RADIOLOGIA最新文献

英文中文

Comités multidisciplinares: encuesta sobre la situación actual y las necesidades de los radiólogos españoles 多学科委员会：西班牙放射科医生现状和需求调查

IF 1.1 Q3 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

RADIOLOGIA

Pub Date : 2024-11-01 DOI: 10.1016/j.rx.2024.04.011

A. Viteri Jusué , P. Puyalto de Pablo , L. Concepción Aramendía , C. García Villar

Introduction and objectives

The increasing participation of radiologists in multidisciplinary boards brings about advantages, challenges and specific needs. The aim of this paper is to identify the boards in which radiologists participate and to detect the needs, problems and opportunities that these boards pose for our specialty.

Methods and materials

The Spanish Society of Medical Radiology (SERAM) conducted an ad-hoc survey that was distributed among members and through social networks. The results were analysed with Stata® v14.2 (StataCorp, Texas, USA).

Results

Between 15 November 2022 and 24 December 2022, we received 743 anonymous responses with 93.7% coming from SERAM members (642 radiologists and 101 radiology trainees). Among the specialists, 82.7% regularly participate in one or more boards (92.5% oncology / 50.7% non-oncology / 43.3% both), which implies two or more meetings per week for 41.6% of the respondents.

Both radiologists who regularly participate in boards and those who do not, are very positive about this aspect of professional activity and agree on its benefits. However, the specialists who do participate, lack enough allocated time and information to prepare cases prior to the meeting. Although attendance is often recorded (69.7%), it is generally not included in the work plan (20.5% of physicians and 30.8% of middle managers, P = .028).

Regarding operational functioning, according to 46.9% of respondents there is no record of imaging tests reviewed, and the handling of discrepancies within radiology departments is poor (written recommendations and review sessions are only available to 14.3% and 7.7% of respondents respectively).

Conclusions

The radiologists surveyed report the high impact of multidisciplinary committees on their workload and clinical decisions. They mention a number of problems, some of which are specific to radiology, which can undermine efficiency and safety. These include work organisation, lack of time and problems of accessibility and the recording of imaging tests and other medical record data.

导言和目的放射科医生越来越多地参与多学科委员会的工作，这带来了优势、挑战和特殊需求。本文旨在确定放射科医师参与的委员会，并发现这些委员会为我们的专业带来的需求、问题和机遇。方法和材料西班牙医学放射学会（SERAM）进行了一项临时调查，调查表通过社交网络在会员中分发。结果在 2022 年 11 月 15 日至 2022 年 12 月 24 日期间，我们收到了 743 份匿名回复，其中 93.7% 来自 SERAM 会员（642 名放射科医生和 101 名放射科实习生）。在这些专家中，82.7% 定期参加一个或多个委员会（92.5% 肿瘤学/50.7% 非肿瘤学/43.3% 两者都参加），这意味着 41.6% 的受访者每周参加两次或两次以上的会议。然而，参加会议的专家缺乏足够的时间和信息来准备会前病例。虽然经常记录出席情况（69.7%），但一般不列入工作计划（20.5% 的医生和 30.8% 的中层管理人员，P = .028）。关于业务运作，46.9% 的受访者认为没有影像检查的审查记录，放射科内部对差异的处理也很差（分别只有 14.3% 和 7.7% 的受访者能提供书面建议和审查会议）。他们提到了一些问题，其中一些是放射科特有的问题，这些问题可能会影响效率和安全。这些问题包括工作组织、缺乏时间以及影像检查和其他医疗记录数据的可及性和记录问题。

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引用次数: 0

Fundamentos de la ecografía con contraste: farmacodinámica y farmacocinética del contraste. Bases de la imagen de ecografía con contraste 造影剂增强超声基础：造影剂的药效学和药代动力学。造影剂增强超声成像基础。

