Using three-dimensional rotational angiography for sizing of covered stents.

OBJECTIVE: The purpose of our study was to determine the value of three-dimensional (3D) rotational angiography in the assessment of patients to be treated with covered stents for peripheral arterial aneurysms. CONCLUSION: Our preliminary experience suggests that 3D rotational angiography appears to be a valid tool in the pre- and perprocedural assessment of patients treated endovascularly for arterial aneurysms.

Effect of dose levels on the diagnostic performance of a selenium-based digital chest system.

RATIONALE AND OBJECTIVES: To evaluate the effect of dose reduction on diagnostic performance by using a digital chest imaging system in which amorphous selenium serves as the x-ray detector. METHODS: Two hundred forty-seven patients were examined with the selenium system. Three sets of images were made in each patient: one set with a standard x-ray dose, one set with 55% of the standard dose, and one set with 35% of the standard dose. All 741 images were read by two radiologists. The diagnostic value of each set of images for detection of pulmonary, mediastinal, and pleural pathology was analyzed with receiver operating characteristic (ROC) methodology by using computed tomography as the reference standard. The authors also assessed the effect of sex, height, and weight of the patients on the diagnostic performance of the readers. RESULTS: The areas under the ROC curves for the detection of various abnormalities at 100%, 55%, and 35% of the standard dose for observer 1, respectively, were pulmonary opacities 0.82, 0.83, 0.84; interstitial disease 0.71, 0.70, 0.72; mediastinal disease 0.81, 0.80, 0.77; and pleural abnormalities 0.71, 0.72, 0.72. There were no statistically significant differences between the two observers. CONCLUSIONS: No statistically significant difference was found between the radiologists' performance in detecting abnormalities with standard x-ray dose images and the performance with images made with 55% and 35% of the standard dose. Sex, height, and weight had no influence on diagnostic performance.

Radiological anatomy of the groin region.

The purpose of this paper is to give an overview of the anatomy of the inguinal region, and to discuss the value of various imaging modalities in the diagnosis of groin hernias. After description of the gross anatomy of the groin, attention is focused on the anatomic features of conventional herniography, US, CT, and MRI. Advantages, disadvantages, and accuracy of each technique is discussed briefly.

Detection of groin hernia with physical examination, ultrasound, and MRI compared with laparoscopic findings.

OBJECTIVE: To determine the diagnostic accuracy of physical examination, ultrasound, and dynamic MRI in patients with inguinal hernia. METHODS: In 41 patients with clinically evident herniations, 82 groins were evaluated using a standard ultrasound and MRI protocol, the latter including T1- and T2-weighted sequences as well as two dynamic sequences. All ultrasound examinations and MRI scans were reviewed without knowledge of clinical findings. In all cases, correlation with findings at laparoscopic surgery was made. RESULTS: At surgery, 55 inguinal herniations were found. Physical examination revealed 42 herniations (one false-positive finding), whereas ultrasound made the diagnosis of a hernia in 56 cases (five false-positive and four false-negative findings). MRI diagnosed 53 herniations (one false-positive and three false-negative findings). Thus, sensitivity and specificity figures were 74.5% and 96.3% for physical examination, 92.7% and 81.5% for ultrasound, and 94.5% and 96.3% for MRI. CONCLUSIONS: In patients with clinically uncertain herniations, MRI is a valid diagnostic tool with a high positive predictive value.

Masses and pain in the groin: a review of imaging findings.

The inguinofemoral region is a crossroads of numerous vascular, nervous and muscular structures. As even the most astute clinician can have difficulty in correctly diagnosing the cause of complaints or a mass in the groin and thigh region, radiological investigation is frequently warranted. For the radiologist involved, knowledge of the anatomy and specific pathology of the groin is essential. This paper deals with the imaging characteristics of the various diseases in the inguinofemoral triangle. Furthermore, this article provides an overview of the role of the various imaging modalities in the evaluation of disease in the groin and upper thigh. A sound working knowledge of groin anatomy and pathology is mandatory. The various imaging modalities used should be considered complementary.

Groin hernia: can dynamic magnetic resonance imaging be of help?

This technical note describes the use of dynamic MRI in the diagnosis of groin herniations. A review of the anatomy of the groin is presented and 4 representative cases are described. This paper indicates that dynamic MRI can be used to confirm the diagnosis in patients with clinically evident groin herniations.

Radiologic prevalence of advanced lateral C1-C2 osteoarthritis.

