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Introducción. Los tumores desmoides o fibromatosis agresiva corresponden a neoplasias mesenquimales poco frecuentes. Son tumores localmente agresivos que ocurren especialmente en jóvenes, no desarrollan metástasis a distancia, pero se asocian con invasión locorregional y alta tasa de recurrencia después de la resección. Su etiología es desconocida, pero se ha asociado al síndrome de Gardner, trauma, embarazo, estados hiperestrogénicos y puerperio. El objetivo de este artículo fue hacer una revisión sobre el tema a propósito de un caso clínico. Caso clínico. Se presenta el caso de una paciente puérpera con progresivo y rápido aumento del volumen abdominal. Se realizó una tomografía computarizada de abdomen y pelvis que confirmó la presencia de una masa intraperitoneal bien definida. La paciente fue operada con escisión de la masa y confirmación histológica de tumor desmoide a partir de la muestra de patología. Discusión. Los tumores desmoides tienen una incidencia de 2 a 4 casos por millón de habitantes por año, con leve predominio en el sexo femenino y representan menos del 3 % de los tumores de partes blandas. Aunque el tumor se puede ubicar a nivel intraabdominal o en la pared, la ubicación más común es en las extremidades. Conclusiones. La sospecha y detección del tumor desmoide es fundamental, así como su adecuado estudio, para determinar el tratamiento quirúrgico como fue realizado en este caso

Introduction. Desmoid tumors or aggressive fibromatosis correspond to rare mesenchymal neoplasms. They are locally aggressive tumors that occur especially in young people, they do not develop distant metastases, but are associated with locoregional invasion and a high recurrence rate after resection. Its etiology is unknown, but it has been associated with Gardner syndrome, trauma, pregnancy, hyperestrogenic states, and puerperium. The objective of this article was to review the topic based on a clinical case. Clinical case. The case of a puerperal patient with progressive and rapid increase in abdominal volume is presented. An abdominal and pelvic CT scan was performed, which confirmed the presence of a well-defined intraperitoneal mass. The patient underwent surgery with excision of the mass and histological confirmation of a desmoid tumor from the pathology sample. Discussion. Desmoid tumors have an incidence of 2 to 4 cases per million inhabitants per year, with a slight predominance in females, and represent less than 3% of soft tissue tumors. Although the tumor can be located intra-abdominal or in the wall, the most common location is in the extremities. Conclusions. The suspicion and detection of the desmoid tumor is essential, as well as its adequate study to determine the surgical treatment as it was done in this case

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Objetivo Evaluar la variabilidad interobservador en el uso de la versión 2.0 del PI- RADS (PI-RADS v2), en lectores experimentados y no experimentados. Materiales y Métodos Estudio retrospectivo de análisis de concordancia de lectores. Entre enero de 2015 y diciembre de 2016, 1.656 sujetos fueron estudiados mediante resonancia magnética multiparamétrica (RMmp) de próstata en nuestra institución. Se estimó la distribución porcentual del reporte en categoría PI-RADS v2, y con esa información, se realizó una selección de 150 casos con esquema de aleatorización estratificada a las distribuciones porcentuales de cada categoría. Dichos casos fueron anonimizados, presentados a tres lectores con cinco, cuatro y dos años de experiencia en lectura de RMmp además de tener más de un año de experiencia en el uso del PI- RADS v2 siendo leídos en forma individual. Los datos resultantes fueron analizados en forma independiente por un cuarto investigador. Resultados El valor de kappa ponderado para los observadores fue de 0,69 (IC 95: 0,64 a 0,75). La mayor concordancia correspondió a los lectores de mayor experiencia, donde alcanza un valor de 0,72 (IC 95%: 0,69 a 0,76). La concordancia entre los valores PI-RADS que determinan seguimiento o bien una intervención de acuerdo a elementos clínicos (1-2-3) y conducta activa (4-5) correspondió a 0,70 (IC 95%: 0,59 a 0,78). Discusión Se logró demostrar un acuerdo sustancial entre radiólogos utilizando el PI- RADS v2 para la detección en RMmp de lesiones sospechosas, mayor entre los dos lectores más experimentados. Sin embargo, la comparación del lector de menor experiencia con los de mayor experiencia también presentó una importante concordancia. Los valores de concordancia entre observadores para PI-RADS 2:4 fueron similares a los reportados en la literatura. Conclusiones El PI-RADSv2 ha demostrado en nuestro centro, con radiólogos dedicados a imágenes de abdomen y estudios de próstata, un alto nivel de acuerdo en la interpretación de la RMmp de próstata, encontrándose a tono con lo reportado en la literatura.

