European Radiology

Chavan, Ajay; Galanski, M.

doi: 10.1007/s00330-002-1616-7pmid: 12271379

Menu, Yves; Vuillerme, Marie-Pierre

doi: 10.1007/s00330-002-1613-xpmid: 12271380

Imaging is the standard method for the evaluation of emergency bile ducts and gallbladder diseases. Imaging may help to treat the patient also. In acute cholecystitis, association of clinical and sonographic data is accurate for the diagnosis, even when the patient is examined by a junior radiologist. Computed tomography may be required for those patients with unusual presentation such as emphysematous cholecystitis, perforation, or abscess. Acalculous cholecystitis is a challenging problem. It sometimes requires percutaneous cholecystostomy for diagnosis or treatment purposes. In patients with acute cholangitis, sonography remains the first step for imaging, but its diagnostic accuracy is disappointing. This is related to low sensitivity, despite a high specificity. Computed tomography carries a slightly better sensitivity, and again a high specificity but overall accuracy is not sufficient. Magnetic resonance cholangiography and endosonography are the best methods for the detection. Both have advantages and limitations, including cost and availability, but endoscopic retrograde cholangiopancreatography remains necessary for therapeutic purposes, especially stone extraction. In conclusion, emergency radiologists should be able to put the patient through multiple imaging modalities in order to make a prompt diagnosis with no delay, and be aware of the therapeutic options, including cooperation between radiologist, endoscopist, and surgeon.

Procacci, Carlo; Mansueto, Giancarlo; D'Onofrio, Mirko; Gasparini, Anna; Ferrara, Rosa; Falconi, Massimo

doi: 10.1007/s00330-002-1498-8pmid: 12271381

Pancreatic emergency, unrelated to traumatic events, can occur as a consequence of the more significant pancreatic pathologies (acute and chronic pancreatitis, tumors) or of the interventional or surgical treatment carried out as therapy for the above-mentioned lesions. Acute pancreatic conditions are represented by pancreatic infections, the involvement of organs, structures, and adjacent spaces within the pancreatic disease, and, lastly, vascular complications. Acute pancreatic conditions are common in pancreatic diseases and can be catastrophic; even if there is a gamut in the severity of clinical presentation, each can be potentially life threatening. Immediate radiological detection of the lesions together with a correct therapeutic percutaneous radiological approach whenever an interventional procedure is preferable to surgery or, when performed before surgery, whenever it can optimize its results, is of fundamental importance in the management of these patients. This article focuses on the essential role of radiology and the integration of imaging and intervention in acute pancreatic conditions.

Rickards, David

doi: 10.1007/s00330-002-1634-5pmid: 12271382

Obstruction of the upper urinary tract is common and shows no signs of decreasing incidence. Investigating obstruction requires knowledge of how the upper tract functions and how, when normal function is compromised by obstruction, imaging findings will differ from normality. Radiologists need to define the extent of obstruction, its likely duration and whether intervention is needed to relieve the obstruction and what form that intervention may take. Percutaneous nephrostomy is the most common interventional therapeutic technique performed and should be available in any acute hospital. It is not a procedure that is in the sole domain of uroradiologists. Close co-operation with urologists is essential.

Cejna, Manfred; Loewe, Christian; Schoder, Maria; Dirisamer, Albert; Hölzenbein, Thomas; Kretschmer, Georg; Lammer, Johannes; Thurnher, Siegfried

doi: 10.1007/s00330-002-1429-8pmid: 12271383

Our objective was to evaluate the accuracy of contrast-enhanced 3D MR angiography (MRA) in the follow-up of patients with endoluminally treated aortic aneurysms and correlate these findings with uni- or biphasic CT angiography (CTA). Forty MR angiograms in 32 patients with implanted aortic nitinol stent grafts were compared to CTA. Twenty-two MR examinations were correlated with arterial-phase CTA (uniphasic), and 18 MR examinations were correlated with biphasic CTA. Uniphasic CTA demonstrated three type-1/type-3 endoleaks and four reperfusion (type-2) endoleaks. In addition, MRA depicted two type-2 reperfusion endoleaks that were missed by CTA. Using biphasic CTA, two type-1/type-3 endoleaks and three reperfusion (type-2) endoleaks were detected; of those, delayed scanning detected three reperfusion (type-2) endoleaks missed during arterial-phase CTA. In addition to the findings by CTA, MRA depicted another type-2 reperfusion endoleak. Magnetic resonance angiography is at least as sensitive as uni- or biphasic CTA for detecting endoleaks and may consequently offer advantages in patients with contraindications to iodinated contrast agents.

