Seguridad del empleo de regadenosón como fármaco vasodilatador en resonancia magnética cardíaca de estrés / Safety of regadenoson for vasodilation in cardiac MRI stress tests

OBJETIVO: Describir la seguridad del regadenosón como fármaco vasodilatador en estudios de resonancia magnética cardíaca (RMC) de estrés realizados para detectar isquemia miocárdica. MATERIAL Y MÉTODOS: Se analizaron de manera retrospectiva los estudios de 120 pacientes (88 varones, edad media 67 ±11,6 años) con sospecha de cardiopatía isquémica o con enfermedad coronaria conocida e indicación clínica para RMC de estrés. Los estudios se realizaron en un equipo de 1,5 Tesla (MAGNETOM Aera, Siemens Healthineers) empleando regadenosón (5ml, 0,4mg) como agente vasodilatador. En todos los pacientes se recogieron los factores de riesgo cardiovascular, fármacos que tomaban e indicación de la prueba, además de las constantes vitales en situación de reposo y bajo estrés y los síntomas y efectos adversos inducidos por el fármaco. RESULTADOS: El 52,6% de los pacientes permanecieron asintomáticos. Los síntomas más frecuentes fueron la opresión centrotorácica (25%) y la disnea (12%). Durante el pico de estrés, el incremento medio de la frecuencia cardíaca fue de 23,9±11,4 lpm y el descenso medio de la presión arterial sistólica y diastólica de 7,1±18,8mmHg y 5,3±9,2mmHg, respectivamente (p < 0,001). En pacientes obesos y diabéticos se objetivó menor respuesta hemodinámica al regadenosón, mientras que los pacientes sintomáticos presentaron mayor incremento de la frecuencia cardíaca (27,4±11,2 lpm frente a 20,6±10,7 lpm, p = 0,001). No se evidenció ningún efecto adverso grave. CONCLUSIÓN: El regadenosón es un fármaco bien tolerado que se puede utilizar con seguridad en RMC de estrés

OBJECTIVE: To determine the safety of regadenoson for vasodilation in cardiac MRI stress tests to detect myocardial ischemia. MATERIAL AND METHODS: We retrospectively analyzed cardiac MRI studies done in 120 patients (mean age, 67±11.6 years; 88 men) with suspected ischemic heart disease or known coronary disease who had clinical indications for cardiac MRI stress tests. All studies were done on a 1.5 T scanner (MAGNETOM Aera, Siemens Healthineers) using regadenoson (5ml, 0.4mg) for vasodilation. We recorded cardiovascular risk factors, medications, and indications for the test as well as vital signs at rest and under stress and the symptoms and adverse effects induced by the drug. RESULTS: No symptoms developed in 52.6% of patients. The most common symptoms were central chest pain (25%) and dyspnea (12%). At peak stress, the mean increase in heart rate was 23.9±11.4 beats per minute and the mean decreases in systolic and diastolic blood pressure were 7.1±18.8mmHg and 5.3±9.2mmHg, respectively (p <0.001). The response to regadenoson was less pronounced in obese and diabetic patients. The increase in heart rate was greater in symptomatic patients (27.4±11.2 bpm vs. 20.6±10.7 bpm in asymptomatic patients, p = 0.001). No severe adverse effects were observed. CONCLUSION: Regadenoson is well tolerated and can be safely used for cardiac MRI stress tests

Reacciones adversas inmunomediadas como predictoras de respuesta en pacientes oncológicos en tratamiento con inmunoterapia / Immune-related adverse events as predictors of response in cancer patients undergoing immunotherapy

