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PubMed1998

MR imaging of the foot: anatomy and pathology.

MR imaging has become a valuable tool in the diagnosis of pathologic conditions of the foot. The direct multiplanar imaging capability, superior soft tissue contrast discrimination, and spatial resolution afforded by MR are advantages over other imaging modalities. The complex anatomy and spectrum of pathology in this region present a significant challenge to the radiologist. Familiarity with the anatomy, various clinical conditions, and their appearance on MR imaging is essential for accurate diagnosis. In this article, a limited review of the anatomy of the foot is presented together with a more in-depth discussion and illustration of a wide variety of pathologic conditions of the foot. Emphasis is placed on those conditions that are relatively unique to the foot.

Foot↗

PubMed1997

Ultrasound in ophthalmology.

The first ocular echogram was published in 1956. Since then, ophthalmic ultrasound has developed into a multifaceted diagnostic discipline, the basic methods being A-scan and B-scan, Doppler techniques and recently also three-dimensional approaches. Unique for ophthalmology is the newly invented, highly resolving equipment utilising ultrasound frequencies of 50 MHz and higher, so-called ultrasound biomicroscopy. During this development, the special ophthalmic items often kept colleagues from other fields at some distance. With a view to a fair balance between specific and more general information, the primary aim of the present overview is to provide insight for other medical branches employing diagnostic ultrasound. Regarding intraocular morphology, ultrasonic evaluation in experienced hands is superior to other imaging methods. As for orbital pathology, imaging by CT and MR appears more complete. Ultrasound is valuable, however, in particular as part of the initial clinical work-up, and for the follow-up of orbital disease. Furthermore, tissue differentiation by way of ultrasound is of great value with regard to certain entities.

Biometry↗

PubMed1997

The variable MR appearance of primary lymphoma of the central nervous system: comparison with histopathologic features.

PURPOSE: To describe the MR features of primary central nervous system (CNS) lymphoma and to determine whether there is a correlation with histopathologic findings. METHODS: The MR images, pathologic specimens, and clinical records of 23 patients with primary CNS lymphoma were reviewed. The imaging and pathologic characteristics were tabulated and compared by using the standard tests for association in a two-dimensional contingency table. RESULTS: A total of 61 lesions were present in 23 patients; 12 patients (52%) had multiple lesions. All lesions were isointense or hypointense on T1-weighted images, and 53% were isointense or hypointense on T2-weighted images. Twenty patients received intravenous contrast material, and 43 (91%) of 47 lesions enhanced. The three patients who had nonenhancing lesions received steroids before the initial MR studies. Enhancement patterns differed between the immunocompetent and the immunocompromised hosts, with the latter group harboring a higher percentage of rim-enhancing lesions. Twenty-seven (44%) of the lesions were centered in a cerebral hemisphere and 14 (23%) were centered in the central gray matter. There was a statistically significant correlation between a higher degree of necrosis histologically and hyperintensity on T2-weighted MR images. The degree of necrosis also showed a positive correlation with rim enhancement. CONCLUSIONS: Primary CNS lymphoma has a variable MR appearance that correlates with the severity of intratumoral necrosis. These imaging characteristics, as well as lesion location, mean lesion size, and proclivity to harbor necrosis, are altered in the immunocompromised host.

Adult↗

PubMed2004

Susceptibility-based imaging of glioblastoma microvascularity at 8 T: correlation of MR imaging and postmortem pathology.

