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At least 307 records · Page 17Linked to original sources

PubMed2003

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↗

PubMed2004

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↗

PubMed2003

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↗

PubMed2005

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↗

PubMedDate not supplied

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↗

PubMed1999

Magnetic source imaging in stereotactic and functional neurosurgery.

Magnetic source imaging (MSI) combines the unique spatial and temporal functional accuracy of magnetoencephalography (MEG) with the anatomic and pathologic detail of magnetic resonance (MR). This relatively new method of evaluating brain function provides a preoperative mapping of brain function and brain structure by integrating the functional information of MEG with the structural information of MR. This results in data on actual neuronal interactions in clinical patients. The temporal and spatial accuracy of the MEG data, combined with the anatomic and pathologic specificity of MRI, results in the magnetic source image, which offers accurate knowledge of cortical functional organization, and is important in the surgical treatment of brain neoplasms, vascular malformations, and epilepsy. MSI allows the tracking of neuronal activity on the scale of milliseconds with millimeter accuracy, and continues to lead to new understanding of many functional brain disorders.

Action Potentials↗

PubMedDate not supplied

MR imaging of the vocal tract during vowel production.

Modeling of vocal tract behavior during speech production requires accurate measurements of the entire vocal tract. To accomplish this, magnetic resonance (MR) imaging was performed on a 0.5-T system with a custom-made, double-loop, wrap-around coil. A midsagittal section of the region from the glottis to the lips was imaged during sustained production of five American English vowels. A gradient-spoiled gradient-echo sequence was used to achieve a 4-second imaging time. Images showed clear profiles of the entire vocal tract and exhibited essential articulatory features of vowel production. It was possible to measure midsagittal widths at various points along the vocal tract with 1-mm resolution. The measurements were used to construct a tube model for prediction of the acoustic output of the vocal tract. It is concluded that risk-free MR imaging promises to be an important means of acquiring data for vocal tract modeling, with applications to speech pathology, linguistics, and artificial speech.

Humans↗

PubMed2001

Orbito-frontal epilepsy masquerading as temporal lobe epilepsy-a case report.

Temporal lobectomy fails to control seizures in a considerable percentage of patients who do not have hippocampal sclerosis. One theoretical reason for failure of surgery is that some of these patients may in fact have extratemporal epilepsy. We present a 28-year-old woman with clinical and scalp electroencephalogram (EEG) evidence of right temporal lobe epilepsy (TLE) supported by functional imaging with interictal positron emission tomography (PET) and ictal single-photon emission computerized tomography (SPECT). An invasive EEG monitoring was prompted by the discovery of a small right orbito-frontal lesion on MRI. Monitoring documented seizure onset at the lesion, with rapid right temporal involvement. The patient was almost seizure-free after a lesionectomy. The index of suspicion of orbito-frontal epilepsy should be high in patients with apparent TLE when the scalp EEG and neuroimaging data are not congruent, or if temporal lobe pathology cannot be identified on structural imaging.

Adult↗

PubMed1999

Spinal cord hamartoma: case report.

OBJECTIVE AND IMPORTANCE: Spinal cord hamartomas are infrequently mentioned in the literature. The authors present a unique report detailing the clinical presentation of a spinal cord hamartoma, with supporting radiographic and pathological data. CLINICAL PRESENTATION: A 26-year-old man presented with progressive right upper extremity weakness. Imaging studies revealed an exophytic cervical spinal cord mass. INTERVENTION: Open biopsy was undertaken and revealed tethering of the lesion to the dura. A pathological examination revealed a spinal cord hamartoma. CONCLUSION: The patient's symptoms improved postoperatively, suggesting that tethering of the spinal cord was responsible for the symptoms. Although unusual, hamartoma should be included in the differential diagnosis of an exophytic spinal cord lesion.

Adult↗

PubMed2006

An electromechanical model of the heart for image analysis and simulation.

This paper presents a new three-dimensional electromechanical model of the two cardiac ventricles designed both for the simulation of their electrical and mechanical activity, and for the segmentation of time series of medical images. First, we present the volumetric biomechanical models built. Then the transmembrane potential propagation is simulated, based on FitzHugh-Nagumo reaction-diffusion equations. The myocardium contraction is modeled through a constitutive law including an electromechanical coupling. Simulation of a cardiac cycle, with boundary conditions representing blood pressure and volume constraints, leads to the correct estimation of global and local parameters of the cardiac function. This model enables the introduction of pathologies and the simulation of electrophysiology interventions. Moreover, it can be used for cardiac image analysis. A new proactive deformable model of the heart is introduced to segment the two ventricles in time series of cardiac images. Preliminary results indicate that this proactive model, which integrates a priori knowledge on the cardiac anatomy and on its dynamical behavior, can improve the accuracy and robustness of the extraction of functional parameters from cardiac images even in the presence of noisy or sparse data. Such a model also allows the simulation of cardiovascular pathologies in order to test therapy strategies and to plan interventions.

Body Surface Potential Mapping↗

PubMed1998

Magnetic resonance imaging data in the evaluation of effects of functional electrical stimulation on knee joints of adolescents with spinal cord injury.

