Stigmasterol stimulates transintestinal cholesterol excretion independent of liver X receptor activation in the small intestine

Despite advances in healthcare, cardiovascular disease (CVD) remains the leading cause of death in the United States. Elevated levels of plasma cholesterol are highly predictive of CVD and stroke and are the principal driver of atherosclerosis. Unfortunately, current cholesterol lowering agents, such as statins, are not known to reverse atherosclerotic disease once it has been established. In preclinical models, agonists of nuclear receptor, LXR, have been shown to reduce and reverse atherosclerosis. Phytosterols are bioactive non-cholesterol sterols that act as LXR agonists and regulate cholesterol metabolism and transport. We hypothesized that stigmasterol would act as an LXR agonist and alter intestinal cholesterol secretion to promote cholesterol elimination. Mice were fed a control diet, or a diet supplemented with stigmasterol (0.3% w/w) or T0901317 (0.015% w/w), a known LXR agonist. In this experiment we analyzed the sterol content of bile, intestinal perfusate, plasma, and feces. Additionally, the liver and small intestine were analyzed for relative levels of transcripts known to be regulated by LXR. We observed that T0901317 robustly promoted cholesterol elimination and acted as a strong LXR agonist. Stigmasterol promoted transintestinal cholesterol secretion through an LXR-independent pathway.

Multiple diagnostic task performance in CT examination of the chest

Objectives In three experiments, we studied the detection of multiple abnormality types using the satisfaction of search (SOS) paradigm, the provision of a computer-aided detection (CAD) of pulmonary nodules and a focused nodule detection task. Methods 51 chest CT examinations (24 that demonstrated subtle pulmonary nodules and 27 that demonstrated no pulmonary nodules) were read by 15 radiology residents and fellows under two experimental conditions: (1) when there were no other abnormalities present except test abnormalities in the exams (non-SOS condition), and (2) when other abnormalities were present in the exams (SOS condition). Trials from the two conditions were intermixed. Readers were invited to return for two sessions: one in which the SOS condition was repeated with a simulated CAD; another in which only the non-SOS condition was presented. Detection accuracy was measured using receiver operating characteristic (ROC) analysis. Results An SOS effect (reduced detection accuracy for the test nodules in the presence of the diverse added abnormalities) was not found. Average accuracy was much higher when the CAD prompt was provided, without cost in the detection of the added abnormalities. Accuracy for detecting nodules appearing without intermixed SOS trials was also substantially improved. Conclusions CT interpretation was highly task dependent. Nodule detection was poor in the general search task. Therefore, CAD may offer a greater performance improvement than demonstrated in experiments assessing CAD using focused search. The absence of SOS may be due to limited nodule detection even without other abnormalities. Advances in knowledge CAD prompts of nodules increase the detection accuracy of nodules and decrease the time to detection-without impairing the detection accuracy-of non-nodule abnormalities.

Multiple diagnostic task performance in CT examination of the chest

OBJECTIVES

In three experiments, we studied the detection of multiple abnormality types using the satisfaction of search (SOS) paradigm, the provision of a computer-aided detection (CAD) of pulmonary nodules and a focused nodule detection task.

METHODS

51 chest CT examinations (24 that demonstrated subtle pulmonary nodules and 27 that demonstrated no pulmonary nodules) were read by 15 radiology residents and fellows under two experimental conditions: (1) when there were no other abnormalities present except test abnormalities in the exams (non-SOS condition), and (2) when other abnormalities were present in the exams (SOS condition). Trials from the two conditions were intermixed. Readers were invited to return for two sessions: one in which the SOS condition was repeated with a simulated CAD; another in which only the non-SOS condition was presented. Detection accuracy was measured using receiver operating characteristic (ROC) analysis.

RESULTS

An SOS effect (reduced detection accuracy for the test nodules in the presence of the diverse added abnormalities) was not found. Average accuracy was much higher when the CAD prompt was provided, without cost in the detection of the added abnormalities. Accuracy for detecting nodules appearing without intermixed SOS trials was also substantially improved.

CONCLUSIONS

CT interpretation was highly task dependent. Nodule detection was poor in the general search task. Therefore, CAD may offer a greater performance improvement than demonstrated in experiments assessing CAD using focused search. The absence of SOS may be due to limited nodule detection even without other abnormalities. Advances in knowledge CAD prompts of nodules increase the detection accuracy of nodules and decrease the time to detection-without impairing the detection accuracy-of non-nodule abnormalities.

Usefulness of the Framingham risk score and body mass index to predict early coronary artery calcium in young adults (Muscatine Study)

The value of a coronary artery disease prediction algorithm, the Framingham risk score (score), for detecting coronary artery calcium (CAC) was examined in 385 men and 472 women, aged 29 to 43 years. Scores were compared in subjects with and without CAC and were also used to predict presence of CAC. Receiver-operating characteristic curves were computed to compare different prediction models. The score model was compared with age only, natural logarithm of body mass index (lnBMI) only, and score plus lnBMI models. CAC was detected in 30% of men and 16% of women. The mean score was significantly higher in men and women with CAC. For every 2-point increase in the score, the odds of CAC increased by 30% in women and 20% in men. Significant associations between CAC status and risk factors were observed for age in women, and high- density lipoprotein cholesterol and blood pressure in men and women. The area under the receiver-operating characteristic curve for the score was 0.67 and 0.57 for women and men, respectively. When lnBMI was added to the score model, the area increased to 0.76 in women (lnBMI p <0.0001, score p <0.005). For men, the area increased from 0.57 to 0.67, and the score was no longer significant (p >0.60) in the model with lnBMI (p <0.0001). Score predicts CAC in asymptomatic young adults. Inclusion of lnBMI in the score model adds significantly to the prediction of CAC in women and men. The lnBMI model has a greater predictive value than the score in this young population.