STUDY DESIGN: The lateral C1-C2 (atlantoaxial) joints were evaluated retrospectively in 355 patients referred for radiographs of the paranasal sinuses. OBJECTIVES: To determine the radiologic prevalence of advanced lateral atlantoaxial osteoarthritis. SUMMARY OF BACKGROUND DATA: Previous studies have shown a relation between atlantoaxial osteoarthritis and referred pain in the suboccipital region. However, the radiologic prevalence of this degenerative disorder is unknown. METHODS: Five hundred radiographs of the paranasal sinuses were evaluated retrospectively. Both lateral atlantoaxial joints were clearly visible on occipitofrontal projections in 355 examinations. Each lateral atlantoaxial joint was considered severely degenerated when advanced narrowing or obliteration of the joint space, subchondral sclerosis, and/or osteophytosis were present. RESULTS: Atlantoaxial osteoarthritis was found in 4.8% of the patients. The radiologic prevalence of advanced degenerative changes at the lateral atlantoaxial joint(s) was found to increase with age, ranging from 5.4% in the sixth decade to 18.2% in the ninth decade of life. CONCLUSION: Because advanced degenerative changes at the lateral atlantoaxial joints can cause suboccipital neck pain, these findings should be included in the differential diagnosis in older patients with this symptom.

Dynamic magnetic resonance imaging in the diagnosis of groin hernia.

RATIONALE AND OBJECTIVES: The authors determine the feasibility of dynamic magnetic resonance (MR) imaging in the diagnosis of groin hernia. METHODS: Ten volunteers and 10 patients with clinically evident and surgically proven herniations were evaluated using T1-, and T2-weighted sequences and two dynamic sequences. The visibility of anatomic structures that are crucial for the assessment and the differentiation of inguinofemoral herniations was evaluated. RESULTS: The inguinal rings could be identified in all subjects. The inferior epigastric vessels could be identified in 85%. In 10 patients, 11 hernias were found at MR imaging, whereas at surgery and physical examination 13 herniations were diagnosed (84.6%). The two hernias that were missed initially could be identified retrospectively on MR imaging. One volunteer showed a small bilateral inguinal hernia on MR imaging that could be confirmed on physical examination. CONCLUSIONS: The anatomic structures that are crucial for the assessment and the differentiation of inguinofemoral herniations can be identified prospectively with MR imaging.

Digital chest imaging using a selenium detector. The impact of hard copy size on observer performance: a computed tomography-controlled study.

RATIONALE AND OBJECTIVES: The authors compare radiologist detection performance under clinical conditions for assessment of the effect of size reduction on the diagnostic performance of digital chest images obtained with a selenium detector. METHODS: Sixty-five patients were examined with the digital system. The images were acquired without an antiscatter grid. Sixty-five posteroanterior life-size images (35 x 43 cm) and sixty-five posteroanterior minified images (56% of life size) were analyzed by three observers for detection of pulmonary, mediastinal, and pleural pathology, using computed tomography as the reference standard. The diagnostic value of life-size and minified images for the detection of these chest abnormalities was analyzed with receiver operating characteristic (ROC) methods. RESULTS: For the detection of the various abnormalities by all radiologists, the areas under the ROC curves with life-size images versus minified images, respectively, were as follows: pulmonary opacities, 0.78 versus 0.78; interstitial disease, 0.74 versus 0.75; mediastinal disease, 0.70 versus 0.72; and pleural abnormalities 0.72 versus 0.67. CONCLUSIONS: There was no statistically significant difference between the radiologists' performance in detecting pulmonary, mediastinal, and pleural pathology with life-size versus that with minified (56% of life size) digital selenium chest radiography.

MRI of atlanto-odontoid osteoarthritis.

We present the MRI appearances of advanced degenerative changes at the atlanto-odontoid (AO) joint. Changes including obliteration of the joint space, subchondral sclerosis and osteophytosis were clearly depicted on fast gradient-echo T1-weighted MRI images. Recognition of these changes may be helpful in the diagnosis in patients with suboccipital pain.

Evaluation of femoropopliteal arteries with duplex ultrasound after angioplasty. Can we predict results at one year?

OBJECTIVES: To determine if Duplex ultrasound (DUS) 1 day after percutaneous transluminal angioplasty (PTA) is prognostic for haemodynamic and clinical results at 1 year. DESIGN: Prospective study. PATIENTS AND METHODS: Thirty-four femoropopliteal artery segments were treated with PTA. The peak systolic velocity ratio (PSV ratio = PSV in stenosis: PSV in normal segment) was determined with DUS before PTA, 1 day after PTA and 1 year after PTA. Clinical results were assessed with the SVS/ISCVS (Society for Vascular Surgery/International Society for CardioVascular Surgery) results classification. RESULTS: A 1 year, clinical benefit from PTA was seen in 16 of 25 patients (64%) and haemodynamic improvement in 20 of 34 treated segments (59%). With DUS three residual stenoses were found 1 day after PTA; all occluded within 1 year. Segments with good DUS results after PTA showed haemodynamic deterioration in 30%. Clinical improvement was seen in most patients with DUS improvement, whereas no change or deterioration was found in patients with both good and poor DUS results at 1 year. CONCLUSIONS: Residual stenosis on DUS 1 day after PTA is prognostic for failure within 1 year. However, good DUS results after PTA cannot predict haemodynamic success. Haemodynamic success at 1 year does not imply clinical success.

