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From tinnitus to acute hepatitis: Drug-induced injury caused by use of naftidrofuryl for one year. Clin Res Hepatol Gastroenterol 2019; 43:e93-e94. [PMID: 31023552 DOI: 10.1016/j.clinre.2019.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Accepted: 03/11/2019] [Indexed: 02/04/2023]
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NBS, nettoyons en bonne santé ! ARCH MAL PROF ENVIRO 2012. [DOI: 10.1016/j.admp.2012.03.231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Abstract
Osteoarthritis, based on either cartilage injury or degeneration, is a leading cause of disability in the United States. Over the last several decades, much progress has been made in understanding cartilage injury and repair. Magnetic resonance (MR) imaging, with its unique ability to noninvasively image and characterize soft tissue, has shown promise in assessment of cartilage integrity. In addition to standard MR imaging methods, MR imaging contrast mechanisms under development may reveal detailed information regarding the physiology and morphology of cartilage. MR imaging will play a crucial role in assessing the success or failure of therapies addressing cartilage injury and degeneration.
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A statistical 3-D pattern processing method for computer-aided detection of polyps in CT colonography. IEEE TRANSACTIONS ON MEDICAL IMAGING 2001; 20:1251-60. [PMID: 11811825 DOI: 10.1109/42.974920] [Citation(s) in RCA: 83] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Adenomatous polyps in the colon are believed to be the precursor to colorectal carcinoma, the second leading cause of cancer deaths in United States. In this paper, we propose a new method for computer-aided detection of polyps in computed tomography (CT) colonography (virtual colonoscopy), a technique in which polyps are imaged along the wall of the air-inflated, cleansed colon with X-ray CT. Initial work with computer aided detection has shown high sensitivity, but at a cost of too many false positives. We present a statistical approach that uses support vector machines to distinguish the differentiating characteristics of polyps and healthy tissue, and uses this information for the classification of the new cases. One of the main contributions of the paper is the new three-dimensional pattern processing approach, called random orthogonal shape sections method, which combines the information from many random images to generate reliable signatures of shape. The input to the proposed system is a collection of volume data from candidate polyps obtained by a high-sensitivity, low-specificity system that we developed previously. The results of our ten-fold cross-validation experiments show that, on the average, the system increases the specificity from 0.19 (0.35) to 0.69 (0.74) at a sensitivity level of 1.0 (0.95).
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Algorithms
- Colonic Polyps/diagnostic imaging
- Colonography, Computed Tomographic/classification
- Colonography, Computed Tomographic/methods
- Colonography, Computed Tomographic/statistics & numerical data
- Diagnosis, Differential
- Female
- Humans
- Imaging, Three-Dimensional/methods
- Imaging, Three-Dimensional/statistics & numerical data
- Male
- Middle Aged
- Pattern Recognition, Automated
- ROC Curve
- Radiographic Image Interpretation, Computer-Assisted/methods
- Reproducibility of Results
- Sensitivity and Specificity
- Tomography, X-Ray Computed/methods
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Dynamic MR imaging and stress testing in glenohumeral instability: comparison with normal shoulders and clinical/surgical findings. J Magn Reson Imaging 2001; 13:748-56. [PMID: 11329197 DOI: 10.1002/jmri.1104] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Our objectives were to test the hypotheses that: 1) during shoulder motion, glenohumeral alignment differs between asymptomatic shoulders and those with symptomatic instability; 2) during magnetic resonance (MR)-monitored physical exam or stress testing, glenohumeral alignment differs between asymptomatic shoulders and those with instability; and 3) glenohumeral translation during MR stress testing correlates with findings of shoulder instability by clinical exam and exam under anesthesia (EUA). Using an open-configuration 0.5 T MR imaging (MRI) system, we studied symptomatic shoulders in 11 subjects and compared them to their contralateral asymptomatic shoulders. Each shoulder was studied during abduction/adduction and internal/external rotation to determine the humeral head position on the glenoid. An examiner also performed the MR stress test on each shoulder by applying manual force on the humeral head during imaging. All shoulders were assigned an instability grade from the MR stress test, and this grade was correlated with: 1) clinical exam grade assigned during preoperative assessment by an orthopedic surgeon and 2) intraoperative instability grade by EUA immediately preceding arthroscopy. With dynamic abduction and internal/external rotation, the humeral head remained centered on the glenoid in 9 of 11 shoulders, but in two subjects there were dramatic demonstrations of subluxation. With stress testing, a trend toward more joint laxity was demonstrated in symptomatic than in asymptomatic joints (P = 0.11). MR grading of instability correlated directly with clinical grading in six cases and underestimated the degree of instability relative to clinical exam in the other cases. MR instability grading systematically underestimated instability compared with EUA in 7 of the 10 cases that underwent surgical repair. We concluded that dynamic MR evaluation of glenohumeral alignment did not demonstrate abnormalities in symptomatic shoulders in 8 of 10 patients, whereas 2 patients showed dramatic findings of subluxation. Manual stress testing during dynamic MR examination showed a strong correlation with clinical instability grading. Dynamic shoulder MR examination during stress testing could, with further validation, become a useful adjunct to shoulder instability evaluations. J. Magn. Reson. Imaging 2001;13:748-756.
