[MRI in the diagnostic and evolutive control of subacute combined degeneration. A case report]. / RM en el diagnóstico y control evolutivo de la degeneración combinada subaguda. A propósito de un caso.

A deficit of vitamin B12, generally resulting from pernicious anaemia, can give rise to disorders of the spinal cord, brain, optic and peripheral nerves. The principal neurological syndrome is subacute combined degeneration of the spinal cord (SCD), which can cause progressive motor and/or sensitive alterations, instability and incontinency, due to the demyelination of the posterior horn of the spinal cord. The identification by magnetic resonance (MR) of signal hyperintensity in T2 weighted sequences at the level of the posterior horns of the spinal and/or cervical cord can be of great use in diagnosising the patient with SCD, above all when the symptoms are mild or nonspecific, and the patient does not have haematological or gastrointestinal alterations. Besides, the evolution of the altered signal of the posterior horns in MR can be of use in evaluating the efficacy of treatment, since their normalization is related to clinical improvement.

La estadificación con resonancia magnética puede cambiar el manejo terapéutico en el cáncer de mama / Using magnetic resonance imaging for staging can change the therapeutic management in patients with breast cancer

Objetivo. Comparar 2 series de pacientes con cáncer de mama, una estadificadas mediante resonancia magnética (RM) preoperatoria y la otra con técnicas convencionales, y estudiar los cambios de tratamiento y el número de mastectomías y de reintervenciones por afectación de los bordes. Material y métodos. Se revisaron 600 pacientes divididas en 300 con RM preoperatoria (serie 1) y 300 sin RM (serie 2). Se valoraron: la edad, el estado menopáusico, el tamaño tumoral anatomopatológico, la multiplicidad y bilateralidad, el tratamiento quirúrgico y tipo de tratamiento, la administración de quimioterapia neoadyuvante y las reintervenciones por márgenes afectos. Las variables fueron comparadas con las pruebas t de Student y la Chi-cuadrado. Resultados. La edad media fue similar (51,5 y 51,8 años, p=0,71). El tamaño tumoral medio fue menor (p<0,001) en la serie 1 (16,9 vs 22,3mm). Se detectaron más tumores múltiples (p<0,001) en la serie 1 (28,7 vs 15,7%). La tasa de mastectomías en la serie 1 (25%) fue menor (p<0,001) que en la 2 (48%). Las técnicas de cirugía oncoplástica y bilaterales solo fueron realizadas en la serie 1. La quimioterapia neoadyuvante fue administrada más frecuentemente (p<0,001) en la serie 1 (30,7 vs 9,3%). La diferencia no fue significativa (p=0,095) en el número de reintervenciones por márgenes afectos (7,2% serie 1; 3,2% serie 2). Conclusión. Las mastectomías disminuyen al emplear la RM, con disponibilidad de técnicas de cirugía oncoplástica y quimioterapia neoadyuvante. Pese al aumento de cirugías conservadoras en la serie con RM, no observamos un aumento significativo del número de reintervenciones por márgenes afectos, aunque existe una tendencia (AU)

Objective. To compare two series of patients with breast cancer, one staged using preoperative MRI and the other staged using conventional techniques, analyzing the changes to treatment, the number of mastectomies, and the number of reinterventions due to involvement of the margins. Material and methods. We reviewed 600 patients divided into 300 patients with preoperative MRI (series 1) and 300 without preoperative MRI (series 2). We recorded the following variables: age, menopausal status, tumor size on pathological examination, multiplicity and bilaterality, surgical treatment and type of treatment, the administration of neoadjuvant chemotherapy, and reintervention for involved margins. We used Student's t-test and the chi-square test to compare the variables between the two series. Results. The mean age of patients in the two series was similar (51.5 and 51.8 years, P=0.71). The mean size of the tumor was smaller in series 1 (16.9mm vs 22.3mm) (P<.001). More multiple tumors were detected in series 1 (28.7 vs 15.7%) (P<.001). The rate of mastectomies was lower in series 1 (25 vs 48%) (P<.001). Oncoplastic and bilateral surgeries were performed only in series 1. Neoadjuvant chemotherapy was administered more often in series 1 (30.7 vs 9.3%) (P<.001). The difference in the number of reinterventions for involved margins did not reach significance (7.2% in series 1 vs 3.2% in series 2) (P=.095). Conclusion. When MRI was used for staging, neoadjuvant chemotherapy and oncoplastic surgery were used more often and the mastectomy rate decreased. Despite the increase in conservative surgery in patients staged with MRI, the number of reinterventions for involved margins did not increase, although there was a trend towards significance (AU)

