Collateral Findings Research Articles

Collateral non cardiac findings in clinical routine CT coronary angiography: results from a multi-center registry.

The aim of the study was to evaluate the prevalence of collateral findings detected in computed tomography coronary angiography (CTCA) in a multi-center registry. We performed a retrospective review of 4303 patients (2719 males, mean age 60.3±10.2years) undergoing 64-slice CTCA for suspected or known coronary artery disease (CAD) at various academic institutions between 01/2006 and 09/2010. Collateral findings were recorded and scored as: non-significant (no signs of relevant pathology, not necessary to be reported), significant (clear signs of pathology, mandatory to be reported), or major (remarkable pathology, mandatory to be reported and further investigated). We detected 6886 non-cardiac findings (1.6 non cardiac finding per patient). Considering all centers, only 865/4303 (20.1%) patients were completely without any additional finding. Overall, 2095 (30.4%) non-significant, 4486 (65.2%) significant, and 305 (4.4%) major findings were detected. Among major findings, primary lung cancer was reported in 21 cases. In every center, most prevalent significant findings were mediastinal lymph nodes >1cm. In 256 patients, collateral findings were clinically more relevant than coexisting CAD and justified the symptoms of patients. The prevalence of significant and major collateral findings in CTCA is high. Radiologists should carefully evaluate the entire scan volume in each patient.

TCT-599 Enlargement of Distal Vessel Diameter after Percutaneous Coronary Intervention of Chronic Total Occlusion - Relationship with Collateral Flow and Intravascular Ultrasound Findings

Background: Although the vessel diameter distal to the recanalized CTO lesion is often smaller than expected immediately after recanalization, the vessel tends to increase their diameter after one year. Therefore, we assessed how the distal segment vessel diameter would increase at 1-year follow-up. Methods: Consecutive patients (n1⁄488) who received successfully recanalization of CTO lesions from July 2007 to September 2011 and had 1-year follow-up catheterization were analyzed. We classified them into two groups by the Rentrop collateral flow grade: Group A, grade 0 to 2 and Group B, grade 3. We evaluated by IVUS the plaque burden and minimum lumen diameter of the distal vessel segment immediately after recanalization. Vessel diameter distal to the recanalized CTO lesions (at 10mm from distal stent edge) was compared between follow-up and immediately after recanalization (baseline) by quantitative coronary angiography. Results: Vessel diameter increased significantly from baseline to follow-up (2.0 0.7mm vs. 2.4 0.7mm, P<0.05). Vessel diameter increased more in Group B than in Group A (76.9% vs. 94.3%mm P<0.05). There was no significant difference in IVUS findings between the patients with and without vessel diameter increase. Conclusions: Vessel diameter in the distal segment of CTO lesion increased at 1-year follow-up especially in the patients with good collateral flow.

Prevalence of extramammary findings on breast MRI: a large retrospective single-centre study

This study sought to determine the prevalence of extramammary findings on magnetic resonance (MR) imaging of the breast. We retrospectively reviewed the data sets of 828 consecutive patients (F/M; 821/7; mean age, 50 ± 11 years) who underwent breast MR imaging. The most common clinical indication was assessment of lesion extent in patients with known breast tumour (n=380, 46%), characterisation of equivocal findings at conventional imaging (n=331, 40%), evaluation of women at high risk for breast cancer (n=43, 5%) and following breast augmentation therapy (n=74, 9%). Collateral findings were found in 282/828 (34%) patients. In those 282 patients, 480 incidental lesions were detected. The most common localisation was the liver (231/480; 48%). Of the 480 collateral findings, 66 (14% in 38 patients) were classified as significant and deserving further investigation. These comprised 26 metastatic bony lesions, 15 mediastinal/axillary lymph nodes, six metastatic lung lesions, five metastatic liver lesions, four pneumonitis, two aneurysms of the ascending aorta, two adrenal adenomas, one neurofibroma of the back, one multiple myeloma, one mediastinal lymphoma, one sternal amyloidosis, one left ventricular dilatation and one trapezium lipoma. There is a high prevalence of extramammary findings on breast MR imaging. Evaluation of the examination should focus not only on the breast fields but also consider extramammary findings to avoid inappropriate management and possible legal issues.

