bluuebunny/crossref_metadata_2025 huggingface dataset:
Alimentary-associated carcinomas in five Vietnamese potbellied pigs
Authors: McCoy Annette M. , Hackett Eileen S. , Callan Robert J. , Powers Barbara E.
Published: December 2009

Case Description—5 Vietnamese potbellied pigs were evaluated for abdominal distress that had not responded to medical treatment (4 pigs) or a draining tract of the cranial abdomen of unknown duration (1 pig).

Clinical Findings—Clinical signs in the pigs included anorexia, vomiting, and constipation. Physical examination revealed a palpable abdominal mass in all pigs. Radiography revealed distended loops of small intestine in 2 pigs.

Treatment and Outcome—3 pigs were treated successfully with wide-margin excision of the abdominal masses, and 2 were euthanized. Primary tumors were diagnosed at necropsy or through histologic evaluation of biopsy specimens obtained during surgery. Types of tumor included cholangiocellular carcinoma, transmural gastric carcinoma, small intestinal adenocarcinoma, metastatic hepatocellular carcinoma, and carcinoma. The tumors involved the stomach, small intestine, spiral colon, liver, and gall bladder. All 3 surgically treated pigs survived at least 9 months after surgery.

Clinical Relevance—Although rare, neoplasia of the alimentary system should be considered among the differential diagnoses for potbellied pigs with signs of abdominal distress. Wide-margin excision of the neoplastic tissue may result in a good outcome in affected pigs.
Stabling causes a significant increase in the pH of the equine airway
Authors: WHITTAKER A. G. , LOVE S. , PARKIN T. D. H. , DUZ M. , HUGHES K. J.
Published: December 2009

Regulation of pH homeostasis in the equine lung is poorly understood. Measurement of exhaled breath condensate (EBC) pH provided a simple, highly repeatable and noninvasive method for the longitudinal investigation of changes in airway pH in response to environmental changes. Stabling of horses was found to lead to a small (approximately 100–200 parts/ billion) but significant (P<0.001) increase in ambient ammonia concentration when compared to pasture. This increase in exposure to ambient ammonia concentration was associated with significant (P = 0.002) increases in EBC pH and exhaled ammonia (P = 0.013). Stable feed/bedding management type had no effect on EBC pH or exhaled ammonia concentration, while ambient ammonia concentration was influenced by stable management type.
A single screw technique compared to a two screw and wire technique as a temporary transphyseal bridge for correction of fetlock varus deformities
Authors: Roberts B. L. , Railton D. , Adkins A. R.
Published: December 2009

A single screw technique is described as a temporary transphyseal bridge for the treatment of fetlock varus angular limb deformity in foals. This has been compared to tension band wiring with regards to rate of correction, cosmetic result and incidence of complications. The single screw was found to be an effective technique resulting in more rapid improvement of deviations in foals aged up to 5 months. Complications were minimal following both techniques and the final cosmetic result was better following single screw surgery.
Prognostic markers for coexistent carcinoma in high‐risk endometrial hyperplasia with negative D‐score: significance of morphometry, hormone receptors and apoptosis for outcome prediction
Authors: ØRBO ANNE , KAINO TURID , ARNES MARIT , LARSEN KURT , PETTERSEN INGER , MOE BJØRN
Published: December 2009

Objectives. Hysterectomy represents the current routine therapy for high‐risk endometrial precancers. More sophisticated methods are needed for treatment decision among women who want to preserve fertility and seriously ill patients. Among women diagnosed with high‐risk hyperplasia, approximately 40% show signs of endometrial cancer in the hysterectomy specimen. Thus, more sophisticated methods are needed to select the women at risk. Setting. University Hospital of Tromsø, Regional Center for Gynecological Oncology in northern Norway. Population. From 1999 to 2004, 258 consecutive patients had endometrial hyperplasia diagnosed by D‐score; 57 among these were high‐risk cases (D‐score < 0) and 10 had coexisting endometrial carcinoma. No further cancers were detected after long‐term follow‐up (4–10 years). Design. From the initial histological specimens, material from the 10 patients with cancer and from the 13 cases without cancer (high‐risk D‐score < 0) was analyzed with selected histomorphometric (architectural and nuclear) and immunohistochemical (hormone receptors and apoptotic) features blinded to the investigator. Method. Original slides were used for computerized histomorphometry (4‐class rule and related procedures). Serial sections from the paraffin embedded material were used for immunohistochemical investigations. Immunohistochemical expression in glands and stroma was evaluated by the semi‐quantitative H‐score (ER‐α, ER‐β, PR‐A, PR‐B, RCAS‐1, Bcl‐2, BAX, and Caspase‐3). Results. The histomorphometric 4‐class rule differentiates between presence and absence of cancers with a sensitivity of 80% and specificity of 77%. Several morphometric and immunohistochemical features were significantly different in cases with cancer and hyperplasia. Conclusions. Histomorphometry seems superior in predicting coexistent carcinoma in high‐risk endometrial hyperplasia and should be considered for clinical use.
Does underutilization of prenatal care explain the excess risk for stillbirth among women with migration background in Germany?
Authors: REIME BIRGIT , LINDWEDEL ULRIKE , ERTL KARIN M. , JACOB CARINA , SCHÜCKING BEATE , WENZLAFF PAUL
Published: December 2009

