George S. Harell

CT-Pathologic Correlations in Hodgkin's Disease and Non-Hodgkin's Lymphoma

In order to assess its potential uses in the staging and treatment planning of lymphoma, CT was performed in 27 newly diagnosed, previously untreated patients with Hodgkins disease or non-Hodgkins lymphoma; 18 staging laparotomies provided pathologic correlations. CT detected and defined disease in areas not well evaluated by conventional techniques (high para-aortic, mesenteric, splenic hilar nodes). CT interpretation of splenic size and weight correlated well with splenic weight confirmed at pathology. Nodules were identified in several spleens containing foci of lymphoma.

Computed tomography of the normal pericardium.

Computed tomographic (CT) scans of 100 patients were reviewed to establish the normal thickness of the pericardium. The pericardium was identified in 95 of 100 patients. The mean width of the thinnest portion of the pericardium was 2.0 +/- 0.6 mm (1 SD) in males (N = 46) and 2.3 +/- 0.5 mm (1 SD) in females (N = 49). The mean width of the combined series was 2.2 +/- 0.6 mm (N = 95). In none of the 95 hearts reviewed was the width of the thinnest portion of the pericardium greater than 4 mm. Focal changes in width of the pericardium were a normal finding in patients without documented pericardial disease.

Neonatal Boerhaave's syndrome.

Abstract A case of neonatal Boerhaaves syndrome is described. Characteristic roentgenographic findings include tension pneumothorax or hydropneumothorax and a tubular, serpentine tract of contrast material extending from the esophagus into the pleural space as seen at esophagraphy. A frontal chest film may demonstrate thin-walled ring shadows on the side of the pneumothorax as a result of fibrinous pleural adhesions. Radiographs of 2 other cases are included.

Diameter of arterial microvessels trapping 8--10 micron, 15 micron and 25 micron microspheres as determined by vital microscopy of the hamster cheek pouch.

An assumption inherent in the use of microsphere methodology for measuring regional blood flow is that microspheres are removed from the circulation by impacting in arterial vessels of approximately their own diameter. We investigated the in vivo relationship between the diameter of varying size microspheres and the calibre of trapping microvessels within the hamster cheek pouch. Intracardiac injection of 8-10, 15 +/- 5, 25 +/- 5 micron carbonized microspheres with diversion of the cardiac output into the bracheocephalic trunk provided direct, in vivo visualization of the impaction sites of these various size microspheres within the cheek pouch microvasculature. Fifteen micron microspheres usually impacted at the orifice or neck of small arterioles and protruded into the lumen of the parent vessel. Eight to ten micron microspheres lodged in vessels with a mean diameter of 11.5 +/- SD 3.4 micron indicating that they usually impacted primarily in terminal arterioles.

Early Experience with the Varian Six Second Body Scanner in the Diagnosis of Hepatobiliary Tract Disease

Thirty-four patients with liver disease were studied with a research model of the Varian Six Second body scanner. Useful information was gained in patients with a variety of hepatic disorders. This scanner permits resolution of normal hepatic parenchymal detail which has not been reported previously and has reduced the streak artifacts originating from high- and low-CT objects which have been a major source of image degradation with other units.

The intraluminal distribution of 15-μ-diameter carbonized microspheres within arterial microvessels as determined by vital microscopy of the golden hamster cheek pouch ☆

Abstract An assumption inherent in the use of microspheres for measuring regional blood flow is that microspheres distribute uniformly with blood. Published studies suggest that carbonized microspheres, 15–80 μm in diameter, concentrate centripetally in blood flowing through medium-size arteries. The intraluminal distribution of carbonized microspheres within blood flowing through arterial microvessels is not known. To study this problem, the passage of 15-μm-diameter, carbonized microspheres through the arterial vasculature of the golden hamster cheek pouch was cinefilmed. The trajectories of 800 microspheres flowing through 24 vessel segments in 14 different golden hamsters ( Mesocricetus auratus ) were tabulated. The mean diameter of the observed arterial vessels was 65.2 ± 13.7 (SD) μm. Carbonized microspheres did not distribute homogeneously across the available lumen of the observed microarteries. Comparison of the experimentally determined microsphere distribution against a null hypothesis of a homogeneous density distribution showed a greater than expected concentration of microspheres at the periphery of the available lumen and a less than expected percentage at its center. This disparity was present whether a blunt velocity flow profile or a parabolic velocity profile was convoluted with the density distribution. If flow approximates the parabolic velocity profile, microspheres become markedly underrepresented at the center of the vessel and overrepresented at its periphery. The greater than expected centrifugal distribution of microspheres was related neither to vessl diameter nor to the microsphere velocities studied. If one assumes that erythrocytes are evenly distributed throughout the available arterial lumen (with the exception of a cell-free zone at the periphery), then 15-μm-diameter carbonized microspheres significantly underrepresent the central concentration of erythrocytes and overrepresent the concentration of red blood cells at the microarterial periphery.

The simultaneous visualization of microspheres and blood flow in the microvascular bed of the hamster cheek pouch

Abstract The accuracy of radioactive, carbonized microspheres for determining blood flow to small tissue regions has not been validated because direct flow measurement techniques have not been applicable to small tissue regions. This paper introduces methodology which allows simultaneous, direct visualization of red blood cell and microsphere flow behavior in vivo in the microvascular bed of the hamster cheek pouch by using vital microscopy and diverting cardiac output into the brachiocephalic artery. This technique demonstrates that 15-μm microspheres may form chains in vivo. The chain represents a collection of individual microspheres lodged one immediately behind each other in an arterial vessel whose diameter is larger than any of the individual microspheres. The cause of the chain is that, even though a 15-μm microsphere lodges in and partially occludes an arterial lumen, it may not obstruct red blood cell flow and more microsphere-rich blood flows into the artery and additional microspheres collect behind the original microsphere forming the chain. This investigation demonstrates that 15 ± SD 2.2-μm microspheres do not always distribute uniformly with red blood cells in microvascular beds.

Non-beta islet cell tumor calcification associated with Zollinger-Ellison syndrome and multiple endocrine adenomatosis

The radiographic triad of a calcified pancreatic mass, duodenal ulcers, and nephrocalcinosis should suggest the Zollinger-Ellison syndrome as part of the multiple endocrine adenomatosis complex. The clinical and radiographic features of the entity are described in this case report.

Profile roentgenographic features of benign greater curvature ulcers.

Certain roentgenographic features have been considered typical of benign gastric ulcers, based almost entirely on studies of the lesser curvature. However, these features frequently are not present on the profile view in benign greater curvature ulcers. Moreover, features stated to suggest malignancy in gastric ulcers are commonly simulated by benign greater curvature ulcers. The authors reviewed the profile roentgenographic features of 19 benign greater curvature ulcers and found that they often appeared to be intraluminal and had shouldered edges due to spasm of the surrounding circular muscles. In 6 patients the adjacent gastric contour was scalloped. These features frequently cause radiologists to misinterpret benign greater curvature ulcers as malignant.

Tumefactive extramedullary hematopoiesis of the stomach

A 3×4 cm submucosal gastric mass of extramedullary hematopoietic tissue occurred in a patient with chronic myelogenous leukemia. Such stomach masses have been misinterpreted as malignant tumor. Tumefactive extramedullary hematopoiesis of the stomach is an infrequent occurrence in patients with extramedullary hematopoiesis but should be considered in the differential diagnosis of patients known to have this condition.