RESUMEN
Coronavirus disease 2019 (COVID-19) has spread fast and extensively around the world, with significant mortality and morbidity. As this is a respiratory infection, chest radiography and computed tomography (CT) are important imaging techniques in the work-up of this disease. Given its highly infectious nature, cross-infection within the healthcare setting and radiology departments needs to be addressed actively and prevented. We describe the response of radiology departments in Singapore to this pandemic, in terms of diagnosis, re-configuration of the department, re-organisation and segregation of staff, infection control, managerial, and leadership issues.
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Infecciones por Coronavirus/diagnóstico por imagen , Neumonía Viral/diagnóstico por imagen , COVID-19 , Infecciones por Coronavirus/epidemiología , Recursos en Salud , Humanos , Organización y Administración , Pandemias , Neumonía Viral/epidemiología , Radiografía Torácica , Servicio de Radiología en Hospital , Singapur/epidemiología , Tomografía Computarizada por Rayos XRESUMEN
AIM: To determine the feasibility, safety, and efficacy of adopting a standardized protocol for emergency transarterial embolization (TAE) of the gastroduodenal artery (GDA) with a uniform sandwich technique in endotherapy-failed bleeding duodenal ulcers (DU). MATERIALS AND METHODS: Between December 2009 and December 2010, 15 patients with endotherapy-failed bleeding DU were underwent embolization. Irrespective of active extravasation, the segment of the GDA supplying the bleeding DU as indicated by endoscopically placed clips was embolized by a uniform sandwich technique with gelfoam between metallic coils. The clinical profile of the patients, re-bleeding, mortality rates, and response time of the intervention radiology team were recorded. The angioembolizations were reviewed for their technical success, clinical success, and complications. Mean duration of follow-up was 266.5 days. RESULTS: Active contrast-medium extravasation was seen in three patients (20%). Early re-bleeding was noted in two patients (13.33%). No patient required surgery. There was 100% technical success, while primary and secondary clinical success rates for TAE were 86.6 and 93.3%, respectively. Focal pancreatitis was the single major procedure-related complication. There was no direct bleeding-DU-related death. The response time of the IR service averaged 150 min (range 60-360 min) with mean value of 170 min. CONCLUSION: Emergency embolization of the GDA using the sandwich technique is a safe and highly effective therapeutic option for bleeding DUs refractory to endotherapy. A prompt response from the IR service can be ensured with an institutional protocol in place for such common medical emergencies.
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Úlcera Duodenal/terapia , Embolización Terapéutica/métodos , Arteria Hepática/cirugía , Úlcera Péptica Hemorrágica/terapia , Adulto , Anciano , Anciano de 80 o más Años , Úlcera Duodenal/complicaciones , Úlcera Duodenal/diagnóstico por imagen , Embolización Terapéutica/efectos adversos , Femenino , Estudios de Seguimiento , Arteria Hepática/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Úlcera Péptica Hemorrágica/diagnóstico por imagen , Radiografía , Reoperación , Resultado del TratamientoAsunto(s)
Hemorragia Gastrointestinal/etiología , Hemobilia/complicaciones , Anciano , Angiografía , Diagnóstico Diferencial , Embolización Terapéutica/métodos , Endoscopía Gastrointestinal , Femenino , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/terapia , Hemobilia/diagnóstico , Humanos , Masculino , Persona de Mediana Edad , Índice de Severidad de la Enfermedad , Tomografía Computarizada por Rayos XRESUMEN
