Cavitación coroidea asociada a coloboma macular. Estudio multimodal. Imagen en face / Choroid cavitation associated with macular coloboma. Multimodal study. Image en face

La cavitación intracoroidea es un hallazgo identificado con OCT descrito inicialmente en pacientes miopes, pero también aparece en pacientes no miopes. Puede presentarse tanto en el área peripapilar como en el polo posterior. El coloboma macular es un defecto del desarrollo embrionario del polo posterior, y en la OCT estructural es imprescindible la ausencia del epitelio pigmentario de la retina y de los vasos coroideos para su diagnóstico. Este caso presenta la cavitación intracoroidea circunscribiendo el coloboma macular, en ausencia de membrana intercalar. La imagen en face permite valorar la relación entre ambas estructuras, así como la magnitud de las mismas. (AU)

Intrachoroidal cavitation is a finding identified with OCT initially described in myopic patients, it also appears in non-myopic patients. It can occur in both the peripapillary area and the posterior pole. Macular coloboma is a defect of embryonic development of the posterior pole, in structural OCT the absence of the retinal pigment epithelium and choroidal vessels is essential. In this case, intrachoroidal cavitation circumscribes the macular coloboma, in the absence of an intercalary membrane. The face image allows us to assess the relationship between the two structures as well as their magnitude. (AU)

Choroid cavitation associated with macular coloboma. Multimodal study. Image en face.

Intrachoroidal cavitation is a finding identified with OCT initially described in myopic patients, it also appears in non-myopic patients. It can occur in both the peripapillary area and the posterior pole. Macular coloboma is a defect of embryonic development of the posterior pole, in structural OCT the absence of the retinal pigment epithelium and choroidal vessels is essential. In this case, intrachoroidal cavitation circumscribes the macular coloboma, in the absence of an intercalary membrane. The en face image allows us to assess the relationship between the two structures as well as their magnitude.

Desprendimiento de la capa bacilar de la retina asociado a enfermedad inflamatoria ocular

El desprendimiento de la capa bacilar de la retina es la separación de los segmentos internos de los fotorreceptores del resto de la retina neurosensorial, o separación entre la zona miode y elipsoide de la retina, que en un hallazgo reciente se puede identificar mediante la tomografía de coherencia óptica de dominio espectral. El objetivo es actualizar los conocimientos sobre el desprendimiento de la capa bacilar de la retina y el uso de la tomografía de coherencia óptica de dominio espectral en las enfermedades oculares que están asociadas con este signo. Se consultaron las fuentes bibliográficas como Google académico, SciELO LAC, Medline y MEDICARIBE. Se limitaron los resultados al idioma español e inglés y a los últimos cinco años. Se recuperaron 54 documentos, de ellos 18 resultaron relevantes a esta investigación. Los autores más mencionados fueron Ramtohul, Metha y Cicinelli. Ellos trabajaron el signo clínico en cuestión y reportaron la experiencia en la atención a los pacientes aquejados con esta enfermedad ocular. El desprendimiento de la capa bacilar de la retina es un signo presente en varias enfermedades asociadas a inflamación del segmento posterior ocular. La tomografía de coherencia óptica de dominio espectral es una técnica efectiva para determinarlo, aunque estos planteamientos aún son escasos en la literatura, lo cual reafirma la importancia científica de continuar los estudios a partir de hipótesis iniciales desde el punto de vista histológico y tomográfico.

Retinal bacillary layer detachment is the separation of the inner segments of the photoreceptors from the rest of the neurosensory retina, or separation between the myode and ellipsoid zone of the retina, which in a recent finding can be identified by spectral-domain optical coherence tomography. The objective is to update the knowledge about the detachment of the bacillary layer of the retina and the use of spectral-domain optical coherence tomography in ocular diseases that are associated with this sign. Bibliographic sources such as academic Google, SciELO LAC, MEDLINE and MEDICARIBE were consulted. Fifty-four documents were retrieved, of which 18 were relevant to this research. The results were limited to the Spanish and English language and to the last five years. The most mentioned authors were Ramtohul, Metha and Cicinelli. They worked on the clinical sign in question and reported the experience in caring for patients afflicted with this ocular disease. Detachment of the bacillary layer of the retina is a sign present in several diseases associated with ocular posterior segment inflammation. Spectral-domain optical coherence tomography is an effective technique to determine it, although it is still scarce in the literature, which reaffirms the scientific validity of continuing studies from initial hypotheses from the histological and tomographic point of view.

