Detection of root canals in historical population from Radom (Poland).

BACKGROUND: The aim of this study was to analyse the number of root canals in maxillary first premolars, first molars and mandibular first molar teeth from an 18th to 19th century Radom (Poland) population, and then assess whether the diversity of root canals has fluctuated for about two hundred years. MATERIALS AND METHODS: A total of 139 human permanent teeth were analysed by cone beam computed tomography in three projections. The types of root canal systems were classified in each tooth root separately. RESULTS: In one-rooted maxillary premolars, two canals occurred most often (53%).In two-rooted majority buccal (91%) and every palatal roots there is one canal. All three-rooted maxillary premolars have one root canal. In two-rooted first maxillary molars, fused roots have two canals. All mesiobuccal roots presented type 2-1 canal configurations. In three-rooted maxillary first molars in the mesiobuccal roots the most common root canal type is 2-1 (72%). A second mesiobuccal canal occurred in 86%. The distobuccal and palatal roots presented one canal in all cases. First mandibular molars occurred in two-rooted form in 98%. In mesial roots, two root canals predominated (59%). Most distal root (66%) had one canal. In three-rooted teeth one root canal was the most frequent finding. CONCLUSIONS: Knowledge about the variation in root canals is important in studies of past populations. This evidence may be important in relation to assessing the variability of human populations. The analysis carried out show the cohesion between the historical population of Radom and other groups from modern Poland.

Visibility of dental pulp spaces in dental ultrasound.

The purpose of this study was to assess the feasibility of dental ultrasound with conventional sonographic equipment. The teeth of three adult volunteers who had cone beam CT examinations performed previously with clinical indications and one extracted tooth were examined using linear and compact (hockey stick) sonographic probes. The sonographic images were compared with cone beam CT images reconstructed accordingly. Dental pulp spaces were demonstrated in all teeth not covered with prosthetic crowns. The dentin and pulp were best visualized at the level of the neck of the teeth. The dentin was hypoechoic, and the superficial layer comprising the cementum and the pulp spaces were hyperechoic. Dental ultrasound is feasible with general purpose sonographic machines. The buccal surfaces of all teeth are accessible with a compact (hockey stick) probe. Visualization and differentiation of dental pulp spaces, dentin and the superficial layer comprising cementum is possible in the portions of teeth not covered by the alveolar bone or prosthetic crowns. The dental pulp spaces are best seen at the level of the tooth neck. Pulp and endodontic fillings can be distinguished on ultrasound.

Vascular patterns in superficial lymphomatous lymph nodes: A detailed sonographic analysis().

PURPOSE: To identify the vascular patterns found in superficial lymph nodes with histologically confirmed lymphomatous involvement and to determine their value in the sonographic diagnosis of lymphadenopathy. METHODS AND MATERIALS: The study involved the prospective classification of vascular patterns observed during power Doppler and/or color Doppler studies of superficial lymph nodes scheduled for resection. Forty patients (27 men and 13 women, aged 22-84 years; mean age: 58 years) with pathologically proven lymphoma were selected for this study (26 cervical, 13 axillary and 1 inguinal). RESULTS: A longitudinal vessel with or without branches (pattern I) was found in 14 lymphomatous nodes. Six contained short vessel segments distributed in the hilum area or centrally (pattern II), five had multiple vessels, partially branching, entering the node in a few rows from its longitudinal side (pattern III), seven presented multiple vessels that branched irregularly or chaotically with avascular areas (pattern IV), and eight had a peripheral vessel distribution (pattern V). Therefore, 50% of the lymphomatous nodes had vascular patterns regarded as characteristic of reactive lymph nodes (patterns I and II), and 37.5% had patterns normally described in lymph nodes with metastatic involvement (patterns IV and V); other lymphomatous lymph nodes had ambiguous vascular patterns that have not been previously classified (pattern III). CONCLUSION: The angioarchitecture of superficial lymphomatous lymph nodes varies widely and is difficult to classify. It may resemble that reported in normal or reactive lymph nodes or patterns that are associated with metastases. The finding of a normal or benign vascular pattern in a lymph node with suspected lymphomatous involvement does not eliminate the need for a diagnostic biopsy.

Adrenal ganglioneuroblastoma in pregnant woman: diagnosis with three-dimensional ultrasound.

