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M Atri

Publications and source records attributed to M Atri.

At least 37 records · Page 2Linked to original sources
PubMed1996

Anatomic variants of the biliary tree: diagnosis with MR cholangiopancreatography.

PURPOSE: To evaluate the accuracy of magnetic resonance (MR) cholangiopancreatography in the diagnosis of anatomic variants of the biliary tree. MATERIALS AND METHODS: In 171 patients, the anatomy of the biliary tree was evaluated with MR cholangiopancreatography. Two independent reviewers evaluated the presence of anatomic variants. Contrast material-enhanced cholangiography that was previously performed opacified the cystic duct in 77 patients and the bile duct bifurcation in 93 patients, and was chosen as the standard of reference in the diagnosis of anatomic variants. RESULTS: MR cholangiopancreatography demonstrated the cystic duct in 126 patients (74%). MR cholangiopancreatography showed a low cystic duct insertion in 11 patients (9%), a medical cystic duct insertion in 22 patients (17%), and a parallel course of the cystic and hepatic ducts in 31 patients (25%). The bile duct bifurcation was demonstrated in 139 patients (81%), and an aberrant right hepatic duct was demonstrated in 12 patients (9%). CONCLUSION: MR cholangiopancreatography is accurate in the diagnosis of anatomic variants of the biliary tree that may increase the risk of bile duct injury during laparoscopic cholecystectomy.

Bile Ducts↗
PubMed1996

Accuracy of sonography in the evaluation of calf deep vein thrombosis in both postoperative surveillance and symptomatic patients.

OBJECTIVE: The purpose of this study was to determine the accuracy and to assess the interobserver variability of compression sonography (CS) in detecting isolated calf deep vein thrombosis (DVT) in postoperative and symptomatic patients without clinical or contrast venographic indication of previous lower extremity DVT. SUBJECTS AND METHODS: A prospective double-blinded study was undertaken on 287 consecutive legs using contrast venography (CV) as the gold standard. One hundred seventy-nine legs were from the postoperative group, and 108 legs were from the symptomatic group. The CS technique was used to diagnose DVT, and color Doppler imaging was used only as a road map. Calves were examined while the patient was sitting. Also, interobserver agreement was measured in the CS evaluation of calf veins of another group of 54 symptomatic legs. RESULTS: Forty (22%) CVs and 13 (7%) CS examinations for calf assessment were indeterminate in the postoperative group as compared with 33 (30%) and 10 (9%) in the symptomatic group. The sensitivity, specificity, negative predictive value, and positive predictive value of CS in detecting calf DVT with or without extension to above-the-calf veins were 92% (confidence interval [Cl], 82-100%), 100%, 98% (Cl, 95-100%), and 100%, respectively, in the postoperative group and 86% (Cl, 72-100%), 96% (Cl, 90-100%), 94% (Cl, 87-100%), and 90% (Cl, 77-100%), respectively, in the symptomatic group. The sensitivity of CS was 92% (Cl, 81-100%) in the postoperative and 88% (CL, 65-100%) in the symptomatic group with isolated calf DVT. Of all calf muscular branch DVTs, 52% were detected by CS alone as compared with 21% seen on CV alone. The kappa value for the CS assessment of isolated calf vein DVTs was 0.60. CONCLUSION: Sonography is a highly accurate test with acceptable reproducibility for the detection of DVT in calf veins in both postoperative and symptomatic patients. Technically adequate calf assessment can be achieved in the majority of patients if the calf examination is performed with the patient sitting.

Adult↗
PubMed1996

A comparison of two injection protocols using helical and dynamic acquisitions in CT examinations of the pancreas.

