bluuebunny/crossref_metadata_2025 huggingface dataset:
Pancreatoblastoma: Three original cases and review of the literature
Authors: Kohda E. , Iseki M. , Ikawa H. , Endoh M. , Yokoyama J. , Mukai M. , Hata J. , Yamazaki H. , Miyauchi J. , Saeki M.
Published: July 2004

Purpose: To describe the characteristics of pancreatoblastoma.

Material and Methods: We studied 3 cases of pancretoblastoma and reviewed another 59 cases. Parameters analyzed were tumor site, hemorrhage, capsule formation, necrosis, vascularity, production of alpha-fetoprotein (AFP), cystic changes and calcification.

Results: The diagnostic findings were as follows: pancreatic head origin (24/54, 44%), pancreatic body and tail origin (30/54, 56%), hemorrhage (16/17, 94%), capsule formation (24/26, 92%), necrosis (28/31, 90%), hypervascularity (10/14, 71%), production of AFP (19/28, 68%), cystic changes (11/16, 69%), and calcification (10/21, 48%). All neonatal cases demonstrated cystic changes. Three of them were patients with Beckwith-Wiedmann syndrome. The incidence of capsule formation and calcification was not related to the origin of the tumor.

Conclusion: The most common features of pancreatoblastoma are hemorrhage, capsule formation and necrosis.
Intraductal papillary tumors of the pancreas: Histopathologic correlation of MR cholangiopancreatography findings
Authors: Arakawa A. , Yamashita Y. , Namimoto T. , Tang Y. , Tsuruta J. , Kanemitsu K. , Hirota M. , Hiraoka T. , Ogawa M. , Tsuchigame T. , Yoshimatsu S. , Kurano R. , Sagara K. , Matsuo A. , Shibata K. , Tanimura M. , Takahashi M.
Published: July 2004

Purpose: To evaluate MR cholangiopancreatography (MRCP) findings of intraductal papillary tumors of the pancreas and correlate them with histopathology.

Material and Methods: Seventeen patients with intraductal papillary tumor of the pancreas underwent MRCP before surgery. MRCP findings were correlated to histopathology with regard to the presence of septa and excrescent nodules in the cystic lesion, communication between the cystic lesion and the main pancreatic duct (MPD), degree of dilatation of MPD, and dilatation of the common bile duct (CBD).

Results: MRCP demonstrated septa in 17 cases (100%), excrescent nodules in 8 cases (47.1%), communication between the intraductal papillary tumor and the MPD in 14 cases (82.3%), dilatation of MPD over 50% in 6 cases (35.3%), and dilatation of CBD in 3 cases (17.6%). These findings showed excellent correlation with histopathology. The septum on MRCP corresponded with a layer of connective tissue with pancreatic duct epithelium. Excrescent nodules in the carcinomas consisted not only of malignant cells, but also of dysplasia and adenoma. Excrescent nodules in adenomas were consistent not only with minimal papillary growth of adenoma, but also with proliferation of fibrosis, and hematoma and organized fibrin with minimal fibrosis. Pancreatic tissue was affected by chronic pancreatitis in all cases. Cases with dilatation of CBD on MRCP were due to microscopic invasion by the carcinoma.

Conclusion: MRCP appearances of intraductal papillary tumors are well correlated with the findings at histopathology.
The role of scintimammography with 99mtc-sestamibi as a complementary diagnostic technique in the detection of breast cancer
Authors: Danielsson R. , Reihnér E. , Grabowska A. , Boné B.
Published: July 2004

Purpose: To prospectively determine the clinical value of scintimammography (Sc) with 99mTc-sestamibi as a complementary method to triple diagnosis (TD) in detecting malignant disease of the breast.

Material and Methods: Ninety-six patients with 119 clinically or mammographically detected breast lesions underwent TD procedures, including clinical examination, mammography and fine-needle aspiration cytology. Prone planar Sc with 99mTc-sestamibi was performed in all 96 patients. Five groups were defined for diagnosis: 1 = normal; 2 = benign; 3 = probably benign; 4 = highly suspect of malignancy; and 5 = malignant. All lesions were histopathologically examined. The results of each method per se and the combination of TD with Sc (TD + Sc) were analyzed.

Results: Histopathology of the 119 surgically excised breast lesions found 83 malignant and 36 benign lesions. TD missed 6 of 83 carcinomas, resulting in a sensitivity of 92.7%. Sc alone showed sensitivity of 85.5%. The combination TD + Sc missed 1 of 83 carcinomas, and thus had a sensitivity of 98.7%. In mammographically dense breasts both TD and Sc detected 16 of 18 carcinomas, while the combination TD + Sc led to detection of all 18 carcinomas.

Conclusion: Adding Sc to TD increases the sensitivity for detection of breast carcinomas. Sc with 99mTc-sestamibi is recommended as a complimentary method to TD in selected cases such as mammographically dense breasts.
Fluor-18-fluorodeoxyglucose positron emission tomography (FDG-PET) in malignant melanoma: Diagnostic comparison with conventional imaging methods
Authors: Krug B. , Dietlein M. , Groth W. , Stützer H. , Psaras T. , Gossmann A. , Scheidhauer K. , Schicha H. , Lackner K.
Published: July 2004

Purpose: To assess the diagnostic value of fluor-18-fluorodeoxyglucose positron emission tomography (FDG-PET) in screening for melanoma metastases.

Material and Methods: The case records of 94 melanoma patients who had been examined by whole-body FDG-PET between 1995 and 1999 were evaluated retrospectively. Forty patients showed evidence of lymphogenous and 42 of hematogenous metastasis. The maximal interval between PET and the diagnostic procedure under comparison was 2 weeks. Confirmation of the findings was based on histology or the clinical or radiological course.

