Purpose
Real‐time virtual sonography (RVS) is a new technique that synchronizes real‐time ultrasonography (US) and multiplanar reconstructed magnetic resonance imaging (MRI). The purpose of this ...study was to evaluate the feasibility and ability of RVS to assess the main pathologies in fetuses with suspected US anomalies.
Method and Materials
Real‐time virtual sonography (Hitachi, HI VISION Ascendus) was offered to 30 patients who had undergone fetal MRI. The acquired MRI image dataset was loaded into the fusion system and displayed together with the real‐time US image. The ability of RVS to assess the main anatomical sites and fetal anomalies was evaluated.
Results
Real‐time virtual sonography was technically possible in all cases. From a total of 30 patients, RVS helped the diagnosis in 10 cases. In 15 cases of encephalic pathology, fusion imaging improved the accuracy of the diagnosis; in the other 5 cases, MRI was superior to US even when using the RVS.
Conclusion
This is a study on the feasibility and practical use of RVS. Thanks to information from both US and MRI, RVS allowed better identification of the fetal pathologies and improved the performance of the ultrasound examination. In our experience, it was really helpful in pathologies that would benefit from US follow‐up.
What's already known about this topic?
Fusion imaging is a technique already used for US‐MRI–guided biopsies.
US and MRI are 2 techniques widespread in the evaluation of fetal anomalies. They are used as single imaging modalities and in most cases performed by different specialist.
What does this study add?
This is a study on the feasibility and practical use of fetal MRI‐US real‐time fusion imaging. Thanks to information from both US and MRI, RVS allows better identification of the different fetal pathologies and could improve the performance of ultrasound examination. In our experience, it is really helpful in pathologies that could benefit of US follow‐up giving the opportunity to show, in real time, images from 2 different—but complementary—techniques.
Purpose
In order to evaluate whether overuse has a significant role in rotator cuff tear (RCT) aetiology, we evaluated both shoulders of patients with old unilateral arm amputation expecting a higher ...rate of RC degeneration in the healthy side.
Methods
Nineteen males and six females (mean age: 57.3 ± 10.1) with an old (>20 years) unilateral arm amputation were submitted to an MRI of both shoulders. Tendon status and muscle tropism were evaluated according to Sugaya and Fuchs classifications, respectively; the acromion humeral distance was measured. Statistical analysis was performed to verify the prevalence of Sugaya and Fuchs categories in each sides.
Results
A significant prevalence of Sugaya type II in the amputated side (
p
= 0.02) and of type I in the healthy side (
p
< 0.001) was found. Rotator cuff was healthy in 28 and 52% of amputated and non-amputated side, respectively. The mean acromio-humeral distances of the amputated and healthy side were 0.8 cm (SD: 0.1) and 0.9 cm (SD: 0.1), respectively, (
p
= 0.02). A significant prevalence of Fuchs type II category in the healthy side (
p
< 0.001) was found. Fuchs III/IV were observed in 40 and 12% of amputated and healthy side, respectively.
Conclusions
The present study resizes the role of overuse on the aetiology of RCT. Cuff tear prevalence in not amputated shoulders, inevitably submitted to functional overload, was not higher than that of coetaneous subjects with two functional upper limbs. Shoulder non-use is a risk factor for rotator cuff tear. As the prevalence of rotator cuff degeneration/tear is higher in the amputee side, non-use is a more relevant risk factor than overuse. In the daily clinical practice, patients with rotator cuff tear should be encouraged to shoulder movement because rotator cuff tendon status could be worsened by disuse.
Level of evidence
III.
Electrocardiogram (ECG) has proven to be useful for early detection of cardiac involvement in Anderson-Fabry disease (AFD); however, little evidence is available on the association between ECG ...alterations and the progression of the disease.
To perform a cross sectional comparison of ECG abnormalities throughout different left ventricular hypertrophy (LVH) severity subgroups, providing ECG patterns specific of the progressive AFD stages. 189 AFD patients from a multicenter cohort underwent comprehensive ECG analysis, echocardiography, and clinical evaluation.
