bluuebunny/crossref_metadata_2025 huggingface dataset:
Estimation or quantification of tumour volume? CT study on irregular phantoms
Authors: Tiitola M. , Kivisaari L. , Tervahartiala P. , Palomäki M. , Kivisaari R.P. , Mankinen P. , Vehmas T.
Published: July 2004

Purpose: To compare radiologists' subjective size estimation to computerised volume quantification of tumour-like phantoms in spiral CT.

Material and Methods: Eight tubular phantoms with the inside irregularly covered with silicone (8.7–31.6 ml) were imaged. The phantoms were pairwise compared to analyse the differences in silicone volumes. The observers, 2 radiologists and 2 residents, used both subjective image analysis (2 sessions) and computerised volume quantification (1 session). Accuracy and observer agreement of both methods were calculated.

Results: Subjective size estimation was correct in 51% (mean weighted kappa, κqw=0.73). Using four observers' mean value (κqw=0.81) or median value (κqw=0.77) slightly improved the results. Average intra-observer agreement was better than average interobserver agreement. In computerised volume quantification 70% of all classifications were correct (mean κqw=0.85). The results were moderate even when every second or fourth slice were measured.

Conclusion: Subjective size estimation of irregular tumours should be repeatedly performed by the same observer, or by using the mean or median estimate of several observers. Computer-based methods are even more reliable and their use is especially recommended for film readers with limited radiological experience. Only every fourth slice may be measured without a major loss of measurement accuracy.
B-Mode, power doppler and contrast-enhanced power doppler ultrasonography in the diagnosis of breast tumors
Authors: Reinikainen H. , Rissanen T. , Päivänsalo M. , Pääkkö E. , Jauhiainen J. , Suramo I.
Published: July 2004

Purpose: To investigate the role of B-mode and unenhanced and enhanced power Doppler ultrasonography (US) in differentiating solid breast lesions, and to find out whether morphologically different tumors differ in terms of vascularity.

Material and Methods: Sixty-five lesions, indeterminate or suggestive of malignancy after mammography were prospectively examined with B-mode and unenhanced and enhanced power Doppler US. The lesions were classified as benign, indeterminate or malignant at B-mode, and as benign or malignant at power Doppler US. The results were compared to the histologic diagnoses. Vascularity was analyzed also quantitatively to find out whether threshold values for differential diagnostics could be set.

Results: The sensitivity, specificity, and overall accuracy of the morphologic evaluation were 100%, 10%, and 57%, respectively. Rounded lesions were more vascular than spiculated lesions, but vascular assessment was only helpful when it supported a benign morphology. In quantitative analysis, due to the overlap between the benign and malignant lesions, no threshold values could be set.

Conclusion: Morphologic criteria were useful in characterizing malignant lesions, but the large proportion of indeterminate findings decreased the specificity of US. Neither unenhanced, nor enhanced power Doppler US was able to improve diagnostic accuracy.
MR imaging in chronic rupture of the ulnar collateral ligament of the thumb
Authors: Lohman M. , Vasenius J. , Kivisaari A. , Kivisaari L.
Published: July 2004

Purpose: MR imaging has been shown as the best radiologic method for verifying and classifying acute ulnar collateral ligament (UCL) ruptures of the thumb. Our aim was to analyse the usefulness of MR also in old ruptures and to establish the most useful sequences.

Material and Methods: Ten patients with an old UCL rupture of the thumb were preoperatively imaged using 1.5 T MR. Three radiologists blinded to the findings separately analysed the MR images of these patients and of 10 age-and sex-matched voluntary controls. MR findings of the patients were compared with those of surgery.

Results: The consensus diagnosis of an UCL rupture was accurate in all 10 patients. All controls were classified as having no UCL rupture. In 5 of the 7 patients with a surgically defined Stener or non-Stener lesion, the consensus diagnosis was the same as the operative diagnosis. Due to excessive scarring it was not possible to verify any Stener lesion intra-operatively in 3 patients. The most informative MR sequence was T2 TSE in the coronal plane, the second most informative was T1 SE with fat suppression in the coronal plane.

Conclusion: An old UCL rupture is well verified by MR but typing of the lesion as either a Stener or non-Stener type is not always possible.
Age-related changes in cortical and trabecular bone mineral status: A quantitative CT study in lumbar vertebrae
Authors: Tanno M. , Horiuchi T. , Nakajima I. , Maeda S. , Igarashi M. , Yamada H.
Published: July 2004

Purpose: To investigate the age and sex dependence of the bone mineral status of human lumbar vertebrae with special regard to differences between cortical and trabecular bone.

Material and Methods: The study group comprised 125 normal Japanese healthy volunteers (54 males and 71 females), and was subdivided into adult male and female groups (subjects younger than 40 years), intermediate male and female groups (ages ranging between 41 and 64 years) and old male and female groups (subjects older than 65 years). The cortical bone mineral status was estimated using a single-energy quantitative CT (SE-QCT) technique, whereas trabecular bone mineral density (BMD) was estimated using a dual-energy (DE-QCT) technique.

Results: A considerable gender difference in the age-related cortical bone status was found. There was a significant reduction of the mean values of the cortical volume and BMD in the old female group compared with those obtained in the old male group.

Conclusion: The results suggest that in men, cortical and trabecular bone volume decrease very little with age. In women, cortical volume and BMD and trabecular BMD decrease with age while trabecular bone volume does not. The study showed that all variables had higher values in men than in women and that the difference increased with age.
Cerebrospinal fluid flow in children with normal and dilated ventricles studied by MR imaging
Authors: Parkkola R.K. , Komu M.E.S. , Äärimaa T.M. , Alanen M.S. , Thomsen C.
Published: July 2004

Purpose: To quantify the cerebrospinal fluid (CSF) dynamics in the aqueduct of children with normal and dilated ventricles using MR phase-contrast technique.

