Berland Ll

The sacroiliac joints: anatomic, plain roentgenographic, and computed tomographic analysis.

Due to its unique bicompartmental anatomy and spatial configuration, the sacroiliac joint can be more accurately defined by computed tomography (CT) than conventional radiography. Using a tilted gantry and paraaxial scanning technique, the synovial portion of the joint is oriented vertically on the CT image, while the ligamentous portion is oriented oblique-horizontally. The tilted CT gantry technique allows full ventral-dorsal imaging of the synovial portion of the sacroiliac joint. We have found the accuracy of CT to be superior to conventional radiography in the detection of early erosive sacroiliitis and joint space narrowing. In all patients with discrepancy between the two radiologic techniques, the changes were either only demonstrated or better demonstrated by CT than conventional radiography.

Evaluation of renal transplants with pulsed Doppler duplex sonography.

Sixty‐seven patients who had had renal transplants were examined 184 times by pulsed Doppler duplex sonography, and a pulsed Doppler index (PDI) was developed to provide an indicator of renal blood‐flow patterns. Arterial Doppler signals were obtained from transplant vessels during all technically satisfactory examinations of viable allografts; interpretations of transplant status based on the PDI and clinical function studies agreed with radionuclide renogram diagnoses in more than 90 per cent of cases when both sonograms and renograms were available. Pulsed Doppler analysis may differentiate between arterial occlusion and severe rejection and may decrease the need for radionuclide studies in some patients.

CT evaluation of esophageal and upper abdominal varices.

Recognition of major abdominal visceral vessels is an integral part of the interpretation of upper abdominal computed tomography (CT) studies. Perivisceral portal systemic varices appear as lobulated or discrete rounded tubular densities in characteristic sites, including periesophageal, perigastric, and peripancreatic locations, the pararenal spaces, and the gallbladder fossa. To avoid confusion with lymphadenopathy and soft tissue tumors, the varices can be specifically identified using contrast enhancement techniques and fast scan times. In portal hypertension, contrast enhanced CT can be used to define both the extrahepatic portal system and the location of the perivisceral varices.

Dynamic computed tomography and pulsed Doppler ultrasonography in the evaluation of splenorenal shunt patency.

Dynamic computed tomography (CT) and real-time/pulsed Doppler ultrasonography were performed in 13 patients following a distal end-to-side splenorenal shunt (Warren procedure). The results were correlated with angiography. The anastomotic site was demonstrated by CT in all patients. Coincident enhancement of the distal splenic vein and left renal vein as demonstrated by dynamic CT was an accurate predictor of shunt patency. Ultrasound studies were performed using a transplenic coronal imaging approach. Although the proximal splenic vein and left renal vein could be identified, it was not possible to directly evaluate the anastomotic site in any patients. Dynamic CT evaluation of splenorenal shunts may be a useful technique for monitoring shunt patency during long term follow-up and for evaluating patients who later rebleed.

Computed tomography in the demonstration of hepatic pseudoaneurysm with hemobilia.

Pseudoaneurysm with hemobilia is an infrequent complication of blunt hepatic trauma. The definitive test for demonstrating an aneurysm is hepatic angiography. The potential value of contrast enhanced computed tomography in defining the surgical approach and demonstrating coexistent hematoma and abscess is illustrated in a case of posttraumatic hemobilia.

Acute hemorrhage into the gallbladder diagnosed by computed tomography and ultrasonography.

Hemorrhage into the gallbladder occurs rarely and may result from gangrenous cholecystitis, cystic artery aneurysm, or varicose veins in the gallbladder wall. A definitive diagnosis of intraluminal gallbladder hemorrhage is possible with computed tomography.

Renal fascial thickening in pancreatitis

The incidence of“ renal fascial thickening in pancreatic inflammatory disease was evaluated by computed tomography. A total of 71 cases including chemical, acute complicated, and acute and chronic uncomplicated pancreatitis were retrospectively evaluated for thickening of the renal fascia. Renal fascial thickening is demonstrated in the majority of patients with complicated and uncomplicated pancreatitis. It is not demonstrated in cases of chemical pancreatitis. Renal fascial thickening is nonspecific and seen with inflammatory. malignant, and traumatic processes, but it is a valuable adjunctive sign of pancreatic inflammatory disease.

Evaluation of canine renal transplants with pulsed doppler duplex sonography

Preliminary studies of human renal transplants suggested that pulsed Doppler sonography may complement other studies of renal transplant dysfunction. To further evaluate the Doppler technique, 11 dogs who received renal transplants were examined a total of 50 times. No antirejection chemotherapy was used, and following rejection the kidneys were removed and examined histologically. The canine transplants underwent accelerated acute or hyperacute rejection. A pulsed Doppler index (PDI) was derived to quantitate patterns of renal blood flow and peripheral vascular resistance. Arterial Doppler signals were obtained from renal transplant branch vessels in vivo and the PDI consistently fell as rejection occurred. No arterial signals were obtained from one kidney which was subsequently proven to have arterial thrombosis. Pulsed Doppler analysis provides new information about renal transplant blood flow patterns and may demonstrate evidence of rejection and renal arterial occlusion.

Perinephric abscess with renal cell carcinoma

A case of perinephric abscess with renal cell carcinoma is presented. Hematuria is uncommon in cases of perinephric abscess. When hematuria is present in a patient with perinephric abscess further evaluation is necessary to rule out an associated malignant process.

Dynamic Computed Tomography and Duplex Ultrasonography: Adjuncts to Arterial Portography

The applications and limitations of contrast enhanced computed tomography (CT) in defining the extrahepatic portal system is discussed in the context of three separate cases in which the CT examination was used as an adjunct to an incomplete arterial portogram examination. Dynamic CT may be useful when excessive contrast dilution precludes the visualization of major venous structures during arterial portography. Real-time/pulsed Doppler ultrasonography is another complementary test but more limited in application than dynamic CT. Patency and flow direction in the proximal splenic vein, portal vein, and hepatic vein can be defined by the ultrasonic technique.