CSF lactate dehydrogenase activity in patients with Creutzfeldt-Jakob disease exceeds that in other dementias

The diagnosis of Creutzfeldt- Jakob disease (CJD) is still made by exclusion of other dementias. We now evaluated lactate dehydrogenase (LDH) in the cerebrospinal fluid (CSF) as a possible additional diagnostic tool. CSF LDH levels of patients with CJD ( n = 26) were compared with those in other dementias ( n = 28). LDH isoenzymes were determined in a subset ( n = 9). Total LDH and isoenzyme LDH-1 were significantly higher, whereas the fractions of LDH-2 and LDH-3 were significantly lower in CJD patients. We conclude that in addition to established CSF parameters, LDH and its isoenzymes might serve as a further help to discriminate between CJD and other dementias. Copyright (C) 2004 S. Karger AG, Basel

Renal artery stenosis evaluation: diagnostic performance of gadobenate dimeglumine-enhanced MR angiography--comparison with DSA

PURPOSE: To prospectively determine diagnostic performance and safety of contrast material-enhanced (CE) magnetic resonance (MR) angiography with 0.1 mmol per kilogram of body weight gadobenate dimeglumine for depiction of significant steno-occlusive disease (> or =51% stenosis) of renal arteries, with digital subtraction angiography (DSA) as reference standard. MATERIALS AND METHODS: This multicenter study was approved by local institutional review boards; all patients provided written informed consent. Patient enrollment and examination at centers in the United States complied with HIPAA. Two hundred ninety-three patients (154 men, 139 women; mean age, 61.0 years) with severe hypertension (82.2%), progressive renal failure (11.3%), and suspected renal artery stenosis (6.5%) underwent CE MR angiography with three-dimensional spoiled gradient-echo sequences after administration of 0.1 mmol/kg gadobenate dimeglumine at 2 mL/sec. Anteroposterior and oblique DSA was performed in 268 (91.5%) patients. Three independent blinded reviewers evaluated CE MR angiographic images. Sensitivity, specificity, and accuracy of CE MR angiography for detection of significant steno-occlusive disease (> or =51% vessel lumen narrowing) were determined at segment (main renal artery) and patient levels. Positive and negative predictive values and positive and negative likelihood ratios were determined. Interobserver agreement was analyzed with generalized kappa statistics. A safety evaluation (clinical examination, electrocardiogram, blood and urine analysis, monitoring for adverse events) was performed. RESULTS: Of 268 patients, 178 who were evaluated with MR angiography and DSA had significant steno-occlusive disease of renal arteries at DSA. Sensitivity, specificity, and accuracy of CE MR angiography for detection of 51% or greater stenosis or occlusion were 60.1%-84.1%, 89.4%-94.7%, and 80.4%-86.9%, respectively, at segment level. Similar values were obtained for predictive values and for patient-level analyses. Few CE MR angiographic examinations (1.9%-2.8%) were technically inadequate. Interobserver agreement for detection of significant steno-occlusive disease was good (79.9% agreement; kappa = 0.69). No safety concerns were noted. CONCLUSION: CE MR angiography performed with 0.1 mmol/kg gadobenate dimeglumine, compared with DSA, is safe and provides good sensitivity, specificity, and accuracy for detection of significant renal artery steno-occlusive disease

Signo de  rueda de carreta en los nódulos tiroídeos: ¿Sinónimo de benignidad? The  spoke wheel sign in thyroid nodules: synonym of benignity?

