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IMPORTANCE: When considering nonoperative treatment in a patient with acute appendicitis, it is crucial to accurately rule out complicated appendicitis. The Atema score, also referred to as the Scoring System of Appendicitis Severity (SAS), has been designed to differentiate between uncomplicated and complicated appendicitis but has not been prospectively externally validated. OBJECTIVE: To externally validate the SAS and, in case of failure, to develop an improved SAS (2.0) for estimating the probability of complicated appendicitis. DESIGN, SETTING, AND PARTICIPANTS: This prospective study included adult patients who underwent operations for suspected acute appendicitis at 11 hospitals in the Netherlands between January 2020 and August 2021. MAIN OUTCOMES AND MEASURES: Appendicitis severity was predicted according to the SAS in 795 patients and its sensitivity and negative predictive value (NPV) for complicated appendicitis were calculated. Since the predefined targets of 95% for both were not met, the SAS 2.0 was developed using the same cohort. This clinical prediction model was developed with multivariable regression using clinical, biochemical, and imaging findings. The SAS 2.0 was externally validated in a temporal validation cohort consisting of 565 patients. RESULTS: In total, 1360 patients were included, 463 of whom (34.5%) had complicated appendicitis. Validation of the SAS resulted in a sensitivity of 83.6% (95% CI, 78.8-87.6) and an NPV of 85.0% (95% CI, 80.6-88.8), meaning that the predefined targets were not achieved. Therefore, the SAS 2.0 was developed, internally validated (C statistic, 0.87; 95% CI, 0.84-0.89), and subsequently externally validated (C statistic, 0.86; 95% CI, 0.82-0.89). The SAS 2.0 was designed to calculate a patient’s individual probability of having complicated appendicitis along with a 95% CI. CONCLUSIONS AND RELEVANCE: In this study, external validation of the SAS fell short in accurately distinguishing complicated from uncomplicated appendicitis. The newly developed and externally validated SAS 2.0 was able to assess an individual patient’s probability of having complicated appendicitis with high accuracy in patients with acute appendicitis. Use of this patient-specific risk assessment tool can be helpful when considering and discussing nonoperative treatment of acute appendicitis with patients.

Recent works in medical image registration have proposed the use of Implicit Neural Representations, demonstrating performance that rivals state-of-the-art learning-based methods. However, these implicit representations need to be optimized for each new image pair, which is a stochastic process that may fail to converge to a global minimum. To improve robustness, we propose a deformable registration method using pairs of cycle-consistent Implicit Neural Representations: each implicit representation is linked to a second implicit representation that estimates the opposite transformation, causing each network to act as a regularizer for its paired opposite. During inference, we generate multiple deformation estimates by numerically inverting the paired backward transformation and evaluating the consensus of the optimized pair. This consensus improves registration accuracy over using a single representation and results in a robust uncertainty metric that can be used for automatic quality control. We evaluate our method with a 4D lung CT dataset. The proposed cycle-consistent optimization method reduces the optimization failure rate from 2.4% to 0.0% compared to the current state-of-the-art. The proposed inference method improves landmark accuracy by 4.5% and the proposed uncertainty metric detects all instances where the registration method fails to converge to a correct solution. We verify the generalizability of these results to other data using a centerline propagation task in abdominal 4D MRI, where our method achieves a 46% improvement in propagation consistency compared with single-INR registration and demonstrates a strong correlation between the proposed uncertainty metric and registration accuracy.

