bluuebunny/crossref_metadata_2025 huggingface dataset:
MR findings in humeral epicondylitis: A systematic review
Authors: Pasternack I. , E.-M. Tuovinen , Lohman M. , Vehmas T. , Malmivaara A.
Published: July 2004

Purpose: To highlight the importance of meta-analysis in diagnostic imaging by presenting a systematic search of the literature on the accuracy of MR imaging in epicondylitis.

Material and Methods: The literature was comprehensively reviewed to identify studies on MR findings in epicondylitis. Reviewers blind to the clinical diagnoses screened the data according to predetermined inclusion criteria. Data were collected and validity and relevance were assessed on structured forms.

Results: Seven studies including 148 patients with epicondylitis were accepted for the analysis. Eleven asymptomatic contralateral elbows and 29 elbows of healthy volunteers served as controls. The volunteers were distinctly younger than the patients. The MR technique was divergent, and the observed pathological changes also varied. The most frequent alteration was a change in the common extensor tendon signal (90%, 95% confidence interval 84-94%); 14% of the healthy volunteers and 50% of the contralateral elbows displayed the similar alteration.

Conclusion: Small sample size and methodological shortcomings in the original studies make the assessment of MR findings in epicondylitis questionable. There is a need for well-designed studies in which clinical features and occupational backgrounds as well as imaging parameters are carefully documented.
Diffusion tensor trace mapping in normal adult brain using single-shot epi technique: A methodological study of the aging brain
Authors: Chen Z.G. , T.-Q. Li , Hindmarsh T.
Published: July 2004

Purpose: To quantify age-related changes of the average diffusion coefficient value in normal adult brain using orientation-independent diffusion tensor trace mapping and to address the methodological influences on diffusion quantification.

Material and Methods: Fifty-four normal subjects (aged 20-79 years) were studied on a 1.5-T whole-body MR medical unit using a diffusion-weighted single-shot echo-planar imaging technique. Orientation-independent diffusion tensor trace maps were constructed for each subject using diffusion-weighted MR measurements in four different directions using a tetrahedral gradient combination pattern. The global average (including cerebral spinal fluid) and the tissue average of diffusion coefficients in adult brains were determined by analyzing the diffusion coefficient distribution histogram for the entire brain. Methodological influences on the measured diffusion coefficient were also investigated by comparing the results obtained using different experimental settings.

Results: Both global and tissue averages of the diffusion coefficient are significantly correlated with age ( p<0.03). The global average of the diffusion coefficient increases 3% per decade after the age of 40, whereas the increase in the tissue average of diffusion coefficient is about 1% per decade. Experimental settings for self-diffusion measurements, such as data acquisition methods and number of b-values, can slightly influence the statistical distribution histogram of the diffusion tensor trace and its average value.

Conclusion: Increased average diffusion coefficient in adult brains with aging are consistent with findings regarding structural changes in the brain that have been associated with aging. The study also demonstrates that it is desirable to use the same experimental parameters for diffusion coefficient quantification when comparing between different subjects and groups of interest.
MR in phenylketonuria-related brain lesions
Authors: Dezortová M. , Hájek M. , Tintěra J. , Hejcmanová L. , Syková E.
Published: July 2004

Purpose: Phenylketonuria (PKU) patients were examined by different MR techniques to explain the pathological changes observed in periventricular white brain matter using conventional MR imaging.

Material and Methods: Fifteen patients with treated classical PKU were examined by 1H spectroscopy, relaxometry and diffusion imaging on a whole-body 1.5-T MR imager.

Results: Known PKU lesions characterized by T2 enhancement in periventricular white matter were observed in all patients. The MR spectra from the lesioned areas showed a significant decrease in choline concentration. The mean ADC of water decreased and tortuosity increased in PKU lesions compared to control data.

Conclusion: The results support the following hypothesis: The T2 increase in the PKU lesion reflects a raised concentration of free water molecules (about 15%) that have an increased trajectory between collisions compared to the same region in controls. The increase in water mobility might be explained by changes in extracellular space volume and myelin sheaths, which, presumably, have a different geometry with more hydrophobic sites in PKU patients. The changes result in increased tortuosity and may be confirmed by the loss of anisotropy in PKU lesions.
Radiologic-pathologic correlation of the hyperdense middle cerebral artery sign: A case report
Authors: Rutgers D.R. , van der Grond J. , Jansen G.H. , Somford D.M. , Mali W.P.T.M.
Published: July 2004

To provide a histopathologic substrate of the hyperdense middle cerebral artery (MCA) sign in a patient with MCA infarction. The sign was found to be correlated with accumulation of erythrocytes, fibrin and cellular debris.
High-resolution and color doppler ultrasonography of cervical lymphadenopathy in children
Authors: Papakonstantinou O. , Bakantaki A. , Paspalaki P. , Charoulakis N. , Gourtsoyiannis N.
Published: July 2004

Purpose: To assess the frequency of high-resolution and color Doppler sonographic findings in the most common diseases of childhood manifested with cervical lymphadenopathy at initial presentation.

Material and Methods: High-resolution and color Doppler US were performed in 103 and 43 children respectively, with cervical lymphadenopathy at initial presentation. Sonomorphology and intranodal vascularity were assessed. Final diagnoses, based on biopsy or clinical and sonographic follow-up, included: Reactive hyperplasia (n=34), infectious mononucleosis (n=20), lymphoma (n=11), bacterial (n=28), tuberculous (n=5) and cat-scratch disease (CSD, n=5) lymphadenites.

