Vicente Martinez De Vega

Hospital Central de la Defensa Gómez Ulla, Madrid, Madrid, Spain

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Publications (33)4.53 Total impact

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    ABSTRACT: Diffusion weighted imaging (DWI) in magnetic resonance imaging (MRI) is currently an important tool for detecting and characterising hepatic lesions, as well as for monitoring and evaluating the response to the treatment of the tumour disease. The use of this technique is also being assessed for the study of diffuse liver disease.Among the additional advantages of DWI-MRI, is the absence of emission of ionising radiation and not having to use paramagnetic contrasts, which means it can be used in the study of patients with renal failure. Another advantage is the short duration of the diffusion sequence, which means that the examination time in abdominal MRI is scarcely increased.Therefore, it is important that the physician is aware of this diagnostic technique, since DWI is a sequence that should be routinely included in the liver MRI study protocol.
    Cirugía Española 01/2013; 91(1):9–16. · 0.87 Impact Factor
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    ABSTRACT: Objective To describe the detection of cortical areas and subcortical pathways involved in language observed in MRI activation studies and tractography in a 3 T MRI scanner and to correlate the findings of these functional studies with direct intraoperative cortical and subcortical stimulation. Material and methods We present a series of 14 patients with focal brain tumors adjacent to eloquent brain areas. All patients underwent neuropsychological evaluation before and after surgery. All patients underwent MRI examination including structural sequences, perfusion imaging, spectroscopy, functional imaging to determine activation of motor and language areas, and 3D tractography. All patients underwent cortical mapping through cortical and subcortical stimulation during the operation to resect the tumor. Postoperative follow-up studies were done 24 hours after surgery. Results The correlation of motor function and of the corticospinal tract determined by functional MRI and tractography with intraoperative mapping of cortical and subcortical motor areas was complete. The eloquent brain areas of language expression and reception were strongly correlated with intraoperative cortical mapping in all but two cases (a high grade infiltrating glioma and a low grade glioma located in the frontal lobe). 3D tractography identified the arcuate fasciculus, the lateral part of the superior longitudinal fasciculus, the subcallosal fasciculus, the inferior fronto-occipital fasciculus, and the optic radiations, which made it possible to mark the limits of the resection. The correlation with the subcortical mapping of the anatomic arrangement of the fasciculi with respect to the lesions was complete. Conclusion The best treatment for brain tumors is maximum resection without associated deficits, so high quality functional studies are necessary for preoperative planning.
    Radiología. 01/2013; 55(6):505–513.
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    ABSTRACT: In recent years, with the development of ultrafast sequences, magnetic resonance (MR) imaging has been established as a valuable diagnostic modality complementary to ultrasonography (US). MR imaging offers several technical advantages over US, including a larger field of view, fewer limitations due to maternal habitus, and the ability to visualize fetal anatomy regardless of fetal presentation. The authors discuss the most frequently found thoracic abnormalities, including congenital diaphragmatic hernia, congenital cystic adenomatoid malformation, bronchopulmonary sequestration, bronchogenic cyst, congenital high airway obstruction syndrome, and bronchial obstruction by a mucus plug, specifically with respect to the effect of fetal MR imaging on diagnosis and treatment. MR imaging can assist in establishing the prognosis and in perinatal management, especially in the case of congenital diaphragmatic hernia, which is the most common indication for thoracic MR imaging. MR imaging can demonstrate hernial contents and quantify lung volume better than US, allowing the prognosis to be determined and postpartum extracorporeal membrane oxygenation needs to be estimated. MR imaging can also be used to distinguish different types of cystic adenomatoid malformations, identify the anomalous vessels of pulmonary sequestration, and assess the functional effects of bronchogenic cysts. Balanced sequences (steady-state free precession sequences) allow performance of unenhanced thoracic vascular studies, which are useful in the diagnosis of intralobar or extralobar sequestration. In summary, fetal MR imaging can provide additional data useful in establishing prognosis and in perinatal management of thoracic malformations. © RSNA, 2012.
