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Purpose: The aim of this study is to assess the diagnostic value of magnetic resonance imaging (MRI), alone or combined with positron emission tomography (PET), for evaluation of mediastinal disease in lymphoma in comparison with PET/computed tomography (CT). Material and methods: Eighteen prospective studies with sample size ranging between 17 and 140 patients were included in this analysis. MRI, regardless of the sequence obtained, where used for the evaluation of lymphoma. Histopathology results and clinical or imaging follow-up were used as the reference standard. Studies were excluded if the sample size was less than 15 cases or if less than 15 lymph nodes assessment were presented. Papers not reporting sufficient data were also excluded. Results: As compared to PET/CT, MRI proved to be an alternative to use in evaluation of mediastinal disease of lymphoma. MRI has high sensitivity and specificity for nodal and extranodal involvement in lymphoma and the agreement between MRI with the standard technique was high. The ALARA principle reinforces these findings because it is a radiation-free technique and its use is preferred in young population at risk of being subjected to several studies. Conclusion: MRI seems to be a promising and free-radiation alternative due to its high sensitivity and specificity, as well as its high level of agreement with the standard reference. This suggests that MRI could play a significant role in lymphoma study. Resumen: Objetivo: El objetivo de este estudio es evaluar el valor diagnóstico de la resonancia magnética (RM), sola o combinada con la tomografía por emisión de positrones (PET), para la valoración de la afectación mediastínica en el linfoma en comparación con la tomografía computarizada (TC)/PET. Material y métodos: Se incluyeron en el análisis 18 estudios prospectivos con un tamaño de muestra que oscilaba entre los 17 y los 140 pacientes. Se utilizó la resonancia magnética, independientemente de la secuencia obtenida para la evaluación del linfoma. Los resultados de histopatología y el seguimiento clínico o de imagen se utilizaron como estándar de referencia. Se excluyeron los estudios si el tamaño de la muestra era inferior a 15 casos, o si se presentaron evaluaciones de menos de 15 ganglios linfáticos. Los artículos que no proporcionaban datos suficientes también fueron excluidos. Resultados: En comparación con PET/TC, la RM demostró ser una alternativa útil en la evaluación de la afectación mediastínica del linfoma. La RM tiene una alta sensibilidad y especificidad para detectar afectación nodal y extranodal en el linfoma y la concordancia entre la RMy la técnica estándar fue alta. El principio ALARA refuerza estos hallazgos porque es una técnica libre de radiación y su uso se prefiere en la población joven en peligro de ser sometida a varios estudios. Conclusión: La RM parece ser una alternativa prometedora y libre de radiación debido a su alta sensibilidad y especificidad, así como a su alto nivel de concordancia con la referencia estándar. Esto sugiere que la RM podría desempeñar un papel importante en el estudio del linfoma.

Pleuroparenchymal fibroelastosis (PPFE) is a rare, generally idiopathic form of interstitial pneumonia with unique clinical, radiological and histopathological features. It is named after the presence of upper lobe pleural and subjacent parenchymal fibrosis, with accompanying elastic fibers. Although it is usually an idiopathic disease, it has been linked to other co-existent diseases. Diagnostic suspicion of PPFE is based on the identification of typical abnormalities on chest CT scan, which are prevailingly located in the upper lobes, adjacent to the apex of the lungs. Diagnosis can be confirmed by histological analysis, although biopsy is not always feasible. The disease is generally progressive, but not uniformly. The course of the disease is frequently slow and involves a progressive loss of upper lobe volume, which results in platythorax, associated with a significant reduction of body mass. PPFE concomitant to other interstitial lung diseases is associated with a poorer prognosis. The disease occasionally progresses rapidly causing irreversible respiratory insufficiency, which leads to death. Currently, there is no effective pharmacological therapy available, and lung transplantation is the best therapeutic option. The purpose of this review is to draw the attention to PPFE, describe its clinical, radiological and histopathological features, analyze its diagnostic criteria, and provide an update on the management of the disease.

Introduction. Lung cancer is a major health problem. Mediastinal staging performed with the aid of imaging techniques is essential for appropriate disease treatment and prognosis. Accordingly, this study aimed to ascertain the usefulness of positron emission tomography (PET) in mediastinal staging, establish the best maximum standardized uptake value (SUVmax) cutoff point, compare its usefulness to that of computed tomography (CT), and determine the influence of histological tumour subtype. Methods. We conducted a retrospective study across a period of 3 years on 128 patients with suspicion of lung cancer and analyzed their demographic and radiological characteristics using CT and PET to perform the mediastinal examination. Histology was regarded as the gold standard. Results. PET displayed a high sensitivity (95%) and negative predictive value (NPV) (92%), outperforming CT (89% and 85%, respectively). Percentage agreement with histology was also higher (0.207 and 0.241 for CT and PET, respectively; p<0.001). Taking an SUVmax value of 0.5 as that which would ensure greatest diagnostic accuracy, S and NPV were 100%, though percentage agreement did not increase (0.189; p<0.001). PET discriminatory power was not affected by histological tumour subtype. Conclusions. The results of our study indicate that PET might be a useful test for examination of the mediastinum in lung cancer patients. Its high NPV suggests that the absence of mediastinal uptake could be used to proceed to surgical treatment without the need for further tests or examinations. Nevertheless, studies directly aimed to answer this specific question are needed.

