European radiology
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Review Meta Analysis
The accuracy of MRI in diagnosis of suspected deep vein thrombosis: systematic review and meta-analysis.
Magnetic resonance imaging (MRI) may be used to diagnose deep vein thrombosis (DVT) in patients for whom ultrasound examination is inappropriate or unfeasible. We undertook a systematic review of the literature and meta-analysis to estimate the diagnostic accuracy of MRI for DVT. We searched databases of medical literature and citation lists of retrieved articles. ⋯ However, pooled estimates should be interpreted with caution as estimates of both sensitivity and specificity were subject to significant heterogeneity (P<0.001). Individual studies reported sensitivity ranging from zero to 100%, while specificity ranged from 43 to 100%. MRI has equivalent sensitivity and specificity to ultrasound for diagnosis of DVT, but has been evaluated in many fewer studies, using a variety of different techniques.
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The diagnosis of nerve entrapment and compressive neuropathy has been traditionally based on the clinical and electrodiagnostic examinations. As a result of improvements in the magnetic resonance (MR) imaging modality, it plays not only a fundamental role in the detection of space-occupying lesions but also a compensatory role in clinically and electrodiagnostically inconclusive cases. Although ultrasound has undergone further development in the past decades and shows high resolution capabilities, it has inherent limitations due to its operator dependency. ⋯ We also review the course of normal peripheral nerves, as well as various clinical demonstrations and pathological features of compressed and entrapped nerves in the lower extremities on MR imaging, according to the nerves involved. The common sites of nerve entrapment of the lower extremity are as follows: sciatic nerve around the piriformis muscle; tibial nerve at the popliteal fossa and tarsal tunnel, common peroneal nerve around the fibular neck, and digital nerve near the metatarsal head. Although MR imaging can depict the peripheral nerves in the extremities effectively, radiologists should be familiar with nerve pathways, common sites of nerve compression, and common space-occupying lesions resulting in nerve compression in MR imaging.
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CT urography has emerged as a serious alternative to conventional urography by utilizing the advantages of modern multislice CT techniques for the visualization of the entire upper urinary tract. Several different examination techniques have been developed in multislice CT (MSCT) urography for improving the opacification and distension of the urinary tract. All efforts in performing MSCT urography have to compromise between the best possible image quality and a reasonably low radiation exposure. ⋯ Operating modern MSCT urography properly is not difficult, but it presupposes basic knowledge on the variety of current MSCT urography techniques, including such issues as present-day indications, split-bolus injection, compression, saline infusion, low-dose diuretic administration, hybrid scanning, timing of the acquisition delay, examination protocols, postprocessing, image analysis, and radiation exposure. This article is not intended to provide guidelines of how to conduct MSCT urography, but everyone will be able to understand the functionality of several robust operating MSCT urography techniques, which helps making an individual selection for the clinical practice. In the near future, systematic studies are awaited evaluating the morphologic and diagnostic accuracy of MSCT urography regarding diverse urinary tract disorders.
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Smoking-related interstitial lung diseases (SRILD) are a heterogeneous group of entities of unknown cause. These diseases include desquamative interstitial pneumonia (DIP), respiratory-bronchiolitis-related interstitial lung disease (RB-ILD), pulmonary Langerhans' cell histiocytosis (LCH) and idiopathic pulmonary fibrosis (IPF). High-resolution CT is highly sensitive in the detection of abnormalities in the lung parenchyma and airways. ⋯ Pathologically, IPF is characterized by its heterogeneity with areas of normal lung, alveolitis and end-stage fibrosis shown in the same biopsy specimen. High-resolution CT findings consist of honeycombing, traction bronchiectasis and intralobular interstitial thickening with subpleural and lower lung predominance. Since coexisting lesions in the same cases have been observed, a better understanding of the different smoking-related interstitial lung diseases (SRILD) allows a more confident and specific diagnosis.
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Accurate MRI characterization of brain lesions is critical for planning therapeutic strategy, assessing prognosis and monitoring response to therapy. Conventional MRI with gadolinium-based contrast agents is useful for the evaluation of brain lesions, but this approach primarily depicts areas of disruption of the blood-brain barrier (BBB) rather than tissue perfusion. Advanced MR imaging techniques such as dynamic contrast agent-enhanced perfusion MRI provide physiological information that complements the anatomic data available from conventional MRI. ⋯ All the procedures carried out were safe and no adverse events occurred. The acquired perfusion images were of good quality in all but two patients. Our findings confirm that high relaxivity contrast agents such as MultiHance are ideal for use in perfusion MRI of the central nervous system.