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PubMed2005

Musculoskeletal ultrasound including definitions for ultrasonographic pathology.

Ultrasound (US) has great potential as an outcome in rheumatoid arthritis trials for detecting bone erosions, synovitis, tendon disease, and enthesopathy. It has a number of distinct advantages over magnetic resonance imaging, including good patient tolerability and ability to scan multiple joints in a short period of time. However, there are scarce data regarding its validity, reproducibility, and responsiveness to change, making interpretation and comparison of studies difficult. In particular, there are limited data describing standardized scanning methodology and standardized definitions of US pathologies. This article presents the first report from the OMERACT ultrasound special interest group, which has compared US against the criteria of the OMERACT filter. Also proposed for the first time are consensus US definitions for common pathological lesions seen in patients with inflammatory arthritis.

Arthritis, Rheumatoid↗

PubMed2004

Modern pacemaker and implantable cardioverter/defibrillator systems can be magnetic resonance imaging safe: in vitro and in vivo assessment of safety and function at 1.5 T.

BACKGROUND: MRI has unparalleled soft-tissue imaging capabilities. The presence of devices such as pacemakers and implantable cardioverter/defibrillators (ICDs), however, is historically considered a contraindication to MRI. These devices are now smaller, with less magnetic material and improved electromagnetic interference protection. Our aim was to determine whether these modern systems can be used in an MR environment. METHODS AND RESULTS: We tested in vitro and in vivo lead heating, device function, force acting on the device, and image distortion at 1.5 T. Clinical MR protocols and in vivo measurements yielded temperature changes <0.5 degrees C. Older (manufactured before 2000) ICDs were damaged by the MR scans. Newer ICD systems and most pacemakers, however, were not. The maximal force acting on newer devices was <100 g. Modern (manufactured after 2000) ICD systems were implanted in dogs (n=18), and after 4 weeks, 3- to 4-hour MR scans were performed (n=15). No device dysfunction occurred. The images were of high quality with distortion dependent on the scan sequence and plane. Pacing threshold and intracardiac electrogram amplitude were unchanged over the 8 weeks, except in 1 animal that, after MRI, had a transient (<12 hours) capture failure. Pathological data of the scanned animals revealed very limited necrosis or fibrosis at the tip of the lead area, which was not different from controls (n=3) not subjected to MRI. CONCLUSIONS: These data suggest that certain modern pacemaker and ICD systems may indeed be MRI safe. This may have major clinical implications for current imaging practices.

Animals↗

PubMed2004

Detection of postoperative relapsing/residual cholesteatomas with diffusion-weighted echo-planar magnetic resonance imaging.

PURPOSE: To assess the capability of echo-planar diffusion-weighted magnetic resonance imaging (MRI) (EPI-DWI) in diagnosing relapsing/residual cholesteatomas after canal wall-up mastoidectomy. MATERIALS AND METHODS: In a blinded study design, we investigated with MRI, including standard spin-echo sequences, 18 patients evaluated with clinical examination and computed tomography (CT) suspected for relapsing/residual cholesteatoma 7 to 19 months after a canal wall-up mastoidectomy. Images were evaluated by two radiologists blinded to patients' identities, CT findings, and clinical data set, who decided in a consensus agreement whether there was a pathologic signal increase in the petrous bone in a single-shot EPI-DWI sequence. All the patients underwent a second tympanoplasty or revision surgery of the mastoidectomy cavity within 15 days after magnetic resonance investigation.Sensitivity, specificity, and predictive values were evaluated separately for standard sequences and EPI-DWI. RESULTS: In EPI-DWI, five of six patients with cholesteatoma showed a bright signal, whereas those patients with a noncholesteatomatous tissue showed no anomalies. The only misdiagnosed cholesteatoma was a pearl 2 mm in diameter. Sensitivity, specificity, and positive predictive values, and negative predictive values of EPI-DWI in diagnosing relapsing/residual cholesteatomas were 86, 100, 100, and 92%, respectively. CONCLUSION: EPI-DWI may be a useful tool in differentiating between cholesteatomatous and noncholesteatomatous tissues after closed cavity mastoidectomy. Further investigations are, however, required to establish the practical utility of EPI-DWI on larger series as a screening modality in the follow-up after closed cavity mastoidectomies.

