bluuebunny/crossref_metadata_2025 huggingface dataset:
CT and MR imaging of the liver: Clinical importance of nutritional status
Authors: Leander P. , Sjöberg S. , Höglund P.
Published: July 2004

Purpose: In an experimental study in rats a correlation between nutritional status and hepatic attenuation in CT and signal intensities in MR imaging was shown. Is physiological nutritional status of importance in clinical CT and MR imaging?

Material and Methods: In a cross-over study including 12 healthy volunteers (6 women and 6 men, mean age 34 years), CT and MR imaging of the liver were performed with nutritional status at three different levels, i.e., normal, fasting and after glycogen-rich meals. CT and MR were performed on clinical imaging systems and hepatic attenuation and signal intensity, respectively, were assessed. In MR, T1-weighted, proton density-weighted and T2-weighted pulse-sequences were used.

Results: In CT there were significantly ( p<0.01) higher liver attenuations in normal nutritional status and after glycogen rich-meals compared to the fasting condition. The difference between fasting and glycogen-rich meals were 10.5 HU for men, 7.4 for women and mean 8.8 HU for all 12 volunteers. In MR imaging the differences were small and non-significant. The results of this study are in accordance with an earlier experimental study in rats.

Conclusion: In CT it may be of importance not to have patients in a fasting condition as it lowers the attenuation in normal liver tissue. The findings are important for planning of clinical studies where hepatic attenuation will be assessed and may be of some importance in clinical CT. In MR imaging the results indicate that the nutritional status is of less importance.
Multishot Echo-Planar Imaging with Gadopentetate Dimeglumine: Preliminary study of efficacy for detection of hypovascular metastatic liver tumors
Authors: Murakami T. , Kim T. , Hori M. , Takamura M. , Tsuda K. , Takahashi S. , Narumi Y. , Nakamura H.
Published: July 2004

Objective: To evaluate the usefulness of sequential T2-weighted spin-echo type multishot echo-planar (T2-EP) imaging with gadopentetate dimeglumine for the detection of hypovascular metastatic liver tumors.

Material and Methods: Fifteen consecutive patients with 56 proven hypovascular metastatic liver tumors were included in the study. Three observers blindly and independently read the whole-liver images obtained with T2-weighted spin-echo, T2-weighted single-shot fast spin-echo, T1-weighted fast multiplanar spoiled GRASS and T2-EP images obtained before and 25, 60, 90 and 120 s after injection of 0.2 mmol/kg b.w. of gadopentetate dimeglumine. The diagnostic accuracy was estimated by calculating the area under the observer-specific binomial receiver operating characteristics curves (Az).

Results: T2-EP images obtained 60 s after contrast injection showed significantly higher contrast-to-noise (C/N) ratios than the other imaging techniques. A combination of all phases of the T2-EP images produced the highest sensitivity and specificity. In terms of the Az value, the diagnostic accuracy for tumor detection achieved with a combination of all phases of the T2-EP images was significantly higher than that with T1-SPGR and T2-SSFSE images ( p < 0.01). The Az values of the T2-EP images (Az = 0.975) were higher than those of T2-CSE images (Az = 0.948), but the difference was not significant.

Conclusion: Our preliminary study revealed that sequential imaging with enhanced T2-EP images was useful for the detection of hypovascular metastatic liver tumors because of its superior C/N ratio and sensitivity.
MR Cholangiopancreaticography and Endoscopic Retrograde Cholangiopancreaticography in Patients with Suspected Common Bile Duct Stones: A prospective blinded study
Authors: Stiris M.G. , Tennøe B. , Aadland E. , Lunde O.C.
Published: July 2004

Purpose: To prospectively compare MR cholangiopancreaticography (MRCP) vs. endoscopic retrograde pancreaticography (ERCP) in patients with suspected common bile duct (CBD) stone disease.

Material and Methods: Fifty consecutive patients with suspected CBD disease underwent MRCP and then ERCP within 12 h of each other. The result of the MRCP was blinded to the reader of the ERCP. The MRCP was done using a superconducting 1.0 T unit with a heavily T2-weighted breath-hold technique. The ERCP was done in the fluoroscopy suite by one of the clinicians and was evaluated by one of the radiologists who had not read the MRCP examinations. Results: There were 28 true-positives, 17 true-negatives, 1 false-positive, and 4 false-negatives. The sensitivity was 87.5% and the specificity 94.4%, respectively. The positive predictive value was 96.6% and the negative predictive value was 81.1%.

Conclusion: MRCP was shown to be good enough to replace ERCP as a diagnostic method in patients with suspected CBD disease. MRCP is now our modality of choice after ultrasound in the diagnostic evaluation of these patients.
CT in the Evaluation of Complicated Autosomal Dominant Polycystic Kidney Disease
Authors: Gupta S. , Seith A. , Sud K. , Kohli H.S. , Singh S.K. , Sakhuja V. , Suri S.
Published: July 2004

Purpose: We retrospectively reviewed the CT findings in 24 cases of autosomal dominant polycystic kidney disease (ADPKD) to assess the role of CT in the diagnostic work-up of patients with complicated ADPKD.

Material and Methods: Twenty-four patients with ADPKD underwent unenhanced and contrast-enhanced CT for flank pain, haematuria, or fever. The images were retrospectively reviewed for presence of complicated cysts, their morphological features and associated findings in the perinephric space/retroperitoneum.