BackgroundChest CT displays chest pathology better than chest X-ray (CXR). We evaluated the effects on health outcomes of replacing CXR by ultra-low-dose chest-CT (ULDCT) in the diagnostic work-up of patients suspected of non-traumatic pulmonary disease at the emergency department.MethodsPragmatic, multicentre, non-inferiority randomised clinical trial in patients suspected of non-traumatic pulmonary disease at the emergency department. Between 31 January 2017 and 31 May 2018, every month, participating centres were randomly allocated to using ULDCT or CXR. Primary outcome was functional health at 28 days, measured by the Short Form (SF)-12 physical component summary scale score (PCS score), non-inferiority margin was set at 1 point. Secondary outcomes included hospital admission, hospital length of stay (LOS) and patients in follow-up because of incidental findings.Results2418 consecutive patients (ULDCT: 1208 and CXR: 1210) were included. Mean SF-12 PCS score at 28 days was 37.0 for ULDCT and 35.9 for CXR (difference 1.1; 95% lower CI: 0.003). After ULDCT, 638/1208 (52.7%) patients were admitted (median LOS of 4.8 days; IQR 2.1–8.8) compared with 659/1210 (54.5%) patients after CXR (median LOS 4.6 days; IQR 2.1–8.8). More ULDCT patients were in follow-up because of incidental findings: 26 (2.2%) versus 4 (0.3%).ConclusionsShort-term functional health was comparable between ULDCT and CXR, as were hospital admissions and LOS, but more incidental findings were found in the ULDCT group. Our trial does not support routine use of ULDCT in the work-up of patients suspected of non-traumatic pulmonary disease at the emergency department.Trial registration numberNTR6163.

Guidelines on Crohn's perianal fistulas recommend anti-tumour necrosis factor (TNF) treatment and suggest considering surgical closure for patients with surgically amenable disease. However, long-term outcomes following these two strategies have not been directly compared. The aim of this study was to assess radiological healing in patients who received short-term anti-TNF treatment and surgical closure compared with those who received anti-TNF treatment alone.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.jtcvs.2007.02.029 Byline: Onno Mets (a), Peter E. Spronk (b)(c), Jan Binnekade (a)(d), Jaap Stoker (e), Bas A.J.M. de Mol (f), Marcus J. Schultz (a)(c)(g) Abbreviations: CI, confidence interval; ICU, intensive care unit; LOS, length of stay Abstract: We sought to determine the effect of elimination of daily routine chest radiographs on chest radiographic practice in cardiothoracic surgery patients in the intensive care unit and the post-intensive care unit ward. Author Affiliation: (a) Department of Intensive Care Medicine, University of Amsterdam, Amsterdam, the Netherlands (d) Department of Clinical Epidemiology and Biostatistics, University of Amsterdam, Amsterdam, the Netherlands (e) Department of Radiology, University of Amsterdam, Amsterdam, the Netherlands (f) Department of Cardiopulmonary Surgery, University of Amsterdam, Amsterdam, the Netherlands (g) Laboratory of Experimental Intensive Care and Anesthesiology (L.E.I.C.A.), Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands (b) Department of Intensive Care Medicine, Gelre Hospital (Location Lukas), Apeldoorn, the Netherlands (c) HERMES Critical Care Group, Amsterdam, The Netherlands. Article History: Received 16 November 2006; Revised 11 January 2007; Accepted 5 February 2007

Stricture length, maximal stricture wall thickness, and maximal associated small bowel dilation at MR enterography can reliably assess Crohn disease stricture severity and serve as eligibility and efficacy criteria in clinical trials.

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Previously published short‐term results (week 16) of this trial showed a significant improvement in clinical, radiologic and biochemical outcomes in Crohn's disease patients with therapy‐refractory perianal fistulas after treatment with hyperbaric oxygen therapy. To assess the long‐term (week 60) efficacy, safety and feasibility of hyperbaric oxygen therapy in perianal fistula in Crohn's disease. Crohn's disease patients with high perianal fistula(s) failing conventional treatment >6 months were included. Exclusion criteria were presence of a stoma, rectovaginal fistula(s) and recent changes in treatment regimens. Patients received 40 hyperbaric oxygen sessions and outcomes were assessed at week 16 and week 60. Twenty patients were included (median age 34 years). At week 16, median scores of the perianal disease activity index and modified Van Assche index (co‐primary outcomes) decreased from 7.5 (95% CI 6–9) to 4 (95% CI 3–6, p< 0.001) and 9.2 (95% CI 7.3–11.2) to 7.3 (95% CI 6.9–9.7, p= 0.004), respectively. At week 60, the respective scores remained significantly lower than baseline: 4 (95% CI 3–7, p< 0.001) and 7.7 (95% CI 5.2–10.2, p= 0.003). Perianal disease activity index score of 4 or less (representing inactive perianal disease) was observed in 13 patients at week 16 and 12 patients at week 60. Using fistula drainage assessment, 12 and 13 patients showed a clinical response at week 16 and 60, respectively, and clinical remission was achieved in four patients for both time points. At week 16, a statistically significant biochemical improvement (C‐reactive protein and faecal calprotectin levels) was found, but this effect was no longer significant at week 60. The clinical and radiologic improvement of perianal fistula in Crohn's disease, that was found at week 16 after treatment with hyperbaric oxygen therapy, is maintained at 1‐year follow‐up.

