Search

Background/aims: Nausea is a major complaint of gastroparesis (GP), and the pathophysiology of this condition is poorly understood. Therefore, this study utilized fMRI to investigate the possible central nervous system (CNS) mechanisms of nausea in 10 GP patients versus 8 healthy controls (HCs)., Methods: Nausea severity was assessed on a 0-10 scale and presented as mean ± SD. Nausea was increased from baseline utilizing up to 30 min of visual stimulation (VS). Functional network connectivity was measured with fMRI at baseline and after 30 min of VS. fMRI data were preprocessed using statistical parametric mapping software. Thirty-four independent components were identified as meaningful resting-state networks (RSNs) by group independent component analysis. The Functional Network Connectivity (FNC) among 5 RSNs considered important in CNS nausea mechanisms was calculated as the Pearson's pairwise correlation., Results: Baseline nausea score in GP patients was 2.7 ± 2.0 and increased to 7.0 ± 1.5 after stimulation (P < 0.01). In HCs nausea scores did not increase from baseline after stimulus (0.3 ± 0.5). When comparing GP patients to HCs after VS, a significant reduction (P < 0.001) in bilateral insula network connectivity compared to the right insula network was detected. No significant differences in connectivity were noted among the other RSNs. Additionally, the average gray matter volume was non-significantly reduced in the insula in GP patients compared to HC., Conclusions: The insula connectivity network is impaired in nauseated GP patients. This phenomenon could explain the susceptibility of GP patients to nausea or may have resulted from a state of chronic nausea.

Healthcare for poor children, also known as Medicaid, is disproportionately relied upon by citizens of poor states such as New Mexico, where (a) there are more unintended pregnancies, (b) domestic violence during and after pregnancies occurs with regularity, (c) youth substance use is much more common, (d) crime rates are some of the worst in the country, (e) many never graduate from high school, and (f) incarceration is often inevitable. Yet, there is a dearth of research into the neuropsychological health of these children. Meanwhile, nonneuropsychologists working for managed care organizations routinely deny authorization for neuropsychological testing based on a lack of medical necessity. The present article addresses the question of neuropsychological medical necessity using community-based neuropsychological data from New Mexico collected on Medicaid and non-Medicaid youth via retroactive chart review. Downstream fiscal implications that are related to the eventual cost of mental illness and crime among those with poor neuropsychological health are discussed.

Double right coronary artery is a very rare anomaly that is usually discovered incidentally during conventional coronary angiography. Double right coronary artery may have clinical implications in symptomatic patients requiring percutaneous coronary intervention and may be associated with other congenital abnormalities, myocardial ischemia and ventricular fibrillation in the absence of atherosclerosis. Here the reported cases in the literature are reviewed and a case of double right coronary artery with ischemia in inferior left ventricular wall is presented., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Fungal infections of the central nervous system (CNS) pose a threat to especially immunocompromised patients and their development is primarily determined by the immune status of the host. With an increasing number of organ transplants, chemotherapy, and human immunodeficiency virus infections, the number of immunocompromised patients as susceptible hosts is growing and fungal infections of the CNS are more frequently encountered. They may result in meningitis, cerebritis, abscess formation, cryptococcoma, and meningeal vasculitis with rapid disease progression and often overlapping symptoms. Although radiological characteristics are often nonspecific, unique imaging patterns can be identified through computer tomography as a first imaging modality and further refined by magnetic resonance imaging. A rapid diagnosis and the institution of the appropriate therapy are crucial in helping prevent an often fatal outcome.

Fungal infections of the nose and paranasal sinuses can be categorized into invasive and non-invasive forms. The clinical presentation and course of the disease is primarily determined by the immune status of the host and can range from harmless or subtle presentations to life threatening complications. Invasive fungal infections are categorized into acute, chronic or chronic granulomatous entities. Immunocompromised patients with poorly controlled diabetes mellitus, HIV and patients receiving chemotherapy or chronic oral corticosteroids are mostly affected. Mycetoma and Allergic Fungal Rhinosinusitis are considered non-invasive forms. Computer tomography is the gold-standard in sinonasal imaging and is complimented by Magnetic resonance imaging (MRI) as it is superior in the evaluation of intraorbital and intracranial extensions. The knowledge and identification of the characteristic imaging patterns in invasive - and non- invasive fungal rhinosinusitis is crucial and the radiologist plays an important role in refining the diagnosis to prevent a possible fatal outcome.