    Radiographics 11/2012; 32(7):E305-E321. · 2.79 Impact Factor
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    ABSTRACT: OBJECTIVE: To describe the detection of cortical areas and subcortical pathways involved in language observed in MRI activation studies and tractography in a 3T MRI scanner and to correlate the findings of these functional studies with direct intraoperative cortical and subcortical stimulation. MATERIAL AND METHODS: We present a series of 14 patients with focal brain tumors adjacent to eloquent brain areas. All patients underwent neuropsychological evaluation before and after surgery. All patients underwent MRI examination including structural sequences, perfusion imaging, spectroscopy, functional imaging to determine activation of motor and language areas, and 3D tractography. All patients underwent cortical mapping through cortical and subcortical stimulation during the operation to resect the tumor. Postoperative follow-up studies were done 24hours after surgery. RESULTS: The correlation of motor function and of the corticospinal tract determined by functional MRI and tractography with intraoperative mapping of cortical and subcortical motor areas was complete. The eloquent brain areas of language expression and reception were strongly correlated with intraoperative cortical mapping in all but two cases (a high grade infiltrating glioma and a low grade glioma located in the frontal lobe). 3D tractography identified the arcuate fasciculus, the lateral part of the superior longitudinal fasciculus, the subcallosal fasciculus, the inferior fronto-occipital fasciculus, and the optic radiations, which made it possible to mark the limits of the resection. The correlation with the subcortical mapping of the anatomic arrangement of the fasciculi with respect to the lesions was complete. CONCLUSION: The best treatment for brain tumors is maximum resection without associated deficits, so high quality functional studies are necessary for preoperative planning.
    Radiología 04/2012;
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    ABSTRACT: The Seventh Edition of the TNM Classification for non-small cell bronchogenic carcinomas include a series of changes in the T and M descriptor, in particular a re-classification of malignant pleural and pericardial effusions and of separated tumour nodes, new tumour size cut-off values and sub-divisions of the T1-T2 and M1 categories. We review these corrections that led to the changes in the staging system that affects stages II-III. Furthermore, we describe and illustrate the role of the different imaging techniques in tumour staging (CT, PET, PET-CT and MRI), highlighting their respective indications, advantages and disadvantages, as well their complementary function.
    Radiología 01/2012; 54(4):306-20.
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    ABSTRACT: The Seventh Edition of the TNM Classification for non-small cell bronchogenic carcinomas include a series of changes in the T and M descriptor, in particular a re-classification of malignant pleural and pericardial effusions and of separated tumour nodes, new tumour size cut-off values and sub-divisions of the T1-T2 and M1 categories. We review these corrections that led to the changes in the staging system that affects stages II-III. Furthermore, we describe and illustrate the role of the different imaging techniques in tumour staging (CT, PET, PET-CT and MRI), highlighting their respective indications, advantages and disadvantages, as well their complementary function.
    Radiología. 01/2012; 54(4):306–320.
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    ABSTRACT: Diffusion weighted imaging (DWI) in magnetic resonance imaging (MRI) is currently an important tool for detecting and characterising hepatic lesions, as well as for monitoring and evaluating the response to the treatment of the tumour disease. The use of this technique is also being assessed for the study of diffuse liver disease. Among the additional advantages of DWI-MRI, is the absence of emission of ionising radiation and not having to use paramagnetic contrasts, which means it can be used in the study of patients with renal failure. Another advantage is the short duration of the diffusion sequence, which means that the examination time in abdominal MRI is scarcely increased. Therefore, it is important that the physician is aware of this diagnostic technique, since DWI is a sequence that should be routinely included in the liver MRI study protocol.
    Cirugía Española 12/2011; · 0.87 Impact Factor
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    ABSTRACT: We report the case of a young man who presented with atrophy of the musculature of the right forearm and hand. The clinician suspected cervical myelopathy in Hirayama's disease on the basis of the findings at electromyography and recommended an MRI examination in both flexed and neutral position. The typical imaging findings for cervical myelopathy in Hirayama's disease were observed and the diagnosis was confirmed. The key findings for Hirayama's disease consist of asymmetrical medullary atrophy with involvement of the anterior horns, dorsal detachment of the dura mater, and dilatation of the epidural venous plexus.
    Radiología 07/2009; 51(5):516-9.
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    ABSTRACT: We report the case of a young man who presented with atrophy of the musculature of the right forearm and hand. The clinician suspected cervical myelopathy in Hirayama's disease on the basis of the findings at electromyography and recommended an MRI examination in both flexed and neutral position. The typical imaging findings for cervical myelopathy in Hirayama's disease were observed and the diagnosis was confirmed. The key findings for Hirayama's disease consist of asymmetrical medullary atrophy with involvement of the anterior horns, dorsal detachment of the dura mater, and dilatation of the epidural venous plexus.
    Radiología. 01/2009; 51(5).
