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Resumen El trauma del globo ocular es una emergencia frecuente en los servicios de urgencia. Su importancia radica en el riesgo de la pérdida visual e incluso la ceguera. La valoración clínica del trauma ocular es un reto diagnóstico. Clínicamente se pueden realizar algunos diagnósticos, pero muchas veces se requiere de la valoración imagenológica para determinar lesiones asociadas. La tomografía computada (TC) permite el diagnóstico oportuno de las lesiones traumáticas del globo ocular, especialmente la presencia de cuerpos extraños. Adicionalmente, el conocimiento de los hallazgos imagenológicos en otras patologías oculares que pueden confundirse con patologías traumáticas es importante para hacer un adecuado diagnóstico diferencial. El objetivo del presente artículo es realizar una revisión de los hallazgos por imagen de las lesiones traumáticas del globo ocular.

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Abstract Traumatic ocular injuries are common cause of emergency room visits. Injuries of the globe are a significant cause of blindness and visual deficits. The clinical assessment of globe trauma can be challenging. Some diagnoses can be made clinically, but imaging assessment is often required to determine associated lesions. Computed tomography (CT) allows the timely diagnosis of traumatic injuries of the globe, especially the presence of foreign bodies. In addition, knowledge of the imaging findings in other ocular pathologies that can be confused with traumatic pathologies is important to make an adequate differential diagnosis. The aim of this article is to carry out a review of imaging findings of traumatic ocular injuries.

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INTRODUCTION: Cortical thinning is a marker of neurodegeneration in Alzheimer's disease (AD). We investigated the age-related trajectory of cortical thickness across the lifespan (9-59 years) in a Colombian kindred with autosomal dominant AD (ADAD). METHODS: Two hundred eleven participants (105 presenilin-1 [PSEN1] E280A mutation carriers, 16 with cognitive impairment; 106 non-carriers) underwent magnetic resonance imaging. A piecewise linear regression identified change-points in the age-related trajectory of cortical thickness in carriers and non-carriers. RESULTS: Unimpaired carriers exhibited elevated cortical thickness compared to non-carriers, and thickness more negatively correlated with age and cognition in carriers relative to non-carriers. We found increased cortical thickness in child carriers, after which thickness steadied compared to non-carriers prior to a rapid reduction in the decade leading up to the expected age at cognitive impairment in carriers. DISCUSSION: Findings suggest that cortical thickness may fluctuate across the ADAD lifespan, from early-life increased thickness to atrophy proximal to clinical onset.

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BACKGROUND: Cardiovascular risk factors increase the risk of developing dementia, including Alzheimer's disease and vascular dementia. OBJECTIVE: Studying individuals with autosomal dominant mutations leading to the early onset of dementia, this study examines the effect of the global cardiovascular risk profile on early cognitive and neuroimaging features of Alzheimer's disease and vascular dementia. METHODS: We studied 85 non-demented and stroke-free individuals, including 20 subjects with Presenilin1 (PSEN1) E280A mutation leading to the early onset of autosomal dominant Alzheimer's disease (ADAD), 20 subjects with NOTCH3 mutations leading to cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) and to the early onset of vascular dementia, and 45 non-affected family members (non-carriers). All subjects underwent clinical and neuropsychological evaluations and an MRI. The global cardiovascular risk profile was estimated using the office-based Framingham Cardiovascular Risk Profile (FCRP) score. RESULTS: In individuals with CADASIL, a higher FCRP score was associated with a reduced hippocampal volume (B = -0.06, p < 0.05) and an increased severity of cerebral microbleeds (B = 0.13, p < 0.001), lacunes (B = 0.30, p < 0.001), and perivascular space enlargement in the basal ganglia (B = 0.50, p < 0.05). There was no significant association between the FCRP score and neuroimaging measures in ADAD or non-carrier subjects. While the FCRP score was related to performance in executive function in non-carrier subjects (B = 0.06, p < 0.05), it was not significantly associated with cognitive performance in individuals with CADASIL or ADAD. CONCLUSION: Our results suggest that individuals with CADASIL and other forms of vascular cognitive impairment might particularly benefit from early interventions aimed at controlling cardiovascular risks.

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Enfermedad de Alzheimer , Encéfalo , Demencia Vascular , Presenilina-1/genética , Receptor Notch3/genética , Enfermedad de Alzheimer/diagnóstico , Enfermedad de Alzheimer/epidemiología , Enfermedad de Alzheimer/genética , Enfermedad de Alzheimer/prevención & control , Encéfalo/diagnóstico por imagen , Encéfalo/patología , Colombia/epidemiología , Demencia Vascular/diagnóstico , Demencia Vascular/epidemiología , Demencia Vascular/genética , Demencia Vascular/prevención & control , Diagnóstico Precoz , Familia , Femenino , Factores de Riesgo de Enfermedad Cardiaca , Humanos , Imagen por Resonancia Magnética/métodos , Masculino , Persona de Mediana Edad , Mutación , Pruebas Neuropsicológicas , Servicios Preventivos de Salud/métodos , Factores de Riesgo , Conducta de Reducción del Riesgo

