The in vivo relationship between cross-sectional area and CT dose index in abdominal multidetector CT with automatic exposure control.

The relationship between patient cross-sectional area and both volume CT dose index (CTDI) and dose length product was explored for abdominal CT in vivo, using a 16 multidetector row CT (MDCT) scanner with automatic exposure control. During a year-long retrospective survey of patients with MDCT for symptoms of abdominal sepsis, cross-sectional areas were estimated using customised ellipses at the level of the middle of vertebra L3. The relationship between cross-sectional area and the exposure parameters was explored. Scans were performed using a LightSpeed 16 (GE Healthcare Medical Systems, Milwaukee, WI) operated with tube current modulation. From a survey of 94 patients it was found that the CTDI increased with the increase in patient cross-sectional area. The relationship was logarithmic rather than linear, with a least-squares fit to the data (R(2) = 0.80). For abdominal CT the cross-sectional area gave a measure of patient size based on the region of the body to be exposed. Exposure parameters increased with increasing cross-sectional area and the greater radiation exposure of larger patients was partly a consequence of their size. Given increasing obesity levels we believe that cross-sectional area and scan length should be added to future dose surveys, allowing patient size to be considered as a factor of relevance when examining population doses.

A comparative study of evaluation of radiographs, CT and 3D reformatted CT in facial trauma: what is the role of 3D?

A panel of 17 trainee maxillofacial surgeons viewed 23 cases of facial trauma, demonstrated on radiographs, axial CT images and three-dimensional (3D) reformatted CT images in a standardized viewing format under standard conditions. Their diagnostic interpretation, extraction of information relevant to surgical management and subjective evaluation of each modality were recorded by standard questionnaire and compared with a gold standard evaluation by a consultant radiologist and surgeon reading based on results of clinical management. There were clear and measurable differences in the viewers' evaluations of radiographs, CT and 3D reformatted images. Overall, surgeons showed more accurate diagnostic reading of radiographs and 3D reformatted images. This was in contrast to their subjective assessment of the clinical value of each modality, which showed a strong preference for 3D over all other techniques and for CT over radiographs. However the perceived benefit of axial CT images over radiographs was not reproduced on objective testing in this group; surgeons appear to perform less well in interpreting CT images than their subjective response to the modality would suggest. This work has supported the view that surgeons value 3D imaging as a front-line tool in the evaluation and management of selected cases of acute facial trauma. We have demonstrated that the perceived benefits of 3D reformatted CT to surgeons appear real.

Nephropathy in the mature pig after the irradiation of a single kidney: a comparison with the immature pig.

The right kidney of 11 mature 10-month-old Large White female pigs was irradiated with single doses of 9.8-14.0 Gy of 60Co gamma rays. Individual kidney glomerular filtration rate (GFR) and effective renal plasma flow (ERPF) were measured using 99mTc-DTPA and 131I-hippuran renography for periods up to 24 weeks after irradiation. Renal function was assessed either as a functional index, FI (FI = irradiated/unirradiated kidney function), or as the individual kidney GFR and ERPF. The radiation-induced changes after the irradiation of a single kidney (unilaterally irradiated--UI) of mature pigs were compared with those previously observed in 14-week-old immature pigs. Irradiation resulted in a dose-dependent reduction in the FI for both GFR and ERPF. However, these reductions were significantly less than those previously seen in immature pigs. Within 2 weeks of irradiation GFR increased in both the irradiated and the unirradiated kidneys in each animal, compared with unirradiated age-matched control kidneys. No marked changes in renal hemodynamics were seen in mature animals after a single dose of 9.8 Gy. This was in marked contrast to the pronounced reduction in the GFR and ERPF in the irradiated kidney previously observed in immature animals irradiated with an equivalent single dose of X rays. After higher doses, the irradiated kidney in mature pigs showed a dose-dependent reduction in GFR and ERPF. However, the extent of this reduction was significantly less than that seen in immature animals. There was no apparent difference in the response of the unirradiated kidneys in mature or immature pigs. The ED50 values, based on a probit fit to the data for the proportion of functional tests in which the irradiated kidney showed a greater than or equal to 50% reduction in GFR or ERPF, were higher in the mature animals; for example for ERPF the ED50 values were 11.76 +/- 0.28 Gy and 7.67 +/- 0.34 Gy for mature and immature animals, respectively. Thus, the UI kidney in mature pigs appears to be less radiosensitive than the UI kidney in immature animals.