Adolescent↗

PubMed1993

Cryptogenic organizing pneumonitis. Bronchiolitis obliterans organizing pneumonia.

The conviction that has rapidly forced itself upon clinicians is that COP is a clinicopathological syndrome relevant in pulmonary medicine. Obscured for a long time by both ambiguities in the clinical interpretation of the pathologic term "bronchiolitis obliterans" and the enduring concept that organizing pneumonia was almost always merely of usual infectious origin, it finally was characterized when clinical and pathologic data were carefully correlated using the clinicopathologic method advocated by Laënnec at the beginning of the last century. COP is now easily recognized in its typical form, in which patients present with a subacute inflammatory pulmonary disease with patchy alveolar opacities on chest imaging. A negative etiologic investigation and characteristic pathologic features confirm the diagnosis. Corticosteroids are a highly effective treatment, despite the relapses occurring when therapy is stopped too rapidly, further indicating that COP is an inflammatory process that may persist for prolonged periods. Less typical forms of COP, solitary focal and diffuse infiltrative COP, need further characterization to define their respective limits with typical COP and UIP. Whatever its origin(s), COP clearly merits recognition as a distinct entity on clinical, imaging, pathologic, and evolutive grounds. COP probably is not a new disease, but its delayed recognition proves that clinicopathologic studies are still of interest.

Adrenal Cortex Hormones↗

PubMed2003

A fully automatic and robust brain MRI tissue classification method.

A novel, fully automatic, adaptive, robust procedure for brain tissue classification from 3D magnetic resonance head images (MRI) is described in this paper. The procedure is adaptive in that it customizes a training set, by using a 'pruning' strategy, such that the classification is robust against anatomical variability and pathology. Starting from a set of samples generated from prior tissue probability maps (a 'model') in a standard, brain-based coordinate system ('stereotaxic space'), the method first reduces the fraction of incorrectly labeled samples in this set by using a minimum spanning tree graph-theoretic approach. Then, the corrected set of samples is used by a supervised kNN classifier for classifying the entire 3D image. The classification procedure is robust against variability in the image quality through a non-parametric implementation: no assumptions are made about the tissue intensity distributions. The performance of this brain tissue classification procedure is demonstrated through quantitative and qualitative validation experiments on both simulated MRI data (10 subjects) and real MRI data (43 subjects). A significant improvement in output quality was observed on subjects who exhibit morphological deviations from the model due to aging and pathology.

Adult↗

PubMed2000

Telepathology: a diagnostic tool for the millennium?

Many developments in science have their origins in science fiction and telepathology is no exception. The concept was first illustrated in 1924 in the magazine 'Radio News'. It was not until 1980, however, that the first working telepathology system was demonstrated. Although the system was shown to work, it required special hardware, dedicated software and special microwave transmission links to be installed. Little interest was shown worldwide because of the very high cost and the inability of many people to replicate such a system. Ten years later, the personal computer (PC) was able to provide more than adequate performance at low cost for both image display quality and speed, and the development of video technology had resulted in high quality images being produced by television cameras that were now easily affordable. Microscopes were also relatively cheaper. Thus, by 1993 or 1994, all the hardware necessary to produce a telepathology system was available at reasonable cost. Telepathology can now be used for remote primary diagnosis, remote referral to a specialist pathologist, remote teaching, remote presentation of post-mortem or microscopic findings, quality assurance image circulation and feedback, and consensus diagnosis for pathological review in clinical trials. There are two residual problems. The first concerns the speed of data transmission, commonly referred to as the bandwidth. The second is that the software provided by most of the manufacturers and suppliers of these systems is not entirely suitable to the task and the systems are not interoperable. It is clear that the approach of the manufacturers is at present unlikely to produce telepathology systems which pathologists feel comfortable in using. A somewhat different approach is illustrated by the accompanying article in this issue from the Berlin group, where a relatively simple Java-based applet and the Internet are used to allow single or multiple users to view slides on a robotic microscope. This could form the basis for a truly useful system, but still needs modification for some applications.

Clinical Trials as Topic↗

PubMed2000

Gadolinium-enhanced MR angiography in the evaluation of congenital cardiovascular disease pre- and postoperative states in infants and children.