Introduction: Magnetic resonance imaging (MRI) sequence acquisition techniques for iron assessment have revolutionized the study of iron overload in different organs. We hypothesized that MRI can accurately and reliably assess possible iron deposition in the myocardium and liver by measurement of T2* value., Materials and Methods: Seventeen patients with end-stage renal disease on hemodialysis were enrolled. An electrocardiography-gated single breath hold fast multiecho T2* sequence was acquired in the short axis at basal and mid-ventricular levels. The same technique was utilized to estimate liver parenchyma iron content., Results: Iron deposition in the liver was present in 50% of the hemodialysis patients. No iron deposition was found in the myocardium. A strong univariable inverse linear association was detected between serum albumin and T2* in the liver (r = -0.84, P < .001). Patients who had been on dialysis for 10 years and longer had a 91% reduction in their odds of developing iron overload in the liver compared to the referent group (exact odds ratio, 0.09; P = .048)., Conclusions: Even though using intravenous iron infusion is a common practice in chronic dialysis patients, it seems the myocardium as opposed to the liver is resistant to or protected against iron deposition. There were no meaningful differences in the relationship between iron overload in the liver and the dialysis time vintage. A more aggressive trend of iron therapy and different formulations of iron infusion could be an explanation of iron deposition in the liver.

Paragangliomas are rare tumors of the endocrine system. They are highly vascular and in some cases hormonally active, making their management challenging. Although there is strong evidence of the safety and effectiveness of preoperative embolization in the management of spinal tumors, only five cases have been reported in the setting of thoracic paragangliomas. We present the case of a 19-year-old man with a large, primary, functional, malignant paraganglioma of the thoracic spine causing a vertebral fracture and spinal cord compression. To our knowledge this is the first report of preoperative trans-arterial balloon augmented Onyx embolization of a thoracic paraganglioma.

Objective: The purpose of this article is to review the normal anatomy of the aortic arch and the most common variations of congenital aortic arch anomalies using low-radiation-dose, defined as a dose-length product of 7-15 mGy × cm, MDCT angiography., Conclusion: Radiologists should be prepared to fully describe congenital aortic arch anomalies; recognize them on CT angiography, especially the presence or absence of vascular rings or aberrant arteries; and explain their association with the trachea and esophagus.

Objective: The purpose of our study was to determine the interobserver reproducibility of CT findings of right ventricular (RV) dysfunction in pulmonary embolism (PE)., Materials and Methods: Two experienced observers independently and retrospectively evaluated pulmonary CT angiography (CTA) studies of 50 patients with acute PE for the following signs: bowing of the interventricular septum, inferior vena cava (IVC) contrast medium reflux, RV diameter (RVD)/left ventricular diameter (LVD) ratio on axial sections and four-chamber (4-CH) views, and RV volume (RVV)/left ventricular volume (LVV) ratio. Analysis used kappa statistics, Spearman's rank correlation, and Bland-Altman statistics., Results: The two observers had fair to moderate agreement (kappa = 0.32-0.44) for septal bowing and moderate to good agreement (kappa = 0.57-0.68) for diagnosing IVC reflux. The Spearman's rank correlation coefficients for RVD(axial)/LVD(axial) ratio and RVD(4-CH)/LVD(4-CH) ratio between the two observers were 0.88 (p < 0.001) and 0.85 (p < 0.001), respectively. On Bland-Altman analysis, the mean differences for RVD(axial)/LVD(axial) ratio and RVD(4-CH)/LVD(4-CH) ratio were 0.014 (+/- 0.195) and 0.001 (+/- 0.242), respectively. The correlation coefficient for RVV/LVV ratio was 0.93 (p < 0.001), and the mean difference was 0.033 (+/- 0.229)., Conclusion: Considerable differences exist in the interobserver reproducibility of CT findings of RV dysfunction on pulmonary CTA in patients with acute PE. Cardiac chamber measurements are more reproducible than septal bowing and IVC reflux. Volumetric determination of the RVV/LVV ratio is the least user dependent and most reproducible.