Radiation-induced changes in glomerular and tubular cell kinetics and morphology following irradiation of a single kidney in the pig.

PURPOSE: Radiation-induced changes in glomerular and tubular cell kinetics and morphology following irradiation of a single pig kidney were assessed. METHODS AND MATERIALS: The right kidney of 13 adult female Large White pigs was irradiated with a single dose of 9.8 Gy gamma rays. Animals were serially killed between 2 and 24 weeks postirradiation (PI); 1 h prior to postmortem each pig received 500 mg bromodeoxyuridine (BrdUrd). At postmortem, both kidneys were removed and tissue taken to prepare cell suspensions. The labeling index (LI) of these suspensions was measured using flow cytometry; in vivo BrdUrd incorporation in glomerular and tubular cells was determined immunohistochemically. The kidneys were also assessed histologically. RESULTS: Irradiation of the right kidney alone resulted in a significant increase in renal cell LI in both the irradiated and the contralateral unirradiated kidney within 2 weeks of irradiation; peak values of 1.57 +/- 0.32% and 1.04 +/- 0.13%, respectively, were seen 4 weeks PI, significantly greater (P < 0.001) than the preirradiation value of 0.18 +/- 0.01%. The LI values then declined with time, but remained greater than those seen prior to irradiation. A similar pattern of response was determined from counts of labeled glomerular and tubular cells identified immunohistochemically. The increase in labeled glomerular cells was seen 2 weeks PI, whereas that for the tubular cells did not occur until 4 weeks PI. The irradiated kidney exhibited diffuse, progressive glomerular alterations. In contrast, tubular damage was focal; the irradiated kidney also exhibited a prominent vasculopathy, involving arteriolar and peripheral interlobular artery thickening. The contralateral unirradiated kidney appeared unchanged. CONCLUSION: These findings confirm the hypothesis that the morphologic and kinetic responses observed after irradiation of a single kidney are similar to those observed after irradiation of both kidneys. Renal irradiation results in significant alterations in glomerular and tubular cell proliferation and morphology within 2-4 weeks of irradiation; glomerular changes appear predominant.

Functional recovery in the irradiated kidney following removal of the contralateral unirradiated kidney.

The right kidneys of seven Large White female pigs, approximately 14 weeks of age, were irradiated with single doses of 7-12.6 Gy of 250 kV X-rays. Sequential measurements of individual kidney glomerular filtration rate (GFR) and effective renal plasma flow (ERPF) were carried out using 99mTc-DTPA and [131I]hippuran renography for time periods up to 24 weeks after irradiation. From this data, kidneys receiving a dose of 7 Gy were found to be functioning (F), while kidneys which received greater than or equal to 8.8 Gy were assessed as having no significant function (NF). When the pigs were approximately 10 months of age the contralateral unirradiated kidney was removed; the left kidney of three age-matched unirradiated pigs was also removed. The response of the right kidney to unilateral nephrectomy (UN) in these animals was assessed in terms of changes in haemodynamics (i.e. GFR and ERPF) for periods up to 24 weeks after UN. At post-mortem, the length and weight of the remaining kidney was measured. A marked increase in renal length was observed in irradiated kidneys following UN. In addition, the weights of irradiated kidneys following UN were greater than those of irradiated kidneys in age-matched pigs where the unirradiated kidney had not been removed. Four weeks after UN there was a pronounced increase in GFR and, in particular, ERPF in previously NF irradiated kidneys. The mean increase in these parameters, measured at the end of the follow-up period, when compared with the pre-surgery values, was 350.1 +/- 84.3 and 781.8 +/- 151.0% respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

The response of the pig kidney to the combined effects of cisplatin and unilateral renal irradiation.

