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Kribbs S, Munk PL, Vellet AD, Levin MF. Diagnosis of osteoid osteoma using STIR magnetic resonance imaging. AUSTRALASIAN RADIOLOGY 1993; 37:292-6. [PMID: 8373340 DOI: 10.1111/j.1440-1673.1993.tb00080.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Two patients with osteoid osteomas were evaluated with magnetic resonance imaging at 1.5 T using both conventional spin-echo (SE) and short TI inversion-recovery (STIR) sequences. On plain films the classic findings of a radiolucent nidus with a dense surrounding reactive zone of sclerosis were absent. The diagnosis was suspected on observing the presence of marked marrow oedema in the involved bone. Conventional SE images were unimpressive in detecting the bone marrow changes. Increased signal intensity indicating bone marrow oedema was striking on the STIR images and facilitated diagnosis. In cases of suspected osteoid osteoma which do not demonstrate the classic radiologic features, adding the STIR sequence to conventional SE magnetic resonance sequences to enhance detection of bone marrow change is recommended.
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Rankin RN, Vellet AD, Munk PL. Excimer-laser-assisted angioplasty in chronic femoropopliteal occlusion: the significance of an intimal flap in predicting reocclusion. Can Assoc Radiol J 1993; 44:257-61. [PMID: 8348352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Angioplasty assisted by excimer laser was performed on 27 chronic femoropopliteal occlusions, ranging from 2 to 30 cm in length, in 26 patients. Twenty-one (78%) of the procedures were successful initially. Of these, 12 (57% [44% of the total]) remained patent at follow-up 3 months later. In seven of the nine cases of reocclusion observed after 3 months (78%) a large intimal flap resulting from the angioplasty-induced dissection could be identified in the postprocedure angiogram. The authors stress the possible importance of such an intimal flap in limiting the success of laser-assisted angioplasty of long femoropopliteal occlusions.
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Kravis MM, Munk PL, McCain GA, Vellet AD, Levin MF. MR imaging of muscle and tender points in fibromyalgia. J Magn Reson Imaging 1993; 3:669-70. [PMID: 8347962 DOI: 10.1002/jmri.1880030418] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Fibromyalgia is a syndrome manifested by chronic, diffuse musculoskeletal aching and soreness, palpable muscle tender points, and other symptoms. Standardized clinical diagnostic criteria have recently been developed. Skeletal muscle has been postulated as the end organ in this disease. Biochemical, histologic, electromyographic, and conventional radiographic studies have demonstrated no definitive abnormality. This study sought to establish whether magnetic resonance (MR) imaging could demonstrate any abnormality in these patients. Eighteen patients were entered in the study, 14 of whom were able to complete their examinations. T1-weighted, T2-weighted, gradient-echo, and STIR (short-tau inversion-recovery) sequences were performed in all patients, with selected patients examined with T1-weighted, gadopentetate dimeglumine-enhanced sequences. The trapezius and suboccipital regions were imaged in patients who, clinically, had active fibromyalgia. No abnormalities could be detected. The authors conclude that the conventional MR imaging used in this study was unable to depict any primary skeletal muscle abnormality in fibromyalgia.
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Munk P, Nicolle D, Downey D, Vellet AD, McKeown M. Posterior scleritis: ultrasound and clinical findings. CANADIAN JOURNAL OF OPHTHALMOLOGY 1993; 28:177-80. [PMID: 8343917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Bach DB, Vellet AD, Karlik SJ, Downey DB, Levin MF, Munk PL. Producing picture-perfect posters. AJR Am J Roentgenol 1993; 160:1303-7. [PMID: 8498238 DOI: 10.2214/ajr.160.6.8498238] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Scientific posters form an integral part of many radiology meetings. They provide the opportunity for interested parties to read the material at an individualized pace, to study the images in detail, and to return to the exhibit numerous times. Although the content of the poster is undoubtedly its most important component, the visual presentation of the material can enhance or detract from the clarity of the message. With the wide availability of sophisticated computer programs for desktop publishing (DTP), one can now create the poster on a computer monitor with full control of the form as well as the content. This process will result in a professional-appearing poster, yet still allow the author the opportunity to make innumerable revisions, as the poster is visualized in detail on the computer monitor before printing. Furthermore, this process is less expensive than the traditional method of typesetting individual sections separately and mounting them on cardboard for display. The purpose of this article is to present our approach to poster production using commercially available DTP computer programs.