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(Abstracted from Hum Reprod2022;37:969–979)A main cause of female infertility is tubal pathology, with 11% to 30% of cases resulting from previous surgery, infections (such as sexually transmitted diseases), or endometriosis. Hysterosalpingography (HSG) is considered as the first choice for a tubal patency test during fertility workup, but the more patient-friendly hysterosalpingo-contrast sonography option has also been introduced.

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Anal cancer is a relatively rare malignancy. Treatment consists of chemoradiation and most patients achieve a complete response. Local evaluation of the T and N stage is performed by MR imaging. Whole-body staging with 18F-fluorodesoxyglucose positron emission tomography computed tomography scans or computed tomography scans is used to detect metastases. T stage is based on tumor size or invasion of organs. N stage is based on nodal location. After chemoradiation, clinical evaluation and MR imaging is used to assess tumor and nodal response. Maximal response is achieved 6 months after chemoradiation. Beware of development of anal cancer in perianal fistulas.

Quantified motility is an objective biomarker of endoscopic and histopathologic inflammatory activity in Crohn disease and is comparable to previously validated gadolinium-enhanced MRI activity scores.

Magnetic resonance colonography with its high tissue contrast and without the use of ionizing radiation was designed as a minimally invasive screening tool for colorectal cancer and its precursors. Nonetheless, heterogeneous data on diagnostic performance and patient burden have hindered its use in screening. This article provides an overview on the status and potential of magnetic resonance colonography in the setting of detection and screening of colorectal cancer and its precursors.

On the basis of randomized controlled screening trial data showing higher participation rates for CT colonography, CT colonography is more cost-effective than colonoscopy screening for colorectal cancer.

To develop a method for intra-patient registration of pre- and post-contrast abdominal MR images with large local deformations and large intensity variations. A hybrid method is proposed to deal with this problem. It consists of two coupled techniques: (1) descriptor matching (DM) at the original resolution using a discrete optimization strategy to avoid getting trapped in a local minimum; (2) continuous optimization to refine the registration outcome based on autocorrelation of local image structure (ALOST). Our method—called DM-ALOST—has become insensitive to the local uptake of contrast agent by exploiting the mean phase and the phase congruency extracted from the multi-scale monogenic signal. The method was extensively tested on abdominal MR data of 30 patients with Crohn’s disease. DM-ALOST produced significantly larger mean Dice coefficients than two state-of-the-art methods $$({p}<0.05)$$ (p<0.05) . Both qualitative and quantitative tests demonstrated improved registration using the proposed method compared to the state-of-the-art. The DM-ALOST method facilitates measurement of corresponding features from different abdominal MR images, which can aid to assess certain diseases, particularly Crohn’s disease.

Proton density fat fraction as measured with MR spectroscopy is superior to the controlled attenuation parameter in detecting biopsy-proven steatosis of at least grade S1 and in grading steatosis.

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We conclude that hepatic ultrasmall superparamagnetic iron oxide particle–enhanced MR imaging is feasible, has high intra- and interreader agreement in nonalcoholic fatty liver disease, and performs well in the differentiation of nonalcoholic steatohepatitis and simple steatosis.

