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At least 397 records · Page 22Linked to original sources
PubMed2000

Central nervous system tuberculosis: imaging manifestations.

Tuberculosis of the brain is a disease of pathologic complexity and clinical subtlety-characteristics that manifest in the radiologic presentation of the disease and may make the task of interpreting radiologic data difficult. Much of the difficulty, however, reflects differences between the pathologic processes of tuberculosis and other infective diseases of the brain, and once these differences are appreciated, interpreting radiologic images becomes clearer.

Brain↗
PubMed1997

Digital radiographic imaging transfer: comparison with plain radiographs.

Advances in digital imaging and computer display technology have allowed development of clinical teleradiographic systems. There are limited data assessing the effectiveness of such systems when applied to urologic pathology. In an effort to appraise the effectiveness of teleradiology in identifying renal calculi, the accuracy of findings on transmitted radiographic images were compared with those made when viewing the actual plain film. Plain films (KUB) were obtained from 26 patients who presented to the radiology department to rule out urinary calculous disease. The films were digitalized by a radiograph scanner into ARCNEMA-2 file format, compressed by a NASA algorithm, and transferred via a 28.8-kbps modern over standard telephone lines to a remote section 25 miles away, where they were decompressed and viewed on a 1600 x 1200-pixel monitor. Two attending urologists and two endourologic fellows were randomized to read either the transmitted image or the original radiograph with minimal clinical history provided. Of the 26 plain radiographic films, 24 were correctly interpreted by the fellows and 25 by the attending physicians (92% and 96% accuracy, respectively) for a total accuracy of 94% with no statistical difference (p = 0.16). After compression, all but one of the digital images were transferred successfully. The attending physicians correctly interpreted 24 of the 25 digital images (96%), whereas the fellows were correct on 21 interpretations (84%), resulting in a total 90% accuracy with a significant difference between the groups (p < or = 0.04). Overall, no statistical difference between the interpretations of the plain film and the digital image was revealed (p = 0.21). Using available technology, KUB images can be transmitted to a remote site, and the location of a stone can be determined correctly. Higher accuracy is demonstrated by experienced surgeons.

Algorithms↗
PubMed1996

Morphometry in histopathology. An image analysis workstation for the pathology laboratory.

OBJECTIVE: To investigate the value of morphometry in comparative histologic analysis of diseases, fixing a set of parameters suitable for analysis and to create a general strategy for data storage and economical data management. STUDY DESIGN: To establish the following fundamental principles for morphometric measurements: (1) linear measurements to determine the distance between two points by using an eyepiece graticule with an engraved scale or alternatively with a ruler on a projected microscopic image or photograph; (2) Stereology based on geometric probability, allowing features in three dimensions to be measured from two-dimensional images; and (3) a computerized image processing and analysis system for image capture, storage and analysis using specialized software and hardware. RESULTS: Measurement procedures were demonstrated in different parameters using regenerative nodules of alcoholic cirrhosis as a model. Comparative analysis between primary biliary cirrhosis, alcoholic cirrhosis, posthepatitic cirrhosis and hepatocellular carcinoma showed the highest regenerative activity in posthepatitic cirrhosis. CONCLUSION: With current advances in computer technology, rapid, automatic measurements can be made from tissue sections and a variety of practical applications for the pathology laboratory, such as nuclear morphometry for comparison of different kinds of liver diseases, including classification of hepatocellular carcinoma.

Humans↗
PubMed2003

Role of computed tomography and magnetic resonance imaging in assessment of acute aortic syndromes.

Acute aortic syndromes refer to the spectrum of aortic emergencies that include nontraumatic diseases of the aorta, such as aortic dissection, intramural hematoma, penetrating atherosclerotic ulcer, aortic aneurysm leak, as well as traumatic aortic transection. Patients presenting with nontraumatic acute aortic syndromes usually have a similar clinical profile; hence, clinical diagnosis is difficult. Computed tomography (CT) and magnetic resonance imaging (MRI) allow for specific diagnosis of the underlying condition. Traumatic rupture of the aorta is one of the most dreaded complications of blunt chest trauma; therefore, in patients with high-risk deceleration injuries, radiographic assessment of the aorta is crucial. Imaging methods should detect even subtle aortic wall disruption and should provide a mechanism for communicating the findings to the surgical team. Noninvasive, cross-sectional imaging techniques have proven efficacy in the diagnosis of aortic pathology and have largely replaced aortography. Both CT and MR imaging provide aortogram-like reconstruction of the original data sets, and in addition to assessing the aortic lumen, permit detailed evaluation of the aortic wall, as well as comprehensive assessment of thoracic and abdominal viscera. This article addresses the role of different imaging modalities in assessment of acute aortic syndromes, with focus on CT and MRI, and with discussion of the key imaging findings that allow distinction among the various aortic pathologies.

