The use of spiral computed tomography in the evaluation of living donors for kidney transplantation.
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Angiography↗
Biomedical subjects
R B Jeffrey
Publications and source records attributed to R B Jeffrey.
Degenerated uterine leiomyoma mimicking acute appendicitis: sonographic diagnosis.
The present study reviews four cases in which degenerated uterine leiomyomas mimicked appendicitis clinically. The correct diagnosis was made prospectively by sonography in each case. Appendicitis was excluded by graded compression sonography and an exophytic uterine leiomyoma was identified at the point of maximal symptoms. The leiomyomas demonstrated central hypoechoic foci, but no detectable Doppler flow indicating necrosis. Although the phenomenon of a degenerated uterine leiomyoma mimicking appendicitis clinically is known, sonographic diagnosis has not been reported previously. The importance of making this diagnosis sonographically is that management of a degenerated leiomyoma is conservative and unnecessary surgery could be avoided.
Acute Disease↗
CT of blunt trauma to the bowel and mesentery.
Injuries to the bowel and mesentery are found in approximately 5% of all patients undergoing laparotomy after blunt abdominal trauma. Bowel and mesenteric injuries are often subtle and difficult to diagnose, and a delay in the diagnosis is associated with increased mortality and morbidity. CT is the best imaging method for diagnosing injuries to the bowel and mesentery. With meticulous scanning techniques, most significant bowel and mesenteric injuries can be reliably identified with CT preoperatively, and associated injuries to other abdominal viscera can be confirmed.
Colon↗
Magnetic resonance imaging and hepatic hemodynamics: correlation with metabolic function in liver transplantation candidates.
BACKGROUND: Preoperative assessment of orthotopic liver transplantation candidates requires definition of both the anatomy and metabolic function of the native liver. Current evaluation techniques combine computed tomographic scanning, duplex ultrasonography with blood chemistry analysis, and physical stigmata of end-stage liver disease. Recently, magnetic resonance imaging (MRI) has emerged as an alternative method for delineation of hepatic and portal venous anatomy. In addition, MRI accurately measures hepatic volume and portal venous blood flow. METHODS: To examine the role of MRI-derived indexes of hepatic hemodynamics in the preoperative assessment of liver function, 39 consecutive liver transplantation candidates were studied in a prospective manner. Liver function (aspartate aminotransferase), alanine aminotransferase, alkaline phosphatase, total bilirubin, and albumin levels), hematologic indexes (complete blood cell count, prothrombin time), and Child's classification were determined at the time of evaluation. Axial breath-held multiplanar spoiled-gradient echo MRI measured hepatic volume, whereas a cine phase-contrast sequence perpendicular to the portal vein measured flow. RESULTS: Hepatic index, defined as hepatic mass corrected for body surface area, was found to correlate with prothrombin time (p < 0.04) and platelet count (p < 0.03) by multivariate regression analysis. Portal flow index (PFI), defined as portal flow corrected for hepatic mass), was associated with aspartate aminotransferase (p < 0.02), alanine aminotransferase (p < 0.04), and albumin (p < 0.03) by multivariate regression analysis. In addition, PFI was closely correlated with the patients' functional status as determined by Child's classification system. Increasing values of PFI were associated with declining hepatic functional reserve. Child's class A patients had a mean PFI that was two times less than that of Child's class B patients (0.26 +/- 0.04 versus 0.04 +/- 0.06 ml/min/gm; p < 0.02) and five times less than that of Child's class C patients (0.26 +/- 0.04 versus 1.05 +/- 0.14 ml/min/gm; p < 0.001). Similarly, the mean PFI associated with Child's class B was two times less than that of Child's class C (0.46 +/- 0.06 versus 1.05 +/- 0.14 ml/min/gm; p < 0.01). These data show that MRI-derived indexes of portal hemodynamics and hepatic mass (1) correlate well with biochemical indexes of hepatic dysfunction and (2) serve as anatomic and hemodynamic correlates to Child's functional classification. CONCLUSIONS: We conclude that MRI may serve to noninvasively delineate preoperative hepatic vascular anatomy and metabolic dysfunction in candidates undergoing examination for liver transplantation.