Purpose To evaluate the interobserver variability in the use of the PI-RADS 2.0 version, in experienced and non-experienced readers. Material and Methods Retrospective studyof readers' concordance analysis. Between January 2015 and December 2016, 1656 subjects were studied through multiparametric MRI (RMmp) of prostate in our institution. The percentage distribution of the report was estimated in each PI-RADS category, and a selection of 150 cases with a stratified randomization scheme was made to the percentage distributions of every category. These cases were anonymized, presented to three readers with 5, 4 and 2 years' experience in reading RMmp, and more than one-year experience with PI-RADS v2, and were read individually. The resulting data were analyzed independently by a fourth investigator. Results The weighted kappa value for the observers was 0.69 (IC 95: 0.64 to 0.75). The highest agreement corresponded to the two most experienced readers, where it reached a value of 0.72 (95% CI: 0.69 to 0.76). The concordance between the PI-RADS values that determine follow-up (1-2-3) and active behavior (4-5) corresponded to 0.70 (95% CI: 0.59 to 0.78). Discussion It was possible to demonstrate a substantial agreement between radiologists using the PI-RADS v2 for the detection in RMmp of suspicious lesions, greater among the two most experienced readers. However, the comparison of the less experienced reader with those of greater experience also presented an important concordance. The inter-observer concordance values for PI-RADS 2:4 were like those reported in the literature. Conclusions The PI-RADS v2 has demonstrated, in our center, with radiologists dedicated to abdominal images and prostate studies, a high level of agreement in the interpretation of prostate MRmp.

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OBJECTIVE: To determine the degree of correlation in the radiological bone age assessment using the Greulich and Pyle method versus automated assessment through BoneXpert® software between 2013 and 2016. MATERIAL AND METHOD: Correlation study of diagnostic techniques of 1500 carpal X-rays to assess bone age in patients under 16 years of age from Clínica Alemana de Santiago. X-rays with bone age assessment using the Atlas of Greulich and Pyle (GP) by 1 out of 7 pediatric radiologists, were analyzed using the BoneXpert (BE) software for automated bone age assessment. 100 cases were taken at random for analysis/re-analysis using the BoneXpert method to determine its accuracy. The level of correlation of the measurements was analyzed using the correlation coefficient (Pearson's r) and the variability of the measurements using the Bland-Altman analysis. RESULTS: 1493 cases were assessed, seven were excluded due to failure in the X-ray technique, 922 females (61.8%), with a median chronological age of 9.96 years and 11.12 years for males (p 0.001). The correlation between manual bone age (GP) and automated bone age using BoneXpert method among radiologists ran ged from 0.91 to 0.93. The Bland-Altman analysis indicated an average difference between manual bone age and bone age using the BoneXpert method of 0.19 years (CI 0.13 to 0.25). In the analysis/ re-analysis of 100 random cases using the BoneXpert software, the correlation was 1.00 (100% accu racy). CONCLUSION: The automated analysis using BoneXpert allows for standardized, low-variability, and high-concordance assessment.

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Background:: Pulmonary cystic nodules are a relatively frequent finding in chest computed tomography (CT). There is a possible association between this finding and lung cancer. Aim: To report eight patients with malignant lung cystic lesions. Material and Methods: Retrospective analysis of images in a CT database from 2007 to 2015, looking for cystic lesions of the lung with wall thickening, whose pathological diagnosis was lung cancer. Results: We identified eight patients with cystic nodules aged 44 to 77 years, of which five were women. Six were active and two former smokers. The pathological diagnosis was adenocarcinoma in seven cases and squamous cell in one. The mean diameter of the cystic lesions was 11.5 mm. The mean diagnostic delay time was 871 days (range 0-1592). The main finding was a gradual thickening of the nodule walls. Conclusions: The presentation of lung cancer as cystic nodules is uncommon. In this series, the change in morphology due to a thickening of the walls with or without a diameter increase, was the clue for the diagnosis.