BACKGROUND AND PURPOSE: Imaging methods are currently being optimized in an attempt to assess and monitor angiogenesis in vivo. The purpose of this investigation was to determine whether areas of apparently increased tumor vascularity, as identified on 8-T gradient-echo (GE) imaging of a known glioblastoma multiforme (GBM), corresponds to foci of increased microvascularity on histopathologic analysis. METHODS: We performed postmortem in situ, high-resolution GE 8-T MR imaging of the brain in a 53-year-old woman with GBM. Ten histopathologic specimens in the region of the tumor bed were studied by using hematoxylin-eosin and reticulin stains. MR and histopathologic results were assessed and compared for microvascular size and density. RESULTS: 8-T GE images showed small, penetrating vessels in the gray matter and white matter. The images, however, were partly inhomogeneous as a result of local magnetic field inhomogeneities adjacent to the skull base and aerated paranasal sinus structures. 8-T MR images demonstrated serpiginous areas of signal intensity loss, which were thought to represent areas of increased microvascularity. Areas of lower microvascularity in the tumor bed corresponded to areas of lower vascularity on histopathologic sections with smaller vessel diameters. There was concurrence between vascular size predicted by histopathologic analysis and 8-T MR imaging in nine of nine biopsy samples. Vascular density agreed in seven of nine biopsy samples. CONCLUSION: Our pilot data suggest that microvascularity in GBM can be identified by use of high-resolution, GE, 8-T MR imaging.

Brain Neoplasms↗

PubMed2006

Elastographic measurements of in-vivo radiofrequency ablation lesions of the kidney.

BACKGROUND AND PURPOSE: Elastography may prove useful for monitoring radiofrequency ablative (RFA) therapy because heat-ablated tissues are more elastic than untreated tissues. Herein, we report our initial evaluations of the reliability of elastography for delineating thermal-lesion boundaries at the time of RFA of porcine kidneys. MATERIALS AND METHODS: In-vivo RFA was performed on 20 kidneys from 10 40-kg female pigs. Elastography was performed at the time of surgery and after 48 hours. The imaging plane was perpendicular to the axis of the RF electrode so that the ablated region was around the center of the plane. Measurements of the sections representing the same image plane used for elastography were taken at pathologic examination and compared with the measurements obtained from the elastograms. RESULTS: We found a statistically significant correlation between elastography and pathology measurements with respect to the area and volume estimates (r = 0.9302 and r = 0.953, respectively). Overall, elastography slightly underestimated the lesion size, as judged by the digitalized pathologic images, a finding consistent with previous reports. CONCLUSION: We found a correlation between the area and volume estimates of thermal lesions that were based on elastographic images and the measurements from gross pathologic dimensions. A significant limitation of renal RFA is the inaccuracy of current imaging modalities to provide real-time monitoring, and elastography may prove to be reliable for delineating the resulting thermal lesions.

Animals↗

PubMed1999

Radionuclide imaging of cardiac pathology: a mechanistic perspective.

Cardiac imaging is performed for a variety of indications using different radiotracers and ligands. The most common is the use of thallium-201 and Tc-labeled tracers for myocardial perfusion imaging. Its uses are manifold, and range from the diagnosis of coronary artery disease to the risk stratification of patients and prognostication. Ischemia is being imaged with nitroimidazole compounds, myocardial necrosis with antimyosin and myocardial infiltration with gallium-labeled leukocytes and somatostatin receptor analogs. The status of myocardial innervation has been evaluated with radiolabeled MIBG. Metabolism in the heart in the normal and ischemic state can be studied with PET and SPECT using fatty acid and glucose analogs. The expression of accessory molecules on the surface of cardiac myocytes in patients with cardiac allograft rejection is now possible. Clearly, much has been accomplished for imaging the heart and pathology related to it. The past has been satisfying, the present interesting and the future promises to be even more exciting!

Journal Article↗

PubMed1996

Factors influencing distant tele-evaluation in cytology, pathology, conventional radiology and mammography.

The present paper summarizes our 1 year's experience with the use of static high resolution videophones (9600 bauds transmission rate, lossless compression, 512 x 512 spatial resolution). The images (n = 610) belong to regular videoconsultation in cytology (160 images), (160 images), pathology (226 images), conventional radiology (50 images) and mammographies (174 images). The results showed an exponential relationship between agreement with 'gold standards' (true diagnosis of the case based on pathology, surgery and follow-up) and the time of training on screen diagnosis (r = 0.9726, P < 0.01) that increases (r = 0.983, P < 0.004) when the screen diagnosis training within the specific topic is examined. Conversely, no significant correlation is found when medical experience itself is considered (r = 0.31, P nonsignificant). Sufficient diagnostic response has been achieved after 1 year of training on screen diagnosis within a specific topic.

