Showing papers in "Radiology in 1983"
TL;DR: This paper refines the statistical comparison of the areas under two ROC curves derived from the same set of patients by taking into account the correlation between the areas that is induced by the paired nature of the data.
Abstract: Receiver operating characteristic (ROC) curves are used to describe and compare the performance of diagnostic technology and diagnostic algorithms. This paper refines the statistical comparison of the areas under two ROC curves derived from the same set of patients by taking into account the correlation between the areas that is induced by the paired nature of the data. The correspondence between the area under an ROC curve and the Wilcoxon statistic is used and underlying Gaussian distributions (binormal) are assumed to provide a table that converts the observed correlations in paired ratings of images into a correlation between the two ROC areas. This between-area correlation can be used to reduce the standard error (uncertainty) about the observed difference in areas. This correction for pairing, analogous to that used in the paired t-test, can produce a considerable increase in the statistical sensitivity (power) of the comparison. For studies involving multiple readers, this method provides a measure...
6,836Â citations
TL;DR: Patients with unresectable hepatoma undergoing transcatheter hepatic artery embolization revealed the selective disappearance of tumor vessels, and computed tomography demonstrated a marked decrease in tumor density without any changes in the surrounding liver parenchyma.
Abstract: Transcatheter hepatic artery embolization was performed in 120 patients with unresectable hepatoma. The cumulative one-year survival rate was 44%. In most cases follow-up angiography revealed the selective disappearance of tumor vessels, and computed tomography demonstrated a marked decrease in tumor density without any changes in the surrounding liver parenchyma. Histologic examination in 14 cases confirmed these findings.
911Â citations
TL;DR: A new system of computed radiography that is based on new concepts and the latest computer technologies has been developed and eliminates the drawbacks of conventional screen-film radiography.
Abstract: A new system of computed radiography that is based on new concepts and the latest computer technologies has been developed. This system eliminates the drawbacks of conventional screen-film radiography. The basic principle of the system is the conversion of the x-ray energy pattern into digital signals utilizing scanning laser stimulated luminescence (SLSL).
866Â citations
TL;DR: The risks to patients with metal surgical implants who are undergoing nuclear magnetic resonance (NMR) imaging and the artifacts caused by such implants were studied and induced ferromagnetism was shown to be related to the composition of the alloys from which the clips were manufactured.
Abstract: The risks to patients with metal surgical implants who are undergoing nuclear magnetic resonance (NMR) imaging and the artifacts caused by such implants were studied. Twenty-one aneurysm and other hemostatic clips and a variety of other materials (e.g., dental amalgam, 14 karat gold) were used. Longitudinal forces and torques were found to be exerted upon 16 of the 21 clips. With five aneurysm clips, forces and torques sufficient to produce risk of hemorrhage from dislocation of the clip from the vessel or aneurysm, or cerebral injury by clip displacement without dislodgement were identified. The induced ferromagnetism was shown to be related to the composition of the alloys from which the clips were manufactured. Clips with 10-14% nickel are evidently without sufficient induced ferromagnetism to cause hazard. The extent of NMR imaging artifacts was greater for materials with measurable ferromagnetic properties, but metals without measurable ferromagnetism in our tests also resulted in significant artifacts. Dental amalgam and 14 karat gold produced no imaging artifacts, but stainless steels in dentures and orthodontic braces produced extensive artifacts in the facial region.
386Â citations
TL;DR: A method is described for the percutaneous catheter placement of expandable nitinol coil stents for the nonoperative restoration and maintenance of patency in internal flow pathways, especially the lumina of blood vessels and biliary ducts.
Abstract: A method is described for the percutaneous catheter placement of expandable nitinol coil stents for the nonoperative restoration and maintenance of patency in internal flow pathways, especially the lumina of blood vessels and biliary ducts.
382Â citations
TL;DR: Ninety-two lung cancers were detected in the Mayo Lung Project in patients undergoing chest radiography every four months for screening, usually presenting as hilar or mediastinal enlargements after normal findings on the previous radiograph obtained four months earlier.
