Showing papers in "American Journal of Roentgenology in 2006"
TL;DR: Axillary sonography is moderately sensitive and fairly specific in the diagnosis of axillary metastatic involvement in patients with breast carcinoma.
Abstract: OBJECTIVE. The purpose of our study was to evaluate the accuracy of sonography and sonographically guided biopsy in the preoperative diagnosis of metastatic invasion of the axilla in patients with breast carcinoma.MATERIALS AND METHODS. We performed a MEDLINE search (keywords, “sonography” OR “ultrasound” AND “axillary”) and a manual search of the references of relevant studies and reviews of preoperative diagnosis on sonography of possible axillary metastases. The gold standard required was axillary lymph node dissection; we accepted sentinel node biopsy as an alternative gold standard. Considering the sonographic findings and the results of the sonographically guided biopsy, the sensitivity and specificity were calculated using metaanalysis. We also checked the existence of heterogeneity of the summary results.RESULTS. Sixteen articles were selected. In sonography of axillae without palpable nodes, and using lymph node size as the criterion for positivity, sensitivity varied between 48.8% (95% confidenc...
474 citations
TL;DR: The imaging findings of internal hernias are illustrated, with emphasis placed on the CT findings, especially in transmesenteric, transmesocolic, and retroanastomotic types of internalHernias.
Abstract: OBJECTIVE. Internal hernias, including paraduodenal (traditionally the most common), pericecal, foramen of Winslow, and intersigmoid hernias, account for approximately 0.5-5.8% of all cases of intestinal obstruction and are associated with a high mortality rate, exceeding 50% in some series. To complicate matters, the incidence of internal hernias is increasing because of a number of relatively new surgical procedures now being performed, including liver transplantation and gastric bypass surgery. A significant increase in hernias is occurring in patients undergoing transmesenteric, transmesocolic, and retroanastomotic surgical procedures. It is important for radiologists to be familiar with and to understand the various types of internal hernias and their imaging features so that prompt and accurate diagnosis of these conditions can be made.CONCLUSION. This article illustrates the imaging findings of internal hernias, with emphasis placed on the CT findings, especially in transmesenteric, transmesocolic,...
469 citations
TL;DR: The normal LV differs in volume and mass between sexes and among certain ethnic groups, and studies that assess cardiovascular risk factors in relationship to cardiac function and structure need to account for these normal variations in the population.
Abstract: OBJECTIVE. MRI provides accurate and high-resolution measurements of cardiac anatomy and function. The purpose of this study was to describe the imaging protocol and normal values of left ventricular (LV) function and mass in the Multi-Ethnic Study of Atherosclerosis (MESA).SUBJECTS AND METHODS. Eight hundred participants (400 men, 400 women) in four age strata (45–54, 55–64, 65–74, 75–84 years) were chosen at random. Participants with the following known cardiovascular risk factors were excluded: current smoker, systolic blood pressure > 140 mm Hg, diastolic blood pressure > 90 mm Hg, fasting glucose > 110 mg/dL, total cholesterol > 240 mg/dL, and high-density lipoprotein (HDL) cholesterol < 40 mg/dL. Cardiac MR images were analyzed using MASS software (version 4.2). Mean values, SDs, and correlation coefficients in relationship to patient age were calculated.RESULTS. There were significant differences in LV volumes and mass between men and women. LV volumes were inversely associated with age (p < 0.05) ...
416 citations
TL;DR: In this article, the potential clinical value of a new generation of 64-MDCT systems with that of invasive coronary angiography in the diagnosis of coronary artery disease (CAD) was evaluated.