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BACKGROUND: Neuroimaging studies of autosomal dominant Alzheimer's disease (ADAD) enable characterization of the trajectories of cerebral amyloid-ß (Aß) and tau accumulation in the decades prior to clinical symptom onset. Longitudinal rates of regional tau accumulation measured with positron emission tomography (PET) and their relationship with other biomarker and cognitive changes remain to be fully characterized in ADAD. METHODS: Fourteen ADAD mutation carriers (Presenilin-1 E280A) and 15 age-matched non-carriers from the Colombian kindred underwent 2-3 sessions of Aß (11C-Pittsburgh compound B) and tau (18F-flortaucipir) PET, structural magnetic resonance imaging, and neuropsychological evaluation over a 2-4-year follow-up period. Annualized rates of change for imaging and cognitive variables were compared between carriers and non-carriers, and relationships among baseline measurements and rates of change were assessed within carriers. RESULTS: Longitudinal measurements were consistent with a sequence of ADAD-related changes beginning with Aß accumulation (16 years prior to expected symptom onset, EYO), followed by entorhinal cortex (EC) tau (9 EYO), neocortical tau (6 EYO), hippocampal atrophy (6 EYO), and cognitive decline (4 EYO). Rates of tau accumulation among carriers were most rapid in parietal neocortex (~ 9%/year). EC tau PET signal at baseline was a significant predictor of subsequent neocortical tau accumulation and cognitive decline within carriers. CONCLUSIONS: Our results are consistent with the sequence of biological changes in ADAD implied by cross-sectional studies and highlight the importance of EC tau as an early biomarker and a potential link between Aß burden and neocortical tau accumulation in ADAD.

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Enfermedad de Alzheimer , Enfermedad de Alzheimer/diagnóstico por imagen , Enfermedad de Alzheimer/genética , Péptidos beta-Amiloides , Biomarcadores , Boston , Colombia , Estudios Transversales , Humanos , Imagen por Resonancia Magnética , Tomografía de Emisión de Positrones , Proteínas tau/genética

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A 28-year-old man presented to the emergency room complaining of right proptosis. He also manifested eye pain and facial fullness and redness in this side. Seven years ago, he had right hemifacial gunshot trauma treated with surgical reconstruction. The CT scan showed expansion of the right maxillary sinus due to a hypodense nonenhancing lesion extending to the nasal cavity, masticatory space, and extraconal space of the orbit. MRI was performed showing high signal intensity of the lesion on T2-weighted images indicating a cystic nature. T1-weighted images also demonstrated high signal intensity of the lesion suggesting hemorrhage. At endoscopic maxillary antrostomy, the diagnosis of a chronic hematic cyst was confirmed. Chronic hematic cysts of the orbit should be included in the differential diagnosis of proptosis, especially if there is clinical history of past trauma. Due to the fact that physical examination is nonspecific, radiologic evaluation is useful to confirm the diagnosis and for presurgical planning.

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Quistes/diagnóstico , Exoftalmia/diagnóstico , Seno Maxilar/diagnóstico por imagen , Enfermedades Orbitales/diagnóstico , Adulto , Diagnóstico Diferencial , Humanos , Masculino , Tomografía Computarizada por Rayos X

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To report MRI findings which reflect a pathological inflammatory condition of the uveal tract. This study includes single-center retrospective case series of five patients with clinical diagnosis of uveitis. There were 1 male (20 %) and 4 female patients (80 %). The average age was 29.6 years (range 25-38 years). Patients and 50 age-range-matched control subjects were scanned using a 1.5 T scanner. Ten additional control subjects scanned at 3 T were evaluated to have reference images at that high field. All patients (n = 5, 100 %) presented uveal tract enhancement on post-contrast T2-FLAIR fat-suppressed images and only 2 (40 %) had enhancement on T1-weighted images. The enhancement was anterior in 2 (40 %), pan-uveal in 2 (40 %), and posterior in 1 patient (20 %). Two patients (40 %) had unilateral increased vitreous signal on T2-FLAIR. One patient (20 %) had bilateral retrobulbar fat enhancement in both post-contrast T2-FLAIR and T1-weighted images. Post-contrast T2-FLAIR images can reveal abnormal enhancement of the uveal tract and retrobulbar fat as well as increased vitreous signal in patients with uveitis. In our small series, the sensitivity of post-contrast T2-FLAIR was higher than the conventional post-contrast T1-weighted images. Nonetheless, when bilateral uveal tract enhancement is present, there should be discretion before calling uveitis because the finding has been reported in different eye conditions as well as in a small percentage of healthy subjects at 1.5 T. In addition, it should be noted that post-contrast T2-FLAIR enhancement of the uveal tract is a normal finding at 3 T imaging.

