Current Issue : April - June Volume : 2012 Issue Number : 2 Articles : 7 Articles
Background: Consolidation with or without ground-glass opacity is the typical radiologic finding of lung\r\nmetastases of adenocarcinoma from the gastrointestinal tract. Lung excavated metastases from gastrointestinal\r\ncarcinoma are very rare.\r\nCase presentation: The authors describe an unusual presentation of multiple cavitated lung metastases from\r\ncolon adenocarcinoma and discuss the outcome of a patient. The absence both of symptoms and other disease\r\nlocalizations, the investigations related to different diagnostic hypotheses and the empirical treatments caused a\r\ndelay in correct diagnosis. Only a transparietal biopsy revealed the neoplastic origin of nodules.\r\nConclusions: This report demonstrates that although lung excavated metastases are described in literature, initial\r\nfailure to reach a diagnosis is common. We would like to alert clinicians and radiologists to the possibility of\r\nunusual atypical features of pulmonary metastases from colon adenocarcinoma....
Background: The application of advanced 3T MRI imaging techniques to study recovery after subarachnoid\r\nhemorrhage (SAH) is complicated by the presence of image artifacts produced by implanted aneurysm clips. To\r\ncharacterize the effect of these artifacts on image quality, we sought to: 1) quantify extent of image artifact in SAH\r\npatients with implanted aneurysm clips across a range of MR sequences typically used in studies of volumetry,\r\nblood oxygen level dependent signal change (BOLD-fMRI), and diffusion-weighted imaging (DW-MRI) and 2) to\r\nexplore the ability to reconstruct white matter pathways in these patients.\r\nMethods: T1- and T2-weighted structural, BOLD-fMRI, and DW-MRI scans were acquired at 3T in two patients with\r\ntitanium alloy clips in ACOM and left ACA respectively. Intensity-based planimetric contouring was performed on\r\naligned image volumes to define each artifact. Artifact volumes were quantified by artifact/clip length and artifact/\r\nbrain volume ratios and analyzed by two-way (scan-by-rater) ANOVAs. Tractography pathways were reconstructed\r\nfrom DW-MRI at varying distances from the artifacts using deterministic methods.\r\nResults: Artifact volume varied by MR sequence for length (p = 0.007) and volume (p < 0.001) ratios: it was\r\nsmallest for structural images, larger for DW-MRI acquisitions, and largest on fMRI images. Inter-rater reliability was\r\nhigh (r = 0.9626, p < 0.0001), and reconstruction of white matter connectivity characteristics increased with\r\ndistance from the artifact border. In both patients, reconstructed white matter pathways of the uncinate fasciculus\r\nand inferior fronto-occipital fasciculus were clearly visible within 2 mm of the artifact border.\r\nConclusions: Advanced 3T MR can successfully image brain tissue around implanted titanium aneurysm clips at\r\ndifferent spatial ranges depending on sequence type. White matter pathways near clip artifacts can be\r\nreconstructed and visualized. These findings provide a reference for designing functional and structural\r\nneuroimaging studies of recovery in aSAH patients after clip placement....
Background: We have previously proposed the use of Doppler ultrasound to non-invasively stage sinus infection,\r\nas we showed that acoustic streaming could be generated in nonpurulent sinus secretions and helped to\r\ndistinguish it from mucopurulent sinus secretions. In order to continue this development of a clinically applicable\r\nDoppler equipment, we need to determine different dimensions of the paranasal sinuses, especially the thickness\r\nof the anterior wall of the maxillary sinus (at the canine fossa). To the best of our knowledge, this is the first report\r\non the thickness of the canine fossa. This study aimed to (a) estimate different dimensions of the maxillary and\r\nfrontal sinuses measured on computed tomography (CT) of the head, (b) define cut-off values for the normal\r\nupper and lower limits of the different measured structures, (c) determine differences in age, side and gender,\r\n(d) compare manually and automatically estimated maxillary sinuses volumes, and (e) present incidental findings in\r\nthe paranasal sinuses among the study patients.\r\nMethods: Dimensions of 120 maxillary and frontal sinuses from head CTs were measured independently by two\r\nradiologists.\r\nResults: The mean value of the maxillary sinus volume was 15.7 �± 5.3 cm3 and significantly larger in males than in\r\nfemales (P = 0.004). There was no statistically significant correlation between the volume of maxillary sinuses with\r\nage or side. The mean value of the bone thickness at the canine fossa was 1.1 �± 0.4 mm. The automatically\r\nestimated volume of the maxillary sinuses was 14-17% higher than the calculated volume. There was high\r\ninterobserver agreement with regard to the different measurements performed in this study. Different types of\r\nincidental findings of the paranasal sinuses were found in 35% of the patients.\r\nConclusion: We presented different dimensions of the maxillary and frontal sinuses on CTs. We believe that our\r\ndata are necessary for further development of a clinically applicable Doppler equipment for staging rhinosinusitis....
