[Radiology before the year 2000. Significance of pictures for diagnosis and therapy will increase].
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Diagnostic Imaging↗
Biomedical subjects
P Aspelin
Publications and source records attributed to P Aspelin.
[New series: ultrasonic diagnosis before year 2000].
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Clinical Competence↗
[Academic specialist and continuing education!].
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Academic Medical Centers↗
Evaluation of planar scintimammography with 99mTc-MIBI in the detection of axillary lymph node metastases of breast carcinoma.
PURPOSE: The aim of our prospective study was to evaluate the role of planar scintimammography with 99mTc-MIBI in detecting axillary lymph node metastases in women with primary breast carcinoma. MATERIAL AND METHODS: Fifty-eight patients underwent scintimammography rior to axillary lymph node dissection. Ten minutes after injection of 700 MBq 99mTc-MIBI, two prone lateral projections were obtained, followed by a supine anterior projection. Sixty-one axillae (3 bilateral) were operated upon and the status of the lymph nodes verified with histopathology. The scintigraphic result was compared to the histopathologic findings. RESULTS: A sensitivity of 67% and a specificity of 80% of planar scintimammography in detecting axillary lymph node metastases were achieved. CONCLUSION: Scintimammography with 99mTc-MIBI is not recommended as a routine method for the detection of axillary lymph node metastases in patients with breast carcinoma.
Axilla↗
Comparison of planar and SPECT scintimammography with 99mTc-sestamibi in the diagnosis of breast carcinoma.
PURPOSE: To compare results of planar and SPECT breast imaging with 99mTc-MIBI in detecting primary breast cancer. MATERIAL AND METHODS: Twenty-six consecutive patients with 34 suspected breast lesions underwent both planar and SPECT scintimammography. Ten minutes after injection of 700 MBq 99mTc-MIBI, 2 prone lateral projections were obtained, followed by a supine anterior projection. Forty minutes after injection, a SPECT study was done. All lesions were operated upon and verified with histopathology. RESULTS: A sensitivity of 85% and specificity of 88% of planar scintimammography in diagnosis of primary breast lesions were achieved. The corresponding values for SPECT were 61% and 64%. CONCLUSION: The diagnostic accuracy of planar scintimammography was not improved by using SPECT imaging.
Breast↗
Sensitivity and specificity of planar scintimammography with 99mTc-sestamibi.
PURPOSE: The aim of our prospective study was to determine the diagnostic accuracy of planar breast imaging with 99mTc-MIBI in detecting malignant disease. MATERIAL AND METHODS: Ninety-six consecutive patients with 121 clinically- and/or mammographically-detected breast lesions underwent preoperative planar scintimammography. Ten minutes after injection of 700 MBq 99mTc-MIBI, two lateral prone and one anterior supine projections with an acquisition time of 8 minutes each were obtained. Interpretation of scintimammographic results was made blindly and any focal accumulation of MIBI in the breasts was the criterion for an abnormal scintigram. All lesions were operated on and histologically verified. RESULTS: Histologically, 86 malignant and 35 benign lesions were found in 121 breast lesions. A sensitivity of 83.7% and a specificity of 74.2% for malignancy was achieved at planar scintimammography. CONCLUSION: Scintimammography with 99mTc-MIBI is an imaging modality of modest usefulness in the investigation of breast lesions. The method has a low sensitivity in lesions smaller than 10 mm in diameter, which decreases the clinical use of the method.
Adult↗
3D-radiographic analysis does not improve the Neer and AO classifications of proximal humeral fractures.
The Neer and AO fracture classifications for fractures of the proximal humerus have shown poor reproducibility based on plain radiography. We wanted to investigate whether the addition of 3-dimensional (3D) reconstructions would increase the reproducibility of classification. 7 observers independently classified 24 fractures of the proximal humerus using both plain radiographs, CT and 3D and the classification was repeated 2 months later. There was a moderate interobserver agreement when using the Neer classification, but only a fair agreement with the AO classification. The Neer system had a mean kappa value of 0.44 and the AO had a value of 0.32 for the first assessment. In the second assessment, the mean kappa values were 0.49 and 0.34, respectively. Intraobserver reproducibility was fair to substantial agreement for Neer (kappa range 0.27-0.73) and for AO (kappa range 0.29-0.74). In conclusion, the addition of CT and 3D to plain radiographs did not improve the reproducibility of the classifications of Neer and AO of the proximal humerus.
Humans↗
[Hazards of health care--for patient and community].
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Humans↗
Standardized CT examination of the multitraumatized patient.