Chest imaging with a selenium detector versus conventional film radiography: a CT-controlled study.

PURPOSE: To compare radiologist detection performance under clinical conditions for assessment of conventional radiographs and digital chest images obtained with a selenium detector. MATERIALS AND METHODS: One hundred four patients were examined with the digital and conventional systems under near identical technical conditions. The digital images were acquired without an antiscatter grid. Two hundred eight images were analyzed by three radiologists for detection of pulmonary, mediastinal, and pleural abnormalities; computed tomography was used as the reference standard. The diagnostic value of both techniques for the detection of these chest abnormalities was analyzed with receiver operating characteristic (ROC) methods. RESULTS: For detection of the various abnormalities by all radiologists, the areas under the ROC curves with conventional imaging versus digital imaging, respectively, were as follows: pulmonary opacities, 0.81 versus 0.79; interstitial disease, 0.69 versus 0.73; mediastinal disease, 0.79 versus 0.74; and pleural abnormalities, 0.73 versus 0.68. CONCLUSION: There was no statistically significant difference between the radiologists' performance in detecting pulmonary, mediastinal, and pleural abnormalities with conventional radiography versus that with digital selenium chest radiography.

Effects of dose reduction on digital chest imaging using a selenium detector: a study of detecting simulated diffuse interstitial pulmonary disease.

OBJECTIVE: The purpose of this study was to evaluate the effect of dose reduction on the diagnostic performance of a new digital chest imaging system in which amorphous selenium is used as the X-ray detector. Diagnostic performance was assessed for the detection of simulated diffuse interstitial pulmonary disease (DIPD). MATERIALS AND METHODS: DIPD was simulated by superimposing plastic sheets that contained small radiopaque objects (birdseed) on an anthropomorphic chest phantom. We varied the number of sheets from zero to four to simulate the degree of abnormality. We made 80 images with a standard X-ray dose, 80 images with 55% of the standard dose, and 80 images with 35% of the standard dose. Six observers were asked to indicate the presence of DIPD using a five-level scale of confidence. Two hundred forty chest images were then analyzed using receiver operating characteristic (ROC) curves. RESULTS: The area under the ROC curve was 87.2 for all readers with standard-dose imaging (95% confidence interval [CI], 83.7-90.7), 91.7 with 55% of the standard dose (95% CI, 88.8-94.6), and 90.0 with the 35% dose (95% CI, 87.1-92.9). The area under the ROC curve for subtle DIPD (one superimposed sheet) was 75.3 for all readers with standard-dose imaging (95% CI, 67.1-83.5), 79.7 with 55% of the standard dose (95% CI, 71.9-87.5), and 70.3 with the 35% dose (95% CI, 61.7-78.9). For each dose, we observed a gradual improvement of the ROC curves with each additional sheet superimposed on the chest phantom (p < .001). CONCLUSION: We found no significant difference in diagnostic performance among images made with standard X-ray dose, those made with a 55% dose, and those made with a 35% dose (95% CI).

Ciprofibrate versus gemfibrozil in the treatment of primary hyperlipidaemia.

The efficacy and short-term safety of ciprofibrate and gemfibrozil were compared in a 12-week, double-blind, randomised study. One-hundred-and-ten primary, type II hyperlipidaemic patients were randomised to receive either ciprofibrate, 100 mg/day once daily, or gemfibrozil, 1200 mg/day twice daily. Treatment efficacy was measured by complete lipid and lipoprotein profiles and by plasma fibrinogen levels. Tolerability was assessed by drug compliance and safety was evaluated by laboratory safety parameters, physical examination and evaluation of adverse events. Mean reductions of plasma TC and low density lipoprotein cholesterol levels were similar in the two treatment groups. In contrast, the mean relative reduction of plasma total triglyceride and very low density lipoprotein triglyceride levels was significantly higher in patients receiving gemfibrozil as compared with ciprofibrate (P < 0.05). The absolute reduction of the last two parameters was higher in the ciprofibrate group compared with the gemfibrozil group; furthermore, the mean concentrations of these parameters were within normal limits at the end of the study. The clinical relevance of the statistically significant difference mentioned should, therefore, be questioned. Ciprofibrate therapy significantly reduced (-8.33%) and gemfibrozil therapy significantly increased (+6.97%) plasma fibrinogen levels (P < 0.001 compared with baseline in each case). Adverse events were rare, mild and equally distributed between the two treatment groups. Laboratory safety parameters did not show any significant changes. Ciprofibrate and gemfibrozil have comparable short-term efficacy and safety profiles. Furthermore, ciprofibrate reduces fibrinogen levels and benefits from a once daily regimen.

