Acta Radiologica

Purpose: To disclose the frequency of abdominal pain that led to post‐procedure hospitalization and the outcome of this major complication.

Material and Methods: 576 patients who had undergone herniography during a 13‐year period were retrospectively analysed.

Results: Nine out of 576 patients (1.6%) undergoing herniography with an iodine contrast medium developed abdominal pain. The pain resolved within 24 h in 6 patients while 3 patients had pain for up to 3 days.

Conclusion: Patients who present with this pain syndrome thus only need careful clinical observation until asymptomatic, with no need for laparotomy or X‐ray examination. Prior to herniography, the patients should be informed about this potential complication.

Purpose: To evaluate the radiological spectrum of sequelae of corrosive acid and alkali injury to the upper gastrointestinal (GI) tract using barium contrast examination.

Material and Methods: Barium contrast radiographic films of 155 patients with a history of corrosive ingestion, acid in 120 and alkali in 35 patients with grade 2b and 3 injury on initial endoscopy, were retrospectively evaluated. Barium contrast examination of the upper GI tract was performed in the course of follow‐up, beyond 3 weeks of corrosive ingestion.

Results: The esophagus was involved in 131 patients and the stomach in 74. Fifty patients had simultaneous involvement of esophagus and stomach. Radiological findings in the esophagus were solitary or multiple strictures of varying length, intramural pseudodiverticula, and carcinoma in long‐standing corrosive injury. The stomach showed cicatrization, predominantly involving the antrum, linitis plastica type deformity with multiple pseudodiverticula. There was no difference in the radiological findings as to the type of corrosive ingested.

Conclusion: Barium examination of the upper GI tract is useful in the evaluation of late sequelae of corrosive injury (acid/alkali). There was no difference in the radiological findings as to the type of corrosive ingested. Thus, contrary to general belief, we found that acid and alkali damage both the esophagus and the stomach with equal degree of severity.

Purpose: To study the efficacy and problems associated with intermittent hepatic artery antibiotic infusion therapy for pyogenic hepatic abscess.

Material and Methods: The material comprised eight patients with pyogenic hepatic abscess in whom percutaneous drainage could not be performed and intravenous administration of antibiotics was ineffective. An injection catheter was introduced into the common hepatic artery. Almost the same dose of antibiotics as with intravenous administration was infused intra‐arterially 2–4 times per day.

Results: A therapeutic effect was achieved in six of the eight cases. In these 6 cases, the mean period of intra‐arterial infusion was 10.8 days, while the mean period of catheter placement was 14.7 days. Using broad spectrum antibiotics, the therapeutic effect was obtained regardless of the numbers, morphologic characteristics, and differences in location of the abscesses. No significant complications were noted except in one case of splenic infarction.

Conclusion: Intermittent hepatic artery antibiotic infusion therapy is useful as an alternative therapeutic procedure for pyogenic hepatic abscess in which percutaneous drainage cannot be performed and intravenous administration of antibiotics is ineffective.

Metaplastic carcinoma of the breast is a rare disease. We describe the MRI findings with the correlative sonographic and pathologic features of two cases. On MRI, T2‐weighted images demonstrate a relatively well‐defined mass with high signal intensity cystic components. Dynamic enhancement subtraction images showed an early enhancing and delayed washout peripheral rim and non‐enhancing internal components. A microlobulated, isoechogenic mass with cystic components was seen sonographically, and was histopathology related to necrosis and cystic degeneration. Although these features are not unique, metaplastic carcinoma should be included in the differential diagnosis for breast masses.

Purpose: To evaluate clinical and hemodynamical long‐term results after laser angioplasty of long occlusions of the superficial femoral artery (SFA).

Material and Methods: In a prospective trial of 452 patients with long occlusions of the SFA, excimer percutaneous transluminal laser angioplasty (PTLA) for recanalization was applied. The average occlusion length of the SFA was 25.5 cm (range 16–38 cm). The recanalization attempt was done with the crossover technique in 398 patients, in 36 patients with the antegrade technique and in another 18 patients with the transpopliteal technique.

