Evaluation of renal transit time [RTT] in children with MR urography

To evaluate use of dynamic contrast material-enhanced.magnetic resonance [MR] urdgraphy for measurement, of renal transit time [RTT of a contrast agent through the kidney and collecting system so as to identify obstructive uropathy in children. One hundred twenty-six children suspected of having hydronephrosis were hydrated prior to undergoing both conventional and dynamic contrast-enhanced MR urography of the kidneys and urinary tract. A three-dimensional sequence was used to track passage of contrast agent through the kidneys. Time between the appearance of contrast material in the kidney and its appearance in the ureter at or below the level of the lower pole of the kidney was defined as RTT. Bland-Altman plots were used to quantify intra- and interobserver performance. In 30 children, a nuclear medicine renogram was also obtained, and the half-life of renal signal decay after furosemide administration was derived and compared with the MR imaging RTT by using receiver operating characteristic curves. On the basis of RTT, kidneys were classified as normal [RTT RTT 490 seconds]. Receiver operating characteristic analysis for comparison of results of MR imaging and diuretic renal scintigraphy showed.good agreement between the modalities, with a mean area under the curve of 0.90. When used in conjunction with morphologic images obtained in the same, examination, RTT generally allowed normal kidneys to be differentiated from obstructed and partially obstructed kidneys

CT and MR imaging of carpal tunnel syndrome [CTS]

This study was undertaken to determine whether objective structural findings exist on CT and MR images that will permit [a] localization of the source of neurobogic findings to an entrapment of the median nerve in the carpal tunnel, [b] determination of the cause of CTS, and [c] identification of the cause of treatment failure. The CT [n = 18] and MR imaging [n = 18] Eighteen wrists in 13 no selected consecutive patients with clinical symptoms of carpal tunnel syndrome were studied over a 1-year period. Eight patients were women and five were men. They ranged in age from 25 to 54 years, with a mean age of 37 years. In four patients the symptoms were bilateral. In the remaining nine subjects with unilateral symptoms, the night hand was symptomatic in six and the left hand in three. All images were reviewed. Among the 18 standard MR imaging studies, compression of the median nerve was evident Diffuse swelling or segmental enlargement of the median nerve demonstrated [usually seen best at the level of the pisiform] [18 wrists]. The median nerve may flatten [usually demonstrated best at the level of the hamate]. Palmar bowing of the flexor retinaculum may be noted [usually demonstrated best at the level of the hamate] [17 wrists].The calcification were found in the floor of carpal tunnel [i.e., the space between the flexor tendons and the carpal bones] [18 wrists], in the carpal bones [17 wrists], in the radiocarpal joint [17 wrists], in the flexor tendons or tendon sheaths [nine wrists], and in the extensor tendons or tendon sheaths [16 wrists], especially the extensor carpi ulnaris. All the tophi manifested low to intermediate signal intensity compared with muscle, often containing small foci of very low signal intensity on T1-weighted spin-echo images Varying degrees of calcification were noted on CT and MR imaging studies. Gadolinium-enhanced MR studies showed heterogeneous enhancement. Is useful for its ability to display and evaluate the cross-sectional volume of the carpal tunnel and for detecting subtle calcification in the tendons within the canal. CT also provides an excellent tool for evaluating the carnal bones through multiplanar and 3- dimensional reconstructions but CT is limited in its ability to visualize the median nerve and tendons of the carpal tunnel well enough to allow definitive differential diagnoses to be rendered. Therefore, MRI is the best method of visualizing the soft tissues of the carpal tunnel

Complementary imaging of breast lesions contribution of mammography, ultrasonography, fine-needle aspiration biopsy, and MR imaging

