The thickness of the temporal squama and its implication for transcranial sonography

BACKGROUND AND PURPOSE

The difficult transtemporal ultrasound window is a relatively frequent occurrence. The authors assessed if the thickness of the temporal bone squama as measured in the "bone window" of the head computerized tomography (CT) scan can predict the transtemporal acoustic window.

METHODS

The authors retrospectively reviewed the head CTs on their bone window setting of patients in which nonimaging transcranial Dopplers (TCDs) had been performed. The thickness of the temporal squama in its thinnest portion was measured. The temporal TCD windows were graded in three classes: class 1 as good, class 2 when only a partial study is possible, and class 3 as an impossible ultrasonic window. In a case-control design, for every patient with any class 2 and 3 TCD temporal window, a patient with a class 1 window was randomly included from the same time period.

RESULTS

Fifty-five temporal bones (56%) were class 1, 17 (17%) were class 2, and 27 (27%) were class 3. Bone thicknesses (in mm, mean +/- SD) were greater in those with poorer windows: class 1 = 2.67 +/- 0.70, class 2 = 4.06 +/- 0.56, and class 3 = 5.04 +/- 1.06, P < or = .0001 by Cusick's nonparametric test of trend. Temporal squama thickness of > or = 5 mm portends 86% sensitivity, 90% specificity, 70% positive predictive value, and a positive likelihood ratio of 8.6 for a class 3 transtemporal ultrasound window.

CONCLUSION

Measurement of temporal bone thickness on the bone window setting of the head CT scan may be useful in identifying patients who are poor candidates for transcranial ultrasound.

Preliminary evaluation of iron phytate (inositol hexaphosphate) as a gastrointestinal MR contrast agent

A simple, effective, safe, and well-tolerated contrast agent is needed as a bowel marker for magnetic resonance (MR) imaging. The authors tested a variety of foodstuffs admixed with ferric iron as potential gastrointestinal MR contrast agents. Phytate (inositol hexaphosphate) more than doubled the relaxivity of solutions of ferric iron. Because of the improved relaxivity of iron phytate, the concentration of iron could be reduced substantially relative to free ferric iron (eg, ferric chloride or ferric ammonium citrate). Imaging studies were performed in five volunteers to determine the optimal dose of iron phytate and in five additional volunteers to test its effectiveness. A 200 mg/L concentration of ferric iron with phytate functions as an effective gastrointestinal MR contrast agent for T1-weighted abdominal MR imaging, significantly improving bowel contrast (P < .01). Blood studies after contrast agent administration showed no appreciable increase in serum iron. Compared with standard chelate complexes that decrease the relaxivity of a given paramagnetic ion, phytate not only decreases the absorption of the iron but increases its relaxivity.