Vascular Diseases of the Spleen: A Review.

Vascular diseases of the spleen are relatively uncommon in the clinical practice. However, the reported incidence has been progressively increasing, probably due to advances in the imaging modalities used to detect them. This disease condition often presents with non-specific clinical manifestations, but can be associated with significant morbidity and mortality. This review article aims to provide updated clinical information on the different vascular diseases of the splenic vasculature-splenic vein thrombosis, splenic vein aneurysm, splenic artery aneurysm, splenic arteriovenous fistula, and spontaneous splenorenal shunt-in order to aid clinicians in early diagnosis and management.

Feasibility of Echocardiographic Techniques to Detect Subclinical Cancer Therapeutics-Related Cardiac Dysfunction among High-Dose Patients When Compared with Cardiac Magnetic Resonance Imaging.

BACKGROUND: Cardiac magnetic resonance imaging (CMR) is the gold standard for the quantification of global and regional myocardial function and can detect subclinical myocardial dysfunction in anthracycline-induced cardiomyopathy. The aim of this study was to ascertain reliable echocardiographic parameters that can be used for the early identification of cancer therapeutics-related cardiac dysfunction, compared with CMR. METHODS: Fifty-seven pediatric cancer survivors, 10 to 42 years of age, with cumulative anthracycline doses ≥ 200 mg/m(2), were studied with transthoracic echocardiography and CMR 2.4 to 26.9 years after chemotherapy. RESULTS: Three-dimensional echocardiography had the highest sensitivity in identifying subjects with CMR-derived ejection fractions < 55%. Subjects with end-systolic volume index values > 29 mL/m(2) were more likely to have CMR-derived ejection fractions < 55%. Three-dimensional speckle-tracking echocardiographic peak global longitudinal strain magnitude < -17.5% best identified subjects with abnormal peak midwall longitudinal strain magnitude by CMR. A decrease in early atrial myocardial velocity of <10 cm/sec at the interventricular septum also identified subjects with lower average peak midwall longitudinal strain and peak midwall circumferential strain magnitudes by CMR. CONCLUSIONS: Three-dimensional echocardiographic ejection fraction < 55%, end-systolic volume index > 29 mL/m(2), three-dimensional speckle-tracking echocardiographic peak global longitudinal strain magnitude < -17.5%, and a decrease in early atrial myocardial velocity at the interventricular septum of <10 cm/sec by Doppler tissue imaging are the most sensitive transthoracic echocardiographic parameters to identify subjects with subclinical myocardial dysfunction by CMR.

Occult cardiotoxicity in childhood cancer survivors exposed to anthracycline therapy.

BACKGROUND: More than 50% of >270 000 childhood cancer survivors in the United States have been treated with anthracyclines and are therefore at risk of developing cardiotoxicity. Cardiac magnetic resonance (CMR) has demonstrated utility to detect diffuse interstitial fibrosis and changes in regional myocardial function. We hypothesized that CMR would identify occult cardiotoxicity characterized by structural and functional myocardial abnormalities in a cohort of asymptomatic pediatric cancer survivors with normal global systolic function. METHODS AND RESULTS: Forty-six long-term childhood cancer survivors with a cumulative anthracycline dose ≥200 mg/m(2) and normal systolic function were studied 2.5 to 26.9 years after anthracycline exposure. Subjects underwent transthoracic echocardiography, CMR with routine cine acquisition, tissue characterization, and left ventricular strain analysis using a modified 16-segment model. Extracellular volume was measured in 27 subjects, all of whom were late gadolinium enhancement negative. End-systolic fiber stress was elevated in 45 of 46 subjects. Low average circumferential strain magnitude (εcc) -14.9±1.4; P<0.001, longitudinal strain magnitude (εll) -13.5±1.9; P<0.001, and regional peak circumferential strain were seen in multiple myocardial segments, despite normal global systolic function by transthoracic echocardiography and CMR. The mean T1 values of the myocardium were significantly lower than that of control subjects at 20 minutes (458±69 versus 487±44 milliseconds; P=0.01). Higher mean extracellular volume was observed in female subjects (0.34 versus 0.22; P=0.01). CONCLUSIONS: Asymptomatic postchemotherapy pediatric patients have abnormal myocardial characteristics and strain parameters by CMR despite normal global cardiac function by standard transthoracic echocardiography and CMR measures.

Dose of reduced z-axis length of computed tomography angiography (CTA) of the chest for pulmonary embolism using 64-detector rows and adaptive iterative reconstruction techniques.

The objective of this study is to compare the dose of CT angiography (CTA) for the diagnosis of pulmonary embolism (PE) performed using a reduced z-axis to conventional CTA for PE, both using adaptive iterative reconstruction technique on a 64-detector row device. The institutional review board approved a waiver of informed consent. A study was performed to consecutive patients having CTA for PE in the emergency department (ED). The patients underwent a reduced z-axis CTA from the top of the aortic arch to the bottom of the heart using the appropriate CT parameters and standard IV contrast injections. All patients had scans performed with 40 % ASIR and had a breast shield placed to limit breast dose. Per ED ordering criteria, the reduced z-axis protocol was appropriate for patients under 50 years old with no significant comorbidity. The control group consisted of patients from the same time period under 50 years of age who received a full z-axis scan. Technical parameters were the same for both groups other than scan length. Dose-length product (DLP) and volume CT dose index (CTDIvol) were the parameters used to evaluate differences in radiation dose to patients. The average effective dose of the full z-axis group was significantly higher (10.9 mSv (SD 4.7, range = 2.8-22)) compared to the reduced z-axis group (5.5 mSv (SD 3.0, range = 1.6-13, p < 0.001). The average effective dose for the reduced z-axis group was 49 % less than that of the full z-axis group. Reducing the z-axis of a CTA for PE significantly reduces effective radiation dose.

