Radiology Bulletin: August 2008

Thursday 28 August 2008

Superior Vena Cava Mass Missed on Transesophageal Echocardiography

Link to journal
Mizuguchi, K Annette ; Fox, Amanda A. ; Burch, Thomas M.
Incidental Finding of Superior Vena Cava Mass Missed on Transesophageal Echocardiography but Seen on Epiaortic Imaging
Anesthesia & Analgesia. 107(3):788-790, September 2008.

Computerized tomographic angiography...carotid artery bypass

Computerized tomographic angiography for preoperative assessment of the superficial temporal artery for external carotid artery to internal carotid artery bypass: a case report
Farsad K, Hayek R, Mamourian A, Friedman J
Cases Journal, 2008 1:119 ( 21 August 2008 )
[Abstract] [Provisional PDF]

Articles from Circulation

Link to journal
Henry, Timothy D. ; Lesser, John R. ; Satran, Daniel
Myocardial Fibrosis From Severe Carbon Monoxide Poisoning Detected by Cardiac Magnetic Resonance Imaging.
Circulation. 118(7):792, August 12, 2008.

Mikolich, J Ronald MD
Right Ventricular Diastolic Collapse by Cardiac Magnetic Resonance Imaging
Circulation. 118(8):e122-e125, August 19, 2008.
Kim, Young Jin ; Kang, Seok-Min ; Hur, Jin ; Lee, Hye-Jeong
Chronic Cardiac Transplant Rejection: Evaluation With Magnetic Resonance Imaging
Circulation. 118(8):885-886, August 19, 2008.

Cury, Ricardo C. ; Shash, Khalid ; Nagurney, John T. ; Rosito, Guido ; Shapiro, Michael D.
Cardiac Magnetic Resonance With T2-Weighted Imaging Improves Detection of Patients With Acute Coronary Syndrome in the Emergency Department
Circulation. 118(8):837-844, August 19, 2008.
Abstract
Background-: Cardiac magnetic resonance (CMR) imaging permits early triage of patients presenting to the emergency department with acute chest pain but has been limited by the inability to differentiate new from old myocardial infarction. Our objective was to evaluate a CMR protocol that includes T2-weighted imaging and assessment of left ventricular wall thickness in detecting patients with acute coronary syndrome in the emergency department.Methods and Results-: In this prospective cohort observational study, we enrolled patients presenting to the emergency department with acute chest pain, negative cardiac biomarkers, and no ECG changes indicative of acute ischemia. The CMR protocol consisted of T2-weighted imaging, first-pass perfusion, cine function, delayed-enhancement magnetic resonance imaging, and assessment of left ventricular wall thickness. The clinical outcome (acute coronary syndrome) was defined by review of clinical charts by a consensus panel that used American Heart Association/American College of Cardiology guidelines. Among 62 patients, 13 developed acute coronary syndrome during the index hospitalization. The mean CMR time was 32+/-8 minutes. The new CMR protocol (with the addition of T2-weighted and left ventricular wall thickness) increased the specificity, positive predictive value, and overall accuracy from 84% to 96%, 55% to 85%, and 84% to 93%, respectively, compared with the conventional CMR protocol (cine, perfusion, and delayed-enhancement magnetic resonance imaging). Moreover, in a logistic regression analysis that contained information on clinical risk assessment (c-statistic=0.695) and traditional cardiac risk factors (c-statistic=0.771), the new CMR protocol significantly improved the c-statistic to 0.958 (P<0.0001).conclusions-:>

Arai, Andrew E. MD
Using Magnetic Resonance Imaging to Characterize Recent Myocardial Injury: Utility in Acute Coronary Syndrome and Other Clinical Scenarios. [Editorial]
Circulation. 118(8):795-796, August 19, 2008.

Prompona, Maria ; Kozlik-Feldmann, Rainer ; Mueller-Hoecker, Josef
Magnetic Resonance Imaging Characteristics in Carvajal Syndrome (Variant of Naxos Disease).
Circulation. 116(20):e524-e530, November 13, 2007.

