Criterion-related validity of four clinical tests used to measure hamstring flexibility in professional futsal players

Objective

To examine the criterion related validity of the sit-and-reach test (SR), toe touch test (TT), modified sit-and-reach test (MSR) and back-saver sit-and-reach test (BSSR) for estimating hamstring flexibility measured through the passive straight leg raise test (PSLR) in professional futsal players.

Design

Correlation laboratory study.

Setting

Controlled laboratory environment.

Participants

One hundred and three futsal players (55 males age 26 ± 4 years, 48 females age 23 ± 5 years).

Main outcome measures

Two trials of SR, TT, MSR, BSSR (left and right) and PSLR right and left (hamstring criterion measure) in a randomized order.

Results

Regression analysis was performed to examine the association of SR, TT, MSR and BSSR with PSLR in both males and females separately. In males, only MSR test had moderate association criterion with PSLR (R² = 0.57). In females, SR (R² = 0.86), TT (R² = 0.85), MSR (R² = 0.53) and average BSSR (R² = 0.82) were associated with PSLR.

Conclusions

SR, TT, MSR and BSSR had moderate criterion related validity for estimating hamstring flexibility in female but not male professional futsal players. The authors recommend that researchers, clinicians, and physical therapists adopt one angular test as a measure of hamstring muscle length in futsal players.     

Prospective versus retrospective ECG gating for dual source CT of the coronary stent: Comparison of image quality, accuracy, and radiation dose

Objective

To compare image quality, diagnostic accuracy and radiation dose of prospective and retrospective electrocardiogram (ECG) gated dual source computed tomography (DSCT) for the evaluation of the coronary stent, using conventional coronary angiography (CA) as a standard reference.

Design, setting and patients

Sixty patients (heart rates ≤70 bpm) with previous stent implantation who were scheduled for CA were divided in two groups, receiving either prospective or retrospective ECG gated DSCT separately. Two reviewers scored coronary stent image quality and evaluated stent lumen.

Results

There was no significant difference in image quality between the two groups. In the prospective group, there were 86.4% (51/59) stents with interpretable images, in the retrospective group, there were 87.5% (49/56) stents with interpretable images. Image quality was not influenced by age, body mass index or heart rate in either group, but heart rate variability had a weak impact on the image quality of the prospective group. Image noise was higher in the prospective group, but this difference reached statistical significance only by using a smooth kernel reconstruction. Per-stent based sensitivity, specificity, and positive and negative predictive value were 100%, 84.1%, 68.2%, and 100%, respectively, in the prospective CT angiography group and 94.4%, 86.8%, 77.3%, and 97.1%, respectively, in the retrospective CT angiography group. There was a significant difference in the effective radiation dose between the two groups, mean effective dose in the prospective and retrospective group was 2.2 ± 0.5 mSv (1.5-3.2 mSv) and 14.6 ± 3.3 mSv (10.0-20.4 mSv) (p < .001) respectively.

Conclusions

Compared with retrospective CT angiography, prospective CT angiography has a similar performance in assessing coronary stent patency, but a lower effective dose in selected patients with regular heart rates ≤70 bpm.     

View-sharing in keyhole imaging: Partially compressed central k-space acquisition in time-resolved MRA at 3.0 T

Introduction

Time-resolved contrast-enhanced magnetic resonance (MR) angiography (CEMRA) of the intracranial vasculature has proved its clinical value for the evaluation of cerebral vascular disease in cases where both flow hemodynamics and morphology are important. The purpose of this study was to evaluate a combination of view-sharing with keyhole imaging to increase spatial and temporal resolution of time-resolved CEMRA at 3.0 T.

Methods

Alternating view-sharing was combined with randomly segmented k-space ordering, keyhole imaging, partial Fourier and parallel imaging (4DkvsMRA). 4DkvsMRA was evaluated using varying compression factors (80-100) resulting in spatial resolutions ranging from (1.1 × 1.1 × 1.4) to (0.96 × 0.96 × 0.95) mm³ and temporal resolutions ranging from 586 ms/dynamic scan - 288 ms/dynamic scan in three protocols in 10 healthy volunteers and seven patients (17 subjects). DSA correlation was available in four patients with cerebral arteriovenous malformations (cAVMs) and one patient with cerebral teleangiectasia.

