A review of selective salpingography and fallopian tube catheterization.

Use of selective salpingography and fallopian tube recanalization has revolutionized the diagnosis and treatment of infertility. Selective salpingography, a diagnostic procedure in which the fallopian tube is directly opacified through a catheter placed in the tubal ostium, has been used since the late 1980s to differentiate spasm from true obstruction and to clarify discrepant findings from other tests. In fallopian tube recanalization, a catheter and guide wire system is used to clear proximal tubal obstructions. The recanalization procedure is simple for interventional radiologists to perform and is successfully completed in most patients (71%-92%). Pregnancy rates after the procedure have been variable, with an average rate of 30%. The combination of selective salpingography with fallopian tube recanalization has improved the overall management of infertility caused by tubal obstruction. The same catheterization technique used in fallopian tube recanalization is currently being explored for use in tubal sterilization.

Effect of gadolinium on phase-contrast MR angiography of the renal arteries.

OBJECTIVE: Our aim was to evaluate the effect of gadolinium chelates on image quality in phase-contrast MR angiography of renal arteries in patients suspected of having renal artery stenosis. MATERIALS AND METHODS: In 24 patients, axial three-dimensional phase-contrast MR angiography of the renal arteries was obtained on a 1.5-T MR imaging system before and after administration of gadolinium contrast agent. The improvement in distal renal artery signal-to-noise ratio after enhancement was measured and correlated with patient age, serum creatinine level, clinical estimation of renal artery flow, and the imaging parameter flip angle. RESULTS: On average, the distal renal artery signal-to-noise ratio increased 2.2-fold after gadolinium administration (p < .001). The increase was greatest in patients more than 60 years old (3.1-fold; p < .001) and in patients with serum creatinine levels greater than 3.0 mg/dl (4.3-fold; p < .01). After enhancement, we found an apparent increase in renal artery diameter (3.5 +/- 1.1 mm before enhancement versus 4.8 +/- 1.4 mm after enhancement [mean +/- SD; p < .001]). We believe this increase reflects improved visualization of slow blood flow along the artery wall. Although the visualization of renal arteries was better in most patients after enhancement, two patients had poorer image quality after enhancement because of increased venous signal obscuring the arteries. CONCLUSION: Gadolinium administration significantly increases distal renal artery signal-to-noise ratio on three-dimensional phase-contrast MR angiography in most patients. The signal-to-noise ratio improvement is greatest in older patients and in patients with impaired renal function. However, in some cases, increased venous signal may obscure arteries.

Evaluation of thoracic aortic disease with the use of helical CT and multiplanar reconstructions: comparison with surgical findings.

PURPOSE: To assess the accuracy of helical computed tomography (CT) in differentiating different types of thoracic aortic disease, to determine the incremental value of multiplanar reconstructions, and to determine if helical CT could help to reliably predict the need for intraoperative hypothermic circulatory arrest. MATERIALS AND METHODS: Forty-nine patients underwent pre-operative helical CT with multiplanar reconstructions. Images were reviewed for type and location of pathologic lesions and for features that indicated the need for hypothermic circulatory arrest. The incremental yield of multiplanar reconstructions compared with that of axial images was assessed. Imaging findings were compared with surgical findings. RESULTS: The types of lesions present in the patients included 36 aneurysms (three were ruptured), six penetrating ulcers, five dissections, and two pseudoaneurysms. The accuracy of diagnosis was 92% (45 of 49 patients) with the use of CT (both with and without multiplanar reconstruction). The necessity of hypothermic circulatory arrest was successfully predicted in 94% (45 of 48 patients) of cases. CONCLUSION: Helical CT, both with and without the use of multiplanar reconstruction, enabled highly accurate differentiation among diseases of the thoracic aorta and prediction of the need for hypothermic circulatory arrest.

Renal masses: assessment of corticomedullary-phase and nephrographic-phase CT scans.

PURPOSE: To evaluate the role of thin-section helical computed tomography (CT) performed during the corticomedullary phase (CMP) and nephrographic phase (NP) of contrast enhancement in the detection and characterization of renal masses. MATERIALS AND METHODS: Renal CT scans and medical records of 33 patients were retrospectively reviewed. In all examinations, 5-mm-thick, contiguous, helical-mode scans were obtained before and 40 seconds after initiation of dynamic bolus injection of contrast material (CMP images); 5-mm-thick, contiguous, axial-mode scans were obtained after completion of CMP scanning (NP images). RESULTS: At review of CMP, NP, and combination images, 259, 389, and 417 lesions, respectively, were identified. The greatest difference in detection occurred in the renal medulla, with 25 lesions identified on CMP images and 111 lesions identified on NP images. False-positive results occurred when CMP images were reviewed without NP images. CONCLUSION: CT scans obtained only during the CMP of contrast enhancement fail to depict many renal masses that are easily seen on NP images.

