Diffusion tensor imaging in patients with acute onset of neuropsychiatric systemic lupus erythematosus: a prospective study of apparent diffusion coefficient, fractional anisotropy values, and eigenvalues in different regions of the brain.

PURPOSE: To investigate whether apparent diffusion coefficient (ADC), fractional anisotropy (FA), and eigenvalues in neuropsychiatric systemic lupus erythematosus (NPSLE) patients differ from those of healthy controls. MATERIAL AND METHODS: Eight NPSLE patients (aged 23-55 years, mean 42.9 years) and 20 healthy age-matched controls (aged 22-59 years, mean 44.4 years) underwent conventional brain magnetic resonance (MR) and diffusion tensor imaging (DTI). The ADC, FA, principal eigenvalue (lambda parallel), and the corresponding average perpendicular eigenvalue (lambda perpendicular) (=(lambda2+lambda3)/2) were measured in selected regions of normal appearing gray and white matter brain parenchyma. For statistical evaluation of differences between the two groups, a Student's t-test was used. The P value for statistical significance was set to P=0.0025 after Bonferroni correction for multiple measurements. RESULTS: Significantly increased ADC values were demonstrated in normal-appearing areas in the insular cortex (P<0.001), thalamus (P<0.001), and the parietal and frontal white matter (P<0.001 and P<0.001, respectively) in NPSLE patients. Significantly decreased FA values were demonstrated in normal-appearing thalamus (P<0.001), corpus callosum (P=0.002), and in the parietal and frontal white matter (P<0.001 and P<0.001, respectively) in NPSLE patients compared to healthy controls. The lambda perpendicular was significantly higher in several of these regions in NPSLE patients compared to healthy controls. CONCLUSION: Our study demonstrates alterations in normal-appearing gray and white matter brain parenchyma of patients with NPSLE by means of abnormal ADC, FA, and eigenvalues. These alterations may be based on loss of tissue integrity in part due to demyelination. It is possible that DTI in the future could assist in the diagnosis of NPSLE and possibly help to further elucidate the pathogenesis of NPSLE.

Changes in paranasal sinus abnormalities found incidentally on MRI.

Abnormal opacification of paranasal sinuses on brain MRI was studied in 178 consecutive adult patients who underwent two examinations separated by at least 4 months because of suspected neurological disease. Sinus abnormality was present in 79 (44%) patients; in 60% the abnormality involved two or more sinuses and it was bilateral in 51%. The most frequently abnormal sinus was the maxillary (46%), followed by the ethmoid (32%), sphenoid (16%), and frontal sinuses (6%). Interval occurrence or complete resolution of abnormalities was observed in 52% of patients (66% of the sinuses). In the remaining 48% of patients the abnormalities were present on two or more examinations, unchanged or of increased or decreased severity. The most frequent interval changing abnormalities were complete sinus opacification and fluid levels, followed by irregular mucoperiosteal thickening more than 4 mm thick. No polypoid abnormalities (polyps or mucosal cysts) decreased over time.

Value of radiography in the management of possible fishbone ingestion.

A retrospective study was performed on 42 consecutive patients to examine the value of radiography in the management of complaints of fishbone ingestion. All patients underwent an oral examination followed by radiographic examination with plain films, barium swallows, barium and water swallows, and an endoscopic examination. All radiographs were reviewed by two unbiased, experienced radiologists. Of the 7 cases with fishbone found at endoscopic examination, only two (29%) bones were seen by the primary radiologist and 5 (71%) by the reviewing radiologists. Except for one case in which all three radiologists detected a fishbone that passed during the examination, and thereby was not found on endoscopy, no fishbones were found at the radiographic examination that were not seen on the endoscopic examination. Thus, radiography added no valuable information but only delayed the endoscopic examination with ensuing removal of the foreign body, which had to be performed regardless of the outcome of the radiographic examination. Therefore, we suggest that patients with a short history of complaints of fishbone ingestion, ie, 48 hours or less, should first be evaluated with oral and endoscopic examination.