Diagnostic accuracy of lumbar CT and MRI in the evaluation of chronic low back pain without red flag symptoms.

BACKGROUND: Low back pain (LBP) is one of the most frequent reasons for medical consultation. Most of the patients will have nonspecific LBP, which usually are self-limited episodes. It is unclear which of the diagnostic imaging pathways is most effective and costeffective and how the imaging impacts on patient treatment. Imaging techniques are usually indicated if symptoms remain after 6 weeks. Magnetic resonance imaging (MRI) is the diagnostic imaging examination of choice in lumbar spine evaluation of low back pain; however, availability of MRI is limited. OBJECTIVES: To evaluate the diagnostic accuracy of computed tomography (CT) with MRI (as standard of reference) in the evaluation of chronic low back pain (LBP) without red flags symptoms. To compare the results obtained by two radiologists with different grades of experience. MATERIALS AND METHODS: Patients with chronic low back pain without red flags symptoms were retrospectively reviewed by two observers with different level of experience. Patients included had undergone a lumbar or abdominal CT and an MRI within a year. Once the radiological information was collected, it was then statistically reviewed. The aim of the statistical analysis is to identify the equivalence between both diagnostic techniques. To this end, sensitivity, specificity and validity index were calculated. In addition, intra and inter-observer reliability were measured by Cohen's kappa values and also using the McNemar test. RESULTS: 340 lumbar levels were evaluated from 68 adult patients with chronic low back pain or sciatica. 63.2% of them were women, with an average age of 60.3 years (SD 14.7). CT shows high values of sensitivity and specificity (>80%) in most of the items evaluated, but sensitivity was low for the evaluation of density of the disc (40%) and for the detection of disc herniation (55%). Moreover, agreement between MRI and CT in most of these items was substantial or almost perfect (Cohen's kappa-coefficient > 0'8), excluding Modic changes (kappa = 0.497), degenerative changes (kappa0.688), signal of the disc (kappa = 0.327) and disc herniation (kappa = 0.639). Finally, agreement between both observers is mostly high (kappa > 0.8). Foraminal stenosis, canal stenosis and the grade of the canal stenosis were overdiagnosed by the inexperienced observer in the evaluation of CT images. CONCLUSIONS AND SIGNIFICANCE: CT is as sensitive as lumbar MRI in the evaluation of most of the items analysed, excluding Modic changes, degenerative changes, signal of the disc and disc herniation. In addition, these results are obtained regardless the experience of the radiologist. The rising use of diagnostic medical imaging and the improvement of image quality brings the opportunity of making a second look of abdominal CT in search of causes of LBP. Thereby, inappropriate medical imaging could be avoided (2). In addition, it would allow to reduce MRI waiting list and prioritize other patients with more severe pathology than LBP.

Percutaneous management of bone metastases: State of the art.

Interventional radiology is playing an increasingly important role in the local treatment of bone metastases; this treatment is usually done with palliative intent, although in selected patients it can be done with curative intent. Two main groups of techniques are available. The first group, centered on bone consolidation, includes osteoplasty/vertebroplasty, in which polymethyl methacrylate (PMMA) is injected to reinforce the bone and relieve pain, and percutaneous osteosynthesis, in which fractures with nondisplaced or minimally bone fragments are fixed in place with screws. The second group centers on tumor ablation. tumor ablation refers to the destruction of tumor tissue by the instillation of alcohol or by other means. Thermoablation is the preferred technique in musculoskeletal tumors because it allows for greater control of ablation. Thermoablation can be done with radiofrequency, in which the application of a high frequency (450 Hz-600 Hz) alternating wave to the tumor-bone interface achieves high temperatures, resulting in coagulative necrosis. Another thermoablation technique uses microwaves, applying electromagnetic waves in an approximate range of 900 MHz-2450 MHz through an antenna that is placed directly in the core of the tumor, stimulating the movement of molecules to generate heat and thus resulting in coagulative necrosis. Cryoablation destroys tumor tissue by applying extreme cold. A more recent, noninvasive technique, magnetic resonance-guided focused ultrasound surgery (MRgFUS), focuses an ultrasound beam from a transducer placed on the patient's skin on the target lesion, where the waves' mechanical energy is converted into thermal energy (65 °C-85 °C). Treatment should be planned by a multidisciplinary team. Treatment can be done with curative or palliative intent. Once the patient is selected, a preprocedural workup should be done to determine the most appropriate technique based on a series of factors. During the procedure, protective measures must be taken and the patient must be closely monitored. After the procedure, patients must be followed up.

