Radiology

Fellmeth, B; Bookstein, J J; Lurie, A

doi: N/Apmid: 2772201

An ultralong, reverse-curve angiographic catheter has been developed to facilitate selective internal pudendal arteriography for evaluation of vasculogenic impotence. The catheter has enabled successful selective catheterization of the internal pudendal arteries in 95% of more than 200 attempts. The catheters have also been used in approximately 100 vascular procedures other than pudendal arteriography.

Hanson, M W; Feldman, J M; Blinder, R A; Moore, J O; Coleman, R E

doi: N/Apmid: 2772175

Eighty-two patients with pathologically proved carcinoid tumors were examined with iodine-131 metaio-dobenzylguanidine (MIBG) scintigraphy. Localization scores of I-131 MIBG accumulation in the primary tumor or metastatic site ranged from 0 to 3+ on the basis of comparison with normal liver. I-131 MIBG uptake varied greatly in different patients with carcinoid tumors. The localization scores in known tumor sites were related to the location of the primary tumor in the stomach (1-3+ in two of five patients), pancreas (1-3+ in four of five patients), cecum (3+ in two of two patients), appendix (0 in one of one patient), jejunum (0 in one of one patient), Meckel diverticulum (3+ in one of one patient), terminal ileum (2-3+ in 19 of 28 patients), bronchus (3+ in one of nine patients), thymus (1+ in one of two patients), and unknown (2-3+ in 18 of 28 patients). Tumors of midgut origin concentrated I-131 MIBG more frequently than those of foregut origin. Uptake of I-131 MIBG was more likely if neurohumor levels, particularly serum serotonin, were elevated. There was no relationship of I-131 MIBG uptake to carcinoid syndrome. I-131 MIBG is useful in the determination of the location and extent of some carcinoid tumors, particularly those of midgut origin.

Sagoh, T; Itoh, K; Togashi, K; Shibata, T; Nishimura, K; Minami, S; Asato, R; Noma, S; Fujisawa, I; Yamashita, K

doi: N/Apmid: 2672093

The authors retrospectively evaluated magnetic resonance (MR) images obtained in 64 patients with portal hypertension. Multiple low-intensity nodules were noted within the spleen in eight patients. In all eight cases, these nodules were most apparent on images obtained with the GRASS (gradient-recalled acquisition in the steady state) technique, which is known to be more sensitive to heterogeneity of the magnetic susceptibility, usually caused by hemosiderin deposition. In one of these cases, ultrasonography demonstrated diffuse hyperechoic spots that had been reported to represent Gamna-Gandy bodies of the spleen (ie, organized hemorrhage caused by portal hypertension). Although there was no pathologic proof in their series, the authors believe these low-intensity nodules seen on MR images may represent the hemosiderin deposits of Gamna-Gandy bodies.

Verstandig, A G; Klin, B; Bloom, R A; Hadas, I; Libson, E

doi: N/Apmid: 2772176

The authors reviewed the radiographic findings in 19 patients with phytobezoars of the small bowel. The most common predisposing causes were previous gastric outlet surgery and persimmon ingestion. Twelve patients underwent contrast material-enhanced studies of the upper gastrointestinal tract, and one patient underwent a barium enema study. These examinations revealed four gastric, two duodenal, and eight small bowel phytobezoars in 10 patients. The obstruction caused by small bowel phytobezoars frequently occurred in the jejunum or proximal ileum, more proximally than has been reported in previous series. Barium studies are useful in differentiating obstruction due to postoperative adhesions from obstruction caused by bezoars. In addition, barium studies enable the detection of residual gastric bezoars. This information has important implications in patient treatment because bezoar obstruction is unlikely to respond to conservative treatment, and concurrent gastric bezoars must be removed to prevent recurrent bowel obstruction.

Mantravadi, R V; Gates, J O; Crawford, J N; Bajpai, D; Trenkner, J D; Jordan, L N

doi: N/Apmid: 2549566

Between 1976 and 1983, 267 patients with non-oat cell carcinoma of the lung were treated with radiation therapy alone. One hundred thirty-four patients had squamous cell carcinoma; 69, large cell carcinoma; and 64, adenocarcinoma. Stage III carcinoma was diagnosed in 87% of the patients. Total radiation dose was less than 45 Gy in 69 patients (low dose group), 45-55 Gy in 161 (middle dose group), and 55-65 Gy in 37 (high dose group); dosage was 180-200 cGy daily, 5 days per week. Minimum follow-up was 3 years (median, 6 years). Tumor control within the radiation fields was achieved in 12%, 43%, and 78% of the low, middle, and high dose groups, respectively. A complete response rate of 13%, 23%, and 35% and an overall response of 43%, 71%, and 86% were seen in the low, middle, and high dose groups, respectively. The 5-year recurrence-free survival rate for all patients was 7% and was dependent on radiation dose and tumor response. This study indicates that tumor control and complete response rates are improved with a radiation dose of 55-65 Gy and that complete responders have improved survival.

