T1-weighted parenchyma attenuated inversion recovery: A novel sequence that improves contrast ratio of enhancing brain lesions.

PURPOSE: The purpose of this study was to develop and test a parenchyma attenuated T1-weighted inversion recovery MR sequence (PAIR) that increases the contrast between enhancing and non-enhancing tissues in the brain and to compare the contrast ratio of enhancing brain tumors on this sequence compared to spin echo magnetization transfer (SEMT). PATIENTS AND METHODS: PAIR sequence parameters were developed to reduce signal from gray matter (GM), white matter (WM), and cerebrospinal fluid (CSF) in a healthy adult volunteer. Forty-one patients (17 men and 24 women) with a mean age of 55±13 (SD) years (range: 21-78years) with known or suspected brain tumors underwent PAIR and SEMT imaging after intravenous administration of gadobenate dimeglumine. In patients with confirmed tumors, PAIR and SEMT images were compared for contrast ratio of tumor-to-WM, tumor-to-GM, and tumor-to-CSF. RESULTS: A total of 23 enhancing neoplastic lesions were found in 14/41 patients. All tumors were visualized on both contrast enhanced PAIR and SEMT images. PAIR images showed a 2.5 fold increase in maximum tumor-to-GM contrast ratio (P<0.0001), a 1.4 fold increase in maximum tumor-to-WM contrast ratio (P=0.0007) and a 5-fold increase in maximum tumor-to-CSF contrast ratio (P<0.0001). CONCLUSION: PAIR provides improved lesion-to-background contrast ratio compared to SEMT and may be useful as an added sequence in tumor evaluation.

Dieulafoy lesion: CT diagnosis of this lesser-known cause of gastrointestinal bleeding.

A Dieulafoy lesion describes a tortuous, submucosal artery in the gastrointestinal tract--most commonly the posterior stomach--that penetrates through the mucosa over time, eventually perforating to cause severe gastrointestinal bleeding. Due to its insidious onset, tendency to cause intermittent but severe bleeding, and difficulty of endoscopic diagnosis, Dieulafoy lesion has a very high mortality rate. Although originally thought not to be a radiologically diagnosable entity, Dieulafoy lesions can be seen at enhanced CT of the abdomen. The purpose of this review is to summarize the pathophysiology, epidemiology, diagnosis, and management of Dieulafoy lesions with a focus on diagnostic findings at enhanced CT imaging.

Effectiveness of clemastine fumarate for treatment of rhinorrhea and sneezing associated with the common cold.

Limited data support the use of first-generation antihistamines for treatment of the common cold. The purpose of this study was to test the effectiveness of clemastine fumarate, a first-generation antihistamine, for treatment of sneezing and rhinorrhea associated with naturally occurring common colds. Four hundred three subjects (202 clemastine fumarate recipients and 201 placebo recipients) who reported new onset (< 24 hours) of cold symptoms that included rhinorrhea or sneezing were studied. At baseline (day 1), the mean symptom-severity scores +/- SEM for the clemastine fumarate and placebo groups were not significantly different. The mean rhinorrhea-severity score +/- SEM was not different on day 2; however, on day 3, the mean rhinorrhea-severity score +/- SEM was 1.02 +/- 0.07 for the clemastine fumarate group and 1.39 +/- 0.07 for the placebo group (P < .001). This treatment effect persisted on day 4. A significant effect on sneezing was noted on days 2-4. Sedation occurred in 14% of the clemastine fumarate-treated subjects and 1.5% of the placebo-treated subjects (P < .0001).