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PubMed1987

Computed tomography of aortoiliac atherosclerosis.

Twenty-three patients with atherosclerotic peripheral vascular disease underwent angiography and CT of the aortoiliac segment within a 72-hour interval. Examinations were evaluated for depiction of disease in the aortic and iliac segments in five categories: stenosis, plaque morphology, vascular ectasia, calcification, and other pathologic conditions. Angiography and CT were equally accurate in their depiction of the degree of aortic stenosis or occlusion and in identification of aortic ectasia. Angiography proved superior to CT in the display of plaque morphology in 57% of aortic lesions and 74% of iliac abnormalities. Angiography also showed clear superiority over CT in quantification of iliac stenosis in 75% of patients with abnormalities, as well as in identification of iliac ectasia. CT detected both intimal calcification and incidental disease or congenital abnormalities better than angiography, including an unsuspected chronic contained aortic rupture. Overall, CT compared favorably with angiography in the identification of all types of aortic disease but major disadvantages of CT were evident in the iliac segment because of vessel tortuosity or heavy calcification. CT cannot replace arteriography in detecting atherosclerotic disease of the aortoiliac segment but can help to clarify angiographic findings in selected groups of patients.

Angiography↗
PubMed1997

A case of hyperoxaluria. Radiological aspects.

PURPOSE: Oxalosis is an unusual pathological condition with calcium oxalate deposits in soft tissue and bone, recognized as osteosclerosis on radiography. Osteosclerotic bone changes in patients treated with hemodialysis are in most cases due to secondary hyperparathyroidism, but several other diagnoses have to be considered. MATERIAL, METHODS AND RESULTS: We describe the case of a young woman with advanced renal failure treated with hemodialysis since her youth. She had skeletal pain and radiological examination showed: osteosclerosis with sclerotic vertebral bodies; irregular sclerosis and unsharp periostal outline in the tubular bones of the extremities; and acrolysis and calcifications of vascular and soft tissue in the hands. Histological examination showed changes typical of oxalosis. A liver biopsy excluded primary oxalosis type I, and she probably had a secondary oxalosis due to renal failure. This condition (as opposed to primary oxalosis) can be treated with renal transplantation. CONCLUSION: Oxalosis is a rare condition but it should be considered in patients with radiological skeletal changes and chronic renal failure and should not be misinterpreted as renal osteodystrophy. The classification of oxalosis as primary or secondary is important for further treatment.

Adult↗
PubMed1988

Accumulation, localization, and compartmentation of transforming growth factor beta during endochondral bone development.

Endochondral bone formation was induced in postnatal rats by implantation of demineralized rat bone matrix. Corresponding control tissue was generated by implanting inactive extracted bone matrix, which did not induce bone formation. At various times, implants were removed and sequentially extracted with guanidine hydrochloride, and then EDTA and guanidine hydrochloride. Transforming growth factor beta (TGF beta) in the extracts was quantitated by a radioreceptor assay. TGF beta was present in demineralized bone matrix before implantation, and the concentration had decreased by 1 d after implantation. Thereafter, TGF beta was undetectable by radioreceptor assay until day 9. From day 9-21 the TGF beta was extracted only after EDTA demineralization, indicating tight association with the mineralized matrix. During this time, the content of TGF beta per milligram soluble protein rose steadily and remained high through day 21. This increased concentration correlated with the onset of vascularization and calcification of cartilage. TGF beta was detected only between days 3-9 in the controls; i.e., non-bone-forming implants. Immunolocalization of TGF beta in bone-forming implants revealed staining of inflammatory cells at early times, followed later by staining of chondrocytes in calcifying cartilage and staining of osteoblasts. The most intense staining of TGF beta was found in calcified cartilage and mineralized bone matrix, again indicating preferential compartmentalization of TGF beta in the mineral phase. In contrast to the delayed expression of TGF beta protein, northern blot analysis showed TGF beta mRNA in implants throughout the sequence of bone formation. The time-dependent accumulation of TGF beta when cartilage is being replaced by bone in this in vivo model of bone formation suggests that TGF beta may play a role in the regulation of ossification during endochondral bone development.

Animals↗
PubMed2000

Cortical dysplasia with ossification.

