Técnicas paramétricas de caracterización tisular del miocardio mediante resonancia magnética (parte 1): mapas de T1 / Parametric techniques for characterizing myocardial tissue by magnetic resonance imaging (part 1): T1 mapping

El desarrollo de fibrosis miocárdica es un proceso común en la aparición de disfunción ventricular en muchas enfermedades cardiacas. La resonancia magnética permite valorar la anatomía y la función cardiaca con precisión, y su papel en la caracterización macroscópica de la fibrosis miocárdica mediante las técnicas de realce tardío ha sido ampliamente validado en clínica. En fechas recientes se ha demostrado que las técnicas de mapeo T1 miocárdico permiten la cuantificación en términos absolutos de la fibrosis difusa y de la expansión del espacio extracelular miocárdico. Sin embargo, se necesitan estudios adicionales que consigan validar la utilidad de esta técnica en la detección temprana del remodelado tisular en un momento en que la instauración de un tratamiento precoz permita mejorar el pronóstico de los pacientes. Este artículo revisa el estado actual de las técnicas de mapeo T1 del miocardio, sus aplicaciones clínicas y sus limitaciones (AU)

The development of myocardial fibrosis is a common process in the appearance of ventricular dysfunction in many heart diseases. Magnetic resonance imaging makes it possible to accurately evaluate the structure and function of the heart, and its role in the macroscopic characterization of myocardial fibrosis by late enhancement techniques has been widely validated clinically. Recent studies have demonstrated that T1-mapping techniques can quantify diffuse myocardial fibrosis and the expansion of the myocardial extracellular space in absolute terms. However, further studies are necessary to validate the usefulness of this technique in the early detection of tissue remodeling at a time when implementing early treatment would improve a patient's prognosis. This article reviews the state of the art for T1 mapping of the myocardium, its clinical applications, and its limitations (AU)

Parametric techniques for characterizing myocardial tissue by magnetic resonance imaging (part 1): T1 mapping. / Técnicas paramétricas de caracterización tisular del miocardio mediante resonancia magnética (parte 1): mapas de T1.

The development of myocardial fibrosis is a common process in the appearance of ventricular dysfunction in many heart diseases. Magnetic resonance imaging makes it possible to accurately evaluate the structure and function of the heart, and its role in the macroscopic characterization of myocardial fibrosis by late enhancement techniques has been widely validated clinically. Recent studies have demonstrated that T1-mapping techniques can quantify diffuse myocardial fibrosis and the expansion of the myocardial extracellular space in absolute terms. However, further studies are necessary to validate the usefulness of this technique in the early detection of tissue remodeling at a time when implementing early treatment would improve a patient's prognosis. This article reviews the state of the art for T1 mapping of the myocardium, its clinical applications, and its limitations.

Técnicas paramétricas de caracterización tisular del miocardio mediante resonancia magnética (parte 2): mapas de T2 / Parametric methods for characterizing myocardial tissue by magnetic resonance imaging (part 2): T2 mapping

La resonancia magnética cardiaca se considera la técnica de referencia para la caracterización tisular del miocardio, como por ejemplo para la valoración del edema. En este sentido, la utilización de secuencias potenciadas en T2 permite valorar áreas de edema o de inflamación del miocardio. Sin embargo, las secuencias tradicionales presentan numerosas limitaciones y solo proporcionan una información cualitativa. Además, dependen de la referencia del miocardio remoto o del músculo esquelético, lo que representa una limitación en la detección y cuantificación del daño miocárdico difuso. El desarrollo reciente de las técnicas de mapeo miocárdico mediante resonancia magnética proporciona una valoración cuantitativa de los parámetros indicativos de edema. Estas secuencias han demostrado su superioridad sobre las secuencias tradicionales, tanto en las miocardiopatías agudas como en la patología isquémica aguda. Este artículo sintetiza el desarrollo actual de las secuencias de mapeo T2, sus aplicaciones clínicas y sus limitaciones (AU)

Cardiac magnetic resonance imaging is considered the reference technique for characterizing myocardial tissue; for example, T2-weighted sequences make it possible to evaluate areas of edema or myocardial inflammation. However, traditional sequences have many limitations and provide only qualitative information. Moreover, traditional sequences depend on the reference to remote myocardium or skeletal muscle, which limits their ability to detect and quantify diffuse myocardial damage. Recently developed magnetic resonance myocardial mapping techniques enable quantitative assessment of parameters indicative of edema. These techniques have proven better than traditional sequences both in acute cardiomyopathy and in acute ischemic heart disease. This article synthesizes current developments in T2 mapping as well as their clinical applications and limitations (AU)

Parametric methods for characterizing myocardial tissue by magnetic resonance imaging (part 2): T2 mapping.

