US-guided Localization and Removal of Soft-Tissue Foreign Bodies.

US-guided foreign body removal is a nonsurgical highly effective technique used to manage symptomatic foreign bodies and should be considered as a first-line treatment procedure. The authors describe a technique used for US detection and US-guided removal of various types of foreign bodies and discuss the efficacy of the procedure. Soft-tissue foreign bodies can result from accidents or medical procedures, and they are a relatively frequent reason that patients obtain medical consultation. Foreign body objects include vegetal, metallic, and glass objects, and they may be medical devices such as contraceptive implants. Frequently, physical examination is not sensitive enough to detect the presence of a foreign body, and imaging is necessary. US has demonstrated high specificity and moderate sensitivity for detection of foreign bodies, and it has the advantage of depicting all types of materials. Thus, US has become the imaging technique of choice for evaluating suspected foreign bodies. Although the US features are dependent on the foreign body type and shape, all foreign bodies are echogenic and frequently demonstrate posterior shadowing or reverberation artifact. US has an added value in that it can be used to plan the removal of a foreign body and also guide the entire percutaneous removal procedure. Through a small incision in the skin, just wide enough for the foreign body to pass through, surgical forceps can be inserted and directed under US guidance to reach the foreign body and remove it. The effectiveness of US-guided percutaneous removal can be near 100%. Online supplemental material is available for this article. ©RSNA, 2020.

Core-needle biopsy in thyroid nodules: performance, accuracy, and complications.

OBJECTIVE: To evaluate the performance of core-needle biopsy (CNB) in thyroid using a cohort of patients in which it was used as first choice. METHODS: Our institutional review board approved this retrospective study. We reviewed all CNB performed in our center over a period of 11 years. Ultrasound-guided CNBs were performed using a spring-loaded 18-gauge biopsy needle. We used a classification with four diagnostic categories for CNB results: insufficient, benign, follicular lesion (indeterminate), and malignant. Final diagnosis was based on surgical diagnosis or follow-up of at least 2 years in non-operated patients. RESULTS: The study included 4412 CNB in 4112 nodules of 3768 patients, 300 of them repeated biopsies. Results were 148 insufficient (3.4%), 3706 benign (84%), 278 follicular lesions (6.3%), and 280 malignant (6.3%). Considering follicular lesion and malignancy CNB results as positive (both lead to the recommendation of surgery) sensitivity was 96% (CI 93.2-97.8) and specificity 93.7% (CI 92.9-94.5). Predictive positive value for a follicular lesion diagnosis was 12.2% and for a malignancy diagnosis, 98.6%. CNB likelihood ratio for malignancy of a malignant diagnosis was 841.9 (CI 315.8-2313.3), of a malignant/follicular lesion diagnosis was 23.4 (CI 20.1-27.3), and of a benign diagnosis was 0.04 (CI 0.02-0.07). Repeated CNB in 53 insufficient biopsies obtained 50 diagnostic results. Minor complications occurred in 2.2% of CNB, and major in four procedures (0.09%). CONCLUSIONS: CNB in thyroid nodules is accurate and has few complications and a low rate of non-diagnostic and indeterminate diagnoses. It can be an alternative method when FNAC has poor performance. Repeating biopsy is useful after non-diagnostic biopsies. KEY POINTS: • Core-needle biopsy of thyroid has a low ratio non-diagnostic and indeterminate results. • Core-needle biopsy results are highly reliable, especially benign results. • Complication rate of core-needle biopsy of thyroid is low.

Accuracy and effectiveness of ultrasound-guided core-needle biopsy in the diagnosis of focal lesions in the salivary glands.

