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Results for “pathological imaging data”

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PubMed1985

MR evaluation of Chiari I malformations at 0.15 T.

Twelve patients with known or presumed Chiari I malformations and two with clinical diagnoses of multiple sclerosis were examined by magnetic resonance (MR) imaging. MR confirmed or established the diagnosis of Chiari I malformation in all 14 cases. The spin-echo technique with a short time to echo (TE = 40 msec) and a short time to recover (TR = 1000 msec) provided optimum imaging of tonsillar position, hydromyelia cavities, and cervicomedullary "kinking." Long TE (greater than 80 msec) and TR (greater than 2000 msec) increase the signal intensity of cerebrospinal fluid and may obscure the pathology. Sagittal, transaxial, and coronal images provided complementary data; sagittal and coronal views best imaged the abnormal spinal cord and tonsils, but slitlike cavities were best seen on transaxial images. Cervicomedullary kinking was found in 10 (71%) of 14 patients and in 90% of the hydromyelic patients. This high incidence suggests that in other radiologic techniques tonsillar herniation masks the kinking. Symptoms of the Chiari I malformation overlap those of demyelinating diseases and brain tumors. Our early experience suggests MR is the preferred noninvasive procedure for identifying Chiari I malformation. Moreover, the ability to portray the variable cavity morphology of hydromyelia directly offers the potential for improved shunt placement.

Arnold-Chiari Malformation↗

PubMed1999

Combined magnetization transfer and proton spectroscopic imaging in the assessment of pathologic brain lesions in multiple sclerosis.

BACKGROUND AND PURPOSE: Conventional MR imaging of multiple sclerosis (MS) provides relatively poor pathologic specificity, which has led to the investigation of more sophisticated MR techniques. The purpose of this study was to combine magnetization transfer (MT) imaging and proton MR spectroscopic imaging (MRSI) to evaluate the specific pathologic features of myelination and neuronal integrity in patients with MS and to determine the relationship between these measures within plaques. METHODS: We acquired conventional MR, MT, and proton MRSI data and evaluated clinical disability in 30 patients with MS, whose conditions were categorized as relapsing-remitting, primary progressive, or secondary progressive. The lesions were classified, using a semiautomated edge-following technique, on T2-weighted MR images, and an analysis of MT and proton MRSI data was conducted for lesion regions as well as for tissue that was categorized as normal. RESULTS: The MT ratio (MTR) of normal-appearing white matter in the patients with MS was significantly lower than in the healthy participants, whereas gray matter values were unchanged. MS lesions showed a large reduction in MTR, with old lesions exhibiting a lower MTR than new lesions. The average lesion MTR and the MR spectroscopic imaging-measured relative concentration of N-acetylaspartate, a marker of neuronal integrity, was positively correlated in patients with relapsing-remitting MS. This relationship was strengthened in regions containing new lesions. CONCLUSION: The integrated use of MT and MR spectroscopic imaging provides a more complete description of the pathologic features of MS than does conventional MR imaging alone, and our data suggest that axonal damage occurs in step with new demyelination and is not a late feature of the disease.

Adult↗

PubMed1986

Magnetic resonance imaging of the breast: functional T1 and three-dimensional imaging.

Thirty-two patients with breast abnormalities and 10 normal volunteers were examined with magnetic resonance imaging (MRI) utilizing a 0.5-Tesla superconducting magnet imaging system. Sagittal, coronal, and transverse breast imaging with the 50-cm body coil and with a specialized 16 X 8 cm breast coil allowed the evaluation of a single breast. Soft-tissue contrast was clearly apparent using proton density-weighted, T1 weighted, calculated T1 images. In addition, the feasibility and potential clinical utility of three-dimensional color imaging was evaluated using computer-based interactive algorithms for edge detection of the breast and for abnormal structures within the breast. MR scan data were correlated with conventional xeromammography, ultrasound, clinical, data, and pathological specimens. In vivo and in vitro breast imaging was evaluated in a feasibility study. It was concluded that MR imaging is a most sensitive modality for the identification of breast lesions, especially when the adjacent normal tissue is primarily fat. There does appear to be significant overlap in soft-tissue contrast when the adjacent breast parenchymal tissue is fibrocystic in nature. The T1 parameter may be a relatively specific measure for identifying a malignant breast mass.

