Showing papers in "Radiology in 1981"
TL;DR: Five categories were found, which are thought to correspond to evolutionary stages of the hydatic cyst, which were detected by ultrasound in 121 cases; all cases were confirmed surgically.
Abstract: Hydatic cysts of the liver were detected by ultrasound in 121 cases; all cases were confirmed surgically. Scans were classified based on sonographic analysis of the morphology and structure of the cyst. Five categories were found, which are thought to correspond to evolutionary stages of the hydatic cyst.
787 citations
TL;DR: Overall, between the two selective approaches, the transfemoral route carried a significantly smaller risk of complications than the transaxillary approach, and there was an inverse relationship between complication rate and the annual number of arteriograms obtained.
Abstract: This study was designed to assess the complications of angiography, including transfemoral, transaxillary, and translumbar approaches. Detailed questionnaires were completed by radiologists at 514 of the 2,066 hospitals surveyed. The radiologists reported on the complications of 118,591 examinations. The overall arteriography complication rates were: transfemoral 1.73%, translumbar 2.89%, and transaxillary 3.29%. Thirty deaths were reported, eight of which were caused by aortic dissection or aneurysm rupture. Among the three techniques, there was no difference in the incidence of cardiac complications. There were significantly more neurologic complications, including seizures, in the transaxillary group than there were in either the transfemoral or translumbar groups. Similarly, hemorrhage, arterial obstruction, and pseudoaneurysms were more common with the transaxillary technique than with either of the other approaches. Vessel perforation and extraluminal contrast material were seen most frequently with...
596 citations
TL;DR: The computed tomographic appearance of volvulus in intestinal malrotation in an adult is presented and the small-bowel loops encircling the superior mesenteric artery create a whirl-like pattern that may be distinctive for this diagnosis.
Abstract: The computed tomographic appearance of volvulus in intestinal malrotation in an adult is presented. The small-bowel loops encircling the superior mesenteric artery create a whirl-like pattern that may be distinctive for this diagnosis.
263 citations
TL;DR: A chronic cavitary form of pulmonary aspergillosis that supports the concept that the traditional allergic, saprophytic, and invasive forms may represent a spectrum of disease dependent on host immune status and lung architecture.
Abstract: A chronic cavitary form of pulmonary aspergillosis may occur with mild immunosuppression or underlying lung disease. In this "semi-invasive" type, the fungus is intermediate between a simple saprophyte and an invasive pathogen. Aspergillus may produce extensive lung destruction despite the lack of vascular invasion. The absence of a previous cavity distinguishes such cases from secondary noninvasive mycetomas. Radiographic features include a chronic infiltrate, progressive cavitation, and subsequent mycetoma formation. Biopsy may be helpful; however, marked squamous metaplasia can produce false-positive Class V cytological findings even though malignancy is excluded. This variety of aspergillosis supports the concept that the traditional allergic, saprophytic, and invasive forms may represent a spectrum of disease dependent on host immune status and lung architecture.
253 citations
TL;DR: Hepatic artery embolization is an effective treatment of hepatic neoplasm and indications for the use of this treatment are failure of chemotherapy, either systemic or intra-arterial infusion, vascular anomalies requiring combined lobar embolizations and lobar infusion, and lack of effective treatment.
Abstract: Seventy-two hepatic artery embolizations were performed in 47 patients to treat hepatic neoplasms. Hepatic artery embolization creates tumor devascularization, but the portal flow prevents infarction of liver parenchyma because of the single vascular supply from the hepatic artery to a neoplasm, in contrast to the dual vascular supply to the liver parenchyma. Indications for the use of hepatic artery embolization are failure of chemotherapy, either systemic or intra-arterial infusion, vascular anomalies requiring combined lobar embolization and lobar infusion, and lack of effective treatment. Three types of embolization were performed: peripheral embolization using Gelfoam, proximal embolization using coils, and combined peripheral and proximal embolization. The complications after embolization were pain, fever, and transient liver function changes. No death or hepatic abscess occurred. The median survival duration of the group was 11.5 months from the time of embolization. Hepatic artery embolization is ...
252 citations
TL;DR: Thirty-four benign renal cysts in 29 patients were treated with 95% ethanol during diagnostic aspiration with a 4.6 French pigtail catheter and all were followed by ultrasound from 3 to 30 months.
Abstract: Thirty-four benign renal cysts in 29 patients were treated with 95% ethanol during diagnostic aspiration with a 4.6 French pigtail catheter. All were followed by ultrasound from 3 to 30 months. There was one recurrence at three months. Minor complications of hematuria and temperature elevation were no more prevalent than with diagnostic aspiration alone. There were no major complications.
