Comparison of mammographic and industrial films in dialysis patients

PURPOSE: To optimize the technique for radiographic studies of bone and joint damage in renal osteodystrophy. MATERIAL AND METHODS: Sixty-four patients with chronic renal failure on dialysis for 0-10 years, were divided into two homogeneous groups and submitted to two different radiographic examinations of the nondominant hand. Group A patients were examined with a conventional radiological unit and an industrial film and a conventional radiological unit with a mammographic film with a dedicated screen, while group B patients with a mammographic with an industrial film and a conventional radiologic unit with a mammographic film with a dedicated screen. The examinations were evaluated by three radiologists in a double-blind fashion. RESULTS: Bone conditions such as osteoporomalacia, trabecular rarefaction, channel enlargement and intracortical absorption were equally demonstrated by mammographic films and the mammograph with industrial films. The mammographic film was superior to the mammograph with an industrial film in 8 cases, comparable in 25 and inferior in 6, but when compared with the conventional radiological unit with an industrial film it was superior in 19 cases, comparable in 2 and never inferior. CONCLUSIONS: The industrial film without a screen combined with a mammograph is considered the gold standard to study fine bone alterations in renal osteodystrophy. However the conventional radiological unit with a mammographic film with a dedicated screen provides the same results with lower irradiation doses and can therefore be considered a good alternative.     

Intracranial epidermoid cyst with hemorrhage: MR imaging findings

We present a case of a 28-year-old woman with a cerebellopontine angle and prepontine cistern epidermoid cyst with unusual signal intensity. She presented with cranial nerve neuropathy and unsteady gait. MR imaging showed a tumor mass with central area of hemorrhage and a focal area of heterogeneous signal intensity with spotty enhancement, which correlated histologically to old blood in a cystic lumen and granulation of a cystic wall, with a large area of hemorrhage and mild vascularity.     

头颅CT检查在新兵体格复检中的价值

 目的 分析探讨头颅CT检查在新兵体格复检中的价值和必要性。方法 回顾性分析武警某部2482名体格复查新兵的头颅CT结果。结果 检出颅内病变共224例(阳性率9.03%)。其中颅内蛛网膜囊肿110例(阳性率4.43%),透明隔间腔或囊肿63例(阳性率2.54%),副鼻窦炎21例(阳性率0.85%),脑内非生理性钙化19例(阳性率0.77%),脑室系统发育异常5例(阳性率0.20%),脑软化灶3例(阳性率0.12%),颅内肿瘤2例(阳性率0.08%),颅骨骨瘤1例(阳性率0.04%)。结论 头颅CT检查能有效排查出新兵头颅内病灶,为降低伤病残率奠定基础,建议列为新兵体格复查项目。     

Reappraisal of the baseline bone scan in breast cancer

Baseline staging bone scans in 1,267 consecutive women with breast cancer attending a single clinic between 1980 and 1986 were reviewed. 0.3% of patients with T1, 3% with T2, 8% with T3, 13% with T4 tumors and none of those with Stage 1, 3% with Stage 2, 7% with Stage 3, and 47% with Stage 4 disease had a positive scan due to bone metastases. Two hundred eight-nine (23%) had bone scan abnormalities secondary to radiologically confirmed benign bone disease. In 20 patients, no cause for a bone scan abnormality could be found after a median follow-up of 3.50 yr, a false-positive frequency of 1.6%. The false-negative rate was 0.08%. It is concluded that patients with tumors less than 2 cm are most unlikely to have a positive scan. In this instance, scans are not required routinely. However, we recommend a baseline scan in all patients with Stage 2, 3, or 4 disease.     

Long-term follow-up of 92 patients with locally advanced follicular or papillary thyroid cancer after combined treatment.

