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Biomedical subjects

R E Bechtold

Publications and source records attributed to R E Bechtold.

At least 19 recordsLinked to original sources
PubMed2000

CT diagnosis of acute flank pain from urolithiasis.

The use of noncontrast helical CT (NHCT) to assess patients with acute flank pain and hematuria for potential urinary tract stone disease was first reported in 1995. After several years of experience with the technique, sensitivity and specificity of NHCT has proven to be better than intravenous urography for evaluating ureteral stones. NHCT imaging findings for urinary calculi and the differential diagnosis are discussed in this article. Various extraurinary diseases found while using NHCT in searching for stone disease are addressed and illustrated. As experience with the use of NHCT has increased, clinicians have broadened the indications for this technique, which has a lower charge than standard CT, beyond the specific evaluation of urinary colic. This indication creep has increased the number of NHCT examinations ordered. It has also reduced the rate of stone positivity and increased the diagnostic yield for extraurinary disease.

Abdominal Pain↗
PubMed2000

Is it necessary to biopsy the obvious?

OBJECTIVE: The radiologist and oncologist are often confident that biopsy will confirm their suspicion of recurrent disease, but a biopsy is performed to confirm the histologic diagnosis before beginning or altering therapy. We have examined data to determine how often the biopsied lesion represents recurrent disease from the primary tumor or is an instance of new cancer, and whether recurrent disease can be predicted. MATERIALS AND METHODS: We reviewed the medical and imaging records of 253 patients who underwent CT-guided biopsy of an abdominal or pelvic lesion between 1993 and 1996. Sixty-nine of the 253 patients had a previously diagnosed primary tumor and were being examined for possible tumor recurrence or metastasis. The images of these 69 patients were analyzed to determine if the pattern of disease was typical of recurrence or metastasis. RESULTS: In 55 of the 69 patients, the pattern was judged to be typical of metastatic or recurrent disease. Biopsy confirmed this suspicion in all 55 patients. In 14 of the 69 patients, the pattern of spread was judged not to be typical of recurrence or metastasis. These 14 patients were found to have a new primary tumor (n = 4), benign processes (n = 2), and recurrences (n = 8). CONCLUSION: Of the patients for whom radiographic findings suggested recurrence, we found no patients in whom a new primary tumor would have been missed if biopsy had been avoided. Data should now be acquired prospectively to determine whether it may be prudent to make treatment decisions on the basis of imaging findings alone, without histologic confirmation.

Abdominal Neoplasms↗
PubMed1999

Abnormal calcification on plain radiographs of the abdomen.

The purpose of this pictorial review is to facilitate recognition and understanding of calcifications seen on conventional radiographs of the abdomen. Calcifications can be categorized by organ system and location in the abdomen. Both common and rare calcifications in the urinary tract, liver, gallbladder, spleen, pancreas, adrenal glands, digestive tract, genital tract, peritoneal cavity, and retroperitoneum are illustrated. Abnormal calcifications in the urinary tract are subcategorized by kidneys, ureters, bladder, and urethra. The density, shape, size, margins, pattern, position, and mobility of calcifications are emphasized for differential diagnoses.

Adrenal Glands↗
PubMed1997

Imaging approach to staging of renal cell carcinoma.

Current imaging techniques, especially CT and MR imaging, make accurate preoperative staging of renal cell carcinoma possible. Because surgery provides the only effective therapy and because survival depends on local and distant extent, precise staging is critical for preoperative planning and prognosis. This article reviews the advantages, limitations, accuracy, and pitfalls of each of the imaging approaches to staging renal cell carcinoma, concentrating on CT and MR imaging. This information then is summarized in a suggested overall approach to staging renal cell carcinoma.

Carcinoma, Renal Cell↗
PubMed1997

The role of imaging in staging renal adenocarcinoma.

Numerous surgical options are available to physicians treating patients with renal adenocarcinoma. In the current clinical setting, imaging plays a key role in determining which options are selected. Newer imaging techniques such as helical CT with CT angiography, MRI, and ultrasound (US) have improved staging capabilities in this patient population. However, to approach staging accuracies recently reported, attention must be paid to proper imaging parameters. This article describes the strengths, limitations, and proper techniques used for staging renal adenocarcinoma with CT, MRI, and US.

Adenocarcinoma↗
PubMed1996

Computed tomography evaluation of colorectal carcinoma.

