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Among cross-sectional imaging modalities, computed tomography (CT) is more available and faster; however, magnetic resonance (MR) performs better in terms of sensitivity and specificity, due to its higher contrast resolution. The appearance of peritoneal deposits on CT and MR depends mainly on the primary tumour histology: in case of unknown primary tumour (3-5% of cases), their behaviour at imaging may provide insights on the tumour origin. The time-point of tumour evolution, previous or ongoing treatments and the peritoneal spaces where they occur, also play an important role in determining the appearance of peritoneal deposits. Thus, knowledge of peritoneal anatomy and fluid circulation is mandatory in detection and characterization of peritoneal deposits. Several benign and malignant conditions may show similar imaging features that overlap those of PC, making the differential diagnosis challenging. Clinical history, laboratory findings and previous imaging examinations must be considered to achieve the correct diagnosis.

REIPI-SEIMC COVID-19 group and COVID@HULP group., [Background] The clinical presentation of COVID-19 in patients admitted to hospital is heterogeneous. We aimed to determine whether clinical phenotypes of patients with COVID-19 can be derived from clinical data, to assess the reproducibility of these phenotypes and correlation with prognosis, and to derive and validate a simplified probabilistic model for phenotype assignment. Phenotype identification was not primarily intended as a predictive tool for mortality., [Methods] In this study, we used data from two cohorts: the COVID-19@Spain cohort, a retrospective cohort including 4035 consecutive adult patients admitted to 127 hospitals in Spain with COVID-19 between Feb 2 and March 17, 2020, and the COVID-19@HULP cohort, including 2226 consecutive adult patients admitted to a teaching hospital in Madrid between Feb 25 and April 19, 2020. The COVID-19@Spain cohort was divided into a derivation cohort, comprising 2667 randomly selected patients, and an internal validation cohort, comprising the remaining 1368 patients. The COVID-19@HULP cohort was used as an external validation cohort. A probabilistic model for phenotype assignment was derived in the derivation cohort using multinomial logistic regression and validated in the internal validation cohort. The model was also applied to the external validation cohort. 30-day mortality and other prognostic variables were assessed in the derived phenotypes and in the phenotypes assigned by the probabilistic model., [Findings] Three distinct phenotypes were derived in the derivation cohort (n=2667)—phenotype A (516 [19%] patients), phenotype B (1955 [73%]) and phenotype C (196 [7%])—and reproduced in the internal validation cohort (n=1368)—phenotype A (233 [17%] patients), phenotype B (1019 [74%]), and phenotype C (116 [8%]). Patients with phenotype A were younger, were less frequently male, had mild viral symptoms, and had normal inflammatory parameters. Patients with phenotype B included more patients with obesity, lymphocytopenia, and moderately elevated inflammatory parameters. Patients with phenotype C included older patients with more comorbidities and even higher inflammatory parameters than phenotype B. We developed a simplified probabilistic model (validated in the internal validation cohort) for phenotype assignment, including 16 variables. In the derivation cohort, 30-day mortality rates were 2·5% (95% CI 1·4–4·3) for patients with phenotype A, 30·5% (28·5–32·6) for patients with phenotype B, and 60·7% (53·7–67·2) for patients with phenotype C (log-rank test p, [Interpretation] Patients admitted to hospital with COVID-19 can be classified into three phenotypes that correlate with mortality. We developed and validated a simplified tool for the probabilistic assignment of patients into phenotypes. These results might help to better classify patients for clinical management, but the pathophysiological mechanisms of the phenotypes must be investigated., [Funding] Instituto de Salud Carlos III, Spanish Ministry of Science and Innovation, and Fundación SEIMC/GeSIDA., Funding: Instituto de Salud Carlos III, Spanish Ministry of Science and Innovation, and Fundación SEIMC/GeSIDA.