OBJECTIVES: To review the diagnostic accuracy of ultrasound-guided core-needle biopsy (CNB) in the diagnosis of salivary gland tumours (SGT). METHODS: Retrospective, institutional review board approved, analysis of the CNB of SGT performed at our centre in 8 years. We used an automatic 18-G spring-loaded device. The final diagnosis was based on surgery in the cases that were operated on, and on clinical evolution and biopsy findings in the rest. RESULTS: Four hundred and nine biopsies were performed in 381 patients (ages, 2-97 years; mean, 55.9). There were two minor complications. Biopsy was diagnostic in 98.3%. There were eight false negatives. The diagnostic values for malignancy were: sensitivity 89.6%, specificity 100%, positive predictive value (PPV) 100% and negative predictive value (NPV) 98%. For the detection of neoplasms were: sensitivity 98.7%, specificity 99%, PPV 99.7% and VPN 96.1%. CONCLUSIONS: Accuracy of CNB in SGT is very high, with a very high sensitivity and an absolutely reliable diagnosis of malignancy. Complication rate is very low. It should be considered the technique of choice when a STG is detected. Normal tissue results warrant repeating biopsy. KEY POINTS: • Ultrasound-guided core-biopsy is the technique of choice in salivary glands nodules • Sensitivity, specificity for detecting neoplasms (which should be resected) are around 99% • Diagnosis of malignancy in core-biopsy is absolutely reliable • A CNB result of "normal tissue", however, warrants repeating the biopsy • Complication rate is very low.

Ultrasound-guided core-needle biopsy in thyroid nodules. A study of 676 consecutive cases with surgical correlation.

OBJECTIVES: To analyze the diagnostic accuracy of ultrasound-guided core-needle biopsy (CNB) of thyroid nodules. METHODS: Of 3517 CNBs performed using an 18G spring-loaded device in one institution, we retrospectively reviewed 676 nodules in 629 consecutive patients who underwent surgery. CNB and pathological examination were compared. CNB diagnosis was standardized in four categories: insufficient (I), benign (B), follicular lesion (FOL), and malignant (M). Main outcome measures were predictive positive values (PPV), false positives (FP), and false negatives (FN). RESULTS: CNB showed a low rate of insufficient and FOL diagnoses (5.8 % and 4.5 %). On surgery, there were eight FNs in 374 benign CNBs and three FPs in 148 malignant CNBs. The 154 nodules classified as FOL in CNB included, at surgery, 122 neoplasms; 28 of them malignant. PPV for malignancy of a malignant CNB was 98 %, and for a CNB diagnosis of FOL 18.2 %. Sensitivity for malignancy if CNB of FOL and M are considered positive was 95.6. Only one major complication was observed. CONCLUSIONS: CNB is reliable, safe, and accurate to evaluate thyroid nodules and can be an alternative technique to FNA. It has low rate of non-diagnostic and undetermined cases, with high sensitivity and PPV. KEY POINTS: Thyroid core-needle biopsy (CNB) has high sensitivity and PPV. Pitfalls of CNB are rare. Pitfalls are due to cystic cancer, histological heterogeneity, and mistakes in analysis. CNB is a reliable, safe, and accurate method to approach thyroid nodules. CNB can be used primarily or after insufficient or indeterminate FNA.

Histological diagnosis of thyroid disease using ultrasound-guided core biopsies.

BACKGROUND: Thyroid core biopsies obtained with ultrasound (US)-guided needles are an alternative to conventional fine-needle aspiration and, according to various authors, have greater sensitivity and specificity. The technique is inexpensive, rapid and reliable with a low rate of complications, similar to conventional fine-needle aspiration procedures. OBJECTIVES: This paper critically reviews the methodology for obtaining samples and processing them in the pathology laboratory. METHODS: Accumulated experience with 1,065 cases of US-guided core biopsy of the thyroid gland in a 15-year period. RESULTS: US-guided core biopsy is a useful, inexpensive and safe method in the histological diagnosis of thyroid gland pathology. Thyroid samples obtained this way are not a substitute for fine-needle aspiration cytology. Indeed, some authors assert that the best results are obtained by combining the two approaches, the methods being complementary. CONCLUSIONS: To take best advantage of the findings from these techniques, pathologists must know which types of diagnoses can be made and the fundamentals of how and, lastly, what cannot be diagnosed and the reasons why. Best results are obtained with a multidisciplinary approach in a hospital committee composed of endocrinologists, surgeons, radiologists and pathologists, who analyse and provide a background on each case.

