Contracture of the deltoid muscle: sonographic evaluation with MRI correlation

OBJECTIVE: This article evaluates the sonographic features of deltoid contracture (DC) with MRI correlation. MATERIAL AND METHODS: Two reviewers evaluated the imaging features in 22 painful shoulders of 20 patients with a sonographic diagnosis of DC and a subsequent confirming MRI study. The sonographic and MRI findings with regard to the lesion extent (assessed by a 3-point scale: 1 = less than or equal to one third of the longitudinal deltoid length involved, 2 = greater than one third and less than or equal to two thirds involved, and 3 = greater than two thirds involved), transverse lesion morphologic appearance, and maximal transverse diameter measured were compared with kappa statistics and Wilcoxon's signed rank test, respectively. RESULTS: Compared with MRI, there were two false-positive diagnoses of DC on sonography. Among the 20 true-positive diagnoses, sonography showed good agreement with MRI in assessing the lesion extent (kappa = 0.796, p < 0.001). Three sonographic lesion morphologic patterns for hyperechoic lesions (I = with multiple < 8-mm hypoechoic spots, II = heteroechoic lesions with predominant 8-15-mm hypointense areas, and III = > 15-mm calcified nodules, respectively) showed excellent agreement with three MRI lesion patterns (I = multiple < 8-mm hypointense spots, II = predominant 8-15-mm hypointense areas, and III = > 15-mm hypointense nodules, respectively) (kappa = 0.921, p < 0.001). However, the maximum lesion diameters appeared significantly larger on sonography than on MRI (2.8 +/- 0.6 cm vs 2.0 +/- 0.8 cm, mean +/- SD; p < 0.001), which was plausibly ascribed to the better sonographic delineation of hyperechoic immature fibrotic tissues. CONCLUSION: Sonography is helpful for evaluating DC and correlates well with MRI.     

Rheumatoid arthritis of the hand and wrist: comparison of three imaging techniques

OBJECTIVE: The purpose of this study was to compare the relative results from conventional high-field-strength 1.5-T MRI, 0.2-T low-field-strength dedicated extremity MRI, and radiography to detect and grade bone erosions, joint-space narrowing, and synovitis in the hands and wrists of patients with rheumatoid arthritis. SUBJECTS AND METHODS: Eighteen patients with rheumatoid arthritis underwent conventional high-field-strength MRI, low-field-strength dedicated extremity MRI, and conventional radiography of both hands and wrists. Two independent reviewers searched for the presence and extent of bone erosions, joint-space narrowing, and synovitis. Bone erosions (E scores) and joint-space narrowing (J scores) were evaluated at 14 and 13 sites, respectively, on conventional high-field-strength MRI, low-field-strength dedicated extremity MRI, and radiography, using the Sharp-Genant scoring system. Synovitis (S scores) were evaluated at 13 sites on conventional high-field-strength MRI and low-field-strength dedicated extremity MRI. RESULTS: For the detection of bone erosions, we found no significant difference (p = 0.71) between conventional high-field-strength MRI (mean +/- SD E score, 27.5 +/- 9.8) and low-field-strength dedicated extremity MRI (28.8 +/- 10.0), but a significant difference (p < 0.001) appeared between MRI and radiography (13.1 +/- 8.3). J scores derived from MRI (conventional high-field-strength MRI, 15.2 +/- 8.3; low-field-strength dedicated extremity MRI, 14.5 +/- 10.4) were higher than those derived from radiography (12.7 +/- 9.6), although the difference was not significant (p = 0.70). Conventional high-field-strength MRI (S score, 35.1 +/- 8.6) and low-field-strength dedicated extremity MRI (30.8 +/- 10.2) were equivalent (p = 0.14) for the evaluation of synovitis. The interobserver agreement for MRI scores was good to excellent (intraclass correlation coefficients, 0.83-0.94). CONCLUSION: Conventional high-field-strength MRI and low-field-strength dedicated extremity MRI showed similar results in terms of cross-sectional grading of bone erosions, joint-space narrowing, and synovitis in the hands and wrists of patients with rheumatoid arthritis.     

