The early manifestation of Yersinia colitis demonstrated by the double-contrast barium enema.

A 19-year old female with a bloody, diarrheal illness of acute onset where Crohn's disease primarily was suspected is presented. The double - contrast barium enema revealed multiple, diffusely scattered aphthous erosions of the colonic mucosa: the rectum was scarcely affected. Biopsies taken by endoscopy demonstrated nonspecific inflammatory changes of the mucous membrane. However, routinely taken stool cultures revealed an infectious colitis due to Yersinia enterocolitica. Our case demonstrates the necessity to consider Yersinia enterocolitis in the radiographic differential diagnosis when the diagnosis of Crohn's disease or ulcerative colitis seems obvious.

Demonstration of thoracic and abdominal fistulas by computed tomography.

One case of esophago-pleural fistula and one case of cutaneo-hepato-colonic fistula demonstrated by computed tomography (CT) are presented, and the value of CT in the diagnosis of fistulas is briefly discussed.

Radiological examination of the nasal cavity.

The complex anatomy of the interior of the nose presents a challenge in radiological imaging. Several radiologic modalities applied in the assessment of anomalies and pathologic changes in the nasal cavity are presented, illustrated by reference to various cases. The excellent ability of computed tomography to reveal valuable information concerning both benign and malignant lesions is emphasized. Magnetic resonance imaging has further extended the possibilities in diagnosis because of its high soft-tissue contrast resolution and multiplanar imaging capabilities.

Calcifications of the palatine tonsillary region: CT demonstration.

The scans of 100 consecutive patients referred for computed tomographic examinations that included the oropharynx were reviewed with regard to calcifications of the palatine tonsillary region. Calcifications were found in 20% of the female patients and 13% of the male patients. Ten patients had one calculus, and six had two or more. The sizes of the calculi ranged from 1 to 7 mm. Tonsillary calculi must be included among the diagnostic possibilities when survey radiographs of the neck show soft-tissue calcifications.

Carcinoid infiltration and fibroplastic changes of the mesentery as a cause of malabsorption.

The presentation of carcinoid involvement of the mesentery is described, with clinical manifestation of severe malabsorption: angiographically it resembled retractile mesenteritis. The special biologic activity of the carcinoid cells inducing fibroblastic activity with secondary alterations of vascular, lymphatic and neural structures of the mesentery is discussed in relation to the altered physiology and morphology of the intestine, causing the clinical picture of sprue.

Vascular mass lesions and hypervascular tumors in the head and neck. Characteristics at CT, MR imaging and angiography.

A retrospective analysis of the findings at contrast-enhanced CT, MR imaging and angiography in 24 patients with vascular mass lesions and 11 patients with hypervascular tumors in the head and neck region was undertaken. We attempted to find criteria at CT and MR imaging that could aid in differentiating between different lesion categories. Parameters such as contrast enhancement at CT, signal intensities at MR imaging, phleboliths and peritumoral hypervascularity were correlated to clinical presentation, biopsies and angiography. MR imaging was superior to CT and far better than angiography in delineating cavernous hemangiomas. Contrast-enhanced CT may better differentiate between cavernous and capillary hemangiomas than MR. MR imaging clearly differentiated cavernous hemangiomas from hypervascular tumors, but was, like CT, inadequate for distinguishing between capillary hemangiomas and hypervascular tumors. Lymphangiomas and cavernous hemangiomas had similar appearances at CT and MR imaging.

CT and angiography in chronic liver disease.

Detailed correlation of CT and angiographic findings in a retrospective analysis of 25 cases of portal hypertension is presented. The largest diameters of the common and proper hepatic arteries, the portal, splenic, and superior mesenteric veins, and perigastric veins were measured by the two methods, including a CT control series of 20 subjects. The splenic transverse diameter was also measured. Portosystemic collaterals and concomitant pathology disclosed by the two methods were compared. A ratio of nearly 1 was found between vessel diameters measured by angiography and CT, and about 1.3 for splenic size, applying uncorrected measures from angiographic films and a vernier caliper on CT studies. The diameters of hepatic arteries, splenic, and superior mesenteric veins and spleens were significantly larger than those of controls. Except for demonstrating arterial details and esophageal varices, CT was found equal or superior to angiography in mapping portosystemic collaterals, and to disclose concomitant pathology.