Results: The application of laser angioplasty demonstrated a successful recanalization of the SFA in 386/452 patients (85.5%). Recanalization with PTLA was not possible in 66 patients (14.5%). The main reason for the unsuccessful PTLAs was obstructing calcified material (n=28) resistant to PTLA application. After a follow‐up period of 48 months there was a primary, primary‐assisted, and secondary patency rate of 22.3%, 40.9%, and 43.2%, respectively.

Conclusion: Laser angioplasty of long occlusions of the SFA is a feasible procedure with a low failure rate. Long‐term results are promising, but additional interventions are required in most patients if a patency rate of 43.2% is to be achieved after 4 years.

Purpose: To compare a ‘standard’ slow phosphorus‐31 magnetic resonance spectroscopy (³¹P‐MRS) sequence with two faster sequences in phantoms and healthy volunteers using a 1.5‐T clinical system.

Material and Methods: Complete 3D localization was performed using a 2D phosphorus chemical‐shift imaging sequence in combination with 30‐mm axial slice‐selective excitation. Two ³¹P‐MRS rapid sequences (RS8‐4: 8×8 phase‐encoding, with an average of 4 acquisitions, and RS16‐1: 16×16 phase‐encoding, 1 acquisition) were compared with the standard sequence (StdP: 16×16 phase‐encoding, with an average of 8 acquisitions) in phantom and healthy volunteers.

Results: Acquisition time for the ³¹P‐MRS procedure with StdP, RS8‐4, and RS16‐1 in the healthy volunteer studies ranged from 30 to 45, 3 to 5, and 3 to 5 minutes, respectively. Metabolite measurements of healthy volunteers obtained from ³¹P‐MRS using RS8‐4 correlated with values obtained using StdP (PCr r² =0.63, P<0.001; ATP r² =0.41, P<0.01 and PCr/ATP ratio r² =0.25, P<0.05). There was no correlation between StdP and RS16‐1 for either ATP or the PCr/ATP ratio (r² =0.03, P=0.60, and r² =0.11, p=0.26, respectively). Reproducibility (intensity of phosphorus signal) with RS16‐1 was worse than that of RS8‐4 or StdP.

Conclusion: ³¹P‐MRS using RS8‐4 may be a valid diagnostic tool for patients with cardiac diseases.

Purpose: To assess the feasibility and accuracy of two magnetic resonance (MR) venography methods in a consecutive series of patients with suspected deep vein thrombosis of the upper extremity (DVTUE).

Material and Methods: Consecutive in‐ and outpatients who were referred for imaging of suspected DVTUE in a large teaching hospital during the period April 2001 to October 2002 were eligible for inclusion. All patients were scheduled to undergo contrast venography with the intention to perform additional MR venography. Both time‐of‐flight and gadolinium‐enhanced 3D MR venography were scheduled. All MR imaging were interpreted independently by consensus of two experienced radiologists, who were blinded for contrast venography outcome. Patients were managed based on contrast venography only.

Results: A total of 44 patients were eligible for inclusion. Thirteen patients were excluded (5 refused consent, 2 inability to gain venous access, 2 renal failure, 4 logistic reasons). Contrast venography was performed in 31 patients, and demonstrated DVTUE in 11 patients. MR imaging was not feasible in 10 patients (4 unable to lie flat, 3 claustrophobia, 1 too large for MR scanner, 1 osteosynthesis of shoulder, 1 pacemaker). The sensitivity and specificity of TOF MRV versus Gadolinium 3D MRV was 71% and 89% versus 50% and 80%, respectively.

Conclusion: A high number of patients were unable to undergo MR venography in this setting. Contrast‐enhanced MRV did not improve diagnostic accuracy. The clinical utility of MR venography in the setting of suspected DVTUE seems disappointing.

Purpose: To elucidate whether emphysematous lesions and other high‐resolution computed tomography (HRCT) findings considered associated with smoking are part of a progressive process, and to measure the extent to which similar changes are found in never‐smokers.

