Osteonecrosis maxilar relacionada con la medicación: el papel del radiólogo / Medication-related osteonecrosis of the jaw: the radiologist's role

En las últimas décadas se ha descrito ampliamente y se ha llegado a conocer en profundidad un temido efecto adverso de los bisfosfonatos, la osteonecrosis maxilar, que consiste en la destrucción ósea de parte del hueso maxilar como consecuencia del consumo de estos fármacos antirresortivos. En los últimos años han salido a la luz nuevos fármacos que también pueden ocasionar osteonecrosis maxilar, como algunos anticuerpos monoclonales o fármacos antiangiogénicos. Es por esto por lo que el término de “osteonecrosis maxilar por bisfosfonatos” ha quedado obsoleto, prefiriéndose el término de “osteonecrosis maxilar relacionada con la medicación”. El objetivo de esta revisión es describir las características radiológicas de la osteonecrosis maxilar relacionada con la medicación que, aunque son inespecíficas, es importante que el radiólogo las reconozca en el marco clínico adecuado.(AU)

In recent decades, the dreaded adverse effect of bisphosphonates, osteonecrosis of the jaw, has been widely reported and described in detail. Osteonecrosis of the jaw consists of the destruction of part of the maxilla as a consequence of these antiresorptive drugs. In recent years, new drugs that can also cause osteonecrosis of the jaw (e.g., some monoclonal antibodies or antiangiogenic drugs) have come on the market. For this reason, the term “bisphosphonate-related osteonecrosis of the jaw” has been replaced with “medication-related osteonecrosis of the jaw (MRONJ). This review aims to describe the radiologic characteristics of MRONJ that, although nonspecific, radiologists need to recognize in the appropriate clinical context.(AU)

Medication-related osteonecrosis of the jaw: the radiologist's role.

In recent decades, the dreaded adverse effect of bisphosphonates, osteonecrosis of the jaw, has been widely reported and described in detail. Osteonecrosis of the jaw consists of the destruction of part of the maxilla as a consequence of these antiresorptive drugs. In recent years, new drugs that can also cause osteonecrosis of the jaw (e.g., some monoclonal antibodies or antiangiogenic drugs) have come on the market. For this reason, the term "bisphosphonate-related osteonecrosis of the jaw" has been replaced with "medication-related osteonecrosis of the jaw (MRONJ). This review aims to describe the radiologic characteristics of MRONJ that, although nonspecific, radiologists need to recognize in the appropriate clinical context.

Correlation between the main clinical, imaging, and arthroscopy findings in patients with temporomandibular disorders.

The purpose of this work was to prospectively correlate the most characteristic clinical symptoms of temporomandibular disorders, such as pain and limitation of mouth opening, with the findings of magnetic resonance imaging (disc position, degenerative changes, and effusion) and arthroscopy findings (roofing, synovitis, chondromalacia, adhesions, and perforations). These examinations were performed in 298 patients diagnosed with internal derangement refractory to conservative treatment. The mean age of the patients was 38.59 years; 92.6% were female. The t-test and one-way analysis of variance (ANOVA) were used to correlate the findings. Significant relationships were found between pain and disc displacement without reduction (P = 0.033) and effusion (P = 0.003) on MRI, coinciding with correlations between pain and roofing of 0-25% (P = 0.016) and synovitis (P = 0.001) on arthroscopy. A significant relationship was also observed between mouth opening limitation and the presence of osteoarthrosis (P = 0.018) on MRI, and between mouth opening limitation and synovitis (P = 0.022), chondromalacia (P = 0.002), and adhesions (P < 0.001) on arthroscopy. All of these findings were observed in patients with a poor initial clinical situation, which highlights the considerable potential of correlating these data with imaging and arthroscopy findings.

Brain CT requests from emergency department: Reality.

OBJECTIVES: To evaluate the most common reasons for requesting brain CT studies from the emergency department and to calculate the prevalence of urgent acute pathology on this population group. MATERIAL AND METHODS: We reviewed brain CT studies requested from the emergency department during October and November 2018. We recorded the following variables: age, sex, reason for requesting the study, CT findings, use of contrast agents and reasons for using them, and, in patients who had undergone previous head CT studies, whether the findings had changed. SPSS was used for statistical analyses. RESULTS: A total of 507 urgent brain CT studies were done (41.4% in men, 58.6% in women; mean age, 65.4±20 years). The most common reason for requesting the study was head trauma (40.5%); only 15.6% of these studies showed acute posttraumatic intracranial lesions. The second most common reason was focal neurologic symptoms (16%); only 16% of these studies showed recent ischemic infarcts or acute bleeding. No pathological findings were reported in 43.2% of the studies. The most common abnormal finding was ischemic lesions in small vessels (20%). Space-occupying lesions (both benign and malignant) were found in 3.9% of all patients. CONCLUSIONS: Most brain CT studies requested from the emergency department showed no findings that would modify the management of the patient. Overuse of urgent brain CT increases the radiology department's workload and exposes patients to radiation unnecessarily.