RM en el diagnóstico y control evolutivo de la degeneración combinada subaguda. A propósito de un caso / MRI in the diagnostic and evolutive control of subacute combined degeneration. A case report

El déficit de vitamina B12, consecuencia generalmente de la anemia perniciosa, puede dar lugar a trastornos de la médula espinal, cerebro, nervios ópticos y periféricos. El principal síndrome neurológico es la degeneración combinada subaguda de la médula (DCS), que puede causar alteraciones motoras y/o sensitivas progresivas, inestabilidad e incontinencia, debido a la desmielinización de los cordones posteriores de la médula. La identificación por resonancia magnética (RM)de una hiperintensidad de señal en secuencias potenciadas en T2 a nivel de los cordones posteriores de la médula cervical y/o dorsal, puede ser de gran utilidad en la orientación diagnóstica del paciente con DCS, sobre todo cuando los síntomas son leves o inespecíficos, y el paciente no tiene alteraciones hematológicas o gastrointestinales. Además, la evolución de la alteración de la señal del cordonal posterior en RM puede ser de utilidad para valorar la eficacia del tratamiento, ya que su normalización se relaciona con la mejoría clínica(AU)

A deficit of vitamin B12, generally resulting from pernicious anaemia, can give rise to disorders of the spinal cord, brain, optic and peripheral nerves. The principal neurological syndrome is subacute combined degeneration of the spinal cord (SCD), which can cause progressive motor and/or sensitive alterations, instability and incontinency, due to the demyelination of the posterior horn of the spinal cord. The identification by magnetic resonance (MR) of signal hyperintensity in T2weighted sequences at the level of the posterior horns of the spinal and/or cervical cord can be of great use in diagnosising the patient with SCD, above all when the symptoms are mild or nonspecific, and the patient does not have haematological or gastrointestinal alterations. Besides, the evolution of the altered signal of the posterior horns in MR can be of use in evaluating the efficacy of treatment, since their normalization is related to clinical improvement(AU)

[Using magnetic resonance imaging for staging can change the therapeutic management in patients with breast cancer]. / La estadificación con resonancia magnética puede cambiar el manejo terapéutico en el cáncer de mama.

OBJECTIVE: To compare two series of patients with breast cancer, one staged using preoperative MRI and the other staged using conventional techniques, analyzing the changes to treatment, the number of mastectomies, and the number of reinterventions due to involvement of the margins. MATERIAL AND METHODS: We reviewed 600 patients divided into 300 patients with preoperative MRI (series 1) and 300 without preoperative MRI (series 2). We recorded the following variables: age, menopausal status, tumor size on pathological examination, multiplicity and bilaterality, surgical treatment and type of treatment, the administration of neoadjuvant chemotherapy, and reintervention for involved margins. We used Student's t-test and the chi-square test to compare the variables between the two series. RESULTS: The mean age of patients in the two series was similar (51.5 and 51.8 years, P=0.71). The mean size of the tumor was smaller in series 1 (16.9 mm vs 22.3 mm) (P<.001). More multiple tumors were detected in series 1 (28.7 vs 15.7%) (P<.001). The rate of mastectomies was lower in series 1 (25 vs 48%) (P<.001). Oncoplastic and bilateral surgeries were performed only in series 1. Neoadjuvant chemotherapy was administered more often in series 1 (30.7 vs 9.3%) (P<.001). The difference in the number of reinterventions for involved margins did not reach significance (7.2% in series 1 vs 3.2% in series 2) (P=.095). CONCLUSION: When MRI was used for staging, neoadjuvant chemotherapy and oncoplastic surgery were used more often and the mastectomy rate decreased. Despite the increase in conservative surgery in patients staged with MRI, the number of reinterventions for involved margins did not increase, although there was a trend towards significance.

