Computerized tomography versus nuclear magnetic resonance in acute pancreatitis

The aim of the study was to compare Computed Tomography (CT) and Nuclear Magnetic Resonance (MR) scan's diagnostic reliability in acute pancreatitis (AP). During a 44-month period 21 patients with a clinical and laboratory diagnosis of AP were submitted to CT and MR study. The scans were evaluated according to pancreatitis degree and presence and rate of necrosis. Pancreatitis degree was assessed using Balthazar's grading for CT scans; a similar classification was used for MR scans. Thirteen patients had oedematous pancreatitis and 8 necrotic pancreatitis. Necrosis was diagnosed intraoperatively or in non operated patients with CT scan. MR staging was identical to that of the CT ones except for 2 patients who were grade E at CT and grade D at MR. MR identified necrosis in all 8 patients with necrotic AP whereas CT diagnosed only 5 patients properly since 3 scans were performed without contrast medium infusion because of renal failure. MR proved to be a valid alternative in AP diagnosis: it provide the same diagnostic and prognostic information as CT and does not need contrast infusion, which makes it preferable to CT in the follow-up of severe AP evolution.     

Principles of functional magnetic resonance tomography

The basic principles of brain activation studies by MRI and functional spectroscopy are presented. The paper introduces the underlying mechanisms, followed by a discussion of the possibilities and limitations of current and new measuring techniques. Functional MRI has already proven to be a useful tool in neurocognitive research. Initial clinical applications have especially been demonstrated in neurosurgical operation planning.     

Cost effectiveness of magnetic resonance imaging of the knee

When compared to diagnostic arthroscopy in patients with knee complaints consistent with internal derangement, MR imaging emerges as a cost effective diagnostic supplement to clinical examination. This article concludes that the results of MR imaging can be used as a guide for the management of knee pain.     

Magnetic resonance angiography and magnetic resonance tomography in dissection of the vertebral artery

Vertebral artery dissection (VAD) is an important cause of posterior circulation stroke in young adults. Initial symptoms are often non-specific and diagnostic arteriography is not performed until neurological deficits are obvious. Since magnetic resonance tomography (MRT) is superior in the diagnosis of vertebrobasilar ischemia, we retrospectively analyzed the role of MRT and MR angiography (MRA) in the detection of dissections of the vertebral artery. Between 1989 and 1995 we identified 24 patients with a vertebral artery dissection and 1 patient with a basilar artery dissection (8 females and 17 males, 23-60 years of age, mean 41.2 years). The diagnosis of VAD (14 left VAD, 9 right VAD, 1 bilateral VAD, 1 basilar artery dissection) was established by specific arteriographical findings (DSA) or clinical and neuroradiological course. All patients underwent a combined MRT/MRA examination protocol at 1.5T that consisted of spin-echo imaging and time of flight MRA of the intra- and extracranial arteries using 2D Flash and 3D Fisp sequences. The MRT/MRA findings were correlated to DSA and ultrasound results. During the acute and subacute stage, MRT/MRA revealed abnormal findings in 21 of 22 dissected vessels (95.5%). There was one false-negative MRT/MRA in a patient with a V1 dissection (intimal flap without peripheral flow disturbances). In 7/22 VAD the MRT/MRA findings were rated specific (double lumen n = 1, mural hematoma n = 4, pseudoaneurysm n = 2). DAS was sensitive in 100% and ultrasound in 77.3%. Specific results were obtained by DSA in 8/ 22 VAD (36.4%) and in 7/22 VAD (30.4%) by MRT/MRA. When MRT/MRA and DSA results were combined, the specific findings increased to 43.5%. Follow-up examinations revealed recanalization in 52% of initially stenosed or occluded vertebral arteries; four patients developed a pseudoaneurysm, and two of them underwent ligation of the VAD. With this retrospective approach, we were able to show a high sensitivity of MRT/ MRA for the presence of disturbed flow in the dissected vertebral artery. The MRA projections tended to overestimate stenosis and were inferior to DSA in the appreciation of irregularities of the vessel wall. Identification of high-grade stenosis, especially in the presence of distal occlusion, was improved on the MRA source images. During the acute and subacute stage, the diagnosis of luminal thrombus can be difficult, because signal ambiguities exist between hemoglobin breakdown products and flow effects and adjacent fat tissues. The differentiation between luminal thrombus and mural hematoma requires interpretation of MRA source images, together with flow compensated spin-echo images. Additional fat suppressed images and flow presaturation may be required at the appropriate levels. The identification of mural hematoma is important, because this finding is considered specific and cannot be obtained with DSA. There is a complementary role of MRT/MRA and DSA for an improved overall specificity for vertebral artery dissection. A negative MRT/MRA result in a patient with appropriate symptoms, however, cannot exclude a dissection and should prompt DSA. On the other hand, a suggestive MRT/MRA result in the appropriate clinical context can replace DSA. The advantage of MRT/MRA is that the method offers a simultaneous diagnosis of posterior fossa ischemia and vertebral artery abnormalities. Therefore, MRT/MRA should be recommended in patients with suspected VAD and especially in those who have no definite neurological deficit. These patients will benefit greatly from early diagnosis and therapy. The fact that all our patients were diagnosed after neurological symptoms and that 64% of them have residual deficits gives an ethical and economical rationale for advocating early MRT/MRA in these patients.     

