bluuebunny/crossref_metadata_2025 huggingface dataset:
Safety of gadolinium contrast agent in hemodialysis patients
Authors: Okada S. , Katagiri K. , Kumazaki T. , Yokoyama H.
Published: July 2004

Purpose: We evaluated the safety of a gadolinium (Gd) contrast agent in hemodialysis patients.

Material and Methods: Seventy hemodialysis patients underwent contrast-enhanced MR examination. After the examination, the patients were hemodialyzed on a usual schedule, i.e., 3 times per week at 4 h each session. The hemodialysis was performed on the same day in 16 patients, the next day in 34, 2 days later in 14 and 3 days later in 6 patients. Serum Gd concentrations before and after the first to fourth hemodialysis sessions were analyzed in 11 patients. Cardiovascular, cutaneous, respiratory, psycho-neurological and digestive side effects were evaluated in all patients. Changes in liver and kidney functions, blood counts, and electrolytes were also checked.

Results and Conclusion: Neither side effects nor blood changes were noted in any of the patients. Average excretory rates were 78.2%, 95.6%, 98.7% and 99.5% in the first to fourth hemodialysis sessions, respectively. These results suggest that Gd contrast agents can be used in hemodialysis patients if hemodialysis is carried out promptly after the examination.
Severe liver injury with hematological disorders following the injection of non-ionic contrast medium: A case report
Authors: Morita Y. , Kawamoto C. , Sato K. , Nakajima T. , Kanda Y. , Shiromizu K.
Published: July 2004

We describe a dramatic case of severe liver injury and hematological disorders following the injection of non-ionic contrast medium in a 49-year-old woman with endometrial cancer. This case developed into a fulminant hepatitis-like picture that required repeated plasmapheresis and hemodialysis.
Book Reviews
Authors: Montelius Anders , Wegenius Göran
Published: July 2004

Achieving Quality in Brachytherapy. By B. Thomadsen, Medical Science Series, Institute of Physics Publishing, Bristol and Philadelphia 2000, ISBN 0 7503 0554 1.

Radiology of Blunt Trauma of the Chest. By P. Schnyder & M. Wintermark. Springer Verlag 2000. ISBN 3-540-66217-0. Price Hardcover: DEM 159.
Post-traumatic cerebral infarction: Neuroimaging findings, etiology and outcome
Authors: Server A. , Dullerud R. , Haakonsen M. , Nakstad P.H. , Johnsen U.L.-H. , Magnæs B.
Published: July 2004

Purpose: To assess the radiological characteristics of post-traumatic cerebral infarctions (PTCIs), the etiology and site of infarction, and to provide neuroimaging indicators of a poor clinical outcome.

Material and Methods: A retrospective study of 16 patients with the neuroimaging-based diagnosis of PTCI was carried out. All CT, MR examinations, cerebral angiograms and medical records of the patients were reviewed.

Results: Infarcts were diagnosed in the territory of the posterior cerebral artery in 9 patients, in the middle cerebral artery in 5, in the anterior cerebral artery in 3, lenticulostriate-thalamoperforating in 2, vertebrobasilar in 3, and cortical infarcts in 2 patients. Neuroimaging studies suggested focal mass effect and/or acquired intracranial herniations as the cause of infarction in 13/16 patients (81.2%). In 3/16 patients (18.8%), PTCI was due to vascular injury of which 2 were angiographically documented (carotid artery dissection). Eight of the 16 patients in this study died or were left in a persistent vegetative state. Patients with associated subdural hematoma, brain swelling/edema and traumatic subarachnoid hemorrhage (tSAH) exhibited the worst outcome.

Conclusion: Gross mechanical shift of the brain and herniation across the falx and/or tentorium accounted for infarction in a majority of cases in our study. The overall death rate was 43.8% and this result suggests that PTCI is an indication of a poor clinical outcome, especially among patients with associated subdural hematoma, brain swelling/edema and tSAH.
Dynamic contrast-enhanced MR imaging in symptomatic bone stress of the pelvis and the lower extremity
Authors: Kiuru M.J. , Pihlajamäki H.K. , Perkiö J.P. , Ahovuo J.A.
Published: July 2004

Purpose: To assess the value of dynamic contrast-enhanced MR imaging in bone stress of the pelvis and the lower extremity.

Material and Methods: Thirty patients (37 reactions; aged 17-25 years, mean 20.5 years) with MR findings of 37 bone stress reactions were examined using dynamic gadolinium contrast enhancement. The enhancement was evaluated with time-intensity curves. The highest slope and maximum enhancement values were calculated and compared with the different precontrast MR imaging signs of bone stress reactions.

Results: There was a significant difference in the highest slope values between the site of the bone stress reaction and the reference points. In 24 of the 37 reactions the dynamic contrast enhancement was regarded as positive. A fracture line, callus, and muscle edema were the MR imaging signs which had a significant correlation to the dynamic contrast enhancement. Neither periosteal nor marrow changes showed any significant correlation. A new MR grading system for bone stress reactions could be assessed.

Conclusion: Increased tissue perfusion could be seen if precontrast MR imaging revealed callus, fracture line or muscle edema surrounding the bone stress reaction.
A comparative study of MR imaging profile of titanium pedicle screws
Authors: Malik A.S. , Boyko O. , Aktar N. , Young W.F.
Published: July 2004

Objective: We compared the MR imaging profile of three different types of titanium pedicle screw implants in common usage in a human cadaveric model. We additionally compared the change in temperature during imaging among three constructs.

Material and Methods: Titanium-based lumbar pedicle screw/rod constructs from three manufacturers were implanted sequentially in a human cadaveric spine. MR imaging was then performed using both conventional spin-echo sequences and advanced imaging pulse sequences. Changes in tissue temperature were also measured during imaging to assess differences among the various implants. MR images were compared in a blinded fashion by two neuroradiologists.