Drescher, Robert; Mathias, Klaus; Jaeger, Horst; Bockisch, Georg; Demirel, Eren; Gissler, Martin; Hauth, Elke

doi: 10.1007/s00330-001-1298-6pmid: 12271384

Our objective was to assess the technical feasibility and the clinical results of internal carotid artery (ICA) stenting using a nitinol self-expanding stent (SMART stent). In 13 patients 13 high-grade stenoses of the internal carotid artery were treated via an implantation of a SMART stent. In all cases a predilation of the stenosis and a postdilation within the stent were performed. Follow-up examinations were carried out in all patients after a period of 6 months. In each case the implantation of the stent was performed without technical complications. In 12 of 13 cases the stent was placed in the patients' internal carotid artery, in 1 case from the internal to the common carotid artery (CCA). The average degree of stenosis of 78% (70–95%) was reduced to an average of 2.8% (0–21%). The 6-month follow-up angiography showed an average degree of restenosis of 11.8% (0–29%) in 8 of 13 patients. Duplex sonography in the remaining 5 patients demonstrated patent stents. One patient showed brief neurological symptoms during the intervention. No further complications occurred during follow-up time. Treatment of internal carotid artery stenosis with the SMART stent seems technically feasible, safe, and promises long-term patency.

Winterer, J.; Ghanem, N.; Roth, M.; Schaefer, O.; Lehnhardt, S.; Thürl, C.; Horch, R.; Laubenberger, J.

doi: 10.1007/s00330-002-1324-3pmid: 12271385

Our objective was to describe the imaging features of hypothenar hammer syndrome using minimally invasive contrast-enhanced MR angiography in comparison with oscillography study. In five patients with hypothenar hammer syndrome Gd-BOPTA-enhanced elliptically reordered 3D pulse sequence MR was compared with oscillography findings and clinical symptoms focusing on angiographic appearance of vessel injury, distribution pattern of hand vasculature and joining branches between the radial and ulnar artery supply. All patients showed segmental occlusion at the site of trauma impact with varying involvement of the superficial palmar arch, common volar digital arteries. Embolic disease was present in 50% of patients and could be clearly identified with MRA. Good correspondence was found between angiographic appearance including the presence of collaterals, clinical symptoms and oscillography. Bilateral comparison was helpful in distinguishing between vessel variants and pathology. Bilateral Gd-BOPTA-enhanced MR angiography is a minimally invasive method to depict clearly the localization and extent of vessel injury in hypothenar hammer syndrome providing valuable information about distribution pattern of hand vasculature and presence of collaterals; however, no flow data can be obtained.

Mellado, J.; Ramos, A.; Salvadó, E.; Camins, A.; Calmet, J.; Saurí, A.

doi: 10.1007/s00330-001-1303-0pmid: 12271386

Avulsion fractures and chronic avulsion injuries of the knee are common lesions in sports-related trauma, especially among adolescents. Magnetic resonance imaging may prove useful in detecting and characterizing such lesions, and has several advantages with regard to other imaging modalities. We review, illustrate, and discuss the MR imaging features of some of the more frequent avulsion fractures and chronic avulsion injuries of the knee, including avulsion fractures of the cruciate ligaments, avulsion fractures of lateral and medial stabilizers, avulsion fractures and chronic avulsion injuries of the extensor mechanism, and avulsive cortical irregularities of the distal femur. The role of MR imaging in evaluating such lesions is emphasized.

Ishifuro, Minoru; Horiguchi, Jun; Nakashige, Aya; Tamura, Akihisa; Marukawa, Kazushi; Fukuda, Hiroshi; Ono, Chiaki; Akiyama, Yuji; Kushima, Toshio; Ito, Katsuhide

doi: 10.1007/s00330-002-1431-1pmid: 12271388

Saito, Kazuhiro; Kotake, Fumio; Ito, Naoki; Tabuchi, Takafumi; Goto, Yoshihisa; Katano, Motonobu; Hashimoto, Tsuyoshi; Abe, Kimihiko

doi: 10.1007/s00330-001-1289-7pmid: 12271389

An inflammatory pseudotumor of the liver was discovered during a metastatic examination of a patient with rectal adenocarcinoma. Magnetic resonance imaging showed a three-component lesion that infiltrated a large portal vein, and CT arteriography and CT during arterial portography showed a portal obstruction. A histopathological examination proved that necrosis was present in the central zone; infiltration by proliferating connective tissue with chronic inflammatory cells was prominent in the middle zone; and fibrous changes, including pseudo-bile duct proliferation, were present in the peripheral zone. Magnetic resonance imaging revealed both portal infiltration and histopathological features including the above-noted three components. Magnetic resonance imaging is perhaps the most useful diagnostic modality.