Differentiation between benign and malignant colon tumors using fast dynamic gadolinium-enhanced MR colonography; a feasibility study.

BACKGROUND: Colorectal cancer will present itself as a bowel obstruction in 16-23% of all cases. However, not all obstructing tumors are malignant and the differentiation between a benign and a malignant tumor can be difficult. The purpose of our study was to determine whether fast dynamic gadolinium-enhanced MR imaging combined with MR colonography could be used to differentiate a benign from a malignant obstructing colon tumor. METHODS: Patients with benign colon tumor stenosis, based on diverticulitis, were asked to participate in the study. The same number of patients with verified colorectal cancer was included. Both groups had to be scheduled for surgery to be included. Two blinded observers analyzed the tumors on MR by placing a region of interest in the tumor and a series of parameters were evaluated, e.g. wash-in, wash-out and time-to-peak. RESULTS: 14 patients were included. The wash-in and wash-out rates were significantly different between the benign and malignant tumors, and a clear distinction between benign and malignant disease was therefore possible by looking only at the MR data. Furthermore, MR colography evaluating the rest of the colon past the stenosis was possible with all patients. CONCLUSION: The results showed the feasibility of using fast dynamic gadolinium-enhanced MR imaging to differentiate between benign and malignant colonic tumors. With a high intra-class correlation and significant differences found on independent segments of the tumor, the method appears to be reproducible. Furthermore, the potential is big in performing a full preoperative colon evaluation even in patients with obstructing cancer. TRIAL NUMBER: NCT00114829.

Patient acceptance of MR colonography with improved fecal tagging versus conventional colonoscopy.

OBJECTIVE: Conventional colonoscopy (CC) is the gold standard for colonic examinations. However, patient acceptance is not high. Patient acceptance is influenced by several factors, notably anticipation and experience. This has led to the assumption that patient acceptance would be higher in non-invasive examinations such as MR/CT colonography (MRC/CTC) and perhaps even higher without bowel preparation. The purpose of this study was to evaluate patient acceptance of MRC with fecal tagging versus CC. MATERIALS AND METHODS: In a 14-month period, all patients first-time referred to our department for CC were asked to participate in the study. Two days prior to MRC, patients ingested an oral contrast mixture (barium/ferumoxsil) together with four meals each day. Standard bowel purgation was performed before CC. Before and after MRC and CC a number of questions were addressed. RESULTS: Sixty-four (34 men, 30 women) patients referred for CC participated in the study. 27% had some discomfort ingesting the contrast mixture, and 49% had some discomfort with the bowel purgation. As a future colonic examination preference, 71% preferred MRC, 13% preferred CC and 15% had no preference. If MRC was to be performed with bowel purgation, 75% would prefer MRC, 12% would prefer CC and 12% had no preference. CONCLUSION: This study shows that there is a potential gain in patient acceptance by using MRC for colonic examination, since MRC is considered less painful and less unpleasant than CC. In addition, the results indicate that patients in this study prefer fecal tagging instead of bowel purgation.

Lumbar elastance and resistance to CSF outflow correlated to patency of the cranial subarachnoid space and clinical outcome of endoscopic third ventriculostomy in obstructive hydrocephalus.

OBJECT: The purpose of the present study was to elucidate the value of the lumbar and intraventricular infusion tests in the selection of patients with obstructive hydrocephalus (OH) for endoscopic third ventriculostomy (ETV), and whether the presence of a diminished cranial subarachnoid space was a source of error in the interpretation of the results. METHODS: In 32 consecutive adult patients (15 M, 17 F, mean age: 46 years) with possible treatment-requiring OH, the resistance to cerebrospinal fluid (CSF) outflow (Rout) and elastance was measured with a lumbar infusion test. Eleven of the patients underwent an additional intraventricular infusion test. An ETV was subsequently performed in 20 patients, of whom 11 presented with idiopathic aqueductal stenosis and 9 with other various causes of OH. RESULTS: The presence of a diminished cranial SAS correlated significantly with increased lumbar elastance, but not with lumbar Rout. However, distinctly increased Rout values (>24 mmHg/mL/min, n=4) were only measured in the presence of a diminished cranial SAS. No significant correlation was demonstrated between the clinical outcome of ETV and lumbar elastance or lumbar Rout, although seven out of the eight improving patients with aqueductal stenosis presented normal lumbar Rout values. In patients undergoing both a lumbar and an intraventricular infusion test and improving after ETV (n=6), lumbar elastance was significantly increased compared to the intraventricular elastance. CONCLUSION: A diminished cranial SAS correlates with increased lumbar elastance and may explain the highly increased lumbar Rout values, possibly by impeding the bulk flow from the infusion. The majority of patients improving after ETV and presenting a normal sized cranial SAS presented normal lumbar Rout values. Supplementing the lumbar infusion test with an intraventricular test may help in predicting the outcome of ETV.