Cell Biology↗

PubMed1997

Conversion of a traditional image archive into an image resource on compact disc.

The conversion of a traditional archive of pathology images was organised on 35 mm slides into a database of images stored on compact disc (CD-ROM), and textual descriptions were added to each image record. Students on a didactic pathology course found this resource useful as an aid to revision, despite relative computer illiteracy, and it is anticipated that students on a new problem based learning course, which incorporates experience with information technology, will benefit even more readily when they use the database as an educational resource. A text and image database on CD-ROM can be updated repeatedly, and the content manipulated to reflect the content and style of the courses it supports.

Archives↗

PubMed2005

Fibrocartilaginous embolization to the spinal cord: serial MR imaging monitoring and pathologic study.

We report the serial MR imaging and neuropathologic findings in a patient with fibrocartilaginous embolism to the spinal cord, presumptively originating from vertebral body endplates. Extensive increased T2 signal intensity, minimal contrast enhancing foci, concomitant vertebral body bone marrow infarction, and terminal cord hemorrhagic necrosis were the main MR imaging features. Pathologic examination of the cord demonstrated arteriolar occlusions by chondrocytic thrombi resulting in hemorrhagic necrosis.

Aged↗

PubMedDate not supplied

Sarcoidosis of the liver: evaluation with multiple imaging modalities.

Although sarcoidosis of the liver is common pathologically, imaging findings are extremely rare, because the noncaseating granulomas are usually not macroscopic and thus do not produce focal abnormalities. We present 2 cases of liver sarcoidosis with focal findings on computed tomography, magnetic resonance imaging, nuclear scanning, and ultrasonography. Imaging characteristics, which may facilitate making the diagnosis, are presented.

Adult↗

PubMed2003

Three-dimensional true FISP for high-resolution imaging of the whole brain.

While high-resolution T1-weighted sequences, such as three-dimensional magnetization-prepared rapid gradient-echo imaging, are widely available, there is a lack of an equivalent fast high-resolution sequence providing T2 contrast. Using fast high-performance gradient systems we show the feasibility of three-dimensional true fast imaging with steady-state precession (FISP) to fill this gap. We applied a three-dimensional true-FISP protocol with voxel sizes down to 0.5 x 0.5 x 0.5 mm and acquisition times of approximately 8 min on a 1.5-T Sonata (Siemens, Erlangen, Germany) magnetic resonance scanner. The sequence was included into routine brain imaging protocols for patients with cerebrospinal-fluid-related intracranial pathology. Images from 20 patients and 20 healthy volunteers were evaluated by two neuroradiologists with respect to diagnostic image quality and artifacts. All true-FISP scans showed excellent imaging quality free of artifacts in patients and volunteers. They were valuable for the assessment of anatomical and pathologic aspects of the included patients. High-resolution true-FISP imaging is a valuable adjunct for the exploration and neuronavigation of intracranial pathologies especially if cerebrospinal fluid is involved.

Adult↗

PubMed2000

The relation between cervical discographic pain responses and radiographic images.

OBJECTIVE: The purpose of this study was to investigate the relation between cervical discographic pain responses and radiographic images. DESIGN: Records were reviewed for a series of patients who had undergone cervical discography. SETTING: All patients were being treated at a spine specialty clinic. PATIENTS: A total of 269 discs were studied in 161 discographic procedures in patients with neck, shoulder, or arm pain. All patients underwent other diagnostic procedures before discography, including magnetic resonance imaging, computed tomography (CT), and CT/myelography. INTERVENTIONS: During the injection of contrast in each disc evaluated, the patient was asked if any pain was felt, and if so, was it similar or dissimilar to the pain typically experienced. OUTCOME MEASURES: Results were determined by analyzing the pain responses during disc injection with respect to imaged pathology seen on the axial CT discographic image of the disc. Results were further analyzed based on patient age. RESULTS: There was a significant relation between the radiographic image of the disc and the results of clinical pain provocation (p < 0.01; chi2). Among the 35 discs appearing as normal, clinical pain was provoked in only 14.3%. Among the 234 discs appearing as abnormal, clinical pain was provoked in 77.8%. The mean age of the patients with painless radiographically abnormal discs was significantly greater than that of the patients in the other subgroups of the study population. CONCLUSIONS: There was good agreement between the radiographic appearance of the disc and the pain provocation results. Discs that were painless but disrupted were found among older patients. Among such patients, discography may be particularly helpful in differentiating clinically significant abnormalities from those associated with aging.

