Janet L. Potter

Renal and Perirenal Infection: The Role of Computerized Tomography

Predisposing factors, onset of symptoms to diagnosis interval, computerized tomography findings and the impact of computerized tomography on the outcome were studied retrospectively in 24 patients with renal or perirenal infections. The most common predisposing factors were diabetes mellitus and urinary tract calculi. The mean interval from the onset of symptoms to diagnosis was 6.8 days. The most common computerized tomography findings were thickening of Gerotas fascia, renal enlargement, focal decreased renal attenuation, perirenal fluid and focal gas. Four patients died despite early diagnosis and appropriate therapy. Computerized tomography aided in the diagnosis, assessment of the extent of disease, treatment and followup. Computerized tomography is the most direct method to evaluate patients with suspected renal or perirenal infection, although mortality may not be altered significantly.

CT appearance of multifocal hepatic steatosis

The CT appearance of focal and diffuse fatty infiltration of the liver has been described in recent radiologic literature. Previous reports of focal steatosis have emphasized the differential diagnosis of the solitary lesion. We report a case of multifocal hepatic involvement and describe a new radiologic sign that is useful in differentiating this process from neoplasia.

Evaluation of computed tomography numbers for treatment planning of lung cancer

Computerized tomography numbers (CTN) were evaluated in 32 computerized tomography scans performed on patients with carcinoma of the lung, with the aim of evaluating CTN in normal (lung, blood, muscle, etc) and pathologic tissues (tumor, atelectasis, effusion, post-radiation fibrosis). Our main findings are: 1. Large individual CTN variations are encountered in both normal and pathologic tissues, above and below mean values. Hence, absolute numbers are meaningless. Measurements of any abnormal intrathoracic structure should be compared in relation to normal tissue CTN values in the same scan. 2. Tumor and complete atelectasis have CTN basically similar to soft tissue. Hence, these numbers are not useful for differential diagnosis. 3. Effusions usually have lower CTN and can be distinguished from previous situations. 4. Dosimetry based on uniform lung density assumptions (i.e., 300 mg/cm3) might produce substantial dose errors as lung CTN exhibit very large variations indicating densities well above and below this value. 5. Preliminary information indicates that partial atelectasis and incipient post-radiation fibrosis can have very low CTN. Hence, they can be differentiated from solid tumors in certain cases, and help in differential diagnosis of post radiation recurrence within the radiotherapy field versus fibrosis.

Assessment of follicular development by ultrasonography and total serum estrogen in human menopausal gonadotropin-stimulated cycles

Ovarian follicular development was assessed by serial ultrasonography in infertile women being treated with human menopausal gonadotropin. Both follicular size and number of follicles correlated with serum estrogen values in most patients, and follicles increased in size 2‐‐3 mm per day. Most patients had serum estrogen values greater than 750 pg/ml when one or more follicles larger than 18 mm were present. A comparison of conception cycles with non‐conception cycles did not reveal a significant difference in size or number of follicles, or in the rate of rise or peak value of serum estrogen. When women monitored with ultrasonography were compared with patients treated with gonadotropins prior to the availability of ultrasonography, there was no significant difference in the rates of successful conception, although the number of ampules of pergonal used by the former was significantly reduced, permitting more efficient use of an expensive medication.

Advantages and limitations of computed tomography scans for treatment planning of lung cancer

Forty-five Chest computed tomography (CT) scans performed on patients with lung carcinoma (LC) were evaluated in an attempt to understand the pattern of intrathoracic tumor spread and the advantages and limitations this technique offers for treatment planning when compared to planning done by conventional X rays. The following findings can help treatment planning. (1) When regular X rays do not show tumor location (i.e., hemithorax opacification), CT scan will show it in 68% of patients. If regular X rays show a well localized mass, unsuspected tumor extensions were disclosed in 78% of these patients. Hence, CT scans should be done in all LC patients prior to treatment planning; (2) Mediastinal masses frequently spread anteriorly toward the sternum and posteriorly around the vertebral bodies toward the cord and costal pleura. This should be considered for radiotherapy boost techniques; (3) Lung masses spread in one third of cases toward the lateral costal pleura. Thus, the usual 1-2cm of safety margin around the LC are not sufficient in some cases; (4) Tumor size can appear much smaller in regular X rays than in CT scans. Hence, CT scans are necessary for accurate staging and evaluation of tumor response. Some CT scan limitations are: (1) Atelectasis blends with tumor in approximately half of the patients, thus obscuring tumor boundaries; (2) CT numbers and contrast enhancement did not help to differentiate between these two structures; and (3) Limited definition of CT scan prevents investigation of suspected microscopic spread around tumor masses.

Real-time ultrasound diagnosis of cardiac fibroma in a neonate

Congenital primary tumors of the heart are rare. Of these, the benign cardiac fibromas account for only 5 per cent in all age groups, with 85 per cent presenting in childhood. 1 Because these tumors are often associated with arrhythmias and sudden death, early diagnosis and treatment is essential. Only in the last few years has echocardiography been employed as the primary diagnostic tool in the work-up of (.~ardiac tumors. The presented case is not simply an interesting example of an unusual tumor, but demonstrates the use of real-time ultrasonography to diagnose the cardiac tumor and evaluate the extent of myocardial involvement. In this case, ultrasonography provided a non-invasive estimate of prognosis on the first day of life.

Computed tomography in acquired absence of thoracic pedicle.

A patient with an acquired absence of a thoracic pedicle is presented, and the contribution of CT examination is demonstrated. A brief anatomical and radiographic review of congenital and acquired absence of pedicles is provided.

Hepatic Amebic Abscess Masquerading as Acute Cholecystitis

Hepatobiliary scintigraphy has disclosed a host of intrahepatic and extrahepatic lesions which mimic gallbladder disease. Two cases of hepatic amebic abscess are reported in which the presentations masqueraded as acute cholecystitis. Correlative, noninvasive imaging rapidly diagnosed both cases and in 1 case identified a serious complication.

Neonatal hepatic malignant tumor. A correlative imaging approach.

We report the hepatobiliary study of a neonate with hepatomegaly. Biliary atresia was ruled out. Fortuitous demonstration of massive parenchymal lesions redirected the clinical management of the child. Other imaging modalities were employed to define further the nature of the lesions. Pediatric reports of non- biliary lesions demonstrated by hepatobiliary scintigraphy are uncommon. To our knowledge, the present case of multiple hepatoblastomas discovered by he patobiliary imaging is the first report in the literature.

IN-VIVO SCREENING FOR BREAST CANCER WITH NMR

Publisher Summary One of the most often mentioned areas for potential application of nuclear magnetic resonance (NMR) is cancer diagnosis; another is heart attack detection even if one is not imminent; a third is the diagnosis of brain abnormalities. It is possible to make an NMR instrument much smaller in size, complexity and cost when it is dedicated to performing measurements on a specific part of the body such as the female breast. This chapter discusses such an instrument that is used to give three types of data: (1) the free induction decay (FID) signals following a single 90o pulse, (2) the echo amplitude following a 90°-τ-18o dual-pulse sequence as a function of the pulse spacing τ from which the graph giving T 2 can be obtained, and (3) the FID amplitude following the second 90° pulse in a dual-pulse sequence as the pulse spacing is varied to permit graphing the amplitude as a function of pulse spacing so that T 1 can be calculated. The results of these measurements are recorded and computer analyzed. The analysis gives the density of the hydrogen nuclei in the water in the breast, the number of binding levels for water, and the relaxation times T 1 and T 2 for each binding level for water in the sensitive area which is a slice through the breast perpendicular to the length axis.