Respuesta sobre el catálogo de prestaciones radiológicas de la SERAM / No disponible

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[Useful tips for CT-angiography]. / Consejos útiles para la realización de una TC-coronariografía.

Multidetector CT scanners are now available in most hospitals; this technology makes it possible to perform cardiac studies. The technique depends on the technology, and certain points must be taken into consideration to improve the results of cardiac studies. We discuss four key points for ensuring high-quality multidetector CT studies. Under the heading patient preparation, we include deciding whether to use beta blockers, aspects related to the routine use of vasodilators, some guidelines for patient breath holding, etc. The next section discusses imaging acquisition, including when to use multisegmentation or even the possibility of prospective acquisition to reduce the dose of radiation. The third point deals with contrast administration to achieve good enhancement of the vessels. The last section reviews postprocessing techniques and comments on possible errors in 3D reconstructions or the need to render reconstructions of the entire thorax to rule out other diseases.

[MR-arthrography of the shoulder. Description and evaluation of the technique using a US-guided pediatric spinal needle]. / RM-artrografía de hombro. Descripción y valoración de la técnica guiada con ecografía y utilizando una aguja espinal infantil.

OBJECTIVE: To describe the technique of US-guided shoulder arthrography using a pediatric needle (modified Valls- Melloni technique) and to assess its efficacy. MATERIAL AND METHODS: Descriptive study of articular puncture for 48 magnetic resonance imaging arthrographs of the shoulder in 48 consecutive patients. The puncture was performed by a radiologist without prior experience in the technique. We used an anterior approach to the shoulder, guiding the puncture using US according to the Valls-Melloni technique; however, we used a pediatric spinal needle (Yale spinal; 22G: 0.7 x 40 mm). The efficacy of the technique was evaluated using the following variables: time employed, number of attempts, extravasation of contrast outside the joint, pain reported by the patient (on a scale from 0 to 10), and immediate or late complications of the technique. RESULTS: The time required for the procedure was 15.2+/-2.6 min (mean+/-standard deviation). A single puncture sufficed in 45 patients (94%); two attempts were necessary in two patients (4%) and three in one patient (2%). Contrast extravasation outside the joint occurred only in two patients (4%). The mean pain reported was 3.6 points (confidence interval: 3.1-4). Three patients (6%) had a vasovagal reaction. No late complications were observed. CONCLUSION: US-guided shoulder arthrography using a pediatric spinal needle is fast, simple, and safe; it can be performed by any radiologist, even without prior experience in the technique.

Consejos útiles para la realización de una TC-coronariografía / Useful tips for CT-angiography

Las tomografías computarizadas multidetectores comienzan a generalizarse en los hospitales y con ellas la posibilidad de realizar estudios cardíacos. La técnica es técnico-dependiente y es necesario conocer ciertas consideraciones que ayudarán a mejorar el resultado del estudio. Se resumen en cuatro puntos. La preparación del paciente para decidir si usaremos bloqueadores beta o no, aspectos en el uso rutinario del vasodilatador, algunas normas para ensayar la apnea del paciente, etc. La segunda parte se centra en la adquisición, cuándo usar una adquisición con multisegmentación o la posibilidad incluso de hacer estudios con adquisición prospectiva que disminuye la dosis de radiación. La tercera está referida a la administración de contraste para conseguir un buen realce en los vasos. El último apartado resume las técnicas de postprocesado, y se comentan los posibles errores con las reconstrucciones 3D o la necesidad de hacer una reconstrucción que abarque todo el tórax para despistar otras patologías

Multidetector CT scanners are now available in most hospitals; this technology makes it possible to perform cardiac studies. The technique depends on the technology, and certain points must be taken into consideration to improve the results of cardiac studies. We discuss four key points for ensuring high-quality multidetector CT studies. Under the heading patient preparation, we include deciding whether to use beta blockers, aspects related to the routine use of vasodilators, some guidelines for patient breath holding, etc. The next section discusses imaging acquisition, including when to use multisegmentation or even the possibility of prospective acquisition to reduce the dose of radiation. The third point deals with contrast administration to achieve good enhancement of the vessels. The last section reviews postprocessing techniques and comments on possible errors in 3D reconstructions or the need to render reconstructions of the entire thorax to rule out other diseases

RM-artrografía de hombro. Descripción y valoración de la técnica guiada con ecografía y utilizando una aguja espinal infantil / MR-arthrography of the shoulder. Description and evaluation of the technique using a US-guided pediatric

Objetivo. Describir la técnica de artrografía de hombro guiada con ecografía utilizando una aguja espinal infantil (técnica modificada de Valls y Melloni) y verificar su eficacia. Material y métodos. Estudio descriptivo de la técnica de punción articular en 48 artrografías de hombro mediante resonancia magnética, realizadas en 48 pacientes consecutivos. La punción la realizó un radiólogo sin experiencia previa en esta técnica. Se empleó un abordaje anterior del hombro guiando la punción mediante ecografía según la técnica de Valls y Melloni, pero utilizando una aguja espinal infantil (Yale spinal; 22G: 0,7 × 40 mm). La eficacia de la prueba se valoró mediante las variables: tiempo empleado, número de intentos, extravasación del contraste fuera de la articulación, dolor referido por el paciente (escala de 0 a 10) y complicaciones inmediatas o tardías de la técnica. Resultados. El tiempo del procedimiento fue de 15,2 ± 2,6 min (media ± desviación estándar). Se precisó una sola punción en 45 pacientes (94%); dos intentos en dos pacientes (4%) y tres en un paciente (2%). Solamente en dos pacientes existió extravasación del contraste fuera de la articulación (4%). La media del dolor referido fue de 3,6 puntos (intervalo de confianza: 3,1-4). Tres pacientes (6%) sufrieron una reacción vaso-vagal. No hubo complicaciones tardías. Conclusión. La artrografía de hombro guiada por ecografía y usando una aguja espinal infantil es una técnica rápida, sencilla y segura, que puede ser realizada por cualquier radiólogo, incluso sin experiencia previa en la técnica

