FASCIOLASIS HEPATICA: REPORTE DE UN CASO Y REVISION DE LA LITERATURA

La fasciolasis humana es una zoonosis causada por la Fasciola hepática, trematodo que en su vida adulta afecta principalmente el ganado ovino y bovino, siendo el hombre huésped accidental. La dificultad en el diagnóstico clínico, dada su variada sintomatología, muchas veces requerirá del apoyo imagenológico, por lo que el radiólogo debe estar preparado y conocer la epidemiología de este patógeno, especialmente en aquellas zonas endémicas (Latinoamérica, zonas de Asia y el Norte de África). Es importante considerarla dentro del diagnóstico diferencial de lesiones focales hepáticas, especialmente en el contexto clínico de eosinofiliaHuman fasciolasis is a zoonosis linked to the trematod Fasciola hepatica, which affects primarily bovine and ovine cattle, and by chance, humans. Difficulty in clinical diagnosis due to its various patterns of presentation, it may be necessary to obtain images that enable a diagnosis. Therefore, in endemic zones (such as Latin America, Asia, and northern Africa), should include this entity as differential diagnosis for focal liver lesion, especially in the presence of eosinophili

HIGADO GRASO: ULTRASONIDO Y CORRELACION ANATOMOPATOLOGICA

: El hígado graso es una entidad patológica que se caracteriza por acumulación de glóbulos de grasa dentro de los hepatocitos. Es una patología que en ultrasonido se diagnostica cada vez más, sin embargo es necesario usar algunos criterios para su diagnóstico. Nuestro objetivo fue estandarizar criterios ultrasonográficos, correlacionándolos con anatomía patológica, para diagnóstico de esteatosis y su cuantificación en grados de severidad (leve, moderado, severo). Este estudio mostró una concordancia moderada entre el ultrasonido y biopsiaAbstract: Fatty liver is a pathology characterized for accumulation of triglycerides within the hepatocytes. Today is diagnosed frequently by ultrasound and is important to know the ultrasonographic findings for the diagnosis. Our purpose was to correlate ultrasound and pathologic findings in the diagnosis of steatosis and propose grades of severity. This study demonstrated moderate concor-dance between ultrasound and biopsy finding

In vivo temperature mapping of prostate during treatment with TherMatrx TMx-2000 device: Heat field and MRI determinations of necrotic lesions

Background and Purpose: The effectiveness of any thermotherapy device is determined by the temperatures created and how long they are applied. Understanding the heating characteristics of a thermotherapy device is vital to its correct implementation. Interstitial temperature mapping was used to determine the heat field created within the prostate by the TherMatrx TMx-2000 transurethral microwave thermotherapy (TUMT) device. Gadolinium-enhanced MRI was used to determine the extent, type, and pattern of coagulation necrosis caused by TUMT. Patients and Methods: Interstitial temperature mapping was performed during treatment in five patients with benign prostatic hyperplasia using 24 temperature sensors inserted through the perineum and arrayed throughout the prostate under ultrasound and X-ray guidance. Gadolinium-enhanced MRI scans were performed on all patients 1 week after treatment. Results: Interstitial temperature mapping found the heat field created to peak at the urethral surfac

Characterizing TUNA® ablative treatments of the prostate for benign hyperplasia with gadolinium-enhanced magnetic resonance imaging

Background and Purpose: Transurethral Needle Ablation of the prostate (TUNA®) has been accepted as an office-based treatment for benign prostatic hyperplasia (BPH) for many years. Clinical outcomes have been reported, but the amount and location of the necrosis produced have yet to be characterized. The necrosis caused by TUNA was evaluated by gadolinium-enhanced magnetic resonance imaging (MRI) of the pelvis. Patients and Methods: Twelve patients with BPH/lower urinary-tract symptoms underwent standard TUNA, and MRI scans with gadolinium enhancement were performed before and 1 week after treatment. The images were studied using Analyze® software to quantify the amount of necrosis compared with the prostatic volume. Transverse, coronal, and sagittal images were obtained to identify the location of the necrosis. Results: New gadolinium defects were seen in all patients after TUNA. The lesions coalesced into continuous areas of necrosis and correlated with the site of needle placement.

Characterizing ProstivaTM RF Treatments of the Prostate for BPH with Gadolinium-Enhanced MRI

Transurethral needle ablation (TUNA) is an accepted and effective therapy for the treatment of lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH). ProstivaTM (Medtronic, Shoreview, MN) is the newest-generation device, which includes a new needle design and radio frequency (RF) generator. This device creates temperatures of 120°C and necrotic lesions in less than 2.5 min. Using previously described techniques, we analyzed dynamic, gadolinium-enhanced MRIs to characterize the ablative properties of the new ProstivaTM RF device

COLANGIORESONANCIA (CPRM) VS ULTRASONIDO (US) FOCALIZADO EN PACIENTES CON ICTERICIA O SOSPECHA DE OBSTRUCCION DE LA VIA BILIAR: RESULTADOS PRELIMINARES

