Three-dimensional simulation of lung nodules for paediatric multidetector array CT.

The purpose of this study was to develop and validate a technique for three-dimensional (3D) modelling of small lung nodules on paediatric multidetector array computed tomography (MDCT) images. Clinical images were selected from 21 patients (<18 years old) who underwent MDCT examinations. Sixteen of the patients had one or more real lung nodules with diameters between 2.5 and 6 mm. A mathematical simulation technique was developed to emulate the 3D characteristics of the real nodules. To validate this technique, MDCT images of 34 real nodules and 55 simulated nodules were randomised and rated independently by four experienced paediatric radiologists on a continuous scale of appearance between 0 (definitely not real) and 100 (definitely real). Receiver operating characteristic (ROC) analysis, t-test, and equivalence test were performed to assess the radiologists' ability to distinguish between simulated and real nodules. The two types of nodules were also compared in terms of measured shape and contrast profile irregularities. The areas under the ROC curves were 0.59, 0.60, 0.40, and 0.63 for the four observers. Mean score differences between simulated and real nodules were -8, -11, 13, and -4 for the four observers with p-values of 0.17, 0.06, 0.17, and 0.26, respectively. The simulated and real nodules were perceptually equivalent and had comparable shape and contrast profile irregularities. In conclusion, mathematical simulation is a feasible technique for creating realistic small lung nodules on paediatric MDCT images.

Reperfusion edema after lung transplantation: effect of daclizumab.

PURPOSE: To determine if daclizumab, an interleukin-2 antagonist, reduced the severity of reperfusion edema in lung transplant recipients. MATERIALS AND METHODS: Eighty-five patients who were to undergo 86 consecutive lung transplants were included; 43 (50%) received daclizumab in addition to conventional immunosuppression. Patients were assigned to one of the following groups: control, right allograft; control, left allograft; daclizumab treated, right allograft; daclizumab treated, left allograft. Radiographs obtained in the first 5 postoperative days were evaluated for degree of edema. Mean daily edema scores and curves for control and daclizumab-treated groups were compared. Differences in survival at 1, 3, 6, and 12 months after transplantation, days of mechanical ventilation, and the ratio of arterial oxygenation to inspired oxygen level at 1, 3, and 5 days after transplantation were also compared. RESULTS: Mean daily edema scores, edema curves, survival, days of mechanical ventilation, and ratio of arterial oxygenation to inspired oxygen level at 1 and 3 days after transplantation did not significantly differ between daclizumab-treated and control groups. A trend toward improved survival in the daclizumab-treated group was noted. CONCLUSION: Daclizumab had no effect on the radiographic or immediate clinical manifestations of reperfusion edema in lung transplant recipients. Additional follow-up is needed to determine if daclizumab offers any long-term benefit in terms of reduced rejection rates or survival.

Ultrasonographic evaluation of the cervix: transperineal versus endovaginal imaging.

OBJECTIVE: This study compares transperineal and endovaginal ultrasonography of the gravid cervix to evaluate image quality and assess for a systematic difference in cervical lengths measured by the 2 techniques. METHODS: Transperineal and endovaginal ultrasonography of the cervix was performed on 64 pregnant women. Two physicians reviewed the images and rated the relative diagnostic value of the techniques for assessing the cervix and for evaluating for placenta previa. Cervical length was measured prospectively in both techniques. Data were analyzed to determine if there is a systematic difference in length using the 2 approaches and if length differences are dependent on gestational age. RESULTS: There was a strong reviewer preference for endovaginal ultrasonographic images over transperineal images for both assessing the cervix (P< .001) and evaluating for placenta previa (P< .001). Despite this, transperineal and endovaginal ultrasonographic images were frequently rated as similar in diagnostic quality by both reviewers for depicting the cervix (35.9% of patients) and evaluating for placenta previa (57.8% of patients). The mean length of the cervix was slightly shorter at transperineal ultrasonography (28.4 mm) than at endovaginal ultrasonography (30.1 mm). When cervical lengths were subdivided by gestational age, however, a significant length discrepancy was found only in the 14- to 20-week gestational age range. In this age range, mean cervical length at transperineal ultrasonography (28.6 mm) averaged 5.5 mm less than at endovaginal ultrasonography (34.1 mm). CONCLUSIONS: Both transperineal and endovaginal ultrasonography can provide satisfactory images of the cervix, but endovaginal images are frequently superior to transperineal images. Endovaginal ultrasonography should be considered the optimal method for imaging the cervix in most situations. Transabdominal or transperineal ultrasonography can also be used, but if the cervix is not adequately depicted from these perspectives, endovaginal ultrasonography is indicated. Transperineal measurements of cervical length can be significantly shorter than endovaginal measurements, particularly before 20 weeks; therefore, short cervical lengths documented at transperineal ultrasonography before 20 weeks should be confirmed by endovaginal ultrasonography.

