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Biomedical subjects

E J Russell

Publications and source records attributed to E J Russell.

At least 19 recordsLinked to original sources
PubMed1992

MR imaging of posterior fossa infarctions: vascular territories and clinical correlates.

Ischemic infarctions in certain vascular territories of the cerebellum and brain stem can produce some characteristic radiologic and clinical patterns. The cerebellum serves as a coordination center for the maintenance of equilibrium and muscle tone and refines the movements of the somatic muscles. The anatomy of the brain stem is extremely complex, and small infarcts can potentially be disastrous. MR imaging depicts the anatomy of the posterior fossa and infarcts in this region with greater accuracy than was previously possible. Familiarity with the vascular territories and patterns of infarction of the posterior fossa depicted with MR imaging and familiarity with the associated clinical symptoms of stroke in this region can help the radiologist recognize these infarcts and correlate clinical and radiologic findings. When patients are referred for MR imaging of the brain because of clinical findings suggestive of infarction, it may be useful to obtain coronal or sagittal views in addition to axial images to better depict the vascular distribution of a suspected ischemic lesion.

Brain Stem↗
PubMed1991

Spinal arteriovenous malformation.

The authors discuss a patient with a large (15 x 10 x 12 cm), bony soft tissue intradural arteriovenous malformation (AVM) who presented with a 20-year history of back pain. Plain radiographs revealed a destructive lesion. Magnetic resonance imaging showed serpentine vascular structures within the thecal sac and lytic bone lesions with multiple level involvement. A Craig needle biopsy by the referring physician, as well as an open biopsy by the authors, caused severe bleeding. There was no evidence of neoplasm. Selective spinal angiography demonstrated a metameric juvenile type AVM whose intradural component was fed by the artery of Adamkiewicz. Because the patient had no neurological deficit on presentation, the options of embolization and then surgery were considered too risky. The patient is being followed conservatively.

Adult↗
PubMed1990

The pituitary "incidentaloma".

PURPOSE: To review evidence related to sellar masses that might be found incidentally on various radiologic procedures, including their differential diagnosis and recommendations for their evaluation and treatment. DATA IDENTIFICATION: An English-language literature search using bibliographic reviews of textbooks and review articles. STUDY SELECTION: Articles were selected on the basis of providing data on the autopsy prevalence of sellar masses, the radiologic and endocrinologic evaluation of such masses, and the prognostic aspects of pituitary adenomas. DATA EXTRACTION: Twelve studies relating autopsy findings, 6 studies describing radiologic characteristics, and 26 articles reviewing various endocrine aspects of pituitary adenomas were evaluated. RESULTS OF DATA SYNTHESIS: Pituitary adenoma is the most common incidental sellar mass. Scanning techniques are of great importance in differentiating the pituitary adenoma from other mass lesions. Autopsy and radiologic studies suggest that microadenomas (less than 10 mm in diameter) may be present in 10% to 20% of the population but that macroadenomas (greater than 10 mm in diameter) are quite rare. Hormone oversecretion by an adenoma may be asymptomatic but, when present, is very helpful in the differential diagnosis. CONCLUSIONS: For adenomas found to be hypersecreting, therapy is as indicated for that specific tumor type. If there is no evidence of hormone oversecretion from microadenomas, we suggest a conservative approach with repeat scanning done at yearly intervals, initially, and subsequently less frequently. Macroadenomas, because they have already indicated some propensity for growth, should either be surgically removed or, if completely asymptomatic, followed closely with repeat scans at 6- to 12-month intervals.

Adenoma↗
PubMed1990

Calvarial and skull base metastases: comparison of nonenhanced and Gd-DTPA-enhanced MR images.