Infiltration patterns of plasmacytomas in magnetic resonance tomography

PURPOSE: To define the different infiltration patterns in the spine in multiple myeloma, in correlation with histological and clinical findings. Quantitative signal evaluation with contrast media (Gd-DTPA). To compare the results in MRI with X-ray films. MATERIAL AND METHODS: 61 patients with proven multiple myeloma and 50 controls were examined (1.0 Tesla, T1-w SE, opposed phase GE images). RESULTS: Five infiltration patterns with different clinical stages were detected: normal bone marrow (11%) in cases of low interstitial marrow infiltration (biopsy), pure diffuse infiltration (25%), focal involvement (33%), combined diffuse/focal infiltration (23%) and a "salt-and pepper" pattern (8%). In diffuse plasmacytoma the 40% signal intensity increase was modification of diffuse infiltration. MRI proved to be more sensitive than radiography. CONCLUSION: MRI is able to show the type and the extension of bone marrow infiltration in multiple myeloma. Diffuse involvement can be objective with gadopentetate dimeglumine.     

Silicon-29 nuclear magnetic resonance spectroscopy detection limits

We show that an unmodified, commercially available high-field (17.61T) NMR spectrometer using the DEPT pulse sequence is capable of detecting silicon-containing species down to concentrations of 150 ng/mL (150 ppb) per spin site. This is in the range given for the concentration of silicon in the blood of silicone breast implant recipients, as determined by ICP analysis, and demonstrates that, contrary to the view expressed in the literature, in theory 29Si NMR may be sufficiently sensitive to be of use in determining the nature of the silicon-containing species present. A summary of the factors affecting the detection limits in NMR spectroscopy is given.     

Proton nuclear magnetic resonance studies on dideoxyribonucleoside methylphosphonates