Breakthrough adverse reactions to low-osmolar contrast media after steroid premedication.

OBJECTIVE: The purpose of this study was to review the nature of adverse reactions, or "breakthrough reactions," experienced by patients who received steroid premedication and low-osmolar contrast media. We compared the demographics of patients having these breakthrough reactions with those of patients who did not develop these reactions. MATERIALS AND METHODS: We retrospectively reviewed our radiology quality improvement database to identify patients with breakthrough reactions that occurred from January 1, 1994, through October 1, 1999, and we reviewed their medical records. We compared these patients with a control cohort of patients who had a history of prior adverse reaction to contrast media but no breakthrough reaction after administration of low-osmolar contrast media and premedication with corticosteroids. RESULTS: Over the 6-year period, 52 patients experienced 61 breakthrough reactions. The breakthrough reaction was mild in 76% of the patients. The breakthrough reaction was similar to the patient's initial adverse reaction in 85% of the patients. A history of seafood allergy or hay fever was statistically more likely to be identified in the breakthrough group than the control group. CONCLUSION: Breakthrough reactions occur in a substantial number of patients despite premedication with steroids and use of low-osmolar contrast agents. Typically the breakthrough reaction is of similar severity to the patient's initial reaction. Severe or life-threatening reactions are seen in 24% of patients.

Two-dimensional multiplanar and three-dimensional volume-rendered vascular CT in pancreatic carcinoma: interobserver agreement and comparison with standard helical techniques.

OBJECTIVE: The purpose of this study was to compare two-dimensional curved multiplanar and three-dimensional reconstructions, routine axial presentations, and combined techniques in the assessment of vascular involvement by pancreatic malignancy. MATERIALS AND METHODS: For 44 patients with known pancreatic malignancy a total of 56 arterial phase helical CT scans were obtained. Targeted pancreatic imaging was performed, and reformatted images were generated. Axial source images, reformatted images, and the combination of axial and reformatted images were interpreted independently by three observers. The observers graded the celiac axis, common and proper hepatic, splenic, gastroduodenal, and superior mesenteric arteries for tumor involvement. Grades of vascular involvement were compared by intra- and interobserver variability analyses. RESULTS: Intraobserver agreement averaged over five vessels was good between the axial and combined techniques for each individual observer (0.64 < or kappa < or = 0.66), but intraobserver agreement was poor between the axial and reformatted (kappa = 0.17 and kappa = 0.31, respectively) and the reformatted and combined techniques (kappa = 0.31 and kappa = 0.38, respectively) for two observers. For grading of vascular involvement in each vessel, intraobserver agreement was good to excellent between the axial and combined techniques (0.48 or = kappa < or = 0.82). Interobserver agreement averaged over five vessels was poor for imaging techniques except between observer 2 and observer 3 on the axial (kappa = 0.47) and combined techniques (kappa = 0.47). For grading of vascular involvement in each vessel, interobserver agreement for reformatted technique was poor (0.09 < or = kappa < or = 0.40). CONCLUSION: Multiplanar and volume-rendered techniques showed the highest intra- and interobserver variability in grading vascular involvement by pancreatic malignancy. These images should be used in combination with routine axial images to decrease observer variability.

Increased brain apparent diffusion coefficient in children with neurofibromatosis type 1.