CT and MR imaging of primary tumors of the masticator space.

A retrospective study of CT and MR examinations in 14 patients with benign and malignant tumors originating in the masticator space is presented. At presentation, 12 patients revealed tumor extension to adjacent regions and spaces. Perineural tumor spread along trigeminal nerve branches to the cavernous sinus and orbits was combined with facial pain, and/or numbness, ophthalmoplegia, and exophthalmus. Detailed analysis of tumor growth and spread, enhancement and signal features at CT and MR imaging indicated the tumor histology was, with a few exceptions, nonspecific. More extensive growth and bone destruction was noted only among malignant tumors. MR imaging was found superior to CT in delineating tumor extension due to better soft tissue contrast resolution and multiplanar imaging. Posttreatment examinations were available in 11 patients and showed long-standing regional edema of the adjacent temporal lobe and masticator muscles in 4 out of 5 patients without clinical evidence of tumor. In 6 patients, CT and MR features were found almost unchanged with only small size differences after various forms of treatment.

CT compared to angiography for staging of tumors of the pancreatic head.

A retrospective study of 32 patients with malignant tumor of the pancreatic head and ampullary region is presented. The aim of the study was to compare the ability of CT and angiography to evaluate the peripancreatic vessels, and to correlate the results of tumor staging based upon CT criteria to angiographic and surgical findings. In 5 patients (16%) CT disclosed contiguous tumor growth around vessels not discernible at angiography and, in contradiction to previous reports, angiography added no valuable information regarding main vessel involvement. In terms of sensitivity, specificity, and positive predictive value CT was more accurate in predicting unresectable than resectable tumors, the former with a sensitivity of 92% and a specificity and positive predictive value of 100%.

Gastrointestinal lymphoma with total involvement of the gut--report of one case.

One case with the roentgenologic demonstration of total primary gastrointestinal lymphoma is presented, to the author's belief as the first in the radiologic literature. Special attention is also paid to the manifestations in the esophagus and the stomach.

Perivascular low attenuation zone at CT of liver transplants. A follow-up study.

A follow-up study of 30 liver transplant patients confirmed that periportal and pericaval rims of low attenuation found at CT reflect hepatic lymph stasis. The perivascular rims are found coexistent with acute allograft rejection, but are not correlated with acute rejection, immunosuppressive agents (cyclosporin A), or intercurrent infection. Disappearance of the perivascular low attenuation zone in our material coincided with normalization of liver biochemistry probably associated with reestablishment of lymphatic drainage. Like previous reports on experimental hepatic lymph stasis, our study thus indicates that lymph stasis may have harmful effects on human liver allografts.

CT, MR imaging and angiography in pancreatic apudomas.

Findings at CT, MR imaging and angiography in 29 patients with pancreatic apudomas are presented. CT and angiography were performed in all the patients, MR imaging in 10. Twenty-five patients underwent laparotomy. The ability of the different imaging methods to localize the primary tumor and detect hepatic metastases was compared. CT and MR imaging depicted the primary tumor in 79% and 88% of the cases respectively, angiography in 72%. Enhancement patterns at CT and signal intensity variations at MR imaging were unspecific parameters regarding different types of tumors. CT and MR imaging were considerably more accurate than angiography in evaluating local tumor resectability. Angiography revealed more numerous small hepatic metastases (< 0.5 cm) than CT or MR imaging, but missed metastases in the left lobe in 5 patients. MR imaging seems promising in localizing and characterizing pancreatic apudomas, but further evaluation is needed before any conclusion can be drawn. At present dynamic incremental CT seems mandatory in the evaluation of pancreatic apudomas. Angiography is of value for preoperative and preembolization vascular mapping, and in localizing small pancreatic apudomas not shown at CT or MR imaging. Faster dynamic thin slice CT scanning and fast-sequence MR imaging may increase the sensitivity of detecting small primary pancreatic apudomas.