Results: No significant differences in imaging profile were noted between the three types of titanium implants with regards to their MR artifact profile. Fast spin-echo sequences led to a decrease in perceptible MR artifacts. Moreover, there were no significant differences in temperature increase among the three manufacturers (mean increase 0.5°C) during imaging.

Conclusion: Slight differences in the percentage of titanium among the three pedicle screw systems does not appear to result in artifact differences during MR imaging. Therefore, with regard to imaging profile considerations, the three systems studied should be considered interchangeable.
MR-guided core biopsies of soft tissue tumours on an open 0.23 T imager
Authors: Parkkola R.K. , Mattila K.T. , Heikkilä J.T. , Ekfors T.O. , Komu M.E.S. , Vaara T. , Aro H.T.
Published: July 2004

Purpose: To assess the feasibility of MR-guided soft tissue core biopsies on an open 0.23 T magnet.

Material and Methods: Twenty-nine consecutive patients with known or suspected benign or malignant soft tissue tumours underwent MR imaging. A one-slice dynamic enhancement sequence was used to obtain an enhancement curve of the tumour. MR-guided core biopsy of the tumour was performed in the same session.

Results: All biopsies could be performed on an open 0.23 T magnet. Standard MR images and dynamic enhancement curves were used in deciding biopsy route and target. The MR-guided core biopsy specimens were sufficient for histopathological diagnosis in 27 of 29 cases.

Conclusion: Open magnet configuration allows easy access to the patient and near real-time imaging guidance of soft tissue tumours. Minimally invasive MR-guided core biopsies of soft tissue tumours are feasible and help to avoid open surgical biopsies.
Radiological image data migration: Practical experience and comparison of the costs of work
Authors: Maass M. , Kosonen M. , Kormano M.
Published: July 2004

Purpose: To identify costs deriving from data migration of obsolete digital archives by measuring the workload, and to analyse migration-associated problems.

Material and Methods: Two digital archives were used (DTL and MOD) and the capacity of these archives could no longer support the needs of the Medical Imaging Centre. The entire content of the DLT archive and selected data from the MOD archive were transferred to the current higher capacity (17 TB) tape archive. The running time of work processes was measured by self-reporting, and the cost of work was calculated.

Results: The transfer of 43,096 studies required 314 working hours over the course of 15 months in total. The work was partly manual, partly automatic. The percentage of non-retrievable MOD images was 35. Less than 0.2% of the DLT image transfers failed due to incorrect patient or image data. The MOD - DLT transfer cost was six times higher per study than the DLT - DLT transmission cost.

Conclusion: At present, data migration may be inevitable as the amount of data increases and technology advances. The data transfer proved to be labour intensive, with high fault sensitivity regarding the MOD archive. The cost of work of data migration was 0.4% of estimated digital archiving total yearly cost. Automated data migration is preferable.
Long-term follow-up of reflux nephropathy in adults with vesicoureteral reflux – radiological and pathoanatomical analysis
Authors: Köhler J. , Thysell H. , Tencer J. , Forsberg L. , Hellström M.
Published: July 2004

Purpose: To study the long-term development of urographic renal morphology in adults with vesicoureteral reflux, to investigate the relationship between renal damage and reflux grade, and to analyse the association between the long-term urographic outcome and the occurrence of acute pyelonephritis and reflux during follow-up. The purpose was also to try to distinguish between acquired and developmental renal damage, based on analyses of renal histological specimens and urographic features, and to analyse associated congenital urogenital abnormalities and family history of reflux, reflux nephropathy, urological malformation or death from end-stage renal disease.

Material and Methods: Renal damage was identified in 100 (83 women) of 115 adults, selected because of documented reflux. Eighty-seven patients had two urographies done (median interval 14.3 years). The extent and progression of renal damage were assessed and features of developmental renal damage were determined. Histological renal specimens were available in 23 patients with renal damage.

Results and Conclusions: The extent of renal damage correlated positively with the severity of reflux. No renal damage developed during the follow-up in 45 previously undamaged kidneys and progression of renal damage was rare (4 of 120 previously damaged kidneys), despite persisting reflux in half of the cases and episodes of acute pyelonephritis during follow-up. Thus, repeated renal imaging is rarely justified in adults with reflux nephropathy. Histological examination showed "chronic pyelonephritis" in all 23 cases and co-existing renal dysplasia in 1 case. The detailed urographic analysis did not reveal support for developmental renal damage. High frequencies of associated congenital urogenital abnormalities and of a positive family history were found. Thus, congenital and/or hereditary factors cannot be discarded as background factors for the development of renal damage.
Neonatal periventricular-intraventricular hemorrhage: Subacute and chronic MR findings
Authors: Asao C. , Korogi Y. , Kondo Y. , Yasunaga T. , Takahashi M.
Published: July 2004

Purpose: To evaluate MR findings at subacute and chronic stages after neonatal periventricular-intraventricular hemorrhage (PIVH), and to determine the clinical significance of follow-up MR.

Material and Methods: Twenty-six children (estimated gestational age, 23-39 weeks; mean 29 weeks) with a history of previous PIVH underwent MR examination during their subacute and chronic clinical courses. PIVHs were initially detected with ultrasound examination in all cases. PIVH was divided into three grades (mild, moderate, and severe) according to the findings at the initial US studies, which were correlated to the MR findings.

Results: Abnormal signal intensities related to hemorrhage were demonstrated in 10 of 21 patients (47.6%) on initial MR studies; the very low signal intensities on T2-weighted images found on the periventricular wall with a linear or a spotty shape had disappeared at one year after the initial US. The children with ventriculomegaly and periventricular leukomalacia (PVL) were increased in number on the follow-up studies.

