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At least 433 records · Page 24Linked to original sources

[3D MRI of the colon: methods and initial results].

PURPOSE: "Exoscopic" and endoscopic identification of colorectal pathologies via MRI. METHODS: 5 patients (36-88 years), two normal and three with different colorectal pathologies (diverticular disease, polyps and carcinoma of the colon), were examined by MRI after colonoscopy. Subsequent to filling of the colon with a gadolinium-water mixture under MRI-monitoring, 3D-data sets of the colon were acquired in prone and supine positions over a 28 sec breath hold interval. Subsequently multiplanar T1-weighted 2D-sequences were acquired before and following i. v. administration of Gd-DTPA (0.1 mmol/kg BW). All imaging was performed in the coronal orientation. The 3D-data were interactively analysed based on various displays: maximum intensity projection (MIP), surface shadowed display (SSD), multiplanar reconstruction (MPR), virtual colonoscopy (VC). RESULTS: All of the colorectal pathologies could be interactively diagnosed by MPR. On MIP images some pathologies were missed. VC presented the morphology of colon haustra as well as of all endoluminally growing lesions in a manner similar to endoscopy. The colon masses showed uptake of contrast media and could thus be differentiated from air or faeces. CONCLUSION: The potential of CMRI in colorectal diagnosis warrants further investigation in a larger series of patients.

Aged↗

Risedronate in the treatment of Murine Chagas' disease.

Risedronate, a bisphosphonate, was used to treat CD-1 mice infected with the Brazil strain of Trypanosoma cruzi. When given by subcutaneous injection 3 times/week, there was a significant reduction in mortality, however, the myocardial pathology and right ventricular dilation was unchanged in these mice compared to control animals. In C57BL/6 mice infected with the Tulahuen strain, there was no change in mortality in response to risedronate treatment. These data suggest that this class of compounds has activity against T. cruzi in vivo and illustrate the utility of imaging and pathologic studies as adjuncts in the evaluation of therapeutic compounds as treatments for experimental Chagas' disease. In addition, it underscores the need to use different strains of T. cruzi.

Animals↗

Validation of computerized three-dimensional reconstruction of intravascular ultrasound: measurements of absolute luminal diameter and cross-sectional area in ex vivo human coronary arteries.

UNLABELLED: Computer based 3-dimensional reconstruction transforms 2-dimensional intravascular ultrasound images into a longitudinal format facilitating analysis of luminal narrowing. To validate the accuracy of current software in measuring coronary artery diameter and cross-sectional area, in arteries with atherosclerosis, we performed 3-dimensional reconstruction in 10 human pathologic coronary arterial segments of 10-25mm length. Images were obtained using a 4.8 French catheter with pullback speed of 1mm/sec acquired at 3 frames/sec onto VHS tape. The data were digitized and intraluminal 3-dimensional reconstruction performed using a voxel-based program. Pathologic sections were obtained every 3mm, and dimensions were measured with a resolution of 0.01 mm. Maximum, minimum, and 3 other representative diameters were recorded by an observer blinded to the ultrasound diameters. Average histo-pathologic diameters were reported, and specimen cross-sectional area was then calculated. RESULTS: In 53 sections, pathological diameters ranged from 1.4-4.5mm (mean 2.7 +/- 0.68mm) while 3-dimensional reconstructed diameters were 1.9 to 3.8mm (mean 2.6 +/- 0.54mm). Pathologic and ultrasound derived 3-dimensional reconstruction diameters had an excellent correlation (r=0.86, SEE=+/-0.36). Pathology and 3-dimensional reconstruction cross-sectional area also correlated closely (r=0.88, SEE=+/-1.50). Diameters less than 2.0mm were systematically overestimated and diameters greater than 3.5mm underestimated by 3-dimensional reconstruction. Most 3 dimensional reconstruction values were within +/- 10% of pathology, but diverged at each diameter extreme, approaching +/- 20%. Thus, computerized 3-dimensional reconstruction of ultrasound images shows excellent quantification of luminal size in the 2.0-3.5mm range, suggesting important investigative and clinical applications.