The diagnostic approach for evaluation of adrenal tumour in pregnant women is a problem. This article presents the multifactorial diagnosis of rare, incidentally detected massive adrenal tumour with 2D and 3D US. Grey-scale 2D and 3D US with tissue harmonic imaging showed inhomogeneous, encapsulated, solid tumour of the right adrenal region. Three-dimensional colour Doppler and power Doppler studies showed ample neovascularization in the tumour and the adrenal vein draining to the inferior vena cava similarly to angiographic studies performed in the past.

Mechanical detachable platinum coil: report of the European phase II clinical trial in 60 patients.

PURPOSE: To determine the safety and reliability of the mechanical detachment system of a platinum coil (Detach-18) when used for neurovascular embolization. MATERIALS AND METHODS: Sixty patients (21 men, 39 women; age range, 26-75 years; mean age, 56.2 years) were treated in seven centers. Ease of introduction of the coil to the microcatheter, effect of coil passage on the microcatheter shape and stability during its delivery, retrievability of the coil before and after the transition zone passed beyond the microcatheter, detachment of the coil, and effect of coil rotation on the microcatheter stability were evaluated. The detachment system itself was evaluated for premature detachment, failure of the coil to detach, detachment time, number of turns, visibility of radiopaque markers, number of coils deployed per patient, and percentage of vessel occlusion obtained. A 0.015-inch-diameter regular coil and a 0.014-inch-diameter soft coil were used. RESULTS: A total of 1,061 coils were used; 1,009 were detached. The number of coils deployed ranged from four to 104 (mean, 17 coils). The coils passed easily through the microcatheter. The detachment maneuver occurred within 5-25 seconds, with five to 60 turns of the introducing wire. One premature coil detachment occurred without clinical sequela; 100% occlusion of the vessel lumen was achieved in 53 patients; 80%-90%, in four; and 70%-80%, in two. There were no device-related complications. CONCLUSION: The detachment system was safe and reliable. This is a useful system for coil embolization in neurovascular diseases.

A report of the clinical use of the detach-18 mechanical detachable platinum coil in 41 patients.

BACKGROUND AND PURPOSE: The purpose of this study was to determine the safety and reliability of the mechanical detachment system of a new platinum coil, Detach-18, when used as a vascular occlusive device for neurovascular disease. METHODS: Forty-one patients (nine male and 32 female patients; age range, 26-75 years; mean age, 54.4 years) underwent treatment at seven centers. Twenty-two patients had dural arteriovenous fistulae of the transverse sinus treated by a transvenous route. Fourteen patients underwent internal carotid artery occlusion in the treatment of aneurysms, meningioma, facial tumor, or carotid injury. One patient underwent occlusion of the basilar artery and one patient underwent occlusion of the vertebral artery for treatment of aneurysms. In two patients, coils were used as part of the treatment of their arteriovenous malformations. In all cases, the Detach-18 coils were delivered through a microcatheter with two distal markers. Two types of coils, a 0.015-inch-diameter "regular" coil and a 0.014-inch-diameter "soft" coil, were used. RESULTS: A total of 569 coils were used, 541 of which were detached. The number of coils in ranged from four to 53 (average number of coils, 14). The coils passed easily through the microcatheter. The detachment maneuver occurred within 10 to 25 s with 20 turns of the introducing wire. No premature coil detachment occurred. Complete occlusion of the vessel lumen was achieved in 35 cases. In three cases, 80% to 90% occlusion was achieved. In two cases, 70% to 80% occlusion was achieved. There were no device-related complications. CONCLUSION: The detachment system was safe, reliable, consistent, and fast. This is a useful system for coil embolization in neurovascular applications.

Neurovascular embolization: in vitro evaluation of a mechanical detachable platinum coil system.

The authors evaluated a mechanically detachable platinum coil system intended for neurovascular use. The introduction characteristics, ease of delivery, ease of retrieval, and detachability were studied with fluoroscopic guidance with in vitro silicone models. All the coils passed easily through the microcatheter. The detachment maneuver occurred within 20 seconds with 20 or fewer rotations of the pusher wire. One of 229 coils detached prematurely but only after deliberate and extreme manipulation. The detachment system is safe, reliable, and consistent and will be useful for interventional neuroradiologists.

Magnetic resonance urography: initial experience of a low-dose Gd-DTPA-enhanced technique.