AIMS: To assess whether retinal arteriolar wall changes (focal narrowing and arteriovenous nicking) are associated with an increased 5 year risk of age related maculopathy (ARM). METHODS: The Blue Mountains Eye Study examined 3654 residents aged 49+ years living in a defined area, during 1992-4 (82.4% participation). After 5 years, 2335 surviving participants (75.1%) were re-examined during 1997-9. Retinal photographs were graded using the Wisconsin ARM grading system. Incident late (neovascular or atrophic) or early stage ARM was defined using a side by side grading method. Focal arteriolar narrowing (localised constricted arteriolar segments causing a sausage-like appearance), and arteriovenous (AV) nicking (constriction on both sides of the venule where crossed by an arteriole), were graded by comparison with standard photographs. All retinal vessels passing through a circumferential zone 0.5-1.0 disc diameters from the optic disc margin were measured from digitised images. Summarised estimates for central retinal arteriolar equivalent (CRAE) represent an average diameter of arterioles for that eye. Associations were assessed after adjusting for age, sex, smoking, mean arterial blood pressure, and other vascular risk factors. RESULTS: Of 2314 baseline participants at risk of late stage ARM, either late stage lesion developed in 34 participants (1.5%). Of 2203 at risk of early stage ARM, this sign developed in 197 participants (8.9%). Focal arteriolar narrowing was present at baseline in at least one eye of 162 survivors (6.9%) and severe AV nicking was present in 187 people (8.1%). Over 5 years, 4.9% of subjects with and 1.2% of those without focal narrowing developed either late stage ARM lesion, age adjusted relative risk (RR) 2.3, 95% confidence interval (CI) 1.0 to 5.1, multivariate adjusted odds ratios (OR) 2.1 (95% CI 0.9 to 4.9). Similarly, 3.7% of subjects with and 1.3% of those without severe AV nicking developed late ARM lesions, age adjusted RR 2.1 (95% CI 0.9 to 5.1), multivariate adjusted OR 2.2 (95% CI 0.9 to 5.6). Corresponding age adjusted RR and multivariate adjusted OR for development of early stage ARM were 1.4 (95% CI 0.9 to 2.0) and 1.3 (95% CI 0.8 to 2.1) for focal arteriolar narrowing, and 1.6 (95% CI 1.0 to 2.3) and 1.8 (95% CI 1.1 to 2.9) for severe AV nicking, respectively. No associations between baseline CRAE and 5 year incident late or early stage ARM were found. CONCLUSIONS: Although of borderline statistical significance, the consistent associations found in this study suggest that structural retinal arteriolar changes may either contribute to ARM progression or may share common pathological pathways with ARM.
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Degeneración Macular/etiología , Oclusión de la Arteria Retiniana/complicaciones , Vena Retiniana/patología , Anciano , Anciano de 80 o más Años , Arteriolas/patología , Constricción Patológica/complicaciones , Progresión de la Enfermedad , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Degeneración Macular/epidemiología , Degeneración Macular/patología , Masculino , Persona de Mediana Edad , Nueva Gales del Sur/epidemiología , Oclusión de la Arteria Retiniana/patología , Factores de Riesgo , Vénulas/patologíaRESUMEN
INTRODUCTION: To study the role of contrast-enhanced computed tomography (CT) of the abdomen and pelvis in the evaluation of patients with clinically-suspected but equivocal acute appendicitis. METHODS: The medical records of 206 consecutive patients who had CT of the abdomen and pelvis for equivocal signs and symptoms of acute appendicitis were reviewed. 7 mm collimated axial sections from the diaphragm to the iliac crest and 5mm collimated sections of the pelvis with intravenous and oral contrast were obtained. The criteria used to diagnose acute appendicitis were: (a) a thickened appendix of more than 7 mm or (b) inflammatory changes in the periappendiceal fat. The CT findings were correlated with the histological diagnosis at appendectomy. If the CT findings were negative for acute appendicitis and surgery not performed, the results were correlated with other corroborating diagnostic investigations or clinical follow-up. RESULTS: A total of 206 patients were scanned, of which 39 were excluded due to lack of any follow-up. Of the final 167 that were studied, there were 36 true positives, 127 true negatives, 4 false negatives and no false positives, resulting in a sensitivity of 93.9 percent, specificity of 100 percent and accuracy of 98.5 percent. CONCLUSION: We have found CT to be a safe, reliable and accurate modality in the diagnosis of acute appendicitis in patients with equivocal presentation.
