Vesical Imaging-Reporting and Data System (VI-RADS): experiencia inicial en la clasificación del cáncer de vejiga músculo-infiltrante / Vesical Imaging-Reporting and Data System (VI-RADS): Initial experience in the classification of muscle-invasive bladder cancer

Objetivo: Analizar la precisión diagnóstica del sistema VI-RADS® en radiólogos sin experiencia previa en su uso para diferenciar tumores de vejiga no músculo-infiltrantes de tumores de vejiga músculo-infiltrantes (TVMI) en lesiones sospechosas de malignidad en cistoscopia sin resección transuretral previa (RTU).Material y métodosEstudio retrospectivo en el que se incluyó a 18 pacientes con lesiones sospechosas en cistoscopia a los que se les realizó una RM de vejiga. Dos radiólogos sin experiencia previa en el sistema VI-RADS® evaluaron los estudios. Tras la RM, a los pacientes se les realizó una RTU de las lesiones sospechosas. Se analizaron la sensibilidad y la especificidad del sistema para valores VI-RADS® ≥3 o VI-RADS® ≥ 4, así como el índice kappa de Cohen, entre ambos radiólogos.ResultadosLos valores medios de sensibilidad y especificidad de ambos radiólogos considerando tanto los estudios VI-RADS® ≥ 3 o VI-RADS® ≥ 4 fueron del 91,7% y el 87,5, respectivamente. El índice kappa, considerando los estudios VI-RADS® ≥ 3 positivos fue de 0,551 (p<0,05) y considerando positivos los estudios VI-RADS® ≥ 4 de 0,571 (p<0,05).ConclusiónEl sistema VI-RADS® presenta unos excelentes valores de sensibilidad (91,7%) y especificidad (87,5%) en la clasificación de los TVMI cuando lo utilizan radiólogos sin experiencia previa en su uso con una moderada concordancia interobservador. (AU)

Objective: to analyze the diagnostic accuracy of the VI-RADS® system in the differentiation of non-muscle-invasive bladder tumors (NMIBT from muscle-invasive bladder tumors (MIBT in suspicious cystoscopic findings without prior transurethral resection (TUR evaluated by radiologists with no prior experience in its use.Material and methodsretrospective study carried out with 18 patients with suspicious lesions in cystoscopy. All of them underwent MRI of the bladder. Two radiologists with no prior experience in the use of the VI-RADS® system evaluated the results. All patients underwent TUR of the suspicious lesions after MRI. The sensitivity and specificity of the system were analyzed for VI-RADS® values ≥ 3 or VI-RADS® ≥ 4, as well as the Cohen's kappa coefficient between both radiologists.Resultsthe mean values of sensitivity and specificity of both radiologists considering both the VI-RADS® ≥ 3 or VI-RADS® ≥ 4 values were 91.7% and 87.5%, respectively. The kappa coefficient considering the VI-RADS® ≥ 3 as positive, was 0.551 (P<.05), while considering the VI-RADS® ≥ 4 as positive, it was 0.571 (P<.05).ConclusionThe VI--RADS® system presents excellent sensitivity (91.7% and specificity (87.5% values in the classification of MIBT performed by radiologists with no prior experience in its use, with a moderate interobserver agreement. (AU)

Vesical Imaging-Reporting and Data System (VI-RADS®): Initial experience in the classification of muscle-invasive bladder cancer. / Vesical Imaging-Reporting and Data System (VI-RADS®): experiencia inicial en la clasificación del cáncer de vejiga músculo-infiltrante.

OBJECTIVE: to analyze the diagnostic accuracy of the VI-RADS® system in the differentiation of non-muscle-invasive bladder tumors (NMIBT from muscle-invasive bladder tumors (MIBT in suspicious cystoscopic findings without prior transurethral resection (TUR evaluated by radiologists with no prior experience in its use. MATERIAL AND METHODS: retrospective study carried out with 18 patients with suspicious lesions in cystoscopy. All of them underwent MRI of the bladder. Two radiologists with no prior experience in the use of the VI-RADS® system evaluated the results. All patients underwent TUR of the suspicious lesions after MRI. The sensitivity and specificity of the system were analyzed for VI-RADS® values ≥ 3 or VI-RADS® ≥ 4, as well as the Cohen's kappa coefficient between both radiologists. RESULTS: the mean values of sensitivity and specificity of both radiologists considering both the VI-RADS® ≥ 3 or VI-RADS® ≥ 4 values were 91.7% and 87.5%, respectively. The kappa coefficient considering the VI-RADS® ≥ 3 as positive, was 0.551 (P<.05), while considering the VI-RADS® ≥ 4 as positive, it was 0.571 (P<.05). CONCLUSION: The VI--RADS® system presents excellent sensitivity (91.7% and specificity (87.5% values in the classification of MIBT performed by radiologists with no prior experience in its use, with a moderate interobserver agreement.

