Catálogo de publicaciones - libros

Systemic diseases are characterized by typical manifestations in more than one organ system. The most common systemic diseases to affect the lungs include sarcoidosis, connective tissue disease, and vasculitis. Imaging, and in particular computed tomography, plays a key role in several respects including (1) formulating a diagnosis, (2) determining the pattern of injury present, and (3) the serial evaluation of patients with progressive or acute symptoms. The goal of this chapter is to describe the typical imaging features of systemic diseases that involve the lungs and to delineate the role of imaging in the multidisciplinary diagnosis of systemic disorders.

Blunt injuries of the thorax are common worldwide, their frequency matched by penetrating injuries in the United States. Patients not directed immediately to the operating room by the presence of shock or by findings on chest radiograph and ultrasound undergo CT imaging. CT has played an essential role in changing management of blunt aortic injuries and is the principal means of detecting both blunt and penetrating injuries of the diaphragm. While those pneumothoraces and contusions detected only by CT (radiographically occult) may not be clinically significant, CT detection of esophageal, central airways and cardiac injuries can be lifesaving. Recognition of chest wall injuries on CT not only aids management of the orthopedic trauma but can draw attention to associated sites of neurologic or vascular injuries needing surgical or endovascular treatment.

Breast cancer is the most cause of female cancer deaths in the western world, with early detection of cancer being pivotal for an improved prognosis and survival. Imaging plays a pivotal role in breast cancer detection and staging and helps guiding treatment decisions. Imaging modalities for diagnosis and staging of breast cancer comprise mammography, digital breast tomosynthesis (DBT), ultrasound, contrast-enhanced mammography (CEM), and magnetic resonance imaging (MRI). Mammography is the mainstay of breast cancer screening and diagnosis. Mammography, together with ultrasound and MRI, is used to detect and characterize lesions found at screening and to evaluate symptomatic women. In patients with breast cancer, mammography, often in conjunction with specialized views, can determine lesion size and location and assess the surrounding tissue and lymph nodes. DBT is a three-dimensional (3D) imaging method with the potential to overcome the main limitation of standard two-dimensional mammography, a masking effect due to overlapping fibroglandular breast tissue, improving diagnostic accuracy in breast cancer, particularly in dense breasts. CEM allows both a morphologic evaluation comparable to routine digital mammography and through contrast agent application a simultaneous assessment of tumor neovascularity as an indicator of malignancy similar to MRI. Data indicate that CEM has an improved sensitivity and increases the specificity compared with mammography. Breast US is widely used to confirm a diagnosis of cancer, to look for additional disease in the breast, for image-guided breast biopsy and localization, assessment of the axilla, and as a second-look tool in patients with abnormalities found on MRI. MRI of the breast is the most sensitive modality for breast cancer detection. MRI of the breast is used for the assessment of disease extent and detection of additional lesion and seems to be more useful than mammography when staging multifocal and multicentric disease or when DCIS is present. This chapters will provide an overview of when and how to use mammography, DBT, ultrasound, CEM, and MRI for diagnosis and staging of breast cancer.

In patients with breast cancer surveillance strategies play an important role. The aims of any follow-up are to detect early local recurrence or contralateral breast cancer and to diagnose and treat cancer and/or therapy-related diseases such as metastases and osteoporosis. Mammography every 1–2 years is the only recommended evidence-based imaging modality during follow-up. Current guidelines recommend against routine use of laboratory or imaging tests to detect asymptomatic metastases during staging or follow-up after breast cancer diagnosis. The purpose of this chapter is to address the role and effectiveness of imaging modalities in the staging and surveillance of patients with breast cancer after primary therapy.

CT and MRI have made enormous strides over the past decades becoming established imaging techniques in patients with suspected ischemic heart disease. The impact of these imaging techniques cannot be overestimated in the diagnosis and prognostication of patients with ischemic heart disease. As ischemic heart disease is highly prevalent, any contribution to improving the diagnosis and work-up of these patients by noninvasive imaging techniques has direct implications to more cost-effective diagnosis and therapy.

Diseases of the myocardium may be classified as either ischemic or nonischemic. Ischemic disease is due to coronary artery disease. The etiology of nonischemic cardiomyopathies is highly varied but may be described as either primary or secondary. Primary cardiomyopathies include abnormalities that are genetic but may be acquired. Secondary cardiomyopathies are secondary to systemic disease. This chapter reviews the clinical presentation and cardiac magnetic resonance features of common nonischemic cardiomyopathies.

Pulmonary vascular diseases are a complex and relevant group of thoracic disease. They encompass the various anatomical and functional components of the pulmonary and also systemic circulation. Furthermore, their genesis can be variable, ranging from congenital to iatrogenic. This chapter will give an overview over the clinically most relevant entities and discuss the role of imaging in the work-up of these disorders. The role of imaging in clinical decision-making and patient management will also be discussed.

Acute aortic syndrome is often a clinical emergency and a situation that demands accurate radiologic diagnosis and intervention to provide lifesaving care. A new classification scheme has been proposed based upon the primary location of the lesion within the aortic wall: aortic dissection principally involves the aortic media, penetrating aortic ulcer originates within the aortic intima, and aortic aneurysm is a disease of all three layers. The presence of intramural hematoma is an observation or epiphenomenon to be applied to any of these three fundamental pathologies. High-quality and comprehensive aortic and end-organ assessment of these diseases should be performed using multi-detector row CT with at least 16 detector rows and typically non-contrast as well as contrast-enhanced images. MRI is reserved for specific problem-solving, post-dissection surveillance, and hemodynamic assessment. Eight essential elements for characterizing the acute aorta are presented, and typical findings CT and MR imaging findings are discussed.

Aortic aneurysmal disease of the thoracic and abdominal aorta is a potentially life-threatening disease and requires besides preventive measures early detection of the disease and if present for the patient-tailored interventional treatment. This paper will discuss the current role of imaging in the assessment of pre- and post-aortic endovascular intervention tailored to treat aortic aneurysmal disease of the thoracic and abdominal aorta.

Over the past decade, noninvasive imaging of the peripheral arteries has evolved into a highly reliable alternative to invasive digital subtraction angiography. Both magnetic resonance angiography (MRA) and computed tomography angiography (CTA) are capable of identifying the location and grade of peripheral arterial disease (PAD) with high accuracy, and both modalities can be used to manage the entire spectrum of patients with suspected or known PAD. Although atherosclerotic PAD is the underlying cause of symptoms in the vast majority of patients, noninvasive cross-sectional imaging is also well suited for identification of alternative non-atherosclerotic causes such as vasculitis and other less frequent causes.