High-performance liquid chromatography multiplex detection of two single nucleotide mutations associated with hereditary hemochromatosis

High-performance liquid chromatography (HPLC) has been applied to the multiplex detection of the two single nucleotide mutations commonly found in hereditary hemochromatosis (HH). HH is associated with a major G to A transition at position 845 (mutation Cys282Tyr) and a minor C to G transition at position 187 (mutation His63Asp) in the cDNA of the HFE gene. Two detection assays were developed based on HPLC analysis of restriction fragment length polymorphism (RFLP) or single nucleotide extension (SNE) products following multiplex PCR amplification. RFLP genotypes the two sites as dsDNA fragments of different lengths generated by restriction enzymes Rsa I/Bcl I. SNE extends primers 5'-adjacent to the sites of interest with a dideoxynucleotide triphosphate (ddNTP) to generate extended ssDNA. The identity of the added ddNTP reveals the identity of the original possible mutation site(s). Application of these methods with HPLC analysis provides simple and reliable genotyping for HH and can be applied to other single nucleotide polymorphism studies.

Imaging of coronary calcium: a case for electron beam computed tomography

Coronary arterial calcification has unequivocally been shown to be a marker of atherosclerosis. To date, much research interest has been generated regarding the quantification of coronary calcification by electron beam computed tomography, and how best to use such measurements to identify and predict those at greatest risk for an adverse cardiac event. This article represents an attempt to provide an objective review of the literature regarding the potential role electron beam computed tomography (EBCT) has as an accurate and cost effective screening modality for coronary arterial disease, as well as a predictor for coronary heart disease.

MR imaging of pulmonary and mediastinal malignancies

The primary goal of performing cross-sectional imaging of the chest in the radiologic evaluation of lung cancer is to obtain information about the character and magnitude of the neoplasm. Patient prognosis and therapy decisions depend directly on identifying the size and full extent of the tumor. The ideal imaging modality therefore should provide reliable information that can be used to assist in accurately staging the malignancy. Traditionally, CT scanning has been used exclusively as part of the preoperative evaluation of primary lung carcinomas. Recent advances in CT scanning technology have greatly improved image acquisition times and image quality and consequently have enhanced the role of CT imaging in the evaluation of bronchogenic carcinomas. Single-breath CT acquisitions of the chest can now be accomplished in a matter of seconds. These rapid acquisitions improve image quality by decreasing respiratory motion, while enhancing patient compliance and throughput. Clearly, CT scanning has matured into an efficient and accurate diagnostic tool to stage primary lung malignancies noninvasively. In its present state of development, MR imaging has one distinct disadvantage that makes it significantly less attractive as a routine lung cancer examination, namely the inability to produce images of the lung that are high in spatial resolution. Also, the sensitivity and specificity of MR imaging, which are similar to those of CT scanning in identifying mediastinal and hilar metastases, offer no clinical advantages. Longer image acquisition times and time constraints force most MR imaging examinations to be abbreviated and limited in coverage. As a result, the necessary exclusion of important anatomic areas routinely visualized by CT scanning may limit the diagnostic power of MR imaging. Finally, MR imaging requires greater physician supervision than CT scanning to direct imaging and to maintain examination quality and thoroughness. Although MR imaging can contribute significantly to the radiologic evaluation of patients with lung cancer, its role is somewhat limited, and it is most useful as a complement to CT scanning. The additional versatility offered by pulse sequences that take advantage of the intrinsic relaxation of tissues greatly facilitates identification of tumor, particularly when local invasion is present. By virtue of the short T1 value of fat, MR imaging may improve the detection of mediastinal disease, particularly in cases in which the sensitivity of CT scanning cannot be optimized because of allergies to contrast or renal insufficiency. MR imaging is superior to CT scanning in demonstrating musculoskeletal anatomy and the neurovascular structures of the neck and mediastinum. Although MR imaging has a potential usefulness in the radiographic evaluation of lung carcinoma, technical shortcomings relegate this modality to a role that is primarily complementary to CT scanning. With time, technological improvements will undoubtedly redefine the role of MR imaging in the radiographic evaluation and staging of bronchogenic carcinomas.

Detection of hemochromatosis through the analysis of single- nucleotide extension products by capillary electrophoresis

Hereditary hemochromatosis is one of the most common hereditary disorders in Caucasians.The disease is linked to two single-nucleotide polymorphisms (SNPs) in the HFE gene.The two point mutations result in a change of Cys to Tyr at position 282 and His to Asp at position 63 in the resultant protein.We have developed a single-nucleotide extension (SNE) assay for hereditary hemochromatosis genetic testing, which employs capillary electrophoresis to simultaneously detect the SNE products generated from the two SNP sites. An upstream or a downstream primer adjacent to the possible mutation site is designed and extended one nucleotide further at the 3' end, complementary to the nucleotide at the possible mutation site.The extended nucleotide is one of four fluorescently labeled dideoxynucleotide triphosphates that also act as terminators. Analysis of the extended products by laser-induced fluorescence capillary electrophoresis (LIF-CE) directly reflects the identity of the possible mutation site. Using one primer upstream or downstream from the possible mutation site, three genotypes at one mutation site can be distinguished. Using both upstream and downstream primers provides a second level of specificity and increases the accuracy of the genetic test. The protocol can also be applied to the study of other SNP analyses and to simultaneous detection of multiple mutation sites.

Personnel exposure rates during simulated biopsies with a real-time CT scanner

RATIONALE AND OBJECTIVES

Real-time computed tomography (CT) has the potential to expedite and improve CT-guided needle biopsies by allowing cross-sectional images to be viewed in real time as a needle is advanced toward the target lesion. A major concern about this procedure is the scattered and leaked radiation to which the operator is exposed. This study was undertaken to determine the exposure rates around a CT scanner during CT-guided needle biopsies and to identify the areas of greatest personnel exposure.

MATERIALS AND METHODS

Pig and human cadavers were used to simulate patients undergoing a CT-guided needle biopsy. Various anatomic biopsy sites were used. The radiologist's exposure was assessed by timing the procedure and measuring the exposure rates around the CT scanner with an ionization-chamber survey meter. Ion-chamber measurements multiplied by the time the radiologist spent performing several mock biopsies were compared with film dosimeter results. Doses to the hands, wrists, and whole body were measured with ring, wrist, body, and collar film dosimeters.

