An Intermodal Correlation Study among Imaging, Histology, Procedural and Clinical Parameters in Cerebral Thrombi Retrieved from Anterior Circulation Ischemic Stroke Patients.

The precise characterization of cerebral thrombi prior to an interventional procedure can ease the procedure and increase its success. This study investigates how well cerebral thrombi can be characterized by computed tomography (CT), magnetic resonance (MR) and histology, and how parameters obtained by these methods correlate with each other as well as with the interventional procedure and clinical parameters. Cerebral thrombi of 25 patients diagnosed by CT with acute ischemic stroke were acquired by mechanical thrombectomy and, subsequently, scanned by a high spatial-resolution 3D MRI including T1-weighted imaging, apparent diffusion coefficient (ADC), T2 mapping and then finally analyzed by histology. Parameter pairs with Pearson correlation coefficient more than 0.5 were further considered by explaining a possible cause for the correlation and its impact on the difficulty of the interventional procedure and the treatment outcome. Significant correlations were found between the variability of ADC and the duration of the mechanical recanalization, the deviation in average Hounsfield units (HU) and the number of passes with the thrombectomy device, length of the thrombus, its RBC content and many others. This study also demonstrates the clinical potentials of high spatial resolution multiparametric MRI in characterization of thrombi and its use for interventional procedure planning.

Study of correlations between CT properties of retrieved cerebral thrombi with treatment outcome of stroke patients.

BACKGROUND: All the patients with suspected stroke are directed to whole-brain CT scan. The purpose of this scan is to look for early features of ischemia and to rule out alternative diagnoses than stroke. In case of ischemic stroke, CT diagnostics (including CT angiography) is used mainly to locate the occlusion and its size, while the Hounsfield Units (HU) values of the thrombus causing the stroke are usually overlooked on CT scan or considered not important. The aim of this study was to demonstrate that the HU value is relevant and can help in better treatment planning. PATIENTS AND METHODS: There were 25 patients included in the study, diagnosed with ischemic stroke in the middle cerebral artery (MCA) territory. In all patients, systemic thrombolysis was not successful and the mechanical recanalization was needed. The retrieved thrombi were also analyzed histologically for the determination of red blood cells (RBC) proportion. CT of the proximal MCA (M1) segment was analyzed for average HU value and its variability both in the occluded section and the symmetrical normal site. These CT parameters were then statistically studied for the possible correlations with different clinical, histological and procedure parameters using the Linear Regression and the Pearson correlation coefficient. RESULTS: Relevant positive correlations were found between average HU value of thrombus and outcome modified Rankin Scale (mRS), initial mRS, number of passes with thrombectomy device as well as RBC proportion. CONCLUSIONS: Results of the present study suggest that measured HU values in CT images of the cerebral thrombi may help in the assessment of thrombus compaction and therefore better treatment planning.

Retrieved cerebral thrombi studied by T2 and ADC mapping: preliminary results.

Background Recent advances in MRI technology makes it increasingly more competitive to CT also in the field of interventions. Multi-parametric MRI offers a significant amount of data relevant for characterization of human cerebral thrombi. Patients and methods Cerebral thrombi of 17 patients diagnosed with acute stroke were acquired by mechanical thrombectomy. The thrombi were subsequently scanned using a high spatial-resolution 3D T1-weighted MRI to obtain morphological characteristics of the thrombi and also by apparent diffusion coefficient (ADC) and transversal nuclear magnetic resonance (NMR) relaxation time (T2) mapping. The MRI results were analysed for possible correlations between thrombectomy procedure parameters (recanalization time and number of passes) and MR-measurable parameters (sample-mean ADC and T2, within-sample coefficient of variation of ADC and T2, and thrombus length). Results Both MRI mapping techniques enabled a good discrimination among thrombi regions of different water mobility and compaction. Within-sample coefficient of variation of ADC was found most sensitive for discrimination between the thrombi where thrombectomy procedure was performed in a single pass and those where is was performed in two or more passes (p = 0.03). Interestingly, negative correlation was found between the recanalization time and thrombus length (ρ = -0.22). Conclusions Preliminary results of presented study shows that pretreatment MRI assessment of thrombi in stroke patients could potentially ease stroke treatment planning. In this study it is shown that within-sample coefficient of variation of ADC could serve for prediction of possible complications during thrombectomy procedures.

