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A-875

Introduction: Peruvian radiology: how is it going?

J. L. Guerrero Gil1, L. Carrillo Diaz1, P. Tapia Puente Arnao2; 1 Lima/PE 2 Lim/PE

Learning Objectives

1. To become familiar with the Peruvian situation in the radiological world.
2. To show some radiological tools and their distribution over the country.
3. To give some information about radiological training in Peru.

Abstract

Peru is a South American country. We are about 30 million people. Our geography is very difficult and our cities have different conditions of life. That is why we have few modern cities specially at seaside with good level of health and education facilities and many other cities in the mountains and jungle regions with not so good level. The best hospitals, clinics and universities are in the main cities. There are 25 universities in Peru, 15 of them have medical schools. There is only one national program of residency and a 3-year training of radiology is included. Approximately 10 universities in different hospitals and clinics are able to train 30 or 40 radiologists a year and most of those are in Lima. There are about 500 radiologists in Peru and almost a half of them live and work in Lima, and are not yet members of the radiology society. We do not have official programs of fellows yet, but this is not bad at all because a Peruvian radiologist usually has to resolve a lot of problems in US, CT, MRI, x-ray in thorax, abdomen, etc. in different patients such as children, adults or old patients every day and that makes them very good general radiologists. We have a few modern hospitals and clinics with modern equipment such as PET CT, MRI, CT scans and digital mammography. They are distributed in the seaside cities specially in Lima; digital mammography, ultrasounds, digital radiography are spread out in almost all the cities of the country.

A-876

MRI findings in CNS tuberculosis

R. Marquina Diaz; Lima/PE

Learning Objectives

1. To give information about the characteristics of the MRI signs of the CNS tuberculosis in Peruvian patients.
2. To understand the accuracy of the MRI signs in CNS tuberculosis.
3. To show MRI images of CNS tuberculosis simulating other pathologies.

Abstract

In Peru, tuberculosis is a major cause of morbidity in the group of young adults, 82% of TB cases reported in 2013 and 2014 primarily affected the lungs. 77% of cases were diagnosed with pulmonary TB smear positive and nearly 40% with smear with a high bacillary load (2-3 crosses). Almost 18% of cases of extra pulmonary tuberculosis and pleural location had the highest percentage (54%), lymph nodes (11.1%) and meningeal/nervous system (9%) was reported. Magnetic resonance (MR) imaging has been shown to be superior to CT in evaluating patients with suspected meningitis and its associated complications. Complications of meningitis include hydrocephalus, vasculitis, cranial nerve involvement, and associated multiple tuberculomas. Tuberculomas are among the most common intracranial mass lesions and the most common manifestation of parenchymal TB and less than 2 to 3 cm in size. Tuberculous abscess are generally larger. In tuberculous spondylodiscitis, MR imaging is currently the imaging modality of choice, given its superior ability in the detection of soft tissue and bone marrow changes. Finally, numerous conditions can mimic tuberculomas on conventional imaging. Other imaging techniques such as diffusion imaging, perfusion and MR spectroscopy may help in differentiating these conditions.

A-877

Interlude: From Peruvian mummies to bones: use of x-rays in Peruvian archaeology (part 1)

J. L. Guerrero Gil1, P. Tapia Puente Arnao2; 1 Lima/PE 2 Lima/PT

Learning Objectives

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Abstract

X-rays are not only useful in medicine but are also particularly useful in other studies like archaeology. We are going to show you some of those applications in the study of mummies in Paracas a Pre Inca civilization types of mummifications, some results about the uses of conventional x-ray and CT scans and differences between dry and freezing mummifications.

A-878

MRI findings in non-tuberculosis infectious diseases in the CNS

P. Tapia Puente Arnao; Lima/PE

Learning Objectives

1. To learn about some infectious illness of the CNS in Peru and their MRI signs.
2. To give information about the accuracy of MRI signs in infection diseases.
3. To show MRI images of CNS infections simulating other pathologies.

Abstract

CNS infectious diseases in Peru are still one of the leading causes of morbidity and mortality. We still have socioeconomic barriers that have limited the physicians from offering the best diagnostic method for the patient. MRI and CT reveal structural abnormalities and play a critical role in the initial diagnosis of new onset of neurologic symptoms in general. Nowadays due to techniques like diffusion, perfusion and spectroscopy associated with clinical and laboratory tests a more detailed analysis can be made that may significantly improve the sensitivity and specificity of MRI. The role of radiology in the diagnosis of infectious diseases is enormous. We need to identify the extension of the disease, the geographic region, and evaluate response of the diseases to different treatments. There are many infectious pathogens known to cause CNS infection, including broad categories of bacteria, viruses, fungi, mycobacteria, and parasites. In most cases, it is impossible for the radiologist with certainty to identify a specific organism as the cause of an observed radiographic abnormality in the CNS. In Peru, we can see cases of infection such as Balamuthia mandrillaris amoeba and co-infection of rhinocerebral mucormicosis and sinonasal aspergillosis. Geographical information, exposures, and clinical information supplied in the medical record can significantly aid in developing a more specific differential diagnosis. Different areas of Peru are well known for specific infectious pathology; for example, the leading cause of late-onset seizures and epilepsy in the north of Peru is neurocysticercosis.

A-879

Interlude: From Peruvian mummies to bones: use of x-rays in Peruvian archaeology (part 2)

J. L. Guerrero Gil, P. Tapia Puente Arnao; Lima/PE

Learning Objectives

-

Abstract

X-rays are not only useful in medicine but are also particularly useful in other studies such as archaeology. We are going to show you some of those applications in the study of mummies in Paracas a Pre Inca civilization types of mummifications, some results about the uses of conventional x-ray and CT scans and differences between dry and freezing mummifications.

A-880

Non-diagnosed spondyloarthritis in MRI of the spine for lower back pain

J. Carpio; Lima/PE

Learning Objectives

1. To demonstrate that routine spine MRI for lower back pain is not sufficient for finding osteitis in spondyloarthritis.
2. To understand the MRI signs in lumbosacral spondyloarthritis.

Abstract

Spondyloarthropathies (SpA) include a group of long-term (chronic) diseases of joints as well as the spine and sacroiliac joints. It is divided into axial spondyloarthritis axSpA (ankylosing spondylitis AS) and peripheral spondyloarthritis. They share clinical and radiologic manifestations as well as familial aggregation and a strong association with HLA B27 antigen. Inflammatory back pain is the leading symptom of the SpA. ASAS criteria to diagnose axial SpA include MRI of sacroiliac joints to find bone marrow oedema (BME). However, MRI-identified structural lesions are not included (contradictory due to the fact that it is criteria in simple x-ray) as neither are spinal lesions. 23% to 50% of patients with ankylosing spondylitis (with disease clinically active) or “non-radiographic’’ axial SpA can have acute spinal inflammatory lesions without evidence of acute sacroiliitis by MRI. Chronic back pain is often investigated by nonrheumatologists and SI joint scanning may be excluded. On the other hand, ASAS criteria only evaluate sacroiliac joints leaving spine without evaluation. Are current criteria sufficiently capable of including all those patients with potential diagnosis of spondyloarthropathies? In any case, what can modify to achieve a greater range of sensitivity in our studies?

Panel discussion: Is MRI the gold standard in CNS infection disease?

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