Between 1960 and 1988, 92 patients with a locally advanced follicular or papillary thyroid cancer have been treated with surgery and radiotherapy consisting of iodine-131 or external (ext RT) radiotherapy or both. Locoregional control in patients less than 38 years of age at diagnosis and in older patients with a papillary cancer and a macroscopically complete resection was 100% with or without ext RT. Locoregional control in patients 38 years of age or older and without palpable postsurgical residual mass was 89% with ext RT and 60% without. In patients with a palpable residual mass, one of ten treated with iodine-131 alone had a permanent local control compared to six of 14 treated with addition of ext RT. Published data concerning iodine-131 and ext RT in the treatment of locally advanced follicular or papillary thyroid cancer are discussed. Routine surgery in our region consists of a near total thyroid resection, followed by iodine-131 ablation of the remnant thyroid. In younger patients with a limited T4 tumour and complete resection, we do not use ext RT. In all older patients with a T4 tumour as well as in younger patients with an extensive T4 tumour, ext RT is added.     

Percutaneous ipsilateral portal vein embolization using a modified four-lumen balloon catheter with fibrin glue: initial clinical experience

Purpose The purpose of the present study was to show the feasibility and safety of ipsilateral portal vein embolization (PVE) using an improved four-lumen balloon catheter with fibrin glue. Materials and methods To improve the ipsilateral PVE with fibrin glue, we modified a commercially available four-lumen balloon catheter to create a catheter comprising one lumen with a catheter tip for a guidewire, one lumen for an occlusion balloon, and two lumens, each with a side-hole just proximal to the balloon. Eight patients had hepatobiliary disease (three with bile duct carcinoma, two with gallbladder carcinoma, one with hepatocellular carcinoma, one with Caroli disease, and one with metastatic carcinoma). Results All embolization procedures were technically successful. After embolization, the volume of the future remnant liver increased a mean of 131%. There was no inadvertent embolization of portal vein branches and no major procedure-related complications. Conclusion Our method is potentially easier and safer than the traditional ipsilateral method with fibrin glue using a three-lumen balloon catheter because the fourth lumen makes possible the use of a guidewire to access the targeted portal vein and measurement of any portal vein pressure elevation following PVE via the fourth lumen.     

Modern CT applications in veterinary medicine.

Although computed tomography (CT) is used primarily for diagnosis in humans, it can also be used to diagnose disease in veterinary patients. CT and associated three-dimensional reconstruction have a role in diagnosis of a range of illnesses in a variety of animals. In a sea turtle with failure to thrive, CT showed a nodal mass in the chest, granulomas in the lungs, and a ball in the stomach. CT of a sea dragon with balance and movement problems showed absence of the swim bladder. In a sloth with failure to thrive, CT allowed diagnosis of a coin in the intestine. CT of a puffin with failure to thrive showed a mass in the chest, which was found to be a hematoma. In a smooth-sided toad whose head was tilted to one side and who was circling in that direction, CT showed partial destruction of the temporal bone. CT of a domestic cat with listlessness showed a mass with focal calcification, which proved to be a leiomyosarcoma. CT of a sea otter showed pectus excavatum, which is caused by the animal smashing oysters against its chest. In a Japanese koi with abdominal swelling, CT allowed diagnosis of a hepatoma.     

Joubert-Plus syndrome with an atretic cephalocele: a case report

Joubert syndrome is a rare heterogeneous disease affecting the cerebellum. It usually presents with hypotonia, abnormal breathing pattern, with distinctive cerebellar and brain stem malformation called the molar tooth sign. It may present with different organ involvement or with other neurological alterations such as Dandy-Walker syndrome. Joubert syndrome with dandy walker syndrome is called Joubert-Plus syndrome, an exceedingly rare entity. Dandy-Walker syndrome is defined by hypoplasia and upward rotation of the cerebellar vermis and cystic dilation of the fourth ventricle. Atretic cephalocele is another rare diagnosis which is characterized by a herniation of intracranial contents through a skull defect. Herein, we present a case of a 6-month-old patient who presented with floppiness and a scalp nodule. After further evaluation, he was diagnosed with Joubert-Plus syndrome with an atretic cephalocele.     

