RESUMEN
The clinical diagnosis of cervical aortic arch rests on the detection of a pulsatile mass in the supraclavicular fossa. Unfortunately, clinical differentiation of a cervical arch from an aneurysm of the great vessels can be difficult. Dynamic computed tomography (CT) can aid in this differentiation and avert the need for angiography.
Asunto(s)
Aorta Torácica/anomalías , Tomografía Computarizada por Rayos X , Adulto , Aorta Torácica/diagnóstico por imagen , Aneurisma de la Aorta/diagnóstico por imagen , Diagnóstico Diferencial , Humanos , MasculinoRESUMEN
Computed tomography (CT) using a geometric magnification technique was found to improve spatial resolution in phantom studies when compared with conventional third-generation geometry images. The clinical feasibility of using geometric magnification, small focal spot size, and dynamic contrast enhancement was studied in 143 patients referred to CT for clinically suspected pancreatic disease. This population included 46 patients with a normal pancreas and 36 patients subsequently proven to have primary pancreatic carcinoma. Using this new technique in conjunction with dynamic contrast enhancement resulted in high quality pancreatic images. Despite the limitations in tube current associated with a small focal spot size and low total heat capacity of the system, clinical imaging was not adversely affected. Use of the geometric magnification technique is recommended in departments where it is technically feasible.
Asunto(s)
Páncreas/diagnóstico por imagen , Magnificación Radiográfica/métodos , Tomografía Computarizada por Rayos X/métodos , Adulto , Anciano , Humanos , Persona de Mediana Edad , Neoplasias Pancreáticas/diagnóstico por imagen , Seudoquiste Pancreático/diagnóstico por imagen , Pancreatitis/diagnóstico por imagenRESUMEN
Numerous radiographic and scintigraphic imaging modalities are now available for evaluating the gastrointestinal system. With a well-formulated plan based on patient history, physical examination, and laboratory values, together with knowledge of patient preparation techniques and consultation, an efficient customized approach to gastrointestinal disease can be accomplished.
Asunto(s)
Enfermedades Gastrointestinales/diagnóstico , Sulfato de Bario , Catárticos/administración & dosificación , Sistema Digestivo/diagnóstico por imagen , Endoscopía , Enema , Enfermedades del Esófago/diagnóstico por imagen , Neoplasias Esofágicas/diagnóstico por imagen , Esófago/diagnóstico por imagen , Ayuno , Fluoroscopía , Enfermedades Gastrointestinales/diagnóstico por imagen , Hemorragia Gastrointestinal/diagnóstico , Neoplasias Gastrointestinales/patología , Humanos , Neoplasias Intestinales/diagnóstico , Neoplasias Intestinales/diagnóstico por imagen , Espectroscopía de Resonancia Magnética , Estadificación de Neoplasias , Intensificación de Imagen Radiográfica , Cintigrafía , Neoplasias Gástricas/diagnóstico por imagen , Tomografía Computarizada por Rayos XRESUMEN
The interaction between the various noninvasive and invasive imaging modalities used to evaluate the liver, biliary tract, and pancreas is demonstrated in this article. By understanding this interaction and correlating noninvasive studies, the clinician will avoid diagnostic redundancy and the need for invasive testing may be reduced.
Asunto(s)
Enfermedades de las Vías Biliares/diagnóstico , Hepatopatías/diagnóstico , Enfermedades Pancreáticas/diagnóstico , Adenocarcinoma/diagnóstico , Biopsia con Aguja , Colangiografía , Colecistectomía , Colelitiasis/diagnóstico , Colelitiasis/diagnóstico por imagen , Colestasis/diagnóstico , Diagnóstico Diferencial , Hepatectomía , Humanos , Hígado/diagnóstico por imagen , Hepatopatías/diagnóstico por imagen , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/patología , Neoplasias Hepáticas/secundario , Neoplasias Pancreáticas/diagnóstico , Neoplasias Pancreáticas/diagnóstico por imagen , Pancreatitis/diagnóstico , Cintigrafía , Bazo/diagnóstico por imagen , Azufre Coloidal Tecnecio Tc 99m , Tomografía Computarizada por Rayos X , UltrasonografíaRESUMEN
In this article, the pancreas is evaluated with regard to the controversies surrounding this organ from a clinical standpoint, and an approach to imaging modalities is examined. The roles of computed tomography, ultrasound, endoscopic retrograde cholangiopancreatography, and magnetic resonance imaging are put into proper perspective.
