The purpose of writing this case study was to compare the accuracy of computed tomography angiography (CTA) and 3D rotational digital subtraction angiography (3D DSA) in demonstrating a giant cerebral aneurysm and its relationship to the parent artery. The patient was a 36-year-old female who presented to our department with a suspected cerebral aneurysm as seen on a non-contrast computerised tomography (CT) brain scan. The CTA and 3D DSA were performed on consecutive days and both demonstrated a giant aneurysm arising from the right posterior cerebral artery. A series of 3D images were produced from both modalities, with each possessing sub-millimeter spatial resolution. After comparison between the two 3D data sets, it was evident that the 3D DSA was superior in delineating the relationship between the aneurysm and its parent artery. The CTA suffered from partial voluming in this area and it seemed as though a connection was present between the aneurysm and posterior cerebral artery distal to the aneurysm neck. Based on the CTA alone, an incorrect report would have resulted. Surgery later confirmed the absence of this connection and, thereby, proved that 3D DSA was more accurate in the visualisation of this patient's aneurysm. Treatment for this patient could therefore be planned more confidently based on the 3D DSA findings.
Experience at our hospital departmentDuringtheperiodOctober2001toNovember200,weperformed 80 MRI examinations on 73 patients (seven had two scans) for Crohn's disease. Forty-eight of the patients were female (66%) and 25 patients male (3%). The average age of the female patients was 38 years (range 17-81) and the male IntroductionCrohn's disease is a chronic inflammatory bowel disease affectingthegastro-intestinal(GI)tractanywherefromthemouth totheanus.Thesmallbowelisaffectedin80%ofcases,most commonlyattheterminalileum.1 Thelargebowelisalsoaffected (20% of the time alone and 50% of the time with the small bowel).2 Thediseaseischaracterisedby'skip'lesionsofnormal and diseased bowel, epitheloid cell granulomas and transmural inflammationoftheaffectedareas.Symptomsincludeabdominalpain,diarrhoea,rectalbleeding, fevers and weight loss and gross pathologic findings include: inflamedbowelwall,enlargedmesentericlymphnodesandthe formationofabdominalandpelvicfistulas. 3ItisacharacteristicofCrohn'sdiseaseforsuffererstoundergo periods of remission and relapse, 1 and it is also not unusual for these patients to undergo surgery to remove affected segments ofbowel.Thecauseofthediseaseisunknownanditmostcommonlyaffectsyoungadults.The medical management of Crohn's disease depends upon on the severity and status of the disease. Medication given to helpmanagetheinflammatoryresponseofthebowelaswellas bacterial over-growth include: immunosuppressants, antiinflammatoriesandantibiotics. Hospital practice and methodologyOurprotocolforacomprehensivemagneticresonanceimaging(MRI)examinationofthesmallbowelincludesbothT1and T2 weighted imaging sequences and post-contrast T1 weighted images.3,5 As with a computer ised tomography (CT) examinationoftheabdomenandpelvis,itisveryimportanttoutiliseoral contrastpriortothescaninordertoadequatelydistendthebowel loops, thus allowing for correct assessment of disease activity withinthebowelwall.3 Atourdepartmentthepatientdrinks1Lof abarium-sulphatesuspension(Redicat ® -2)whichappearsaslowsignalintensityonT1-weightedimagesandhigh-signalintensity on T2-weighted images. We also distend the large bowel with 700mlofwateradministeredasanenema.Thepatientmustalso MR imaging of Crohn
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