Cardiac adrenergic denervation in patients with non-Q-wave versus Q-wave myocardial infarction

In spite of smaller infarct size and better preserved left ventricular function the long-term prognosis after a non-Q-wave infarction is not better than after a Q-wave infarction. In fact, the risk of sudden cardiac death is higher in patients with a non-Q-wave infarction than in patients with a Q-wave infarction. One possible reason for postinfarction arrhythmias is cardiac adrenergic denervation resulting from myocardial infarction. In this study we compared cardiac adrenergic innervation after non-Q-wave and Q-wave infarctions. Single-photon emission tomography using iodine-123 metaiodobentzylguanidine (MIBG) and technetium-99m sestamibi (MIBI) tracers were conducted in order to compare cardiac adrenergic denervation and myocardial perfusion in 12 patients with a non-Q-wave infarction and 15 patients with a Q-wave infarction. MIBG and MIBI defects were determined as regional uptake < or = 30% of maximal myocardial activity. The size of MIBI defects calculated as a percentage of left ventricular mass was significantly smaller in patients with a non-Q-wave infarction than in patients with a Q-wave infarction (4%+/-3% vs 9%+/-7%, P<0.05, respectively). According to the maximal serum creatine kinase activity, less myocardium was damaged in patients with a non-Q-wave infarction than in patients with a Q-wave infarction (502+/-436 IU/l vs 1878+/-1265 IU/l, P<0.001). In spite of this, the extent of MIBG defects was similar in patients with a non-Q-wave and patients with a Q-wave infarction (21%+/-18% vs 23%+/-12%, respectively). In addition, the size of MIBG defect correlated with the infarct size (maximal creatine kinase activity) (r=0.52, P<0.05) after a Q-wave infarction but not after a non-Q-wave infarction. In conclusion, despite a smaller infarct size in non-Q-wave infarct patients, the extent of cardiac adrenergic denervation was similar in patients with a non-Q-wave and patients with a Q-wave infarction. In addition, the extent of cardiac adrenergic denervation was related to the infarct size in patients with a Q-wave infarction but not in patients with a non-Q-wave infarction.     

PET for the evaluation of pleural thickening observed on CT.

Early discrimination between benign and malignant pleural diseases is vital for the treatment and prognosis of a patient. Imaging is traditionally performed with CT or MRI, with an accuracy of 50%-75%. PET has proven to be superior as a diagnostic tool in several malignancies. In this prospective study, PET results in patients with pleural abnormalities on CT were compared with histologic results. METHODS: Eligible patients had pleural thickening on CT and were medically fit for surgical diagnostic procedures. All patients underwent PET. Qualitative assessment led to a PET score of 1 (definitely normal), 2 (probably normal), 3 (probably abnormal), or 4 (definitely abnormal). PET scores of 1 or 2 indicated a negative PET finding, whereas PET scores of 3 or 4 indicated a positive PET finding. Pathologic verification techniques included thoracocentesis, thoracoscopy, or open pleural biopsy at thoracotomy. RESULTS: Thirty-two patients were enrolled, 19 with malignant and 13 with benign pleural disease. PET was true positive in 18 and true negative in 12 patients, with an accuracy and negative predictive value of 94% and 92%, respectively. PET was false negative in a patient with a slowly growing malignant solitary fibrous tumor and false positive in a patient with infectious pleuritis. Median standardized uptake values calculated for 7 patients with malignant and benign pleural diseases were 6.28 and 1.69, respectively. Patients with a PET score of 1 or 2 survived significantly longer than patients with a PET score of 3 or 4. CONCLUSION: Qualitative assessment of pleural thickening with PET accurately discriminates between malignant and benign pleural thickening, with a high accuracy and negative predictive value.     

