European radiology
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Multicenter Study
Diagnosis of pulmonary embolism with spiral CT as a second procedure following scintigraphy.
Our objective was to evaluate, in a routine clinical setting, the role of spiral CT as a second procedure in patients with clinically suspected pulmonary embolism (PE) and abnormal perfusion scan. We prospectively studied the role of spiral CT in 279 patients suspected of PE. All patients started their diagnostic algorithm with chest radiographs and perfusion scintigraphy. ⋯ In the high-probability group, sensitivity and specificity increased to 97 and 100%, respectively, with a prevalence of 90%. In the non-high probability-group sensitivity and specificity decreased to 61 and 89%, respectively, with a prevalence of 25%. In a routine clinical setting single-detector spiral CT technology has limited value as a second diagnostic test because of low added value in patients with a high-probability lung scan and low sensitivity in patients with non-high-probability lung scan result.
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Our objective was to systematically examine the influence of probe geometry, puncture route, and composition of the abdominal wall on the deviation error with needle display. We made a simplified simulation model of the puncture needle passing to the liver tumor, using a microcomputer system, and visualized the degree of distortion of the puncture needle, changing the thickness and component of the abdominal wall as well as the radius of the probe, site, and angle of puncture. The puncture needle exhibited a displacement error of -10.9 to 3.8 mm (center hole) and -11.3 to 3.8 mm (side attachment). ⋯ The displacement error was less accentuated in the center and accentuated in the left side of the field of view. It is recommended that liver puncture under US guidance be generally performed using a probe with a larger radius through the center hole with the most obtuse puncture angle possible, but when the tumor is localized in the hepatic dome, a more tightly curved probe should be used with an acute angle. We must consider a possible large error in display of the puncture needle during liver puncture and try to prevent hazardous complications.
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Endovascular treatment of stenoses in the superior vena cava syndrome caused by non-tumoral lesions.
We report our experience in percutaneous treatment of non-tumoral superior vena cava syndrome (SVCS) between December 1998 and July 2001. During a period of 2.5 years, 9 patients (age range 27-84 years, mean age 50 years) were treated percutaneously for significant non-tumoral SVCS. Symptomatic SVCS were due to dialysis catheters (7), central line (1) and radiation therapy (1). ⋯ Stent placement in benign symptomatic SVCS is a safe and minimally invasive procedure, with no technical and clinical complications in our experience. It allowed immediate relief of symptoms, and in dialysed patients could provide continued use of hemodialysis access. Close clinical surveillance is mandatory to assess stent patency.
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Comparative Study
Prospective comparison of helical CT with angiography in pulmonary embolism: global and selective vascular territory analysis. Interobserver agreement.
The objective of this prospective study was to evaluate the sensitivity, specificity, positive and negative predictive values, and interobserver agreement in the diagnosis of pulmonary embolism with helical CT, compared with pulmonary angiography, for both global results and for selective vascular territories. Helical CT and pulmonary angiography were performed on 66 consecutive patients with clinical suspicion of pulmonary embolism. The exams were blindly interpreted by a vascular radiologist and by two independent thoracic radiologists. ⋯ For each vascular territory, this was 98% (kappa 0.91) for main arteries, 92% (kappa 0.78) for lobar arteries, 79% (kappa 0.56) for segmental arteries, and 59% (kappa 0.21) for subsegmental arteries. Helical CT is a reliable method for pulmonary embolism diagnosis, with good interobserver agreement for main, lobar, and segmental territories. Worse results are found for subsegmental arteries, with high incidence of non-valuable branches and poor interobserver agreement.
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Comparative Study
Transcranial Doppler ultrasonography in neurologically asymptomatic children and young adults with sickle cell disease.
The purpose of the study was to evaluate transcranial Doppler ultrasonography for identifying cerebrovascular disease in neurologically asymptomatic children and young adults with sickle cell disease. A total of 47 consecutive patients with sickle cell disease (28 females, 19 males; age range 8 months to 29 years, mean age 9 years 6 months) were evaluated by transcranial color and duplex Doppler ultrasonography via transtemporal and occipital (2-MHz probe) as well as by transocular (5-MHz probe) approach. Eleven vessels (middle, posterior, anterior cerebral artery, vertebral artery, ophthalmic artery on each side and basilar artery) were analyzed in each patient. ⋯ Our findings indicate the usefulness of transcranial Doppler ultrasonography to reveal occult cerebrovascular lesions in neurologically asymptomatic patients with sickle cell disease. It should regularly be performed in all sickle cell patients in order to detect patients at risk for later stroke. Patients with homozygous disease and a high frequency of preceding sickle cell crises should be followed most closely.