Acute Disease↗
PubMed2005

Standardized volume-rendering of contrast-enhanced renal magnetic resonance angiography.

PURPOSE: To propose a technique for standardizing volume-rendering technique (VRT) protocols and to compare this with maximum intensity projection (MIP) in regard to image quality and diagnostic confidence in stenosis diagnosis with magnetic resonance angiography (MRA). MATERIAL AND METHODS: Twenty patients were examined with MRA under suspicion of renal artery stenosis. Using the histogram function in the volume-rendering software, the 95th and 99th percentiles of the 3D data set were identified and used to define the VRT transfer function. Two radiologists assessed the stenosis pathology and image quality from rotational sequences of MIP and VRT images. RESULTS: Good overall agreement (mean kappa=0.72) was found between MIP and VRT diagnoses. The agreement between MIP and VRT was considerably better than that between observers (mean kappa=0.43). One of the observers judged VRT images as having higher image quality than MIP images. CONCLUSION: Presenting renal MRA images with VRT gave results in good agreement with MIP. With VRT protocols defined from the histogram of the image, the lack of an absolute gray scale in MRI need not be a major problem.

Adult↗
PubMed2005

The Gail model predicts breast cancer in women with suspicious radiographic lesions.

BACKGROUND: We sought to evaluate whether a woman's 5-year Gail risk adds to the predictive value of the Breast Imaging Reporting and Data System (BI-RADS) classification for the detection of breast cancer. METHODS: We performed a retrospective review of the BI-RADS classifications and pathology results for all image-guided needle breast biopsy examinations over a 3-year period at our institution. The 5-year Gail risk was calculated for eligible patients. Chi-square analysis was used to compare rates of malignancy based on Gail and BI-RADS scores. RESULTS: A total of 632 image-guided needle biopsy examinations were performed in 609 women. A total of 414 women had suspicious (BI-RADS 4) lesions and underwent 424 biopsy examinations. For this subset, women with a Gail risk of less than 1.7% had 21% malignant results, whereas those with a Gail risk of 1.7% or greater had 42% malignant results (relative risk, 1.94; 95% confidence interval, 1.45-2.66). CONCLUSIONS: The Gail model can stratify further the risk for breast cancer in women with suspicious breast imaging reports.

Adult↗
PubMed2005

Site-select procedure for non-palpable breast lesions: feasibility study with a 15-mm cannula.

BACKGROUND: As screening mammography becomes more commonplace, increasing numbers of non-palpable breast lesions are being found. The aim of this prospective study was to evaluate the feasibility, utility, and patient-perceived cosmesis and satisfaction of the Site-Select procedure in women with non-palpable breast lesions. METHODS: Thirty-two consecutive patients underwent the Site-Select procedure, performed under local anesthesia by the same surgeon. The Site-Select procedure was included in a protocol for small (<15 mm) breast imaging reporting and data system (BI-RADS) grade 3 and 4 breast lesions. The pathologic diagnosis, specimen size, length of the procedure, perioperative and postoperative complications, subsequent interventions, patient satisfaction, and esthetic results were documented. RESULTS: The Site-Select procedure was successful in all 32 patients (mean age, 56 years; range, 44-79 years). Mammographic lesions corresponded to microcalcifications in 21 patients, microcalcifications with architectural distortion in 4 patients, microcalcifications with nodules in 2 patients, and architectural distortion alone in 5 patients. The Site-Select procedure was used on an outpatient basis. Carcinomas were diagnosed in five patients (15.6%). No complications occurred during the procedure. The only postoperative complication was a hematoma, which did not require surgical drainage. No missed cancers were detected by follow-up mammography (mean 8 months later; range, 1-18 months). The esthetic results and patient satisfaction were excellent. CONCLUSIONS: This study demonstrates that the Site-Select procedure is an effective diagnostic method in selected cases. It has a low complication rate, high patient satisfaction, and excellent esthetic results.