A series of dideoxyribonucleoside methylphosphonates, d-ApA, d-ApT, d-TpA, and TpT, were synthesized chemically and the diastereoisomers of each dimer were separated [Miller, P. S., Yano, J., Yano, E., Carroll, C., Jayaraman, K., & Ts'o, P. O. P. (1979) Biochemistry 18, 5134]. The 1H NMR spectra of these compounds are similar to those of their parent diester compounds. Specifically, the assignments of the 1H resonances of the two diastereoisomers of d-ApA (designated as 1 and 2) were reaffirmed by comparing with the unmodified, parent d-ApA. The absolute configuration of the phosphonate methyl group of the two isomers (d-ApA)1 and (d-ApA)2 was determined by the NOE technique. The 1H NMR spectra of the diastereoisomers of d-ApA, as well as the corresponding monomer components dAp and CH3pdA, and TpT were analyzed by spectrum simulation techniques. Thus, all the coupling constants and chemical shifts of the proton resonances of the deoxyribofuranose ring and the phosphonate methyl group could be precisely determined. These data provide the information for an analysis of the sugar puckering and backbone conformations of these novel nonionic nucleic acid analogues. It was found that the conformations of the sugar-phosphate backbones of each isomer are similar to each other and are similar to the conformations of the parent dinucleoside monophosphates. The average adenine stacking conformations of (d-ApA)1 and (d-ApA)2 were described in numerical coordinates derived from a computer analysis which included both ring-current magnetic anisotropy and atomic diamagnetic anisotropy effects. The two computer-derived conformational models are similar to those derived from the graphic approximation based only on the ring-current effects. For each pair of dimer analogues, the base stacking mode of isomer 1 is similar to that of its parent diester while the extent of base overlap in isomer 2 is less than that in isomer 1. The results of the conformational analysis based on NMR data are consistent with the results obtained from ultraviolet and circular dichroism measurements on these dimers.     

原子核磁共振显微检测芯片的磁路设计

基于磁路设计理论首先设计了一种适用于原子核磁共振显微检测芯片的永磁磁路;然后根据磁路磁通折射定理和基尔霍夫第一定律对设计的磁路模型进行理论分析,提出了单一匀场环磁路性能优化方法;最后利用有限元方法分别计算了优化前的磁路、单一匀场环优化后磁路和传统的双匀场环优化后磁路.计算结果表明:相比优化前和采用传统的双匀场环优化后的磁路,采用单一匀场环优化后的磁路其性能最优,工作区域内磁场强度和均匀度都得到了极大的提高,磁场强度达到0.703 544 T,工作区域内磁场均匀度为14×10-6.因此所设计的磁路能够较好地满足原子核磁共振显微检测芯片的需求.     

Influence of magnetic resonance imaging on indications for arthroscopy of the knee

In a prospective study, magnetic resonance imaging was performed before arthroscopy for all patients (n = 121) with a meniscal tear (n = 125). Criteria of the study were stable cruciate and collateral ligaments, absence of pathologic radiographic findings, and absence of prior surgical interventions of the involved knee joint. In 43 knees (34%), the clinical diagnosis of a meniscal tear was discarded because of the results of the magnetic resonance imaging examination. Synovitis was diagnosed in 16 patients (13%), articular cartilage damage in 10 patients (8%), bone bruise injuries in 10 patients (8%), osteochondritis dissecans in 3 patients (2%), disruption of the inner layer of the medial collateral ligament in 3 patients (2%), and osteonecrosis in 1 patient. The use of magnetic resonance imaging in establishing diagnosis of disorders of the knee joint altered treatment in a significant proportion of patients. Magnetic resonance imaging should be done before arthroscopy of the knee in all cases in which the clinical diagnosis has been reduced to a suspected meniscus injury.     

The ovary. Computed tomography and magnetic resonance imaging

CT and MR imaging can both contribute valuable clinical information in women with benign and malignant ovarian masses; the superior soft tissue contrast and multiplanar capabilities provided by MR imaging make it a valuable tool to evaluate the normal ovary, polycystic ovaries, endometriosis, and disorders of sexual differentiation. CT is currently the recommended modality to stage ovarian carcinoma, and peritoneal implants as small as 5 mm can be visualized. With the addition of contrast-enhanced images to conventional MR sequences, however, improved visualization of intratumoral architecture has also allowed for accurate MR characterization of benign versus malignant ovarian masses. Fat saturation techniques used with conventional MR sequences can also be used for definitive characterization of benign fat-containing teratomas and differentiate these tumors from hemorrhagic ovarian cysts or endometriomas. Finally, the detailed visualization of the normal-sized ovary on MR images provided by both the body coil and the new phased-array coil allows detection of the normal ovaries, ovarian follicles, and ovarian cysts throughout the premenopausal and postmenopausal years. Findings of polycystic ovarian syndrome, which cannot be evaluated by CT, are characteristic on MR images. MR is unparalleled in the evaluation of disorders of sexual differentiation because MR images can depict ectopic and normally positioned gonads and provide multiplanar depiction of the other pelvic organs and perineum as well. CT and MR imaging can provide valuable and specific clinical information about the ovary and benign and malignant ovarian disease.     

