Advanced multiparametric magnetic resonance imaging of multinodular and vacuolating neuronal tumor.

BACKGROUND AND PURPOSE: Multinodular and vacuolating neuronal tumor (MVNT) of the cerebrum is a rare brain lesion with suggestive imaging features. The aim of our study was to report the largest series of MVNTs so far and to evaluate the utility of advanced multiparametric magnetic resonance (MR) techniques. METHODS: This multicenter retrospective study was approved by our institutional research ethics board. From July 2014 to May 2019, two radiologists read in consensus the MR examinations of patients presenting with a lesion suggestive of an MVNT. They analyzed the lesions' MR characteristics on structural images and advanced multiparametric MR imaging. RESULTS: A total of 64 patients (29 women and 35 men, mean age 44.2 ± 15.1 years) from 25 centers were included. Lesions were all hyperintense on fluid-attenuated inversion recovery and T2-weighted imaging without post-contrast enhancement. The median relative apparent diffusion coefficient on diffusion-weighted imaging was 1.13 [interquartile range (IQR), 0.2]. Perfusion-weighted imaging showed no increase in perfusion, with a relative cerebral blood volume of 1.02 (IQR, 0.05) and a relative cerebral blood flow of 1.01 (IQR, 0.08). MR spectroscopy showed no abnormal peaks. Median follow-up was 2 (IQR, 1.2) years, without any changes in size. CONCLUSIONS: A comprehensive characterization protocol including advanced multiparametric magnetic resonance imaging sequences showed no imaging patterns suggestive of malignancy in MVNTs. It might be useful to better characterize MVNTs.

[Basal ganglia calcification]. / Calcifications des noyaux gris centraux.

Calcifications of the basal ganglia are frequently seen on the cerebral CT scans and particularly in the globus pallidus. Their frequency increases physiologically with age after 50 years old. However, pathological processes can also be associated with calcium deposits in the gray nuclei, posterior fossa or white matter. Unilateral calcification is often related to an acquired origin whereas bilateral ones are mostly linked to an acquired or genetic origin that will be sought after eliminating a perturbation of phosphocalcic metabolism. In pathological contexts, these calcifications may be accompanied by neurological symptoms related to the underlying disease: Parkinson's syndrome, psychiatric and cognitive disorders, epilepsy or headache. The purpose of this article is to provide a diagnostic aid, in addition to clinical and biology, through the analysis of calcification topography and the study of different MRI sequences.

Validation of the PROFUND index to predict early post-hospital discharge mortality.

BACKGROUND: The PROFUND index (PI) is a prognostic scale for polypathological patients at 12 months. The objective of the study was to validate the PI as a predictor of 1-year mortality in a current cohort of polypathological patients and analyse its prognostic usefulness in the short-term (1 month and 3 months) after discharge from Internal Medicine. DESIGN: We conducted a prospective observational study and all polypathological patients discharged from an Internal Medicine Department between 01 March 2016 and 28 February 2017 were enrolled. METHODS: The variables recorded for each patient were age, sex, diseases and diagnostic categories defining patients as polypathological patients, PI at discharge, number of hospital admissions, length of stay, vital status at 1 year, and date and place of death if applicable. Follow-up lasted 1 year from the time of enrolment. RESULTS: Six hundred and ten polypathological patients were enrolled. Mortality was 41% and the patients who died were older, their length of stay was longer and their PI was higher compared with those who survived. The discrimination of the PI for predicting mortality was good, with a C-statistic of 0.718 [95% confidence interval (CI) 0.67-0.76]. In addition, a subgroup of patients with early mortality after discharge was identified, with a C-statistic of 0.74 (95% CI 0.67-0.80) at 30 days and 0.73 (95% CI 0.68-0.78) at 90 days. CONCLUSIONS: The PI is a valid tool for predicting early and 1-year mortality in polypathological patients after discharge from Internal Medicine.

A quantitative and semi-automatic measurement of transverse sinus stenosis improves idiopathic intracranial hypertension diagnostic accuracy.

We propose a new reliable transverse sinus stenosis (TSS) index based on magnetic resonance venography (MRV) for the diagnosis of idiopathic intracranial hypertension (IIH). Our quantitative semi-automatic measurement analysis based on segmentation and cross-sectional TS diameter from 48 IIH patients and controls matched for age and sex, had a good inter-observer agreement (κ=0.729) compared to a visual examination (κ=0.467). A cut-off point≥2 discriminate IIH patients from controls, with a sensitivity and specificity of 100%.

