Spontaneous intracranial arterial dissection in the young: diagnosis by CT angiography

Background  

Spontaneous carotid artery dissections have been rarely reported in children. Diagnosis has traditionally been confirmed by catheter arteriography. More recently diagnosis has been made by magnetic resonance imaging and magnetic resonance angiography; however the sensitivity of these techniques has yet to be determined. The authors are unaware of reports of carotid dissection confirmed by dynamic computed tomography (computerized tomographic arteriography) in the young.     

Complex radiodiagnosis of oropharyngeal neoplasms

The paper describes the magnetic resonance imaging (MRI) and spiral computed tomographic (SCT) symptoms of malignant and benign tumors of the oral cavity and throat. It also depicts different types of tumors, such as squamous cell carcinoma, adenocarcinoma, papilloma, and lipoma. The MRI and SCT symptoms of malignant and benign tumors, as well as metastatic lesion in lymph nodes and destruction of bone elements are described in detail.     

Evaluation of circle of willis aneurysms with spiral computed tomographic angiography

The aim of this retrospective study is to evaluate the specificity and sensitivity of spiral computed tomographic angiograohy (SCTA) in the detection of intracranial aneurysms. Patients were included in this study on the ground of the SCTA, digital subtraction angiography, magnetic resonance angiography, neurosurgeons operative findings and autopsy reports. Scanning protocol was slice thickness of 1mm, reconstruction interval of 0.5 mm, pitch 1. Flow rate was 3-4 ml/s, with standard scan delay time of 15-20s. In 18 patients with average age of 49.3 years SCTA results were positive for cerebral aneurysms and confirmed with other methods. On a per aneurysm basis SCTA sensitivity for detection of aneurysms was 89.47% specificity was 86.96%, positive predictive value of 85.00% and negative predictive value of 90.91%. SCTA should be used for the detection of cerebral aneurysms, especially for aneurysms with maximum diameter larger than 5mm.     

Techniques d’imagerie de la cardiopathie ischémique : le point de vue du clinicien

Coronary angiography often remains an unavoidable gold standard in cardiology practice for determining the severity, extent and prognosis of coronary artery disease and for therapeutic decision making, although established non-invasive testing – such as myocardial perfusion imaging or stress echocardiography – have demonstrated their diagnostic value and their incremental pronostic value over coronary angiography. Newer noninvasive techniques, such as multidetector computed tomography and magnetic resonance imaging, are currently being validated and will very soon be considered as alternatives to these imaging modalities in clinical practice. Facing this wide choice of tests, the cardiology community has the difficult task to determine the role and place of these various investigating techniques and to evaluate their resource implications, in other words, to optimize the cost-efficacy and ratios in the management of coronary artery disease.     

Images and Image: Technology and the Social Politics of Revealing Disorder in a North American Hospital

In the United States and elsewhere diagnostic activities are now prominently centered on images derived from technologies such as magnetic resonance, computed tomography, and angiography. In this article I examine language, actions, and interactions in a multidisciplinary team of biomedical specialists whose members meet routinely to visually interpret and assess such images. Convened behind the scenes, in a conference room from which patients are excluded, these meetings are examined as privileged performances in which team members exercise their visual faculties and interpretive skills to address issues that include their statuses and reputations, and to politically position themselves and their specialties. Ethnographic data derived from close observation of 23 such diagnostic meetings are presented. I suggest that problems posed by the attempt to synthesize information from diagnostic images serve as vehicles for evaluating or "diagnosing" the professional capabilities and "image" of the participating physicians. Team-based divisions and attempts to reassert challenged autonomies also characterize this socially oriented diagnostic process.     

