Showing papers in "American Journal of Roentgenology in 1979"

Radiographic evaluation of adenoidal size in children: adenoidal-nasopharyngeal ratio.

Abstract: Adenoidal-nasopharyngeal ratios (AN ratios) obtained by simple linear measurements from lateral skull radiographs are described. The AN ratio reliably expresses adenoidal size and patency of the nasopharyngeal airway. The validity of the ratio as an indicator of adenoidal size was determined by evaluation of measurements of radiographs of 1,398 infants and children and comparison with a subjective visual assessment made by experienced observers in 92 patients. An AN ratio greater than 0.80 was present in 34 of 36 patients (94%) subjectively judged to have enlarged adenoids.

Ventilation-perfusion studies in suspected pulmonary embolism.

Abstract: The results of ventilation-perfusion (V-Q) imaging and pulmonary angiography were retrospectively analyzed in 146 patients with suspected pulmonary embolism (PE) to define the frequency of PE associated with various scintigraphic patterns. When the radionuclide images demonstrated at least two moderate-sized or one large area of V-Q mismatch, the probability of PE was 92%. However, only one of three patients with a single moderate-sized V-Q mismatch had PE, while small V-Q mismatches were not associated with PE in any of 19 patients. Matched V-Q abnormalities in lung regions that were radiographically normal were infrequently due to PE (4.8%). When a perfusion defect was substantially smaller than a corresponding radiographic abnormality, the frequency of PE was low (7.7%). Conversely, when a perfusion defect was substantially larger than the corresponding radiographic abnormality, there was a high probability of PE (87%). Matched perfusion and radiographic abnormalities indicated an intermediate probability of PE (27%). Patients with suspected pulmonary embolism may be classified into groups with low, intermediate, or high probability of pulmonary embolism on the basis of size and number of perfusion defects and a careful comparison of perfusion defects with ventilatory and radiographic findings.

Breast cancer missed by mammography.

Abstract: Because a "negative" mammogram that is followed by a biopsy diagnostic of cancer is a matter of deep concern, a retrospective review was conducted of 48 such missed diagnoses at four Breast Cancer Detection Centers. The study group comprised 40,000 women participating in breast cancer screening examinations. From 3,271 biopsies during screening, 499 cancers had been found. Biopsies in the interval between screening examinations totaled 630 and yielded 48 malignancies. These 48 interval cancers were studied in an attempt to discover why they were not found on the preceding mammographic examination. Three major categories of error were disclosed and each is discussed: (1) poor radiographic technique; (2) absence of radiographic criteria of cancer; (3a) obvious oversight by the radiologist; and (3b) lack of recognition of subtle radiographic signs. This last reason is discussed in detail in the belief that better recognition of these indirect radiographic signs will lead to more accurate diagnoses, particularly in early cancers.

Technique of percutaneous transluminal angioplasty with the Grüntzig ballon catheter.

Abstract: Recanalization of superficial femoral artery occlusions and of stenoses in the superficial femoral and pelvic arteries using the Gruntzig balloon catheter are described. Among patients successfully treated, 2 year patency rates of 72% and 87% for superficial femoral and iliac artery lesions, respectively, were achieved by this method. The catheter is now commercially available in the United States and Europe.

Partial splenic embolization in the treatment of hypersplenism.

Abstract: Transcatheter embolization of the spleen has been associated with serious complications, such as splenic abscess, rupture of the spleen, pneumonia, and septicemia. These complications, with their grave consequences, have prevented the use of this procedure as an alternative to operative splenectomy in selected cases. A detailed description of our method, which consists of partial splenic embolization, antibiotic prophylaxis, adequate pain control, and careful pre- and postembolization, is reported. Thirteen patients with hypersplenism were successfully treated with transcatheter partial embolization of their spleen.

Carpal injuries: analytic approach and case exercises.

Abstract: Radiographic wrist relationships are reviewed emphasizing the posteroanterior view, and analyzing the three normal arcs, principles of parallelism, and overlapping articular surfaces Use of these concepts, which are not stressed in the literature, enables the radiographic interpreter to easily arrive at a definitive diagnosis and to detect and interpret subtle and complex abnormalities Case material is included to emphasize major different diagnostic points

Percutaneous catheter drainage of abdominal abscesses guided by ultrasound and computed tomography.

