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MRI of achilles tendon injury
ABSTRACTS EFFECT OF VITAMIN C MEASURED BY IN VIVO
765
POSTERS
R A D I O F R E Q U E N C Y ESR O N T H E B I O R E D U C T I O N O F
ISNPCA IN RATS G. R. CHERRYMAN, A. R. MOODY, A. STEVENS and C. M. SMITH
University of Leicester, Department of Radiology, Leicester
SPLENORENAL SHUNT DEMONSTRATION WITH MRI C. J, BAUDOUIN, J. A. GUTHRIE, J. WARD, J. P. RIDGWAY and P. J. ROBINSON
St James's University Hospital, Leeds The current development of ESR imaging demands an increased understanding of the biological behaviour of potential ESR tracers such as 15NPCA (2,2,5,5Tetramethylpyrrolidine-dl5; 1)SN-l-oxyl-3carboxylic acid). To determine whether the injection of compounds with a redox potential different to 15NPCA will alter the observed bioreduction of 15NPCA into the corresponding hydroxylamine, serial radiofrequency ESR spectra were obtained in anaesthetised rats injected with 1 ml. 16mM. 15NPCA. Spectra were aquired in a minimum of 27 seconds and a maximum of 96 seconds. Serial plot of peak intensity against time demonstrated a mon-exponential reduction in intensity (S 43.0e-~176176176 Following the iv injection of vitamin C significant changes in observed rate of bioreduction could be observed (p < 0.01). We conclude that the bioreduction of 15NPCA in the rat as measured by ESR spectroscopy is altered by the concurrent injection of vitamin C. This observation suggests that ESR may be used to determine the redox potential of plasma in vivo.
INTERSTITIAL LYMPHANGIOGRAPHY FOR EVALUATION OF LYMPHOEDEMA D. A. GOULD and G. I. A. N. ABBOTT
Broadgreen Hospital NHS Trust, Liverpool Purpose: Interstitial non-ionic contrast lymphangiography was used in 21 patients with lymphoedema to demonstrate lymphatic morphology and try to determine the level of lymphatic obstruction. Methods,: 2-3ml of iotrolan 300mg/ml, (Schering, Berlin) was infused intradermally via 25 gauge needles into the affected limb at 1 ml/10min using a gravity feed cantilever pump. Radiographs were taken at 5 and 10 minutes using mammography film and at 5 minute intervals thereafter using extremity film. This outpatient procedure usually took 30 minutes to perform and was generally well tolerated. Results: Abnormal patterns of contrast uptake included increased subdermal lymphatics - dermal pooling of contrast with limited subcutaneous diffusion producing a bowler hat appearance tortuosity, dilation & increased or decreased main lymphatic vessels. No specific pattern of contrast uptake distinguished primary from secondary lymphoedema. Conclusion: Interstital non-ionic contrast lymphangiography is a useful technique for demonstrating peripheral lymphatic morphology. Its role in the investigation of lymphoedema will be discussed.
Splenorenal shunts in patients with portal hypertension and end stage liver failure are said to be associated with reduced gastro-intestinal bleeding and increased hepatic encephalopathy. The MR appearances and clinical findings in patients with spontaneous and surgically created splenorenal shunts were reviewed, Clinical notes and MR examinations in patients reported to have splenorenal shunts were reviewed retrospectively. Patients with liver failure who were referred for MRI prior to liver transplantation were included in the study. The MR sequences performed at 1.0 Tesla were: proton density and T2 weighted axial images, (TR 2000, TE 45, 90) and breathhold, dynamic, gadoliniumenhanced FLASH oblique coronal images (TR100, TE 4msec, 80~ Single slices and maximal intensity projection were assessed. 19 patients had evidence of splenorenal shunts, 14 were spontaneous and 5 surgical. Clinically evident encephalopathy occurred in 23% and episodes of upper gastrointestinal variceal haemorrhage in 21%. The shunt was well demonstrated on both axial and coronal oblique scans in 36%, better on axial images in 32% and coronal oblique scans in 32%. Maximum intensity projections allowed visualisation of tortuous vessels particularly well. Other retroperitoneal collateral vessels were demonstrated in 74%, a dilated umbilical vein in 37%, gastric collaterals in 63% and dilated oesophageal vessels in 32%. Conclusion: MR is a good means of demonstrating spIenorenal shunts in patients with end stage liver failure.
BOWEL INCARCERATION IN LAPAROSCOPY PUNCHHOLES: TWO CASES AND A SUGGESTION J. F. BRAY and D. ELLER
Cedars-Sinai Medical Center, Department of Radiology, Los Angeles, CA, USA Laparoscopic surgery, exploding in popularity world-wide, is showing its own complications. Two patients developed small bowel obstruction following laparoscopic surgery. At laparotomy, in both cases, a knuckle of small bowel was found herniated and entrapped in a trochar punchhole. Both patients suffered prolonged distress. Obstruction developed on post-laparoscopy days 2 and 3 respectively, surgery was performed on days 11 and 12. A similar delay was discussed in three of the ten previously reported cases. In one of our patients a tangenital film of the anterior abdominal wall demonstrated intramural bowel and led to surgery. We suggest obtaining a tangential film of the anterior abdominal wall in any post-laparoscopy patient with bowel obstruction.