Objective: To evaluate the feasibility of adenosine-stress dynamic myocardial volume perfusion imaging with second generation dual source computed tomography (CT) for the qualitative and quantitative assessment of myocardial blood flow (MBF) compared with stress perfusion and viability magnetic resonance imaging (MRI)., Material and Methods: Ten patients (8 male, 2 female, mean age 62.7 +/- 7.1 years) underwent stress/rest perfusion and delayed-enhancement MRI, and a cardiac CT protocol comprising prospectively electrocardiogram -triggered coronary CT angiography, dynamic adenosine-stress myocardial perfusion imaging using a "shuttle" mode, and delayed enhancement acquisitions. Two independent observers visually assessed myocardial perfusion defects. For semi-quantitative evaluation, CT- and MRI-derived myocardial-to-left ventricular upslope indices were compared. Additionally, absolute MBF was quantified based on dynamic perfusion CT and correlated with semi quantitative CT measurements. Myocardial perfusion analysis was performed on a segmental basis. Analysis used paired t tests, Wilcoxon signed-rank test, linear correlation, and Bland-Altman statistics., Results: A total of 149 segments (93.1%) were suitable for analysis. Sensitivity, specificity, positive and negative predictive values for detection of myocardial perfusion defects at CT compared with MRI were 86.1%, 98.2%, 93.9%, and 95.7%, respectively. Semiquantitative analysis of CT data showed significant differences between ischemic and nonischemic myocardium with a signal intensity upslope that was comparable with MRI-derived values (CT: 5.2 +/- 2 SI/s, MRI: 4.8 +/- 2.3 SI/s, P > 0.05). Moderate correlation was observed between absolute CT quantification of MBF and semi-quantitative CT measurements. Mean total dose length product for the entire cardiac CT protocol was 1290.4 +/- 233.3 mGy cm., Conclusion: Adenosine-stress volumetric first pass CT perfusion imaging is feasible and may enable the evaluation of qualitative and semi quantitative parameters of myocardial perfusion in a comparable fashion as MRI.

Objective: To evaluate the performance of a computer-aided algorithm for automated stenosis detection at coronary CT angiography (cCTA)., Methods: We investigated 59 patients (38 men, mean age 58 +/- 12 years) who underwent cCTA and quantitative coronary angiography (QCA). All cCTA data sets were analyzed using a software algorithm for automated, without human interaction, detection of coronary artery stenosis. The performance of the algorithm for detection of stenosis of 50% or more was compared with QCA., Results: QCA revealed a total of 38 stenoses of 50% or more of which the algorithm correctly identified 28 (74%). Overall, the automated detection algorithm had 74%/100% sensitivity, 83%/65% specificity, 46%/58% positive predictive value, and 94%/100% negative predictive value for diagnosing stenosis of 50% or more on per-vessel/per-patient analysis, respectively. There were 33 false positive detection marks (average 0.56/patient), of which 19 were associated with stenotic lesions of less than 50% on QCA and 14 were not associated with an atherosclerotic surrogate., Conclusion: Compared with QCA, the automated detection algorithm evaluated has relatively high accuracy for diagnosing significant coronary artery stenosis at cCTA. If used as a second reader, the high negative predictive value may further enhance the confidence of excluding significant stenosis based on a normal or near-normal cCTA study.

Recent research suggests that multidetector-row CT may have potential as a standalone modality for integrative imaging of coronary heart disease, including the assessment of the myocardial blood supply. However, the technical prerequisites for volumetric, time-resolved imaging of the passage of a contrast medium bolus through the myocardium have only been met with latest generation wide-detector CT scanners. Second-generation dual-source CT enables performing electrocardiographic (ECG)-synchronized dynamic myocardial perfusion imaging by a dedicated "shuttle" mode. With this acquisition mode, image data can be acquired during contrast medium infusion at 2 alternating table positions with the table shuttling back and forth between the 2 positions covering a 73-mm anatomic volume. We applied this acquisition technique for detecting differences in perfusion patterns between healthy and diseased myocardium and for quantifying myocardial blood flow under adenosine stress in 3 patients with coronary heart disease. According to our initial experience, the addition of adenosine stress volumetric dynamic CT perfusion to a cardiac CT protocol comprising coronary artery calcium quantification, prospectively ECG-triggered coronary CT angiography, and delayed acquisition appears promising for the comprehensive assessment of coronary artery luminal integrity, cardiac function, perfusion, and viability with a single modality., (Copyright 2010 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.)