Breast cancer is the second most common cancer in the women. Fifty patients with suspected breast mass lesion [40 palpable and 10 nonpalpable] were included in this study. Both mammography and MRI [Plain and Contrast enhanced] were performed in every patient. Ultrasonography and galactorgraphy were performed in few patients whenever required. Following this, fine needle aspiration of the breast mass was done and the materials were studied cytopathologically. For nonpalpable lesions sensitivity of mammography and MRI was 65% and 90%, while the specificity was 25% and 50% respectively. For palpable lesions both methods showed high sensitivity [Mammography 90% and MRI 95%] and MRI demonstrated comparatively higher specificity [Mammography 30% and MRI 50%]. In two mammographically negative patients MRI showed positive result. With the complementary use of MRI, it is possible to increase the sensitivity for detection of breast cancer and multicentric disease. In patients in whom the status of a palpable breast mass remains unclear but where strong clinical suspicion exists, MRI may help to reduce the amount of unnecessary biopsies. This study aimed to assess the value of B-mode, nonenhanced and enhanced power Doppler ultrasonography [US], fine-needle aspiration biopsy [FNAB] and magnetic resonance [MR] imaging as adjunctive tools in breast diagnostics

Evaluation of benign salivary gland disorders comparative study of MR sialography and digital subtraction sialography

To evaluate the accuracy of magnetic resonance [MR] sialography in detecting salivary glandular calculi and ductal stenosis. MR sialography has become an alternative imaging technique for ductal salivary gland diseases. We compared the diagnostic accuracy of MR sialography and digital subtraction sialography in patients with benign salivary gland disorders. In our study, we attempted to examine salivary glands in 65 patients with clinically suspected diagnoses of sialadenitis and/or sialolithiasis. Each patient underwent digital subtraction sialography and MR sialography. MR sialography was obtained with a T2-weighted single-shot turbo spin-echo sequence [TR/TE 2800/1100 msec, acquisition time 7 seconds], with use of a quadrature head coil. Final diagnoses were confirmed by clinical follow-up and results of biopsy [n = 9] or surgery [n = 19]. Eighty-one salivary glands [48 parotid, 33 submandibular] in 65 patients were successfully visualized with both modalities. MR sialography depicted the main ductal system and first- and second-order branches, whereas digital subtraction sialography was able to depict third-order branches. Sensitivity and specificity to diagnose chronic sialadenitis were 70% and 98% with MR and 96% and 100% with digital subtraction sialography. MR sialography enabled diagnosis of sialolithiasis with a sensitivity of 80% and a specificity of 98% versus 90% and 98% for each with digital subtraction sialography. MR sialography with a heavily T2-weighted sequence is highly successful in the noninvasive visualization of the ductal system of major salivary glands. It is useful for diagnosing sialolithiasis and sialadenitis. Digital subtraction sialography, an invasive technique, had a substantial procedural failure rate, particularly for the submandibular duct. However, because of its higher spatial resolution, successfully completed digital subtraction sialography achieved superior diagnostic information compared with that of MR sialography

Comparison of MR enteroclysis images and conventional enteroclysis in small-bowel disease

To investigate if magnetic resonance [MR] enteroclysis can be performed routinely and to compare MR enteroclysis findings with those of conventional enteroclysis. MR enteroclysis was performed in 30 patients with symptoms of inflammatory bowel disease or small-bowel obstruction [SBO]. A methylcellulose-water solution was used to distend the small bowel. To monitor dynamic changes in the small bowel, a single-shot fast spin-echo T2-weighted sequence was applied. For morphologic assessment, breath-hold T2-weighted fast spin-echo and coronal T1-weighted gradient-recalled-echo MR images were obtained without and with gadolinium enhancement. Image quality and degree of small-bowel distention were graded. MR imaging findings and degree of SBO were compared with findings at conventional enteroclysis [n = 25]. MR enteroclysis was well tolerated and provided adequate image quality and sufficient small-bowel distention. SBO grade based on MR enteroclysis images [n = 10] was identical to that based on conventional enteroclysis images [n = 6]. MR findings were identical to those at enteroclysis in 23 patients, superior in six patients, and inferior in one patient. MR enteroclysis can be performed routinely with adequate image quality and sufficient small-bowel distention. The functional information provided by MR enteroclysis is identical to that provided at conventional enteroclysis