Conclusion: MR imaging provided valuable information about the consequences of neonatal PIVH such as developments of ventriculomegaly or PVL. It is noteworthy that hemorrhagic lesions could not be detected in half of the cases at the subacute or chronic stage of PIVH.
Dynamic helical CT-guided needle localization of non-palpable and mammographically occult breast lesions: Case reports
Authors: Ueda T. , Takano H. , Suzuki M. , Yamamoto S. , Motoori K. , Nagashima T. , Yagata H. , Ito H.
Published: July 2004

Dynamic helical CT-guided needle localization of non-palpable and mammographically occult breast lesions is described. Dynamic helical CT-technique enabled fast volume scanning of the whole breast during the early contrast enhancement phase, which provided sufficient contrast to localize the target lesions. The procedures were successfully completed without complications.
Pulmonary sarcoidosis: Correlation of expiratory high-resolution CT findings with inspiratory patterns and pulmonary function tests
Authors: Magkanas E. , Voloudaki A. , Bouros D. , Prassopoulos P. , Alexopoulou C. , Tzanakis N. , Linardakis M. , Gourtsoyiannis N.
Published: July 2004

Purpose: To assess the presence and extent of air trapping (AT) on chest high-resolution CT (HRCT) in sarcoidosis and to correlate such findings with patterns, lesion extent on inspiratory CT and pulmonary function tests (PFT).

Material and Methods: Thirty patients with sarcoidosis underwent inspiratory and expiratory HRCT and PFT. HRCT images were evaluated for presence, distribution and AT extent as well as the predominant HRCT pattern and the extent of lesions at inspiration. Attenuation difference in the AT regions at expiration and at inspiration were calculated. The presence and extent of AT were correlated with PFT, extent of involvement and predominant inspiratory patterns.

Results: AT was present in 25/30 patients with no lung zone predilection. AT was the only CT indication of pulmonary sarcoidosis in 3/30 patients who also had normal PFT. Attenuation difference between inspiration and expiration ranged from -40 HU to 106 HU. In 2 patients, a paradoxical decrease of lung attenuation was observed at expiration. A significant correlation was found between AT extent at expiration, with residual volume-total lung capacity ratio and residual volume.

Conclusion: AT is an additional HRCT finding in sarcoidosis. AT may involve any lung zone, including costophrenic angles and may be the only CT feature of pulmonary sarcoidosis. Strong correlation is only found with PFT values that are specific for incomplete lung emptying at expiration.
Stent placement in short unilateral iliac occlusion: Technique and 24-month results
Authors: Steinkamp H. , Werk M. , Wissgott C. , Settmacher U. , Haufe M. , Hierholzer C. , Felix R.
Published: July 2004

Purpose: To determine the success rate and 24-month follow-up results of primary stent implantation for reconstruction of unilateral short iliac occlusion involving the aortic bifurcation.

Material and Methods: In 90 patients attempts of percutaneous transluminal recanalization of a short unilateral occlusion of the iliac arteries were performed. In 72/90 patients, the treatment was successful. Stent implantation was performed after recanalization in all 72 patients. Pre-interventional angiography of successfully treated patients showed unilateral occlusions and contralateral stenosis in 34/72 patients. In 38/72 patients unilateral occlusion without contralateral stenosis was diagnosed. The recanalization of the common iliac artery obstructions were performed with a guidewire and excimer laser angioplasty. Totally 152 stents were used for the treatment of iliac occlusion. Standardized treadmill testing and color-coded Doppler ultrasound were performed before treatment and during the follow-up.

Results: In all patients, stents were placed successfully; 5 major and 7 minor complications were observed. A clinical improvement of +2 to +3 according to the American Heart Association criteria was observed in 62 and 10 patients, respectively. Angiographic control was performed after 1-30 months. The primary angiographic patency rate was 83.1%. Angiography revealed significant restenoses in 4 patients successfully treated with transluminal angioplasty, and re-occlusion in 6 patients which were referred to surgery. The patency rate after 24 months was 90.0%.

Conclusion: Primary stent implantation is an effective treatment for short iliac obstructions and represents a true endovascular alternative to surgery.
Contrast agent distribution in microvascular damage of infarcted pig myocardium
Authors: Mark J. , Dai G. , Xiang B. , Sun J. , Lindsay W.G. , Deslauriers R. , Tian G.
Published: July 2004

Purpose: We determined whether reperfusion damage was sufficient to allow extravasation of a large molecular weight contrast agent into infarcted pig myocardium.

Material and Methods: Five pig hearts were subjected to in situ occlusion of the left anterior descending coronary artery (2 h) followed by reperfusion (1 h). The hearts were excised and perfused in the Langendorff mode for ex vivo MR imaging. Polylysine-Gd-DTPA (50,000 Da) and Gd-DTPA (500-700 Da) were injected into the aorta (alternately) and followed by measurements of T1 relaxation and mean transit time (MTT).

Results: In the normal myocardium, MTT of Gd-DTPA (56.8±23.2 s) was significantly ( p=0.02) longer than that of polylysine-Gd-DTPA (29.0±7 s). However, both normal and infarcted myocardium showed similar MTT (29.0±7.0 vs. 28.0±5.0 s, p>0.05) when using polylysine-Gd-DTPA.

