Severe non-cardiovascular thoracic trauma: diagnostic clues on computed tomography.

OBJECTIVE: About 60% of multiple trauma patients have thoracic trauma, and thoracic trauma results in the death of 10% of these patients. Computed tomography (CT) is the most sensitive and specific imaging modality for the diagnosis of acute disease, and it helps in the management and prognostic evaluation of patients with high-impact trauma. This paper aims to show the practical points that are key for diagnosing severe non-cardiovascular thoracic trauma by CT. CONCLUSION: Knowing the key features of severe acute thoracic trauma on CT is crucial to avoid diagnostic errors. Radiologists play a fundamental role in the accurate early diagnosis of severe non-cardiovascular thoracic trauma, because the patient's management and outcome will depend largely on the imaging findings.

Traumatismo torácico grave no cardiovascular: claves diagnósticas en tomografía computarizada / Severe non-cardiovascular thoracic trauma: diagnostic clues on computed tomography

Objetivo: El traumatismo torácico ocurre en aproximadamente el 60% de los pacientes politraumatizados y es causa de muerte en un 10%. La tomografía computarizada (TC) es la prueba de imagen más sensible y específica en el diagnóstico de patología aguda y contribuye en el manejo y valoración del pronóstico en los pacientes con un traumatismo de alto impacto. El objetivo de este artículo es mostrar puntos clave y prácticos para el diagnóstico con TC de patología no cardiovascular en el traumatismo torácico grave.ConclusiónEl conocimiento de los aspectos clave en la TC de patología aguda en el traumatismo torácico grave es crucial para evitar errores diagnósticos. El radiólogo tiene un papel fundamental en el diagnóstico correcto y precoz de dicha patología, ya que de ello dependerá en gran parte el manejo y evolución de los pacientes.(AU)

Objective: About 60% of polytrauma patients present thoracic traumatic injuries, accounting for approximately 10% of trauma-related deaths. Computed tomography (CT) is the most sensitive and specific imaging modality for the diagnosis of acute injuries, and it improves management and prognostic evaluation of patients with high-impact trauma. This paper aims to show practical clues that are key for diagnosing severe non-cardiovascular thoracic trauma by CT.ConclusionKnowing the key features of severe acute thoracic trauma on CT is crucial to avoid diagnostic errors. Radiologists play a fundamental role in the accurate early diagnosis of severe non-cardiovascular thoracic trauma, because the patient's management and outcome will depend largely on the imaging findings.(AU)

Pleural appendages: Description, incidence and relations with body mass index

BACKGROUND AND AIMS: Pleural appendages (PA) are portions of extrapleural fat that hang from the chest wall. They have been described on videothoracoscopy, however their appearance, frequency and possible relationship with the amount of patient's fat remain unknown. Our aim is to describe their appearances and prevalence on CT, and determinate whether their size and number is higher in obese patients. PATIENTS AND METHODS: Axial images of 226 patients with pneumothorax on CT chest were retrospectively reviewed. Exclusion criteria included known pleural disease, previous thoracic surgery and small pneumothorax. Patients were divided in obese (BMI>30) and non-obese (BMI<30) groups. Presence, position, size and number of PA were recorded. Chi square and Fisher's exact test were used to evaluate differences between the two groups, considering p<0.05 as significant. RESULTS: Valid CT studies were available for 101 patients. Extrapleural fat was identified in 50 (49.5%) patients. Most were solitary (n=31). Most were located in the cardiophrenic angle (n=27), and most measured <5cm (n=39). There was no significant difference between obese and non-obese patients regarding the presence or absence of PA (p=0.315), number (p=0.458) and size (p=0.458). CONCLUSIONS: Pleural appendages were seen in 49.5% patients with pneumothorax on CT. There was no significant difference between obese and non-obese patients regarding presence, number and size of pleural appendages.

