying tendinopathy. We also review the following CT-guided procedures: diagnosis of spondylodiscitis, FNAC of metastases, arthrography, drainages. Finally, we also mention more complex procedures that can only be done in appropriate settings: bone biopsies, treatment of facet joint pain, radiofrequency treatment.

Intervencionismo en musculoesquelético. Ecografía y tac / Musculoskeletal interventional radiology: ultrasound and CT

Nuestro objetivo es describir aquellas técnicas de intervencionismo musculoesquéletico guiadas por imagen (ecografía y/o tac) que pueden ser realizadas por un radiólogo general, ya sea en hospitales, centros de salud, consultas privadas, etc. El primer requisito para la realización de estos procedimientos es el disponer de un adecuado conocimiento de la anatomía del sistema musculoesquelético. El segundo, que el paciente debe ser informado adecuadamente sobre la técnica, riesgos y alternativas al mismo, relativo por tanto, a la obtención del consentimiento firmado. El tercero es que estos procedimientos se realizan siguiendo los principios de asepsia de la zona de punción, así como del material empleado y lo que acontece durante la realización del procedimiento. Los principales procedimientos que pueden realizarse guiados por ecografía son los siguientes: punción aspiración con aguja fina (PAAF), biopsia con aguja gruesa (BAG), artrocentesis diagnósticas y/o terapéuticas, drenajes de colecciones yuxtaarticulares, drenajes de abscesos, drenaje de hematomas, tratamiento de quiste de Baker, tratamiento de gangliones, tratamiento de las bursitis, infiltraciones y tratamiento de la fascitis plantar, la fibrosis plantar, las epicondilitis, las tendinopatía del tendón de Aquiles o del neuroma de Morton, punción- lavado de calcificaciones en la tendinopatía calcificante. En cuanto a los procedimientos guiados por tac, revisaremos los siguientes: diagnóstico de las espondilodiscitis, PAAF de las metástasis, artrografía, drenajes. También haremos un recordatorio de procedimientos más complejos que deben realizarse en el entorno adecuado: biopsias óseas, tratamiento del dolor facetario, radiofrecuencia terapéutica (AU)

We aim to describe imaging-guided (ultrasound and CT) interventional techniques in the musculoskeletal system that can be performed by general radiologists, whether in hospitals, primary care clinics, private offices, or other settings. The first requirement for doing these procedures is adequate knowledge of the anatomy of the musculoskeletal system. The second requirement is to inform the patient thoroughly about the technique, the risks involved, and the alternatives available in order to obtain written informed consent. The third requirement is to ensure that the procedure is performed in accordance with the principles of asepsis in relation to the puncture zone and to all the material employed throughout the procedure. The main procedures that can be done under ultrasound guidance are the following: fine needle aspiration cytology (FNAC), core needle biopsy (CNB), diagnostic and/or therapeutic arthrocentesis, drainage of juxta-articular fluid collections, drainage of abscesses, drainage of hematomas, treatment of Baker's cyst, treatment of ganglia, treatment of bursitis, infiltrations and treatment of plantar fasciitis, plantar fibrosis, epicondylitis, Achilles tendinopathy, and Morton's neuroma, puncture and lavage of calcifications in calcifying tendinopathy. We also review the following CT-guided procedures: diagnosis of spondylodiscitis, FNAC of metastases, arthrography, drainages. Finally, we also mention more complex procedures that can only be done in appropriate settings: bone biopsies, treatment of facet joint pain, radiofrequency treatment (AU)

Precisión de la resonancia magnética en la diferenciación entre lesión vertebral maligna y benigna: papel de las secuencias de difusión, del cociente fuera de fase/en fase y de los valores del coeficiente de difusión aparente / Accuracy of magnetic resonance imaging in differentiating between benign and malignant vertebral lesions: Role of Diffusion-weighted imaging, in-phase/opposed-phase imaging and apparent diffusion coefficient

