Contents

Historical facts and events
Naumov G - 95th Anniversary of Prof Dr Gotze Tenchov

Survey
Shopova V, Salovsky P, Dancheva V - Radiation pneumonitis and fibrosis

Methodological novelties
Nikolov Vl - Examination of  jaws and teeths using Dental CT

Original articles
Piperkovski T - Results of treatment in patients with nontraumatic avascular necrosis of the femoral head by monitor assisted core decompression
Balev B, Bliznakova D, Konstantinova D, Stoyanov V, Temelkova I, Krasnaliev I, Vassileva P, Svrakov P - Prenatal ultrasonography and postnatal diagnostic protocol in obstructive uropathies
Boyanov M - Diagnostic relevance of a questionnaire for osteoporosis risk assessment - comparison with osteodensitometry data
Klisarova A, Minchev D, Nedelchev K,  Tranulov G, Stoilova S, Georgieva E - Tc-99m-HMPAO SPECT used in patients with crossed cerebellar diaschisis
Nikolova T, Benova D, Georgieva I, H djidekova V, Grigorova M, Boulanova M, Atanasova M, Doncheva Zh, Nikolova T - Cytogenetic investigation of the radioprotective potential of the polyvitamin product "Biostrong" in cultured murine splenocytes

Case reports
Bliznakova D, Galabova M, Galabov I, Balev B, Klisarova A - Thoracic dystopia of the left kidney
Mihaylova h - Subcutaneous emphysema

Problems relating to education
Impressions from congresses
Specializations abroad
News of the BAR
Book reviews
Abstracts of current literature
Forthcoming scientific events
News items
Instructions to authors

Radiation pneumonitis and fibrosis

V. Shopova, P. Salovsky, V. Dancheva
Sector of Disaster Medicine, Department of Clinical and experimental pharmacology and Disaster Medicine, University of Medicine - Pleven

Summary. The likelihood of toxic pulmonary lesions development as the result of radiation therapy for pulmonary carcinoma and breast cancer is discussed. Two possible forms of radiation induced changes are described, namely: classical radiation pneumonitis (RP) terminating with lung fibrosis circumscribed in the radiation zone, and sporadic RP giving rise to bilateral lymphatic alveolitis and manifestations outside the irradiation field. Attention is called to the fact that chemotherapy augments the risk of toxic lung damage occurrence. A number of markers for early RP diagnosis, including lactate dehydrogenase activity, KL-6, procollagen III, transforming growth factor b, C-reactive protein and partial oxygen pressure are listed.
Therapeutic possibilities in coping with RP and pulmonary fibrosis are assayed. Apart from the standard therapeutic approach using corticosteroids and azatioprin, ideas are set forth concerning the application of some antioxidants, angiotensin converting enzyme inhibitors and g-interferon. It is pointed out that radiation pneumonitis and pulmonary fibrosis treatment has an essential practical bearing on life expectancy and quality of life in a great number of cancer patients.

Address for correspondence: Assoc. Prof. Dr. V. Shopova, Department of Disaster Medicine, University of Medicine, 1, Kliment Ohridski Str., Pleven 5800, Bulgaria

Examination of  jaws and teeths using Dental CT

Vl. Nikolov
Department of imaging diagnostic, Military Medical Academy - Sofia

Summary. The aim of the present work was to establish a new method for dental imaging using Dental CT. Dental computer assisted tomography represents a valuable addition to the diagnostic spectrum for planning oral and maxillofacial surgery. High resolution spiral CT and specially designed computer software allow representation of the jaws in different planes that are easy to match. They further allow the display of very small structures relevant to oral surgical interventions and reveal their spatial relationship in three dimensions. Dental CT is indicated, when clinical and conventional radiological techniques will not allow exact interpretation of the situation. It is modern oral implantology that primarily benefits from computer software enabling the assessment of surgical sites in the presurgical phase. Such planning was not yet possible using two dimensional radiographic techniques. The dental-implantological part expects from radiography sharply defined contours of the external bony contours and the mandibular canal, exactly defined relation between slices and planes, no distortion in the orthoradial planes, tools for reliable measurements of distances, angles and volumes, possibility to transmit pictures electronically or on hardcopy without loss of quality. Thus communication between dentists and radiologists may and must be intensified and supported by usage of modern telecommunication systems. 

Key words: DENTAL CT, SPIRAL COMPUTED TOMOGRAPHY, ORAL IMPLANTOLOGY, PRE-SURGICAL PLANING, DENTISTS AND RADIOLOGISTS.

Address for correspondence: Dr. Vl. Nikolov, Department of imaging diagnostic, Military Medical Academy, 1606 Sofia, Bulg ria
Key words: Radiation pneumonitis. Lung fibrosis. Antioxidants. Angiotensin converting enzyme inhibitors.

Results of treatment in patients with nontraumatic avascular necrosis of the femoral head by monitor assisted core decompression

T. Piperkovski
Clinic for Orthopedic Surgery, Medical Faculty - Skopje, Macedonia

Summary. We tried to evaluate the results of treatmeat in 32 patients (39 hips) with nontraumatic avascular necrosis (AVN) of the femoral head by monitor assisted core decompression. Average age - 44 years, 19 were male and 13  - female. Seven patients had bilateral involvement. The diagnosis AVN has been made by anteroposterior and lateral conventional radiographs, bone scintigraphy and MRI. We have also done histopathological examinations of the speciments taken during the operation in order to confirm the primary diagnosis. We manage to establish early diagnosis in stage I, stage II A and II B (we have used the modified staging system of Ficat and Arlet, in combination with the system of Steinberg et al.).
All patients were treated by core decompression. The operative technique that we have used was modified phemister, which is similar to Ficat-Arlet. After the operation we did periodically X-ray and MRI investigations. The mean follow up time was 4 years.
79.36 % of the hips showed radiographic and MRI stabilization within two to four years after core decompression.  In 10.25 % the results were moderate and in the rest (10.25 %) we had to implant total or bi-polar hip prosthesis.
We justify the benefit of core decompression in patients with nontraumatic avascular necrosis of the femoral head.

Key words: AVN of the femoral head. core decompression.

Address for correspondence: Dr T. Piperkovski, Clinic for Orthopaedic Surgery, Medical Faculty, Skopje, Macedonia
 

Prenatal ultrasonography and postnatal diagnostic protocol 
in obstructive uropathies

B. Balev1, D. Bliznakova2, D. Konstantinova2, V. Stoyanov2, I. Temelkova1, I. Krasnaliev3, P. Vassileva4, P. Svrakov4
1Department of Radiology, 2Department of Pediatrics, 3Department of Pathology, 4Department of Obstetrics, Medical University - Varna

Summary. Obstructive uropathies are suitable for prenatal ultrasound diagnosis due to the easy visualisation of the anechogenic content of the dilated collector system of the kidneys against the background of hyperechogenic abdominal structures. The different authors suggest different criteria for hydronephrosis dependent on the size of the fetal pyelon.
The objective of the present study is to demonstrate the prenatal ultrasound signs for obstructive uropathy (OU) and through postnatal monitoring to establish the size of the fetal pyelon below which there is no obstructive uropathy and above which obstructive uropathy is always present and to suggest diagnostic strategy for children with pre- and postnatally established hydronephrosis.
The study comprises the results of the prenatal ultrasound investigation of 420 consequent pregnancies for a period of 3 years. Examinations were done at 16 - 18 gestational weeks, at 24 - 25 g.w. and at 32 - 34 g.w. Fourteen dilated collector systems of 9 fetuses were established prenatally by ultrasound. By pre- and postnatal ultrasound and contrast X-ray monitoring the following cases were determined: 2 transient dilatations, 2 with lethal uropathy (polycystosis of a single kidney and bilateral obstruction of the pyeloureteral passage), 2 with bilateral vesicoureteral reflux, 3 with stenosis of the pyeloureteral passage. On the basis of our data and other published data we suggest a diagnostic strategy for neonates with pre- and postnatal dilatation of the collector system.
Prenatal ultrasonography is an only and sufficient means for diagnosing obstructive uropathy. Establishing the size of fetal pyelon during pregnancy to be above 8 mm suggests uropathy and necessitates performance of contrast X-ray investigation after birth. A size of fetal pyelon during pregnancy between 5 and 8 mm suggests mild uropathy with 50 % probability and necessitates ultrasound monitoring for 1 year after birth. A size of fetal pyelon during pregnancy below 5 mm excludes uropathy.

Key words: PRENATAL ULTRASOUND DIAGNOSIS. OBSTRUCTIVE UROPATHY. POSTNATAL DIAGNOSIS.

Address for correspondence: Dr. B. Balev, Department of Radiology, Medical University, 55 Marin Drinov, 9000 Varna, Bulgaria
 

Diagnostic relevance of a questionnaire for osteoporosis risk assessment - comparison with osteodensitometry data

M. Boyanov
Endocrinology Clinic, University Hospital "Alexandrovska" - Sofia

Summary. The early detection of osteoporosis is a key factor for reducing associated costs. Clinical risk factors have been used for selection of subjects suitable for bone densitometry. Questionnaires for preliminary osteoporosis risk assessment have already been implemented. The purpose of this study is to apply an original questionnaire for risk assessment and to assess its diagnostic value by comparison to forearm bone mineral density (BMD) data. 285 females were included - mean age 53,2 + 8,8 years, 82 % were menopausal. The osteoporosis risk was assessed by an original score system based on a questionnaire. Forearm BMD was measured by single-energy X-ray absorptiometry using own reference ranges. Two diagnostic models were tested by "cluster analysis" - classifications with 3 or 2 diagnostic items. The second proved better. Sensitivity in detecting women with forearm osteoporosis was  86,7 %, specificity - 16,5 %, and 75,8 % of all women were correctly classified. The total score distribution in the study population is skewed to the right which reflects the two subgroups - at high and low risk for osteoporosis. The value of  a similar questionnaire in the overall strategy for diagnosis and treatment of low BMD is discussed. 

Key words: QUESTIONNAIRE, FOREARM X-RAY OSTEODENSITOMETRY, DIAGNOSTIC VALUE

Address for correspondence: Dr. M. Boyanov, Endocrinology Clinic, Hospital "Alexandrovska", 1, Sv. G. Sofiiski str., 1431 Sofia, Bulgaria
e-mail: boyanov@sun.medun.acad.bg
 

Tc-99m-HMPAO-SPECT used in patients with crossed 
cerebellar diaschisis

A. Klisarova1, D. Minchev2, K. Nedelchev2, G. Tranulov1, S. Stoilova1, E. Georgieva1
1Department of imaging diagnostic and radiotherapy,  2Department of Neurology, Medical University - Varna

Summary. 99mTc-HMPAO SPECT plays an important part in the diagnosis of a number of cerebrovascular diseases. It is the purpose of the work to assay the part of acetazolamide in scintigraphic imaging using 99mTc-HMPAO SPECT in patients presenting crossed cerebellar diaschisis. The study covers 20 patients with supratentorial infarctions, examined between 15 and 30 days after the accident. 99mTc-HMPAO SPECT is conducted at rest after injecting acetazolamide with radiotracer uptake in the cerebellar hemispheres being recorded. Asymmetry perfusion indices are calculated at rest and after vasodilator administration.
The obtained results point to perfusion asymmetry indices increase after acetazolamide in 70 % of the cases, in 20 % the indices remain unchanged, and in 10 % vasodilator perfusion capacity in the cerebellar hemispheres affected is preserved.
The study demonstrates that 99mTc-HMPAO SPECT is a method of choice for cerebellar perfusion assessment in patients presenting crossed diaschisis, and following acetazolamide administration, it contributes to evaluate the vasodilating capacity of cerebellar hemispheres. The asymmetry perfusion indices in cerebellar diaschisis show an increase after acetazolamide in 99mTc-HMPAO SPECT.

