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OBJECTIVE: The aim of our study was to evaluate the accuracy of multidetector computed tomography (MDCT) on a 16-row CT scanner in the detection and differentiation of adnexal masses. METHODS: We prospectively examined 102 consecutive women with clinically or sonographically detected adnexal masses. Preoperative CT examination was performed, including scanning of the abdomen during the portal phase, using a detector collimation of 16 x 0.75 mm and a pitch of 1.2. Multiplanar reformatted images were evaluated for the presence of an adnexal mass and differentiation between benign and malignant ones, using the surgical and pathologic results as standard of reference. CT findings used to diagnose malignancy were: diameter greater than 4 cm, presence of masses bilaterally, cystic-solid mass, necrosis in a solid lesion, cystic lesion with thick, irregular walls or septa and/or with papillary projections. Presence of ascites, peritoneal metastases and lymphadenopathy was used to confirm malignancy. Multiple logistic regression analysis of the MDCT findings was performed to determine those more predictive of malignancy. RESULTS: Histopathologic examination demonstrated 143 adnexal mass lesions, 96 (67%) of which were benign and 47 (33%) malignant. Multidetector CT detected 129 (90%) of the 143 adnexal masses, with an overall accuracy for the diagnosis of malignancy of 89.15%. The MDCT findings that found more predictive of malignancy were the presence of papillary projections in a cystic lesion, necrosis in solid mass and peritoneal metastases. CONCLUSION: Multidetector computed tomography on a 16-row CT scanner proved accurate in the detection and characterization of adnexal masses. Gynecol Oncol

A 70-year-old man presented with fever, left flank pain and scrotal enlargement. CT scan of the thorax and abdomen revealed findings compatible with pulmonary and kidney tuberculous involvement. Sonographic and MRI examination of the scrotum showed bilateral testicular enlargement and the presence of multiple nodules involving both the testis and the epididymis. Urine cultures obtained from a percutaneous left nephrostomy were positive for tuberculous bacilli, and the patient was placed on anti-tuberculous treatment.

OBJECTIVE: The purpose of this study was to evaluate the utility of 16-MDCT cystoscopy in the detection of urinary bladder neoplasms in a high-risk population. SUBJECTS AND METHODS: Fifty patients who presented with hematuria and a recent diagnosis or a history of bladder carcinoma underwent CT cystoscopy. All patients were examined in the supine and prone positions after bladder distention with room air. A detector configuration of 16 x 0.75 mm and a pitch of 1.2 was used. Virtual images were obtained with volume-rendered algorithms. Transverse tomographic slices, multiplanar reformatted images, and virtual images were prospectively evaluated separately and in combination. Conventional cystoscopy was considered the standard of reference for assessing the efficacy of MDCT cystoscopy in the detection of urinary bladder tumors. RESULTS: Fifty-five (96%) of 57 urinary bladder lesions recognized at conventional cystoscopy were detected with MDCT cystoscopy. The size of the lesions ranged from 0.3 to 9.7 cm in diameter, including 18 lesions with a diameter of 0.5 cm or less. Transverse, multiplanar reformatted, and virtual images proved complementary for lesion detection. CONCLUSION: MDCT cystoscopy is an accurate technique for the detection of urinary bladder neoplasms in patients at high risk, yielding satisfactory results in the identification of lesions smaller than 0.5 cm. AJR Am J Roentgenol

Recent pathologic studies of hepatic resection and transplantation specimens have elucidated the morphologic features of the precancerous lesions and small hepatocellular carcinomas (HCCs) arising in cirrhotic livers. Small HCCs measuring less than 2 cm in diameter are of two types: vaguely nodular, well-differentiated tumors, also known as "early" HCCs, and distinctly nodular tumors, with histologic features of "classic" HCC. The precancerous lesions include dysplastic foci and dysplastic nodules. "Classic" small HCCs are supplied by nontriadal arteries, whereas early HCCs and dysplastic nodules may receive blood supply from both portal tracts and nontriadal arteries. The similarities in blood supply of these three types of nodular lesions result in significant overlap of findings on dynamic imaging. Nevertheless, small HCCs sometimes display characteristic radiologic features, such as "nodule-in-nodule" configuration and "corona enhancement" pattern. Moreover, various histologic features of these nodular lesions may also be related to a variety of signal intensities and attenuation coefficients, while the presence of cirrhosis is known to limit the sensitivity and specificity of any imaging modality, due to liver inhomogeneity. Because of these reasons, imaging findings of nodular lesions in cirrhotic livers are often inconclusive, emphasizing the need for a better understanding of these imaging features. European Radiology

The purpose of this study was to assess the role of multi-detector row CT urography (MDCTU), on a 16-row CT scanner in the evaluation of patients with painless hematuria, with emphasis placed in the detection of urothelial tumors. We retrospectively reviewed the MDCT urographies of 75 patients, referred for painless hematuria. The CT protocol included unenhanced images, obtained with a detector configuration of 16x1.5 mm and pitch of 1.2, nephrographic and excretory-phase images, obtained with a detector collimation of 16x0.75 mm and pitch of 1.2. Axial and coronal reformatted images were evaluated. Three-dimensional reformation of the excretory-phase images was performed using the volume-rendering technique. The standard of reference included clinical and imaging follow-up, cystoscopic, surgical and histologic findings. In 55 (73%) of 75 patients, the cause of hematuria was identified on MDCTU; the most common cause was urothelial cancer, including seven tumors with a diameter equal or smaller than 0.5 cm in diameter. Sixteen-row MDCTU provided satisfactory results in the investigation of patients with painless hematuria. The main advantage of the technique is its ability to detect uroepithelial malignancies. European Radiology