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Apendicitis/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Enfermedad Aguda , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Apendicectomía , Apendicitis/cirugía , Diagnóstico Diferencial , Femenino , Humanos , Masculino , Persona de Mediana Edad , Sensibilidad y EspecificidadRESUMEN
Colorectal cancer is a common malignancy that often metastasizes to the liver. Evaluation of the liver for metastases is important for staging and prognosis. Resection of limited hepatic metastases can result in prolonged survival. Imaging is vital to select appropriate patients to avoid unnecessary surgery. A variety of modern imaging tools can be used to detect and characterise hepatic lesions. These include contrast enhanced helical computed tomography (CT), CT arterial portography, magnetic resonance imaging (MRI) and intraoperative ultrasound (IOUS). Each has their advantages as well as disadvantages. Besides accuracy, availability, cost and presence of expertise determine the optimal modality or combination of modalities to use. The appearance of metastases on imaging can be correlated with histopathological abnormalities. Though metastases can often be distinguished from benign lesions, their appearances are by no means pathognomonic. Follow-up imaging for interval change and for assessment of response is often required.
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Neoplasias Colorrectales/diagnóstico , Neoplasias Hepáticas/diagnóstico , Neoplasias Colorrectales/patología , Humanos , Neoplasias Hepáticas/diagnóstico por imagen , Neoplasias Hepáticas/secundario , Imagen por Resonancia Magnética , Monitoreo Intraoperatorio , Metástasis de la Neoplasia , Sensibilidad y Especificidad , Tomografía Computarizada por Rayos X , UltrasonografíaRESUMEN
INTRODUCTION: We review the clinical applications of magnetic resonance cholangiopancreatography (MRCP) and illustrate them with clinical examples. METHODS: A literature search was performed in MedLine using the keywords "MR cholangiopancreatography" and "MRCP". The relevant articles were reviewed. The radiology information system was searched for MRCP examinations performed from July 1999 to December 2002. A surgical database of resected cases was also referenced. Illustrative cases were chosen in consultation with surgical authors to show the clinical applications of MRCP. RESULTS: MRCP is useful for assessment of choledocholithiasis, choledochal cysts, pancreas divisum, primary sclerosing cholangitis, pancreatitis and anatomical variation of the biliary ducts. When complemented with dynamic gadolinium-enhanced studies, MRCP is useful for assessment of ductal cholangiocarcinoma, pancreatic and gall bladder neoplasms. Illustrative cases are provided. CONCLUSION: MRCP is an important modality for the clinical assessment of biliary and pancreatic disorders.
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Neoplasias de los Conductos Biliares/diagnóstico , Conductos Biliares Intrahepáticos , Colangiocarcinoma/diagnóstico , Colangiopancreatografia Retrógrada Endoscópica/métodos , Neoplasias Pancreáticas/diagnóstico , Medios de Contraste , Femenino , Gadolinio , Humanos , Masculino , Sensibilidad y EspecificidadRESUMEN
INTRODUCTION: Septic ovarian venous thrombosis is an uncommon condition. Diagnosis is often not immediately apparent clinically and there are many that mimic this condition. We described an unusual case of septic ovarian vein thrombosis associated with Campylobacter fetus (C. fetus) bacteraemia. CLINICAL PICTURE: A 46-year-old female presented with fever and acute right loin pain. Right ovarian venous thrombosis was demonstrated on sonography and confirmed with computed tomography and magnetic resonance imaging. C. fetus was isolated from the blood. TREATMENT AND OUTCOME: The patient was given antibiotics and anticoagulation therapy with good response. CONCLUSION: Septic ovarian vein thrombosis should be considered as a differential diagnosis in female patients presenting with fever associated with lower abdominal pain. C. fetus bacteraemia also predisposes to thrombophlebitis, including septic ovarian vein thrombosis. When they are diagnosed in a timely manner and treated appropriately, the response is good and potential serious complications, including thromboembolism, and death could be averted. Radiological imaging is useful in the diagnostic work-up of this condition.