Unilateral Lichtenstein tension-free mesh hernia repair and testicular perfusion: a prospective control study.

PURPOSE: Compare testicular perfusion between the herniated and the healthy side pre- and post-surgery. MATERIALS AND METHODS: Our study was done on patients with unilateral inguinal hernia. A Doppler ultrasound study was performed in the healthy and herniated side before surgery and 3 months after it. RESULTS: 31 patients were included, 74.2% on the right and 25.8% on the left side. When comparing the pre-surgical values of testicular resistance index from the healthy side with those on the herniated side, there was a significant difference at the spermatic cord levels (0.73 ± 0.11 and 0.81 ± 0.13, p = 0.018) and the extra-testicular level (0.66 ± 0.92 and 0.74 ± 0.10, p = 0.032), but a significant difference was not present at the intra-testicular level (0.62 ± 0.07 and 0.65 ± 0.08). Three months after the surgery, there were no statistically significant differences at any of the levels studied. CONCLUSION: There are no intra-testicular perfusion differences caused by the presence of hernia, nor during post-surgery.

Epidemiological study of primary systemic vasculitides among adults in southern Spain and review of the main epidemiological studies.

OBJECTIVES: To study the incidence and prevalence of primary systemic vasculitides (PSV) in the Costa del Sol region (southern Spain) and to compare the major epidemiological studies in PSV with the results obtained in our area. METHODS: Retrospective study including permanent residents ≥14 years (or older) diagnosed with PSV at the Hospital Costa del Sol (Marbella, Spain) between 1994 and 2010. Epidemiological data were collected and the annual incidence rate during the study period and the prevalence in 2010 were calculated per million population, except for GCA, which was estimated per 100,000 population >50 years. RESULTS: Seventy-four adult patients were diagnosed with PSV, representing an annual incidence of 15.8 (95%CI 12.2-19.4) patients/million population. These diagnoses included 29 (39.1%) giant cell arteritis (GCA), 5 (6.7%) Takayasu's arteritis (TKA), 3 (4%) poly-arteritis nodosa (PAN), 29 (39.1%) antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) [10 (13.5%) granulomatosis with polyangiitis (GPA) (Wegener), 16 (21.6%) microscopic polyangiitis (MPA) and 3 (4%) eosinophilic granulomatosis with polyangiitis (EGPA) (Churg-Strauss)], 7 (9.4%) IgA vasculitis (Henoch-Schönlein) (IgAV) and one (1.3%) cryobulinaemic vasculitis (CV). The annual incidence and 2010 prevalence for each of the PSV, respectively, were: GCA: 2.2/12.2; TKA: 1.1/10.5; PAN: 0.6/2.6; AAV: 6.2/44.8 (GPA: 2.1/15.8; MPA: 3.4/23.8; EGPA: 0.6/5.3); IgAV: 1.5/7.9; and CV: 0.2/0. CONCLUSIONS: The first epidemiological study of PSV in southern Spain corroborates their infrequency, with GCA and AAV as the PSV most often diagnosed. In southern Spain, the incidence and prevalence of PSV are lower than in northern Spain and in countries in the Northern Hemisphere.

[General adverse reactions to contrast agents. Classification and general concepts]. / Reacciones adversas generales a los contrastes. Clasificación y conceptos generales.

General adverse reactions to intravenous contrast agents are uncommon, although relevant due to the growing number of radiologic tests that use iodinated or gadolinium-based contrast agents. Although most of these reactions are mild, some patients can experience significant reactions that radiologists should know how to prevent and treat.

Fístulas aortoesofágica y aortobronquial secundarias a reparación endovascular de aneurisma de aorta torácica / Aorto-oesophageal and aorto-bronchial fistulae secondary to endovascular repair of a thoracic aortic aneurysm

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Predicción mediante radiología simple y tomografía axial computarizada de la energía necesaria para fragmentar litiasis de distinta composición empleando litotricia extracorpórea por ondas de choque / Prediction of the energy required for extracorporeal shock wave lithotripsy of certain stones composition using simple radiology and computerized axial tomography

