Can a structured questionnaire identify patients with reduced renal function?

Objectives

To evaluate a structured questionnaire in identifying outpatients with renal dysfunction before MRI or CT in various age groups.

Methods

All patients completed a questionnaire with five risk factors indicating renal dysfunction: renal disease, renal surgery, hypertension, gout and diabetes. Serum creatinine determined by the point-of-care (POC) technique and estimated glomerular filtration (eGFR) rate was calculated using CKD-EPI equation.

Results

A total of 1,467 patients were enrolled. Thirty-four patients (2 %) had an eGFR <30 ml/min/1.73 m² and 123 (8 %) had an eGFR <45 ml/min/1.73 m². Among 55 % of the 1,467 patients reporting at least one risk factor, 30 (4 %) had an eGFR <30 ml/min/1.73 m² and 105 (13 %) had an eGFR <45 ml/min/1.73 m². Among 651 patients not reporting a risk factor, 4 (0.6 %) had an eGFR <30 ml/min/1.73 m² and 18 (3 %) had an eGFR <45 ml/min/1.73 m². All four patients were >70 years old, and 12 of the 18 patients were >70 years old.

Conclusion

The questionnaire used in patients <70 years old and determination of eGFR in patients >70 years old identified all patients with an eGFR between 30 and 45 ml/min/1.73 m² except 0.4 %.

Key points

? A questionnaire can adequately identify patients under 70 with renal dysfunction ? 8 % of patients referred to CT/MRI have an eGFR <45 ml/min/1.73 m ² ? 55 % reported risk factors, but renal dysfunction was only found in 13 % ? Patients over 70 years should have eGFR determined before CT ? eGFR determination is not beneficial when stable MRI agents are used     

Eye imaging with a 3.0-T MRI using a surface coil – a study on volunteers and initial patients with uveal melanoma

MRI of uveal melanoma using 1.5-T technology and surface coils has developed into a standard procedure. The purpose of the study was to evaluate the feasibility of 3.0-T technology in eye imaging. To optimize the MRI sequences for clinical eye imaging with 3.0-T, six healthy volunteers were conducted using a 4.0-cm surface coil. Evaluation criteria were the signal-to-noise-ratio (SNR), contrast-to-noise-ratio (CNR) and image quality. A further six patients with uveal melanoma were examined with 1.5- and 3.0-T under retrobulbar anesthesia. During 3.0-T examinations of volunteers, eye movements caused significant artifacts. On the contrary, excellent imaging quality was reached in examinations of patients under retrobulbar anesthesia at 3.0 T. Subjective assessment showed no significant difference between 1.5 and 3.0 T in patients. Due to the increased SNR, the 3.0-T technique has the potential to improve eye imaging, but the higher susceptibility to motion artifacts limits the clinical use of this technique to patients receiving retrobulbar anesthesia.     

Do patients with primary sclerosing cholangitis have a greater frequency of pancreatic abnormalities at MRI than patients with other liver diseases?

PURPOSE: It has been proposed that there is an increased frequency of pancreatic abnormalities in patients with primary sclerosing cholangitis (PSC). Our purpose is to compare the frequency of pancreatic abnormalities detected at MRI in patients with PSC and to compare these findings with those found in a matched cohort with other liver diseases. METHOD: We identified 29 patients who had either a histologic or an endoscopic retrograde cholangiopancreatography diagnosis of PSC and 29 age- and gender-matched patients with liver disease without PSC who underwent MRI at 1.5 T. The protocol included breath-hold T1-weighted gradient echo, echo train, fast spin echo, T2-weighted images and dynamic gadolinium-enhanced MRI. Two blinded readers retrospectively evaluated the MR images for abnormalities of pancreatic size and morphology, T1 and T2 signal intensity, duct size and irregularities, arterial-phase contrast enhancement, focal pancreatic masses, cystic lesions, peripancreatic fluid/edema, ascites, and capsular-like rim surrounding the pancreas. RESULTS: The prevalence of pancreatic and peripancreatic abnormalities was 10 of 29 (35%) in PSC patients and 14 of 29 (48%) in control patients. MR findings included ascites (9 PSC, 12 controls), peripancreatic edema (7 PSC, 11 controls), atrophy (4 PSC, 3 control), increased T2 signal (3 PSC, 4 controls), cystic lesions (2 PSC, 3 controls), abnormal T1 signal (1 PSC, 2 controls), and dilated pancreatic ducts (3 PSC, 2 controls). Quantitative parameters were not significantly different between PSC patients and the control subjects with pancreatic findings. CONCLUSION: There is no significant difference in pancreatic abnormalities detected on MRI between patients with PSC and those with other liver diseases.     

