Radiology

Roizental, M; Kane, R A; Takahashi, J; Kruskal, J; Crenshaw, W B; Perry, L; Stokes, K; Clouse, M E

doi: N/Apmid: 7644659

To mark the portal vein prior to transjugular intrahepatic portosystemic shunt (TIPS) placement, metallic coils adjacent to (n = 18) and a wire within (n = 18) the portal vein were placed with ultrasonographic (US) guidance. The mean number of punctures for successful portal vein entry was 3.0 with coils and 2.9 with a wire, and the mean total procedure time was 127.5 and 110.0 minutes, respectively (differences, not significant), and mean time at US was 20 and 10 minutes, respectively.

Ferretti, G; Jouvan, F B; Thony, F; Pison, C; Coulomb, M

doi: N/Apmid: 7644651

PURPOSE: To assess the efficacy of balloon dilation in the treatment of acquired, noninflammatory bronchial stenosis of benign origin. MATERIALS AND METHODS: Balloon bronchoplasty was performed with fluoroscopic guidance 36 times in 19 bronchial stenoses in 16 consecutive patients, with use of a local anesthetic. RESULTS: Initial technical success was attained in all cases; clinical success was achieved in 13 (68%) of 19 bronchial stenoses. Six of the 19 stenoses were dilated unsuccessfully because they were caused by localized bronchomalacias. Of these initial successes, seven stenoses recurred but were redilated with success in four cases. At a mean follow-up of 21.6 months (range, 7-60 months), improvement in both fiberoptic bronchoscopy and respiratory status was seen in nine (69%) of 13 patients with fibrous stenoses. CONCLUSION: Balloon bronchial dilation can be proposed as the primary treatment in acquired, noninflammatory bronchial stenoses of various benign origins including stenoses after lung transplantation.

Madeline, L A; Elster, A D

doi: N/Apmid: 7644639

PURPOSE: To chronicle the development of ossification centers, sutures, and synchondroses in the chondrocranium throughout childhood by using computed tomography (CT). MATERIALS AND METHODS: One hundred eighty-nine children (age range, newborn to 18 years; median age, 4.0 years) without skull base deformity were referred for cranial CT. The closure of 18 sutures and synchondroses was graded. RESULTS: In the occipital bone at birth, six components were identified. The Kerckring ossicle rapidly fused to the supraoccipital bone within the 1st month. At age 1-3 years, the posterior and anterior intraoccipital synchondroses began to fuse. The occipitomastoidal, petro-occipital, and spheno-occipital synchondroses remained partially open into the teenage years. In the sphenoid bone at birth, 13 ossification centers were identified; most assimilated into the sphenoidal body during the first 2 years. Pneumatization of the sphenoid sinus appeared at age 1-2 years and advanced posteriorly over the next 3-5 years. CONCLUSION: The complex process of skull base development is chronicled, which provides CT standards for judgment of the patterns and timing of sutural or synchondrosal closure.

Boone, J M; Duryea, J; Moore, E H

doi: N/Apmid: 7644654

PURPOSE: To determine the feasibility of using the filter wheel equalization (FWE) technique for radiographic equalization in chest radiography. MATERIALS AND METHODS: An FWE system with two rotating wheels (one for each lung) with 25 lung-shaped, 1.0-mm-thick copper templates was constructed. Preexposure images were acquired; the computer used these images to select and position templates for each lung. An equalized radiograph was then produced. Radiographs were acquired in two male volunteers (both 33 years of age) and in a phantom. RESULTS: Optical densities in the lungs and nonlung areas on a conventional phantom radiograph were 2.07 and 0.55, respectively; after equalization, the corresponding optical densities were 2.06 and 1.42. Outside the lungs, radiographic contrast (difference in optical density) increased threefold; in the lungs, there was a very small decrease in radiographic contrast due to beam hardening. Well-equalized and relatively artifact-free radiographs were obtained with a 20-msec exposure time. CONCLUSION: The FWE system was shown in the laboratory to be feasible.

Link, T M; Schuierer, G; Hufendiek, A; Horch, C; Peters, P E

doi: N/Apmid: 7644638

PURPOSE: To evaluate the usefulness of routine performance of computed tomography (CT) of the craniocervical junction in unconscious patients with substantial head injury. MATERIALS AND METHODS: In a prospective study, CT of the head and the cervicocranium was performed in 202 patients with substantial cranial trauma (Glasgow Coma Scale scores of 3-6). Plain radiography was performed in all patients. Radiographs and CT scans were then blindly interpreted. RESULTS: Twenty-eight patients (13.9%) had C-1 or C-2 fractures; plain radiographs did not demonstrate cervical fractures in 11 of these patients. Nine patients (4.4%) had fractures of the occipital condyles; plain radiographs did not demonstrate occipital condyle fractures in eight of these patients. CONCLUSION: Because 5.4% of all patients had fractures of either C-1 or C-2 and 4.0% had occipital condyle fractures not seen at plain radiography, routine additional performance of CT of the craniocervical junction is useful in patients with substantial cranial trauma.