Results: In 24 patients, all diagnostic examinations including CT had been performed within 2 weeks from PET. In no case did PET change the staging. In 13 patients, PET agreed with morphological diagnosis in the number of metastatically invaded organs. This included 3 patients without metastases. The estimated number of organs invaded by metastases was higher with PET in 5 patients and higher with morphological imaging techniques in 6 patients. Among the PET findings with higher or equivocal counts of organs with metastases there were 2 confirmed false-positive findings.

Conclusion: In a selected patient population, FDG-PET was found to be inferior to CT for diagnosing lung and liver metastases. The supplementary use of FDG-PET is not generally of value once metastasis has been established.
Contrast-Enhanced color doppler US in malignant portal vein thrombosis
Authors: Ricci P. , Cantisani V. , Biancari F. , Drudi F.M. , Coniglio M. , Di Filippo A. , Fasoli F. , Passariello R.
Published: July 2004

Purpose: To assess the role of contrast-enhanced color Doppler US in the differential diagnosis of benign and malignant portal vein thrombosis.

Material and Methods: Fifty-six patients with portal vein thrombosis underwent color and power Doppler US examination before and after i.v. injection of galactose-palmitic acid suspension. The criterion for diagnosing the presence and extension of thrombosis was the lack of visualization of portal vein flow in a segment of the portal vein. The criterion for diagnosing malignant portal vein thrombosis was the detection of pulsatile arterial flow, either hepatopetal or hepatofugal, in the thrombus. The US data were correlated with the types of portal vein thrombosis.

Results: Among the 56 patients, there were 40 benign and 16 malignant portal thromboses. Unenhanced Doppler US detected continuous blood flow in 24 benign thromboses and pulsatile in 3 malignant thromboses. No flow, either continuous or pulsatile, was detected in 16 cases with benign thrombosis and in 13 cases with malignant thrombosis. Contrast-enhanced Doppler US allowed to assess pulsatile flow in 15 cases with malignant thrombosis (94%). The use of pulsatile flow as diagnostic criterion of malignant thrombosis yielded a sensitivity of 57% and a specificity of 95% with conventional Doppler US, whereas contrast-enhanced US achieved a sensitivity of 94% and a specificity of 100%.

Conclusion: Contrast-enhanced Doppler US is a reliable diagnostic tool for assessing malignant portal vein thrombosis.
Transjugular intrahepatic portosystemic shunt: Experiences at a liver transplantation center
Authors: Hidajat N. , Vogl T. , Stobbe H. , Schmidt J. , Wex C. , Lenzen R. , Berg T. , Neuhaus P. , Felix R.
Published: July 2004

Objective: Transjugular intrahepatic portosystemic shunt (TIPS) placement is an established therapy for portal hypertension that leads to variceal bleeding or refractory ascites. We present experiences of the role of TIPS at a liver transplantation center.

Material and Methods: One hundred and ten patients were referred to the Radiological Department for TIPS placement. One of the 110 patients had recurrent cirrhosis after liver transplantation with refractory ascites. Function of the TIPS was controlled with Doppler US at 1 day, 1 week, 4 weeks and 4 months after TIPS placement and subsequently every 3 months. Shunt insufficiency was supposed when the blood flow velocity within the stent tract was under 50 cm/s and was an indication for TIPS revision.

Results: TIPS was placed in 101 patients. After TIPS placement, 10 patients underwent liver transplantation. While waiting for the new liver, none of them developed variceal rebleeding, ascites or other complications of portal hypertension. Two of the 101 patients had episodes of rebleeding. The frequency of patients undergoing TIPS revision within the first year after TIPS placement was 67.5%, within the second year 38.0% and within the third year 24.4%. The revisions led to sufficient reduction of the portosystemic pressure gradient.

Conclusion: In some liver transplant candidates, TIPS can be useful in minimizing the risk of complications of portal hypertension during the waiting time for a liver transplantation. TIPS can be monitored by Doppler US and revised if occlusion occurs.
Barium sulfate as contrast medium for evaluation of postoperative anastomotic leaks
Authors: Tanomkiat W. , Galassi W.
Published: July 2004

Objective: To assess the value of barium swallow as a method for immediate re-examination after the failure of an aqueous iodinated agent in detection of clinically suspected postoperative esophageal leakage, and as the initial study in asymptomatic postoperative patients.

Material and Methods: Prospective examinations were performed in 114 postoperative patients, 95 males and 19 females (mean age 60 years). Initial esophagography with an aqueous contrast agent was performed in all cases. The patients who had no evidence of leakage underwent immediate re-examination with barium sulfate. Leakage volume was calculated in cm3. Clinical presentations of leakage before the examinations and the complications after the study were recorded.

Results: Leakage was shown with the initial study, using aqueous medium, in 23 patients (20%). The volume of leakage was between 0.05 and 36 cm3 (mean 3.95 cm3). Clinical signs and symptoms presented in 13 cases (56%). Fourteen of 91 patients (15%), who had negative results with the initial study, had evidence of leakage at barium swallow. The leakage volume ranged between 0.06 and 0.53 cm3 (mean 0.18 cm3). Clinical evidence of leakage was shown in 3/14 (21%) cases. No complications were detected over a 6-month period following the study.

Conclusion: A barium swallow should follow a negative study using an aqueous agent in clinically suspected postoperative leakage, and could be considered as a safe initial study in postoperative patients where a leak is not suspected on clinical grounds.
Ultrasonography in acute appendicitis: Body mass index as selection factor for US examination
Authors: Josephson T. , Styrud J. , Eriksson S.
Published: July 2004

Purpose: Acute appendicitis is often difficult to diagnose and a negative laparotomy rate of about 25% is common. At Danderyd Hospital we started routine US in these patients, the aim being to estimate the sensitivity and the specificity for US when compared with the body mass index (BMI) of the patient.

