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Biomedical subjects

R Kier

Publications and source records attributed to R Kier.

At least 37 records · Page 2Linked to original sources
PubMed1992

Submucosal uterine leiomyomas: diagnosis of prolapse into the cervix and vagina based on MR imaging.

OBJECTIVE: We describe the MR appearance, signs and symptoms, and pathologic findings in five patients with submucosal leiomyomas that prolapsed into the cervical or vaginal canal. SUBJECTS AND METHODS: During the past 3 years, five women aged 33-53 years (mean, 43 years) were identified prospectively at MR imaging as having prolapsing uterine leiomyomas. The diagnosis was confirmed by surgical pathology. MR imaging was performed on a 1.5-T unit, using both T1- and T2-weighted spin-echo or fast spin-echo sequences. The images were analyzed for signal intensity, presence of a stalk, and caudal extent of the prolapsed leiomyoma. RESULTS: These leiomyomas, the presence of prolapse, and the caudal extent of prolapse were detected prospectively on MR images in all five cases. Prospective localization of the stalk in two cases aided subsequent hysteroscopic resection. MR imaging correctly indicated the presence of hemorrhage in one, degeneration in a second, and the absence of these complications in two others. In the fifth case, a hemorrhagic focus in the distal tip of the leiomyoma was not detected on MR images obtained 3 days before surgery. CONCLUSION: MR imaging is useful for the diagnosis and characterization of uterine leiomyomas that have prolapsed into the cervical or vaginal canal.

Adult↗
PubMed1991

Sequelae of lateral ovarian transposition in irradiated cervical cancer patients.

Lateral ovarian transposition (LOT) is a useful technique for preserving ovarian function in "high-risk" premenopausal Stage I cervix cancer patients who undergo hysterectomy and subsequent postoperative whole pelvic radiation therapy. From 1978 to 1988, 38 FIGO Stage I cervical cancer patients underwent LOT as part of their initial operative procedure and 14 of these patients (37%) subsequently received pelvic radiation therapy (LOT + RT) because of pathological findings such as metastatic pelvic lymph node involvement or positive surgical margins (13 patients) or recurrent disease (1 patient). Ten (71%) of the 14 (LOT + RT) patients have maintained ovarian function with a median follow-up of 35 months. Preservation of ovarian function was directly related to the estimated scatter dose to the ovaries. For patients whose estimated ovarian dose was 300 cGy or less, only 1 of 9 patients (11%) underwent menopause, whereas 3 of 5 patients (60%) became menopausal if the ovarian dose was more than 300 cGy. The placement of the ovaries was also crucial for preservation of ovarian function, with 100% of the patients developing menopause if the ovaries were placed below the iliac crest. A major side effect of LOT was the development of symptomatic ovarian cysts in 7 (18%) of the 38 Stage I patients who underwent LOT. In the 24 patients who underwent LOT alone without RT, the incidence of symptomatic ovarian cysts was 25% compared to only 7% of the patients who underwent LOT + RT, although this difference was not statistically significant (p = .18).

Combined Modality Therapy↗
PubMed1991

MR appearance of painful conditions of the ankle.

Magnetic resonance (MR) imaging was performed in 60 patients with ankle pain who were suspected of having various soft-tissue or osseous abnormalities. Results of conventional radiographs had been normal or inconclusive. Soft-tissue disorders depicted by MR imaging included tendon and ligament tears, tendinitis, tenosynovitis, and plantar fasciitis. Osseous conditions demonstrated by MR imaging included osteochondritis dessicans, infarcts, bone bruises, stress fractures, tarsal coalition, and osteoid osteoma. The authors believe that MR imaging is useful in the assessment of a variety of painful ankle disorders.

Adult↗
PubMed1991

Plantar fasciitis: MR imaging.

The clinical presentation of plantar fasciitis may be mimicked by a number of other painful heel conditions. Thus, magnetic resonance (MR) imaging was used to develop objective morphologic criteria to establish a diagnosis of plantar fasciitis in eight patients. Sagittal T1-weighted and coronal intermediate and T2-weighted images of symptomatic and asymptomatic feet were obtained; additional sequences were used for symptomatic feet. Maximum thickness of the plantar fascia was significantly increased (P less than .0001) in patients with plantar fasciitis (sagittal, 7.40 mm +/- 1.17, and coronal, 7.56 mm +/- 1.01) compared with age- and sex-matched volunteers (sagittal, 3.22 mm +/- 0.44, and coronal, 3.44 mm +/- 0.53) and young male controls (sagittal, 3.00 mm +/- 0.8, and coronal, 3.00 mm +/- 0.0). Furthermore, nine of 10 feet with plantar fasciitis had areas of moderately increased signal intensity in the substance of the fascia. MR imaging may provide an objective assessment of the morphologic changes associated with plantar fasciitis, as well as assist in excluding other causes of heel pain.

