Metabolic white matter diseases and the utility of MR spectroscopy.

Magnetic resonance spectroscopy (MRS) can be useful as an adjuvant diagnostic tool to traditional MR imaging of the brain. MRS can provide both quantitative and qualitative information about white matter pathologic abnormality. It is important to interpret MRS in conjunction with other clinical factors including but not limited to additional diagnostic neuroimaging, history and physical examination findings, and genetics.

Ultrasound imaging of carotid artery stenosis: application of the Society of Radiologists in Ultrasound Consensus Criteria to a Single Institution Clinical Practice.

Carotid duplex Doppler ultrasound (CDDU) is increasingly used for the evaluation of internal carotid artery (ICA) stenosis. In CDDU, velocity measurements are used to estimate the degree of ICA stenosis. Traditionally, radiologists have relied on institutional experience and published research when interpreting CDDU. In 2003, a consensus committee of experts convened as the Society of Radiologists in Ultrasound Consensus Committee and proposed standard criteria for grading ICA stenosis including the use of peak systolic velocity (PSV) of greater than 230 cm/s for assigning ICA stenosis of greater than 70%. The purpose of this study was to evaluate the accuracy of the Society of Radiologists in Ultrasound Consensus Criteria in classifying carotid stenoses. This study shows the following: (1) that the criterion of PSV of greater than 230 cm/s for angiographic stenosis of greater than 70% performs as predicted by the consensus committee, with sensitivity of 95.3% (95% confidence interval [CI], 0.89-0.99) and specificity of 84.4% (95% CI, 0.80-0.88); (2) using Pearson correlations, there is no statistical difference found between the correlation of PSV with angiography (0.825 [95% CI, 0.792-0.853]), end diastolic velocity with angiography (0.762 [95% CI, 0.718-0.799]), and the ICA/common carotid artery (CCA) systolic ratio with angiography (0.766 [95% CI, 0.723-0.802]). The correlation of the ICA/CCA diastolic ratio with angiography (0.643 [95% CI, 0.584-0.696]) is less predictive at a 95% confidence interval than the other 3 velocity-based variables, and (3) when the 4 velocity-based variables are taken in pairs (eg, PSV and end diastolic velocity), there is no pair that shows statistically significant improvement in performance. Peak systolic velocity in combination with other variables does show a slight trend toward superior performance.

Midgut volvulus in an adult patient with malrotation and abdominal heterotaxia: a case report.

Midgut volvulus is rare in adulthood and if not diagnosed accurately, carries a high mortality rate. We present a case of a young adult man who presented with acute abdominal pain and was found to have malrotation with abdominal heterotaxia. Abdominal computed tomography can identify anomalies associated with intestinal malrotation. With the awareness of the potential for malrotation to predispose to midgut volvulus, the patient and his physician will have a higher index of suspicion when abdominal pain occurs. Appropriate treatment of midgut volvulus will reduce morbidity and mortality.