Abstract: Ninety-two lung cancers were detected in the Mayo Lung Project in patients undergoing chest radiography every four months for screening. Fifty patients had a peripheral nodule, 16 had a perihilar nodule, 20 had hilar or mediastinal enlargement, and six had pneumonitis. The peripheral cancers grew slowly. Ninety per cent were visible in retrospect for months or even years. Despite this, 70% of the peripheral cancers were classified as postsurgical American Joint Committee (AJC) Stage 1. The central cancers grew rapidly, usually presenting as hilar or mediastinal enlargements after normal findings on the previous radiograph obtained four months earlier. Most were classified as AJC Stage 3 tumors.
341Â citations
TL;DR: Multifocal strictures involving both intra- and extra-hepatic bile ducts were most common in PSC; they were diffusely distributed, short, and annular, alternating with normal or slightly dilated segments to produce a "beaded" appearance.
Abstract: Cholangiograms of 86 patients with primary sclerosing cholangitis (PSC) were compared with those of 82 patients with primary bile duct carcinoma and 16 with primary biliary cirrhosis. Multifocal strictures involving both intra- and extra-hepatic bile ducts were most common in PSC; they were diffusely distributed, short, and annular, alternating with normal or slightly dilated segments to produce a "beaded" appearance. Very short, band-like strictures occurred in 18 patients; 9 also had diverticulum-like out-pouchings. Fourteen patients had "diverticula" without band strictures. Both findings appear to be specific for PSC. Inflammatory bowel disease was seen in 57 patients (66%), who could not be distinguished cholangiographically from other PSC patients. Of 40 patients with adequate retrograde pancreatograms, 3 had abnormalities of the pancreatic ducts.
303Â citations
TL;DR: CT can very precisely determine the size and gross morphology of normal nodes in the retropharyngeal region and the neck, which should have important applications in the management of patients with head and neck cancer.
Abstract: The retropharyngeal and cervical lymph-node-bearing areas in 30 patients were examined with computed tomography (CT) to determine the range of normal variation in these nodal groups. The data agree with those in the pathologic, anatomic, and surgical literature, and indicate that CT can very precisely determine the size and gross morphology of normal nodes in the retropharyngeal region and the neck. This should have important applications in the management of patients with head and neck cancer.
292Â citations
TL;DR: Bone scintigraphy is established as an early and accurate means for the detection of lower extremity stress fractures, even in the absence of radiographic findings, in a prospective study of stress injuries of U.S. Marine recruits.
Abstract: In a prospective study of stress injuries of the lower extremities of U.S. Marine recruits, we derived a frequency distribution of stress fractures. The most frequently fractured bone was the tibia (73%), while the single most common site was the posterior calcaneal tuberosity (21%). The natural history of stress fractures by scintigraphy and radiography has been outlined, showing the evolutionary changes on either study as a universal progression independent of injury site or type of stress. An identical spectrum of changes should be present within any group undergoing intense new exercise. The frequency distribution of stress fractures should be a function of differing forms and intensities of exercise, therefore, our figures should not be applied to other groups. We used the presence of a scintigraphic abnormality at a symptomatic site as the criterion for diagnosis of stress fracture. Since the distribution of skeletal radiotracer uptake is directly dependent on local metabolic activity, it is expected that a focal alteration in bone metabolism will result in a scintigram approaching 100% sensitivity for the abnormality (9). In the proper clinical setting, the specificity should approximate this figure; however, a focal, nonstress-related bone abnormality which has not manifested any radiographic change, such as early osteomyelitis, could result in a false-positive examination. Specificity cannot, therefore, be accurately determined without an actual determination of the pathologic changes within the bone, necessarily involving biopsy. In summary, we believe that we have established bone scintigraphy as an early and accurate means for the detection of lower extremity stress fractures, even in the absence of radiographic findings (6). We feel that a focally abnormal scintigram, in the proper clinical setting, establishes the diagnosis of stress fracture, with radiography to be performed at the time of initial work-up only to rule out a non-stress injury (such as complete fracture, fibrous dysplasia, osteomyelitis, primary bone tumor).