Sinus histocytosis with massive lymphadenopathy is a rare disease that has been described by Rosai and Dorfman. It is characterized by massive, cervical lymphadenopathy, with extranodal manifestations in about 40% of patients. It occurs as a distinct entity, never associated with other diseases, and in most cases the prognosis is good. Lymphadenopathy is also a frequent sign of patients with primary Sjogren's syndrome (SS), usually associated with disease activity or concurrent infection. However, excessive lymphadenopathy in SS patients is a sign of lymphoproliferative disorder development. In this report, we describe a patient with primary SS, and excessive lymphadenopathy and splenomegaly who developed Rosai-Dorfman disease, and we discuss the possible aetiopathophysiological mechanism linking these two entities. Scandinavian Journal of Rheumatology

Our purpose was to measure the size of the pons and cerebellum in preterm babies with periventricular leukomalacia (PVL), and to study their relationship with the severity of PVL and with perinatal risk factors. We examined 33 premature children, mean gestational age 31 weeks, range 26-36 weeks with PVL on MRI, and 27 full-term controls. On MRI at 0.4-5.5 years (mean 1.4 years) we measured the area of the corpus callosum and vermis, the anteroposterior diameter of the pons and the volume of the cerebellum. The area of the corpus callosum was used as a marker of white matter loss and PVL severity. All regional brain measurements except that of the vermis were significantly lower in patients than controls: corpus callosum (mm(2)): 239.6+/-92.5 vs 434.8+/-126.8, P

Our objective was to study, in thalassemic patients, if hepatic siderosis evaluated by MRI could predict the pituitary iron overload. In 36 thalassemic patients (age range 6-44 years, mean age 21.7 years) the liver/fat ratio (L/F), the pituitary/fat ratio (P/F), the liver and pituitary T2 relaxation times were evaluated, by using a multiecho spin-echo sequence. Serum ferritin levels were measured and an extensive endocrine evaluation was performed. The L/F, the P/F and pituitary T2 showed a good correlation with serum ferritin ( r=-0.55, r=-0.55 and r=-0.53, respectively; p0.01). Liver T2 did not show significant correlation with serum ferritin. The variability of L/F explained only the 10.8% of the variability of pituitary T2 and of the P/F. When ferritin was added to the model it predicted only the 26.85% and the 30.8% of the variability of pituitary T2 and of the P/F, respectively. The P/F and pituitary T2 were lower in patients with hypogonadotropic hypogonadism (group 1) compared with those without pituitary dysfunction (group 2). No significant differences of L/F were found between the two groups. Hepatic iron overload evaluated by MR is a poor predictor of pituitary siderosis. The MR studies of the pituitary gland might be necessary to evaluate the pituitary iron overload.

The biophysical properties of the aortic wall seems to play a significant role in the pathogenesis of cardiovascular disease such as atherosclerosis, hypertension, aneurysm formation, Marfan's syndrome, and in normal aging. The presence and the proportion of smooth muscle, collagen, and elastin proteins contribute to the compliance of the vessel wall with the latter being the most extensible component. However, elastin fibers fracture at low stresses contributing to a decrease of the aortic compliance and consequently to an elevation of the pulse pressure, which is a risk factor of cardiovascular disease. Early detection of a decrease in the aortic compliance could help to identify early cardiovascular disease in asymptomatic patients and monitor the results of the therapeutic interventions. Therefore, estimation of the aortic compliance can be used for both screening as well as long-term follow-up. Magnetic resonance imaging which is a noninvasive, accurate, and reproducible method can estimate the compliance of the aortic wall either by measuring the relative change in cross sectional area of a chosen segment using ECG-triggered spin echo or gradient echo sequences or by measuring the pulse wave velocity through the aorta using the phase contrast-magnetic resonance imaging (PC-MRI) technique. Both techniques have been validated and many sudies suggest MRI as a valuable tool for evaluating aortic wall function. However, large prospective studies are mandatory for the method to be established as a screening tool.

The purpose of this study was to determine which high-resolution computed tomography (HRCT) features in patients with cystic fibrosis are most strongly associated with functional impairment as expressed by forced expiratory volume in one second (FEV1). Forty-seven patients with cystic fibrosis underwent chest HRCT and had pulmonary function tests. The HRCT examinations were evaluated for 11 features scored using a modification of Bhalla system and FEV1 was recorded as percentage of the predicted value. Univariate and multivariate correlations between HRCT scores and FEV1 were performed. The most common HRCT feature was bronchiectasis (98%) followed by atelectasis-consolidation (81%), bronchial wall thickening (77%), tree-in-bud sign (74%), mucous plugging (72%) and mosaic perfusion pattern (47%). On univariate analysis the following features correlated strongly with FEV1: bronchial wall thickening ( p

OBJECTIVE: Inversion of the superior mesenteric vessels is associated with various conditions. The purpose of this study was to prospectively evaluate the position of these vessels in infants with idiopathic ileocolic intussusception. SUBJECTS AND METHODS: Abdominal sonography was performed before and after reduction of ileocolic intussusception in 16 infants. RESULTS: In 14 infants with ileocolic intussusception proximal to the splenic flexure, the relationship of the superior mesenteric vessels was normal (superior mesenteric vein to the right ventral side of superior mesenteric artery). Inversion of the superior mesenteric vessels (superior mesenteric vein to the left of the superior mesenteric artery) was found in two patients with distal ileocolic intussusception (head of the intussusceptum at the sigmoid colon or rectum). After reduction, the relationship of these vessels was normal in all 16 infants. CONCLUSION: Inversion of the superior mesenteric vessels is sometimes caused by distal ileocolic intussusception in infants. AJR Am J Roentgenol