Obstructive sleep apnea is a risk factor for pulmonary embolism, although its association with pulmonary embolism severity is unknown. Our objective was to study if obstructive sleep apnea is associated with worse pulmonary embolism severity scores and greater extent of arterial obstruction. In consecutive pulmonary embolism patients, we performed respiratory polygraphy and recorded sleep characteristics, classical risk factors for pulmonary embolism and physical activity 6-12 months after the pulmonary embolism episode. Simplified Geneva Prognostic Score and Pulmonary Embolism Severity Index were calculated at the time of the pulmonary embolism diagnosis. The Pulmonary Artery Obstruction Index and the right ventricle to left ventricle diameter ratio were measured by computed tomography pulmonary angiography. We included 120 patients, of whom 45.8% had moderate-severe obstructive sleep apnea (apnea-hypopnea index > 15 hr-1 ). There was a larger proportion of moderate-severe obstructive sleep apnea patients in the third and fourth Pulmonary Artery Obstruction Index quartiles and in the III-V Pulmonary Embolism Severity Index levels compared with apnea-hypopnea index 15 hr-1 group (p < .05). Multiple linear regression analysis identified apnea-hypopnea index as the only independent factor related to Pulmonary Artery Obstruction Index and Pulmonary Embolism Severity Index, whereas desaturation index was associated with simplified Geneva Prognostic Score. Patients with pulmonary embolism and moderate-severe obstructive sleep apnea had greater pulmonary artery obstruction as well as more pulmonary embolism severity, assessed by both the simplified Geneva Prognostic Score and the Pulmonary Embolism Severity Index, compared with patients with apnea-hypopnea index ≤ 15 hr-1 . Moreover, these prognostic indices were independently related to sleep parameters.

Left ventricular pseudoaneurysms have become a rare complication of acute myocardial infarction, occurring in approximately 2% of cases and even less frequently when primary percutaneous intervention can be performed. Regardless of treatment strategy, left ventricle pseudoaneurysms are associated with a high mortality rate. We report on the extremely rare occurrence of a patient surviving two episodes of free wall rupture associated with extensive chest wall destruction and secondary traumatic rib fractures. The key to success in this case is related to both the cardiac and chest wall repair.

Objective: The main objective of this work is to study usefulness of ultrasound (US) for the emergency diagnosis of the penile fracture. Material and methods: We reviewed all the penile US studies registered in our Emergency Department between July 2007 and August 2009 with suspicion of a corpus cavernosum fracture. We compared US findings (subcutaneous hematoma, peri-albuginea hematoma, albuginea rupture and Buck’s fascia rupture), and the clinical progress, with those of the surgery. We studied sensitivity, specificity, positive predictive value and negative predictive value of US in the diagnosis of rupture of the tunica albuginea. The epidemiological data of all the cases reviewed were collected. Results: Twelve patients with a mean age of 37.8 years were reviewed. The most common cause of injury was sexual intercourse. A subcutaneous hematoma was found in nine patients, a peri-albuginea hematoma in eleven of the cases, and an albuginea rupture was seen in six of them. We found no Buck’s fascia rupture. Seven patients underwent surgical treatment and in the remaining five patients, treatment was conservative. Clinical progress was good in all cases. US, as an emergency test to diagnose albuginea fracture gave 0.83 sensitivity, 1 specificity, 1 positive predictive value and 0.83 negative predictive value. Conclusion: We believe that US is a useful procedure in the diagnosis of acute penile fracture and that it could be proposed as the diagnostic method of choice to confirm the clinical suspicion of penile fracture. Identifying the exact site of a tear in the tunica albuginea facilitates the

Resumen Objetivo Valorar la utilidad de los hallazgos ecograficos en la sospecha de fractura de pene. Material y metodos Se revisan las ecografias de pene realizadas en urgencias entre julio de 2007 y agosto de 2009 por sospecha clinica de fractura del cuerpo cavernoso, comparando los hallazgos ecograficos (hematoma subcutaneo, hematoma perialbuginea, rotura de la albuginea y rotura de la fascia de Buck) con los quirurgicos, y la evolucion a medio plazo. Se calculan sensibilidad (S), especificidad (E), valor predictivo positivo (VPP) y valor predictivo negativo (VPN) de los hallazgos ecograficos para el diagnostico de fractura del cuerpo cavernoso. Recogemos datos epidemiologicos de los casos revisados. Resultados Se estudiaron a 12 pacientes, con edad media de 35,75 anos. El origen mas frecuente de la lesion es el traumatismo durante el acto sexual. Ecograficamente, presentaron un hematoma subcutaneo 9 pacientes, perialbuginea 11 sujetos y discontinuidad de la albuginea 6 pacientes. No se visualizaron roturas de la fascia de Buck. Siete fueron operados. En los 5 sujetos restantes se realizo manejo conservador. La evolucion fue siempre satisfactoria. La identificacion mediante ecografia de la discontinuidad de la albuginea mostro una S de 0, 83, E de 1, VPP de 1 y VPN de 0,83. Conclusion Consideramos la ecografia como un procedimiento util para diagnosticar la fractura de cuerpo cavernoso y que se puede proponer como de eleccion para confirmar la sospecha clinica. La identificacion del punto exacto de rotura dirige y facilita la cirugia.