Conclusion: The results indicate that the permeability of capillaries to polylysine-Gd-DTPA was not significantly higher in infarcted regions of the myocardium compared to normal tissue. However, infarcted myocardium displayed an increased permeability to the small molecular weight Gd-DTPA. We conclude that microvascular damage may not be sufficient to allow the extravasation of polylysine-Gd-DTPA in infarcted myocardium.
The triple-phase CT image appearance of post-irradiated livers
Authors: S.-Y. Chiou , R.-C. Lee , K.-H. Chi , Cheng J. Chia-Hsien , J.-H. Chiang , C.-Y. Chang
Published: July 2004

Objective To evaluate the sequential CT appearance of the liver after hepatic irradiation and to investigate the correlation between CT findings and radiation-induced hepatic injury.

Material and Methods: The triple-phase CT images of 18 patients with hepatocellular carcinomas (HCC) after hepatic irradiation were retrospectively reviewed (in total 41 CT studies). The high-dose region within the liver was defined as the area receiving more than 90% of the prescribed irradiation dose. The mean radiation dose was 55.5 Gy. Density changes and patterns of enhancement in the high-dose region were classified as three types: type I, constant low-density change in all phases; type II, low-density change in both pre-contrast and arterial phases, and iso-density change in the portal phase; type III, low- or iso-density change in the pre-contrast phase, low- or high-density change in the arterial phase, and persistent high-density change in the portal phase. The interval between completion of radiotherapy and the CT examinations ranged from 9 to 469 days, with a mean of 147 days.

Results: Nine of the 41 CT studies presented with type I, 9 with type II, and 16 with type III CT findings. The mean interval between completion of radiotherapy and the appearance of types I, II, and III CT findings were 74, 183, and 220 days, respectively. The interval was significantly shorter for type I findings than for type II and type III. The difference in interval was not significant between type II and type III. A type I finding with constant low-density change in the high-dose region of the liver was the most common pattern of CT findings within the first 3 months after hepatic irradiation. Either types II or III findings were frequently seen after 3 months.

Conclusion: The sequential CT appearance and the density changes may indicate correlation with the pathogenesis of veno-occlusive disease.
MR pyelography in 115 patients with a dilated renal collecting system
Authors: Blandino A. , Gaeta M. , Minutoli F. , Scribano E. , Vinci S. , Famulari C. , Pandolfo I.
Published: July 2004

Purpose: To evaluate the accuracy of MR pyelography in the assessment of hydroureteronephrosis.

Material and Methods: One hundred and fifteen patients, with variable degree of hydroureteronephrosis demonstrated by US and urography were subjected to MR pyelography obtained by means of two ultra-fast sequences.

Results: Of the 228 kidneys examined, the collecting systems of 130 kidneys were dilated and correctly identified on MR pyelography, with only 2 false-positive results. The specificity of MR pyelography in detecting hydronephrosis was 98%. Accuracy in revealing level of obstruction was 100%. Sensitivity in detecting stones, strictures and congenital ureteropelvic junction obstructions was respectively 68.9%, 98.5% and 100%.

Conclusion: MR pyelography can rapidly and accurately depict the morphological features of dilated urinary tracts with information regarding the degree and level of obstruction, without using contrast medium or ionizing radiation.
Supraspinatus outlet view in the diagnosis of stages II and III impingement syndrome
Authors: Hyvönen P. , Päivänsalo M. , Lehtiniemi H. , Leppilahti J. , Jalovaara P.
Published: July 2004

Purpose: To compare supraspinatus outlet view (SOV) findings at different stages of the impingement syndrome (IS) with findings in asymptomatic age- and sex-matched controls.

Material and Methods: Pre-operative SOVs were obtained of 37 shoulders of patients scheduled for unilateral open repair of a full-thickness rotator cuff tear (stage III IS) and 74 shoulders of patients scheduled for open (n=46) or arthroscopic (n=28) acromioplasty for tendinitis (stage II IS). Each view of a patient's shoulder was paired with a control view obtained from an age- and sex-matched person with no shoulder problems (n=111).

Results: There were no significant differences in acromial morphology as evaluated on the scale devised by Bigliani et al. or in the tilt, slope or length of the acromion between the study groups and their controls. However, hooked acromion seemed to be more common in the patients. The thickness of the anterior part of the acromion at the tendinitis stage and the acromial angle at the tear stage of IS were the only parameters that showed significant differences between patients and controls.

Conclusion: Variation of the morphology of the acromion as evaluated on a basis of the SOV is associated with IS, but the association is weak and its value in the diagnosis of IS is therefore only as an adjunctive to other diagnostic modalities.
CT characterization of developmental variations of the paranasal sinuses in cystic fibrosis
Authors: Eggesbø H.B. , Søvik S. , Dølvik S. , Eiklid K. , Kolmannskog F.
Published: July 2004

Purpose: To describe variations of paranasal sinus development in patients with cystic fibrosis (CF) and in non-CF patients examined for inflammatory sinonasal disease. We focused on anatomic variants that predispose to orbital and cerebral penetration during functional endoscopic sinus surgery (FESS), e.g. hypoplasia of the maxillary sinus and low ethmoid roof.

Material and Methods: One hundred and sixteen CF patients (3-54 years, median 18) and 136 control patients (7-51 years, median 31) were examined with coronal CT of the paranasal sinuses. CF patients were grouped according to number of confirmed mutations: CF-2 (n=70), CF-1 (n=32), CF-0 (n=14). CT images were evaluated with respect to paranasal sinus development, pneumatization variants and bony variants.

Results: Frontal sinus aplasia and maxillary, ethmoid, and sphenoid sinus hypoplasia were markedly more frequent in CF-2 than in control patients. No CF-2 patient had pneumatization variants such as Haller cells or concha bullosa. Low ethmoid roof was seen in 30% of CF-2 children, but in no control children. CF-1 and CF-0 groups had prevalences of aplasia and hypoplasia intermediate to that of CF-2 and control patients.