Results

4DkvsMRA was successfully performed in all subjects and showed clear depiction of arterial and venous phases with diagnostic image quality. At the maximum view-sharing compression factor (=100), a “flickering” artefact was observed.

Conclusion

View-sharing in keyhole imaging allows for increased spatial and temporal resolution in time-resolved MRA.     

Pain and complications of directional vacuum-assisted stereotactic biopsy: comparison of the Mammotome and Vacora techniques

Objective

The aim of our study is to compare the Mammotome and Vacora methods of stereotactic directional vacuum-assisted biopsy in terms of pain and complications.

Materials and methods

From June 2001 to May 2005, 1114 consecutive patients underwent directional stereotactic vacuum-assisted breast biopsy (DVAB) for nonpalpable mammographically detected breast lesions (BI-RADS 3, 4 or 5). Respectively 967 and 147 patients underwent the Mammotome and Vacora procedures. Pain was evaluated with a visual analog scale. Immediate and late complications were recorded.

Results

The mean ± S.D. (range) pain scores in the Mammotome and Vacora groups were 1.7 ± 1.8 (0-9) and 2.9 ± 2.3 (0-10), respectively (p < 0.001). Patient age and operator experience were the main determinants of pain. Immediate complications were significantly more frequent in the Mammotome group (p = 0.003), and so were late hematomas (p = 0.04). Moderate and severe complications occurred exclusively in the Mammotome group.

Conclusion

The Mammotome technique is associated with a higher risk of immediate and late complications, while the Vacora technique is associated with more frequent severe pain. Patient age was the major factor influencing pain. Further prospective studies are needed to clarify factors incriminated in pain or complications after DVAB procedures.     

Tumorsize dependent detection rate of endorectal MRI of prostate cancer—A histopathologic correlation with whole-mount sections in 70 patients with prostate cancer

Purpose

To evaluate the value of T2w endorectal MRI (eMRI) for correct detection of tumor foci within the prostate regarding tumor size.

Materials and Methods

70 patients with histologically proven prostate cancer were examined with T2w eMRI before radical prostatectomy at a 1.5 T scanner. For evaluation of eMRI, two radiologists evaluated each tumor focus within the gland. After radical prostatectomy, the prostates were prepared as whole-mount sections, according to transversal T2w eMRI. For each slice, tumor surroundings were marked and compared with eMRI. Based on whole-mount section, 315 slices were evaluated and 533 tumor lesions were documented.

Results

Based on the T2w eMRI, 213 tumor lesions were described. In 137/213, histology could prove these lesions. EMRI was able to visualize 0/56 lesions with a maximum size of <0.3 cm (detection rate 0%), between 0.3 and 0.5 cm 4/116 (3%), between 1 and 0.5 cm 22/169 (13%), between 2 and 1 cm 61/136 (45%) and for >2 cm 50/56 (89%). False positive eMRI findings were: <0.3 cm n = 0, 0.5-0.3 cm n = 12, 0.5-1 cm n = 34, 1-2 cm n = 28 and >2 cm n = 2.

Conclusion

T2w eMRI cannot exclude prostate cancer with lesions smaller 10 mm and 0.4 cm³ respectively. The detection rate for lesions more than 20 mm (1.6 cm³) is to be considered as high.     

Planimetry of the aortic valve orifice area: Comparison of multislice spiral computed tomography and magnetic resonance imaging

Objective

We sought to determine the comparability of multislice computed tomography (MSCT) and magnetic resonance imaging (MRI) for measuring the aortic valve orifice area (AVA) and grading aortic valve stenosis.

Materials and methods

Twenty-seven individuals, among them 18 patients with valvular stenosis, underwent AVA planimetry by both MSCT and MRI. In the subset of patients with valvular stenosis, AVA was also calculated from transthoracic Doppler echocardiography (TTE) using the continuity equation.