Treatment of renal tumors by percutaneous ultrasound-guided radiofrequency ablation using a multitined electrode: effectiveness and complications.

BACKGROUND: Radiofrequency ablation (RFA) is a minimally aggressive, therapeutic alternative for renal tumors. It can be an alternative to nephrectomy in patients with previous nephrectomy, bilateral tumors, von Hippel-Lindau disease, or small renal carcinomas and in those with contraindications for surgery. OBJECTIVE: To assess the effectiveness of the treatment of renal tumors by RFA in the short and medium term and to identify the possible complications and the factors that determine therapeutic success. DESIGN, SETTING, AND PARTICIPANTS: A retrospective review of patients with renal tumors treated with RFA between May 2005 and December 2008 was performed in a tertiary academic hospital. Patients were selected among those with previous nephrectomy, bilateral neoplasms, von Hippel-Lindau disease, surgical risk, comorbidity, advanced age, or patient's refusal to surgery. Tumors with evidence of extrarenal extension were excluded. Patients were followed up for 10-50 mo using computed tomography and magnetic resonance imaging. INTERVENTION: Ultrasound-guided RFA was performed on 65 tumors (range: 1.2-5.3 cm) of 58 patients using multitined electrodes. MEASUREMENTS: Incomplete ablation rate, therapeutic success rate, and complications rate. RESULTS AND LIMITATIONS: Therapeutic success was achieved in 59 of 65 tumors (91%): 53 in a single session, 5 in two sessions, and 1 in three sessions. A significant relationship was observed between size and growth pattern of the tumor and both therapeutic success and incomplete ablation rates. Therapeutic success in tumors >5 cm was 60%. Complications were detected in 10 patients (13%); 5% were considered major complications. Limitations include the lack of pathologic studies to confirm a complete ablation and the lack of a control group to compare with the results of those who underwent nephrectomy. CONCLUSIONS: RFA is safe and effective in renal tumors. Corticomedullary lesions and tumors >3 cm have greater possibility of incomplete ablation. In tumors >5 cm, RFA has a significant failure rate.

El diagnóstico histológico de la patología tiroideaen biopsias guiadas por control ecográfico / The histological diagnosis of thyroid pathology in ultrasound-guided core biopsies

La biopsia de tiroides obtenida con aguja guiada porcontrol ecográfico es una alternativa a la punción aspiracióncon aguja fina que, según múltiples autores, ofrece mayorsensibilidad y especificidad diagnóstica que ésta. Este trabajorevisa de una manera crítica la metodología de obtenciónde la muestra, su manipulación óptima en el Laboratoriode Anatomía Patológica, lo que se puede diagnosticar,cómo hacerlo, y lo que no, y por qué no. El rendimientoóptimo de este procedimiento se obtiene en el contexto deun comité multidisciplinario en el que los diversos especialistasimplicados discuten los casos complejos (AU)

Thyroid biopsy obtained with a sonographically guidedneedle is a more specific and sensitive alternative to fineneedle aspiration cytology, according to several authors.This article presents a critical review of the methodology forobtaining the sample, its optimal management in the pathologylaboratory and how and what can be diagnosed as wellas the reasons for what can not be not be diagnosed. Thebest results of this technique are obtained when the specialistsinvolved cooperate on a multidisciplinary committee todiscuss complex cases (AU)

Sonographically guided percutaneous needle lavage in calcific tendinitis of the shoulder: short- and long-term results.