Objective. To explore the role of utilization of prenatal care on the risk for stillbirth among women with migration background in Germany by comparing stillbirth rates of women from different origins characterized by adequate and inadequate utilization of prenatal care to German women with adequate utilization of care. Design. Retrospective cohort study. Setting. Lower Saxony, Germany. Population. Singletons born in 1990, 1995 and 1999 (n = 182,444). Methods. We analyzed perinatal data collected by obstetricians and midwives prospectively during pregnancy and after birth. The Adequacy of Prenatal Care Utilization Index was applied. Chi‐squared tests and bivariate and multivariable logistic regression models were used. Main outcome measures. Stillbirth rates. Results. In crude analyses, inadequate utilization of prenatal care (OR = 1.86, 95% CI 1.52, 2.28), and origin from Central and Eastern Europe (OR = 2.05, 95% CI 1.63, 2.58), the Mediterranean (OR = 1.77, 95% CI 1.38, 2.65), the Middle East (OR = 2.63, 95% CI 2.24, 3.09) and other countries (OR = 1.79, 95% CI 1.10, 2.89) were related to stillbirths. After adjustment for age, parity, smoking, inter‐pregnancy interval, employment status and year of observation, compared to Germans with adequate utilization of prenatal care, women with adequate utilization of care from Central and Eastern Europe (OR = 1.74, 95% CI 1.33, 2.29) and the Middle East (OR = 1.98, 95% CI 1.64, 2.39) and women with inadequate utilization of prenatal care from the Mediterranean (OR = 3.00, 95% CI 1.71, 5.26) were at higher risk for stillbirths. Conclusion. There are inconsistent relation patterns between stillbirth, area of origin and utilization of prenatal care. Among women from the Mediterranean, increasing utilization of prenatal care may result in lower stillbirth rates.
Physiological fluctuation of 99mtc-sestamibi uptake in normal mammary glands: a systematic investigation in female rats
Authors: Larson M. , Larson M. , Li Zhixin , Larson M. , Li Zhixin , Hall C. L. , Jensen E. , McAllister D. M. , Kalyanaraman B. , Zhao Ming
Published: December 2009

Background: Scintimammography is an imaging tool for the diagnosis and management of primary breast tumors. There remains a significant knowledge gap regarding the physiological fluctuations in the basal level of 99mTc-sestamibi uptake in normal mammary tissues with respect to the female reproductive cycle.

Purpose: To systematically characterize 99mTc-sestamibi uptake in normal mammary tissues in female Sprague Dawley (SD) rats in different estrous phases.

Material and Methods: The exact phase of the reproductive cycle was determined in 18 female SD rats. Each rat was sacrificed at 20 min after 99mTc-sestamibi injection (14.8 MBq/kg). The mammary glands were dissected, and the radioactivity uptake was measured by gamma counting.

Results: Tc-99m-sestamibi uptake oscillates by about twofold and reaches a maximum at the proestrous phase of the rat reproductive cycle.

Conclusion: Tc-99m-sestamibi uptake fluctuates significantly in normal mammary tissues in synchrony with the female reproductive cycle, and peaks in the proestrous phase in rats, which is equivalent to the early to mid-follicular phase in the human menstrual cycle. This finding will likely benefit the detection of breast lesions that may otherwise be obscured by fluctuating background signals in surrounding normal breast tissues.
Efficient use of automatic exposure control systems in computed tomography requires correct patient positioning
Authors: Gudjonsdottir J. , Svensson J. R. , Campling S. , Brennan P. C. , Jonsdottir B.
Published: December 2009

Background: Image quality and radiation dose to the patient are important factors in computed tomography (CT). To provide constant image quality, tube current modulation (TCM) performed by automatic exposure control (AEC) adjusts the tube current to the patient's size and shape.

Purpose: To evaluate the effects of patient centering on tube current–time product (mAs) and image noise.

Material and Methods: An oval-shaped acrylic phantom was scanned in various off-center positions, at 30-mm intervals within a 500-mm field of view, using three different CT scanners. Acquisition parameters were similar to routine abdomen examinations at each site. The mAs was recorded and noise measured in the images. The correlation of mAs and noise with position was calculated using Pearson correlation.

Results: In all three scanners, the mAs delivered by the AEC changed with y-position of the phantom ( P<0.001), with correlation values of 0.98 for scanners A and B and −0.98 for scanner C. With x-position, mAs changes were 4.9% or less. As the phantom moved into the y-positions, compared with the iso-center, the mAs varied by up to +70%, −34%, and +56% in scanners A, B, and C, respectively. For scanners A and B, noise in two regions of interest in the lower part of the phantom decreased with elevation, with correlation factors from −0.95 to −0.86 ( P<0.02). In the x-direction, significant noise relationships ( P<0.005) were only seen in scanner A.

Conclusion: This study demonstrates that patient centering markedly affects the efficacy of AEC function and that tube current changes vary between scanners. Tube position when acquiring the scout projection radiograph is decisive for the direction of the mAs change. Off-center patient positions cause errors in tube current modulation that can outweigh the dose reduction gained by AEC use, and image quality is affected.
Pitfalls in interpreting rat knee joint magnetic resonance images and their histological correlation
Authors: Wang Hao-Hao , Wang Yi-Xiang J. , Griffith J. F. , Sun Yan-Lin , Zhang Ge , Chan Chun-Wai , Qin Ling , Ahuja A. T. , Teng Li-Song
Published: December 2009

Background: Magnetic resonance (MR) imaging has been increasingly used as an investigational tool for assessing the structure and function of animal joint disease models, while to date MR tomographic knowledge of laboratory animal skeletal microanatomy remains limited.

Purpose: To describe pitfalls in interpreting rat knee joint MR images and their histological correlation.

Material and Methods: MR scans of the right knee of five 3-month-old Sprague-Dawley (SD) rats were carried out using a 4.7T magnet, using a fat-suppressed three-dimensional (3D) gradient echo sequence with a spatial resolution of 59×117×234 µm. Histology assessment with hematoxylin and eosin staining and Safranin O staining was carried out in the five 3-month-old SD rats and two SD rats of 1 month and 6 months old, respectively. MR images were analyzed by a radiologist, and histology data were assessed by a radiologist and a pathologist.

