Accumulation Of Contrast Medium Research Articles

CSF - injected contrast medium enhances post-traumatic spinal cord cysts. An experimental study in rats.

Spinal cord injury (SCI) is still one of the most challenging problems in neurosurgical practice. One of the major obstacles to neural regeneration following trauma is the formation of glial scarring and post-traumatic cysts which acts against proper growth of axons through the site of injury. Cerebrospinal fluid (CSF) delivery of bioactive agents into cystic cavities could represent a promising therapeutic strategy. In the present study, we investigated specifically the dynamics of intradural delivery of contrast medium and its relocation into post-traumatic cysts in an experimental model of spinal cord cryoinjury in rats. 32 male Sprague Dawley SPF rats were submitted to injury as previously described. Omnipaque-240 was injected either into the cisterna magna or at the level of the cauda equina. Subsequently, cerebral CT scan examinations were performed in order to check the CSF dynamics of the contrast medium. There was a steady accumulation of contrast medium into post-traumatic cysts as early as five minutes after injection. A dosage of 65 mg of iodine per kilogram ensured an adequate feeling of the cysts at an average of 30 minutes. Our data indicate that intraspinal injection of bioactive agents can easily reach the site of injury and fill post-traumatic cysts. This could represent an interesting potential therapeutic protocol for SCI.

The clue is in the kidneys: greater renal contrast medium accumulation on ipsilateral side down CT myelogram after lateral decubitus digital subtraction myelogram as a predictor of laterality of cerebrospinal fluid leak

To assess the potential correlation of the laterality of a cerebrospinal fluid (CSF)-venous fistula with the laterality of decubitus computed tomography (CT) myelogram (post decubitus digital subtraction myelogram) based on which side demonstrated more renal contrast medium excretion.Patients with CSF-venous fistulas diagnosed at lateral decubitus digital subtraction myelograms were reviewed retrospectively. Patients who did not have CT myelogram following one or both left and right lateral decubitus digital subtraction myelograms were excluded. Two neuroradiologists independently interpreted the CT myelogram for the presence or absence of renal contrast, and whether subjectively more renal contrast medium was visualised on the left or right lateral decubitus CT myelogram.Renal contrast medium was seen in lateral decubitus CT myelograms in 28 of 30 (93.3%) patients with CSF-venous fistulas. Having more renal contrast medium in right lateral decubitus CT myelogram was 73.9% sensitive and 71.4% specific for the diagnosis of a right-sided CSF-venous fistula, whereas having more renal contrast medium in the left lateral decubitus CT myelogram was 71.4% sensitive and 82.6% specific for a left-sided CSF-venous fistula (p=0.02).When the CSF-venous fistula lies on the dependent side of a decubitus CT myelogram performed after decubitus digital subtraction myelogram, relatively more renal contrast medium is visualised compared to when the fistula lies on the non-dependent side.

Reversible intracranial contrast medium accumulation after embolization of unruptured cerebral aneurysms and its association with transient neurological deficits: A single center experience.

Use of iodine-containing contrast medium (CM) is obligatory for endovascular treatment (EVT) of cerebral aneurysms. After EVT, intracranial density increases (DIs) can be detected in cranial computed tomography (CT). Those DI can correspond to subarachnoid hemorrhage (SAH), infarction or reversible CM accumulation (RCMA). The latter can be mistaken for hemorrhage, especially if they are accompanied by neurological deficits. To analyze postinterventional DI after EVT of unruptured cerebral aneurysms and associated clinical symptoms and to identify risk factors for the occurrence of RCMA. For differentiation of DI, we compared CT scans following EVT and additionally 24 h ± 5 h later. Diagnosis of RCMA was based on marked regression of DI on follow-up scans. We analyzed continuous variables (age, duration of intervention and anesthesia, aneurysm diameter, amount of CM and renal function) and categorial variables (gender, aneurysm location, devices for EVT, antiplatelet therapy [APT] and associated neurological deficits) to identify risk factors for the occurrence of RCMA. We studied 58 patients (44 female, mean age 59.5 [range 39-81]) who underwent EVT for a total of 68 cerebral aneurysms in 62 therapy sessions over a 3-year period without periprocedural complications. Postinterventional DI occurred after 17 therapy sessions. All 17 DI turned out to be RCMA in the follow-up imaging. Two patients who had no DI on initial postinterventional CT showed new SAH on follow-up CT. Infarctions were not observed. Transient neurological deficits occurred in eight patients (12.9%) and were associated with RCMA (P = 0.010). Postinterventional RCMA was associated with the duration of EVT (P = 0.038) and with APT (acetylsalicylic acid [ASA] + clopidogrel: P =0.040; ASA alone: P =0.011). RCMA is common after EVT of unruptured cerebral aneurysms and often accompanied by transient neurological deficits. Long procedure duration and APT appear to predispose to the occurrence of RCMA.

