Vicente Martinez De Vega

Hospital Universitario Madrid Montepríncipe, Madrid, Madrid, Spain

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Publications (33)4.51 Total impact

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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 11/2013; 55(6):505–513. DOI:10.1016/j.rx.2012.01.004
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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. DOI:10.1016/j.ciresp.2011.10.006 · 0.89 Impact Factor
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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. DOI:10.1148/rg.327125053 · 2.73 Impact Factor
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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 07/2012; 54(4):306–320. DOI:10.1016/j.rx.2011.09.017
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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; 55(6). DOI:10.1016/j.rxeng.2012.01.001
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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. DOI:10.1016/j.rxeng.2011.09.002
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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; 91(1). DOI:10.1016/j.cireng.2011.10.001 · 0.89 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 09/2009; 51(5). DOI:10.1016/j.rx.2009.02.006
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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: PURPOSE/AIM The aim of this exhibit is to: - Specify the normal US and MRI anatomy of the developing fetal posterior fossa. - Describe posterior fossa pathologies amenable to prenatal diagnosis. - Establish a diagnostic imaging strategy for posterior fossa abnormalities. CONTENT ORGANIZATION Posterior fossa malformations are among the most common brain anomalies identified by current fetal imaging techniques. A good knowledge of embryology and anatomy of the posterior fossa is mandatory to analyse the US and MR images. Although US remains the primary imaging method for routine examination of the developing fetal brain, MRI provides better soft-tissue contrast, especially within the PF . We describe posterior fossa pathologies: Chiari‘s malformations, Dandy Walker malformation, vermian agenesis, vermian hypoplasia, rombencephalosynapsis, Joubert syndrome, cerebellar hypoplasia, pontocerebellar hypoplasia, cerebellar atrophy, mega cisterna magna, posterior fossa arachnoid cyst, Blake pouch cyst (delayed closure of the vermis) unilateral cerebellar damage, PHACE syndrome, fetomaternal infection (CMV), cerebellar hemorrhage. and occipital meningocele We establish a diagnostic algorithm based on radiological findings. SUMMARY A systematic analysis of the posterior fossa in fetal MRI makes it possible to diagnose accurately most posterior fossa malformations.
    Radiological Society of North America 2013 Scientific Assembly and Annual Meeting;
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    ABSTRACT: PURPOSE/AIM Describe breast VAB biopsy guided by MRI. The most relevant technical aspects Correlate the lesion morphology and pathological results in 500 cases CONTENT ORGANIZATION Review the most relevant technical aspects when performing breast VAB guided by MRI: Selection of biopsy system: grid vs. pillar system. Selection of access: external vs. medial quadrants Patient position Pulse sequences and acquisition plane Compression of the breast Simultaneous multiple biopsies Placement of titanium markers Complications Post-biopsy care False negatives Analysis results: grouping of the lesions according with morphology by BIRADS classification.Correlation with histology Strategies to follow after positive or negative pathological results SUMMARY Breast interventional procedures guided by MRI are the first choice technique for suspicious lesions found on MRI that were not seen with mammography or ultrasound. Breast VAB is accurate and easy to perform. However it is important to know some tricks on the realization of biopsies that can help improve our results. Clinical indications, recommendations for the positioning of the patient, possibility of multiple simultaneous biopsies, placement of titanium markers after biopsy, are important issues reviewed in this presentation.