Results: Cyst haemorrhage was present in all patients, seen as high-density cysts, which were mostly bilateral. Most of these cysts had sharply outlined contours, sharp interfaces with adjacent renal parenchyma, imperceptible walls, and homogeneous density, and did not enhance following i.v. contrast administration. However, a few haemorrhagic cysts (9 cysts in 6 patients) showed inhomogeneous density (n = 7), dependent layering of high-density blood leading to fluid-fluid level (n = 2), and contour irregularity (n = 3).

CT revealed presence of cyst infection in 6 cases; the involved cysts were larger (average size 4.2 cm) than adjacent cysts, had only a mildly increased or near water density, and showed wall thickening and enhancement. Other findings included air within the infected cyst (n = 1), thickening and enhancement of peri- and paranephric fasciae (n = 5), and abscesses in the posterior paranephric space and adjoining psoas muscle (n = 2). In 2 other patients, although CT suggested cyst infection because of presence of wall enhancement, diagnostic needle aspiration revealed only sterile haemorrhagic fluid. In 1 case, CT revealed a soft tissue density enhancing mass in one of the cysts; this proved to be a renal cell carcinoma by fine-needle biopsy. Calculi were observed in 7 patients, and cyst wall calcification in 11 cases.

Conclusion: A combination of unenhanced and contrast-enhanced CT allows correct diagnosis and differentiation amongst the various complications affecting patients with ADPKD. However, in a small subgroup of patients, it may not be possible to differentiate between haemorrhage and infection; such cases require diagnostic needle aspiration for diagnosis.
From Donor to Recipient: Doppler US, power US and scintigraphy of kidney perfusion before and after transplantation
Authors: Isiklar I. , Aktas A. , Akgun S. , Karakayali H.
Published: July 2004

Purpose: To follow kidneys from the donor to the recipient by assessing whether perfusion changes occur by using duplex Doppler US, power Doppler US and scintigraphy.

Material and Methods: The prospective study included 12 donors and their corresponding 12 recipients. For each donor, both donor kidneys were evaluated by duplex Doppler US, power Doppler US and scintigraphy 1 day before surgery. The same procedure was carried out on the renal allografts at days 1, 3, 5 and months 1 and 3 post-transplantation. Power Doppler findings were classified according to a grading system of 1 to 4. Resistive indices (RIs) were determined based on interlobar and segmental arterial flow. Peak systolic velocity and RIs of the main renal artery were also measured. A perfusion parameter named the peak-to-plateau ratio was calculated. Statistical analysis was performed using the paired-samples t-test.

Results: Intrarenal RI elevation and decreased renal artery peak systolic velocity was observed in normally functioning recipient kidneys.

Conclusion: Duplex Doppler sonography demonstrated that transplanted kidneys had an increase in intrarenal vascular resistance at 1 month and a decrease in renal artery peak systolic velocity at 3 months post-transplantation. Scintigraphy and power Doppler US did not reveal any statistically significant perfusion change in normally functioning kidneys from donor to recipient.
Enhancement Pattern of Normal Extraocular Muscles in Dynamic Contrast-Enhanced Mr Imaging with Fat Suppression
Authors: Taoka T. , Iwasaki S. , Uchida H. , Fukusumi A. , Kichikawa K. , Nakagawa H. , Takayama K. , Sakamoto M. , Ohishi H.
Published: July 2004

Purpose: To evaluate the internal structure of normal extraocular muscles on fat-suppressed dynamic contrast-enhanced MR imaging.

Material and Methods: Ten subjects were examined using fat-suppressed dynamic contrast-enhanced MR imaging. We evaluated the enhancement pattern (C-shaped or ring-like) of extraocular muscles and quantified the maximum ratios of enhancement (Rmax) and maximum ratios of signal increase (Vmax). We also quantified Rmax and Vmax in the central and peripheral portions of medial rectus muscles.

Results: In the early phase of dynamic contrast-enhanced MR imaging, a C-shaped or ring-like pattern was observed in 100% of inferior rectus, 95% of medial rectus, 55% of superior rectus, 20% of lateral rectus, and 15% of superior oblique muscles. Overall mean Rmax and Vmax values showed statistically significant differences to the temporal muscles. For the peripheral portion of medial rectus muscles, mean Rmax and Vmax values were greater than for the central portion.

Conclusion: Using fat-suppressed dynamic contrast-enhanced MR imaging, the C-shape or ring-like internal structure of the extraocular muscles could be visualized, and were considered to reflect their structure of orbital and global layers. Potential usefulness of the fat-suppressed dynamic contrast-enhanced MR imaging for detecting pathological status is suggested.
Pulmonary disease in liver transplant recipients: Spectrum of CT features
Authors: Knollmann F.D. , Mäurer J. , Bechstein W.O. , Vogl T.J. , Neuhaus P. , Felix R.
Published: July 2004

Purpose: To determine the features of pulmonary disease in liver transplant recipients by CT.

Material and Methods: Of 792 patients, 102 were referred to thoracic CT 3-2093 days after the transplantation procedure (median 107 days). All CT studies were retrospectively analyzed and correlated with clinical, microbiological, serological and histopathological findings.

Results: Eighty-eight of 102 patients (86%) had an abnormal CT. In 25 patients (25%), an elevated right hemidiaphragm, basal atelectasis and small effusions were the only abnormalities. Fourty-one patients (40%) displayed an infiltrate and 13 (13%) a mass lesion. Evidence of cytomegalovirus (CMV) infection was found in 20 patients. CMV pneumonia was suggested by an interstitial pattern of pneumonia on CT (n=13). Pneumocystis carinii pneumonia was highlighted by peribronchovascular infiltrates (n=5/8), bacterial pneumonia (n=24) including legionellosis (n=13) by bilateral effusions (n=14) and lobar consolidation (n=13). In 7/41 patients (17%) with both clinically apparent pulmonary disease and CT signs of pneumonia, no pathogen could be detected. Neoplastic disease was mostly due to tumor recurrence (n=6).