Lesión de Morel-Lavallée: diagnóstico y tratamiento con técnicas de imagen / Morel-Lavallée lesion: diagnosis and treatment with imaging techniques

Objetivo: Revisar las características de las lesiones de Morel-Lavallée y valorar su tratamiento. Material y métodos: Hemos revisado de forma retrospectiva 17 pacientes diagnosticados de lesión de Morel-Lavallée en dos servicios diferentes: 11 hombres y 6 mujeres, edad media 56,1 años, rango de edad 25-81 años. En todos se hizo un estudio con ecografía, en cinco se realizó tomografía computarizada y en nueve resonancia magnética. Trece fueron tratados de forma percutánea mediante aspiración con aguja fina o drenaje con catéter de 6-8 F, o con ambos procedimientos. Dos pacientes requirieron esclerosis percutánea con doxiciclina. Resultados: Todos los pacientes respondieron de forma adecuada al tratamiento percutáneo, aunque en cuatro hubo que repetir el procedimiento. Conclusiones: El radiólogo debe estar familiarizado con esta patología cuyo tratamiento percutáneo, cuando no está asociada a otras afecciones, puede realizarse con éxito en la sala de ecografía

Objectives: We aim to review the characteristics of Morel-Lavallée lesions and to evaluate their treatment. Material and methods: We retrospectively reviewed 17 patients (11 men and 6 women; mean age, 56.1 years, range 25-81 years) diagnosed with Morel-Lavallée lesions in two different departments. All patients underwent ultrasonography, 5 underwent computed tomography, and 9 underwent magnetic resonance imaging. Percutaneous treatment with fine-needle aspiration and/or drainage with a 6F-8F catheter was performed in 13 patients. Two patients required percutaneous sclerosis with doxycycline. Results: All patients responded adequately to percutaneous treatment, although it was necessary to repeat the procedure in 4 patients. Conclusions: Radiologists need to be familiar with this lesion that can be treated percutaneously in the ultrasonography suite when it is not associated with other entities

Morel-Lavallée lesion: diagnosis and treatment with imaging techniques. / Lesión de Morel-Lavallée: diagnóstico y tratamiento con técnicas de imagen.

OBJECTIVES: We aim to review the characteristics of Morel-Lavallée lesions and to evaluate their treatment. MATERIAL AND METHODS: We retrospectively reviewed 17 patients (11 men and 6 women; mean age, 56.1 years, range 25-81 years) diagnosed with Morel-Lavallée lesions in two different departments. All patients underwent ultrasonography, 5 underwent computed tomography, and 9 underwent magnetic resonance imaging. Percutaneous treatment with fine-needle aspiration and/or drainage with a 6F-8F catheter was performed in 13 patients. Two patients required percutaneous sclerosis with doxycycline. RESULTS: All patients responded adequately to percutaneous treatment, although it was necessary to repeat the procedure in 4 patients. CONCLUSIONS: Radiologists need to be familiar with this lesion that can be treated percutaneously in the ultrasonography suite when it is not associated with other entities.

Musculoskeletal interventional radiology: ultrasound and CT. / Intervencionismo en musculoesquelético. Ecografía y tac.