Ergonomía del puesto de trabajo en radiología / Ergonomics of the workplace in radiology

La sustitución de la película convencional y los negatoscopios por monitores y ordenadores en los nuevos sistemas PACS ha cambiado por completo los puestos de trabajo en los servicios de radiodiagnóstico, suponiendo un avance claro en este campo. Estos sistemas ofrecen muchas ventajas como la mejora de la productividad de los radiólogos al reducir de forma global el tiempo necesario para la interpretación de imágenes. Por otro lado, su implantación ha provocado que factores como la posición de la silla y la mesa de trabajo, el ratón, el teclado, los monitores y el tipo de iluminación de la habitación cobren una especial relevancia para prevenir lesiones que puedan inhabilitar al radiólogo. La influencia de estos factores es habitualmente poco valorada a la hora de la planificación e implantación de los puestos de trabajo radiológico. El presente trabajo aporta recomendaciones para el correcto diseño de los mismos, basados en los datos aportados por la ergonomía, que es la ciencia que estudia su influencia en la actividad humana (AU)

The replacement of conventional films and view boxes with digital images and computer monitors managed by PACS has clearly improved the diagnostic imaging workplace. The new setup has many advantages, including increased productivity brought about by decreased overall time required for image interpretation. On the other hand, the implementation of the digital workplace has increased the importance of factors like background lighting and the position of the chair, work table, mouse, keyboard, and monitor to prevent lesions that can disable the radiologist. The influence of these factors is often undervalued in the design and implementation of the radiological workplace. This article provides recommendations for the design of the radiological workplace based on ergonomics, which is the science that studies interactions among humans and other elements of a system (AU)

[Ergonomics of the workplace in radiology]. / Ergonomía del puesto de trabajo en radiología.

The replacement of conventional films and view boxes with digital images and computer monitors managed by PACS has clearly improved the diagnostic imaging workplace. The new setup has many advantages, including increased productivity brought about by decreased overall time required for image interpretation. On the other hand, the implementation of the digital workplace has increased the importance of factors like background lighting and the position of the chair, work table, mouse, keyboard, and monitor to prevent lesions that can disable the radiologist. The influence of these factors is often undervalued in the design and implementation of the radiological workplace. This article provides recommendations for the design of the radiological workplace based on ergonomics, which is the science that studies interactions among humans and other elements of a system.

Drenaje permanente tunelizado de la ascitis maligna: experiencia inicial con el catéter PleurX(R) / Permanent tunneled drainage for malignant ascites: Initial experience with the PleurX(R) catheter

Objetivo. El tratamiento más utilizado en la ascitis maligna de repetición es generalmente el drenaje peritoneal temporal. Presentamos nuestra experiencia en la colocación de catéteres tunelizados permanentes en una serie de pacientes y el análisis de la seguridad y efectividad del mismo. Material y métodos. El procedimiento se llevó a cabo en una serie de 10 pacientes, con medidas de asepsia total, en la sala de ecografías dedicada a intervencionismo, únicamente con control ecográfico y bajo anestesia local. Resultados. Los catéteres se mantuvieron permeables una mediana de 52 días en los 9 pacientes que fallecieron. A uno de estos pacientes se le retiró el catéter, que permanecía permeable, por una sepsis generalizada. Un paciente permanecía con el catéter permeable a la conclusión del estudio 124 días tras la colocación. Conclusión. A pesar del escaso número de pacientes, el catéter peritoneal tunelizado parece ser un procedimiento seguro, efectivo y mínimamente invasivo para el tratamiento de la ascitis maligna en pacientes oncológicos terminales, facilitando la evacuación de la ascitis en el domicilio sin necesidad de acudir a un centro hospitalario y evitando punciones de repetición con el consiguiente riesgo para el paciente. No obstante, sería necesaria una mayor experiencia y estudios prospectivos aleatorizados (AU)

