Transesophageal echocardiographic diagnosis of pulmonary arteriovenous malformation. Role of contrast and pulsed Doppler echocardiography.

Contrast echocardiography produced by peripheral injection of agitated saline solution is widely used for detecting intracardiac and intrathoracic extracardiac shunts, like pulmonary arteriovenous malformation (PAVM). Currently, localization of PAVM requires pulmonary angiography even after detection by computed tomography of the chest. Pulsed Doppler along with contrast echocardiography of the pulmonary veins performed during transesophageal echocardiography may aid in the localization of PAVM and in its diagnosis.

Comparison of clinical and computed tomographic staging of head and neck tumors.

The extent of tumor was staged independently using conventional clinical methods and high-resolution computed tomography (CT) in 100 patients with tumors at the base of the skull, nasopharynx, oropharynx, hypopharynx, larynx, nose, and paranasal sinuses. Conventional clinical methods used for staging included physical examination, routine biopsy, routine radiography, tomography, and sonography when appropriate. In 10 patients, CT identified tumors that had not been apparent clinically; eight of these were in the nasopharynx and two in the hypopharynx. In another 26 patients, CT showed the tumor to be more locally extensive than had been evident clinically; 12 of these tumors were in the oropharynx. A new technique of CT-guided biopsy of head and neck tumors was used in 20 patients to attain histologic information or to confirm the extent of the tumor. Thus, information obtained by CT scanning or CT-guided biopsy significantly altered treatment planning in 36 of the 100 patients.

CT-guided biopsy for the detection and staging of tumors of the head and neck.

Twenty patients underwent computed tomography (CT)-guided thin-needle biopsy of tumors of the had and neck without complication. This technique was found to have wide application in confirming the presence and extent of primary disease as well as documenting nodal and bony metastases not apparent clinically.

External imaging techniques for quantitation of distribution of I-131 F(ab')2 fragments of monoclonal antibody in humans.

We have employed noninvasive, external counting techniques for quantitation of I-131 F(ab')2 fragment of mouse monoclonal antibody localized in metastatic lesions and surrounding liver tissue in humans. This method utilizes counts from diametrically opposed views of tumor deposits and surrounding normal tissue. Corrections were made for patient attenuation, lesion size, and surrounding tissue activity. The validity of this method was evaluated using a fillable, tissue-equivalent organ-scanning phantom with organs and tumors of selected size. Less than 10% error was found in quantitation of various activities of I-131 in a 4-cm-diam lesion. Tumor activity ranged from 0.001% to 0.018% of administered dose per cm3 of tissue compared with 0.000 12% to 0.0023% per cm3 of liver. In addition, the vascular clearance of total I-131 and protein-bound I-131 was found to follow a two-compartment model with mean half lives of 3.8 and 21.4 h for total I-131 and 3.9 and 24.4 h for protein-bound I-131.

Endometriosis: clinical and ultrasonic correlation.

Thirteen patients with surgically proven endometriosis underwent ultrasonography as part of their diagnostic evaluation. An attempt was made to assess the sonographic characteristics of endometriosis to determine if a characteristic pattern would emerge when the clinical presentations and physical findings were coupled with the ultrasonic picture. Ultrasound showed pelvic masses in all patients. Most masses appeared spherical and separate from the uterus and were cystic or predominantly cystic with scattered peripheral echoes. This retrospective study suggests a more useful role for ultrasound than previously recognized in the clinical management of patients with endometriosis.

Computed tomography guided thin needle biopsy of small lytic bone lesions.

Twelve patients with small lytic bone lesions underwent computed tomography (CT) guided thin (22-gauge) needle biopsy when fluoroscopic guidance was not possible. Adequate tissue for diagnosis was obtained in all twelve patients without complications. CT can be invaluable in directing the needle to a small lesion, detecting extraosseous extention of tumor for biopsy, and avoiding overlying bony structures.

The specificity of renal vein thrombosis.

Clinical and roentgenographic features of renal vein thrombosis are discussed. The authors' experience with 17 cases is presented. The roentgenologist with a high degree of suspicion can, by correlation of clinical and urographic findings, make the specific diagnosis of renal vein thrombosis in a high percentage of cases.

Nonuniform attenuation in computed tomography study of the cirrhotic liver.