285Â citations
TL;DR: A new type of endovascular prosthesis has been developed using a unique metal alloy (nitinol) with a heat-sensitive memory that may eventually be used in the nonsurgical treatment of several forms of vascular disease.
Abstract: A new type of endovascular prosthesis has been developed using a unique metal alloy (nitinol) with a heat-sensitive memory. Nitinol wire coil grafts were straightened in ice water and passed into the canine aorta via catheter, where they reformed into their original shapes. Follow-up aortograms demonstrated long-term patency with minimal thrombus formation. Nitinol endovascular coil grafts may eventually be used in the nonsurgical treatment of several forms of vascular disease.
281Â citations
TL;DR: CT was found to be highly accurate in predicting tumor size and assessing invasion of the tracheobronchial tree and spread to the liver, adrenals, and celiac and left gastric nodes and insensitive in detecting metastatic spread to local periesophageal nodes.
Abstract: The computed tomographic (CT) findings in 52 patients with histologically proved esophageal carcinoma were reviewed. In 30 of these patients, the CT findings were correlated with findings at surgery or autopsy. CT was found to be highly accurate in predicting tumor size and assessing invasion of the tracheobronchial tree and spread to the liver, adrenals, and celiac and left gastric nodes. By quantifying the contact between the tumor and aorta, it was found that the CT appearance correctly predicted the presence or absence of aortic invasion in 24 of 25 cases (five cases were indeterminate). CT was insensitive in detecting metastatic spread to local periesophageal nodes; in these cases the tumor tended to involve the nodes without enlarging them. CT is an accurate method for assessing the spread of esophageal carcinoma. Its use can prevent unnecessary surgery in patients with inoperable tumors.
TL;DR: Nitroxide stable free radicals are a group of synthetic, strongly paramagnetic compounds that have several characteristics that make them promising contrast enhancers.
Abstract: Contrast-enhancing pharmaceuticals and manipulation of the physical properties of tissue may extend the diagnostic usefulness of nuclear magnetic resonance (NMR) imaging. Potential applications of contrast enhancers include differentiation of isomagnetic tissues, direct evaluation of tissue function, evaluation of metabolic pathways, and measurement of tissue perfusion. Numerous means of enhancing NMR contrast are available, but many, such as manipulation of tissue viscosity or temperature, are not clinically feasible. Changing the chemical composition of tissue, and particularly the use of paramagnetic pharmaceuticals, appears to be more advantageous. Nitroxide stable free radicals are a group of synthetic, strongly paramagnetic compounds that have several characteristics that make them promising contrast enhancers.
TL;DR: Radiological findings in 563 abused infants and children who were studied retrospectively emphasize the limitations of diagnostic imaging, specifically radiographic examination of the skeleton.
Abstract: Radiological findings in 563 abused infants and children who were studied retrospectively emphasize the limitations of diagnostic imaging, specifically radiographic examination of the skeleton. Skeletal trauma was detected in less than one-third of all patients and was uncommon beyond two years of age. Fractures were rarely present without clinical evidence of physical abuse. Radiographic features considered specific for child abuse (epiphyseal-metaphyseal, rib fractures) or highly suggestive (occult, multiple/repetitive fractures) were distinctly infrequent and limited to infancy. A more efficacious approach to radiological evaluation based on clinical presentation is offered.
TL;DR: Small-bore needles having an acute bevel angle were superior to flat-bevel needles of similar gauge in terms of specimen size and preservation, and large- bore needles were superiorTo perform percutaneous biopsy, a wide variety of needles were evaluated.