Abstract: OBJECTIVE. The aim of this study was to evaluate the potential clinical value of a new generation of 64-MDCT systems with that of invasive coronary angiography in the diagnosis of coronary artery disease (CAD).SUBJECTS AND METHODS. Seventy-two consecutive patients with known or suspected CAD underwent both 64-MDCT and quantitative coronary angiography (QCA). A CT system with acquisition of 64 slices per gantry rotation was used with a spatial resolution of 0.4 × 0.4 × 0.4 mm and a gantry rotation time of 330 milliseconds. Sensitivity, specificity, and diagnostic accuracy of 64-MDCT in the detection or exclusion of CAD were evaluated on both a per patient and a per segment basis.RESULTS. Sixty-eight of 72 coronary CT angiograms (CTAs) (94%) were of diagnostic image quality. QCA showed significant CAD (i.e., one or more stenoses in > 50%) in 57% (39/68) and nonsignificant disease or healthy CTAs in 43% (29/68) of the patients. Sensitivity, specificity, and the negative predictive value (NPV) of 64-MDCT per ...
320 citations
TL;DR: Optimally performed hysterosalpingography and saline infusion sonohysterography can be relatively comfortable procedures for the patient that provide a great deal of useful diagnostic information.
Abstract: OBJECTIVE. The objectives of this article are to review the examination techniques for hysterosalpingography and saline infusion sonohysterography and to present practical tips to enhance physician performance and minimize patient discomfort during these procedures.CONCLUSION. Optimally performed hysterosalpingography and saline infusion sonohysterography can be relatively comfortable procedures for the patient that provide a great deal of useful diagnostic information.
301 citations
TL;DR: Clinical ADC measurements of abdominal organs and lesions using parallel imaging appear to be reliable and useful, and the effect of parallel imaging on calculated values is considered to be minimal.
Abstract: OBJECTIVE. The purpose of our study was to assess the reliability and usefulness of parallel imaging for apparent diffusion coefficient (ADC) measurement of abdominal organs and lesions.MATERIALS AND METHODS. Single-shot spin-echo echo-planar diffusion-weighted MRI (TE = 66, b = 0, 600 s/mm2) was performed in phantom and clinical studies. The b value was set to minimize the effects of perfusion in tissue and to maintain signal-to-noise ratio. Bottle phantoms were scanned with and without parallel imaging and with various parallel imaging factors and at various positions to evaluate the effects of parallel imaging on ADCs. In 200 consecutive clinical patients (122 men and 78 women: mean age, 61.9 years), ADCs were calculated for liver (four segments), spleen, pancreas (head, body, tail), gallbladder, renal parenchyma, and back muscle, and then compared to evaluate the reliability of clinical ADC measurements with parallel imaging. ADCs were also calculated for diffuse diseases and focal lesions (94 maligna...
291 citations
TL;DR: Size of rotator cuff tear and degree of fatty degeneration of the infraspinatus muscle have the most pronounced influence on acromiohumeral distance.
Abstract: OBJECTIVE. The purpose of this study was to evaluate the association between rotator cuff abnormalities and reduced acromiohumeral distance.MATERIALS AND METHODS. Acromiohumeral distance was measured on conventional radiographs and on MR images. Three age- and sex-matched patient groups each including 21 patients were stratified according to acromiohumeral distance on conventional radiographs (group 1, ≤ 7 mm; group 2, 8-10 mm; group 3, > 10 mm). Acromiohumeral distance was related to the presence, location, and size of a rotator cuff tear and the degree of fatty degeneration of the muscle assessed on MR arthrography. The relative influence on acromiohumeral distance of the various MR arthrographic findings was assessed. Spearman's rank correlation and stepwise regression were used for statistical analysis.RESULTS. In group 1 (acromiohumeral distance ≤ 7 mm) full-thickness supraspinatus tendon tears were present in 90% (19/21) of the patients, infraspinatus tendon tears in 67% (14/21) of the patients, and...
245 citations
TL;DR: The liposomal-based iodinated contrast agent shows long residence time in the blood pool, very high attenuation within submillimeter vessels, and no significant renal clearance rendering it an effective contrast agent for murine vascular imaging using a micro-CT scanner.
