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Resumen La COVID-19 es una enfermedad con una gran semiologia clinica, bioquimica y radiologica, que tiene una afectacion preferente por el pulmon, probablemente debido a un mayor numero de receptores ECA-2. La infeccion celular activa sustancias proinflamatorias y provoca un dano alveolar difuso, que es la base histopatologica del distres respiratorio del adulto. La fase exudativa explicaria las imagenes “en vidrio deslustrado” y consolidacion, mientras que la tendencia hacia una morfologia mas lineal representa la fase proliferativa. Tanto la tomografia computarizada (TC) como la tomografia por emision de positrones/ tomografia computarizada (PET/TC) apoyan el caracter inflamatorio de las lesiones pulmonares cuando la enfermedad esta en fase inicial o es leve-moderada. Los casos graves muestran una hipoperfusion pulmonar que se explicaria por una alteracion de la ventilacion-perfusion alveolar (V/Q). Por otro lado, un estado protrombotico conlleva mayor probabilidad de enfermedad tromboembolica por la activacion de la via de la coagulacion y plaquetaria, con la produccion de sustancia de degradacion de la fibrina (dimero D) asi como el consumo de plaquetas.

Resumen Objetivo Valorar las implicaciones de los falsos negativos (FN) y de los falsos positivos (FP) de la tomografia computarizada (TC) y la tomografia por emision de positrones (PET) con fluorodesoxiglucosa ( 18 F-FDG) en nuestro medio en la estadificacion ganglionar mediastinica de pacientes operados de carcinoma de pulmon de celulas no pequenas (CPCNP). Material y metodos Estudio retrospectivo de 113 pacientes consecutivos con 120 CPCNP operados; 22 pacientes recibieron tratamiento neoadyuvante. Se compararon los resultados obtenidos en la 18 F-FDG PET-TC prequirurgica con los patologicos. Se analizaron el tamano ganglionar y del tumor primario en la TC, y su valoracion cualitativa y semicuantitativa (SUVmax) en la PET. Resultados Se encontraron ganglios metastasicos en el 21,7% de los 120 tumores y en el 7,7% de las 528 estaciones ganglionares analizadas. La 18 F-FDG PET-TC en el estudio por tumor mostro una sensibilidad del 53,8%, una especificidad del 76,6%, un valor predictivo positivo del 38,9%, un valor predictivo negativo del 85,7% y una precision diagnostica del 71,7%. La tasa de FN fue del 14,2%. El analisis multivariable mostro que un grado de diferenciacion moderado del tumor primario (p = 0,005) y una SUVmax del tumor primario >4 (p = 0,027) eran los factores asociados con los FN. La tasa de FP fue del 61,1% y el tamano ganglionar >1 cm era el factor asociado con los FP (p Conclusiones La 18 F-FDG PET-TC en la estadificacion ganglionar mediastinica de pacientes con CPCNP mejora la especificidad y el valor predictivo negativo, y ayuda al clinico a seleccionar los pacientes que se beneficiaran de la cirugia. Dada la elevada tasa de FP, es recomendable que, antes de excluir a pacientes de la cirugia, se confirmen histologicamente los casos positivos.

Left ventricular systolic function: How to understand it and analyze it Abstract In cardiac magnetic resonance imaging studies, left ventricular systolic function is usually calculated automatically. To understand and interpret parameters of left ventricular systolic function correctly, it is fundamental to understand how each parameter is obtained and why values obtained with different techniques, for example, ultrasonography and magnetic resonance imaging, can differ. This article provides details about the usual analysis of systolic function from the quantitative and qualitative points of view; it also explains other methods that do not require specific software. Moreover, we provide a file that we designed for use with Microsoft Excel ® to enable simple, intuitive analysis of systolic function. Readers can use this file freely.

Papillary carcinoma is the second most common renal cell carcinoma. It has a better prognosis than the more frequent clear cell carcinoma, although this does not hold true for advanced cases, because no specific treatment exists. It presents as a circumscribed peripheral tumor (small and homogeneously solid or larger and cystic/hemorrhagic) or as an infiltrating lesion that invades the veins, which has a worse prognosis. Due to their low vascular density, papillary renal cell carcinomas enhance less than other renal tumors, and this facilitates their characterization. On computed tomography, they might not enhance conclusively, and in these cases they are impossible to distinguish from hyperattenuating cysts. Contrast-enhanced ultrasonography and magnetic resonance imaging are more sensitive for detecting vascularization. Other characteristics include a specific vascular pattern, hypointensity on T2-weighted images, restricted water diffusion, and increased signal intensity in opposed phase images. We discuss the genetic, histologic, clinical, and radiological aspects of these tumors in which radiologists play a fundamental role in management.