Seven mature Large White female pigs, approximately 10 months of age received a single dose of cis-dichlorodiammineplatinum(II), c-DDP (2.5 mg/kg body weight). Prior to, and 4 weeks after c-DDP administration, individual kidney glomerular filtration rate (GFR) and effective renal plasma flow (ERPF) were measured by [99mTc]DTPA and [131I]hippuran renography. Of the 5 pigs surviving the c-DDP treatment most exhibited a reduction in both GFR and ERPF; the mean reduction in GFR (36.2 +/- 18.9%) was more pronounced than that for ERPF (12.6 +/- 19.4%). However, the difference in the severity of the impairment in these two parameters was not significant (p greater than 0.55). Haematocrit, haemoglobin and red blood cell counts were markedly reduced 14 days after c-DDP infusion, and despite some recovery evident 21 days after treatment, all three haematological parameters were still reduced 28 days after c-DDP administration. The right kidneys of these 5 animals, plus 5 pigs which did not receive c-DDP, were irradiated with a single dose of 11.9 Gy of 60Co gamma-rays. Individual kidney GFR and ERPF was routinely measured up to 24 weeks after irradiation. Pigs in which only the right kidney was irradiated showed a marked increase in both GFR and ERPF values 2 weeks after irradiation. This was followed by a decline in function with a reduction of 50% in terms of ERPF 16 weeks after irradiation. Values then showed some evidence of a recovery in function. There was a concomitant compensatory response by the contralateral unirradiated kidney.(ABSTRACT TRUNCATED AT 250 WORDS)

A morphological study of radiation nephropathy in the pig.

Both kidneys of mature pigs received a single dose of 9.8 Gy 60Co gamma rays. Pigs were killed between 2 and 24 weeks after irradiation and the kidneys examined histologically. Glomerular and tubular changes were observed within 2 weeks of irradiation. Neutrophils and other leukocytes were seen within glomerular capillary loops; mesangial matrix and cell number increased. A progressive increase in thickening of the basement membrane and a decrease in capillary lumina were then noted. Basement membrane duplication occurred within 12 weeks. By 24 weeks these lesions had increased in severity, sclerotic endstage glomeruli, predominantly subcapsular or juxtamedullary, being evident. Tubular lesions initially consisted of focal areas of tubular atrophy in the juxtamedullary region. By 6 weeks subcapsular foci of tubular degeneration, regeneration, and necrosis were found; these appeared to resolve 12 weeks after irradiation. At later times the severity of the tubular lesions varied between pigs, with some exhibiting interstitial fibrosis involving a complete band of subcapsular tissue, while others showed relatively mild changes. There was no apparent change in the vasculature. These findings indicate that (a) there is no one target or dose-limiting cell, and (b) the vasculature does not play a primary role in the development of radiation nephropathy.

Radiation-induced changes in the kinetics of glomerular and tubular cells in the pig kidney.

Both kidneys of 13 mature female Large White pigs were irradiated with a single dose of 9.8 Gy 60Co gamma rays. The pigs were killed serially between 2 to 24 weeks after irradiation. One hour prior to sacrifice bromodeoxyuridine (BrdU) (500 mg/pig) was injected intravenously. At postmortem the kidneys were removed and tissue was taken to prepare cell suspensions. The labeling index (LI) of these suspensions was determined using flow cytometry. In vivo BrdU incorporation in tubular and glomerular cells was determined immunohistochemically. The kinetics of glomerular and tubular cells was evaluated by counting the number of labeled cells/glomerulus and the number of labeled tubular cells/field of view. An average of 1200 glomeruli and 1500 fields of view/time were counted. Similar analyses were performed on renal tissue from unirradiated control animals. Flow cytometry revealed rapid and significant increases in the LI of kidney cells; 2 weeks after irradiation the LI increased from a control value of 0.18 +/- 0.01 to 1.23 +/- 0.22% (P < 0.001). By 4 weeks the maximal value of 2.45 +/- 0.36% was seen; the LI then declined progressively but at 24 weeks after irradiation still remained significantly above control values (P < 0.001). A similar pattern of response was determined by counting the labeled glomerular and tubular cells identified immunohistochemically. However, the increase in labeled glomerular cells occurred 2 weeks after irradiation, whereas that for the tubules occurred 4 weeks after irradiation. These findings indicate that irradiation of the kidney, classically regarded as a "late-responding" organ, is associated with rapid and significant changes in the kinetics of both tubular and glomerular cells.

