Primary amyloidosis presenting as renal infarction

We report a case of primary amyloidosis affecting the kidney and presenting as a renal infraction on computed tomography and ultrasound examination. To our knowledge, it is the first case in the radiological literature with these imaging characteristics.Correspondence to: M. Arias     

慢性期脑梗死患者脑梗死灶扩散变化及Wallerian变性与运动功能关系的DTI研究

目的:应用DTI检测脑梗死慢性期患者脑梗死灶的改变及皮质脊髓束(CST)的Wallerian变性,并分析其与运动功能的关系。方法:搜集36例病程半年以上的单侧大脑中动脉供血区脑梗死(MCAO)患者及36例与其性别、年龄相匹配的健康志愿者于1.5T磁共振扫描仪上行全颅15个方向的DTI检查。采用手工法在双侧CST走行区及脑梗死灶取不同兴趣区(ROI)进行测量得到FA值及ADC值。结果:慢性期单侧MCAO患者脑梗死灶及其同侧CST不同ROI的FA值和ADC值与对侧相应部位差异均存在统计学意义(P<0.05)。脑梗死灶同侧CST不同ROI及与CST相关的脑梗死灶的FA值改变率(rFA)均与运动功能存在相关性。结论:慢性期脑梗死患者同侧CST及与CST相关的脑梗死灶rFA均与运动功能存在相关性。     

Omental infarction as a delayed complication of abdominal surgery.

Omental infarction, an uncommon cause of acute abdominal pain, is the result of compromised perfusion to the greater omentum. Although its etiology remains uncertain, predisposing factors include obesity [Surg. Today 30 (2000) 451], strenuous activity [N. Z. Med. J. 111 (1998) 211], trauma, and idiopathic omental torsion. Often confused with acute appendicitis or cholecystitis on clinical grounds [Surg. Today 30 (2000) 451], its diagnosis has traditionally been one of exclusion, based on intraoperative and pathologic findings. This diagnosis can be made radiologically based on the characteristic findings of an inflammatory mass containing fat and fluid. We describe a case of right lower quadrant omental infarction temporally related to bowel surgery.     

Left ventricular asynergy score as an indicator of previous myocardial infarction

Sixty-eight patients with coronary heart disease (CHD) i.e. a history of angina of effort and/or previous 'possible infarction' were examined inter alia with ECG and cinecardioangiography. A system of scoring was designed which allowed a semiquantitative estimate of the left ventricular asynergy from cinecardioangiography--the left ventricular motion score (LVMS). The LVMS was associated with the presence of a previous myocardial infarction (MI), as indicated by the history and ECG findings. The ECG changes specific for a previous MI were associated with high LVMS values and unspecific or absent ECG changes with low LVMS values. Decision thresholds for ECG changes and asynergy in diagnosing a previous MI were evaluated by means of a ROC analysis. The accuracy of ECG in detecting a previous MI was slightly higher when asynergy indicated a 'true MI' than when autopsy result did so in a comparable group. Therefore the accuracy of asynergy (LVMS greater than or equal to 1) in detecting a previous MI or myocardial fibrosis in patients with CHD should be at least comparable with that of autopsy (scar greater than 1 cm).     

Anterior choroidal artery infarction presenting as a progressive cognitive deficit

PURPOSE: The authors describe a patient in whom neuroimaging using Tc-99m HMPAO SPECT, F-18 fluorodeoxyglucose (F-18 FDG) coincidence imaging, and magnetic resonance imaging (MRI) identified an anterior choroidal artery infarction. Neuroimaging played a critical role in confirming this diagnosis, because the patient had symptoms of progressive cognitive decline and satisfied the National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association criteria for Alzheimer's disease (AD). METHODS: Tc-99m HMPAO brain SPECT was performed using a triple-head gamma camera. F-18 FDG scanning was obtained 40 minutes after intravenous injection of 5 mCi F-18 FDG using a coincidence camera. A brain MRI scan was performed using a 1.5-Tesla scanner. RESULTS: Tc-99m HMPAO SPECT showed focal hypoperfusion to the right parahippocampal cortex. F-18 FDG coincidence imaging showed a more extensive reduction in glucose metabolism compared with SPECT. The MRI scan confirmed the presence of a small segmental choroidal artery infarction. The Tc-99m HMPAO and F-18 FDG scans were not consistent with AD. CONCLUSIONS: This case illustrates the value of the regional cerebral blood flow SPECT for evaluating memory impairment in the elderly. Decreased regional cerebral blood flow to the posterior temporoparietal region is consistent with AD, whereas regional cerebral blood flow diminution in a vascular territory is consistent with vascular dementia. In this case, the patient was clinically diagnosed with AD, and SPECT was performed to establish the baseline regional cerebral blood flow before the cholinesterase inhibitor donepezil was administered. An infarction was diagnosed on the regional cerebral blood flow brain SPECT scan, which was later confirmed by MRI. Infarctions of the parahippocampal cortex may resuft in memory impairment, which can appear clinically similar to AD.     

Assessment of serum myoglobin as a marker for acute myocardial infarction.

The reliability of serum myoglobin as a marker for acute myocardial infarction was evaluated in 157 consecutive coronary-care admissions. Admission myoglobin was elevated in 47 of 52 patients with acute infarction. Excluding those patients who presented later than 24 hr after symptom onset, only one patient with acute infarct had a normal admission myoglobin. In 22 of 105 patients with no infarct, myoglobin was elevated in association with angina, congestive heart failure, arrhythmias, and renal insufficiency. The detection of acute infarction by serum myoglobin measurement equals that of serial serum creatine phosphokinase isoenzymes (CPK-MB) by electrophoresis, but an elevated myoglobin is not specific for what is now considered clinically significant myocardial infarction.     