We present the first case of cortical dysplasia with extensive intracerebral ossification. An eight-year-old epilepsy patient with a calcified lesion was successfully treated by surgical intervention. Pathological examination revealed a number of bizarre dysplastic cells in the whole lesion, which consisted of an epileptogenic cerebral cortex and a nonepileptogenic hamartomatous lesion with adipose tissue, vascular tissue, calcification, and ossification. The patient was diagnosed as having cortical dysplasia with ossification. Our findings support the notion that cortical dysplasia has a multipotentiality of cellular differentiation, including various hamartomatous tissues. We suggest that cortical dysplasia should be considered as a potential cause for epileptogenicity of a hamartomatous lesion even when magnetic resonance imaging (MRI) fails to disclose cortical dysplasia.

Brain Diseases↗
PubMed2006

Intraductal papillary mucinous neoplasm of pancreas: multi-detector row CT with 2D curved reformations--correlation with MRCP.

PURPOSE: To retrospectively compare accuracy of multi-detector row computed tomography (CT), combined with two-dimensional (2D) curved reformations, and that of magnetic resonance (MR) cholangiopancreatography (MRCP) for characterization of intraductal papillary mucinous neoplasm (IPMN) as malignant, with pathologic examination as reference standard. MATERIALS AND METHODS: Institutional review board approval was obtained, informed consent was waived, and study was HIPAA compliant. Twenty-five patients (12 women, 13 men; age range, 44-88 years) with pathologically proved IPMN were examined with dual-phase CT with 1.25-mm-thick sections for pancreatic phase; 2D curved reformations along main pancreatic duct (MPD) were generated. T2-weighted MRCP included thick- and thin-slab single-shot fast spin-echo imaging and transverse fast spin-echo imaging. Two radiologists, blinded to surgical and pathologic findings, evaluated images for lesion location, septa, mural nodules, communication with MPD, extent and diameter of MPD dilatation, calcifications, and vascular encasement. Malignancy was suspected when one of the following was present: MPD diameter larger than 10 mm, mural nodules, vascular encasement, peripancreatic lymphadenopathy, or metastases. Sensitivity and specificity values for prediction of malignancy were calculated for CT and MRCP. Interobserver variability was determined (kappa analysis). RESULTS: Excellent correlation between modalities was observed. Cyst communication was seen in 20 and 21 of 24 branch pancreatic duct (BPD) IPMNs with CT and MRCP, respectively. Sensitivity, specificity, and accuracy for detection of malignancy were 70%, 87%, and 76% (CT) and 70%, 92%, and 80% (MRCP), respectively. Interobserver agreement was good to perfect for both readers in all comparisons (overall, kappa = 0.70-1.00). CONCLUSION: CT combined with 2D curved reformation can provide imaging details of IPMN, including communication of BPD IPMN with MPD, that are almost equivalent to those provided at MRCP. Presence of mural nodules, dilated MPD (>10-mm diameter), or thick septa at CT or MRCP may be used as independent predictors of malignancy.

Adenocarcinoma, Mucinous↗
PubMed2003

Parathyroid adenomas and cardiovascular risk.

In recent decades, primary hyperparathyroidism (pHPT) has changed its clinical presentation from a disease with bone and renal involvement to a frequently asymptomatic disorder detected on routine biochemistry. Nevertheless, it remains unclear whether patients with untreated mild asymptomatic hyperparathyroidism are at risk for other complications such as increased morbidity and mortality from cardiovascular diseases. There are limited data on the incidence of cardiovascular abnormalities in mild pHPT. However, pHPT has been associated with increased risk of death from cardiovascular disease, hypertension, left ventricular hypertrophy (LVH), valvular and myocardial calcifications, impaired vascular reactivity, alterations in cardiac conduction, impaired glucose metabolism, dyslipidaemia, and alterations in body composition. The nature of some of these associations is in question, because cure of pHPT does not lead to improvement of the cardiovascular disorder e.g. hypertension. In contrast, currently available data suggest that LVH, impaired glucose metabolism and dyslipidaemia may improve after surgery and that successful parathyroidectomy could decrease the excess mortality in patients with pHPT due to cardiovascular disease.

