The value of magnetic resonance imaging and computed tomography in the study of spinal disorders

Computed tomography (CT) and magnetic resonance imaging (MRI) have replaced conventional radiography in the study of many spinal conditions, it is essential to know when these techniques are indicated instead of or as complementary tests to radiography, which findings can be expected in different clinical settings, and their significance in the diagnosis of different spinal conditions. Proper use of CT and MRI in spinal disorders may facilitate diagnosis and management of spinal conditions. An adequate clinical approach, a good understanding of the pathological manifestations demonstrated by these imaging techniques and a comprehensive report based on a universally accepted nomenclature represent the indispensable tools to improve the diagnostic approach and the decision-making process in patients with spinal pain. Several guidelines are available to assist clinicians in ordering appropriate imaging techniques to achieve an accurate diagnosis and to ensure appropriate medical care that meets the efficacy and safety needs of patients. This article reviews the clinical indications of CT and MRI in different pathologic conditions affecting the spine, including congenital, traumatic, degenerative, inflammatory, infectious and tumor disorders, as well as their main imaging features. It is intended to be a pictorial guide to clinicians involved in the diagnosis and treatment of spinal disorders

Hallazgos ecográficos en las roturas tendinosas del tobillo y su correlación con imágenes de TC y RM

El Trabajo fin de máster ha sido realizado en el Hospital Universitario de Traumatología Virgen de las Nieves de Granada durante el segundo año de formación médica en la especialidad de Radiodiagnóstico.Aunque en ocasiones el diagnóstico de la patología del tobillo y pie puede realizarse mediante la historia clínica y la exploración física, con frecuencia se apoya en los estudios de imagen. La radiografía convencional sigue siendo el método de valoración inicial, y cada vez más se complementa con la ecografía, que valora la patología tendinosa y de los tejidos blandos de una forma eficaz y precisa. Vamos a presentar una serie de casos, diagnosticados en el Hospital de Traumatología Virgen de las Nieves de Granada, de rotura tendinosa por ecografía y su correlación con las imágenes de TC y RM. Éste es un análisis retrospectivo con 14 pacientes diagnosticados de rotura tendinosa de tobillo por diferentes técnicas de imagen en un periodo comprendido entre 2008 y 2013. De estos pacientes, 7 fueron diagnosticados inicialmente con ecografía y confirmado con RM, 6 fueron diagnosticados con RM inicial y 1 fue diagnosticado inicialmente con TC. Las lesiones afectaron al tendón peroneo lateral largo en 5 casos, al peroneo lateral corto en 6 casos, al flexor común de los dedos en 2 casos, al extensor común de los dedos en 1 caso, al flexor del dedo gordo en 1 caso, al tibial posterior en 2 casos y al tibial anterior en 1 caso. De ellas 4 fueron roturas completas y 10 parciales. Todas se confirmaron con RM o TC y además 4 se confirmaron con cirugía. Teniendo en cuenta los resultados, concluimos que la ecografía es una excelente prueba para el diagnóstico inicial de roturas tendinosas de tobillo debido a sus conocidas ventajas: disponibilidad, rapidez, economía, imagen en tiempo real (dinámica, comparativa). La RM es útil para el diagnóstico preoperatorio. En TC las lesiones tendinosas también se pueden diagnosticar, por lo que los tendones deben de valorarse conjuntamente con el estudio óseo.Universidad de Granada. Departamento de Radiología y Medicina Física. Máster Avances en radiología diagnóstica y terapéutica y medicina física, curso 2012/2013Hospital Universitario Virgen de las Nieve

Percutaneous Microwave Ablation of Desmoid Fibromatosis.

To demonstrate the feasibility of percutaneous microwave ablation in desmoid fibromatosis with respect to tumor volume control and improvement in the quality of life. Twelve microwave ablations were performed in 9 patients with a histological diagnosis of desmoid fibromatosis between January 2010 and January 2019. The study population included 6 female and 3 male, with an age range of 21-76 years (mean = 46.6 years; standard deviation [SD] = 19.3 years). The mean major axis of the tumors was 10.9 cm (SD = 5.2 cm) and mean lesion volume was 212.7 cm³ (SD = 213 cm³). Their anatomical distribution was as follows: 3 lesions in the thigh, 2 in the gluteus, 2 in the leg and 2 in the periscapular region. We evaluated the reduction in tumor volume and improvement in the quality of life based on the Eastern Cooperative Oncology Group (ECOG) scale. An average tumor volume reduction of 70.4% (SD = 24.9) was achieved, while the quality of life (ECOG scale) improved in 88.9% of patients. Percutaneous microwave ablation may potentially be a safe, effective, and promising technique for controlling tumor volume and improving the quality of life in patients with desmoid fibromatosis

Mexican Asthma Guidelines: GUIMA 2017

Background: The need for a national guideline, with a broad basis among specialists and primary care physicians was felt in Mexico, to try unifying asthma management. As several high-quality asthma guidelines exist worldwide, it was decided to select the best three for transculturation. Methods: Following the internationally recommended methodology for guideline transculturation, ADAPTE, a literature search for asthma guidelines, published 1-1-2007 through 31-12-2015 was conducted. AGREE-II evaluations yielded 3/40 most suitable for transculturation. Their compound evidence was fused with local reality, patient preference, cost and safety considerations to draft the guideline document. Subsequently, this was adjusted by physicians from 12 national medical societies in several rounds of a Delphi process and 3 face-to-face meetings to reach the final version. Results: Evidence was fused from British Thoracic Society Asthma Guideline 2014, Global Initiative on Asthma 2015, and Guía Española del Manejo del Asma 2015 (2016 updates included). After 3 Delphi-rounds we developed an evidence-based document taking into account patient characteristics, including age, treatment costs and safety and best locally available medication. Conclusion: In cooperation pulmonologists, allergists, ENT physicians, paediatricians and GPs were able to develop an evidence-based document for the prevention, diagnosis and treatment of asthma and its exacerbations in Mexico