MR imaging of the pleura and chest wall.

Evaluation of pleural and chest-wall disease begins with a chest radiograph. In many cases, further evaluation of the chest wall and pleura requires cross-sectional imaging with CT scan or MR imaging. MR imaging is reserved for specific cases of tumors, infections, pleural effusions, and masses. The superior soft-tissue contrast of MR imaging is useful in evaluating the extent of infections and tumors involving the pleura and chest wall. The multiplanar capability of MR imaging aids in the evaluation of chest wall and pleural abnormalities, particularly in the apical regions.

Bronchoperitoneal fistula secondary to chronic Klebsiella pneumoniae subphrenic abscess.

We treated a case of bronchoperitoneal fistula secondary to a Klebsiella pneumoniae subphrenic abscess. This fistulous communication and the surgical procedure used to treat it are described.

Topical contrast-enhanced CT and MR dacryocystography: imaging the lacrimal drainage apparatus of healthy volunteers.

OBJECTIVE: The purpose of this study was to evaluate the feasibility of administering topical contrast material during helical CT dacryocystography and topical saline solution during MR dacryocystography to reveal the lacrimal drainage apparatus. SUBJECTS AND METHODS: Fourteen healthy volunteers underwent helical CT dacryocystography, MR dacryocystography, or both. Eight of the 14 subjects underwent both techniques; three subjects underwent MR dacryocystography, and three subjects underwent CT dacryocystography. Images were evaluated by two radiologists for degree of visualization of components of the lacrimal drainage apparatus. Each volunteer was questioned about the relative discomfort of contrast material and saline solution administration. RESULTS: The lacrimal drainage system was seen on both CT dacryocystography and MR dacryocystography. CT dacryocystography allowed two-dimensional and three-dimensional reconstructions on which adjacent bone anatomy could be seen. The MR dacryocystography two-dimensional reconstructions and maximum intensity projections also showed the drainage apparatus. However, smaller drainage structures were more consistently seen on CT dacryocystography than on MR dacryocystography. Saline solution was more comfortable than contrast material. CONCLUSION: CT dacryocystography and MR dacryocystography reproducibly and non-invasively revealed the lacrimal drainage apparatus and allowed a better physiologic examination than cannulation dacryocystography. MR dacryocystography can be performed without administration of ionizing radiation or contrast material, but this technique cannot show adjacent bone anatomy and less consistently showed the smaller drainage structures than CT dacryocystography.

Imaging of lung cancer: old and new.

Lung cancer is the leading cause of cancer death in the United States. Lung cancer is frequently encountered by the radiologist, whether the lung cancer is detected on a chest radiograph obtained in a symptomatic patient, or is an incidental finding. The radiologic workup of pulmonary lesions suspected of being lung carcinoma has evolved as new technology has become available. Current imaging modalities which are useful in the workup of suspected lung cancers include plain radiography, computed tomography, magnetic resonance imaging, with the recent addition of positron emission tomography and endoscopic ultrasound. The following article discusses the merits of these imaging modalities and their role in the workup of patients with lung cancer.

Pulmonary aspergillosis: a spectrum of disease.

Although many species of the fungus Aspergillus have been identified, the most common human pathogen is A. fumigatus, which has a worldwide distribution. Although any organ may become infected, pulmonary aspergillosis is the most common manifestation. The spectrum of pulmonary aspergillosis includes saprophytic aspergillomas, allergic bronchopulmonary aspergillosis, chronic necrotizing aspergillosis, and invasive aspergillosis. Immune status of the host, and the presence of underlying lung disease are important in determining the type of pulmonary involvement. Thus, the radiographic findings are variable. This article reviews the various manifestations of pulmonary aspergillosis, including the immune status of the patient, the presence of underlying lung disease, and the radiographic appearance of the different entities.

CT evaluation of normal interatrial fat thickness.

PURPOSE: This study was performed to determine the normal thickness of fat in the interatrial septum as demonstrated by CT. METHOD: Eighty-seven subjects underwent helical chest CT examination as part of a separate protocol to compare the quantification of coronary artery calcification by CT to coronary angiographic findings, using a slice width of 3 mm, reconstructed every 1.5 mm. The thickness of the interatrial fat in both groups was measured anterior and posterior to the fossa ovalis. The mean and standard deviation were calculated. RESULTS: The mean thickness of interatrial fat anterior and posterior to the fossa ovalis was 4.6 (SD = 2.5) and 3.7 (SD = 3.1) mm, respectively. CONCLUSION: The normal range of thickness of the interatrial fat is 0-9.6 mm anterior to and 0-9.9 mm posterior to the fossa (2 SD above the mean).

