[Magnetic imaging as an additional tool in clinical assessment].
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Biomedical subjects
Publications and source records attributed to I Suramo.
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We reviewed the imaging findings of 14 splenic abscesses in 13 patients. All patients underwent chest radiography, 12 ultrasonography (US), 9 CT, 4 plain abdominal radiography, 2 99mTc-HMPAO leukocyte scan and 2 99mTc-HIG scan. Three patients were treated with percutaneous catheter drainage, and 5 with diagnostic or therapeutic fine-needle aspiration (FNA). At US the abscess was hypoechoic (n = 9), anechoic (n = 2), or anechoic with gas-bubbles (n = 1), or the entire spleen was inhomogeneous with gas-bubbles (n = 1). At CT the abscesses appeared as low density (18-30 HU) lesions with (n = 2) or without (n = 7) gas. In 2 cases 99mTc-HMPAO leukocyte scan, and in one case 99mTc-HIG scan showed an intrasplenic defect, and in one case 99mTc-HIG scan was considered normal. At plain abdominal radiography extraintestinal gas was suggested in 2 patients, and the findings were normal in 2. US-guided FNA confirmed infectious etiology of the lesion in 4 patients, and a necrotic specimen suggested infection in one. One patient was cured with repeated aspirations. Catheter drainage was successful in all 3 patients who underwent the procedure. We conclude that US and CT are accurate in detecting splenic abscesses. Our results in splenic interventions advocate wider use of the procedures.
STUDY OBJECTIVE: The aim was to find out if it is possible, by classifying screening mammograms according to the likelihood of malignancy, to divide the recalled women to a group in which there is high suspicion of malignancy, most having breast cancers, and a group with more obscure findings. DESIGN: Screening mammograms of recalled women were classified according to the likelihood of malignancy. 0 = technically insufficient, 1 = normal, 2 = benign tumour, 3 = malignancy cannot be excluded, 4 = strongly suspicious for malignancy, 5 = malignant. SETTING: This study was a population based survey of mammography screening in Helsinki and surroundings in Finland. PATIENTS: 21,417 women (aged 50-59 years) were invited to be screened, 18,012 (84.10%) participated. Of these 579 (3.21% of those screened) were recalled for further studies; 124 of these were referred for surgical biopsy and 82 had breast cancer. MEASUREMENTS AND MAIN RESULTS: All cases classified as 5, 60% of the cases classified as 4, 6.5% of the cases classified as 3, 0% of the cases classified as 2 or 1, and 1.2% of the cases classified as 0 proved to have breast cancers. However classification 5 represented 5.9% of all recalled women and 41.5% of all screening detected breast cancers; classification 4, 6.0% of all recalled women and 25.6% of all screening detected breast cancers; classification 3, 68.9% of all recalled women and 31.7% of all screening detected breast cancers; classification 2, 11.7% and classification 1, 2.9% of all recalled women. No breast cancers were detected with these classifications. Classification 0 represented 4.5% of all recalled women and 1.2% of all screening detected breast cancers. Classifications 5 and 4 represented only 11.9% of all recalled women but 67.1% of all screening detected breast cancers. CONCLUSIONS: By classifying screening mammograms according to the likelihood of malignancy, recalled women can be divided into two groups: (1) a quite small subgroup in which everyone or almost everyone will be shown to have breast cancer; and (2) a much larger subgroup in which only a few will be proven to have breast cancer. The invitation procedure for the further studies should be improved on this basis of minimising anxiety among recalled women.
Mammography screening was carried out in 18,012 women (aged 50-59) of whom 579 (3.21%) had to be recalled for clinical mammography. After completion of the clinical mammography each woman also had ultrasonography (US) with a hand-held real-time apparatus using a 7.5 MHz probe. There were 79 verified breast cancers; 32 of these were palpable and were also depicted at US, but only 29 (61.7%) of non-palpable breast cancers (n = 47) were found at US. Twenty-two of the non-palpable breast cancers were seen at US as a tumor-like lesion, 2 because of local echo-architecture distortion, and 5 only because of acoustic shadowing. The US image did not help to differentiate between malignant and benign lesions.
The reasons for recall and the influence of experience on recall were studied in 579 women (3.21%) recalled from mammography screening. The proportion of recalls for further studies was the greatest (6.30%) at the onset of screening. With increased experience, the proportion decreased by stages and in the second screening round it was only 2.04%. The proportion of cases referred for surgical biopsy in the first screening round was 0.7% and the proportion of screening-detected breast cancers was 0.52%. These change little with increasing experience. In the second screening round, however, the proportion of referrals for surgical biopsy (0.43% of those screened) and of screening-detected breast cancers, (0.30%) were both low. A tumour-like density was the commonest finding resulting in recall for further studies, and the number caused by superimposition of normal parenchymal structures decreased with experience, while the proportion of breast cancers and benign tumours increased. The proportion of cases with parenchymal distortion resulting in recall for further studies was similar in both screening rounds but the number of those referred for biopsy fell dramatically in the second screening round. The number of recalls for microcalcification also fell with experience and the proportion of breast cancers in this group increased over the two screening rounds. A high ratio of malignancies in surgical biopsies can be expected when the radiologists undertaking primary screening also perform all further studies.