Material and Methods: Healthy smokers and never‐smokers were recruited from a randomized epidemiological study and investigated with a 6‐year interval. Emphysema, parenchymal and subpleural nodules, ground‐glass opacities, bronchial alterations, and septal lines were evaluated in 66 subjects (40 smokers, 11 of whom had stopped smoking in the interval, and 26 never‐smokers). Lung function was tested.

Results: All except emphysematous lesions were present to some extent in never‐smokers. Emphysema, parenchymal nodules, and septal lines occurred significantly more in current smokers, and a progression in extent of emphysema, ground‐glass opacities, bronchial alterations and septal lines was seen. There was no significant change among those who stopped and never‐smokers except for bronchial alterations, which progressed in never‐smokers.

Conclusion: In healthy, elderly never‐smokers a low extent of various HRCT findings has to be considered normal. Emphysema, parenchymal nodules, and ground‐glass opacities are indicative of smoking‐induced disease. Further progress may cease if smoking is stopped.

Purpose: To determine regional variations in the thickness of human cervical spine endplates with high spatial resolution.

Material and Methods: Six explanted human cadaveric spine specimens underwent computed tomography (CT) scanning. Measurement of endplate thickness was done fully automatically at every point of the endplate using a computer program written specifically for this purpose. Variations in thickness along sagittal and coronal lines were determined and statistical parametric mapping was used to test for significant regional variations at every point.

Results: Anterior and medial aspects of superior endplates were shown to be significantly thinner than lateral and dorsal parts. Superior endplates were found to be thicker than inferior endplates.

Conclusion: Fully automatic assessment of endplate thickness from CT data is feasible. Central regions of the cervical spine endplates are thinner than peripheral parts of the endplates. This distribution is more pronounced in superior than in inferior endplates.

Purpose: To understand the peak bone mineral density (BMD) and annual loss of BMD of the lumbar spine (L‐BMD) and the proximal femur (F‐BMD) and the prevalence of osteoporosis in both sexes in Taipei City, Taiwan.

Material and Methods: The medical records from a recent 3‐year period of annual health examinations at a single institution were reviewed. A total of 1514 men (mean age 49.08±13.62) and 1955 women (48.07±14.12), who lived in the Taipei area, had no major systemic disorders, and who had undergone both L‐BMD and F‐BMD examinations, were recruited.

Results: In women, peak L‐BMD (1.078±0.133 g/cm²) occurred in the 30 to 39‐year age group, whereas peak F‐BMD (0.873±0.101 g/cm²) occurred in the 17 to 29‐year age group. In men, peak L‐BMD (1.095±0.137 g/cm²) and F‐BMD (0.989±0.140 g/cm²) both occurred in the 17 to 29‐year age group. The estimated annual bone loss was 0.69% of peak L‐BMD in women over 50 years; in the proximal femur this was 0.688% in women and 0.332% in men. In women over 60 years, approximately half of the population had osteoporosis in the lumbar spine.

Conclusion: We report descriptive BMD data of a Chinese population recruited from a Taipei urban area who underwent routine health examination. The values are similar to or higher than those of Japanese, Canadian and Greek populations. L‐BMD was lower than that in the Lebanese, and F‐BMD of both sexes was lower than that reported in the Greek study.

Purpose: To assess acute phase multidetector computed tomography (MDCT) findings in elbow traumas.

Material and Methods: Fifty‐six patients (32 M, 24 F, age 16 to 88 years, mean 44 years) underwent MDCT of the elbow due to an acute trauma during a time period of 34 months.

Results: A total of 65 fractures and 3 main fracture types were established: 16 (25%) ulnar coronoid process fractures, 13 (20%) radial head fractures, and 12 (18%) humeral supracondylar fractures. Three main injury mechanisms were falling (38 (68%) patients), falling from high places (6 (11%) patients), and traffic accidents (5 (9%) patients). In 6 (11%) patients, MDCT revealed 13 occult fractures in the elbow joint compared to primary radiography. In four (7%) patients a displaced fracture fragment was detected in primary radiography, but the origin of the fragment was unclear. In all four cases, MDCT revealed the origin of the fragment.

