Mejora en el manejo de la sospecha del síndrome aórtico agudo en urgencias mediante un algoritmo clínico y el estudio de factores predictivos / Improvement in the management of suspected acute aortic syndrome in the emergency room through a clinical algorithm and study of predictive factors

Antecedentes y objetivo: El síndrome aórtico agudo (SAA) es poco frecuente y difícil de diagnosticar, con una gran variabilidad en su cuadro clínico inicial. Los objetivos son: 1) desarrollar un algoritmo informático, o un sistema de apoyo a las decisiones clínicas (SADC), para el manejo y la solicitud de estudios de diagnóstico por imagen en el servicio de Urgencias, en concreto de una tomografía computarizada (TC) de la aorta, ante la sospecha de SAA, 2) determinar el efecto de la implantación de este sistema, y 3) determinar los factores asociados a un diagnóstico radiológico positivo que mejoren la capacidad predictiva de los hallazgos de la TC de aorta. Material y métodos: Tras desarrollar e implementar un algoritmo basado en la evidencia, se estudiaron casos de sospecha de SAA. Se utilizó el test de la χ2 para analizar la asociación entre las variables incluidas en el algoritmo y el diagnóstico radiológico, con 3 categorías: sin hallazgos relevantes, positivo para SAA y diagnósticos alternativos. Resultados: Se identificaron 130 solicitudes; 19 (14,6%) tenían SAA y 34 (26,2%) tenían otra patología aguda. De las 19 con SAA, 15 habían sido estratificadas como de alto riesgo y 4 como de riesgo intermedio. La probabilidad de SAA era 3,4 veces mayor en los pacientes con aneurisma aórtico conocido (p=0,021, IC del 95%: 1,2-9,6) y 5,1 veces mayor en los pacientes con un soplo de insuficiencia vascular aórtica de novo(p=0,019, IC del 95 %: 1,3-20,1). La probabilidad de tener una enfermedad aguda grave alternativa fue 3,2 veces mayor en los pacientes con hipotensión o choque (p=0,02, IC del 95 %: 1,2-8,5). Conclusión: El uso de un SADC en el servicio de Urgencias puede ayudar a optimizar el diagnóstico del SAA. Se demostró que la presencia de un aneurisma aórtico conocido y de insuficiencia valvular aórtica de nueva aparición aumentan significativamente la probabilidad de SAA. Se necesitan más estudios para establecer una regla de predicción clínica.(AU)

Background and objective: Acute aortic syndrome (AAS) is uncommon and difficult to diagnose, with great variability in clinical presentation. To develop a computerized algorithm, or clinical decision support system (CDSS), for managing and requesting imaging in the emergency department, specifically computerized tomography of the aorta (CTA), when there is suspicion of AAS, and to determine the effect of implementing this system. To determine the factors associated with a positive radiological diagnosis that improve the predictive capacity of CTA findings. Materials and methods: After developing and implementing an evidence-based algorithm, we studied suspected cases of AAS. Chi-squared test was used to analyze the association between the variables included in the algorithm and radiological diagnosis, with 3 categories: no relevant findings, positive for AAS, and alternative diagnoses. Results: 130 requests were identified; 19 (14.6%) had AAS and 34 (26.2%) had a different acute pathology. Of the 19 with AAS, 15 had been stratified as high risk and 4 as intermediate risk. The probability of AAS was 3.4 times higher in patients with known aortic aneurysm (P=.021, 95% CI 1.2–9.6) and 5.1 times higher in patients with a new aortic regurgitation murmur (P=.019, 95% CI 1.3–20.1). The probability of having an alternative severe acute pathology was 3.2 times higher in patients with hypotension or shock (P=.02, 95% CI 1.2–8.5). Conclusion: The use of a CDSS in the emergency department can help optimize AAS diagnosis. The presence of a known aortic aneurysm and new-onset aortic regurgitation were shown to significantly increase the probability of AAS. Further studies are needed to establish a clinical prediction rule.(AU)

Improvement in the management of suspected acute aortic syndrome in the emergency room through a clinical algorithm and study of predictive factors.