Adult↗
PubMed1994

Syndromes identified in fetuses with prenatally diagnosed cephaloceles.

An evaluation of all fetuses from our institution with prenatally diagnosed cephaloceles was conducted to determine the frequency and spectrum of genetic syndromes associated with this abnormality. Review of the sonographic images, postnatal autopsy or pathology reports, delivery room records, paediatric neurosurgical findings, radiographs, and cytogenetic data were collected. Fifteen postnatally confirmed cases of prenatally diagnosed cephaloceles and two misdiagnosed cases were identified. Thirteen were midline occipital lesions, one was frontoparietal, and one was frontoethmoidal. Excluding microcephaly, hydrocephaly, and distortion of intracranial anatomy, 9 of 15 (60 per cent) had other associated anomalies, including two fetuses with aneuploidy. The prenatal diagnosis of a cephalocele should initiate a thorough search for other abnormalities. In this series, there were three multifactorial, two chromosomal, two sporadic, and two autosomal recessive syndromes identified. An accurate diagnosis is critical in determining the prognosis and providing appropriate genetic counselling.

Abnormalities, Multiple↗
PubMed1992

A fast T1 algorithm.

Multispectral tissue classification using magnetic resonance T1, T2, and rho images may be useful in diagnosing and locating certain pathology. Techniques for generating the T1 images necessary for this classification scheme often require longer data collection and post processing times than are practical. As a consequence, further development of this classification scheme may be limited. This paper addresses an improvement in the post processing time required to generate T1 images. A nonlinear least-squares algorithm is described for rapidly generating spin-lattice relaxation time images from variable repetition time magnetic resonance images. The algorithm generates a 256 x 256 pixel T1 image from nine variable repetition time images in approximately 60 sec on a VAX-6510 computer.

Algorithms↗
PubMed1995

CT of the lungs in patients with pulmonary emphysema.

Pulmonary emphysema is a pathological diagnosis. The clinical diagnosis of emphysema can be difficult because correlations between results of lung function tests and the extent of emphysema are poor. Features of chronic bronchitis or asthma may overlap with emphysema, making the clinical diagnosis more challenging. Nonetheless, the diagnosis of pulmonary emphysema can be made with relative confidence on the basis of clinical and radiological criteria. Despite not detecting mild emphysema and underestimating the severity of disease, CT--and high-resolution CT in particular--is the best noninvasive modality for detecting or corroborating pulmonary emphysema. This review focuses on several important aspects of pulmonary emphysema: (1) the definition and pathological characterization, (2) techniques of CT imaging, (3) CT findings and their correlation with pathophysiological data, and (4) quantification with CT.

Humans↗
PubMed2004

Incidence of primary neoplasms in explanted lungs: long-term follow-up from 214 lung transplant patients.

BACKGROUND: Undetected neoplasms in explanted lungs at transplantation are an unusual occurrence that may significantly complicate both the short- and long-term outcome of these patients. The incidence and survival of undetected primary neoplasms in explanted lungs with clinical and radiologic correlation have not been studied in a large cohort of patients. METHODS: We reviewed the files of 214 consecutive lung transplants from the Transplant Center at the Cleveland Clinic Foundation from 1991 to 2000. Data collected included age, gender, pathology of explanted lung, and survival. Retrospective review of all imaging studies was performed in those cases where a primary neoplasm was detected after transplant. RESULTS: One hundred thirteen males and 101 females underwent lung transplantation for the following diagnoses: emphysema, 118; cystic fibrosis, 35; primary pulmonary hypertension, 27; usual interstitial pneumonia, 26; lymphangioleiomyomatosis, 4; sarcoidosis, 2; and pneumoconiosis, 2. Four neoplasms were found in the explanted lungs, representing a 2% incidence. All four neoplasms were bronchogenic carcinomas, including three adenocarcinomas and one squamous cell carcinoma. Three of four neoplasms were found in the setting of emphysema and were detected at an early stage (stage I), and the fourth presented as stage IV in the setting of usual interstitial fibrosis. No recurrence of tumor was seen in the stage I cases. The stage IV case died in the perioperative period. Retrospective review of the imaging studies showed that, in all four cases, a portable chest radiograph performed immediately before transplant failed to identify the lesions. A chest computerized tomogram was performed in all four cases from 3 to 27 months prior to transplantation and revealed a suspicious lesion in one of the four. CONCLUSIONS: Undetected neoplasms in explanted lungs at transplantation are uncommon, with an incidence of 2% at our institution. Adenocarcinoma was the most common cell type. In long-term survivors, no recurrences were found. The 3-year survival was 50% and this approaches the 3-year survival of transplant recipients without lung tumors (58.8%) at our institution. Chest radiographs appear to have a very low sensitivity for the detection of small lesions suspicious for a neoplasm. Chest computerized tomograms performed immediately prior to transplantation may be of benefit in detecting these neoplasms.

