P. Van Dyck

Imaging of pulmonary tuberculosis

Abstract. Tuberculosis, more than any other infectious disease, has always been a challenge, since it has been responsible for a great amount of morbidity and mortality in humans. After a steady decline in the number of new cases during the twentieth century, due to improved social and environmental conditions, early diagnosis, and the development of antituberculous medication, a stagnation and even an increase in the number of new cases was noted in the mid-1980s. The epidemiological alteration is multifactorial: global increase in developing countries; minority groups (HIV and other immunocompromised patients); and elderly patients due to an altered immune status. Other factors that may be responsible are a delayed diagnosis, especially in elderly patients, incomplete or inadequate therapy, and the emergence of multidrug-resistant tuberculosis. The course of the disease and its corresponding clinicoradiological pattern depends on the interaction between the organism and the host response. Classically, pulmonary tuberculosis has been classified in primary tuberculosis, which occurred previously in children, and postprimary tuberculosis, occurring in adult patients. In industrialized countries, however, there seems to be a shift of primary tuberculosis towards adults. Furthermore, due to an altered immunological response in certain groups, such as immunocompromised and elderly patients, an atypical radioclinical pattern may occur. The changing landscape, in which tuberculosis occurs, as well as the global resurgence, and the changed spectrum of the clinical and radiological presentation, justify a renewed interest of radiologists for the imaging features of pulmonary tuberculosis. This article deals with the usual imaging features of pulmonary tuberculosis as well as the atypical patterns encountered in immunodepressed and elderly patients.

Tears of the supraspinatus tendon: assessment with indirect magnetic resonance arthrography in 67 patients with arthroscopic correlation

Background: Magnetic resonance (MR) arthrography is generally regarded as the gold standard for shoulder imaging. As an alternative to direct MR arthrography, the less invasive indirect MR arthrography technique was proposed, offering logistic advantages because fluoroscopic or ultrasonographic guidance for joint injection is not required. Purpose: To assess the diagnostic performance of indirect MR arthrography in the diagnosis of full- and partial-thickness supraspinatus tears in a symptomatic population. Material and Methods: Two radiologists with different levels of experience independently and retrospectively interpreted indirect MR (1.5T) arthrograms of the shoulder obtained in 67 symptomatic patients who underwent subsequent arthroscopy. On MR, the supraspinatus tendon was evaluated for full- or partial-thickness tear. With arthroscopy as the standard of reference, sensitivity, specificity, and diagnostic accuracy of indirect MR arthrography in the detection of full- and partial-thickness tears of the supraspinatus tendon was calculated. Kappa (κ) statistics were used for the assessment of the agreement between arthroscopic and imaging findings and for the assessment of interobserver agreement. Results: For full-thickness tears of the supraspinatus tendon, sensitivities, specificities, and accuracies exceeded 90% for both observers, with excellent interobserver agreement (κ = 0.910). For partial-thickness tears, sensitivities (38–50%) and accuracies (76–78%) were poor for both reviewers, and interobserver agreement was moderate (κ = 0.491). Discrepancies between MR diagnosis and arthroscopy were predominantly observed with small partial-thickness tears. Conclusion: Indirect MR arthrography is highly accurate in the diagnosis of full-thickness rotator cuff tears. However, the diagnosis of partial-thickness tears with indirect MR arthrography remains faulty, because exact demarcation of degenerative change and partial rupture is difficult. On the basis of the above findings, we do not recommend indirect MR arthrography on patients for whom rotator cuff disease is suspected clinically.

Grading and characterization of soft tissue tumors on magnetic resonance imaging: the value of an expert second opinion report

ObjectiveTo retrospectively compare the accuracy of the initial MRI (magnetic resonance imaging) report of referring radiologists and the second opinion report.Material and methodsMRI of 155 patients presenting with a soft tissue tumor (STT) in a single large community center were referred for inclusion in the Belgian Soft Tissue Neoplasm Registry (BSTNR). The initial report and the second opinion report were made independently. Histopathology (gold standard) was obtained in 90 patients (group 1). In 65 patients, the diagnosis was made by the combination of clinical findings and/or follow-up (group 2). In group 1, the concordance in grading and tissue-specific (TS) diagnosis between the referring center (RC) and expert center (EC) was reviewed.ResultsIn group 1, MR grading yields a sensitivity of 100% and a specificity of 89% in the EC. The sensitivity was 88% and the specificity 81% in the RC. The accuracy was significantly higher in the EC (92%) compared to the RC (83%) (p = 0.039). The TS diagnosis was correct in 50% versus 38.5% of malignant tumors and in 71.8% versus 51.6% of benign tumors in the EC and RC respectively.ConclusionA second opinion report increases the accuracy in the diagnosis of STT on MRI.Main Messages• A second opinion MRI report increases the overall accuracy in the diagnosis of soft tissue tumors.• There is a good overall agreement in MR grading between the referring and expert institution.• In the expert center, there were fewer false-negative and false-positive diagnoses.• MRI performs better in the tissue-specific diagnosis of benign versus malignant STT.

Multi-element analysis of urine by energy-dispersive x-ray fluorescence spectrometry

Abstract For multi-element analysis of human urine, 25-ml samples doped with yttrium as internal standard are evaporated gently and then ashed up to 460°C overnight. The residue is pelletized and analysed by energy-dispersive x-ray fluorescence. Acid addition to facilitate the digestion is not mandatory. Recoveries are nearly quantitative for traces of Fe, Ni, Cu, Zn and Sr, to a lesser extent for lead, but not for arsenic or selenium. The standard deviation per measurement is typically around 6%. The detection limits are such that some 10 elements can be determined simultaneously in normal urine, and possibly more in cases of importance to toxicology or industrial hygiene.

AUTOMATED ENERGY-DISPERSIVE X-RAY FLUORESCENCE ANALYSIS FOR DIVERSE ENVIRONMENTAL SAMPLES

ABSTRACT A fully automatic and versatile X-ray fluorescence analysis is described which incorporates convenient corrections for matrix effects and allows to convert measured signals directly into elementary concentrations. Good accuracy and high precision are obtained for samples of variable composition and thickness, for elements ranging from Mg up to U.

Tumor and Tumor-Like Lesions of Soft Tissue

Masses of the hand and wrist are a common clinical problem. Soft-tissue tumors of the hand and wrist are far more frequent than bone tumors. If clinical examination is equivocal, imaging is often requested. This chapter aims to present an overview of the imaging characteristics of the most frequent tumor and tumor-like soft-tissue lesions of the hand and wrist.

Automated quantitative electron-microprobe analysis of particulate material

An automated electron microprobe, equipped with an energy-dispersive X-ray spectrometer and an additional backscattered electron signal digitalization system, can allow rapid sizing and major element analysis on numerous particles. A software package has been developed to exploit the particle size and shape information to achieve quantitative analysis of single particles, and to compare the performance of the different matrix correction procedures.