Sequential evaluation of radiation-induced glomerular ultrastructural changes in the pig kidney.

Both kidneys of 12 mature female pigs received either a single dose of 9.8 Gy 60Co gamma rays or sham irradiation. At intervals of 1-4 weeks serial renal biopsies were obtained, followed by sacrifice at 24 weeks after irradiation. Individual kidney glomerular filtration rate (GFR), effective renal plasma flow (ERPF), and the hematocrit (Hct) were measured routinely. Renal irradiation resulted in a progressive decline in GFR, ERPF, and Hct, with minimal values being observed within 12 weeks of irradiation. No change in any of these parameters was noted in the sham-irradiated pigs. The initial morphological change in irradiated glomeruli was leukocyte attachment to capillary endothelial cells 3-6 weeks after irradiation followed by activation and swelling of the endothelial cells. This was followed by pronounced increases in capillary permeability with fluid and erythrocyte, leukocyte, and platelet exudation into the subendothelial/mesangial space. This resulted in compression of glomerular capillary lumina, which occurred concomitantly with the reduction in GFR. By 12 to 15 weeks after irradiation the changes in endothelial cells were less evident. However, mesangial cells exhibited evidence of activation and proliferation accompanied by progressive mesangial expansion and sclerosis. Thus the glomerular capillary endothelial and mesangial cells appear particularly important in the pathogenesis of radiation nephropathy.

The effect of unilateral nephrectomy on the subsequent radiation response of the pig kidney.

The left kidney of 14 Large White female pigs, approximately 14 weeks of age, was surgically removed. Thirty weeks after unilateral nephrectomy (UN) the remaining kidney was irradiated with a single dose of between 11.9 and 15.6 Gy of 60Co gamma-rays; three pigs received sham irradiation. Following irradiation glomerular filtration rate (GFR), effective renal plasma flow (ERPF) and haematocrit (Hct) were determined for up to 48 weeks after irradiation. Irradiation resulted in a dose-dependent decline in GFR, evident 8 weeks after irradiation. This was followed by a gradual improvement in GFR, although after doses of 14.0 Gy GFR remained below control values throughout the study. A similar pattern of response was seen in terms of ERPF, but this was not dose-related. Doses of greater than or equal to 14.0 Gy also caused a significant reduction (p less than 0.001) in Hct within 4-8 weeks. Minimal levels were evident 16 weeks after irradiation; Hct then increased, but remained below preirradiation values. Dose-effect curves were obtained by determining the percentage of irradiated kidneys which showed a greater than or equal to 50% reduction in GFR and ERPF, fitted by probit analysis, and ED50 values (+/- SE) were calculated for each parameter. The ED50 values for GFR and ERPF were 14.49 +/- 0.27 Gy and 12.56 +/- 0.98 Gy, respectively. These values were not significantly different from those obtained from intact age-matched pigs in which the right kidney alone was irradiated; UN did not compromise or alter the radiation response of the kidney to irradiation. However, the ED50 values obtained for the UN pigs were significantly greater (p less than 0.001) than the values of 9.76 +/- 0.17 Gy and 6.19 +/- 0.93 Gy, seen for GFR and ERPF in intact age-matched pigs in which both kidneys were irradiated. Thus although both experimental situations involved irradiating the entire renal tissue, the relative radiosensitivity of the kidneys varied considerably. These findings show that the radiosensitivity of the pig kidney can vary markedly, depending on the physiological status of the kidney at the time of irradiation.

Residual radiation-induced damage to the kidney of the pig as assayed by retreatment.