BMJ 14 Aug 2008

Outsourced radiology: will doctors be deskilled?
Amy Davis, editorial registrar
adavis@bmj.com
Outsourcing of radiology has boomed in recent years as hospitals struggle to keep up with the increased demand for imaging, but how well does it work? Amy Davis reports
The first 150 words of the full text of this article appear below.
The technology available to radiologists has changed dramatically over the past decade. The internet, affordable high performance computers, the wide adoption of digital imaging, and picture archiving and communication systems (PACS) have propelled radiology into the digital era. These changes mean that imaging and interpretation are no longer confined to the one site—an image taken in a UK hospital can be viewed almost immediately somewhere else.
Remote assessment has become embedded in the United States. Even back in 1999, a survey of US radiologists found that 75% of radiology practices with more than one radiologist and 30% of practices with only one radiologist did their on-call work from outside the hospital, using teleradiology.1
Although this technology has undoubted benefits for clinicians and patients, the digital revolution has directly led to and accelerated the outsourcing of images

Radiologic Clinics of North America Vol 46 No 3 2008

Preface
Peter L. Munk, Wilfred C.G. Peh
pages xi-xii
http://www.radiologic.theclinics.com/article/S0033-8389%2808%2900098-5/abstract
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Therapeutic and Diagnostic Joint Injections
David Malfair
pages 439-453
http://www.radiologic.theclinics.com/article/S0033-8389%2808%2900033-X/abstract
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Image-Guided Musculoskeletal Biopsy
Apoorva Gogna, Wilfred C.G. Peh, Peter L. Munk
pages 455-473
http://www.radiologic.theclinics.com/article/S0033-8389%2808%2900061-4/abstract
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Positron Emission Tomography–CT Imaging in Guiding Musculoskeletal Biopsy
Paul J. O'Sullivan, Eric M. Rohren, John E. Madewell
pages 475-486
http://www.radiologic.theclinics.com/article/S0033-8389%2808%2900035-3/abstract
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Spinal Injection Procedures: A Review of Concepts, Controversies, and Complications
Manraj K.S. Heran, Andrew D. Smith, Gerald M. Legiehn
pages 487-514
http://www.radiologic.theclinics.com/article/S0033-8389%2808%2900037-7/abstract
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Musculoskeletal Ultrasound Intervention: Principles and Advances
Luck J. Louis
pages 515-533
http://www.radiologic.theclinics.com/article/S0033-8389%2808%2900034-1/abstract
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Embolization of Musculoskeletal Tumors
Richard J.T. Owen
pages 535-543
http://www.radiologic.theclinics.com/article/S0033-8389%2808%2900032-8/abstract
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Venous Malformations: Classification, Development, Diagnosis, and Interventional Radiologic Management
Gerald M. Legiehn, Manraj K.S. Heran
pages 545-597
http://www.radiologic.theclinics.com/article/S0033-8389%2808%2900038-9/abstract
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Musculoskeletal Interventional Radiology: Radiofrequency Ablation
Emily Ward, Peter L. Munk, Faisal Rashid, William C. Torreggiani
pages 599-610
http://www.radiologic.theclinics.com/article/S0033-8389%2808%2900036-5/abstract
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Percutaneous Vertebral Augmentation: Vertebroplasty, Kyphoplasty and Skyphoplasty
Wilfred C.G. Peh, Peter L. Munk, Faisal Rashid, Louis A. Gilula
pages 611-635
http://www.radiologic.theclinics.com/article/S0033-8389%2808%2900066-3/abstract

Articles from Anesthesiology

Link to journal
Patel, Santosh I. ; Souter, Michael J.
Equipment-related Electrocardiographic Artifacts: Causes, Characteristics, Consequences, and Correction [Review]
Anesthesiology. 108(1):138-148, January 2008.
Abstract
Interference of the monitored or recorded electrocardiogram is common within operating room and intensive care unit environments. Artifactual signals, which corrupt the normal cardiac signal, may arise from internal or external sources. Electrical devices used in the clinical setting can induce artifacts by various different mechanisms. Newer diagnostic and therapeutic modalities may generate artifactual changes. These artifacts may be nonspecific or may resemble serious arrhythmia. Clinical signs, along with monitored waveforms from other simultaneously monitored parameters, may provide the clues to differentiate artifacts from true changes on the electrocardiogram. Simple measures, such as proper attention to basic principles of electrocardiographic measurement, can eliminate some artifacts. However, in persistent cases, expert help may be required to identify the precise source and minimize interference on the electrocardiogram. Technological advancements in processing the electrocardiographic signal may be useful to detect and eliminate artifacts. Ultimately, an improved understanding of the artifacts generated by equipment, and their identifying characteristics, is important to avoid misinterpretation, misdiagnosis, and iatrogenic complication.

