Pulmonary thromboembolism and alveolar hemorrhage as initial manifestations of systemic lupus erythematosus.

Systemic lupus erythematosus (SLE) is an autoimmune disease that affects multiple organs. SLE can affect the lung, the pulmonary vasculature, and the pleura. A 38-year-old female with limb pain and ecchymosis who later developed pulmonary thromboembolism and alveolar hemorrhage is presented here. Clinical, imaging, laboratory, and histopathological evidence is presented. The patient met the European League Against Rheumatism (EULAR) and the American College of Rheumatology (ACR) criteria for SLE. Furthermore, the patient had a Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) score of 35; thus, indicating severe disease. This case is an example of concomitant venous and arterial lung complications in an SLE patient.

Vertebral endplate changes are not associated with chronic low back pain among Southern European subjects: a case control study.

BACKGROUND AND PURPOSE: Data on the association between vertebral endplate changes and low back pain are contradictory. This study was designed to assess whether this association exists among Southern European subjects. MATERIALS AND METHODS: Patients in this study serving as cases were 35-50 years of age with low back pain lasting >90 days, for whom a lumbar MR imaging had been prescribed. Controls were subjects 35-50 years of age, having a cranial MR imaging for headache with normal findings, and no history of clinically relevant LBP. Two hundred forty cases and 64 controls were recruited consecutively in the radiology services across 6 cities in Spain. Imaging findings and subject characteristics were gathered through previously validated instruments. Radiologists who interpreted MRI were blinded to the subject characteristics. A multivariate logistic regression model was developed to assess the association of vertebral endplate changes with LBP, adjusting for sex, age, body mass index, lifetime exposure to smoking, physical activity, disk degeneration, and the interaction between disk degeneration and vertebral endplate changes. RESULTS: Vertebral endplate changes were found in 80.4% of the cases and in 87.5% of the controls. In the regression model, disk degeneration was the only variable showing a confounding effect. Results showed that after adjusting for disk degeneration, the presence of vertebral endplate changes is associated with the absence of chronic LBP (OR for LBP: 0.31; 95% CI, 0.10-0.95). CONCLUSIONS: In Southern European subjects, vertebral endplate changes are not associated with chronic LBP.

Utilidad de la correcta medida de la presión arterial / Utility of correct measurement of blood pressure arterial

La correcta medición de la presión arterial (PA) es fundamental para el diagnóstico y seguimiento del paciente hipertenso. Sin embargo, los errores en la toma de la PA relacionados con la patología local del paciente son poco frecuentes y pasan desapercibidos. Presentamos los casos de dos pacientes hipertensos con obstrucción de la arteria subclavia, lo que provocó errores en la medida de la PA e incorrecto manejo debido a esta circunstancia

Correct measurement of blood pressure (BP) is essential for diagnosis and follow-up of the hypertensive patient. However, errors in measuring BP related with local condition of the patient are uncommon and are overlooked. We present the cases of two hypertensive patients with obstruction of subclavian artery that caused errors in BP measurement and incorrect management due to this circumstance

Enhancement characteristics of hepatic focal nodular hyperplasia and its scar by dynamic magnetic resonance imaging.

RATIONALE AND OBJECTIVES: To determine the relationship between the lesion and the scar enhancement characteristic in a series of hepatic Focal Nodular Hyperplasia (FNH) lesions studied with dynamic MR imaging. METHODS: Nine patients with FNH were studied. The slice showing the largest scar was selected for the dynamic single slice T1-weighted Gradient-echo sequence before and after contrast administration (15 images, one every 20 s). Analysis was performed with ROI measurements in the lesion and the scar. Signal-intensity and enhancement curves were obtained from both structures. RESULTS: Dynamic MRI showed the typical homogeneous early enhancement of the lesion with delayed enhancement of the scar. The scar enhanced early and vigorously in all cases. Two patterns of enhancement curves were defined. In the parallel pattern, both curves started early, quickly reaching a plateau maintained over time (77.8%). In the divergent pattern the curve of the scar was above the curve of the FNH (22.2%), after the maximum slope was reached, with progressive separation of the curves. CONCLUSION: There is a hypervascular scar enhancement within FNH lesions with either a parallel or divergent course after the maximum early enhancement.

MR imaging of Baker cysts --prevalence and relation to internal derangements of the knee.

