Melvyn Korobkin

Arteriographie Demonstration of Collateral Arterial Supply to the Liver after Hepatic Artery Ligation1

Eight patients were studied arteriographically after hepatic artery ligation (done to control bleeding in 6). Sources of arterial flow to the liver after ligation were (a) replaced or accessory hepatic artery; (b) interlobar collaterals in the liver; (c) right inferior phrenic artery; (d) through the gastroduodenal artery from arterial branches in the pancreas, duodenum, and omentum; (e) fine collateral branches of the gastroduodenal artery as they pass into the porta hepatis; and (f) recanalization of the ligated hepatic artery. Collateral vessels, seen as early as four hours after ligation, increased in size and number during the following six months.

Percutaneous CT-guided biopsy of adrenal masses : immediate and delayed complications

Objective To determine the immediate and delayed complications of percutaneous adrenal biopsy and any relationship between biopsy methods and complications. Materials and Methods Medical records and radiological examinations of 83 percutaneous adrenal biopsy were reviewed. Indication for biopsy, inpatient/outpatient status, lesion size and location, imaging modality used, needle type, size, approach and number of passes, biopsy results, immediate complications, and delayed complications were recorded. Results Computed tomography was used in 79 cases (95%) and ultrasound in 4 (5%). The biopsy approach was posterior in 37 cases, transhepatic in 33, transpancreatic in 9, anterior in 2, transsplenic in 1, and lateral in 1. The total complication rate was 8.4% and was slightly higher for the transhepatic approach (12%) than the posterior approach (8%). Seven complications occurred: two pneumothoraces, two pain, one perinephric hemorrhage, one subcapsular and intrahepatic hematoma, and one hepatic needle-tract metastasis. The posterior approach was complicated by the two pneumothoraces and perinephric blood; the transhepatic was used in the other four. Five of the complications occurred with 22 gauge needles. Conclusion Percutaneous adrenal biopsy is a safe procedure. Complications occurred in 7 of our patients (8.4%).

Comparison of computed tomography, ultrasonography, and gallium-67 scanning in the evaluation of suspected abdominal abscess.

A retrospective study was made of 29 consecutive patients who were evaluated for suspected abdominal abscess by at least two of three imaging modalities: gallium-67 scanning, ultrasonography, and computed tomography. No statistically significant difference in accuracy of the findings could be demonstrated. Consideration of the advantages and disadvantages of each imaging modality will often indicate which to use in an individual case. Findings from the three imaging techniques sometimes provided complementary rather than identical information.

Does medical school performance predict radiology resident performance

RATIONALE AND OBJECTIVES The authors performed this study to examine the relationship, if any, of a large number of measures of medical school performance with radiology residency performance. MATERIALS AND METHODS Applications of 77 radiology residents enrolled from 1991 to 2000 were reviewed. Medical school grades, deans letter summary statements, letters of recommendation, selection to Alpha Omega Alpha (AOA), and National Board of Medical Examiners (NBME) and U.S. Medical Licensing Examination (USMLE) Step 1 scores were recorded. Student t tests, analysis of variance, and correlation coefficients were used to examine the relationship between these measures of medical school performance and subsequent performance during radiology residency as determined by rotation evaluations, retrospective faculty recall scores, and American College of Radiology (ACR) and American Board of Radiology (ABR) examination scores. Resident performance was also correlated with prestige of the medical school attended. RESULTS Preclinical grades of Honors or A; clinical grades of Honors or A in medicine, surgery, and pediatrics; and high NBME/USMLE scores strongly predicted success on the ABR written clinical examination but did not predict rotation performance. Most other measures of medical school performance, including outstanding Deans letters and letters of recommendation, AOA selection during the senior year, and high medical school prestige did not predict high examination scores or superior rotation performance during residency. CONCLUSION Success on the ABR examination can be predicted by medical school success in preclinical courses, some clinical courses, and USMLE examination scores. Deans letters, letters of recommendation, AOA selection during the senior year, and medical school prestige do not appear to predict future resident performance as reliably.

CT appearance of adrenal cortical carcinoma

The computed tomographic (CT) findings in eight patients with proven primary adrenal cortical carcinoma are presented. The tumors ranged in size from 9 to 22 cm in diameter and all exhibited central necrosis. Contrast enhancement was irregular in all cases and associated tumor calcification was present in three cases. The CT appearance of a huge adrenal mass with central necrosis is typical of adrenal cortical carcinoma hut can occasionally he seen with pheochromocytoma or a large metastasis to the adrenal gland.

