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PubMed2002

Group for research in pathology education online resources to facilitate pathology instruction.

BACKGROUND: The Group for Research in Pathology Education (GRIPE) is an organization of pathology educators whose purpose is to promote and facilitate excellence in pathology education. One important function of GRIPE is the maintenance of image and multiple-choice test question data banks. These resources have recently been made available online via the GRIPE Digital Library Web site. The purpose of the GRIPE Digital Library project was to develop an online searchable database that would facilitate access to the GRIPE resources for pathology education. DESIGN: The GRIPE image bank--containing approximately 3000 peer-reviewed gross and microscopic pathologic images along with textual descriptions--was linked with the GRIPE test question bank using Gossamer Thread's DBMan Web database management program. The search and display templates create a functional user interface that integrates images, image descriptions, and test questions into a single online digital library. Using any Web browser, faculty can access the GRIPE Digital Library and search for images and/or test items that can be used in teaching. RESULTS: In the first 18 months (February 2000 through July 2001), users at 40 GRIPE member institutions signed up and used the GRIPE Digital Library to perform more than 6000 individual searches and view more than 37500 images. These digital images were used to produce lectures and laboratory modules that were posted on Web pages and made available to students remotely. CONCLUSIONS: The GRIPE Digital Library provides a unique resource that can facilitate development of educational materials for pathology instruction and helps to fulfill the educational mission of GRIPE.

Computer Communication Networks↗

PubMed2005

Adult tethered cord syndrome in patients with postrepair myelomeningocele: an evidence-based outcome study.

OBJECT: As patients with myelomeningocele age, tethered cord syndrome (TCS) in adults with postrepair myelomeningocele has become more common. The authors have structured an evidence-based review of the literature for the purpose of addressing the following questions. (1) How is the diagnosis made? (2) What is the natural history that occurs in adults with postrepair myelomeningocele and TCS? (3) What are the criteria for operative intervention? (4) What is the functional outcome for patients with postrepair myelomeningocele? METHODS: A computerized search of the National Library of Medicine of the English-language literature published from 1966 to 2003 was performed. Articles pertaining to the clinical aspects and management of postrepair myelomeningocele in adults, TCS in adults resulting from closed defects, and pediatric patients with postrepair myelomeningocele were reviewed. No Level 1 or 2 data were located; however, the search yielded Level 3 and 4 evidence in the literature in which the clinical syndrome, underlying pathology, and the imaging and electrophysiological evaluation for TCS in adults are discussed. CONCLUSIONS: Analysis of the available data indicates the following. (1) A lower lesion level predisposes patients to symptomatic tethering; moreover, orthopedic and urological deterioration will occur in the majority of these patients. (2) Tethered cord release should be considered for adult patients with postrepair myelomeningocele when clinical symptoms, imaging studies, urodynamics, and somatosensory evoked potentials are consistent with TCS. (3) Prompt, aggressive untethering surgery within 5 years of symptom onset, along with long-term follow up to check for delayed retethering, is recommended. The overall outcome for patients with postrepair myelomeningocele may not be as good as the outcome for adults with closed dysraphism.

Adult↗

PubMed2000

Plantar fasciitis and fascial rupture: MR imaging findings in 26 patients supplemented with anatomic data in cadavers.

Understanding of the normal anatomy of the plantar aponeurosis (PA) and familiarity with pathologic conditions are required for an accurate evaluation of the patient with subcalcaneal heel pain. In this study, we evaluated the diagnostic capabilities of magnetic resonance (MR) imaging in the assessment of the PA with close anatomic correlation. Herein, we describe the MR imaging features of plantar fasciitis and fascial rupture in 26 patients. High-spatial-resolution MR imaging was performed in four cadaveric feet, and a prescribed imaging plane was used for depiction of the peroneal component of the PA. MR imaging delineated the anatomy of the PA and perifascial soft tissues. The peroneal component was best visualized in prescribed sagittal oblique images. Perifascial edema was the most common finding of plantar fasciitis, and it was remarkable in those cases with acute fascial rupture. MR imaging reliably delineated the anatomy of the PA and may allow precise localization and definition of the extent of involvement in disease processes.

Adolescent↗

PubMed2004

Littoral cell angioma of the spleen: CT features with clinicopathologic comparison.

