ABSTRACT BACKGROUND: The preoperative nutritional state has prognostic postoperative value. Tomographic density and area of psoas muscle are validated tools for assessing nutritional status. There are few reports assessing the utility of staging tomography in gastric cancer patients in this field. AIMS: This study aimed to determine the influence of sarcopenia, measured by a preoperative staging computed tomography scan, on postoperative morbimortality and long-term survival in patients operated on for gastric cancer with curative intent. METHODS: This retrospective study was conducted from 2007 to 2013. The definition of radiological sarcopenia was by measurement of cross-sectional area and density of psoas muscle at the L3 (third lumbar vertebra) level in an axial cut of an abdominopelvic computed tomography scan (in the selection without intravascular contrast media). The software used was OsirixX version 10.0.2, with the tool “propagate segmentation”, and all muscle seen in the image was manually adjusted. RESULTS: We included 70 patients, 77% men, with a mean cross-sectional in L3 of 16.6 cm2 (standard deviation+6.1) and mean density of psoas muscle in L3 of 36.1 mean muscle density (standard deviation+7.1). Advanced cancers were 86, 28.6% had signet-ring cells, 78.6% required a total gastrectomy, postoperative surgical morbidity and mortality were 22.8 and 2.8%, respectively, and overall 5-year long-term survival was 57.1%. In the multivariate analysis, cross-sectional area failed to predict surgical morbidity (p=0.4) and 5-year long-term survival (p=0.34), while density of psoas muscle was able to predict anastomotic fistulas (p=0.009; OR 0.86; 95%CI 0.76–0.96) and 5-year long-term survival (p=0.04; OR 2.9; 95%CI 1.04–8.15). CONCLUSIONS: Tomographic diagnosis of sarcopenia from density of psoas muscle can predict anastomotic fistulas and long-term survival in gastric cancer patients treated with curative intent. BACKGROUND value status field AIMS longterm long term intent METHODS 200 2013 crosssectional cross sectional L third vertebra media. media . media) 1002 10 0 2 10.0.2 propagate segmentation, segmentation , segmentation” adjusted RESULTS 7 77 men 166 16 6 16. cm standard deviation+6.1 deviation61 deviation 1 361 36 36. deviation+7.1. deviation71 deviation+7.1 deviation+7.1) 86 286 28 28.6 signetring signet ring cells 786 78 78.6 gastrectomy 228 22 8 22. 2.8% respectively 5year year 5 571 57 57.1% analysis p=0.4 p04 p 4 (p=0.4 p=0.34, p034 p=0.34 34 (p=0.34) p=0.009 p0009 009 (p=0.009 0.86 086 95CI CI 95 0.76–0.96 076096 76 96 p=0.04 p004 04 (p=0.04 2.9 29 9 1.04–8.15. 104815 1.04–8.15 15 1.04–8.15) CONCLUSIONS 20 201 100 10.0. deviation+6. deviation6 3 deviation7 deviation+7. 28. 78. 2.8 57.1 p=0. p0 (p=0. p03 p=0.3 (p=0.34 p=0.00 p000 00 (p=0.00 0.8 08 0.76–0.9 07609 p=0.0 p00 (p=0.0 2. 10481 1.04–8.1 10.0 deviation+6 deviation+7 57. p=0 (p=0 (p=0.3 0. 0.76–0. 0760 1048 1.04–8. 10. deviation+ p= (p= 0.76–0 076 104 1.04–8 (p 0.76– 07 1.04– 0.76 1.04 0.7 1.0 1.

RESUMO RACIONAL: O estado nutricional pré-operatório tem valor prognóstico pós-operatório. A densidade tomográfica e a área do músculo psoas é uma ferramenta validada para o estado nutricional. Existem poucos estudos avaliando a utilidade da tomografia de estadiamento em pacientes com câncer gástrico neste campo. OBJETIVOS: Determinar a influência da sarcopenia, medida por tomografia computadorizada de estadiamento pré-operatório, na morbimortalidade pós-operatória e sobrevida em longo prazo em pacientes operados de câncer gástrico com intenção curativa. MÉTODOS: Estudo retrospectivo de 2007 a 2013. A definição de sarcopenia radiológica foi pela medida da área (PA) e densidade do músculo psoas (PD) a nível de L3 (Terceira vertebra lombar), em um corte axial de tomografia computadorizada abdominopélvica (na seleção sem meio de contraste intravascular). O Software utilizado foi o OsirixX v 10.0.2, com a ferramenta “propagar segmentação”, ajustando manualmente todos os músculos vistos na imagem. RESULTADOS: Foram incluídos 70 pacientes, 77% homens, PA média em L3: 16,6 cm2 (desvio padrão+6,1), PD média em L3: 36,1 mean muscle density (desvio padrão+7,1). Os cânceres avançados foram de 86, 28,6% tinham células em anel de sinete, 78,6% necessitaram de gastrectomia total, a morbidade e mortalidade cirúrgica pós-operatória foi de 22,8 e 2,8%, respectivamente, a sobrevida global de 5 anos a longo prazo (SV5) foi de 57,1%. Na análise multivariada, PA falhou em prever morbidade cirúrgica (p=0,4) e sobrevida global de 5 anos (p=0,34), enquanto PD foi capaz de prever fístulas anastomóticas (p=0,009; OR 0,86; IC95% 0,76–0,96) e SV5 (p=0,04; OR 2,9; IC95% 1,04–8,15). CONCLUSÕES: O diagnóstico tomográfico de sarcopenia por desvio padrão é capaz de predizer fístulas anastomóticas e sobrevida a longo prazo em pacientes com câncer gástrico tratados com intenção curativa. RACIONAL préoperatório pré operatório pósoperatório. pósoperatório pós operatório. pós-operatório campo OBJETIVOS préoperatório, operatório, pósoperatória operatória curativa MÉTODOS 200 2013 (PA (PD L Terceira lombar, lombar , lombar) intravascular. intravascular . intravascular) 1002 10 0 2 10.0.2 propagar segmentação, segmentação segmentação” imagem RESULTADOS 7 77 homens 166 16 6 16, cm padrão+6,1, padrão61 padrão+6,1 1 padrão+6,1) 361 36 36, padrão+7,1. padrão71 padrão+7,1 padrão+7,1) 86 286 28 28,6 sinete 786 78 78,6 total 228 22 8 22, 2,8% respectivamente SV (SV5 571 57 57,1% multivariada p=0,4 p04 p 4 (p=0,4 p=0,34, p034 p=0,34 34 (p=0,34) p=0,009 p0009 009 (p=0,009 0,86 086 IC95 IC 0,76–0,96 076096 76 96 p=0,04 p004 04 (p=0,04 2,9 29 9 1,04–8,15. 104815 1,04–8,15 15 1,04–8,15) CONCLUSÕES 20 201 100 10.0. padrão6 padrão+6, 3 padrão7 padrão+7, 28, 78, 2,8 (SV 57,1 p=0, p0 (p=0, p03 p=0,3 (p=0,34 p=0,00 p000 00 (p=0,00 0,8 08 IC9 0,76–0,9 07609 p=0,0 p00 (p=0,0 2, 10481 1,04–8,1 10.0 padrão+6 padrão+7 57, p=0 (p=0 (p=0,3 0, 0,76–0, 0760 1048 1,04–8, 10. padrão+ p= (p= 0,76–0 076 104 1,04–8 (p 0,76– 07 1,04– 0,76 1,04 0,7 1,0 1,