Objetivo: Establecer la capacidad diagnóstica de la RM para distinguir las lesiones vertebrales benignas de las malignas. Material y métodos: Incluimos en el estudio a 85 pacientes con un total de 213 vértebras estudiadas (tanto patológicas como normales). Para cada vértebra determinamos si la lesión era hipointensa en T1 y si era hiperintensa o no en las secuencias STIR y potenciada en difusión. Calculamos el valor del cociente fuera de fase/en fase y el valor del coeficiente de difusión aparente de cada vértebra. A partir de los parámetros T1, difusión y STIR establecimos una combinación diagnóstica de lesión maligna. Resultados: El grupo comprendía 60 (70,6%) mujeres y 25 (29,4%) hombres con una edad media de 67 ± 13,5 años (33-90 años). De los 85 pacientes, un total de 26 (30,6%) tenían antecedentes de tumor primario. Cuando la lesión era hipointensa en las imágenes potenciadas en T1, hiperintensa en STIR y en las imágenes potenciadas en difusión, y con un cociente de intensidad de señal mayor de 0,8, la sensibilidad fue del 97,2%; la especificidad del 90% y la exactitud diagnóstica del 91,2%. Si el paciente tenía un tumor primario conocido, los valores se incrementaron hasta el 97,2; 99,4 y 99%, respectivamente. Conclusión: Es posible distinguir las lesiones benignas de las malignas si valoramos de forma conjunta la señal en T1, STIR y difusión y el cociente fuera de fase/en fase de la lesión detectada con RM en el cuerpo vertebral (AU)

Objective: To determine the ability of MRI to distinguish between benign and malignant vertebral lesions. Material and methods: We included 85 patients and studied a total of 213 vertebrae (both pathologic and normal). For each vertebra, we determined whether the lesion was hypointense in T1-weighted sequences and whether it was hyperintense in STIR and in diffusion-weighted sequences. We calculated the in-phase/out-of-phase quotient and the apparent diffusion coefficient for each vertebra. We combined parameters from T1-weighted, diffusion-weighted, and STIR sequences to devise a formula to distinguish benign from malignant lesions. Results: The group comprised 60 (70.6%) women and 25 (29.4%) men with a mean age of 67 ± 13.5 years (range, 33-90 y). Of the 85 patients, 26 (30.6%) had a known primary tumor. When the lesion was hypointense on T1-weighted sequences, hyperintense on STIR and diffusion-weighted sequences, and had a signal intensity quotient greater than 0.8, the sensitivity was 97.2%, the specificity was 90%, and the diagnostic accuracy was 91.2%. If the patient had a known primary tumor, these values increased to 97.2%, 99.4%, and 99%, respectively. Conclusion: Benign lesions can be distinguished from malignant lesions if we combine the information from T1-weighted, STIR, and diffusion-weighted sequences together with the in-phase/out-of-phase quotient of the lesion detected in the vertebral body on MRI (AU)

Multidisciplinary Approach in Hepatocellular Carcinoma in a Level II Hospital: The First Decade of Hospital Universitario Fundacion Alcorcon.

BACKGROUND/AIMS: Mean survival in hepatocellular carcinoma remains low. Many efforts have been done during the last years through screening, diagnosis and treatment to improve the results. The aim of this work is to present the experience of our hospital multidisciplinary group during the first decade of this century. METHODOLOGY: The patients with hepatocellullar carcinoma presented at the multidisciplinary meeting from 1999 to 2009 were prospectively studied. According to the tumor and functional status they were treated through the current available guidelines by transplant, partial hepatectomy, local/regional procedures, systemic or symptomatic treatment. RESULTS: One hundred and forty two patients were studied. Median tumor size was 3 cm. A single tumor was diagnosed in 64.8% of the patients. Eighteen patients had liver resection (6 transplantation and 12 with partial resection), 53 tumors were not treated due to advanced stage or liver dysfunction, and in the remaining patients radiofrequency, ethanol or embolization treatments were used, single or combined. CONCLUSIONS: a multidisciplinary approach of hepatocellular carcinoma in a second level hospital with trained professionals permits a diagnosis in early tumoral and functional stages in the majority of patients, and a variety of possible treatments with adequate survival outcomes.

Accuracy of magnetic resonance imaging in differentiating between benign and malignant vertebral lesions: role of diffusion-weighted imaging, in-phase/opposed-phase imaging and apparent diffusion coefficient.

OBJECTIVE: To determine the ability of MRI to distinguish between benign and malignant vertebral lesions. MATERIAL AND METHODS: We included 85 patients and studied a total of 213 vertebrae (both pathologic and normal). For each vertebra, we determined whether the lesion was hypointense in T1-weighted sequences and whether it was hyperintense in STIR and in diffusion-weighted sequences. We calculated the in-phase/out-of-phase quotient and the apparent diffusion coefficient for each vertebra. We combined parameters from T1-weighted, diffusion-weighted, and STIR sequences to devise a formula to distinguish benign from malignant lesions. RESULTS: The group comprised 60 (70.6%) women and 25 (29.4%) men with a mean age of 67±13.5 years (range, 33-90 y). Of the 85 patients, 26 (30.6%) had a known primary tumor. When the lesion was hypointense on T1-weighted sequences, hyperintense on STIR and diffusion-weighted sequences, and had a signal intensity quotient greater than 0.8, the sensitivity was 97.2%, the specificity was 90%, and the diagnostic accuracy was 91.2%. If the patient had a known primary tumor, these values increased to 97.2%, 99.4%, and 99%, respectively. CONCLUSION: Benign lesions can be distinguished from malignant lesions if we combine the information from T1-weighted, STIR, and diffusion-weighted sequences together with the in-phase/out-of-phase quotient of the lesion detected in the vertebral body on MRI.