Results

There was excellent correlation between MSCT and MRI (r = 0.99) and limits of agreement were in an acceptable range (±0.42 cm²) although MSCT yielded a slightly smaller mean AVA than MRI (1.57 ± 0.83 cm² vs. 1.67 ± 0.98 cm², p < 0.05). However, in the subset of patients with valvular stenosis, the mean AVA was not different between MSCT and MRI (1.05 ± 0.30 cm² vs. 1.04 ± 0.39 cm²; p > 0.05). The mean AVAs on both MSCT and MRI were systematically larger than on TTE (0.88 ± 0.28 cm², p < 0.001 each). Using an AVA of 1.0 cm² on TTE as reference, the best threshold for detecting severe-to-critical stenosis on MSCT and MRI was an AVA of 1.25 cm² and 1.30 cm², respectively, resulting in an accuracy of 96% each.

Conclusion

Our study specifies recent reports on the suitability of MSCT for quantifying AVA. The data presented here suggest that certain methodical discrepancies of AVA measurements exist between MSCT, MRI and TTE. However, MSCT and MRI have shown excellent correlation in AVA planimetry and similar accuracy in grading aortic valve stenosis.     

Non-mass-like enhancement on contrast-enhanced breast MR imaging: Lesion characterization using combination of dynamic contrast-enhanced and diffusion-weighted MR images

Purpose

To evaluate the diagnostic accuracy of a combination of dynamic contrast-enhanced MR imaging (DCE-MRI) and diffusion-weighted MR imaging (DWI) in characterization of lesions showing non-mass-like enhancement on breast MR imaging and to find the strongest discriminators between carcinoma and benignancy.

Materials and methods

We analyzed consecutive MR images in 45 lesions showing non-mass like enhancement in 41 patients. We analyzed lesion size, distribution, internal enhancement, kinetic curve pattern, and apparent diffusion coefficient (ADC) values. We applied univariate and multivariate analyses to find the strongest indicators for malignancy. In a validation study, 22 non-mass-like enhancement lesions in 21 patients were examined. We calculated diagnostic accuracy when we presume category 4b, 4c, and 5 lesions as malignant or high to moderate suspicion for malignancy, and category 4a and 3 as low suspicion for malignancy or benign.

Results

Segmental distribution (P = 0.018), clumped internal enhancement (P = 0.005), and ADC less than 1.3 × 10⁻³ mm²/s (P = 0.047) were the strongest MR indicators of malignancy. In a validation study, sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 87% (13/15), 86% (6/7), 93% (13/14), 75% (6/8) and 86% (19/22), respectively.

Conclusion

The combination of DCE-MRI and DWI showed high diagnostic accuracy in characterization of non-mass-like enhancement lesions on breast MR images.     

Evaluation of stereotactic core biopsies of the breast with the 10-gauge Vacora® biopsy device: a review of 541 procedures

Purpose

To evaluate stereotactic core biopsies of the breast with the 10-gauge Vacora^® biopsy device.

Patients and methods

Retrospective study of 541 procedures in 502 patients performed between 2007 and 2009.

Results

The procedure failed in 2 % of cases, non-complicated hematomas occurred in 5 % of cases and unsightly scars in two cases. A clip was deployed in 70 % of cases, successfully in 99 % of cases. The procedure was well tolerated in 88 % of cases. Core biopsies confirmed a benign lesion in 55 % of cases, borderline lesions in 19 % of cases and malignant lesions in 26 % of cases with complementary surgery performed in 40 % of cases. For surgical lesions, sensitivity, specificity, PPV and NPV were 89 %, 100 %, 100 % and 84 % respectively. Atypical ductal dysplasia was under-estimated in 8 % of cases while DCIS was under-estimated in 14 % of cases. After review of the mammograms, 3 % of Bi-Rads 4 lesions were reclassified as Bi-Rads 3 lesions, all benign at core biopsy. Half of these results were from screening mammography programs.

Conclusion

Results with the 10-gauge Vacora^® biopsy device are similar to reports from the literature, mainly using the Mammotome system, with regards to tolerability and reliability for a lesser cost.     

Metachronous pancreatic metastases from renal cell carcinoma: Role of imaging in a review of 17 cases with surgical correlation

Purpose

To describe the imaging features of pancreatic metastases from renal cell carcinoma.

Patients and methods

Retrospective study of 17 patients with isolated metachronous pancreatic metastases from renal cell carcinoma with surgical and pathological correlation.

