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Introducción y objetivos: Los sindesmofitos parecen elevar falsamente los valores de densidad mineral ósea lumbar, lo que limita el diagnóstico de osteoporosis por absorciometría de rayosX de doble energía en pacientes con espondiloartritis axial. Por este motivo, el objetivo del estudio fue analizar la influencia de sindesmofitos a nivel lumbar en los valores de puntuación de hueso trabecular y densidad mineral ósea lumbar y cuello femoral, y evaluar los factores clínicos y analíticos asociados a puntuación de hueso trabecular en la espondiloartritis axial. Material y métodos: Estudio transversal en el que se incluyeron, de manera consecutiva desde enero de 2017 a junio de 2018, pacientes con espondiloartritis axial según los criterios ASAS. Se evaluaron los valores de puntuación de hueso trabecular y densidad mineral ósea. Se recogieron variables clínico-demográficas, relativas a la enfermedad y analíticas. Resultados: Se incluyeron 82 sujetos con espondiloartritis axial (38 con sindesmofitos y 44 sin sindesmofitos). La edad media fue de 44,36+/-11,85años en espondiloartritis axial sin sindesmofitos y de 55,7+/-10,27años con sindesmofitos (p<0,001). El valor de puntuación de hueso trabecular medio fue de 1,345+/-0,14 en pacientes con sindesmofitos y de 1,41+/-0,11 sin sindesmofitos (p=0,05). Se encontró asociación entre un mayor índice de masa corporal, velocidad de sedimentación globular, duración de la enfermedad y número de niveles afectados por sindesmofitos y un mayor riesgo de fractura por puntuación de hueso trabecular. Conclusión: Los valores de puntuación de hueso trabecular no parecen estar enmascarados por la presencia de sindesmofitos

Introduction and objectives: Syndesmophytes appear to falsely raise lumbar bone mineral density values, thereby hindering the diagnosis of osteoporosis by dual-energy X-ray absorptiometry in patients with axial spondyloarthritis. The objective of the study was therefore to analyse the influence of syndesmophytes at the lumbar level on trabecular bone scores and lumbar and femoral neck bone mineral density values and to assess the clinical and analytical factors associated with trabecular bone scores in axial spondyloarthritis. Material and methods: From January 2017 to June 2018, a cross-sectional study consecutively included patients with axial spondyloarthritis according to Assessment in Ankylosing Spondylitis criteria. We assessed the trabecular bone scores and bone mineral density values and recorded clinical, demographic, disease-related and laboratory variables. Results: The study included 82 patients with axial spondyloarthritis (38 with syndesmophytes and 44 without syndesmophytes). The mean age of the patients with and without syndesmophytes was 55.7+/-10.27years and 44.36+/-11.85years, respectively (P<.001). The mean trabecular bone score for the patients with and without syndesmophytes was 1.345+/-0.14 and 1.41+/-0.11, respectively (p < 0.05). There was an association between higher body mass index, erythrocyte sedimentation rate, disease duration and the number of levels affected by syndesmophytes and a greater risk of fracture as measured by the trabecular bone score. Conclusion: Trabecular bone scores do not appear to be masked by the presence of syndesmophytes

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INTRODUCTION AND OBJECTIVES: Syndesmophytes appear to falsely raise lumbar bone mineral density values, thereby hindering the diagnosis of osteoporosis by dual-energy X-ray absorptiometry in patients with axial spondyloarthritis. The objective of the study was therefore to analyse the influence of syndesmophytes at the lumbar level on trabecular bone scores and lumbar and femoral neck bone mineral density values and to assess the clinical and analytical factors associated with trabecular bone scores in axial spondyloarthritis. MATERIAL AND METHODS: From January 2017 to June 2018, a cross-sectional study consecutively included patients with axial spondyloarthritis according to Assessment in Ankylosing Spondylitis criteria. We assessed the trabecular bone scores and bone mineral density values and recorded clinical, demographic, disease-related and laboratory variables. RESULTS: The study included 82 patients with axial spondyloarthritis (38 with syndesmophytes and 44 without syndesmophytes). The mean age of the patients with and without syndesmophytes was 55.7±10.27years and 44.36±11.85years, respectively (P<.001). The mean trabecular bone score for the patients with and without syndesmophytes was 1.345±0.14 and 1.41±0.11, respectively (p < 0.05). There was an association between higher body mass index, erythrocyte sedimentation rate, disease duration and the number of levels affected by syndesmophytes and a greater risk of fracture as measured by the trabecular bone score. CONCLUSION: Trabecular bone scores do not appear to be masked by the presence of syndesmophytes.