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Levin MF, Bach DB, Vellet AD, Munk PL, Downey DB, Reitz WG. Sonolucent peripancreatic masses: differential diagnosis and related imaging. Can Assoc Radiol J 1993; 44:168-75. [PMID: 8504327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
The most common cause of a sonolucent mass in the epigastrium is a pancreatic pseudocyst; however, several other conditions can simulate a pseudocyst on ultrasonography (US) scans. This pictorial essay illustrates the spectrum of conditions that may present in this fashion and demonstrates the use of other imaging modalities, such as colour-flow and pulsed Doppler US, computed tomography, magnetic resonance imaging and angiography, in their evaluation.
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Munk P, Downey D, Nicolle D, Vellet AD, Rankin R, Lin DT. The role of colour flow Doppler ultrasonography in the investigation of disease in the eye and orbit. CANADIAN JOURNAL OF OPHTHALMOLOGY 1993; 28:171-6. [PMID: 8343916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Colour flow Doppler ultrasonography is a relatively new technique in which colour-encoded representations of flowing blood are imposed over a conventional grey-scale ultrasound image. This allows interrogation of a relatively large volume of tissue to determine the presence and direction of blood flow. The waveform tracings are then evaluated by means of conventional Doppler imaging. We demonstrate examples of normal vascular structures in the orbit and describe the application of this technique in the investigation of vascular disease, such as carotid-cavernous fistula and ischemic disease. The technique can also be used to evaluate ocular membranes and masses. Colour flow Doppler imaging promises to be an important advance in ophthalmic ultrasonography.
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Garvin GJ, Munk PL, Vellet AD. Tears of the medial collateral ligament: magnetic resonance imaging findings and associated injuries. Can Assoc Radiol J 1993; 44:199-204. [PMID: 8504333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
For 23 patients with a surgically proven tear of the medial collateral ligament the findings from magnetic resonance imaging (MRI) of the knee were evaluated retrospectively. MRI revealed the tear in all cases, although when the injury was severe, distinguishing high-grade partial tears from complete tears was difficult. Physical examination had indicated a tear in 22 (96%) of the cases. A high prevalence of associated cruciate and meniscal injuries was seen (in 23 [100%] and 12 [52%] of the cases respectively). Tears of the fibular collateral ligament occurred in 13 (57%) of the patients and at least one bony infraction in 22 (96%); most of the infractions were in the lateral compartment. Infractions of the lateral femoral condyle were frequently geographic (in 14 [70%] of the 20 cases) or impacted (in 5 [25%]). The spectrum of injuries associated with tears of the medial collateral ligament was consistent with the findings of previous studies focusing on cruciate and meniscal abnormalities; the minor variations were likely due to the severity of valgus stress in this sample.
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Munk PL, Vellet AD, Levin MF. Leaking Baker's cyst detected by magnetic resonance imaging. Can Assoc Radiol J 1993; 44:125-8. [PMID: 8462030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Popliteal or Baker's cysts, often found incidentally during examination of the knee, are common. The authors report the magnetic resonance imaging (MRI) manifestations of a leaking Baker's cyst that initially presented as thrombophlebitis in a patient who had undergone reconstruction of the anterior cruciate ligament 4 months before; no cyst was present at the time of the surgery. Marked inflammatory changes apparent in the surrounding muscle and subcutaneous tissues were best appreciated in T2-weighted and fat-suppressed inversion recovery images. Although the results of ultrasonography suggested the diagnosis, they were not conclusive; MRI was a useful noninvasive adjunct in making the definitive diagnosis.