Tumefactive multiple sclerosis is a rare entity in children. Differential diagnosis includes other mass lesions such as neoplasm and abscess. A case of tumefactive multiple sclerosis in a child is presented. The open-ring pattern of enhancement on conventional MRI and magnetisation transfer imaging was important for the initial diagnosis and the evaluation of the course of the disease. Neuroradiology

In transfusion-dependent beta-thalassemia major, increased iron deposition in the pituitary gland has a cytotoxic effect leading mainly to hypogonadotropic hypogonadism. Our purpose was to assess in these patients the height of the pituitary gland and to evaluate whether it represents a marker of pituitary gland function. In 29 patients with beta-thalassemia major and 35 age- and gender-matched controls the pituitary gland height was evaluated in a midline sagittal scan using a spin echo T1 -weighted (500/20 TR/TE) sequence. In all patients, an extensive endocrine evaluation was performed, including measurements of spontaneous and stimulated levels of gonadotropins, thyroid hormones, growth hormone, insulin-like growth factor, and adrenal hormones. The pituitary gland height was lower in thalassemic patients with hypogonadotropic hypogonadism (n = 15) (mean 3.48; SD 0.46) than in the age- and gender-matched controls (mean 6.29; SD 0.77), (P0.001). No statistically significant difference was found between thalassemic patients without hormone dysfunction (n = 14) (mean 5.34; SD 1.52) and age- and gender-matched controls (mean 5.91; SD 1.06). We conclude that in thalassemic patients the pituitary gland height is an additional marker of pituitary gland function and might be useful in clinical management.

In transfusion-dependent ss-thalassemia major, increased iron deposition in the pituitary gland has a cytotoxic effect, leading mainly to hypogonadotropic hypogonadism. Early detection and quantification of iron in the pituitary gland are of particular importance for successful treatment. The purpose of this study was to evaluate the T2 relaxation rate (1/T2) as a marker of pituitary siderosis.In 29 patients with ss-thalassemia major and 40 controls, we assessed the 1/T2 of the pituitary gland in a 1.5-T MR unit, using a multiecho spin-echo sequence. In all patients, an extensive endocrine evaluation was performed, including measurements of spontaneous and stimulated levels of gonadotropins, thyroid hormones, growth hormone, insulinlike growth factor, and adrenal hormones.A positive correlation was found between the 1/T2 and the serum ferritin level (r = 0.73, p0.001). The 1/T2 was higher in patients (mean, 0.020 msec(-1); SD, 0.006) compared with that of controls (mean, 0.011 msec(-1); SD, 0.001; p0.001). The 1/T2 was higher in patients with hypogonadotropic hypogonadism (mean, 0.024 msec(-1); SD, 0.006) in comparison with that of patients without any pituitary dysfunction (mean, 0.017 msec(-1); SD, 0.004; p0.05).The T2 relaxation rate could be used as an index of pituitary iron overload, and it might be of value to monitor treatment with deferoxamine in patients with ss-thalassemia major.

BACKGROUND: Voiding urosonography with harmonic imaging (VUS HI) has been introduced as a sensitive and radiation-free imaging method for the diagnosis and follow-up of vesicoureteral reflux (VUR) in children. OBJECTIVE: The purpose of this study was to evaluate the sensitivity of VUS HI using a second-generation US contrast agent compared to standard voiding cystourethrography (VCUG). MATERIALS AND METHODS: A total of 228 children with 463 kidney-ureter units (KUUs) underwent two cycles of VUS HI and two cycles of VCUG at the same session. VUS HI was performed after intravesical administration of 1 ml of a second-generation US contrast agent (sulphur-hexafluoride gas microbubbles, SonoVue, Bracco, Italy). For statistical analysis we used McNemar's test, Student's t-test and k coefficient tests. RESULTS: VUR was shown in 161/463 (34.7%) KUUs, 57 by both methods, 90 only by VUS, and 14 only by VCUG. Concordance in findings regarding the presence or absence of VUR was found in 359/463 (77.5%) KUUs (k=0.40). The difference in the detection rate of reflux between the two methods was significant (P

A 70-year-old man presented with fever, left flank pain and scrotal enlargement. CT scan of the thorax and abdomen revealed findings compatible with pulmonary and kidney tuberculous involvement. Sonographic and MRI examination of the scrotum showed bilateral testicular enlargement and the presence of multiple nodules involving both the testis and the epididymis. Urine cultures obtained from a percutaneous left nephrostomy were positive for tuberculous bacilli, and the patient was placed on anti-tuberculous treatment.