OBJECTIVE: The purpose of our study was to evaluate the short- and long-term effectiveness of sonographically guided percutaneous needle aspiration and lavage in calcific tendinitis of the shoulder and to study the progress of calcifications and symptoms in the first year after treatment. MATERIALS AND METHODS: Symptoms and radiologic findings after percutaneous aspiration of calcific tendinitis were prospectively evaluated in the short and the long term using a shoulder pain and disability index, evaluation of shoulder motion, and a survey of the self-perception by the patients regarding the progress of their disease. RESULTS: Sixty-seven consecutive shoulders were treated. A significant improvement was seen in shoulder motion, pain, and disability in the short term and in the long term (p < 0.0001). One year after treatment, 91% of shoulders had substantially or completely improved, 64% had perfect motion, and calcifications on radiography had resolved completely or nearly completely in 89%. A transitory recurrence was observed approximately 15 weeks after treatment in 44.3% of shoulders that improved. CONCLUSION: Percutaneous needle aspiration and lavage is effective in the short term and in the long term in calcific tendinitis of the shoulder, with results similar to or better than those published for other techniques, and it is only slightly invasive and painful. Progress after treatment may include a transitory period of recurrence of the pain.

Value of ultrasound-guided core biopsy in the diagnosis of malignant lymphoma.

PURPOSE: Ultrasound-guided core needle biopsy for the diagnosis and management of malignant lymphomas is controversial and has not been accepted as an alternative to surgical biopsy. We investigate the clinical usefulness of this procedure in a large series of patients. METHODS: Over a 5-year period (2000-2004), ultrasound-guided core needle biopsies were performed in 102 malignant lymphomas. Five diagnostic categories were considered: large B-cell lymphomas (LBCL), small B-cell lymphomas (SBCL), Hodgkin's disease (HD), T cell lymphomas, and miscellaneous. Surgical excisional biopsy of the node was performed in 47 cases (46.1%) for diagnostic confirmation. RESULTS: The overall diagnostic accuracy of ultrasound-guided core needle biopsy was 88.2% (90/102). SBCL (39), LBCL (36), HD (15), T cell lymphomas (5), and miscellaneous (7) [including T cell-rich B cell (2), natural killer cell (1), Burkitt's lymphoma (1), and non-Hodgkin's lymphoma of the B cell type, NOS (3)] were correctly diagnosed. Three HDs, 1 natural killer cell lymphoma, 1 follicular lymphoma, and 1 LBCL were not correctly diagnosed. The core needle biopsy did not yield tumor tissue in 6 cases. CONCLUSIONS: Ultrasound-guided core needle biopsy is effective in the diagnosis of malignant lymphomas and can be used as the first diagnostic approach in selected clinical situations.

Utilidad de la biopsia cilindro guiada por control ecográfico en el diagnóstico y manejo de los tumores renales / Usefulness of ultrasound-guided core biopsy in the diagnosis and management of renal tumours

Antecedentes: La biopsia guiada por control ecográfico está siendo utilizada de manera creciente en los últimos años como aproximación diagnóstica inicial en los tumores renales, aunque su aceptación entre radiólogos y patólogos aún no es generalizada. Métodos: Durante un periodo de 6 años (2000-2005), se han biopsiado por este método y con agujas 18G un total de 48 tumores renales en 47 pacientes. Resultados: Se observó un predominio de varones (34V/13M) y la edad promedio se situó en 51,7 años (rango 1-92). Treinta y siete (77,1%) casos correspondieron a neoplasias, incluyendo adenocarcinomas renales (25 casos), oncocitomas (3 casos), linfomas (3 casos), tumores de Wilms (2 casos), un tumor carcinoide metastásico, un carcinoma epidermoide metastático, un nefroma quístico y un sarcoma fusocelular. Cinco casos (10,4%) correspondieron a pseudotumores (3 quistes renales y 2 pielonefritis crónicas). La biopsia proporcionó tejido renal normal en 4 casos y tejido fibroadiposo en 2. Se detectaron mínimas discrepancias en la adjudicación de la variante histológica del cáncer en 2 casos. Conclusiones: La biopsia cilindro guiada por ecografía es un método muy útil y fiable para el diagnóstico de los tumores renales, y debería ser incluida como herramienta de primera línea en su manejo. Sin embargo, para la obtención de óptimos resultados que puedan llevar a un tratamiento individualizado, se precisa una estrecha colaboración entre clínicos, radiólogos y patólogos