Material and Methods: Eighteen patients (6 months to 17 years of age) with various neurological symptoms underwent routine brain MR imaging and CSF flow measurement in the aqueduct. Nine patients had normal ventricles, 5 had dilated ventricles and 4 had a ventriculoperitoneal shunt.

Results: The CSF velocity and flow rates in the aqueduct in patients with normal and dilated ventricles showed marked inter-individual variation and clear overlap. In a patient with tight aqueductal stenosis and increased ventricular pressure, pronounced CSF flow in the aqueduct was measured. Absence of flow in another patient with aqueductal stenosis was detected. Measurable although low flow in the aqueduct in 4 patients with a ventriculoperitoneal shunt was found.

Conclusion: Quantitative phase MR flow measurement in the aqueduct demonstrated aqueductal stenosis; these patients had either pronounced flow or no flow in the aqueduct.
Frequency of benign hepatic lesions incidentally detected with contrast-enhanced thin-section portal venous phase spiral CT
Authors: Völk M. , Strotzer M. , Lenhart M. , Techert J. , Seitz J. , Feuerbach S.
Published: July 2004

Purpose: To evaluate the frequency of benign focal hepatic lesions incidentally detected at contrast-enhanced thin-section portal venous phase spiral CT.

Material and Methods: Between January 1998 and February 1999, contrast-enhanced hepatic spiral CT examinations were performed in 1,892 patients. Out of these, only 100 patients fulfilled the following inclusion criteria: No underlying malignant disease, no liver cirrhosis, no suspected or known focal liver lesions. Standardized spiral CT parameters were applied. All CT studies were reviewed retrospectively by one radiologist. Any focal lesion was recorded and classified. Lesion size and number were noted.

Results: A total of 108 hepatic lesions were reported in 33 out of 100 patients (80 cysts; 18 hemangiomas; 3 focal fatty infiltrations; 2 focal non-tumorous perfusion defects; 1 calcification; and 4 non-classified lesions). The average lesion size was 9.4 mm (≤5 mm: n=40; 6-10 mm: n=30; 11-15 mm: n=28; >15 mm: n=10).

Conclusion: Benign liver lesions are probably a frequent incidental finding at abdominal spiral CT.
MR imaging of upper abdomen following cholecystectomy: Normal and abnormal findings
Authors: Håkansson K. , Leander P. , Ekberg O. , Håkansson H.-O.
Published: July 2004

Purpose: To describe the normal MR appearance after cholecystectomy and the findings in patients with postoperative complications using fast pulse sequences in abdominal MR imaging.

Material and Methods: In a prospective study of 119 patients, 64 were examined with MR after cholecystectomy. In total, 56 patients with uncomplicated cholecystectomy were examined with MR 1–5 days (mean 1.6 days) after cholecystectomy. Nine patients had an abdominal postoperative complication and 8 of these were examined with MR after the complication commenced 1–12 days after the cholecystectomy.

Results: Oedema in the gallbladder fossa was the only finding in 39 patients (61%), all with uneventful recovery. Small fluid collections in an area consistent with the gallbladder fossa were seen in 9/64 (14%) patients, of which 3 had surgical complications: 1 bleeding and 2 bile duct leakage. Twenty-two (34%) patients had small locally situated fluid collections adjacent to the liver, 14 were uneventful and 8 showed postoperative surgical complications. Seven patients had fluid in the rest of the abdomen of which 5 had surgical complications; 4 due to bile duct leakage and 1 acute pancreatitis. One patient had a postoperative bleeding not seen on MR images.

Conclusion: MR is very sensitive in detecting fluid collections. Early MR findings following cholecystectomy are normally only subtle changes, mainly in the gallbladder fossa. Fluid collections diagnosed elsewhere than in the gallbladder fossa usually indicate a surgical complication and a surgical complication is unlikely if MR fails to show a fluid collection.
Femorotibial rotation and the Q-angle related to the dislocating patella
Authors: Sanfridsson J. , Arnbjörnsson A. , Fridén T. , Ryd L. , Svahn G. , Jonsson K.
Published: July 2004

Purpose: To compare the femorotibial rotation, the patellar translation, the hip-knee-ankle angle and the Q-angle in patients with a dislocation of the patella with those of healthy volunteers. Further, the clinically measured Q-angle was compared to that measured by radiography.

Material and Methods: A system for measurement of patellar variables was previously developed and applied to 80 healthy volunteers. In the present study, 28 patients (20 women, 8 men) with dislocation of the patella were examined bilaterally. Fourteen patients had habitual dislocations (20 affected knees) and 14 patients traumatic dislocations (17 affected knees). In 20 patients the clinical Q-angle was measured bilaterally by an orthopaedic surgeon and in 9 of these patients also by a second independent orthopaedic surgeon.

Results: The most striking finding was that dislocating knees in both groups showed a smaller Q-angle than the healthy knees. Further, the habitual group showed greater relative rotation between the tibia and the femur and an increased patellar translation compared to the traumatic group and to the healthy volunteers. There was a poor correlation between clinical and radiographic measurements of the Q-angle and no correlation was found between two independent clinical measurements.

Conclusion: Surgical operations aiming at decreasing the Q-angle should be challenged.
Doppler ultrasonography in testicular tumors presenting with acute scrotal pain
Authors: Varsamidis K. , Varsamidou E. , Mavropoulos G.
Published: July 2004

Purpose: To determine whether Doppler ultrasonography (US) could be useful in the evaluation of testicular neoplasms presenting with acute scrotal pain.