Adenocarcinoma↗
PubMed2001

Three-dimensional ultrasound in obstetrics and gynecology.

Three-dimensional ultrasound is a new modality finding its way into clinical practice. Most of the major ultrasound vendors are now developing three-dimensional ultrasound capabilities. We expect that although three-dimensional ultrasound will not replace two-dimensional ultrasound, many additional benefits will be identified and its use will continue to grow. The ability to evaluate anatomy and pathology with multiplanar and surface-rendered images provides physicians additional valuable clinical information. Volume data allows for a specific point in space to be evaluated from many different orienta tions by rotating, slicing, and referencing the slice to other orthogonal slices. It also allows for new volume-rendering displays that show depth, curvature, and surface images not available with conventional methods. The current limitations of image resolution, intuitive interfaces for obtaining and displaying optimal images, and technologic limitations for data storage and manipulation (including real-time three-dimensional ultrasound) will surely be overcome in the near future.

Female↗
PubMed1995

Nerve root compression by a ganglion cyst of the lumbar anulus fibrosus. A case report.

STUDY DESIGN: A case report of a ganglion cyst rising from the anulus pulposus, causing lumbar nerve root compression. OBJECTIVES: A rare pathologic condition causing sciatica is described. The pathologic anatomy and the magnetic resonance image of the lesion is discussed. SUMMARY OF BACKGROUND DATA: A 35-year-old man was subjected to an abrupt twisting motion of the torso during a motor vehicle accident. The patient had a L5-S1 discectomy 1 year before the accident. His low back discomfort and right lower extremity pain were clearly exacerbated by the recent trauma. METHODS: Magnetic resonance imaging revealed enhancing lobulated epidural mass displacing the S1 nerve. RESULTS: Intraoperative findings were a lobulated cystic mass rising from the degenerated anulus fibrosus, determined on histologic examination to be a ganglion cyst. The patient noted significant relief of the right sciatica after surgery. CONCLUSION: The appearance and the signal intensity of the epidural mass appear to be important parameters in diagnosing the presence of a ganglion cyst of the anulus fibrous. Excision of the ganglion cyst is indicated in a patient who fails to respond to conservative treatment and where the symptoms correlate with the abnormality seen with magnetic resonance imaging.

Adult↗
PubMed2005

MR quantification of the washout changes in breast tumors under preoperative chemotherapy: feasibility and preliminary results.

OBJECTIVE: The objective of our study was to describe and determine the feasibility of an MR washout quantification method in patients with breast cancer under preoperative chemotherapy. MATERIALS AND METHODS: Nineteen patients with breast T2 or T3 tumors were enrolled in a previous study for tumor response evaluation during chemotherapy based on dynamic contrast-enhanced MRI. We retrospectively used the dynamic acquisition data to produce parametric images representing the washout pattern. Two radiologists unaware of the final pathologic results measured the volume of pixels exhibiting washout within the tumor before chemotherapy (volume 1), after two courses of chemotherapy (volume 2), and before surgery after four courses of chemotherapy (volume 3). The interobserver variability and intraobserver variability were calculated to evaluate the reproducibility of our method with the Pearson's correlation coefficient and the concordance correlation coefficient. We correlated the washout changes by means of a Student's t test and noted the histopathologic final outcome. RESULTS: A washout pattern was present in all patients on the initial MR study. The quantification method of the washout changes was reproducible with good interobserver agreement (r = 0.85, p < 10(-5)) and an excellent intraobserver agreement (r = 0.94, p < 10(-5)). A significant decrease of the washout volume was observed after two courses of chemotherapy (p = 0.004), whereas no significant modification was observed between two and four courses of chemotherapy (p = 0.52). CONCLUSION: Quantification of the washout variation in breast tumor based on the use of parametric images is feasible and reproducible. It may add information to the evaluation of tumor response to preoperative therapy.

