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The purpose of this study is to compare color Doppler sonography with biphasic helical CT in the evaluation of abdominal aortic aneurysms after endovascular repair.Fifty-five patients prospectively underwent both color Doppler sonography and helical CT within 7 days after treatment by endovascular stent-graft. Aneurysmal thrombosis, the patency of the grafts, and the presence of a leak were evaluated in all patients. When a perigraft leak was observed, an attempt was made to identify its origin and outflow vessels. Helical CT was considered the gold standard technique.Helical CT revealed aneurysmal thrombosis in 33 patients and a perigraft leak in 22 patients. In five patients, helical CT detected a small perigraft leak not shown by color Doppler sonography. In three patients with suboptimal examinations, color Doppler sonography revealed a suspected perigraft leak that was not confirmed by helical CT. In these eight patients, the perigraft leak was sealed or no longer observed during follow-up. Compared with enhanced helical CT, the sensitivity and specificity of color Doppler sonography for the diagnosis of a perigraft leak were 77% and 90%, respectively. In seven other patients, helical CT was superior to color Doppler sonography in detecting the origin of the perigraft leak and the outflow vessels. Two iliac artery dissections and one distal migration of the prosthesis were revealed only by helical CT.Although color Doppler sonography may detect substantial perigraft leaks, helical CT is superior for detecting the origin of the perigraft leak, the outflow vessels, and the detection of complications related to the procedure.

Endovascular repair of abdominal aortic aneurysm is becoming a valuable alternative to open surgery in selected patients. With the recognition of this new treatment, however, many complications, some of them life-threatening, are reported. Imaging plays a major role in the detection of these complications. This article reviews the role of imaging techniques in the detection of these complications.

The recently published clinical trials of endoluminal repair of aortic aneurysms underline the need for a close imaging follow-up of patients undergoing these procedures. This article discusses the role of different imaging modalities in the evaluation of these patients.

To compare prospectively the data provided with endoscopic retrograde cholangiopancreatography (ERCP) and magnetic resonance (MR) cholangiopancreatography (MRCP) in eight patients with symptomatic choledochal cysts.Eight patients (three children, five adults) with choledochal cyst and abdominal pain underwent sequential single-shot turbo spin-echo T2-weighted MRCP and ERCP. Seven of the eight patients had relapsing pancreatitis. In three patients, a dynamic MR examination was performed after secretin stimulation of exocrine pancreatic function.A complete correlation was observed between ERCP and MRCP for defining the anatomic characteristics of the cyst (seven type I cysts, one type IV cyst) and the presence of an abnormal pancreaticobiliary junction (PBJ) (six patients) with a long common channel. Of the seven patients with acute pancreatitis, six had an abnormal PBJ and one had common bile duct (CBD) stones with a normal ductal union evidenced with both techniques. In two patients, dynamic MRCP demonstrated preferential filling of the gallbladder and the CBD after secretin injection, whereas normal duodenal filling was observed in another patient without a junctional abnormality.MRCP provides information equivalent to that provided with ERCP, without potential complications, for the preoperative assessment of choledochal cysts. Dynamic secretin-stimulated MRCP studies might help better understand the pathophysiologic characteristics of this entity.

Purpose: To present four cases of penetrating ulcer of the descending thoracic aorta treated by transfemoral insertion of an endoluminal stent-graft. Methods: Four patients with penetrating aortic ulcers were reviewed. Three cases were complicated by rupture, false aneurysm, or retrograde dissection. All patients were treated by endovascular stent-graft and were followed by helical computed tomography (CT). Results: Endovascular stent-graft deployment was successful in all patients. However, in one case we observed a perigraft leak that spontaneously disappeared within the first month, and two interventions were needed for another patient. Following treatment, one episode of transient spinal ischemia was observed. The 30-day survival rate was 100%, but one patient died from pneumonia with cardiac failure 34 days after the procedure. In one patient, helical CT performed at 3 months showed a false aneurysm independent of the first ulcer. This patient refused any further treatment and suddenly died at home (unknown cause) after a 6-month follow-up period. Conclusion: Transluminal placement of endovascular stent-grafts for treatment of penetrating ulcers of the descending thoracic aorta appears to be a possible alternative to classical surgery. After treatment, follow-up by CT is essential to detect possible complications of the disease.