Case report: bronchial to coronary artery anastomosis--a potential hazard in bronchial artery embolization.

Bronchial artery embolization is a well-established treatment for patients with haemoptysis. Communications between coronary and bronchial vessels have been seen on coronary angiography. This report describes a case of a bronchial to coronary artery anastomosis diagnosed prior to embolization in a patient with haemoptysis.

Iliac artery stenoses after percutaneous transluminal angioplasty: follow-up with duplex ultrasonography.

PURPOSE: To assess iliac artery stenosis before and up to 1 year after percutaneous transluminal angioplasty (PTA) with duplex ultrasound (DUS) to determine the incidence of residual and recurrent stenoses and correlate these findings to clinical outcome. PATIENTS AND METHODS: Sixty-one patients with 70 iliac artery segments treated with PTA were examined. The peak systolic velocity (PSV) ratio (PSV ratio = PSV in stenosis divided by PSV proximal or distal to stenosis) was determined by DUS before PTA and 1 day, 3 months and 1 year after PTA. Three categories of results were identified by using PSV ratios at the site of the treated stenosis 1 day and 1 year after PTA (good result, residual stenosis, and recurrent stenosis). The DUS-determined anatomic result was correlated with the clinical outcome at 1 year. Clinical outcome was classified according to Society for Vascular Surgery/International Society for Cardiovascular Surgery (SVS/ISCVS) criteria. RESULTS: Good results with DUS (PSV ratio 1 day and 1 year after PTA > or = to 2.5) were found in 45 of 70 segments (64.3%), residual stenoses (PSV ratio > or .5 1 day after PTA) in 15 of 70 segments (21.4%), and recurrent stenosis (PSV ratio 1 day after PTA < 2.5 and 1 year after PTA > or = 2.5) in 10 of 70 segments (14.3%). PSV ratios of residual stenoses decreased significantly between 1 day and 1 year after PTA because some residual stenoses improved hemodynamically in time. Clinical results were significantly better in patients with a good result compared with other patients. However, the clinical outcome of patients with residual stenoses was not significantly different from the patients with good DUS results. CONCLUSION: Some residual stenoses improved sonographically after PTA. Clinical results at 1 year are highly variable within different groups. Clinical outcome of patients with residual stenoses did not differ from patients with good DUS results, whereas clinical outcome in patients with recurrent stenoses was worse than in the other groups.

Digital chest imaging with a selenium detector: comparison with conventional radiography for visualization of specific anatomic regions of the chest.

OBJECTIVE: The purpose of this study was to compare a new digital chest radiography system that uses amorphous selenium as the X-ray detector with conventional radiography for the visualization of various anatomic regions of the chest as a first phase of testing image quality. MATERIALS AND METHODS: Six observers analyzed pairs of posteroanterior chest radiographs of 40 patients. One radiograph in each pair was obtained with a conventional chest film changer, and the other was obtained with the digital selenium chest radiography system. Each observer rated the visibility and the radiographic quality of 12 different anatomic regions. RESULTS: The observers rated visualization obtained with the digital system as better than that obtained with the conventional system in four regions (right lower lobe, upper lobes, ribs, and soft tissue), as better than or equal to that obtained with the conventional system in four regions (retrocardiac, retrodiaphragmatic, hilum, and upper mediastinum), and as equal to that obtained with the conventional system in four regions (horizontal fissure, carina, azygoesophageal recess, and thoracic spine). Some observers had a strong preference for the digital images, whereas others showed no preference. The conventional system was not ranked high for any region (2880 observations, p < .01, sign test). CONCLUSION: The digital selenium chest radiography system performs well in a clinical setting, providing visualization of anatomic structures that is better than or at least equal to that provided by standard screen-film images.

Digital chest imaging using a selenium detector. A simulated diffuse interstitial pulmonary disease detection study.

RATIONALE AND OBJECTIVES: To assess the diagnostic performance of a new digital chest imaging system based on a selenium detector in the detection of simulated diffuse interstitial pulmonary disease (DIPD). METHODS: Diffuse interstitial pulmonary disease was simulated by superimposing plastic sheets containing small radio-paque objects (birdseed) on an anthropomorphic chest phantom. the number of sheets was varied from 0 to 4 to simulate the degree of pathology. Eighty conventional radiographs and 80 images with the selenium detector were obtained under comparable conditions. Six observers were asked to indicate the presence of DIPD using a five-level scale of confidence. The total 160 chest images were analyzed using receiver operating characteristic curves. RESULTS: There was no significant difference in detection performance between the conventional and the digital images (95% confidence interval). CONCLUSIONS: None of the observers assessed the diagnostic performance of the digital chest images as significantly different from that of the conventional system. The interobserver differences were higher than the differences between digital and conventional chest images.