Abstract: OBJECTIVE The goal of this study was to determine if an iodinated, liposomal contrast agent could be used for high-resolution, micro-CT of low-contrast, small-size vessels in a murine modelMATERIALS AND METHODS A second-generation, liposomal blood pool contrast agent encapsulating a high concentration of iodine (83–105 mg I/mL) was evaluated A total of five mice weighing between 20 and 28 g were infused with equivalent volume doses (500 μL of contrast agent/25 g of mouse weight) and imaged with our micro-CT system for intervals of up to 240 min postinfusion The animals were anesthetized, mechanically ventilated, and vital signs monitored allowing for simultaneous cardiac and respiratory gating of image acquisitionRESULTS Initial enhancement of about 900 H in the aorta was obtained, which decreased to a plateau level of approximately 800 H after 2 hr Excellent contrast discrimination was shown between the myocardium and cardiac blood pool (650–700 H) No significant nephrogram was identified, indic
235 citations
TL;DR: Radiation doses to the fetus from institutional MDCT protocols that may be used during pregnancy (for pulmonary embolus, appendicitis, and renal colic) are below the level thought to induce neurologic detriment to the unborn child.
Abstract: OBJECTIVE. The purpose of our study was to determine radiation dose to the fetus at early gestation when contemporary MDCT scanners are used for common clinical indications.MATERIALS AND METHODS. Anthropomorphic phantoms were constructed to reflect a pregnant woman. Thermoluminescence dosimeters (TLDs) and metal oxide semiconductor field effect transistor (MOSFET) detectors were placed in appropriate locations to determine real-time radiation exposure to the fetus at 0 and 3 months' gestation. Imaging was performed on a 16-MDCT scanner using current institutional CT protocols: renal stone (140 kVp, 160 mA, rotation time of 0.5 sec, 16 × 0.625 mm), appendix (140 kVp, 340 mA, rotation time of 0.5 sec, 16 × 0.625 mm), and pulmonary embolus (140 kVp, 380 mA, rotation time of 0.8 sec, 16 × 1.25 mm).RESULTS. The radiation dose to the fetus at 0 and 3 months, respectively, was as follows: renal stone protocol, 0.8–1.2 and 0.4–0.7 cGy; appendix protocol, 1.52–1.68 and 2–4 cGy; and pulmonary embolus protocol, 0.02...
233 citations
TL;DR: Imaging findings of a solid mass near a cesarean section scar strongly suggest its diagnosis of abdominal wall endometriosis frequently presents with noncyclic symptoms.
Abstract: OBJECTIVE. The purpose of our study was to evaluate clinical findings and sonographic features of abdominal wall endometriosis and also to report its CT and MR appearance.MATERIALS AND METHODS. A computerized search of our institution's database over a 5-year period was performed, yielding 12 surgically proven cases of abdominal wall endometriosis that were retrospectively studied. All patients had undergone sonography including power Doppler examination. Additional CT was performed in one patient and MRI in four. Pathologic material was preoperatively obtained by sonographically guided puncture in six patients. The clinical data were analyzed, and the imaging studies were reviewed by two radiologists working in consensus.RESULTS. All patients had a history of at least one prior cesarean section. All presented with focal pain near the surgical scar, which was cyclic in three patients. Nine patients presented with a palpable mass near the scar. Sonography detected 11 lesions within the abdominal wall, with...
222 citations
TL;DR: The anatomic distribution of the healthy paraganglion system and the imaging and pathologic features of various extraadrenal paragANGliomas occurring in the head and neck, chest, and abdomen are illustrated.
Abstract: OBJECTIVE. This article illustrates the anatomic distribution of the healthy paraganglion system and the imaging and pathologic features of various extraadrenal paragangliomas occurring in the head and neck, chest, and abdomen.CONCLUSION. Although paragangliomas can occur in a variety of anatomic locations, the majority are seen in relatively predictable regions of the body. Extraadrenal paragangliomas have nearly identical imaging features, including a homogeneous or heterogeneous hyperenhancing soft-tissue mass at CT, multiple areas of signal void interspersed with hyperintense foci (salt-and-pepper appearance) within tumor mass at MRI, and an intense tumor blush with enlarged feeding arteries at angiography.