PURPOSE: To describe the changes in brain water diffusibility in five anatomic locations in children with neurofibromatosis type 1 (NF 1) compared with these changes in control subjects and to describe the water diffusibility changes associated with hyperintense basal ganglia lesions in children with NF 1. MATERIALS AND METHODS: Twenty highly related pairs of children consisting of one child with NF 1 and one unaffected child were examined. Prospective comparisons of isotropic apparent diffusion coefficient (ADC) values at five anatomic locations were performed, with and without T2-hyperintense lesions included. Retrospective analysis of hyperintense globus pallidus lesions in 16 children and in the paired control subjects also was performed. RESULTS: Significant increases in ADC values were seen in all five anatomic locations in the NF 1 group. The greatest increases were seen in the globus pallidus (14%; P =.002) and brachium pontis (10.8%; P =.003). With exclusion of hyperintense lesions, significant ADC increases were measured in four locations. Significant ADC increases were seen in hyperintense globus pallidus lesions in the NF 1 group compared with ADC values in the normal-appearing contralateral globus pallidus (4.9%; P =.02) and those in the globus pallidus of the paired control subjects (16%; P =.003). CONCLUSION: Significant ADC increases were measured both in the hyperintense lesions and in the normal-appearing areas of the brain in children with NF 1.

Use of exponential diffusion imaging to determine the age of ischemic infarcts.

OBJECTIVE: Diffusion-weighted magnetic resonance imaging (DWI) detects acute ischemic infarcts with high lesion conspicuity. Determination of infarct age is difficult on DWI alone because infarct signal intensity (SIinfarct) on DWI is influenced by T2 properties ("T2 shine-through"). Maps of the apparent diffusion coefficient (ADC) reflect pure diffusion characteristics without T2 effects but have low lesion conspicuity. Thus, in clinical practice, combined use of DWI and ADC maps is required. Exponential DWI (eDWI) is an innovative means of MRI-diffusion data analysis that merges the advantages of DWI and ADC maps. The authors hypothesized that SIinfarct on eDWI would correlate with infarct age. The authors studied 114 consecutive patients who had 120 ischemic strokes with clearly determined onset times and who underwent echo-planar DWI. The eDWI were generated by dividing the signal intensity on DWI by that on the corresponding T2 image on a pixel-by-pixel basis. SIinfarct on eDWI was measured in the lesion core and expressed as a percentage of contralateral control tissue. On eDWI, relative SIinfarct changed significantly with infarct age (P < .0001). When patients were sorted in infarct-age groups, no significant differences were found within the first 120 hours. However, for patients studied within 5 days, the mean relative SIinfarct was significantly higher compared with patients studied > or = 8 days after stroke (P < .05). For all infarcts up to 5 days old, the eDWI signal intensity was higher than control tissue (hyperintense appearance). All infarcts > 10 days old had an eDWI signal intensity lower than control tissue (hypointense appearance). The authors concluded that the use of eDWI, as a single set of images, reliably differentiates acute infarcts (< or = 5 days old) from infarcts > 10 days old. This feature would be expected to be helpful when the distinction between acute and nonacute infarction cannot be determined on clinical grounds.

The anterior iliac separation: alternative index for pelvic morphometry in fetuses with Down syndrome.

OBJECTIVE: The goal of this study was to assess the diagnostic use of an anterior iliac separation measurement as an alternative index for the iliac angle in the assessment of fetal pelvic morphometry. SUBJECTS AND METHODS: In 358 fetuses, the anterior iliac separation, iliac length, and iliac angle were prospectively measured on antenatal sonography. All measurements were obtained at two axial levels (superior and inferior). The gestational age of the fetus was recorded. The anterior iliac separation was normalized by iliac length, and coefficients of variation were calculated for all measurements. The effects of axial level and gestational age were assessed in a linear regression model. The diagnostic use of the anterior iliac separation relative to that of the iliac angle was assessed in a comparison of 24 fetuses with Down syndrome and 247 non-Down syndrome fetuses. RESULTS: The anterior iliac separation was less variable than the iliac angle at both superior and inferior levels. There were statistically significant effects for gestational age and axial level on both the anterior iliac separation and the iliac angle, but there was no significant effect for either factor when the anterior iliac separation was normalized by the iliac length. Comparing Down and non-Down syndrome fetuses, we found that the normalized anterior iliac separation had discriminating power similar to the iliac angle. CONCLUSION: The linear measurement of the anterior iliac separation has diagnostic properties similar to the iliac angle and is subject to less measurement variability. This simpler measurement may be particularly useful when normalized by the iliac length.

Nonenhanced helical CT and US in the emergency evaluation of patients with renal colic: prospective comparison.

