Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy: MR findings.

PURPOSE: To describe the MR appearances of cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy. METHODS: MR examinations were performed on 15 family members (both symptomatic and asymptomatic). The phenotype was defined by the presence of abnormalities on MR scanning in genetically susceptible individuals. RESULTS: There were 10 abnormal and 5 normal MR scans. Three subjects with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy had moderate or severe neurologic deficits, 4 had transient focal neurologic symptoms, 2 had migraine, and 1 was asymptomatic (all these had abnormal MR scans). Only 1 subject with migraine had a normal MR. Four other asymptomatic family members had normal scans. Two main abnormalities emerged. First, small, linear, and punctate lesions were identified in the periventricular white matter, brain stem, basal ganglia, and thalamus. Second, large confluent patches of abnormal tissue were present in subcortical regions that often were symmetric and had a tendency to occur in the temporal lobes. CONCLUSIONS: The diffuse myelin loss and small infarcts that cause cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy are well demonstrated with MR. Presymptomatic abnormalities can be seen on MR.

Pain and increased mammographic density in women receiving hormone replacement therapy: a prospective study.

OBJECTIVE: A prospective study was designed to evaluate the effects of hormone replacement therapy on mammographic density in postmenopausal women. The possible association of breast pain with increased mammographic density was evaluated. SUBJECTS AND METHODS: Thirty-three postmenopausal women undergoing hormone replacement therapy for a mean of 11 months had mammography before and after commencing treatment. As a control, 31 postmenopausal women who never had hormone therapy also had baseline and follow-up mammograms after a mean of 13 months. Subjects were asked whether breast pain, which they graded as mild, moderate, or severe, had developed since their entry into the study. Baseline and follow-up mammograms were assessed objectively and subjectively for interval changes in density. The presence of breast pain was correlated with changes in density on the mammograms. RESULTS: A subjective increase in mammographic density was seen in nine (27%) of the women taking hormones and in none of the control subjects (p = .002). Changes were focal in four, multifocal in four, and diffuse in one. An increase in density was seen with all types of treatment used, and was noted as early as 4 months after the start of treatment. Seven (78%) of nine patients with mammographic changes had breast pain, which they classed as moderate or severe, that had developed since the start of treatment. In five patients with mild or moderate breast pain, an increase in density was not shown on mammograms. Of the 21 women taking hormones who did not have breast pain, increased density on follow-up mammograms was shown in only two (p = .004). None of the patients in the control group had breast pain. CONCLUSION: Focal, multifocal, or diffuse mammographic increases in density occur in a significant percentage of women undergoing hormone replacement therapy. A large proportion of these women have breast pain. Increased mammographic density appears to be associated with breast pain in women receiving hormones. This has implications for mammography in women receiving hormone replacement therapy.

Magnetic resonance imaging of rectal carcinoma: a prospective study.

Accurate preoperative staging of rectal cancer is necessary to identify patients who might benefit from adjuvant therapy. Magnetic resonance imaging (MRI) was evaluated in 20 consecutive patients with rectal cancer undergoing 'curative' surgery. Detailed histopathological examination of the resected lesion was correlated with findings of MRI. MRI staging concurred with histological staging in 18 of 20 patients using the Dukes or tumour node metastasis classification but in only 14 using the modified Astler-Coller system. MRI diagnosed transmural invasion in all but one patient with microscopic mural invasion (positive predictive value, 100 per cent; negative predictive value, 80 per cent; overall accuracy, 95 per cent). MRI correctly diagnosed tumour deposits or involved lymph nodes in 12 patients. MRI overstaged one patient, in whom nodes that were enlarged on imaging studies were negative at histological examination (positive predictive value, 92 per cent; negative predictive value, 100 per cent; overall accuracy, 95 per cent). MRI has a role in selected cases for the preoperative assessment of rectal carcinoma.

Radiologically guided balloon dilatation of obstructing gastrointestinal strictures.

Balloon dilatations is the preferred method of dilatation for most gastrointestinal strictures, because of its efficacy and relative safety. Radiologically guided balloon dilatation was successful in 20 of 24 patients referred for dilatation with a variety of tight gastrointestinal strictures with diameters of 0.5 cm or less. Attempts at endoscopic or bougie dilatation had either failed or were felt unlikely to be successful. A satisfactory result was obtained in all cases in which dilatation was performed. There were no serious complications. Radiologically guided balloon dilatation is both safe and effective for the treatment of very tight or obstructing gastrointestinal strictures.

Imaging of primary vaginal lymphoma.

Two cases of primary vaginal lymphoma are reviewed and their imaging features presented. On sonography, both lesions appeared as well defined, slightly lobulated masses of medium to low echogenicity. On computed tomography (CT) the lesions were well circumscribed and of homogeneous density similar to that of muscle. Magnetic resonance (MR) imaging in one case after treatment showed a non-enhancing lesion of intermediate signal intensity on T1- and T2-weighted images. Ultrasound was particularly useful in one case where the lesion was shown to be separate to the uterus--a fact which was not easily appreciated on CT. The differential diagnosis is discussed.