Vesical Imaging-Reporting and Data System (VI-RADS): experiencia inicial en la clasificación del cáncer de vejiga músculo-infiltrante / Vesical Imaging-Reporting and Data System (VI-RADS): Initial experience in the classification of muscle-invasive bladder cancer

Objetivo: Analizar la precisión diagnóstica del sistema VI-RADS® en radiólogos sin experiencia previa en su uso para diferenciar tumores de vejiga no músculo-infiltrantes de tumores de vejiga músculo-infiltrantes (TVMI) en lesiones sospechosas de malignidad en cistoscopia sin resección transuretral previa (RTU).Material y métodosEstudio retrospectivo en el que se incluyó a 18 pacientes con lesiones sospechosas en cistoscopia a los que se les realizó una RM de vejiga. Dos radiólogos sin experiencia previa en el sistema VI-RADS® evaluaron los estudios. Tras la RM, a los pacientes se les realizó una RTU de las lesiones sospechosas. Se analizaron la sensibilidad y la especificidad del sistema para valores VI-RADS® ≥3 o VI-RADS® ≥ 4, así como el índice kappa de Cohen, entre ambos radiólogos.ResultadosLos valores medios de sensibilidad y especificidad de ambos radiólogos considerando tanto los estudios VI-RADS® ≥ 3 o VI-RADS® ≥ 4 fueron del 91,7% y el 87,5, respectivamente. El índice kappa, considerando los estudios VI-RADS® ≥ 3 positivos fue de 0,551 (p<0,05) y considerando positivos los estudios VI-RADS® ≥ 4 de 0,571 (p<0,05).ConclusiónEl sistema VI-RADS® presenta unos excelentes valores de sensibilidad (91,7%) y especificidad (87,5%) en la clasificación de los TVMI cuando lo utilizan radiólogos sin experiencia previa en su uso con una moderada concordancia interobservador. (AU)

Objective: to analyze the diagnostic accuracy of the VI-RADS® system in the differentiation of non-muscle-invasive bladder tumors (NMIBT from muscle-invasive bladder tumors (MIBT in suspicious cystoscopic findings without prior transurethral resection (TUR evaluated by radiologists with no prior experience in its use.Material and methodsretrospective study carried out with 18 patients with suspicious lesions in cystoscopy. All of them underwent MRI of the bladder. Two radiologists with no prior experience in the use of the VI-RADS® system evaluated the results. All patients underwent TUR of the suspicious lesions after MRI. The sensitivity and specificity of the system were analyzed for VI-RADS® values ≥ 3 or VI-RADS® ≥ 4, as well as the Cohen's kappa coefficient between both radiologists.Resultsthe mean values of sensitivity and specificity of both radiologists considering both the VI-RADS® ≥ 3 or VI-RADS® ≥ 4 values were 91.7% and 87.5%, respectively. The kappa coefficient considering the VI-RADS® ≥ 3 as positive, was 0.551 (P<.05), while considering the VI-RADS® ≥ 4 as positive, it was 0.571 (P<.05).ConclusionThe VI--RADS® system presents excellent sensitivity (91.7% and specificity (87.5% values in the classification of MIBT performed by radiologists with no prior experience in its use, with a moderate interobserver agreement. (AU)

Vesical Imaging-Reporting and Data System (VI-RADS®): Initial experience in the classification of muscle-invasive bladder cancer. / Vesical Imaging-Reporting and Data System (VI-RADS®): experiencia inicial en la clasificación del cáncer de vejiga músculo-infiltrante.

OBJECTIVE: to analyze the diagnostic accuracy of the VI-RADS® system in the differentiation of non-muscle-invasive bladder tumors (NMIBT from muscle-invasive bladder tumors (MIBT in suspicious cystoscopic findings without prior transurethral resection (TUR evaluated by radiologists with no prior experience in its use. MATERIAL AND METHODS: retrospective study carried out with 18 patients with suspicious lesions in cystoscopy. All of them underwent MRI of the bladder. Two radiologists with no prior experience in the use of the VI-RADS® system evaluated the results. All patients underwent TUR of the suspicious lesions after MRI. The sensitivity and specificity of the system were analyzed for VI-RADS® values ≥ 3 or VI-RADS® ≥ 4, as well as the Cohen's kappa coefficient between both radiologists. RESULTS: the mean values of sensitivity and specificity of both radiologists considering both the VI-RADS® ≥ 3 or VI-RADS® ≥ 4 values were 91.7% and 87.5%, respectively. The kappa coefficient considering the VI-RADS® ≥ 3 as positive, was 0.551 (P<.05), while considering the VI-RADS® ≥ 4 as positive, it was 0.571 (P<.05). CONCLUSION: The VI--RADS® system presents excellent sensitivity (91.7% and specificity (87.5% values in the classification of MIBT performed by radiologists with no prior experience in its use, with a moderate interobserver agreement.