PURPOSE: To evaluate the clinical, pathologic, and computed tomographic (CT) features of littoral cell angioma of the spleen in eight patients. MATERIALS AND METHODS: Two abdominal radiologists retrospectively reviewed the contrast material-enhanced CT images obtained in six, the contrast-enhanced and nonenhanced CT images obtained in two, and the photographs of gross pathologic specimens resected from seven patients. They also retrospectively reviewed clinical data (ie, demographic data, presenting signs and symptoms, physical findings, and medical histories). Histopathologic specimens from the eight patients were reviewed by a hematopathologist. The CT images were reviewed for the presence of splenomegaly. The number, size, and enhancement characteristics of the splenic masses at CT were compared with the histopathologic and gross pathologic specimen findings. RESULTS: All patients had laboratory evidence of hypersplenism. Seven patients (88%) had splenomegaly and innumerable splenic masses ranging from 0.2 to 6.0 cm in diameter at CT. The single patient with a normal spleen size had four splenic masses. The splenic masses were hypoattenuating relative to the normal spleen at CT in all patients and correlated with blood-filled nodules at gross pathologic examination and with blood-filled vascular channels of littoral cell angioma at histopathologic examination. The early and late portal venous phase CT images that were available in one case demonstrated progressive homogeneous contrast enhancement of the masses such that they were indistinguishable from the normal splenic parenchyma. CONCLUSION: Littoral cell angioma is a primary splenic neoplasm that most commonly manifests at CT as multiple hypoattenuating masses in an enlarged spleen. Histopathologically, these masses represent blood-filled vascular channels.

Adult↗

PubMed1985

Improvements in the clinical utility of calculated T2 images of the human brain.

Magnetic Resonance Imaging (MRI) affords a considerable improvement in image contrast over other methods by virtue of the intrinsic NMR parameters spin density, T1, and T2. However, the clinical utility of routine quantification of these parameters is currently unknown. Calculated T2 images might afford additional disease specific information provided the calculation algorithm generates accurate T2 values. In this study, calculated T2 images of a MnCl2 phantom (spanning a T2 range of interest of 45.7 ms to 346.6 ms at 6 MHz) were generated utilizing a variety of calculation algorithms based upon a data set of 32 sequential spin-echo (SE) images. In general, when utilizing only the earliest sequential SE after the 90 degree pulse for the T2 calculation, the greater the number of SE used in the calculation algorithm, regardless of how they were averaged, the more accurate and less noisy was the calculated image. When only limited numbers of SE were used in the calculation algorithm, accuracy and noise varied with the choice of TE suggesting that there may be optimal timings for TE for a particular T2 range of interest. Forty-two calculated T2 head images of normal subjects, based upon data sets of 16 sequential SE, were evaluated for the T2 values of normal brain. These were compared to T2 images calculated via 7 different algorithms based upon 16 SE data sets from two patients with CNS pathology. An optimal algorithm was identified in which 16 SE Carr-Purcell-Meiboom-Gill (CPMG) were averaged into two images for the T2 calculation. With this algorithm, calculated images could be generated efficiently which were accurate and relatively noise free. The availability of such images maximized whatever disease specificity, and thus clinical utility, T2 information affords.

Brain↗

PubMed2006

Application of magnetic resonance virtual endoscopy as a presurgical procedure before sialoendoscopy.

OBJECTIVES: The objectives of this study were to investigate the feasibility of clinical application of magnetic resonance (MR) virtual endoscopy as a presurgical procedure before sialoendoscopy and to evaluate its value in the diagnosis of obstructive salivary gland diseases and preoperative visualization of endoluminal views. STUDY DESIGN: This study presents our initial experience to use MR virtual endoscopy for the presurgical visualization of salivary duct lumen and ductal pathologies in comparison to the sialoendoscopy findings in a feasibility study. METHODS: Six consecutive patients with suspected obstructive salivary gland diseases underwent MR sialography with a three-dimensional fast imaging using steady-state acquisition. The three-dimensional MR data were transferred to an independent workstation and were postprocessed with navigator software to generate three-dimensional reconstruction and virtual endoscopic images. The fly-through mode was used to imitate the sialoendoscopic exploratory procedure. Then the patients underwent sialoendoscopy and the endoscopic findings were compared with the preoperative virtual endoscopic images. RESULTS: The MR data acquisition and postprocessing protocol were feasible. The virtual endoscopy created clear endoluminal views of salivary duct and the ductal pathologies. The diagnoses were all confirmed by surgical sialoendoscopy. The virtual endoscopic images showed close resemblance to the sialoendoscopic findings. CONCLUSIONS: MR virtual endoscopy is an effective and noninvasive diagnostic method for evaluating the endoluminal anatomy and pathologies of the salivary duct. The clinical application of MR virtual endoscopy as a presurgical procedure before sialoendoscopy is a valuable and promising approach, which can provide surgeons useful morphologic and pathologic information.

