Diagnostic confidence and image quality of CT pulmonary angiography at 100 kVp in overweight and obese patients

AIM

To compare image quality and diagnostic confidence of 100 kVp CT pulmonary angiography (CTPA) in patients with body weights (BWs) below and above 100kg.

MATERIALS AND METHODS

The present retrospective study comprised 216 patients (BWs of 75-99kg, 114 patients; 100-125kg, 88 patients; >125kg, 14 patients), who received 100 kVp CTPA to exclude pulmonary embolism. The attenuation was measured and the contrast-to-noise ratio (CNR) was calculated in the pulmonary trunk. Size-specific dose estimates (SSDEs) were evaluated. Three blinded radiologists rated subjective image quality and diagnostic confidence. Results between the BW groups and between three body mass index (BMI) groups (BMI <25kg/m(2), BMI = 25-29.9kg/m(2), and BMI ≥30kg/m(2), i.e., normal weight, overweight, and obese patients) were compared using the Kruskal-Wallis test.

RESULTS

Vessel attenuation was higher and SDDE was lower in the 75-99kg group than at higher BWs (p-values between <0.001 and 0.03), with no difference between the 100-125 and >125kg groups (p = 0.892 and 1). Subjective image quality and diagnostic confidence were not different among the BW groups (p = 0.225 and 1). CNR was lower (p < 0.006) in obese patients than in normal weight or overweight subjects. Diagnostic confidence was not different in the BMI groups (p = 0.105).

CONCLUSION

CTPA at 100 kVp tube voltage can be used in patients weighing up to 125kg with no significant deterioration of subjective image quality and confidence. The applicability of 100 kVp in the 125-150kg BW range needs further testing in larger collectives.

Is every sharply defined, symmetrical, necrotic-demyelinating lesion in the corpus callosum an actual manifestation of Marchiafava-Bignami disease?

Neuroimaging of a 75-year-old lady demonstrated the characteristic pathological features of the Marchiafava-Bignami disease (MBD), which develops usually in chronic alcoholics. The onset of the neurological symptoms and signs were abrupt and similar to those seen in common ischemic vascular lesions. Our patient denied that she had consumed alcoholic beverage during her life. Laboratory results showed her liver enzymes were not elevated and a subsequent abdominal ultrasound examination revealed no liver pathology. The attack responded fairly well to anti-ischemic therapy and a complete recovery was observed within a week. In this sense, her pathology cannot be considered as a true MBD in spite of the presence of the CT and MRI findings of MBD. Our case seems to show that the CT and MRI findings in MBD are not specific because new imaging procedures reveal edematous, necrotic lesions that may have the appearance of MBD.

Posterior interbody fusion using laminectomy bone and transpedicular screw fixation in the treatment of lumbar spondylolisthesis

BACKGROUND

Laminectomy bone is used widely in posterolateral lumbar fusion, but not interbody fusion. No prospective evaluation of interbody fusion using bone grafts from the posterior neural arch in spondylolisthesis has been found in the literature. We prospectively studied series of patients operated on for lumbar spondylolisthesis to evaluate clinical improvement and bony fusion.

METHODS

Forty-six patients were operated on for lumbar spondylolisthesis using a simplified one-stage posterior procedure. The whole mobile dorsal segment of the vertebral arch was taken out in one piece and the bone was used for interbody fusion. Fixation was performed with transpedicular screws and rods using transverse connectors.

RESULTS

After an average follow-up time of 27.3 months, 87% of the patients could be considered to have an excellent or good clinical outcome. The rate of successful fusion was 95.7%. No noteworthy complications occurred.

CONCLUSION

Laminectomy bone seems to be optimal for posterior interbody fusion and together with transpedicular rigid fixation the long-term clinical and radiological results are convincingly good. The method is advisable even for severe spondylolisthesis.

[Diagnostic possibilities in gastric leiomyoma in relation to two of our cases]

Two cases of rare, benignant gastric tumors are reported. The suggest that while in the diagnosis of tumors with a mucous membrane involvement endoscopy has doubtless a leading role, tumors not infiltrating the mucous membrane are usually better recognizable by radiological (ultrasonography, computer tomography and double contrast x-ray) methods. An appropriate diagnosis followed by surgical removal of the tumor might result in a complete healing of the patient.

