[Time consumption and quality of an automated fusion tool for SPECT and MRI images of the brain]. / Automatisierte Fusion von SPECT- und MRT-Bildern des Gehirns: Zeitbedarf und Ergebnisqualität.

AIM: Although the fusion of images from different modalities may improve diagnostic accuracy, it is rarely used in clinical routine work due to logistic problems. Therefore we evaluated performance and time needed for fusing MRI and SPECT images using a semiautomated dedicated software. PATIENTS, MATERIAL AND METHOD: In 32 patients regional cerebral blood flow was measured using (99m)Tc ethylcystein dimer (ECD) and the three-headed SPECT camera MultiSPECT 3. MRI scans of the brain were performed using either a 0,2 T Open or a 1,5 T Sonata. Twelve of the MRI data sets were acquired using a 3D-T1w MPRAGE sequence, 20 with a 2D acquisition technique and different echo sequences. Image fusion was performed on a Syngo workstation using an entropy minimizing algorithm by an experienced user of the software. The fusion results were classified. We measured the time needed for the automated fusion procedure and in case of need that for manual realignment after automated, but insufficient fusion. RESULTS: The mean time of the automated fusion procedure was 123 s. It was for the 2D significantly shorter than for the 3D MRI datasets. For four of the 2D data sets and two of the 3D data sets an optimal fit was reached using the automated approach. The remaining 26 data sets required manual correction. The sum of the time required for automated fusion and that needed for manual correction averaged 320 s (50-886 s). CONCLUSION: The fusion of 3D MRI data sets lasted significantly longer than that of the 2D MRI data. The automated fusion tool delivered in 20% an optimal fit, in 80% manual correction was necessary. Nevertheless, each of the 32 SPECT data sets could be merged in less than 15 min with the corresponding MRI data, which seems acceptable for clinical routine use.

Thrombophlebitis of the internal jugular vein: noninvasive imaging.

Internal jugular thrombophlebitis usually results from contiguous infection or central catheterization. Ultrasonography and CT allow rapid, noninvasive methods of confirming the diagnosis of this condition. Although the choice of modality has not been systematically examined, where local expertise exists for both, ultrasonography is less expensive and should provide adequate images.

Computerized tomography in evaluation of hepatic neoplasms.

We reviewed our experience with computerized tomography (CT) of the abdomen in 212 patients with histologically documented liver neoplasms seen during a 30-month period. The CT findings in cavernous hemangioma and focal nodular hyperplasia were specific, and permitted accurate diagnosis of this lesion before biopsy. The CT appearance of all other lesions was variable. We consider CT useful in providing an accurate evaluation of the intrahepatic and extrahepatic extent of the neoplasm.

CT appearance of sclerosing cholangitis.

Ten cases of sclerosing cholangitis, both primary and secondary forms, were found to have similar abnormalities within the liver on CT examinations. These changes are different from those seen in cases of biliary obstruction due to tumor, stone, inflammatory mass, or other focal process. The finding of focal, discontinuous areas of minimal intrahepatic biliary dilatation without associated mass lesion seems to be highly suggestive of sclerosing cholangitis. Only the rare, diffuse form of cholangiocarcinoma would be likely to produce a similar CT appearance.

Diagnostic and interventional angiography in acute gastrointestinal hemorrhage.

The use of vasopressin infusion or arterial embolization in the treatment of 87 patients with gastrointestinal hemorrhage is reviewed. A bleeding point was identified angiographically in 46 patients (53%), with a higher success rate in those with upper gastrointestinal hemorrhage (63%) than in those with lower (39%) gastrointestinal hemorrhage. Vasopressin infusion in 33 patients completely stopped hemorrhage in 14 and slowed hemorrhage pending surgery in another 5. Gelfoam embolization was successful as definitive therapy in 12 of 15 patients. Mortality as a result of hemorrhage or its sequelae was 40% in patients with upper gastrointestinal hemorrhage and 21% in those with lower gastrointestinal hemorrhage.

Tension hydrothorax: roentgenographic characteristics and pathogenetic consideration.

We have described a 24-year-old diabetic woman with rapidly developing left-sided tension hydrothorax. The pleural effusion was characterized by high contents of protein and glucose. The chest roentgenogram exhibited massive pleural effusion, prominent air bronchograms, mediastinal shift, and diaphragmatic inversion. Prompt thoracocentesis proved to be life-saving.