Conclusion: Thoracic CT of liver transplant recipients aids in detecting and classifying both infectious and neoplastic complications.
Radiological changes of the symphysis in ankylosing spondylitis
Authors: Jajić Z. , Jajić I. , Grazio S.
Published: July 2004

Purpose: To evaluate the symphyseal changes in patients with ankylosing spondylitis.

Material and Methods: Radiological-morphological changes of the symphysis were studied in 68 patients (66 men, 2 women) with ankylosing spondylitis whose age ranged from 21 to 75 years. The duration of the disease was from 2 to 50 years.

Results and Conclusion: Changes in the symphysis were found in 16 patients (23.5%) and were less prominent than findings in the sacroiliac joints. We classified these changes into four stages: minimal changes, apparent destruction, reparation and ankylosis. The third and the fourth stages of the changes in the symphsis were found more frequently in patients who suffered from the disease for more than 15 years. Radiological evaluation of symphyseal changes can be helpful in the evaluation of disease progression as well as in establishing a differential diagnosis.
Non-invasive myocardial iron assessment in thalassaemic patients: T2 relaxometry and magnetization transfer ratio measurements
Authors: Papanikolaou N. , Ghiatas A. , Kattamis A. , Ladis C. , Kritikos N. , Kattamis C.
Published: July 2004

Purpose: To compare T2 relaxometry and magnetization transfer ratio (MTR) measurements of myocardial tissue in normal volunteers and thalassaemic patients for assessment of the myocardial iron levels.

Material and Methods: All examinations were done on a 1 T MR system using a multi-echo spin-echo sequence with 8 echoes for T2 measurements and a gradient echo sequence for MTR measurements. Diastolic cardiac triggering was used in both sequences. Ten patients and 10 normal subjects were included in the study. T2 and MTR measurements were correlated with serum ferritin levels.

Results: Regression analysis between T2 and MTR measurements and ferritin demonstrated a reversed linear relationship, (r=−0.932, p<0.05) and (r=−0.824, p<0.05), respectively. Mean T2 relaxation time and mean MTR of the normal subjects (57.95±4.9 ms and 43.70±3.3%) was significantly higher than that of the thalassaemic patients (38.8±6.2 ms and 26.40±6.1%) ( p<0.01), respectively.

Conclusion: MTR measurements can be used to complement T2 measurements for non-invasive myocardial iron assessment.
Imaging end-stage kidney disease in adults: Low-field MR imaging with magnetization transfer vs. ultrasonography
Authors: Kajander S. , Kallio T. , Alanen A. , Komu M. , Forsström J.
Published: July 2004

Purpose: To 1) assess the potential of magnetization transfer (MT)-weighted MR imaging to improve the often poor visibility of native kidneys in patients with a renal transplant; and 2) compare low-field MR imaging and ultrasonography (US) for imaging these fibrotic kidney remnants.

Material and Methods: Seventy-two native kidneys of 36 patients were prospectively evaluated with US and MR. In low-field (0.1 T) MR imaging, T1-, T2- and MT-weighted sequences were used. MT-weighted images were compared with T2-weighted images in their ability to delineate the kidneys from their surroundings whereas US and MR were compared for detection of renal cysts and possible solid tumors.

Results: MT-weighted images proved superior to conventional T2-weighted images in producing contrast between the kidney remnants and their fatty surroundings. Although US revealed a few small renal cysts that were not seen at MR images, no statistical difference was found between the two modalities in this respect.

Conclusion: MT imaging, due to its unique protein-specific signal depression, offers significantly improved visualization and delineation of end-stage kidneys. US, because its better availability and cost-benefit ratio, remains the method-of-choice compared to low-field MR imaging in detecting cysts in multicystic kidneys. MR investigation is helpful in selected patients and may be used as an alternative.
Chiasmatic glioblastoma of childhood: A case report
Authors: Cirak B. , Unal O. , Arslan H. , Cinal A.
Published: July 2004

A 6-year-old girl presented with visual deterioration that had progressively worsened over 2 months. MR imaging revealed a sellar, para- and suprasellar lesion. Subtotal tumor resection was performed. Histopathological diagnosis was glioblastoma of the optic chiasma. Chiasmatic glioblastoma is rare in adults and extremely uncommon in children. Surgical resection implies a risk of severe endocrinologic and opthalmologic complications.
Differentiated thyroid carcinomas: Prediction of tumor invasion with MR imaging
Authors: Takashima S. , Takayama F. , Wang Q. , Kawakami S. , Saito A. , Kobayashi S. , Sone S.
Published: July 2004

Purpose: To assess diagnostic accuracy for tumor invasion of surrounding organs by measurement of tumor circumferences on MR images in patients with differentiated thyroid carcinomas.

Material and Methods: Surgical and MR imaging findings in 50 patients with differentiated thyroid carcinoma (43 primary, 7 recurrent lesions) were retrospectively reviewed. The degrees of circumference of tumor encroachment to the organs were measured, and the measurements and morphologic diagnosis of tumor invasion made by a head and neck radiologist were compared with surgical and pathologic findings using receiver operating characteristic curves.

Results: Diagnosis of tumor invasion by the radiologist was superior to the measurements of the carotid artery and cartilage, while the reverse was true for the trachea and esophagus. However, no statistical differences were noted between them for each structure. Optimal thresholds for tumor invasion were 90° or more for the cartilage (94% accuracy) and esophagus (86% accuracy), 135° or more for the trachea (86% accuracy), and 225° or more for the carotid artery (90% accuracy).