Staging of carcinoma of the palatine tonsils by computed tomography.

In a retrospective study of 24 patients with biopsy-verified tonsillar malignancies, the tumoral staging by CT and by clinical examination were compared, applying the criteria of the 1983 edition of the International Union Against Cancer; the T classifications corresponded well. The N classifications, however, differed, as CT showed more advanced lymph node disease than indicated by clinical examination. Involvement of the jugulodigastric node was diagnosed equally well by CT and by palpation. Computed tomography revealed more suspect nodes than palpation in the rest of the anterior chain and in the posterior triangle.

Carcinoma of the hypopharynx: CT staging.

The CT examinations of 42 patients with carcinoma of the hypopharynx were analyzed. Tumor site of origin and detailed patterns of extent and spread were noted and a T and N classification attempted. The results were compared to findings achieved by palpation, mirror examination, laryngoscopy, and hypopharyngoscopy. Computed tomography yielded valuable information concerning submucous tumor extension and cartilage involvement. The additional information obtained by CT led to upstaging 29% of the cases to a higher T level and 36% of the cases to a higher N level.

High resolution CT and bronchography in the assessment of bronchiectasis.

To elucidate the reliability of CT in the assessment of bronchiectasis, a retrospective study of high resolution CT and bronchography was carried out. A segment by segment comparison of 259 segmental bronchi from 70 lobes of 27 lungs in 19 patients was performed using bronchography as standard. CT was positive in 87 of 89 segmental bronchi with bronchiectasis giving a false-negative rate of 2%. CT was negative in 169 of 170 segmental bronchi without bronchiectasis at bronchography, giving a false-positive rate of 1%. There was agreement between the two modalities in identifying the different types of bronchiectasis.

CT findings in benign expansions of the larynx.

The CT findings in six patients with benign laryngeal expansions are reported. Although CT in laryngeal carcinomas has been extensively dealt with in the literature, little mention has been made of benign conditions. The CT appearances of expansions due to chondroma, tuberculosis, hypertrophic lingual tonsilla, fluid-filled laryngocele, aberrant thyroid adenoma, and chronic granulomatous inflammation are described.

Prognostic significance of contrast enhancement and tumor demarcation at CT of squamous cell carcinomas of the oral cavity and oropharynx.

A retrospective analysis of the CT examinations of 45 patients with squamous cell carcinomas of the tongue, floor of the mouth and tongue base with long-term follow-up is presented. The aim of the study was to determine whether differences in tumor contrast enhancement and tumor demarcation at contrast-enhanced CT were correlated to prognosis in terms of posttreatment residual tumor or local recurrence. Ill-defined tumor margins were by means of multiple regression analysis significantly correlated to local failures (p = 0.043). This feature was, however, not associated with a significant decreased survival. The degree of tumor contrast enhancement did not parallel variations in the histopathologic composition of the tumors.

Rheumatic disease of temporomandibular joint with development of anterior disk displacement as revealed by magnetic resonance imaging. A case report.

A 34-year-old woman with known rheumatic disease (psoriatic arthritis) in joints other than the temporomandibular joint (TMJ) developed condylar posterosuperior destruction and anterior disk displacement of the right symptomatic TMJ during a 7-month period, as revealed by magnetic resonance imaging. A theory is proposed that destruction of the posterior attachment by pannus was the main reason for the disk displacement, although the pannus formation itself could not be depicted. Follow-up studies also indicated the potential of magnetic resonance imaging to demonstrate fluctuation of inflammatory changes in the TMJ.

Periostitis ossificans of the mandible. The value of computed tomography.

Periostitis ossificans in the mandible of a 9-year-old girl was assessed by means of computed tomography. Impaired mandibular function was the most consistent clinical sign and led on to referral for suspicion of a temporomandibular joint disease. Her symptoms improved with antibiotic therapy over a period of 2 months. During this time follow-up computed tomography demonstrated a more or less complete resolution of the new bone formation. The aetiology of the periostitis was considered non-dental due to haematogeneous spread from a pharyngitis.