Material and Methods: All patient records were examined: During a period of 6 months 142 patients over 14 years of age were investigated with US. Their height and weight were noted and the BMI was calculated.

Results: The sensitivity for US examination was 0.76 in patients with a BMI <25 but only 0.37 in patients with BMI ≥25. This difference was statistically significant.

Conclusion: US is a good method for examination of patients with BMI less than 25 but not in patients with BMI over 25.
Persistence of both proatlantal arteries with occlusion of the internal carotid arteries: A case report
Authors: Lode I.
Published: July 2004

A case of bilateral persistence of the proatlantal arteries with occlusion of both internal carotid arteries is reported.
Analysis of patellar cartilage: Comparison of conventional MR imaging and MR and CT arthrography in cadavers
Authors: Rand T. , Brossmann J. , Pedowitz R. , Ahn J.M. , Haghigi P. , Resnick D.
Published: July 2004

Objective: To compare the sensitivity of conventional MR sequences, MR arthrography, and CT arthrography for the detection of cartilage lesions of the patella in cadavers.

Material and Methods: Cartilage lesions in 10 cadaveric specimens were evaluated by MR imaging, including T1-weighted, proton density-weighted and T2-weighted sequences, and fat-suppressed spoiled gradient recalled acquisition in the steady state (SPGR), MR arthrography including T1-weighted and SPGR sequences, and double-contrast CT arthrography including conventional and subtracted images. The sensitivities with regard to detection of lesions were compared to results from morphologic and histologic investigations of sectioned specimens.

Results: Twenty-one lesions were detected morphologically. For the detection of these lesions, sensitivities were as follows: T1-weighted images 33.3%; proton density-weighted images 85.7%; T2-weighted images 85.7%; SPGR images 80.9%; MR arthrography with T1-SE sequences 57.1%; MR arthrography with SPGR sequence 90.5%; and CT arthrography, both regular and subtracted images 85.7%.

Conclusion: For noninvasive techniques, T2-weighted images revealed the highest sensitivity for the detection of patellar cartilage lesions, which was surpassed only by MR arthrography using the SPGR sequence. CT arthrography delineated surface irregularities but failed to demonstrate intrachondral lesions.
Nephrotoxicity of high- and low-osmolar contrast media: The protective role of amlodipine in a rat model
Authors: Duan S. , Liu F. , Luo J. , Wu H. , Liu R. , Peng Y. , Yang X.
Published: July 2004

Purpose: To evaluate the nephrotoxicity of high- and low-osmolar contrast media (HOCM, LOCM) on kidneys in Sprague-Dawley rats. The protective role of amlodipine was studied.

Material and Methods: Forty rats of both sexes were randomly divided into 5 groups (n = 8/group) and glycerine for inducing renal failure was given to all rats except controls.

Results: In diatrizoate-injected rats, blood urea nitrogen (BUN) and serum creatinine (SCr) were increased; levels of phospholipase A2 (PLA2), lipid peroxide (LPO) and calcium were also increased in renal tissues. There was no significant difference between LOCM (iohexol) animals and glycerol controls either in the renal levels of PLA2, LPO and calcium or in the levels of BUN and SCr. The histologic changes were milder in the LOCM animals than in the HOCM animals. In the group pretreated with amlodipine, no increase in the levels of BUN or SCr was discovered and the renal content of PLA2, LPO and calcium were significantly lower than in the HOCM group; the renal injuries induced by diatrizoate were alleviated.

Conclusion: The HOCM, diatrizoate, was more toxic to rat kidneys than the LOCM iohexol; PLA2, LPO and calcium load played a role in producing renal function impairment induced by diatrizoate meglumine; amlodipine protected the renal tissue from nephrotoxicity induced by diatrizoate.
Imaging features of myoepithelioma arising from the hard palate: A case report
Authors: Hiwatashi A. , Matsumoto S. , Kamoi I. , Yamashita H. , Nakashima A.
Published: July 2004

A 53-year-old Japanese woman presented with a mass of the hard palate that was histologically diagnosed as myoepithelioma. By CT, the well-demarcated ovoid isodense mass showed faint contrast enhancement. By MR imaging, the mass was homogeneous and isointense on T1-weighted images with homogeneous enhancement after administration of contrast material and markedly hyperintense on T2-weighted images. Myoepithelioma should be kept in mind as differential diagnosis of hard palatine tumors.
Hard-Copy Versus Soft-Copy with and Without Simple Image Manipulation for Detection of Pulmonary Nodules and Masses
Authors: Kosuda S. , Kaji T. , Kobayashi H. , Watanabe M. , Iwasaki Y. , Kusano S.
Published: July 2004

Purpose: To compare interpretation performance on soft-copy presentations, with and without simple image manipulation, and on unmodified hard-copy presentations with regard to detection of pulmonary nodules and masses.

Material and Methods: Fifty chest digital radiograph combinations of patients with a total of 60 nodules, 32 of which were 2.0 cm in diameter, were selected for the study. Three readers evaluated three separate image formats: unmodified hard- and soft-copies, and soft-copies with simple image manipulation of lung and mediastinum window settings, and zooming. The screen display was 1600×1200 pixels with 8 bits/pixel.

Results: The sensitivity, accuracy, detectability, and Az value of the soft-copy systems were clearly inferior to hard-copy evaluation. The mean Az values were 0.921 for unmodified hard-copy, 0.820 for image-manipulated soft-copy, and 0.781 for unmodified soft-copy.

Conclusion: Soft-copy interpretations were not as sensitive in detecting pulmonary nodules and masses as hard-copy evaluation.
Local breast cancer recurrence caused by mammographically guided punctures
Authors: Thurfjell M.G. , Jansson T. , Nordgren H. , Bergh J. , Lindgren A. , Thurfjell E.
Published: July 2004

Purpose: To evaluate the risk of needle track seeding or tumor cell implantation as the cause of locally recurrent breast cancer after breast conserving surgery.