Self-treatment of chronic headache with suppositories containing paracetamol and acetylsalaicylic acid may lead to serious complications. We report the radiological features of five cases of rectal stenosis following the use of such suppositories. The role of the double-contrast barium enema in suggesting the diagnosis of this complication of a chronic and often unrecognized self-treatment is emphasized.

OBJECTIVE: The purpose of this study is to report a new sign, "acinar filling," observed on dynamic MR pancreatography after secretin stimulation in patients with suspected early chronic pancreatitis. CONCLUSION: Acinar filling might reflect tissue hypertension or loss of pancreatic parenchyma compliance or both. This finding is probably an insensitive but specific sign of early chronic pancreatitis.

extensive necrosis of the mucosa and multiple vascular microthrombosis found in duodenal biopsy specimens confirmed our suspicion of ischemia. Our patient had a good clinical response to conservative treatment, probably because of the limited extension of the bowel ischemia. Indeed, a second endoscopy, performed 2 weeks after admission, revealed a significant improvement. This course seems to be similar to that described for ischemic colitis, in which rapid resolution of lesions occurs in most cases.9 This report emphasizes that the clinician should look for an ischemic episode when a PNH patient presents acute abdominal pain. Unfortunately for these patients, bowel thrombosis tends to be recurrent and the overall prognosis remains poor.

The aim of this study was to investigate whether IV secretin administration is useful to enhance the delineation of the main pancreatic duct (MPD) and its side branches, and if it provides additional information concerning signal voids and strictures. Twenty-seven patients referred for abdominal pain or laboratory abnormalities (group 1, n = 13) or for the follow-up of chronic pancreatitis (CP; group 2, n = 14) were studied. Magnetic resonance cholangiopancreatography was acquired at 1.5 T before and after IV secretin by a coronal 3D TSE T2-weighted sequence with maximum intensity projection postprocessing. In group 1 secretin provided a better visualization of MPD in 9 patients. In a patient with pancreas divisum, it allowed suggestion of stenosis of the accessory papilla, confirmed at endoscopic retrograde cholangiopancreatography (ERCP). In group 2 secretin provided a better visualization of MPD only in the 3 patients with mild disease. A mild dilation upstream a stricture occurred in 2 cases and a marked dilation appeared upstream a wallstent which was non-patent at ERCP. Few changes were noticed concerning side branches. These preliminary results indicate that in patients without CP, secretin improves MPD delineation avoiding invasive diagnostic ERCP. In patients with mild CP secretin does not improve the characterization of signal voids, but it may be useful to appreciate their significance and to follow-up stenosis.

To evaluate the therapeutic role of angiography in patients with pseudoaneurysms complicating pancreatitis.Thirteen symptomatic pseudoaneurysms were treated in nine patients with pancreatitis. Eight patients had chronic pancreatitis and pseudocyst and one had acute pancreatitis. Clinical presentation included gastrointestinal bleeding in seven patients and epigastric pain without bleeding in two. All patients underwent transcatheter embolization.Transcatheter embolization resulted in symptomatic resolution in all patients. Rebleeding occurred in two patients, 18 and 28 days after embolization respectively, and was successfully treated by repeated embolization. One patient with severe pancreatitis died from sepsis 28 days after embolization. Follow-up was then available for eight patients with no relapse of bleeding after a mean follow-up of 32 months (range 9-48 months).Transcatheter embolization is safe and effective in the management of pseudoaneurysms complicating pancreatitis.

Purpose Splenic parenchymal complications of pancreatitis are unusual and potentially life threatening. They usually require splenectomy in patients in poor condition. The present study describes natural history of splenic parenchymal complications and the role of CT scan in diagnosis and follow-up. Method A retrospective study of 16 consecutive patients with splenic complications diagnosed by CT during staging of pancreatitis was performed. The presence and importance of splenic infarct, abscess, subcapsular collection, and hemoperitoneum were correlated with the patients' symptoms, type of management, and follow-up. Results No specific symptomatology was observed except in two cases of acute and massive hemoperitoneum. Fourteen infarcts, 11 subcapsular collections, 1 abscess, and 3 hemoperitoneums were observed. Four patients underwent splenectomy including two as an emergency for hemodynamic instability. Twelve patients were conservatively and successfully managed. Conclusion Most splenic parenchymal complications of pancreatitis regress spontaneously and may be managed conservatively. Surgical indication is based mainly on clinical findings. CT is useful for detection and follow-up of these complications.

