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[Painful shoulders. Clinico-echographic evaluation].

Painful shoulders are a frequent pathology and its specific diagnosis and therapeutic control are common challenges to medical professionals. To solve these problems a non invasive morphologic method of study--Real Time Ultrasonography--is presented. A standardized routine ultrasonographic technique using static and dynamic imaging was applied to the analysis of fifty patients whose clinical data suggested soft tissue pathology of that joint. Initial sonographic diagnostic data were compared with clinical signs and x-ray information and in some cases arthrographic and surgical observation as well. The utility of sonography in the therapeutic control was specially evaluated in a sub-group of twenty patients with clinical and ultrasonographic evidence of tendinitis or bursitis at that location and submitted to physiatric treatment. Sonographic criteria established in terms of echogenicity, dimensions and dynamic scanning performance are described and its value as diagnostic and therapeutic control tools are discussed. Our results suggest that real time ultrasonography is a useful method to confirm the diagnosis and could be indispensable to follow and control the therapeutic results in Painful Shoulders.

Bursitis↗

[Pathologic and X-ray features of primary malignant fibrous histiocytoma of bone--a report of 16 cases].

BACKGROUND & OBJECTIVE: Malignant fibrous histiocytoma (MFH) is a common soft tissue tumor, which rarely occur in the skeleton. Its histological origin still remains controversial. This study was to investigate the pathologic and X-ray features of primary MFH of bone, and provide reference for imaging diagnosis. METHODS: Clinical data and X-ray images of 16 MFH patients, treated from Jan. 1982 to Jun. 2002 in the First Affiliated Hospital of Soochow University, were analyzed retrospectively. RESULTS: Pathologic manifestations of the patients were malignant multinucleated giant cells, pleomorphic and bizarre form of the tumor cells, and wheel-spoke arrangement of the fibroblast-like cells. Pathologically, the tumor tissue was consisted of various kinds of cells, which were mainly fibroblasts and histiocytes. The principal X-ray manifestations included solitary osteolytic changes, cortical expansion around the tumor, the penetration of the cortex with soft tissue mass formation, slight periosteal reaction and pathologic fracture. CONCLUSION: The diagnosis of MFH mainly depends on pathologic examination and X-ray manifestations.

Adult↗

Method of help for the diagnosis of the temporomandibular joint internal derangements. Discriminant analysis applied to the temporomandibular derangements.

OBJECTIVE: The purpose of the study is to find an objective method of help for the clinician in the diagnosis of the pathology of the temporomandibular joint, different of the image methods habitually utilized until this moment. MATERIAL AND METHOD: This study is based initially on the data obtained of a sample of 1164 patients with symptoms and/or signs of pathology of the temporomandibular joint. Nine different and excluding diagnostic groups settled down, according to the classification of the American Academy of Orofacial Pain (AAOP), in collaboration with the International Headache Society (IHS). We realized magnetic resonances to the patients and were selected those that adjust to the clinical criterion and of diagnosis for the image, and could only in a diagnostic group. Finally 449 patients were selected, 390 women and 59 men. RESULTS: The results obtained (expressed in percentage of well classified cases) by means of the proposed method were: Arthrosis 98.9%, Anterior Disk Displacement with Reduction (ADDR) 87.5%, Anterior Disk Displacement without Reduction (ADD) 100%, Capsulitis 100%, Disk Immobile (DIN) 97.9%, Hypermobility Condylar (HC)95.8%, Lateral Displacement Without Reduction (LD) 100%, Pathology Muscular (PM)100%, Disk Hipomobile (DHM) 86.4%. CONCLUSION: The proposed method reaches a fine percentage of successes in the diagnosis of these processes good enough, through its effectiveness as for its cost and should be considered an alternative in the diagnosis of temporomandibular derangements.

Diagnosis, Computer-Assisted↗

Surgical management of recurrent pancreatitis in children with pancreas divisum.

