Update of cartilaginous tumours according to the WHO classification 2020.

Cartilaginous tumours are a large and heterogeneous group of neoplasms characterised by the presence of a chondroid matrix, with lobular growth and arcuate, ring-like or popcorn-like calcification patterns. MRI shows hyperintensity in T2-weighted sequences and a lobulated or septal relief in postcontrast images. In the WHO 2020 classification, chondral tumours are classified as benign, intermediate or malignant. Despite technological advances, they continue to pose a challenge for both the radiologist and the pathologist, being the main difficulty the differentiation between benign and malignant tumours, which is why they require a multidisciplinary approach. This paper describes the main changes introduced in the 2020 update, describes the imaging characteristics of the main cartilaginous tumours and provides the radiological keys to differentiate between benign and malignant tumours.

Actualización de los tumores cartilaginosos según la clasificación de la OMS de 2020 / Update of cartilaginous tumours according to the WHO classification 2020

Los tumores cartilaginosos son un grupo amplio y heterogéneo de neoplasias caracterizadas por la presencia de una matriz condroide que presenta crecimiento lobular y patrones de calcificación en arcos y anillos o en palomitas de maíz. En RM destaca su hiperintensidad en las secuencias potenciadas en T2, y en las imágenes poscontraste, un relace lobulado o septal. En la clasificación de 2020 de la OMS, los tumores de estirpe condral se clasifican en benignos, intermedios o malignos. A pesar de los avances tecnológicos, siguen suponiendo un reto tanto para el radiólogo como para el patólogo, siendo la principal dificultad la diferenciación entre los tumores benignos y malignos, razón por la que requieren un abordaje multidisciplinar. Este trabajo recoge los principales cambios introducidos en la actualización de 2020, describe las características de imagen de los principales tumores cartilaginosos y proporciona las claves radiológicas para diferenciar entre tumores benignos y malignos.(AU)

Cartilaginous tumours are a large and heterogeneous group of neoplasms characterised by the presence of a chondroid matrix, with lobular growth and arcuate, ring-like or popcorn-like calcification patterns. MRI shows hyperintensity in T2-weighted sequences and a lobulated or septal relief in postcontrast images. In the WHO 2020 classification, chondral tumours are classified as benign, intermediate or malignant. Despite technological advances, they continue to pose a challenge for both the radiologist and the pathologist, being the main difficulty the differentiation between benign and malignant tumours, which is why they require a multidisciplinary approach. This paper describes the main changes introduced in the 2020 update, describes the imaging characteristics of the main cartilaginous tumours and provides the radiological keys to differentiate between benign and malignant tumours.(AU)

Diagnosis of lesions of the acetabular labrum, of the labral-chondral transition zone, and of the cartilage in femoroacetabular impingement: Correlation between direct magnetic resonance arthrography and hip arthroscopy.

OBJECTIVE: To determine the sensitivity and accuracy of direct MR arthrography in the diagnosis of intra-articular lesions associated with femoroacetabular impingement. MATERIAL AND METHODS: We used direct MR arthrography to study 51 patients with femoroacetabular impingement who underwent arthroscopic hip surgery. Surgery demonstrated 37 labral tears, 44 lesions in the labral-chondral transitional zone, and 40 lesions of the articular cartilage. We correlated the findings at preoperative direct MR arthrography with those of hip arthroscopy and calculated the sensitivity, specificity, positive predictive value, negative predictive value, and validity index for direct MR arthrography. RESULTS: The sensitivity and specificity of MR arthrography were 94.5% and 100%, respectively, for diagnosing labral tears, 100% and 87.5%, respectively, for diagnosing lesions of the labral-chondral transition zone, and 92.5% and 54.5%, respectively, for diagnosing lesions of the articular cartilage. The negative predictive value of MR arthrography for lesions of the labral-chondral transitional zone was 100%. MR arthrography accurately defined extensive lesions of the cartilage and the secondary osseous changes (the main factor in poor prognosis), although its diagnostic performance was not so good in small chondral lesions. CONCLUSION: In patients with femoroacetabular impingement, direct MR arthrography can adequately detect and characterize lesions of the acetabular labrum and of the labral-chondral transitional zone as well as extensive lesions of the articular cartilage and secondary osseous changes.

