Eero Ilkko

Initial experience with a wireless personal digital assistant as a teleradiology terminal for reporting emergency computerized tomography scans

A new type of terminal device, a wireless personal digital assistant (PDA) based on a GSM digital cellular phone, was used to transmit computerized tomography scans of 21 patients to a neuroradiologist. All transmitted images were suitable for a preliminary consultation and in one case a final report could be made. In 18 cases the findings were compatible with the reference film reading performed later and in three cases there were minor differences of no clinical importance. Transmission of a single image lasted 1 min 30 s and the transmission of a complete brain scan (14 images) took on average 21 min. The total process of transmission and interpretation of a brain examination series took on average 40 min. In this pilot study the neuroradiologist gained essential information in 24% of the cases and beneficial information in 62%. The neuroradiologist considered that the image consultation saved a hospital visit in 15 cases (71%). Although PDA technology is at an early stage of development and has numerous limitations, it is likely that future technical improvements will allow easier clinical consultations for neurosurgeons and neurologists.

Association of Atherosclerosis with Low Back Pain and the Degree of Disc Degeneration

STUDY DESIGN This was a cross-sectional observational study in which the abdominal aorta was evaluated for atheromatous lesions visible in computed tomographic scans in patients with and without low back pain. OBJECTIVES To evaluate whether patients with low back pain have more atherosclerosis in the abdominal aorta than patients without low back pain and whether the severity of atherosclerosis in the abdominal aorta correlates with the grade of disc damage. SUMMARY OF BACKGROUND DATA There are studies in which results indicate that insufficient blood supply may be a significant causative factor in disc degeneration. There are also studies in which smoking, one of the risk factors for arterial disease, has been correlated with low back pain. Calf pain has also been shown to correlate with low back pain. Results in a long-term follow-up study have further indicated an association between disc diseases and fatal ischemic heart disease. However, there seems to be only one postmortem study in which results show an association between atherosclerosis in the arteries of the lumbar area and disc diseases. METHODS Computed tomographic images of 29 patients with low back pain, who had been evaluated with computed tomographic discography for diagnostic purposes, were evaluated for the quantity of atherosclerotic calcifications visible on computed tomographic scans of the abdominal aorta. A similar evaluation was performed in an age- and sex-matched control group of 52 patients without low back pain selected from among the patients referred for abdominal computed tomography. RESULTS Sixteen (55%) of the 29 patients with low back pain had atherosclerotic calcifications visible on computed tomographic scans, whereas 11 (21%) of the 52 age-matched patients without low back pain were found to have aortic calcifications. Eleven (48%) patients with low back pain who were 50 years of age or less (n = 23) had aortic calcifications, whereas only 3 (8%) of the 36 control patients aged less than 50 years had aortic calcifications. There was no correlation between the amount of calcifications and the degree of disc degeneration assessed by computed tomographic discography. CONCLUSIONS A significant association is indicated between atheromatous lesions in the abdominal aorta and low back pain.

MRI changes of cervical spine in asymptomatic and symptomatic young adults.

Abstract. Several work-related, psychosocial and individual factors have been verified as being related to neck and shoulder pain, but the role of pathology visualized by magnetic resonance imaging (MRI) remains unclear. In this study, the relationship between neck and shoulder pain and cervical high-field MRI findings was investigated in a sample of persons in a longitudinal survey. The study aimed to determine whether subjects with persistent or recurrent neck and shoulder pain were more likely to have abnormal MRI findings of cervical spine than those without neck and shoulder pain. A random sample of 826 high-school students was investigated initially when the students were 17–19 years, and again when they had reached 24–26 years of age. Eighty-seven percent participated in the first survey in 1989, of whom 76% took part in the second survey, in 1996. The validated Nordic Musculoskeletal Questionnaire was used to collect data about neck and shoulder symptoms. Two groups were chosen for the MRI study: the first group (n=15) consisted of the participants who had reported no neck and shoulder symptoms in either of the inquiries, while the second group (n=16) comprised those who were suffering from neck and shoulder symptoms once a week or more often at the time of both surveys. The degrees of disc degeneration, anular tear, disc herniation and protrusion were assessed by two radiologists. The differences between the two study groups were evaluated. The study found that abnormal MRI findings were common in both study groups. Disc herniation was the only MRI finding that was significantly associated with neck pain. These findings indicate that pathophysiological changes of cervical spine verified on MRI seem to explain only part of the occurrence of neck and shoulder pain in young adults.

