Primary staging of rectal cancer on MRI: an updated pictorial review with focus on common pitfalls and current controversies.

Magnetic resonance imaging (MRI) plays a pivotal role in primary staging of rectal cancer, enabling the determination of appropriate management strategies and prediction of patient outcomes. However, inconsistencies and pitfalls exist in various aspects, including rectal anatomy, MRI protocols and strategies for artifact resolution, as well as in T- and N-staging, all of which limit the diagnostic value of MRI. This narrative and pictorial review offers a comprehensive overview of factors influencing primary staging of rectal cancer and the role of MRI in assessing them. It highlights the significance of the circumferential resection margin and its relationship with the mesorectal fascia, as well as the prognostic role of extramural venous invasion and tumor deposits. Special attention is given to tumors of the lower rectum due to their complex anatomy and the challenges they pose in MRI staging. The review also addresses current controversies in rectal cancer staging and the need for personalized risk stratification. In summary, this review provides valuable insights into the role of MRI in the primary staging of rectal cancer, emphasizing key aspects for accurate assessment to enhance patient outcomes.

Trombosis parcial segmentaria de cuerpo cavernoso: hallazgos por imagen / Partial segmental thrombosis of the corpus cavernosum: imaging findings

La trombosis parcial segmentaria de cuerpo cavernoso es una enfermedad poco frecuente y de origen desconocido que afecta principalmente a varones jóvenes, cuya presentación característica es la aparición de dolor perineal inexplicable asociado a una masa perineal palpable. Consiste en una trombosis en la porción perineal del cuerpo cavernoso, normalmente unilateral, y se asocia a patologías malignas subyacentes y a factores predisponentes, como los microtraumatismos repetidos. Tras la instauración y la adecuada adherencia al tratamiento conservador, es muy infrecuente la aparición de complicaciones como la disfunción eréctil

Partial segmental thrombosis of the corpus cavernosum is an unusual clinical condition of unknown origin that mainly affects young males, whose characteristic presentation is the appearance of unexplained perineal pain associated with a palpable perineal mass. This entity consists of thrombosis in the perineal portion of the corpus cavernosum, usually unilateral and it is associated with underlying malignant pathologies and predisposing factors such as microtrauma. After the adequate adherence to conservative treatment, the appearance of complications such as erectile dysfunction is very uncommon

Partial segmental thrombosis of the corpus cavernosum: imaging findings. / Trombosis parcial segmentaria de cuerpo cavernoso: hallazgos por imagen.

Partial segmental thrombosis of the corpus cavernosum is an unusual clinical condition of unknown origin that mainly affects young males, whose characteristic presentation is the appearance of unexplained perineal pain associated with a palpable perineal mass. This entity consists of thrombosis in the perineal portion of the corpus cavernosum, usually unilateral and it is associated with underlying malignant pathologies and predisposing factors such as microtrauma. After the adequate adherence to conservative treatment, the appearance of complications such as erectile dysfunction is very uncommon.

[Desmoid tumor of the thoraco-abdominal wall characterized with 18F-fluorodeoxyglucose PET/ CT scan. Correlation with magnetic resonance and bone scintigraphy. Review of the literature]. / Tumor desmoide de la pared torácico-abdominal. Caracterización con PET-TAC con 18F-fluorodesoxiglucosa y correlación con resonancia magnética y gammagrafía ósea. Revisión de la literatura.

Desmoid tumours are uncommon benign tumours but with aggressive behaviour, resulting from the proliferation of well-differentiated fibroblasts. Clinically, they present as a painless firm soft tissue mass. They can be solitary or multiple and have potential infiltrative capacity. When planning treatment, it is important to assess the correct tumour extent to permit curative radical surgery minimizing possible local recurrence. Different imaging techniques help to characterise these tumours. At present, magnetic resonance is the tool of choice for studying these tumours. The role of nuclear medicine techniques, such as bone scintigraphy, or more recently FDG-PET, has not been defined in the evaluation of these neoplasms. We present the case of a patient with a desmoid tumour of the abdominal-chest wall and we review the related literature.

Tumor desmoide de la pared torácico-abdominal. Caracterización con PET-TAC con 18F-fluorodesoxiglucosa y correlación con resonancia magnética y gammagrafía ósea. Revisión de la literatura / Desmoid tumor of the chest wall characterized with 18F-fluorodeoxyglucose PET/ CT scan. Correlation with magnetic resonancy and bone scintigraphy. Review of the literature

Los tumores desmoides son una entidad benigna infrecuente, pero con un comportamiento agresivo, que provienen de una proliferación de fibroblastos bien diferenciados. Clínicamente se muestran como una masa dura e indolora de partes blandas, que puede ser solitaria o múltiple. Presenta un potencial infiltrativo local del que deriva su agresividad. A la hora de planear su tratamiento es fundamental determinar sus correctas extensión y delimitación para permitir una cirugía curativa y minimizar el riesgo de recurrencias locales. Diferentes técnicas de imagen ayudan a la caracterización de estos tumores. En la actualidad, la resonancia magnética es la herramienta de elección en la evaluación de estas neoplasias. Queda por definir el papel de las técnicas de medicina nuclear, como la gammagrafía ósea o, más recientemente, la tomografía de positrones con 18F-fluorodesoxiglucosa, en el diagnóstico y la evaluación de este tipo de tumores. Presentamos el caso de un paciente con un tumor desmoide de la pared toracicoabdominal en que estudiamos las técnicas de medicina nuclear y revisamos la literatura al respecto(AU)