IF 1.1 Q3 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

RADIOLOGIA

Pub Date : 2024-10-01 DOI: 10.1016/j.rx.2024.06.006

M.T. Fontanilla Echeveste , T. Ripollés González , E. Aguirre Pascual

Contrast-enhanced ultrasound (CEUS) is a medical imaging technique that offers multiple advantages over other modalities such as computed tomography (CT) or magnetic resonance imaging (MRI). These advantages include portability, no ionising radiation, no renal toxicity, and the major advantage of real-time imaging. CEUS has numerous applications already established for the study of different pathologies, using both intravenous and intracavitary modes of contrast administration. The contrast used in CEUS has a different composition and function to that used in CT or MRI. It only enhances blood vessels and therefore the enhancement of lesions may differ somewhat from CT or MRI in the equilibrium phase. Ultrasound contrast has a very good safety record, with adverse effects being infrequent, generally mild and immediate in intravascular use and non-existent in intracavitary use. It is important to be familiar with the basic concepts of contrast-enhanced ultrasound, the different ways that images can be optimised and the different artifacts that can be produced.

对比增强超声（CEUS）是一种医学成像技术，与计算机断层扫描（CT）或磁共振成像（MRI）等其他方式相比具有多种优势。这些优势包括便携、无电离辐射、无肾毒性以及实时成像的主要优势。CEUS 采用静脉和腔内两种造影剂给药模式，已在不同病理研究中得到广泛应用。CEUS 使用的造影剂与 CT 或 MRI 使用的造影剂的成分和功能不同。它只能增强血管，因此在平衡阶段病变的增强效果可能与 CT 或 MRI 有一定差异。超声造影剂具有良好的安全性记录，不良反应不常见，一般较轻，血管内使用时可立即出现，腔内使用时则不存在不良反应。熟悉造影剂增强超声的基本概念、优化图像的不同方法以及可能产生的不同伪影非常重要。

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引用次数: 0

Contraste intestinal en resonancia magnética 磁共振成像中的肠道对比剂

IF 1.1 Q3 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

RADIOLOGIA

Pub Date : 2024-10-01 DOI: 10.1016/j.rx.2024.06.001

A. Álvarez-Cofiño Tuñón, M. da Silva Torres, A. Fernández del Valle, P. Noriega Menéndez, R. Menéndez de Llano Ortega, P. González Filgueira

Magnetic resonance enterography is primarily indicated for inflammatory bowel diseases. MRI of the gastrointestinal tract has become feasible due to the emergence of ultrafast sequences with higher spatial resolution and phased-array coils, enabling wider fields of vision. However, to ensure that the examination is of sufficient quality, the patient should be given an oral or rectal contrast preparation to distend the lumen and improve intestinal wall definition. These contrast agents are defined as positive, negative or biphasic, according to the signal intensity they induce in the intestinal lumen. The contrast agents most commonly used are biphasic and these appear hyperintense on T2 and hypointense on T1. A ‘black’ intestinal lumen has to be achieved on contrast-enhanced 3D T1-weighted sequences for mucosal assessment and parietal enhancement. While biphasic agents, such as PEG and mannitol, are more cost-effective and accessible, they are relatively unpleasant for patients. Negative agents are preferred, but are not routinely available. The purpose of this article is to review the different types of contrast agent that can be used in gastrointestinal MRI and that are mentioned in the literature, analysing the effects they generate on the image, their possible indications and limitations.

磁共振肠道成像主要适用于炎症性肠道疾病。由于出现了空间分辨率更高的超快序列和相控阵线圈，胃肠道磁共振成像变得可行，从而实现了更广阔的视野。然而，为确保检查质量，患者应口服或直肠服用造影剂，以扩张管腔并改善肠壁的清晰度。这些造影剂根据其在肠腔中引起的信号强度被定义为阳性、阴性或双相。最常用的造影剂为双相型，在 T2 上呈高密度，在 T1 上呈低密度。在造影剂增强的三维 T1 加权序列上，肠腔必须呈现 "黑色"，以便进行粘膜评估和顶叶增强。虽然双相制剂（如 PEG 和甘露醇）更具成本效益，也更容易获得，但对患者来说相对不舒服。阴性制剂是首选，但并不常见。本文旨在回顾文献中提到的可用于胃肠道核磁共振成像的不同类型造影剂，分析它们对图像产生的影响、可能的适应症和局限性。

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引用次数: 0

Reacciones adversas al contraste: cómo prevenirlas y cómo tratarlas 造影剂不良反应：如何预防和治疗