Arteries↗

[Standardizing a protocol of magnetic resonance imaging of temporomandibular joints. Part 2. Unification of analysis of obtained data].

The paper presents a unified protocol for analyzing the data obtained by magnetic resonance tomography, which has been used to examine 350 patients. It characterizes the MR semiotics of different pathological conditions of articular structures, which are illustrated by MR images. An optimal terminology is proposed for the evaluation of bone and soft tissue changes.

Clinical Protocols↗

A study of the morphological parameters of cervical squamous epithelium.

Electrical impedance spectroscopy is a technique that has been investigated as a potential method for the diagnosis of epithelial carcinomas. Finite element modelling can provide an insight into the patterns of current flow in normal and pathological epithelium and hence aid in the process of probe design optimization. In order to develop a finite element model of the structure of normal and precancerous cervical squamous epithelium, it was first necessary to obtain the mean values and ranges of a number of morphological tissue parameters. The most important parameters in discriminating normal from neoplastic tissue were identified as being cell size and shape distribution, nuclear-to-cytoplasmic volume ratio and volume of extracellular space. A survey of the literature revealed an absence of reliable quantitative data for these parameters. We therefore present the results of our own basic image analysis on normal and pathological tissue sections, which we hope will be of use to other workers wishing to model cervical squamous epithelium, or other similar tissue structures.

Carcinoma in Situ↗

Computed tomographic colonography (CTC): Possibilities and limitations of clinical application in colorectal polyps and cancer.

Colorectal cancer is the second leading cause of cancer-related deaths in Europe and the United States. Most colorectal cancers develop from adenomatous polyps over a number of years. Early detection of polyps eliminates the risk of subsequent carcinomas. Computed tomographic (CT) colonography is a diagnostic technique detecting colorectal neoplasms. With the introduction of multidetector-row computed tomography (MD-CT), CT colonography (CTC) has gained influence as a new diagnostic tool in early detection of colonic pathologies by acquiring volumetric CT data sets of the abdomen. This volumetric data is analyzed using CTC workstations, which provide an interactive display of 2D and 3D images of the colon. In several studies, CTC revealed a high accuracy (sensitivity/patient: 83-100% and specificity/patient: 93-100%) in detecting pathological colonic changes. Furthermore, CTC is an excellent diagnostic technique for the evaluation of patients with incomplete conventional colonoscopy and allows the assessment of extracolonic abdominal and pelvic organs. In this article, the status of CT colonography as a method of detecting colonic polyps and colorectal carcinomas using single- and multidetector-row CT will be reviewed.

Adenomatous Polyposis Coli↗

[Reconstruction methods in postprocessing of CT- and MR-angiography of the aorta].

The aim of the study was to investigate the use of 2D and 3D reconstructions in examinations of the aorta with CT and MRI. Postprocessing of 5 data sets including 2D MPR reconstructions, 3D MIP reconstructions and 3D volume rendering reconstructions acquired with contrast enhanced CTA and 5 data sets acquired with contrast enhanced MRA were performed. The luminal diameter, the length of the aneurysm and the detection of dissection was assessed for the reconstructions and the source images. Aneurysms and dissections of the aorta were correctly identified on source images. 2D MPR reconstructions and source images allow for a clear and easy image analysis including cases with high signal intensity or density of surrounding tissue and complex anatomical structures. The diameter and length of pathological findings can be determined correctly wit 2D MPR reconstructions, even when the vessel orientation is not exactly inplane or throughplane in relation to the source images. MIP reconstructions are suitable for contrast enhanced MRA data sets with high C/N ratio and volume rendering reconstructions are suitable for contrast enhanced CTA data sets, where calcifications and bone have also high density. For 3D visualization of large volumes MIP reconstructions are the method of choice for MRA and volume rendering reconstructions for CTA, respectively. In addition, 2D MPR can be necessary to determine the diameter and length of pathological findings.

Adult↗

CT and MRI features of pure acinar cell carcinoma of the pancreas in adults.