Tomografía computarizada cerebral solicitada desde Urgencias: la realidad / Brain CT requests from emergency department: reality

Objetivos: Evaluar los motivos más frecuentes por los que se solicitan estudios de imagen craneales desde el Servicio de Urgencias y calcular la prevalencia de la patología aguda urgente en este grupo de población. Material y métodos: Se recogieron las tomografías computarizadas (TC) cerebrales solicitadas por el Servicio de Urgencias en los meses de octubre y noviembre de 2018. Se recogieron los siguientes datos: edad, sexo, motivo de solicitud del estudio, hallazgos encontrados en la prueba de imagen, administración de medios de contraste y motivo, y en caso de que el paciente tuviera estudios de imagen craneales previos, reseñar la existencia de cambios. Se utilizó el programa SPSS para hacer el análisis estadístico. Resultados: Se realizaron 507 TC de cerebro urgentes, 41,4% en hombres y 58,6% en mujeres, con una edad media de 65,4±20 años. El motivo de solicitud más frecuente fue el traumatismo craneal (40,5%), y de ellos únicamente el 15,6% presentó patología intracraneal postraumática aguda. El segundo motivo fue sintomatología neurológica focal (16%), de los cuales el 16% presentó infarto isquémico reciente o hemorragia aguda. En cuanto a los hallazgos, el 43,2% de los estudios fueron informados como normales. El hallazgo más frecuentemente encontrado fue lesiones isquémicas de pequeño vaso, en un 20%. En un 3,9% de todos los pacientes se encontraron lesiones ocupantes de espacio, incluyendo lesiones tanto benignas como malignas. Conclusiones: La mayoría de los estudios cerebrales solicitados desde urgencias no muestran patología que modifique el manejo del paciente. La sobreutilización de la TC cerebral urgente sobrecarga los servicios de radiología y somete a la población a radiación innecesaria.(AU)

Objectives: To evaluate the most common reasons for requesting brain CT studies from the emergency department and to calculate the prevalence of urgent acute pathology on this population group. Material and methods: We reviewed brain CT studies requested from the emergency department during October and November 2018. We recorded the following variables: age, sex, reason for requesting the study, CT findings, use of contrast agents and reasons for using them, and, in patients who had undergone previous head CT studies, whether the findings had changed. SPSS was used for statistical analyses. Results: A total of 507 urgent brain CT studies were done (41.4% in men, 58.6% in women; mean age, 65.4±20 years). The most common reason for requesting the study was head trauma (40.5%); only 15.6% of these studies showed acute posttraumatic intracranial lesions. The second most common reason was focal neurologic symptoms (16%); only 16% of these studies showed recent ischemic infarcts or acute bleeding. No pathological findings were reported in 43.2% of the studies. The most common abnormal finding was small vessel disease (20%). Space-occupying lesions (both benign and malignant) were found in 3.9% of all patients. Conclusions: Most brain CT studies requested from the emergency department showed no findings that would modify the management of the patient. Overuse of urgent brain CT increases the radiology department's workload and exposes patients to radiation unnecessarily.(AU)

Strengths, weaknesses, opportunities, and threat analysis of dual-energy CT in head and neck imaging.

Technological development of dual-energy computed tomography (DECT) can play an important role in head and neck area. Multiple innovative applications have evolved, optimizing images, achieving metallic artifact reduction, differentiating materials with better primary tumor delineation, thyroid cartilage and bone invasion. Furthermore, quantification algorithms allow measuring iodine concentration, reflecting the blood supply of a lesion indirectly. DECT enables acquiring images with lower radiation doses and iodine intravenous contrast load to obtain the same CT values.. However, DECT uses ionizing radiation, which does not occur with MRI, and requires long post-processing times. Artifacts on iodine maps may be a potential source of pseudolesions. Besides, photon-counting CT scanners are a promising technique that may displace some DECT advantages. A review analyzing the current status of DECT applied to head and neck imaging from the scope of strengths, weaknesses, opportunities, and threatsanalysis would be very interesting to facilitate a realistic, fact-based, data-driven look of this technique.

Análisis de las fortalezas, oportunidades, debilidades y amenazas de la tomografía computarizada de doble energía en el diagnóstico por la imagen de la cabeza y el cuello / Strengths, weaknesses, opportunities, and threat analysis of dual-energy CT in head and neck imaging

El desarrollo tecnológico de la tomografía computarizada de energía dual (TCED) en el área de la cabeza y el cuello ha supuesto un avance importante, ya que se han desarrollado múltiples aplicaciones para optimizar las imágenes y reducir los artefactos metálicos, así como para diferenciar los materiales, permitiendo una mejor delineación del tumor primario, del cartílago tiroideo y la invasión ósea. Además, los algoritmos de cuantificación permiten medir la concentración de yodo, lo que refleja el flujo de sangre que llega a una lesión de forma indirecta. Permite adquirir imágenes con menores dosis de radiación y menor cantidad de contraste yodado para obtener los mismos valores de TC. Sin embargo, utiliza radiaciones ionizantes y el posprocesamiento de las imágenes consume tiempo, y los artefactos en los mapas de yodo pueden suponer una fuente potencial de pseudolesiones. Además, los escáneres de TC con tecnología de recuento de fotones son una técnica prometedora que puede desplazar algunas de las ventajas de la TCED.Esta revisión hace un análisis de la TCED aplicada a las imágenes de cabeza y cuello desde el ámbito del análisis de las fortalezas, oportunidades, debilidades y amenazas para facilitar una visión realista, basada en datos, de esta técnica.(AU)