IF 1.1 Q3 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

RADIOLOGIA

Pub Date : 2024-10-01 DOI: 10.1016/j.rx.2024.03.011

F. Vega

Radiological contrast media, both iodinated and gadolinium-based, can lead to adverse reactions. Type A reactions are related to the pharmacological characteristics of the contrast, including side, secondary and toxic effects. Post-contrast acute kidney injury is the most frequent adverse reaction to iodinated contrast media. Less frequently, thyroid, neurological, cardiovascular, haematological, and salivary gland effects are also detected. With gadolinium-based contrast agents, nausea is the most frequent reaction, but there is also a risk of producing nephrogenic systemic fibrosis and cerebral deposits of uncertain significance.

The most effective way of avoiding type A reactions is to decrease the dose and frequency of contrast media administration, especially in patients with pre-existing renal insufficiency. To prevent post-contrast acute kidney injury, adequate hydration of the patient should be maintained orally or intravenously, avoiding prolonged periods of liquid fasting.

On the other hand, hypersensitivity reactions are dose-independent and clinically can range from mild cutaneous reactions to anaphylaxis. This article proposes an algorithm that differentiates between nonspecific reactions and true hypersensitivity reactions, as well as levels of severity. It also provides a treatment scheme for immediate reactions adjusted to the severity level, with a focus on the management of anaphylaxis and an early intramuscular administration of adrenaline. Finally, it sets out recommendations for the management of patients with previous hypersensitivity reactions who require elective or urgent contrast administration, favouring the use of alternative contrast media with confirmed tolerance instead of the indiscriminate use of premedication.

放射造影剂，包括碘基和钆基造影剂，都可能导致不良反应。A 类不良反应与造影剂的药理特性有关，包括副作用、继发性作用和毒性作用。造影后急性肾损伤是碘化造影剂最常见的不良反应。甲状腺、神经系统、心血管、血液学和唾液腺方面的不良反应也较少见。对于钆类造影剂，恶心是最常见的反应，但也有产生肾源性全身纤维化和意义不明的脑沉积物的风险。避免 A 型反应的最有效方法是减少造影剂的剂量和使用频率，尤其是对已存在肾功能不全的患者。另一方面，超敏反应与剂量无关，临床上可从轻微的皮肤反应到过敏性休克。本文提出了一种区分非特异性反应和真正超敏反应以及严重程度的算法。文章还提供了根据严重程度调整的即时反应治疗方案，重点是过敏性休克的处理和肾上腺素的早期肌肉注射。最后，它还提出了对曾有过超敏反应、需要择期或紧急使用造影剂的患者的处理建议，主张在确认耐受的情况下使用其他造影剂，而不是不加选择地使用预处理药物。

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引用次数: 0

Equipos multienergía y contraste yodado 多能量和碘造影设备

IF 1.1 Q3 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

RADIOLOGIA

Pub Date : 2024-10-01 DOI: 10.1016/j.rx.2024.03.008

Spectral CT acquires images with the emission or detection of two separate energy spectra. This enables material decomposition due to the photoelectric effect (prevalent in low-energy photons) and Compton scattering (prevalent in high-energy photons).

Iodine and other materials with high atomic numbers appear more hyperdense on low-energy monoenergetic images because of the direct relation between the photoelectric effect and the Z value.

Given the way iodine behaves on spectral maps, radiologists can optimise the use of contrast media in these CTs, thus allowing lower doses of radiation and lower volumes of contrast media while achieving the same CT values and even enabling lower contrast flow rates, which is especially helpful in patients with poor vascular access. Moreover, in suboptimal diagnostic cases caused by poor contrast opacification, the resolution can be improved, thus avoiding the need to repeat the study.

