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Biomedical subjects

I Suramo

Publications and source records attributed to I Suramo.

At least 37 records · Page 2Linked to original sources
PubMed2000

Diagnosis of meningeoma. A comparison of costs before CT, during CT and after introduction of MR imaging.

OBJECTIVE: To assess whether the capital investment required by advances in radiological technology is offset by savings in the direct costs of diagnostic services. MATERIAL AND METHODS: Meningeoma was used as an indicator case. All meningeoma patients from three study periods were included: Twenty patients in 1976-77 before the introduction of CT, 22 patients in 1984-85 when CT was used and 16 patients in 1992 when MR imaging had replaced CT as the most informative imaging modality. Radiological and other diagnostic investigations, and the hospital stay were identified and cost analyzed. RESULTS: The costs of radiological examinations increased from 293 Euros in 1976-77 to 513 Euros in 1992. The average number of diagnostic examinations per patient decreased from 5.1 in 1976 77 to 2.4 in 1992. The length of hospital stay decreased from 11.5 to 2.7 days and the total costs of the diagnostic work-up decreased to one-third of the original, i.e. from 3423 Euros in 1976-77 to 1282 Euros in 1992. CONCLUSION: The costs of the radiological examinations rose, but the development of radiological technology simplified the diagnostic practice. The hospital stay drastically decreased. The total costs of diagnostic work-up per patient dropped to one-third of the baseline costs.

Costs and Cost Analysis↗
PubMed1999

Association of atherosclerosis with low back pain and the degree of disc degeneration.

STUDY DESIGN: This was a cross-sectional observational study in which the abdominal aorta was evaluated for atheromatous lesions visible in computed tomographic scans in patients with and without low back pain. OBJECTIVES: To evaluate whether patients with low back pain have more atherosclerosis in the abdominal aorta than patients without low back pain and whether the severity of atherosclerosis in the abdominal aorta correlates with the grade of disc damage. SUMMARY OF BACKGROUND DATA: There are studies in which results indicate that insufficient blood supply may be a significant causative factor in disc degeneration. There are also studies in which smoking, one of the risk factors for arterial disease, has been correlated with low back pain. Calf pain has also been shown to correlate with low back pain. Results in a long-term follow-up study have further indicated an association between disc diseases and fatal ischemic heart disease. However, there seems to be only one postmortem study in which results show an association between atherosclerosis in the arteries of the lumbar area and disc diseases. METHODS: Computed tomographic images of 29 patients with low back pain, who had been evaluated with computed tomographic discography for diagnostic purposes, were evaluated for the quantity of atherosclerotic calcifications visible on computed tomographic scans of the abdominal aorta. A similar evaluation was performed in an age- and sex-matched control group of 52 patients without low back pain selected from among the patients referred for abdominal computed tomography. RESULTS: Sixteen (55%) of the 29 patients with low back pain had atherosclerotic calcifications visible on computed tomographic scans, whereas 11 (21%) of the 52 age-matched patients without low back pain were found to have aortic calcifications. Eleven (48%) patients with low back pain who were 50 years of age or less (n = 23) had aortic calcifications, whereas only 3 (8%) of the 36 control patients aged less than 50 years had aortic calcifications. There was no correlation between the amount of calcifications and the degree of disc degeneration assessed by computed tomographic discography. CONCLUSIONS: A significant association is indicated between atheromatous lesions in the abdominal aorta and low back pain.

Adult↗
PubMed1999

Effect of an internal carotid stenosis on orbital blood velocity.

PURPOSE: To examine how an internal carotid artery (ICA) stenosis influences the orbital blood velocity and to determine which velocity parameters are most useful. MATERIAL AND METHODS: The study group comprised 94 randomly selected patients examined with orbital US; most of the patients had a carotid artery stenosis. There were 58 men and 36 women, ranging in age from 22 to 88 years with a mean age of 63.1 years. The ICA stenosis grade was determined with carotid US. Peak systolic (Vp) and end-diastolic blood velocities, systolic acceleration, mean velocity, pulsatile index (PI) and resistance index (RI) were measured within the central retinal artery (CRA) and the ophthalmic artery (OA), and peak velocity was measured within the central retinal vein (CRV). The area under the ROC curve was used to compare the outcome of diagnostic tests. RESULTS: Only a severe (> or =80%) ICA stenosis decreased orbital blood velocity significantly, while milder stenoses did not cause significant flow decrease or side differences. According to ROC curve analysis, the threshold values giving the highest accuracy in detecting a > or =80% ICA stenosis were Vp < or =0.08 cm/s for the CRA and Vp < or =0.14 cm/s for the OA. The sensitivities for detecting a > or =80% ICA stenosis were 45% for Vp CRA and 60% for Vp OA. Systolic acceleration also decreased in severe stenoses, but RI, PI and velocity in the CRV did not correlate with ICA pathology. Reversal of OA flow was seen in 92% of ICA occlusion and in 47% of severe ICA stenosis. CONCLUSION: Orbital Doppler combined with carotid Doppler can be helpful in the diagnosis of the ocular ischaemic syndrome and in the evaluation of whether the symptoms are related to occlusion of the ophthalmic or central retinal vessels or are a consequence of carotid artery stenosis.

