Radiology
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Dynamic chest computed tomography (CT) was performed in 326 patients who had undergone abdominal CT for blunt trauma to evaluate the role of chest CT in screening for thoracic aortic injury. Evidence of mediastinal bleeding constituted an abnormal CT examination. The results were correlated with those from aortography in 131 patients. ⋯ With CT there was a significant improvement over plain radiography in specificity, accuracy, and predictive value of positive results. If chest CT were used as an adjunct to chest radiography in the screening for traumatic aortic tear, the need for aortography would decrease by 56%. Chest CT can safely help discriminate candidates for aortography, is cost-effective, and, in hemodynamically stable patients, should be incorporated in the screening for traumatic aortic tear.
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The pulmonary angiograms of 250 patients evaluated for chronic thromboembolic pulmonary hypertension were reviewed. Pulmonary thromboendarterectomy was performed in each of these individuals, and the surgical findings were correlated with abnormal angiographic patterns. ⋯ Carefully obtained and properly interpreted pulmonary angiograms are necessary to confirm the diagnosis of operable chronic thromboembolic disease. Differential diagnostic possibilities should be considered prior to a decision to perform surgical correction.
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Comparative Study
Metabolic disorders of the brain in chronic hepatic encephalopathy detected with H-1 MR spectroscopy.
Proton magnetic resonance (MR) spectroscopy of the brain was performed in 11 patients with chronic hepatic encephalopathy (CHE), and the results were compared with those of patients with liver disease but without CHE; clinical control subjects with diabetes, uremia, or cortical atrophy; and healthy subjects. The technique of water-suppressed stimulated-echo hydrogen-1 MR spectroscopy for detection of cerebral glutamate, glutamine, glucose, N-acetylaspartate, choline metabolites, (phospho)creatine, and myo-inositol is described. ⋯ In four of the 15 patients with liver disease but without clinical CHE, a significant reduction in the myo-inositol level was detected, and in two of these patients an elevation in the glutamine concentration was also observed. These findings indicate a role for image-guided H-1 MR spectroscopy in the diagnosis and monitoring of both overt and preclinical CHE.
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The accuracy of T1-, proton-density-, and T2-weighted magnetic resonance (MR) imaging sequences and gadolinium-enhanced MR arthrography in evaluation of the triangular fibro-cartilage complex (TFCC) and the scapholunate (SL) and lunotriquetral (LT) ligaments was studied in 15 patients with chronic wrist pain. Arthrography and arthroscopy were used as standards of reference. Twelve patients also underwent imaging with short tau inversion recovery (STIR) sequences. ⋯ Accuracy with MR arthrography was higher than with the other sequences. STIR images were effective in evaluation of the TFCC. The combination of proton-density-and T2-weighted images appears to be useful because morphologic characteristics and the presence of fluid can be evaluated.
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Comparative Study
Epithelial tumors of the ovary: comparison of MR and CT findings.
Forty patients with 50 ovarian epithelial tumors of the ovary were retrospectively studied. They underwent computed tomography and magnetic resonance (MR) imaging within 1 week of surgery. MR examinations were performed with a superconducting magnet (0.5 T) and predominantly T1- and T2-weighted MR imaging. ⋯ On the basis of signal intensity and morphologic characteristics, MR imaging helped in the correct diagnosis of benign serous cystadenoma in 10 of 13 tumors, benign mucinous cystadenoma in seven of 10 tumors, and tumors of low malignant potential and malignant tumors in 23 of 27 tumors. Accuracy for overall characterization of benign versus malignant tumors was 86% with MR imaging and 92% with computed tomography. There was no difference in sensitivity (P = 1) or specificity (P = .5).