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PURPOSE: To evaluate the diagnostic efficacy of mangafodipir trisodium (MnDPDP, Teslascan) as a new contrast agent for MR imaging of the liver based on an independent evaluation of the MR images from the European phase III studies. MATERIAL AND METHODS: MR imaging of the liver was done at 0.5-2.0 T in 17 European centres and included T1-weighted spin-echo and gradient-echo sequences before and after administration of MnDPDP to patients at a dose of 5 mumol/kg b.w. T2-weighted images were also obtained in all cases before the i.v. injection of the agent. Images of a total of 592 patients were evaluated by 4 independent experienced radiologists who were not involved in the on-site clinical trials. RESULTS: Statistically significantly more lesions were detected (p = 0.0014) in MnDPDP-enhanced T1-weighted MR images than in unenhanced images. T1-weighted gradient-echo sequences were found to be superior to T1-weighted spin-echo sequences after injection of MnDPDP. The post-contrast images were found to be statistically significantly superior to the pre-contrast images in confidence in the presence of a lesion (p < or = 0.0001), quality of lesion delineation (p < or = 0.0001), lesion conspicuity (p < or = 0.0001) and in the confidence in the diagnosis of a lesion (p = 0.001). CONCLUSION: This independent evaluation of the European phase III trials confirmed the superiority of MnDPDP-enhanced MR images over unenhanced images for lesion detection and characterization.

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Pulmonary arteriovenous fistulae were first managed nonsurgically by Porstmann in 1977 with homemade metallic coils (1). During the intervening twenty years better catheterization techniques have been developed and our understanding of the clinical outcomings of these lesions has improved. This report discusses the natural history of pulmonary arteriovenous fistulae, including the neurological and other complications, the importance of family screening in the detection of asymptomatic family members, the diagnostic strategy and the description of improved techniques for embolotherapy with stainless steel coils.

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Four patients aged 8 to 54 years, under mechanical ventilation, presented with sudden tension mediastinal emphysema and exhibited typical clinical symptoms of compromised venous return. Diagnosis of tension mediastinal emphysema was confirmed by CT. A percutaneous catheter with a diameter varying from F12 to F20 was inserted in the anterior mediastinal compartment with CT control and connected to a waterseal aspiration. Emergency treatment was efficient in all patients. Percutaneous aspiration was continued for 3 to 20 days.

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PACS integrated to RIS and HIS will have a significant impact on the hospital operation. This paper describes the current radiological process and indicates at what points PACS may prove to be important, in order to guarantee its successful implementation with the objective to improve patient care by better management of personnel, equipment and information.

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All complications occurring in 55 local thrombolytic infusions performed for (sub)acute limb ischemia using streptokinase (SK) in 22 procedures and urokinase (UK) in 33 procedures were recorded. Success was achieved in 74.5% of the procedures. Major complications occurred in 31.8% of the procedures using SK, and in 12.1% of the procedures using UK (p = 0.07). Hemorrhage was the most common major complication and occurred in 27.2% of SK procedures and in 9.0% of UK procedures, a difference which was not significant. Overall, 30 day mortality was 16.3% and procedure-related death was 1.8%. Moderate complications necessitating only the adjustment of drug regimen and minor complications without consequence were observed in 45.5% and 45.5%, respectively, of the SK procedures, and in 57.6% and 66.7% of the UK procedures.

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A 60-year-old woman was admitted with mild intestinal obstruction. Enteroclysis showed segmental narrowing with mucosal fold thickening of the proximal jejunum. Computed tomography in addition demonstrated enlarged mesenteric lymph nodes in the proximity of the diseased intestinal loop. Histological examination of the resected intestinal segment showed extramedullary hemopoiesis. Bone marrow examination confirmed myeloproliferative syndrome.

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Over an 11-year period, percutaneous retrieval of intravascular foreign bodies was performed in 12 patients, using urological forceps and retrieval baskets. No clinically significant complication occurred, success rate was 100%. Review of 176 cases from the literature showed a success rate of 90%.

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A pulmonary hydatid cyst was diagnosed and cured by percutaneous CT guided aspiration. Pleural effusion related to incomplete aspiration of the loculated cyst was observed. No deleterious effect occurred, after a follow-up of 22 months.

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Nineteen patients who had pyogenic liver abscesses underwent percutaneous treatment assisted by computed tomography. Percutaneous drainage was performed with Fr 8-14 catheters in 12 patients and percutaneous aspiration in 7 patients. A solitary abscess was present in 15 patients and multiple abscesses were present in 4. The average drainage duration was 26 days. Successful treatment was obtained in 16 of 19 (84%) cases. One abscess recurred and was cured by repeat drainage. Two patients died. Reviewing 14 reports from the literature with a total of 252 patients treated percutaneously, an overall success rate of 77% and a mortality rate of 6% was found.

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Two patients with acute occlusion of the lower abdominal aorta have been successfully treated with total of 7,425,000 and 8,850,000 units of urokinase infused locally over 93 and 86 hours, respectively, with restoration of flow. No complication occurred.

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Twenty-one percutaneous neurolyses of the upper thoracic sympathetic chain were performed in 12 patients with CT guidance by a single injection of 1 to 3 ml of phenol at the level of Th3. Results were assessed after a follow-up period varying from 4 to 33 months. Three patients with hyperhidrosis had immediate and complete disappearance of symptoms, but only one patient remained dry. In 7/14 procedures done for Raynaud's disease symptoms disappeared or diminished. These long term results are competitive with surgery. Three transitory Horner syndromes and one pneumothorax occurred.

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