3D Enhancement Color Maps in the Characterization of Intracranial Atherosclerotic Plaques

BACKGROUND AND PURPOSE

High-resolution MR imaging allows the identification of culprit symptomatic plaques after the administration of gadolinium. Current high-resolution MR imaging methods are limited by 2D multiplanar views and manual sampling of ROIs. We analyzed a new 3D method to objectively quantify gadolinium plaque enhancement.

MATERIALS AND METHODS

Patients with stroke due to intracranial atherosclerotic disease underwent 7T high-resolution MR imaging. 3D segmentations of the plaque and its parent vessel were generated. Signal intensity probes were automatically extended from the lumen into the plaque and the vessel wall to generate 3D enhancement color maps. Plaque gadolinium (Gd) uptake was quantified from 3D color maps as gadolinium uptake = (µPlaque T1 + Gd -µPlaque T1/SDPlaque T1). Additional metrics of enhancement such as enhancement ratio, variance, and plaque-versus-parent vessel enhancement were also calculated. Conventional 2D measures of enhancement were collected for comparison.

RESULTS

Thirty-six culprit and 44 nonculprit plaques from 36 patients were analyzed. Culprit plaques had higher gadolinium uptake than nonculprit plaques (P < .001). Gadolinium uptake was the most accurate metric for identifying culprit plaques (OR, 3.9; 95% CI 2.1-8.3). Gadolinium uptake was more sensitive (86% versus 70%) and specific (71% versus 68%) in identifying culprit plaques than conventional 2D measurements. A multivariate model, including gadolinium uptake and plaque burden, identified culprit plaques with an 83% sensitivity and 86% specificity.

CONCLUSIONS

The new 3D color map method of plaque-enhancement analysis is more accurate for identifying culprit plaques than conventional 2D methods. This new method generates a new set of metrics that could potentially be used to assess disease progression.

Evaluation of retrobulbar circulation in type 2 diabetic patients using color Doppler imaging

Purpose:

To investigate the retrobulbar circulatory parameters in type 2 diabetes mellitus patients with color Doppler imaging (CDI) and compare the results with nondiabetic controls.

Methods:

This prospective study included 50 type 2 diabetic patients and 50 age-matched controls. Seven field stereo fundus photography was used to diagnose and classify diabetic retinopathy (DR). Diabetic patients were further divided into two: Group 1, consisted of patients with no DR, mild and moderate non-proliferative DR (n = 36); Group 2, severe nonproliferative and proliferative DR (n = 14). CDI was performed using Philips iU22 xMATRIX ultrasound. The peak systolic velocity (PSV), end-diastolic velocity (EDV), resistivity index (RI) and pulsatile index (PI) of ophthalmic (OA), posterior ciliary artery (PCA), and central retinal artery (CRA) along with central retinal vein (CRV) were recorded.

Results:

RI in the ophthalmic artery was significantly higher in both DR groups than the control group (P = 0.000). Diabetic Group 1 had decreased blood flow velocity (PSV and EDV) in PCA compared to controls (P = 0.046 and P = 0.010, respectively). Group 2 DR had significantly reduced EDV and increased RI in CRA compared to Group 1 (P = 0.015). Binary logistic regression analysis revealed glycosylated hemoglobin and RI of OA to be independent risk factors of DR.

Conclusion:

Significant changes in resistivity index and flow velocities were observed in the retrobulbar vessels, especially in ophthalmic artery in diabetics compared to controls. CDI with results of increased resistance or decreased flow could be useful to predict individuals at higher risk for developing severe DR.

Cortical visual loss in posterior reversible encephalopathy syndrome in late postpartum eclampsia: case series

The purpose of this study was to determine the prevalence of visual disturbances in patients with posterior reversible encephalopathy syndrome (PRES) associated with late postpartum eclampsia. We retrospectively reviewed the clinical records of late postpartum eclampsia patients with features of PRES for the presence of visual disturbances and location of radiological abnormalities. We found a higher prevalence of cortical visual loss in patients with PRES associated with late postpartum eclampsia. Bilateral symmetrical vasogenic edema of the parieto-occipital lobe was the most common magnetic resonance imaging (MRI) abnormality noted. No significant differences were observed in the extent of edema in patients with and without visual loss.

Intracameral injection of bevacizumab (Avastin) to treat anterior chamber neovascular membrane in a painful blind eye

Intracameral injection of bevacizumab (Avastin) helped in the successful regression of an anterior chamber neovascular membrane in a painful blind eye. The effect was persistent even after six months of follow-up. This is the first report on intracameral administration of bevacizumab with six months of follow-up.

