Epidemiologic study of asymptomatic men screened by maximal treadmill testing for latent coronary artery disease

A group of 1,390 asymptomatic men screened for latent coronary artery disease by maximal treadmill testing and double Master two-step test were followed up for a mean of 6.3 years. Angina, sudden death or acute myocardial infarction was used as the end point for coronary heart disease. There were differences in testing sensitivity and specificity among age and subject groups, but maximal treadmill testing out-performed the double Master test as a screening technique. Maximal treadmill testing demonstrated a 60.9 percent sensitivity, 92 percent specificity and a 20 percent probability that coronary artery disease would develop in a subject with an abnormal response. A risk ratio of 14.3 was obtained and demonstrated that maximal treadmill testing was a valuable screening technique for latent coronary artery disease. However, limitations of the sensitivity and specificity of the functional S-T segment response were apparent. The abnormal S-T segment response to exercise testing did not absolutely predict the future presentation of coronary artery disease, and a normal response to maximal treadmill testing did not rule out this possibility. Because premature ventricular contractions demonstrated a very low sensitivity, predictive value and risk ratio they were not a practical indicator of increased risk for latent coronary artery disease except when associated with an abnormal S-T segment response.     

血管紧张素受体抑制剂：可降低老年痴呆发病率

本研究的目的是探讨血管紧张素受体抑制剂能否预防阿尔茨海默病和痴呆,或者减缓这两种疾病的病情进展。     

White paper of the European Association of Nuclear Medicine (EANM) and the European Society of Radiology (ESR) on multimodality imaging

Introduction New multimodality imaging systems bring together anatomical and molecular information and require the competency and accreditation of individuals from both nuclear medicine and radiology. Aim This paper sets out the positions and aspirations of the European Association of Nuclear Medicine (EANM) and the European Society of Radiology (ESR) working together on an equal and constructive basis for the future benefit of both specialties. Discussion EANM and ESR recognise the importance of coordinating working practices for multimodality imaging systems and that undertaking the nuclear medicine and radiology components of imaging with hybrid systems requires different skills. It is important to provide adequate and appropriate training in the two disciplines in order to offer a proper service to the patient using hybrid systems. Training models are proposed with the overall objective of providing opportunities for acquisition of special competency certification in multimodality imaging. Both organisations plan to develop common procedural guidelines and recognise the importance of coordinating the purchasing and management of hybrid systems to maximise the benefits to both specialties and to ensure appropriate reimbursement of these examinations. European multimodality imaging research is operating in a highly competitive environment. The coming years will decide whether European research in this area manages to defend its leading position or whether it falls behind research in other leading economies. Since research teams in the Member States are not always sufficiently interconnected, more European input is necessary to create interdisciplinary bridges between research institutions in Europe and to stimulate excellence. EANM and ESR will work with the European Institute for Biomedical Imaging Research (EIBIR) to develop further research opportunities across Europe. Recommendation European Union grant-funding bodies should allocate funds to joint research initiatives that encompass clinical research in diagnostic imaging in conjunction with research in mechanical and electronic engineering, informatics and biostatistics, and epidemiology. This paper is a result of working party negotiations of ESR and EANM delegations throughout the period from October 2005 to February 2007. All authors contributed equally to the production of this paper. This paper was approved by the executive council of the ESR, the general assembly of the European Association of Radiology (EAR), the executive committee of the EANM and the executive committees of the UEMS sections of radiology and nuclear medicine. The document was presented at the EANM strategy committee meeting held in London in February 2007. It was also presented at both the EANM advisory council meeting and the EANM extraordinary delegates’ meeting that took place in Vienna in March 2007.Authors are listed in alphabetical order. Authors on behalf of the EANM are: Angelika Bischof Delaloye, Ignasi Carrió, Alberto Cuocolo and Wolfram Knapp. Authors on behalf of the ESR are: Nicholas Gourtsoyiannis, Iain McCall, Maximilian Reiser and Bruno Silberman. An editorial relating to this paper is available at .     