Adult↗
Quantitative evaluation of pancreatic enhancement during dual-phase helical CT.
PURPOSE: To determine the improvement in pancreatic enhancement at helical computed tomography (CT) performed with an early delay after administration of contrast material compared with that performed with a standard delay. MATERIALS AND METHODS: Dual-phase helical CT of the abdomen was performed in 120 patients with a 150-mL bolus of contrast material infused at 5 mL/sec. Early and standard delayed scanning was performed beginning at 20 seconds and 49-71 seconds, respectively. Regions of interest were measured in the head, body, and tail of the pancreas in 92 patients. The difference in enhancement between early and standard delayed scanning was calculated. RESULTS: Mean pancreatic enhancement was 82 HU +/- 3 (standard error) with an early delay, whereas enhancement on standard delay scans was 62 HU +/- 2 (P < .001). An improvement in enhancement greater than 10 HU was attained in 66 of 92 cases (72%). CONCLUSION: Pancreatic enhancement at helical CT with an early delay after contrast material administration is often significantly greater than the enhancement seen with a standard delay when a monophasic, rapidly infused bolus of contrast material is used.
Abdominal Neoplasms↗
Assessment of living renal donors with spiral CT.
PURPOSE: To determine whether spiral computed tomography (CT) can be used to evaluate potential living renal donors. MATERIALS AND METHODS: Twelve potential living renal donors underwent spiral CT and conventional arteriography. CT angiography was performed with 30-second spiral acquisition during injection of 150 mL of nonionic iodinated contrast material into an antecubital vein at 5 mL/sec. Five minutes after injection, a frontal abdominal scout projection was obtained to assess the renal collecting system. Results of blinded interpretations of axial CT angiograms, three-dimensional CT angiograms, and conventional arteriograms were correlated with intraoperative findings in 11 cases. RESULTS: Axial and three-dimensional CT angiography were 100% sensitive for identifying seven accessory renal arteries and 14% and 93% sensitive for identifying five prehilar renal artery branches. Renal venous anomalies were confirmed in three patients at surgery. Operative management changed in four of 11 patients who underwent donor nephrectomy. CONCLUSION: Spiral CT holds promise as a single examination for anatomic assessment of living renal donors.
Adult↗
Lymphoma and leukemia involving the testicles: findings on gray-scale and color Doppler sonography.
OBJECTIVE: The purpose of this study was to determine the gray-scale and color Doppler sonographic appearance of testicular lymphoma and leukemia to aid in its differentiation from primary testicular neoplasms and inflammatory processes. MATERIALS AND METHODS: We retrospectively reviewed the testicular sonograms of eight male patients 5-74 years old (mean age, 43 years) with pathologically proved testicular leukemia or lymphoma. All patients presented with testicular enlargement. Gray-scale sonograms were obtained to determine the presence or absence of a mass, focal nodule, or diffuse infiltration, as well as the degree of parenchymal echogenicity. Color Doppler sonography was applied in each case to determine the degree of vascularity compared with normal ipsilateral or contralateral testicular parenchyma. In patients with focal, measurable lesions, the size was correlated with its color Doppler sonographic appearance. RESULTS: Gray-scale sonograms showed either homogeneously hypoechoic testes in patients with diffuse round-cell infiltration or multifocal hypoechoic lesions of various sizes. Five patients had a total of 11 focal lesions that ranged in size from 8 mm to 26 mm in maximum diameter (mean diameter, 16 mm). Color Doppler sonography revealed increased intralesional flow in all areas of lymphomatous or leukemic involvement irrespective of lesion size. CONCLUSION: Our results show that testicular lymphoma and leukemia are hypervascular on color Doppler sonograms regardless of the size of the tumor. Although color Doppler sonography may provide useful information, differentiating round-cell infiltration from inflammatory processes of the testes remains difficult.
Adolescent↗
Dual-phase helical CT of the liver: value of arterial phase scans in the detection of small (< or = 1.5 cm) malignant hepatic neoplasms.