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    ABSTRACT: PURPOSE/AIM 1. To describe segmental enhancement (SE) pattern on breast MRI. 2. To display the correlation between radiological appearance and pathological features in 45 cases of SE on breast MRI. 3. To emphasize the importance of recognizing SE on breast MRI otherwise unsuspected in mammography or ultrasound CONTENT ORGANIZATION 1. MR appearances of SE: diffuse non-mass enhancement SE with associated mass enhancement inside 2. Analysis of dynamic kinetic patterns in SE. 3. Analysis of indications for Breast MR examinations in our series: cancer staging (20), nipple blood discharge (2), high risk patient (21), suspicion for a ruptured implant (2) 4. How to deal with SE on breast MRI with no abnormalities in mammography nor ultrasound. 5. Histological diagnosis is reviewed and illustrated. SUMMARY 77.78% (35 cases) of the SE depicted on breast MR were malignant: 57.14% ductal carcinoma in situ, 37.14% Infiltrating ductal carcinoma with associated ductal carcinoma in situ and 5.7 % lobular infiltrating carcinoma with lobular in situ carcinoma. Any SE brought to light on breast MR and otherwise unsuspected on mammography or ultrasound is a finding to be classified as BIRADS 4 independently of the enhancement curve type, and is also an indication for vacuum biopsy guided with MR
    Radiological Society of North America 2011 Scientific Assembly and Annual Meeting;
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    ABSTRACT: PURPOSE/AIM The purpose of this exhibit is: 1. To review the technical issues related to the performance of MR enterography. 2. To review the state-of-the-art role for MRI in assessing the activity of small bowel Crohn’s disease. 3. To illustrate the different subtypes of Crohn's disease and describe the imaging based classification of Crohn's subtypes. CONTENT ORGANIZATION - Technical issues related to the performance of MR enterography. - Typical MRI findings. - Crohn's subtypes: Imaging based classification - Illustrative examples of the different subtypes of Crohn's disease. - MRI index in assessing the severity of activity in Crohn’s disease. SUMMARY MRI is an accurate tool in evaluating the crucial issue of Crohn’s disease activity. Magnetic Resonance Imaging (MRI) has been proposed as the most promising technique for small bowel imaging evaluation, since it can provide an accurate assessment of disease activity using different parameters, without radiation exposure and with reduced discomfort.
    Radiological Society of North America 2010 Scientific Assembly and Annual Meeting;
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    ABSTRACT: PURPOSE/AIM The aim of this exhibit is to: - Describe basic concepts of 18 F-Choline regarding molecular biology and biodistribution. - Establish a PET/CT protocol with a first early static pelvic acquisition and a delayed static acquisition. - Review the role of PET/CT with 18 F-Choline in primary staging and restaging of prostate cancer patients. CONTENT ORGANIZATION The goal of current prostate cancer care is to administer risk-adjusted patient-specific treatment . We review 18 F-Choline PET/CT imaging of prostate cancer analyzing: - Molecular biology correlates of tumor choline uptake. - PET/CT protocol. - Staging: Primary Tumor, lymph node metastases and bone metastases. - Therapeutic management - Biochemical failure and restaging. SUMMARY 18F Choline PET/TAC can be useful in guiding biopsy for the assessment of primary prostate cancer; however, it cannot accurately differentiate BPH or chronic prostatitis from cancerous prostate lesions by means of SUV. It is useful in the evaluation of patients with prostate cancer who are at high risk for extracapsular. disease, and it could be used to preoperatively exclude distant metastases. It could led to a change in therapy of the patients, especially in high risk patients and may have a role in the management of men with biochemical recurrence of prostate cancer and restaging.
    Radiological Society of North America 2013 Scientific Assembly and Annual Meeting;
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    ABSTRACT: PURPOSE/AIM • Definition and prevalence of invasive endometriosis with bowel involvement. • To determine the usefulness of MRI in the preoperative planning of invasive intestinal endometriosis. • To illustrate the variable appearance and the most common locations of bowel endometriotic implants. • Describe the advantage of combining high-resolution pelvic studies with MRI-enterography or colonography. • Describe the criteria for involvement of intestinal resection for endometriosis. CONTENT ORGANIZATION 1. Introduction: 1.1-Definition. 1.2-Etiopathogenic theories. 1.3-Prevalence. Most common locations. 1.4-Clinical presentation. 2 MR Imaging. 2.1 Technical considerations. 2.1.1 High-resolution Pelvic MRI. 2.1.2 MR enterography / MR colonography. 2.2 MRI Characteristics of bowel implants. 2.3 Differential diagnosis of intestinal endometriosis vs peritoneal adhesions. 2.4 Complications. 3 Presurgical Diagnostic Methods. 4. Surgical criteria. Usefulness of MRI. 5. Tips and details to avoid diagnostic errors. SUMMARY MRI is a useful technique in the presurgical evaluation of invasive intestinal endometriosis, with greater diagnostic accuracy intestinal transit and ultrasound, and with the advantage of lacking ionizing radiation.