Resumen Fundamento y objetivo Analizar prospectivamente la precision de la tomografia por emision de positrones/tomografia computarizada (PET/TC) frente al patron oro en la estadificacion inicial de los pacientes con linfoma no hodgkiniano (LNH) e identificar el protocolo tecnico mas adecuado. Pacientes y metodo Estudio transversal prospectivo de 76 pacientes diagnosticados de LNH durante 3 anos consecutivos en el Hospital Universitario La Paz de Madrid no tratados previamente. Todos los pacientes fueron estudiados con la tecnica PET/TC: inicialmente se obtuvo una TC de dosis baja, despues el escaner de emision de la PET y posteriormente un estudio de TC de dosis alta con contraste intravenoso. Se reconstruyeron dos estudios de PET/TC para cada paciente: uno de PET/TC de dosis baja (PET/TC DB) y otro de PET/TC de dosis alta (PET/TC DA). Cada modalidad de PET/TC fue evaluada en consenso por un equipo de medico nuclear y radiologo, diferente para cada una de las modalidades. Las imagenes de TC y de PET fueron interpretadas por separado por otro radiologo y otro medico nuclear independientes. Resultados La concordancia con el patron de referencia fue en el 52,2% de los pacientes (κ = 0,458) para la TC, 46% para la PET (κ = 0,335), 75% para la PET/TC DB (κ = 0,664) y 76,8% para la PET/TC DA (κ = 0,679), con p Conclusion La PET/TC es superior en la estadificacion inicial de los pacientes con LNH, siendo la PET/TC DA la tecnica mas precisa de las que hemos estudiado.

The aim of this study was to determine the radiologic findings associated with admission to the intensive care unit (ICU) and the development of acute respiratory distress syndrome (ARDS) in patients with pH1N1 infection. One hundred and four patients (15–96 years) with laboratory-confirmed pH1N1 infection seen at the Emergency Department from July to December 2009 who underwent chest radiographs were studied. Radiographs were evaluated for consolidation, ground-glass opacities, interstitial patterns, distribution, and extent of findings. Eighty-seven (83.7%) of the patients were managed in the ward, and 17 (16.3%) patients eventually required admission to the ICU. All patients admitted to the ICU showed abnormalities on the initial radiograph. The presence of consolidation, multifocal, diffuse, and bilateral involvement on the initial radiograph was associated with a statistically higher risk of requiring ICU admission (p

Resumen Objetivos Determinar si existen diferencias en los hallazgos de la radiografia de torax inicial entre un grupo de pacientes con gripe A y pacientes con sintomas gripales en periodo de gripe estacional. Material y metodos La muestra esta formada por pacientes que ingresan con sintomas gripales y a los que se les realiza radiografia de torax en Urgencias. El grupo de estudio lo constituyen 95 pacientes con gripe A confirmada atendidos entre los meses de julio a diciembre de 2009 y el grupo control 98 pacientes con sintomas de gripe estacional atendidos en enero de 2009. Se analizan los hallazgos radiologicos, su distribucion y localizacion, edad, sexo, enfermedad previa y proyecciones obtenidas. Resultados El grupo de estudio presento menor edad que el control (media 40,2 vs 50,9 anos, p Conclusion Encontramos diferencias significativas entre los hallazgos radiologicos en los pacientes con gripe A (grave) y aquellos con sintomas gripales en periodo de gripe estacional, con mayor incidencia de consolidacion de distribucion parcheada multifocal en la gripe A y en pacientes mas jovenes.

Objectives To determine whether there are differences in the findings on the initial plain chest films of patients with H1N1 influenza and those of patients with flu symptoms during the flu season. Material and methods All patients underwent plain-film chest radiography in the Emergency Department for flu symptoms; 95 patients had H1N1 influenza confirmed between July 2009 and December 2009 and 95 patients were attended for symptoms of seasonal flu in January 2009. We analyzed the views obtained, the distribution and location of the radiologic findings, and patients’ age, sex, and previous disease. Results Patients with H1N1 influenza were younger than those with seasonal flu symptoms (mean 40.2 vs 50.9 years; p Conclusion We found significant differences between the radiologic findings of patients with H1N1 influenza (severe) and those of patients with symptoms of flu during the flu season: the incidence of multifocal patchy consolidation was greater in H1N1 patients and H1N1 patients were younger.