OBJECTIVE: The patterns of pancreatic enhancement and their relation to various injection parameters remain largely unknown. The purpose of this study was twofold: to compare pancreatic enhancement obtained after high and low rates of i.v. injection of contrast medium and to compare image quality between helical and dynamic sequential CT examinations of the pancreas using optimized scanning parameters. SUBJECTS AND METHODS: One hundred patients were randomly allocated to undergo either a helical CT (HC) acquisition after contrast injection at 6 ml/sec or a dynamic sequential CT (DS) acquisition after contrast injection at 2 ml/sec. Both ionic and nonionic contrast material were used in each group. Pancreatic attenuation values were measured on each section in each patient and averaged for each group. Image quality and visualization of anatomic landmarks were scored by two independent reviewers who were blinded to the acquisition technique. RESULTS: Mean pancreatic enhancement was higher in the HC (61 +/- 17 H) than in the DS group (54 +/- 17 H) (p < .05). Peak pancreatic enhancement was similar in the HC (74 +/- 19 H) and DS (74 +/- 17 H) groups. In the HC group, the optimal pancreatic enhancement index was 47% versus 35% for the DS group. The time to peak enhancement was 39 sec in the HC group and 71 sec in the DS group. The optimal scanning interval was 13 sec in the HC group versus 21 sec in the DS group. Image quality was not significantly different between the protocols, but misregistration and motion artifacts were fewer on HC examinations. CONCLUSION: Overall pancreatic enhancement was higher in the HC group, but the faster rate of injection did not increase the peak pancreatic enhancement and decreased the optimal scanning interval (the interval of time during which pancreatic enhancement was greater than 60 H). Image quality was similar with both protocols.

Adult↗
PubMed1995

Bile duct obstruction and choledocholithiasis: diagnosis with MR cholangiography.

PURPOSE: To evaluate the accuracy of magnetic resonance (MR) cholangiopancreatography in the diagnosis of bile duct obstruction. MATERIALS AND METHODS: One hundred twenty-six patients with clinically suspected bile duct obstruction underwent MR cholangiopancreatography with heavily T2-weighted fast spin-echo sequences. Reviewers were blinded to clinical and imaging findings. RESULTS: Seventy-nine patients had biliary obstruction that was diagnosed with MR cholangiopancreatography in 72 patients for a sensitivity of 91%, specificity of 100%, and overall accuracy of 94%. Thirty-two patients had choledocholithiasis that was diagnosed with MR cholangiopancreatography in 26 patients for an accuracy of 94%, sensitivity of 81%, specificity of 98%, positive predictive value of 93%, and negative predictive value of 94%. Fourteen patients had malignant obstruction that was diagnosed with MR cholangiopancreatography in 12 patients for a sensitivity and a positive predictive value of 86%, specificity and negative predictive value of 98%, and accuracy of 97%. CONCLUSION: MR cholangiopancreatography is a noninvasive technique with excellent accuracy in the diagnosis of bile duct obstruction and its causes.

Adolescent↗
PubMed1995

Helical CT of the liver: value of an early hepatic arterial phase.

PURPOSE: To prospectively evaluate a dual-phase helical acquisition in computed tomography (CT) of the liver. MATERIALS AND METHODS: Two helical CT acquisitions were performed in 103 patients: hepatic arterial phase (HAP) 15 seconds after injection of 2 mL/kg contrast material at a rate of 6 mL/sec and the portal venous phase (PVP) 90 seconds after injection. Detection of focal liver lesions, vascular anatomic features, and perfusion abnormalities were assessed by two reviewers. Liver enhancement was also calculated on every section. RESULTS: Of 119 detected focal liver lesions, nine were seen during HAP only and 40 during PVP only. According to a 0-3 score, visualization of the arterial anatomic landmarks was better during HAP (P < .0001). Five right replaced and two left replaced hepatic arteries were visualized only during HAP. Parenchymal perfusion abnormalities were found in 32 patients during HAP and in four patients during PVP. CONCLUSION: A dual-phase acquisition depicted 8% additional focal liver lesions and outlined the entire vasculature of the liver.

Adult↗
PubMed1995

Diffuse uterine adenomyosis: morphologic criteria and diagnostic accuracy of endovaginal sonography.

PURPOSE: To determine the accuracy of endovaginal ultrasound (US) in the diagnosis of uterine adenomyosis and to evaluate the frequency of observed sonographic criteria. MATERIALS AND METHODS: Endovaginal US was performed in 100 consecutive women undergoing hysterectomy for a variety of benign and malignant conditions. Adenomyosis was diagnosed when a poorly defined area of abnormal echotexture (decreased or increased echogenicity, heterogeneous echotexture, myometrial cysts) was present in the myometrium. All endovaginal US findings were correlated with those from histologic examination. RESULTS: Endovaginal US depicted 25 of 29 pathologically proved cases of adenomyosis. Adenomyosis was correctly ruled out in 61 of 71 patients. Endovaginal US had a sensitivity of 86%, a specificity of 86%, and a positive and negative predictive value of 71% and 94%, respectively. Of the 25 patients with true-positive findings at US, the myometrium demonstrated heterogeneous and hypoechoic areas with or without the presence of cysts in 21 (84%) patients, hypoechoic areas with cysts in three (12%) patients, and heterogeneous areas within the myometrium in one (4%) patient. CONCLUSION: Adenomyosis of the uterus can be accurately diagnosed with endovaginal US with use of specific sonographic criteria.