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Gadolinio DTPA/farmacología , Imagen por Resonancia Magnética/métodos , Uveítis/diagnóstico , Adulto , Medios de Contraste/farmacología , Femenino , Humanos , Masculino , Reproducibilidad de los Resultados , Estudios Retrospectivos

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Anomalies of the anterior belly of the digastric muscle (DM) are uncommon. We present a case of hypoplasia of the anterior belly of the left DM with hypertrophy of the anterior belly of the contralateral DM. The importance of recognizing this finding is to differentiate hypoplasia of the anterior belly of the DM from denervation atrophy, and not to confuse contralateral hypertrophy with a submental mass or lymphadenopathy. In denervation atrophy of the anterior belly of the DM, associated atrophy of the ipsilateral mylohyoid muscle is present. Hypertrophy of the anterior belly of the contralateral DM can be differentiated from a submental mass or lymphadenopathy by recognizing its isodensity on computed tomography and isointensity on magnetic resonance imaging to other muscles, without abnormal contrast enhancement.

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Linfadenopatía/diagnóstico , Músculos Masticadores/patología , Atrofia Muscular/diagnóstico , Desnervación/efectos adversos , Humanos , Hipertrofia , Masculino , Persona de Mediana Edad , Atrofia Muscular/etiología , Atrofia Muscular/patología

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El trasplante de hígado es un método terapéutico efectivo para el tratamiento de múltiples enfermedades hepáticas terminales irreversibles, tanto agudas como crónicas. Los avances en la terapia inmunosupresora, la técnica quirúrgica y el cuidado perioperatorio han mejorado el pronóstico de los pacientes sometidos a este procedimiento. La ecografía con evaluación Doppler es el método de imagen más utilizado para valorar a estos pacientes, tanto en la etapa inicial como en el seguimiento a largo plazo. Tiene como ventajas estar ampliamente disponible, la posibilidad de volverse portátil, no generar efectos secundarios y no asociarse con efectos por radiación ionizante. Permite realizar una valoración anatómica en escala de grises y funcional con la evaluación del flujo de las diferentes anastomosis vasculares. Es el método diagnóstico ideal ante la sospecha de complicaciones vasculares. Las complicaciones más comunes y con más importancia clínica son las vasculares: trombosis arterial, trombosis venosa, estenosis, fístulas. También se encuentran complicaciones de la anastomosis biliar, las colecciones, las neoplasias y el rechazo. En este artículo se revisan los hallazgos normales y anormales en el Doppler de los pacientes sometidos a trasplante de hígado.

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Liver transplantation is an effective therapeutic method for treatment of multiple irreversible terminal liver disease, both acute and chronic. Advances in immunosuppressive therapy, surgical technique and post-surgical care have improved the prognosis of patients undergoing this procedure. The ultrasound with Doppler assessment is the image method which is most commonly used to assess these patients, both in the initial phase and during long-term follow-up. The advantages of ultrasound Doppler are the following: It is widely available, it can be portable, it does not cause sideeffects, and it is not associated with ionizing radiation effects. In addition, it also allows an anatomical assessment of grey and functional scales, with flow evaluation of different vascular complications. The most common complications during liver transplantation, as well as the ones with the highest clinical importance are vascular complications: arterial thrombosis, venous thrombosis, stenosis, fistulas. In addition, one can find complications of biliary anastomosis, as well as collections, neoplasms and rejection. Normal and abnormal Doppler findings in patients undergoing liver transplantation are reviewed in this article.

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Humanos , Ultrasonografía , Trasplante de Hígado , Ultrasonografía Doppler en Color

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OBJECTIVE: To determine the diagnostic usefulness of multidetector computed angiotomography in the diagnosis limb arterial injuries in patients with suspicion of arterial injury with no indication of immediate surgery. METHODS: Non-invasive 64-channel multidetector computed tomography (MDCT) was performed on 99 limbs suspected of having a traumatic vascular injury over a 44-month period between August 2004 and April 2008. The results were interpreted by the duty radiologist and his findings were compared with those from surgery or clinical follow-up. Inter-observer variability was evaluated by comparing the reading of the MDCT by the duty radiologists with the retrospective reading by radiology specialist in trauma. RESULTS: MDCT as a diagnostic method of vascular injury of the limbs, interpreted by a general radiologist showed a sensitivity of 98% (95% CI: 93-100), a specificity of 88% (5% CI: 77-99), a positive predictive value of 91% (95% CI: 82-99), a negative predictive value of 97% (95% CI: 90-100), a positive likelihood radio of 8.24 (3.6-18.7), and a negative likelihood radio of 0.02 (0-0.15). The inter-observer variability by comparing the interpretation of the MDCT by the duty radiologist with that of the radiology specialist in trauma had a kappa of 0.869. CONCLUSION: Multidetector computed angiotomography is a high precision diagnostic imaging method in arterial injury of the limbs, offering a suitable and appropriate therapeutic approach, and could be considered as new gold standard for the diagnosis of arterial injuries of the limbs.

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Arterias/lesiones , Extremidades/irrigación sanguínea , Tomografía Computarizada Multidetector , Lesiones del Sistema Vascular/diagnóstico por imagen , Adolescente , Adulto , Anciano , Angiografía/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Adulto Joven