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Evaluation of renal artery stenosis with CT angiography; Comparison with DSA
Pl g MATURATIONOF THE SACRUMAND COCCYX: MR, CT AND CONVENTIONAL RADIOGRAPHS, D.R. Broome, M.D., L.A. Hayman, M.D., R.M. Braverman, M.D•, L.M. Fahr, M.D., KB. Glass, M D., Baylor Collegeof Medicine, Houston, TX Pumose: This exhibit will provide the first detailed rediographic dascription of the posmatal development of the sacmar and coccyx. Methods: 83 normal patients (newborn to 30 years old) were imaged with either MR, CT and/or conventional radiography. A total of g4 imaging examinations of the sacrum and coccyx (including 37 CTs, 37 radiographs and 10 ~ exams) were analyzed as to appearance end fusion of ossification centers. Results: An orgacized presentation ofthe temporal chenges in the anatomy of the sacrum end coccyx will be presented with attention to the ossification end fusion of the numerous prima,-3, and secondary" ossificationcenters. Selected t~presentetiveimageswill illustratethe age-related changes in the 58 sacral and g coccygeal ossificationcenters. Conclusions: The osseous maturation of the sacrum and coccyx is a complex and integrated developmentalprocess that spans the first thirty years of life. The appearance and fusion of epiphysas are frequently asymmetric and caution shouldbe exercised not to misinterpretunfused growth plates as fractures. The authors believethat radiographicinterpretation of the sacrum end coccyx will be improvedby the use of this practical review of sacral and coceygeal maturation.
P21 DISSOCIATION OF POLYETHYLENE CUP LINERS AFTER TOTAL HIP ARTHROPLASTY, Saniav Misra. M.D.. G• Kimbiris, M.D., P. Richardson, M.D., P. A. Khoury, M.D., and O. Silverstein, M.D., Hahnematm University Hospital, Philadelphia,PA Pumose: To present the mdiologic findings of 13 surgicallyproven polyethylene acetabnias cup liner dissociation in patients presenting with hip pain after total hip arthroplasty. Methods: 12 patients, for a total of 13 hips, presented to Hahnemann University Hospital in the past 4 years with hip pain after total hip arthroplasty. One patient presented during this time for hip pain in each separate hip 6 months apart. Results: A diagnosis of dissociationof polyethylene cup liner was made in all 13 cases after an arthrogram was perfomled. The arthrogram findings included dissociated polyethylene cup liner from the metal backed acetabular component and in some instances a fractured polyethylene liner or fractured metal tab which beld the liner to the cup. Conclusions: An arthrogram is the gold standard and must be perfurmed in ail patients in which a dissociation of polyethylene cup liner is suspected.
P23 EVALUATION OF RENAL ARTERY STENOSIS WITH CT ANGIOGRAPHY; COMPARISON WITH D S A . P. Chang, R. Bloch, P. Dure-Smith, A. Fyruat, P. Hammond, and M. Jarmakaal. Loma Linda University Medical Center and Jerry L. Pettis Memorial VA Medical Center, Loma Linda, CA. CT angiography is a developing modality with tremendous potential in diagnostic vascular evaluation of the renal arteries. In prospective fashion, we evaluated patients with strong clinical suspicion for renal artery stenosis using both CI'A and conventional angiography. The results are promising for CTA, but there are both areas of advantage and caveats to be emphasized with this rnodality, which requires a variety of techniques in image reconstruction and demands thorough reader understanding of and orientation to the different types of images viewed. The technique, its advantages over DSA and its areas of limitation will be pictorially demonstrated. In addition the results of blinded reader comparison of CTA with DSA in our patients will be presented.
P20 EVALUATION OF E-SELECTIN-BINDING PEPTIDES FOR IMAGING INFLAMMATORY DISEASE. Kurt R. Zinn D.V.M.. Ph.D.. T.R. Chandhuri, Ph.D., J.D. Mountz, M.D., Ph.D., T. Zhou, Ph.D., James M. Mountz, M.D., Ph.D. University of Alabama at BirminghamMedical Center, Birmingham,AL. Purp0sc: E-Selectin is an adhesion molecule expressed on activated endothelial cells early in inflalmnatory diseases such as rheumatoid arthritis. A l~olypeptidecontaining a high affinity binding site for E-Selectinwas synthesized (KYDGD1TWDQLWDLMK,MW=2027 Da) based on a published sequence (JBC 270:21129-36, 1995), labeled either with biotin or Tc-99m, and evaluated for E-Selectinbinding. Methods: Human umbilical vein endothelial cells (HUVECs) grown in culture were stimulated with IL-11~(25 U/ml, 4 hr) to induce E-Selectin. E-Selectin expression was demonstrated with flow cytometry using anti-E-Selectinandbody or the biotinylatedE-Selectin-bindingpeptide. The same peptide was radiolabeledwith Tc-99m using hydrezino nieotinamide. Results: E-Selectin, while low or absent in unsfimulated HUVECs, showed high expression following 1L-l!3stimulation, using the antibody probe. Similar results were obtained with the biotinylated peptide, demonstratinghigh affinity of the sequence for E-Selectin. The peptide was radiolabeled with Tc-99m and retained the bindingaffinity for E-Selectinon stimulatedHUVECs. Conclusions: A small polypeptide for imaging E-Selectin expression early in inflammatory disease offers advantages including shorter biological half-life for greater efficiency in nuclear medicine imaging,with the capabilityfor repeated evaluations.
