Magnetic resonance imaging: evaluation of palliative systemic-pulmonary artery shunts

Eleven patients with a total of 17 palliative systemic-pulmonary artery shunts underwent evaluation by electrocardiogram-gated magnetic resonance imaging (GMRI). GMRI successfully imaged 11 of 17 shunts (65%), including five of nine Blalock-Taussig shunts, four of six Glenn shunts, and both aortopulmonary shunts. All shunts except for the Waterston were imaged on coronal sections during end-systole. The single Waterston shunt was seen on sagittal and transverse scans. Shunt localization and identification were facilitated by obtaining multiple, contiguous sections through the body. Glenn shunts could be imaged entirely in one section, although multiple sections were required to locate the correct plane. Blalock-Taussig shunts generally required multiple sections to image different segments of the shunt. Both aortopulmonary shunts were seen as direct side-to-side connections of the aorta and pulmonary artery. GMRI permitted assessment of the size, course, patency, and distribution of systemic-pulmonary artery shunts as well as the size and morphology of the proximal pulmonary arteries. We conclude that GMRI is a useful, noninvasive method for imaging the anatomy of systemic-pulmonary artery shunts.     

Abdominal bruits in renovascular hypertension.

A study of 87 patients surgically treated for renal arterial stenosis revealed that upper abdominal bruits were heard more frequently in patients whose stenosis was due to fibrous disease than to atherosclerosis. A diastolic bruit in a patient with fibrous disease of the renal artery usually indicated a favorable surgical result. Conclusions regarding the prognostic value of diastolic bruits in atherosclerotic renal artery disease must be deferred until a larger number of patients with this finding can be studied. When hypertension of less than 3 year's duration was combined with presence of a diastolic bruit, 17 or 18 patients had a favorable surgical outcome. An abdominal bruit should be carefully sought for in all patients evaluated for hypertension; when found, should be characterized acurately, because of the important diagnostic and prognostic information it may provide.     

CT-guided percutaneous biopsies in pediatric patients

Twenty (5%) of 432 pediatric patients scanned during the last 36 months underwent percutaneous biopsy with CT guidance. Sixteen patients had suspected or a known malignancy. Four patients were clinically suspected of having an inflammatory process. Cytologic and histologic specimens were taken when technically possible. Total diagnostic tissue recovery rate equalled 88% in the patients with known or suspected malignancy. Diagnostic tissue was obtained in three of four patients with inflammatory disease. No immediate or delayed complications were encountered. Although the percutaneous method under CT guidance has been shown to be advantageous in various aspects of medical care, the utilization of this modality in the pediatric population, to our knowledge, has been limited. We have found this technique to be useful in the tissue diagnosis of pediatric disease, and in guiding the subsequent clinical treatment. The clinical indications, technique, and results utilizing this method are presented.