Desmoid tumours are uncommon benign tumours but with aggressive behaviour, resulting from the proliferation of well-differentiated fibroblasts. Clinically, they present as a painless firm soft tissue mass. They can be solitary or multiple and have potential infiltrative capacity. When planning treatment, it is important to assess the correct tumour extent to permit curative radical surgery minimizing possible local recurrence. Different imaging techniques help to characterise these tumours. At present, magnetic resonance is the tool of choice for studying these tumours. The role of nuclear medicine techniques, such as bone scintigraphy, or more recently FDG-PET, has not been defined in the evaluation of these neoplasms. We present the case of a patient with a desmoid tumour of the abdominal-chest wall and we review the related literature(AU)

Hepatosplenic brucelloma: clinical presentation and imaging features in six cases.

BACKGROUND: We conducted a retrospective analysis of the clinical presentation and the computed tomographic (CT) and ultrasound (US) findings in six episodes of hepatosplenic brucelloma in five patients. METHODS: In four episodes, the diagnosis was based on clinical history, serology, and characteristic imaging findings. In the other two episodes in the same patient, the diagnosis was suspected after a biopsy was taken. CT was performed in all six cases and US in five. RESULTS: On US, brucellomas were iso- or hypoechogenic with the liver. Hyperechogenic masses were seen in one patient. Brucellomas were very poorly defined and contained small scattered cystic areas. All lesions showed central or marginal gross focal calcification, except multiple lesions in one patient. Contrast-enhanced CT showed predominantly solid masses with irregular borders and fine or thick enhancing trabeculations separating hypodense solid areas and/or small cystic areas. Two patients showed transdiaphragmatic lung invasion by brucelloma, a complication not previously published. CONCLUSION: In regions where brucellosis is endemic, brucelloma should be included in the differential diagnosis if a hepatic or splenic mass with irregular borders and central or marginal gross focal calcification is detected, and contrast-enhanced CT shows enhancing trabeculations that separate hypodense solid areas and/or small liquid collections.

Ruptura espontánea de un aneurisma de aorta en una vena renal izquierda retroaórtica. A propósito de un caso / Spontaneous rupture of an aortic aneurysm in a retroaortic left renal vein. A case report

Introducción. La complicación más frecuente de un aneurisma de aorta infrarrenal (AAI) es la rotura. En un porcentaje muy escaso de casos (3-4 por ciento) se asocian a una fístula aortocava. Mucho más rara es la fistuliza ción entre la aorta y la vena renal izquierda (VRI) y más rara todavía si ésta se encuentra en posición retroaórtica. Caso clínico. Mujer de 73 años con una clínica de dolor abdominal, hipotensión y hematuria de pocas horas de evolución. La exploración física reveló la existencia de un soplo abdominal continuo y gran distensión abdominal. Con ecografía Doppler se demostró la existencia de un AAI de 7 cm de diámetro, y una TAC puso de manifiesto la ruptura del mismo y la existencia de una fístula entre la VRI retroaórtica y el cuello del aneurisma. Simultáneamente, el riñón izquierdo presentaba una hipocaptación importante. La reparación quirúrgica se realizó mediante una derivación aortobifemoral de 16 × 8 mm y la ligadura de la VRI desestructurada. La perfusión renal se recuperó inmediatamente tras la cirugía, y la paciente sobrevive tras un postoperatorio complicado. La tríada clínica consistente en dolor abdominal, aneurisma de aorta y hematuria debe hacer sospechar la existencia de una fístula aorta-vena renal. La realización de una TAC, práctica habitual previa a la reparación quirúrgica, permite identificar anomalías venosas como la descrita, evitar importantes pérdidas hemáticas y el mejor control intraoperatorio del paciente ante esta grave y rara complicación aneurismática (AU)

[Tubular ectasia of the rete testis: ultrasonography findings in 19 patients]. / Ectasia tubular de la rete testis: hallazgos ecográficos en 19 pacientes.

OBJECTIVE: The sonographic findings and associated etiological conditions in 19 patients with tubular ectasia of the rete testis are described. METHODS: 19 patients with tubular ectasia of the rete testis diagnosed by ultrasound over a two-year period are presented. Twenty-seven testes showed ectasia. The mean age at the time of diagnosis was 59 years. US evaluation was performed with the 7-8 MHz multifrequency linear probe (Acuson 128, Mountain View, CA, USA). The patients were evaluated in the supine position and the scrotal content was examined in the sagittal and transverse planes. A color and pulsed Doppler study were performed in all the cases. RESULTS: 8 patients showed bilateral involvement, 7 had left and 4 right tubular ectasia. Other frequently associated findings were spermatocele (8 cases), cord cyst (6 cases) and varicocele (5 cases). Four patients had undergone scrotal surgery and one had a previous history of epididymitis. CONCLUSIONS: Tubular ectasia of the rete testis is an uncommon, benign condition that is usually associated with epididymal obstruction following trauma or infection in most of the cases. Diagnosis of tubular ectasia by US, in a correct clinical context, obviates the need to perform a biopsy and orchidectomy for its diagnosis in a vast majority of the cases.