Abstract: Ultrasonography and computed tomography were used to diagnose, localize, and guide the percutaneous drainage of 24 intraabdominal and retroperitoneal abscesses in 23 surgical and medical inpatients 16 of whom had abscess formation as a postoperative complication. On the basis of anatomic detail from sectional imaging, safe percutaneous drainage routes similar to surgical approaches were defined. After confirmation by needle aspiration, one of two methods of percutaneous catheter introduction were used: (1) a modified Seldinger technique for placement of an 8 French pigtail catheter and (2) a trocar catheter technique for placement of a 12 or 16 French catheter. Once in position, the catheters were managed as a surgically placed drain. In 22 of 24 cases, percutaneous catheter drainage was curative with no surgery required. There were no deaths or recurrences with an average follow-up period of 12 months ranging from 1 week to 3 years. Percutaneous aspiration and drainage should be considered as an alternative to surgery in the treatment of intraabdominal or retroperitoneal abscess.

Intraventricular hemorrhage and hydrocephalus in premature newborns: a prospective study with CT

Abstract: In a prospective study, 100 premature infants were studied with computed tomography (CT) brain scans within the first week of life. In 44 of these,hemorrhages originated from the subependymal germinal matrix, and ranged in severity from isolated germinal matrix hemorrhages to blood-filled, dilated ventricles with extension of hemorrhage into the brain parenchyma. A system of grading the severity of hemorrhage was developed. Grades I and II hemorrhages resolved spontaneously and grades III and IV were associated with progressive hydrocephalus. Asymptomatic hemorrhages that would not have been diagnosed on clinical grounds were detected by CT. This study offers a clearer understanding of the true incidence and natural history of cerebroventricular hemorrhage and associated hydrocephalus in premature neonates and may clarify etiologic factors and identify children at risk for subsequent neurologic abnormalities.

Transcatheter arterial embolization for control of persistent massive puerperal hemorrhage after bilateral surgical hypogastric artery ligation.

Abstract: Surgical ligation of the hypogastnic arteries for control of intractable pelvic hemorrhage is a well established procedune [1 -6]. Indications for ligation for treatment of lifethreatening hemorrhage include bleeding from malignancy, pelvic trauma, vascular malformation, iatnogenic injury to major vessels, and postpartum hemorrhage. Due to the rapid collateral flow development in the pelvis, persistent bleeding may be difficult to control. Further ligation, suturing, tight packing, on a more extensive surgical approach have all been suggested [2, 4]. Recent experience suggests that selective transartenial embolization may be a more effective means of therapy than surgery. This paper reports successful hemostasis of massive postpartum pelvic hemornhage by transcatheten embolization of absorbable gelatin sponge for bleeding which continued despite bilateral sungical internal iliac artery ligation, total abdominal hystenectomy, and vaginal packing. The internal iliac ligation actually complicated the embolization by limiting accessibility of vessels to embolization. To our knowledge neither arterial embolization following bilateral internal iliac artery ligation non its use in the postpartum setting have been previously reported.

Accuracy of ultrasonography in diagnosis of hepatocellular disease.

Abstract: Retrospective evaluations were made of abdominal echograms in 61 patients who underwent liver biopsy within 3 weeks after ultrasound study Without knowledge of clinical or biopsy data, determinations were made by two independent observers of: (1) liver size, (2) beam penetration, (3) echogenicity, (4) vascularity, (5) ancillary abnormality, and (6) diagnostic impression Using these parameters, the presence of generalized parenchymal disease was identified in 81% of reviews of patients with cirrhosis Thus, in patients with known cirrhosis, there was a 19% false negative rate In normal patients, 76% were correctly called normal by the reviewers However, in 24% generalized parenchymal disease was suggested (24% false positive) Patients with fatty liver could not be reliably distinguished from patients with cirrhosis, nor could patients with hepatitis be easily separated from those with normal livers In all of these determinations, the combination of several features provided more diagnostic accuracy than any single echographic finding

Complications of central venous catheterization

Abstract: The complications of central venous catheterization are discussed in a review of experience and of the literature. The anatomy surrounding the subclavian and internal jugular veins is described. Indications and contraindications of catheterization are reported. Common and unusual complications are discussed and illustrated. Laceration of pleura, subclavian artery puncture, hematoma, catheter malposition, fragment embolization, air embolism, venous thrombosis, and infection are included. The radiologist is responsible for recognizing immediate, as well as delayed, complications of central venous catheterization.