    Radiological Society of North America 2012 Scientific Assembly and Annual Meeting;
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    ABSTRACT: PURPOSE/AIM 1. To bring attention to the importance of T1 non-enhanced sequences on breast MRI for the detection and characterization of fat tissue. 2. To reinforce the significance of fat detection as a sign of benignity on breast lesions. 3. To describe and illustrate the spectrum of imaging findings of fat-containing lesions on breast MRI. CONTENT ORGANIZATION The usefulness of T1 weighted sequences with and without fat suppression as an important tool to characterize fat-containing lesions is discussed. Breast MR imaging findings and semiology of fat-containing lesions (such as hamartomas, fat necrosis, intra mammary lymph nodes, lipomas and oily cysts ) are described and illustrasted. An analysis of MRI contrast enhancement curves and patterns in fat-containing lesions of the breast is also provided. SUMMARY Breast MRI characteristics of fat containing lesions are reviewed. Adequate knowledge of their radiologic semiology may help to avoid or reduce unnecessary biopsies, as recognition of fat tissue inside a lesion that shows enhancement represents a sign of benignity. Our opinion is that the use of T1 weighted sequences without contrast and without fat-suppression ( such as SET1) combined with dynamic T1 weighted sequences with fat suppression is the best protocol to characterize fat tissue.
    Radiological Society of North America 2011 Scientific Assembly and Annual Meeting;
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    ABSTRACT: PURPOSE/AIM To define the potential of MRI to delineate the gross tumor volume, the clinical target volume and organs at risk in brachytherapy of cervical carcinoma To demonstrate the ability to visualize the brachytherapy applicator on MRI studiesand to familiarize the radiologist to the correct probe positioning as well with any potential complications. CONTENT ORGANIZATION 3T MRI studies were performed at the time of diagnosis, before and after placement of the brachytherapy applicator and after completion of treatment Multiplannar T2WI are used in the MR-brachytheraphy session to improve the proper placement of the implant. MRI studies are suitable in the diagnosis of the cervical carcinoma, guidance for applicator positioning, assisted treatment planning and control treatment. The most representative cases with their evolution and complications are shown SUMMARY Brachytherapy increases both local control and survival, specially in patients with advanced disease, indicating its critical role in the treatment of malignant cervical tumors.MRI-guided brachytherapy is superior to TC-based brachytherapy in delineating the target volume and organs at risk. In routine clinical practice, this procedure is feasible and efficient for patients with locally advanced cervical cancer and the radiologist must be familiarized with this increasingly used therapy
    Radiological Society of North America 2011 Scientific Assembly and Annual Meeting;
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    ABSTRACT: PURPOSE/AIM Diffusion-weighted imaging has generated substantial interest in the hope that it can be developed into a robust technique to improve the accuracy of MRI for the evaluation of prostate cancer. We reviews the basic concepts for the biologic basis of DWI, illustrates its potential clinical applications at 3 T, and discusses its current limitations. CONTENT ORGANIZATION We review techniques of prostate 3-T DWI, clinical application of MRI in localised prostate cancer , potential uses of DWI in prostate cancer detection, extraprostatic involvement, pre-treatment detection (tumour localization and prognostication), implications in the planning of radiation therapy and monitoring treatment, clinical relevance and potencial limits in radical prostatectomy planning and detection of local recurrence after radical prostatectomy. SUMMARY DWI is a powerful noninvasive imaging method that may yield useful qualitative and quantitative information about tumor cellularity and tissue structure in prostate cancer. It may improve the diagnostic accuracy of tumor detection, staging, and posttreatment follow-up. Additionally, it may be a useful tool tomonitor the therapeutic effects of prostate cancer after hormonal or radiation therapy and for guiding targeted biopsy in patients with previously negative biopsy results.
