Current Issue : October - December Volume : 2014 Issue Number : 4 Articles : 7 Articles
Background: Magnetic resonance cholangiopancreatography (MRCP) is an established technique for the evaluation\nof intra- and extrahepatic bile ducts in patients with known or suspected hepatobiliary disease. However, the ideal\nacquisition and reconstruction plane for optimal bile duct evaluation with 3D technique has not been evaluated.\nThe purpose of our study was to compare different acquisition and reconstruction planes of 3D-MRCP for bile duct\nassessment.\nMethods: 34 patients (17f/17 m, mean age 41y) referred for MRCP were included in this prospective IRB-approved\nstudy. Respiratory-triggered 3D-T2w-MRCP sequences were acquired in coronal and axial plane. Coronal and axial\nMIP were reconstructed based on each dataset (resulting in two coronal and two axial MIP, respectively). Three\nreaders in two sessions independently assessed the MIP, regarding visualization of bile ducts and image quality.\nResults were compared (Wilcoxon test). Intra- and interobserver variability were calculated (kappa-statistic).\nResults: In case of coronal data acquisition, visualization of bile duct segments was significantly better on coronal\nreconstructed MIP images as compared to axial reconstructed MIP (p < 0.05). Regarding visualization, coronal MIP of\nthe coronal acquisition were equal to coronal MIP of the axial acquisition (p > 0.05). Image quality of coronal and\naxial datasets did not differ significantly. Intra- and interobserver agreement regarding bile duct visualization were\nmoderate to excellent (?-range 0.55-1.00 and 0.42-0.85, respectively).\nConclusions: The results of our study suggest that for visualization and evaluation of intra- and extrahepatic bile\nduct segments reconstructed images in coronal orientation are preferable. The orientation of the primary dataset\n(coronal or axial) is negligibl...
Background: Hepatic angiomyolipoma is a rare benign mesenchymal tumor. We report an unusual case of a\npatient with multiple hepatic angiomyolipomas exhibiting high 18 F-fluorodeoxyglucose (FDG) uptake.\nCase presentation: A 29-year-old man with a medical history of tuberous sclerosis was admitted to our hospital for\nfever, vomiting, and weight loss. Abdominal dynamic computed tomography revealed faint hypervascular hepatic\ntumors in segments 5 (67 mm) and 6 (10 mm), with rapid washout and clear borders; however, the tumors exhibited\nno definite fatty density. Abdominal magnetic resonance imaging revealed that the hepatic lesions were slightly\nhypointense on T1-weighted imaging, slightly hyperintense on T2-weighted imaging, and hyperintense with no\napparent fat component on diffusion-weighted imaging. FDG-positron emission tomography (PET) imaging revealed\nhigh maximum standardized uptake values (SUVmax) of 6.27 (Segment 5) and 3.22 (Segment 6) in the hepatic\ntumors. A right hepatic lobectomy was performed, and part of the middle hepatic vein was also excised. Histological\nexamination revealed that these tumors were characterized by the background infiltration of numerous inflammatory\ncells, including spindle-shaped cells, and a resemblance to an inflammatory pseudotumor. Immunohistochemical\nevaluation revealed that the tumor stained positively for human melanoma black-45. The tumor was therefore considered\nan inflammatory pseudotumor-like angiomyolipoma. Although several case reports of hepatic angiomyolipoma\nhave been described or reviewed in the literature, only 3 have exhibited high 18 F-FDG uptake on PET imaging\nwith SUVmax ranging from 3.3ââ?¬â??4.0. In this case, increased 18 F-FDG uptake is more likely to appear, particularly if\nthe inflammation is predominant.\nConclusion: Although literature regarding the role of 18 F-FDG-PET in hepatic angiomyolipoma diagnosis is limited\nand the diagnostic value of 18 F-FDG-PET has not yet been clearly defined, the possibility that hepatic angiomyolipoma\nmight exhibit high 18 F-FDG uptake should be considered....
Background: Alzheimer�s disease (AD) is a progressive, incurable neurodegenerative disease and the most common\ntype of dementia. It cannot be prevented, cured or drastically slowed, even though AD research has increased in the\npast 5-10 years. Instead of focusing on the brain volume or on the single brain structures like hippocampus, this paper\ninvestigates the relationship and proximity between regions in the brain and uses this information as a novel way of\nclassifying normal control (NC), mild cognitive impaired (MCI), and AD subjects.\nMethods: A longitudinal cohort of 528 subjects (170 NC, 240 MCI, and 114 AD) from ADNI at baseline and month 12\nwas studied. We investigated a marker based on Procrustes aligned center of masses and the percentile surface\nconnectivity between regions. These markers were classified using a linear discriminant analysis in a cross validation\nsetting and compared to whole brain and hippocampus volume.\nResults: We found that both our markers was able to significantly classify the subjects. The surface connectivity\nmarker showed the best results with an area under the curve (AUC) at 0.877 (p < 0.001), 0.784 (p < 0.001), 0,766\n(p < 0.001) for NC-AD, NC-MCI, and MCI-AD, respectively, for the functional regions in the brain. The surface\nconnectivity marker was able to classify MCI-converters with an AUC of 0.599 (p < 0.05) for the 1-year period.\nConclusion: Our results show that our relative proximity markers include more information than whole brain and\nhippocampus volume. Our results demonstrate that our proximity markers have the potential to assist in early\ndiagnosis of AD....