Abstract: Radiologists are frequently called upon to perform percutaneous biopsy. Selection of the proper needle is becoming more complex as the number of types increases and reports of better results with certain needles proliferate. The authors evaluated a wide variety of needles of different caliber, cutting tip, and bevel. Using a standard biopsy technique for in vitro specimens, the samples were analyzed quantitatively by precise weight measurement and qualitatively by cytopathological means. It was concluded that large-bore needles were superior to "skinny" needles, and small-bore needles having an acute bevel angle were superior to flat-bevel needles of similar gauge in terms of specimen size and preservation.
TL;DR: Specific radiographic features, including bone erosion, hyperostosis, fragmentation, and crystal deposition, may allow a precise diagnosis of enthesopathy.
Abstract: Entheses are sites of tendon and ligament attachment to bone, and enthesopathy is a disease process occurring at these sites. It may be inflammatory, degenerative, endocrine, metabolic, or traumatic in nature. Common sites of involvement include the pelvis, femoral trochanter, humeral tuberosity, patella, olecranon, and calcaneus as well as portions of the vertebral column. Specific radiographic features, including bone erosion, hyperostosis, fragmentation, and crystal deposition, may allow a precise diagnosis.
TL;DR: Normal values and upper limits of liver, spleen, pancreas, and portal vein size were determined prospectively with ultrasound in 915 healthy subjects, since correlation of longitudinal and transverse organ diameters with physical data was poor.
Abstract: Normal values and upper limits (95th percentile) of liver, spleen, pancreas, and portal vein size were determined prospectively with ultrasound in 915 healthy subjects. Sex, age, weight, height, and body surface area were determined in each case. Since correlation of longitudinal and transverse organ diameters with physical data was poor (r less than or equal to 0.3), the authors do not consider it necessary to correct the measurements accordingly. However, the liver is oriented longitudinally in slender subjects and transversely in heavy subjects; thus both longitudinal and anteroposterior diameters need to be measured, since the longitudinal diameter alone will give too high or too low a value, respectively.
TL;DR: The findings and a review of the literature indicate that this lesion is a neoplasm that can be strongly suspected preoperatively if pelvic herniation or a multilocular pattern is noted on imaging studies.
Abstract: Clinical radiographic, and pathologic findings of multilocular cystic nephroma (MLCN) in 58 patients are presented. The lesion that affects predominantly boys in childhood and women in adulthood is usually solitary but rarely can be multiple, and it commonly occurs as an asymptomatic mass, occasionally with hematuria. Tumors may grow slowly over years or rapidly within months. A mass that is usually identified on plain radiographs occasionally has curvilinear calcification. Excretory urography and retrograde pyelography are helpful when pelvic herniation of the tumor is recognized, or when septae are noted with total body opacification. Angiography showed an avascular mass (six lesions), a hypovascular mass (14 lesions), or a hypervascular mass three lesions). Ultrasonography is helpful when multiple circumscribed sonolucent areas are identified. Similarly, a multilocular mass with septae is usually identified by computed tomography (six of seven cases). Our findings and a review of the literature indicate that this lesion is a neoplasm that can be strongly suspected preoperatively if pelvic herniation or a multilocular pattern is noted on imaging studies.
TL;DR: CT estimates of the extent of hemoperitoneum (small, moderate, or large) correlated well with clinical assessments and surgical findings and may obviate the need for a peritoneal lavage and laparotomy in many instances.
Abstract: Three hundred patients who had sustained blunt abdominal injury were evaluated with computed tomography (CT). The images showed areas of hemorrhage by varying attenuation coefficients (average, 45 Hounsfield units; exceeding 30 Hounsfield units in all cases except in those patients with bleeding more than 48 hours old). Small hematomas tended to accumulate near the site of origin while free intraperitoneal bleeding most frequently accumulated in the Morison pouch, paracolic gutters, and pelvis. CT estimates of the extent of hemoperitoneum (small, moderate, or large) correlated well with clinical assessments and surgical findings. Only one false-negative and two false-positive CT interpretations occurred, and each was potentially avoidable in retrospect. CT is sensitive and specific for the diagnosis of hemoperitoneum and can estimate the extent and probable source of bleeding. This information may obviate the need for a peritoneal lavage and laparotomy in many instances.