Forstner, R; Hricak, H; Powell, C B; Azizi, L; Frankel, S B; Stern, J L

doi: N/Apmid: 7644634

PURPOSE: To assess magnetic resonance (MR) imaging in depiction of ovarian tumor recurrence and for identification of patients who may not benefit from surgical reexploration. MATERIALS AND METHODS: In a prospective study, 34 patients (mean age, 57.07 years) with surgically staged ovarian cancer underwent MR imaging before reexploration. Findings at MR imaging and surgery were correlated. MR imaging tumor depiction was correlated with tumor size, presence of ascites, and CA-125 levels. RESULTS: Tumor recurrence was identified in 29 patients at surgery. MR imaging depicted tumor in 20 patients. Accuracy for lesions smaller than 2 cm was 35% and increased to 82% for lesions larger than 2 cm (P < .01). MR imaging had low sensitivity for depiction of implants in the peritoneum and mesentery. Ascites improved depiction of smaller lesions (< 2 cm). MR imaging in combination with CA-125 levels improved detection of recurrent disease (CA-125 measurement alone 53% vs CA-125 measurement and MR imaging 75%, P = .048). CONCLUSION: MR imaging is a useful adjunct to the clinical examination to identify patients with recurrent disease and those in whom reexploration may not be beneficial.

Langen, H J; Klose, K C; Keulers, P; Adam, G; Jochims, M; Günther, R W

doi: N/Apmid: 7644632

PURPOSE: To assess the utility of artificial widening of the extrapleural space to gain an extrapleural biopsy access route to the anterior and posterior mediastinum. MATERIALS AND METHODS: The authors retrospectively analyzed the findings in 20 patients who underwent biopsy of mediastinal masses after dilation of the extrapleural space with injection of approximately 20 mL of physiologic saline solution. The solution was injected to provide ventral (n = 6) or dorsal (n = 14) extrapleural access to the mediastinum. Biopsies were performed under computed tomographic guidance. RESULTS: Right-sided paravertebral extrapleural access to the mediastinum was achieved in 11 of the 14 patients in whom a dorsal approach was used. The paravertebral extrapleural soft tissue was dilated from a mean of 0.2 cm to a mean of 0.9 cm. Extrapleural biopsy was performed in nine patients. The pleura was traversed in four patients, causing pneumothoraces in two. A parasternal access route was created in all six patients in whom a ventral approach was used, and biopsies were performed without complications. The minimal width of the anterior mediastinum in these six patients increased from a mean of 2.8 cm to a mean of 4.6 cm with dilation. CONCLUSION: Artificial widening of the extrapleural space provides an access route to the anterior and posterior mediastinum for large-bore biopsy.

Halpern, E J; Deane, C R; Needleman, L; Merton, D A; East, S A

doi: N/Apmid: 7644627

PURPOSE: To characterize the spectral Doppler tracing of the normal renal artery. MATERIALS AND METHODS: Doppler tracings were obtained from a phantom of a vessel with variable compliance and from the kidneys of 15 healthy volunteers. RESULTS: In the phantom, vascular compliance had the following effects on systolic flow velocity patterns: low compliance, little change in the sharp appearance of the systolic component of the transmitted pulse; mildly increased compliance, down-stream dampening of early systolic acceleration (ESA) with the appearance of a sharp early systolic transmitted peak and of a more rounded late systolic compliance peak; high compliance, delayed and diminished transmitted peak that eventually disappeared within the enlarging down-stream compliance peak. Healthy subjects with compliant vessels had greater ESA and more frequently visualized early systolic peaks in the renal hilum than in the renal sinus. CONCLUSION: Absence of a discrete early systolic peak is a normal finding in young patients, especially in the more distal interlobar arteries. Loss of the early systolic peak may be explained on the basis of vascular compliance.

Bankier, A A; Kiener, H P; Wiesmayr, M N; Fleischmann, D; Kontrus, M; Herold, C J; Graninger, W; Hübsch, P

doi: N/Apmid: 7644652

PURPOSE: To study the computed tomographic (CT) appearance of early lung involvement in systemic lupus erythematosus (SLE). MATERIALS AND METHODS: In a prospective study, 48 patients with serologically confirmed SLE but no prior clinical evidence of lung involvement underwent chest radiography, CT, and lung function tests. Radiographs and CT scans were compared, and CT scans were evaluated for signs suggestive of parenchymal and pleural disease. Extent and distribution of disease were determined. CT findings were correlated with clinical and functional data. RESULTS: Of 45 patients with normal chest radiographs, 17 (38%) had abnormal CT findings. Extent of disease was statistically significantly correlated with duration of clinical history (r = .93) and decreased single-breath diffusing capacity for carbon monoxide (r = .8) and ratio of forced expiratory volume in 1 second to forced vital capacity (r = .77). CONCLUSION: CT is superior to chest radiography for detection of functionally relevant pulmonary disease and is an important adjunct in early assessment of SLE.

Wehrli, F W; Ford, J C; Haddad, J G

doi: N/Apmid: 7644622

PURPOSE: To determine if the magnetic resonance (MR) imaging effective transverse relaxation rate (R2*) of trabecular bone marrow is lowered in osteoporosis. MATERIALS AND METHODS: R2* was measured in 146 women. Control subjects (n = 77; mean age, 46.6 years) had high mean spinal bone mineral densities (BMDs) and no vertebral deformities. Patients with spinal osteoporosis (n = 59; mean age, 59.7 years) had at least one thoracic vertebral deformity and/or low BMDs. RESULTS: R2* was lower in patients for L-2 through L-5 (P < .001). Average R2* of L-3 through L-5 (R2*av) was the best discriminator (64.79 sec-1 +/- 1.18 standard error for control subjects vs 53.39 sec-1 +/- 1.24 for patients; P < .0001). R2*av decreased with age in control subjects. The difference in R2*av in a subset of 38 age-matched pairs of patients and control subjects was 8.25 sec-1 (P < .0001). Subjects with deformities had lower 52*av than did control subjects (52.3 sec-1 +/- 1.6 vs 62.5 sec-1 +/- 1.1, P < .0001). R2*av was correlated with mean BMD (r = .54, P < .0001). CONCLUSION: Patients with osteoporosis have lower R2*s in vertebral marrow.