ABSTRACT
The purpose of this research was to evaluate two sources of error in the performance of computerized tomography (CT) and magnetic resonance imaging (MRI) of the abdomen/pelvis. The sources of error assessed were inter- and intra-observer reliability. Thirty abdomen/pelvis CT scans were randomly selected from each of three hospitals (university, VA, military) with different CT scanners. Two radiologists were recruited from each site to be CT observers. Forty-five abdomen/pelvis MRI scans were randomly selected from two institutions with different MRI scanners. Four observers were recruited to read the MRI scans. All scans were read blind without clinical information or patient identification. Overall inter-observer and intra-observer diagnostic agreement was significantly higher for MRI compared to CT. Inter-observer diagnostic agreement rates were also significantly higher for MRI when the etiologies of neoplastic vascular and metabolic/toxic were assigned. Observer experience in CT (range: 5-9 yr) or MRI (range: 2-4 yr) was not statistically associated with improved diagnostic agreement. This research addresses many of the criticisms of the MRI literature and compares MRI favorably to CT.
Subject(s)
Abdomen/pathology , Magnetic Resonance Imaging/statistics & numerical data , Pelvis/pathology , Tomography, X-Ray Computed/statistics & numerical data , Diagnosis , Disease/etiology , Hospitals, Military , Hospitals, University , Hospitals, Veterans , Humans , Observer Variation , Pelvis/diagnostic imaging , Radiography, Abdominal , Reproducibility of ResultsABSTRACT
Ten out of 40 near-term neonates on extracorporeal membrane oxygenation (ECMO) therapy developed abnormal neurosonograms. We identified two abnormal patterns. Hyperechoic areas of intracranial hemorrhage were observed in two patients (a significantly lower incidence than previously reported). Diffuse or focal echogenic areas of hypoxia-ischemia resulting from periventricular leukomalacia, cerebral edema or large vessel infarction had not previously been noted in nine of these patients. Three of the ten patients survived with neurological sequelae. Recognition of hemorrhage or a hypoxic-ischemic pattern should serve as a warning to initiate or accelerate the weaning of infants from ECMO.
Subject(s)
Brain Diseases/diagnosis , Cerebral Hemorrhage/diagnosis , Extracorporeal Circulation/adverse effects , Oxygenators, Membrane/adverse effects , Ultrasonography , Brain Diseases/etiology , Brain Edema/diagnosis , Brain Edema/etiology , Cerebral Hemorrhage/etiology , Cerebral Infarction/diagnosis , Cerebral Infarction/etiology , Female , Humans , Infant, Newborn , Leukomalacia, Periventricular/diagnosis , Leukomalacia, Periventricular/etiology , MaleABSTRACT
A case of malignant rhabdoid tumor of the spine and a description of its CT findings are presented. The CT demonstrated a heterogeneous contrast enhancing epidural mass associated with severe bony destruction of the adjacent vertebra and cord compression.
Subject(s)
Rhabdomyosarcoma/surgery , Spinal Neoplasms/surgery , Thoracic Neoplasms , Adolescent , Humans , Male , Rhabdomyosarcoma/complications , Rhabdomyosarcoma/ultrastructure , Spinal Cord Compression/etiology , Spinal Fusion , Spinal Neoplasms/complications , Spinal Neoplasms/ultrastructureABSTRACT
The use of embolization for control of hemorrhage following blunt trauma is well accepted in the adult population. This paper describes 2 cases in which embolization techniques were used successfully to control hemorrhage following blunt trauma in pediatric patients.
Subject(s)
Embolization, Therapeutic/methods , Hemorrhage/therapy , Hepatic Artery/injuries , Kidney/injuries , Wounds, Nonpenetrating/complications , Abdominal Injuries/complications , Adolescent , Angiography , Child , Female , Hematoma/diagnostic imaging , Hematoma/therapy , Hemorrhage/etiology , Hepatic Artery/diagnostic imaging , Humans , Kidney/diagnostic imaging , Tomography, X-Ray ComputedABSTRACT
A patient with a sacrococcygeal malignant germ cell tumor developed epidural spinal cord compression syndrome 32 days after surgical resection of tumor. Rapid resolution of symptoms was observed after chemotherapy with vinblastine, bleomycin, and cisplatinum. There was no radiation therapy or laminectomy for spinal compression. The patient had an excellent neurological recovery without any sequelae from spinal compression. Chemotherapy alone is an excellent approach to the management of epidural compression by malignant germ tumor.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Neoplasms, Germ Cell and Embryonal/drug therapy , Spinal Cord Compression/drug therapy , Humans , Infant , Male , Neoplasms, Germ Cell and Embryonal/complications , Sacrococcygeal Region , Spinal Cord Compression/etiologyABSTRACT
Duplex sonography and intravenous digital subtraction angiography (DSA) were compared in 102 carotid bifurcations in 51 patients. Sonograms were adequate in 87 (85%) vessels and angiograms were adequate on at least one view in 86 (84%) vessels. An adequate image was obtained by one or the other method in all but two vessels (98%). Although most vessels were seen well on one view only on DSA, agreement with sonography was exact in 73% of compared vessels and acceptable in 96%. Furthermore, no difference was found in the rate of agreement with sonography for vessels seen well by DSA on two or more views compared with those seen well on one view only. It was concluded that DSA and sonography are comparable screening methods for carotid disease and that a suboptimal study by either can usually be compensated for by performance of the other.
Subject(s)
Carotid Artery Diseases/diagnosis , Cerebral Angiography/methods , Intracranial Arteriosclerosis/diagnosis , Ultrasonography , Carotid Artery Diseases/diagnostic imaging , Humans , Intracranial Arteriosclerosis/diagnostic imaging , Subtraction TechniqueABSTRACT
Digital subtraction angiography (DSA), with its rapid imaging rate (30 video frames per second) and immediately available subtraction images, provides excellent vascular detail in localization of the exact site of internal carotid-cavernous fistula. In a patient with two fistulas, we successfully used DSA to determine the sites of fistula and accurately positioned detachable balloons to occlude them.
Subject(s)
Angiography/methods , Arteriovenous Fistula/diagnostic imaging , Carotid Artery Diseases/diagnostic imaging , Cavernous Sinus/diagnostic imaging , Subtraction Technique , Adult , Arteriovenous Fistula/therapy , Carotid Artery Diseases/therapy , Computers , Contrast Media/administration & dosage , Embolization, Therapeutic , Female , Humans , Injections, Intra-ArterialABSTRACT
Percutaneous transluminal angioplasty was performed successfully in three patients with total occlusions involving the iliac artery. Two patients had occlusion of the external iliac artery and the third patient had occlusion of the common iliac artery. The vessels were still patent at 3-12 months after the procedure. One complication occurred involving a thrombus in the common femoral artery of the diseased leg. The thrombus was surgically removed under local anesthesia. In high-risk patients, percutaneous transluminal angioplasty of total iliac artery occlusions may represent a viable alternative to surgery.