Partial nephrectomy and tumour enucleation are increasingly accepted as an organ sparing approach for small renal cell carcinomas. Repeated computed tomography or sonography for the early detection of tumour recurrence are mandatory during the follow-up. We report two cases of renal pseudotumour mimicking a tumour recurrence: one case is related to the pseudotumoral appearance on sonography of a tumour defect rilled by a fatty flap, and the other to the relative migration of an accessory spleen into the site of the cuneiform nephrectomy. The recognition of renal pseudotumours following partial nephrectomy prevents confusion with tumour recurrence on follow-up examinations. Partial nephrectomy and tumour enucleation are increasingly accepted as an organ-sparing approach for small renal cell carcinomas. Repeated radiological examinations are recommended for follow-up. However, this conservative approach has led to imaging appearances that can cause confusion. The pressure to detect an early recurrence increases the risk of misinterpreting a renal pseudotumour. We report two examples of renal pseudotumours that mimic tumour recurrence following partial nephrectomy. Case reports Case 1 A 42-year-old woman, with a previous history of right radical nephrectomy for a renal cell carcinoma 12 years previously, underwent enucleation of a second renal cell carcinoma which measured 29x24x2 2 mm and was located in the upper pole of the left kidney. This tumour was completely resected. The first sonographic followup examination was performed 6 months later and snowed a 17x15 mm hyperechoic mass in the upper pole of the left kidney. The mass was slightly heterogeneous and was associated with posterior acoustic shadowing. It was separated from the adjacent normal

To compare the value of conventional CT (CCT) and high-resolution CT (HRCT) to detect benign asbestos-related diseases, 159 exposed workers with a normal chest radiography were imaged by both techniques. Pleural plaques were detected in a total of 59 cases (37.1%). Ten cases (16.9%) were detected by CCT only and one case (1.7%) by HRCT only. Pulmonary lesions compatible with parenchymal asbestosis were detected by HRCT in 20 cases, whereas CCT showed abnormalities in 45% of these. Rounded atelectasis was equally recognized by both techniques. The results confirm that in a subject with a normal chest radiography, HRCT is a better diagnostic tool to demonstrate lesions of asbestosis. On the other hand, HRCT is insufficient to exclude the presence of pleural plaques. When HRCT does not reveal pleural abnormalities, CCT should be performed.

We retrospectively analyzed pre- and postoperative sonographic and medical records of 335 children who had surgical or endoscopic treatment at the ureterovesical junction, in order to determine normal and atypical sonographic appearances. Normal sonographic findings after ureteral reimplantation include thickening of the posterior bladder wall, pseudodiverticular sacculations, bladder asymmetry, and transitory hydroureteronephrosis. Short-term or persistent (lasting more than 1 month) hydroureteronephrosis, urinoma, hematoma, bladder lithiasis, and diverticula were abnormal findings, occurring in 17% of the patients. After partial ureteronephrectomies, visualization of the residual ureter on sonograms was not possible in cases without complications; in one patient, reflux of fluid dilated the residual ureter and made the ureter visible on sonograms. After endoscopic incisions, the masslike appearance of a collapsed ureterocele was observed. Submucosally injected Teflon always appeared as a curvilinear hyperechoic area with an acoustic shadow. Marked acute or persistent hydroureteronephrosis or ectopic intracavitary Teflon particles were observed in 2% of patients. Granuloma formation was considered likely in 5% of the patients when the area of injected Teflon material was longer than 12 mm on sonograms. Submucosally injected collagen appeared less echogenic than Teflon and showed no acoustic shadowing. The various normal sonographic appearances after treatment must be known in order to distinguish them from significant abnormalities. In patients with anatomic anomalies, such as short-term or persistent hydroureteronephrosis, urinoma, hematoma, and lithiasis, complementary uroradiologic examinations may be necessary to clarify the diagnosis.