MRI of endolymphatic hydrops in patients with Meniere’s disease: a case-controlled study with a simplified classification based on saccular morphology

Objectives

Endolymphatic hydrops (EH) can be studied in patients by MRI. With the semi-quantitative grading system, previous imaging studies showed discrepancies in the occurrence and grading of EH in patients with Meniere’s disease (MD). Here, we compared the inversion of the saccule to utricle area ratio (SURI) with the semi-quantitative method of grading conventionally used to diagnose MD.

Methods

Imaging was carried out on a 3-T MRI scanner. We performed 3D-FLAIR sequences 4 h after a single intravenous dose of contrast agent. Two radiologists independently studied the morphology of the inner ear structures in the healthy subjects and MD patients. Each subject was then graded on the basis of the EH semi-quantitative analysis and on saccular morphology using axial and sagittal reference slices in the vestibule plane.

Results

Thirty healthy subjects and 30 MD patients had MRI scans. Using the semi-quantitative method, we found no significant difference in the number of subjects with EH between the two groups. SURI was found in 15 out of 30 MD patients and in none of the 30 healthy subjects. In three MD patients the saccule was not visible.

Conclusion

SURI is currently the most specific criterion for imaging diagnosis of MD.

Key points

? Half of MD patients presented with inversion of the saccule to utricle ratio. ? Saccular analysis is crucial when assessing patients with Meniere’s disease. ? In some patients, the saccule is not visible, suggestive of intra-labyrinthine fistulae.

     

Nuclear myocardial perfusion imaging with a cadmium–telluride semiconductor detector gamma camera in patients with acute myocardial infarction

Objective

Since myocardial perfusion imaging (MPI) with conventional sodium iodine (NaI) device has low spatial resolution, there have been some cases in which small structures such as non-transmural myocardial infarction could not be properly detected. The purpose of this study was to evaluate potential usefulness of cadmium–telluride (CdTe) semiconductor detector-based high spatial resolution gamma cameras in detecting myocardial infarction sites, especially non-transmural infarction.

Methods

A total of 38 patients (mean age ± SD: 64 ± 21 year) who were clinically diagnosed with acute myocardial infarction were included. Twenty-eight cases of them were with ST segment elevation myocardial infarction (STEMI) and 10 cases with non-ST segment elevation myocardial infarction (NSTEMI). In all patients, myocardial perfusion single photon emission computed tomography images were acquired with Infinia (NaI device) and R1-M (CdTe device), and the images were compared concerning the detectability of acute myocardial infarction sites.

Results

The detection rates of the myocardial infarction site in cases with STEMI were 100 % both by NaI and CdTe images. In cases with NSTEMI, detection rate by NaI images was 50 %, while that of CdTe images was 100 % (p = 0.033). The summed rest score (SRS) value derived from CdTe images was significantly higher than that from NaI images in cases with STEMI [NaI images: 12 (7–18) versus CdTe images: 14 (9–20)] (p < 0.001). SRS derived from CdTe images was significantly higher than that derived from NaI images in cases with NSTEMI [NaI images: 2 (0–5) versus CdTe images: 6 (6–8)] (p = 0.006).

Conclusions

These results indicate that MPI using CdTe-semiconductor device will provide a much more accurate assessment of acute myocardial infarction in comparison to current methods.     

Usefulness of albumin–globulin ratio as a clinical prognostic factor in patients with thyroid cancer treated with radioiodine

Annals of Nuclear Medicine - Albumin–globulin ratio (AGR), which is calculated by dividing serum albumin by serum globulin, is considered as a cancer-related inflammation biomarker. Although...     

Dynamic ultrasound of the subacromial–subdeltoid bursa in patients with shoulder impingement: a comparison with normal volunteers

Objective

The purpose of the study was to determine if the thickness of the subacromial–subdeltoid (SASD) bursa during dynamic ultrasound and on static views differs between patients with shoulder impingement syndrome and healthy volunteers.

Materials and methods

Twenty-two patients with a clinical diagnosis of shoulder impingement syndrome and 23 healthy volunteers were recruited. A subset of patients showing an immediate symptom response following intrabursal injection was identified as “injection responders”. Ultrasound of the shoulder was performed on all participants using three standard static views and two dynamic views (before and after arm abduction). The thickness of both the intrabursal fluid and the superficial peribursal fat was measured on all views. The bursal thickness measurements in the two groups were compared using a t test for significance.

