Clinical magnetic resonance imaging.
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Biomedical subjects
Publications and source records attributed to R J Alfidi.
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In this preliminary report, computerized tomography guidance was instrumental in allowing the safe and rapid removal of a metallic foreign body from paravesical soft tissues deep within the male pelvis. Hopefully, expanded future experience with this technique will further clarify its value in the management of retained foreign bodies.
The authors are preparing a series of communications on CT-guided biopsy procedures to be published in future issues of this journal. The present article, which previously appeared in the Cleveland Clinic Quarterly, is intended to serve as an introduction to the concept of CT-guided biopsies. Because the principles of the biopsy procedure remain the same, we do not believe that a "rewrite" of the previously published article would be required. We hope that by presenting this article and subsequent articles concerning the use of CT-guided biopsies, the reader will acquire an appreciation of the proper role of this exciting new technique in comparison to the available imaging modalities. We believe that as individuals become more experienced with the imaging capabilities of these CT devices, they will want to develop the technique of obtaining biopsy confirmation of the imaging diagnosis.
Computerized tomography scanning of the chest and abdomen has been used as a diagnostic technique in more than 4,500 patients since 1974, 190 of whom had histologically proved disorders of the genitourinary system and retroperitoneum. On the basis of this experience computerized tomography scanning has been found to be safe and effective, and offers certain advantages over conventional techniques. The number, extent and content of renal mass lesions can be determined with relatively great accuracy. The presence and extent of metastases into the retroperitoneum, liver and chest can often be shown by computerized tomography scanning when other tests are negative. Placement of needles for aspiration, biopsy, injection of contrast medium or insertion of drainage tubes can be done more accurately under computerized tomography control. Computerized tomography in itself is non-invasive, carries a low radiation exposure comparable to other radiographic procedures and therefore, can be valuable in following the course of patients with various diseases during and after therapy. While scanning will not replace other diagnostic procedures it should lead to a more judicious selection of potentially hazardous tests in selected cases, such as angiography, aspiration and open biopsy.
Computed tomography (CT) was used to study 79 patients with suspected gallbladder disease. First and second generation scanners were used to determine the efficacy of CT in detecting cholecystitis or cholelithiasis. Manifestations of gallbladder disease such as hydrops, opaque and nonopaque gallstones, chronic cholecystitis with thickened inflammatory walls, and secondary liver abscesses can be easily detected. It is a useful technique for individuals in whom the gallbladder has failed to opacity on oral cholecystography. The scanning method is described, and estimates of reliability are given including its accuracy, limitations, and place in the management of gallbladder disease, especially cholelithiasis. When conventional radiographic examinations or ultrasound fail to give definitive diagnostic information, CT can be a useful alternative with an overall diagnostic accuracy greater than 80%.
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In the institutions represented by the authors, more than 7,500 body CT examinations have been performed. Body CT has been found to be particularly useful in solving specific problems, especially when other diagnostic procedures yield confusiing results. Radiologists and their collegues, and not governmental agencies and insurance companies, should define the experimental, research and clinical usefulness of computed tomography.
In a group of 188 patients, 192 computed tomographic (CT) scans of the pancreas were done, and the diagnostic accuracy of CT determined relative to other modalities. CT was the most effective method of detecting neoplastic and inflammatory diseases. The full extent of the disease process, including involvement of the retroperitoneum and metastasis to the liver, was visualized with one examination. Calcification and cystic collections associated with pancreatitis were also clearly seen.
Computed tomography (CT) is effective in detecting intraabdominal abscesses. Loculations of fluid and extraluminal gas are clearly localized in relation to other organs. Of 22 abscess in this series, CT successfully detected 20; comparative information with gallium, techneticum, and ultrasound scans is presented. In addition to localizing these collections, CT can be used to guide needle aspiration and drainage procedures. Three sizes of needles were used to aspirate specimens and/or provide drainage. This was accomplished successfully in 12 of 14 CT-guided procedures.
Percutaneous antegrade pyelography and percutaneous nephrostomy can be easily performed using CT guidance. CT provides cross-sectional images which facilitate accurate needle placement into the renal pelvis. CT is capable of detecting subtle density differences within the tissues so that even renal pelvises which do not contain contrast material and are not dilated can be accurately punctured. In addition to these procedures, CT accurately displays the perinephric space so that assessment of complications is possible. Four of five attempted percutaneous nephrostomies and two antegrade pyelograms were successfully performed using CT gudance.
Forty-four patients with confirmed biliary diseases were studied to determine the value of computed tomography (CT) in the diagnosis of biliary pathology. The results indicate that CT is useful and highly accurate in differentiating between obstructive (surgical) and nonobstructive (medical) disease entities. Of the cases with proved obstruction, 88% were correctly identified. All of the nonobstructive cases had positive CT correlation. In addition, the underlying cause of the occlusion was determined in the majority of cases.
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We attempted to control variceal hemorrhage, using transhepatic variceal sclerotherapy of a coronary varix. The procedure transiently controlled hemorrhage, but bleeding resumed from short gastric varices hours later.