Adenoma↗
PubMed2003

Common and uncommon sonographic features of papillary thyroid carcinoma.

OBJECTIVE: To determine the relative frequency of various sonographic findings in papillary carcinoma of the thyroid. METHODS: We retrospectively analyzed the sonographic features in 55 patients with proven papillary carcinoma of the thyroid. Sonographic features analyzed were echo texture, cystic change, margin, contour, presence of a peripheral halo, vascularity, and calcification pattern. Features were classified as common (> or = 35% of cases) or uncommon (< 10% of cases). Combinations of features were also analyzed. RESULTS: Common sonographic features of papillary carcinoma included hypoechoic texture (86%), microcalcifications (42%) or no calcifications (47%), well-defined margins (47%), and intrinsic hypervascularity (69%). Uncommon features included hyperechoic or mixed echo texture, cystic elements, irregular margins, hypovascularity, and coarse or peripheral calcifications. Of the 29 lesions that had calcifications, 20 (69%) had microcalcifications; 5 (17%) had coarse calcifications; and 1 had peripheral calcifications. In total, 54% of cases had at least 1 uncommon feature, and 11% had 2 or more uncommon features. Cystic carcinomas were rare and accounted for only 6% of lesions; all had hypervascular solid components. No carcinomas in our series were completely avascular. CONCLUSIONS: There is a broad spectrum of sonographic findings in papillary carcinoma of the thyroid. Half of the lesions in this series had at least 1 uncommon sonographic feature.

Carcinoma, Papillary↗
PubMed2003

Peripheral macrohemodynamics in patients with lower limb arteriosclerosis obliterans and type II diabetes mellitus.

The paper presents characteristic features of lower limb atherosclerotic lesions in patients with diabetes mellitus: more prominent calcification of vascular wall (involving media), frequent involvement of distal vascular segments and a symmetry of lesions. Typical variants are shown in images obtained with duplex angioscanning. The authors conclude that there are no principal differences in the course of lower limb arteriosclerosis obliterans between diabetics and non-diabetics. Nevertheless some special features were mentioned, particularly in clinical manifestation of intermittent claudication that can be attributed to concurrent diabetic neuropathy. Difficulties in clinical interpretation of lower limb arterial insufficiency for patients with diabetes mellitus determine the necessity of obligatory examination of peripheral vasculature. The authors advocate the discrete subclinical stage of the disease with increased rate of vascular accidents. The data may be interesting for angiologists, vascular surgeons, endocrine legists and other medical professions.

Aged↗
PubMed1981

Which pathologic characteristics influence echographic patterns of retinoblastoma?

Disagreement still exists regarding the influence of rosette formation, pseudorosettes, necrotic changes, vascularity, and calcification on the echographic characteristics of retinoblastoma. To further evaluate the echographic pattern of retinoblastoma confirmed by tissue diagnosis, we studied 11 consecutive cases of retinoblastoma and correlated pathologic findings with A- and B-scan echographic findings. In five patients with heavily calcified tumors, the A-scan echograms were more accurate in documenting reflectivity and revealed an extremely highly reflective pattern attenuating the ultrasonic beam substantially and casting characteristic shadows on the sclera. The B-scan echogram revealed a mass attenuating the ultrasound beam. This mass had dense focal echoes persisting at lower sensitivity within the tumor. In five patients with mild calcification on pathological examination, the A-scan echogram showed a highly reflective pattern. In one case with no calcification, the A-scan echogram revealed a medium reflective pattern. The B-scan echogram revealed a well-defined mass in each case. The degree of rosette differentiation, pseudorosettes, or necrosis failed to correlate with A-scan echographic pattern specific for retinoblastoma. No case showed a cystic appearance on B-scan echogram regardless of the degree of necrosis seen in the pathologic specimen. The echographic findings in retinoblastoma depend primarily on the degree of calcification and are not influenced independently by other specific pathologic characteristics of the tumors.

Calcinosis↗
PubMed1994

Calciphylaxis: early recognition and management.

