Overdiagnosis in imaging. / Sobrediagnóstico por imagen.

Overdiagnosis, more than an error regarding the diagnosis, is an error regarding the prognosis. We cannot know what consequences some lesions that we detect by imaging would have on our patients' lives if they were left untreated. As long as it is not possible for imaging techniques to differentiate between lesions that will have an indolent course from those that will have an aggressive course, there will be overdiagnosis. Advanced imaging techniques, radiomics, and radiogenomics, together with artificial intelligence, promise advances in this sense. In the meantime, it is important that radiologists be careful to ensure that only strictly necessary imaging tests are done. Moreover, we need to participate, together with patients, in making multidisciplinary decisions about diagnosis and clinical management. Finally, of course, we need to continue to contribute to the technological and scientific advance of our profession, so that we can continue to improve the diagnosis and early detection of abnormalities, especially those that require treatment.

Morel-Lavallée lesion: diagnosis and treatment with imaging techniques. / Lesión de Morel-Lavallée: diagnóstico y tratamiento con técnicas de imagen.

OBJECTIVES: We aim to review the characteristics of Morel-Lavallée lesions and to evaluate their treatment. MATERIAL AND METHODS: We retrospectively reviewed 17 patients (11 men and 6 women; mean age, 56.1 years, range 25-81 years) diagnosed with Morel-Lavallée lesions in two different departments. All patients underwent ultrasonography, 5 underwent computed tomography, and 9 underwent magnetic resonance imaging. Percutaneous treatment with fine-needle aspiration and/or drainage with a 6F-8F catheter was performed in 13 patients. Two patients required percutaneous sclerosis with doxycycline. RESULTS: All patients responded adequately to percutaneous treatment, although it was necessary to repeat the procedure in 4 patients. CONCLUSIONS: Radiologists need to be familiar with this lesion that can be treated percutaneously in the ultrasonography suite when it is not associated with other entities.

Pelvic arteriovenous malformations: gadolinium-enhanced three-dimensional MR angiography findings.

Pelvic arteriovenous malformations (PAV-Ms) are rare disorders traditionally diagnosed by conventional angiography. Breath-hold three-dimensional gadolinium-enhanced MR angiography (3D-Gd-MRA) is a state-of-the-art alternative for vascular imaging. We describe the 3D-Gd-MRA findings in two patients with PAVMs. The 3D-Gd-MRA approach provides a noninvasive and versatile method for evaluation of PAVMs that enables both angiographic assessment of the malformations and evaluation of visceral involvement, which can preclude surgical intervention.

Colonic metastasis from renal cell carcinoma: helical-CT demonstration.

Clinically evident colonic metastasis from renal cell carcinoma (RCC) is rare. In the present study a hypervascular sigmoid mass was demonstrated on arterial-phase helical CT using a water enema in a patient who had suffered left nephrectomy 8 years previously for RCC. The intense and early enhancement of the lesion suggested the possibility of a solitary colonic metastasis from RCC, a diagnosis which was pathologically confirmed.

Amyloidosis presenting as a perforated giant colonic diverticulum.

Colonic amyloidosis is frequent, although rarely radiographically evident. The radiological findings are varied and unspecific. We report a case of perforated giant colonic diverticulum (GCD) diagnosed by helical CT in which amyloid deposition was pathologically demonstrated. The patient was a renal transplant recipient who previously had undergone hemodialysis for 10 years. A possible role of amyloidosis in the pathogenesis of this case is discussed. Giant colonic diverticulum must be included in the spectrum of gastrointestinal manifestations of amyloidosis.

Intrafibular varix: MR diagnosis.

We describe a case of a surgically proven intraosseous venous anomaly of the fibula in a patient who presented with ankle pain and swelling with deep venous thrombosis. MRI, including gadolinium-enhanced MR angiography, provides a less invasive means than conventional venography for diagnosing these lesions and assessing venous patency while also allowing for evaluation of extravascular structures.

Pancreatic tuberculosis: CT findings.

BACKGROUND: The purpose of this study was to describe the computed tomography (CT) findings in pancreatic tuberculosis (PT). METHODS: We retrospectively reviewed the CT features in six patients with PT, three of whom had AIDS. RESULTS: Pancreatic lesion masses were found in four patients, small (< 1 cm) low-attenuation pancreatic nodules in one, and diffuse enlargement of the pancreas in one. The pancreatic lesion masses were found in all the non-AIDS patients and in one patient with AIDS and were located in the head of the pancreas in two cases and involved the body, neck, and head of the gland in the other two. The masses showed low attenuation in two cases, soft-tissue attenuation in one, and appeared as an infiltrating inhomogeneous lesion with retropancreatic spread, encasing the celiac trunk and superior mesenteric artery in one. Low-attenuation peripancreatic and/or periportal adenopathies with peripheral rim enhancement were found in three cases, and slight bile duct dilatation was evident in four. Four patients had disseminated tuberculosis, whereas pancreatic and peripancreatic tuberculosis were the sole manifestation of tuberculosis in the other two. CONCLUSION: The present data suggest that PT usually appears as a nonspecific focal lesion mass in HIV-seronegative patients, whereas there is a variable spectrum of CT findings including focal lesion mass, multiple small low-attenuation pancreatic nodules, or diffuse enlargement of the gland in AIDS patients. Low-attenuation peripancreatic and periportal adenopathies with peripheral rim enhancement and other data of disseminated tuberculosis are ancillary findings that should support a diagnosis of PT.