Radiologia最新文献

Transcatheter aortic valve implantation (TAVI) is the alternative to surgical valve replacement, expanding its indications in the latest guidelines. Multimodal CT (MDCT) is essential in patient selection and detection of complications. Vascular complications are frequent, so it is important to analyse the anatomy of the vessels before the procedure. Regarding annular ruptures and ventricular perforations, the volume and distribution of calcium and the ventricular diameter play an important role. Finally, valve migration is a rare complication that can occur both during and after TAVI. Proper planning of the MDCT procedure reduces the risk of complications and gives the interventional cardiologist security both before and during the procedure.

Papillary endothelial hyperplasia (PEH) or Masson's tumor is a rare benign vascular tumor that usually appears in the soft tissues of the head and neck, trunk and extremities, being extremely rare in the breast. Its diagnosis can be a challenge, especially in the follow-up of patients with previous disease of breast carcinoma. We present the case of a 65-year-old patient, with a history of bilateral breast cancer and reconstruction with implants, who presented a Masson's tumor during follow-up. An ultrasound scan was performed, showing a well-circumscribed mass in the left breast, located in the posterior contour of the implant. Subsequently, magnetic resonance imaging (MR) depicted an enhancing tumor, without infiltration of adjacent structures. Finally, the definitive anatomopathological diagnosis was obtained after surgical excision.

Thoracic surgical procedures are increasing in recent years, and there are different types of lung resections. Postsurgical complications vary depending on the type of resection and the time elapsed, with imaging techniques being key in the postoperative follow-up. Multidisciplinary management of these patients throughout the perioperative period is essential to ensure an optimal surgical outcome. This pictorial review will review the different thoracic surgical techniques, normal postoperative findings and postsurgical complications.

Introduction

Pneumatosis intestinalis is a radiological finding characterized by the presence of gas in the bowel wall that is associated with multiple entities. Our aim is to know its incidence in lung transplant patients, its physiopathology and its clinical relevance.

Methods

A search of patients with pneumatosis intestinalis was performed in the database of the Lung Transplant Unit of our hospital. The presence of pneumatosis after transplantation was confirmed in all of them and relevant demographic, clinical and imaging variables were collected to evaluate its association and clinical expression, as well as the therapeutic approach after the findings.

Results

The incidence of pneumatosis intestinalis after lung transplantation in our center was 3.1% (17/546), developing between 9 and 1270 days after transplantation (mean, 198 days; median 68 days). Most of the patients were asymptomatic or with mild symptoms, without any major analytical alterations, and with a cystic and expansive radiological appearance. Pneumoperitoneum was associated in 70% of the patients (12/17). Conservative treatment was chosen in all cases. The mean time to resolution was 389 days.

Conclusion

Pneumatosis intestinalis in lung transplant patients is a rare complication of uncertain origin, which can appear for a very long period of time after transplantation. It has little clinical relevance and can be managed without other diagnostic or therapeutic interventions.

Introduction

In recent years, systems that use artificial intelligence (AI) in medical imaging have been developed, such as the interpretation of chest X-ray to rule out pathology. This has produced an increase in systematic reviews (SR) published on this topic. This article aims to evaluate the methodological quality of SRs that use AI for the diagnosis of thoracic pathology by simple chest X-ray.

Material and methods

SRs evaluating the use of AI systems for the automatic reading of chest X-ray were selected. Searches were conducted (from inception to May 2022): PubMed, EMBASE, and the Cochrane Database of Systematic Reviews. Two investigators selected the reviews. From each SR, general, methodological and transparency characteristics were extracted. The PRISMA statement for diagnostic tests (PRISMA-DTA) and AMSTAR-2 were used. A narrative synthesis of the evidence was performed. Protocol registry: Open Science Framework: https://osf.io/4b6u2/.

Results

After applying the inclusion and exclusion criteria, 7 SRs were selected (mean of 36 included studies per review). All the included SRs evaluated “deep learning” systems in which chest X-ray was used for the diagnosis of infectious diseases. Only 2 (29%) SRs indicated the existence of a review protocol. None of the SRs specified the design of the included studies or provided a list of excluded studies with their justification. Six (86%) SRs mentioned the use of PRISMA or one of its extensions. The risk of bias assessment was performed in 4 (57%) SRs. One (14%) SR included studies with some validation of AI techniques. Five (71%) SRs presented results in favour of the diagnostic capacity of the intervention. All SRs were rated "critically low" following AMSTAR-2 criteria.

Conclusions

The methodological quality of SRs that use AI systems in chest radiography can be improved. The lack of compliance in some items of the tools used means that the SRs published in this field must be interpreted with caution.

The migration phenomenon is increasingly common worldwide. It is essential for radiologists to be aware of the endemic diseases of the migrant's country as well as the characteristics of the journey to be able to understand and interpret radiological findings when admitted to our centre.

This article aims to use imaging from our centre to describe the most common pathologies that migrant patients present with after long journeys by boat.

Introduction

The use of abdominal radiography (AXR) apparently continues to be widespread despite its limited indications, the potential radiation and unnecessary costs associated. In addition, the interpretation and its report seem variable and not always performed by a radiologist. Our objective is to analyze the use, adequacy and usefulness of AXR in the emergency of a tertiary referral hospital.

Material and methods

We retrospectively reviewed all the AXR performed in January 2020 in the emergency of our centre, as well as the patient’s demographics and medical records, technical quality of the radiographs, indications according to the SERAM (Spanish Society of Radiology) Appropriateness Guidelines, presence of a formal radiology report, and impact on the clinical management of the patient. Of all non-appropriated AXR we calculated the radiation received by the patients and its extra costs.

Results

In January 2020, 429 AXR (9.1% of all radiographies) were performed in the emergency of our centre. The most frequent indication was abdominal pain (40%, n = 176), followed by low back pain (21.4%, n = 92). 12.4% of AXR requested did not include any clinical information. Most of the AXR (79.6%) had sufficient technical quality. 61.3% (n = 263) of the AXR performed were not indicated, assuming an average unjustified radiation dose per patient of 0.50 ± 0.33 mSv, and a total additional cost of 6575;. Only 6% of the inadequate AXRs led to a change in the clinical management of the patient, compared to 29% of the adequate AXR (p < 0.001). Only 3% of the AXR had a formal radiology report.

Conclusions

AXR is still common in the emergency setting, although most of them might be inadequate according to the SERAM Appropriateness Guidelines. Its use should be optimized to avoid unnecessary radiation and costs. Radiologists must have a more active participation in the management of AXR.

After introducing what is understood by teaching innovation and its requirements, various methodologies that can be applied in university and radiological teaching are presented, such as: the flipped classroom focuses on the student’s previous study and the teacher’s subsequent contribution to resolve doubts or highlight important aspects. Team learning or cooperative teaching allows learning among the students themselves. Problem-based or case-based learning encourages students, in teams or individually, to carry out structured learning based on learning objectives. Teaching based on games or simulation can facilitate knowledge acquisition playfully and practically. Personalized tutoring allows the transmission of knowledge in an individualized way. Various evaluation modalities that can be used for training purposes are also shown.