Diagnóstico por imagen del osteoma osteoide intraarticular / No disponible

No disponible

[Primary mesenchymal chondrosarcoma of the mediastinum]. / Condrosarcoma mesenquimal primario en el mediastino.

Cartilaginous lesions of the mediastinum are quite rare and primary cartilage forming tumors arising within the mediastinum are even more exceptional. Radiologic findings are unspecific. However, certain characteristics can orient the diagnosis. They are presented one mediastinal chondrosarcoma case in adult patient of patho-anatomical diagnosis. The findings described entail chest radiography, computed tomography and magnetic resonance.

Condrosarcoma mesenquimal primario en el mediastino / Primary mesenchymal chondrosarcoma of the mediastinum

Las lesiones cartilaginosas en el mediastino son muy infrecuentes y los tumores primarios formadores de cartílago que asientan en el mediastino son incluso más excepcionales. Los hallazgos radiológicos a menudo son inespecíficos. No obstante, existen ciertas características que nos pueden orientar hacia el diagnóstico.Presentamos un caso de condrosarcoma mediastínico en un paciente adulto cuyo diagnóstico se realizó por anatomía patológica. Describimos los hallazgos en la radiografía de tórax, tomografía computarizada y resonancia magnética

Cartilaginous lesions of the mediastinum are quite rare and primary cartilage forming tumors arising within the mediastinum are even more excepcional. Radiologic findings are unspecific. However, certain characteristicscan orient the diagnosis.They are presented one mediastinal chondrosarcoma case in adult patient of patho-anatomical diagnosis. The findings described entail chest radiography, computed tomography and magnetic resonance

Tratamiento de fístulas carótido-cavernosas / Treatment of carotid-cavernous fistulas

Objetivos. Valorar los resultados del tratamiento de 33 pacientes con fístula carótido-cavernosa (FCC) de acuerdo con criterios clínicos y angiográficos. Material y métodos. De enero de 1993 a diciembre de 2003, 33 pacientes fueron diagnosticados y tratados de FCC en nuestro hospital. Se realizó examen clínico y angiografía antes y después del tratamiento. Las modalidades terapéuticas disponibles son el tratamiento conservador, mediante compresiones, y el tratamiento intervencionista, con distintos procedimientos según la vía de abordaje y el material de embolización empleados. Resultados. De las 11 FCC directas, una fue tratada de forma conservadora y 10 se sometieron a procedimientos de embolización. La vía de abordaje fue transarterial en 5, transvenosa en 2 y en 3 se utilizaron ambas, consiguiendo la desaparición de los síntomas en el 90% de los pacientes. De las 22 FCC indirectas o durales, 6 fueron tratadas de forma conservadora, con óptimo resultado, mientras que las 16 restantes se embolizaron, 11 por vía transarterial y 5 combinando los accesos transarterial y transvenoso. La terapia endovascular logró la desaparición completa de los síntomas en 9 pacientes y parcial en 7. Sólo se produjo una complicación transitoria. Conclusiones. La adecuada selección tanto del tipo de tratamiento (conservador o intervencionista), como del procedimiento (vía de abordaje y material de embolización), caso de que fuera necesario, optimiza los resultados en el manejo de pacientes con FCC