Magnetic resonance imaging with liver-specific contrast agent in primary amyloidosis and intrahepatic cholestasis.

Magnetic resonance imaging (MRI) findings in hepatic amyloidosis are not well defined. Here, we report on a patient with renal failure caused by primary amyloidosis (AL type) who developed jaundice. Ultrasound and computed tomography were normal except for some ascites. MRI with oral manganese-containing contrast agent revealed several focal areas without contrast uptake in the hepatocytes and no bile secretion after 8 hours. No extrahepatic bile obstructions were found. Liver biopsy showed severe intraportal, vascular, and parenchymal amyloidosis causing severe cholestasis and atrophy of hepatocytes.

Implementation of MR colonography.

BACKGROUND: MR colonography (MRC) is a promising method of examining the colon, but is limited to a few specialist centres. The purpose of this article was to describe the implementation of MRC with fecal tagging. MATERIALS AND METHODS: Patients referred for conventional colonoscopy (CC) were offered MRC with fecal tagging before CC. Two days before MRC patients ingested an oral contrast agent. Before and after MRC and CC a number of questions were addressed. MR images were rated by a blinded investigator. RESULTS: In 6 months, 30 consecutive patients were included. The median time in the MR suite was 44 min, 23 min for the MRC examination and 9 min for the evaluation. The median time for CC was 32 min. Sixty-six percent of the patients preferred MRC as the future method of examination, 10% preferred CC, 21% had no preferences. Of the oral contrast agents, barium sulphate with ferumoxsil was significantly better than barium sulphate alone. CONCLUSION: The majority of the patients found MRC less unpleasant than CC and a majority would prefer MRC over CC as a future colon examination. MRC also appears to be less time consuming to the patients and medical personnel than CC with post-procedural monitoring.

Magnetic resonance investigation of bone marrow following priming and stem cell mobilization.

PURPOSE: To evaluate application of MRI and magnetic resonance spectroscopy (MRS) to monitor bone marrow cellularity during pretransplant priming with chemotherapy and hematopoietic growth factor (HGF) administration. MATERIALS AND METHODS: A total of 10 lymphoma and myeloma patients, in remission following induction therapy and considered eligible for high-dose therapy and autologous stem cell transplantation, were included in the study. MR investigation was scheduled four times: at study entry, and one, two, and four weeks following priming. Priming with cyclophosphamide and recombinant human granulocyte colony-stimulating factor (rhG-CSF) started the day after study entry. MR parameters studied in a region of interest were as follows: bone marrow intensity on short-time inversion-recovery (STIR) turbo spin-echo (TSE; thus STIRTSE) and on T1-weighted TSE (T1TSE) images, T2 value for fat component, T2 value for water component, water/fat ratio (W/F), T1 value for fat component, and T1 value for water component. RESULTS: The results did not support the hypothesis that hematopoietic expansion quantitated and monitored by MR correlates to the level of mobilized progenitor cells. CONCLUSION: The results indicate that release of stem cells is a more complex phenomenon than hematopoietic expansion and reduction of fat tissue in bone marrow.

Combined MR examination of prostate: is it reliable?

A combination of magnetic resonance (MR) methods (T2-weighted MRI, proton MR spectroscopy, and dynamic contrast enhancement) gives the highest sensitivity and specificity for identification of prostate cancer by MRI. The prostate MR findings of a patient with a congenital cystic disease of seminal vesicle are presented. To our knowledge, this is the only case described in the literature. The MR examination resulted in a false-positive indication of prostate cancer.

Effect of new manganese contrast agent on tissue intensities in human volunteers: comparison of 0.23, 0.6 and 1.5 T MRI, a part of a phase I trial.