Adult↗

PubMed2002

Feature-based, automated segmentation of cerebral infarct patterns using T2- and diffusion-weighted imaging.

Diffusion-weighted imaging enables the diagnosis of cerebral ischemias very early, thus supporting therapies such as thrombolysis. However, morphology and tissue-characterizing parameters (e.g. relaxation times or water diffusion) may vary strongly in ischemic regions, indicating different underlying pathologic processes. As the determination of the parameters by a supervised segmentation is very time consuming, we evaluated whether different infarct patterns may be segmented by an automated, multidimensional feature-based method using a unified segmentation procedure. Ischemias were classified into 5 characteristic patterns. For each class, a 3D histogram based on T(2)- and diffusion-weighted images as well as calculated apparent diffusion coefficients (ADC) was generated from a representative data set. Healthy and pathologic tissue classes were segmented in the histogram as separate, local density maxima with freely shaped borders. Segmentation control parameters were optimized in a 3-step procedure. The method was evaluated using synthetic images as well as results of a supervised segmentation. For the analysis of cerebral ischemias, the optimal control parameter set led to sensitivities and specificities between 1.0 and 0.9.

Algorithms↗

PubMed1998

[Suprarenal surgical pathology. Experience of 10 years and review of the literature].

OBJECTIVES: Our experience with 34 patients who underwent surgery of the adrenal gland over the last 10 years is presented. The most important clinical and pathological aspects are analyzed, particularly from the perspective of surgery, and the literature on the different pathologies observed in our series is reviewed. METHODS: A retrospective study was conducted to analyze the clinical features, analytical and hormonal data, imaging technique findings, types of anesthesia, surgical approaches, intra and postoperative morbidity and mortality, course of the disease, and pathological diagnosis. RESULTS: 53% were female. Mean age was 48.8 years. Left-sided involvement was more prevalent (70.7%). The most common pathology was adrenal adenoma (21 pts), followed by metastasis (4), cysts-pseudocysts (4), primary carcinoma (2), pheochromocytoma (1), etc. Hyperaldosteronism (16 pts) was the most common hormonal disorder; 2 patients had Cushing's syndrome, 2 virilizing syndrome, 1 pheochromocytoma, and 13 patients had a nonfunctioning tumor (3 were incidentalomas). The mean size and weight were 5.6 cm and 21.1 gm, respectively. Adenomas were the smallest tumors and those that weighed the least (mean 2.5 cm; 11.5 gm). Primary carcinomas were the largest tumors (mean 18 cm; 52 gm). US and CT were diagnostic in 56% and 100% of the cases and indicated the size of the mass correctly in 75% and 77%, respectively. Special anesthetic was required in 31%; nitroprusside, phenoxybenzamine, labetolol, corticosteroids and spironolactone were administered according to the hormone disorder. Lumbotomy via the 11th or 12th rib was the most common approach (58.7%), followed by the subcostal and transpleuro-diaphragmatic approach (14.7%, 11.7%, respectively), etc. The mean operating time was 162.2 min; adenoma of the adrenal gland required the shortest operating time (133.06 min), while carcinoma of the adrenal gland required the longest (405 min). Some type of intraoperative event arising from the hormonal disorder was observed in 44.2% of the patients. At 45.1 months mean follow-up, 70.5% of the patients were asymptomatic, arterial hypertension persisted in 11.7% and there were 5 deaths (all cases had a malignant tumor). CONCLUSIONS: The incidence of adrenal gland disease in our series is not unlike that reported in the literature. CT and complementary US are the diagnostic imaging techniques of choice. CT, moreover, has demonstrated a higher specificity. The surgical approach utilized was based on the pathological condition for which surgery had been indicated. The posterolateral and transpleurodiaphragmatic approaches were utilized for small tumors and no remarkable events were observed during the procedure. The anterior and combined approaches were utilized for large or bilateral tumors or obese patients. Our morbidity rate is not unlike that reported in the literature and basically depends on the chronic disease of the patient, type of hormonal disorder and size or malignant nature of the tumor.

Adolescent↗

PubMed1999

Dysplasia epiphysealis hemimelica of the scaphoid bone.

We report a rare case of dysplasia epiphysealis hemimelica (DEH) in the wrist of a 7-year-old boy. Clinical, radiological and histopathological manifestations are discussed. The correct diagnosis of DEH, however, was made by the confrontation of the radiological and pathological data. The radiologist should inform the pathologist correctly about the imaging findings in order to avoid misdiagnosis of the lesion as osteochondroma.