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Abstract
OBJECTIVE Clinically, three-dimensional CT of the extremities is most often used to display bony anatomy. However, by combining unenhanced CT with volume-rendering computer graphics, visualization of relationships between bone and soft-tissue structures such as muscle tendon is also possible. The aims of this study were to quantify CT attenuation values of peripheral tendon, muscle, and bone on unenhanced CT and to develop custom opacity transforms on the basis of the attenuation measurements to effectively depict tendon-muscle-bone relationships. CONCLUSION The mean attenuation of peripheral tendon ( approximately 100 H) is distinctly higher than that of muscle ( approximately 60 H) enabling high-quality volume rendering of muscle-tendon-bone relationships with unenhanced CT. High-frequency (bone) CT reconstruction algorithms commonly used for extremity CT produce approximately twofold higher image noise and inferior three-dimensional renderings compared with those based on less noisy standard or soft-tissue reconstruction algorithms. These concepts can be used to uniquely reveal tendon-muscle-bone relationships for clinical, scientific, and educational purposes.
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Multidetector CT of the pancreas and bile duct system: value of curved planar reformations. AJR Am J Roentgenol 2001; 176:689-93. [PMID: 11222206 DOI: 10.2214/ajr.176.3.1760689] [Citation(s) in RCA: 93] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Abstract
PURPOSE To compare the effects of acquisition parameters on the magnitude and appearance of artifacts between single and multiple detector-row helical computed tomography (CT). MATERIALS AND METHODS A cylindric (12.7 x 305.0-mm) acrylic rod inclined 45 degrees relative to the z axis was scanned at the isocenter and 100 mm from the isocenter with single detector-row (single-channel) helical CT (beam width, 1-10 mm; pitch, 1.0, 2.0, or 3.0) and multiple detector-row (four-channel) helical CT (detector width, 1. 25, 2.5, 3.75, and 5 mm; pitch, 0.75 or 1.5). The SD of radius measurements along the rod (SD(r)) was used to quantify artifacts in all 72 data sets and to analyze their frequency patterns. Volume-rendered images of the data sets were ranked by six independent and blinded readers; findings were correlated with acquisition parameters and SD(r) measurements. RESULTS SD(r) was smaller in four- than in single-channel helical CT for any given table increment (TI). In single-channel helical CT, SD(r) increased linearly with beam width and geometrically with pitch. In four-channel helical CT, SD(r) measurements were directly proportional to the TI, regardless of the detector width and pitch combination used. Off-center object position on average increased SD(r) by a factor of 1.6 for single-channel helical CT and by a factor of 2.0 for four-channel helical CT. Subjective rankings of image quality correlated excellently with SD(r) (Spearman r = 0.94, P <.001). CONCLUSION Artifacts are quantitatively and subjectively smaller with four- compared with single-channel helical CT for any given TI.
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Abstract
An abdominal computed tomographic scan was modified by inserting 10 simulated colonic polyps with use of methods that closely mimic the attenuation, noise, and polyp-colon wall interface of naturally occurring polyps. A shape-based polyp detector successfully located six of the 10 polyps. When settings that enhanced the edge profile of polyps were chosen, eight of 10 polyps were detected. There were no false-positive detections. Shape analysis is technically feasible and is a promising approach to automated polyp detection.
