The Role of the New Imaging Modalities in the Investigation of Menière's Disease

Thirty one patients with Menière's disease investigated with HRCT and MRI of the inner ear are presented. The parameters evaluated were:

a) Pneumatization of the petrous bone, b) Width of the vestibular aqueduct (VA) in its postisthmic segment, c) Visualization of the endolymphatic duct (ELD).

A similar survey was performed in other 50 patients with no previous history of ear disease which served as controls. There was evidence of statistically significant differences in the pneumatization of the petrous bones (p<0.05), as well as the width of the vestibular aqueducts (p<0.001) between the two groups of patients. Also the percentage of the visualized endolymphatic ducts was higher in the control group as compared to the patients with Menière's disease (p<0.05).

Radiation induced pneumonitis following whole breast radiotherapy treatment in early breast cancer patients treated with breast conserving surgery: a single institution study

BACKGROUND

Hypofractionated Radiotherapy (RT) regimens for breast cancer, although reduce cost and time for patients and health care systems, could have a negative impact on normal underlying lung tissue. We studied and compared lung function and the post-RT radiological changes using High-Resolution Computed Tomography (HRCT) in early breast cancer patients, treated with 3-Dimentional conformal whole breast radiotherapy (WBRT) using either conventional or hypofractionated regime.

PATIENTS AND METHODS

Between 2008 and 2009, 61 early breast cancer patients (T1-2N0M0) were randomised into two groups .Group A (n=31) received standard radiotherapy with 50Gy/25f/5w plus boost 10Gy/5f/1w to tumour bed. Group B (n=30) received 43.2Gy/16f/22d plus boost 10Gy/5f/1w to tumour bed. Patients of both groups were subjected to dynamic lung testing, using spirometry and gas diffusion tests on Day 0 (D0, before RT), during RT and after completion of RT at 3 and 6 months. HRCT scans were performed in all patients at baseline, and 3,6,12 months after completion of RT. Respiratory symptoms were recorded at 3 and 6 months post completion of RT. Dosimetric factors, such as Central Lung Dose (CLD), lung Volume receiving more 20 Gy (V20), D25 and Mean Lung Dose (MLD) were calculated for all patients.

RESULTS

At 3 months after RT, the pulmonary changes were classified at HRCT as follows: 91.8 % were Grade 0, 8.19 % Grade 1, and 0 % Grade 2. At 6 months, 86.98 % were Grade 0, 11.47 % Grade 1, and 1.6 % Grade 2. At 12 months, 88.52 % were Grade 0, 9.19 % Grade 1 and 3.27% Grade 2. Univariate analysis showed strong association between radiation pneumonitis, age and all dosimetric parameters. There was no association between fractionation type and incidence of RN. FEV1, FVC, FEV 25, FEV 50 and DLCO showed no statistically significant reduction in both treatment groups in 3 and 6 months following completion of RT, compared to baseline. Multivariate analysis showed no relation between HRCT findings and other variables (age, smoking, chemotherapy, hormonotherapy, V20).

CONCLUSION

Lung toxicity, as assessed with HRCT and PFTs, was minimal in both treatment arms and our results are in consistency with other published data. Hypofractionated RT was a safe modality and well tolerated by the majority of the patients. Longer follow-up is required for robust assessment of incidence of late lung fibrosis in our series.

The influence of distressing symptoms to levels of depression in cancer patients

PURPOSE

Our objectives were to identify the depression and the distressing symptoms in younger and elderly advanced cancer patients.

METHODS

: The instruments that have been used were the Beck Depression Inventory (BDI) for younger patients, the Geriatric Depression Scale (GDS) for geriatric patients and the M. D. Anderson Symptom Inventory (MDASI) for the severity and impact of cancer-related symptoms.

RESULTS

A trend for significant correlation was found between the GDS and MDASI symptoms for nausea (p=0.058), while a significant correlation was observed for increased sadness (p=0.011), increased constipation (p=0.021), interference of symptoms in mood (p=0.012) and in relations with people (p=0.007); interference of symptoms in mood was the most important risk factor. For younger patients, many statistically significant associations were found between distressing symptoms and depression; however, interference of symptoms in mood (p=0.045) was the only important risk factor.

CONCLUSION

Health-care professionals should take into consideration the risk factors for depressive symptoms suggesting a holistic care in advanced cancer patients.

Super-selective hepatic arterial infusions as established technique ('ARETAIEION' Protocol) of [177Lu]DOTA-TATE in inoperable neuroendocrine liver metastases of gastro-entero-pancreatic (GEP) tumors

AIM

Aim of this study was to evaluate the effectiveness of non-carrier added (n. c. a.) [177Lu]DOTA-TATE in inoperable liver metastases, positive for sst2 receptor overexpression (verified by Octreoscan and confirmed by biopsy) due to neuroendocrine gastroenteropancreatic (GEP) tumors. [177Lu]DOTA-TATE has been infused after selective catheterization of the hepatic artery, minimising in parallel the toxicity of non-target tissues.

METHODS

The dose per session administered to each patient (12 cases in total) was 7400 MBq (200 mCi). Repetitions did not exceed 6-fold with treatment intervals of 5-8 weeks. Response assessment was classified according to the therapeutic benefit. Absorbed doses delivered to metastases, kidneys and red marrow were calculated according to OLINDA 1.1 program and the derived values were correlated to the Response Evaluating Criteria in Solid Tumors (RECIST). CT/MRI scans were performed as baseline before, during and after the end of treatment and monthly ultrasound images for follow-up estimation and measurements. Toxicity (World Health Organization criteria) was measured using blood and urine tests of renal, hepatic and bone marrow function.

RESULTS

None of the patients resulted complete response (0.0%); partial response was assessed in 8 (66.7%), disease stabilization in 3 (25%) and progressive disease in 1(8.3%). A 14-month median survival time was estimated for all patients, so far. Eight of 12 (66.7%) showed a mean target diameter shrinkage ranging from 33% to 45%. The organ average radiation dose estimation was found as follows: a) liver tumor 20.8 mGy/MBq; b) liver 0.14 mGy/MBq; c) kidneys 0.41 mGy/MBq; d) spleen 1.4 mGy/MBq; and f) bone marrow 0.022 mGy/MBq. The average absorbed dose per session to a tumor for a spherical mass of 20 g was estimated to be 20.8 mGy/MBq, depending on the histotype of the tumor. WHO toxicity grade 2 to 3 erythro-, leuko- and thrombo-cytopenia occurred in 9 (75%) cases observed about after the third session.

