Clinical imaging
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The association between main pulmonary artery (MPA) size and pulmonary arterial hypertension (PAHTN) is well established; however, the clinical utility of routine measurement of MPA is uncertain due to considerable overlap between normal patients and those with pulmonary hypertension. The lack of diagnostic accuracy could be further degraded by variability among the radiologists. It is unknown whether the addition of right and left pulmonary artery measurements would improve accuracy or further impair it. The purposes of this study are to verify the accuracy of a proposed cutoff value for the size of MPA in the diagnosis PAHTN, to determine the interrater agreement for this measurement, and to determine whether addition of right pulmonary artery (RPA) and left pulmonary artery (LPA) measurement or simple assessment of patient comorbidities can improve the accuracy. ⋯ Previously proposed threshold of MPAD ≥3.15cm is likely optimal but is not specific for identifying patient with PAHTN. Interobserver differences in MPAD measurement do not account this inaccuracy. Incorporation or RPA and LPA measurement does not improve diagnostic accuracy of PAHTN, and assessment of comorbidities does not easily identify likely false positive cases. Diagnosis of PAHTN based solely on CT examinations of the chest may not be sufficiently accurate for clinical use.
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Case Reports
Active extravasation of gadolinium-based contrast agent into the subdural space following lumbar puncture.
A 38year-old male presented with cauda equina syndrome following multiple lumbar puncture attempts. Lumbar spine magnetic resonance imaging (MRI) showed a subdural hematoma and an area of apparent contrast enhancement in the spinal canal on sagittal post-contrast images. Axial post-contrast images obtained seven minutes later demonstrated an increase in size and change in shape of the region of apparent contrast enhancement, indicating active extravasation of the contrast agent. This is the first reported case of active extravasation of gadolinium-based contrast agent in the spine.
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The objective was to investigate the capabilities of diffusional kurtosis imaging (DKI) in detection of age-related white matter (WM) changes in elderly patients with leukoaraiosis. ⋯ DKI can provide sensitive imaging biomarkers for assessing the severity of leukoaraiosis in reference to Fazekas score.