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Rotator cuff injuries: from imaging to therapeutic. A systematic and structured approach whit arthroscopic correlation

A. M. Perez1, L. Cerezal2, E. Llopis3, C. Pisanti4, A. Cruz2, L. GARCIA5; 1 caracas/VE 2 Santander/ES 3 Alzira-Valencia/ES 4 Caracas/VE 5 CARACAS/VE

Learning objectives: Highlight the relevance of the different types  of rotator cuff tears under a therapeutic approach. Identify and evaluate the different types of rotator cuff  tears through MRI  or MRA whit arthroscopy correlation. Offer a guide for a  structured radiologic reports based on the [...]

Background: There is lack of uniformity in radiologic reports regarding rotator cuff tears.  There are no standardized criteria and usually they do not give the information require by the orthopaedic surgeon.  As radiologist we have the duty to provide essential information in a clear an simple manne[...]

Findings and procedure details: ISAKOS proposes to asses rotator cuff injuries using the following characteristics from the acronym PEARL: Pattern, Extension, Atrophy, Retraction and Localization. (Image 1)   LOCALIZATION: Where is the lesión? posterosuperior? (SS, IS or TM) or anterior (subscapularis),since their surgical a[...]

Conclusion: The RADIOLOGIC REPORT in rotator cuff injuries plays a critical role in the decision making process for the surgeon and  the prognostic and outcome of the patient. Radiologist must be aware of the treatment implications of the different types of tear and learn what are the parameters to evaluat[...]

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References: Alireza Eajazi Steve Kussman. Rotator Cuff Tear Arthropathy: Pathophysiology, Imaging Characteristics, and Treatment Options. AJR 2015; 205:W502–W511. Davidson J, Burkhart SS (2010). The geometric classification of rotator cuff tears: a system linking tear pattern to treatment and prognosis. Arthros[...]


Fractional anisotropy changes in the subventricular zone in patients with multiple sclerosis

G. García-Martí, L. Marti-Bonmati, C. Alcala, R. Sanz-Requena, B. Casanova; Valencia/ES

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Aims and objectives: The subventricular zone (SVZ) contains multi-potent neural stem cells and is able to replace neural cells lost during a neurodegenerative process. Some studies have shown microstructural and functional interhemispheric asymmetries of several areas of the central nervous system in patients with multi[...]

Methods and materials: Forty-eight subjects (37 patients with multiple sclerosis and 11 healthy matched controls) were included in the study. MR images were obtained on a 3T magnet (Achieva, Philips) using the following parameters (DTI sequence, 32 directions, b value=1300, TR=7000 ms, TE=75 ms, FA=90º, 66 slices with no [...]

Results: Age and sex did not differ between groups of patients and controls (ANOVA; p=0.83; F=0.42), (Chi-Square; p=0.12), respectively. FA values showed a statistically significant increase (ANOVA; p=0.014; F=6.49) in the left SVZ in patients with multiple sclerosis when compared with the healthy control gr[...]

Conclusion: The present work revealed macroscopic significant tissue organization differences in the left SVZ in patients with multiple sclerosis. Further studies will help to clarify the effect and/or influence of the SVZ in multiple sclerosis.

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References: 1.    Schmierer K, Wheeler-Kingshott CA, Boulby PA, Scaravilli F, Altmann DR, Barker GJ, Tofts PS, Miller DH. Diffusion tensor imaging of post mortem multiple sclerosis brain. Neuroimage. 2007;35:467–477. 2.    Savio S, Hakulinen U, Ryymin P, Hagman S, Dastidar P, Soimakall[...]


Solitary Fibrous Tumors with Nervous System Involvement. Diagnostic Imaging Criteria.

M. Morán-Hevia, A. Saiz, E. Santamarta, M. Vicente Quilez, A. Cernuda García, J. Sanz Díaz, J. Peña, Á. Meilán, M. González del Rey Rodríguez; Oviedo/ES

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Learning objectives: The objectives of this exhibit are: To describe and illustrate the radiological findings present in solitary fibrous tumour (SFT) with central nervous system involvement in our series of 5 patients using CT and multiparametric MRI. To review the new classification and immuno-histochemical findings[...]

Background: MAJOR CHANGES IN THE 2016 CNS WHO The current WHO classification of CNS tumours update uses for the first time molecular parameters in addition to histology to define tumour entities. Recent studies have shown that both SFT and HPC share a recurrent inversion of the long arm of chromosome 12 (12q1[...]

Findings and procedure details: We retrospectively reviewed the imaging findings (on CT and MRI) and medical records of nine histologically proven cases of SFT and HPC at our institution between 2007 and 2015. We collected data about its clinical (sex, age, symptoms) and radiological characteristics: size, morphology and location [...]