Background: A variety of neuroimaging software packages have been released from various laboratories\r\nworldwide, and many researchers use these packages in combination. Though most of these software packages\r\nare freely available, some people find them difficult to install and configure because they are mostly based on\r\nUNIX-like operating systems. We developed a live USB-bootable Linux package named ââ?¬Å?Lin4Neuro.ââ?¬Â This system\r\nincludes popular neuroimaging analysis tools. The user interface is customized so that even Windows users can use\r\nit intuitively.\r\nResults: The boot time of this system was only around 40 seconds. We performed a benchmark test of\r\ninhomogeneity correction on 10 subjects of three-dimensional T1-weighted MRI scans. The processing speed of\r\nUSB-booted Lin4Neuro was as fast as that of the package installed on the hard disk drive. We also installed\r\nLin4Neuro on a virtualization software package that emulates the Linux environment on a Windows-based\r\noperation system. Although the processing speed was slower than that under other conditions, it remained\r\ncomparable.\r\nConclusions: With Lin4Neuro in oneââ?¬â?¢s hand, one can access neuroimaging software packages easily, and\r\nimmediately focus on analyzing data. Lin4Neuro can be a good primer for beginners of neuroimaging analysis or\r\nstudents who are interested in neuroimaging analysis. It also provides a practical means of sharing analysis\r\nenvironments across sites....
Background: Discomfort characterized by pain and warmth are common adverse effects associated with the use of\r\nintra-arterial iodinated contrast media (CM). The objective of this review was to pool patient-reported outcomes\r\navailable from head-to-head randomized controlled trials (RCTs) and to compare the discomfort rates associated with\r\niso-osmolar contrast media (IOCM; i.e., iodixanol) to those reported with various low-osmolar contrast media (LOCM).\r\nMethods: A review of the literature published between 1990 and 2009 available through Medline, Medline\r\nPreprints, Embase, Biological Abstracts, BioBase, Cab Abstracts, International Pharmaceutical Abstracts, Life Sciences\r\nCollection, Inside Conferences, Energy Database, Engineering Index and Technology Collection was performed\r\nto compare rates of discomfort associated with the use of the IOCM (iodixanol) vs. various LOCM agents in\r\nhead-to-head RCTs. All trials with a Jadad score =2 that reported patient discomfort data following intra-arterial\r\nadministration of CM were reviewed, coded, and extracted.\r\nResults: A total of 22 RCTs (n = 8087) were included. Overall discomfort (regardless of severity) was significantly\r\ndifferent between patients receiving IOCM and various LOCMs (risk difference [RD] -0.049; 95% confidence interval [CI]:\r\n-0.076, -0.021; p = 0.001). IOCM was favored over all LOCMs combined with a summary RD value of -0.188 (95% CI:\r\n-0.265, -0.112; p < 0.001) for incidence of pain, regardless of severity. A greater reduction in the magnitude of pain was\r\nobserved with IOCM (iodixanol), particularly with selective limb and carotid/intracerebral procedures. Similarly, the\r\nmeta-analysis of warmth sensation, regardless of severity, favored IOCM over LOCMs with an RD of -0.043 (95% CI:\r\n-0.074, -0.011; p = 0.008). A positive linear relationship was observed between the discomfort effect size and age and a\r\nnegative relationship with increasing proportion of women. The opposite trends were observed with warmth sensation.\r\nConclusions: IOCM was associated with less frequent and severe patient discomfort during intra-arterial\r\nadministration. These data support differences in osmolality as a possible determinant of CM discomfort....
