BACKGROUND: To define radiographically simple prolapse or intussusception in cases of distal migration of duodenal tumors. METHODS: In one pyloric and four duodenal tumors showing distal migration, the findings of gastrointestinal contrast examinations were retrospectively evaluated in relation to CT and operative findings. RESULTS: All lesions were intraluminal growing and well demarcated, and they included two carcinoids, a papillary adenoma, a Brunner's gland adenoma, and a hyperplastic polyp. All lesions were accompanied by long mucosal stalks, and, in three, folding deformity of the proximal jejunum was observed. CT showed no target signs except for one with gastroduodenal intussusception. Intussusception was not verified surgically in any cases. CONCLUSION: Distal migration of duodenal tumors can occur as the result of mucosal elongation and slipping. Duodenojejunal intussusception is not necessarily associated with that phenomenon.

Adenoma↗

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Prostatic abscess in young males: a rare complication of Crohn's disease.

We report a rare case of prostatic abscess with Crohn's disease in a 21-year-old male. Computed tomography showed a typical prostatic abscess. Moreover, filling of the abscess cavities with contrast medium was demonstrated after micturition, which represented the rupturing of the abscess into the urethra. Crohn's disease should be included in the differential diagnosis of prostatic abscesses even in young males.

Abdominal Abscess↗

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Subtraction CT with low-flow-rate arterial contrast injection to estimate drug distribution during balloon-occluded arterial chemotherapy infusion for bladder cancer.

PURPOSE: To simulate drug distribution during balloon-occluded arterial chemotherapy infusion (BOAI) for urinary bladder cancer using subtraction computed tomography (CT) with low-flow-rate arterial contrast injection (S-CTLA). METHODS: Ten patients with bladder cancer underwent S-CTLA, and the distribution of contrast agent during BOAI into both internal iliac arteries simultaneously was evaluated in nine pairs of internal iliac arteries and one single artery. For S-CTLA, spiral CT data were acquired before and after 0.2 ml/sec intraarterial injection of contrast material. The enhancement of the urinary bladder wall, the gluteal muscles, and the pelvic bones was categorized using a 4-grade scale. The grades were compared in each of the three pelvic components and differences were tested for significance using the Wilcoxon test for paired groups. RESULTS: S-CTLA revealed the distribution of the contrast agent clearly. Gluteal muscles grades were significantly higher than those of the other two assessed components. CONCLUSION: BOAI does not improve the concentration of contrast agent to the bladder wall over neighboring structures, suggesting that the balloon occlusion technique does not achieve its desired goal for chemotherapy targeting.

Aged↗

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PACS and the reporting system. Present status of PACS in the University of Tsukuba.

In the University of Tsukuba, PACS research is being carried out with a special emphasis on the reporting system. The radiological diagnostic system in Japan is not sufficiently developed and the number of diagnostic radiologists in Japan is not as large as in many European countries (M. Akisada, Present status of PACS activities in Japan. Med. Inform. 13 (1988) 289-293). With recognition of this fact, PACS research in Japan should also focus on the reporting system. Recently, the first PACS workstation was installed in the Department of Radiology of the University Hospital, but it has not yet been put to clinical use. Reports can be made on this workstation while viewing the properly provided digital images of MR and CT. As to the concepts of the reporting system, there are three important points. The first one is the double check system to maintain the standard quality of diagnostic performance. This system is expected to provide proper training and education to students and young doctors (S.E. Selzer, S.J. Hessel, P.G. Herman et al., Resident film interpretations and staff review. Am. J. Radiol. 137 (1981) 129-133). The second one is to develop a transcriber workstation, through which reports are easily handled as routine work. The last point is to provide a well-organized diagnostic coding system. For this purpose, a modified IRD (Index for Radiological Diagnosis, by the American College of Radiology) is assumed to be one of the best choices.

Computer Systems↗

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CT of the medial umbilical folds.

PURPOSE: The goal of our study was to investigate the appearance of the medial umbilical folds on CT. METHOD: We retrospectively reviewed the CT images of 30 consecutive patients with massive ascites. In addition, we inspected the inner pelvic wall in cadavers. RESULTS: The medial umbilical folds were well recognized on CT in 21 of 30 patients, bilaterally in 20 and unilaterally in 1. In four patients the folds were undetectable after the ascites resolved. The CT findings were supported by those studied in cadavers, in which the folds were recognized as a peritoneal reflection in 13 of 20. CONCLUSION: We concluded that medial umbilical folds could be commonly visualized on CT when ascites was present.

Administration, Oral↗

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Early radiation effects on the liver demonstrated on superparamegnetic iron oxide-enhanced T1-weighted MRI.

Early radiation-induced liver injury during radiotherapy detected by a particulate reticuloendothelial MR contrast agent (superparamagnetic iron oxide; SPIO) is described in a patient with cholangiocarcinoma. The irradiated hepatic parenchyma appeared as a heterogeneous, less decreased signal intensity area than the nonirradiated area on MR images after SPIO administration. Resultant differences in signal intensity were better visualized on SPIO-enhanced T1-weighted images than SPIO-enhanced T2-weighted images, although SPIO-enhanced T2*-weighted fast field echo imaging was the most sensitive.

Contrast Media↗

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Reevaluation of spiral CT cholangiography: basic considerations and reliability for detecting choledocholithiasis in 80 patients.

PURPOSE: The purpose of this work was to reevaluate the characteristics and diagnostic accuracy of spiral CT cholangiography (CTC) for detecting biliary calculi. METHOD: Spiral CTC was performed in 133 patients with suspected biliary or pancreatic diseases. All source images were reviewed by two radiologists who were unaware of final diagnoses. Attenuation values of bile were correlated with biochemical data and visualization of anatomic detail. The statistical measures in detecting the presence of choledocholithiasis were calculated in 80 patients with confirmed diagnoses. RESULTS: Statistically significant correlations were found between the degree of biliary enhancement and both serum bilirubin and alkaline phosphatase levels. Of the 80 patients, 18 (23%) had choledocholithiasis and 62 did not. Observers diagnosed them with a sensitivity of 89% and a specificity of 98%. A mild adverse reaction to contrast material was observed in three (2.3%) patients. CONCLUSION: Spiral CTC is a reliable, noninvasive, and accessible technique for detecting choledocholithiasis.

Adult↗

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Intrahepatic portosystemic venous shunts: spectrum of CT findings in external and internal subtypes.

PURPOSE: The purpose of this work was to survey the spectrum of CT findings in intrahepatic portosystemic venous shunts (IPSVSs). METHOD: One thousand consecutive liver CT scans examined with an enhanced helical technique were retrospectively reviewed on workstation to find IPSVSs. RESULTS: IPSVSs were noted in 37 patients and divided into two subtypes according to the location of the communicating systemic vein, either outside (external type, n = 34) or within (n = 4) the liver (one patient had both internal and external types). All the external-type shunts were noted in cases with portal hypertension (n = 34). Most shunts (n = 30) ran through segment 4 and/or 3 and came out near the falciform ligament, but five shunts were noted in segment 2 communicating either with the systemic vein (n = 3) or probably with an enlarged left gastric vein (n = 2). Solitary portohepatic venous shunts (internal type) were noted in three cases with (n = 2) or without (n = 1) aneurysmal dilatation and many portohepatic venous shunts in another patient. CONCLUSION: IPSVSs of the external type were far common than those of the internal type, always associated with increased pressure of the portal system and in specific sites probably lacking the hepatic capsule.

Adult↗