Carpal Bones↗

PubMed2006

Frameshift mutation in GJA12 leading to nystagmus, spastic ataxia and CNS dys-/demyelination.

Mutations in GJA12 have been shown to cause Pelizaeus-Merzbacher-like disease (PMLD). We present two additional patients from one family carrying a homozygous frameshift mutation in GJA12. Both presented initially with nystagmus. The older girl developed ataxia first, then progressive spastic ataxia. The younger boy suffered from severe sensory neuropathy. Magnetic resonance imaging (MRI) of both children showed progressive demyelination in addition to dysmyelination, and also characteristic brainstem abnormalities. In children with nystagmus, ataxia and dysmyelination, mutation analysis of GJA12 should be considered early, especially if inheritance is autosomal recessive.

Ataxia↗

PubMed1989

Inflammatory disorders of the vertebral column: seronegative spondyloarthropathies, adult-onset rheumatoid arthritis, and juvenile chronic arthritis.

A variety of inflammatory disorders may involve the spine and sacroiliac joint. Of these, the seronegative spondyloarthropathies (consisting principally of ankylosing spondylitis, psoriasis, Reiter's syndrome, and certain intestinal diseases), adult-onset rheumatoid arthritis, and juvenile chronic arthritis are particularly important. The imaging abnormalities accompanying these disorders, supplemented with some clinical and pathologic data, are the subject of this review.

Arthritis, Juvenile↗

PubMed2003

The CIP (comprehensive integrative puzzle) assessment method.

This paper describes a novel tool for assessment in medical education, the comprehensive integrative puzzle (CIP). The dual scoring system of the puzzle stresses the integrative elements of diagnostic thinking and clinical reasoning, while preserving the ability to discern proficiency in various disciplinary elements. The CIP has the format of an 'extended matching' crossword puzzle. Its answer sheet is a grid comprising rows and columns. The left-hand column contains diagnoses or brief clinical vignettes. To complete the cells of the grid the student is required to match, stepwise, the various 'disciplinary investigations' to the diagnoses or clinical vignettes. When the puzzle is completed each horizontal row reflects a coherent medical case. The completed horizontal rows reflect integrative ability (diagnostic thinking and clinical reasoning) and the vertical columns measure the student's proficiency in interpreting medical history data, physical examination findings, laboratory test results, ECG, imaging, special tests, pathology and pharmacology. The CIP has been well accepted by teachers and students during the last seven years at the Bruce Rappaport Faculty of Medicine in Haifa, and it has favorably affected both student assessment and teaching. The reliability of the test and its validity will be reported separately.

Cardiology↗

PubMed2005

The role of the sternocleidomastoid muscle flap for esophageal fistula repair in anterior cervical spine surgery.

STUDY DESIGN: A retrospective study was undertaken which evaluated the medical records and imaging studies of a subset of patients managed by the spine service at Jackson Memorial Hospital who were diagnosed with an esophageal perforation in the setting of spinal surgery. OBJECTIVE: To assess the safety and efficacy of a sternocleidomastoid muscle flap in the repair of esophageal perforation in the setting of anterior cervical spine surgery. SUMMARY OF BACKGROUND DATA: The management of an esophageal fistula in the setting of spine surgery is challenging and starts with a prompt and accurate diagnosis. In addition to broad spectrum intravenous antibiotics, several methods have been described to repair the fistula, which range from enteral tube feeding, direct repair, and/or repair with a local or free muscle flap. METHODS: The review encompassed medical records, discharge summaries, operative reports, and imaging studies. Data were gathered with specific attention to demographics, primary pathology, mechanism of esophageal injury, method of spinal stabilization, method of esophageal repair, and time to initiation of oral intake. Follow-up interviews were conducted either in-person or by telephone. RESULTS: Six patients were treated over the study period. There were 3 men and 3 women. The mean age was 52.8 years. Primary pathologies were penetrating trauma, blunt trauma (2 cases), degenerative disease (2 cases), and tumor. Mechanisms of esophageal injury were penetrating trauma, acute iatrogenic, chronic iatrogenic (3 cases), and intubation trauma. The time to diagnosis ranged from immediate to 10 months. The method of spinal stabilization was anterior autograft followed by posterior instrumentation in 4 of 6 patients. The method of esophageal repair was an inferiorly based sternocleidomastoid (SCM) flap in 4 cases, primary repair in 1 case, and esophageal diversion alone in 1 case. The time to oral intake averaged 59.2 days (range, 23-113 days) in those with a SCM flap versus 153.5 days (range, 119-188 days) in those treated without a flap. CONCLUSION: The use of an SCM flap for the repair of esophageal injury, in the setting of anterior cervical spine surgery, is a safe and effective tool. An SCM flap appeared to improve the time in initiating oral intake without any significant morbidity.