Fourteen patients with calvarial metastases were studied with magnetic resonance (MR) imaging before and after intravenous administration of gadolinium diethylenetriamine-pentaacetic acid (DTPA) to evaluate the utility of contrast material enhancement for the detection of calvarial metastatic tumor. MR imaging was also performed before and after enhancement in 60 patients for reasons other than evaluation of metastases or calvarial tumor, to determine the apperance of the normal calvaria with enhancement. The normal pattern of fat distribution in the diploic space was typically symmetric. Except for enhancement of diploic veins and meninges near pacchionian granulations, the normal diploic space did not enhance. Calvarial metastases typically enhanced with Gd-DTPA. Enhanced MR images were superior to nonenhanced studies for detecting subtle intradiploic metastases but were inferior to nonenhanced studies for detecting tumor extension into fat-containing areas. Careful comparison of nonenhanced and enhanced MR images is required for complete evaluation of lesions affecting the calvaria and skull base.

Contrast Media↗
PubMed1990

MR imaging of the normal and abnormal clivus.

We retrospectively reviewed 330 T1-weighted sagittal images, 80 T2-weighted sagittal images, and 83 gadopentetate-dimeglumine-enhanced scans of normal adults to determine the MR appearance of the normal adult clivus. MR images of 21 patients with an abnormal clivus (19 with tumor invasion and two with marrow reconversion) were also evaluated retrospectively and compared with those of the control group to assess MR features distinguishing the two groups. Our study revealed that a normal adult clivus consisted of low- and high-intensity portions mixed in various proportions on T1-weighted images. The low-intensity portion was isointense or hyperintense relative to the pons and always contained foci of bright signal intensity. The low-intensity tumor of a pathologic clivus tended to be hypointense relative to the pons (17/19), and was completely devoid of foci of bright signal intensity. The normal adult clivus was approximately isointense relative to the pons on T2-weighted images. Clival tumors were grossly hyperintense relative to the pons on T2-weighted images in 11 of 17 patients. In the remaining six patients, either a portion of or the entire lesion was isointense relative to the pons and, therefore, was not detectable on T2-weighted images. A normal adult clivus can enhance to some degree (19/83). Clival tumors were found to enhance intensely. A clivus of very low signal intensity (signal void) on T1- or T2-weighted images was always abnormal. The clivus with marrow reconversion was uniformly hypointense relative to the pons on T1-weighted images and isointense relative to normal marrow on T2-weighted images. The intensity patterns of the normal clivus on T1- and T2-weighted MR images change predictably with advancing age. Intensity patterns of abnormal clivi differ from those of normal clivi. When contrast material is used, normal and abnormal clivi generally show different patterns of enhancement.

Adult↗
PubMed1989

Flexion teardrop fracture of the cervical spine: radiographic characteristics.

Teardrop fracture of the cervical spine is a confusing and loosely used term, often referring to any fracture with a triangular fragment in the involved body. The flexion teardrop fracture is a specific entity that should not be confused with other types of injury with a teardrop fragment. In a radiographic analysis of 45 patients with flexion teardrop fracture, the most characteristic feature was posterior displacement of the upper column of the divided cervical spine, observed in 78% of the cases. Other radiographic characteristics included backward displacement of the posterior fragment of the involved body, widening of the interlaminar and interspinous spaces, widening of the facet joint with backward displacement of the inferior facet, and kyphotic deformity of the cervical spine at the level of injury. The injury was frequently associated with sagittal-body and laminar fractures and occurred predominantly at the C5 level.

Cervical Vertebrae↗
PubMed1989

Multicenter double-blind placebo-controlled study of gadopentetate dimeglumine as an MR contrast agent: evaluation in patients with cerebral lesions.