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Bacteriemia/complicaciones , Infecciones por Campylobacter/complicaciones , Campylobacter fetus , Ovario/irrigación sanguínea , Trombosis de la Vena/etiología , Femenino , Fiebre/etiología , Humanos , Persona de Mediana Edad , Tomografía Computarizada por Rayos X , Ultrasonografía Doppler Dúplex , Trombosis de la Vena/diagnóstico por imagenRESUMEN
INTRODUCTION: Diagnosis of hip fracture is normally readily made from clinical evaluation and plain radiographs. Occasionally, clinical suspicion of fracture is not confirmed on plain X-rays. MATERIALS AND METHOD: Between January 2001 and March 2002, 422 patients were admitted to our department for post-traumatic hip pain. The diagnosis of hip fracture was unequivocally made in 365 patients (86%). Fifty-seven (14%) patients had a negative or equivocal radiograph. RESULTS: Limited magnetic resonance imaging (MRI) of the hip in this group of 57 patients confirmed that 8 (14%) sustained a femoral neck fracture, while 5 (9%) had an intertrochanteric fracture. In 19 patients (33%), some other pathology was found, mainly stable fractures of the femoral trochanters and pubic rami. Overall, 32 scans (56%) were positive and 25 (44%) were negative. Limited MRI detected patients with undisplaced hip fractures and identified them as candidates for surgery. CONCLUSION: The use of MRI in this specific and 'limited' way provides orthopaedic surgeons with a rapid, accurate and cost-effective diagnostic tool in this clinical scenario. Definitive diagnosis allows the correct management plan to be implemented early. We recommend that patients, who have significant hip pain following injury but indeterminate plain radiographs, undergo a limited MRI scan as a matter of routine.
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Fracturas Cerradas/diagnóstico , Fracturas de Cadera/diagnóstico , Imagen por Resonancia Magnética , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Femenino , Fracturas de Cadera/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , RadiografíaRESUMEN
INTRODUCTION: We compare the breath-hold fast recovery fast spin echo (BHFRFSE) T2-weighted and non-breath-hold fast spin echo (NBHFSE) T2-weighted sequences in image quality and lesion characterisation of focal liver lesions. MATERIALS AND METHODS: Fat-suppressed T2-weighted magnetic resonance (MR) images obtained with the 2 sequences (BHFRFSE and NBHFSE) in 79 patients with 113 liver lesions were analysed retrospectively. The image quality and nature of the lesions were evaluated by 2 experienced radiologists. RESULTS: Based on receiver operating characteristic curve analysis, lesion characterisation was comparable for both sequences. The image quality of BHFRFSE was significantly better than that of NBHFSE. The NBHFSE missed 4 malignant lesions while BHFRFSE missed 2 malignant lesions. CONCLUSION: BHFRFSE performs similarly to NBHFSE in image quality and liver lesion characterisation.
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Imagen Eco-Planar/métodos , Procesamiento de Imagen Asistido por Computador/métodos , Neoplasias Hepáticas/diagnóstico , Hígado/patología , Adulto , Anciano , Anciano de 80 o más Años , Artefactos , Femenino , Humanos , Hepatopatías/diagnóstico , Masculino , Persona de Mediana Edad , Curva ROC , Respiración , Medición de Riesgo , Sensibilidad y Especificidad , Estadísticas no ParamétricasRESUMEN
INTRODUCTION: This article reviews the various computed tomography (CT) appearances of hepatic metastases from colorectal primaries and assesses the frequency of occurrence of the various patterns. MATERIALS AND METHODS: This is a retrospective study of the CT appearances of histologically proven colorectal hepatic metastases in a group of 52 patients who had undergone surgical hepatic resection between January 1994 and December 2001. A total of 74 hepatic metastatic lesions were reviewed. All lesions were examined in the portal venous phase. RESULTS: A discernible rim was seen in 54 lesions (73%). Thick rim was present in 36 lesions (48.6%) and thin rim in 18 lesions (24.3%). Enhancement of the rim was present in 62 cases (83.8%). Increased central attenuation was seen in 38 lesions (51.4%). Of these, the centre was heterogeneous in 76.3% and scar-like in 23.7%. A non-enhancing rim was seen in 12 lesions (16.2%) which appeared as lesions with "bevelled edge". Thick enhancing rim with non-enhancing centre was the most common combination in 15 lesions (20.3%). CONCLUSION: An enhancing rim could be seen in 83.8% of lesions. Increased central attenuation was present in 51.4% of the lesions. Familiarity with the various CT appearances may facilitate identification and diagnosis of colorectal liver metastases.