Material and Methods: We reviewed recurrences from a consecutive series of 303 clinically nonpalpable breast cancers treated with breast conserving surgery after pre-operative localization. The median mammographic follow-up was 5.4 years. The suspicion of seeding or implantation was based on the location of the recurrent lesion in comparison with the needle path in two orthogonal mammographic projections. Pre-operative percutaneous biopsies had been done in 71% (214/303) of the cases. Postoperative radiotherapy was administered to 82% (194/238) of the invasive cancers and to 28% (18/65) of the ductal cancers in situ (DCIS).

Results: Locally recurrent cancer occurred in 11% (33/303) of the cases. Radiotherapy demonstrated a protective effect from relapse among invasive cancers but not for DCIS. Seeding or implantation was suspected in 3 recurrent invasive cancers which had not been subject to radiotherapy. The histopathological diagnosis of the primary cancer and the recurrent cancer were the same in these cases: adenoid cystic, mucinous and tubuloductal cancer.

Conclusion: Seeding or implantation was suspected as the cause of local recurrence in 7% (3/44) of the invasive cancers which did not receive radiotherapy.
Dynamic MR imaging of neurohypophyseal germ cell tumors for differential diagnosis of infundibular diseases
Authors: Liang L. , Korogi Y. , Sugahara T. , Ikushima I. , Shigematsu Y. , Okuda T. , Takahashi M.
Published: July 2004

Purpose: To investigate the MR dynamic patterns of neurohypophyseal germ cell tumors (GCTs) for differential diagnosis of infundibular diseases affecting young people.

Material and Methods: Eleven patients with neurohypophyseal GCTs underwent dynamic MR studies with T1-weighted spin-echo (SE) or turbo SE techniques. Other infundibular lesions, including adenohypophysitis (n=3), Langerhans' cell histiocytosis (LCH, n=2), and 1 hemangioblastoma from von Hippel-Lindau disease, were also evaluated. Serial images were obtained every 15 s (turbo SE) or 30 s (SE technique) for 240 s after rapid injection of contrast medium. The dynamic patterns were analyzed quantitatively with the contrast medium enhancement ratio.

Results: On dynamic MR images, GCTs typically showed a gradual enhancement increase with a peak between 105 s and 180 s, while two showed a relatively rapid increase. LCH and hemangioblastoma showed a dynamic pattern similar to GCTs, while adenohypophysitis demonstrated a sharp rise and a steeper wash-out with an obvious peak before 90 s.

Conclusion: Typical dynamic pattern of GCTs was the gradual enhancement increase without wash-out. Dynamic MR imaging can distinguish GCTs from adenohypophysitis, but is not useful for differentiation from LCH.
Intramedullary tuberculomas: MR findings in seven patients
Authors: Parmar H. , Shah J. , Patkar D. , Varma R.
Published: July 2004

Purpose: To describe the MR findings in intramedullary tuberculomas and to discuss the usefulness of MR in the management of this pathology.

Material and Methods: A retrospective study of 7 patients from 21 to 60 years of age with clinical and radiological evidence of intramedullary tuberculomas was undertaken. Both T1- and T2-weighted images (WI) were obtained along with postcontrast T1WI. Signal intensities (SIs) of the granulomas were compared with SIs of the normal spinal cord.

Results: Six patients showed focus of tuberculosis elsewhere in the body. Six out of 7 showed fusiform swelling of the cord. Ill-defined iso-intensity (in 4 patients) to hyperintensity (in 3 patients) was seen at the site of granuloma on T1WI. On T2WI, 2 patients revealed a hypointense area (with disc enhancement). An iso-hypointense rim was seen surrounding a hyperintense centre in 5 patients (with rim enhancement). Adjacent oedema was seen in all patients. In 2 patients meningeal enhancement was also seen. In 2 patients the histopathology following surgical biopsy confirmed the diagnosis. In the remaining 5 patients, another known focus of tuberculosis elsewhere in the body and a marked response to antitubercular treatment was considered confirmatory for tuberculomas.

Conclusion: Hypo- or iso-intensity on T2WI within the spinal cord with surrounding hyperintense oedema is suggestive of intramedullary tuberculomas. Central hyperintensities are also detected at times due to a variable amount of caseous necrosis with liquefaction. On T1WI, fusiform swelling of the cord is seen along with iso- to hyperintense foci, surrounded by hypointense oedema of the cord. Such findings should prompt a contrast-enhanced study, which may show single or conglomerate disc- or ring-enhancing lesions. MR thus plays an important role not only in detection and diagnosis, but also in deciding the treatment options and in the follow-up of those patients.
Cerebrospinal fluid flow in the cervical spinal canal in patients with chronic neck pain
Authors: Parkkola R.K. , Rytökoski U.M. , Komu M.E.S. , Thomsen C.
Published: July 2004

Purpose: To measure the cerebrospinal fluid (CSF) velocity in the cervical spinal canal both above and below a stenotic segment in patients with cervical spinal stenosis. The cord velocity was also measured at the level of C2.

Material and Methods: Thirteen patients with chronic neck pain were examined with MR imaging. The degree of cervical spinal stenosis was assessed and measured on MR images and CSF velocity in the cervical spinal canal was measured using the phase MR flow quantification method at the level of C2 and below the stenotic segment. The cord motion was measured at the level of C2.

Results: The peak velocities of CSF in front of the cord at the level of C2 were, on average, a little higher than behind the cord, but the interindividual variation was high. The caudal or rostral velocities of CSF above and below the stenotic segment could be measured in most cases and they were not dependent on the degree of stenosis when assessed visually. When the stenosis was assessed by relating the cord area to the dural sac area, a statistical correlation between narrow spinal canal and high velocities in the anterior CSF space below the stenotic segment was found.