Adult↗

PubMed1988

Potential applications for digital image processing at the Armed Forces Institute of Pathology.

Digital image processing systems are fast becoming valuable tools in the quantitative study of visual images. These systems not only enhance image features, but provide the investigator with information about those features expressed in numeric form. Now, statistical analyses can be performed on information that was formerly only qualitative. At the Armed Forces Institute of Pathology (AFIP), we are studying the potential applications of digital image processing systems to a variety of problems including morphological analysis of cell, tissue, and organ samples; reconstruction and enhancement of photographic images; three-dimensional reconstruction of organ systems; analysis of terrain, material, and human remains involved in aircraft accidents; and the archiving of histological images and pathological records. This report outlines the basic characteristics of image processing systems and discusses their potential applications in pathological studies at the AFIP. Information was collected from interviews with the AFIP professional staff.

Arteriosclerosis↗

PubMed1998

An initial trial of a prototype telepathology system featuring static imaging with discrete control of the remote microscope.

Routine diagnosis of pathology images transmitted over telecommunications lines remains an elusive goal. Part of the resistance stems from the difficulty of enabling image selection by the remote pathologist. To address this problem, a telepathology microscope system (TelePath, TeleMedicine Solutions, Birmingham, Ala) that has features associated with static and dynamic imaging systems was constructed. Features of the system include near real time image transmission, provision of a tiled overview image, free choice of any fields at any desired optical magnification, and automated tracking of the pathologist's image selection. All commands and images are discrete, avoiding many inherent problems of full motion video and continuous remote control. A set of 64 slides was reviewed by 3 pathologists in a simulated frozen section environment. Each pathologist provided diagnoses for all 64 slides, as well as qualitative information about the system. Thirty-one of 192 diagnoses disagreed with the reference diagnosis that had been reached before the trial began. Qf the 31, 13 were deferrals and 12 were diagnoses of cases that had a deferral as the reference diagnosis. In 6 cases, the diagnosis disagreed with the reference diagnosis yielding an overall accuracy of 96.9%. Confidence levels in the diagnoses were high. This trial suggests that this system provides high-quality anatomic pathology services, including intraoperative diagnoses, over telecommunications lines.

Diagnostic Imaging↗

PubMed2006

[Clinical characteristics of hepatic sinusoidal obstruction syndrome: analysis of 8 cases].

OBJECTIVE: To investigate the diagnosis and treatment of sinusoidal obstruction syndrome (SOS). METHODS: The data of 8 patients with SOS, including clinical manifestations, laboratory results, imaging, pathology, and the course of diagnosis and treatment were reviewed. All cases were followed up. RESULTS: The main clinical manifestations included abdominal distention, hepatalgia and signs of ascites and hepatomegaly. There were mild or moderate hepatocellular injury in 6 patients and heavy injury in 2. All patients' serum-ascites albumin gradient exceeded 11.1 g/L. The levels of CA125 in both serum and ascites elevated significantly. All patients' ultrasonography showed hepatomegaly, appearance of portal hypertension and attenuated hepatic veins. Reverse blood flow in portal vein was observed in 5 cases. Magnetic resonance imaging showed that contrast agent accumulated unevenly in liver in both portal period and lag period, but filled poorly in hepatic veins. Per cutsem liver biopsy showed that all patients' hepatic sinusoids were congested, but venular occlusion was observed in only 3 cases. Five cases had been misdiagnosed. One patient healed after liver transplantation, 4 patients recovered gradually by treatment with heparin and so on and 3 patients died. CONCLUSIONS: Signs of outstanding portal hypertension with mild hepatocellular injury is the main clinical feature of SOS. Both serum and ascites CA125 levels in SOS patients are elevated significantly. The misdiagnosis rate of SOS is quite high, ultrasonography and magnetic resonance imaging have significant value in diagnosis and differential diagnosis, while the value of per cutsem liver biopsy is limited. Combination of imaging and pathology should contribute to correct diagnosis of SOS. Application of anticoagulant in early course is vital, liver transplantation should be considered in severe cases.

