Radiology

Gilbert H. Fletcher

doi: 10.1148/127.1.3pmid: 345340

In his overview of the history and theoretical developments of radiotherapy, the author stresses the following concepts: ( a ) sensitivity is not linked to histology but to the volume of cancer; ( b ) the dose must not necessarily be homogeneous in the target volume but related to varying volumes of cancer; ( c ) the fact that irradiation may not be the sole treatment in some tumors does not mean that it does not have a place in their management; ( d ) as a general rule, large tumors should not be treated with irradiation only, if gross cancer can be resected simply; ( e ) since there is a dose-response curve for control rates and for complications, an optimum dose level must be maintained; and ( f ) the patient's quality of life is a major concern. Index terms Radiological Society of North America Therapeutic radiology Copyrighted 1978 by the Radiological Society of North America, Inc.

Charles B. Higgins ; Martin J. Lipton ; Allen D. Johnson ; Kirk L. Peterson ; W. V. R. Vieweg

doi: 10.1148/127.1.21pmid: 635185

False aneurysms of the left ventricle were observed in 14 patients. They were caused by obstructive coronary arterial disease with resultant myocardial infarction in 11, bacterial endocarditis in 1, a knife wound in 1, and disruption of a ventriculotomy in 1. Most of them extended posteriorly on the lateral radiograph, as opposed to the usual anterior position of true aneurysms. Enlargement was frequently observed on sequential studies. Angiography usually demonstrated involvement of the diaphragmatic or posterolateral segment due to occlusion of the right coronary artery; in contrast, true aneurysms are apical or anterolateral and are due to occlusion of the left anterior descending artery. The frequency of rupture of false aneurysms points up the importance of distinguishing them from true aneurysms. Index terms Aneurysm, cardiac, 51.730 (Left ventricle, aneurysm, 524.730) Coronary arteries, disease Endocarditis Heart, surgery Heart, wounds and injuries Myocardium, infarction

Hugo Spindola-Franco ; Norman Kronacher

doi: 10.1148/127.1.29pmid: 635201

Left ventricular pseudoaneurysms represent intrapericardial ruptures contained by adherent pericardium and fibrous tissue, forming an avascular wall; in contrast, the wall of a true aneurysm is formed of fibrous elements of the infarcted myocardium and contains coronary vessels. Prior myocardial infarction and/or aneurysmectomy may predispose to pseudoaneurysm formation. Plain radiographs, echocardiography, gated cardiac blood pool imaging, and left ventriculography are helpful, and the combination of left ventriculography and selective coronary arteriography is diagnostic. A uni- or multiloculated chamber communicating with the left ventricle by a relatively small orifice without draping of coronary vessels is diagnostic of pseudoaneurysm. Index terms Aneurysm, cardiac, 51.773 Myocardium, infarction (Heart, effect of atherosclerosis, 51.770) Copyrighted 1978 by the Radiological Society of North America, Inc.

Anthony F. Lalli ; Lawrence J. McCormack ; Margaret Zelch ; Norbert E. Reich ; Doris Belovich

doi: 10.1148/127.1.35pmid: 635202

1223 patients underwent aspiration biopsy with a diagnostic yield of 86.4 %; 24.2 % of the patients had a small pneumothorax, but only 4.4% required treatment; one patient developed a moderate hemothorax. The method, problems, and complications including morbidity and mortality are discussed. The relative success of aspiration biopsy with different lesions of the lung and mediastinum is identified. Index terms Biopsies, technique (Lung, closed needle biopsy, 60.1261) Lung neoplasms, diagnosis Lungs, biopsy, 60.126 Mediastinum, biopsy, 67.126 Mediastinum, neoplasms

Joel Rubenstein ; Gordon Weisbrod ; Marvin I. Steinhardt

doi: 10.1148/127.1.41pmid: 635203

Department of Radiological Sciences Mount Sinai Hospital 600 University Ave.Toronto, Ontario, Canada M5G 1X5 Two cases of “saber-sheath” trachea in which the inner tracheal contours were very suggestive of neoplasm are reported. Index terms (Lung, pulmonary emphysema, 60.751) Trachea (Trachea, anatomical detail, 671.920) Trachea, neoplasms

Seltzer, Steven E.; Balikian, Jirayr P.; Birnholz, Jason C.; Hargreaves, Hilary; Cartier, Pierre; Herman, Peter G.