TL;DR: NMR proved capable of demonstrating important anatomic structures in the region of the lumbosacral spine and the excellent soft-tissue contrast of NMR proved useful in the evaluation of bony and soft-Tissue tumors.
Abstract: Thirty healthy subjects and 15 patients with a variety of musculoskeletal disorders were examined by conventional radiography, computed tomography (CT), and nuclear magnetic resonance (NMR). NMR proved capable of demonstrating important anatomic structures in the region of the lumbosacral spine. Lumbar disk protrusion was demonstrated in three patients with CT evidence of the disease. NMR appeared to differentiate annulus fibrosus from nucleus pulposus in intervertebral disk material. Avascular necrosis of the femoral head was demonstrated in two patients. The cruciate ligaments of the knee were well defined by NMR. Muscles, tendons and ligaments, and blood vessels could be reliably differentiated, and the excellent soft-tissue contrast of NMR proved useful in the evaluation of bony and soft-tissue tumors. NMR holds promise in the evaluation of musculoskeletal disorders.
TL;DR: The effect of nuclear magnetic resonance (NMR) imaging on six representative cardiac pacemakers was studied and the results indicate that the threshold for initiating the asynchronous mode of a pacemaker is 17 gauss.
Abstract: The effect of nuclear magnetic resonance (NMR) imaging on six representative cardiac pacemakers was studied. The results indicate that the threshold for initiating the asynchronous mode of a pacemaker is 17 gauss. Radiofrequency levels are present in an NMR unit and may confuse or possibly inhibit demand pacemakers, although sensing circuitry is normally provided with electromagnetic interference discrimination. Time-varying magnetic fields can generate pulse amplitudes and frequencies to mimic cardiac activity. A serious limitation in the possibility of imaging a patient with a pacemaker would be the alteration of normal pulsing parameters due to time-varying magnetic fields.
TL;DR: In 8 cases of hepatocellular carcinoma, hepatectomy was performed after hepatic artery embolization with Gelfoam, and complete necrosis of the tumor was found in 4 of these cases.
Abstract: In 8 cases of hepatocellular carcinoma, hepatectomy was performed after hepatic artery embolization with Gelfoam. Complete necrosis of the tumor was found in 4 of these cases. Compared with the tumors that showed incomplete necrosis, the tumor in the complete necrosis group were small, thickly encapsulated, and located at sites remote from collateral circulation. Angiography and computed tomography after embolization accurately demonstrated tumor necrosis or continued viability, as confirmed by examination of resected specimens.
TL;DR: Bronchial artery embolization is an effective way to control massive hemoptysis with a low recurrence rate and reduced mortality among severely ill patients and reports of neurological damage following bronchial angiography indicate care in avoiding obstruction of the artery of Adamkiewicz.
Abstract: Massive hemoptysis is a major clinical and surgical problem with a mortality of 80%, which is most often related to asphyxiation. Thirty-three patients with massive hemoptysis underwent selective bronchial arteriography and treatment by embolization or surgery. Lasting control of hemoptysis was achieved in 27 of 33 patients (81.8%) at follow-up ranging from one to 24 months. Hemoptysis recurred in six of 33 patients (18.2%). Mortality related to hemoptysis was three of 33 patients (9.0%), and overall mortality was six of 33 patients (18.2%). Seven patients underwent surgical treatment in addition to bronchial artery embolization. Patients with mycetoma suffered the highest relapse of bleeding and the highest mortality in this series. In these patients, bronchial artery embolization may be effective in the control of acute bleeding, but permanent control of hemoptysis is achieved only by later surgery. Bronchial artery embolization is an effective way to control massive hemoptysis with a low recurrence rate and reduced mortality among severely ill patients. Although we have had no unfavorable sequelae, reports of neurological damage following bronchial angiography indicate care in avoiding obstruction of the artery of Adamkiewicz.
