Elisabeth Heiberg

The unreliability of CT scans and initial chest radiographs in evaluating blunt trauma induced diaphragmatic rupture

OBJECTIVE There is no gold standard for early and reliable diagnosis of traumatic diaphragmatic rupture (TDR). The purpose of this study is to correlate CT scans, chest radiographs, and intubation on the ability to diagnosis traumatic diaphragmatic rupture. MATERIALS AND METHODS Twenty patients with blunt trauma induced diaphragmatic rupture were identified from a five year review of a Level 1 Trauma Registry. RESULTS Ten of the 20 (50%) patients had TDR on initial chest X-ray, all on the left side. Twelve patients had both chest X-rays and a chest and abdominal CT scan; however, only five (42%) of the CT scans were diagnostic. Of the 12 patients initially intubated, TDR was diagnosed in only four (33%) patients on initial chest X-ray and in one (14%) of seven patients having chest and abdominal CT scans and being intubated. CONCLUSION The early diagnosis of blunt traumatic diaphragmatic rupture, especially in intubated patients, continues to be a diagnostic dilemma. There is a significantly better possibility of identifying left over right-sided TDR (P < or = 0.05). Diagnosing TDR is also facilitated by extubation. If the suspicion exists, a post extubation chest radiograph should be performed to evaluate for TDR.

Magnetic resonance imaging of lesions of synovial origin

Three patients with histologically differing lesions of synovial origin and two with synovial cysts, one of which was a dissecting popliteal cyst, were examined by magnetic resonance imaging (MR) and computerized tomography (CT). The three histologically proven synovial lesions were synovial sarcoma, diffuse giant cell tumor of tendon sheath, and synovial chondromatosis. In two of the five patients MR provided better anatomic and morphologic appreciation than CT, while in the others they were of equal value. CT demonstrated calcification in two of the lesions while on MR calcification could be identified in only one patient where it outlined the mass. MR did not demonstrate calcification in the substance of the diffuse giant cell tumor of tendon sheath. Coronal, transverse, and sagittal images of magnetic resonance graphically demonstrated the extent of the soft tissue masses and their relationship to bone, vessels, and soft tissue structures. Synovial sarcoma had a shorter T1 than diffuse giant cell tumor of tendon sheath (these two lesions being of comparable size) and also had a uniformly longer T2. The dissecting popliteal cyst showed the most intense signals on the T1 weighted images, while the uncomplicated synovial cyst showed a long T1. On the T2 weighted images, each type of cyst showed a long T2. The variance and overlap of intensity of MR signals suggest limited specificity in predicting the histologic nature of the synovial lesion.

Effects of Varying Potential and Electrolytic Dosage in Direct Current Treatment of Tumors

The effects of different voltages and dosages during direct current treatment were studied to determine the most effective tumor treatment. Groups of nude mice with subcutaneous human colon cancer nodules were treated with a single electrolytic dose (charge) of direct current using two percutaneously placed needle electrodes. All the treated groups responded and the residual tumor volumes were significantly lower (p < 0.001) than the control group. 7.5 V gave the greatest tumor reduction, significantly more than for 12.5, 10.0, and 2.5 V. 35 C/ml of tumor was more effective than 30 C/ml (p < 0.05) and no difference in response was obtained between 35 and 50 C/ml. Hyperthermia did not appear to play a significant part in direct current treatment in the examined voltage range as no intra-tumoral temperature elevation was observed. Direct current may allow effective percutaneous treatment of metastases which are unresponsive or unsuitable for conventional treatment.

The role of computed tomography in pelvic fractures.

Adequate radiologic demonstration of the extent of pelvic fractures facilitates planning of their treatment by the orthopedic surgeon. Traditionally, this evaluation has been by conventional radiology. This report details results of computed tomography (CT) in the evaluation of pelvic fractures in 34 patients. In most cases. CT was able to identify and delineate the extent of fractures, demonstrate displacement of the involved bones, localize bone fragments and characterize joint derangements. Many of these features were better demonstrated at CT compared with conventional radiographs. In particular, in 10 patients loose bodies were seen at CT that were not evident on conventional radiography. The extent of associated soft tissue injury is also well shown by CT and demonstrated peripelvic or intraarticular fluid collections can be aspirated under CT guidance to rule out sepsis. This study suggests that CT is useful in the assessment of major pelvic fractures.

A fast 3D-imaging technique for performing dynamic Gd-enhanced MRI of breast lesions.