RESULTS

The average time required to perform a single biopsy was about 1 minute. The dose to the radiologist performing the simulated biopsies was calculated to be 123 mR, 68 mR, 14 mR, and less than 0.5 mR to the fingers, wrist, collar, and body, respectively, as calculated from ionization-chamber and time measurements. These exposure rates correlate well with the film dosimeter readings accumulated during the mock procedures.

CONCLUSION

The dose received by the radiologist performing a CT-guided biopsy was comparable to that of other interventional procedures. In addition, operating from the head of the machine (ie, distal to the bed) appeared to markedly reduce personnel exposure, due to the shielding in the gantry of the CT scanner used in the study.

Multicenter clinical trial of ultrasmall superparamagnetic iron oxide in the evaluation of mediastinal lymph nodes in patients with primary lung carcinoma

The purpose of this study was to evaluate the clinical efficacy of ultrasmall superparamagnetic iron oxide particles as a magnetic resonance (MR) contrast agent in differentiating metastatic from benign lymph nodes. Eighteen patients with primary lung malignancy and suspected regional lymph node metastases underwent MR imaging before and after Combidex(R) infusion in a multi-institutional study. All MR sequences were interpreted by one or more board-certified radiologists experienced in imaging thoracic malignancy. Each patient was evaluated for the number and location of lymph nodes, homogeneity of nodal signal, and possible change of MR signal post contrast. All patients underwent resection or sampling of the MR-identified lymph node(s) 1-35 day(s) post contrast MR imaging. In all, 27 lymph nodes or nodal groups were available for histopathologic correlation. Combidex had a sensitivity of 92% and a specificity of 80% in identifying pathologically confirmed metastatic mediastinal lymph nodes. Based on our preliminary data, Combidex MR imaging may provide additional functional information useful in the staging of mediastinal lymph nodes.

PET, CT, and MRI with Combidex for mediastinal staging in non-small cell lung carcinoma

BACKGROUND

To determine the relative utility of positron emission tomography (PET), computed tomography (CT), and magnetic resonance imaging with Combidex (MRI-C) in the non-invasive staging of non-small cell lung cancer (NSCLC) mediastinal lymph nodes (MLN), we compared the three tests' individual performance with surgical mediastinal sampling. In contrast to prior studies, cytology was not used.

METHODS

The MLN were evaluated using PET and CT in 64 NSCLC patients. MRI-C was performed in 9 of these patients. MLN with a PET standard uptake value greater than or equal to 2.5, or greater than 1 cm in the short axis by CT or lack of MRI-C signal change were considered positive for metastatic disease. All MLN were sampled and subjected to standard pathologic analysis. PET, CT, and MRI-C scans were interpreted blinded to the histopathological results. Sensitivity, specificity, and accuracy for each scan type to appropriately stage MLN was determined using pathologic results as the standard.

RESULTS

Thirty patients had stage I disease, 8 stage II, 9 stage IIIA, 7 stage IIIB, and 10 stage IV. Two-hundred-and-thirty MLN were sampled. Sixteen patients had metastatic mediastinal disease. Compared to the pathological results, PET, CT, and MRI-C had a sensitivity, specificity, and accuracy of 70%, 86%, 84%; 65%, 79%, 76%; 86%, 82%, and 83%, respectively. PET and MRI-C were statistically more accurate than CT (p<0.001). In cases where PET and CT did not identify MLN involvement with NSCLC, 8% (2/25) were pathologically positive.

CONCLUSIONS

PET and MRI-C are statistically more accurate than CT. However, the differences are small and may not be clinically relevant. No technique was sensitive or specific enough to change the current recommendation to perform mediastinoscopy for MLN staging in NSCLC.

Imaging of coronary artery calcification. Its importance in assessing atherosclerotic disease

Coronary artery calcification is a marker for atherosclerotic disease. The calcifications frequently occur early in the disease process and often before the development of luminal narrowing or cardiac events. Electron beam CT has a high accuracy in detecting calcifications, and thus has prognostic value in predicting luminal narrowing and future cardiac events.

Coronary atherosclerosis and its effect on cardiac structure and function: evaluation by electron beam computed tomography

Coronary artery disease affects millions of Americans annually. In evaluating coronary artery disease, it is important to develop diagnostic methodology that can screen patients before the onset of symptoms or cardiac events and, in addition, evaluate the functional aspects of coronary artery disease, including any residual effects on the heart after events have occurred. Electron beam computed tomography allows the identification of coronary calcium, which is a marker for coronary atherosclerotic disease, and also allows the quantification of cardiac function, which may be altered from coronary atherosclerosis or the occurrence of a cardiac event. Thus, electron beam computed tomographic imaging is having a major impact on the diagnosis and follow-up on coronary artery disease.

Identifying left lower lobe pneumonia at chest radiography: performance of family practice residents before and after a didactic session

RATIONALE AND OBJECTIVES

The authors sought to determine whether the lateral chest radiograph is helpful in identifying left lower lobe pneumonia among inexperienced readers.

MATERIALS AND METHODS

The authors selected all patients who presented to a family practice training program with radiologic and clinical evidence of left lower lobe pneumonia (n = 65). They then selected an equal number of patients in whom chest radiographs were taken to "rule out pneumonia" and were found to be normal. Eight 1st-year family practice residents were asked to read the radiographs before and after a didactic session that emphasized lateral chest radiograph interpretation. The radiographs were presented under two viewing conditions: posteroanterior (PA) only versus PA and lateral. Receiver operating characteristic (ROC) curve methods were used to compare the effect of both the didactic session and the viewing condition on diagnostic accuracy.

RESULTS

There were no significant differences in performance before and after the didactic session and no differences between the two viewing conditions. After including only abnormal radiographs that demonstrated the "spine sign" (an apparent increased opacification of the lower vertebral bodies on the lateral view), the residents performed better when presented with both PA and lateral radiographs than when presented with the PA radiograph only (area under ROC curve, .8158 vs .7418, respectively; P = 0.24).

CONCLUSION

In patients with left lower lobe pneumonia whose radiographs demonstrated the spine sign, diagnostic accuracy improved when the lateral chest radiograph was viewed.