CONCLUSION

In unresectable metastatic liver lesions positive for somatostatin receptors repeated, trans-hepatic high doses of [177Lu]DOTA-TATE resulted in a more than promising therapeutic outcome with a partial response in 75% of the treated patients. Given the loco-regional modality character of the administration technique, no nephro-toxicity has been so far observed whereas a remarkable myelotoxicity was noticed.

Differences in levels of self-efficacy and anxiety between cancer and chronically-ill patients attending a Palliative Care Unit

PURPOSE

To investigate the differences in anxiety and self-efficacy beliefs as well as the sociodemographic and clinical characteristics, between cancer and chronically-ill patients.

METHODS

A total of 175 patients from a pain relief and palliative care unit participated in this study. Patient sociode-mographic and clinical characteristics were recorded. Patients completed the Greek version of the Spielberger State-Trait Anxiety Inventory (STAI) and the Greek version of the General Perceived Self-Efficacy Scale (GSE).

RESULTS

No statistically significant differences were found between the two patient populations regarding self-efficacy. Statistically significant differences were found between chronically-ill and cancer patients in the scales of "emotionality" (p<0.0005), and "self-deprecation" (p<0.0005). Statistically significant negative correlations were found between all STAI scales and self-efficacy for both cancer and chronically-ill patients (r ranged from -0.231 to -0.503).

CONCLUSION

Chronically-ill patients experienced increased anxiety compared to cancer patients. Self-efficacy had a significant negative correlation with anxiety between the two groups of patients.

Posttraumatic stress disorder and preparatory grief in advanced cancer

PURPOSE

The purpose of the current study was to investigate the prevalence of posttraumatic stress disorder (PTSD) and its association with sociodemographic variables and preparatory grief in patients with advanced cancer.

METHODS

195 advanced cancer patients participated in the study. Out of them, 170 had PTSD and 25 had other anxiety disorders. The diagnoses were made in strict accordance with Structured Clinical Interview for DSM-IV Axis I disorders (SCID-I)-Clinician version. Patients completed also the Preparatory Grief in Advanced Cancer Patients (PGAC) scale.

RESULTS

Patients with PTSD were younger (63.54 ± 12.07 years) than those without PTSD (70.36 ± 13.03 years, p=0.010). Patients with PTSD revealed more preparatory grief (37.69 ± 12.11) than those without PTSD (29.58 ± 14.04, p= 0.003). Multiple logistic regression analysis showed that preparatory grief (p=0.012), and metastatic disease (p=0.009) remained in the model whereas age showed a trend for independent significance (p=0.067).

CONCLUSION

In advanced cancer stages, younger patients, those with metastatic disease or patients with elevated scores on preparatory grief seemed to have a greater likelihood to develop PTSD. Thus, given the prevalence of PTSD in advanced cancer patients, health care professionals should be able to better recognize those who are at risk for or exhibit symptoms of this disorder so that appropriate treatment referrals can be made.

Transcatheter arterial embolization as therapy of renal angiomyolipomas: the evolution in 15 years of experience

OBJECTIVE

This study aims at presenting the evolution of the embolization technique in treating renal angiomyolipomas (AMLs) either diagnosed in patients with acute bleeding or discovered accidentally.

METHODS

Ten patients with renal AMLs have been through thirteen selective transcatheter arterial embolizations for 15 years. Two patients had tuberous sclerosis complex (TSC) with bilateral tumors and were embolized twice. Four embolic materials were employed: PVA particles, Gianturco coils, microspheres and microcoils. Catheterization was achieved by means of 5F Cobra 2 catheters and coaxial microcatheter systems.

RESULTS

On an emergency basis, embolization was a first-line treatment. In one case, surgery was necessary; in two patients, a second embolization was performed. When treatment was preventive, a single embolization proved to be sufficient, as well. There was no significant deterioration of the serum creatinine levels in the post-embolization period.

CONCLUSION

Selective arterial embolization is a rather safe and effective technique to treat AMLs both urgently and preventively. Different embolic materials can be employed. Microspheres and microcatheters stand for new promising materials.

Recurrent vertebral hydatid disease: spectrum of MR imaging features

INTRODUCTION

This study aimed to describe a spectrum of magnetic resonance (MR) imaging findings in a case series of four patients with recurrent vertebral hydatid disease (HD).

METHODS

Four patients with recurrent spinal HD, who were studied with MR imaging at 1.5T or 0.5T MR units, were encountered during a ten-year period. All patients had a history of repeated spinal surgery for hydatid resection.

RESULTS

HD involving the lumbar spine was found in two patients, the thoracolumbar spine in one patient and the lumbosacral in one patient. Skip lesions were seen in one patient. All patients had extensive involvement of the extradural space, soft tissues of the back and posterior vertebral elements. HD involving the vertebral body, intervertebral disk and iliopsoas muscles were noted in three, two and three patients, respectively. Bone and extradural hydatids were typically small, and appeared hypointense on T1-weighted images, with a mildly enhancing rim on post-contrast T1-weighted images. Sacral hydatid was an expansile multicystic process. Muscle hydatids were large, surrounded by a gadolinium-enhancing rim and assumed a variety of patterns - either multilocular or a nonspecific inhomogenous cystic or dumbbell configuration.

CONCLUSION

MR imaging is a valuable diagnostic tool for follow-up of patients with vertebral HD. Recurrent HD is characterised by extensive involvement of soft tissues of the back and extradural space. Extension into the intervertebral disk and iliopsoas muscles and skip lesions in the extradural space are not uncommon.

Conventional versus virtual simulation for radiation treatment planning of prostate cancer: final results

PURPOSE

Radiotherapy is widely used to treat patients with prostate cancer. Using conventional x-ray simulation is often difficult to accurately localize the extent of the tumor, to cover exactly the lymph nodes at risk and shield the organs at risk. We report on the results of a study comparing target localization with conventional and virtual simulation.

METHODS

One hundred prostate cancer patients underwent both conventional and virtual simulation. The conventional simulation films were compared with digitally reconstructed radiographs (DDRs) produced from the computed tomography (CT) data. All patients underwent target localization for radical prostate radiotherapy. The treatment fields were initially marked with a conventional portal film on linear accelerator (LINAC), plain x-ray film and available diagnostic imaging. Each patient then had a CT and these simulated treatment fields were reproduced within the virtual simulation planning system. The treatment fields defined by the clinicians using each modality were compared in terms of field area and implications for target coverage.