Key words: Crossed cerebellar diaschisis. Acetazolamide. 99mTc-HMPAO SPECT.

Address for correspondence: Dr. A. Klisarova, Department of imaging diagnostic and radiotherapy, Medical University, 55 Marin Drinov, 9000 Varna, Bulgaria
 

Cytogenetic investigation of the radioprotective potential 
of "Biostrong"polyvitamin product in cultured 
murine splenocytes

T. Nikolova, D. Benova, I. Georgieva, V. H djidekova, M. Grigorova, M. Bulanova, 
M. Atanasova, Z. Doncheva, T. Nikolova
National Center of Radiobiology and Radiation Protection - Sofia

Summary. This is a report on the results of assaying the clastogenic and anticlastogenic potential of "Biostrong" polyvitamin product, representing a constellation of 12 vitamins + 12 minerals. It is administered per os to groups of experimental animals - C57BL mice. In one group, following 20-day "Biostrong" administration, short-term cultures from the splenocytes of experimental animals are isolated, and after cell harvesting microscopic preparations are set up for chromosome aberrations' analysis in first mitosis metaphases to assay the presence or not of clastogenic effects of the product. Other groups are irradiated with gamma rays at fractionated daily dose of 0.2 Gy for 10 days post "Biostrong" (prophylactic scheme), or with sustained administration of the drug (prophylactic-therapeutic scheme). These experimental groups are compared to positive controls (irradiated with analogical dose for 10 days) in terms of the frequency and type of aberrations induced. Under in vivo conditions the polyvitamin product does not exhibit any deleterious clastogenic effects. A statistically significant reduction in the yield of cells with aberrations and of the total number of aberrations is observed in the prophylactic scheme, by comparison with positive controls. There is no reduction in the yield of dicentrics - an aberration pattern considered as a cytogenetic marker of ionizing radiation exposure. As shown by the obtained data, the combinations antioxidant vitamins + microelements provide for a low-degree protection against clastogens against the background of chronic ionizing radiation exposure.

Key words: GAMMA-RAYS. IN VIVO. MICE. POLYVITAMIN PRODUCT. RADIATION PROTECTION.

Address for correspondence: Dr. T. Nikolova, National Center of Radiobiology and Radiation Protection, 132, Kliment Ohridski Blvd., Sofia 1756, Bulgaria
 

Thoracic dystopia of the left kidney: a case report

D. Bliznakova1, M. Galabova1, I. Galabov1, B. Balev2, A. Klisarova2
1Chair of Pediatrics and Genetics, Chair of Radiology, Medical University - Varna

Summary. Urinary malformations are among the serious clinical problems faced in pediatric nephrology. The exact and timely made diagnosis enables the undertaking of adequate prophylaxis against eventual complications. Ranal dystopia is one of the often met with anomalies involving the position of the kidney, usually lacking clinical manifestation and fortuitously discovered. Embryogenetically dystopia is attributable to incomplete ascent of the kidney. Intrathoracic ectopic kidney is a rare developmental anomaly unlike the relatively common lumbar and pelvic dystopies.
 This is a report on a child aged 2 y and 6 m, presenting thoracic dystopia of the left kidney. The reason for hospitalization is a rounded formation seen on the front-view AP chest x-ray. The abdominal US examination, urography, scintigraphy and CT study performed document an extremely rare variant of renal dystopia - ectopic intrathoracic positioning of the left kidney.

Key words: Thoracic dystopia. Imaging diagnostics. Childhood.

Address for correspondence: Dr. D. Bliznakova, Chair of Pediatrics and Genetics, Medical University, "St. Marina" Hospital, 1, Hr. Smirnenski Str., 9010 Varna, Bulgaria
 

Subcutane(r)us emphysema

H. Mihaylova
Faculty of Stomatology - Sofia

Summary. The issue of subcutaneous emphysema is comprehensively discussed. After specifying the terminology, differentiation is made between traumatic and surgical emphysema. Problems relating to the onset of emphysema resulting from direct or indirect trauma to bone or soft tissues, regardless of the presence or not of fractures, are studied in detail. As shown by pertinent literature data, surgical emphysema is the commonets, with dental procedures, dental extraction in particular, presenting single or combined accumulation of air, being the most frequent causes of its development. Diseaes with unknown etiology and unpredictable circumstances promoting the occurrence of emphysema are assigned under a separate heading. Emphasis is laid on the importance of x-ray methods of study for demonstrating the different localization of air, contributing to diagnose not merely orbital and cervico-facial, but also mediastinal and parapharyngeal emphysema.
A case from the surgical dental practice is presented concerning a largely spread subcutaneous emphysema in an attempt at wisdom tooth extraction.

Key words: Subcutaneous emphysema. Dental procedures. Dental extraction.

Address for correspondence: Dr H. Mihaylova, Faculty of Stomatology, Department of Maxillo-facial Radiology and Oral Diagnostic, 1, G. Sofiiski str., 1431 Sofia, Bulgaria
e-mail: eli_hrisi@usa.net
 

11th Course "Radiology Today"
Abdominal imaging and intervention 2001"
Salzburg,  July 5  - 7,  2001

7th International workshop on interventional radiology
Prague,  June 7  - 9,  2001

Teaching manual of color duplex sonography

A workbook on color duplex ultrasound and echocardiography

Edited by Mathias Hofer

Thieme, New York, 2001
104 ±²°., 440 ¨«¾±²° ¶¨¨

Musculoskeletal Imaging
A Concise Multimodality Approach

Klaus Bohndorf, Herwig Imhof, Thomas Lee Pope Jr.
Georg Thieme Verlag, Stuttgart-New York, 2001
387 ±²°., 1300 (r)²¤¥«­¨ ¨«¾±²° ¶¨¨
 
 

Clinical MR Imaging
A practical  pproach

P. Reimer, P. M. Parizel, F.-A. Stichnoth

Springer, Berlin - Heidelberg - New York, 1999
542 ±²°., 390 ´¨£., 126 ² ¡«¨¶¨

Radiotherapy of prostate cancer

Edited by Carlo Greco and Michael  J. Zelefski

Harwood Academic Publishers, Amsterdam, 2000
484 ±²°., 144 ´¨£., 83 ² ¡«¨¶¨

Current practice of TIPS

Editors: Petr H¶lek, Anton?n Krajina

Olga ????tambergov¡ Graphic studio, Hradec Kr¡lov(c), Czech Republic, 2001
220 ±²°., 145 ¨«¾±²° ¶¨¨
 

Abstracts of
current literature 

Sentinel lymph nodes identification in early breast cancer - peritumoral or subareolar injection of lymphotropic blue dye?

George Baichev1, Sonia Sergieva2, Grigor Gorchev1

1Dept. of Surgical Oncology, University Centre of Oncology, Pleven, Bulgaria, 2Dept. of Nuclear Medicine, National Centre of Oncology, Sofia, Bulgaria

Background. The sentinel lymph node (SLN) biopsy is a recently developed, minimally invasive method for staging the axilla in patients with early breast cancer. The authors investigated the optimal technique - peritumoral versus subareolar injection for the localization of the SLN.
Patients and methods. 192 procedures out of 238 ones were performed using a blue dye peritumoral injection at the early breast cancer site against 46, with a subareolar technique. All patients underwent sentinel node biopsy, followed by an axillary lymph node dissection.
Results. The SLN were metastatic in 69 out of 80 axillary positive patients that accounted for 86,3%. The sentinel node histology correctly predicted the axillary disease in 90,6% with a peritumoral injection versus 68,8% with a subareolar lymphatic mapping. 
Conclusions. This experience indicates that the peritumoral injection of blue dye is a more accurate than the subareolar one for axillary staging.
Key words: breast neoplasms, lymphatic metastasis, axilla, lymph nodes-pathology, biopsy, early breast cancer, sentinel lymph node biopsy.
 
 
 

Usefulness of endorectal ultrasound after preoperative radiotherapy in rectal cancer: comparison between sonographic and histopathologic changes.

M Gavioli, A Bagul, I Piccagli, S Fundaro, G Natalini

Dis Colon Rectum 2000 Aug; 43(8): 1075-83.
Purpose. Our aim was to assess the advantages of endorectal ultrasound after preoperative radiotherapy in rectal cancer, its reliability in tumoral staging, and its capacity to identify completely sterilized lesions.
Methods. From 1994 to 1997, 29 patients with rectal cancer were systematically subjected to endorectal ultrasound before and after preoperative radiotherapy. Each patient was administered 30 to 50 Gy, followed by surgery six to eight weeks after completion of radiotherapy. Endorectal ultrasound was performed using a biplanar (linear and sectorial) endorectal probe. The morphologic, quantitative, and echo-pattern changes of the irradiated tumor were examined. Results of ultrasound findings before and after radiotherapy and a histologic examination of the surgical specimens were compared. Histopathologic studies were used to evaluate macromicroscopical radiation-induced changes, case by case. A comparison between tumoral shrinkage and fibrotic replacement was made using the semiquantitative Dworak's method.
Results. Morphologically and quantitatively, postradiation endorectal ultrasound showed the reappearance of anatomic cleavage planes, a considerable shrinkage of the tumor, and in low rectal tumors, an increase in the distance from the anorectal ring in more than 50 % of the cases. These data had a direct influence on surgical treatment. Histologic examination showed that, in  28 out of 29 cases, fibrosis was the most dominant component of the irradiated lesions, varying by more than 50 to 100 % of the lesion (four cases pTO). A comparison of postradiation endorectal ultrasound with histopathology revealed that fibrosis became the morphologic basis of ultrasound images; therefore, after radiotherapy, what endorectal ultrasound staged was no longer the tumor but the extent of fibrosis in the rectal wall. A histopathologic examination showed that the residual tumor, when present, was always within the fibrosis, never outside or separate from it. Postradiation endorectal ultrasound showed echo-pattern changes. Some of the changes (more echogenic and nonhomogeneous lesions) were histologically related to the persistence of the tumor to a considerable degree; other changes (reappearance of parietal layers) were related to complete sterilization of lesions in two of three cases.
Conclusions. From the morphologic and quantitative point of view, postradiation endorectal ultrasound provides oncologists and surgeons useful information to assess treatment effectiveness and plan the surgical approach. From the tumor staging point of view, our report presents a completely new concept: that six to eight weeks after radiotherapy, endorectal ultrasound no longer stages the tumor, but rather the fibrosis that takes its place. However, postradiation endorectal ultrasound is a valid too, because the extent of fibrosis in the rectal wall is a direct indication of the depth of residual cancer. A residual tumor, when present, is always inside the fibrosis. Finally, however, as regards the capacity of endorectal ultrasound to exclude or indicate complete sterilization of the lesion, the actual significance of the echo-pattern changes we observed needs to be as sessed further by studies on a large number of cases.
 