We aim to describe imaging-guided (ultrasound and CT) interventional techniques in the musculoskeletal system that can be performed by general radiologists, whether in hospitals, primary care clinics, private offices, or other settings. The first requirement for doing these procedures is adequate knowledge of the anatomy of the musculoskeletal system. The second requirement is to inform the patient thoroughly about the technique, the risks involved, and the alternatives available in order to obtain written informed consent. The third requirement is to ensure that the procedure is performed in accordance with the principles of asepsis in relation to the puncture zone and to all the material employed throughout the procedure. The main procedures that can be done under ultrasound guidance are the following: fine needle aspiration cytology (FNAC), core needle biopsy (CNB), diagnostic and/or therapeutic arthrocentesis, drainage of juxta-articular fluid collections, drainage of abscesses, drainage of hematomas, treatment of Baker's cyst, treatment of ganglia, treatment of bursitis, infiltrations and treatment of plantar fasciitis, plantar fibrosis, epicondylitis, Achilles tendinopathy, and Morton's neuroma, puncture and lavage of calcifications in calcifying tendinopathy. We also review the following CT-guided procedures: diagnosis of spondylodiscitis, FNAC of metastases, arthrography, drainages. Finally, we also mention more complex procedures that can only be done in appropriate settings: bone biopsies, treatment of facet joint pain, radiofrequency treatment.

Intervencionismo en musculoesquelético. Ecografía y tac / Musculoskeletal interventional radiology: ultrasound and CT

Nuestro objetivo es describir aquellas técnicas de intervencionismo musculoesquéletico guiadas por imagen (ecografía y/o tac) que pueden ser realizadas por un radiólogo general, ya sea en hospitales, centros de salud, consultas privadas, etc. El primer requisito para la realización de estos procedimientos es el disponer de un adecuado conocimiento de la anatomía del sistema musculoesquelético. El segundo, que el paciente debe ser informado adecuadamente sobre la técnica, riesgos y alternativas al mismo, relativo por tanto, a la obtención del consentimiento firmado. El tercero es que estos procedimientos se realizan siguiendo los principios de asepsia de la zona de punción, así como del material empleado y lo que acontece durante la realización del procedimiento. Los principales procedimientos que pueden realizarse guiados por ecografía son los siguientes: punción aspiración con aguja fina (PAAF), biopsia con aguja gruesa (BAG), artrocentesis diagnósticas y/o terapéuticas, drenajes de colecciones yuxtaarticulares, drenajes de abscesos, drenaje de hematomas, tratamiento de quiste de Baker, tratamiento de gangliones, tratamiento de las bursitis, infiltraciones y tratamiento de la fascitis plantar, la fibrosis plantar, las epicondilitis, las tendinopatía del tendón de Aquiles o del neuroma de Morton, punción- lavado de calcificaciones en la tendinopatía calcificante. En cuanto a los procedimientos guiados por tac, revisaremos los siguientes: diagnóstico de las espondilodiscitis, PAAF de las metástasis, artrografía, drenajes. También haremos un recordatorio de procedimientos más complejos que deben realizarse en el entorno adecuado: biopsias óseas, tratamiento del dolor facetario, radiofrecuencia terapéutica (AU)

We aim to describe imaging-guided (ultrasound and CT) interventional techniques in the musculoskeletal system that can be performed by general radiologists, whether in hospitals, primary care clinics, private offices, or other settings. The first requirement for doing these procedures is adequate knowledge of the anatomy of the musculoskeletal system. The second requirement is to inform the patient thoroughly about the technique, the risks involved, and the alternatives available in order to obtain written informed consent. The third requirement is to ensure that the procedure is performed in accordance with the principles of asepsis in relation to the puncture zone and to all the material employed throughout the procedure. The main procedures that can be done under ultrasound guidance are the following: fine needle aspiration cytology (FNAC), core needle biopsy (CNB), diagnostic and/or therapeutic arthrocentesis, drainage of juxta-articular fluid collections, drainage of abscesses, drainage of hematomas, treatment of Baker's cyst, treatment of ganglia, treatment of bursitis, infiltrations and treatment of plantar fasciitis, plantar fibrosis, epicondylitis, Achilles tendinopathy, and Morton's neuroma, puncture and lavage of calcifications in calcifying tendinopathy. We also review the following CT-guided procedures: diagnosis of spondylodiscitis, FNAC of metastases, arthrography, drainages. Finally, we also mention more complex procedures that can only be done in appropriate settings: bone biopsies, treatment of facet joint pain, radiofrequency treatment (AU)

Resonancia magnética en espondiloartritis axial: estudio Delphi sobre pautas de actuación y realización / Guidelines for magnetic resonance imaging in axial spondyloarthritis: a Delphi study