Lung cancer is the leading cause of cancer-related death. Accurate staging is essential for the optimal management and treatment of these patients. Positron emission tomography (PET) and, more recently, PET/CT have been introduced into the diagnostic algorithms for oncologic patients because they provide valuable functional information. The hybrid PET/ CT technique acquires both anatomic (CT) and metabolic (PET) images in a single session, combining the benefits of each modality and minimizing their limitations. This article reviews the role of PET/CT in lung cancer staging, with emphasis on non-small cell carcinoma, evaluating the advantages and limitations of the technique. Other applications of the technique, such as planning radiotherapy, are also discussed.

Objetivo Describir nuestra experiencia con la tecnica combinada tomografia por emision de positrones-tomografia computarizada (PET/TC) en el manejo de la patologia oncologica. Material y metodos El equipo PET/TC combina en un sistema hibrido un escaner helicoidal multicorte y un escaner PET. La tecnica es multidisciplinar interviniendo un medico nuclear, un radiologo, un fisico y un radiofarmaceutico, con funciones diferenciadas. Las indicaciones de la PET se determinan bajo uso tutelado en el Sistema Nacional de Salud (SNS), coordinado por la Unidad de Evaluacion de Tecnologias Sanitarias de la Agencia Lain Entralgo, bajo la supervision y realizacion de un medico nuclear ayudado si se requiere para interpretar la TC por un radiologo. Cuando se usa como estudio combinado, los estudios son supervisados por un medico nuclear y un radiologo. Resultados Entre septiembre de 2003 y agosto de 2005 hemos efectuado 2.459 estudios: 2.200 como PET, con TC de baja dosis (indicaciones clinicas bajo uso tutelado en el SNS) y 259 como estudios realizados en el marco de proyectos de investigacion utilizandose, en estos casos, como sistema hibrido en una unica sesion. Los resultados globales muestran los siguientes porcentajes: cancer de pulmon 14,7%, nodulo pulmonar solitario 7%, neoplasias linfoides 23,5%, cancer colorrectal 18,5%, cancer gastrico 1,9%, tumores cerebrales 2,6%, tumores de cabeza-cuello 5,5%, tiroides 5%, mama 4%, tumores de origen desconocido 4,3%, epilepsia 1,4% y otros 11,6%. Conclusion En nuestra experiencia el sistema hibrido PET/TC aporta ventajas en comparacion con la PET y/o TC aisladamente, pero son necesarios estudios de validacion diagnostica, que estamos realizando en indicaciones clinicas concretas.

We present the case of an 18-year-old man involved in a fall with blunt abdominal trauma. The patient had hypovolemic shock and findings of an acute abdomen. Initial computed tomography (CT) showed pulmonary contusion, pneumohemothorax, hemoperitoneum, hepatic contusion, right kidney laceration and vascular avulsion, rupture of the mesenteric vein, rupture of the right rectus muscle with bowel hernia, and infrarenal aortic dissection. There were no signs of limb or medullar ischemia. After hemodynamic stabilization and surgical repair of the associated lesions, the dissection was successfully treated with a self-expanding aortic Wallstent. Postprocedure CT showed a well-positioned patent stent and the patient was discharged asymptomatic. Percutaneous endovascular stent implantation is minimally invasive and seems to be a safe treatment for traumatic dissection of the abdominal aorta.

To evaluate the long-term effectiveness of nasolacrimal stents for the treatment of obstructive epiphora, and the complications related to the procedure.This study is a non-randomized prospective clinical trial. Eighty-five patients underwent fluoroscopally-guided placement of polyurethane stent in 86 lacrimal systems for the treatment of severe idiopathic obstructive epiphora. The sites of obstruction were: sac-duct junction (n = 65), sac (n = 10), and nasolacrimal duct (n = 11). The procedure was performed in an outpatient basis under local anesthesia. Patients were followed for a mean of 24 months (1-84) with clinical examinations and/or dacryocystography. Clinical success was defined as symptoms resolution or improvement, and the patency of the lacrimal system to irrigation.Stent placement was technically successful in 76 (88.4%) eyes. Technical failures (11.6%) were caused by inability to pass the guide-wire through the lacrimal system. Immediate complications occurred in 19 (22%) eyes, were mild and included: self-limited epistaxis (7), mild palpebral hematoma (7), moderate pain (3), lacrimal puncta bleeding (1), palpebral emphysema (1), and false passage (1). Of the 76 inserted stents, 33 (43.4%) became occluded, and 43 (56.6%) remained patent after a mean of 24 months. Mean duration of stent patency was 38 months. Clinical success was achieved in 40 (52.6%) of the successfully implanted stents.The procedure is well tolerated and can be performed on an outpatient basis. Patency decreases with follow-up, and, in the long-term, the success rate is inferior to that achieved by external dacryocystorhynostomy. However, it many be considered as a valid alternative to surgery in selected patients.