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Abstract
PURPOSE To present our early experience with a classification scheme for categorizing focal liver lesions on the basis of the enhancement patterns that they exhibit in the arterial phase of computed tomography (CT) and to determine whether particular enhancement patterns suggest particular diagnoses. MATERIALS AND METHODS The authors reviewed arterial phase CT images in 100 consecutive patients with focal liver lesions, excluding simple cysts. The enhancement pattern of the dominant or representative lesion in each patient was classified into one of five categories-homogeneous, abnormal internal vessels or variegated, peripheral puddles, complete ring, or incomplete ring-by three radiologists blinded to the proved diagnosis. Lesions without enhancement were recorded separately. Agreement was reached by consensus in all cases. Standards of reference included findings at histologic examination, correlative imaging, or clinical and imaging follow-up. RESULTS Ninety-two percent of the 100 lesions demonstrated arterial phase enhancement. Patterns associated with positive predictive values of 82% or greater and specificity of 80% or greater included abnormal internal vessels or variegated (hepatocellular carcinoma), peripheral puddles (hemangioma), and complete ring (metastasis). CONCLUSION The appearance of hepatic lesions in the arterial phase of enhancement has potential use in the determination of specific diagnoses. The classification scheme used in this study may be a useful tool for the interpretation of arterial phase CT studies.
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Abstract
PURPOSE To compare computed tomographic (CT) angiography and conventional angiography for determining the success of endoluminal stent-graft treatment of aortic aneurysms. MATERIALS AND METHODS Forty patients underwent conventional angiography and CT angiography following treatment of aortoiliac aneurysms with endoluminal stent-grafts. Six additional sets of conventional angiographic-CT angiographic examinations were performed in five patients after placement of additional stent-grafts or coil embolization to treat perigraft leakage. Three faculty CT radiologists who were blinded to patient clinical data and outcome independently interpreted the CT angiograms, and three faculty angiographers, who were not involved in the stent-graft deployment, interpreted the conventional angiograms. Images were assessed for the presence of postdeployment complications. A reference standard was developed by experienced radiologists using all available images and clinical data. Sensitivities, specificities, and kappa values were calculated. RESULTS Perigraft leakage was the most commonly identified complication. Twenty perigraft leaks were detected in the results of 46 examinations. Sensitivities and specificities for detecting perigraft leakage were 63% and 77% for conventional angiography and 92% and 90% for CT angiography, respectively. The kappa value was 0. 41 for conventional angiography and 0.81 for CT angiography. CONCLUSION CT angiography is the preferred method for establishing the presence of perigraft leakage following treatment of aortoiliac aneurysms with stent-grafts.
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Abstract
PURPOSE The purpose of this study was to demonstrate the limitations to the effectiveness of CT colonography, colloquially called virtual colonoscopy (VC), for detecting polyps in the colon and to describe a new technique, map projection CT colonography using Mercator projection and stereographic projection, that overcomes these limitations. METHOD In one experiment, data sets from nine patients undergoing CT colonography were analyzed to determine the percentage of the mucosal surface visible in various visualization modes as a function of field of view (FOV). In another experiment, 40 digitally synthesized polyps of various sizes (10, 7, 5, and 3.5 mm) were randomly inserted into four copies of one patient data set. Both Mercator and stereographic projections were used to visualize the surface of the colon of each data set. The sensitivity and positive predictive value (PPV) were calculated and compared with the results of an earlier study of visualization modes using the same CT colonography data. RESULTS The percentage of mucosal surface visualized by VC increases with greater FOV but only approaches that of map projection VC (98.8%) at a distorting, very high FOV. For both readers and polyp sizes of > or =7 mm, sensitivity for Mercator projection (87.5%) and stereographic projection (82.5%) was significantly greater (p < 0.05) than for viewing axial slices (62.5%), and Mercator projection was significantly more sensitive than VC (67.5%). Mercator and stereographic projection had PPVs of 75.4 and 78.9%, respectively. CONCLUSION The sensitivity of conventional CT colonography is limited by the percentage of the mucosal surface seen. Map projection CT colonography overcomes this problem and provides a more sensitive method with a high PPV for detecting polyps than other methods currently being investigated.
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Glenohumeral relationships during physiologic shoulder motion and stress testing: initial experience with open MR imaging and active imaging-plane registration. Radiology 1999; 212:699-705. [PMID: 10478235 DOI: 10.1148/radiology.212.3.r99se31699] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To test the hypotheses that open dynamic magnetic resonance (MR) imaging can (a) be used to evaluate and define normal shoulder motion in active joint motion and muscle contraction and (b) be used in conjunction with physical examination. MATERIALS AND METHODS With an open-configuration, 0.5-T MR imaging system and active image-plane tracking, 10 shoulders were studied in five asymptomatic subjects to establish normal patterns of glenohumeral motion during abduction and adduction and internal and external rotation. Preliminary studies of physical examination during MR imaging, in which a physician examiner applied mechanical force to the humeral head, were also performed. RESULTS During abduction and adduction and internal and external rotation maneuvers with active subjects muscle contraction, the humeral head remained precisely centered on the glenoid fossa in all asymptomatic subjects, which is in agreement with findings of previous radiographic studies. Application of force to the humeral head by an examiner was associated with as much as 6 mm of anterior translation and 13 mm of posterior translation. CONCLUSION Dynamic MR imaging of the glenohumeral joint is possible over a wide range of physiologic motion in vertically open systems. Use of an MR tracking coil enabled accurate tracking of the anatomy of interest. These preliminary measurements of normal glenohumeral motion patterns begin to establish normal ranges of motion and constitute a necessary first step in characterizing pathologic motion in patients with common clinical problems such as instability and impingement.