 
 

Role of endoscopic ultrasound and magnetic resonance imaging in the preoperative staging of pancreatic adenocarcinoma.

NA Ahmad, JD Lewis, ES Siegelman, EF Rosato, GG Ginsberg, ML Kochman

Am J Gastroenterol 2000; 95(8): 1926 - 31.

Objective. Endoscopic ultrasound (EUS) and magnetic resonance imaging (MRI) have both been assessed individually as staging modalities for pancreatic cancer. The aim of our study was to assess whether tumor staging by both EUS and MRI in the same cohort of patients could predict resectability and unresectability in patients with pancreatic cancer.
Methods. A review of 63 patients evaluated preoperatively with both EUS and MRI for pancreatic adenocarcinoma between January 1995 and December 1998 was done. Patients were staged as resectable or unresectable by predefined criteria. Preoperative staging by both modalities was compared to surgical outcome and the sensitivity and predictive values of each modality for determining resectability and unresectability was determined.
Results. EUS did not allow for complete T- and N-staging in 10 patients; therefore, for EUS, this final analysis was done on 63 of 73 patients (86 %). EUS correctly staged 22 of 36 patients with resectable tumors. The sensitivity of EUS for resectability was 61 %, with a positive predictive value of 69 %. All 73 patients had complete MRI examinations; therefore, the final analysis was done on all 73 patients. MRI correctly staged 30 of 41 patients with resectable tumors. The sensitivity of MRI for predicting resectability was 73 % witn a positive predictive value of 77 %. MRI and EUS both predicted resectability in 18 patients, of whom 16 (89 %) were found to be resectable on surgical exploration. MRI and EUS both predicted unresectability in 17 (27 %) patients, of whom 4 (24 %) were found to be resectable on surgical exploration. When both MRI and EUS agreed on resectability, the positive predictive value for resectability was 89 %. When both MRI and EUS agreed on unresectability, the positive predictive value for unresectability was 76 %.
Conclusions. Neither MRI nor EUS alone were highly sensitive or predictive of resectability. However, when both tests agreed on resectability, nearly all patients were found to be resectable on surgical exploration.
 
 
 

Angioplasty and stenting of the extracranial carotid arteries.

M Henry, M Amor, C Klonaris, I Henry, I Masson, Z Chati, E Leborgne, M Hugel

Tex Heart Inst J 2000; 27 (2): 150 - 8.

We performed percutaneous transluminal angioplasty and stenting in patients with carotid artery stenosis to determine the efficacy of these techniques as an alternative to surgical endarterectomy. From April 1995 through July 1999, 315 carotid angioplasty procedures were performed (right, 151; left, 164) in 290 patients ranging in age from 40 to 93 years. Of these patients, 42 % were symptomatic and 58 % were asymptomatic. Twenty-five patients underwent bilateral procedures. The mean percentage of stenosis was 82.3 % + 8.7 % SD. Angioplasty and stenting were performed without cerebral protection in 165 arteries and with protection in 150. Two methods of protection were used: the Theron technique and the PercuSurge Guardwire temporary occlusion and aspiration system. Balloon dilation and stent placement were successful in 289 patients; in the last patient, severe arterial tortuosity prevented catheterization and stenting. We observed 13 periprocedural neurologic complications due to ischemia (4.20 %): 4 transient ischemic attacks (1.3 %), 4 minor strokes (1.3 %), and 5 major strokes (1.6 %), including 1 death. At 6 month, 210 patients had a follow-up angiogram (155) or duplex ultrasound (55). There were 10 restenoses (4.70 %), 1 of which was symptomatic and 2 of which showed mild compression of a Palmaz stent without marked stenosis. Primary and secondary 4-year patency rates were 96 % and 99 %, respectively. These results demonstrate acceptable mortality and morbidity rates related to carotid angioplasty and stenting. However, we found the risk of embolic stroke to be substantial. Cerebral protection may improve the results of carotid angioplasty and expand the indications for this procedure.
 
 
 

Preoperative intraarterial thrombolysis before surgical revascularization for popliteal artery aneurysm with acute ischemia.

E Steinmetz, O Bouchot, F Faroy, L Charmasson, B Terriat, F Becker, JP Cercueil, D Krause, R Brenot, M David

Ann Vasc Surg 2000; 14 (4): 360 - 4.
Because a popliteal artery aneurysm (PAA) generates emboli that progressively deteriorate the distal arterial network, they can constitute limb-threatening lesions. In  20 to 40 % of cases, discovery of PAA coincides with sudden occlusion and resulting acute ischemia. In 40 to 60 % of these patients, surgical revascularization fails and amputation is required. The objective of this prospective study was to assess the value of intraarterial thrombolysis to restore distal runoff before surgical revascularization. Between January 1, 1992 and December 31, 1996 we treated 15 PAA causing acute ischemia in 15 male patents with a mean age of 66.7 years (range, 44 to 87 years). Diagnosis was documented by clinical examination and ultrasound imaging. Intraarterial thrombolysis was performed under arteriographic control through a multiperforated catheter inserted by the anterograde femoral route to the thrombus. After an initial bolus of 100.000 U of urokinase, 600.000 to 1.600.000 U was continuously infused over a period of 6 to 18 hr. Heparin sodium was administered throughout thrombolysis. Surgical revascularization was performed, within 1 to 4 days (mean, 2 days) after thrombolysis by exclusion and bypass in 14 cases and percutaneous transluminal angioplasty with stenting in 1 case. The ensuing results showed that, if performed carefully, intraarterial thrombolysis can safely prepare patients presenting with occluded PAA with acute ischemia for surgical revascularization to restore distal runoff. We use this combined technique routinely in our department. Morbidity is low in comparison with the risks of amputation.
 
 
 

Prenatal detection of trisomy 21: combined experience of two British hospitals.

D Roberts, SA Walkinshaw, MJ McCormack and Jill Ellis

Prenat Diagn 2000; 20: 17 - 22.

A retrospective study was performed determine the detection rate of trisomy 21 in two British hospitals using a combination of:
1. second trimester serum screening with maternal age, aFP and hCG karyotyping for raised maternal age and high background risk of aneuploidy; and second trimester fetal anomaly ultrasonography at 18 - 22 week gestation, 36 410 women with a median age of 27 years were studied.
Trisomy 21 detected by the combination of methods in both hospitals was compared with the actual number of pregnancies affected by trisomy 21, to determine the detection rate. Serum screening as the backbone of the service detected 31/48 (65 %) trisomy 21 affected pregnancies.
Background. Our purpose was to weigh various monographic parameters as predicting malignant cervical lymphadenopathy and build a reliable prediction rule.
Methods. One hundred and eighty-nine cervical lymph node lesions from 125 consecutive patients were used for building the prediction model. Sonographic variables, including 15 morphologic features of B-mode, 5 vascular parameters of color Doppler mode, along with age and sex, were analyzed with multivariate logistic regression to evaluate the joint effect of a set of independent variables. A prediction rule for malignant lymphadenopathy was established, and prospective validation was assessed on a new group consisting of 100 lymph nodes from another 60 consecutive patients.
Results. The association of heterogeneous content, long transverse diameter, pathologic vascular pattern, high vascular density, and older age provided the most robust prediction value. Scoring scale was designed as 1x (age)+ 2x (vascularity index) + 3x (short axis) + 4x (vascular pattern) + 4x (internal echo) according to the parameter estimates of multivariate logistic regression analysis. Cut-off value of score i 10 as malignancy resulted in 89.2 % sensitivity and 85.2 % specificity. Prospective validation also showed satisfactory results (sensitivity, 82,9 %; specificity, 86.2 %).
Conclusions. By measuring only 4 sonographic parameters and age, this prediction rule could provide the physician a nonconfusing and reliable probability reference for managing cervical lymphadenopathy.
An economic evaluation of sonographic examination of children with suspected appendicitis.

DA Axelrod, SS Sonnad, RB Hirschl 

J Pediatr Surg 2000, 35 (8): 1236 - 41.

Background/Purpose. Appendicitis is the most common surgical emergency presenting in the pediatric population. Approximately one third of these patients present with equivocal signs and symptoms frequently resulting in impatient observation or additional diagnostic investigation. Although sonographic examination of patients with suspected appendicitis has been shown to be a highly accurate diagnostic modality, the cost effectiveness of this technology in the pediatric population has not been addressed. The economic value of this technology in the pediatric population has not been addressed. The economic value of this examination can be evaluated using structured decision analysis.
Methods.  The authors constructed a decision analysis model of treatment strategies for 2 groups of patients with a suspected diagnosis of acute appendicitis. Patients were categorized as either presenting with a "definitive acute abdomen" or "equivocal examination." Data drawn from published literature reports of the sensitivity and specificity of ultrasound, institution-specific cost data, and expert judgement were used to construct 2 decision trees. These data were used to determine the least costly diagnostic strategy for each group of patients, and sensitivity analysis performed to assess the robustness of the conclusions.
Results.  The use of ultrasonography in patients with "an acute abdomen" is not cost efficient and results in average additional cost of $ 234 per patient.  In patients with equivocal diagnoses who are discharged from the emergency room after a negative ultrasound examination finding results in an average cost savings of $ 260 when compared with admission and observation. Patients who are discharged without examination incur an average additional cost of $ 373 as a result of the high cost of a missed diagnosis resulting in a perforated appendix. 
Conclusion. The use of ultrasonography can be recommended for children with suspected appendicitis and equivocal examinations who are discharged from the emergency room after a negative examination result.
 
 
 

Diagnosis of nonpalpable testes in childhood: comparison of magnetic resonance imaging and laparoscopy in a prospective study.

S Siemer, U Humke, M Under, U Hildebrandt, N Karadiakos, M Ziegler

Eur J Pediatr Surg 2000; 10 (2): 114 - 8.

