Joachim F. Seeger

Epidemiologic features of asymptomatic cerebral infarction in patients with nonvalvular atrial fibrillation

We performed unenhanced computed tomographic scans on 141 asymptomatic patients with nonvalvular atrial fibrillation. Thirty-six patients (26%) had hypodense areas consistent with cerebral infarction. The majority of these were small deep infarcts, seen in 29 patients (21%), but 13 patients (9%) had cortical or large deep infarctions. Twelve patients had more than one infarct on computed tomographic scan. Increasing age and increased left atrial diameter were the only clinical features associated with asymptomatic infarction. Patients older than 65 years with a left atrial diameter greater than 5.0 cm (n = 23) had a 52% prevalence of asymptomatic infarction. Patients younger than 65 years with a left atrial diameter less than 5.0 cm (n = 38) had an 11% prevalence of silent infarction. Patients with only one of these risk factors (n = 72) had a 24% prevalence of silent infarction. Infarction was more common in those with chronic (34%) as opposed to intermittent (22%) nonvalvular atrial fibrillation, but this difference was not significant. Hypertension, diabetes, duration of atrial fibrillation, congestive heart failure, history of myocardial infarction, and echocardiographic evidence of left ventricular dysfunction were not associated with asymptomatic infarction. A history of hypertension was present in only 35% of our patients with small-deep asymptomatic infarction, similar to the percentage in patients without stroke. Asymptomatic cerebral infarction is common in nonvalvular atrial fibrillation. The association with enlarged left atria and the lack of correlation with major cerebrovascular risk factors suggests a cardioembolic mechanism. Further study is needed to determine the functional and prognostic significance of these strokes.

Bone marrow imaging using STIR at 0.5 and 1.5 T

We retrospectively examined MR images in 82 patients to evaluate the usefulness of short inversion time inversion recovery (STIR) in bone marrow imaging at 0.5 and 1.5 T. The study included 56 patients at 1.5 T and 26 patients at 0.5 T with a variety of pathologic bone marrow lesions (principally oncological), and compared the contrast and image quality of STIR imaging with spin-echo short repetition time/echo time (TR/TE), long TR/TE, and gradient-echo sequences. The pulse sequences were adjusted for optimal image quality, contrast, and fat nulling. STIR appears especially useful for the evaluation of red marrow (e.g., spine), where contrast between normal and infiltrated marrow is greater than with either gradient-echo or T1-weighted images. STIR is also extremely sensitive for evaluation of osteomyelitis, including soft tissue extent. In more peripheral (yellow) marrow, T1-weighted images are usually as sensitive as STIR. Limitations of STIR include artifacts, in particular motion artifact that at high field strength necessitates motion compensation. At 0.5 T, however, motion compensation is usually not necessary. Also, because of extreme sensitivity to water content, STIR may overstate the margins of a marrow lesion. With these limitations in mind, STIR is a very effective pulse sequence at both 0.5 and 1.5 T for evaluation of marrow abnormalities.

Premature Closure of the Frontosphenoidal Suture in Synostosis of the Coronal Suture

Fourteen cases of premature coronal synostosis are reviewed. Thirteen of these showed extension into the base of the skull involving the Irontosphenoidal suture. Recognition of this fact is of importance if surgical correction is attempted. Pertinent radiographic findings include narrowing or absence of the coronal suture, shortened frontal bone and anterior fossa, outward and upward sweep of the sphenoid wing and orbital roof, and shallowness of the orbit on the involved side. Because of the basal involvement, simple craniectomy may not be sufficient for correction in infants over two months of age and additional cuts may be necessary.

Interstitial thermoradiotherapy of brain tumors: Preliminary results of a phase I clinical trial

A Phase I clinical trial has been initiated to determine the feasibility, tolerance, and toxicity of interstitial thermoradiotherapy in the treatment of high-grade supratentorial brain gliomas. Hyperthermia was delivered by means of thermally-regulating ferromagnetic implants afterloaded into stereotactically placed plastic catheters. Heat treatments were given immediately before interstitial irradiation; in addition, five patients received a second heat treatment at the completion of brachytherapy. The desired target temperature for the 60-minute hyperthermia session was between 42 degrees C and 45 degrees C. Following hyperthermia, the catheters were afterloaded with Ir-192, which delivered a variable radiation dose of 14-50 Gy depending on the clinical situation. Interstitial irradiation was supplemented with external beam radiotherapy (40-41.4 Gy) in patients with previously untreated tumors. A total of 14 patients (4 males, 10 females) have been treated to date on this protocol. Eleven of the patients had a diagnosis of glioblastoma multiforme, whereas three had anaplastic astrocytoma. The mean implant volume was 61.5 cm3 (range: 9-119 cm3); the median number of interstitial treatment catheters implanted was 19 (range: 7-33). Continuous temperature monitoring was performed by means of multisensor thermocouple probes inserted in the center as well as in the periphery of the tumor. Of the 175 monitored intratumoral points, 83 (47%) had time-averaged mean temperatures of greater than 42 degrees C, and only 12 sensors (7%) exceeded a temperature of 45 degrees C. Among the 19 heat treatments attempted, there have been four minor acute toxicities, all of which resolved with conservative medical management and one major complication resulting in the demise of a patient. These preliminary results indicate that ferromagnetic implants offer a promising new approach to treating brain tumors with hyperthermia.

