Subclinical cardiovascular disease and Systemic Sclerosis: A comparison between risk charts, quantification of coronary calcium and carotid ultrasonography.

BACKGROUND AND OBJECTIVES: Recently published population-based cohort studies have shown a high prevalence of cardiovascular disease in Systemic Sclerosis (SSc) patients. The aim of this study is to compare three different methods to measure cardiovascular risk in patients with scleroderma. METHODS: Forty-three SSc patients were included. A prospective study was performed for evaluation of cardiovascular risk and subclinical atheromatosis using 3 non-invasive methods: cardiovascular risk tables, carotid Doppler ultrasonography and quantification of coronary calcium by computerized tomography (CT). RESULTS: The cardiovascular risk charts for the Spanish population did not identify patients at high cardiovascular risk. Framingham-REGICOR identified 13 intermediate-risk patients. Twenty-two patients (51.2%) had plaques on carotid ultrasonography. We performed a ROC curve to identify the best cutoff point for the quantification of coronary artery calcium (CACscore), the value of CACscore > 28 AU (Agatston Units) had the highest sensitivity (73%) and specificity (81%) for the diagnosis of subclinical atheromatosis. In the multiple regression study, age and decreased HDL cholesterol levels were identified as independent factors for subclinical atherosclerotic disease. No disease-related factors were associated with increased subclinical arteriosclerosis. CONCLUSION: Carotid ultrasound and CACscore are useful for identifying subclinical atheromatosis in patients with SSc and are superior compared to risk charts used for general population. HDL cholesterol and age were independent factors for the presence of subclinical atherosclerotic disease. A carotid ultrasound or CT should be performed for early detection of subclinical atheromatosis if these factors are present.

Metodología de la PET/TC con 18F-FDG cardíaca para el diagnóstico de la endocarditis protésica y de dispositivos intracardíacos / Cardiac 18F-FDG PET/CT procedure for the diagnosis of prosthetic endocarditis and intracardiac devices

La endocarditis infecciosa (EI) es una patología grave y con mal pronóstico cuya mortalidad no se ha modificado significativamente a pesar de los avances en su diagnóstico y tratamiento en los últimos 30años. La capacidad diagnóstica de los criterios de Duke modificados en la endocarditis protésica y/o de dispositivos no supera el 50%, por lo que se hacen necesarias nuevas herramientas para el diagnóstico de esta entidad en dicho contexto. La 18F-FDG PET/aTC combina una técnica con gran sensibilidad para detectar actividad inflamatoria-infecciosa y una técnica con gran resolución anatómica para valorar las lesiones estructurales asociadas a la endocarditis. Con una sensibilidad diagnóstica entre el 91 y el 97%, esta técnica híbrida se ha convertido en una herramienta de diagnóstico útil en la sospecha de EI de pacientes con válvulas protésicas o dispositivos, convirtiéndose en un criterio mayor en el algoritmo diagnóstico de las guías actuales. Esta excelente capacidad diagnóstica depende de forma directa de la calidad de la exploración obtenida y del conocimiento a la hora de interpretar las imágenes. El objetivo de esta revisión es describir y estandarizar la metodología de la 18F-FDG-PET/aTC cardíaca en el diagnóstico de endocarditis protésica y de dispositivos intracardíacos, haciendo especial énfasis en las particularidades de la preparación del paciente, de la adquisición de los estudios PET y TC, y del posterior posprocesado e interpretación de las imágenes

Infective endocarditis (IE) is a serious condition with a poor prognosis, its mortality unchanged significantly despite diagnostic and therapeutic advances in the last 30years. The diagnostic ability of the modified Duke criteria in prosthetic endocarditis and/or devices does not exceed 50%, so new tools are necessary for the diagnosis of this entity in this context. The 18F-FDG PET/CTA combines a highly sensitive technique to detect inflammatory-infectious activity with a technique with high anatomical resolution to assess the structural lesions associated with endocarditis. With a diagnostic sensitivity between 91-97%, this hybrid technique has become a useful diagnostic tool for patients with prosthetic valves or devices and suspicion of IE, becoming a major criterion in the diagnostic algorithm of current guidelines. This excellent diagnostic ability depends directly on the quality of the obtained exploration and the knowledge at the time of interpreting the images. The aim of this review is to describe and standardize the methodology of cardiac 18F-FDG PET/CTA in the diagnosis of endocarditis in prosthetic valves and intracardiac devices, with special emphasis on the particularities of the patient's preparation, the PET and CT acquisition procedures, and the subsequent imaging postprocessing and interpretation

Cardiac 18F-FDG PET/CT procedure for the diagnosis of prosthetic endocarditis and intracardiac devices. / Metodología de la PET/TC con 18F-FDG cardíaca para el diagnóstico de la endocarditis protésica y de dispositivos intracardíacos.