Results: Though the MR images were acquired in normal rats, many signs unfamiliar to radiologists were noted, including notch-like bright signal areas in the epiphysis, gray signal areas in the epiphysis, and fuzzy joint surface of the epiphysis of the femur and tibia. Detailed inspection of the histology specimen showed more unfamiliar features of rat knee microanatomy, including curvy or dipped surface of the femur/tibia epiphysis, areas composed of a mixture of cartilage and bone components, normal notch structure, cyst-like structure, and cavity between cortical lamellae under the joint cartilage.

Conclusion: There are a number of normal microstructures of the rat knee joint that can be potentially misinterpreted as arthritic changes on MR images. Recognizing these rat knee microstructures can help correct image reading during biomedical research.
Diagnostic value of early-phase-enhanced computed tomography for the differentiation of pulmonary metastases from hepatocellular carcinoma and primary lung cancer
Authors: Choi Joon-Il , Choi Hyuck Jae , Jung Dae Chul , Kim Min-Ju , Hong Eun Kyung , Park Joong-Won , Jang Yun-Jin , Kim Chang-Min
Published: December 2009

Background: The lung is the most common site of distant metastases from hepatocellular carcinoma. Correct differentiation between metastatic hepatocellular carcinoma of the lung and primary lung cancer is sometimes difficult without biopsy.

Purpose: To evaluate the usefulness of measuring the attenuations of pulmonary nodules on early-phase contrast-enhanced computed tomography (CT) for the differentiation of pulmonary metastases from hepatocellular carcinoma and primary lung cancer.

Material and Methods: Thirteen patients with pulmonary metastases from hepatocellular carcinoma (nine men, four women; age 53.9±14.2 years, range 16–70 years) and 25 patients with primary lung cancer (14 men, 11 women; age 62.2±9.4 years, range 43–72 years) were retrospectively evaluated. Contrast-enhanced scans were obtained 35 s after commencing intravenous injection of contrast medium. Attenuation values and the size of the pulmonary nodules were measured on contrast-enhanced CT scans. CT and clinical features were analyzed with regard to age, sex, body surface area of the patients, the attenuation values and size of the nodules, and CT machines using univariate analysis (Fisher's exact test for binary data sets and the Mann-Whitney U test for continuous data sets). Multiple linear regression analysis was used to eliminate confounding factors.

Results: The mean attenuation value of metastatic pulmonary nodules from hepatocellular carcinoma (75.7±24.9 HU) was higher than that of primary lung cancer nodules (45.8±14.4 HU) ( P<0.01). Other variables such as age, sex, body surface area of the patients, CT device, and nodule size were not significant variables on multiple regression analysis. When a cut-off value of 75 HU was applied, the positive predictive value for diagnosing metastatic nodules from hepatocellular carcinoma was 100%.

Conclusion: Pending confirmation in a large study, our findings suggest that there is a difference in contrast enhancement between pulmonary metastases from hepatocellular carcinoma and primary lung cancer.
Progression of emphysema evaluated by MRI using hyperpolarized 3he (hp 3he) measurements in patients with alpha-1-antitrypsin (a1at) deficiency compared with CT and lung function tests
Authors: Stavngaard T. , Søgaard L. Vejby , Batz M. , Schreiber L. M. , Dirksen A.
Published: December 2009

Background: The progression of emphysema is traditionally measured by pulmonary function test, with forced expiratory volume in 1 s (FEV1) being the most accepted and used measurement. However, FEV1 is insensitive in detecting mild/slow progression of emphysema because of low reproducibility as compared to yearly decline.

Purpose: To investigate the progression of emphysema over a period of 2 years using diffusion-weighted hyperpolarized (HP) 3He magnetic resonance imaging (MRI) in patients with alpha-1-antitrypsin (A1AT) deficiency.

Material and Methods: Nine patients with severe A1AT deficiency were studied over a period of 2 years (baseline, year 1, and year 2) with HP 3He MRI using apparent diffusion coefficient (ADC), lung function tests (FEV1 and carbon monoxide lung diffusion capacity [DL,CO]), and computed tomography (CT) using densitometric parameters (15th percentile density [CT-PD15] and relative area of emphysema below -910 HU [CT-RA-910]).

Results: Seven patients were scanned three times, one patient two times, and one patient only at baseline. The mean increase in ADC values from first to last HP 3He MR scanning was 3.8% (0.014 cm2/s [SD 0.024 cm2/s]; not significant). The time trends for FEV1, DL,CO, CT-PD15, and CT-RA-910 were all statistically significant. We found a high correlation between ADC and DL,CO ( P<0.001).

Conclusion: This pilot study indicates the possible use of nonionizing HP 3He MRI for monitoring the progression of emphysema. However, in the future, larger studies are needed to confirm these preliminary results.
T2 relaxation time mapping of proximal tibiofibular cartilage by 3-tesla magnetic resonance imaging
Authors: Kwack Kyu-Sung , Min Byoung-Hyun , Cho Jae Hyun , Kim Jun Man , Yoon Seung-Hyun , Kim Sun Yong
Published: December 2009

Background: The proximal tibiofibular joint (PTFJ) can be considered the fourth compartment of the knee joint. However, there have been no studies of the T2 values (T2 relaxation time) of PTFJ cartilage.

Purpose: To assess the T2 values of PTFJ cartilage at 3T magnetic resonance imaging (MRI), and to show the clinical utility of T2 values of PTFJ cartilage for the diagnosis of osteoarthritis (OA).