Knowledge of the extent of primary colorectal carcinoma at initial diagnosis is critical for proper management of disease. Currently, CT does not have a role in screening for colorectal carcinoma, though promising work on virtual colonoscopy is on the horizon. In patients with proven colorectal carcinoma, accurate prospective noninvasive assessment can identify those who may benefit from preoperative local radiotherapy, hepatic resection or cryoablation, or intra-arterial chemotherapy. CT should be considered complementary to the clinical assessment of colorectal carcinoma and to other modalities, such as barium enema, endorectal ultrasonography, MRI, and immunoscintigraphy. Although limited in evaluation of the primary tumor and local spread, CT has proven useful in assessing patients thought to harbor extensive local or metastatic disease. CT is generally the modality of choice for imaging the postoperative patient. The cross-sectional display of CT clearly depicts the operative bed, particularly after abdominoperineal resection. Baseline examinations should be obtained 2 to 4 months after surgery, with follow-up examinations every 6 to 9 months for 2 years, and yearly studies thereafter. CT-guided biopsies should be performed when findings suggest recurrent carcinoma.

Colon↗
PubMed1996

The perirenal space: relationship of pathologic processes to normal retroperitoneal anatomy.

The perirenal space may be involved by disease processes that arise within or outside the perirenal space. Key anatomic details that dictate the features of perirenal processes include the renal capsule, the perirenal septa, the renal fascia, and the conic shape and inferomedial orientation of the perirenal space. Superiorly, the perirenal space is open to the bare area of the liver. The perirenal spaces communicate with one another at the level of the lower lumbar vertebrae. The hallmark of perirenal infection is localized or diffuse gas. Chronic urinoma appears as an encapsulated cystic mass, often aligned parallel with the perirenal space. Fat within an apparent spontaneous hematoma of the perirenal space suggests angiomyolipoma. Renal cell carcinoma, lymphoma, and melanoma are the most common causes of discrete solid masses in the perirenal space; metastases occur due to the characteristic lymphatic and vascular supply of the space. Amyloidosis and fibrosis create a nonspecific rind of soft tissue around the kidneys. Diaphragmatic pseudotumor produces a linear "lesion" in the perirenal space.

Amyloidosis↗
PubMed1995

The CT nephrogram: implications for evaluation of urinary tract disease.

The urographic nephrogram is an important indicator of underlying functional and structural renal disease. With expansions in use of cross-sectional imaging, the computed tomographic (CT) nephrogram (ie, contrast material enhancement within the renal parenchyma) has assumed a greater role in the evaluation of urinary tract disorders. Both quantitative and qualitative nephrographic abnormalities are well demonstrated by CT, including global or segmental absence or persistence of the nephrogram, slowed temporal progression, striated pattern, and rim pattern. Global absence is nearly always unilateral and is most often seen with blunt abdominal trauma with renal pedicle injury. Segmental absence is attributable to focal renal infarction, most likely due to arterial emboli. Global persistence, which is much more common than segmental persistence, may be unilateral (caused by renal artery stenosis, renal vein thrombosis, or urinary tract obstruction) or bilateral (due to systemic hypotension, intratubular obstruction, or abnormalities in tubular function). Striated nephrograms may be unilateral or bilateral and are caused by ureteric obstruction, acute pyelonephritis, contusion, renal vein thrombosis, tubular obstruction, hypotension, and autosomal recessive polycystic kidney disease. The rim pattern is most often associated with renal infarction and occasionally with acute tubular necrosis and renal vein thrombosis. Careful evaluation of the CT nephrogram is an integral part of the abdominal CT examination.

Contrast Media↗
PubMed1995

Nodular sarcoidosis of the liver and spleen: analysis of 32 cases.

PURPOSE: To describe the computed tomographic (CT) appearance of nodular hepatosplenic sarcoidosis and its association with stage with chest radiography and clinical status. MATERIALS AND METHODS: Thirty-two patients (21 women, 11 men; aged 25-68 years) with nodular hepatosplenic sarcoidosis were evaluated. CT findings were described along with chest radiographic stage, clinical status, and level of angiotensin-converting enzyme (ACE). RESULTS: Nodules were small, multiple, and of low attenuation. Organomegaly was common. Abdominal adenopathy was present in 76% of the patients. Chest radiographs were normal in 25%; 61% had stage 1 or 2 radiographs. Abdominal or systemic symptoms were present in 66%. ACE level was elevated in 10 (91%) of 11 patients tested. No change in chest radiographic stage was noted in 74% of patients with follow-up radiographs. CONCLUSION: Nodular hepatosplenic sarcoidosis is associated with organomegaly, adenopathy, and symptoms. Nodules were not associated with advanced lung disease and did not herald a change in chest radiographic stage. An elevated ACE level may be helpful in diagnosis.

Adult↗
PubMed1995

Staging of renal adenocarcinoma: role of various imaging procedures.

