Magnetic resonance spectroscopy of the breast at 3T: pre- and post-contrast evaluation for breast lesion characterization.

PURPOSE: To determine whether in vivo proton magnetic resonance spectroscopy at 3T can provide accurate breast lesion characterization, and to determine the effect of gadolinium on the resonance of tCho. METHODS: Twenty-four positive-mammogram patients were examined on a 3T MR scanner. 1H-MRS was performed before and after gadolinium administration. tCho peak was qualitatively evaluated before and after contrast injection. RESULTS: Fourteen out of 27 lesions proved to be malignant after histopathological diagnosis. Using 1H-MRS, before contrast injection, 6/14 confirmed malignancies and 11/13 benign lesions were correctly classified; while, after contrast injection, 11/14 confirmed malignancies and 12/13 benign processes were correctly classified. Post gadolinium 1H-MRS proved useful in picking up tCho signal, improving the overall accuracy, sensitivity, and specificity by 35%, 83%, and 9%, respectively. CONCLUSION: 1H-MRS overall accuracy, sensitivity, and specificity in detecting breast lesion's malignancy were increased after gadolinium administration. It is prudent to perform 1H-MRS before contrast injection in large breast lesions to avoid choline underestimation. In cases of small or non-mass lesions, it is recommended to perform 1H-MRS after contrast injection for better voxel prescription to enable a reliable preoperative diagnosis.

Increased soluble E-selectin levels in type 2 diabetic patients with peripheral arterial disease.

AIM: Abnormal endothelial function is well known in patients with type 2 diabetes mellitus and thought to induce macroangiopathy. Increased levels of adhesion molecules have been found in type 2 diabetic patients and it has been suggested that they play an important role in the initiation of atherosclerosis. The aim of the present study was to clarify the relationship between objectively proven peripheral arterial disease (pAVD) and serum levels of soluble adhesion molecules in patients with type 2 diabetes mellitus. METHODS: Levels of soluble E-selectin, ICAM-1 and VCAM-1 were evaluated in 18 type 2 diabetic patients with pAVD assessed by Doppler ultrasound, in 19 type 2 diabetic patients and 22 non-diabetic subjects without pAVD. RESULTS: Soluble E-selectin levels were significantly increased in pAVD-diabetic patients compared to diabetics and non-diabetics without pAVD (78.7+/-29 vs 49.7+/-20.4 and 36+/-17 ng/ml respectively, p<0.001), while sICAM-1 and sVCAM-1 levels were comparable between the groups. No significant correlation was found between pAVD and adhesion molecule levels. Peripheral AVD was correlated with smoking (p=0.024), duration of diabetes (p=0.048) and microalbuminuria (p=0.041). Regression analysis revealed that only smoking (R=0.536, p=0.012) and glycosylated hemoglobin (R=0.435, p=0.036) were independent factors related to pAVD. Soluble ICAM-1 levels were significantly higher (p=0.041) in diabetic smokers with pAVD and sVCAM-1 (p=0.011) in patients with longer duration of diabetes. CONCLUSION: Type 2 diabetic patients with pAVD showed increased serum sE-selectin levels. No significant relationship was found between the presence or extent of pAVD and measured adhesion molecules. Our results suggest that sE-selectin reflects endothelial activation and is possibly involved in the atherogenesis process with the contribution of other factors that characterize the metabolic syndrome of diabetes.

Paraplegia-related alterations of bone density in forearm and hip in Greek patients after spinal cord injury.

