CT Evaluation of Mechanical Intestinal Obstruction

PURPOSE: To evaluate the usefulness of CT for the diagnosis and treatment planning of mechanical intestinal obstruction. MATERIALS AND METHODS: We retrospectively reviewed 38 patients who were clinically suspected of mechanical intestinal obstruction and had undergone abdominal CT. The CT scans were evaluated for the absence or presence, severity, cause and site of intestinal obstruction. CT findings were compared with the results of laparotomy, barium study and clinical course. The absence or presence and severity of intestinal obstruction were classified into no obstruction, partial obstruction, complete obstruction. Diagnosis was estabilished by means of laparotomy in 20 cases, barium study in 9 cases and clinical course in 9 cases. RESULTS: Of 38 cases, 7(18.4%) showed no obstruction, 22(57.9%) showed partial obstruction, and 9(23.7%) showed complete obstruction. The presence or absence and severity on CT scans were corretly predicted in 36 of 38 cases (sensitivity 95%, specificity 97%, accuracy 96%) (in case of no obstruction:sensitivity 100%, specificity 94%, accuracy 95%;in case of partial obstruction:sensitivity 91%, specificity 100%, accuracy 95%;in case of complete obstruction:sensitivity 100%, specificity 100%, accuracy 100%). All 9 cases with complete obstruction underwent prompt and immediate laparotomy. 13 cases, excluding those with mass around the site of transition and adhesion with strangulation, with partial obstruction improved with conservative treatment without laparotomy. The causes of obstruction were adhesion in 13, hernia in 6, primary cancer in 5, metastatic cancer in 3, abscess in 2, intestinal tbc in 1, and Crohn's disease in 1. The cause of obstruction on CT scans were correctly predicted in 27 of 31 cases (87.1%). The sites of obstruction on CT scans were correctly predicted in 22 of 26 cases (84.6%). CONCLUSION: CT is valuable in the evaluation of absence or presence, severity, cause and site of intestinal obstruction, and is considered to be helpful in treatment planning for the patients with intestinal obstruction.

Comparison and Analysis for CT Findings of Gastric Adenocarcinoma and Gastric Lymphoma

PURPOSE: The purpose of this study is to analyze and compare the CT findings of gastric adenocarcmoma and gastric lymphoma. MATERIALS AND METHODS: We retrospectively analyzed and compared the CT findings in 46 cases of adenocarcinoma and 12 cases of lymphoma, which were pathologically confirmed by operation and endoscopic biopsy. RESULTS: Antral involvement was more common in adenocarcinoma(71.7%) than in lymphoma(41.7%). Localized involvement was more common in adenocarcinoma(83.7%), while diffuse involvement was more common in lymphoma(55.6%). Adenocarcinoma tended to have smooth inner margin(83.8%), while lymphoma had nodular or irregular inner margin(36.4%). Mean gastric wall thickness of adenocarcinoma was 1.7cm, while mean thickeness of lymphoma was 2.7cm. The involved wall of adenocarcinoma tended to be highly enhanced (59.5%), while lymphoma was moderately enhanced(90.1%). Perigastric lymphadenopathy was present in 40% (group I) and 42%(group II) of adenocarcinoma and 33% of lymphoma(group I and II). Three cases of lymphoma had lymphadenopathy below renal vascular pedicles with no or minimal perigastric lymphadenopathy. When only the distal portion of the stomach was involved, disturbance in passage developed in six adenocarcinoma (12%), while none developed in the lymphoma. CONCLUSION: CT features help to differentiate between gastric adenocarcinoma and gastric lymphoma

Sonographic Findings in Gouty Nephropathy

PURPOSE: Ultrasound(US) findings of hyperechoic renal medulla in gouty nephropathy were compared with clinical features such as serum uric acid level to evaluate its usefulness in determination of the treatment and prognosis. MATERIALS AND METHODS: A retrospective review of US of 36 cases of gouty arthritis was classified into four groups according to the medullary echogenicity (O:normal, grade 1 :renal medulla as isoechoic as renal cortex, grade 2'heterogeneous increased echogenicity of renal medulla than that of renal cortex, grade 3 :the echogenicity of all renal medulla higher than that of renal cortex with renal contour deformity) which were compared with the serum urate level and associated conditions. Nephrocalcinosis and nephrolithiasis were analyzed through the KUB and the RGP. RESULTS: The degree of hyperechoic renal medulla was related to the level of serum uric acid, and in group IV, six cases of obstructive uropathy (nephrocalcinosis and nephrolithiasis) showed deformed renal contour. Associated conditions such as hypertension, alcoholism, diabetes mellitus and drug abuse were distributed in relation to the degree of hyperechoic renal medullas. CONCLUSION: US findings of hyperechoic renal medulla was related with uric acid level in gouty nephropathy and thus could be valuable for treatment decision and prediction of prognosis.