Efficacy and durability of radiopaque gelified ethanol in management of herniated discs.

Background Percutaneous image-guided intradiscal injection of gelified ethanol was introduced to treat herniated disc disease lately. The aim of the study was to assess clinical efficacy and durability over a 36 months' period. Patients and methods Eighty-three patients (47 males, 36 females, mean age 48.9 years (18-79 years) were treated between May 2014 and December 2015 for 16 cervical and 67 lumbar chronical contained disc herniations. For pain assessment evaluation, the visual analog scale (VAS) was used. Physical activity, the use of analgesics, patients' satisfaction with the treatment results and patient's willingness to repeat the treatment were also evaluated. Results Fifty-nine patients responded to questionnaire. 89.8% had significant reduction in VAS after 1 month (p < 0.001); 76.9% of patients with cervical symptoms and 93.5% of patients with lumbar symptoms. In cervical group it remained stable, while in lumbar group VAS decreased even more during 36 months (p = 0.012). Single patient had spinal surgery. Moderate and severe physical disability prior to treatment (96.6%) was reduced to less than 30% after 12 months. The majority of active patients returned to their regular job (71.1%); 78% needed less analgesics. Only 5.1% patients were not satisfied with the treatment and 10.2% would not repeat the treatment if needed. Conclusions Percutaneous image-guided intradiscal injection of gelified ethanol is safe, effective and durable therapy for chronic contained cervical and lumbar herniations. Due to minimal invasiveness and long-lasting benefits, this kind of treatment should be proposed to designated group of patients as first-line therapy.

Dynamics of CT visible pleural effusion in patients with pulmonary infarction.

Background Pleural effusion remains largely unexplored in patients with pulmonary embolism and concurrent pulmonary infarction. The aim of the study was to investigate the relationship between the size of pulmonary infarction and pleural effusion as well as the time course of pleural effusion in patients with pulmonary infarction. Patients and methods Data from 103 patients with pulmonary infarction was retrospectively analysed along with patient comorbidities, size of pulmonary infarction, presence and size of pleural effusion with the time between the onset of clinical symptoms of pulmonary infarction and CT study. Results Assessment of possible correlations between the size of pulmonary infarction and age revealed a significant negative correlation. There was a highly significant difference (p = 0.005) in the mean size of pulmonary infarction in patients with effusion (34.5 cm3) compared to those without it (14.3 cm3), but the size of the effusion had no correlation with the size of pulmonary infarction. The size of the effusion peaked between 4th-5th day after the onset of clinical symptoms of pulmonary infarction. In the first 5 days after the onset of clinical symptoms of pulmonary infarction a significant correlation was found between the size of the effusion and time with approximation of 1.3 mm/12 h. Conclusions The data shows that patients with a pleural effusion are more likely to have a larger pulmonary infarction than those without it. If present, the effusion can be expected to increase in a relatively slow linear fashion in the first 5 days after the onset of clinical symptoms of pulmonary infarction.

Primary pulmonary choriocarcinoma.