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Resumen: Objetivo: Determinar el grado de correlación en la valoración de la edad ósea radiológica mediante el método de Greulich y Pyle versus la evaluación automatizada por el programa computacional BoneXpert® entre los años 2013-2016. Material y Método: Estudio de correlación de técnicas diag nósticas de 1500 radiografías de carpo para evaluar la edad ósea, en pacientes menores de 16 años pertenecientes a Clínica Alemana de Santiago. Las radiografías con evaluación de la edad ósea por el Atlas de Greulich y Pyle (GP) por 1 de 7 radiólogos pediatras fueron sometidas al programa BoneX pert (BE) para la evaluación automatizada de la edad ósea. Se tomó 100 casos al azar para un análisis/ re-análisis del método BE, para conocer su precisión. Se analizó el nivel de correlación de las medicio nes por coeficiente de correlación (r de Pearson) y la variabilidad de las mediciones mediante análisis de Bland-Altman. Resultados: Se incluyeron 1.493 casos, se excluyeron 7 por falla en técnica de la radiografía, 922 de sexo femenino (61.8%), mediana de edad cronológica 9.96 años y 11.12 años para los varones (p 0,001). La correlación entre la edad ósea manual GP y la edad ósea automatizada BE entre los lectores varió entre 0,91 y 0,93. El análisis de Bland-Altman indicó una diferencia promedio entre la edad ósea manual y la edad ósea BE de 0,19 años (IC 0,13 a 0,25). En el análisis/re-análisis de 100 casos al azar mediante BoneXpert, la correlación fue de 1,0. Conclusión: El análisis automatizado mediante BoneXpert permite una evaluación estandarizada, de baja variabilidad, y alta concordancia.

Abstract: Objective: To determine the degree of correlation in the radiological bone age assessment using the Greulich and Pyle method versus automated assessment through BoneXpert® software between 2013 and 2016. Material and Method: Correlation study of diagnostic techniques of 1500 carpal X-rays to assess bone age in patients under 16 years of age from Clínica Alemana de Santiago. X-rays with bone age assessment using the Atlas of Greulich and Pyle (GP) by 1 out of 7 pediatric radiologists, were analyzed using the BoneXpert (BE) software for automated bone age assessment. 100 cases were taken at random for analysis/re-analysis using the BoneXpert method to determine its accuracy. The level of correlation of the measurements was analyzed using the correlation coefficient (Pearson's r) and the variability of the measurements using the Bland-Altman analysis. Results: 1493 cases were assessed, seven were excluded due to failure in the X-ray technique, 922 females (61.8%), with a median chronological age of 9.96 years and 11.12 years for males (p 0.001). The correlation between manual bone age (GP) and automated bone age using BoneXpert method among radiologists ran ged from 0.91 to 0.93. The Bland-Altman analysis indicated an average difference between manual bone age and bone age using the BoneXpert method of 0.19 years (CI 0.13 to 0.25). In the analysis/ re-analysis of 100 random cases using the BoneXpert software, the correlation was 1.00 (100% accu racy). Conclusion: The automated analysis using BoneXpert allows for standardized, low-variability, and high-concordance assessment.

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BACKGROUND: Pulmonary cystic nodules are a relatively frequent finding in chest computed tomography (CT). There is a possible association between this finding and lung cancer. AIM: To report eight patients with malignant lung cystic lesions. MATERIAL AND METHODS: Retrospective analysis of images in a CT database from 2007 to 2015, looking for cystic lesions of the lung with wall thickening, whose pathological diagnosis was lung cancer. RESULTS: We identified eight patients with cystic nodules aged 44 to 77 years, of which five were women. Six were active and two former smokers. The pathological diagnosis was adenocarcinoma in seven cases and squamous cell in one. The mean diameter of the cystic lesions was 11.5 mm. The mean diagnostic delay time was 871 days (range 0-1592). The main finding was a gradual thickening of the nodule walls. CONCLUSIONS: The presentation of lung cancer as cystic nodules is uncommon. In this series, the change in morphology due to a thickening of the walls with or without a diameter increase, was the clue for the diagnosis.

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Abstract. The Luftsichel sign corresponds to a crescent-shaped paraaortic hyperlucency in frontal chest radiograph caused by the collapse of the left upper lobe. Its recognition is relevant, especially in adult patients, where we should considered an endobronchial neoplasia as the first possible etiology of the lobar collapse. The differential diagnosis includes the right lung herniation through the midline, medial pneumothorax, pneumomediastinum and bullous disease.