Acceptance by patients of multidetector CT colonography compared with barium enema examinations, flexible sigmoidoscopy, and colonoscopy

OBJECTIVE: The purpose of this study was to compare patient acceptance of multidetector CT colonography, total colonoscopy, flexible sigmoidoscopy, and double-contrast barium enema to ascertain any overall preference. SUBJECTS AND METHODS. One hundred sixty-eight patients underwent CT colonography followed by either flexible sigmoidoscopy (n = 59) or colonoscopy (n = 109). A 25-point questionnaire with principal components relating to satisfaction, worry, and physical discomfort was administered after CT colonography and after endoscopy, and a follow-up questionnaire was administered 1 week after the procedures. Questionnaires were also completed by 140 patients undergoing double-contrast barium enema examinations. Responses were compared using Wilcoxon's matched pairs test and the Mann-Whitney test. RESULTS: Overall satisfaction was greater with colonoscopy (p = 0.01), but CT colonography caused less discomfort (p = 0.002), was better tolerated (p = 0.005), and was the preferred follow-up investigation of those expressing a preference (p = 0.003). Compared with flexible sigmoidoscopy, CT colonography caused less pain (p = 0.004), was more acceptable (p = 0.04), and was preferred as the follow-up investigation (p < 0.001). Tolerance of colonoscopy was significantly less in women (p = 0.03), but such was not the case for CT colonography (p = 0.58). Patients undergoing CT colonography were less worried (p < 0.001), were more satisfied (p = 0.001), and suffered less discomfort (p < 0.001) than those having barium enema. CONCLUSION: Patients' experiences with barium enema examinations were significantly worse than with any other test. Although patients were most satisfied with colonoscopy, they reported more pain during both colonoscopy and sigmoidoscopy than during CT colonography, and they also found CT more acceptable. In patients expressing a preference, CT colonography was the preferred follow-up investigation.     

Low power laser in the treatment of the acute low back pain

BECKGROUND/AIM: Acute low back pain (ALBP) is one of the most frequent painful conditions in the human population. The objective of the paper was to compare the efficacy of the low power laser (LPL) in the pain and the muscular spasm reduction with conservative methods of physical medicine. METHOD: The prospective cohort study was done. The study involved 70 patients, both men and women, from 25 to 64 years of age with the diagnosis of ALBP. Two groups were formed. There were 40 patients in the first group and they were treated with the LPL with frequency of 73 Hz. The second group was the control one and it consisted of 30 patients who were treated with conservative methods of physical medicine (electrotherapy: diadynamic currents CP +/- 3 and CP +/- 3, interferent currents--90 Hz for 15 min; electrophoresis with novocaine). The ALBP were diagnosed by clinical examination and by the nuclear magnetic resonance imaging (NMRI). The low power laser--Gallium Arsenide (GaAs) was used. The laser sonde consisted of 4 laser diodes, each powered of 15 mW, wavelength 904 nm and with frequency 73 Hz. The total period of time for each treatment was 10 minutes and the total dose per treatment was 15 J. The intensity of acute low back pain was assessed by Roland's scale. The degree of the spasm was assessed in the relaxed position and during movements. Results. The average score in the first group before the onset of rehabilitation was 3.3 +/- 1.1 (Me = 3.0), and in the control group was 3.43 +/- 0.89 (Me = 3.0). After five treatments in patients who were treated with LPL the average score in Roland's scale was decreased (1.12 +/- 1.3, Me = 2.0) and in the control group there were no changes. After 10 treatments with the LPL the analgesic effect was obtained in 82.5% of patients from the first group and in 20% of patients in the control group. The analgesic effect in patients of the first group was obtained after 7.5 +/- 2.1 treatments and in the second group after 17.9 +/- 3.2 treatments. The difference was statistically significant (t = 15.652173, p < 0.001). The spasm disappeared in 92.5% of patients in the first group and in 20% of patients in the control group after 7.02 +/- 2.2 and 17.9 +/- 3.2 treatments respectively. The difference was statistically significant (t = 15.652173, p < 0.001). CONCLUSION: The pain and spasm reduction were obtained in the greater number of patients by usage of the LPL than by usage of conservative methods of physical medicine.     