Results: Round shape (L/S<2) was common both in lymphoma (78%), infectious mononucleosis (85%) and bacterial lymphadenitis (73%) while 91% of reactive nodes had L/S>2. Wide hilum conforming to nodal shape characterized reactive hyperplasia (94%) and infectious mononucleosis whereas absent or narrow hilum was frequent in lymphoma (100%) and bacterial lymphadenitis (60%). Central irregular hyperechogenic areas, blurred margins and central necrosis were most frequent in bacterial, tuberculous and CSD lymphadenites. On color Doppler US, hyperplastic nodes more frequently exhibited a solitary hilar vessel (48%), whereas infectious mononucleosis nodes had a central radial pattern (75%). Bacterial lymphadenitis presented with a variety of vascular patterns.

Conclusion: Although individual sonographic signs are not specific, the categorization and combination of findings might be highly suggestive of diagnosis of the underlying disease presenting with cervical lymphadenopathy.
Treatment of autonomous and toxic thyroid adenomas by percutaneous ultrasound-guided ethanol injection
Authors: Brkljacic B. , Sucic M. , Bozikov V. , Hauser M. , Hebrang A.
Published: July 2004

Purpose: To evaluate the feasibility and efficacy of US-guided percutaneous ethanol injection (PEI) in the treatment of autonomous and toxic thyroid adenomas.

Material and Methods: PEI was performed in 42 patients with solitary, scintigraphically "hot" nodules (n=37) or toxic nodular goiter (n=5). The nodular volume ranged from 2.5 to 38 cm3 (mean volume, 20.7±14.1 cm3). Ethanol was injected using a free-hand technique, usually in multiple sessions, using color and power Doppler US guidance. Treatment success was evaluated following 3-4 months after PEI by scintigraphy, hormonal status, and US findings.

Results: The procedure was technically successful in 39 patients (93%). Three patients were lost to follow-up. Minor complications were pain (all patients), subcutaneous hematoma (n=6), and transitory dysphonia (n=1). A complete cure was achieved in 22 patients (52%), and a partial cure in 10 patients (24%). In 4 cases (9%), the result was unsatisfactory since only moderate hormonal remission was observed. A satisfactory results was thus achieved in 32/42 patients (76%). Significant nodular volume reduction was observed in all cases. Better results were observed in smaller nodules and in cases of autonomous adenomas. There were no cases of recurrent hyperthyreosis.

Conclusion: US-guided PEI is an efficient and safe method in the treatment of autonomous thyroid nodules and it enables inactivation of nodules with minimal or transitory complications.
Apparent diffusion coefficients and T2 relaxation time measurements to evaluate disc degeneration: A quantitative MR study of young patients with previous vertebral fracture
Authors: Kerttula L. , Kurunlahti M. , Jauhiainen J. , Koivula A. , Oikarinen J. , Tervonen O.
Published: July 2004

Purpose: To assess the suitability of apparent diffusion coefficient (ADC) measurements to evaluate degeneration processes of the vertebral disc and to compare the results with T2 relaxation time measurements in both degenerated and normal intervertebral discs.

Material and Methods: Fourteen young patients (8.8-20.8 years old) who had had a vertebral compression fracture at least 1 year earlier, underwent MR studies with diffusion imaging in three orthogonal directions and T2 relaxation time measurements. ADC values and T2 relaxation times of both degenerated and normal intervertebral discs were compared to the values of 20 healthy young asymptomatic control subjects.

Results: In the degenerated discs of patients, the ADCx and ADCy values were decreased compared to earlier determined values of healthy controls. ADC values in the z-direction in degenerated discs did not differ significantly from the values of controls. T2 relaxation times were shorter in the degenerated discs of patients compared to the values of controls. The greatest changes in both these values were observed in degenerated discs followed by discs with normal signal intensity adjacent to primary trauma area and secondary trauma area.

Conclusion: We suggest that decreased ADC values reflect the lost integrity of the intervertebral disc. ADC measurements at MR may prove sensitive depicting of early degenerative changes in vertebral discs.
Palliative treatment of hepatocellular carcinoma by chemoembolization
Authors: Poyanli A. , Rozaneş I. , Acunaş B. , Sencer S.
Published: July 2004

Purpose: The efficacy of transcatheter arterial chemoembolization (TACE) and the correlation between iodized oil uptake pattern and tumor response were investigated in cases with inoperable hepatocellular carcinoma (HCC).

Material and Methods: TACE, using sequential intra-arterial doxorubicin, mitomycin, iodized oil and gelatin sponge particles, was used to treat patients with inoperable HCC localized to the liver. One hundred and two patients (aged 16-80) were treated in this manner from 1995 to 2001. The objective response was determined by sequential CT. Iodized oil uptake pattern as well as the relationship between uptake pattern and tumor response was evaluated in each case.

Results: The one-year survival rate was 46%. Tumor response was found to be better in cases with dense and peripheral iodized oil uptake in comparison to those displaying scarce and patchy iodized oil uptake.

Conclusion: TACE is an efficient and safe palliative treatment for inoperable HCC with prolonged survival and good life quality. Iodized oil uptake pattern can be considered a good prognostic marker.
Inadequacies of repeated radiological examinations in a university hospital
Authors: Krug B. , Wolters U. , Stützer H. , Lackner K.
Published: July 2004

Purpose: To establish why 16% of 1,045 patients undergoing abdominal and/or vascular surgery referred to the University Department of Radiology for a B-image sonogram reported that a US of the same regions of the body had been conducted during the previous 6 weeks without any changes in the clinical status.Statement of the problem: Evaluation of the reasons for these superfluous examinations and analysis of the consequences that the US follow-up examinations implied for the patient.