BACKGROUND AND OBJECTIVE: Acute aortic syndrome (AAS) is uncommon and difficult to diagnose, with great variability in clinical presentation. To develop a computerized algorithm, or clinical decision support system (CDSS), for managing and requesting imaging in the emergency department, specifically computerized tomography of the aorta (CTA), when there is suspicion of AAS, and to determine the effect of implementing this system. To determine the factors associated with a positive radiological diagnosis that improve the predictive capacity of CTA findings. MATERIALS AND METHODS: After developing and implementing an evidence-based algorithm, we studied suspected cases of AAS. Chi-squared test was used to analyze the association between the variables included in the algorithm and radiological diagnosis, with 3 categories: no relevant findings, positive for AAS, and alternative diagnoses. RESULTS: 130 requests were identified; 19 (14.6%) had AAS and 34 (26.2%) had a different acute pathology. Of the 19 with AAS, 15 had been stratified as high risk and 4 as intermediate risk. The probability of AAS was 3.4 times higher in patients with known aortic aneurysm (P = .021, 95% CI 1.2-9.6) and 5.1 times higher in patients with a new aortic regurgitation murmur (P = .019, 95% CI 1.3-20.1). The probability of having an alternative severe acute pathology was 3.2 times higher in patients with hypotension or shock (P = .02, 95% CI 1.2-8.5). CONCLUSION: The use of a CDSS in the emergency department can help optimize AAS diagnosis. The presence of a known aortic aneurysm and new-onset aortic regurgitation were shown to significantly increase the probability of AAS. Further studies are needed to establish a clinical prediction rule.

Tomografía computarizada coronaria en urgencias: importancia de la experiencia del radiólogo / Coronary computed tomography in emergencies: the importance of the radiologist's experience

Introducción: La incorporación de la angiografía coronaria por tomografía computarizada (ACTC) a la atención sanitaria en las urgencias hospitalarias hace necesaria una adecuada capacitación para la interpretación de esta prueba de imagen. Esta capacitación puede afectar al grado de concordancia interobservador de los radiólogos que evalúan dichos estudios. Objetivo: Evaluar la concordancia interobservador en función de la experiencia en la interpretación de ACTC realizadas a pacientes que acuden a urgencias por dolor torácico agudo (DTA) con probabilidad baja-intermedia de síndrome coronario agudo (SCA). Materiales y método: Estudio de concordancia interobservador en la evaluación de ACTC realizadas en contexto urgente utilizando CAD-RADS como registro de resultados. Se crearon parejas de observadores entre un total de 8 evaluadores (4 staff y 4 en formación). Se estimó el grado de concordancia global y entre subgrupos de acuerdo con su experiencia mediante el coeficiente kappa. Resultados: La concordancia fue sustancial entre radiólogos experimentados y en formación (k= 0,627; IC95%: 0,436-0,826), así como para todas las parejas de evaluadores (k=0,661; IC95%: 0,506-0,823) para todas las categorías CAD-RADS en conjunto. El grado de acuerdo del grupo de radiólogos experimentados fue superior al de los radiólogos en formación en todos los análisis realizados. La concordancia fue excelente para CAD-RADS global (k= 0,950; IC95%: 0,896-1) y para CAD-RADS ≥ 4 (k = 1), observando un menor acuerdo para CAD-RADS ≥ 3 (k= 0,754; IC95%: 0,246-1,255). Los valores del personal en formación para estas categorías fueron k= 0,623, k= 0,596 y k= 0,473, respectivamente. Conclusión: La concordancia entre radiólogos staff en la evaluación de ACTC realizadas a pacientes en el contexto de urgencias es excelente. El grado de acuerdo es menor cuando el personal inexperto forma parte de las parejas analizadas...(AU)

