Comparative study of technetium-99m bone scans and orthopantomography in determining mandible invasion in intraoral squamous cell carcinoma.

The accuracy of preoperative assessment in determining invasion of the mandible by intraoral squamous cell carcinoma was analyzed in 48 patients who underwent mandibulectomy, and the results correlated with the histopathological reports of the resected specimens. Only 50% of the patients underwent the "ideal" surgery based primarily on clinical judgement, whereas 10 patients in the series were significantly undertreated. Clinical judgement and routine preoperative x-rays are accurate in cases where there is gross involvement of the mandible (17 of 19) but are significantly less successful in determining early bone invasion, invasion of the periosteum, or periosteal new bone formation. In such cases (26 of 48), a technetium-99m bone scan provides additional information. A grading system for reporting orthopantomographics (OPTs) and bone scans has been developed and utilized to form a reference grid to determine the optimum extent of mandibular surgery. The results show that using this protocol, unnecessary mandibular surgery may be reduced and inadequate surgical excision avoided.

Endoscopy and routine and double-contrast barium meal in diagnosis of gastric and duodenal disorders.

A double-contrast barium meal has been carried out on 37 patients in whom there had been disagreement in diagnosis between the routine barium meal and subsequent oesophago-gastro-duodenoscopy. There was an 81% agreement between the endoscopic diagnosis and the diagnosis obtained with double-contrast barium meal. Confirmation of the endoscopic and double-contrast radiological diagnosis was obtained all 11 patients who had surgical treatment. These findings suggest that a double-contrast barium meal should be routinely used in the diagnosis of dyspepsia.

The early use of fine-needle percutaneous transhepatic cholangiography in an approach to the diagnosis of jaundice in a surgical unit.

Fine-needle percutaneous transhepatic cholangiography (PTC) was performed in a series of 46 patients with jaundice or suspected biliary tract disease. The ductal system was successfully outlined in each of 20 patients with dilated intrahepatic ducts and in 19 of 26 patients with intrahepatic ducts of normal calibre. There were two episodes of septicaemia after PTC, one of them fatal. Valuable accurate diagnostic information was obtained in all cases with biliary tract obstruction. A programmed approach to diagnosis of suspected obstructive jaundice is outlined. Fine-needle PTC is an acceptably safe procedure and need not be followed by immediate laparotomy.

Comparison of the Doppler perfusion index and intraoperative ultrasonography in diagnosing colorectal liver metastases. Evaluation with postoperative follow-up results.

OBJECTIVE: The authors compared the accuracy of intraoperative ultrasound with the Doppler perfusion index (DPI) in the detection of occult liver metastases. SUMMARY BACKGROUND DATA: Intraoperative ultrasound is well recognized to be very sensitive in the detection of small liver tumors. Previous studies using duplex/color Doppler sonography have shown that the measurement of the DPI (hepatic arterial to total liver blood flow ratio) can detect the presence of occult colorectal liver metastases. METHODS: Intraoperative ultrasound and DPI were evaluated in 90 patients with colorectal cancer with apparently disease-free livers (on the basis of computed tomography scans and laparotomies). All patients subsequently were observed for follow-up with 3 monthly clinical examinations, ultrasound scans, and yearly computed tomography scans. RESULTS: Intraoperative ultrasound detected liver metastases in 4 of the 23 patients who subsequently developed overt liver metastases during 1-year follow-up. However, DPI predicted the development of hepatic metastases in all 23 cases. CONCLUSION: The results suggest that DPI is more sensitive than intraoperative ultrasound in the early detection of occult colorectal liver metastases. The Doppler technique can identify patients at high risk, suitable for adjuvant therapy. The routine use of intraoperative ultrasound in screening for occult colorectal liver metastases is not recommended.

Detection of colorectal liver metastases: comparison of laparotomy, CT, US, and Doppler perfusion index and evaluation of postoperative follow-up results.

PURPOSE: To assess the value of the Doppler perfusion index (DPI = the ratio of hepatic arterial to total liver blood flow) as measured with duplex and color Doppler sonography (DCDS) in comparison with computed tomography (CT), conventional ultrasound (US), and laparotomy for the detection of liver metastases in patients with colorectal cancer. MATERIALS AND METHODS: DCDS measurement of the DPI and CT, US, and laparotomy were performed in 161 consecutive colorectal cancer patients. Patients who underwent an apparently curative resection were followed up at 3-month intervals with US and at annual CT. RESULTS: Fifty-six patients had histologically proved liver metastases at initial examination. Liver metastases were detected with DPI, CT, US, and laparotomy in 56, 45, 27, and 36 patients, respectively. After a 1-year follow-up, 23 patients had developed liver metastases, all of which were predicted on the basis of an abnormal DPI value. CONCLUSION: Results suggest that DCDS measurement of the DPI is the most sensitive technique in detection of colorectal liver metastases. All studies should attempt to define normal liver on the basis of follow-up results rather than those of laparotomy.

Hepatic perfusion changes in patients with liver metastases: comparison with those patients with cirrhosis.

Previous studies using dynamic scintigraphy have shown that the measurement of changes in hepatic perfusion may be exploited to detect liver metastases. Similar hepatic haemodynamic changes also occur in cirrhosis, however, thereby reducing the diagnostic power of the technique. The ability of duplex colour Doppler sonography (DCDS) to differentiate between the changes in liver perfusion in patients with cirrhosis and those with hepatic metastases was assessed. Hepatic arterial and portal venous blood flows were measured in 30 control subjects, 20 patients with cirrhosis, and 55 patients with overt liver metastases. The Doppler perfusion index (DPI) (the rate of hepatic arterial to total liver blood flow) and the congestive index (ratio of the cross sectional area of the vessel to time averaged velocity of blood flow in the vessel) of the hepatic artery (HCI) and portal vein (PCI) were calculated. The hepatic arterial blood flow of the cirrhotic and metastatic groups was significantly raised compared with that of controls, and the portal venous blood flow of the former groups were reduced (p < 0.0001). The DPIs of the cirrhotic and metastatic groups were therefore significantly raised compared with those of controls (p < 0.0001). No significant difference was noted in HCI values between the three groups. The PCI values of the cirrhotic group, however, were significantly raised compared with those of controls and patients with metastases (p < 0.0001). The data suggest that DCDS measurement of PCI may be of value in differentiating between the hepatic perfusion changes caused by cirrhosis and those resulting from hepatic metastases, thereby increasing the diagnostic power of this technique.

Improved sensitivity of colour Doppler flow imaging of colorectal hepatic metastases using galactose microparticles: a preliminary report.

The clinical application of ultrasonographic contrast agents in colour Doppler flow imaging of hepatic tumours is receiving increasing attention. Levovist is a suspension of galactose microparticles that provides reproducible concentrations of stabilized air bubbles with transpulmonary stability. Its effect on colour Doppler imaging was assessed in 26 patients with colorectal cancer and histologically proven hepatic metastases. Colour Doppler flow imaging was performed before and after intravenous injection of 10 ml Levovist 300 mg/ml. At 5-10 s after injection there was significant enhancement of the hepatic lesions with colour Doppler signals in 23 patients, lasting for a mean(s.d.) of 180(45) s. A consistent pattern of colour Doppler signal was observed, with increased enhancement predominantly around the tumour periphery and little or no central enhancement. These data suggest that Levovist may increase the sensitivity and specificity of colour Doppler flow imaging of colorectal hepatic metastases.