Kroner, Anke ; Binnekade, Jan M. ; Graat, Marleen E. ; Vroom, Margreeth B. ; Stoker, Jaap
On-demand Rather than Daily-routine Chest Radiography Prescription May Change Neither the Number Nor the Impact of Chest Computed Tomography and Ultrasound Studies in a Multidisciplinary Intensive Care Unit
Anesthesiology. 108(1):40-45, January 2008.
Abstract
Background: Elimination of daily-routine chest radiographs (CXRs) may influence chest computed tomography (CT) and ultrasound practice in critically ill patients.Methods: This was a retrospective cohort study including all patients admitted to a university-affiliated intensive care unit during two consecutive periods of 5 months, one before and one after elimination of daily-routine CXR. Chest CT and ultrasound studies were identified retrospectively by using the radiology department information system. Indications for and the diagnostic/therapeutic yield of chest CT and ultrasound studies were collected.Results: Elimination of daily-routine CXR resulted in a decrease of CXRs per patient day from 1.1 +/- 0.3 to 0.6 +/- 0.4 (P <>

Wednesday 27 August 2008

Articles from Neurology

Link to journal
Virtanen, J K. ; Siscovick, D S.; Longstreth, W T. Jr ; Kuller, L H.
Fish consumption and risk of subclinical brain abnormalities on MRI in older adults
Neurology. 71(6):439-446, August 5, 2008.
Abstract
Objective: To investigate the association between fish consumption and subclinical brain abnormalities.Methods: In the population-based Cardiovascular Health Study, 3,660 participants age >=65 underwent an MRI scan in 1992-1994. Five years later, 2,313 were scanned. Neuroradiologists assessed MRI scans in a standardized and blinded manner. Food frequency questionnaires were used to assess dietary intakes. Participants with known cerebrovascular disease were excluded from the analyses.Results: After adjustment for multiple risk factors, the risk of having one or more prevalent subclinical infarcts was lower among those consuming tuna/other fish >=3 times/week, compared to <1/month ci =" 0.54-1.01," p =" 0.06," trend =" 0.03)."

Desikan, R S. ; Fischl, B ; Cabral, H J. ; Kemper, T L. ; Guttmann, C R. ; Blacker, D et al
MRI measures of temporoparietal regions show differential rates of atrophy during prodromal AD
Neurology. Status Publish Ahead of Print, POST AUTHOR CORRECTIONS, 30 July 2008 Background: MRI studies have demonstrated differential rates of atrophy in the entorhinal cortex and hippocampus during the prodromal phase of Alzheimer disease (AD). The current study was designed to determine whether a broader set of temporoparietal regions show differential rates of atrophy during the evolution of AD.Methods: Sixteen regions of interest (ROIs) were analyzed on MRI scans obtained at baseline and follow-up in 66 subjects comprising three groups: controls = individuals who were cognitively normal at both baseline and follow-up; nonconverters = subjects with mild cognitive impairment (MCI) at both baseline and follow-up; converters had MCI at baseline but had progressed to AD at follow-up.Results: Annualized percent change was analyzed with multivariate analysis of variance (MANOVA), covaried for age. The MANOVA demonstrated an effect of group (p = 0.004). Post hoc comparisons demonstrated greater rates of atrophy for converters vs nonconverters for six ROIs: hippocampus, entorhinal cortex, temporal pole, middle temporal gyrus, fusiform gyrus, and inferior temporal gyrus. Converters showed differentially greater rates of atrophy than controls in five of the same ROIs (and inferior parietal lobule). Rates of change in clinical status were correlated with the atrophy rates in these regions. Comparisons between controls and nonconverters demonstrated no differences.Conclusion: These results demonstrate that temporoparietal regions show differential rates of atrophy on MRI during prodromal Alzheimer disease (AD). MRI data correlate with measures of clinical severity and cognitive decline, suggesting the potential of these regions of interest as antemortem markers of prodromal AD.(C)2008AAN Enterprises, Inc.

