Usefulness of ultrafast dynamic 3D-T1w data acquisition in detection of hypervascular lesions of the middle ear: first experience.

OBJECTIVE: To evaluate ultrafast dynamic 3D-T1w acquisition for improved detection of tympanic hypervascularized lesions. METHODS: Retrospective evaluation of a total of 50 patients referred from ENT-Department for suspected tympanic lesion. All underwent magnetic resonance imaging including ultrafast dynamic 3D-T1w acquisition imaging. Quantitative and qualitative evaluation was performed as well as statistical analysis. Comparison with intra-operative results. RESULTS: 12/50 patients showed a hypervascularized lesion proved intraoperative as 8 paragangliomas, 2 adenoms, 1 hemangioma and 1 neurinoma. 8/50 do not show hypervascularization though an enhancement was detected. Intra-operative granulation tissue was found. 30 patients did not show any lesions or enhancement. Sensitivity and specificity was 100%/100% for ultrafast dynamic imaging. CONCLUSION: Additional ultrafast dynamic 3D-T1w imaging is superior to conventional imaging in detection of hypervascularized lesions.

Compression of the celiac trunk caused by median arcuate ligament in children and adolescent subjects: evaluation with contrast-enhanced MR angiography and comparison with Doppler US evaluation.

PURPOSE: Compression of the celiac trunk by the median arcuate ligament can lead to clinically significant reduction in celiac blood flow and cause clinical symptoms. Doppler ultrasound (US) can be used to screen for stenoses of the celiac trunk and to reduce unnecessary catheter angiography. A noninvasive alternative method is magnetic resonance (MR) angiography. MATERIALS AND METHODS: A series of 32 children and adolescent patients were evaluated retrospectively; 22 had a positive history of abdominal angina and the other 10 were referred for abdominal imaging including MR angiography for other reasons and were used as a control group. RESULTS: In the patient group, all evaluated patients showed the typical hook-shaped appearance of the celiac trunk and focal narrowing with high-grade stenosis on MR angiography, which were eliminated after laparoscopic treatment. In the control group, no typical signs of median arcuate ligament syndrome were detected. US measurement of the mean preoperative peak velocity in the patient group was 304 cm/s ± 49. The mean postoperative peak velocity was 163 cm/s ± 29. In the control group without symptoms, the mean peak velocity was 140 cm/s ± 25. The difference in pre- and postoperative peak velocities in the patient group was highly significant (P <.0001). CONCLUSIONS: MR angiography can confirm the diagnosis of median arcuate ligament syndrome by demonstrating the characteristic focal narrowing of the celiac artery in children presenting with the appropriate clinical symptoms and is an excellent alternative to catheter angiography, especially in a pediatric population.

Diffusion-weighted imaging and ADC mapping of head-and-neck paragangliomas: initial experience.

BACKGROUND: Paragangliomas are rare, hypervascularized benign tumors. In some cases a clear differentiation of paragangliomas and other entities is impossible. PATIENTS AND METHODS: The authors evaluated ten patients with skull base lesions (paraganglioma n = 7, meningioma n = 1, giant cell tumor n = 1, and neurinoma n = 1) in addition to conventional magnetic resonance imaging (MRI) with diffusion-weighted imaging (DWI), and calculation of apparent diffusion coefficient (ADC). RESULTS: Mean ADC values +/- standard deviation of the paragangliomas were 1.304 +/- 0.257 x 10(-3) mm(2)/s and differed from ADC values of the other jugular fossa tumors with 0.743 +/- 0.108 x 10(-3) mm(2)/s and measurement derived from the cerebellum with 0.802 +/- 0.075 x 10(-3) mm(2)/s. CONCLUSION: Due to the difference of ADC values, the authors propose that DWI and ADC mapping could be a promising tool in the diagnostic work-up of paragangliomas.

Stent-assisted coil embolization of posterior circulation aneurysms using solitaire ab: preliminary experience.

OBJECTIVE: To evaluate patients with wide-necked aneurysms of the posterior circulation who underwent Solitaire AB (ev3, Inc., Irvine, CA) stent-assisted coil embolization. METHODS: Retrospective analysis of 10 patients (age range, 32-76 years; mean age, 59.1 years) with aneurysms of the basilar artery (basilar tip, n = 5; basilar trunk, n = 4; posterior cerebral artery, n = 1). Seven of the patients presented with an acute subarachnoid hemorrhage. Five aneurysms were small, 2 were large, and 3 were giant. All patients were treated by different applications (n = 14) of the Solitaire AB neurovascular remodeling device followed by a standard coiling procedure using bioactive coils. RESULTS: Positioning of all Solitaire AB stents was easy and successful. No stent required retrieving and repositioning after full deployment. There were no thromboembolic complications, and no dissection/rupture or vasospasm occurred during stent placement. In all cases except 3, 100% lesion occlusion was observed after the initial treatment. CONCLUSION: The initial technical and clinical results of Solitaire AB stent-assisted coiling of different types of wide-necked aneurysms in the posterior circulation are highly encouraging, and this technique may improve the endovascular treatment of these aneurysms.

Interventional treatment of traumatic priapism.

PURPOSE: To describe the effectiveness of transarterial embolization of traumatic priapism. METHODS: Six patients ranging in age from 6 to 37 years with traumatic high-flow priapism underwent superselective embolization with gelatin sponges (n=3) or minicoils (n=3). Embolization was repeated up to 3 times. RESULTS: Embolization was successful in all cases. In 2 patients, repeated embolization led to a flow reduction in the fistula, which spontaneously occluded a few days later. All patients experienced normal erections after intervention, and no side effects were observed. CONCLUSIONS: Transarterial superselective embolization is an effective and well-tolerated therapy in patients with traumatic priapism.