RATIONALE AND OBJECTIVES: To evaluate the prevalence of popliteal cysts in patients studied with magnetic resonance (MR) imaging. Cyst presence and volume will be related to other internal derangement of the knee. MATERIALS AND METHODS: Three hundred and eighty-two consecutive patients with a MR study of the knee were included. Images were obtained in the three spatial orthogonal planes and evaluated through consensus. Four categories were established for the Baker cyst and synovial fluid (absence, minimum, moderate and massive), and the presence of meniscal, cruciate ligaments and cartilage lesions were recorded. Statistical analysis was carried out with bivariate analysis (chi(2) of Pearson and Gamma tests). RESULTS: From the 382 patients, 145 had Baker cysts (38.0%). Cyst content was minimum in 99, moderate in 34 and massive in 12. Joint effusion was observed in 269 patients (70.4%), being minimal in 140 patients, moderate in 119 and massive in ten. Meniscal lesions were observed in 195 patients (51%), while 58 patients (15%) had a cruciate ligament lesion. Baker cyst had a statistically significant direct relationship with the presence and quantity of synovial fluid (P=0.002) and with the presence and type of meniscal lesion (P=0.01) but not with cruciate ligaments or cartilage lesions. CONCLUSIONS: The prevalence of Baker cysts in MR studies of the knee is high. Its presence and volume are related to the quantity of synovial fluid, and to the presence and severity of meniscal lesions.

[Value of MR myelography in the diagnosis of the spine disorders]. / Utilidad de la mielografía mediante resonancia magnética en el diagnóstico de las enfermedades de la columna vertebral.

To evaluate the utility of myelography obtained with MR imaging (MR-myelography) as a complementary tool in patients studied with a conventional MR examination of the spine. 275 consecutive patients were included. All of them were studied with MR-myelography in 2 planes, coronal and sagittal, with a turbo spin-echo single-shot technique, as a complement to a conventional MR study of the spine; 130 were males and 145 women, with ages ranging from 20 to 71 years (mean, 45 years). The analyzed variables were age, sex, vertebral segment studied, alteration of the dural sac, intradural nerve roots, emergent roots, and presence of intradural lesions, meningeal cysts, and spinal stenosis. The added value of MR-myelography regarding conventional MR was categorized. MR-myelography obtained new information in 88 cases (32%), being considered irrelevant information in 42 cases and relevant in 46 cases (16.7% of all cases) (amputations of the emergent roots and alterations of the intradural roots). MR-myelography did not contribute to any type of additional information to the conventional MR study in 187 cases (68% of all studies). MR-myelography is a rapid acquisition technique that supplements the conventional MR study of the spine, contributing with relevant new information in the analysis of the spine diseases 16.7% of cases.

Synovialisation of the torn anterior cruciate ligament of the knee: comparison between magnetic resonance and arthroscopy.

The aim of this study was to assess the accuracy of MR in the diagnosis of synovialisation of the anterior cruciate ligament (ACL) compared with arthroscopy. One hundred and forty-nine patients were examined with MR imaging and arthroscopy of the knee. The MR sign used to consider a synovialised ACL consisted of hypointense fibrillar tracts, disrupted and wavily, in its expected course. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV), comparison of proportions (McNemar test) and Kappa values for agreement between MR imaging and arthroscopy were calculated. Of the 133 (89.3 %) ligaments without synovialisation at arthroscopy, 130 accorded with the MR results. Of the 16 (10.7 %) synovialised ligaments, 13 accorded with the MR results. Three false-positive and three false-negative MR diagnoses were identified. The agreement between both techniques was excellent (Kappa = 0.79; p = 0.000), without differences (McNemar test; p = 1). Sensitivity was 0.81, specificity 0.98, PPV 0.98 and NPV 0.81. Magnetic resonance imaging is highly reliability for synovialisation diagnosis. The imaging sign used to diagnose synovialised ACL (hypointense comma-like tracts in its expected course) is reliable. As this reparative process can simulate an intact ligament, knowledge of this sign is important in diagnosing synovialisation of ACL tears so as not to confuse it with normal ACL.

Dose effect of dicyclomine on the reduction of peristaltic artifacts on MRI of the abdomen.