TL;DR: High-b-value DW-MRI allows detection of colorectal adenocarcinoma with a high sensitivity and specificity.
Abstract: OBJECTIVE. The purpose of this article is to evaluate the usefulness of high-b-value diffusion-weighted MRI (DW-MRI) in the detection of colorectal adenocarcinoma.CONCLUSION. High-b-value DW-MRI allows detection of colorectal adenocarcinoma with a high sensitivity and specificity.
TL;DR: This study showed the combined effect of lowering the kilovoltage setting and using an automatic modulation technique (ECG-pulsed tube current modulation) for coronary CT that can be reduced by up to 88% for slim patients without impairing image quality.
Abstract: OBJECTIVE. The objective of our study was to show the feasibility of coronary CT using low kilovoltage (80 kV) combined with ECG-pulsed tube current modulation in selected patients.CONCLUSION. This study showed the combined effect of lowering the kilovoltage setting (80 kV) and using an automatic modulation technique (ECG-pulsed tube current modulation) for coronary CT. Radiation dose exposure can be reduced by up to 88% for slim patients without impairing image quality.
TL;DR: A combination of MR arthrography and a small field of view is more sensitive in detecting labral abnormalities than is conventional MRI with either a large or a smallField of view.
Abstract: OBJECTIVE. MRI has historically provided suboptimal visualization of tears of the acetabular labrum. Degenerative fraying and underlying cartilage abnormalities can often mimic tears of the labrum on conventional MRI. Administration of intraarticular gadolinium enhances the MRI appearance of the labrum to improve detection of labral abnormalities. This study examined the improved diagnostic sensitivity of MR arthrography compared with conventional MRI and the importance of confining the study to a small field of view.MATERIALS AND METHODS. Fifty-one hips were imaged in 48 patients. Fourteen hips underwent conventional MRI with a large field of view (30-38 cm). Seven hips underwent conventional MRI with a small field of view (14-20 cm). Thirty hips underwent MR arthrography with a small field of view (14-20 cm). Labral tears were diagnosed when contrast material was identified within the labrum or between the labrum and the acetabulum, when a displaced fragment was noted, or when a paralabral cyst was iden...
TL;DR: Patients with abscesses smaller than 3 cm in size can be treated with antibiotics alone and, in some cases, as outpatients, and may not uniformly require surgery, although the results in this group were limited by a small sample size.
Abstract: OBJECTIVE. Our objective was to determine whether abscess size can be used as a discriminating factor to guide management of patients with diverticular abscesses.MATERIALS AND METHODS. We performed a word search of our CT database between July 2001 and July 2002 for the CT diagnosis of diverticulitis. CTs were retrospectively reviewed as consensus opinion of two reviewers. CTs were evaluated for presence of an abscess, its location, maximum diameter, and feasibility of percutaneous abscess drainage. Abscesses were categorized into smaller than 3 cm and larger than or equal to 3 cm, and the management of these groups was compared.RESULTS. Thirty-one abscesses were noted in 30 (17%) of 181 patients with a CT diagnosis of diverticulitis. Twenty-two (73%) of 30 patients had 23 abscesses, all of which were smaller than 3 cm and were treated and resolved with antibiotics alone (p < 0.001). Eight (36%) of 22 required surgical treatment. Eight (26%) of 31 abscesses had a maximum diameter larger than or equal to 3...
TL;DR: An overview of systematic reviews of diagnostic performance is provided and statistical methods for the most common variant of the problem are discussed: meta-analysis of studies in which a pair of estimates of sensitivity and specificity is reported.
