The effect of antibiotic prophylaxis for acute pelvic inflammatory disease after hysterosalpingography: a retrospective cohort study.

AIMS: Concerns about acute pelvic inflammatory disease (PID) after hysterosalpingography (HSG) have been raised since 1980. However, the effectiveness of prophylactic antibiotics remains unclear. This study investigated the effect of antibiotic prophylaxis in women undergoing HSG. METHODS: Women undergoing HSG between 2000 and 2012 were screened from the Taiwan National Health Insurance Research Database for eligibility. The prophylactic cohort included patients using any antibiotics of 1st-generation cephalosporins, doxycycline, clindamycin, and metronidazole, within 7 days before HSG (n = 3257). Patients not using any antibiotics were registered as the non-prophylactic cohort (n = 4662). An unconditional logistic regression model was applied to calculate the odds ratio (OR) and 95% confidence interval (CI) of acute PID after HSG associated with prophylactic antibiotics. RESULTS: The cumulative incidences of acute PID after HSG were 0.46% and 1.42% in the prophylactic and non-prophylactic cohorts, respectively. Prophylactic patients had a significantly reduced estimated relative risk of acute PID compared with non-prophylactic patients (adjusted OR = 0.33, 95% CI = 0.19-0.58; p = .001). Doxycycline users had the lowest adjusted OR of 0.20 (95% CI = 0.04-0.81; p = .02), followed by users of 1st-generation cephalosporins (adjusted OR = 0.35, 95% CI = 0.18-0.68; p = .002). Multivariate sub-group analysis verified this protective effect for almost all sub-groups of prophylactic patients. CONCLUSIONS: Antibiotic prophylaxis is associated with a decreased estimated relative risk of acute PID in HSG patients. Doxycycline and 1st-generation cephalosporins may be effective prophylactic regimens for HSG.

Multilayer appearance on contrast-enhanced susceptibility-weighted images on patients with brain abscesses: Possible origins and effects of postprocessing.

PURPOSE: To demonstrate the presence of a multilayer appearance of the capsule on contrast-enhanced (CE) susceptibility-weighted imaging (SWI) in patients with pyogenic brain abscesses. Possible origins for the appearance and effects of postprocessing settings are discussed. MATERIALS AND METHODS: Fourteen patients with pyogenic brain abscesses underwent post gadolinium-enhanced SWI at 1.5 T. All SWI images were postprocessed with various filter and mask settings to compare the image appearance. Computer simulations using a paramagnetic spherical shell model were performed to verify the clinical findings. RESULTS: Pyogenic brain abscesses demonstrated a multilayer appearance with a darkened ring within the enhanced capsule on CE-SWI in all patients. The multilayer appearance was slice-orientation-dependent, decreased with larger widths of the high-pass filter, and increased with larger numbers of phase mask multiplication operations, consistently on both simulation results and the clinical images. CONCLUSION: CE-SWI shows the multilayer appearance of the capsule in pyogenic brain abscesses, which may arise from postprocessing procedures originally designed to enhance susceptibility contrast. Although SWI may provide additional information valuable in the diagnosis of pyogenic brain abscesses, image interpretation should be exercised with caution, particularly for CE-SWI.

Intramural blood pools accompanying aortic intramural hematoma: CT appearance and natural course.

PURPOSE: To evaluate multidetector computed tomographic (CT) images to investigate the prevalence, morphology, natural course, and prognostic effect of intramural blood pools (IBPs) in patients with acute intramural hematoma (IMH). MATERIALS AND METHODS: Institutional review board approval and written informed consent were obtained. Sixty-five patients (41 men; mean age, 65.9 years ± 11.3 [standard deviation]) with acute IMH undergoing three or more multidetector CT examinations during follow-up for 12 months or longer (median = 18 months), except for those undergoing surgery (n = 16), were enrolled. Associated factors of developing and resorption of IBP in IMH were analyzed by using logistic regression. RESULTS: There were 40 IBPs in 10 patients at initial multidetector CT, and 15 new IBPs developed in 11 patients during follow-up. IBPs occurred most in the descending thoracic (55% [31 of 56]) and abdominal (41% [23 of 56]) aorta in 28% (18 of 65) of patients. During 33.8 months (range, 2.8-50 months) of follow-up in these 18 patients, 57% (32 of 56) of IBPs showed complete resorption in 15 patients, 29% (16 of 56) of IBPs showed incomplete resorption in eight patients, and 14% (eight of 56) of IBPs had interrupted follow-up because of surgery or death in three patients. Logistic regression showed that age younger than 70 years (odds ratio [OR], 8.74; 95% confidence interval [CI]: 1.03, 76.9) and IMH wall thickness greater than 10 mm (OR, 4.93; 95% CI: 1.04, 23.0) were associated with developing IBP at initial multidetector CT, while IBP with larger transmural diameter (OR, 1.16; 95% CI: 1.02, 1.31) and multidetector CT-demonstrated connection with intercostal or lumbar artery (63% [35 of 56]) (OR, 5.44; 95% CI: 1.43, 20.9) were associated with incomplete resorption. CONCLUSION: IBPs are frequently observed at multidetector CT in patients with IMH. They may resolve over time or appear during follow-up. These findings are not associated with a poor prognosis, and IBPs should be distinguished from ulcerlike projections.

Comparison of real-time three-dimensional gadolinium-enhanced elliptic centric-ordered MR venography and two-dimensional time-of-flight MR venography of the intracranial venous system.

BACKGROUND: To compare 3-dimensional gadolinium-enhanced elliptic centric-ordered (3D GEC) magnetic resonance venography (MRV) with traditional 2-dimensional time-of-flight (2D TOF) MRV for imaging of the intracranial venous system. METHODS: Fifty-three patients underwent 2D and 3D MRV, whereby venous structures were evaluated by 2 neuroradiologists. RESULTS: Of the 53 patients, 10 were diagnosed with dural venous sinus thrombosis and 12 with intracranial tumors. 3D GEC MRV displayed superior sensitivity/specificity (90.9%/96.8%) compared to 2D TOF MRV (63.6%/48.4%). Analysis of the areas under the receiver operating characteristic curves also showed superiority of 3D GEC (0.91) versus 2D TOF (0.53) MRV. Of the remaining 31 healthy patients, the rate of complete visibility of venous structures was also greater for 3D GEC (95.8%) than for 2D TOF (62.1%) MRV. CONCLUSION: 3D GEC MRV is superior to 2D TOF MRV for providing more detail of the intracranial venous system, and can lead to better diagnosis of venous conditions.

Dissection of arteria lusoria by transradial coronary catheterization: a rare complication evaluated by multidetector CT.

An aberrant right subclavian artery (arteria lusoria) arising from the descending thoracic aorta is an uncommon congenital variant that occurs in about 0.2-1.7% of the population. In such cases, the angular course of the arteria lusoria to the ascending aorta imposes difficulty in passing a guide wire to the ascending aorta during right transradial catheterization. Here, we present the first report of an iatrogenic dissection of arteria lusoria during transradial coronary angiography evaluated by multidetector computed tomography. Computed tomography is useful for assessing the severity and extension of the dissection to guide the clinical management of this complication.