BACKGROUND: The aim of the study was to establish whether there are different clinical entities of primary pulmonary choriocarcinoma (PPC) that deserve different diagnostic approach and the most optimal treatment. PATIENTS AND METHODS: A systematic review with PubMed search was conducted to identify studies that reported cases of PPC. The eligibility criteria were histological diagnosis of pulmonary choriocarcinoma and thorough examination of the reproductive organs to exclude potential primary choriocarcinoma in the gonads. Furthermore, to illustrate the review we additionally present a patient referred at our institution. RESULTS: 55 cases (17 men) were included in the review with a median age of 34 years. Women with the history of gestational event showed better survival outcome than women without the history of gestational event. Patients treated with combined modality treatment (surgery and chemotherapy) survived longer than the patients without combined modality treatment. Furthermore, multivariate analysis of prognostic factors showed that the combined modality treatment had independent prognostic significance. Size of the tumour showed significant prognostic influence in univariate and multivariate analysis. CONCLUSIONS: PPC is an extreme rarity with variable clinical characteristics and outcome. It is important to capture and treat patients in the early stages of the disease. Women with the history of gestational event may show better survival, therefore genetic examination could help us to predict patient's prognosis. Surgery followed by adjuvant chemotherapy appears to represent the best treatment for PPC.

The value of the sagittal-oblique MRI technique for injuries of the anterior cruciate ligament in the knee.

BACKGROUND: Complete rupture of the anterior cruciate ligament (ACL) does not represent a diagnostic problem for the standard magnetic resonance (MR) protocol of the knee. Lower accuracy of the standard MR protocol for partial rupture of the ACL can be improved by using additional, dedicated MR techniques. The study goal was to draw a comparison between sagittal-oblique MR technique of ACL imaging versus flexion MR technique of ACL imaging and, versus ACL imaging obtained with standard MR protocol of the knee. PATIENTS AND METHODS: In this prospective study we included 149 patients who were referred to magnetic resonance imaging (MRI) examination due to knee soft tissues trauma during 12 months period. MRI signs of ACL trauma, especially detection of partial tears, number of slices per technique showing the whole ACL, duration of applied additional protocols, and reproducibility of examination were analysed. RESULTS: Accuracy of standard MRI protocol of the knee comparing to both additional techniques is identical in detection of a complete ACL rupture. Presentations of the partial ruptures of ACL using flexion technique and sagittal-oblique technique were more sensitive (p<0.001) than presentation using standard MR protocol. There was no statistically significant difference between MRI detection of the ruptured ACL between additional techniques (p> 0.65). Sagittal-oblique technique provides a higher number of MRI slices showing the whole course of the ACL and requires a shorter scan time compared to flexion technique (p<0.001). CONCLUSIONS: Both additional techniques (flexion and sagittal-oblique) are just as precise as the standard MR protocol for the evaluation of a complete rupture of the ACL, so they should be used in cases of suspicion of partial rupture of the ACL. Our study showed sagittal-oblique technique was superior, because it did not depend on patient's ability to exactly repeat the same external rotation if standard MR protocol was used or to repeat exactly the same flexion in flexion MR technique in further MR examinations. Sagittal-oblique technique does not require the patient's knee to be repositioned, which makes this technique faster. We propose this technique in addition to the standard MR protocol for detection of partial ACL tears.

Multimodal therapy for the treatment of severe ischemic stroke combining endovascular embolectomy and stenting of long intracranial artery occlusion.

Embolic occlusion of cerebral arteries is a major cause for stroke. Intravenous thrombolysis showed positive results in this condition, however even when strict criteria are used, the risk of hemorrhagic transformation is possible. Microsurgical embolectomy has been described earlier. Purpose. We performed multimodal therapy of cerebral artery occlusion. Case Report. We present a case of a 49-year-old female patient who-according to the National Institute of Health Stroke Scale (NIHSS)-was rated as 19 due to acute occlusion of the horizontal segment of the left middle cerebral artery (MCA). After failed i.v. thrombolysis, only a part of the clot could be evacuated by the endovascular approach-without restoration of blood flow. Normal patency of the left MCA was re-established after stenting. Within 72 hours, the patient had an NIHSS score of 14, with a small haematoma in the left hemisphere. Conclusion. In our case multimodal therapy combining i.v. thrombolysis, mechanical disruption of thrombus, MCA stenting and platelet function antagonists, resulted in successful recanalization of the acutely occluded left MCA.