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Abstract
A system for active scan plane guidance during kinematic magnetic resonance (MR) examination of joint motion was developed utilizing an external tracking coil and MR tracking software. In a phantom study and during upright, weight-bearing, physiologic knee flexion, the external tracking coil maintained the scan plane through desired structures. Thus, MR tracking provides a robust method to guide the scan plane during MR imaging of active joint motion.
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Display modes for CT colonography. Part II. Blinded comparison of axial CT and virtual endoscopic and panoramic endoscopic volume-rendered studies. Radiology 1999; 212:203-12. [PMID: 10405743 DOI: 10.1148/radiology.212.1.r99jl17203] [Citation(s) in RCA: 95] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To determine the sensitivity of radiologist observers for detecting colonic polyps by using three different data review (display) modes for computed tomographic (CT) colonography, or "virtual colonoscopy." MATERIALS AND METHODS CT colonographic data in a patient with a normal colon were used as base data for insertion of digitally synthesized polyps. Forty such polyps (3.5, 5, 7, and 10 mm in diameter) were randomly inserted in four copies of the base data. Axial CT studies, volume-rendered virtual endoscopic movies, and studies from a three-dimensional mode termed "panoramic endoscopy" were reviewed blindly and independently by two radiologists. RESULTS Detection improved with increasing polyp size. Trends in sensitivity were dependent on whether all inserted lesions or only visible lesions were considered, because modes differed in how completely the colonic surface was depicted. For both reviewers and all polyps 7 mm or larger, panoramic endoscopy resulted in significantly greater sensitivity (90%) than did virtual endoscopy (68%, P = .014). For visible lesions only, the sensitivities were 85%, 81%, and 60% for one reader and 65%, 62%, and 28% for the other for virtual endoscopy, panoramic endoscopy, and axial CT, respectively. Three-dimensional displays were more sensitive than two-dimensional displays (P < .05). CONCLUSION The sensitivity of panoramic endoscopy is higher than that of virtual endoscopy, because the former displays more of the colonic surface. Higher sensitivities for three-dimensional displays may justify the additional computation and review time.
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Abstract
PURPOSE To develop and validate a method for the insertion of digitally synthesized polyps into computed tomographic (CT) images of the human colon for use as ground truth for evaluation of virtual colonoscopy. MATERIALS AND METHODS Spiral CT simulator software was used to generate 10 synthetic polyps in various configurations. Additional software was developed to insert these polyps into volume CT scans. Ten polyps in eight patients were selected for comparison. Three radiologists evaluated whether two-dimensional (2D) CT images and three-dimensional (3D) volume-rendered CT images showed synthetic or real polyps. RESULTS Edge-response profiles and noise of simulated polyps matched those of native polyps. Frequency distributions of reviewers' responses were not significantly different for synthetic versus real polyps in either 3D or 2D images. Responses were clustered around the response of "unsure" if lesions were real or synthetic. Receiver operating characteristic curves had areas of 0.54 (95% CI = 0.39, 0.68) for 3D and 0.39 (95% CI = 0.25, 0.53) for 2D images, which were not significantly different from random guessing (P = .70 and .28 for 3D and 2D images, respectively). CONCLUSION Synthetic polyps were indistinguishable from real polyps. This method can be used to generate ground truth experimental data for comparison of CT colonographic display and detection methods.
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Magnetic resonance imaging of knee cartilage repair. Top Magn Reson Imaging 1998; 9:377-92. [PMID: 9894740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Cartilage injury resulting in osteoarthritis is a frequent cause of disability in young people. Osteoarthritis, based on either cartilage injury or degeneration, is a leading cause of disability in the United States. Over the last several decades, much progress has been made in understanding cartilage injury and repair. Magnetic resonance (MR) imaging, with its unique ability to noninvasively image and characterize soft tissue, has shown promise in assessment of cartilage integrity. In addition to standard MR imaging methods, MR imaging contrast mechanisms under development may reveal detailed information regarding the physiology and morphology of cartilage. MR imaging will play a crucial role in assessing the success or failure of therapies for cartilage injury and degeneration.
