Intestinal intussusception in adults: Location, causes, symptoms, and therapeutic management.

OBJECTIVE: Intestinal intussusception is difficult to diagnose in adults because the symptoms are nonspecific. However, most have structural causes that require surgical treatment. This paper reviews the epidemiologic characteristics, imaging findings, and therapeutic management of intussusception in adults. MATERIALS AND METHODS: This retrospective study identified patients diagnosed with intestinal intussusception who required admission to our hospital between 2016 and 2020. Of the 73 cases identified, 6 were excluded due to coding errors and 46 were excluded because the patients were aged <16 years. Thus, 21 cases in adults (mean age, 57 years) were analyzed. RESULTS: The most common clinical manifestation was abdominal pain, reported in 8 (38%) cases. In CT studies, the target sign yielded 100% sensitivity. The most common site of intussusception was the ileocecal region, reported in 8 (38%) patients. A structural cause was identified in 18 (85.7%) patients, and 17 (81%) patients required surgery. The pathology findings were concordant with the CT findings in 94.1% of cases; tumours were the most frequent cause (6 (35.3%) benign and 9 (64.7%) malignant). CONCLUSIONS: CT is the first-choice test for the diagnosis of intussusception and plays a crucial role in determining its aetiology and therapeutic management.

Invaginaciones intestinales en el adulto: localización, etiología, sintomatología y manejo terapéutico / Intestinal intussusception in adults: location, causes, symptoms, and therapeutic management

Objetivo: Las invaginaciones intestinales en adultos son de difícil diagnóstico debido a la inespecificidad de los síntomas. Sin embargo, la mayoría tienen una causa estructural que requiere tratamiento quirúrgico. El objetivo de este estudio es revisar sus características epidemiológicas, hallazgos en imagen y manejo terapéutico. Materiales y métodos: Estudio retrospectivo de las invaginaciones intestinales que precisaron ingreso hospitalario diagnosticadas en nuestro hospital entre 2016 y 2020. De un total de 73 casos fueron excluidos errores de codificación (n=6) y pacientes menores de 16 años (n=46), resultando 21 invaginaciones en adultos. Resultados: La edad media fue de 57 años, y el dolor abdominal fue la manifestación clínica más frecuente en el 38% de los casos (n=8). El diagnóstico mediante tomografía computarizada (TC), con la presencia “del signo de la diana”, alcanzó una sensibilidad del 100%, siendo la región ileocecal la localización más frecuente en un 38% de los pacientes (n=8). Un 85,7% de los casos (n=18) tenían una causa estructural y el 81% (n=17) requirió cirugía. Los resultados anatomopatológicos fueron concordantes con la TC en un 94,1%, siendo la etiología más frecuente la neoplásica: 35,3% benignas (n=6) y 64,7% malignas (n=9). Conclusiones: La TC es la prueba de elección en el diagnóstico de las invaginaciones intestinales y resulta determinante a la hora de identificar la etiología y decidir el manejo terapéutico.(AU)

Objective: Intestinal intussusception is difficult to diagnose in adults because the symptoms are nonspecific. However, most have structural causes that require surgical treatment. This paper reviews the epidemiologic characteristics, imaging findings, and therapeutic management of intussusception in adults. Materials and methods: This retrospective study identified patients diagnosed with intestinal intussusception who required admission to our hospital between 2016 and 2020. Of the 73 cases identified, 6 were excluded due to coding errors and 46 were excluded because the patients were aged<16 years. Thus, 21 cases in adults (mean age, 57 y) were analyzed. Results: The most common clinical manifestation was abdominal pain, reported in 8 (38%) cases. In CT studies, the target sign yielded 100% sensitivity. The most common site of intussusception was the ileocecal region, reported in 8 (38%) patients. A structural cause was identified in 18 (85.7%) patients, and 17 (81%) patients required surgery. The pathology findings were concordant with the CT findings in 94.1% of cases; tumors were the most frequent cause (6 (35.3%) benign and 9 (64.7%) malignant). Conclusions: CT is the first-choice test for the diagnosis of intussusception and plays a crucial role in determining its etiology and therapeutic management.(AU)

Intestinal intussusception in adults: location, causes, symptoms, and therapeutic management. / Invaginaciones intestinales en el adulto: localización, etiología, sintomatología y manejo terapéutico.