Diagnostic imaging, consisting of roentgenograms and magnetic resonance images (MRIs), was performed as part of an evaluation of the effects of a functional electrical stimulation (FES) program on the knee joints of 29 adolescents with spinal cord injuries following implantation of fine-wire intramuscular electrodes in their lower extremity muscles. The subjects underwent a regimen consisting of stimulated exercise, standing and/or walking. The effects of FES on knee joints were prospectively studied by reviewing diagnostic imaging data. Evaluation of MRIs and plain radiographs showed no evidence of knee joint pathology secondary to FES exercise or weight bearing. In fact, based on follow-up of MRI scan, many of the joints improved following participation in the program. The MRI data supported the clinical examination of the knee joints of these children. Clinical examination appears adequate for screening for potential knee joint problems.

Adolescent↗

PubMed2000

Three-dimensional ultrasound in the evaluation of fetal anomalies.

OBJECTIVES: To determine the additional information and clinical impact provided by three-dimensional ultrasound (3D US) imaging of fetal anomalies compared to conventional 2-dimensional ultrasound (2D US). MATERIALS AND METHODS: Sixty-three patients with 103 anomalies were scanned prospectively with both 2D and 3D US. Each anomaly was reviewed by one or more fetal imaging specialists to determine whether the 3D US data were advantageous, equivalent, or disadvantageous when compared with 2D US images. Clinical impact and pathologic or clinical outcome were determined in all cases. RESULTS: The 3D US images provided additional information in 53 anomalies (51%), were equivalent to 2D US images in 46 anomalies (45%), and were disadvantageous in four anomalies (4%). The 3D US was most helpful in evaluating fetuses with facial anomalies, hand and foot abnormalities and axial spine and neural tube defects. Planar images derived from 3D US volume data sets generally were more helpful for diagnostic purposes, whereas rendered 3D US images were more useful as a point of reference and were better appreciated by patients in understanding fetal abnormalities. Additional information provided by 3D US images impacted clinical management in 5% of patients. The 3D US images were disadvantageous in two fetuses with multiple anomalies and two with cardiac anomalies. CONCLUSION: The 3D US offered diagnostic advantages in about one-half of the selected cases studied and had effect on patient management in 5% of cases. This modality can be a powerful adjunctive tool to 2D US in providing a more comprehensible, 3D US impression of congenital anomalies. Thus, 3D US is currently most helpful as a targeted study complementing 2D US.

Congenital Abnormalities↗

PubMed1995

The impact of the inclusion of endorectal coil magnetic resonance imaging in a multivariate analysis to predict clinically unsuspected extraprostatic cancer.

BACKGROUND: The introduction of the endorectal coil magnetic resonance imaging (MRI) technique has improved the accuracy of preoperative staging for prostate cancer. This study quantifies the improvement in the ability to identify clinically unsuspected extraprostatic disease with the use of the endorectal coil MRI. METHODS: A retrospective review of the pathologic findings of 347 patients with prostate cancer treated with a radical retropubic prostatectomy was performed. The preoperative clinical indicators including prostate specific antigen (PSA), clinical stage, Gleason score, and endorectal coil MRI data were employed in a multivariate analysis to identify patients who were at high risk for seminal vesicle invasion (SVI) or extracapsular extension (ECE). The sensitivity, specificity, and positive and negative predictive values for predicting SVI and ECE were calculated using the significant clinical indicators found on the multivariate analysis. RESULTS: The clinical factors identified on multivariate analysis as significant predictors of SVI include the endorectal coil MRI data (P < 0.0001), PSA (P = 0.0096), and the Gleason score (P = 0.012). Endorectal coil MRI data (P < 0.0001), PSA (P = .0001), and Gleason score (P < .0001) were significant predictors of ECE. In the patient subgroup with PSA (> 10-20 ng/ml) and Gleason score of 5 to 7, the addition of the endorectal coil MRI data enabled an additional 71 and 27% of patients with SVI and ECE, respectively, to be correctly identified. These patients would have been missed based on the prediction obtained from the PSA and Gleason score alone. CONCLUSIONS: The use of the endorectal coil magnetic resonance imaging data, in addition to prostate specific antigen and Gleason score, provides a more accurate prediction of the pathologic outcome of seminal vesicle invasion and extracapsular extension than the PSA and Gleason score alone for the patient subgroup with a PSA of greater than 10 to 20 ng/ml and Gleason score of 5 to 7.

Adenocarcinoma↗

PubMed1982

Computed tomography of the normal adrenal gland. Pathologic implications.

Computed tomography of the adrenals from 100 selected patients and from adrenal models was used to investigate the morphology, anatomic relations, and transaxial imaging of the normal glands. The recorded data were correlated with the classical anatomy and with the relevant reports in the literature. A system of nomenclature which is felt to be best suited for describing normal and pathologic adrenals, besides being applicable to all specialties, is suggested. Some sources of diagnostic errors were disclosed by reviewing the concepts of the normal axial imaging in the light of pathologic adrenal characteristics.

Adrenal Glands↗

PubMed2007

Lack of correlation between cortical demyelination and white matter pathologic changes in multiple sclerosis.