Resumen. El signo de Luftsichel corresponde a una hiperclaridad paraaórtica en forma de creciente en la radiografía de tórax frontal, causado por el colapso del lóbulo superior izquierdo. Su reconocimiento es importante, sobre todo en el paciente adulto, en donde se debe considerar una neoplasia endobronquial como primera posibilidad etiológica del colapso lobar. El diagnóstico diferencial incluye herniación del pulmón derecho a través de la línea media, neumotórax medial, neumomediastino y enfermedad bulosa.

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Abstract: Objective. Assess the performance of digital 2D mammography and tomosynthesis in the characterisation of architectural breast distortion (ABD). Material and method. A retrospective study, approved by the Ethics Committee, was conducted on mammographic studies on cases with a diagnosis of ABD selected from August 2015-August 2016. Cases with imaging modalities available on PACS were included: digital mammography (2D), tomosynthesis (TS), ultrasound (US), magnetic resonance (MR), and with biopsy performed at our institution. ABD cases associated with micro-calcifications and post-surgical changes were excluded. Detection rates and imaging characteristics were analysed, as well as the histopathological concordance. Results. A total of 81 cases of ABD without microcalcifications were detected on the mammographs, but only 52 met the inclusion criteria. According to histopathology, 23 (44%) were malignant, 17 (33%) were benign, and 12 (23%) were high-risk lesions. All were detected by TS and US, and classified as suspicious lesions (BI-RADS 4 or 5). In 2D mammography, 24 cases (46%) were not seen and 8 (33%) of these were malignant. Malignant lesions showed dense centres in 87% of cases. The most frequent lesion on ultrasound was a hypoechogenic area (60%) in 86% of lesions with penetrating vessels. A total of 21 MRI were performed, with mass enhancement being identified in all of them. Conclusion. ABD is better displayed in TS than 2D mammography. Despite its characteristics, histological examination is essential (even when a radiolucent centre is observed). Focused US should be the next procedure to follow, since it allows to visualize the lesion to be visualised, and can direct the percutaneous biopsy in most cases.

Resumen: Objetivo. Determinar en qué método de imagen se logra visualizar y caracterizar mejor una distorsión de la arquitectura mamaria (DAM). Material y método. Estudio retrospectivo, aprobado por el Comité de Ética. Se seleccionaron los estudios mamográficos con diagnóstico de DAM en nuestro servicio entre agosto de 2015 y agosto de 2016. Se incluyeron casos estudiados con al menos 3 de las modalidades de imágenes disponibles en PACS: mamografía digital (2D), tomosíntesis (TS), ecografía (US), resonancia (RM) y que fueron biopsiados en nuestra institución. Se excluyeron casos de DAM asociadas con microcalcificaciones y cambios posquirúrgicos. Se evaluaron la tasa de detección, las características imagenológicas y la concordancia histopatológica. Resultados. En 15 meses se detectaron 81 casos de DAM en mamografía; de estos, 52 cumplieron con los criterios de inclusión. Según la histopatología, 23 (44%) resultaron malignas, 17 (33%) benignas y 12 (23%) lesiones de alto riesgo (LAR). Todas fueron detectadas por TS y US, clasificadas como lesiones sospechosas (BI-RADS 4 o 5). En mamografía 2D, 24 casos (46%) quedaron ocultos, y de estos, 8 (33%) resultaron malignos. Las lesiones malignas presentaron centro denso en el 87% de los casos. La lesión más frecuente en ecografía fue el área hipoecogénica (60%), en el 86% de las lesiones con vasos penetrantes. Se contó con 21 RM, identificándose captación tipo masa en las patologías malignas. Conclusión. La DAM es mejor visualizada en TS que en mamografía 2D. Pese a sus características, un estudio histológico es indispensable (incluso al observar un centro radiolúcido). El US dirigido es el paso a seguir, ya que permite visualizar la lesión y dirigir su biopsia percutánea en la mayoría de los casos.

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Gastric banding has become a common procedure amongst bariatric surgery techniques. Because of the possibility of using a laparoscopic route to achieve a good technical result and low complication rates, this method has become the most frequently used options in the treatment of morbid obesity in Chile. We report an uncommon complication that, if left undiagnosed, could lead to considerable morbidity and even mortality: gastric band erosion and intragastric migration. Radiologists, gastroenterologists and surgeons should be able to recognize this event to provide a prompt diagnosis.

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