Preoperative Virtual Endoscopy and Three-Dimensional Imaging of the Surface Landmarks of the Internal Carotid Arteries in Trans-sphenoidal Pituitary Surgery

In trans-sphenoidal pituitary adenoma surgery the sella turcica is opened between the internal carotid arteries. Three-dimensional image processing methods were applied in this study to avoid the risk of damaging the arteries during the opening of the anterior wall of the sella. By using graphical software it was possible to combine the anatomies of the carotid arteries and the sellar wall into one non-perspective three-dimensional image. With a perspective image (virtual endoscopy), the sphenoid sinus landmarks were presented as if looking through a nasoendoscope. This also facilitated preoperative planning but the non-perspective images, with the carotid arteries marked, were found to be the most useful and suitable for clinical routine. The pituitary tumor itself and its relations with the adjacent structures were best evaluated from magnetic resonance imaging scans but, for the opening of the sellar wall and in the three-dimensional orientation with endoscopy, three-dimensional computerized tomography imaging with the carotid arteries marked was found to be helpful.In trans-sphenoidal pituitary adenoma surgery the sella turcica is opened between the internal carotid arteries. Three-dimensional image processing methods were applied in this study to avoid the risk of damaging the arteries during the opening of the anterior wall of the sella. By using graphical software it was possible to combine the anatomies of the carotid arteries and the sellar wall into one non-perspective three-dimensional image. With a perspective image (virtual endoscopy), the sphenoid sinus landmarks were presented as if looking through a nasoendoscope. This also facilitated preoperative planning but the non-perspective images, with the carotid arteries marked, were found to be the most useful and suitable for clinical routine. The pituitary tumor itself and its relations with the adjacent structures were best evaluated from magnetic resonance imaging scans but, for the opening of the sellar wall and in the three-dimensional orientation with endoscopy, three-dimensional computerized tomography imaging with the carotid arteries marked was found to be helpful.

A portable diagnostic workstation based on a Webpad: implementation and evaluation

A wireless hand-held Webpad device was used to review a sample set of cranial computerized tomography (CT) studies to assess its diagnostic capabilities and its feasibility as a portable diagnostic workstation for radiology. The data-set consisted of 30 head CT studies of emergency cases. Two neuroradiologists and a senior radiologist participated in the evaluation of the portable workstation. They used a Web-based viewer that we developed, which provided all the major functionalities required for radiological image review. The reported radiological findings and diagnoses were compared with a gold standard, comprising a set of diagnoses previously formulated by a consensus panel of radiologists who had reviewed the original studies. The diagnoses made using the Webpad were correct (no major discrepancies) in 82 out of 90 interpretations (91%), which is comparable to the accuracy reported in image review with a conventional radiological workstation. The average total working time per diagnosis was 5 min 25 s (range 2–12 min). The simplicity of use of the system and its low cost make it suitable for distributing radiological studies within hospital facilities.

Spontaneous migration of foreign bodies in the central nervous system

The authors present four cases where foreign bodies within the central nervous system had spontaneously migrated. Two of these were surgical clips and two were bullets. The clips seemed to pass intradurally into the lumbar region with minor or no symptoms. Possible explanations for the migration are the circulation of CSF and the gravity. A new observation was that an infection may develop at the site where the foreign body had been situated before migration. From the clinical point of view, the removal of foreign bodies from the intradural space is not indicated, if the patient has no connected symptoms.