Material and Methods: We examined 18 patients with acute scrotal pain using Doppler US. Peak systolic and end-diastolic velocity measurements were performed at first admission and on completion of 1-week proper antibiotic treatment. Data were retrospectively reviewed and compared with findings of a control group of 17 age-matched subjects.

Results: Of the 18 patients evaluated, 11 were found to have testicular tumors and 7 testicular inflammation. Peak systolic and end-diastolic velocities were significantly increased in patients with testicular tumor ( p<0.002) and orchitis ( p<0.01) versus normal controls. Follow-up examination on completion of 1-week antibiotic treatment demonstrated persistent high velocity values in patients with tumor and normalization of velocity values in patients with orchitis.

Conclusion: Our results support the concept that follow-up Doppler US examination is of value in patients with acute scrotal pain submitted to antibiotic treatment since it may contribute to the differentiation between orchitis and testicular tumor.
High signal intensity of the posterior pituitary gland on T1-weighted MR images: Correlation with plasma vasopressin concentration to water deprivation
Authors: Lee M.-H. , Choi H.-Y. , Sung Y.-A. , Lee J.-K.
Published: July 2004

Purpose: To evaluate the effect of water deprivation on the signal intensity of the posterior pituitary gland on T1-weighted MR images and correlate the signal intensity with the plasma vasopressin concentration.

Material and Methods: Fifteen rabbits were studied: Group 1 (n=10) was deprived of water for 9 days and Group 2 (n=5) was replenished water for 7 days after 7-day water deprivation. MR imaging and plasma vasopressin measurement by radioimmunoassay were made before and after water deprivation and replenishment. Sequential changes of the signal intensity ratio of the posterior lobe to the pons and plasma vasopressin concentration were correlated.

Results: Before water deprivation, the hyperintense posterior lobe was demonstrated in all rabbits. During water deprivation, the signal intensity ratio decreased and vasopressin concentration increased gradually. On the contrary, the signal intensity ratio increased and vasopressin concentration decreased with water replenishment. The signal intensity ratio correlated well with the plasma vasopressin concentration ( p<0.05).

Conclusion: There was a negative, linear correlation between the signal intensity ratio of the posterior pituitary gland on T1-weighted MR images and plasma vasopressin concentration to water deprivation. The results support that the high signal intensity of the posterior pituitary gland on T1-weighted MR images is attributed to the normal content of vasopressin-neurosecretory granules.
Image quality in extended ARC filtered digital tomosynthesis
Authors: Badea C. , Kolitsi Z. , Pallikarakis N.
Published: July 2004

Purpose: To study image quality in filtered digital tomosynthesis (FDTS) tomograms as a function of their reconstruction arc, using isocentrically acquired, fluoroscopic projection data.

Material and Methods: Both digital tomosynthesis (DTS) and cone beam CT (CBCT) reconstruction algorithms are based on backprojection and use cone beam projection data as input. Under limited angle conditions, CBCT is reduced to FDTS, where only a subset of projection data are used for reconstruction. The effect of the reconstruction arc on the spatial resolution, slice thickness, contrast sensitivity, shape distortion and artifacts, was also experimentally studied. The investigation was performed using both simulated and actual fluoroscopic images.

Results and Conclusion: Image quality in terms of spatial resolution, slice thickness, shape distortion and artifacts, improved with increasing reconstruction arc and was optimized at 180°, while contrast continued to improve as the arc was increased to 360°. However, DTS was determined to be the technique of choice when reconstruction arcs of less than 40° were used. Consequently, FDTS may be successfully implemented in applications involving extended arc reconstructions, in the range between 40° delimiting the DTS domain and 360° corresponding to CBCT.
Contrast-enhanced ultrasound doppler examination of the retrobulbar arteries
Authors: Brabrand K. , Kerty E. , Jakobsen J.Å.
Published: July 2004

Purpose: To evaluate the diagnostic usefulness of an ultrasound contrast agent in examination of the retrobulbar arteries.

Material and Methods: Ten healthy volunteers received a galactose-based echo-contrast medium (Levovist) by i.v. infusion. The ophthalmic, central retinal, the nasal and the temporal posterior ciliary arteries and the short ciliary arteries were studied in 19 eyes by color and spectral Doppler ultrasonography before and after contrast administration. Peak systolic and end diastolic velocities and spectral Doppler indices (pulsatility and resistive) were assessed. The quality of the spectral and color Doppler imaging of the arteries were visually graded on a 5-point scale.

Results: There were significant differences in pre- and post-contrast peak systolic velocities in the ophthalmic arteries ( p<0.05), but not in the other retrobulbar arteries, or in any of the spectral Doppler indices. After contrast administration the mean spectral Doppler score for vessels poorly visualized before contrast increased from 2.2 (±0.4) to 3.1 (±0.9). The number of short ciliary arteries with sufficient spectral Doppler quality increased from 7 prior to contrast to 14 following contrast. Prior to the infusion of Levovist, 62 (73%) out of 85 retrobulbar arteries could be evaluated with a sufficient spectral Doppler quality. Following the administration of contrast 66 (78%) arteries had sufficient spectral Doppler quality. However, by combining the results of the pre- and post-contrast examinations, sufficient spectral Doppler quality was obtained in 77 (91%) of the 85 retrobulbar arteries.