Background: Nesidioblastosis is often resistant to medical therapy and requires near-total pancreatectomy. There is little information on the postoperative imaging findings of these patients. Objective: To demonstrate by US the late imaging findings in these patients. Materials and methods: Children diagnosed with nesidioblastosis and who had undergone 90–95% pancreatectomy received preoperative, immediate-postoperative (within 10 days of surgery) and long-term annual US examinations. In the preoperative study, three anterior–posterior (AP) measurements were obtained of the head, body and tail of the pancreas. In the postoperative and long-term follow-up US, AP and transverse measurements of the pancreatic remnant were obtained. Pancreatic echogenicity was also assessed. The results were compared with normal pancreatic dimensions as a function of age. Glucose metabolism and pancreatic enzymes were also analysed. Results: The study group comprised 22 patients (aged 9 days to 2 years). The pancreas was normal in all preoperative US examinations. The first postoperative examination showed, in all patients, a remnant of the pancreatic head measuring 8–13 mm. The last follow-up US was similar to the first postoperative study in 6 patients, and 12 showed complete pancreatic regeneration (normal size, echogenicity and function), and 4 had incomplete regeneration with head and body normal in size, but lack of a pancreatic tail. All patients were asymptomatic and showed normal laboratory tests. Conclusions: US measurements indicated normal age-dependent growth after near-total resection in 54% of patients. The function and echogenicity of the regenerated pancreas indicate that the increase in organ size was due to normal pancreatic tissue.

Living donor liver transplantation is increasingly being used to help compensate for the increasing shortage of cadaveric liver grafts. However, the extreme variability of the hepatic vascular systems can impede this surgical procedure. Evaluation of potential living donors was conducted in which a two-detector-row computed tomographic (CT) scanner was used to obtain arterial phase and portal dominant phase images following the intravenous injection of contrast material, after which three-dimensional maximum-intensity-projection and volume-rendered images were created. The vascular anatomy was evaluated, with special attention given to the origin and course of the artery to segment IV and the presence of variants, especially those considered relative or absolute contraindications for donation, those requiring reconstruction, or those potentially altering the surgical approach. In addition, graft and remnant liver volumes were determined and the liver parenchyma evaluated. Multidetector CT is proving to be valuable in the evaluation of potential living liver donors, contributing to donor safety and providing comprehensive information about the hepatic vascular anatomy, the liver parenchyma, and graft and remnant liver volume. This information is critical in choosing the most suitable potential donor, in surgical planning, and in obtaining an optimal graft that maintains the balance between blood supply and venous drainage.

Myofibroblastic inflammatory tumor is a controversial entity that shows great variability in clinical presentation, histological findings, evolution, and prognosis. It is a rare cause of primary lung tumor in adults; however, it is the most common cause of lung tumors in children. The diagnosis is fundamentally histological, although histological diagnosis is not easy because myofibroblastic inflammatory tumor is characterized by a polymorphic cellular infiltration of variable cellular composition that could be similar to other diseases such as lymphoma or low-grade sarcoma. We report the case of a 23-year-old woman in whom a solitary pulmonary nodule was discovered incidentally at plain-film chest x-ray.