Adult↗
PubMed1995

Comparison of helical and conventional computed tomography of the liver.

OBJECTIVE: To compare helical and conventional computed tomography (CT) of the liver in terms of enhancement (with different contrast media) and image quality, using optimal technique for each type of acquisition. PATIENTS AND METHODS: Of 218 consecutive patients referred to a tertiary-care hospital for CT of the liver, 166 were randomly assigned to undergo helical (79 patients) or conventional (87) CT. Fifty patients were excluded from the study because they were unable to hold their breath or were unable to cooperate or because they weighted more than 120 kg. Two other patients were excluded at the time of scanning because of a technical problem. Monophasic injections of contrast agent at 3 mL/second were given to patients undergoing helical CT and biphasic injections at 2 and 0.7 mL/second to patients undergoing conventional CT. The contrast media used were iothalamate meglumine, ioversol, iopamidol and iohexol. For each patient, liver enhancement over baseline attenuation was calculated for every slice, and time to peak enhancement was calculated. In addition, visualization of anatomic landmarks and image quality were scored by two independent reviewers. RESULTS: Minimum, maximum and mean liver enhancement were significantly greater in the group that underwent helical imaging (49, 62 and 55 Hounsfield units [HU] respectively) than in the group that underwent conventional imaging (36, 51 and 44 HU respectively) (Student's t-test, p < 0.0001). Similar differences were obtained when the results were analysed separately for each contrast medium. Image quality was not significantly different between the two acquisition modes. CONCLUSIONS: For computed tomography of the liver, monophasic injection of contrast medium at a high rate and helical acquisition (rather than biphasic injection and conventional acquisition) resulted in significantly better enhancement, without compromising image quality.

Adult↗
PubMed1994

Transvaginal US appearance of endometrial abnormalities.

A retrospective study was performed on a series of 44 patients who had undergone transvaginal ultrasound (US) before hysterectomy. The surgically proved endometrial abnormalities included cystic atrophy, cystic and adenomatous hyperplasia, polyps, and malignancy. The following endometrial findings were evaluated: endometrial thickness, echogenicity, smoothness or irregularity of the contour, definition of the contour, and the presence of cystic areas. Some overlapping features were present between the benign and malignant conditions. Although cystic changes were seen in 76% of benign conditions manifesting with endometrial thickening, cystic changes were also present in 24% of endometrial malignancies. In the majority of endometrial malignancies, the endometrial contour was poorly defined, but 40% of the cases manifested as well-defined endometrial thickening. Most endometrial carcinomas (88%) were either diffusely or partially echogenic, 12% were isoechoic, and there was no endometrial carcinoma that was purely hypoechoic. Although the presence of cystic changes favors a benign condition, malignancy cannot be reliably excluded. Malignancy should be considered in the presence of a poorly defined, irregular endometrium. Transvaginal US has a significant role in the assessment of the endometrium, and although it can help in the differentiation between some benign and malignant conditions, there remain some overlapping features.

Adult↗
PubMed1994

Endovaginal sonographic appearance of benign ovarian masses.

This article illustrates the different appearances of benign ovarian and paraovarian masses at endovaginal sonography. A retrospective study was performed of the records for 118 patients with 140 surgically proved benign adnexal masses, including dermoid cysts (n = 27), endometriomas (n = 40), epithelial inclusion cysts (n = 14), serous cystadenomas (n = 11), mucinous cystadenomas (n = 14), fibromas (n = 11), cystadenofibromas (n = 12), paratubal cysts (n = 5), hydrosalpinges (n = 3), and tubo-ovarian abscesses (n = 3). Preoperative diagnosis was made in 96% of the dermoid cysts on the basis of a hyperechoic attenuating component or multiple small horizontal interfaces and in 100% of uncomplicated fibromas on the basis of a hypoechoic attenuating mass. There was an overlap among the endovaginal sonographic appearances of the other condition.