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Munk PL, Vellet AD, Levin MF, Bell DA, Harth MM, McCain GA. Intravenous administration of gadolinium in the evaluation of rheumatoid arthritis of the shoulder. Can Assoc Radiol J 1993; 44:99-106. [PMID: 8462039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
The authors sought to determine the utility of intravenously administered gadolinium chelates in magnetic resonance imaging (MRI) of patients with rheumatoid arthritis of the shoulder. One shoulder was examined for each of 12 patients--6 men and 6 women, ranging in age from 48 to 71 (average 63) years--with well-established disease. The patients had had the disease for 1 to 25 (average 13) years. Static MRI was performed before and after infusion of gadolinium diethylenetriaminepentaacetic acid (Gd-DTPA) (0.1 mmol/kg body weight); T1-weighted or proton-density images (repetition time [TR] 600 to 1000 ms, echo time [TE] 15 to 30 ms) were obtained. Images obtained after enhancement were particularly useful in the differentiation of pannus from fluid and also allowed improved delineation of tears of the supraspinatus tendon. In addition, contrast-enhanced dynamic gradient-echo spoiled GRASS sequences (TR 50 ms, TE 11 ms, flip angle 70 degrees) were obtained for all patients; for these sequences the same slice was imaged repeatedly at 20-second intervals. The rate of increase of signal intensity in abnormal synovium varied from 0.64 to 5.83 (average 2.30, standard deviation [SD] 1.67) units/second; the enhancement factor ranged from 1.55 to 4.64 (average 2.63, SD 0.98). The authors conclude that for imaging the shoulder enhancement with Gd-DTPA allows improved distinction between synovial thickening and joint effusion and may improve assessment of the rotator cuff. The wide range in the rate of signal increase and total enhancement during dynamic imaging probably reflected heterogeneity in the study population.
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Munk PL, Vellet AD, Bramwell V, Bell R, Hammond A, Beauchamp C. Soft tissue sarcomas: a plea for proper management. Can J Surg 1993; 36:178-80. [PMID: 8472231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Although soft tissue sarcomas are relatively uncommon, they often occur in young patients and if properly treated are often curable. Unfortunately, inappropriate approaches to biopsy before adequate staging may compromise a successful outcome. The roles of diagnostic imaging (particularly magnetic resonance imaging) in adequate preoperative evaluation and staging and the fundamental principles of surgical management are discussed.
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Munk PL, Vellet AD, Fowler PJ, Miniaci T, Crues JV. Magnetic resonance imaging of reconstructed knee ligaments. Can Assoc Radiol J 1992; 43:411-9. [PMID: 1450969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Reconstruction of knee ligaments is now a common orthopedic procedure. Patients are frequently referred for magnetic resonance imaging (MRI) after later reinjury, and the ability to recognize normal reconstructed knee ligaments is therefore becoming increasingly important. This pictorial essay demonstrates various reconstructions of the cruciate and the collateral ligaments, as well as several abnormalities of these ligaments.
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Munk PL, Vellet AD, Lin DT, Levin MF, Downey D. Ultrasonographic findings in the anterior segment of the eye obtained with a nondedicated unit. Can Assoc Radiol J 1992; 43:425-30. [PMID: 1450971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Many abnormalities of the anterior segment of the eye can be detected by ultrasonography (US), and associated anomalies of the posterior segment that are difficult to detect clinically may also be demonstrated by this modality. A total of 48 patients with ultrasonographically detectable abnormalities in the anterior segment were examined with real-time high-resolution US; 51 abnormalities were demonstrated. The most common problems were cataract (19 cases), intraocular lens implant (10), dislocated lens (9) and tumour (8). In addition, 23 abnormalities of the posterior segment of the eye were found. Six of the lesions in the posterior segment were obscured by those in the anterior segment and could be detected only by US.
