Radiology

Ichikawa, T; Haradome, H; Hachiya, J; Nitatori, T; Ohtomo, K; Kinoshita, T; Araki, T

doi: N/Apmid: 9051012

PURPOSE: To compare helical computed tomography (CT) and dynamic, magnetic resonance (MR) imaging in the evaluation of pancreatic ductal adenocarcinoma. MATERIALS AND METHODS: Dynamic MR images obtained with breath holding, 256 phase- and 512 frequency-encoding steps, 5-mm section thickness, phased-array multicoil, and double-dose gadolinium were available from 21 patients. Dynamic MR images were retrospectively compared with helical CT images in the evaluation of tumor detection, local tumor extension, and vascular involvement. RESULTS: Tumors were detected on dynamic MR images of 19 of 21 (90%) patients and on helical CT scans of 16 (76%) patients. Dynamic MR imaging had equal or better sensitivity, accuracy, and agreement of tumor grade than did helical CT in the comparison of imaging findings and histopathologic findings. Dynamic MR imaging also had equal or better specificity than had helical CT in determination of local tumor extension and vascular involvement, except in the factors of duodenal invasion and portal venous system involvement. However, there was no statistically significant difference among any of these measurements. CONCLUSION: Dynamic MR imaging may be better than helical CT in the preoperative detection and evaluation of local tumor extension and of vascular involvement of pancreatic ductal adenocarcinomas.

Feldman, D R; Kulling, D P; Hawes, R H; Kay, C L; Muckenfuss, V R; Cotton, P B; Bohning, D E; Young, J W

doi: N/Apmid: 9051048

The authors performed local staging of esophageal and rectal cancer (without pathologic correlation) with use of a nonferromagnetic magnetic resonance (MR) endoscope with a 3-cm-long receive-only coil embedded in its tip in 16 patients (eight with esophageal cancer and eight with anorectal cancer). Results with spin-echo sequences were optimal in all cases corrected.

Cognard, C; Pierot, L; Boulin, A; Weill, A; Tovi, M; Castaings, L; Rey, A; Moret, J; Toevi, M

doi: N/Apmid: 9051034

PURPOSE: To evaluate preliminary results with endovascular treatment (EVT) of intracranial aneurysms with mechanical detachable spirals. MATERIALS AND METHODS: EVT with spirals was attempted in 57 patients with 60 aneurysms (47 berry, nine large, and four giant aneurysms). Thirty-seven patients had subarachnoid hemorrhage (three of whom were also treated for associated aneurysm), nine were asymptomatic, six had headache, three had mass effect, and two had neurologic deficits. RESULTS: EVT with the spirals was achieved in 55 (92%) of the 60 aneurysms. Of 42 treated berry aneurysms and 13 treated large and giant aneurysms, 33 berry and nine large and giant aneurysms underwent 3-month angiographic follow-up. Complete occlusion was attained in 23 berry and four large and giant aneurysms, subtotal occlusion (doubtful or obvious small neck remnant) was obtained in eight berry and four large and giant aneurysms, and incomplete occlusion was obtained in two berry aneurysms and one giant aneurysm. These results were obtained after one procedure in 21 patients, after two procedures in 19 patients, and after three procedures in two patients. Seven patients had complications that necessitated infusion of urokinase. Permanent neurologic deficits were found in three. There were no deaths. CONCLUSION: Good results were obtained with EVT of intracranial aneurysms with mechanical detachable spirals. These spirals are characterized by rapid detachment and low cost.