Conclusion: Genetically verified CF patients had less developed sinuses, lacked pneumatization variants, and more often had anatomic variants that predispose to complications during FESS. Normally developed sinuses and pneumatization variants in some genetically unverified CF patients (CF-1, CF-0) suggest that these patients may be erroneously diagnosed.
Digital skeletal radiography: Reduction of absorbed dose by adaptation of exposure factors and image processing
Authors: Axelsson B. , Petersen U. , Wiltz H.J.
Published: July 2004

Purpose: The possibility to reduce the absorbed dose to the patient by increase of tube potential while maintaining the same exposure to the image plate and sufficient image quality in skeletal radiography has been investigated.

Material and Methods: Image processing parameters were adjusted to account for an increase in tube potential by 20 kV. Revision of image processing parameters was based on measurements with phantoms constructed to simulate the histogram shape recorded for clinical images. Image quality was evaluated both using image quality criteria and visual grading analysis. Energy imparted was calculated from measurement of the kerma-area-product.

Results and Conclusion: Energy imparted was reduced by 20-30% using the modified technique with increased kV. All images were considered of accurate quality for diagnosis and the difference in image quality score was marginal. There was, however, a significant shift towards lower grades for the "high kV" technique using visual grading analysis.
Marking of nonpalpable breast lesions using a custom carbon suspension
Authors: Arman A. , Kilicoglu G. , Guner H. Hatipoglu , Celik L.
Published: July 2004

Purpose: To review results of carbon marking in non-palpable breast lesions using a different type of a carbon suspension containing 0.5% polyoxyethylene sorbitan monooleate (PSM).

Material and Methods: Sixteen lesions of 16 patients with indeterminate or suspicious mammographic findings underwent stereotaxic carbon marking. With the aid of tracing of the carbon stains surgery was then performed.

Results: Pathology revealed malignancy in 26% of the cases and the missed rate by carbon marking was 6% (1 lesion). Carbon marking is an easier application compared to hook-wire systems in localizing occult breast lesions. PSM added to a 4% carbon suspension results in a more homogeneous suspension, prevents early precipitation and eases injection. Animal studies have shown that no local or peripheral tissue reactions are elicited with either pure PSM or in a mixture with carbon.

Conclusion: We recommend addition of PSM to carbon marking suspensions.
Allergic reactions at repeat femoral angiography with ioxaglate
Authors: Nilsson S. , Bergstrand L. , Erikson U. , Johansson J. , Ö. Smedby , Walldius G.
Published: July 2004

Purpose: To study the occurrence of allergy-like reactions at angiography, repeated several times, and, secondly, to evaluate the effect of prophylactic treatment in individuals who had earlier experienced such reactions.

Material and Methods: One hundred and fifty-seven patients with hypercholesterolaemia, participating in the Probucol Quantitative Regression Swedish Trial (PQRST), underwent aortofemoral angiography with ioxaglate (Hexabrix) repeated annually for 3 years. Allergic reactions to the contrast medium were recorded. At the following angiographies, all patients who had earlier experienced such reactions were treated prophylactically with steroids and antihistamine.

Results: Allergic reactions were observed in 35 patients. Twelve reacted only year 0, 3 only year 1, 5 only year 2 and 6 only year 3. Eight patients had at least one reaction also when treated prophylactically. It was significantly ( p<0.05) more common to react at year 0 but not at year 1 than to react at year 1 but not at year 0. At years 1, 2 and 3 the frequency of reactions was significantly greater in the group given prophylactic treatment than in the group without any earlier reaction at all: 8/20 versus 3/137, 4/23 versus 6/134, and 6/29 versus 6/128, respectively.

Conclusion: Some individuals had an increased risk of an allergy-like reaction to the contrast agent. Prophylactic treatment reduced the risk of renewed reactions, but not to the same level as for those without earlier reaction. Nevertheless, individuals who have had earlier reactions can be investigated in the future, with prophylactic treatment.
Spinal dural AV fistula mimicking a vertebral neoplasm
Authors: Shetty D. , Lakhkar B. , Shetty C. , Rai S.
Published: July 2004

A middle-aged man with spinal dural arteriovenous fistula mimicking a vertebral neoplasm of Th11 is described. CT and MR imaging revealed the rare case of extensive vertebral destruction of Th11.
Book Reviews
Authors: Mallmin Hans , Söderman Michael , Rossitti Sandro , Jangland Lars , Friberg Ulla
Published: July 2004

Manual of Bone Densitometry Measurements. An Aid to the Interpretation of Bone Densitometry Measurements in a Clinical Setting. Edited by J. N. Fordham. Springer-Verlag 2000. ISBN 1-85233-278-6. 226 pages. Price: Hardcover DEM 269.

Thrombolytic Therapy for Stroke. Edited by Patrick D. Lyden. The Human Press 2001. 410 pages. ISBN 0-896-03746-0. Price: Hardcover 125 USD

Magnetic Resonance in Medicine, 4th Edn. Edited by P. A. Rinck. Blackwell Wissenschaft 2001 245 pages; 290 figures; 45 tables; includes a CD-ROMwith MR Image Expert version 2.5, and Dynalize version 1.0 Demo. ISBN 0-632-05986-9. Price: hardcover: DEM 198.00

Computed Tomography. By W. A. Kalender. Publicis MCD Verlag 2000. ISBN 3-89578-081-2.