Conclusion: Contrast enhancement increased the number of detectable retrobulbar vessels. However, in the case of good quality pre-contrast imaging of the retrobulbar vessels, the use of Levovist did not add any substantial diagnostic information. The optimal spectral Doppler results were obtained when both pre- and post-contrast examinations were performed.
Cerebral air emboli from angiography in a patient with stroke: A case report
Authors: Söderman M. , Bystam J.
Published: July 2004

A 42-year-old woman with subarachnoid and intracerebral hemorrhage was investigated with diagnostic angiography, disclosing an occlusion of the left internal carotid artery and the middle cerebral artery. CT examination immediately after the angiography revealed a 12-h-old infarct of the left middle cerebral artery territory. There was also gas in the arteries supplying the infarcted part of the brain, but not in other vessels. Air had most probably been introduced during the angiography and had consequently been “trapped” in the cortical arteries of the ischemic brain. In the non-ischemic parts of the brain air may have passed through the vessels leaving no trace.
Complementary role of MR imaging of ethmomaxillary sinus disease depicted at CT in cystic fibrosis
Authors: Eggesbø H.B. , Dølvik S. , Stiris M. , Søvik S. , Storrøsten O.T. , Kolmannskog F.
Published: July 2004

Purpose: To assess whether MR imaging can improve characterization of ethmomaxillary opacification diagnosed at CT in patients with cystic fibrosis (CF) in order to select patients that may benefit from functional endoscopic sinus surgery (FESS).

Material and Methods: Sixty-two CF patients (26 females and 36 males) aged 4–50 years (median 20 years) with ethmomaxillary sinus disease at CT underwent MR examination of the paranasal sinuses (coronal T1 and STIR sequences). FESS had been performed in 28 of the patients prior to this study. MR signal intensities were interpreted as mucosal thickening or infectious material, according to a previous study.

Results: Three major maxillary sinus MR patterns could be distinguished: Air-filled, oval-shaped pus-filled, and streaky-shaped pus-filled sinus lumen. For air-filled maxillary sinuses with mucosal thickening, CT and MR imaging were diagnostically equivalent. Where CT showed homogeneous opacification of the maxillary sinuses, MR imaging differentiated between thickened mucosa and pus-filled areas. Patients who had undergone FESS most commonly had air-filled or streaky-shaped pus-filled maxillary sinus lumen. In non-operated patients oval-shaped pus-filled sinus lumen was most common and could occur without ethmoid disease.

Conclusion: MR imaging of the paranasal sinuses can differentiate between infectious material and thickened mucosa and should be used to select CF patients with pus-filled areas that can be eradicated with FESS.
Abscesses of the breast: US-guided serial percutaneous aspiration and local antibiotic therapy after unsuccessful systemic antibiotic therapy
Authors: Imperiale A. , Zandrino F. , Calabrese M. , Parodi G. , Massa T.
Published: July 2004

Purpose: The usual therapeutic approach to acute breast abscesses (ABAs) not responsive to systemic antibiotics is surgical incision and drainage. Our purpose was to assess the efficacy of treating ABAs with serial US-guided percutaneous aspiration and local injection of antibiotics.

Material and Methods: Twenty-six patients with 28 ABAs, in whom systemic antibiotic therapy had failed, underwent serial US-guided aspiration with local injection a of large-spectrum antibiotic. The treatment was repeated weekly until complete resolution was observed at clinical and US examination. The volume of the ABAs was calculated before each US-guided aspiration. Follow-up US examinations were performed at 1, 4, and 12 weeks after clinical and US resolution. A comparison betweeen costs of surgical and US-guided treatment of ABAs in our institution was done.

Results: In 27 ABAs the treatment was successful: a progressive volume reduction and a complete resolution at clinical and US examination was observed within 1 to 7 weeks. In 1 case only, with a large ABA markedly increased in volume at the second examination, surgical drainage was performed.

Conclusion: US-guided aspiration with local antibiotic injection is a safe and effective approach to ABAs, cheaper than surgical drainage of these lesions.
Doppler sonography of the deep lingual artery
Authors: Kimura Y. , Ariji Y. , Gotoh M. , Toyoda T. , Kato M. , Kawamata A. , Fuwa N. , Ariji E.
Published: July 2004

Purpose: To clarify the Doppler sonographic features of the lingual artery in normal subjects and to evaluate those of patients with cancer of the tongue.

Material and Methods: Sixty-seven volunteers and 12 patients with cancer and/or leukoplakia of the tongue were examined with an intraoral sonographic probe. The visibility of the deep lingual artery was determined on transverse and anteroposterior images. On the transverse images, the vascular index, which was defined as the number of colored pixels, was measured on bilateral lingual arteries. Thereafter, the degree of symmetry was evaluated for normal subjects and patients.

Results: In normal subjects, between younger and older volunteers, there were no significant differences in visibility of the trunk but differences were found between the two groups for the dorsal branches. The vascular indices of the right and left sides were not different. The characteristic Doppler sonographic feature was vasculature in and around the tumors in the patients with cancer of the tongue. The symmetry indices of the cancer patients were significantly different from those of normal subjects.

Conclusion: Doppler sonography should be an important procedure for evaluation of tongue neoplasms.
Splenic involvement in lymphomas: Evaluation on serial CT examinations
Authors: Daskalogiannaki M. , Prassopoulos P. , Katrinakis G. , Tritou I. , Eliopoulos G. , Gourtsoyiannis N.
Published: July 2004

Purpose: To prospectively evaluate changes in splenic volume (SV) on serial CT of patients with lymphoma and correlate them with other indicators of the disease process.

Material and Methods: SV was calculated in 290 abdominal CT examinations of 58 consecutive adults with lymphoma (42 non-Hodgkin's lymphoma, 16 Hodgkin's disease). Each patient had one CT investigation before, 2 during chemotherapy and 2 post-chemotherapy. The changes in SV were correlated with clinical, laboratory and other imaging indicators of the disease process.