AJR 2008 ; VOL 191 ; PART 2

AJR 2008 ; VOL 191 ; PART 1

Stroke. 39(6) June 2008

Link to journal
Sylaja, P N.; Coutts, Shelagh B.; Krol, Andrea; Hill, Michael D.; Demchuk, Andrew M.; for the VISION Study Group
From the Calgary Stroke Program, University of Calgary, Alberta, Canada.
When to Expect Negative Diffusion-Weighted Images in Stroke and Transient Ischemic Attack.[Letter]
p.1898-1900
Abstract
Background and Purpose-: The frequency of DWI negative cerebral ischemia and clinical factors associated with such a circumstance is not well understood.Methods-: We performed MRI including diffusion-weighted imaging (DWI) in patients with stroke and transient ischemic attack (TIA) within 24 hours of symptom onset and again at 30 days.Results-: Of 401 patients, 103 (25.6%) had an initial negative DWI study. In the DWI negative group, among the stroke patients, 6/26 (23.1%) had infarcts on follow-up MRI (4 lacunar and 2 posterior circulation syndromes) and 1 had a rMTT deficit. Among the TIA patients, 4/63 (6.3%) showed rMTT deficits and 2/63 (3.2%) had infarcts on follow-up MRI.Conclusions-: Baseline perfusion weighted imaging sequences may detect ischemia in a small proportion of DWI negative cases. Only those with brain stem location or lacunar syndrome were DWI negative initially and yet had a follow-up imaging confirmation of infarct or a final clinical diagnosis of stroke.(C) 2008 American Heart Association, Inc.

Shah, Rajiv R. ; Haghpanah, Sepideh ; Elovic, Elie P. ; Flanagan, Steven R. et al
MRI Findings in the Painful Poststroke Shoulder
p. 1808-1813
Abstract
Background and Purpose-: We describe the structural abnormalities in the painful shoulder of stroke survivors and their relationships to clinical characteristics.Method-: Eighty-nine chronic stroke survivors with poststroke shoulder pain underwent T1- and T2-weighted multiplanar, multisequence MRI of the painful paretic shoulder. All scans were reviewed by one radiologist for the following abnormalities: rotator cuff, biceps and deltoid tears, tendinopathies and atrophy, subacromial bursa fluid, labral ligamentous complex abnormalities, and acromioclavicular capsular hypertrophy. Clinical variables included subject demographics, stroke characteristics, and the Brief Pain Inventory Questions 12. The relationship between MRI findings and clinical characteristics was assessed through logistic regression.Results-: Thirty-five percent of subjects exhibited a tear of at least one rotator cuff, biceps or deltoid muscle. Fifty-three percent of subjects exhibited tendinopathy of at least one rotator cuff, bicep or deltoid muscle. The prevalence of rotator cuff tears increased with age. However, rotator cuff tears and rotator cuff and deltoid tendinopathies were not related to severity of poststroke shoulder pain. In approximately 20% of cases, rotator cuff and deltoid muscles exhibited evidence of atrophy. Atrophy was associated with reduced motor strength and reduced severity of shoulder pain.Conclusions-: Rotator cuff tears and rotator cuff and deltoid tendinopathies are highly prevalent in poststroke shoulder pain. However, their relationship to shoulder pain is uncertain. Atrophy is less common but is associated with less severe shoulder pain.(C) 2008 American Heart Association, Inc.

