Charles B. Mulhern

Nonuniform attenuation in computed tomography study of the cirrhotic liver.

Diffuse hepatocellular processes are not well imaged by most radiologic modalities. At present, CT has not added significantly to the evaluation of hepatocellular disease, particularly in the cirrhotic liver. The CT patterns of cirrhosis previously described are reviewed, and the pathophysiology of cirrhosis is discussed. In 3 cases, a pattern was seen in cirrhotic livers characterized by nonuniform attenuation with varied response to administration of intravenous contrast agents. With further evaluation of fatty infiltration and cirrhosis, CT may prove helpful in understanding these disease processes.

Role of Computed Tomography in the Presurgical Evaluation of Carcinoma of the Cervix

Thirty-six consecutive patients either with primary or recurrent carcinoma of the cervix were evaluated by computed tomography (CT) to assess CTs ability to screen patients prior to radical surgery. Overall accuracy when compared to surgical findings or skinny needle biopsies was 80%. Inaccuracies by CT were the result of inability to assess minimally enlarged lymph nodes, inability to distinguish fibrosis from recurrent tumors, and difficulty in delineating actual tumor invasion versus contiguity of adjacent pelvic organs. Computed tomography proved to be a sensitive indicator in delineating actual tumor bulk and sidewall extension. Information gained by CT compared favorably with that obtained by intravenous urography, barium enemas, lymphangiography, and nuclear medicine bone scans. This comparison indicates that CT can serve as a sensitive imaging modality to assess the surgical candidacy of patients either with initial or recurrent carcinoma of the cervix. An algorithm of studies is proposed based on this preliminary investigation.

Bilateral Complete Ureteral Obstruction Secondary to an Abdominal Aortic Aneurysm with Perianeurysmal Fibrosis: Diagnosis by Computed Tomography

The sixteenth case of bilateral ureteral obstruction with anuria secondary to an abdominal aortic aneurysm with perianeurysmal fibrosis is presented. The details of this case clearly indicate the need for a combined vascular and urologic approach to patients with this disorder. A complete preoperative evaluation, including excretory urography, retrograde pyeloureterography, aortography and, when indicated, venacavography, may determine renal and vascular abnormalities that will allow a more definitive and successful management of this difficult problem. Furthermore, we believe that the use of computed tomography is an invaluable tool to define this retroperitoneal disease process and its precise relationship to the ureters.

CT evaluation of mediastinal pseudocyst.

Rarely do pancreatic pseudocysts extend into the mediastinum. We recently evaluated a case exemplifying this phenomenon. Although ultrasonography demonstrated the nature of the mass, computed tomography (CT) allowed better definition of various anatomic relationships and afforded improved definition of the superior aspect of the pancreatic pseudocyst. The role of CT and its advantages over ultrasonography in the diagnosis and management of pancreatic pseudocyst are discussed.

CT Differentiation of Solitary from Diffuse Bronchioloalveolar Carcinoma

The therapy and prognosis of bronchioloalveolar carcinoma vary greatly with the solitary versus the diffuse form of the disease. Solitary disease demonstrates a high resectability rate with good long-term prognosis. This contrasts with the rapidly fatal course associated with the diffuse form. To date, categorization of patients into either the solitary or the diffuse form has been based solely on conventional radiography. Multiple authors have reported cases of disease not demonstrated radiographically but discovered at surgery or autopsy. With the superiority of chest computed tomography (CT) for demonstrating parenchymal abnormalities, we propose that preoperative CT may be crucial in the workup of patients with presumed solitary bronchiolalveolar cell carcinoma. Early identification of diffuse disease or confirmation of the presence of solitary disease by CT may allow the institution of proper therapy and better evaluation of patient prognosis.

New observations of soft tissue sarcomas with contrast medium-enhanced computed tomography

Computed tomography examinations were performed on 74 patients who presented to the Childrens Hospital of Philadelphia and the Hospital of the University of Pennsylvania with a known or suspected diagnosis of primary or secondary soft tissue sarcoma. Focal masses were detected on computed tomography study in 59 patients. These masses were classified into three broad categories: centrally necrotic masses with a large predominantly liquefactive center and higher density periphery (29); multilocular, septated masses with distinct linear bands or striations (21); and miscellaneous masses (9). The miscellaneous category included six inhomogeneous and three homogeneous masses. The apparent density differences within these sarcomas were best appreciated on dynamic postcontrast scans. The computed tomography appearance of these sarcomas may be explained by the pathologic findings of cystic degeneration, extensive necrosis, central cavitation, focal hemorrhage, and myxoid changes.

Wilms' tumor: diagnostic therapeutic implications.

Twenty-four cases of Wilms’ tumor were analyzed. The gray-scale echographic characteristics of the tumors were categorized. Correlation with pathologic characteristics, clinical presentation, prognosis, and therapy response was assessed.Two echographic patterns emerged: (a) hypoechoic solid — 3; and (b) hyperechoic solid — 21. Necrotic degeneration as well as decrease in tumor size were echographic features correlated with positive response to therapy.The results of this analysis showed no initial correlation between the echographic patterns and the clinical presentation or prognosis. On the other hand, the echographic features of Wilms’ tumor seem distinctive enough to help in etiologic differentiation and therapy management.