[Imaging-guided percutaneous biopsy of tumors of the locomotor apparatus]. / Biopsia percutánea guiada por técnicas de imagen en patología tumoral del aparato locomotor.

The prognosis of musculoskeletal sarcomas is related to appropriate management by specifically trained multidisciplinary teams. Musculoskeletal radiologists are responsible for the image-guided percutaneous biopsy of these tumors, which has a diagnostic accuracy of at least 80%. It is essential for radiologists to know: a) the limitations of percutaneous biopsy with respect to surgical biopsy; b) what should and should not be biopsied; c) how to appropriately plan percutaneous biopsy, with special attention to the route of approach, taking into account the compartmental anatomy and the route of approach after surgical treatment; and d) technical aspects of the procedure, like the area of the tumor to biopsy, the caliber of the needle, the number and length of the specimens to obtain to ensure optimal pathological diagnosis, and techniques in function of the imaging modality and bone penetration.

Biopsia percutánea guiada por técnicas de imagen en patología tumoral del aparato locomotor / Imaging-guided percutaneous biopsy of tumors of the locomotor apparatus

El pronóstico de los sarcomas musculoesqueléticos se relaciona con su adecuado manejo en el seno de los equipos multidisciplinarios con formación específica. El radiólogo musculoesquelético es el responsable de la biopsia percutánea con control de imagen de estos tumores, que se ha impuesto a la quirúrgica en la mayoría de los casos, con una fiabilidad diagnóstica de al menos el 80%. Debe conocer: a) sus limitaciones respecto de la biopsia quirúrgica; b) qué se debe y no se debe biopsiar; c) la adecuada planificación de la biopsia percutánea, con especial atención a la vía de abordaje, teniendo en cuenta la anatomía compartimental y la vía de abordaje del posterior tratamiento quirúrgico; y d) aspectos técnicos del procedimiento, tales como la zona de la tumoración a biopsiar, calibre de la aguja, número y longitud de las muestras obtenidas para optimización del rendimiento diagnóstico, y técnicas en función de la modalidad de imagen y penetración ósea (AU)

The prognosis of musculoskeletal sarcomas is related to appropriate management by specifically trained multidisciplinary teams. Musculoskeletal radiologists are responsible for the image-guided percutaneous biopsy of these tumors, which has a diagnostic accuracy of at least 80%. It is essential for radiologists to know: a) the limitations of percutaneous biopsy with respect to surgical biopsy; b) what should and should not be biopsied; c) how to appropriately plan percutaneous biopsy, with special attention to the route of approach, taking into account the compartmental anatomy and the route of approach after surgical treatment; and d) technical aspects of the procedure, like the area of the tumor to biopsy, the caliber of the needle, the number and length of the specimens to obtain to ensure optimal pathological diagnosis, and techniques in function of the imaging modality and bone penetration (AU)

La radiología musculoesquelética en el catálogo de prestaciones radiológicas de la SERAM / Musculoskeletal imaging in the SERAM's catalogue of services

No disponible

Tratamiento mediante radiofrecuencia percutánea de los tumores óseos benignos: osteoma osteoide, osteoblastoma y condroblastoma / Percutaneous radiofrequency ablation of benign bone tumors: osteoid osteoma, osteoblastoma, and chondroblastoma

El objetivo del presente trabajo es compartir con el lector nuestra experiencia en el tratamiento percutáneo con radiofrecuencia guiada por tomografía computarizada de los tumores óseos benignos tras haber realizado más de 100 intervenciones en los últimos 8 años. En la actualidad, puede afirmarse que esta técnica debe ser el tratamiento de elección de la inmensa mayoría de los osteomas osteoides y que también tiene aplicaciones, como tratamiento definitivo, en muchos casos de osteoblastomas o de condroblastomas así como en otros tumores óseos benignos más infrecuentes. El procedimiento ha demostrado ser altamente eficaz y ha presentado escasas complicaciones, permitiendo a los pacientes unos tiempos de recuperación muy rápidos (AU)

We report our experience in the computed tomography (CT)-guided percutaneous radiofrequency ablation of more than 100 benign bone tumors in the last eight years. We affirm that this should be the technique of choice in the vast majority of osteoid osteomas; it can also be applied as a definitive treatment in many cases of osteoblastomas or chondroblastomas as well as in less common benign bone tumors. CT-guided percutaneous radiofrequency ablation has proven highly efficacious and has resulted in very few complications; thus, patients tend to recover very quickly (AU)

[Percutaneous radiofrequency ablation of benign bone tumors: osteoid osteoma, osteoblastoma, and chondroblastoma]. / Tratamiento mediante radiofrecuencia percutánea de los tumores óseos benignos: osteoma osteoide, osteoblastoma y condroblastoma.