    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 We evaluate the main indications for fetal chest MRI and the findings of normal lung and chest abnormalities. One hundred eighteen fetuses between the 20th and the 37.5th weeks of gestation were examined employing FIESTA , SSFSE , diffusion and gradient T1 pulse sequences, using a 1.5T MR scanner with 10% of chest abnormalities. CONTENT ORGANIZATION The most common congenital chest anomalies include congenital cystic adenomatoid malformation, congenital diaphragmatic hernia, bronchopulmonary sequestration and congenital bronchogenic cyst. The use of fetal magnetic resonance imaging helps identify potentially lethal pulmonary abnormalities. We briefly review fetal MR imaging technique and the normal lung anatomy, and we discuss and illustrate the most common congenital chest abnormalities seen at fetal MR imaging. SUMMARY Congenital chest malformations are usually evaluated in the prenatal period with fetal sonography, but fetal magnetic resonance imaging is a well-established modality that is used as an adjunct technique in difficult diagnostic situations. An understanding of the in utero complications associated with fetal chest masses is essential for appropriate monitoring during pregnancy, treatment recommendations, and delivery management.
    Radiological Society of North America 2011 Scientific Assembly and Annual Meeting;
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    ABSTRACT: PURPOSE/AIM The purpose of this review is: 1. To demonstrate the complex anatomy of perianal region with 3.0T MRI 2. To review the technical issues of 3.0T MRI with hign resolution protocol 3. To illustrate the different non-tumorous perirectal and perianal lesions (developmental cysts, fistula-in-ano, esphinteric anomalies, postsurgical complications...) CONTENT ORGANIZATION - Perirectal and perianal anatomy - 3.0T MRI High resolution protocol - Case-based revision and classification of non-tumorous perirectal and perianal lesions. SUMMARY The perirectal and perianal regions are composed with complex anatomical structures. Various lesions including developmental, functional and inflammatory disorders involving perirectal and perianal regions can be optimally evaluated with 3.0T MRI. We illustrate these lesions with a case based revision.
    0 T MRI Protocol. Radiological Society of North America 2010 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 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;
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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 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 On the basis of the brain mapping data, specific subcortical tracts seem to be essential for language and reading. These tracts are clearly identified in diffusion tensor imaging (DTI) studies, being situated near the cortical language areas. We review the function and the anatomic relations of these tracts based on the DTI studies. We also provide a correlation of the findings from the DTI studies with the subcortical intraoperative mapping in a large serie of patients with lesions near eloquent areas. CONTENT ORGANIZATION Preoperative fMRI and DTI studies in a serie of 22 patients with tumors located near eloquent language areas, evidenced the anatomic relations of their main subcortical fascicles involved in language and reading. A subcortical intraoperative mapping were performed in these patients, showing a complete anatomic correlation of the stimulated tracts with the information obtained from the DTI data . These main tracts were the arcuate fascicle, the inferior frontooccipital and the inferior longitudinal tracts, the subcallosal fascicle and the optic radiations. SUMMARY DTI sequences are a powerful preoperative tool in the daily practice to localize the subcortical fasciculus involved in language and reading, as show the good anatomic correlation with the subcortical intraoperative mapping
    3D-Tractography Correlated with Intraoperative Electrostimulation. Radiological Society of North America 2013 Scientific Assembly and Annual Meeting;
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    ABSTRACT: PURPOSE/AIM 1. Show the correlation between ADC values and histologic findings in breast lesions. 2. Show false positives (benign lesions with low ADC values) and correlate with pathologic findings. 3. Show false positives (malignant lesions with high ADC values) and correlate with pathologic findings. CONTENT ORGANIZATION General description of the diffusion technique in breast MRI. Benign lesions with low ADC values: abscess, hemorrhagic cyst, intramammary lymph node, papilloma, fat necrosis, radial scar, fibroadenoma, sclerosing adenosis, benign lesions of small size. Malignant lesions with high ADC values: cystic or necrotic cancer, colloid cancer, lobular invasive cancer, ductal carcinoma in situ, cancer with recent percutaneous biopsy. SUMMARY Diffusion has been shown to decrease in tissues with high cellularity. Malignant tumors in general have a higher cellularity than benign lesions. ADC is a sensitive and specific parameter that can help to differentiate benign and malignant breast lesions. Although diffusion MRI is a powerful tool to discriminate between benign and malignant lesions, is important to recognize false positives and false negatives of this technique. The correlation with pathologic examination can help to understand the reason for the discordant results.
    Radiological Society of North America 2013 Scientific Assembly and Annual Meeting;