Background: We tested the feasibility of a simple method for assessment of prostate cancer (PCa) aggressiveness\nusing diffusion-weighted magnetic resonance imaging (MRI) to calculate apparent diffusion coefficient (ADC) ratios\nbetween prostate cancer and healthy prostatic tissue.\nMethods: The requirement for institutional review board approval was waived. A set of 20 standardized core\ntransperineal saturation biopsy specimens served as the reference standard for placement of regions of interest on\nADC maps in tumorous and normal prostatic tissue of 22 men with PCa (median Gleason score: 7; range, 6ââ?¬â??9). A\ntotal of 128 positive sectors were included for evaluation. Two diagnostic ratios were computed between tumor\nADCs and normal sector ADCs: the ADC peripheral ratio (the ratio between tumor ADC and normal peripheral zone\ntissue, ADC-PR), and the ADC central ratio (the ratio between tumor ADC and normal central zone tissue, ADC-CR).\nThe performance of the two ratios in detecting high-risk tumor foci (Gleason 8 and 9) was assessed using the area\nunder the receiver operating characteristic curve (AUC).\nResults: Both ADC ratios presented significantly lower values in high-risk tumors (0.48 Ã?± 0.13 for ADC-CR and 0.40 Ã?±\n0.09 for ADC-PR) compared with low-risk tumors (0.66 Ã?± 0.17 for ADC-CR and 0.54 Ã?± 0.09 for ADC-PR) (p < 0.001) and\nhad better diagnostic performance (ADC-CR AUC = 0.77, sensitivity = 82.2%, specificity = 66.7% and ADC-PR\nAUC = 0.90, sensitivity = 93.7%, specificity = 80%) than stand-alone tumor ADCs (AUC of 0.75, sensitivity = 72.7%,\nspecificity = 70.6%) for identifying high-risk lesions.\nConclusions: The ADC ratio as an intrapatient-normalized diagnostic tool may be better in detecting high-grade\nlesions compared with analysis based on tumor ADCs alone, and may reduce the rate of biopsies....
Background: Studies of prenatal detection of congenital heart disease (CHD) in the UK, Italy, and Norway indicate\nthat it should be possible to improve the prenatal detection rate of CHD in Sweden. These studies have shown\nthat training programs, visualization of the outflow tracts and color-Doppler all can help to speed up and improve\nthe detection rate and accuracy. We aimed to introduce a more accurate standardized fetal cardiac ultrasound\nscreening protocol in Sweden.\nMethods: A novel pedagogical model for training midwives in standardized cardiac imaging was developed, a\nmodel using a think-aloud analysis during a pre- and post-course test and a subsequent group reflection. The\nself-estimated difficulties and knowledge gaps of two experienced and two beginner midwives were identified.\nA two-day course with mixed lectures, demonstrations and hands-on sessions was followed by a feedback session\nthree months later consisting of an interview and check-up. The long-term effects were tested two years later.\nResults: At the post-course test the self-assessed uncertainty was lower than at the pre-course test. The qualitative\nevaluation showed that the color Doppler images were difficult to interpret, but the training seems to have\nimproved their ability to use the new technique. The ability to perform the method remained at the new level at\nfollow-up both three months and two years later.\nConclusions: Our results indicate that by implementing new imaging modalities and providing hands-on training,\nuncertainty can be reduced and examination time decreased, but they also show that continuous on-site training\nwith clinical and technical back-up is important....
Background: FDG-PET/CT is part of the standard diagnostic management of a patients with a large variety of\ncommon and less common malignant tumors, based on the increased glucose metabolism within tumors.\nCase presentation: A hybrid fluorodeoxyglucose positron emission tomography and computed tomography\n(FDG-PET/CT) was performed in a neurofibromatosis patient to rule out relapse of malignant peripheral nerve sheet\ntumor. The scan revealed non-malignant neurofibromas, a testis seminoma and hypermetabolic syphilitic granulomata.\nConclusion: This case stresses the need to rule out infectious diseases when atypical hypermetabolic lesions are present....
Background: Ensuring an adequate blood supply is essential to the safe performance of an anastomosis during\nesophagectomy and the prevention of anastomotic leakage. Recently, indocyanine green (ICG) fluorescence\nimaging has been used to visualize the blood supply when anastomosis is performed in vascular surgery.\nWe used ICG fluorescence imaging to visualize the blood supply for reconstruction during esophagectomy.\nMethods: Since January 2009, we have performed ICG fluorescence imaging in 33 patients with thoracic\nesophageal cancer who underwent thoracic esophagectomy. After pulling up the reconstructed stomach, 2.5 mg\nof ICG was injected as a bolus. ICG fluorescence imaging was performed with a near-infrared camera, and the\nimages were recorded.\nResults: ICG fluorescence was easily detected in all patients 1 min after injection. Vascular networks were well\nvisualized in the gastric wall and omentum. The blood supply route was located in the greater omentum beside\nthe splenic hilum in 22 (66.7%) of the 33 patients.\nConclusions: ICG fluorescence can be used to evaluate the blood supply to the reconstructed stomach in\npatients undergoing esophagectomy for esophageal cancer. On ICG fluorescence imaging, the splenic hiatal\nvessels were the major blood supply for the anastomosis in most patients....
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