Technological development of dual-energy computed tomography (DECT) can play an important role in head and neck area. Multiple innovative applications have evolved, optimizing images, achieving metallic artifact reduction, differentiating materials with better primary tumor delineation, thyroid cartilage and bone invasion. Furthermore, quantification algorithms allow measuring iodine concentration, reflecting the blood supply of a lesion indirectly.DECT enables acquiring images with lower radiation doses and iodine intravenous contrast load to obtain the same CT values. However, DECT uses ionizing radiation, which does not occur with MRI, and requires long post-processing times. Artifacts on iodine maps may be a potential source of pseudolesions. Besides, photon-counting CT scanners are a promising technique that may displace some DECT advantages.A review analyzing the current status of DECT applied to head and neck imaging from the scope of strengths, weaknesses, opportunities, and threatsanalysis would be very interesting to facilitate a realistic, fact-based, data-driven look of this technique.(AU)

Ultralow-dose CT of the petrous bone using iterative reconstruction technique, tin filter and high resolution detectors allows an adequate assessment of the petrous bone structures.

OBJECTIVES: To assess image quality and radiation dose in computed tomography (CT) studies of the petrous bone done with a scanner using a tin filter, high-resolution detectors, and iterative reconstruction, and to compare versus in studies done with another scanner without a tin filter using filtered back projection reconstruction. MATERIAL AND METHODS: Thirty two patients (group 1) were acquired with an ultra-low dose CT (32-MDCT, 130kV, tin filter and iterative reconstruction). Images and radiation doses were compared to 36 patients (group 2) acquired in a 16-MDCT (120kV and filtered back-projection). Muscle density, bone density, and background noise were measured. Signal-to-noise ratio (SNR) was calculated. To assess image quality, two independent radiologists subjectively evaluated the visualization of the different structures of the middle and inner ear (0=not visualized, 3=perfectly identified and delimited). Interobserver agreement was calculated. Effective dose at different anatomical levels with the dose-length product was recorded. RESULTS: In the quantitative analysis, there were no significant differences in image noise between the two groups. In the qualitative analysis, a similar or slightly lower subjective score was obtained in the delimitation of different structures of the ossicular chain and cochlea in the 32-MDCT, compared to 16-MDCT, with statistically significant differences. Mean effective dose (±standard deviation) was 0.16±0.04mSv for the 32-MDCT and 1.25±0.30mSv for the 16-MDCT. CONCLUSIONS: The use of scanners with tin filters, high-resolution detectors, and iterative reconstruction allows to obtain images with adequate quality for the evaluation of the petrous bone structures with ultralow doses of radiation (0.16±0.04mSv).

La tomografía computarizada de peñascos con dosis ultrabaja, utilizando filtro de estaño, detectores de alta resolución y reconstrucción iterativa, permite una adecuada valoración de las estructuras del peñasco / Evaluation of the petrous part of the temporal bone using ultralow-dose computed tomography with a tin filter, high-resolution detectors, and iterative reconstruction

Objetivos: Valorar la calidad de imagen y la dosis de radiación en tomografía computarizada (TC) de peñascos adquiridos con una TC multidetector (TCMD) con filtro de estaño, detectores de alta resolución y reconstrucción iterativa, comparándola con otro equipo sin filtro de estaño y con reconstrucción por retroproyección filtrada. Material y métodos: Se incluyeron retrospectivamente 32 pacientes con TC de peñascos, realizadas con dosis ultrabaja en una 32-TCMD (130 kV con filtro de estaño y reconstrucción iterativa). Se compararon con 36 estudios realizados en una 16-TCMD (120 kV y retroproyección filtrada). Se cuantificó la densidad muscular, ósea y el ruido de fondo, y se calculó la relación señal/ruido. Para valorar la calidad de imagen, dos radiólogos evaluaron de forma subjetiva e independiente la visualización de las diferentes estructuras del oído (0=no se visualiza; 3=se identifica y delimita perfectamente). Se calculó el coeficiente de concordancia interobservador kappa. Utilizando un software comercial, se cuantificó a diferentes niveles anatómicos la dosis efectiva con el producto dosis-longitud. Resultados: En el análisis cuantitativo de las imágenes no se observaron diferencias significativas en el ruido de fondo. En el análisis cualitativo se obtuvo una puntuación subjetiva similar o ligeramente menor en la delimitación de las diferentes estructuras de la cadena osicular y cóclea en la 32-TCMD, con diferencias estadísticamente significativas. La dosis media efectiva fue de 0,16±0,04 mSv para la 32-TCMD frente a 1,25±0,30 mSv para la 16-TCMD. Conclusiones: La utilización de equipos con filtro de estaño, detectores de alta resolución y reconstrucción iterativa permiten obtener TC con dosis de radiación ultrabaja (0,16±0,04 mSv) con una calidad de imagen adecuada para valorar las estructuras de los peñascos.(AU)