239 citations
TL;DR: While many joint changes could not be explained on a traumatic basis alone, all could be explained by a vascular mechanism.
Abstract: The most widely accepted and propagated theory of neurotrophic joint pathogenesis is the neurotraumatic one. Seldom published and little known is the neurovascular theory. To gain better understanding of the pathogenesis, we reviewed radiographs of 91 neurotrophic joints with attention to the particular joint affected, the type of changes present (resorptive vs. productive), and the time sequence involved. The pathological findings, when available, were also reviewed. While many joint changes could not be explained on a traumatic basis alone, all could be explained by a vascular mechanism.
224 citations
TL;DR: "Vacuum" phenomena relate to the accumulation of gas in crevices within the intervertebral disk or vertebra, and are helpful indicators as to the precise nature of the spinal disorder.
Abstract: "Vacuum" phenomena relate to the accumulation of gas, principally nitrogen, in crevices within the intervertebral disk or vertebra. Their appearance does not uniformly indicate "degenerative" disk disease (primary intervertebral osteochondrosis), as gaseous collections may accompany other processes (vertebral osteomyelitis, Schmorl node formation, spondylosis deformans, vertebral collapse with osteonecrosis) affecting the disk and adjacent vertebral bodies. The location and appearance of the "vacuum" phenomena are helpful indicators as to the precise nature of the spinal disorder.
220 citations
TL;DR: In cirrhotic patients studied prior to and 7-10 days after a distal splenorenal shunt, the mean liver volume fell and the mean spleen volume fell, supporting the use of such a shunt in selective decompression of varices and maintenance of portal hypertension.
Abstract: Liver and spleen size were measured in 11 normal subjects and 12 patients with cirrhosis. Volume was calculated by adding together the area measurements obtained from successive transverse abdominal scans. The normal mean volume of the liver (+/- S.D.) was 1,493 +/- 230 cm3 and that of the spleen was 219 +/- 76 cm3; interobserver variability was 4-8% and the day-to-day coefficient of variation was 6-10%. In cirrhotic patients studied prior to and 7-10 days after a distal splenorenal shunt, the mean liver volume fell from 1,642 to 1,529 cm3 (p less than 0.06) and the mean spleen volume from 660 to 507 cm3 (p less than 0.006), supporting the use of such a shunt in selective decompression of varices and maintenance of portal hypertension. This is a clinically useful method of measuring organ volume with the required sensitivity.
215 citations
211 citations
TL;DR: In this article, a CT scan was used to detect and stage primary rectal and rectosigmoid carcinoma in 39 patients with varying levels of wall thickness and invasion of adjacent tissue, muscles, or organs.
Abstract: Thirty-nine patients were examined by computed tomography (CT) prior to resection of primary rectal [23] or rectosigmoid carcinoma [16]. There were 3 patients in Stage II [thickened bowel (greater than 0.5 cm) alone], 12 in Stage IIIa (thickened bowel wall and invasion of adjacent tissue, muscles, or organs, but no extension to the pelvic side walls), 18 in Stage IIIb (extension to the pelvic side walls), 6 in Stage IV (pelvic tumor and distant metastases), and none in Stage I (intraluminal mass without wall thickening). CT detected all 39 rectal or rectosigmoid tumors (sensitivity = 100%) and had an overall staging accuracy of 92%. These results show that CT is useful and accurate in detecting and staging primary rectal and rectosigmoid tumors.
TL;DR: The authors conclude that the so-called venous angioma has little clinical significance, that neither arteries nor capillaries are involved in this type of vascular malformation, and that the small, dilated veins which develop secondarily are due to an abnormality in venous development during embryogenesis.
Abstract: The authors report 6 cases of cerebral venous angioma and compare the angiographic findings, clinical symptoms, electroencephalographic foci, and histological features to those in 26 previously reported cases. They conclude that the so-called venous angioma has little clinical significance, that neither arteries nor capillaries are involved in this type of vascular malformation, and that the small, dilated veins which develop secondarily are due to an abnormality in venous development during embryogenesis.
TL;DR: Digital subtraction angiography is a safe, rapid procedure that can be performed on an outpatient basis and can accurately evaluate the carotid bifurcation in approximately 70% of the arteries examined.