Since the only successful curative treatment of renal adenocarcinoma is surgery, accurate radiologic information is crucial during initial tumor staging for optimal operative planning. Accurate radiologic staging can be achieved by use of proper imaging techniques, usually a combination of contrast-enhanced CT or multiplanar MR imaging with fast scanning techniques. These techniques permit the demonstration of regional lymph nodes, vascular extension, and distant metastases. Sonography and inferior venacavography are used occasionally to supplement the information obtained from CT or MR imaging. We review the principles of staging of renal adenocarcinoma, emphasizing the strengths and weaknesses of each imaging technique.

Carcinoma, Renal Cell↗
PubMed1992

Blunt upper abdominal trauma: evaluation by CT.

CT is the technique of choice for initial examination of hemodynamically stable patients after blunt abdominal trauma. It is highly sensitive, specific, and accurate for use in detecting the presence or absence of injury and defining its extent. Nonoperative management of many posttraumatic injuries, particularly in the liver, spleen, and kidney, is possible in part because of the diagnostic usefulness of CT. CT can be used effectively to visualize the progression of liver and spleen injuries in those patients chosen for conservative management. CT helps in treatment decisions in patients with renal injury by defining the character and extent and distinguishing minor from severe renal trauma. Posttraumatic injuries to the pancrease, bowel, and mesentery can be detected with CT. In these areas, however, signs may be subtle, and a significant injury may be missed on an initial examination.

Abdominal Injuries↗
PubMed1992

Evaluation of PACS in ultrasonography.

We review our experience with a picture archiving and communication system to replace film in the ultrasound section of a clinical radiology department. The system includes three ultrasound units connected by a fiberoptic network via acquisition nodes to a central data management system, workstation, and optical jukebox. The system handles 80% of sonographic studies in the department. Image production, interpretation, storage, and retrieval are evaluated. Despite limitations, a picture archiving and communication system can be integrated into a functioning ultrasound section of an active radiology department with minimal disruption and promising results.

Computer Systems↗
PubMed1989

Relationship between mammographic features and hormone receptor content in patients with breast cancer.

Recurrences of breast cancer are more responsive to hormone therapy if the tumors are positive for estrogen receptors or progesterone receptors. To assess the relationship between hormone receptor content, mammographic tumor morphology, and breast parenchymal patterns, we reviewed charts and mammograms of 210 patients with primary unilateral breast cancer. Mammograms of tumors in 97 patients were divided morphologically into five groups: (1) spiculated mass, (2) architectural distortion, (3) calcifications only, (4) circumscribed mass, and (5) tumor not visible. Estrogen receptor positivity was 81% (39/48) in group 1, 37% (7/19) in group 2, 17% (2/12) in group 3, 31% (4/13) in group 4, and 60% (3/5) in group 5 (P less than .001). Mean estrogen receptor content was also significantly different among groups (P less than .001). There was no statistically significant association between tumor morphology and progesterone receptors, or between calcifications and receptor status. In all 210 patients, hormone-receptor-positive tumors showed no association with mammographic parenchymal pattern. When direct assay of estrogen receptors is unavailable, mammographic appearance of the tumor may suggest the estrogen receptor status.

Breast Neoplasms↗
PubMed1987

Renal sinus histiocytosis.

A 26-year-old woman had an infiltrative renal lesion accompanied by massive regional lymphadenopathy. Biopsy of the renal mass and a coexistent orbital mass revealed identical histologic evidence of sinus histiocytosis. This unusual benign entity is uncommon in the kidney, but radiographically, it may closely simulate an infiltrative renal neoplasm, especially a lymphoma or leukemia or even renal cell carcinoma.

Adult↗
PubMed1987

Recurrent colorectal carcinoma: evaluation with barium enema examination and CT.

The efficacy of the barium enema examination and abdominal computed tomography (CT) was investigated in 81 patients who had undergone operation for colorectal carcinoma. Recurrent disease was found in 52 patients and was divided into local (anastomotic and perianastomotic) and remote (distant and hepatic metastases) types. In 32 patients with locally recurrent carcinoma, the sensitivity of the barium enema examination was 88%; for CT it was 69%. Conversely, the barium enema examination was not useful for detecting remote metastases shown on CT, which disclosed disease at one or more sites in 47 (90%) of the 52 patients. CT best evaluated recurrences remote from the anastomosis, pelvic recurrences in patients with colostomies, and hepatic metastases. Barium enema examination and CT were therefore found to be complementary modalities.

Adolescent↗
PubMed1985

Superior vena caval obstruction: detection using CT.

A review of 210 chest computed tomographic (CT) examinations demonstrating upper chest masses revealed 16 cases of superior vena caval obstruction (SVCO); 11 of these were clinically occult. Two of the occult cases subsequently became clinically evident. Contrast-enhanced chest CT permits the diagnosis of clinically occult SVCO and should be considered in patients with upper chest masses, even in the absence of any physical signs of SVCO.

Aged↗