OBJECTIVE: To analyze an institutional experience with pancreatitis in childhood to clarify the frequency of pancreas divisum in that patient population, the characteristics of pancreatitis in children with pancreas divisum, and the role of surgical management in their treatment. SUMMARY BACKGROUND DATA: The role of pancreas divisum in causing acute and relapsing pancreatitis and chronic, recurring abdominal pain is controversial. Although the anatomical abnormality is present from birth, most investigators have reported cases with onset of symptoms in adulthood. The reported pediatric experience with this disorder is small, and the natural history of pancreatitis in children with pancreas divisum has not been well elucidated. METHODS: A retrospective chart review of all children 18 years of age and younger with a discharge diagnosis of pancreatitis identified 135 patients treated in the authors' institution from 1978 to 1998. Ten patients were found to have anatomical variants of pancreas divisum associated with recurrent or chronic pancreatitis. The medical records of these patients were reviewed for data on the presentation, diagnostic findings, imaging studies, treatment, surgical findings, and pathologic findings in these children. Chart review and telephone calls were used to assess the current state of health in nine patients available for follow-up. RESULTS: Pancreas divisum was identified in 7.4% of all children with pancreatitis and 19.2% of children with relapsing or chronic pancreatitis. Patients had early onset of recurrent episodic epigastric pain and vomiting, at a mean age of 6 years. Three patients had a positive family history of pancreatitis and one was proven by DNA analysis to have hereditary pancreatitis. Pancreatitis was documented by elevated amylase or lipase levels, and endoscopic retrograde cholangiopancreatography was the method of diagnosis of pancreas divisum in all patients. Eight patients had complete pancreas divisum and two had incomplete variants. Eight patients underwent surgery to improve ductal drainage. Seven underwent transduodenal sphincteroplasty of the accessory papilla, along with sphincteroplasty of the major papilla in two (plus septoplasty in one). Three patients underwent longitudinal pancreaticojejunostomy, as a primary procedure in one patient with midductal stenosis and in two because of recurring pancreatitis after sphincteroplasty. The surgical findings and histologic examination of five patients undergoing distal pancreatectomy revealed striking changes of advanced chronic pancreatitis. Patients responding to sphincteroplasty alone showed less severe histologic changes. Overall, three of seven patients had excellent results, three were improved, and one had continued disabling attacks of pancreatitis. The mean duration of follow-up was 7.3 years, and there were no deaths. No patients had endocrine or exocrine pancreatic insufficiency, and none required chronic analgesics. CONCLUSIONS: Pancreas divisum is an important cause of recurrent pancreatitis in childhood and should be sought aggressively in children with more than one episode of pancreatitis or pancreatitis with a history of chronic recurrent abdominal pain. Surgical intervention is directed toward relief of ductal obstruction and may involve accessory duct sphincteroplasty alone or in combination with major sphincteroplasty and septoplasty. Patients with more distal ductal obstruction or ductal ectasia may benefit from pancreaticojejunostomy.

Acute Disease↗

Peripheral T-cell lymphoma: spectrum of imaging findings with clinical and pathologic features.

Most radiologists are unfamiliar with peripheral T-cell lymphoma (PTCL) because PTCL represents a relatively small proportion of lymphomas and has a lower prevalence in Western countries. The World Health Organization classification of lymphoid neoplasms announced in 1999 resolved criticisms about lymphoma classification and aroused new interest in PTCL. The specific clinicopathologic entities of PTCL have particular primary locations and particular clinical and pathologic features. Radiologic images of patients with pathologically proved PTCL were retrospectively reviewed; clinical and pathologic data were also reviewed. PTCL involves various organs including the sinonasal cavity, airway, intestinal tract, skin, lymph nodes, liver, lung, and musculoskeletal system. The pattern of disease involvement in PTCL is not random. There is a correlation between specific clinicopathologic entities and the primary site of involvement, although the findings in the disseminated stage of disease do not allow differential diagnosis. It is significant that the radiologic features or locations of several entities are different from those of lymphoma with the B-cell phenotype. Radiologic demonstration of disease progression beyond the primary site is clinically important because systemic dissemination in most of the entities leads to a dramatic change in the prognosis.

Adult↗

Lymph node staging in non-small-cell lung cancer with FDG-PET scan: a prospective study on 690 lymph node stations from 68 patients.