Acute and chronic liver dysfunction is common after allogeneic bone marrow transplantation (BMT). Although toxicity, graft versus-host disease (GVHD), and viral infections are the major causes, etiologic diagnosis is difficult and often remains unknown. We conducted a prospective study to establish the role of the infection with both the hepatitis C virus (HCV) and the recently discovered hepatitis G virus (HGV) in liver dysfunction after BMT. From January 1994 to December 1995, 59 patients who had undergone an allogeneic BMT at our institution were enrolled in the study. HGV-RNA was identified in serum by nested polymerase chain reaction (PCR), and HCV was studied by the presence of second generation enzyme-linked immunosorbent assay (ELISA)-antibodies and HCV-RNA by nested PCR. HGV-RNA was detected in 25 patients (42%) (before BMT in 18 and after BMT in 7). HCV-RNA was present in 12 patients (20%) (before BMT in 11 and after BMT in one). The presence of HCV-RNA and HGV-RNA was clearly associated with a previous history of blood transfusions. No significant association was found between viral infection and acute liver toxicity. Some degree of liver dysfunction was present 6 months after BMT in 25 of 40 evaluable patients (62%). Long-term liver dysfunction was more common among patients infected with HCV alone (3 of 4) or with both HCV and HGV (3 of 3) than in those infected with either HGV alone (eight of 13) or with no virus infection (10 of 20). We found a high prevalence of HGV infection in our BMT population. However, no role for HGV in liver disease could be established in this study, and the relationship between HGV infection and liver dysfunction requires further clarification.

Acute gastrointestinal bleeding is a common reason for emergency department admissions and an important cause of morbidity and mortality. Factors that complicate its clinical management include patient debility due to comorbidities; intermittence of hemorrhage; and multiple sites of simultaneous bleeding. Its management, therefore, must be multidisciplinary and include emergency physicians, gastroenterologists, and surgeons, as well as radiologists for diagnostic imaging and interventional therapy. Upper gastrointestinal tract bleeding is usually managed endoscopically, with radiologic intervention reserved as an alternative to be used if endoscopic therapy fails. Endoscopy is often less successful in the management of acute lower gastrointestinal tract bleeding, where colonoscopy may be more effective. The merits of performing bowel cleansing before colonoscopy in such cases might be offset by the resultant increase in response time and should be weighed carefully against the deficits in visualization and diagnostic accuracy that would result from performing colonoscopy without bowel preparation. In recent years, multidetector computed tomographic (CT) angiography has gained acceptance as a first-line option for the diagnosis and management of lower gastrointestinal tract bleeding. In selected cases of upper gastrointestinal tract bleeding, CT angiography also provides accurate information about the presence or absence of active bleeding, its source, and its cause. This information helps shorten the total diagnostic time and minimizes or eliminates the need for more expensive and more invasive procedures.

To prospectively analyze the diagnostic accuracy of PET/CT in non-Hodgkin's lymphoma (NHL) and to evaluate the most appropriate study protocol of this technique.Seventy-six biopsy proven NHL patients were enrolled in this prospective study for 3 years. Patients initially underwent a low-dose CT without intravenous contrast, then a PET emission scan and finally a full-dose CT with intravenous contrast. For every patient, two modalities of PET/CT images were reconstructed: a low-dose unenhanced PET/CT and a full-dose enhanced PET/CT. Each modality was evaluated by either of two pairs of readers, different for each modality. Enhanced CT and PET images were evaluated by an independent radiologist and nuclear medicine physician respectively.Agreement between reference standard and techniques was as follows: 52.2% of patients with enhanced CT (κ=0.458), 46% with PET (κ=0.335), 75% with low-dose unenhanced PET/CT (κ=0.664) and 76.8% with full-dose enhanced PET/CT (κ=0.679), with p0.001. Although all techniques underestimated the stage in comparison to gold standard, the lowest percentage was for full-dose enhanced PET/CT (20.3%).PET/CT improved staging accuracy of NHL, being full-dose enhanced PET/CT the most accurate technique in our study.

To report the second case of solitary neurofibroma arising from the tunica albuginea in the literature and to show its imaging findings.We present a case of neurofibroma arising from the tunica albuginea in an adult patient not affected by neurofibromatosis. We describe the ultrasonographic and magnetic resonance imaging (MRI) features and the histopathological characteristics along with a brief bibliographic review.MRI may be useful to characterize paratesticular lesions. Neurofibroma should be included in the differential diagnosis when MRI depicts a well-circunscribed tumour with high-signal intensity on T2 and marked enhancement after gadolinium administration.