Conclusion: SFT/HPCs of the CNS are rare and represent a challenge for the radiologist as their imaging features are nonspecific and can mimic other more common CNS tumours. Some of their key imaging features, might be useful in the diagnosis of SFTs: well-defined round or lobulated margins a patched pattern w[...]

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References: Keraliya, Abhishek R. et al. Solitary Fibrous Tumours: 2016 Imaging Update. Radiologic Clinics , Volume 54 , Issue 3 , 565 – 579 Schweizer, Leonille, et al. Meningeal hemangiopericytoma and solitary fibrous tumors carry the NAB2-STAT6 fusion and can be diagnosed by nuclear expression of STAT6 protei[...]


Complications of renal transplantation: Diagnosis and treatment

C. Garcia-Villar, M. García-Alvarez, E. Vallejos-Roca; Cadiz/ES

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Learning objectives: To describe the characteristic features of renal transplantation complications. To establish radiological management for each and treatment to be administrated.  To review the applications of interventional radiology to manage of renal transplantation complications.

Background: Renal transplantation is considered a treatment of choice in cases of chronic renal failure. Whilst kidney transplant dysfunction can present with an elevated rising serum creatinine level, decreasing urine output and pain and tenderness over the graft, often it is clinically asymptomatic and presen[...]

Findings and procedure details: Postoperative complications occur in approximately 12%–20% of patients with renal transplants. Posttransplant complications can be divided into five categories following the imaging-based classification of renal transplant complications (Figure 4): Perinephric collections, parenchymal abnormalitie[...]

Conclusion: A wide range of postoperative complications of renal transplant can be diagnosed and managed with minimally invasive techniques. Radiologists must know about post-renal transplant complications, since it is essential to respond with early treatment, which improves the prognosis of the transplanted k[...]

Personal information: Cristina García-Villar. Radiology Department. Hospital Universitario Puerta del Mar. Cádiz, Spain. Teresa García-Álvarez. Nephrology Department. Hospital Universitario Puerta del Mar. Cádiz, Spain.   Eduardo Valloejos-Roca. Radiology Department. Hospital Universitario Puerta del Mar. Cádiz, S[...]

References: Irshad A, Ackerman S, Sosnouski D, Anis M, Chavin K, Baliga P. A review of sonographic evaluation of renal transplant complication. Curr Probl Diagn Radiol. 2008;37:67-79. Irshad A, Ackerman S, Campbell A, Anis M. An overview of renal transplantation: Current practice and use of ultrasound. Semin Ul[...]


Evaluation of response to locoregional treatment of hepatocellular carcinoma

J. Delgado Moraleda, S. Brugger Frigols, J. Flores Mendez, Y. Ochoa Santiago, P. Oliván Sasot, A. Yepes Agudelo; Valencia/ES

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Learning objectives: Assessment of different treatment loco-regional options. Indication of the different imaging techniques to assess response to treatment. Evaluation of main imaging findings after locoregional therapy available for liver cancer. Definition of response criteria to evaluate imaging loco-regional t[...]

Background: There are different alternatives for the treatment of hepatocarcinoma. In all of them, the radiologist plays a fundamental role, both in diagnosis, treatment and follow-up. Therefore, it is necessary for the radiologist to know the techniques and radiological findings that indicate response to treat[...]

Findings and procedure details: ASSESSMENT OF DIFFERENT TREATMENT LOCO-REGIONAL OPTIONS The radical treatment in hepatocellular carcinoma involves tumor resection or liver transplantation. If this is not possible, locoregional or systemic treatments are used.   The image on interventionist processes of the liver plays an im[...]

Conclusion: The assessment of tumor response after locoregional therapies is essential for the therapeutic management of hepatocellular carcinoma. This requires a proper understanding of the therapeutic strategies and post-treatment tumor appearance. The assessment of tumor response should include both anatomic[...]

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References: 1. Yaghmai V, Besa C, Kim E, Gatlin JL, Siddiqui NA, Taouli B. Imaging assessment of hepatocellular carcinoma response to locoregional and systemic therapy. AJR Am J Roentgenol. 2013 Jul;201(1):80–96. 2. Lencioni R. Loco-regional treatment of hepatocellular carcinoma. Hepatology. 2010 Aug;52(2):76[...]


Cardiac imaging findings in stroke patients: what radiologists need to know. 

F. Zuccarino, M. Vilas, S. Medrano, E. Ripoll, L. Del Carpio Bellido, M. Cufi, H. Tizon, A. Gayete, F. Fernández Alarza; Barcelona/ES

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Learning objectives: To describe CT and MRI cardiac imaging findings that might be cause of stroke. To identify subtle cardiac findings in angiographic-CT study usually performed in initial diagnosis of stroke. To perform a proper differential diagnosis in order to establish an optimal therapeutic approach in the acute [...]

Background: Stroke is a leading cause of death and disability in developed countries. Worldwide, brain infarction is the second most common cause of mortality and the third most common cause of disability. While the overall rate of stroke-related mortality is decreasing, the absolute number of people with strok[...]