Imagen multimodal en la estenosis aórtica: nuevas fronteras diagnósticas y terapéuticas / Multimodality imaging in aortic stenosis: new diagnostic and therapeutic frontiers

El desarrollo del implante percutáneo de válvula aórtica ha revolucionado el tratamiento de la estenosis de válvula aórtica calcificada. Los pacientes ancianos a los que se consideraba inoperables ahora cuentan con un tratamiento eficaz y seguro que proporciona una mejor supervivencia. Además, las guías de práctica actuales tienden a recomendar una intervención más temprana para evitar las consecuencias irreversibles de la sobrecarga de presión de larga duración causada por la válvula aórtica estenótica. El momento adecuado para la intervención depende en gran medida de las técnicas de imagen que informan de la gravedad de la estenosis aórtica, pero también de las consecuencias hemodinámicas y el remodelado cardiaco. Si bien la fracción de eyección del ventrículo izquierdo sigue siendo uno de los principales parámetros funcionales para la estratificación del riesgo de los pacientes con estenosis aórtica grave, los avances en las técnicas de imagen han proporcionado nuevos parámetros estructurales y funcionales que permiten identificar a los pacientes que se beneficiarán de la intervención antes de que aparezcan síntomas o daño cardiaco irreversible. Además, el desarrollo de tratamientos médicos que pueden detener de manera efectiva la progresión de la estenosis aórtica depende en gran medida de la información que las técnicas de imagen aportan, y la caracterización de la actividad metabólica de la estenosis aórtica calcificada con técnicas de medicina nuclear o tomografía computarizada ha permitido monitorizar los efectos de esos tratamientos. El presente artículo de revisión brinda una visión actualizada de los avances en técnicas de imagen que caracterizan la fisiopatología y han cambiado el paradigma del tratamiento de la estenosis aórtica.(AU)

The advent of transcatheter aortic valve implantation has revolutionized the treatment of calcific aortic valve stenosis. Elderly patients who were previously considered inoperable have currently an efficacious and safe therapy that provides better survival. In addition, current practice guidelines tend to recommend earlier intervention to avoid the irreversible consequences of long-lasting pressure overload caused by the stenotic aortic valve. Appropriate timing of the intervention relies significantly on imaging techniques that provide information on the severity of the aortic stenosis as well as on the hemodynamic consequences and cardiac remodeling. While left ventricular ejection fraction remains one of the main functional parameters for risk stratification in patients with severe aortic stenosis, advances in imaging techniques have provided new structural and functional parameters that allow the identification of patients who will benefit from intervention before the occurrence of symptoms or irreversible cardiac damage. Furthermore, ongoing research aiming to identify the medical therapies that can effectively halt the progression of aortic stenosis relies heavily on imaging endpoints, and new imaging techniques that characterize the metabolic activity of calcific aortic stenosis have been proposed to monitor the effects of these therapies. The present review provides an up-to-date overview of the imaging advances that characterizes the pathophysiology and that have changed the management paradigm of aortic stenosis.(AU)

Multimodality imaging in aortic stenosis: new diagnostic and therapeutic frontiers.

The advent of transcatheter aortic valve implantation has revolutionized the treatment of calcific aortic valve stenosis. Elderly patients who were previously considered inoperable have currently an efficacious and safe therapy that provides better survival. In addition, current practice guidelines tend to recommend earlier intervention to avoid the irreversible consequences of long-lasting pressure overload caused by the stenotic aortic valve. Appropriate timing of the intervention relies significantly on imaging techniques that provide information on the severity of the aortic stenosis as well as on the hemodynamic consequences and cardiac remodeling. While left ventricular ejection fraction remains one of the main functional parameters for risk stratification in patients with severe aortic stenosis, advances in imaging techniques have provided new structural and functional parameters that allow the identification of patients who will benefit from intervention before the occurrence of symptoms or irreversible cardiac damage. Furthermore, ongoing research aiming to identify the medical therapies that can effectively halt the progression of aortic stenosis relies heavily on imaging endpoints, and new imaging techniques that characterize the metabolic activity of calcific aortic stenosis have been proposed to monitor the effects of these therapies. The present review provides an up-to-date overview of the imaging advances that characterizes the pathophysiology and that have changed the management paradigm of aortic stenosis.