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Neoplasias Colorrectales/patología , Neoplasias Hepáticas/diagnóstico por imagen , Neoplasias Hepáticas/epidemiología , Adulto , Anciano , Neoplasias Colorrectales/cirugía , Femenino , Humanos , Neoplasias Hepáticas/etiología , Neoplasias Hepáticas/secundario , Neoplasias Hepáticas/cirugía , Masculino , Registros Médicos , Persona de Mediana Edad , Metástasis de la Neoplasia , Estudios Retrospectivos , Singapur/epidemiología , Tomografía Computarizada por Rayos X/estadística & datos numéricosRESUMEN
We assessed the associations between body mass index (BMI) and blood pressure (BP) with the retinal microvasculature among preschool-aged children. Three hundred and seventy-nine children aged 3-<6 years old had gradable retinal photographs, and quantifiable retinal vascular caliber using validated computer-based methods. Weight, height, BMI, waist circumference and BP were obtained using standardized protocols. Mean (±s.d.) BMI and systolic BP in preschool-aged children were 16.0 (±1.8) kg m(-2) and 93.2 (±9.9) mm Hg, respectively. After multivariable adjustment, each kg m(-2) increase in BMI was associated with a 1.06 µm narrowing of retinal arteriolar caliber (P=0.01) and 1.12 µm widening of retinal venular caliber (P=0.02). Children in the î¶95th percentile (obese) compared with those in the <85th percentile (healthy weight) had narrower retinal arteriolar caliber (â¼6.1 µm, Ptrend=0.01) and wider retinal venular caliber (â¼6.4 µm, Ptrend=0.01). Each 10 mm Hg increase in systolic BP was associated with a 1.70 µm narrower retinal arteriolar caliber (multivariable-adjusted P=0.02). We show that BMI and systolic BP have inverse linear associations with retinal arteriolar caliber, and BMI has a positive linear association with retinal venular caliber during early childhood. These findings suggests that the influence of BP and BMI on small vessels are continuous and commence early in life.
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Arteriolas/anatomía & histología , Presión Sanguínea/fisiología , Índice de Masa Corporal , Microvasos/anatomía & histología , Vasos Retinianos/anatomía & histología , Vénulas/anatomía & histología , Factores de Edad , Enfermedades Cardiovasculares/epidemiología , Preescolar , Femenino , Angiografía con Fluoresceína , Humanos , Estilo de Vida , Modelos Lineales , Masculino , Estudios Retrospectivos , Factores de Riesgo , Circunferencia de la CinturaRESUMEN
Surgery is the standard treatment for the extremely rare pathology of isolated anomalous systemic arterial supply to normal lung (ISSNL). We describe our experience with this anomaly in a 29-year-old male presenting with recurrent haemoptysis that was successfully treated with a combination of metallic coils and cyanoacrylate glue. In addition to contributing to the extremely limited data on endovascular therapeutic options in ISSNL, we also intend to raise the awareness among endovascular therapists of the need to be cautious ofand preserve the radiculomedullary/pial branches arising from an anomalous artery before embolising it.
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Cianoacrilatos , Embolización Terapéutica/métodos , Circulación Pulmonar , Adulto , Angiografía , Aortografía , Arterias/anomalías , Humanos , Masculino , Metales , Tomografía Computarizada por Rayos XRESUMEN
AIM: To assess the prevalence of retrodots and vacuoles and their associations with the prevalence and long-term incidence of age-related cataract in an older Australian cohort. METHODS: Of 3654 baseline participants of the Blue Mountains Eye Study aged 49+ years (1992-1994), 2335 and 1952 were re-examined after 5 and 10 years, respectively. Lens photographs were graded for cataract, retrodots, and vacuoles. Eye-specific data were used to assess the associations between retrodots or vacuoles at baseline and the prevalence and 10-year incidence of nuclear, cortical, and posterior subcapsular (PSC) cataract and cataract surgery. RESULTS: At baseline, retrodots were present in 142 persons (4%) and vacuoles in 1333 persons (40%). Prevalence of both lens features increased with increasing age (P for trend <0.0001). After adjusting for age and gender, vacuoles were associated with prevalent PSC cataract at baseline (odds ratio (OR), 1.60, 95% confidence interval (CI), 1.25-2.05). After adjusting for age, gender, smoking, hypertension, diabetes, education, and use of inhaled/oral steroids, baseline retrodots were associated with an increased incidence of cataract surgery (OR 2.90, 95% CI 1.71-4.91), while 3+ vacuoles at baseline were associated with an increased risk of PSC cataract (OR 3.56, 95% CI 2.13-5.95) and cataract surgery (OR 1.84, 95% CI 1.22-2.77). DISCUSSION: Lens retrodots and vacuoles were found to be positively associated with 10-year incidence of cataract surgery, and vacuoles associated with PSC cataract, a finding suggestive of shared risk factors or pathogenesis between these two lens features and the development of PSC cataract.
