Friday, April 29, 2005

Journal Watch-Role of ultrasound in dengue fever.

Venkata Sai PM, Dev B, Krishnan R.

This study was performed to find out whether ultrasound is an important adjunct to clinical and laboratory profile in diagnosing dengue fever or dengue haemorrhagic fever and to further determine whether ultrasound is useful in predicting the severity of the disease. Ultrasound was performed on 128 patients (2-9 years) with clinical suspicion of dengue fever. Serological tests were performed to confirm the diagnosis. 40 patients were serologically negative for dengue fever and later excluded from the study. Of the remaining 88 serologically positive cases, 32 patients underwent ultrasound on second to third day, repeated on fifth to seventh day of fever and in 56 patients ultrasound was done only on fifth to seventh day of fever. Of the 32 patients who underwent the study on second to third day of fever, all showed gall bladder wall thickening and pericholecystic fluid, 21% had hepatomegaly, 6.25% had splenomegaly and right minimal pleural effusion. Follow-up ultrasound on fifth to seventh day revealed ascites in 53% left pleural effusion in 22% and pericardial effusion in 28%. Of the 56 patients who underwent the study on fifth to seventh day of fever for the first time all had gall bladder wall thickening, 21% had hepatomegaly, 7% had splenomegaly, 96% had ascites, 87.5% had right pleural effusion, 66% had left pleural effusion and 28.5% had pericardial fluid. To conclude, in an epidemic of dengue, ultrasound features of thickened gall bladder wall, pleural effusion and ascites should strongly favour the diagnosis of dengue fever.
Br J Radiol. 2005 May;78(929):416-8.

Friday, April 22, 2005

Journal Watch-Use of Functional MRI to Guide Decisions in a Clinical Stroke Trial.

Cramer SC, Benson RR, Himes DM, Burra VC, Janowsky JS, Weinand ME, Brown JA, Lutsep HL.

BACKGROUND AND PURPOSE: An investigational trial examined safety and efficacy of targeted subthreshold cortical stimulation in patients with chronic stroke. The anatomical location for the target, hand motor area, varies across subjects, and so was localized with functional MRI (fMRI). This report describes the experience of incorporating standardized fMRI into a multisite stroke trial.

METHODS: At 3 enrollment centers, patients moved (0.25 Hz) the affected hand during fMRI. Hand motor function was localized at a fourth center guiding intervention for those randomized to stimulation.

RESULTS: The fMRI results were available within 24 hours. Across 12 patients, activation site variability was substantial (12, 23, and 11 mm in x, y, and z directions), exceeding stimulating electrode dimensions.

CONCLUSIONS: Use of fMRI to guide decision-making in a clinical stroke trial is feasible.

Stroke. 2005 Apr 14; [Epub ahead of print]

Monday, April 18, 2005

Post-mortem MRI as an adjunct to fetal or neonatal autopsy.

Griffiths PD, Paley MN, Whitby EH.
CONTEXT: Understanding what was wrong with a dead fetus or why a newborn child died can help the parents to grieve, while any findings can be used to inform the parents if there is a risk to future pregnancies and the level of risk. This information is mainly obtained from autopsies, but the number of parents agreeing to autopsy has dropped, which has prompted the search for adjuncts to autopsy.
STARTING POINT: The UK's Chief Medical Officer outlined the rationale for exploring alternatives to autopsy in 2000 and 2001. After wide consultation, MRI was deemed to offer the most realistic chance of making a contribution. Results so far are promising, but of insufficient depth and quality to make firm recommendations about providing a service in the future. In 2004, the UK Department of Health therefore tendered for this research to be done in fetal and neonatal (and adult) cases, and this work is due to start in 2005.
WHERE NEXT? High-quality anatomical information about the brain and spine of fetuses and neonates can be easily obtained with standard MRI scanners. Most developmental and acquired abnormalities can be seen on post-mortem MRI. More work needs to be done on organs not in the central nervous system, and heart malformations, in particular, might present diagnostic problems. A possible outcome could be whole-body MRI plus targeted biopsies of abnormalities taken under image guidance as an adjunct to formal autopsy.
Lancet. 2005 Apr;365(9466):1271-3.