Corporeal veno-occlusive dysfunction is an important cause of organic impotence and is characterized by increased flow rates to create and to maintain erection during artificial erection produced by intracavernous saline infusion. Sixty-seven patients with this erectile insufficiency underwent penile ligature-resection of deep dorsal vein between 1982 and 1986, and were evaluated by nocturnal plethysmography, pharmacocavernometry as well as a questionnaire about their sexual life for long-term follow-up. The surgical procedure was controlled in the operating room by reduction of the erectile flow rates. Thirty-one patients were potent postoperatively and were able to have satisfactory intercourse. Results after resection were slightly better than after simple ligation of the deep dorsal vein. Four patients had penile glans insensibility resulting from the surgical dissection. There were 7 relapses several months after the procedure due to leakage through other deeper veins. Eight failures were due to additional psychogenic disorders or to neurologic disease not accurately diagnosed before the treatment because they all developed normal papaverine-induced erection after venous surgery while before it they only developed a slight tumescence. Reduction of the erectile flow rates within normal values was impossible during surgery in 3 patients. Eleven failures were due to concomitant arterial disease. Resection of the deep dorsal vein can restore penile erection in patients with cavernovenous leakage in about 50% of well-selected patients.

A premature 34 week old female newborn infant of atriplet pregnancy was admitted in the neonatal unit withmoderate axial hypotonia. A few hours later, she wasfound to be suffering from respiratory distress and stridor.Clinical examination revealed a premature hypotonicbaby with respiratory retraction of suprasternal and infra-sternal soft tissue, stridor, and regurgitation. The abdomenwas slightly distended. Chest radiograph and arterialblood gas determination showed normal results, and alaryngeal abnormality was suspected.Cervical ultrasonography showed a cystic mass 12 mmin diameter at the right aryepiglottic fold, displacing theglottis toward the left side (Fig. 1). No flow was detectedwith Doppler ultrasonography. The ultrasonographicfindings suggested the diagnosis of aryepiglottic cyst.Limited endoscopic marsupialization was performedbut with transient clinical improvement. Ultrasonographyrevealed persistence or recurrence of the cyst, and a sec-ondary complete removal of the cyst was performed endo-scopically (Fig. 2). Microscopic examination revealed amucinous cyst. No recurrence was detected on sono-graphic follow-up, and deviation of the glottis wasreduced. The infant is now 32 months old and is com-pletely asymptomatic. On an ultrasonogram, the glottis isno longer deviated (Fig. 3).

Cysts of the prostate and seminal vesicles are confusing abnormalities because they are uncommon and their origin is uncertain. Several approaches to diagnosis have been used, most recently CT and transrectal sonography. In this study, we investigated the value of MR imaging in the diagnosis of six cases of prostatic cyst and five cases of cysts of the seminal vesicles. All patients were symptomatic. T1- and T2-weighted spin-echo images were obtained in all cases; pathologic confirmation was available in four patients. MR images were analyzed prospectively without knowledge of clinical data or the results of other imaging procedures. In all cases, low- and high-signal masses were observed on T1- and T2-weighted images, respectively. The cysts were unilocular with a sharply defined margin, ranging from 0.5 to 3.0 cm in diameter. The thin wall was of low signal intensity on T2-weighted images. Our experience suggests that MR imaging is useful in demonstrating the liquid content of prostatic and seminal-vesicle cysts and in establishing their size and location.

Prostatic magnetic resonance images of 22 male volunteers less than 30 years old and with no known genito-urinary tract disease were obtained at 1.5 T. Normal anatomical features of the prostate were studied with spin-echo techniques. Different zones of the normal gland are shown by T2-weighted images: the anterior fibromuscular fascia, the central prostate, the peripheral prostate and the periurethral zone can be differentiated. The normal prostate gland is shown on T1-weighted images as a homogeneous appearance. It is important to recognize the normal zonal anatomy of the prostate since prostatic disorders arise in different anatomical zones.

Bronchial tumors that invade the mediastinum are not necessarily inoperable. Whether surgery is possible depends, among other things, on the extent of pulmonary artery invasion. The authors have studied the value of cardiac-gated MRI and compared it with CT and venous DSA for staging tumor invasion. CT demonstrated the areas of contact between tumor and mediastinum. The MRI planes were transverse and also in the main axis of the pulmonary arteries. Twenty-one patients were studied and in 16 the findings could be checked during surgery. In all cases the findings on MRI were confirmed. In eight patients MRI provided more information than CT and DSA combined and thereby showed its superiority for evaluating arterial invasion.