Adult↗
PubMed1998

Computed tomographic evaluation of retrosternal adhesions after pericardial substitution.

BACKGROUND: Reoperative median sternotomy can result in cardiac injury and serious bleeding, with the rate ranging from 2% to 6%. Closure of the native pericardium can maintain a preventing plane of cleavage. In patients in whom primary pericardial closure is not possible, several substitutes have been tried with variable results. We conducted a prospective study to evaluate the clinical feasibility of polytetrafluoroethylene and polyglycolic acid patches as pericardial substitutes, using computed tomography for imaging the postoperative state of the retrosternal space. METHODS: The basic population comprised 540 patients who were scheduled for coronary artery bypass grafting, and 52 of them who met the research criteria were chosen for computed tomographic evaluation after 5 years after the primary operation. RESULTS: As a substitute, polytetrafluoroethylene seemed to be less adhesive to the posterior surface of the sternum. Total adhesion scores were also statistically significant (p < 0.001) to the advantage of polytetrafluoroethylene over polyglycolic acid as a pericardial substitute. CONCLUSIONS: Polytetrafluoroethylene membrane seems to be capable of minimizing retrosternal adhesion formation and thus it may protect the heart during subsequent reoperative sternotomy.

Coronary Artery Bypass↗
PubMed1998

Interobserver, interequipment and intersubject variability of echo-Doppler examination of the common carotid and vertebral arteries.

OBJECTIVE: We evaluated interobserver and interequipment variability in common carotid and vertebral flow measurements, using seven female members of nursing staff as subjects, four different ultrasound machines and three different radiologists as operators. METHODS: The flow of the common carotid and vertebral arteries in each subject was examined at 0, 10, 20 and 30 min after lying down in a supine position. Peak velocity, end-diastolic velocity, mean velocity, systolic acceleration, cross-sectional area of the vessel, flow volume/min, resistance index and Doppler angle were measured. RESULTS: A large proportion of the variance of peak velocity, cross-sectional area of the vessel and flow volume was patient-related. Significantly different values of end-diastolic velocity, mean velocity, resistance index, Doppler angle and systolic acceleration were obtained with different equipment. Significantly different values of systolic acceleration, vertebral peak velocity, common carotid artery flow and Doppler angle were obtained by different operators. However, part of the variability may be physiological due to the study protocol. CONCLUSION: The use of the same operator and equipment is recommended in follow-up examinations.

Analysis of Variance↗
PubMed1998

Duplex ultrasound in the subclavian steal syndrome.