The study cohort (39% males, median age 47 years, 68% classical AFD) was divided into 4 groups according to different degree of left ventricular (LV) thickness: group A ≤ 9 mm (
= 52, 28%); group B 10-14 mm (
= 76, 40%); group C 15-19 mm (
= 46, 24%); group D ≥ 20 mm (
= 15, 8%). The most frequent conduction delay was right bundle branch block (RBBB), incomplete in groups B and C (20%,22%) and complete RBBB in group D (54%,
< 0.001); none of the patients had left bundle branch block (LBBB). Left anterior fascicular block, LVH criteria, negative T waves, ST depression were more common in the advanced stages of the disease (
< 0.001). Summarizing our results, we suggested ECG patterns representative of the different AFD stages as assessed by the increases in LV thickness over time (Central Figure). Patients from group A showed mostly a normal ECG (77%) or minor anomalies like LVH criteria (8%) and delta wave/slurred QR onset + borderline PR (8%). Differently, patients from groups B and C exhibited more heterogeneous ECG patterns: LVH (17%; 7% respectively); LVH + LV strain (9%; 17%); incomplete RBBB + repolarization abnormalities (8%; 9%), more frequently associated with LVH criteria in group C than B (8%; 15%). Finally, patients from group D showed very peculiar ECG patterns, represented by complete RBBB + LVH and repolarization abnormalities (40%), sometimes associated with QRS fragmentation (13%).
ECG is a sensitive tool for early identification and long-term monitoring of cardiac involvement in patients with AFD, providing "instantaneous pictures" along the natural history of AFD. Whether ECG changes may be associated with clinical events remains to be determined.
Le chylothorax (CT) est une effusion exsudative lactescente dans la cavité pleurale due à une accumulation de triglycérides et/ou chylomicrons. Son incidence est très rare chez les patients en ...hémodialyse. En dehors des lésions du canal thoracique, les principales causes non traumatiques peuvent survenir dans des contextes de néoplasie, infection ou obstruction du canal thoracique (sarcoïdose, amylose…).
Nous rapportons le cas d’un CT chez une patiente de 63 ans (29kg) d’origine hispanique hémodialysée via un cathéter tunnelisé jugulaire interne droit depuis 10 ans pour insuffisance rénale terminale sur probable néphroangiosclérose. Devant une dyspnée modérée, en dehors de toute chirurgie ou traumatisme, une radiographie de thorax a révélé un épanchement pleural droit de grande abondance. Un liquide exsudatif opalescent à la ponction pleurale, associé un taux de triglycérides élevé (300mg/dL) nous a permis de poser le diagnostic de CT. La cytologie, les analyses bactériologiques (y compris mycobactéries) et mycologiques se sont révélées négatives. Aucun signe de thrombose ou de sténose vasculaire n’ont été mis en évidence à l’angio-scanner et l’échographie des vaisseaux du cou L’association CT et ascite chyleuse a été éliminée par l’échographie abdominale. Une ponction évacuatrice à visée thérapeutique a été réalisée, cependant l’épanchement pleural a rapidement récidivé. La revue du dossier médical retrouve l’adjonction récente de la lercanidipine (20mg/j) au traitement de base comprenant irbésartan et carvédilol, en raison d’une hypertension artérielle mal contrôlée. L’épanchement pleural a été évacué à nouveau et la lercanidipine arrêtée. L’instauration d’un régime pauvre en triglycérides à longues chaînes ramifiées a été parallèlement associée. Le suivi radiologique a montré l’absence de récidive de l’épanchement pleural dans les trois semaines suivantes.