Contrast-enhanced magnetic resonance urography (MRU) is a promising tool in the evaluation of the renal collecting system, but it can be limited by T2* effects resulting from hyperconcentrated gadolinium chelates. The aim of this study was to evaluate a low-dose dimeglumine gadopentetate (Gd-DTPA) MRU technique consisting of a dynamic fast low-angle-shot (FLASH) 2D sequence and a static fast imaging in steady state precession (FISP) 3D sequence for depicting the kidneys and urinary tract. The Gd-DTPA dose (0.01 mmol/kg) was established experimentally in a healthy volunteer study. Ninety-one patients presenting with various renal disorders were examined with a low-dose Gd-DTPA MRU and a T2-weighted turbo spin echo (TSE) MRU technique on a 1.5-T system. Image quality and diagnostic value were considered at least satisfactory in 98.9% of the FLASH 2D studies, 83.5% of the FISP 3D studies and 78.5% of the TSE T2-weighted studies. Typical enhancement patterns were established for the renal cell carcinoma and transitional cell carcinoma. The major limitations were motion artefacts and insufficient hydration of the patients. Low-dose Gd-DTPA MRU appears to be a useful technique in the evaluation of the kidneys and urinary tract, especially in cases of renal tumours.

[Progress in imaging diagnostics of adrenal neoplasms]. / Postep w diagnostyce obrazowej guzów nadnerczy.

Computed tomography is the modality of choice in imaging of adrenal glands. Density measurements on images without contrast agent are essential for differentiation of adrenal masses. Application of spiral computed tomography for diagnostics of adrenal masses enables sensitive detection of small adrenal tumors and reliable density measurements by elimination of uneven breath-holds effect and minimization of partial volume effect. Tissue harmonic imaging in ultrasonography is a new technique, which enables visualization of abdominal parenchymal organs with higher tissue contrast with less artifacts and is especially useful in ultrasound imaging of difficult-to-image patients with high body weight. Further comparative research will enable to learn the advantages of using that technique in diagnostics of adrenal masses. Magnetic resonance imaging enables very accurate visualization diagnostics of adrenal masses. It is due to its inherent multiplanar imaging capabilities and high tissue contrast of soft tissues which enables very accurate visualization of anatomical structures in adrenal region. Introduction of new techniques of magnetic resonance imaging as chemical shift imaging and dynamic studies with paramagnetic contrast agent enables accurate differentiation of adrenal cortex adenomas from non-adenomas. In case of difficulties in adrenal diagnostics magnetic resonance imaging is often a problem solving examination in regard to other imaging techniques of adrenal region.

[Magnetic resonance techniques used in the differentiation of adrenal tumors]. / Techniki rezonansu magnetycznego przydatne w róznicowaniu guzów nadnerczy.

Noninvasive differentiation of adrenal masses by imaging studies as computed tomography and magnetic resonance imaging is an accepted diagnostic procedure in patients with extraadrenal neoplasm and discovered on imaging studies adrenal mass or in patients with incidentally discovered adrenal mass. Significant impact on possibilities of differentiation of adrenal masses with magnetic resonance imaging was due to introduction to adrenal imaging such techniques as chemical shift imaging and dynamic imaging with paramagnetic contrast agent. Differentiation of adrenal masses with magnetic resonance imaging involves following parameters: tumor diameter, signal intensity of adrenal mass on T2 weighted images, lipid contents in adrenal tumor evaluated with chemical shift imaging and washout of paramagnetic contrast agent from adrenal mass evaluated with dynamic examination. The best results, reaching 100% sensitivity and 100% specificity in differentiation adrenal adenomas from non-adenomas, can be achieved by combined analysis of all mentioned parameters. In regard to availability and costs computed tomography not magnetic resonance imaging is the examination of choice in visualization of adrenal glands and their pathology and in differentiation of adrenal masses. Adrenal tumors on non-enhanced images with density below 0 Hounsfield units can reliably be diagnosed as adenomas, whereas adrenal tumors with density above 20 Hounsfield units can reliably be diagnosed as non-adenomas. Tumors with density in 0-20 Hounsfield range are ambiguous in character, that in many cases can be determined in magnetic resonance imaging.

[Evolution of vestibular schwannoma: radiological evaluation]. / Ewolucja nerwiaków nerwu VIII--ocena radiologiczna.

Objective evaluation of natural history of vestibular schwannomas can be performed based on the modern radiological investigations, mainly MR. This study included 7 vestibular schwannomas. The average observation period was 28 months. Tumor growth was calculated based on the comparison of volume on the first and subsequent MR image using a special dedicated software. All tumors in this study were growing. The average growth rate was 143 mm3/month. Among 7 primarily observed tumors, 4 schwannomas were already removed surgically. The remaining 3 tumors are still observed. The authors pointed out that longer were the radiological observations of vestibular schwannomas greater was the conviction about progression of majority of these tumors.