Adult↗
PubMed1991

CT pelvimetry: the foveae are not an accurate landmark for the level of the ischial spines.

The most important distance measured during CT pelvimetry is the interspinous diameter of the pelvis as seen on axial scans, because most cases of obstructed labor occur at the level of the ischial spines. As the spines are difficult to identify on the anteroposterior digital scout radiograph, the fovea of the femoral head has been used as a landmark to determine the level of the appropriate axial slice. We assessed the accuracy of this landmark on CT scans in 23 women undergoing CT pelvimetry and in 20 nonpregnant women having pelvic CT scans. In each case the relationship between the level of the foveae and the level of the ischial spines was determined. True interspinous distances were measured and compared with the apparent interspinous distances at the level of the foveae. In none of the women were the ischial spines above the foveae. In 15 (65%) of 23 pregnant women and in seven (35%) of 20 nonpregnant women, the ischial spines were below the foveae. An incorrect scanning level led to an overestimation of interspinous distance by an average of 1.0 cm. We conclude that for CT pelvimetry, the fovea as seen on the anteroposterior digital radiograph is an inaccurate landmark for the level of the ischial spines.

Breech Presentation↗
PubMed1990

Renal masses: characterization with Doppler US.

The vascularity of indeterminate renal masses in 70 patients was investigated prospectively with duplex ultrasound. The peak-systolic Doppler shift frequency obtained from the renal mass was utilized to attempt distinction between benign and malignant lesions. With use of the criterion of a peak-systolic Doppler shift frequency of 2.5 kHz or greater as evidence of neovascularity, 26 of 37 malignant lesions demonstrated tumor signals (70% sensitivity). Thirty-one of 33 benign lesions lacked tumor signals (94% specificity). Both of the false-positive lesions were infections with inflammatory masses, with peak frequencies of 3.0 and 3.7 kHz. Tumor vascularity in most malignant renal mass lesions gives rise to abnormal, high-frequency, Doppler-shifted signals that can aid the differential diagnosis of renal masses.

Carcinoma, Renal Cell↗
PubMed1990

Pelvic masses in pregnancy: MR imaging.

The value of magnetic resonance (MR) imaging was assessed for 17 pregnant patients with sonograms suggestive of a pelvic mass. The MR imaging signal features improved lesion characterization in 47% (eight of 17) of cases, including two of four mature cystic teratomas of the ovary, three uterine fibroids, one solid ovarian tumor, one endometrioma, and a distended urinary bladder that had been mistaken for an ovarian cystic mass. Both MR imaging and sonography were accurate for the characterization of three ovarian cystadenomas and two simple ovarian cysts. On both MR images and sonograms, two simple ovarian cysts were incorrectly diagnosed as complex cystic masses and one teratoma was incorrectly diagnosed as a simple cyst. The origin of the pelvic mass (13 in the ovary, three in the uterus, and one distended urinary bladder) was accurately determined on 100% (17 of 17) of the MR images versus 71% (12 of 17) of the sonograms. In three cases, the results of MR imaging led to cancellation of surgery, which would have proceeded on the basis of the sonographic results alone. MR imaging is a valuable complement to sonography for preoperative evaluation of pelvic masses in pregnant patients.

Adolescent↗
PubMed1989

MR characterization of adrenal masses: field strength and pulse sequence considerations.

The authors evaluated the ability of magnetic resonance (MR) imaging at 1.5 T to characterize 28 adrenal masses, using several variables: signal intensity ratios (adrenal/liver and adrenal/fat) on T2- and T1-weighted images, and the calculated T2 relaxation time of the adrenal mass. Signal intensity ratios were unreliable in distinguishing adenomas from nonadenomas. The calculated T2 relaxation time was more useful: All 15 adrenal masses with a T2 of less than 60 msec were adenomas. A T2 greater than 60 msec was less specific and included six metastases, two pheochromocytomas, one adrenal carcinoma, two adrenal hemorrhages, and two nonhyper-functioning adenomas. Therefore, T2 values are more accurate than signal intensity ratios for characterization of adrenal masses at 1.5 T. The unsuitability of previously published criteria determined with 0.35- and 0.5-T systems may reflect the change of T1 and T2 relaxation times with field strength, altering the relative T1 and T2 weighting by a given pulse sequence.

