ABSTRACT
Aneurysm of the intrapetrous carotid artery is an extremely rare and potentially serious occurrence that presents diagnostic and therapeutic difficulties. Such aneurysms may follow trauma, atherosclerosis, mastoid surgery or most commonly can represent a developmental abnormality. We present the case of an 18-year-old female with a short history of recurrent left-sided otalgia and epistaxis who underwent successful endovascular balloon entrapment of a left intrapetrous carotid aneurysm.
Subject(s)
Aneurysm/complications , Carotid Artery Diseases/complications , Earache/etiology , Epistaxis/etiology , Adolescent , Aneurysm/therapy , Carotid Artery Diseases/therapy , Carotid Artery, Internal/diagnostic imaging , Female , Humans , Magnetic Resonance Imaging , RadiographyABSTRACT
PURPOSE: Successful management of anal fistulas depends upon accurate assessment of the primary tract and any secondary extensions. Preoperative imaging has, to date, been disappointing. METHODS: A prospective study of 35 patients with a clinical diagnosis of fistula-in-ano was performed comparing magnetic resonance imaging with the independently documented operative findings. Magnetic resonance imaging was also compared with anal endosonography in 20 patients. RESULTS: Magnetic resonance imaging is accurate and demonstrates pathology missed at surgery by experienced coloproctologists. Magnetic resonance imaging is superior to anal endosonography. CONCLUSIONS: Magnetic resonance imaging is advocated as the method of choice when imaging is required for anal fistulas.
Subject(s)
Anus Diseases/diagnosis , Magnetic Resonance Imaging , Rectal Fistula/diagnosis , Adult , Aged , Anus Diseases/diagnostic imaging , Anus Diseases/surgery , Female , Humans , Intraoperative Period , Male , Middle Aged , Preoperative Care , Prospective Studies , Rectal Fistula/diagnostic imaging , Rectal Fistula/surgery , Reproducibility of Results , UltrasonographyABSTRACT
The aim of this study was to document the appearances of fistula-in-ano on magnetic resonance imaging (MRI) and to prospectively evaluate the accuracy of MRI in the pre-operative assessment of anal fistulae. Patients with a clinical diagnosis of fistula-in-ano and awaiting surgery (n = 35) were examined with MRI. The fistulous tracks with their secondary extensions and abscesses are readily seen as low signal on T1-weighted images and high signal areas on STIR images. In order to determine the accuracy of the MRI interpretations, an experienced coloproctologist operated on all 35 patients without the knowledge of the scan interpretations and the findings at surgery were compared with the MRI scan interpretations. Concordance rates between MRI and operative findings were 86% for presence and course of the primary track, 91% for the presence and site of secondary extensions or abscesses and 97% for the presence of horse-shoeing. Although operative findings by an experienced coloproctologist were taken as the gold standard, we have shown that in 9% of our study group, failure of healing was related to pathology missed at surgery which had been documented on pre-operative MRI. It is probable, therefore, that the accuracy of MRI is higher than the figures quoted above. MRI is advocated as the imaging method of choice in the assessment of anal fistulae and its use may lead to a reduction in the recurrence rate due to inaccurate surgical assessment.
Subject(s)
Magnetic Resonance Imaging , Rectal Fistula/diagnosis , Adult , Aged , Evaluation Studies as Topic , Female , Humans , Magnetic Resonance Imaging/methods , Male , Middle Aged , Prospective Studies , Rectal Fistula/classificationABSTRACT
The subtraction method of Des Plantes has been applied to gadolinium enhanced magnetic resonance imaging (GdMR). Using short acquisition times, T1 weighted spin echo pulse sequences are made immediately before and after the intravenous administration of gadolinium DTPA. To avoid moving the patient from the scanning tunnel the venipuncture is made into the dorsum of the foot. The needle is placed in the vein prior to putting the patient into the scanner and is irrigated with saline while the control series is obtained. 42 patients with naso-sinus or skull base tumours have been successfully investigated by this technique and satisfactory subtraction studies are now obtained on all patients other than the claustrophobic. Subtraction GdMR provides the best demonstration of the effects of gadolinium DTPA on the magnetic resonance signal for both normal and abnormal tissues. The signal recorded on the subtraction image is dependent on tissue blood supply and provides a more accurate record of tumour extent than that shown by unsubtracted GdMR scans.
Subject(s)
Brain Neoplasms/diagnosis , Magnetic Resonance Imaging/methods , Paranasal Sinus Neoplasms/diagnosis , Carcinoma, Adenoid Cystic/diagnosis , Carcinoma, Squamous Cell/diagnosis , Gadolinium , Glomus Jugulare Tumor/diagnosis , Humans , Nasopharyngeal Neoplasms/diagnosisABSTRACT
Success of surgery for an anal fistula depends on accurate assessment of the fistula; however, such assessment is technically difficult. We have done a prospective study that determined the accuracy of magnetic resonance imaging (MRI) in demonstrating the course of fistulae, by comparing MRI scan interpretations with subsequent operative findings. 16 patients (mean [range] age 42 [24-66] years) had MRI followed by surgery within a mean of 22 (1-101) days. MRI scan interpretations agreed precisely with independently documented operative findings in 14 of 16 patients. MRI is an accurate method of delineating anal fistulae, and should be considered for patients with difficult fistulae that recur despite skilled attention because it demonstrates abnormalities that might otherwise be missed.
Subject(s)
Anus Diseases/diagnosis , Rectal Fistula/diagnosis , Adult , Aged , Anus Diseases/surgery , Female , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Prospective Studies , Rectal Fistula/surgerySubject(s)
Back Pain/etiology , Epidural Neoplasms/complications , Lymphoma, Non-Hodgkin/complications , Military Personnel , Acute Disease , Adult , Epidural Neoplasms/diagnostic imaging , Humans , Lumbar Vertebrae/diagnostic imaging , Lymphoma, Non-Hodgkin/diagnostic imaging , Male , Recurrence , Tomography, X-Ray ComputedABSTRACT
The feasibility of mass population screening for breast cancer by clinical examination and x-ray mammography was studied. The results indicate that such a programme could be conducted effectively by non-medical staff and be safe from the dangers of irradiation. The response rate of women invited for screening suggests that such a service is acceptable to the general public. The additional work load produced by screening would not overburden the existing surgical services.
Subject(s)
Breast Neoplasms/prevention & control , Mass Screening , Aged , Biopsy , Breast Neoplasms/diagnostic imaging , Breast Neoplasms/pathology , Female , Humans , Mammography , Middle Aged , Palpation , Radiation Dosage , Social ClassABSTRACT
The D.H.S.S. is supporting research in several centres to determine the feasibility of establishing a nationwide Breast Cancer Screening Programme. This paper answers the questions "What is the radiation dose produced by mammography, and is it safe?". In the context of well-women screening surveys a maximum skin dose of 2 R has been recommended. The variation of dose across the breast surface is recorded and the reasons for this enumerated. The lowest mean dose recorded with industrial quality film was 4-9 R, so that such fine-grain film cannot be used for this purpose. Doses within the recommended safety limit are achieved by the use of vacuum-packed film-screen combinations. The new rare-earth phosphor screens produce the lowest dose (0-2 R). There was no significant gonad dose. It is concluded that mammographic examination of well-women can be performed at safe radiation levels.