OBJETIVO: Comunicar el segundo caso descrito en la literatura de neurofibroma solitario con origen en la tunica albuginea testicular y los hallazgos radiologicos. METODO/RESULTADOS: Presentamos un neurofibroma de la tunica albuginea en un paciente adulto no afectado por neurofibromatosis. Se describen los hallazgos de este tumor en ecografia-doppler y resonancia magnetica (RM) con correlacion histopatologica, asi como una breve revision de la literatura. CONCLUSION: La RM puede ser una tecnica util para ayudar en la caracterizacion prequirurgica de las lesiones paratesticulares. El neurofibroma debe ser incluido en el diagnostico diferencial de masas escrotales cuando estan bien delimitadas y muestran hiperintensidad de senal en T2 y realce intenso tras la administracion de gadolinio.

Accurate diagnosis and staging are essential for an optimal management of cancer patients. Positron emision tomography with 2-deoxy-2-fluorine-18-fluoro-D-glucose ( 18 FDG-PET) and, more recently, 18 FDG-PET/computed tomography ( 18 FDG-PET/CT) have emerged as powerful imaging tools in oncology, because of the valuable functional information they provide. The combined acquisition of PET and CT has synergistic advantages over its isolated constituents and minimizes their limitations. It decreases examination times by 25%–40%, leads to a higher patient throughput and unificates two imaging procedures in a single session. There is evidence that 18 FDG-PET/CT is a more accurate test than either of its components for the evaluation of various tumors. It is a particularly valuable tool for detection of recurrence, especially in asymptomatic patients with rising tumor markers and those with negative or equivocal findings on conventional imaging tests. Yet, there are some limitations and areas of uncertainty, mainly regarding the lack of specificity of the 18 FDG uptake and the variable 18 FDG avidity of some cancers. This article reviews the advantages, limitations and main applications of 18 FDG-PET/CT in oncology, with especial emphasis on lung cancer, colorectal cancer, lymphomas, melanoma and head and neck cancers.

Persistence of the primitive hepatic venous plexus (PPHVP) is an uncommon anomaly that can present associated with complex congenital heart disease and inferior vena cava (IVC) development anomalies and complicate endovascular and surgical procedures. We report a case of PPHVP in a patient with complex congenital heart disease with unexplained persistent arterial desaturation after Kawashima operation and describe magnetic resonance angiography (Angio-MRI) findings leading to the diagnosis. We recommend that IVC-Angio-MRI be performed in preoperative evaluation of patients with complex congenital heart disease and left isomerism when redirection of systemic venous blood to the pulmonary arterial circulation is considered.

PET/CT combines functional and morphologic data and increases diagnostic accuracy in a variety of malignancies. This study prospectively compares the agreement between contrast-enhanced full-dose PET/CT and unenhanced low-dose PET/CT in lesion detection and initial staging of Hodgkin's disease and non-Hodgkin's lymphoma.Forty-seven biopsy-proven lymphoma patients underwent a 18F-FDG PET/CT study that included unenhanced low-dose CT and enhanced full-dose CT for initial staging. Patients who had undergone previous diagnostic CT for initial staging were excluded. For every patient, each modality of PET/CT images was evaluated by either of 2 pairs of readers, with each pair comprising 1 experienced radiologist and 1 experienced nuclear physician. While evaluating one of the 2 types of PET/CT, the readers were unaware of the results of the other type. Lesion detection, number of sites affected in each anatomic region, and disease stage were assessed. Agreement between techniques was determined by the kappa-statistic, and discordances were studied by the McNemar test. Clinical, analytic, histopathologic, diagnostic CT, and PET data; data from other imaging techniques; and follow-up data constituted the reference standard.For region-based analysis, no significant differences were found between unenhanced low-dose PET/CT and contrast-enhanced full-dose PET/CT, although full-dose PET/CT showed fewer indeterminate findings and a higher number of extranodal sites affected than did low-dose PET/CT. Agreement between the 2 types of PET/CT was almost perfect for disease stage (kappa = 0.92; P0.001).Our study showed a good correlation between unenhanced low-dose PET/CT and contrast-enhanced full-dose PET/CT for lymph node and extranodal disease in lymphomas, suggesting that unenhanced low-dose PET/CT might suffice in most patients as the only imaging technique for the initial staging of lymphomas, reserving diagnostic CT for selected cases.

