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Biomedical subjects

G Krinsky

Publications and source records attributed to G Krinsky.

27 records · Page 2Linked to original sources
PubMedDate not supplied

Tortuosity of the descending thoracic aorta simulating dissection on transesophageal echocardiography.

In an 80-year-old patient with syncope, a markedly tortuous descending thoracic aorta produced images on transesophageal echocardiography which were suggestive of an intimal flap caused by dissection. A magnetic resonance aortogram clearly showed that the trans-esophageal echocardiogram was a false positive. In addition, multiplanar reconstructed images of the magnetic resonance aortogram through the tortuous descending thoracic aorta could reproduce images similar to that seen by transesophageal echocardiography. Because transesophageal echocardiography has become a popular imaging modality for the detection of aortic dissection, it is essential for echocardiographers to be aware of possible pitfalls which may create false positive findings.

Aged↗
PubMedDate not supplied

CT diagnosis of ileal diverticulitis.

The preoperative diagnosis of ileal diverticulitis has been reported during small-bowel series when inflammatory changes are associated with ileal diverticula. Previous CT reports of this entity have failed to establish the specific diagnosis preoperatively. We report the CT findings in a patient with right lower quadrant pain that enabled the specific diagnosis of ileal diverticulitis to be made.

Diverticulitis↗
PubMedDate not supplied

Comparison between in-phase and opposed-phase T1-weighted breath-hold FLASH sequences for hepatic imaging.

PURPOSE: Our goal was to compare in-phase (IP) and opposed-phase (OP) sequences for GRE breath-hold hepatic imaging. METHOD: Non-contrast-enhanced IP and OP GRE breath-hold images were obtained in 104 consecutive patients referred for abdominal MRI at 1.0 T. For both sequences, the TR, FA, matrix, FOV, slice thickness, interslice gap, and measurements were kept constant. Images were compared quantitatively [liver/spleen and liver/lesion signal difference/noise ratio, (SD/N)] and qualitatively (artifacts, lesion detection and conspicuity, and intrahepatic anatomy). RESULTS: There was no statistically significant difference when comparing IP and OP sequences for liver/spleen and liver/lesion SD/N or for the qualitative parameters. In patients with fatty infiltration, the OP sequences yielded substantially lower values for liver/spleen and liver/lesion SD/N (0.9 and -1.2, respectively) than the IP sequences (20 and 17, respectively). Furthermore, in several cases with fatty infiltration, many more lesions were identified using IP images. CONCLUSION: The use of IP and OP GRE sequences provides complementary diagnostic information. Focal liver lesions may be obscured in the setting of fatty infiltration if only OP sequences are employed. A complete assessment of the liver with MR should include both IP and OP imaging.

Female↗
PubMedDate not supplied

Venous aneurysms: MR diagnosis with the "layered gadolinium" sign.

OBJECTIVE: Our goal was to present MR findings in venous aneurysms and introduce the "layered gadolinium" sign as an ancillary diagnostic finding. METHOD: Gadolinium-enhanced MR images of three patients with retroperitoneal venous aneurysms were retrospectively reviewed. Prior to MRI, venous aneurysm had been suspected clinically in only one patient. Surgical correlation was available in one patient. A phantom was constructed and imaged to investigate the cause of the layered gadolinium sign. RESULTS: A gradation of signal intensity, the layered gadolinium sign, was observed in three patients with venous aneurysms on postcontrast T1-weighted images. The anterior portion of the aneurysms demonstrated high signal intensity separated by a sharp interface from the low signal intensity posterior region. Unenhanced time-of-flight MR venography, color Doppler, and duplex sonography failed to demonstrate flow in the patient with surgical proof. CONCLUSION: The layered gadolinium sign may be helpful in the diagnosis of venous aneurysm and in differentiating these masses from solid neoplasms.

Aged↗
PubMedDate not supplied

Dynamic breath-hold 3D gadolinium-enhanced MRI of intraarterial masses: findings in two patients.

We describe the use of dynamic breath-hold gadolinium-enhanced 3D MRI for the evaluation of intraarterial masses and its potential use in differentiating thrombus from neoplasm. This rapid technique overcomes the flow artifacts that may obscure intraarterial masses on contrast-enhanced ECG-gated SE MR and can be performed on patients who otherwise cannot be ECG gated.

