[Comparison of spiral computed tomography without contrast media and intravenous urography in the diagnosis of renal colic]. / Comparaison du scanner spiralé sans contraste et de l'urographie intraveineuse dans le diagnostic de la colique néphrétique.

OBJECTIVES: This prospective study was designed to determine the reliability of noncontrast spiral CT scan, compared to that of intravenous urography (IVU), in the diagnostic assessment of acute renal colic. MATERIAL AND METHODS: 53 patients, admitted with an empirical diagnosis of renal colic after initial assessment, were included and underwent spiral CT scan without contrast agent injection, immediately followed by IVU. These examinations were performed according to a blind protocol by two different radiologists. We initially looked for the presence of stones and/or urinary tract obstruction. Patients with a stone and/or obstruction (urinary tract dilatation) visible on CT scan were then examined for the presence of CT signs associated with stone disease (infiltration of the perirenal and periureteric fat, oedema of the ureteric wall and loss of sinus fat). We calculated the statistical correlation between the presence or absence of obstruction and these accessory signs. RESULTS: 45 stones were recovered (in 36 cases before the two examinations). 36 stones were identified on CT versus only 24 on urography. Urinary tract dilatation was demonstrated in 26 out of 53 cases by both urography and CT. The frequency of accessory signs visible on CT in the presence of stones (n = 36) was 66% for infiltration of periureteric fat, 36% for infiltration of perirenal fat and 75% for oedema of the ureteric wall. In the presence of urinary tract dilatation, these frequencies were 92%, 84% and 60% respectively. CONCLUSION: Noncontrast spiral CT is a reliable and rapid diagnostic modality for the detection of urinary stones, providing a morphological study equivalent to that of IVU and able to guide appropriate treatment. It should replace IVU in the diagnostic assessment of renal colic.

[Pneumatosis cystoides intestinalis revisited]. / La pneumatose kystique intestinale reconsidérée.

Two cases of pneumatosis cystoides coli are reported. The authors present an anatomic and physiopathologic review of the entity and give the list of etiologies with the worse prognosis. The radiologic signs are described and their contribution to an accurate diagnosis is stressed, as it may avoid useless surgical interventions.

Klatskin tumors: radiological and imaging findings in eleven patients.

A retrospective study of 11 patients with Klatskin tumor is presented. The series includes 3 men and 8 women with a mean age of 71 years (range: 61-84 years). Histologic examination revealed a well-differentiated cholangiocarcinoma in 7 cases, an undifferentiated type in 3 and a sclerosing type in one. Ultrasound plays an increasing role in setting a directive diagnosis. Preoperative localisation of the tumor and status of the intrahepatic bile ducts are best depicted with cholangiography. CT findings are non specific, but are useful for an adequate pre- and post-treatment staging.

[Appendicitis: advantages of US and CT in aspecific clinical and radiological findings]. / Appendicitis: voordelen van US en CT in aspecifieke klinische en radiologische bevindingen.

We present the case of a 23-year-old woman with atypical clinical and radiological findings of subacute appendicitis. When abdominal plain film and contrast medium enema examination show atypical findings and ultrasound results are uncertain, CT should be considered. CT after peroral and intravenous contrast administration can confirm or exclude the diagnosis of suspected appendicitis showing the possible presence, location and degree of inflammation, phlegmon and abscess masses.

A comparative study of the patello-femoral joint on axial roentgenogram, axial arthrogram, and computed tomography following arthrography.

After arthrography 71 young patients with pain in the knee had a computed tomography (CT) examination. The form of the patella is classified according to the method of Wiberg [12] and on CT 50% of them do not correspond to the type described on the axial roentgenogram. The position of the patella can be examined on CT with a relaxed knee in 15 degrees of flexion. The patellar cartilage is easier to assess on CT: congruity, regularity, imbibition of contrast material and thickness are studied.

The value of computed tomography scanning in chondromalacia patellae.

Sixty seven patients with pain in the knee were studied. A compound tomography (CT) score indicating chondromalacia was devised, based on the results of CT after arthrography. This score takes account of the regularity, the congruity, and the imbibition of contrast material. Thus the patients could be divided into four groups: those who definitely have chondromalacia (++), probably (+), probably not (+/-), and definitely not (-). These results were compared with the clinical diagnosis based on clinical signs, arthroscopy, or operation. Eighteen patients had clinically proved chondromalacia, CT scored 14++, 3+ and 1+/-. Twenty nine patients had no chondromalacia, CT scored 19-, 8+/-, and 2+. Twenty patients had an uncertain clinical diagnosis. Arthrography was less accurate in detecting chondromalacia.

The use of computerised tomographs in the diagnosis of thoracolumbar injury.

This paper presents four patients with injuries to the thoracolumbar spine assessed by computerised tomography. This technique enabled an easy, quick and accurate diagnosis to be made, avoiding dangerous manipulation of the patient. The scans were analysed using the anatomical classification of Louis to evaluate the instability of the lesions. Control CT scans were used to monitor progress and to provide an accurate prognosis within acceptable limits of irradiation.