Results: Three groups of patients were identified. Group A (n=20) presented no changes in SV, showed no splenic parenchymal abnormalities and had normal SV and serum lactic dehydrogenase (S-LDH). Group B (n=25) presented a decrease in SV during treatment suggesting response to therapy. Splenic parenchymal abnormalities (n=5) and other subdiaphragmatic sites of involvement (n=20) underwent remission during treatment. Eighteen patients with high S-LDH at presentation showed normal values during therapy. Group C (n=12) showed an increase in SV post-therapy associated with manifestations of disease recurrence. The S-LDH levels were elevated in 10 patients at the same time.

Conclusion: Quantitatively assessed splenic size on CT may serve as an indicator of splenic involvement in the course of lymphomas.
Large middle cerebral artery infarctions and the hyperdense middle cerebral artery sign in patients with atrial fibrillation
Authors: Berge E. , Nakstad P.H. , Sandset P.M.
Published: July 2004

Purpose: Strokes in patients with atrial fibrillation are often due to large middle cerebral artery (MCA) infarctions, caused by cardiogenic emboli. The purpose of this study was to characterise the large MCA infarctions and to describe the prevalence and prognostic value of the hyperdense middle cerebral artery sign (HMCAS) in patients with atrial fibrillation.

Material and Methods: The patient material comprised all 449 patients included in a randomised clinical trial of low molecular-weight heparin versus aspirin in patients with acute ischaemic stroke and atrial fibrillation. Patients with Scandinavian Stroke Scale score <8 were excluded. CT was performed on admission and at day 7, and was evaluated blinded to clinical data. The CT findings on admission were related to functional outcome at 14 days and 3 months, and incidence of cerebral haemorrhage within 7 days.

Results: Altogether 66/449 (15%) of the patients had large MCA infarctions. These patients had poorer clinical outcomes, and a higher frequency of haemorrhage on control CT within 7 days (15/59, 26% vs. 43/368, 12%). The HMCAS was found in 32/449 (7%) of the patients. It was significantly more frequent in patients with large MCA infarctions (17/66, 26% vs. 15/383, 4%), and was found most frequently within the first few hours following stroke onset. The HMCAS was associated with poor clinical outcomes and a higher frequency of cerebral haemorrhage, but these effects were partially explained by a preponderance of other risk factors in the HMCAS group.

Conclusion: Large MCA infarction is a frequent finding in patients with atrial fibrillation. These patients have a high prevalence of the HMCAS, which is an early infarction sign and a marker of a poor prognosis.
MR evaluation of chronic achilles tendinosis: A longitudinal study of 15 patients preoperatively and two years postoperatively
Authors: Shalabi A. , Kristoffersen-Wiberg M. , Aspelin P. , Movin T.
Published: July 2004

Purpose: To evaluate surgically treated patients with chronic Achilles tendinosis by MR.

Material and Methods: Gd-contrast-enhanced (CME) T1-, precontrast T1-, PD- and T2-weighted images were obtained preoperatively and 2 years following surgical treatment on 15 middle-aged patients with severe symptoms of chronic Achilles tendinosis. MR evaluation included the depiction of intratendinous signal alterations and their volume, and also measurement of tendon diameter. A questionnaire and clinical examination evaluated the clinical outcome.

Results: The most sensitive sequence to depict an intratendinous lesion was the CME T1-WI. There was marked regress of the estimated volume of the intratendinous signal alteration from a median of 1.2 cm3 preoperatively to 0.0 cm3 postoperatively on CME T1-WI. CME T1-WI showed a regress in intratendinous signal abnormality from 13 out of 15 patients preoperatively to 4 of 15 patients 2 years postoperatively. The a.p. dimension was 9 mm at both MR occasions. The clinical outcome was excellent in 8, good in 5, fair in 1 and poor in 1 patient.

Conclusion: Surgical treatment of chronic Achilles tendinosis and its healing resulted in a decrease or elimination of the intratendinous signal alteration correlating to an improved clinical outcome 2 years postoperatively.
Direct MR arthrography of plica synovialis mediopatellaris
Authors: Kobayashi Y. , Murakami R. , Tajima H. , Yamamoto K. , Ichikawa T. , Mase Y. , Kumazaki T.
Published: July 2004

Objective: To evaluate the efficacy of direct MR arthrography for diagnosing plica synovialis mediopatellaris (PSM).

Material and Methods: Twenty-two knees of 19 patients were examined by direct MR arthrography. In 19 of those knees, field-echo T2*-weighted transaxial images were obtained with intra-articular administration of 40 ml of saline (“direct MR arthrography”). In the other 3 knees, T1-weighted transaxial images were obtained with intra-articular administration of 40 ml of gadopentetate dimeglumine. Conventional MR images were evaluated prior to direct MR arthrography in 12 of the 22 knees. The results of direct MR arthrography and conventional MR imaging were compared with the arthroscopic findings.

Results: Direct MR arthrography demonstrated 17 of 19 PSMs proved on arthroscopy. The features of 16 PSMs on direct MR arthrography corresponded accurately with the arthroscopic classification. Conventional MR demonstrated only 3 plicae.

Conclusion: Direct MR arthrography enabled accurate diagnosis of PSMs and could replace diagnostic arthroscopy.
Vascularization of malignant and benign skin tumours measured by d-galactose-based signal-enhanced colour doppler sonography
Authors: Schröder R.-J. , Mäurer J. , Zlowodski M. , Hidajat N. , Schlums D. , Weber S. , Felix R.
Published: July 2004

Purpose: Evaluation of colour Doppler criteria to differentiate between malignant and benign skin tumours on the basis of the degree of vascularization.