Adolescent↗

PubMed1999

[Brain imaging in AIDS].

Encephalic diseases remain an important problem in AIDS patients despite improvement in the rate of disease spread. We provide data on the current situation and describe the clinical, pathological and imaging features commonly observed in encephalic diseases in AIDS patients.

AIDS Dementia Complex↗

PubMed1997

Inflammatory pseudotumor of spleen. Report of two cases and literature review.

OBJECTIVE: We report two new cases of inflammatory pseudotumor of the spleen and review the cases reported to date. We discuss the diagnostic value of the clinical manifestations, the modern image technics and the laboratory data and conclude that only pathological and immunohistochemical studies allow a reliable diagnosis of this disease. DATA SOURCES: We have obtained the cases for the review through a computer search with the system SilverPlatter 3.11 (SilverPlatter Software Copyright NU 1992). The new cases have been obtained from our files. DATA SYNTHESIS: 53% were random findings (47% in the workup of another disease and 5% at autopsy). In the remaining cases, the clinical signs were not specific and none of the image technics could establish diagnosis. Neither fine needle aspiration nor laboratory data rendered conclusive results. Only pathological and immunohistochemical study after splenectomy allowed diagnosis. The clinical signs disappeared in all the cases following splenectomy and none of the patients have had recurrences. CONCLUSIONS: Inflammatory pseudotumor is a benign disease of unknown etiology and pathogenesis. It consists of solitary or multiple tumors that can affect virtually any organ. Clinical signs are non-specific. This lesion can render diagnostic problems with neoplasms of the lymphoreticular system. Splenectomy is diagnostic and curative.

Aged↗

PubMed1997

Disc pathology after whiplash injury. A prospective magnetic resonance imaging and clinical investigation.

STUDY DESIGN: This study was used to evaluate the relationship between magnetic resonance imaging findings and clinical findings after whiplash injury. OBJECTIVES: To identify initial soft-tissue damage after whiplash injury, the development of disc pathology, and the relationship of disc pathology to clinical findings. SUMMARY OF BACKGROUND DATA: Although a few studies have reported pathological magnetic resonance imaging findings after whiplash injuries, there is no prospective study published to our knowledge. METHODS: Thirty-nine patients, 20 women and 19 men with a mean age of 32 years, were treated for whiplash injury. Magnetic resonance imaging and clinical examination were performed in a blinded manner at a mean of 11 days after trauma. The procedure was repeated at a 2-year follow-up visit. Two patients could not be examined with the second magnetic resonance imaging because of claustrophobia and pregnancy, respectively. RESULTS: The authors found 13 patients (33%) with disc herniations with medullary (six cases) or dura (seven cases) impingement over the 2-year follow-up period. At the follow-up examination all patients with medullary impingement had persistent or increased symptoms, and three of 27 patients (11%) with no or slight changes on magnetic resonance imaging had persistent symptoms. No ligament injuries were diagnosed. CONCLUSION: Although disc pathology seems to be one contributing factor in the development of chronic symptoms after whiplash injury, it may be unnecessary to examine these patients in the acute phase with magnetic resonance imaging; correlating initial symptoms and signs to magnetic resonance imaging findings is difficult because of the relatively high proportion of false-positive results. Magnetic resonance imaging is indicated later in the course of treatment in patients with persistent arm pain, neurologic deficits or clinical signs of nerve root compression to diagnose disc herniations requiring surgery.

Adolescent↗

PubMed2005

Pathologic correlates of false positive breast magnetic resonance imaging findings: which lesions warrant biopsy?