Objective. The most common treatment in recurrent malignant ascites is generally temporary peritoneal drainage. We present our experience in placing permanent tunneled catheters in a series of patients and analyze the safety and efficacy of the treatment. Material and methods. We used total aseptic measures in the interventional ultrasonography suite to place permanent tunneled catheters in 10 patients under ultrasonographic guidance and local anesthesia. Results. The catheters remained patent for a median of 52 days in the nine patients who died. In one of these, the catheter was withdrawn while still patent due to generalized sepsis. At the end of the study, one patient still had a permeable catheter 124 days after placement. Conclusion. Although the low number of patients in our series precludes generalizations, tunneled peritoneal catheters seem to be a safe and effective minimally invasive treatment for malignant ascites in terminal oncologic patients. This approach facilitates the draining of the ascites at home, obviating the need for repeated hospital visits and punctures and the risks involved therein. Nevertheless, further experience and prospective randomized trials are necessary (AU)

[Permanent tunneled drainage for malignant ascites: initial experience with the PleurX® catheter]. / Drenaje permanente tunelizado de la ascitis maligna: experiencia inicial con el catéter PleurX®.

OBJECTIVE: The most common treatment in recurrent malignant ascites is generally temporary peritoneal drainage. We present our experience in placing permanent tunneled catheters in a series of patients and analyze the safety and efficacy of the treatment. MATERIAL AND METHODS: We used total aseptic measures in the interventional ultrasonography suite to place permanent tunneled catheters in 10 patients under ultrasonographic guidance and local anesthesia. RESULTS: The catheters remained patent for a median of 52 days in the nine patients who died. In one of these, the catheter was withdrawn while still patent due to generalized sepsis. At the end of the study, one patient still had a permeable catheter 124 days after placement. CONCLUSION: Although the low number of patients in our series precludes generalizations, tunneled peritoneal catheters seem to be a safe and effective minimally invasive treatment for malignant ascites in terminal oncologic patients. This approach facilitates the draining of the ascites at home, obviating the need for repeated hospital visits and punctures and the risks involved therein. Nevertheless, further experience and prospective randomized trials are necessary.

Cuantificación de la calcificación coronaria en tomografía computarizada torácica de baja dosis de radiación sin sincronización cardiaca / Coronary artery calcium quantification with non-ECG-gated low-radiation dose CT of the chest

Objetivo: Evaluar la posibilidad de cuantificar la calcificación coronaria en las tomografías computarizadas (TC) de baja dosis de radiación (TCBD) torácicas realizadas en un programa de detección precoz de cáncer de pulmón con respecto al protocolo cardíaco específico realizado con sincronización electrocardiográfica (ECG) retrospectiva. Material y métodos: Tras obtener el consentimiento informado se analizaron las exploraciones de 48 fumadores asintomáticos consecutivos (44 varones, 4 mujeres; edad media 59,7 años) incluidos en un programa de detección precoz de cáncer de pulmón a los que se realizó TCBD torácica y un estudio cardíaco específicamente dirigido a cuantificar la calcificación coronaria con sincronización ECG retrospectiva en un equipo TC multicorte (Volume Zoom, Siemens). La exploración TC de baja dosis de radiación se reconstruyó para reproducir los parámetros del estudio cardíaco. Los valores de calcio coronario se compararon con el test de Wilcoxon. Se calculó el coeficiente de correlación de concordancia (CCC) para determinar la concordancia entre ambos métodos. Resultados: Los valores del calcio coronario oscilaron entre 0 y 1.908,4 (mediana: 89,6; amplitud intercuartil [AIC]: 3,2; 227,4) en TCBD y entre 0 y 1.486,6 (mediana: 81,3; AIC: 2,5; 316,4) en los estudios cardíacos. No se observaron diferencias estadísticamente significativas en la estimación total de calcio coronario (p=0,28). La concordancia entre ambas técnicas fue buena (CCC≥0,81). Conclusión: Los estudios de TC de baja dosis de radiación realizados en programas de detección precoz de cáncer de pulmón permiten cuantificar la calcificación coronaria con la misma exactitud que el protocolo cardíaco específico realizado con sincronización ECG retrospectiva (AU)