Choroidal macrovessel and persistent metamorphopsia after epiretinal membrane surgery.

We report the case of a 59-year-old man with decreased visual acuity and metamorphopsia in both eyes in the context of bilateral epiretinal membrane (ERM) who underwent retinovitreal surgery (chromovitrectomy plus peeling of internal limiting membrane). He recovered visual acuity in his left eye. However, the visual results of his right eye were not satisfactory, with persistence of metamorphopsia in that eye. The multimodal imaging study that included color and red filter retinographies, enhanced depth imaging optical coherence tomography (EDI-OCT), fluorescein angiography (FA), indocyanine green angiography (ICGA), OCT angiography (OCTA) and OCT en face, were useful to diagnose a choroidal macrovessel. This ran from the fovea to the temporal macula. EDI-OCT revealed that the choroidal macrovessel generated a foveal deformation of both the ellipsoid zone (EZ) and the retinal pigment epithelium (RPE). This paper discusses whether structural changes in the fovea generated by the choroidal macrovessel are related to persistent metamorfopsia in the affected eye.

Macrovaso coroideo y metamorfopsia persistente después de cirugía de membrana epirretiniana / Choroidal macrovessel and persistent metamorphopsia after epiretinal membrane surgery

Presentamos el caso de un hombre de 59 años con disminución de agudeza visual y metamorfopsia en ambos ojos en el contexto de membrana epirretiniana bilateral (MER) que fue intervenido con cirugía retinovítrea (cromovitrectomía más pelado de membrana limitante interna). Presentó recuperación de agudeza visual en su ojo izquierdo. Sin embargo, los resultados visuales de su ojo derecho no fueron satisfactorios, con persistencia de metamorfopsia en dicho ojo. El estudio con imagen multimodal que incluyó retinografía en color y filtro rojo, tomografía de coherencia óptica con imagen de profundidad mejorada (OCT-EDI), angiografía fluoresceínica (AF), angiografía verde de indocianina (ICGA), OCT-angiografía (OCTA) y OCT en-face fue útil para diagnosticar un macrovaso coroideo. Este recorría desde la fóvea hasta la mácula temporal. La OCT-EDI reveló que el macrovaso coroideo generaba una deformación foveal tanto de la zona elipsoide (ZE) como del epitelio pigmentario de retina (EPR). En este trabajo se discute si los cambios estructurales en la fóvea generados por el macrovaso coroideo están relacionados con la metamorfopsia persistente en el ojo afectado (AU)

We report the case of a 59-year-old man with decreased visual acuity and metamorphopsia in both eyes in the context of bilateral epiretinal membrane (ERM) who underwent retinovitreal surgery (chromovitrectomy plus peeling of internal limiting membrane). He recovered visual acuity in his left eye. However, the visual results of his right eye were not satisfactory, with persistence of metamorphopsia in that eye. The multimodal imaging study that included colour and red filter retinographies, enhanced depth imaging optical coherence tomography (EDI-OCT), fluorescein angiography (FA), indocyanine green angiography (ICGA), OCT angiography (OCTA) and OCT en face, were useful to diagnose a choroidal macrovessel. This ran from the fovea to the temporal macula. EDI-OCT revealed that the choroidal macrovessel generated a foveal deformation of both the ellipsoid zone (EZ) and the retinal pigment epithelium (RPE). This paper discusses whether structural changes in the fovea generated by the choroidal macrovessel are related to persistent metamorfopsia in the affected eye (AU)

Evaluación multimodal de un «micromelanocitoma» del disco óptico: un reporte de caso / Multimodal imaging assessment of a “micro” optic disk melanocytoma: A case report

Un melanocitoma del disco óptico es una lesión neoplásica pigmentada y benigna que en promedio mide 2,00mm de diámetro. Melanocitomas del disco óptico más pequeños son raros y no han sido estudiados con múltiples técnicas de imagen. Un caso de un «micromelanocitoma» del disco óptico con un diámetro de 0,71mm fue estudiado con múltiples estudios de imagen, incluyendo autofluorescencia de fondo de ojo, ultrasonido ocular, campos visuales, tomografía de coherencia óptica (OCT) y angiografía por OCT. Mientras que la exploración con biomicroscopia y la autoflourescencia de fondo de ojo revelan cambios compatibles con los casos de tamaño promedio previamente publicados, la OCT, angiografía por OCT y el ultrasonido revelan cambios que difieren de los artículos previos y que podrían ser útiles para el seguimiento (AU)