TL;DR: Whole body nuclear magnetic resonance imaging of the cardiovascular system was carried out in early clinical trials in 244 volunteers and patients using a 3.5 KGauss (0.35 T) unit and preliminary experience indicates the considerable potential of NMR imaging in the evaluation of cardiovascular diseases.
Abstract: Whole body nuclear magnetic resonance (NMR) imaging of the cardiovascular system was carried out in early clinical trials in 244 volunteers and patients using a 3.5 KGauss (0.35 T) unit. The spin echo technique with multiple imaging parameters was used. Blood vessels were clearly discriminated from solid organs and lesions because little or no intraluminal signal is seen with laminar blood flow at normal velocities, whereas a more intense image is generated by solid organs. Characteristic flow signals were observed in normal patients and were accentuated by varying the imaging parameters. Cardiac chambers were well delineated in some patients on nongated images. In one case, internal topography of the ventricles was exquisitely displayed on a gated image. Intraluminal pathology, such as dissection of the aorta, aneurysms of the aorta and left ventricle, and aortic atheroma, was clearly demonstrated. Patency of coronary arterial bypass grafts was shown. Abnormal flow patterns due to slow or turbulent flow ...
TL;DR: TES-enhanced spin echo renal images clearly demonstrated the presence of disease and functional abnormalities in diseased kidneys and these abnormalities were either not evident or only indirectly suggested on nonenhanced NMR images.
Abstract: A piperidinyl nitroxide stable free radical derivative, TES, was tested as an NMR contrast enhancer of renal structures in normal animals and animals with experimentally induced unilateral renal ischemia, renal vascular congestion, and hydronephrosis. Physiologic measurements indicated that TES is rapidly excreted in the urine with a clearance rate equal to the glomerular filtration rate. Because the compound is strongly paramagnetic, it increases the observable NMR intensity within the kidneys and urine in relatively low doses (0.04 to 0.9 g/kg). TES-enhanced spin echo renal images clearly demonstrated the presence of disease and functional abnormalities in diseased kidneys. These abnormalities were either not evident or only indirectly suggested on nonenhanced NMR images.
TL;DR: NMR was accurate in diagnosing spinal cord trauma and spinal canal block and Saturation recovery images were best in differentiating between soft tissue and cerebrospinal fluid.
Abstract: Forty subjects were examined to determine the accuracy and clinical usefulness of nuclear magnetic resonance (NMR) examination of the spine. The NMR images were compared with plain radiographs, high-resolution computed tomograms, and myelograms. The study included 15 patients with normal spinal cord anatomy and 25 patients whose pathological conditions included canal stenosis, herniated discs, metastatic tumors, primary cord tumor, trauma, Chiari malformations, syringomyelia, and developmental disorders. Saturation recovery images were best in differentiating between soft tissue and cerebrospinal fluid. NMR was excellent for the evaluation of the foramen magnum region and is presently the modality of choice for the diagnosis of syringomyelia and Chiari malformation. NMR was accurate in diagnosing spinal cord trauma and spinal canal block. The normal disc was seen, but with rare exceptions bulging of the annulus and herniation of the nucleus pulposus were not visualized.
TL;DR: Dynamic sequential computed tomography with table incrementation during arterial portography (DSCTI-AP) of the entire liver was performed in an attempt to improve the detection of hepatic neoplasms.
Abstract: Dynamic sequential computed tomography with table incrementation during arterial portography (DSCTI-AP) of the entire liver was performed in an attempt to improve the detection of hepatic neoplasms. In 13 of 17 patients, DSCTI-AP detected more hepatic lesions than were detected by other imaging methods, including radionuclide liver scans, ultrasound, computed tomography, and hepatic angiography. In only one case, an extremely hypervascular hepatocellular carcinoma, hepatic angiography was superior to DSCTI-AP. DSCTI-AP is a simple technique that may be carried out as a part of hepatic angiography. We believe that DSCTI-AP is a sensitive and useful method for the accurate detection of hepatic neoplasms.