The Relation of Liver Fat to Computed Tomography Numbers: A Preliminary Experimental Study in Rabbits

The relation of liver fat content to CT number was studied in 20 rabbits (17 experimental, 3 control), where fatty degeneration was produced by carbon tetrachloride (CCl4) ingestion. Liver scanning was performed before and 2--5 days after CCl4 administration.. Changes (decrease) in CT number were compared with triglyceride (TG), water, and protein content of resected livers. A decrease of 12--20 CT numbers (24--40 H) reflected a TG concentration of 20--40 mg/g.

Cystic Renal Masses: A Reevaluation of the Usefulness of the Bosniak Classification System

RATIONALE AND OBJECTIVES We evaluated the utility of the Bosniak system for classifying cystic renal masses on computed tomography (CT) scans. METHODS The CT scans of 20 patients with 24 cystic renal masses that were subsequently surgically removed or biopsied were reviewed retrospectively. Masses were categorized using the Bosniak system and were correlated with the pathology results. RESULTS The final pathology results of the cystic renal masses were as follows: Seven of seven category I lesions were benign, one of five category II lesions was benign, zero of four category III lesions were benign, and zero of six category IV lesions were benign. Neither of two unclassifiable cystic lesions were benign. The average enhancement of lesions in categories II, III, and IV was 6.3, 2.3, and 27.6 Hounsfield units (H), respectively. The two uncategorizable lesions had a mean enhancement of 26.8 H. CONCLUSION The results of our study serve to underscore some limitations of the Bosniak classification system because most of our category II and all of our category III lesions were malignant, suggesting that minimally complex cystic renal masses may contain malignant cells. Contrast enhancement of less than 10 H was demonstrated in lesions in categories II and III.

TRAUMATIC PNEUMOPERITONEUM : IMPLICATIONS OF COMPUTED TOMOGRAPHY DIAGNOSIS

Pneumoperitoneum detected on plain radiographs following blunt abdominal trauma is nearly pathognomonic of bowel perforation and usually mandates exploratory laparotomy. To determine the significance of computed tomography (CT)-detected pneumoperitoneum, we reviewed the clinical records and imaging studies of all trauma patients in our hospital over a seven-year period whose abdominal CT scans showed free intraperitoneal gas. Patients who had penetrating injuries or peritoneal lavage prior to CT were excluded. Of the 18 patients who met these inclusion criteria, surgically confirmed bowel injury was found in only four (22%). In the remaining 14 patients, no evidence of gastrointestinal perforation was found by exploratory laparotomy (2 patients), diagnostic peritoneal lavage (4 patients), GI studies and clinical follow-up (6 patients), or clinical follow-up alone (5 patients). Seven patients had a pneumothorax as a possible cause for pneumoperitoneum. Two additional patients were on mechanical ventilation. Unlike pneumoperitoneum seen on plain film, CT-detected pneumoperitoneum is not pathognomonic of bowel perforation. While laparotomy is not mandatory in the non-surgically explored patient, close clinical observation is essential, and additional diagnostic tests such as peritoneal lavage or radiographic contrast studies can be beneficial to confirm the absence of intestinal injury.

Diagnosis of Patellofemoral Malalignment by Computed Tomography

Conventional radiographic assessment of the patellofemoral joint (PFJ) is often unsatisfactory for a variety of technical and theoretical reasons. Using a simple device designed to allow easy and reproducible control of knee flexion, we used computed tomography (CT) to evaluate the PFJ in 10 normal volunteers and five patients with a history suggestive of recurrent subluxation or dislocation of the PFJ. At full extension of the knee the patients with a history of malalignment showed an abnormal patellar centralization and tilt compared with those of the normal volunteers. The abnormalities were absent or less pronounced on images obtained at 20 and 45 degrees of knee flexion.

Computed Tomography of Focal Hepatic Lesions: A Blind Clinical Evaluation of the Effect of Contrast Enhancement

Hepatic CT scans in 61 consecutive patients with proved liver metastasis performed both before and after administration of contrast medium were subjected to blind analysis by two observers. In 10 patients (16%) hepatic lesions were better defined before CE and focal hepatic lesions were diagnostically visible only before CE in 8 patients (13%). Lesions were better defined following CE in 16 patients (26%) but in only 2 cases (3%) were lesions diagnostically visible only after CE. The majority of lesions [35 (58%)] were equally well visualized before and after CE.