The aim of the study was to evaluate the role of ultrasonography (US) in the management of jumper's knees. Sixty-two cases of clinically suggested jumper's knees, 52 asymptomatic contralateral knees and 100 asymptomatic knees of healthy middle aged men were examined. In the symptomatic group US was normal in 25 cases, all recovered with conservative therapy. In 31 symptomatic knees the findings were consistent with jumper's knee as a hypoechoic lesion located in the upper insertion of the patellar tendon in 23 cases and in the distal insertion in one case. In 7 cases the lesion was situated in the insertion of the quadriceps tendon. Surgery was performed on 20 knees and in all of them there was a lesion matching the lesion detected by US. In 6 cases US findings were pathologic, but different from jumper's knee. US findings consistent with jumper's knee could not be detected in the asymptomatic group.
Ninety-three abdominal abscesses and fluid collections (pseudocysts, hematomas and bilomas) in 79 patients were treated under radiological guidance, for a total of 111 procedures (23 needle aspirations (NA) of 17 foci and 88 catheter drainages (CD) of 84 foci). In eight foci both methods were used. Catheter drainage was curative in 65% of abscesses and in 56% of pseudocysts and improved the patients' condition before surgery in another 11% or 10%, respectively. The aim of CD could not be achieved in 24% of the abscesses and in 34% of the pseudocysts. Needle aspiration showed little effect being curative in only 6% and partially beneficial in 24% as all the foci were considered. Complications occurred in 8% of CD:s and in 0% of NA:s. We suggest that radiologically guided CD of abscesses and fluid collections should be the primary therapeutic approach in all cases where this can be performed safely. The therapeutic effect of NA was poor.
The venous drainage of the femoral neck in 73 children with Perthes' disease was analyzed from intraosseous venography films. 55 contralater symptomless hips were used as controls. In active stages of Perthes' disease, i.e. initial and fragmentation stage, the venous drainage was pathological in 46/55 hips (82%). In the restitution stage the finding was pathological in 7/18 (39%) and in healed Perthes' the venous drainage was normal in all six cases. Two out of the 55 symptomless hips showed pathological venous drainage. The disturbances in the venous drainage of the femoral neck seem to correlate with the stage of activity of Perthes' disease. Along with clinical and radiological signs of restitution the venous drainage seems to return to normal.
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Forty patients who underwent ultrasound, endoscopic retrograde pancreatography (ERP), and selective arteriography examinations and who had a finding of or were suspected of having pancreatic carcinoma in one or several of these examinations form the basis of the study. Nineteen pancreatic carcinomas were verified at operation. Eighteen of these could be detected with ERP, 18 with arteriography, and 15 with sonography. ERP had no, arteriography one and sonography one false-negative finding. All methods had difficulties in distinguishing carcinoma from other pancreatic diseases, and therefore there were many false-positive findings.
200 patients with radiologically detected gallbladder stones were examined with gray scale ultrasound. Nine different ultrasound signs caused by the stones were found. A physical and chemical analysis of the gallstones of 33 patients from different image groups was performed. Viscosity of the bile and the thickness of the gallbladder wall were measured. Phantom experiments were performed and four different ultrasound signs were found but there was no significant correlation between these and the physicochemical properties of the gallstones.
The relative merits of gray-scale ultrasound and roentgen examinations of biliary tract diseases have been compared. Sonography was able to give a definite diagnosis in 74 of 95 roentgenologically unclear cases, and roentgen examination gave a diagnosis in 70 out of 105 cases unclear at sonography.
In chronic lymphatic leukemia there are also leukemic changes in the gastrointestinal tract; these can be detected roentgenologically and endoscopically.
Five boys who had Noonan's syndrome and lymphatic abnormalities are reported. The youngest boy had clinical lymphoedema and the other four showed dermal backflow after interdigital injection of Patent Blue indicating impairment of flow along the superficial lymphatics. One boy had severe bilateral chylothorax. The lymphographic findings in four of these boys are reported. Patients with the Noonan syndrome frequently have oedema of the hands and feet at birth, which decreases during the first years of life [10]. It has been demonstrated by lymphography that similar peripheral oedema in patients with the Turner's syndrome is due to lymphatic hypoplasia [1, 3]. We report certain lymphatic abnormalities diagnosed by lymphography in four out of five patients with Noonan's syndrome.
The lymphographic findings in a 4 year old girl with general lymphangiomatosis are presented. The number of iliac and lumbar lymphatics had increased markedly and the lymph nodes were enlarged with very loose structure and with contrast medium distributed in scattered droplets and filiform channels.
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