Background: Ultrasound-guided core biopsy (USCB) has being increasingly used in the last years for diagnosis of renal masses. However, its use has not still reached a generalised acceptance among radiologists and pathologists. Methods: Over a 6-year period (2000-2005), a total of 48 renal masses in 47 patients were biopsied under ultrasound guidance using 18G needles. Results: Males predominated in the series (34M/13F), and the average age was 51.7 years (range 1-92). Thirty-seven (77.1%) cases were neoplasms. Diagnostic categories included renal cell carcinoma (25 cases), oncocytoma (3 cases), malignant lymphoma (3 cases), Wilms tumour (2 cases), carcinoid tumour, squamous cell carcinoma, metastatic, cystic nephroma, and spindle cell sarcoma (one each). Five cases (10.4%) were pseudotumours (3 renal cysts and 2 chronic pyelonephritides). The core biopsy obtained was normal renal tissue in 4 cases and fibroadipous tissue in 2. Minor discrepancies in the assignment of the histological variant were detected in 2 cases. Conclusions: Ultrasound-guided core biopsy is a very useful and reliable method in the diagnosis of renal masses and should be included as a first-line tool in its management. Close cooperation between clinicians, radiologists and pathologists is needed to obtain optimal results that may prompt an individualised treatment in every case

Role of ultrasound-guided core biopsy in the evaluation of spleen pathology.

Core biopsy has not traditionally been recommended in the study of spleen nodules due to the supposed fragility of this organ leading to a high risk of post-core biopsy complications. A total of 13 patients who presented solid spleen nodules, diffuse splenomegaly, or both on imaging studies (CT, MR, US) were biopsied under ultrasound control with 18G BioPince needles. Cytological (imprints and cytocentrifugates) and histological material were obtained for diagnosis in every case. Malignant lymphomas were the most commonly found pathology (four diffuse large B-cell lymphomas, two follicular lymphomas, one Hodgkin's disease, one B-cell lymphoma, NOS). In addition, there was one littoral-cell angioma, one well-differentiated neuroendocrine carcinoma, metastatic, and one haemangioma. The remaining two cases showed congestive features, and supposed spleen involvement by lymphoma in one of them was ruled out. On follow up, there were no complications related to the core biopsy. Splenectomy was performed in six cases, two diagnostic and four therapeutic. We conclude that core biopsy is a safe and efficient method in the diagnosis of spleen nodules that could be considered in the routine diagnostic algorithm of these lesions.

Consentimiento informado de Medicina Interna en el Hospital Universitario San Ignacio / Internal Medicine informed consent at Hospital Universitario San Ignacio

Objetivo: Establecer la pertinencia del consentimiento informado(CI) en el servicio de Medicina Interna del Hospital Universitario San Ignacio (HUSI). Material y métodos: Estudio cualitativo mediante encuestas. Generación de sugerencias cualitativas a modo de cuasiestadísticas, para el análisis de datos. Participaron 253 pacientes hospitalizados y 253 familiares a cargo, entrevistados entre noviembre de 2003 y mayo de 2004, y 9 internistas (tratantes de la muestra de usuarios), en julio de 2004. Resultados: Consenso en la claridad de razones de hospitalización e información del diagnóstico. Patrón de comportamiento del CI percibido por las familias idéntico al percibido por los pacientes, pero más deteriorado. Buen recibimiento de la comunicación del tratamiento y la comprensibilidad de la información. Falencias en el planteamiento de alternativas y de efectos y riesgos. Regulares resultados en la explicación de los procedimientos y el pronóstico. Decisiones de autorización del paciente medianamente apalancadas por la información. Los médicos se hacen reconocer por el nombre, pero les falta aclarar su condición de tratantes. Son los más optimistas sobre el desempeño del CI, a la vez que castigan más las deficiencias. Valoran más la forma de la comunicación que el contenido. Conclusiones: Intervenir primero la relación con las familias. Mejorar, en orden: advertencia de efectos y riesgos, planteamiento de alternativas, hablar del pronóstico, explicar los procedimientos, explicar comprensiblemente, y comunicar y explicar eltratamiento, además de insistir en que el médico tratante se identifique como tal y se haga reconocer por el nombre.