Diagnosing of parotid gland masses with ultrasonography-guided core-needle biopsy [USCNB]

An accurate diagnosis of a parotid gland mass is essential for adequate management. We determined the clinical efficacy of ultrasound-guided core needle biopsy [USCNB] in diagnosing parotid gland masses by using cutting needles of different bores. We reviewed records for 40 benign and 13 malignant parotid lesions. Ultrasound-guided core needle biopsy [USCNB] was performed by using 14-20-gauge needles [mean, 16.6 gauge] with one to five [mean, 2.43] passes and a 15-mm throw or specimen notch. Final diagnoses were established on the basis of surgicopathologic results in 31 cases, and on the basis of histopathologic analysis of biopsy specimens, clinical data, and/or imaging studies in 22, with a follow-up of 12.2-77.5 months [mean, 33.6 months]. Compared with surgicopathology, USCNB had a sensitivity of 83%, a specificity of 100%, and an accuracy of 97% in providing specific tissue diagnoses and in differentiating malignant from benign masses. Its positive and negative predictive values were 100% and 96%, respectively, in diagnosing malignancy. One patient [2%] had a local hematoma without sequela after surgical removal of a Warthin tumor. Core biopsy results were completely concordant with surgical findings in 30 [97%] of 31 cases. USCNB is a safe and efficient diagnostic procedure with an accuracy of 97% in the pathologic diagnosis of parotid masses. It can be performed in an outpatient clinic and enables specific tissue diagnosis to obviate intraoperative frozen biopsy and unnecessary surgery. An 18-gauge needle is sufficient for accurate and specific tissue diagnosis of parotid masses

Role of magnetic resonance imaging in early detection of nasopharyngeal carcinoma

The aim of the study was to determine whether MR imaging has the potential to replace invasive Endoscopic guided biopsy [EGB] in patients with suspected nasopharyngeal carcinoma [NPC]. Data from 2 groups of patients was reviewed, group 1 with proved NPC for MR staging [n = 465] and group 2 with suspected NPC [n = 77]. In group 1, which included 118 of 456 [26%] with stage 1 disease, cancer was detected in all patients. In group 2, MR imaging was negative for NPC in 70 [91%] patients, MR imaging was positive for NPC in 7 [9%] patients and NPC was confirmed by biopsy in 3 [4%]. Two of these 3 patients had undergone negative endoscopy and biopsy before the MR imaging. NPC was not present in the remaining 4 patients, 2 of whom were found to have lymphoid hyperplasia. MR imaging has the potential to screen healthy patients who do not require EGB and direct the site of biopsy in small cancers that may be missed by endoscopy

Blood-flow volume quantification in internal carotid and vertebral arteries: using of 3 different ultrasound techniques - comparison with phase-contrast MR imaging

Optimal estimation cerebral blood-flow volume [BFV] may be an important indicator for better evaluation of the patients with cerebrovascular disorders. In this study, we compared the BFV values at bilateral internal carotid and vertebral arteries of healthy volunteers obtained with color Doppler, power Doppler, and B-flow ultrasound [US] studies and tried to determine which examination is more correlated with MR phase-contrast quantification. BFVs of the internal carotid and vertebral arteries of 40 healthy volunteers [19 men and 21 women; age range, 20-47 years] were measured by using color Doppler, power Doppler, B-flow US and MR phase-contrast imaging. The flow measurements obtained with the sonographic techniques were compared with MR phase contrast, which is accepted as the most reliable method for the estimation of cerebral BFV. Quantification with power Doppler imaging showed the highest values among sonography techniques, followed by color Doppler imaging, B-flow imaging [BFI], and MR phase-contrast flow quantification. There was a statistically significant difference between the flow-volume values obtained with these 4 different techniques [P < .05]. BFI yielded the closest values [internal carotid arteries, 238.84 mL/min; vertebral arteries, 51.16 mL/min] to MR phase-contrast flow quantification study with higher correlation rates. Flow volumes obtained with BFI showed the highest correlation with MR phase-contrast imaging among 3 different sonographic techniques. B-flow sonography may be a very effective and cost-efficient alternative for MR phase-contrast studies for the calculation of cerebral BFV