An optic disk melanocytoma is a benign pigmented neoplasm of the optic disk measuring 2.00mm of diameter in average. Smaller optic disk melanocytomas are rare and have not been studied with multiple imaging studies. A case of a “micro” optic disk melanocytoma measuring 0.71mm in diameter was studied by multiple imaging modalities, including fundus autofluorescence, ultrasound, visual fields, optical coherence tomography (OCT) and OCT angiography. While clinical appreciation and fundus autofluorescence reveal changes compatible with previously reported cases, OCT, OCT angiography and ultrasound reveal specific changes that could be useful for follow up (AU)

Multimodal imaging assessment of a "micro" optic disk melanocytoma: A case report.

An optic disk melanocytoma is a benign pigmented neoplasm of the optic disk measuring 2.00 mm of diameter in average. Smaller optic disk melanocytomas are rare and have not been studied with multiple imaging studies. A case of a "micro" optic disk melanocytoma measuring 0.71 mm in diameter was studied by multiple imaging modalities, including fundus autofluorescence, ultrasound, visual fields, optical coherence tomography (OCT) and OCT angiography. While clinical appreciation and fundus autofluorescence reveal changes compatible with previously reported cases, OCT, OCT angiography and ultrasound reveal specific changes that could be useful for follow up.

Multimodal imaging assessment of a "micro" optic disk melanocytoma: A case report. / Evaluación multimodal de un «micromelanocitoma¼ del disco óptico: un reporte de caso.

An optic disk melanocytoma is a benign pigmented neoplasm of the optic disk measuring 2.00mm of diameter in average. Smaller optic disk melanocytomas are rare and have not been studied with multiple imaging studies. A case of a "micro" optic disk melanocytoma measuring 0.71mm in diameter was studied by multiple imaging modalities, including fundus autofluorescence, ultrasound, visual fields, optical coherence tomography (OCT) and OCT angiography. While clinical appreciation and fundus autofluorescence reveal changes compatible with previously reported cases, OCT, OCT angiography and ultrasound reveal specific changes that could be useful for follow up.

Focal laser for idiopathic macular telangectasia type 1 refractory to ozurdex, ranibizumab and aflibercept. / Láser focal para telangectasia macular idiopática tipo 1 refractario a ozurdex, ranibizumab y aflibercept.

We present a case of a woman with idiopathic macular telangiectasia type 1, characterized by the presence of a capillary macroanaeurysm associated with macular edema with a macular star pattern. Several differential diagnoses were proposed, in which the study with a multimodal image was key to clarify the diagnosis. In addition, the various treatments used and their effectiveness are discussed.

Multimodal imaging in phototoxic maculopathy: description of findings in a series of 12 patients. / Imagen multimodal en la maculopatía fototóxica: descripción de hallazgos en una serie de 12 pacientes.

OBJECTIVE: To study the differences between solar retinopathy (SR) and the maculopathy produced by laser pointer (LPM) using multimodal imaging. METHOD: A retrospective series is presented of 20 eyes of 12 patients with injuries associated with light, 7 with SR-compatible injuries, and 5 with LPM. At diagnosis, a complete ophthalmological examination was performed, including visual acuity (VA), retinography, and spectral domain optical coherence tomography (OCT). The patients were followed-up for a mean period of 20 months. RESULTS: LPM is common in paediatrics (mean age 15.60±1.5years), and SR affects patients of all ages (mean age 47.56±1.51years). VA at diagnosis in LPM is greater, and recovery is more complete than in solar retinopathy. In conventional retinography, SR is shown as a single lesion in the macular area (100% of cases), while LPM usually presents as multifocal lesions (86% of cases). Infrared reflectance makes this difference clearer. The main sign in OCT is the disruption of the ellipsoid layer and interdigitation zone. This sign is maintained over time, and its size is greater in the SR than in the LPM. Hyper-reflective columns and hyper-reflective reaction of the retinal pigment epithelium are associated with the acute phase. CONCLUSIONS: LPM and SR show significant differences in the type of patient affected, as well as in the signs in multimodal imaging, as well as in functional impairment and their evolution.