Usefulness and limitations of ultrasound-guided core biopsy in the diagnosis of musculoskeletal tumours.

Ultrasound-guided needle biopsy is a safe and efficient diagnostic method increasingly used in the initial approach to superficial and deep musculoskeletal tumours. However, so far no general consensus has been reached regarding its reliability. During a 6-year period (1999-2004), biopsies were taken from 188 patients (100 females, 88 males; age average 55.8 years) with musculoskeletal tumours under ultrasound guidance using 18G BioPince or 14G ProMag 2.2 true-cut type needles. Cytological (imprints and cytocentrifugates) and histological material was obtained for diagnosis in every case. The lower extremity (59 cases) and the abdominal wall (29 cases) were the most commonly affected sites. Benign/reactive tumours (77 cases), metastatic epithelial malignancies (40 cases), and sarcomas (36 cases) were most frequently diagnosed. In 180 (95.75%) cases, core needle results were concordant with the definitive diagnosis (97 true positives and 83 true negatives). Relevant diagnostic discordance was seen in 8 (4.25%) cases (8 false negatives and 0 false positives). Sensitivity, specificity and positive and negative predictive values were 92%, 100%, 100%, and 91%, respectively. Ultrasound-guided core biopsy is thus a useful method in the initial approach to musculoskeletal tumours that allows correct patient management in the vast majority of cases.

The use of unenhanced Doppler sonography in the evaluation of solid breast lesions.

OBJECTIVE: The objectives of our study were to investigate differences in Doppler sonography features between benign and malignant breast lesions and between malignant lesions with different prognostic factors and to propose diagnostic criteria for Doppler sonography of breast lesions. SUBJECTS AND METHODS: We performed power and duplex Doppler sonography examinations in 826 breast lesions scheduled for sonographically guided core needle biopsy. Lesion vascularity, pulsatility index (PI), and resistive index (RI) of the vessels detected were analyzed and correlated with histologic results. RESULTS: Color flow was more frequently seen in malignant (237/348 lesions, 68%) than in benign (171/478, 36%) lesions (p < 0.001). However, sensitivity, specificity, and positive and negative predictive values for this sign were low (68%, 64%, 58%, and 73%, respectively). The RI and PI values were significantly higher (p < 0.001) in cancers. Although an overlap in these values between benign and malignant lesions was observed, all but one nodule with an RI of greater than 0.99 (those with null or inverted diastolic flow) or a PI of greater than 4 were malignant. No significant relationship was found between PI, RI, or flow visualization on power Doppler sonography and tumor grade or lymph node involvement in cancers. CONCLUSION: Flow visualization on power Doppler sonography indicates a higher possibility of malignancy but is not useful as the main sign for malignancy. However, any lesion with a vessel that has an RI value greater than 0.99 or a PI value greater than 4 within it must be considered as probably malignant regardless of any other sonography sign present. Doppler findings are not useful to predict tumor grade or lymph node involvement.

Patología del sistema musculosquelético en pacientes con sida / Musculoskeletal system pathology in aids patients