Lee, C H; Egglin, T K; Philpotts, L; Mainiero, M B; Tocino, I

doi: N/Apmid: 9051045

PURPOSE: To determine the cost savings of stereotactic core needle biopsy over open surgical biopsy in patient subgroups defined according to mammographic findings. MATERIALS AND METHODS: From July 1992 through February 1995, stereotactic core needle biopsy was performed in 356 women with 405 nonpalpable breast lesions (254 were masses and 151 were calcification). Lesions were classified according to mammographic finding, size, and level of suspicion. Two hundred three lesions were classified as indeterminate, 166 as suspicious, and 36 as highly suspicious. Medicare reimbursements for 1995 were used to determine costs and cost savings. RESULTS: Overall cost savings for stereotactic core biopsy over open surgical biopsy was $741 per case. Average cost savings per case was $807 for masses and $630 for calcifications. The greatest savings occurred in the cases of indeterminate masses, with an average of $856 saved per case. The least savings occurred in the cases of highly suspicious calcifications, with $446 saved per case. CONCLUSION: Cost savings of stereotactic core needle biopsy vary in subgroups of patients defined according to mammographic findings. Over-all savings will depend on the distribution of patients among these groups. In this series, cost savings were realized with stereotactic core biopsy over open surgical biopsy for all mammographic subgroups.

Buecker, A; Wein, B B; Neuerburg, J M; Guenther, R W

doi: N/Apmid: 9051016

PURPOSE: To assess the need for follow-up esophagography with barium-containing contrast medium after examination with a water-soluble contrast medium in the detection of esophageal perforation. MATERIALS AND METHODS: Sixty-seven patients suspected of having esophageal perforation were examined prospectively with use of an aqueous contrast medium during a 1-year period. The examinations were performed with a digital fluoroscopy unit. Eighteen patients without proved extravasation at esophagography performed with aqueous contrast medium and without other contraindications underwent esophagography with barium-containing contrast medium. RESULTS: In four of 18 patients (22%) with unremarkable findings at esophagography performed with a water-soluble contrast medium, a perforation was detected subsequently with use of a barium-containing contrast medium. No complications related to barium extravasation occurred. CONCLUSION: Patients suspected of having esophageal perforation and who have unremarkable findings at esophagography with water-soluble contrast media need to undergo follow-up esophagography with a barium-containing contrast medium. The use of a digital fluoroscopy unit does not obviate the follow-up examination.

Golzarian, J; Struyven, J; Abada, H T; Wery, D; Dussaussois, L; Madani, A; Ferreira, J; Dereume, J P

doi: N/Apmid: 9051026

PURPOSE: To assess efficacy of transcatheter embolization of peri prosthetic leaks from aortic stent-grafts MATERIALS AND METHODS: Eight patients with a long-standing (3-13 months) perigraft leak after stent-graft implantation underwent transcatheter embolization. Leakage was demonstrated at helical computed tomography (CT). Angiography was performed for evaluation of outflow vessels and transcatheter embolization. All patients underwent helical CT follow-up after the procedure and every 3 months. RESULTS: Embolization was successful in seven patients and resulted in aneurysmal sac thrombosis. A second procedure was necessary in one patient to complete occlusion of the aneurysm. No further aneurysmal growth was detected during 4-9 months follow-up. Right leg paresis was observed in one patient immediately after the procedure, but symptoms disappeared completely after 8 days. Another patient had a minor sensory deficit in the region of the right crural nerve. CONCLUSION: Transcatheter embolization of perigraft leaks appears to be an effective technique to achieve aneurysmal thrombosis.

Keener, T S; Winter, T C; Nghiem, H V; Schmiedl, U P

doi: N/Apmid: 9051022

PURPOSE: To reevaluate blood flow patterns in the normal epididymis with color Doppler sonography. MATERIALS AND METHODS: Twenty-seven healthy volunteers (aged 19-68 years) with no history of scrotal disease, infection, or surgery (including vasectomy) underwent gray-scale imaging, color Doppler imaging, and pulsed Doppler spectral analysis of the head, body, and tail of each epididymis. All volunteers had negative results of urinalysis. RESULTS: In each of the 54 epididymides, blood flow was detected with pulsed Doppler and color Doppler imaging 100% of the time in the head, body, and tail. The mean resistive indexes for the right epididymal head, body, and tail were 0.55, 0.55, and 0.58, respectively. Similar values for the left side were 0.54, 0.55, and 0.55, respectively. None of these values were statistically significantly different. CONCLUSION: With current ultrasound imaging technology, epididymal flow was demonstrated not only in the head but also in the body and tail of the epididymides of all of our healthy volunteers. Thus, detection of flow in the epididymis at color Doppler imaging can be a normal finding and does not necessarily imply epididymitis.