PURPOSE: To compare nonenhanced helical computed tomography (CT) with ultrasonography (US) for the depiction of urolithiasis. MATERIALS AND METHODS: During 9 months, 45 patients (mean age, 44 years; mean weight, 92.5 kg) prospectively underwent both nonenhanced helical CT (5-mm collimation; pitch of 1.5) and US of the kidneys, ureters, and bladder. US evaluation included a careful search for ureteral calculi. Presence of calculi and obstruction and incidental diagnoses were recorded. Clinical, surgical, and/or imaging follow-up data were obtained in all patients. The McNemar test was used to compare groups. RESULTS: Diagnoses included 23 ureteral calculi and one each of renal cell carcinoma, appendicitis, ureteropelvic junction obstruction, renal subcapsular hematoma, cholelithiasis, medullary calcinosis, and myelolipoma. CT depicted 22 of 23 ureteral calculi (sensitivity, 96%). US depicted 14 of 23 ureteral calculi (sensitivity, 61%). Differences in sensitivity were statistically significant (P: =.02). Specificity for each technique was 100%. When modalities were compared for the detection of any clinically relevant abnormality (eg, unilateral hydronephrosis and/or urolithiasis in patients with an obstructing calculus), sensitivities of US and CT increased to 92% and 100%, respectively. One case of appendicitis was missed at US, whereas medullary calcinosis and myelolipoma were missed at CT. CONCLUSION: Nonenhanced CT has a higher sensitivity for the detection of ureteral calculi compared with US.

The effect of aging on the apparent diffusion coefficient of normal-appearing white matter.

OBJECTIVE: The purpose of our study was to test the hypothesis that the apparent diffusion coefficient (ADC) of normal-appearing white matter increases with advancing age. SUBJECTS AND METHODS: We selected 38 patients with normal MR imaging findings from 332 patients undergoing clinical MR imaging. Diffusion-weighted MR imaging was performed with diffusion gradients applied in three orthogonal directions. For each patient, the average ADC on trace-weighted diffusion images of white matter at prespecified regions of interest and at the thalamus were compared with the patient's age. RESULTS: For the white matter, ADC sorted by patient age in decades increased with advancing age. Patients at least 60 years old had significantly higher ADC (0.769 +/- 0.019 mm(2)/sec x 10(-3)) than patients less than 60 years old (0.740 +/- 0.013 mm(2)/sec x 10(-3)) (p < 0.001). Comparison of individual white matter ADC and age showed a significant increase with advancing age (p < 0.0001). For the thalamus, the average ADC among patients at least 60 years old (0.766 +/- 0.015 mm(2)/sec x 10(-3)) exceeded the average ADC for patients less than 60 years old (0.745 +/- 0.022 mm(2)/sec x 10(-3)) (p < 0.05). However, comparison of individual thalamic ADC and patient ages, although showing a trend to higher ADC with increasing age, did not reach statistical significance (p = 0.06). CONCLUSION: Advancing age is associated with a small but statistically significant increase of water diffusibility in human white matter. A similar trend was present in the thalamus. These increases may reflect mild structural changes associated with normal aging.

Normal fetal pelvis: important factors for morphometric characterization with US.

PURPOSE: To prospectively evaluate iliac angle and iliac length in a large number of normal fetuses and to identify factors that may influence these measurements. MATERIALS AND METHODS: At antenatal ultrasonography (US) in 356 fetuses, the iliac angle and iliac length were measured at two axial levels (superior and inferior). In mixed linear models, the statistical significance and magnitude of effect on the measurement of iliac angle and iliac length were estimated for gestational age, fetal sex, maternal diabetes status, axial level, and spine position relative to the transducer. RESULTS: Statistically significant effects were found for gestational age, axial level, and spine orientation but not for fetal sex or maternal diabetes status. The iliac angle was found to decrease by 15.7 degrees from the superior to inferior portion of the pelvis, decrease by approximately 0.37 degrees /wk, and decrease by as much as 15.6 degrees when the spine is directed to the side. Iliac length was found to increase by 0.8 mm/wk from 13 weeks to term, decrease by 1.2 mm from the superior to the inferior portion of the pelvis, and increase by as much as 1.29 mm when the spine is not directly subjacent to the transducer. CONCLUSION: The axial level of measurement, gestational age, and spine orientation must be accounted for if these morphometric indexes are used to discriminate fetuses with and those without Down syndrome.

