The influence of MR imaging on changes in patient counseling in obstetric patients with suspected fetal anomalies by ultrasound.

OBJECTIVE: To determine the frequency of additional information provided by magnetic resonance (MR) imaging in supplement to ultrasound (US) in patients with fetal anomaly and to determine the influence of MR imaging findings on patient counseling. MATERIAL AND METHOD: MR imaging offetus was performed in 26 patients who have abnormal ultrasound results. Referring obstetricians were asked about how the additional information provided by MR imaging have effect on their decision marking, patient counseling, and case management. RESULTS: MR imaging in 23 of 26 fetuses was technically successful. MR imaging provided additional information in 14/23 (60.9%) cases. In the other nine (39.1%) cases, MR imaging confirmed US diagnosis but did not give supplementary information. Additional information from MR imaging affected patient counseling in five (21.7%) cases and did not affect patient counseling in the other nine (39.1%) cases. In 14 cases with additional information from MR imaging, there were isolated CNS involvement in five (35.7%) cases, isolated extra-CNS involvement in two (14.3%) cases, multisystem involvement in five (35.7%) cases, and other-category in two (14.3%) case. CONCLUSION: MR imaging can provide additional information that have influence on patient counseling and patient care, particularly in cases with CNS and multisystem anomaly.

Evaluating the mean cross-sectional area (CSA) of median nerve by use of ultrasound in Thai population.

BACKGROUND: The diagnosis of carpal tunnel syndrome (CTS) is usually based on clinical combining with nerve conductive study (NCS). Recently, ultrasound (US) is the choice for investigation of median nerve morphology and size. The advantages of US are non-invasive in nature and no discomfort or pain. Data on median nerve cross sectional area (CSA) in healthy Thai subjects are still limited. OBJECTIVE: To know the mean value of normal CSA in healthy Thai population. Is it different from the other countries? MATERIAL AND METHOD: Thai populations, without clinical sign or symptom of CTS, were included in the present study. A linear array transducer was used to scan and measure median nerve cross-sectional area and the maximum transverse and anteroposterior diameter were recorded. RESULTS: Eighty-eight wrists of 44 asymptomatic of CTS and healthy Thai volunteer were examined with US. The mean CSA measurement were found as 6.83 +/- 0.98 mm2 by tracing method (TM) and 6.81 +/- 1.12 mm2 by ellipsoid formula (EF) method. No significant differentiation was observed between CSA calculated using TM and EF of median nerve. There was no significant difference in CSA between right and left hand or dominate and non-dominate hand. CSA calculated by the TM and EF method were found to be significantly larger in male than in female. There was no correlation between CSA and age or BMI. CONCLUSION: Although body habitus of people was different among countries, the mean CSA of median nerve in healthy people are not significantly difference.

Herlyn-Werner-Wunderlich syndrome emphasizes ultrasonographic and MR findings: a case report and review of the literatures.

Herlyn-Werner-Wunderlich (HWW) syndrome is a rare developmental anomaly that is consists of uterus didelphys with obstructed hemivagina and ipsilateral renal agenesis. This rare entity is the spectrum of Mullerian duct anomalies (MDA) accompanied by developmental anomaly of one of Wolffian ducts. The present report demonstrated HWW syndrome and reviewed literatures in term of embryological etiology, clinical manifestation, radiographic findings and surgical management. In this case report is a 11-year-old girl presented with chronic pelvic pain. She had menarche at the age of 10 and her menstrual cycles were regular with moderate dysmenorrhea. Physical examination revealed palpable pelvic mass with tenderness. Transabdominal ultrasonography (US) and Magnetic resonance imaging (MRI) demonstrated uterine didelphys with right-sided hematometrocolpos and absent right kidney. Right hematosalpinx was also detected due to distal tubal occlusion from adhesion. These preoperative images can verify all of the features of this syndrome and correctly anticipated diagnosis was achieved. The patient underwent laparoscopic right tubal drainage with lysis of pelvic adhesion and hysteroscopic resection of vaginal septum. Her symptoms were improved uneventfully. In conclusion, HWW syndrome exhibits unique clinical presentation with characteristic radiographic findings and symptom can be relieved dramatically after receiving appropriate surgical management.