PURPOSE: To compare the accuracy of computed tomography-(CT) scan and the radiolabeled glucose analog 18F-fluoro-2-deoxy-D-glucose (FDG) positron emission tomography (PET) visually correlated with CT (PET + CT) in the locoregional lymph node (LN) staging of non-small-cell lung cancer (NSCLC). PATIENTS AND METHODS: Sixty-eight patients with potentially operable NSCLC underwent thoracic CT, PET, and invasive surgical staging (ISS). Imaging studies were read prospectively and blinded to the surgical and pathologic data. A five-point visual scale was used for the interpretation of LNs on PET. Afterwards, with knowledge of the pathology, the relationship between standardized uptake values (SUVs) and the presence of metastasis in LNs was explored in a receiver operating characteristic (ROC) analysis, and the likelihood ratios (LRs) for SUVs of LNs were determined. RESULTS: ISS was available for 690 LN stations. CT correctly identified the nodal stage in 40 of 68 patients (59%), with understaging in 12 patients and overstaging in 16 patients. PET + CT was accurate in 59 patients (87%), with understaging in five patients and overstaging in four patients. In the detection of locally advanced disease (N2/N3), the sensitivity, specificity, and accuracy of CT were 75%, 63%, and 68%, respectively. For PET + CT, this was 93%, 95%, and 94% (P = .0004). In the ROC curve, the best SUV threshold to distinguish benign from malignant LNs was 4.40. The analysis with this SUV threshold was not superior to the use of a five-point visual scale. The LR of a SUV less than 3.5 in an LN was 0.152; for a SUV between 3.5 and 4.5, it was 3.157; and for a SUV greater than 4.5, it was 253.096. CONCLUSION: PET + CT is significantly more accurate than CT alone in LN staging of NSCLC. A five-point visual scale is as accurate as the use of an SUV threshold for LNs in the distinction between benign and malignant nodes. The very high negative predictive value of mediastinal PET could reduce the need for mediastinal ISS in NSCLC substantially.

Adult↗

Influence of film digitization on radiological interpretation.

Our objective was to evaluate the influence of changing from analogue to digital imaging on interobserver and intraobserver image interpretation. Three radiologists interpreted 96 three image series of occipitomental radiographs of paranasal sinuses from the films and from the corresponding digitized images from the screen. Images were classified according to degree of abnormality as either normal, with mucosal thickening of less than 5 mm, with mucosal thickening of 5 mm or more, total opacity, air-fluid level or polyp or cyst of maxillary sinuses. In the present study we found that there were more differences between two radiologist's interpretations with a single method than in a single radiologist's interpretations between the methods, although radiologists interpreted fewer pathological findings from the digitized images than from the corresponding films. Our data show that the results of image interpretation are preferentially dependent on the reader rather than on the method of reading.

Adult↗

MR imaging of CSF-like choroidal fissure and parenchymal cysts of the brain.

The purposes of this study were to delineate the MR characteristics of CSF-like parenchymal or fissural cysts of the brain and to correlate them with the clinical findings. Clinical data and MR images of 34 patients with these abnormalities were reviewed. Pathologic correlation was not available. Two types of cystic lesions were identified and separated by location: medial temporal lobe cysts arising in or near the choroidal fissure (26 patients) and parenchymal or pseudoparenchymal cysts not related to the choroidal fissure (eight patients). The choroidal fissure cysts simulated intraparenchymal cysts on axial images but their extraaxial location was well portrayed on the coronal images. Choroidal fissure cysts had a characteristic spindle shape on sagittal images. The other cysts were found in the temporal lobe (seven patients) or thalamus (one patient) and appeared parenchymal but situated close to the subarachnoid space. These lesions were round or ovoid. There was no abnormal enhancement in 10 patients studied with gadopentetate dimeglumine. Coronal images were most useful, revealing the cysts as focal CSF-intensity lesions expanding the choroidal fissure of the temporal lobe. All the cysts appeared to represent incidental findings that did not correlate with the clinical signs and/or symptoms that prompted the imaging evaluations. The MR characteristics of CSF-like cysts are important to recognize so that they are not confused with other, more serious entities, such as intraaxial cystic tumors, infarctions, or parasitic lesions.

Adolescent↗

Glucagonoma and pseudoglucagonoma syndrome.

CONTEXT: Glucagonoma syndrome may present either associated with a pancreatic neoplasm which secretes glucagon or as a pseudo-glucagonoma associated with other diseases. It is extremely infrequent but well-known with a current prevalence estimated at 1/20,000,000. DESIGN: A retrospective review of glucagonoma and pseudoglucagonoma cases observed between January 1998 and December 2003 in three hospitals. PATIENTS: Five cases: 3 with a demonstrable glucagon-secreting tumor and 2 cases without an associated neoplasm. MAIN OUTCOME MEASURES: Age, sex, initial diagnosis, associated symptoms, and pathology were analyzed as were procedures employed in diagnosis, imaging studies, laboratory data, surgery and follow-up. RESULTS: Hyperglycemia and elevated plasma glucagon levels were found in all cases. In 3 cases, hypo-aminoacidemia and a descrease in fatty acids were found. No changes of zinc levels were observed. Abdominal ultrasound studies were of no value except in evaluating pancreatitis. A CT-scan was conclusive when a pancreatic neoplasm existed and 3 patients were operated on a curative basis. DISCUSSION: Necrolytic migratory erythema was the key diagnosis in all cases. Surgery was intended to be curative. The follow-up was of 8, 37 and 57 months in the cases of true glucagonoma syndrome. CONCLUSIONS: A real prevalence of glucagonoma syndrome could be greater than currently estimated. In our series, it was 13.5/20,000,000. Pseudoglucagonoma syndrome remains a rarity.