Objetivo: Demostrar que las litiasis urinarias necesitan, según su composición, una determinada energía para ser fracturadas mediante litotricia extracorpórea por ondas de choque (LEOC), pudiendo ser estimada antes del tratamiento mediante radiografía simple y TAC. Material y método: Estudio experimental, prospectivo y ciego, con 308 cálculos urinarios de 4 hospitales. No cumplieron criterios de inclusión 115: litiasis intactas, mayores de 0,5 cm y de composición pura (> 75%) de oxalato cálcico monohidrato (OCM), úrico o carboapatita, o mixta oxalocálcica mono y dihidratada (OCMix). Las 193 restantes fueron sometidas a radiografía simple y a tomografía (TAC), valorando digitalmente el gris máximo (Gmax) y el gris mediano (Gmda) presentado mediante Adobe Photoshop(R) CS5, y la atenuación en unidades Hounsfield (UH). Posteriormente se les administró LEOC a una frecuencia fija de 1 Hz hasta alcanzar una conminución preestablecida, registrándose así la dosis de energía (Edose) y la Edose ajustada a superficie litiásica (EdAJ). Resultados: La composición OCM resultó la más dura, precisando una Edose de 119.624 mJ/cm3 y una EdAJ de 36.983 mJ/cm3, seguida de OCMix (75.501/36.983), carboapatita (22.734/21.186) y úrico (22.580/6.837) (p < 0,05). Gmax y Gmda se correlacionaron con Edose (r = 0,434 y r = 0,420) y EdAJ (r = 0,599 y r = 0,545) (p < 0,01). Las UH se correlacionaron, tanto en ventana de tejido blando como óseo, con Edose/cm3 (r = 0,478 y r = 0,539) y EdAJ/cm3 (r = 0,745 y r = 0,758) (p < 0,01). Conclusiones: Las litiasis precisan, por las características propias de su composición, una determinada cantidad de energía para su rotura con LEOC en fragmentos de diámetro menor de 2 mm, que es predecible empleando la atenuación en UH en TAC, o escala de grises en la radiografía simple

Objective: To demonstrate that urinary lithiasis have a specific susceptibility to fracture through extracorporeal shock wave lithotripsy (ESWL), which is common for all calculi with the same composition and which can be estimated before treatment using CT or plain X-ray. Material and method: We present an in vitro, prospective, randomized, blind and multi-center study involving 308 urinary calculi. 193 of these met the inclusion criteria: whole calculi composed purely of calcium oxalate monohydrate (COM), uric acid (UA) or carbonate apatite (CA), or a mix of oxalate (COMix) and of a size greater than 0.5 cm. The samples were broken using lithotripsy until reaching a pre-established level of comminution. The variables employed were energy dose (Edose) per cm3 of lithiasis and Edose adjusted to lithiasic surface (EdAJ) per cm3. Results: COM was the hardest, requiring an Edose of 119,624 mJ/cm3 and an EdAJ of 36,983 mJ/cm3, followed by COMix (75,501/36,983), CA (22,734/21,186) and UA (22,580/6837) (p < 0.05). Gmax and Gmda were correlated with Edose (r = 0.434/r = 0.420) and EdAJ (r = 0.599/r = 0.545) (p < 0.01). UH were correlated, in bone window and soft tissue window, with Edose/cm3 (r = 0.478/r = 0.539) y EdAJ/cm3 (r = 0.745/r = 0.758) (p < 0.01). Conclusions: In our in vitro research lithiasis require, due to the specific nature of their composition, a given amount of energy in order to be broken by ESWL, which is inherent to all those sharing the same composition, and can be predicted using CT or plain X-ray

Prediction of the energy required for extracorporeal shock wave lithotripsy of certain stones composition using simple radiology and computerized axial tomography.

OBJECTIVE: To demonstrate that urinary lithiasis have a specific susceptibility to fracture through extracorporeal shock wave lithotripsy (ESWL), which is common for all calculi with the same composition and which can be estimated before treatment using CT or plain x-ray. MATERIAL AND METHOD: We present an in vitro, prospective, randomized, blind and multi-centre study involving 308 urinary calculi. 193 of these met the inclusion criteria: whole calculi composed purely of calcium oxalate monohydrate (COM), uric acid (UA) or carbonate apatite (CA), or a mix of oxalate (COMix) and of a size greater than 0.5 cm. The samples were broken using lithotripsy until reaching a pre-established level of comminution. The variables employed were energy dose (Edose) per cm(3) of lithiasis and Edose adjusted to lithiasic surface (EdAJ) per cm(3). RESULTS: COM was the hardest, requiring an Edose of 119,624 mJ/cm(3) and an EdAJ of 36,983 mJ/cm(3), followed by COMix (75,501/36,983), CA (22,734/21,186) and UA (22,580/6,837) (P < .05). Gmax y Gmda were correlated with Edose (r = 0.434/r = 0.420) and EdAJ (r = 0.599/r = 0.545) (P < .01). UH were correlated, in bone window and soft tissue window, with Edose/cm(3) (r = 0.478/r = 0.539) y EdAJ/cm(3) (r = 0.745/r = 0.758) (P < .01). CONCLUSIONS: In our in vitro research lithiasis require, due to the specific nature of their composition, a given amount of energy in order to be broken by ESWL, which is inherent to all those sharing the same composition, and can be predicted using CT or plain x-ray.