Measurement of coronary artery calcium with dual-slice helical CT compared with coronary angiography: evaluation of CT scoring methods, interobserver variations, and reproducibility.

OBJECTIVE: This study was performed to evaluate new scoring methods for quantitating coronary artery calcifications with helical CT and to compare the results with those of quantitative coronary angiography in patients with suspected coronary artery disease. SUBJECTS AND METHODS: Unenhanced dual-slice helical CT and coronary angiography were performed within 24 hr of each other in 101 patients with symptoms of coronary artery disease. Coronary artery calcifications with a density above 90 H were identified on each slice and, with the same regions of interest, quantitative scoring was performed at thresholds of 90 H (new) 130 H (old). Two mathematical algorithms (one new and one old) were evaluated for both thresholds (yielding four scoring systems). By CT imaging, we defined disease as a score of greater than zero. By angiography, we defined disease as a 50% or greater reduction in the luminal diameter of any major vessel. Interobserver variations in calcification scoring were evaluated. Seventeen of our patients. also underwent a second, consecutive CT scan to determine reproducibility. RESULTS: With the new threshold and the new algorithm, the sensitivity, specificity, and accuracy of helical CT in predicting disease were 88%, 52%, and 76%, respectively. We found a moderate positive association between the total CT calcification score and the number of stenotic coronary arteries at angiography (Pearson's correlation coefficient, .43; p = .05 [analysis of variance]). The accuracy and the area under the receiver operating characteristic curve were higher with the new threshold and the new algorithm. Interobserver agreement in calcification scoring was high (intraclass correlation coefficient, .99 [n = 85]), as was reproducibility (intraclass correlation coefficient, .94 [n = 17]). Reproducibility was higher when scoring was based on the new threshold and the new algorithm. CONCLUSION: The quantity of coronary artery calcifications as measured by helical CT correlated positively with obstructive coronary artery disease as measured by angiography. Interobserver agreement and reproducibility were excellent. A new scoring method showed promise.

Reexpansion pulmonary edema.

Reexpansion pulmonary edema is a rare complication attending the rapid reexpansion of a chronically collapsed lung, such as occurs after evacuation of a large amount of air or fluid from the pleural space. The condition usually appears unexpectedly and dramatically-immediately or within 1 h in 64% of patients and within 24 h in the remainder. The clinical manifestations are varied; they range from roentgenographic findings alone in asymptomatic patients to severe cardiorespiratory insufficiency. The radiographic evidence of reexpansion pulmonary edema is a unilateral alveolar filling pattern, seen within a few hours of reexpansion of the lung. The edema may progress for 24-48 h and persist for 4-5 days. Human data on the pathophysiology of reexpansion pulmonary edema derive from small series of patients, case reports, and reviews of the literature. On the other hand, a larger body of data exists on experimental reexpansion pulmonary edema in cats, monkeys, rabbits, sheep, and goats. This review examines the clinical and experimental evidence for reexpansion pulmonary edema. In addition, we detail the historical background, clinical setting, treatment, and outcome of reexpansion pulmonary edema.

Severity of articular cartilage abnormality in patients with osteoarthritis: evaluation with fast spin-echo MR vs arthroscopy.

OBJECTIVE: The purpose of this study was to assess the accuracy of fast spin-echo MR imaging for depicting the severity of articular cartilage abnormalities in patients with osteoarthritis. SUBJECTS AND METHODS: Twenty-three subjects (10 volunteers less than 35 years old and 13 patients with proved, symptomatic, idiopathic osteoarthritis of the knee of 6 months' to 10 years' clinical duration) underwent fast spin-echo MR imaging of the knee. Two observers graded each articular surface using a five-category scale that took into account abnormalities in the signal intensity of cartilage as well as thickness and contour. The 13 patients also underwent arthroscopic evaluation (as part of a separate protocol) in which cartilage abnormalities were graded by using a similar five-category grading scale, without the graders knowing the results of MR imaging. Articular cartilage was assumed to be normal in the volunteers. RESULTS: One hundred thirty-seven joint surfaces were graded; one surface was obscured by artifact and was excluded. The Spearman rank linear correlation between arthroscopic and MR grading was highly significant (p < .002) for each of the six articular regions evaluated. The MR and arthroscopic grades were the same in 93 (68%) of 137 joint surfaces, they were the same or differed by one grade in 123 surfaces (90%), and they were the same or differed by one or two grades in 129 surfaces (94%). CONCLUSION: Our results suggest that fat-presaturated fast spin-echo MR imaging depicts the severity of articular cartilage abnormalities in osteoarthritis with reasonable accuracy, as compared with arthroscopic evaluation as the standard of reference.