Aged↗

[Clinical characteristics of hepatic sinusoidal obstruction syndrome: analysis of 8 cases].

OBJECTIVE: To investigate the diagnosis and treatment of sinusoidal obstruction syndrome (SOS). METHODS: The data of 8 patients with SOS, including clinical manifestations, laboratory results, imaging, pathology, and the course of diagnosis and treatment were reviewed. All cases were followed up. RESULTS: The main clinical manifestations included abdominal distention, hepatalgia and signs of ascites and hepatomegaly. There were mild or moderate hepatocellular injury in 6 patients and heavy injury in 2. All patients' serum-ascites albumin gradient exceeded 11.1 g/L. The levels of CA125 in both serum and ascites elevated significantly. All patients' ultrasonography showed hepatomegaly, appearance of portal hypertension and attenuated hepatic veins. Reverse blood flow in portal vein was observed in 5 cases. Magnetic resonance imaging showed that contrast agent accumulated unevenly in liver in both portal period and lag period, but filled poorly in hepatic veins. Per cutsem liver biopsy showed that all patients' hepatic sinusoids were congested, but venular occlusion was observed in only 3 cases. Five cases had been misdiagnosed. One patient healed after liver transplantation, 4 patients recovered gradually by treatment with heparin and so on and 3 patients died. CONCLUSIONS: Signs of outstanding portal hypertension with mild hepatocellular injury is the main clinical feature of SOS. Both serum and ascites CA125 levels in SOS patients are elevated significantly. The misdiagnosis rate of SOS is quite high, ultrasonography and magnetic resonance imaging have significant value in diagnosis and differential diagnosis, while the value of per cutsem liver biopsy is limited. Combination of imaging and pathology should contribute to correct diagnosis of SOS. Application of anticoagulant in early course is vital, liver transplantation should be considered in severe cases.

Adult↗

MR imaging of CSF-like choroidal fissure and parenchymal cysts of the brain.

The purposes of this study were to delineate the MR characteristics of CSF-like parenchymal or fissural cysts of the brain and to correlate them with the clinical findings. Clinical data and MR images of 34 patients with these abnormalities were reviewed. Pathologic correlation was not available. Two types of cystic lesions were identified and separated by location: medial temporal lobe cysts arising in or near the choroidal fissure (26 patients) and parenchymal or pseudoparenchymal cysts not related to the choroidal fissure (eight patients). The choroidal fissure cysts simulated intraparenchymal cysts on axial images but their extraaxial location was well portrayed on the coronal images. Choroidal fissure cysts had a characteristic spindle shape on sagittal images. The other cysts were found in the temporal lobe (seven patients) or thalamus (one patient) and appeared parenchymal but situated close to the subarachnoid space. These lesions were round or ovoid. There was no abnormal enhancement in 10 patients studied with gadopentetate dimeglumine. Coronal images were most useful, revealing the cysts as focal CSF-intensity lesions expanding the choroidal fissure of the temporal lobe. All the cysts appeared to represent incidental findings that did not correlate with the clinical signs and/or symptoms that prompted the imaging evaluations. The MR characteristics of CSF-like cysts are important to recognize so that they are not confused with other, more serious entities, such as intraaxial cystic tumors, infarctions, or parasitic lesions.

Adolescent↗

[Value of molecular biology methods for diagnosis in bacteriology].

Progress in molecular biology has led to the development of new tools for bacteriological diagnosis. Sporadic genes coding for virulence factors can be detected with highly specific genetic probes applied to cultured bacteria. Such genetic probes can also be used to specifically identified cultured bacteria whose general taxonomic classification is known. Another advantage of molecular genetics is the possibility that the cell culture step may not be needed, bacteria being identified directly in the sample specimen. Such techniques are particularly interesting to identify bacteria which are difficult to culture (for example: Borrelia burgdorferi, Chlamydia trachomatis) or which grow slowly (mycobacteria). The bacterial DNA must be isolated and amplified with an enzyme reaction. This is a critical step in the method: several positive and negative controls are required. When performed under optimal conditions, amplification techniques are excellent methods which can offer results similar to culture methods in culturable bacteria. Finally, molecular biology can be used to identify previously cultured bacteria for which there is no taxonomic orientation. Here the ribosome 165 DNA must be amplified and sequenced. The sequence is then compared with a data bank allowing classification. One could image future techniques applied to certain pathology samples for the detection and identification of bacteria without need for a culture step. However, direct microscope examination and bacterial culture remain the basic methods for bacteriologic diagnosis, the advantages and disadvantages of molecular biology leading to its use a complementary method for improving the quality of the diagnosis.