Adult↗

PubMed1999

[The diagnostic value of modelling the urinary bladder wall in women with pelvis minor tumors].

Basing on the authors' own observations and literature data diagnostic value of different imaging techniques was presented in differentiating pathologic changes deduced from deformations of urinary bladder walls. Modelling of the walls has proved to enable the localisation of the tumour without determining its character. The degree of modelling of urinary bladder wall, however, is proportionate to the size of tumour. In a considerable number of cases it was possible to exclude infiltration of the bladder wall or to show overgrowing it by neoplastic mass.

Adolescent↗

PubMed2004

Bladder tumors: dynamic contrast-enhanced axial imaging, multiplanar reformation, three-dimensional reconstruction and virtual cystoscopy using helical CT.

BACKGROUND: There have been few studies to evaluate the effects of helical CT on bladder tumor. This study was to evaluate the clinical applications of helical CT dynamic contrast-enhanced axial imaging, multiplanar reformation (MPR), three-dimensional (3D) reconstruction and virtual cystoscopy (CTVC) in bladder tumors. METHODS: The precontrast and four-phase postcontrast helical CT scans were performed in 42 patients with bladder tumors confirmed by conventional cystoscopy and pathology. MPR, 3D and CTVC images were generated from the volumetric data of the excretory phase. The results were then compared with the findings of conventional cystoscopy and surgery in a double-blinded mode. RESULTS: The sensitivity of the axial, 3D and CTVC images in detecting the bladder tumors were 90.8%, 76.9% and 95.4% respectively. The dynamic contrast-enhanced axial images could provide excellent intramural and extravesical information, and the accuracy in preoperative tumor staging was 87.7%. MPR could directly demonstrate the origin and extravesical invasions of the tumors and their relation to the ureter. 3D and CTVC images were useful for displaying the surface morphology of the tumor and the relationship between the tumor and the ureteric orifices, whereas CTVC could depict the tumors smaller than 5 mm that were not seen on the axial images. CONCLUSIONS: The combination of axial, MPR, 3D and CTVC images with helical CT can provide comprehensive information on bladder tumor.

Adult↗

PubMed1989

[Tumors of the pineal region: MRI aspects. Apropos of 20 cases].

MR imaging (0,5 T) was performed in twenty patients with a tumor of the pineal region (17 pathological correlations). To establish the place of this technique, MR imaging data are studied. There is a great variety of tumor types, but the signal of the tumor is usually non specific. The main indication of MR imaging appears to be the evaluation of the extension of the tumor before surgery.

Adolescent↗

PubMed1999

Disorders of cortical formation: radiologic-pathologic correlation.

The advent of newer imaging techniques, such as high resolution MR imaging and surface reconstructions of 3-dimensional data sets, has led to a greater in-vivo understanding of cortical malformations of the brain. The disorders of cortical formation are illustrated with routine imaging, surface reconstruction, and pathologic specimens.

Brain↗

PubMed1999

[Virtual endoscopy of the upper urinary tract based on contrast-enhanced MR urography data sets].

PURPOSE: To investigate the feasibility of reconstructing a virtual endoscopy from MR imaging data sets of the upper urinary tract. METHOD: The data obtained from 28 contrast-enhanced MR urographic examinations (5 normal; 23 pathologic) were post-processed to reconstruct a virtual ureterorenoscopy (VURS) using a threshold image segmentation. The visualization of the upper urinary tract was based on the acquisition of T1-weighted 3D gradient-echo sequences after intravenous administration of gadolinium-DTPA and a prior injection of low-dose furosemide. RESULTS: The employed MR urography technique created in all 28 cases a complete and strong contrast enhancement of the urinary tract. These 3D sequence data allowed the reconstruction of a VURS, even when the collecting system was not dilated. The best accuracy was provided by the MR urography sequences with the smallest voxel size. Moreover, the data acquisition based on a breath-hold technique has proved superior to that using a respiratory gating. Inside the renal pelvis, all calices could be assessed by turning the virtual endoscope in the appropriate direction. The visualization of the ureteral orifices in the bladder was also possible. All filling defects that were diagnosed by MR urography could be evaluated from the endoluminal view using the VURS. The exact characterization of the lesions based only on the assessment of the surface structure was difficult. CONCLUSION: A virtual endoscopy of the upper urinary tract can be successfully reconstructed using the data sets of high-resolution 3D MR urography sequences.

Adult↗