Conclusion: Tumor invasion was more accurately diagnosed by measurement of tumor circumferences of each organ on MR images.
Iodixanol and iohexol in cardioangiography: A comparative vectorcardiographic study
Authors: Flinck A. , Selin K. , Björneld L. , Nossen J.Ø.
Published: July 2004

Purpose: The non-ionic dimeric contrast medium (CM) iodixanol is isotonic with blood through the addition of electrolytes. In this study, we evaluated computerised dynamic vectorcardiography (VCG) as a tool in CM research by comparing the electrophysiological effects of iodixanol with those of the low-osmolar CM iohexol.

Material and Methods: A total of 119 patients referred for cardioangiography were included in this double-blind, randomised, parallel comparison of iodixanol (320 mg I/ml) and iohexol (350 mg I/ml). VCG was recorded and different VCG parameters were analysed. General tolerability, safety and radiographic efficacy were also assessed.

Results: Iodixanol induced less changes than iohexol in all VCG parameters and the sensation of warmth was significantly milder after iodixanol, but both CM were well tolerated. VCG might be useful in future studies to analyse electrophysiological effects caused by CM.
Seasonal variation in the occurrence of late adverse skin reactions to iodine-based contrast media
Authors: Mikkonen R. , Vehmas T. , Granlund H. , Kivisaari L.
Published: July 2004

Purpose: To study the possible seasonal effect in the occurrence of late adverse skin reactions to iodine-based contrast media (CM).

Material and Methods: Data on 4,875 adult patients followed for late adverse reactions after i.v. injections of iohexol or iopamidol, or intra-arterial injection of ioxaglate were retrospectively investigated with respect to the amount of global radiation vs. the occurrence of reactions. The information on these reactions was collected from questionnaires that were filled out by the patients (outpatients) or by nurses (in-patients). The follow-up time was 24 h.

Results: Fifty-two of 4,875 patients (1.07%) had experienced a late skin reaction (urticaria or rash); this number exceeds the reports on spontaneous occurrence of such reactions by a factor of 300. Most of the reactions in a known location occurred on sun-exposed areas of the body. A 2-month peak in the incidence of reactions (May to June) included 35% of all events ( p<0.025) and a 3-month peak (April to June) 46% of all events ( p<0.01). There was a significant rank correlation (r=0.613, p<0.05) between the frequency of reactions and the mean amount of global radiation.

Conclusion: This study demonstrates a seasonal variation in skin reactions after intravascular injection of iodine-based CM. The possible photosensitising effect of these drugs should be further studied.
Radiation dose and image information in computed radiography: A phantom study of angle measurements in the weight-bearing knee
Authors: Sanfridsson J. , Holje G. , Svahn G. , Ryd L. , Jonsson K.
Published: July 2004

Purpose: To establish a correlation between radiation dose and diagnostic accuracy when employing a new digital method for angle determinations. The specific intention was to determine how far the radiation dose can be reduced without losing measuring accuracy and to compare this radiation dose with that employed with our conventional method.

Material and Methods: An image succession of an anthropomorphic phantom was generated with a computed radiography (CR) system, by reducing the exposure stepwise. The images were archived and transferred to a workstation for evaluation. The intraobserver variation of two angle determinations was used as an indicator of the evaluation accuracy. Patient radiation doses were measured with thermoluminescent dosimeters. The energy imparted, indicating the relative risk associated with exposure to ionising radiation, and the effective dose, which determines the absolute risk, were calculated.

Results and Conclusion: No significant correlation was found between patient dose and measuring accuracy within the evaluated exposure interval. At the lowest exposure of the CR system, the energy imparted to the patient was 30 μJ. Compared with our conventional analogue method this is a reduction by 98%. The effective dose was as low as 1.5 μSv. The CR technique creates possibilities to adapt exposure parameters, and thus the radiation dose to the patient, according to the purpose of the investigation.
Gadobenate dimeglumine and cerebral glucose metabolism: Continuous monitoring of striatal lactate levels in freely moving rats
Authors: La Noce A. , Frigeni V. , Filatori I. , Danieli A. , Tirone P.
Published: July 2004

Purpose: Brain contrast-enhanced MR imaging reflects the leakage of contrast material into the brain tissue due to blood-brain barrier (BBB) disruption. The contact between brain tissue and contrast material requires a high level of neurotolerability of the contrast agent (CA). In the present study, we investigated the neurotolerability of the paramagnetic CA gadobenate dimeglumine, locally applied into the corpus striatum of freely moving rats, by evaluating its potential effects on cerebral glucose metabolism based on lactate levels.

Material and Methods: Lactate levels were monitored using a microdialysis technique coupled with an enzyme reaction. A microdialysis probe for extracellular fluid sampling, together with a stainless steel cannula for CA administration, were inserted into the right corpus striatum of rats. Lactate levels were monitored for 2 h after gadobenate dimeglumine administration at 120 nmol/rat, at fixed volume of 1.2  μl. The same volume of artificial cerebrospinal fluid (aCSF) was administered to control rats.

Results: Gadobenate dimeglumine did not induce any significant changes in the lactate striatal levels over the 30-min period after administration. Small, but significant, reductions in lactate concentration were found from the 45-min control point after gadobenate dimeglumine administration. Lactate response showed the same pattern in rats given aCSF.

