Can the radiologist recognize Helicobacter pylori gastritis?

To evaluate radiologic findings of Helicobacter pylori (H. pylori) in the upper gastrointestinal (UGI) tract, we retrospectively reviewed consecutive records of 676 symptomatic adults with gastric biopsies (224 positive) and 150 symptomatic adults with rapid urease tests (57 positive). All the UGI series of patients with positive biopsies or urease tests for H. pylori were compared with the UGI series of patients with negative urease tests. UGI examinations were evaluated blindly by two gastrointestinal radiologists without knowledge of clinical findings, original radiologic interpretations, or test results. They agreed that 8 of 18 (44%) UGIs of patients with H. pylori had abnormally increased gastric folds in the fundus, body, or antrum as compared with none of 14 (0%) UGIs of patients without H. pylori (p < 0.01) (P.P.V. = 1.0). Interobserver agreement was good (kappa = 0.63). Endoscopy in the eight patients with radiographic evidence of enlarged gastric folds all demonstrated marked abnormalities such as prominent gastric folds, gastric erythema, erosions, or peptic ulcers. Our findings indicate that enlarged gastric folds on the UGI series of a symptomatic adult are very suggestive of H. pylori gastritis.

Limitations in distinguishing malignant from benign lesions of the breast by systematic review of mammograms.

Our objective was to assess whether or not a systematic review of mammographic descriptors would result in improved classifications of nonpalpable lesions of the breast and reductions of biopsies for benign conditions. The prelocalization mammograms of 200 consecutive patients who had 231 biopsies were reviewed in random order by four radiologists experienced in mammography. Each reader assessed the presence of 32 specific descriptors regarding masses and calcifications. The following descriptors were highly associated with malignancy: for masses, inhomogeneous density; irregular shape; spiculated borders; and for calcifications, many calcifications; microcalcifications; linear or branching patterns, or both, and high spatial density. For masses, the descriptors highly associated with benignity were homogeneous density, oval shape and sharp or lobulated borders. For calcifications, the descriptors highly associated with benignity were solid, round and irregularly shaped. Readers indicated their over-all rating of each lesion, ranging from definitely benign to definitely malignant. Ratings were compared with the findings of pathologic reports (181 benign to 50 malignant), and receiver operating characteristic analyses were performed. The areas under the curves (A[z]) varied from 0.65 to 0.78. If biopsies had not been performed on those patients who were judged to have most likely benign lesions, one could reduce the number of biopsies for benign conditions by 48 to 69 per cent; however, 18 to 46 per cent of the malignancies would be missed. We conclude that diagnoses based on a systematic review of descriptors are not sufficiently accurate to reduce the number of mammary biopsies.

Complications of percutaneous nephrolithotomy.

Of 582 patients who underwent percutaneous nephrolithotomy, 4% had complications. The most common complications were fever (23%) and bleeding necessitating transfusion (12%). Extravasation was seen in 7% of patients and transient ureteral obstruction in 6%. Other complications included pneumothorax or hydrothorax, pneumonia/atelectasis, paralytic ileus, nephrostomy-tube dislodgment or urine drainage from the flank lasting more than 1 week, significant infection, urinoma formation, renal pelvic laceration, ureteral avulsion, ureteropelvic or ureteral stricture, bowel injury, or escape of stone fragments into the retroperitoneum. Seven patients (1%) required immediate surgery: four to repair renal pelvic lacerations, one to repair a ureteral avulsion, and two to control bleeding after nephrostomy-tube removal when embolization failed. Four patients required delayed surgery for ureteral or ureteropelvic junction strictures, which may have been caused by a tissue reaction to the stones rather than by the procedure itself. There were two deaths--one from respiratory failure in a patient with severe interstitial pulmonary fibrosis and chronic renal failure and the other from myocardial infarction in an obese diabetic patient with hypertension.

Percutaneous nephrolithotomy: analysis of 500 consecutive cases.