Patterns, incidence and predictive factors for pain after interventional radiology

AIM: To evaluate prospectively the pattern, severity and predictive factors of pain after interventional radiological procedures. MATERIALS AND METHODS: All patients undergoing non-arterial radiological interventional procedures were assessed using a visual-analogue scale (VAS) for pain before and at regular intervals for 24 h after their procedure. RESULTS: One hundred and fifty patients (87 men, mean age 62 years, range 18-92 years) were entered into the study. Significant increases in VAS score occurred 8 h after percutaneous biliary procedures (+47.7 mm, SD 14.9 mm; p=0.001), 6 h after central venous access and gastrostomy insertion (+23.7 mm, SD 19.5 mm; p=0.001 and +28.4 mm, SD 9.7 mm; p=0.007, respectively) and 4h after oesophageal stenting (+27.8 mm, SD 20.2 mm, p=0.001). Non-significant increases in VAS pain score were observed after duodenal and colonic stenting (duodenal: +5.13 mm, SD 7.47 mm; p=0.055, colonic: +23.3 mm, SD 13.10 mm, p=0.250) at a mean of 5h (range 4-6h). Patients reported a significant reduction in pain score for nephrostomy insertion (-28.4mm, SD 7.11 mm, p=0.001). Post-procedural analgesia was required in 99 patients (69.2%), 40 (28.0%) requiring opiates. Maximum post-procedural VAS pain score was significantly higher in patients who had no pre-procedural analgesia (p=0.003). CONCLUSION: Post-procedural pain is common and the pattern and severity of pain between procedures is variable. Pain control after interventional procedures is often inadequate, and improvements in pain management are required.     

Depiction of renal perfusion defects with contrast-enhanced harmonic sonography in a porcine model.

OBJECTIVE: Our purpose was to test the feasibility and optimization of contrast-enhanced gray-scale harmonic sonography for the evaluation of focal renal perfusion defects in an animal model. SUBJECTS AND METHODS: We performed arteriography and contrast-enhanced harmonic sonography on six anesthetized piglets after embolization of each kidney with an autologous clot through the main renal artery. Harmonic images were obtained with continuous (30 Hz) and ECG-triggered acquisition. The two harmonic sonography strategies were compared with respect to the number and conspicuity of devascularized areas, and correlation was made with arteriographic findings. RESULTS: Contrast-enhanced harmonic sonography showed focal areas of absent or diminished vascularity that corresponded closely with perfusion defects seen on angiography. Enhancement ratios to perfused cortex were significantly higher than to devascularized cortex in both continuous (mean +/- SD, 469 +/- 5% versus 102 +/- 8%, p < .0005 by t test) and triggered (673 +/- 7% versus 198 +/- 7%, p < .0001) modes. Triggered acquisition increased the conspicuity of perfusion defects over that obtained with continuous imaging (p < .002 by t test). CONCLUSION: Contrast-enhanced harmonic sonography is an effective method of depicting focal renal perfusion defects. Triggered acquisition further improves lesion conspicuity.     

Whole-body magnetic resonance imaging and FDG-PET/CT for lymphoma staging: Assessment of patient experience

Purpose

To compare patient experience of whole-body MRI and FDG-PET/CT performed for lymphoma staging.

Treatment of vertebral tumor with posterior wall defect using image-guided radiofrequency ablation combined with vertebroplasty: preliminary results in 12 patients

PURPOSE: To evaluate the safety and clinical benefit of vertebral tumor treatment by combined radiofrequency ablation (RFA) and vertebroplasty, for pain reduction in patients who are unable to benefit from noninvasive treatment methods. MATERIALS AND METHODS: Twelve patients with painful vertebral tumors with posterior wall defect, in whom medical treatment together with radiation therapy and/or chemotherapy had failed, were treated with RFA combined with vertebroplasty. Procedures were performed using multislice CT-fluoroscopy and lateral C-arm fluoroscopic guidance. All patients had posterior wall defects of the vertebra being treated. Ten had lytic posterior wall destruction and two had posterior wall fracture. The visual analog scale (VAS) pain score was measured before, one week after, and three months after treatment. VAS patient satisfaction score was measured before and one week after treatment. The VAS score range was 0-20. The analgesic use was evaluated before and four weeks after treatment and complications were monitored. RESULTS: Combined RFA and vertebroplasty treatment was technically successful in all patients. Pain significantly decreased after treatment: the mean VAS pain score before treatment was 17.33 +/- 2.46 (range, 13-20) versus 9.25 +/- 4.81 (range, 2-18) one week after treatment (P < .001) and was 7.00 +/- 5.26 (range, 1-14) three months after treatment (P = .020). The mean VAS satisfaction score of all patients was 15.83 +/- 4.26 (range, 4-20). Analgesic use decreased after treatment. No serious treatment related complications occurred. CONCLUSION: RFA in combination with vertebroplasty for treating vertebral tumors with posterior wall defect appeared safe, and reduced pain substantially in patients who did not benefit from other noninvasive treatment methods.     