Objectives:Volumetric growth assessment has been proposed for predicting advanced histology at surveillance computed tomography (CT) colonography (CTC). We examined whether is it possible to predict which small (6–9 mm) polyps are likely to become advanced adenomas at surveillance by assessing volumetric growth.Methods:In an invitational population-based CTC screening trial, 93 participants were diagnosed with one or two 6–9 mm polyps as the largest lesion(s). They were offered a 3-year surveillance CTC. Participants in whom surveillance CTC showed lesion(s) of ≥6 mm were offered colonoscopy. Volumetric measurements were performed on index and surveillance CTC, and polyps were classified into growth categories according to ±30% volumetric change (>30% growth as progression, 30% growth to 30% decrease as stable, and >30% decrease as regression). Polyp growth was related to histopathology.Results:Between July 2012 and May 2014, 70 patients underwent surveillance CTC after a mean surveillance interval of 3.3 years (s.d. 0.3; range 3.0–4.6 years). In all, 33 (35%) of 95 polyps progressed, 36 (38%) remained stable, and 26 (27%) regressed, including an apparent resolution in 13 (14%) polyps. In 68 (83%) of the 82 polyps at surveillance, histopathology was obtained; 15 (47%) of 32 progressing polyps were advanced adenomas, 6 (21%) of 28 stable polyps, and none of the regressing polyps.Conclusions:The majority of 6–9 mm polyps will not progress to advanced neoplasia within 3 years. Those that do progress to advanced status can in particular be found among the lesions that increased in size on surveillance CTC.

•Median craniocaudal extension of uterine cervical cancer on MRI is systematically slightly smaller compared to histopathology (2.1 vs. 2.5cm). Pearson’s correlation: 0.83 (p<0.001).•Regarding the craniocaudal extension on MRI, 91% (19/21) of the extension would have been covered by a clinical uncertainty margin of 1.2cm.•Comparison of tumour measurements on MRI and surgical specimen is hampered by organ deformation. However, this methodological limitation might be solved by use of deformable image registration.

Fistulizing Crohn’s disease represents an evolving, yet unresolved, issue for multidisciplinary management. Perianal fistulas are the most frequent findings in fistulizing Crohn’s disease. While enterocutaneous fistulas are rare, they are associated with considerable morbidity and mortality. Detailed evaluation of the fistula tract by advanced imaging techniques is required to determine the most suitable management options. The fundamentals of perianal fistula management are to evaluate the complexity of the fistula tract, and exclude proctitis and associated abscess. The main goals of the treatment are abscess drainage, which is mandatory, before initiating immunosuppressive medical therapy, resolution of fistula discharge, preservation of continence and, in the long term, avoidance of proctectomy with permanent stoma. The management of enterocutaneous fistulas comprises of sepsis control, skin care, nutritional optimization and, if needed, delayed surgery.

Magnetic resonance (MR)-based methods are increasingly used for liver fat quantification as a noninvasive alternative to liver biopsy in diagnostic studies, observational studies and clinical trials. Many studies have addressed the diagnostic accuracy of MR-based methods and of other noninvasive imaging methods (CT and ultrasound). Important advantages of MR-based methods over CT and ultrasound are their quantitative nature and lack of ionizing radiation exposure. In this article, we give an overview of the most commonly available MR-based techniques (MRI and MR spectroscopy) for liver fat detection and quantification. Technical aspects, advantages, disadvantages and diagnostic accuracies are also discussed.

The aim of the study was to determine the accuracy of magnetic resonance enterography (MRE) in diagnosing and differentiating pediatric inflammatory bowel disease (IBD). The secondary aims were to determine the accuracy of MRE in grading disease activity and determine the interobserver agreement for individual MRE parameters.

The aim of this study was to identify patients in whom the clinical diagnosis of diverticulitis can be made with a high certainty, distinguishing them from patients requiring imaging.

