RESUMEN
We report the finding of multiple cerebral aneurysms in a pair of identical twins. One twin had subarachnoid hemorrhage and intracerebral hematoma; her sister had subarachnoid hemorrhage and intraventricular bleeding. Angiography in both cases showed multiple cerebral aneurysms. It is appropriate to recommend a cerebral angiographic examination of an asymptomatic twin after the other twin has suffered an aneurysmal subarachnoid hemorrhage.
Asunto(s)
Angiografía Cerebral , Enfermedades en Gemelos/genética , Aneurisma Intracraneal/genética , Hemorragia Subaracnoidea/genética , Gemelos Monocigóticos , Adulto , Diagnóstico Diferencial , Supervivencia sin Enfermedad , Enfermedades en Gemelos/diagnóstico , Resultado Fatal , Femenino , Humanos , Aneurisma Intracraneal/diagnóstico , Aneurisma Intracraneal/cirugía , Hemorragia Subaracnoidea/diagnóstico , Hemorragia Subaracnoidea/cirugía , Tomografía Computarizada por Rayos XRESUMEN
PURPOSE: To compare the sensitivities of superparamagnetic iron oxide-enhanced and unenhanced magnetic resonance (MR) imaging at 1.5 T with those of percutaneous ultrasound (US), intraoperative US (IOUS), and dynamic computed tomography (CT) in the preoperative assessment of metastatic liver disease. MATERIALS AND METHODS: Eighteen patients with liver metastases who were candidates for curative surgery underwent presurgical imaging. Thirteen patients underwent surgery and IOUS after undergoing preoperative US, CT, and MR imaging. RESULTS: In the preoperative imaging group, the standard of reference was the total number of lesions detected with any of the modalities. Superparamagnetic iron oxide-enhanced MR imaging was the most sensitive modality (99%). In the surgical group, the standard of reference was the total number of metastases identified at IOUS and pathologic examination. IOUS had the highest sensitivity (80%), followed by superparamagnetic iron oxide-enhanced MR imaging (56%). CONCLUSION: Superparamagnetic iron oxide-enhanced high-field-strength MR imaging facilitates the preoperative evaluation of potentially curable metastatic liver disease; however, it is inferior to IOUS.
Asunto(s)
Medios de Contraste , Hierro , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/secundario , Hígado/patología , Imagen por Resonancia Magnética/métodos , Óxidos , Neoplasias Colorrectales/patología , Dextranos , Femenino , Óxido Ferrosoférrico , Humanos , Cuidados Intraoperatorios , Ácido Yotalámico/análogos & derivados , Hígado/diagnóstico por imagen , Neoplasias Hepáticas/cirugía , Nanopartículas de Magnetita , Masculino , Persona de Mediana Edad , Cuidados Preoperatorios , Sensibilidad y Especificidad , Tomografía Computarizada por Rayos X/métodos , Ultrasonografía/métodosRESUMEN
The development of special computer and software systems has exerted great influence on computer-assisted image processing in neuroradiology. In this article we try to give an overview of the present and future applications. The applications can be subdivided into segmentation, image analysis, three-dimensional imaging and image fusion. Segmentation plays an important role, because it is frequently the basis for the other methods. Image analysis, like planimetry, volumetry or the calculation of angles, is already used in clinical applications. In this way the course of diseases can be checked objectively. Three-dimensional imaging is especially useful in the planning of surgical and stereotactic approaches. The results and value of three-dimensional imaging depend on the segmentation technique. Therefore, they are evaluated differently. Image fusion allows the simultaneous presentation of image data of different modalities. In particular, the image fusion of morphological findings and functional parameters is applied in clinical neuroradiology. Our experience with these methods suggests that computer-assisted image processing will be of considerable help in neuroradiology.
Asunto(s)
Encefalopatías/diagnóstico , Neoplasias Encefálicas/diagnóstico , Procesamiento de Imagen Asistido por Computador/instrumentación , Imagen por Resonancia Magnética/instrumentación , Programas Informáticos , Tomografía Computarizada de Emisión de Fotón Único/instrumentación , Tomografía Computarizada de Emisión/instrumentación , Tomografía Computarizada por Rayos X/instrumentación , Encéfalo/patología , Humanos , Redes Neurales de la ComputaciónRESUMEN
We investigated 55 patients with suspected neoplasms of the liver and/or pancreas using fat-suppressed spin echo and gradient echo MR sequences. T1 and T2 weighted fat-suppressed spin echo sequences provided higher sensitivity for the detection of liver metastases. In the diagnosis of pancreatic tumours, T1 weighted fat-suppressed gradient echo sequences after application of intravenous and oral paramagnetic contrast agents offered more information than other sequences. Drawbacks of fat-suppressed sequences are an increase in scan time and inhomogeneous fat-suppression at the periphery of the image.