Adult↗

PubMed2004

Diagnosis of palpable breast masses: ultrasound-guided large core biopsy in a multidisciplinary setting.

Cytologic diagnosis of palpable breast masses is an accepted method for diagnosis. However, the high nondiagnostic rate causes repeat biopsy, unnecessary delays, and increased costs. Our purpose is to evaluate the use of ultrasound (US)-guided large-core needle biopsy as part of the minimally invasive multidisciplinary diagnosis of palpable breast masses. We studied 502 consecutive patients with 510 palpable solid breast masses seen and evaluated by a multidisciplinary team. Patients had US-guided core biopsy. Clinical-imaging-pathologic correlation (CIPC) was done in all cases. Core biopsy was deemed conclusive if CIPC was congruent and was used to guide definitive management. The median age of our patients was 39 years. Median tumor size was 2.2 cm. Of these cases, 463 (91%) had a conclusive diagnosis on CIPC. Core needle findings on 47 masses were nondefinitive to guide therapy (fibroepithelial lesion, atypical ductal hyperplasia, intraductal papilloma, CIPC). Three cancers were detected in this group on excisional biopsy. In conclusion, US-guided large-core needle biopsy is a sensitive method for diagnosis of palpable breast masses. Multidisciplinary correlation of clinical findings, imaging, and pathology is essential for success. This approach improves use of operating room resources and maximizes patient participation in the decision-making process.

Adolescent↗

PubMed2002

Cancerous nuclei detection on digitized pathological lung color images.

In this paper, we propose a methodology (in the form of a software package) for automatic extraction of the cancerous nuclei in lung pathological color images. We first segment the images using an unsupervised Hopfield artificial neural network classifier and we label the segmented image based on chromaticity features and histogram analysis of the RGB color space components of the raw image. Then, we fill the holes inside the extracted nuclei regions based on the maximum drawable circle algorithm. All corrected nuclei regions are then classified into normal and cancerous using diagnostic rules formulated with respect to the rules used by experimented pathologist. The proposed method provides quantitative results in diagnosing a lung pathological image set of 16 cases that are comparable to an expert's diagnosis.

Adenocarcinoma↗

PubMed1989

Magnetic resonance imaging of intracavernous pathology.

To evaluate the usefulness of magnetic resonance (MR) imaging of intracavernous pathology, T1-weighted spin echo images of four vascular lesions and 10 neoplastic lesions with surgically confirmed cavernous sinus (CS) invasion were reviewed retrospectively. In one case of traumatic carotid-cavernous fistula (CCF) and one of dural arteriovenous malformation (AVM), the internal carotid artery (ICA) and rapid shunted flow were depicted as signal voids, and the relationship between the ICA and shunted flow was clearly shown. Normal venous flow appeared as a low-intensity area and was observed even in the presence of the CCF and dural AVM. In two cases of thrombosed aneurysms, the thrombosis was clearly demonstrated, along with patent arterial flow in one case; in the other case, however, it was impossible to differentiate patent arterial flow from calcification. The intensity of all neoplastic lesions was similar to that of the cerebral cortex. The relationship between the ICA and the tumors was clearly demonstrated. The visual pathways were also plainly shown unless they were involved, or markedly compressed, by tumor. CS invasion was strongly associated with four findings: 1) encasement of the ICA by the tumor; 2) marked displacement of the ICA; 3) absence of low intensity, which reflects normal venous flow, in the CS; and 4) extension of extrasellar tumors to the medial wall or of intrasellar tumors to the lateral wall. MR imaging was judged promising in the evaluation of intracavernous pathology.

Adenoma↗