Material and Methods: One senior resident radiologist and one senior resident surgeon reviewed the medical records of the patients reporting previous examinations and examinations scheduled at the time of the questioning of the patients.

Results: One hundred and eight (63%) of the 171 medical records were available. Data on previous examinations mentioned in the report forms were incorrect in 14 cases (13%). Therefore, further evaluations were based on 94 patients. Ten (8%) out of 121 sonograms, 4 (10%) out of 40 CT and 2 (20%) out of 10 MR investigations documented in the medical records had not been mentioned by the patients. As many as 41 (75%) of the 55 preliminary sonograms performed by general practitioners and specialists in private practice were not documented in the medical records. Even though records existed of clinically plausible findings, 36 (84%) of the 43 preliminary US investigations performed by doctors in the University Hospital were repeated to verify the diagnosis without any further diagnostic benefit.

Conclusion: A cross-speciality consensus over the diagnostic value of B-image sonography and management of the findings obtained is of paramount importance.
Visualization of inner ear dysplasias in patients with sensorineural hearing loss: High-resolution MR imaging and volume-rendered reconstructions
Authors: Klingebiel R. , Bockmühl U. , Werbs M. , Freigang B. , Vorwerk W. , Thieme N. , Lehmann R.
Published: July 2004

Purpose: We evaluated a data acquisition and post-processing protocol for inner ear (IE) assessment by MR imaging in patients, suffering from various labyrinth malformations.

Material and Methods: MR IE studies of 158 consecutive patients (316 IEs) suffering from sensorineural hearing loss without evidence of an acoustic neurinoma were reviewed for pathologies of the IE and internal acoustic meatus. High-resolution MR data of all abnormal IE studies (n=45) were post-processed to previously standardized 3D volume rendered (VR) reconstructions.

Results: In 9 patients (5.7%) the following IE dysplasias were detected: malformation of the cochlea (6 IEs), vestibulum (4 IEs), semicircular canals (12 IEs) and vestibular aqueduct/endolymphatic sac (10 IEs). One patient showed evidence of an aplasia of the vestibulocochlear nerve. In 4 patients multiple IE dysplasias were encountered. Comprehensive 3D visualization of all labyrinthine dysplasias was achieved by the use of two VR reconstructions. The overall time for bilateral IE assessment amounted to 30-35 min.

Conclusion: The imaging protocol allows for rapid and comprehensive visualization of various IE dysplasias, based on a limited number of VR reconstructions.
3D steady-state MR cisternography in CSF rhinorrhoea
Authors: Jayakumar P.N. , Kovoor J.M.E. , Srikanth S.G. , Praharaj S.S.
Published: July 2004

Purpose: To determine the utility of 3D steady-state MR cisternography in the demonstration and localisation of cerebrospinal fluid (CSF) leak in patients with clinically suspected CSF rhinorrhoea.

Material and Methods: Six consecutive patients with clinically suspected CSF rhinorrhoea were examined with routine MR evaluation and MR cisternography (MRC). All MR examinations included fast spin-echo (SE) T1WI in axial and sagittal planes, fast SE T2WI in axial and coronal planes and fluid attenuated inversion recovery (FLAIR) images in the axial plane. 3D evaluation was done using the CISS technique with 0.7-mm thickness in the sagittal and coronal planes. The site and extent of the defect, and any brain herniation detected on MRC were correlated with surgical findings.

Results: In the 6 patients who underwent surgical exploration and repair, intraoperative findings correlated with the defect revealed by MRC in all cases.

Conclusion: In clinically suspected CSF rhinorrhoea, MRC is highly accurate in localising the site and extent of CSF fistula and may be used as the first investigation due to its efficacy and non-invasive nature.
Visual grading of emphysema severity in candidates for lung volume reduction surgery: Comparison between HRCT, spiral CT and “density-masked” images
Authors: Cederlund K. , Bergstrand L. , Högberg S. , Rasmussen E. , Svane B. , Aspelin P.
Published: July 2004

Purpose: To investigate which of three types of CT imaging yielded the best results in estimating the degree of emphysema in patients undergoing evaluation for lung volume reduction surgery (LVRS), whether there was any difference in this regard between the cranial and caudal part of the lung, and whether the degree of emphysema had an impact on the estimation.

Material and Methods: Four radiologists visually classified different degrees of emphysema on three different types of CT images into four groups. The degree of emphysema was calculated by a computer. The three types of images were as follows: HRCT images (2-mm slice thickness); spiral CT images (10-mm slice thickness); and density-masked images (spiral CT images printed with pixels below -960 HU, depicted in white).

Results: The conventionally presented images from HRCT and spiral CT yielded the same results (60% respective 62% correct classifications) in assessing the degree of emphysema irrespective of localisation. Significantly improved results were obtained when the spiral CT images were presented as density-masked images (74%).

Conclusion: There was no difference between HRCT and spiral CT in assessing the degree of emphysema in candidates for LVRS. Improvement can be achieved by the use of density-masked images.
Reproducibility of scoring emphysema by HRCT: Comparison of visual interpretation methods with pulmonary function tests among farmer's lung patients
Authors: Malinen A. , Erkinjuntti-Pekkanen R. , Partanen K. , Rytkönen H. , Vanninen R.
Published: July 2004

Purpose: We evaluated the reproducibility of three visual scoring methods of emphysema and compared these methods with pulmonary function tests (VC, DLCO, FEV1 and FEV%) among farmer's lung patients and farmers.