光谱 CT 通过发射或探测两个独立的能谱来获取图像。由于光电效应和 Z 值之间的直接关系，碘和其他原子序数较高的物质在低能量单能谱图像上显得更加高密度。鉴于碘在光谱图上的表现，放射科医生可以优化造影剂在这些 CT 中的使用，从而在获得相同 CT 值的同时降低辐射剂量和造影剂用量，甚至降低造影剂流速，这对血管通路不畅的患者尤其有帮助。此外，在因造影剂不透光而导致诊断结果不理想的病例中，可以提高分辨率，从而避免重复检查。

引用次数: 0

Responsabilidad del radiólogo en el manejo de los medios de contraste. Consentimiento informado y otras controversias 放射医师在处理造影剂方面的责任。知情同意和其他争议

IF 1.1 Q3 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

RADIOLOGIA

Pub Date : 2024-10-01 DOI: 10.1016/j.rx.2024.04.009

Radiological contrast media play an essential role in radiology departments by facilitating more precise and detailed images. It is important to note that for radiologists the use of these contrast agents implies several legal responsibilities and ethical considerations towards patients. This article will explore the main issues related to responsibility and complication management for radiologists, referring physicians and other related professionals, as well as issues around informed consent, contraindications for their use and the benefit-risk balance assessed when deciding if a contrast-enhanced test should be carried out. In addition, we will address the crucial role of the radiologist in effective communication with patients and in obtaining informed consent. This research relates to Spanish legislation in the context of medical practice.

放射造影剂在放射科发挥着至关重要的作用，因为它能提供更精确、更详细的图像。值得注意的是，对于放射科医生来说，使用这些造影剂意味着要对患者承担一些法律责任和道德考量。本文将探讨与放射科医生、转诊医生和其他相关专业人员的责任和并发症处理有关的主要问题，以及与知情同意、造影剂使用禁忌症和决定是否进行造影剂增强检查时的利益-风险平衡评估有关的问题。此外，我们还将讨论放射科医生在与患者有效沟通和获得知情同意方面的关键作用。这项研究涉及医疗实践中的西班牙立法。

引用次数: 0

Medios de contraste basados en gadolinio de distribución extracelular 细胞外分布的钆基造影剂

IF 1.1 Q3 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

RADIOLOGIA

Pub Date : 2024-10-01 DOI: 10.1016/j.rx.2024.04.007

Extracellular gadolinium-based contrast agents (GBCA) are commonly used in magnetic resonance imaging (MRI) because they increase the detection of alterations, improve tissue characterisation and enable a more precise differential diagnosis.

GBCAs are considered to be safe but they are not risk-free. When using GBCAs, it is important to be aware of the risks and to know how to react in different situations (pregnancy, breastfeeding, kidney failure) including if complications occur (extravasations, adverse, allergic or anaphylactic reactions).

The article describes the characteristics of the gadolinium molecule, the differences in the biochemical structure of these GBCA, their biodistribution and the effect on the MRI signal. It also reviews s

afety aspects and the most common clinical applications.

细胞外钆基造影剂（GBCA）常用于磁共振成像（MRI），因为它们能增加对病变的检测、改善组织特征并能进行更精确的鉴别诊断。在使用 GBCA 时，重要的是要了解其风险，并知道在不同情况下（怀孕、哺乳、肾衰竭）应如何应对，包括如果出现并发症（外渗、不良反应、过敏反应或过敏性反应）。文章还回顾了安全性问题和最常见的临床应用。

引用次数: 0

Medios de contraste específicos para el estudio del hígado en resonancia magnética 用于核磁共振肝脏研究的特定造影剂

IF 1.1 Q3 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

RADIOLOGIA

Pub Date : 2024-10-01 DOI: 10.1016/j.rx.2024.05.004

A. Perez-Girbes , J.M. Lee , L. Martí-Bonmatí

The use of hepatobiliary-specific contrast agents in liver MRI is a crucial diagnostic tool for evaluating liver disease, enabling the detection and characterisation of focal lesions and vascular alterations, as well as the assessment and grading of chronic hepatopathy. Paramagnetic hepatobiliary-specific contrast agents are gadolinium-based, partially taken up by hepatocytes, and excreted via both renal and biliary pathways. There are two linear ionic molecules that are currently commercially available: gadobenic acid (Gd-BOPTA) and gadoxetic acid (Gd-EOB-DTPA). Their main clinical indications include distinguishing and characterising focal liver lesions on healthy liver tissue, diagnosing and staging hepatocellular carcinoma in patients with chronic hepatopathy, and increasing reliability in the detection of hepatic metastases in oncology patients, especially prior to surgery. They are also useful in the evaluation of the biliary tract and in assessing complications of hepatic surgery such as bile leaks.

