Matilde Nino-Murcia

Colonic transit in spinal cord-injured patients.

This report describes a study of transit time through the colon, as well as the caliber of the colon and distal small bowel, in 28 spinal cord-injured patients to see if there is a correlation between those findings and difficulty with bowel care and symptoms. In 15 of these 28 patients anorectal dynamic studies were also done. Each patient ingested 20 radiopaque markers, after which colon transit times were measured by multiple abdominal radiographs. The width of the ileum was measured and correlated with symptoms. The findings indicate that transit time was delayed in the left and rectosigmoid colon; four patients had a large and highly compliant rectum, whereas six had anorectal dyssynergia. All ten had difficulty with bowel care. The distal small bowel was dilated in ten patients, all of whom had symptoms and nine of whom had spinal cord lesions superior to T5.

Multidetector-row helical CT and advanced postprocessing techniques for the evaluation of pancreatic neoplasms

AbstractAn important feature of multidetector-row helical computed tomography (CT) is the increased speed of scanning that permits routine use of very thin collimation and acquisition of near isometric imaging data of the abdomen within the time span of a single breath-hold. The parallel escalation in the capabilities of workstations makes feasible the practical use of advanced postprocessing techniques to create high quality volumetric imaging. This article highlights the unique contributions of multidetector-row CT and advanced postprocessing techniques to the evaluation of the pancreas and peripancreatic vascular structures and their value in the diagnosis and staging of pancreatic neoplasms.

Evaluation of Fluorodeoxyglucose Positron Emission Tomography Imaging in Metastatic Transitional Cell Carcinoma with and without Prior Chemotherapy

Introduction: This study was designed to determine the value of fluorodeoxyglucose (FDG) positron emission tomography (PET) in the evaluation of metastatic transitional cell carcinoma (TCC). Methods: Fifty-eight FDG PET scans were performed on 46 consecutive patients with TCC. Results were correlated with radiologic, pathologic, and histologic findings in these patients and the sensitivity of PET for detecting malignancy in untreated TCC patients (n = 48) was compared to the sensitivity in patients who had undergone prior chemotherapy (n = 10). Results: Of 48 scans in patients who had no prior systemic chemotherapy, 10 had increased uptake in proven metastatic TCC lesions and 3 PET studies failed to reveal metastatic TCC (sensitivity 76.9%). In patients free of metastatic disease, 33 revealed no abnormal uptake and 1 study revealed a suspicious area in a patient free of metastases (specificity = 97.1%). However, in 10 patients imaged after receiving chemotherapy, the sensitivity fell to 50% for the detection of histologically confirmed residual/recurrent tumor by PET. Conclusions: FDG PET detects increased metabolic activity. After chemotherapy, viable cancer cells may still be present but with a diminished metabolic rate. As a result, PET imaging is often useful in the evaluation of untreated metastatic TCC metastasis but should be interpreted with caution in patients who have received prior chemotherapy.

Congenital anomalies of the inferior vena cava: embryogenesis and MR features.

This article describes the MR appearances of the six most common congenital anomalies of the inferior vena cava. As a basis for understanding those anomalies, it describes the embryology of the inferior vena cava, based on an actual study of embryos and fetuses. The article takes a fresh look at the original research in this area, discusses the possible embryogenesis of the relevant anomalies, and describes different opinions on that subject, where different opinions exist.

The efficacy of rehabilitative management of dysphagia

Efficacy of treatment for dysphagia in medically stable patients was defined as a reduction in the occurrence of aspiration pneumonia. Aspiration pneumonia was diagnosed by radiographic and/or laboratory analysis and was identified by retrospective chart review. Two groups of treated patients (48 without and 13 with a history of aspiration pneumonia) were compared to a group of untreated patients. There were no statistically significant differences in the occurrence of aspiration pneumonia in the treated groups, but both treated groups were subject to significantly less aspiration pneumonia than the untreated group. Measures of severity indicated that even mildly dysphagic patients were at risk for the development of aspiration pneumonia, and even severely dysphagic patients responded to rehabilitative management of their swallowing problems. Efficacy of treating swallowing was demonstrated, and a general outcome criterion for treatment was proposed.

Hepatic focal nodular hyperplasia: findings with color Doppler sonography.

Color Doppler sonographic images of five patients with a total of six lesions of FNH were reviewed. All cases were confirmed pathologically. All six lesions showed increased intralesional flow in comparison to surrounding liver parenchyma on color Doppler sonography. Four of the six lesions showed significant peripheral flow; two of the six lesions showed central flow radiating peripherally from a central vessel. We conclude that increased color Doppler flow may be a characteristic feature of FNH. Increased internal flow has also been reported in HCC and hepatic metastatic disease. Considerable overlap is seen in color Doppler flow patterns. However, in patients clinically at low risk for malignancy, detection of a liver mass with increased color Doppler flow should suggest the diagnosis of FNH.

Color Doppler sonography of the cystic artery : comparison of normal controls and patients with acute cholecystitis

Color Doppler sonography was used to evaluate the length and distribution of the cystic artery in the gallbladder wall in 115 normal adults and in 54 patients with surgically proved cholecystitis. All patients were scanned with a 5 MHz curved array transducer optimized for low volume color sensitivity. A specific attempt was made to visualize the cystic artery throughout its course. Spectral Doppler waveforms were obtained to document arterial flow. The length of the cystic artery visualized was analyzed as a quartile percentage length of the anterior gallbladder wall. The distribution of the cystic artery flow also was analyzed in specific quartiles. Of 54 patients with acute cholecystitis, 26% had cystic artery length greater than half of the anterior gallbladder wall, compared with 2% of 115 normal controls (P < 0.001); 19% of patients with cholecystitis had flow in the distal (fundal) quartile, compared to 0% of normal controls (P < 0.0001). Although the presence or absence of flow in the gallbladder is not a reliable finding to establish the diagnosis of acute cholecystitis, length of cystic artery visualized is a potentially useful criterion to suggest the diagnosis of acute cholecystitis, especially in cases in which flow in the distal fundal quartile of the gallbladder. The usefulness of color Doppler sonography in acute cholecystitis is limited owing to the fact that it is insensitive, and many patients with cholecystitis have no detectable flow or have normal flow patterns.

CT of pancreas: minimum intensity projections.

ObjectiveThe purpose of this pictorial essay is to showcase the use of minimum intensity projection in the imaging of low attenuation structures such as the pancreatic duct.ConclusionMinimum intensity projection is a valuable adjunct to other processing techniques for the diagnosis and staging of pancreatic adenocarcinoma and cystic tumors of the pancreas.

The role of bone scan and radiography in the diagnostic evaluation of suspected pedal osteomyelitis.

The authors reviewed the three-phase bone scans and radiographs of 24 patients with suspected pedal osteomyelitis who also had histologic confirmation of the diagnosis. Twenty patients had a pedal ulcer, cellulitis, or necrosis. Sensitivity and specificity of bone scanning were 70% and 43% respectively. Sensitivity and specificity of radiography were 70% and 50% respectively. The non-invasive diagnosis of pedal osteomyelitis remains problematic due to the poor specificity of bone scans and radiographs.

Evaluation of Periampullary Pathology With CT Volumetric Oblique Coronal Reformations

OBJECTIVE The purpose of this article is to show the value of volumetric oblique coronal reformation of CT data sets for assessing the normal anatomy and abnormalities of the ampulla of Vater. CONCLUSION Volumetric oblique coronal reformations are a useful noninvasive method to provide diagnostic information about periampullary abnormalities as well as show secondary features important for local staging and management. The technique is also valuable in providing a time-efficient method to review pertinent findings with clinicians.