Lee C. Chiu

The resectability of primary lung carcinoma: A diagnostic staging review

Summary All patients suspected of having primary lung carcinomafrom the initial chest x-ray need bronchoscopy as the initial staging procedure. The chest x-ray serves as a basis for classifying the patients into one of three groups: the central lesions, peripheral lesions, or collapse lesions. When viewing the entire population, there is no single diagnostic modality that has a better diagnostic yield than the other, yet when separated into the various subgroups, there are certain tests that have a higher diagnostic yield and therefore serve as the primary screening test. CT is the primary modality of choice in central lessions, with a sensityvity of 95% and a specificity of 80% for predicting medicastinal metastases. At times, tomography and mediastinoscopy may be used as ad- junctive procedures. CT is also the modality of choice for pleural and lung parenchymal metastases.Galium scintigraphy is the first modality of choice in patients with collapse and/or consolidation as seen on chest x-ray to assess rof tumoruptake and mediastinal metastases.Again, mediastionoscopy may be used as an adjunctive procedure.In these instances,it is difficult to differentiate between collapsed lung and tumor density with CT and tomographic studies. Gallium 67 is the primary modality of choice in peripheral lesions without hilar granulomas. However, tomograms have a lesser false-positive yield if hilar granulomas are present. Tomograms are also often helpful in localizing the lesion by defining the segmental anatomy.

Computerized tomography of brain abscess

Computerized tomography CT with contrast enhancement is of great value in the diagnosis and follow-up of brain abscess. Wc have reviewed 58 CT Scans done on 17 patients and have observed four different patterns depending on the stage of the abscess. The CT scan may show an irregular area of decreased density, a well defined nodular-appearing mass, a thick or thin walled cavity or a lesion with an incompletewall. These patterns may be seen either initially or at some stage in the development or r~solution of an abscess.

Computed tomography of the liver: A review

Abstract The following literature review includes most of the observations reported until the spring of 1978. In view of the rapid evolution of body CT, it is reasonable to expect that additional material on hepatic CT will have appeared by the time this manuscript comes to publication. Unfortunately, this is not avoidable. We have attempted to illustrate the observations reported in the literature with selected cases from our own experience.

Abdominal abscess. II. Diagnostic efficacy of computed tomography and comparison with ultrasonography

Abstract In our experience, a combination of Ultrasonographic and computed tomographic examinations is attended by a probability of less than 10% in failing to detect an intraabdominal abscess. Viewed as individual procedures, CT had an overall diagnostic accuracy between 80% and 85%, whereas the accuracy of US was 61%. A positive CT diagnosis denotes a 94% probability that a mass lesion is pressnt in the abdomen while a positive US diagnosis denotes a probability between 81% and 84%. The present patient sample suggests that between 62% and 72% of patients with negative CT diagnoses do not have an abscess, with a corresponding level of confidence of negative US diagnoses being restricted to 46 to 53%. It is to be emphasized that the cata was derived from a rather high risk patient population in which about two-thirds of the cases were found to be localized abscesses or other mass lesions. Patient-related factors are much more likely to render an ultrasonographic examination totally useless than is the case with CT.

Computed tomography and ultrasonography in the diagnosis of calcified renal masses.

The significance of radiographically visible calciumcontaining renal masses has been widely debated in the literature over the years. Calcium has been regarded as a sign of malignancy with certain prognostic value by some authors, whereas others have considered certain patterns of calcification as suggestive of a benign lesion. In 1905, Albrecht described an apple-sized renal cell carcinoma surrounded by a calcified fibrous capsule (1). Most of the subsequent literature has emphasized the differential diagnostic features of calcified renal masses. Lang stated that eggshell calcification in the periphery of a renal mass is more common in benign simple cysts and that the thickness and coarseness of the mural calcification is of some help in distinguishing neoplasms from benign cysts (2). However, Krieger et al. (3) and Kikkawa et al. (4) emphasized that ringlike peripheral calcification may be more frequent in renal cell carcinoma than previously described. Thus, it appears that little importance should be assigned to the location of calcification in relation to the mass. With the conventional diagnostic procedures, including excretory urography, nephrotomography, and angiography, calcified renal masses pose an unusual diagnostic challenge. However, with the modern diagnostic armamentaria, including ultrasound, cyst puncture with contrast cystogram, and computed tomography, the diagnostic dilemma of calcified renal masses may be resolved. In the last six months, five cases of calci-

Comparison of radionuclide and computed tomography scanning in non-neoplastic intracranial disease

In this comparison of computed tomography (CT) and radionuclide scanning (RN) in non-neoplastic disease, the CT and RN patterns in vascular occlusive disease, vascular anomalies, cerebral hemorrhage, cerebral infections, and trauma are described in detail. A retrospective evaluation of CT and RN findings in 514 patients provides a basis for determining which modality is more sensitive in a given disease entity. Illustrative cases demonstrate pertinent findings in both CT and RN scanning in the aforementioned disease categories.

Ultrasonography in maternal complications of pregnancy

Diagnostic ultrasonography has proved to be one of the simplest and most reliable adjunct methods for the evaluation of many complicating problems in pregnancy. Its major value lies in detecting problems that can be visualized anatomically in relation to the maternal pelvic organs as well as determining their potential effects on the fetus. Pelvic masses, whether functional, inflammatory, or neoplastic, constitute one of the most commonly encountered problems that the obstetrician is faced with in the pregnant patient. Any form of invasive diagnostic procedure is liable to disturb the pregnancy and potentially precipitate premature labor. Diagnostic ultrasonography, however, not only can provide information concerning the size, location, organ of origin, and internal consistency of the pelvic mass, but also can be very helpful in the management of these patients. It is relatively important to differentiate between uterine and extrauterine or adnexal pathology as well as benign and malignant processes, particularly in association with pregnancy. Although obstetricians are particularly conservative in the face of pregnancy, in certain malignant as well as complicated benign conditions surgical interventions are inevitable. Sonography can be utilized to follow up the progression or regression of benign and functional masses as well as to determine the optimal time for surgical intervention if clinically indicated. A comprehensive analysis of the patient’s history, physical, and laboratory findings along with the