Abscess↗
PubMed1994

Splenic vein thrombosis after splenectomy: frequency and role of imaging.

PURPOSE: To assess the frequency of splenic vein thrombosis (SVT) after splenectomy and its consequences on patient treatment. MATERIALS AND METHODS: A group of 183 consecutive patients who underwent splenectomy were evaluated. Of these patients, 119 underwent postoperative ultrasound (US) or computed tomography. RESULTS: SVT was diagnosed in 13 of 119 patients in the first 2 weeks after surgery. In these 13 patients, splenectomy had been performed for hematologic disorders (n = 12) or trauma (n = 1). Seven of the 13 patients were asymptomatic. After anticoagulant therapy, follow-up US of 12 patients showed resolution of thrombosis with no complications in 10 patients; two patients developed cavernous transformation of the portal vein. CONCLUSION: Since only 65% of patients underwent imaging, the true frequency of SVT could not be determined; however, it occurred in at least 7% of patients who underwent splenectomy. Routine Doppler US should be performed after splenectomy to allow early anticoagulant therapy in patients with SVT.

Humans↗
PubMed1994

Hypoechogenic embryologic ventral aspect of the head and uncinate process of the pancreas: in vitro correlation of US with histopathologic findings.

PURPOSE: To evaluate the hypothesis that hypoechogenicity of the embryologic ventral aspect of the head of the pancreas is due to diminished fat content. MATERIALS AND METHODS: Ultrasound and histopathologic findings in 13 pancreatic autopsy specimens were compared, and the prevalence of areas of hyperattenuation of the embryologic ventral aspect of the head of the pancreas at computed tomography (CT) was studied. RESULTS: In vitro examination of pancreatic autopsy specimens showed this variant in seven (54%) of the 13 specimens, and histopathologic correlation confirmed that there is diminished fat content corresponding to the hypoechoic portion of the head of the pancreas. This difference in attenuation was visible on 21 (22%) of 96 CT scans. There was a statistically significant (P < .05, r = .212) increase in the prevalence of this finding with increasing age. CONCLUSION: Hypoechogenicity of the embryologic ventral aspect of the head of the pancreas is due to diminished fat content. This difference in attenuation is also commonly seen on CT scans.

Adipose Tissue↗
PubMed1994

Diagnosis of choledocholithiasis: value of MR cholangiography.

OBJECTIVE: T2-weighted fast spin-echo MR imaging (MR cholangiography) of the right upper quadrant of the abdomen depicts the biliary tree in considerable detail. We studied the value of this procedure for detecting stones in the common bile duct in a series of patients with proved calculi. MATERIALS AND METHODS: MR images of 10 consecutive patients with stones in the common bile duct were retrospectively reviewed. The diagnosis of choledocholithiasis was proved by stone extraction in all cases. Axial, coronal, and oblique images were obtained by using heavily T2-weighted fast spin-echo sequences, and the images were processed by using a maximum-intensity-projection (MIP) algorithm and a commercially available multiplanar reformatting software. Two reviewers who were not blinded to the diagnosis analyzed hard copy images and reformatted images at the MR console. The rate of stone detection was evaluated for each acquisition plane. The mean stone/bile signal-intensity ratio and the number and size of stones were recorded. RESULTS: In all patients, the entire length of the extrahepatic bile ducts was visualized, and the diagnosis of choledocholithiasis could be made on the basis of findings on MR images. Eight stones, including two that were impacted in the ampulla, were located in the distal part of the common bile duct. On the hard copy films, the stones were visible in eight of 10 coronal images, six of 10 axial images, and four of 10 oblique images. On the three-dimensional (3D) MIP reconstructions, the stones were seen in five of the coronal sets and in six of the axial sets. The best results were obtained when the multiplanar reconstruction software was used: nine of the 10 coronal sets and eight of the 10 axial sets showed stones in the bile ducts. By use of a combination of 3D MIP and multiplanar reconstruction, choledocholithiasis was detected in all 10 patients. The mean signal intensity of the stones was 58 (range, 18-87). The mean stone/bile signal-intensity ratio was 0.15 (range, 0.05-0.24). CONCLUSION: In this preliminary study, we showed that MR cholangiography, based on T2-weighted fast spin-echo sequences, could be an important imaging technique for patients with suspected bile duct obstruction and equivocal sonography and/or CT results. However, a large prospective clinical trial is needed to confirm these results.