Introduction: Incorporating coronary computed tomography angiography (CTA) in the hospital workup for suspected acute coronary syndrome requires appropriate skills for interpreting this imaging test. Radiologists’ skills can affect the interobserver agreement in evaluating these studies. Objective: To determine the interobserver agreement according to radiologists’ experience in the interpretation of coronary CTA studies done in patients who present at the emergency department with acute chest pain and low-to-intermediate probability of acute coronary syndrome. Materials and methods: We studied the interobserver agreement in the urgent evaluation of coronary CTA studies in which CAD-RADS was used to register the findings. We created pairs of observers among a total of 8 assessors (4 attending radiologists and 4 radiology residents). We used the kappa coefficient to estimate the overall concordance and the concordance between subgroups according to their experience. Results: The agreement was substantial between experienced radiologists and residents (k = 0.627; 95%CI: 0.436 – 0.826) as well as between all the pairs of observers (k=0.661; 95%CI: 0.506 – 0.823) for all the CAD-RADS together. The degree of agreement within the group of experienced radiologists was greater than that within the group of residents in all the analyses. The agreement was excellent for the overall CAD-RADS (k=0.950; 95% CI: 0.896 – 1) and for CAD-RADS ≥ 4 (k=1); the agreement was lower for CAD-RADS ≥ 3 (k = 0.754; 95% CI: 0.246 – 1.255). The agreement for the residents for these categories was k= 0.623, k=0.596, and k=0.473, respectively. Conclusion: The agreement among attending radiologists regarding the assessment of urgent coronary CTA studies is excellent. The agreement is lower when residents are paired with attending radiologists...(AU)

Coronary computed tomography in emergencies: The importance of the radiologist's experience.

INTRODUCTION: Incorporating coronary computed tomography angiography (CTA) in the hospital workup for suspected acute coronary syndrome requires appropriate skills for interpreting this imaging test. Radiologists' skills can affect the interobserver agreement in evaluating these studies. OBJECTIVE: To determine the interobserver agreement according to radiologists' experience in the interpretation of coronary CTA studies done in patients who present at the emergency department with acute chest pain and low-to-intermediate probability of acute coronary syndrome. MATERIALS AND METHODS: We studied the interobserver agreement in the urgent evaluation of coronary CTA studies in which CAD-RADS was used to register the findings. We created pairs of observers among a total of 8 assessors (4 attending radiologists and 4 radiology residents). We used the kappa coefficient to estimate the overall concordance and the concordance between subgroups according to their experience. RESULTS: The agreement was substantial between experienced radiologists and residents (k=0.627; 95%CI: 0.436-0.826) as well as between all the pairs of observers (k=0.661; 95%CI: 0.506-0.823) for all the CAD-RADS together. The degree of agreement within the group of experienced radiologists was greater than that within the group of residents in all the analyses. The agreement was excellent for the overall CAD-RADS (k=0.950; 95% CI: 0.896-1) and for CAD-RADS ≥ 4 (k=1); the agreement was lower for CAD-RADS ≥ 3 (k=0.754; 95% CI: 0.246-1.255). The agreement for the residents for these categories was k=0.623, k=0.596, and k=0.473, respectively. CONCLUSION: The agreement among attending radiologists regarding the assessment of urgent coronary CTA studies is excellent. The agreement is lower when residents are paired with attending radiologists. These findings should be taken into consideration when implementing coronary CTA in emergency departments and in the organisation of radiological staff for interpreting and reporting this imaging test.

Recommendations on the use of computed tomography in the stroke code: Consensus document SENR, SERAU, GEECV-SEN, SERAM.

The Spanish Society of Emergency Radiology (SERAU), the Spanish Society of Neuroradiology (SENR), the Spanish Society of Neurology through its Cerebrovascular Diseases Study Group (GEECV-SEN) and the Spanish Society of Medical Radiology (SERAM) have met to draft this consensus document that will review the use of computed tomography in the stroke code patients, focusing on its indications, the technique for its correct acquisition and the possible interpretation mistakes.