Immediate surgical treatment for massive extravasation of computed tomography contrast medium in the hand: a case report

There are no treatment guidelines for the extravasation of contrast medium. A 71-year-old man underwent coronary artery computed tomography. When contrast medium (iohexol) was injected through the right cephalic vein, massive leakage into the surrounding tissues occurred. A physical examination showed severe swelling of the hand and a prolonged capillary refill time. X-rays showed a massive accumulation of contrast medium in the hand. We immediately performed surgical treatment, including four skin incisions on the hand, subcutaneous dissection, and squeezing, which led to the removal of 50 mL of liquid. The immediate postoperative radiographic findings showed dramatic fading of most of the contrast medium. Four days postoperatively, radiography showed complete dissolution of all contrast medium, and a physical examination revealed full recovery of skin color and capillary refill time. We successfully managed massive extravasation of contrast medium in the hand with immediate surgical treatment. An immediate surgical approach for massive extravasation should be considered to achieve favorable outcomes.

An Unusual Case of Chest Pain and Pyrexia

Question: A 44-year-old man with tearing retrosternal pain for 2 weeks was admitted to our department. A day before the onset of symptoms, he had pharyngalgia, cough, sputum production, moderate pyrexia, and fatigue, which he thought was due to a common cold. He then had sudden-onset severe chest pain, which lasted 4 to 6 seconds and occurred every 30 seconds, with acid reflux and heartburn. The patient had consumed nothing after the start of the symptoms until this consultation. He denied emesis, hematemesis, melena, dysphagia, odynophagia, history of esophageal disease, eating hurriedly, ingestion of hot or rough food, anticoagulants, or foreign body. His medical history was significant for alcohol consumption (100 g/d) for more than 20 years. He visited a local hospital and underwent chest computer tomography (CT); however, the diagnosis was unclear, and an attempt to insert a nasogastric tube failed. The patient visited another hospital, and a CT scan revealed dilation of the esophageal lumen and thickening of the esophageal wall, with exudation in the periesophageal areas and lung fields. Esophagoscopy revealed a large depressed lesion at 20 cm from the incisors, measuring 1 cm in diameter and covered with pus. The background esophageal mucosa was severely inflamed and edematous. Contrast esophagography performed a week later showed accumulation of contrast medium in the middle and lower esophagus, which formed a sac-like shadow beside the esophagus, without communication with the thoracic or gastric cavity. The patient was treated conservatively, and his symptoms were partially relieved. Because the pathogenesis was still unknown, the patient was referred to our institution for further evaluation. What is the correct diagnosis and management of this condition? See the Gastroenterology website (www.gastrojournal.org) for more information on submitting to Gastro Curbside Consult According to his medical history from other hospitals, normal electrocardiography and cardiac enzyme levels excluded the diagnosis of myocardial infarction; absence of hypertension and no abnormalities in aortic anatomy disclosed by means of contrast CT argued against aortic dissection; absence of emesis and no extravasation of contrast medium demonstrated by contrast esophagography excluded Boerhaave’s syndrome. Then contrast chest CT scan, which revealed thickening and liquid accumulation in the middle and lower esophageal wall, with little extra-esophageal air leakage and pneumonia (Figures A and B), and upper endoscopy (Figures C and D) were performed. A diagnosis of spontaneous intramural esophageal dissection (SIED) complicated by infectious esophagitis and pneumonia was made. SIED is a rare disease entity characterized by transverse and longitudinal separation of the mucosal and submucosal layers from the esophageal wall. Sudden onset of severe retrosternal chest pain, odynophagia, dysphagia, and hematemesis are the most common symptoms. Contrast esophagography and chest CT are the preferred methods to establish the diagnosis, and endoscopy also proved to be safe and useful in this condition. In most cases, conservative treatment has a good prognosis. Endoscopic interventions and surgery are alternative therapies when patients are refractory to conservative management or when complex complications occur.1Khil E.K. Lee H. Her K. Spontaneous intramural full-length dissection of esophagus treated with surgical intervention: multidetector CT diagnosis with multiplanar reformations and virtual endoscopic display.Korean J Radiol. 2014; 15: 173-177Crossref PubMed Scopus (4) Google Scholar,2Jung K.W. Lee O.J. Extensive spontaneous submucosal dissection of the esophagus: long-term sequential endoscopic observation and treatment.Gastrointest Endosc. 2002; 55: 262-265Abstract Full Text Full Text PDF PubMed Scopus (14) Google Scholar The patient was treated conservatively and discharged on day 35. Seven weeks later, follow-up endoscopy showed complete mucosal healing (Figure E), and he was asymptomatic at the time of writing (August 1, 2022).