Calciphylaxis, a syndrome of disseminated calcification found in chronic renal failure patients with secondary hyperparathyroidism, results in soft tissue calcification and vascular medial calcinosis leading to subsequent ischemic tissue necrosis. It is a rarely occurring condition in which patients present with painful, violaceous, mottled lesions of the extremities and/or trunk that progress to skin and subcutaneous tissue necrosis, non-healing ulcers, and gangrene. We reviewed the clinical course of seven patients (aged 24-69) with calciphylaxis treated at our institution over a 4-year period (October 1988-June 1992). All seven patients underwent parathyroidectomy, with a mean time of 8 weeks (range 3-20 weeks) between the onset of calciphylactic symptoms and parathyroidectomy. Four patients died, three secondary to wound-related sepsis. Of the three survivors, two healed soft tissue lesions primarily. The other required extremity amputation and wound excision before healing. Neither anatomical location of the soft tissue lesions nor post-parathyroidectomy serum calcium and phosphorus levels had any bearing on wound healing or mortality. Lesion severity at the time of parathyroidectomy appeared to best correlate with clinical course. Although treatment with phosphate-binding antacids, total or subtotal parathyroidectomy, and avoidance of challengers such as Vitamin D or local tissue trauma remain the mainstays of therapy, the uniform cure for calciphylaxis remains elusive. Prognosis for patients with calciphylaxis is dismal, even following late surgical intervention. Earlier recognition of the signs and symptoms of calciphylaxis should lead to timely parathyroidectomy in the hopes of ameliorating the symptoms and preventing or retarding its progressive sequelae.

Adult↗
PubMed1993

[Calciphylaxis in chronic renal failure].

Three cases of calciphylaxis in patients with terminal renal insufficiency are discussed. The existence of metastatic calcifications, mainly vascular, in patients with chronic renal insufficiency is frequent. However calciphylaxis is a process which is rarely found in these patients. This entity is characterized by the obliteration of small vessels with ischemia and necrosis. The exceptionality of the disease, its difficult treatment and poor evolution make calciphylaxis a bad prognostic complication which should be considered in the differential diagnosis of cutaneous lesions in patients with chronic renal insufficiency.

Aged↗
PubMed1997

Calcific chronic lateral epicondylitis: a histological and ultrastructural study.

Fragments of insertion tissue from right arm common extensor muscle have been collected from a 25-year patient with chronic lateral epicondylitis. Specimens, processed for light (LM) and electron (EM) microscopy, evidentiated a variety of degenerative alterations, such as focal hyalinosis, lipoidosis, collagen fiber redistribution, calcifications and vascular changes. Evidence of collagen normal function maintenance and turnover have been also observed in tenocytes.

Adult↗
PubMed1997

[Bronchial carcinoma: new radiologic methods].

New imaging techniques, technical modifications, and new applications of established imaging techniques are discussed with regard to their cost-effectiveness in improving the end result (cure, survival, quality of life). In detecting lung cancer, two methods seem most likely to overcome the known limits of chest radiography: digital radiography with postprocessing and, for risk groups, low-dose CT. Specific diagnosis depends on detection of tiny calcifications, increased vascularization (CT, MRI) or metabolic activity (PET). Clinical staging will be improved by very short time acquisition (MRI), combination of morphologic and biological information (cross sectional techniques) and by observing metabolic activity (PET).

Carcinoma, Bronchogenic↗
PubMed1976

Noninvasive ultrasonic carotid angiography: prospective validation by contrast arteriography.

Pulsed ultrasonic images of the carotid bifurcation in 82 vessels of 43 patients were compared independently with contrast arteriograms for stenosis (by percentage quartiles) or occlusion of the internal carotid artery. All 14 occluded vessels were identified correctly by ultrasound but were visualized on repeat examination. Estimation of percentage stenosis on ultrasonic images agreed with the quartile determination by contrast arteriography in 35 of 68 (51 percent) vessels and was within one quartile of correct interpretation in 48 of 68 (71 percent). The interpretative error of grading stenosis of ultrasonic images was due to vascular wall calcification which inhibited ultrasound transmission. This limitation was overcome by sound spectral (sonographic) analysis of distal internal carotid flow velocity which allowed estimation of stenosis within one quartile of that determined by contrast arteriography in 46 of 47 (98 percent) vessels.

Adult↗