Radiology Bulletin

Wednesday, 27 August 2008

AJR 2008 ; VOL 191 ; PART 2

AJR 2008 ; VOL 191 ; PART 1

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

Wednesday, 27 August 2008

AJR 2008 ; VOL 191 ; PART 2

AJR 2008 ; VOL 191 ; PART 1

Stroke. 39(6) June 2008

Laryngoscope 118(8) August 2008

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

Preoperative Planning of the Abdominal Perforator Flap with Multidetector Row CT

Friday, 1 August 2008

Diffusion-negative MRI in acute ischemic stroke

Successful surgery for epilepsy in children

Magnetic Resonance Angiography for Internal Carotid Artery Disease

British Journal of Radiology 2008 Vol 81 Part 967

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