Hand compartment syndrome secondary to contrast media extravasation: A case report

IntroductionContrast media extravasation injury is a recognized complication of contrast media use. Compartmental syndrome of the hand secondary to contrast extravasation is exceptional. We describe a case of compartment syndrome of the hand secondary to contrast media extravasation.Case presentationWe present a 47-year-old woman with a history of pulmonary embolism who was diagnosed of compartment syndrome of the left hand after injection of contrast medium during a CT scan. Whose first diagnosis was mild contrast medium extravasation injury 24 h before the compartment syndrome. Standard radiography showed an accumulation of contrast medium in the left hand. The patient underwent a fasciotomy and secondary healing. Follow-up showed good radiographic, clinical, and hand function after 2 months.DiscussionThe occurrence of hand compartment syndrome secondary to contrast media extravasation is rare. Most of the time, they are initially diagnosed as medium extravasation before the worsening of symptoms. Because of its unknown incidence, treatment is not codified. The goal of treatment is to save the limb and restore function. This can be achieved rapidly with early surgery because of the unpredictable course.ConclusionContrast media injection is not a harmless gesture. Hand compartment syndrome after contrast extravasation is rare and is a severe injury, our experience with this case suggests that early surgery helps save the limb and restore function. Always fear a compartmental syndrome in case of extravasation of contrast medium.

Small Renal Masses without Gross Fat: What Is the Role of Contrast-Enhanced MDCT?

Increased detection of small renal masses (SRMs) has encouraged research for non-invasive diagnostic tools capable of adequately differentiating malignant vs. benign SRMs and the type of the tumour. Multi-detector computed tomography (MDCT) has been suggested as an alternative to intervention, therefore, it is important to determine both the capabilities and limitations of MDCT for SRM evaluation. In our study, two abdominal radiologists retrospectively blindly assessed MDCT scan images of 98 patients with incidentally detected lipid-poor SRMs that did not present as definitely aggressive lesions on CT. Radiological conclusions were compared to histopathological findings of materials obtained during surgery that were assumed as the gold standard. The probability (odds ratio (OR)) in regression analyses, sensitivity (SE), and specificity (SP) of predetermined SRM characteristics were calculated. Correct differentiation between malignant vs. benign SRMs was detected in 70.4% of cases, with more accurate identification of malignant (73%) in comparison to benign (65.7%) lesions. The radiological conclusions of SRM type matched histopathological findings in 56.1%. Central scarring (OR 10.6, p = 0.001), diameter of lesion (OR 2.4, p = 0.003), and homogeneous accumulation of contrast medium (OR 3.4, p = 0.03) significantly influenced the accuracy of malignant diagnosis. SE and SP of these parameters varied from 20.6% to 91.3% and 22.9% to 74.3%, respectively. In conclusion, MDCT is able to correctly differentiate malignant versus uncharacteristic benign SRMs in more than 2/3 of cases. However, frequency of the correct histopathological SRM type MDCT identification remains low.

