CT demonstration of a pancreatic duct stricture and obstructive pancreatitis with ERCP and intraoperative correlation.

We describe a case of a pancreatic duct stricture in a young female resulting in chronic intermittent obstructive pancreatitis, and requiring repeated hospitalizations over a ten year period. The stricture was identified by computed tomographic (CT) scan and endoscopic retrograde cholangio-pancreatography (ERCP) and noted to be in the distal pancreatic duct. The patient was treated successfully with distal pancreatectomy. This case report illustrates the utility of CT scanning and ERCP in determining the etiology of pancreatitis. When a stricture is identified, these studies give anatomic detail that aid in intra-operative decision making.

Myelolipoma of the thoracic spine.

We describe a myelolipoma of the thoracic spine in a patient with gradual and progressive myelopathy. MR imaging showed this predominately fatty lesion to be extradural in location.

Shoulder impingement syndrome: diagnostic accuracy of magnetic resonance imaging and radiographic signs.

Shoulder impingement syndrome is commonly encountered in orthopaedics. In a blinded retrospective study, magnetic resonance imaging and roentgenographic signs in 41 patients with clinical signs of impingement syndrome were compared with 40 control patients. Statistically significant differences between the groups included the absence of subarcromial fat, as well as the presence of a supraspinatus tear, subacromial osteophytes, and a decreased coracohumeral distance. Other signs reported to occur in patients with impingement syndrome did not vary significantly in the population studied.

Doppler analysis of hemodialysis grafts: resistive index as a predictor of stenosis.

A series of six hemodialysis vascular access patients was evaluated with duplex Doppler sonography and angiography to identify Doppler sonographic parameters that are predictors of venous outflow stenosis. This preliminary series indicates that no venous outflow stenosis was present angiographically when the resistive index gradient across the venous anastomosis is less than or equal to zero and a significant venous outflow stenosis (50 to 100%) was present when the resistive index gradient is 0.15 or greater (P = 0.002, r = 0.963). Doppler acquisition of resistive index gradients across regions of venous outflow is a promising, noninvasive means of rapid radiologic evaluation of hemodialysis graft patients, especially when the need for angiography is equivocal.

Glenoid labral tears: prospective evaluation with MRI imaging, MR arthrography, and CT arthrography.

OBJECTIVE: We prospectively compared MR imaging, MR arthrography, and CT arthrography to determine the sensitivity of each technique in detecting glenoid labral tears and in determining whether the labrum is detached or degenerated. SUBJECTS AND METHODS: Thirty patients 19-39 years old (mean, 27 years old) who had either signs and symptoms of shoulder instability or shoulder pain of unexplained origin were referred for diagnostic imaging. Each patient underwent MR imaging, followed by MR arthrography after intraarticular injection of 25 ml of a dilute solution of gadopentetate dimeglumine. Twenty-eight of thirty patients underwent CT arthrography after intraarticular injection of air and radiographic contrast material. Each patient also underwent arthroscopy or open surgery. RESULTS: At surgery, labral tears were found in 28 patients; a detached fragment was found in 26 patients. The labrum was found to be degenerated in 18. A labral tear was detected on MR images in 26 (93%) of 28, on MR arthrograms in 27 (96%) of 28, and on CT arthrograms in 19 (73%) of 26. A detached labral fragment was detected on MR images in 12 (46%) of 26, on MR arthrograms in 25 (96%) of 26, and on CT arthrograms in 13 (52%) of 25. Labral degeneration was detected on MR images in two (11%) of 18, on MR arthrograms in 10 (56%) of 18, and on CT arthrograms in four (24%) of 17. MR arthrography was the best of the three imaging techniques for showing the inferior part of the glenoid labrum and inferior glenohumeral ligament. CONCLUSION: MR arthrography and MR imaging both showed labral tears with greater sensitivity than CT arthrography did. MR arthrography was the most sensitive of the three techniques for detecting a detached labral fragment and labral degeneration. Furthermore, MR arthrography afforded the best visualization of the inferior part of the labrum and the inferior glenohumeral ligament. MR imaging and MR arthrography also enabled direct visualization of rotator cuff disease and other unsuspected associated abnormalities.

Efficacy of automated biopsy guns versus conventional biopsy needles in the pygmy pig.

Debate over which biopsy needle is the best has intensified recently with the introduction of automated biopsy guns including the 18-gauge long-throw and short-throw Biopty, the 18-gauge Cook, and the 14- and 18-gauge Klear Kut. To evaluate the efficacy of these mechanized biopsy guns versus that of conventional manual biopsy needles in the acquisition of adequate tissue for histopathologic evaluation, open hepatic and renal biopsies were performed in 15 pygmy pigs. The specimens were evaluated separately in a double-blind fashion by two histopathologists using graded criteria. Overall, the best results were obtained with the manual 14-gauge Tru-Cut needle, the long-throw 18-gauge Biopty gun, and the 18-gauge Cook biopsy gun. By comparison, the aspiration-type needles did not perform as well when considered as a group. Several other needles scored well in the biopsy of either the liver or kidney, but not in both. Disappointing results were obtained with the Klear Kut guns (both 14- and 18-gauge) and the Vacu Cut and PercuCut needles.