Tomosíntesis de mama: una nueva herramienta en el diagnóstico del cáncer de mama / Breast tomosynthesis: a new tool for diagnosing breast cancer

El cáncer de mama sigue siendo el tumor maligno más frecuente entre las mujeres occidentales. La mamografía es, hoy por hoy, la técnica de elección para el cribado poblacional. Aunque es una técnica ampliamente validada, tiene limitaciones, especialmente en las mamas densas. La tomosíntesis de mama ha supuesto una revolución en el diagnóstico de cáncer de mama. Permite definir lesiones ocultas en el interior del tejido glandular y, por tanto, detectar tumores de mama no visibles mediante estudios mamográficos convencionales. Para considerar el uso combinado de ambas técnicas, hay que tener en cuenta muchos factores aparte de la detección de cáncer, como la radiación adicional, la tasa de rellamadas, y el tiempo de realización y lectura de ambas pruebas. En este artículo revisamos los principios técnicos de la tomosíntesis, sus principales utilidades y las perspectivas de futuro de esta técnica de imagen (AU)

Breast cancer continues to be the most common malignant tumor in women in occidental countries. Mammography is currently the technique of choice for screening programs; however, although it has been widely validated, mammography has its limitations, especially in dense breasts. Breast tomosynthesis is a revolutionary advance in the diagnosis of breast cancer. It makes it possible to define lesions that are occult in the glandular tissue and therefore to detect breast tumors that are impossible to see on conventional mammograms. In considering the combined use of mammography and tomosynthesis, many factors must be taken into account apart from cancer detection; these include additional radiation, the recall rate, and the time necessary to carry out and interpret the two tests. In this article, we review the technical principles of tomosynthesis, it main uses, and the future perspective for this imaging technique (AU)

Evaluación de la reproducibilidad de un protocolo de resonancia magnética dinámica para el estudio farmacocinético de los tumores de mama / Evaluation of the reproducibility of a protocol for the pharmacokinetic study of breast tumors by dynamic magnetic resonance imaging

Objetivo. Evaluar la reproducibilidad de un protocolo de resonancia magnética dinámica (RM-DC) con contraste para el estudio farmacocinético de los tumores de mama. Material y métodos. Estudio prospectivo realizado entre octubre y diciembre de 2009, que incluyó 12 pacientes con cáncer de mama infiltrante en estadios ii-iii sin tratamiento previo. Este trabajo fue aprobado por el Comité de Ética de Investigación de nuestro centro. A las 12 pacientes se les realizó 2 RM-DC en 2 días consecutivos con un protocolo de alta resolución temporal (21 adquisiciones/minuto). Se analizaron por separado los datos obtenidos en un ROI trazado alrededor del diámetro tumoral mayor (ROI 1) y otro que abarcaba la zona de mayor intensidad de Ktrans de la lesión (ROI 2). Se emplearon pruebas estadísticas paramétricas y no paramétricas para estudiar la reproducibilidad y concordancia de las principales variables farmacocinéticas (Ktrans, Kep, Ve y AUC90). Resultados. Las correlaciones fueron muy altas (r > 0,80; p < 0,01) en todas las variables del ROI 1, y altas (r = 0,70-0,80; p < 0,01) en todas las del ROI 2, excepto en Ve tanto en el ROI 1 (r = 0,44; p = 0,07) como en el ROI 2 (r = 0,13; p = 0,235). No hubo diferencias estadísticamente significativas entre los 2 estudios para los valores obtenidos de Ktrans, Kep y AUC90 (p > 0,05 para todas ellas), pero sí que las hubo para Ve en el ROI 2 (p = 0,008). Conclusión. El protocolo de alta resolución temporal de RM-DC de nuestro centro es muy reproducible para las principales constantes farmacocinéticas de los tumores de mama (AU)