Pontine infarction due to basilar artery stenosis presenting as pathological laughter

A 69-year-old woman presented right hemiparesis accompanied by pathological laughter (“fou rire prodromique”). The right hemiparesis progressed over several days and MRI revealed a left pontine infarct caused by basilar artery stenosis which was demonstrated by MRA. Received: 9 April 1996 Accepted: 1 July 1996     

MRI appearances consistent with haemorrhagic infarction as an early manifestation of carbon monoxide poisoning

High signal in the globus pallidus on T1-weighted images was observed in two patients who underwent early MRI, after exposure to carbon monoxide (CO). We compare these MRI abnormalities with those previously reported, and with CT findings which suggested that the damage to the globi pallidi is of vascular origin. We discuss also the hypothesis that haemorrhagic infarction is an early manifestation of CO poisoning.     

Cerebellar and brainstem infarction as a complication of CT-guided transforaminal cervical nerve root block

A 60-year-old man with a 4-year history of intractable neck pain and radicular pain in the C5 nerve root distribution presented to our department for a CT-guided transforaminal left C5 nerve root block. He had had a similar procedure on the right 2 months previously, and had significant improvement of his symptoms with considerable pain relief. On this occasion he was again accepted for the procedure after the risks and potential complications had been explained. Under CT guidance, a 25G spinal needle was introduced and after confirmation of the position of the needle, steroid was injected. Immediately the patient became unresponsive, and later developed a MR-proven infarct affecting the left vertebral artery (VA) territory. This is the first report of a major complication of a cervical root injection under CT guidance reported in the literature. We present this case report and the literature review of the potential complications of this procedure.     

Neurosarcoidosis presenting as acute infarction on diffusion-weighted MR imaging: summary of radiologic findings

A 36-year-old woman presented with acute-onset right lower extremity paresthesias, dysarthria, right facial droop, and right hemiparesis. CT and MR imaging of the brain revealed extensive white matter disease and left basal ganglia infarction with dural and leptomeningeal enhancement. Differential considerations included vasculitis, granulomatous disease, and neoplasm. Chest, abdomen, and pelvis CTs were normal. Right temporal lobe biopsy revealed noncaseating granulomatous inflammation consistent with neurosarcoidosis.     

急性心肌梗死患者血清MMP-9与冠状动脉疾病严重性及预后的关系

目的探讨血清基质金属蛋白酶-9(MMP-9)水平与急性心肌梗死(AMI)患者冠状动脉疾病严重性及预后的关系。方法选取AMI患者87例,在急诊经皮穿刺冠脉内介入术(PCI)后根据冠脉造影结果分为1支、2支和3支病变组,正常对照组30例。对照组于清晨空腹,AMI患者于PCI术前采血,采用ELISA法测定MMP-9,随访其心血管事件半年。结果 AMI患者PCI术前血清MMP-9水平在3支病变组均显著高于2支、1支病变组、对照组;在2支、1支病变组显著高于对照组;经随访,25例发生心血管事件,3支病变组心血管事件发生率显著高于2支、1支病变组;以血清MMP-9水平846μg/L为界分为A组和B组,A组心血管事件发生率显著高于B组。结论 AMI患者血清MMP-9可能用于评价冠状动脉疾病严重性,并对冠脉支架置入术后的心血管事件的发生有预测价值。     

Metabolism and blood flow as new markers of myocardial viability in the evolution of myocardial infarction

Animal studies have shown that increased regional ¹⁸F-deoxyglucose (FDG) uptake as demonstrated by positron emission tomography (PET) in ischemic and reperfused myocardium reflects reversible tissue injury. Therefore, we studied patients with acute myocardial infarction to define the extent and severity of injury. Left ventricular segments with reduced blood flow and metabolism, as demonstrated by matching defects of flow and FDG uptake, revealed irreversible injury as evidenced by lack of functional recovery. In contrast, segments with reduced flow but maintained FDG uptake showed variable functional outcome with improvement of the average wall motion score. Thus, PET may be useful in identifying myocardium at risk which may benefit from therapeutic interventions.

     

Bone infarction and fat island appearing as local defects in radionuclide bone marrow imaging

Parallel studies of radionuclide bone marrow imaging and bone scanning are helpful in the early diagnosis of skeletal metastasis. In bone marrow imaging, most lesions are observed as a local defect. We had two cases of nonmetastatic lesions which appeared as local defects in bone marrow imaging. The first case was a male Hodgkin's disease patient, aged 48, who had been treated with frequent chemotherapy, including the administration of a large quantities of steroids. He complained of slight pain in the left shoulder. Without increased uptake in bone scanning, abnormal accumulation of 67Ga-citrate and a local defect in bone marrow imaging appeared, corresponding to localization of the pain. Suspecting bone marrow metastasis, we performed magnetic resonance imaging (MRI). An area of slightly decreased intensity in T1-weighted spin-echo images and lower intensity than fat tissue in T2-weighted images were observed, although it was slightly enhanced by Gd-DTPA. This lesion was diagnosed by biopsy as a bone infarction. The second case was that of a 69-year-old male lung cancer patient. Though no abnormality was revealed by bone scanning or 67Ga-citrate scintigraphy, an apparent defect at the 10th thoracic vertebra was observed in bone marrow imaging. It was not accompanied by pain. MRI was also performed in this case. This was depicted as a clearly defined high intensity area. This was diagnosed as a fat island, and no change has been seen in the seven months of follow up. In conclusion, it is necessary to consider the possibility of nonmetastatic lesions, when local defects appear in bone marrow imaging performed on cancer patients.