Objetivo: Estudiar mediante resonancia magnética (RM) los diferentes procesos que pueden afectar al sistema musculosquelético en pacientes con sida. Material y métodos: Se han estudiado 22 pacientes con sida que presentaban patología del sistema musculosquelético. Se realizó radiografía simple del área afectada y RM. El estudio de RM se realizó con un imán de 1 Tesla. Se emplearon secuencias eco del epín (SE) potenciadas en T1 y T2 y secuencias de inversión recuperación (STIR). En nueve casos se utilizó gadolinio intravenoso a una dosis de 0,2 ml/kg. El plano de estudio se seleccionó dependiendo de la localización de la lesión y se emplearon bobinas de superficie en los casos susceptibles de ello y en aquellos pacientes en los que la patología estaba alejada del esqueleto apendicular se empleó el imán principal como transmisor y receptor. En un caso se realizó además estudio con tomografía computarizada (TC). Los datos evaluados fueron: a) localización; b) erosión ósea; c) masa de partes blandas; d) derrame articular; e) afectación cartilaginosa; f) señal en T1 y T2, y g) realce con gadolinio. Se llegó el diagnóstico por cultivo, biopsia o clínica y evolución. Resultados: La afectación más frecuente fue la de la columna (13 casos). Doce casos fueron espondilodiscitis, 10 por tuberculosis, una por Staphylococcus y una por Candida. En todos los casos existía una erosión de los platillos vertebrales, una alteración de la señal de la médula ósea de la zona afectada y del disco con masa de partes blandas. En los nueve casos en los que se empleó gadolinio el disco, los platillos vertebrales y la masa de partes blandas se realzaban de forma heterogénea demostrándose un absceso con realce en anillo y una zona necrótica central únicamente en un caso. En un paciente se demostró una de afectación de la columna por un linfoma no hodgkiniano. En seis casos se demostró una artritis infecciosa, dos en articulación coxofemoral, tres en rodilla y uno en articulación glenohumeral. Los gémenes aislados fueron Staphylococcus en tres casos, Mycobacterium tuberculosis en uno, M. kansasii en uno y Candida en uno. En todos los casos existía derrame articular, engrosamiento sinovial, afectación del cartílago articular y erosiones óseas. Encontramos un caso de miositis en el músculo recto anterior del muslo en la que se aisló Streptococcus; un caso de infarto óseo en el fémur y uno de linfoma en el peroné. Conclusiones: El área anatómica del sistema musculosquelético afectada con más frecuencia en pacientes con sida es la columna, fundamentalmente la columna lumbar, siendo la espondilodiscitis tuberculosa la causa más común. Es frecuente encontrar también en estos pacientes artritis infecciosas, siendo en estos casos el espectro de gérmenes implicados más amplio (AU)

Aim: to study by means of Magnetic Resonance the different processes that can affect the musculoskeletal system in AIDS patients. Material and methods: We studied 22 AIDS patients who presented musculoskeletal system pathology. The affected area underwent simple X-Ray and MR. The MR study was performed using a 1 Tesla magnet. T1 and T2 weighted echo spin sequences, as well as sequences of short TI inversion recovery (STIR). In nine cases, intravenous gadolinium was used at a dose of 0.2cc / kg. The study plane was selected depending on the location of the lesion and surface coils were used when appropriate. In those patients showing pathology which was removed from the appendicular skeleton, the principal magnet was used as both transmitter and receiver. In one case, an On-Line Tomography (CT) was also carried out. The evaluated data were: a) localization; b) bony erosion; c) soft-tissue mass; d) articular effusion; e) cartilaginous changes; f) T1 and T2 signals, and g) gadolinium enhancement. A diagnosis was made on the basis of biopsy or clinical culture, and evolution. Results: Spinal cord alterations were the most frequent, being found in 13 cases. Twelve were caused by spondylodiscitis, 10 by tuberculosis, one by staphylococcal infection and one by candidiasis. In all cases, there appeared disk damage, as well as bone marrow signal alterations in the affected area and disks with soft-tissue. In the nine cases in which gadolinium was used, the disk, vertebral plates and soft-tissue mass heterogeneously enhanced, demonstrating an abscess with ring enhancement, and a central necrotic area in one case. In one patient, a spinal cord alteration due to non-Hodgkin's lymphoma was observed. In six cases, there was observed an infectious arthritis -- two in coxofemoral joints, three in knees and one in a glenohumeral joint. Isolated germs were staphylococcal in three cases -- one being Mycobacterium tuberculosis, another being M. kansasii and the third identified as Candida. In all cases, there was observed joint effusion, synovial thickening, joint cartilage damage and bony erosions. We found one case of myositis in the right anterior thigh muscle in which Streptococcus was isolated, one case of femoral bone infarction, and one case showed signs of lymphoma in the fibula. Conclusions: The spinal cord is that anatomical area of the musculoskeletal system most frequently affected in AIDS patients. It is primarily of the lumbar column, with tuberculous spondylodiscitis being the most common cause. Infectious arthritis is also commonly found in such patients, with a wider range of such related germs being present (AU)