Conclusion: Gadobenate dimeglumine, intracerebrally administered, did not affect cerebral glucose metabolism in rats as it showed the same behaviour as aCSF on cerebral glucose utilization. The gradual attenuation in the endogenous lactate release observed 45 min after test compound administration is possibly due to a slight reduction in the probe recovery. The present findings confirm the neurotolerability of gadobenate dimeglumine previously shown in behavioural and electrophysiological studies.
The pelvic digit - A rare developmental anomaly: A case report with CT correlation and review of the literature
Authors: Goyen M. , Barkhausen J. , Markschies N.A. , Debatin J.F.
Published: July 2004

Radiography of the pelvis may incidentally reveal a rare congenital anomaly called “pelvic digit” and it is important to be aware of its existence in order to differentiate it from acquired abnormalities due to trauma. A case of a pelvic digit with CT correlation is presented and the literature is reviewed.
Intraosseous lipoma of the frontal bone: A case report
Authors: Arslan G. , Karaali K. , Çubuk M. , Şenol U. , Lüleci E.
Published: July 2004

Intraosseous lipomas are among the most uncommon bone tumors. They arise most often in the appendicular skeleton. There are very few reported cases of intraosseous lipomas within the skull bones. We report a case of intraosseous lipoma of the frontal bone with conventional radiography and CT findings.
MR imaging in clinically suspected acute cholecystitis: A comparison with ultrasonography
Authors: Håkansson K. , Leander P. , Ekberg O. , Håkansson H.-O.
Published: July 2004

Purpose: The diagnostic value of fast pulse sequences in MR imaging was compared with US in patients with clinically suspected acute cholecystitis.

Material and Methods: In a prospective study of 94 patients, 35 were examined with both MR and US within 24 h.

Results: MR diagnoses were acute cholecystitis in 23, gallbladder and common bile duct stones in 3, other pathologic conditions of the abdomen in 7 and normal in 2 patients. US diagnoses were acute cholecystitis in 17, gallbladder stones in 8, other pathologic conditions of the abdomen in 2, normal in 5 and non-conclusive in 3 patients.

Conclusion: MR has a higher sensitivity than US for diagnosing acute cholecystitis and, with increased accessibility, may be the first imaging method.
Hepatic falciform artery: Angiographic findings in 25 patients
Authors: Baba Y. , Miyazono N. , Ueno K. , Kanetsuki I. , Nishi H. , Inoue H. , Nakajo M.
Published: July 2004

Purpose: To determine the frequency of hepatic falciform artery (HFA) occurrence on celiac or hepatic angiograms and elucidate the anatomy and clinical importance.

Material and Methods: Among 1,250 patients who underwent celiac or hepatic arteriography, we encountered 25 patients (2%) with a HFA. Prospectively, CT hepatic falciform arteriography (CTHA) was performed in 4 patients. Indigocarmine dye was injected into the HFA in 6 patients to evaluate whether the abdominal skin was stained. Embolization of the HFA before chemoembolization for hepatocellular carcinoma was performed in 4 patients to prevent abdominal wall injury.

Results: Among 25 patients, the HFA arose as a terminal branch of the middle hepatic artery in 14 patients (56%) and of the left hepatic artery in 11 patients (44%). The vessel was single in 18 patients (72%) and double in 7 patients (28%). Two vessels ran side by side along the hepatic falciform ligament. On CTHA, the HFA ran within the hepatic falciform ligament and the branches were connected with the liver around the hepatic falciform ligament. After indigocarmine dye injection, the stain of abdominal skin was recognized in all 6 patients. No abdominal wall injury occurred in any of the 4 patients who were subjected to hepatic chemoembolization.

Conclusion: HFA is an extrahepatic pathway which runs to the abdominal wall. Before chemoembolization of the middle or left hepatic artery for hepatic malignancy, the HFA should be recognized.
Percutaneous management of occluded biliary duct endoprostheses
Authors: Cwikiel W.
Published: July 2004

Purpose: To present interventional methods for percutaneous treatment of patients with occluded bile duct endoprostheses.

Material and Methods: Thirteen patients with endoscopically inserted occluded or damaged bile duct endoprostheses and recurrent jaundice were treated percutaneously. Endoscopic treatment was not available in 2 cases and unsuccessful in 11 other patients. Eleven interventions were performed under systemic sedation and local anaesthesia and 2 under general anaesthesia. The endoprostheses were dislodged to the bowel using different interventional devices. Adequate bile duct drainage was subsequently achieved by insertion of self-expanding metallic stents.

Results: All procedures were accomplished successfully and without immediate serious complications. Two metallic stents and 18 plastic endoprostheses were dislodged to the bowel using percutaneous interventional techniques. One plastic endoprosthesis became bent in the duodenum and had to be removed endoscopically due to abdominal pain. None of the other endoprostheses left in the bowel caused any symptoms. Two patients died during the first week after the procedure due to progressive liver failure.

Conclusion: Occluded bile duct endoprostheses can be safely dislodged to the bowel and replaced by metallic stents using percutaneous interventional techniques.
Acute neuromedical and neurosurgical admissions: Standard and ultrafast MR imaging of the brain compared with cranial CT
Authors: Griffiths P.D. , Wilkinson I.D. , Patel M.C. , Romanowski C.A.J. , Mitchell P. , Graham A. , Powell T. , Hodgson T.J. , Paley M.N.J.
Published: July 2004

Purpose: To evaluate the role of standard and ultrafast MR brain imaging and compare the information with CT.