Material and Methods: The B-mode sonomorphology and the degree of vascularization in colour Doppler of 81 clinically potentially malignant tumours of cutaneous and subcutaneous structures were analyzed and quantified by number of intratumoral vessels per sonographic slice and percentage vessel area.

Results: Of all criteria employed, counting the intratumoral vessels visible on one ultrasound slice after application of a signal-enhancing agent led to highest sensitivity (94%) of all used criteria but the specificity was poor (64%). The highest specificity (88%) and greatest diagnostic accuracy (86%) discriminating benign and malignant lesions were found using the criterion "percentage vessel area >5.0%" after all inflamed lesions had been excluded on the basis of clinical criteria. Plain colour Doppler increased the specificity up to 97%, although the sensitivity decreased simultaneously to max. 75%. Analysis of the B-mode morphology and spectral Doppler parameter of intratumoral vessels did not contribute to the differential diagnosis.

Conclusion: Signal-enhanced colour Doppler sonography is a valuable tool in the pretherapeutic assessment of cutaneous lesions. This method may be relevant for therapy and prognosis.
Nontumorous perfusion abnormalities of liver parenchyma adjacent to the falciform ligament as revealed by angiographic helical CT and angiography
Authors: Yamagami T. , Nakamura T. , Iida S. , Kato T. , Nishimura T.
Published: July 2004

Purpose: To investigate nontumorous abnormalities in the liver around the falciform ligament as revealed by arteriography and helical CT arterial portography (CTAP) and helical CT during hepatic arteriography (CTHA).

Material and Methods: One hundred and seventeen patients simultaneously underwent hepatic arteriography and CTAP and CTHA of the common hepatic artery. The number, size, and shape of nontumorous defects of portal perfusion in the liver adjacent to the falciform ligament on CTAP as well as the nontumorous contrast enhancement in the same area on CTHA were determined. In 1 case, in which nontumorous enhancement was observed on CTHA, selective arteriography from the gastric arteries was performed.

Results: On CTAP a nontumorous area of decreased portal perfusion of the liver around the falciform ligament was detected in 18 (15.4%) of the 117 patients, while nontumorous enhancement on CTHA was seen in 7 (6.0%). In 4 patients, both of these nontumorous abnormalities were observed. In the patient undergoing selective gastric arteriography, nonportal venous inflow to the liver in the direction to the liver adjacent to the falciform ligament was seen.

Conclusion: One cause of nontumorous vascular abnormalities adjacent to the falciform ligament as shown on angiographic helical CT is aberrant gastric venous inflow to this region.
Imaging and estimation of the prognostic features of primary sclerosing cholangitis by ultrasonography and MR cholangiography
Authors: Oikarinen H. , Pääkkö E. , Suramo I. , Päivänsalo M. , Tervonen O. , Lehtola J. , Aukee J.
Published: July 2004

Purpose: To evaluate the ability of US and MR cholangiography (MRC) to detect bile duct changes and prognostic signs of primary sclerosing cholangitis (PSC) seen at endoscopic retrograde cholangiography (ERC).

Material and Methods: In a prospective study, 9 patients with PSC underwent US, MRC, MR imaging and ERC of the bile ducts and the liver. Eight age- and sex-matched control patients were examined with MRC, MR imaging and ERC. A segmental comparison was performed to assess the ability of MRC-MR and US to reveal the accurate ductal involvement in different segments of the biliary tree and the specific criteria of poor prognostic outcome in PSC. The ability of MRC-MR to detect the presence of PSC in different patients was analysed blindly.

Results: MRC-MR depicted changes of PSC correctly in 9 patients (radiologist 1) and in 8 patients with 1 false-positive finding (radiologist 2) in the blinded analysis. In the segmental comparison, MRC missed especially bile duct dilatations. MRC was too pessimistic in the evaluation of the outcome. US detected features suggestive of PSC in 8 patients (radiologist 3). US was unable to show the predictors of poor outcome.

Conclusion: MRC and US seem to be useful in the detection of PSC. US is unable and MRC is too pessimistic to estimate the outcome of PSC.
MR imaging of primary, secondary, and mixed forms of lymphedema
Authors: Åström K.G.O. , Abdsaleh S. , Brenning G.C. , Ahlström K.H.
Published: July 2004

Purpose: To describe the pathological features and assess the diagnostic information of different MR sequences in patients with primary, secondary, and mixed (phlebo-, lipophlebo-, or lipolymphedema) forms of lymphedema of the lower leg.

Material and Methods: In 26 patients with clinical diagnoses of primary (n=10), pure secondary (n=4), mixed (n=9) and combined secondary and mixed forms of lymphedema (n=3), MR imaging was performed with coronal and axial T1 SE, T2 TSE, fat-suppressed (SPIR) T2 sequences and axial T1 SE after i.v. injection of Gd-DTPA.

Results: In 24 patients there was a honeycomb pattern in the subcutis with a signal intensity corresponding to fluid (n=11), fibrosis (n=3), or both (n=10). Five patients with primary lymphedema showed subfascial fluid accumulation. Dermal edema was noted in 23 patients. Fat or edema components in the muscles were mostly seen in patients with phlebolymphedema. The honeycomb pattern was best seen on coronal T1 images, and fluid accumulations on axial SPIR-T2 images. Fibrosis was only assessible from the T2 TSE sequence. Gd-DTPA did not improve the diagnostic information.