The purpose of this study was to simplify HRCT scoring systems (SS) for CF by selecting representative HRCT parameters. Forty-two consecutive patients with CF underwent baseline and follow-up chest HRCT. Three radiologists evaluated 84 HRCTs employing five SS. "Simplified" HRCT SS were formed by selection of parameters exhibiting statistically significant relations with FEV1. Pulmonary function tests (PFTs) and nutrition (IBW%) were recorded. Regression analysis, Pearson correlation and T-test were used for statistical analysis. Three HRCT parameters were selected for the formation of "simplified" HRCT SS (severity of bronchiectasis, bronchial wall thickening, atelectasis-consolidation) using regression analysis. There was excellent correlation between each "simplified" and corresponding complete score (0.892 < r < 0.0967, p < 0.0001) or the remaining four complete scores (0.786 < r < 0.961, p < 0.0001). Strong correlation was found among the five "simplified" scores (0.803 < r < 0.997, p < 0.0001). Comparing baseline complete and "simplified" scores with corresponding follow-up ones, significant worsening was observed (p < 0.0001). PFTs and IBW% did not change significantly. HRCT scores correlated moderately with FVC and FEV1, but there was no correlation with FEF25-75 and IBW%. "Simplified" HRCT SS are as reliable as the complete ones and detect progression of lung disease earlier than clinical parameters. They are easy to use and could be adopted in clinical practice. European Radiology

The purpose was to evaluate the accuracy of multidetector CT (MDCT) on a 16-row CT scanner in local staging of endometrial carcinoma and more specifically in the assessment of the depth of myometrial invasion and presence of cervical infiltration. This prospective study includes 21 women with newly diagnosed endometrial carcinoma. All CT examinations were performed on a 16-row CT scanner, and the protocol included scanning of the abdomen after intravenous administration of iodinated contrast material, during the portal phase, using a detector collimation of 16 x 0.75 mm and a pitch of 1.2. Sagittal, parasagittal and oblique reformatted images were evaluated for the depth of myometrial invasion, whether superficial or deep, and the presence of cervical infiltration. Imaging findings were correlated with the histopathologic results. The sensitivity, specificity and accuracy of MDCT in evaluating myometrial invasion were 100%, 80% and 95%, respectively, and for assessing cervical infiltration were 78%, 83% and 81%, respectively. In conclusion, MDCT on a 16-row CT scanner proved accurate in local staging of endometrial carcinoma. European Radiology

The purpose was to compare the accuracy of multidetector CT (MDCT) on a 16-row CT scanner and magnetic resonance (MR) imaging in the characterization of ovarian masses. Preoperative CT examination of the abdomen and MR imaging of the pelvis was performed in 67 women, with clinically or sonographically detected adnexal masses. The CT examinations were performed on a 16-row CT scanner, and the protocol included scanning of the abdomen during the portal phase, using a detector collimation of 16 x 0.75 mm and a pitch of 1.2. We used a 1.5-T magnet unit to perform T1, T2 and fat-suppressed T1-weighted sequences, before and after intravenous administration of gadolinium chelate compounds. The accuracy of multidetector CT and MR imaging in the differentiation between benign and malignant ovarian masses was evaluated, using histopathologic results as the standard of reference. The sensitivity, specificity and accuracy of MDCT in the characterization of ovarian masses were 90.5%, 93.7% and 92.9%, respectively, and that of MR imaging 95.2%, 98.4% and 97.6%, respectively. Although MRI performed slightly better, this did not reach statistical significance. In conclusion, both MDCT on a 16-row CT scanner and MR imaging demonstrated satisfactory results in the characterization of ovarian masses. European Radiology

OBJECTIVE: The purpose of our study was to investigate the potential role of MRI in the preoperative characterization of the histologic type of testicular tumors and, more specifically, to differentiate seminomatous from nonseminomatous testicular neoplasms. MATERIALS AND METHODS: Twenty-one patients with histologically proven germ cell testicular tumors underwent MRI of the scrotum on a 1.5-T unit. T2- and T1-weighted sequences before and after i.v. administration of gadolinium chelate were performed. MRI studies were retrospectively reviewed by two radiologists and findings were correlated with the histopathologic diagnosis. An attempt was made to differentiate seminomatous from nonseminomatous testicular tumors on the basis of signal intensity and homogeneity of the lesions, presence of fibrovascular septa, tumor encapsulation, and patterns of contrast enhancement. Interobserver agreement was assessed using weighted kappa statistics. RESULTS: MRI findings correctly characterized 19 (91%) of 21 testicular neoplasms (nine seminomatous and 10 nonseminomatous testicular tumors), with excellent interobserver agreement. The presence of an intratesticular lesion of predominantly low signal intensity on T2-weighted images, with septa enhancing more than tumor tissue after contrast material administration, was more suggestive for the diagnosis of a seminoma. Tumors that were markedly heterogeneous both on unenhanced and contrast-enhanced images were indicative of a nonseminomatous neoplasm. CONCLUSION: Our study shows that MRI provides a credible preoperative differentiation of seminomatous from nonseminomatous testicular tumors, with excellent interobserver agreement. American Journal of Roentgenology

OBJECTIVES: To assess the pleuropulmonary changes in patients with early rheumatoid arthritis (RA), using high-resolution computed tomography (HRCT). METHODS: Forty-three non-smoking patients with early RA were included. The disease duration was

Thirty-seven patients with beta-thalassemia major, including 14 adolescents (15.2 +/- 3.0 years) and 23 adults (26.4 +/- 6.9 years), were studied. T2 relaxation time (T2) of the liver, bone marrow, pancreas and pituitary gland was measured in a 1.5-Tesla magnetic resonance (MR) imager, using a multiecho spin-echo sequence (TR/TE 2,000/20, 40, 60, 80, 100, 120, 140, 160 ms). Pituitary gland height was evaluated in a midline sagittal scan of a spin-echo sequence (TR/TE, 500/20 ms). The T2 of the pituitary gland was higher in adolescents (59.4 +/- 15 ms) than in adults (45.3 +/- 10.4 ms), P < 0.05. The T2 of the pancreas was lower in adolescents (43.6 +/- 10.3 ms) than in adults (54.4 +/- 10.4 ms). No difference among groups was found in the T2 of the liver and bone marrow. There was no significant correlation of the T2 among the liver, pancreas, pituitary gland and bone marrow. There was no significant correlation between serum ferritin and T2 of the liver, pancreas and bone marrow. Pituitary T2 showed a significant correlation with pituitary gland height (adolescents: R=0.63, adults: R=0.62, P < 0.05) and serum ferritin (adolescents: R=-0.60, adults: R=-0.50, P < 0.05). In conclusion, iron overload evaluated by T2 is organ specific. After adolescence, age-related T2 changes are predominantly associated with pituitary siderosis and fatty degeneration of the pancreas. Pituitary size decreases with progressing siderosis. European Radiology