Hematoma pélvico subepitelial / Subepithelial Pelvic Hematoma

Introducción: El hematoma pélvico subepitelial (lesión de Antopol-Goldman) es una rara entidad que clínicamente simula una neoplasia renal o pélvica, cuyo diagnóstico definitivo se establece, en la mayoría de las ocasiones, por el anatomopatólogo tras la nefrectomía. Para evitar esta, son esenciales las pruebas de imagen y una alta sospecha diagnóstica. Material y métodos: Se presenta a una paciente de 43 años, sin antecedentes de interés, que acudió con un cuadro de dolor agudo en la fosa renal izquierda tras un esfuerzo físico y que fue estudiada mediante ecografía, tomografía computarizada (TC) y evolutivamente con resonancia magnética (RM). Resultados: Las exploraciones radiológicas mostraron una lesión en el seno renal izquierdo con características sugestivas de hematoma subepitelial de la pelvis renal, sin datos que sugiriesen una lesión subyacente. El tratamiento de la paciente fue conservador, confirmándose en exploraciones de seguimiento la desaparición de la lesión. Conclusión: El conocimiento de los hallazgos radiológicos de la lesión de Antopol-Goldman en las distintas pruebas de imagen y un índice de sospecha elevado son cruciales en el manejo de los pacientes afectados por esta infrecuente entidad, pudiendo evitar una nefrectomía innecesaria (AU)

Introduction: Subepithelial pelvic hematoma (Antopol Goldman lesion) is a rare condition that may clinical and radiologically simulate a renal or pelvic neoplasm and whose final diagnosis has been established after nephrectomy in most published cases. To avoid misdiagnosis, imaging tests and high diagnostic suspicion are essential. Material and methods: We present the case of a 43-year-old woman with no background of interest who was admitted to our Hospital complaining of acute left flank pain after a physical effort. The patient was studied by Ultrasonography, Computed Tomography and evolutively by Magnetic Resonance Imaging. Results: The radiologic exams showed a lesion in the left renal sinus with characteristics suggestive of subepithelial pelvic hematoma and without data revealing any underlying lesion. The patient was treated conservatively and follow-up examinations confirmed the disappearance of the lesion. Conclusion: Knowledge of the radiologic features of Antopol Goldman lesion as well as a high degree of clinical suspicion are crucial in the management of patients affected by this uncommon condition and may avoid an unnecessary nephrectomy (AU)

Necrosis grasa intraabdominal / Intraabdominal fat necrosis

Los procesos que cursan con necrosis grasa intraabdominal se manifiestan frecuentemente por dolor abdominal agudo/subagudo, hallazgos clínicos que pueden ser originados por afecciones tan variadas como la apendicitis epiploica, el infarto omental, la necrosis grasa encapsulada, la paniculitis mesentérica, la apendicitis, la diverticulitis y ciertas neoplasias. En este contexto, y a pesar de que la localización anatómica del dolor y la sintomatología acompañante pueden ayudar a la orientación diagnóstica, ésta puede ser equívoca llevando a una cirugía innecesaria. Para el diagnóstico van a resultar imprescindibles pruebas de imagen como la ecografía y, sobre todo la tomografía computarizada, debiendo el radiólogo reconocer los hallazgos característicos de cada una de ellas, lo que permitirá el adecuado manejo del dolor abdominal y prevenir una cirugía innecesaria (AU)

The processes that course with intraabdominal fat necrosis often manifest with acute or subacute abdominal pain; these clinical findings can be caused by various conditions, including epiploic appendagitis, omental infarction, encapsulated fat necrosis, mesenteric panniculitis, appendicitis, diverticulitis, and certain neoplasms. In this context, although the anatomic location of the pain and accompanying symptomatology can help orient the diagnosis, there is a risk of unnecessary surgery. Imaging tests like ultrasonography and especially computed tomography are essential for diagnosing intraabdominal fat necrosis. Radiologists must be familiar with the characteristic findings for all the conditions that can cause acute or subacute abdominal pain to ensure appropriate management and prevent unnecessary surgery (AU)

[Subepithelial pelvic hematoma]. / Hematoma pélvico subepitelial.