Conclusion: Spinal stenosis does not alter the cord or CSF velocities at the C2 level, but increases the velocity of CSF in the anterior CSF space below the stenotic segment when the stenosis is assessed by cord and dural sac area measurements.
Cholangiopathy in extrahepatic portal venous obstruction: Radiological appearances
Authors: Nagi B. , Kochhar R. , Bhasin D. , Singh K.
Published: July 2004

Purpose: To evaluate cholangiographic abnormalities resulting from extrahepatic portal venous obstruction (EHPVO) by sonography and endoscopic retrograde cholangiopancreaticography (ERCP).

Material and Methods: Forty-three patients with an established diagnosis of EHPVO were subjected to duplex Doppler sonography and ERCP. Of these, 8 patients had obstructive jaundice.

Results: Dilated common bile duct with pericholedochal varices showing a continuous type of flow pattern was seen in 5 EHPVO patients with obstructive jaundice. ERCP revealed cholangiographic abnormalities in 40 patients (93%). Extrahepatic bile ducts were involved in 100% of cases compared to intrahepatic bile ducts (57%). Abnormalities noted were contour irregularity with indentations, displacement and angulation, strictures and filling defects in the extrahepatic ductal system. Intrahepatic bile ducts showed dilatation with areas of narrowing and filling defects.

Conclusion: Cholangiographic abnormalities are very common in patients with EHPVO, even without clinical manifestations of biliary disease. Extrahepatic bile ducts are far more often involved compared to intrahepatic bile ducts. Extrinsic compression with contour irregularity is the most common cholangiographic finding. Sonographic findings are not diagnostic. Dilated common bile duct with pericholedochal varices was seen in only 5 patients.
US and CR findings in splenic focal lesions in AIDS
Authors: Schininà V. , Rizzi E.B. , Mazzuoli G. , David V. , Bibbolino C.
Published: July 2004

Purpose: To evaluate the role of US and CT in focal splenic lesions in AIDS patients in relation to etiology.

Material and Methods: A total of 66 patients with AIDS and focal splenic lesions were examined with sonography. CT with administration of contrast medium was performed in 12 cases.

Results: Of the focal splenic lesions, 67% were correlated with an infective pathology with prevalence of Mycobacteria tuberculosis (75%), 26% were neoplastic and 6% splenic infarcts. The lesions were hypoechoic in 60% of the cases, while 10% were hypoanechoic and 1% anechoic. At CT, all lesions appeared hypodense, even after i.v. administration of contrast medium.

Conclusion: The combination of echographic reports and clinical and laboratory data allows for a diagnosis that can be confirmed, and making a decision for effective therapy of AIDS is possible. CT does not provide any additional information.
Non-invasive determination of metabolite concentrations in human transplanted kidney in Vivo by 31P MR spectroscopy
Authors: Kugel H. , Wittsack H.-J. , Wenzel F. , Stippel D. , Heindel W. , Lackner K.
Published: July 2004

Purpose: To investigate concentrations of phosphorus-containing metabolites in human transplanted kidney in vivo by quantitative 31P MR spectroscopy (MRS) using surface coils and to compare the obtained values with previous data.

Material and Methods: In 5 patients with well-functioning transplanted kidneys, 31P spectra were obtained with the three-dimensional localization image-selected in vivo spectroscopy technique applying a protocol for quantitative spectroscopy using surface coils. Relaxation corrected signal intensities determined by time domain fitting were used to derive absolute molar concentrations for phosphate-containing metabolites.

Results: Little or no phosphocreatine in all spectra verified the absence of muscle contamination, confirming proper volume localization. The mean concentrations in the transplanted kidneys were as follows: ATP 1.60±0.26 mmol/l, PDE 2.14±0.91 mmol/l, Pi 0.66±0.25 mmol/l, PME 2.32±0.50 mmol/l. These values are consistent with previously reported values determined by other techniques.

Conclusion: The non-invasive determination of absolute metabolite concentrations in human kidney using MRS supplements the use of signal intensity ratios to detect pathologic changes in the energy metabolism of transplanted kidneys.
Functional evaluation of hydronephrosis by diffusion-weighted MR imaging: Relationship between apparent diffusion coefficient and split glomerular filtration rate
Authors: Toyoshima S. , Noguchi K. , Seto H. , Shimizu M. , Watanabe N.
Published: July 2004

Purpose: To determine the relationship between apparent diffusion coefficient (ADC) values measured by diffusion-weighted MR imaging and split renal function determined by renal scintigraphy in patients with hydronephrosis.

Material and Methods: Diffusion-weighted imaging on a 1.5 T MR unit and renal scintigraphy were performed in 36 patients with hydronephrosis (45 hydronephrotic kidneys, 21 non-hydronephrotic kidneys). ADC values of the individual kidneys were measured by diffusion-weighted MR imaging. Split renal function (glomerular filtration rate (GFR)) was determined by renal scintigraphy using 99mTc-DTPA. The relationship between ADC values and split GFR was examined in 66 kidneys. The hydronephrotic kidneys were further classified into three groups (severe renal dysfunction, GFR <10 ml/min, n=7; moderate renal dysfunction, GFR 10-25 ml/min, n=10; normal renal function, GFR >25 ml/min, n=28), and mean values for ADCs were calculated.

Results: In hydronephrotic kidneys, there was a moderate positive correlation between ADC values and split GFR (R2=0.56). On the other hand, in non-hydronephrotic kidneys, poor correlation between ADC values and split GFR was observed (R2=0.08). The mean values for ADCs of the dysfunctioning hydronephrotic kidneys (severe renal dysfunction, 1.32×10-3±0.18×10-3 mm2/s; moderate renal dysfunction, 1.38×10-3±0.10×10-3 mm2/s) were significantly lower than that of the normal functioning hydronephrotic kidneys (1.63×10-3±0.12±10-3 mm2/s).