Magnetic resonance imaging of the colon is widely used for the diagnosis and treatment of anorectal disorders, but other applications can be considered as well. In this article we discuss the application of MRI in colorectal cancer, inflammatory bowel disease (Crohns disease and ulcerative colitis) and acute abdominal pain. The latter concerns MRI without a specific preparation while the other two applications concern the use of bowel preparation and colon distension (magnetic resonance colonography). CT is now the principal technique for these applications. The major advantage of MRI of the colon over CT is the lack of ionizing radiation exposure. The high soft-tissue contrast might be another advantage. Research over the last decade has demonstrated that MRI is a valuable alternative to CT, with accuracy values equal or superior to CT. Colorectal diffusion-weighted imaging has been increasingly studied with promising results.

Background Computed tomography (CT) is often used to confirm the diagnosis of encapsulating peritoneal sclerosis (EPS) but there is no consensus on specific CT abnormalities. To establish CT findings characteristic for EPS, we compared CT findings between EPS patients and long-term peritoneal dialysis (PD) patients without EPS.Methods We included as cases all EPS patients in our center from 1996 to 2008 that underwent a CT scan at the time of diagnosis. Controls were all other long-term PD patients (PD duration ≥ 4 years) without EPS that had a CT scan for different reasons. The CT scans were blindly and independently reviewed by 3 radiologists: 2 abdominal radiologists with PD knowledge (Observers 1 and 2) and 1 radiologist without PD experience (Observer 3).Results We included 15 EPS patients and 16 controls. Observer 1 found 6 CT findings that were significantly more often present in EPS than in controls (p≤ 0.05): peritoneal enhancement, thickening, and calcifications; adhesions of bowel loops; signs of obstruction; and fluid loculation/septation. Observer 2 scored almost identically but Observer 3 scored differently. The sensitivity and specificity of a combination of specific CT findings were, respectively, 100% and 94% for Observers 1 and 2, and 79% and 88% for Observer 3.Conclusion CT scans showed characteristic abnormalities that were significantly more often present in EPS patients compared to long-term PD control patients. CT can be used to confirm the diagnosis of EPS when experienced radiologists apply a combination of specific CT findings.

Zusammenfassung: Fragestellung und Hintergrund:: Durch Anwendung der endoanalen Magnetresonanz Imaging-Technik (MRI) kann eine Atrophie des externen analen Sphinkters festgestellt werden. Diese Situation wurde durch Anwendung der dreidimensionalen analen Endosonographie (3D-AE) noch nicht genau untersucht. Zweck dieser Studie war es, die 3D-AE mit der MRI prospektiv zu vergleichen, und zwar bei der Erkennung einer Atrophie wie auch von Defekten des externen analen Sphinkters bei Patienten mit fkaler Inkontinenz. Auerdem verglichen wir beide Techniken hinsichtlich der Dicke und Lnge des analen Sphinkters.Patienten und Methodik:: Patienten mit fkaler Inkontinenz bekamen eine 3D-AE sowie eine MRI. Die Bilder beider endoluminaler Techniken wurden hinsichtlich einer Atrophie und Defekten des externen analen Sphinkters evaluiert. Das Scoring einer Atrophie des externen analen Sphinkters mittels 3D-AE war von der Differenzierung des externen analen Sphinkters und seinen Reflektionseigenschaften abhngig. Das Scoring einer Atrophie des externen analen Sphinkters mittels MRI war abhngig von der Muskelmasse und dem Vorliegen von Fetteinlagerungen. Der Atrophie-Score wurde als nicht vorhanden, mig, und schwer definiert. Ein Defekt wurde bei der analen Endosonographie durch eine hypoechogene Zone und bei der MRI als Diskontinuitt des Sphinkterrings und/oder Narbengewebe definiert. Unterschiede zwischen 3D-AE und MRI bei der Erkennung einer externen analen Sphinkteratrophie und Defekten wurden erarbeitet. Zustzlich verglichen wir die externe anale Sphinkterdicke und -lnge bei 3D-AE und MRI.Ergebnisse:: Es wurden 18 Patienten in die Studie eingeschlossen (mittleres Alter 58 Jahre; Bereich 27–80; 15 Frauen). Die 3D-AE und die MRI unterschied sich nicht signifikant bei der Erkennung einer externen analen Sphinkteratrophie (p = 0,25) und von Defekten (p = 0,38). Die 3D-AE zeigte bei 16 Patienten und die MRI bei 13 Patienten eine Atrophie. Die 3D-AE stimmte mit der MRI bei 15 von 18 Patienten bei der Erkennung einer externen analen Sphinkteratrophie berein. Unter Anwendung des Gradingsystems erreichten 8 der 18 Patienten den gleichen Grad. Die 3D-AE erkannte sieben externe anale Sphinkterdefekte und die MRI erkannte zehn. Die 3D-AE und die MRI stimmten bei der Erkennung externer analer Sphinkterdefekte bei 13 von 18 Patienten berein. Der Vergleich zwischen 3D-AE und MRI bei der Messung von Sphinkterdicke und -lnge zeigte keine statistisch signifikante bereinstimmung und hatte keine Korrelation zu einer externen analen Sphinkteratrophie.Schlussfolgerung:: Dies ist die erste Studie, die zeigt, dass die 3D-AE zur Erkennung einer externen analen Sphinkteratrophie eingesetzt werden kann. Die beiden endoanalen Techniken sind bei der Erkennung einer Atrophie sowie Defekten des externen analen Sphinkters vergleichbar, es gibt jedoch einen wichtigen Unterschied beim Grading einer externen analen Sphinkteratrophie. Die Korrelation zwischen 3D-AE und MRI bei der Dicke- und Lngenmessung ist schlecht. Die Unterschiede zwischen den beiden Methoden mssen noch nher untersucht werden.