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Detection of colonic polyps in a phantom model: implications for virtual colonoscopy data acquisition. J Comput Assist Tomogr 1998; 22:656-63. [PMID: 9676463 DOI: 10.1097/00004728-199807000-00028] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE Virtual colonoscopy is a new method of colon examination in which computer-aided 3D visualization of spiral CT simulates fiberoptic colonoscopy. We used a colon phantom containing various-sized spheres to determine the influence of CT acquisition parameters on lesion detectability and sizing. METHOD Spherical plastic beads with diameters of 2.5, 4, 6, 8 and 10 mm were randomly attached to the inner wall of segments of plastic tubing. Groups of three sealed tubes were scanned at 3/1, 3/2, 5/1 collimation (mm)/pitch settings in orientations perpendicular and parallel to the scanner gantry. For each acquisition, image sets were reconstructed at intervals from 0.5 to 5.0 mm. Two blinded reviewers assessed transverse cross-sections of the phantoms for bead detection, using source CT images for images for acquisitions obtained with the tubes oriented perpendicular to the gantry and using orthogonal reformatted images for scans oriented parallel to the gantry. RESULTS Detection of beads of > or = 4 mm was 100% for both tube orientations and for all collimator/pitch settings and reconstruction intervals. For the 2.5 mm beads, detection decreased to 78-94% for 5 mm collimation/pitch 2 scans when the phantom sections were oriented parallel to the gantry (p = 0.01). Apparent elongation of beads in the slice direction occurred as the collimation and pitch increased. The majority of the elongation (approximately 75%) was attributable to changing the collimator from 3 to 5 mm, with the remainder of the elongation due to doubling the pitch from 1 to 2. CONCLUSION CT scanning at 5 mm collimation and up to pitch 2 is adequate for detection of high contrast lesions as small as 4 mm in this model. However, lesion size and geometry are less accurately depicted than at narrower collimation and lower pitch settings.
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Anterior cruciate ligament injury: fast spin-echo MR imaging with arthroscopic correlation in 217 examinations. AJR Am J Roentgenol 1998; 170:1215-9. [PMID: 9574587 DOI: 10.2214/ajr.170.5.9574587] [Citation(s) in RCA: 87] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Our objective was to evaluate the accuracy of MR imaging strategy that uses primarily fast spin-echo sequences for the diagnosis of anterior cruciate ligament tears. MATERIALS AND METHODS The original clinical interpretations of MR images of 217 examinations of the knee joint were correlated with subsequent arthroscopic results. Each MR examination included a double-echo fast spin-echo sequence as the only imaging sequence in the sagittal plane. Subsequent discordant MR and arthroscopic examinations were then subjected to reanalysis by two observers who were unaware of arthroscopic results to determine if misinterpretations were observer or image dependent. Two hundred sixteen patients who underwent MR imaging for suspected internal derangement of the knee subsequently underwent arthroscopic surgery. Two patients had both knees evaluated. One patient was excluded because he was referred for evaluation for osteomyelitis, not internal derangement. This yielded a total number of 217 MR examinations for suspected internal derangement of the knee. RESULTS For 56 arthroscopically proven tears, the sensitivity of MR imaging was 96%. The specificity was 98%, yielding an overall accuracy rate of 98%. The positive and negative predictive values were 95% and 99%, respectively. These values are within the ranges of previously reported MR imaging strategies using conventional spin-echo sequences. CONCLUSION Fast spin-echo MR imaging of the knee can be an alternative to conventional spin-echo imaging for the detection of anterior cruciate ligament tears.
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Abstract
In this paper, a novel technique for rapid and automatic computation of flight paths for guiding virtual endoscopic exploration of three-dimensional medical images is described. While manually planning flight paths is a tedious and time consuming task, our algorithm is automated and fast. Our method for positioning the virtual camera is based on the medial axis transform but is much more computationally efficient. By iteratively correcting a path toward the medial axis, the necessity of evaluating simple point criteria during morphological thinning is eliminated. The virtual camera is also oriented in a stable viewing direction, avoiding sudden twists and turns. We tested our algorithm on volumetric data sets of eight colons, one aorta and one bronchial tree. The algorithm computed the flight paths in several minutes per volume on an inexpensive workstation with minimal computation time added for multiple paths through branching structures (10%-13% per extra path). The results of our algorithm are smooth, centralized paths that aid in the task of navigation in virtual endoscopic exploration of three-dimensional medical images.