PURPOSE: Paraplegia due to spinal cord injury is related with sublesional bone demineralization with an increased incidence of pathologic fractures in lower extremities. This study was carried out in order to evaluate bone density alterations in forearm and hip in Greek paraplegic patients after spinal cord injury and to correlate the findings with the level of injury, the neurological status, the time interval from injury and the performing of physiotherapy and therapeutic standing. METHOD: Fifty-seven paraplegic patients (33 men and 24 women, with injuries sustained from 6 months to 27 years) and 36 able-bodied age-matched controls (25 men, 16 women) participated in the study. Bone mineral density (BMD) was measured by dual X-ray absorptiometry (DXA) in the proximal and distal forearm, the femoral neck, the greater trochanter and Ward's triangle. RESULTS: The measurements revealed a significant reduction of BMD of femoral neck (p<0.001 in male, p<0.001 in female paraplegics), greater trochanter (p<0.001 and p=0.001, respectively) and Ward's triangle (p=0.001 and p=0.005, respectively). Proximal forearm depicted non-significantly decreased BMD values and distal forearm depicted a slight increase in BMD values. The degree of demineralization was independent of factors such as complete or incomplete spinal cord injury, level of the lesion, physiotherapy and performing of standing. In addition to that, BMD values in both hip and forearm showed no statistically significant correlation with time after injury. CONCLUSIONS: BMD measurements in Greek paraplegic patients reveal bone loss, which most dramatically occurs in the region of hip with a consequent increase of fracture risk. Forearm measurements depict a non-homogeneous response with limited proximal bone loss and slight distal increase of BMD, the latter being possibly attributed to daily activities.

Mammographic findings following reduction mammoplasty.

Breast reduction mammoplasty is becoming an increasingly common procedure. A baseline mammogram is recommended after 35 years of age as the most effective method for detection of small breast cancers. A prospective study was conducted for the evaluation of the mammographic findings after reduction mammoplasty. During the last 7 years, 113 patients over 35 years of age underwent bilateral reduction mammoplasty. All patients had a preoperative mammogram. A new mammogram was obtained at 6 and 18 months after the procedure. All films were reviewed by the same two radiologists. Breast reduction was performed with the vertical bipedicle flap technique (McKissock) and the inferior pedicle technique. There were no apparent differences in the findings between the two methods. Most common findings were parenchymal redistribution in 102 (90.2%) and elevation of the nipple in 96 (84.9%), produced by a shift of the breast tissue to a lower position. Calcifications were seen in 29 (25.6%), and "oil cysts" in 22 (19.4%), caused by localized fat necrosis. A retroareolar fibrotic band was found in 23 (20.3%), from the transposed flap. Areolar thickening was observed in six (5.3%), and skin thickening in only two (1.7%), from scar tissue. Mammographic findings after reduction mammoplasty are predictable, thus preventing unnecessary biopsies and making the diagnosis of lesions unrelated to the procedure easier. All patients over 35 years of age should have a preoperative and a postoperative mammogram for future reference.

Comparison of T1-weighted spin-echo and 3D T1-weighted multi-shot Echo Planar pulse sequences in imaging the brain at it.

The purpose of this study was to evaluate the ability of three dimensional T1-weighted multi-shot Echo Planar Imaging (3D T1w EPI) MR pulse sequence to provide comparable to T1w Spin Echo (SE) results in various diseases of the brain, during shorter acquisition times. Thirty-six patients (aged 30-74 years) with various indications were included in the study. All examinations were performed with a 1T MR scanner with a maximum gradient strength of 15 mT/m. The SE sequence lasted 3 min 50s and the 3D T1w EPI 59s. The quantitative analysis included number of enhancing lesions, signal-to-noise ratio of the enhancing lesions and contrast-to-noise ratio (CNR) between enhancing lesions and white matter in both sequences before and after i.v. administration of 0.1 mmol/kg gadopentetate dimeglumine. In addition, the percentage increase of enhancement was measured in each lesion of each sequence. The qualitative analysis included a) conspicuity of the lesions and b) presence of artifacts. The T1w SE sequence was significantly better compared to 3D T1w EPI in all quantitative measurements with the exception of CNR of enhancing lesions before contrast administration and the percentage enhancement. The conspicuity of the lesions did not differ between the two sequences. The EPI sequence presented with significantly more artifacts. We conclude that the 3D T1w EPI sequence could not be used instead of the conventional T1w SE, in routine imaging of the brain. Its overall diagnostic capability, could be useful only in uncooperative patients.