Tomographic methods in the assessment of myocardial perfusion

Myocardium visualization using the most up-to-date tomographic techniques is extremely important in clinical cardiology. Myocardial viability assessment is of particular importance in management of patients with Ischemic Heart Disease (IHD). Although rest echocardiography is the most common in assessment of heart function, nuclear cardiology (SPECT and PET), and recently cardiac computed tomography and magnetic resonance become playing important clinical roles. Determining and understanding of real capabilities of these methods is of great necessity in this regard. This review examines the current abilities of current cardiac tomographic modalities for the assessment of myocardial perfusion in patients with known IHD.     

多功能磁共振造影剂研究进展

磁共振成像技术因对人体无创、任意方向断层扫描三维图像且分辨率较高、提供形态与功能两方面诊断评价等突出优点,成为了临床上用于疾病诊断的重要手段之一。临床上使用磁共振造影剂可以提高成像的分辨率和灵敏度,提高图像质量,增强对比度和可读性。但是,各种成像技术由于实现原理不同,具有各自的优势和缺陷,靠传统单一的诊断模式无法提供疾病的全面信息,因而在对各种复杂疾病进行诊断时会受到一定的限制。因此,将磁共振成像与其他成像技术如CT成像、超声成像等联合起来使用,则可以达到优势互补的效果,能为疾病的临床诊断提供更快捷精确的信息,同时可将磁共振成像与各种治疗方式结合在一起,即开发基于磁共振成像的诊断治疗一体化试剂,以实现对疾病的即时治疗和实时监控。本文主要介绍了磁共振成像造影剂的原理和种类,并且综述了目前国内外在基于磁共振成像的多功能造影剂/诊疗制剂这一领域的研究进展,最后就未来可能的研究方向进行了展望。     

缺血性心肌病的多模态心血管影像学方法进展

近年来,超声(ultrasound, US)、CT冠状动脉造影(CT coronary angiography, CCTA)、血管内超声(intravenous ultrasound,IVUS)、光学相干断层成像(optical coherence tomography, OCT)、多层螺旋CT成像(multi-slice computed tomography, MSCT)、单光子发射计算机断层成像(single-photon emission computed tomography, SPECT)、正电子发射计算机断层成像(positron emission computed tomography, PET)及心脏磁共振(cardiac magnetic resonance, CMR)等多种心血管成像技术能够提供与冠脉病变及心肌形态和功能相关的解剖学、血流动力学、细胞生物学及病理生理学等方面的重要信息,在缺血性心肌病的临床诊疗及预后评估中发挥着日益重要的作用。然而,如何恰当选择的多模态心血管影像技术是临床医师面临的一大难题。因此,本文在归纳总结主要心血管成像技术临床应用进展的基础上,对多模态心血管影像学在缺血性心肌病相关的冠脉解剖与斑块成像、心肌功能、心肌灌注及心肌活性显像中的临床应用价值进行综述。旨在帮助临床医师客观认识各种成像技术的优势与不足,从而制定最优化的选择方案。     

50 years of radiation research: medicine

The advances brought about by research in radiation medicine over the past 50 years are presented. The era began with the atomic explosions in Hiroshima and Nagasaki and the establishment of the Atomic Bomb Casualty Commission to understand what damage was caused by exposure of a large population to radiation. A better understanding of the effects of whole-body exposure led to the development of whole-body radiation treatment techniques and to bone marrow transplantation in the treatment of leukemias. The field of diagnostic imaging was revolutionized by a series of inventions that included angiography, mammography, computed tomography, magnetic resonance imaging, magnetic resonance spectroscopy, and ultrasound imaging. The field of nuclear medicine came of age through new man-made radionuclides and the invention of scanning and imaging techniques including positron emission tomography. Radiotherapy, a minor sideline of radiology, developed into radiation oncology, an extremely important component of modern cancer therapy. The advances in clinical radiotherapy were made possible by discoveries and inventions in physics and engineering and by insights and discoveries in radiobiology. The result of the last 50 years of progress is a very powerful set of clinical tools.     