Role of helical computed tomography and duplex sonography in evaluation of the lower extremity veins in patients with suspected pulmonary embolism

The purpose of this study was to evaluate the role of gray scale and color Doppler appearances and applications of Helical CT in evaluation of patients with suspected venous thromboembolic disease. In patients undergoing a combined CT angiography and venography, the accuracy of helical CT venography for the detection of deep venous thrombosis was compared with that of lower extremity Duplex sonography. Seventy consecutive patients with clinically suspected pulmonary embolism underwent both combined CT angiography and venography and bilateral leg sonography within 24 hr. The final reports were evaluated for the presence or absence of deep venous thrombosis and the final assessment based on multiple subjective and objective clinical and imaging criteria was recorded in three categories: 1, CT venography better than sonography; 2, CT venography equivalent to sonography; and 3, sonography better than CT venography. Sixty-eight patients [97%] had a satisfactory or good quality CT venography examination. Two CT venography studies had false-positive findings due to flow artifacts. Both CT venography and sonography had positive findings for deep venous thrombosis in five patients, and both had negative findings in 63 patients. CT venography was better and more efficacious than sonography [category 1] in 25 patients [36%]. CT venography was equivalent to sonography [category 2] in 26 patients [37%], and sonography was better than CT venography [category 3] in 19 patients [27%]. Compared with sonography, CT venography is a relatively accurate method for evaluation of deep venous thrombosis. Combined CT pulmonary angiography and CT venography may be more efficacious than, sonography and CT

Relationship between transcranial doppler and CT data in acute CT intracerebral hemorrhage

It would be useful to have a noninvasive test for correlation with CT findings in patients with intracerebral hemorrhage [ICH]. We determined which transcranial Doppler [TCD] variables are related to CT data in patients with ICH. We included 51 patients [age +/- SD, 66.2 +/- 12.4 years; 30 men, 21 women] with first-ever supratentorial, nontraumatic ICH. CT and TCD examination were performed in the acute stage [less than 12 hours from symptom onset]. TCD recordings were obtained from the middle cerebral arteries, and the following variables were analyzed: systolic [Vs], diastolic [Vd], mean [Vm] velocities, and pulsatiliy index [PI] from the affected [a] and unaffected [u] hemispheres. PIs obtained for both hemispheres were positively correlated with hematoma volume [aPI, r = 0.43, P = .001; uPI, r = 0.44, P = .001], volume of hypoattenuation [aPI r = 0.64, P <.0001; uPI, r = 0.39, P = .005], total volume [aPI, r = 0.59, P <.0001; uPI, r = 0.48, P < .0001], and midline shift [aPI, r = 0.28, P = .04; uPI, r = 0.29, P = .03]. Both PIs were increased in patients with intraventricular hemorrhage [aPI, P = .01; uPl P .004]. No TCD parameter was correlated with ventricular size. Most TCD parameters were correlated with CT data in the acute stage of ICH. An increase in PI probably reflects intracranial hypertension and mass effect. Further studies are needed to determine the clinical application of our findings

effect of pentoxifylline on hepatocyte growth factor and liver functions in cirrhotic patients undergoing splenectomy and decongestion

