Fistula in ano: evaluation with low-field magnetic resonance imaging (0.1 T).

BACKGROUND: Patients suspected of having perianal suppurative disease often undergo a combination of several potentially painful, invasive procedures to establish or rule out the diagnosis. To evaluate the accuracy of low-field magnetic resonance imaging (MRI) in distinguishing patients with active anal fistulae and patients with no active fistulation we performed a retrospective study. METHODS: Fifty-six patients suspected of having anal fistulation were evaluated in the surgical outpatient clinic. Patients were examined with low-field MRI (0.1 T; gradient echo technique, TR/TE 1,500/40 and TR/TE 115/25, +/- gadodiamide (0.1 mM/kg intravenously)) in both coronal and axial planes, using a body quadrature coil. Altogether 71 MRIs were performed. In selected patients evaluation included endoanal ultrasonography, fistulography, and/or surgery. On the basis of the combined results of all available follow-up data for 6 months after the MRI, patients were placed in groups either having active fistulation or not. RESULTS: MRI findings agreed with the combined findings of other examinations in 54 patients. Active or possibly active fistulae were found in 36 cases, whereas 33 patients showed no active fistulae. The kappa value is 0.944 (95% confidence limits, 0.866-1.021). In two patients the MRI findings disagreed with the combined findings of the other modalities. CONCLUSION: The use of low-field MRI of the pelvic region in the investigation of suspected perianal fistulae is a feasible, reliable, and painless examination. MRI should be considered in patients with suspected complex anal fistulae. Future prospective studies are warranted.

Frequency of unexpected multifocal metastasis in patients with acute spinal cord compression. Evaluation by low-field MR imaging in cancer patients.

PURPOSE: The aim of the study was to estimate, in an acute care service, the frequency of multiple-level lesion involvement in patients with clinically suspected spinal cord compression or spinal blockage. MATERIAL AND METHODS: Over a period of 17 months, 240 patients with symptoms of acute spinal cord compression underwent acute MR examination of the spine in a 0.1 T MR unit. The cervical spine was only added to the examination if there was clinical suspicion of cord compression above Th1. RESULTS: In 65 (27%) of the 240 patients, involvement of at least one level was found. Of these patients, 32 (49%) showed involvement of more than one level. This high rate was surprising, since only 14 (44%) of the 32 multiple lesions had been clinically suspected. There was no correlation to age or original type of cancer. CONCLUSION: MR accurately demonstrates the anatomy of the spine and spinal cord, showing the level and complexity of spinal lesions. Multiple lesions may be underestimated when the combination of myelography/radiculography and CT is used.

Determination of prostate gland volume by transrectal ultrasound: correlation with radical prostatectomy specimens.

Seventy six patients underwent transrectal ultrasound examination of the prostate prior to radical prostatectomy. All radical specimens were weighed and measured when freshly excised. Corresponding measurements calculated using transrectal ultrasound dimensions were retrospectively compared with those of the freshly excised glands. Estimation of gland volume by ultrasound measurement, utilizing the prolate ellipse formula [Width x Height x Length) x 0.70 was applied to a control group of 19 patients, and a close correlation (r = 0.77) between ultrasound estimated volume and actual weight was shown. A modified prolate ellipse formula, using the factor of 0.70, appears to be a more reliable means of estimating gland volume with transrectal ultrasound than the original formula [Width x Height x Length) x 0.523).

[Preoperative ultrasonic diagnosis of maldescended testis]. / Praeoperativ ultralydundersøgelse af den maldescenderede testis.

In 30 boys with a total of 35 maldescended testicles, the present authors found that ultrasonic examination was a useful aid in the diagnosis of maldescended testicles, including intraabdominal testicles. Ultrasonic examination is recommended preoperatively in boys with non-palpable testicles in order to provide optimal surgical intervention.