Asunto(s)
Enfermedades Pancreáticas/diagnóstico , Enfermedad Aguda , Adenoma de Células de los Islotes Pancreáticos/diagnóstico , Colangiopancreatografia Retrógrada Endoscópica , Enfermedad Crónica , Humanos , Espectroscopía de Resonancia Magnética , Quiste Pancreático/diagnóstico , Enfermedades Pancreáticas/diagnóstico por imagen , Neoplasias Pancreáticas/diagnóstico , Neoplasias Pancreáticas/diagnóstico por imagen , Seudoquiste Pancreático/diagnóstico , Pancreatitis/complicaciones , Pancreatitis/diagnóstico , Tomografía Computarizada por Rayos X , UltrasonografíaRESUMEN
The authors present their algorithmic approach to the detection, characterization, and staging of renal masses. Based on classification of urographic findings, the patient may be triaged to the appropriate cross-sectional or invasive imaging modality that will result in the most cost-effective management.
Asunto(s)
Enfermedades Renales/diagnóstico , Absceso/diagnóstico , Adulto , Angiografía , Calcinosis/diagnóstico , Carcinoma de Células Renales/diagnóstico , Diagnóstico Diferencial , Hematuria/etiología , Humanos , Riñón/anomalías , Enfermedades Renales/diagnóstico por imagen , Enfermedades Renales Quísticas/diagnóstico , Neoplasias Renales/diagnóstico , Neoplasias Renales/secundario , Pelvis Renal , Estadificación de Neoplasias/métodos , Nefritis/etiología , Enfermedades Renales Poliquísticas/diagnóstico , Pielonefritis Xantogranulomatosa/diagnóstico , Tomografía Computarizada por Rayos X , Ultrasonografía , Tumor de Wilms/diagnósticoRESUMEN
The radiologist needs to be aware of the varied appearance of hepatic mass lesions and be prepared to recommend the most cost-effective imaging approach. In this article, the authors discuss their hepatic imaging experience, common pitfalls, and current recommendations.
Asunto(s)
Hepatopatías/diagnóstico , Biopsia con Aguja/métodos , Medios de Contraste , Diagnóstico Diferencial , Errores Diagnósticos , Arteria Hepática/diagnóstico por imagen , Humanos , Hepatopatías/diagnóstico por imagen , Neoplasias Hepáticas/diagnóstico por imagen , Neoplasias Hepáticas/secundario , Espectroscopía de Resonancia Magnética , Tomografía Computarizada de Emisión , Tomografía Computarizada por Rayos X , UltrasonografíaRESUMEN
Although vast differences exist among the many pelvic malignancies, several unifying concepts emerge from this discussion. First, there is a different role for diagnostic imaging for each type of pelvic malignancy. The radiologist should be aware that although the radiographic findings may be similar, the clinical impact varies greatly with a particular tumor. Second, although clinical staging is notoriously inaccurate, nevertheless diagnostic imaging techniques only improve upon but do not replace it because of false-positive and false-negative results. Third, because of the high false-negative rates of most of the modalities in use, negative studies do not in fact rule out the presence of disease. A surgical procedure may still be needed. Finally, several new techniques, including MRI and transrectal or transurethral ultrasound, may improve the accuracy rates. These developments will probably further enliven the controversies surrounding the radiologic evaluation of pelvic malignancies.