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Catarata/epidemiología , Cristalino/patología , Distribución por Edad , Anciano , Anciano de 80 o más Años , Envejecimiento/fisiología , Australia/epidemiología , Catarata/patología , Catarata/fisiopatología , Estudios Transversales , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Prevalencia , Agudeza Visual/fisiologíaRESUMEN
This pictorial review aims to highlight the clinical and imaging features of melioidosis in various organ systems. The patients were from two centres: one in Thailand and one in Singapore. The annual average incidence of melioidosis is estimated to be 4.4 in 100 000 in north-eastern Thailand and 1.7 in 100 000 in Singapore. Melioidosis affects many different organs and produces a spectrum of imaging features. The lung is the most frequently involved organ and, on radiographs and computed tomography, melioidosis may manifest as acute pulmonary consolidation, multiple nodules and abscesses. The finding of multiple small discrete abscesses in both the liver and the spleen is highly suggestive of visceral melioidosis and is best diagnosed on ultrasonography and computed tomography. Bone and soft tissue musculoskeletal involvement is usually part of disseminated melioidosis, with changes being seen on radiographs and MRI. Although imaging findings of melioidosis are not specific, this infection requires a high index of clinical suspicion, particularly in patients with pre-disposing comorbidities, such as diabetes mellitus, chronic renal failure, alcoholism or malignancy, those who are immunosuppressed as the result of either diseases or drug treatment, and those living in or with a history of travel to endemic areas.
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Enfermedades Óseas Infecciosas/diagnóstico , Encefalopatías/diagnóstico , Infecciones Bacterianas del Sistema Nervioso Central/diagnóstico , Enfermedades Pulmonares/diagnóstico , Melioidosis/diagnóstico , Enfermedades del Bazo/diagnóstico , Adulto , Anciano , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Factores de Riesgo , Tomografía Computarizada por Rayos XAsunto(s)
Fractales , Vasos Retinianos/patología , Accidente Cerebrovascular/mortalidad , Accidente Cerebrovascular/patología , Anciano , Australia/epidemiología , Encéfalo/patología , Estudios de Casos y Controles , Estudios de Cohortes , Femenino , Humanos , Hipertensión/complicaciones , Masculino , Persona de Mediana Edad , Medición de Riesgo , Accidente Cerebrovascular/epidemiologíaRESUMEN
OBJECTIVE: Real-time interactive duplex MR imaging is a new phase-contrast MR imaging technique that enables the quantification and display of flow velocities in real time without the need for cardiac gating. We investigated the feasibility and reliability of the technique to assess hemodynamic information both in vitro and in vivo in the carotid arteries and in the venous sinuses. SUBJECTS AND METHODS: Real-time interactive duplex MR measurements (TR/TE, 53/27; flip angle, 90 degrees; encoding velocity, 100 or 150 cm/sec) were performed in vitro with a steady-flow phantom and in 10 healthy volunteers in whom common and internal carotid artery velocities were measured. In eight volunteers, velocity measurements were also performed in the superior sagittal sinus during both normal breathing and hyperventilation. Time-velocity plots were analyzed qualitatively and quantitatively and compared with findings from conventional segmented k-space phase-contrast MR imaging and Doppler sonography. RESULTS: Velocity determinations for real-time duplex MR and conventional phase-contrast MR imaging showed an in vitro correlation of 0.99 and an in vivo correlation of 0.83 (carotid arteries) and 0.76 (venous sinus). Velocity measurements in the carotid arteries with real-time MR imaging were significantly lower than those obtained with conventional phase-contrast MR (averaged, 7.8%; p = 0.003) or sonography (23.7%, p < 0.001), likely because of volume averaging. Small but significant velocity changes occurring in the venous sinus during hyperventilation were reliably identified with both MR techniques. CONCLUSION: Real-time interactive duplex MR imaging can be effectively applied in neurovascular imaging to obtain hemodynamic information.