Material and Methods: This was a prospective study of 114 patients with acute neurological symptoms and signs. CT brain examinations consisted of axial non-enhanced images. MR imaging consisted of standard spin-echo/fast spin-echo sequences and a series of rapid techniques including echoplanar and single shot fast spin-echo sequences.

Results: Using standard MR methods, 41% of the patients had all five sequences of good technical quality, while using ultrafast methods 81% of the patients had good technical quality examinations in all five sequences. In 3% of the cases, ischaemic stroke was incorrectly reported on CT. In 24% of the cases, MR gave extra diagnostic information not reported on CT and in a further 8%, one neuroradiologist reported the abnormality in agreement with the MR, whilst the other neuroradiologist reported the CT as normal. In 2 cases, subarachnoid haemorrhage was missed on MR. Subarachnoid haemorrhage was not shown on the ultrafast sequences.

Conclusion: MR can be used to image acute neurological admissions with a high success rate, particularly using ultrafast methods. In many cases, MR provided extra information of direct clinical relevance not shown on CT.
Differentiation of vascular birthmarks by MR imaging: An investigation of hemangiomas, venous and lymphatic malformations
Authors: Kern S. , Niemeyer C. , Darge K. , Merz C. , Laubenberger J. , Uhl M.
Published: July 2004

Purpose: To evaluate the use of MR imaging using standard sequences in the differentiation of common vascular birthmarks of soft tissues in childhood.

Material and Methods: Forty-three lesions in 37 children (median age 33 months) with hemangiomas (n = 25), venous (n = 8) and lymphatic (n = 10) malformations were retrospectively studied. Images were obtained with a 0.2 T and a 1.5 T MR unit, using T1-weighted spin-echo, T2-weighted turbo spin-echo and turbo STIR sequences. In addition, 19 contrast studies were evaluated. Signal intensities and morphological characteristics were analyzed.

Results: All hemangiomas were hyperintense in T2-weighted, and mostly (22/25) isointense compared to the surrounding skeletal muscle in T1-weighted images. The lesions were homogeneous or mildly inhomogeneous and well defined. Venous and lymphatic malformations showed similar patterns. Contrary to other lesions, no vessels or lobular architecture were detectable and contrast enhancement was absent in lymphatic malformations.

Conclusion: A reliable differentiation between hemangiomas, venous and lymphatic malformations in childhood is not possible by standard MR sequences alone. Contrast media may be helpful as lymphatic malformations show no contrast enhancement. The main role of MR imaging is to determine the local extent or infiltration of deeper tissue layers and narrow the differential diagnosis of other soft tissue tumors.
High-dose percutaneous ethanol injection therapy of liver tumors: Patient acceptance and complications
Authors: Elgindy N. , Lindholm H. , Gunvén P.
Published: July 2004

Purpose: To study the safety of high-dose ethanol injections in liver tumors and their acceptability as out-patient procedures under local anesthesia.

Material and Methods: Twenty-nine patients received 20–95 ml of 95% ethanol by 62 percutaneous injections under local anesthesia. Pain was assessed by a visual analogue scale from 1 to 10 for 33 of the sessions. Side effects, complications, post-treatment requirement of parenteral analgesics, and hospital stay (discharge the same day or later) were recorded. The sessions were compared to 80 injections of  < 20 ml of ethanol in 18 patients.

Results: High-dose injections with an average volume of 39 ml gave a mean pain score of 5.1, with a weak relationship between pain and volume. Other side effects and complications were unrelated to the ethanol dose. They comprised 1 syncopation, 1 occasion of hypoventilation requiring antidote to opiates, 12 short episodes of nausea or vomiting without need for i.v. fluids, 2 instances of sepsis, and 1 abscess that was drained percutaneously. Thirty-nine of the 62 sessions were performed in day care. Ethanol was given in high doses without apparent complications after or shortly before liver resections (3 patients in each group), and on 4 occasions in 2 HIV carriers. Low-dose injections resulted in a mean pain score of 4.7 with the same requirement of i.v. analgesics as high doses, fewer instances of nausea and no infectious complications.

Conclusion: High-dose ethanol injections in patients with liver malignancy had no mortality and a reasonable complication rate. They could be given without general anesthesia, often in day care.
Miliary hepatic tuberculosis not associated with splenic or lung involvement: A case report
Authors: Tritou I. , Prassopoulos P. , Daskalogiannaki M. , Charoulakis N. , Papakonstantinou O. , Gourtsoyiannis N.
Published: July 2004

Miliary hepatic involvement is a frequent finding on autopsy in patients with disseminated tuberculosis. Imaging studies may reveal hepatosplenomegaly and/or parenchymal inhomogeneity and, in a minority of cases, focal lesions, invariably associated with miliary lung disease. An unusual case of disseminated tuberculosis with manifestations of miliary hepatic involvement, abdominal and neck lymphadenopathy on US and CT without any evidence of active disease in the lungs, spleen or other organ, is described.
Ultrasonography and CT findings of a dermoid cyst of the cecum: A case report
Authors: Mellado J. , Bosch-Príncep R. , Pérez-del-Palomar L.
Published: July 2004

We report the US and CT findings of a dermoid cyst of the cecum, which is a very uncommon location for this entity. Pathological correlation and differential diagnosis are briefly discussed.
Swedish metacarpophalangeal standards compared with previously published norms
Authors: Laurencikas E. , Rosenborg M.
Published: July 2004

Purpose: Metacarpophalangeal lengths are used to create pattern profiles that are useful for assessment of skeletal dysplasias and malformation syndromes. The purpose of this study was to establish Swedish standards and compare them with previously published norms.