Diagnosing left lower lobe pneumonia: usefulness of the 'spine sign' on lateral chest radiographs

BACKGROUND

Left lower lobe pneumonia may be obscured by the heart on the postero-anterior (PA) chest radiograph. In such cases, the lateral projection may be helpful, especially if it exhibits the "spine sign", which is an interruption in the progressive increase in lucency of the vertebral bodies from superior to inferior. We investigated whether the spine sign would help family physicians diagnose left lower lobe pneumonia on chest radiographs.

METHODS

We selected the chest radiographs of all patients with left lower lobe pneumonia who were seen between 1983 and 1995 at a family practice training program (N = 78) and an equal number of chest radiographs of patients without pneumonia. Six family physicians read these radiographs under two viewing conditions: PA only vs PA and lateral. We used receiver operating characteristic (ROC) curve methodology to compare the two viewing conditions.

RESULTS

There was no significant difference in performance between the two viewing conditions. The lateral view was helpful in some patients but misleading in others. Among patients with pneumonia, the lateral view was helpful when the spine sign was present, but it was misleading when the spine sign was absent.

CONCLUSIONS

In this study of family physicians, the lateral chest radiograph did not improve overall diagnostic accuracy in patients with left lower lobe pneumonia. Among pneumonia patients with the spine sign, however, the lateral view was often helpful.

The utility of the frontal chest radiograph in the evaluation of chest drain placement

AIM

To define the utility of the frontal chest radiograph in the assessment of chest drain position.

PATIENTS AND METHODS

Fifty-six frontal chest radiographs in 45 patients with 61 chest drains (18 anterior, 9 interlobar, and 34 posterior position) were reviewed retrospectively to determine radiographic characteristics.

RESULTS

Eighty-nine percent of the anterior drains demonstrated a curved appearance at the insertion site, while 50% of posterior drains and all interlobar drains were straight at the insertion site. A curved intrapleural drain was a common finding when positioned anteriorly and posteriorly (67% and 59%, respectively). Interlobar drains were often straight throughout their course (89%). The tips of interlobar drains were usually positioned at the hilum (89%).

CONCLUSION

Results suggest that interlobar positioning can be suspected on the frontal chest radiograph. A curving chest drain with straight appearance at the insertion site was indicative of a posterior location.

Coronary risk factors measured in childhood and young adult life are associated with coronary artery calcification in young adults: the Muscatine Study

OBJECTIVES

This study was designed to estimate the prevalence of coronary artery calcification in young adult men and women and to examine the association between the presence of coronary artery calcification and coronary risk factors measured in childhood and young adult life.

BACKGROUND

Electron beam computed tomography is a sensitive, noninvasive method for detecting coronary artery calcification, a marker of the atherosclerotic process. Coronary artery calcification is associated with coronary risk factors in older adults.

METHODS

Subjects (197 men, 187 women) had coronary risk factors measured in childhood (mean age 15 years) and twice during young adult life (mean ages 27 and 33 years). Each underwent an electron beam computed tomographic study at their second young adult examination.

RESULTS

The prevalence of coronary artery calcification was 31% in men and 10% in women. Increased body size, increased blood pressure and decreased high density lipoprotein (HDL) cholesterol levels were the coronary risk factors that showed the strongest association with coronary artery calcification. Significant odds ratios for coronary artery calcification, using standardized risk factor measurements at a mean age of 33 years in men and women, respectively, were 6.4 and 13.6 for the highest decile of body mass index, 6.4 and 6.4 for the highest decile of systolic blood pressure and 4.3 and 4.7 for the lowest decile of HDL cholesterol.

CONCLUSIONS

Coronary artery calcification is more prevalent in men in this young adult population. Coronary risk factors measured in children and young adults are associated with the early development of coronary artery calcification. Increased body mass index measured during childhood and young adult life and increased blood pressure and decreased HDL cholesterol levels measured during young adult life are associated with the presence of coronary artery calcification in young adults.

Varied radiologic appearances of pulmonary aspergillosis

Pulmonary aspergillosis represents a common, potentially lethal opportunistic infection that has four unique forms: allergic bronchopulmonary aspergillosis (ABPA), aspergilloma, and invasive and semi-invasive aspergillosis. In individuals who are at risk, pulmonary aspergillosis is characterized by a spectrum of clinical and radiographic findings that are intrinsically related to the status of the immune system or the presence of structural lung disease. ABPA, occurring almost exclusively in asthma patients, is characterized radiographically by fleeting pulmonary alveolar opacities caused by deposition of immune complexes and inflammatory cells within the lung parenchyma. Mucus plugging and bronchial wall thickening can be expected in time. Aspergilloma, occurring in patients with structural lung disease, typically appears radiographically as a focal intracavitary mass and is characterized initially by an increase in the wall thickness of a preexisting cavity or cyst. Invasive aspergillosis, which occurs primarily in profoundly immunocompromised patients, may exhibit nonspecific patchy nodular opacities or lobar-type air-space disease in cases with vascular invasion. Computed tomography may reveal a halo or ground-glass attenuation and is more accurate in the detection of early disease. Cavitation often develops with time and typically results in the air crescent sign. Semi-invasive aspergillosis is radiographically similar to the invasive form but differs in clinical course, being associated with mild immunosuppression or chronic illness and typically progressing over the course of months rather than weeks.