The purpose of this study was to evaluate the utility of dynamic contrast magnetic resonance (MR) angiography under sedation for assessing congenital cardiovascular disease in infants and small children before and after cardiac surgery. In 38 patients with cardiovascular abnormalities, thoracic vasculatures were evaluated in either the preoperative (group 1; 23 patients, median age 9 months old) or the postoperative (group 2; 15 patients median age 1. 3 years old) state using gadolinium-enhanced dynamic MR angiography. Acquired data were processed with a multiprojection volume reconstruction. Image quality (grades 1-5, undiagnostic to excellent), presence or absence of the extracardiac vasculature, its pathology (group 1), and the patency of the postsurgical shunt or reconstructed vasculature (group 2) were evaluated. All images were of diagnostic image quality (mean grade 4.4-3.2). Recognition of the thoracic vasculature was correctly made in all cases (38/38, 100%). In group 1, anomalies and pathologic changes were correctly identified in 22 of 23 cases (95.7%). In one patient with dextrocardia and the cardiac type of total anomalous pulmonary venous return, the abnormality was not recognized. In group 2, the patency of the shunt flow after Glenn (n = 6), modified Fontan (n = 4), Rastelli (n = 1), and Blalock-Taussig (n = 3) operations was well demonstrated in each case. The reconstructed pulmonary artery (n = 1), veins (n = 2), and aorta (n = 1) were correctly visualized. In one case, stenosis of the reconstructed left pulmonary vein was missed by MR angiography. In 14 of 15 cases in group 2 (93.3%), MR angiography correctly gave information on the operated areas. In conclusion, dynamic contrast MR angiography under sedation is useful for evaluation of the thoracic vasculature of infants and small children in the pre- and postoperative states. J. Magn. Reson. Imaging 2000;12:1034-1042.

Aortography↗

PubMed2003

How valid is dopamine transporter imaging as a surrogate marker in research trials in Parkinson's disease?

To use functional imaging data as indices of disease progression, it is essential that methods are valid. It is not possible for that validation to come from pathology and the methods can only gain validity from the relationship to clinical indices of progression. Validity as a measurement of disease progression depends upon sensitivity to clinical progression, low scan-to-scan error, and resilience to confounding effects. Data from the available dopamine transporter (DAT) positron emission tomography (PET) and single photon emission computed tomography (SPECT) studies are examined for these three key factors. Presently, there are insufficient data to enable the satisfactory design of neuroprotection studies and to enable statements on their relevance to disease progression and neuroprotection. The recently completed CALM-PD neuroimaging study is examined. There is sufficient doubt surrounding the sensitivity, reproducibility, and confounding effects in this study that these data should not be used to formulate a decision on de novo therapy in Parkinson's disease.

Biomarkers↗

PubMed2006

Added value of SPECT/CT in patients suspected of having bone infection: preliminary results.

AIM: We evaluated the contribution of SPECT/CT as an adjunct to combined three-phase bone scintigraphy (planar and SPECT) for diagnosing and localizing bone infection. Subsequently, the diagnostic performance of SPECT/CT was compared to visual fusion of SPECT with data of additional CT, X-ray, or MRI studies (SPECT + CT/X-ray/MRI). MATERIALS AND METHODS: Thirty-one patients suspected of bone infection, presenting pathological findings on triple-phase bone scintigraphy, underwent additional SPECT/CT. The SPECT/CT-technology combines the acquisition of SPECT and CT data with the same imaging device enabling perfect overlay of anatomical and functional images. (99m)Tc-DPD was used as radiopharmaceutical in all patients. For data analysis findings of bone scintigraphy (planar scans as well as SPECT) were categorized as positive, negative, or equivocal for the presence of osteomyelitis. In a second step, they were compared with SPECT/CT and SPECT + CT/X-ray/MRI with respect to localization and classification of lesions. Validation was achieved by surgery, biopsy, or by clinical follow up over at least 9 months including microbiological and radiological findings. RESULTS: Three-phase bone scan (incl. SPECT) correctly classified 7 lesions as positive and 11 lesions as negative for osteomyelitis. Six scans were interpreted false positive, two false negative, and five as equivocal. Rating the latter as positive for osteomyelitis, sensitivity of bone scan was (78%), specificity (50%). SPECT/CT was true positive in 7 patients, and true negative in 19. There were two false positive and two false negative findings, one scan was equivocal (sensitivity 78%, specificity 86%). Definition of anatomical localization of inflammatory foci was much easier by SPECT/CT due to better depiction of underlying anatomical details. SPECT + CT/X-ray/MRI yielded the highest sensitivity (100% compared to 78% of SPECT/CT), if equivocal findings (5/31 compared to 1/31 for SPECT/CT) are rated as true positive for osteomyelitis. Among radiological techniques, MRI (2 x FP) and CT (2 x FN) proved equal and expectedly superior to X-ray in delivering the correct diagnosis. CONCLUSION: SPECT/CT improves the diagnostic performance of three-phase bone scan for osteomyelitis by avoiding false positive or equivocal results. An additional benefit over visual fusion of SPECT with X-ray, CT, or MRI studies could not be confirmed in our study.