Thursday, April 14, 2005

Differentiation of Nonperforated from Perforated Appendicitis: Accuracy of CT Diagnosis and Relationship of CT Findings to Length of Hospital Stay

Thomas A. Foley, BS, Frank Earnest IV, MD, Mark A. Nathan, MD, David M. Hough, MD, Henry J. Schiller, MD and Tanya L. Hoskin, MS
PURPOSE: To determine retrospectively the sensitivity and specificity of computed tomographic (CT) signs in differentiating acute nonperforated appendicitis from perforated appendicitis and to compare CT findings with the length of hospital stay.
MATERIALS AND METHODS: Institutional Review Board approval was obtained for this study, and patient informed consent was obtained for record review for research purposes. Two radiologists were blinded to patient identification but were informed that all patients presented to the emergency department with abdominal pain and underwent appendectomy. Radiologists independently reviewed CT images of 86 consecutive patients (45 males, 41 females; mean age, 33.7 years; age range, 8.2–87.1 years) who presented to the emergency department with acute abdominal pain, who underwent CT after initial emergency department assessment, and who underwent appendectomy within the subsequent 24 hours. Individual findings and confidence level for the diagnosis of perforated appendicitis were noted. Consensus interpretation was performed with a third radiologist. The consensus CT findings were correlated with the surgical and pathologic findings by using 2 or Fisher exact tests for univariate analysis and logistic regression for multiple variable analysis. Wilcoxon rank sum tests were used to assess the association between consensus CT findings and length of hospital stay.
RESULTS: Twenty-one (24%) of the 86 patients had appendiceal perforation. Extraluminal air and either moderate or severe periappendiceal inflammatory stranding were statistically significant independent predictors for perforation (P < .001). A focal defect in enhancing appendiceal wall was significantly associated with perforation (P < .001) and had a sensitivity of 58.8% and specificity of 85.7% on consensus review, with eight false-positive results. There was a strong association between the degree of periappendiceal inflammatory stranding and the length of hospital stay (P < .001).
CONCLUSION: Extraluminal air and moderate or severe periappendiceal inflammatory stranding are statistically significant independent predictors for appendiceal perforation and are associated with increased hospital stay.
(Radiology 2005;235:89.)

Monday, April 11, 2005


Give the complete diagnosis-in this CXR-PA view

Another opportunity to win my book "Review Of Radiology".All you have to do is diagnose this case post your answers as comments here and send your full name,current occupation and postal address to sumerdoc-AT-yahoo-DOT-com.

NOTE-In case of many correct entries the prize would be given by a lucky draw.

Saturday, April 09, 2005

Is infiltrate a useful term in the interpretation of chest radiographs? Physician survey results.

Patterson HS, Sponaugle DN.
PURPOSE: To determine how physicians interpret the word infiltrate when it is used in a chest radiography report and if the word is helpful in the clinical management of patients.
MATERIALS AND METHODS: Informed consent from participants was not required, and the study protocol was granted exempt status. One hundred sixty-five questionnaires were distributed, in conjunction with various physician meetings, at three separate nonaffiliated training hospitals. In the three-question survey, respondents were asked the definition of infiltrate, whether the term is helpful in guiding patient therapy, and whether it implies an etiology. The respondent demographic data obtained included date of graduation from medical school, amount of postgraduate training completed, primary or training specialty, and board or sub-board qualification.
RESULTS: There were 151 physician respondents, 94 (62.3%) of whom were house staff members. One hundred fifteen (76%) responders chose bacterial pneumonia as a condition consistent with infiltrate. One hundred thirty (86.1%) respondents replied that infiltrate implied more than one pathophysiologic condition. Eighty-two (54.3%) of those surveyed thought infiltrate could mean any of six or more different pathophysiologic conditions, including nonspecific pneumonia, interstitial pneumonia, viral pneumonia, consolidation, or nonspecific interstitial process. The number of terms selected did not vary according to level of residency training (P = .23); however, there was a significant specialty-related difference in the number of terms selected (P = .018). Internists selected a median of 10 terms, while others selected a median of six. Only 54 (36%) respondents thought that the term infiltrate was helpful in patient care, and only five (3%) thought that the term implied an etiology.
CONCLUSION: Infiltrate is a nonspecific and imprecise term when it is used as a radiograph descriptor, and use of this term does not usually enhance patient care.

Radiology. 2005 Apr;235(1):5-8.

Thursday, April 07, 2005

Radiation Cost of Helical High-Resolution Chest CT

David A. Leswick, Steve T. Webster, Brad A. Wilcox and Derek A. Fladeland
OBJECTIVE. In our department, most high-resolution CT (HRCT) scans of the lungs are performed in conjunction with a standard helical examination to assess the entire chest. This requires scanning the patient twice. The goal of this study was to determine if the radiation dose could be decreased by performing a single combination helical scan of the chest from which both 5-mm standard and 1.25-mm HRCT images could be obtained.
CONCLUSION. Because the total measured radiation dose is 32% greater from a single combination helical HRCT scan of the chest versus separate standard helical plus axial HRCT scans, helical HRCT is not a clinically advisable technique.
AJR 2005; 184:742-745

Wednesday, April 06, 2005

Computer-aided detection (CAD) in mammography: Does it help the junior or the senior radiologist?