To assess the importance of false-negative and false-positive findings in computed tomography (CT) andThis retrospective study included 113 consecutive patients and 120 resected NSCLCs; 22 patients received neoadjuvant treatment. We compared the findings on preoperativeMetastatic lymph nodes were found in 26 (21.7%) of the 120 tumors and in 41 (7.7%) of the 528 lymph node stations analyzed.In mediastinal lymph node staging in patients with NSCLC

Cancer of the esophagus is a tumor with aggressive behavior that is usually diagnosed in advanced stages. The absence of serosa allows it to spread quickly to neighboring mediastinal structures, and an extensive lymphatic drainage network facilitates tumor spread even in early stages. The current TNM classification, harmonized with the classification for gastric cancer, provides new definitions for the anatomic classification, adds non-anatomic characteristics of the tumor, and includes tumors of the gastroesophageal junction. Combining endoscopic ultrasound, computed tomography, positron emission tomography, and magnetic resonance imaging provides greater accuracy in determining the initial clinical stage, and these imaging techniques play an essential role in the selection, planning, and evaluation of treatment. In this article, we review some particularities that explain the behavior of this tumor and we describe the current TNM staging system; furthermore, we discuss the different imaging tests available for its evaluation and include a diagnostic algorithm.

Heart failure is not always due to an alteration in systolic function, and a diastolic dysfunction could explain many cases of heart failure with a normal systolic function. Diastolic function depends on the left ventricular filling capacity to ensure a normal stroke volume. It is routinely measured with transthoracic echocardiography, as it is an easily accessible non-invasive test. The MRI, using flow sequences, shows good agreement with the echocardiography, analysing the diastolic function in a practical way, by the flow into the mitral valve and pulmonary veins. In this sense, the analysis of diastolic function should be added as part of a routine cardiac MR examination.

In cardiac magnetic resonance imaging studies, left ventricular systolic function is usually calculated automatically. To understand and interpret parameters of left ventricular systolic function correctly, it is fundamental to understand how each parameter is obtained and why values obtained with different techniques, for example, ultrasonography and magnetic resonance imaging, can differ. This article provides details about the usual analysis of systolic function from the quantitative and qualitative points of view; it also explains other methods that do not require specific software. Moreover, we provide a file that we designed for use with Microsoft Excel(®) to enable simple, intuitive analysis of systolic function. Readers can use this file freely.

Heart valve disease is a clinical problem that has been studied with classical imaging techniques like echocardiography and MRI. Technological advances in CT make it possible to obtain static and dynamic images that enable not only a morphological but also a functional analysis in many cases. Although it is currently indicated only in patients with inconclusive findings at echocardiography and MRI or those in whom these techniques are contraindicated, multidetector CT makes it possible to diagnose stenosis or regurgitation through planimetry, to evaluate and quantify valvular calcium, and to show the functional repercussions of these phenomena on the rest of the structures of the heart. Given that multidetector CT is being increasingly used in the diagnosis of ischemic heart disease, we think it is interesting for radiologists to know its potential for the study of valvular disease.

Heart failure is not always due to an alteration in systolic function, and a diastolic dysfunction could explain many cases of heart failure with a normal systolic function. Diastolic function depends on the left ventricular filling capacity to ensure a normal stroke volume. It is routinely measured with transthoracic echocardiography, as it is an easily accessible non-invasive test. The MRI, using flow sequences, shows good agreement with the echocardiography, analysing the diastolic function in a practical way, by the flow into the mitral valve and pulmonary veins. In this sense, the analysis of diastolic function should be added as part of a routine cardiac MR examination.

We present the cases of two men with isolated spontaneous dissection of visceral arteries diagnosed by multidetector CT. In the first patient, dissection of the celiac trunk was associated with periarterial changes. In the second patient, dissection of the superior mesenteric artery was associated with stenosis at the root of the celiac trunk. Both patients presented with acute pain, which was more intense and longer lasting in the first patient. Aortic dissection was suspected clinically in both patients. Both dissections were short and had patent saccular false lumens and reduced caliber of the true lumens. This morphological type is one of the most uncommon within this rare entity. However, in recent years, the number of cases published is rising. This suggests that this entity may have been underdiagnosed before the widespread use of multidetector CT. We discuss the two morphological classifications of dissection of the visceral arteries and the need to adapt therapeutic management to the particular circumstances of each case.