OBJECTIVE: Helical CT scanners now allow sequential arterial phase and portal venous phase scans of the entire liver to be obtained during a single bolus injection of contrast material. The purpose of this study was to determine if arterial phase scans improve detection of small (< or = 1.5 cm) malignant hepatic neoplasms when compared with portal venous scans alone. MATERIALS AND METHODS: Dual-phase helical CT of the liver was done in 96 patients referred for known or suspected malignant hepatic lesions. Malignant hepatic neoplasms were detected in 38 patients (27 with at least one small neoplasm), one patient had undetected metastases, one patient had a benign hepatic neoplasm, and 56 patients had no hepatic neoplasm. Proof of individual neoplasms was based on biopsy results, surgical findings, or findings on other imaging studies (primarily follow-up CT). The absence of disease was established by surgical or autopsy findings, findings on subsequent imaging studies, or a combination of clinical and laboratory data. A total of 150 ml of 60% nonionic contrast material was infused at 5 ml/sec followed by sequential arterial phase and portal venous phase helical scans of the liver. Three radiologists retrospectively reviewed the scans. Individual lesions were measured and the conspicuity of each lesion on arterial phase and portal venous phase scans was compared. The percentage of patients in whom some malignant neoplasms were detected better on the arterial phase scan was calculated using categories based on lesion size and typical tumor vascularity. RESULTS: In 10 (37%) of 27 patients who had at least one small malignant neoplasm, lesions 1.5 cm or less in diameter were only visible or were more conspicuous on the arterial phase scan. No malignant neoplasms more than 1.5 cm in diameter were visible only on the arterial phase scan. In four (11%) of 38 cases, malignant neoplasms more than 1.5 cm in diameter were more conspicuous on the arterial phase scan. The arterial phase scans improved lesion conspicuity in nine (39%) of 23 patients who had typically hypervascular neoplasms, whereas lesion conspicuity was improved in three (20%) of 15 patients who had typically hypovascular neoplasms (p = .02). The arterial phase scan resulted in the false-positive detection of lesions in two (2%) of 96 cases. CONCLUSION: Arterial phase helical CT of the liver improves detection of some small, malignant hepatic neoplasms when performed in addition to portal venous scanning. The value is greatest in those patients who have hypervascular neoplasms.
Adolescent↗
In patients with right lower quadrant pain, is sonography or CT the preferred imaging technique for initial evaluation?
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Adult↗
Detection of ureteral calculi in patients with suspected renal colic: value of reformatted noncontrast helical CT.
OBJECTIVE: The purpose of this study was to determine the value of reformatted noncontrast helical CT in patients with suspected renal colic. We hoped to determine whether this technique might create images acceptable to both radiologists and clinicians and replace our current protocol of sonography and abdominal plain film. SUBJECTS AND METHODS: Thirty-four consecutive patients with signs and symptoms of renal colic were imaged with both noncontrast helical CT and a combination of plain film of the abdomen and renal sonography. Reformatting of the helical CT data was performed on a workstation to create a variety of reformatted displays. The correlative studies were interpreted by separate blinded observers. Clinical data, including the presence of hematuria and the documentation of stone passage or removal, were recorded. RESULTS: Findings on 18 CT examinations were interpreted as positive for the presence of ureteral calculi; 16 of these cases were determined to be true positives on the basis of later-documented passage of a calculus. Thirteen of the 16 cases proved to be positive were interpreted as positive for renal calculi using the combination of abdominal plain film and renal sonography. The most useful CT reformatting technique was curved planar reformatting of the ureters to determine whether a ureteral calculus was present. CONCLUSION: In this study, noncontrast helical CT was a rapid and accurate method for determining the presence of ureteral calculi causing renal colic. The reformatted views produced images similar in appearance to excretory urograms, aiding greatly in communicating with clinicians. Limitations on the technique include the time and equipment necessary for reformatting and the suboptimal quality of reformatted images when little retroperitoneal fat is present.
Adult↗
Color Doppler sonography of the cystic artery: comparison of normal controls and patients with acute cholecystitis.