The effect of re-irradiation on the previously irradiated kidney was studied in the Large White female pig. Both kidneys of 14-week-old pigs were initially irradiated with a single dose of 3-7 Gy of 250 kV X-rays. The individual kidney glomerular filtration rate (GFR), effective renal plasma flow (ERPF), and the haematocrit (Hct) were serially measured up to 24 weeks after X-irradiation. Doses of 3 and 5 Gy of X-rays had little effect on the GFR. However, 7 Gy of X-rays caused a marked decline in the GFR up to 12 weeks after irradiation; the GFR then began to recover. A similar pattern of response was seen in the ERPF. In contrast, the Hct was reduced in all pigs 4 weeks after X-irradiation. The extent of the decline and subsequent recovery 24 weeks after irradiation appeared to be related to dose. Twenty-four weeks after X-irradiation both kidneys were re-irradiated with a single dose of 7.9 Gy of 60Co gamma-rays; both kidneys of four age-matched control pigs which had not previously received X-irradiation were similarly treated. Individual kidney GFR, ERPF and Hct were again serially measured up to 24 weeks after gamma-irradiation. Re-irradiation resulted in a significantly greater reduction in the GFR, ERPF and Hct compared with that seen after gamma-irradiation alone. Moreover, the severity of the reduction in the GFR and Hct observed after gamma-irradiation was related, in a dose-dependent manner, to the initial X-ray doses employed. These results indicate that the kidney fails to exhibit complete long-term recovery in function following irradiation. Re-irradiation of the kidney in patients should thus be viewed with extreme caution.

Radiation nephropathy in mature pigs following the irradiation of both kidneys.

Both kidneys in mature female Large White pigs, ca. 45 weeks old were irradiated with single doses of 7.8-14.0 Gy of 60Co gamma-rays. Radiation-induced changes in renal function were assessed on the basis of sequential individual measurements of kidney glomerular filtration rate (GFR) and effective renal plasma flow (ERPF) for up to 24 weeks after irradiation. At the same time intervals blood samples were taken to determine plasma renin levels and the haematological status of each animal. Two weeks after irradiation the ERPF and in particular the GFR was increased. This was followed by a pronounced, dose-dependent, decline in renal haemodynamics. Minimal functional levels were observed 8-12 weeks after irradiation. Function then somewhat recovered. There was a significant (r greater than or equal to 0.98; p less than 0.001) inverse relationship between the mean values of GFR and ERPF, determined at 4-24 weeks after irradiation, and the radiation dose. After a dose of 7.8 Gy the reduction in ERPF was greater than that for GFR. However, at higher doses both parameters were reduced to an equal extent. The resulting slope of the dose-effect curve for impaired renal function versus dose was significantly steeper for GFR than that for ERPF (p less than 0.001). There was a significant reduction (p less than 0.002) in the erythrocyte count, the haematocrit and haemoglobin levels within 6-8 weeks of irradiation; this anaemia was characterized as a normochromic normocytic anaemia. There were no marked changes in plasma renin levels as a result of renal irradiation. The pathogenesis of late radiation-induced damage to the kidney is discussed in the light of these findings.

The effect of age and the proportion of renal tissue irradiated on the apparent radiosensitivity of the pig kidney.

In 14-week-old (immature) and 45-week-old (mature) pigs either the right kidney (unilateral irradiation, UI) or both kidneys (bilateral irradiation, BI) were irradiated. The kidneys of immature pigs received single doses of 7.0-12.6 Gy of 250 kV X-rays; mature pigs received single doses of 7.8-14.0 Gy of 60Co gamma-rays. These were assumed to be approximately equivalent to the X-ray doses using a RBE of 0.9 gamma-rays/X-rays. The glomerular filtration rates (GFR) and effective renal plasma flows (ERPF), were determined for up to 24 weeks after irradiation. From these data dose-effect curves were obtained by determining, at each dose level, the percentage of irradiated kidneys which exhibited a greater than or equal to 50 per cent reduction in GFR and ERPF. 60Co gamma-ray doses were normalised to approximately equivalent X-ray doses. The dose-effect curves were fitted by probit analysis, and ED50 values (+/- SE) calculated for both GFR and ERPF. Similar conclusions could be drawn from the results obtained following the determination of both GFR and ERPF. However, the ED50 values obtained for ERPF were significantly lower than those for GFR (p less than 0.05). In 14-week-old animals the kidney of UI animals was significantly more radiosensitive than that of BI animals, i.e. the ED50 values, in terms of GFR, were 8.74 +/- 0.31 Gy and 10.97 +/- 0.23 Gy, respectively (p less than 0.001). In 45-week-old pigs the reverse was true; the ED50 values were 12.67 +/- 0.34 Gy and 8.78 +/- 0.15 Gy (p less than 0.001) for unilateral- or bilateral-irradiated animals, respectively. The kidney of BI mature animals appeared to be as radiosensitive as the UI immature pigs. Thus the renal response to radiation was markedly influenced by the age of the animals and by the proportion of the renal tissue irradiated.

