European radiology
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Many disease processes manifest either primarily or secondarily by cranial nerve deficits. Neurologists, ENT surgeons, ophthalmologists and maxillo-facial surgeons are often confronted with patients with symptoms and signs of cranial nerve dysfunction. Seeking the cause of this dysfunction is a common indication for imaging. ⋯ Both with CT and MR, multiplanar and curved reconstructions can follow the entire course of a cranial nerve or branch, improving tremendously our diagnostic yield of neural pathology. This review article will focus on the contribution of current imaging techniques in the depiction of normal anatomy and on infectious and inflammatory, traumatic and congenital pathology affecting the cranial nerves. A detailed discussion of individual cranial nerves lesions is beyond the scope of this article.
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The purpose of this study was to determine non-invasively the frequency of ectopic bronchial arteries (BA) (i.e., bronchial arteries originating at a level of the descending aorta other than T5-T6 or from any aortic collateral vessel) on multidetector-row CT angiograms (CTA) obtained in patients with hemoptysis. Over a 5-year period (2000-2005), 251 consecutive patients with hemoptysis underwent multidetector-row CT angiography of the thorax. From this population, 37 patients were excluded because of a suboptimal CTA examination (n = 19), the presence of extensive mediastinal disease (n = 15) or severe chest deformation (n = 3) precluding any precise analysis of the bronchial arteries at CTA. ⋯ Bronchial artery embolization was indicated in 26 patients. On the basis of CTA information, (1) bronchial embolization was attempted in 24 patients; it was technically successful in 21 patients (orthotopic BAs: 6 patients; orthotopic and ectopic BAs: 3 patients; ectopic BAs: 12 patients) and failed in 3 patients due to an instable catheterization of the ectopic BAs; the absence of additional bronchial arterial supply and no abnormalities of nonbronchial systemic arteries at CTA avoided additional arteriograms in these 3 patients; (2) owing to the iatrogenic risk of the embolization procedure of ectopic BAs, the surgical ligation of the abnormal vessels was the favored therapeutic option in 2 patients. This study enabled the depiction of ectopic bronchial arteries in 36% of the studied population, important anatomical information prior to therapeutic decision making.
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Proton magnetic resonance spectroscopy ((1)H-MRS) provides specific metabolic information not otherwise observable by any other imaging method. (1)H-MRS of the brain at 3 T is a new tool in the modern neuroradiological armamentarium whose main advantages, with respect to the well-established and technologically advanced 1.5-T (1)H-MRS, include a higher signal-to-noise ratio, with a consequent increase in spatial and temporal resolutions, and better spectral resolution. These advantages allow the acquisition of higher quality and more easily quantifiable spectra in smaller voxels and/or in shorter times, and increase the sensitivity in metabolite detection. ⋯ Furthermore, advanced (1)H-MRS techniques, such as specific spectral editing, fast (1)H-MRS imaging and diffusion tensor (1)H-MRS imaging, have been successfully implemented at 3 T. However, easier and more robust implementations of these techniques are still needed before they can become more widely used and undertake most of the clinical and research (1)H-MRS applications.
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Greater trochanteric pain syndrome is commonly due to gluteus minimus or medius injury rather than trochanteric bursitis. Gluteal tendinopathy most frequently occurs in late-middle aged females. ⋯ The direct (peritendinitis, tendinosis, partial and complete tear) and indirect (bursal fluid, bony changes and fatty atrophy) MRI signs of gluteal tendon injury are illustrated. The key sonographic findings of gluteal tendinopathy are also discussed.
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Many pathologies of the airway involve the bronchial wall and the parabronchial structures. The view of the endoscopist, however, is limited to the lumen and the internal surface of the airway. Processes within the airway wall and outside the airway can only be assessed by indirect signs. ⋯ The investigation of a suspected malignant adenopathy justifies a complete examination by mediastinoscopy or mediastinotomy, which are considered gold standards. EBUS-TBNA constitutes the recent evolution of TBNA, a method known for 20 years now but underused. The aim of this review is to highlight to the different techniques and to discuss the results of published trials.