Computed tomography in the diagnosis of adrenal disease.

Abstract: A series of 63 patients with suspected adrenal disease was evaluated by computed tomography (CT). In 15 additional patients CT diagnosed unsuspected adrenal disease. The CT results were correlated with surgical, postmortem, or compelling clinical data. In those patients with adequate visualization of both adrenals, CT correctly identified all adrenal masses subsequently proven at surgery or postmortem examination. CT accurately predicted the presence or absence of a unilateral adrenal neoplasm in patients with Cushing's syndrome and primary aldosteronism. Unsuspected primary or metastatic neoplasms of the adrenals were occasionally detected in patients scanned for other reasons. CT is a safe and accurate method of evaluating patients with suspected adrenal disease.

Comparison of scintigraphy, sonography, and computed tomography in the evaluation of hepatic neoplasms

Abstract: A comparison of scintigraphy, ultrasonography, and computed tomography (CT) in 94 proven patients with clinically suspected liver disease is reported. CT proved to be the most accurate in detecting masses and assessing the complete extent of intrahepatic disease. The most reliable combination was CT and scintigraphy. The specific advantages and disadvantages of each method are discussed. The diagnostic scheme followed in the imaging evaluation of an hepatic mass in our clinical practice is discussed.

A second look at the utility of radiographic skull examination for trauma

Abstract: A prospective study tested the hypothesis of Bell and Loop (1971) that 21 high yield findings are significantly associated with the presence of a skull fracture and can be used to decide which patients need skull radiography. In our study, 17 fractures were detected in 594 patients who had skull radiography because of trauma to the head. Six of these fractures occurred in children who had none of the 21 Bell and Loop high yield findings. These six patients were asymptomatic except for superficial injury at the site of trauma. Had the Bell and Loop criteria been used to decide which patients had skull radiography, 35% (all in children) of the fractures would have gone undetected. Thus, in our study population, the Bell and Loop high yield findings were not satisfactory criteria for the decision about obtaining skull films in children.

Modification of cyanoacrylate for therapeutic embolization: preliminary experience.

Abstract: Cyanoacrylate is a satisfactory material for therapeutic embolization, but it has the disadvantage of not being radiopaque and polymerizing within 1 sec after contact with ionic materials. Its behavior was modified with varying concentrations of iophendylate and were able to satisfactorily control its polymerization from 1 to 30 sec. This control should allow penetration of arteriovenous malformations, which is necessary if cure is to result. The iophendylate adds radiopacity and seems to enhance the suspension of tentalum, another opacifying agent. Preliminary experience in dogs is encouraging, but too few humans have been treated with this method to recommend it as more than an experimental procedure at this time.

Rapid and accurate diagnosis of acute cholecystitis with 99mTc-HIDA cholescintigraphy.

Abstract: Technetium-99m dimethyl acetanilide iminodiacetic acid (HIDA) cholescintigraphy was performed on 90 patients with suspected acute cholecystitis. Visualization of the gallbladder established patency of the cystic duct and excluded the diagnosis of acute cholecystitis in 50 of 52 patients. Nonvisualization of the gallbladder with visualization of the common bile duct was diagnostic of acute cholecystitis in 38 patients, all subsequently proven at surgery. The observed accuracy of this procedure is 98% and specificity is 100%. The false negative rate is 5% and false positive rate is zero. Technetium-99m-HIDA has many advantages which make it the procedure of choice in evaluating a patient for suspected acute cholecystitis. It is a rapid, simple, safe examination which provides functional as well as anatomic information about the hepatobiliary system in individuals with a serum bilirubin level up to 8 mg/100 ml.

Intraperitoneal contrast infusion for assessment of intraperitoneal fluid dynamics

Abstract: For patients undergoing intraperitoneal ("belly bath") chemotherapy, it is useful to verify the distribution of infusion fluid. For this reason, 10 patients were examined by computed tomography (CT) after intraperitoneal instillation of dialysate mixed with water soluble contrast material. The extent of intraperitoneal distribution was assessed, and in two patients filling defects, presumably representing tumor, were identified.