Forced Diuresis with Matched Isotonic Intravenous Hydration Prevents Renal Contrast Media Accumulation.

The accumulation of contrast media in the kidneys might lead to contrast-induced acute kidney injury. In this prospective, controlled observational study, we aimed to evaluate whether forced diuresis with matched isotonic intravenous hydration prevents the accumulation of contrast media in the kidneys of patients undergoing cardiac interventional procedures. We compared the intensity of contrast media accumulation as observed in nephrograms following these procedures, with and without peri-procedural controlled renal flushing. The study group consisted of 25 patients with impaired renal function treated with the RenalGuard system. The two control groups included 25 patients with normal kidney function and 8 patients with impaired renal function undergoing similar procedures with routine pre-procedural hydration, but without controlled renal flushing. Renal contrast media accumulation at the end of each procedure was scored by blinded cardiologists. The renal contrast accumulation score (CAS) in the study group was significantly lower, with a median score of 0 (IQR (0–0)) compared with 1.5 (IQR (1–2)) in the normal renal function control group and 1 (IQR (0.38–1.62)) in the impaired renal function control group (p < 0.001 and 0.003, respectively). In a multivariate analysis of CAS, RenalGuard treatment was independently associated with lower CAS compared to both control groups. In conclusion, RenalGuard use prevents renal contrast accumulation in patients with impaired renal function undergoing cardiac procedures with intra-arterial contrast media injection.

Residual oil-based iodinated contrast medium accumulation that mimicked an abdominal foreign body, following an emergency cesarean delivery : a case report

Residual oil-based iodinated contrast medium accumulation that mimicked an abdominal foreign body, following an emergency cesarean delivery : a case report

Renal Dysplasia in a Free-Living Giant Anteater Cub (Myrmecophaga tridactyla) - Ultrasonographic and Tomographic Aspects