Objectives: To compare image quality and radiation dose in computed tomography (CT) studies of the petrous part of the temporal bone done with a scanner using a tin filter, high-resolution detectors, and iterative reconstruction versus in studies done with another scanner without a tin filter using filtered back projection. Material and methods: This retrospective study compared CT studies in 32 patients who underwent ultralow-dose CT of the petrous part of the temporal bone in a 32-detector CT scanner (130 kV with a tin filter and iterative reconstruction) and in 36 patients who underwent the studies in a 16-detector CT scanner (120 kV and filtered back projection). We quantified the densities of muscle and bone tissues and background noise, and we calculated the signal-to-noise ratio. To evaluate image quality, two radiologists working independently subjectively evaluated the visualization of the different structures of the ear on a four-point scale (0=not visible; 3=perfectly identifiable and delimited), and we calculated the coefficient of interobserver concordance (k). Using commercial software, we quantified the effective dose of radiation at different anatomic levels with the dose-length product. Results: In the quantitative analysis, no significant differences were observed in background noise. In the qualitative analysis, the score on the subjective evaluation was similar or slightly lower for the delimitation of the different structures in the ossicular chain and cochlea in the studies done with the 32-detector scanner, with statistically significant differences. The mean effective dose of radiation was 0.16±0.04 mSv for the 32-detector scanner versus 1.25±0.30 mSv for the 16-detector scanner.(AU)

Valoración del ASPECTS automatizado como herramienta de inteligencia artificial en la práctica clínica diaria / Valuation of automatized ASPECTS as an artificial intelligence tool in daily clinical

Objetivos: Evaluar un software del Alberta Stroke Program Early CT Score (ASPECTS) automatizado (ASPECTS-a) frente a la lectura de dos radiólogos en las tomografías computarizadas (TC) solicitadas desde el servicio de urgencias. Describir los fallos más frecuentes del ASPECTS-a. Material y métodos. Se recogieron las TC cerebrales solicitadas por el servicio de urgencias en el período de un mes. Se registraron los siguientes datos: edad, sexo, motivo de solicitud del estudio y hallazgos en la prueba de imagen. Se utilizó un programa que proporciona una puntuación del ASPECTS automáticamente. Posteriormente, dos radiólogos examinaron de forma independiente todos los estudios y realizaron un ASPECTS visual (ASPECTS-v). En caso de discrepancia, se hizo una nueva lectura en consenso. Se compararon los resultados del ASPECTS-a con el ASPECTS-v. Resultados: Se realizaron un total de 295 TC cerebrales urgentes con una edad media de 65 ± 20 años. El 91,8% lo interpretaron los dos lectores como ASPECTS 10 en ambos hemisferios cerebrales. El ASPECTS-a puntuó el 45% con ASPECTS 10 en ambos hemisferios cerebrales. En 152 (51,5%), el ASPECTS-a y el ASPECTS-v no coincidieron. Las causas de la discrepancia fueron fundamentalmente por errores en la segmentación (generalmente por atrofias asimétricas). La mayor parte de los errores en la segmentación se localizaban en la cabeza del núcleo caudado, lo que se observó en 60 estudios. Conclusiones: El ASPECTS-a es una herramienta potente y de gran ayuda, pero siempre es necesaria una supervisión humana, particularmente en grupos de pacientes con cambios cerebrales preexistentes.(AU)

Aims: To evaluate an automated ASPECTS (ASPECTS-a) software against two radiologists’ reading of CT scans requested from the Emergency Department. Describe the most frequent failures of the ASPECTS-a. Material and methods: All the cranial CT Scans requested by the Emergency Department in one month were collected. The following data were recorded: age, sex, the reason for requesting the study, and imaging findings. A program was used that provides an ASPECTS score automatically. Subsequently, 2 radiologists independently reviewed all of the studies and provided the visual ASPECTS (ASPECTS-v). In case of discrepancy, a new reading was made by consensus. Results: A total of 295 brain CT scans (45.1% male) with a mean age of 65 ± 20.0 years were included. 91.8% were interpreted as ASPECTS-v 10 in both cerebral hemispheres by both readers. ASPECTS-a scored 45% with ASPECTS 10 in both cerebral hemispheres. In 152 (51.5%) the ASPECTS-a and the ASPECTS-v did not coincide. The causes of the discrepancy were mainly due to segmentation errors (usually due to asymmetric atrophies). Most of the segmentation errors were located in the head of the caudate nucleus, observed in 60 studies. Conclusions: ASPECTS-a is a powerful and helpful tool, but human supervision is always necessary, particularly in groups of patients with pre-existing brain changes.(AU)

[Valuation of automatized ASPECTS as an artificial intelligence tool in daily clinical]. / Valoración del ASPECTS automatizado como herramienta de inteligencia artificial en la práctica clínica diaria.

