Biomedical subjects
Publications and source records attributed to D A Oppenheimer.
The sclerotic pedicle is a commonly encountered roentgen sign that may be associated with numerous conditions, both benign and malignant. The following paper discusses the common as well as the unusual causes of this interesting phenomenon and demonstrates the radiographic presentations of the various etiologies.
Dual-energy scanned projection radiography was used to evaluate eight patients with both lytic and blastic metastatic disease in the axial skeleton. The ability to selectively cancel obscuring soft-tissue structures from images resulted in improved conspicuity of involved sites, compared with conventional radiographic studies, despite greater quantum noise and lower inherent spatial resolution. Other desirable features of the technique include a projected format, image enhancement by contrast and brightness optimization, rapid data acquisition, convenient image storage and retrieval, and low radiation dose. Since the majority of osseous metastases involve axial sites, dual-energy scanned projection radiography may be a useful adjunctive modality in the management of oncology patients.
Diatrizoate distribution volume (DDV) is a property of living tissue which characterizes the distribution of diatrizoate contrast material within the tissue. This study compiles DDV and enhancement data from computed tomography (CT) of normal human adults. Tissues examined include liver, spleen, muscle, fat, and renal cortex. Four abnormal tissues, a cirrhotic liver, a liver infiltrated with metastatic colon carcinoma, and two examples of renal malignant lymphoma, were used for comparison. Time-DDV and time-enhancement values were generated for the normal tissues after a bolus of intravenous diatrizoate. The CT-DDV appears to be a potentially reliable indicator of diffuse organ pathology.
Ninety-two consecutive neonates were prospectively evaluated with real-time ultrasound to assess the frequency of adrenal visualization. The right gland was identified in 97% of neonates and the left in 83%. Criteria for normal length and width are presented. The characteristic sonographic appearance of the neonatal adrenal is described and correlated with histologic data. Ultrasound is the examination of choice for evaluating the neonatal adrenal gland.
Computed tomography can be used to evaluate tumor volume changes after therapy. Pre- and posttreatment results are presented for nine human neoplasms. Volume changes are correlated with the behavior of intravenous diatrizoate contrast material. The five-minute diatrizoate distribution volume appears to be a potential contrast material marker for therapeutically induced tumor volume changes. Neoplasms decreasing in volume demonstrate a decrease in the diatrizoate distribution volume; those increasing in volume demonstrate an increase.
Duplex ultrasound examination of the carotid arteries using high-resolution realtime imaging and pulsed Doppler flow measurements with velocity spectrum analysis was performed on a series of 50 consecutive patients (100 vessels), and findings were compared with findings of conventional carotid arteriography. The criteria for an abnormal duplex examination included: a velocity ratio of 1.5 or more (ratio of the maximum internal carotid artery [ICA] flow velocity to the maximum common carotid artery flow velocity); turbulence, as indicated by an ICA velocity spectral width of 40 cm per second or more; visible plaque that produced an ICA stenosis of 50% or more; a maximum ICA velocity of 100 cm per second or more; and inability to detect ICA flow. A flow-limiting stenosis was defined arteriographically as a 50% or greater stenosis of the diameter of the arterial lumen. The velocity ratio was the best single duplex criterion, with an overall accuracy of 88%. The sensitivity or specificity of the duplex examination was as high as 97%, depending on the number of duplex criteria that were abnormal.
Real-time sonography provides a noninvasive method of determining the level of obstruction in patients with imperforate anus. The authors describe one technique for evaluating this anomaly which was employed in 6 neonates. A pouch-perineum distance of less than 1.5 cm is consistent with a low lesion, while a pouch that terminates above the base of the bladder is indicative of a high lesion.
The case of a 14-year-old girl with painful periostitis and ulcerative colitis is reported. The association of chronic inflammatory bowel disease with osteoarthropathy is rare and has previously been reported in eight patients. The periosteal reaction found in association with inflammatory bowel disease is apparently related to a chronic disease course and may cause extreme localized pain.
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Seventy-one neonates with umbilical arterial catheters received serial real-time ultrasound examinations in order that the identification and natural history of catheter-associated thrombosis could be prospectively evaluated. Twelve (17%) of the infants had clinically evident signs of vascular compromise. Ultrasound detected abnormal intravascular echoes or lack of expansile pulsation in 10 of these 12 (83%). Abnormal echogenic foci were consistent with thrombus and intimal dissection. Two infants without clinical evidence of vascular compromise had ultrasonic findings consistent with thrombus. The ultrasonically detected abnormalities persisted from two to 70 days.
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Intravenous and intraarterial DSA studies were performed in patients being evaluated for possible neoplastic disease. DSA studies were obtained of the head, neck, chest, abdomen and extremities to evaluate the potential use of this technique in the cancer patient's workup. The results of this study suggest that many cancer patients can have the extent of tumor involvement defined using intravenous digital subtraction angiography. However, due to the number of false negative examinations, this study should not be relied upon as the only screening procedure. The current best application of DSA appears to be its use in conjunction with intraarterial injections as a faster and more economical alternative to angiography and in following up these neoplasms with intravenous DSA after appropriate therapy to evaluate possible recurrence or metastatic spread. Hybrid subtraction techniques and/or the development of new contrast media may greatly facilitate the use of intravenous DSA in conjunction with cancer diagnosis.
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