In a prospective study, the accuracy of magnetic resonance imaging (MRI) and laparoscopy in the diagnosis of nonpalpable testes was evaluated.  Advantages and disadvantages of the two procedures were compared. 29 boys with unilateral nonpalpable testis underwent MRI. When MRI failed to demonstrate a testis, laparoscopy with a 1.9 mm mini-laparoscope was performed. All cases were verified by operative exploration of the inguinal region. MRI demonstrated 10 inguinal and 7 abdominal testes. MRI revealed no testis in 12 boys. The false positive rate was 32 %, correct negative findings were confirmed in four patients. When laparoscopy was performed, preservable testis could be demonstrated in 8 of 12 patients (1 abdominal, 7 inguinal) which otherwise were not visible on MRI. The correct positive rate was 100 %. We encountered no complications with laparoscopy. In summary, laparoscopy evaluation is recommended as the preferable method in pediatric cases of nonpalpable testes.
 
 
 

Role of Transesophageal Endosonography-Guided Fine-Needle Aspiration in the Diagnosis of Lung Cancer.

Annette Fritscher-Ravens, Nib Soehendra, Lars Schirrow, Parupadi V.J. Sriram, Andreas Meyer, Hans-Peter Hauber and Almuth Pforte

CHEST 2000; 117: 339 - 345.

Study objective. Bronchoscopy methods fail to diagnose lung cancer in up to 30 % of patients. We studied the role of transesophageal endosonography (EUS)-guided fine-needle aspiration (FNA; EUS-FNA) in such patients.
Design. Prospective study. The final diagnosis was confirmed by cytology, histology, or clinical follow-up.
Setting. University hospital.
Patients. Thirty-five patients (30 male and 5 female; mean age, 60.9 years; range, 34 to 88 years) with suspected lung cancer in whom bronchoscopy methods failed. Patients with a known diagnosis, recurrence of lung cancer, or mediastinal metastasis from an extrathoracic primary were excluded.
Interventions.  EUS and guided FNA of mediastinal lymph nodes.
Results. The procedure was uneventful, and material was adequate in all.  The final diagnosis by EUS-FNA was malignancy in 25 patients (11 adenocarcinoma, 10 small cell, 3 squamous cell, and 1 lymphoma) and benign disease in 9 patients (5 inflammatory, 2 sarcoidosis, and 2 anthracosis). Another patient with a benign result had signet-ring cell carcinoma diagnosed on pleural fluid cytology (probably false-negative in EUS-FNA). The sensitivity, specificity, accuracy, and positive and negative predictive values were 96, 100, 97, 100, and 90 %, respectively. There were no complications. Reviewing the EUS morphology, the nodes were predominantly located in levels 7 and 8 of American Thoracic Society mediastinal lymph node mapping (subcarinal and paraesophageal region).  In seven patients, the punctured nodes were < 1 cm (four malignant and three benign), which are difficult to sample by other methods. The malignant nodes had a hypoechoic, homogeneous echotexture.
Conclusions. EUS-FNA is a safe, reliable, and accurate method to establish the diagnosis of suspected lung cancer when bronchoscopic methods fail, especially in the presence of small nodes.
Peripheral Hypoechoic Lesions of the Prostate: Evaluation with Color and Power Doppler Ultrasound.

Jeong Yeon Cho, Seung Hyup Kim, Sang Eun Lee

Euro Urol 2000; 37: 443 - 448.

Objective. To assess the usefulness of color and power Doppler ultrasound in predicting the benignity and malignancy of the peripheral hypoechoic lesion of the prostate.
Methods. Thirty-nine patients who had peripheral hypoechoic lesions on transrectal ultrasound were evaluated with color and power Doppler ultrasound followed by lesion-specific transrectal ultrasound-guided biopsies. The interpretation of color and power Doppler ultrasound was not performed separately and flow signals were categorized using a combination of the two modalities. The amount of flow signals within the lesion was evaluated and categorized into three groups: increased /equal/ decreased flow compared to surrounding normal tissue on ultrasound. Doppler spectra could be obtained from the lesions in 23 patients. The amount of flow signals and resistive indexes of the spectra of the lesions were compared with those of surrounding normal tissue using the Mann-Whithney U test.
Results. Transrectal ultrasound-guided biopsy of the hypoechoic lesions revealed prostate cancer in 20 patients and benign prostatic diseases in 19. Flow signals within the lesions were of increased /equal/ decreased flow compared to surrounding normal tissue in 16/2/2 in the prostate cancer group and 3/9/7 in the benign disease group, respectively. The difference was statistically significant (p = 0.0003). Resistive indexes of the lesion were 0.58-1.0 (mean 0.75) in the prostate cancer group and 0.57 - 1.0 (mean 0.80) in the benign disease group, and there was no significant difference between the two groups (p = 0.82). If we consider an increased flow signal within a  peripheral hypoechoic lesion as a  sign of prostate cancer, color, power Doppler ultra-sound has a sensitivity of 80 %, a specificity of 84 %, and an accuracy of 82 %.
Conclusion. Evaluation of peripheral hypoechoic lesions of the prostate with color and power Doppler may enhance the diagnostic capability of transrectal ultrasound.
 
 
 

'h¥ role of colour Doppler ultrasonoraphy in detecting prostate cancer.

Š Shigeno, M Igawa, H Shiina, H Wada, ' Yoneda

BJU Int 2000 Aug; 86 (3): 229 - 233.

Objective. To determine the usefulness of colour Doppler ultrasonography (CDUS) in detecting prostate cancer, by comparing CDUS with grey-scale transrectal ultrasonography (TRUS) and magnetic resonance imaging (MRI).
Patients and methods. In all, 278 patients who underwent prostate biopsies because of an abnormal digital rectal examination, elevated prostate specific antigen levels, and/or abnormal TRUS between May 1998 and November 1999 were evaluated. The diagnostic accuracies of TRUS, CDUS, MRI and combinations of these imaging techniques in detecting prostate cancer were compared, based on the biopsy results.
Results. Carcinoma was detected in 233 of 1696 specimens, and 87 patients were diagnosed with prostate cancer. For each detected cancer site, the sensitivity of CDUS was lower than those of other imaging techniques, but CDUS had high a specificity and positive predictive value. The combination of grey-scale TRUS and CDUS or MRI improved the sensitivity and negative predictive value. The specificity and positive predictive value of the combination of grey-scale TRUS and MRI were less than those for grey-scale TRUS alone, while those for the combination of grey-scaie TRUS and CDUS were higher than those for grey-scale TRUS alone. Five tumours were isoechoic but seen as hypervascular lesions with CDUS.
Conclusion. CDUS provides information useful for detecting prostate cancer when used in combination with grey-scale TRUS, and should be included in the routine examination for prostate cancer.
Prostate blood flow characteristics in the chronic prostatitis/pelvic pain syndrome.

R Cho, Thomas S Keener, Hahn V Nghiem, Thomas Winter and John N Krieger

Journal Urology 2000; 163: 1130 - 3.

Purpose. We determine whether the chronic prostatitis/pelvic pain syndrome is associated with abnormal prostate blood flow.
Materials and Methods. We used color Doppler ultrasonography to examine 53 patients with inflammation, 80 men without inflammation and 22 healthy controls. Images were recorded and scored using standardized criteria to characterize the degree and distribution of prostatic vascularity.
Results. Flow was observed to the entire prostatic capsule in 77 % of patients but only 18 % of flow was classified as grade 2 in 74 % of patients compared to 27 % of controls (p < 0.0001). Similar findings were noted on a Doppler spot scale, with flow classified as grade 2 in 47 % of patients compared to 14 % of controls (p < 0.004). Patients also had more parenchymal Doppler spots than controls (p < 0.01). Diffuse blood flow throughout the prostatic parenchyma was observed in 63 % of patients compared to 36 % of controls (p < 0.03). There was no significant difference in the amount or distribution of blood flow in patients with and without inflammation.
Conclusions. The chronic prostatitis/pelvic pain syndrome was associated with increased blood flow to the prostatic capsule and diffuse flow throughout the prostatic parenchyma. Despite technical limitations, color Doppler ultrasonography may provide objective documentation of prostate blood flow abnormalities in patients with this syndrome.
 
 
 

Endorectal magnetic resonance imaging as a predictor of biochemical outcome after radical prostatectomy in men with clinically localized prostate cancer.

AV D'Amico, R Whittington, B Malkowicz, M Schnall, D Schultz, K Cote, JE Tomaszewski, A Wein
J Urol 2000; 164 (3 Pt 1): 759 - 63.

Purpose. Endorectal magnetic resonance imaging (MRI) of the prostate is sometimes performed before radical prostatectomy but to our knowledge its role for predicting outcome after radical prostatectomy is not yet established. We evaluated the clinical usefulness of endorectal MRI for predicting time to prostate specific antigen (PSA) failure after radical prostatectomy in 1.025 consecutive men with clinically localized or PSA detected prostate cancer. Our analysis controlled for PSA level, biopsy Gleason score, clinical T stage and percent of positive biopsies.
Materials and methods. Using Cox regression analysis we prospectively assessed time to PSA failure to determine the role of endorectal MRI in predicting PSA outcome after radical prostatectomy at our institution, where an expert prostate magnetic resonance radiologist is available. The main outcome measure was actuarial freedom from PSA failure.
Results. Endorectal MRI did not add clinically meaningful information in 834 of our 1.025 cases (81 %) after accounting for the prognostic value of PSA, biopsy Gleason score, clinical T stage and percent of positive biopsies. However, this modality provided a clinically and statistically relevant stratification of 5-year PSA outcome in the remaining 191 patients at intermediate risk based on established prognostic factors. Specifically when endorectal MRI was interpreted as indicating extracapsular versus organ confined disease the relative risk of PSA failure was 3.6 (95 % confidence interval 2.0 to 6.3), and 5 year actuarial freedom from PSA failure was 33 % versus 72 % (p < 0.0001).
Conclusions. Despite expert radiological interpretation endorectal MRI had potential clinical value in less than 20 % of the cases in our study after accounting for established prognostic factors. While further study of the value of this modality for predicting clinical outcome after radical prostatectomy should be performed in this selected cohort, routine use of endorectal MRI cannot be justified based on these data.
Transperineal magnetic resonance image guided prostate biopsy.

AV D'Amico, CM Tempany, R Cormack, N Hata, M Jinzaki, K Tuncali, M Weinstein, JP Richie

J Urol 2000; 164 (2): 885 - 7.

Purpose. We report the findings of a transperineal magnetic resonance image (MRI) guided biopsy of the prostate in a man with increasing prostate specific antigen who was not a candidate for a transrectal ultrasound guided biopsy.
Materials and methods. Using an open configuration 0.5 Tesla MRI scanner and pelvic coil, a random sextant sample was obtained under real time MRI guidance from the peripheral zone of the prostate gland as well as a  single core from each MRI defined lesion. The patient had previously undergone proctocolectomy, for ulcerative colitis and, therefore, was not a candidate for transrectal ultrasound guided biopsy. Prior attempts to make the diagnosis of prostate cancer using a transurethral approach were unsuccessful.
Results. The random sextant samples contained benign prostatic hyperplasia, whereas Gleason grade 3 + 3 = 6 adenocarcinoma was confirmed in 15 % and 25 % of the 2 cores obtained, from the MRI targeted specimens of 2 defined lesions. The procedure was well tolerated by the patient.
Conclusions. Transperineal MRI guided biopsy is a new technique that may be useful in detecting prostate cancer in men with increasing prostate specific antigen who are not candidates for transrectal ultrasound guided biopsy.
 