Adult↗
PubMed2007

Improvements in cancer staging with PET/CT: literature-based evidence as of September 2006.

PET/CT with 18F-FDG is increasingly being used for staging, restaging, and treatment monitoring for cancer patients. CT is still frequently used only for attenuation correction and lesion localization. However, increasing sales of high-end scanners that combine PET with 64-detector CT strongly suggest that the field is moving toward a comprehensive concept, whereby diagnostic CT studies during intravenous contrast material application are combined with the highest-quality PET studies. At many institutions, in-line PET/CT has replaced separately acquired PET and CT examinations for many oncologic indications. This replacement has occurred despite the fact that only a relatively small number of well-designed prospective studies have verified imaging findings against the gold standard of histopathologic tissue evaluation. However, a large number of studies have used acceptable reference standards, such as pathology, imaging, and other clinical follow-up findings, for validating PET/CT findings. From these data, we believe, has emerged reliable evidence in support of the notion that PET/CT offers diagnostic advantages over its individual components for the major cancers.

Clinical Trials as Topic↗
PubMed1993

[Experience with the combined diagnosis and therapy of locally advanced carcinoma of the uterine cervix (stage FIGO IIB-III). Transrectal ultrasonography and CT in the staging and in follow-up after therapy. Preliminary results].

The diagnosis, staging, therapy and follow-up of advanced epidermoid cervical carcinoma (FIGO stages IIB-III) have been studied in our university since January 1990. By December 1992, a team of specialists including radiologists, radiotherapists, gynecologists and pathologists divided 54 patients into two random treatment groups: group A patients, after systemic chemotherapy (CDP, 2 cycles) and diagnostic reevaluation, underwent radical surgery; group B patients received conventional radiotherapy alone (ERT 45 Gy+IRT or END-RT 20-25 Gy). All patients were examined by means of transrectal US (TRUS) and CT, after clinical examination under sedation, at staging and during the follow-up. The exams were performed periodically for group B patients and after systemic chemotherapy for group A patients. Imaging findings were compared with pathology only in group A. All imaging results were filed. The results confirm some literature data--e.g., 62% diagnostic accuracy for CT and 69% for TRUS, with higher diagnostic accuracy of the latter to evaluate cervical volume and to diagnose local relapses. As for parametrial involvement, both imaging methods tend to understage the early involvement, but only CT tends to overstage the lesions, especially in irradiated patients, due to fibrosclerosis phenomena. TRUS exhibited 69% accuracy, 70% sensitivity and 69% specificity, versus 61%, 62% and 60%, respectively, for CT; clinical examination under sedation had 58%, 60% and 60%, respectively. Both TRUS and CT are faster than endoscopic methods in evaluating vesical and/or rectal involvement. Lymph node metastases at staging, especially those in lumboaortic locations, proved to be unfavorable prognostic signs, as demonstrated by lumboaortic lymph node relapses in 5 group B patients (only 2 of them presented with lymph node metastases at staging; 3 patients had micronodules near the renal vessels), in spite of good local response after radiotherapy. In conclusion, we would like to point out that our team has had an MR unit at its disposal only recently: since the method is considered as the gold standard of imaging, especially in this kind of lesions, the study is still in progress.

Female↗
PubMed1998

[Sarcomatoid renal carcinoma].

OBJECTIVE: To analyze the pathological and clinical features of a variant of renal carcinoma: sarcomatoid renal carcinoma. METHODS: Of 316 patients diagnosed as having a renal tumor from 1975 to 1995, 11 (3.5%) with a pathological diagnosis of sarcomatoid renal carcinoma were analyzed. The clinical history, biological data and diagnostic imaging findings of these patients were reviewed. All patients had undergone surgical exploration. RESULTS: All the tumors showed a double cellular population, with a fusiform component. Histological analysis showed a high grade and stage tumor. Ten patients died from the disease, the mean survival rate was 9 months (range 2-48) following diagnosis. CONCLUSIONS: Sarcomatoid carcinoma of the kidney is uncommon and can be occasionally difficult to distinguish from sarcoma. It has a worse prognosis than other variants of renal carcinoma.

Aged↗