OBJECTIVE: Intestinal intussusception is difficult to diagnose in adults because the symptoms are nonspecific. However, most have structural causes that require surgical treatment. This paper reviews the epidemiologic characteristics, imaging findings, and therapeutic management of intussusception in adults. MATERIALS AND METHODS: This retrospective study identified patients diagnosed with intestinal intussusception who required admission to our hospital between 2016 and 2020. Of the 73 cases identified, 6 were excluded due to coding errors and 46 were excluded because the patients were aged<16 years. Thus, 21 cases in adults (mean age, 57 y) were analyzed. RESULTS: The most common clinical manifestation was abdominal pain, reported in 8 (38%) cases. In CT studies, the target sign yielded 100% sensitivity. The most common site of intussusception was the ileocecal region, reported in 8 (38%) patients. A structural cause was identified in 18 (85.7%) patients, and 17 (81%) patients required surgery. The pathology findings were concordant with the CT findings in 94.1% of cases; tumors were the most frequent cause (6 (35.3%) benign and 9 (64.7%) malignant). CONCLUSIONS: CT is the first-choice test for the diagnosis of intussusception and plays a crucial role in determining its etiology and therapeutic management.

CT findings of pulmonary cysts.

Pulmonary cysts are thin-walled radiolucent lesions that may appear in a variety of uncommon disorders known as diffuse cystic lung diseases (DCLD) that essentially includes lymphangioleiomyomatosis (LAM), Langerhans cell histiocytosis (LCH), lymphocytic interstitial pneumonia (LIP), Pneumocystis jiroveci pneumonia (PJP), and Birt-Hogg-Dubé syndrome (BHDS). Moreover, they have been reported in several cases of coronavirus disease 2019 (COVID-19). The purpose of this review is to provide a practical approach for evaluating lung cysts when encountered on CT. We describe the imaging findings of DLCD emphasising their differences in terms of shape and distribution of the cysts, as well as their association with other findings such as nodules or ground-glass opacities, which may help in making a confident diagnosis. We also discuss the link between pulmonary cysts and COVID-19.

Imaging acute pancreatitis. / Pancreatitis aguda en imágenes.

OBJECTIVES: Acute pancreatitis is common; the clinical course of this potentially severe condition varies widely. This paper aims to review the role of different imaging techniques in the management of acute pancreatitis, describe the main imaging findings for this entity, and explain the terms and criteria used to classify them. CONCLUSIONS: Imaging techniques play a key role in the management of acute pancreatitis, from diagnosis and staging to identifying and treating complications, as well as in determining the underlying causes of the condition. For these reasons, radiologists should know the advantages and limitations of each imaging technique in the evaluation of acute pancreatitis, be familiar with the wide spectrum of imaging findings associated with it, and how to use the specific terminology derived from the Atlanta classification to ensure the standardization and quality of reports.

La radiología en tiempos de distopías y cisnes negros: reflexiones desde el confinamiento COVID-19 / Radiology in times of dystopia and black swans: reflections during the COVID-19 lockdown

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Lesiones inguinales pediátricas: hallazgos radiológicos / Pediatric groin lesions: imaging findings

OBJETIVOS: La región inguinal es un área anatómica compleja que ha sido tradicionalmente olvidada por los radiólogos dado que la mayoría de las lesiones pueden diagnosticarse mediante datos clínicos y con la exploración física. No obstante, cada vez es más frecuente la solicitud de ecografías, bien para confirmar la existencia de patología o para resolver casos dudosos. Por otra parte, la patología inguinal incluye entidades únicas de la edad infantil. El objetivo de este trabajo es describir los hallazgos radiológicos clave de las lesiones inguinales pediátricas, poniendo especial énfasis en los datos ecográficos CONCLUSIONES: El conocimiento de la patología inguinal pediátrica y sus claves en imagen ayudan a mejorar el rendimiento diagnóstico de la ecografía

OBJECTIVES: The groin is a complex anatomic region that has traditionally been ignored by radiologists because most lesions can be diagnosed from clinical data and physical examination. Nevertheless, ultrasound examinations of the groin are increasingly being requested to confirm injury or to resolve diagnostic uncertainty. On the other hand, some conditions involving the groin are found only in pediatric patients. This article describes the key imaging findings in pediatric groin injuries, placing special emphasis on the ultrasound appearance. CONCLUSIONS: Knowledge about conditions that can affect the groin in pediatric patients and the key imaging findings associated with them helps improve the diagnostic performance of ultrasound

Pediatric groin lesions: imaging findings. / Lesiones inguinales pediátricas: hallazgos radiológicos.