Abstract: Conventional angiography and intravenous digital subtraction angiography (DSA) were used to examine the common carotid artery bifurcations in 100 patients with clinically suspected arteriosclerotic disease. In 60% of the patients, the quality of the DSA examination was good or excellent bilaterally; in 23%, the quality was good or excellent on one side; in the remaining 17%, both bifurcations were poorly visualized. There was excellent correlation of conventional and digital angiograms when the carotid bifurcations were well visualized with DSA (sensitivity 95%, specificity 99%, accuracy 97%). When the carotid bifurcations were not well visualized with DSA, there was a substantial chance for misinterpretation of the study (sensitivity 54%, specificity 70%, accuracy 64%). Digital subtraction angiography is a safe, rapid procedure that can be performed on an outpatient basis and can accurately evaluate the carotid bifurcation in approximately 70% of the arteries examined.
TL;DR: Computed tomography was used in the evaluation of 100 patients suffering abdominal trauma, and there were no cases in which medical or surgical management was inappropriately guided by CT.
Abstract: Computed tomography (CT) was used in the evaluation of 100 patients suffering abdominal trauma. The type of trauma was blunt in 78 patients, penetrating in eight, and iatrogenic in 14. Forty per cent of cases had normal CT scans, while 60% showed substantial abdominal or retroperitoneal injuries. Surgery, clinical follow-up, and repeated radiologic examinations confirmed the accuracy of CT, and there were no cases in which medical or surgical management was inappropriately guided by CT. A wide variety of injuries was detected, including 19 splenic, eight hepatic, six pancreatic, 13 renal, 13 retroperitoneal or abdominal wall, and one intraperitoneal. CT has major advantages over plain radiography, radionuclide imaging, and angiography in assessment of trauma-induced injuries.
TL;DR: The computed tomographic appearance and the pain radiographic and myelographic findings of vertebral hydatid disease (caused by Echinococcus granulosus) in two patients are presented.
Abstract: The computed tomographic (CT) appearance and the pain radiographic and myelographic findings of vertebral hydatid disease (caused by Echinococcus granulosus) in two patients are presented. CT proved to be more useful in the initial assessment and measurement of progress of this disease than conventional radiography and myelography.
TL;DR: Of 11 patients with serial scintigraphy, six demonstrated a return to normal, symmetrical patterns following successful therapy, suggesting the scan may reflect an active, potentially reversible disorder of local blood flow in RSDS.
Abstract: Sixty-four consecutive patients were studied for possible reflex sympathetic dystrophy syndrome (RSDS) They were divided into five groups, based upon specific clinical criteria, and the radiographic and scintigraphic findings in each group were examined Osteoporosis was the most common radiographic abnormality, present in 69% of subjects with definite, probable, or possible RSDS, as compared with 21% opf those with RSDS Scintigraphic abnormalities were noted in 60% of RSDS patients but in only 7% of the others These findings included increased blood flow and enhanced periarticular radionuclide activity in the affected extremity Of 11 patients with serial scintigraphy, six (55%) demonstrated a return to normal, symmetrical patterns following successful therapy The scan may reflect an active, potentially reversible disorder of local blood flow in RSDS Furthermore, the scintigraphic patterns may be useful in the diagnosis and in predicting which pattients are likely to respond to systemic steroid therapy
TL;DR: The most characteristic pathological findings at autopsy were a diffuse area of incomplete infarction containing multiple small infarcts as well as cyst formation and marked stenotic atherosclerotic changes in the medullary arteries.
Abstract: CT findings in 6 autopsy cases of subcortical arteriosclerotic encephalopathy (SAE) are reported. A diffuse area of nonhomogeneous decreased density was observed in the deep white matter of both cerebral hemispheres, together with moderate dilatation of the lateral ventricles and ragged margins. The most characteristic pathological findings at autopsy were a diffuse area of incomplete infarction containing multiple small infarcts as well as cyst formation and marked stenotic atherosclerotic changes in the medullary arteries. Clinical features included patchy mental lapses, frontal-lobe syndromes, minor motor signs, and hypertension. The authors feel that SAE or a similar disease might occur in most cases of multi-infarct dementia.
TL;DR: Multiple mechanisms of action of intraarterial ethanol are proposed, including perivascular tissue toxicity, sludging of erythrocytes in small arteries, small artery spasm, and endothelial damage.
Abstract: Transcatheter injection of absolute ethanol into the renal artery is an effective method of producing renal ablation. There has been no evidence of inadvertent damage to vessels or tissues remote from the target organ. The "postembolization syndrome" of pain, nausea, vomiting, and fever is minimal when compared with other methods of renal artery occlusion. Multiple mechanisms of action of intraarterial ethanol are proposed, including perivascular tissue toxicity, sludging of erythrocytes in small arteries, small artery spasm, and endothelial damage. Experience with this technique in six patients has resulted in specific recommendations regarding the amount and method of injection of ethanol. Angiographic criteria indicating adequate renal ablation are described.