Lee, M G; Lee, H J; Kim, M H; Kang, E M; Kim, Y H; Lee, S G; Kim, P N; Ha, H K; Auh, Y H

doi: N/Apmid: 9051013

PURPOSE: To assess the diagnostic value of three-dimensional (3D) magnetic resonance (MR) cholangiopancreatography versus endoscopic retrograde cholangiopancreatography (ERCP) in various pancreaticobiliary diseases. MATERIALS AND METHODS: Forty-six consecutive adult patients suspected to have extrahepatic biliary disease were examined. Breath-hold 3D steady-state free-precession MR cholangiopancreatography was performed. Correct determination of the level of biliary obstruction (n = 23) and of the cause of lesions (n = 46) was independently assessed with both MR cholangiopancreatography and ERCP by two readers blinded to the diagnosis. Results were compared. The overall diagnostic accuracies of both modalities also were compared. RESULTS: Level of obstruction was accurate in 91% (21 of 23) with MR cholangiopancreatography and in 83% (19 of 23) with ERCP (P > .05). The sensitivity, specificity, and accuracy in distinguishing malignant from benign lesions were 81%, 92%, and 87%, respectively, for MR cholangiopancreatography and 71%, 92%, and 83%, respectively, for ERCP. However, the differences were not significant (P > .05). The overall diagnostic accuracies of MR cholangiopancreatography and ERCP were 72% and 61% (P > .05), respectively. CONCLUSION: 3D MR cholangiopancreatography not only is fast and reliable in evaluating the extrahepatic bile duct, but also offers a diagnostic value equivalent to that of ERCP.

Murata, S; Itai, Y; Satake, M; Asato, M; Kobayashi, H; Eguchi, N; Moriyama, N

doi: N/Apmid: 9051023

PURPOSE: To assess the hemodynamics of the liver and of hepatocellular carcinomas (HCCs) with hepatic vein occlusion. MATERIALS AND METHODS: Selected hepatic veins were temporarily occluded with a balloon catheter in 21 patients with 28 nontreated nodular HCCs. Computed tomographic (CT) arteriography was performed without and with temporary occlusion of a hepatic vein that drained the blood from segmental liver parenchyma containing tumor by using a unified spiral CT and angiography system. The degree of enhancement and change in appearance of the HCC in each condition were compared. RESULTS: All HCCs were well-enhanced, almost round masses at CT arteriography. At CT arteriography with hepatic vein occlusion, however, HCCs were changed as follows: (a) the absolute attenuation of the HCC was decreased in 27 (96%) of 28 tumors compared with that at CT arteriography without hepatic vein occlusion, while attenuation of the surrounding liver parenchyma was increased; (b) the size of the highly enhanced area in HCC became smaller in 17 (61%) tumors (of these, two disappeared); and (c) the shape was changed in 12 (43%) tumors. CONCLUSION: Hepatic vein occlusion resulted in reciprocal hemodynamic changes in the liver parenchyma relative to HCCs: Enhancement of the liver increases and that of HCCs decreases.

Bramson, R T; Shiels, W E; Eskey, C J; Hu, S Y

doi: N/Apmid: 9051040

PURPOSE: To determine the effects of the Valsalva maneuver on intraluminal colon pressure during air enema studies. MATERIALS AND METHODS: Air enema studies were performed in four adult volunteers, and intraluminal colon pressure measurements were recorded with a high-speed electronic strip chart and aneroid gauge methods. One hundred thirty-five Valsalva maneuvers were produced with open- and closed-glottis maneuvers, with varying degrees of straining, and during normal peristalsis. RESULTS: Valsalva pressure waves are discrete waveforms that can be distinguished from baseline insufflation and normal peristaltic waves. Valsalva waves are of both simple and complex types. The range of peak Valsalva pressures was 12-148 mm Hg. Average mild, moderate, and vigorous pressures with a closed glottis were 22, 38, and 90 mm Hg, respectively. High pressures (120-130 mm Hg) were observed with open- and closed-glottis maneuvers. CONCLUSION: Valsalva maneuvers increase intracolonic pressure 12-148 mm Hg above baseline pressure. Valsalva pressure waves are discrete and can be accurately detected with both aneroid and electronic transducer systems.