Apéndices pleurales: descripción, incidencia y relación con el índice de masa corporal / Pleural appendages: Description, incidence and relations with body mass index

Antecedentes y objetivo Los apéndices pleurales son grasa extrapleural que cuelga de la pared torácica. Han sido descritos mediante videotoracoscopia, pero no se conocen exactamente ni el aspecto ni la frecuencia con que se observan apéndices pleurales en tomografía computarizada (TC) ni tampoco si están relacionados con la cantidad de grasa del paciente. Pretendemos describir el aspecto y conocer la prevalencia de los apéndices pleurales observados en TC, así como saber si su presencia, tamaño y número es mayor en pacientes obesos que en no obesos. Pacientes y métodos Se han revisado retrospectivamente las imágenes axiales de tomografía computarizada de 226 pacientes con neumotórax. Fueron excluidos del estudio los pacientes con antecedentes de enfermedad pleural, cirugía torácica o neumotórax pequeños. Se dividió a los pacientes en dos grupos según el índice de masa corporal (IMC): obesos (IMC?≥?30) y no obesos (IMC<30). Se recogieron el número y tamaño de apéndices pleurales en cada paciente. Se emplearon una prueba de χ2 y el test exacto de Fisher para evaluar las diferencias entre los dos grupos. Un valor de p<0,05 se consideró significativo. Resultados 101 pacientes presentaron estudios de TC válidos. Se identificaron apéndices pleurales en 50 de los 101 pacientes (49,5%). La mayoría se presentan de forma solitaria (n=31), en el seno cardiofrénico (n=27) y tienen un tamaño inferior a 5cm (n=39). No hubo diferencia significativa entre los pacientes obesos y los no obesos en relación con la presencia o ausencia (p=0,315), número (p=0,458) y tamaño (p=0,458) de apéndices pleurales. Conclusiones Los apéndices pleurales se observan en el 49,5% de los pacientes con neumotórax estudiados con TC en este estudio. No hubo diferencia significativa entre los pacientes obesos y los no obesos respecto a la presencia, número y tamaño de apéndices pleurales (AU)

Background and aims Pleural appendages (PA) are portions of extrapleural fat that hang from the chest wall. They have been described on videothoracoscopy, however their appearance, frequency and possible relationship with the amount of patient's fat remain unknown. Our aim is to describe their appearances and prevalence on CT, and determinate whether their size and number is higher in obese patients. Patients and methods Axial images of 226 patients with pneumothorax on CT chest were retrospectively reviewed. Exclusion criteria included known pleural disease, previous thoracic surgery and small pneumothorax. Patients were divided in obese (BMI > 30) and non-obese (BMI < 30) groups. Presence, position, size and number of PA were recorded. Chi square and Fisher's exact test were used to evaluate differences between the two groups, considering p<0.05 as significant. Results Valid CT studies were available for 101 patients. Extrapleural fat was identified in 50 (49.5%) patients. Most were solitary (n=31). Most were located in the cardiophrenic angle (n=27), and most measured < 5cm (n=39). There was no significant difference between obese and non-obese patients regarding the presence or absence of PA (p=0.315), number (p=0.458) and size (p=0.458). Conclusions Pleural appendages were seen in 49.5% patients with pneumothorax on CT. There was no significant difference between obese and non-obese patients regarding presence, number and size of pleural appendages (AU)

Extrapleural fat: description, incidence, and relation with body mass index. / Apéndices pleurales: descripción, incidencia y relación con el índice de masa corporal.

BACKGROUND AND AIMS: Pleural appendages (PA) are portions of extrapleural fat that hang from the chest wall. They have been described on videothoracoscopy, however their appearance, frequency and possible relationship with the amount of patient's fat remain unknown. Our aim is to describe their appearances and prevalence on CT, and determinate whether their size and number is higher in obese patients. PATIENTS AND METHODS: Axial images of 226 patients with pneumothorax on CT chest were retrospectively reviewed. Exclusion criteria included known pleural disease, previous thoracic surgery and small pneumothorax. Patients were divided in obese (BMI > 30) and non-obese (BMI < 30) groups. Presence, position, size and number of PA were recorded. Chi square and Fisher's exact test were used to evaluate differences between the two groups, considering p<0.05 as significant. RESULTS: Valid CT studies were available for 101 patients. Extrapleural fat was identified in 50 (49.5%) patients. Most were solitary (n=31). Most were located in the cardiophrenic angle (n=27), and most measured < 5cm (n=39). There was no significant difference between obese and non-obese patients regarding the presence or absence of PA (p=0.315), number (p=0.458) and size (p=0.458). CONCLUSIONS: Pleural appendages were seen in 49.5% patients with pneumothorax on CT. There was no significant difference between obese and non-obese patients regarding presence, number and size of pleural appendages.