Electron-beam computed tomographic detection of coronary calcification in patients undergoing percutaneous transluminal coronary angioplasty: predictability of restenosis. A preliminary report

Coronary artery calcification is a recognized marker for coronary atherosclerosis; however, the relationship between calcification and the success of balloon angioplasty at a calcification site has not been determined. The purpose of this study was to evaluate whether the presence of coronary artery calcification, as detected by electron bean computed tomography (EBCT), was predictive of restenosis after percutaneous transluminal coronary angioplasty (PTCA). Site- specific coronary calcification was determined by EBCT in 20 patients with 24 lesions before, immediately after, and 2 to 18 month after PTCA. Calcification was scored using >130 Hounsfield units and >1.02-mm2 area criteria. Coronary calcium at the PTCA site was significantly greater in restenosed versus nonrestenosed patients (109.16 +/- 198.16 mm2 v 4.39 +/- 9.50 mm2) (P < .025). The amount of coronary calcium did not change as a result of the PTCA procedure (+2.72 +/- 22.31 mm2 v -4.81 +/- 7.82 mm2) (P = NS). The rate of progression of calcification was not greater in restenosed versus nonrestenosed patients (1.78 +/- 3.32 mm2/month v 0.09 +/- 0.19 mm2/mo) (P = NS). Site-specific coronary calcification as determined by EBCT appeared to be predictive of patients with an increased likelihood to restenose after PTCA. Further studies are needed to verify these observations in a considerably larger patient population.

Cranial osteomyelitis: diagnosis and follow-up with In-111 white blood cell and Tc-99m methylene diphosphonate bone SPECT, CT, and MR imaging

PURPOSE

To assess the usefulness of indium-111 white blood cell and technetium-99m methylene diphosphonate bone single photon emission computed tomography (SPECT), computed tomography (CT), and magnetic resonance (MR) imaging in cranial osteomyelitis.

MATERIALS AND METHODS

Twenty-six cases (25 patients: 13 male, 12 female; mean age, 55 years) of suspected osteomyelitis were evaluated. Sixteen were postoperative. Final diagnosis was established by means of bone culture in 18 cases and clinical follow-up in eight.

RESULTS

Of 35 CT scans, 10 were true-positive (TP); three false-negative (FN); 13, true-negative (TN); one, false-positive (FP); and eight, equivocal. Of 36 SPECT scans, 19 were TP; 13, TN; one, FP; one, FN; and two, equivocal. Of 11 MR images four were TP; five, TN; and two, FN.

CONCLUSION

CT is best for differentiation between soft-tissue and bone infection. MR imaging is best for assessment of the calvaria and skull base. SPECT is best for assessment of altered bone and may be the best technique for follow-up.

Evaluation of temporal and facial osteomyelitis by simultaneous In-WBC/Tc-99m-MDP bone SPECT scintigraphy and computed tomography scan

A reliable imaging technique is needed for follow-up of patients with temporal and facial osteomyelitis. Clinical outcome in 20 patients with suspected osteomyelitis of the temporal/mastoid, calvarium, and mandible facial bones was evaluated with 30 combined In-WBC/Tc-99m MDP bone single photon emission computed tomographic (SPECT) scans and 27 computed tomographic scans. Simultaneous dual-tracer 25-minute SPECT scans were acquired 18 to 20 hours after radiotracer injection by use of a three-detector system. Diagnosis of the 20 patients (age range, 3 to 74 years) included 8 with facial osteomyelitis, 6 with malignant otitis externa, 3 with mandibular osteomyelitis, and 3 with calvarial osteomyelitis. Diagnosis was confirmed by biopsy/culture results in 18 patients and by endoscopic and clinical evaluation in 2 patients with initial negative scans. Of the 30 In-WBC/MDP scans, 15 were true-positive, 13 true-negative, 1 false-negative, and 1 equivocal. Of a total of 27 CT scans, 9 were true-positive, 5 false-negative, and 1 equivocal in patients with biopsy-proven osteomyelitis. Three computed tomographic scans were false-positive and 1 was equivocal in patients without osteomyelitis, because of concurrent postoperative bone abnormalities. Additionally, 8 computed tomographic scans were true-negative. These results suggest that dual In-WBC/Tc-99m MDP bone SPECT scintigraphy provides an accurate imaging modality for diagnosis and follow-up of temporal and facial osteomyelitis when existing clinical or postoperative bone changes make it difficult to detect active osteomyelitis by computed tomographic scan.

Electron beam computed tomographic imaging of aortic aneurysms and dissections

Electron Beam Computed Tomography (EBCT), like conventional CT has the capability to acquire high resolution images of the aorta. The millisecond image acquisition time characteristic of EBCT makes it an ideal modality to evaluate patients with suspected aneurysms or dissections of the aorta. Unlike conventional CT, electron beam technology produces images with excellent resolution, minimal respiratory artifact, and superior vascular enhancement. Compared with alternative modalities, EBCT probably represents a superior tool in the workup of aortic pathology. Whether in the acute or chronic setting, the reliability, speed, ease, and reproducibility of EBCT makes it truly superior in the diagnosis and follow-up of aortic aneurysms and dissections.

Evaluation of cardiac function with ultrafast computed tomography

Ultrafast computed tomography (UFCT) possesses many features that make it uniquely capable in performing measurements of cardiac function. Over the years, numerous validation studies have verified UFCT's ability to provide qualitative and quantitative information about cardiac performance. Documented accuracy and reproducibility in measuring functional parameters, such as volume, mass, contractility, and cardiac output, make UFCT a valuable tool in cardiac imaging.

Contrast-enhanced thin slice ultrafast computed tomography for the detection of small pulmonary emboli. Studies using autologous emboli in the pig

RATIONALE AND OBJECTIVES

Ultrafast computed tomography (UFCT) has proven useful, but is of limited practical application in the diagnosis of central pulmonary embolism; however, its ability to detect more peripheral emboli has not been established. In this study, the use of contrast-enhanced UFCT images for the detection of autologous peripheral pulmonary emboli in the pig is evaluated.

METHODS

A single autologous embolus measuring 0.7 x 1.5 cm was introduced into the superior vena cava of eight pigs. Contiguous, 3-mm axial UFCT images from the lung apex to the base were obtained before and after the introduction of the embolus. After scanning, the pigs were killed, and the thorax was removed intact and was frozen in a dry ice-alcohol mixture. Later, the thorax was sliced at 10-mm thicknesses, and the locations of the emboli were determined by a pulmonary pathologist blinded to the imaging results. Concomitantly, the locations of the emboli were determined by consensus of three chest radiologists blinded to the autopsy results.

