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Kim SH, Choi D, Kim SH, Lim JH, Lee WJ, Kim MJ, Lim HK, Lee SJ.
OBJECTIVE: We compared ferucarbotran-enhanced MRI with triple-phase MDCT for the preoperative detection of hepatocellular carcinoma.
SUBJECTS AND METHODS: Seventy-three consecutive patients with 121 hepatocellular carcinomas underwent ferucarbotran-enhanced MRI, including a dynamic study, and triple-phase MDCT before hepatic resection. The diagnosis of hepatocellular carcinoma was confirmed in all patients by means of pathologic examination after surgical resection. Three experienced radiologists independently reviewed the MR and CT images on a segment-by-segment basis. The accuracy of these techniques for the detection of hepatocellular carcinoma was assessed by conducting a receiver operating characteristic (ROC) analysis of the observations of 88 resected hepatic segments with at least one hepatocellular carcinoma each and 121 resected hepatic segments without hepatocellular carcinoma.
RESULTS: The mean values of the area under the ROC curve (A(z)) for ferucarbotran-enhanced MRI and triple-phase MDCT for all observers were 0.947 and 0.949, respectively; the difference between these two values was not statistically significant (p = 0.799). The mean sensitivities of MRI and triple-phase MDCT were 90.2% and 91.3%, respectively, and their mean specificities were 97.0% and 95.3%, respectively. The differences in the mean sensitivities and specificities of these two imaging techniques were not statistically significant (p > 0.05 in each case).
CONCLUSION: Ferucarbotran-enhanced MRI seems to be as accurate as triple-phase MDCT for the preoperative detection of hepatocellular carcinoma.
AJR Am J Roentgenol. 2005 Apr;184(4):1069-76.
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March 2005
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Fellner C, Lang W, Janka R, Wutke R, Bautz W, Fellner FA.
PURPOSE: To compare three different magnetic resonance angiography (MRA) techniques with x-ray angiography and endarterectomy specimens.
MATERIALS AND METHODS: Twenty-one patients underwent x-ray angiography, three-dimensional time-of-flight (TOF) focusing on the carotid bifurcation, high-resolution (HR) contrast-enhanced (CE) MRA, and time-resolved CE MRA. Stenoses of internal carotid arteries were evaluated by three independent observers on identical projection of x-ray angiography and MRA. Maximum stenosis grades on MRA were assessed additionally and correlated with endarterectomy specimens in 12 cases.
RESULTS: Sensitivity for the detection of severe stenoses was excellent (100%) for all MRA techniques, and specificity was superior for three-dimensional TOF (96.7%) compared with HR CE MRA (80.6%) and time-resolved CE MRA (83.9%). The correlation between x-ray angiography and MRA for all stenoses was slightly superior for three-dimensional TOF and HR CE MRA compared with the time-resolved technique (kappa = 0.87 and 0.86 vs. 0.84). The same trend was seen for the interobserver agreement and for the correlation with endarterectomy specimens. Eleven up to 17 stenoses (depending on the MRA technique) were graded higher using additional projections.
CONCLUSION: Three-dimensional TOF MRA yielded even more accurate results than HR CE MRA in grading of stenoses near the carotid bifurcation. Therefore, a combination of both methods seems to be advantageous.
J. Magn. Reson. Imaging 2005;21:424-431.
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March 2005
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Causes-
Most common-frost bite
Alkaptonuria
Cushing syndrome
Addisons disease
Relapsing polychondritis
From- Review of Radiology-second edition by Sumer K Sethi,Peepee publishers.
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March 2005
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Fischmann A, Siegmann KC, Wersebe A, Claussen CD, Muller-Schimpfle M.
The objective of this study is to compare image quality and lesion detection for full field digital mammography (FFDM) and film-screen mammography (FSM). In 200 women we performed digital mammography of one breast and film-screen mammography of the other breast. Imaging parameters were set automatically. Image quality, visualization of calcifications and masses were rated by three readers independently. Mean glandular dose was calculated for both systems. We found no significant difference in mean glandular dose. Image quality was rated by reader A/B/C as excellent for FFDM in 153/155/167 cases and for FSM in 139/116/114 cases (p less than 0.03/0.001/0.001). FFDM demonstrated improved image quality compared with film-screen mammography. Microcalcification detection was also significantly better with the digital mammography system for two of the three readers.
Br J Radiol. 2005 Apr;78(928):312-5.
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March 2005
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Saunders M, Budden A, Maciver F, Teunis M, Warren-Forward H.
Fluoroscopy is increasingly being used as a positioning device prior to obtaining plain film radiographs. This is particularly true for those examinations where the type of projection and habitus of the patient present difficulties. An example is the examination of the lumbar spine; especially the L5/S1 projection. The purpose of this study was to determine the effect of fluoroscopy-guided positioning (FGP) on patient dose. The study assessed the difference in dose-area product (DAP) between conventional film-screen radiography (FSR) and a FGP assisted series of the lumbar spine. DAP values were monitored on 102 patients (50 FSR, 52 FGP) over 7 (4 FSR, 3 FGP) study sites. The median values for all FGP and FSR procedures were 8.3 Gy cm(2) and 12.5 Gy cm(2), respectively. The differences in doses were attributed to lower mAs and tighter collimation used in FGP assisted procedures. The study has demonstrated that it is possible to achieve lower DAP values using FGP. What now has to be asked is whether FGP should be acknowledged and further introduced into clinical practice. If so, there is a need for careful monitoring and reporting of dose so that strict protocols can be set in place to ensure the ALARA principle is enforced.