Asunto(s)
Tejido Adiposo/patología , Neoplasias Hepáticas/diagnóstico , Imagen por Resonancia Magnética/métodos , Neoplasias Pancreáticas/diagnóstico , Adulto , Artefactos , Medios de Contraste , Gadolinio , Gadolinio DTPA , Humanos , Hígado/patología , Neoplasias Hepáticas/secundario , Imagen por Resonancia Magnética/instrumentación , Imagen por Resonancia Magnética/estadística & datos numéricos , Compuestos Organometálicos , Páncreas/patología , Ácido Pentético/análogos & derivadosRESUMEN
Nuclear medicine techniques have been powerful tools in neurology since their introduction. Computed tomography, magnetic resonance imaging and newer techniques, i.e. MR spectroscopy and angiography, sonography, Doppler sonography and EEG mapping with squid elements have overtaken most earlier nuclear medicine techniques for neurological diagnosis. Positron emission tomography is the gold standard for in vivo research in neurophysiology and pathology. The introduction of SPECT and the development of such tracers as 99mTc-HMPAO (99mTc-d,l-hexamethylpropylenaminoxim) and, more recently, 123I-iomazenil and 123I-IBZM (123I-3-iodo-6-methoxybenzamide) allowed closer examination of the perfusion of the brain and neuroreceptor density mapping in more than the few institutions that can afford PET and the production of special tracers marked with a positron emitting nucleus. Nuclear medicine's future will be based on neuroreceptor density mapping, as further tracers will become commercially available and no other technique can probably show such low concentrations of the receptors. Probably MR techniques will be used for brain's perfusion measurement in future. For examination of a limited cerebral region xenon-enhanced CT is an alternative to perfusion measurements with HMPAO, or a very interesting supplement. Of the old techniques in nuclear medicine, examination of the liquor dynamics is still feasible and well supplemented by SPECT.
Asunto(s)
Encefalopatías/diagnóstico por imagen , Tomografía Computarizada de Emisión de Fotón Único , Benzamidas , Flumazenil/análogos & derivados , Humanos , Radioisótopos de Yodo , Compuestos de Organotecnecio , Oximas , Pirrolidinas , Exametazima de Tecnecio Tc 99mRESUMEN
MRI can be regarded as a standard procedure for diagnosis of the painful wrist. Because of its high costs, it must be used with discretion. For the detection of lesions of the marrow, joint effusions and soft tissue pathology (exception for ruptured ligaments), MRI is generally the most sensitive imaging modality. It shows the living part of bone and soft tissue with unique contrast. An integrative imaging approach including MRI is often successful. X-ray of the wrist is the basic investigation. Ultrasound often allows the diagnosis of pathology of ganglia, tendons and vessels. Lesions of the ligaments are shown best by arthrography, although MRI can also demonstrate these lesions. The introduction of MRI has limited the use of CT to pathologic changes in cortical and cancellous bone and displacement or malalignment. Scintigraphy and MRI are mostly complementary rather than mutually exclusive.
Asunto(s)
Imagen por Resonancia Magnética , Articulación de la Muñeca/patología , Artrografía , Humanos , Artropatías/diagnóstico , Artropatías/patología , Compuestos de Organotecnecio , Oximas , Exametazima de Tecnecio Tc 99m , Ultrasonografía , Articulación de la Muñeca/diagnóstico por imagenRESUMEN
Corticosteroids and immunosuppressive agents are standard treatment for polymyositis (PM) and dermatomyositis (DM) respectively. Recent reports have emphasized a potentially successful regimen with intravenous immune gammaglobulins (IVIG). The short term success of this treatment in a personally observed case is described. IVIG treatment resulted in normalization of the serum concentrations of the muscle enzymes after continued inflammatory activity under treatment with azathioprine, cyclophosphamide and methotrexate in combination with corticosteroids. The improvement of PM by IVIG was further documented by an increase in muscle strength of up to 367% of the initial value and a regression of the myositic changes in the muscles of the thighs as evidenced by magnetic resonance imaging (MRI). The therapeutic response was paralleled by reversal of peripheral lymphopenia. Experience with IVIG treatment in PM/DM is reviewed and the potential role of this regimen in the management of PM/DM is discussed.
