Visualization of the Long Thoracic Nerve using High-Resolution Sonography.

PURPOSE: The long thoracic nerve (LTN) innervates the serratus anterior muscle (SA) which plays an important role in shoulder function. Evaluation of the LTN has so far been restricted to clinical assessment and partly electromyography and neurography. Progress of high-resolution ultrasound (HRUS) increasingly enables visualization of small peripheral nerves and their pathologies. We therefore aimed at (a) clarifying the possibility of visualization of the LTN from its origin to the most distal point in the supraclavicular region visible and (b) developing an ultrasound protocol for routine use. We further present two cases of patients with LTN pathology. METHODS: The study consisted of two parts: Part 1 included 4 non-enbalmed human bodies in whom the LTN (n = 8) was located and then marked by ink injection. Correct identification was confirmed by anatomical dissection. Part 2 included 20 healthy volunteers whose LTN (n = 40) was assessed independently by two radiologists. Identification of the LTN was defined as consensus in recorded images. RESULTS: LTN was clearly visible in all anatomical specimens and volunteers using HRUS and could be followed until the second slip of the serratus anterior muscle from the supraclavicular region. In anatomical specimens, dissection confirmed HRUS findings. For all volunteers, consensus was obtained. The mean nerve diameter was 1.6 mm ±â€Š0.3 (range 1.1 - 2.1 mm) after the formation of the main trunk. DISCUSSION: We hereby confirm a reliable possibility of visualization of the LTN in anatomical specimens as well as in volunteers. We encourage HRUS of the LTN to be part of the diagnostic work-up in patients presenting with scapular winging, shoulder weakness or pain of unknown origin.

High-Resolution Ultrasound for Diagnostic Assessment of the Great Auricular Nerve--Normal and First Pathologic Findings.

PURPOSE: The great auricular nerve (GAN) is a sensory branch of the superficial cervical plexus. While its blockade is an established procedure, little is known about the ultrasound appearance of pathologic conditions of the GAN itself. We, therefore, aimed to evaluate the possibility of the visualization and diagnostic assessment of the GAN along its entire course by means of high-resolution ultrasound (HRUS). MATERIALS AND METHODS: To assess the feasibility of visualization, we performed HRUS with an 18 MHz probe, HRUS-guided, fine-needle ink markings and consecutive dissection in six anatomical specimens. Then, we measured the diameter of the GAN in healthy volunteers and finally performed a retrospective review of patients referred for HRUS examinations because of pain within GAN territory between August 1, 2012 and August 1, 2013. RESULTS: The GAN was clearly visible with HRUS from its formation to the final branches, and was marked successfully on both sides in all anatomical specimens (n = 12). The mean average in-vivo was 0.14 cm ± 0.03 (range 0.08-0.2). Seven cases of patients with GAN pathologies of various origins (idiopathic, traumatic, tumorous and iatrogenic) were identified, of which 6 were visible on HRUS and all of which could be confirmed by complete resolution of symptoms after selective HRUS-guided GAN block. CONCLUSION: This study confirms the reliable ability to visualize the GAN with HRUS throughout its course, both in anatomical specimens and in vivo. The provided cases show that pathologies of the GAN seem to have a variety of causes and may not be rare. We, therefore, encourage the use of HRUS in patients with unclear pain in the auricular, periauricular and posterior-lateral head.

Fat saturation in dynamic breast MRI at 3 Tesla: is the Dixon technique superior to spectral fat saturation? A visual grading characteristics study.

PURPOSE: To intra-individually compare the diagnostic image quality of Dixon and spectral fat suppression at 3 T. METHODS: Fifty consecutive patients (mean age 55.1 years) undergoing 3 T breast MRI were recruited for this prospective study. The image protocol included pre-contrast and delayed post-contrast spectral and Dixon fat-suppressed T1w series. Two independent blinded readers compared spectral and Dixon fat-suppressed series by evaluating six ordinal (1 worst to 5 best) image quality criteria (image quality, delineation of anatomical structures, fat suppression in the breast and axilla, lesion delineation and internal enhancement). Breast density and size were assessed. Data analysis included Spearman's rank correlation coefficient and visual grading characteristics (VGC) analysis. RESULTS: Four examinations were excluded; 48 examinations in 46 patients were evaluated. In VGC analysis, the Dixon technique was superior regarding image quality criteria analysed (P < 0.01). Smaller breast size and lower breast density were significantly (P < 0.01) correlated with impaired spectral fat suppression quality. No such correlation was identified for the Dixon technique, which showed reconstruction-based water-fat mixups leading to insufficient image quality in 20.8%. CONCLUSIONS: The Dixon technique outperformed spectral fat suppression in all evaluated criteria (P < 0.01). Non-diagnostic examinations can be avoided by fat and water image reconstruction. The superior image quality of the Dixon technique can improve breast MRI interpretation. KEY POINTS: Optimal fat suppression quality is necessary for optimal image interpretation. Superior fat suppression quality is achieved using the Dixon technique. Lesion margin and internal enhancement evaluation improves using the Dixon technique. Superior image quality of the Dixon technique improves breast MRI interpretation.