Background: Renal dysplasia is a congenital disorder that occurs during differentiation of the renal parenchyma or as a consequence of a functional and/or structural obstruction of the lower urinary tract. In wild animals, this pathology has been reported in cynomolgus monkeys (Macaca fascicularis), golden hamsters (Mesocricetus auratus) and African elephants (Loxodanta africana). However, there are no reports of the disease in the giant anteater (Myrmecophaga tridactyla). Thus, this paper describes a case of renal dysplasia in a free-living giant anteater cub, which was sent to the wild animal clinic of the Federal University of Mato Grosso (UFMT) in Cuiabá, MT, Brazil. Case: The rescued animal had a good body condition score and clinical parameters within the normal range for the species. After a routine clinical evaluation, the anteater cub was subjected to radiography and ultrasound tests. Blood tests, serum tests for hepatic and renal profiles, urinalysis, urinary protein creatinine ratio, and chest X-rays did not reveal significant changes. However, the abdominal ultrasound examination revealed a volumetric loss of about 1.17 cm in length in the left kidney, and a renal length to aortic artery diameter ratio of approximately 2.8. This kidney showed irregular contours, loss of corticomedullary demarcation, with preserved echogenicity and cortical echotexture. The right kidney showed the standard size of the species, with a length of approximately 3.08 cm. In view of the suspicion of renal dysplasia, a contrast-enhanced CT scan was performed in order to assess the dynamics of uptake and excretion of the contrast medium in the affected kidney and in the ipsilateral collecting system. An examination of the tomographic images indicated that the volume of the left kidney was reduced, isodense in relation to the right kidney, with discrete and homogeneous uptake in all phases after administration of the contrast medium, no occurrence of nephrogram and pyelogram phases, or any detection of contrast in the corresponding ureter.Discussion: Giant anteaters (Myrmecophaga tridactyla) are animals classified as a species vulnerable to extinction. Today, most research involving this species focuses on its ecology, behavior, diet, morphology and parasitology, but little is known about the imaging aspects of the species or about congenital changes such as renal dysplasia. Although the definitive diagnosis of this pathology depends on a histopathological examination, the same diagnosis can be made with a wide margin of safety by assessing the epidemiological aspects and the dynamics of renal uptake of the contrast medium through computed tomography. In this analysis, both vascularization and renal filtration capacity can be assessed. Thus, based on CT imaging, it was concluded that this was a case of renal dysplasia, since the left kidney showed a discrete homogeneous uptake stable in both the arterial and venous phases, without producing any accumulation of contrast medium in the pelvic region or the collecting system, proving to be completely nonfunctional. These findings differ from cases of renal hypoplasia, which, although they reduce renal volume, do not cause structural changes in the renal parenchyma or disturbances in the filtration dynamics of contrast media. They also differ from cases of acquired chronic nephropathy, since, albeit associated with reduced renal volume and changes in renal filtration dynamics, they produce different parenchymal ultrasound changes that usually occur in elderly animals and generally produce bilateral lesions.

Spontaneous Raman spectroscopy for intracranial tumors diagnostics ex vivo

Neurosurgery of intracranial tumors, especially of glial origin, is a non-trivial task due to their infiltrative growth. In recent years, optical methods of intraoperative navigation have been actively used in neurosurgery. However, one of the most widely used approaches based on the selective accumulation of fluorescent contrast medium (5-ALA-induced protoporphyrin IX) by the tumor cannot be applied to a significant number of tumors due to its low accumulation. On the contrary, Raman spectroscopy, which allows analyzing the molecular composition of tissues while preserving all the advantages of the method of fluorescence spectroscopy, does not require the use of an exogenous dye and may become a method of choice when composing a system for intraoperative navigation or optical biopsy. This work presents the first results of using the principal component method to classify Raman spectra of human glioblastoma with intermediate processing of spectra to minimize possible errors from the fluorescence of both endogenous fluorophores and photosensitizers used in fluorescence navigation. As a result, differences were found in the principal component space, corresponding to tissue samples with microcystic components, extensive areas of necrosis, and foci of fresh hemorrhages. It is shown that this approach can serve as the basis for constructing a system for automatic intraoperative tissue classification based on the analysis of Raman spectra.

Lacrimal Drainage System Obstruction Following Inferior Turbinate Surgery

Objective: To provide information on the clinical characteristics and management of an uncommon acquired nasolacrimal drainage system obstruction (NLDSO).Methods: A patient was treated with microdebrider-assisted endoscopic marsupialization for a cystic lesion located in the synechiae between the inferior turbinate and the lateral wall of the inferior meatus.Results: A 21-year-old woman suffered from epiphora and purulent discharge 1 week after inferior turbinate surgery. Endoscopy reveled synechiae between the inferior turbinate and the lateral wall of the inferior meatus. Computed tomography-dacrocystography (CT-DCG) showed enlargement of the nasolacrimal duct and cystic accumulation of contrast medium from the lacrimal orifice posteriorly. The patient was treated with nasal endoscopic marsupialization of the cyst and then powered inferior turbinoplasty. Six months after the operation, both endoscopy and CT scan showed a widely patent left inferior meatus and nasolacrimal orifice.Conclusions: We report the first case of post-operative NLDSO following inferior turbinate surgery. Nasal endoscopy and CT-DCG are useful to diagnose the location of a NLDSO. Otorhinolaryngologists should be aware that surgery may lead to the formation of a NLDSO and that endoscopic marsupialization is a curative treatment for these distal-end NLDSO. NLDSOs are caused by synechiae, which are a complication of inferior turbinate surgery.