Material and Methods: Three radiologists examined high-resolution CT images of farmer's lung patients and their matched controls (n=70) for chronic interstitial lung diseases. Intraobserver reproducibility and interobserver variability were assessed for three methods: severity, Sanders' (extent) and Sakai. Pulmonary function tests as spirometry and diffusing capacity were measured.

Results: Intraobserver κ-values for all three methods were good (0.51-0.74). Interobserver κ varied from 0.35 to 0.72. The Sanders' and the severity methods correlated strongly with pulmonary function tests, especially DLCO and FEV1.

Conclusion: The Sanders' method proved to be reliable in evaluating emphysema, in terms of good consistency of interpretation and good correlation with pulmonary function tests.
Depiction of vasculature in small hepatocellular carcinoma, and dysplastic nodules evaluated with carbon dioxide ultrasonography and angiography
Authors: R.-C. Chen , C.-K. Wang , C.-S. Wang , W.-T. Chen , L.-S. Shih , L.-C. Chiang , P.-H. Chen
Published: July 2004

Purpose: To evaluate the vascularity in dysplastic nodules and well-differentiated and moderately to poorly differentiated hepatocellular carcinomas (HCCs) less than 2 cm using carbon-dioxide (CO2) US and angiography.

Material and Methods: A total of 115 pathologically proven small liver tumors (0.7∼2.0 cm) were included in the study. There were 31 dysplastic nodules, 49 well-differentiated HCCs and 35 moderately to poorly differentiated HCCs. A comparative study of angiography and CO2 US was carried out.

Results: Of the dysplastic nodules, 28 out of 31 tumors were hypo- or isovascular at CO2 US. Twenty-seven out of 31 tumors were hypovascular at angiography. Of the well-differentiated HCCs, 38/49 showed hypervascularity at CO2 US while 24/49 tumors were hypervascular at angiography. All moderately to poorly differentiated HCCs showed hypervascularity at CO2 US, compared to 30/35 tumors at angiography.

Conclusion: Most of the dysplastic nodules were hypovascular and most of the moderately to poorly differentiated HCCs were hypervascular. The vascularity of well-differentiated HCCs was in between the above tumors. Both CO2 US and angiography were equally effective in demonstrating the vascularities in dysplastic nodules and moderately to poorly differentiated HCCs. CO2 US was significantly superior to angiography when identifying the vascularity in well-differentiated HCCs.
Interobserver agreement in ultrasound examination of the biliary tract
Authors: Grantcharov T.P. , Rasti Z. , Rossen B. , Kristiansen V.B. , Rosenberg J.
Published: July 2004

Purpose: To prospectively evaluate the interobserver agreement in US examination of the gallbladder and the biliary tract performed by an experienced and a novice radiologist.

Material and Methods: Fifty consecutive patients underwent US examination because of clinically suspected gallstones. The examination was performed by a consultant and a trainee radiologist on the same day. The following outcome measures were registered: presence of gallstones, filling of the gallbladder, thickness of the gallbladder wall, splitting of the gallbladder wall, fluid around the gallbladder, diameter of the common bile duct (CBD), and presence of CBD stones.

Results: None of the radiologists observed CBD stones or fluid around the gallbladder. The CBD was clearly distinguished by both observers in all patients. There was good agreement in the conclusions of the two radiologists regarding the presence of gallbladder stones and substantial agreement regarding the filling of the gallbladder and splitting of the gallbladder wall. Significant difference existed in the measurements by the two radiologists regarding the thickness of the gallbladder wall and the diameter of the CBD.

Conclusion: The novice radiologist's expertise in the primary diagnosis of uncomplicated gallstone disease was as good as the one provided by the experienced colleague. The significant interobserver difference in the measurements of the thickness of the gallbladder wall and the CBD diameter might indicate that assessment of these parameters requires extensive practise and the opinion of an experienced colleague must be sought in cases where complications are suspected.
Bowel wall visualisation at CT colonography
Authors: Svensson M.H. , Svensson E. , Hellström M.
Published: July 2004

Purpose: To evaluate the quality of bowel wall visualisation at CT colonography and the impact of examination in the supine and prone positions.

Material and Methods: After bowel preparation, 111 patients underwent CT colonography. Air distension, degree of fluid redistribution with change in body position (supine and prone), influence of residual stool on bowel wall assessability, and quality of overall colon visualisation were evaluated using scales.

Results: Thirty of 110 patients (27%) had complete overall visualisation of the colon wall and 52 (47%) had subtotal visualisation of a limited part of the colon. The entire colon was more often air-filled in the prone position (46%) than in the supine position (18%). Joint review of supine and prone data showed that for all colon segments, except the sigmoid (86%), ≥95% of the patients had complete air filling. All patients had residual fluid. In 75% to 99%, depending on segment, fluid did not interfere with the bowel wall visualisation in the combined evaluation of supine and prone data sets. Thirty-one patients had residual stool with potential negative influence on polyp detection.

Conclusions: The colon wall was completely, or almost completely, visualised in 75% of the patients, and examination in the supine and prone positions was necessary for complete visualisation.
cAMP and cGMP do not mediate the vasorelaxation induced by iodinated radiographic contrast media in isolated swine renal arteries
Authors: Uder M. , Heinrich M. , Jansen A. , Humke U. , Utz J. , Trautwein W. , Kramann B.
Published: July 2004

Purpose: Vasodilatation is a frequent side effect of radiographic contrast media, partially due to a direct effect on vascular smooth muscles. Our purpose was therefore to examine any possible implication of the cyclic adenosine monophospate (cAMP) and cyclic guanosine monophosphate (cGMP) pathways in contrast media induced vasorelaxation.