Br J Radiol. 2005 Feb;78(926):130-4.
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March 2005
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Lam WW, Yap TL, Jacobsen AS, Teo HJ.
Background: Traditionally, every patient with an acute scrotum needed surgical exploration for definitive exclusion of testicular torsion. Objective: In this study, we aimed to evaluate the improved accuracy in clinical diagnosis with colour Doppler Ultrasonography (US) added to normal clinical assessment.
Materials and methods: We retrospectively reviewed 626 patients, who presented with acute scrotal pain between January 1998 and June 2004. Following history and physical examination, the patients either proceeded directly to surgery or underwent US examination. If clinical suspicion of testicular torsion persisted after US, the patients would still undergo scrotal exploration.
Results: Of the 294 patients who had routine scrotal exploration without preliminary US, only 23 (7.8%) were found to have testicular torsion. Amongst the 332 cases that had initial US, 9 (2.7%) patients revealed testicular torsion that was confirmed at subsequent surgery. The remaining 323 patients had initial negative US, but 29 were explored eventually on clinical indications. Of these, 4 (1.2% of 323) cases were diagnosed intra-operatively as testicular torsion. None of the remaining 294 patients who were managed conservatively proved to have testicular torsion after a minimum follow-up of 2 weeks. For testicular torsion, US yielded a sensitivity of 69.2% (95% confidence interval =38.9-89.5), specificity of 100% (95% CI=98.5-100), positive predictive value of 100% and negative predictive value of 97.5%.
Conclusions: US has proven to decrease the number of emergency scrotal explorations, length of hospital stay and hence reduce the cost of management of acute scrotum.
Pediatr Radiol. 2005 Mar 11; [Epub ahead of print]
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March 2005
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A T-2 weighted MR image-Axial section brain
An unique opportunity to win my book "Review Of Radiology".All you have to do is diagnose this case post your answers as comments here and send your full name,current occupation and postal address to sumerdoc-AT-yahoo-DOT-com.
NOTE-In case of many correct entries the prize would be given by a lucky draw.
ANSWER-CLOSED LIP SCHIZENCEPHALY WITH HETEROTOPIC GRAY MATTER
Schizencephaly is one of the migrational disorders of brain, which include lissencephaly, pachygyria, heterotopia, and polymicrogyria.it is characterized by a gray matter lined cleft that extends from the ependymal surface of the brain through the white matter to the pia.
Two types are recognized: type I, or closed lip schizencephaly, in which the cleft walls are in apposition, and type II, or open lip schizencephaly, in which the walls are separated. In either instance the cleft is lined by heterotopic gray matter. The clefts can be unilateral or bilateral, symmetric or asymmetric.
Bilateral clefts have a worse prognosis for development, with seizures present in the majority. Patients may present with hemiparesis (more likely in unilateral forms) or tetraparesis (more likely in bilateral forms). Mental retardation and seizures are other common presentations, being more severe in bilateral clefts.
CT scans of closed lip schizencephaly may show only a slight outpouching, or "nipple" at the ependymal surface of the cleft. The full thickness cleft or the pial-ependymal seam may be difficult to detect on CT scans. Open lip schizencephaly has a larger, more apparent gray matter lined CSF cleft. The majority of patients have bilateral clefts, most of them roughly symmetrical in location and more likely open (type II) than closed (type I) the presence of heterotopic gray matter is considered pathognomic for schizencephaly, distinguishing it from an acquired condition.
Schizencephaly was earlier considered a rare anomaly but now with advent of axial imaging (CT and MRI) this condition is more frequently recognized.
COPYRIGHT (SUMER)
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Grand rounds 25 are up... it goes on like this-
As a child of television, I had to wonder what Grand Rounds would look like if it were TV, presented by a TV critic from a magazine known for its somewhat snarky TV reviews...
Check out Respectful Insolence (a.k.a. "Orac Knows")
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Alveolar pulmonary edema showing the classical bat wing appearance, seen as perihilar fluffy opacities.
COPYRIGHT (SUMER)
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Chen YK, Ding HJ, Su CT, Shen YY, Chen LK, Liao AC, Hung TZ, Hu FL, Kao CH
The aim of this study was to evaluate the potential application of 18-fluorodeoxyglucose positron emission tomography (FDG PET) and PET/CT for cancer screening in asymptomatic individuals. The subjects consisted of 3631 physical check-up examinees (1947 men, 1684 women; mean age +/- SD, 52.1 +/- 8.2 y) with non-specific medical histories. Whole-body FDG PET (or PET/CT), ultrasound and tumor markers were performed on all patients. Focal hypermetabolic areas with intensities equal to or exceeding the level of FDG uptake in the brain were considered abnormal and interpreted as neoplasia. Follow-up periods were longer than one year. Among the 3631 FDG PET (including 1687 PET/CT), ultrasound and tumor markers examinations, malignant tumors were discovered in 47 examinees (1.29%). PET findings were true-positive in 38 of the 47 cancers (80.9%). In addition, 32 of the 47 cancers were screened with the PET/CT scan. PET detected cancer lesions in 28 of the 32 examinees. However, the CT detected cancer lesions in only 15 out of 32 examinees. The sensitivity of FDG PET in the detection of a wide variety of cancers is high. Most cancer can be detected with FDG PET at a resectable stage. CT of the PET/CT for localization and characteristics of the lesion showed an increased specificity of the PET scan. The use of ultrasound and tumor markers may complement the PET scan in cancer screening for hepatic and urologic neoplasms.
Anticancer Res. 2004 Nov-Dec;24(6):4103-8
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