Follow-up in head and neck cancer. What the radiologist must know. / Seguimiento del cáncer de cabeza y cuello tratado. Lo que el radiólogo debe conocer.

The management of patients with head and neck cancer implies a multidisciplinary treatment with surgery, radiotherapy and chemotherapy. Imaging is crucial in their follow-up, especially when the tumor recurrence is not clinically evident. Radiologically distinguishing post-treatment changes from a tumor recurrence is a challenge due to the anatomical alteration due to surgical techniques and their reconstructions, radiotherapy treatment and chemotherapeutic guidelines. The differential diagnosis must include the possible complications derived from radiotherapy (mucosal necrosis, osteoradionecrosis, vasculopathy, cerebral radionecrosis) and surgery (wound infections, flap necrosis, fistulas,...). A wide knowledge of the expected findings of multimodal treatment and its complications is essential for an accurate diagnosis of tumor recurrence. Finally, choosing the appropriate image study and having a baseline post-treatment study is also relevant for a suitable radiological control.

The role of multimodal imaging in stroke code patients. / Papel del estudio radiológico multimodal en el código ictus.

In stroke code patients, multimodal imaging workup encompasses various imaging techniques, including baseline computed tomography (CT), magnetic resonance (MR) imaging, diffusion MR imaging, CT or MR perfusion studies, and CT or MR angiography, that are used to rule out bleeding, confirm arterial occlusion, establish tissue viability, and help select candidates for endovascular treatment as early as possible. Five recently published relevant clinical trials have demonstrated the efficacy of mechanical thrombectomy in proximal arterial occlusions; all these trials used different imaging techniques to select patients. Analyzing these trials and the scientific literature, we conclude that conventional CT interpreted with the Alberta Stroke Programme Computed Tomography Score (ASPECTS) and CT or MR angiography should always be used (level of evidence I, grade of recommendation A) and that CT and MR perfusion studies are useful in specific circumstances.

Rol de la multimodalidad de imagen en insuficiencia cardíaca / Role of multimodality imaging in heart failure

En la presente revisión los autores abordan el concepto de multimodalidad de imagen a través del conocimiento de las diferentes técnicas de imagen cardiológica y el aporte de cada una de ellas al diagnóstico de la insuficiencia cardíaca para así construir un esquema de secuencias de estudios o complementariedad de los mismos por separado o en conjunto (técnicas de fusión) aplicable a los pacientes con insuficiencia cardíaca confirmada o sospechada. Se analizan someramente los fundamentos técnicos y clínicos de cada técnica, los aportes de la multimodalidad al diagnóstico de insuficiencia cardíaca encarando las perspectivas futuras de esta metodología. Al final del capítulo se ofrece un resumen conceptual para la aplicación práctica de los conceptos analizados en el mismo.

In this review the authors intend to approach to the concept of multimodality of images, through the knowledge of the different techniques and the contribution of each of them to the diagnosis of heart failure, in order to construct a scheme of studies sequences or complementarity of them, either separately or together (fusion techniques) applicable to the patient with confirmed or suspected heart failure. They briefly analyze the technical and clinical bases of each technique, the contributions of multimodality to the diagnosis of heart failure facing the future perspectives of this methodology. At the end of the chapter a conceptual summary is offered for the practical application of the concepts analyzed above.

Perineural spread in head and neck tumors.

Perineural spread is the dissemination of some types of head and neck tumors along nervous structures. Perineural spread has negative repercussions on treatment because it requires more extensive resection and larger fields of irradiation. Moreover, perineural spread is associated with increased local recurrence, and it is considered an independent indicator of poor prognosis in the TNM classification for tumor staging. However, perineural spread often goes undetected on imaging studies. In this update, we review the concept of perineural spread, its pathogenesis, and the main pathways and connections among the facial nerves, which are essential to understand this process. Furthermore, we discuss the appropriate techniques for imaging studies, and we describe and illustrate the typical imaging signs that help identify perineural spread on CT and MRI. Finally, we discuss the differential diagnosis with other entities.