CT colonography in detection of colorectal carcinoma.

BACKGROUND: Diagnostic methods used in screening and detecting colorectal carcinoma are digitorectal examination, faecal occult blood testing, sigmoidoscopy, DNA stool analysis, barium enema, colonoscopy, and as of recently CT colonography. The aim of this study was to establish diagnostic accuracy and comfort of CT colonography compared to colonoscopy and barium enema. PATIENTS AND METHODS: We included 231 patients in the prospective study. For all patients CT colonography and barium enema followed by colonoscopy were performed. After the procedures a comfort assessment was done in all patients. Diagnostic positive results were verified by the pato-histological examination. Sensitivity, specificity, positive predicative value (PPV) and negative predicative value (NPV) were calculated for each procedure. RESULTS: With CT colonography, barium enema and colonoscopy 95 lesions were found, 56 (59%) of them were tumours and 39 (41%) were polyps. Among polyps pato-histology revealed 34 adenomas, 3 tubulovillous adenomas and 2 lipomas, among tumours there were 55 adenocarcinomas and 1 lymphoma. Results showed CT colonography sensitivity to polyps to be 89.7%, barium enema 48.7%, and colonoscopy 94.9%. Sensitivity to tumours of CT colonography and colonoscopy was 100% and of barium enema 94.6%. Specificities and PPV were 100% in all procedures. The comfort assessment showed CT colonography as the far most comfortable out of three procedures.

3T MRI in evaluation of asbestos-related thoracic diseases - preliminary results.

BACKGROUND: 3T high-field magnetic resonance imaging (MRI) scanners have recently become available for the clinical use and are being increasingly applied in the field of whole-body imaging and chest imaging as well. The aim of this study was to evaluate the diagnostic potential of 3 T MRI as a complementary imaging modality to CT in detecting the pathological changes of asbestos-related thoracic diseases. PATIENTS AND METHODS: Fifteen patients with the asbestos-related thoracic disease were scheduled for 3T MRI. Five had a benign form of the disease and 10 had malignant pleural mesothelioma (MPM). From the patients with a benign form of the disease their last CT examination in digital form was acquired and patients with MPM were scheduled for CT examination with contrast media. The protocol of MR imaging consists of T2-weighted cardiac-gated breath-hold turbo spin echo (TSE) sequences in coronal, sagittal and axial plane and T1-weighted cardiac-gated breath-hold TSE black blood in axial plane. In T2-weighted sequences in axial plane, fat saturation was also used. CT examinations were obtained with the administration of the contrast medium from lung apices to the lower end of the liver. Images of 5 mm (mediastinum window) and 3 mm (lung window) in axial plan were reconstructed. MRI signal intensity of lesions and adjacent muscles on Syngo MultiModality Work Place were measured. RESULTS: Compared to muscles pleural plaques appeared hypo-intense to iso-intense on T1 weighted images (in 100%) and also hypo-intense on T2 fs-weighted images (in 100%). MPM appeared inhomogeneous hypo-intense to iso-intense on T1-weighted and hyperintense on T2 fs-weighted images in all patients (100%). CONCLUSIONS: These preliminary results pointed out that MRI was equal or even better compared with CT examination for detecting possible malignant potential of pleural changes in the asbestos-related pleural disease, using signal intensity measurements of T2 fs-weighted images. The 3T MRI enabled the accurate determination of chest pathology and it could be used for imaging of patients with the asbestos-related thoracic disease. MRI is particularly valuable because a patient is not exposed to the harmful radiation which is important if imaging methods are used repeatedly, like in screening programs or in monitoring of treatment results. This finding turned us to propose 3T MRI imaging technique as a non-ionizing imaging method for the follow-up of patients with the isolated pleural form of the asbestos-related disease.

Sonographic evaluation of pleural fluid in a large group of adult healthy individuals--end trial results.

