The Usefulness of Three-Dimensional Gadolinium-Enhanced MR Venography for the Evaluation of Varices in Lower Extremities

PURPOSE: To assess the performance of contrast-enhanced three-dimensional(3-D) magnetic resonance venography (MRV) of the pelvis and lower extremities in patients with varicose veins. MATERIALS AND METHODS: Ascending and MR venography were performed in seven legs of seven patients, and duplex Doppler sonography and MR venography in 15 legs of 12 patients, all referred for evaluation of varicose veins. For analysis, the venous system as revealed by ascending and MR venographic images was divided into 13 segments. For detection of reflux to the great saphenous vein, duplex Doppler sonography and MRV were performed. RESULTS: In ascending venography and MRV, 91 venous segments were potentially visible; both modalities depicted 78 of these, but failed to detect four. Ascending venography and MRV detected 17 and 19 varices, respectively. When two tourniquets were placed around the ankle and knee using the Valsalva maneuver, MRV and duplex Doppler sonography detected reflux in 8 of 11 and 13 of 15 legs, respectively. CONCLUSION: Contrast-enhanced 3-D MRV comprehensively displays the venous system of the lower extremities and permits assessment of varicose veins. MRV using the Valsalva maneuver allows assessment of reflux to the great saphenous vein.

Roentgenographic Findings in Hyaline Membrane Disease Treated with Exogenous Surfactant: Comparison with Control Group

PURPOSE: To compare, with the use of chest radiographic findings, improvement and complications in newborns treated with exogenous surfactant for hyaline membrane disease(HMD), and an untreated control group. MATERIALS AND METHODS: Thirty-six patients with HMD were randomly assigned to a control group (n=18) or surfactant treated group (n=18). As part of an initial evaluation of their pulmonary status, we then performed a retrospective statistical analysis of chest radiographic findings obtained in exogenous surfactant treated and untreated infants within the first 90 minutes of life. Subsequent examinations were performed at less than 24 hours of age. RESULTS: Chest radiograph before treatment showed no significant differences between the two groups, but significant improvement was noted in the surfactant treated group, in contrast to the control group. The most common chest radiographic finding after surfactant administration was uniform (n=15) or disproportionate (n=2) improvement of pulmonary aeration. Patent ductus arteriosus developed in three treated neonates and in four cases in the control group. Air leak occurred in three cases in the treated group and in five cases in the control group. In one treated patient pulmonary hemorrhage developed and intracranial hemorrhage occurred in three treated neonates and in four cases in the control group. Bronchopulmonary dysplasia was developed in 6 cases of treated group and 3 cases of control group. CONCLUSION: A chest radiograph is considered to be helpful in the evaluation of improvement and complications of HMD in infants treated with surfactant.

MR Imaging of Medial Collateral Ligament Injury and Associated Internal Knee Joint Injury

PURPOSE: To assess the value of MR imaging in the diagnosis of medial collateral ligament injury of the knee, we used MR imaging to evaluate the characteristic findings in MCL tears and the frequency of associated knee joint injury. MATERIALS AND METHODS: We retrospectively reviewed 26 patients within four weeks of MCL injury, analysed MR findings and correlated them with surgical findings. We evaluated discontinuity, heterogeneous signal intensityof MCL, thin band- like low signal intensity at MCL, facial edema, loss of clear demarcation of adjacent fat andalso combined bone injury, meniscus injury and other ligament injury. RESULTS: Complete MCL tears were present in 14 patients and partial tears in 12. Complete tears showed discontinuity of MCL, fascial edema and loss of clear demarcation from adjacent fat in 11 patients (79%) ; proximal MCL tears are more common than distal tears. Partial tears showed thin band-like low signal intensity within MCL, fascial edema and loss of clear demarcation fromadjacent fat in seven patients (58%) ; all patients with MCL injury showed fascial edema ; in 12 patients there was loss of clear demarcation from adjacent fat. We could not, however, distinguish between complete tears and partial tears when MCL showed heterogeneous high signal intensity. Combined bone injury in MCL tears was found in eight patients (62%) ; the most common sites of this were the lateral femoral condyle and lateral tibial plateau. There was associated injury involving other ligaments(ACL:50%; PCL: 27%). Combined meniscus injury in MCL tearswas present in 17 patients and the most common meniscus site (50%) is the posterior horn of the medial meniscus. CONCLUSION: Complete MCL tears showed discontinuity of MCL and partial tears showed a thin band-like low signal intensity within MCL. All patients with MCL injury showed fascial edema, and loss of clear demarcation fromadjacent fat. Various other injuries combine with MCL tears. MR imaging is therefore useful in the evaluation ofmedial collateral ligament injury and associated knee joint injury.

Radiographic Findings of Pulmonary Tuberculosis in Non-AIDS Immunocompromised adult Patients: Comparison with Immunocompetent Adult Patients

PURPOSE: To compare chest radiographic findings of pulmonary tuberculosis in non-AIDS immunocom- promised adult patients with those in immunocompetent patients. MATERIAL AND METHOD: Eighty six patients who had pulmonary tuberculosis were included in the study. Of these, 41 were non-AIDS immunocompromised adult patients and 45 were immunocompetent adult patients. Chest radiographs obtained from 86 patients were retrospectively evaluated with regard to the followings ;the anatomic distribution and extent of tuberculous lesions, typical or atypical patterns of radiographic findings. We then compared the results in non-AIDS immunocompromised adult patients with those in immunocompetent adult patients. RESULTS: The characteristic manifestation of pulmonary tuberculosis was a tendency of pulmonary lesions to localize in the apico-posterior segments of the upper lobe and the superior segment of the lower lobe in both groups but more wide distribution such as the anterior segment and the lingular segment of the upper lobe and the basal segments of the lower lobe was frequently identified in non-AIDS immunocompromised adult patients, and also bilateral, multisegmental and multilobular extents were common findings. in immunocompetent adult patients, more common findings were in local exudative and productive lesions and several cavities in preferential sites. Atypical plain radiographic findings were more common in non-AIDS immunocompromised adult patients, and which were multiple cavitary lesions, wide extent of bronchogenic spread and tuberculous pneumonia, and .miliary disseminations and mass like lesions. CONCLUSIONS: Pulmonary tuberculosis in non-AIDS immunocompromised adult patients is characterized by frequent bilateral distribution, wide pulmonary extent, and atypical radiographic findings.