Asunto(s)
Inmunoglobulinas Intravenosas/uso terapéutico , Polimiositis/terapia , Corticoesteroides/administración & dosificación , Adulto , Azatioprina/administración & dosificación , Pruebas Enzimáticas Clínicas , Ciclofosfamida/administración & dosificación , Dermatomiositis/terapia , Quimioterapia Combinada , Femenino , Humanos , Imagen por Resonancia Magnética , Metotrexato/administración & dosificación , Polimiositis/diagnósticoRESUMEN
99mTc(V)-DMSA scintigraphy is a non-invasive diagnostic tool for diagnostic differentiation and localisation of medullary carcinoma of the thyroid. For primary tumours its sensitivity is 77%. This diagnostic means is not only helpful for the diagnosis of primary tumours, but is especially informative for recidives and metastases of the medullary carcinoma of the thyroid. Its sensitivity for recidives and metastases is 66%. The sensitivity obtained in our study, which included four patients, corresponded to that reported in the literature.
Asunto(s)
Carcinoma/diagnóstico por imagen , Compuestos de Organotecnecio , Succímero , Neoplasias de la Tiroides/diagnóstico por imagen , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Cintigrafía , Sensibilidad y Especificidad , Ácido Dimercaptosuccínico de Tecnecio Tc 99mRESUMEN
Pre-operative staging, using transrectal prostatic sonography and CT, was carried out in 30 patients with cytologically confirmed carcinomas of the prostate and the results compared with the clinical findings. All patients underwent radical prostatectomy and the pre-operative findings could be verified histologically. Transrectal prostatic sonography is better than CT or clinical examination for determining local tumour spread or penetration of the capsule. A high proportion of enlarged pelvic lymph-nodes shown by CT had non-specific changes; failure to demonstrate enlarged nodes excludes lymph node metastases with considerable certainty. Transrectal prostatic sonography provides a higher degree of information regarding local tumour spread, whereas CT indicates the presence or absence of lymph node metastases.
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Próstata/patología , Neoplasias de la Próstata/diagnóstico , Tomografía Computarizada por Rayos X , Ultrasonografía , Anciano , Estudios de Evaluación como Asunto , Humanos , Metástasis Linfática , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Cuidados Preoperatorios , Próstata/diagnóstico por imagen , Neoplasias de la Próstata/patología , RectoRESUMEN
Esophago-gastro-duodenoscopies with multiple mucosa biopsies were performed before and after irradiation of the mantle field or the spleen pedicle in 13 patients with Hodgkin's disease in stage I and II. For the irradiation the photons of a 4 MeV linear accelerator were applied with focal doses of 40 to 44 Gy. Contrast simulator radiographs were made in order to verify the position within the irradiation field of the organs from which biopsies were taken. In 0/10 patients examined before the irradiation, 0/5 patients examined less than 15 weeks after the irradiation, and 0/12 patients examined 15 weeks or later after the irradiation, histomorphologic investigation of the mucosa of the esophagus showed no pathologic findings. With the same intervals of examination related to irradiation, the gastric mucosa showed a pathologic histomorphology in 1/13, 7/9, and 5/9 patients, respectively, and the duodenal mucosa in 0/13, 5/9, and 2/9 patients, respectively. With the exception of one ulcer in the duodenal bulb the histopathologic findings as well as the macroscopic findings were neither significant nor characteristic, i.e. not radiospecific. Most of these findings were inflammatory alterations of the mucosa, erosions, and capillarectasies.