Conclusion: Radiography remains the primary imaging modality in elbow trauma, but in complex fracture patterns, where the extent of the fractures and the position or origin of dislocated fragments is not clear by radiography, the MDCT is a recommended complementary examination.

Purpose: To study the role of dynamic contrast enhanced magnetic resonance imaging (DCE‐MRI) in monitoring the response of bone metastases to endocrine therapy combined with bisphosphonates in patients with breast cancer.

Material and Methods: Ten breast cancer patients with bone metastases who were to receive endocrine therapy and bisphosphonates were investigated prospectively by DCE‐MRI. We chose a reference lesion for each patient who was studied at baseline, within 3 weeks from the second administration of bisphosphonates, and after 4 and 8 months from the initiation of medical treatment. Time/intensity curves, representing temporal changes of signal intensity in areas of interest in the context of the target lesions (ROI), were obtained for each DCE‐MRI.

Results: Changes in the shape of the T/I curves suggesting tumor regression were seen shortly after the initiation of medical treatment in the three patients who had the most durable responses.

Conclusion: DCE‐MRI has the potential to detect early changes related to medical treatment in bone metastases from breast cancer. If confirmed in larger series, these data identify DCE‐MRI as a diagnostic tool for evaluating new bone targeting antineoplastic agents.

Preoperative imaging of a 45‐year‐old woman disclosed a large (32 cc) meningeal cyst of the thoracic spine. A chest radiograph performed about four and a half years earlier exhibited a minute widening of the mediastinum in the same place, presumably representing the lesion in its nascent state. It is concluded that a meningeal cyst with a linear tendency to grow enlarges by about 6 cc per year.

Purpose: To investigate the efficacy of diffusion‐weighted imaging in patients with Wallenberg's lateral medullary syndrome.

Material and Methods: Thirteen patients with Wallenberg's lateral medullary syndrome were examined with conventional and echoplanar diffusion‐weighted magnetic resonance (MR) imaging in a 1.5 T magnetic resonance unit. MR examinations were obtained in the acute or subacute stage of clinical syndrome, and diffusion‐weighted imaging (DWI) was considered to be positive for infarction when an increase in signal was seen on b=1000 s/mm² images in the posterolateral medullary localization.

Results: DWIs were positive in 12 patients in the acute or subacute stages of this clinical syndrome. A false‐negative result was obtained in only one patient examined within the first day, 10 h after onset of the symptoms. In the visual evaluation of the DWI, the contrast between normal and infarcted brainstem area was better in the high b‐value images than in the apparent diffusion coefficient map images.

Conclusion: DWI is a valuable technique for examining patients presenting with the signs and symptoms of Wallenberg's syndrome and high b‐value images can provide complementary data to T2‐weighted images. However, because most of our case group were in either the acute or subacute stage, true sensitivity of the method in the hyperacute stage of the syndrome remains unclear.

Purpose: To present MRI findings in two cases of cerebral hydatid disease with an emphasis on diffusion‐weighted imaging (DWI) findings of Echinococcus granulosus (EG) versus Echinococcus alveolaris (EA).

Results: EG lesions were isointense with cerebrospinal fluid in all sequences including DWI. On DWI, EA lesions remained hypointense on b=1000 s/mm² diffusion‐weighted images. Apparent diffusion coefficient (ADC) values of EG and EA lesions were completely different from each other, 2.88±0.24×10⁻³ s/mm² and 1.33±0.15×10⁻³ s/mm², respectively.

Conclusion: The ADC values could not be used to discriminate from other differential diagnoses.

Purpose: To describe the magnetic resonance imaging (MRI) findings of four patients with proven tick‐borne encephalitis (TBE). These are the most northern cases reported from Scandinavia. Experience of turbo fluid‐attenuated inversion recovery (FLAIR) and diffusion‐weighted imaging (DWI) has not previously been published in this context.

Material and Methods: The MRI findings of four consecutive patients with TBE treated in our hospital during the year 2002 were evaluated. MRI was done during the first week of illness, and follow‐up scans were available in three cases.