[Usefulness of Doppler-color ultrasonography and identification of resistance indexes as early indicators of testicular infarction secondary to orchiepididymitis]. / Utilidad de la ecografía Doppler-color y la determinación de los índices de resistencia como indicadores precoces de infarto testicular secundario a orquiepididimitis.

The testicular infarction can be a rare complication of the orchiepididymitis. The ultrasonography appearance of the partial infarctions creates confusion with expansive intratesticular processes. We present three cases of focal testicular infarction associated with orchiepididymitis, stressing the usefulness of the Color doppler sonography for detecting the avascular nature o these lesions. The determination of de indeces of resistance (IR) in the doppler spectrum of intratesticular arteries showed a highly increased vascular resistance in respect of the healthy testicle. In patients with grave orchiepididymitis vein drainage can be affected due to compressive edema or to thrombosis, causing the raising of the resistance indeces. Acknowledging the avascular resistance of the focal post-orchiepididymitis infarction we can prevent unnecessary orchiectomy.

[Renal vein partial thrombosis in 3 recipients of kidney transplantation]. / Trombosis parcial de la vena renal en tres pacientes trasplantados.

OBJECTIVE: To report on three patients with partial graft renal vein thrombosis diagnosed by ultrasound. METHODS: The vascular complications diagnosed by ultrasound in 400 transplants performed from 1995-1998 were reviewed. RESULTS: Three patients with partial graft renal vein thrombosis were found. Two patients were treated with anticoagulant therapy. No thrombosis could be detected in all three patients on subsequent US control evaluation. CONCLUSIONS: Unlike complete thrombosis, partial graft renal vein thrombosis presents late, without significant clinical features and can be managed conservatively.

Utilidad de la ecografía doppler-color y la determinación de los índices de resistencia como indicadores precoces de infarto testicular secundario a orquiepididimitis / Utility of the color doppler sonography and of the determination of the resistivi indices as precocious of infartion of the testis following epidimo-orchitis

El infarto testicular puede ser una complicación rara de las orquiepididimitis. La apariencia eco-gráfica de los infartos testiculares parciales plantea confusión con neoplasias intratesticulares. Presentamos tres casos de infarto focal asociados a orquiepididimitis, en los que la ecografía doppler-color permitió su diagnóstico al demostrar la naturaleza avascular de estas lesiones. La detección de índices de resistencia (IR) elevados en arterias intratesticulares en pacientes con orquiepididimitis, puede poner sobre aviso de un compromiso en el drenaje venoso, por edema com-presivo o por trombosis, responsables con posterioridad de una zona de infarto testicular. Reconociendo la naturaleza avascular del infarto focal post-orquiepididimitis se pueden prevenir orquiectomías innecesarias (AU)

[Costal osteolysis due to a giant arteriosclerotic aneurysm of the ascending thoracic aorta]. / Osteólisis costal por un aneurisma arteriosclerótico gigante de la aorta torácica ascendente.

In this case report the patient had a giant saccular aneurysm caused by arteriosclerosis, located in the ascending aorta and protruding through the anterior thoracic wall, with osteolysis of the two adjacent ribs. Costal involvement in arteriosclerotic aneurysms has not been described in the literature. We review the incidence, types and clinical signs of aneurysms of the ascending aorta, emphasizing the complications caused by arteriosclerotic aneurysms.

Aneurysms of the portal venous system: ultrasonography and CT findings.

OBJECTIVE: The retrospective study of aneurysms of the portal venous system and their possible aetiology, using different imaging methods. MATERIAL AND METHODS: Between 1992 and 1995 we collected 13 cases of portal vein aneurysm from 11 patients, eight of whom suffered portal hypertension (PH) secondary to hepatic cirrhosis. All were diagnosed by means of ultrasonography (155) and/or computed tomography (CT). The aneurysms were defined as fusiform expansions when in the main portal vein and its branches or as cystic lesions with internal flow when in the intrahepatic branches. RESULTS: Ten of the aneurysms (76.9%) were in the extrahepatic portal venous system and three (23.1%) in intrahepatic branches. Of the extrahepatic aneurysms, the two most common locations were the main portal vein and the confluence of superior mesenteric and splenic veins (30.7% each site). The largest were generally those at the confluence (37.6+/-9.7 mm maximum diameter). CONCLUSION: Aneurysms in the portal system can be congenital or acquired. Although their aetiology is uncertain, we found a clear relation to PH syndrome; of 13 aneurysms in the study, eight were related to this disease. PH should be suspected in the evaluation of portal aneurysms.