Objective: To evaluate the feasibility of quantifying coronary artery calcification in low-radiation dose chest CT (LDCT) studies performed in an early lung cancer detection program by comparing the results of this technique with those of dedicated retrospectively ECG-gated cardiac CT. Material and methods: After obtaining informed consent, we evaluated the CT studies of 48 consecutive asymptomatic smokers (44 male, 4 female; mean age 59.7 years) included in an early lung cancer detection trial who underwent multislice LDCT (Volume Zoom, Siemens) of the chest and a retrospectively ECG-gated cardiac CT specifically dedicated to quantifying coronary artery calcification. LDCT examinations were reconstructed to reproduce cardiac CT parameters. Coronary calcium values were compared using the Wilcoxon signed-rank test. The concordance correlation coefficient (CCC) was calculated to determine the agreement between the two methods. Results: Coronary calcium values ranged from 0 to 1,908.4 (median: 89.6; IQR: 3.2; 227.4) in LDCT exams and from 0 to 1,486.6 (median: 81.3; IQR: 2.5; 316.4) in cardiac CT studies. No statistically significant difference was observed in the estimation of total coronary calcium score (p=0.28). The concordance between the two techniques was excellent (CCC≥0.81). Conclusion: The LDCT study performed in lung cancer early detection trials enables coronary artery calcification to be quantified with the same accuracy as the dedicated retrospectively ECG-gated cardiac CT examination (AU)

[Coronary artery calcium quantification with non-ECG-gated low-radiation dose CT of the chest]. / Cuantificación de la calcificación coronaria en tomografía computarizada torácica de baja dosis de radiación sin sincronización cardiaca.

OBJECTIVE: To evaluate the feasibility of quantifying coronary artery calcification in low-radiation dose chest CT (LDCT) studies performed in an early lung cancer detection program by comparing the results of this technique with those of dedicated retrospectively ECG-gated cardiac CT. MATERIAL AND METHODS: After obtaining informed consent, we evaluated the CT studies of 48 consecutive asymptomatic smokers (44 male, 4 female; mean age 59.7 years) included in an early lung cancer detection trial who underwent multislice LDCT (Volume Zoom, Siemens) of the chest and a retrospectively ECG-gated cardiac CT specifically dedicated to quantifying coronary artery calcification. LDCT examinations were reconstructed to reproduce cardiac CT parameters. Coronary calcium values were compared using the Wilcoxon signed-rank test. The concordance correlation coefficient (CCC) was calculated to determine the agreement between the two methods. RESULTS: Coronary calcium values ranged from 0 to 1,908.4 (median: 89.6; IQR: 3.2; 227.4) in LDCT exams and from 0 to 1,486.6 (median: 81.3; IQR: 2.5; 316.4) in cardiac CT studies. No statistically significant difference was observed in the estimation of total coronary calcium score (p=0.28). The concordance between the two techniques was excellent (CCC > or = 0.81). CONCLUSION: The LDCT study performed in lung cancer early detection trials enables coronary artery calcification to be quantified with the same accuracy as the dedicated retrospectively ECG-gated cardiac CT examination.