在肝脏磁共振成像中使用肝胆特异性造影剂是评估肝脏疾病的重要诊断工具，可用于检测和描述病灶和血管改变，以及评估和分级慢性肝病。顺磁性肝胆特异性造影剂以钆为基础，部分被肝细胞吸收，并通过肾脏和胆道排泄。目前市面上有两种线性离子分子：钆本酸（Gd-BOPTA）和钆醋酸（Gd-EOB-DTPA）。它们的主要临床适应症包括：区分健康肝组织上的肝脏病灶并确定其特征；对慢性肝病患者的肝细胞癌进行诊断和分期；提高检测肿瘤患者肝转移的可靠性，尤其是在手术前。它们在评估胆道和肝脏手术并发症（如胆漏）方面也很有用。

引用次数: 0

Los retos futuros de los medios de contraste en Radiología 放射学造影剂的未来挑战

IF 1.1 Q3 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

RADIOLOGIA

Pub Date : 2024-10-01 DOI: 10.1016/j.rx.2024.05.012

E. Alvarez-Hornia Pérez , C. Carnelli , P.A. Gutierrez , R. González Sánchez , J. Mesa Quesada

Contrast media (CM) were first used soon after the discovery of X-rays in 1895. Ever since, continuous technological development and pharmaceutical research has led to tremendous progress in radiology, more available techniques and contrast media, and expanded knowledge around their indications.

A greater prevalence of chronic diseases, population ageing, and the rise in diagnosis and survival times among cancer patients have resulted in a growing demand for diagnostic imaging and an increased consumption of CM.

This article presents the main lines of research in CM development which seek to minimise toxicity and maximise efficacy, opening up new diagnostic and therapeutic possibilities through new molecules or nanomedicine. The sector, which is continuously evolving, faces challenges such as shortages and the need for more equitable and sustainable practices.

造影剂（CM）是在 1895 年发现 X 射线后不久开始使用的。自那时起，不断的技术发展和药物研究带来了放射学的巨大进步、更多可用的技术和造影剂，以及有关其适应症的更多知识。慢性疾病的流行、人口老龄化以及癌症患者诊断和存活时间的增加导致了对诊断成像的需求不断增长，造影剂的消耗量也随之增加。本文介绍了造影剂开发的主要研究方向，这些方向旨在通过新分子或纳米医学将毒性降至最低并将疗效最大化，从而开辟新的诊断和治疗可能性。该行业在不断发展的同时也面临着各种挑战，如短缺以及需要更加公平和可持续的做法。

引用次数: 0

Tipos de análisis de la captación de gadolinio extracelular 细胞外钆摄取分析的类型

IF 1.1 Q3 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

RADIOLOGIA

Pub Date : 2024-10-01 DOI: 10.1016/j.rx.2024.04.002

The use of extracellular gadolinium-based contrast agents provides valuable information in magnetic resonance studies, thus increasing diagnostic confidence. These contrast agents make it easier to detect and define injuries, and narrow down the differential diagnosis. They are indicated for several different reasons, both for diagnostic purposes and for evaluating the response to treatment. Morphological analysis can assess the type of uptake, the qualitative and semiquantitative study of the signal intensity vs time curves in multiphase sequences, and the quantitative analysis of the uptake with T1 or T2* perfusion studies associated with pharmacokinetic models.

Multiphase dynamic studies with 3 D sequences contain valuable information that is not exploited by a simple visual analysis of 2 D images. To take advantage of this information and the imaging biomarkers provided, computational analysis should be used. To this end, the future role of artificial intelligence is increasingly evident.

细胞外钆基造影剂的使用为磁共振研究提供了宝贵的信息，从而提高了诊断的可信度。这些造影剂能更容易地检测和确定损伤，缩小鉴别诊断的范围。它们适用于多种不同的原因，既可用于诊断，也可用于评估治疗反应。形态学分析可评估摄取类型，多相序列中信号强度与时间曲线的定性和半定量研究，以及与药代动力学模型相关的 T1 或 T2* 灌注研究对摄取的定量分析。要利用这些信息和所提供的成像生物标志物，就应该使用计算分析。为此，人工智能未来的作用越来越明显。

引用次数: 0

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