Material and Methods: 118 patients who had knee MR imaging and knee radiography were enrolled. MRI was performed using a 3T MRI scanner, and T2 maps were calculated from a sagittal multi-echo acquisition. Two regions of interest (ROIs) were positioned within PTFJ cartilage and medial femoral condyle (MFC) cartilage. The average T2 value and standard deviation (SD) of each ROI were recorded. Using PTFJ cartilage as a standard reference, the T2 index (( MFC/ PTFJ)×100) and T2SD index (( MFCSD/ PTFJSD)×100) were calculated. A paired t test was performed to compare the mean and SD of ROIs within PTFJ and MFC cartilage. Correlation analyses were performed among the parameters age, Kellgren–Lawrence (KL) score, means and SDs of ROIs within PTFJ and MFC cartilage, T2 index, and T2SD index.

Results: PTFJ cartilage had a significantly shorter T2 value than did MFC cartilage ( P<0.0001). ROIs within PTFJ cartilage showed significantly smaller SDs than did those within MFC cartilage ( P<0.0001). The average T2 value and SD of MFC and the T2SD index showed a positive correlation to the KL score ( P<0.05). The correlation coefficients for the average T2 value, SD, and T2SD index of MFC were R=0.203, 0.254, and 0.268, respectively. However, there was no significant correlation between T2 values of PTFJ cartilage and KL score ( P=0.643).

Conclusion: PTFJ cartilage showed shorter and more homogeneous T2 values with a small SD than did MFC cartilage, regardless of the degree of OA at femorotibial compartments. PTFJ cartilage may be a useful internal standard reference to diagnose OA and would be a good candidate as a standard reference for cartilage imaging.
Dobutamine stress cardiovascular magnetic resonance imaging in patients after invasive coronary revascularization with stent placement
Authors: Heilmaier C. , Bruder O. , Meier F. , Jochims M. , Forsting M. , Sabin G. V. , Barkhausen J. , Schlosser T. W.
Published: December 2009

Background: High-dose dobutamine stress magnetic resonance (DSMR) is a well-established imaging technique for the detection of coronary artery disease (CAD).

Purpose: To investigate the value of DSMR for the detection of in-stent restenoses (ISR) in patients with prior coronary stenting, using invasive coronary angiography (ICA) as the standard of reference.

Material and Methods: 50 patients with 74 stents and without wall motion abnormalities at rest were examined on a 1.5T MR scanner and underwent ICA for clinical reasons within 14 days after DSMR examination. A dobutamine/atropine stress protocol was employed until age-predicted heart rate was achieved, and imaging was performed in at least three long- and three short-axis views using a segmented steady-state free precession sequence (repetition/echo time [TR/TE] 3/1.5 ms, flip angle 60°). All examinations were read by an experienced cardiologist and radiologist in consensus, with myocardial ischemia being defined as a new stress-induced wall motion abnormality in at least one myocardial segment. Statistical analysis was performed on a per-vessel (left circumflex artery [LCX], left anterior descending artery [LAD], and right coronary artery [RCA]) basis and with regard to the number of affected vessels (one-, two- or three-vessel disease).

Results: ICA yielded seven ISR, of which one was missed by DSMR (sensitivity 86%, 95% confidence interval [CI] 0.42–0.99). Sixty-seven coronary arteries showed no ISR in ICA; however, due to new wall motion abnormalities, seven ISR were suspected in DSMR (2×RCA, 3×LCX, and 2×LAD; sensitivity 86%, specificity 90%, positive predictive value 46%, negative predictive value 98%, and diagnostic accuracy 89%). The per-vessel analysis of the three main coronary arteries revealed highest sensitivity (100%), specificity (93%), and diagnostic accuracy (94%) for the LAD.

Conclusion: High-dose DSMR is an accurate, noninvasive technique for the detection of ISR and reliably allows identification of patients who need to undergo control ICA.
Role of manual aspiration in treating pneumothorax after computed tomography-guided lung biopsy
Authors: Yamagami T. , Terayama K. , Yoshimatsu R. , Matsumoto T. , Miura H. , Nishimura T.
Published: December 2009

Background: Pneumothorax is the most common complication after computed tomography (CT)-guided lung biopsy. The presence of a pneumothorax per se does not complicate patient management, but an increasing pneumothorax, making chest tube placement necessary, is highly problematic.

Purpose: To evaluate the efficacy and limitations of simple aspiration of air from the pleural space to prevent increased pneumothorax and avoid chest tube placement in cases of pneumothorax following CT-guided lung biopsy.

Material and Methods: The subjects of our study were 642 consecutive lung lesions in 594 patients for which percutaneous needle lung biopsies were performed using CT guidance. While patients were on the CT scanner table, percutaneous manual aspiration was performed in all patients with a non-small pneumothorax demonstrated on post-biopsy chest CT images. The frequency of pneumothorax, management of each such case, and factors influencing the incidence of worsening pneumothorax that finally required chest tube placement were evaluated.

Results: Post-biopsy pneumothorax occurred in 243 of 642 (38%) procedures. Of the 243 cases, 112 were treated with manual aspiration immediately after biopsy. In 210 (86.4%), the pneumothorax had resolved completely on follow-up chest radiographs without chest tube placement. Only 33 patients required chest tube placement. Requirement of chest tube insertion significantly increased in parallel with the degree of pneumothorax as shown on post-biopsy CT images. The rate of chest tube insertion was statistically higher in subjects with values for aspirated air above 543 ml.