Optimization of fetal weight estimates using MRI: comparison of acquisitions

OBJECTIVE: The purpose of this study was to determine whether differences are seen in calculation of fetal weight using 5-mm sagittal, 3-mm coronal, and 8-mm axial MRI acquisitions compared with term birth weight and contemporaneous sonography. MATERIALS AND METHODS: Fetal volume measurements were obtained from MRI acquisitions as follows: 5-mm sagittal (2 acquisitions), 3-mm coronal (2 acquisitions), and 8-mm axial (1 acquisition). A 90-sec single-shot fast spin-echo sequence was used. MRI and sonographic studies for fetal weight estimates were performed within 3 hr of term delivery. MRI calculation was based on the equation 0.12 + 1.031 x fetal volume (fetal area x slice thickness) (mL) = MRI fetal weight (kg). The sonographic fetal weight estimate was calculated using the Hadlock formula. MRI and sonographic calculations were compared with birth weight. Concordance coefficient analysis was performed. RESULTS: Thirty-five retrospective fetal calculations were performed. Concordance coefficients, gram weight means and standard deviations (mean +/- SD) between birth weight and MRI acquisitions were as follows: 8-mm axial, 0.91 (3,554 +/- 431 g); 3-mm coronal, 0.84 (3,752 +/- 578 g); and 5-mm sagittal, 0.83 (3,685 +/- 567 g), compared with 0.78 (3,518 +/- 332 g) for sonography. The MRI axial concordance coefficient was significantly different from that of the sonographic estimates (p = 0.05). MRI axial concordance coefficient was not statistically different from that of the MRI coronal concordance coefficient (p = 0.22) or the MRI sagittal concordance coefficient (p = 0.19). CONCLUSION: Calculated weights from a 90-sec single-shot fast spin-echo sequence MR acquisition with 8-mm-thick slices in the axial plane at term are better than sonographic estimates.     

Pain, functional status, social function and conditions of habitation in elderly unilateraly lower limb amputees

BACKGROUND/AIM: Few authors are involved in home rehabilitation of amputees or their reintegration into the community. It has been remarked that there is a discontinuity between the phases of the amputee rehabilitation in Serbia. The aim of the study was to establish pain characteristics and functional status of amputees two months after the amputation and to determine their social function and the conditions of their habitation. METHODS: This prospective observation study involved 38 elderly amputees with unilateral lower limb amputations. The patients were tested at the hospital on discharge and at their homes two months after the amputation. Pain intensity and functional status were measured by a visual analogue scale (VAS) and by Functional Independence Measure (FIM). The patients' social function was assessed using the Social Dysfunction Rating Scale (SDRS) and conditions of their habitation by the self-created Scale of Conditions of Habitation (SCH). In statistic analysis we used the Student t test, chi2 test and Analysis of variance (ANOVA). RESULTS: The majority of patients (63%) underwent below knee amputation caused by diabetes (89%). A significant number of patients (84%, chi2 = 17.78; p < 0.01) was not visited by a physiotherapist nor an occupational therapist during two months at home. In this period, the majority of the amputees (68%) had phantom pain or residual limb pain (21%). Two months after amputation the pain intensity was significantly lower (VAS = 4.07 +/- 2.19; 2.34 +/- 1.41; p < 0.001), and the functional status significantly better than on discharge (FIM = 75.13 +/- 16.52; 87.87 +/- 16.48; p < 0.001). The amputees had the average level of social dysfunction (SDRS = 62.00 +/- 11.68) and conditions of habitation (SCH = 7.81 +/- 1.97). CONCLUSION: A total 38 elderly amputees with unilateral lower limb amputations achieved significant functional improvement and reduction of pain, in spite of their social dysfunction, the absence of socio-medical support and inadequacy of the conditions of habitation.     

Comparison of mangafodipir trisodium- and ferucarbotran-enhanced MRI for detection and characterization of hepatic metastases in colorectal cancer patients