Infective endocarditis (IE) is a serious condition with a poor prognosis, its mortality unchanged significantly despite diagnostic and therapeutic advances in the last 30years. The diagnostic ability of the modified Duke criteria in prosthetic endocarditis and/or devices does not exceed 50%, so new tools are necessary for the diagnosis of this entity in this context. The 18F-FDG PET/CTA combines a highly sensitive technique to detect inflammatory-infectious activity with a technique with high anatomical resolution to assess the structural lesions associated with endocarditis. With a diagnostic sensitivity between 91-97%, this hybrid technique has become a useful diagnostic tool for patients with prosthetic valves or devices and suspicion of IE, becoming a major criterion in the diagnostic algorithm of current guidelines. This excellent diagnostic ability depends directly on the quality of the obtained exploration and the knowledge at the time of interpreting the images. The aim of this review is to describe and standardize the methodology of cardiac 18F-FDG PET/CTA in the diagnosis of endocarditis in prosthetic valves and intracardiac devices, with special emphasis on the particularities of the patient's preparation, the PET and CT acquisition procedures, and the subsequent imaging postprocessing and interpretation.

Patología vascular torácica en pacientes oncológicos / Thoracic vascular disease in oncologic patients

La patología oncológica requiere frecuentes controles mediante pruebas de imagen, de forma predominante con tomografía computarizada (TC). En estos pacientes podemos encontrar patología vascular torácica que puede influir en el diagnóstico, el tratamiento y el pronóstico de su enfermedad neoplásica. Los tumores primarios vasculares pueden afectar a los vasos torácicos, como las arterias pulmonares (sarcoma de arteria pulmonar), y la enfermedad neoplásica se puede extender localmente (neoplasia pulmonar) o a distancia hacia los vasos torácicos (embolia pulmonar tumoral y microangiopatía trombótica tumoral pulmonar). El tratamiento oncológico es la causa de múltiples complicaciones sobre los vasos torácicos que en determinados casos llegan a comprometer la vida del paciente. La TC, especialmente con técnica multicorte, permite la evaluación de la enfermedad neoplásica y la patología vascular torácica asociada en el paciente oncológico (AU)

Patients with oncologic disease require frequent imaging tests (predominantly computed tomography) for follow-up. These patients may have thoracic vascular disease that can influence the diagnosis, treatment, and prognosis of their cancer. Primary vascular tumors can involve the thoracic vessels, like the pulmonary arteries (pulmonary artery sarcoma), and the neoplastic disease can extend locally (lung tumor) or remotely to the thoracic vessels (pulmonary tumor embolism and pulmonary tumor thrombotic microangiopathy). Oncologic treatment results in multiple complications that involve the thoracic vessels and can even compromise the patient's life in certain cases. CT, and especially multislice CT, makes it possible to evaluate neoplastic disease and associated thoracic vascular disease in oncologic patients (AU)

[Thoracic vascular disease in oncologic patients]. / Patología vascular torácica en pacientes oncológicos.

Patients with oncologic disease require frequent imaging tests (predominantly computed tomography) for follow-up. These patients may have thoracic vascular disease that can influence the diagnosis, treatment, and prognosis of their cancer. Primary vascular tumors can involve the thoracic vessels, like the pulmonary arteries (pulmonary artery sarcoma), and the neoplastic disease can extend locally (lung tumor) or remotely to the thoracic vessels (pulmonary tumor embolism and pulmonary tumor thrombotic microangiopathy). Oncologic treatment results in multiple complications that involve the thoracic vessels and can even compromise the patient's life in certain cases. CT, and especially multislice CT, makes it possible to evaluate neoplastic disease and associated thoracic vascular disease in oncologic patients.

Secuestro pulmonar intralobar / Intralobar pulmonary sequestration

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