Bacteriological Techniques↗

Application of three-dimensional power Doppler ultrasound in prenatal diagnosis.

OBJECTIVE: To assess the fetal cardiovascular system using three-dimensional power Doppler ultrasound (3D-PDU) in normal and abnormal conditions during the second half of gestation. SUBJECTS: Forty-five normal fetuses and 87 selected pregnancies with different abnormalities involving the vascular system were examined. METHODS: The following regions of interest were assessed: placental, umbilical, abdominal, renal, pulmonary and intracranial vessels together with the heart and great arteries. Equipment used was a commercially available HDI-3000 and 5000 ultrasound system with integrated 3D-Color Power Angio software. Data acquisition was performed by the free-hand technique. Images were reconstructed online. In pathological cases, a maximum of three attempts of 3D reconstruction was allowed to obtain the information needed. RESULTS: Satisfactory visualization of the fetal vascular system using 3D-PDU could be achieved in normal pregnancies. The main difficulty during the learning curve was the optimization of the power Doppler image prior to 3D data acquisition. Despite good visualization conditions, the reconstruction of satisfactory images was only possible in 56 out of the 87 (64%) pregnancies with abnormal vascular anatomy. These were abnormalities of placenta and umbilical vessels (n = 26), intra-abdominal and intrathoracic anomalies (n = 12), renal malformations (n = 9), central nervous system (n = 4) and cardiac defects (n = 5). The main reasons for the lack of information were fetal position and movements, overlapping with signals from neighboring vessels as well as technical limitations of the online system. Details and figures of the potential field of interest in prenatal diagnosis are presented.

Cardiovascular System↗

Initial experience with a new on-line transthoracic three-dimensional technique: assessment of feasibility and of diagnostic potential.

BACKGROUND: Despite its wide diagnostic potential, three-dimensional (3D) echocardiography is a quite rarely employed technique. The ideal method to obtain transthoracic 3D imaging is on-line 3D echocardiography, but first-generation real-time instruments had technical limitations. A new on-line 3D technology which allows true real-time volume rendering of the cardiac anatomy has been recently introduced and its feasibility and diagnostic advantages have been evaluated in the clinical setting. METHODS: The system utilizes a "matrix" transducer with a dedicated software. It allows instantaneous acquisition and rendering on-line 3D images and interactive manipulation of 3D data. Eighty-three adult patients with various cardiac pathologies underwent on-line 3D echocardiography. Long- and short-axis views of the aorta, mitral valve and left ventricle and surgical views of these structures were attempted. The duration of acquisition and reconstruction, and the quality and incremental clinical value of 3D images in comparison with two-dimensional imaging were annotated. RESULTS: The mean time of 3D examination was 10 +/- 5 min; the mean number of acquisitions was 10.8 per patient. The quality of the 3D images was optimal in 39%, good in 37%, sufficient in 19%, and insufficient in 5% of the patients. In all cases at least one optimal or good live 3D image was obtained from the parasternal and apical views. The reconstruction of surgical or en face views was easily and rapidly (1-2 min) achieved by two experts in 3D echocardiography. The additional clinical values of 3D vs two-dimensional imaging was demonstrated in 7 patients with mitral valve disease, 3 with aortic valve pathology, and 3 with congenital heart disease. Several on-line 3D images that have not correspondence with two-dimensional echocardiography were reconstructed, creating projections dedicated to the diagnostic goal. CONCLUSIONS: On-line 3D echocardiography can be easily performed in adult patients and allows for unique planes and projections. The instant rendering of 3D images facilitates the recognition of cardiac structures and increases the diagnostic potential of transthoracic echocardiography.

Adolescent↗

The role of brain infarcts and hippocampal atrophy in subcortical ischaemic vascular dementia.