BACKGROUND: It has been demonstrated that oral administration of dicyclomine significantly reduces the noise associated with the movement of the gastrointestinal tract in abdominal magnetic resonance (MR) images. Our objective was to determine the efficacy and security of two different doses of oral dicyclomine for the reduction of the gastrointestinal noise in abdominal MR imaging. METHODS: Forty-eight patients with MR imaging of the upper abdomen were enrolled in a prospective, controlled, randomized, and double-blind study. All patients ingested barium of high density (196 g in 130 mL of tap water, 250 w/v) approximately 25 min before the MR examination. Patients were randomly distributed into three groups of 16 patients each: (a) no-drug control group, (b) 20 mg of dicyclomine chlorhydrate, and (c) 80 mg of dicyclomine chlorhydrate. Quantitative image analysis was performed with region-of-interest measurements of the signal intensity in background air posterior and lateral to the patient and in the liver. Adverse effects were counted at 2 h and 1 day after the MR examination. RESULTS: The liver and incoherent noise signal intensities were not statistically different among groups. The control group presented a gastrointestinal noise (mean and SD of the air signal intensity) that was statistically superior to that of the groups with dicyclomine (p = 0.004 and p = 0.004, respectively), although significant differences were not observed between the two dicyclomine groups. Although the differences were not significant, adverse effects were more frequently associated with the higher doses of dicyclomine. All the adverse effects (most frequently, constipation, diarrhea, and abdominal pain) were considered minor and did not require treatment. CONCLUSION: Oral dicyclomine is effective and safe for the reduction of peristaltic artifacts on abdominal MR imaging. The dose of 20 mg presents an efficacy similar to that of 80 mg, with a probably lower incidence of adverse reactions.

Atypical hepatic hemangiomas with intense arterial enhancement and early fading.

BACKGROUND: Our purpose is to analyze the prevalence and characteristics of the enhancement patterns of hemangiomas. METHODS: Fifty-five proven hemangiomas studied with a dynamic single-slice T1-weighted spoiled gradient echo sequence (50/13/65 degrees) were retrospectively selected. Fifteen images of the tumor in 5 min were obtained after a bolus of gadolinium. A temporal planar reconstruction image was generated to analyze the dynamic evolution of a line of interest through the tumor. RESULTS: Most hemangiomas (60%) had a typical progressive pattern with hyperintensity on late images. Of these, 34.6% had an intense enhancement pattern with the highest slope close to the arterial or portal phases of perfusion and 25.5% had a less intense enhancement with a more constant rate. In 10.9% of cases, the enhancement was slowly progressive with late isointensity and 7.3% had a very slow progressive pattern with late hypointensity; all had a globular peripheral initial enhancement pattern. There were 12 hemangiomas (21.8%) with intense arterial enhancement and early fading; eight of 12 (66.7%) showed peripheral globular enhancement, with all 12 hemangiomas remaining hyperintense to the liver at the end of the dynamic study. In four cases, the initial enhancement was diffuse throughout the entire lesion. CONCLUSIONS: Hemangiomas can have early intense enhancement with early fading and diffuse intense enhancement.

MnDPDP enhancement characteristics and differentiation between cirrhotic and noncirrhotic livers.

RATIONALE AND OBJECTIVES: The objective was to analyze if liver enhancement with mangafodipir trisodium was influenced by liver cirrhosis. METHODS: Eighty patients (49 with cirrhotic and 31 with noncirrhotic livers) were studied with spin-echo and spoiled gradient-echo T1-weighted images, before and after administration of mangafodipir trisodium. Hepatic insufficiency was assessed using the Child classification. Image analysis was performed both qualitatively and quantitatively. RESULTS: Noncirrhotic livers enhanced homogeneously but 37% of cirrhotic livers did not; the difference was significant. Areas corresponding to collapsed fibrous zones enhanced less than the rest of the parenchyma; areas of regenerating nodular zones enhanced more. Signal-to-noise ratios were significantly less for cirrhotic livers on postcontrast spoiled gradient-echo images. Cirrhotic livers had significantly lower relative enhancement ratios than noncirrhotic ones. The Child index and aspartate aminotransferase values were statistically related to the enhancement ratio. CONCLUSIONS: Mangafodipir trisodium enhancement in cirrhotic livers is related to necrosis and regeneration of the hepatocytes. Cirrhotic livers enhanced less than noncirrhotic ones.

Pseudotumoral presentation of nodular regenerative hyperplasia of the liver: imaging in five patients including MR imaging.