Color Doppler sonography was used to evaluate the length and distribution of the cystic artery in the gallbladder wall in 115 normal adults and in 54 patients with surgically proved cholecystitis. All patients were scanned with a 5 MHz curved array transducer optimized for low volume color sensitivity. A specific attempt was made to visualize the cystic artery throughout its course. Spectral Doppler waveforms were obtained to document arterial flow. The length of the cystic artery visualized was analyzed as a quartile percentage length of the anterior gallbladder wall. The distribution of the cystic artery flow also was analyzed in specific quartiles. Of 54 patients with acute cholecystitis, 26% had cystic artery length greater than half of the anterior gallbladder wall, compared with 2% of 115 normal controls (P < 0.001); 19% of patients with cholecystitis had flow in the distal (fundal) quartile, compared to 0% of normal controls (P < 0.0001). Although the presence or absence of flow in the gallbladder is not a reliable finding to establish the diagnosis of acute cholecystitis, length of cystic artery visualized is a potentially useful criterion to suggest the diagnosis of acute cholecystitis, especially in cases in which flow in the distal fundal quartile of the gallbladder. The usefulness of color Doppler sonography in acute cholecystitis is limited owing to the fact that it is insensitive, and many patients with cholecystitis have no detectable flow or have normal flow patterns.
Acute Disease↗
Inflamed pericholecystic fat: color Doppler flow imaging and clinical features.
PURPOSE: To analyze the color Doppler flow imaging features and clinical importance of inflamed pericholecystic fat. MATERIALS AND METHODS: Forty patients with surgically proved right upper quadrant inflammatory lesions in the gallbladder or the pericholecystic space underwent color Doppler sonography (CDS). Findings in the pericholecystic space were correlated with those at computed tomography (CT) in four patients and with surgical findings in 40 patients. RESULTS: CDS performed in 12 (30%) of the 40 patients demonstrated echogenic pericholecystic masses greater than 1 cm in diameter that contained internal vascularity. CT in four patients and surgical findings in all 12 patients demonstrated inflamed fat adherent to the gallbladder. CONCLUSION: Identification with CDS of inflamed pericholecystic fat may provide preoperative information that could be pertinent in the decision to perform open or laparoscopic cholecystectomy in patients with acute cholecystitis.
Acute Disease↗
CT diagnosis of blunt pancreatic trauma: importance of detecting fluid between the pancreas and the splenic vein.
OBJECTIVE: The purpose of this study was to determine the value of detecting fluid between the splenic vein and the pancreas on CT scans in the diagnosis of pancreatic injury after blunt abdominal trauma. MATERIALS AND METHODS: We retrospectively reviewed the abdominal CT scans of 10 patients with surgical- or autopsy-proved pancreatic injury after blunt abdominal trauma. The finding of fluid interdigitating between the pancreas and the splenic vein was then studied along with the reported CT features of pancreatic injury. These included intraperitoneal fluid, fluid in the lesser sac, extraperitoneal fluid, pancreatic edema or hematoma, and thickening of the anterior renal fascia. RESULTS: The CT scans of all 10 patients reviewed showed abnormalities suggesting pancreatic injury. Only 40% of patients showed all of the findings reported in the literature. Fluid interdigitating between the splenic vein and the pancreatic parenchyma was seen on CT scans in 90%. CONCLUSION: Our experience suggests that fluid between the splenic vein and the pancreas is a helpful CT finding for the diagnosis of pancreatic injury after blunt abdominal trauma. This finding was easy to recognize and in the proper clinical setting directs attention to additional subtle findings of pancreatic injury.
Adult↗
Evaluation of pelvic masses with magnetic resonance imaging and ultrasonography.
Magnetic resonance imaging is becoming increasingly useful in characterizing adnexal masses, whereas endovaginal ultrasound is an invaluable technique for examining the uterus and adnexa. This pictorial essay depicts the internal architectural details necessary for characterization of various adnexal masses imaged with both EVU and MR imaging. Forty consecutive examinations that revealed 51 adnexal masses were reviewed. All patients had MR imaging and EVU examinations within 1 week of each other. T1- and T2-weighted images in coronal, axial, and sagittal planes were included. Fat suppression technique also was used in selected cases. EVU, because of its high spatial resolution, was able to depict better internal architectural details, allowing specific diagnosis of most adnexal masses, whereas MR imaging was superior in differentiating hemorrhagic masses from dermoids when specific fat suppression techniques were used.