 
 

lntracorporeal imaging and differentiation of living tissue with an ultrahigh-frequency ultrasound probe.

Koichi Yokosawa, Kazuaki Sasaki, Shinichiro Umemura, Ryuichi Shinomura, Shizuo Ishikawa, Shyuzo Sano and Yukio Ito

Ultrasound in Me & Biol

Intraoperative diagnostic tissue differentiation is expected to be useful clinically. We have fabricated a 3 mm diameter rod-shaped ultrasound (US) probe mounted with a 120 MHz transducer whose lateral resolution is the same as the cellular size of 13 mm. The probe can image a microscopic structure (i.e. the cellular arrangement inside intracorporeal living tissue). We imaged normal kidney tissue of a living mouse and tumor tissue implanted in another mouse kidney. We anesthetized the mice, exteriorized the kidneys, and punctured the kidneys with the probe. Renal corpuscle-like structures were seen in the healthy kidney, but a wavy spindle-like structure was seen in the tumor. The similarity between the ultrasonic images and histological sections taken from the imaged organs demonstrates the possibility, of real-time tissue differentiation by ultrahigh-frequency US.
 
 
 

Cone-beam computed tomography with a flat-panel imager: Initial performance characterization.

DA Jaffray and JH Siewerdsen

American Association of physicists in Medicine 2000; S0094-2405 (00) 01306 - 7.

The development and performance of a system for x-ray cone-beam computed tomography (CBCT) using an indirect-detection flat-panel imager (FPI) is presented. Developed as a bench-top prototype for initial investigation of FPI-based CBCT for bone and soft-tissue localization in radiotherapy, the system provides fully three-dimensional volumetric image data from projections acquired during a single rotation. The system employs a 512x512 active matrix of a-Si:H thin-film transistors and photodiodes in combination with a luminescent phosphor. Tomographic imaging performance is quantified in terms of response uniformity, response linearity, voxel noise, noise-power spectrum (NPS), and modulation transfer function (MTF), each in comparison to the performance measured on a conventional CT scanner. For the geometry employed and the objects considered, response is uniform to within 2 % and linear within 1 %. Voxel noise, at a level of 20 HU, is comparable to the conventional CT scanner. NPS and MTF results highlight the frequency-dependent transfer characteristics, confirming that the CBCT system can provide high spatial resolution and does not suffer greatly from additive noise levels. For larger objects and/or low exposures, additive noise levels must be reduced to maintain high performance. Imaging studies of a low-contrast phantom and a small animal (a euthanized rat) qualitatively demonstrate excellent soft-tissue visibility and high spatial resolution. Image quality appears comparable or superior to that of the conventional scanner. These quantitative and qualitative results clearly demonstrate the potential of CBCT systems based upon flat-panel imagers. Advances in FPI technology (e.g., improved x-ray converters and enhanced electronics) are anticipated to allow high-performance FPI-based CBCT for medical imaging. General and specific requirements of kilovoltage CBCT systems are discussed, and the applicability of FPI-based CBCT systems to tomographic localization and image-guidance for radiotherapy is considered.
 
 
 

Retroperitoneal complications of Erdheim-Chester disease.

O Leluc (1), M Andr(c) (1), S Marciano (1), P Lafforgue (2), D Rossi (3), JM Bartoli (1)

J Radiol 2001; 82: 580 - 2.

Erdheim-Chester disease is a non-langerhans cell histiocytosis. It is a rare and plurifocal disease. Retroperitoneal involvement manifests as a mass associated with fibrosis, which is well visualized on CT scan and MRI. This disease is characterized by its potential to involve the whole retroperitoneum. We report a case of this disease that developed over twenty years, consisting of renal arteries stenosis, bilateral ureteral stenosis and evolutive adhesive capsulitis.
Kew words: Erdheim-Chester disease. Lipogranulomatosis. Renal arteries stenosis. Retroperitoneal space CT-MR. Retroperitoneal space neoplasms.
Potential Embolization by Atherosclerotic Debris Dislodged From Aortic Wall During Cardiac Catheterization: Histologic and Clinical Findings in 7621 Patients

H Eggebrecht, Ž Oldenburg. O Dirsch, M Haude, D Baumgart, D Welge, J Herrmann, G Arnold, K Werner Schmid, MD and R Erbel

Department of Cardiology, Division of Internal Medicine, University GHS Essen, Germany.

Institute for Pathology, University GHS Essen, Essen, Germany. 
Institute for Pathology, Essen-Steele, Germany. 

Catheterization and Cardiovascular Interventions 2000:49, 389-394.

Embolic events during cardiac catheterization have been attributed to atherosclerotic aortic debris dislodged by catheter manipulation. We evaluated the frequency and the histologic morphology of atherothrombotic material retrieved during placement of coronary catheters in patients undergoing diagnostic or interventional cardiac procedures. Over a 4-year period, macroscopically visible aortic debris from coronary catheters, if present after advancement to the ascending aorta, was obtained for histologic examination. In 41 of 7,621 patients (0.54%), visible atherothrombotic material was present in the backflow of catheters. Debris occurred most frequently with 8 Fr guiding catheters (98%). Histologic examination showed foam cells, cholesterol crystals, and amorphic lipoid substance as markers of atheromatous material from atherosclerotic plaques in 38/41 patients (93%) with former plaque hemorrhage in 55% of them. In three patients, fresh thrombus material was observed (7%). None of these patients showed inhospital ischemic complications. Although visible atheromatous material is a rare phenomenon in cardiac catheterization, an increased risk of scraping debris is associated with largelumen guiding catheters. In order to avoid vascular embolization, the use of smaller guiding catheters and sufficient free backflow of catheters after advancement are recommended.
Quantification of carotid stenoses using 3D morphometer, CT angiography and conventional angiography.

A Lucas, Y Rolland, E Calon, R Duvauferrier, Y Kerdiles

Service de Chirurgie Vasculaire, Service de Radiologie, H´pital sud-Rennes, France.

J Cardiovasc Surg (Torino) 2000 Feb:
41(1):73-8.

Background. The aim of this study is to compare the performances of 3D morphometer (M3D) regarding the quantification of extracranial carotid stenoses with selective 2D conventional angiography (reference technique) and spiral CT scan.
Methods. It is a prospective study, including 15 patients (mean age 75) presenting a symptomatic carotid lesion detected via duplex Doppler to be operated. Patients had to hold their breath for 20 seconds. Twenty-nine carotid bifurcations were studied by means of M3D and 2D conventional angiography (15 patients). Only 10 patients (19 bifurcations) underwent a CT scan. The measures were performed on a visual display unit by measuring the pixels as per the NASCET technique. Diameters (MIP technique) and surfaces (reformated axial slices) were measured. 
Results. With MIP technique, a good correlation was found 20 times in 29 (69%) (overestimation: n=8/29) between M3D and angiography, but only in 9 of 19 cases (47%) between CT scan and angiography. Unlike with M3D, the slices re-oriented with CT scan gave better correlations: 15 times in 19 (79%). With the CT scan, the measures were impossible 8 times on MIP technique, and twice on reformated slices for calcified tight stenoses. Therefore, the quantification by means of spiral CT  can is easier by planimetry on slices.
Conclusions. The reliability of these 3D explorations regarding quantification remains uncertain. The use of a morphometer, provided that technical adaptations are made, could replace selective sequences in multiple incidences that become accessible in the post-treatment period, with an acquisition field larger than the one of the CT scan.
Quantification of liver iron concentration with magnetic resonance imaging by combining T1-, T2-weighted spin echo sequences and a gradient echo sequence

HG Kreeftenberg Jr, EL Mooyaart, JR Huizenga, WJ Sluiter, HG Kreeftenberg

Department of Internal Medicine, University Hospital. P.O. Box 30001, 9700 RB Groningen. The Netherlands.
Department of Radiology. University Hospital Groningen. Groningen. The Netherlands.

The Netherlands Journal of Medicine 2000; 56:133-137.

Background. The aim of the study was to quantify hepatic iron by MRI for practical use.
Methods. In twenty-three patients with various degrees of iron overload, measurements were carried out with a 1.5 Tesla MR unit. A combination of pulse sequences (T1, T2 and gradient echo) enabled us to quantify smaller amounts of liver iron as accurately as larger amounts of liver iron. The gradient echo sequence provided us with a good correlation when detecting smaller amounts of iron in the liver where the T1 sequence provided a good correlation when larger amounts of iron were present.
Results. The combination of the 3 sequences showed a nice correlation (r=-0.93, P<0.001) and provided us with an accurate estimate of the liver iron content (LIC). This correlation was achieved with a LIC from the lower range of normal up to LIC of 146 mmol/kg dry weight, which seems the highest measurable liver iron content for a 1.5 Tesla MRI. Measuring in the lower range makes it possible to decide whether further invasive diagnostic investigations by a liver biopsy are indicated.
Conclusion. MRI is a useful tool to quantify iron overload non-invasively. In cases where a liver biopsy is hazardous MRI can easily be used to obtain reliable, quantitative information about the initial LIC. Quantification by MRI could also be used for follow up of the iron content during depletion treatment by phlebotomy or iron chelation. The stronger the magnet the more sensitive the detection of concentrations up to 150 mmol/kg is. A semi-quantitive judgement will only be possible with severe iron overload over 150 mmol/kg. If such an iron excess is found, a liver biopsy should be performed to exclude cirrhosis.
 
 
 

Assessment of disease activity and extent by magnetic resonance imaging in ulcerative colitis

T Nozue, A Kobayashi, Y Takagi, H Okabe and M Hasegawa

Departments of Pediatrics and Radiology, Showa University Toyosu Hospital, Tokyo, Japan.

Pediatrics international 2000:42:285-288.

Background. We determined  whether magnetic resonance imaging (MRI) could determine the activity and site of involvement in ulcerative colitis.
Methods. Colonoscopy, double-contrast barium enema and gadodiamide-enhanced MRI were performed prospectively in six patients with ulcerative colitis, including three females aged 10-22 years, both in the active and the remission stages.
Results. Characteristic findings of MRI in the active stage of ulcerative colitis were loss of haustral markings and thickening and contrast enhancement of the colonic wall. In five of six patients, the site of disease distribution determined by MRI was in accordance with that determined by colonoscopy. 
Conclusions. Gadodiamide-enhanced MRI is a safe and useful method of determining disease activity and extent in patients with ulcerative colitis.
 
 
 

The potential impact of high-quality MRI of the biliary tree on ERCP workload

AR Tanner, AD Dwarakanath, NP Tait

Department of Medicine, North Tees General Hospital, Stockton on Tees. UK.