Conclusion: Percutaneous manual aspiration of biopsy-induced pneumothorax performed immediately after biopsy may prevent worsening of pneumothorax and avoid chest tube placement. The amount of aspirated air can be predictive of the requirement for chest tube placement.
Lcd versus crt monitors for digital mammography: a comparison of observer performance for the detection of clustered microcalcifications and masses
Authors: Cha Joo Hee , Moon Woo Kyung , Cho Nariya , Lee Eun Hye , Park Jeong Seon , Jang Mi Jung
Published: December 2009

Background: There are two types of soft-copy display of digital mammograms, cathode-ray tube (CRT) and liquid-crystal display (LCD) monitors, and these present different resolutions and noise characteristics.

Purpose: To compare observer performances for the detection of clustered microcalcifications and masses in digital mammograms, using LCD and CRT monitors.

Material and Methods: Four radiologists evaluated 100 digital mammograms. Of these, 28 mammograms depicted clustered microcalcifications (12 benign, 16 malignant), 18 depicted masses (10 benign, eight malignant), and 54 depicted no apparent abnormality. The images were stored uncompressed as Digital Imaging and Communications in Medicine (DICOM) files and randomized for two sessions of soft-copy reading. The readers independently read all cases displayed on two 5-megapixel LCD and two CRT monitors with an interval of 3 months. Observers were asked to rate using a five-point scale the likelihoods of microcalcifications and masses independently. Receiver operating characteristic analysis was used to analyze results.

Results: For the LCD and CRT monitors, average area-under-the-curve (Az) values for microcalcification detection were 0.977 (0.976, 0.970, 0.980, and 0.983 for the four readers) and 0.958 (0.910, 0.990, 0.976, 0.956), respectively. Corresponding Az values for masses were 0.971 (0.955, 0.990, 0.949, 0.989) and 0.944 (0.928, 0.966, 0.955, 0.925). No statistically significant difference was detected between the two monitor types (P>0.05).

Conclusion: The LCD and CRT monitors are comparable in terms of detecting clustered microcalcifications and masses in digital mammograms.
Multidetector-row computed tomographic angiography findings of musculoskeletal tumors: retrospective analysis and correlation with surgical findings
Authors: Argin M. , Isayev H. , Kececi B. , Arkun R. , Sabah D.
Published: December 2009

Background: Although magnetic resonance imaging (MRI) is a valuable method in staging musculoskeletal tumors, it may not give enough information on the association between the tumor and the main vascular structures adjacent to the tumor. In this respect, computed tomographic angiography (CTA) may be a useful alternative imaging technique.

Purpose: To evaluate the effectiveness of CTA in determining vascular invasion in patients with musculoskeletal tumors and suspected vascular invasion by MRI, and to correlate the CTA findings with the surgical findings.

Material and Methods: Twenty patients who had musculoskeletal tumors and lacked a fat plane between the tumor and adjacent vessels by MRI were included in this study. All patients were evaluated with CTA, and the CTA findings were reviewed by two radiologists to determine the presence of vascular invasion. Statistical analysis was carried out by using surgical findings as the gold standard.

Results: There were nine women and 11 men (mean age 31 years) with either bone ( n=9) or soft-tissue ( n=11) tumors. Twelve patients without invasion according to the CTA examination were also surgically negative (true-negative cases). Of the eight patients with invasion shown by CTA, only three had adhesions and were considered surgically negative (false-positive cases). Five had invasions proven by surgery and were considered surgically positive (true-positive cases). Compared to the surgical findings, CTA had 100% sensitivity, 80% specificity, 62.5% positive predictive value, 100% negative predictive value, and 80% accuracy.

Conclusion: CTA is a more accurate imaging technique than MRI in evaluating vascular invasion of musculoskeletal tumors, and provides valuable preoperative data.
Book Review
Authors: Nørgaard Henrik
Published: December 2009

Adrenal Imaging. Edited by M. A. Blake & G. W. L. Boland. Humana Press, 2009. 224 pages. ISBN 978-1-934115-86-2:
Book Review
Authors: Skaane Per
Published: December 2009

Breast cancer imaging: A multidisciplinary, multimodality approach. Third edition. By M. Tartar, C. E. Comstock, & M. S. Kipper. Philadelphia, PA: Mosby Elsevier, 2008. 614 pages. ISBN: 978-0-323-04677-0. Hardcover.
Inflammatory response in patients undergoing uterine artery embolization as compared to patients undergoing conventional hysterectomy
Authors: Brøchner A.C. , Mygil B. , Elle B. , Toft P.
Published: December 2009

Background: Uterine fibroids are benign tumors seen in 20-40% of women of childbearing age, and these fibroids are usually treated by hysterectomy. During the last decade, embolization of the uterine arteries with polyvinyl alcohol microparticles has become an alternative treatment.

Purpose: To investigate whether uterine artery embolization generates a reduced inflammatory response as compared with conventional hysterectomy.

Material and Methods: 40 women, 20 in each group, entered this prospective, non-randomized study. The two groups were comparable concerning age, comorbidity, and body-mass index (BMI).

Results: We found a significant difference between the inflammatory responses in women undergoing embolization compared with the inflammatory response in women having an abdominal hysterectomy. Women undergoing embolization were subjected to a much smaller inflammatory burden, their total morphine consumption was lower, and their return to work was faster than women subjected to conventional hysterectomy.

Conclusion: Uterine artery embolization generates a reduced inflammatory response compared with conventional hysterectomy.
Percutaneous preoperative portal vein embolization using a combination of gelatin sponge and histoacryl glue
Authors: Bae Ji Hea , Kim Kab Cheol , Ryeom Hyeun Kue
Published: December 2009

Background: Inadequate remnant liver volume is a major cause of postoperative liver failure. Preoperative portal vein embolization (PVE) is used clinically to prevent postoperative liver insufficiency.