Comparison of sonographic and CT guidance techniques: does CT fluoroscopy decrease procedure time?

OBJECTIVE: Procedure times for percutaneous biopsies were compared for various guidance techniques including helical CT, CT fluoroscopy, sonography with an attached needle guide, and freehand sonography with computer guidance. MATERIALS AND METHODS: Three interventional radiologists experienced in CT- and sonographically guided procedures performed biopsies on a phantom model. The phantom simulated hepatic metastases of various sizes and depths with subcostal or intercostal locations. Lesion sizes were 7, 10, and 20 mm, at 3- and 7-cm depths. Using self-aspirating needles, two passes were performed in each lesion. Mean procedure time per biopsy pass was calculated. A two-tailed Student's t test was used to compare guidance techniques. RESULTS: Mean procedure time per biopsy pass for the four guidance techniques was sonography with a needle guide, 36+/-9 sec; sonography with computer guidance, 43+/-10 sec; helical CT, 146+/-42 sec; and CT fluoroscopy, 50+/-18 sec. CT fluoroscopy required 2.6+/-1.0 sec per biopsy. Helical CT required more procedure time than sonography with a needle guide, CT with computer guidance, and CT fluoroscopy (p < 0.0001). Sonography with a needle guide required less procedure time than sonography with computer guidance (p < 0.002) and CT fluoroscopy (p = 0.0003). Procedure times for CT fluoroscopy and sonography with computer guidance were not statistically different (p = 0.06). CT and sonographic guidance were equally effective regardless of lesion size, depth, or location. CONCLUSION: Traditional sonographic biopsy techniques are faster and more cost-effective than traditional CT techniques; however, CT fluoroscopy offers the localization advantages of CT with improved procedure times.

Comparison of patient age with MR imaging features of gangliogliomas.

OBJECTIVE: The purpose of this study was to compare MR imaging features of gangliogliomas in children less than 10 years old with those seen in patients at least 10 years old. MATERIALS AND METHODS: Our study population consisted of 15 female patients and 10 male patients with a mean age of 20 years. The early childhood group was composed of six children with a mean age of 5.5 years. The older group was composed of 19 patients with a mean age of 25.6 years. We assessed tumor volume, tumor location, percentage of tumor that was cystic, pattern of contrast enhancement, and degree of edema. RESULTS: The temporal lobe was the most common tumor location in both groups. Mean tumor volume in the early childhood group was 83 cm3, which was significantly larger than the mean tumor volume (9.78 cm3) for the older group (p = 0.001). Cystic tumors were more common in the early childhood group (83%) than in the older group (63%), and the average percentage of cysts in the cystic tumors was much higher in the early childhood group (67%) than in the older group (30%). Contrast enhancement was seen in five of six early childhood tumors and 13 of 16 tumors in older patients. Four of six tumors in the early childhood group and five of 19 tumors in the older patient group had associated edema. CONCLUSION: The mean tumor volume of gangliogliomas in the early childhood group was significantly larger than that of the older patient group. This finding may be indicative of differences in tumor growth patterns in the two groups, ability of the hemicranium to adjust to mass effect in childhood, or sampling error as a result of a relatively small sample size.

Hepatic parenchymal enhancement during triple-phase helical CT: can it be used to predict which patients with breast cancer will develop hepatic metastases?

PURPOSE: To evaluate the efficacy of hepatic enhancement characteristics for identification of patients with breast cancer who are at risk for future hepatic metastases. MATERIALS AND METHODS: Triple-phase helical computed tomography (CT) was performed in 60 patients with known breast cancer without visible hepatic metastases. Peak hepatic attenuation and enhancement, and attenuation and enhancement at 25 and 30 seconds were obtained. Ratios of hepatic attenuation or enhancement at 25 and 30 seconds to peak hepatic attenuation or enhancement were calculated. A Wilcoxon rank sum test was used to compare patients with and those without subsequent hepatic metastases. RESULTS: During a mean 18-month follow-up, 18 patients (30%) developed hepatic metastases. Decreases in peak hepatic attenuation and enhancement and increases in hepatic attenuation and enhancement ratios at 25 and 30 seconds were seen in patients who developed metastases compared with those who did not (P < .05). When corrected for chemotherapy interval, these differences were not statistically significant. Using a threshold value of 0.40 or more for the enhancement ratio at 30 seconds resulted in sensitivity of 28%, specificity of 92%, and accuracy of 55%. CONCLUSION: Patients with breast cancer who develop subsequent hepatic metastases have higher relative hepatic arterial perfusion during triple-phase CT; however, after correction for chemotherapy interval, this difference was not statistically significant. Threshold values cannot be used reliably to identify patients who will develop metastases.