Cuantificación de la concentración del iodo con TC de doble energía en pacientes con pancreatitis aguda / Quantification of iodine concentration by dual-energy CT in patients with acute pancreatitis

OBJETIVO: Determinar si existen diferencias en la concentración de iodo cuantificada con TC de doble energía en el páncreas de pacientes con pancreatitis aguda y pacientes sin signos analíticos ni en imagen de patología pancreática. MATERIAL Y MÉTODOS: Se estudian 27 casos de pancreatitis aguda a los que se realizó una TC con energía dual a las 48-72 horas del inicio de los síntomas, realizada con contraste intravenoso y una sola fase con un retraso de 55 segundos. Se compara con un grupo control de 11 pacientes con una TC realizada con el mismo protocolo, pero sin datos radiológicos de pancreatitis y amilasa y lipasa normales. Mediante posprocesado se obtienen reconstrucciones con mapa de iodo y se realizan tres regiones de interés en cabeza, cuerpo y cola pancreática para obtener los valores de concentración de iodo (mg/ml) y se comparan entre ambos grupos. Se hace un segundo cálculo normalizando la densidad de iodo con la aorta. RESULTADOS:En las pancreatitis, el valor medio de densidad de iodo es 2,5mg/ml. En el grupo de los controles es de 3,65mg/ml (p = 0,02). Hay tres casos con necrosis glandular en los que la densidad de iodo es 1,53mg/ml. CONCLUSIONES: Existen diferencias significativas en la concentración de iodo del páncreas medida en TC con energía dual entre pacientes con pancreatitis aguda en fases iniciales y pacientes sin signos analíticos ni en imagen de patología pancreática

OBJECTIVE: To determine whether pancreatic iodine concentrations quantified by dual-energy CT differ between patients with acute pancreatitis and those without imaging or laboratory findings indicative of pancreatic disease. MATERIAL AND METHODS: We compared findings on single-phase dual-energy CT images acquired 55seconds after the intravenous administration of contrast material in 27 patients with acute pancreatitis who underwent the examination 48 to 72hours after the onset of symptoms versus in 11 patients (controls) with no imaging findings suggestive of pancreatic disease and normal amylase and lipase who underwent the examination with the same protocol for other purposes. Imaging postprocessing included the generation of iodine maps. Three regions of interest were selected (pancreatic head, body, and tail) to obtain iodine concentrations (mg/ml) to compare between groups. Iodine concentrations were also calculated a second time by normalizing the density of iodine with the aorta. RESULTS: The mean density of iodine was 2.5mg/ml in patients with pancreatitis vs. 3.65mg/ml in controls (p = 0.02). In three patients with glandular necrosis, the density of iodine was 1.53mg/ml. CONCLUSIONS: The concentration of iodine in the pancreas measured with dual-energy CT differs significantly between patients with initial-stage acute pancreatitis and those without imaging or laboratory findings indicative of pancreatic disease

¿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

Gastrointestinal perforation caused by ingested fish bone. Computed tomography findings in 58 patients. / Perforación gastrointestinal por espina de pescado. Hallazgos radiológicos en tomografía computarizada en 58 pacientes.