Recomendaciones sobre el uso de la tomografía computarizada en el código ictus: Documento de consenso SENR, SERAU, GEECV-SEN, SERAM / Recommendations on the use of computed tomography in the stroke code: Consensus document SENR, SERAU, GEECV-SEN, SERAM

La Sociedad Española de Radiología de Urgencias (SERAU), la Sociedad Española de Neurorradiología (SENR), la Sociedad Española de Neurología a través de su Grupo de Estudio de Enfermedades Cerebrovasculares (GEECV-SEN) y la Sociedad Española de Radiología Médica (SERAM) se han reunido para redactar este documento de consenso que repasará el uso de la tomografía computarizada en el código ictus, centrándose en sus indicaciones, la técnica para su correcta adquisición y las posibles causas de error en su interpretación (AU)

The Spanish Society of Emergency Radiology (SERAU), the Spanish Society of Neuroradiology (SENR), the Spanish Society of Neurology through its Cerebrovascular Diseases Study Group (GEECV-SEN) and the Spanish Society of Medical Radiology (SERAM) have met to draft this consensus document that will review the use of computed tomography in the stroke code patients, focusing on its indications, the technique for its correct acquisition and the possible interpretation mistakes (AU)

Dolor abdominal agudo en la enfermedad de Crohn. ¿Qué prueba de imagen urgente se debe hacer? / Acute abdominal pain in patients with Crohn's disease: what urgent imaging tests should be done?

La enfermedad de Crohn es una patología de etiología autoinmunitaria, con afectación predominante del aparato digestivo. Se trata de una enfermedad que se diagnostica a edad temprana y presenta un curso crónico con reagudizaciones. Estos brotes se suelen manejar de forma similar a un abdomen agudo en los pacientes que acuden a los servicios de urgencias, y no existe un consenso sobre cuáles serían las pruebas de imagen más adecuadas. Debido a esta controversia, se ha decidido realizar una revisión de la bibliografía actual sobre cuáles serían las pruebas de imagen indicadas (ya sea por rendimiento diagnóstico o por menor exposición a radiación ionizante) en el brote agudo de pacientes con enfermedad de Crohn

Crohn's disease is an autoimmune disease that predominantly affects the gastrointestinal tract. Crohn's disease is diagnosed at a young age and runs a chronic course with acute flare-ups. When patients with Crohn's disease present with flare-ups at the emergency department, they are usually managed in a way similar to patients with acute abdomen; there is no consensus about the most appropriate imaging work-up for patients with flare-ups of Crohn's disease. Thus, we decided to review the literature about the imaging tests indicated (whether related to their diagnostic performance or to lower exposure to ionizing radiation) for acute flare-ups in patients with Crohn's disease

Acute abdominal pain in patients with Crohn's disease: what urgent imaging tests should be done? / Dolor abdominal agudo en la enfermedad de Crohn. ¿Qué prueba de imagen urgente se debe hacer?

Crohn's disease is an autoimmune disease that predominantly affects the gastrointestinal tract. Crohn's disease is diagnosed at a young age and runs a chronic course with acute flare-ups. When patients with Crohn's disease present with flare-ups at the emergency department, they are usually managed in a way similar to patients with acute abdomen; there is no consensus about the most appropriate imaging work-up for patients with flare-ups of Crohn's disease. Thus, we decided to review the literature about the imaging tests indicated (whether related to their diagnostic performance or to lower exposure to ionizing radiation) for acute flare-ups in patients with Crohn's disease.

PanGen-Fam: Spanish registry of hereditary pancreatic cancer.