To report a new CT sign of small bowel strangulation. Two cases of small bowel obstruction evaluated by spiral CT with intravenous contrast injection. In both cases we observed an absence of parietal enhancement of the diseased bowel loop, visible on early scans only. This feature was accompanied by signs of bowel obstruction. The two patients had a segment of necrotic ileum resected. Delayed enhancement of a bowel loop in cases of small bowel obstruction should suggest the diagnosis of strangulation and lead to rapid surgical treatment. 8 refs., 2 figs.

The authors report the experience of using long coils of 2 m length in the management of large anuerysms. Knowledge of the characteristics of these coils is of value for correct placement. These coils are safe and cost-effective for excluding large aneurysms.

Granulomatous prostatitis is an uncommon disease that can prostatic carcinoma on both digital rectal examination and transrectal ultrasound. Four patients who underwent magnetic resonance imaging of the prostate had a histological diagnosis of graanulomatous prostatitis; three of them had recent urinary tract infections. The other patient had an associated midline prostatic cyst and a focus of malignancy. T1-and T2-weighted spin-echo images were obtained in all cases. Peripheral zone lesions of decreased signal intensity, suggestive of carcinoma,were found in all four patients on T2-weighted images. Granulomatous prostatitis should be considered in the differential diagnosis of low signal intensity areas with prostatic magnetic resonance imaging.

The authors report the unusual presentation of a mycotic aneurysm of the superior gluteal artery in a patient with unsuspected bacterial endocarditis. The diagnosis of this atypically large lesion, the therapeutic considerations, and the technical aspects of the endovascular occlusion are discussed.

We report a case of radiation-induced hepatic injury as a complication of localized abdominal radiotherapy for epidural spread of non-Hodgkin's lymphoma. The liver was evaluated by triphasic contrast enhanced helical CT scan. Hepatic biopsy demonstrated changes typical of veno-occlusive disease. The pattern of hepatic enhancement resulting from the radiation-induced veno-occlusive process is discussed.

We report a case of blunt traumatic right diaphragm rupture with hepatic hernia. The diagnosis was first suggested by an abnormal hepatic location depicted on axial CT. This finding can be considered as a potentially new indirect sign of right diaphragm rupture in patients with blunt trauma. The diagnosis was then confirmed by reformatted CT and MR images.

To identify the hemodynamic determinants of ground-glass opacification on thin-section computed tomographic (CT) scans of hydrostatic pulmonary edema and to compare attenuation and subjective assessments of ground-glass opacification with extravascular lung water.Left atrial pressure, pulmonary arterial pressure, effective pulmonary capillary pressure, and extravascular lung water were measured in six dogs before and during progressive increase of effective pulmonary capillary pressure. A thin-section CT scan was obtained at each step. Lung attenuation and subjective assessments of ground-glass opacification were compared with hemodynamic variables and extravascular lung water.Ground-glass opacification was identified when effective pulmonary capillary pressure equaled critical pulmonary capillary pressure. Extravascular lung water increased, and the distribution curve of lung attenuation coefficients shifted to higher attenuation from the second measurement at an effective pulmonary capillary pressure greater than the critical pulmonary capillary pressure. Attenuation was highly correlated (r = 0.98, P.001) with extravascular lung water; ground-glass opacification was detected before a significant (P = .615, analysis of variance) increase in extravascular lung water.Thin-section CT depicts ground-glass opacification when effective pulmonary capillary pressure equals critical pulmonary capillary pressure and before a detectable increase in extravascular lung water. Attenuation reflects extravascular lung water.

We report our prospective study evaluating biphasic helical CT of the aorta after endoluminal stent-graft placement.Biphasic helical CT scans in 95 patients with abdominal and thoracic aortic aneurysms who had undergone endoluminal stent-graft placement were reviewed. After a test bolus injection of 15 ml of contrast media at a rate of 3.5 ml/sec for the measurement of the optimal start delay, the aorta was scanned using the following parameters: collimation of 5 mm, table speed of 7 mm per rotation, tube rotation time of 0.75 sec, 120 kV, and 295 mA. A delayed helical CT scan was obtained 15 sec after the initial acquisition using the same parameters.Biphasic helical CT scans showed perigraft leakage in 45 (47%) of 95 patients. Leakage was shown only on arterial phase CT in eight patients and only on the delayed scans in three patients. In two patients, leakage shown on the delayed acquisition was retrospectively seen on the first scan. Leakage and outflow vessels were most visible on the arterial phase acquisition in 17 patients and on the second acquisition in six patients. Overall, biphasic acquisition was superior to arterial phase acquisition alone in 15 (16%) of 95 patients.The diagnostic value of biphasic helical CT is superior to arterial phase acquisition alone for the evaluation of the aorta after endoluminal stent-graft therapy.