Objective. To describe the technique of US-guided shoulder arthrography using a pediatric needle (modified Valls- Melloni technique) and to assess its efficacy. Material and methods. Descriptive study of articular puncture for 48 magnetic resonance imaging arthrographs of the shoulder in 48 consecutive patients. The puncture was performed by a radiologist without prior experience in the technique. We used an anterior approach to the shoulder, guiding the puncture using US according to the Valls-Melloni technique; however, we used a pediatric spinal needle (Yale spinal; 22G: 0.7 × 40 mm). The efficacy of the technique was evaluated using the following variables: time employed, number of attempts, extravasation of contrast outside the joint, pain reported by the patient (on a scale from 0 to 10), and immediate or late complications of the technique. Results. The time required for the procedure was 15.2 ± 2.6 min (mean ± standard deviation). A single puncture sufficed in 45 patients (94%); two attempts were necessary in two patients (4%) and three in one patient (2%). Contrast extravasation outside the joint occurred only in two patients (4%). The mean pain reported was 3.6 points (confidence interval: 3.1-4). Three patients (6%) had a vasovagal reaction. No late complications were observed. Conclusion. US-guided shoulder arthrography using a pediatric spinal needle is fast, simple, and safe; it can be performed by any radiologist, even without prior experience in the technique

Case report: MRI in the diagnosis of testicular Leydig cell tumour.

We report the appearance of three cases of Leydig cell tumours on MRI. This imaging method showed well-defined and peripheral intratesticular tumours displaying marked and homogeneous enhancement when contrast medium was used. This latter finding was only observed in Leydig cell tumours when they were compared in a series of 104 patients with different scrotal pathologies.

[Late pancreatic metastasis from renal carcinoma]. / Metástasis pancreática tardía por carcinoma renal.

The appearance of solitary late metastases of renal cell carcinoma has seldom been documented. A male patient, who 5 years ago underwent left radical nefrectomy for renal cell carcinoma, presented with a solitary pancreatic metastasis (an uncommon site of metastasis for renal cell carcinoma), which was successfully treated with partial pancreatectomy. The diagnostic, treatment and prognostic implications of solitary late metastases are discussed.

Metástasis pancreática tardía por carcinoma renal / Late pancreatic metastases for renal cell carcinoma

La aparición de metástasis tardías únicas por carcinomas renales, aunque poco frecuentes, es un hecho bien documentado y con características particulares. Presentamos un paciente con antecedente de nefrectomía radical izquierda por carcinoma renal, y que a los 5 años desarrolla una metástasis única a nivel del páncreas (localización poco habitual de metástasis renales), tratado satisfactoriamente mediante pancreatectomía parcial. Se comentan aspectos diagnósticos, terapéuticos y pronósticos de este tipo de lesiones (AU)

Lipoleiomioma uterino y hemangioma de ovario / Uterine lipoleiomyoma and ovarian hemangioma

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Case report 866. Pseudotumor of the muscle associated with necrotizing vasculitis of medium- and small-sized arteries and chronic myositis.

A case of polymyositis and localized vasculitis presenting as a muscular pseudotumor of a lower extremity and periostitis several years after the onset of symptoms was reported and the MRI characteristics were described. This imaging modality demonstrated muscle signal abnormalities in several muscle groups and was useful in ruling out the presence of a mass and fatty degeneration of the muscle. The ability of the STIR sequence (Fig. 3D) to show muscle abnormalities and to allow fatty infiltration or degeneration to be ruled out has not been reported before in patients with vasculitic muscle involvement.

[Acquired cystic renal disease. Association with hypernephroma]. / Enfermedad renal quística adquirida. Asociación con hipernefroma.

Emergence of multiple bilateral renal cysts observed in patients undergoing periodic haemodialysis is 40%. The pathology, known as Acquired Cystic Renal Disease (A.C.R.D.) presents a high association to renal cancer. Two cases of A.C.R.D. and their association with hypernephroma, one resulting in secondary retroperitoneal haemorrhage and the other in intracystic haemorrhage, are presented. Forms and diagnosis are analyzed, insisting upon the need of monitoring the patients in haemodialysis from the point of view of tumour emergence.

[Adenocarcinoma in bladder. Apropos of a case]. / Adenocarcinoma en vejiga. A propósito de un caso.

Finding an adenocarcinoma at the vesicle suggests three possible diagnosis: Intestinal adenocarcinoma with vesical location. Adenocarcinoma of the urachus. Vesical primitive adenocarcinoma. Presentation of one case of intestinal adenocarcinoma, revealed by its mictional symptomatology, with the endoscopic appearance of being a single vesical tumour, later shown to be a vesical adenocarcinoma, on which extended surgery of the gut and partial surgery of the bladder was performed.

[Value of LDH in the diagnosis of pseudocystic renal cancer]. / Valor de la LDH en el diagnóstico de cáncer renal pseudoquistico.

An asymptomatic case of cystic renal carcinoma is presented. The only diagnosis of certainty was given by a marked increase in L.D.H. levels in the fluid of the tumor after puncture. The pros and cons of imaging studies, and the relative lack of value of aspiration cytology when negative results are encountered are discussed. The pathological anatomical findings of the nephrectomy sample certified the diagnosis, showing the presence of a pseudocystic adenocarcinoma due to intratumor necrosis.