Dynamic magnetic resonance angiography of the arteries of the hand. A comparison between an extracellular and an intravascular contrast agent

The purpose of this study was to compare the image quality of the intravascular contrast agent gadofosveset with the extracellular contrast agent gadoterate meglumine in time-resolved three-dimensional magnetic resonance (MR) angiography of the human arteries of the hand. The value of cuff compression technique for suppression of venous enhancement for both contrast agents was also investigated. Three-dimensional MR angiograms of both hands of 11 healthy volunteers were acquired for each contrast agent at 1.5-T, while subsystolic cuff compression was applied at one side. Quantitative and qualitative evaluation were performed and analyzed with Student's t-test. Visualization of vessels was superior in the images acquired with gadofosveset, especially in the late phases. Quantitative and qualitative evaluation showed significantly higher values for gadofosveset. The cuff compression at the lower arm proved to be an effective method to enhance arterial vessels. In conclusion the blood pool agent gadofosveset is superior for the dynamic imaging of the vessels of the hand when compared with the extracellular contrast agent gadoterate meglumine. To fully utilize the advantages of intravascular contrast agents, venous overlay has to be delayed or reduced, which can be achieved effectively by subsystolic lower arm cuff compressio

Bilateral upper lobe pulmonary edema during gynecologic laparoscopic surgery in the Trendelenberg position -A case report-

A 25-year-old woman was diagnosed with a ruptured ectopic pregnancy. During laparoscopic surgery, the patient was in the Trendelenberg position (20° degrees). Massive froth in the endotracheal tube was observed at the end of surgery. A portable chest x-ray, checked at the end of the operation, showed diffuse haziness in both upper lung fields. After one hour of aggressive treatment with drugs and positive mechanical ventilation, the amount of froth in the endotracheal tube was reduced considerably. Considering the symptom and radiologic findings, we concluded that diffuse bilateral upper lung field haziness was due to atypical pulmonary edema. We speculated that the rapid improvement of pulmonary edema was due to redistribution of fluid to the lowest part of lung by immediate reversing the patient's Trendelenberg position, along with aggressive treatment

Primary uncleansed 2D versus primary electronically cleansed 3D in limited bowel preparation CT-colonography. Is there a difference for novices and experienced readers?

The purpose of this study was to compare a primary uncleansed 2D and a primary electronically cleansed 3D reading strategy in CTC in limited prepped patients. Seventy-two patients received a low-fibre diet with oral iodine before CT-colonography. Six novices and two experienced observers reviewed both cleansed and uncleansed examinations in randomized order. Mean per-polyp sensitivity was compared between the methods by using generalized estimating equations. Mean per-patient sensitivity, and specificity were compared using the McNemar test. Results were stratified for experience (experienced observers versus novice observers). Mean per-polyp sensitivity for polyps 6 mm or larger was significantly higher for novices using cleansed 3D (65%; 95%CI 57–73%) compared with uncleansed 2D (51%; 95%CI 44–59%). For experienced observers there was no significant difference. Mean per-patient sensitivity for polyps 6 mm or larger was significantly higher for novices as well: respectively 75% (95%CI 70–80%) versus 64% (95%CI 59–70%). For experienced observers there was no statistically significant difference. Specificity for both novices and experienced observers was not significantly different. For novices primary electronically cleansed 3D is better for polyp detection than primary uncleansed 2D

Monomolecular and Bimolecular Recombination of Electron-Hole Pairs at the Interface of a Bilayer Organic Solar Cell

While it has been argued that field-dependent geminate pair recombination (GR) is important, this process is often disregarded when analyzing the recombination kinetics in bulk heterojunction organic solar cells (OSCs). To differentiate between the contributions of GR and nongeminate recombination (NGR) the authors study bilayer OSCs using either a PCDTBTtype polymer layer with a thickness from 14 to 66 nm or a 60 nm thick p-DTS(FBTTh2)(2) layer as donor material and C-60 as acceptor. The authors measure JV-characteristics as a function of intensity and charge-extraction-by-linearly-increasing-voltage-type hole mobilities. The experiments have been complemented by Monte Carlo simulations. The authors find that fill factor (FF) decreases with increasing donor layer thickness (L-p) even at the lowest light intensities where geminate recombination dominates. The authors interpret this in terms of thickness dependent back diffusion of holes toward their siblings at the donor-acceptor interface that are already beyond the Langevin capture sphere rather than to charge accumulation at the donor-acceptor interface. This effect is absent in the p-DTS(FBTTh2)(2) diode in which the hole mobility is by two orders of magnitude higher. At higher light intensities, NGR occurs as evidenced by the evolution of s-shape of the JV-curves and the concomitant additional decrease of the FF with increasing layer thickness.The authors acknowledge financial support by the Bavarian State Ministry of Science, Research, and the Arts through the Collaborative Research Network “Solar Technologies go Hybrid”, by the Volkswagen foundation and by the German Science Foundation DFG through the doctoral training center “GRK 1640.” This project further received funding from the Universidad Carlos III de Madrid, the European Union’s Seventh Framework Programme for research, technological development and demonstration under grant agreement no. 600371, el Ministerio de Economía y Competitividad (COFUND2014-51509), el Ministerio de Educación, cultura y Deporte (CEI-15-17), and Banco Santander. M.R. additionally acknowledges support from the Hanns Seidel Foundation for a stipend through funds from the German Ministry of Education and Research (BMBF). T.-Q.N. thanks the Office of Naval Research (#N000141410076) for the support. Furthermore, the authors would like to thank the anonymous referees for helpful suggestions

