Lung clearance index and high-resolution computed tomography scores in primary ciliary dyskinesia.

RATIONALE: Lung clearance index (LCI) is a more sensitive measure of lung function than spirometry in cystic fibrosis (CF) and correlates well with abnormalities in high-resolution computed tomography (HRCT) scanning. We hypothesized LCI would be equally sensitive to lung disease in primary ciliary dyskinesia (PCD). OBJECTIVES: To test the relationships between LCI, spirometry, and HRCT in PCD and to compare them to the established relationships in CF. METHODS: Cross-sectional study of 127 patients with CF and 33 patients with PCD, all of whom had spirometry and LCI, of which a subset of 21 of each had HRCT performed. HRCT was scored for individual features and these features compared with physiological parameters. MEASUREMENTS AND MAIN RESULTS: Unlike in CF, and contrary to our hypothesis, there was no correlation between spirometry and LCI in PCD and no correlation between HRCT features and LCI or spirometry in PCD. CONCLUSIONS: We show for the first time that HRCT, spirometry, and LCI have different relationships in different airway diseases and that LCI does not appear to be a sensitive test of airway disease in advanced PCD. We hypothesize that this results from dissimilarities between the components of large and small airway disease in CF and PCD. These differences may in part lead to the different prognosis in these two neutrophilic airway diseases.

MR imaging evaluation of fibroid clearance following open myomectomy for massive/multiple symptomatic fibroids.

PURPOSE: To evaluate the technical success of total fibroid clearance at open myomectomy for massive and/or multiple symptomatic fibroids using MR imaging (MRI) as the imaging modality. METHODS: The study group comprised 27 women [mean age 37.4 ± 6.9 years (range 27-53)] who underwent open myomectomy for the treatment of massive/multiple symptomatic fibroids at our institution between January 2009 and April 2010. Myomectomy was performed with the intention of achieving complete fibroid clearance. Pre- and postmyomectomy MRI was performed to assess changes in uterine volume and fibroid burden. Periprocedural data (including blood loss and complications) and relief of clinical symptoms at follow-up were also recorded. RESULTS: The mean time to MRI and clinical follow-up was 10 months (range 6-15 months). The mean uterine volume premyomectomy was 795 ± 580 cc and postmyomectomy was 123 ± 70 cc (p < 0.001). The mean percentage reduction in uterine volume was 80.3 % (range 43.0-98.1 %). Of the 10/27 (37.0 %) women with residual fibroids at follow-up: 7 patients had fibroids measuring up to 1 cc in volume, 3 patients had fibroids measuring up to 6 cc. Postoperative adnexal seromas were observed in 6/27 (22.2 %) patients. The clinical success rates of myomectomy amongst the 22/27 (81 %) responders were: 73 % for menorrhagia, 64 % for pain, and 36-64 % for mass-related symptoms. CONCLUSIONS: Using MRI, we have confirmed that open myomectomy can achieve total or near-total fibroid clearance in the majority of patients with massive and/or multiple fibroids.

Imaging in the assessment and management of Achilles tendinopathy and paratendinitis.

Achilles tendinopathy is a common overuse injury in patients engaged in athletic activities. Tendon degeneration is often accompanied by paratendinitis. Radiologists are frequently asked to use imaging techniques to evaluate patients with problems at or around the Achilles tendon. The main imaging modalities used in the assessment of Achilles tendon disorders are plain radiography, ultrasound, and magnetic resonance imaging. In recent years, ultrasound has also been used to guide minimally invasive local treatments for Achilles tendinopathy, which may prevent the need for surgery if conservative treatments have failed. In this article, we review the imaging features of Achilles tendinopathy and consider the relative strengths and weaknesses of the various imaging techniques. The role of imaging in directing patient management is also discussed, with particular focus on ultrasound-guided treatments.

X-ray computed tomography of the heart.

INTRODUCTION: Cardiac imaging is an emerging application of multidetector computed tomography (MDCT). This review summarizes the current capabilities, possible applications, limitations and developments of cardiac CT. SOURCES OF DATA: Relevant publications in peer reviewed literature and national and international guidelines are used to discuss important issues in cardiac CT imaging. AREAS OF AGREEMENT AND CONTROVERSY: There is broad consensus that coronary CT angiography is indicated in patients with an intermediate pre-test probability of coronary artery disease (CAD) when other non-invasive tests have been equivocal. In this context, CT can reliably exclude significant CAD. Cardiac CT also has an established role in the evaluation of bypass grafts and suspected coronary anomalies. Radiation exposure from CT procedures remains a concern, although techniques are now available to reduce the X-ray dosage without significantly compromising the image quality. However, with the current level of knowledge, the cardiac CT examinations are not justified to screen for CAD in asymptomatic individuals. Neither is it considered appropriate in patients with a high pre-test probability of CAD, for whom invasive catheter coronary angiography is usually of more benefit. GROWING POINTS AND AREAS TIMELY FOR DEVELOPING RESEARCH: The ability to reconstruct the volumetric cardiac CT data set opens up avenues for advanced physiological analyses of the heart. For example, if CT myocardial perfusion assessment becomes a reality, there is potential to revolutionize the practice of MDCT imaging. Research is also ongoing to investigate whether cardiac CT has a role in the appropriate triage of patients with chest pain in the emergency department.

Ultrasound-guided treatments for chronic Achilles tendinopathy: an update and current status.

Minimally-invasive treatments for chronic Achilles tendinopathy may prevent the need for surgery when conservative methods have failed. Whilst injections have traditionally been used to manage symptoms, recently described therapies may also have disease-modifying potential. Ultrasound provides the ability to guide therapeutic interventions, ensuring that treatment is delivered to the exact site of pathology. Treatments can be broadly categorised according to their intended therapeutic targets, although some may act through several possible mechanisms. In this article, we review the ultrasound-guided techniques currently used to treat chronic Achilles tendinopathy, with reference to the available literature. There is strong pilot-level evidence supporting the use of many of these techniques, although large definitive trials are lacking. An approach towards the management of chronic Achilles tendinopathy is suggested.

Image quality of computed tomographic pulmonary angiography for suspected pulmonary embolus in patients with diffuse interstitial lung disease.

PURPOSE: To investigate the effect of diffuse interstitial lung disease (DILD) on the image quality of computed tomographic pulmonary angiography (CTPA). MATERIALS AND METHODS: The study group comprised 130 patients with DILD who underwent CTPA between April 2005 and April 2009. One hundred and thirty patients without significant parenchymal lung disease were used as a control group. Contrast enhancement of pulmonary arteries in the left upper lobe and right lower lobe was evaluated to the sub-subsegmental level both subjectively and objectively. The global and lobar extents of interstitial lung disease were also estimated in the study group. Subjective assessment was performed by 2 observers, initially independently and subsequently by consensus in cases of discordance. RESULTS: At the sub-subsegmental level, the number of patients with adequately opacified arteries was significantly lower in the DILD group (29.2% left upper lobe, 36.2% right lower lobe) compared with the control group (78.5% left upper lobe, 89.2% right lower lobe) (P<0.001). Subjective image quality scores of the sub-subsegmental arteries were strongly correlated with mean vascular attenuation values at this level (P<0.001) but not to the global or lobar extent of lung parenchymal disease. There was no clinically significant difference in image quality (either subjectively or objectively) between the DILD and control groups in the subsegmental and more proximal arterial branches. CONCLUSIONS: In the majority of patients with DILD, CTPA image quality is sufficient only to the subsegmental level. Emboli at the sub-subsegmental level, which may have greater clinical significance in patients with DILD than in those without, are unlikely to be excluded using CTPA.