PURPOSE: To describe the organisation of the registry and the preliminary results in terms of characteristics of high-risk pancreatic ductal adenocarcinoma (PDAC) families recruited to date and findings of the screening programme. To compare early onset sporadic cases (⩽50 years), sporadic cases (>50 years) and cases with family history of cancer, for PDAC possible risk factors. METHODS/PATIENTS: Families with hereditary cancer syndromes predisposing to PDAC were recruited from two main sources: Spanish hospitals participating in PanGenEU, a pan-European multicentre case-control study, and their genetic counseling unit. Individuals at high-risk of PDAC were enrolled into a screening programme, consisting of Endoscopic ultrasound, computerised tomography, magnetic resonance imaging. Genetic testing of candidate genes was offered according to each patient's risk. RESULTS: Among 577 consecutive PDAC cases, recruited via PanGenEU, 36 (6%) had ⩾2 first-degree relative with PDAC: Familial pancreatic cancer (FPC). So far PanGen-Fam has recruited 42 high-risk PDAC families; 25 (60%) had FPC. Five index cases with cancer were positive for BRCA2 and one for BRCA1 germline mutations. In the second year of prospective PDAC screening, one neuroendocrine tumour and a high-grade dysplasia lesion suspicious of carcinoma were diagnosed among 41 high-risk individuals. Furthermore EUS detected chronic-pancreatitis-like parenchymal changes in 15 patients. CONCLUDING STATEMENT: The identification and recruitment of PDAC high-risk families into the PanGen-Fam registry provides an opportunity to detect early onset cancer and precursor pancreatic cancer lesions at a potentially curative stage and to increase the knowledge of the natural history of the disease.

Accuracy of CT angiography in the diagnosis of acute gastrointestinal bleeding: systematic review and meta-analysis.

OBJECTIVE: To assess the diagnostic accuracy of computed tomography (CT) angiography in the evaluation of patients with an episode of acute gastrointestinal haemorrhage. METHODS: Systematic review and meta-analysis to estimate pooled accuracy indices. A bivariate random effects model was adjusted to obtain a summary receiver-operating characteristic (sROC) curve and the corresponding area under the curve (AUC). RESULTS: Twenty-two studies were included and provided data on 672 patients (range of age 5-74) with a mean age of 65 years. The overall sensitivity of CT angiography for detecting active acute GI haemorrhage was 85.2 % (95 % CI 75.5 % to 91.5 %). The overall specificity of CT angiography was 92.1 % (95 % CI 76.7 % to 97.7 %). The likelihood ratios for positive and negative test results were 10.8 (95 % CI 3.4 to 34.4) and 0.16 (95 % CI 0.1 to 0.27) respectively, with an AUC of 0.935 (95 % CI 0.693 to 0.989). The sources of heterogeneity explored had no significant impact on diagnostic performance. CONCLUSIONS: CT shows high diagnostic accuracy and is an excellent diagnostic tool for detection and localising of intestinal bleeding sites. It is highly available, provides fast detection and localisation of the bleeding site, and is minimally invasive. KEY POINTS: • CT angiography is increasingly used for investigating severe gastrointestinal bleeding. • This systematic review and meta-analysis updates previous ones. • In patients with massive gastrointestinal bleeding, CT angiography/MDCT detects bleeding accurately. • CT angiography is useful in locating the bleeding site and determining appropriate treatment.

[Multimodal CT in the diagnostic workup of stroke]. / TC multimodal en el diagnóstico del código ictus.

Stroke results in significant morbidity and mortality. Recent years have seen a revolution in the diagnosis and treatment of stroke, with advances in diagnostic imaging and improvements in early and specific treatment. Multimodal CT (unenhanced CT, perfusion CT, and CT angiography) is widely available, fast, and efficacious, all of which give it a key role in the early diagnosis of stroke and in the selection of patients who will benefit from thrombolytic treatment. Unenhanced CT is useful for ruling out hemorrhage or lesions that simulate stroke and for evaluating the presence of early signs. Perfusion CT enables us to know the presence and extension of infarcted ischemic tissue (irrecoverable) and of penumbra (tissue at risk that is potentially recoverable), thus ensuring more appropriate selection of candidates for treatment. Finally, CT angiography makes it possible to evaluate the intra- and extra-cranial circulation, to know the vascular alteration that originated the stroke, and to guide treatment (intra-arterial or mechanical thrombolysis).