RESULTS

Virtual simulation showed significantly greater clinical tumor volume coverage and less normal tissue volume irradiated compared with conventional simulation (p <0.001).

CONCLUSION

CT localization and virtual simulation allow more accurate definition of the clinical target volume. This could enable a reduction in geographical misses, reducing at the same time treatment-related toxicity.

The value of transcranial Doppler sonography with a transorbital approach in the confirmation of cerebral circulatory arrest

OBJECTIVE

Transcranial Doppler sonography (TCD) provides accurate confirmation of cerebral circulatory arrest (CCA) in brain death (BD), but is not feasible in patients with absent temporal bone windows. We added the transorbital approach in the TCD protocol for the diagnosis of CCA and compared findings with angiography. Furthermore, we evaluated whether reporting the angiographic and sonographic confirmation of CCA to relatives of brain-dead patients improves their comprehension and satisfaction with the medical information.

PATIENTS AND METHODS

Eighty-two clinically brain-dead patients underwent 4-vessel angiography, TCD of the basilar and middle cerebral arteries, and transorbital Doppler sonography (TOD) of the internal carotid arteries. Relatives were randomly allocated to 41 in whom BD was presented as a clinical diagnosis (group A) and to 41 in whom BD was presented as a clinical diagnosis confirmed by TCD and angiography (group B). Comprehension and satisfaction of the relatives were assessed using an interview and a questionnaire.

RESULTS

Both angiography and TCD verified CCA in all cases (k = 1). In 11 patients with failure of the transtemporal approach, CCA was confirmed by the transorbital recordings. The addition of TOD enabled 15.5% more cases of CCA to be diagnosed by TCD. Group B exhibited improved comprehension and satisfaction rates (P < .05).

CONCLUSIONS

The addition of TOD increases the efficacy of TCD in confirming CCA in BD. Reporting confirmation of CCA to families of brain-dead patients may improve their comprehension and satisfaction with the provided medical information.

Comparison of conventional and virtual simulation for radiation treatment planning of prostate cancer

PURPOSE

radiotherapy is widely used to treat patients with prostate cancer. Using conventional x-ray simulation is often difficult to accurately localize the extent of the tumor, to cover exactly the lymph nodes at risk and shield the organs at risk. We report the initial results of a study conducted to compare target localization with conventional and virtual simulation.

METHODS

fifty patients with prostate cancer underwent target localization for radical prostate radiotherapy using conventional and virtual simulation. The treatment fields were initially marked with a conventional portal film on LINAC, plain x-ray film and available diagnostic imaging. Each patient then had a computed tomography (CT) and these simulated treatment fields were reproduced within the virtual simulation planning system. The treatment fields defined by the clinicians using each modality were compared in terms of field area and implications for target coverage.

RESULTS

there was significantly greater clinical tumor volume coverage using virtual simulation compared with conventional simulation and less normal tissue volume irradiated (p<0.001).

CONCLUSION

CT localization and virtual simulation allow for more accurate definition of the clinical target volume. This could enable a reduction in geographical misses, while also reducing treatment-related toxicity.

A comparative study of prophylactic antiemetic treatment in cancer patients receiving radiotherapy

PURPOSE

Gastrointestinal side effects can often complicate radiotherapy (RT) in cancer patients. This work presents results of a retrospective open label study aiming to evaluate the optimum prophylactic treatment for nausea and vomiting in patients receiving fractionated radical or palliative RT.

METHODS

576 cancer patients were allocated in 5 treatment groups: 120 patients received tropisetron, 129 tropisetron plus dexamethasone, 101 metochlopramide, 119 dexamethasone, and 107 received metochlopramide plus dexamethasone. To determine the optimum antiemetic prophylactic treatment, nausea and vomiting were evaluated at baseline, 24 and 72 h after the initiation of RT, and at the end of every week during RT. Adverse effects, Eastern Cooperative Oncology Group (ECOG) performance status (PS), and the intensity of nausea and vomiting were recorded.

RESULTS

Statistically significant differences in incidence and intensity of nausea and vomiting were found among the 5 antiemetic treatment groups from the 1st till the 5th week of the RT. Tropisetron + dexamethasone group had significantly reduced odds for nausea and vomiting, and significantly less severe nausea and vomiting than any other treatment group. Factors significantly associated with increased ECOG PS were palliative RT, dose fraction >3Gy, field size >200 cm(2), and treatment with metochlopramide, metochlopramide+dexamethasone and dexamethasone.

CONCLUSION

Patients receiving prophylactic antiemetic treatment with tropisetron+dexamethasone completed RT with lower intensity of nausea and vomiting and lower ECOG PS scores compared to groups that received other antiemetic treatments.

Optic nerve sonography: a new window for the non-invasive evaluation of intracranial pressure in brain injury

Enlargement of the optic nerve sheath has been described in patients with raised intracranial pressure (ICP), thereby serving as one of its indicators. Optic nerve sonography offers rapid bedside assessment of the optic nerve sheath diameter and has recently been introduced for the non-invasive detection of raised ICP, particularly in patients with severe brain injury. This review explains the pathophysiology of optic nerve sheath enlargement as a result of intracranial hypertension, describes the technique and clinical use of optic nerve sonography, and summarises the studies which have tested this modality in the non-invasive evaluation of ICP.

Gray-scale and color Doppler ultrasonographic evaluation of reactivated post-traumatic/postoperative chronic osteomyelitis

OBJECTIVE

We aimed to carry out a systematic assessment of gray-scale and color Doppler ultrasonography (CDUS) findings of reactivated post-traumatic/postoperative chronic osteomyelitis (COM) in adults.

MATERIALS AND METHODS

Gray-scale and color Doppler ultrasonography were performed on 40 consecutive patients with a history of long-standing post-traumatic/post-operative chronic osteomyelitis and clinical suggestion of reactivation, in a 32-month-period. All patients had metallic implants: 16 internal fixations, nine external fixations, 11 hip arthroplasties and four knee arthroplasties. The final diagnosis of reactivated COM was based upon biopsy findings, with microbiological and histological examination (n = 27), or a combination of laboratory, clinical and magnetic resonance (MR) findings (n = 13). The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of sonographic signs, including fistulous tracts, periosteal thickening, cortical discontinuity, soft tissue abscess and cellulitis, juxtacortical fluid, distension of the pseudocapsule in arthroplasties, and periosteal vascularity, were estimated.