Cholangiography↗
PubMed1994

Accuracy of endovaginal sonography for the detection of fallopian tube blockage.

The patency of 814 fallopian tubes in 414 patients was evaluated by endovaginal sonography immediately prior to hysterosalpingography. In the 659 fallopian tubes that were normal with free spillage, endovaginal sonography did not reveal any tubal or peritubal abnormality (specificity 100%). Of the 64 fallopian tubes with definite hydrosalpinx on hysterosalpingography, only 22 were detected on endovaginal sonography (sensitivity 34%). Four of 57 (7%) fallopian tubes with definite proximal blockage on the hysterosalpingogram showed hydrosalpinx on the same side on endovaginal sonography, indicating the association of proximal and distal tubal blockages in a small group of patients with blocked fallopian tubes. This combination can only be detected by the addition of endovaginal sonography to hysterosalpingography. Ten of 11 (91%) hydrosalpinges in seven patients who underwent endovaginal sonography immediately after hysterosalpingography were detected by ultrasonography. Only two of these had been visible on pre-hysterosalpingography endovaginal sonograms. This would indicate that the poor sensitivity of endovaginal sonography for diagnosing hydrosalpinx is at least partly due to its lack of distention. We conclude that an abnormal endovaginal sonogram is highly predictive of the presence of a blocked tube, but endovaginal sonography has a poor sensitivity for the diagnosis of a hydrosalpinx detectable by hysterosalpingography. Endovaginal sonography would be useful to detect a combination of proximal and distal blockage in a subgroup of patients with tubal blockage.

Adult↗
PubMed1993

Spontaneous resolution of ectopic pregnancy: initial appearance and evolution at transvaginal US.

Spontaneous resolution of ectopic pregnancy (EP) diagnosed with transvaginal ultrasound (US) was confirmed in 13 patients from May 1990 to December 1991. These cases accounted for 24% of the total number of EPs seen in our institution during the same period. These EPs ranged in size from 1 to 3.5 cm, and the beta subunit of human chorionic gonadotropin (beta-hCG) level was less than 1,000 IU/L in all patients. The serum beta-hCG levels became undetectable in 3-45 days (mean, 15.8 days). All EPs had completely resolved at follow-up transvaginal US performed 10-63 days (mean, 30 days) after initial examination. A gestational sac was present in three of these patients, and various degrees of vascularity were detected in four. Four of the resolving EPs increased in size. Four of the nine EPs without detectable flow initially became mildly vascular during the course of resolution. The authors concluded that spontaneous resolution of EP is not an uncommon phenomenon and occurs more commonly in patients with less advanced and less vascular EPs and serum beta-hCG levels less than 1,000 IU/L. EPs can increase in size and become more vascular during their course of resolution.

Adult↗
PubMed1993

Ultrasonographic appearance of uterine lipoleiomyoma.

A uterine lipoleiomyoma in a 43-year-old woman is described and pathological correlation of the diagnosis provided. The lesion appeared in transabdominal ultrasonography (US) scans as highly echogenic areas producing the marked attenuation typical of a lipomatous tumour of the uterus. In this case US alone was specific enough to allow tissue characterization and establish an accurate preoperative diagnosis.

Adult↗
PubMed1992

Accuracy of transvaginal ultrasonography for detection of hematosalpinx in ectopic pregnancy.

The transvaginal approach has significantly improved the accuracy of ultrasonography for the detection of ectopic pregnancy. However, there has been limited emphasis given to determining the sensitivity of ultrasonography when a hematosalpinx was used as a specific finding to identify an ectopic pregnancy. The sensitivity of transvaginal ultrasonography was evaluated for the detection of a hematosalpinx defined as an "echogenic homogeneous or inhomogeneous, rounded or elongated structure" in a group of patients with surgically proven ectopic pregnancy. Retrospectively, transvaginal ultrasonography showed a hematosalpinx in 16 out of 18 (88.8%) tubal pregnancies. In 6/6 (100%) patients with a ruptured tube and 10/12 (83.3%) patients with an unruptured tube, a hematosalpinx was detected sonographically. A gestational sac with a live embryo was seen in 26.3% of these patients. The significance of identifying a hematosalpinx, predictability of rupture and implication in the treatment of ectopic pregnancy are discussed.

Adult↗