MRI in psychiatry: 731 cases.

The frequency of brain pathology found in the 731 patients who underwent MRI scans in the present study was higher than expected on the basis of reports in the literature (Owens et al., 1980). This underlines the value of a simple MRI examination as an effective diagnostic complement in the investigation of patients with psychiatric symptoms that may have an underlying organic basis.

Reduced blood flow in the transverse sinus visualized by ultra low field magnetic resonance imaging.

With an ultra low field magnetic resonance imager (ULF-MRI) operating at 0.02 Tesla we describe a case of increased signal intensity from the transverse and sigmoid sinuses of the brain. A comparison with radionuclide angiography and skull computer tomography is made. The difficulties in differentiating low blood flow and venous thrombosis is also discussed.

Visual rating of magnetic resonance images of human cerebrospinal fluid spaces and white brain matter: relation to sex and age in healthy volunteers.

The size of the cerebrospinal fluid spaces and the occurrence of white matter lesions were estimated from the intracranial volumes of 76 apparently healthy adult volunteers of different ages using 0.02-T/0.8-MHz magnetic resonance imaging. A relation between the occurrence of white matter lesions and the size of cerebrospinal fluid spaces independent of age could not be demonstrated. In men, white matter changes were more numerous and lateral ventricular size was larger, but sex differences were not statistically significant except for lateral ventricular size. The results confirm that age is the most significant parameter correlated with alterations in brain anatomy over time. Body mass and other clinical parameters were not influential factors in the present material.

A new method for characterization of low grade gliomas using ultra low field magnetic resonance imaging.

Low grade gliomas were studied with ultra low field magnetic resonance imaging (ULF MRI). The tumors exhibited high tissue contrast in both T1 and T2-weighted images as compared to normal brain tissue. Moreover they were sharply delineated towards the surrounding brain tissue. When compared with X-ray computed tomography the tumors were more readily detected and delineated by using ultra-low field magnetic imaging. A computer-assisted classification procedure was used to define new regions of interest for relaxation time estimations. By using this procedure more accurate estimations of the T1 and T2 values were obtained.

[Magnetic resonance tomography in psychiatry--clear benefits for health care services]. / Magnetisk resonanstomografi inom psykiatrin--sjukvårdsmässiga vinsterna uppenbara.

The use of MRI in clinical psychiatry is evaluated on the basis of over four years' experience. Of 931 psychiatric patients examined, 156 were found to manifest pathological cerebral conditions, a frequency of 17 per cent, as compared with 2 per cent (2/101) among apparently healthy controls. The occurrence of intracerebral lesions, with exclusively psychiatric symptoms, is illustrated with case reports. The importance is stressed of early examination with neurodiagnostic imaging techniques in cases of psychiatric disorders where any of the following symptoms or preliminary diagnoses are present: atypical psychiatric features, first episode psychosis, late onset depression, dementia, HIV and other infections in conjunction with psychiatric symptoms, hysteria, and alcohol or drug abuse. The findings suggest MRI to be a useful supplementary diagnostic tool for improving the care of the psychiatric patient, while relieving the burden both on the patient's family and on mental health care resources.

Congenital constriction of the foramen of Monro.

We report two cases of hydrocephalus in adults. The radiological investigations and direct inspection during surgery in one of the cases indicate that the hydrocephalus is caused in both cases by a benign stricture in the region of the foramen of Monro and that this constriction is congenital. This origin of hydrocephalus has not been reported previously in adults.

Diminished space in the acromioclavicular joint in forced arm adduction as a radiographic sign of degeneration and osteoarthrosis.

The purpose of this study was to examine the acromioclavicular joint by radiography under forced arm adduction to demonstrate diminished joint space as a sign of cartilage degeneration and osteoarthrosis. A total of 192 right and left joints were investigated in 96 healthy working men. There were three main results from the manoeuvre: in 135 of the 192 joints the space was reduced, in 33 joints it was unchanged, and in 24 joints the joint space was increased. In 43 joints (22% of the total) a marked reduction of the joint space to 1 mm or less occurred during the manoeuvre; in the remaining 92 joints with space reduction the reduction was less pronounced. A narrow acromioclavicular joint space during forced adduction of the arm indicates cartilage thinning and may be interpreted as a sign of osteoarthrosis.

A triad of airencephalographic findings in patients with mental impairment: a controlled prospective study.

A controlled prospective study of 82 patients examined consecutively during one year by airencephalography was made. Care was taken to excude bias and to assess observer error. A close correlation was found between mental impairment (as a sign of "organic brain syndrome", resulting from various cerebral diseases), and three airencephalographic findings, namely 1) lack of air filling over the parietal convexities (parietal air block), 2) widening of the lateral and third ventricles and 3) widening of the Sylvian and interhemispheric fissures. Of these, parietal air block was found to be the most sensitive sign. In addition to the patients with normal-pressure hydrocephalus, the majority of patients with presenile dementia and alcoholic encephalopathy had parietal air block. The results are in agreement with those reported in an earlier retrospective study. Leptomeningeal changes may account for the finding of parietal air block in certain patients, but in the majority of cases there is no complete obstruction of the subarachnoid space, as judged from the results of isotope cisternography. Organic changes in the brain and leptomeninges may create special physical conditions for the appearance of convexity air block at airencephalography. Recognition of convexity air blocks seems to have considerable diagnostic and therapeutic implications, since it contributes appreciably to the judgment whether a patient's condition is basically determined by an organic brain syndrome or constitutes a functional mental disorder. The possible pathophysiological association between mental impairment and parietal air block warrants attention.

Air filling of the subarachnoid space over the cerebral convexities at repeat encephalography.