Adenoma↗
PubMed1989

Surgical transposition of the ovaries: imaging findings in 14 patients.

Pelvic radiation therapy for cervical or vaginal cancer often leads to ovarian failure. To remove the ovaries from the radiation portal and preserve their function, they can be transposed to the lateral abdomen. Serial imaging studies in 14 patients who had undergone ovarian transposition (five bilateral, nine unilateral) were reviewed. Images obtained included 32 CT scans, 20 sonograms, and one MR image. Most transposed ovaries were located along the paracolic gutters near the iliac crests, creating an extrinsic mass effect on adjacent bowel. Detection of surgical clips on the ovary on CT scans allowed confident recognition of all 19 transposed ovaries. Cysts in the transposed ovaries, noted on most imaging studies, did not correlate with complications of pain or hormonal dysfunction. In one case, a large physiologic cyst in a transposed ovary distorted the cecum and was mistaken for a mucocele of the appendix. In another case, a large ovarian cyst was thought to be tumor recurrence or a lymphocele. These findings indicate that although the transposed ovaries can be recognized on CT scans by the surgical clips attached to the ovaries, the appearance of the ovary does not predict reliably the development of complications.

Adult↗
PubMed1988

High resolution computed tomography of the cadaveric sternoclavicular joint: findings in degenerative joint disease.

High resolution, narrow collimation, axial computed tomography of the sternoclavicular joint was used to describe changes secondary to degenerative joint disease in 32 cadaveric specimens. The distribution and pattern of sclerosis, cystic changes, and osteophyte formation in the axial plane were well demonstrated using this technique. Joint space narrowing was sometimes difficult to assess. Subtle joint space calcification was exquisitely demonstrated using computed tomography. Clavicular head cupping, an anatomic variant, may predispose to more severe degenerative change. Computed tomography is an excellent means to analyze the sternoclavicular joint for the presence of degenerative joint disease and may be the imaging modality of choice in assessing articular disorders of the sternoclavicular joint.

Adolescent↗
PubMed1988

Tumor vascular signals in renal masses: detection with Doppler US.

The vascularity of 49 renal masses (26 malignant and 23 benign lesions) was investigated with duplex Doppler ultrasound. Doppler signals obtained at the margins of renal masses were defined as "tumor signals" when the Doppler-shifted frequency of the lesion exceeded the frequency shift in the ipsilateral main renal artery. These exceeded 2.5 kHz with a 3-MHz insonating frequency. Among the 26 renal masses that subsequently proved to be malignant, tumor signals were obtained in 15 of 18 (83%) untreated renal cell carcinomas, in three of four Wilms tumors, and in two patients with metastases to the kidney, but not in the one patient with lymphoma. None of the 23 benign renal masses demonstrated tumor signals. Tumor vascularity in malignant lesions gives rise to abnormal, high-velocity, Doppler-shifted signals that can help in the differential diagnosis of renal masses.

Adolescent↗
PubMed1988

Nonpalpable testes in young boys: evaluation with MR imaging.

A prospective evaluation of magnetic resonance (MR) imaging for localization of a nonpalpable testis was performed in 24 boys aged 11 months to 6 years. Definitive surgical follow-up was obtained for 15 nonpalpable testes in 14 patients who form the basis of this study. MR imaging correctly indicated the unilateral absence of a testis in six of seven patients prospectively and all seven patients retrospectively. Surgically localized undescended testes were identified with MR imaging in five of eight cases prospectively and seven of eight cases retrospectively. Like scrotal testes, undescended testes were hypointense to fat on sequences with a short repetition time (TR) and echo time (TE) in all cases, and hyperintense or isointense to fat on long TR/TE sequences in all but two cases. Inguinal testes were located along the course of a linear low-signal-intensity structure that extended to the scrotum, which may represent the remnant of the gubernaculum testis. A low-signal-intensity band through the testis, presumably the mediastinum testis, was seen in five of the undescended testes. Although MR imaging can often be used to localize a nonpalpable testis, currently MR is not sensitive enough to allow complete exclusion of the diagnosis of an undescended testis; thus failure to localize a testis with MR imaging should not defer laparoscopy or surgical exploration when indicated.

Child, Preschool↗
PubMed1987

The radiographic distinction between pericardial and myocardial calcifications.