The first 500 patients who underwent percutaneous stone removal at our hospital and who have been evaluated for at least 8 months were reviewed. Comparison of the first 100 patients with the entire series showed a sharp improvement in the success rate as the radiologic and urologic team gained experience. The success rate for simple pelvicaliceal stones was 98% in the entire series (vs. 89% in the first 100 cases) and 87% for staghorn calculi. The most common complication was bleeding, with 12% of the patients requiring transfusion. Other complications include infection (0.6%), retained stone fragments (4%), and ureteropelvic junction stricture (1%). There was 1 death, an obese diabetic woman who suffered a myocardial infarction. Successful stone extraction requires a properly placed nephrostomy tract, and radiologic and urologic expertise. The advent of extracorporeal shock-wave lithotripsy will not abolish the need for nephrostolithotomy.

Percutaneous extraction of renal stones: experience in 100 patients.

Recent developments in technology and instrumentation have made it possible to remove most kidney stones and many ureteral stones percutaneously. The first 100 cases at this institution were reviewed in which grasping, ultrasonic lithotripsy, basketing, and irrigation were used. In all cases, the follow-up was at least 1 year. The success rates were 92.4% for renal pelvic stones, 92% for caliceal stones, and 68% for ureteral stones. Ten of the 14 patients who required open operation after an unsuccessful percutaneous procedure were among the first 18 patients, whereas only one open operation was needed in the last 40 patients. Proper patient selection; the size, number, and location of stones; proper selection of the nephrostomy site; and the expertise of the operator are critical factors in determining the success rate. To date, the short-term results of percutaneous stone removal have been as good as those of open surgery.

Computed tomography of diverticulitis.

Six cases of diverticulitis were studied by means of pelvic computed tomography (CT) and contrast enema. CT is effective in defining the intramural and extracolonic component of diverticulitis; abscess formation in the extracolonic space resulted in consistent changes in the contour of the opacified urinary bladder. Inflammatory extracolonic masses were imaged on CT as low or mixed-attenuation lesions frequently containing pockets of gas. Bladder wall thickening and edema, as well as contour asymmetry of the opacified and distended bladder, were reliable indicators of pericolonic or extracolonic extension of diverticular disease. Contrast enema and sigmoidoscopy are inherently limited in the evaluation of diverticulitis; CT of the pelvis reveals secondary changes outside the mucosa and bowel wall, CT directly images the inflammatory mass and associated changes in pelvic anatomic relationships. CT findings of pelvic inflammatory mass are not specific for abscess of diverticular origin; however, CT interpretation is reliable and confident since it is directed by the supporting findings on contrast enema. Integrated study by CT and contrast enema effectively defines the extent of disease in patients with diverticulitis. Summary evaluation of these studies has a serious impact on the choice of medical or surgical management.

CT of gastric masses: image patterns and a note on potential pitfalls.

Computed tomography (CT) was performed in 9 consecutive cases of primary gastric neoplasm. Lesions were surgically or endoscopically proved; cross-sectional images are correlated to specific histopathology in each case. The CT images of leiomyoma and leiomyoblastoma are characterized as models of pure bulging intramural growth resulting in a lunate contrast distribution when imaged in the cross-sectional plane. In 5 cases of lymphoma, distortion of the contrast-filled hollow viscus is relatively consistent. Nodular growth is reflected on the CT image as a series of digitations encroaching on the opacified portion of the gastric lumen. Image pattern recognition, relative to histopathology, is of more than academic interest since endoscopy is frequently unreliable in cases of submucosal and exophytic pathology. Further, biopsy of such lesions is commonly nondiagnostic as a result of random choice of biopsy site or inadequate depth of tissue sample. Additionally, this report includes images of lesions that simulate the primary gastric pathology and may be a source of erroneous interpretation. These include: pseudocyst of the pancreas (2 cases) and enlargement of the left lobe of the liver with encroachment on the gastric lumen (1 case). Image specificity on CT examination is increasingly essential to diagnosis and surgical planning.