Adnexal Diseases↗
Graded compression sonography of abdominal neoplasms mimicking acute appendicitis.
Over a 3-year period nine patients (mean age of 43 years) with acute abdominal pain and unsuspected abdominal neoplasms were referred for graded compression sonography to rule out appendicitis. Six of the nine patients had right lower quadrant neoplasms involving the cecum, terminal ileum, iliacus muscle, or iliac lymph nodes. However, in three patients neoplasm was noted outside the right iliac fossa involving the liver, right kidney, and upper abdominal mesentery. This study underscores the fact that in patients without sonographic evidence of acute appendicitis, a survey of the upper abdomen and right flank should routinely be performed in addition to scanning the right iliac fossa and pelvis. In patients more than 50 years of age neoplasm must also be kept in mind in the differential diagnosis of appendicitis.
Abdominal Neoplasms↗
Coaxial transthoracic fine-needle biopsy in patients with a history of malignant lymphoma.
Efficacy and safety of coaxial transthoracic fine-needle biopsy were evaluated in 54 patients with a history of malignant lymphoma and new chest lesions. Twenty-one patients had recurrent lymphoma. Correct diagnosis was made in 17 of the 21 patients (81%) after one biopsy. The sensitivity increased to 95% with repeat needle biopsy in three patients. Immunophenotyping (determining phenotype by means of immunologic examination) was essential for a definitive diagnosis of lymphoma in three patients. Non-lymphomatous malignancies were correctly diagnosed in 14 patients. An infectious organism was identified in 11 of 19 patients (58%) with benign lesions. Pneumothorax occurred in eight patients (15%), necessitating placement of a chest tube in two (4%). Mild hemoptysis was observed in four patients (7%). The authors conclude that coaxial transthoracic fine-needle biopsy in patients with a history of lymphoma is safe and accurate. The use of large cutting needles or surgical biopsy can be restricted to patients with false-negative findings at percutaneous biopsy and to patients in whom histologic transformation of lymphoma is suspected.
Adult↗
Limitations of liver surface US in the diagnosis of cirrhosis.
Ultrasound (US) of the liver surface with a high-frequency, small-parts, short-focused probe has been proposed as a method of diagnosing cirrhosis. US of the liver was performed in 50 consecutive patients undergoing diagnostic liver biopsy to assess the clinical usefulness of this noninvasive procedure in diagnosing hepatic cirrhosis. Eight patients had histologically proved cirrhosis, and 42 had no histologic evidence of cirrhosis. Seven of the eight patients with cirrhosis had a normal liver surface at US, and five of the 42 patients without cirrhosis had an abnormal liver surface. US of the liver surface with this probe was not reliable in this heterogeneous patient population.
Humans↗
The pelvis: T2-weighted fast spin-echo MR imaging.
Fast spin-echo (SE) T2-weighted magnetic resonance (MR) imaging provides images with highly T2-weighted contrast in substantially reduced imaging times. In a prospective evaluation, fast SE T2-weighted imaging of the pelvis was compared with conventional SE T2-weighted imaging in 30 consecutive patients in whom pelvic pathologic conditions were suspected. Three reviewers independently analyzed the images for (a) overall image quality, (b) pelvic organ definition, (c) conspicuity of pelvic fluid, and (d) conspicuity of pelvic pathologic conditions. Fast SE images were rated superior to conventional SE T2-weighted images in 60% (54 of 90) of the case reviews for overall image quality, in 69% (62 of 90) for pelvic organ definition, in 63% (57 of 90) for conspicuity of pelvic fluid, and in 68% (43 of 63) for conspicuity of pelvic pathologic conditions. The fast SE examinations were typically three to four times faster than conventional SE T2-weighted examinations. No pathologic findings seen on conventional SE T2-weighted images were undetected on fast SE images. Fast SE images may replace conventional SE T2-weighted images in MR imaging of the pelvis.
Abdomen↗