Possibilities of magnetic resonance imaging in SWI mode in differential diagnosis of brain gliomas (G3–G4) and primary lymphomas

The study objectiveis to assess the possibilities of magnetic resonance imaging (MRI) in SWI (susceptibility weighted imaging) in the differential diagnosis of glial brain tumors and primary brain lymphomas.Materials and methods.Fifty-four patients with brain tumors were studied (men – 27 (50 %), women – 27 (50 %)). Average age 57.9 years. Histological examination of the surgical material revealed the glial nature of tumors in 41 patients (26 of them with glioblastoma, anaplastic astrocytomas – 15), primary brain lymphomas – in 13 patients. Brain MRI was performed using tomographs with a magnetic field of 3 and 1.5 T. A semi-quantitative assessment of the data obtained in the SWI mode based on the classification of ITSS (intratumoral susceptibility signals), reflecting the severity of interstitial vascular architectonics and microbleeding.Results.The degree of ITSS was 3 in glioblastomas (G4 ) in 26 (100 %) cases, in the structure of gliomas (G3 ) the ITSS values were 3 in 3 (20 %) cases, in the remaining 12 (80 %) cases – ITSS 2. In the group of primary brain lymphomas, the ITSS 1 was in 4 (30.7 %) cases, ITSS 0 was in 9 (69.3 %) cases.Conclusion.MRI in SWI mode is a promising technique that allows one to quantify the degree of pathological changes in tumor vascular architectonics and intratumoral hemorrhages and has shown high specificity in the differential diagnosis of malignant gliomas and lymphomas of the brain, accompanied by active accumulation of contrast medium.

Компьютерная и магнитно-резонансная томография при неходжкинской лимфоме периренальной локализации

A description of specific features of CT-MRI in rare patient with perirenal non-Hodgkins lymphoma is presented in the article. CT scan was used to determine the accumulation of contrast medium and pathological vessels along the right kidneys border. Diffusion weighted MRI revealed the low values of the measured diffusion coefficient (MDC) and high accumulation index of the paramagnetic in the tumor tissue (0.59-0.62). The specific features of perirenal non-Hodgkins lymphoma on CT/MRI, an evaluation of the tumors volume and stage, and signs of malignancy are described.

Magnetic Resonance Spectroscopy in the Diagnosis and Prognosis of Breast Cancer

Objective. To evaluate the efficiency of magnetic resonance spectroscopy in the diagnosis and prognosis of breast cancer (BC).Material and methods. Twenty-eight patients aged 37 to 80 years with established primary invasive BC were examined. Its grade was determined according to pathomorphological verification with immunohistochemical analysis. Breast MRI was performed using the standard protocol, by determining the measured diffusion coefficient (MDC), dynamic contrast enhancement (DCE). Proton magnetic resonance spectroscopy was carried out using the Breeze software package. The clinical and morphological findings and the results of radiation studies were compared to determine Nottingham prognostic index (NPI) scores. To identify the Spearman rank correlation coefficient between MRI findings (the type of pharmacokinetic curves, the total choline-containing (tCho) peak integral) and the values characterizing tumor size and grade.Results. NPI calculation showed that the scoring range was 2.4 to 6.76; the expected 5-year survival rates reached 93%. The mean MDC was 0.856×10-3 mm2/sec; type II pharmacokinetic curve prevailed (n=16; 57.1%). There was a statistically significant negative correlation between the values of MDC, the type of a contrast agent accumulation curve, the levels of HER2/neu and the proliferation marker Ki-67; there was a statistically significant strong positive correlation between the presence of 1H-MPC tCho peak and the indicators determining tumor malignancy (the levels of HER2/neu and Ki-67). Statistically significant differences between the type of a pharmacokinetic curve in DCE and the level of tCho in the prognostic groups defined when calculating NPI were determined in patients with moderate (n=4; 14.2%) and poor (n=10; 35.7%) prognosis.Conclusion. The capabilities of MR spectroscopy are superior in information content to the data obtained by determining the MDC, the nature of contrast medium accumulation in breast tumor, and are comparable with the data determining the type of a tumor (the presence of the HER2/neu gene, Ki-67 proliferation marker) in predicting BC cancer grade and 5-year survival rates.