CONTEXT AND OBJETIVE: Fish bones (FB) are the most commonly ingested objects and the most common cause of foreign body perforation of the GI tract. Patients present with varied and nonspecific clinical presentations. The inability to obtain a history of FB ingestion and its wide spectrum of nonspecific clinical presentations makes dietary FB perforation extremely difficult to diagnose, being a laparoscopic or surgical diagnosis. The aim of our study is to describe radiological features in CT that will alert you to look for the FB and then make an accurate presurgical diagnosis. MATERIALS AND METHODS: All patients (n=58) with radiological diagnosis of gastrointestinal perforation caused by fish bone detected by CT between 2007 to 2017 were retrospectively reviewed. Inclusion criteria were: fish bone located beyond the esophagus, radiological diagnosis by CT and confirmation by surgery, endoscopy or radiological control. Descriptive analysis was made. Radiological features were studied including radioopaque foreign body, mural thickness, fatty infiltration or extraluminal air bubbles. Also potential complications were assessed. RESULTS: There were 58 patients, 39 men and 19 women, with an average age of 70. Ileon was the most frequent site of perforation (20 patients). 100% showed regional fatty infiltration, 98% included foreign body, 45% had mural thickening and 20% localized extraluminal air bubbles. 15 abscess were found (3 in the liver) and just 5 showed pneumoperitoneum. CONCLUSION: Fatty infiltration is the feature more common. Therefore, if fatty infiltration is seen in isolation radiologist should look for foreign body.

Quantification of iodine concentration by dual-energy CT in patients with acute pancreatitis. / Cuantificación de la concentración del iodo con TC de doble energía en pacientes con pancreatitis aguda.

OBJECTIVE: To determine whether pancreatic iodine concentrations quantified by dual-energy CT differ between patients with acute pancreatitis and those without imaging or laboratory findings indicative of pancreatic disease. MATERIAL AND METHODS: We compared findings on single-phase dual-energy CT images acquired 55seconds after the intravenous administration of contrast material in 27 patients with acute pancreatitis who underwent the examination 48 to 72hours after the onset of symptoms versus in 11 patients (controls) with no imaging findings suggestive of pancreatic disease and normal amylase and lipase who underwent the examination with the same protocol for other purposes. Imaging postprocessing included the generation of iodine maps. Three regions of interest were selected (pancreatic head, body, and tail) to obtain iodine concentrations (mg/ml) to compare between groups. Iodine concentrations were also calculated a second time by normalizing the density of iodine with the aorta. RESULTS: The mean density of iodine was 2.5mg/ml in patients with pancreatitis vs. 3.65mg/ml in controls (p = 0.02). In three patients with glandular necrosis, the density of iodine was 1.53mg/ml. CONCLUSIONS: The concentration of iodine in the pancreas measured with dual-energy CT differs significantly between patients with initial-stage acute pancreatitis and those without imaging or laboratory findings indicative of pancreatic disease.

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.

Current management of small renal masses. / Manejo actual de las masas renales pequeñas.

One of the consequences of the growing use of diagnostic imaging techniques is the notable growth in the detection of small renal masses presumably corresponding to localized tumors that are potentially curable with surgical treatment. When faced with the finding of a small renal mass, radiologists must determine whether it is benign or malignant, and if it is malignant, what subtype it belong to, and whether it should be managed with surgical treatment, with ablative techniques, or with watchful waiting with active surveillance. Small renal masses are now a clinical entity that require management different from the approaches used for classical renal cell carcinomas. In this scenario, radiologists are key because they are involved in all aspects of the management of these tumors, including in their diagnosis, treatment, and follow-up.

Seudocavitación en las neoplasias de pulmón. ¿Permite predecir el diagnóstico de adenocarcinoma con crecimiento lepídico? / Can pseudocavitation in lung tumors predict the diagnosis of adenocarcinoma with lepidic growth?

