Kyo Rak Lee

Comparison of computed tomography and other imaging modalities in the evaluation of musculoskeletal tumors.

An algorithmic approach for the evaluation of musculoskeletal tumors is proposed on the basis of a prospective comparison of different imaging techniques in 50 unselected patients. Conventional radiography was superior to other techniques in predicting the nature of primary bone tumors. Computed tomography proved the most effective method for assessing the extent of musculoskeletal tumors and therefore had a significant influence on management in 66% of patients studied. CT was more informative than angiography and also provided more anatomical detail than ultrasound. Radionuclide scanning was mainly of value in detecting unsuspected skeletal metastases in patients with apparently solitary skeletal lesions.

Computed tomographic staging of malignant gastric neoplasms.

Eight patients with proved gastric carcinoma and 3 with gastric lymphoma were studied preoperatively with computed tomography. CT accurately identified abnormal stomach wall thickening and intra-abdominal tumor extension. Mural thickening was seen on the CT scan when a moderately distended stomach had a wall more than 10 mm thick. CT was useful for assessing surgical resectability, evaluating tumor response to chemotherapy or radiotherapy, and detecting postoperative recurrence. Fourteen patients with an abnormal barium study suggesting gastric malignancy were also studied with CT, which correctly demonstrated a normal stomach or identified the reason for the abnormal barium study, such as an unusual placed spleen or a pancreatic carcinoma invading the stomach.

Preoperative determination of abdominal extent of renal cell carcinoma by computed tomography.

CT scans were assessed for ability to detect abdominal extent of tumor in 17 patients with renal cell carcinoma. Computed tomography has a unique advantage over other imaging modalities in that it can distinguish between tumors confined to Gerotas fascia and those which show contiguous spread, invading adjacent structures such as muscles, liver and the periaortic and pericaval regions. CT can also detect regional lymph node metastases and tumor extension into the renal vein and inferior vena cava. Preoperative assessment of tumor extent helps to determine patient prognosis, surgical approach and whether transcatheter tumor embolization should be used.

Computed tomography in the diagnosis of renal carcinoma complicating Hippel-Lindau syndrome.

Four patients on long-term follow-up for Hippel-Lindau syndrome (HLS) are presented. All had undergone nephrectomy for renal carcinoma; in 2, carcinoma subsequently developed in the remaining kidney. Because of the tendency of these tumors to develop bilaterally, wide local resection is preferable to radical nephrectomy if the tumors can be diagnosed when small and noninvasive. CT is currently the most accurate method of regularly screening patients with HLS for asymptomatic renal carcinoma.

Computed tomography in diagnosis of pelvic lipomatosis.

Pelvic lipomatosis is a rare condition which may be associated with obstructive uropathy. The radiologic features may be stimulated by pelvic malignancy and, in the past, surgery has often had to be performed for confirmation of the diagnosis. A case is described in which computed tomography (CT) provided definite proof that the pelvic organ displacement was due to excessive fat. It is considered that CT may obviate the need for further workup or surgery in these patients unless exploration is required for the relief of ureteric obstruction.