Introducción. Existe controversia en el algoritmo de estudio de obstrucción de la vía biliar (VB). La colangiopacreatografía endoscópica retrógrada (ERCP) ha sido el examen de referencia. La colangioresonancia (CPRM) es un examen no invasivo con buena correlación entre observadores al evaluar la VB, pero aún cuestionada en nuestro medio por su mayor costo. El US convencional focalizado detecta dilatación de VB y disminuye los costos del algoritmo de estudio, seleccionando los pacientes que debieran referirse a otros métodos de estudio más costosos o invasivos (CPRM-ERCP). Objetivo. Comparar la validez, valores predictivos y cambios de probabilidad post-test de CPRM y US focalizado a la VB, en el estudio de pacientes con ictericia o sospecha de obstrucción biliar. Materiales y métodos. Se realizó un ensayo clínico pareado ciego. La muestra la constituyeron pacientes con sospecha de patología obstructiva de la VB a los cuales se les solicitó CPRM entre Enero-Julio 2003. Se les realizó US 24 hr antes o después de la CPRM por ecografistas de diferente experiencia. La CPRM se realizó con protocolos estándar, se registró el uso de Gadolinio y secuencias adicionales. El estándar dorado lo constituyeron la cirugía, la ERCP, seguimiento de al menos 30 días y revisión de informes de Anatomía Patológica. Se clasificó el riesgo de obstrucción de la VB en alto, moderado o bajo. Análisis. Se construyeron tablas de contingencia de 2x2 para estimar los valores del test: Sensibilidad (S), Especificidad (E), Valores predictivos positivo (VPP) y negativo (VPN), Likelihood ratios (LR) y probabilidades pre y post test. Resultados. Muestra constituida por 76 pacientes de los cuales 64 han completado el seguimiento. En el grupo de Alto riesgo en 21 pacientes se comprobó obstrucción, en 1 de los de moderado, en ninguno de los de bajo riesgo y en 2 de los no clasificados. La prevalencia de obstrucción (probabilidad pre-test) fue de 24/64 (37.5%). El US encontró dilatación de la VB en el 50% de los pacientes y la CPRM en el 48%. La principal causa de obstrucción fue la coledocolitiasis (25%), siendo las neoplasias la segunda. Para el diagnóstico de obstrucción de la vía biliar de cualquier causa el US mostró una S de 58.33%, la cual aumentó a 70% cuando el ecografista era experimentado, una E de 82.5%, VPP de 66.67% y VPN de 76.74% y LR(+) de 3.3 con una probabilidad post-test de 55%, un LR(-) de 0.49 con una probabilidad post-test de 20%. La CPRM para este mismo diagnóstico presentó una S de 95.83% y una E de 87.5%, así como un VPP de 82.14% y VPN de 97.22%; un LR(+) de 7.7 lo que lleva a una probabilidad post-test de 80% y un LR(-) de 0.05, con una probabilidad post-test de 3%. Para coledocolitiasis los VP(+) y VP(-) fueron, respectivamente, 53.33% y 83.67% para el US, y 70% y 95.45% para la CPRM. Conclusiones. CPRM posee sensibilidad, valores predictivos y LR(s) mejores que ultrasonido focal en la detección de obstrucción de la vía biliar. Ambos métodos poseen valores cercanos de Especificidad y de detección de dilatación de los conductos biliares. En el algoritmo de estudio de un paciente con sospecha de obstrucción de la vía biliar usar US en serie y luego CPRM cuando no se diagnostica la causa de obstrucción, sería la alternativa actual, probablemente más costo-efectiva en el estudio de estos pacientes.Between January and July, 2003, a single blinded matched trial was done to assess focalized biliary ultrasound (US) and MR cholangiography (MRCP) compared with ERCP or surgery as reference standard in patients with suspected biliary obstruction. Focalized US was performed 24 hrs before/after MRCP. Patients were triage according symptoms, signs and laboratory in high, intermediate and low risk for obstruction. Radiologists sonographers were divided in low and highly experienced. None of the radiologist who reported either US or MRCP was aware to the other test results. Sensitivity, Specificity, PPV and NPV, (LR) Likelihood Ratios and pre and post-test odds for positive and negative test were estimated. We analized 64 out of 76 sampled patients, the prevalence of obstruction was 37 % (24 out of 64 patients). US found biliary tree dilated in 50% and MRCP in 48% of the patients. Main cause of obstruction was common bile duct stones in (16) 25%. and tumors were the second more common cause. US shown a Sensitivity (S) 58.3% when a non experienced radiologist perform the exam, and 70% when an experienced radiologist doest it. Specificity (Sp) 82,5%, PPV 66.7% and NPV 76.7%. RMCP Shown S 95.8%, Sp 87.5%, PPV 82.1%, NPV 97.2% For common bile duct stones US shown a PPV 53.3% and NPV 83.6% on the other hand MRCP a PPV 70% and NPV 95.4%. MRCP perform better than focalized US in overall patients with high risk of obstruction (37.5%), detecting the cause of obstruction but using aditional sequences rising the examination time and costs. With a positive ultrasound and LR(+) 3.3 pre-test odds rise from 0.37/37% to a post-test odds of 0.55/55% and with negative test result and LR(-) 0.49 pre-test odds 0.37/37% will decrease to post-test odds of 0.2/20%. With MRCP a positive test with LR(+) 7.7 initial pre-test odds 0.37/37.5% to post-test odds of 0.8/ 80% and with a negative test result LR(-) 0.05 pretest odds 0.37/37% will decrease to post-test odds of 0.03%. Ultrasound performed by experienced sonographers has a Specificity and NPV over 80%, and perform similar to MRCP for detecting biliary tree dilatation the best predictor of obstruction. In patients with low pre-test odds (low risk) of obstruction, to use focalized US and then MRCP, when the cause of obstruction is not diagnosed could be the more cost/efective initial alternative in this patients. This data must be confirmed with further studies with cost/effectivenes analysis