Endoscopic Evaluation and Treatment of Swallowing Disorders. By S. E. Langmore. Thieme Verlag 2000. ISBN 3-13-116391-7. Price: DEM 228
Cardioprotective effects of the MR contrast agent MnDPDP and its metabolite MnPLED upon reperfusion of the ischemic porcine myocardium
Authors: Karlsson J.O.G. , Brurok H. , Eriksen M. , Towart R. , Toft K.G. , Moen O. , Engebretsen B. , Jynge P. , Refsum H.
Published: July 2004

Purpose: To evaluate whether manganese dipyridoxyl diphosphate (MnDPDP) or its metabolite manganese dipyridoxyl ethyldiamine (MnPLED) reduces post-ischemic myocardial injury.

Material and Methods: Left anterior descending artery (LAD) in anesthetized pigs was occluded (30 min) followed by reperfusion (120 min) during hemodynamic monitoring and infarct assessment. Three μmol/kg MnDPDP, 1 μmol/kg MnPLED (or a mixture of both) or saline was injected i.v. 10 min before reperfusion followed by infusion of either 3 μmol/kg/h MnDPDP, 1 μmol/kg/h MnPLED (or a mixture of both) or saline. The plasma concentrations of MnDPDP, MnPLED and other metabolites (e.g., ZnDPDP and ZnPLED) were analyzed.

Results: Femoral blood flow was reduced by 60% during early reperfusion in controls, whereas only 23 and 31% reductions were seen in animals treated with MnDPDP and MnPLED. During that time, +LV/dP and -LV/dP (maximum rate of left ventricular isovolumic contraction and relaxation, respectively), systolic pressure and diastolic pressure fell significantly less in animals treated with MnDPDP or MnPLED. Three out of 5 control animals experienced ventricular fibrillation (VF) during reperfusion, whereas VF was not seen in any of the pigs treated with MnPLED or/and MnDPDP. The infarct sizes in saline- and MnPLED-treated animals were 39±6 and 16±5%, respectively, of the occluded areas. MnDPDP did not reduce the infarct size. A mixture of MnDPDP and MnPLED significantly reduced infarct size (10±4%). When reperfusion started and throughout reperfusion, almost all injected MnDPDP was present as Zn-metabolites.

Conclusion: MnPLED seems to reduce reperfusion-induced cardiac dysfunction and infarct size in pigs. MnDPDP does not reduce infarct size in the pig, probably because of the rapid exchange of Mn2+ for Zn2+ taking place in the pig.
PRE-operative grading of intracranial glioma: Comparison of MR-determined cerebral blood volume maps with thallium-201 SPECT
Authors: W.W.-M. Lam , K.-W. Chan , W.-L. Wong , W.-S. Poon , Metreweli C.
Published: July 2004

Aim: To compare the accuracy of MR-determined cerebral blood volume (CBV) maps with SPECT imaging with thallium-201 in pre-operative grading of intracranial glioma.

Material and Methods: Nineteen patients (7 female and 12 male, mean age 46.8 years) with intracranial gliomas were examined with MR perfusion imaging pre-operatively. Sixteen of these patients were also examined with SPECT imaging with thallium-201. The tumour to contralateral white matter NI (negative integral) and tracer uptake ratios were evaluated. The ratios in high-grade and low-grade tumours were compared.

Results: The maximum CBV ratios of grades I and II gliomas (2.958±2.217) were significantly lower than the maximum CBV ratio of grades III and IV (9.484±4.520), p<0.001. There was no statistical difference when CBV ratios of grades I and II ( p=0.381), grades II and III ( p=0.229) and grades III and IV ( p=0.476) gliomas were compared. Thallium SPECT imaging showed no difference in tumour uptake ratio between low-grade and high-grade gliomas ( p=0.299).

Conclusion: MR-determined NI was useful for pre-operative grading of intracranial gliomas but SPECT thallium-201 imaging was not.
Isolated neurosarcoidosis – MR findings and pathologic correlation: A case report
Authors: Bode M.K. , Tikkakoski T. , Tuisku S. , Kronqvist E. , Tuominen H.
Published: July 2004

Neurosarcoidosis is a diagnostic challenge, especially if systemic symptoms are absent. We present a 49-year-old woman with isolated neurosarcoidosis. The main symptom was loss of vision in the left eye. Brain MR imaging showed 6 high-signal white matter lesions frontotemporally on proton density and T2-weighted turbo spin-echo images. Coronal fat-saturated turbo FLAIR images of the orbits showed a swollen left optic nerve with increased signal intensity, which finding has not been previously published in sarcoid optic neuropathy. A control MR examination showed meningeal enhancement of the left optic nerve and leptomeningeal enhancing lesions around the brain stem. Spinal MR revealed leptomeningeal enhancement throughout the spinal cord and asymptomatic enhancing cauda equina lesions, mimicking subarachnoid tumour seeding, and an enhancing nerve root mass at Th12/L1. Biopsy of the latter lesion revealed non-caseating granulomas consistent with sarcoidosis.
Value of high-resolution MR in patients scheduled for cochlear implantation
Authors: Seitz J. , Held P. , Waldeck A. , Strotzer M. , Völk M. , Strutz J. , Feuerbach S.
Published: July 2004

Objective: To determine sensitivity and specificity of high-resolution MR imaging and of high-resolution axial CT (HRCT) and to compare the two modalities in predicting the surgical and functional success of cochlear implantation.

Material and Methods: The presurgical MR images (2D T2W TSE, 3D T2*W CISS, plain and contrast-enhanced 3D T1W MP-RAGE) and axial HRCT findings of 26 patients were evaluated with regard to the predictive value concerning the success of cochlear implantation.

Results: We found a high correlation between MR and HRCT and the success of cochlear implantation. In all 26 patients, the MR-based predictions concerning the success of cochlear implantation were correct. In 10 patients, MR gave additional information to HRCT. In all patients, MR gave sufficient information about the status of the inner ear, inner auditory canal and cochlear nerve to aid the surgeon during the operation.