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OBJECTIVE: To audit the breast cancer screening mammograms performed in a general hospital and to assess the variation in medical practice in the diagnostic process. MATERIAL AND METHODS: A review was carried out on the screening mammograms performed between 1 May 2010 and 30 April 2011, with clinical follow up for two years, and a comparison with the published standards. RESULTS: Of the 3,878 women examined, 368 (9.48%) were called back to complete the study (97 [16.1%] in the initial screening and 271 [8.2%] in revisions). Forty three biopsies (1.1%) were indicated, of which 24 were diagnosed with cancer. The positive predictive value (PPV) in screening studies (PPV1) was 6.52%. For the recommended biopsy (PPV2) it was 55%, with a sensitivity of 100%, a specificity of 91% and a cancer detection rate of 6.1/1,000. There were no false negatives. Twenty tumours were invasive; with no axillary lymph node infiltration was observed 15 of them. In 6 cases, the size of the tumour was less than or equal to 10mm, and in 17 it was less than 15mm. There were a higher percentage of new appointments by two radiologists (12% and 17.2% versus 7.3%) (P<.001). In 217 cases (58.96%; P<.001) only one radiologist indicated new appointments. Of this group, 73% were discharged in the first visit, compared to 47.6% in the non-discrepant group (P<.001). Four of the cancers were detected in these 217 patients. CONCLUSIONS: The observed results are adjusted to the reference values. The discordant data are the new appointments rate, both in the initial screening and in the review, with a significant variation depending on the radiology reader.

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Genetic biomarkers could be useful for orienting treatment of patients with rheumatoid arthritis (RA), but none has been convincingly validated yet. Putative biomarkers include 14 single nucleotide polymorphisms that have shown association with response to TNF inhibitors (TNFi) in candidate gene studies and that we assayed here in 755 RA patients. Three of them, in the PTPRC, IL10 and CHUK genes, were significantly associated with response to TNFi. The most significant result was obtained with rs10919563 in PTPRC, which is a confirmed RA susceptibility locus. Its RA risk allele was associated with improved response (B=0.33, P=0.006). This is the second independent replication of this biomarker (P=9.08 × 10(-8) in the combined 3003 RA patients). In this way, PTPRC has become the most replicated genetic biomarker of response to TNFi. In addition, the positive but weaker replication of IL10 and CHUK should stimulate further validation studies.

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Introducción. Nuestro objetivo es valorar la utilidad de la resonancia magnética (RM) en el diagnóstico de las fracturas ocultas de escafoides, mostrando las ventajas y el coste comparativo frente al protocolo de seguimiento tradicional. Material y método. El protocolo de actuación tradicional en nuestro centro consistía en inmovilización y revisiones clínico-radiológicas periódicas (radiología convencional y tomografía computarizada en la fase final del proceso). En el nuevo protocolo, si en el primer control del traumatólogo (10 días post-traumatismo) la radiología convencional seguía siendo negativa se realizaba un protocolo limitado de RM de muñeca (coronal T1 y T2-supresión grasa). Se valoraron los hallazgos visualizados en RM, el tiempo de inmovilización del paciente, el coste económico de ambos protocolos y la dosis de radiación recibida. Resultados. Se incluyeron 33 casos de pacientes con sospecha clínica de fractura de escafoides y radiología negativa. En 13 pacientes la RM fue negativa. En 12 se confirmó el diagnóstico de fractura de escafoides, 6 asociadas a otra afección. En 8 se diagnosticó otro proceso. El coste del nuevo protocolo fue de 131.06€ por paciente y de 114.41 o 151.06€ para el tradicional, según las revisiones necesarias. Se redujo la dosis de radiación al eliminar la realización de sucesivas exploraciones radiológicas. Conclusiones. El nuevo protocolo mejora el manejo de estos pacientes, reduciendo el tiempo de inmovilización, mejorando la rigidez articular y disminuyendo el periodo de baja laboral. Permite el diagnóstico de otras lesiones radiológicamente ocultas. El coste es similar e incluso inferior en algunos casos, y la irradiación es menor (AU)