OBJECTIVES: The groin is a complex anatomic region that has traditionally been ignored by radiologists because most lesions can be diagnosed from clinical data and physical examination. Nevertheless, ultrasound examinations of the groin are increasingly being requested to confirm injury or to resolve diagnostic uncertainty. On the other hand, some conditions involving the groin are found only in pediatric patients. This article describes the key imaging findings in pediatric groin injuries, placing special emphasis on the ultrasound appearance. CONCLUSIONS: Knowledge about conditions that can affect the groin in pediatric patients and the key imaging findings associated with them helps improve the diagnostic performance of ultrasound.

Imagen funcional de la patología pancreática / Functional imaging in pancreatic disease

El constante avance tecnológico de las técnicas de imagen basadas fundamentalmente en la tomografía computarizada y la resonancia magnética ha permitido, además de la clásica valoración morfológica de la patología pancreática, su evaluación cuantitativa funcional y molecular. Esta información basada en la imagen conlleva en muchos casos un sustancial cambio en el manejo de los pacientes y podría ser una herramienta fundamental en el desarrollo de biomarcadores. El objetivo de este artículo es revisar el papel de las técnicas emergentes funcionales y moleculares basadas en la tomografía computarizada y la resonancia magnética, para la valoración de la patología pancreática

In addition to the classical morphological evaluation of pancreatic disease, the constant technological advances in imaging techniques based fundamentally on computed tomography and magnetic resonance imaging have enabled the quantitative functional and molecular evaluation of this organ. In many cases, this imaging-based information results in substantial changes to patient management and can be a fundamental tool for the development of biomarkers. The aim of this article is to review the role of emerging functional and molecular techniques based on computed tomography and magnetic resonance imaging in the evaluation of pancreatic disease

Valoración mediante Dixon modificado de las lesiones suprarrenales incidentales en RM 3T / Using the modified Dixon technique to evaluate incidental adrenal lesions on 3T MRI

Objetivo: Cuantificar mediante secuencia mDIXON-Quant la fracción grasa (FG) de las lesiones suprarrenales encontradas incidentalmente en estudios de TC. Analizar la relación de la caída de señal entre las secuencias potenciadas en T1 en fase y fase opuesta con la FG en mDIXON-Quant. Comparar la sensibilidad y especificidad de ambos métodos para caracterizar las lesiones suprarrenales. Material y métodos: Se realizó un estudio prospectivo descriptivo que incluyó a 31 pacientes con lesiones suprarrenales incidentales evaluados mediante RM 3T con las secuencias T1 en fase y fase opuesta y mDIXON-Quant. Se midió la FG de las lesiones suprarrenales mediante mDIXON-Quant y la intensidad de señal en secuencias T1 en fase y fase opuesta, calculando su porcentaje de pérdida de señal (PPS). Resultados: El PPS medio fue significativamente mayor en el grupo adenoma (61,3% ± 20,4%) que en el no adenoma (5,1% ± 5,8%) (p < 0,005). La FG media de los adenomas también fue significativamente mayor (26,9% ± 10,8% vs. 3,4% ± 3,0%) (p < 0,005). El área bajo la curva ROC fue 0,99 (0,96-1,00) para el PPS y 0,98 (0,94-1,00) para la FG. El punto de corte obtenido fue de 24,42% para el PPS y de 9,2% para la FG. Los valores diagnósticos fueron iguales para los dos métodos: sensibilidad del 96% (79,6-99,9), especificidad del 100% (39,8-100,0), valor predictivo positivo del 100% (85,8-100,0) y valor predictivo negativo del 80% (28,4-99,5). Conclusión: La FG obtenida mediante técnica Dixon modificada es capaz de diferenciar adenomas de no adenomas con la misma sensibilidad y especificidad que la PPS