Material and Methods: Isolated segments of swine renal arteries were precontracted with 10 μM phenylephrine and relaxed with iomeprol before and after blockade of the cAMP and cGMP pathways.

Results: 80 mM and 160 mM of iomeprol significantly relaxed about 52% and 68% of the precontracted arterial rings, respectively. 10 μm of IBMX, a phosphodiesterase inhibitor, did not increase the relaxant effect of 80 mM iomeprol but increased the relaxations induced by 400 nM forskolin by about 1.9 times (which stimulates the production of cAMP), and by 1 μm sodium nitroprusside (which stimulates the production of cGMP). 1 μm of H89 (an inhibitor of the cAMP-dependent protein kinase), was able to reduce the relaxation induced by 4 μM forskolin by about 2.5 times but had no significant effect on the relaxation induced by 160 mM iomeprol. 10 μM of ODQ (an inhibitor of the soluble guanylate cyclase), could reduce the relaxation induced by 10 μM of SNP but not the one induced by 160 mM iomeprol. Moreover, the absence of endothelial cells did not alter the relaxation induced by iomeprol.

Conclusion: The activation of the cAMP and cGMP pathways are not involved in the in vitro relaxation induced by iomeprol in swine renal arteries.
CT characterization of inflammatory paranasal sinus disease in cystic fibrosis
Authors: Eggesbø H.B. , Søvik S. , Dølvik S. , Kolmannskog F.
Published: July 2004

Purpose: In patients with cystic fibrosis (CF) the prevalence of paranasal sinus affection approaches 100%. We hypothesized that the hyperviscous mucus reducing mucociliary clearance in CF patients could give sinonasal inflammatory patterns different from those in non-CF patients. We wanted to compare the extent and distribution of paranasal sinus disease and the inflammatory patterns in these two groups of patients.

Material and Methods: One-hundred-and-eight CF patients (3-54 years old) and 79 controls (7-51 years old) with paranasal sinus disease confirmed at coronal CT were compared. The extent of disease was noted for each sinus and summed for all sinuses. Inflammatory patterns were identified and classified into: 1) routine surgery group (sporadic, infundibular and ostiomeatal complex (OMC) patterns) and 2) complex surgery group (sinonasal polyposis and sphenoethmoid recess (SER) patterns).

Results: CF patients had more widespread sinonasal inflammatory changes and more advanced disease for each sinus. Most CF patients displayed sinonasal polyposis and SER patterns while most controls displayed sporadic, infundibular or OMC patterns. As a result, 67% of CF patients were classified to the complex surgery group, compared to only 19% of controls.

Conclusion: The impaired mucociliary clearance in CF causes widespread inflammatory paranasal sinus disease, with inflammatory patterns more often requiring extensive surgery, with a higher risk of cerebrospinal fluid leak or bleeding, or involving areas that are more difficult to reach with the endoscope.
Utility of the tumor bed marker in patients with breast cancer receiving induction chemotherapy
Authors: Alonso-Bartolome P. , Garcia E. Ortega , Ayensa F. Garijo , de Juan Ferre A. , Bolivar A. Vega
Published: July 2004

Purpose: Induction or neoadjuvant chemotherapy is used in patients with locally advanced breast cancer to offer a higher rate of conservative surgery. The possibility of reduction in size, even in some cases complete clinical and mammographic regression, can make the localization of the tumor bed difficult at the time of surgery. The purpose of this study was to describe our experience about the utility of US-guided implantation of a metallic marker in patients with breast cancer before induction chemotherapy.

Material and Methods: Forty-three patients with 44 masses were diagnosed with percutaneous biopsy of breast carcinoma. Before beginning of the induction chemotherapy all of them were referred for metallic marker placement. A metallic harpoon was placed under US guidance.

Results: One patient died during the chemotherapy. Six underwent mastectomy, and 9 still had a palpable tumor at the time of surgery. In the remaining 27 patients (with 28 lesions) pre-operative wire localization of the tumor bed was carried out: in 11 cases the harpoon was necessary for the localization of the tumor bed, in 6 the harpoon was useful, and in 11 patients the localization of the tumor could have been done without the marker. No complications were observed and the marker remained stable in all patients.

Conclusion: In patients who undergo induction chemotherapy, the placement of a metallic harpoon under US guidance is a safe, simple and inexpensive technique for localization of the tumor bed previous to conservative surgery.
Differentiation of phyllodes tumors versus fibroadenomas: Mammographic and sonographic features
Authors: Yilmaz E. , Sal S. , Lebe B.
Published: July 2004

Purpose: To determine if mammographic and sonographic findings allow discrimination between phyllodes tumor and large sized fibroadenoma, which mimic each other in the clinical, radiologic and histopathologic appearances.

Material and Methods: Thirty-one histopathologically proven masses including 12 phyllodes tumors and 19 fibroadenomas 3 cm or greater in diameter were compared. In total 28 women were retrospectively evaluated by mammography and pre-operative sonography.

Results: Mammography revealed a high-density mass compared with surrounding fibroglandular breast tissue to be present in 9 of the 12 (75%) phyllodes tumors and 7 of the 19 (37%) fibroadenomas. At sonography a mass, which had a round or lobulated shape, marked posterior acoustic enhancement and intramural cystic areas, were statistically significantly more likely to be phyllodes tumors than fibroadenomas. None of the other mammographic or sonographic characteristics proved to be useful in differentiating phyllodes tumors and fibroadenomas.