AIMS: To evaluate an automated ASPECTS (ASPECTS-a) software against two radiologists' reading of CT scans requested from the Emergency Department. Describe the most frequent failures of the ASPECTS-a. MATERIAL AND METHODS: All the cranial CT Scans requested by the Emergency Department in one month were collected. The following data were recorded: age, sex, the reason for requesting the study, and imaging findings. A program was used that provides an ASPECTS score automatically. Subsequently, 2 radiologists independently reviewed all of the studies and provided the visual ASPECTS (ASPECTS-v). In case of discrepancy, a new reading was made by consensus. RESULTS: A total of 295 brain CT scans (45.1% male) with a mean age of 65 ± 20.0 years were included. 91.8% were interpreted as ASPECTS-v 10 in both cerebral hemispheres by both readers. ASPECTS-a scored 45% with ASPECTS 10 in both cerebral hemispheres. In 152 (51.5%) the ASPECTS-a and the ASPECTS-v did not coincide. The causes of the discrepancy were mainly due to segmentation errors (usually due to asymmetric atrophies). Most of the segmentation errors were located in the head of the caudate nucleus, observed in 60 studies. CONCLUSIONS: ASPECTS-a is a powerful and helpful tool, but human supervision is always necessary, particularly in groups of patients with pre-existing brain changes.

TITLE: Valoración del ASPECTS automatizado como herramienta de inteligencia artificial en la práctica clínica diaria.Objetivos. Evaluar un software del Alberta Stroke Program Early CT Score (ASPECTS) automatizado (ASPECTS-a) frente a la lectura de dos radiólogos en las tomografías computarizadas (TC) solicitadas desde el servicio de urgencias. Describir los fallos más frecuentes del ASPECTS-a. Material y métodos. Se recogieron las TC cerebrales solicitadas por el servicio de urgencias en el período de un mes. Se registraron los siguientes datos: edad, sexo, motivo de solicitud del estudio y hallazgos en la prueba de imagen. Se utilizó un programa que proporciona una puntuación del ASPECTS automáticamente. Posteriormente, dos radiólogos examinaron de forma independiente todos los estudios y realizaron un ASPECTS visual (ASPECTS-v). En caso de discrepancia, se hizo una nueva lectura en consenso. Se compararon los resultados del ASPECTS-a con el ASPECTS-v. Resultados. Se realizaron un total de 295 TC cerebrales urgentes con una edad media de 65 ± 20 años. El 91,8% lo interpretaron los dos lectores como ASPECTS 10 en ambos hemisferios cerebrales. El ASPECTS-a puntuó el 45% con ASPECTS 10 en ambos hemisferios cerebrales. En 152 (51,5%), el ASPECTS-a y el ASPECTS-v no coincidieron. Las causas de la discrepancia fueron fundamentalmente por errores en la segmentación (generalmente por atrofias asimétricas). La mayor parte de los errores en la segmentación se localizaban en la cabeza del núcleo caudado, lo que se observó en 60 estudios. Conclusiones. El ASPECTS-a es una herramienta potente y de gran ayuda, pero siempre es necesaria una supervisión humana, particularmente en grupos de pacientes con cambios cerebrales preexistentes.

Brain CT requests from emergency department: reality. / Tomografía computarizada cerebral solicitada desde Urgencias: la realidad.

OBJECTIVES: To evaluate the most common reasons for requesting brain CT studies from the emergency department and to calculate the prevalence of urgent acute pathology on this population group. MATERIAL AND METHODS: We reviewed brain CT studies requested from the emergency department during October and November 2018. We recorded the following variables: age, sex, reason for requesting the study, CT findings, use of contrast agents and reasons for using them, and, in patients who had undergone previous head CT studies, whether the findings had changed. SPSS was used for statistical analyses. RESULTS: A total of 507 urgent brain CT studies were done (41.4% in men, 58.6% in women; mean age, 65.4±20 years). The most common reason for requesting the study was head trauma (40.5%); only 15.6% of these studies showed acute posttraumatic intracranial lesions. The second most common reason was focal neurologic symptoms (16%); only 16% of these studies showed recent ischemic infarcts or acute bleeding. No pathological findings were reported in 43.2% of the studies. The most common abnormal finding was small vessel disease (20%). Space-occupying lesions (both benign and malignant) were found in 3.9% of all patients. CONCLUSIONS: Most brain CT studies requested from the emergency department showed no findings that would modify the management of the patient. Overuse of urgent brain CT increases the radiology department's workload and exposes patients to radiation unnecessarily.

Resonancia magnética de conducto auditivo interno: ¿es siempre útil administrar contraste intravenoso? / Inner ear MRI: is it always useful to manage intravenous contrast?

