We report a patient with a clinical syndrome indistinguishable from Parkinson's disease in which postmortem examination revealed extensive lacunar infarction of the basal ganglia without evidence of coexistent Parkinson's disease. This case provides pathologic confirmation of the concept of vascular parkinsonism.

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OBJECTIVE. The purposeof this studywas to evaluatea recentlydevelopedhardware and software system for CT scanning that generates images in real time and switches to heli cal CT scanning by either a visual cue or a region of interest (ROI) amplitude threshold. SUBJECTS AND METHODS. We randomlyandprospectivelydivided 120 abdominalCT examinations into three groups. Two groups received 75 ml of contrast agent at 1.5 ml/sec.Helical CT scanning began after visualization of the contrast bolus arrival in the hepatic veins (visual cue triggering) (39 patients) or after reaching an ROI threshold (automated ROI threshold triggering) (39 patients). A third group served as a control group (42 patients) and received 150 ml of contrast agent at I mllsec. Quality of hepatic enhancement was assessed objectively and subjectively. Comparisons were made after stratifying each group into three weight classes. RESULTS. Errorsoccurredin 12 (31%) of 39 examinationsin the groupwith automatedROl threshold triggering. In that group, we found a significantly (p < .04) lower mean hepatic enhancement in two of three weight categories, and a significantly (p < .04) lower mean sub jective scan quality in one of three weight categories, than we found in the group with visual cue triggering. CONCLUSION.Optimizing portalvenousphasehelicalCT of the liver after a low-vol ume bolus of contrast agent and an injection rate of 1.5 mI/sec is best achieved by initiating helical CT scanning after visualizing the contrast bolus arrival within the liver rather than af ter reaching a preset attenuation threshold.T he use of helical CT, with its abil ity to image a target organ rap idly, can greatly improve the probability of seeing all desired anatomy in a short time [1â€"5]. However, the rapid scan ning time of helical CT can increase the diffi culty of optimizing the delay time between the beginning of contrast material injection and the acquisition of images [2â€"4].Recent advances in reconstructionspeed al low helical CT scanning delay time to be individualizedon a case-by-case basis by mon itoring contrast enhancement with rapidly re constructed CT images obtained at a stationary level within or near the organ of interestduring the bolus injection of IV contrast material. Sil verman et al. [6][7][8] and Kopka et al. [9,10] evaluated a system in which this rapid recon struction process allowed monitoring of hepatic contrast enhancement by near real-time graphic and numeric display ofhepatic density in a pre determined region of interest (ROl). Their sys tem allowed the operator to initiate helical CT imaging when hepatic density reached a preset numeric threshold (automated ROI threshold triggering). These investigators reported an im provement in the quality of hepatic contrast en hancement when compared with that of standard helical examinations using a fixed scanning delay time and suggested that the amount of contrast material could be reduced without compromising scan quality [8, 10].A recently developed hardware and soft ware system devised for bol...

OBJECTIVE.Our objective was to evaluate the accuracy of color Doppler sonography for assessing tumor thrombus extension into the renal veins, the inferior vena cava, and the right side of the heart in patients with renal cell carcinoma. MATERIALS

The case histories of five patients with celiac disease and postbulbar duodenal ulceration and stenosis are presented. Celiac disease was unexpected in three of the five patients until endoscopic biopsy revealed villous atrophy. Our findings suggest that duodenal ulceration and stenosis may be a more common complication of celiac disease than previously thought and may precede the clinical diagnosis of celiac disease or occur when there are minimal symptoms and nonspecific radiographic findings for the disease.