After 3 Years of Starvation: Duodenum Swallowed Remaining Stomach

A 42-year-old morbidly obese patient (BMI 44.1 kg/m²) was admitted to our emergency room with upper abdominal pain, nausea, and cholestasis. Nine years ago, a vertical banded gastroplasty had been performed (former BMI 53.5 kg/m²) with a subsequent weight loss to BMI 33.0 kg/m². After regaining weight up to a BMI of 47.6 kg/m², 5 years ago a conversion to a gastric bypass was realized. A computed tomography of the abdomen showed an invagination of the remaining stomach into the duodenum causing obstruction of the orifice of common bile duct. The patient underwent an open desinvagination of the intussusception and resection of the remaining stomach. Gastroduodenal intussusception is rare and mostly secondary to gastric lipoma. To prevent this rare but serious complication, the remaining stomach could be fixed at the crura of the diaphragm, tagged to the anterior abdominal wall by temporary gastrostomy tube, or resected. The authors have no commercial interests.     

Multidimensional scaling analysis of dysphonia in two speaker groups

The objective of this research was to identify perceptually relevant features of 30 dysphonic female voices. The perceptual dimensions used by listeners in judging the similarity of the dysphonic voices were derived in two multidimensional scaling (MDS) procedures using ALSCAL. Three dimensions were extracted in each MDS solution and accounted for approximately 60% of the total variance in the judgments. The three dimensions were related to measures of intensity, frequency, and perturbation. The results are discussed in relation to how clinicians use perceptual judgments in evaluating dysphonic voices.     

Mixed-bandwidth acquisitions: signal-to-noise ratio and signal-to-noise efficiency

Purpose:

To measure the hemodynamic response to exercise using real‐time velocity mapping magnetic resonance imaging (MRI), incorporating a high temporal resolution spiral phase contrast (PC) sequence accelerated with sensitivity encoding (SENSE).

Materials and Methods:

Twenty healthy adults underwent MRI at rest and during supine exercise at two different exercise levels. Flow volumes were assessed in the ascending aorta using a spiral SENSE real‐time PC sequence. The sequence was validated at rest against a vendor supplied gated PC sequence, and also at rest and during exercise against left ventricular volumes assessed using a radial k‐t SENSE real‐time sequence. Combining the measured flow volumes with simultaneous oscillometric blood pressure measurements, enabled the noninvasive calculations of systemic vascular resistance (SVR) and arterial compliance (C).

Results:

Measured flow volumes correlated very well between the sequences at rest and during exercise. Cardiac output (CO) and heart rate were found to significantly increase during exercise, while SVR and C were found to decrease significantly.

Conclusion:

Hemodynamic response to exercise can be accurately quantified using a high temporal resolution spiral SENSE real‐time flow imaging. This may allow early detection of hypertension and a greater understanding of the early changes in this condition. J. Magn. Reson. Imaging 2010;31:997–1003. ©2010 Wiley‐Liss, Inc.     

Toward rapid high resolution in vivo intravascular MRI: evaluation of vessel wall conspicuity in a porcine model using multiple imaging protocols

PURPOSE: To assess magnetic resonance (MR) pulse sequences for high resolution intravascular imaging. MATERIALS AND METHODS: Intravascular imaging of the abdominal aorta and iliac arteries was performed in vivo in a porcine model at 1.5 T using catheter-mounted micro-receive coils. Ten protocols, including spin-echo (SE)-echo planar imaging (SE-EPI), segmented EPI, half-Fourier single-shot turbo spin-echo (HASTE), fast imaging with steady-state free precession (TrueFISP), turbo spin-echo (TSE), and SE acquisition schemes were employed in 13 trials. Images were analyzed by six expert raters with respect to wall-conspicuity, wall-to-lumen/tissue contrast, visible layers of the arterial wall, anticipated clinical usefulness, and overall image quality. Mean differences between sequence-types were evaluated using analysis of variance (ANOVA) between groups with planned comparisons. RESULTS: The vessel wall was delineated in almost all protocols. Motion artifacts from physiological and device motion were reduced in fast techniques. The best contrast between the wall and surrounding tissue was provided by a HASTE protocol. Anatomic layers of the vessel wall were best depicted on dark blood T2-weighted TSE. Overall, TrueFISP was ranked highest on the remaining measures. CONCLUSION: Dedicated catheter-coils combined with fast sequences have potential for in vivo characterization of vessel walls. TrueFISP offered the best overall image quality and acquisition speed, but suffered from the inability to delineate the multiple layers of the wall, which seems associated with dark blood- and T2-weighted contrast. We believe future intra-arterial trials should proceed from this study in normal artery imaging and initially focus on fast T2-weighted dark blood techniques in trials with pathology.     

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