Conclusion: Although masses of high density at mammography, circumscribed border associated with posterior acoustic enhancement and internal cystic areas at sonography should suggest the diagnosis of phyllodes tumors rather than large sized fibroadenomas, there was a substantial overlap in the mammographic and sonographic characteristics of these two tumors. Therefore, an excisional biopsy would be necessary for equivocal masses.
Correlation of immunologic status with high-resolution CT and distributions of pulmonary tuberculosis
Authors: Yabuuchi H. , Murayama S. , Murakami J. , Sakai S. , Hashiguchi N. , Soeda H. , Masuda K.
Published: July 2004

Purpose: To investigate the correlation of cluster of differentiation (CD)4 lymphocyte counts with high-resolution CT (HRCT) findings and distribution of pulmonary tuberculosis.

Material and Methods: Thirty-seven bacteriologically proven pulmonary tuberculosis, clinically non-AIDS, patients underwent HRCT and CD4 lymphocyte counts in peripheral blood cells were obtained within 3 days after the CT examinations. Patients were categorized into four groups according to CD4 lymphocyte counts (A >800; B 800-500; C 500-200; D <200). HRCT findings analyzed were as follows: typical, atypical, and mixed findings of post-primary tuberculosis, common, uncommon, and mixed distribution, and number of lobes involved.

Results: CD4 lymphocyte counts correlated with the degree of the mixture of atypical CT findings (ρ=0.565, p<0.001) and the degree of the mixture of uncommon distribution (ρ=0.431, p<0.01). Number of involved lobes showed no statistically significant correlation (ρ=0.209, p=0.21).

Conclusion: In patients with low CD4 levels, atypical HRCT findings co-exist with typical findings, and uncommon sites are involved in addition to common sites.
HRCT findings in the lungs of primary care patients with lower respiratory tract infection
Authors: Lähde S. , Jartti A. , Broas M. , Koivisto M. , Syrjälä H.
Published: July 2004

Purpose: To survey the prevalence and type of lung patterns detectable at high-resolution CT (HRCT) in a primary care population seeking help for cough and fever.

Material and Methods: The HRCT patterns of 103 patients obtained at the primary visit to a municipal health centre for cough and fever were evaluated. Forced expiratory examinations were obtained in 93 patients.

Results: Lower respiratory tract infection (LRTI)-related findings (present at inclusion, healed at follow-up, not explained by any other factor) were seen in 19 patients (18.7%), of whom 11 also showed opacities, even though of lesser extent, at conventional chest radiography. The following patterns were found: ground-glass opacity (58%), discrete consolidations (52%), confluent consolidations (16%; 1 case with an air bronchogram), air space nodules (10%), peribronchovascular thickening (37%), tree-in-bud pattern (26%), free pleural fluid (5%), and septal thickening (5%). An expiratory mosaic pattern was seen in 19 (20%) out of 93 patients. In addition, lymph node enlargement (>1 cm) was recorded in 7 patients out of 103.

Conclusion: HRCT is more sensitive than chest radiography in detecting LRTI-related lung lesions in a primary care population. The pattern typically comprises subtle scattered polymorphous opacities with varying attenuation affecting several lung segments. LRTI-related HRCT pattern deserves consideration as a differential diagnostic alternative in patients examined due to any lower respiratory tract symptoms.
An unusual radiographic finding in pulmonary parenchymal endometriosis: A case report
Authors: Kiyan E. , Kilicaslan Z. , Çaglar E. , Yilmazbayhan D. , Tabak L. , Gürgan M.
Published: July 2004

Thoracic endometriosis is an uncommon disorder. In most cases, the diagnosis is based on history alone and radiographic findings depend on the menstrual cycle. CT findings include ill-defined or well-defined opacities, nodular lesions, cavities, cystic changes and bullous formation. We report a case of pulmonary parenchymal endometriosis with an unusual radiographic finding.
Lateral thoracic artery embolization in cystic fibrosis: A case report
Authors: Salerno S. , Mercadante G.G. , Rabiolo A. , Furnari M.L. , Pardo F.
Published: July 2004

We report the embolization of an aberrant origin of haemoptysis - from the internal branch of the lateral thoracic artery - in a patient affected by cystic fibrosis. The technical implications for embolotheraphy in case of an aberrant origin of a haemorrhage are emphasized. Many different systemic arteries may contribute to the blood supply of the lung and many connections may exist between the systemic, bronchial and pulmonary circulations. The presence of non-bronchial systemic arteries supply should be investigated when inconclusive findings are seen during bronchial artery embolization for haemoptysis.
MR characteristics of acute cholangitis
Authors: Håkansson K. , Ekberg O. , Håkansson H.-O. , Leander P.
Published: July 2004

Purpose: To describe the MR appearance of acute cholangitis and discuss the role of MR imaging as a diagnostic method in this disease.

Material and Methods: Of 60 patients with clinical acute cholangitis, 12 were examined with MR before endoscopic retrograde pancreatography (ERCP). A retrospective review was performed of MR and ERCP findings. The MR findings registered were presence of biliary duct dilatation, intraluminal filling defects due to stones or sludge, bands of mucosal oedema of the biliary ducts, intra- and retroperitoneal oedema/fluid, and definition of the cause of obstruction, e.g. stones, stenosis or tumour was made.

Results: Acute cholangitis was related to obstruction from choledocholithiasis (n=8), pancreatic cancer (n=1), benign biliary duct stricture (n=1), papillary stenosis (n=1) and without evidence of an obstructing cause (n=1). One patient had an acute obstructive suppurative (toxic) cholangitis.