Introduction. We aimed to evaluate the usefulness of magnetic resonance imaging (MRI) in the diagnosis of occult fractures of the scaphoid and to determine the advantages and cost in comparison with the traditional follow-up protocol. Material and method. The traditional approach at our center consisted of immobilization and periodic clinical and radiological follow-up (plain-film X-rays and computed tomography in the final phase of the process). The new protocol called for a limited MRI study consisting of coronal T1- and T2-weighted fat suppression sequences if the findings at plain-film X-rays continued to be negative at the first follow-up examination with the traumatologist (10 days after trauma). We evaluated the MRI findings, the time the patient was immobilized, the cost of each protocol, and the dose of radiation received. Results. We included 33 cases of patients with clinically suspected fractures of the scaphoid and negative findings on plain-film X-rays. In 13 patients, the MRI findings were negative. In 12 patients, the MRI findings confirmed the diagnosis of a fracture of the scaphoid, which was associated with other pathology in 6 cases. In 8 patients, another pathological process was diagnosed. The cost of the new protocol was €131.06 per patient; the cost of the traditional protocol was €114.41 or €151.06 per patient, depending on the follow-up studies required. The new protocol reduced the dose of radiation by eliminating successive radiologic studies. Conclusions. The new protocol improved the management of these patients, reducing the time of immobilization, improving joint rigidity, and reducing the time off work. The limited MRI study makes it possible to diagnose other radiologically occult lesions. The cost of the new protocol is similar to that of the traditional protocol and even lower in some cases. The new protocol results in a reduction in the dose of radiation (AU)

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INTRODUCTION: We aimed to evaluate the usefulness of magnetic resonance imaging (MRI) in the diagnosis of occult fractures of the scaphoid and to determine the advantages and cost in comparison with the traditional follow-up protocol. MATERIAL AND METHOD: The traditional approach at our center consisted of immobilization and periodic clinical and radiological follow-up (plain-film X-rays and computed tomography in the final phase of the process). The new protocol called for a limited MRI study consisting of coronal T1- and T2-weighted fat suppression sequences if the findings at plain-film X-rays continued to be negative at the first follow-up examination with the traumatologist (10 days after trauma). We evaluated the MRI findings, the time the patient was immobilized, the cost of each protocol, and the dose of radiation received. RESULTS: We included 33 cases of patients with clinically suspected fractures of the scaphoid and negative findings on plain-film X-rays. In 13 patients, the MRI findings were negative. In 12 patients, the MRI findings confirmed the diagnosis of a fracture of the scaphoid, which was associated with other pathology in 6 cases. In 8 patients, another pathological process was diagnosed. The cost of the new protocol was €131.06 per patient; the cost of the traditional protocol was €114.41 or €151.06 per patient, depending on the follow-up studies required. The new protocol reduced the dose of radiation by eliminating successive radiologic studies. CONCLUSIONS: The new protocol improved the management of these patients, reducing the time of immobilization, improving joint rigidity, and reducing the time off work. The limited MRI study makes it possible to diagnose other radiologically occult lesions. The cost of the new protocol is similar to that of the traditional protocol and even lower in some cases. The new protocol results in a reduction in the dose of radiation.

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OBJECTIVES: Cerebral venous thrombosis (CVT) is an uncommon condition. Its variable, unspecific clinical presentation causes delays in diagnosis. We analyze the validity of different neuroimaging techniques, including CT, MRI, MR angiography, and conventional angiography in the diagnosis of CVT. MATERIAL AND METHODS: We review the imaging findings of 12 patients with the final diagnosis of CVT. All 12 patients underwent CT as the initial imaging test; all 12 underwent MRI; 11 underwent MR angiography; and 4 underwent conventional angiography. Visualization of the thrombus or filling defects in the affected vessel were considered direct signs of CVT, whereas findings compatible with venous infarction were considered indirect signs. RESULTS: Of the 12 CT examinations, 4 showed direct signs, 2 indirect signs, and 6 only normal findings. Indirect signs of CVT were seen on follow-up CT in three of the patients with normal initial CT examination. CT failed to show the real extent of the process except in one case in which a cortical vein was affected. MRI detected thrombi in the affected territory in 6 cases; the empty delta sign was seen in 2 and signs of venous infarction in 8. MRI failed to diagnose CVT in one case. MR angiography showed direct signs of CVT in all cases, even without intravenous contrast, and the results were similar to those seen at conventional angiography. More than two locations were affected in 11 patients. CONCLUSIONS: At CT, indirect signs of CVT are seen, although sometimes not immediately. Direct signs can be so subtle that they can only be interpreted with experience. Furthermore, CT does not show the real extent of the process. Nevertheless, given its availability, contrast-enhanced CT should be the primary imaging test, both to rule out other possibilities and to indicate other neuroimaging studies, in this case MRI and MR angiography. The results obtained when these two techniques are performed simultaneously, even without contrast administration, are sufficient for diagnosis and are comparable to those at conventional angiography, but without the risks entailed and without exposing the patient to ionizing radiation.