Diagnostic neuroimaging: computed tomography and magnetic resonance imaging

BACKGROUND: Computed tomography (CT) and magnetic resonance imaging (MR) are commonly used neuroimaging modalities for patients with signs or symptoms of neuro-ophthalmic disorders. Understanding the technology and clinical uses of these modalities is vital in patient management. METHODS/RESULTS: Basic instrument design and technology are presented together with a discussion of indications and contraindications to the use of these imaging techniques. Case reports are presented to illustrate the usefulness in diagnosis of orbital and neuro-ophthalmic disease. CONCLUSIONS: A basic knowledge of CT and MR helps the optometrist correlate imaging with clinical signs and symptoms of disease. This understanding also results in more effective communication with other health care providers and patients.     

Stimulation of peripheral nerves by time-varying magnetic field gradients in magnetic resonance tomography

PURPOSE: The objective of this study is to explain how peripheral nerves can be stimulated by magnetic resonance imaging (MRI) and to describe the associated potential risk. Present knowledge on the bioeffects of time-varying magnetic fields used in MRI are summarized and discussed. MATERIAL AND METHODS: This review summarizes current reports on peripheral nerve stimulation during MRI and studies which determine threshold values for stimulation effects. RESULTS/DISCUSSION: The comparison of the different studies indicates that it is reasonable to express the stimulation threshold in terms of the gradient amplitude rather than in terms of the rate of change of the magnetic field gradient. Further studies are necessary to obtain reliable threshold values for peripheral nerve stimulation during MRI and, even more important, to find out how these results can be used to define threshold values in order to avoid excitation of the myocardium during MRI.     

Ultra-low magnetic resonance tomography of thoracic and lumbar spine osteochondrosis

The paper presents the results of tomographic studies of 119 patients with clinical manifestations of radiculopathy or radiculomyelopathy. MR tomography was performed on the Magnaview unit ("Instrumentarium", Finland) at field intensity 0.04 T. The analysis of T1- and T2-weighted sagittal tomograms providing MRT picture of osteochondrosis and various hernias shows that osteochondrosis involves several disks simultaneously while their bulging towards the vertebral canal is multiple. The severity of the hernia in some cases does not closely agree with degeneration degree or the decline of the vertebral disk height. However there is a close correlation between the size and direction of the hernia on the one hand and the clinical manifestations on the other hand.     

Unusual computerized tomography and magnetic resonance imaging of cerebellar metastasis

AIM: To see whether increasing use of ultrasound scans in pyloric stenosis is leading to false-positive diagnoses, and even negative laparotomies. METHODS: Over a 2-year period, 76 neonates underwent laparotomy with a preoperative diagnosis of pyloric stenosis (PS). There were 57 males and 19 females, age ranged from 10 days to 7 weeks. RESULTS: Six patients proceeded straight to surgery after undergoing a test feed. The remaining 70 patients had one or more imaging investigations. Of these; 56 patients had an ultrasound only, 5 had a barium meal only while 9 patients had both investigations. Ultrasound showed evolving lesions in 2 patients. It was equivocal or falsely negative in 8 - all were diagnosed correctly after undergoing barium meals. Fifty-two patients were diagnosed correctly on ultrasound. There were, however, 3 false-positive ultrasonic diagnosis--i.e., at laparotomy the pylorus was found to be normal. One of these patients even had a "diagnostic" barium meal. The factors leading to these negative explorations are discussed. CONCLUSION: Pyloric "tumours" can be difficult to palpate early in the evolution of the disease. Reliance upon the ultrasound appearance of the pylorus without taking into account other important diagnostic evidence will increase the risk of false-positive diagnoses and unnecessary laparotomy. The importance of clinical examination and test feed is emphasised.