RESEARCHING RESEARCH
A. L. BROWN, N. T. F. RIDLEY and J. G. MURRAY
Northwick Park Hospital, Harrow There is perceived to be increasing pressure on trainee radiologists to publish and present research. This prospect may be daunting for many trainees who have limited previous exposure to research. The purpose of this study was to assess the value of the introduction of structured research guidance at Northwick Park Hospital over the last 18 months. Research meetings were held every 2 months, attended by trainee radiologists and chaired by a consultant. New ideas were discussed and the value of adopting these ideas as projects determined. At each subsequent meeting ongoing projects were reviewed. Particular problems encountered included funding, sessional time and access to statisticians. The minutes of all meetings were reviewed to determine numbers of ideas generated and numbers of presentations/publications. 82 new ideas were generated of which 2 were immediately rejected. 47 ideas were subsequently rejected and 33 studies have been completed. 19 studies have been submitted for publication and at this time 8 have been accepted. 16 studies have been presented. 8 trainee radiologists participated with a 72% attendance rate. All trainees felt that these meetings were particularly useful. Structured research guidance should be introduced for all trainees.
MR1 OF ACHILLES TENDON INJURY M. P. CAPLAN, H. LEWIS-JONES and G. H. WHITEHOUSE
Magnetic Resonance Research Centre, University of Liverpool, Liverpool Introduction: MRI is accepted as the method of choice for imaging injuries to and around tendons. A number of cases are presented to demonstrate the appearances of acute and chronic injuries of the Achilles Tendon. Design: A retrospective study. Subject and Method: The cases were selected from 40 patients referred with suspected Achilles Tendon injury and examined using a General Electrics Signa 1.5T scanner, in the axial and sagittal planes. Results: A normal subject was used to demonstrate normal anatomy. The MRI appearances of acute and chronic tendinitis, partial and complete tears of the Achilles tendon are demonstrated as well as the differential diagnosis of retrocalcaneal bursitis and tenosynovitis of other tendons around the ankle. A brief discussion of the relative roles of MRI and other imaging modalities is presented. Conclusion: The excellent ability of MRI to demonstrate Achilles Tendon injury is illustrated.
765
POSTERS
R A D I O F R E Q U E N C Y ESR O N T H E B I O R E D U C T I O N O F
ISNPCA IN RATS G. R. CHERRYMAN, A. R. MOODY, A. STEVENS and C. M. SMITH
University of Leicester, Department of Radiology, Leicester
SPLENORENAL SHUNT DEMONSTRATION WITH MRI C. J, BAUDOUIN, J. A. GUTHRIE, J. WARD, J. P. RIDGWAY and P. J. ROBINSON
St James's University Hospital, Leeds The current development of ESR imaging demands an increased understanding of the biological behaviour of potential ESR tracers such as 15NPCA (2,2,5,5Tetramethylpyrrolidine-dl5; 1)SN-l-oxyl-3carboxylic acid). To determine whether the injection of compounds with a redox potential different to 15NPCA will alter the observed bioreduction of 15NPCA into the corresponding hydroxylamine, serial radiofrequency ESR spectra were obtained in anaesthetised rats injected with 1 ml. 16mM. 15NPCA. Spectra were aquired in a minimum of 27 seconds and a maximum of 96 seconds. Serial plot of peak intensity against time demonstrated a mon-exponential reduction in intensity (S 43.0e-~176176176 Following the iv injection of vitamin C significant changes in observed rate of bioreduction could be observed (p < 0.01). We conclude that the bioreduction of 15NPCA in the rat as measured by ESR spectroscopy is altered by the concurrent injection of vitamin C. This observation suggests that ESR may be used to determine the redox potential of plasma in vivo.
INTERSTITIAL LYMPHANGIOGRAPHY FOR EVALUATION OF LYMPHOEDEMA D. A. GOULD and G. I. A. N. ABBOTT
Broadgreen Hospital NHS Trust, Liverpool Purpose: Interstitial non-ionic contrast lymphangiography was used in 21 patients with lymphoedema to demonstrate lymphatic morphology and try to determine the level of lymphatic obstruction. Methods,: 2-3ml of iotrolan 300mg/ml, (Schering, Berlin) was infused intradermally via 25 gauge needles into the affected limb at 1 ml/10min using a gravity feed cantilever pump. Radiographs were taken at 5 and 10 minutes using mammography film and at 5 minute intervals thereafter using extremity film. This outpatient procedure usually took 30 minutes to perform and was generally well tolerated. Results: Abnormal patterns of contrast uptake included increased subdermal lymphatics - dermal pooling of contrast with limited subcutaneous diffusion producing a bowler hat appearance tortuosity, dilation & increased or decreased main lymphatic vessels. No specific pattern of contrast uptake distinguished primary from secondary lymphoedema. Conclusion: Interstital non-ionic contrast lymphangiography is a useful technique for demonstrating peripheral lymphatic morphology. Its role in the investigation of lymphoedema will be discussed.