Results

The preoperative diagnosis was made on ultrasound in 13 cases. Contrast-enhanced CT showed intense tumor enhancement at the arterial phase, mostly homogeneous but sometimes heterogeneous. There were multiple lesions in six cases. Following complete surgical resection, survival was fairly good.

Conclusion

Long-term follow-up with CT obtained in the arterial and portal venous phases is mandatory. The arterial phase acquisition is essential for the diagnosis of pancreatic metastases from renal cell carcinoma.     

Evaluation of anterior knee laxity on MRI

Purpose

Evaluation of the ACL and anterior knee laxity on MR during anterior tibial translation.

Patients and methods

Three groups were identified based on clinical and arthrometric (KT-1000) data: normal ACL (n = 12), complete tear (n = 10) and partial tear (n = 20). MRI was performed without and with anterior tibial translation (pneumatic device) with morphological and laximetric analysis: drawer tests and dynamic evaluation of ligamentous tension.

Results

Intra- and inter-observer reproducibility was excellent, correlated to arthrometric data and clinical tests (Lachman, pivot shift). The difference between the drawer signs of normal subjects and patients with ACL tear was significant for a threshold value of 1,1 mm for the anterior drawer (sensitivity: 93,33%, specificity: 91,7%) and 2,8 mm for the posterior drawer (sensitivity: 86,7%, specificity: 100%). Dynamic evaluation of ligamentous tension was also reproducible, statistically correlated to the MR drawer tests and reliable for the diagnosis of ACL lesions. In this preliminary study, the distinction between complete and partial ACL tears could not be detected.

Conclusion

Anterior cruciate ligament function can be demonstrated on MR. The predictive value of this morphological and functional association should be determined in the management of patients with partial tears.     

Transient elastography of calcaneal tendon: preliminary results and future prospects

Purpose

To evaluate transient ShearWave elastography of the normal Achilles’ tendon.

Patients and methods

The Achilles’ tendon of 30 normal subjects were prospectively assessed using a Rubi V1Sq prototype (Supersonic Imagine). Quantitative elastography maps displayed in kilopascals with a scale of 0 to 600 kPa were generated from transverse and longitudinal images at 3 different levels of plantar flexion. Subgroups were compared and analyzed based on proven or suspected variation factors (age, gender, level of physical activity).

Results

On sagittal images, mean elasticity was 104 ± 46 kPa during extension, 464 ± 144 kPa in neutral position and 410 ± 196 kPa during maximum dorsiflexion. There was significant increase in elasticity when the Achilles’ tendon was maximally stretched (p < 0.01). The intra-individual correlation between right and left tendons during ankle extension was good (Pearson Coefficient 0.8; p < 0.01). Finally, physically active subjects showed significantly greater elasticity than non-active subjects (p < 0.05).

Conclusion

Transient ShearWave elastography of the Achilles’ tendon is a simple technique that provides real-time information about tissue elasticity.     

Sonographic determination of normal spleen size in an adult African population

Objective

The purpose of this study was to determine the normal range of spleen size in an adult African population, and compare the findings to published data to determine any correlation with ethnicity.

Materials and methods

Three hundred and seventy-four African adults without conditions that can affect the spleen or splenic abnormalities were evaluated with ultrasonography. Spleen length, width and thickness were measured and spleen volume calculated. Spleen size was correlated with age, gender, height, weight, and body mass index.

Results

The mean spleen volume was 120 cm³. Spleen volume correlated with spleen width (r = 0.85), thickness (r = 0.83) and length (r = 0.80). Men had a larger mean spleen volume than women. No correlation was found between spleen volume and age, weight, height, or body mass index.

Conclusion

Mean spleen volume in African adults is smaller than data from Western sources, and cannot be explained by difference in body habitus.     

Intracranial cerebral artery stenosis with associated coronary artery and extracranial carotid artery stenosis in Turkish patients

Purpose

Although it has been demonstrated that there is a high prevalence of extracranial carotid artery stenosis (ECAS) in patients with severe coronary artery disease, intracranial cerebral artery stenosis (ICAS) is rarely mentioned. We evaluated the prevalence of ICAS in patients with ECAS having elective coronary artery bypass grafting (CABG) surgery to determine the relations between ICAS, ECAS and atherosclerotic risk factors.