Conclusion: MR imaging has a role in the non-invasive radiographic arsenal of techniques to confirm or exclude the diagnosis of acute cholangitis, especially in older patients where the clinical symptoms may be vague.
Relapsing hydatid disease involving the vertebral body and paravertebral soft tissues
Authors: Basak M. , Ozel A. , Yildirim O. , Erturk M.
Published: July 2004

Hydatid disease involving the vertebral body and paravertebral soft tissues is rare even in rural areas where echinococcosis is endemic. We report a case with hydatid disease in the T11-L1 vertebral bodies and involvement in bilateral psoas muscles.
Gray-scale and doppler ultrasound imaging features of vascular canals in human femoral condylar epiphysis
Authors: Oshima H. , Mizutani H. , Ohba S.
Published: July 2004

Purpose: To describe the gray-scale and color Doppler ultrasound imaging features of vascular canals in human femoral condylar epiphysis.

Material and Methods: Vascular canals in the femoral condylar epiphysis were examined using gray-scale and Doppler US. The study was performed in 45 volunteers (aged <1 month-72 years) who comprised 1 subject with short stature, 1 subject with Klippel-Trenaunay-Weber syndrome and 43 subjects with normal growth.

Results: In the 8-year-old and younger group (n=34), vascular canals were observed in 32 subjects (94%), whereas vascular canals were not observed in the 9-year-old and older group (n=11). Vascular canals were visualized as hyperechoic lines and dots. With Doppler US, blood flow in the vascular canals was observed in 20 of the 32 subjects (62.5%). Spectral Doppler analysis was possible in 15 subjects, in all of whom only arterial waveforms were observed.

Conclusion: US was helpful to delineate the vascular canals and flow therein. The detection and evaluation of vascular canals and blood flow therein may prove useful in understanding growth.
Acetabular inclination and anteversion in infants using 3D MR imaging
Authors: Falliner A. , Muhle C. , Brossmann J.
Published: July 2004

Purpose: To establish if 3D MR imaging could be used for measurements of acetabular inclination and anteversion in infants specimens.

Material and Methods: 3D MR data of 3 pelvic preparations of 6-week- to 10-month-old infant specimens was gathered. MR imaging in transaxial and frontal planes was carried out to measure the acetabular inclination and anteversion: a method to determine the MR planes for measurements is described. It was oriented on anatomical landmarks of the pelvis and therefore allowed adjustment of the frontal and transaxial planes, independent of the pelvis position.

Results: The mean acetabular inclination angle was 48°, and the mean acetabular anteversion was 23°. Because of the low number of cases the results can only be assessed as a tendency, but MR imaging seems to be suitable for measurements of acetabular inclination and anteversion.
Image-guided fine-needle aspiration cytology of deep-seated enlarged lymph nodes
Authors: Saikia U. Nahar , Khirdwadkar N. , Saikia B. , Sood B. , Goldsmith R. , Dey P. , Gupta S.K.
Published: July 2004

Purpose: To evaluate the role of image-guided fine-needle aspiration cytology (FNAC) of deep-seated lymph nodes.

Material and Methods: Image-guided FNACs were performed on 242 patients of deep-seated lymph nodes which included thoracic, retroperitoneal and abdominal nodes. A sterile 3.5/5-MHz micro convex sector probe was used for localisation of the node. The FNAC was performed using a 0.7- to 0.9-mm needle with the stylet removed and attached to a 20-ml syringe and FNAC handle after the needle was visualised in the lesion. For each case a minimum of 4-5 smears were made, and two observers without bias interpreted the smears.

Results: A total of 242 patients were aspirated, of which 216 (90%) aspirations were US-guided and the remaining 26 (10%) were CT-guided. Adequate material for cytologic diagnosis was obtained in 208 (86%) patients with a similar diagnostic accuracy. The aspirate material was non-representative or scanty in 34 (14%) patients. The most common cytological diagnosis was tuberculosis/consistent with tuberculosis seen in 108 (45%) patients followed by metastasis (17%) and reactive hyperplasia (10%). Non-Hodgkin lymphoma was diagnosed in 22 (9%) patients. All patients were briefly followed for a period of 1 1/2 to 2 years (mean 1 year).

Conclusion: Image-guided FNAC has a pivotal role, and is a cost-effective tool for establishing tissue diagnosis as a primary investigative modality. It is also helpful and accurate in follow-up of patients with a known malignant disease, thereby avoiding surgical intervention.
Book Reviews
Authors: Pech Peter , Hietala Sven-Ola , Lönnemark Maria , Raininko Raili , Jonsson Kjell
Published: July 2004

Paediatric Ultrasound. Edited by H. M. L. Carty. Greenwich Medical Media Ltd., London 2001.

The Pathophysiologic Basis of Nuclear Medicine. Edited by A. H. Elgazzar. Springer-Verlag 2001. ISBN 3-540-65914-5. Price: DEM 349.

Imaging for Students, 2nd edn. By D. A. Lisle & A. Russell. Arnold, London 2001. ISBN 0-340-76231-4.

The Encyclopaedia of Medical Imaging, vols. VI:1 Neuroradiology, and VI:2 Head and Neck Imaging. Edited by H. Pettersson, D. Allison, G. Scotti & R. Hermans. The NICER Institute, Oslo, Norway 2000. ISBN 82-91942-07-2.