Adult↗

PubMed1989

Determination of ultrasonic velocity in human enamel and dentine.

Acoustic velocity data have been obtained preparatory to investigation of high frequency ultrasound as a non-invasive imaging technique for dental hard tissues and their pathology. In vitro studies were conducted on extracted human permanent teeth. Pulse-echo ultrasound of 18 MHz centre frequency and approx. 150 ns pulse duration successfully detected the front and back surfaces of 0.45-1.07 mm thick sections of enamel and of dentine. Water was used as the coupling agent. The oscilloscope traces of the echoes from pure enamel and pure dentine were similar. The longitudinal ultrasonic velocities for pure enamel and dentine were experimentally determined for a number of teeth in different planes of section. For enamel in longitudinal and transverse sections, the mean ultrasonic velocities were 6150 +/- 140 and 6500 +/- 190 m/s respectively. For dentine in longitudinal section, the mean ultrasonic velocity was 4050 +/- 30 m/s.

Dental Enamel↗

PubMed2004

Association of breast cancer with papillary lesions identified at percutaneous image-guided breast biopsy.

BACKGROUND: The management of papillary lesions identified on image-guided breast biopsy remains controversial. In the literature, data regarding papillary lesions are limited because of small sample sizes. The purpose of this study was to identify the prevalence of atypical ductal hyperplasia and malignancy associated with papillary lesions identified on image-guided breast biopsy. METHODS: This study is a retrospective review of 9,310 consecutive image-guided biopsies performed at our institution between January 1996 and November 2003. Patients were included if they underwent an excisional biopsy after a papillary lesion was diagnosed on image-guided biopsy. RESULTS: Papillary lesions were identified in 153 (2%) of the 9,310 image-guided biopsies performed, and 87 of these patients underwent subsequent excisional biopsy at our institution. Breast cancer (in situ or invasive) was identified in 15 patients (17%), and 16 patients (18%) had atypical ductal hyperplasia identified at excisional biopsy. CONCLUSIONS: These data suggest that excisional biopsy should be considered when a papillary lesion is identified at percutaneous image-guided breast biopsy. The final surgical pathology may impact the treatment plan, risk reduction, and/or surveillance for more than a third of patients diagnosed with a papillary lesion on image-guided biopsy.

Biopsy, Needle↗

PubMed2000

Three-dimensional transesophageal echocardiography (TEE) and other future directions.

As faster imaging systems enter the market, three-dimensional echocardiography is gearing up to become a useful tool in assisting the clinician to image the heart in many innovative projections. What started out as a novel idea of displaying a three-dimensional anatomic picture of the heart now provides a multitude of views of the heart and its structures. Information gained from anatomic and dynamic data has helped clinicians and surgeons in making clinical decisions. In the future, this imaging modality may become a routine imaging modality for assessing cardiac pathology and may serve to increase understanding of the dynamics of the heart.

Echocardiography, Doppler, Color↗

PubMed2001

Facial "glomangiomas": large facial venous malformations with glomus cells.