Influence of a low protein diet on radiation nephropathy in the pig.

Nine mature, approximately 45-week-old pigs, were fed a standard diet (SD) containing 16% protein; 10 pigs were fed an isocaloric low protein (LP) pig feed containing 4% protein 2 weeks prior to and 16 weeks after renal or sham-irradiation. The pigs then received the SD for a further 4 weeks. Both kidneys of seven pigs fed the LP diet, and six pigs fed the SD, were irradiated with a single dose of 9.8 Gy of 60Co gamma-rays. The remaining pigs received sham-irradiation. The individual kidney glomerular filtration rate (GFR), effective renal plasma flow (ERPF), and the haematocrit were serially measured before and up to 20 weeks after irradiation. The radiation-induced reduction in mean individual kidney GFR, expressed as either absolute values or as a percentage of the respective sham-irradiated controls, was significantly greater in pigs fed the SD compared with pigs fed the LP diet (p < 0.05). In contrast, the radiation-induced reduction in mean individual kidney ERPF, expressed as absolute values, observed in pigs fed the SD was not significantly different from that seen in pigs fed the LP diet. However, if these data were expressed as a percentage of the respective sham-irradiated controls, then a significantly greater reduction in ERPF was seen in pigs fed the SD compared with pigs fed the LP diet (p < 0.001). Morphological analysis of renal tissue removed 20 weeks after irradiation showed that the extent and severity of the glomerular lesions seen in pigs fed the SD were significantly reduced in pigs fed the LP diet. Thus dietary protein restriction appears to reduce some of the signs of radiation nephropathy in the pig.

Preliminary results of a modified surface rendering technique in the display of magnetic resonance angiography images.

Maximum intensity projections are the currently accepted method of displaying Magnetic resonance angiography (MRA) data. In this study, we introduce a modified surface rendering method for displaying this same MRA data. The system we have developed is designed to reconstruct three-dimensional (3D) images of vasculature using standard magnetic resonance images. A workstation was used for post-processing that is readily available and inexpensive. Software was written to process the original images and control the commercially available surface rendering algorithm while performing the reconstruction. The standard surface rendering technique was modified by including several velocities of blood flow in the reconstruction. These velocities were assigned varying degrees of translucency, which allow flow information to be included in the reconstructed images. Six subjects were examined using this technique and the images were compared with those from other imaging modalities. This surface rendering method has been shown to produce clearer and more comprehensible images of complex vasculature, both for radiologists, and for physicians of other disciplines. Its success is based on improvements in computing techniques and in acquisition of vascular MR images. The method shows great potential, and with future clinical trials, the true uses of this method will be discovered or confirmed.

Increasing patient throughput in magnetic resonance imaging: a practical approach. Oxford MRI Group.