RESULTS

Statistically significant differences between patients with and without reactivated COM were found for fistulous tracts (P < 0.0001), juxtacortical fluid collections (P < 0.001) periosteal thickening (P < 0.01), distension of pseudocapsule (P < 0.05), and periosteal vascularity (P < 0.0001). Low-resistance arterial flow of periosteal vessels presented the highest sensitivity (92%), specificity, and PPV (100%), yielding only two false negative results in two obese patients. Among gray-scale findings, the presence of a fistulous tract yielded the highest specificity and PPV (100%), whereas periosteal thickening was the most sensitive (92%), though not specific, finding (specificity 50%).

CONCLUSION

A constellation of gray-scale and CDUS findings can be highly indicative of reactivated bone infection in patients with long-standing chronic post-traumatic/post-operative osteomyelitis.

The efficacy of combined treatment with cetuximab (erbitux) and radiation therapy in patients with head and neck cancer

Squamous cell carcinoma of the head and neck (SCCHN) region is among the most frequent human tumors due to the alcohol and tobacco abuse. Its management has evolved gradually from surgery as the mainstay of therapy to irradiation as the principal treatment. When radiation therapy is combined with chemotherapy, additional benefit is obtained. The value of chemoradiotherapy (CRT) is, however, counterbalanced by increased and often prohibitive toxicity, particularly among patients with coexisting medical conditions and decreased performance status. A member of the ErbB family of receptor tyrosine kinases known as the epidermal growth factor receptor (EGFR) is abnormally activated in epithelial cancers, including head and neck cancers. Overexpression of EGFR is a feature associated with poor clinical outcome. It is observed that radiation increases the expression of EGFR in cancer cells and the blockade of EGFR signaling sensitizes cells to the effects of radiation. The cytotoxic effects of radiation therapy in squamous cell carcinoma could be enhanced by cetuximab (erbitux), a monoclonal antibody against the ligand-binding domain of EGFR. The major studies that focus on the efficacy of adding cetuximab to radiotherapy in the treatment of patients with head and neck cancer and its impact in quality of life are reviewed in this study.

Hemodynamic alterations and wall properties in large arteries of young, normotensive, and non-obese women with polycystic ovary syndrome

Young, normotensive, and non-obese women with polycystic ovary syndrome (PCOS) may present abnormal hemodynamic alterations (HA). The purpose of this study was to investigate heart rate (HR), intima-media thickness (IMT), and diameter (DCCA) in the common carotid arteries (CCA), flow velocities, and resistance index in both extracranial carotid and vertebral arteries (VA), in the abdominal aorta (AO) and in the renal arteries (RA) in PCOS women and matched controls. This was a case-control study conducted at a tertiary University Hospital. We studied 53 PCOS women and 53 healthy matched volunteers as controls. The previously reported parameters were assessed using color Doppler ultrasonography. HR, IMT in the CCA, and peak systolic velocity in all examined arteries were significantly increased in PCOS women compared to controls. On the contrary, DCCA was significantly decreased in PCOS women compared to controls. End diastolic velocity (EDV) in both VA and RA, in the AO and in the left extracranial carotid system was significantly increased in the PCOS group compared to controls. Furthermore, the peripheral resistance (PR) of AO and right external carotid artery was also found to be increased while in both RA and in left VA, PR was decreased. No further statistical significant HA in EDV and PR were noted. The results of this study provide evidence for a mild hyperdynamic circulation in young, normotensive, non-obese women with PCOS compared to controls, indicating a mild sympathetic activation at an early age, which may be an underlying cause of hypertension and cardiovascular risk.

Interstitial magnetic resonance lymphography: the clinical effectiveness of a new method

The aim of this study is to evaluate effectiveness of interstitial magnetic resonance lymphography as an examination for the depiction of the lymphatic system in humans by comparison with direct x-ray lymphography. We studied 14 subjects (two volunteers and 12 patients with clinical suspicion of lymphedema of the lower extremities). We first administered subcutaneous gadobutrol between the toes and performed MR lymphography. After seven days, we injected lipiodol into the lymph vessels of 8 patients and performed x-ray direct lymphography to compare findings of two methods. We identified the normal lymphatic system (lymph vessels and inguinal lymph nodes) of volunteers. In seven subjects, we were able to image an abnormal lymphatic system with decreased number of lymph vessels, lymphoceles, and ectatic lymph vessels. In three subjects we identified both an abnormal lymphatic and venous system and in two patients only the venous system. In all cases x-ray direct lymphography confirmed the findings of the MR lymphography. No side effects were observed from either contrast agent. We expect that in the future, interstitial MR lymphography will be improved and evolve into a valuable diagnostic tool for the evaluation of lymphatic diseases particularly those who present with primarily lymphedema in the lower limbs or second, in regions other than extremities.

Interstitial magnetic resonance lymphography: is it a new method for the diagnosis of lymphedema?

AIM

The aim of this study was to evaluate the method of interstitial magnetic resonance lymphography (MRL) as an examination for the depiction of the lymphatic system in humans in comparison with the method of direct X-ray lymphography.

METHODS

We studied 6 persons, 2 volunteers and 4 patients with clinical suspicion of lymphedema in lower extremities. We administered subcutaneous gadobutrol for the MRL with a volume of 5 mL composed of 4.5 mL of Gadobutrol mixed with 0.5 mL of lidocaine hydrochloride and after 7 days lipiodol in the lymph vessel for the X-ray direct lymphography (in 3 patients) in order to compare the findings of the two

METHODS

We then followed up all individuals for 7 days for any possible side effect of the contrast agents.

RESULTS

Using MRL, we depicted the lymphatic system (lymph vessels and inguinal lymph nodes) of volunteers in 60 min. Moreover, in patients we depicted several abnormalities of the lymphatic system including decreased number of lymph vessels, lymphocele and ectatic lymph vessels. X-ray direct lymphography confirmed the findings of the MRL in all cases. No side effects were observed.

CONCLUSION

In our pilot study, Gadobutrol seems to be a good contrast agent for the painless depiction of the lymphatic system in humans through interstitial MRL. More extensive studies are needed in order to establish the efficacy and the dosage of Gadobutrol.

Transorbital sonographic monitoring of optic nerve diameter in patients with severe brain injury

OBJECTIVE

We investigated whether alterations in the optic nerve diameter (OND) correlated with brain computed tomography (CT) imaging results among patients with brain injury and whether monitoring of OND could predict brain death.