Asunto(s)
Neoplasias Pélvicas/diagnóstico por imagen , Femenino , Humanos , Linfografía , Espectroscopía de Resonancia Magnética , Masculino , Neoplasias Ováricas/diagnóstico , Neoplasias Ováricas/diagnóstico por imagen , Neoplasias de la Próstata/diagnóstico , Neoplasias de la Próstata/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Ultrasonografía , Neoplasias de la Vejiga Urinaria/diagnóstico , Neoplasias de la Vejiga Urinaria/diagnóstico por imagen , Neoplasias del Cuello Uterino/diagnóstico , Neoplasias del Cuello Uterino/diagnóstico por imagen , Neoplasias Uterinas/diagnóstico , Neoplasias Uterinas/diagnóstico por imagenRESUMEN
Medical records of 55 dogs with a diagnosis of cutaneous mast cell tumour were reviewed. Twenty-seven of the dogs were treated with surgery plus deionized water and the remaining 28 with surgery alone. A survival analysis was performed to determine whether deionized water, as an adjunct to surgery for cutaneous mast cell tumour, affected survival time or time to tumour recurrence. Dogs in which mast cell tumour recurred had a significantly shorter survival time compared with dogs with no recurrence (P = 0.05), regardless of the method of treatment. A significant negative association between tumour recurrence and method of treatment (P = 0.0097) and clinical stage (P = 0.0223) was observed. Dogs treated with surgery and deionized water had a significantly shorter time to recurrence of their mast cell tumour (P = 0.0113). Based on these results, deionized water does not appear to be beneficial in prolonging survival time or time to tumour recurrence for dogs with cutaneous mast cell tumours.
Asunto(s)
Sarcoma de Mastocitos/veterinaria , Recurrencia Local de Neoplasia/veterinaria , Neoplasias Cutáneas/veterinaria , Animales , Perros , Femenino , Concentración de Iones de Hidrógeno , Masculino , Sarcoma de Mastocitos/tratamiento farmacológico , Sarcoma de Mastocitos/cirugía , Neoplasias Cutáneas/tratamiento farmacológico , Neoplasias Cutáneas/cirugía , Análisis de Supervivencia , AguaRESUMEN
The relative frequencies of the different sonographic features and patterns of uterine leiomyomas have been examined by prospective and retrospective analyses of the sonograms in 41 proven cases. The original sonographic reports correctly predicted the presence of myomas in 27/45 studies (sensitivity = 60 per cent). Retrospective analyses of the sonograms revealed abnormalities in 32/41 patients (sensitivity = 78 per cent). Most myomatous uteri had two or more sonographic abnormalities, most frequently uterine contour irregularity (76 per cent), altered echo texture (68 per cent) and/or enlargement (66 per cent). Minimal contour irregularity at the interface between the uterus and the bladder deserves emphasis as a subtle diagnostic sign of leiomyoma. Careful attention to the uterus in examining a patient referred for an adnexal mass should improve the diagnostic accuracy of myoma detection by sonography.
Asunto(s)
Leiomioma/diagnóstico , Ultrasonografía , Neoplasias Uterinas/diagnóstico , Calcinosis/diagnóstico , Errores Diagnósticos , Femenino , Humanos , Linfoma/diagnóstico , Embarazo , Embarazo Múltiple , GemelosRESUMEN
Endoscopic retrograde cholangiopancreatography (ERCP) and computed tomography (CT) are well established diagnostic studies for pancreatic evaluation. We conducted a study to determine whether performing these examinations in tandem increased diagnostic accuracy. Patients undergoing ERCP with successful cannulation of the pancreatic duct and who could be placed in the gantry of our CT scanner within 30 min were included in the study. The combined examination, or endoscopic retrograde computed tomography of the pancreas (ERCTP), provided additional useful information in several types of patients including those who had intrapancreatic air without clinical abscess, those with apparent total obstruction of the pancreatic duct on ERCP, and those who were post partial pancreatectomy and were being considered for additional surgery. No additional useful information was provided in patients with a normal ERCP or in routine cases of pancreatitis.