Laryngoscope 118(8) August 2008

Link to journal
Barkdull, Gregory C. ; Kohl, Chad A. ; Patel, Minal ; Davidson, Terence M.
Computed Tomography Imaging of Patients With Obstructive Sleep Apnea
p.1486-1492
Abstract
Objectives/Hypothesis: This study used computed tomography (CT) to identify anatomic features of the awake upper respiratory tract (URT) that correlate with severity of obstructive sleep apnea (OSA).Study Design: An IRB approved radiographic study of 80 patients with OSA and 56 patients from the general population.Methods: Awake, noncontrast CT was performed from the skull base to the thoracic inlet in patients with OSA. Cross-sectional measurements of the retropalatal and retrolingual airways were made along with the size of the cervicomandibular ring and the percentage neck fat. The mandibular plane to hyoid distance, neck length, and laryngeal descent were also recorded. The posterior tongue fat content was estimated using the Hounsfield unit for radiodensity. The radiographic data were then compared with clinical information, including apnea-hypopnea index (AHI), body mass index, and neck circumference using linear regression.Results: AHI increases with smaller retrolingual cross-sectional airway (P = .0026) and increasing mandibular plane to hyoid distance (P = .0003) but not retropalatal airway or laryngeal descent. The posterior tongue is hypodense with higher fat content than other muscles of the head and neck.Conclusions: This study describes anatomic findings of the retrolingual airway in patients that correlate with OSA and can be measured on an upper airway CT. Patients with severe OSA (AHI >=40) tend to have retrolingual airways less than 4% of the cross-sectional area of the cervicomandibular ring. The retrolingual airspace is the major site of obstruction in severe OSA and should be carefully evaluated before surgical treatment is considered.(C) The American Laryngological, Rhinological & Otological Society, Inc.

Yoshida, Tadao ; Sugiura, Makoto ; Naganawa, Shinji ; Teranishi, Masaaki ; Nakata, Seiichi ; Nakashima, Tsutomu
Three-Dimensional Fluid-Attenuated Inversion Recovery Magnetic Resonance Imaging Findings and Prognosis in Sudden Sensorineural Hearing Loss
p.1433-1437
Abstract
Objectives/Hypothesis: Three-dimensional fluid-attenuated inversion recovery (3D-FLAIR) magnetic resonance imaging (MRI) has recently been developed to detect high concentrations of protein or hemorrhage. We have previously reported that 50% of patients with sudden sensorineural hearing loss (SNHL) show high signals in the affected inner ear on 3D-FLAIR MRI. However, the relationship between 3D-FLAIR findings and hearing prognosis is unclear. Our objective was to evaluate the relationship between the results of 3D-FLAIR MRI at 3 Tesla and prognosis in sudden SNHL.Study Design and Methods: We used 3D-FLAIR at 3 Tesla with and without gadolinium enhancement to evaluate the pathologic conditions in the inner ears of 48 patients with sudden SNHL.Results: Thirty-one of 48 patients with sudden SNHL showed high signals in the affected inner ear on precontrast 3D-FLAIR. Hearing improvement in patients with high signals in the affected inner ear on precontrast 3D-FLAIR (25 +/- 19 dB) was significantly worse than that in patients with no signal (45 +/- 27 dB; P < .05). Our analysis suggests that high signals in the affected inner ear on precontrast 3D-FLAIR MRI is a new prognostic factor for sudden SNHL.Conclusions: 3D-FLAIR findings show that high signals in the cochlea on precontrast 3D-FLAIR are related to a poor hearing prognosis. These signals may reflect minor hemorrhage or an increased concentration of protein in the inner ear, which has passed through blood vessels with increased permeability or has originated in disrupted cells in the inner ear.

Accuracy of Computed Tomographic Angiography for Mapping the Perforators of the DIEA

Rozen, Warren M. ; Ashton, Mark W.; Stella, Damien L. ; Phillips, Timothy J.; Taylor, G Ian
The Accuracy of Computed Tomographic Angiography for Mapping the Perforators of the DIEA: A Cadaveric Study.
Plastic & Reconstructive Surgery. 122(2):363-369, August 2008.
Abstract
Background: The deep inferior epigastric artery (DIEA) perforator flap is increasingly used for breast reconstruction, with preoperative imaging sought as a means of improving operative outcome. Computed tomographic angiography has been recently described as the preferred imaging modality; however, formal evaluation of computed tomographic angiography has not been described. A cadaveric study was undertaken to evaluate the accuracy of computed tomographic angiography for perforator mapping.Methods: Ten cadaveric hemiabdominal walls from five fresh cadavers underwent contrast injection of each DIEA and subsequent computed tomographic scanning, with each DIEA and all perforating branches documented. Dissection was then performed, with the recording of the course of the DIEA and the course of all perforators in each specimen. The concordance of computed tomographic angiography with dissection findings was evaluated.Results: Cadaveric computed tomographic angiography identified 154 perforators in 10 hemiabdominal walls. Computed tomographic angiography was highly accurate, with eight false-positives and six false-negatives on cadaveric computed tomographic angiography, establishing an overall sensitivity of 96 percent and a positive predictive value of 95 percent for mapping perforators. For perforators greater than 1 mm in diameter, the sensitivity was 100 percent and the positive predictive value was 100 percent.Conclusions: Computed tomographic angiography is a highly accurate tool for identifying the perforators of the DIEA before DIEA perforator flaps for breast reconstruction. Preoperative identification of these vessels can aid planning for the preferred hemiabdomen for dissection, and may save operative time, angst, and potentially complications.