Conclusion: These results indicated that measurement of ADC values by diffusion-weighted MR imaging has a potential value in the evaluation of the functional status of hydronephrotic kidneys.
Staging uterine cervical carcinoma with low-field MR imaging
Authors: Hansen M.A. , Pedersen P.H. , Andreasson B. , Bjerregaard B. , Thomsen H.S.
Published: July 2004

Purpose: To assess the validity of low-field MR in staging cervical cancer compared to clinical staging.

Material and Methods: A total of 95 women entered the study over a 3-year period. MR examinations with a 0.1 T resistive magnet using a body coil and clinical staging according to the FIGO recommendations (1988) were performed within 2 weeks from clinical diagnosis. T1- and T2-weighted sequences were obtained in transversal and sagittal acquisitions, and an additional T1 before and after contrast (randomisation to 0.1 or 0.3 mmol/kg b.w. gadodiamide). Treatment decisions on surgery or radiation therapy were made solely on the clinical staging.

Results: Sixty-one patients were found to be eligible for surgery. In 5 women, the pathological results revealed a more advanced stage of the disease than assessed by clinical staging. MR correctly staged 4 of the 5 but otherwise tended to overstate the disease. Contrast enhancement significantly reduced this trend ( p<0.05) regardless of the contrast medium dose used. Divided into two groups, an operable (less than stage 2b) and an inoperable group (more than stage 2a), the clinical staging correctly classified 57 patients (accuracy 92%) compared to 52 patients with MR using contrast enhancement (accuracy 84%). The specificity was no higher than 31%, whereas the reproducibility of the MR assessment was fairly good with kappa values around 0.65 for both intra- and interobserver variations.

Conclusion: In the present set-up, clinical assessment was superior to low-field MR in staging cervical cancer. When using contrast enhancement, the staging accuracies of low-field MR were comparable to the ones reported for techniques with higher tesla values, whereas the specificity and reproducibility errors were lower. The method, therefore, needs to be optimised.
Ultrasound-guided transthoracic co-axial biopsy of thoracic mass lesions
Authors: Sagar P. , Gulati M. , Gupta S.K. , Gupta S. , Shankar S. , Joshi K. , Jindal S.K. , Suri S.
Published: July 2004

Purpose: To compare the diagnostic yield of fine-needle aspiration biopsy (FNAB) and cutting needle biopsy in thoracic lesions.

Material and Methods: Thirty patients with thoracic mass lesions were subjected to ultrasound-guided co-axial FNAB and cutting needle biopsy using 0.7-mm aspirating and 1.0-mm cutting needles, respectively. The diagnostic yield of the individual modalities was compared with the combined yield.

Results: A conclusive diagnosis was obtained in 76.6% (n=23) of patients by FNAB and in 66.6% (n=20) by cutting needle biopsy. The combined diagnostic yield of FNAB and cutting needle biopsy was 93.3% (n=28) with a significant statistical difference ( p<0.03) as compared to cutting biopsy alone. Of the patients, 23.2% (n=7) had benign and 76.6% (n=23) malignant aetiologies. The diagnostic yield of FNAB versus cutting needle biopsy in benign lesions was 57.1% (n=4) and 100% (n=7), respectively. The diagnostic yield of FNAB versus cutting needle biopsy in malignant lesions was 82.6% (n=19) and 56.5% (n=13). Two patients remained undiagnosed by either modality. There were no complications.

Conclusion: FNAB and cutting needle biopsy are complementary to each other and attempts should be made to obtain small tissue cores in addition to routine cytologic specimens in diagnosing thoracic lesions, especially in benign pathologies. US provides a safe guidance modality for lesions abutting the chest wall.
Influence of pre-examination starvation on liver uptake of the hepatocyte-specific contrast medium FP 736-04 AT CT: An experimental study in the rat
Authors: Bergman A. , Magnusson A.
Published: July 2004

Purpose: To investigate the effect of starvation on contrast-enhanced CT of the liver using the iodinated hepatocyte-specific lipid emulsion FP 736-04.

Material and Methods: CT examination of the liver was performed in Sprague-Dawley rats before and after an i.v. infusion of 1.0 ml/kg b.w. of FP 736-04. The examination was preceded by a 15-h period of food withdrawal (the starvation group). A control group was subjected to the same CT examination protocol with use of FP 736-04 but without prior starvation.

Results: Liver attenuation values did not differ significantly between the starvation and the control group ( p>0.05).

Conclusion: A pre-examination period of starvation had no effect on FP 736-04 liver enhancement on CT. However, liver attenuation tended to decrease more slowly in the starvation group than in the controls.
Reduced iopromide elimination in hemodialysis with cuprophan membranes
Authors: Matzkies F.K. , Reinecke H. , Tombach B. , Koeneke J. , Hohage H. , Kisters K. , Schaefer R.M.
Published: July 2004

Purpose: To evaluate the influence of different membrane materials on the efficiency of iopromide elimination.

Material and Methods: Twenty stable patients with chronic renal failure after coronary angiography were investigated for contrast medium elimination during hemodialysis directly after contrast medium application.

Results: Clearance during hemodialysis with cuprophan membranes was 102±7 mg/ml in contrast to 153±4 mg/ml in polysulfone membranes. Elimination half-time was 94±5 min in cuprophan and 79±3 min in polysulfone membranes, and the elimination rate after 120 min was 59±2% and 66±1.5%, respectively. Plasma clearance of iopromide was elevated in polysulfone membranes (188±17 ml/min); however, not significantly different to cuprophane membranes (153±11 ml/min). Accordingly, 24-h urinary iopromide excretion was reduced to 26±4 g/24 h vs. 32±7 g/24 h.

