Serum C reactive protein does not reliably exclude lower limb deep venous thrombosis.
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Adult↗
Biomedical subjects
R D Laitt
Publications and source records attributed to R D Laitt.
Magnetic resonance imaging and magnetic resonance angiography in long term survivors of acute lymphoblastic leukemia treated with cranial irradiation.
BACKGROUND: Successful treatment of acute lymphoblastic leukemia (ALL) has resulted in an increasing number of patients whose disease is cured. This treatment includes cranial irradiation as prophylaxis against central nervous system relapse. The late effects of irradiation are well documented, but their incidence is unknown. The authors investigated the late effects of this treatment modality further by scanning 35 long term survivors of ALL who received cranial irradiation. METHODS: Thirty-five survivors of ALL with no known complication of treatment were included in this study. They were examined with magnetic resonance imaging (MRI) of the brain and magnetic resonance angiography (MRA) of the circle of Willis. A control group of 24 patients who were cured of other childhood malignancies without exposure to cranial irradiation also were scanned. RESULTS: Fifteen of 35 (43%) abnormalities were found in the study group versus 4/24 (17%) in the control group. Excluding minor atrophic changes that are known to be produced by irradiation and chemotherapy, there were 9/35 (26%) abnormalities in the study group and 1/24 (4%) in the control group (P < 0.05). These abnormalities included three tumors, a meningioma, a paranasal sinus rhabdomyosarcoma, and an anaplastic astrocytoma. In addition, there were two cases of large vessel vasculopathy, two small cystic infarcts, one diffuse white matter abnormality, and one cryptic vascular malformation. The abnormal control patient had a cerebellar infarct. CONCLUSION: Complications of cranial irradiation in the treatment of ALL appear to be more frequent than currently are appreciated. That these complications include tumors that are potentially treatable suggests that screening may be valuable for these patients.
Adolescent↗
Intracranial large vessel vasculopathy and anaplastic meningioma 19 years after cranial irradiation for acute lymphoblastic leukaemia.
A child was diagnosed in 1969 as having acute lymphoblastic leukaemia (ALL) and received chemotherapy. On bone marrow relapse in 1973, he was treated with cranial irradiation (20 Gy) in addition to chemotherapy. He continues in complete remission 19 years after his relapse. At age 25 years, he presented with headaches and left hemiparesis. Computerised tomograph demonstrated a large, enhancing right-sided intracranial tumour. Angiography was performed and showed the right internal carotid artery was occluded. Most of the right hemisphere was supplied from the external carotid via the middle meningeal artery. The left posterior cerebral artery and the left anterior cerebral artery were absent presumably as a result of radiation-induced arteritis. A resection of an anaplastic meningioma arising from the right sphenoidal ridge was achieved. There was a rapid improvement in function and he returned to work. Vasculopathy of the large intracranial arteries has been described after high dose radiation. It may occur as in this case after moderate dose radiation. There is a correlation with meningioma. There is a possibility that large artery vasculopathy will be present in a proportion of patients irradiated for ALL. The long lag time between irradiation and the development of meningioma may mean that, as survivors of childhood ALL enter their third decade since cure, this tumour may be seen increasingly.
Adult↗
The STIR sequence MRI in the assessment of extraocular muscles in thyroid eye disease.
Nineteen patients with thyroid eye disease were examined with magnetic resonance imaging using the Short Tau Inversion Recovery (STIR) sequence and compared with normal controls. The Signal Intensity Ratio (SIR) of each of the four recti was obtained by comparison with the signal intensity of the adjacent temporalis muscle. The SIR was compared with disease activity assessed using Werner's grading system, a clinical inflammatory score, and the range of extraocular movements. Results show that a high SIR is associated with a high index of disease activity. This technique is likely to prove useful in assessing disease activity and planning the management of thyroid eye disease, particularly with respect to immunosuppression.
Adult↗
The value of the short tau inversion recovery sequence in magnetic resonance imaging of thyroid eye disease.
22 patients with thyroid eye disease were examined with magnetic resonance imaging (MRI) and the results compared with 10 controls. Imaging was performed on a 1.0 T scanner using a head coil. All patients were examined using both T1W and short tau inversion recovery (STIR) sequences. The relative signal intensity (SI) of individual extraocular muscles were quantified by comparison with SI from the adjacent temporalis muscle to give a signal intensity ratio (SIR). The results were compared with clinical disease activity assessed by the Werner grading system. Visual evaluation of muscle size and calculated SIRs showed an increase when compared to normals in 15 of the 22 patients. This difference was significant in patients with high grade (4-6) clinical disease. The known histological changes in this disease suggest that this increase in signal is caused by oedema secondary to acute inflammation. STIR sequences suppress the retro-orbital fat and thus enhance these changes both in the muscles and in the fat itself. The MR findings suggest that the STIR sequence can be used to predict those patients that will respond to anti-inflammatory treatment.
Adult↗
Subclavian artery aneurysm: the role of magnetic resonance imaging.
Subclavian artery aneurysms are rare. Diagnosis is important as complications can be life threatening. A case is reported which is diagnosed by magnetic resonance imaging; moreover it is suggested that magnetic resonance imaging is now the initial imaging modality of choice in the investigation of these lesions.