OBJECTIVE: We sought to describe the CT and MRI features of pure acinar cell carcinoma of the pancreas in adults. MATERIALS AND METHODS: Eleven patients (six women and five men; mean age, 64 years) with acinar cell carcinoma, documented by pathologic examination of resected specimens, underwent CT (n=9) or MRI (n=2) examinations. Two radiologists evaluated imaging studies and determined, by consensus, the following data for each tumor: size, location, margination, internal density or signal intensity, and contrast enhancement pattern. In addition, they assessed the presence of calcification, pancreatic or bile duct dilation, and metastases. Imaging features were correlated with gross and microscopic pathologic features of the tumors. RESULTS: Masses were distributed throughout the pancreas (head, n=5; body, n=2; and tail, n=4). The mean largest dimensions were 6.0 x 5.3 cm (range, from 2 x 1.7 to 15 x 11 cm). Tumors were oval (n=5), round (n=4), or lobular (n=2). Ten (91%) masses were well marginated; nine (82%) were exophytic. Five (45%) masses enhanced homogeneously; the remaining tumors contained cystic areas. All masses enhanced less than the surrounding pancreas. Three (27%) masses contained calcifications. Four (80%) masses invaded the duodenum. Common bile and pancreatic duct dilatation was present in two and three patients, respectively. One patient had metastatic liver disease at presentation. CONCLUSION: Pure acinar cell carcinoma of the pancreas is usually an exophytic, oval or round, well-marginated, and hypovascular mass on CT and MRI. It typically is completely solid when small and contains cystic areas due to necrosis when large.

Adult↗

Adrenal incidentalomas in Taiwan: high prevalence and malignancy rate.

BACKGROUND: The endocrine adrenal gland has 3 zones comprised of the cortex and medulla. The character of multi-hormonal expression results in multiple clinical manifestations. To define the clinical characteristics of adrenal tumors in Taiwan, we reviewed 336 pathologically proven adrenal tumors at Chang Gung Memorial Hospital in Linkou. METHODS: We retrospectively analyzed 258 pathologically proven adrenal tumors with sufficient data treated from 1983 to 2000. Among them, 174 (67%) were functional and 84 (33%) were nonfunctional. The diagnosis was based on clinical features, hormonal status, imaging studies, and pathology. RESULTS: Of the 258 patients, 161 were women (mean age, 38.5 +/- 15.4; range, 1-75 years) and 97 men (mean age, 41.6 +/- 17.8; range, 1-81 years). The prevalence of cortical tumors was much higher in females than in males. Fifty-two percent of patients with an adrenal tumor were diagnosed at an age between 30 and 50 years. Incidentalomas (N = 84) accounted for about 1/3 of total tumor cases. Of the 46 cases proven to be malignant, 40 (87%) were found incidentally. All malignant tumors had a diameter of greater than 3 cm. Postoperative adrenal insufficiency was present in 18% of cases, and overall mortality in this study was 0.4%. CONCLUSIONS: In our series, adrenal incidentalomas corresponded to about 1/3 of adrenal tumors and accounted for 87% of malignancies. It is mandatory to increase medical attention for incidentally found adrenal masses in Taiwan. Those incidentalomas with a diameter of more than 3 cm should undergo a pathological examination.

Adolescent↗

Proton magnetic resonance spectroscopic imaging integrated into image-guided surgery: correlation to standard magnetic resonance imaging and tumor cell density.