Balleyguier C, Kinkel K, Fermanian J, Malan S, Djen G, Taourel P, Helenon O.

OBJECTIVES:: To evaluate the impact of a computer-aided detection (CAD) system on the ability of a junior and senior radiologist to detect breast cancers on mammograms, and to determine the potential of CAD as a teaching tool in mammography.
METHODS:: Hundred biopsy-proven cancers and 100 normal mammograms were randomly analyzed by a CAD system. The sensitivity (Se) and specificity (Sp) of the CAD system were calculated. In the second phase, to simulate daily practice, 110 mammograms (97 normal or with benign lesions, and 13 cancers) were examined independently by a junior and a senior radiologist, with and without CAD. Interpretations were standardized according to BI-RADS classification. Sensitivity, Specificity, positive and negative predictive values (PPV, NPV) were calculated for each session.
RESULTS:: For the senior radiologist, Se slightly improved from 76.9 to 84.6% after CAD analysis (NS) (one case of clustered microcalcifications case overlooked by the senior radiologist was detected by CAD). Sp, PPV and PNV did not change significantly. For the junior radiologist, Se improved from 61.9 to 84.6% (significant change). Three cancers overlooked by the junior radiologist were detected by CAD. Sp was unchanged.
CONCLUSION:: CAD mammography proved more useful for the junior than for the senior radiologist, improving sensitivity. The CAD system may represent a useful educational tool for mammography.

Eur J Radiol. 2005 Apr;54(1):90-6.

Tuesday, April 05, 2005

Radiolology News-MSK ultrasound shows signs of neglect

Most musculoskeletal radiologists prefer to use MRI in their daily practice even though they recognize the value of ultrasound to evaluate and diagnose many MSK conditions, according to results of a survey presented at the 2004 RSNA meeting.
Dr. Sandra Allison and colleagues at Thomas Jefferson University sent a questionnaire via e-mail to 300 members of the Society of Skeletal Radiology and to 105 members of the Society of Radiologists in Ultrasound. The 110 radiologists who responded (25%) had on average 13 years of experience.
More than three-quarters of respondents said that MRI should be the modality of choice to evaluate tendon, ligament, and muscle injuries. Two-thirds, however, indicated that too few musculoskeletal ultrasound examinations were ordered, and 80% of those said that reimbursement for MSK ultrasound is too low.
Almost 70% reported that their MSK ultrasound training was inadequate, while two-thirds indicated that ultrasound required too much physician time.
The survey also accounted for the specialists' respective biases. Sonologists were more likely to favor ultrasound, while musculoskeletal radiologists preferred MRI, the researchers said.

Friday, April 01, 2005

Terri Schiavo dies 13 days after feeding tube is removed - but the arguments go on

For those of you not aware of the whole story, this is Terri's Fight for life: The 15-year struggle
February 1990
Terri Schiavo collapses at home, the flow of oxygen to her brain is interrupted for five minutes, causing permanent damage.
Michael Schiavo and wife's parents fall out over care she is receiving. The parents later try and fail to have Michael removed as Terri's guardian.
May 1998
Mr Schiavo files petition to remove feeding tube, but nothing is done until April 24 2001. Two days later medical evidence compels an appeal court to insist feeding begins again.
November 2002
A court agrees that Mrs Schiavo will not recover and orders her feeding tube to be removed again. This happens the following October. Florida governor Jeb Bush uses new legislation, Terri's Law, to demand that the tube be put back.
September 2004
Florida's supreme court rules Terri's Law unconstitutional. Appeal court sets March 18 2005 as day the tube will be removed.
March 18 2005
Judge orders the tube to be removed. Congress rushes through emergency bill which president signs - forcing a federal court to review decision.
March 22
Florida court stands by its judgment, so Mrs Schiavo's feeding tube will not be reconnected.
March 24
The US supreme court refuses another request to review the Schiavo case.
March 25
US district court turns down parents' request for an emergency order to force doctors to feed their daughter.Soon afterwards Florida supreme court turns down an emergency appeal.
March 30
Late Wednesday night, the US supreme court refuses for the sixth time to hear an appeal on Terri's plight.
March 31
Attorney David Gibbs announces that Terri Schiavo died at 9:05 Thursday morning (local time).

well for the interested people this is a single section of her CT scan available on the net, agreed there is cerebral atrophy but what is that white object in her lateral ventricle, is it a shunt put for hydrocephalus?? if it is a malfunctioning shunt would her prognosis be different?? any comments are welcome!
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excellent discussion on this at-Codeblueblog

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