Imaging techniques are clinical decision-making tools in the evaluation of patients with colorectal cancer (CRC). The aim of this article is to discuss the potential of recent advances in imaging for diagnosis, prognosis, therapy planning, and assessment of response to treatment of CRC. Recent developments and new clinical applications of conventional imaging techniques such as virtual colonoscopy, dual-energy spectral computed tomography, elastography, advanced computing techniques (including volumetric rendering techniques and machine learning), magnetic resonance (MR) imaging-based magnetization transfer, and new liver imaging techniques, which may offer additional clinical information in patients with CRC, are summarized. In addition, the clinical value of functional and molecular imaging techniques such as diffusion-weighted MR imaging, dynamic contrast material-enhanced imaging, blood oxygen level-dependent imaging, lymphography with contrast agents, positron emission tomography with different radiotracers, and MR spectroscopy is reviewed, and the advantages and disadvantages of these modalities are evaluated. Finally, the future role of imaging-based analysis of tumor heterogeneity and multiparametric imaging, the development of radiomics and radiogenomics, and future challenges for imaging of patients with CRC are discussed. Online supplemental material is available for this article. ©RSNA, 2018.

Background: Lung cancer is the second most common cancer in both men and women. Mediastinal lymph node involvement in these patients, determined by imaging tests, indicates prognosis and modifies therapeutic attitude. Purpose: The aim of this study was to analyze the diagnostic capacity of magnetic resonance imaging (MRI) in the study of the mediastinum in comparison with conventional tests (computed tomography [CT] and positron-emission tomography [PET] or PET/CT scans), taking histology as the gold standard. Materials and Methods: An observational study was conducted on 16 patients with suspicion of primary lung cancer (June 2016 through December 2018). We studied their demographic characteristics and used CT, PET, or PET/CT scans and MRI (diffusion-weighted imaging-MRI sequence) to examine mediastinal disease and compare MRIs diagnostic yield and percentage agreement to that of conventional tests. Results: As compared to CT and PET scanning, MRI displayed a very low sensitivity and a specificity of 90 and 88%, respectively; positive predictive value was 0.67 (both) and negative predictive value (NPV) was 0.28 and 0.22, respectively. MRI showed a high degree of agreement in lymph node diagnosis when compared with histology (91.2%; P = 0.001): specificity in this case was high (E = 0.94), as was the NPV (NPV = 0.97). Conclusions: The results of this study would appear to indicate that MRI could play a relevant role in mediastinal staging of lung cancer. More prospective, multicenter studies are, however, needed to be able to draw up firm recommendations about the role of MRI and its place in lung cancer staging.

Pleural epithelioid haemangioendothelioma (EHE) is a rare tumour that originates in the vascular endothelium with an intermediate degree of malignancy between haemangioma and angiosarcoma. Smoking and asbestos exposure are unproven risk factors and diagnosis is usually confirmed by thoracoscopy, since pleural fluid (PF) cytology is often not conclusive. Immunohistochemistry can also help to confirm the diagnosis. We report an 85-year-old patient with bilateral pleural EHE diagnosed by thoracoscopy, who debuted with a spontaneous bilateral haemothorax, the second described so far, and we conducted a thorough review of the literature to describe the clinical, radiological and prognostic features, as well as the PF, of this rare tumour.

Introduction The aim of this study is to assess the diagnostic value of the magnetic resonance imaging (MRI) in differentiating metastasic from non-metastatic lymph nodes in NSCLC patients compared with computed tomography (CT) and fluorodeoxyglucose (FDG) - positron emission tomography (PET) or both combined. Methods Twenty-three studies (19 studies and 4 meta-analysis) with sample size ranging between 22 and 250 patients were included in this analysis. MRI, regardless of the sequence obtained, where used for the evaluation of N-staging of NSCLC. Histopathology results and clinical or imaging follow-up were used as the reference standard. Studies were excluded if the sample size was less than 20 cases, if less than 10 lymph nodes assessment were presented or studies where standard reference was not used. Papers not reporting sufficient data were also excluded. Results As compared to CT and PET, MRI demonstrated a higher sensitivity, specificity and diagnostic accuracy in the diagnosis of metastatic or non-metastatic lymph nodes in N-staging in NSCLC patients. No study considered MRI inferior than conventional techniques (CT, PET or PET/CT). Other outstanding results of this review are fewer false positives with MRI in comparison with PET, their superiority over PET/CT to detect non-resectable lung cancer, to diagnosing infiltration of adjacent structures or brain metastasis and detecting small nodules. Conclusion MRI has shown at least similar or better results in diagnostic accuracy to differentiate metastatic from non-metastatic mediastinal lymph nodes. This suggests that MRI could play a significant role in mediastinal NSCLC staging.