BACKGROUND: "Glomangiomas" are benign cutaneous vascular lesions consisting of convoluted, abnormally formed venous channels lined by cuboidal and oval epithelioid, alpha-actin-positive, glomus cells. Three different clinical variants of glomangioma have been recognized: solitary, multiple, and nodular, or plaquelike. Inheritable forms are common. OBJECTIVE: We describe in 7 patients (2 of them having a familial glomangiomatosis) the rare facial location of glomangiomas to differentiate this type from common facial venous malformation (VM). METHODS: We analyzed clinical data (photographs), course, investigations (computed tomographic scans in 4 patients, magnetic resonance imaging in 6, arteriography in 2, direct puncture phlebography in 4, and pathologic examinations in all 7), and outcome with treatment. RESULTS: Lesions were soft, composed of multiple nodules, confluent and plaquelike, deep blue or blue-to-purple, sometimes sagging, one-sided in a cheek, extending to the lips in 5 patients, to the chin in 4, and to the lower eyelid in 4. They were poorly compressible, a finding different from common facial VMs. In a young man extensive back involvement was associated. Among radiologic investigations, only magnetic resonance imaging after gadolinium enhancement offered some differential features with common VMs. However, histopathologic examination clarified the differential diagnosis: although the large tortuous venous channels were reminiscent of capillary-venous malformation, in many vessels the walls contained one or several rows of glomus cells. CONCLUSION: Multiple plaquelike facial "glomangiomas" mimic a common venous malformation because of their blue hue. However, with experience, one can clinically recognize them, and their pathologic aspect is distinctive. Management should differ slightly from that for common facial VM because sclerotherapy has proven to be less effective. Therefore surgical treatment is the only helpful therapeutic option.

Adolescent↗

PubMed2006

Mainstreaming kink: the politics of BDSM representation in U.S. popular media.

This article explores nonpractitioners' understandings of and responses to the increasingly mainstream representation of BDSM in U.S. media, focusing on the film Secretary (Shainberg, 2002). Survey, focus group, and interview data indicate that popular images of SM promote the acceptance and understanding of sexual minorities through two mechanisms: acceptance via normalization, and understanding via pathologizing. Rather than challenging the privileged status of normative sexuality, these mechanisms reinforce boundaries between protected/privileged and policed/pathological sexualities. Instead of celebrating increased representation, this article argues that political energy might be directed toward the desire that the popularity of BDSM representations signifies: the desire to encounter authentic, undisciplined, and noncommodified representations that would transgress the sexual norms of American postmodern consumer culture.

Adult↗

PubMed2003

Multiwavelength three-dimensional near-infrared tomography of the breast: initial simulation, phantom, and clinical results.

Three-dimensional (3D), multiwavelength near-infrared tomography has the potential to provide new physiological information about biological tissue function and pathological transformation. Fast and reliable measurements of multiwavelength data from multiple planes over a region of interest, together with adequate model-based nonlinear image reconstruction, form the major components of successful estimation of internal optical properties of the region. These images can then be used to examine the concentration of chromophores such as hemoglobin, deoxyhemoglobin, water, and lipids that in turn can serve to identify and characterize abnormalities located deep within the domain. We introduce and discuss a 3D modeling method and image reconstruction algorithm that is currently in place. Reconstructed images of optical properties are presented from simulated data, measured phantoms, and clinical data acquired from a breast cancer patient. It is shown that, with a relatively fast 3D inversion algorithm, useful images of optical absorption and scatter can be calculated with good separation and localization in all cases. It is also shown that, by use of the calculated optical absorption over a range of wavelengths, the oxygen saturation distribution of a tissue under investigation can be deduced from oxygenated and deoxygenated hemoglobin maps. With this method the reconstructed tumor from the breast cancer patient was found to have a higher oxy-deoxy hemoglobin concentration and also a higher oxygen saturation level than the background, indicating a ductal carcinoma that corresponds well to histology findings.

Aged↗

PubMed2000

Computerized tomographic ureteroscopy for diagnosing ureteral tumors.