Purpose: To evaluate the efficacy and safety of preoperative portal vein embolization, by using a combination of gelatin sponge and histoacryl to induce hypertrophy of future liver remnant (FLR) in patients with a hepatobiliary malignancy.

Material and Methods: PVE using a combination of gelatin sponge and histoacryl glue was performed in 11 patients (nine men, two women; mean age 60 years, range 46–70 years). These patients were diagnosed with a hepatobiliary malignancy before surgery and their FLR volumes were judged as insufficient to allow for safe resection (FLR <25% in patients with a normal liver or FLR <40% in patients with a chronic liver disease). Liver volume changes, levels of biochemical markers, complications related to PVE, and postoperative complications were retrospectively evaluated.

Results: PVE was successful in all patients, and there were no procedural complications. The enlargement of nonembolized liver lobe was 30% (mean 118 cm3). A planned hepatectomy was cancelled in four patients due to the presence of a late-detected extrahepatic metastasis. Seven of the 11 patients underwent hepatectomy without complications.

Conclusion: Preoperative PVE with a combination of gelatin sponge and histoacryl glue is a safe and effective procedure to induce hypertrophy of nonembolized parts of the liver.
Age- and sex-associated changes in cerebral glucose metabolism in normal healthy subjects: statistical parametric mapping analysis of f-18 fluorodeoxyglucose brain positron emission tomography
Authors: Kim In-Ju , Kim Seong-Jang , Kim Yong-Ki
Published: December 2009

Background: The age- and sex-associated changes of brain development are unclear and controversial. Several previous studies showed conflicting results of a specific pattern of cerebral glucose metabolism or no differences of cerebral glucose metabolism in association with normal aging process and sex.

Purpose: To investigate the effects of age and sex on changes in cerebral glucose metabolism in healthy subjects using fluorine-18 fluorodeoxyglucose (F-18 FDG) brain positron emission tomography (PET) and statistical parametric mapping (SPM) analysis.

Material and Methods: Seventy-eight healthy subjects (32 males, mean age 46.6±18.2 years; 46 females, mean age 40.6±19.8 years) underwent F-18 FDG brain PET. Using SPM, age- and sex-associated changes in cerebral glucose metabolism were investigated.

Results: In males, a negative correlation existed in several gray matter areas, including the right temporopolar (Brodmann area [BA] 38), right orbitofrontal (BA 47), left orbitofrontal gyrus (BA 10), left dorsolateral frontal gyrus (BA 8), and left insula (BA 13) areas. A positive relationship existed in the left claustrum and left thalamus. In females, negative changes existed in the left caudate body, left temporopolar area (BA 38), right orbitofrontal gyri (BA 47 and BA 10), and right dorsolateral prefrontal cortex (BA 46). A positive association was demonstrated in the left subthalamic nucleus and the left superior frontal gyrus. In white matter, an age-associated decrease in FDG uptake in males was shown in the left insula, and increased FDG uptake was found in the left corpus callosum. The female group had an age-associated negative correlation of FDG uptake only in the right corpus callosum.

Conclusion: Using SPM, we found not only similar areas of brain, but also sex-specific cerebral areas of age-associated changes of FDG uptake.
Severe subdural hemorrhage due to minimal prenatal trauma
Authors: Piastra Marco , Pietrini Domenico , Massimi Luca , Caldarelli Massimo , De Luca Daniele , Del Lungo Laura Minguell , De Carolis Maria Pia , Di Rocco Concezio , Conti Giorgio , Zecca Enrico
Published: December 2009

The authors report a case of minimal prenatal trauma producing a large subdural hematoma in the fetus, which was diagnosed in utero by MR imaging. The occurrence of such a complication is extremely rare in the absence of significant maternal trauma. Prenatally diagnosed intracranial hemorrhages, particularly those that are subdural in origin, have a poor prognosis in most cases. After birth, brain compression required a complex neurosurgical intervention because simple hematoma evacuation was not possible. The clinical and neurological outcome at 6 months was excellent, as confirmed by the neuroimaging findings.
Treatment of intermittent obstructive hydrocephalus secondary to a choroid plexus cyst
Authors: Filardi Tanya Z. , Finn Laura , Gabikian Patrik , Giussani Carlo , Ebenezer Sudesh , Avellino Anthony M.
Published: December 2009

The authors present the case of an 11-week-old girl in whom hydrocephalus developed secondary to intermittent obstruction of the third ventricle by a choroid plexus cyst. The patient presented to the emergency department at the authors' institution with a 1-day history of projectile vomiting, lethargy, and dysconjugate gaze. Hydrocephalus was confirmed on head CT. During hospitalization, the symptoms resolved with a decrease in ventricular size. One week later, the patient again presented with similar symptoms, and MR images with 3D-constructive interference in steady state sequences revealed that a cyst was blocking the third ventricle. The patient subsequently underwent endoscopic fenestration of the cyst with resolution of hydrocephalus and symptoms. The authors present a unique description of the diagnosis of intermittent obstructive hydrocephalus caused by a third ventricular region choroid plexus cyst in an infant.
Cystic choroid plexus papilloma in the cavum septum pellucidum
Authors: Tuchman Alexander , Kalhorn Stephen P. , Mikolaenko Irina , Wisoff Jeffrey H.
Published: December 2009