OBJETIVO: Evaluar la prevalencia de seudocavitación en las neoplasias de pulmón y si permite predecir el diagnóstico del adenocarcinoma con crecimiento lepídico. MATERIAL Y MÉTODOS: Revisión retrospectiva de las tomografías computarizadas (TC) de tórax de 212 neoplasias de pulmón consecutivas incluidas en una base de datos de perfusión por TC y de 351 adenocarcinomas consecutivos diagnosticados entre julio de 2007 y septiembre de 2017. Dos radiólogos recogieron la presencia o ausencia de quistes aéreos en el tumor sin conocer los resultados de anatomía patológica, excluyendo las lesiones con necrosis, rodeadas de bullas o enfisema. Se analizó si la presencia de seudocavitación tenía relación con el tipo histológico, el tamaño de la lesión y la positividad para el receptor del factor de crecimiento epidérmico (EGFR) del tumor, la edad y el sexo del paciente. También se valoró la relación con el subtipo histológico del adenocarcinoma en aquellos pacientes sometidos a cirugía. Se utilizó la prueba de la χ2 para variables cualitativas y el modelo de regresión logística para variables cuantitativas. RESULTADOS: El 15% de las neoplasias presentaron seudocavitación, que fue significativamente más frecuente en los adenocarcinomas (24,1%), p = 0,003, si bien también se observó en el 9,8% de los carcinomas epidermoides y en el 3% de los carcinomas microcíticos. Presentó una especificidad del 92,4% para predecir el diagnóstico del adenocarcinoma, con una sensibilidad del 24%, un valor predictivo positivo (VPP) del 73,3%, un valor predictivo negativo del 58,4% y una precisión del 37,6%. En los adenocarcinomas resecados, el 65% de los tumores con seudocavitación presentaron crecimiento lepídico con una prevalencia del 40,6% en lepídicos, 31,5% en acinares y 33% en papilares. Fue significativamente más frecuente en mujeres (29%) y no se encontraron diferencias en función de la edad, tamaño y positividad para EGFR. CONCLUSIONES: La seudocavitación es más frecuente en los adenocarcinomas con crecimiento lepídico y en mujeres

OBJECTIVE: To determine the prevalence of pseudocavitation in lung tumors and whether its presence makes it possible to predict the diagnosis of adenocarcinoma with lepidic growth. MATERIAL AND METHODS: We retrospectively reviewed chest CT studies for 212 consecutive lung tumors included in a CT perfusion database and for 351 consecutive adenocarcinomas diagnosed between July 2007 and September 2017. Two radiologists blinded to the pathology report determined whether air cysts were present in the tumors, excluding lesions with necrosis and those surrounded by bullae or emphysema. We analyzed whether the presence of pseudocavitation was associated with the histologic type, size, or EGFR positivity of the tumor as well as with the age or sex of the patient. We also evaluated the relationship with the histologic subtype of the tumor in patients who underwent surgery. We used the chi-square test for categorical variables and logistic regression for continuous variables. RESULTS: Pseudocavitation was present in 15% of the tumors and was significantly more common in adenocarcinomas (24.1%), p = 0.003, although it was also observed in 9.8% of the epidermoid carcinomas and in 3% of the microcytic carcinomas. For the diagnosis of adenocarcinoma, the presence of pseudocavitation yielded 92.4% specificity, 24% sensitivity, 73.3% PPV, 58.4% NPV, and 37.6% accuracy. In the resected adenocarcinomas, 65% of the tumors with pseudocavitation had lepidic growth; the prevalence of pseudocavitation was 40.6% in tumors with lepidic growth, 31.5% in those with acinar growth, and 33% in those with papillary growth. Pseudocavitation was significantly more common in women (29%); no differences were found with respect to age, size, or EGFR positivity. CONCLUSIONS: Pseudocavitation is more common in adenocarcinomas with lepidic growth and in women

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.

Can pseudocavitation in lung tumors predict the diagnosis of adenocarcinoma with lepidic growth? / Seudocavitación en las neoplasias de pulmón. ¿Permite predecir el diagnóstico de adenocarcinoma con crecimiento lepídico?