A major factor governing the throughput of patients in a magnetic resonance imaging (MRI) service is the number and length of sequences employed. This study investigated the feasibility of prospectively selecting patients for whom a pre-planned examination of the brain, spine or knee could be applied with a high chance of success. The implications on throughput of using these pre-planned examinations were determined. 173 patients were studied. A successful outcome was defined as an examination in which a diagnosis could be made with 100% confidence and without the need for further sequences. Examinations of the brain (n = 113), knee (n = 23) and lumbar spine (for disc degeneration, n = 14) were performed with success rates of 96%, 87% and 64%, respectively. Examinations of the lumbar spine (for radicular symptoms, n = 20) and cervical spine (n = 3) were performed with success rates of 85% and 66%, respectively. The examinations of the brain, knee and lumbar spine (for disc degeneration) were completed within the target time of 20 min in 92%, 95% and 69% of cases, respectively. Examinations of the lumbar spine (for radicular symptoms) and cervical spine were completed within 30 min in 75% and 33% of cases, respectively. Analysis of our results suggests that success rates could be improved by minor changes in sequence design. Carefully selected patients can be successfully examined in short examination times. Instituting these practices would increase the efficiency of MR machine time and improve patient throughput by 80-125%. This would have a marked effect on the length of waiting lists, and would increase the general availability of MRI.

The role of computed tomography in the management of soft tissue sarcomas.

Seventy-seven patients with soft tissue sarcoma underwent computed tomography (CT) between 1977 and 1981. The results have been analysed to determine the characteristics of these tumours on CT, the accuracy of CT in predicting resectability and in the detection of distant metastases, and the influence of CT findings on patient management. The majority of tumours appeared as masses which were well-defined, either by surrounding soft tissue planes or because the tumour had a significantly different attenuation value to the surrounding tissues. No correlation was found between the characteristics on CT and the tumour histology. A prediction of operability based on the CT appearances was compared with the surgical findings in 24 patients. This prediction was correct in 22 patients (92%) and further useful surgical information was provided in 11 patients (46%). A comparison of the CT findings with those of chest radiography, including whole lung tomography, showed that CT demonstrated a significantly larger number of pulmonary metastases. CT was also useful in revealing unsuspected local recurrences in four of 18 patients although one false positive diagnosis was made. Overall, the information provided by CT altered the clinical management in 18 patients (23%); the most important change was that surgery was avoided. Computed tomography should be regarded as the investigation of choice for the assessment of the primary or locally recurrent tumour and the detection of "occult" pulmonary metastases.

The role of computed tomography in the management of children with advanced neuroblastoma.

Computed tomography (CT) was found to be a valuable method of assessing the extent of local disease in 36 patients with advanced neuroblastoma. Precise predictions on the operability of tumours can be made so that the timing of primary or "second look" surgery may be optimised. However, intraspinal extension of tumour is not detected on CT examinations without intrathecal contrast medium and plain radiographs are not a reliable guide to the presence of intraspinal disease; the examination should include intrathecal contrast medium (CT myelography) when patients undergo pre-operative staging by CT. The majority of neuroblastomas appear calcified on CT. During chemotherapy the most common change in tumour morphology is decrease in size and increase in calcification. There is however no correlation between tumour size or behaviour during chemotherapy and eventual survival but an increase in size during or after treatment is a serious prognostic sign.

The role of MRI in facial swelling due to presumed salivary gland disease.

50 consecutive patients presenting with facial swelling thought clinically to be due to salivary gland disease underwent MRI. Examinations were interpreted by one radiologist without access to previous investigations. Records were reviewed to determine the reliability and role of MRI in patient management, and the contribution of other prior or subsequent investigations. MRI findings were verified against operative findings, percutaneous biopsy or clinical follow-up (periods ranging from 8-58 months). A mass was found in 27 patients; in 11 of these patients, disease was extrinsic to the salivary gland. MRI diagnosis of tumour was correct in all patients and MRI was a reliable investigation for planning surgical resection. No mass was found in 23 patients, 8 of whom had normal appearances. Evidence of salivary duct dilatation was seen in 12 patients and fatty infiltration was seen in 3. MRI findings appeared correct in all patients. Prior investigation was undertaken in 29 patients, including orthopantomography, ultrasound and sialography; none provided additional information. Sialography was carried out in three patients after MRI and concurred with MRI in all cases. MRI was an adequate basis for management in all patients and therefore appears to be an effective first line investigation of facial swelling. It is reasonable for patients to undergo preliminary investigation for dental sepsis, this being the most common cause of facial swelling. Further study is required to determine whether MRI can completely replace invasive sialography.