Acute ischemic infarction defined by a region of multiple hypointense vessels on gradient-echo T2* MR imaging at 3T.

BACKGROUND AND PURPOSE: During the hyperacute phase of stroke, multiple hypointense vessels were identified specifically in the ischemic territory on gradient-echo T2*-weighted MR images (GRE-T2* WI) at 3T. The area was named a "region of multiple hypointense vessels (RMHV)." The aim of this study was to assess the usefulness of RMHV for the diagnosis of acute ischemic stroke (AIS) and to establish the relationship of this finding to other MR imaging studies. MATERIALS AND METHODS: Twenty patients with AIS underwent MR imaging at 3T consisting of GRE-T2*, diffusion-weighted images (DWI), and perfusion-weighted images (PWI) within 6 hours of symptom onset and follow-up images at 72 hours. RMHV was defined as an area containing multiple hypointense vessels strictly in the region of the ischemic territory on GRE-T2*. The RMHV volume on GRE-T2*, initial ischemic lesion volumes on DWI, PWI maps, and on follow-up images were measured and compared with the RMHV volume. RESULTS: RMHV on GRE-T2* was identified in 20 patients. There was no significant difference between the ischemic lesion volumes on mean transit time (247.3 +/- 88.1 mL), time-to-peak (228.6 +/- 88.8 mL), cerebral blood flow (200.6 +/- 89.7 mL), RMHV on GRE-T2* (214.4 +/- 86 mL), and the infarct volume at 72 hours (210.3 +/- 90.4 mL) (P = .975). CONCLUSIONS: RMHV on GRE-T2* can be used as a supportive imaging finding for the diagnosis of hyperacute ischemic stroke. RMHV volume provides information that is in accordance with the infarct volume at 72 hours and the data supplied by PWI.

Evaluation by angiography of the lateral dominance of the drainage of the dural venous sinuses.

Venous drainage dominance of the dural venous sinuses may be defined as the drainage only or mainly into one of the transverse sinuses, as shown by bilateral carotid angiography. The aim of this study was to evaluate the venous drainage dominance in bilateral carotid angiograms of 189 cases retrospectively. Among these cases 41.3% showed drainage mainly to the right side, 37.6% showed equal drainage to each side, 18.5% showed drainage mainly to the left side, 2.1% showed drainage only to the right side and 0.53% showed drainage only to the left side. Cerebral venous drainage dominance is of great importance and should be considered before operations on patients for radical neck dissection, removal of tumors in the neck that invade the internal jugular vein or tumors of the glomus jugulare which may require ligation of the internal jugular vein.

Digital subtraction sialography: technique, advantages and results in 107 cases.

Sialographic examinations with the digital subtraction technique were performed in 107 salivary glands (90 parotid and 17 submandibular) of 99 patients. Diagnostic and technical advantages of the digital imaging and subtraction for sialography were investigated. Superior quality enabled detailed imaging of the entire ductal system. Reduced radiation exposure, short examination time and almost painless examinations with good patient tolerance proved to be the major advantages of digital subtraction sialography as a diagnostic tool.

Management of the limitations in low-speed rotational transluminal angioplasty: technical note.

The low-speed rotational transluminal angioplasty catheter system (ROTACS) is a recently available device for recanalization of occlusions prior to balloon angioplasty. The presence of large collaterals originating just proximal to the occlusion with an acute angle, and insufficient space between the puncture site and the occlusion for placing an introducer sheath are reported to be limitations for ROTACS. To avoid the rotating catheter entering the collateral, we propose a technique to create a pilot inlet on the proximal aspect of the occlusion. This technique was applied successfully in 4 patients. A contralateral approach was used in 3 patients, in whom an ipsilateral access was not possible because of the insufficient space to place an introducer sheath.

Acute appendicitis associated with pneumoperitoneum.

Spontaneous pneumoperitoneum is infrequently encountered as a radiographic finding in association with a perforated appendicitis. This may lead to diagnostic errors, of which every radiologist and surgeon should be aware. We report a case of perforated appendicitis associated with free intraperitoneal gas.