Objectives. To evaluate the results of the treatment of 33 patients with carotid-cavernous fistula (CCF) with respect to clinical and angiographic criteria. Material and methods. From January 1993 to December 2003, 33 patients were diagnosed with CCF and treated at our hospital. All patients underwent clinical examination and angiography before and after treatment. Available treatment modalities were conservative treatment, consisting of compressions, and interventional treatment, with different procedures depending on the approach and the materials employed for embolization. Results. Of the 11 direct CCFs, one received conservative treatment and 10 underwent embolization procedures. An arterial approach was used in 5 cases, a venous approach in 2, and a combined venous-arterial approach in the remaining 3, with symptoms disappearing in 90% of the patients. Of the 22 indirect or dural CCFs, 6 received conservative treatment, with optimal results, and the remaining 16 underwent embolization (11 using an arterial approach and 5 using a combined venous-arterial approach). Endovascular treatment brought about the complete disappearance of symptoms in 9 patients and partial disappearance in 7. Only one transitory complication was observed. Conclusions. The appropriate selection of both the type of treatment (conservative vs. interventional) and the interventional procedure (approach and material for embolization), yields optimal results in the management of patients with CCF

[Progression following the embolisation of 100 intracranial arteriovenous malformations]. / Evolución tras la embolización de 100 malformaciones arteriovenosas intracraneales.

INTRODUCTION: We analysed the characteristics, progression and outcomes observed following the embolisation of 100 intracranial arteriovenous malformations (AVM) that were performed in order to achieve complete obliteration of the AVM, the elimination of associated vascular risk factors and also to reduce their size with a view to increasing the effectiveness of later treatments. PATIENTS AND METHODS: The demographic and anatomical characteristics of 110 patients with AVM were analysed over a period of 13 years, and embolisation was performed in 100 of them. In all, 203 embolisation sessions were carried out with an average of 3 embolisations per patient. Of the 100 AVM that were embolised, 36 were AVM which were treated by embolisation with no later therapy, 48 required radiosurgery after the embolisation and the other 16 were submitted to surgery following the embolisation. The type of materials used included liquid adhesive embolic agents (Hystoacryl, Glubran), non-adhesive embolic agents (Onyx) and polyvinyl alcohol particles. Patients were examined clinically and arteriographically. RESULTS: Of the 100 AVM that were embolised, complete eradication was accomplished with just embolisation in 27 cases of AVM (27%). Of the 48 AVM in which radiosurgery was carried out at a later date, the average rate of obliteration was 78% and of the 16 AVM in which surgery was carried out some time later, the average rate of obliteration was 70%. Of the 100 AVM that were embolised, some residue remained in 16 cases. Embolisation eliminated most of the associated vascular risk factors, as can be seen by the fact that associated risk factors disappeared in 28 (65%) out of the 43 AVM with such factors. The morbidity and mortality rates with embolisation were 8% and 2%, respectively. CONCLUSIONS: Embolisation eliminated most of the vascular risk factors, with complete obliteration in 27 cases and size was satisfactorily reduced for later treatment; at the same time, morbidity and mortality rates were acceptable.

Evolución tras la embolización de 100 malformaciones arteriovenosas intracraneales / Progression following the embolisation of 100 intracranial arteriovenous malformations

Introducción. Analizamos las características, evolución y resultados tras la embolización de 100 malformaciones arteriovenosas (MAV) intracraneales con el objetivo de conseguir la obliteración completa de la MAV, la eliminación de los factores de riesgo vascular asociados y disminuir su tamaño para la efectividad de posteriores tratamientos. Pacientes y métodos. Analizamos las características demográficas y anatómicas de 110 pacientes portadores de MAV durante 13 años, y se realizó una embolización a 100de éstos. Se practicaron 203 sesiones de embolización con una media de 3 embolizaciones/paciente. De las 100 MAV embolizadas, hubo 36 MAV a las que sólo se realizó embolización sin otro tratamiento posterior, a 48 se les realizó radiocirugía postembolización y a los 16 restantes cirugía postembolización. El tipo del material usado fueron agentes embólicos líquidos adhesivos (Hystoacril, Glubran®), agentes embólicos no adhesivos (Onyx) y partículas de polivinil alcohol. Se revisó a los pacientes clínica y arteriográficamente. Resultados. De las 100 MAV embolizadas, hubo una erradicación completa con sólo embolización en 27 MAV (27%). De las48 MAV a las que se les realizó radiocirugía posterior, hubo una obliteración media del 78%. De las 16 MAV a las que se realizó cirugía posterior, hubo una obliteración media del 70%. De las 100MAV embolizadas, hubo 16 en las que quedaron restos. La embolización eliminó la mayoría de los factores de riesgo vascular asociados: de 43 MAV con factores de riesgo asociados, desaparecieron en 28 MAV (65%). Con la embolización se produjo una morbilidad del 8% y mortalidad del 2%. Conclusión. La embolización eliminó la mayoría de los factores de riesgo vascular, con una obliteración completa en 27 casos y se redujo el tamaño para posteriores tratamientos de manera satisfactoria, y todo ello con una morbimortalidad aceptable (AU)

