Visual assessment of total heart volume and specific chamber size from standard chest radiographs.

Ten radiologists at three levels of training visually assessed total heart and individual chamber size in 95 adults of both sexes with well defined cardiac diagnoses. Overall accuracy was highest for total heart size (82.2% correct), followed by left ventricular size, left atrial size and right heart size 79.6%, 75.0%, and 72.8%, respectively. Right heart and left atrial enlargement had a statistically significant negative effect on visual assessment of other chambers (P less than .05). Attempts to subclassify left ventricular enlargement into hypertrophy and hypertrophy and dilatation groups proved unsuccessful. While 63% of the hypertrophy group was detected as abnormal, only 24.3% were correctly subclassified as hypertrophy. For the hypertrophy and dilatation group, the corresponding values were 82% and 70%, respectively. Oblique views were useful in assessing left ventricular size only when inexperienced observers were included in the group of evaluators (P less than .05). A statistically significant improvement in assessment of normal left ventricular size and overall left atrial size was noted with experience (P less than .01 and P less than .05, respectively).     

Evaluating carotid artery disease. The concordance between pulsed Doppler/spectrum analysis and angiography

The results of ultrasonic pulsed Doppler duplex scanning with spectral analysis and computer pattern recognition are compared with the results of contrast arteriography in patients screened for extracranial carotid artery disease. The intraangiographer variability (one radiologist reading the same films twice) and the interangiographer variability (two radiologists reading the same film independently) were also studied. To calculate degrees of agreement corrected for chance, the Kappa statistic was computed for all the evaluation methods employed.At the present time, the concordance between spectral analysis and cerebral contrast angiography reaches a Kappa value of 0.682±0.064. This level of agreement compares favorably with the interangiographer agreement level (K) = 0.568 ± 0.058 and the intraangiographer agreement (K) = 0.711 ± 0.054. The computer pattern recognition program predicted the degree of stenosis by angiography with an agreement of K = 0.721 ± 0.059. This concordance compares favorably to that observed when the radiologists are compared with themselves and is greater than that reached by two different radiologists. The continuous improvement in precision and accuracy of duplex scanning offers the promise of its usefulness in clinical and epidemiological studies.     

Lipohyalinosis and miliary microaneurysms causing cerebral hemorrhage in a patient with moyamoya. A clinicopathological study

Moyamoya is an intriguing and controversial syndrome. This patient study serves to align the pathophysiology of intracranial hemorrhage in moyamoya with the cerebral vascular disease seen with hypertension, or aging. The historical evidence linking lipohyalinosis and microaneurysms to cerebral hemorrhage is reviewed, the pathogenesis of this angiopathy is discussed, and explanations considered for its association with the vascular pattern of moyamoya. We propose that hemodynamics, genetics or both are among the primary operant etiologic factors.     

Ultrasonic evaluation of radiographic opacities of the chest.

The nature of pleural based radiographic opacities in the chest can be uncertain; however, ultrasonic examination provides a reliable means of distinguishing solid from fluid-containing lesions. It is superior to both fluoroscopy and radiography in accurately localizing loculated fluid collections for thoracentesis and can be performed with commercially available gray scale contact scanning equipment. Cases representing a spectrum of clinical applications are discussed.     

Subarachnoid hemorrhage in hereditary hemorrhagic telangiectasia

Summary Two patients with hereditary hemorrhagic telangiectasia, who presented with subarachnoid hemorrhage and were investigated with cerebral angiography, are reported. Both showed multiple vascular malformations, and one showed a posterior communicating artery aneurysm which was treated successfully surgically.

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Subarachnoidalblutung der Teleangiectasia Hemorrhagica Familiaris

Zusammenfassung Eine Subarachnoidalblutung war das Initialsymptom bei 2 Patienten mit Teleangiectasia hemorrhagica familiaris. Angiographisch konnten in beiden Fällen multiple Gefäßmißbildungen nachgewiesen werden. Ein Aneurysma der A. communicans posterior wurde bei 1 Patienten erfolgreich operiert.

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Hemorragie sous-arachnoïdienne dans deux cas de telangiectasie. Hemorragique hereditaire

Résumé Compte rendu de deux cas de télangiectasie hémorragique héréditaire qui présentent une hémorragie sous arachnoidieane et furent investigués par angiographie cérébrale. Ces deux cas révèlent des malformations vasculaires multiples, et un des cas présente un anévrisme artériel postérieur communiquant qui a été traité avec succès par chirurgie.

     

Geometric modeling of the carotid bifurcation in humans: implications in ultrasonic Doppler and radiologic investigations

A geometric representation of the carotid bifurcation is presented with data obtained from biplane angiograms of normal branches and branches exhibiting less than 5% vessel diameter reduction. Three features are identified that are of importance in the interpretation of ultrasonic Doppler velocity information and in the design of engineering flow models for evaluation of carotid branch hemodynamics: the variability of the bifurcation angles, the degree of tortuosity, and the nonplanar nature of the branches. In addition, data collected demonstrate the potential usefulness of the common carotid artery as a reference diameter in evaluating stenosis of the carotid bulb.     

Computer based classification of carotid arterial disease: a prospective assessment

A minicomputer based pattern recognition method has been used to prospectively classify the category of disease involvement of 105 carotid arteries. The system utilized spectral patterns obtained from a combined B-mode/pulsed Doppler unit. All decisions are based upon comparison of an unknown, averaged waveform with a series of vessels with known severity of disease. The variability in the computer decision as compared to arteriography is discussed.     

Papillary adenoma of the gall bladder: ultrasonic demonstration.

A papillary adenoma of the gall bladder was demonstrated by gray scale echography. The pathology of the tumor was described and the ultrasonic characteristics which distinguish it from a calculus were discussed.     

A prospective evaluation of oculoplethysmography and carotid phonoangiography.

With oculoplethysmography, conclusions are drawn regarding the state of internal carotid artery disease by measurements based upon pressure and flow in the eye, a location far removed from the site of the disease. Thus, many potential variables including ocular disease, vessel wall properties, intracranial atherosclerosis and collateral flow may affect the results. Although oculoplethysmography was quite accurate in detecting occlusion of the internal carotid artery, the identification of a high grade stenosis was much less precise. Furthermore, it could not distinguish between stenosis and occlusion, making angiography necessary for accurate diagnosis. In this study, oculoplethysmography, either alone or in combination with carotid phonoangiography, was not of sufficient accuracy to recommend its use as part of a noninvasive evaluation of carotid artery occlusive disease.