Material and Methods: A group of healthy Swedish children was followed longitudinally from the age of 1 month to 18 years. The length of the tubular bones of the hand was measured on radiographs. In addition to the conventional measurements including epiphyses, diaphyseal lengths alone were recorded.

Results: Means and standard deviations of the metacarpophalangeal lengths are presented by gender and age.

Conclusion: In spite of reasonably good correlation to previously published norms, demonstrated deviations encourage us to recommend the use of local standards whenever available.
Arterial enhancement at abdominal CT angiography: Low- versus high-osmolality contrast media
Authors: Rouvière O. , Ecochard R. , Berger P. , Pangaud C. , Fontaine B. , Lyonnet D.
Published: July 2004

Purpose: To evaluate the effects of contrast media pharmokinetic differences on aortic enhancement at abdominal CT angiography and to determine whether these effects are of clinical relevance.

Material and Methods: Two hundred and twelve patients referred for abdominal CT angiography were included in the study. All abdominal CT angiograms were performed with the same parameters (collimation 3 mm, pitch ratio 1.7, scan delay 30 s) after i.v. injection of 120 ml of contrast medium at 3 ml/s. After randomization, patients received either iobitridol 300 (low-osmolar, 300 mg I/ml), iobitridol 350 (low-osmolar, 350 mg I/ml) or ioxithalamate 350 (high-osmolar, 350 mg I/ml). The time attenuation curves obtained with the three contrast media were compared.

Results: The time attenuation curve obtained with ioxithalamate 350 was not parallel to those obtained with iobitridol 300 and iobitridol 350. Mean peak enhancements obtained with iobitridol 350 and ioxithalamate 350 were not significantly different but iobitridol 350 provided higher mean peak enhancement than iobitridol 300. Mean delays of the peak enhancements were the same with the three contrast media. After peak enhancement, the decrease of aortic opacification under a selected threshold of 200 HU was significantly slower with iobitridol 350 than with iobitridol 300 and ioxithalamate 350, whereas iobitridol 300 and ioxithalamate 350 showed no significant differences.

Conclusion: For a given iodine concentration, low-osmolality contrast media provide longer aortic opacification and may be recommended for CT angiography when long acquisition times are needed.
Contrast-enhanced color doppler ultrasonography in suspected parathyroid lesions
Authors: Mazzeo S. , Caramella D. , Marcocci C. , Lonzi S. , Cambi L. , Miccoli P. , Pinchera A. , Bartolozzi C.
Published: July 2004

Purpose: To assess the usefulness of US contrast media in the evaluation of patients with primary hyperparathyroidism, with a nodule showing US features of a primary parathyroid lesion but lacking the color Doppler US appearance of a parathyroid mass.

Material and Methods: Thirteen patients (7 female, 6 male; age range 51-79 years) were examined with US before and after administration of a stabilized galactose-based microbubble contrast agent. Ten patients underwent surgery and the final histological examination demonstrated parathyroid adenoma in 9 cases and a mesenchymal benign nodule in 1 case. Three nodules were proved to be of thyroid origin at fine-needle aspiration biopsy.

Results and Conclusion: The use of a US contrast agent resulted in a diagnostic gain compared to unenhanced studies in 12/13 cases. Color Doppler findings characteristic of parathyroid lesions were observed in 7/13 cases, of thyroid nodules in 4/13 cases, and nonspecific patterns in 2/13 cases. Contrast-enhanced color Doppler US can be proposed in selected patients in whom unenhanced color Doppler provides uncertain findings. Its ideal application should be the evaluation of cervical lesions without detectable intranodular flow at unenhanced Doppler studies. In these cases, the contrast agent helps in visualizing typical color Doppler signals of the parathyroid lesions (“vascular pole” and “mixed pattern”).
Symptomatic Improvement in Dyspnea Following Tracheobronchial Metallic Stenting for Malignant Airway Obstruction
Authors: Tanigawa N. , Sawada S. , Okuda Y. , Kobayashi M. , Mishima K.
Published: July 2004

Purpose: To investigate the value and limitation of Gianturco expandable metallic stenting for patients with dyspnea due to stenotic tracheobronchial lesions associated with malignancies.

Material and Methods: We treated 55 lesions of 44 patients with obstructing stenotic tracheobronchial lesions related to end-stage malignancies by Gianturco expandable metallic stents (EMSs).

Results: In 42 of 44 patients, the dyspnea subjectively improved after the procedure (95.5%). An improvement over one grade of the Hugh-Jones classification was shown in 79.5% (35/44); in 80% (20 of 25 patients) with intraluminal tumor and in 78.9% (15 of 19 patients) with extrinsic compression. Seven of the 44 patients developed dyspnea related to re-stenosis of 10 lesions and 1 of these patients developed dyspnea related to re-re-stenosis during follow-up. The mean duration of survival was 4.3 months in patients who underwent stenting. No significant differences in survival rates and primary patency rates were seen in patients with extrinsic compression compared to patients with intraluminal tumors.

Conclusion: Gianturco EMS therapy was valuable in patients who suffered from dyspnea due to airway stenosis causing obstruction.
CT features of mediastinal lymphangiohemangioma associated with superior vena cava ectasia: A case report
Authors: Wong A.M.-C. , Wan Y.-L. , Cheung Y.-C. , Ng S.-H. , Lee K.-F.
Published: July 2004

We present a case of mediastinal mesenchymal tumor in a 53-year-old woman with a 1-month history of chest tightness. A histological diagnosis of lymphangiohemangioma was obtained by excisional biopsy. CT findings are reported with emphasis on its association with intratumoral superior vena cava ectasia.
Poland's syndrome with lung cancer: A case report
Authors: Ahn M.I. , Park S.H. , Park Y.H.
Published: July 2004

Poland's syndrome, a rare congenital anomaly characterized by pectoralis muscle defect, has been reported in association with lymphoreticular malignancies and some solid tumors. Lung cancer associated with Poland's syndrome has not been previously described. We present the first report of a case of Poland's syndrome associated with lung cancer and demonstrate the CT findings.
Proton MR spectroscopy of the brain in patients treated with tips
Authors: Hamuro M. , Nakamura K. , Matsuoka T. , Kaminou T. , Higashida M. , Yamada R.
Published: July 2004

Purpose: To evaluate the utility of proton MR spectroscopy (MRS) for the early detection of hepatic encephalopathy (HE) after transjugular intrahepatic portosystemic shunting (TIPS).

Material and Methods: Six patients, who underwent TIPS for treatment of portal hypertension, were examined by MRS 1 week before and 1 week after TIPS. They were simultaneously clinically examined for number connection test, blood NH3 level, liver function test and the Fischer ratio.

Result: Three of 6 patients showed overt HE 1 to 5 weeks after TIPS and the other 3 patients did not show overt HE. The overt HE group showed the larger ratio of the amounts of glutamine and glutamate/myo-inositol (Glx/MI) than that of non-overt HE group ( p<0.05).

Conclusion: The Glx/MI ratio estimated by MRS was useful for early detection of HE after TIPS.
Radiological findings in angiofibroma
Authors: Schick B. , Kahle G.
Published: July 2004

Surgery after pre-operative embolization has become the main treatment modality in angiofibroma therapy. As surgical planning is based on precise pre-operative tumour evaluation, knowledge of the characteristic growth patterns is of great interest. Analysis of tumour extension and blood supply, as well as methods of controlling intra-operative bleeding, help in determining the appropriate surgical approach. Though benign, angiofibroma demonstrates a locally aggressive nature. This fibrovascular tumour is characterised by typical radiological findings and by predictable growth patterns. The tumour extension and blood supply can be accurately determined by CT, MR imaging and angiography. With classic radiological findings, no pre-operative biopsy is necessary in most angiofibromas. Advances in radiological imaging have contributed to improved surgical planning and tumour resection. The surgeon is able to select the least traumatic approach with secure haemostatic control, which is also critical for avoiding the disturbance of facial skeletal growth in this group of young patients. Embolization, pre-operative autologous donation and the cell saver system for immediate retransfusion of the collected blood after filtration, are important tools for dealing with blood loss in angiofibroma surgery as they minimize homologous blood transfusion.
Morphology and hemodynamics in dissection of the descending aorta: Assessment with MR imaging
Authors: Strotzer M. , Aebert H. , Lenhart M. , Nitz W. , Wild T. , Manke C. , Völk M. , Feuerbach S.
Published: July 2004

Purpose: To obtain morphologic and functional information in patients with dissection of the descending aorta using contrast-enhanced MR angiography (MRA) and MR blood flow quantification of the true and false lumina.

Material and Methods: Fourteen patients were studied prospectively using a 1.5 T unit. MRA was performed with a 3D FISP sequence (TR/TE/flip angle 4.7/1.9 ms/30°) after injection of 0.2 mmol Gd-DTPA per kg b.w. Flow quantification with phase velocity mapping was done at the level of the diaphragm using a 2D FLASH technique (TR/TE/flip angle 28/6.5 ms/30°) with an average temporal resolution of 23 frames per cardiac cycle (34 ms). A spectral broadening index was applied to quantify the amount of flow irregularity within both channels of the aorta. Extension of the dissection and involvement of the major branch vessels were analyzed.

Results: The mean flow volume per minute was 1982 ml (SD 1083 ml) in the true and 1052 ml (SD 763 ml) in the false lumen. Average peak-velocities were 98 cm/s (SD 33 cm/s) in the true channel and 47 cm/s (SD 26 cm/s) in the false channel. Ten patients had bidirectional flow in the false lumen with a reflux volume ranging between 6.8% and 98%. Only 1 patient presented with bidirectional flow in the true lumen (reflux volume 15%). A significantly higher degree of flow irregularity was found in the false lumen compared with the true channel.

Conclusion: Different hemodynamic patterns were found in aortic dissection. Their prognostic value and the impact on therapy, specifically percutaneous interventional procedures, have to be further studied.
A new stent designed for carotid artery application: An experimental study
Authors: Cwikiel W. , Harnek J.
Published: July 2004

Purpose: To evaluate a new stent developed for treating arterial stenoses located adjacent to the bifurcation of the carotid artery.

Material and Methods: Eight 4-cm-long nitinol stents, each with a diameter of 6 mm in its distal half and 9 mm in its proximal half, were tested in 4 pigs. In each animal, the abdominal aorta was catheterized through the left common carotid artery, and 2 stents were inserted into the right and left iliac arteries, respectively, with the wider portion in the common iliac artery and the narrower portion in the corresponding external iliac artery. The pigs were killed after 24 hours, or 1, 4 or 8 weeks, following control angiography. The arteries were examined macroscopically and by scanning electron microscopy.

Results: All stents remained in the intended position, fitting the arterial wall, following successive expansion to their maximum diameter and after 4 weeks were completely covered by endothelium. The arteries remained patent, with preserved flow to the side branches through the stent mesh. A small thrombus was found in 1 artery.

Conclusion: In animal experiments, the new stent was safely inserted over the arterial bifurcation, remained in place and was covered by endothelium while flow through side branches was preserved.