Preoperative Planning of the Abdominal Perforator Flap with Multidetector Row CT

Masia, Jaume ; Clavero, Juan Angel ; Larranaga, Jose ; Vives, Lorena ; Pons, Gemma
Preoperative Planning of the Abdominal Perforator Flap with Multidetector Row Computed Tomography: 3 Years of Experience. [Editorial]
Plastic & Reconstructive Surgery. 122(2):80e-81e, August 2008

Friday 1 August 2008

Diffusion-negative MRI in acute ischemic stroke

Diffusion-negative MRI in acute ischemic stroke: a case report
Rathakrishnan R, Sharma V, Chan B
Cases Journal, 2008 1:65 ( 29 July 2008 )
[Abstract] [Provisional PDF]

Successful surgery for epilepsy in children

Link to journal
Wyllie, E ; Lachhwani, D K.; Gupta, A ; Chirla, A ; Cosmo, G ; Worley, S et al
Successful surgery for epilepsy due to early brain lesions despite generalized EEG findings
Neurology. 69(4):389-397, July 24, 2007.
Abstract
Objective: To understand the role of epilepsy surgery in children with generalized or bilateral findings on preoperative scalp EEG.Methods: From our pediatric epilepsy surgery series, we identified 50 patients in whom 30 to 100% of preoperative epileptiform discharges (ictal, interictal, or both) were generalized or contralateral to the side of surgery.Results: All patients had severe refractory epilepsy and an epileptogenic lesion on brain MRI. Ninety percent of the lesions were congenital, perinatal, or acquired during infancy, predominantly malformations of cortical development (44%) or cystic encephalomalacia (40%). Age at surgery was 0.2 to 24 (median 7.7) years. Surgeries were hemispherectomy (64%) or lobar or multilobar resection. At last follow-up (median 24.0 months), 72% of patients were seizure-free, 16% had marked improvement with only brief episodes of staring or tonic stiffening, and 12% were not improved. The rate of seizure-free outcome was not significantly associated with age at seizure onset or surgery, presence of hemiparesis or focal clinical features during seizures, type of lesion, or surgery type. Postoperative seizure-free rate did not differ from that in a comparison group of similar patients who matched the study group except for their high percentage (70 to 100%) of ipsilateral ictal and interictal epileptiform discharges on preoperative EEG.Conclusions: Epilepsy surgery may be successful for selected children and adolescents with a congenital or early-acquired brain lesion, despite abundant generalized or bilateral epileptiform discharges on EEG. The diffuse EEG expression may be due to an interaction between the early lesion and the developing brain.