To evaluate the effect of a new oral manganese contrast agent (CMC-001) on magnetic resonance imaging (MRI) intensities at different magnetic field strengths. Twelve healthy volunteers underwent abdominal MRI 1 week before and within 2.5-4.5 h after CMC-001 (MnCl(2) and absorption promoters dissolved in water) intake at three different MR scanners of 0.23, 0.6 and 1.5 T. Image contrast and intensity enhancement of liver and pancreas were analysed relatively to muscle and fat intensities. Manganese blood levels were followed for 24 h. Whole-blood manganese concentration levels stayed within the normal range. The liver intensities on T2w images decreased about 10% for the 1/2 contrast dose and about 20% for the full contrast dose independent of the field strength. The liver intensities on T1w images increased more than 30% for 1/2 contrast dose and over 40% for full contrast dose. The maximum T1 enhancement was achieved at the highest field. Pancreas intensities were not affected. Contrast between liver, muscle and fat intensities increased with magnetic field, as well as standard errors of the volunteer-averaged intensities. Oral intake of CMC-001 influences liver intensities and does not affect pancreas intensities at different magnetic field strengths.

Radiographic knee osteoarthritis in floorlayers and carpenters.

OBJECTIVES: The aim of the present study was to examine the relationship between knee-straining work and radiological findings of knee osteoarthritis and to study the relation between radiological findings and self-reported knee complaints and clinical signs of knee osteoarthritis. METHODS: The material consisted of 133 floorlayers, 506 carpenters, and 327 compositors, 26-72 years of age, who had completed a questionnaire and reported no previous knee trauma. A stratified sample of these questionnaire respondents, 50 floorlayers, 51 carpenters, and 49 compositors, were radiologically examined for knee osteoarthritis by 2 radiologists. The X-ray films were independently assessed by 2 radiologists and blinded with respect to knee complaints, trade, and age. RESULTS: The radiological investigation showed estimated prevalences of knee-osteoarthritis (grades 2-4) for 14% of the floorlayers, 8% of the carpenters, and 6% of the compositors (not significantly different). For the subjects > or =50 years of age the estimated prevalences of the combination of radiological grades 2-4 for knee osteoarthritis and knee complaints during the last 12 months were 29% [95% confidence interval (95% CI) 17-44%], 9% (95% CI 1-26%), and 1% (95% CI 1-10%) for the floorlayers, carpenters, and compositors, respectively. Radiological grades 2-4 were mainly found for subjects above the age of 50 years, subjects with knee complaints, and floorlayers. Radiological knee osteoarthritis was positively associated with self-reported knee complaints and with clinical signs of intraarticular and retropatellar crepitation. CONCLUSIONS: The data suggest that work in which a considerable amount of time is spent in knee-straining positions may be a risk factor for the development of knee osteoarthritis above the age of 50 years.

[Subcutaneous cysticercosis and neurocysticercosis]. / Subkutan- og neurocysticerkose.

Two cases, one of subcutaneous cysticercosis and one of neurocysticercosis, are described--both in young women, who had been in Mexico and ex-Yugoslavia, respectively. Neurocysticercosis is the most common neuroparasitosis in the world (and probably the reason for 2/3 of the cases of epilepsy) and as travels to endemic areas and immigration are on the increase, general practitioners should have cysticercosis in mind when treating a patient with subcutaneous noduli or cerebral symptoms.

The limited value of routine chest X-ray in the follow-up of stage II breast cancer.

In 280 patients with stage II breast cancer, chest X-ray was performed at 6 and 12 months and yearly thereafter to the 6th year or until recurrence, another cancer was detected, the patient refused further follow-up or died. Among 1289 scheduled chest X-rays, malignant changes were found in 20 patients, of which only 3 had pulmonary symptoms. In a further 14 patients malignant changes were suspected, but follow-up examinations could not prove malignancy. 26 patients presented within 12 months after the last scheduled X-ray with pulmonary symptoms and a work-up chest X-ray revealed malignant changes. Thus, in only 1.3% of the scheduled X-rays were unsuspected malignant changes diagnosed. Median survival of patients with malignant chest X-rays found at scheduled controls versus between scheduled controls did not differ significantly (P = 0.26). It is concluded that routine chest X-ray is not indicated in patients with stage II breast cancer.