Results: In T2‐weighted and turbo FLAIR images, thalamic hyperintensity was equally evident in three of the four patients. One of them also showed hyperintensity in the left putamen and the internal capsule and another patient in the peduncles and the hypothalamus. T1‐weighted images without contrast were normal in all patients, and leptomeningeal enhancement was detected in only one patient. The two patients who underwent DW images did not show any restricted diffusion. Follow‐up MR images showed no atrophy or necrotic foci, and the signal abnormalities disappeared during 16–34 weeks of follow‐up.

Conclusion: T2‐weighted and turbo FLAIR sequences proved equally effective in detecting and delineating the thalamic, brainstem, and basal ganglia pathologies. According to our results, mechanisms other than cytotoxic edema contribute to the signal pathology. Radiologists should be familiar with the MR findings of TBE even in non‐endemic areas.

Purpose: To evaluate the potential use of multi‐slice computed tomography urography (MSCTU) after diuretic injection in children with urinary tract dilatation.

Material and Methods: MSCTU was performed in 19 patients (11 boys, 8 girls, mean age 5.4 years) with suspicion of urinary tract obstruction and dilatation. Furosemide, 1 mg/kg, was injected 3 min before contrast material administration and followed by a bolus of 30 ml of physiologic saline solution immediately after application of contrast material. Excretory‐phase images were obtained through the abdomen and pelvis beginning 10 min after initiation of the injection of contrast material. Maximum intensity projection (MIP) and volume rendering (VR) images were post‐processed to obtain urographic views.

Results: MSCTU revealed pathology in 16 of 19 patients, while 3 patients had normal findings. Ureteropelvic obstruction was found in 4 patients, obstructive megaureter in 8. Both ureteropelvic obstruction and obstructive megaureter were disclosed in 1 patient, partial ureteral duplication in 1 patient, and both complete ureteral duplication and ureterocele in 2 patients. In all patients, MIP and VR images could satisfactorily show the pathologies of the urinary tract. The estimated effective average doses of MSCTU were higher than IVU.

Conclusion: Preliminary results of furosemide‐enhanced MSCTU demonstrated consistently dilated urinary tracts, obstruction levels, and underlying pathologies better than US and IVU.

Purpose: To evaluate whether magnetic resonance imaging (MRI) can be used to differentiate between malignant and benign multicystic uterine cervical lesions.

Material and Methods: Twenty‐two patients with cervical adenocarcinomas, including minimal deviation adenocarcinoma, and five patients with benign multicystic lesions were classified as a percentage of solid components on MRI. Cystic components were further classified by average cyst diameter and signal intensity of the cyst fluid on T1WI.

Results: All nine of the entirely solid lesions were malignant. In contrast, two of the entirely cystic lesions were benign. Ten of the ordinary adenocarcinomas had both solid and cystic components. However, three of the 16 solid and cystic lesions were benign. Lesions composed of cysts smaller than 5 mm tended to be malignant; however, some lesions composed of larger cysts were also malignant. Three of 5 lesions with low‐signal and 7 of 10 with intermediate‐signal fluid were malignant.

Conclusion: The malignancy potential was higher in the lesions with a higher percentage of solid components. However, determining whether multicystic lesions were benign or malignant based on the existence of solid components, the average cyst size, and the signal intensity of cyst fluid was impossible. Although a multicystic lesion with solid components in the deep cervical stroma had been reported as a MR finding of a minimal deviation adenocarcinoma, this does not appear to be pathognomonic.

Clinical MR Imaging. A Practical Approach, 2nd completely revised and updated edition. Edited by P. Reimer, P. M. Parizel, F.-A. Stichnoth. Springer-Verlag 2003. ISBN 3-540-43467-4. 600 pages, 494 figures, 141 tables. Price hardcover: €99.95 (net).

Perinatal Imaging. From Ultrasound to MR Imaging. Edited by F. E. Avni. (Medical Radiology, Diagnostic Imaging). A. L. Baert, L. W. Brady, H.-P. Heilmann et al. Springer-Verlag, Berlin, Heidelberg, 2003. ISBN 3-540- 67327-X. Hardcover. 304 pages, 420 illustrations (14 in color). Price €129.00.