A multicenter double-blind randomized study was designed to evaluate and compare the safety and diagnostic efficacy of gadopentetate dimeglumine (Gd-DTPA) (0.1 mmol/kg) against a saline placebo for use as an IV contrast agent for MR. The randomization code provided for a 2:1 ratio of Gd-DTPA and saline patients. Six investigators studied 88 patients with signs and symptoms of a cerebral lesion. Although safety data were complete in all 88 cases, only 83 had valid efficacy data (57 received Gd-DTPA, 26 placebo). Three patients were excluded from efficacy evaluation because of incomplete scans or scans with severe motion artifacts. Two patients were excluded for protocol variations (did not have a mass lesion). The protocol required that spin-echo MR images be acquired both before and after infusion at mode 1, 500/30/2 (TR/TE/excitations), and at a single-echo mode 2 sequence within a selected range, 1500-2000/56-90/2. Additional TEs could also be used at the discretion of each investigator. Efficacy was determined by comparing post- with preinjection images for relative degree of enhancement and improvement of diagnostic ability after injection, and by comparing these results with placebo results. Enhancement was reported in 43 (75%) of 57 Gd-DTPA patients and in none of the 26 placebo patients. Improvement of diagnostic ability was noted in 37 of 57 Gd-DTPA patients and in no placebo patients. Of 17 patients receiving Gd-DTPA for whom no diagnosis could be made before infusion, nine of 17 were diagnosed after infusion. By comparison, none of five patients not diagnosed before infusion of placebo could be diagnosed after infusion. Of 43 patients in whom lesion enhancement was observed after Gd-DTPA infusion, the diagnosis changed after infusion in 16 (37%) and the number of lesions detected after infusion increased in 10 (23%). Safety studies showed no clinically significant abnormal trends. Minor changes in blood pressure, pulse, and serum iron levels were noted in a higher percentage of Gd-DTPA patients. This study confirms that Gd-DTPA is an efficacious contrast agent for use with MR and that it exhibits excellent patient tolerance. Enhancement allows for a decisive diagnosis to be made in selected cases in which such capability had previously been lacking with unenhanced MR.

Adolescent↗
PubMed1988

Superselective embolization of laryngeal hemangioma.

Diffuse upper respiratory hemangiomas are extremely rare lesions. Unlike the much more common congenital subglottic hemangiomas, diffuse upper respiratory hemangiomas do not resolve spontaneously and may prove quite recalcitrant to conventional forms of therapy. Superselective embolization, a highly successful technique for the management of head and neck vascular lesions, was used to effectively control an obstinate laryngotracheal hemangioma. Superselective embolization appears to provide yet another viable therapeutic option in the management of laryngeal hemangiomas.

Child↗
PubMed1988

Combined treatment of arteriovenous malformations by transarterial microembolization and surgery.

An arteriovenous malformation is defined as a congenital lesion of dysplastic vascular origin with large feeding arteries causing decreased vascular resistance. Previously, initial attempts toward treatment by complete excision of the vascular mass were complicated by hemorrhage and infection. Cardiac failure and abnormal growth may result from the shunted blood flow. With the advancement of angiography, more defined study of the arteriovenous anomaly can be identified and a reduction of risk during treatment can be promised. Three cases of extensive arteriovenous malformations are presented. Each has been successfully treated by combining radiologic microembolization followed by surgical extirpation of the vascular mass, without complication.

Adolescent↗
PubMed1987

Safety and efficacy of sodium and meglumine ioxaglate (Hexabrix) and Hypaque M60% in contrast-enhanced computed cranial tomographic scanning. A double-blind clinical study.

The safety and efficacy of sodium and meglumine ioxaglate (Hexabrix, Mallinckrodt, Inc., St. Louis, MO), a new low-osmolality contrast agent, and Hypaque Meglumine 60% (Wintrop-Breon, Inc., New York, NY) were compared for contrast-enhanced computed cranial tomographic scanning. Fifty-two patients with possible enhancing lesions of the brain received a total of 59 injections of either Hexabrix or Hypaque M60 in a double-blind, randomized fashion. Hexabrix was superior to Hypaque M60 in both subjective and objective patient tolerance. A lower incidence of heat and pain in patients receiving Hexabrix was believed to be related to its lower osmolality. Lesion enhancement with both Hexabrix and Hypaque M60 was excellent. There was a statistically significant increase in the degree of enhancement immediately after injection with Hexabrix. Hexabrix had less effect on the cardiovascular system than Hypaque M60. No neurologic complications or adverse reactions requiring treatment occurred in either group. Hexabrix is a suitable agent for intravenous contrast-enhancement for cranial CT.

Adult↗