OBJECTIVE: To determine the prevalence of pseudocavitation in lung tumors and whether its presence makes it possible to predict the diagnosis of adenocarcinoma with lepidic growth. MATERIAL AND METHODS: We retrospectively reviewed chest CT studies for 212 consecutive lung tumors included in a CT perfusion database and for 351 consecutive adenocarcinomas diagnosed between July 2007 and September 2017. Two radiologists blinded to the pathology report determined whether air cysts were present in the tumors, excluding lesions with necrosis and those surrounded by bullae or emphysema. We analyzed whether the presence of pseudocavitation was associated with the histologic type, size, or EGFR positivity of the tumor as well as with the age or sex of the patient. We also evaluated the relationship with the histologic subtype of the tumor in patients who underwent surgery. We used the chi-square test for categorical variables and logistic regression for continuous variables. RESULTS: Pseudocavitation was present in 15% of the tumors and was significantly more common in adenocarcinomas (24.1%), p=0.003, although it was also observed in 9.8% of the epidermoid carcinomas and in 3% of the microcytic carcinomas. For the diagnosis of adenocarcinoma, the presence of pseudocavitation yielded 92.4% specificity, 24% sensitivity, 73.3% PPV, 58.4% NPV, and 37.6% accuracy. In the resected adenocarcinomas, 65% of the tumors with pseudocavitation had lepidic growth; the prevalence of pseudocavitation was 40.6% in tumors with lepidic growth, 31.5% in those with acinar growth, and 33% in those with papillary growth. Pseudocavitation was significantly more common in women (29%); no differences were found with respect to age, size, or EGFR positivity. CONCLUSIONS: Pseudocavitation is more common in adenocarcinomas with lepidic growth and in women.

The utility of dual-energy CT for metal artifact reduction from intracranial clipping and coiling. / Utilidad de la tomografía computarizada de energía dual en la reducción del artefacto metálico generado por clips y coils intracraneales.

OBJECTIVE: To assess the ability of dual-energy CT (DECT) to reduce metal-related artifacts in patients with clips and coils in head CT angiography, and to analyze the differences in this reduction between both type of devices. MATERIALS AND METHODS: Thirteen patients (6 clips, 7 coils) were selected and retrospectively analized. Virtual monoenergetic images (MEI) with photon energies from 40 to 150 keV were obtained. Noise was measured at the area of maximum artifact. Subjective evaluation of streak artifact was performed by two radiologists independently. Differences between noise values in all groups were tested by using the ANOVA test. Mann-Whitney U test was used to compare the differences between clips and coils. Cohens κ statistic was used to determine interobserver agreement. RESULTS: The lowest noise value was observed at high energy levels (p<0,05). Noise was higher in the coil group than in the clip group (p<0.001). Interobserver agreement was good (κ=0.72). CONCLUSIONS: TCED with MEI helps to minimize the artifact from clips ands coils in patients who undergo head CT angiography. The reduction of the artifact is greater in patients with surgical clipping than in patients with endovascular coiling.

Value of dual-energy CT enterography in the analysis of pathological bowel segments in patients with Crohn's disease. / Valor de la enterografía por tomografía computarizada con doble energía en el análisis de segmentos intestinales patológicos en pacientes con enfermedad de Crohn.

OBJECTIVE: To analyze whether there are significant differences in the objective quantitative parameters obtained in the postprocessing of dual-energy CT enterography studies between bowel segments with radiologic signs of Crohn's disease and radiologically normal segments. MATERIAL AND METHODS: This retrospective study analyzed 33 patients (16 men and 17 women; mean age 54 years) with known Crohn's disease who underwent CT enterography on a dual-energy scanner with oral sorbitol and intravenous contrast material in the portal phase. Images obtained with dual energy were postprocessed to obtain color maps (iodine maps). For each patient, regions of interest were traced on these color maps and the density of iodine (mg/ml) and the fat fraction (%) were calculated for the wall of a pathologic bowel segment with radiologic signs of Crohn's disease and for the wall of a healthy bowel segment; the differences in these parameters between the two segments were analyzed. RESULTS: The density of iodine was lower in the radiologically normal segments than in the pathologic segments [1.8 ± 0.4mg/ml vs. 3.7 ± 0.9mg/ml; p<0.05]. The fat fraction was higher in the radiologically normal segments than in the pathologic segments [32.42% ± 6.5 vs. 22.23% ± 9.4; p<0.05]. CONCLUSION: There are significant differences in the iodine density and fat fraction between bowel segments with radiologic signs of Crohn's disease and radiologically normal segments.