Nancy O. Whitley

CT diagnosis of acalculous cholecystitis

Acalculous cholecystitis is an uncommon but potentially fatal complication of prolonged critical illness. Both clinical and biochemical parameters lack sufficient sensitivity and specificity to confidently make the diagnosis preoperatively. Over a 2 year period we have evaluated 16 patients with suspected acute acalculous cholecystitis by CT. Based on CT findings, a positive diagnosis of acalculous cholecystitis was made in seven of these patients and confirmed pathologically in six. Criteria used in reaching the CT diagnosis and potential advantages of CT over other imaging modalities in this clinical context are considered.

CT patterns of mesenteric disease.

Abstract To evaluate the patterns of mesenteric disease as visualized by computed tomography (CT). we reviewed the scans of 370 patients whose primary diagnoses coincided with diseases known from the pathology literature to have frequent mesenteric involvement. Diagnoses included selected malignancies, inflammatory diseases, and traumatic injuries. Four general patterns of involvement of the mesentery were recognized: (a) rounded masses, (b) “cake-like” masses, (c) ill-defined masses, and (d) stellate mesentery. Of the malignancies reviewed, mesenteric involvement as visualized by CT occurred most commonly with ovarian carcinoma (20/52) and non-Hodgkins lymphoma (41/134). The incidences of CT evidence of involvement of the mesentery with other common malignancies were carcinoma of the colon (8/68). carcinoma of the pancreas (5/21). and leukemia (5/19). Certain benign and malignant lesions of the mesentery do demonstrate unique CT patterns of involvement. Examples of the individual patterns in common and unusual disease states are illustrated.

Computed tomography for localization of parathyroid adenomas.

Fourteen consecutive patients with the clinical diagnosis of primary hyperparathyroidism had computed tomography (CT) preoperatively to evaluate the use of CT in localizing parathyroid adenomas. The patients were scanned from above the level of the thyroid cartilage to the bifurcation of the trachea. Computed tomography correctly identified, prospectively, the site of the adenoma in 7 of 14 patients, including one adenoma that was ectopic in location. Nine of these patients also had barium esophagrams, and this study was accurate in only three of the nine. Our study suggests that CT may be beneficial in the preoperative localization of parathyroid adenomas, particularly those in ectopic locations.

An Aid to Image Interpretation and Differential Diagnosis

RATIONALE AND OBJECTIVES.Proven case conference is a weekly 1-hour session designed to aid diagnostic radiology residents in their ability to interpret images and formulate differential diagnoses. This article provides a detailed description of the format of this conference and its use in evaluating resident performance. METHODS.The scores of all residents on the written portion of this conference over a 2-year period were compiled. Results were divided according to each residency class, and each resident was compared with the mean of his or her class and with previous performance. RESULTS.There was overall improvement of the group over the course of residency. All individual scores showed improvement during the 2-year period studied. CONCLUSION.Proven case conference is a simply performed, well-accepted aid to image interpretation and differential diagnosis. It affords residents an ongoing opportunity for practical learning and provides the residency program director with an objective tool for resident evaluation.

Tumor volume and treatment outcome in small cell lung carcinoma

The volume of some tumors correlates with local disease control, response, and survival. Small cell lung carcinoma presents with variable and often large intrathoracic masses. We assessed volume by two methods (summation of cross-sectional areas and Simpsons rule for estimating volume) and correlated volume with treatment outcome. Twenty-nine patients with small cell lung carcinoma (12 limited disease and 17 extensive disease) were analyzed for volume outcome correlations. There were five early deaths. Twenty-four had response correlations (11 limited disease and 13 extensive disease). Eighteen of the twenty-four achieved complete response. There was no apparent correlation between complete and/or partial response and pretreatment tumor volume. There was no apparent correlation between survival and volume. The methods of volume assessment correlate well with each other (r = 0.88) and either can be used with accuracy. So far there is also no correlation between chest tumor volume and intrathoracic recurrence. Our projections suggest that there is a low probability of correlating chest tumor volume and either response or survival. This is in keeping with the disseminated nature of the tumor which is its limiting factor in survival.

COMPUTED TOMOGRAPHY IN INVASIVE CARCINOMA OF THE CERVIX: AN APPRAISAL

The clinical staging, computed tomographic scans, and surgical findings in 42 patients with cervical carcinoma were compared prospectively to determine the accuracy and clinical utility of computed tomography in demonstrating extent of disease and involvement of paraaortic lymph nodes. Computed tomography was of limited value in stage IB and IIB tumors, but was comparable in accuracy to clinical examination in the assessment of IIB disease. Computed tomography was of value in radiation therapy and may detect unsuspected bony metastases (stage IVB). Retroperitoneal adenopathy can be detected by computed tomography with an overall accuracy of 83% and a specificity of 86%. Computed tomography is an important adjunct in determining tumor extent in more advanced disease (stages IIIB and IVB) and in detecting paraaortic adenopathy.