The aim of this study was to develop a standardized non-helical-CT protocol including head, body and proximal extremities in order to achieve a good time efficiency and diagnostic accuracy in the initial radiological evaluation of the multitraumatized patient. A total of 111 circulatory stable blunt trauma patients, brought in to a trauma level II-III hospital, were examined according to a standardized CT protocol. After examining the head with contiguous 10-mm slices without i.v. contrast medium injection, the trunk was examined with 10-mm slices every 30 mm through thorax-abdomen-pelvis with i.v. contrast medium enhancement (occasionally modified). All data in the medical reports were collected and used as "end-point", and the outcome of the CT examination was compared with this final diagnosis. Mean examination time was 20 min (range 12-32 min). In total, 55 head injuries, 89 thoracic injuries, 27 abdominal/pelvic injuries and 62 fractures were found. Computed tomography correctly identified the injuries, except one brain stem injury, one contusion/rupture of the heart, one hepatic injury, two intestinal injuries, eight vertebral injuries and one joint dislocation. A standardized non-helical-CT examination of the head and body may be achieved in 20 min. Its diagnostic accuracy was high, except for vertebral column injuries, which is why we recommend it as the method of choice for initial radiological examination of multitraumatized patients. When available, helical scanning would improve both examination speed and accuracy.
Abdominal Injuries↗
Intraosseous compared to intravenous infusion of allogeneic bone marrow.
Thirty-eight patients (> or = 18 years) receiving marrow transplants from HLA-identical or one antigen-mismatched related donors were randomized to intraosseous (i.o.) + intravenous (i.v.) (n = 10), i.o. (n = 8) or i.v. (n = 20) infusions of bone marrow. There were no significant differences in patient characteristics. PMN/l more than 0.5 x 10(9) occurred on days 19 (median), 20 and 18.5 in the i.o. + i.v., i.o. and i.v. groups, respectively. We found a significant reduction in the number of days on total parenteral nutrition (P = 0.03) and a tendency to a reduction in the number of days on antibiotics (P = 0.06) in the i.o. compared to the i.v. group. Bacteraemia did not occur in the i.o. group, but was seen in 30% of the i.v. group (NS). The incidences of acute and chronic graft-versus-host disease, transplantation-related mortality, relapse and patient survival rates were similar in the three groups. Five patients examined with bone marrow scintigraphy showed the same distribution of granulocytes in the bone marrow directly after transplantation and 3 weeks after transplantation, whether the bone marrow was given by the i.o. or by the i.v. route. We conclude that allogeneic bone marrow transplantation can safely be performed by i.o. infusion, but haematopoietic recovery is not improved.
Adult↗
MR imaging of multiple myeloma patients with bone-marrow transplants.
PURPOSE: To evaluate the role of MR imaging in the examination of multiple myeloma (MM) patients with bone-marrow transplants. MATERIAL AND METHODS: A total of 40 MR examinations were made of 20 patients: 33 examinations of the spine and pelvis in 20/20 patients; and 7 examinations of the femora in 5/20 patients. The 40 examinations were evaluated and the results compared with those found at radiography. Altogether 13/20 patients were re-examined: 10 after 1 year (1 patient twice); and 3 after 2 years. Five sequences were tested, 3 of them first without and then with i.v. contrast enhancement. RESULTS: In 24/33 examinations, active MM lesions were shown by MR. In 16/33 examinations, MR showed greater spread and detectability than radiography. In the 5/20 femoral patients, 3 had a peripheral red bone-marrow extension in the femora. In the 13 re-examinations, the lesions had spread in 4 patients, were unchanged in 7, and had decreased in 2. The lesions were easier to detect with the turbo inversion recovery (TIR) technique and with fat saturation than with the conventional spin-echo sequences. Contrast enhancement made the lesions more conspicuous in 8/17 examinations. CONCLUSION: MR has the potential to be a useful routine examination with T1-weighted and TIR sequences of selected areas, and without the use of contrast enhancement. However, further longitudinal studies are necessary in order to evaluate its possible predictive value.
Adult↗
MR imaging in chronic Achilles tendon disorder.