PATIENTS AND METHODS

We enrolled 54 patients with brain injury (Glasgow Coma Scale < 8) and 53 controls. OND measurements were performed 3 mm posterior to the papillae by means of transorbital sonography. The severity of the injury was classified according to a semiquantitative CT neuroimaging scale (1 to 4). All patients underwent 3 repeated evaluations of OND combined with synchronous CT scans.

RESULTS

Twenty-two patients progressed to brain death, while 32 patients showed gradual clinical improvement. Upon admission, the patients showed significantly increased OND (4.84 +/- 1.2 mm) compared with the controls (3.49 +/- 1.1 mm; P < .001). The median intraobserver variation of OND was 0.2 mm (95% confidence intervals [CI]: 0.1-0.7). The median interobserver variation of OND was 0.3 mm (95% CI: 0.1-0.9). Alterations in the OND were significantly correlated with the neuroimaging scale on 3 repeated evaluations: r = .65, r = .70, and r = .73 (all P < .001). An OND greater than 5.9 mm (specificity = 65% and sensitivity = 74%; P < .01) and a 2.5 mm increased OND between repeated measurements (specificity = 70% and sensitivity = 81%; P < .01) were associated with a poor prognosis.

CONCLUSIONS

Alterations in OND strongly correlated with neuroimaging results among patients with brain injury. However, monitoring of OND exhibited a low predictive value for brain death.

Interstitial magnetic resonance lymphography with gadobutrol in rabbits and an initial experience in humans

The purpose of this study was first to evaluate gadobutrol as a contrast agent for interstitial Magnetic Resonance Lymphography (MRL) in rabbits, and second, to extend the study to humans, if the initial results were satisfactory. In our experiment, gadobutrol was injected into twelve white New Zealand rabbits. In nine animals, 0.5 ml of gadobutrol was subcutaneously administered through each foot pad of the hindlegs while in the remaining three animals the agent was given in each foot of the forelegs. In four of the nine rabbits, slight local massage was applied at the site of administration. Subsequently, we proceeded to administer 5 ml (4.5 ml gadobutrol mixed with 0.5 ml hydrochloride lidocaine) into the limbs of two healthy humans. We achieved imaging of four lymph node groups (popliteal, inguinal, iliac and paraortic) in the hind-legs of the nine-rabbit group, whereas, in the forelegs of the remaining three rabbits, three lymph node groups (axillary, parasternal, mediastinal) were depicted. The flow of the contrast agent was significantly faster in the rabbits that received local massage (P<0.02). In humans, normal lymph vessels, as well as inguinal lymph nodes, were depicted in the legs. No side-effects were observed either in the rabbits or humans.

Screening of patients after colectomy: virtual colonography

BACKGROUND

Virtual colonography is a powerful new method of imaging the entire colon and is useful to assess polyps and diagnose colon cancer. We evaluated virtual colonography in the postoperative screening of patients who had colon cancer.

METHODS

Fifty-three patients were examined with virtual colonography 12 to 48 months postoperatively. Forty-four patients had received segmental colectomy with restoration of the gastrointestinal tract, and nine patients underwent abdominoperineal resection and permanent colostomy. After proper cleaning of the colon and distention with air, spiral computed tomographic examination of the abdomen with a slice thickness of 5 mm (table speed [TS] 10 mm, reconstruction interval [RI] 2.5 mm) was performed in the supine and prone positions (including intravenous contrast medium infusion). Images were transferred to a separate workstation (Philips Easy Vision) for postprocessing, three-dimensional rendering, and endoluminal viewing.

RESULTS

Eleven recurrences (16.41%) were identified in 10 patients by virtual colonography, but one recurrence was missed. Conventional colonoscopy was incomplete in six cases, and two patients with colostomy refused colonoscopy. In these eight cases (15%), virtual colonoscopy was completed without problems. A second tumor in one patient who had received abdominoperineal resection was demonstrated by virtual colonography, but conventional colonoscopy failed to demonstrate the lesion. Liver metastases were identified in only one patient.

CONCLUSIONS

Virtual colonography seems to provide a good alternative in the follow-up of patients after colectomy. The technique is effective in the diagnosis of locoregional recurrences and distant metastases and is well accepted by patients, and results are equal to those of the conventional colonoscopy.

Image findings of a tailgut cyst. Case report and short review of the literature

We present a case of retrorectal hamartoma (tailgut cyst). Imaging findings on ultrasound, computed tomography and magnetic resonance imaging, pathologic findings, as well as the diagnostic pitfalls during the patient's management are documented. As it is a rare lesion with a non specific clinical presentation, it is usually misdiagnosed. Our aim is to present image characteristics of these lesions in all modalities and include retrorectal hamartomas in our differential diagnosis in patients with lesions with similar image findings.

Ovarian masses in young adolescents: imaging findings with surgical confirmation

Functional cysts and benign neoplasms are the most common ovarian masses among young adolescents. Ovarian cancer on the other hand, although rare in this age group, is the most common genital tract malignancy. The purpose of this study was to define imaging characteristics of ovarian masses in adolescents between 12 and 21 years old and correlate imaging and surgical findings. Thirty-seven female adolescent patients aged between 12 and 21 years were operated on because of a diagnosed ovarian mass between 1997 and 2002. All patients underwent pelvic ultrasound, five had an abdominal CT scan, two had abdominal MRI, one abdominal X-ray and one intravenous pyelography. Ultrasound was used to define the size of the lesion and to characterize its gross morphologic condition as solid, simple cyst or complex cyst. The records were reviewed for age at presentation, presenting symptoms, diagnostic studies, surgical procedure and pathology findings, which were available for all patients. In our study 32 patients (86.5%) were symptomatic and five asymptomatic (13.5%). The most common presenting symptom was abdominal pain (59.5%). Thirty-four patients (91.1%) had benign lesions, two had malignant tumors (5.4%) and one patient had a borderline lesion (2.7%). The most common ovarian masses detected were germ cell tumors (27.5%) and functional cysts (25%). Twenty patients (54%) underwent operative laparoscopy and 17 patients (46%) exploratory laparotomy. Simple resection of the ovarian mass was achieved in the majority of cases (84%). Bilateral salpingo-oophorectomy was performed in only one case (2.7%).

Hepatic primary and secondary malignancies: comparison of helical CT and helical CT during arterial portography

BACKGROUND/AIMS

To compare the sensitivity of helical CT to that of helical CT arterial portography in the detection of hepatic primary or secondary malignancies, in 20 patients who subsequently underwent surgery to confirm findings.