Abstract No. 412 - CT spectrum of findings in liver parenchyma after transarterial chemoembolization with DC-beads

Purpose To describe MDCT findings and parenchymal changes after transarterial chemoembolization (TACE) with DC-beads in the treatment of primary and metastasic liver tumors. Materials and Methods Baseline and follow-up CT scans obtained in 93 patients with TACE DC-bead treatment between September 2009 and March 2012 were reviewed retrospectively to evaluate changes in biliary ducts, adjacent portal vein branches and hepatic parenchyma. Clinical data including etiology and correlation with CT findings were analyzed using the Fischer test. A p Results 93 patients, 55 men and 38 women (21-78 years) were evaluated. Etiologies included 44 hepatocellular carcinomas (38 with cirrhosis), 17 neuroendocrine metastases, 10 colorectal metastases and 22 others. The average time between TACE and follow-up CT was 50 days (r6-172). The most frequent findings at follow-up were bile duct dilatation (41.9%, n 39), obliteration of adjacent intrahepatic portal vein branches (31.1%, n 29), bilomas (26.8%, n 25), parenchymal hypodense ill-defined areas (44%, n 41), parenchymal infarcts (6.4%, n 6), periportal edema (35.4%, n 33) and perilesional parenchymal enhancement (23.6%, n 22). One patient (1.07%) had an abscess. The first 4 findings showed significant negative association with cirrhosis. In spite of these findings, there were no clinical relevant manifestations in these patients. There were no mayor complications reported. Only one patient required a percutaneous drainage catheter to drain an abscess. Conclusion The spectrum of MDCT findings we report after transarterial chemoembolization with DC-beads were not related with clinical manifestations of mayor complications in most cases. It is important for the radiologist to be familiar with these changes in order to distinguish collateral findings from complications and residual or recurrent tumor.

MDCT findings after hepatic chemoembolization with DC-beads: What the radiologist needs to know

Transcatheter arterial chemoembolization with drug-eluting beads (TACE-DC-beads) is a new local treatment for primary or metastatic liver tumors. Despite technical efforts to achieve highly selective embolization of the tumor-supplying vessels, small, or large insults to the non-tumorous parenchyma are inevitably induced by the embolic materials or procedure itself. Parenchymal changes following TACE-DC-beads include bile duct injuries (bile duct dilatation, periportal edema, and bilomas), obliteration of intrahepatic portal vein branches, hypodense ill-defined areas, and perilesional parenchymal enhancement. The radiologist must be familiar with the changes induced by this treatment in order to distinguish therapeutic effect and collateral findings from complications and residual or recurrent tumor.

ON THE STUDY OF BIFURCATIONS IN DELAY-DIFFERENTIAL EQUATIONS: A FREQUENCY-DOMAIN APPROACH

An improved version of a frequency-domain approach to study bifurcations in delay-differential equations is presented. The proposed methodology provides information about the frequency, amplitude, and stability of the orbit emerging from Hopf bifurcation. We apply this method to different schemes of the delayed van der Pol oscillator. The time-delay dependence can appear intrinsically because of the system dynamics or can be intentionally introduced in a feedback loop. Also, a discussion about system controllability and observability is given for a proper and rigorous application of the frequency domain technique. Collateral findings involving some types of static bifurcations are included for completeness.

Incidental Findings with Dual-Energy X-Ray Absorptiometry: Spectrum of Possible Diagnoses

New dual-energy X-ray absorptiometry (DXA) technologies provide improved spatial resolution and high image quality. Our purpose was to review DXA examinations to detect collateral findings and to understand their potential impact on patient healthcare. We retrospectively and randomly reviewed 739 DXA examinations (191 of 739, 25.8%, whole body; 96 of 739, 13.0%, vertebral fracture assessment; 231 of 739, 31.3%, lumbar spine; 221 of 739, 29.9%, femur) that were performed in our institution with a new DXA equipment. Whenever an extra finding was discovered, the physician's report was read and the clinical history of the patient was investigated to understand whether that finding was already known, as well as to check the diagnosis. The population included 208 male and 531 female subjects (58±14years old). Incidental findings were detected in 117 (15.8%) of 739 DXA examinations (17 of 117, 14.5%, whole body; 41 of 117, 35.0%, vertebral fracture assessment; 32 of 117, 27.4%, lumbar spine; 27 of 117, 23.1%, femur): biliary and urinary stones (4.8%), vascular calcifications (33.7%), other soft tissue calcifications (25.3%-e.g., tendons, lymph nodes, intraparenchymatous calcifications), vertebral abnormalities (14.5%), other bone abnormalities (12.1%), and morphovolumetric alterations or abnormal anatomical structures (9.6%). Among all these findings, 50 (42.7%) of 117 could be verified by other imaging modalities. Forty-nine (98.0%) of 50 incidental findings were identified as true findings, and DXA was able to orient the diagnosis (exact diagnosis in 37 of 50, 74.0%); however, none of them was mentioned on available DXA reports. An interpreting physician should treat the DXA image with the same attention given to any other X-ray image. Sometimes DXA may allow a qualitative diagnosis of collateral findings. However, potential negative effects on healthcare economy should be considered for false-positive or insignificant findings.

