Thyroid carcinoma in an autonomously functioning nodule.
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Biomedical subjects
Publications and source records attributed to J H Christie.
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In this comparison of computed tomography (CT) and radionuclide scanning (RN) in non-neoplastic disease, the CT and RN patterns in vascular occlusive disease, vascular anomalies, cerebral hemorrhage, cerebral infections, and trauma are described in detail. A retrospective evaluation of CT and RN findings in 514 patients provides a basis for determining which modality is more sensitive in a given disease entity. Illustrative cases demonstrate pertinent findings in both CT and RN scanning in the aforementioned disease categories.
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The computed tomography scans of 90 patients with extracerebral fluid collections were reviewed. Epidural hematomas, acute, subacute, and chronic subdural hematomas, convexity subarachnoid hemorrhages, subdural hygromas, and one epidural empyema were seen. The CT findings were analyzed and correlated with the time elapsed since injury (when known) and the results of radionuclide scans (when available). The overall accuracy of CT in detecting extracerebral fluid was 90% with no acute hemorrhages missed. In subacute and chronic subdural collections, six CT scans were false negative in whole or in part. Three false positive interpretations were made and are discussed.
Transient diminution of activity was seen on early radionuclide images of the brain in 5 patients with hyperostosis frontalis interna and filled in on subsequent studies. Radiographs confirmed the diagnosis. In 3 patients the changes corresponded extremely well with both modalities. This entity should be considered when diminished activity is seen in the frontal area.
The individualized approach to the performance of computerized tomography of the skull is described. With the use of the 160X160 matrix it is possible to look at the initial scans almost immediately after their completion. If necessary, unsatisfactory scans can be repeated, the position of the head can be changed and artifacts due to motion can be minimized or eliminated. Lesions can be revealed or enhanced with intravenously injected contrast material if desired. The individualized approach has eliminated the need to recall patients and has improved the diagnostic capability of the method.
The accuracy of CT and radionuclide studiies in the diagnosis of intracranial disease is analyzed based on experience in 641 patients. Results indicate that both modalities give reasonably similar precision and that a modest improvement in diagnosis can be expected if both techniques are employed. It is emphasized that the radionuclide studies used routinely included what are rightfully considered adjunctive scanning procedures, so that results must be considered in this light.
Radionuclide and computed tomographic (CT) scans were reviewed in 215 patients with ischemic stroke. The findings vary depending on the site of vascular occlusion. In middle cerebral artery occlusion, four distinct patterns may be seen on the scintigrams. The CT scans show little variation in appearance. The tentorial confluence sign is an important finding on scintigrams of patients with occipital infarction; the absence of this signs should suggest another diagnosis. During the first week and after the fourth week following an ischemic stroke, the scintigram is usually negative, whereas the lesion is visible by CT. However, there are a significant number of false negative CT scans; therefore, both examinations are advocated in difficult cases.
A new method of diagnosing myocardial contusion was studied in 8 patients in whom the injured mycardium was visualized as an abnormal area of increased activity in the region of the heart one hour after intravenous injection of 10 mCi of 99m-Tc-Sn-polyphosphate or pyrophosphate. Serum enzymes in these patients were elevated, but electrocardiograms were nonspecific for myocardial injury. It is hoped that this new technique of imaging the injured myocardium will provide specific and confirmatory diagnosis of myocardial contusion associated with closed chest injuries.
A survey of the literature pertaining to several serial brain scanning procedures has been presented. These procedures include rapid brain imaging, sequential brain imaging, delayed from imaging, and follow-up brain imaging. Applications of these techniques to specific clinical problems have been stressed and the reported results reviewed. Thus, it has been indicated that rapid brain imaging is most useful in detecting lesions secondary to cerebrovascular disease but may also provide some helpful information pertaining to the differential diagnosis of other C.N.S. lesions demonstrated on subsequent static brain scans. Sequential brain imaging is a time-consuming adjunctive procedure which, however, can be extraordinarily helpful in a highly selected group of problem cases which present with relatively small lesions adjacent to normal anatomic structures which themselves have considerable radioactivity. Delayed brain imaging has the distinction of detecting the greatest number of intracranial lesions but is attended by tactical problems in maintaining an optimal patient flow through the department and also has the undesirable consequence of reduced information density and diminished image quality, unless greater radiation doses are injected. Follow-up brain imaging is useful in the differential diagnosis of cerebrovascular and neoplastic disease and in the assessment of effectiveness of radiation therapy.