Magnetic Resonance Angiography for Internal Carotid Artery Disease

Link to journal
Debrey, Sarah M. ; Yu, Hua MD; Lynch, John K. ; Lovblad, Karl-Olof; Wright, Violet
Diagnostic Accuracy of Magnetic Resonance Angiography for Internal Carotid Artery Disease: A Systematic Review and Meta-Analysis
Stroke. 39(8):2237-2248, August 2008.
Abstract
Background and Purpose-: Accurate diagnosis of the degree of internal carotid artery (ICA) stenosis is needed for decisions regarding optimal stroke prevention. Noninvasive magnetic resonance angiography (MRA) is being proposed and used as a replacement for the gold standard, intra-arterial angiography. Our purpose was to perform a systematic review and diagnostic meta-analysis to determine the sensitivity and specificity of time-of-flight (TOF) MRA and contrast-enhanced (CE) MRA for the detection of (1) high-grade (>=70% to 99%) ICA stenoses; (2) ICA occlusions; (3) moderately severe (50% to 69%) ICA stenoses; and (4) compare the overall accuracy of the 2 MRA techniques.Methods-: The medical literature on MRA and the diagnosis of ICA steno-occlusive disease was reviewed through the PubMed, EMBASE, and SCOPUS databases. All publication years were included through to November 2006. Studies were eligible for inclusion if they compared the accuracy of TOF or CE MRA for the detection of ICA disease against intra-arterial angiography and reported sufficient data.Results-: The overall sensitivity of TOF MRA for the detection of >=70% to 99% ICA stenoses was 91.2% (95% CI: 88.9% to 93.1%) with a specificity of 88.3% (86.7% to 89.7%), whereas the sensitivity of CE MRA was 94.6% (92.4% to 96.4%) with a specificity of 91.9% (90.3% to 93.4%). For the detection of ICA occlusions, the sensitivity of TOF MRA was 94.5% (91.2% to 96.8%) and the specificity was 99.3% (98.9% to 99.6%), whereas the sensitivity and specificity values for CE MRA were 99.4% (96.8% to 100%) and 99.6% (99.2% to 99.9%), respectively. For moderately severe (50% to 69%) stenoses, TOF MRA had a sensitivity of only 37.9% (29.3% to 47.1%) and a specificity of 92.1% (89.6% to 94.1%); for CE MRA, the pooled sensitivity value was somewhat better at 65.9% (57.0% to 74.0%), whereas the specificity was 93.5% (91.3% to 95.3%).Conclusions-: TOF MRA and CE MRA showed high accuracy for the detection of high-grade ICA stenoses and occlusions with CE MRA having the edge over TOF MRA, but had only poor (TOF MRA) to fair (CE MRA) sensitivity for the detection of moderately severe stenoses.(C) 2008 American Heart Association, Inc.

British Journal of Radiology 2008 Vol 81 Part 967

Effective dose : a flawed concept that could and should be replaced
Brenner , D . J
Page: 521-523

The EFSUMB guidelines for contrast - enhanced ultrasound are comprehensive and informative for good clinical practice : will radiologists take the lead ?
Sidhu , P . S
Page: 524-525

Adrenal incidentaloma detected on triphasic helical CT : evaluation with modified relative percentage of enhancement washout values
Park , B . K . ; Kim , C . K . ; Kim , B .
Page: 526-530

MRI of chronic sclerosing sialoadenitis
Abu , A . ; Motoori , K . ; Yamamoto , S . ; Hanazawa , T . ; Nagai , Y . ; Kaneoya , K . ; Ito , H .
Page: 531-536

Day - case diagnostic and interventional peripheral angiography : 10 - year experience in a radiology specialist nurse - led unit
Huang , D . Y . ; Ong , C . - M . ; Walters , H . L . ; Wilkins , C . J . et al
Page: 537-544

Radiological detection of post - oesophagectomy anastomotic leak - a comparison between multidetector CT and fluoroscopy
Upponi , S . ; Ganeshan , A . ; D Costa , H . ; Betts , M . ; Maynard , N . ; Bungay , H . ; Slater , A .
Page: 545-548

Radiotherapy treatment delays and their influence on tumour control achieved by various fractionation schedules
Wyatt , R . M . ; Jones , B . J . ; Dale , R . G .
Page: 549-563

High - intensity focused ultrasound ablation of liver tumours : can radiological assessment predict the histological response ?
Author(s):
Leslie , T . A . ; Kennedy , J . E . ; Illing , R . O . ; Haar , G . R . T . et al
Page: 564-571

Comparative study of experienced vs non - experienced radiologists in assessing parametric CT images of the response of the prostate gland to radiotherapy
Win , Z . ; Ariff , B . ; Harvey , C . J . ; Rangi , P . ; Eckersley , R . et al
Page: 572-576

Effects of heart rate , filling and slice thickness on the accuracy of left ventricular volume measurements in a dynamic cardiac phantom using ECG - gated MDCT
Dogan , H . ; Veldkamp , W . J . H . ; Dibbets - Schneider , P . et al
Page: 577-582

MR sialography : the effect of a sialogogue and ductal occlusion in volunteers
Hugill , J . ; Sala , E . ; Hollingsworth , K . G . ; Lomas , D . J .
Page: 583-586

Imaging breast augmentation and reconstruction
Glynn , C . ; Litherland , J .
Page: 587-595

A male infant passing urine per rectum since birth
Subramanian , S . ; Gupta , A . K . ; Bhatnagar , V .
Page: 596-599

Radiology Bulletin