Comparison of the diagnostic capacities of imaging methods for childhood hemangiomas

The diagnostic capacities of three imaging methods: B-mode ultrasonography, computed tomography (CT), and magnetic resonance imaging (MRI) in orbital hemangiomas in babies were compared. Orbital ultrasound, computed tomography, and MRI scans were examined in 358, 384, and 48 babies, respectively. Their mean age was 6.7 months. Out of three techniques, ultrasound scanning proved to be of less informative value. MRI and CT were much more informative although each of them had advantages and limitations. The authors give some preference to CT despite its ionization.     

Diagnostic imaging at its centennial: the past,the present and the future.

Since the discovery of x-rays by Wilhelm Conrad Röntgen 100 years ago, diagnostic imaging has profoundly influenced the practice of medicine. As a result of discoveries during this period, ultrasonography, nuclear imaging, computed tomography and magnetic resonance imaging, as well as conventional radiography, have assumed a major role in diagnostic medicine. In addition to their traditional role in diagnosis, imaging techniques are becoming an increasingly important factor in innovative treatment methods, and this role is likely to expand. In the current climate of rising health care costs, radiologists and other health care providers who use imaging must increasingly account to health care funders for the cost-effectiveness of imaging in relation to other diagnostic and interventional techniques. They must also assure minimum standards of quality and training, and determine the appropriate role for diagnostic imaging in health care systems of the future.     

Possibilities of CT and US in the diagnosis of colonic cancer

The data of examination of 59 patients with colonic cancer were used to consider the potentialities of transabdominal, transrectal ultrasonography and X-ray computed tomography and to assess their value in diagnosing colonic cancer, including its "minor" forms. The paper describes the ultrasound and computed tomographic semiotics of colonic cancer and determines a place of the above techniques in the algorithm of radiation and instrumental studies. Inclusion of these techniques into the diagnostic algorithm may solve a range of differentially diagnostic problems and allows a preliminary analysis to be made in a tumor lesion according to the International TNM classification. Ultrasonography and X-ray computed tomography should be included into a range of basic methods for diagnosis of colonic cancer.     

Mapping human brain activity in vivo.

A wide range of structural and functional techniques now exists to map the human brain in health and disease. These approaches span the gamut from external tomographic imaging devices (positron-emission tomography, single photon-emission computed tomography, magnetic resonance imaging, computed tomography), to surface detectors (electroencephalography, magnetoencephalography, transcranial magnetic stimulation), to measurements made directly on the brain''s surface or beneath it (intrinsic signal imaging, electrocorticography). The noninvasive methods have been combined to provide unique and previously unavailable insights into the macroscopic organization of the functional neuroanatomy of human vision, sensation, hearing, movement, language, learning, and memory. All methods have been applied to patients with neurologic, neurosurgical, and psychiatric disease and have provided a rapidly expanding knowledge of the pathophysiology of diseases such as epilepsy, cerebrovascular disease, neoplasms, neurodegenerative diseases, mental illness, and addiction states. In addition, these new methods have become a mainstay of preoperative surgical planning and the monitoring of pharmacologic or surgical (transplantation) interventions. Most recently, the ability to observe the reorganization of the human nervous system after acute injury, such as occurs with cerebral infarction or head trauma, or in the course of a progressive degenerative process such as Alzheimer''s or Parkinson''s disease, may provide new insights and methods in the rapidly expanding field of neurorehabilitation. Our newfound ability to generate maps and databases of human brain development, maturation, skill acquisition, aging, and disease states is both an exciting and formidable task.     