Systematic review: the use of ultrasonography, computed tomography and magnetic resonance imaging for the diagnosis, assessment of activity and abdominal complications of Crohn's disease.

BACKGROUND: Cross-sectional imaging techniques, including ultrasonography (US), computed tomography (CT) and magnetic resonance imaging (MRI), are increasingly used for evaluation of Crohn's disease (CD). Aim To perform an assessment of the diagnostic accuracy of cross-sectional imaging techniques for diagnosis of CD, evaluation of disease extension and activity and diagnosis of complications, and to provide recommendations for their optimal use. METHODS: Relevant publications were identified by literature search and selected based on predefined quality parameters, including a prospective design, sample size and reference standard. A total of 68 publications were chosen. RESULTS: Ultrasonography is an accurate technique for diagnosis of suspected CD and for evaluation of disease activity (sensitivity 0.84, specificity 0.92), is widely available and non-invasive, but its accuracy is lower for disease proximal to the terminal ileum. MRI has a high diagnostic accuracy for the diagnosis of suspected CD and for evaluation of disease extension and activity (sensitivity 0.93, specificity 0.90), and is less dependent on the examiner and disease location compared with US. CT has a similar accuracy to MRI for assessment of disease extension and activity. The three techniques have a high accuracy for identification of fistulas, abscesses and stenosis (sensitivities and specificities >0.80), although US has false positive results for abscesses. As a result of the lack of radiation, US or MRI should be preferred over CT, particularly in young patients. CONCLUSIONS: Cross-sectional imaging techniques have a high accuracy for evaluation of suspected and established CD, reliably measure disease severity and complications; they may offer the possibility to monitor disease progression.

[Low grade astroblastoma: pathological and magnetic resonance findings]. / Astroblastoma de baixo grau: Achados patológicos e da ressonância magnética.

INTRODUCTION: The astroblastoma is an uncommon type of glial tumour. It accounts for less than 1% of all tumours of the central nervous system. It originates in the tanicytes, ependymal cells present in the embryo and usually seen in adolescents and young adults. Radiologically it presents as a well delimited, heterogeneous tumour with a solid component which takes up contrast and is cystic, giving the same signal as cerebrospinal fluid (CSF). The pathological characteristics are of the formation of radial astroblastic pseudorosettes with perivascular hyalinization. CASE REPORT: An 18 year old woman presented with a 15 month history of motor deficit of her right limbs with occasional left frontal headache and horizontal diplopia on looking towards the left. On examination there was minimal claudication of the right limbs and bilateral papilloedema. Magnetic resonance showed a very well circumscribed left prefrontal neoplasm of heterogeneous aspect, with areas of solid and cystic appearance in the different sequences. The area of cystic appearance did not show the CSF signal in all sequences of the pulse. The tumour was totally excised. On histological study there were radial astroblastic pseudorosettes with perivascular hyalinization, with two mitoses per 10 fields of great magnification and the final diagnosis was of low grade astroblastoma. The apparently cystic portion was composed of friable gelatinous tissue. Fifteen months after her operation the patient is still asymptomatic. CONCLUSION: We report the radiological and pathological findings of a low grade astroblastoma.