OBJECTIVE: The purpose of our study was to evaluate the validity of mangafodipir trisodium-enhanced versus ferucarbotran-enhanced MRI in the detection and characterization of hepatic lesions in colorectal cancer patients. MATERIALS AND METHODS: Forty-one patients who were known to have or suspected of having hepatic metastasis from colorectal carcinoma underwent mangafodipir trisodium- or ferucarbotran-enhanced MRI in block randomization methods. Two radiologists independently reviewed the MR images to determine the number of hepatic lesions and to characterize the lesions as malignant or benign. Each lesion was assessed according to its size (small, 2 cm in diameter) on both mangafodipir trisodium- or ferucarbotran-enhanced MRI. The data were correlated with the reference diagnosis: histopathology and intraoperative sonography (n = 16); intraoperative sonography (n = 4); and imaging and clinical diagnosis with follow-up (> 3 months; n = 21). The detection rates and diagnostic accuracies of hepatic lesions on both sets of MR images were assessed using Fisher's exact test. RESULTS: Eighty-two hepatic lesions (53 metastatic and 29 benign) were identified in 41 patients. No significant differences were seen between mangafodipir trisodium- and ferucarbotran-enhanced MRI for detecting all hepatic lesions (p = 0.183), small hepatic lesions (p = 0.299), all metastases (p = 0.695), and small metastases (p = 0.689). The diagnostic accuracies of mangafodipir trisodium- and ferucarbotran-enhanced MRI showed no significant differences in all hepatic lesions (p = 0.624) and small hepatic lesions (p = 0.641). CONCLUSION: Mangafodipir trisodium- and ferucarbotran-enhanced MRI are similar in hepatic lesion detection and characterization in colorectal cancer patients.     

Arthroscopic knee chondroplasty using a bipolar radiofrequency-based device compared to mechanical shaver: results of a prospective, randomized, controlled study

Both mechanical shavers and radiofrequency-based devices are used to treat symptomatic partial thickness chondral lesions. Controversy exists as to which mode of treatment provides better outcomes. The purpose of this study was to compare clinical results after bipolar radiofrequency-based chondroplasty (RFC) to mechanical shaver debridement (MSD). Patients (n = 60) included in the study presented with knee pain associated with a medial meniscus tear and idiopathic ICRS grade III defect of the medial femoral condyle. Patients who had osteoarthritis, grade II or higher cartilage defects of the tibial joint surface, the lateral compartment, or the femoro-patellar joint, or had previously undergone surgery on the affected knee were excluded. Patients underwent partial meniscectomy; during the procedure, they were randomly assigned to receive bipolar RFC (Paragon, ArthroCare Corporation, Austin, TX) or MSD (Full radius resector LR 4.85 x 12.5 cm), Arthrex, Naples, FL). Postoperatively, the same physiotherapist provided instructions for a daily 2-h home training program consisting of isometric, isotonic, and leg lifting exercises; patients were provided the option of using crutches. Clinical outcomes were assessed using the Tegner score, visual analogue scale (VAS) score, and Knee and Osteoarthritis Outcome Score (KOOS) assessment, which consists of five principal domains including pain, symptoms, function in daily living (ADL), and knee related quality of life (QOL), where a score of 0 indicates extreme symptoms and 100 represents no symptoms. Age and time from injury onset did not differ significantly between the RFC and MSD groups (43 +/- 10 vs. 44 +/- 9 years, P = 0.732; 8 +/- 3 vs. 7 +/- 4 months, P = 0.279). No complications or adverse events were observed. Preoperatively, mean (+/-SD) scores for all KOOS principal domains were <20 and did not differ significantly (P > 0.05) between treatment groups. Postoperatively, the RFC patients returned to activity significantly earlier than MSD patients (17 +/- 7 vs. 22 +/- 6 days, P = 0.002). VAS pain scores at 6 h, 24 h, 6 weeks, and 1 year were significantly (P < 0.001) lower for the RFC group than for the MSD group (4 +/- 2, 2 +/- 0.5, 2 +/- 1, 2 +/- 1 vs. 8 +/- 1, 4 +/- 1, 4 +/- 1, 3 +/- 1, respectively). At 1 year, RFC patients had significantly better Tegner score (4.1 +/- 0.8 vs. 2.8 +/- 0.6, P < 0.001) and KOOS domain scores for pain, symptoms, ADL, QOL, respectively (81.1 +/- 8, vs. 59.4 +/- 12.8; 80.7 +/- 7.5 vs. 59.6 +/- 7.5; 81.5 +/- 6.5 vs. 60.1 +/- 6.9; 80 +/- 10 vs. 61.3 +/- 12.5; P < 0.001) than MSD patients. Significantly fewer RFC patients (2% vs 23%, p = 0.026) reported using NSAIDS for knee pain at 1 year. Patients undergoing radiofrequency-based chondroplasty for ICRS grade III medial femoral condyle chondral lesions in conjunction with partial meniscectomy had significantly better clinical outcomes through 1 year than patients with similar pathology receiving chondral debridement using the mechanical shaver.     