A hitherto unknown combination of congenital anomalies was found in an anatomical specimen of a female neonate. External examination and additional CT and MRI studies showed thanatophoric dysplasia type II with cloverleaf skull and concomitant parietal meningoencephalocele and hypoplasia of the descending aorta. The possibilities of causal correlations are discussed. © 2003 Wiley-Liss, Inc.

The purpose of this study was to compare prospectively computed tomography (CT) and magnetic resonance (MR) imaging before and after mangafodipir trisodium infusion for the detection and staging of focal pancreatic lesions. From November 1996 to October 1997, 43 consecutive patients suspected to have a focal pancreatic lesion were included in a phase III study. Triphasic helical CT was performed, as well as MRI at 1.5 T, as follows: axial T1-weighted (T1w) turbo spin echo (TSE), spectral presaturation with inversion recovery (SPIR) T1w TSE, T1w turbo field echo (TFE), and SPIR T2w TSE before and after mangafodipir trisodium (0.01 mmol/ml, 0.5 ml/kg) infusion. Imaging results were correlated with surgery, laparoscopy, laparoscopic ultrasound, and biopsy. Objective measurements were performed by measuring signal intensities (SIs) of lesion and parenchyma and calculating contrast indexes (CIs) and contrast-to-noise-ratios (CNRs) to assess the delineation of the tumor. SIs were correlated with four phantom standards with a known SI. Thirty-eight pancreatic adenocarcinomas were present, as well as one cystadenoma, two papillomas, and two cases of focal pancreatitis. SI measurements revealed significant increases in CIs for the lesion compared with the parenchyma in T1w TSE (69.7 vs 152.7; P = 0.0003) and T1w TFE (107.8 vs 194.2; P = 0.0002). These series also revealed significant increases in CNRs (for T1w TSE: 9.7 vs 13.0; P = 0.0407 and for T1w TFE: 14.5 vs 26.1; P = 0.0001). In the other series, there was no significant increase. CT detected 38 lesions, MRI without mangafodipir trisodium detected 39 lesions, and MRI with mangafodipir trisodium detected 40 lesions, giving detection accuracy rates of 88%, 91%, and 93%, respectively. Staging accuracy rates for vascular ingrowth were 81%, 75%, and 81%, respectively. Overall staging accuracy rates were 57%, 54%, and 54%, respectively, mostly due to undetected small metastases in the peritoneum, omentum, or liver (&lt; 1 cm). This study indicates that a) MRI after mangafodipir trisodium gives a better delineation of the tumor in T1w series, but b) does not significantly improve the detection rate and staging accuracy of focal pancreatic lesions over MRI without this contrast medium. J. Magn. Reson. Imaging 2000;12:261–268. © 2000 Wiley-Liss, Inc.