PURPOSE: The effect of subclavian steal on the contralateral vertebral flow and its possible effect on carotid flow were studied and the US results were compared to the angiographic findings. MATERIAL AND METHODS: The study consisted of the records of 74 patients with a duplex Doppler finding of subclavian steal syndrome. Of these, 48 patients had had both angiography and US of the neck arteries and were selected for comparison. For a comparison of the US flow values, a control series of 48 was selected from our carotid archive and consisted of patients without subclavian steal who had also been examined with both US and angiography. RESULTS: Of the 48 patients, 44 had a subclavian steal syndrome at angiography, 31 on the left side and 13 on the right. Of the 44, 21 patients had subclavian occlusion, and 23 stenosis. In 84% of the subclavian occlusions, US showed a complete systodiastolic steal and in 16% a partial systolic steal, while the corresponding findings for subclavian stenoses were 17% and 83%. Of the 48 cases, 4 were not real subclavian steals: 2 had vertebral occlusion (1 with a 90% subclavian diameter stenosis) on the side of retrograde flow at US and a steal through the vertebral and collateral arteries to the spinal arteries; and 2 had a 70% diameter stenosis of the subclavian artery and to-and-fro flow in the vertebral artery at angiography. In the 21 cases of complete steals, the subclavian diameter stenosis was 97 +/- 8% at angiography, and in the 23 partial steals, it was 85 +/- 10%. There was a significant increase in contralateral vertebral and common carotid flow in the cases with retrograde vertebral flow compared to the vertebral and common carotid flow of the control subjects. The retrograde flow values, the ipsilateral vertebral lumen diameter, and the flow values in the common carotid arteries were higher in complete steals and subclavian occlusions than in partial steals. CONCLUSION: A complete vertebral steal at US correlated well with subclavian occlusion and a partial steal suggested stenosis of the subclavian artery. There were also flow changes in the contralateral vertebral artery and the common carotid arteries that compensated for the steal. Retrograde vertebral flow at US was sometimes associated with vertebral occlusion in subclavian stenosis without a true subclavian steal.

Adult↗
PubMed1998

Costs of plain-film radiography in a partially digitized radiology department. An activity-based cost analysis.

PURPOSE: The aim of the study was to analyse the costs of computed radiography (CR) as part of a small picture archiving and communication system (mini-PACS), and to compare these costs with those of conventional analogue radiography using activity-based accounting (ABC). MATERIAL AND METHODS: The study was conducted at the Central Hospital of Vaasa where in 1993 the Radiology Department acquired a mini-PACS with a CR reader, a chest CR unit, and a CT unit as digital image processing modalities. Of altogether 34140 plain-film examinations, 3/4 were made with CR and stored mostly on film, and 1/4 were made with conventional analogue radiography. The costs and activities of these two modes were analysed by means of the ABC method which identifies and allocates indirect costs in radiological procedures. RESULTS: The costs of CR imaging were 9% higher than those of conventional radiography. The costs of the chest CR unit were equal to those of conventional radiography. The difference was due to higher investment costs in digital image processing. The time gained from a reduction in the number of retakes did not shorten the time spent by patients in the examination room, and its effect on film costs was minimal. CONCLUSION: In planning the step-by-step transition of conventional film-based analogue radiography to fully digitized radiography, it should be noted that films are still used in the transition period and that this is associated with higher costs than in the previous system of conventional analogue plain-film imaging.

Costs and Cost Analysis↗
PubMed1998

Multiplanar and 3D CT of acetabular fractures.

PURPOSE: To establish a standard protocol for the multiplanar (MPR) and 3D shaded surface display (SSD) reconstruction of CT data on acetabular fractures, and to assess the usefulness of these reformats. MATERIAL AND METHODS: Acetabular fractures in 15 patients were imaged by means of plain radiographs, transaxial CT, MPR reformats, and SSD reformats. RESULTS: The classification of the acetabular fracture was revised in 7/15 cases when the transaxial CT images were read after the plain radiographs. Although the MPR and SSD reformats did not alter the classification, they did add to the degree of confidence in the diagnosis in 9/15 cases. In 2 patients, the MPR and SSD reformats indicated operative instead of conservative treatment. In the MPR reformats, the following views were considered essential in all cases: (a) along the anterior column; (b) along the posterior column; and (c) along both columns and the inferior ramus. In the SSD reformats, the following views were considered essential in all cases: (d) the latero-caudal en face view into the acetabulum; and 180 degrees opposite to this, (e) the medio-cranial view (facing the quadrilateral plate). In 10/15 cases, these views were all that was needed for classification. It was, however, essential to remove the femur from the images before reconstructing the SSD views. CONCLUSION: Complex acetabular fractures with displacement should be evaluated by means of transaxial CT and additional MPR and SSD reformats. The use of appropriate standard MPR and SSD views shortens the time required to produce the reformats and thereby maximizes the benefit gained.

Acetabulum↗
PubMed1998

Ultrasonography as a guidance method in the evaluation of mammographically detected nonpalpable breast lesions of suspected malignancy.