Methods of imaging in the diagnosis of temporomandibular joint disorders

BACKGROUND: Different methods of temporomandibular joint imaging are presented and discussed. Research reports published from 1979 to 2002 have been evaluated. METHOD AND RESULTS: The aim of this paper is to summarize the main findings from research. Basic X-ray examination is the most readily available method of imaging which usually does not have any contraindication. The use of computer tomography offers all advantages of tomographic scanning in different layers and projections, imaging soft tissues close to the joint and the possibility of "3D" reconstruction of bone structures. In case of joint dysfunctions and internal joint derangement, it is more preferable to use nuclear magnetic resonance for the depiction of the joint structures. To make a diagnosis more efficient, miniinvasive diagnostic methods are becoming necessary. Arthroscopy allows direct visual control of the joint space with the possibility of therapeutic help in cases when conservative treatment has failed. Ultrasonography, as a completely non-invasive procedure, is applied even in diagnosing functional temporomandibular defects. In these cases the diagnostic value of ultrasonography is almost comparable with this of nuclear magnetic resonance. CONCLUSIONS: So it is possible that, together with the improvement of the equipment, development of the diagnostic methods used during the treatment of temporomandibular joint defects could continue in this direction.     

Diagnosis and treatment of brainstem mass lesions by CT-guided stereotactic surgery

Current neuroradiographic techniques including computed tomographic scanning (CT) and magnetic resonance imaging (MRI) when added to the clinical neurologic examination can localize precisely even small lesions within the brainstem. While the clinical-radiographic diagnosis is accurate with respect to locale, it is often in error with respect to the pathologic nature of the solitary brainstem lesion. Therefore, empiric treatment without the benefit of a tissue diagnosis will often be inappropriate. CT-guided stereotactic surgery can safely and reliably provide a tissue diagnosis in such cases. Furthermore, in selected cases, therapeutic interventions can be of substantial and lasting benefit to the patient.     

Early experience with computed tomographic angiography in microsurgical reconstruction

Preoperative angiography is frequently used in the planning of microsurgical reconstruction. However, several potentially devastating complications can result from angiography, including arterial occlusion and pseudoaneurysm. Computed tomographic angiography is a relatively new technique that can provide detailed information about vascular anatomy as well as soft and bony tissue without the risks of traditional angiography. In addition, three-dimensional image reconstruction uniquely demonstrates anatomical relationships among blood vessels, bones, and soft tissue. Fourteen computed tomographic angiograms were obtained in 10 patients undergoing microsurgical reconstruction of the head and neck, lower extremity, or upper extremity. The average patient age was 46.9 years (range, 22 to 67 years). Charges related to the computed tomographic procedure were compared with those of conventional preoperative imaging for microsurgical repair. At our institution, the average computed tomographic angiogram charge was 1140 US dollars, whereas the average charge for traditional arteriography was 3900 US dollars. When compared with intraoperative evaluation, computed tomographic angiograms demonstrated clinically relevant surgical anatomy. No complications were noted for the radiographic procedure or after free flap reconstruction. Computed tomographic angiography provides high-resolution, three-dimensional arterial, venous, and soft-tissue imaging without the risks of traditional angiogram and at a lower cost.     

Measurement of subclinical atherosclerosis: beyond risk factor assessment

PURPOSE OF REVIEW: Assessment of subclinical atherosclerosis using the current available noninvasive imaging modalities holds promise for individual cardiovascular risk management and monitoring efficacy of therapeutic interventions (i.e. surrogate end-points). The present review addresses benefits and limitations of flow-mediated dilatation, intima-media thickness, electron-beam computed tomography and magnetic resonance coronary angiography. RECENT FINDINGS: Both carotid intima-media thickness and peripheral flow-mediated dilatation correlate inversely with cardiovascular risk factors and coronary artery disease. They have been shown to carry predictive value for future cardiovascular events, but clinical application of both intima-media thickness and flow-mediated dilatation demands further methodological maturation of these techniques. Intima thickening has been successfully targeted in numerous intervention trials, but determination of an explicit threshold value beyond which cardiovascular risk significantly increases will facilitate its utility as a routine clinical tool. Electron-beam computed tomography can accurately detect and quantify coronary artery calcification (an established marker of the total coronary plaque burden). However, lack of evidence of its additional predictive power for future coronary events warrants for further research. Finally, magnetic resonance coronary angiography appears to be a promising technique, integrating both functional and anatomical aspects of coronary artery disease. Properly designed studies are needed to determine its value in clinical practice. SUMMARY: Various noninvasive imaging techniques have recently emerged that may find applications in clinical research. However, before widespread clinical utilization, further technical refinement of all of the cited imaging modalities is mandatory. It will be a challenge over the coming few years to clarify whether improvements in surrogate end-points can directly be translated into improved outcomes.     