BACKGROUND: Contrast-enhanced breast magnetic resonance imaging (MRI) is highly sensitive for breast cancer. However, adoption of breast MRI is hampered by frequent false positive (FP) findings. Though ultimately proven benign, these suspicious findings require biopsy due to abnormal morphology and/or kinetic enhancement curves that simulate malignancy on MRI. We hypothesized that analysis of a series of FP MRI findings could reveal a pattern of association between certain "suspicious" lesions and benign disease that might help avoid unnecessary biopsy of such lesions in the future. METHODS: A retrospective chart review identified women undergoing breast MRI between June 1995 and March 2002 with FP findings identified by MRI alone. Lesions were retrospectively characterized according to an MRI Breast Imaging-Reporting and Data System lexicon and matched to pathology. RESULTS: Twenty-two women were identified with 29 FP lesions. Morphology revealed 1 focus (3.5%), 5 masses less than 5 mm (17%), 11 masses greater than 5 mm (38%), 1 (3.5%) linear enhancement, and 11 (38%) non-mass-like enhancement. Kinetic curves were suspicious in 15 (52%). Histology demonstrated 20 (69%) variants of normal tissue and 9 (31%) benign masses. MRI lesions less than 5 mm (n = 6, 20.5%) were small, well-delineated nodules of benign breast tissue. CONCLUSION: Suspicious MRI lesions less than 5 mm often represent benign breast tissue and could potentially undergo surveillance instead of biopsy.

Adult↗

PubMed2004

Consider the diagnosis of splenosis for soft tissue masses long after any splenic injury.

Splenosis represents the autotransplantation of splenic tissue after splenic trauma or surgery. Disruption of the splenic capsule causes fragments of splenic tissue to be seeded mainly throughout the peritoneal cavity, where they are characterized by diffusely scattered bluish implants. Extraperitoneal locations are very rare and mainly include the thoracic cavity after thoracoabdominal trauma with simultaneous splenic rupture and diaphragmatic laceration. We retrospectively identified all patients in the pathology registry with the diagnosis of splenosis between December 1974 and July 2003 at our urban teaching hospital. Data collected included presenting signs and symptoms, history, imaging studies, treatment, pathology, and outcome. Five cases of splenosis were identified and described. Location of the splenosis was intraperitoneal in two and intrahepatic, intrathoracic, and subcutaneous in one each. In these cases, there was an average interval of 29 years between splenic injury and diagnosis, and most were found incidentally. One of the cases was managed entirely laparoscopically and another thoracoscopically.

Adult↗

PubMed1992

[Diagnostic imaging of chondroblastoma: a radiological, pathological and postoperative analysis of 58 cases].

Imageological data of 58 cases with chondroblastoma including plain radiographs in all cases, CT scan in 10 and scintigraphy of bone in 6 proved pathologically were reviewed and analysed. 33 cases were followed-up for 1 to 20 years after operation. The authors hold that plain radiograph is still the primary approach to assessment of this disorder. Position of the disease, calcification inside the focus, scalloping sclerotic rim and periosteal new bone formation frequently seen in metaphysis near the lesion are essential X-ray appearance. CT scan has some advantages in showing fine pathological fracture of cortex, subtel calcification, scope of involvement and recurrent signs in earlier stage, whereas bone scintigraphy is non-specific. The main factors of postoperative recurrence are incomplete curettage and more active biological behaviour of the tumor itself in part of cases. And some points for diagnosing chondroblastoma with atypical X-ray manifestations were also presented.

Adolescent↗

PubMed2001

Spectral imaging of multi-color chromogenic dyes in pathological specimens.

We have investigated the use of spectral imaging for multi-color analysis of permanent cytochemical dyes and enzyme precipitates on cytopathological specimens. Spectral imaging is based on Fourier-transform spectroscopy and digital imaging. A pixel-by-pixel spectrum-based color classification is presented of single-, double-, and triple-color in situ hybridization for centromeric probes in T24 bladder cancer cells, and immunocytochemical staining of nuclear antigens Ki-67 and TP53 in paraffin-embedded cervical brush material (AgarCyto). The results demonstrate that spectral imaging unambiguously identifies three chromogenic dyes in a single bright-field microscopic specimen. Serial microscopic fields from the same specimen can be analyzed using a spectral reference library. We conclude that spectral imaging of multi-color chromogenic dyes is a reliable and robust method for pixel color recognition and classification. Our data further indicate that the use of spectral imaging (a) may increase the number of parameters studied simultaneously in pathological diagnosis, (b) may provide quantitative data (such as positive labeling indices) more accurately, and (c) may solve segmentation problems currently faced in automated screening of cell- and tissue specimens.