Asunto(s)
Duodeno/efectos de la radiación , Esófago/efectos de la radiación , Enfermedad de Hodgkin/radioterapia , Radioterapia de Alta Energía/efectos adversos , Estómago/efectos de la radiación , Adulto , Biopsia , Endoscopía , Humanos , Persona de Mediana Edad , Membrana Mucosa/patología , Membrana Mucosa/efectos de la radiaciónRESUMEN
The hemodynamic effects of molsidomine were studied in 48 patients with acute myocardial infarction and compared with hemodynamic properties in a control group of 24 patients. The most pronounced decrease in pulmonary artery diastolic pressure occurs between 30 and 60 minutes after oral administration of 8 to 12 mg (n = 16). There is no major difference in action between the oral and intravenous application of 8 to 12 mg (n = 22). Its effect lasts about 3 to 4 hours and may exceed up to 8 hours in patients with left heart failure (n = 10). The mean arterial pressure is affected only with high doses (12 mg). Cardiac output decreases slightly only in patients without left heart failure. An additional intraindividual comparison of nitroglycerin (1.6 mg sublingually) and molsidomine (12 mg intravenously) (n = 11) revealed no significant difference in hemodynamic effectiveness. Molsidomine, like nitroglycerin, acts primarily to reduce cardiac preload. An additional moderate action on afterload with a slight decline in arterial pressure may be noticed at high doses.
Asunto(s)
Hemodinámica/efectos de los fármacos , Infarto del Miocardio/tratamiento farmacológico , Oxadiazoles/uso terapéutico , Sidnonas/uso terapéutico , Vasodilatadores/uso terapéutico , Presión Sanguínea/efectos de los fármacos , Gasto Cardíaco/efectos de los fármacos , Ensayos Clínicos como Asunto , Humanos , Molsidomina , Infarto del Miocardio/fisiopatología , Nitroglicerina/farmacología , Nitroglicerina/uso terapéutico , Arteria Pulmonar/fisiopatología , Distribución Aleatoria , Sidnonas/farmacología , Vasodilatadores/farmacologíaRESUMEN
In preparation for the colon double contrast method two groups of patients, both with identical dietary regimen, were compared. In one case an oral mannitol dose (20%) plus sodium picosulphate was given, in the other enema plus bisacodyl was applied. In a total of 132 patients, the group which was treated with mannitol showed significantly better cleansing results and a better coating with the contrast medium. Considerable side effects did not occur. Further advantages: reduced number of personnel required, less trouble for the patients, out-patient investigation possible.
Asunto(s)
Catárticos/administración & dosificación , Colon/diagnóstico por imagen , Enfermedades del Colon/diagnóstico por imagen , Enema/métodos , Manitol/administración & dosificación , Picolinas/administración & dosificación , Administración Oral , Citratos , Neoplasias del Colon/diagnóstico por imagen , Diagnóstico Diferencial , Quimioterapia Combinada , Conducta Alimentaria , Humanos , Pólipos Intestinales/diagnóstico por imagen , Compuestos Organometálicos , Estudios Prospectivos , RadiografíaRESUMEN
The effect of molsidomine on hemodynamics and myocardial ischemia were studied in 48 patients with acute myocardial infarction. Between 8 and 12 mg of orally and intravenously administered molsidomine led to a significant reduction in left ventricular filling pressure. In response to 2 x 4 mg p.o., diastolic pulmonary arterial pressure fell from 12.1 to 8.8 mm Hg in patients with filling pressure below 20 mm Hg. Patients with left heart failure and left ventricular filling pressure above 20 mm Hg (Group 2) displayed a decline in filling pressure from 23.8 to 17.4 mm Hg following 12 mg i.v. In addition, right atrial pressure dropped significantly across the entire range of dosages. Although patients without left ventricular failure (Group I) showed a decline in cardiac output (5.7 to 4.7 l/min), this parameter remained unchanged in Group 2. Heart rate in Group 2 fell from 85 to 81 per min. Arterial blood pressure was reduced by a mean of only 10 mm Hg at high dosages and remained unchanged at lower dosages. No change was observed in peripheral resistance. The maximum effect was seen 30 min after oral administration. Three hours later, the effect was reduced by half. Only minimal activity could be observed after 8 h. The incidence of side effects was low, with transient headaches occurring in 8% of the patients. An intraindividual comparison with 1.6 mg of sublingually administered nitroglycerin demonstrated no significant difference in hemodynamic effectiveness (n = 11). Molsidomine, not unlike nitroglycerin, exerts a favorable effect on hemodynamics and myocardial ischemia. It acts primarily to reduce preload. The additional moderate effect on afterload with a slight decline in arterial pressure at high dosages may also be considered advantageous.