P22 PATELLAR FATIGUE FRACTURES R W Mason MD. TE Moore MD, CW Walker MD, MH Kathol MD, S Ehara, MD University of Nebraska, Omaha, Nebraska Pumose: To differentiate spontaneous displaced patellar fatigue fractures from pathological fractures. Method: Clinical and radiological findings were reviewed in three patellar fatigue fractures. Comparison was made to radiographs of five pathological patellar fractures. Results: The fatigue fractures showed clearly defined margins and otherwise normal bone. Two gave a history of mild pain prior to presentation with acute pain and fracture displacement. They were initially considered pathological fractures. Five pathological fractures showed obvious abnormalities of the adjacent bone. Discussion: Literature review revealed six spontaneous displaced patellar fatigue fractures, at least one of which was initially considered pathological. Patients who present with displaced patellar fatigue fractures may be suspected of having pathological fractures and be subjected to unnecessary cancer screening. However, patellar neoplasms are exceedingly uncommon, most are benign, and most show obvious radiological findings of a pre-existing abnormality. Conclusions: Unless there is other clinical or radiological evidence to suggest a pathological fracture, a patient who presents with a spontaneous displaced patellar fracture, with or without a history of preceding pain, almost certainly has a fatigue fracture.
P24 MR DETECTION OF PERIRENAL FLUID IN ACUTE URETERIC OBSTRUCTION. Fintan Reean M.D.. ~. Petronis M.D., R. Khazan M.D., M. Bohlman M.D. Johns Hopkins 15niversity Medical School, Baltimore. MD. Purvose: To determine the incidence of renal extravasafion in ureteric obstruction and'whether Magnetic Resonance (MR) can differentiate between acute and chronic ureteric obstruction based on the presence of perirenal fluid. Subjects and Methods: A prospective double blind evaluation of 41 consecutive patients with ureteric obstruction was performed using a heavily T2 weighted MR sequence (HASTE). Images were compared to concurrent intravenous urography (WU). Degree of perirenal fluid was graded from 0 - 4. Results: Based on clinical evaluation, 23 patients were acutely obstructed, and 18 had chronic ureteric obstruction• Perirenal fluid was seen on MR in 87% of acutely obstructed kidneys. Sensitivity of MR in predicting acute ureteric obstruction based on presence of perirenal fluid was 20/23 (87%) with a specificity of 15/18 (83%). None of these showed contrast extravasation on the concurrent WU. Conclusion: The study suggests that perirena] fluid occurs more frequently in acute obstruction than previously realized. HASTE MR can accurately distinguish between acute and chronic ureteric obstruction based on the degree of perirena] fluid.
P21 DISSOCIATION OF POLYETHYLENE CUP LINERS AFTER TOTAL HIP ARTHROPLASTY, Saniav Misra. M.D.. G• Kimbiris, M.D., P. Richardson, M.D., P. A. Khoury, M.D., and O. Silverstein, M.D., Hahnematm University Hospital, Philadelphia,PA Pumose: To present the mdiologic findings of 13 surgicallyproven polyethylene acetabnias cup liner dissociation in patients presenting with hip pain after total hip arthroplasty. Methods: 12 patients, for a total of 13 hips, presented to Hahnemann University Hospital in the past 4 years with hip pain after total hip arthroplasty. One patient presented during this time for hip pain in each separate hip 6 months apart. Results: A diagnosis of dissociationof polyethylene cup liner was made in all 13 cases after an arthrogram was perfomled. The arthrogram findings included dissociated polyethylene cup liner from the metal backed acetabular component and in some instances a fractured polyethylene liner or fractured metal tab which beld the liner to the cup. Conclusions: An arthrogram is the gold standard and must be perfurmed in ail patients in which a dissociation of polyethylene cup liner is suspected.
P23 EVALUATION OF RENAL ARTERY STENOSIS WITH CT ANGIOGRAPHY; COMPARISON WITH D S A . P. Chang, R. Bloch, P. Dure-Smith, A. Fyruat, P. Hammond, and M. Jarmakaal. Loma Linda University Medical Center and Jerry L. Pettis Memorial VA Medical Center, Loma Linda, CA. CT angiography is a developing modality with tremendous potential in diagnostic vascular evaluation of the renal arteries. In prospective fashion, we evaluated patients with strong clinical suspicion for renal artery stenosis using both CI'A and conventional angiography. The results are promising for CTA, but there are both areas of advantage and caveats to be emphasized with this rnodality, which requires a variety of techniques in image reconstruction and demands thorough reader understanding of and orientation to the different types of images viewed. The technique, its advantages over DSA and its areas of limitation will be pictorially demonstrated. In addition the results of blinded reader comparison of CTA with DSA in our patients will be presented.