Calcification overlying the left side of the heart on a chest radiograph may involve either the pericardium or, alternatively, the myocardium in association with a left ventricular aneurysm. Distinction between these two conditions can be of great clinical significance. To identify distinguishing features, we reviewed the radiographs and medical records of 29 patients: 14 had proven calcific pericarditis and 15 had proven calcified left ventricular aneurysm. Pericardial calcification was found primarily over the right-sided cardiac chambers (14 of 14 patients) and in the atrioventricular grooves (11 of 14), infrequently over the base of the left ventricle (five of 14), and rarely over the apex of the left ventricle (two of 14). When the left ventricle was involved, there was always more extensive calcification elsewhere in the pericardium. Myocardial calcification occurred predominantly in the apex of the left ventricle (13 of 15 patients), although it was rarely confined to the posterior wall of the left ventricle (two of 15). By noting characteristic sites of calcium deposition, pericardial calcification can be effectively distinguished from myocardial calcification. Isolated calcification in the region of the left ventricular apex, therefore, strongly suggests left ventricular aneurysm.

Adolescent↗
PubMed1986

Basaloid-squamous carcinoma of the tongue, hypopharynx, and larynx: report of 10 cases.

Ten cases of an unusual form of carcinoma involving the mucosa and underlying tissue of the tongue, hypopharynx, and larynx are described. All ten of the tumors were evaluated by light microscopy; five were also studied by electron microscopy. The major histopathologic feature is carcinoma with a basaloid pattern in intimate association with squamous cell carcinoma, carcinoma in situ, or focal squamous differentiation. The basaloid tumor consists of small crowded cells with hyperchromatic nuclei, scant cytoplasm, small cystic spaces, and foci of tumor necrosis. Prominent hyalinosis is evident. Ultrastructurally, the basaloid epithelial cells possess rare tonofilaments and varying amounts of desmosomes. The cystic spaces contain either loose stellate granules or replicated basal lamina arranged in parallel stacks or globoid masses. This unique tumor was found to be highly malignant, with histologically proved metastases in 80 per cent of the cases. Most of the patients were treated by radical surgery supplemented with radiation and/or chemotherapy. It is concluded that tumors with these characteristic features constitute a distinct histopathologic entity, not previously described, for which basaloid-squamous carcinoma is an appropriate term.

Aged↗
PubMed1986

Osteoarthritis of the sternoclavicular joint. Radiographic features and pathologic correlation.

Osteoarthritis (OA) of the sternoclavicular (SC) joint has been extensively characterized in the pathology literature, but the radiographic appearance of this entity has received comparatively little attention. To define the radiographic patterns of OA at this joint, we used high resolution PA radiographs (industrial grade film) to examine 55 SC joints obtained by block resection at autopsy. Ten of these also were selected for coronal complex motion tomography. Fifty cases were histologically correlated. Radiographic and pathologic material was evaluated by four criteria characteristic of OA: joint-space narrowing, osteophytes, sclerosis, and cysts. Each criterion was independently assessed for severity and distribution. Moderate or severe radiographic changes of OA were uncommon in specimens younger than age 40, but present in 53% older than age 60. Changes were typically bilateral, although a mild degree of asymmetry was common. OA was most severe along the inferior portion of the clavicular head, which comprises its articulating margin with the sternum. Complex motion tomography was generally more accurate than plain radiography for assessing OA in the ten specimens in which comparison was performed.

Adolescent↗
PubMed1986

MRI with surface coils for parathyroid tumors: preliminary investigation.

The ability of MRI to detect parathyroid gland enlargement was assessed using 1.5-T systems and surface coil reception. Nine patients with primary hyperparathyroidism were studied before surgical neck exploration. Five-millimeter-thick axial images were obtained from the thyroid cartilage to the sternal notch. Both T1 and T2 contrast-weighted spin-echo sequences were performed in most cases. MRI correctly identified six out of seven parathyroid adenomas. In the false-negative case, T2 contrast-weighted sequences were not performed for technical reasons. In the one case of surgically proven parathyroid hyperplasia, a lesion identified by MRI as a parathyroid adenoma coincided at surgery with the largest of three hyperplastic parathyroid glands. A single case demonstrated a potential pitfall in the search for ectopic parathyroid glands: A large colloid cyst in the posterior portion of the thyroid gland showed signal characteristics indistinguishable from a parathyroid adenoma. The enlarged parathyroid glands were best visualized on T2 contrast-weighted sequences, with the lesions demonstrating greater signal than surrounding tissues.

Adenoma↗