    Radiological Society of North America 2011 Scientific Assembly and Annual Meeting;
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    ABSTRACT: PURPOSE/AIM 1. To show the multiples faces of fibroadenoma on MRI 2. To describe typical and atypical MRI diagnostic features of breast fibroadenomas in order to avoid unnecessary biopsies. 3. To learn to discriminate between fibroadenomas and other breast masses CONTENT ORGANIZATION 1. Typical breast MRI findings in cellular fibroadenomas and fibrous fibroadenomas 2. What to analyze: signal, morphology, margins, kinetic curve, hipointense septa, ADC values 3. Fibroadenomas with unfrequent MR findings: irregular margins, cysts inside, enhanced septa, curve type 3 with early wash out, low ADC value 4. Main differential diagnosis: intrammamary lymph node, hamartoma, phyllodes tumor, PASH, colloid cancer, cancer with well define margins SUMMARY Key characteristics of fibroadenomas on MRI are highlighted The more spatial resolution the better diagnostic accuracy particularly in small lesions Imaging findings of non typical fibroadenomas, with histopathologic correlation are reviewed
    Radiological Society of North America 2011 Scientific Assembly and Annual Meeting;
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    ABSTRACT: PURPOSE/AIM We review the normal anatomy of the white matter (WM) tracts as they appear on directional diffusion tensor imaging (DTI) color maps at 3T diffusion tensor and the main clinical applications in developmental abnormalities,demyelinating disease, ischemic disease, infectious diseases, neurodegenerative disordes, neoplasms and preoperative studies. CONTENT ORGANIZATION WM fiber tracts traditionally have been classified as follows: Association fibers interconnect cortical areas in each hemisphere,projection fibers interconnect cortical areas with deep nuclei, brain stem, cerebellum, and spinal cord, commissural fibers interconnect similar cortical areas between opposite hemispheres, and other tracts. Anatomic gross dissection photographs. are correlated with the directional DTI color maps.We review the main clinical applications. SUMMARY Diffusion-tensor (DT) imaging is capable of demonstrating abnormalities in a variety of disorders, potentially with higher sensitivity and specificity than conventional imaging. Clinical tractography is poised to make substantial contributions to preoperative planning in neuro-oncology and epilepsy.
    Radiological Society of North America 2010 Scientific Assembly and Annual Meeting;
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    ABSTRACT: PURPOSE/AIM 1. Show the correlation between ADC values and histologic findings in bone tumors and soft tissue tumors. 2. To assess the accuracy of DW-MRI in evaluating response to chemotherapy in the treatment of osteosarcoma and Ewing sarcoma, more specifically at mid-course of treatment, because during successful chemotherapy of osteosarcomas, tumor size does not diminish significantly. 3. We try to discriminate low-grade chondrosarcoma from enchondroma. CONTENT ORGANIZATION General description of the diffusion technique in bone tumors and soft tissue tumors. Try to understand why tumors have a lower ADC as round cell tumors (lymphoma or myeloma) because they present greater cellularity and less stroma; meanwhile tumors with a higher ADC (angiomas, myxomas…) have more stroma and less cellularity. SUMMARY There is no value of ADC in differentiating benign-malignant tumors, each tumor have their own values. It is not possible only with ADC values discriminate low-grade chondrosarcoma from enchondroma. The ADC values on DWI scans, holds promise as a valuable tool for monitoring the therapeutic response of primary bone sarcomas. The correlation with pathologic examination can help to understand the reason for the ADC values.
    Radiological Society of North America 2013 Scientific Assembly and Annual Meeting;
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    ABSTRACT: PURPOSE/AIM Neurodegenerative diseases are a continuous challenge for both the departments of radiology and neurology. Overlapping clinical findings are commonly found in these cases, and therefore neuroimaging is frequently requested. Although degenerative brain diseases occasionally show some MR imaging structural findings that can lead to a definitive diagnosis, advanced functional imaging (MR-spectroscopy, diffusion tensor imaging , functional MR and FDG-PET) also provide useful information for an early diagnosis of these disorders, and specially for the evaluation of the disease evolution. CONTENT ORGANIZATION A pictorial review of morphological findings of the most common neurodegenerative diseases is provided, including Alzheimer dementia, multisystem atrophy, hypertrophic olivary degeneration, frontotemporal dementia, amyotrophic lateral sclerosis, Parkinson disease, and Creutzfeld-Jacob disease. We specially focus in the utility of diffusion tensor imaging for the diagnosis of some of these diseases due to the early involvement of the uncinate fasciculus. SUMMARY We review morphological MR findings obtained from conventional pulse sequences, as well as the spectrum of findings that can be observed in advanced functional imaging in the most commonly found degenerative brain diseases in the daily practice.
    Radiological Society of North America 2013 Scientific Assembly and Annual Meeting;