Diffuse hepatocellular processes are not well imaged by most radiologic modalities. At present, CT has not added significantly to the evaluation of hepatocellular disease, particularly in the cirrhotic liver. The CT patterns of cirrhosis previously described are reviewed, and the pathophysiology of cirrhosis is discussed. In 3 cases, a pattern was seen in cirrhotic livers characterized by nonuniform attenuation with varied response to administration of intravenous contrast agents. With further evaluation of fatty infiltration and cirrhosis, CT may prove helpful in understanding these disease processes.

CT evaluation of mediastinal pseudocyst.

Rarely do pancreatic pseudocysts extend into the mediastinum. We recently evaluated a case exemplifying this phenomenon. Although ultrasonography demonstrated the nature of the mass, computed tomography (CT) allowed better definition of various anatomic relationships and afforded improved definition of the superior aspect of the pancreatic pseudocyst. The role of CT and its advantages over ultrasonography in the diagnosis and management of pancreatic pseudocyst are discussed.

An analysis of pancreatic sonography in suspected pancreatic disease.

To assess the value of pancreatic sonography in patients suspected of having pancreatic disease, our first 500 pancreatic examinations using gray scale imaging were reviewed in a prospective manner without clinical information. Various parameters of each examination were recorded. The pancreas was localized by its relationships to surrounding vessels and the duodenum. The ability to define the head, body, and tail of the pancreas as well as anterior--posterior size measurements were noted and recorded. A retrospective clinical pathologic follow-up was then carried out and correlated with the ultrasonic findings. Four categories of patients were identified. The features seen in pancreatic ultrasonography of the entire group, as well as those seen in the individual categories, were analyzed. This analysis indicates that pancreatic sonography can be used in patients suspected of having pancreatic disease, defining both normal and abnormal pancreas. A high index of suspicion for the type of abnormality present can be achieved.

Computed-tomographic-guided biopsy of small apical and peripheral upper-lobe lung masses.

After undergoing unsuccessful bronchoscopic and fluoroscopic biopsy attempts, 15 patients with small, peripheral upper-lobe and apical lung masses underwent computed-tomographic-guided biopsy. Malignant tissue was obtained in all cases. No complications resulted.

Ultrasonic assessment of renal transitional cell carcinoma: preliminary report.

The value of ultrasound in determining the etiology of nonopaque filling defects seen in the renal pelvis at intravenous urography is under study. The ultrasound findings in three patients with proven transitional cell carcinoma of the kidney were similar and consisted of separation of the central renal echo complex by a region of low-intensity echoes. This pattern is distinct from characteristically echogenic nonopaque renal calculi and anechoic hydronephrosis. Renal collecting system blood clots may have an echo pattern similar to collecting system tumors, but can usually be distinguished by their mobility and transitory nature. Further investigation into the specificity and sensitivity of the ultrasonic diagnosis of renal collecting system masses is underway.

Gray-scale sonographic assessment of pancreatitis in children.

A total of 144 gray-scale sonograms were obtained in 110 children to evaluate the pancreas. The entire gland was adequately visualized in just over 86% of cases. The size, contour, echo pattern, and echo intensity were assessed. Either diffuse or focal enlargement of the pancreas was the most consistent finding in the 25 children with pancreatitis. In contrast to previous reports, decreased echo intensity was not a reliable indicator of inflammation. Numerous complications were detected on the 54 sonograms of these 25 patients. These complications included pseudocysts, lesser sac fluid collections, ascites, biliary obstruction, and hemorrhage. It is recommended that ultrasound be the initial imaging procedure in the evaluation of children with suspected pancreatic disease, and that it be used in conjunction with clinical and biochemical data.

Wilms' tumor: diagnostic therapeutic implications.

Twenty-four cases of Wilms' tumor were analyzed. The gray-scale echographic characteristics of the tumors were categorized. Correlation with pathologic characteristics, clinical presentation, prognosis, and therapy response was assessed. Two echographic patterns emerged: (a) hypoechoic solid--3; and (b) hyperechoic solid--21. Necrotic degeneration as well as decrease in tumor size were echographic features correlated with positive response to therapy. The results of this analysis showed no initial correlation between the echographic patterns and the clinical presentation or prognosis. On the other hand, the echographic features of Wilms' tumor seem distinctive enough to help in etiologic differentiation and therapy management.