Results

The mean increase in SASD bursal fluid thickness following arm abduction was not statistically different among all patients (0.39?±?0.41?mm) and controls (0.35?±?0.32?mm), p?=?0.72. The same was true comparing injection responders (0.46?±?0.49?mm) with controls, p?=?0.41. On static views, greater bursal fluid thickness was found in patients (1.01?±?0.48?mm) compared with controls (0.67?±?0.32?mm) when using the short axis view of the supraspinatus, p?=?0.006. No statistically significant difference was found between injection responders and controls when measuring peribursal fat thickness on any view.

Conclusions

Gathering of the SASD bursa demonstrated during dynamic ultrasound does not necessarily indicate painful impingement of the bursa as it is found to a similar degree in patients with a clinical diagnosis of impingement and healthy volunteers.     

Image-guided biopsy in patients with suspected ovarian carcinoma: a safe and effective technique?

In patients with suspected advanced ovarian carcinoma, a precise histological diagnosis is required before commencing neo-adjuvant chemotherapy. This study aims to determine the diagnostic accuracy and complication rate of percutaneous biopsies performed under ultrasound or computed tomography guidance. Between 2002 to 2007, 60 consecutive image-guided percutaneous biopsies were performed in patients with suspected ovarian cancer. The following variables were recorded: tissue biopsied, imaging technique, experience of operator, biopsy needle gauge, number of passes, complications, and final histology. Forty-seven patients had omental biopsies, 12 pelvic mass biopsies, and 1 para-aortic lymph node biopsy. Thirty-five biopsies were performed under ultrasound, 25 under computed tomography guidance. Biopsy needle gauges ranged from 14–20 swg with two to five passes for each patient. There were no complications. Histology was obtained in 52 (87%) patients. Percutaneous image-guided biopsy of peritoneal disease or pelvic mass is safe with high diagnostic accuracy. The large-gauge biopsy needle is as safe as the small gauge needle, but has the added value of obtaining tissue samples for immunohistochemistry and genomic studies.     

Can patients with McArdle's disease run?

Patients with McArdle's disease commonly adopt a sedentary lifestyle. This sedentary behaviour, however, usually worsens the limited exercise capacity of these patients. Although eccentric muscle work can be associated with rhabdomyolysis, supervised eccentric training with gradually increasing loads has important advantages compared with conventional concentric work, particularly for patients with a poor cardiorespiratory system. We report the beneficial effects (particularly, increased VO(2peak) (from 14.6 to 30.8 ml/kg/min) and increased gross muscle efficiency (from 13.8% to 17.2%)) induced by a supervised aerobic training programme of 7 months duration including 3-4 running sessions (< or =60 min/session) per week in a 38-year-old patient. These preliminary data suggest the potential therapeutic value of this type of exercise in these patients.     

Reduced cardiac 123I-metaiodobenzylguanidine uptake in patients with spinocerebellar ataxia type 2: a comparative study with Parkinson’s disease

Purpose

Spinocerebellar ataxia type 2 (SCA2) is an autosomal dominant neurodegenerative disorder characterized by cerebellar ataxia, supranuclear ophthalmoplegia, and peripheral neuropathy. Autonomic nervous system dysfunction is often present. This study evaluated the cardiac sympathetic function in patients with SCA2 using ¹²³I-metaiodobenzylguanidine (MIBG) in comparison with patients with Parkinson’s disease (PD) and control subjects.

Methods

Nine patients with SCA2, nine patients with PD, and nine control subjects underwent ¹²³I-MIBG imaging studies from which early and late heart-to-mediastinum (H/M) ratios and myocardial washout rates were calculated.

Results

Early (F?=?12.3, p?<?0.0001) and late (F?=?16.8, p?<?0.0001) H/M ratios were significantly different among groups. In controls, early and late H/M ratios (2.2?±?0.12 and 2.1?±?0.20) were significantly higher than in patients with SCA2 (1.9?±?0.23 and 1.8?±?0.20, both p?<?0.05) and with patients with PD (1.7?±?0.29 and 1.4?±?0.35, both p?<?0.001). There was also a significant difference in washout rates among groups (F?=?11.7, p?<?0.0001). In controls the washout rate (19.9?±?9.6 %) was significantly lower (p?<?0.005) than in patients with PD (51.0?±?23.7 %), but not different from that in SCA2 patients (19.5?±?9.4 %). In SCA2 patients, in a multivariable linear regression analysis only the Scale for the Assessment and Rating of Ataxia score was independently associated with early H/M ratio (β?=??0.12, p?<?0.05).