OBJECTIVE: In this study, we attempted to improve the delineation of the infiltration zone in gliomas using proton magnetic resonance spectroscopic imaging (1H MRSI). In conventional magnetic resonance imaging (MRI), the boundaries of gliomas sometimes are underestimated. 1H MRSI is a noninvasive tool that can be used to investigate the spatial distribution of metabolic changes in brain lesions. The purpose was to correlate tumor cell density from histopathological specimens with metabolic levels and the coregistered metabolic maps. METHODS: We developed a method to integrate spectroscopic data depicted as metabolic maps of biochemically pathological tissue into frameless stereotaxy. In seven patients harboring gliomas, we performed 1H MRSI with high spatial resolution and evaluated the spectral data. An algorithm was developed for user-independent calculation of pathological voxels and for visualization as metabolic maps. These maps were integrated into a three-dimensional MRI data set used for frameless stereotaxy. Stereotactic biopsies were taken from three different areas in and around the tumor involving the maximum pathological change, the border zone, and an area from outside the spectroscopically suspicious area. These specimens were correlated to the exact voxel positions in the stereotactic image space and evaluated histopathologically. RESULTS: In all cases, the implementation of the metabolic maps into frameless stereotaxy was successful, and stereotactic biopsies were acquired by use of the spectral data. A relation could be demonstrated between the metabolic changes and tumor cell density ranging from 60 to 100% in the maximum pathological area to 5 to 15% in the border zone. Interestingly, the tumor areas defined by the metabolic maps and histopathologically confirmed by biopsy exceeded the T2-weighted signal change in all cases, ranging from 6 to 32% in the examined volume. CONCLUSION: Our preliminary data suggest that 1H MRSI may be useful in combination with frameless stereotaxy to define more exactly the tumor infiltration zone in glioma surgery compared with conventional anatomic MRI alone.

Algorithms↗

Spinal cord pial metastases: MR imaging with gadopentetate dimeglumine.

The purpose of this investigation was to describe gadopentetate-dimeglumine-enhanced MR findings in metastatic disease to the pial lining of the spinal cord. Correlation was made with clinical data, other radiologic studies, and pathologic findings. Eighty-six patients with a known malignancy and unexplained neurologic signs or symptoms were studied with pre- and postcontrast T1-weighted images. In seven of these patients, abnormal enhancement of the pial lining of the cord was seen on the sagittal postcontrast T1-weighted images. This appeared as a thin rim of enhancement along the surface of the cord in six patients and as a focal, thick rim of enhancement in addition to the thin rim of enhancement in the seventh patient. Axial images confirmed the location along the pial lining in each case. Precontrast T1-weighted images in all seven cases and precontrast T2-weighted images in five cases failed to detect any focal abnormalities of the pial lining of the cord. Pathologic confirmation was available in five of the seven patients. Primary malignancies in these patients included breast carcinomas (two), lymphoma (one), leukemia (one), adenocarcinoma of the lung (one), prostate carcinoma (one), and malignant melanoma (one). Three of seven patients had metastatic disease evident only within the CNS, while four patients had widespread disease outside the CNS. We conclude that contrast-enhanced MR imaging is useful in the diagnosis of pial spread of metastatic disease in patients with a known primary malignancy and unexplained neurologic signs or symptoms.

Adult↗

Spinal cord pial metastases: MR imaging with gadopentetate dimeglumine.

The purpose of this investigation was to describe gadopentetate-dimeglumine-enhanced MR findings in metastatic disease to the pial lining of the spinal cord. Correlation was made with clinical data, other radiologic studies, and pathologic findings. Eighty-six patients with a known malignancy and unexplained neurologic signs or symptoms were studied with pre- and postcontrast T1-weighted images. In seven of these patients, abnormal enhancement of the pial lining of the cord was seen on the sagittal postcontrast T1-weighted images. This appeared as a thin rim of enhancement along the surface of the cord in six patients and as a focal, thick rim of enhancement in addition to the thin rim of enhancement in the seventh patient. Axial images confirmed the location along the pial lining in each case. Precontrast T1-weighted images in all seven cases and precontrast T2-weighted images in five cases failed to detect any focal abnormalities of the pial lining of the cord. Pathologic confirmation was available in five of the seven patients. Primary malignancies in these patients included breast carcinoma (two), lymphoma (one), leukemia (one), adenocarcinoma of the lung (one), prostate carcinoma (one), and malignant melanoma (one). Three of seven patients had metastatic disease evident only within the CNS, while four patients had widespread disease outside the CNS. We conclude that contrast-enhanced MR imaging is useful in the diagnosis of pial spread of metastatic disease in patients with a known primary malignancy and unexplained neurologic signs or symptoms.

Adult↗

Robust measures of three-dimensional vascular tortuosity based on the minimum curvature of approximating polynomial spline fits to the vessel mid-line.

