Hepatic imaging by computed tomography: a comparison with 99mTc-sulfur colloid, ultrasonography, and angiography.
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Biomedical subjects
Publications and source records attributed to R R Hattery.
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Detecting pulmonary metastasis is important when planning surgical therapy, radiotherapy, or chemotherapy in patients with known malignancy. A series of 91 patients was studied by both whole lung tomography and computed tomography (CT) of the lungs. More pulmonary nodules were detected with CT than with whole lung tomography in 32 (35%) of the patients. Of the 91 patients in the study, 31 had resection of some or all of the pulmonary nodules. In 27 patients, the nodules were primary or metastatic malignant lesions. Bilateral pulmonary nodules were detected with CT in 13 patients when whole lung tomography had demonstrated nodules in only one lung. CT has replaced whole lung tomography as the method preferred by the authors for detecting pulmonary nodules in selected patients at risk to develop pulmonary metastasis.
Ureteral obstruction occurring five years or more after renal transplantation is uncommon and may mimic allograft rejection. In 2 patients who had received cadaveric renal allograft, ureteral obstruction was detected six and one-half and five and one-half years after transplantation. In both patients, surgery was needed to restore normal renal function and to prevent further renal damage. Excretory urography is important in the follow-up of patients who have undergone renal transplantation, and conditions such as ureteral obstruction should be ruled out before antirejection treatment is started.
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.
The authors assess the efficacy of CT of the pancreas in a series of 151 patients with suspected pancreatic carcinoma. CT diagnoses were divided into four categories based on the original interpretation: "mass" or carcinoma (53 scans); normal pancreas (68 scans); normal pancreas, but another pathologic process was discovered on the CT scan (20 scans); and unsatisfactory or indeterminate examinations (10 scans). In more than 50% of the erroneous diagnoses of pancreatic carcinoma, the mass lesion seen on CT was found at surgery or angiography to be adjacent to, not arising from, the pancreas. False-positive interpretation can be avoided by improved equipment and technique and the accumulation of interpreter experience.
The diagnostic value of computed tomography (CT) of the liver depends on proper conduct of the examination, knowledgeable interpretation of findings, and an appreciation of the capabilities and limitations of the method. This report documents 10 months of experience with abdominal CT in more than 600 liver examinations using a system fast enough to eliminate respiratory motion. This experience supplied data on the CT appearance of the normal liver and its variations and of various hepatic abnormalities, on the conduct of the examination, including the appropriate of contrast material, and on some of the problems that reduce the technical quality of the examination. CT was highly accurate, but not infallible, in detecting and defining space-occupying lesions and in detecting fatty infiltration; it was less helpful in detecting diffuse hepatic disease. In bile duct obstruction, CT displayed not only the dilated ducts but often the obstructing lesion.
Computed tomography (CT) and radionuclide examinations of the liver and pancreas in 50 patients were compared retrospectively to evaluate their value as diagnostic tests. CT was superior to 75Se-selenomethionine in evaluating pancreatic disease. Both 99mTc-sulfur colloid scans and CT scans were sensitive detectors of liver masses; however, there were more false positive 99mTc-sulfur colloid scans (16% compared to 4%). CT was superior in detecting biliary obstruction and ascites, in assessing diseases that involved the liver extrinsically, and in evaluating the status of adjacent organs. 99mTc-sulfur colloid scans were more sensitive in detection of diffuse non-neoplastic liver diseases (cirrhosis, hepatitis, and cholangitis). Simultaneous interpretation of CT and radionuclide scans was often more helpful than independent interpretation, and the two techniques are therefore complementary.
From 1964 to 1974, 1,668 patients with renal carcinoma were seen at the Mayo Clinic. Bone metastases were present in 167 of these patients (only lung metastatic involvement ranked higher in frequency). More than one-third of the patients with bone metastasis from renal carcinoma had this as a presenting lesion of occult renal tumor. This group constituted 4% of all patients with renal carcinoma evaluated during the study period. While most bone lesions were in the pelvis and lower lumbar spine, any bone may be involved. All patients with bone metastases from renal carcinoma have a poor prognosis. However, some bone lesions appeared as long as 10 or more years after the initial tumor. The most common radiographic features are a lytic destructive process with indistinct margins, erosion of the cortex, and frequent expansion into the soft tissues. Pathological features are common in the long bones, and calcifications are occasionally seen. The synovial joints are not affected. A well defined sclerotic margin is a common finding after radiation treatment, although it is not a reliable indicator of the stability of the lesion.
Nineteen patients with primary and recurrent retroperitoneal tumors were examined by computed tomography. Correlation between CT and subsequent operative findings was remarkably accurate. CT provided clinically useful information regarding the presence, size, extent, and composition of the tumors and also their effect on adjacent structures. CT is recommended for any patient suspected to have a primary or recurrent retroperitoneal tumor.
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Computed body tomography is an easily accomplished method that precisely displays the normal and pathologic anatomy of the retroperitoneal space. Suspected retroperitoneal disorders, which are often clinically confusing or obscure, can now be detected or excluded with remarkable accuracy. Few innovations in radiology have more effectively fulfilled such a conspicuous need.
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Forty-eight patients undergoing elective repair of an abdominal aortic aneurysm were randomly selected for correlation of diagnosis of aneurysm and aneurysm size as determined by direct surgical measurements, ultrasound examination, and lumbar spine X-ray. The preoperative diagnosis was confirmed by lumbar spine plain films in 72% of patients and by B-mode ultrasound in all of patients. Aneurysm size could be measured by lumbar spine X-ray in 55% of patients and with gray-scale B-mode ultrasound in all of patients. The average difference between surgically measured and roentogenographically determined aneurysm size was 1.5 cm in the transverse diameter and 0.87 cm in the anteroposterior diameter of the aneurysm. The average difference between surgically measured aneurysm size and ultrasound-determined external wall diameter of the aneurysm was 0.42 cm in the transverse diameter and 0.29 cm in the anteroposterior diameter. From these data we conclude that gray-scale B-mode ultrasound of the aorta is a more sensitive and accurate method of assessing abdominal aortic aneurysms than is the use of lumbar spine X-ray.
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Performance evaluation of equipment for computed tomography (CT) involves the integration of: (a) establishing performance criteria; (b) designing and implementing test procedures; and (c) reconciling test results in terms of desired performance. Precision (noise), contrast scale, linearity, accuracy, spatial independence, spatial resolution, artifacts, reproducible performance, and patient exposure are several parameters discussed, as are problems of measurement with regard to non-water bath scanners. Performance and quality control tests for the ACTA, Delta, and EMI scanners are outlined. Guidance for the prospective purchaser of CT equipment is presented as a summary of the ideas discussed.