doi: 10.1148/127.1.43pmid: 635204

A large, calcified paratracheal mass was identified in a patient with secondary hyperparathyroidism. The mass proved to be a giant, calcified, cystic, hyperplastic parathyroid gland. Radiographic and ultrasonic imaging techniques were quite useful in diagnostic evaluation. Whenever a calcified mediastinal or neck mass is discovered, especially in a patient with hyperparathyroidism, parathyroid enlargement should be a diagnostic consideration. (Mediastinum, other neoplasm, 67.3159) Parathyroid, hyperparathyroidism, 274.531 Parathyroid, ultrasound studies, 274-.1298 (Skeletal system, renal osteodystrophy, 48.573)

Gerlock, A. James; Goncharenko, Victor; Sloan, Oplis M.

doi: 10.1148/127.1.45pmid: 635205

The right posterior oblique (RPO) is the most helpful aortographic projection for demonstrating the origins of the renal arteries. In 59% of the 692 hypertensive patients studied, the origins of both renal arteries were seen in this projection. The second most helpful aortographic projection was the anteroposterior (AP) view, which showed the origins of the renal arteries in 22.6% of these patients. The remaining 18.4% of the patients required both the AP and RPO projections in order to show the origins of both renal arteries. Index terms (Abdominal aorta, aortography, 981. 121) Aortography, technique (Kidney, renovascular hypertension, 81.720) Hypertension Renal arteries (Renal artery, aortography, 9 61. 122)

Miller, Roscoe E.; Chernish, Stanley M.; Brunelle, Rocco L.; Rosenak, Bernard D.

doi: 10.1148/127.1.49pmid: 345341

In a study to determine a dose response to glucagon during hypotonic duodenography, 15 male and female volunteers received placebo and 0.25 mg, 0.5 mg, 1 mg and 2 mg glucagon intramuscularly, double-blind and cross-over. When 0.25 mg glucagon was given, the onset of drug effect was approximately 13–18 min: the mean duration of moderate hypotonicity was approximately 4–7 min. The larger the dose, the greater the duration of drug action. When 2 mg glucagon was given, the onset of drug effect occurred in approximately 4–7 min; the mean duration of moderate hypotonicity was 22–32 min. There were no changes in pulse or blood pressure attributable to the drug with these doses, and reports of nausea and diarrhea did not increase significantly until a dose above 1 mg was given. One mg glucagon given IM is useful in hypotonic upper GI radiographic examinations. The onset of hypotonicity was 8–10 min with a duration of 12–27 min when this dose was given. Few reports of side effects were attributable to this dose. Index terms Duodenography, technique (Duodenum, hypotonic duodenography, 73.1234) Glucagon

Miller, Roscoe E.; Chernish, Stanley M.; Brunelle, Rocco L.; Rosenak, Bernard D.

doi: 10.1148/127.1.55pmid: 345342

This study was undertaken to determine a dose response to glucagon during hypotonic duodenography. Fifteen male and female volunteers received placebo and 0.25 mg, 0.5 mg, 1 mg, and 2 mg of glucagon intravenously, double-blind, and crossover. Onset of drug effect occurred in approximately 45 seconds, regardless of the dose of glucagon given. There was a significant ( p <0.01) decrease in gastrointestinal tonicity with all doses. The larger the dose, the greater the duration of drug action. Satisfactory stomach, duodenal, and small bowel hypotonicity for radiography were obtained with 0.25 to 0.5 mg of glucagon given intravenously with few side effects. Index terms Duodenography, technique (Duodenum, hypotonic duodenography, 7 3-.1234) Glucagon

Merlo, Richard B.; Stone, Margie; Baugus, Pat; Martin, Martha

doi: 10.1148/127.1.61pmid: 635206

Immediate and satisfactory gastrointestinal hypotonia was induced in 48 patients with 5–10 mg of intravenous Pro-Banthine during radiographic examination; side-effects were minimal. If given intravenously in small doses, Pro-Banthine is a satisfactory alternative when glucagon is contraindicated or not available. Index terms (Colon,use of pharmacologic agent, 74.1279) Computed tomography, abdominal, 70.1211 (Duodenum, hypotonic duodenography, 73.1234) Gastrointestinal tract, radiography Glucagon Propantheline bromide (Small intestine, use of pharmacologic agent, 75.1289)