C. Papavasiliou

Magnetic resonance angiography compared to intra-arterial digital subtraction angiography in patients with subarachnoid haemorrhage

SummaryIn order to evaluate the sensitivity and specificity of magnetic resonance angiography (MRA) in spontaneous subarachnoid haemorrhage, 14 patients with recent haemorrhage verified by CT or lumbar puncture were investigated with both selective intra-arterial digital subtraction angiography (IA-DSA) and MRA by two independent teams, each having the same preangiographic information. The results were compared with each other and whenever possible (all positive cases except one) with those of surgical intervention. Seven patients were identified by MRA and IA-DSA as having a single aneurysm on the circle of Willis, 1 an aneurysm of the posterior inferior cerebellar artery 1 an aneurysm of the internal carotid artery (siphon) and 2 patients with two aneurysms on the circle of Willis. MRA and IA-DSA both failed to demonstrate aneurysms in 2 cases. Three patients had negative results on both methods and no surgical intervention was attempted. The aneurysms ranged from 0.3 to 1.5 cm in size. In most cases there was agreement between MRA and DSA, leading us to believe that, if the proper protocols are followed, MRA is a powerful alternative to other established methods in the detection of intracranial aneurysms. At this stage it will not replace IA-DSA prior to surgery, but the ability to obtain various projections using 3D MRA may improve surgical planning.

MRI of abdominal hydatid disease

Seventy hydatid cysts in 30 patients were studied with magnetic resonance imaging (MRI) and computed tomography (CT); all cases were confirmed surgically. MRI detected all cysts when confined to solid organs, whereas small-sized cysts (≤2 cm) may be missed when located in the peritoneal cavity. Hydatid cysts of less than 3 cm (noncomplicated) present no specific findings of hydatid disease. MRI findings suggesting hydatid disease demonstrate a relatively thick hydatid cyst wall, daughter cysts, and germinal membrane detachment. T2-weighted images proved to be superior to T1 or PD-weighted images in demonstrating hydatid cyst wall thickness, germinal membrane detachment, and daughter cysts. In all spin-echo sequences, the maternal cystic content presented much higher signal intensities than that of daughter cysts. This difference in signal intensity is more obvious in T2 weighted images, except in complicated, infected cases. CT proved to be superior to MRI in demonstrating wall calcifications.

CT and MRI of symptomatic spinal involvement by extramedullary haemopoiesis

Five cases of tumour-like extramedullary haemopoiesis (EH) causing spinal cord compression or back pain are reported. Three patients were suffering from thalassaemia major, one from sickle cell anaemia and one from thalassaemia intermedia. CT findings included soft tissue masses in the epidural space of the spinal canal, spinal cord displacement and involvement of the underlying bone. MRI studies showed masses compressing the spinal cord. On T1-weighted images there was a signal of slightly higher intensity compared to that of the adjacent marrow. CT suggested the diagnosis in four cases (in the fifth it was not performed), while MRI was positive in all five. There was good correlation between the MRI findings and the CT appearance of the EH masses. Our results suggest that MRI may eliminate the need for other diagnostic examinations in the investigation of patients with EH.

Prophylactic administration of indomethacin for irradiation esophagitis

This is a double-blind study in which 14 randomly selected patients treated for lung cancer by irradiation, were receiving indomethacin, while 14 patients treated also by irradiation served as controls. The purpose of the study was to investigate a possible protective effect of the drug in irradiation esophagitis. The esophagus was included in the irradiation field in all patients. Histologic findings of esophagitis were not different in the two groups. However, endoscopic esophagitis and symptomatology were milder in the patients who received indomethacin.

Masses of myeloadipose tissue: Radiological and clinical considerations

The records of 30 patients presenting radiological evidence of masses of extramedullary myeloadipose (hemopoietic) tissue, 25 patients suffering from thalassemia, one from sickle-cell anemia, and one from myelofibrosis were studied. Three patients presented with primary myelolipomas. Most of the patients with thalassemia presented with masses of hemopoiesis in the costovertebral angle and five patients presented with spinal cord compression. Magnetic resonance imaging is the best method for visualization and assessment of the extent of the masses in the thorax and spinal canal. Radiotherapy is the treatment of choice for spinal cord compression. One patient with thalassemia and one patient with myelofibrosis presented with masses of extramedullary hemopoiesis in the adrenals. All five patients with masses of myeloadipose tissue in the adrenals were treated surgically.

Comparative study between ultrasound, computed tomography, intra-arterial digital subtraction angiography, and magnetic resonance imaging in the differentiation of tumors of the liver

Forty-one patients with liver tumor have been evaluated with ultrasound (US), computed tomography (CT), intra-arterial digital subtraction angiography (IA-DSA), and magnetic resonance imaging (MRI) in order to establish the accuracy of each technique. In group A (24 patients), in which all four imaging modalities were performed, our results show that MRI detected all hemangiomas (25/25) compared to 22/25, 21/25, and 20/25 with US, CT, and IA-DSA, respectively. No difference between the various methods was seen in the case of hepatoma. Finally, in the patients with metastases, all four techniques had the same sensitivity (100%) but the specificity of MRI was also 100%, compared to 33% for IA-DSA and 66% for US and CT.

Magnetic resonance imaging of marrow heterotopia in haemoglobinopathy

The MRI findings of masses of MH in three patients suffering from thalassaemia major, sickle-cell anaemia and thalassaemia intermedia, respectively, are presented. There was good correlation between the MRI findings and the conventional radiology or CT appearance of the masses. The masses produced a low intensity signal, similar to that of the adjacent marrow of the thoracic spine, while they were surrounded by a high-intensity signal rim attributed to a layer of fat surrounding the masses. The latter MRI finding is thought to be characteristic of MH masses.

Treatment of cervical carcinoma by total hysterectomy and postoperative external irradiation

The survival rates of 36 patients with early cervical carcinoma who had undergone total hysterectomy and bilateral salpingoophorectomy (THBSO) were compared to the survival rates of 41 patients who were subjected to the radical operation. As an integral part of their therapy both groups postoperatively received adequate doses of external beam supervoltage irradiation. Satisfactory results were obtained in both groups of patients. According to these results THBSO followed by postoperative radiotherapy is adequate treatment for early cervical carcinoma. In comparison to the radical operation or curietherapy alone this type of treatment has the advantage of requiring less surgical or radiotherapeutic expertise; it probably is associated with less morbidity.

Computed tomographic localization of pelvic hydatid disease.

Nine patients with history of hydatid disease have been examined by CT. Localization of the hydatid cysts in the pelvis was established by anatomical criteria. Occasionally, the transverse plane can be confusing for the precise localization of a lesion. A central location, close to the boundaries of the bladder and rectum, can define peritoneal location. Further posterolateral retrovesical location can be considered retroperitoneal. Using these criteria, 8 cysts were situated within the peritoneum and 1 within the retroperitoneum.

Correlation between spinal cord MRI and clinical features in patients with demyelinating disease

Localisation of spinal cord lesions by MRI was correlated with neurological symptoms and signs in 16 patients with clinical and laboratory evidence of multiple sclerosis. There was good correspondence between spinal cord lesions and motor tract signs. On the other hand, superficial or deep sensory disturbances correlated with spinal cord lesions in only about a quarter of the patients. MRI of the spinal cord appeared to explain the myelopathy in 11 patients, while in 3 there was strong clinical evidence of more extensive demyelinating lesions. In 7 of the 16 patients MRI of the brain was normal.