We report our experience in the computed tomography (CT)-guided percutaneous radiofrequency ablation of more than 100 benign bone tumors in the last eight years. We affirm that this should be the technique of choice in the vast majority of osteoid osteomas; it can also be applied as a definitive treatment in many cases of osteoblastomas or chondroblastomas as well as in less common benign bone tumors. CT-guided percutaneous radiofrequency ablation has proven highly efficacious and has resulted in very few complications; thus, patients tend to recover very quickly.

[Radiological characteristics of malignant fibrous histiocytoma of bone]. / Características radiológicas del fibrohistiocitoma maligno del hueso.

Malignant fibrous histiocytoma (MFH) was only recognized as a primary bone tumor a few years ago. Although it is much rarer than malignant fibrous histiocytoma of soft tissues, it is not extremely uncommon. It predominantly affects long bones; however, it has been reported to occur in many different sites and at any age. MFH are aggressive tumors that can appear in association with other bone lesions, and they have a poor prognosis. We present our experience with 13 cases of MFH and review the literature to describe the main characteristics of this tumor.

Características radiológicas del fibrohistiocitoma maligno del hueso / Radiological characteristics of malignant fibrous histiocytoma of bone

El fibrohistiocitoma maligno óseo fue reconocido como tumor óseo primario hace pocos años y, aunque mucho más raro que su homónimo de partes blandas, no es excesivamente infrecuente. Aunque afecta preferentemente a huesos largos, ha sido descrito en múltiples localizaciones y a cualquier edad. Son tumores agresivos que pueden aparecer en relación con otras lesiones óseas y tienen mal pronóstico. Presentamos nuestra experiencia con 13 casos y realizamos una revisión bibliográfica que nos permita conocer mejor las principales características de este tumor

Malignant fibrous histiocytoma (MFH) was only recognized as a primary bone tumor a few years ago. Although it is much rarer than malignant fibrous histiocytoma of soft tissues, it is not extremely uncommon. It predominately affects long bones; however, it has been reported to occur in many different sites and at any age. MFH are aggressive tumors that can appear in association with other bone lesions, and they have a poor prognosis. We present our experience with 13 cases of MFH and review the literature to describe the main characteristics of this tumor

[Renal oncocytoma. Fundamental radiologic manifestations and enhancement patterns in tri-phase helical CT]. / Oncocitoma renal. Manifestaciones radiológicas fundamentales y patrones de captación en tomografía computarizada helicoidal trifásica.

OBJECTIVE: Oncocytoma is a relatively uncommon benign kidney tumor. To date, it has been impossible to differentiate this tumor from renal cell carcinoma radiologically, although few articles report on the use of tri-phase CT in this tumor. We describe the triphasic CT findings in these tumors and evaluate whether some characteristics, although not sufficient to ensure the diagnosis, can suggest the possibility of oncocytoma. In some cases, this may lead to a different approach to the management of patients. MATERIAL AND METHODS: We describe the tri-phase CT findings in 10 cases of oncocytoma in eight patients (one case was bilateral and multifocal). The diagnosis was made after histological examination of surgical specimens in all cases. RESULTS: All the tumors were found incidentally at ultrasound examination prior to CT study. Tumors all had well-defined borders, and their size ranged from 3 to 15 cm, with a mean diameter of 5.2 cm. One patient had bilateral tumors (2 right and 1 left). All but one of the tumors had a star-shaped scar inside, with a marked lobular pattern in one case. All tumors showed avid uptake, with mean enhancement of 120 HU in the arterial phase and 116 HU in the venous phase. All patients evolved favorably with no post-surgical relapse. CONCLUSIONS: Although oncocytoma cannot be differentiated from renal cell carcinoma with certainty, the possibility of oncocytoma should be suggested in the case of small tumors with a central scar, without necrosis or infiltration, and an enhancement pattern as described here. Regardless of the size of the tumor, lobular morphology should also suggest this possibility.