Background: Incremental palmar stimulation of the median nerve sensory conduction at the wrist, the ââ?¬Å?inching\r\ntestââ?¬Â, provides an assessment with reference to segments proximal and distal to the entrapment. This study used\r\nhigh-resolution ultrasonography (US) to measure the median nerveââ?¬â?¢s cross-section areas (CSAs) like the ââ?¬Å?inching\r\ntestââ?¬Â and to correlate with the nerve conduction study (NCS) severity and duration of carpal tunnel syndrome\r\n(CTS).\r\nMethods: Two hundred and twelve (212) ââ?¬Å?CTS-handsââ?¬Â from 135 CTS patients and 50 asymptomatic hands\r\n(ââ?¬Å?A-handsââ?¬Â) from 25 control individuals were enrolled. The median nerve CSAs were measured at the 8-point\r\nmarked as i4, i3, i2, i1, w, o1, o2, and 03 in inching test. The NCS severities were classified into six groups based on\r\nmotor and sensory responses (i.e., negative, minimal, mild, moderate, severe, and extreme). Results of US studies\r\nwere compared in terms of NCS severity and duration of clinical CTS symptoms.\r\nResults: There was significantly larger CSA of the NCS negative group of ââ?¬Å?CTS-handsââ?¬Â than of ââ?¬Å?A-handsââ?¬Â. The cutoff\r\nvalues of the CSAs of the NCS negative CTS group were 12.5 mm2, 11.5 mm2 and 10.1 mm2 at the inlet, wrist\r\ncrease, and outlet, respectively. Of the 212 ââ?¬Å?CTS-handsââ?¬Â, 32 were NCS negative while 40 had minimal, 43 mild, 85\r\nmoderate, 10 severe, and two extreme NCS severities. The CSAs of ââ?¬Å?CTS-handsââ?¬Â positively correlated with different\r\nNCS severities and with the duration of CTS symptoms. By duration of clinical symptoms, 12 of the 212 ââ?¬Å?CTShandsââ?¬Â\r\nwere in the 1 month group; 82 in >1 month and =12 months group, and 118 in >12 months group. In\r\nââ?¬Å?inching testââ?¬Â, segments i4-i3 and i3-i2 were the most common ââ?¬Å?positive-siteââ?¬Â. The corresponding CSAs measured\r\nat i4 and i3, but not at i2, were significantly larger than those measured at points that were not ââ?¬Å?positive-siteââ?¬Â.\r\nConclusions: Using the 8-point measurement of the median nerve CSA from inlet to outlet similar to the ââ?¬Å?inching\r\ntestââ?¬Â has positive correlations with NCS severity and duration of CTS clinical symptoms, and can provide more\r\ninformation on anatomic changes. Combined NCS and US studies using the 8-point measurement may have a\r\nhigher positive rate than NCS alone for diagnosing CTS....
Background: Functional and morphological changes of the heart influence blood flow patterns. Therefore, flow\r\npatterns may carry diagnostic and prognostic information. Three-dimensional, time-resolved, three-directional phase\r\ncontrast cardiovascular magnetic resonance (4D PC-CMR) can image flow patterns with unique detail, and using\r\nnew flow visualization methods may lead to new insights. The aim of this study is to present and validate a novel\r\nvisualization method with a quantitative potential for blood flow from 4D PC-CMR, called Volume Tracking, and\r\ninvestigate if Volume Tracking complements particle tracing, the most common visualization method used today.\r\nMethods: Eight healthy volunteers and one patient with a large apical left ventricular aneurysm underwent 4D PCCMR\r\nflow imaging of the whole heart. Volume Tracking and particle tracing visualizations were compared visually\r\nside-by-side in a visualization software package. To validate Volume Tracking, the number of particle traces that\r\nagreed with the Volume Tracking visualizations was counted and expressed as a percentage of total released\r\nparticles in mid-diastole and end-diastole respectively. Two independent observers described blood flow patterns\r\nin the left ventricle using Volume Tracking visualizations.\r\nResults: Volume Tracking was feasible in all eight healthy volunteers and in the patient. Visually, Volume Tracking\r\nand particle tracing are complementary methods, showing different aspects of the flow. When validated against\r\nparticle tracing, on average 90.5% and 87.8% of the particles agreed with the Volume Tracking surface in middiastole\r\nand end-diastole respectively. Inflow patterns in the left ventricle varied between the subjects, with\r\nexcellent agreement between observers. The left ventricular inflow pattern in the patient differed from the healthy\r\nsubjects.\r\nConclusion: Volume Tracking is a new visualization method for blood flow measured by 4D PC-CMR. Volume\r\nTracking complements and provides incremental information compared to particle tracing that may lead to a\r\nbetter understanding of blood flow and may improve diagnosis and prognosis of cardiovascular diseases....
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