Pretreatment and posttreatment radiography in patients with pulmonary tuberculosis with and without human immunodeficiency virus infection.

PURPOSE: The purpose of this study was to determine differences in pretreatment and posttreatment radiographic findings in pulmonary tuberculosis (PTB) patients with and without human immunodeficiency virus (HIV) infection. MATERIALS AND METHODS: All patients were reviewed in terms of pre- and posttreatment radiographic findings comparing non-HIV-related versus HIV-related PTB. RESULTS: Among 177 PTB patients, 38 (22%) were HIV seropositive and 139 (78%) were HIV-seronegative. The most common radiographic finding in non-HIV-related TB was reticular infiltration (66.2%), whereas the miliary pattern was the most common radiographic finding in HIV-related TB (34.2%). Radiographic findings in HIV related TB significantly presented with higher prevalence of the miliary pattern (P < 0.0001) and lower prevalence of reticular infiltration (P < 0.0001), cavitation (P = 0.003), and mass-like lesions (P = 0.039) compared to non-HIV-related TB. During the posttreatment period, normal chest radiographs were significantly present in the patients who had HIV-seropositivity, the miliary pattern, and sputum negative for acid-fast bacilli during the pretreatment period (P < 0.05). CONCLUSION: Pretreatment radiographic features of HIV-related TB had a significantly higher prevalence of the miliary pattern and lower prevalence of reticular infiltration, cavitation, and mass-like lesions. HIV-related TB and the miliary pattern seen by pretreatment radiography were significantly associated with normal chest radiographs during the posttreatment period.

Systematic approach to the analysis of cross-sectional imaging for surveillance of recurrent colorectal cancer.

Recurrent disease in colorectal cancer occurs in approximately 50% of patients who undergo a "curative" operation. Tumor recurrence may occur locally (at the anastomotic site), in the mesentery or mesocolon adjacent to the post-operative site, in the nodal echelon downstream to the post-operative site, and as distant metastases to the peritoneal cavity, liver or lung. Local recurrence at the anastomosis is frequently diagnosed at follow-up endoscopic examinations as part of screening for metachronous lesions. Other types of recurrences require imaging studies, most frequently CT or MR imaging to diagnose. We developed an approach to analyze imaging obtained after curative resection of colorectal cancer. Our approach is based on the knowledge of patterns of disease spread, of types of surgical procedures and of pathologic staging. Using this approach has the potential to detect recurrent disease at an early stage because the locoregional and nodal spread of this disease is predictable. Early diagnosis of recurrent disease, even in asymptomatic cases, allows for more effective treatment that can improve the long-term survival of these patients.

FDG PET in the evaluation of treatment for lymphoma: clinical usefulness and pitfalls.

Positron emission tomography (PET) with 2-[fluorine-18] fluoro-2-deoxy-d-glucose (FDG) may play an important role in the evaluation and management of malignant lymphoma. FDG uptake is predictive of therapeutic response during the course of treatment. After completion of chemotherapy, residual abnormalities representing either residual tumor or necrotic or fibrotic tissue are not uncommon, and FDG PET may be more accurate than computed tomography (CT) or magnetic resonance imaging in assessing residual disease and identifying patients who require more intense treatment. However, posttreatment FDG PET does not help exclude the presence of minimal residual disease, which may lead to disease relapse. Furthermore, FDG is not a tumor-specific substance, and increased accumulation may be seen in a variety of benign entities and scenarios (eg, infection, drug toxicity, granulocyte colony-stimulating factor therapy, radiation therapy, physiologic activity, postoperative or postbiopsy changes, fracture, degenerative change, injection leakage), which may yield false-positive findings. Nevertheless, recognition of these entities and correlation of FDG PET findings with clinical and other radiologic findings-especially those at combined PET and CT or PET-CT fusion imaging-allows improved diagnostic accuracy. If the interpretation of positive findings is exceptionally difficult, short-term follow-up may be helpful.

Lymphomatous involvement of gastrointestinal tract: evaluation by positron emission tomography with (18)F-fluorodeoxyglucose.