Introduction. We analysed the characteristics, progression and outcomes observed following the embolisation of 100intracranial arteriovenous malformations (AVM) that were performed in order to achieve complete obliteration of the AVM, the elimination of associated vascular risk factors and also to reduce their size with a view to increasing the effectiveness of later treatments. Patients and methods. The demographic and anatomical characteristics of 110 patients with AVM were analysed over a period of 13 years, and embolisation was performed in 100 of them. In all, 203 embolisation sessions were carried out with an average of 3 embolisations per patient. Of the 100 AVM that were embolised, 36 were AVM which were treated by embolisation with no later therapy, 48 required radiosurgery after the embolisation and the other 16 were submitted to surgery following the embolisation. The type of materials used included liquid adhesive embolic agents (Hystoacryl, Glubran ®), non adhesiveembolic agents (Onyx) and polyvinyl alcohol particles. Patients were examined clinically and arteriographically. Results. Of the 100 AVM that were embolised, complete eradication was accomplished with just embolisation in 27 cases of AVM (27%). Of the 48 AVM in which radiosurgery was carried out at a later date, the average rate of obliteration was 78% and of the 16 AVM in which surgery was carried out some time later, the average rate of obliteration was 70%. Of the 100 AVM tha twere embolised, some residue remained in 16 cases. Embolisation eliminated most of the associated vascular risk factors, as can be seen by the fact that associated risk factors disappeared in 28 (65%) out of the 43 AVM with such factors. The morbidity and mortality rates with embolisation were 8% and 2%, respectively. Conclusions. Embolisation eliminated most of the vascular risk factors, with complete obliteration in 27 cases and size was satisfactorily reduced for later treatment; at the same time, morbidity and mortality rates were acceptable (AU)

[Hypothalamic-infundibular histiocytosis: magnetic resonance findings]. / Histiocitosis hipotálamo-infundibular: hallazgos en resonancia magnética.

INTRODUCTION: We report the magnetic resonance imaging (MRI) of a case of Langerhans cell histiocytosis in the pituitary. Isolated central nervous system involvement is uncommon. CASE REPORT: An eighteen-years old female patient who had an acute onset of central diabetes insipidus because of the Langerhans cell histiocytosis. The MRI evidenced a lesion in the hypothalamic-pituitary axis. The hyperintensity in the posterior pituitary lobe, which is seen in normal subjects on T1-weighted images, was absent. The pituitary stalk was thickened and enhanced homogeneously following contrast administration. During the follow-up, the infundibullar lesion extended to the hypothalamic region and other systemic manifestations appeared. Diagnosis of Langerhans cell histiocytosis was confirmed by lung biopsy. After radiotherapy and chemotherapy, MRI showed regression of the hypothalamic-pituitary lesion. CONCLUSION: The combination of these findings, although nonspecific of Langerhans cell histiocytosis, should nevertheless prompt further studies, including chest films, bone scanning and temporal bone computerized tomography in order to narrow the differential diagnosis.