This partly prospective, partly retrospective trial was performed in adult healthy volunteers to confirm the prevalence of sonographically visible physiological pleural and to establish possible individual variations of the presence and amount of pleural fluid over time as well as to asses relations in between pleural fluid and individual characteristics like age, sex, body mass index, smoking history and hormone therapy (in woman). A reliable threshold between normal and pathological pleural fluid findings was determined. Prospective chest sonography of both pleural spaces was performed with 3-12 MHz transducer in 71 randomly selected healthy adults and presence of pleural fluid was evaluated and measured as an anechoic layer at least 2 mm in thickness. Each individual was reexamined three times in two to four months intervals. Another 86 individuals were prospectively re-examined for the third time, 24 to 36 months after completed previous trials while the data on the baseline and follow up examination were retrospectively acquired. Maximum thickness of the pleural fluid was measured in the elbow position after five minutes leaning in lateral decubitus position. Examinees served as their own controls, with the quantitative measurement of the fluid layer over time. The fluid layer was visible in at least one pleural space in 51/157 (32.5%) subjects, whereas 35 (22.3%) examinees had a positive finding on all three examinations. Consistency of this finding was high between each pair of examinations over time (Cohen's Kappa > or = 0.8, p < 0.001). The maximum thickness of fluid layer ranged from 2.0 to 5.2 mm, with a mean of 2.9 mm independently of left or right pleural space and unilateral or bilateral presence. Regression models indicate that odds for observing pleural fluid in an individual decrease with age ( p = 0.013) and that if observed, the fluid tends to be thicker in women ( p = 0.017) and in subjects with higher BMI ( p = 0.028). Sonography detected small amounts of pleural fluid in 32.5% of healthy individuals. If present, maximum thickness of the fluid layer doesn't exceed the threshold value of 5.2 mm with mean values around 3 mm. The amount of physiological pleural fluid is relative stable over time and is very likely an individual characteristic with lower frequencies in elders while the frequencies of sonographically detected pleural fluid in healthy adults does not correlate with sex, obesity, smoking or hormonal therapy.

Dual cerebral protection technique during carotid stenting.

PURPOSE: To present a technique for internal carotid artery stenting (CAS) with dual cerebral protection in patients with high-grade stenosis caused by large, soft atherosclerotic plaques. TECHNIQUE: The MO.MA proximal cerebral protection device is first placed in the external and common carotid arteries. Complete blockade of blood flow is achieved by inflating the occlusion balloons. A Spider filter is delivered to the distal internal carotid artery. All procedural steps of CAS are performed during continuous and simultaneous proximal occlusion and distal filter protection. After postdilation of the stent, the occlusion balloons are deflated, and antegrade flow is re-established with the distal filter basket still open. CONCLUSION: In selected patients with large atherosclerotic plaques, a dual cerebral protection technique during CAS may be a more efficacious form of cerebral protection than a single protection device.

Diagnostic imaging of small amounts of pleural fluid: pleural effusion vs. physiologic pleural fluid.

The aim of this article is to present an overview of our 10 years clinical research work and early clinical experience with small pleural effusions. Small amounts of pleural fluid are severely difficult to identify with imaging methods (chest x-rays and ultrasound). Nevertheless, it may be an important finding, sometimes leading to a definitive diagnosis of pleural carcinomatosis, infection or other pathologic condition. Chest x-rays were used for many years for the diagnosis of small pleural effusions. Lateral decubitus chest radiographs represented a gold standard for imaging of small amounts of plural fluid for more than 80 years. In the last two decades, ultrasonography of pleural space became a leading real-time method for demonstrating small pleural effusions. Furthermore, the advent of sonographic technology actually enables detection of physiologic pleural fluid in some otherwise healthy individuals. In conclusion, new definitions of the key terms in the field of diagnostic imaging of small amounts of pleural fluid seem to be justified. We suggest that the term pleural fluid should determine physiologic pleural space condition while the term pleural effusion should only be used in the cases of pleural involvement or pleural illness.