Objectives: To use the mDIXON-Quant sequence to quantify the fat fraction of adrenal lesions discovered incidentally on CT studies. To analyze the relation between the signal loss between in-phase and out-of-phase T1-weighted sequences and the fat fraction in mDIXON-Quant. To compare the sensitivity and specificity of the two methods for characterizing adrenal lesions. Material and methods: This prospective descriptive study included 31 patients with incidentally discovered adrenal lesions evaluated with 3T MRI using in-phase and out-of-phase T1-weighted sequences and mDIXON-Quant; the fat fraction of the adrenal lesions was measured by mDIXON-Quant and by calculating the percentage of signal loss between in-phase and out-of-phase T1-weighted sequences. Results: The percentage of signal loss was significantly higher in the group of patients with adenoma (61.3% ± 20.4% vs. 5.1% ± 5.8% in the group without adenoma, p<0.005). The mean fat fraction measured by mDIXON-Quant was also higher for the adenomas (26.9% ±10.8% vs. 3.4% ± 3.0%, p<0.005).The area under the ROC curve was 0.99 (0.96 - 1.00) for the percentage of signal loss and 0.98 (0.94 - 1.00) for the fat fraction measured by mDIXON-Quant. The cutoffs obtained were 24.42% for the percentage of signal loss and 9.2% for the fat fraction measured by mDIXON-Quant. The two techniques had the same values for diagnostic accuracy: sensitivity 96% (79.6 - 99.9), specificity 100% (39.8 - 100.0), positive predictive value 100% (85.8 - 100.0), and negative predictive value 80% (28.4 - 99.5). Conclusion: The fat fraction measured by the modified Dixon technique can differentiate between adenomas and other adrenal lesions with the same sensitivity and specificity as the percentage of signal loss between in-phase and out-of-phase T1-weighted sequences

Functional imaging in pancreatic disease. / Imagen funcional de la patología pancreática.

In addition to the classical morphological evaluation of pancreatic disease, the constant technological advances in imaging techniques based fundamentally on computed tomography and magnetic resonance imaging have enabled the quantitative functional and molecular evaluation of this organ. In many cases, this imaging-based information results in substantial changes to patient management and can be a fundamental tool for the development of biomarkers. The aim of this article is to review the role of emerging functional and molecular techniques based on computed tomography and magnetic resonance imaging in the evaluation of pancreatic disease.

Using the modified Dixon technique to evaluate incidental adrenal lesions on 3T MRI. / Valoración mediante Dixon modificado de las lesiones suprarrenales incidentales en RM 3T.

OBJECTIVES: To use the mDIXON-Quant sequence to quantify the fat fraction of adrenal lesions discovered incidentally on CT studies. To analyze the relation between the signal loss between in-phase and out-of-phase T1-weighted sequences and the fat fraction in mDIXON-Quant. To compare the sensitivity and specificity of the two methods for characterizing adrenal lesions. MATERIAL AND METHODS: This prospective descriptive study included 31 patients with incidentally discovered adrenal lesions evaluated with 3T MRI using in-phase and out-of-phase T1-weighted sequences and mDIXON-Quant; the fat fraction of the adrenal lesions was measured by mDIXON-Quant and by calculating the percentage of signal loss between in-phase and out-of-phase T1-weighted sequences. RESULTS: The percentage of signal loss was significantly higher in the group of patients with adenoma (61.3% ± 20.4% vs. 5.1% ± 5.8% in the group without adenoma, p<0.005). The mean fat fraction measured by mDIXON-Quant was also higher for the adenomas (26.9% ±10.8% vs. 3.4% ± 3.0%, p<0.005).The area under the ROC curve was 0.99 (0.96 - 1.00) for the percentage of signal loss and 0.98 (0.94 - 1.00) for the fat fraction measured by mDIXON-Quant. The cutoffs obtained were 24.42% for the percentage of signal loss and 9.2% for the fat fraction measured by mDIXON-Quant. The two techniques had the same values for diagnostic accuracy: sensitivity 96% (79.6 - 99.9), specificity 100% (39.8 - 100.0), positive predictive value 100% (85.8 - 100.0), and negative predictive value 80% (28.4 - 99.5). CONCLUSION: The fat fraction measured by the modified Dixon technique can differentiate between adenomas and other adrenal lesions with the same sensitivity and specificity as the percentage of signal loss between in-phase and out-of-phase T1-weighted sequences.