To investigate by magnetic resonance (MR) imaging the occurrence of cervical spine (CS) involvement in rheumatoid arthritis (RA) patients.Fifty-one consecutive unselected patients, who fulfilled the revised American College of Rheumatology criteria for RA, were investigated. All patients had a complete physical and laboratory evaluation. Radiological evaluation included hand and wrist x-rays, as well as CS radiographs in anteroposterior, lateral and lateral in full flexion views. In addition, MR (Spin Echo T2-weighted sagittal scans [neutral and flexion position], plain and contrast enhanced T1-weighted sagittal and axial scans) was performed in all patients. Hand x-rays were evaluated according to the Larsen's criteria, while CS radiographs were evaluated according to Winfield classification. Disease activity was assessed by disease activity score for 28 joint indices (DAS-28).There were 42 females and 9 males with a mean age of 56.5 +/- 10.4 years and mean disease duration 12.4 +/- 8.5 years. Thirty-three patients (64.7%) had positive IgM rheumatoid factor (RF). Thirty patients presented clinical findings, mainly cervical pain and stiffness of CS (25 with positive and 5 with negative MR), while, radiological findings of CS involvement were found in 40 patients. Forty-four patients (86.2%) presented MR findings of CS involvement (peridental pannus 88%; dens erosion 23.5%; atlantoaxial subluxation 13.7%; subaxial subluxations 10%; brainstem compression 5.9%). Peridental pannus correlated with high DAS-28, positive IgM RF and advanced erosive changes of the wrist and hand (p0.05) in the univariate analysis. However, multivariate logistic regression analysis did not confirm such correlation.We conclude that the frequency of CS involvement in Greek RA patients is high but the destructive changes are mild. However, in patients with active erosive peripheral disease it is very probable to also have some changes in CS. These may be clinically important and in such cases, MR may offer valuable information.

The purpose of this study was to evaluate whether a second cycle of contrast-enhanced voiding urosonography (VUS) with no added contrast medium (CM) can increase the detection rate of vesicoureteral reflux (VUR). One hundred twelve consecutive children with a mean age of 2.9 years with 224 kidney-ureter units (KUU) underwent two cycles of contrast-enhanced harmonic VUS. The first cycle of VUS was performed with 3.5-12.5 ml of suspension 300 mg/ml SH U 508 A and was followed immediately by a second cycle with only saline without adding CM. VUR was detected in 57 KUU from 44 children (39%) at the first cycle of VUS. Eight of the remaining 68 non-refluxing children (12%) demonstrated VUR at the second cycle (P=0.045). Most cases of missed reflux at the first cycle were grade II (75%). However, in two KUU from two children missed reflux was grade III. In one child reflux (grade II) was missed on the second cycle. Comparing the second cycle of VUS with the first cycle, concordant findings regarding the presence or absence as well as the grade of reflux were found in 94% of KUU. A second cycle of contrast-enhanced harmonic VUS with no added CM discloses significantly more cases of VUR at no additional cost for the examination. European Radiology

We present a case of a solitary fibrous tumour, located at the epididymis, in a 65-year-old man, presented with a scrotal mass. Ultrasound and MRI of the scrotum revealed a paratesticular mass, with rich vascularity, arising in the left epididymis. Radiological findings were non-specific and the patient underwent surgery. British Journal of Radiology

Aim. – To investigate the clinical response and to evaluate by magnetic resonance imaging the inflammatory tissue changes in refractory rheumatoid arthritis patients treated with infliximab. Methods. – Sixteen refractory rheumatoid arthritis patients who were treated with intravenous infliximab (3 mg/kg) at weeks 0, 2, 6 and every 8 weeks thereafter were examined with magnetic resonance imaging of the dominant affected wrist and hand before treatment and 1 year after therapy. The volume of the enhancing inflammatory tissue was evaluated in fat suppressed contrast enhanced T1-weighted images by using the Analyse 4.0 software. Disease activity was evaluated by assessing the disease activity score for 28 joint indices. The clinical improvement was evaluated according to the American College of Rheumatology 20% response criteria. Results. – There were 13 females and 3 males with mean age 49.5 (17.0) years and mean disease duration 10.5 (8.0) years. Ten patients had positive IgM rheumatoid factor. One year after treatment, a significant reduction of the erythrocyte sedimentation rate, the C-reactive protein, the disease activity score for 28 joint indices and the volume of the enhancing inflammatory tissue was observed. All but two of the rheumatoid arthritis patients achieved the American College of Rheumatology 20% response criteria, while 9 (56.25%) and 5 (31.25%) patients achieved the 50% and 70% American College of Rheumatology response criteria, respectively. A positive correlation among the volume of the enhancing inflammatory tissue, swollen joint count, tender joint count, as well as disease activity score for 28 joint indices ( r = 0.66, r = 0.79, r = 0.57 respectively) was found before treatment. Conclusions. – In refractory rheumatoid arthritis patients, the addition of infliximab therapy may result in clinical, laboratory and magnetic resonance imaging improvement. Magnetic resonance imaging assessment of the volume of the enhancing inflammatory tissue may represent an additional tool for the investigation of joint disease activity and responsiveness to treatment.

