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Archives for the week: May 1 - 7 2001

Author:Giuseppe Brancatelli
Title:CT Findings with Emphasis on Multiphasic Helical CT in 78 Patient
Source:Radiology 2001 219: 61-68
Review: The article is a definitive article on 78 patients with 124 FNH tumors. They have described a whole bunch of signs with respect ot FNH. A classic FNH is subcapsular, ill-defined, with a smooth margin and shows marked homogeneous enhancement on the arterial phase study. A central scar is seen in larger lesions. Atypical but known features include lobulation, exophytic appearance, peritumoral vessels and pseudocapsule.
Differenital diagnoses include hemangioma, adenoma, fibrolamellar HCC, conventional HCC and hypervascular metastases, but differentiation is usually not difficult.
Additional comment: In the last two years, there have been other similar definitive articles on adenoma, hemangioma, etc. which I will try and review in the next few days.
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Author:Rüdiger von Kummer,et al
Title:Early Prediction of Irreversible Brain Damage after Ischemic Stroke at CT
Source:Radiology 2001 219: 95-100
Review: This is a spin-off from the data of ECASSII, a trial conducted to assess the utility of rTPA in early stroke.They have shown that whenever even a subtle hypodensity is seen on a CT in an arterial territory within six hours of a stroke, it predicts irreversible brain damage in that region. The reason this occurs is because an ischemic area attracts water and water results in reduced parenchymal density. The positive predictive value for this sign was 96%, which means that if a parenchymal hypodensity is present, it is 96% definite that there is irreversible brain damage. The negative predictive value was only 27%, which means that if there is no hypodensity, only 27% of patients will not have irreversible brain damage. This is expected considering the low sensitivity of CT to ischemic brain damage.
This essentially means that all our subtle signs of infarct (insular ribbon sign, hypodense lentiform nucleus sign) mean that the patient already has irreversible brain damage.
This of course does not translate into what it means for patient who are to go on rTPA and no conclusions have been drawn regarding that issue.
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Author:Kejal Kantarci et al
Title:Mild Cognitive Impairment and Alzheimer Disease: Regional Diffusivity of Water
Source:Radiology 2001 219: 101-107
Review: This article is a landmark article by Kantarci K et al from the Mayo Clinic. The article shows how hippocampal apparent diffusion coefficient (ADC) is higher in patients with Alzheimer's disease than in normal controls. This reflects ultrastructural changes in the hippocampi. Similar changes are also noted in other parts of the brain. This however does not translate into clinical use to diagnose Alzheimer's disease due to overlap with normal subjects, but as the authors say would be useful in drug trials and longitudinal follow-up. A commentary on this by Shwartz R B is also available in the same issue.
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