Objetivo. La espondiloartritis axial (EspA) pertenece a un grupo de enfermedades reumáticas inflamatorias crónicas que cursan con afectación axial, periférica y de entesis y tienen bases genéticas comunes. Recientemente, la Assessment of SpondyloArthritis International Society (ASAS) ha establecido unos criterios diagnósticos, incluyendo por primera vez la resonancia magnética (RM). Al ser esta una técnica de difícil acceso en determinados medios y ante la falta de experiencia con esta enfermedad, un grupo de radiólogos y reumatólogos propuso buscar recomendaciones prácticas para usarla correctamente. Material y métodos. Encuesta realizada (método Delphi) a 46 expertos sobre el diagnóstico de EspA mediante RM, con 49 ítems estratificados en 4 bloques. Resultados. Se consensuó el 82% de los ítems. El grado de consenso fue del 100% en el bloque «Importancia del diagnóstico precoz de la EspA», del 69% en la «Optimización del uso de la RM en el diagnóstico de la EspA», del 93% en el «Uso de la RM en la EspA: cuestiones técnicas», y del 57% en la «Utilidad de la RM en el pronóstico, seguimiento y valoración del tratamiento de la EspA». Conclusiones. A pesar de la importancia de la RM para diagnosticar precozmente la EspA, este trabajo refleja la necesidad de estandarizarla, y pone de manifiesto una falta de consenso relativa sobre cómo usarla para seguir la enfermedad y valorar la respuesta al tratamiento. Se aportan recomendaciones para mejorar el uso de la RM para diagnosticar la EspA (AU)

Objective. The term axial spondyloarthritis refers to a group of chronic inflammatory rheumatic diseases with a common genetic basis that course with axial and peripheral involvement and enthesitis. Recently, the Assessment of SpondyloArthritis international Society (ASAS) established some diagnostic criteria, including for the first time magnetic resonance imaging (MRI) findings. Given the difficulties of obtaining MRI in some environments and the lack of experience with axial spondyloarthritis, a group of radiologists and rheumatologists sought to establish some practical guidelines to ensure the correct use of MRI in this disease. Material and methods. Using the Delphi method, we used a questionnaire with 49 items stratified into 4 blocks to survey 46 experts in the MRI diagnosis of axial spondyloarthritis. Results. The experts agreed on 82% of the items. The degree of agreement was 100% in the block “Importance of early diagnosis of axial spondyloarthritis”, 69% in the block “Optimization of the use of MRI in the diagnosis of axial spondyloarthritis”, 93% in the block “Use of MRI in axial spondyloarthritis: Technical aspects”, and 57% in the block “Usefulness of MRI in the prognosis, follow-up, and evaluation of the response to treatment in axial spondyloarthritis”. Conclusions. Despite the importance of MRI in the early diagnosis of axial spondyloarthritis, this study shows the need for standardization and points to relative disagreement about how to use MRI in the follow-up of the disease and evaluation of the response to treatment. The results of this study can help improve the use of MRI in axial spondyloarthritis (AU)

Precisión de la resonancia magnética en la diferenciación entre lesión vertebral maligna y benigna: papel de las secuencias de difusión, del cociente fuera de fase/en fase y de los valores del coeficiente de difusión aparente / Accuracy of magnetic resonance imaging in differentiating between benign and malignant vertebral lesions: Role of Diffusion-weighted imaging, in-phase/opposed-phase imaging and apparent diffusion coefficient

