Three-dimensional contrast magnetic resonance angiography has rapidly advanced over recent years. It is now a highly accurate and safe method of diagnosing vascular abnormalities of the thoracic, abdominal and peripheral vessels. We describe techniques for the examination of the thoracic and abdominal aorta, the renal arteries and the lower limb vessels together with strategies to improve their diagnostic accuracy.
Objective To test the hypothesis that magnetic resonance imaging (MRI)-guided laser thermal ablation (LTA) of inoperable renal tumours is a safe, tolerable and potentially effective treatment . Patients and methods Nine patients (aged 56-81 years) with malignant renal tumours underwent percutaneous LTA under MRI guidance in a 0.5 T open magnet. Real-time colour thermal mapping was used to monitor tumour ablation, and the follow-up was with gadolinium-enhanced MRI at 6 weeks and (where appropriate) 3-4 months after the procedure. Tumour volume and percentage tumour enhancement before and after ablation were compared . The percentage of tumour ablated on real-time T1-weighted thermal maps was compared with that on gadoliniumenhanced follow-up MRI . Results The mean (range) follow-up was 16.9 (3-32) months after the first ablation. The mean tumour size did not change significantly, but the mean percentage of viable tumour decreased significantly from 73.7% before to 29.5% after ablation ( P = 0.012, Wilcoxon signed-ranks test). Thermal maps correlated moderately well with follow-up MRI in predicting the extent of tumour ablation (Pearson correlation coefficient 0.55). There were two minor and one major complication. Conclusion In this pilot study of patients unsuitable for surgery, MRI-guided LTA of renal tumours was safe, feasible (being well tolerated by the patient) and significantly reduced enhancing tumour volume by a mean of 45%.
Pneumatosis intestinalis (PI) is defined as the presence of gas within the serosal or mucosal layer bowel wall. This sign is usually found upon radiographic imaging and is most commonly secondary to acute gastro-intestinal ischaemia. Fifteen per cent of cases can present with a primary condition called pneumatosis cystoides intestinalis (PCI). PCI is usually a benign condition and patients are usually asymptomatic. Portal venous gas (PVG) or the presence/accumulation of free gas within the hepatic portal vein. It is most commonly associated with acute bowel ischaemia, and when seen in the presence of ischaemia the mortality rate is between 75 and 90%. Other associations include mechanical causes (e.g. obstruction), chemotherapy, liver transplant and diverticulitis. Benign PI has previously been described with PVG, but usually in the presence of other associated conditions such as AIDS, malignancy or chemotherapy. Some examples have been described without these associations, but not with free intra-peritoneal air. We describe a case of PCI and PVG with pneumoperitoneum, investigations and ongoing management.
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