Mammary ductoscopy by helical CT: -Initial experience-

BACKGROUND: An attempt was made to visualize minute intraductal lesions using helical CT in patients with abnormal nipple discharge. METHODS: Galactography was performed, immediately followed by CT (ductal CT examination). Based on the image data obtained, ductal images were constructed on a workstation using a Pegasus viewer (ductal CT imaging). Since no criteria for diagnosis by this method are available, ductal CT images were diagnosed by reference to the known ductal fiberscopic findings. RESULTS: Ductal CT examination was performed in 10 cases, in 9 of whom ductal CT images were successfully constructed. Pathological examination was performed in 8 cases. It was possible to observe the structure of the luminal surface on the constructed ductoscopic images from all directions, but the color tone or the presence or absence of hemorrhage could not be observed. CONCLUSIONS: In the examination for abnormal nipple discharge, ductal CT examination was useful for intraductal observation. Currently, it is a method that allows for observation of the most minute intraductal lesions. However, some issues still remain unresolved. The results of this study suggest that further studies with more cases hold the promise of making ductal CT imaging a useful examination method.     

Female body image following acquired brain injury

Primary objective: To investigate body image concerns and psycho-emotional health in females with acquired brain injury (ABI). Research design: Between subjects design. Methods and procedures: Thirteen females with ABI and thirteen matched controls were assessed on a number of variables relating to body image, self-esteem and affect. Main outcomes and results: Indicated that women with ABI had a different profile of body image dissatisfaction than controls and that in some areas it was significantly worse. The women with ABI had significantly lower self-esteem and higher levels of depression than controls and this related to body image. Conclusion: Significant changes in body image and self-concept are potentially damaging to quality of life post-injury and suggest a role for targeted therapeutic work with women with ABI.     

Combined helium-3/proton magnetic resonance imaging measurement of ventilated lung volumes in smokers compared to never-smokers

PURPOSE: To use a combination of helium-3 (3-He) magnetic resonance imaging (MRI) and proton single-shot fast spin echo (SSFSE) to compare ventilated lung volumes in groups of "healthy" smokers, smokers diagnosed with moderate chronic obstructive pulmonary disease (COPD), and never-smokers. MATERIALS AND METHODS: All study participants were assessed with spirometry prior to imaging. 3-He images were collected during an arrested breath hold, after inhaling a mixture of 200 mL of hyperpolarized 3-He/800 mL of N2. Proton SSFSE images were acquired after inhaling 1 liter of room air. The ventilated volume for each study participant was calculated from the 3-He images, and a ratio was calculated to give a percentage ventilated lung volume. RESULTS: Never-smokers exhibited a 90% mean ventilated volume. The mean ventilated lung volumes for healthy smokers and smokers diagnosed with COPD were 75.2% and 67.6%, respectively. No correlation with spirometry was demonstrated for either of the smoking groups. CONCLUSION: Combined 3-He/Proton SSFSE MRI of the lungs is a noninvasive method, using nonionizing radiation, which demonstrates ventilated airspaces and enables the calculation of ventilated lung volumes. This method appears to be sensitive to early obstructive changes in the lungs of smokers.     

Combined tag tracking and strain reconstruction from tagged cardiac MR images without user-defined myocardial contours

PURPOSE: To develop an unsupervised method for measuring quantitative three-dimensional regional strain in the left ventricular wall from tagged cardiac MR images. MATERIALS AND METHODS: A total of 10 normal human volunteers and eight patients with myocardial infarction were imaged using a parallel tagged imaging protocol. Each study was analyzed using the combined tag tracking and strain reconstruction (COTTER) algorithm. In contrast to existing techniques, which first track tag lines independently in each slice, then reconstruct myocardial deformation, the COTTER algorithm fits a three-dimensional cardiac deformation model directly to the image data. This approach ensures that tag line positions identified in the image data are consistent from slice to slice. A total of 10 imaging studies (six normals, four patients) were used to optimize parameters of the COTTER algorithm. RESULTS: In the remaining eight imaging studies, the root-mean-square difference between tags tracked by COTTER and user-supervised analysis was 0.66 pixels at end-systole. The correlation coefficient between circumferential shortening strains at end-systole computed by COTTER and user-supervised analysis was 0.84 (P < 0.005) at the midwall. CONCLUSION: The COTTER algorithm can compute accurate measurements of three-dimensional regional strain without user supervision.     

MR imaging of the normal appendix and acute appendicitis

PURPOSE: To describe the MR appearance of the normal appendix and the MR imaging characteristics of acute appendicitis with correlation to pathological severity. MATERIALS AND METHODS: A total of 20 volunteers participated in this study to demonstrate normal appendices by MR imaging. A total of 37 consecutive patients with clinically diagnosed acute appendicitis were also scanned. T1-weighted (T1WI) spin-echo images, T2-weighted (T2WI) fast spin-echo, and fat-suppressed spectral presaturation inversion recovery T2-weighted (T2SPIR) fast spin-echo images were obtained. The MR criteria for considering acute appendicitis were as follows: 1) thickening of the appendiceal wall with high intensity on T2WI or T2SPIR; 2) dilated lumen filled with high intensity material on T2WI or T2SPIR; and 3) increased intensity of periappendiceal tissue on T2WI or T2SPIR. RESULTS: The visibility of a normal appendix on MR imaging was 90% (18/20). It appeared as a cord-like structure of medium intensity without fluid collection in the lumen. A total of 30 cases with clinically diagnosed acute appendicitis had positive MR findings and all except one were pathologically proven. The one had cecal diverticulitis. These cases demonstrated filled lumen, with a hypointense wall on T1WI and slightly hyperintense on T2WI or T2SPIR. MR findings correlated well with pathological severity, especially a thicker wall, periappendiceal high intensity, and ascites were useful for suspecting severe appendicitis. CONCLUSION: Correct diagnosis of acute appendicitis was obtained with MRI, and correlated well with its pathological severity. MRI is a powerful alternative for diagnosing acute appendicitis especially for the patients in whom the radiation is major concern.     