METHODOLOGY

Twenty patients with suspected primary hepatic or secondary malignancies who all underwent helical CT and helical CT arterial portography preoperatively were prospectively evaluated. All the images were reviewed by two radiologists. The results were subsequently correlated with surgical and pathological findings. The sensitivity and the positive predictive values for lesion detection were determined for each modality.

RESULTS

There were 39 pathologically confirmed hepatic malignant lesions. The overall sensitivity and positive predictive value of helical CT arterial portography were 87.1% and 82.5%, respectively, while of helical CT were 84.6% and 94.2%, respectively.

CONCLUSIONS

Helical CT arterial portography and helical CT of the liver were approximately equivalent for lesion detection in patients who were evaluated preoperatively for resection of liver malignancies. The lower cost and non-invasive nature of helical CT suggest that it should be the preferred modality.

CT appearance of solitary and multiple cystic and cavitary lung lesions

Cystic and cavitary lung lesions constitute a spectrum of pulmonary diseases diagnosed in both children and adults. We reviewed the CT findings of the most common cystic and cavitary lung lesions and we defined useful morphological criteria that will help radiologists to distinguish benign from malignant cavitary lesions. However, in many cases the considerable overlap in morphological features of benign and malignant cavities renders transthoracic needle biopsy necessary to establish the correct diagnosis.

Cystic pancreatic neoplasms: computed tomography and magnetic resonance imaging findings

Cystic pancreatic neoplasms include serous cystadenomas (SCA), mucin-producing cystic tumors, cystic islet-cell tumors, and cystic solid and papillary epithelial neoplasms. Imaging techniques are of great value in the demonstration and differential diagnosis of these tumors. In this article we present the computed tomography (CT) and magnetic resonance imaging (MRI) findings of the aforementioned cystic neoplasms. Although the radiological features are in many cases informative, a significant overlap does exist; fine-needle aspiration biopsy and cytology or excisional biopsy and histological examination are necessary to determine a definitive diagnosis.

Comparison of CT, MRI and CT during arterial portography in the detection of malignant hepatic lesions

BACKGROUND/AIMS

A prospective study was performed to compare the sensitivities of computed tomography, magnetic resonance imaging and CTAP (CT during arterial portography) in the detection of focal malignant hepatic lesions.

METHODOLOGY

Twenty-eight (28) patients with primary and secondary hepatic malignant tumors were evaluated. All of these patients underwent hepatic resection and a lesion-to-lesion imaging-pathological analysis was performed.

RESULTS

The overall sensitivities were 53% for CT, 66% for MRI sequences and 88% for CTAP. For lesions smaller than 1 cm the sensitivities were 6% for CT, 17% for MRI and 72% for CTAP. The combination of CTAP and MRI yielded an overall detection rate of 93%. The difference between the sensitivity of CTAP and that of the other two imaging techniques was statistically significant (P < 0.04) according to the McNemar test. CTAP demonstrated four false-positive lesions, two of which were correctly characterized by MRI and one by CT. In 6 patients (21.4%) the surgical plan was modified after CTAP.

CONCLUSIONS

We conclude that, CTAP has the highest sensitivity and should be part of the preoperative examination. In some instances, the addition of MR imaging must be considered a helpful adjuvant. Both techniques should be considered complementary in the preoperative diagnostic algorithm.

Comparison of dual spin echo echo planar imaging (SE_EPI), turbo spin echo with fat suppression and conventional dual spin echo sequences for T(2)-weighted MR imaging of focal liver lesions

The performance of T(2)-weighted spin-echo version of echo planar imaging (SE_EPI), conventional spin echo (SE) and fat-suppressed turbo spin-echo (TSE_SPIR) sequences for the detection of focal liver lesions was evaluated. Twenty patients that were included in our study, had CT examinations prior to the MR study and were scheduled for surgery for removal of liver lesions. All patients had intraoperative sonographic examinations. Qualitative and quantitative analysis of the images was performed. Overall image quality of SE_EPI sequences was better than SE (p<0.001) and similar to TSE_SPIR sequences. There were fewer motion and ghost artifacts on SE_EPI and TSE_SPIR images compared to SE images (p<0.001). Susceptibility artifacts were statistically equivalent on SE_EPI and SE images (p<0.001) while chemical shift artifacts were equally observed on SE and SE_EPI sequences. Overall image quality of EPI-SE and TSE_SPIR sequences was better compared to SE sequences. There was no significant difference in the number of lesions detected by each of the three sequences. Quantitative analysis showed that liver/lesion contrast-to-noise ratio (CNR) and signal-to-noise ratio (SNR) of liver, lesion, spleen was higher on TSE_SPIR sequences (p<0.001) while SE_EPI and SE sequences showed non-significant differences (p>0.05). SE_EPI sequences of the liver resulted in fewer artifacts and shorter acquisition times than SE sequences. They provide a diagnostic performance similar to TSE_SPIR and better than that of SE sequences.

Postcarotid endarterectomy symptoms. Pre- and postoperative clinical and MRI findings

BACKGROUND

The hyperperfusion syndrome represents a highly debated clinical entity, without having yet any clinically identifiable limits. The correlation of clinical with pre- and postoperative magnetic resonance imaging (MRI) findings following carotid endarterectomy in patients with a possible hyperperfusion syndrome was investigated.

METHODS

DESIGN

Prospective clinical and laboratory study.

SETTING

At the Aretaieio University Hospital.

MEASURES

Comparison to the postoperative clinical symptomatic and MRI findings. Patients. We studied 30 patients (mean age 66.6) of whom 14 (46.6%) were asymptomatic, 16 (53.4%) were symptomatic, 17 (56.6%) were hypertensive, 18 (60%) hyperlipidaemic, 5 (16.6%) diabetic and 17 (56.6%) had coronary artery disease.

RESULTS

Twenty-one patients (70%) exhibited disturbances such as ipsilateral headache, seizures, vomiting or facial pain; immediate postoperative MRI scans revealed new ischaemic foci in 4 (19%) without any objective neurological findings. Lesions displayed in postoperative MRI scans did not always cause symptoms and normal findings on MRI did not exclude the presence of symptoms. Hypertension favoured the presence of subjective disturbances, without necessarily any change in the MRI appearances. Preoperative MRI and clinical findings did not contribute to the identification of patients who might have exhibited postoperative symptoms. Thus, the symptomatology remains unclear and open to debate, as a variety of other conditions may produce the same clinical picture postoperatively.

