Dina F. Caroline

Optimal evaluation of patients with nonobstructive esophageal dysphagia : Manometry, scintigraphy, or videoesophagography ?

The aims of this study were to compare diagnostic accuracy, cost, and patient tolerance of videoesophagography and esophageal transit scintigraphy to esophageal manometry in the evaluation of nonobstructive esophageal dysphagia. Eighty-nine consecutive patients underwent videoesophagography, scintigraphy, and manometry. The sensitivities for diagnosing specific esophageal motility disorders, using esophageal manometry as the standard, were 75% and 68% for videoesophagography and scintigraphy, respectively, with positive predictive accuracies of 96% and 95% for achalasia, 100% and 67% for diffuse esophageal spasm, 100% and 75% for scleroderma, 50% and 67% for isolated LES dysfunction, 57% and 48% for nonspecific esophageal motility disorders, and 70% and 68% for normal esophageal motility. The cost for videoesophagography is less than that for either manometry or scintigraphy. Both videoesophagography and scintigraphy were better tolerated than manometry. It is concluded that videoesophagography and scintigraphy accurately diagnose primary esophageal motility disorders, achalasia, scleroderma, and diffuse esophageal spasm, but are less accurate in distinguishing nonspecific esophageal motility disorders from normal. When considering accuracy, cost, and patient acceptance, these findings suggest that videoesophagography is a useful initial diagnostic study for the evaluation of nonobstructive esophageal dysphagia.

MRI differentiation of recurrent colorectal carcinoma from postoperative fibrosis.

The potential applications of magnetic resonance imaging in the differential diagnosis of recurrent colorectal carcinoma from postoperative fibrosis are described. Correlation with computed tomographic findings is presented in 2 cases.

Staging of ureteral transitional cellcarcinoma by CT and MRI

Intravenous urography and retrograde pyelography are the primary radiologic studies for detecting ureteral carcinoma but give limited information regarding stage of disease. Computed tomography (CT) and magnetic resonance imaging (MRI) delineate the extent of ureteral carcinomas with a high degree of accuracy by depicting the periureteral fat and presence or absence of lymphadenopathy. In selected cases, CT and MRI are valuable for assessing the presence or absence of tumor in a ureteral stump and for the differential diagnosis of ureteral obstruction. Five cases of ureteral carcinoma and 2 cases of stump carcinoma are presented with preoperative CT and/or MRI evaluation and staging.

CT surveillance of the thorax in patients with squamous cell carcinoma of the head and neck : A preliminary experience

Purpose: Our goal was to determine the number of malignancies detected by thoracic CT in patients with head and neck squamous cell carcinoma (SCCA) in three clinical settings. Method: We retrospectively examined 168 thorax CT scans in 93 patients with head and neck SCCA and determined the number of malignancies (second primary cancers or metastasis) (a) at the time of diagnosis of the primary neck tumor (57 patients), (b) at approximately yearly intervals following treatment of the primary cancer (93 examinations in 43 patients), and (c) at the time of local/regional recurrence of the neck neoplasm (18 patients). Results: CT detected malignancy in 9 of 57 patients examined during diagnosis of the neck tumor, in 9 of 43 patients during follow-up, and in 6 of 18 patients evaluated at the time of local/regional neck recurrence. Conclusion: Chest CT demonstrates a high number of additional malignancies in patients presenting with advanced SCCA of the head and neck.

Scar sign of renal oncocytoma: magnetic resonance imaging appearance and lack of specificity

This case report illustrates the magnetic resonance imaging (MRI) appearance of a typically asymptomatic renal oncocytoma as a homogeneous mass of medium signal with a stellate central region of decreased signal, representing the central scar. The MRI was correlated with computed tomography (CT), ultrasound (US), and gross pathologic appearance. The appearance of a central scar is not specific for oncocytoma and does not exclude renal cell carcinoma, as illustrated by a second case.

Relative merits of mri, transrectal endosonography and ct in diagnosis and staging of carcinoma of prostate

Magnetic resonance imaging (MRI) and transrectal sonography of 27 patients with biopsy-proved carcinoma of the prostate were performed to compare the sensitivity of these modalities to each other for diagnosis and to computed tomography (CT) for staging. Sonography was superior to MRI for the detection of intraglandular carcinoma and capsular disruption. MRI was superior to both sonography and CT for evaluating seminal vesicle invasion, and slightly better than CT for detecting lymphadenopathy.

The radiology of inflammatory Bowel disease

This article presents various imaging modalities, including plain films, ultrasonography, magnetic resonance imaging, and radionuclide imaging, used for the diagnosis of inflammatory bowel disease (IBD), ulcerative colitis (UC), and Crohns disease (CD). Also discussed are how to distinguish UC from CD and some of the intestinal complications of IBD.