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MR arthrography of the wrist: scanning-room injection of the radiocarpal joint based on clinical landmarks. AJR Am J Roentgenol 1998; 170:606-8. [PMID: 9490938 DOI: 10.2214/ajr.170.3.9490938] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Do arterial phase helical CT images improve detection or characterization of colorectal liver metastases? J Comput Assist Tomogr 1997; 21:391-7. [PMID: 9135646 DOI: 10.1097/00004728-199705000-00010] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Our goal was to determine if arterial phase images from dual phase helical CT improve either the detection or the characterization of hepatic metastases in patients with colorectal carcinoma. Sixty-two patients with known colorectal cancer underwent 65 dual phase helical CT examinations to evaluate for possible liver metastases. Three blinded reviewers independently evaluated the portal venous phase images alone to determine if hepatic metastases were present or absent. Arterial phase images were then analyzed to determine if they identified additional lesions or aided in characterizing small hepatic lesions. Scores of the two methods for diagnosing metastases were compared with the "gold standard" established by a consensus panel of three other radiologists who reviewed all images together with clinical, pathologic, and other imaging data. The addition of arterial phase imaging did not detect any new metastases. However, in 6 of the 64 technically adequate examinations, hepatic arterial phase images increased lesion conspicuity and significantly increased diagnostic confidence when compared with portal vein phase scans alone. In patients with colorectal cancer, the addition of arterial phase imaging does not increase sensitivity, but improves the specificity in diagnosing liver metastases in a small number of cases. Dual phase helical CT does not appear to be indicated in the evaluation of liver metastases from colorectal cancer.
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The infraconal compartment: a multidirectional pathway for spread of disease between the extraperitoneal abdomen and pelvis. J Comput Assist Tomogr 1997; 21:223-8. [PMID: 9071290 DOI: 10.1097/00004728-199703000-00011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE The space below the kidneys where the anterior and posterior pararenal spaces converge has been defined only vaguley in the past. We describe observations on clinical CT cases and studies on cadavers that lead to a refinement in the terminology for this extraperitoneal compartment. METHOD Abdominal/pelvic CT scans from 18 patients and the scans of 2 cadavers injected in the femoral region with iodinated contrast material were reviewed concerning the location and distribution of fluid or gas collections relative to the renal fascial enclosure. RESULTS Pathologic processes involving the anterior or posterior pararenal spaces in addition to the pelvic extraperitoneal spaces were always accompanied by collections in the space below the cone of renal fascia. CONCLUSION The term infraconal compartment is a suggested term for the caudal continuation of the anterior and posterior pararenal spaces. This compartment serves as an important multidirectional pathway for the spread of disease between the extraperitoneal abdomen and the pelvis. Fluid collections within this compartment have a characteristic CT appearance.
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Abstract
PURPOSE To use perspective volume rendering (PVR) of computed tomographic (CT) and magnetic resonance (MR) imaging data sets to simulate endoscopic views of human organ systems. MATERIALS AND METHODS Perspective views of helical CT and MR images were reconstructed from the data, and tissues were classified by assigning color and opacity based on their CT attenuation or MR signal intensity. "Flight paths" were constructed through anatomic regions by defining key views along a spline path. Twelve movies of the thoracic aorta (n=3), tracheobronchial tree (n=4), colon (n=3), paranasal sinuses (n=1), and shoulder joint (n=1) were generated to display images along the flight path. All abnormal results were confirmed at surgery. RESULTS PVR fly-through enabled evaluation of the full range of tissue densities, signal intensities, and their three-dimensional spatial relationships. CONCLUSION PVR is a novel way to present volumetric data and may enable noninvasive diagnostic endoscopy and provide an alternate method to analyze volumetric imaging data for primary diagnosis.
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Abstract
A simple method was devised to reduce ringing and blurring artifacts caused by discontinuous T2 weighting of k-space data in fast spin-echo magnetic resonance (MR) imaging. The method demodulates the weighting function along the phase-encoding direction by using multiple T2 values derived from a set of non-phase-encoded echoes obtained from an extra excitation. The performance of this method was evaluated by computer simulations and experiments, which confirmed its capability of effectively reducing or, in some cases, even completely removing the ringing and blurring artifacts. The results also show that the proposed method produces better results than other artifact reduction methods. The method is particularly useful at high magnetic field strengths (7.1-9.4 T) and with strong gradients (> 20 G/cm) used in MR microscopy, in which the apparent T2 values are short for most tissues. The authors expect that the proposed method will find useful applications in various fast spin-echo pulse sequences.