The incidence of Hodgkin's disease (HD) and Non-Hodgkin's lymphoma (NHL) is around 8% of all malignancies. Fortunately, HD and NHL are among the few malignancies that are potentially curable with current existing treatment modalities, even in advanced or recurrent disease. Accurate staging, early therapy monitoring, and posttreatment evaluation of lymphomas are important for optimum management of these patients. We reviewed the imaging findings of patients with histologically proved lymphoma who underwent staging positron emission tomography/computed tomography (PET/CT), early monitoring therapy PET/CT (after 3 cycles of chemotherapy), and posttreatment PET/CT. PET/CT imaging findings are shown. Utility of PET/CT in recognizing false-positive and false-negative cases of CT and PET alone is addressed. Pitfalls and diagnostic difficulties are analyzed. PET/CT is a new imaging technology that improves the evaluation of lymphoma. This review will help the reader to better understand the imaging findings and applications of PET/CT in the management of lymphoma.

The objective of our study was to determine the significance of mild hydronephrosis in newborns and infants as an indicator of vesicoureteral reflux (VUR). The voiding cystourethrography (VCUG) of 573 patients aged 0–18 months with mild, sonographically detected hydronephrosis were reviewed for VUR. Patients with secondary reflux or anomalies making an exact reflux grading impossible were excluded. Normal kidneys, contralateral to hydronephrotic ones, were included. Each kidney was considered separately, forming a total of 1,146 renal units. Mild hydronephrosis was defined as an anteroposterior diameter of the renal pelvis of 0.5–1.5 cm without caliectasis. The International Grading System was used to grade VUR. Seven hundred and thirty-six kidneys had mild hydronephrosis. VUR occurred in 189 out of 736 (25.7%) of these kidneys, and in 108 out of 410 (26.3%) non-distended kidneys, contralateral to hydronephrotic ones (p=0.806). No statistical differences in the frequency of VUR and dilatation were found between the subgroups of patients with and without infection, except for a higher grade of reflux in the group with infection. The frequency of VUR in mildly dilated kidneys was not significantly different from that in non-distended ones. There was a poor correlation between VUR and mild hydronephrosis. The latter should not be considered in itself an indication for VCUG in asymptomatic neonates and infants.

Cystic adenomatoid malformation is an uncommon embryonic developmental abnormality usually diagnosed in neonates and infants. Its presentation in adulthood is rare, with only 27 cases reported up to now. Due to its rarity, it is seldom suspected and adult physicians are not familiar with its clinical and radiologic features. We report two cases of cystic adenomatoid malformation presenting in adults, one as a recurrent pneumonia, and another as a coincidental finding on a chest roentgenogram. We describe the clinical features, radiologic and computed tomographic findings, and the histopathologic characteristics in this article, along with a review of the literature.

Abstract 3920 Poster Board III-856 Introduction Accurate staging is critical in patients with lymphoma. Despite the lack of functional information CT remains the standard imaging technique based on anatomic criteria. PET with FDG provides functional evaluation but lacks of specificity due to the absence of anatomic landmarks. We have prospectively compared the accuracy of combined PET/CT with that of CT and PET alone at initial staging in lymphoma patients. Material and Methods. Patients with newly diagnosed lymphoma were prospectively included in the study. All patients underwent conventional staging studies which included clinical history, physical examination, laboratory work-up, biopsy of enlarged lymph node and of the iliac crest bone marrow, and PET/CT (either with full-dose contrast enhanced CT (FD PET/CT) and with low-dose non-enhanced CT (LD-PET/CT)) before starting therapy. The combined results of the clinical and imaging studies and the results of biopsies of suspected sites involved with lymphoma, when possible, formed the basis of our reference standard. The primary objective of the study was to address the accuracy of the PET/CT examination in clinical staging. For each patient, staging was assessed according to the Ann Arbor classification system on the basis of CT, PET images alone and the PET/CT images. The results were then compared with the true clinical stage based on the reference standard. Secondary objectives were: evaluation of the influence of clinical staging with PET/CT in the treatment approach, assessment of the efficacy of PET in evaluating bone marrow (BM) involvement, and definition of the accuracy of PET/CT imaging in the staging of different histologic subgroups. Results. 108 patients (64 female and 44 male; mean age 50 years; range 18-75 years) were included in the study. 76 patients had NHL and 32 had HL. 36% of the patients (28) had DLBCL whereas 18% (14 patients) had Follicular lymphoma. Other subtypes of NHL accounted for less than 10%. 31 of HL patients had classic variants. True clinical stage for NHL patients was I (7), II (11), III (6) and IV (52), and for HL was II (17), III (4) and IV (10). Agreement in staging was statistically significant between the reference standard and the staging algorithms by CT (k=0.493 p Disclosures: No relevant conflicts of interest to declare.