CT Staging of Renal Pelvis Tumor

PURPOSE: To assess the value of computed tomography (CT) in the preoperative staging of transitional cellcarcinoma (TCC) of the renal pelvis. MATERIALS AND METHODS: We retrospectively evaluated the CT TNM staging of 38patients with TCC of the renal pelvis who had undergone preoperative abdominal CT examination between January 1990and January 1998. In CT staging for differentiation between early-stage (TO-2) and advanced-stage disease (T3-T4),three criteria were used, namely the presence or obliteration of the renal sinus fat layer, the smoothness orirregularity of margin between the tumor and renal parenchyma, and the presence or absence of hydronephrosisproximal to the tumor. CT staging was performed by two genitourinary radiologists blinded to the pathologicresults, and was compared with pathologic staging. RESULTS: Pathologic results revealed 19 cases of early stagedisease (TO=8, T1=9, T2=2) and 19 of advanced stage (T3=12, T4=7). Overall CT staging accuracy was 82%(31/38);fourcases were overstaged and three were understaged. In early-stage disease, sensitivity and specificity were 79%,and 84%, and in advanced stage disease were 83% and 80%. Three of four overstaged cases showed hydronephrosisproximal to the tumor. In the second CT staging, using proximal hydronephrosis of the tumor as a criterion forearly-stage disease, the sensitivity and specificity of early-stage disease were 95% and 75%, respectively, andthe specificity of advanced-stage disease was 95%. CONCLUSION: When hydronephrosis proximal to a tumor wasconsidered to be a sign of early stage disease, the CT staging of renal pelvic TCC was highly accurate.

Analysis of Angiographic Findings in Cerebral Arteriovenous Malformation with Hemorrhage: Comparison between Intracerebral and Intraventricular Hemorrhage

PURPOSE: The purpose of this study was to analyze the angioarchitectures of cerebral arteriovenousmalformation(AVM) and to determine whether there was correlation between angioarchitectures and patterns ofintracranial hemorrhage(intracerebral, intraventricular, and both) in cerebral AVM. MATERIALS AND METHODS: Onehundred and twenty-eight patients who between November 1989 and December 1994 suffered supratentorial AVM withintracranial hemorrhage were studied retrospectively. Among 128 patients, intracerebral and intraventricularhemorrhage were seen in 68 (53%) and 24 patients (19%), respectively, while both types were seen in the remaining36 (28%). We analyzed the angioarchitectual characteristics of AVM. namely nidi, feeding arteries and drainingveins, in three hemorrhagic groups of patients with intracerebral hemorrhage, intraventricular hemorrhage andboth. The kappa2 test or Fisher's exact test was used for statistical analysis. RESULTS: A cortically located niduswas most common in patients with intracerebral hemorrhage, while a periventricular location was most common inthose with intraventricular hemorrhage (p<0.001). Location in the corpus callosum, choroid plexus, orintraventricular area was more frequent in the intraventricular than the intracerebral hemorrhagic group (p<0.05). Superficial venous drainage was most common in patients with intracerebral hemorrhage (p<0.001), and deep venousdrainage in those with intraventricular hemorrhage (p=0.001). CONCLUSION: The angioarchitectual characteristicsof cerebral arteriovenous malformation correlate significantly with patterns of intracranial hemorrhage, andawareness of the type of hemorrhage could help to manage patients and determine prognosis.

Modified Small Bowel Follow-through Using Methylcellulose After Administration of Barium Suspension :Comparison with Conventional Series

PURPOSE: To compare modified small bowel follow-through (SBFT) using methylcellulose after the administrationof barium suspension with a conventional series. MATERIALS AND METHODS: In order to evaluate small bowelpathology, modified SBFT was performed in 155 patients during a 15 month period. All patients received 600mL ofmethylcellulose ; 98 had taken 250mL of 40% wt/vol barium suspension and 57 had taken 150mL of 70% barium. For thegroup of 98, the barium suspension was prepared by mixing barium powder with water (n=46) or with methylcellulosein(n=52). For comparison with a modified series, 49 patients who underwent conventional SBFT using 500mL of 40%wt/vol barium were lso included. Image quality was rated by three radiologists as "poor", "fair", "good", or"excellent". We analyzed the relationship between image quality, transit time and small bowel pathology;the sensitivity and specificity of each technique was also determined. RESULT: Among the four techniques, modifiedSBFT with 250mL of 40% wt/vol barium suspension, prepared by mixing barium powder with methylcellulose, showed thebest image quality ["excellent" result in 33 of the 52 patients (63%)] and shortest transit time to the cecum. Thehigh image quality of this technique was not affected by the presence of small bowel pathology;its use resulted inthe lowest incidence and slowest development of flocculation. The sensitivity (91-95%) of the three modified SBFTprocedures was superior to that of a conventional series(76%), but there was no difference in specificity. CONCLUSION: Modified SBFT using methylcellulose after administering barium suspension with barium powder as amixing agent is a simple technique. Its use easily improves the image quality and diagnostic accuracy of peroralSBFT.