Conclusion: Hemodialysis for iopromide elimination with polysulfone membranes is more effective than with cuprophan membranes.
Experimental acute intracerebral hemorrhage: Value of MR sequences for a safe diagnosis at 1.5 and 0.5 T
Authors: Küker W. , Thiex R. , Rohde I. , Rohde V. , Thron A.
Published: July 2004

Purpose: To determine the detectability of intracerebral hematomas with MR imaging at 1.5 T and 0.5 T with fluid attenuated inversion recovery turbo spin-echo (FLAIR) and gradient-echo sequences.

Material and Methods: Twenty-seven intracerebral hematomas were created in 25 piglets by injection of venous blood into the brain through a burr hole. All were imaged with T2*-weighted gradient echo sequences (fast field echo, FFE), T2-weighted fluid attenuated inversion recovery turbo spin-echo sequences (FLAIR), T2-weighted turbo spin-echo (TSE) and T1-weighted spin-echo sequences. Follow-up was performed on the 2nd, 4th and 10th postoperative days. Ten animals were additionally investigated with similar sequences at 0.5 T. Histologic correlation was obtained in all cases.

Results: T2* FFE sequences detected all acute intracerebral hematomas and demonstrated the size correctly at 1.5 T and 0.5 T. The conspicuity was better at 1.5 T. FLAIR sequences were unreliable in the hyperacute phase at 1.5 T. However, subarachnoid and intraventricular extension was best appreciated with FLAIR images. T2 TSE images were incapable of detecting paraventricular and subarachnoid hemorrhages, but clearly demonstrated intracerebral blood in other locations. T1-weighted images were insensitive to hemorrhage in the acute state but very useful in subacute and chronic hematomas.

Conclusion: The safe and reliable diagnosis of intracerebral hemorrhage is probably possible with MR imaging at 1.5 T and 0.5 T even of hematomas less than 90 min old, but requires the application of at least FLAIR, T2* FFE and T1 sequences and is therefore time consuming.
Comparison of MR sequences in early cerebral infarction at 0.5 T
Authors: Saatci I. , Baskan O. , Cekirge H.Saruhan , Besim A.
Published: July 2004

Purpose: To compare the diagnostic values of fluid-attenuated inversion recovery (FLAIR) and gradient spin-echo (GRASE) with those of conventional spin-echo (SE) and fast SE T2-weighted sequences in the evaluation of acute cerebrovascular lesions at 0.5 T.

Material and Methods: Twenty-two consecutive patients with the clinical diagnosis of acute cerebrovascular accident were examined by MR imaging within the first 48 h of ictus. MR examination included 5-mm axial conventional SE and turbo SE (TSE) T2-weighted, dual-echo GRASE and FLAIR sequences. The patients also had pre- and postcontrast T1-weighted axial images. Two examiners evaluated the images and scored the conspicuity of the acute lesions.

Results: Regardless of location, FLAIR provided the best lesion conspicuity in the detection of acute infarcts, followed by the GRASE sequence. In the posterior fossa, TSE and SE demonstrated the lesions better than GRASE and FLAIR techniques. In the detection of hemorrhagic elements within the ischemic region, TSE demonstrated statistically significant superiority over other sequences.

Conclusion: In the detection of acute ischemic lesions in locations other than the posterior fossa, FLAIR provided the best lesion conspicuity among four T2-weighted sequences, including SE, TSE, GRASE and FLAIR. However, for the posterior fossa examination, preference of SE or TSE T2-weighted sequences is suggested.
Assessment of optic nerve compression in graves' ophthalmopathy: The usefulness of a quick T1-weighted sequence
Authors: So N.M.C. , Lam W.W.M. , Cheng G. , Metreweli C. , Lam D.
Published: July 2004

Purpose: Diagnosis of optic nerve compression can be difficult in patients with equivocal clinical signs. We examined the usefulness of a quick coronal MR sequence performed at a predetermined plane as a screening tool for selecting patients at high risk of optic nerve compression.

Material and Methods: Direct coronal images of the orbit were obtained in 37 patients with Graves' disease in a predetermined plane. The muscular indices (MI) of each orbit were calculated. Mann-Whitney U-Wilcoxon rank sum test was used to assess if there was any statistically significant difference between patients with and without signs of optic nerve compression. The ROC curve was used to identify a value useful for discriminating patients with a higher risk of developing optic nerve compression.

Results: There was a statistically significant difference ( p<0.05) in the MI between patients with and without optic nerve compression. An MI of ≥0.48 had 100% sensitivity, 89% specificity and 91% accuracy in identifying patients with optic nerve compression.

Conclusion: A quick coronal MR image obtained at the mid-orbital plane is useful in screening patients with Graves' disease for optic nerve compression.
Contrast-enhanced MR imaging of experimental acute tubular necrosis
Authors: Dupas B. , Buzelin M.F. , Karam G. , Vasse N. , Meflah K. , Bach-Gansmo T.
Published: July 2004

Purpose: To demonstrate the involvement of the various renal structures in acute tubular necrosis (ATN).

Material and Methods: In 15 rats, using a T1-/T2-weighted sequence, either gadodiamide alone, or gadodiamide in combination with sprodiamide (a susceptibility agent) were used to enhance the various anatomical substrates of the kidney. The results were compared to those of pathological verification.

Results: Experimentally induced ATN of the rat kidney causes profound changes in the medulla, leaving the cortex largely intact. The difference between the normal cortex and the partially necrotic outer medulla, on the one hand, and the papillary region, was significantly enhanced with the combination, whereas a larger region composed of the inner and outer medulla was enhanced after the gadolinium chelate alone.