OBJETIVO: Identificar la incidencia de reacciones adversas inmunomediadas (irAE, immune related adverse events), con y sin manifestaciones radiológicas, y correlacionarla con la respuesta al tratamiento inmunoterápico. MATERIAL Y MÉTODOS: Se reclutaron retrospectivamente 79 pacientes con carcinomas de pulmón (n=24), renal (n=11) y melanoma (n=44) en estadio IV que fueron tratados con fármacos inmunoterápicos. Se valoró la aparición de irAE, sus manifestaciones radiológicas y el tipo de patrón de respuesta de acuerdo con los criterios de respuesta a la inmunoterapia (irRC). Se relacionó la presencia de irAE con el patrón de respuesta al tratamiento. RESULTADOS: El 27,8% de los pacientes sufrieron irAE. Estas reacciones fueron más frecuentes en pacientes con melanoma (40,9% de los pacientes). Más de la mitad de las reacciones (59,1%) presentaron manifestaciones radiológicas a modo de neumonitis, colitis, hipofisitis, tiroiditis y miocarditis. La neumonitis fue la irAE con expresión radiológica más frecuente, incluso en pacientes asintomáticos. En la población estudiada, la tasa de respuesta a la inmunoterapia fue significativamente mejor en pacientes que desarrollaron irAE (68,2% frente a 38,6%, χ2=5,58; p = 0,018). La tasa de respuesta favorable en los pacientes con y sin manifestaciones radiológicas de las irAE fue de 84,6% y 44,4%, respectivamente (p = 0,023). CONCLUSIONES: La presencia de reacciones adversas inmunomediadas se asocia, de forma significativa, con una mejor respuesta a la inmunoterapia. La asociación con respuesta favorable es incluso mayor en pacientes con manifestaciones radiológicas de las irAE

OBJECTIVE: To determine the incidence of immune-mediated adverse reactions with and without radiologic manifestations and to correlate them with the response to immunotherapy. MATERIAL AND METHODS: We retrospectively included 79 patients with stage IV lung carcinomas (n=24), renal carcinomas (n=11), or melanoma (n=44) treated with immunotherapy. We evaluated the occurrence of immune-mediated adverse reactions, their radiologic manifestations, and the response pattern according to the immune-related response criteria (irRC). We correlated the presence of immune-mediated adverse reactions with the response pattern. RESULTS: Immune-mediated adverse reactions occurred in 27.8%, being most common in patients with melanoma (40.9%). In 59.1% of patients with adverse reactions, there were radiologic manifestations such as pneumonitis, colitis, hypophysitis, thyroiditis, or myocarditis. Pneumonitis was the most common radiologic manifestation of immune-mediated adverse reactions, even in asymptomatic patients. The rate of response to immunotherapy was higher among patients who developed immune-mediated adverse reactions than in those who did not (68.2% vs. 38.6%, respectively, χ2 5.58; p = 0.018). The rate of favorable responses was higher in patients with radiologic manifestations of immune-mediated adverse reactions than in those without radiologic manifestations (84.6% vs. 44.4%, respectively; p = 0.023). CONCLUSIONS: The presence of immune-mediated adverse reactions is associated with a better response to immunotherapy. The association with a favorable response is even stronger in patients with radiologic manifestations of the immune-mediated adverse reactions

Immune-related adverse events as predictors of response in cancer patients undergoing immunotherapy. / Reacciones adversas inmunomediadas como predictoras de respuesta en pacientes oncológicos en tratamiento con inmunoterapia.

OBJECTIVE: To determine the incidence of immune-mediated adverse reactions with and without radiologic manifestations and to correlate them with the response to immunotherapy. MATERIAL AND METHODS: We retrospectively included 79 patients with stage IV lung carcinomas (n=24), renal carcinomas (n=11), or melanoma (n=44) treated with immunotherapy. We evaluated the occurrence of immune-mediated adverse reactions, their radiologic manifestations, and the response pattern according to the immune-related response criteria (irRC). We correlated the presence of immune-mediated adverse reactions with the response pattern. RESULTS: Immune-mediated adverse reactions occurred in 27.8%, being most common in patients with melanoma (40.9%). In 59.1% of patients with adverse reactions, there were radiologic manifestations such as pneumonitis, colitis, hypophysitis, thyroiditis, or myocarditis. Pneumonitis was the most common radiologic manifestation of immune-mediated adverse reactions, even in asymptomatic patients. The rate of response to immunotherapy was higher among patients who developed immune-mediated adverse reactions than in those who did not (68.2% vs. 38.6%, respectively, χ2 5.58; p=0.018). The rate of favorable responses was higher in patients with radiologic manifestations of immune-mediated adverse reactions than in those without radiologic manifestations (84.6% vs. 44.4%, respectively; p=0.023). CONCLUSIONS: The presence of immune-mediated adverse reactions is associated with a better response to immunotherapy. The association with a favorable response is even stronger in patients with radiologic manifestations of the immune-mediated adverse reactions.