Conclusion: For evaluation of lymphedema and its mixed forms, an axial T2-weighted SPIR sequence in conjunction with a coronal T1 SE sequence are sufficient.
Ionic and non-ionic contrast agent-mediated endothelial injury: Quantitative analysis of cell proliferation during endothelial repair
Authors: Gabelmann A. , Haberstroh J. , Weyrich G.
Published: July 2004

Purpose: To quantitatively evaluate endothelial injury in vivo and to assess the time course of cellular repair after endothelial cell exposure to ionic and non-ionic contrast media.

Material and Methods: Local changes at the cellular level following intraaortic injection of 1 ml of the ionic contrast agent ioxithalamate or 1 ml of the non-ionic contrast agent iomeprol, each with an iodine content of 300 mg/ml, were investigated using rat endothelium as an in vivo model. A sorbitol solution iso-osmolar to iomeprol served as control. Quantitative analysis of endothelial changes by autoradiography of 3H-thymidine-labeled endothelial cells was assessed after 3, 5 and 10 days, determining the 3H-thymidine index and the DNA synthesis rate.

Results: Ioxithalamate showed a clear harmful effect on the endothelium, with an elevated 3H-thymidine index of 7.68% on day 3 and 6.89% on day 5, versus 2.97% on day 3 and 2.55% on day 5 for iomeprol and 2.29% on day 3 and 1.91% on day 5 for the control.

Conclusion: Ionic contrast agents lead to reversible transient focal endothelial cell injury. No such side effect was detectable for non-ionic contrast agents.
Book Review
Authors: Hietala Sven-Ola
Published: July 2004

Atlas of Diagnostic Nuclear Medicine by A. el Helou. Springer- Verlag 2001. ISBN 3-540-65175-6. Price: hardcover DEM 498.
Prostatic MR imaging: Accuracy in differentiating cancer from other prostatic disorders
Authors: Ikonen S. , Kivisaari L. , Tervahartiala P. , Vehmas T. , Taari K. , Rannikko S.
Published: July 2004

Purpose: We assessed the accuracy of MR imaging in differentiating between cancer and other prostatic disorders, and evaluated the diagnostic criteria for various prostatic diseases.

Material and Methods: A total of 74 endorectal coil MR studies were performed on 72 patients. Twenty patients had prostatic cancer, 20 benign prostatic hyperplasia (BPH), 4 acute bacterial prostatitis, 5 chronic bacterial prostatitis (2 also belonging to the previous category), 19 chronic non-bacterial prostatitis/chronic pelvic pain syndrome, and 6 were symptomless voluntary controls. All studies were interpreted by two experienced radiologists in random order. Radiologists were blinded to all clinical data including the age of the patients. Based on MR findings, both radiologists filled in a form covering diagnostic criteria and diagnosis.

Results: Accuracy in diagnosing prostate cancer was 74%. Sensitivity was 50% and specificity 83%, and positive and negative predictive values were 53 and 82%, respectively. Bacterial prostatitis showed some features similar to carcinoma. Abundant BPH rendered cancer detection more difficult. No diagnostic criterion was clearly better than the others. Interobserver agreement on the MR diagnosis ranged from moderate to good.

Conclusion: Without knowledge of accurate clinical data, MR seems to be too insensitive in detecting prostate cancer to be used as a primary diagnostic tool.
Diffusion-weighted MR and apparent diffusion coefficient in the evaluation of severe brain injury
Authors: Nakahara M. , Ericson K. , Bellander B.M.
Published: July 2004

Purpose: To study apparent diffusion coefficient (ADC) maps in severely brain-injured patients.

Material and Methods: Four deeply comatose patients with severe brain injury were investigated with single-shot, diffusion-weighted, spin-echo echoplanar imaging. The tetrahedral diffusion gradient configuration and four iterations of a set of b-values (one time of 0 mm2/s, and four times of 1000 mm2/s) were used to create isotropic ADC maps with high signal-to-noise ratio. ADC values of gray and white matter were compared among patients and 4 reference subjects.

Results: One patient was diagnosed as clinically brain dead after the MR examination. The patient's ADC values of gray and white matter were significantly lower than those of 3 other brain-injured patients. In addition the ADC value of white matter was significantly lower than that of gray matter.

Conclusion: The patient with fatal outcome shortly after MR examination differed significantly from other patients with severe brain injury but non-fatal outcome, with regard to ADC values in gray and white matter. This might indicate a prognostic value of ADC maps in the evaluation of traumatic brain injury.
MR imaging of the lingual thyroid: Comparison to other submucosal lesions
Authors: Takashima S. , Ueda M. , Shibata A. , Takayama F. , Momose M. , Yamashita K.
Published: July 2004

Purpose: To study MR findings for clues to the diagnosis of lingual thyroid.

Material and Methods: MR findings and clinical and scintigraphic data of 5 cases of lingual thyroid were reviewed and the MR findings were compared to those of 16 cases of other submucosal lesions in the base of the tongue.

Results: Four of the 5 patients with lingual thyroid were women and all had hypothyroidism. MR imaging depicted lingual thyroid in the midline in the base of the tongue (n=5) and additional ectopic thyroid glands in the floor of the mouth (n=2) or between the right and left sternohyoid muscles (n=1). Ectopic thyroid glands appeared isointense or hyperintense relative to muscle tissue on T1-weighted images and showed slight or fair contrast enhancement. All glands had low to intermediate T2 signal, which was also seen in 1 case of non-Hodgkin's lymphoma and 1 case of adenoid cystic carcinoma. All ectopic thyroid glands had well-defined margins, whereas malignant tumors tended to have ill-defined margins and to invade the surrounding structures. All but the 5 cases of lingual thyroid had an MR-demonstrable thyroid gland in the normal cervical position.