Asunto(s)
Colangiopancreatografia Retrógrada Endoscópica , Enfermedades Pancreáticas/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Medios de Contraste/administración & dosificación , Humanos , Páncreas/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodosRESUMEN
The authors examined 139 patients thought to have early, partial, or intermittent biliary obstruction, using sonography, hepatobiliary scintigraphy, and in selected cases contrast cholangiography. Of 125 patients with a well-established final diagnosis, sonography and scintigraphy disagreed in 29 (23%). Scintigraphy revealed early or low-grade obstruction in 13 patients who had no evidence of dilated ductules, while 7 patients with dilatation from prior stone passage or biliary surgery showed normal clearance. The authors conclude that in a preselected population in whom early or low-grade biliary obstruction may be present, disagreement between sonography and scintigraphy is not rare, and the absence of sonographically detectable dilatation does not exclude obstruction.
Asunto(s)
Colestasis/diagnóstico por imagen , Ultrasonografía , Adulto , Anciano , Enfermedades de las Vías Biliares/diagnóstico , Enfermedades de las Vías Biliares/diagnóstico por imagen , Colangiografía , Colestasis/diagnóstico , Femenino , Humanos , Ictericia/diagnóstico , Ictericia/diagnóstico por imagen , Masculino , Persona de Mediana Edad , CintigrafíaRESUMEN
Cranial sonography is an established procedure for the detection of neonatal intracranial hemorrhage. A 3 year experience in imaging such infants is reviewed. Representative examples are presented to comprehensively illustrate the spectrum of sonographic appearances of intracranial hemorrhage and its complications from the initial hemorrhage to resolution. Diagnostic problems in the initial staging of the grade of hemorrhage and in evaluating subsequent ventricular changes are addressed.
Asunto(s)
Hemorragia Cerebral/diagnóstico , Ultrasonografía , Hemorragia Cerebral/clasificación , Hemorragia Cerebral/patología , Ventrículos Cerebrales/patología , Humanos , Recién NacidoRESUMEN
We prospectively studied 30 patients with postcholecystectomy syndrome to determine the efficacy of biliary scintigraphy in the detection of stenosis of the sphincter of Oddi. All patients underwent endoscopic retrograde cholangiopancreatography (ERCP). Biliary scintigraphy disclosed stenosis of the sphincter by agreement with the ERCP or surgical findings in nine (90%) of ten patients and in eight (100%) of eight patients with biliary obstruction from other causes. Retention of activity at 2 hours in visually prominent ducts was the best predictor of abnormal biliary drainage. Biliary scintigraphy is a useful, noninvasive screening test for the detection of postcholecystectomy biliary obstruction.
Asunto(s)
Colangiografía , Colangiopancreatografia Retrógrada Endoscópica , Colecistectomía , Colestasis/diagnóstico por imagen , Complicaciones Posoperatorias/diagnóstico por imagen , Adulto , Anciano , Ampolla Hepatopancreática/diagnóstico por imagen , Colestasis/etiología , Constricción Patológica/complicaciones , Constricción Patológica/diagnóstico por imagen , Femenino , Humanos , Masculino , Persona de Mediana Edad , Dolor/diagnóstico , Dolor/etiología , Páncreas/diagnóstico por imagen , Estudios Prospectivos , CintigrafíaRESUMEN
Pelvic hematomas following prostatic biopsy are rare. We describe 2 cases of hematomas occurring in the prevesical space (space of Retzius) following transrectal biopsy. Computed tomography (CT) was useful in defining the extent of the hematoma and showing density changes related to the age and suppuration of the hematoma. While cystography has been used to diagnose prevesical hematomas, CT better assesses the size of the hematoma and changes that may occur over time.
Asunto(s)
Hematoma/etiología , Próstata/patología , Enfermedades de la Vejiga Urinaria/etiología , Biopsia/efectos adversos , Hematoma/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Tomografía Computarizada por Rayos X , Enfermedades de la Vejiga Urinaria/diagnóstico por imagenRESUMEN
A 10-year-old, spayed female, mixed-breed dog was referred for evaluation of bilateral hindlimb edema and weakness. Abdominal ultrasonography showed increased echogenicity of the lumen of the caudal vena cava from the level of the urinary bladder to the level of the cranial pole of the right kidney. Bilateral saphenous venograms displayed numerous filling defects in the caudal vena cava, right external iliac vein, right femoral vein, and the right common iliac vein. Extensive venous thrombosis was diagnosed, and the animal was euthanized. Necropsy confirmed the presence of venous thrombosis and revealed a right adrenocortical carcinoma that had invaded the caudal vena cava.