RESULTS

In 6 of 8 animals with emboli, the embolus location correlated exactly with the autopsy findings. In one, the embolus was on the same side, but 1.6 cm further distal. In the other, a marking suture was identified, but no clot was identified on the pathologic or UFCT examination. In the eight animals scanned before the introduction of the embolus, no embolus was found. Interobserver agreement was 100%.

CONCLUSIONS

Ultrafast computed tomography has the potential to detect autologous emboli in second- to fourth-division pulmonary vessels. Further studies are needed to determine if in vivo emboli can be similarly visualized.

Coronary artery calcification: clinical significance and current methods of detection

Coronary artery disease affects 1,500,000 Americans each year; 500,000 of these will die. The earliest detectable lesion of coronary atherosclerosis is the fatty streak. Later, crescent-shaped lipid plaques occur, which may rupture and produce either progressive stenosis or sudden occlusion with myocardial infarction. Calcium is deposited early in the formation of the atherosclerotic plaque, and calcification can be used as a marker of the atherosclerotic process. Many imaging techniques can be used to detect calcification of coronary arteries. The most promising are fluoroscopy, ultrafast CT, and intravascular sonography. Detection of calcification is most valuable in persons less than 40 years old in whom modification of risk factors may be important. In addition, the progression and possible regression of calcification can be used as an indicator of the atherosclerotic process. The absence of calcification in coronary arteries may diminish the need for further testing.

Coronary artery visualization using ultrafast computed tomography

The advantages and limitations of ultrafast computed tomography in the imaging of normal and pathologic conditions of the coronary artery are discussed. The scanner's speed, resolution, and lack of significant motion artifact enhance the visualization of coronary arteries. Coronary artery calcification also is well visualized, and coronary artery fistuli, coronary bypass graft patency, and Kawasaki disease can be assessed accurately using contrast-enhanced flow studies. The inability to image stenoses and the lack of longitudinal images detract from its usefulness. Future scanner upgrades to provide increased resolution and thinner slices should improve the scanner's ability to evaluate the coronary artery.

Automated myocardial edge detection on MR images: accuracy in consecutive subjects

The authors previously demonstrated the feasibility of graph-searching-based automated edge detection in cardiac magnetic resonance (MR) imaging. To further assess the clinical utility of this method, unselected images from 11 consecutive subjects undergoing clinically indicated (except for one healthy volunteer) short-axis spin-echo MR imaging were analyzed. A total of 142 images from the 11 subjects, encompassing the left ventricle from apex to outflow tract, were analyzed. The computer algorithm correctly identified complete endocardial and epicardial contours in 121 of 142 images (85%). Correlations between observer-traced and computer-derived epicardial areas for all images were good (r = .71 for epicardium, r = .83 for endocardium); they improved for a subset of higher-quality images (r = .82 for epicardium, r = .92 for endocardium). The authors conclude that the current data further support the usefulness of computer digital image processing in geometric analysis of cardiac MR image data.

Nonangiographic assessment of coronary artery bypass graft patency

Coronary artery bypass graft patency can be assessed using the indirect techniques of evaluating patients' symptoms and exercise tolerance, changes in stress electrocardiogram, radioisotope regional perfusion, and myocardial wall contraction. The direct techniques assess graft patency directly by visualizing grafts using conventional computed tomography (CT), ultrafast CT, magnetic resonance imaging, digital subtraction angiography, and echocardiography. The advantages and disadvantages of each of these modalities are reviewed. At the present time, ultrafast CT and possibly magnetic resonance imaging and Doppler appear to be the only techniques besides angiography that can consistently evaluate bypass graft patency. Although they have the advantage of being minimally invasive, they cannot show graft stenosis or sequential graft patency. These techniques are best used in following patients after coronary bypass graft surgery and ruling out graft closure as the source of chest pain.

Utility of ultrafast computed tomography in the detection of thoracic aortic aneurysms and dissections

The millisecond image acquisition time characteristic of the ultrafast computed tomography (UFCT) scanner makes it an ideal modality for evaluating patients with suspected vascular lesions of the thoracic aorta. Unlike conventional CT, the UFCT electron beam technology produces images with excellent resolution, minimal respiratory artifact, and superior vascular enhancement. This report discusses the (1) basic characteristics of the UFCT scanner as they relate to the imaging of the thoracic aorta, (2) UFCT appearances of uncomplicated and complicated aneurysms and dissections, (3) appropriate CT protocols used in the work-up of suspected thoracic aortic disease, and (4) strengths and weaknesses of other imaging modalities compared with UFCT.

Evaluation of great heart vessels and pulmonary vasculature

This year's literature relating to imaging of the great heart vessels was devoted primarily to measurements of aortic size and to comparisons of imaging modalities in evaluating aortic aneurysms, dissections, and coarctation. The imaging modalities compared were plain chest roentgenography, conventional CT, ultrafast CT, MR imaging, transcutaneous esophageal echocardiography, and Doppler echocardiography. The pulmonary vasculature literature dealt with MR imaging of pulmonary vessels and the estimations of pulmonary pressure using echocardiography and Doppler techniques.

Two new uses of 8-F feeding tube in performing injecting urethrograms

A modification of a previously described method for visualizing the urethrovesical junction is described. This modification is easier to perform, less messy, and obtains superior images to the method now used. A new method for outlining urethral strictures is also described. Both methods use an 8-F feeding tube.

Thrombus-trapping efficiency of the Greenfield filter in vivo

A total of 100 radiopaque blood clots were injected into seven adult sheep under fluoroscopic observation to assess the clot-trapping efficiency of the Greenfield vena caval filter. Eleven percent of the clots passed through the filter, with all failures limited to the two smallest clot sizes: 4 x 10 mm (five of 25) and 4 x 30 mm (six of 25). The Greenfield filter was 100% efficient in trapping larger clots (8 x 10 mm and 8 x 30 mm). There was a tendency toward poorer clot-trapping performance when the Greenfield filter was tilted within the vena cava, but this was not significant. There were no significant differences in hemodynamic measurements obtained immediately before and after injection of each clot, and no significant changes were noted in the animal's hemodynamic status or in blood gas measurements in those cases in which the clots passed through the filter. Since the caval diameter in sheep approximates that in humans, the authors conclude that the Greenfield filter in the clinical setting is capable of stopping large, likely fatal, emboli and a large number of smaller, possibly less clinically significant, emboli.