Methods

We retrospectively reviewed the digital subtraction angiography findings of 183 patients with ECAS ≥ 50% preparing for CABG surgery. The analyses focused on the intracranial or extracranial location and degree of the stenosis. The degree of extracranial stenoses were categorized as normal, <50%, 50-69%, 70-89%, and 90-99% stenosis and occluded. The degree of intracranial stenosis was classified as normal or ≤25%, 25-49%, and ≥50% stenosis and occluded. Traditional atherosclerotic risk factors were recorded.

Results

ECAS < 70% in 42 patients and ECAS ≥ 70% in 141 patients. ICAS was found in 51 patients and ICAS ≥ 50% in 30 patients. Regarding risk factors, we found hypertension in 135 patients, diabetes mellitus in 91 patients, hyperlipidemia in 84 patients, and smoking in 81 patients. No risk factor was significant predictors of intracranial atherosclerosis. The severity of ICAS was not significantly associated with that of the ECAS.

Conclusions

We found ICAS in 27.8% of the patients with ECAS > 50% on digital subtraction angiography preparing for CABG. Therefore a complete evaluation of the neck vessels with magnetic resonance or catheter angiography seems to be indicated as well as intracranial circulation for the risk assessment of CABG.     

Effect of cardiac function on aortic peak time and peak enhancement during coronary CT angiography

Purpose

To examine the manner in which cardiac function affects the magnitude and timing of aortic contrast enhancement during coronary CT angiography (CTA).

Materials and methods

Twenty-nine patients (21 men, 8 women; mean age, 64.4 ± 13.4 years; mean weight, 59.4 ± 10.3 kg) underwent measurement of cardiac output within 2 weeks of coronary CTA. The cardiac output of each patient was measured by the thermodilution technique and the cardiac index was calculated from the body surface area. During coronary CTA, attenuation of the descending aorta was measured at the workstation every 3 s. The aortic peak time (APT) and aortic peak enhancement (APE) of each patient were calculated. Pearson's correlation coefficient analysis was used to investigate the relationships between the cardiac output or cardiac index and APT or APE. Furthermore, the relationship between patient factors or parameters on test bolus injection and APT or APE was also evaluated.

Results

The range of cardiac output, cardiac index, APT, and APE was 1.55-10.46 L/min (mean: 4.77 ± 2.13), 1.11-5.30 L/(min-m²) (mean: 3.28 ± 1.08), 25-51 s (mean: 38.3 ± 7.5), and 273.1-598.1 HU (mean: 390.4 ± 72.1), respectively. With an increase in the cardiac index, both APT (r = −0.698, p < 0.0001) and APE (r = −0.573, p = 0.0009) decreased. There were significant correlations between the patient body weight and APT and APE with the test bolus injection, and with APT and APE during coronary CTA.

Conclusion

The APT and APE during coronary CTA are closely related to cardiac function.     

Comparison of lateral abdominal muscle thickness between weightlifters and matched controls

Objective

To compare lateral abdominal muscle thickness between weightlifters and matched controls.

Design

A case control study design.

Setting

University laboratory.

Subjects

16 female Thai national weightlifters and 16 matched controls participated in this study.

Main outcome measures

Ultrasound imaging with a 12-MHz linear array was used to measure the resting thickness of transversus abdominis (TrA), internal oblique (IO) and total thickness (Total) of lateral abdominal muscle (LAM) on the right side of abdominal wall. The absolute muscle thickness and the relative contribution of each muscle to the total thickness were determined.

Results

Weightlifters had significantly thicker absolute TrA and IO muscles than matched controls (p < 0.01). Further, the relative thickness of the IO was significantly greater in weightlifters than matched controls (p < 0.05).

Conclusions

The findings of this study suggest that routine Olympic style weight training among female weightlifters appears to result in preferential hypertrophy or adaptation of the IO muscle.     

Renal cortical volume measured using automatic contouring software for computed tomography and its relationship with BMI, age and renal function

Purpose

To evaluate the relationship between renal cortical volume, measured by an automatic contouring software, with body mass index (BMI), age and renal function.