Detection of myocarditis by contrast-enhanced MRI in patients presenting with acute coronary syndrome but no coronary stenosis

PURPOSE: To prospectively assess the use of cardiac MRI with delayed contrast enhancement (DCE) for identifying patients with active myocarditis among those presenting with acute coronary syndrome (ACS) but no coronary stenosis. MATERIALS AND METHODS: A total of 27 consecutive patients (age = 45 +/- 17 years; 14 male) presenting with ACS (chest pain, positive troponin-I) and no coronary stenosis, underwent cardiac MRI 9 +/- 7 days after pain onset and 8 +/- 5 months later (N = 19). Steady-state free-precession pulse (SSFP) sequence was applied for the assessment of myocardial function and both inversion-recovery (IR) and SSFP sequences were used for analyzing the topography and extent of DCE areas. Rest sestamibi-gated-single photon emission CT (SPECT) was also systematically performed. RESULTS: Subepicardial DCE pattern typical of acute myocarditis was documented in 12 patients (44%). Ischemic DCE pattern (transmural or subendocardial focal DCE) was documented in 12 of the 15 remaining patients (44%). Patients with subepicardial DCE had: higher C-reactive protein (CRP) levels (38 +/- 32 vs. 14 +/- 24 mg/mL; P = 0.04), lower Framingham cardiovascular risk (3 +/- 3% vs. 9 +/- 5%; P < 0.001), lower incidence of perfusion SPECT defects (17% vs. 73%; P = 0.01), higher left ventricular (LV) end-diastolic volume (77 +/- 16 vs. 64 +/- 10 mL/m(2); P = 0.02), and higher regression of DCE areas at follow-up (-65 +/- 17% vs. -18 +/- 23%; P = 0.002). CONCLUSION: DCE pattern of active myocarditis can be seen in patients presenting with ACS but no coronary stenosis.     

Power Doppler sonography: evaluation of hepatocellular carcinoma after treatment with transarterial embolization or percutaneous ethanol injection therapy

OBJECTIVE: The aim of this study was to compare tumor detectability by assessing the vascularity on power and color Doppler sonography and CT after transarterial embolization or percutaneous ethanol injection therapy or both in hepatocellular carcinoma. SUBJECTS AND METHODS: Forty-seven nodules of hepatocellular carcinoma (size, 28 +/- 7 mm [mean +/- standard deviation]; range, 20-40 mm) in 38 patients were treated with transarterial embolization (n = 6), percutaneous ethanol injection therapy (n = 23), and transarterial embolization plus percutaneous ethanol injection therapy (n = 9). Power Doppler sonography, color Doppler sonography, and CT were performed before and 2 weeks, 3 months, and 6 months after the treatments. The existence of hepatocellular carcinoma was confirmed by positive findings for color signals on both Doppler sonography techniques and for tumor stains on CT. All the tumors were determined to be malignant by microscopic examination of biopsy specimens. RESULTS: Before the treatments, power Doppler sonography (100%) and CT (100%) were significantly more effective than color Doppler sonography (61.7%) (p < 0.001, for both). Six months after the treatments, the sensitivity of power Doppler sonography (87.5%) was significantly better than that of color Doppler sonography (12.5%) but was not significant in comparison with CT (66.6%). However, power Doppler sonography detected color signals in two of three tumors in which iodized oil was accumulated and no tumor stain appeared on CT, and the two lesions detected with power Doppler sonography were carcinomas. CONCLUSION: Power Doppler sonography can be considered the most sensitive technique in assessing the viability of hepatocellular carcinoma treated with transarterial embolization or percutaneous ethanol injection therapy or both.     

Mid- and long-term quality-of-life assessment in patients undergoing uterine fibroid embolization

