PACS monitors: an evolution of radiologist's viewing techniques.

When initially evaluating picture archiving communication systems (PACS) many radiologists try to duplicate the film environment and believe that multiple monitors are required to maintain the productivity of the radiologist. The authors were under the same impression initially but found that they underwent a paradigm shift over a period of time. This report documents the evolution that the radiologists underwent. The author's department consists of 28 diagnostic radiologists and 21 residents who actively read cases on a PACS. The department has been filmless for 6 months, although they have been reading soft copy films for 2 years. All modalities except mammography are included. The authors conducted interviews with both attending radiologists and residents to evaluate the change in methodology from the preconceptions to initial use to current use. The number and kind of monitors preferred for plain films, ultrasound scan, computed tomography (CT), and magnetic resonance imaging (MRI) were recorded. Additionally, viewing methods of different modalities were discussed. The authors found that there was a decrease in the number of monitors from preconceptions to actual use. Furthermore, to a lesser degree, there is a reduction of monitors used initially to that which is currently being used. The style of viewing cross-sectional images has changed. There has been a decrease in the number of images displayed on each monitor. The use of the roller ball on the mouse has affected this viewing style. Changing from a film-based reading environment to PACS environment not only brings about change in the overall technology in image delivery but also in the viewing techniques by radiologists. At our institution we have evolved from initially expecting to use 4 monitors all the time to actually preferring 2 monitors and occasionally 1 monitor to view images. Presentation software and viewing aids such as the roller ball on a mouse for viewing CTs in stack mode are key contributions to this paradigm shift. The decrease in monitors makes PACS more affordable and will allow further penetration of filmless radiology. The authors have found that after using PACS, radiologists prefer using 2 monitors. The style of reading films has changed with experience. Hospitals that plan to purchase PACS should consider this and ensure that the vendor has presentation software that optimizes the 2 monitor system.

Cirrhosis: spectrum of findings on unenhanced and dynamic gadolinium-enhanced MR imaging.

The appearance of the cirrhotic liver on computed tomography can be difficult to evaluate and can frustrate the radiologist distinguishing benign from malignant lesions. Hepatic edema, fibrosis, atrophy, and vascular abnormalities are common in the cirrhotic liver and produce derangements in morphology, attenuation, and perfusion, limiting the accurate characterization of hepatic masses. With the development of fast magnetic resonance (MR) sequences and dynamic postgadolinium-enhanced imaging, most hepatic lesions with uncertain etiology on computed tomography can be accurately characterized on MR imaging. We describe MR imaging techniques useful for imaging cirrhosis and its complications. We also illustrate the spectrum of findings in the cirrhotic liver on dynamic gadolinium-enhanced MR imaging, including reticular and confluent fibrosis, fatty infiltration, hemochromatosis, regenerating nodules, dysplastic nodules, hepatocellular carcinoma, and sequela of portal hypertension.

Primary angiosarcoma of the spleen--CT, MR, and sonographic characteristics: report of two cases.

Primary angiosarcoma of the spleen is a rare entity, but it is the most common primary splenic malignancy. These tumors demonstrate an aggressive growth pattern and can be single or multiple. The diagnosis should be suspected in a patient who presents with splenomegaly but without evidence of lymphoma, malaria, leukemia, or portal hypertension. The tumor may also present with acute abdominal symptoms secondary to spontaneous splenic rupture. We describe two cases of primary angiosarcoma of the spleen with computed tomographic, magnetic resonance, and sonographic features.

Gangliosides stimulate calcium flux in neuro-2A cells and require exogenous calcium for neuritogenesis.

The neuritogenic effect of exogenous ganglioside has been documented with a variety of neuronal and neuroblastoma systems, but the mechanism is not understood. Involvement of Ca2+ is suggested by this study which demonstrates that treatment of Neuro-2A cells with bovine brain gangliosides (BBG) in Ca2(+)-depleted medium failed to produce neurite outgrowth. This was in contrast to treatment with retinoic acid or dibutyryl cyclic AMP which induced differentiation under the same conditions. Addition of BBG to Neuro-2A cells caused small, but significant, increases in both influx and efflux of Ca2+. It thus appears that although neuritogenesis can proceed by more than one mechanism, that induced by BBG requires exogenous Ca2+ and involves stimulation of Ca2+ flux.

Exogenous gangliosides stimulate breakdown of neuro-2A phosphoinositides in a manner unrelated to neurite outgrowth.

Gangliosides administered exogenously are well-known effectors of differentiation in many neuroblastoma lines and primary neuronal cultures. Previous studies suggested the phosphoinositide signaling mechanism could be a contributing factor. We have found that treatment of Neuro-2A cells with bovine brain ganglioside mixture (BBG) causes breakdown of phosphoinositides, as measured by increased levels of inositol phosphates. The effect was optimal at 60 min and required a minimal BBG concentration of 25 microM. However, addition of neomycin, which blocked phosphoinositide breakdown, had no observable effect on ganglioside-stimulated neurite outgrowth. A similar result was obtained with psi-tectorigenin, which also inhibited phosphoinositide hydrolysis. When cells were treated with maitotoxin, an agent that promotes phosphoinositide breakdown, there was no enhancement of neurite outgrowth. These findings indicate that although exogenous gangliosides elevate inositol phosphate formation over a prolonged period in neuro-2A cells, this reaction is not integral to the differentiation of these cells. The possibility of secondary effects influencing neurite type and structure cannot be excluded.

Effect of 7,12-dimethylbenz[a]anthracene-induced mammary carcinogenesis on the opioid peptide levels in the rat central nervous system.

Mammary tumors were induced in female Sprague-Dawley rats by giving a single oral dose of 20 mg 7,12-dimethylbenz[a]anthracene (DMBA). Animals were killed after full development of tumors 4 months after the ingestion of DMBA. Opioid peptides in various tissues were estimated by radioimmunoassay (RIA). Tumor-bearing rats (n = 5) had higher (P less than 0.05) contents of beta-endorphin in pituitary (+60%), striatum (+52%) and midbrain (+85%) compared to animals with no tumors. However, tumor-bearing rats showed a decrease of 35% in striatal met-enkephalin content. Dynorphin level decreased (P less than 0.05) in pituitary (-49%) and hypothalamus (-29%) of tumor-bearing rats. Thus for the first time, we report the alteration in the level of these neuropeptides during the process of chemical carcinogenesis.

Enhancement in the activities of mouse epidermal glucose-6-phosphate dehydrogenase, hexokinase, phosphofructokinase, and pyruvate kinase by 12-O-tetradecanoyl-phorbol-13-acetate.

The active ingredient in the tumor-promoting croton oil, 12-O-tetradecanoyl-phorbol-13-acetate (TPA), was shown to increase the activity of mouse skin epidermal glucose-6-phosphate dehydrogenase (+84%), hexokinase (+100%), phosphofructokinase (+158%), and pyruvate kinase (+101%). This increase in activity of these key enzymes of glucose metabolism occurred 2-8 h after TPA application and was due to a net increase in the enzyme content. This increase in the activity of the glycolytic enzymes, as well as the reported TPA-induced increase in the synthesis of RNA and DNA and cell proliferation, suggest that activation of the glycolytic pathway may be involved in the carcinogenic effects of tumor promoters.