Transient osteoporosis of pregnancy in a 34-year-old female.

A 34-year-old Caucasian female presented during the third trimester of her pregnancy with bilateral hip pain that became progressively severe. Imaging of her pelvis and bilateral hips with MRI obtained during her third trimester of pregnancy demonstrated bilateral bone-marrow edema of the femoral heads and the sacrum at S1. Repeat MRI performed at 6 months postpartum revealed resolution of edema. MRI is considered the best diagnostic test for this condition in regards to sensitivity and specificity.

Reduced Z-axis coverage multidetector CT angiography for suspected acute pulmonary embolism could decrease dose and maintain diagnostic accuracy.

Multidetector computed tomographic angiography (MDCTA) is the method of choice for evaluation of suspected acute pulmonary embolism (PE) in most patients because it is accurate and widely available. The use of computed tomography, including MDCTA for PE, has risen dramatically over the last several years with an attendant rise in radiation exposure. Many methods currently employed to reduce radiation dose may affect image quality and potentially affect diagnostic accuracy. Reducing Z-axis coverage would decrease radiation dose without any effect on image quality. This study was performed to assess the effect on the accuracy of MDCTA for suspected acute PE if the Z-axis coverage was reduced to the anatomic range from the top of the aortic arch through the heart. Two hundred ninety-five examinations were performed on a 64-detector-row MDCT and interpreted as positive for PE from July 2005 to February 2008. When the anatomic range of these data sets were retrospectively reduced and reinterpreted for PE, no case was interpreted as negative for PE. The Z-axis coverage was reduced by 37%. In the interest of keeping radiation doses as low as reasonably achievable, further research in this area is warranted.

A psychoanalytic exploration of collective trauma among Indigenous Australians and a suggestion for intervention.

OBJECTIVE: Psychoanalysis is used to explore the effects of the annihilation of culture and how this leads to a loss of identification with a collective subjectivity and triggers catastrophic symptoms including loss of collective hope, the rise of addictive and self-destructive behaviours, and the intergenerational transmission of trauma among Indigenous Australian communities. CONCLUSIONS: I propose restorative educational interventions for young Indigenous children that seek to engage them with ancestral memory, cultural narratives, and a sense of purpose so that healing from historically transmitted trauma may be initiated and a grounded sense of subjectivity restored.

Added cancer yield of MRI in screening the contralateral breast of women recently diagnosed with breast cancer: results from the International Breast Magnetic Resonance Consortium (IBMC) trial.

OBJECTIVE: To estimate the added cancer yield of magnetic resonance imaging (MRI) over mammography in the contralateral breast of patients with a recent diagnosis of breast cancer. METHODS: We conducted a prospective, international study of mammography and MRI in women with a recent diagnosis of unilateral breast cancer. Each subject received a mammogram, clinical breast exam (CBE), and MRI of the unaffected breast within a 90 day time period. Definitive diagnosis of suspicious findings was determined through biopsy and central pathology review. RESULTS: Of the 103 eligible women included in study analyses, MRI detected 4 cancers in the contralateral breast while mammography detected none. MRI resulted in 12% (95% CI, 6%-20%) of women recommended for biopsy and 10% of women undergoing additional biopsy. The added cancer yield of MRI was 4% (95% CI, 1%-10%) and the positive predictive value of an abnormal MRI was 33% (95% CI, 10%-65%). Forty percent (4/10) of the biopsies performed based on the MRI recommendation were positive for malignancy. CONCLUSION: In women with a recent breast cancer diagnosis, approximately 4% will have an otherwise occult invasive breast cancer detected in the opposite breast by MRI alone.

Screening women at high risk for breast cancer with mammography and magnetic resonance imaging.

BACKGROUND: The authors compared the performance of screening mammography versus magnetic resonance imaging (MRI) in women at genetically high risk for breast cancer. METHODS: The authors conducted an international prospective study of screening mammography and MRI in asymptomatic, genetically high-risk women age >/= 25 years. Women with a history of breast cancer were eligible for a contralateral screening if they had been diagnosed within 5 years or a bilateral screening if they had been diagnosed > 5 years previously. All examinations (MRI, mammography, and clinical breast examination [CBE]) were performed within 90 days of each other. RESULTS: In total, 390 eligible women were enrolled by 13 sites, and 367 women completed all study examinations. Imaging evaluations recommended 38 biopsies, and 27 biopsies were performed, resulting in 4 cancers diagnosed for an overall 1.1% cancer yield (95% confidence interval [95%CI], 0.3-2.8%). MRI detected all four cancers, whereas mammography detected one cancer. The diagnostic yield of mammography was 0.3% (95%CI, 0.01-1.5%). The yield of cancer by MRI alone was 0.8% (95%CI, - 0.3-2.0%). The biopsy recommendation rates for MRI and mammography were 8.5% (95%CI, 5.8-11.8%) and 2.2% (95%CI, 0.1-4.3%). CONCLUSIONS: Screening MRI in high-risk women was capable of detecting mammographically and clinically occult breast cancer. Screening MRI resulted in 22 of 367 of women (6%) who had negative mammogram and negative CBE examinations undergoing biopsy, resulting in 3 additional cancers detected. MRI also resulted in 19 (5%) false-positive outcomes, which resulted in benign biopsies.

Sonographically guided percutaneous radio frequency ablation of a renal cell carcinoma in a transplanted kidney.

Radio frequency ablation is an effective treatment for focal renal cell carcinoma (RCC). We report a patient with RCC in a transplanted kidney that was successfully treated with percutaneous sonographically guided radio frequency ablation.