Asunto(s)
Carcinoma Corticosuprarrenal/veterinaria , Enfermedades de los Perros/diagnóstico , Neoplasias Vasculares/veterinaria , Vena Cava Inferior , Trombosis de la Vena/veterinaria , Carcinoma Corticosuprarrenal/diagnóstico , Animales , Enfermedades de los Perros/diagnóstico por imagen , Perros , Edema , Resultado Fatal , Femenino , Miembro Posterior , Radiografía , Neoplasias Vasculares/diagnóstico , Trombosis de la Vena/diagnósticoRESUMEN
The gray-scale ultrasonic features of Wilms tumor are reported with pathologic comparison. The most consistent ultrasonic features are large size, sharp margination, and echogenic heterogeneity. The frequently observed anechoic areas correlated with hemorrhage and necrosis. A rare case of mesoblastic nephroma is included for comparison. Pitfalls in diagnosis are discussed.
Asunto(s)
Neoplasias Renales/diagnóstico , Ultrasonografía , Tumor de Wilms/diagnóstico , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Riñón/diagnóstico por imagen , Riñón/patología , Neoplasias Renales/patología , Masculino , Recurrencia Local de Neoplasia/diagnóstico , Osificación Heterotópica/diagnóstico por imagen , Radiografía , Tumor de Wilms/patologíaRESUMEN
Although initially described as representing collateral venous structures, perirenal cobwebs may be due to a variety of benign and malignant conditions. Six representative cases illustrating the broad differential diagnosis are presented.
Asunto(s)
Fascia/diagnóstico por imagen , Riñón/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Anciano , Carcinoma de Células Transicionales/diagnóstico por imagen , Circulación Colateral , Diagnóstico Diferencial , Fascia/irrigación sanguínea , Fascia/patología , Femenino , Humanos , Riñón/irrigación sanguínea , Neoplasias Renales/diagnóstico por imagen , Linfoma/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Invasividad Neoplásica , Nefritis/diagnóstico por imagen , Pancreatitis/diagnóstico por imagenRESUMEN
Dynamic thin-section computed tomography (CT) was used to evaluate renal cell carcinoma in 80 patients. The lesion was correctly staged with CT in 90% of patients. With use of the dynamic technique, the ipsilateral renal vein was depicted in 99% of patients. Extension of the tumor to the renal vein or the inferior vena cava was correctly detected in 18 of 19 patients. Actual depiction of tumor thrombus was a far more accurate indicator of renal vein invasion than was the identification of isolated renal vein enlargement. Dynamic thin-section CT of the kidney should be considered the routine method for comparison studies with other newer cross-sectional techniques in the evaluation of renal cell carcinoma.
Asunto(s)
Carcinoma de Células Renales/diagnóstico por imagen , Neoplasias Renales/diagnóstico por imagen , Venas Renales/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Carcinoma de Células Renales/irrigación sanguínea , Carcinoma de Células Renales/patología , Humanos , Neoplasias Renales/irrigación sanguínea , Neoplasias Renales/patología , Invasividad Neoplásica , Estadificación de Neoplasias , Células Neoplásicas Circulantes , Venas Renales/patología , Vena Cava Inferior/diagnóstico por imagen , Vena Cava Inferior/patologíaRESUMEN
The sonographic features of eight surgically confirmed pheochromocytomas are described and correlated with pathologic findings. The purely solid masses were homogeneous or heterogeneous sonographically. Pathologic examination of the gross specimen provided explanations for the variety of sonographic findings. Two tumors had large cystic components due to old blood. Other hypoechoic areas corresponded to necrosis pathologically. Hyperechoic areas represented hemorrhage. Generally, pheochromocytomas are quite large, sharply marginated, and usually have a significant solid component with or without central necrosis or hemorrhage. Recognition of these features should facilitate their identification on sonography.