Objective: The purpose of this study was to determine how the slice thickness reconstruction influences quantitative perfusion CT parameters. Materials and Methods: Eighteen patients with cancer (15 non-small-cell lung cancer, 2 rectal cancer and 1 renal cancer) were examined prospectively with multidetector row CT. A 90-second perfusion study was performed after intravenous bolus injection of contrast material. Blood flow, blood volume, mean transit time and permeability-surface area product were determined at three different slice thickness reconstruction (1.25, 2.5 and 5 mms) both in tumors and in paraspinal muscle. Mean values, limits of agreement between measurements and within-subject coefficient of correlation were obtained for these thicknesses. Results: Mean ± standard deviation BF, BV, MTT and PS in lesions were 118.7 ± 117.9 mL/min/100g tissue, 8.2 ± 8.2 mL/100g tissue, 7.5 ± 5.4 seconds and 10.3 ± 7.2 mL/min/100g tissue respectively at1.25 mmslice thickness; 116.1 ± 115.7 mL/min/100g tissue, 7.8 ± 8.7 mL/100g tissue, 7 ± 4.5 seconds and 10.4 ± 7.5 mL/min/100g tissue at 2.5 mms; and 119.6 ± 115.7 mL/min/100g tissue, 7.8 ± 8.8 mL/100g tissue, 5.4 ± 3.4 seconds and 9.6 ± 7.5 mL/min/100g tissue at 5 mms. Differences between means for different slice thickness where relatively small in all parameters (

Adult intussusception (AI) is a rare entity with an organic lesion within the intussusception in 70-90% of the cases. Intussusception is classified according to location, etiology, and to the presence or not of a lead point. We illustrate several causes of AI with a variety of radiological findings on plain film, ultrasonography, computed tomography, magnetic resonance, and endoscopy seen at our institution. Imaging plays a major role in their diagnosis and in determining the appropriate treatment.

Immunoglobulin G4 (IgG4)-related disease is a relatively recently proposed clinical-pathologic entity that is characterized by fibro-inflammatory lesions rich in IgG4-positive plasma cells and, often but not always, elevated serum IgG4 concentrations. IgG4-related disease was recognized as a systemic disease in 2003, when extrapancreatic manifestations were identified in patients with autoimmune pancreatitis. Since then, the disease has been reported as affecting virtually every organ system and has been identified in the biliary tree, salivary and lacrimal glands, periorbital tissues, lungs, lymph nodes, thyroid gland, kidneys, prostate gland, testicles, breasts, and pituitary gland. Its pathogenesis is poorly understood, but findings are consistent with both an autoimmune and an allergic disorder. Although definitive diagnosis requires histopathologic analysis, imaging plays an important role in demonstrating infiltration and enlargement of involved organs. Because of the systemic nature of the disease, imaging workup of IgG4-related disease should always include whole-body examinations to detect multiorgan involvement. Patients often present with subacute development of a mass in or diffuse enlargement of the affected organ, sometimes mimicking a neoplastic process. In every anatomic location, several inflammatory and neoplastic entities must be considered in the differential diagnosis. Because IgG4-related disease usually shows a marked response to corticosteroid therapy, radiologists should be familiar with its clinical and imaging manifestations to avoid a delay in diagnosis and unnecessary surgical interventions.

Caseous calcification of the mitral annulus is a rare form of periannular calcification with a mass-like appearance, that has to be in the differential of the cardiologist and radiologist. It classically looks like a round or semilunar hyperdense mass with an even denser peripheral rim, located in the posterior mitral annulus and having in general no clinical significance.

Arteriovenous fistulas (AVFs) are abnormal communications with shunting of blood from an artery to a vein. AVFs mainly involve the peripheral vascular system but can affect virtually any organ or system in the body. They may be congenital, created surgically for hemodialysis, or caused by pathologic processes. This review describes the diverse origins of AVFs and illustrates the spectrum of imaging findings at radiography, ultrasound, CT, MRI, and digital angiography for AVFs in different locations: the CNS, thorax, abdomen, musculoskeletal system, and peripheral vascular system. We also discuss syndromes associated with AVFs and describe recent interventional techniques for treating AVFs.Familiarity with the spectrum of imaging findings in AVFs is essential for the accurate interpretation of images and facilitates diagnosis and therapeutic management. Radiologists can play a critical role in the diagnosis and treatment of AVFs. Digital angiography is helpful in elaborating a vascular map for endovascular treatment.

