[MRI of the temporomandibular joint--the gold standard].

MRI has been established as the imaging modality of choice for the evaluation of temporomandibular joint disorders (TMD), as it allows for a noninvasive detailed evaluation of the joint that is not otherwise available. During the last decade, the introduction of dynamic (cine-mode) MR imaging has made functional evaluation feasible in addition to the morphologic study of the joint. The major advantage of MRI is its ability to study the articular disc and its congruity as well as its location relative to the condyle in both closed- and open-mouth positions. Due to its high contrast resolution, MRI is unique in demonstrating joint effusion, bone edema and sclerosis, rupture of the retrodiscal layers and impairment of the lateral pterigoid muscle. In Mor-Mar Imaging Center we performed during the last two years MRI studies of the TMJ in 234 subjects, 172 (74%) female and 62 (26%) male patients. The average age of the patients was 29 years. In this article we present our experience in the evaluation of TMD and review the main indications and findings. In addition, our experience in optimizing the MRI sequence protocols in both static and dynamic modes are discussed. MRI examinations provide the clinician with anatomic and physiologic information that can guide treatment decisions. It has a special role in monitoring and evaluating treatment results, both conservative and surgical.

Congenital coronary artery anomalies in adults: non-invasive assessment with multidetector CT.

Congenital coronary anomalies (CCAs) are uncommon but can cause sudden cardiac death or other symptoms of myocardial ischaemia, especially in young healthy subjects. Conventional coronary angiography (CA) is an invasive and expensive procedure, and cannot provide three-dimensional data on the anomalous vessel. Electrocardiographic gated multidetector CT (MDCT) has been reported to be useful for non-invasive evaluation of CCAs. The purpose of this pictorial review is to discuss and illustrate different CCAs in terms of clinical importance, type and manifestations using MDCT. Knowledge of the CT appearances and an understanding of the clinical significance of these anomalies are essential for making the correct diagnosis and planning patient treatment.

Acute myocardial infarction in a young woman with normal coronary arteries and myocardial bridging.

Myocardial bridging (MB) is defined as an intramural segment of a coronary artery that normally courses epicardially. MB is usually a benign condition; however, some cases resulting in myocardial ischaemia, infarction and sudden death have been reported. We describe a case of myocardial infarction related to MB in a young healthy woman with no risk factors for coronary artery disease. The bridge was demonstrated in detail by coronary CT angiography using multiplanar reconstruction and three-dimensional volume-rendered techniques.

Coronary-pulmonary artery fistula diagnosed by multidetector computed tomography.

Coronary-pulmonary artery fistula is an uncommon cardiac anomaly, usually congenital. Most coronary-pulmonary artery fistulas are clinically and haemodynamically insignificant and are usually found incidentally. This report describes a case of complex coronary-pulmonary artery fistula with two feeding vessels of separate origins: one from the proximal part of the left anterior descending artery and another arising from the right aortic cusp. The complex anatomy of the fistula was shown in detail by multidetector computed tomography using multiplanar reconstruction and 3D volume rendering techniques.

Pulsatile venous insufficiency in severe tricuspid regurgitation: does pulsatility protect against complications of venous disease?