OBJETIVO: Evaluar el valor añadido que aporta administrar contraste intravenoso (CIV) rutinariamente en las resonancias magnéticas (RM) de pacientes con síntomas audiovestibulares en la lectura de un neurorradiólogo y un residente. MATERIAL Y MÉTODOS: Estudio retrospectivo que incluía pacientes que durante 2 meses se realizaron una RM de oídos. Dos radiólogos revisaron las imágenes de forma independiente y cegada. Se realizó una lectura analizando las secuencias adquiridas sin contraste, y posteriormente una segunda lectura analizando todas las secuencias, incluidas las secuencias T1-poscontraste. Se calculó la correlación interobservador y la correlación entre los hallazgos en RM y el motivo de solicitud. RESULTADOS: Se incluyeron 40 pacientes. El rango de edad fue de 36-80 años. El motivo de solicitud más frecuente fue hipoacusia (52,5%). El neurorradiólogo sin CIV encontró un 82,5% de patología extraótica y un 17,5% de patología ótica, entre las que destacaba un neurinoma del VIII par (7,5%); también laberintitis osificante, otosclerosis retrofenestrada y colesteatoma. Tras la administración de CIV, los hallazgos fueron similares. El residente identificó patología ótica en el 5% en las secuencias basales y un 20% usando CIV. La correlación interobservador usando CIV fue excelente (0,97), pero débil sin CIV (0,52). Existió correlación entre los motivos de solicitud y los hallazgos en los oídos, tanto en los protocolos sin CIV (p = 0,004) como en los protocolos con CIV (p = 0,002). CONCLUSIONES: La RM de oídos sin contraste da información relevante para valorar síntomas audiovestibulares. El uso de CIV aumenta el grado de confianza en un radiólogo novel, mientras que en el experto su uso es menos relevante. Se debería plantear un protocolo en el que se use gadolinio en pacientes seleccionados

OBJECTIVE: To evaluate the added value of administering intravenous contrast (IVC) routinely to the MRI of patients with audiovestibular symptoms in the assessment of a neuroradiologist and a resident. MATERIALS AND METHODS: Retrospective study including patients who had an inner ear MRI for two months. Two radiologists reviewed independently and blinded the images. A first assessment was made analyzing just the sequences acquired without contrast and then a second evaluation of all the sequences, including post-contrast T1 sequences. The interobserver correlation and the correlation between MRI findings and the reason for requesting the study were calculated. RESULTS: 40 patients were included. The range age was 36-80 years. The most frequent reason for request the MRI was hearing loss (52.5%). Neuroradiologist without IVC found 82.5% of extraotic pathology and 17.5% of otic pathology, highlighting the neurinoma of the VIII pair (7.5%); ossifying labyrinthitis, retrofenestrated otosclerosis and cholesteatoma. After IVC administration, findings were similar. The resident identified otic pathology in 5% in baseline sequences and 20% using CIV. The interobserver correlation using IVC was excellent (0.97), but weak without IVC (0.52). There was a correlation between the reasons for request the MRI and the findings in the ears, both in protocols without IVC (p = 0.004) and in protocols with IVC (p = 0.002). CONCLUSION: Inner ear MRI without contrast gives relevant information to assess audiovestibular symptoms. The use of IVC increases the degree of confidence in a novel radiologist, while in the expert its use is less relevant. A protocol should be proposed in which gadolinium is used in selected patients

Ultralow-dose CT of the petrous bone using iterative reconstruction technique, tin filter and high resolution detectors allows an adequate assessment of the petrous bone structures. / La tomografía computarizada de peñascos con dosis ultrabaja, utilizando filtro de estaño, detectores de alta resolución y reconstrucción iterativa, permite una adecuada valoración de las estructuras del peñasco.

OBJECTIVES: To assess image quality and radiation dose in computed tomography (CT) studies of the petrous bone done with a scanner using a tin filter, high-resolution detectors, and iterative reconstruction, and to compare versus in studies done with another scanner without a tin filter using filtered back projection reconstruction. MATERIAL AND METHODS: Thirty two patients (group 1) were acquired with an ultra-low dose CT (32-MDCT, 130 kV, tin filter and iterative reconstruction). Images and radiation doses were compared to 36 patients (group 2) acquired in a 16-MDCT (120 kV and filtered back-projection). Muscle density, bone density, and background noise were measured. Signal-to-noise ratio (SNR) was calculated. To assess image quality, two independent radiologists subjectively evaluated the visualization of the different structures of the middle and inner ear (0 = not visualized, 3 = perfectly identified and delimited). Interobserver agreement was calculated. Effective dose at different anatomical levels with the dose-length product was recorded. RESULTS: In the quantitative analysis, there were no significant differences in image noise between the two groups. In the qualitative analysis, a similar or slightly lower subjective score was obtained in the delimitation of different structures of the ossicular chain and cochlea in the 32-MDCT, compared to 16-MDCT, with statistically significant differences. Mean effective dose (± standard deviation) was 0.16 ± 0.04 mSv for the 32-MDCT and 1.25 ± 0.30 mSv for the 16-MDCT. CONCLUSIONS: The use of scanners with tin filters, high-resolution detectors, and iterative reconstruction allows to obtain images with adequate quality for the evaluation of the petrous bone structures with ultralow doses of radiation (0.16±0.04 mSv).