CONCLUSIONS

Subjective disturbances, objective neurological findings and MRI abnormalities with or without hypertension may appear independently after carotid endarterectomy, a fact which makes the pathogenesis of the hyperperfusion syndrome more difficult to elucidate.

Abdominal retained surgical sponges: CT appearance

Retention of surgical sponges is rare. They cause either an aseptic reaction without significant symptoms or an exudative reaction which results in early but nonspecific symptoms. Computed tomography is very useful for recognition of retained sponges. The appearance of retained sponges is widely variable. Air trapping into a surgical sponge results in the spongiform pattern which is characteristic but unfortunately uncommon. A low-density, high-density, or complex mass is found in the majority of cases, but these patterns are not specific. Sometimes, a thin high-density capsule may be seen. Rim or internal calcification is a rare finding. Finally, a radiopaque marker is not a reliable sign. Differentiation from abscess and hematoma is sometimes difficult.

The real incidence of extracapsular (satellite) cysts of liver echinococcus

BACKGROUND

The presence of extracapsular (Satellite) cysts in liver echinococcus granulosus is known for many years. In one of our previous studies of radiological (CT) material they were found to be present in 16% of cases.

METHODS

In the present study the operative findings, in cases of total capsectomy (cystopericystectomy) or partial lobectomy are presented.

RESULTS

The real incidence of these cysts in operative specimens was as high as 29,5%. They were present in 15 out of 51 totally excised cysts.

CONCLUSIONS

We conclude that satellite cysts are present more often than they are radiologically detected. As they can be incriminated as a cause of recurrence of the disease they must be excised en block with the main parasitic cysts, by means of more radical procedures such as cystopericystectomy or partial hepatectomy, whenever it is feasible.

Bone lesions with soft-tissue mass: magnetic resonance imaging diagnosis of lymphomatous involvement of the bone marrow versus multiple myeloma and bone metastases

Bone metastases from solid primary tumors, as well as multiple myeloma and secondary lymphoma may all present with bone lesions and associated soft-tissue masses on magnetic resonance images of the spine. In bone metastases and myeloma, the cortex of the affected bone is usually destroyed and a bulging contour is observed at the site of extraosseous spread. In cases of lymphomatous involvement of the bone marrow, however, we have observed that spread to the extraosseous soft-tissues occurs without alteration of the shape or contour of the affected bone. In order to assess whether this pattern of spread is indeed suggestive or even diagnostic of lymphoma of the bone marrow, we reviewed spinal bone marrow MR images of 66 patients, with bone metastases from solid primary tumors (33 patients), multiple myeloma (20 patients) and stage IV lymphoma with bone marrow involvement (13 patients), who had bone lesions and contiguous soft-tissue masses. If tumor was present on either side of the bony cortex but the contour of the affected bone was preserved, a "wrap-around" sign was diagnosed. A "wrap-around" sign was found in 12 of the 13 patients with lymphoma but in none of the patients with metastases or myeloma. On MR images of the bone marrow, the demonstration of tumor spread beyond the bony cortex without disruption of the outline of the diseased bone may favor the diagnosis of lymphoma more than that of metastases or multiple myeloma.

Quantification of liver iron overload by T2 quantitative magnetic resonance imaging in thalassemia: impact of chronic hepatitis C on measurements

PURPOSE

Measurement of liver T2 values seems to be an accurate and sensitive magnetic resonance imaging (MRI) method for the quantification of liver hemosiderosis in multiple transfused patients with thalassemia. Because many of these patients have coexistent chronic hepatitis C virus (HCV) infection, the effect of inflammatory changes on liver T2 values was assessed.

MATERIALS AND METHODS

Liver MRI studies of 35 HCV+ and 17 HCV- patients with beta-thalassemia, 9 HCV+ patients without thalassemia, and 10 healthy controls of the same age range (13 to 32 years) were reviewed. Iron status was assessed by serum ferritin in all patients, and determination of liver iron concentration (LIC) was available in 16 HCV+ patients with thalassemia. Histologic activity index (HAI) and grades of siderosis were evaluated in all HCV+ patients with thalassemia.

RESULTS

Patients with thalassemia had significantly lower T2 values (P < 0.0001) than subjects without thalassemia, whereas no difference existed between HCV+ patients without thalassemia and healthy controls. In HCV+ patients, LIC correlated more nearly with T2 values (r = 0.93) than with serum ferritin (r = 0.73). T2 values were not influenced by HAI score or fibrosis.

CONCLUSION

Liver T2 values were found to be more accurate than serum ferritin in predicting liver iron overload and were not influenced by the presence of chronic hepatitis C. Therefore, MRI could serve as a noninvasive alternative to liver biopsy for the quantification of hemosiderosis in HCV+ patients with thalassemia.

MR appearance of pelvic hemangiopericytoma

A case of pelvic hemangiopericytoma in a 59-year-old woman is reported. The MR imaging features are presented. The tumor was unresectable and the patient received postoperative irradiation of 4200 cGy on the pelvis. One year after diagnosis, metastasis to a lumbar vertebra was discovered and additional irradiation of 3900 cGy was applied. One year later, CT showed control of the pelvic tumor and its metastasis.

MR imaging of complex tail-gut cysts

Retrorectal-cyst hamartomas (RCH) are rare developmental tail-gut cystic tumours of the retrorectal space, which occasionally undergo malignant transformation. We describe the magnetic resonance imaging (MRI) findings in two patients with RCH and in a third patient with unclassified sarcoma arising from a RCH. The RCH were hypointense or hyperintense on T1-weighted images and hyperintense on T2-weighted images; they did not enhance and they contained multiple septations. A solid component in the periphery of one cyst was markedly hypointense on T2-weighted images in keeping with fibrous material. The sarcoma arising from the wall of the RCH enhanced and was of intermediate signal intensity on all sequences. MR may help establish the diagnosis of RCH if an unenhanced cystic tumour is discovered in the retrorectal space and it can help detect those rare cases of malignant transformation of these developmental tumours.

Retroperitoneal tumors: do the satellite tumors mean something?

BACKGROUND AND OBJECTIVES

Primary retroperitoneal tumors constitute a rather uncommon disease with an incidence of 2 in 100,000. Local recurrence after surgical resection is reported between 60% and 90% at 10 yr. The aim of this study was to present the problem of satellite tumors around the main tumor mass and their possible relation to local recurrence.