Materials and methods

The study was performed in accordance to the institutional guidelines at our hospital. Sixty-four patients (34 men, 30 women), aged 19 to 79 years had their CT scans for diagnosis or follow-up of hepatocellular carcinoma retrospectively examined by a computer workstation using a software that automatically contours the renal cortex and the renal parenchyma. Body mass index and estimated glomerular filtration rate (eGFR) were calculated based on data collected. Statistical analysis was done using the Student t-test, multiple regression analysis, and intraclass correlation coefficient (ICC).

Results

The ICC for total renal and renal cortical volumes were 0.98 and 0.99, respectively. Renal volume measurements yielded a mean cortical volume of 105.8 cm³ ± 28.4 SD, mean total volume of 153 cm³ ± 39 SD and mean medullary volume of 47.8 cm³ ± 19.5 SD. The correlation between body weight/height/BMI and both total renal and cortical volumes presented r = 0.6, 0.6 and 0.4, respectively, p < 0.05, while the correlation between renal cortex and age was r = −0.3, p < 0.05. eGFR showed correlation with renal cortical volume r = 0.6, p < 0.05.

Conclusion

This study demonstrated that renal cortical volume had a moderate positive relationship with BMI, moderate negative relationship with age, and a strong positive relationship with the renal function, and provided a new method to routinely produce volumetric assessment of the kidney.     

Diagnostic performance of prospectively ECG triggered versus retrospectively ECG gated 64-slice computed tomography coronary angiography in a heterogeneous patient population

Objective

To compare diagnostic performance and applicability of prospectively versus retrospectively gated 64-slice computed tomography coronary angiography (pro-CTCA vs. retro-CTCA) in a heterogeneous patient population compared to invasive coronary angiography.

Methods

77 patients referred to an ECG-gated-CT of the chest were retrospectively included. Pro-CTCA was applied, whenever possible, alternatively retro-CTCA was performed. All coronary artery segments ≥1.5 mm were analysed and image quality was assessed.

Results

In 39 patients retro-CTCA and in 38 patients pro-CTCA was applied, mean heart rate (HR) was 69.5 ± 9.1 min⁻¹ and 62.8 ± 5.9, respectively. For a stenosis ≥50% segment-based (patient-based) analysis revealed a sensitivity, specificity, positive (PPV) and negative predictive value (NPV) of 97%, 98%, 71%, 100% (91%, 82%, 67%, 96%) using retro-CTCA and 94%, 97%, 75%, 99% (93%, 96%, 93%, 96%) using pro-CTCA. Sensitivity and NPV increased in the pro-CTCA group in patients with a HR < 65. Vessel-based analysis showed lower diagnostic performance for the right coronary artery (RCA) using pro-CTCA, which increased when HR < 65. Image quality did not differ significantly in both groups.

Conclusions

Prospectively triggered CTCA in a heterogeneous patient group has a very high diagnostic accuracy and image quality, when used in HR ≤ 65. A low HR is of special importance for the evaluation of the RCA.     

The outcome of partial splenic embolization for hypersplenism in the cirrhotic patients

Background

Although partial splenic embolization (PSE) has been widely used for treatment of leucocytopaenia and thrombocytopaenia in cirrhosis, only few studies evaluate both benefits and complications of it.

Objective

To evaluate outcome of partial splenic embolization benefits on both platelet and leukocytes counts and its complications in treatment of cirrhotic patients.

Patients and methods

Cirrhotic patients with hypersplenism-induced thrombo-cytopenia underwent partial splenic embolization (PSE). From All patients complete history and full clinical examination were taken and subjected to Laboratory investigations. After PSE was performed, the precise extent of embolization was calculated on CT examinations 2 weeks after PSE. Prophylactic antibiotics was given for 5 days after PSE. All patients were then followed up at the outpatient clinic. Peripheral blood cell parameters including white blood cell (WBC), platelet (PLT) and red blood cell (RBC) counts were monitored prior to PSE, on the 3rd, 14th, 30th day after PSE, and subsequently at 3-month intervals during the 2-year follow-up period. The complications associated with PSE were appropriately recorded. All patients underwent abdominal CT scanning before and 2 weeks after PSE.