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Abstract
A diffusion-weighted fast spin-echo (FSE) imaging sequence for high-field MR microscopy was developed and experimentally validated in a phantom and in a live rat. Pulsed diffusion gradients were executed before and after the initial 180 degrees pulse in the FSE pulse train. This produced diffusion-related reductions in image signal intensity corresponding to gradient ("b") factors between 1.80 and 1352 s/mm2. The degree of diffusion weighting was demonstrated to be independent of echo train length for experiments using trains up to 16 echoes long. Quantitative measurements on a phantom and on a live rat produced diffusion coefficients consistent with literature values. Importantly, the eight- to 16-fold increase in imaging efficiency with FSE was not accompanied by a significant loss of spatial resolution or contrast. This permits acquisition of in vivo three-dimensional data in time periods that are appropriate for evolving biological processes. The combination of accurate diffusion weighting and high spatial resolution provided by FSE makes the technique particularly useful for MR microscopy.
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31P nuclear magnetic resonance and laser spectroscopic analyses of lens transparency during calcium-induced opacification. Invest Ophthalmol Vis Sci 1990; 31:1339-47. [PMID: 2365564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The authors studied the relationships between lens phosphate metabolites and transparency in (1) normal intact calf lenses, (2) whole-lens homogenates, (3) cortical homogenates, and (4) cortical homogenates that were opacified by the addition of calcium. Transparency was measured with the use of laser spectroscopy. Phosphate metabolites and pH were measured with the use of phosphorus nuclear magnetic resonance (31P NMR) spectroscopy. 31P NMR spectra of fresh whole-lens homogenates and fresh intact lenses were nearly identical. In fresh tissue, adenosine triphosphate (ATP) accounted for 59%, 55%, and 61% of the total phosphorus detected in intact lenses, whole-lens homogenates, and cortical homogenates, respectively. As ATP decreased over time to undetectable levels, no loss of transparency was measured, indicating no relationship between ATP levels and lens opacification. In contrast, the authors found that the loss of transparency in cortical homogenates produced by additions of 5, 10, and 20 mM calcium chloride was associated with increased levels of sugar phosphates and glycerol phosphorylcholine and with decreased levels of inorganic phosphate. Loss of cortical transparency was associated with both increases or decreases in pH from the normal value.
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Oligomerization and conformation change in solutions of calf lens gamma II-crystallin. Results from 1/T1 nuclear magnetic relaxation dispersion profiles. Biophys J 1990; 57:461-9. [PMID: 2306495 PMCID: PMC1280740 DOI: 10.1016/s0006-3495(90)82562-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
From analyses of the magnetic field dependence of 1/T1 (nuclear magnetic relaxation dispersion [NMRD] profiles) of water protons in solutions of highly purified calf lens gamma II-crystallin, we find that monomers form oligomers at relatively low concentrations, which increase in size with increasing concentration and decreasing temperature. At approximately 16% by volume and -4 degrees C, the mean oligomeric molecular weight is approximately 120-fold greater than the monomeric value of 20 kD. Below this concentration, there is no indication of any substantive change in conformation of the monomeric subunits. At higher concentrations, the tertiary structure of the monomer appears to reconfigure rather abruptly, but reversibly, as evidenced by the appearance of spectra-like 14N peaks in the NMRD profiles. The magnitudes of these peaks, known to arise from cross-relaxation of water protons through access to amide (NH) moieties of the protein backbone, indicate that the high concentration conformation is not compact, but open and extended in a manner that allows enhanced interaction with solvent. The data are analogous to those found for homogenates of calf and chicken lens (Beaulieu, C. F., J. I. Clark, R. D. Brown III, M. Spiller, and S. H. Koenig. 1988. Magn. Reson. Med. 8:47-57; Beaulieu, C. F., R. D. Brown III, J. I. Clark, M. Spiller, and S. H. Koenig. 1989. Magn. Reson. Med. 10:62-72). This unusually large dependence of oligomeric size and conformation on concentration in the physiological range is suggested as the mechanism by which osmotic equilibrium is maintained, at minimal metabolic expense, in the presence of large gradients of protein concentration in the lens in vivo (cf Vérétout and Tardieu, 1989. Eur. Biophys. J. 17:61-68). Finally, the results of the NMRD data provide a ready explanation of the low temperature phase transition, and "cold-cataract" separation of phases, observed in gamma II-crystallin solutions; we suggest that the phases that separate are the two major conformers detected by NMRD.