¿Se debe incluir la secuencia de susceptibilidad magnética en el protocolo de resonancia magnética cerebral básico? / Should susceptibility-weighted imaging be included in the basic protocol for magnetic resonance imaging of the brain?

OBJETIVO: Analizar el impacto clínico de adquirir la secuencia de susceptibilidad magnética (SWI) de forma rutinaria en los estudios de resonancia magnética (RM) cerebral. MATERIAL Y MÉTODOS: Se lleva a cabo un estudio prospectivo observacional unicéntrico durante 6 meses a pacientes a los que se le realizó una RM cerebral. Los grupos de estudio se establecieron basándose en la información clínica remitida: el grupo 1 de estudio está formado por aquellos pacientes a los que el radiólogo protocolizó la adquisición de la secuencia SWI, y el grupo 2, por aquellos a los que se les realizó la secuencia SWI sin haber sido protocolizada. Se recogen la edad, sexo y factores de riesgo (hipertensión arterial, historia de traumatismo craneal o de malformaciones vasculares intracraneales). Se analizaron los hallazgos en la secuencia de SWI, si estos eran visibles en el resto de las secuencias y si su identificación suponía cambios sustanciales en el informe radiológico del paciente. RESULTADOS: El grupo 1 estaba formado por 62 pacientes y el grupo 2, por 79. No hubo diferencias al comparar la edad y los factores de riesgo entre los dos grupos. En el grupo 1, los hallazgos de la SWI supusieron un cambio en el informe radiológico en el 34% de los pacientes, y en el grupo 2, en un 14%: las diferencias fueron estadísticamente significativas. CONCLUSIÓN: La secuencia SWI puede ayudar al radiólogo a detectar hallazgos adicionales a las secuencias convencionales en la RM cerebral, que en algunos casos suponen un cambio en el informe radiológico

OBJECTIVE: To analyze the clinical impact of routine acquisition of susceptibility-weighted imaging (SWI) in magnetic resonance imaging (MRI) studies of the brain. MATERIAL AND METHODS: This prospective observational study included all patients undergoing brain MRI including SWI during a 6-month period. Patients were divided into two groups based on the clinical information provided: Group 1 comprised patients in whom SWI acquisition formed part of the brain MRI protocol, and Group comprised patients who underwent SWI without these sequences being included in the protocol. We recorded patients' age, sex, and risk factors (hypertension, history of brain trauma or intracranial vascular malformations). We analyzed the SWI findings, whether these findings were visible on the other sequences, and whether identifying these findings resulted in substantial changes to the radiological report. RESULTS: There were 62 patients in Group 1 and 79 in Group 2. The groups were similar in age and risk factors. SWI findings resulted in substantial changes to the radiological report in 34% of the patients in Group 1 and in 14% of those in Group 2; this difference was statistically significant. CONCLUSION: SWI can help radiologists detect findings not seen on conventional brain MRI that sometimes result in substantial changes to the radiological report

Inner ear MRI: is it always useful to manage intravenous contrast? / Resonancia magnética de conducto auditivo interno: ¿es siempre útil administrar contraste intravenoso?

OBJECTIVE: To evaluate the added value of administering intravenous contrast (IVC) routinely to the MRI of patients with audiovestibular symptoms in the assessment of a neuroradiologist and a resident. MATERIALS AND METHODS: Retrospective study including patients who had an inner ear MRI for two months. Two radiologists reviewed independently and blinded the images. A first assessment was made analyzing just the sequences acquired without contrast and then a second evaluation of all the sequences, including post-contrast T1 sequences. The interobserver correlation and the correlation between MRI findings and the reason for requesting the study were calculated. RESULTS: 40 patients were included. The range age was 36-80 years. The most frequent reason for request the MRI was hearing loss (52.5%). Neuroradiologist without IVC found 82.5% of extraotic pathology and 17.5% of otic pathology, highlighting the neurinoma of the VIII pair (7.5%); ossifying labyrinthitis, retrofenestrated otosclerosis and cholesteatoma. After IVC administration, findings were similar. The resident identified otic pathology in 5% in baseline sequences and 20% using CIV. The interobserver correlation using IVC was excellent (0.97), but weak without IVC (0.52). There was a correlation between the reasons for request the MRI and the findings in the ears, both in protocols without IVC (p = 0.004) and in protocols with IVC (p = 0.002). CONCLUSION: Inner ear MRI without contrast gives relevant information to assess audiovestibular symptoms. The use of IVC increases the degree of confidence in a novel radiologist, while in the expert its use is less relevant. A protocol should be proposed in which gadolinium is used in selected patients.

Should susceptibility-weighted imaging be included in the basic protocol for magnetic resonance imaging of the brain? / ¿Se debe incluir la secuencia de susceptibilidad magnética en el protocolo de resonancia magnética cerebral básico?

