Rheumatoid arthritis: similarity of radiographic abnormalities in men and women

To test the hypothesis that there are significant differences in the radiographic appearance of rheumatoid arthritis between men and women, the authors blindly evaluated bilateral hand and wrist radiographs in 32 men with definite rheumatoid arthritis and 32 age- and disease duration-matched women (mean age, 56.4 years; mean disease duration, 10.5 years). Radiographically, disease distribution and severity were identical in these matched groups. Superimposed osteoarthritis was frequent in both groups and related to age. Ill-defined bone proliferation was present in 13 of 64 hands in both groups. Cystic changes and well-defined erosions were present in 12 of 64 male hands and six of 64 female hands, but this difference was not statistically significant. In women, presence of cysts and bone proliferation was related to disease duration, whereas men exhibited these atypical features independent of disease duration. There was no statistically significant difference in the frequencies of typical and atypical features of rheumatoid arthritis between the two sexes, and the authors postulate that previously reported differences relate to patient selection and lack of adequate matching.     

Liver volume measurements and three-dimensional display from MR images

A method was investigated for measuring the volumes of human livers in vivo from magnetic resonance images and subsequently displaying these livers in three dimensions. Volumetric image sets of phantoms, healthy volunteers, and patients with cirrhotic livers were processed. Two image-processing approaches were compared for accuracy of liver measurements, intrasubject and interobserver variation, and speed of processing. Results indicated that both processing methods had a high degree of volume-measuring accuracy (within 8%), the interobserver measurements had a high coefficient of correlation (r = .9994), the intrasubject measurements had a low coefficient of variation (1.8%), and one method was four to five times faster than the other. The faster and easier of the two image-processing approaches provided satisfactory results for measuring liver volumes, but the slower approach provided more realistic-looking three-dimensional images of the liver.     

Breast disease: tissue characterization with Gd-DTPA enhancement profiles

Magnetic resonance (MR) imaging of the breast is currently of limited value because of lack of specificity. Enhanced MR imaging with gadolinium diethylenetriaminepentaacetic acid (DTPA) has been shown to be helpful in the further characterization of breast tissue. This prospective study attempted to differentiate benign and malignant breast disease with a dynamic enhancement technique. Bolus injection of Gd-DTPA and a short MR imaging time were used to examine 18 patients with a palpable breast mass. Construction of enhancement profiles helped effectively differentiate benign and malignant lesion (P less than .001). Dynamic MR imaging shows promise for the further characterization of breast tissue and, particularly, identification of breast carcinoma.     

Non-migraine headache across the menstrual cycle in women with and without premenstrual syndrome

Fluctuation of estrogen levels across the menstrual cycle influences migraine headache. In this study, 53 women documented prospectively the incidence and severity of headache daily for an average of three menstrual cycles. Seven of the women met the criteria established by the International Headache Society for migraine with or without aura, while the remaining 46 women failed to do so. Chi-square analysis revealed that, overall, the incidence of non-migraine headache was dependent on day of the cycle (chi 2 [1,66] = 247.7, p < 0.001), with more headaches occurring during the perimenstrual phase. The 46 women without migraine were further classified according to NIMH criteria into PMS (n = 26) and non-PMS groups (n = 20). An association between headache and menstrual cycle phase was noted for both groups (p < 0.001), although the incidence of severe headache was greater for the PMS women, during both the perimenstrual and intermenstrual phases. Both groups experienced an increase in severe headaches during the perimenstrual phase. The PMS women peaked on the day prior to menstruation, while the non-PMS women peaked on the first day of menstruation. There did not appear to be an overall difference in the reporting of mild headache across the cycle between women with or without PMS.(ABSTRACT TRUNCATED AT 250 WORDS)     

Positional precautions in needle aspiration lung biopsy

The authors performed 308 needle aspiration biopsies of parenchymal lung masses. The patients were then placed with the puncture site down for a period of at least 1 hour or until air leakage stopped. Coughing, talking, and activity were restricted. Complications included pneumothorax, at a rate of 25.0%, and chest tube placement, at a rate of 1.6%. In a subgroup of 262 patients who required only one pleural puncture at biopsy, a pneumothorax rate of 17.9% and a chest tube placement rate of 0.4% were encountered. When compared with a similar series of 143 control patients, significant reductions in both pneumothorax rate (P = .0004) and chest tube placement rate (P = .0001) were demonstrated.     

Cerebellopontine angle-petromastoid mass lesions: comparative study of diagnosis with MR imaging and CT

Capabilities of computed tomography (CT) and magnetic resonance (MR) imaging in the diagnosis of cerebellopontine angle-petromastoid (CPA-PM) lesions were compared in 75 patients. CT and MR demonstrated 95.8% and 98.7% of the lesions, respectively. MR was often more helpful for characterization of neuromas, epidermoid cysts, exophytic gliomas, and vascular lesions, while CT was usually more informative for meningiomas, metastases, and tympanomastoid cholesteatomas. A specific diagnosis could be made with MR for most types of lesions through use of relaxation parameters and characteristic morphologic changes. Size, shape, location, and contour of the lesions, however, were generally more helpful for differential diagnosis than relaxation times. With the exception of metastatic lesions, cholesteatomas, and some meningiomas, MR was usually more helpful than CT in defining the full extent of the lesions and their relationships to contiguous structures. MR, because of its high accuracy in lesion detection, characterization, and localization, is a suitable primary diagnostic modality for evaluating patients with suspected CPA-PM lesions.