PURPOSE: To evaluate the role of ultrasonography (US) as a method of guidance for fine-needle aspiration biopsy or preoperative wire localization in the demonstration of nonpalpable mammographically detected breast lesions. MATERIAL AND METHODS: A total of 168 nonpalpable mammographically detected breast lesions were examined by means of high-resolution real-time US. RESULTS: US depicted: 55% of all the lesions (92/168); 88% of the circumscribed densities (45/51); 80% of the stellate densities (35/44); 47% of the asymmetric densities (7/15); and 9% of the microcalcifications (5/58). CONCLUSION: US was useful in guiding needle biopsy or wire localization in most of the circumscribed and stellate breast lesions, even in fatty breasts. However, with the equipment that is currently available, US was of no value in localizing microcalcifications.

Adult↗
PubMed1998

High-resolution computed tomography for the diagnosis of community-acquired pneumonia.

We compared high-resolution computed tomography (HRCT) with chest radiography (CR) to determine if there is any advantage to using HRCT in the diagnosis of community-acquired pneumonia (CAP). Simultaneously obtained chest radiographs were compared with HRCT scans for 47 patients with clinical symptoms and signs suspicious for CAP, HRCT identified all 18 CAP cases (38.3%) apparent on radiographs as well as eight additional cases (i.e., 55.3%); P = .004. The corresponding figures for bilateral involvement were six by CR (33.3%) and 16 by HRCT (61.5%), P = .001. CR did not show changes particularly affecting the upper and lower lung lobes and the lingula. Bronchopneumonia was visualized by CR in 11 cases (61.1%) and by HRCT in 22 cases (84.6%). The corresponding figures for airspace pneumonia were four (22.2%) and one (3.8%), respectively. The use of HRCT seems to increase the number of CAP cases confirmed by imaging and to improve the accuracy of diagnosing and typing of CAP.

Adult↗
PubMed1998

Evaluation of humeral head erosions in rheumatoid arthritis: a comparison of ultrasonography, magnetic resonance imaging, computed tomography and plain radiography.

The value of ultrasonography (US), magnetic resonance imaging (MRI), computed tomography (CT) and plain radiography (PR) in detecting bone erosions on the humeral head was evaluated in a study of 26 in-patients (26 shoulders) with rheumatoid arthritis (RA). MRI depicted humeral erosions in 25 (96%), US in 24 (92%), CT in 20 (77%) and PR in 19 (73%) of the 26 shoulders. MRI and US were superior to CT in detecting small erosions. US was the most sensitive method to show surface erosions on the greater tuberosity. US, CT and MRI detected large erosions quite similarly. PR frequently missed small erosions. In the evaluation of early erosions in the rheumatoid shoulder, US and MRI are more sensitive methods than the traditionally used PR. US and MRI are suitable for the evaluation of soft-tissue involvement in the rheumatoid shoulder, but also for the detection of bone erosions of the humeral head.

Adult↗
PubMed1998

Digital wireless radiology consultations with a portable computer.

A wireless system for radiological subspecialist consultation based on a portable personal computer and a GSM cellular phone was tested. A link with secure access to the hospital image network was built. A total of 68 emergency computerized tomography (CT) examinations were transmitted. Transmission time via GSM for a single CT image was 1 min and for a complete head scan was 18 min. The transmitted images were acceptable for final diagnosis in 72% of the cases, the rest being acceptable for preliminary diagnosis. The diagnosis from the transmitted images did not change after a later review of the original images in 97% of cases. The wireless link saved a hospital visit by the senior radiologist in 24% of cases. The results show that a remote consultation link can be built with readily available technology and that the technique is useful in radiological subspecialist consultations for CT images.

Adolescent↗
PubMed1998

Effect of hypertension, diabetes and other cardiovascular risk factors on kidney size in middle-aged adults.