Abstract: OBJECTIVE. Interest in evidence-based diagnosis is growing rapidly as diagnostic and screening techniques proliferate. In this article we provide an overview of systematic reviews of diagnostic performance and discuss in detail statistical methods for the most common variant of the problem: meta-analysis of studies in which a pair of estimates of sensitivity and specificity is reported. The need to account for possible variations in threshold for test positivity across studies led to the formulation of the Summary ROC (SROC) curve method. We discuss graphical and model-based ways to estimate, summarize, and compare SROC curves, and we present an example from a meta-analysis of data on techniques for staging cervical cancer. We also present a brief survey of the methodologic literature for addressing heterogeneity, correlated data, multiple thresholds per study, and systematic reviews of ROC studies. We conclude with a discussion of the significant methodologic challenges that continue to face investigator...
TL;DR: Abdominal MR sequence protocols optimized for 1.5-T scanners should not be transferred to 3.0 T without substantial modification, and specific patient groups--for example, large patients with ascites--are not well suited to undergo an abdominal MRI study at 3.
Abstract: OBJECTIVE. The purpose of our article is to describe the underlying physics concepts of abdominal MRI at 3.0 T and their impact on signal-to-noise ratio, susceptibility artifacts, chemical shift artifacts, and dielectric effects.CONCLUSION. Abdominal MR sequence protocols optimized for 1.5-T scanners should not be transferred to 3.0 T without substantial modification. In addition, specific patient groups—for example, large patients with ascites—are not well suited to undergo an abdominal MRI study at 3.0 T.
TL;DR: Patients with a history of nephrolithiasis and flank pain are at increased risk for serial CT with potentially high cumulative effective doses.
Abstract: OBJECTIVE The purpose of our study was to assess the dose of ionizing radiation delivered through the use of unenhanced CT for suspected renal colic by determining the incidence of repeated unenhanced CT examinations and the cumulative radiation dose deliveredMATERIALS AND METHODS All unenhanced CT examinations for suspected renal colic performed at our institution over a 6-year period were included, and patient age, sex, and multiplicity of examinations were determined For the adult patient, this protocol prescribes a fixed tube current of 200 mA, 140 kVp, and a nominal slice width of 5 mm The dose–length product (DLP) was estimated for 15 randomly chosen single-detector CT (SDCT) and MDCT adult flank pain examinations using manufacturer's software The mean DLPs for SDCT and MDCT were computed and converted to effective doses Total effective doses were calculated for patients who underwent more than three examinations, and values were compared with established standardsRESULTS A total of 5,564 e
TL;DR: Compared with using a constant tube current to scan the abdomen and pelvis, the use of a combined modulation technique results in a substantial reduction in radiation dose with acceptable image noise and diagnostic acceptability.
Abstract: OBJECTIVE. The objective of our study was to compare image quality and radiation dose associated with abdominopelvic CT using combined modulation, angular modulation, and constant tube current.CONCLUSION. Compared with using a constant tube current to scan the abdomen and pelvis, the use of a combined modulation technique results in a substantial reduction (42-44%) in radiation dose with acceptable image noise and diagnostic acceptability.
TL;DR: Accurate diagnosis and staging of aggressive fibromatosis by MRI have important treatment and prognostic implications and MRI and pathology findings did not predict recurrence.
Abstract: OBJECTIVE. We present the MRI features with pathologic correlation of aggressive fibromatosis, incorporating 203 cases over a 5-year period from the Royal Marsden Hospital Sarcoma Unit database.MATERIALS AND METHODS. Sixty patients had imaging available for retrospective review of which 29 had preoperative MRI and final histopathologic diagnosis of aggressive fibromatosis.RESULTS. The average age at diagnosis was 41.3 years with a female-to-male sex ratio of 1.2:1. Twenty lesions were extraabdominal; six, intraabdominal; and three, in the abdominal wall (classic desmoid). The average tumor size was 6.4 cm (range, 2.2-13.7 cm). Intraabdominal aggressive fibromatosis produced the largest tumors, averaging 9.5 cm. Most lesions were ovoid (52%) or infiltrative (34.5%) in outline with an irregular or lobulated contour (76%). The lesions crossed major fascial boundaries in 31% of cases overall and in 66% of patients referred for recurrent disease. On MRI, homogeneous isointensity or mild hyperintensity on T1-we...