Hepatic artery pseudoaneurysm following laparoscopic cholecystectomy: transcatheter intraarterial embolization.

We present a case of hepatic artery injury with pseudoaneurysm formation following laparoscopic cholecystectomy. A 29-year-old man was referred to our hospital with right upper quadrant pain, jaundice and upper gastrointestinal bleeding one month after laparoscopic cholecystectomy. Gastroscopy showed mucosal erosions at the gastroesophageal junction. The patient did well after medical treatment only and was discharged one week later. However, ten days later he was readmitted with recurrent upper gastrointestinal bleeding. Usual laboratory tests, routine imagine diagnostic procedures and selective hepatic arteriogram were performed. Usual laboratory tests and routine imagine diagnostic procedures were inconclusive, but selective hepatic arteriogram showed a right hepatic artery pseudoaneurysm. The diagnosis of hemobilia was established. Embolization of the aneurysm with coils was carried out. Bleeding was controlled, the patient was discharged one week later and since then he remains under close follow up without any evidence of bleeding recurrence. We believe that the intraarterial embolization of a pseudoaneurysm is a safe and effective method to manage some complications such as bleeding or hemobilia.

Sonographic detection of vesicoureteral reflux with fluid and air cystography. Comparison with VCUG.

PURPOSE: Attempt to find out an effective and reliable alternative method for the diagnosis of vesicoureteral reflux (VUR), without irradiation, in children, and the comparison of its results with those of voiding cystourethrography (VCUG). METHODS: In a prospective comparative study we examined 88 children (176 units) (average age = 2.8 years) sonographically and with VCUG, in order to detect VUR. First we examined sonographically the kidney's morphology on an empty bladder. Then we examined them sonographically after filling the urinary bladder with fluid (fluid-cystorenography, fluid-CRG), and after filling it with air (air cystorenography, air CRG). Within the following 2-5 days the standard VCUG was performed. We compared the results of these three methods. RESULTS: Fluid CRG showed fluid reflux to the pelvicalyceal system in 25/176 Kidneys (sensitivity = 94.4%, specificity = 94.9%, accuracy = 94.9%). Air CRG showed air reflux in 19/176 kidneys (sensitivity = 83.3%, specificity = 96.8%, accuracy = 95.4%). VCUG showed VUR in 18/176 pelvicalyceal systems and/or ureters. CONCLUSION: Fluid CRG and/or air CRG can be used as complementary methods to the VCUG, or during the follow up of patients with known VUR: VCUG cannot be replaced completely by fluid CRG or air CRG, especially the first and the last one, because of the false negative results of these methods and because none of them can show the renal collecting system, the urinary bladder and the urethra in the standard way.

Fibrin glue for sealing the needle track after percutaneous lung biopsy: Part I--Experimental study.

PURPOSE: Evaluate the effectiveness of fibrin glue for the embolic occlusion of needle tracks following percutaneous lung biopsy (PLB). METHODS: Twenty-six rabbits underwent computed tomography (CT)-guided PLB using a coaxial system consisting of 19- and 22-gauge needles. Thirteen rabbits were used as controls (group A). In 13 other rabbits (group B), fibrin glue labelled with I131 fibrinogen and contrast medium was injected into the track. Both groups were examined by CT for the presence and severity of pneumothorax (mild: less than 20%; severe: more than 20%). Group B was also examined scintigraphically and their lungs were studied histologically. RESULTS: In group A, pneumothorax developed in eight animals (61.6%) and was severe in six (46.1%) whereas in group B, pneumothorax developed in five animals (38.5%) and was severe in one (7.7%). Though the difference between the two groups in overall incidence of pneumothorax was not significant (p > 0.1), it was significantly higher (p < 0.025) for severe pneumothorax in group A. No signs of systemic embolism were observed. CONCLUSIONS: Based on this animal model, fibrin glue is a safe and useful sealant following PLB and reduces the incidence of severe pneumothorax.