TC multimodal en el diagnóstico del código ictus / Multimodal CT in the diagnostic workup of stroke

La importancia del ictus y los avances en el tratamiento precoz y específico en los estudios de imagen han contribuido a la revolución diagnóstica y terapéutica del mismo. La TC multimodal (TC basal, TC de perfusión y TC-angiografía) está considerada como una técnica eficaz, rápida y disponible. Resulta clave para el diagnóstico precoz y para la selección de los pacientes que se beneficiarán del tratamiento trombolítico. La TC basal, sin contraste, es adecuada para descartar un origen hemorrágico o una lesión simuladora de ictus y para valorar la existencia de signos precoces. La TC de perfusión nos permitirá conocer la presencia y extensión de tejido isquémico infartado (no recuperable) y de tejido en riesgo o zona de penumbra (potencialmente recuperable), se pudiendo seleccionar así más apropiadamente los pacientes candidatos a tratamiento. Por último, la angio-TC permitirá valorar la circulación intra y extracraneal, conocer la alteración vascular que origina el cuadro y podrá servir de guía para el tratamiento (trombólisis intraarterial o mecánica) (AU)

Stroke results in significant morbidity and mortality. Recent years have seen a revolution in the diagnosis and treatment of stroke, with advances in diagnostic imaging and improvements in early and specific treatment. Multimodal CT (unenhanced CT, perfusion CT, and CT angiography) is widely available, fast, and efficacious, all of which give it a key role in the early diagnosis of stroke and in the selection of patients who will benefit from thrombolytic treatment. Unenhanced CT is useful for ruling out hemorrhage or lesions that simulate stroke and for evaluating the presence of early signs. Perfusion CT enables us to know the presence and extension of infarcted ischemic tissue (irrecoverable) and of penumbra (tissue at risk that is potentially recoverable), thus ensuring more appropriate selection of candidates for treatment. Finally, CT angiography makes it possible to evaluate the intra- and extra-cranial circulation, to know the vascular alteration that originated the stroke, and to guide treatment (intra-arterial or mechanical thrombolysis) (AU)

Manejo radiológico del paciente politraumatizado. Evolución histórica y situación actual / Radiological management of patients with multiple trauma: history and current practice

El radiólogo desempeña un papel crucial en el manejo multidisciplinar del paciente politraumatizado, que en las últimas décadas ha sufrido un cambio evolutivo desde la radiología simple hasta la tomografía computarizada multidetector de cuerpo completo, propiciado por los avances tecnológicos y los cambios culturales sanitarios.En este artículo se muestra la evolución de los diferentes protocolos y la situación actual del manejo del paciente politraumatizado.El radiólogo integrado en un equipo multidisciplinar debe decidir la técnica de imagen y el protocolo más idóneo en cada situación, adaptándose a los recursos tecnológicos disponibles (AU)

The radiologist plays a crucial role in the multidisciplinary management of patients with multiple trauma. In the last few decades, technological advances and changes in the healthcare culture have led to changes in the imaging work-up of multiple trauma patients, with emphasis shifting from plain-film radiography to whole-body multidetector CT.AbstractThis article describes the evolution of the different protocols and the current practice in the management of patients with multiple trauma.AbstractAs a member of the multidisciplinary team, the radiologist must decide on the best imaging technique and protocol for each situation in function of the technological resources available (AU)

[Radiological management of patients with multiple trauma: history and current practice]. / Manejo radiológico del paciente politraumatizado. Evolución histórica y situación actual.

The radiologist plays a crucial role in the multidisciplinary management of patients with multiple trauma. In the last few decades, technological advances and changes in the healthcare culture have led to changes in the imaging work-up of multiple trauma patients, with emphasis shifting from plain-film radiography to whole-body multidetector CT. This article describes the evolution of the different protocols and the current practice in the management of patients with multiple trauma. As a member of the multidisciplinary team, the radiologist must decide on the best imaging technique and protocol for each situation in function of the technological resources available.

[PET/CT: protocol aspects and legal controversies]. / PET/TC: aspectos de protocolo y controversias legales.