Conclusion: A well-defined mass of low-intermediate T2 signal in the midline base of the tongue, neither with invasive tendency nor with a cervical thyroid gland in the normal site on MR imaging, may strongly indicate lingual thyroid.
Detection of myocardial ischemia by electron beam CT: Experimental studies
Authors: Knollmann F.D. , Muschick P. , Krause W. , Hausmann H. , Hetzer R. , Felix R.
Published: July 2004

Purpose: To determine if contrast-enhanced electron beam CT (EBCT) can detect areas of acute myocardial ischemia, and if pharmacological stress testing improves the diagnostic accuracy of EBCT.

Material and Methods: We injected 0.5 ml/kg and 1.0 ml/kg b.w. of iopromide at a rate of 4 ml/s into the right atrium of 5 ventilated female minipigs at rest and after occlusion of the left anterior descending (LAD) coronary artery. Both ventricles were examined at six short axis levels with an EBCT unit. Myocardial perfusion was calculated from the time-density curves of four left ventricular myocardial segments and the aorta. We also tested the effect of the contrast agent on myocardial density after i.v. administration of 0.6 mg/kg dipyridamole before and after LAD occlusion.

Results: At rest, the contrast agent increased myocardial density by 28±2 HU, corresponding to a myocardial perfusion estimate of 67±7 ml/min/100 g. After dipyridamole, myocardial density increased by 29±4 HU. Following occlusion of the LAD, anteroseptal myocardium displayed 10±4 HU density increase. The area of non-enhancement corresponded to ischemic myocardium in stained pathologic sections.

Conclusion: Contrast-enhanced stress EBCT can be used to detect areas of myocardial ischemia, and EBCT stress perfusion imaging may be necessary to consistently differentiate ischemic from non-ischemic myocardial tissue.
Evaluation of pleural disease using MR and CT: With special reference to malignant pleural mesothelioma
Authors: Knuuttila A. , Kivisaari L. , Kivisaari A. , Palomäki M. , Tervahartiala P. , Mattson K.
Published: July 2004

Purpose: To evaluate MR imaging and CT in differentiating malignant pleural mesothelioma from other malignancies or benign pleural disease.

Material and Methods: Thirty-four patients (18 pleural mesotheliomas, 9 other malignancies, 7 benign pleural diseases) were examined using enhanced CT and MR. Two radiologists reviewed the CT and two others the MR images. Comparisons were made between the diagnostic groups and the imaging methods.

Results: The abnormalities commonly found in malignant disease, but significantly less frequently in benign pleural disease, were focal thickening and enhancement of interlobar fissures. In mesothelioma, enhancement of interlobar fissures, tumour invasion of the diaphragm, mediastinal soft tissue or chest wall, were significantly more often observed than in other malignancies and MR was the most sensitive method. In other malignancies, invasion of bony structures was a more common finding and was also better shown by MR. The contrast-enhanced T1 fat-suppressed (CET1fs) sequence detected these features better than other MR sequences.

Conclusion: MR, especially the CET1fs sequence in three planes, gave more information than enhanced CT. Focal thickening and enhancement of interlobar fissures were early abnormalities indicating malignant pleural disease. MR could be clinically useful for differentiating mesothelioma from other pleural diseases.
Gastro-oesophageal reflux demonstrated by radiography
Authors: Madsen E. , Aksglæde K. , Jacobsen N.O. , Funch-Jensen P. , Thommesen P.
Published: July 2004

Purpose: Gastro-oesophageal reflux (GOR) is demonstrated by radiography as a supplement to 24-h pH monitoring.

Material and Methods: Forty-two patients (mean age 44 years) with suspicion of GOR disease were assessed according to a standard questionnaire. GOR was investigated by 24-h pH-monitoring and by radiography. Oesophageal emptying and the presence of rings or strictures were registered as well. Mucosal biopsies, classified as normal, light oesophagitis, severe oesophagitis, or Barrett's oesophagus, were correlated to age, gender, symptomatology, pH monitoring, and oesophageal emptying. GOR and morphological changes demonstrated by radiography were correlated to pH monitoring and mucosa biopsies.

Results: Based on pH monitoring, patients with severe oesophagitis and Barrett's oesophagus had a significantly higher acid exposure compared to patients with normal mucosa and light oesophagitis, with no difference concerning age, gender, and symptoms. Severe oesophagitis, including Barrett's oesophagus, was found only in patients with a positive test for radiologic GOR. Eleven patients had rings or strictures independent of oesophageal mucosal changes.

Conclusion: GOR demonstrated by radiography identified patients where complications could be expected, which was not possible by pH monitoring alone.
Book Reviews
Authors: Sandro Rossitti , Sven-Ola Hietala , Göran Wegenius
Published: July 2004

Recent Advances in Diagnostic Neuroradiology. Edited by P. Demaerel. Medical Radiology Series, XII+530 pages. 367 figures in 925 parts, 34 in color. 18 tables. Springer-Verlag, XII+530 pages. 367 figures in 925 parts, 34 in color. 18 tables. Springer- Verlag 2001. ISBN 3-540-65723-1. Price: USD 279.

Physics and Radiobiology of Nuclear Medicine, 2nd edn. By G. B. Saha. Springer-Verlag 2001. ISBN 0-387-95021-4. Price: Hardcover DEM 132.

Clinical Imaging in Non-Pulmonary Tuberculosis. By F. E. McGuinness. Springer-Verlag 2000. ISBN 3-540-65940-4. Price: Hardcover: DEM 169.