Splenorenal shunts in patients with portal hypertension and end stage liver failure are said to be associated with reduced gastro-intestinal bleeding and increased hepatic encephalopathy. The MR appearances and clinical findings in patients with spontaneous and surgically created splenorenal shunts were reviewed, Clinical notes and MR examinations in patients reported to have splenorenal shunts were reviewed retrospectively. Patients with liver failure who were referred for MRI prior to liver transplantation were included in the study. The MR sequences performed at 1.0 Tesla were: proton density and T2 weighted axial images, (TR 2000, TE 45, 90) and breathhold, dynamic, gadoliniumenhanced FLASH oblique coronal images (TR100, TE 4msec, 80~ Single slices and maximal intensity projection were assessed. 19 patients had evidence of splenorenal shunts, 14 were spontaneous and 5 surgical. Clinically evident encephalopathy occurred in 23% and episodes of upper gastrointestinal variceal haemorrhage in 21%. The shunt was well demonstrated on both axial and coronal oblique scans in 36%, better on axial images in 32% and coronal oblique scans in 32%. Maximum intensity projections allowed visualisation of tortuous vessels particularly well. Other retroperitoneal collateral vessels were demonstrated in 74%, a dilated umbilical vein in 37%, gastric collaterals in 63% and dilated oesophageal vessels in 32%. Conclusion: MR is a good means of demonstrating spIenorenal shunts in patients with end stage liver failure.
BOWEL INCARCERATION IN LAPAROSCOPY PUNCHHOLES: TWO CASES AND A SUGGESTION J. F. BRAY and D. ELLER
Cedars-Sinai Medical Center, Department of Radiology, Los Angeles, CA, USA Laparoscopic surgery, exploding in popularity world-wide, is showing its own complications. Two patients developed small bowel obstruction following laparoscopic surgery. At laparotomy, in both cases, a knuckle of small bowel was found herniated and entrapped in a trochar punchhole. Both patients suffered prolonged distress. Obstruction developed on post-laparoscopy days 2 and 3 respectively, surgery was performed on days 11 and 12. A similar delay was discussed in three of the ten previously reported cases. In one of our patients a tangenital film of the anterior abdominal wall demonstrated intramural bowel and led to surgery. We suggest obtaining a tangential film of the anterior abdominal wall in any post-laparoscopy patient with bowel obstruction.
RESEARCHING RESEARCH
A. L. BROWN, N. T. F. RIDLEY and J. G. MURRAY
Northwick Park Hospital, Harrow There is perceived to be increasing pressure on trainee radiologists to publish and present research. This prospect may be daunting for many trainees who have limited previous exposure to research. The purpose of this study was to assess the value of the introduction of structured research guidance at Northwick Park Hospital over the last 18 months. Research meetings were held every 2 months, attended by trainee radiologists and chaired by a consultant. New ideas were discussed and the value of adopting these ideas as projects determined. At each subsequent meeting ongoing projects were reviewed. Particular problems encountered included funding, sessional time and access to statisticians. The minutes of all meetings were reviewed to determine numbers of ideas generated and numbers of presentations/publications. 82 new ideas were generated of which 2 were immediately rejected. 47 ideas were subsequently rejected and 33 studies have been completed. 19 studies have been submitted for publication and at this time 8 have been accepted. 16 studies have been presented. 8 trainee radiologists participated with a 72% attendance rate. All trainees felt that these meetings were particularly useful. Structured research guidance should be introduced for all trainees.
MR1 OF ACHILLES TENDON INJURY M. P. CAPLAN, H. LEWIS-JONES and G. H. WHITEHOUSE
Magnetic Resonance Research Centre, University of Liverpool, Liverpool Introduction: MRI is accepted as the method of choice for imaging injuries to and around tendons. A number of cases are presented to demonstrate the appearances of acute and chronic injuries of the Achilles Tendon. Design: A retrospective study. Subject and Method: The cases were selected from 40 patients referred with suspected Achilles Tendon injury and examined using a General Electrics Signa 1.5T scanner, in the axial and sagittal planes. Results: A normal subject was used to demonstrate normal anatomy. The MRI appearances of acute and chronic tendinitis, partial and complete tears of the Achilles tendon are demonstrated as well as the differential diagnosis of retrocalcaneal bursitis and tenosynovitis of other tendons around the ankle. A brief discussion of the relative roles of MRI and other imaging modalities is presented. Conclusion: The excellent ability of MRI to demonstrate Achilles Tendon injury is illustrated.