Primary Sjögren's syndrome associated with non-Hodgkin's lymphoma of salivary gland and cystic lung disease.

A rare case of a young nonsmoker woman with Sjigren's syndrome and salivary gland non-Hodgkin's lymphoma, diagnosed one year later, is presented. Three years after treatment of the lymphoma, asymptomatic progression of the Sjögren 's syndrome was observed with pulmonary involvement--predominantly bullous or cystic lung disease. To our knowledge, this is the only report of Sjögren 's syndrome associated with non-Hodgkin's lymphoma in salivary gland, and complicated with multiple lung cysts.

Sonography of pleural space in healthy individuals.

PURPOSE: This research was performed to detect physiologic pleural fluid by chest ultrasonography, to assess the frequency of this finding, and to check the status of pleural space, searching for possible individual variations of the amounts of pleural fluid. MATERIALS AND METHODS: In the baseline study, chest ultrasonography of both pleural spaces was performed in a group of 106 healthy volunteers, searching for pleural fluid, first in the lateral decubitus position and then leaning on the elbow. An anechoic fluid layer at least 2-mm thick was taken as a positive result. The follow-up study was repeated on each subject after 2-4 months. RESULTS: In the baseline study, a 2-mm-thick pleural fluid layer was found in 28 of 106 (26%) volunteers, both sided in 17 of 28 (61%), and unilaterally in 11 of 28 (39%). The follow-up study, showed a fluid layer in 24 of 106 (23%) volunteers, on both sides in 14 of 24 (58%), and unilaterally in 10 of 24 (42%). In the first study, the mean fluid layer thickness in the decubitus examination position was 2.9 mm (SD, 0.4 mm) and in elbow examination position 2.8 mm (SD, 0.4 mm). On follow-up study, the mean fluid layer thickness in both examination positions was the same, 3.1 mm (SD, 0.6 mm). Taking into consideration baseline and follow-up studies, the fluid was observed in 32 subjects, and 21 (66%) of them showed pleural fluid twice. Their mean fluid layer (3.1 mm) was significantly larger than the group of subjects with only one positive result (2.5 mm), with p values of <.01 for the baseline and <.05 for the follow-up study. CONCLUSION: In experimental conditions, small amounts of pleural fluid can be detected by chest sonography in healthy individuals. Our research suggests that there are individuals with sonographically permanently less ("dry pleural space") or more ("wet pleural space") physiologic pleural fluid.

Sonographic detection of physiologic pleural fluid in normal pregnant women.

PURPOSE: This prospective study was conducted to determine the normal incidence of a small amount of pleural fluid in healthy pregnant women on sonography. METHODS: Chest sonography to detect pleural fluid was performed in 47 pregnant volunteers, first with the subjects leaning on 1 elbow (the "elbow position") and then with subjects in a sitting position. A 9-12-MHz linear-array probe was used. If the result of this first examination was positive (showing a 2-mm or thicker anechoic layer), the subject was rescanned with a 3-6-MHz large-radius curved-array probe. RESULTS: A thin layer of fluid with a typical wedge-shaped appearance was visible in the pleural cul de sac space of 28/47 (59.5%) pregnant volunteers, on both sides in 18/47 (38.3%) and unilaterally in 10/47 (21.2%). The mean (+/- standard deviation) thickness of fluid layer (mean of measurements obtained in both positions) was 2.9 +/- 1.1 mm (range, 1.8-6.4 mm). The number of pregnant women with visible pleural fluid was the same regardless of the fetus' sex, but the difference in fluid layer thickness between the 2 groups was statistically significant (by the t-test, p <0.05). A fluid layer thicker than 3 mm was easily detected with the 3-6-MHz abdominal curved-array probe in 7/47 (15%) women. CONCLUSIONS: Small amounts of pleural fluid can be visualized by chest sonography in healthy pregnant women. This result, if isolated, should not be taken as a sign of occult thoracic disease.