The characterization of breast lesions by their Gd-enhancement profiles has been proposed as a method for differentiating benign from malignant breast lesions. The limitations of dynamic contrast enhanced 2D imaging of the breast are the low number of slices that can be acquired, and the need to know the location of the lesion a priori to correctly select the noncontiguous 2D slice locations. These problems are exacerbated when multi-focal disease is present but not anticipated. Standard fast 3D gradient-echo imaging has a variable delay between successive acquisitions. We have developed a fast 3D gradient-echo imaging technique for dynamic Gd-DTPA enhanced breast imaging which obtains multiple 3D image sets of 32 contiguous images at 44 s intervals without an interscan delay time. This rapid 3D imaging technique achieves good temporal resolution and reduces patient motion between pre- and postcontrast images while covering a much larger portion of the breast and eliminating the need for a priori knowledge concerning the location of the lesion(s) when performing Gd-enhanced dynamic MR imaging.

Body computed tomography findings in systemic lupus erythematosus

Fifty-five computed tomography scans in 27 patients with systemic lupus erythematosus were reviewed. The most frequent indication for scanning was suspected intraabdominal sepsis, and the most frequent finding was mild lymphadenopathy. Renal abnormalities were: subcapsular hematoma, focal defects, overall enlargement, and diminution of size. Other findings included serositis, bowel wall thickening with pneumatosis intestinalis, pancreatic pseudocyst, and hepatic and splenic enlargement. Five abscesses were found that were indistinguishable from other fluid collections. Computed tomography was helpful in clinical evaluation and in some cases changed management.

Ipsilateral decubitus position for percutaneous CT-guided adrenal biopsy.

Positioning the patient on the side to be biopsied elevates and relatively immobilizes the diaphragmatic leaf on the dependent side, allowing percutaneous adrenal needle biopsy by a direct posterior approach without traversing lung tissue. The ipsilateral decubitus position was used successfully for biopsy of four small adrenal lesions in which lung precluded a direct posterior approach in the prone position. In addition, the relative stability of the diaphragmatic leaf further facilitated accurate needle placement.

Computed tomography in the diagnosis of gluteal abscess and other peripelvic fluid collections

Abstract: During an 18 month period, five patients of all those being investigated by computed tomography (CT) for suspected abscess were found to have localized peripelvic extraabdominal fluid collections. In three, this was due to primary abscess or pyarthrosis and to probable secondary infection of a degenerated hematoma or seroma in two. The lesions were responsible for or considered contributory to the patients febrile illness in each case. The collections were inconspicuous or poorly localized clinically but readily apparent on CT. Treatment by CT guided needle aspiration or operative drainage was performed in each patient and was followed by relief of symptoms and fever.

Observer reliability in CT and MRI of the abdomen/pelvis☆

The purpose of this research was to evaluate two sources of error in the performance of computerized tomography (CT) and magnetic resonance imaging (MRI) of the abdomen/pelvis. The sources of error assessed were inter- and intra-observer reliability. Thirty abdomen/pelvis CT scans were randomly selected from each of three hospitals (university, VA, military) with different CT scanners. Two radiologists were recruited from each site to be CT observers. Forty-five abdomen/pelvis MRI scans were randomly selected from two institutions with different MRI scanners. Four observers were recruited to read the MRI scans. All scans were read blind without clinical information or patient identification. Overall inter-observer and intra-observer diagnostic agreement was significantly higher for MRI compared to CT. Inter-observer diagnostic agreement rates were also significantly higher for MRI when the etiologies of neoplastic vascular and metabolic/toxic were assigned. Observer experience in CT (range: 5-9 yr) or MRI (range: 2-4 yr) was not statistically associated with improved diagnostic agreement. This research addresses many of the criticisms of the MRI literature and compares MRI favorably to CT.

Correlation of fine needle aspiration biopsy and dynamic contrast-enhanced 3D magnetic resonance imaging of the breast

OBJECTIVE To correlate and assess the utility of dynamic contrast-enhanced three-dimensional gadolinium-enhanced magnetic resonance imaging (Gd-3DMRI) and fine needle aspiration biopsy (FNAB) findings in patients with suspected breast disease. STUDY DESIGN Beginning in 1993, all patients who underwent percutaneous FNAB of the breast and had concurrent Gd-3DMRI evaluation of the breast were selected for this study. Findings for FNAB and Gd-3DMRI were stratified into two categories, positive and negative. Subsequent clinical management decisions, which included surgical intervention and/or clinical follow-up, were recorded for all patients. RESULTS There were 69 FNABs in 59 patients with corresponding Gd-3DMRI evaluation. A positive result by both FNAB and Gd-3DMRI was found in 15 of 18 malignant cases. FNAB missed one case, and Gd-3DMRI missed two, and each of these was thought to be technical. Combining the methods yielded 100% sensitivity. False positive results on Gd-3DMRI (17 cases) were all confirmed to be benign by FNAB and subsequent tissue evaluation. All 32 cases with combined negative results by FNAB and Gd-3DMRI demonstrated a benign process, yielding a specificity of 100% (32/32). CONCLUSION Our combined testing modalities showed a high degree of specificity and good sensitivity. FNAB used with dynamic contrast-enhanced Gd-3DMRI can contribute valuable information for physicians treating patients with suspected breast abnormalities.