BACKGROUND: Histopathologic studies have shown that subpial cortical demyelination is extensive in chronic multiple sclerosis (MS). OBJECTIVE: To study whether subpial cortical demyelination in MS is associated with focal or diffuse white matter (WM) pathologic features on magnetic resonance imaging (MR imaging). DESIGN: Comparison of postmortem MR imaging findings with histopathologic findings. SETTING: Brain donations from a general community. PATIENTS: Three patients with MS with extensive cortical demyelination and 3 patients with minor cortical demyelination were selected from an MS autopsy data set. The postmortem MR imaging and histopathologic data of the patients were compared. MAIN OUTCOME MEASURES: Two observers blinded to the results of each other assessed the presence, extent, and distribution of focal and diffuse pathologic changes in WM by MR imaging and by histopathology. RESULTS: Extensive subpial demyelination was not associated with a significant increase in the area of focal and diffuse WM pathologic changes as assessed by Luxol fast blue histochemistry or by MR imaging or with the presence or extent of juxtacortical abnormalities on MR imaging. CONCLUSIONS: The lack of association of MS gray matter demyelination with diffuse or focal WM changes indicates that gray matter demyelination in MS occurs largely independent of WM pathologic changes. The extent or distribution of WM abnormalities cannot be used to identify extensive cortical demyelination in the clinical setting.

Aged↗

PubMed1991

[Notes on the use of equilibrium radionuclide angiography in the study of diastolic ventricular function].

Diastolic ventricular heart failure, as an isolated pathologic process, recently assumed a great speculative interest and become a fashionable concept, although not so readily defined and understood. Gated blood pool radionuclide ventriculography allows the measure of parametric data which investigate the dynamics of ventricular filling volumetric changes. Radionuclide ventriculography presents peculiar characteristics of non geometric analysis with practically tridimensional approach to the study of ventricular imaging. The parametric data obtained are indicated to verify diastolic functional condition in many types of cardiovascular pathology, but present same practical limitations, due in part to the impossibility of a precise identification of the four fundamental components of diastole on time-activity curve. Keeping these limitations in mind, and also the incomplete definition of pathophysiological mechanism of diastolic derangement, nuclear cardiology still offers way of serially investigate diastolic function in many clinical settings. From a review of our preceding researches, the radio between maximal rates of diastolic and systolic ventricular volumetric changes (PFR/PER) is here considered. Purpose of this review is a deeper knowledge of radionuclide parameters which investigate the function and dynamics of ventricular filling.

Diastole↗

PubMed2006

[Parathyroid carcinoma: clinical case and review of the literature].

INTRODUCTION: Parathyroid carcinoma is a rare endocrine neoplasm, difficult to define clinically and histopathologically. CASE REPORT: The case concerns of a 20 years old male with situs viscerum inversus (with dextrocardia), and symptoms: asthenia, oliguresis, nausea, emesis, myalgia, lower limb paresthesia and very high levels of calcium and PTH. Laboratory findings (PTH 580 pg/ml; Ca 12.40 mg/dl; P 1.9 mg/dl), echography, TC, and parathyroid scintigraphy, associated with clinical data, have suggested hypothesis of parathyroid carcinoma confirmed by histological examination and immunochemistry. Surgery was efficacious with normalization of Calcium and PTH levels, and disappearance of symptoms. After two years no signs of local recurrence were present, but imaging show pulmonary micronodulations of uncertain pathological meaning. DISCUSSION AND CONCLUSION: No clinical or bio-humoral data allows a preoperative diagnosis of parathyroid carcinoma. Only with definitive pathology and immunohistochemistry it is possible to differentiate an adenoma from a carcinoma. Surgery is the only effective therapy and therefore should be always performed. This neoplasm usually relapses, locally first and later with distant metastases. For this reason after surgery the patients should always undergo a strict follow-up programme including evaluation of PTH and calcemia.

Adult↗

PubMed1994

Spiral computed tomography arterial portography with three-dimensional volumetric rendering for oncologic surgery planning. A retrospective analysis.

RATIONALE AND OBJECTIVES: Surgical resection of metastatic neoplasms of the liver can prolong survival of patients. The decision to resect a tumor depends to a great extent on the location of lesions relative to hepatic vasculature. Spiral computed tomography arterial portography (SCTAP) is an excellent technique for preoperative localization of tumors. The addition of three-dimensional rendering of image data sets should enhance the efficiency and accuracy of the interpretation of these data by the surgeon. METHODS: Fourteen patients with surgically and pathologically proven solitary and multiple metastatic hepatic neoplasms underwent SCTAP: Volume data sets thus derived were used to produce life-like three-dimensional animated images through a process known as volumetric rendering. These images were presented to the surgeon, who evaluated them based on several criteria. RESULTS: Accurate and clinically useful images were produced routinely in 13 of 14 patients. CONCLUSIONS: Clinical utility of three-dimensional rendering of SCTAP data sets for preoperative localization of hepatic lesions has been shown retrospectively. A larger, prospective study is suggested to demonstrate the accuracy and efficacy of the technique.

Adult↗