TL;DR: Proper use of CT in combination with appropriate angiographic studies is necessary for diagnosis and confirmation of sinus and venous thrombosis and can result in decreased morbidity and mortality associated with this condition.
Abstract: Cerebral sinus and venous thrombosis were diagnosed by computed tomography (CT) and subsequently confirmed by other studies in eleven patients. CT revealed normal or small ventricles, hemorrhages, low-density areas, and increased density of dural sinuses and tentorium. CT in combination with appropriate angiographic studies is necessary for diagnosis and confirmation of sinus and venous thrombosis. Proper use of CT can result in decreased morbidity and mortality associated with this condition.
TL;DR: The authors believe that percutaneous skeletal biopsy should be considered a radiological procedure, and that radiologists could and should perform this procedure as part of a team effort.
Abstract: A retrospective study of 169 percutaneous skeletal biopsies performed by radiologists at the Mallinckrodt Institute of Radiology and Barnes Hospital between October 1974 and July 1980 showed an overall accuracy of 94%; a negative result had a predictive value of 92% A review of the English-language literature revealed that nearly 10,000 aspiration or trephine musculoskeletal biopsies have been reported during the past 50 years; historical accuracy is approximately 80%, but this figure is probably an underestimate because true-negative cases may not have been well documented or tabulated The authors believe that percutaneous skeletal biopsy should be considered a radiological procedure, and that radiologists could and should perform this procedure as part of a team effort
TL;DR: Preoperative transcatheter embolization of a renal neoplasm is helpful to the urologist, especially with large, hypervascular tumors, and when combined with nephrectomy and hormonal therapy offers promise in the management of patients with renal carcinoma.
Abstract: Preoperative transcatheter embolization of a renal neoplasm is helpful to the urologist, especially with large, hypervascular tumors. When combined with nephrectomy and hormonal therapy, it offers promise in the management of patients with renal carcinoma. Delay between embolization and nephrectomy seems to be important, but the optimal time for stimulating a therapeutic response has not been established. Among 49 patients in this series with known metastases, occlusion of the renal artery followed 4 to 7 days later by nephrectomy and hormonal therapy changed the course of the disease, producing a 36% response rate.
TL;DR: Computed tomographic scans of 34 cases of abdominal fatty masses were reviewed retrospectively in order to establish criteria for distinguishing benign conditions from malignant tumors.
Abstract: Computed tomographic (CT) scans of 34 cases of abdominal fatty masses were reviewed retrospectively in order to establish criteria for distinguishing benign conditions from malignant tumors. By evaluating location, attenuation, internal consistency, and margination, it is possible not only to make this distinction but frequently to suggest a specific diagnosis. Abdominal fatty masses that are sharply marginated, homogeneous, and that show CT numbers less than or equal to the patient's normal fat can be considered benign. Malignancy should be suspected when an extrarenal abdominal fatty mass displays one or more of the following characteristics: inhomogeneity, infiltration or poor margination, CT numbers greater than the patient's normal fat, or contrast enhancement. Criteria for distinguishing between angiomyolipoma and liposarcoma are also discussed.
TL;DR: A randomized, controlled mammographic screening procedure has been initiated in Sweden and since 1977 in Kopparberg county and since 1978 in Ostergötland county as well as the method of screening used.
Abstract: A randomized, controlled mammographic screening procedure has been initiated in Sweden. The study has been conducted since 1977 in Kopparberg county and since 1978 in Ostergotland county. This paper describes the planning and organization of the study as well as the method of screening used. The results of the first 27 months in Kopparberg county are presented.
TL;DR: Because acute cholecystitis is found in the minority of patients with acute right upper quadrant pain, and because ultrasound is rapid, accurate, and noninvasive, it should be the initial modality used to evaluate these patients.
Abstract: To define the role of ultrasound in evaluating acute right upper quadrant pain, a prospective study was performed on 52 patients having clinically suspected acute cholecystitis. Ultrasonographic determination of acute or chronic cholecystitis, or diagnosis of a normal gallbladder, was based on analysis of location of tenderness, calculi, sludge, and wall thickness. The diagnosis of acute cholecystitis (34.6% of patients) was based on the highly significant observations of focal gallbladder tenderness and calculi. Sludge and wall thickening were also statistically significant, but to a lesser degree. Cholelithiasis allowed differentiation of patients with chronic cholecystitis (32.7%) from patients with normal gallbladders (32.7%). Neither of these two groups had significant focal gallbladder tenderness, sludge, or thickened walls. Because acute cholecystitis is found in the minority of patients with acute right upper quadrant pain, and because ultrasound is rapid, accurate, and noninvasive, it should be the initial modality used to evaluate these patients.