Variability of Doppler US measurements along the common carotid artery: effects on estimates of internal carotid arterial stenosis in patients with angiographically proved disease.

PURPOSE: To determine the effect of variability of common carotid arterial (CCA) velocities on velocity ratios used to assess internal carotid arterial (ICA) stenosis. MATERIALS AND METHODS: Doppler ultrasonographic (US) velocity measurements were obtained at three levels in the CCA and in the carotid bulb and ICA in all patients referred for carotid US between September 1996 and October 1997. Only ICAs (n = 98, in 57 patients) without ipsilateral CCA disease at angiography were analyzed. The range of CCA peak systolic velocities (PSVs) and end diastolic velocities (EDVs) and velocity ratios were calculated for each CCA measurement. For each ICA/CCA velocity ratio, receiver operating characteristic analysis was performed. RESULTS: CCA PSV and EDV ranges averaged 23.1 cm/sec +/- 15.7 (SD) and 5.1 cm/sec +/- 3.6, respectively. For a given side, the difference averaged 1.0 +/- 1.3 for PSV ratios and 2.7 +/- 6.9 for EDV ratios, depending on where CCA measurements were taken. By using a threshold of 60% stenosis as indication for endarterectomy, variability in CCA velocities could have altered recommendations in 16 (28%) of 57 patients. Receiver operating characteristic analysis showed that ratios made by using the three CCA velocities or their mean were not significantly different. CONCLUSION: Variability in velocity measurements along the course of the CCA in patients with ICA disease can be substantial and can result in inaccuracies in assessment of carotid stenosis.

Evaluation of pseudoenhancement of renal cysts during contrast-enhanced CT.

OBJECTIVE: The purpose of our study was to evaluate renal cyst pseudoenhancement during helical CT in a phantom model and in patients. MATERIALS AND METHODS: Iodine baths containing water-filled spheres and cylinders were constructed to simulate cysts in enhancing renal parenchyma. Iodine concentration, cyst size and location, collimation, and peak kilovoltage were varied and cyst attenuation was measured. Data were analyzed with the mixed linear models and Mantel-Haenszel tests. Subsequently, a paired t test compared CT attenuation values before and after contrast material enhancement in 40 patients with 68 renal cysts (radiographic stability >3 months). RESULTS: The attenuation values of phantom cysts increased when placed in a contrast media bath (p = 0.001). The increase in attenuation values became more pronounced with increasing iodine concentrations, decreasing peak kilovoltage, and smaller sphere sizes. In patients, mean cyst attenuation increased 3.4 +/- 6.2 H after administration of contrast material (p = 0.00002). The attenuation did not increase more than 10 H in any of the 37 cysts larger than 2 cm found in patients. Eight (26%) of the 31 cysts smaller than 2 cm found in patients increased by at least 10 H. CONCLUSION: In a phantom model, at simulated physiologic levels of renal enhancement, cysts may pseudoenhance by more than 10 H. Similarly, in patients, cysts may also pseudoenhance; however, most pseudoenhancement does not exceed 10 H. In patients, pseudoenhancement of at least 10 H is more likely in cysts smaller than 2 cm.

Pelvic CT morphometry in Down syndrome: implications for prenatal US evaluation--preliminary results.