The clinical recognition of abnormal vascular tortuosity is important in the diagnosis of many diseases. This paper presents a novel approach to the quantification of vascular tortuosity, using robust metrics based on unit speed parameterizations of three-dimensional (3D) curvature. The use of approximating polynomial spline-fitting obviates the need for arbitrary filtering of mid-line data which is necessary with other tortuosity indices. The metrics were tested using both two-dimensional and three-dimensional synthesized images that mimicked clinically significant pathologies: two of the three metrics were scale invariant, additive, and produced tortuosity values tailored to be independent of the resolution of the imaging system. Our methodology is designed to explicitly handle the challenge of noisy data, and is largely tolerant of the inaccuracies in the mid-line extraction. While all the proposed metrics are sensitive to gently curved vessels, the rms curvature of the smoothest path was more effective in recognizing abnormalities involving high-frequency coiling such as occurs in malignant tumors. We have also indicated how values from two projection images, such as acquired in biplane angiography, can be combined to give an accurate approximation of the 3D value of this metric. Our proposed methodology is well-suited to automated detection and measurement, which are a prerequisite for clinical implementation.

Algorithms↗

Retro-dental reactive lesions related to development of myelopathy in patients with atlantoaxial instability secondary to Os odontoideum.

STUDY DESIGN: A retrospective analysis of 13 patients with atlantoaxial instability secondary to Os odontoideum who underwent posterior atlantoaxial fusion. OBJECTIVE: To assess the relationships between the development of myelopathy and plain radiographic parameters in patients with atlantoaxial instability secondary to Os odontoideum and to determine whether the pathologic structures, which compress the spinal cord, are visualized using magnetic resonance imaging. SUMMARY OF BACKGROUND DATA: The development of myelopathy, which is the most serious complication associated with Os odontoideum, was thought to be related to either the degree of instability or direction of instability, or a decrease in the space available for the cord. However, such indirect radiographic parameters measured using plain radiographs cannot provide direct information concerning the causes of myelopathy in patients with atlantoaxial instability secondary to Os odontoideum. METHODS: Thirteen patients who underwent posterior atlantoaxial fusion for clinical symptoms due to Os odontoideum were classified into two groups depending on whether they had (n = 9) or did not have (n = 4) myelopathy. Four radiographic parameters were measured using flexion and extension lateral radiographs; the degree of instability, the direction of instability, and the space available for the cord in flexion and extension. MRI was performed on all patients in the myelopathy group. The radiologic and clinical data were compared for the two groups. RESULTS: There were no significant statistical differences in the degree of instability (6.83 vs. 7.38, P = 0.816), space available for the cord in flexion (6.94 vs. 7.13, P = 0.938), and space available for cord in extension (7.56 vs. 5.75, P = 0.434) between the two groups. There was a poor agreement between the direction of instability and the development of myelopathy (kappa = 0.268, P = 0.308). Magnetic resonance imaging did demonstrate, however, cord compression caused by retro-dental reactive lesions in the myelopathy; cystic masses were present in two patients; and fibrocartilaginous masses were present in seven. CONCLUSION: The current study suggests that the value of plain radiographic parameters should be reevaluated as a means of evaluating myelopathy in patients with atlantoaxial instability secondary to Os odontoideum, and that retro-dental reactive lesions should be considered as the potential cause of myelopathy.

Adult↗

Comparison of sequential versus simultaneous methods of adrenal venous sampling.