OBJECTIVES: The primary objective was to compare 4 imaging sequences (T1-weighted, T2-weighted, proton density, and T1-weighted with gadolinium contrast agent enhancement) with regard to intratendinous signal abnormality in patients with achillodynia. The secondary objective was to relate the images to the clinical symptoms and histopathological findings. MATERIAL AND METHODS: Twenty patients (16 men, 4 women, median age 40 years) with chronic achillodynia participated in the study. The symptoms prohibited activity and clinical examination revealed swelling and tenderness 1.5-6 cm proximal to the Achilles tendon insertion. Of the 20 patients: 5 had bilateral achillodynia, 4 had had previous contralateral Achilles tendon disorder, and 11 had never had symptoms in the contralateral tendon region. These 11 tendons served as controls for comparison. MR imaging was performed on a superconductive 1.5 T unit. Both Achilles tendons were examined (n = 40) at the same time, and multiple sagittal and transversal images were obtained. The corresponding sections on these images were visually graded according to both extension and level of MR signal intensity. Tissue was obtained for microscopic examination from the most symptomatic side in all patients (n = 20). RESULTS: T1-weighted images following gadolinium contrast medium enhancement proved to be the best method by which to visualize intratendinous signal abnormality. This sequence revealed signal abnormality in 24/25 symptomatic tendons and in 1/11 control tendons (p < 0.001). Histopathological examination showed an increased noncollagenous extracellular matrix and altered fiber structure in the lesions corresponding to the contrast-enhanced areas. CONCLUSION: Gadolinium enhancement improved the imaging of intratendinous signal abnormality on T1-weighted images. There was a high level of extracellular glycosaminoglycans, which are highly-fixed negatively-charged macromolecules with extreme water-retaining capacity and which may have contributed to the enhancement by the gadolinium contrast agent.
Achilles Tendon↗
Frequency of late allergy-like adverse reactions following injection of intravascular non-ionic contrast media. A retrospective study comparing a non-ionic monomeric contrast medium with a non-ionic dimeric contrast medium.
PURPOSE: A retrospective study was undertaken of the late adverse reactions following the injection of contrast media. The purpose was to determine whether there was a difference between non-ionic monomeric (iohexol) and non-ionic dimeric (iodixanol) contrast media in the reactions produced. MATERIAL AND METHODS: A total of 3,408 patients were sent a written questionnaire in which they were asked to confirm or deny any subjective discomfort or adverse event during a period of one hour to one week after a previous radiological examination with contrast medium. Patients who had undergone angiography (i.v. or i.a. injection) and CT (i.v. injection) were included. Objective signs of an allergy-like reaction were listed and the patients were asked to subjectively quantify any consequent discomfort. RESULTS: The compliance rate was 84%. Of the 3075 injections finally included in the study, 133 (4.3%) had resulted in contrast-medium-related adverse reactions of which 72 (2.3%) were immediate and 61 (2%) were late. Iohexol induced late reactions in 14/851 (1.7%) cases, and iodixanol in 24/1218 (2.0%) cases following i.v. injection and in 23/1006 (2.3%) cases following i.a. injection. The differences were not significant. There were no differences between the two contrast media in the subjective rating of discomfort except that the patients who had received iodixanol also had the highest individual-intensity score. No patient had been hospitalized owing to an adverse reaction and all reactions had been regarded as mild or moderate. CONCLUSION: The number of late adverse reactions was low. There was no difference in the frequency of the late adverse reactions following i.v. injection between iodixanol and iohexol. There was also no difference in the reactions between the i.a. and i.v. injections of iodixanol.
Contrast Media↗
Contrast-enhanced MR imaging as a prognostic indicator of breast cancer.
BACKGROUND: Using contrast-enhanced MR imaging in the diagnosis of breast cancer may provide additional information not only on tumor extension but also on the biological behavior of tumors. Thus certain characteristics such as tumor angiogenesis and the proliferating activity of the tumor, which have been shown to correlate significantly with prognosis, are both potentially amenable to analysis by MR imaging. MATERIAL AND METHODS: We compared contrast enhancement in 50 malignant breast tumors at MR imaging to several prognostic factors, such as tumor size, lymph-node status, histological grade of malignancy, tumor angiogenesis, and proliferating activity as shown by the mitotic count and PCNA immunoreactivity. RESULTS: There was significant correlation between contrast enhancement at MR imaging of breast cancer and both tumor angiogenesis and proliferative cellular activity as shown by PCNA immunoreactivity. Furthermore, there was a correlation between contrast enhancement and tumor malignancy grade as well as tumor invasiveness. CONCLUSION: These observations suggest that contrast enhancement at MR imaging may be influenced by factors that have prognostic value. If this assumption is correct, contrast-enhanced MR imaging may become a valuable prognostic tool in the pre-operative evaluation of breast cancers.
Breast Neoplasms↗
Mechanism of contrast enhancement in breast lesions at MR imaging.