Objective. To evaluate the reproducibility of a protocol for dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) for the pharmacokinetic study of breast tumors. Material and methods. We carried out this prospective study from October 2009 through December 2009. We studied 12 patients with stage ii-iii invasive breast cancer without prior treatment. Our center's research ethics committee approved the study. The 12 patients underwent on two consecutive days DCE-MRI with a high temporal resolution protocol (21 acquisitions/minute). The data obtained in an ROI traced around the largest diameter of the tumor (ROI 1) and in another ROI traced around the area of the lesion's highest Ktrans intensity (ROI 2) were analyzed separately. We used parametric and nonparametric statistical tests to study the reproducibility and concordance of the principal pharmacokinetic variables (Ktrans, Kep, Ve and AUC90). Results. The correlations were very high (r>.80; P<.01) for all the variables for ROI 1 and high (r=.70-.80; P<.01) for all the variables for ROI 2, with the exception of Ve both in ROI 1 (r=.44; P=.07) and in ROI 2 (r=.13; P=.235). There were no statistically significant differences between the two studies in the values obtained for Ktrans, Kep and AUC90 (P>.05 for each), but there was a statistically significant difference between the two studies in the values obtained for Ve in ROI 2 (P=.008). Conclusions. The high temporal resolution protocol for DCE-MRI used at out center is very reproducible for the principal pharmacokinetic constants of breast (AU)

[Breast tomosynthesis: a new tool for diagnosing breast cancer]. / Tomosíntesis de mama: una nueva herramienta en el diagnóstico del cáncer de mama.

Breast cancer continues to be the most common malignant tumor in women in occidental countries. Mammography is currently the technique of choice for screening programs; however, although it has been widely validated, mammography has its limitations, especially in dense breasts. Breast tomosynthesis is a revolutionary advance in the diagnosis of breast cancer. It makes it possible to define lesions that are occult in the glandular tissue and therefore to detect breast tumors that are impossible to see on conventional mammograms. In considering the combined use of mammography and tomosynthesis, many factors must be taken into account apart from cancer detection; these include additional radiation, the recall rate, and the time necessary to carry out and interpret the two tests. In this article, we review the technical principles of tomosynthesis, it main uses, and the future perspective for this imaging technique.

Evaluation of the reproducibility of a protocol for the pharmacokinetic study of breast tumors by dynamic magnetic resonance imaging.

OBJECTIVE: To evaluate the reproducibility of a protocol for dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) for the pharmacokinetic study of breast tumors. MATERIAL AND METHODS: We carried out this prospective study from October 2009 through December 2009. We studied 12 patients with stage ii-iii invasive breast cancer without prior treatment. Our center's research ethics committee approved the study. The 12 patients underwent on two consecutive days DCE-MRI with a high temporal resolution protocol (21 acquisitions/minute). The data obtained in an ROI traced around the largest diameter of the tumor (ROI 1) and in another ROI traced around the area of the lesion's highest K(trans) intensity (ROI 2) were analyzed separately. We used parametric and nonparametric statistical tests to study the reproducibility and concordance of the principal pharmacokinetic variables (K(trans), Kep, Ve and AUC90). RESULTS: The correlations were very high (r>.80; P<.01) for all the variables for ROI 1 and high (r=.70-.80; P<.01) for all the variables for ROI 2, with the exception of Ve both in ROI 1 (r=.44; P=.07) and in ROI 2 (r=.13; P=.235). There were no statistically significant differences between the two studies in the values obtained for K(trans), Kep and AUC90 (P>.05 for each), but there was a statistically significant difference between the two studies in the values obtained for Ve in ROI 2 (P=.008). CONCLUSIONS: The high temporal resolution protocol for DCE-MRI used at out center is very reproducible for the principal pharmacokinetic constants of breast.

Valoración de la comorbilidad cardíaca en pacientes con enfermedad pulmonar obstructiva crónica mediante tomografía computarizada multidetector / Multidetector computed tomography assessment of cardiac comorbidity in patients with chronic obstructive pulmonary disease