A choroid plexus papilloma is a rare CNS neoplasm arising from the neuroepithelial lining of the choroid plexus. A third ventricular location of a choroid plexus papilloma is rare compared with the more common sites in the lateral and fourth ventricles. Cystic choroid plexus papilloma represents an infrequent subtype that may present diagnostic ambiguity. The authors present a case of cystic choroid plexus papilloma within a cavum septum pellucidum that radiographically mimicked neurocysticercosis.
Intraventricular fungus ball: a unique manifestation of refractory intracranial candidiasis in an immunocompetent neonate
Authors: Binning Mandy J. , Lee Janet , Thorell Emily A. , Riva-Cambrin Jay K.
Published: December 2009

The authors report on a case of intracranial candidiasis in an immunocompetent neonate with a ventriculo-peritoneal shunt. The child was known to be colonized with yeast as she had been treated for oral thrush; however, she did not have systemic candidiasis. Despite initial treatment with antifungal medication, intraventricular fungus balls developed that were visible on imaging and confirmed with pathological analysis. Multiple endoscopic intraventricular operations were required for excision of the initial and recurrent fungus balls, multiple fenestrations of loculations and cysts were performed, and ultimately 3 ventriculoperitoneal shunts were placed. The finding of an intraventricular fungus ball is a unique manifestation of intracranial candidiasis, and to the authors' knowledge has not been previously reported in the English literature.
A “neurosurgical crisis” of sickle cell disease
Authors: Dahdaleh Nader S. , Lindley Timothy E. , Kirby Patricia A. , Oya Hiroyuki , Howard Matthew A.
Published: December 2009

The occurrence of spontaneous acute epidural hematomas is rare in patients with sickle cell disease. The authors report the case of a patient with sickle cell anemia who presented with a sickle cell crisis that was complicated by the development of multiple acute epidural and subgaleal hematomas requiring surgical evacuation. Possible underlying mechanisms are discussed. Although rare, clinicians should be aware of this phenomenon as part of a spectrum of neurological complications in these patients.
Management of large scalp and skull defects in a severe case of Adams-Oliver syndrome
Authors: Khashab Mostafa El , Rhee Samuel T. , Pierce Sean D. , Khashab Yasmin El , Nejat Farideh , Fried Arno
Published: December 2009

Adams-Oliver syndrome is a rare congenital disorder that includes congenital scalp and skull defects, variable degrees of terminal transverse limb anomalies, and cardiac malformations. Cutis aplasia occurring in 75% of patients is a potentially life-threatening condition. Large skin defects that cannot be closed primarily present a management dilemma, and may require skin grafting or flaps, or a combination of both operative and conservative modalities. The authors' experience in management of huge scalp and bone defects with the Integra Dermal Regeneration Template and regular dressing changes showed good scalp repair and no serious complications attributed to this approach.
Sinus pericranii in children: report of 16 patients and preoperative evaluation of surgical risk
Authors: Park Seong-Cheol , Kim Seung-Ki , Cho Byung-Kyu , Kim Hyun Jib , Kim Jeong Eun , Phi Ji Hoon , Kim In-One , Wang Kyu-Chang
Published: December 2009

Object

Sinus pericranii (SP) is a rare venous varix in an extracranial location connected to the intracranial venous system. The aim of this retrospective study was to report on 16 pediatric cases of SP with consideration of the preoperative evaluation of surgical risk.

Methods

The study population consisted of 10 patients who had undergone surgery for SP and 6 patients with concomitant craniosynostosis and SP. The mean age of the patients at presentation was 3.7 years. To identify characteristics of SP with high operative risk, 8 cases in this report and 11 previously reported cases of SP with sufficient information were categorized on the basis of the number and size of SP, the number and size of transcranial channels, the venous drainage type, and the amount of blood loss. Hemorrhage amounts were classified into 3 grades based on the description of intraoperative blood loss.

Results

Sinus pericranii not associated with craniosynostosis were resected without any postoperative morbidity. Sinus pericranii associated with craniosynostosis were preserved. After craniofacial reconstruction, 2 cases of SP with craniosynostosis regressed, completely in one patient and partially in another. These 2 patients with SP were confirmed to have compromised intracranial sinus before craniofacial reconstruction. Among a total of 19 patients, multiplicity or size (> 6 cm) of SP (p = 0.036) and multiplicity (> 3) or size (> 3 mm) of transcranial channels (p = 0.004) was associated with more severe hemorrhage grade. Sinus pericranii with peripheral venous drainage (drainer type) was not associated with hemorrhage grade after classification into 3 grades (p = 0.192). However, all 3 cases of SP with massive Grade 3 hemorrhage were the drainer type. Hemorrhage grade was correlated with the number of risk factors for SP (r = 0.793, p < 0.001).

Conclusions

Three risk factors of SP and the presence of compromised intracranial sinus are markers for highrisk SP. “Squeezed-out sinus syndrome” is suggested as a concept for SP associated with compromised intracranial sinus, mainly caused by craniosynostosis. Sinus pericranii in squeezed-out sinus syndrome probably serves as a crucial alternative to venous drainage of the brain with intracranial venous compromise. Conservative treatment for such patients with SP is recommended.
Control of brain metastases using frameless image-guided radiosurgery
Authors: Chen Joseph C. T. , Bugoci Darlene M. , Girvigian Michael R. , Miller Michael J. , Arellano Alonso , Rahimian Javad
Published: December 2009

Object

Radiosurgery is an important and well-accepted method in the management of brain metastases. Using conventional frame-based techniques, high lesional control rates are expected. The introduction of image-guided techniques allows for improved patient comfort and workflow. Some controversy exists as to the accuracy of imageguided techniques and consequently the impact they might have on control of brain metastases (as opposed to the level of control achieved with frame-based methods). The authors describe their initial 15-month experience with image-guided radiosurgery (IGRS) using Novalis with ExacTrac for management of brain metastases.