Clinical application of bilateral high temporal and spatial resolution dynamic contrast-enhanced magnetic resonance imaging of the breast at 7 T.

OBJECTIVE: The objective of our study was to evaluate the clinical application of bilateral high spatial and temporal resolution dynamic contrast-enhanced magnetic resonance imaging (HR DCE-MRI) of the breast at 7 T. METHODS: Following institutional review board approval 23 patients with a breast lesion (BIRADS 0, 4-5) were included in our prospective study. All patients underwent bilateral HR DCE-MRI of the breast at 7 T (spatial resolution of 0.7 mm(3) voxel size, temporal resolution of 14 s). Two experienced readers (r1, r2) and one less experienced reader (r3) independently assessed lesions according to BI-RADS®. Image quality, lesion conspicuity and artefacts were graded from 1 to 5. Sensitivity, specificity and diagnostic accuracy were assessed using histopathology as the standard of reference. RESULTS: HR DCE-MRI at 7 T revealed 29 lesions in 23 patients (sensitivity 100 % (19/19); specificity of 90 % (9/10)) resulting in a diagnostic accuracy of 96.6 % (28/29) with an AUC of 0.95. Overall image quality was excellent in the majority of cases (27/29) and examinations were not hampered by artefacts. There was excellent inter-reader agreement for diagnosis and image quality parameters (κ = 0.89-1). CONCLUSION: Bilateral HR DCE-MRI of the breast at 7 T is feasible with excellent image quality in clinical practice and allows accurate breast cancer diagnosis. KEY POINTS: • Dynamic contrast-enhanced 7-T MRI is being developed in several centres. • Bilateral high resolution DCE-MRI of the breast at 7 T is clinically applicable. • 7-T HR DCE-MRI of the breast provides excellent image quality. • 7-T HR DCE-MRI should detect breast cancer with high diagnostic accuracy.

Sonographic imaging of abdominal and extraabdominal desmoids.

PURPOSE: To describe the sonographic imaging characteristics of abdominal and extraabdominal desmoids. MATERIALS AND METHODS: We retrospectively investigated 12 histologically and pathologically proven abdominal and extraabdominal desmoids. Two radiologists with musculoskeletal sonography experience reviewed sonographic images for lesion location, size, echotexture, and vascularity with agreement by consensus. RESULTS: Desmoids were seen in 9 females and 3 males. They manifested as slowly growing masses. Nine lesions were intramuscular and 3 were found within the subcutaneous adipose tissue. A typical sonographic feature of all intramuscular desmoids was the spindle-shaped margin at the tumor ends when scanned along the long axis of the affected muscle. The desmoids arising from the fascia had an irregular shape. Tumor vascularity was rich in 6 cases and poor in 6 cases. A fibrillar pattern within the tumor was found in 75% of the cases. CONCLUSION: A spindle-shaped appearance is common in intramuscular desmoids. Hyperechoic areas and a fibrillar pattern within desmoids are also common sonographic features.

[Anti-inflammatory activity of (o-cresotinate) copper and zinc aquacomplexes]. / Protizápalová aktivita (o-krezotináto)mednatého a-zinocnatého akvakomplexu.

Using rat paw dextran-induced and carrageenan-induced edemas, the antiedematous activities of monohydrate of the diaquatetrakis(o-cresotato)dicopper(II) complex (CuoC) and the diaquabis(o-cresotato)zinc(II) complex (ZnoC) were assayed plethysmometrically. Dihydrate of the diaquabis(salicylato)copper(II) complex (CuS) and the diaquabis(salicylato)zinc(II) complex (ZnS) were used as the standards of comparison. All compounds were administered i.p. in a single dose of 50 mumol/kg body weight (calculated for the RCOO-fragment) 30 min before injecting the irritants. The antidextran/anticarrageenan activities of the species (expressed as a mean edema reduction) were found: CuoC 36/54%--ZnoC 59/65%--CuS 71/52%--ZnS 63/10%. The relationships between the coordination-chemical properties and the biological effects of the corresponding complexes are discussed.