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Imaging of Kidney Cysts and Cystic Kidney
Diseases in Children: An International Working Group
Consensus Statement
Autor: Charlotte Gimpel, MB, BChir, MA; E. Fred Avni, MD, PhD; Luc Breysem, MD; Kathrin Burgmaier, MD;
Anna Caroli, PhD; Metin Cetiner, MD; Dieter Haffner, MD, PhD; Erum A. Hartung, MD, MTR;
Doris Franke, MD; Jens König, MD; Max C. Liebau, MD; Djalila Mekahli, MD, PhD;
Albert C. M. Ong, DM, MA, FRCP; Lars Pape, MD, PhD; Andrea Titieni, MD; Roser Torra, MD, PhD;
Paul J. D. Winyard, BM, BCh, MA, PhD; Franz Schaefer, MD, PhD.
Objetivo Describir la técnica y resultados en cuanto a la mejoría del dolor y
complicaciones al realizar este procedimiento mediante guía por tomografía
computada.
Materiales y Métodos Estudio observacional descriptivo de una serie de 108
pacientes a quienes se les realizó vertebroplastia percutánea guiada por tomografía
computada realizadas en dos hospitales universitarios, entre mayo 2007 y mayo 2017.
Todos los procedimientos se realizaron de forma ambulatoria con anestesia local y se
valoró el dolor mediante la escala visual análoga.
Resultados Se realizaron 125 vertebroplastias, en el 87,9% de los pacientes (n ¼ 95)
se realizó el procedimiento en un cuerpo vertebral, en el 8,3% (n ¼ 9) y 3,7% (n ¼ 4) de
los pacientes se cementaron 2 y 3 vertebras respectivamente. El rango de dolor según
la escala visual análoga (EVA) previo al tratamiento varió entre 5 y 10, donde un 94%
(n ¼ 102) de los pacientes manifestaban una intensidad 10/10. En el postratamiento el
rango de dolor varió entre 0 a 7 donde el 98% de la población reportó un valor menor o
igual a 3. Se presentaron 3 complicaciones: tromboembolismo pulmonar por metilmetacrilato,
extravasación al plexo de Batson y extravasación al espacio interdiscal,
cada una en tres pacientes diferentes.
Conclusión La vertebroplastia percutánea guiada por TC ofrece una indiscutible
mejora inmediata del dolor en pacientes con fractura de uno o más cuerpos
vertebrales, con una baja tasa de complicaciones.
Palabras clave: vertebroplastia, tomografía
computada, multidetector, fractura vertebra.
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Kidney cysts can manifest as focal disease (simple and complex kidney cysts), affect a whole kidney (eg, multicystic dysplastic kidney or cystic dysplasia), or manifest as bilateral cystic disease (eg, autosomal recessive polycystic kidney disease [ARPKD] or autosomal dominant polycystic kidney disease [ADPKD]). In children, as opposed to adults, a larger proportion of kidney cysts are due
to genetic diseases (eg, HNF1B nephropathy, various ciliopathies, and tuberous sclerosis complex), and fewer patients have simple
cysts or acquired cystic kidney disease. The purpose of this consensus statement is to provide clinical guidance on standardization
of imaging tests to evaluate kidney cysts in children. A committee of international experts in pediatric nephrology, pediatric radiology, pediatric US, and adult nephrology prepared systematic literature reviews and formulated recommendations at a consensus
meeting. The final statement was endorsed by the European Society of Pediatric Radiology, the European Federation of Societies
for Ultrasound in Medicine and Biology, the European Society of Pediatric Nephrology, and reviewed by the European Reference
Network for Rare Kidney Diseases. Main recommendations are as follows: US is the method of choice when assessing pediatric
kidney cysts, with selected indications for MRI and contrast-enhanced US. CT should be avoided whenever possible because of
ionizing radiation. Renal US yields essential diagnostic information in many cases. In patients with ARPKD or other ciliopathies,
abdominal US is needed for diagnosis and screening of portal hypertension. US is usually sufficient for follow-up kidney imaging,
but MRI can be valuable for clinical trials in patients with ADPKD or in older children with tuberous sclerosis complex to evaluate
both kidney cysts and angiomyolipomas.
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