La comorbilidad cardíaca es uno de los factores pronósticos más importantes en las enfermedades pulmonares, particularmente en la enfermedad pulmonar obstructiva crónica (EPOC). Entre las distintas técnicas de imagen disponibles para estudiar dicha manifestación sistémica concomitante a la EPOC se incluyen el cateterismo cardíaco, la ecocardiografía transtorácica y la resonancia magnética. La tomografía computarizada multidetector (TCMD) ha supuesto un progreso significativo en este campo, al permitir obtener estudios simultáneos de la anatomía cardiopulmonar que van más allá del análisis anatómico-morfológico e incluyen una aproximación funcional a dicha afectación. En este trabajo se repasan aspectos prácticos necesarios para valorar la comorbilidad cardíaca en pacientes con EPOC, tanto desde el punto de vista de la hipertensión pulmonar, como del análisis de la disfunción ventricular y de la enfermedad coronaria (AU)

Cardiac comorbidity is one of the most important prognostic factors in lung disease, especially in chronic obstructive pulmonary disease (COPD). The imaging techniques available for the study of this systemic manifestation concomitant with COPD include heart catheterization, transthoracic echocardiography, and magnetic resonance imaging. Multidetector computed tomography (MDCT) represents a significant advance in this field because it enables the acquisition of simultaneous studies of the cardiopulmonary anatomy that go beyond anatomic and morphologic analysis to include a functional approach to this condition. In this article, we review the practical aspects necessary to evaluate cardiac comorbidity in patients with COPD, both from the point of view of pulmonary hypertension and of the analysis of ventricular dysfunction and coronary heart disease (AU)

[Multidetector computed tomography assessment of cardiac comorbidity in patients with chronic obstructive pulmonary disease]. / Valoración de la comorbilidad cardíaca en pacientes con enfermedad pulmonar obstructiva crónica mediante tomografía computarizada multidetector.

Cardiac comorbidity is one of the most important prognostic factors in lung disease, especially in chronic obstructive pulmonary disease (COPD). The imaging techniques available for the study of this systemic manifestation concomitant with COPD include heart catheterization, transthoracic echocardiography, and magnetic resonance imaging. Multidetector computed tomography (MDCT) represents a significant advance in this field because it enables the acquisition of simultaneous studies of the cardiopulmonary anatomy that go beyond anatomic and morphologic analysis to include a functional approach to this condition. In this article, we review the practical aspects necessary to evaluate cardiac comorbidity in patients with COPD, both from the point of view of pulmonary hypertension and of the analysis of ventricular dysfunction and coronary heart disease.

[Right aortic arch, Kommerell's diverticulum and aberrant left subclavian artery]. / Arco aórtico derecho, divertículo de Kommerell y arteria subclavia izquierda aberrante.

The right aberrant subclavian artery or "arteria lusoria" is the most common anatomical variant of the embryonic development of the aorta and its branches, with a presence in 0.5-2% of the population. Less frequently, a right aortic arch with aberrant left subclavian artery may be present. These anatomical variations should be included in the differential diagnosis of superior mediastinal widening seen on chest radiographs. In this report, we present a right aortic arch with left aberrant subclavian artery dilated at its origin (Kommerell's diverticulum) as a cause of superior mediastinal widening detected incidentally on a chest radiograph.

Arco aórtico derecho, divertículo de Kommerell y arteria subclavia izquierda aberrante / Right aortic arch, Kommerell’s diverticulum and aberrant left subclavian artery

La arteria subclavia derecha aberrante o «arterialusoria» es la variante anatómica más común del desarrolloembrionario de la aorta y sus ramas, llegando aestar presente en un 0,5-2% de la población; con menosfrecuencia se puede encontrar una arteria subclaviaizquierda aberrante asociada al arco aórtico derecho.Estas variantes anatómicas deben incluirse en el diagnósticodiferencial del ensanchamiento mediastínicosuperior visible en la radiografía de tórax. Se presentael caso clínico de un paciente que presentaba arcoaórtico derecho y arteria subclavia izquierda aberrantecon dilatación en su origen (divertículo de Kommerell)como causa de ensanchamiento mediastínico superiorde etiología incierta detectado de manera incidental enuna radiografía de tórax realizada en un paciente consintomatología respiratoria (AU)

The right aberrant subclavian artery or «arterialusoria» is the most common anatomical variant of theembryonic development of the aorta and its branches,with a presence in 0.5-2% of the population. Less frequently,a right aortic arch with aberrant left subclavianartery may be present. These anatomical variationsshould be included in the differential diagnosisof superior mediastinal widening seen on chest radiographs.In this report, we present a right aortic archwith left aberrant subclavian artery dilated at its origin(Kommerell’s diverticulum) as a cause of superiormediastinal widening detected incidentally on a chestradiograph (AU)