AIM: To demonstrate the (18)F-fluorodeoxyglucose positron emission tomography ((18)F-FDG PET) findings in patients with non-Hodgkinos lymphoma (NHL) involving the gastrointestinal (GI) tract and the clinical utility of modality despite of the known normal uptake of FDG in the GI tract. METHODS: Thirty-three patients with biopsy-proven gastrointestinal NHL who had undergone FDG-PET scan were included. All the patients were injected with 10-15 mCi FDG and scanned approximately 60 min later with a CTI/Siemens HR (+) PET scanner. PET scans were reviewed and the maximum standard uptake value (SUV(max)) of the lesions was measured before and after the treatment, if data were available and compared with histologic diagnoses. RESULTS: Twenty-five patients had a high-grade lymphoma and eight had a low-grade lymphoma. The stomach was the most common site of the involvement (20 patients). In high-grade lymphoma, PET showed focal nodular or diffuse hypermetabolic activity. The average SUV(max)+/-SD was 11.58+/-5.83. After the therapy, the patients whose biopsies showed no evidence of lymphoma had a lower uptake without focal lesions. The SUV(max)+/-SD decreased from 11.58+/-5.83 to 2.21+/-0.78. In patients whose post-treatment biopsies showed lymphoma, the SUV(max)+/-SD was 9.42+/-6.27. Low-grade follicular lymphomas of the colon and stomach showed diffuse hypermetabolic activity in the bowel wall (SUV(max) 8.2 and 10.3, respectively). The SUV(max) was 2.02-3.8 (mean 3.02) in the stomach lesions of patients with MALT lymphoma. ONCLUSION: (18)F-FDG PET contributes to the diagnosis of high-grade gastrointestinal non-Hodgkin's lymphoma, even when there is the normal background FDG activity. Furthermore, the SUV plays a role in evaluating treatment response. Low-grade NHL demonstrates FDG uptake but at a lesser intensity than seen in high-grade NHL.

The efficacy of roselle (Hibicus sabdariffa Linn.) flower tea as oral negative contrast agent for MRCP study.

OBJECTIVE: To evaluate the efficacy of roselle flower tea (RFT) administration as oral negative contrast agent for MRCP study. MATERIAL AND METHOD: Roselle flower tea was prepared by packing 4,000 mg of dry ground roselle flower in a tea bag and soaked with 480 ml of hot distilled water RFT was tested in phantom, volunteer subjects and was studied in patients for MRCP study. Quanlitative analysis was made by evaluation of the conspicuity of biliary system after RFT administration. Quantitative comparison was performed by comparing the contrast-to-noise ratio between each part of the biliary system with stomach and duodenum. RESULTS: Roselle flower tea can effectively reduce signal intensity of the stomach and duodenum. There was statistically significant (p < 0.05) improvement in conspicuity of the common bile duct. There was slight improvement of conspicuity of common hepatic duct, ampulla and main pancreatic duct. Contrast-to-noise ratios were all statistically significantly improved. RFT contains 0.6 mg of iron and 1.28 mg of manganese content. CONCLUSION: Roselle flower tea is a very efficient oral negative contrast agent. It is natural, safe, inexpensive and palatable for oral administration.

MR imaging of common and uncommon large pelvic masses.

Magnetic resonance (MR) imaging is often used in the detection and staging of large pelvic masses. Many large masses in the female pelvis arise from the reproductive organs (eg, uterus, cervix, ovaries, fallopian tubes). In addition, these masses may arise from the gastrointestinal system, urinary system, adjacent soft tissues, peritoneum, or retroperitoneum or from metastases. The majority of large masses in the female pelvis represent such commonly encountered entities as uterine fibroid tumor, dermoid tumor, ovarian cyst, and ovarian cancer. However, uncommon pelvic masses such as mesothelioma, adenocarcinoma, carcinosarcoma, leiomyosarcoma, and desmoid tumor may also be seen. Thus, the differential diagnosis for female pelvic masses is extensive. However, the site of origin, MR imaging characteristics, and clinical history may all help narrow the differential diagnosis. Although with large tumors it may not always be possible to determine the site of origin or distinguish between various tumors at radiology, familiarity with the clinicopathologic and MR imaging features of common and uncommon pelvic masses is important for diagnosis and treatment.