La patología nodular tiroidea es altamente prevalente. La mayoría de los nódulos son asintomáticos y solo identificados en imágenes. Hemos establecido la relación entre una morfología especial del nódulo en  rueda de carreta e histología benigna. Se realizó una revisión de la base de datos de nódulos puncionados bajo US y estudiados histológicamente entre 2003 y 2011. Criterios de selección: nódulos mixtos/sólidos, redondos/ovales, rodeados por un halo, presentando estructuras convergentes hacia un punto central con o sin calcificaciones y vasos periféricos con otros orientados hacia el centro del nódulo. De 3.204 nódulos puncionados 79 (2,5%) presentaron el signo. Tamaño promedio: 28,3 mm. Cincuenta y ocho resultaron nódulos coloideos benignos en PAAF. El resto fueron informados como lesiones foliculares (4 operados benignos, 7 en seguimiento y estables, 10 sin información). Este signo es poco frecuente, pero puede ser un elemento más que colabore en la discriminación ecográfica de benignidad/malignidad, especialmente en nódulos tiroideos de gran tamaño.Thyroid nodular disease is a highly prevalent condition. Most nodules are asymptomatic and only identifiable on images. We have established a relationship between the particular  spoke wheel pattern of thyroid masses and a benign histology. A review of our institutional database of thyroid punctured under ultrasound guidance, histologically studied between 2003 and 2011, was performed. Node selection criteria included: mixed /solid, round /oval, surrounded by a halo, with radial structures converging toward a central point, with or without calcifications, and with peripheral vessels along with others oriented toward the center of the thyroid masses. Seventy-nine (2.5%) out of 3.204 punctured masses exhibited this sign. Average size: 28.3 mm. Fifty-eight masses were benign colloid nodules as diagnosed on FNA biopsy. Remaining masses corresponded to Lesion Follicular (4 benign, surgically treated; 7 under follow-up, stable; 10 with no information). Despite being a rare radiologic finding, the  spoke wheel sign may be another element contributing to ultrasonographic discrimination between benignity and malignancy, especially in large thyroid masses

Renal artery stenosis evaluation : Diagnostic performance of gadobenate dimeglumine - Enhanced MR angiography - Comparison with DSA

Purpose: To prospectively determine diagnostic performance and safety of contrast material\u2013enhanced (CE) magnetic resonance (MR) angiography with 0.1 mmol per kilogram of body weight gadobenate dimeglumine for depiction of significant steno-occlusive disease ( 6551% stenosis) of renal arteries, with digital subtraction angiography (DSA) as reference standard. Materials and Methods: This multicenter study was approved by local institutional review boards; all patients provided written informed consent. Patient enrollment and examination at centers in the United States complied with HIPAA. Two hundred ninety-three patients (154 men, 139 women; mean age, 61.0 years) with severe hypertension (82.2%), progressive renal failure (11.3%), and suspected renal artery stenosis (6.5%) underwent CE MR angiography with three-dimensional spoiled gradient-echo sequences after administration of 0.1 mmol/kg gadobenate dimeglumine at 2 mL/sec. Anteroposterior and oblique DSA was performed in 268 (91.5%) patients. Three independent blinded reviewers evaluated CE MR angiographic images. Sensitivity, specificity, and accuracy of CE MR angiography for detection of significant steno-occlusive disease ( 6551% vessel lumen narrowing) were determined at segment (main renal artery) and patient levels. Positive and negative predictive values and positive and negative likelihood ratios were determined. Interobserver agreement was analyzed with generalized \u3ba statistics. A safety evaluation (clinical examination, electrocardiogram, blood and urine analysis, monitoring for adverse events) was performed. Results: Of 268 patients, 178 who were evaluated with MR angiography and DSA had significant steno-occlusive disease of renal arteries at DSA. Sensitivity, specificity, and accuracy of CE MR angiography for detection of 51% or greater stenosis or occlusion were 60.1%\u201384.1%, 89.4%\u201394.7%, and 80.4%\u201386.9%, respectively, at segment level. Similar values were obtained for predictive values and for patient-level analyses. Few CE MR angiographic examinations (1.9%\u20132.8%) were technically inadequate. Interobserver agreement for detection of significant steno-occlusive disease was good (79.9% agreement; \u3ba = 0.69). No safety concerns were noted. Conclusion: CE MR angiography performed with 0.1 mmol/kg gadobenate dimeglumine, compared with DSA, is safe and provides good sensitivity, specificity, and accuracy for detection of significant renal artery steno-occlusive disease