Occupational exposure in the electrophysiology laboratory: quantifying and minimizing radiation burden

Fluoroscopically guided procedures in the electrophysiology room, such as radiofrequency catheter ablation and implantation of cardiac resynchronization devices, may result in high radiation exposure of electrophysiologists and assisting staff. Our aim was to provide accurate and applicable data on occupational doses to the electrophysiology laboratory personnel. We exposed fluoroscopically an anthropomorphic phantom at three projections common in electrophysiology studies. For each exposure, scattered radiation was measured at 182 sites of the cardiology room at four body levels. Effective dose values, eye lens, skin and gonadal doses to the laboratory staff were calculated. Our study has shown that a procedure requiring 40 min of fluoroscopy yields a maximum effective dose of 129 microSv and a maximum value of gonadal dose of 56.8 microSv to staff using a 0.35 mm lead-equivalent apron. A conservative estimate of the electrophysiologist's annual maximum permissible workload is 155 procedures. Staff effective dose values vary by a factor of 40 due to positioning during fluoroscopy and by a factor of 11 due to radiation protection equipment. Undercouch protective shields may reduce gonadal doses up to 98% and effective dose up to 25%. Consequently, radiation levels in the electrophysiology room are not negligible. Mitigation of occupational exposure is feasible through good fluoroscopy and working practices.     

Sacroiliac joints: anatomical variants on CT

The purpose of this work was to examine the type and prevalence of anatomical variants of the sacroiliac joints (SJs) in patients without SJ disease on CT examinations. The study comprised 534 consecutive patients undergoing pelvic CT with various indications not related to diseases that could involve the SJ. Images printed on bone window settings were evaluated with reference to any deviation from the usual appearance of the SJ. Physical data and history of low back pain were recorded in each patient. Six types of anatomical variants were observed: accessory joints in 102 patients (19.1%), "iliosacral complex" in 31 (5.8%), bipartite iliac bony plate in 22 (4.1%), crescent-like iliac bony plate in 20 (3.7%), semicircular defects at the sacral or iliac side in 16 (3%), and ossification centers in 3 patients (0.6%). Accessory joints were more common in obese than in normal-weight individuals (p < 0.05) and in older than younger (<60 years) patients (p < 0.001) and presented degenerative alterations especially in patients with episodes of low back pain. Three of these variants (iliosacral complex, bipartite iliac bony plate, and crescent-like iliac bony plate) had higher incidence in women than in men (p < 0.05) and were not associated with degenerative changes. Knowledge of the normal variations in the SJ appearance broadens the understanding of SJ anatomy, facilitating image interpretation.     

Proliferative myositis: value of imaging

Imaging findings in a 52-year-old woman with proven proliferative myositis are described. US revealed preservation of continuous muscle bundles and patchy areas of hyperechogenicity, containing hypoechoic lines. MRI showed at T2-w sequences an ill-defined, hyperintense, intramuscular lesion, containing isointense lines. Subtotal enhancement, a nonenhancing geometrical web, and fascial enhancement were noted. In patients with painful growing masses, US and MRI correlation may suggest the diagnosis of proliferative myositis leading to biopsy, thus avoiding mutilating surgery.     

Malignant peritoneal mesothelioma presenting with respiratory symptoms

Malignant peritoneal mesothelioma is a rare disease associated with mild, nonspecific abdominal symptoms and a wide spectrum of imaging findings, with thickened mesentery and peritoneum being the most common ones. A case of a malignant peritoneal mesothelioma presenting with manifestations of pulmonary disease is reported. Imaging evaluation revealed pleural, lung and pericardial involvement together with retroperitoneal lymphadenopathy, little ascites and extensive omental, but only subtle, mesenteric thickening. Received: 1 February 1999; Revised: 14 June 1999; Accepted: 22 September 1999