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Gasecki AP, Ebers GC, Vellet AD, Buchan A. Sciatic neuropathy associated with persistent sciatic artery. ARCHIVES OF NEUROLOGY 1992; 49:967-8. [PMID: 1325766 DOI: 10.1001/archneur.1992.00530330091022] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Persistent sciatic artery is a congenital vascular anomaly of the arterial supply to the lower extremity. Thrombosis, distal embolization, aneurysmal dilatation, and rupture of this vessel with compression of the sciatic nerve have been recorded. Although rare in occurrence, complications of persistent sciatic artery should be included in the differential diagnosis of sciatic neuropathy. We present a case of an acute sciatic neuropathy secondary to pseudoaneurysm formation of a persistent sciatic artery. We demonstrate the diagnostic usefulness of magnetic resonance imaging.
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Vellet AD. The evolution of post-traumatic osteoarthritis: its relationship to occult post-traumatic subcortical fractures identified on MRI. BILDGEBUNG = IMAGING 1992; 59:121-2. [PMID: 1421995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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42
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Levin MF, Vellet AD, Bach DB, Munk PL, Downey DB, Bennett JD. Peripancreatic fluid collections: vascular structures masquerading as pseudocysts. Can Assoc Radiol J 1992; 43:267-72. [PMID: 1638424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Five patients with splanchnic arterial aneurysms and one patient with a tortuous splenic vessel presented with peripancreatic masses that exhibited an anechoic portion in real-time ultrasonography (US) images; the masses were incorrectly diagnosed as pseudocysts. In two patients a vascular abnormality was suspected, and colour-flow Doppler and pulsed Doppler US were performed; these techniques showed the presence of pseudoaneurysms. In the other four patients the possibility of a pseudoaneurysm was not entertained until further studies had been performed. These results emphasize the need for colour-duplex US evaluation of all peripancreatic fluid collections during the initial US examination to avoid the misinterpretation of an aneurysm or a pseudoaneurysm as a simple or complex fluid collection and to prevent the potential disaster of performing biopsy, surgery or other interventions.
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Bach DB, Levin MF, Vellet AD, Downey DB, Munk PL, Grant DR, Wall WJ. CT findings in patients with small-bowel transplants. AJR Am J Roentgenol 1992; 159:311-5. [PMID: 1632345 DOI: 10.2214/ajr.159.2.1632345] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Orthotopic small-bowel transplantation procedures are being performed increasingly often worldwide. CT plays an important role in both the preoperative assessment and the postoperative care of these patients. This pictorial essay serves to acquaint radiologists with the CT findings related to small-bowel transplantation.
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Munk PL, Downey D, Pelz D, Vellet AD, Nicolle DA, Levin MF. Colour-flow Doppler imaging of a carotid-cavernous fistula. Can Assoc Radiol J 1992; 43:227-9. [PMID: 1596772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
The authors describe a case of carotid-cavernous fistula evaluated with both conventional carotid angiography and colour-flow Doppler ultrasonography. The findings in the colour-flow Doppler images correlated well with those from angiography; in addition, Doppler imaging supplied extra information about the direction and the velocity of flow. After embolization, colour-flow Doppler imaging demonstrated a marked decrease in the flow. The authors conclude that colour-flow Doppler imaging may be useful for noninvasively detecting and evaluating a carotid-cavernous fistula, as well as for monitoring the patient's progress after therapy.