The aim of the study was to investigate in a population-based series (1031 subjects, age range 40-60 years) whether the renal size of hypertensive subjects differs from that of control subjects and whether the difference might be due to hypertension itself or risk factors associated with hypertension. The renal measurements were performed by abdominal ultrasound. The genders were analyzed separately. Hypertensive men had slightly larger kidneys than controls (70.1+/-8.9 cm2 vs. 67.9+/-8.7 cm2, p <0.008). The difference was, however, mediated mainly through the body mass index (BMI), whereas hypertension, blood pressure or hypertensive medication did not affect renal size. High serum concentrations of uric acid and creatinine were associated with smaller kidney size (p <0.001 and p <0.05, respectively). Alcohol users had slightly larger kidneys than abstainers, but the difference was not significant. Renal size increased with pack years of smoking. Diabetics had 4.8% larger kidneys (p <0.039), but no difference was observed between the subjects with impaired glucose tolerance and those with normal test results. In multivariate analysis, the most significant factors associated with enlarged kidney size were the fasting blood glucose concentration (p < or = 0.0001), smoking (p < or = 0.0001) and atherosclerotic lesions in carotid arteries (p <0.002). The kidneys were also slightly larger in hypertensive women than in control subjects, but the difference was only of borderline significance (p <0.08). Women on hormone replacement therapy had smaller kidneys than other women (p <0.05), but there was no difference in renal measures between premenopausal and postmenopausal women. In multivariate analysis, the most significant factors contributing to large kidney size were blood glucose concentration (p <0.0001) and smoking (p <0.05), while age and serum creatinine concentration were associated with smaller kidney size (p <0.0001 and p <0.0001). We conclude that renal size is related to sex and the subject's height and weight. Smoking, abnormal glucose tolerance, blood uric acid, creatinine, carotid atherosclerosis and hormone replacement therapy in women were also significant factors for renal size. Hypertensive subjects had larger kidneys than controls, mainly because of their more frequent obesity and abnormal glucose test.

Adult↗
PubMed1997

The effect of carotid endarterectomy on ocular blood velocity.

PURPOSE: The authors studied the effect of carotid endarterectomy on blood velocity in the ophthalmic artery and in the central retinal artery (CRA) and central retinal vein. METHODS: Pre- and postoperative ultrasonographic and preoperative angiographic determination of the internal carotid artery occlusion rate and orbital color Doppler imaging measurements were performed on 18 consecutive cases of carotid endarterectomy (17 patients). RESULTS: Most of the blood velocity values in the CRA improved and corresponded to the contralateral values postoperatively. The peak systolic (vp) and end diastolic velocity (edv) in the CRA and ophthalmic artery (OA) increased significantly postoperatively (vpCRA: P = 0.027; edvCRA: P = 0.023; vpOA: P = 0.034; edv OA: P = 0.047). Systolic acceleration in the OA also increased (P = 0.018). However, the individual response was variable. In 81%, the ratio of vpCRA of the operation side and the contralateral side was higher postoperatively than preoperatively. The flow increased also in the OA. The flow was reversed in the OA in two cases and in both the direction of flow changed postoperatively. There was no increase in the peak velocity in the central retinal vein. CONCLUSIONS: Carotid endarterectomy resulted in significantly increased flow in the CRA and OA, but no effect was observed on the central retinal vein.

Aged↗
PubMed1997

Helical CT in evaluation of the bronchial tree.

PURPOSE: To establish a protocol for and to assess the value of helical CT in the imaging of the bronchial tree. MATERIAL AND METHODS: Noncontrast helical CT was performed in 30 patients undergoing fiberoptic bronchoscopy for different reasons. Different protocols were compared; they included overlapping 10 mm, 5 mm, or 3 mm slices and non-tilted, cephalad or caudad tilted images. Ordinary cross-sectional and multiplanar 2D reformats were applied for visualization of the bronchial branches. The effect of increasing the helical pitch was tested in one patient. RESULTS: A total of 92.1-100% of the segmental bronchi present in the helical acquisitions were identified by the different protocols. The collimation had no significant impact on the identification of the bronchial branches, but utilization of 3-mm overlapping slices made it easier to distinguish the nearby branches and provided better longitudinal visualization of the bronchi in 2D reformats. The tilted scans illustrated the disadvantage of not covering all segmental bronchi in one breath-hold. An increase of the pitch from 1 to 1.5 did not cause noticeable blurring of the images. CT and bronchoscopic findings correlated well in the area accessible to bronchoscopy, but CT detected 5 additional pathological lesions (including 2 cancers) in the peripheral lung. CONCLUSION: Helical CT supplemented with bronchography-like 2D reformats provides an effective method complementary to bronchoscopy in the examination of the bronchial tree.

Adult↗
PubMed1997

A simple device for the stereoscopic display of 3D CT images.

We describe a simple device for creating true 3D views of image pairs obtained at 3D CT reconstruction. The device presents the images in a slightly different angle of view for the left and the right eyes. This true 3D viewing technique was applied experimentally in the evaluation of complex acetabular fractures. Experiments were also made to determine the optimal angle between the images for each eye. The angle varied between 1 degree and 7 degrees for different observers and also depended on the display field of view used.

Acetabulum↗