Our purpose was to determine the pituitary gland signal of premature neonates and infants. We retrospectively measured, in a midline sagittal T1-weighted MRI scan, the pituitary signal of 121 premature infants (mean gestational age: 32.8 weeks, mean chronological age: 6.9 months, mean corrected age: 5.2 months). The relative signal intensity of the adenohypophysis and neurohypophysis was measured as (A-V)/V and (P-V)/V, respectively (where A, P, V are the mean signal intensities of the adenohypophysis, neurohypophysis and vermis white matter, respectively). On visual inspection the adenohypophysis was rated relative to the vermis white matter (VWM) and scored as hyperintense (grade 3), isointense (grade 2) and hypointense (grade 1). (A-V)/V and (P-V)/V had a negative correlation with chronological age (r=-0.38, r=-0.35, respectively, P

An increased incidence of cardiovascular disease has been found in rheumatic disorders. Changes in the variables of aortic elasticity in patients with juvenile idiopathic arthritis (JIA) were evaluated and their relationship to inflammation, anti-rheumatic drugs and traditional cardiovascular risk factors were investigated in this study.Phase contrast MR was performed in 31 patients with JIA and 28 age and sex matched controls to evaluate the aortic distensibility and pulse wave velocity (PWV). Disease activity variables, plasma lipid profile, homocysteine, thyroid hormones, glucose and insulin were assessed in the patients.Eighteen patients had oligoarticular, 6 polyarticular and 7 systemic disease. Distensibility was lower (mean: 10.25; SD: 4.18) and PWV was higher (mean: 3.68; SD: 1.59) in the patients compared to the controls (mean: 13.4; SD: 4.99), (mean: 1.38; SD: 0.54) respectively (p0.01). A positive correlation between PWV and age was observed in the patients (rs = 0.47, p0.01) and controls (rs = 0.72, p0.01), and a negative correlation between distensibility and age in the patients (rs = -0.59, p0.01) and controls (rs = -0.63, p0.01). No statistically significant correlations were found between distensibility and PWV and metabolic and disease activity parameters. When distensibility and PWV were adjusted for age no significant differences were found between the three subtypes of JIA.JIA is associated with increased aortic stiffness that might suggest subclinical atherosclerosis. Early detection and follow-up by non-invasive methods may be useful in the prevention of future cardiovascular disease.

We report on a case of spontaneous intracranial hypotension (SIH) presenting with classic MR findings, such as diffuse smooth thickening and intense contrast enhancement of the dura matter, increased size of the pituitary gland and downward displacement of the brain. In this case an engorgement of the cavernous sinuses is reported as an additional imaging finding of SIH. Moreover, phase-contrast MR study of the CSF flow dynamics revealed at the level of the aqueduct a decrease of the systolic and diastolic flow volume of CSF. A normalization of the flow volume was observed when SIH subsided. European Radiology

Objective: To evaluate the role of computed tomographic virtual cystoscopy (CTVC) in the detection of bladder neoplasms and to compare CTVC at conventional and reduced milliAmperes-second (mAs) settings. Methods: Twenty-four patients with known bladder neoplasms from previous conventional cystoscopy were examined with CTVC. The urinary bladder was insufflated with room air and helical CT data were obtained. Virtual images were created using volume rendering algorithms. In eight patients we used both regular (240) and reduced (70) mAs values. The lesions were recorded on transverse tomographic slices and virtual images and compared with conventional cystoscopy, operative and pathology results. Results: All bladder lesions (30) seen on conventional cystoscopy were demonstrated with CTVC. Two lesions detected on imaging studies and subsequently found at operation were not seen on conventional cystoscopy. In a third case of a neobladder, conventional cystoscopy was impossible due to neoplastic involvement of the penis. In all cases the lesions were equally conspicuous with conventional and low mAs values. Conclusions: Computed tomographic virtual cystoscopy is a minimally invasive technique that can provide comprehensive information about urinary bladder tumors. Furthermore, low mAs studies are equally effective for the examination of such patients.

Pituitary secretory activity is different in premature and full-term infants. The height of the pituitary is a marker of its secretory activity. Our purpose was to use MRI to measure height of the pituitary of premature infants and to compare it with full-term controls. The height was measured on a midline sagittal T1-weighted image in 86 premature infants (gestational age 26-36.9 weeks, mean 32.3+/-2.85 weeks, corrected age 0.33-2 years, mean 0.76+/-0.42 years) and in 70 age- and sex-matched full-term controls. The children were was divided into four age groups: A:or =0.5 years; B: 0.51-1.0 year; C: 1.01-1.5 years; and D: 1.51-2.00 years. The gland was significantly (P0.01) higher in the preterm infants than in the controls (3.88+/-0.61 vs 3.31+/-0.64 mm). In the preterm group no significant difference was found between children small or appropriate for gestational age or between those with and without periventricular leukomalacia. Pituitary height by age group was: A: 3.71+/-0.57, B: 3.81+/-0.56, C: 4.09+/-0.68; and D:4.45+/-0.57 mm; statistically significant (P0.01) differences were found between groups A and D and B and D. The pituitary is thus higher in premature than in full-term controls and shows a trend to increase after the first year of corrected-age life.