Aged↗
Pontine myelinolysis in a normonatraemic alcoholic.
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Adult↗
Sclerosing cholangitis associated with multifocal fibrosis: a case report.
The association of sclerosing cholangitis, retroperitoneal fibrosis, and Riedel's thyroiditis has been reported twice before, and on both occasions the authors successfully used steroids to control the fibrotic process. A further case of fibrosis with this triad of organ involvement in which a combination of surgery and steroid treatment has arrested disease progression is described. This suggests an inappropriate immune response in this type of fibrotic overlap syndrome.
Cholangitis, Sclerosing↗
Video loop MRI of ocular motility disorders.
OBJECTIVE: Our aim was to evaluate a novel means of assessing ocular motility disorders using MRI. MATERIALS AND METHODS: A GE image of the orbit was acquired in a set plane each time the patient fixed on a series of points spread across the field of view. The images were transferred in sequence to a video recorder to create a cineloop of ocular movement. The technique was used in 33 patients with a range of ocular motility disorders including thyroid eye disease, posttraumatic diplopia, and Duane syndrome. RESULTS: In addition to anatomical detail, functional information could be derived from motion of the globe, motion of the optic nerve, and contractility of individual muscles. This is of particular use to the ophthalmic surgeon in disorders of ocular motility following eye surgery. CONCLUSION: A method of recording eye movements using MRI is described that offers useful functional information in the evaluation of disorders of ocular motility.
Eye↗
Memory dysfunction in multiple sclerosis corresponds to juxtacortical lesion load on fast fluid-attenuated inversion-recovery MR images.
BACKGROUND AND PURPOSE: MR imaging is a sensitive diagnostic tool and paraclinical marker of disease activity and prognosis in multiple sclerosis (MS), yet the role of MR imaging of MS is controversial. The aim of this study was to describe the relationship between cognitive function and MS lesion size and position, as shown on comparative images from conventional spin-echo (CSE) and fast fluid-attenuated inversion-recovery (fast FLAIR) MR studies. METHODS: CSE and fast FLAIR sequences consisted of 40 noncontiguous, 3-mm-thick axial sections matched for geometric position in 18 patients with relapsing-remitting MS. Lesions were scored for size, anatomic position, and their comparative appearance on CSE and fast FLAIR images. The neuropsychological assessment tested general psychological performance, memory, and frontal lobe executive function. RESULTS: Fast FLAIR images showed significantly more small (146 versus six) and medium-sized (18 versus four) juxtacortical lesions than did CSE sequences. Small juxtacortical lesions displayed only on fast FLAIR images had a distinctive appearance, suggestive of small areas of perivascular inflammation. The number of these lesions corresponded to reduced performance on the fifth and delayed trials of the Rey Auditory Verbal Learning memory function test. CONCLUSION: Fast FLAIR images show small lesions at the juxtacortical boundary that are not seen on CSE studies. The presence of such lesions correlates with impaired retention of information in memory tasks, which is characteristic of cognitive problems in patients with MS.
Adult↗
Combined fat- and water-suppressed MR imaging of orbital tumors.
BACKGROUND AND PURPOSE: The use of a high-resolution T2-weighted MR sequence, which suppresses signal from both fat and water, has been shown to be highly effective for depicting areas of inflammatory damage within the optic nerve. The ability of this sequence to show neoplastic and inflammatory orbital lesions, which may mimic neuritis, is unknown. This study was designed to examine the characteristics of such a sequence for the investigation of orbital mass lesions. METHODS: Twenty-eight patients with known or suspected mass lesions of the orbit and six healthy volunteers were recruited for study. Imaging was performed with a 1.5-T MR unit. Participants were examined by selective partial inversion recovery (SPIR) sequences with T2-weighted fast spin-echo acquisition, selective partial inversion recovery/fluid attenuated inversion recovery (SPIR/FLAIR) sequences with fast spin-echo acquisition, short tau inversion recovery (STIR) sequences with fast spin-echo acquisition, and SPIR sequences with contrast-enhanced T1-weighted fast spin-echo acquisition. Two neuroradiologists, using a randomised, blinded method, scored images for lesion presence and extent. Lesion extent was defined as the number of images with visible abnormality, and was compared with the standard of reference established at a later date by consensus review of all imaging sequences. The ability of the sequences to show the presence and extent of pathologic lesions was compared. RESULTS: The SPIR/FLAIR sequence showed both the presence and extent of orbital masses significantly better than did either STIR or T2-weighted SPIR sequences (P<.01 and P<.001, respectively). Contrast-enhanced T1-weighted SPIR images ranked better than SPIR/FLAIR images, although the difference failed to reach statistical significance. In the orbital apex, the SPIR/FLAIR technique was superior to all other techniques used. This reflected its ability to distinguish enhancing, pathologic lesions from enhancing, normal anatomy. CONCLUSION: SPIR/FLAIR is an appropriate screening technique for orbital masses and offers significant advantages over currently used fat-suppressed sequences for the investigation of orbital disease.
Adolescent↗