Screening for depressive symptoms in the acute phase of stroke

Depressive symptoms can often be observed after stroke. We prospectively evaluated patients at a stroke unit in order to determine the occurrence and severity of depressive symptoms in the acute phase of stroke in 82 patients 7 +/- 2 days after admission to the stroke unit. Severity of stroke was evaluated by the Scandinavian and Orgogozo scales and the Barthel index. Severity of depressive symptoms was measured by the 13-item Beck scale. Mean age of the patients was 65.8 years. No gender difference was observed in the severity of stroke or depressive symptoms. DSM-IV criteria of adjustment disorder with depressed mood were fulfilled by 27% of the patients. In this group, stroke was significantly more severe by the Barthel, Orgogozo, and Scandinavian scales (p < 0.001). Whereas Beck score was at least 10 in 19.5%, severe depressive symptoms (Beck score > or = 15) occurred in less than 5% of patients with acute stroke. Those who could not walk by themselves or who were aphasic had significantly higher mean Beck scores (6.3 +/- 5.1 vs 2.4 +/- 3.1, p < 0.001, and 7.0 +/- 5.8 vs 3.4 +/- 3.9, p = 0.002). Significant correlation was found between the severity of stroke and that of the depressive symptoms (r = -0.56, -0.58, and -0.54 for the Scandinavian, Orgogozo, and Barthel scales, p < 0.001).

Screening of vascular cognitive impairment on a Hungarian cohort

Cerebrovascular disease is a major public health problem in Eastern European countries. A Hungarian post-stroke population was examined to estimate the rate of dementia, the risk factors for cognitive impairment, and the applicability of a recently established Canadian diagnostic checklist in this cohort. Chronic cerebrovascular outpatients were screened for cognitive impairment with a combined checklist: the Diagnostic Checklist for Vascular Dementia established by the Consortium of Canadian Centres for Clinical Cognitive Research using the Mini Mental State Examination instead of the detailed neuropsychological part of the Checklist. Of the 247 consecutive patients at a cerebrovascular outpatient unit, 176 had cerebrovascular disorder diagnosed either by computed tomography (CT; n=126) or by the clinical signs. Of these, 15% were cognitively impaired and 5% fulfilled the criteria of dementia. The mean age of the patients with cognitive impairment was significantly higher than that of patients with normal cognition (68.2+/-10.2 and 60.5+/-10.5 years, P<0.001). The Barthel index was significantly lower in the cognitively affected group than in non-affected patients (92.4+/-16.0 and 97.1+/-8.7, P=0.027). Diabetes and more than two subcortical infarcts on CT or magnetic resonance imaging were more frequent in patients with cognitive loss (P=0.043 and P=0.013, respectively). Cognitive performance was also influenced by the level of education. Higher age, diabetes, motor deficits, and multiple subcortical infarcts are risk factors for cognitive impairment after stroke. The combined checklist appears to be a practical screening test for cognitive impairment in patients with chronic cerebrovascular diseases.

Posterior lumbar interbody fusion (PLIF) using the bony elements of the dorsal spinal segment

Many different types of surgical technics for treating unstable degenerative spondylolisthesis of the lumbar spine has been reported. The most important part of the different procedures is to achieve a solid bony fusion between the two vertebrae. Authors report a new simple method of posterior lumbar interbody fusion in spondylolisthesis. The whole posterior segment of the mobile neural arch is removed and used for fusion. Corticospongiosus dowels and small bone chips are impacted into the disc space emptied totally before. Monosegmental transpedicular fixateur is required for stability. 33 patients with an average follow up of 20 months showed a clinical improvement of 88%. The radiologically proved fusion rate was 90%. Authors achieved good clinical outcome and high bony fusion rate with the one stage operation from posterior approach for treating lumbar spondylolisthesis.