Eur J Gastroenterol Hepatol 2000 July; 12(7):773-6.

Background. Magnetic resonance cholangiography (MRC) is a non-invasive method of imaging the biliary tree with virtually no morbidity. Endoscopic retrograde cholangiopancreatography (ERCP) has a significant morbidity, mortality and failed imaging rate. Unlike MRC, ERCP is highly dependent on the clinical team for high-quality results and minimal morbidity. MRC requires high-quality image acquisition and appropriate reconstructions, with skilled reading of the images. 
Objectives. To assess the impact on ERCP workload of using MRC as the initial imaging modality for the biliary tree in selected patient groups, and to assess procedure-related morbidity and mortality.
Methods. An analysis of 1078 consecutive ERCP examinations performed at our institution over the six years to 1996 has been undertaken. Complications, imaging failure rates and ERCP findings have been analysed in the different referral categories to assess the potential impact of MRC on future ERCP workload and patient outcomes.
Results: At our institution, if MRC had been used as the first imaging investigation in patients with abdominal pain (n=336, with or without abnormal liver function tests but without clinical jaundice) and those with present or past acute pancreatitis (n=101), we estimate that 83 (19%) would have needed to go on to ERCP, but 354 (81%) would not have required further invasive investigation. In these categories, this would have resulted in five patients with stones missed at MRC, but 14 extra patients with stones would have been identified whose stones would have been missed at ERCP (failed examinations). There would be an overall 33% reduction in ERCP workload and 20 serious complications related to ERCP would have been avoided. Overall 7% of patients would be subjected to both investigations.
Conclusions. In the interests of efficient use of resources, minimization of patient complications and accurate identification of those requiring therapeutic ERCP, MRC should be the preferred initial investigation in selected groups of patients presently being subjected to ERCP.
Blunt Splenic Injuries: Dedicated Trauma Surgeons Can Achieve a High Rate of Nonoperative Success in Patients of All Ages

JG Myers, DL Dent, RM Stewart, GA Gray, DS Smith, JE Rhodes, BA, HD Root, BA Pruitt, Jr. and WE Strodel

University of Texas Health. Science Center at San Antonio, Department of Surgery. Floyd Curt Drive. San Antonio 7842.

The Journal of Trauma: Injury, Infection, and Critical Care.

Background. Selective nonoperative management (NOM) of blunt splenic injuries is becoming a more prevalent practice. Inclusion .criteria for NOM, which have been a source of controversy, continue to evolve. Age i 55 years has been proposed as a predictor for failure of and even a contraindication to NOM of blunt splenic trauma. Additionally, the high rate of NOM in children (up to 79%) has been attributed to their management by pediatric surgeons. We evaluated our experience with NOM of blunt splenic injury with special attention to these age groups.
Methods. By using our trauma registry, all patients with blunt splenic injuries (documented by computed tomography, operative findings, or both) cared for over a 36-month period, at a single American College of Surgeons verified Level I trauma center were reviewed. Detailed chart reviews were performed to examine admission demographics, laboratory data, radiologic findings, outcome measures, and patient management strategy. All patients were managed by nonpediatric trauma surgeons. We then compared our adult data with that in the recent literature and our pediatric data with that of the National Pediatric Trauma Registry over the same time period.
Results. We identified 251 consecutive patients with blunt splenic injuries. Eighteen patients who expired in the immediate postinjury period were excluded from statistical evaluation. No deaths occurred as a result of splenic injury. Of the remaining 233 patients, 73 patients (31%) required early celiotomy, 160 patients (69%) were selected for NOM, with 151 patients (94%) being successfully managed without operation. Blunt splenic injury occurred in 23 patients age 55 years or older. Eighteen patients (78%) were selected for NOM and 17 patients (94%) were successfully treated without operation. Blunt splenic injury occurred in 35 patients less than 16 years of age. Thirty-two patients (91%) were selected for NOM. Thirty-one patients (89% of all pediatric patients) were successfully treated without operation.
Conclusion. Age i 55 years is not a contraindication to nonoperative management of blunt splenic injuries. Children with blunt splenic injuries can be successfully managed nonoperatively by nonpediatric trauma surgeons.
 
 
 

Radiofrequency Lesions of the Stellate Ganglion in Chronic Pain Syndromes: Retrospective Analysis of Clinical Efficacy in 86 Patients

T Forouzanfar, M van Kleef, Ph D, W EJ Weber, M 

Pain Management and Research Centre, Department of Anesthesiology, University Hospital  Maastricht, Maastricht,   The Netherlands. 

The Clinical Journal of Pain16:164-168, 2000.

Objective. Stellate ganglion (SG) blockade is used for the treatment of chronic pain syndromes in which the sympathetic nervous system is hypothesized to be involved. A possible treatment modality to achieve long-term pain reduction is blockade of the SG by means of a radiofrequency lesion (RF-SG). To evaluate the outcome of RF-SG as a therapy for different chronic pain syndromes, we reviewed 86 RF-SG procedures.
Design. Medical records containing treatment information were reviewed systematically. A systematic MEDLINE literature review search on SG blockade was also performed.
Results. In our clinic, 39.5% of 221 patients who received a prognostic SG block subsequently underwent RF-SG. Of these patients, 40.7% noted a more than 50% reduction of pain, 54.7% reported no effect on pain, and 4.7% showed worsening of pain. The mean follow-up interval was 52 weeks. The computer-assisted literature search resulted in 31 studies: 12 about complications and 19 about the efficacy of SG blockade. A review of these studies showed partial pain relief in 41.3% of patients, complete pain relief in 37.8%, and no pain relief in 20.9%.
Conclusions. The efficacy of RF-SG blockade seems to be in line with that of other SG blockade procedures reported in the literature. Our retrospective study shows that an RF-SG block is most likely to be of benefit for patients suffering from complex regional pain syndrome type 2, ischemic pain, cervicobrachialgia, or postthoracotomy pain. Clinical efficacy remains to be proven in a randomized controlled trial, however.
 
 
 

Magnetic Resonance Imaging Guided Corticosteroid Injection of the Sacroiliac Joints in Patients with Therapy Resistant Spondyloarthropathy: A Pilot Study

I G¼naydin, P L Pereira, T Daikeler, M Mohren, J Tr¼benbach, F Schick, L Kanz, I K¶tter

Medizinische Klinik und Poliklinik II. Rheumaambulanz 72076 T¼bingen. Germany.

J Rheumatol 2000, 27:424-8.

Objective. To evaluate magnetic resonance imaging (MRI) guided corticosteroid injections of inflamed sacroiliac (SI) joints in patients with Spondyloarthropathy with therapy resistant sacroiliitis.
Methods. We performed 16 injections in 9 patients on an outpatient basis (6 men, 3 women, mean age at onset 24.7+7.5 yrs). All patients had MRI guided injection of 40 mg triamcinolone acetonide into SI joints using an open 0.2 Tesia unit. Before and 3 months after corticosteroid injection they underwent an MRI examination with a closed 1.5 Tesia unit.
Results. Seven of 9 patients reported subjective improvement that lasted at least a mean of 10.8+5.6 months. Subchondral bone marrow edema on fat suppressed images resolved in 8 patients after corticosteroid injection.
Conclusion. MRI guided corticosteroid injection of SI joints appears to be an effective and safe procedure without exposure to radiation. It is a useful therapeutic modality, especially in young patients with severe isolated sacroiliitis.
 
 
 

Computerized Tomographic Localization of Clinically Guided Sacroiliac Joint Injections

J M Rosenberg, D J Quint, A Michael de Rosayro

Departments of Anesthesiology and Radiology. University of Michigan Hospitals and Veterans Administration Hospital, Ann Arbor, Michigan.

The Clinical of Pain 2000:16:18-21.

Objective. The goal of this study was to use computed tomographic (CT) scanning to localize clinically guided sacroiliac (SI) joint injections and identify other structures affected by this procedure.
Design. A prospective, double-blind, correlational outcome study design was used. Injection of 39 SI joints with a mixture of bupivacaine (0.25 %), methylprednisolone (40 mg), and iohexol (Omnipaque; 180 mg/dl) using a clinically guided technique (i.e., no image guidance) was performed. Patients had CT scans obtained both immediately after needle placement and after contrast injection. Neither the patients nor their clinicians were aware of the CT findings at the time of injection.
Setting. Academic multidisciplinary pain center.
Patients. Patients with SI disease by clinical criteria.
Results. Intra-articular injection was accomplished in 8 of 37 (22%) patients. Injected material was identified within 1 cm of the joint 68% of the time. Epidural (spinal canal) injected material was seen 24% of the time.
Conclusions. The low rate of intra-articular injection seen with this clinically guided technique suggests restraint in its use for injection therapy. Some image guidance (e.g. fluoroscopy, CT) is probably necessary to reliably inject the SI joint. Perhaps in clinical settings, where image guidance is not readily available, a clinically guided technique could initially be tried in patients at low risk for complications from such injections. This study also provides an anatomic explanation for the occasional
weakness observed after SI joint injection.
 
 
 

Radial MRI of the hip with moderate osteoarthritis

H Motoyuki, K Toshikazu, H Yasusuke

Kyoto Prefectural University of Medicine, Kyoto, Japan

J Bone Joint Surg [Br] 2000;82-B:364-368.

We carried out radial MRI in 30 hips with moderate osteoarthritis and in ten normal hips.  On a  scout view containing the entire acetabular rim, 12 vertical radial slices were set at 15ø intervals.
Different appearances were observed in different parts of the joint. In the weight-bearing portion, from 45ø anterosuperior to 45ø posterosuperior, "attenuation" (n=16) and "disappearance" (n=25) were observed as abnormalities of the labrum with "capsular stripping" (n=29) and "extraosseous high signal lesion" (n=27) as capsular abnormalities, seen more often in the anterosuperior portion. In all 12 planes there were osteophytes on the acetabuler edge (n=24), femoral head (n=22) and/or at the central acetabulum (n=6), a bone cyst on the acetabulum (n=18) and/or the femoral head (n=9), irregularity of the articular cartilage (n=30), and an effusion (n=28). Our findings indicate that radial MRI may be a useful non-invasive diagnostic method for demonstrating pathology in moderate osteoarthritis of the hip.
 
 
 

Magnetic resonance imaging, radiography, and scintigraphy of the finger joints: one year follow up of patients with early arthritis. The TIRA Group

M Klarlund, M Ostergaard, KE Jensen, JL Madsen, H Skjodt, I Lorenzen
The Danish Research Centre of Magnetic Resonance. H-S Hvidovre Hospital, University of Copenhagen.

Ann Rheum Dis 2000:59(7):521-528.