Detecting lymphatic metastases from prostatic carcinoma: superiority of CT.

CT scanning was performed on 29 consecutive patients with clinically localized prostatic carcinoma (stage A or B). Bipedal lymphangiography was performed in 12 cases. Histologic confirmation was obtained in 15 cases (pelvic lymphadenectomy in 12 and positive percutaneous needle biopsy in three). In these 15 proven cases, the overall accuracy of CT was 93% with one false positive and no false negatives. Lymphangiography was far less accurate (55%) with two false positives and three false negatives in 11 proven cases. The greater accuracy of CT resulted primarily from its ability to detect abnormal nodes in the pelvis, particularly hypogastric nodes, which are rarely opacified by lymphangiography. Preliminary experience suggests that CT is superior to lymphangiography in detecting early lymphatic spread from prostatic carcinoma in the pelvis. In the future, CT-guided percutaneous needle biopsy should be useful for documenting metastases in these patients.

Management of solid tumors in children: contribution of computed tomography.

To evaluate the impact of computed tomography (CT) on therapeutic management decisions in solid tumors of the chest and abdomen, 92 examinations on 54 children with 13 histologic tumor types were analyzed. The CT impact on the management decisions was analyzed in relation to other diagnostic procedures of the same body part including sonography, chest films with tomography, abdominal/pelvic films, and excretory urography. Overall, CT provided the essential information of 47% of management decision. By confirming non-CT examination results it helped direct therapeutic decisions in 28%. No additional information was derived from CT in 20%. Technically poor studies in 5% resulted in CT errors. According to the procedural method, CT provided additional information in 42% when compared with sonography, in 38% when compared with chest films and tomography, in 41% when compared with abdominal/pelvic films, and in 27% when compared with intravenous urography. The investigation showed that CT provided information directly affecting the therapeutic management decision in a significant number of patients.

The accuracy of gray-scale renal ultrasonography in differentiating cystic neoplasms from benign cysts.

To evaluate the ability of gray-scale renal ultrasonography to distinguish cystic neoplasms from benign cysts, 182 cysts or cyst-like masses were reviewed retrospectively by three radiologists with varying degrees of experience in nephrosonography. All cases were proved by needle puncture or surgery. An unequivocal diagnosis of "cyst" based solely on ultrasonography was 98% accurate, with 2% being due to hematomas, localized hydronephrosis, or septa within the cyst. No cystic neoplasms were mistaken for benign cysts. These results indicate that experienced observers using proper technique will rarely be in error in distinguishing non-neoplastic cystic masses from cystic neoplasms by articulated-arm gray-scale ultrasonography, and that routine needle puncture may be unnecessary in such cases.

Computed tomography of renal pelvic filling defects.

Thirteen patients with a variety of renal pelvic filling defects were evaluated using computed tomography (CT). Nonopaque calculi and some blood clots can be more accurately differentiated with this modality than has heretofore been possible. In transitional-cell carcinoma of the renal pelvis, the main value of CT appears to be in tumor staging. CT may also be helpful where urography cannot discriminate between extrinsic compression and true intraluminal renal pelvic defects.

Mucocutaneous lymph node syndrome with hydrops of the gallbladder diagnosed by ultrasound.

One of the complications of the mucocutaneous lymph node syndrome is acute hydrops of the gallbladder. Although surgery may be required occasionally, spontaneous resolution of gallbladder hydrops in patients is common. Ultrasound is the optimal method for evaluating these patients.

CT staging of bladder carcinoma.

CT staging was performed in 49 consecutive patients with known carcinoma of the bladder. The overall accuracy of CT staging in 25 patients with surgically confirmed disease stage was 64%. Most diagnostic errors in this series were related to the determination of perivesical fat involvement by tumor. The overall accuracy of CT in predicting lymph node metastasis was 92%. The sensitivity was 60% and the specificity ws 100%. Because of the current management of bladder carcinoma, the major role of CT is in the evaluation of lymph nodes for metastatic disease. Since CT cannot detect metastasis to nonenlarged lymph nodes, it has only a limited role in the staging of bladder carcinoma at this time.