Carcinoma, Transitional Cell↗

PubMed1998

Initial Experience with an Internally Rotating Transthoracic Three-Dimensional Echocardiographic Probe and Image Acquisition on a Conventional Echocardiogram Machine.

Three-dimensional echocardiography has required motorized external scanning devices that move a standard echo transducer to obtain data sets before reconstruction. These transducer holders are susceptible to axis alignment errors and transducer movement. The use of a three-dimensional workstation makes acquisition cumbersome. An internally rotating 5-MHz "omniplane" transthoracic transducer, specifically designed for three-dimensional echocardiography, and an integrated three-dimensional acquisition software package that allows single machine acquisitions were validated in 50 pediatric patients. Children were 1 day to 16 years old and had 22 different cardiac pathological conditions imaged. Ninety-eight of the 104 (94%) data sets collected were successfully reconstructed in three dimensions. Acquisitions took 3-6 minutes depending on the increment of internal rotation. Minimum total study time to set up and complete the acquisition was 12 minutes. The new probe and software makes three-dimensional acquisitions and reconstructions of consistently high quality, rapid, reliable, and user friendly.

Journal Article↗

PubMed2002

Accuracy of multiphasic helical computed tomography and intraoperative sonography in patients undergoing orthotopic liver transplantation for hepatoma: what is the truth?

OBJECTIVE: To determine the real value of liver imaging in cirrhosis by macro- and histomorphologic examination of the entire organ after orthotopic liver transplantation for hepatocellular carcinoma (HCC). SUMMARY BACKGROUND DATA: In comparative studies, a virtual sensitivity of up to 94% is described for helical computed tomography in HCC staging. The tumor detection rate of intraoperative ultrasonography (IOUS) is reported to be almost 100%. METHODS: This prospective observational study comprised 23 patients with HCC in cirrhosis admitted for orthotopic liver transplantation. Results of preoperative triphasic helical computed tomography (HCT) and IOUS were correlated with histopathologic results after 3-mm-slicing of the explanted liver. RESULTS: Overall, 179 liver segments were examined by HCT, IOUS, and MHM. Fifty-two malignant lesions and 10 dysplastic nodules were revealed by MHM. Using HCT, 13 HCCs could not be identified in 8 patients and 15 results were falsely positive in 10 patients. The detection rate of dysplastic nodes was 40% for HCT and 60% for IOUS. IOUS missed four HCCs in four patients and had six false-positive results in six patients. In a segment-based analysis, the overall accuracy of IOUS was significantly higher for IOUS (95.5%) versus HCT (89.9%). In the lesion-by-lesion analysis, the sensitivity was 92.3% for IOUS and 75.0% for HCT, with a significant difference. CONCLUSIONS: Correlation of explanted liver pathologic results offers precise evaluation of imaging modalities. The data of this histopathologically based study confirm that IOUS is significantly superior in staging HCC in cirrhosis versus CT, even after technical refinements through enhanced multiphasic high-velocity helical scanning.

Adult↗

PubMed2000

Correlation between quantitative EMG and muscle MRI in patients with axonal neuropathy.

The aim of the study was to investigate whether there are correlations between electromyography (EMG) data and findings in muscle magnetic resonance imaging (MRI). Quantitative EMG data and the amount of pathologic spontaneous activity (PSA) were compared with MRI signal intensities of the tibialis anterior muscles of 20 patients with axonal polyneuropathy and 14 healthy subjects. Using hierarchical regression analysis, the mean motor unit action potential (MUAP) size index (SI) and the amount of PSA were accurate predictors of T1-weighted signal intensity in MRI, an expression of fatty degeneration. The MUAP SI was superior to MUAP amplitude in explaining the variance of T1 signal intensity. Age was not a relevant factor. A high correlation was found between the amount of PSA and the T2-weighted signal intensity in short tau inversion recovery sequence. Magnetic resonance imaging demonstrates the structural changes and thus visualizes the outcome of the functional changes of denervation and reinnervation detected by EMG.