Intravitreal bevacizumab (Avastin) for post laser anterior segment ischemia in aggressive posterior retinopathy of prematurity

Aggressive posterior retinopathy of prematurity (formerly known as fulminate/type II/rush disease) occurs in zone 1 or posterior zone 2. Treatment involves extensive near confluent laser ablation of a large area of avascular retina. Anterior segment ischemia is a rare complication that can occur due to injury to the long posterior ciliary arteries in the horizontal meridians during aggressive posterior laser treatment. The outcome of this rare complication is very poor. This case describes a favorable outcome of intravitreal injection of bevacizumab (Avastin) in a case of anterior segment ischemia.

Pharmacological validation of Kantha chendooram for antiulcer activity in modified pylorus ligated (shay) rat model

The use of metals and minerals is predominant in siddha system of medicine. As per siddha concept, peptic ulcer is known as Valigunmam, the basic abnormality appears to be the derangement of metabolism in the stomach and duodenum resulting in malfunctioning of the secretory process of gastric mucosa. Chendooram is a group of siddha drugs which is used for anemia, obesity, rheumatic diseases; abdominal tumours etc.During the present study standardized Kantha chendooram was selected and evaluated for its anti-ulcer activity, which could not be attempted by researchers earlier.

Fulminate retinopathy of prematurity - clinical characteristics and laser outcome

PURPOSE

To analyse the clinical characteristics and treatment outcome of zone 1 Fulminate type of Retinopathy of Prematurity (ROP) and compare it to Conventional ROP.

METHODS

Preterm infants from two neonatal intensive care units (NICU) born between July 2002 and November 2003 were screened for ROP. Cases with Conventional ROP were classified according to the International Classification of Retinopathy of Prematurity (ICROP) while that of Fulminate ROP according to Shapiro's classification. Threshold disease was kept the cut off for treatment for Conventional ROP and stage 3A for Fulminate ROP.

RESULTS

Of the 54 cases that had treatable ROP, 36 (66.67%) had Fulminate type. The mean gestational age and birth weight was higher in Fulminate ROP compared to Conventional disease (31.75 weeks and 1554 gms vs 31 weeks 1387 gms) whereas the mean postnatal age at laser was lower (4.62 weeks vs 6.3 weeks). The average number of laser spots given was 3036.6 for Fulminate disease.

CONCLUSION

Fulminate ROP had an atypical morphology which was difficult to classify according to ICROP classification and we would like to lay stress upon the importance of screening of premature infants from the age of 4 weeks and to start treatment immediately once Fulminate ROP has been diagnosed.

Screening for retinopathy of prematurity-a comparison between binocular indirect ophthalmoscopy and RetCam 120

AIM

To compare the photographic screening for retinopathy of prematurity (ROP) using RetCam 120 with binocular indirect ophthalmoscope (BIO), which is the current gold standard.

SETTING AND DESIGN

Prospective, comparative study.

MATERIALS AND METHODS

A total of 87 RetCam examinations were performed on 27 premature babies. They were stored in a separate file after deleting the identifying information. At the same visit using the BIO with scleral depression, an experienced vitreoretinal surgeon evaluated the fundus in detail. A masked examiner then evaluated the RetCam photographs for presence or absence of ROP, the stage and zone of the disease and the presence or absence of plus disease. These data were then compared with the BIO findings to determine the sensitivity, specificity and the positive and negative predictive values of the method.

RESULTS

ROP was detected in 63 of 87 examinations by BIO and in 56 of 87 RetCam examinations. Nine RetCam examinations were false-negative and two were false-positive. Sensitivity of RetCam was 85.71% (54/63) and specificity was 91.66% (22/24). The positive and negative predictive values were 96.43% and 70.97% respectively.

CONCLUSION

Nine cases having ROP were missed by the RetCam. All these cases were either in zone 3 or the outer part of zone 2, which later regressed. These were missed mostly because of the restricted mobility of the camera head caused by its size and the barrier caused by the lid speculum arms. No case of threshold ROP was missed. RetCam may replace BIO for screening of ROP.

Fulminate type of retinopathy of prematurity

Routine ophthalmoscopic screening for retinopathy of prematurity (ROP) from the age of 2 weeks is necessary to detect and treat fulminate ROP.