P nmary hyperoxaluria type 1 (PH!) is a hereditary metabolic disease caused by a deficiency of the hepatic-specific peroxisomal enzyme, alanine-glyoxalate aminotransferase, and is characterized by an overproduction of oxalate. Renal deposition of insoluble calcium oxalate leads to urolithiasis or nephrocalcinosis and finally to chronic renal failure. At this stage of chronic renal failure, oxalate starts to accumulate in other tissues such as bone, constituting SyStemiC oxalosis [1]. Clinically, PH! is an cxtremely heterogeneous disease. Most commonly, symptoms and renal failure occur in childhood and early adulthood. Infrequently, the patient remains asymptomatic until late in adult life [1, 2]. Radiographic bone lesions of oxalosis in children and young patients have been extensively described [3, 4]. In older patients, radiographic bone lesions are less specific and can mimic those of renal osteodystrophy. The diagnosis is then difficult to make, and the symptoms can be attributed to secondary hyperparathyroidism, which may also complicate the course of the disease after long-term hemodialysis, superimposing radiographic abnormalities. Furthermore, it is important to distinguish patients with PH! and no associated secondary hyperparathyroidism from those with associated hyperparathyroidism, to avoid useless and harmful parathyroidectomy. In the present case, we report some radiographic features suggesting the diagnosis of oxalate osteopathy late in adult life.

Perinatal ultrasonography is very important for thedetection, identification, and follow-up of abdominalwall defects. The ability to distinguish between typesof abdominal wall defects and reach a correct diag-nosis is not always easy. We present two unusualcases of gastroschisis with change in the ultrasono-graphic appearance as pregnancy progressed anddiscuss perinatal management.

EFE is a rare cardiac disorder with poor prognosis and uncertain cause. Primary and secondary forms have been described. Most authors consider that all EFE is secondary--a reactive process set off in the endocardium by stress on the myocardium. We report two cases representing the primary dilated form and the secondary contracted form. The dilated form was associated with intracavitary thrombus of the left ventricle. In both cases, an unusual presence of subendocardial calcifications was noted. The ultrasonographic findings are discussed.

Areas of increased echogenicity in the fetal abdomen are defined as abnormally bright areas with an echogenicity similar to that of surrounding bones. Such areas are encountered in various normal and abnormal processes. When increased echogenicity is discovered in the fetal abdomen, a careful search should be made for a potential cause. The causes to be considered depend on the location of the areas of increased echogenicity, which can be classified as intestinal, peritoneal, hepatic, retroperitoneal, and parietal. In each case, vascular, ischemic, infectious, tumoral, metabolic, and chromosomal abnormalities should be included in the differential diagnosis before considering the finding a normal variant. Therefore, in utero detection of fetal abdominal areas of increased echogenicity requires a complete sonographic survey of the fetus and placenta along with close sonographic follow-up, evaluation of familial factors, and testing for possible associated cystic fibrosis, infection, or a chromosomal anomaly. The prognosis depends more on the underlying disease than on the extent of the increased echogenicity.

To assess the value of magnetic resonance angiography (MRA) in the evaluation of vascular patency after intravascular endoprosthesis placement.Three different metallic stents (Wallstent, Strecker, Palmaz) were studied in vitro, and in vivo in six patients with spin-echo (SE) and gradient-echo (GRE) MR imaging. Time-of-flight, two-dimensional (2D) gadolinium-enhanced MRA was performed with GRE and flow-compensation technique, and reconstructed with a maximum-intensity projection (MIP) algorithm. MRA was compared to digital angiograms.In vitro studies demonstrated that the signal intensity (SI) within the stent differed according to the device employed, the lowest SI being observed within the Palmaz stent (p = .001). There was no difference in SI or apparent diameter of the stent according to the sequence (SE vs GRE) or length of echo time (TE). In patients, the endoprostheses recorded as a well-defined area of signal void or drop-out (p = 0.004), whereas vessels above and below the stent displayed high signal intensities.MRA does not seem as yet to be well suited for evaluating vascular patency after endoprosthesis placement, even if the Strecker and Wallstent endoprostheses provide fewer artifacts than the Palmaz stent.