[Cerebral positron emission tomographic study in systemic lupus erythematosus]

The cerebral glucose metabolism in eight patients with systemic lupus erythematosus (SLE) and in five healthy controls were examined by positron emission tomography (PET) using 18-F-labeled deoxy-glucose (FDG) as tracer. One of the eight patients had no abnormality by magnetic resonance imaging (MRI), three of them had cerebral atrophy and four patients had multiple white matter hyperintensities and vascular infarcts in the striatum as assessed by MRI. With FDG-PET, inhomogeneous multifocal cerebral glucose hypometabolism was detected, more frequently in the temporal lobe of right hemisphere. The PET findings did not correlate always with the neurological symptoms. Abnormalities in brain metabolism can be detected more frequently by PET, than morphological changes by MRI, indicating the involvement of the central nervous system.

[Angiographical evaluation of extracranial carotid artery: comparison between Japanese and Hungarian]

We investigated the cervical level of carotid bifurcation, diameter of common carotid artery (CCA) and internal carotid artery (ICA) in 147 Japanese patients (150 arteries, range of age 31-79) and in 490 Hungarian patients (517 arteries, range of age 12-77). The cervical level of carotid bifurcation was determined by comparison with cervical vertebra. The carotid bifurcation of Japanese was most frequent at the lower part of 3rd cervical vertebra but in Hungarian the bifurcation was most frequent at the middle part of 4th cervical vertebra. Japanese carotid bifurcation was high-positioned compared with Hungarian. The mean CCA diameter in Japanese was 7.47 mm in male and 7.07 mm in female, in Hungarian 9.24 mm in male and 7.80 mm in female. The mean ICA diameter in Japanese was 4.96 mm in male and 4.83 mm in female, in Hungarian 8.56 mm in male and 7.66 mm in female. CCA and ICA diameter were larger in male than in female. The diameter of CCA had a significantly positive correlation with age (p < 0.002) but ICA had no similar correlation.

[First Hungarian experiences with positron emission tomography (PET) studies. Members of the PET working group]

Diagnostic investigations commenced on the 28th of June 1994 in Hungary's and Central Europe's first PET Centre at the University Medical School of Debrecen. The Centre is equipped with a GE 4096 Plus whole body PET scanner. A metabolic tracer, 18F-deoxy-D-glucose (FDG), was used in the investigations. During the first 15 months 249 PET investigations were made in the Centre of which 242 were diagnostic and 7 normal subjects served as control for the patient studies with brain scans. The number of oncological indications (intra- and extracranial tumours, Hodgkin's lymphomas) was n = 105 (43.4% of the 242 diagnostic examinations), neurological investigations (without intracranial tumours) formed the dominant group (n = 117; 48.3%), whereas the number of cardiological indications was 20 (8.3%). The oncological studies included those of intracranial tumours (n = 76; 31.4%); thyroid tumours (n = 9; 3.7%); Hodgkin's lymphomas (n = 7; 2.9%) and other extracranial tumours (n = 13; 5.4%). The distribution of different neurological and psychiatric investigations was as follows: localization of focal epileptogen zone (n = 60; 24.8%); differential diagnosis of dementias (n = 30; 12.4%); exploration of cerebrovascular diseases (n = 10; 4.1%); and other neurological diseases (n = 17; 7.0%). The main objective of the cardiological PET investigations was the exploration of viable myocardium. The present paper overviews both the procedures (including administrative issues, as well) and the results of the first 249 FDG-PET investigations.

[Morphological differences in carotid angiograms and their relation to age]

The level of carotid bifurcation, frequency of the kinking of the internal carotid artery, correlation between the diameter of carotid arteries and the age of the Hungarians was examined. The cervical level of carotid bifurcation, diameter of extracranial carotid arteries, frequency of kinking of internal carotid arteries were measured on conventional carotid angiograms in 490 Hungarian patients (517 arteries, age range 12-77 yr). The cervical level of the carotid bifurcation was determined by comparison with cervical vertebra. The most frequent level of carotid bifurcation was found at the middle part of 4th cervical vertebra. The position shifted higher with ageing. The mean common carotid artery diameter was 9.24 +/- 1.58 mm in males and 7.80 +/- 1.10 mm in females. The mean internal carotid artery diameter was 8.56 +/- 1.84 in males and 7.66 +/- 1.39 in females. The mean external carotid artery diameter was 5.53 +/- 1.11 mm in males and 4.76 +/- 0.91 in females. The diameter of the common carotid artery has a significantly positive correlation with age (p < 0.05) but internal carotid artery and external carotid artery had no similar correlation. The kinking of internal carotid artery was observed frequently in patients who had higher level of carotid bifurcation.