METHODS

Twenty-nine patients with retroperitoneal tumors underwent surgical resection in our department during an 8-yr period. We reviewed their records including their preoperative computed tomography (CT) scans.

RESULTS

Twenty patients had "complete" resections requiring seven nephrectomies, four colectomies, two splenectomies, and one appendectomy. In nine cases the resection was incomplete because of tumor invasion to vital structures. Histopathology revealed that the resected tumors were: liposarcomas (12), leiomyosarcomas (4), paragangliomas (5), malignant fibrous histiocytomas (3), other sarcomas (3), schwannoma (1), myelolipoma (1), and the malignancy grade was I in 6, grade II in 11, and grade III in 12 cases. Two patients died within 30 d of the operation. The I year recurrence rate was 41.4% (12/29) and the total recurrence rate 55.2% (16/29). Survival at 5 yr was 31% (9/29), whereas the disease-free survival was 20.7% (6/29). Four patients required reoperations. In seven cases (24,1%) preoperative CT scans revealed small nodular lesions around the main tumor that were removed en bloc and were of the same histopathological type as the main tumor. We called these "satellite" tumors. All seven patients had local recurrence within 1 yr.

CONCLUSIONS

There seems to be a close relationship between the finding of satellite tumors and the recurrence of the disease. The existence of satellite tumors on the preoperative CT scan may be used as a guide for the extent of the resection, and further investigations are necessary before they are used as a prognostic sign.

Subcortical frontal lesions on MRI in patients with motor neurone disease

MRI was performed in 32 patients with motor neurone disease (26 men and 6 women, aged 40-77 years) and in a control group of 21 subjects. Of the patients studied, 19 had definite and 11 probable amyotrophic lateral sclerosis (ALS) and two had progressive bulbar palsy. In 10 patients there were asymmetrical bilateral foci of increased signal intensity on proton-density and T2-weighted images, confined to the white matter. Two patients had only cortical frontal atrophy and slightly increased ventricular size, whereas 20 had normal MRI. The focal lesions were not confined to corticospinal tracts, but were also observed in subcortical frontal areas. While the lesions along the corticospinal tracts correspond to pyramidal tract degeneration, the subcortical foci correlate with degeneration of the frontal bundles and indicate generalised involvement of the central nervous system.

Myocardial iron deposition in beta-thalassemia studied by magnetic resonance imaging

Myocardial iron deposition is a common finding in beta-thalassemia. The iron content of the myocardium was assessed using the T2 relaxation time of the heart. The T2 relaxation time of the liver and skeletal muscle was also assessed in order to study the relation of iron deposition between heart, liver and skeletal muscle. ECG gated spin echo images were obtained from thirty-eight consecutive adult thalassemic patients examined in an outpatient clinic, aged (x +/- SD) 25 +/- 6 years, using a 0.5 T system. Patients were divided into groups A and B, according to their average serum ferritin levels of the preceding five years (> or < 2000 ng/ml). Results were compared with nine controls, aged 24 +/- 7 years. Heart T2 relaxation time in the control group (x +/- SD) (48.3 +/- 5.5 msec) was higher compared to group A (28.4 +/- 6.7 msec, p < 0.001) but not to group B (43.4 +/- 7.4 msec). The T2 relaxation time of the heart correlated positively with the T2 relaxation time of the liver (r = 0.68, p < 0.001) and negatively with ferritin levels (r = -0.67, p < 0.001). There was no correlation with the T2 relaxation time of skeletal muscle. This study indicates that regularly transfused beta-thalassemia patients may present with a broad variation of heart iron deposition which, however, is related to serum ferritin levels.

The cerebral effects of carbon dioxide during digital subtraction angiography in the aortic arch and its branches in rabbits

PURPOSE

We studied the neurotoxicity of carbon dioxide as a contrast agent in the central nervous system by performing CO2 digital subtraction angiography (DSA) in the aortic arch and its branches in experimental animals.

METHODS

Twenty-five rabbits underwent intraarterial CO2 DSA while under general anesthesia, during which 50 angiograms were obtained after administration of 3 mL/kg CO2. MR imaging was performed before and after the angiographic procedure. The animals were killed 12 hours later and their brains examined macroscopically and microscopically.

RESULTS

Three animals died of a cause irrelevant to CO2. No animal had clinical symptoms of hemiplegia or stroke. Neither MR imaging nor macroscopic and microscopic examination of the brain revealed any ischemic infarct hemorrhage, thrombosis, or foci of necrosis.

CONCLUSION

The absence of neurologic symptoms, the lack of pathologic findings at MR imaging, and the negative pathologic findings in the brain encourage further research on CO2 neurotoxicity of the central nervous system and support its application in the imaging of intracranial vessels.

MRI and ultrasonographic findings in the investigation of lymphedema and lipedema

METHODS

Twenty-four healthy subjects and 16 patients with lymphedema and lipedema were studied with MRI and ultratomography.

RESULTS

In chronic lymphedema, ultrasonography revealed a statistically significant increase of the subcutaneous fat without difference in skin thickness as compared to the healthy subjects. MRI revealed in lymphedema a statistically significant increase of skin thickness + subcutaneous tissue + muscular mass (p = 0.048); in lipedema, a statistically significant increase of skin thickness and subcutaneous tissue (p < 0.0001) as compared to the healthy controls.

CONCLUSIONS

MRI offers strong qualitative and quantitative parameters in the diagnosis of lymphedema and lipolymphedema, while ultrasonography is expected to improve its diagnostic efficiency with the aid of high frequency echo with more sophisticated resolution apparatus. Age, weight and height of the patient as well as duration of the disease do not seem to affect the above-mentioned parameters.

Cognitive function in non-demented individuals complaining of short-term memory disturbances: a study with event-related potentials (P 300) and brain CT scan

Event-related potentials (ERPs) were elicited in 30, non-consecutive, non-demented individuals, complaining of short-term memory disturbances. Fifteen of them had a moderate diffuse cerebral atrophy on their brain CT and the other 15 had a negative brain CT. ERPs were also elicited in 15 age-matched controls with no reported memory disturbances and negative brain CTs. The statistical analysis showed that the group of individuals with cerebral atrophy had a significantly prolonged P300 (P3) latency and a decreased P3 amplitude compared to controls. It is concluded that among persons complaining of short-term memory disturbances, the individuals who show cerebral atrophy, taken as a group, have a P3 latency prolongation and/or low P3 amplitude a finding which reflects an impaired information processing.