Action Potentials↗

PubMed2006

Monitoring primary breast cancer throughout chemotherapy using FDG-PET.

UNLABELLED: We have compared 2-deoxy-2-[(18)F]-fluoro-D-glucose positron emission tomography (FDG-PET) images of large or locally advanced breast cancers (LABC) acquired during Anthracycline-based chemotherapy. The purpose was to determine whether there is an optimal method for defining tumour volume and an optimal imaging time for predicting pathologic chemotherapy response. METHOD: PET data were acquired before the first and second cycles, at the midpoint and at the endpoint of neoadjuvant chemotherapy. FDG uptake was quantified using the mean and maximum standardized uptake values (SUV) and the coefficient of variation within a region of interest. Receiver-operator characteristic (ROC) analysis was used to determine the discrimination between tumours demonstrating a high pathological response (i.e. those with greater than 90% reduction in viable tumour cells) and low pathological response. RESULTS: Only tumours with an initial tumour to background ratio (TBR) of greater than five showed a difference between response categories. In terms of response discrimination, there was no statistically significant advantage of any of the methods used for image quantification or any of the time points. The best discrimination was measured for mean SUV at the midpoint of therapy, which identified 77% of low responding tumours whilst correctly identifying 100% of high responding tumours and had an ROC area of 0.93. CONCLUSION: FDG-PET is efficacious for predicting the pathologic response of most primary breast tumours throughout the duration of a neoadjuvant chemotherapy regimen. However, this technique is ineffective for tumours with low image contrast on pre-therapy PET scans.

Adult↗

PubMed1996

MR characteristics of histopathologic subtypes of spinal ependymoma.

PURPOSE: To examine MR characteristics and enhancement patterns of spinal ependymomas and compare these data with histopathologic subtypes. METHODS: The MR images from 26 cases of pathologically proved spinal ependymomas were evaluated with respect to seven criteria: signal characteristics, enhancement pattern, length of involvement, cysts or syrinxes, hemorrhage, bony changes, and type of cord expansion. Signal characteristics were then correlated with histologic subtype. RESULTS: In the category of enhancement pattern, our results differed markedly from published data, with only 38% of cases demonstrating classic homogeneous enhancement. The remainder of our cases (62%) demonstrated other enhancement patterns, including heterogeneous (31%), rim (19%), minimal (6%), and no enhancement (6%). Pathologic comparison revealed that one histologic subtype, the myxopapillary ependymoma, demonstrated unique imaging characteristics on T1-weighted images. A highly statistically significant percentage of this variant was hyperintense on T1, whereas most nonmyxopapillary ependymomas were hypointense. CONCLUSION: The radiologist should be aware of alternative patterns of enhancement of spinal ependymomas and not be dissuaded from the diagnosis in appropriate clinical settings. In addition, one histologic subtype, myxopapillary, often exhibits signal characteristics different from nonmyxopapillary types, appearing hyperintense on T1 probably because of their intracellular and perivascular accumulation of mucin.

Adult↗

PubMed2006

Does this patient with headache have a migraine or need neuroimaging?