Objetivo: Establecer la capacidad diagnóstica de la RM para distinguir las lesiones vertebrales benignas de las malignas. Material y métodos: Incluimos en el estudio a 85 pacientes con un total de 213 vértebras estudiadas (tanto patológicas como normales). Para cada vértebra determinamos si la lesión era hipointensa en T1 y si era hiperintensa o no en las secuencias STIR y potenciada en difusión. Calculamos el valor del cociente fuera de fase/en fase y el valor del coeficiente de difusión aparente de cada vértebra. A partir de los parámetros T1, difusión y STIR establecimos una combinación diagnóstica de lesión maligna. Resultados: El grupo comprendía 60 (70,6%) mujeres y 25 (29,4%) hombres con una edad media de 67 ± 13,5 años (33-90 años). De los 85 pacientes, un total de 26 (30,6%) tenían antecedentes de tumor primario. Cuando la lesión era hipointensa en las imágenes potenciadas en T1, hiperintensa en STIR y en las imágenes potenciadas en difusión, y con un cociente de intensidad de señal mayor de 0,8, la sensibilidad fue del 97,2%; la especificidad del 90% y la exactitud diagnóstica del 91,2%. Si el paciente tenía un tumor primario conocido, los valores se incrementaron hasta el 97,2; 99,4 y 99%, respectivamente. Conclusión: Es posible distinguir las lesiones benignas de las malignas si valoramos de forma conjunta la señal en T1, STIR y difusión y el cociente fuera de fase/en fase de la lesión detectada con RM en el cuerpo vertebral (AU)

Objective: To determine the ability of MRI to distinguish between benign and malignant vertebral lesions. Material and methods: We included 85 patients and studied a total of 213 vertebrae (both pathologic and normal). For each vertebra, we determined whether the lesion was hypointense in T1-weighted sequences and whether it was hyperintense in STIR and in diffusion-weighted sequences. We calculated the in-phase/out-of-phase quotient and the apparent diffusion coefficient for each vertebra. We combined parameters from T1-weighted, diffusion-weighted, and STIR sequences to devise a formula to distinguish benign from malignant lesions. Results: The group comprised 60 (70.6%) women and 25 (29.4%) men with a mean age of 67 ± 13.5 years (range, 33-90 y). Of the 85 patients, 26 (30.6%) had a known primary tumor. When the lesion was hypointense on T1-weighted sequences, hyperintense on STIR and diffusion-weighted sequences, and had a signal intensity quotient greater than 0.8, the sensitivity was 97.2%, the specificity was 90%, and the diagnostic accuracy was 91.2%. If the patient had a known primary tumor, these values increased to 97.2%, 99.4%, and 99%, respectively. Conclusion: Benign lesions can be distinguished from malignant lesions if we combine the information from T1-weighted, STIR, and diffusion-weighted sequences together with the in-phase/out-of-phase quotient of the lesion detected in the vertebral body on MRI (AU)

Guidelines for magnetic resonance imaging in axial spondyloarthritis: A Delphi study.

OBJECTIVE: The term axial spondyloarthritis refers to a group of chronic inflammatory rheumatic diseases with a common genetic basis that course with axial and peripheral involvement and enthesitis. Recently, the Assessment of SpondyloArthritis international Society (ASAS) established some diagnostic criteria, including for the first time magnetic resonance imaging (MRI) findings. Given the difficulties of obtaining MRI in some environments and the lack of experience with axial spondyloarthritis, a group of radiologists and rheumatologists sought to establish some practical guidelines to ensure the correct use of MRI in this disease. MATERIAL AND METHODS: Using the Delphi method, we used a questionnaire with 49 items stratified into 4 blocks to survey 46 experts in the MRI diagnosis of axial spondyloarthritis. RESULTS: The experts agreed on 82% of the items. The degree of agreement was 100% in the block "Importance of early diagnosis of axial spondyloarthritis", 69% in the block "Optimization of the use of MRI in the diagnosis of axial spondyloarthritis", 93% in the block "Use of MRI in axial spondyloarthritis: Technical aspects", and 57% in the block "Usefulness of MRI in the prognosis, follow-up, and evaluation of the response to treatment in axial spondyloarthritis". CONCLUSIONS: Despite the importance of MRI in the early diagnosis of axial spondyloarthritis, this study shows the need for standardization and points to relative disagreement about how to use MRI in the follow-up of the disease and evaluation of the response to treatment. The results of this study can help improve the use of MRI in axial spondyloarthritis.

Accuracy of magnetic resonance imaging in differentiating between benign and malignant vertebral lesions: role of diffusion-weighted imaging, in-phase/opposed-phase imaging and apparent diffusion coefficient.