PURPOSE: To compare two methods of adrenal venous sampling (AVS) in preoperative localization of adrenal lesions in primary hyperaldosteronism. MATERIALS AND METHODS: Twenty-one patients (13 men, eight women) underwent selective adrenal venous sampling between July 2001 and May 2003. One of the 21 patients underwent repeat AVS, for a total of 22 procedures. In half the procedures (n = 11), simultaneous bilateral adrenal venous catheterization and sampling was performed before and after intraprocedural adrenocorticotropic hormone (ACTH) administration; in the remaining half (n = 11), sequential catheterization of the left and right adrenal veins was performed during continuous ACTH infusion 1 hour before and throughout AVS. Chart review provided procedural data, including sampling intervals and aldosterone/cortisol ratios. Patient records provided clinical data, including blood pressure, serum aldosterone levels, and computed tomography and magnetic resonance imaging findings. Surgical pathology reports confirmed unilateral disease but were not applicable to bilateral disease. RESULTS: Selective AVS was completed successfully in 21 of 22 procedures (95%); the unsuccessful sampling was repeated successfully. Disease lateralized in 13 of 22 cases. Simultaneous bilateral AVS localized unilateral disease in seven of eight cases (88%) and was nondiagnostic in one case (13%), with cases confirmed by surgical pathology reports. Sequential bilateral AVS localized unilateral disease in four of four cases (100%) confirmed by surgical pathology reports, with one lost to follow-up. Bilateral disease was diagnosed in six of 22 cases: two of 11 by simultaneous AVS and four of 11 by sequential AVS. Three of 22 cases demonstrated borderline hormone levels that failed to meet the diagnostic threshold for recommended adrenalectomy. Mean elapsed time between acquisition of right and left samples did not differ between simultaneous and sequential AVS (P = .09). Baseline (prestimulation) sampling did not contribute unique diagnostic information in any case and provided contradictory or confounding information in three of 11 simultaneous AVS procedures (27%). CONCLUSIONS: Sequential bilateral catheterization does not compromise the reliability of time-sensitive AVS. Both simultaneous and sequential AVS are adequate studies; however, obtaining baseline prestimulation samples during simultaneous AVS is unnecessary and increases the cost of the procedure.

Adrenal Glands↗

Cysts of the prostate and seminal vesicles: MR imaging findings in 11 cases.

Cysts of the prostate and seminal vesicles are confusing abnormalities because they are uncommon and their origin is uncertain. Several approaches to diagnosis have been used, most recently CT and transrectal sonography. In this study, we investigated the value of MR imaging in the diagnosis of six cases of prostatic cyst and five cases of cysts of the seminal vesicles. All patients were symptomatic. T1- and T2-weighted spin-echo images were obtained in all cases; pathologic confirmation was available in four patients. MR images were analyzed prospectively without knowledge of clinical data or the results of other imaging procedures. In all cases, low- and high-signal masses were observed on T1- and T2-weighted images, respectively. The cysts were unilocular with a sharply defined margin, ranging from 0.5 to 3.0 cm in diameter. The thin wall was of low signal intensity on T2-weighted images. Our experience suggests that MR imaging is useful in demonstrating the liquid content of prostatic and seminal-vesicle cysts and in establishing their size and location.

Adult↗

[A case of a non-reading child. Application of the aphasiologic methods. Results].

Children over nine who can't manage to learn written language insofar as they have no major handicap (be it intellectual, sensorial, psycho-affective or socio-cultural) and in spite of psychotherapy and educational and orthophonic measures that have been tried successfully, can be placed in the category of non-readers. Applying aphasiological reeducation methods to one child of eleven who was a non-reader with a well-documented therapeutic past allowed him to learn to read and write in six months. This approach is based on an enlarged definition of aphasia and theoretical hypotheses derived from the theories of the linguist Gustave Guillaume. A pragmatic approach emerges, analyzing and placing the observed weakness in an outline of linguistic functions: a set of the circuits connecting mental images (oral and graphic) to words and sensorial data. Each time a weak point or a pathological mechanism can be pinned down and analyzed, it can lead to an adapted strategy of reeducation which, because its success can be checked, allows us to keep the original hypothesis. In this case, setting up a lexical procedure that could be closely checked and within a reasonable time frame, whereas all the other methods had been inefficient, shows how reliable this way is, and therefore its theoretical interest.

Aphasia↗

Post-mortem aeroportography.

The authors suggest a new methodology for the study of the intrahepatic portal system, using atmospheric air as a contrast medium. They used 48 livers of normal and pathological corpses, obtaining post-mortem cholangiographies and vinyl molds. Comparing the images obtained with literature data and with the vinyl molds, the authors conclude that the method is accurate, presenting furthermore many advantages with regard to contrasts generally used, such as low cost, easy performance, possibility repeating the radiographs as many times as necessary, and the possibility of simultaneous obtaining contrasts of other intra-hepatic systems by use of other radio-opaque contrast media in another system, as for example the biliary or the arterial system.

Air↗