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Objetivos. La trombosis venosa cerebral (TVC) es una patología poco frecuente. Su presentación clínica es inespecífica y variable, lo que ocasiona retrasos en el diagnóstico. Analizamos la validez de las diferentes pruebas de neuroimagen, tomografía computarizada (TC), resonancia magnética (RM), angio-resonancia magnética (RMV) y angiografía, en el diagnóstico de TVC. Material y métodos. Estudio retrospectivo sobre 12 pacientes con diagnóstico final de TVC. Se realizó TC, que fue la prueba inicial, y RM a todos los pacientes, a 11 RMV y en 4 ocasiones se hizo angiografía. Se valoraron como signos directos la visualización del trombo o defectos de repleción en el vaso afecto y como signo indirecto la identificación de hallazgos compatibles con infarto venoso. Resultados. De las 12 TC, 4 mostraron signos directos, 2 indirectos y 6 fueron normales; de éstas, en 3 pacientes se objetivaron signos indirectos en TC evolutivos. No mostró la extensión real del proceso salvo en un caso de afectación localizada de una vena cortical. En la RM se objetivó ocupación de los vasos del territorio venosos afecto en 6 casos, en 2 se apreció el signo del delta vacío y en 8 signos de infarto venoso. En una ocasión no fue diagnóstica. En todas las RMV se visualizaron signos directos de TVC, incluso sin contraste intravenoso. Los resultados fueron similares a los de las angiografías. Once pacientes presentaban afectación de más de 2 localizaciones. Conclusiones. La TC pone de manifiesto signos indirectos, a veces de modo tardío, y signos directos tan sutiles que requieren experiencia para ser interpretados. Además no valora la extensión real del proceso. De todos modos debe utilizarse como técnica de primer nivel, con contraste intravenoso, dada su disponibilidad en la mayoría de los centros, para excluir otras causas y servir para la indicación de otras pruebas de neuroimagen, en este caso RM y RMV. Los resultados obtenidos con la realización simultánea de ambas son equiparables a los de la angiografía, evita los riesgos de esta técnica, no expone al paciente a radiaciones ionizantes y es diagnóstica incluso sin la administración de contraste

Objectives. Cerebral venous thrombosis (CVT) is an uncommon condition. Its variable, unspecific clinical presentation causes delays in diagnosis. We analyze the validity of different neuroimaging techniques, including CT, MRI, MR angiography, and conventional angiography in the diagnosis of CVT. Material and methods. We review the imaging findings of 12 patients with the final diagnosis of CVT. All 12 patients underwent CT as the initial imaging test; all 12 underwent MRI; 11 underwent MR angiography; and 4 underwent conventional angiography. Visualization of the thrombus or filling defects in the affected vessel were considered direct signs of CVT, whereas findings compatible with venous infarction were considered indirect signs. Results. Of the 12 CT examinations, 4 showed direct signs, 2 indirect signs, and 6 only normal findings. Indirect signs of CVT were seen on follow-up CT in three of the patients with normal initial CT examination. CT failed to show the real extent of the process except in one case in which a cortical vein was affected. MRI detected thrombi in the affected territory in 6 cases; the empty delta sign was seen in 2 and signs of venous infarction in 8. MRI failed to diagnose CVT in one case. MR angiography showed direct signs of CVT in all cases, even without intravenous contrast, and the results were similar to those seen at conventional angiography. More than two locations were affected in 11 patients. Conclusions. At CT, indirect signs of CVT are seen, although sometimes not immediately. Direct signs can be so subtle that they can only be interpreted with experience. Furthermore, CT does not show the real extent of the process. Nevertheless, given its availability, contrast-enhanced CT should be the primary imaging test, both to rule out other possibilities and to indicate other neuroimaging studies, in this case MRI and MR angiography. The results obtained when these two techniques are performed simultaneously, even without contrast administration, are sufficient for diagnosis and are comparable to those at conventional angiography, but without the risks entailed and without exposing the patient to ionizing radiation

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