Subdural contrast effusion during endovascular therapy: case report

Accumulation of contrast medium in the subdural space after diagnostic intraarterial contrast administration is a rare observation. The authors report the case of a subdural contrast effusion (SCE) presenting during endovascular treatment of an intracranial dural arteriovenous fistula (DAVF) mimicking an acute subdural hematoma. Differentiation between the two by computed tomography (CT) or intraprocedural Dyna CT and early neurological examination can be crucial for patient management. We believe that repeated large-volume contrast injections via large-bore intermediate catheters into the territory of an (even partly) occluded DAVF may induce leakage of contrast medium into the extravascular subdural space thereby causing a SCE.

AUTOIMMUNE BRAINSTEM ENCEPHALITIS (CLIPPERS-SYNDROM): A CASE REPORT

Aim. In this paper, we aim to analyse our own clinical observation of a patient with CLIPPERS syndrome on the basis of available literature data. Materials and methods. The medical record of a patient treated at the Neurology Unit of the S.V. Ochapovsky Regional Clinical Hospital No. 1 (Kradnodarsy Krai) was investigated, along with available national and foreign literary sources. Results. The patient was diagnosed with autoimmune brainstem encephalitis (CLIPPERS syndrome) on the basis of the diagnostic CLIPPERS syndrome criteria modified and adapted by W. Tobin and co-authors in 2017. Among them are: 1) subacute development of symptoms for the pons and cerebellum lesions along with other signs of CNS damage (onset is characterised by diplopia and ataxia); 2) good response to glucocorticosteroid (GCS) therapy; 3) lack of involvement of the peripheral nervous system; 4) enhanced MRI lesions homogeneously accumulating contrast agents without a mass effect; 5) a significant decrease in the accumulation of contrast material during GCS therapy; 6) absence of myelin loss. Conclusion. Considering that the GCS therapy produces a rapid and significant effect, it is important to focus on early detection and treatment of this disease through the development of more accurate markers and evaluation criteria for its diagnosis.

Diagnosis of Lymphangiomatosis: A Study Based on CT Lymphangiography

Lymphangiomatosis is a rare disease characterized by the widespread presence of lymphangiomas in any part of the body. In previous studies, lymphatic vessel abnormalities in lymphangiomatosis have only rarely been mentioned. The objective of this paper is to discuss the imaging features of lymphangiomatosis, including cystic lesions and lymphatic abnormalities, on computed tomography lymphangiography (CTL). All 34 patients who were diagnosed with lymphangiomatosis underwent direct lymphangiography followed by CTL. The CTL images were independently analyzed by two experienced radiologists. The CTL image analyses included assessment of the features of cystic lesions and lymphatic vessel abnormalities. (i) CTL revealed several cystic lesions ranging in size from 3 mm to 14 cm; the lesions were located in the neck and shoulders (61.8%), mediastinum (52.9%), retroperitoneum (70.6%), and pelvis and perineum (64.7%). (ii) Approximately 29.4% of patients showed abnormal contrast medium accumulation in cystic masses. (iii) Approximately 67.6% of patients showed lymphatic reflux. (iv) Dilated lymphatic vessels were distributed in the mediastinum (38.2%), retroperitoneum (50.0%), pelvis and lower limbs (47.1%). (v) Finally, 8.8% of patients had perineal lymphatic fistulae, and 2.9% of patients had chyluria. Lymphangiomatosis is a type of systemic lymphatic abnormality that is accompanied by multiple cystic lesions. The therapeutic measures for lymphangiomatosis are determined by the size of the cystic lesions. Furthermore, the prognosis of lymphangiomatosis is affected by lymphatic abnormalities.