Preoperative Tumor Localization by Means of Venous Sampling for Fibroblast Growth Factor-23 in a Patient with Tumor-Induced Osteomalacia

ObjectiveTo report on a novel strategy for tumor localization in a 62-year-old man with hypophosphatemic tumor-induced osteomalacia (TIO).MethodsRepeated computed tomographic and magnetic resonance imaging scans failed to localize any tumor in a patient with adult-onset hypophosphatemic osteomalacia. Therefore, venous sampling for fibroblast growth factor-23 (FGF23)—a circulating hormone that has been identified as a causative factor for TIO—in major veins was conducted. Serum FGF23 was measured from collected samples by an intact FGF23 enzyme-linked immunosorbent assay.ResultsVenous sampling suggested a local increase in serum FGF23 in the left femoral vein; this finding prompted performance of octreotide scintigraphy restricted to the left leg. A tumor was located at the lateral condyle of the left femur, which was also confirmed by magnetic resonance imaging. Surgical resection of the tumor normalized the serum phosphorus and 1,25-dihydroxyvitamin D₃ levels within 5 to 10 days, and FGF23 declined to normal levels within 24 hours. Histologic analysis supported the diagnosis of a soft-tissue giant cell tumor.ConclusionOur study case demonstrates the diagnostic complexity and difficulties in localizing a small tumor in a patient with TIO. Venous sampling for FGF23 may be helpful in tumor localization in sporadic cases of hypophosphatemic osteomalacia, especially when noninvasive diagnostic techniques prove insufficient. (Endocr Pract. 2008;14:362-367)     

Coronary computed tomographic angiography as gatekeeper for new-onset stable angina

Patients with new-onset stable angina constitute a substantial part of the population seen by cardiologists. Currently, the diagnostic workup of these patients depends on the pre-test probability of having obstructive coronary artery disease. It consists of either functional testing for myocardial ischaemia or anatomical testing by using coronary computed tomographic angiography (CCTA) or invasive coronary angiography. In case the pre-test probability is > 5%, the current guidelines for the management of chronic coronary syndromes do not state a clear preference for one of the noninvasive techniques. However, based on the recently published cost-effectiveness analysis of the PROMISE trial and considering the diagnostic yield in patients with angina and nonobstructive coronary artery disease, we argue a more prominent role for CCTA as a gatekeeper for patients with new-onset stable angina.     

Current complex noninvasive diagnosis of parathyroid tumors

The diagnosis of bulky formations of the parathyroid glands (PTG) has become possible since current high-resolution techniques of visualization, such as ultrasound study (USS), computed tomography (CT), magnetic resonance imaging (MRI), were introduced into practice. The presence of clinical and/or laboratory signs of hyperparathyroidism (HPT) is a signal to initiate a goal-oriented search for abnormal PTG formations. The complex diagnosis of HPT involves the methods of detecting osteoporosis ranging from routine X-ray study of the hand and foot to more in-depth techniques: dichromatic X-ray absorptiometry (DXA) and quantitative CT (QCT). USS is an excellent method for screening if abnormal PTC changes are suspected; however, negative USS results in the presence of clinical and/or laboratory signs of HPT should not stop a diagnostic search. CT with intravenous contrast bolus specifies the site and structure of an formation, has some advantage in detecting retrosternal tumors. Due to its high tissue contrast, three-dimensional images, none ionizing radiation and osseous structural artefacts, MRI becomes a preferable tool for studying PTG when they are typically or atypically located. Needle biopsy is required when noninvasive methods cannot characterize the pattern of an abnormal PTG formation properly or their results are contradictory.