Findings and procedure details: TABLE OF CONTENTS Overview   Atrium (> left) High risk causes: atrial fibrillation, atrial thrombi, atrial tumors. Low risk causes: patent foramen ovale, interatrial septal aneurysm, interatrial communication  Ventricle (> left) High risk causes: ventricular thrombi and myocar[...]

Conclusion: Radiologists play a pivotal role in stroke diagnosis and management. Further neuroimaging, new cardiac imaging techniques as CT and MRI can be used to identify several subtle cardiac pathologies responsible for stroke that otherwise may remain unnoticed. Radiologists should be able to recognize thes[...]

Personal information: Contact details: Dr. Flavio Zuccarino Thoracic Radiology Section. Department of Radiology, Hospital del Mar. Passeig Marítim, 25-29, 08003 Barcelona, Spain.   Email: flaviozuccarino@gmail.com   Dr. Marta Vilas Resident in training. Department of Radiology, Hospital del Mar. Passeig [...]

References: 1. Ajlan AM, Bagdadi RR, Alama MN, Ayoub O. Impact of Implementing Cardiac CT in Evaluating Patients Suspected of Cardioembolic Stroke. J Comput Assist Tomogr. 2016 May-Jun;40(3):380-6.  2. Arboix A, Alió J. Cardioembolic Stroke: Clinical Features, Specific Cardiac Disorders and Prognosis. Cur[...]


Cystic mediastinal masses: A diagnostic approach

A. Tenorio Gallardo1, A. P. Quispe Mauricio2, A. Joaquín Laguna3; 1 Salamanca/ES 2 Alcalá de Henares/ES 3 Guadalajara/ES

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Learning objectives: Describe the radiological characteristics and features of benignity of mediastinal cystic masses.   Illustrate the typical locations in the different mediastinal compartments.    

Background: Mediastinal cystic masses are a heterogeneous group of entities that have a congenital, neoplastic and inflammatory nature. They represent 20-32% of all primary mediastinal masses. They are present in children and in adults.   In almost all cases, each condition shows preference for a specific [...]

Findings and procedure details: The growing use of MDCT has increased the finding of these entities, even in asymptomatic patients. Locating them in the different mediastinal compartments is essential for diagnosis.   Morphologically, they are round, with well-defined edges, liquid content and surrounded by a wall of epitheli[...]

Conclusion: CONCLUSIONS In order to reach a correct presumptive diagnosis of mediastinal cystic masses, the most important parameter is their exact location in the mediastinal compartments.   It is important to know the morphological findings due to the risks of complications and the subsequent treatment[...]

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References:   Daniel Vargas, MD, Thomas Suby-long, MD and Carlos S.Restrepo, MD. Cystic lesions of the mediastinum. Semin Ultrasound CT MRI 37: 212-222. Kemal Odev, Bilgin K. Arıbaş , Alaaddin Nayman, Olgun K. Arıbaş , Tamer Altınok , Ahmet Küçükapa. Imaging of Cystic and Cyst-like Lesions of the Mediasti[...]


Magnetic Resonance findings in HIV patients with Progressive Multifocal Leukoencephalopthy - Immune Reconstitution Inflammatory Syndrome 

C. Saavedra Gutierrez1, J. Fernández Gajardo2, M. M. Mendigana Ramos1; 1 Pamplona/ES 2 31008/ES

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Learning objectives: To describe the etiology and pathophysiology of PML-IRIS To review the MR findings of both PML and PML-IRIS To recognize the patterns that should make the radiologist suspect PML-IRIS after initiation of retroviral therapy

Background: Progressive multifocal leukoencephalopathy (PML) is a rare and usually fatal disease caused by reactivation of the polyomavirus JC, characterized by progressive demyelinating of the brain at multiple locations.   Paradoxically, some patients may develop PML during highly active antiretroviral [...]

Findings and procedure details: 1. Introduction and definitions   Progressive multifocal leukoencephalopathy (PML) was first described in 1958. It was first reported in rare association with lymphoma. In 1971, the John Cunningham Virus (JCV) was identified to be the causative agent. PML originally was found to be very rare, h[...]

Conclusion: Neuroimaging findings of PML in patients with HIV are varied. HAART may lead to improvement of many of the imaging findings, but it can occasionally result in IRIS, which has atypical imaging findings. Given the substantial morbidity and mortality associated with PML-IRIS, knowledge of the imaging[...]

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References: Post MJ et al. CNS-Immune Reconstitution Inflammatory Syndrome in the Setting of HIV Infection, part 1: Overview and Discussion of Progressive Multifocal Leukoencephalopathy-Immune Reconstitution Inflammatory Syndrome and Cryptococcal-Immune Reconstitution Inflammatory Syndrome. AJNR Am J Neuroradio[...]

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