Locating neuroblastoma in the opsoclonus-myoclonus syndrome.

We examined the role of various medical imaging modalities, particularly metaiodobenzylguanidine (MIBG) scintigraphy in the investigation of patients presenting with the opsoclonus-myoclonus syndrome (OMS) who may harbor neuroblastomas. A retrospective analysis was therefore performed of all patients presenting with OMS in a 5 1/2 year period. Between December, 1988 and May, 1994, all 13 patients (mean age 15.2 months, range 3 days-30 months) presenting with OMS were extensively studied. A wide range of medical imaging modalities including CT, MRI and [131I] or [123I]-metaiodobenzylguanidine (MIBG) scintigraphy (total of 21 scans) were examined as a means of detecting a structural brain lesion or locating a neuroblastoma, a tumor generally found in less than half of patients with OMS. As anticipated a minority of patients (4) were eventually found to harbor neuroblastomas. In these four cases, two tumors were revealed on preoperative MIBG scintigraphy, one gave a false negative study and one tumor was not studied preoperatively. Each patient was also subjected to extensive radiological investigations in addition to MIBG scintigraphy, many of which were repetitive, redundant or had low clinical yield. The relative merits of the various procedures are compared, and an algorithm incorporating MIBG scintigraphy and limited central nervous system and abdominal anatomical modalities for the investigation of opsoclonus-myoclonus is suggested.

Retroperitoneal plexiform neurofibromas: CT findings.

OBJECTIVE: CT findings in retroperitoneal plexiform neurofibromas have been described previously only in a few case reports. This study was performed to characterize the CT features in a larger group of patients with this benign neoplasm and to delineate those findings that suggest the presence of concurrent malignant tumors of the nerve sheath. MATERIALS AND METHODS: From a review of CT scans showing retroperitoneal masses in 25 patients with neurofibromatosis type 1, we identified 16 patients whose clinical and CT features suggested the diagnosis of plexiform neurofibromas. The diagnosis was confirmed by biopsy of the mass in three patients. In the remaining 13 patients, the diagnosis was supported by long-term follow-up in eight and by biopsy confirmation of either a neurofibroma or a plexiform neurofibroma elsewhere in the body in the other five patients. Concurrent retroperitoneal malignant tumors of the nerve sheath were confirmed by biopsy in five patients. RESULTS: CT showed bilateral, remarkably symmetric masses extending along the medial and posterior aspects of the psoas muscles in 15 of the 16 patients. Parapsoas masses tended to be long and cylindrical. In addition to parapsoas masses, eight patients had bilateral, symmetric masses extending along the anterior aspect of the sacrum in a sheetlike fashion. Masses were identified in the region of the celiac axis and the origin of the superior mesenteric artery in four patients. Only one patient had an isolated celiac/superior mesenteric artery mass without associated parapsoas or presacral masses. Retroperitoneal masses were of homogeneous, low attenuation when compared with adjacent muscle on CT images of 14 patients. Two patients had an unusual swirling and serpiginous pattern of increased attenuation superimposed on a low-attenuation background. Asymmetry in size and attenuation was due to malignant nerve sheath tumors in five patients. CONCLUSION: Retroperitoneal plexiform neurofibromas have a characteristic appearance on CT scans. They are typically bilateral, symmetric, low-attenuation masses in a parapsoas or presacral location. Asymmetry in size and attenuation of a larger mass suggests the possibility of a malignant tumor of the nerve sheath. Recognition of the CT features of a retroperitoneal plexiform neurofibroma can obviate the expense, pain, and risk of an unnecessary biopsy. Conversely, detection of findings suggestive of malignant tumor can lead to appropriate recommendation of biopsy.

Cutaneous T-cell lymphoma: CT in evaluation and staging.

Among 63 patients with cutaneous T-cell lymphoma (CTCL), 29% (n = 18) had positive computed tomographic (CT) findings, with frequencies of 65% (n = 13) among patients thought to have stages II-IV disease at clinical examination and 12% (n = 5) among patients thought to have stage I. Among eight patients with atypical CTCL variants such as cutaneous large-cell lymphoma, only one had negative findings at CT; extracutaneous disease was not suspected in five before they underwent CT. In contrast, CT findings were positive in only 5% (n = 2) of patients with classic early mycosis fungoides-type CTCL (scaling patches, small epidermotropic CD4+ cells), and CT is unlikely to provide substantial information in this patient subgroup. Contrary to earlier reports, the authors' data suggest that body CT is extremely useful in staging and evaluating patients with CTCL. CT should be included in the evaluation of atypical CTCL variants, Sézary syndrome, advanced-stage mycosis fungoides, and cases in which the CTCL subtype is unclear.

Visual skill. Correlation with detection of solitary pulmonary nodules.