PURPOSE: Helical computerized tomography (CT) image acquisition has led to the availability of improved data sets for CT endoscopic imaging that represent virtual endoscopy using CT. We assessed the usefulness of CT ureteroscopic imaging for diagnosing ureteral tumors. MATERIALS AND METHODS: A total of 16 patients with ureteral stenosis underwent surface rendering CT ureteroscopy after the intravenous administration of contrast material and furosemide. To distinguish ureteral tumors from ureteral strictures 2 observers blinded to other patient history and evaluation data independently and prospectively evaluated CT ureteroscopy with reformatted CT ureterograms in these 16 patients. CT ureteroscopic images were then correlated with surgical and pathological findings, which served as the gold standard. RESULTS: Surgical and pathological findings in the 16 patients revealed 16 ureteral tumors, including carcinoma in 10 (carcinoma in situ in 1, fibroepithelial polyps in 2 and hyperplastic polypoids in 4), inflammatory intrinsic stricture in 2 and extrinsic stricture in 4 caused by retroperitoneal fibrosis in 2 and lymph node metastasis in 2. CT ureteroscopy correctly detected all lesions except 1 carcinoma in situ, 1 polypoid carcinoma and 1 hyperplastic polypoid. The sensitivity and specificity of CT ureteroscopy for detecting ureteral tumors and carcinoma were 81% and 100%, and 80% and 75%, respectively, when tumors without stalks were considered carcinoma. CONCLUSIONS: CT ureteroscopy is useful for visualizing the complex morphology of ureteral tumors and distinguishing tumor from ureteral stricture.

Adult↗

PubMed1990

[Dynamic esophageal scintigraphy by a condensed imaging method].

The paper is concerned with preliminary evaluation of a method of condensed imaging during processing of the results of dynamic esophageal scintigraphy to detect motor evacuatory function of the esophagus. Altogether 34 patients (20 patients with primary esophageal cancer and 14 without G. I. tract pathology) were investigated. Comparison of the results of analysis of dynamic esophageal scintigraphy by a method of condensed imaging and standard methods of diagnostic data processing has shown that a condensed image of the esophagus objectively reflects some passage features of a food lump in the organ. Condensed imaging seems superior for analysis of the results of investigation and diagnostic data storage. However, this method must not be regarded as an alternative one ruling out a necessity of analysis of esophageal histograms and calculation of RP transport in the esophagus.

Adolescent↗

PubMed1979

[Tomographic incidence of the petrous bone by the controlateral suboccipital approach, in the plane of the ear-drum and in line with the general axis of the ossicules (author's transl)].

Definition and technique of the Dulac 7 incidence. Diagrams 1 and 2 give details of the anatomical orientations which define this incidence. It is:--centered on the head of the malleus,--orientated in the plane of the ossicules or in the neighbouring plane of the ear-drum,--parallel to the general axis of the ossicules,--close to the perpendicular to the tegment tympani. This incidence is easy to obtain with our technique, using a fixed intracranial centering point, The transversal linear scanning is very effective and can be completed in a very short period. It should be noted, however, that in obese subjects with short necks, the entry point of the incidence is difficult to obtain as there is interposition of the neck muscles. Under these conditions, one should try to be as close to this entry point as possible, knowing that the results are still valid. Tomographic anatomy. A close examination of the text of figures 6, 7, and 8 will familiarize the reader with the tomographic anatomy of this incidence. To summarize the important information obtained from the Dulac 7 incidence we should note that in tomographies of normal petrous bones:--the attic is always perfectly visible, expecially its internal and external walls throughout their total length, and more especially the anterior wall;--the ossicles (head of the malleus, body of the incus, and their articulation) are always perfectly visible and distinct;--the inferior processes of the malleus and incus are always visible;--the external wall of the attic is visible throughout its length, more especially the anterior and posterior portions;--the anterior and posterior contours of the external auditory canal are particularly well-defined. Finally, this incidence also gives clear images of the temporo-mandibular joint, the antral region, the superior canal, and the internal auditory canal. A large experience of this incidence is required before interpreting the image of the foramen ovale. Tomographic pathognomonic signs. The texts of figures 9 to 24 are sufficiently demonstrative of the richness of the pathological data obtained from this incidence, without needing to repeat them here. We would only add that the degree of calcification of the ossicles and the anterior wall of the attic can be precisely determined. This incidence, therefore, gives valuable information in almost all middle ear affections. It is also necessary in order to study the external auditory canal.

Ear Diseases↗