L’absence de récidive à l’arrêt du traitement par lercanidipine sont en faveur de l’imputabilité de la lercanidipine dans la survenue du CT. La pleurésie chyleuse est un effet indésirable de la lecarnidipine rare décrit chez des patients hispaniques et japonais en dialyse péritonéale. La lercanipidine est un antagoniste calcique lipophile non dialysé (forte liaison aux protéines plasmatiques). Un effet d’accumulation dose-dépendant est probable chez notre patiente de faible poids, susceptible d’entraîner une effusion lymphatique par augmentation de la perméabilité du canal thoracique.
Devant la survenue d’un épanchement pleural unilatéral sans contexte traumatique, infectieux ou néoplasique chez un patient hémodialysé et hypertendu, l’introduction récente de lercanidipine devrait être recherchée.
The association of extrapyramidal side effects (EPS) with the use of conventional antipsychotics is well established, however, EPS can occur during treatment with anticonvulsant medications as well. ...We will present the case of a patient who developed an acute dystonic reaction during treatment with lamotrigine and again during re-challenge with the same agent. We will review common side effects of this medication and the previous reports of lamotrigine-associated dystonias. We will also discuss a possible underlying mechanism.
High-resolution ultrasound (US), as a readily available, cost-effective and harmless imaging technique, is appropriately the initial imaging modality for salivary gland lesions. Benign tumors are ...reported to present with regular and well-defined margins, a homogeneous hypoechoic structure and demarcated vessel distribution, whereas malignant lesions are irregular, heterogeneous and diffusely perfused. Ultrasound and color Doppler features of benign and malignant salivary gland lesions overlap, and many benign tumors, particularly pleomorphic adenomas, may appear irregularly shaped, with a heterogeneous echo-structure indistinguishable from a malignant lesion. Often skilled US operators are not always able to differentiate benign from malignant lesions. The introduction of US contrast agents has allowed further perspectives in the possible improvement of lesion characterization, and the emergence of US elastography, an innovative tool for assessing lesion stiffness/elasticity characteristics, has been advocated for differentiating salivary gland lesions. When lesions are atypical on US, contrast-enhanced magnetic resonance (MR) imaging is usually the definitive imaging modality. We present a current review of benign and malignant parotid gland tumors with emphasis on the role of multiparametric US and MR imaging.
The aim of this study was to evaluate the accuracy of unenhanced whole-body MRI, including whole-body Diffusion Weighted Imaging (DWI), used as a diagnostic modality to detect pathologic lymph nodes ...and skeletal metastases in patients with prostate cancer (PCa) undergoing restaging after primary treatment.
152 male patients with biochemical recurrence after radical prostatectomy (RP) or external beam radiation therapy (EBRT) underwent MRI at a 1.5 Tesla magnet with whole spinal sagittal T2-weighted, sagittal T1-weighted, sagittal STIR images, axial T1 and T2-weighted and STIR images of the pelvis and whole-body. 18Fcholine-PET/CT exam was used as the reference standard.
MRI protocol including whole-body combined T1-weighted+T2-weighted+STIR+DWI showed a sensitivity (Se) of 99%, a specificity (Spe) of 98%, a positive predictive value (PPV) of 98%, a negative predictive value (NPV) of 96%, an accuracy of 98% and an area under the receiver operating characteristic curve (AUC) of 0.971 for identification of bone metastatic lesion. The same protocol, displayed a Se of 98%, a Spe of 99%, a PPV of 97%, a NPV of 98%, an accuracy of 98 % and an AUC of 0.960 in the detection of pathologic lymph nodes.
Unenhanced whole-body MRI, including whole-body-DWI, is an accurate and cost-effective diagnostic tool which is able to detect lymph node involvement and bone metastases in patients with biochemically recurrent PCa after RP or EBRT. Thanks to its lack of ionizing radiation, excellent soft tissue contrast, high spatial resolution, no need of contrast agent, high Se and Spe, it could play a role in the restaging procedure of such patients.
To determine whether CT-perfusion (CT-p) can be used to evaluate the effects of chemotherapy and anti-angiogenic treatment in patients with non-small-cell lung carcinoma (NSCLC) and whether CT-p and ...standard therapeutic response assessment (RECIST) data obtained before and after therapy correlate.