The combination of positron emission tomography (PET) and computed tomography (CT) in a single scanner (PET/CT) allows anatomic and metabolic images to be fused and correlated with a high degree of accuracy; this represents a very important landmark in the history of medicine and especially in the area of diagnostic imaging. Nevertheless, the implementation, startup, and operation of a PET/CT scanner presents particularly interesting challenges, because it involves the integration of two well-established and consolidated techniques (CT and PET, which provide complementary information) that have traditionally been carried out in the context of two different specialties (radiology and nuclear medicine). The rapid diffusion of this new integrated technology raises a series of questions related to the optimal protocols for image acquisition, the supervision of the examinations, image interpretation, and reporting, as well as questions related to the legal competence and responsibility of the specialists involved in a PET/CT study. The objective of this article is to approach these aspects from a constructive perspective and to stimulate the dialog between the specialties of radiology and nuclear medicine, with the aim of maximizing the diagnostic potential of PET/CT and thus of providing better care for patients.

PET/TC: aspectos de protocolo y controversias legales / PET/CT: protocol aspects and legal controversies

La combinación de una tomografía por emisión de positrones (PET) y de una tomografía computarizada (TC) en un único equipo (PET/TC) permite fusionar y correlacionar con un elevado grado de precisión imágenes anatómicas y metabólicas, y ha supuesto un hito reciente muy importante en la historia de la Medicina, y especialmente en el área del diagnóstico por la imagen. No obstante, la implementación, puesta en marcha y desarrollo de un equipo de PET/TC presenta desafíos particularmente interesantes, ya que supone la integración de dos técnicas diagnósticas reconocidas y consolidadas (la TC y la PET, que proporcionan información complementaria), pero que se han desarrollado tradicionalmente al amparo de dos especialidades diferentes (Radiología y Medicina Nuclear). La rápida difusión de esta nueva tecnología integrada plantea una serie de cuestiones relacionadas con los protocolos óptimos de adquisición de las imágenes, supervisión de los estudios, interpretación de las mismas, elaboración de informes y, especialmente, con la competencia y responsabilidad de los especialistas responsables de un estudio de PET/TC. El objetivo de este artículo es abordar estos aspectos desde una perspectiva constructiva, y estimular el diálogo entre las especialidades de Radiología y Medicina Nuclear, en un intento de maximizar el potencial diagnóstico de la PET/TC y así ofrecer una mejor atención a los pacientes (AU)

The combination of positron emission tomography (PET) and computed tomography (CT) in a single scanner (PET/CT) allows anatomic and metabolic images to be fused and correlated with a high degree of accuracy; this represents a very important landmark in the history of medicine and especially in the area of diagnostic imaging. Nevertheless, the implementation, startup, and operation of a PET/CT scanner presents particularly interesting challenges, because it involves the integration of two well-established and consolidated techniques (CT and PET, which provide complementary information) that have traditionally been carried out in the context of two different specialties (radiology and nuclear medicine). The rapid diffusion of this new integrated technology raises a series of questions related to the optimal protocols for image acquisition, the supervision of the examinations, image interpretation, and reporting, as well as questions related to the legal competence and responsibility of the specialists involved in a PET/CT study. The objective of this article is to approach these aspects from a constructive perspective and to stimulate the dialog between the specialties of radiology and nuclear medicine, with the aim of maximizing the diagnostic potential of PET/CT and thus of providing better care for patients (AU)

[Nodular alveolar pattern of presentation for amiodarone pulmonary toxicity]. / Patrón alveolar nodular como forma de presentación de la toxicidad pulmonar por amiodarona.

Amiodarone is a triiodinated antiarrhythmic drug that accumulates in alveolar macrophages. Its use is limited by its high rate of associated pulmonary toxicity, estimated at 5-7%. Radiologic findings for pulmonary toxicity caused by amiodarone are unspecific and varied. The most common finding is subpleural reticular-type interstitial thickening, predominately in the bases of the lungs. However, the presence of parenchymal nodules is an uncommon presentation. We report the case of a woman treated with amiodarone that presented multiple nodular lesions at plain-film radiography and high-resolution CT that were compatible with pulmonary toxicity caused by amiodarone at pathologic examination.