Magnetic Resonance Imaging Diagnosis of Budd-Chiari Syndrome

Noninvasive imaging modalities may suggest the diagnosis of Budd-Chiari syndrome but they are rarely diagnostic. Inferior vena cavography, hepatic venography, and liver biopsy, alone or in combination, are usually necessary for definitive diagnosis. Because of its excellent depiction of blood vessels as regions of absent signal, magnetic resonance imaging has the potential to make a noninvasive diagnosis of hepatic vein thrombosis. A case illustrating the usefulness of magnetic resonance imaging in the diagnosis of Budd-Chiari syndrome is presented.

A Retrospective Review of Enteroclysis in Patients with Obscure Gastrointestinal Bleeding and Chronic Abdominal Pain of Undetermined Etiology

Our purpose was to determine the diagnostic utility of enteroclysis in the evaluation of obscure gastrointestinal bleeding and abdominal pain of unknown etiology. This is a retrospective review of 97 consecutive patients (mean age, 54.1 ± 17.5 [SD] years; 49 male and 48 female) who underwent enteroclysis at Temple University Hospital from January 1994 to October 2001 for the evaluation of obscure GI bleeding or chronic abdominal pain of undetermined etiology. Prior to enteroclysis all patients had an EGD and colonoscopy, which were nondiagnostic for their symptoms. Sixty-three patients (64.9%) had enteroscopy performed prior to enteroclysis that was also negative. Enteroclysis results were defined as positive based on anatomical or functional abnormalities. Analysis of the data included the percentage yield of positive exams, the percentage of positive results per symptom category, and the percentage of patients with a change in clinical management based on positive enteroclysis results. Ninety-seven patients underwent enteroclysis. The indications for enteroclysis were obscure GI bleeding in 67 patients (69.1%) and chronic abdominal pain in 30 patients (30.9%). The number of positive exams was 19 (19.6%). Fourteen of the 67 patients with the indication of GI bleeding had a positive exam (21%), while 5 of the 30 patients with chronic abdominal pain had a positive result (16.7%). There was a change in clinical management due to the enteroclysis results in 10 patients: 7 patients with GI bleeding (10%) and 3 patients with chronic abdominal pain (10%). Positive enteroclysis findings included adhesions (7), filling defects and masses (5), strictures (2), small bowel diverticulosis (1), mucosal abnormalities (3), and a motility disorder (1). The overall positive yield for enteroclysis was 19.6%, with a yield of 16.7% for chronic abdominal pain and 21% for gastrointestinal bleeding. Enteroclysis results changed the clinical management in approximately 10% of the patients.

Laparoscopic Esophagomyotomy for Achalasia: Does Anterior Hemifundoplication Affect Clinical Outcome?

Objective:To determine whether the addition of anterior hemifundoplication to laparoscopic esophagomyotomy for achalasia yields better clinical outcomes than laparoscopic esophagomyotomy alone. Summary Background Data:Although hemifundoplication may prevent gastroesophageal reflux after esophagomyotomy for achalasia, it may also lead to persistent dysphagia in these patients with esophageal aperistalsis. Methods:This is a retrospective study of 51 consecutive patients (mean age 47.5 ± 12.6 years) who had laparoscopic esophagomyotomy for achalasia by our group between August 1995 and January 2001. In 29 patients (57%) an anterior hemifundoplication was added to the esophagomyotomy. In 22 patients (43%), no wrap was added. Patients scored (0 = none; 1 = mild; 2 = moderate; 3 = severe) symptom severity (dysphagia, regurgitation, heartburn, chest pain) preoperatively and postoperatively. Weight gain, use of gastrointestinal (GI) medication, tolerance to food, and patient satisfaction were also assessed. Results:Mean patient follow-up was 33 months, and there were no operative deaths. Four patients were converted to open operation (8%). The wrap and no wrap groups were similar in terms of esophageal dilation, preoperative symptom severity and duration (5.7 ± 7.1 versus 6.1 ± 7.0 years), and preoperative weight loss (18 ± 15 versus 20 ± 20 pounds). Both groups had similar improvement in symptom grade postoperatively and equivalent satisfaction rates (86%). Postoperative weight gain, GI medication use, and food intolerance was also similar. Postoperatively, patients in the wrap group did not have higher dysphagia scores or lower heartburn scores than the no wrap group. Conclusion:The addition of anterior hemifundoplication to esophagomyotomy for achalasia does not improve or worsen clinical results.