Criterios específicos de respuesta tumoral / Specific criteria for tumor response

Los avances recientes en la biología y la genética han acelerado nuestro conocimiento sobre el desarrollo, el crecimiento y la diseminación del cáncer, generando grandes expectativas de poder trasladar esos nuevos descubrimientos a tratamientos efectivos para los pacientes. Las técnicas de imagen ocupan un lugar central en la asistencia del paciente oncológico, dado que se han convertido en herramientas capaces de valorar importantes características tumorales y la respuesta de los tumores a las distintas terapias. El objetivo de este artículo es evaluar los diferentes criterios de respuesta tumoral basados en la imagen, conociendo sus ventajas y limitaciones, e ilustrar la posible aportación de las nuevas técnicas de imagen como biomarcadores de respuesta

Recent advances in biology and genetics have accelerated our knowledge about the development, growth, and dissemination of cancer, generating great expectations that these new discoveries will be translated into effective treatments for patients. Imaging techniques play a central role in the care of oncologic patients, since they have become tools capable of evaluating important characteristics of tumors and the response of tumors to different treatments. The objective of this article is to evaluate the different imaging-based criteria for assessing tumor response, discussing their advantages and limitations and illustrating the possible contribution of new imaging techniques as biomarkers of tumor response

Demostración de fístula biliobronquial mediante resonancia magnética con contraste hepatoespecífico / Demonstration of a bronchobiliary fistula using magnetic resonance image with hepatospecific contrast agent

La fístula biliobronquial es una situación poco común y de muy difícil diagnóstico. Para su demostración, el uso de resonancia magnética (RM) con un agente de contraste específico para el hígado apenas aparece recogido en la literatura científica. Presentamos el caso de un paciente con clínica infecciosa pulmonar con antecedentes de cirugía hepática por enfermedad hidatídica, en quien se sospechó una fístula biliobronquial al detectarse bilis en el esputo. La RM hepática con contraste hepatoespecífico permitió demostrar la comunicación entre los árboles biliar y bronquial, y aportó datos anatómicos para decidir el abordaje terapéutico (AU)

Bronchobiliary fistulas are a rare entity of difficult diagnosis. The utility of magnetic resonance image (MRI) with hepatospecific contrast agents to demonstrate such condition is seldom described in the literature. This case reports a patient with pulmonary infection with a past history of hepatic surgery for hydatid disease in whom the presence of bile in the sputum rose the suspicious of a bronchobiliary fistula. MRI with hepatospecific contrast agents showed the communication between the biliary and bronchial tree and provided anatomic data to allow a therapeutic approach (AU)

Demonstration of a bronchobiliary fistula using magnetic resonance image with hepatospecific contrast agent. / Demostración de fístula biliobronquial mediante resonancia magnética con contraste hepatoespecífico.

Bronchobiliary fistulas are a rare entity of difficult diagnosis. The utility of magnetic resonance image (MRI) with hepatospecific contrast agents to demonstrate such condition is seldom described in the literature. This case reports a patient with pulmonary infection with a past history of hepatic surgery for hydatid disease in whom the presence of bile in the sputum rose the suspicious of a bronchobiliary fistula. MRI with hepatospecific contrast agents showed the communication between the biliary and bronchial tree and provided anatomic data to allow a therapeutic approach.

Imagen por resonancia magnética en la estadificación y planificación del tratamiento del cáncer de cérvix / Magnetic resonance imaging for staging and treatment planning in cervical cancer

Objetivo. En este artículo revisamos los puntos clave indispensables para realizar una correcta estadificación del cáncer de cérvix mediante resonancia magnética. Conclusión. La resonancia magnética es el método de elección para la estadificación locorregional del cáncer de cérvix. Una correcta valoración de sus factores pronósticos, como el tamaño tumoral, la invasión de estructuras adyacentes y la presencia de metástasis ganglionares, resulta fundamental para decidir un adecuado manejo terapéutico (AU)

Objective. To review the key points that are essential for the correct staging of cervical cancer by magnetic resonance imaging. Conclusion. Magnetic resonance imaging is the method of choice for locoregional staging of cervical cancer. Thorough evaluation of prognostic factors such as tumor size, invasion of adjacent structures, and the presence of lymph node metastases is fundamental for planning appropriate treatment (AU)