Comparison of retinal nerve fiber layer measurements between NTG and HTG using GDx-vCC.

PURPOSE: To compare quantitative polarimetric measurements in eyes with NTG and HTG using GDx-VCC. Both groups were matched by age and glaucoma stage based on the Humphrey visual field test. METHODS: We retrospectively reviewed the records of 146 patients who underwent Humphrey field analysis (HFA) and GDx-VCC. We compared outcomes of retinal nerve fiber layer (RNFL) parameters among the three groups by ANOVA and between each pair of groups using the Tukey-Kramer Post-Hoc test. We also evaluated the sensitivity and specificity of GDx-VCC in detecting glaucoma in each group. RESULTS: The mean age and HFA mean deviation (MD) were 55.6 +/- 9.5 years and -0.8 +/- 1.5 dB in 47 control patients, 59.4 +/- 9.0 years and -5.77 +/- 4.38 dB in 49 NTG patients, and 59.4 +/- 11.7 years and -8.09 +/- 6.77 dB in 51 HTG patients, respectively. All thickness parameters were lower in HTG patients compared to NTG patients, but there were no significant differences in ratio parameters between age-matched early HTG and NTG patients. The sensitivity of GDx-VCC was significantly higher in both early and total HTG patients compared to the respective groups of NTG patients. CONCLUSIONS: Compared to eyes with NTG, eyes with HTG showed reduced RNFL thickness and ratio parameters when patients were age and visual field matched. GDx-VCC appeared to be more sensitive in detecting RNFL damage in HTG patients.

CT differentiation of pneumonic-type bronchioloalveolar cell carcinoma and infectious pneumonia.

The objective was to analyse the potential of CT to distinguish pneumonic-type bronchioloalveolar cell carcinoma (BAC) from infectious pneumonia. The study consisted of 21 patients with pathologically proven BAC and 30 patients with infectious pneumonia. Both groups of patients had patchy or diffuse consolidation of more than half the area of a lobe or lobes on CT. CT findings in these two groups were compared with regard to morphological appearance, including CT angiogram, air bronchogram, mucous bronchogram, contrast enhancement pattern, pseudocavitation, cavity with air-fluid level, location, satellite lesion, ground-glass opacity and bulging of the interlobar fissure. Air-filled bronchi were morphologically analysed as dilatation, stretching, sweeping, widening of the branching angle, squeezing and crowding. Lymphadenopathy and pleural effusion were also analysed. CT findings favouring the diagnosis of BAC included an air-filled bronchus within the consolidation with stretching, squeezing, sweeping, widening of the branching angle and bulging of the interlobar fissure (p<0.05). It is concluded that CT may be helpful in differentiating pneumonic-type BAC from infectious pneumonia if the air-filled bronchus within the consolidation shows stretching, squeezing, widening of the branching angle or bulging of the interlobar fissure.

N-butyl-2-cyanoacrylate pulmonary embolism after endoscopic injection sclerotherapy for gastric variceal bleeding.

PURPOSE: The purpose of this work was to describe the radiologic and clinical manifestations of n-butyl-2-cyanoacrylate pulmonary embolism (PE) after endoscopic injection sclerotherapy (EIS) for gastric variceal bleeding. METHOD: From 1992 to 1999, the medical records of 140 patients who had undergone EIS using n-butyl-2-cyanoacrylate were reviewed for identification of respiratory symptoms and amount of injection, and their pre- and postprocedure chest radiographs were reviewed to identify PE. In patients with PE, pre- and postprocedure chest radiographs (6/6), chest CT scans (3/6), lung perfusion scans (3/6), and follow-up chest radiographs (6/6) were analyzed retrospectively. RESULTS: Radiographically evident PE was observed in 6 (4.3%) of 140 patients. In comparison with patients without emboli, these patients received a higher mean volume of injection (4.2 vs. 1.8 ml) (p = 0.0011). Four of the six patients with pulmonary emboli had respiratory symptoms. Chest radiographs and CT scans showed unusual tubular or nodular, radiopaque pulmonary emboli along the pulmonary vessels. Multiple peripheral, wedge-shaped, subsegmental perfusion defects were seen on perfusion lung scans. In five of six patients, the radiographic abnormalities showed complete or partial resolution. There were no fatalities directly associated with PE. CONCLUSION: Radiographically evident PEs are uncommonly observed following EIS and appear to be more common in patients receiving a higher volume of liquid acrylate. Affected patients were either mildly symptomatic or asymptomatic, and there were no direct fatalities of this complication.

Mediastinal lymphadenopathy in pulmonary fibrosis: correlation with disease severity.