Results

Twenty three patients were included in this study. 13 (57%) males and 10 (43%) females with mean age 42.37 years. PSE was successfully performed in all 23 patients. Post-embolization syndrome 91.3% (21/23) was the most frequent side effect. Other minor complications as puncture site hematoma occurred to one patient at site of femoral artery. Severe complications occurred in eight patients (34.8%). two patients had a large amount of pleural effusion and ascites. One patients developed bacterial peritonitis and died of septicemia. One patient complicated by splenic abscess. One patient had recurrent thrombo-cytopenia and treated by PSE. Portal vein thrombosis was found in one patient. One patient presented with huge splenomegaly and improved after splenectomy. Post-PSE, the platelets and leukocytes counts showed increase in the number. Best results obtained with larger splenic infarction area but in the expense of more major complications.

Statistical analysis

Blood parameters were compared using paired t test. P < 0.05 means significant differences.

Conclusion

PSE is a useful treatment in patients with hypersplenism caused by cirrhosis. PSE is safe in advanced disease patients, not suitable for splenectomy, with good long-term effect on the hematological parameters and a reduction in bleeding episodes from esophageal varices.     

Dose performance and image quality: dual source CT versus single source CT in cardiac CT angiography

Objective

To evaluate dose performance and image quality of 64-slice dual source CT (DSCT) in comparison to 64-slice single source CT (SSCT) in cardiac CT angiography (CTA).

Methods

100 patients examined by DSCT and 60 patients scanned by SSCT were included in this study. Objective indices such as image noise, contrast-to-noise ratio and signal-to-noise ratio were analyzed. Subjective image quality was assessed by two cardiovascular radiologists in consensus using a four-point scale (1 = excellent to 4 = not acceptable). Estimation of effective dose was performed on the basis of dose length product (DLP).

Results

At low heart rates (<70 bpm), image quality of SSCT was equivalent to that of DSCT (P > 0.05), but, at high heart rates (>70 bpm), DSCT provided robust image quality (P < 0.05). The average effective dose of SSCT was 9.3 ± 0.9 mSv at low heart rates (<70 bpm) while, the average estimated effective doses of DSCT were 9.1 ± 1.3 mSv, 8.3 ± 1.1 mSv, 7.9 ± 1.1 mSv, 6.9 ± 0.7 mSv, and 5.9 ± 1.3 mSv, corresponding to heart rates of 50-59 bpm, 60-69 bpm, 70-79 bpm, 80-89 bpm, and 90-100 bpm.

Conclusion

For cardiac CTA, both DSCT and SSCT can get good image quality at low heart rates (<70 bpm) with a similar radiation dose, but, at high heart rates (>70 bpm), DSCT is able to provide robust diagnostic image quality at doses far below that of SSCT.     

Contrast-enhanced ultrasound is helpful in the differentiation of malignant and benign breast lesions

Objective

To evaluate the significance of contrast-enhanced ultrasound (CEUS) examination in differential diagnosis of malignant and benign breast lesions.

Methods

Seventy-one patients with seventy-six breast tumors are selected randomly. CEUS examinations were performed before and after bolus injection of the contrast agent SonoVue (Bracco, Milan, Italy). Specific sonographic quantification software, Qontrast, was adopted to determine the morphology of vessels. Wash-in and wash-out parameters of each lesion were assessed for both procedures.

Results

The final histopathological findings distinguished 45 malignant and 31 benign from all of the lesions. Following SonoVue administration different perfusion phases could be identified: early (0-1 min), mid (1-4 min) and late (4-6 min) phases. In the early phase, CEUS identified 91.1% of malignant tumors characterized by a claw-shaped enhancement, while 83.9% of benign tumors had a homogeneous enhancement, with a statistically significant difference between the two enhancement patterns (χ² = 43.16, P < 0.01). Moreover, contrast medium persistence in the late phase was helpful in the identification of benign and malignant tumors (χ² = 46.88, P < 0.01): contrast medium was present in 88.9% of malignant tumors, while in only 9.7% of the benign tumors. The study showed that various parametric imaging color maps for peak intensity and time to peak were mostly suggestive of malignancy, while quite uniform peak intensity and time to peak of color maps were the characteristic of benign tumors. The study also found that malignant lesions presented with a higher maximum intensity signal than benign ones (P < 0.05) on the time-intensity curves.

Conclusions

CEUS cooperating with conventional US shows improved accuracy in differentiating between malignant and benign breast tumors. It could be a reliable diagnostic method of breast lesions.