Incidental fibromuscular dysplasia in potential renal donors: long-term clinical follow-up

The clinical natural history of renal arterial fibromuscular dysplasia (FMD) in patients with normal blood pressure is unknown, to the authors' knowledge. The authors reviewed the results of 1,862 renal angiograms obtained in potential renal donors. FMD was present in 71 patients (3.8%). The average age at which FMD was discovered was 50.8 years. Seventy-five percent of the patients with FMD were female. Of 30 patients who did not undergo nephrectomy, eight (26.6%) developed hypertension over a mean followup interval of 7.5 years. Of 19 patients who underwent nephrectomy, despite the presence of FMD, five (26.3%) developed hypertension over a mean follow-up interval of 4.4 years. In comparison, three subjects (6.1%) (from a randomized control group of 49 age- and sex-matched healthy individuals) developed hypertension over a mean follow-up period of 7.1 years. The authors conclude that asymptomatic middle-aged individuals with renal FMD develop hypertension at a rate greater than that of age-matched control subjects with normal blood pressure.

Traumatic brain stem injury: MR imaging

Eighty-seven patients with acute (n = 70) or chronic (n = 17) head injuries were prospectively studied with magnetic resonance (MR) imaging and computed tomography (CT) to characterize the frequency and nature of traumatic brain stem injury (BSI). Forty-eight traumatic lesions were identified in 36 patients. Of 36 patients, 35 had neurologic findings that corroborated the radiographic impression of BSI. T1- and T2-weighted MR images demonstrated a significantly higher number of lesions than did CT. Patients with BSI had a significantly higher frequency of corpus callosum and diffuse axonal "shear" lesions. The number of cortical contusions and extraaxial hematomas was similar in both groups. The mean Glasgow Coma Scale (GCS) scores at admission were significantly lower in patients with evidence of BSI on MR images. Patients with primary BSI had lower initial GCS scores, a longer duration of coma, more diffuse axonal "shear" lesions, and a higher frequency of corpus callosum injury than patients with secondary BSI. The location of primary and secondary lesions was significantly different. Overall, MR imaging was more helpful than CT in detecting, localizing, and characterizing BSI.

Gastroschisis and omphalocele: prenatal diagnosis and perinatal management

Obstetric ultrasonography has made the prenatal diagnosis of gastroschisis and omphalocele more common. We present illustrative cases and review the ultrasonographic features. Because of the increased risk of concomitant abnormalities (including trisomies) with omphalocele, full evaluation is indicated when this diagnosis is suspected. Recent perinatal approaches to delivery have favoured caesarean section, without scientific evidence that outcome is improved. Our experience, as well as a review of the literature, suggests that the outcome for vaginally delivered infants is acceptable. A prospective study of this question is needed.

An efficient technique for laboratory rearing of Simulium verecundum S. & J. (Diptera; Simuliidae)

A series of 10 similar rearing vessels, each containing 500 ml of water circulated by a rotating magnetic stirring bar, was used to rear cohorts of 50 first-instar Simulium verecundum larvae to adults. Ground 'TETRA' tropical fish meal was used as food. The culture water was replaced daily to remove toxic nitrogenous products excreted by the larvae. In three experiments, the mean [Formula: see text] survival rates were 71.60 ± 3.19%, 81.73 ± 2.78%, and 66.60 ± 2.60%; larval development was reasonably synchronous and the median periods required for growth from first instar to adult were 25, 22, and 21 days.

Studies on the attraction of Simulium damnosum s.l. (Diptera: Simuliidae) to its hosts. III. Experiments with animal-baited traps

In the forest zone of the United Republic of Cameroon, a live chicken proved far more attractive to hunting S. damnosum s.l. than did a live sheep; but in the Sudan-savanna zone, a sheep was more attractive than a chicken. It is suggested that the populations of flies in the two areas represented different species of the S. damnosum s.l. complex with different host-finding mechanisms, that in the forest (? S. squamosum) hunting mainly by smell, and that in the Sudan savanna (? S. damnosum s.s.) hunting mainly by sight.

Studies on the attraction of Simulium damnosum s.l. (Diptera: Simuliidae) to its hosts. II. The nature of substances on the human skin responsible for atrractant olfactory stimuli

In the Cameroon rain-forest, electric fan traps, baited with trousers which had been worn by men for several days, captured more females of S. damnosum s.l. than did traps baited with worn shirts of similar material. A number of human body fluids were used as bait, but only sweat appeared to contain the olfactory attractant(s). The fluid portion of filtered arm sweat attracted more flies than did the residue. The attractant substances from human skin would not dissolve directly in organic solvents, but when an artificial sweat solution was used to swab men's arms and legs, and this was then saturated with salt and shaken with an organic solvent, the extract was attractive to S. damnosum. Treatment of attractive worn cloths with dilute aqueous solutions of hydrochloric acid, sodium hydroxide or mercuric chloride greatly reduced their attractiveness. A number of organic compounds which occur on the human skin were found to be ineffective as attractants.

Hereditary deficiency of the third component of complement in a child with fever, skin rash, and arthralgias: response to transfusion of whole blood

A previously well 34-month-old male presenting with fever, skin rash, and arthralgias was found to lack C3 by immunochemical (undetectable) and hemolytic (1% normal) assays. No infectious agent could be demonstrated. Protein levels of Clq. C4, C5, properdin, and C3b-INA and hemolytic activities of complement components C1 to C9 except C3 were normal or elevated; total hemolytic complement activity was 13% of normal and was reconstituted by purified C3. Properdin factor B was 702 (normal 175 to 275) mug/ml, and was not cleaver upon addition of zymosan or cobra venom factor. The serum had normal immune adherence activity, but was deficient in ability to opsonize Candida albicans for uptake and Escherichia coli for killing by neurophils, generate neutrophil chemotactic factors and inhibit the growth of E. coli; these activities were restored by purified C3. A transfusion of 320 ml 1-hour-old normal whole blood on the fifty-second day resulted in transitory elevation of the C3 level to 25 mg/dl with a fall-off (approximately 2 1/2% per hour) to undetectable levels by 69 hours; it was followed by disappearance of the skin rash and arthralgias and return to normal of the previously elevated temperature and CRP levels. C3 levels in family members (seven of 24 half-normal), lack of anti-C3 activity, normal C3b-INA levels and a normal rate of catabolism of transfused C3 indicated that the deficiency was inherited with autosomal codominance and involved decreased synthesis of C3. Thus, this child is a unique individual with inherited C3 deficiency presenting with absence of repeated infections, whose symptoms of fever, skin rash, and arthralgia were abated by whole blood transfusion.