A series of visual tests was administered to 65 individuals: 9 Board-certified radiologists, 41 radiology residents, and 15 fourth-year medical students on the senior radiology elective. Results of these visual tests were compared with performance in detection of solitary pulmonary nodules. Among radiology residents or board-certified radiologists, no correlation was found between performance on tests of visual perception and the ability to correctly locate pulmonary nodules. A correlation between visual test scores and nodule detection was evident among medical students. These findings suggest that factors other than skill in visual perception determine a radiologist's ability to correctly identify solitary pulmonary nodules.

MR imaging of experimental and clinical thrombi at 1.5 T.

We have previously reported that the T1 and T2 of experimental clots at 0.47 T varies considerably depending upon the method used in their preparation. However, these studies, while relevant to midfield imaging, may not reflect accurately the behavior of such thrombi at higher field strengths. Accordingly, we studied the T1 and T2 at 1.5 T of experimental thrombi prepared by several methods and compared these results with the relaxation times of clinical deep venous thrombi measured in situ in patients. The relationship between the T2 values for the different clot preparation methods was different at 1.5 T than at 0.47 T. The combined use of thrombin and epsilon-amino caproic acid produced thrombi with T1 and T2 indistinguishable from clinical deep venous thrombi.

Estrogen-sensitive proliferation pattern of cloned Syrian hamster kidney tumor cells.

Estrogen-sensitive hamster kidney tumor cells H301 and their clonal derivatives were inhibited from proliferating in culture by charcoal-dextran (CD) stripped serum in a dose-dependent manner. Homologous serum was more potent an inhibitor than heterologous (human, bovine, equine) sera. Natural and synthetic estrogens failed to increase the proliferation rate of cells maintained in 2% CD Syrian hamster serum (SHS). At CDSHS concentrations above 2%, cell proliferation was significantly inhibited and estrogens completely reversed this inhibitory effect. Nonestrogenic steroids failed to overcome the serum inhibition. Two synthetic estrogens, moxestrol and 11 beta-chloromethylestradiol, were 10-fold more potent than estradiol in increasing cell proliferation yields; they were however, less potent than estradiol in inhibiting [3H]estradiol binding to intracellular estrophilins. d-Equilenin, a poor inducer of kidney tumors, was a weak estrogen in the "in culture" proliferation assay. Ethynylestradiol was highly estrogenic in culture while reports suggest that it is poor tumor inducer in the animal. Progestagens inhibit the growth of estrogen-induced kidney tumors; only promegestone partially blocked the proliferative effect of estradiol in cultures supplemented with 10% CDSHS. Charcoal-dextran stripped serum from animals bearing a diethylstillbestrol implant was as effective as the serum of untreated male hamsters in inhibiting the proliferation of B3H301 cells. These results are compatible with the following interpretations: (a) hamster serum contains a potent specific inhibitor of the proliferation of estrogen-sensitive cells (estrocolyone); (b) estrogens induce cell proliferation by neutralizing the effect of this serum-borne inhibitor; (c) the poor correlation between estrophilin binding and proliferative potency suggests no direct estrophilin involvement in the proliferative effect of estrogens on these cells; (d) the results obtained in this "in culture" model using estrogen (except ethynylestradiol) and other steroids are compatible with the results obtained in the animal; and (e) the tumorigenic process in Syrian hamster kidneys triggered by estrogens probably involves their direct interaction within these cells (shut-off effect) in addition to the neutralization of the estrocolyone.

A study of classification criteria for a diagnosis of juvenile rheumatoid arthritis.

Criteria for the classification of juvenile rheumatoid arthritis were analyzed in a detailed database of 250 children in order to assess the accuracy of diagnosis and validity of onset types and course subtypes. A number of conclusions have been derived from this study: All definitions of the 1973 criteria for classification of juvenile rheumatoid arthritis should be retained. The addition of onset types to the 1976 revision of the criteria has been validated. The course of the disease after the onset period of 6 months is as important to the outcome of a group of children as is the onset type. The current classification should be broadened to include the course subtypes.

Pirprofen (Rengasil) in the treatment of juvenile rheumatoid arthritis. A segment I study.

Thirty-two patients with JRA were enrolled in a 4-wk open-labeled, non-controlled multicentre trial of pirprofen. An initial dose of about 300 mg/m2/d (range 250-330) was gradually increased to a maximum of 600 mg/m2/d (range 413-761). The medication was provided as an aqueous suspension (10 mg/ml), and was given 4 times/d. Efficacy analysis showed significant decreases occurred in the DMS, travel time, grip strength, and the severity of swelling score (in all cases p less than 0.05 based on the paired Student t test, 2-tailed). Nineteen patients reported a total of 27 adverse experiences; 6 of which were attributable to pirprofen. At the study dosages used pirprofen seems to be very similar in efficacy and safety to other nonsteroidal antiinflammatory drugs investigated in children with JRA.