The effect of contrast material on transcranial Doppler evaluation of normal middle cerebral artery peak systolic velocity.

BACKGROUND AND PURPOSE: Several recent studies have shown that sonographic contrast agents may affect transcranial Doppler evaluation of the arterial peak systolic velocity (PSV). Some investigators reported an increase in PSV, and others reported no change in PSV compared with baseline values. This study was conducted to determine the effect of sonographic contrast agent on PSV measured in normal middle cerebral arteries. METHODS: Continuous spectral Doppler sonography was performed on the right middle cerebral artery of 20 participants with angiographically proven normal intracranial vasculature. Videotaping was performed in each case from the initiation of the administration of contrast medium until the effect of the contrast agent on the PSV subsided. The PSV values were normalized for each participant, were pooled, and were plotted as a function of time. RESULTS: PSV increased in all participants after the administration of contrast material; the mean maximum increase was 24+/-7.4% (mean +/- standard deviation) (range, 15-36%). The mean duration of PSV increase was 320+/-97 s (range, 165-465 s). CONCLUSION: The middle cerebral artery PSV increased substantially after the administration of contrast material. This effect needs to be considered if velocity thresholds developed for disease detection without the use of contrast materials are used when contrast agents are administered.

Metabolic heterogeneity at the level of the anterior and posterior commissures.

Multislice, 2D proton spectroscopic imaging was performed in six healthy volunteers at long echo time (TE = 280 msec). The center of the most inferior of three slices was placed directly at the level of the line connecting the anterior and posterior commissures. Significant regional variations in metabolite levels were observed. In particular, based on statistical analysis, levels of choline were significantly high in insular cortex, thalamus, and centrum semiovale compared to other brain regions such as parietal or occipital gray and white matter. NAA levels were highest in the centrum semiovale white matter, while creatine levels were relatively constant. Globus pallidus exhibited lower signal intensities and increased linewidths for all metabolites. No spectra could be obtained from the inferior frontal lobe because of field inhomogeneity. These data show that the metabolism, and perhaps the underlying cellular composition, of thalamus and insular cortex appears to be different from other neocortical gray matter. Normal regional variations in the brain spectra should be considered when evaluating pathological conditions.

Occurrence of adverse reactions to gadolinium-based contrast material and management of patients at increased risk: a survey of the American Society of Neuroradiology Fellowship Directors.

RATIONALE AND OBJECTIVES: The authors attempted to determine the frequency and severity of adverse reactions to gadolinium-based magnetic resonance (MR) contrast agents and to identify strategies for management of patients at increased risk. MATERIALS AND METHODS: American Society of Neuroradiology program directors were surveyed about adverse reactions at their institutions to gadolinium-based contrast agents, the contrast agents responsible, and the management of patients with allergy-like reactions to iodinated or gadolinium-based agents who required MR contrast agent administration. RESULTS: Fifty-three (50.5%) surveys were received from 105 centers. Of 687,255 gadopentetate dimeglumine injections, 314 (0.046%) nonallergic reactions and 107 (0.016%) mild, 28 (0.004%) moderate, and five (0.001%) severe allergy-like reactions occurred. Of 74,275 gadodiamide injections, 11 (0.015%) nonallergic and 12 (0.016%) mild allergy-like reactions occurred. Of 64,005 gadoteridol administrations, 171 (0.267%) nonallergic reactions and 49 (0.077%) mild, 29 (0.047%) moderate, and 11 (0.017%) severe allergy-like reactions occurred. Twenty-six departments took no precautions for patients with previous allergy-like reactions to iodinated contrast material. Nineteen did not premedicate patients who previously had reactions to gadolinium-based agents before repeat administration of MR contrast agents. CONCLUSION: Although MR contrast agents are safe, adverse reactions occur. Many centers have not adopted policies for the OFF

[A case of giant hemangioma of the vertebral canal]. / Przypadek olbrzymiego naczyniaka rdzenia kregowego.

An 18-year-old girl with rarely occurring extensive vertebral canal haemangioma is described. The clinical onset of the disease was sudden, with weakness of lower extremities and girdle pains at the level of lower ribs. Despite several recurrences of the symptoms and permanent motor function deficit the patient was able after reparative operations, radiotherapy, rehabilitation treatment and pharmacological therapy to move around unaided using elbow crutches.