Transvaginal sonography in the evaluation of normal early pregnancy: correlation with HCG level

Transvaginal sonography (TVS) is the procedure of choice in evaluating the viability of embryos early in pregnancy. However, viability based on TVS can be assessed more accurately when the exact gestational age from the last menstrual period is known or when the findings are correlated with beta human chorionic gonadotropin (HCG) levels. No large series has been reported with correlative data between early pregnancy findings, HCG, and gestational age. We performed 75 transvaginal examinations in 53 patients with proved normal pregnancy in the fifth through seventh weeks of gestation. The presence and size of the gestational sac, presence of a yolk sac, and identification of embryonic heart activity were correlated with the level of HCG. Sac size was correlated with yolk sac and heart activity and the three parameters correlated with gestational age in days. When the level of HCG reached 1000 mIU/ml by using the first International Reference Preparation, a gestational sac was seen sonographically in each patient. When the HCG level reached 7200 mIU/ml, a yolk sac was seen in every patient. Ten of 22 patients with HCG between 1000 and 7200 mIU/ml had a visible yolk sac. Every patient with an HCG level greater than 10,800 mIU/ml had a visible embryo with a heartbeat. A discriminatory level of 32 days was found for the presence of a gestational sac. A yolk sac was first seen in every patient between 36 and 40 days. Every patient with accurate dates greater than 40 days had an embryo with a heartbeat identified. When correlating sac size with structures within the sac, a yolk sac was first seen in a gestational sac between 6 and 9 mm and a heartbeat seen in every patient with a 9-mm or greater gestational sac diameter. These data allow identification of normal intrauterine pregnancy and distinction of normal from ectopic gestation at least 1 week earlier than is possible with transabdominal techniques.     

Arterial angiography in high-kilovoltage technique with gadolinium as the contrast agent: first clinical experience

Iodine-containing contrast agents are currently used for angiography. However, due to the relatively low atomic number of iodine, imaging must be performed with a relatively low tube voltage. Gadolinium has been used for several years as a contrast agent in MRI with low adverse side effects. This substance has a higher atomic number as compared with iodine. We investigated whether the use of a gadolinium-containing contrast agent with a higher tube voltage reduces the radiation exposure in angiography, and how the image quality compares with the previous technique. A total of 15 patients were examined with either a survey angiography or a selective angiography. In all patients angiography was performed with an iodine-containing contrast agent with a tube voltage of 75 kV. Then gadolinium-containing contrast agent was administered immediately with a tube voltage of 110 kV. Radiation exposure and image quality were compared. On average, a dose reduction factor of 3.57 times was achieved by using 110 instead of 75 kV. However, the image quality was poorer in the majority of cases as compared with the images taken with iodine as a contrast agent and a tube voltage of 75 kV. The poorer image quality is caused by the relative low concentration (0.5) m of the used gadolinium solution. A 1 m solution is currently tested for market approval and would probably solve this problem. Correspondence to: F. Fobbe     

武警某部战士个性特征及应对方式的调查与分析

 目的 探讨武警战士个性特征及应对方式的关系。方法 采用艾森克人格量表(EPQ)和应对方式问卷,选取某部武警战士163名进行调查。结果 武警战士个性特征以外向稳定为主,应对方式以解决问题和求助为主,外向与退避、自责、合理化负相关,与解决问题正相关;神经质、精神质与退避、幻想、自责正相关,与求助、解决问题负相关;掩饰性与退避、幻想、自责、合理化负相关,与求助、解决问题无显著相关性。结论 武警战士成熟应对方式与神经质、精神质呈显著负相关,与外向(高E)呈显著正相关;不成熟应对方式与外向(高E)、掩饰维度呈负相关,与神经质、精神质呈显著正相关。     

Clinical evaluation of irreversible image compression: analysis of chest imaging with computed radiography