Pneumomediastinum, pneumopericardium, and pneumoperitoneum caused by peridiverticulitis of the colon: report of a case.

A 50-year-old woman with breast carcinoma metastases in the left supraclavicular region was treated because of free air in the mediastinum, around the heart and vascular pedicle, below the diaphragmatic dome, and subcutaneous neck and supraclavicular emphysema, without radiologic signs of pneumothorax. Diverticulosis of the colon and an occult perforation of the diverticulum in the retroperitoneal region of the colon were diagnosed. The patient was treated by segmental resection of the colon with anastomosis, drainage of the abdominal cavity, and antibiotics. To our knowledge, this is the only report in the literature about pneumopericardium caused by peridiverticulitis of the colon.

Role of sonographically guided fine-needle aspiration biopsy of adrenal masses in patients with lung cancer.

PURPOSE: The aims of this retrospective study were to determine the accuracy and safety of sonographically guided fine-needle aspiration biopsy (FNAB) in evaluating enlarged adrenal glands in patients with lung cancer and to correlate the metastatic involvement of the adrenal glands with the surgical stage of the primary lung tumor. METHODS: During an 11-year period, 64 patients with cytologically proven lung cancer had undergone sonographically guided FNABs of an adrenal mass. The accuracy of this method was assessed on the basis of cytologic findings and the safety, on the number of complications reported after FNAB. The location of the adrenal metastasis relative to the primary tumor (ipsilateral, contralateral, or bilateral) was correlated with the surgical stage of the disease. RESULTS: FNAB results were accurate in 58 of the 64 cases (91%), and the procedure was associated with no serious complications. In 6 (9%) of the 64 patients, the FNAB specimen had been inadequate. Cytologic analysis of the aspirates revealed malignancy in 52 (90%) of the 58 patients in whom the FNAB specimen had been adequate for an accurate diagnosis. The adrenal metastases were ipsilateral in 21 patients, contralateral in 15, and bilateral in 16, for an ipsilateral-to-contralateral ratio of 1.4:1. Among patients with operable disease, an ipsilateral pattern of metastasis was present in 65%, whereas among those with inoperable disease, the ipsilateral pattern was present in only 31%. The difference between these 2 groups was statistically significant (p < 0.05). CONCLUSIONS: Sonographically guided FNAB is accurate and safe for evaluating enlarged adrenal glands in patients with lung cancer. Our results also suggest that a solitary ipsilateral adrenal metastasis in a patient with resectable primary lung cancer may represent a regional extension of the disease rather than systemic spread.

Chest sonography versus lateral decubitus radiography in the diagnosis of small pleural effusions.

PURPOSE: The aim of this prospective study was to assess the value of chest sonography in the radiologic diagnosis of small pleural effusions (relative to expiratory lateral decubitus radiography) and to suggest gray-scale sonographic criteria for detecting the presence of small pleural effusions. METHODS: Patients referred for abdominal or chest sonographic evaluation for various reasons were also examined for sonographic features of pleural effusion from May 1, 1997, until January 31, 2000. Patients who had evidence of small pleural effusions were included. Patients with no such evidence served as a control group. Subsequently, all patients underwent erect posteroanterior and expiratory lateral decubitus chest radiography. RESULTS: On chest sonography, 52 patients were found to have small pleural effusions. The control group consisted of 17 patients. The mean thickness of the pleural effusion was 9.2 mm on sonography and 7.6 mm on expiratory lateral decubitus radiography (p < 0.01). Compared with radiologic examination, chest sonography had a positive predictive value of 92% in the diagnosis of small pleural effusions in our study population. CONCLUSIONS: Chest sonography showed a high degree of accuracy relative to that of lateral decubitus chest radiography in the diagnosis of small pleural effusions, which appeared as thin (usually 15 mm thick or less) anechoic areas that changed shape with the phases of respiration.