Conclusion: The results varied considerably between the two procedures; the double contrast demonstrated a clear difference between the inner and outer medulla, and the gadolinium chelate alone demonstrated a clear difference between the medulla and the cortex. These results demonstrated a clear difference in the compartmentalization between the inner and outer medullary regions, providing complementary information about the pathological condition of the kidney.
Percutaneous transcatheter renal embolization with absolute ethanol for uncontrolled nephrotic syndrome: Case reports
Authors: Tikkakoski T. , Leppänen M. , Turunen J. , Anderson S. , Södervik H.
Published: July 2004

Purpose: To retrospectively evaluate renal ethanol embolization in 2 patients with uncontrolled nephrotic syndrome.

Material and Methods: Three kidneys in 2 patients with uncontrolled nephrotic syndrome were embolized with absolute ethanol. The embolization technique, patient outcome and complications were analyzed retrospectively.

Results: The treatment was successful in both patients, with angiography-verified exclusion of blood flow to the renal arteries. Elimination of proteinuria was achieved in both patients and their body weight decreased by 25 and 10 kg, respectively. Hospitalization and protein substitution were no longer needed. No complications occurred.

Conclusion: Permanent bilateral ethanol embolization of the renal arteries is a feasible method of managing a treatment-resistant nephrotic syndrome in selected patients. Non-target embolization can be avoided by using a balloon occlusion catheter.
The combined use of US and MR imaging for the diagnosis of masses in the parotid region
Authors: Goto T.K. , Yoshiura K. , Nakayama E. , Yuasa K. , Tabata O. , Nakano T. , Kawazu T. , Tanaka T. , Miwa K. , Shimizu M. , Chikui T. , Okamura K. , Kanda S.
Published: July 2004

Purpose: To evaluate the usefulness of the combination of the two non-invasive modalities US and MR imaging to diagnose masses in the parotid region.

Material and Methods: The US and MR findings of 21 patients with parotid masses were analyzed retrospectively by two radiologists without any clinical or histopathological information. The specific points evaluated were location, shape, margin, internal architecture, and intensity level on both US and MR, posterior echo enhancement on US, and capsule-like lining of the tumor on MR.

Results: The findings concerning the shape and margin on US and MR were in fairly good agreement. Concerning the findings of the internal architecture, US could reveal the minute structures of the tumor while MR demonstrated differences in the signal intensities of histological tissue types of the various tumors. The posterior echo enhancement on US and the capsule-like lining on MR of the tumors were also useful for the diagnosis.

Conclusion: Our results suggest that the combination of US and MR is useful for examining soft tissue masses in the parotid region to make a more accurate diagnosis, and not just differentiate malignant lesions from those which are benign.
The efficacy of a continuous quality improvement (CQI) method in a radiological department: Comparison with non-CQI control material
Authors: Laurila J. , Standertskjöld-Nordenstam C.-G. , Suramo I. , Tolppanen E.-M. , Tervonen O. , Korhola O. , Brommels M.
Published: July 2004

Objective: To study the efficacy of continuous quality improvement (CQI) compared to ordinary management in an on-duty radiology department.

Material and Methods: Because of complaints regarding delivery of on-duty radiological services, an improvement was initiated simultaneously at two hospitals, at the HUCH (Helsinki University Central Hospital) utilising the CQI-method, and at the OUH (Oulu University Hospital) with a traditional management process. For the CQI project, a team was formed to evaluate the process with flow-charts, cause and effect diagrams, Pareto analysis and control charts. Interventions to improve the process were based on the results of these analyses.

Results: The team at the HUCH implemented the following changes: A radiologist was added to the evening shift between 15:00-22:00 and a radiographer was moved from the morning shift to 15:00-22:00. A clear improvement was achieved in the turn-around time, but in the follow-up some of the gains were lost. Only minimal changes were achieved at the OUH, where the intervention was based on traditional management processes.

Conclusion: CQI was an effective method for improving the quality of performance of a radiology department compared with ordinary management methods, but some of this improvement may be subsequently lost without a continuous measurement system.
The knee joint in early juvenile idiopathic arthritis: An ROC study for evaluating the diagnostic accuracy of contrast-enhanced MR imaging
Authors: Uhl M. , Krauss M. , Kern S. , Herget G. , Hauer M.P. , Altehoefer C. , Darge K. , Berner R. , Langer M.
Published: July 2004

Purpose: Diagnosis of juvenile idiopathic arthritis (JIA) remains difficult due to unspecific clinical and laboratory findings, especially in early stages of the disease. The purpose of our study was to determine the sensitivity and specificity of MR imaging in diagnosing JIA of the knee joints.

Material and Methods: Forty children (3–17 years old) clinically diagnosed with JIA (follow-up >1 year) of a knee joint and a control group of 40 children with painful knee joints (MR diagnosis: bone bruise of the knee (n=7), normal knee joint (n=12), osteomyelitis (n=6), septic arthritis (n=2), bone tumor (n=7) and miscellaneous bone lesions (n=6)) were examined using a 1.5 T MR unit. T1-weighted spin-echo (SE), T2-weighted fast SE, contrast-enhanced T1-weighted SE and 2D gradient echo sequences were performed. The receiver operating characteristic (ROC) curves evaluation was conducted by 5 independent radiologists.

Results: The positive criteria for diagnosing JIA were joint effusions (n=40), contrast-enhancing synovitis (n=39), cartilage lesions (n=15), subchondral erosions and bony destruction (n=1). Sensitivity and specificity were 93.5= and 92.5=, respectively. Both cases of septic arthritis were misdiagnosed as JIA by all radiologists.

Conclusion: Contrast-enhanced MR imaging seems to be a highly sensitive tool in establishing the diagnosis of JIA.