Conclusion: A high-resolution MR protocol consisting of coronal 2D T2W TSE, 3D T2*W axial CISS, plain and contrast-enhanced sagittal T1W 3D MP-RAGE is recommended for the evaluation of candidates scheduled for cochlear implantation. It provides information which cannot be obtained by HRCT.
Emphysema in heavy smokers with normal chest radiography: Detection and quantification by HRCT
Authors: Sashidhar K. , Gulati M. , Gupta D. , Monga S. , Suri S.
Published: July 2004

Purpose: To determine the severity and extent of emphysema in heavy smokers by high-resolution CT (HRCT) and to correlate the findings with spirometric tests (STs) and symptomatology.

Material and Methods: Fifty adult smokers with a mean age of 53 years with a smoking history of more than 30 pack years and normal chest radiographs underwent HRCT of the chest and ST (FEV1, FEV1/FVC, PEFR). Among these, 22 had symptoms of pulmonary disease and 28 were asymptomatic. Quantification of emphysema was done using a density mask program and the visual scoring method. The results were correlated with ST and symptomatology.

Results: 58% (29 out of 50) of the subjects had significant emphysema on HRCT. Eleven out of 15 with normal ST showed emphysema on HRCT while 2 with airflow obstruction on ST showed normal CT scores. 14% (4 out of 28) asymptomatic subjects had severe emphysema compared to 64% of symptomatic subjects. Emphysematous changes were predominantly seen in upper lung zones in 48% of the patients while in 52% it was distributed equally in both upper and lower zones. The number of pack years of smoking showed a positive correlation with CT scores. The correlation between HRCT scores and ST was statistically significant.

Conclusion: A significant number of asymptomatic and clinically undiagnosed smokers tend to have significant emphysema. HRCT helps in early detection of disease and thus helps implementation of preventive measures.
Accuracy of CT in local staging of gallbladder carcinoma
Authors: Kim B.S. , Ha H.K. , I.-J. Lee , Kim J.H. , Eun H.W. , Bae I.Y. , Kim A.Y. , Kim T.K. , Kim M.H. , Lee S.K. , Kang W.
Published: July 2004

Purpose: To evaluate the accuracy of CT for staging gallbladder cancers, especially the T-factor of the TNM staging system.

Material and Methods: CT investigations of 100 patients with surgically proven gallbladder cancers were retrospectively analyzed. Dynamic helical CT was performed in 16 patients and conventional CT in the remaining 84. On CT, three radiologists attempted tumor staging for these patients; the majority opinion was used for final decision. According to CT protocols (dynamic helical CT vs. conventional CT) and each tumor type (thickened wall/intraluminal mass/massive), the accuracy of CT staging was compared. The CT staging was correlated with the surgico-pathologic results.

Results: The overall accuracy of CT for staging gallbladder cancers was 71%; it was 79% for T1 and T2 tumors, 46% for T3 tumors, and 73% for T4 tumors. For all three readers, the poorest accuracy was obtained in T3 tumors. No statistically significant difference was noted in the accuracy between the groups undergoing conventional CT and dynamic helical CT. A statistically significant difference was noted in the accuracy for staging thickened wall and intraluminal mass types of tumors ( p<0.05); the highest accuracy was obtained in the intraluminal mass type (89%) and the massive type (83%), while it was 54% in the thickened wall type.

Conclusion: The accuracy of tumor staging with CT in patients with gallbladder cancer depends on the morphological type of tumor. The poorest result is obtained in the thickened wall type.
MR and ultrasound in screening of patients with suspected biliary tract disease
Authors: Håkansson K. , Ekberg O. , H.-O. Håkansson , Leander P.
Published: July 2004

Purpose: The diagnostic value and cost-efficiency of MR imaging were compared with US before endoscopic retrograde cholangiopancreatography (ERCP) in patients with clinically suspected biliary tract disease.

Material and Methods: In a prospective study of 219 patients, 85 were examined with both MR and US before ERCP.

Results: To find the correct diagnosis in the jaundiced patients the sensitivity of US, MR and ERCP was 53%, 93%, and 89%, respectively. In the patients with abdominal upper quadrant pain and normal serum bilirubin, the sensitivity of US, MR and ERCP was 50%, 100% and 70%, respectively. Examination with MR costs four times more than US. Screening with US and supplemental MR in non-diagnostic cases would cost 80% of the total amount compared to screening with MR only.

Conclusion: MR had a higher sensitivity than US for diagnosing biliary tract disease and MR was superior to US in visualising stones in the common bile duct and in diagnosing the cause of cholestasis. However, screening with US and supplemental MR in non-diagnostic cases is at present most cost-effective. With increased accessibility and slightly lower costs, MR will probably replace US as screening method in patients with suspected biliary tract disease.
MR imaging of the neural foramina of the cervical spine: Comparison of 3D-DESS and 3D-FISP sequences
Authors: Muhle C. , Ahn J.M. , Biederer J. , Schäfer F.K.W. , Frahm C.H. , Mohr A. , Brossmann J. , Resnick D.
Published: July 2004

Purpose: To assess whether a single three-dimensional double-echo steady state (3D-DESS) sequence can produce equivalent results when compared to a 3D free induction with steady precession (3D-FISP) sequence for the evaluation of the neural foraminal diameter and structures.

Material and Methods: Five phantoms were imaged on CT with 3-mm axial slices followed by reformatted axial 3D-DESS and 3D-FISP sequences. In addition, 3D-DESS and 3D-FISP sequences of 20 healthy subjects were compared with regard to image quality, differentiation between vertebrae and discs, differentiation between discs and neural foramina, and differentiation between vertebrae and neural foramina.

