Radiology

Burk, D L; Mears, D C; Kennedy, W H; Cooperstein, L A; Herbert, D L

doi: N/Apmid: 3975401

Computer programs that produce 3D surface reformations from sets of contiguous axial CT scans were used in evaluating a variety of acetabular fractures in 20 patients. The 3D images were easily correlated with plain radiographs, and new views were produced that provided a unique perspective not obtainable by conventional radiography. The 3D images were useful in complex displaced fractures in cases in which the interpretation of plain radiographs was difficult. Plain radiographs and conventional CT scans were more sensitive than the 3D images in detecting undisplaced fractures.

Solbiati, L; Volterrani, L; Rizzatto, G; Bazzocchi, M; Busilacci, P; Candiani, F; Ferrari, F; Giuseppetti, G; Maresca, G; Mirk, P

doi: N/Apmid: 3883413

An ultrasound examination was performed in 401 patients who had isotopically cold, solitary lesions of the thyroid gland. Of the parameters studied, the level of echoes was the most useful in making the sonographic diagnosis: the rate of malignancy was extremely low both in hyperechoic and echo-free lesions. The presence of a peripheral, complete "halo" appeared to be helpful in differentiating benign lesions from malignant lesions. Approximately 20-25% of the lesions thought to be solitary on the radionuclide study were found to be multinodular on US. When fine-needle aspiration biopsy was used with US the need for surgical exploration of the thyroid gland was obviated in selected cases.

Cardella, J F; Hunter, D W; Castaneda-Zuniga, W R; Hulbert, J; Young, A T; Coleman, C C; Mercado, S; Amplatz, K

doi: N/Apmid: 3975425

Nine recent endourologic cases are presented that evidence percutaneous electrolysis and electrocautery as new and safe techniques for incising the urothelium. Electrolysis with balloon dilation was employed to remove stones sequestered behind infundibular and/or diverticular neck stenoses, to correct uretero-pelvic junction (UPJ) stenoses and strictures, and to recanalize a totally obstructed fibrotic UPJ.

Smith, D C; Simmons, C R

doi: N/Apmid: 3975404

The Simmons sidewinder catheter is frequently used, but reforming its unique curve may be a problem. In our original description, we used the left subclavian artery to reform the catheter's curve. We no longer use this as our primary method of reformation. Our current method, which is simpler, quicker, and more reliably successful, is described.

McAfee, J G; Samin, A

doi: N/Apmid: 3919419

Leukocyte suspensions labeled with In-111 oxine or tropolone were administered intravenously to 150 patients for the detection of suspected foci of bacterial infection by gamma camera imaging. The results were correlated with other imaging modalities, and clinical, laboratory, and surgical findings after a minimum follow-up period of six months. Twenty-five of 29 foci of bacterial infection were demonstrated on the leukocyte-labeled images (sensitivity of detection = 86%). Three of the four missed lesions were chronic active osteomyelitis. The specificity of detection proved difficult to define, varying with different criteria for a false positive diagnosis. In every region of the body, a variety of lesions other than foci of bacterial infection produced positive uptake of the labeled leukocytes. An intense focal uptake was uncommon in lesions other than abscesses and hematomas. It was concluded that imaging with labeled leukocytes is valuable for demonstrating sites of infection in conjunction with other diagnostic methods. Detectable leukocytic infiltration, however, may occur in inflammatory lesions of any cause and in some noninflammatory states as well.

Potter, J L; Sullivan, B M; Flournoy, J G; Gerza, C

doi: N/Apmid: 3883423

Two diabetic patients in whom emphysematous pyelonephritis developed after renal transplantation are described. Clinical recognition of this unusual and serious infection is masked by the effects of immunosuppression. Abdominal radiographic, ultrasound, and computed tomography findings are discussed. The clinical presentation includes urinary tract infection, sepsis, and acute tubular malfunction of the allograft in insulin-dependent diabetics.

Takahashi, S; Goto, K; Fukasawa, H; Kawata, Y; Uemura, K; Yaguchi, K

doi: N/Apmid: 3975389

Computed tomographic (CT) manifestations of cerebral infarction along the distribution of the basal perforating arteries were reviewed and correlated with cerebral angiography. Infarcts in the territories of perforators were demonstrated individually based on knowledge of their three-dimensional distribution as shown by microangiography of cadavers. In Part II of the study, the posterior areas supplied by the thalamic arteries were examined. Infarcts in the area supplied by the thalamotuberal arteries involved the anterior pole of the thalamus; those in the area of the thalamoperforate arteries involved the medial portion of the thalamus, along the lateral wall of the third ventricle; those in the area of the thalamogeniculate arteries involved the posterolateral portion of the thalamus; and those in the area of the choroidal arteries of the lateral ventricle involved the most posterolateral and dorsolateral portions of the thalamus. Clinical and neuroradiological correlations are discussed.

Rubin, J M; Dohrmann, G J

doi: N/Apmid: 3883416

Intraoperative ultrasound scanning of the spinal cord and spine was performed during 36 operations in 35 patients. The technique allows neurosurgeons to evaluate an operative procedure during the operation. Effectiveness of shunt placement in syringomyelia can be detected and the completeness of tumor or disk removal can be determined. Precise locations for biopsy of intramedullary lesions can be made. Periodic motion of the spinal cord at the cardiac rate was also detected. This motion was usually due to transmitted pulsations from the anterior spinal artery and appeared to be most pronounced when the artery was compressed between a mass and the spinal cord. This finding refutes the commonly held idea that spinal cord motion implies that the cord is free within the thecal sac.

Levine, M S; Trenkner, S W; Herlinger, H; Mishkin, J D; Reynolds, J C

doi: N/Apmid: 3975417

Appendiceal intussusception has been considered a rare entity that is difficult to diagnose radiographically. However, a characteristic coiled-spring appearance in the cecum with nonfilling of the appendix has been observed on double-contrast barium enema (DCE) examinations in 11 cases of apparent or proved appendiceal intussusception. In two surgically proved cases, the intussusception was precipitated by an appendiceal mucocele and by endometriosis implants in the appendix. In four other cases, the intussusception was transient and the coiled-spring defect in the cecum disappeared with filling of the appendix on the DCE examination (three cases) or on a subsequent barium enema study (one case). The remaining five cases were unproved, although two patients had undergone prior appendectomy and the coiled-spring finding presumably resulted from an intussuscepted appendiceal stump. Only one patient was found to have appendiceal-related symptoms. It appears that appendiceal intussusception often occurs as a transient phenomenon in asymptomatic patients, and that it can be diagnosed on the routine DCE examination by a characteristic coiled-spring defect in the cecum.

Kerlan, R K; Jeffrey, R B; Pogany, A C; Ring, E J

doi: N/Apmid: 3975423

Abdominal abscesses in 72 patients were drained percutaneously. Sinograms were obtained at the time of drainage and repeated three to six days later. In 32 patients, a low-output fistulous communication to the alimentary canal, biliary tract, or pancreatic duct was demonstrated. Percutaneously placed drainage catheters provided successful treatment in 27 of these 32 patients. We conclude that low-output fistulous communications to abdominal cavities occur frequently, but can be managed successfully with percutaneous techniques in the majority of patients.