The value of the preoperative barium-enema examination in the assessment of pelvic masses.

The value of the barium-enema examination in the assessment of pelvic masses was studied in 44 patients. Findings from those barium-enema examinations and from pathological specimens from 37 patients who had malignant tumors and seven patients who had endometriosis were retrospectively analyzed to determine if the barium-enema examination is useful in differentiating extrinsic lesions with and without invasion of the colon. None of the 12 patients who had extrinsic lesions had any of the criteria that indicated bowel-wall invasion. These criteria included fixation and serrations of the bowel wall in all patients with invasion, and ulceration and fistulization in those patients who had complete transmural invasion. In patients with pelvic masses, the preoperative barium-enema examination may be useful to the surgeon in planning surgery and in preparing the patient for the possibility of partial colectomy or colostomy.

High kVp vs. low kVp for T-tube and operative cholangiography.

Based on several considerations, high kVp and high contrast agent concentration should produce better-quality operative and T-tube cholangiograms than the currently recommended low kVp and low contrast agent concentration. To test this theory, two kinds of studies were performed. In a laboratory phantom, the influence of kVp and contrast agent concentration on detectability of different size phantom stones was evaluated. High kVp and high contrast agent concentration (110 kVp, 38% iodine) were also compared with low kVp and low contrast agent concentration (75 kVp, 15% iodine) in 62 patients undergoing operative or T-tube cholangiography. Almost all phantom stones were well shown with all kVps and iodine concentrations. As the kVp was raised there was a mild decrease in stone detectability but this decrease was partially corrected by raising the iodine concentration. Overall stone detectability with high kVp and high contrast agent concentration technique was better than or similar to the currently recommended low kVp and low contrast agent concentration technique. Evaluation of the direct cholangiograms by five radiologists revealed that the high kVp, high contrast agent concentration studies were superior or similar to the low kVp and low contrast agent concentration radiographs in 70% of the cases. Based on these results high kVp (100-110) and a high contrast agent concentration (38%) are recommended for direct cholangiography.

Radiologic investigation of peptic ulcer disease.

Fiberoptic endoscopy has uncovered some of the weaknesses with the traditional upper gastrointestinal series and has prompted more critical evaluation of the radiographic examination of the stomach. The biphasic examination using gas distention as well as thick and thin barium suspensions incorporates the best features of both single- and double-contrast examinations. The radiologist needs to be aware of the different signs of ulcer disease as demonstrated by the two different types of examinations, and attention to technical details is critical if thick barium coating is really going to produce striking anatomic detail. Knowing the radiographic features of the common and uncommon manifestations of peptic ulcer disease is important for the radiologist performing gastrointestinal studies. By performing technically excellent studies and by recognizing the various manifestations of peptic ulcer disease, the radiologist will continue to play an important role in diagnosing suspected or known peptic ulcer disease.

The peroral pneumocolon: its role in evaluating the terminal ileum.

Peroral pneumocolon examination was performed on 40 patients for further radiographic evaluation of the terminal ileum after antegrade small bowel study. Patients were selected because of poor visualization of the terminal ileum on routine study (17 patients), clinically suspected Crohn disease but normal terminal ileum on routine study (ten), abnormal terminal ileum on routine study (seven), and previous ileocolic anastomosis (six). Use of the technique resulted in additional diagnostic information in 20 (50%) of the 40 patients. Its main value was in showing a previously poorly visualized terminal ileum to be normal (eight patients) and in confirming a normal terminal ileum in clinically suspected Crohn disease (six). In addition, it more precisely defined the proximal extent of recurrent ileal Crohn disease in two patients and detected otherwise unrecognized early ileal Crohn disease in one patient. The technique can be carried out immediately after any antegrade small bowel examination, and if reserved for the above indications, is a valuable adjunct to routine compression spot films of the terminal ileum or reflux study of the terminal ileum at barium enema.

Radiologic diagnosis of Crohn disease (with emphasis on its early manifestations).

Crohn disease can affect any part of the gastrointestinal tract. The early manifestations of the disease are readily recognizable in the colon if double-contrast technique is employed. Small bowel and gastroduodenal involvement in the early stages have been less frequently identified, but enteroclysis and double-contrast UGI examination have yielded encouraging results. There is some evidence that failure to utilize the double-contrast barium enema and enteroclysis contributes to delay in diagnosis of Crohn disease. Use of these more sophisticated techniques is encouraged. As follow-up radiography in Crohn disease appears less indicated than previously considered, it is particularly important that initial assessment employs the most sensitive and accurate radiographic techniques available.

Ectopic pancreas: usual and unusual features.

Nine patients with ectopic pancreas in the stomach (8 patients) and duodenum (1 patient) were studied both radiographically and endoscopically. Correct diagnosis was made by radiography in six cases and by endoscopy in seven cases. Masses radiographically larger than 3 cm in diameter were seen in three patients. The incorrect radiographic diagnoses were related to the presence of a large mass in one patient and to the complications of severe bleeding and gastric outlet obstruction in the other two. Endoscopy and radiography are complementary modalities in the diagnosis of ectopic pancreas.

Iodine absorption from the gastrointestinal tract during hypaque-enema examination.

Iodinated contrast agents administered intravenously or intra-arterially may cause serious reactions in hypersensitive patients. Oral administration of Hypaque (diatrizoate sodium) results in minimal absorption of iodine, but the amount of iodine absorbed with Hypaque-enema studies is unreported. Hypaque-enema examinations were performed in 20 normal, nonsensitive patients and increased serum iodine levels ten to 200 times base-line values, peaking after approximately one hour in patients who had measurements obtained for four hours. Therefore, before Hypague-enema studies, patients must be carefully questioned about their tolerance of iodinated contrast agents, and preparations should be made for possible serious hypersensitivity reactions.