Prevalence and clinical significance of collateral findings detected by chest computed tomography in patients undergoing atrial fibrillation ablation

Chest computed tomography (CT) scanning is increasingly used as an imaging technique in patients undergoing atrial fibrillation (AF) catheter ablation. Chest CT scans visualize organs other than the heart and collateral findings may be identified incidentally. Our study aims to assess the prevalence and clinical relevance of such collateral findings in patients undergoing AF ablation. One hundred and seventy-three patients (127 males, age 59 ± 10 years) underwent chest CT scan for image integration in AF ablation. Collateral findings from visualized thoracic and upper abdominal organs were collected. Findings that required further investigations or treatment according to current guidelines were considered as clinically significant. A total of 164 collateral findings were identified in 97 (56%) patients, and most patients showed abnormalities of the lungs (67 patients, 39%). Forty-nine (28%) patients had clinically significant findings needing further investigation and 17 (10%) of them required specific treatments, including three cases (1.7 %) of lung malignancy. Chest CT images acquired for integration in AF ablation should be read thoroughly as they may serve as a screening tool for otherwise unrecognized clinically significant conditions of the heart, lungs, or other visualized organs.

Prevalence of extravascular collateral findings during 64-slice CT angiography of the abdominal aorta and lower limbs

The aim of this study was to assess the prevalence of extravascular collateral findings during 64-slice CT angiography of the abdominal aorta (AA-CTA) and lower limbs (LL-CTA). The images of 536 AA-CTA and LL-CTA examinations performed for suspected aortic and peripheral vascular disease in 500 patients were retrospectively reviewed. Two radiologists evaluated the 5-mm axial images independently using appropriate window settings for the area under investigation. Collateral findings were divided according to their clinical significance into significant, nonsignificant and meriting further investigation. No collateral findings were identified in 97/500 patients (19.4%). In the remaining patients, 821 collateral findings were detected, of which 43 (5.24%) were classified as significant, 135 (16.44%) as meriting further investigation and 643 (78.32%) as nonsignificant. The findings indicative of the presence of a malignant lesion totalled 36 (4.5%). AA-CTA and LL-CTA demonstrate a nonnegligible prevalence of collateral findings, many of them major. It therefore appears that the evaluation should focus not only on the image reconstructions to identify vascular disease, but also on the native axial images to detect incidental findings.

Spectrum of collateral findings in multislice CT coronary angiography

The aim of the study was to investigate the prevalence of the noncardiac collateral findings during multislice computed tomography coronary angiography (MSCT-CA). Six hundred and seventy patients undergoing MSCT-CA with 16-slice and 64-slice CT scanners for suspected atherosclerotic disease of the coronary arteries were retrospectively reviewed. All data sets obtained with a large field of view (FOV) were analysed by two radiologists using standard mediastinal and lung window settings. Collateral findings were divided according to clinical importance into nonsignificant, remarkable and compulsory to be investigated. Eighty-five percent of patients revealed coronary artery disease (CAD). Only 138/670 (20.6%) were without any additional finding. An additional 1,234 findings were recorded: nonsignificant 332 (26.9%), mild 821 (66.53%), compulsory for study 81 (6.56%). A total of 81 patients (12.08%) had significant noncardiac pathology requiring clinical or radiological follow-up. Among these, newly discovered pathologies were revealed in two patients (2.46%). A significant number of noncardiac findings might have been missed in MSCT-CA scans; the appropriate approach should be as a team trained in cardiology and radiology.

Concordance among biological, interview, and self-report measures of drug use among African American and Hispanic adolescents referred for drug abuse treatment.

This study examined the concordance among urine assays, interview measures, and self-report measures of marijuana and cocaine use among 190 drug-abusing/dependent African American and Hispanic adolescents and their families at 3 assessment points of an 18-month randomized clinical trial study. Results demonstrated concordance among urine assays, a calendar method self-report measure (Timeline Follow Back [TLFB]), and a noncalendar method self-report measure (Adolescent Drug Abuse Diagnosis Scale). Diagnostic criteria of marijuana and cocaine abuse/dependence from a clinical structured interview (Diagnostic Interview Schedule for Children [DISC]) also converged, albeit weakly, with self-report measures. Adolescent and parent reports on DISC marijuana abuse/dependence diagnostic criteria were related; however, collateral findings for DISC cocaine abuse/dependence diagnostic criteria were equivocal. Differences in concordance among biological and self-report cocaine use measures were found for baseline TLFB assessments among African American participants. Implications for future use and refinement of adolescent drug use assessments are discussed.

Musculoskeletal MR: knee.