The purpose of this study was to evaluate the role of MRI in the assessment of hip joint involvement in clinical subtypes of juvenile idiopathic arthritis (JIA). 28 patients (mean age 12.5 years) with JIA (oligoarthritis 8, polyarthritis 13, systemic arthritis 7) were examined with T(2) weighted turbo spin echo and T(1) weighted spin echo (plain and contrast enhanced) sequences. The severity of joint involvement was evaluated using an MR grading score: grade 1=no contrast enhancement; grade 2=focal synovial contrast enhancement; grade 3=diffuse synovial contrast enhancement; grade 4=grade 3+diffuse synovial thickening; grade 5=grade 4+villonodular synovial thickening; and grade 6=grade 5+cartilage and subchondral bone erosions. MRI was abnormal in 57.1% of cases (25% of oligoarthritis, 53.8% of polyarthritis and 100% of systemic arthritis). Clinical examination was positive in 32.1% of cases and was associated with higher MR grades (mean 4.6, SD 1.34) compared with a negative clinical examination, which was associated with lower MR grades (mean 1.78, SD 1.13) (p

A 45-year-old man presented with a 5-year history of progressive sensorineural hearing loss, ataxia, spastic paraparesis, and headaches. At age 21, he had a stretch injury of the left brachial plexus. Figure. Gradient echo, …

Subarachnoid haemorrhage due to cauda equina tumour is rare. We report two myxopapillary ependymomas of the conus terminalis, presenting with in this way. Rims of low signal were observed at their upper and lower borders, mainly on T2-weighted images. This finding has been described in ependymomas of the cervical region but not, to our knowledge, in myxopapillary ependymomas of the conus terminalis. Neuroradiology

In thalassaemic patients, neurophysiological disturbances have been associated with high serum ferritin levels and desferrioxamine therapy. In the presence of a magnetic field, ferritin, the main iron storage protein, induces a preferential decrease of the T(2) relaxation time. The purpose of this study was to evaluate thalassaemic patients for brain iron deposition by assessing the T(2) relaxation rate (1/T(2)) of the grey matter. 41 thalassaemic patients (age range 8.5-44 years, mean 24 years) and 58 age- and sex-matched controls were included in the study. Current serum ferritin levels were obtained. The 1/T(2) values of the cortex (motor and temporal) (mean 0.0122 ms(-1), SD 0.0004), putamen (mean 0.0137 ms(-1), SD 0.0004) and caudate nucleus (mean 0.0132 ms(-1), SD 0.0003) were higher in patients compared with the controls (mean 0.0110 ms(-1), SD 0.0004; mean 0.0120 ms(-1), SD 0.0005; mean 0.0117 ms(-1), SD 0.0003, respectively) (p

Hepatocarcinogenesis in the cirrhotic liver has recently become a subject of intense investigation. The development of hepatocellular nodules demonstrating varying degrees of cellular and architectural atypia suggests that these nodular lesions represent a pathway of carcinogenesis in cirrhosis of different etiologies. This pathway involves processes, such as capillarization and neoangiogenesis, leading to a gradual change in blood supply from portal to arterial, as a dysplastic nodule becomes hepatocellular carcinoma. These changes in intranodular blood supply create different enhancement patterns in the two phases of liver circulation after an intravenous contrast injection on multi-phase helical CT or dynamic gadolinium-enhanced MRI. This article reviews the current concepts regarding the vascular changes occurring in dysplastic nodules in the multistep process of hepatocarcinogenesis, along with the associated imaging manifestations. Some practical issues and dilemmas regarding the follow-up and biopsy of these lesions are also discussed. European Radiology

Magnetisation transfer (MT) techniques provide tissue contrast depending mainly on the concentration of macromolecules. Because many macromolecules are involved in the secretory activity of the pituitary gland, MT techniques might be useful in the study of pituitary gland disorders. Our purpose was to establish a quantitative database of the MT ratio (MTR) of the normal adenohypophysis and to see whether there are age- and sex-related differences. Using a three-dimensional gradient-echo sequence for MT we studied the adenohypophysis in 56 males and 61 females aged 7 months-77 years; postsaturation images were obtained using an on-resonance binomial prepulse. The images were normal in all but three patients, two with meningiomas, one with a schwannoma). Adenohypophyseal MTR increased in both sexes up to 19 years of age (r = 0.47 males, 0.39 females, P < 0.05). In men after 20 years and in women from 20-49 years MTR decreased (r = -0.68, P < 0.001, r = -0.46, P < 0.05, respectively). In women aged 50-59 years the MTR again increased slightly. The MTR in males was slightly higher at all ages except before 9 and after 50 years of age. These differences were not statistically significant except in the 40-49 year group (P < 0.05).

Dysembryoplastic neuroepithelial tumours (DNET) are mainly benign cortical lesions. DNET in the caudate nucleus, thalamus, hypothalamus, pons and cerebellar hemispheres has also been reported. We describe a fronto-temporo-parietal DNET extending to the ipsilateral thalamus and internal capsule, associated with cerebellar lobe atrophy. Involvement of the internal capsule and complication of DNET with cerebellar atrophy have not been reported previously. We emphasise the importance of early diagnosis and treatment of this rare condition. Neuroradiology

Background Hepatocellular carcinoma is one of the world's most common malignancies. The aims of the present paper are to review data on (1) epidemiology and screening programmes for the early detection of the tumour and (2) advances in the diagnostic imaging and management. Methods Relevant English language articles, published between January 1985 and December 1997, were reviewed. Articles were identified through Medline search, using the key words ‘hepatocellular carcinoma’. Articles cited in the bibliographies of these articles were searched manually. Results Hepatocellular carcinoma has a heterogeneous geographical distribution. Although its risk factors have been identified, the efficacy of screening programmes remains uncertain. Imaging has improved substantially with the recent application of dual-phase helical computed tomography and magnetic resonance imaging employing specific contrast agents. The comparative efficacy of conservative therapy and surgical resection is uncertain, since well controlled trials are lacking. Conclusion Hepatocellular carcinoma is commonly a problem of two diseases, the malignancy itself and cirrhosis. This renders treatment rarely curative, even when surgical resection can be applied in a technically successful sense. Liver transplantation could be a definitive treatment but this is plagued by limited donor resources.