Results: Compared with CT, 3D-DESS and 3D-FISP sequences consistently underestimated the diameters of the neural foramina. The mean difference values for the 3D-DESS was 12.8%, compared to 9.5% for the 3D-FISP sequence. Concerning the in vivo studies, the 3D-DESS sequence was superior but not statistical significant to the 3D-FISP sequence with regard to image quality, differentiation between vertebrae and discs, differentiation between discs and neural formina, and identification of the nerve roots.

Conclusion: The 3D-DESS sequence is moderately accurate in the evaluation of the neural foraminal size. Compared to the 3D-FISP sequence, the 3D-DESS sequence is compatible concerning the image quality, differentiation between the cervical vertebrae and discs, and between the discs and neural foramina.
MR follow-up of small experimental intracranial haemorrhages from hyperacute to subacute phase
Authors: Ripoll M. Alemany , Gustafsson O. , Siösteen B. , Olsson Y. , Raininko R.
Published: July 2004

Purpose: To compare pulse sequences in revealing intracranial bleeding from the hyperacute to subacute phase.

Material and Methods: We injected 0.3-1 ml of autologous blood into the brain of 8 rabbits. MR imaging was performed immediately after haematoma creation and then at determined intervals up to 9-12 days. All images were analysed by two observers. After the last MR investigation, the brain was fixed in formalin. The last MR images were compared to the fixed brain sections and to the histologic findings.

Results: T2*-weighted GE sequences, both conventional spoiled and echoplanar sequences, revealed the intraparenchymal haematomas as hypointensities in all but 1 case, which was negative from the second day onward (a rabbit with 0.3 ml blood injected). The signal patterns remained unchanged during the follow-up. The haematoma sizes and shapes corresponded well to gross pathology. Blood in the cerebrospinal fluid (CSF) space was detected with T2*-weighted GE sequences in a great majority of the examinations during the first 2 days. The cases with the smallest injected volume of blood were negative. SE sequences were rather insensitive. The FLAIR sequence often revealed blood in CSF spaces but not in the brain.

Conclusion: T2*-weighted GE sequences are capable of revealing very small intraparenchymal haemorrhages from the hyperacute to the subacute phase, and blood in CSF spaces during at least the first 2 days.
Book Review
Authors: Rossitti Sandro
Published: July 2004

Voxel-Man 3D-Navigator. Brain and Skull: Regional, Functional, and Radiological Anatomy, 2nd edn. Edited by K. H. Höhne. 2 CD-ROMs with red/green spectacles; booklet 24 pp. Springer- Verlag 2001. ISBN 3-540-14910-4. Price: USD 69.95; GBP 56.40.
MR angiography in the follow-up of coiled cerebral aneurysms after treatment with guglielmi detachable coils
Authors: Nome T. , Bakke S.J. , Nakstad P.H.
Published: July 2004

Purpose: Intra-arterial digital subtraction angiography (DSA) has been considered the gold standard examination in the follow-up of patients treated with Guglielmi detachable coils (GDCs). However, DSA is an invasive and expensive investigation and results in exposure to ionising radiation to both patient and operator. The aim of this study was to compare MR angiography (MRA) with DSA with regard to patency of the occlusion of aneurysms following GDC treatment.

Material and Methods: We performed 75 MRA and DSA examinations on 51 patients treated with GDCs. The examinations were performed 3-36 months after embolisation and the interval between MRA and DSA was less than 1 week. Hard copies of both studies were interpreted retrospectively and independently for residual flow within the aneurysm, residual aneurysmal neck, and parent and branch vessel flow.

Results: Patency status of parent and branch vessel flow was correctly identified with MRA in all patients except 1. The sensitivity of MRA in revealing residual flow within the aneurysm was 97%. The specificity in ruling out residual flow within the aneurysm was 91%.

Conclusion: MRA may replace DSA in the long-term follow-up of coiled cerebral aneurysms. The initial follow-up examination should, however, include both modalities.
Embolization of cranial/spinal tumours and vascular malformations with hydrogel microspheres: An experience of 69 cases
Authors: Phadke R.V. , Venkatesh S.K. , Kumar S. , Tandon V. , Pandey R. , Tyagi I. , Jain V.K. , Chhabra D.K.
Published: July 2004

Objective: To evaluate polymethyl methacrylate hydrogel microspheres (HMs) as an embolization material in the management of hypervascular craniofacial and spinal lesions.

Material and Methods: Sixty-nine patients with vascular lesions of the craniofacial and spinal regions underwent embolization with HM. The pathologies included craniofacial tumours (n=38), cranial arteriovenous malformations (AVMs) (n=7), dural AVM (n=1), cavernous carotid fistula (n=1), spinal tumours (n=7), spinal AVMs (n=6), orbital lesions (n=4) and scalp AVMs (n=5). Surgery was done in 56 patients. The blood loss at surgery, tumour shrinkage, surgical cleavage and ease of removal of tumour was noted from the records. Histopathology was available in 39 patients. A follow-up of 3 months to 6 years was available in 13 patients in whom embolization was the sole treatment. Surgical and histopathological findings were correlated with angio-embolization findings.

Results: HMs were easy to inject through the microcatheter with good control. Good devascularization was obtained in 61 patients and partial in 8 patients. Two patients developed complications due to presence of anastomoses between intra- and extracranial circulation and 1 patient due to tumor swelling. Histopathology showed presence of HMs in all the lesions, with minimal inflammatory reaction in 2 patients. Patients with spinal lesions treated with embolization only stabilised in neurologic deficits.

Conclusion: HMs are highly suitable as embolization agents in the management of craniofacial and spinal hypervascular lesions.