OBJECTIVE: To analyze the clinical impact of routine acquisition of susceptibility-weighted imaging (SWI) in magnetic resonance imaging (MRI) studies of the brain. MATERIAL AND METHODS: This prospective observational study included all patients undergoing brain MRI including SWI during a 6-month period. Patients were divided into two groups based on the clinical information provided: Group 1 comprised patients in whom SWI acquisition formed part of the brain MRI protocol, and Group comprised patients who underwent SWI without these sequences being included in the protocol. We recorded patients' age, sex, and risk factors (hypertension, history of brain trauma or intracranial vascular malformations). We analyzed the SWI findings, whether these findings were visible on the other sequences, and whether identifying these findings resulted in substantial changes to the radiological report. RESULTS: There were 62 patients in Group 1 and 79 in Group 2. The groups were similar in age and risk factors. SWI findings resulted in substantial changes to the radiological report in 34% of the patients in Group 1 and in 14% of those in Group 2; this difference was statistically significant. CONCLUSION: SWI can help radiologists detect findings not seen on conventional brain MRI that sometimes result in substantial changes to the radiological report.

Mediolisis arterial segmentaria / Segmental arterial mediolysis

Se presenta el caso de una paciente de 51 años con esclerosis múltiple en la que de forma incidental se observó un hematoma intramural en la arteria carótida interna extracraneal en una resonancia magnética (RM) cerebral de control por su enfermedad de base. Adicionalmente se realizó una angio-RM de troncos supraaórticos y una angiografía por tomografía computarizada de aorta, donde se observó la presencia de dilataciones arteriales, aneurismas, disecciones y hematomas intramurales de las arterias carótidas internas, arterias vertebrales y arterias del territorio esplácnico. Estos hallazgos condujeron a la sospecha de mediolisis arterial segmentaria. Seis meses después, tras tratamiento antiagregante, la afectación arterial se autorresolvió. La mediolisis arterial segmentaria es una patología infrecuente, lo que unido a la baja sospecha clínica y al desconocimiento de esta entidad por parte de los radiólogos hace que pueda pasar desapercibida o ser confundida con otras vasculitis. En esta comunicación, se describen los hallazgos fisiopatológicos más relevantes y su correlación con las pruebas de imagen

This article reports the case of a 51-year-old woman in whom brain MRI to follow up multiple sclerosis incidentally discovered an intramural hematoma in the extracranial internal carotid artery. MR angiography of the supra-aortic trunks and CT angiography of the aorta showed arterial dilations, aneurysms, dissections, and intramural hematomas in the internal carotid arteries, vertebral arteries, and arteries in the splanchnic territory. These findings raised suspicion of segmental arterial mediolysis. After 6 months of treatment with antiplatelet drugs, the arterial involvement resolved. Segmental arterial mediolysis is an uncommon disease; low clinical suspicion and radiologists' lack of knowledge about this entity mean that it can go undetected or be confused with other vasculitides. This report describes the most relevant pathophysiological findings and correlates them with the imaging findings

Segmental arterial mediolysis. / Mediolisis arterial segmentaria.

This article reports the case of a 51-year-old woman in whom brain MRI to follow up multiple sclerosis incidentally discovered an intramural hematoma in the extracranial internal carotid artery. MR angiography of the supra-aortic trunks and CT angiography of the aorta showed arterial dilations, aneurysms, dissections, and intramural hematomas in the internal carotid arteries, vertebral arteries, and arteries in the splanchnic territory. These findings raised suspicion of segmental arterial mediolysis. After 6 months of treatment with antiplatelet drugs, the arterial involvement resolved. Segmental arterial mediolysis is an uncommon disease; low clinical suspicion and radiologists' lack of knowledge about this entity mean that it can go undetected or be confused with other vasculitides. This report describes the most relevant pathophysiological findings and correlates them with the imaging findings.

Técnicas avanzadas de resonancia magnética en patología tumoral de cabeza y cuello / Advanced magnetic resonance imaging techniques for tumors of the head and neck

La resonancia magnética se ha convertido en una herramienta fundamental en la valoración de la patología tumoral de cabeza y cuello. Los detalles anatómicos que proporcionan las imágenes de resonancia son fundamentales para diagnosticar, caracterizar y estadificar tanto la tumoración primaria como las metástasis ganglionares. Además de las mejoras técnicas en las secuencias anatómicas, como es el caso del Dixon para mejorar la supresión de la grasa, se están desarrollando otras secuencias como son la difusión y la perfusión, que dan información molecular, biológica y fisiológica del tumor proporcionando biomarcadores que pueden ayudar a conocer la biología del tumor en el momento del diagnóstico y posteriormente a monitorizar la enfermedad, y facilitan información muy relevante de la respuesta al tratamiento

Magnetic resonance imaging has become a fundamental tool for the evaluation of head and neck tumors. The anatomic details that magnetic resonance images provide are fundamental for diagnosing, characterizing, and staging both primary tumors and lymph node metastases. In addition to technical improvements in anatomic sequences, such as Dixon techniques to improve fat suppression, other sequences being developed, such as diffusion and perfusion, provide molecular, biological, and physiological information about the tumor and are yielding imaging biomarkers that can help in determining the tumor's biology at the time of diagnosis and in the follow-up of the disease. Magnetic resonance imaging also provides very useful information about the response to treatment