PURPOSE: The aim of the study was to explain why breast lesions are enhanced by contrast medium at MR imaging and to elucidate the histopathological basis for the overlap in the enhancement patterns of benign and malignant breast lesions. MATERIAL AND METHODS: Ten invasive breast carcinomas and 10 benign breast lesions were selected for the study. Of the 10 carcinomas, 5 showed a strong and early contrast enhancement, and 5 did not. Of the 10 benign lesions, 5 showed a strong and early contrast enhancement, and 5 showed no enhancement. The following morphometric variables were evaluated: proliferation cell index of neoplastic parenchymal cells, S-phase fraction, nuclear ploidy analysed by image DNA-cytometry, microvessel density, and the percentage proportion of the interstitial area. RESULTS: Contrast enhancement was related to the proliferating activity of the hyperplastic or neoplastic parenchymal cells and was inversely correlated with the interstitial area in carcinomas as well as in benign tumours and non-neoplastic lesions of the breast. CONCLUSION: Morphometric variables play an important role in the general mechanism of MR contrast enhancement in examinations of the breast and explain the histopathological basis for the overlap in the enhancement patterns of benign and malignant breast lesions.
Breast↗
Rapid increase in volume of the remnant after hemithyroidectomy does not correlate with serum concentration of thyroid stimulating hormone.
OBJECTIVE: To study the effect of postoperative thyroxine on the volume of the thyroid remnant after lobectomy for benign nontoxic goitre. DESIGN: Prospective, randomised study. SETTING: University hospital, Sweden. SUBJECTS: 50 consecutive patients who underwent lobectomy for benign non-toxic goitre. INTERVENTIONS: Patients were randomised postoperatively to take thyroxine 0.1 mg or placebo daily. MAIN OUTCOME MEASURES: The median volume of the remaining thyroid lobe measured by ultrasound. Serum concentrations of thyroxine, triiodothyronine (T3) and thyroid stimulating hormone (TSH) were measured preoperatively and 1, 3, 6, 12 months postoperatively. RESULTS: The median volume of the remaining lobe had increased significantly compared with preoperatively by 1 month postoperatively by 30% in the thyroxine group and 25% in the placebo group (p < 0.01). The difference between the groups was not significant. After the first month the volume did not change significantly. In the thyroxine group, the TSH concentration was unchanged and the thyroxine concentration increased significantly throughout the study. In the placebo group there was a significant increase in TSH concentration and a significant decrease in that of thyroxine at all follow-up examinations. CONCLUSIONS: There is a significant increase in the volume of the remaining thyroid 1 month after lobectomy that persisted throughout the first year. Thyroxine given in a dose that kept the serum TSH concentration at the same level as preoperatively did not seem to influence volume changes; consequently we consider that these are caused by factors other than TSH.
Adult↗
Intratendinous alterations as imaged by ultrasound and contrast medium-enhanced magnetic resonance in chronic achillodynia.
OBJECTIVES: We performed a comparative study of ultrasonography and gadolinium imaging contrast-enhanced T1-weighted magnetic resonance to evaluate tendon pathology in chronic Achilles tendon disorder. Another main issue was to evaluate the structural basis as defined by histopathology from hypoechoic compared with normoechoic areas within the same tendon. MATERIALS AND METHODS: Twenty patients (16 male, 4 females, median age 40 years) with chronic achillodynia participated in the study. Clinical examination revealed swelling and tenderness localized to the midportion of the Achilles tendon. Contrast medium-enhanced magnetic resonance imaging (CME-MRI) was performed in all patients. Ultrasonography-guided core biopsies were taken from regions with a clear widening of the tendon and a pathologic low-echo signal as well as from normoechoic areas. The specimens were analyzed with a standardized protocol giving a total tendon score (0-24), and a stereologic method for quantification of glycosaminoglycan (GAG)-rich areas. RESULTS: The volume of the intratendinous abnormality was larger in 13 of 20 when imaged by CME-MR (P < 0.05), whereas the shape and enlargement of the tendon per se were similarly imaged by ultrasound (US) and CME-MR. Tendon pathology as imaged by US was graded as severe from hypoechoic regions and moderate from normoechoic regions. The corresponding quantification of GAGs was 0.36 compared with 0.17, respectively (P < 0.001). CONCLUSION: CME-MR imaging revealed greater sensitivity in demonstrating intratendinous pathology than the ultrasound; this was documented by the larger size of the corresponding lesion and the fact that the pathology was occurring in areas that were considered normal by ultrasonography. US hypoechoic areas showed a markedly abnormal tendon structure including an increased amount of GAG-rich areas. However, moderate pathology was also found in the neighboring normoechogenous areas within the same tendon, indicating a more generalized disorder than depicted by echogenic properties.
Achilles Tendon↗