OBJECTIVE: Our objective was to assess the mid- and long-term outcomes concerning fibroid-specific and fibroid-associated quality of life in patients treated by uterine fibroid embolization. MATERIALS AND METHODS: A retrospective cohort study was performed, including consecutive patients with a minimum follow-up of 1 year. Analysis was performed by a questionnaire consisting of 49 questions about six topics: baseline characteristics, preinterventional status, diagnostic workup and treatment planning, periinterventional period and procedure-related quality of life, follow-up, and general satisfaction. RESULTS: The analysis was performed based on questionnaires from 53 (85.5%) of 62 patients. The mean follow-up was 3.0 +/- 1.0 (SD) years (range, 1.0-5.0 years). Uterine fibroid embolization led to a reduction of bleeding symptoms in 79.2% of patients (n = 48 before uterine fibroid embolization; n = 10 after uterine fibroid embolization), pain in 81.5% (n = 27; n = five, respectively), bulk-related symptoms in 78.6% (n = 14; n = three, respectively), urinary dysfunction in 60% (n = 10; n = four, respectively), sexual dysfunction in 71.4% (n = seven; n = two, respectively), fatigue in 62.5% (n = 24; n = nine, respectively), limitations in social life in 88.2% (n = 17; n = two, respectively), and a depressed mood in 89.5% (n = 19; n = two, respectively). The median impairment score for bleeding and pain decreased significantly from 6 to 0 and from 4 to 0, respectively (both p < 0.001). The general quality-of-life index increased significantly from 6 to 9 (p < 0.001). Forty-two (79.2%) patients judged the result as very satisfactory and would highly recommend uterine fibroid embolization to other patients. CONCLUSION: Uterine fibroid embolization leads to an impressive mid- and long-term improvement of all investigated physical and psychological fibroid-related and fibroid-associated symptoms and significantly improves women's health-related quality of life.     

Correlation of contrast-enhanced power Doppler sonography and conventional angiography of abduction-induced hip ischemia in piglets

OBJECTIVE: The purpose of this study was to determine if enhanced power Doppler sonography can detect early ischemia of the capital femoral epiphysis induced by hip hyperabduction in piglets and to correlate these findings with angiography. MATERIALS AND METHODS: Proximal femoral perfusion was evaluated in 18 studies of 10 piglet hips with unenhanced power Doppler sonography, enhanced power Doppler sonography with IV contrast agent, and digital angiography, in neutral position, hyperabduction, and after release to neutral position. Enhancement ratios between pixel intensities of power Doppler sonography and enhanced power Doppler images in each position were calculated. Angiograms were analyzed for differences in flow with changes in hip position. RESULTS: With the piglet in neutral position, power Doppler sonography revealed few vessels in the femoral head. Contrast administration resulted in a temporary marked increase in the visualization of vessels in the femoral head. Quantitative enhanced power Doppler sonography revealed a marked decrease in pixel intensity with abduction (p < 0.001) that was not apparent on unenhanced studies (p = 0.28). The enhancement ratio decreased from 0.45 (mean +/- SD, +/- 0.26) in neutral position to 0.10 (+/- 0.21) after abduction; it returned to 0.41 (+/- 0.14) after release of abduction (p < 0.001 for each comparison). Angiographic studies in hyperabduction revealed a variable level of ischemia. CONCLUSION: Enhanced power Doppler sonography can be used to visualize the vascular supply to the cartilaginous femoral head in piglets and can detect reversible ischemia induced by hip hyperabduction. These differences correlate with digital angiographic evidence of ischemia.     

Evaluation of global left ventricular myocardial function with electrocardiogram-gated multidetector computed tomography: comparison with magnetic resonance imaging

RATIONALE AND OBJECTIVES: Electrocardiogram-gated 3D volume data from multidetector computed tomography coronary angiography (MDCT-CA) enable image reconstruction in any phase of the cardiac cycle. The objective was to determine left ventricular (LV) function parameters by MDCT in comparison to cine magnetic resonance imaging (MRI). METHOD: Thirty patients with known or suspected coronary artery disease (CAD) underwent MDCT-CA. From multiplanar reformations in short axis orientation end-diastolic and end-systolic LV volumes (LVEDV, LVESV) were determined to calculate LV stroke volume and ejection fraction (LVSV, LVEF) and compared with MRI measurements. RESULTS: LVEDV (147 +/- 27 mL) and LVESV (65 +/- 22 mL) determined by MDCT correlated well to the respective MRI measurements (LVEDV 133 +/- 27 mL, r = 0.80, P < 0.001; LVESV 48 +/- 19 mL, r = 0.89, P < 0.001). LVSV (MDCT 82 +/- 15 mL; MRI 85 +/- 17 mL; r = 0.77, P < 0.001) and LVEF (MDCT 56 +/- 9%; MRI 65 +/- 8%; r = 0.85, P < 0.001) showed a good correlation as well. LVEF was significantly underestimated by MDCT (-8.5 +/- 4.7%, P < 0.001). CONCLUSIONS: Initial experience in patients evaluated for CAD shows that spiral MDCT studies may provide LV functional data in good correlation to Cine MRI.     