Design and testing of artifact-suppressed adaptive histogram equalization : a contrast-enhancement technique for display of digital chest radiographs

One of the goals of our research in the field of digital radiography has been to develop contrast-enhancement algorithms for eventual use in the display of chest images on video devices with the aim of preserving the diagnostic information presently available with film, some of which would normally be lost because of the smaller dynamic range of video monitors. The ASAHE algorithm discussed in this article has been tested by investigating observer performance in a difficult detection task involving phantoms and simulated lung nodules, using film as the output medium. The results of the experiment showed that the algorithm is successful in providing contrast-enhanced, natural-looking chest images while maintaining diagnostic information. The algorithm did not effect an increase in nodule detectability, but this was not unexpected because film is a medium capable of displaying a wide range of gray levels. It is sufficient at this stage to show that there is no degradation in observer performance. Future tests will evaluate the performance of the ASAHE algorithm in preparing chest images for video display.

Imaging Characteristics of Diffuse Idiopathic Skeletal Hyperostosis With an Emphasis on Acute Spinal Fractures: Review

OBJECTIVE The educational objectives of this self-assessment module are for the participant to exercise, self-assess, and improve his or her understanding of the imaging of diffuse idiopathic skeletal hyperostosis (DISH), with emphasis on acute spinal fractures. CONCLUSION Understanding the pathomechanics of the fractures in the ankylosed spine is important in the differentiation of the acute spinal fractures in DISH and ankylosing spondylitis. This article emphasizes the imaging features of spinal DISH and acute spinal fractures in DISH, distinguishing them specifically from those in ankylosing spondylitis.

Persistent Basilar/Middle Meningeal Artery Anastomosis

Three cases of a basilar/middle meningeal artery anastomosis are demonstrated angiographically. No reference to previous angiographic demonstration of this vascular anomaly has been found in the literature, and only one similar case with an anatomical description has been located. An embryological explanation of this rare anastomosis is presented.

Diagnostic performance of teleradiology in cervical spine fracture detection

Yoshino MT, Carmody R, Fajardo LL, Seeger J, Jones K. Diagnostic performance of teleradiology in cervical spine fracture detection. Invest Radiol 1992;27:55–59.This study was done to assess the diagnostic accuracy of high-resolution (5 Ip/mm) teleradiology for detecting cervical spine fractures. Single radiographs from 25 patients with and 25 patients without cervical spine fractures were transmitted between two units of our teleradiology system (Dupont DTR 2000) located 5 miles apart. Each image was examined by four readers. Fracture detection accuracy was assessed by generating receiver operating characteristic (ROC) curves and comparing the areas under each readers curves for original and transmitted images. Two readers had statistically significant better fracture detection using nontransmitted images, whereas two had no significant differences in accuracy. The authors conclude that high resolution in and of itself is not adequate for fracture detection, and that issues concerning image contrast manipulation also will have to be addressed before teleradiology systems can be used for clinical cervical spine fracture screening.

Isotropic diffusion weighting in radial fast spin-echo magnetic resonance imaging

Radial fast spin‐echo (radial‐FSE) methods enable multishot diffusion‐weighted MRI (DWMRI) to be carried out without significant artifacts due to motion and/or susceptibility and can be used to generate DWMRI images with high spatial resolution. In this work, a novel method that allows isotropic diffusion weighting to be obtained in a single radial k‐space data set is presented. This is accomplished by altering the direction of diffusion weighting gradients between groups of TR periods, which yield sets of radial lines that possess diffusion weighting sensitive to motion in different directions. By altering the diffusion weighting directions and controlling the view ordering appropriately within the sequence, an effectively isotropic diffusion‐weighted image can be obtained within one radial‐FSE scan. The order in which radial lines are acquired can also be controlled to yield data sets without significant artifacts due to motion, T2 decay, and/or diffusion anisotropy. Magn Reson Med 53:1347–1354, 2005.

Affective self-report during the intracarotid sodium amobarbital test

Changes in internal affective state were investigated in patients undergoing the intracarotid sodium amobarbital test. It was found that when the left hemisphere was inactivated, patients rated their mood as significantly more negative than during baseline conditions. No significant change in affective state was observed during the inactivation of the right hemisphere. The findings are interpreted in terms of a differential lateralization model of emotion, in which the right hemisphere is more involved in the more powerful and salient negative affects.