Aorta, Thoracic↗
PubMedDate not supplied

Gadolinium-enhanced 3D MRA of the aortic arch vessels in the detection of atherosclerotic cerebrovascular occlusive disease.

PURPOSE: Our goal was to evaluate non-breath-hold Gd-enhanced 3D MR angiography (MRA) for the detection of atherosclerotic occlusive disease of the aortic arch vessels and to compare image quality with two breath-hold techniques. METHOD: One hundred sixty consecutive patients with known or clinically suspected atherosclerotic cerebrovascular occlusive disease underwent Gd-enhanced 3D MRA of the aortic arch and great vessels. One hundred twenty-six examinations were performed with the body coil after infusion of 40 ml of Gd-DTPA; 89 of these were performed without breath-holding and 37 were acquired during suspended respiration. Thirty-four examinations were performed in a body phased-array coil with breath-holding, a timing examination, and 20 ml of contrast agent by manual (n = 17) or power (n = 17) injection. Images were evaluated for the presence of blurring and ghosting artifacts and venous enhancement. Of the 27 patients who underwent non-breath-hold MRI and digital subtraction angiography (DSA), two readers blinded to the DSA results retrospectively evaluated the MRA examinations for the presence of occlusive disease of the innominate, carotid, subclavian, and vertebral arteries. DSA correlation was not evaluated for the 71 breath-hold studies. RESULTS: Sensitivity and specificity for arch vessel occlusive disease with non-breath-hold MRA were 38 and 94% for Reader A and 38 and 95% for Reader B. Breath-holding significantly reduced blurring and ghosting artifacts (p < 0.001) when compared with non-breath-hold imaging, and use of 20 ml of contrast medium, with a timing examination, resulted in significantly less venous enhancement than seen with 40 ml (p < 0.001). CONCLUSION: Non-breath-hold Gd-enhanced 3D MRA is insensitive for detecting arch vessel occlusive disease. Breath-hold imaging, in conjunction with a timing examination and a lower dose of contrast agent, improves image quality, but further studies are needed to assess diagnostic accuracy.

Adult↗
PubMedDate not supplied

Interrupted aortic arch: diagnosis with gadolinium-enhanced 3D MRA.

PURPOSE: Our goal was to describe the use of gadolinium-enhanced 3D MR angiography (MRA) in the diagnosis of interrupted aortic arch (IAA). METHOD: A review of our MR data base from a 1 year period yielded three patients (1 day, 8 days, and 16 years old) with IAA. All were referred for evaluation of aortic arch abnormalities, only one of whom had suspected IAA. Patients were imaged at 1.5 T with a 3D spoiled gradient echo pulse sequence (TR/TE 3.8-8/1.3-2.7 ms) following the administration of intravenous gadolinium chelates. Surgical correlation was available in all cases. RESULTS: In the patient with clinically suspected IAA, a previously unsuspected aberrant right subclavian artery was identified that was not seen on preoperative echocardiography. In another patient with a history of previous mediastinal surgery, IAA was diagnosed without concomitant cardiac anomalies, suggesting surgical ligation. In the remaining patient, IAA was detected as well as a patent truncus arteriosus. CONCLUSION: Gadolinium-enhanced 3D MRA may provide for a rapid diagnosis of IAA that may not be possible with other noninvasive modalities. The rapid acquisition time enables unstable pediatric patients to spend minimal time in the MR suite.

Adolescent↗
PubMedDate not supplied

Spontaneous progression of ascending aortic intramural hematoma to Stanford type A dissection fortuitously witnessed during an MR examination.

Aortic intramural hematoma may occur as a primary event (spontaneous dissection without intimal flap) or secondary to a penetrating atherosclerotic ulcer. The management of intramural hematoma of the ascending aorta is somewhat controversial because of limited published data, but some centers advocate early surgical intervention. We describe a patient with an intramural hematoma of the ascending aorta that progressed to a classic communicating dissection during an MR examination. This case graphically demonstrates the potential instability of patients with intramural hematoma of the ascending aorta.

Aortic Dissection↗