Rheumatoid arthritis (RA) is a chronic inflammatory disease which is characterised mainly by synovial inflammation and joint destruction, as well as extra-articular manifestations.1 Cytokines have a central role in the pathogenesis of this synovial inflammation. Tumour necrosis factor α (TNFα) is one of the dominant cytokines. Many studies have shown that TNFα is present in biologically significant amounts in RA synovial tissue and fluids, and the amount seems to parallel the extent of inflammation and bone erosion.2,3 Persistent inflamed monarthritis in patients with RA is difficult to treat. Usually it is treated with local patches, intra-articular injections of steroids, or even with chemical, radioactive, or surgical synovectomy.4 The introduction of anti-TNFα treatments, especially the infusion of infliximab,5 prompted us to investigate the effectiveness and safety of intra-articular injection of infliximab in patients with RA and resistant monarthritis. Five patients who fulfilled the American College of Rheumatology criteria for RA were studied.6 All were receiving treatment with …

A case of nephroblastomatosis is described in a previously healthy child with a palpable mass in the right upper quadrant as an incidental finding. This case of nephroblastomatosis demonstrates the whole spectrum of abnormalities from local regression to formation of true Wilms' tumors bilaterally over a 4-year period. The evolution of these changes provides a graphic and dramatic example of this interesting entity, indicating its potential malignant association with Wilms' tumor. Pediatric Radiology

Sir,We thank the authors of this letter fortheir thoughtful remarks.We agree that the performance ofunenhanced CT is necessary for thefull characterization of adnexalmasses, especially in ‘differentiatingenhancing lesion components fromhaemorrhage or mucinous content’.This could probably enable the correctcharacterization of one of the false-negative cases with multidetector CT(MDCT) in our study, by detecting theenhancing element within a borderlineovarian tumour with haemorrhagiccontent [1]. This study was one of thefirst conducted on our 16-row MDCTsystem, and unenhanced CT was notperformed due to concern about irra-diation. The effective dose for the CTprotocol used in this study was mea-sured at 7 mSv, i.e. not different fromthat for conventional CT of the abdo-men [2]. The protocol we use nowincludes unenhanced CTof the pelvis,covering the area from the iliac creststo the symphysis pubis, or the adnexalmass if larger, followed by enhancedCT of the abdomen and pelvis.RegardingtheareaofcoveragewithMR imaging this included the pelvis‘covering the area from the iliac creststo the symphysis pubis, or the ovarianmass, if larger’, as already mentionedin our paper in the ‘Material andmethods’ section [1].With regards to the statisticalanalysis,theROCcurvewasproducedusing the SPSS/PC (version 15.0)statistical software. ROC curves foreach diagnostic method were basedon 67 patients, who underwentmultidetector CT, MR imaging andhistopathological examination, whichwas used as gold standard. TheSPSS/PC (version 15.0) did notestimate statistical significancebetween two ROC curves. It justestimated the areas under the curve(0.921 and 0.982 for multidetector CTand MR imaging, respectively). Wejust compared these percentages, andthe difference was not statisticallysignificant for

A comparative study using computed tomography and conventional posteroanterior radiography was performed on 27 patients with mesothelioma and 13 patients with advanced asbestosis. The major pathologic features of both asbestosis and mesothelioma were well demonstrated by both modalities; computed tomography demonstrated the findings more frequently and in greater detail. No distinguishing features could be established based on configuration and size of the lesion. Many pleural plaques associated with advanced asbestosis were large and irregular and resembled those associated with mesothelioma. However, nodular involvement of the pleural fissures, pleural effusion, and ipsilateral volume loss with a fixed mediastinum were features predominating in mesothelioma. Growth determination of the plaques associated with asbestosis may be of minimal value since such plaques also undergo growth due to active inflammatory changes.

A lobar perfusion defect in the presence of a normal arterial phase in the pulmonary angiogram may be due to stasis secondary to compression of a pulmonary vein by a hilar or perihilar mass. In this report we present a patient with metastasis to the right lung and hilum by malignant melanoma. A lobar perfusion defect was present in an area of lung tht appeared normal by radiograph. This defect was shown to be due to stagnating blood flow reflected by delayed intense capillary phase in that lobe and late opacification of the corresponding draining vein.

There are many controversies and treatment regimens in managing patients with prostatic carcinoma. The available treatment modalities have differing rates of success and complications. Extent and aggressiveness of the various treatments differ according to the treatment philosophy of the physician. Some are aggressive and aim for cure even in advanced disease, while others opt for symptomatic therapy, leaving curative therapy for those patients proved to have localised disease. In any case, accurate staging of extent of disease allows the most careful matching of treatment to patient. Over-staging localised disease as regionally metastatic may deny potentially curative therapy to those with localised disease, or may greatly increase complications by improperly extending aggressive therapy. Understaging may erroneously restrict aggressive therapy to the prostate or deny more systemic therapy with a better chance at cure or palliation.