James H. Ellis

Comparison of nmr and ct imaging in the evaluation of metastatic retroperitoneal lymphadenopathy from testicular carcinoma

Twenty-five patients with nonseminomatous germ cell carcinoma of the testis underwent CT and nuclear magnetic resonance (NMR) of the retro-peritoneum followed by radical retroperitoneal lymph node dissection for surgical proof of metastatic disease. Computed tomography correctly predicted the presence or absence of adenopathy in 88% and assigned the correct stage in 84%. Nuclear magnetic resonance had comparable figures of 84 and 8;0%. Computed tomography appeared superior to NMR in detecting other abdominal abnormalities, although these were few in number. Nuclear magnetic resonance is nearly equivalent to CT in staging retroperitoneal lymphadenopathy from testicular cancer and may surpass CT following technical advances and the introduction of oral contrast agents.

CT diagnosis of fracture of the coracoid process of the scapula

A case of fracture of the coracoid process of the scapula is presented in which the findings were not apparent on plain films. CT demonstrated the fracture, and the absence of soft tissue mass suggested a remote traumatic etiology rather than metastatic disease. The findings were confirmed surgically and pathologically.

Different patterns for bile leakage following cholecystectomy demonstrated by hepatobiliary imaging.

Tc-99m labeled iminodiacetic acid (Tc-99m IDA) studies were performed in three patients with bile leaks. The radiotracer distribution was different in all three. A diffuse peritoneal pattern was seen in one patient. Localized radioactivity was seen in two; in one in the gallbladder bed and in the other in the perihepatic region.

‘Cold spot’ on bone scan at the site of primary osteosarcoma

A 5-year-old girl presented with a rapidly growing osteosarcoma of the proximal right tibia. The radiographically osteoblastic lesions appeared as a ‘cold’ on the 99mTc-MDP bone scan. Possible explantations for this unusual finding on the bone scan are discuessed.

Computed tomographic diagnosis of pancreatic pseudoaneurysm

Hemorrhagic complications of pancreatic pseudocysts are potentially life threatening. This case, definitively diagnosed by bolus CT study, demonstrated pseudoaneurysm formation within a pancreatic pseudocyst.

Transcatheter brush biopsy of a liver mass with CT-proven intracaval extension

We report the adjunctive use of CT scanning in confirming the intraluminal location of an intracaval mass prior to transcatheter brush biopsy. In addition, we review several important reports of transcatheter biopsies in both the IVC and SVC, and cite potential complications.

Magnetic resonance imaging of extremity masses.

Twenty-seven adults with extremity masses were examined by magnetic resonance imaging (MRI). In 26/27 cases, computed tomography (CT) scans were available for comparison. Imaging with multiple pulse sequences is necessary to optimize diagnosis by MRI. Advantages of MRI include direct sagittal and coronal imaging, demonstration of vessels without contrast and superior soft tissue contrast. CT better demonstrates cortical destruction and small calcifications, which may be important in some cases. For noncalcified masses without bone involvement, MRI is equivalent or superior to CT. In those cases with calcification or bone involvement, MRI plays a role complementary to CT.