OBJECTIVE: To determine the ability of MRI to distinguish between benign and malignant vertebral lesions. MATERIAL AND METHODS: We included 85 patients and studied a total of 213 vertebrae (both pathologic and normal). For each vertebra, we determined whether the lesion was hypointense in T1-weighted sequences and whether it was hyperintense in STIR and in diffusion-weighted sequences. We calculated the in-phase/out-of-phase quotient and the apparent diffusion coefficient for each vertebra. We combined parameters from T1-weighted, diffusion-weighted, and STIR sequences to devise a formula to distinguish benign from malignant lesions. RESULTS: The group comprised 60 (70.6%) women and 25 (29.4%) men with a mean age of 67±13.5 years (range, 33-90 y). Of the 85 patients, 26 (30.6%) had a known primary tumor. When the lesion was hypointense on T1-weighted sequences, hyperintense on STIR and diffusion-weighted sequences, and had a signal intensity quotient greater than 0.8, the sensitivity was 97.2%, the specificity was 90%, and the diagnostic accuracy was 91.2%. If the patient had a known primary tumor, these values increased to 97.2%, 99.4%, and 99%, respectively. CONCLUSION: Benign lesions can be distinguished from malignant lesions if we combine the information from T1-weighted, STIR, and diffusion-weighted sequences together with the in-phase/out-of-phase quotient of the lesion detected in the vertebral body on MRI.

[Imaging-guided percutaneous biopsy of tumors of the locomotor apparatus]. / Biopsia percutánea guiada por técnicas de imagen en patología tumoral del aparato locomotor.

The prognosis of musculoskeletal sarcomas is related to appropriate management by specifically trained multidisciplinary teams. Musculoskeletal radiologists are responsible for the image-guided percutaneous biopsy of these tumors, which has a diagnostic accuracy of at least 80%. It is essential for radiologists to know: a) the limitations of percutaneous biopsy with respect to surgical biopsy; b) what should and should not be biopsied; c) how to appropriately plan percutaneous biopsy, with special attention to the route of approach, taking into account the compartmental anatomy and the route of approach after surgical treatment; and d) technical aspects of the procedure, like the area of the tumor to biopsy, the caliber of the needle, the number and length of the specimens to obtain to ensure optimal pathological diagnosis, and techniques in function of the imaging modality and bone penetration.

Biopsia percutánea guiada por técnicas de imagen en patología tumoral del aparato locomotor / Imaging-guided percutaneous biopsy of tumors of the locomotor apparatus

El pronóstico de los sarcomas musculoesqueléticos se relaciona con su adecuado manejo en el seno de los equipos multidisciplinarios con formación específica. El radiólogo musculoesquelético es el responsable de la biopsia percutánea con control de imagen de estos tumores, que se ha impuesto a la quirúrgica en la mayoría de los casos, con una fiabilidad diagnóstica de al menos el 80%. Debe conocer: a) sus limitaciones respecto de la biopsia quirúrgica; b) qué se debe y no se debe biopsiar; c) la adecuada planificación de la biopsia percutánea, con especial atención a la vía de abordaje, teniendo en cuenta la anatomía compartimental y la vía de abordaje del posterior tratamiento quirúrgico; y d) aspectos técnicos del procedimiento, tales como la zona de la tumoración a biopsiar, calibre de la aguja, número y longitud de las muestras obtenidas para optimización del rendimiento diagnóstico, y técnicas en función de la modalidad de imagen y penetración ósea (AU)

The prognosis of musculoskeletal sarcomas is related to appropriate management by specifically trained multidisciplinary teams. Musculoskeletal radiologists are responsible for the image-guided percutaneous biopsy of these tumors, which has a diagnostic accuracy of at least 80%. It is essential for radiologists to know: a) the limitations of percutaneous biopsy with respect to surgical biopsy; b) what should and should not be biopsied; c) how to appropriately plan percutaneous biopsy, with special attention to the route of approach, taking into account the compartmental anatomy and the route of approach after surgical treatment; and d) technical aspects of the procedure, like the area of the tumor to biopsy, the caliber of the needle, the number and length of the specimens to obtain to ensure optimal pathological diagnosis, and techniques in function of the imaging modality and bone penetration (AU)

Informe de la Sociedad Española de Ultrasonidos (SEUS) sobre delegación y transferencia de competencias en ecografía a los técnicos de radiología / Report of the Spanish Society of Ultrasound (SEUS) about the delegation and transfer of responsibility in ultrasonography to radiology technologists

No disponible

[Usefulness of IPC continuous monitoring in shunt dysfunction]. / Utilidad de la monitorizacion de la PIC en pacientes con sospecha de disfuncion valvular.