To implement a picture archiving and communication system, clinical evaluation of irreversible image compression with a newly developed modified two-dimensional discrete cosine transform (DCT) and bit-allocation technique was performed for chest images with computed radiography (CR). CR images were observed on a cathode-ray-tube monitor in a 1,024 X 1,536 matrix. One original and five reconstructed versions of the same images with compression ratios of 3:1, 6:1, 13:1, 19:1, and 31:1 were ranked according to quality. Test images with higher spatial frequency were ranked better than those with lower spatial frequency and the acceptable upper limit of the compression ratio was 19:1. In studies of receiver operating characteristics for scoring the presence or absence of nodules and linear shadows, the images with a compression ratio of 25:1 showed a statistical difference as compared with the other images with a compression ratio of 20:1 or less. Both studies show that plain CR chest images with a compression ratio of 10:1 are acceptable and, with use of an improved DCT technique, the upper limit of the compression ratio is 20:1.     

The xeroradiographic appearances of some uncommon malignant mammary neoplasms

The clinical and xeroradiographic appearances are described of four patients with malignant lymphomatous involvement of the breast, two with breast involvement by acute leukaemia, and four with primary fibrosarcoma of the breast. In one patient with malignant lymhoma and multiple palpable masses, the radiological appearance resembled benign mammary dysplasia, but in the three other patients, one with a discrete clinical mass, and two with diffuse clinical involvement, radiological examination of the breast showed skin thickening with diffuse abnormalities of the trabecular pattern, most marked in the subdermal area. One of the patients with leukaemia had a discrete palpable mass and the other had diffuse clinical involvement, but the radiological appearances in both patients were similar and resembled those of a carcinoma. The clinical and radiological appearance of the patients with fibrosarcoma were those of a benign cyst or a fibroadenoma.     

Sensitivity of two electron beam tomography protocols for the detection and quantification of coronary artery calcium

OBJECTIVE: The purpose of this study was to compare the sensitivity of two electron beam tomography protocols for detection and quantification of coronary artery calcium. SUBJECTS AND METHODS: We selected 101 patients (57% men, mean age 53 +/- 10 years) to undergo two consecutive electron beam tomography and acquired imaging with both a 6-mm and a 3-mm slicing protocol. Three pixels (area, 1.03 mm(2)) and a minimal density of 130 H were used for definition of calcified plaque. RESULTS: We found coronary artery calcifications in 46 patients when we used a 6-mm protocol and in 61 patients when we used a 3-mm protocol (p < 0.001). The average total calcium score was 77 (+/-140) with a 6-mm protocol and 251 (+/-395) with a 3-mm protocol (p < 0.005). The average number of calcified lesions per patient was 1.7 for a 6-mm protocol and 3.7 for a 3-mm protocol (p < 0.01). Of 179 individual lesions seen using a 3-mm protocol, 103 (58%) were missed using a 6-mm protocol, and only 27% of the lesions with a calcium score less than or equal to 40 seen with a 3-mm protocol were detected with 6-mm slicing (p < 0.001). The mean lesion attenuation with a 6-mm protocol was 160 (+/-42) H, compared with 218 (+/-44) H with a 3-mm protocol (p < 0.001), indicating a significantly greater partial volume averaging with the former protocol. CONCLUSION: A 6-mm slicing protocol is significantly less sensitive than a 3-mm protocol for the detection and quantification of coronary artery calcium. Since one third of coronary events occur in patients with low calcium scores, a 6-mm protocol might be unreliable for risk assessment because of substantial loss of information in this calcium score range.     

MR of Leigh's disease (subacute necrotizing encephalomyelopathy)

MR images of three patients with Leigh's disease (subacute necrotizing encephalomyelopathy) were compared with CT findings. In all patients typical lesions in the basal ganglia were identified with both MR and CT. In two patients MR permitted identification of additional lesions not detected with CT. In one patient progression of MR abnormalities over a 4-month period correlated well with clinical deterioration in neurologic status. T2-weighted images with a repetition time (TR) greater than 1950 msec and an echo time (TE) greater than or equal to 60 msec or inversion-recovery images with a 50-msec TE, 1213-msec inversion time, and 3000-msec TR were advantageous in identifying multiple necrotic lesions in the brainstem, deep gray matter, periventricular white matter, and cerebral cortex. In this series MR was more sensitive in detecting and localizing multifocal necrotic lesions of Leigh's disease than CT was, and thus may be a useful diagnostic tool for patients with the appropriate clinical and laboratory abnormalities.     