Studies on the attraction of Simulium damnosum s.l. (Diptera: Simuliidae) to its hosts. I. The relative importance of sight, exhaled breath, and smell

Four traps used in capturing hunting female S. damnosum s.l. are discribed: the slat trap, the enclosure trap, the fan trap, and the sticky trap. In forest a man hidden inside a trap, but removing his exhaled breath through a long hose, attracted 4 times as many flies as did an unbaited trap. When the man exhaled normally into the trap the number of flies taken rose again by a further factor of 4. Carbon dioxide gas, emitted from inside the trap attracted some two-thirds as many flies as a man exhaling normally inside the trap. In both forest and Sudan-savanna environments the catches of a man stationed on an open stretch of land and fully exposed to view while his exhaled breath was removed through a long hose, were not substantially lower than those of a man in a similar situation who exhaled normally. In forest a motionless man, partly hidden among vegetation, attracted fewer flies than a moving man who was fully exposed to view (a) when both men removed their exhaled breath through long hoses, and (b) when they exhaled normally. In the forest a trap baited with CO2 gas (250 cc per min) caught more flies than a similar, unbaited trap, but the preformance of CO2-baited traps, as compared with that of human collectors, was highly variable. Catches in CO2-baited traps were uniformly low in the Sudan-savanna. In forest, removal of olfactory substances from the human skin, by vigorous washing and application of petroleum jelly, or by wearing impermeable clothing, greatly reduced the numbers of flies attracted. No such reduction was observed in Sudan savanna. In the forest, cloths, worn by men for several days and then used as bait, attracted about 10 times as many flies as did similar, unworn cloths. Addition of CO2 gas produced a 4-fold increase in the attractiveness of worn cloths and an 18-fold increase in that of unworn cloths. No corresponding experiments were done in the savanna. Fan traps could become contaminated by human handling during the assembly and setting-up procedures. They were thus rendered attractive to flies. In the Sudan-savanna, the catches of men positioned in front of warm rock surfaces were lower than those of men stationed on coller, sandy surfaces. This suggests that body heat may be an additional attractant factor. The results suggest that "forest" S. damnosum s.l. (presumably S. squamosum) females rely heavily on smell as an attractant and, to a lesser extent, on sight and exhaled breath. Smell appears to be the only obligatory attractant, and it can act by itself. This raises the possibility that a trap might be developed which incorporates only smell stimuli as bait. For "savanna" S. damnosum s.l. (presumably S. damnosum s.s.) neither smell nor exhaled breath appear to be important attractants, and some other factor, perhaps sight, appears to be the dominant attractant in this zone.

Studies on the flight range and dispersal of Simulium damnosum (Diptera: Simuliidae) in the rain-forest of Cameroon

Five marking/recapture experiments were carried out on Simulium damnosum in the rain-forest of the United Republic of Cameroon, in order to determine the regression in biting density at increasing distances from the marking point. Flies were captured unfed, marked with fluorescent dust, and then released on the bank of a large river. Recaptures were made over the six-seven days after marking, at seven stations situated from 200 m to 79 km along a large river, from the marking site. Marked flies, which showed fluorescent pigment when examined under an ultraviolet lamp, were recovered at all seven sites. The ratios of the number of recaptures per man-hour at each distant site to the recaptures per man-hour at the marking point were calculated to obtain values for the proportional biting density (Z). The value of Z declined in a logarithmic manner with increasing distance from the marking site, such that it fell to 0-1 at distances of 34-1 km on a large river, 5-5 km on a small river, and 1-5 km on a road leading away from a large river. The peak number of flies recaptured at the farthest sites along a large river (56 km and 79 km) occurred one day later than at the station nearest the marking point. The dispersal of marked flies which had fed on volunteers carrying Onchocerca volvulus microfilariae, was studied along a large river. Of three flies recaptured 24 km upstream from the marking point, one contained 10 infective larvae of O. volvulus.

The intervals between the blood-meals of man-biting Simulium damnosum (Diptera: Simuliidae)

Six marking-recapture experiments were carried out with Simulium damnosum in the Cameroon Republic, five in the rain-forest and one in the Sudan-savanna zone. Adult flies were marked by applying a small spot of oil paint to the mesonotum while they were engorging with blood on the legs of volunteers infected with Onchocerca volvulus microfilariae. Catches of wild flies were carried out for 12-13 days after the first day of marking, and all marked flies recaptured were examined. Some of the flies recaptured on days 0, 1 and 2 were nulliparous and had probably been disturbed by the application of the paint before they had completed their blood-meal. The frequency distribution of recaptured marked parous flies returning for their "second" blood-meal rose to a peak early on day 4, but more flies returned earlier,three days after taking a blood-meal, than later on day 5. After day 5, the numbers of recaptured flies were too low to demonstrate any peaks corresponding to "third" and later blood-meals. The longest surviving fly was recaptured 10 days after marking. Twenty-six percent of the flies recaptured on days 3 and 4 contained developing O. volvulus larvae three-five days old, which had presumably been ingested as microfilariae during the blood-meal taken on day 0. Infective larvae first appeared in flies returning late on day 6, and the highest percentage of infective flies occurred on day 7. Infective larvae were found in recaptured flies until day 10, the last day on which marked flies were recovered. Of 929 flies marked on the Sudan-savanna experiment, three (0-32%) flies were recaptured. Two returned on day 4 and one on day 6.