A computerized pulmonary segmentation based on the detection of oriented edges was performed in postero-anterior (PA) digital radiography (DR) images. To further improve detection of lung contours, a method based on the use of active contours models was developed. First, the technique calculates a set of reference lines to determine the relative position of the lungs in the image. Then, vertical and horizontal rectangular regions of interest (ROIs) are studied to identify the preliminary edge. These points are an approximation to the lung edges that are adjusted using the active contours models. We studied the influence of the different parameters of the active contours on the final result over 30 DR images. Results prove that the active contour models, with selected parameters, can be used to improve the results of a given segmentation scheme.

Sr. Director: La ingestion de cuerpos extranos es relativamente frecuente en determinados grupos de pacientes (ninos de corta edad, ancianos o individuos con trastornos de la deglucion, poblacion penitenciaria, enfermos psiquiatricos y disminuidos psiquicos) causando el 80% de las perforaciones esofagicas cervicales1, 2. Sin embargo, la ingestion de comprimidos encapsulados (dentro del blister) es poco frecuente3, 4, 5, 6, 7, 8, 9, 10. Presentamos un caso de perforacion esofagica tras la ingestion accidental de un comprimido encapsulado. Varon de 68 anos con antecedentes de diabetes mellitus tipo 2, hipertension arterial, fibrilacion auricular y alcoholismo cronico que acudio a urgencias por disfagia y disnea. Le habia sido dada el alta 24h antes tras un ingreso por un sindrome de abstinencia alcoholica. Previamente al alta habia sufrido un episodio de atragantamiento con un comprimido, aparentemente resuelto. Tras llegar a su domicilio e intentar ingerir alimentos el paciente presento odinofagia, tos y, progresivamente, disnea y malestar general, por lo que acudio nuevamente a urgencias. A su llegada presentaba fiebre, disminucion del murmullo vesicular y roncus en el hemitorax derecho. Las exploraciones complementarias realizadas (analitica, gasometria arterial y radiografia de torax) demostraron leucocitosis con neutrofilia, insuficiencia respiratoria y una radiopacidad pulmonar en la base derecha compatible con neumonia por aspiracion. Una TC urgente de cuello y torax revelo un cuerpo extrano de densidad calcio en el esofago (Figura 1 A, corte axial, flecha; Figura 1 B, corte coronal, flecha), asociado a una pequena perforacion en la pared esofagica (Figura 1 A, asterisco). La endoscopia digestiva alta...

Sr. Director: La lipomatosis mediastinica (LM) es un trastorno benigno caracterizado por el deposito de tejido adiposo no encapsulado en el mediastino1. Presentamos un caso de LM secundaria a tratamiento con corticoides en un paciente con sindrome de superposicion hepatitis autoinmune-cirrosis biliar primaria. Varon de 63 anos, ex fumador y bebedor de unos 40g de etanol/dia, sin otros antecedentes de interes que fue diagnosticado de sindrome de superposicion hepatitis autoinmune-cirrosis biliar primaria iniciando tratamiento con prednisona (60mg/dia) y azatioprina (100mg/dia). A pesar de este tratamiento persistieron datos bioquimicos de hepatitis colestasica por lo que se asocio tacrolimus (9mg/dia). A los 2 meses, el paciente refirio disnea progresiva hasta hacerse de minimos esfuerzos por lo que se decidio su ingreso para estudio. En la exploracion fisica el paciente estaba normotenso, afebril y con habito cushingoide, sin otros hallazgos. En la analitica destacaban: bilirrubina 0,80mg/dl; GOT 54 UI/l; GPT 128 UI/l; GGT 411 UI/l y fosfatasa alcalina 228 UI/l; el hemograma y la coagulacion eran normales. La radiografia de torax demostraba un aumento de la silueta cardiopericardica, no presente en estudios previos. El electrocardiograma era normal. El ecocardiograma demostro una hipertrofia ventricular izquierda leve con funcion sistolica conservada (66%). El electromiograma descarto polineuropatia o miopatia. El estudio funcional respiratorio revelo una alteracion ventilatoria restrictiva moderada. Con estos hallazgos se realizo una tomografia computarizada (TC) toracica que descarto una enfermedad pulmonar primaria y revelo una severa lipomatosis mediastinica y una gran acumulacion de grasa extrapleural bilateral (Figura 1, izquierda), hallazgos indicativos de lipomatosis mediastinica inducida...

[Figure][1] [![Graphic][3] ][3][![Graphic][4] ][4][![Graphic][5] ][5][![Graphic][6] ][6] A 71-year-old man was admitted to the coronary care unit after septal branch perforation (angiogram) during percutaneous coronary intervention of complex stenosis in the left