Carbon dioxide digital subtraction angiography as an option for detection of endoleaks in endovascular abdominal aortic aneurysm repair procedure

ObjectiveThe purpose of this study was to evaluate carbon dioxide digital subtraction angiography (CO2-DSA) as an option for the detection of endoleaks (ELs) in the endovascular abdominal aortic aneurysm repair (EVAR) procedure.MethodsForty patients with abdominal aortic aneurysm who were scheduled to undergo EVAR were enrolled in the study. There were 35 men and five women (mean age, 77.9 years). All patients had both iodinated contrast conventional DSA (C-DSA) and CO2-DSA immediately after EVAR. The sensitivity and specificity were calculated for the ability of CO2-DSA to detect ELs. We also correlated with computed tomography findings 6 months after EVAR.ResultsC-DSA showed that 27 of the 40 patients (68%) had 28 ELs (type I, four; type II, 20; type III, three; type IV, one). CO2-DSA showed that 16 of the 40 patients (40%) had 17 ELs (type I, four; type II, 10; type III, three; type IV, none). For the prediction of direct ELs (type I and type III) with use of C-DSA as the criterion standard, CO2-DSA has a sensitivity of 1.0 and a specificity of 1.0. For the detection of persistent type II ELs (n = 11) with use of computed tomography findings 6 months from EVAR as the criterion standard, CO2-DSA has a sensitivity of 0.87 and a specificity of 0.97. C-DSA has a sensitivity of 0.82 and a specificity of 0.64.ConclusionsCO2-DSA is reliable for the detection of direct ELs and persistent type II ELs in EVAR. CO2-DSA can be an option to detect ELs in the EVAR procedure

Bone marrow edema and subchondral fracture in osteonecrosis of the femoral head: analysis with MRI and CT

Purpose: To study the relationship between bone marrow edema (BME) and subchondral fracture in osteonecrosis of the femoral head (ONFH), and to analyze MRI findings of subchondral fracture and correlate them with those of CT.Materials and Methods: Fifty seven hips in 38 patients with ONFH were studied retrospectively. Images were obtained with 1.5-T MRI unit and multidetector helical CT. Selected hips were divided into edema positive and edema negative groups. In each group presence or absence of subchondral fracture and/or collapse of femoral head was assessed, and the MR findings were compared with those of CT.Results: Thirty (52.6%) of 57 hips showed BME during the course of ONFH. In these edema positive group, 29 (96.7%) of 30 hips showed subchondral fracture and/or femoral head collapse, whereas only 7 (25.9%) of 27 hips in edema negative group showed subchondral fracture and/or FH collapse (P <0.0001). A low-signal intensity line on T1 and T2 weighted MR images and linear lucency on CT were the most common patterns of subchondral fracture.Conclusion: Our study showed significant relationship between BME and subchondral fracture/ femoral head collapse and supported the results of previous studies in considering BME as a marker for potential progression of osteonecrosis

Contraction Function of the Left Ventricle in Patients with Dilated Cardiomyopathy: Comparison of Delayed Enhanced MR imaging and indine -123- metaiodobenzylguanidine (123I-MIBG) scintigram

Objective: The purpose of this study was to compare delayed enhancement (DE) cardiac magnetic resonance (MR) imaging with the indine-123-metaiodobenzylguanidine(123I-MIBG) scintigram for measurement of left ventricular (LV) contraction function in patients with dilated cardiomyopathy (DCM). Materials and methods: DCM patients (n=29: mean age,51.9years; seven women) were evaluated by both DE cardiac MR imaging and 123I-MIBG scintigram. In all patients biopsy specimen showed disarray of the myocardium that was consistent with DCM. DE cardiac MR images were acquired using a two-dimensional segmented inversion-recovery prepared gradient-echo sequence (TI=250msec) 15minutes after intravenous administration of 0.1 mmol/kg gadolinium.The average CNR per slice (aCNR) for the LV myocardium was calculated.123I-MIBG scintigram was acquired at 15minutes and 3 hours (delayed imaging) after intravenous administration of 123I-MIBG (111MBq). The heart-to-mediastinum radioactivity ratio (H/M ratio) and washout rate (WR) was calculated. We evaluated the relationships between aCNR, WR, delayed H/M ratio, and the contraction function of the LV. Results: In MR imaging, mean aCNR was significantly higher in the low LV ejection fraction (LVEF<25%) group (n=11, 6.6±3.6) than in the high LVEF (?25%) group (n=18, 2.4±2.9). However, with the 123I-MIBG scintigram, delayed H/M and WR were not significantly different between high (delayed H/M ratio ; 1.7±0.3, WR; 37.6±14.5) and low (delayed H/M ratio; 1.7±0.2, WR; 38.2±14.2) LVEF groups. Conclusions: DE MR imaging reflects the contraction function of the LV in patients with DCM, which may be related with myocardial fibrosis. DE MR imaging may be more useful to evaluate the contraction function of LV than 123I-MIBG scintigram

Use of Short Inversion Time Inversion Recovery Imaging to Differentiate between Aplastic Anemia and Myelodysplastic Syndrome