In order to check the constancy of convexity block, the airencephalograms (AEG) of seventeen patients who had undergone two separate examinations were reexamined. A satisfactory filling by air of the basal cisterns or Sylvian fissures was a prerequisite for including the AEG in this series. Consistent results related to air filling of the parietal region were obtained at the two examinations except in one patient with clinical signs of a pontine neoplasm. When the AEG was repeated in a very short time and with unchanged clinical conditions, the degree of air filling over the convexity was practically identical. But, with progressive neurological signs, the parietal air blocks showed a slight increase and also extended to the frontal region. It was concluded, firstly, that upper convexity block is a reproducible finding; secondly, that it is related to organic brain disease, the extent of the convexity block being correlated to the degree of clinical deterioration. As judged from other studies using isotope cisternography, the subarachnoid space is usually not complelely obstructed. It is suggested that the organically changed brain and leptomeninges create special physical conditions for the appearance of convexity air block in the AEG.

Constancy of convexity air block on pneumoencephalography.

Twenty-two patients with dementia were examined by pneumoencephalography using special technic with the aim of filling the subarachnoid convexity space. Seven had no obvious hydrocephalus. All patients had convexity blocks which were more or less extensive. Ten had bilateral air block in the frontal, parietal and occipital regions. It was concluded that convexity air block is not a technical artifact and consequently seems to have an organic background.

Correlation of macroscopic osteoarthrotic changes and radiographic findings in the acromioclavicular joint.

In a total of 108 acromioclavicular articulations from cadavers the osteoarthrotic changes were studied. The articulations were macroscopically and radiographically ranked according to their grade of osteoarthrosis. The two ranking lines were correlated statistically and showed a rank correlation of 0.741. In 38 articulations tomography was also carried out. These articulations were classified into five grades of osteoarthrosis and the macroscopic, conventional radiographic and tomographic gradings were compared. The correlation coefficient for tomography versus macroscopy was 0.714. Tomography versus standard radiography showed a correlation of 0.767 and standard radiography versus macroscopy a correlation of 0.841. The standard radiographic investigation reveals moderate and severe osteoarthrotic changes in the acromioclavicular joint but cannot depict smaller changes. Tomography does not seem to improve the specificity. There is a need for a better radiologic technique in the examination of the acromioclavicular joint. Radiography during some kind of loading might be a practical way of improving the specificity and make it possible to show early osteoarthrosis in the acromioclavicular articulation.

Sclerotherapy of esophageal varices: an endoscopic and portographic study.

A prospective series of 26 patients with portal hypertension and recent bleeding from esophageal varices was investigated with percutaneous transhepatic selective portography (PTP). PTP was performed immediately prior to and, in 23 patients, just after the initial endoscopic injection sclerotherapy (ST) session to study the acute effects of ST on the mediastinal portal-systemic collaterals. Late follow-up PTP was performed after a median of 8 months in 21 of 26 patients considered endoscopically to be free from esophageal varices after a median of 6 ST sessions. Five patients rebled from esophageal or gastric varices during the follow-up period of 15 months, but there were no fatalities due to variceal hemorrhage. In all patients, the initial PTP showed portal-systemic mediastinal collaterals. Immediately after ST, it was not possible to opacify esophageal varices at all (10 patients) or only partially (7 patients). Five patients died prior to late follow-up PTP. Endoscopic judgment of complete eradication of esophageal varices after repeated ST was in agreement with the late PTP results in 18 of 21 patients. In one patient, PTP showed residual esophageal varices subsequently confirmed by endoscopy. The results were uncertain in two patients for technical reasons. This study supports the opinion that submucosal esophageal varicose veins, as visualized by PTP, can be efficiently eradicated by serial ST, leaving the other mediastinal collaterals unaffected.

Radiographic osteoarthrosis in the acromioclavicular joint resulting from manual work or exposure to vibration.

The hypothesis that manual work and exposure to vibration are antecedents to the development of osteoarthrosis was assessed employing a cross sectional study design. The frequency of osteoarthrosis in the acromioclavicular joint was studied in three groups of workers in the construction industry. Two groups were manual workers (54 bricklayers and 55 rock blasters); the third group consisted of 98 foremen. The radiographic appearance of the right and left acromioclavicular joints was classified into one of five grades of osteoarthrosis. A protocol was developed to assess exposure on the basis of job title, years of manual work, total weight lifted during working life, and total hours of exposure to vibrating tools. Odds ratios for job titles (manual worker v foreman) and for years of manual work as indicators of exposure were of similar magnitude of around 2.5. Construction workers who had lifted more than 709 tonnes had an increased risk of developing severe osteoarthrosis of the right acromioclavicular joint, odds ratio: 2.62 (95% confidence interval (95% CI), 1.13-6.06). The odds ratio for the left side was 7.67 (95% CI, 2.76-21.34). In the analysis of vibration exposure, workers who had been highly exposed to vibration had an odds ratio of 1.99 (95% CI, 1.00-3.92) on the right side and 2.20 (95% CI, 1.07-4.56) on the left. This effect almost disappeared after simultaneous adjustment for manual work. Occupational and ergonomic factors, such as the sum of lifted tonnes during working life, job title, and the sum of years of manual work seem to be risk factors for osteoarthrosis of the acromioclavicular joint, whereas vibration alone was a weaker risk factor.

Low field magnetic resonance imaging of the central nervous system in 15 children with autistic disorder.

Fifteen children, 10 boys and 5 girls, with autistic disorder, were studied with low field magnetic resonance imaging (MRI). The age ranged from 2.7-13.1 years, with a mean of 8.3 years. All patients but one (who refused) had a normal CT scan of the C.N.S. The MRI investigation was performed during anaesthesia with a low field magnetic resonance imager. The cerebrum, cerebellum, and brain stem were examined. No pathological changes were found in any of the patients studied.