RESUMO
BACKGROUND AND PURPOSE: Although brain MR imaging findings in adult Wilson disease have been described in considerable detail, a paucity of information currently exists regarding brain MR imaging findings in pediatric Wilson disease. The purpose of this study was to analyze the brain MR imaging findings in Wilson disease of childhood at the initial stage and during follow-up after treatment and to correlate these observations with clinical response. METHODS: We evaluated 50 patients with pediatric Wilson disease. Fifty initial and 20 follow-up MR images from 15 patients following penicillamine treatment were analyzed retrospectively, and the data were correlated with clinical findings. RESULTS: Patients were categorized into 3 groups on the basis of initial MR imaging findings. Group I (n = 23) showed normal MR imaging findings. Group II (n = 15) was characterized by T1-weighted images with increased signal intensity in the globus pallidus (n = 15, 100%) followed by the putamen, midbrain, and caudate nucleus. Group III (n = 12) demonstrated T2-weighted images with increased signal intensity in the putamen (n = 10, 83%), followed by the caudate nucleus, globus pallidus, thalamus, midbrain, and pons. There was a significant difference in mean age, the presence of neurologic symptoms, and Child-Pugh classification among the 3 groups (P < .001). Following copper chelating therapy, the changes on follow-up MR imaging were strongly correlated with clinical response to treatment (P < .001). CONCLUSION: Brain MR imaging in children with Wilson disease can be categorized into distinct groups and demonstrated a significant correlation with clinical findings. Interval changes on follow-up MR imaging were also closely correlated with clinical findings and helpful in assessing the clinical response.
Assuntos
Encéfalo/patologia , Degeneração Hepatolenticular/patologia , Imageamento por Ressonância Magnética , Adolescente , Quelantes/uso terapêutico , Criança , Pré-Escolar , Feminino , Degeneração Hepatolenticular/tratamento farmacológico , Humanos , Masculino , Penicilamina/uso terapêuticoRESUMO
Pelvic fistulas may result from obstetric complications, inflammatory bowel disease, pelvic malignancy, pelvic radiation therapy, pelvic surgery, or other traumatic causes, and their symptoms may be distressing. In our experience, various types of pelvic fistulas are identified after pelvic disease or pelvic surgery. Because of its close proximity, the majority of such fistulas occur in the pelvic cavity and include the vesicovaginal, vesicouterine, vesicoenteric, ureterovaginal, ureteroenteric and enterovaginal type. The purpose of this article is to illustrate the spectrum of imaging features of pelvic fistulas.
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Fístula/diagnóstico , Fístula/etiologia , Pelve , Feminino , Humanos , Fístula Intestinal/diagnóstico , Fístula Intestinal/etiologia , Doenças Ureterais/diagnóstico , Doenças Ureterais/etiologia , Fístula da Bexiga Urinária/diagnóstico , Fístula da Bexiga Urinária/etiologia , Fístula Urinária/diagnóstico , Fístula Urinária/etiologia , Doenças Uterinas/diagnóstico , Doenças Uterinas/etiologia , Fístula Vaginal/diagnóstico , Fístula Vaginal/etiologiaAssuntos
Próteses e Implantes , Bexiga Urinária , Incontinência Urinária/cirurgia , Humanos , MasculinoRESUMO
OBJECTIVE: To evaluate that single photon emission computed tomography (SPECT) could reflect the clinical severity of knee osteoarthritis (OA) and to determine the clinical usefulness of SPECT as a sensitive imaging method detecting early OA. METHODS: Sixty knees of thirty OA patients were examined with (99m)Tc-methylene diphosphonate (MDP) bone SPECT, the intensity of uptake was graded and the sites of uptake were localized. One hundred millimeter visual analog scale (VAS), Western Ontario McMaster Universities (WOMAC) Osteoarthritis Index scores and physical examination were assessed. Simple radiograph and musculoskeletal ultrasonography (US) were performed, and Kellgren-Lawrence (K-L) grades were determined. The relationships between clinical findings, simple radiographic findings, US findings and the intensity of uptake in SPECT were analyzed. RESULTS: There were increased uptakes in 91.7% of the knees, and patella and medial tibial condyle were the most common sites of the uptakes. Symptomatic knees had significantly higher intensity of uptake than asymptomatic knees. Uptake intensity of medial compartment in SPECT well correlated with clinical findings, such as VAS, WOMAC scores, and physical examination, as well as US findings. Even in the symptomatic knees without abnormal radiographic findings, the increased uptake was observed in SPECT. CONCLUSION: In patients with knee OA, SPECT findings are well correlated with clinical findings, such as pain scores and physical examinations, and SPECT appears to be a sensitive tool for early detection of knee OA. SPECT information could be useful for determining clinical severity of knee OA and for diagnosing early OA more effectively.