Fundamentals of Hand and Wrist Imaging. Edited by G. Guglielmi et al. Springer-Verlag 2001. ISBN 3-540-67854-9. Price: hardcover DEM 399.
MR imaging of pituitary adenomas treated with the prolactin inhibitor quinagolide
Authors: Ilkko E. , Tikkakoski T. , Salmela P. , Pyhtinen J. , Kurunlahti M.
Published: July 2004

Purpose: To evaluate the volume of micro- and macroadenomas in quinagolide-treated patients with resistance to or intolerance of bromocriptine.

Material and Methods: The effect of the prolactin inhibitor quinagolide on the volume of pituitary adenoma was evaluated retrospectively in 11 female patients. Prolactin levels before and after the treatment were also recorded. The indications for quinagolide therapy were side-effects of bromocriptine in 5 cases, a poor response to bromocriptine in 5 cases and both in 1 case. MR imaging with a 1.0-T magnet was performed to determine the volume reduction of the adenomas.

Results: The average volume reduction of macroadenomas was 324 mm3 (46%) and that of microadenomas 73 mm3 (57%). The level of prolactin secreted by macroadenomas was reduced by an average of 163 μg/l (65%) and that by microadenomas of 113 μg (73%). In 2 microadenomas and in 1 macroadenoma, signal intensity changed during the treatment in T1-weighted images. In follow-up no changes in signal intensity were seen in 8 adenomas in non-contrast T1-weighted images. A haemorrhagic lesion was seen in 1 macroadenoma before treatment, but it disappeared during treatment.

Conclusion: Quinagolide was found to be an effective alternative to bromocriptine in cases with drug intolerance or resistance, and MR imaging a suitable method for the follow-up of macro- and microadenomas.
US-guided fine-needle aspiration biopsy of thyroid nodules
Authors: Court-Payen M. , Nygaard B. , Horn T. , Jacobsen G. Krag , Brændstrup O. , Narvestad E. , Pedersen L. Mark , Hancke S. , Holm H.H.
Published: July 2004

Purpose: To determine which nodular areas provide most adequate and accurate material for cytology during US-guided fine-needle aspiration biopsy (FNAB) of thyroid nodules.

Material and Methods: In a prospective multicentre study, US-guided FNAB (0.8 mm) was performed in 342 thyroid nodules (338 patients, 285 women, 18-83 years, 285 palpable). Histology was obtained in 169 nodules, revealing 75 neoplasms (44.4%) including 18 cancers (10.7%). In 206 solid nodules, 2 passes (central and peripheral) were compared. In 82 complex nodules, 2 passes (solid area and cystic area) were compared.

Results: The inadequacy rate was 16.4% and the false-negative rates were 2.2% and 28.1% for the diagnosis of cancer and neoplasm, respectively. In solid nodules, material was more adequate with peripheral passes compared to central passes, but the difference was not significant. In complex nodules, the inadequacy rate was much higher for passes in cystic areas (80.5%) compared to passes in solid areas (46.3%).

Conclusion: Cystic areas due to degeneration seldom provided adequate material when aspirated. Aspiration should always be obtained from solid areas, at best using US-guidance. Adenomas and non-neoplastic nodules were difficult to distinguish.
Ectopic thymic tissue in the paediatric age group
Authors: Chu W.C.W. , Metreweli C.
Published: July 2004

Purpose: The presence of ectopic thymic tissue is well known along the embryological descent track in the neck. The aim of this study was to detect the frequency of cervical thymic rests in children.

Material and Methods: Eighteen consecutive children had neck US performed using an ATL 5000 unit with a 12.5 MHz liner probe. The presence of small rests of thymic tissue was sought.

Results: 61% of the children had thymic tissue detected in the neck. Out of those with positive findings, 82% had a thymic rest on the right side, 9% on the left side and 9% had thymic rests bilaterally.

Conclusion: Small rests of ectopic thymic tissue in the cervical region are commonly seen in the paediatric age group. It is important to identify the thymic rests for what they are and avoid unnecessary anxiety or intervention.
Two cheers? South African democracy's first decade
Authors: Szeftel Morris
Published: July 2004

The contributions in this issue mark the tenth anniversary of democracy and political liberation in South Africa. They are a selection of the papers originally presented to a Workshop organised in September 2003 in Johannesburg by the Democracy and Governance section of the Human Sciences Research Council of South Africa. We are grateful to Roger Southall, its director, and to John Daniel for organising the conference, agreeing to a joint publication of papers with ROAPE and co-editing this issue. All the contributors are scholars and activists living and working in South Africa.
A Political economy of land reform in South Africa*
Authors: Hall Ruth
Published: July 2004

Land reform is one way in which the ‘new’ South Africa set out to redress the injustices of apartheid and, by redistributing land to black South Africans, to transform the structural basis of racial inequality. During the first decade of democracy, land reform has fallen far short of both public expectations and official targets. This article describes the progress of the programme and its changing nature. It is argued that a recent shift in land policy, from a focus on the rural poor to ‘emerging’ black commercial farmers, is consistent with changes in macro-economic policy and reflects shifting class alliances. The programme now appears to pursue a limited deracialisation of the commercial farming areas rather than a process of agrarian restructuring. Most fundamentally, land reform has not yet provided a strategy to overcome agrarian dualism.

This paper draws on research by the author under the aegis of the ‘Evaluating Land and Agrarian Reform in South Africa’ research programme at the Programme for Land and Agrarian Studies (PLAAS), University of Western Cape, and in particular the final report of that research, co-authored with Peter Jacobs and Edward Lahiff (Hall, Jacobs and Lahiff, 2003).