We investigated if, in patients with vascular lesions, the variable that best discriminated demented from non-demented patients was the severity of the vascular pathology or the degree of hippocampal atrophy. A total of 39 patients multiple subcortical infarcts, who could be considered as possible vascular dementia with small vessel pathology, with underwent a neuropsychological study and brain magnetic resonance imaging (MRI) DSM IV criteria supported by neuropsychological data were used to distinguish demented from non-demented patients. The MRI study took into account the degree of hippocampal atrophy (hippocampal height and interuncal distance) and the severity of vascular pathology (number of brain infarcts). The distribution of lesions and a factor analysis showed that hippocampal atrophy is a better predictor of dementia than the number of brain infarcts. Multiple subcortical infarcts alone are probably not able to cause clinical dementia but the presence of vascular lesions increases the expression of concomitant Alzheimer's disease.

Aged↗

Brain imaging in the unsedated pediatric patient: comparison of periodically rotated overlapping parallel lines with enhanced reconstruction and single-shot fast spin-echo sequences.

BACKGROUND AND PURPOSE: Periodically rotated overlapping parallel lines with enhanced reconstruction (PROPELLER or PROP) is an effective means of compensating for head motion during MR imaging in adults. The aim of this study was to assess the value of this novel technique in unsedated children. METHODS: PROP T2-weighted fast spin-echo (FSE) imaging (TR/TE/NEX, 4000/83/2; 50 seconds) and T2-weighted single-shot FSE (SS-FSE) imaging (19,929/92/0.5; imaging time, 25 seconds) were performed in 35 unsedated children (mean age, 4.7 years +/- 4.2) who were undergoing brain MR imaging. Two observers assessed unlabelled images for motion artifact, other artifacts, visibility of pathology, and the preferred image overall. Sequences were compared by using the chi(2) test and concordant data from both observers. RESULTS: Both PROP and the SS-FSE imaging offered equal degrees of motion correction. Metallic artifacts were worse on PROP imaging, likely because of a higher receiver bandwidth (P <.001, chi(2) test). Pathology was present in 28 subjects and equally well seen on PROP and SS-FSE images. Overall, PROP was preferred, largely because of its improvements in image contrast (P <.001, chi(2) test). CONCLUSION: SS-FSE imaging and PROP provide equal motion correction, although PROP enables better assessment of the brain parenchyma.

Adolescent↗

Ultrasound image transmission via camera phones for overreading.

UNLABELLED: Emergency physicians using ultrasound frequently encounter unfamiliar findings during routine ultrasound examination. This is especially common for less experienced practitioners. OBJECTIVE: To compare high-resolution thermal printer ultrasound images and images recorded and transmitted via commercial camera cell phones. METHODS: This was a study comparing randomly selected images of actual ultrasound examinations performed in an academic level I ED with hospital-based emergency ultrasound credentialing. Two hospital credentialed emergency sonologists with extensive experience were asked to review 50 randomly selected images from actual patients as seen on a camera cell phone screen after being captured from a high-resolution thermal printout and sent to a similar phone. Reviewers recorded initial impression of the image and identified structures, measurements, and pathology. After hearing a brief clinical vignette, reviewer rated the images for image quality, detail, resolution, as previously defined, on a 10-point Likert scale. This process was then repeated with the original thermal printouts. Data were analyzed using descriptive statistics, agreement analysis, and the Student t test. RESULTS: Reviewers showed good interrater agreement for pathology and structure detection between phone and thermal printer images. There was no statistically significant difference in image quality, resolution, and detail between phone images and thermal printer images. However, there was statistically significantly increase in confidence in diagnosis for reviewers when using thermal printer images as compared with phone images, P = .003 and P = .02. Several phone images were felt to be suboptimal, and there was moderate agreement on these between reviewers. CONCLUSIONS: Ultrasound pictures recorded by one phone and then sent to another yielded images that showed no statistically significant differences from traditional high-resolution thermal printouts in image quality, detail, and resolution. Measurements were too small to be read on the camera phones, and reviewers had statistically significantly lower confidence in their diagnosis when using the camera phones to review images.

Cell Phone↗

True three-dimensional nuclear magnetic resonance neuro-imaging in ischemic stroke: correlation of NMR, X-ray CT and pathology.

True three-dimensional proton nuclear magnetic resonance (NMR) imaging was performed on an 84-year-old man following a recent cerebral embolic infarction. NMR data obtained using different pulse sequences were inter-correlated, stressing the significance of image appearance in terms of the NMR tissue parameters. Planes selected for display from the three-dimensional data set allowed optimal visualization of the pathology. Accurate correlations of the NMR data with X-ray computerized tomography scans and with subsequent autopsy findings indicate that NMR may play an important role in the detection and diagnosis of ischemic stroke.

Aged↗