PURPOSE: To characterize pelvic morphometric differences in patients with and those without Down syndrome by using computed tomography (CT) and to determine useful indexes for ultrasonographic (US) evaluation. MATERIALS AND METHODS: Pelvic CT scans in seven patients with Down syndrome and in 27 patients without Down syndrome were reviewed. Iliac angle, iliac length, sacroiliac joint angle, and anterior iliac wing separation were measured at superior, middle, and inferior transverse sacral levels. The effects of chromosomal status and transverse level were evaluated statistically. RESULTS: Significant differences were found for mean iliac angle (P < .007) and length (P < .005) between patients without Down syndrome (angle, 75 degrees; length, 8.4 cm) and those with Down syndrome (angle, 82 degrees; length, 7.5 cm). Depending on the level of measurement, variations in iliac angle between patients without and those with Down syndrome were as much as 13 degrees and 15 degrees, respectively, and variations in length were as much as 1.6 cm and 0.9 cm, respectively. The greatest differences were at the middle sacral level. Sacroiliac joint angle and the anterior iliac wing separation were not different between groups. CONCLUSION: Patients with Down syndrome had a larger mean iliac angle and a shorter mean iliac length. The most pronounced differences were at the middle sacral level, which suggests that this may be the optimal level for measuring these parameters at prenatal US.

Mammography pain in women treated conservatively for breast cancer.

In this study, pain during mammography in women treated conservatively for breast cancer was examined. It studied pain intensity and its relation to a variety of demographic, medical, and pain coping variables as well as to objective measures of breast compression. Ninety-nine women, treated with lumpectomy (with or without radiation) and undergoing follow-up screening mammography, were asked about strategies they use to cope with everyday pain and then were asked to report pain experienced during the mammogram. Treated and untreated breasts were rated separately and compared with a sample of 125 control women with no history of breast cancer. Women reported significantly greater pain in the treated breast (41% greater than the untreated breast and 32% greater than the control group). There was no consistent relationship between mammography pain and pain coping. Average intensity of pain at last mammogram was the best predictor of pain in both breasts. Women treated conservatively for breast cancer experience significantly greater pain during mammography of their treated breast. Radiologists and technologists can identify women at risk for a painful mammogram by asking about the pain at last mammogram. By applying pain-reducing interventions, they might be able to make the mammography experience more tolerable for these women.

Intracerebral hemorrhage outcome: apolipoprotein E genotype, hematoma, and edema volumes.

We investigated whether early hematoma or edema volumes could explain the adverse association between APOE epsilon4 and survival in intracerebral hemorrhage. Among 102 patients, epsilon4 carriers had a higher mortality rate than non-epsilon4 carriers (38 versus 24%, p = 0.05). Nonsurvivors had larger hematoma (75.5 cm3 versus 27.1 cm3, p<0.001) and edema volumes (37.5 cm3 versus 17.1 cm3, p<0.01), but these were not associated with epsilon4 after adjusting for race, age, and type of hemorrhage.

Comparison of unenhanced, hepatic arterial-dominant, and portal venous-dominant phase helical CT for the detection of liver metastases in women with breast carcinoma.

OBJECTIVE: The purpose of this study was to evaluate triple-phase helical CT for detection of hepatic metastases from breast carcinoma. SUBJECTS AND METHODS: Breast cancer patients were studied prospectively with triple-phase helical CT in 300 consecutive examinations. Hepatic arterial-dominant and portal venous-dominant phase scans were initiated at 20 and 65 sec, respectively, after IV injection of 175 ml of iopamidol (30 mg/ml) at 5 ml/sec. Three independent observers each reviewed 200 cases of the portal venous-dominant phase for lesion number, conspicuity, and attenuation. Subsequently, portal venous-dominant phase images were reevaluated in conjunction with hepatic arterial-dominant phase or unenhanced images. RESULTS: Hepatic metastases were identified in 79 (26%) of 300 cases. Lesions detected on portal venous-dominant, hepatic arterial-dominant, and unenhanced images were as follows: observer 1, n = 198, 164, and 171; observer 2, n = 254, 233, and 233; and observer 3, n = 291, 270, and 276 (p > .05). The mean total lesion count was 387, with more lesions detected on portal venous-dominant phase than on either hepatic arterial-dominant phase or unenhanced images (p < .001 and p < .0001, respectively). For individual observers, 10-26% of lesions were hypervascular on hepatic arterial-dominant phase images. Two to 4% of lesions were identified only on hepatic arterial-dominant phase or unenhanced images. However, in these few cases, the lesions either were false-positives or were seen in conjunction with additional metastases on portal venous-dominant images. CONCLUSION: Routine use of triple-phase CT in patients with breast carcinoma may not be warranted: Addition of the hepatic arterial-dominant phase or unenhanced images revealed few additional lesions in our group of 300 patients.