Aneurysm rupture secondary to transcatheter embolization

Abstract: False aneurysms of the pancreatic and peripancreatic arteries are a well recognized complication of chronic pancreatitis due to proteolytic enzymatic digestion of the arterial wall. These false aneurysms can be a source of life-threatening hemorrhage. Three cases are reported in which attempted embolizations of these bleeding aneurysms resulted in rupture into the gastrointestinal tract. Special precautions should be taken in such a procedure because of the inherent weakness of the aneurysmal wall.

Hemorrhage with pelvic fractures: efficacy of transcatheter embolization

Abstract: To determine the effectiveness of angiography in identifying bleeding sites and controlling the massive and often fatal hemorrhage accompanying pelvic fractures, the hospital course and outcome of 28 patients who underwent angiography after pelvic trauma were reviewed. In 20 patients, active bleeding was demonstrated. Transcatheter occlusions of bleeding arteries were performed in 18 of these, with angiographic ontrol of hemorrhage in 18 and clinical control in 17. Two patients with active bleeding were not embolized because of subsequent surgical intervention in one and technical angiographic difficulties in the other. Blood transfusion requirements averaged 32.1 units in the 48 hr or less before occlusion and 5.2 units during 48 hr after occlusion. Of the 18 patients who underwent arterial embolization, nine died, seven of associated injuries, one of extrapelvic hemorrhage, and one of hypotension. Nine patients survived to be discharged. These results confirm that transcatheter occlusion of bleeding vessels in the pelvis reduces hemorrhage and facilitates the management of patients with pelvic trauma.

Arthrotomography of the temporomandibular joint: new technique and preliminary observations

Abstract: A technique for arthrography of the temporomandibular joint using multidirectional tomography is described that greatly simplifies interpretation. In 21 attempts, 20 successful arthrograms were obtained in patients complaining of pain, tenderness, and clicking and locking of the joint who had not responded to conservative therapy. Abnormalities demonstrated were perforation of the meniscus, anterior dislocation and subluxation of the meniscus; and redundancy of the bilaminar zone. In all 11 patients who underwent surgical meniscoplasty, disc abnormalities included thinning, perforation, flaccidity, and bilaminar redundancy. No permanent complications of the arthrographic procedure occurred, but temporary postprocedure discomfort was frequent. This preliminary experience with temporomandibular joint arthrotomography suggests this easily performed procedure offers reliable information about disc function and integrity that may assist in a selection of patients for meniscoplasty and other surgical treatment.

CT demonstration of cardiac structures.

Abstract: Cross-sectional cardiac anatomy was studied by computed tomography (CT) in normal patients and in patients with well documented cardiac pathology. Specific cardiac chambers, aortic and pulmonary artery enlargement, ventricular aneurysms, coronary artery, and intracardiac calcifications were demonstrated using a 3 sec scan time with and without intravenous iodinated contrast media. Although CT imaging of the heart is in its infancy, the clarity with which cardiac chambers and other structures were visualized is encouraging and suggests the potential value of CT scanning for detecting significant intracardiac pathology on routine thoracic CT scans.

CT evaluation of anomalies of the inferior vena cava and left renal vein.

Abstract: Two patients with duplication of the inferior vena cava and two patients with a retroaortic left renal vein were examined by computed tomography (CT). The characteristic CT appearance of these two entities, as well as circumaortic left renal vein and transposition of the inferior vena cava, is discussed. A scheme by which these anomalies of the inferior vena cava and left renal vein may be distinguished from one another and from pathologic entities such as lymphadenopathy and a dilated gonadal vein is reported.

Observer variation in the interpretation of lower limb venograms.

Abstract: After agreeing on diagnostic criteria and after a pilot study, two experienced radiologists twice independently reviewed 40 lower limb venograms performed by a standard technique in patients suspected or known to have venous thrombosis. The observers reviewed 20 examinations at a time, their analysis requiring separate identification of 11 major veins. At each site observers stated whether thrombus was "absent," "doubtful," "presumed," or "definite," or declared "no opinion possible." They then rediscussed criteria of diagnosis and, using the same experimental design, examined another 40 venograms. To correct for agreement expected by chance, data were analyzed by using the kappa statistic. In general, levels of agreement were higher than those reported for many other clinical and radiologic investigations, probably because of refinement of criteria after the pilot study. Nonetheless, observers disagreed about the probable presence or absence of thrombus at some site in the limb in about 10% of examinatio...