High morbidity and mortality rates in cirrhotic patients undergoing intraabdominal surgery underscore the need for identifying a therapy that will decrease postoperative hepatic dysfunction and enhance hepatic regenerative activity. Perioperative administration of pentoxifylline [PTX] is suggested to decrease liver fibrosis and enhance hepatic regenerative activity in cirrhotic patients. Hepatocyte growth factor [HGF] is hepatocyte mitogen, that is suggested to play a role in liver regeneration during injury. The aim of this study is to investigate the value of perioperative administration of PTX on reducing liver injury as reflected by changes in serum level of hepatocyte growth factor [HGF], and standard liver functions in cirrhotic patients undergoing Splenectomy and decongestion. 20 adult patients with cirrhotic liver were randomly allocated into two equal groups. Patients in the first group [PTX Gp], received 300 mg i.v. PTX before induction of general anesthesia followed by 100 mg /h PTX in 500 ml glucose 5% infused in 10 hours. Patients in the second group [control Gp], received 15ml i.v. glucose 5% solution before induction of general anesthesia followed by 500 ml glucose 5% infused in 10 hours. All patients' were Child class A. Hepatocyte growth factor increased significantly at postoperative time when it was compared with preoperative value in control group. Liver enzymes SGOT, SGPT, prothrombin activity, total bilirubin, serum albumin, blood urea and creatinine did not significantly change in the studied groups when postoperative values were compared with preoperative ones or when the studied groups were compared with each other. White blood count and platelets increased significantly postoperatively compared with preoperative values in the studied groups. The current study suggested that perioperative administration of PTX could produce hepatocyte protection during intra-abdominal surgery as hepatocyte growth factor did not significantly increase at postoperative time in PTX group meanwhile, it increased significantly at postoperative time compared to preoperative value in control group. It did not influence liver or kidney functions, as SGOT, SGPT, prothrombin activity, serum albumin, total bilirubin as well as blood urea and creatinine did not significantly change postoperatively compared with preoperative values in both studied groups

Radiological approach for pineal region masses

Thirty-two pineal and related tumors were diagnosed by computed tomography [CT] and magnetic resonance imaging [MRI]. Pineal region tumors were classified as germ-cell tumors, glial tumors, pineal parenchymal tumors and cysts. They demonstrated different MR signal characteristics on pre-contrast scans and nodular or ring type enhancement with occasional central lucencies, except for benign cysts which have not shown any enhancement. MR images were useful in defining the relationship of the tumor to the posterior third ventricle, Sylvian aqueduct, vein of Galen and tentorium. Although CT can demonstrate more evident fashion displacement of the original pineal calcification as well as tumor calcifications, MR imaging demonstrates different signal characteristics in germinomas and pineoblastomas which can be a useful adjunct in the evaluation and differential diagnosis of these tumors. There were eight germinomas, four primary pineal tumors, two embryonal cell carcinomas and choriocarcinoma, five teratoma, two primitive neuroectodermal tumor, four astrocytomas, two lipomas, four meningiomas and one pineal cyst

Laparoscopis cholecystectomy: Evaluation with Ultrasonography

To determine the postoperative appearance of the gallbladder bed and the significance of fluid collections after surgery, a routine postoperative scanning with ultrasound of the right upper quadrant was performed for 40 patients 24 hours after laparoscopic cholecystectomy [LC]. The location, volume and appearances of fluid collection were recorded. The maximum diameter of the common bile duct was measured in all patients and compared with the preoperative measurements. The minimal fluid collections were identified in the gallbladder fossa and/or peritoneal cavity in 30 patients. Fluid collections were not associated with fever or elevated white blood cell count. In six patients, the diameter of the common bile duct increased on the postoperative scan. This was not associated with an elevation in alkaline phosphatase or bilirubin levels. Thirty-six patients were discharged in the first postoperative day. So, routine postoperative ultrasound is important in the evaluation of patients who had had laparoscopic cholecystectomy

Early CT diagnosis of brain infarction in normotensive patients

The aim of this work was to evaluate the role of spiral CT in the early diagnosis of brain infarction in normotensive patients. The study included 20 patients clinically suspected to have acute focal central neurological deficit. They were subjected to full clinical examination and non contrast enhanced spiral CT. Initial CT scan was performed within few hours [3: 6] after the onset of the symptoms, followed by second CT scan [24: 30 hours] after the onset of the symptoms. Positive initial CT findings were noted in 18 cases. Spiral CT has proved to have good potential in the early diagnosis of brain infarction