The authors evaluate ex vivo the role of endoluminal magnetic resonance imaging (MRI) in the tumor and regional lymph node staging of esophageal carcinoma.

Endoluminal magnetic resonance imaging (MRI) has become an important technique in the diagnostic work-up of patients with anorectal diseases. The high spatial resolution of endoluminal MRI gives a detailed demonstration of the anal and rectal anatomy and pathology. This technique has been demonstrated to be superior to endoluminal sonography and body coil MRI. Endoanal MRI and phased-array coil MRI seem to have comparable results in perianal fistulas, but comparative data are lacking. Phased-array coil MRI is the imaging technique of choice for imaging rectal tumors, while endoluminal MRI is the alternative technique for imaging rectal tumors and the preferred technique for imaging anal tumors. Endoluminal MRI is superior to phased-array coil MRI in fecal incontinence, as phased-array coil MRI does not give the detailed spatial resolution required for evaluation of anal sphincter lesions.J. Magn. Reson. Imaging 1999;9:631–634. © 1999 Wiley-Liss, Inc.

ObjectivesThree-dimensional echocardiography (3DE) calculates left ventricular volumes (LVV) and ejection fraction (EF) without geometric assumptions, but prolonged analysis time limits its routine use. This study was designed to validate a modified 3DE method for rapid and accurate LVV and EF calculation compared with magnetic resonance imaging (MRI). MethodsForty subjects included 15 normal volunteers (group A) and 25 patients with segmental wall motion abnormalities and global hypokinesis caused by ischemic heart disease (group B) who underwent 3DE with precordial rotational acquisition technique (2-degree interval with electrocardiographic and respiratory gating) and MRI at 0.5 T, electrocardiogram (ECG)-triggered multislice multiphase T1-weighted fast field echo. End-diastolic and end-systolic LVV and EF were calculated from both techniques with Simpson’s rule by manual endocardial tracing of equidistant parallel left ventricular short-axis slices. Slicing from the 3DE data sets were done by both 2.9-mm slice thickness (method 3DE-A) and by 8 equidistant short-axis slices (method 3DE-B); for MRI analysis, 9-mm slice thickness was used. ResultsAnalysis time required for manual endocardial tracing of end-diastolic and end-systolic short-axis slices was 10 minutes for the 3DE-B method compared with 40 minutes by the 3DE-A method. For all 40 subjects the mean ± SD of end-diastolic LVV (mL) were 181 ± 76, 179 ± 73, and 182 ± 76; for end-systolic LVV (mL), 120 ± 76, 120 ± 75, and 122 ± 77; and for EF (%), 39 ± 18, 38 ± 18, and 38 ± 18 for MRI, 3DE-A, and 3DE-B methods, respectively. The differences between 3DE-A and 3DE-B with MRI for calculating end-diastolic and end-systolic LVV and EF were not significant for the whole group of subjects as well as for the subgroups. The 3DE-B method had excellent correlation and close limits of agreement with MRI for calculating end-diastolic and end-systolic LVV and EF: r= 0.98 (–1.3 ± 26.6), 0.99 (–1.6 ± 21.2), and 0.99 (0.2 ± 5.2), respectively. The correlation between 3DE-A and MRI were r= 0.97, 0.98, and 0.98, and the limits of agreement were –1.4 ± 36, –0.6 ± 26, and 0.6 ± 8 for calculating end-diastolic and end-systolic LVV and EF, respectively. In addition, excellent correlation and close limits of agreement between 3DE-A and 3DE-B with MRI for LVV and EF calculation was also found for the subgroups. Intraobserver and interobserver variability (SEE) of MRI for calculating end-diastolic and end-systolic LVV and EF were 6.3, 4.7, and 2.1; and 13.6, 11.5, and 4.7; respectively, whereas that for 3DE-B were 3.1, 4.4, and 2.2; and 6.2, 3.8, and 3.6; respectively. Comparable observer variability was also found for the A and B subgroups. ConclusionsThe 3DE-A and 3DE-B methods have excellent correlation and close limits of agreement with MRI for calculating LVV and EF in both normal subjects and cardiac patients. The 3DE-B method by paraplane analysis with 8 equidistant short-axis slices has observer variability similar to MRI and reduces the 3DE analysis time to 10 minutes, therefore offering a rapid, reproducible, and accurate method for LVV and EF calculation. (Am Heart J 1999;137:134-43.)