Fibrotic Changes in the Myocardium as an Independent Predictor of Rhythm Disturbance in Patients with Hypertrophic Cardiomyopathy

The aim: to show the possibilities of the method of magnetic resonance imaging (MRI) in the detection and characterization of hypertrophic cardiomyopathy (HCM). Identify the relationship between the presence of foci of fibrosis in the myocardium of the left ventricle (LV) and the occurrence of arrhythmia.Materials and methods.The study involved 31 patients with HCM and obstruction of the LV outflow tract, who subsequently underwent Morrose's myoseptectomy. In order to detect abnormalities of rhythm, all patients underwent daily Holter monitoring. The presence and nature of the accumulation of contrast medium was assessed by the MRI method in the early and delayed phases of contrasting.Results.The use of MRI with contrast enhancement made it possible to identify areas of delayed contrast in the hypertrophied walls of the LV - fibrotic changes in the myocardium. The centers of fibrosis were revealed in 14 (45.2%) patients. In 5 patients (16.1%), there were no cardiac rhythm disturbances in the presence of changes in the myocardium. Multivariate regression analysis of risk factors showed the relationship between the presence of foci of fibrosis in the myocardium of the LV and the occurrence of arrhythmia (p = 0.021). The presence of violation zones of local contractility (p = 0.327) and the thickness of the hypertrophic wall (p = 0.146) have no significant effect on cardiac rhythm disturbance.Conclusions.The presence of foci of delayed contrast (fibrosis) in the wall of the left ventricle, detected by MRI, increases the chance of arrhythmia in patients with HCM in 12.9 times. MRI with contrast enhancement should be included in the algorithm for diagnosis of HCM, including for evaluating the onset of structural changes in the myocardium.

MRI morphologic alterations after liver SBRT : Direct dose correlation with intermodal matching.

CT morphologic and histopathologic alterations have been reported after SBRT. We analyzed the correlation of MRI morphologic alterations with radiation doses to assess the potential for MRI-based dose-effect correlation in healthy liver tissue. MRI data of 24patients with liver metastases 7±3weeks after image-guided SBRT in deep-inspiration breath-hold were retrospectively analyzed. MRI images were intermodally matched to the planning CT and corresponding dose distribution. Absolute doses were converted to EQD2,α/β=x with α/β values of 2, 3 for healthy liver tissue, 8Gy for modelled predamaged liver tissue and 10Gy for tumor tissue. A central nonenhancing area was observed within the isodose lines of nominally 48.2± 15.2Gy, EQD2Gy/α/β=10 92.5± 27.7Gy. Contrast-enhancement around the central nonenhancing area was observed within the isodose lines of nominally 46.9± 15.3Gy, EQD2Gy/α/β=10 90.5± 28.3Gy. Outside the high-dose volume, in the beam path, characteristic sharply defined, nonblurred MRI morphologic alterations were observed that corresponded with the following isodose lines: T1-intensity changes occurred at isodose lines of nominally 21.9± 6.7Gy (EQD2,α/β=2 42.5± 8.7Gy, EQD2,α/β=3 38.5± 7.6Gy, EQD2,α/β=8 30.2±6.3Gy). T2-hyper/hypointensity was observed within isodose lines of nominally 22.4± 6.6Gy (EQD2,α/β=2 42.7± 8.1Gy, EQD2,α/β=3 38.7± 7Gy; EQD2,α/β=8 30.5± 5.9Gy). Using deformable matching, direct spatial/dosimetric correlation of SBRT-induced changes in liver tissue was possible. In the PTV high-dose region, acentral nonenhancing area and peripheral contrast medium accumulation was observed. Beam path doses of 38-42Gy (EQD2,α/β=2-3) induce characteristic MRI morphologic alterations.