OBJECTIVE: To evaluate the relationship between mediastinal lymph node enlargement and disease severity score in patients with pulmonary fibrosis. MATERIALS AND METHODS: A retrospective study included 30 patients with pulmonary fibrosis: idiopathic pulmonary fibrosis (n = 25), usual interstitial pneumonia (UIP) associated with collagen vascular disease (n = 4), and UIP associated with hepatitis C (n = 1). Disease severity was determined by a computed tomography (CT) scoring system. Each patient's lobe was scored by two radiologists on a scale of 0-5 for both ground glass opacity (GGO) and fibrosis. The presence, number, and sites of enlarged nodes (short axis > or = 10 mm) were assessed. CT severity scores were compared with total number of enlarged lymph nodes (L/Ns) and short axis diameter of the largest L/N (LLN). According to each severity score, patients were divided into two groups: the GGO-predominant group (n = 10) and the fibrosis-predominant group (n = 20). Total numbers of enlarged L/Ns and short axis diameter of LLN were compared in each group. RESULTS: Enlarged mediastinal L/Ns were present in 86%. Total severity score, GGO score, and fibrosis score strongly correlated with total number of enlarged L/Ns (p<0.05). Total severity score and GGO score correlated well with short axis diameter of LLN; however, the fibrosis score did not correlate with the short axis diameter of LLN. In respect to total number of enlarged L/Ns, the difference between the GGO group and fibrosis group was not apparent. In respect to the short axis diameter of LLN, the GGO group LLN was larger in diameter than the fibrosis group LLN (p<0.05). CONCLUSION: The greater the severity score of pulmonary fibrosis, the larger the total number of enlarged L/Ns. Those patients with more GGO had larger lymph nodes.

The value of CT-guided percutaneous needle aspiration in immunocompromised patients with suspected pulmonary infection.

OBJECTIVE: We evaluated the diagnostic efficacy of CT-guided percutaneous needle aspiration in immunocompromised patients with suspected pulmonary infection. SUBJECTS AND METHODS: We reviewed the findings and yields of 24 CT-guided percutaneous needle aspirations in 21 immunocompromised patients. Cytologic evaluation and culture for aerobes, anaerobes, Mycobacterium species, and fungus were performed in all aspirates. RESULTS: We identified one or more etiologic microorganisms in 19 (79.2%) of 24 CT-guided percutaneous needle aspirations. Of 19 aspirates with positive findings, single causal microorganisms were identified in 18. Staphylococcus aureus was found in four aspirates, and Aspergillus fumigatus in seven; these microorganisms were the principal bacterial (4/11) and fungal (7/9) causative organisms. One of the 19 aspirates with positive findings yielded two microorganisms. In the remaining five aspirates, no microorganisms were identified and cytologic examination revealed nonspecific inflammatory cells. No major complications were observed during or after the procedure. CONCLUSION: CT-guided percutaneous needle aspiration is a safe and useful diagnostic method for the identification of specific microorganisms in immunocompromised patients with suspected pulmonary infection.

MR characteristics of progressive massive fibrosis.

This study was performed to evaluate the static and dynamic magnetic resonance imaging (MRI) contrast enhancement pattern of progressive massive fibrosis (PMF) in coal workers' pneumoconiosis. Eighteen lesions in 12 patients were evaluated using a 1.5-T MR unit. T1-weighted FLASH images were obtained before and 0.5, 1, 2, 3, 4, 5, 7.5, 10, 12.5, and 15 minutes after injection of gadolinium diethylenetriamine penta-acetic acid (Gd-DTPA; 0.1 mmol/kg). Imaging findings, the contrast enhancing pattern, enhancement time curve, and the contrast uptake equivalent (CE; mmol/L) were evaluated. On T1-weighted images, 14 lesions showed high signal intensity, and four showed low signal intensity. On T2-weighted images, all lesions were of low signal intensity and were indistinguishable from aerated lung parenchyma. After contrast infusion, all lesions except two enhanced markedly. The time enhancement curve showed a marked, gradual increase in signal intensity up to 3 minutes, a subtle increase in signal intensity up to 7.5 minutes, and then a plateau until 15 minutes after Gd-DTPA injection. Characteristic MR findings of PMF in coal workers' pneumoconiosis include T1 high signal intensity, T2 low signal intensity, and marked postinfusion enhancement. The time enhancement curve shows a marked, gradual increase of signal intensity up to 3 minutes and plateau up to 15 minutes.

Teratoma with malignant transformation in the anterior mediastinum: a case report.

Malignant transformation of teratoma in the anterior mediastinum is rare; the mass usually has a long history and is seen in older patients. We report a case of teratoma with malignant transformation in the anterior mediastinum, complicated by rupture. CT revealed a lobulated, inhomogeneous cystic mass with a fat component and wall calcifications. The lateral wall was disrupted and consolidation in the adjacent left upper lobe was noted, suggesting rupture. A heterogeneously enhanced solid portion, obliterating the fat plane between the mass and the great vessels was present in the medial aspect of the mass, and pathologic examination demonstrated the presence of adenocarcinoma.

Cervical thymic cyst in the elderly: a case report.

Cervical thymic cyst is uncommon and usually occurs in the first and second decades. Cervical thymic cyst after the third decade is so rare that it is very difficult to diagnose in spite of its typical location. We present a rare case of cervical thymic cyst in the lower left - anterior of the neck in a 50-year-old woman. It showed well-defined, anechoic cyst on ultrasonography and non-enhancing low attenuation mass on CT. A typical anatomic relationship was noted between the mass and carotid sheath.