TL;DR: A simple diagnostic algorithm for interpretation of microbubble contrast-enhanced pulse-inversion sonography provides sensitive and accurate diagnosis of commonly encountered liver masses.
Abstract: OBJECTIVE. The objective of this study was to develop an algorithm for liver mass diagnosis using microbubble contrast-enhanced pulse-inversion sonography.SUBJECTS AND METHODS. Ninety-six lesions in 92 patients were evaluated with DMP 115 (Definity)-enhanced pulse-inversion sonography, comprising 44 malignancies (29 hepatocellular carcinomas, 12 metastases, two peripheral cholangiocarcinomas, and one hepatic lymphoma) and 52 benign lesions (26 hemangiomas, 20 focal nodular hyperplasias, and six others). All had continuous low-mechanical-index imaging through the arterial and portal venous phase. A three-person blind review evaluated single images at baseline, early and peak arterial phases, and through the extended portal phases with a movie showing arterial phase wash-in. Reviewers assessed lesional vascularity and enhancement blindly but did not make a diagnosis. Combinations of answers were compared with independently determined final diagnoses to develop an algorithm for liver mass diagnosis.RESULTS. ...
TL;DR: CT underestimates the number of nodules relative to sonography, which suggests that sonography is a useful adjunctive test after the incidental detection of a thyroid abnormality on CT, and there is at least an 11.3% prevalence of malignant or potentially malignant lesions among incidental thyroid abnormalities detected on CT.
Abstract: OBJECTIVE. The purpose of our study was to determine the prevalence of malignancy in incidental abnormalities of the thyroid gland detected on CT and to determine the relative accuracy of characterizing these abnormalities on CT as compared with sonography and pathology.MATERIALS AND METHODS. We searched our department's computerized clinical database for all thoracic and cervical CT scans in which a new abnormality was incidentally identified in the thyroid gland from 1998-2001. Two hundred thirty patients with abnormal findings in the gland on CT subsequently underwent thyroid sonography, and 118 of the 230 patients underwent a diagnostic biopsy or resection. CT and sonographic images were directly reviewed to identify imaging features of each thyroid abnormality, including the location, size, appearance, and presence or absence of calcifications. Associations were evaluated using Fisher's exact test of significance and the Student's t test. The overall rate of malignant and potentially malignant lesion...
TL;DR: Analysis of MDCT images was predictive of the site of gastrointestinal tract perforation in 73 (86%) of 85 patients, and three of eight CT findings significantly correlate with surgical diagnosis.
Abstract: OBJECTIVE. The purpose of this study was to prospectively evaluate the accuracy of MDCT for preoperative determination of the site of surgically proven gastrointestinal tract perforations and to determine the most predictive findings in this diagnosis. SUBJECTS AND METHODS. We prospectively studied 85 consecutive patients with extraluminal air on MDCT who had surgically proven gastrointestinal tract perforations. All patients underwent surgery within 12 hours after MDCT was performed. Two experienced radiologists, blinded to the surgical diagnosis, reached a consensus prediction of the site of the perforation using the following eight MDCT findings: concentration of extraluminal air bubbles adjacent to the bowel wall, free air in supramesocolic or inframesocolic compartments, extraluminal air in both abdomen and pelvis, focal defect in the bowel wall, segmental bowel-wall thickening, perivisceral fat stranding, abscess, and extraluminal fluid. MDCT imaging results were compared with surgical and pathologic findings. Logistic regression analyses were performed to assess the significance of the different radiologic criteria. RESULTS. Analysis of MDCT images was predictive of the site of gastrointestinal tract perforation in 73 (86%) of 85 patients. Logistic regression showed that concentration of extraluminal air bubbles (p < 0.001), segmental bowel wall thickening (p < 0.001), and focal defect of the bowel wall (p = 0.007) were strong predictors of the site of bowel perforation. CONCLUSION. MDCT is highly accurate for predicting the site of gastrointestinal tract perforations. Three of eight CT findings significantly correlate with surgical diagnosis.