Nodular regenerative hyperplasia (NRH) of the liver is a condition characterized by multiple monoacinar regenerative nodules in the absence of fibrous septa. When these nodules become confluent they may be seen with sonography or CT. The appearance of these pseudotumoral pattern of NRH has been scarcely described with MRI. We present the imaging findings of five patients with NRH and a pseudotumoral form at sonography. Sonography depicted hyperechoic lesions in four patients and hypoechoic lesions in another. Computed tomography showed hypodense lesions with little contrast enhancement in two patients. Three patients showed subtle focal liver lesions on MRI: isointense in one, mildly hypointense in another, and minimally hyperintense in a patient with siderosis. The dynamic behavior at MRI was similar to the normal liver parenchyma. Hyperechoic lesions on sonography or hypodense lesions on CT, barely or not seen on MRI, can be indicative of NRH in an appropriate clinical setting.

Differentiation of healthy from cirrhotic livers. Evaluation of parametric images after contrast administration in magnetic resonance imaging.

RATIONALE AND OBJECTIVES: The authors describe a method to differentiate healthy from cirrhotic livers by the analysis of their behavior after paramagnetic contrast administration on magnetic resonance imaging. METHODS: A dynamic single-slice spoiled-gradient recalled echo magnetic resonance imaging after contrast administration was performed on 67 patients (36 healthy livers and 31 cirrhotic livers). Three parametric images (averaged-enhancement, maximum-enhancement, and maximum-velocity) were reconstructed from the temporal dynamic images. Liver values were quantified by means of a region-of-interest procedure. RESULTS: Relative averaged-enhancement and maximum-enhancement values were significantly different ( P < 0.05) between cirrhotic and normal livers. There was a significant correlation between the parametric values and the Child-Turcotte index of hepatic chronic insufficiency (P < 0.05). CONCLUSIONS: Parametric images allow characterization of the signal-versus-time pixel-by-pixel variations in dynamic magnetic resonance imaging. The averaged-enhancement and maximum-enhancement values can be used to differentiate healthy from cirrhotic livers with accuracy. The higher values found in cirrhotic patients may reflect an overall increase in the amount of extracellular contrast present with respect to healthy livers. The degree of liver brightness in cirrhotic patients probably is related to an increased amount of interstitial space, an indirect measurement of hepatic necrosis.

Randomised double-blind clinical trial of intermediate- versus high-dose chloral hydrate for neuroimaging of children.

Orally administered chloral hydrate is the most widely used sedative in children undergoing MRI. We compared intermediate- and high-dose oral chloral hydrate in 97 consecutive children undergoing MRI in a prospective, controlled, double-blind, randomised clinical trial. There were 50 girls and 47 boys, mean weight (+/- SD) 14.7 +/- 6.4 kg, and mean age 38 +/- 31. The children were randomly allocated to receive chloral hydrate syrup either 70 mg/kg (group A, n = 50) or 100 mg/kg (group B, n = 47). These two groups were not significantly different in sex, weight, age, diagnosis or ambulatory medication. The mean initial dose (+/- SEM) was 64 +/- 2 mg/kg for group A and 93 +/- 2 mg/kg for group B. Because adequate sedation was not achieved, 14 patients in group A and 6 in group B required a second dose, giving a mean total dose of 70 +/- 2 mg/kg for group A and 96 +/- 2 mg/kg for group B. The percentage of successful examinations after the initial dose (A: 64%, B: 87%; p < 0.05) and the total dose (A: 92%, B:100%; p = 0.14) was higher in group B. Significant differences were found for the time of onset of sedation (A:28 +/- 2 min, B: 21 +/- 1 min; p < 0.05), but not for the time to spontaneous awakening after the completion of the examination. The rate of adverse reactions was similar (A: 20%, B: 21%; p = 1.00). We conclude that high-dose oral chloral hydrate improves the management of children undergoing MRI.

[Percutaneous nephrostomy. Review of 92 cases]. / Nefrostomías percutáneas. Revisión de 92 casos.

Presentation of 92 nephrostomies percutaneous in 70 patients. Nephrostomy was bilateral in 5 cases. Three patients had collections of renal origin (2 urinomas and 1 abscess) which were treated percutaneously. The indication for nephrostomy was in all cases obstruction of the collector system, with one exception where the indication was ureteral fistula. Origin was lithiasis in 53 cases, 15 cases vesical carcinoma, 3 post-surgical iatrogenic stenosis, 1 fistula and formation of urinoma after lithotrity, 5 prostate carcinoma infiltration, 8 infectious origin, 4 congenital and 1 due to glandular cystitis. 9 patients were monorenal. In 6 patients leucocytosis was present, 4 has fever, and in 11 coexisted fever and leucocytosis. High creatinine and urea levels were present in 55.7% and 41% patients, respectively.. Renal puncture through lower calyceal group was the preferred option. Purulent urine was obtained in 17 cases. With regard to nephrostomy complications haematuria occurred in 30 cases (only in 9 it lasted more than 1 day); and there was 1 case of pararenal haematoma. Pain was significant in 12% procedures and contrast extravasation resulted in 14% cases (in all of them proper positioning of nephrostomy catheter was possible). Spontaneous expulsion and the subsequent replacement of the catheter occurred in 12 cases. On average, residence time of catheter was 44.8 days. In all cases both the patient's signs and symptoms, and the laboratory results were improved.