INTRODUCTION: Subepithelial pelvic hematoma (Antopol Goldman lesion) is a rare condition that may clinical and radiologically simulate a renal or pelvic neoplasm and whose final diagnosis has been established after nephrectomy in most published cases. To avoid misdiagnosis, imaging tests and high diagnostic suspicion are essential. MATERIAL AND METHODS: We present the case of a 43-year-old woman with no background of interest who was admitted to our Hospital complaining of acute left flank pain after a physical effort. The patient was studied by Ultrasonography, Computed Tomography and evolutively by Magnetic Resonance Imaging. RESULTS: The radiologic exams showed a lesion in the left renal sinus with characteristics suggestive of subepithelial pelvic hematoma and without data revealing any underlying lesion. The patient was treated conservatively and follow-up examinations confirmed the disappearance of the lesion. CONCLUSION: Knowledge of the radiologic features of Antopol Goldman lesion as well as a high degree of clinical suspicion are crucial in the management of patients affected by this uncommon condition and may avoid an unnecessary nephrectomy.

Sindrome de Ortner como causa de disfonía en paciente fumador / Ortner syndrome as the cause of dysphony in smokers

El síndrome de Ortner es una causa rara de parálisis del nervio recurrente laríngeo izquierdo debido a una etiología cardiovascular. Presentamos el caso clínico de un hombre de 70 años con historia de disfonía de un mes y medio de evolución diagnosticado de síndrome de Ortner por aneurisma del cayado aórtico (AU)

Ortner's syndrome is a rare cause of left recurrent laryngeal nerve paralysis due to a cardiovascular aetiology. We present a 70 years old man case with one and a half month history of dysphonia with Ortner’s syndrome caused by aortic arch aneurysm diagnosed (AU)

[Intraabdominal fat necrosis]. / Necrosis grasa intraabdominal.

The processes that course with intraabdominal fat necrosis often manifest with acute or subacute abdominal pain; these clinical findings can be caused by various conditions, including epiploic appendagitis, omental infarction, encapsulated fat necrosis, mesenteric panniculitis, appendicitis, diverticulitis, and certain neoplasms. In this context, although the anatomic location of the pain and accompanying symptomatology can help orient the diagnosis, there is a risk of unnecessary surgery. Imaging tests like ultrasonography and especially computed tomography are essential for diagnosing intraabdominal fat necrosis. Radiologists must be familiar with the characteristic findings for all the conditions that can cause acute or subacute abdominal pain to ensure appropriate management and prevent unnecessary surgery.

Discusión y revisión de la bibliografía a partir de un caso de un varón joven con síndrome de Down y trombosis venosa cerebral / Discussion and review of the literature following the case of a young man with Down’s syndrome and cerebral venous thrombosis

Discusión y revisión de la bibliografía a partir de un caso de un varón joven con síndrome de Down (SD) y trombosis venosa cerebral (TVC). Caso clínico. Varón de 27 años que comienza con cefalea, vómitos y hemiparesia izquierda. Tras encontrarse hallazgos en la neuroimagen compatibles con trombosis venosa cerebral, se inició tratamiento anticoagulante, con una evolución clínica favorable. Discusión. Los pacientes con SD están predispuestos a la aparición de ictus embólicos secundarios a cardiopatías congénitas; sin embargo, las causas de TVC en el SD son inciertas, teniendo probablemente un origen multifactorial. Hasta la fecha hay dos casos publicados de TVC en pacientes con SD (AU)

This review and discussion of the current literature is based on the case of a young man with Down’s syndrome (DS) and cerebral venous thrombosis (CVT). Clinical case. Twenty-seven-year-old male who presented with headache, vomiting and left hemiparesis. After finding signs consistent with cerebral venous thrombosis on neuroimaging, anticoagulant treatment was started, and eventuated in a favorable clinical outcome. Discussion. DS patients are predisposed to the occurrence of embolic stroke secondary to congenital heart disease. However, the causes of CVT in DS are uncertain, but probably have a multifactorial origin. There are to date two published cases of CVT in patients with DS (AU)