Thanks to the wider use of sonography to examine the spinal content in the neonate, normal anatomy and anomalies may be detected easily. Yet, unusual sonographic patterns are also observed. These must be differentiated from true pathologies. During a prospective study of 103 neurologically asymptomatic neonates, atypical sonographic patterns were found in 16 patients, corresponding to normal variants in 13. Nine of these 13 patients presented with a widening of the distal part of the central echo complex (one had a dilated ventriculus terminalis). Nerve roots of the cauda equina were disposed asymmetrically in three patients; the spinal cord movements were still present. In two of these babies, this distribution was associated with thin arachnoid pseudocysts. One patient presented with transitorily hyperechoic and narrow subdural spaces, probably related to neonatal dehydration. None of the 13 patients showing normal variants required any treatment. The other 3 patients (of 16) presented with equivocal entities of unknown evolution: sonographic tethered cord, fibrolipoma of the filum terminale and epidural varices. Sonography is highly accurate in evaluating the spinal cord content and aids differentiation of normal and normal variants from equivocal or pathological entities.

During a TIPS procedure using the left hepatic vein approach, a Wallstent was misplaced into a dilated paraumbilical vein instead of the left portal vein. The correct shunt direction from the left portal vein to the left hepatic vein was restored by coaxially inserting a second Wallstent through the stretched mesh of the misplaced stent. To prevent such stent misplacement, it seems useful to emphasize the importance of maintaining the exchange guidewire within the distal portion of the splenic or mesenteric vein throughout dilatation and stenting of the liver parenchyma.

Plain radiographs obtained in 25 patients with acute anterior cruciate ligament (ACL) tears detected with magnetic resonance imaging were retrospectively evaluated to identify associated bone lesions. Fracture of the posterior part of the lateral tibial plateau (LTP) was seen in 11 patients, impacted fracture of the lateral femoral condyle (LFC) in two, lateral tibial rim fracture (Segond fracture) in three, and avulsion fracture of the tibial attachment of the ACL in two. The latter three fractures have been associated with an ACL tear. Conversely, fractures of the posterior part of the LTP have not been associated with ACL tear and are recognizable on plain radiographs. Impaction of the LFC on the LTP and avulsion of the posterior tibial capsular junction may account for the association of the fracture of the LTP with the acute ACL tear. This type of fracture represents the most frequent indirect sign of ACL tear seen on plain radiographs.

Rationale and objectives High-resolution computed tomography of the lung has been advocated in the evaluation of interstitial lung diseases and emphysema. To provide material for correlations with gross pathology and macroscopic quantitation of emphysema, the authors have shortened and simplified the Gough-Wentworth technique. Methods The method permits more precise correlation of cross-sectional images and pathologic specimens and is less time-consuming. Results and conclusions This modified method can be routinely performed in a clinical laboratory of pathology and provides paper-mounted whole lung sections within four days. The sections are protected by a transparency film.

The aims of the study were to determine the frequency of visualization of the normal transverse geniculate ligament (TGL) of the knee on lateral plain radiographs with magnetic resonance imaging (MRI) as a reference, and to determine features that make this ligament apparent on plain radiographs. 50 consecutive lateral plain radiographs and sagittal T1-weighted images of corresponding knees were evaluated prospectively. A TGL was considered visualized on plain radiographs when an opacity of soft-tissue density was apparent in the posterior part of the Hoffa's fat pad. The TGL was identified in 29 of the 50 (58%) sagittal MR images; a TGL was observed on the lateral plain radiographs of six patients (12%). Correlation with the MR images showed that, when visualized on plain radiographs, the ligament is at least 3 mm thick and completely surrounded by fat. Our study shows that the TGL is a normal variant that can be recognized frequently on lateral plain radiographs of the knee.

Glans hyperemia after penile revascularization is a well known complication normally treated by surgery. However, this reintervention is often difficult due to local fibrosis. We report a case of successful embolization after supra-selective catheterization of the deep dorsal vein through the surgical anastomosis.