Methods

The authors reviewed the cases of brain metastasis treated by means of IGRS in their tertiary regional radiation oncology service over a 15-month period. During the study period 54 patients (median age 57.9 years) harboring 108 metastases were treated with IGRS. The median time from cancer diagnosis to development of brain metastasis was 12 months (range 0–144 months). The median tumor volume was 0.98 cm3 (range 0.03–19.07 cm3). The median prescribed dose was 18 Gy to the 80% isodose line (range 14–20 Gy). Lesions were followed with postradiosurgery MR imaging every 2–3 months following treatment.

Results

The median follow-up period was 9 months (range 0–20 months). Median actuarial survival was 8.6 months following IGRS. Eight patients with 18 lesions died within the first 2 months after the procedure, before scheduled follow-up imaging. Thus 90 lesions (in 46 patients) were followed up with imaging studies. Lesions that were unchanged or reduced in size were considered to be under control. The 6-month actuarial lesion control rate was 88%. Smaller lesions (< 1 cm3) had a statistically improved likelihood of complete imaging response (loss of all contrast-enhancement p = 0.01).

Conclusions

Image-guided radiosurgical treatment of brain metastases resulted in high rates of tumor control comparable to control rates reported for frame-based methods. High control rates were seen for small lesions in which spatial precision in dose delivery is critical. These data suggests that in regard to lesion control, IGRS using Novalis with ExacTrac is equivalent to frame-based radiosurgery methods.
Non-audiofacial morbidity after Gamma Knife surgery for vestibular schwannoma
Authors: Sughrue Michael E. , Yang Isaac , Han Seunggu J. , Aranda Derick , Kane Ari J. , Amoils Misha , Smith Zachary A. , Parsa Andrew T.
Published: December 2009

Object

While many studies have been published outlining morbidity following radiosurgical treatment of vestibular schwannomas, significant interpractitioner and institutional variability still exists. For this reason, the authors conducted a systematic review of the literature for non-audiofacial-related morbidity after the treatment of vestibular schwannoma with radiosurgery.

Methods

The authors performed a comprehensive search of the English-language literature to identify studies that published outcome data of patients undergoing radiosurgery treatment for vestibular schwannomas. In total, 254 articles were found that described more than 50,000 patients and were analyzed for satisfying the authors' inclusion criteria. Patients from these studies were then separated into 2 cohorts based on the marginal dose of radiation: ≤ 13 Gy and > 13 Gy. All tumors included in this study were < 25 mm in their largest diameter.

Results

A total of 63 articles met the criteria of the established search protocol, which combined for a total of 5631 patients. Patients receiving > 13 Gy were significantly more likely to develop trigeminal nerve neuropathy than those receiving < 13 Gy (p < 0.001). While we found no relationship between radiation dose and the rate of developing hydrocephalus (0.6% for both cohorts), patients with hydrocephalus who received doses > 13 Gy appeared to have a higher rate of symptomatic hydrocephalus requiring shunt treatment (96% [> 13 Gy] vs 56% [≤ 13 Gy], p < 0.001). The rates of vertigo or balance disturbance (1.1% [> 13 Gy] vs 1.8% [≤ 13 Gy], p = 0.001) and tinnitus (0.1% [> 13 Gy] vs 0.7% [≤ 13 Gy], p = 0.001) were significantly higher in the lower dose cohort than those in the higher dose cohort.

Conclusions

The results of our review of the literature provide a systematic summary of the published rates of nonaudiofacial morbidity following radiosurgery for vestibular schwannoma.
Emerging applications of stereotactic radiotherapy in head and neck cancer
Authors: Truong Minh Tam , Grillone Gregory , Tschoe Christine , Chin Lawrence , Kachnic Lisa Ann , Jalisi Scharukh
Published: December 2009

Advances in the management of locally advanced head and neck cancer (HNC) have been focused on treatment intensification, including concomitant chemoradiotherapy, biological agents, and combining surgery with chemoradiotherapy. Despite these improvements, locoregional recurrence still constitutes the main pattern of treatment failure. As improvements in radiotherapy delivery and image-guided therapy have come to fruition, the principles of stereotactic radiosurgery are now being applied to extracranial sites, leading to stereotactic body radiotherapy. This article focuses on the emerging evidence for the use of stereotactic body radiotherapy for treatment of HNC as a boost after conventional external-beam radiotherapy, and also as reirradiation in recurrent or second primary HNC.
The Use of Micronutrient Supplements Is Not Associated with Better Quality of Life and Disease Activity in Canadian Patients with Systemic Lupus Erythematosus
Authors: AGHDASSI ELAHEH , MORRISON STACEY , LANDOLT-MARTICORENA CAROLINA , SU JIANDONG , PINEAU CHRISTIAN A. , GLADMAN DAFNA , UROWITZ MURRAY , POPE JANET , PESCHKEN CHRISTINE ,   CaNIOS LuNNET and HIPP Investigators, DACOSTA DEBORAH , WITHER JOAN , FORTIN PAUL R.
Published: December 2009

Objective.

Associations between the use of micronutrient supplements (MS) and disease activity, quality of life (QOL), and healthcare resource utilization were studied in a Canadian population of patients with systemic lupus erythematosus (SLE).

Methods.

QOL was assessed by the Medical Outcomes Study 36-item Short Form. Healthcare resource utilization and disease activity/damage were determined.

Results.

Of the 259 subjects studied, 53% were MS users and 34% used only calcium/vitamin D. MS users had a higher Systemic Lupus International Collaborating Clinics score and utilized more healthcare resources. Disease activity and QOL were similar between MS users and nonusers.

Conclusion.

MS are frequently used by patients with SLE and are not associated with concomitant benefit on QOL. MS users utilized more healthcare resources.