Abstract: Aim: To establish the diagnostic accuracy of doubling time (DT) assessment in evaluation of solid lung nodules (LN). Method: Computed Tomography (CT) of patients referred for PN were reviewed, selecting those with an available CT for comparingcomparison. We included LN with histologic confirmationconfirmed by histology only. LN histologically proved as metastases were excluded. DT were calculated both by methodology 2D and 3D methods. Results: Seventy oneSeventy-one LN in 60 patients (median 68 y, 45-92 y,59% men) were studied, 63 of them malignant (corresponding a primaries primary lung neoplasms), and 8 were benign. There were not no significant differences in ROC curves among DT calculated by 2D or 3D methodology. Sensitivity, specificity and negative predictive value were 63,5%, 62,5% and 17,9% for DT between 40-400 days; and 80,9%, 37,5% and 20,0% for DT between 20-600 days. Conclusion: DT assessment has limited utility for rule outruling out malignant nature of a solid LN.

Resumen: Objetivo: Establecer el valor diagnóstico del tiempo de duplicación (TD) en la evaluación de nódulos pulmonares sólidos. Método: Se revisó las tomografías computadas (TC) de pacientes derivados por nódulo pulmonar (NP) sólido, que contaran con TC comparativo previo o posterior, incluyendo sólo aquellas lesiones con confirmación histológica. Las metástasis fueron excluidas. Los TD fueron calculados con metodología 2D y 3D. Resultados: La muestra correspondió a 71 NP en 60 pacientes (mediana 68 años, 45-92 años, 59% hombres), 63 de ellos malignos (neoplasias primarias pulmonares) y 8 benignos. No hubo diferencias en las curvas ROC entre TD calculado mediante método 2D vs 3D. Para TD de entre 40 y 400 días, la sensibilidad, especificidad y valor predictivo negativo (VPN) fueron de 63,5%, 62,5% y 17,9%; y para TD de entre 20 y 600 días, de 80,9%, 37,5% y 20,0%. Conclusión: La medición del TD de un NP es de limitada utilidad al querer descartar su naturaleza maligna.

Abstract: Introduction. Ankylosing spondyloarthritis (AS) is the most common and representative of seronegative spondyloarthropathy. It is characterised by chronic inflammation of the axial skeleton, leading to chronic back pain and progressive stiffness. It typically occurs in young patients, with symptoms often appearing with peak onset between 20 and 30 years of age, and is strongly associated with human leukocyte antigen B-27 (HLA B-27). Current imaging techniques are central in the management of these patients. The recognition of its classic imaging findings and its complications is essential for radiologists. Objectives. To present a pictorial review of the spinal imaging findings in patients with AS. Methods and materials. An analysis will be made of the spinal imaging findings in conventional radiography, CT and MRI in multiple patients from our medical centre. The most representative findings, complications, differential diagnoses, and some radiological key points will be shown.

Resumen: Introducción. La espondilitis anquilosante (EA) es la artropatía seronegativa más común y representativa. Se caracteriza por inflamación crónica del esqueleto axial, dolor referido a la columna vertebral de tipo inflamatorio y rigidez progresiva. Típicamente se manifiesta en pacientes jóvenes que inician su sintomatología entre los 20-30 años de edad y está ligada al antígeno leucocitario humano B-27 (HLA B-27). Las imágenes son fundamentales en el manejo de estos pacientes. Es deber del radiólogo reconocer los hallazgos imagenológicos presentes. Objetivos. Realizar una revisión pictográfica de hallazgos imagenológicos presentes en la columna vertebral de pacientes portadores de EA. Material y método. Análisis de las manifestaciones imagenológicas de columna más representativas de la EA en pacientes de nuestro centro en radiografía convencional, TC y RM, junto con posibles complicaciones y diagnósticos diferenciales.