CT colonography: optimisation, diagnostic performance and patient acceptability of reduced-laxative regimens using barium-based faecal tagging

To establish the optimum barium-based reduced-laxative tagging regimen prior to CT colonography (CTC). Ninety-five subjects underwent reduced-laxative (13 g senna/18 g magnesium citrate) CTC prior to same-day colonoscopy and were randomised to one of four tagging regimens using 20 ml 40%w/v barium sulphate: regimen A: four doses, B: three doses, C: three doses plus 220 ml 2.1% barium sulphate, or D: three doses plus 15 ml diatriazoate megluamine. Patient experience was assessed immediately after CTC and 1 week later. Two radiologists graded residual stool (1: none/scattered to 4: >50% circumference) and tagging efficacy for stool (1: untagged to 5: 100% tagged) and fluid (1: untagged, 2: layered, 3: tagged), noting the HU of tagged fluid. Preparation was good (76–94% segments graded 1), although best for regimen D (P = 0.02). Across all regimens, stool tagging quality was high (mean 3.7–4.5) and not significantly different among regimens. The HU of layered tagged fluid was higher for regimens C/D than A/B (P = 0.002). Detection of cancer (n = 2), polyps ≥6 mm (n = 21), and ≤5 mm (n = 72) was 100, 81 and 32% respectively, with only four false positives ≥6 mm. Reduced preparation was tolerated better than full endoscopic preparation by 61%. Reduced-laxative CTC with three doses of 20 ml 40% barium sulphate is as effective as more complex regimens, retaining adequate diagnostic accuracy

Feasibility study of computed tomography colonography using limited bowel preparation at normal and low-dose levels study

The purpose was to evaluate low-dose CT colonography without cathartic cleansing in terms of image quality, polyp visualization and patient acceptance. Sixty-one patients scheduled for colonoscopy started a low-fiber diet, lactulose and amidotrizoic-acid for fecal tagging 2 days prior to the CT scan (standard dose, 5.8–8.2 mSv). The original raw data of 51 patients were modified and reconstructed at simulated 2.3 and 0.7 mSv levels. Two observers evaluated the standard dose scan regarding image quality and polyps. A third evaluated the presence of polyps at all three mSv levels in a blinded prospective way. All observers were blinded to the reference standard: colonoscopy. At three times patients were given questionnaires relating to their experiences and preference. Image quality was sufficient in all patients, but significantly lower in the cecum, sigmoid and rectum. The two observers correctly identified respectively 10/15 (67%) and 9/15 (60%) polyps ≥10 mm, with 5 and 8 false-positive lesions (standard dose scan). Dose reduction down to 0.7 mSv was not associated with significant changes in diagnostic value (polyps ≥10 mm). Eighty percent of patients preferred CT colonography and 13% preferred colonoscopy (P<0.001). CT colonography without cleansing is preferred to colonoscopy and shows sufficient image quality and moderate sensitivity, without impaired diagnostic value at dose-levels as low as 0.7 mSv

Frequency and Nature of Incidental Extra-Enteric Lesions Found on Magnetic Resonance Enterography (MR-E) in Patients with Inflammatory Bowel Diseases (IBD)

The aim of this study was to determine the occurrence of extra-enteric findings in a large cohort of patients undergoing magnetic resonance enterography (MR-E) and to classify the clinical significance of these findings.We retrospectively analyzed 1154 MR-E performed in 1006 patients referred to our radiological department between 1999-2005. The reasons for referral were suspected or proven inflammatory bowel diseases (IBD) (n = 710), further diagnostic work-up for small bowel disease because of non-specific abdominal symptoms (SBD; n = 182) or suspected small bowel malignancies (SBM; n = 114). All extra-enteric findings were reviewed by a radiologist and a gastroenterologist and were classified as having high, moderate, or low significance for further diagnostic or therapeutic procedures.The average age of all patients was 40+/-16 (Mean+/-SD) years (y) (IBD 35+/-13 y; SBD 49+/-16 y; SBM 57+/-15 y). A total of 1113 extra-enteric findings were detected in 600 of 1006 patients (59.6%). Of these findings 180 (16.2%) were judged as having a high, 212 (19.0%) a moderate and 721 (64.8%) a low significance. On a per group basis in patients with IBD 12.0% of the findings were of major clinical significance compared to 13.7% and 33.3% in patients with SBD and SBM, respectively. The most common major findings were abscesses (69.9%) in the IBD group and extraintestinal tumors, metastases or masses in the SBD and SBM groups (41.9% and 74.2%, respectively).MR-E reveals a substantial number of extra-enteric findings, supporting the role of a cross-sectional imaging method for the evaluation of the small bowel