Pulmonary emphysema has been redefined as “a condition of the lung characterized by abnormal, permanent enlargement of the airspaces distal to the terminal bronchioles, accompanied by destruction of their walls, without obvious fibrosis”[1]. This diagnosis can theoretically only be established either at autopsy or by examination of surgically resected lobes or lungs. Emphysema is difficult to diagnose accurately during life and almost impossible to quantify. In the 48 autopsy lungs available from the 228 patients who died during the NIH trial of intermittent positive-pressure breathing involving 935 non-hypoxemic patients, Nagai showed that there were no significant relationships between clinical or physiologic variables and either the interalveolar wall thickness or the alveolar surface area, as calculated from measurements of the mean linear intercept [2].

Visualization of the transverse geniculate ligament of the knee in four patients is described. This normal variant was seen on lateral plain radiographs as a small, rounded opacity surrounded by fatty tissue and located anterior to the knee joint. Magnetic resonance imaging helped confirm this image to be that of the transverse geniculate ligament.

The use of ultrasound (US) in the diagnosis of renal vein thrombosis (RVT) remains ill defined because the classical features lack specificity. The authors report three cases of renal vein thrombosis with a common US pattern: hyperechoic streaks in the interlobulary spaces confirming previous reports with the same pattern. The pattern has been observed in neonates as well as in utero. Associated vena cava thrombosis was present in two cases. This sign might be a specific sign of RVT.

Twenty four asbestos and silica-exposed individuals were evaluated by means of conventional computed tomography (CT) and high-resolution computed tomography (HRCT). The aspects of asbestosis and silicosis and the diagnostic value of both methods were compared. The accuracy of each method was evaluated for the following abnormalities: nodules, masses, curvilinear subpleural lines, thickened interlobular lines, irregular interfaces, honeycombing, subpleural dependent density, parenchymal bands, ground-glass opacities, emphysema, subpleural blebs, rounded atelectasis, segmental or sub-segmental atelectasis, and hyaline and calcified pleural plaques. The diagnostic value of each technique is also estimated. HRCT is much more accurate in detecting curvilinear subpleural lines, thickened interlobular lines, irregular interfaces, honeycombing, ground-glass opacities and subpleural blebs. Conventional CT is dramatically more reliable for detection of small nodules. For the other abnormalities, our study was too limited by the relatively small number of cases to permit a definitive conclusion. We concluded on the basis of the preliminary report that both conventional and high-resolution computed tomography should be used in the examination of patient with occupational chest diseases.

Pancreatic metastasis from renal cell carcinoma is exceptional, but may appear many years after initial diagnosis and radical nephrectomy of an apparently limited tumour. We report one case of an asymptomatic isolated pancreatic metastasis discovered fortuitously, 21 years after right radical nephrectomy for a low-grade renal cancer. In 1969, a 47-year-old man underwent right nephrectomy for renal cell carcinoma of “low-grade malignancy”. At this time, no metastases were evident and he remained well on follow-up.

A premature baby boy presented at birth with respiratory distress. A right lower lobe opacity was found on chest X-ray. Pulmonary sequestration was the diagnosis suggested by ultrasound. The size of the mass decreased on subsequent examinations. 4 months later X-rays and sonography failed to demonstrate any remaining mass. This case illustrates another example of involutive pathology and suggests that not all pulmonary sequestration-like anomalies should be operated on.

A management system for a University Department of Radiology was developed for scheduling, registration, file room managing, reporting and billing. The system is usefully used for clinical research. This radiological information system (RIS) is interconnected with the hospital information system (HIS). The system was developed on a Data General MV/2000 CD using a modified commercially available software (Meditech Inc.).

Laser thermal angioplasty is now widely used for the treatment of arterial occlusions or stenoses (Ginsberg et al, 1985; Cumberland et al, 1986; MacCowan et al, 1988). The first commercially available intravascular laser system uses a metal-capped laser fibre to convert the laser energy into thermal energy. New laser catheters for vascular recanalization have been developed, some of which can be used over a guidewire. A 56-year-old man presented with left intermittent claudication. An arteriogram revealed a very tight stenosis of the left popliteal artery and diffuse atherosclerotic lesions of the run-off vessels associated with a high-grade stenosis of the origin of the anterior tibial artery and of the tibioperoneal trunk.