Dynamic MR imaging of liver tumors: analysis with temporal reconstruction images.

PURPOSE: To graphically display the time dependency of contrast enhancement of liver tumors at examination with dynamic magnetic resonance (MR) imaging. MATERIALS AND METHODS: A temporal reconstruction image was generated by obtaining a line of interest drawn on a single image through the liver and the tumor and reformatted over a sequence of temporal images. This calculated image expressed the temporal evolution of the line, including nontumoral liver and tumor, with regard to three variables: signal intensity, enhancement, and velocity. This allowed a visually integrated analysis of 95 hepatic lesions studied with dynamic single-section MR imaging after contrast material administration. RESULTS: Temporal reconstruction images were obtained for all the dynamic studies. Five patterns of enhancement based on signal intensity and velocity variations coupled with morphologic information were found: wall, diffusion, moderate enhancement, marked progressive, and early intense patterns. CONCLUSION: Temporal reconstruction of liver tumors after contrast material administration can be used to analyze, describe, and report the dynamics of lesion enhancement with morphologic and temporal resolution.

Influence of acute alterations in cycle length on ventricular function in chick embryos.

Heart rate (HR), developed pressure, and stroke volume (SV) increase dramatically during cardiac morphogenesis. During acute changes in cycle length (CL), the chick embryo maintains cardiac output by a compensatory change in SV. We determined embryonic pressure-volume relations during alterations in CL in the stage 21 while Leghorn chick embryo to quantitate the relationship between CL and cardiac time intervals, ventricular preload, and ventricular function. CL was transiently altered to 73-191% of initial baseline CL with a 1-mm randomly preheated or cooled metal probe applied to the sinus venosus. Isometric relaxation, diastolic filling, and systolic ejection times varied linearly with CL, whereas isometric contraction times were similar. SV varied linearly with CL, ejection time, and end-diastolic volume. In contrast to the mature heart, the relationship between SV and end-systolic pressure was inverse. Embryonic ventricular preload was influenced acutely by diastolic filling time, and cardiac output was optimized during changes in CL by ventricular-vascular interactions that matched SV inversely to HR.

Oral chloral hydrate provides effective and safe sedation in paediatric magnetic resonance imaging.

Sedation is routinely required for successful Magnetic Resonance imaging in infants and children. Five hundred and ninety-six paediatric patients (270 female and 326 male, age (mean +/- SD) 41 +/- 30 months and weight 14.8 +/- 6.5 kg) entered an open, non-comparative, prospective study to assess oral chloral hydrate sedation in a large and homogeneous paediatric population undergoing Magnetic Resonance imaging. Chloral hydrate syrup 70 mg/ml was administered 20-40 min prior to the procedure. Effective sedation was reached in 94.1% with a total dose (mean +/- SEM) of 68 +/- 1 mg/kg (range 20-170 mg/kg). Statistical analysis of sedation failures vs. successful examinations after the total dose showed significant differences for dose (62 +/- 4 vs. 69 +/- 1 mg/kg; P < 0.05), age (64 +/- 7 vs. 40 +/- 1 months; P < 0.001) and weight (19.8 +/- 1.5 vs. 14.5 +/- 0.0 kg; P < 0.001). Effectiveness fell to around 80% in children with encephalic white matter alterations, medullary tumours or syringohydromyela (P = 0.07). The mean time of onset of sedation was 26 +/- 1 min, and the mean time to spontaneous awakening after the completion of the Magnetic Resonance examination was 38 +/- 2 min. Fifty-nine children (9.9%) experienced adverse reactions, with nausea and vomiting being the most common (n = 41), followed by nervousness and unusual excitement (n = 6). Discriminant function analysis identified age and total dose as the quantitative variables helping to differentiate between sedation failures and satisfactory examinations (sensitivity = 0.73, and specificity = 0.61; r = 0.20, P < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)