P20 EVALUATION OF E-SELECTIN-BINDING PEPTIDES FOR IMAGING INFLAMMATORY DISEASE. Kurt R. Zinn D.V.M.. Ph.D.. T.R. Chandhuri, Ph.D., J.D. Mountz, M.D., Ph.D., T. Zhou, Ph.D., James M. Mountz, M.D., Ph.D. University of Alabama at BirminghamMedical Center, Birmingham,AL. Purp0sc: E-Selectin is an adhesion molecule expressed on activated endothelial cells early in inflalmnatory diseases such as rheumatoid arthritis. A l~olypeptidecontaining a high affinity binding site for E-Selectinwas synthesized (KYDGD1TWDQLWDLMK,MW=2027 Da) based on a published sequence (JBC 270:21129-36, 1995), labeled either with biotin or Tc-99m, and evaluated for E-Selectinbinding. Methods: Human umbilical vein endothelial cells (HUVECs) grown in culture were stimulated with IL-11~(25 U/ml, 4 hr) to induce E-Selectin. E-Selectin expression was demonstrated with flow cytometry using anti-E-Selectinandbody or the biotinylatedE-Selectin-bindingpeptide. The same peptide was radiolabeledwith Tc-99m using hydrezino nieotinamide. Results: E-Selectin, while low or absent in unsfimulated HUVECs, showed high expression following 1L-l!3stimulation, using the antibody probe. Similar results were obtained with the biotinylated peptide, demonstratinghigh affinity of the sequence for E-Selectin. The peptide was radiolabeled with Tc-99m and retained the bindingaffinity for E-Selectinon stimulatedHUVECs. Conclusions: A small polypeptide for imaging E-Selectin expression early in inflammatory disease offers advantages including shorter biological half-life for greater efficiency in nuclear medicine imaging,with the capabilityfor repeated evaluations.
P22 PATELLAR FATIGUE FRACTURES R W Mason MD. TE Moore MD, CW Walker MD, MH Kathol MD, S Ehara, MD University of Nebraska, Omaha, Nebraska Pumose: To differentiate spontaneous displaced patellar fatigue fractures from pathological fractures. Method: Clinical and radiological findings were reviewed in three patellar fatigue fractures. Comparison was made to radiographs of five pathological patellar fractures. Results: The fatigue fractures showed clearly defined margins and otherwise normal bone. Two gave a history of mild pain prior to presentation with acute pain and fracture displacement. They were initially considered pathological fractures. Five pathological fractures showed obvious abnormalities of the adjacent bone. Discussion: Literature review revealed six spontaneous displaced patellar fatigue fractures, at least one of which was initially considered pathological. Patients who present with displaced patellar fatigue fractures may be suspected of having pathological fractures and be subjected to unnecessary cancer screening. However, patellar neoplasms are exceedingly uncommon, most are benign, and most show obvious radiological findings of a pre-existing abnormality. Conclusions: Unless there is other clinical or radiological evidence to suggest a pathological fracture, a patient who presents with a spontaneous displaced patellar fracture, with or without a history of preceding pain, almost certainly has a fatigue fracture.
P24 MR DETECTION OF PERIRENAL FLUID IN ACUTE URETERIC OBSTRUCTION. Fintan Reean M.D.. ~. Petronis M.D., R. Khazan M.D., M. Bohlman M.D. Johns Hopkins 15niversity Medical School, Baltimore. MD. Purvose: To determine the incidence of renal extravasafion in ureteric obstruction and'whether Magnetic Resonance (MR) can differentiate between acute and chronic ureteric obstruction based on the presence of perirenal fluid. Subjects and Methods: A prospective double blind evaluation of 41 consecutive patients with ureteric obstruction was performed using a heavily T2 weighted MR sequence (HASTE). Images were compared to concurrent intravenous urography (WU). Degree of perirenal fluid was graded from 0 - 4. Results: Based on clinical evaluation, 23 patients were acutely obstructed, and 18 had chronic ureteric obstruction• Perirenal fluid was seen on MR in 87% of acutely obstructed kidneys. Sensitivity of MR in predicting acute ureteric obstruction based on presence of perirenal fluid was 20/23 (87%) with a specificity of 15/18 (83%). None of these showed contrast extravasation on the concurrent WU. Conclusion: The study suggests that perirena] fluid occurs more frequently in acute obstruction than previously realized. HASTE MR can accurately distinguish between acute and chronic ureteric obstruction based on the degree of perirena] fluid.