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Relaxometry of lens homogenates. II. Temperature dependence and comparison with other proteins. Magn Reson Med 1989; 10:362-72. [PMID: 2733592 DOI: 10.1002/mrm.1910100308] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
We have extended our earlier work (C.F. Beaulieu, J.I. Clark, R.D. Brown III, M. Spiller, and S.H. Koenig, Magn. Reson. Med. 8, 45 (1988] on the magnetic field dependence of 1/T1 (NMRD profiles) of calf lens nuclear homogenates, at 25 degrees C, to 5 degrees C, and to other protein systems as well. These include concentrated solutions of myoglobin and bovine serum albumin, both globular proteins, the first compact and roughly spherical, the other extended, flexible, and with weak internal bonding; chicken lens homogenate, for which the dominant crystallins (lens proteins) are approximately 70% alpha-helical compared with calf crystallins, which are essentially all beta-sheet; and hen egg white, both native and heat-denatured. Our earlier conjectures regarding a reversible change in protein organization of the calf lens crystallins as a function of solute protein concentration is given added support. Our findings suggest that cytoplasmic homogenate can be characterized as a heterogeneous and polymorphic solution of crystallins. At high concentrations the NH moieties of the protein backbone become accessible to solvent with water (not NH proton) exchange rates greater than 10(4) s-1. This conclusion is based on two aspects of the observed NMRD profiles. At low crystallin concentration, the profiles of calf and chicken lens homogenates are similar in form to those of myoglobin and native hen egg white, a form that has been studied previously for a range of diamagnetic globular proteins and has been demonstrated to arise from the rotational thermal motion of the solute molecules. At high crystallin concentrations, the NMRD profiles of the lens homogenates develop a monotonic background (high rates at low fields), much like that of the heat-denatured egg-white sample and those of most tissues. In addition, there is a set of peaks in the central part of the profiles of the concentrated crystallins, seen also in the denatured egg white and some tissues but not in the myoglobin sample, which is known to arise from cross-relaxation interactions between the water protons and (through the intermediary of the NH proton) the 14N quadrupolar levels. The magnitude of these peaks, which is larger by an order of magnitude for native calf lens homogenates than for any tissue, requires that the majority of the NH moieties be accessible to water. Finally, going to 5 degrees C for the native calf lens homogenate takes the sample below the temperature of reversible phase separation, and it becomes opaque.(ABSTRACT TRUNCATED AT 400 WORDS)
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Abstract
We studied the magnetic field dependence of the longitudinal relaxation rates of water protons (1/T1 nuclear magnetic relaxation dispersion (NMRD) profiles) in transparent homogenates of calf lens. The samples included nuclear homogenates with total (heterogeneous) crystallin contents between 34% (v/v) (native) and 14% (diluted) as well as cortical homogenate, 21% (native) and 34% (concentrated). The NMRD profiles had two components: a monotonic dispersive component (analogous to that of both globular protein solutions and diamagnetic tissue) and "14N quadrupolar peaks." 14N peaks have never been reported for protein solutions, only for tissues and dehydrated proteins. These peaks occur between 0.5 and 5 MHz proton Larmor frequency and arise from interactions of solvent water protons with NH moieties of proteins. The 14N peaks in lens cytoplasm are very large and may correlate with the crystallin structure and interactions required to maintain short-range order and lens transparency. The monotonic and 14N quadrupolar components were largest in concentrated samples, but with different concentration dependencies. The dispersive components of samples above approximately 19% protein concentration had a fixed functional form, the amplitude of which varied with protein volume fraction, f, by the multiplicative factor f/(1 - f), suggesting spatial organization and dynamics of the solute proteins that are relatively independent of water content. In contrast, at concentrations less than 19%, the NMRD profiles are concentration dependent, indicating a dependence of the orientational relaxation time of the proteins on protein-protein interactions seen previously in other globular proteins at these concentrations. The 14N peaks are not resolved below approximately 19% protein and increase linearly with incremental volume fraction at protein concentrations above 19%. In addition, the 14N peaks in nuclear homogenates are 50-100% larger than those of cortical homogenates at the same concentrations. Partial substitution of solvent D2O for H2O decreases the peak heights, indicating that an exchangeable proton mediates the interaction between solvent protons and protein 14N nuclei.
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