Malignant ectopic thymoma in the neck: a case report.

We report a case of malignant ectopic thymoma in the neck. Contrast-enhanced CT of the neck showed a well-defined inhomogeneously enhancing mass in the left jugulodigastric chain. One year after surgery, the mass had metastasized to the tongue base, and CT of the neck showed an ill-defined densely enhancing mass with lymphadenopathy.

Analysis of the factors affecting decentration in photorefractive keratectomy and laser in situ keratomileusis for myopia.

To evaluate the relationship between ablation zone decentration measured by corneal topography and various factors such as sex, age, order of operation, preoperative sedative prescription, ablation diameter and depth, type of procedure (photorefractive keratectomy = PRK, laser in situ keratomileusis = LASIK), and the use of a passive eye tracker, we examined the data of 80 eyes in 50 patients. The patients received PRK (43 eyes in 30 patients) or LASIK (37 eyes in 20 patients), and were followed for 3 months postoperatively. Statistical analysis of the data was performed using t-test, ANOVA and multiple regression analysis. The overall average ablation decentration from the pupil center was 0.43 +/- 0.27 mm, 0.35 +/- 0.22 mm in PRK and 0.47 +/- 0.30 mm in LASIK. Overall 91.3% of patients were decentered less than 0.75 mm and 95.0% were decentered less than 1.00 mm, while 93.9% of patients were decentered less than 0.75 mm in PRK and 88.7% were decentered less than 0.75 mm in LASIK. The most meridional displacement was toward the superonasal quadrant; 46% in PRK and 51% in LASIK. There was less decentration in males, in the 2nd-operated eye, in older age, PRK, in larger ablation diameter, and in shallower ablation depth, but these differences were not statistically significant.

Mucormycosis of the central airways: CT findings in three patients.

Computed tomographic (CT) findings are described in three diabetic patients with central airways mucormycosis. The CT findings of the tracheobronchial mucormycosis include enhancing areas of mural thickening (n = 3), luminal narrowing (n = 3), intramural air (n = 3), low-attenuation nonenhancing bronchial wall thickening (n = 2), and bronchonodal fistula formation (n = 1). These CT features in a diabetic patient should raise a high index of suspicion for tracheobronchial mucormycosis, particularly when typical radiographic features of pulmonary tuberculosis are absent.

Radiological findings in myxoid liposarcoma of the anterior mediastinum.

CT and MR findings of a rare myxoid liposarcoma involving the anterior mediastinum are reported. The mass was a low density lesion with calcific septations and some peripheral frond-like enhancement on CT. MRI showed heterogeneous intermediate to high signal intensity on T1 weighted images and high signal intensity on T2 weighted images. The signal of the mass was not suppressed on fat suppressed images.

CT differentiation of tuberculous peritonitis and peritoneal carcinomatosis.

OBJECTIVE: The purpose of this study was to determine the potential of CT for distinguishing tuberculous peritonitis from peritoneal carcinomatosis in 135 clinically or pathologically proven cases. MATERIALS AND METHODS: Abdominal CT scans in 135 patients of tuberculous peritonitis (n = 42) and peritoneal carcinomatosis (n = 93) with documented omental, mesenteric, or peritoneal pathology were retrospectively reviewed. CT findings were evaluated in each group of patients for the morphologic appearance of mesenteric or omental abnormalities as well as for visualization of the spleen and liver, the lymph nodes, and ascites. Statistical comparisons using multivariate logistic regression analysis were performed to adjust for the differences in CT findings between the two groups. RESULTS: Mesenteric changes were more commonly seen in patients with tuberculous peritonitis (98%) than in patients with peritoneal carcinomatosis (70%) (p < .01). Micronodules (less than 5 mm in diameter) were noted in approximately one half of patients with tuberculous peritonitis or peritoneal carcinomatosis, but macronodules (> or = 5 mm in diameter) were much more frequently seen in patients with tuberculous peritonitis (52%) than in patients with peritoneal carcinomatosis (12%) (p < .01). The omentum appeared to be more irregularly infiltrated in peritoneal carcinomatosis patients (p < .01). The thin omental line covering the infiltrated omentum was seen in 13 patients with tuberculous peritonitis but in only four patients with peritoneal carcinomatosis (p < .01). In peritoneal or extraperitoneal masses in patients with tuberculous peritonitis, a low-density center was seen in 18 cases (43%) and calcification was noted in six cases (14%). The prevalences of splenomegaly and splenic calcification were higher in patients with tuberculous peritonitis. Using multivariate analysis, we calculated the sensitivity of CT for predicting tuberculous peritonitis and peritoneal carcinomatosis as 69% and 91%, respectively. CONCLUSION: Although most CT findings that we analyzed overlap these diseases, using a combination of CT findings increased our ability to distinguish tuberculous peritonitis from peritoneal carcinomatosis.