Objectives. To evaluate synovial membrane hypertrophy, tenosynovitis, and erosion development of the 2nd to 5th metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints by magnetic resonance imaging in a group of patients with rheumatoid arthritis (RA) or suspected RA followed up for one year. Additionally to compare the results with radiography, bone scintigraphy, and clinical findings.
Patients and methods. Fifty five patients were examined at baseline, of whom 34 were followed up for one year. Twenty one patients already fulfilled the American College of Rheumatology (ACR) criteria for RA at baseline, five fulfilled the criteria only after one year's follow up, whereas eight maintained the original diagnosis of early unclassified polyarthritis. The following MRI variables were assessed at baseline and one year: synovial membrane hypertrophy score, number of erosions, and tenosynovitis score.
Results. MRI detected progression of erosions earlier and more often than did radiography of the same joints; at baseline the MRI to radiography ratio was 28:4. Erosions were exclusively found in patients with RA at baseline or fulfilling the ACR criteria at one year. At one year follow up, scores of MR synovial membrane hypertrophy, tenosynovitis, and scintigraphic tracer accumulation had not changad significantly from baseline; in contrast, swollen and tender joint counts had declined significantly (p<O.05).
Conclusions. MRI detected more erosions than radiography. MR synovial membrane hypertrophy and scintigraphy scores did not parallel the changes seen over time in clinically assessed swollen and tender joint counts. Although joint disease activity may be assessed as quiescent by conventional clinical methods, a more detailed evaluation by MRI may show that a pathological condition is still present within the synovium.
Tumor volume change as a predictor of chemotherapeutic response in osteosarcoma

KH Shin, SH Moon, JS Sun, Wl Yang

Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea.

Clin Orthop 2000:376:200-208.

The change in osteosarcoma tumor volume after preoperative adjuvant chemotherapy and its relationship to the histopathologic response was investigated using various reproducible volumetric methods. Tumor volume was measured before and afterchemotherapy in 41 patients with osteosarcoma using an ellipsoid formula in plain radiography and magnetic resonance imaging and three-dimensional magnetic resonance imaging measurement. Based on intraobserver and interobserver variability for the volumetric measurements of each method, three-dimensional magnetic resonance imaging measurement was the most reproducible. In three-dimensional magnetic resonance measurements, the correlation of the histopathologic response with absolute and relative total tumor volume changes and extraosseous volume change were significant. The good responder group showed a greater reduction in tumor volume after chemotherapy, although there was no significant difference in pretreatment tumor volume between the good and poor responder groups. The group with a decreased or stable tumor volume represented a good histopathologic response with a sensitivity of 85%, specificity of 76 %, and positive predictive value of 88 %. The change in tumor volume of osteosarcoma measured by three-dimensional magnetic resonance imaging could predict histopathologic response after three cycles of neoadjuvant chemotherapy. 
 
 
 

The MR Imaging Appearance of Longitudinal Split Tears of the Peroneus Brevis Tendon

MN Major MD, AC Helms, RC Fritz and KP Speer
Department of Orthopaedics. Sports Medicine, Duke University Medical Center. Durham, NC 27710.

Foot & Ankle International 2000.

Purpose. Longitudinal split tears of the peroneus brevis tendon have been increasingly reported as a source of lateral ankle pain and disability. MR imaging is useful in identifying the appearance of longitudinal split tears of the peroneous brevis tendon to differentiate this entity from other causes of chronic lateral ankle pain. We observed variations in anatomy associated with these tears.
Materials and Methods. Twenty-two patients (eleven males, eleven females) were identified as having longitudinal split tears of the peroneous brevis tendon. These cases were reviewed retrospectively to evaluate for the following: shape of the pero-
neus brevis tendon, high signal in the peroneus brevis tendon, tendon subluxation, appearance of the superior peroneal retinaculum, presence of osseous changes in the ankle, lateral ankle ligaments, presence of a bony fibular spur, flattening of the peroneal groove of the fibula and presence of a peroneus quartus.
A control group consisted of twenty ankles imaged for reasons other than lateral ankle pain. The same structures were assessed in this group. A Fisher's exact P-value was used to determine the significance of each finding in the two groups.
Results. Statistically significant associated findings were chevron shaped tendon (p=.0001), high signal in the peroneus brevis (p=.0017), bony changes (p=.0001), flat peroneal groove (p=.0001), abnormal lateral ligaments (p=.0004), and lateral fi-
bular spur (p=.0006).
Conclusions. MR Imaging is useful in differentiating longitudinal split tears of the peroneus brevis tendon from other lateral ankle disorders. It can show the extent of the abnormality in the tendon and the associated findings of soft tissue and/or bone
variations which must be addressed at the time of surgery.
 
 
 

Signal Intensity Changes in Anterior Cruciate Ligament Autografts: Relation to Magnetic Field Orientation

J Echigo, H Yoshioka, H Takahashi, HM Niitsu, T Fukubayashi, Y Itai

Department ot Radiology, Institute of Clinical Medicine, University of Tsukuba, 1-1 1-chome Tennoudai Tsukuba-city, Ibaraki  305-8675, Japan.

Acad Radiol 1999:6:206-210.

Rationale and Objectives. The purpose of this study was to use magnetic resonance (MR) imaging to investigate the contribution of graft alignment to changes in signal intensity in anterior cruciate ligament (ACL) autografts.
Materials and Methods. Forty patients who had undergone reconstruction of the ACL with an autograft underwent MR examinations of the knee in extension and flexion. The signal intensity of the intratibial bone tunnel and intraarticular portions of ACL graft were measured, and signal intensity ratios were defined by dividing the mean signal intensity of the graft by the mean signal intensity of the fatty marrow. The angles from the intraarticular and intratibial bone tunnel portions of the graft to the static magnetic field were measured for each signal intensity ratio. The Hotteling T2 test was used to evaluate the differences in signal intensity ratios to the differences in angles from flexion to extension for the intratibial bone tunnel and intraarticular portions of the graft.
Results. Significant increases occurred in the signal intensity of the graft and the angle with the change in position from flexion to extension for both the intratibial bone tunnel (P<.01) and intraarticular (P<.01) portions of the graft. Changes in signal intensity ratios were greater than zero, and these values differed significantly for the intraarticular and the intratibial bone tunnel (P<.01) portions of the graft.
Conclusion. The signal intensity changes of the ACL graft related to changes in to alignment are likely a result of the magic angle effect.
Key words: Grafts, knee, ligaments, menisci and cartilage, knee surgery.
 

Imaging of Sacroiliitis

J Braun, J Sieper and M Bollow

Section of Rheumatology, Department of Nephrology and Endocrinology, UK Benjamin Franklin, Free University, Berlin. Department of Radiology, UK Charit(c), Humboldt University, Berlin, Germany.

Clin Rheumatol 2000:19:51-57.

Abstract. Inflammation of one or both sacroiliac joints is a characteristic feature of patients with spondyloarthropathies (SpA). Sacroiliitis often leads to inflammatory back pain (IBP). IBP and asymmetric peripheral arthritis of the lower limbs are the main clinical symptoms and criteria for classification and diagnosis of SpA in which sacroiliac joints are uni- or bilatedy affected with an intensity ranging from mild to very severe inflammation resulting in partial or complete ankylosis Sacroiliitis is a very frequent feature of undifferentiated SpA. In ankylosing spondylitis (AS) inflammation in the axial skeleton occurs rarely in the absence of Sacroiliitis. Objective evidence of Sacroiliitis obtained by imaging procedures, especially x-rays, has always been part of diagnostic and classification criteria for AS. This is in contrast to spinal radiography which, however, has been recently included in a core set of outcome items to be assessed in clinical studies. In early and acute stages of Sacroiliitis the diagnosis can be difficult because conventional radiographs - which are known to have considerable intra- and interobserver variability - may be normal. Since IBP is not a specific indicator of Sacroiliitis there is need for valuable imaging techniques. Scintigraphy lacks specificity. Computed tomography (CT) is a very good method to demonstrate already established bony changes and magnetic resonance imaging (MRI) has the advantage of combining a good visualisation of the complicated anatomy of the sacroiliac joint with the ability to localise different degrees of inflammation and oedema and prove a possible spread to muscles as it occurs in septic Sacroiliitis, an important differential diagnosis.
High-resolution imaging of the human esophagus and stomach in vivo using optical coherence tomography.

Brett E Bouma, Guillermo J Tearney, Carolyn C Compton, Norman S Nishioka

Gastrointestinal endoscopie 2000.

Background. Optical coherence tomography is a new, high spatial-resolution, cross-sectional imaging technique. We investigated the ability of optical coherence tomography to provide detailed images of subsurface structures in the upper gastrointestinal (GI) tract.
Methods. Optical coherence tomography was performed during routine upper GI endoscopy on 32 patients including 20 patients with Barrett's esophagus. An endoscopic mucosal biopsy was obtained immediately after imaging and was used for histopathologic correlation.
Results. Optical coherence tomography provided clear delineation of layers of the normal human esophagus extending from the epithelium to the longitudinal muscularis propria. Gastric mucosa was differentiated from esophageal mucosa, Barrett's esophagus was differentiated from normal esophageal mucosa, and esophageal adenocarcinoma was distinguished from normal esophagus and Barrett's esophagus.
Conclusions. Optical coherence tomography allows visualization of the subsurface architectural morphology of the upper GI tract. The diagnostic information provided by this new imaging modality suggests that it may be a useful adjunct to endoscopy.
 
 
 

Bone scintigraphy in clinical routine

Vika M¼ller1, J¶rn Steinhagen2, Maike de Wit3, Karl H. Bohuslavizki1

Department of 1Nuclear Medicine, 2Orthopedic Surgery and 3Hematology and Oncology, University Hospital Eppendorf, 20246 Hamburg, Germany
Background. In 1971, bone scintigraphy was performed the first time using 99mTc-labeled polyphosphonates. Since that time, bone scintigraphy has become one of the most frequent diagnostic procedures in nuclear medicine departments. However, in the last decade, indications for this skeletal imaging procedure have been changing continuously. This paper, therefore gives a concise review of the current spectrum of indications for bone scintigraphy and its realization. 
Conclusions. Just as many other nuclear medicine procedures, the bone scintigraphy has a high sensitivity, and the changes of the bone metabolism are seen often earlier than the changes in bone structure developing after x-ray. Therefore, occult lesions in the whole skeleton might be detected early by bone scintigraphy. On the other hand, bone turnover is increased in various bone diseases. Consequently, bone scintigraphy usually has a low specificity, and differential diagnosis of the underlying etiology is often not feasible. However, three-phases bone scintigraphy and SPECT can significantly increase the specificity in some skeletal areas.
Key words: Bone diseases-radionuclide imaging, technetium, diphosphonates, bone neoplasms, bone scintigraphy, 99mTc-diphosphonates, indications
 
 
 

Diagnostic imaging of hypertrophic pyloric stenosis (HPS)

Marija Frkovió, Marina ?eronja Kuhar, ³eljka Perhoü, Vinka Barbarió-Babió, Melita Molnar, Jurica Vukovió