Cardiac magnetic resonance imaging is considered the reference technique for characterizing myocardial tissue; for example, T2-weighted sequences make it possible to evaluate areas of edema or myocardial inflammation. However, traditional sequences have many limitations and provide only qualitative information. Moreover, traditional sequences depend on the reference to remote myocardium or skeletal muscle, which limits their ability to detect and quantify diffuse myocardial damage. Recently developed magnetic resonance myocardial mapping techniques enable quantitative assessment of parameters indicative of edema. These techniques have proven better than traditional sequences both in acute cardiomyopathy and in acute ischemic heart disease. This article synthesizes current developments in T2 mapping as well as their clinical applications and limitations.

Proptosis y tumoración orbitaria en una mujer de 80 años / Proptosis and orbital tumor in a 80-year old female patient

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[Cat-scratch disease. Presentation of 2 cases in a family with serologic follow-up and discussion of diagnostic methods]. / Enfermedad por arañazo de gato. Presentación de dos casos familiares con seguimiento serológico y discusión de métodos diagnósticos.

Two cases are reported of cat scratch disease which we consider worth describing both because of their familial presentation (the involved patients were brothers) and the serologic follow-up performed after diagnosis, which showed significant increases in IgG antibody titers to Bartonella henselae in both patients, one on day 35 and the other on day 45 after diagnosis. Cat scratch disease is a rarely diagnosed condition in our environment and it is easily misdiagnosed with other regional lymphadenitis; hence, a serologic test revealing a seroconversion or a significant increase in serologic titers will be very useful, as well as the epidemiologic antecedent of cat exposure.

Clinical picture of the amyloid arthropathy in patients with chronic renal failure maintained on haemodialysis using cellulose membranes.

The clinical picture of 15 patients (10 male, five female) with amyloid arthropathy secondary to chronic renal failure treated with haemodialysis has been studied. The average period of haemodialysis was 10.8 years. Joint symptoms appeared between three and 13 years after starting haemodialysis. No patient had renal amyloidosis. Early symptoms were varied and often overlapped: knee swelling (seven patients), painful and stiff shoulders (seven), and carpal tunnel syndrome (six) were the most prominent. Follow up showed extension to other joints. Joint effusions were generally of the non-inflammatory type. Radiologically, geodes and erosions of variable sizes were seen in the affected joints, which can develop into a destructive arthropathy. Amyloid was found in abdominal fat in three of the 12 patients on whom a needle aspiration was performed. Four of 12 patients showed changes compatible with amyloid infiltration in the echocardiogram. One patient had amyloid in the gastric muscular layer, another in the colon mucus, and two of four in rectal biopsy specimens. Amyloid deposits showed the presence of beta 2 microglobulin in 10 patients. The clinical and radiological picture was similar to the amyloid arthropathy associated with multiple myeloma. These patients can develop systemic amyloidosis.

Synovial fluid examination for the diagnosis of synovial amyloidosis in patients with chronic renal failure undergoing haemodialysis.

The diagnosis of synovial amyloidosis is based upon synovial biopsy. Synovial fluid (SF) in seven patients with amyloid arthropathy associated with chronic renal failure undergoing haemodialysis were studied. The SF and synovial samples of 10 consecutive patients with seronegative mono- or oligoarthritis served as controls. Six of the seven patients with amyloid positive synovial biopsy specimens showed amyloid in their SF. No amyloid was found in the synovial tissue or fluid of the 10 patients in the control group, the sensitivity being 87.7%. The finding of amyloid in SF was highly reproducible, showing its presence in the same joint on several occasions. The deposits were Congophilia resistant to potassium permanganate pretreatment, and the immunohistochemical analysis proved that they contained beta 2 microglobulin. The high sensitivity and good reproducibility of the method shows that the finding of amyloid in SF is sufficient for the diagnosis of synovial amyloidosis. It is possible to perform immunohistochemical analysis on the SF sediment. Amyloid arthropathy can therefore be added to the list of conditions in which synovial fluid examination can be clinically helpful.

Amyloid arthropathy in patients undergoing periodical haemodialysis for chronic renal failure: a new complication.

Seven patients (five male and two female) with chronic renal failure (CRF) treated by periodical haemodialysis presented with swelling and effusion of more than three months' duration in knees (four bilateral), shoulders (two, one of them bilateral), elbow (one), and ankle (one). Four had a carpal tunnel syndrome both clinically and electromyographically (three bilateral). All patients had hyperparathyroidism secondary to their CRF, which was not due to amyloidosis in any of them. The dialysis duration period varied from five to 14 years, with an average of 8.6 years. Amyloid deposits (Congo red positive areas with green birefringence under polarising microscopy) were shown in six of the seven synovial biopsy specimens of the knee, in five of the sediments of the synovial fluids, and in specimens removed during carpal tunnel syndrome surgery. No amyloid was found in the biopsy specimen of abdominal fat of six of the patients. The finding of amyloid only in the synovial membrane and fluid, and carpal tunnel, its absence in abdominal fat, and the lack of other manifestations of generalised amyloidosis (cardiomyopathy, malabsorption syndrome, macroglossia, etc.) and of Bence Jones myeloma (protein immunoelectrophoresis normal) raises the possibility that this is a form of amyloidosis which is peculiar to CRF treated by periodical haemodialysis.