[Computer tomography in implantology]

During the planning of implantation the CT method helps in determining the location of the implant and aids in choosing the right implant. It provides the following measurable information about the jaw-bones: height and width; exact location of bone deficiencies; the orovestibular shape of the alveolar process; the course of the mandibular canal; the location of the mental foramen; the location and size of the canalis incisivus; the area of the nasal cavity and the maxillary sinus; the quality of the bones and the relationship between cortical and spongious bone. In comparison to the X-ray examinations possession of these informations increase significantly the safety of planning before surgery.

Are intra- and suprasellar masses detected by CT and MR really tumours?

The difficulties of differential diagnosis between intra- and suprasellar tumours resp. inflammatory processes are discussed, based on three personal cases. In all three computed tomography (CT) and magnetic resonance imaging (MR) had demonstrated a tumour, but the clinical signs with discrepancies between radiological and clinical findings were pointing to an inflammatory process. The correct diagnosis of an inflammation was achieved by co-operation between neurologist, neurosurgeon, otologist and ophthalmologist. An unnecessary neurosurgical operation was avoided and the patients were cured by otological intervention and antibiotic therapy.

[Ischemic cerebrovascular lesion caused by left atrial myxoma]

A case presentation is given of a 40 years old woman with acute ischemic cerebrovascular lesion in the territory of the left middle cerebral artery caused by embolization from a myxoma in the left atrium. The tumor was diagnosed by transthoracic echocardiography. Histological examination after cardiac surgery revealed a benignant myxoma. In the six-month-long postoperative follow up gradual improvement of the neurological signs was observed. The most important morphological and clinical characteristics of myxomas are summarized. The necessity of detailed cardiological examination of each young patient with stroke is emphasized.

[Use of Ceolat (dimethylpolysiloxan) chewing tablets in the preparation of patients for radiologic examinations]

Via statistic methods, the authors examine the capability of Ceolat tablet in improving the diagnostic efficacy of plain abdominal films, US and CT examinations. It has been proved on the basis of self-control examinations that by decreasing the amount of intestinal gas, Ceolat improves the quality of the images in all the three methods examined.

Subtentorial subdural empyema: Case report

We present a case of an extensive subtentorial subdural empyema of otorhinological origin. Although 3%-6% of all intracranial suppurations are infratentorial, there is no report on extensive multiloculated subtentorial empyema so far.

[Significance of computer analysis of dynamic brain scintigraphy in patients with cerebrovascular disorders]

Dynamic cerebral scintigraphy was performed on 41 patients with cerebrovascular disease. The diagnostic value of parametric images formed by a computer was correlated to angiographic findings and clinical sings, respectively. Having the appropriate software these examinations can be performed with traditional gamma-cameras. Analysis of parametric pictures increases the reliability of the method. Analysis of cinematic display of serial images had the highest sensitivity and accuracy, while time-of-maximum pictures had the highest specificity. In departments, where digitized subtraction angiography, single photon emission computed tomography or positron emission tomography is not available, the non invasive dynamic brain scintigraphy is a useful screening method, its application is proposed by the authors.

Alterations of the connective tissue in nude mice

The epiphyseal cartilage of nude mice was studied by light and electron microscopy. The resting and maturation zones become narrow and mineralization of the ground substance starts already in the zone of proliferation. Electron microscopy reveals signs of degeneration in the chondrocytes of this latter zone. An increased osteoclast activity can be observed in the metaphysis. The alterations may be due to a decrease in T-cell-mediated immunoreactivity of nude mice, as well as to an increased production of the osteoclast-activating factor, which might be attributed, among other things, to the B lymphocytes or macrophages.