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Bach DB, Vellet AD, Levin MF, Downey DB, Munk PL, Grant DR. Radiology of clinical small bowel transplantation. Transplant Proc 1992; 24:1245. [PMID: 1318593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Levin MF, Vellet AD, Munk PL, Chait PG. Tuberculosis of the odontoid bone: a rare but treatable cause of quadriplegia. Can Assoc Radiol J 1992; 43:199-202. [PMID: 1596764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Radiologic investigation plays an important role in the diagnosis and management of tuberculosis of the odontoid bone. Immediate confirmation of the condition by examination of tissue and surgery may save lives and reduce the morbidity rate substantially. When the clinical history is appropriate, a diagnosis of tuberculosis is strongly suggested by plain films of the cervical spine showing precervical swelling of the soft tissues, narrowing of the disk spaces and focal erosion of the bones and by computed tomography scans demonstrating details of the soft-tissue abnormality, focal bony erosion and sclerosis.
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Goodacre BW, Connell DG, Beauchamp CP, Quenville NF, Munk PL, Vellet AD. High-grade chondrosarcoma of the sacrum--the crucial role of MR in surgical planning. AUSTRALASIAN RADIOLOGY 1992; 36:168-71. [PMID: 1520184 DOI: 10.1111/j.1440-1673.1992.tb03112.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Marks PH, Goldenberg JA, Vezina WC, Chamberlain MJ, Vellet AD, Fowler PJ. Subchondral bone infractions in acute ligamentous knee injuries demonstrated on bone scintigraphy and magnetic resonance imaging. J Nucl Med 1992; 33:516-20. [PMID: 1552334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Bone scintigraphy is used to detect radiographically silent fractures. Magnetic resonance imaging (MRI) is currently used to screen knee injuries for cartilage and ligament damage. MRI also delineates bone marrow and fractures. We investigated the bone scintigraphic findings in patients who had subchondral bone injuries demonstrated on MRI. Thirteen patients underwent MRI, three-phase bone scintigraphy with SPECT, and arthroscopic surgery after sustaining acute traumatic hemarthrosis of a knee. They all had clinically unsuspected subchondral bone injuries demonstrated on MRI with normal radiographs and normal overlying articular cartilage at arthroscopy, consistent with occult fractures. All showed focal bone repair on scintigraphy. Two of the 13 patients showed additional bone injuries only on bone scan. Two other patients scintigraphically showed focal bone repair at the medial femoral condyle due to avulsion of the medial collateral ligament. SPECT was easier to interpret than multi-view planar imaging. Bone scintigraphy confirms subchondral fractures demonstrated on MRI but also demonstrates ligament avulsion injuries and additional more subtle bone injuries.
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Vellet AD, Romano W, Bach DB, Passi RB, Taves DH, Munk PL. Adenocarcinoma of the pancreatic ducts: comparative evaluation with CT and MR imaging at 1.5 T. Radiology 1992; 183:87-95. [PMID: 1312736 DOI: 10.1148/radiology.183.1.1312736] [Citation(s) in RCA: 95] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
A prospective comparison of computed tomography (CT) and magnetic resonance (MR) imaging at 1.5 T was performed in 50 patients with the suspected diagnosis of pancreatic carcinoma. CT scans were obtained before and after administration of contrast material in 41 of 50 patients (82%); 34 of 41 postcontrast scans (83%) were obtained with dynamic CT. MR images were interpreted without knowledge of the results of CT, ultrasound, cholangiography, or endoscopic retrograde cholangiopancreatography in 48 patients (96%). Surgical correlation of findings at CT and MR imaging was performed in 24 patients (48%) at laparotomy and in two patients (4%) at autopsy. On T1-weighted MR images, relatively diminished signal intensity of tumor compared with that of the adjacent pancreas was a consistent finding. MR imaging proved superior to CT in identification of pancreatic carcinoma (particularly in smaller intrapancreatic tumors), peripancreatic extension, vascular and portal vein invasion, and duodenal invasion. These results suggest that MR imaging of the pancreas is superior in many instances to CT in preoperative evaluation of pancreatic carcinoma.
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Munk PL, Vellet AD. MRI of the anterior cruciate. THE JOURNAL OF BONE AND JOINT SURGERY. BRITISH VOLUME 1992; 74:321-2. [PMID: 1544985 DOI: 10.1302/0301-620x.74b2.1544985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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