TL;DR: Clinical presentation and radiography are unreliable in the preoperative diagnosis of fish bone perforation of the GI tract, but this limitation can be overcome with the use of CT, which is accurate in showing the offending fish bone.
Abstract: OBJECTIVE. Foreign body perforation of the gastrointestinal (GI) tract has diverse clinical manifestations, and the correct preoperative diagnosis is seldom made. We report our experience with the use of CT in the preoperative diagnosis of fish bone perforation of the GI tract in seven patients. To our knowledge, this series is the largest to date addressing the role of CT in the diagnosis of fish bone perforation.CONCLUSION. Clinical presentation and radiography are unreliable in the preoperative diagnosis of fish bone perforation of the GI tract. This limitation can be overcome with the use of CT, which is accurate in showing the offending fish bone. The accuracy of CT is limited by observer dependence. A high index of suspicion should always be maintained for the correct diagnosis to be made.
TL;DR: The PPV of biopsy for lesions identified at breast MRI using a 1.5-T magnet significantly increased with increasing lesion size, and further work is needed to develop an algorithm that uses size in addition to other patient and lesion factors to guide biopsy recommendations for MRI-detected breast lesions.
Abstract: OBJECTIVE. The purpose of this study was to determine the impact of lesion size on the positive predictive value (PPV) of biopsy in MRI-detected breast lesions.MATERIALS AND METHODS. A retrospective review was performed of 666 consecutive nonpalpable, mammographically occult lesions that had MRI-guided localization. MRI examinations were performed using a 1.5-T magnet. Lesions were measured by the interpreting radiologist before biopsy. Malignancy rate versus lesion size was determined.RESULTS. The median MRI lesion size was 1 cm (range, 0.3-7.0 cm). Malignancy was present in 149/666 (22%) lesions, of which 80 (54%) were ductal carcinoma in situ (DCIS), 66 (44%) were invasive cancer, and three (2%) were lymphoma. The frequency of malignancy increased significantly (p = 0.0005) with lesion size, with malignancy found in one (3%) of 37 lesions less than 5 mm, 44 (17%) of 254 lesions 5-9 mm, 37 (25%) of 151 lesions 10-14 mm, 21 (28%) of 74 lesions 15-19 mm, and 46 (31%) of 150 lesions 20 mm or larger. Lesion...
TL;DR: Color Doppler sonography is more accurate than gray-scale sonography for characterizing median nerve involvement in patients with suspected carpal tunnel syndrome.
Abstract: OBJECTIVE. The purpose of this study was to retrospectively assess the accuracy of gray-scale and color Doppler sonography in the diagnosis of carpal tunnel syndrome.MATERIALS AND METHODS. A total of 206 wrists in 151 patients with a clinical suspicion of carpal tunnel syndrome were examined with high-resolution sonography using a 7-15-MHz linear array transducer. The presence of median nerve swelling, edema, and flattening and increased bowing of the flexor retinaculum was evaluated with gray-scale sonography, and the presence of nerve hypervascularization was evaluated with color Doppler sonography. Sensitivity and specificity were calculated for each sonographic feature in comparison with nerve conduction studies as the standard of reference. Multivariate logistic regression analysis was used to determine variables predictive of carpal tunnel syndrome.RESULTS. Carpal tunnel syndrome was confirmed in 172 wrists at nerve conduction studies. A median nerve cross-sectional area of at least 0.11 cm2 was cal...
TL;DR: Contrast-enhanced Doppler sonography is a noninvasive imaging technique that allows the early prediction of tumor response in c-kit-positive GIST treated with Glivec.