Prior observations showed that the consequences of venous hypertension depend not only on the magnitude of the venous pressure but also on the efficiency of compensatory mechanisms that protect against the effects of excessive pressures on the microcirculation. Pulsatile venous insufficiency (PVI) associated with severe tricuspid regurgitation (TR) provides the opportunity to investigate the effect of the pulsatile shear stress on the outcome of venous insufficiency. The authors conducted a study to assess the flow characteristics and clinical outcome of PVI associated with TR. Five patients were evaluated, presenting venous insufficiency associated with ectasia, varices, and visible systolic pulsations of the leg veins. Characteristics of the venous flow were assessed by duplex ultrasound. In two patients, flow in the distal calf veins was evaluated by power Doppler sonography, and the supine-to-sitting leukocyte trapping was calculated. Results of the latter measurements were compared with measurements in five control patients who presented chronic nonpulsatile venous insufficiency. A survey of complications of PVI was conducted. On follow-up for 6 to 15 years (average 9.4 years) none of the patients developed venous thrombosis, phlebitis, or cutaneous ulcer. Flow in the distal calf vessels was increased in PVI (12-20 vessels/field) as compared with nonpulsatile venous insufficiency (0-7 vessels/field). Leukocyte trapping in the upright position was diminished in PVI (0.8-3%) as compared with nonpulsatile venous insufficiency (7-22%). In conclusion, PVI is characterized by increased flow in the distal calf veins, diminished leukocyte trapping, and a benign clinical course. These data are in agreement with experimental studies showing that pulsatile shear stress enhances secretion of cytokines by venous endothelial cells and, consequently, counteracts a predisposition to platelet aggregation, hypercoagulability, and white cell adhesion and promotes healing of leg ulcers.

[Space-occupying lesions in the iliopsoas space: a challenge in the Department of Internal Medicine].

Mass lesions in the iliopsoas compartment (MLIPC) are uncommon in patients in departments of medicine and their incidence and etiologies are unclear. In a prospective study we diagnosed various MLIPCs in 7 patients during a 10-year period, representing 0.03% of admissions. Symptoms included abdominal or flank pain (4 cases), pain along the thigh (5), diminished psoas muscle strength (2), fever (2), and hypotension (1). MLIPC was suspected on clinical grounds in 5 cases. In all cases the diagnosis was established by computed tomography (CT). Tissue was sampled by needle biopsy in 4 and on surgery in 1. MLIPCs were caused by hemorrhage (2), infection (2), neoplasia (2) and inflammatory mass (1). Often MLIPCs are life-threatening so their timely diagnosis by early CT scan is important.

Duplex scanning and CT angiography in the diagnosis of carotid artery occlusion: a prospective study.

OBJECTIVES: Differentiating total occlusion from tight stenosis of the internal carotid artery is crucial with regard to treatment and prognosis. At our institution, the diagnosis of carotid stenosis is based on duplex scanning. In cases of occlusion, duplex is not reliable, and angiography is performed, thereby increasing morbidity. We tried to determine whether a combination of duplex scanning and CT angiography (CTA) can replace angiography in the diagnosis of carotid occlusion. DESIGN: Prospective study. MATERIALS AND METHODS: From 1995 to 1997, 148 patients were diagnosed as having carotid occlusion by duplex scanning. CTA was performed on all patients. Forty-four patients underwent angiography and 10 patients were surgically explored. Both procedures were considered "gold standard" for the diagnosis of occlusion. RESULTS: Arteries found to be occluded by both CTA and duplex scan were confirmed as occluded by angiography or operation in 95% of the cases (42/44). Arteries found to be occluded by duplex but patent by CTA were confirmed as patent in 100% of cases (10/10). CTA has a significantly higher positive predicting value for diagnosing occlusion than duplex scan (95% vs. 77%, p value < 0.01). CONCLUSIONS: Combination of duplex scanning and CTA is safe and accurate in the diagnosis of carotid occlusion and can replace angiography in most cases, thereby reducing morbidity.

Diagnosis of cystitis glandularis.

Bladder tumor mass may represent a benign lesion and the diagnosis of cystitis glandularis should be considered and cystoscopically evaluated.

Calcified subdural haematomas associated with arrested hydrocephalus--late sequelae of shunt operation in infancy.

Calcified chronic subdural haematomas (SDH) and features of arrested (compensated) hydrocephalus were demonstrated by skull radiography and cranial computed tomography (CT) in two children who had no neurological deficit. Ventricular surgical drainage had been performed 8 and 11 years prior to admission and the haematomas remained subsequently undetected. The following presentation will serve to illustrate the characteristic radiological features of this entity, the issue of management, and includes a review of the literature.