55 patients with unresectable NSCLC underwent CT-p before the beginning of therapy and 50 of them repeated CT-p 90 days after it. Therapeutic protocol included platinum-based doublets plus bevacizumab for non-squamous carcinoma and platinum-based doublets for squamous carcinoma. RECIST measurements and calculations of blood flow (BF), blood volume (BV), time to peak (TTP) and permeability surface (PS) were performed, and baseline and post-treatment measurements were tested for statistically significant differences. Baseline and follow-up perfusion parameters were also compared based on histopathological subclassification (2004 World Health Organization Classification of Tumours) and therapy response assessed by RECIST.
Tumour histology was consistent with large cell carcinoma in 14/50 (28%) cases, adenocarcinoma in 22/50 (44%) cases and squamous cell carcinoma in the remaining 14/50 (28%) cases. BF and PS differences for all tumours between baseline and post-therapy measurements were significant (p=0.001); no significant changes were found for BV (p=0.3) and TTP (p=0.1). The highest increase of BV was demonstrated in adenocarcinoma (5.2±34.1%), whereas the highest increase of TTP was shown in large cell carcinoma (6.9±22.4%), and the highest decrease of PS was shown in squamous cell carcinoma (-21.5±18.5%). A significant difference between the three histological subtypes was demonstrated only for BV (p<0.007). On the basis of RECIST criteria, 8 (16%) patients were classified as partial response (PR), 2 (4%) as progressive disease (PD) and the remaining 40 (80%) as stable disease (SD). Among PR, a decrease of both BF (18±9.6%) and BV (12.6±9.2%) were observed; TTP increased in 3 (37.5%) cases, and PS decreased in 6 (75%) cases. SD patients showed an increase of BF, BV, TTP and PS in 6 (15%), 21 (52.5%), 23 (57.5%) and 2 (5%) cases, respectively. PD patients demonstrated an increase of BF (26±0.2%), BV (2.7±0.1%) and TTP (3.1±0.8%) while only PS decreased (23±0.2%).
CT-p can adequately evaluate therapy-induced alterations in NSCLC, and perfusion parameters correlate with therapy response assessment performed with RECIST criteria.
Evaluating perfusional parameters, CT-p can demonstrate therapy-induced changes in patients with different types of lung cancer and identify response to treatment with excellent agreement to RECIST measurements.
A white light source using direct phosphor-conversion excited by a blue laser diode is presented. In this preliminary study we have investigated the influence of phosphor’s thickness and operating ...current of the laser diode over the (x, y) chromaticity coordinates, Correlated Color Temperature (CCT) and Color Rendering Index (CRI). The best values found were 4000 K and 94. A 40 lm/W luminous efficacy was achieved together with a CRI close to 90 for an operating current of 0.8 A. Those values, to the best of our knowledge, were not previously reported in the literature.
Associations among feeding habit, beak type, and food source in birds have been widely studied and are well known to exist. The relationship between feeding habit and jaw apparatus in birds has not ...attracted attention from ornithologists, perhaps because of the complexity of the skeletal morphology of the feeding system of birds. The goal of this study was to compare the jaw apparatus and foraging strategies of various Oriental species of the Picidae (Meiglyptini and Picini tribes) using a morphofunctional analysis of the skeletal structure of the jaw apparatus. This study showed that there are at least three types of jaw apparatus in these woodpeckers, as follows: 1) robust, developed, and complex; 2) complexity and development intermediate, as observed in Meiglyptes tristis and Dinopium spp., whose main foraging method involves gleaning, probing, and tapping; and 3) poorly developed, as observed in Picus miniaceus and Hemicircus concretus. The success of woodpeckers as a natural group is due not only to their feeding diversity, but also their ability to explore a wide range of different resources, as appropriate to their jaw apparatus.
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