Haller, J; Resnick, D; Miller, C W; Schils, J P; Kerr, R; Bielecki, D; Sartoris, D J; Gundry, C R

doi: N/Apmid: 2788894

Retrospective evaluation of the osseous pelvis in 93 patients with severe diffuse idiopathic skeletal hyperostosis (DISH) revealed 14 locations of radiographic abnormalities. Two osteoradiologists independently studied these sites for abnormalities in a prospective, blinded fashion in 103 patients over the age of 45 years. Lateral radiographs of the thoracolumbar spine were quantitatively and qualitatively evaluated to determine whether DISH, spondylosis deformans, or a normal spine was present. Statistical analysis was performed for evaluation of interobserver reliability, the relationship between pelvic and spinal abnormalities, and the significance and predictive values of pelvic abnormalities for DISH versus non-DISH and DISH versus spondylosis deformans. Although significantly higher frequencies and greater extents of radiographic abnormalities at 10 of 14 pelvic locations were noted for DISH compared with non-DISH, this number decreased to four of 14 locations when compared with spondylosis deformans. The alterations in three of these four pelvic sites consisted of ossification of ligaments. These changes appear to be good indicators of the presence of spinal DISH and support the concept that DISH is an entity separate from spondylosis deformans.

Fleckenstein, J L; Weatherall, P T; Parkey, R W; Payne, J A; Peshock, R M

doi: N/Apmid: 2772190

Sports-related muscle pain is frequent in both trained and untrained persons; however, its severity and significance may be difficult to assess clinically. The authors used magnetic resonance (MR) imaging to evaluate acute strains and delayed-onset muscle soreness in sedentary subjects and postmarathon myalgia in trained runners. MR imaging documented the distribution of affected muscles and the absence of focal hematoma, fascial herniation, subsequent fibrosis, and fatty infiltration. Pain associated with strain and that occurring several days after exercise were both associated with prolongation of muscle T1 and T2. In a prospective evaluation of delayed-onset muscle soreness, abnormalities depicted at MR imaging persisted longer than symptoms by up to 3 weeks, indicating that MR imaging is sensitive to tissue alteration that is not apparent clinically. Highly trained marathon runners tended to have relatively mild abnormalities involving the myotendinous junctions.

Abrahams, J J; Lange, R C

doi: N/Apmid: 2772200

To improve the efficiency of magnetic resonance imaging of the total spine, the authors developed a coil holder and marker system to accurately localize the level of the spine imaged. The patient's external auditory canal and the alignment light on the imager are lined up with marks on the coil holder. The spine is then imaged in three segments by using a 24-cm field of view. The device has been successful in 20 of the 23 patients in whom it was used. The three failures were due to technical problems.

Moore, E H; Greenberg, R W; Merrick, S H; Miller, S W; McLoud, T C; Shepard, J A

doi: N/Apmid: 2772178

A scoring system was devised for the assessment of coronary artery calcifications apparent on computed tomographic (CT) scans, with width and length used to assess severity. The degree of calcification was compared with the presence of stenoses of 70% or greater at cardiac catheterization in 46 patients who underwent both studies. Although many significantly stenosed vessels showed no calcification, heavy calcifications had a high positive predictive value for significant disease. In a separate branch of the study, the perioperative cardiac morbidity and mortality were compared in 30 age- and sex-matched pairs of patients undergoing thoracotomy who did and did not have coronary calcifications on CT scans obtained before surgery. Patients with calcifications had a higher frequency of cardiac complications, including arrhythmias, ischemia, hypotension, myocardial infarction, and death.

Mayr, B; Ingrisch, H; Häussinger, K; Huber, R M; Sunder-Plassmann, L

doi: N/Apmid: 2772171

Computed tomography (CT) was performed in 142 patients thought to have an endobronchial tumor based on clinical or radiologic grounds. In 121 patients an endobronchial mass was confirmed at bronchoscopy with biopsy or at surgery. The CT scans were evaluated independently by two experienced observers (A and B). For statistical purposes the result in each single bronchus from the level of the trachea to the segmental bronchi was considered separately. A total of 361 abnormal and 1,413 normal bronchi were confirmed with bronchoscopy or surgery. Observers A and B identified 100% and 99%, respectively, of the abnormal bronchi and 97% and 96%, respectively, of the normal bronchi on CT scans. For the standard CT examination (8-mm-thick sections) a sensitivity of 94% (observer A) or 91% (observer B) and a specificity of 99% (observers A and B) were found in the diagnosis of a normal or narrowed bronchial lumen. CT proved to be a reliable method for demonstrating tumor lesions of the bronchi.