Magnetic resonance imaging is the most sensitive, specific, and accurate noninvasive method for diagnosing internal derangement of the knee. During the past 15 years knowledge of pathologic conditions of the knee had evolved significantly. Beyond the basic principles of imaging knee injuries great impact was made on the understanding of indirect or collateral findings, even in rare diseases. In this article the spectrum of disorders of the knee are reviewed and an overview of the current literature is given. This includes considerations about how to achieve a high-standard MR imaging study of the knee, and principles of imaging anterior cruciate ligament and meniscal tears. A focus is put on distinct diseases including intra-articular and intraosseous ganglion cysts, iliotibial band friction syndrome, transient osteoporosis, osteonecrosis, osteochondritis dissecans, and imaging of the articular cartilage.

Cytopathologic evaluation of lung carcinomas presenting as brain metastasis.

Brain metastasis is an uncommon initial presentation of lung carcinoma. One arm of this analysis is a retrospective review of 137 cases of surgically diagnosed solitary brain metastasis, which were eventually found to be of lung origin, encountered at Hines VA Hospital during the period 1958 to 1996. The second arm is composed of fine-needle aspiration biopsy specimens of primary lung tumor in 23 patients with an initial clinical diagnosis of brain metastasis and without the benefit of surgery, seen from 1981 through 1996. Our results in both analyses indicate that pulmonary adenocarcinoma is the predominant primary tumor that initially manifests as a brain metastasis, approaching 76% (107 and 17 cases, respectively), followed by small-cell carcinoma at 20% (24 and five cases, respectively) and large-cell undifferentiated carcinoma and squamous-cell carcinoma at 2% each. The predominance of adenocarcinoma as a source of brain metastasis in lung cancer patients probably reflects its rising incidence overall of late. Collateral findings also suggest that surgical resection of a solitary and small brain metastasis as well as of a discrete lung primary, whenever feasible, as the most effective procedure to improve survival and quality of life of patients.

Ultrastructural studies on the effect of Triton WR-1339 on macrophage-mycobacteria interaction.

Mycobacterium bovis (BCG organisms) suspended in saline or a 5% solution of a non-ionic detergent, Triton WR-1339, was injected intraperitoneally into mice. Electron-microscopic observation was carried out on peritoneal exudate cells harvested therefrom. Electron-lucent vacuoles limited by the membrane structure were found in macrophages of the mice injected with BCG suspended in the detergent, but not in polymorphonuclear leukocytes or lymphocytes. Mycobacterial cells were present within such vacuoles. Without the detergent, the ingested mycobacterial cells were in close contact with the phagosomal membrane. Within the electron-lucent vacuoles, however, such close contact was not present. These observations, together with other collateral findings, led us to a view that Triton WR-1339 may inhibit the interaction between mycobacteria and the phagosomal membrane by intervening between them thus making the progress of infection delayed.

Mechanism of bactericidal activity of lysolecithin and its biological implication.

Lysolecithin exhibited bactericidal effect on mycobacteria and staphylococci, but not on E. coli. The effect on staphylococci was manifested shortly after exposure, but that on mycobacteria was of the delayed type. The mycobactericidal activity was dependent on the fatty acid moiety of the chemical structure reflecting the cytotoxicity of the free form. The activity on staphylococci was not, however, of such fatty acid dependency and showed the same pattern of molecular species in hemolytic activity. These and other collateral findings suggest that the mycobactericidal effect of lysolecithin is due to the free fatty acids released therefrom by the enzymatic activity of the exposed bacterial cells, but that staphylococci are killed by the detergent effect of the whole lysolecithin molecule.

Occupational Aspirations Among the Totally Blind

Fundamental problems in social psychology are being explored through a program of research among the totally blind. This article presents comparative findings on the occupational aspirations of children and adults, both Negro and white, all of whom have been blind from birth or early childhood, plus collateral findings on the parents and sighted siblings of the blind children. Neither ignorance and fantasy nor the sense that they have been labeled and consigned to a brutish existence—both plausible hypotheses—have, in fact, shaped their approach to a career. The burdens of class and race that weigh heavily upon ordinary aspirants are unexpectedly lightened for them, and special processes of socialization within the family and of communication lead to the setting of high but not unrealistic goals.

Occupational Aspirations among the Totally Blind

Fundamental problems in social psychology are being explored through a program of research among the totally blind. This article presents comparative findings on the occupational aspirations of children and adults, both Negro and white, all of whom have been blind from birth or early childhood, plus collateral findings on the parents and sighted siblings of the blind children. Neither ignorance and fantasy nor the sense that they have been labeled and consigned to a brutish existence—both plausible hypotheses—have, in fact, shaped their approach to a career. The burdens of class and race that weigh heavily upon ordinary aspirants are unexpectedly lightened for them, and special processes of socialization within the family and of communication lead to the setting of high but not unrealistic goals.