Harry L. Stein

Nuclear magnetic resonance imaging in evaluation and follow-up of children treated for coarctation of the aorta

Electrocardiographic-gated nuclear magnetic resonance imaging was used to evaluate 10 patients, aged 2.5 to 18 years, with coarctation of the aorta. Six patients had balloon dilation angioplasty, one had surgical repair and three are awaiting treatment. Imaging studies were performed before and after therapy in three patients. In all pretreatment studies, the sagittal and 60 degrees left anterior oblique imaging planes adequately revealed the anatomy of the coarctation. Post-treatment imaging studies demonstrated effective relief of the coarctation in all cases. In three of the six patients who had balloon angioplasty, there was a variable degree of dilation of the aorta at the site of the previous coarctation. Nuclear magnetic resonance imaging is an effective noninvasive imaging method for visualizing coarctation of the aorta and for follow-up after treatment.

Computed tomographic evaluation of therapeutically induced changes in primary and secondary brain tumors.

SummaryA prospective study was initiated to evaluate computed tomography as a method for monitoring therapeutically induced changes in brain tumors. Early postoperative scans may be misleading in the evaluation of residual tumor because of trauma to the blood-brain barrier during operation. The size of the dominant mass (17/25), enhancement (11/25), edema (11/25), and ventricular distorition (14/25) were decreased in many patients after radiation therapy. Occasional tumors increased in size during radiation therapy (3/25). Enlargement of the lateral ventricles developed in 9 of 25 patients. Computed tomography offers definite advantages over nuclide brain scans, angiography and other diagnostic studies for evaluating therapeutically induced changes in brain tumors.

Computed tomography in ossification of the posterior longitudinal spinal ligament

SummaryA patient with cervical myelopathy was found to have extensive ossification within the posterior longitudinal ligament. Computed tomography of the spine was of value for precisely defining the degree of narrowing of the spinal canal. The nature of this disease entity is discussed.

MRI in staging of endometrial and cervical carcinoma

MRI of 54 patients with endometrial and cervical carcinoma was performed on a 0.6-T superconducting magnet. In 18 of 24 cases of surgically proved endometrial carcinoma, MRI accurately showed the depth of myometrial invasion. MRI was superior to CT scan for defining the primary site and extent of the tumor in 14 of 24 cases. Of 25 patients with cervical carcinoma studied, MRI was superior to CT scan in 15 of 19 cases with CT correlation for localizing the primary site. MRI showed parametrial extension and invasion of surrounding structures but is probably less reliable than CT scan for detection of adenopathy because of false positive findings from volume averaging with bowel.

Noninvasive diagnosis of congenital left coronary artery to right ventricle fistula by nuclear magnetic resonance imaging

SummaryIn two children with left coronary artery to right ventricle fistula, nuclear magnetic resonance imaging provided high-quality images of the course of the dilated coronary artery and its termination in the right ventricular apex. The advantages of this noninvasive multiplanar imaging technique for visualization of coronary fistulae and dilated coronary arteries are described. This report represents the first description of coronary artery fistula by nuclear magnetic resonance imaging.

The value of MRI in evaluating perirectal and pelvic disease

MRI of the perirectal region is facilitated by the superb soft tissue contrast, multiplanar imaging capability, lack of respiratory motion artifact and absence of clip artifact which can hamper visualization by CT scan. MRI provides distinct advantages over CT scanning without the need for ionizing radiation or the injection of intravenous contrast material. This study reviews the findings in 18 consecutive patients with a variety of perirectal pathologies including rectal carcinoma (3), gynecologic neoplasm (8), sacral lesions (2), pelvic arteriovenous malformations (2), inflammatory bowel disease (2), and a pelvic kidney (1). In the perirectal region, MR was useful to show normal tissue planes, benign processes which can mimic neoplasm, intrapelvic extension of malignancy and adenopathy.

Digital clubbing: A unique case and a new hypothesis

A study of a unique case of unilateral digital clubbing secondary to a true posttmaumatic aneurysm of the ulnar artery in the palm is presented. The clubbing of the digits resolved following resection of the aneurysm. Detailed evaluation of the patient included Doppler flow studies, differential pulse pressure recordings, measurement of reactive hyperemia, angiography, and differential capillary blood gas determinations. The contralateral hand of this otherwise healthy young patient was employed as a control. Findings of increased blood flow, decreased peripheral resistance, and increased oxygenation then were evaluated in light of the findings of other investigators. This study and the information gathered from an extensive review of the literature strongly suggest that a neurocirculatory reflex is the common denominator of the various conditions associated with clubbing. The afferent and efferent limbs of this reflex are proposed.