TL;DR: Using a three-dimensional Fourier transform approach, proton nuclear magnetic resonance (NMR) chemical shift images have been obtained in vivo for the first time and it is shown that relatively little signal originates from membrane lipids in the brain.
Abstract: Using a three-dimensional Fourier transform approach, proton nuclear magnetic resonance (NMR) chemical shift images have been obtained in vivo for the first time. At a proton resonance frequency of 61.5 MHz, chemical shift-resolved images of simple phantoms indicate that a spectral resolution of 0.7 parts per million (ppm) is readily achievable at all locations within the image matrix, even when using a magnet not specifically designed for chemical shift spectroscopy. In vivo images of the human forearm and of a cat head yield separable signals from water and lipid protons. However, using simple radiofrequency pulse sequences, our data show that relatively little signal originates from membrane lipids (e.g., myelin) in the brain. The measurement of magnetic susceptibility using this technique is also demonstrated. While helping to elucidate the genesis of the NMR response in complex biological systems, this methodology also has potential applications in medical diagnosis. The technique is also applicable to the chemical shift imaging of other nuclei; for example, phosphorus (P-31).
TL;DR: NMR may more specifically identify hepatocellular iron overload than do other techniques that do not distinguish hepato cellular from reticuloendothelial iron.
Abstract: Experimental animal models of hepatitis, fatty liver, and hepatic iron overload were evaluated using a 3.5-kGauss nuclear magnetic resonance (NMR) imaging system. Increases in image intensity measurements and in T2 relaxation times equalled the sensitivity of histologic findings for the detection of early stages of hepatitis. A significant shift in T1 relaxation times characterized the early stages of hepatic necrosis. Liver triglyceride content correlated significantly with increases in NMR intensity measurements (p less than 0.01); however, changes in liver water content had a much greater influence on intensity, T1, and T2. Thus, it may be possible to distinguish hepatitis from benign fatty liver. Liver iron content correlated with decreases in NMR intensity measurements (p less than 0.001), and iron levels as low as 1.2 mg/g were detected. NMR may more specifically identify hepatocellular iron overload than do other techniques that do not distinguish hepatocellular from reticuloendothelial iron.
TL;DR: Extensive lower limb paresis developed in three patients with terminal cancer following internal iliac (hypogastric) artery embolization, carried out for control of hemorrhage in two of the patients and for reduction of the bulk of metastatic tumor in another.
Abstract: Extensive lower limb paresis developed in three patients with terminal cancer following internal iliac (hypogastric) artery embolization. This procedure was carried out for control of hemorrhage in two of the patients and for reduction of the bulk of metastatic tumor in another. The embolic materials used resulted in extensive obliteration of small and large vessels of the posterior and anterior divisions of the internal iliac artery. The paresis is attributed to the resulting ischemia of the sciatic and femoral nerves; previous radiotherapy may also have been a contributing factor. To reduce the incidence of paralysis, identification of the bleeding vessels and selective embolization are recommended. If this cannot be achieved, and the catheter lies in the main stem, it is recommended that the emboli should not be smaller than Gelfoam pledgets (1 X 1 X 10 mm) to preserve the peripheral circulation and lessen the risk of complication.
TL;DR: The authors found five uncommon complications relating to the peritoneal end of the catheter: cerebrospinal fluid (CSF) pseudocyst of the lesser sac, subphrenic CSF loculation, bowel perforation and formation of a CSF-enteric fistula, intrathoracic migration of the tip of the shunt, and intractable CSF ascites.
Abstract: Placement of ventriculo-peritoneal (VP) shunts is an established procedure for treatment of hydrocephalus. With increasing longevity following successful treatment, complications are becoming more common. The authors reviewed 350 VP shunts in 242 patients and found five uncommon complications relating to the peritoneal end of the catheter: (a) cerebrospinal fluid (CSF) pseudocyst of the lesser sac, (b) subphrenic CSF loculation, (c) bowel perforation and formation of a CSF-enteric fistula, (d) intrathoracic migration of the tip of the shunt, and (e) intractable CSF ascites.