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Articulação do Joelho/diagnóstico por imagem , Osteoartrite do Joelho/diagnóstico por imagem , Medronato de Tecnécio Tc 99m , Tomografia Computadorizada de Emissão de Fóton Único/métodos , Feminino , Humanos , Articulação do Joelho/patologia , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/diagnóstico , Medição da Dor , Sensibilidade e Especificidade , Índice de Gravidade de DoençaRESUMO
PURPOSE: To evaluate contrast agent-enhancement patterns in hepatic hemangiomas, hepatic metastases, and hepatocellular carcinomas (HCCs) at pulse-inversion harmonic ultrasonography (US) with a microbubble contrast agent. MATERIALS AND METHODS: Twenty hepatic hemangiomas in 20 patients and 41 malignant hepatic tumors in 23 patients (33 metastases and eight HCCs) were evaluated with pulse-inversion harmonic US. US images were obtained before injection and every 10-15 seconds after injection of a 4-g bolus (300 mg/mL) of SH U 508A (a microbubble contrast agent) for 5 minutes. The contrast-enhancement patterns of 61 hepatic lesions were assessed. RESULTS: Of 20 hemangiomas, 19 revealed peripheral enhancement, which was globular in 14 (70%) and rimlike in five (25%), with centripetal fill-in; the remaining one (5%) showed homogeneous enhancement. In 33 metastases, the enhancement was rimlike in 16 (48%), homogeneous in seven (21%), and stippled in two (6%); in the remaining eight metastases (24%), no enhancement was seen. Of eight HCCs, four (50%) showed homogeneous enhancement and the remaining four (50%) showed heterogeneous enhancement. Centripetal fill-in of lesions with intratumoral enhancement was not seen in any malignancy. CONCLUSION: Pulse-inversion harmonic US with a microbubble contrast agent is potentially useful for the specific diagnosis of hemangiomas that demonstrate characteristic enhancement features.
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Meios de Contraste , Aumento da Imagem/métodos , Neoplasias Hepáticas/diagnóstico por imagem , Adulto , Idoso , Carcinoma/diagnóstico por imagem , Carcinoma/secundário , Carcinoma Hepatocelular/diagnóstico por imagem , Carcinoma de Células das Ilhotas Pancreáticas/diagnóstico por imagem , Carcinoma de Células das Ilhotas Pancreáticas/secundário , Feminino , Seguimentos , Hemangioma/diagnóstico por imagem , Humanos , Fígado/diagnóstico por imagem , Neoplasias Hepáticas/secundário , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Polissacarídeos , Tomografia Computadorizada por Raios X , UltrassonografiaRESUMO
BACKGROUND: We describe the thin-section helical computed tomographic (CT) findings of biliary obstruction caused by metastasis. METHODS: Thin-section helical CT (5 mm slice thickness, 1:1 pitch, portal phase) and direct cholangiography in 50 consecutive patients with biliary obstruction caused by metastases were reviewed retrospectively by three radiologists. The primary sites were the stomach ( n = 36), colon ( n = 12), jejunum ( n = 1), and uterus ( n = 1). The level of biliary obstruction was analyzed with the Bismuth classification, and the CT findings of biliary obstruction were classified into six types: small (<2 cm) periductal masses, large (>/=2 cm) periductal masses, extrinsic compression by a metastatic liver mass, high-attenuation intraductal mass, intrapancreatic mass, and no demonstrable lesion. RESULTS: The level of biliary obstruction was the hilum in 18 patients (36%), the proximal common duct in 20 (40%), the distal common duct in five (10%), and the periampullary area in seven (14%). Of 18 hilar obstructions, tumor involvement of the secondary confluence of intrahepatic bile ducts was seen in 10 (right in six, left in one, and bilateral in three). Periductal masses were seen in 68% (small in 18, large in 16). In one patient (2%), a large metastatic mass of the liver resulted in extrinsic compression and biliary obstruction. Lesions mimicking primary biliary or pancreatic tumor were seen in four, respectively. In seven, we found no obstructing lesion on CT. CONCLUSION: Biliary obstruction in patients with known primary malignancies can show atypical patterns mimicking primary pancreatobiliary malignancies on thin-section helical CT.
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Neoplasias dos Ductos Biliares/diagnóstico por imagem , Neoplasias dos Ductos Biliares/secundário , Colestase/diagnóstico por imagem , Tomografia Computadorizada Espiral , Tomografia Computadorizada por Raios X , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias dos Ductos Biliares/complicações , Colestase/etiologia , Feminino , Humanos , Neoplasias Intestinais/patologia , Masculino , Pessoa de Meia-Idade , Neoplasias Gástricas/patologia , Neoplasias Uterinas/patologiaRESUMO
Erectile impotence has been a problem for the patient and a frustration for the physician since the beginning of medical history. The inflatable penile prosthesis rapidly is becoming the standard for treatment of organic erectile impotence. A technique is described for implantation through a single midline scrotal incision. Intra-abdominal reservoir placement is possible through this incision. The technique shortens operative time and hospital stay, and minimizes postoperative patient discomfort. Of the 31 patients who have been managed in this way the postoperative course for 18 is more than 12 months. The results as judged by patient and sexual partner have been excellent to date.