Comparison of coronary artery calcium screening image quality between C-150 and e-Speed electron beam scanners

RATIONALE AND OBJECTIVE: The newest generation of electron beam tomographic scanner (e-Speed) has increased spatial and temporal resolution compared with the C-150 XP scanner. The aim of this study was to evaluate coronary artery calcium screening image quality between the e-Speed and C-150 scanners (GE Imatron, San Francisco, CA). MATERIALS AND METHODS: Studies from 41 patients (14 women and 27 men) who underwent serial coronary artery calcium screening with the C-150 (first study) and the e-Speed (second study) were analyzed. Individual computed tomography (CT) slices were assessed for coronary artery motion artifacts, and CT Hounsfield units (HU) and noise values (CT HU standard deviation) at 16 discrete cardiac sites were measured and averaged. RESULTS: With the e-Speed scanner, there were significant decreases in right coronary artery motion artifacts compared with the C-150 scanner (0.3% versus 1.8%, P < .001) as well as decreased noise values (24.3 versus 32.0 HU, P < .001). CONCLUSION: Image quality is significantly improved with use of the e-Speed scanner, due to its improved temporal and spatial resolution, compared with the C-150 scanner.     

Evaluation of semiautomated measurements of mesothelioma tumor thickness on CT scans

RATIONALE AND OBJECTIVES: To evaluate the clinical acceptability of semiautomated methods for the measurement of mesothelioma tumor thickness in computed tomography (CT) scans. MATERIALS AND METHODS: A computer interface was developed to allow the acquisition of semiautomated mesothelioma tumor thickness measurements, which require the manual selection of a point along the outer margin of the tumor in a CT section. After application of an automated lung segmentation method, the computer automatically identifies a corresponding point along the inner margin of the tumor (as represented by the lung boundary), constructs a line segment between the manually selected outer tumor margin point and the computer-determined inner tumor margin point, and computes tumor thickness as the length of this line segment. Three radiologists and oncologists independently reviewed line segments representing the semiautomated measurements generated by three different algorithms at 134 measurement sites in the CT scans of 22 mesothelioma patients. The observers either accepted a measurement line segment or modified it through the interface. Differences between the initial semiautomated measurements and the measurements as modified by the observers were analyzed. RESULTS: The frequency with which observers accepted the semiautomated measurements without modification was as high as 86%. Of all measurements across all observers and methods (1,206 measurements), 89% were changed by 2 mm or less. CONCLUSION: We have developed semiautomated methods to measure mesothelioma tumor thickness. The potential of these methods has been demonstrated through an observer study. We expect these methods to become important tools for the efficient quantification of tumor extent.     

Semiautomatic nonrigid registration for the prostate and pelvic MR volumes

RATIONALE AND OBJECTIVES: Three-dimensional (3D) nonrigid image registration for potential applications in prostate cancer treatment and interventional magnetic resonance (iMRI) imaging-guided therapies were investigated. MATERIALS AND METHODS: An almost fully automated 3D nonrigid registration algorithm using mutual information and a thin plate spline (TPS) transformation for MR images of the prostate and pelvis were created and evaluated. In the first step, an automatic rigid body registration with special features was used to capture the global transformation. In the second step, local feature points (FPs) were registered using mutual information. An operator entered only five FPs located at the prostate center, left and right hip joints, and left and right distal femurs. The program automatically determined and optimized other FPs at the external pelvic skin surface and along the femurs. More than 600 control points were used to establish a TPS transformation for deformation of the pelvic region and prostate. Ten volume pairs were acquired from three volunteers in the diagnostic (supine) and treatment positions (supine with legs raised). RESULTS: Various visualization techniques showed that warping rectified the significant pelvic misalignment by the rigid-body method. Gray-value measures of registration quality, including mutual information, correlation coefficient, and intensity difference, all improved with warping. The distance between prostate 3D centroids was 0.7 +/- 0.2 mm after warping compared with 4.9 +/- 3.4 mm with rigid-body registration. CONCLUSION: Semiautomatic nonrigid registration works better than rigid-body registration when patient position is changed greatly between acquisitions. It could be a useful tool for many applications in the management of prostate.     

Self-Perception and Self-Esteem of Patients Seeking Cosmetic Surgery

Cosmetic surgery represents a particular application of plastic surgery, in which the operative competence of the discipline is focused not on the correction of pathological disorders, but on the correction of some morphologic traits not accepted by the patients, or not adherent with the aesthetic canons of the time, although they are absolutely compatible with the norm. As a consequence, cosmetic surgery recognizes subjective indications. According to a particular literature on the subject, patients seeking these interventions would live a dualism between (their own) body image and inner self-image. Very psychotic case histories would come out of this. A base psychological approach adopted by the surgeon, competent both in the surgical and the psychological level, is absolutely needed. In this study, the psychological features of patients seeking cosmetic surgery were explored in an attempt to define common profiles or prevalent characteristics, and to isolate major psychiatric disorders. Patient self-esteem and physical self-perception also were investigated.