Astroblastoma de bajo grado: hallazgos patológicos y en resonancia magnética / Low grade astroblastoma: pathological findings and on magnetic resonance

Introducción. El astroblastoma es un tumor de estirpe glial muy poco frecuente. Constituye menos del 1 por ciento de todas las neoplasias del sistema nervioso central. Tiene su origen en los tanicitos, células ependimarias presentes en edad embrionaria y suele aparecer en adolescentes y adultos jóvenes. Radiológicamente se presenta como una tumoración bien delimitada, heterogénea, con componente sólido que capta contraste y quístico con señal idéntica a la del líquido cefalorraquídeo (LCR). Patológicamente se caracteriza por la formación de pseudorrosetas astroblásticas radiales con hialinización perivascular. Caso clínico. Mujer de 18 años con un cuadro de 15 meses de evolución de un déficit motor de extremidades derechas acompañada ocasionalmente de una cefalea frontal izquierda y de diplopía horizontal en la mirada a la izquierda. La exploración mostró una mínima claudicación de extremidades derechas y un edema de papila bilateral. La resonancia reveló una neoplasia prefrontal izquierda muy bien circunscrita de aspecto heterogéneo con áreas de apariencia sólida y quística en las diferentes secuencias. El área de apariencia quística no tenía la señal del LCR en todas las secuencias de pulso. El tumor fue resecado de forma completa. Patológicamente se caracterizaba por la formación de pseudorrosetas astroblásticas radiales con hialinización perivascular con dos mitosis por 10 campos de gran aumento y el diagnóstico final fue de astroblastoma de bajo grado. La porción aparentemente quística correspondía a tejido gelatinoso friable. La paciente permanece asintomática 15 meses después de la intervención. Conclusión. Presentamos los hallazgos radiológicos y patológicos de un astroblastoma de bajo grado (AU)

[Follow up of a spontaneous ventral subarachnoid spinal haematoma by means of magnetic resonance]. / Seguimiento con resonancia magnética de un hematoma medular subaracnoideo ventral espontáneo.

INTRODUCTION: Subarachnoid spinal haematomas are uncommon when compared with epidural and subdural hematomas. Since bleeding is into the cerebro spinal fluid, its composition and pulsatility make it difficult for the blood to coagulate. It is even rarer for bleeding to be spontaneous, with no demonstrable cause on laboratory and neuro imaging investigations. Usually occupation of the vertebral canal by a haematoma indicates the need for surgical decompression to free the spinal cord or medulla oblongata. Magnetic resonance is the technique of choice to study disorders of the spinal cord and soft tissues, due to the clear contrast imaging. CASE REPORT: We report the case of a 70 year old woman with acute lumbar pain followed by motor deficit in both legs. Magnetic resonance showed a collection of blood in the subarachnoid space ventral to the medullar oblongata. In spite of doing laboratory and radio imaging investigations, no cause could be found for the bleeding. Hematomas ventral to the spinal cord can be treated medically as there is less risk of spinal compression at this site, since the subarachnoid space is greater. The patient improved with conservative treatment. CONCLUSIONS: Magnetic resonance following treatment showed that the subarachnoid hematoma had resolved.

Seguimiento con resonancia magnéticade un hematoma medular subaracnoideo ventral espontáneo / Follow-up of a spontaneous ventral subarachnoid spinal hematoma by means of magnetic resonance

Introducción. Los hematomas espinales subaracnoideos son muy poco frecuentes en comparación con los hematomas de los compartimentos epidural y subdural. El sangrado suele diluirse ya que la composición del líquido cefalorraquídeo y su pulsatilidad dificultan que se forme el coágulo. Es todavía menos común que el sangrado sea espontáneo, sin que se demuestre analíticamente ni por técnicas de neuroimagen una causa que lo justifique. En la mayoría de las ocasiones la ocupación del canal por el hematoma precisa de descompresión quirúrgica para liberar la médula o el cono medular. La resonancia magnética es la técnica de elección para el estudio de patología raquimedular y de partes blandas por su gran resolución de contraste. Caso clínico. Presentamos el caso de una mujer de 70 años con un cuadro de dolor lumbar agudo seguido de déficit motor de ambas piernas. La resonancia magnética demostró una colección hemática espinal subaracnoidea ventral al cono medular. Los estudios analíticos y de imagen no revelaron ninguna anomalía que justificara el sangrado. Los hematomas ventrales a la médula pueden ser tratados médicamente ya que en esta localización hay menor riesgo de compresión medular al ser mayor el espacio subaracnoideo. La paciente fue tratada de forma conservadora con una buena evolución clínica.Conclusión. La resonancia magnética de control demostró la resolución del hematoma subaracnoideo (AU)