Detection and quantification of recent myocardial infarction: diagnostic value of multiecho multislice spin echo imaging

Thirty-four patients with documented transmural MI were studied with gated three echo, multislice MR imaging. In 12 patients MRI MI size was compared with CK release measurement, Tl-201 SPECT defect, and with Tc-99m LVEF. Infarct was visualised in 29/34 patients on 3rd echo images (18/34 on 2nd and 6/34 on 1st echo images). Mean MR infarct size (planimetered from 3rd echo images): 33.1 +/- 9% overestimated the SPECT defect (mean value of 23.8 +/- 15%). However, the overall correlation between MRI and Tl-201 sizing was significant: r = 0.82; p less than 0.001; SEE = 5.5%. The correlation with LVEF also appeared significant: r = -0.61; p less than 0.038.     

Thoracic CT in pediatric patients with difficult-to-treat asthma

OBJECTIVE:. The aim of this study was to establish objective, simple criteria for bronchial wall thickening in children with difficult-to-treat asthma. SUBJECTS AND METHODS:. Bronchial sections were counted at five levels in both lungs and at three levels in the right lung on high-resolution CT and plotted against lung function. Findings from 27 children with persistent symptoms of asthma (mean age, 11.4 years; SD, +/-3.1 years) that were severe (group A, n = 15) or moderate (group B, n = 12) were compared with findings from 21 control subjects (mean age, 10.8 years; SD, +/-3.0 years) using the Student's t test, analysis of variance, and Dunn-Bonferroni test. RESULTS:. A bronchial wall thickening score based on the number of visible bronchi at three levels (three-level score) proved to be as valuable as and simpler to obtain than a score based on the number of bronchi at five levels (five-level score). The three-level scores for groups A and B were similar (mean +/- SD, 16.8 +/- 4.2 vs 18.4 +/- 3.4, respectively; p = not significant), but these scores were significantly higher than those for the control subjects (mean +/- SD, 8.2 +/- 3.4, respectively; p < 0.001). There was no correlation between the three-level score and forced expiratory volume in 1 sec or forced expiratory flow between 25% and 75% of forced vital capacity. In contrast with adults with severe asthma, our pediatric patients with difficult-to-treat asthma did not have CT evidence of mucoid impaction, emphysema, areas of hyperlucency, bronchiectasis, or sequellar line shadows. CONCLUSION:. Bronchial wall thickening visible on high-resolution CT may constitute an additional criterion of asthma severity in children. CT evidence of bronchial wall thickening might help to identify patients with a higher risk of airway remodeling.     

Effect of tadalafil on erectile dysfunction in male patients with diabetes mellitus

BACKGROUND/AIM: [corrected] During the first 10 years over 50% of diabetes patients develop erectile dysfunction (ED). It is more severe and resistant to therapy than in male patients with normal glucoregulation. The purpose of this pilot study was to estimate the tadalafil (Cialis) efficacy and safety in male patients with diabetes mellitus (DM), together with moderate to severe ED. METHODS: The study included 30 male patients with diagnozed type 1 or type 2 DM together with ED. ED was estimated through the International Index of Erectile Function (IIEF-6), Sexual Encounter Profile (SEP) questionnaire and prostaglandin test, at the beginning of the research and three months after the 20 mg tadalafil therapy initiation, once a week (on Fridays). Glycosylated haemoglobin in blood (HbAlc) values were also monitored. According to the ED severity (IIEF values at the beginning of the therapy) the patients were divided into 2 groups. The previous experience with sildenafil citrate (Viagra) and prostaglandin E1 intracavernous therapy was recorded. RESULTS: Tadalafil significantly improved ED (p < 0.001) for 7.40 points of the IIEF score, i.e. for 58% and 60% towards SEP2 and SEP3 questionnaire, respectively. Compared to the previous ED therapy subjectively better tadalafil experience was recorded. Each group experienced a significant improvement in IIEF score (p < 0.001), more significantly in the group 2 (8.26+/-1.49 points) compared with the medium improvement in the group 1 (6.27+/-1.35 points). After three months HbA1c values decreased for 2.26+/-1.62 (p < 0.001). CONCLUSION: Tadalafil is an effective tool for treating ED in diabetes patients. In some situations tadalafil application could replace prostaglandin test. The sexual sphere motivation leads to the improvement of glucoregulation in DM patients.