Clinical Institute for Diagnostic and Interventional Radiology, Clinical Hospital Centre Zagreb - Rebro, Croatia

Background. Imaging of the abdomen in children with suspected hypertrophic pyloric stenosis has been traditionally performed by plain film radiography and upper gastrointestinal contrast studies. In many clinical situations, this approach has been modified or replaced by ultrasound examination. The authors aimed to analyse the value of diagnostic algorithm in children with hypertrophic pyloric stenosis confirmed at surgery in our hospital. 
Patients and methods. The authors made a five year retrospective review of hospital records of all children operated on for HPS in Clinical Hospital Centre Zagreb - Rebro and found out that 14 boys, between 2 (17 days) and 10 weeks of life (75 days) underwent surgery due to HPS.
Results. Specific radiographic signs were: string sign, double track sign, elongation and narrowing of pyloric canal, mushroom sign, gastric distension with fluid and beak sign. Ultrasound was performed in 9 patients, one of them was false negative (sonographer admitted that he had no experience), the rest were positive.
Conclusions. If the physical examination is negative or equivocal, sonography by an experienced sonographer must be performed. If the ultrasound finding is negative, than the infant should undergo to barium upper gastrointestinal studies (UGI). If HPS isn't a primary diagnostic question, it's better to perform UGI first in order to make a correct diagnosis.
Key words: pyloric stenosis - radiography - surgery, hyperthrophy, child
 
 
 

Biliary small intestinal submucosa covered Z-stents: preliminary results in an animal model

Koichiro Yamakado1,3, Du«an Pavünik1, Barry T Uchida1, Hans Timmermans1, Christopher L. Corless2, Joong Wha Park1, Katsuyuki Yamada1, Frederic S. Keller1, Josef R¶sch1

1Dotter Interventional Institute, Oregon Health Science University, Portland, Oregon, 2Department of Pathology, Oregon Health Science University and Portland Veterans Administration Medical Center, Portland, Oregon, USA, 3Mie University Scholl of Medicine, Japan

Background. Purpose of the study was to test the function and biological response of metallic stents covered with small intestinal submucosa (SIS) in the swine biliary system.
Material and methods. A total of 9 SIS-covered single Z-stents were placed in the common bile duct (CBD) in 6 pigs. Stents were delivered into the CBD at laparotomy via the gall bladder and the cystic duct. Animals were sacrificed or died at 2 weeks (n=1), 4 weeks (n=1), 8 weeks (n=2), and 10 weeks (n=2) after stenting and histological studies were performed.
Results. Nine stents were deployed in 6 animals. During follow-up, 3 stents in 3 animals (2, 4 and 10 weeks) remained stable, while one stent shifted distally in CBD and 5 of them turned sideways. All stents remained patent. Duct dilatation and bile slugging were noted at 10 weeks. The SIS-membrane was present at 2 weeks, but was not histologically distinct at 4 weeks and later. Histological study showed no significant inflammatory changes in the bile duct in any pig. Mucosal hyperplasia was absent in 2 of 3 stable stents at 2 and 10 weeks, and 1 distally shifted stent at 10 weeks. Mild mucosal hyperplasia was seen at the distal stent end in 1 stable stent at 4 weeks and in 5 dislodged stents at 8 and 10 weeks.
Conclusions. Even when the study is limited by dislodgment of high percentage of placed stents, the results in stable stents conducting the bile flow suggest that SIS helps to prevent bile duct inflammation and mucosal hyperplasia typical for uncoated stents. Further studies, particularly with improved wet SIS are warranted.
Key words: bile ducts, stents, intestinal mucosa.
 
 

25.11. - 30.11.2001
Chicago, USA
 

11.12. - 14.12.2001
Edinburgh, UK
 
 

01.03. - 05.03.2002
Vienna, Austria
 

19.03. - 23.03.2002
Barcelona, Spain
 

05.05. - 10.05.2002
Jerusalem, Israel
 

15.05. - 19.05.2002
Salzburg, Austria
 

12.06. - 16.06.2002
Ohrid, Macedonia
 
 

16.06. - 19.06.2002
Stockholm, Sweden
 
 

24.06. - 28.06.2002
Cancun, Mexico
 

26.06. - 29.06.2002
Paris, France
 

26.06. - 30.06.2002
Warsaw, Poland
 
 

30.06. - 5.07.2002
Oslo, Norway
 

06.07. - 09.07.2002
Madrid, Spain
 
 

18.08. - 24.08.2002
Paris, France
 
 
 

01.09. - 05.09.2002
Athens, Greece
 

16.09. - 19.09.2002
Prague, Czech Rep.
 
 

19.09. - 22.09.2002
Florence, Italy
 
 

20.09. - 22.09.2002
Ulaanbatar, Mongolia
 

28.09. - 03.10.2002
Luzern, Switzerland
 
 

11.10. - 12.10.2002
Valencia, Spain
 

18.10. - 22.10.2002
Nice, France
 

19.10. - 23. 10.2002
Paris, France
 

87th Meeting of the Radiological Society of North America (RSNA)
Contact: Steven T. Drew, Ass. Exec. Director, 920 Jorie Boulevard, Oak Brook, IL 60523-2251, USA. Fax: 1-630-5717837, E-mail: sdrew@rsna.org

EUROSON 2001: 13th Congress of the European Federation of Soc. for US in Medicine and Biology
Contact: Mrs Elaine Brown, Gen. Secretary BMUS, 36 Portland Place, W1N 3DG London, UK. Fax: 44-20-73232175, E-mail: euroson@bmus.org

14th European Congress of Radiology
Contact: ECR Office, Neutorgasse 9/2A, A-1010 Vienna, Austria. Fax: 43-1-5334064-9, E-mail: office@ecr.org

EBCC 3: 3rd European Breast Cancer Conference 
Contact: Ms Kris Vantongelen, FECS Conference Unit, Av. E. Mounier 83, B-1200 Brussels, Belgium. Fax: 32-2-7750245, E-mail: Kris@fecs.be
 
12th International Congress on Breast Diseases of the Senologic International Society 
Contact: Secretariat, Kenes, P. O. Box 50006, 61500 Tel Aviv, Israel. Fax: 972-3-5140077/5175674, E-mail: breast@kenes.com

7th International Meeting on Progress in Radio-Oncology/ICRO/OGRO 7
Contact: Univ. Prof. Dr. H. D. Kogelnik, Landeskl., St. Johanns-Spital, M¼llner Hauptstr. 48, A-5020 Salzburg, Austria. Fax: 43-662-4482887, E-mail: D.Kogelnik@1kasbg.gv.at

Third Macedonian Congress of Radiology with International Participation
Contact: Congress Secretariat, Institute of Radiology, University Clinical Center, Vodnjanska 17, 1000 Skopje, Republic of Macedonia. Fax: 389-2-236974, E-mail: rentgen@unet.com.mk

7th Meeting of the World Association of Sarcoidosis and other Granulomatous Disorders (WASOG)
Contact: Mr. Chr. Carlsson, Stockholm Convention Bureau, P. O. Box 6911, S- 102 39 Stockholm, Sweden. Fax: 46-8-348441

22nd International Congress of Radiology (ICR)
Contact: Fed. Mexicana de Radiologia e, Imagen, Coahuila No. 35, Col. Roma, C.P. 06700, Mexico, D.F. Fax: 52-5-5745374, E-mail: fmri@compuserve.com

CARS 2002 - Computer Assisted Radiology and Surgery
Contact: Mrs. Franziska Schweikert, CARS 2002 Conference Office, Im Gut 11/15, D-79790 K¼ssaberg, Germany. Fax: 49-7742-922438, E-mail: francis.cars@d-plus.net

EUROSON 2002 - 14th Congress of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB)
Contact: Polish Ultrasound Society, ul. Kondratowicza 8, 03-242 Warszawa, Poland. Fax: 48-22-8119591, E-mail: euroson@euroson.edu.pl

18th International Cancer Congress
Contact: Congrex Sweden AB, P.O. Box 5619, SE-114 86 Stockholm, Sweden. Fax: 46-8-6619125, E-mail: amelie.svanstrom@congrex.se

EACR XVII - European Association for Cancer Research
Contact: Mr Luc Hendrickx, FECS Conference Unit, Av. E. Mounier 83, B-1200 Brussels, Belgium
Fax: 32-2-7750200, E-mail: EACRXVII@fecs.be

XVII Symposium Neuroradiologicum of the World Federation of Neuroradiological Societies (WFNRS)
Contact: Prof. Luc Picard, Serv. Neurorad., H´p. Central, 29 av. Mar(c)chal de Lattre de Tassigny-CO 34, F-54035 Nancy Cedex, France. Fax: 33-3-83852236/83851391, E-mail: 1.picard@chu-nancy.fr

Annual Congress of the European Association of Nuclear Medicine (EANM)
Contact: Quality Associates, Secretariat EANM, Van Breestraat 156, NL-1071 ZX Amsterdam, The Netherlands. Fax: 31-20-6759410

ESTRO 21 - 21st Annual Meeting of the Eurpoean Society for Therapeutic Radiology and Oncology
Contact: ESTRO office, Av. E. Mounierlaan 83/12
B-1200 Brussels, Belgium. Fax: 32-2-7795494, E-mail: info@estro.be

19th Annual Meeting of the European Society for Magnetic Resonance in Medicine and Biology (ESMRMB)
Contact: Prof. C. Bartolozzi, ESMRMB Office, Neutorgasse 9/2A, A-1010 Vienna, Austria. Fax: 43-1-5357041, E-mail: Office@esmrmb.org

Annual Meeting of the Mongolian Radiological Society
Contact: Dr. D. Gonchigsuren, Dept. of Radiol., Nat. Univ. Hosp., P.O. Box 34, Ulaanbatar 48, Mongolia. Fax: 976-1-321249/302818, E-mail: dgonchigsuren@hotmail.com

CIRSE 2002 - Annual Meeting of the Cardiovascular and Interventional Radiological Society of Europe (CIRSE)
Contact: CIRSE 2002, Bellerivestrasse 42, CH-8008 Z¼rich, Switzerland. Fax: 41-1-3849339
E-mail: cirse@congressorg.ch

9th Annual Meeting of the European Society of Musculoskeletal Radiology (ESSR)
Contact: Dr Francisco Aparisi, C. Dr. Sanchis Sivera 18, E-46008 Valencia, Spain
Fax: 34-96-3177870

27th Congress of the European Society of Medical Oncology (ESMO)
Contact: ESMO Congress Secretariat, Via Soldino 22, CH-6900 Lugano, Switzerland
Fax: 41-91-9500781, E-mail: esmo@dial.eunet.ch

Journ(c)es francaises de radiologie - JFR 2002 
Contact; Prof. Guy Frija, Secr. Gen. SFR, 20, av. Rapp, F-75343, Paris Cedex 07, France
Fax: 33-1-53595960, E-mail: sfr@sfradiologie.or