Abstract: OBJECTIVE. The purpose of this study was to evaluate contrast-enhanced Doppler sonography with perfusion software as a predictor of early tumor response to imatinib (Glivec) in c-kit-positive gastrointestinal stromal tumors (GISTs).SUBJECTS AND METHODS. Thirty patients (59 tumors) with metastases or a recurrence from a GIST were prospectively included in a single-center imaging trial. Contrast-enhanced Doppler sonography was performed with an Aplio scanner the day before (day-1) starting oral treatment (400 mg) and at days 1, 7, 14, 60, 90, and 6 months, 9 months, and 1 year. The percentage of contrast uptake (Levovist or Sonovue) before treatment and at the different stages of follow-up was evaluated by two radiologists. Digitized quantification was performed using Photoshop software. To define the benchmark standard, all patients were rated as responders or nonresponders at 2 and 6 months by a board consisting of oncologists and radiologists who had all clinical and imaging data at their disposal. Chang...
TL;DR: This pictorial essay is to illustrate the various appearances of solid pseudopapillary tumor of the pancreas, a rare neoplasm usually found in young women, which can have an atypical appearance.
Abstract: OBJECTIVE. The purpose of this pictorial essay is to illustrate the various appearances of solid pseudopapillary tumor of the pancreas.CONCLUSION. Solid pseudopapillary tumor of the pancreas is a rare neoplasm usually found in young women. Typical solid pseudopapillary tumor is characterized by a well-encapsulated mass with varying amounts of intratumoral hemorrhage. However, the tumor can have an atypical appearance, such as metastasis, ductal obstruction, parenchymal and extracapsular invasion, simulation of islet cell tumor, intratumoral calcification, and occurrence in a male patient. The typical and atypical manifestations of solid pseudopapillary tumor can be visualized with cross-sectional imaging.
TL;DR: The correlation between the maximum radiation skin dose with DAP is more striking than that with fluoroscopic time in both RFCA and percutaneous coronary intervention procedures and it is recommended that physicians record the DAP when it can be monitored and that Physicians record the fluoroscope time when DAP cannot be monitored for estimating the maximum patient skin dose in RFCA procedures.
Abstract: OBJECTIVE. Real-time maximum dose monitoring of the skin is unavailable on many of the X-ray machines that are used for cardiac intervention procedures. Therefore, some reports have recommended that physicians record the fluoroscopic time for patients undergoing fluoroscopically guided intervention procedures. However, the relationship between the fluoroscopic time and the maximum radiation skin dose is not clear. This article describes the correlation between the maximum radiation skin dose and fluoroscopic time for patients undergoing cardiac intervention procedures. In addition, we examined whether the correlations between maximum radiation skin dose and body weight, fluoroscopic time, and dose–area product (DAP) were useful for estimating the maximum skin dose during cardiac intervention procedures.MATERIALS AND METHODS. Two hundred consecutive cardiac intervention procedures were studied: 172 percutaneous coronary interventions and 28 cardiac radiofrequency catheter ablation (RFCA) procedures. The pa...
TL;DR: The role of contrast-enhanced dynamic MRI in predicting disease activity of Crohn's disease was evaluated in this paper, where axial dynamic T1-weighted sequences were performed every 4-6 sec for a total duration of 2-3 min after contrast administration.
Abstract: OBJECTIVE. The purpose of this study was to evaluate the role of contrast-enhanced dynamic MRI in predicting the disease activity of Crohn's disease.MATERIALS AND METHODS. Forty-eight patients in two hospitals who had clinically suspected exacerbation of Crohn's disease were included in this study. In three levels of thickened small-bowel wall, axial dynamic T1-weighted sequences were performed every 4-6 sec for a total duration of 2-3 min after contrast administration; static T1-weighted turbo spin-echo sequences were acquired both before and after contrast administration. The slope of enhancement, enhancement ratio, time to enhancement, enhancement time, and thickness of the small-bowel wall were determined. These MRI results were compared with overall clinical grade, Crohn's disease activity index (CDAI), and Van Hees activity index. Clinical grade was based on clinical information, physical findings, laboratory studies, endoscopy, surgery, and other imaging studies. Spearman's correlation coefficient ...