The chemical shift or proton‐resonance frequency (phase mapping) can be used to measure temperature changes. As a subtraction technique, it requires scans at exactly the same location, making it prone to respiration‐induced artifacts. The accuracy of magnetic resonance (MR) phase mapping for temperature monitoring of interstitial laser coagulation (ILC) was therefore investigated in two ex vivo models with simulated respiration. MR temperatures were calibrated to interstitially measured temperature. Gradual cooling of a homogenous medium (gel) was monitored for four starting temperatures (room temperature, 40°C, 50°C, and 60°C) during 30 min. Temperature increases were measured during ILC in ex vivo porcine liver with Nd:YAG for 6 min with 5 Watt. Experiments were performed at rest and with simulated respiratory motion (both n= 5). In liver, accuracy did not decrease with respiration simulation (P= 0.32), whereas a significant decline was found in the gel model (P= 0.002). In all experiments a small drift over time was observed between temperature determined with MR and thermoprobes. Correction for temperature‐independent phase‐shift at a reference location did not enhance agreement. Temperatures could be determined correctly by MR in the moving liver within a range of ±3.5°C after 6 min of laser application (95% confidence interval), justifying further pre‐clinical studies. Magn Reson Med 41:919–925, 1999. © 1999 Wiley‐Liss, Inc.

Two randomized controlled trials conducted within the SIGGAR study have reported efficacy results. In patients with symptoms of colorectal cancer, CT colonography should replace barium enema and is a good alternative to colonoscopy.

Introduction The clinical value of daily routine chest radiographs (CXRs) in critically ill patients is unknown. We conducted this study to evaluate how frequently unexpected predefined major abnormalities are identified with daily routine CXRs, and how often these findings lead to a change in care for intensive care unit (ICU) patients.Method This was a prospective observational study conducted in a 28-bed, mixed medical–surgical ICU of a university hospital.Results Over a 5-month period, 2,457 daily routine CXRs were done in 745 consecutive ICU patients. The majority of these CXRs did not reveal any new predefined major finding. In only 5.8% of daily routine CXRs (14.3% of patients) was one or more new and unexpected abnormality encountered, including large atelectases (24 times in 20 patients), large infiltrates (23 in 22), severe pulmonary congestion (29 in 25), severe pleural effusion (13 in 13), pneumothorax/pneumomediastinum (14 in 13), and malposition of the orotracheal tube (32 in 26). Fewer than half of the CXRs with a new and unexpected finding were ultimately clinically relevant; in only 2.2% of all daily routine CXRs (6.4% of patients) did these radiologic abnormalities result in a change to therapy. Subgroup analysis revealed no differences between medical and surgical patients with regard to the incidence of new and unexpected findings on daily routine CXRs and the effect of new and unexpected CXR findings on daily care.Conclusion In the ICU, daily routine CXRs seldom reveal unexpected, clinically relevant abnormalities, and they rarely prompt action. We propose that this diagnostic examination be abandoned in ICU patients.