Significance of Transcatheter Arterial Embolization in the Treatment of Pseudoaneurysm ComplicatingPancreatitis

PURPOSE: To evaluate the significance of transcatheter arterial embolization(TAE) of pseudoaneurysmcomplicating pancreatitis. MATERIALS AND METHODS: This study was based on a retrospective analysis of eightcases, in which TAE for the control of pseudoaneurysm complicating pancreatitis was attempted. All patients weremales, and were aged between 35 and 65(mean, 47) years. Seven had a history of episodes of chronic pancreatitisand one case was the result of acute pancreatitis. All patients underwent diagnostic angiography andsuperselective embolization. RESULTS: Arteries in which pseudoaneurysm had occurred were the gastroduodenal(n=5), inferior pancreaticoduodenal (n=1), superior mesenteric artery root (n=1), and the celiac axis (n=1). Sixcases were treated successfully without complications, but in two, embolization failed due to a wide aneurysmalneck arising from the superior mesenteric artery root and celiac axis. In four successful cases, pseudoaneurysmswere completely resolved within three to six months of embolization. One of the other two remained as apseudocyst, while in the other, also a pseudocyst, surgery was performed. CONCLUSION: Because TAE in patientswith pseudoaneurysm complicating pancreatitis has a high success rate, and also leads to absolute resorption of apseudocyst, TAE is the preferred pre-surgical treatment mode.

Evaluation of the Lesions of Synovial-lined Clefts in the infrapatellar Hoffa's Fat Pad with MR imaging

PURPOSE: Within Hoffa's infrapatellar fat pad there are two synovial clefts, horizontal and vertical, whichcommunicate with the intra-articular space. Intra-articular lesions can also occur in these clefts, and are oftendifficult to differentiate from extra-articular lesions. The purpose of this study is to evaluate, using MRimaging, the lesions occurring in these synovial lined clefts, as well as associated abnormalities. MATERIALS AND METHODS: Thirty-one knees of 31 patients with lesions in horizontal and vertical clefts in Hoffa's infrapatellarfat pad were retrospectively evaluated. Using a 1.5T MR imager, axial, sagittal, and coronal MR images of kneeswere obtained. Lesions in clefts, degree of joint effusion and associated knee abnormalities were analyzed. RESULTS: Horizontal cleft lesions were noted in 21 cases ; there were 17 cystic dilatations, two loose bodies,one synovial chondroma, and one case of pigmented villonodular synovitis(PVNS). Vertical cleft lesions were notedin 15 cases ; these comprised 11 cystic dilatations, two loose bodies, one synovial osteochondromatosis, and onePVNS. Among all cases, three cystic dilatations, one loose body, and one PVNS occurred in both horizontal andvertical clefts. Among 25 knees with cystic dilatations of clefts, five showed grade I joint effusion, ten gradeII, and ten grade III. Associated abnormalities were meniscal tear in 16 cases, osteoarthritis in 13, cruciateligament tear in five, osteochondritis dissecans in three, osteochondral fracture in two, osteonecrosis in one,loose body in one, and synovitis in one. CONCLUSION: Among synovial-lined clefts in Hoffa's fat pad, the mostcommon lesion was cystic dilatation ; there were various associated abnormalities and a close relationship tojoint effusion. An awareness of the types of lesions found in clefts is helpful for narrowing the differentialdiagnosis of lesions occurring in the area of Hoffa's fat pad.

Comparison of Single-Shot Fast Spin-Echo Sequence and T2-Weighted Fast Spin-Echo Sequence in MR Imaging of the Brain

PURPOSE: The purpose of this study was to evaluate the usefulness of the single-shot fast spin-echo (SS-FSE)sequence in comparison with the T2-weighted fast spin-echo (T2-FSE) sequence in brain MR imaging. MATERIALS AND METHODS: In 41 patients aged 15-75 years with intracranial lesion, both SS-FSE and T2-FSE images were obtainedusing a 1.5-T MR system. Lesions included cerebral ischemia or infarcts (n=23), tumors (n=10), hemorrhages (n=3),inflammatory diseases (n=2), arachnoid cysts (n=2), and vascular disease (n=1), and the MR images wereretrospectively evaluated. To calculate contrast-to-noise ratio (CNR), percentage contrast, and signal-to-noiseratio (SNR)-and thus make a quantitative comparison-the mean signal intensities of lesions, normal brain tissue,and noise outside the patient were measured. For qualitative comparison, the visbility, margin, and extent of thelesions were rated using a five-grade system, and the degree of MR artifacts was also evaluated. Wilcoxon's signedranks test was used for statistical analysis. RESULTS: The mean CNR of lesions was significantly higher on SS-FSE(31.3) than on T2-FSE images (27.5) (p= 0.0131). Mean percentage contrast was also higher on SS-FSE (159.0) thanon T2-FSE images (108.5) (p=0.0222), but mean SNR was higher on T2-FSE (80.3) than on SS-FSE images (53.5)(p=0.0000). No significant differences in lesion visibility were observed between the two imaging sequences,though margin and extent of the lesion were worse on SS-FSE images. For MR artifacts, no significant differenceswere demonstrated. CONCLUSION: For the evaluation of most intracranial lesions, MR imaging using the SS-FSEsequence appears to be slightly inferior to the T2-FSE sequence, but may be useful where patients are ill oruncooperative, or where children require sedation.

Acute Traumatic Spinal Fracture: Comparison between Plain

PURPOSE: To reassess the diagnostic value of plain radiographs, compared with computed tomography, in thediagnosis of acute traumatic spinal fracture. MATERIALS AND METHODS: Forty-six patients (total 64 cases) withacute traumatic spinal fracture were studied using plain radiographs and computed tomography. Fracture site andtype (according to the three-column theory), classification as major or minor injury, stability of fracture, andthe presence of associated soft tissue change were evaluated on plain radiographs and CT. The results of the twoimaging techniques were compared. RESULTS: Excluding eight cases of C1 and C2 fractures, 41 cases involvedfractures of the vertebral body, and 15 involved only the posterior column. Plain radiographs and CT showed,respectively, 27 and 25 cases of simple compression fracture, 13 and 16 of bursting fracture. One case ofcompression fracture was not detected on plain radiographs. The results of classification as major (43/56) orminor (13/56) injury were equivalent on plain and CT films. For the evalvation of unstable fracture, plainradiographs were superior to CT(stable fracture, 46/64; unstable fracture, 18/64), while for the evaluation ofsoft tissue change, CT was better than plain radiographs. CONCLUSION: If correct procedures are meticulouslyadhered to, plain radiographs of acute traumatic spinal injury provide good information for the diagnosis oftraumatic fracture.