Diabetic retinopathy among self reported diabetics in southern India: a population based assessment

AIMS

To estimate the prevalence of diabetic retinopathy among self reported diabetics in a population of southern India.

METHODS

A cross sectional sample of subjects aged 50 years and older was selected using a cluster sampling technique from Palakkad district of Kerala state. Eligible subjects were identified through a door to door survey. Ocular examinations including visual acuity and anterior and posterior segment examinations were performed at preselected sites within clusters. History of diabetes was elicited, and height, weight, and blood pressure were measured for all subjects.

RESULTS

Among the 5212 examined people (92% response rate), 68 (26.2%) of 260 people with self reported history of diabetes had diabetic retinopathy. The age-sex adjusted prevalence of diabetes among people aged 50 years and older was 5.1% (95% CI 3.9, 6.3, deff 4.33) and of diabetic retinopathy among the diabetics was 26.8% (95% CI: 19.2, 34.4, deff 1.99). Non-proliferative diabetic retinopathy (94.1%) was the most common form of retinopathy seen. Two eyes were blind (presenting vision <6/60) as a result of retinopathy.

CONCLUSION

Preventive strategies have to be evolved to ensure that blindness due to diabetic retinopathy does not become a public health problem in India. Further studies are required to understand the risk factors for retinopathy and vision loss in this population.

Investigation and management of patients with pleuritic chest pain presenting to the accident and emergency department

The assessment of a patient with pleuritic chest pain calls for a high degree of clinical acumen and a high degree of suspicion that the diagnosis might be pulmonary embolism. This area is one of the most difficult in A&E medicine (and indeed chest medicine). One error is to "think the best" when considering the diagnosis in such patients but experience soon teaches to "think PE" and diagnose less serious conditions only when pulmonary embolism has been excluded. A key consideration is the presence of risk factors. Because the diagnosis is difficult, there should be no hesitation in requesting a senior opinion or referring to the inpatient medical team. We have produced an algorithm (fig 1) for the investigation and management of pleuritic chest pain as discussed in this article. Three questions relating to this article are: (1) Can pulmonary embolism be the diagnosis in a patient with pleuritic chest pain but a normal chest radiograph, ECG, and arterial blood gases? (2) What is the chest radiograph abnormality which is most likely to alert you to the possibility of pulmonary embolism? (3) What percentage of patients with a low clinical suspicion of pulmonary embolism but a high probability V/Q scan will have pulmonary embolism demonstrated on pulmonary angiography? The three key references are The PIOPED Investigators, Dalen, and Fennerty.

Training primary care health workers in mental health care: evaluation of attitudes towards mental illness before and after training

One hundred and fifty primary care paramedical health workers who underwent a short term training in mental health care were evaluated to understand their attitudes towards mental health before, and immediately after, the training course. The trainees showed a significant change in attitudes in the desirable direction towards different mental health problems. Baseline attitude of health workers was not related to age, sex, level of education or duration of their professional service. However, health workers with low baseline attitude scores registered a significantly higher gain. Item analysis revealed that 10 of the 35 items of the attitude questionnaire failed to reveal significant post training changes.

Standardisation of multiple-choice questionnaire for evaluating medical officers' training in psychiatry

This study reports the standardisation of a multiple choice questionnaire (MCQ) for evaluating the training of primary care physicians in psychiatry. An item pool of 104 multiple-choice questions of the 'single best response' type was written. This item pool along with an 'MCQ assessment sheet' was mailed to 90 psychiatrists with a request to evaluate the questionnaire. Twenty five psychiatrists responded to the enquiry, of which 22 gave their detailed comments regarding the MCQ. Based on the responses that were received, 14 items were discarded, 77 items were modified and 13 items accepted without any modification. The final pool of 90 items was split into two comparable sets, one for pre-training assessment and the other for post-training assessment. The questionnaire was administered to a group of 32 medical officers and was found to be sensitive in detecting gains in knowledge following training.

Outcome of family therapy--two year follow-up

The authors report the findings of an evaluation exercise to assess the efficacy of brief, integrative, inpatient family therapy with a follow-up period of two years. The index patients and their families were assessed for improvement in symptoms and satisfaction in family life. The assessment was possible for 55% of the families, either in person or by post. Nearly 43% of the families reported good improvement, 8% reported no improvement at all and the remaining families reported varying degrees of improvement. Regularity of follow up visits and degree of improvement did not seem to be related. One fifth of the families had not reported for any follow up visits, but when assessed after two years reported good improvement and satisfaction with the treatment.