PURPOSE: The purpose of this study is to determine whether adding an angled oblique sagittal plane to the routine shoulder MRI improves the diagnostic performance in the evaluation of supraspinatus tendon tears with arthroscopic correlation. MATERIALS AND METHODS: The study included 121 patients who had a shoulder MRI followed by arthroscopy. Two radiologists separately evaluated the supraspinatus tendon for tears on shoulder MRI either with or without the angled oblique sagittal images. Arthroscopy was used as the reference standard. The sensitivity and specificity for diagnosing supraspinatus tendon tears were calculated and compared by using McNemar test. Interobserver and intertechnique variability in the interpretation of supraspinatus tendon tears were calculated as a kappa value. RESULTS: Adding the angled oblique sagittal images to the standard shoulder MRI showed improvement in the sensitivity for diagnosing full-thickness supraspinatus tendon tears and also in the sensitivity, specificity and accuracy for the detection of partial-thickness tears. However, there was no statistically significant difference in all of them between with and without the angled set. Interobserver agreement was substantial to almost perfect and intertechnique agreement was moderate. CONCLUSION: Adding an angled oblique sagittal plane image to the routine shoulder MRI showed no significantly different diagnostic performance in detecting the partial- and full-thickness supraspinatus tendon tears, compared to MRI without angled oblique sagittal plane.
Arthroscopy ; Humans ; Magnetic Resonance Imaging* ; Rotator Cuff ; Sensitivity and Specificity ; Shoulder Joint ; Shoulder* ; Tendon Injuries ; Tendons*

PURPOSE: To evaluate by US and CT the incidence and complications of acquired cystic kidney disease (ACKD) in dialysis and renal transplant patients and to compare the effectiveness of US and CT in the diagnosis of this entity. MATERIALS AND METHODS: This study was prospectively performed in 70 dialysis patients and 13 renal transplant patients, and excluded any with multiple renal cysts or polycystic kidney disease, on as seen on initial films. US were obtained in all patients, and CT scans were randomly obtained in 27 who had been on dialysis for 3 years or more; all these US and CT scans were analyzed, with particular emphasis on whether or not cysts were present. In order to correlate the numbers of cysts with duration of dialysis, all patients were assigned to one of three groups, according to the number of cysts found (group 1, 0; group 2, 1-4; group 3, >4).Only group 3 was diagnosed as suffering from ACKD. In order to compare the cyst-detection capability of US with that of CT, 27 dialysis patients who had undergone US and CT were divided into four groups according to the numberof cysts found (grade 1, 0; grade 2, 1-4; grade 3, 5-10; grade 4, >10). RESULTS: Seventy dialysis patients were divided according to the results of US, as follows : group 1, 20%; group 2, 47.1%; group 3, 32.9%. The mean duration of dialysis in group 1 (31.9 months) was statistically different from that in group 2 (50.6 months) and in group 3 (95.8 months) (p<0.000). Thirteen renal transplant patients were divided as follows : group1, 61.5%; group 2, 38.5%; group 3, 0%. In dialysis patients with ACKD, complications noted were renal cell carcinoma(n=1), hemorrhagic cysts(n=2), and hematomas(n=2) Among the 27 dialysis patients who underwent CT, this and US showed an equal grade of cystic change in 53.7%, while CT showed a higher grade in 46.3%. The detection rate of ACKD in these 27 patients was 46% on US and 63% on CT. CONCLUSION: A prolongation of dialysis corresponded to an increased incidence of ACKD; renal neoplasm and hemorrhage may occur in dialysis patients, but ACKD and its complications did not develop in renal transplant patients. In long-term dyalysis patients, regular follow-up studies of kidneys using US or CT are therefore needed. CT was superior to US in diagnosing ACKD.
Diagnosis ; Dialysis* ; Follow-Up Studies ; Hemorrhage ; Humans ; Incidence ; Kidney ; Kidney Diseases, Cystic ; Kidney Neoplasms ; Polycystic Kidney Diseases ; Prospective Studies ; Tomography, X-Ray Computed ; Ultrasonography*

PURPOSE: To evaluate the usefulness of percutaneous management and prognosis in venous rupture during angioplasty of hemodialytic arteriovenous fistulas. MATERIALS AND METHODS: Among 814 patients who underwent angioplasty on account of inadequate hemodialysis, 63[39 women and 24 men aged 20-78 (mean, 55.8) years] were included in this study. All 63 had peripheral venous stenosis. Venous rupture was diagnosed when contrast leakage was seen at venography after percutaneous angioplasty (PTA). In order to manage venous rupture, the sites at which this occurred were compressed manually for 3-5 minutes or blood flow was blocked with a balloon catheter for the same period. In one case, a stent was inserted at the rupture site. Using the Kaplan-Meier method, we investigated the patency rate of arteriovenous fistula (AVF) in cases of successful PTA. We also compared PTA patency rates in cases with and without peripheral venous rupture. RESULTS: Venous rupture occurred in 38 cephalic, 16 brachial, and 9 basilic veins. In 63 patients, bleeding stopped and in 54 (85.7%) of these, PTA was successful. Among the nine failed cases, dilatation was incomplete in five, though bleeding had stopped. In patients with brachial and cephalic vein rupture, the venous tract at the rupture site was not located. Two patients underwent surgery: one of these experienced brachial venous rupture, with incontrollable bleeding, and the other had nerve compression symptoms due to hematoma. Among 54 patients in whom PTA was successful, the primary and secondary six-month rates for angioaccess were 47.9% and 81.2%, and the mean patency period was 6.1 and 15.8 months, respectively. In cases of non-venous rupture, the mean patency period was 9.6 months, significantly longer than in cases involving venous rupture (p=0.02). CONCLUSION: Venous rupture occurring during the PTA of hemodialytic AVF can be managed percutaneously.
Angioplasty* ; Arteriovenous Fistula ; Catheters ; Constriction, Pathologic ; Dilatation ; Female ; Hematoma ; Hemorrhage ; Humans ; Male ; Ocimum basilicum ; Phlebography ; Prognosis ; Renal Dialysis* ; Rupture* ; Stents ; Veins

PURPOSE: To analyse the effectiveness of percutaneous treatment of central venous obstruction in patients undergoing hemodialysis. MATERIALS AND METHODS: In 100 patients, 107 central venous strictures [56 subclavian (occlusion:21, stenosis:35) and 51 innominate (occlusion:23, stenosis:28)] were assessed, and 170 percutaneous angioplasty procedures were performed. Balloon dilation of the venous lumen was the preferred mode, but if dilation was incomplete we inserted a stent at the site of the stricture. Technical success, procedural complications and the long-term patency rate were evaluated, and the patency difference according to location and degree of stricture, the existence of DM, and any history of central catheter insertion were also determined. RESULTS: We inserted 52 stents in 170 procedures, in 157 (92.4%) of which initial technical success was achieved. Stent migration occurred in two cases and balloon rupture in three. The 6- and 12-month primary patency rates were 46.2% and 24.1%, respectively, and the mean patency rate was 8.5 months. The 1-, 2- and 3-year accumulative patency rates were 59.8%, 47.5% and 35.7%, respectively, and the mean patency rate was 23.5 months. Other than in the history of central catheter insertion, there were no statistically significant differences in patency rates (p=0.0128). CONCLUSION: In hemodialysis patients with a central venous stricture, percutaneous angioplasty is a safe and useful procedure, but to maintain long-term central venous patency, repeated interventions are required.
Angioplasty ; Catheters ; Constriction, Pathologic ; Dialysis ; Humans ; Renal Dialysis* ; Rupture ; Stents ; Subclavian Vein