Conclusion

¹²³I-MIBG myocardial scintigraphy demonstrated an impairment of cardiac sympathetic function in patients with SCA2, which was less marked than in PD patients. These results suggest that ¹²³I-MIBG cardiac imaging could become a useful tool for analysing the pathophysiology of SCA2.     

Head and neck angiography at 70 kVp with a third-generation dual-source CT system in patients: comparison with 100 kVp

Purpose

This study was conducted in order to evaluate the image quality of 70 kVp and 25 mL contrast medium (CM) volume for head and neck computed tomographic angiography (CTA) and assess the diagnostic accuracy for arterial stenosis.

Methods

Fifty patients were prospectively divided into two groups randomly: group A (n = 25), 70 kVp with 25 mL CM, and group B (n = 25), 100 kVp with 40 mL CM. CT attenuation values, noise, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) of the shoulder, neck, and cerebral arteries were measured for objective image quality. Subjective image quality of the shoulder and cerebral arteries was also evaluated. For patients undergoing digital subtracted angiography (DSA), diagnostic accuracy of CTA was assessed with DSA as reference standard.

Results

The SNRs of the shoulder, neck, and cerebral arteries in group A were higher than those in group B (P < 0.05). The CNRs of the shoulder and neck arteries in group A were higher than those in group B (P < 0.05). There was no significant difference in subjective image quality of arteries between group A and group B (P > 0.05). The accuracy was noted as 94.0% (156/166) in group A and 97.1% (134/138) in group B for ≥?50% stenosis. The accuracy of intracranial arterial stenosis was lower than that of extracranial arterial stenosis in group A. The radiation dose of group A was significantly decreased by 56% than that of group B.

Conclusion

Head and neck CTA at 70 kVp using 25 mL CM can obtain diagnostic image quality with lower radiation dose while maintaining high accuracy in detecting the arterial stenosis compared with the 100-kVp and 40-mL CM.

     

Do patients with a limited number of brain metastases need whole-brain radiotherapy in addition to radiosurgery?

Background

About 40% of patients with brain metastases have a very limited number of lesions and may be candidates for radiosurgery. Radiosurgery alone is superior to whole-brain radiotherapy (WBRT) alone for control of treated and new brain metastases. In patients with a good performance status, radiosurgery also resulted in better survival. However, the question is whether the results of radiosurgery alone can be further improved with additional WBRT.

Methods

Information for this review was compiled by searching the PubMed and MEDLINE databases. Very important published meeting abstracts were also considered.

Results

Based on both retrospective and prospective studies, the addition of WBRT to radiosurgery improved control of treated and new brain metastases but not survival. However, because a recurrence within the brain has a negative impact on neurocognitive function, it is important to achieve long-term control of brain metastases.

Conclusion

The addition of WBRT provides significant benefits. Further randomized studies including adequate assessment of neurocognitive function and a follow-up period of at least 2?years are needed to help customize the treatment for individual patients.     

“Pulmonary tongue” a right ventricle phase abnormality in muga studies in patients with pulmonary hypertention

Pulmonary hypertension (PH) produces strain followed by hypertrophy and later dilatation of the right ventricle (RV) and pulmonary artery. The signs and symptoms are nonspecific. There is a need for a noninvasive sensitive way to diagnose PH. The purpose of this study is to evaluate phase abnormalities in radionuclide MUGA studies of patients with referred diagnosis of PH. In a retrospective analysis of 44 patients who had a radionuclide multigated study (MUGA) and contrast ventriculography (CV), 19 had high mean pulmonary pressure (over 20 mmHg) and a high pulmonary vascular resistance index (over 2.0). In 15 patients, a delayed phase segment in the RV corresponding to the pulmonary infundibulum and pulmonary conus was noted The Pulmonary Tongue sign (PT), 12 had PH (True positive) and 3 did not (false positive) on CV. No PT was seen in the remaining 29 patients, only 7 of them had PH (False negative). The sensitivity, specificity and accuracy of the PT sign in detecting PH was 80%, 72% and 77% respectively. The number of patients was too small to calculate the correlation of the grade of PT with the severity of PH. We conclude that The Pulmonary Tongue sign on a MUGA study is clinically useful in detecting PH.This project is supported by research project MLNO13 and funded by research Council, Kuwait University