Shunt dysfunction is a common situation in neurosurgery. Often symptoms, physical examination and radiology are not enough to set a diagnosis. ICP continuous monitoring is a safe and reliable tool that provides valuable information about CSF dynamics in these patients. Not only quantitative analysis is needed but also a qualitative one that enables pathological waves identification, because high amplitude B waves are strongly related to shunt dysfunction. In this paper experience about ICP continuous monitoring in patients with shunt dysfunction suspect is presented. Quantitative and qualitative data analysis led to a correct diagnosis, improving all the patients treated according to this criterion. An intraparenchymatous Camino® sensor and neuroPICture software (developed by first author) for data collection and graphic representation were used. Complications related to monitoring were absent and graphics obtained useful for qualitative analysis.

Utilidad de la monitorizacion de la PIC en pacientes con sospecha de disfunción valvular / No disponible

La sospecha de disfunción valvular constituye una situación frecuente en neurocirugía. En numerosas ocasiones ni la clínica, ni la exploración, ni la radiología pueden confirmar o descartar el diagnóstico. La monitorización continua de la PIC es un método seguro y fiable que aporta valiosa información acerca de la situación de la dinámica del LCR en estos pacientes. El sistema de registro debe permitir no sólo el análisis cuantitativo de la PIC sino también morfológico deltrazado, para identificar ondas patológicas (como las B de alta amplitud) relacionadas con situaciones de disfunción valvular. En el presente trabajo se recogela experiencia de monitorización continua de la PIC en pacientes con sospecha de disfunción valvular sincriterios clínicos y radiológicos concluyentes, en los que el análisis morfológico del registro permitió un diagnósticofiable que se tradujo en la mejoría de todos los pacientes tratados conforme a este criterio. El método utilizado fue un sensor intraparenquimatoso Camino®con software de recogida y representación neuroPICture© (desarrollado por el primer autor). Las complicaciones relacionadas con la monitorización fueron nulas y el registro obtenido útil para las objetivos propuestos (AU)

Shunt dysfunction is a common situation in neurosurgery. Often symptoms, physical examination and radiology are not enough to set a diagnosis. ICP continuous monitoring is a safe and reliable tool that provides valuable information about CSF dynamics in these patients. Not only quantitative analysis is needed but also a qualitative one that enables pathological waves identification, because high amplitude B waves are strongly related to shunt dysfunction. In this paper experience about ICP continuous monitoring in patients with shunt dysfunction suspect is presented. Quantitative and qualitative data analysis led to a correctdiagnosis, improving all the patients treated according to this criterion. An intraparenchymatous Camino®sensor and neuroPICture software (developed by firstauthor) for data collection and graphic representation were used. Complications related to monitoring wereabsent and graphics obtained useful for qualitative analysis (AU)

Microsurgical technique for previously coiled aneurysms.

Since the introduction of Guglielmi detachable coils to treat intracranial aneurysms in 1991, the number of patients undergoing endovascular coiling has continuously risen as well as the number of those residual and recurrent previously coiled aneurysms that necessitate a microsurgical occlusion. Between July 1995 and August 2009 we retrospectively analyzed 81 patients with 82 previously coiled aneurysms treated microsurgically at two Finnish Neurosurgical University Hospitals, Helsinki and Kuopio. Fifty-eight aneurysms (71%) were located at anterior circulation and 24 (29%) at posterior circulation. Fifteen patients were operated on within the first month (early surgery) after coiling, whereas 66 were treated later (late surgery). Complete or partial removal of coils during surgery may facilitate clipping, but is significantly (P<0.001) more difficult to accomplish in late surgery. Removal of coils may also increase the chance for poor outcome. Chance of poor outcome increased also with intraoperative aneurysm rupture, size of the aneurysm and posterior circulation location. Good clinical outcome, three months after surgery, was achieved in 71 patients (88%); four patients were severely disabled, and six patients died (three of them due to poor clinical condition). Complete microsurgical occlusion of the residual previously coiled aneurysm is a high-risk procedure in large and giant aneurysms, and these patients should be referred to a dedicated neurovascular center to minimize surgical complications. Bypass procedures may be the best option for demanding growing lesions, especially those in posterior circulation.