Resonancia magnética intraoperatoria de 3 teslas: Nuestra experiencia en patología tumoral / Intraoperative 3 tesla magnetic resonance imaging: our experience in tumors

Objetivo. Describir nuestra experiencia con la resonancia magnética intraoperatoria (RMio) de 3 teslas en procedimientos neuroquirúrgicos en patología tumoral y evaluar los criterios que condicionaron la ampliación quirúrgica. Material y métodos. Estudio retrospectivo en el que se incluyeron todas las RMio consecutivas realizadas por patología neurooncológica en los primeros 13 meses tras su instalación. Se registraron las posibles complicaciones inmediatas, la presencia de restos tumorales y la modificación de la actitud quirúrgica por los resultados de la RMio. Se midió el tiempo quirúrgico en todos los casos. Resultados. El mayor porcentaje de lesiones resecadas correspondió a glioblastomas recidivados, seguido de glioblastomas primarios y metástasis. Se evidenció una resección completa en un 28% y restos tumorales en un 72%. La RMio permitió a los neurocirujanos mejorar la extensión de la resección en un 85%. La media del tiempo quirúrgico fue de 390±122 minutos. Conclusión. La RMio con equipos de alto campo (3 teslas) es una técnica novedosa y válida, que permite estudiar la resección tumoral de forma precisa y evaluar si se puede continuar la resección sin dañar zonas elocuentes. Aunque su empleo conlleva una prolongación del tiempo quirúrgico, este mejora con la curva de aprendizaje del personal

Objective. To report our experience in the use of 3 tesla intraoperative magnetic resonance imaging (MRI) in neurosurgical procedures for tumors, and to evaluate the criteria for increasing the extension of resection. Material and methods. This retrospective study included all consecutive intraoperative MRI studies done for neuro-oncologic disease in the first 13 months after the implementation of the technique. We registered possible immediate complications, the presence of tumor remnants, and whether the results of the intraoperative MRI study changed the surgical management. We recorded the duration of surgery in all cases. Results. The most common tumor was recurrent glioblastoma, followed by primary glioblastoma and metastases. Complete resection was achieved in 28%, and tumor remnants remained in 72%. Intraoperative MRI enabled neurosurgeons to improve the extent of the resection in 85% of cases. The mean duration of surgery was 390±122minutes. Conclusion. Intraoperative MRI using a strong magnetic field (3 teslas) is a valid new technique that enables precise study of the tumor resection to determine whether the resection can be extended without damaging eloquent zones. Although the use of MRI increases the duration of surgery, the time required decreases as the team becomes more familiar with the technique

Intraoperative 3 tesla magnetic resonance imaging: our experience in tumors. / Resonancia magnética intraoperatoria de 3 teslas: Nuestra experiencia en patología tumoral.

OBJECTIVE: To report our experience in the use of 3 tesla intraoperative magnetic resonance imaging (MRI) in neurosurgical procedures for tumors, and to evaluate the criteria for increasing the extension of resection. MATERIAL AND METHODS: This retrospective study included all consecutive intraoperative MRI studies done for neuro-oncologic disease in the first 13 months after the implementation of the technique. We registered possible immediate complications, the presence of tumor remnants, and whether the results of the intraoperative MRI study changed the surgical management. We recorded the duration of surgery in all cases. RESULTS: The most common tumor was recurrent glioblastoma, followed by primary glioblastoma and metastases. Complete resection was achieved in 28%, and tumor remnants remained in 72%. Intraoperative MRI enabled neurosurgeons to improve the extent of the resection in 85% of cases. The mean duration of surgery was 390±122minutes. CONCLUSION: Intraoperative MRI using a strong magnetic field (3 teslas) is a valid new technique that enables precise study of the tumor resection to determine whether the resection can be extended without damaging eloquent zones. Although the use of MRI increases the duration of surgery, the time required decreases as the team becomes more familiar with the technique.