The value of short inversion time inversion recovery (STIR) imaging in differentiating patients with aplastic anemia (AA) from those with myelodysplastic syndrome (MDS) was investigated. Thirty-nine patients with pancytopenia were diagnosed hematologically as having AA or MDS. These patients and 95 volunteers without hematologic disorders were then examined with STIR imaging. Hyperintense posterior pelvis was present in 25 of the 29 patients with MDS, including 17 of the 19 patients with refractory anemia. In contrast, high intensity of the posterior pelvis was absent in 8 of the AA 10 patients. High intensity of the femoral elements was present in 6 of the 8 patients with severe MDS and 3 of the 19 patients with refractory anemia. High intensity in the femoral elements was absent in all 10 AA patients. STIR imaging was useful in differentiating patients with AA from those with MDS

In-111-labeled Leukocyte Scintigraphy in Postoperative Joint Infection

To evaluate the role of In-111-labeled leukocyte scintigraphy in the patients with suspected postoperative joint infection, 41 scintigraphic examinations were performed in 24 patients. Scintigrams were interpreted by the degree of accumulation of labeled leukocytes, and were classified into 3 groups: positive, intermediate, and negative. In the cases of positive leukocyte scans, definite diagnosis of infection was made in all cases except one. In the cases of negative scans, there was no evidence of infection. In 13 cases, leukocyte scintigrams were interpreted in conjunction with bone scintigrams. Definite diagnosis of infection was made in all of the cases with positive combined leukocyte/bone scan, and there was no evidence of infection in cases with negative combined leukocyte/bone scan. This study demonstrates that In-111-labeled leukocyte scintigraphy is a useful method in diagnosis of postoperative joint infection, and accuracy of the examination improves when combined with bone scintigraphy

Pictorial review Articular and Juxtaarticular Cystic Lesions: Evaluation with MR Imaging

MR imaging is the most appropriate imaging modality for the evaluation of articular or juxtaarticular cystic lesions. Most of the cystic lesions show a typical signal intensity pattern of fluid, but debris or hemorrhage within the cyst may alter the signal intensity pattern of the cyst. The location and relationship with the surrounding structure are important for the differential diagnosis of cystic lesions. Associated joint abnormalities that include meniscus or labral tears, ligamentous injury, degeneration, and inflammation should also be evaluated

Dysplasia Epiphysealis Hemimelica of The Trochlear Epiphysis

Dysplasia epiphysealis hemimelica is an uncommon disorder primarily involving the epiphyes of the lower extremities. We report imaging findings of a case of dysplasia epiphysealis hemimelica involving the trochlear epiphysis of the humerus. Conventional radiography showed irregular ossification in the area of trochlear epiphysis, the finding thought to be diagnostic of this discorder. However, other imaging modalities, such as double contrast arthrography, computed tomography and MR imaging, provided valuable information about the nature and extent of the epiphyseal pathology

Pictorial Essay Magnetic Resonance Imaging in Rheumatoid Arthritis and Related Disorders

In this pictorial essay we outline the role of MRI in the work-up of RA and related disorders, and discuss its strengths and limitations with the help of representative case presentations. MRI provides detailed information about the involvement of bones, joints and soft tissue, which may not be evident on radiography. Moreover, MRI often reveals changes consistent with the early inflammatory changes in the synovium and bone marrow. Contrast enhancement study, especially with fat-suppression technique, can be useful in providing objective and quantitative parameters to determine a disease activity and an effect of treatment

Neurogenic Tumor of The Chest Wall: A

A rare case of schwannoma of the chest wall is presented. A 65-year-old Japanese man had a painful mass, measuring 3×3cm, in the 10th intercostal space of the right back. A fine needle biopsy seemed to fail to prove a nature of the tumor. A computed tomography (CT) scan of the chest showed a well-demarcated low density mass with no invasion to the ribs, lung and pleura with the CT density being 30 Hounsfield unit. These findings were suggestive of a neurogenic tumor. The tumor was easily extirpated and a histological diagnosis was schwannoma

Evaluation of Aortic Disease with Spiral CT Angiography and Multiplanar Reconstructions: Comparison with Catheter Angiography

Purpose: To assess the usefulness of spiral CT angiography (CTA) in the evaluation of aortic aneurysm (AA) or dissection (AD). Methods: Ninety-eight patients with AA (n = 78) or AD (n = 20) were examined with CTA. Imaging results were correlated with angiographic (n = 98) findings in all cases and surgical findings in AA cases (n = 64). The spiral CT angiography were analyzed by an experienced radiologist without knowledge of the result of the catheter angiography, to evaluate the same features. The catheter angiograms were individually interpreted by two experienced radiologists. Results: In AA, all of major aortic branches were depicted on CTA except two of seven accessory renal arteries and six of 26 inferior mesenteric arteries. CTA correctly assessed aneurysm involvement of left subclavian (LSA), renal (RA), and iliac arteries (IA) in all patients. In AD, CTA correctly assessed Stanford classification in all patients, and the relationship between 70 major aortic branches and true/false lumen in all but two branches. CTA showed 23 of 30 intimal tears in double barreled AD. Conclusion: CTA might replace catheter angiography in evaluation of AA and AD except in cases of type A dissection. Index Terms: computed tomography - CT angiography - aorta, aneurysm - aorta, dissection - Catheter angiograph