Biomedical subjects

D Pickuth

Publications and source records attributed to D Pickuth.

21 records · Page 2Linked to original sources

PubMedDate not supplied

Radiologic diagnosis of common bile duct stones.

Unenhanced spiral CT and, in the hands of the experienced, US are accurate noninvasive methods of imaging the common bile duct. This is particularly true when there is a low clinical and laboratory probability of a common bile duct stone being present. In the diagnosis of bile duct stones, CT and US are effective and readily available screening techniques and may aid in the selection of patients who require MRCP or treatment with ERCP. Avoiding ERCP and the associated expense and morbidity is a goal that is becoming attainable with optimized CT, US, and MRCP techniques and an awareness of subtle findings.

Bile Ducts↗

PubMedDate not supplied

Detection of choledocholithiasis: comparison of unenhanced spiral CT, US, and ERCP.

BACKGROUND/AIMS: ERCP is an established method for the diagnosis and treatment of common bile duct stones, however, it is invasive, time-consuming, and expensive. The purpose of this study was to determine whether unenhanced spiral CT and US, compared with ERCP, have sufficient sensitivity and negative predictive value to be useful screening techniques in patients suspected of having choledocholithiasis. METHODOLOGY: Over a period of 2 years, 82 patients with clinically suspected choledocholithiasis underwent unenhanced spiral computed tomography and US immediately before undergoing endoscopic retrograde cholangiopancreatography. CT/US scans and ERCP images were evaluated for the presence of bile duct stones, ampullary stones, and extrahepatic biliary dilatation. RESULTS: Unenhanced spiral computed tomography (US) depicted common bile duct stones in 24 (23) of 28 patients found to have stones at endoscopic retrograde cholangiopancreatography. Five patients had stones impacted at the ampulla, all (two) of which were detected with CT (US). Computed tomography (US) had a sensitivity of 86% (82%) and a specificity of 98% (98%) in the diagnosis of choledocholithiasis. CONCLUSIONS: Both unenhanced spiral CT and US are useful for evaluating suspected common bile duct stones. Unenhanced spiral CT is especially useful when the patient is likely to have ampullary stones and is a safe, more available and less expensive alternative to magnetic resonance cholangiography.

Adult↗

PubMedDate not supplied

Unenhanced spiral CT for evaluating acute appendicitis in daily routine. A prospective study.

BACKGROUND/AIMS: The purpose of this study was to define in a routine setting the role of spiral computed tomography in patients with suspected acute appendicitis and to determine the effect of computed tomography on the treatment of such patients. METHODOLOGY: Appendiceal computed tomography was performed in 120 consecutive patients with acute appendicitis in the differential diagnosis, whose clinical findings were insufficient to perform surgery or to discharge from the hospital. Each scan was obtained in a single breath hold from the lower abdomen to the upper pelvis using a 5-mm collimation and a pitch of 1.6. Computed tomography results were correlated with surgical and pathologic findings at appendectomy or clinical follow-up. RESULTS: Eighty-eight of the 93 patients with acute appendicitis were correctly diagnosed by computed tomography, 24 of the 27 patients without acute appendicitis were correctly diagnosed by computed tomography (95% sensitivity, 89% specificity). Computed tomography signs of acute appendicitis included fat stranding (100%), enlarged appendix (> 6 mm) (97%), adenopathy (63%), appendicoliths (43%), abscess (10%), and phlegmon (5%). CONCLUSIONS: The use of spiral computed tomography in patients with equivocal clinical presentation suspected of having acute appendicitis led to a significant improvement in the preoperative diagnosis and a lower negative appendectomy rate. Appendiceal computed tomography is an accurate technique even if performed in the daily routine of scanning.

Acute Disease↗