[Aneurysmal subarachnoid hemorrhage: group of study of cerebrovascular pathology of the Spanish society of neurosurgery management guideline]. / Hemorragia subaracnoidea aneurismática: guía de tratamiento del grupo de patología vascular de la sociedad Española de neurocirugía.

An actualized revision of the most important aspects of aneurismal subarachnoid hemorrhage is presented from the guidelines previously published by the group of study of cerebrovascular pathology of the Spanish Society of Neurosurgery. The proposed recommendations should be considered as a general guide for the management of this pathological condition. However, they can be modified, even in a significant manner according to the circumstances relating each clinical case and the variations in the therapeutic and diagnostic procedures available in the center attending each patient.

Hemorragia subaracnoidea aneurismática: guía de tratamiento del Grupo de Patología Vascularde la Sociedad Española de Neurocirugía / Aneurysmal subarachnoid hemorrhage: group of study of Cerebrovascular Pathology of the Spanish Society of Neurosurgery management guideline

Se realiza una actualización sobre los aspectos másimportantes de la hemorragia subaracnoidea aneurismáticarespecto a las guías previamente publicadaspor el grupo de trabajo de la SENEC. Las recomendacionespropuestas deben considerarse como una guíageneral de manejo de esta patología. Sin embargo,pueden ser modificadas, incluso de manera significativapor las circunstancias propias de cada casoclínico, o las variaciones en los recursos diagnósticosy terapéuticos del centro hospitalario que reciba alpaciente (AU)

An actualized revision of the most important aspectsof aneurismal subarachnoid hemorrhage is presentedfrom the guidelines previously published by the groupof study of cerebrovascular pathology of the SpanishSociety of Neurosurgery. The proposed recommendationsshould be considered as a general guide for themanagement of this pathological condition. However,they can be modified, even in a significant manneraccording to the circumstances relating each clinicalcase and the variations in the therapeutic and diagnosticprocedures available in the center attending eachpatient (AU)

Idiopathic subarachnoid hemorrhage: a multicentre series of 220 patients.

BACKGROUND. The Spanish neurosurgical society created a multicentre data base on spontaneous SAH to analyze the real problematic of this disease in our country. This paper focuses on the group of patients with idiopathic SAH (ISAH). METHODS. 16 participant hospitals collect their spontaneous SAH cases in a common data base shared in the internet through a secured web page, considering clinical, radiological, evolution and outcome variables. The 220 ISAH cases collected from November 2004 to November 2007 were statistically analyzed as a whole and divided into 3 subgroups depending on the CT blood pattern (aneurysmal, perimesencephalic, or normal). RESULTS. The 220 ISAH patients constitute 19% of all 1149 spontaneous SAH collected in the study period. In 46,8% of ISAH the blood CT pattern was aneurysmal, which was related to older age, worse clinical condition, higher Fisher grade, more hydrocephalus and worse outcome, compared to perimesencephalic (42.7%) or normal CT (10.4%) pattern. Once surpassed the acute phase, outcome of ISAH patients is similarly good in all 3 ISAH subgroups, significantly better as a whole compared to aneurysmal SAH patients. The only variable related to outcome in ISAH after a logistic regression analysis was the admission clinical grade. CONCLUSIONS. ISAH percentage of spontaneous SAH is diminishing in Spain. Classification of ISAH cases depending on the blood CT pattern is important to differentiate higher risk groups although complications are not negligible in any of the ISAH subgroups. Neurological status on admission is the single most valuable prognostic factor for outcome in ISAH patients.