CONTEXT: In assessing the patient with headache, clinicians are often faced with 2 important questions: Is this headache a migraine? Does this patient require neuroimaging? The diagnosis of migraine can direct therapy, and information obtained from the history and physical examination is used by physicians to determine which patients require neuroimaging. OBJECTIVE: To determine the usefulness of the history and physical examination that distinguish patients with migraine from those with other headache types and that identify those patients who should undergo neuroimaging. DATA SOURCES AND STUDY SELECTION: A systematic review was performed using articles from MEDLINE (1966-November 2005) that assessed the performance characteristics of screening questions in diagnosing migraine (with the International Headache Society diagnostic criteria as a gold standard) and addressed the accuracy of the clinical examination in predicting the presence of underlying intracranial pathology (with computed tomography/magnetic resonance imaging as the reference standard). DATA EXTRACTION: Two authors independently reviewed each study to determine eligibility, abstract data, and classify methodological quality using predetermined criteria. Disagreement was resolved by consensus with a third author. DATA SYNTHESIS: Four studies of screening questions for migraine (n = 1745 patients) and 11 neuroimaging studies (n = 3725 patients) met inclusion criteria. All 4 of the migraine studies illustrated high sensitivity and specificity if 3 or 4 criteria were met. The best predictors can be summarized by the mnemonic POUNDing (Pulsating, duration of 4-72 hOurs, Unilateral, Nausea, Disabling). If 4 of the 5 criteria are met, the likelihood ratio (LR) for definite or possible migraine is 24 (95% confidence interval [CI], 1.5-388); if 3 are met, the LR is 3.5 (95% CI, 1.3-9.2), and if 2 or fewer are met, the LR is 0.41 (95% CI, 0.32-0.52). For the neuroimaging question, several clinical features were found on pooled analysis to predict the presence of a serious intracranial abnormality: cluster-type headache (LR, 10.7; 95% CI, 2.2-52); abnormal findings on neurologic examination (LR, 5.3; 95% CI, 2.4-12); undefined headache (ie, not cluster-, migraine-, or tension-type) (LR, 3.8; 95% CI, 2.0-7.1); headache with aura (LR, 3.2; 95% CI, 1.6-6.6); headache aggravated by exertion or a valsalva-like maneuver (LR, 2.3; 95% CI, 1.4-3.8); and headache with vomiting (LR, 1.8; 95% CI, 1.2-2.6). No clinical features were useful in ruling out significant pathologic conditions. CONCLUSIONS: The presence of 4 simple historical features can accurately diagnose migraine. Several individual clinical features were found to be associated with a significant intracranial abnormality, and patients with these features should undergo neuroimaging.

Algorithms↗

PubMed1996

Human aorta: preliminary results with virtual endoscopy based on three-dimensional MR imaging data sets.

PURPOSE: To determine the feasibility of use of magnetic resonance (MR) imaging data sets to perform virtual intraarterial endoscopy (VIE). MATERIALS AND METHODS: Seven female and 14 male patients (aged 9-86 years [mean, 42 years]) with various pathologic aortic conditions underwent three-dimensional gadolinium-enhanced spoiled gradient-echo MR imaging. With prototype software, VIE postprocessing algorithms (based on ray casting) were applied to the imaging data sets. Findings at conventional angiography were used as the standards of reference. RESULTS: The vessel wall was seen from the inside in each case, and the following pathologic conditions were depicted clearly: the two lumina in a congenial double aortic arch and the single lumen after correction, vessel narrowing in coarctations, characteristics of Leriche syndrome, stenoses, occlusions, and the true and false lumina of dissections. CONCLUSIONS: Limitations of VIE include the image quality of the original data set, the threshold chosen to minimize intraluminal artifacts, and the inherent smoothing of vessel walls.

Adult↗

PubMed2005

Multislice computed tomography of the sternum: which image reconstruction do we need?

OBJECTIVE: To assess the diagnostic value and to optimize image reconstruction for multislice spiral computed tomography (MSCT) of the sternum. MATERIALS AND METHODS: Forty patients underwent MSCT of the sternum using a standardized examination protocol (4x1 mm or 4x2.5 mm collimation; 120 kV, 120 mAseff). Axial images with an effective slice thickness of 1.25 mm or 3 mm and an increment of 0.8 mm or 1 mm were reconstructed. Coronal and sagittal reformations with a slice thickness between 2 mm or 3 mm and 5 mm and a slice distance ranging from 1 mm to 4 mm (overlap 1 mm) were calculated. In all patients, additional plain film radiographs (n=9) or clinical follow-up data were available. Image quality was assessed visually using a five-point grading scale. RESULTS: In all patients, the correct diagnosis was established using multiplanar reformats (MPR) exclusively. Best image quality for MPR was achieved using a slice thickness of 3 mm and a slice distance of 2 mm. Images acquired with a 4x1 mm collimation proved superior to images reconstructed from data obtained with a 4x2.5 mm collimation. CONCLUSION: MPR from MSCT data are a valuable tool for the diagnosis of sternal pathologies. For best image quality the thinnest possible collimation should be chosen.

Diagnosis, Differential↗