Spontaneous Rupture of the Hepatic Artery in a Patient with Type 1 Neurofibromatosis Treated by Embolization: A Case Report

We report the case of a 48-year-old man with neurofibromatosis presenting with sudden-onset abdominal pain, profound hypotension, and a drop in hemoglobin. CT scan demonstrated a massive hematoma within the right lobe of the liver with rupture into the peritoneal cavity. Angiography demonstrated diffuse abnormalities of the hepatic circulation with fusifom, ectatic, and stenotic segments. Acute extravasation from a peripheral branch of the right hepatic artery was identified and successfully embolized with subsequent hemodynamic stabilization of the patient. To the best of our knowledge this is the first case report of this kind in a patient with type I neurofibromatosis.     

Does the accuracy of single reading with CAD (computer-aided detection) compare with that of double reading?: A review of the literature

AIM: To examine current evidence to determine whether the accuracy of single reading with computed-aided detection (CAD) compares with that of double reading. METHODS: We performed a literature review to identify studies where both protocols had been investigated and compared. We identified eight studies that compared single reading with CAD against double reading, of which six reported on comparisons of both sensitivity and specificity. RESULTS: Of the six studies identified, three showed no differences in either sensitivity or specificity. One showed single reading with CAD had a higher sensitivity at the same specificity, another that single reading with CAD had a higher specificity at the same sensitivity. However, one study, in a real-life setting, showed that single reading with CAD had a higher sensitivity but a lower specificity. CONCLUSION: As the majority of the studies were not in a real-life setting, used test sets, lacked sufficient training in the use of CAD and simulated double reading (using a protocol of recall if one suggests), current evidence is therefore limited as to the accuracy, in terms of sensitivity and specificity, of single reading with CAD in comparison with the most common practice in the UK of double reading using a protocol of consensus or arbitration.     

Extension of radiofrequency ablation of the liver by transcatheter arterial embolization with iodized oil and gelatin sponge: results in a pig model

PURPOSE: To determine whether transcatheter arterial embolization (TAE) with iodized oil and gelatin sponge particles can be used to expand radiofrequency (RF)-induced coagulation necrosis, the morphology and histologic characteristics of ablation lesions were evaluated in the normal pig liver after three different TAE procedures. MATERIALS AND METHODS: Ten consecutive animals with 33 ablation lesions produced with an RF ablation system were randomly assigned to one of three treatment groups and a control group: a group treated with TAE with iodized oil, a group treated with TAE with gelatin sponge, a group treated with TAE with iodized oil and gelatin sponge, and a control group in which TAE was not performed. After the completion of ablation, the lesions were excised for gross and histologic examination. RESULTS: The longest and shortest diameters of ablation lesions were greatest in the group treated with TAE with iodized oil and gelatin sponge, followed by the groups treated with TAE with gelatin sponge and TAE with iodized oil (P < .05 vs controls, respectively). The hemorrhagic rim was also widest in the group treated with TAE with iodized oil and gelatin sponge (P < .05 vs controls), and it spread toward the liver periphery like a segmental hemorrhagic area adjacent to the ablation lesion. Histochemical staining for lactate dehydrogenase, maleate dehydrogenase, and nicotinamide adenine dinucleotide diaphorase showed what appeared to be 100% cellular destruction in all the ablation lesions and their hemorrhagic rims. CONCLUSION: RF ablation combined with TAE with iodized oil and gelatin sponge induces the greatest area of coagulation necrosis accompanied by peripherally spreading segmental necrosis in normal pig liver tissue.