Computed tomography in adrenal tumors

Abstract: Computed tomography (CT) was used to evaluate 26 patients with a variety of adrenal lesions. Surgical proof was available in 22 patients and clinical confirmation with a variety of other studies in the other four patients. Nine patients ahd aldosterone-producing adrenal adenomas and CT correctly identified seven. Four patients had cortisol-producing adenomas and five patients had cortisol-producing carcinomas; CT identified each of these tumors. Prominent but normal shaped glands were seen in each of the four patients with adrenal hyperplasia. Adrenal metastases from malignant melanoma in two patients were identified. Only one of two pheochromocytomas in two patients could be seen on CT. CT is a noninvasive method of localizing adrenal tumors and may be helpful in distinguishing adenomas from adrenal hyperplasia.

Evaluation of 111In leukocyte whole body scanning

Abstract: Indium-111 oxine, polymorphonuclear cells isolated and labeled with 111In were used for studying absecesses and inflammatory conditions. There were 64 total scans done in 59 patients, 32 male and 27 female, aged 3-81 years (average, 51). The original clinical diagnosis was abscess in 33 patients. The whole blood cell scan was abnormal in 12 (36%) of these, and a good clinical correlation was obtained in 11 of the 12. In the 21 with a normal scan, 18 had no evidence of abscess, yielding one false-positive and three false-negative interpretations in the abscess group. Thirteen patients had fever of unknown origin, nine had negative scans and no subsequent evidence of abscess, and four had positive scans with good correlation in three. Acute bone and joint infections were positive on scan (4/4), whereas chronic osteomyelitis was negative (0/2). Three patients with acute myocardial infarction and three of four with subacute bacterial endocarditis had normal scans. All three studies in renal transplant rejection showed positive uptake in the pelvic kidneys. Indium-111 white blood cell scans have proved useful to diagnose or exclude a diagnosis of abscess or inflammatory condition infiltrated with polymorphonuclear leukocytes.

B-mode echoencephalography in the normal and high risk infant

Abstract: Commercially available high resolution, contact, gray scale imaging systems can now dependably visualize the normal and abnormal ventricular system as well as some other intracranial structures in all newborns. On 25 normal infants and 41 high risk infants, 135 B-mode echoencephalograms were performed. The technique for obtaining these scans is described. The normal lateral ventricle at the midbody in term infants is 0.9--1.3 cm wide (mean, 1.1 cm). Normal ratio of lateral ventricle to hemisphere is 28% (range, 24%--30%). High risk premature infants have a ratio of 31% (range, 24%--34%). The demonstration of hydrocephalus and cystic intracranial masses is reliable and the correlation with computed tomography is excellent. Postoperative or high risk infants can be repeatedly evaluated without radiation, at a lower cost, and more rapidly with ultrasound than with computed tomography. Ventricular size can be closely monitored and shunt failure detected at any early stage.

CT of the renal cyst: is cyst aspiration necessary?

Abstract: Fifty patients with a total of 56 renal masses discovered on routine excretory urography or abdominal plain films and with ultrasonographic diagnoses of definite or probable benign cysts underwent computed tomography (CT) prior to cyst aspiration with cytologic study. All lesions met strict criteria for the CT diagnosis of benign cyst and subsequently proved to be benign cysts. In addition, CT scanning detected 11 other renal masses, only one of which could be retrospectively diagnosed on the original urogram. It is suggested that renal cyst aspiration need not be performed when lesions meet all CT criteria for a benign cyst.

Ultrasound of gallbladder wall thickening and its relation to cholecystitis.

Abstract: A prospective ultrasound study of gallbladder wall thickness in patients with suspected gallbladder disease was performed over a 9 month period. Gallbladder walls thicker than 3 mm in fasting patients whose gallbladders were wider than 2 cm were considered abnormal. Gallstones were documented by ultrasound in 62 patients, a thickened gallbladder wall was demonstrated in 12 of these. Five patients without cholelithiasis had thick-walled gallbladders and were diagnosed as acalculous cholecystitis.