ABSTRACT
Endoluminal virtual computed tomographic (CT) cholangiopancreatoscopic views of the pancreatic and common bile ducts were generated in 16 patients by using helical CT data sets and endoscopic three-dimensional reconstruction images. In all patients with ductal dilatation, virtual images were obtained and findings correlated with those at helical CT and endoscopic retrograde cholangiopancreatography. Virtual CT cholangiopancreatoscopy is a feasible technique, and initial experience shows promising results.
Subject(s)
Cholangiopancreatography, Endoscopic Retrograde/methods , Image Processing, Computer-Assisted/methods , Tomography, X-Ray Computed/methods , Common Bile Duct/diagnostic imaging , Common Bile Duct Diseases/diagnostic imaging , Feasibility Studies , Female , Humans , Male , Middle Aged , Pancreatic Diseases/diagnostic imaging , Pancreatic Ducts/diagnostic imagingABSTRACT
PURPOSE: To develop a technique of projectional computed tomographic (CT) cholangiopancreatography (CTCP). MATERIALS AND METHODS: Sixty-one patients underwent CT for suspected biliary or pancreatic abnormalities. The axial CT and CTCP techniques included spiral scanning during the portal venous phase and thick-slab minimum intensity projections. Visualization of pancreatic and extrahepatic bile ducts (divided in five duct segments per patient) was graded blindly on a scale of 1-5 by a consensus of two radiologists. Two hundred seventy-seven duct segments were used to compare axial CT and CTCP in the depiction of duct segments and dilatation; 109 segments were used to compare CTCP with ERCP. RESULTS: Fifty-six of 277 duct segments were not visualized on axial CT images; 15 segments were not visualized on CTCP images (P < .001). There was no statistically significant difference between the number of segments missed with ERCP and the number missed with CTCP: nine and three of 109 segments, respectively. Duct visualization was equal on axial CT and CTCP images in 35 of 109 duct segments and was superior on CTCP images in all but one of the remaining segments (P < .001). Duct visualization on CTCP images was equal to that on ERCP images in 35 segments, superior in nine, and significantly inferior in 66 (P < .001). CONCLUSION: CTCP improves CT depiction of pancreatic and bile ducts with a quality that approaches that of ERCP.
Subject(s)
Cholangiography/methods , Pancreas/diagnostic imaging , Tomography, X-Ray Computed/methods , Aged , Aged, 80 and over , Bile Duct Diseases/diagnostic imaging , Bile Ducts, Extrahepatic/diagnostic imaging , Cholangiopancreatography, Endoscopic Retrograde , Common Bile Duct/diagnostic imaging , Dilatation, Pathologic/diagnostic imaging , Female , Gallstones/diagnostic imaging , Humans , Image Processing, Computer-Assisted/methods , Male , Middle Aged , Observer Variation , Pancreatic Diseases/diagnostic imaging , Pancreatic Ducts/diagnostic imaging , Pancreatic Neoplasms/diagnostic imaging , Pancreatitis/diagnostic imaging , Portography , Radiographic Image Enhancement/methods , Sensitivity and Specificity , Single-Blind MethodSubject(s)
Afferent Loop Syndrome/diagnosis , Bile Ducts/pathology , