bluuebunny/crossref_metadata_2025 huggingface dataset:
Scoring of extensive deep leg vein thrombosis displayed as wide-spread non-filling of contrast on phlebography: A comparison with colour Doppler ultrasonography
Authors: Björgell O. , Nilsson P.E. , Jarenros H. , Nylander G.
Published: July 2004

Purpose: To evaluate whether wide-spread non-filling of contrast in vein segments, displayed on phlebography, is interpreted as deep venous thrombosis (DVT) on colour Doppler ultrasonography (CDU) and if the same score value is obtained.

Material and Methods: Twenty consecutive patients were analysed by both phlebography and CDU with a scoring system.

Results: One hundred and fifty-one venous segments were initially analysed, but 19 (12.6%) were excluded because their entire extent could not be interpreted by CDU. The total score was 366 (mean 18.3) according to the phlebograms and 298 (mean 14.9) when interpreted by CDU, p=0.0001. The difference was due mainly to the scoring of the anterior tibial vein found to be open on CDU in most cases, and then the thrombotic burden percentage was 84% and 75%, respectively. In 19 of the 20 patients (95%) a DVT was confirmed by CDU. The great saphenous vein, the femoropopliteal vein, and the deep femoral vein, formed the main collateral circulation.

Conclusion: Wide-spread non-filling of vein segments is due to an extensive DVT in the vast majority of cases. Scoring is possible by both phlebography and CDU and the difference in the results of the scoring is generally of minor importance.
Functional MR imaging of pulmonary ventilation using hyperpolarized noble gases
Authors: Guenther D. , Hanisch G. , Kauczor H.-U.
Published: July 2004

The current status of experimental and clinical applications for functional MR imaging of pulmonary ventilation using hyperpolarized noble gases are reviewed. 3-helium (3He) and 129-xenon (129Xe) can be hyperpolarized by optical pumping techniques such as spin exchange or metastability exchange in sufficient amounts. This process leads to an artificial, non-equilibrium increase of the density of excited nuclei which represents the source of the MR signal. Those hyperpolarized gases are administered mostly via inhalation, and will fill airways and airspaces allowing for ventilation imaging. Recent human studies concentrate on imaging the airways and airspaces with high spatial resolution. Normal ventilation is reflected by an almost complete and homogeneous distribution of the hyperpolarized gas represented by the signal detected. Loss of signal or inhomogeneous signal distribution represent mass effects and ventilatory abnormalities. Even healthy subjects with seasonal allergies without pulmonary symptoms have been observed to exhibit transient ventilation defects. Real-time imaging of ventilation has become feasible for 3He MR imaging and allows for assessment of ventilation-distribution. Furthermore, functional oxygen-sensitive 3He MR imaging opens the field of non-invasive assessment of regional intrapulmonary oxygen concentrations in vivo. Knowing that the diffusion of gas is affected by the geometry and nature of its environment, diffusion measurements are under investigation as a sensitive marker of diseases that involve structural changes of lung parenchyma, such as emphysema and fibrosis. Whereas 3He is not absorbed and is restricted to the airspaces, 129Xe is soluble in blood and lipid-rich tissue. This presents the opportunity for additional dissolved-phase imaging, providing a step towards simultaneous ventilation-perfusion studies.
Schwachman-diamond syndrome: A case report
Authors: Çubuk M. , Arslan G. , Çeken K. , Özkaynak C. , Lüleci E.
Published: July 2004

Schwachman-Diamond syndrome is an autosomal recessive disorder consisting of exocrine pancreatic insufficiency and neutropenia. The typical pathological finding with this syndrome is fatty infiltration in the pancreas of patients. We report a case of Scwachman-Diamond syndrome examined with abdominal ultrasonography, CT and radiography.
Added value of cea scintigraphy in the detection of recurrence of rectal carcinoma
Authors: Järv V. , Blomqvist L. , Holm T. , Ringertz H. , Jacobsson H.
Published: July 2004

Purpose: To explore the diagnostic value of immunoscintigraphy compared to CT and/or MR imaging in the diagnosis of local recurrence (LR) of rectal cancer.

Material and Methods: Forty-six patients suspected of having LR of rectal cancer were retrospectively studied. Carcinoembryonic antigen (CEA) scintigraphy findings were compared to CT and/or MR in all patients, and with data from surgery and morphology (31 patients), biopsy (7 cases) and follow-up (8 patients).

Results: CEA scintigraphy was not complementary to CT and/or MR in the detection of LR. Two false-positive and 14 false-negative diagnoses of LR occurred with CEA scintigraphy. Distant metastases including metastatic lymph nodes were found by this method in only 7 of 27 patients with proven metastases. CT/MR were able to demonstrate these metastases in 21 of 27 patients.

Conclusion: Accuracy and sensitivity of CEA scintigraphy in the detection of LR and distant metastases is lower than that of CT and/or MR. However, CEA scintigraphy seems to have a high specificity and could therefore be used in patients with a strong clinical suspicion of LR but negative CT/MR investigations. Available diagnostic methods have limitations in differentiating between benign, post-treatment changes and LR of rectal cancer and in staging of malignant disease.
Ultrasonographic evaluation of bilateral groins in children with unilateral inguinal hernia
Authors: Kervancioglu R. , Bayram M.M. , Ertaskin I. , Ozkur A.
Published: July 2004

Purpose: The presence of hernia was investigated prospectively by US in both groins of children with clinically suspected or apparent unilateral inguinal hernia.

Material and Methods: One hundred and twenty-eight (103 boys, 25 girls) were classified into three groups according to age: 0-2, 3-5 and 6-15 years. The widest diameter of the inguinal canal was measured in the longitudinal plane while the children were in the supine position and at rest. The patent processus vaginalis (PPV) values of 4 mm and higher were accepted as hernia. The groins diagnosed clinically and/or ultrasonographically as hernia were explored surgically. The clinical and US findings were compared with surgical results. The relations between hernia diameters and the age groups, sex, right/left and inguinal/scrotal hernias were analyzed statistically.

Results: In 128 children, 138 groins were treated with surgery. One hundred and eleven cases were unilateral hernia (73 right, 38 left) and 10 were bilateral. Seven cases were found to be normal. Ten cases with clinically unilateral hernia were bilateral at US and surgery. One hundred and thirty-one of 138 groins were correctly diagnosed by US. The accuracy, specificity and sensitivity of US were 94.9%, 85.7% and 95.4%, respectively. The accuracy of physical examination was 87.7%. There were no significant differences between hernia diameters and the age groups, sex and right/left side except the difference between inguinal and scrotal hernia diameters ( p<0.0001).

Conclusion: US can be used routinely in the pre-operative diagnosis of inguinal hernia in children. PPV values higher than 4 mm, with a high accuracy indicate hernia.
Radiographic evaluation of anterior dislocation of the shoulder
Authors: Ceroni D. , Sadri H. , Leuenberger A.
Published: July 2004

Purpose: To establish radiographic criteria to choose the most appropriate technique of reduction for each type of anterior glenohumeral dislocation, and to determine the type of dislocation which requires general anesthesia.

Material and Methods: Radiography in two different projections was performed in 67 patients with antero-inferior shoulder dislocations before a reduction attempt. The method proposed by Boss-Holzach-Matter was used as the primary technique for all shoulder dislocations.

Results: Most subcoracoid dislocations (84.4%) could be reduced by the Boss-Holzach-Matter method while only a few subglenoid dislocations (15.8%) were reducible by this technique. Displaced associated fractures significantly reduced the success rate of the reduction attempts.

Conclusion: Anterior dislocations of the shoulder require different methods of reduction depending upon the type (sub-group) of dislocation. Reduction of subglenoid dislocations with associated greater tuberosity fracture should be performed under general anesthesia to avoid head-splitting fracture.
Incidence of adverse events after I.V. injection of MR contrast agents in a chinese population: A comparison between gadopentetate and gadodiamide
Authors: Chu W.C.W. , Lam W.W.M. , Metreweli C.
Published: July 2004

Purpose: To study the incidence of adverse events after i.v. injection of MR contrast agents in a Chinese population. A comparison was made between an ionic contrast agent (dimeglumine gadopentetate, Magnevist) and a non-ionic contrast agent (gadodiamide, Omniscan).

Material and Methods: During a 24-month period, 2,049 Chinese patients who randomly received an i.v. bolus injection of either Magnevist or Omniscan were investigated. All patients were questioned for the presence of any generalized or localized adverse reaction on the following day after the MR examination according to a standardized questionnaire.

Results: Three hundred and nine out of 2,049 patients (15%) reported an adverse event. There was a higher incidence of adverse events in patients receiving Magnevist as compared to those receiving Omniscan injection. All reported adverse events were clinically mild and required neither treatment nor hospitalization.

Conclusion: There was a higher incidence of adverse reaction in patients receiving Magnevist than in those receiving Omniscan.
Predictors of radiological sequelae of pulmonary tuberculosis
Authors: Al-Hajjaj M.S. , Joharjy I.A.
Published: July 2004

Purpose: In patients with pulmonary tuberculosis, clinical factors that are associated with poor radiological outcome have not been adequately addressed in the medical literature. The aim of this study was to explore some of these factors in patients admitted to a large chest hospital in Saudi Arabia with pulmonary tuberculosis.

Material and Methods: Chest radiographs of 1080 patients with pulmonary tuberculosis were reviewed. Post-treatment residual changes were classified from 1 to 5 according to the severity of these changes. Data analysis was done by tabulating these classes against different variables that were likely to influence the final radiological appearance at the end of the treatment period.

Results: Near-complete or complete clearance of chest radiography (Class 1) was seen in 43.5% of patients <20 years old compared to 30.3% in patients >40 years old ( p<0.05). The latter group also had significantly higher rate of pleural thickening (9.4% vs. 3.6%), higher rate of fibronodular densities (24.9% vs. 19.5%) and higher rate of persistent cavitation (18.3% vs. 11.9%). Females had a significantly lower rate of chest radiography clearance (30.5%) than males (41.4%). Patients with a duration of respiratory symptoms of <4 weeks had 45.2% Class 1 radiography compared to 24.6% for those with longer duration of symptoms (>8 weeks). Chest radiography clearance was more frequent (51.6%) in patients with good compliance with drug therapy compared to those with poor compliance (18.8%). Persistent cavitation (Class 5) was seen in 30.4% of cases with a past history of tuberculosis and in only 14% of cases with no such history.

Conclusion: Old age, female gender, long duration of symptoms (delayed diagnosis), poor compliance with treatment and positive history of tuberculosis were associated with poor radiological outcome.
Diagnosis of meningeoma: A comparison of costs before CT, during CT and after introduction of MR imaging
Authors: Laurila J. , Suramo I. , Brommels M. , Servo A. , Kotikangas J. , Standertskjöld-Nordenstam C.-G.
Published: July 2004

Objective: To assess whether the capital investment required by advances in radiological technology is offset by savings in the direct costs of diagnostic services.

Material and Methods: Meningeoma was used as an indicator case. All meningeoma patients from three study periods were included: Twenty patients in 1976-77 before the introduction of CT, 22 patients in 1984-85 when CT was used and 16 patients in 1992 when MR imaging had replaced CT as the most informative imaging modality. Radiological and other diagnostic investigations, and the hospital stay were identified and cost analyzed.

Results: The costs of radiological examinations increased from 293 Euros in 1976-77 to 513 Euros in 1992. The average number of diagnostic examinations per patient decreased from 5.1 in 1976-77 to 2.4 in 1992. The length of hospital stay decreased from 11.5 to 2.7 days and the total costs of the diagnostic work-up decreased to one-third of the original, i.e. from 3423 Euros in 1976-77 to 1282 Euros in 1992.

Conclusion: The costs of the radiological examinations rose, but the development of radiological technology simplified the diagnostic practice. The hospital stay drastically decreased. The total costs of diagnostic work-up per patient dropped to one-third of the baseline costs.
Pre-operative radiotherapy in soft tissue tumors: Assessment of response by static post-contrast MR imaging compared to histopathology
Authors: Einarsdottir H. , Wejde J. , Bauer H.C.F.
Published: July 2004

Purpose: To evaluate if static post-contrast MR imaging was adequate to assess tumor viability after pre-operative radiotherapy in soft tissue sarcoma.

Material and Methods: Post-contrast MR imaging of 36 soft tissue sarcomas performed 0-54 days (median 13 days) after pre-operative radiotherapy, were retrospectively reviewed and compared to post-operative histopathology reports. The contrast enhancement of the tumor was visually graded as minor, moderate or extensive. From the post-operative histopathology reports, three types of tumor response to radiotherapy were defined: Poor, intermediate or good. The size of the tumors before and after radiation was compared.

Results: Even if most viable tumors enhanced more than non-viable tumors, there was major overlapping and significant contrast enhancement could be seen in tumors where histopathological examination revealed no viable tumor tissue. Based on histopathology, there were 12 good responders; 8 of these showed minor, 3 moderate and 1 extensive contrast enhancement on MR imaging. Sixteen tumors had an intermediate response; 3 showed minor, 8 moderate and 5 extensive enhancement. Eight tumors had poor response; none showed minor enhancement, 3 moderate and 5 extensive enhancement. Both increase and decrease in tumor size was seen in lesions with a good therapy response.

Conclusion: Static post-contrast MR imaging cannot reliably assess tumor viability after pre-operative radiotherapy in soft tissue sarcoma. In tumors with no viable tumor tissue, moderate and extensive contrast enhancement can be seen.
CTA in patients with acute subarachnoid haemorrhage: A comparative study with selective, digital angiography and blinded, independent review
Authors: Pedersen H.K. , Bakke S.J. , Hald J.K. , Skalpe I.O. , Anke I.M. , Sagsveen R. , Langmoen I.A. , Lindegaard K.F. , Nakstad P.H.
Published: July 2004

Purpose: Minimal- or non-invasive methods replacing intra-arterial digital subtraction angiography (IA-DSA) would be of great importance in patients suffering from acute subarachnoid haemorrhage (SAH). The aims of this study were to compare CTA with IA-DSA in patients with acute SAH, to compare CTA interpretations with those of blinded, independent reviewers and to evaluate improvement in CTA diagnostics after 1 year of experience with CTA.

Material and Method: During 2 years 162 patients with SAH underwent CTA as well as IA-DSA. Independent blinded review of 77 patients was performed for 1 year.

Results: Totally 144 aneurysms were demonstrated in 119 patients at IA-DSA, while 43 patients had normal intracranial arteries. Initially 131 aneurysms were detected at CTA while 2 normal, tortuous arteries were misinterpreted as aneurysms, giving a sensitivity of 91% and a specificity of 95%. At independent blinded review the observer agreement was 87% and the kappa value 0.68.

Conclusion: CTA in SAH is of great value in demonstrating vascular anatomy and the exact size of an aneurysm. However, IA-DSA is still needed for diagnostic evaluation in aneurysms smaller than 5 mm in diameter, especially in those located near bony structures.
Contrast-enhanced thoracic 3D-MR angiography in infants and children
Authors: Holmqvist C. , Larsson E.-M. , Ståhlberg F. , Laurin S.
Published: July 2004

Purpose: To optimise breath-hold contrast-enhanced MR angiography (MRA) in infants and children with suspected congenital heart or thoracic vessel malformation.

Material and Methods: Thirty-nine children (median age 1 year) were examined, using five different ultrafast MRA sequences with a TR between 3.2 and 5.0 ms and the contrast agent meglumine gadoterate. A test injection was used to determine contrast travel time. Different parameters for contrast injection were evaluated. Signal-to-noise ratio (SNR) measurements were performed and image quality and injection timing were evaluated.

Results: MRA was successful in all patients and image quality was considered very good in 52%. Adequate SNR was achieved with no significant differences between the MR sequences. SNR decreased only 25-30% between subsequent scans. The mean contrast dose was 0.23 mmol/kg. The mean scan time was 12.5±3.8 s; the shorter scan times made dynamic examinations possible with high temporal resolution. Highest spatial resolution was obtained with TR 4.6/5.0 sequences.

Conclusion: A contrast dose of 0.2 mmol/kg b.w. is recommended with an injection rate of 0.5 to 1.2 ml/s, depending on patient size and scan time. The scan delay time should equal the contrast travel time for optimal vessel enhancement. In the future, contrast-enhanced MRA may be a potential alternative to angiocardiography in infants and children.
CT-Guided aspiration biopsy of infected aortic graft in a patient with hypertrophic osteoarthropathy: Saline injection to improve diagnostic yield - A case report
Authors: Golder W. , Wolf K.-J.
Published: July 2004

Unilateral hypertrophic osteoarthropathy can be a diagnostic clue to chronic infection of an aortic graft and aorto-enteric fistula. In a 62-year-old woman, non-invasive diagnostic procedures failed to prove the infection. CT-guided fine needle biopsy revealed the pathogens prompting re-intervention. The biopsy result was markedly improved by injecting physiologic saline into the perigraft tissue.
Pre-operative evaluation with MR in tetralogy of fallot and pulmonary atresia with ventricular septal defect
Authors: Holmqvist C. , Hochbergs P. , Björkhem G. , Brockstedt S. , Laurin S.
Published: July 2004

Purpose: To assess whether MR imaging could replace angiography in pre-operative evaluation of patients with tetralogy of Fallot and pulmonary atresia with ventricular septal defect (VSD), especially since the surgical correction was done earlier than was previously the rule.

Material and Methods: Fourteen patients with tetralogy of Fallot (n=10) or pulmonary atresia with VSD (n=4), mean age 7.5±4.4 months, were evaluated with angiocardiography and MR before definitive surgical correction.

Results: There was good diagnostic agreement between the two modalities when evaluating right ventricular outflow obstruction; 86% for valvular and 93% for supravalvular stenosis, but the agreement was somewhat lower for the subvalvular obstruction (57%). Surgery findings, however, were in favour of MR in 5 patients concerning the subvalvular right ventricular outflow tract obstruction. MR images identified all stenoses in the right and left pulmonary arteries, but overlooked one stenosis in the main pulmonary artery. MR could evaluate patency in all palliative shunts.

Conclusion: Even in this young age group, MR imaging offers a good alternative to angiocardiography for the pre-operative evaluation of the right ventricular outflow tract, the main pulmonary artery and the proximal right and left pulmonary arteries, before definitive surgical correction of tetralogy of Fallot and pulmonary atresia with VSD.
Optimal timing of post-biopsy MR imaging of the prostate
Authors: Ikonen S. , Kivisaari L. , Vehmas T. , Tervahartiala P. , Salo J.O. , Taari K. , Rannikko S.
Published: July 2004

Purpose: To assess the quantity and frequency of hemorrhage after prostatic biopsy. As post-biopsy blood products may interfere with interpretation of MR images, we also investigated the optimal timing for MR examination after biopsy.

Material and Methods: Fifteen patients scheduled for prostatic biopsies were imaged with endorectal MR before and after the procedure. In addition, MR studies of 42 patients with prostate cancer were retrospectively analyzed. The amount of post-biopsy blood product and the degree of its interference with image interpretation were assessed.

Results: Of a total of 57 patients, 44 (77%) had visible post-biopsy hemorrhage. However, the presence of blood products were considered to interfere with interpretation of the images in only 12 (21%) cases. This disturbing effect seems to diminish after 21 days from biopsy. The total amount of blood clearly decreased after 28 days.

Conclusion: Deferring MR imaging for at least 3 weeks after prostatic biopsy is advisable. T1-weighted images are necessary to rule out false-positive findings caused by post-biopsy hemorrhage.
CT of the oral vestibule with distended cheeks
Authors: Bredesen K. , Aaløkken T.M. , Kolbenstvedt A.
Published: July 2004

Purpose: To evaluate patient compliance in CT examination of the oral vestibule with distended, blown-up cheeks and to determine how often such images provided additional information when disease processes in this area were suspected.

Material and Methods: Fifty-four patients were examined with CT of the oral vestibule with distended cheeks and 16 of them had diseases where oral vestibule affection was considered possible.

Results: Fifty-three of 54 patients were able to perform cheek distension. Of 16 patients with possible disease involvement of the oral vestibule, additional information was thus obtained in 11 patients.

Conclusion: When lesions involving the oral vestibule or adjacent regions are suspected, CT examination with distended cheeks is recommended as a routine procedure.
Mucinous ductal ectasia of the biliary tree secondary to mucous metaplasia: A case report
Authors: Arslan A. , Løberg E.M. , Osnes M. , Geitung J.T.
Published: July 2004

Mucinous ductal ectasia is an uncommon disorder, characterized by ductal dilatation and filling with thick, viscid mucus, described in the pancreas. We report a case of mucinous ductal ectasia of the biliary tree. The cause of the mucus production was mucous metaplasia in the biliary epithelium. The patient was followed for 16 years, treated with serial saline flushings of the biliary tree whenever he became symptomatic.
Vertebral pneumatocysts
Authors: Arslan G. , Çeken K. , Çubuk M. , Özkaynak C. , Lüleci E.
Published: July 2004

Objective: To review the prevalence and location of vertebral pneumatocysts and evaluate the CT findings of these benign lesions.Material and Methods: Retrospectively we reviewed CT images of 89 patients with suspected disc disease during a 6-month period.Results: Distinctive CT pattern of intraosseous pneumatocysts involving the cervical, thoracic and lumbar spine was found. In 8 patients (9%), 10 vertebral pneumatocysts were detected. Five were located in the vertebral body and 4 of these were associated with vacuum phenomenon in adjacent intervertebral discs. Five were located near the facet joint and all were associated with vacuum phenomenon in adjacent facet joint.Conclusion: Intraosseous pneumatocyst is a benign lesion, therefore biopsy and follow-up are unnecessary. Although vertebral pneumatocysts seem to be uncommon with a few reported cases, this study shows them to be more frequent than previously thought.
MR and other imaging methods in the investigation of mycetomas
Authors: Czechowski J. , Nork M. , Haas D. , Lestringant G. , Ekelund L.
Published: July 2004

Purpose: To report features of mycetomas (actino- and eumycetoma infection), which belong to the so-called rare bone infections, as evaluated by MR and other imaging methods and to assess chemotherapy treatment.

Material and Methods: Twenty patients (average age 57 years) were diagnosed by different modalities. Analyses of 57 plain films, 31 three-phase bone scans, 28 CT and 35 MR examinations were performed. The MR protocol included T1-weighting without and with contrast, T2-weighted, proton density and fat suppressing sequences.

Results: Signs of chronic osteomyelitis were seen in plain films of 10 patients (50%), but the healing process was difficult to assess. Bone scintigraphy was positive in 12 patients (60%). In 14 patients (70%), CT could demonstrate bone lesions, but the healing process was difficult to estimate in 4 patients. MR imaging provided accurate diagnostic information in 15 cases (75%). In 16 patients (80%), small lesions could be identified due to grains, which seemed to differentiate mycetoma from other infections and tumorous lesions. MR examination gave definitive answer about the healing process in 18 cases (90%).

Conclusion: MR investigation was superior to the other imaging techniques in the evaluation of mycetoma and the assessment of therapy.
Contrast-enhanced T1-weighted black-blood fast spin-echo MR imaging of the brain: Technique for suppression of enhancing venous signal
Authors: Amano Y. , Takagi R. , Takahama K. , Kumazaki T.
Published: July 2004

Purpose: Contrast-enhanced T1-weighted black-blood fast spin-echo MR imaging (BB-FSE) was performed to suppress enhancing venous signal and flow artifacts in the brain without sacrificing the T1-weighted imaging contrast.

Material and Methods: Twenty-five MR imaging sections (17 transverse and 8 coronal images) in 15 patients with various brain diseases were obtained by contrast-enhanced T1-weighted SE and BB-FSE images.

Results: In contrast-enhanced T1-weighted BB-FSE images, venous signal was significantly less and T1-weighted contrast of the brain was more evident. No differences in flow artifacts were found between the two imaging techniques. The interobserver agreements were good for the venous signal and flow artifacts using both techniques.

Conclusion: Contrast-enhanced T1-weighted BB-FSE imaging reduced the venous signal in the brain with maintaining T1-weighted contrast. This novel MR technique can be used when the suppression of enhancing venous signal is expected to improve the depiction of enhancing lesions in the brain.
MR diffusion imaging and 1H spectroscopy in a child with medulloblastoma: A case report
Authors: Wilke M. , Eidenschink A. , Müller-Weihrich S. , Auer D.P.
Published: July 2004

We report on a child with a metastasising medulloblastoma which was assessed by MR diffusion imaging and 1H MR spectroscopy (MRS). Reduced mean apparent diffusion coefficients and a high amount of taurine could be demonstrated. This is the first reported case of high taurine in medulloblastoma in vivo and confirms earlier in vitro findings. It is suggested that the changes on diffusion imaging, possibly reflecting the small-cell histology of the tumour and high taurine in MRS, are indicative of medulloblastoma.
Perfusion-related parameters in intravoxel incoherent motion MR imaging compared with CBV and CBF measured by dynamic susceptibility-contrast MR technique
Authors: Wirestam R. , Borg M. , Brockstedt S. , Lindgren A. , Holtås S. , Ståhlberg F.
Published: July 2004

Objective: Perfusion-related parameters obtained by intravoxel incoherent motion (IVIM) MR imaging (MRI) were compared with cerebral blood volume and flow (CBV and CBF), retrieved by dynamic susceptibility-contrast (DSC) MRI.

Material and Methods: Twenty-eight volunteers (average age 68.5 years) were investigated. Spin-echo echo-planar imaging with IVIM-encoding gradients was employed (36 different b values, 0-1200 s/mm2). The perfusion fraction and the pseudo-diffusion coefficient were calculated for regions in thalamus gray matter and frontal white matter, using asymptotic and full fitting. In DSC-MRI, a Gd-DTPA-BMA contrast-agent bolus was monitored using simultaneous-dual FLASH. Deconvolution of the measured tissue concentration-versus-time curve with an arterial input function from the carotid artery was applied, and maps of CBV and CBF were calculated.

Results: The correlation between the perfusion fraction and CBV was r=0.56 ( p<0.0000006) using asymptotic fitting, and r=0.35 ( p<0.0004) when full fitting was applied. Average CBF was 41.5 ml/(min 100 g), to be compared with the IVIM-based value of 63.6 ml/(min 100 g), obtained from the median value of the pseudo-diffusion coefficient in combination with assumptions about capillary network structure.

Conclusion: The IVIM concept provided results that agreed reasonably with conventional CBV and CBF. The non-linear fitting to noisy signal data was problematic, in accordance with previously presented simulations.
Self-expandable metal stents in the treatment of antro-pyloric and/or duodenal strictures
Authors: Profili S. , Meloni G.B. , Bifulco V. , Conti M. , Feo C.F. , Canalis G.C.
Published: July 2004

Purpose: To assess the usefulness of self-expandable metal stents in the recanalization of antro-pyloric and/or duodenal strictures.

Material and Methods: We report our experience of 15 patients with inoperable antro-pyloric and/or duodenal strictures treated by implantation of 21 self-expandable metal stents (18 uncovered and 3 covered) inserted perorally under fluoroscopic guidance. The patients were 11 men and 4 women, mean age 65.3 years. Fourteen of 15 patients were affected by a malignant stricture of the antro-pyloric region and/or duodenum either primary or secondary in 10 and 4 cases, respectively. Only in 1 case there was a benign stricture from postoperative scarring. Stricture length and diameter varied from 3 to 9 cm (mean 5.4 cm) and from 0 to 4 mm (mean 1.27 mm), respectively.

Results: Twenty-one stents were placed in 15 patients: Technical success was achieved in all cases while clinical improvement was obtained in 14 cases. No short-term complications were observed. A mean 4.3-month follow-up was obtained. Two patients had emesis secondary to peritoneal dissemination of the tumor after 1 and 2 months, respectively. Two other patients showed tumor overgrowth of the oral edge of the prosthesis after 3 and 2 months, respectively, and required another coaxial stent to bridge the new stenosis. The patient treated for a benign stricture had jaundice after 3 months and percutaneous internal-external biliary drainage was necessary.

Conclusion: Self-expandable metal stents are a safe and effective treatment of antro-pyloric and duodenal strictures; therefore, they should be considered an alternative to palliative resection in cases of advanced stage disease or poor general physical condition.
The prevalence of disc aging and back pain after fusion extending into the lower lumbar Spine: A matched MR study twenty-five years after surgery for adolescent idiopathic scoliosis
Authors: Danielsson A.J. , Cederlund C.G. , Ekholm S. , Nachemson A.L.
Published: July 2004

Purpose: To determine the long-term outcome after fusion for adolescent idiopathic scoliosis in terms of degenerative disc findings diagnosed using MR imaging and to elucidate the clinical consequences.

Material and Methods: Thirty-two patients with adolescent idiopathic scoliosis, who had undergone spinal fusion using Harrington rods to the lower lumbar spine with one or two unfused discs below the fusion, were re-examined 25 years after the fusion. The re-examinations included validated questionnaires, clinical examination, full standing frontal and lateral radiographs and MR examination of the lower lumbar region. Curve size and degenerative findings on MR images were evaluated by two unbiased radiologists, blinded to the clinical findings. A matched control group of 32 persons without scoliosis was subjected to the same examinations.

Results and Conclusion: There were significantly more degenerative disc changes ( p<0.0001), disc height reduction ( p=0.0010) and end-plate changes ( p<0.0001 for both upper and lower end-plates) in the lowest unfused disc in the patient group compared with the control group. The MR findings in the lowest unfused disc, but not the one above, in the patient group correlated to lumbar pain intensity as well as to the diminished lumbar lordosis.
Radiographic measurement of femorotibial rotation in weight-bearing: The influence of flexion and extension in the knee on the extensor mechanism and angles of the lower extremity in a healthy population
Authors: Sanfridsson J. , Ryd L. , Svahn G. , Fridén T. , Jonsson K.
Published: July 2004

Purpose: A system for examination and measurement of the weight-bearing knee was developed earlier on examination equipment used for QUESTOR Precision Radiography (QPR), adapted to computed radiography and to a picture archiving and communication system. In this study the same system was used to develop a method to define “patellar variables” including measurements of the rotation of the femur and the tibia and the patellar translation, between semiflexion and extension, as well as the Q-angle. The aim of this study was to evaluate the reproducibility of these patellar variables and also to establish “normal” reference values for both the patellar variables and the variables in the original QPR system.

Material and Methods: For evaluation of the reproducibility 10 volunteers with healthy knees were examined twice. To obtain the reference values, 80 volunteers with healthy knees, 10 females and 10 males within each decade between 20 and 59 years of age, were examined.

Results and Conclusion: The reproducibility of the rotation of the femur and the tibia and of the Q-angle was 2–3° (SD) and of the patellar translation about 3 mm (SD). The result from the healthy volunteers will be a useful tool for evaluation of disorders in the knee joint.
Enhanced visualisation of the normal prostate blood flow in young healthy volunteers using a new ultrasound contrast agent
Authors: Hagen E. Krüger , Magnusson A. , Aksnes A.-K. , Norberg M.
Published: July 2004

Purpose: To evaluate the sonographic appearance of normal prostate vascularity before and after injection of a new ultrasound contrast agent, Sonazoid (NC100100, Nycomed Amersham).

Material and Methods: Five healthy male volunteers were given three injections of Sonazoid each. Transrectal B-mode, colour Doppler and colour Doppler energy (i.e. power Doppler) imaging was performed. The visibility of the vascular pattern and the vascular architecture of the prostate, including dynamics of contrast inflow and blood flow symmetry, were evaluated.

Results: The depiction of the vascularity was improved in all subjects after injection of Sonazoid for both Doppler modes. No improvement was seen for B-mode. Contrast dynamics within the prostate vessels were demonstrated with a mean time from injection of the ultrasound contrast agent to enhancement of the Doppler signals in the subcapsular arteries of 14±1 s (11-17 s), and the ultrasound contrast agent reached the central periurethral veins 4-7 s later. A symmetric, radial, spoke-like intraprostatic vascular pattern could be identified in all subjects using power Doppler imaging and ultrasound contrast agent.

Conclusion: Sonazoid improved the detection of normal human prostate vascular anatomy for both colour and power Doppler imaging. Contrast dynamic studies revealed a radial spoke-like intraprostatic vascular pattern. This information might be useful in examination of patients with suspicion of prostate cancer, and needs to be further investigated.
Uterine artery embolization of symptomatic uterine fibroids: Initial success and short-term results
Authors: Andersen P.E. , Lund N. , Justesen P. , Munk T. , Elle B. , Floridon C.
Published: July 2004

Purpose: To evaluate reduction in fibroid volume, the effect on clinical symptoms, adverse events and complications after percutaneous uterine artery embolization (UAE) as primary invasive treatment for symptomatic uterine fibroids.

Material and Methods: Sixty-two patients entered the study. Indications for treatment were fibroid-induced menorrhagia, bulk symptoms, pain, and/or large fibroid size. The first 50 patients were evaluated by clinical examination and ultrasonography with measurement of fibroid volume before treament and 1, 6 and 12 months after UAE. The remaining 12 patients were followed 3 and 12 months after treatment. Embolization with microparticles was performed percutaneously in local analgesia by selective catheterization of both uterine arteries.

Results: A primary technical success with bilateral UAE was achieved in 60/62 (97%) of the patients. They were treated for postprocedural pain lasting up to 24 h. In 30 of the 62 patients with 6 months follow-up, the mean fibroid volume was reduced 68% 6 months after treatment. Twenty-nine (96%) of the patients experienced reduced bleeding, 21 (70%) reduced pain, and 18 (61%) reduced bulk symptoms at follow-up.

Conclusion: UAE is a method with a high technical success rate. The treatment has good effect on fibroid volume reduction and clinical symptoms. Severe post-procedural pain occurs generally in successful bilateral embolizations, but complications and adverse events are otherwise few and minor. UAE represents a promising new method for treating uterine fibroid-related symptoms.
CT-guided percutaneous core biopsies of pulmonary lesions: Diagnostic accuracy, complications and therapeutic impact
Authors: Hänninen E. Lopez , Vogl T.J. , Ricke J. , Felix R.
Published: July 2004

Purpose: To evaluate the diagnostic accuracy, complications, and therapeutic impact of CT-guided percutaneous core biopsies of pulmonary lesions.

Material and Methods: Seventy-nine patients underwent diagnostic CT-guided percutaneous core biopsies of pulmonary lesions between July 1995 and March 1999. Evaluation included corresponding clinical data, pathologic results, and therapeutic consequences.

Results: There were 29 benign and 50 malignant lesions. Percutaneous core biopsy had an overall diagnostic accuracy of 95%. For malignant lesions, core biopsy was positive in 48 patients (sensitivity 96%), and for benign lesions, in 27 (sensitivity 93%). There were no false-positive findings. Pneumothoraces were observed in 19 patients (24%) and 4 of them required a chest drain (5%). There were no hematothoraces or major bleeding complications; however, postinterventional local hemorrhages were observed in 23 patients (29%). No hemoptysis was noted.

Conclusion: Percutaneous core biopsies of pulmonary lesions offer excellent diagnostic accuracy for both benign and malignant pulmonary lesions at a low complication rate.
Effects of JPEG and wavelet compression of spiral low-dose CT images on detection of small lung cancers
Authors: Li F. , Sone S. , Takashima S. , Kiyono K. , Yang Z.-G. , Hasegawa M. , Kawakami S. , Saito A. , Hanamura K. , Asakura K.
Published: July 2004

Purpose: To compare the effect of compression of spiral low-dose CT images by the Joint Photographic Experts Group (JPEG) and wavelet algorithms on detection of small lung cancers.

Material and Methods: Low-dose spiral CT images of 104 individuals (52 with peripheral lung cancers smaller than 20 mm and 52 control subjects) were used. The original images were compressed using JPEG or wavelet algorithms at a ratio of 10:1 or 20:1. Five radiologists interpreted these images and evaluated the image quality on a high-resolution CRT monitor. Observer performance was studied by receiver operating characteristic (ROC) analysis.

Results: There was no significant difference in the detection of cancers measuring 6 to 15 mm in uncompressed images and in those compressed by either of the algorithms, although the quality of images compressed at 20:1 with the wavelet algorithm was somewhat inferior. A lower diagnostic accuracy was noted using images compressed by the JPEG or wavelet algorithms at 20:1 in detecting lung cancers measuring 6 to 10 mm and cancers measuring from 6 to 15 mm with ground-glass opacity.

Conclusion: Compression of low-dose CT images at a ratio of 10:1 using JPEG and wavelet algorithms does not compromise the detection rate of small lung cancers.
Palliative treatment of inoperable malignant esophageal strictures with conically shaped covered self-expanding stents
Authors: Poyanli A. , Sencer S. , Rozanes I. , Acunaş B.
Published: July 2004

Purpose: To investigate the effectiveness of conically shaped covered self-expanding (Flamingo) stents in palliative treatment of malignant esophagogastric strictures in terms of patency, improved dysphagia score and survival.

Material and Methods: Flamingo stents were placed under fluoroscopic guidance between August 1998 and December 1999 for palliation of malignant dysphagia in 33 cases. There were 21 males and 12 females aged 40–80 years (average 64.2 years).

Results: Stent placement was successful in all patients, with good symptomatic control and no procedure-related complications. Spontaneous esophago-respiratory fistula and perforation accompanying malignant esophageal stricture in a total of 4 cases (12.2%) were successfully closed. In 1 case, tumor ingrowth was detected from the distal uncovered segment of the stent. In 2 cases with esophago-respiratory fistula, gastrointestinal bleeding occurred. The cause of hemorrhage could not be found by angiography. The mean survival time in 17 patients, later deceased, was 129 days (range 9–360), and the mean observation time in 16 patients still alive is 180 days (range 18–365).

Conclusion: Flamingo stents provide an effective and safe choice of palliative therapy in inoperable malignant esophagogastric strictures.
Detection of occult metastatic lymph nodes in the neck with gray-scale and power doppler us
Authors: Wang Q. , Takashima S. , Takayama F. , Wang J. , Kawakami S. , Saito A. , Matsushita T. , Sone S.
Published: July 2004

Purpose: To determine the most accurate criterion for predicting malignancy of small cervical lymph nodes with gray-scale ultrasound (GSUS) and power Doppler ultrasound (PDUS).

Material and Methods: Findings of 69 pathologically verified cervical nodes (38 benign, 31 malignant) in 57 patients without wide echogenic hilum on GSUS that measured less than 10 mm in minimal axial diameter were prospectively studied. Minimal and maximal axial diameters, ratios of minimal to maximal axial diameters, and presence or absence of calcification or necrosis of the nodes were assessed. On PDUS, vascularity in the node was classified into 4 pattern groups. A logistic model was used to evaluate the significant factors for predicting malignancy.

Results: The logistic model revealed that the minimal axial diameter and vascularity patterns were the only significant factors for malignancy. Using the minimal axial diameter, a node larger than 8 mm showed the highest accuracy (73%) with 45% sensitivity and 93% specificity. Of the vascularity patterns, spotted or peripheral pattern had the highest accuracy (80%) with 61% sensitivity and 93% specificity. A combined criterion of the minimal axial diameter larger than 8 mm and spotted or peripheral pattern increased the accuracy to 82% and sensitivity to 77% but specificity decreased to 86%.

Conclusion: A combined criterion of minimal axial diameter and vascular patterns was most accurate for diagnosing occult metastatic lymph nodes in the neck.
Large vestibular aqueduct in distal renal tubular acidosis: High-resolution MR in three cases
Authors: Berrettini S. , Neri E. , Forli F. , Panconi M. , Massimetti M. , Ravecca F. , Sellari-Franceschini S. , Bartolozzi C.
Published: July 2004

High-resolution MR of the inner ear performed in 3 consecutive pediatric patients affected by distal renal tubular acidosis (dRTA) and progressive sensorineural hearing loss (SNHL) revealed enlarged vestibular aqueducts (LVA) (bilateral in 1 case and unilateral in 2). LVA is associated to sporadic, progressive SNHL, often secondary to minor head trauma and activities involving the Valsalva maneuver.

We believe that the presence of LVA may have contributed to the onset of SNHL and its progression in our patients, and therefore want to stress the importance of morphological studies of the inner ear in patients affected by dRTA and SNHL.
Hepatic subcapsular steatosis in diabetic CAPD patients treated with intraperitoneal insulin: Description of a typical pattern
Authors: Kallio T. , Nevalainen P.I. , Lahtela J.T. , Mustonen J. , Pasternack A.
Published: July 2004

Purpose: To describe a specific imaging pattern of hepatic fatty change typical of diabetic patients on continuous ambulatory peritoneal dialysis (CAPD) treated with intraperitoneal (i.p.) insulin.

Material and Methods: Liver ultrasound was applied in 16 CAPD patients with insulin-dependent diabetes mellitus. Presence of hepatic subcapsular steatosis and maximum thickness of the fatty layer were recorded. Liver MR examination was made of 1 patient found to have extensive subcapsular steatosis.

Results: Hepatic ultrasound revealed a typical pattern of subcapsular steatosis ("coating-of-fat") in 7/8 patients treated with i.p. insulin. None (0/8) of the diabetic CAPD patients treated with subcutaneous insulin had subcapsular steatosis.

Conclusion: Hepatic subcapsular steatosis is specific to CAPD patients on i.p. insulin treatment. To our knowledge this is the first report to describe imaging findings in this particular form of hepatic fatty change.
Quantification of the ionising radiation effect over angiogenesis in the chick embryo and its chorioallantoic membrane by computerised analysis of angiographic images
Authors: Karnabatidis D. , Dimopoulos J.C.A. , Siablis D. , Papazafiropoulos D. , Kalogeropoulou C.P. , Nikiforidis G.
Published: July 2004

Purpose: We evaluated, in vivo, the effect of ionising radiation on the angiogenesis process in the chick embryo and its chorioallantoic membrane (CAM) using digital subtraction angiography (DSA) in conjunction with computer-assisted image analysis. Information regarding the ionising effect on endothelial cells during radiation treatment was extracted.

Material and Methods: Two series of fertilized eggs were irradiated with a single ionising radiation dose of 10 Gy on days 9 and 13 of embryonic development. Angiography was carried out 24 h after irradiation. The angiographic images were digitized and subsequently processed. A set of specific morphological parameters was defined to allow an analytical characterization of the vascularity status. Vessels were classified into three categories according to their diameters (≥200 μm, 100-200 μm and 50-100 μm). The data were normalized and statistically evaluated.

Results: On day 10, total vascular area and total vascular length presented a 15.6±1.2% and 18.4±2.4% reduction, respectively, while vascular diameters increased 3.3±0.5%. The vessel area and length of the first category (≥200 μm) increased 9.8±1.1% and 8.1±0.9%, respectively, while these morphometric parameters for each of the remaining two categories decreased 44.3±2.9%, 38.7±4.2% and 45±3.8%, 30.7±3.4%, respectively. On day 14 insignificant changes were observed.

Conclusion: Computerised analysis of angiographic images showed that the antiangiogenic effect of irradiation during the various phases of CAM development is larger on the 10th day than that observed on day 14 and it depends on the vessel size.