TL;DR: Nuclear magnetic resonance (NMR) images of live rats with sterile and pyogenic abscesses, hematomas, and various implanted and spontaneous neoplasms demonstrated good contrast differentiation between pathologic and surrounding normal tissues.
Abstract: Nuclear magnetic resonance (NMR) images of live rats with sterile and pyogenic abscesses, hematomas, and various implanted and spontaneous neoplasms demonstrated good contrast differentiation between pathologic and surrounding normal tissues. This differentiation was maximal when both the T1 and T2 tissue relaxation times were used as criteria. Neoplasms have a broad range of T1 and T2 values and may be confused with abscesses or hematomas. Tissue rate constants (1/T1 and 1/T2) are mainly dependent on total water content, the exception being fat, which has a 1/T2 value much shorter than that expected on the basis of water content alone.
TL;DR: Aortic disease, including intravascular clots and occlusions, was faithfully delineated by DSA and the sensitivity of the new technique was 93% (55/59) and the specificity 91.5% (54/59).
Abstract: Digital subtraction angiography (DSA) was used to study the cardiovascular system in more than 400 patients and was specifically compared with conventional angiography of the aorta and renal arteries in 30 patients. For the renal arteries, the overall accuracy of DSA was 71% (50/70). Excluding 11 cases of inadequate visualization of the renal arteries on DSA, the sensitivity of the new technique was 93% (55/59) and the specificity 91.5% (54/59). Aortic disease, including intravascular clots and occlusions, was faithfully delineated by DSA.
TL;DR: Measurement of the distance between the third ventricle and Sylvian fissure indicated that the dementia patients had significantly more atrophy in this area, which may aid in differentiating cerebral atrophy associated with dementia from that associated with normal aging.
Abstract: Quantitative indexes of compute tomography were compared in 28 patients with Alzheimer dementia and in 30 elderly persons with no history of neurologic disease. Age-corrected ventricle-brain ratios were abnormal for half of the dementia patients, whereas only a single subject in the control group had ventricles outside the limits of normal variation. Measurement of the distance between the third ventricle and Sylvian fissure indicated that the dementia patients had significantly more atrophy in this area. Employment of quantitative indexes standardized for age may aid in differentiating cerebral atrophy associated with dementia from that associated with normal aging.
TL;DR: mediastinal needle biopsy made it possible to avoid surgery and mediastinoscopy in 72 patients with unresectable malignant neoplasms and 5 patients with innocuous benign mediastinal masses, and in all 8 patients with benign masses, the biopsy results were correct.
Abstract: Needle aspiration biopsy of hilar and mediastinal masses was attempted in 100 patients and completed in 91. There were no major complications. In the group with completed biopsies, there were 83 patients with malignant neoplasms; a positive diagnosis of malignancy was established in 80 (96%). Two of the three false-negative results occurred in patients with Hodgkin disease. In all 8 patients with benign masses, the biopsy results were correct. Five of the nine incomplete biopsies occurred in patients with aortic aneurysms that simulated lung or mediastinal masses. In the other 4 patients, the needle biopsy was not completed for technical reasons. Needle biopsy can be performed in practically all areas of the mediastinum, does not require general anesthesia or hospitalization, and is well tolerated by the patient. In this series, the use of mediastinal needle biopsy made it possible to avoid surgery and mediastinoscopy in 72 patients with unresectable malignant neoplasms and 5 patients with innocuous benig...
TL;DR: With the exception of minimal change (1+ fat or fibrosis), ultrasound detected many of the pathological changes seen in alcoholic liver disease.
Abstract: In alcoholic liver disease (fatty infiltration, alcoholic cirrhosis), the liver is diffusely abnormal on ultrasound. Changes in size, dilatation of the hepatic veins, and ascites may also occur. The authors conducted a histological correlation of these abnormalities in 22 alcoholic patients and 16 controls, grading the changes on a scale of 0 to 4+ for fat, fibrosis, and necrosis and noting tumor whenever present. Ultrasound detected abnormality in 21 cases (sensitivity = 95%) and correctly identified 15 controls (specificity = 94%). Of the 5 tumors seen, 4 hepatomas were detected and biopsied and 1 metastatic squamous-cell carcinoma was missed. Applications of commercially available A-scan module are considered and its limitations discussed. With the exception of minimal change (1+ fat or fibrosis), ultrasound detected many of the pathological changes seen in alcoholic liver disease.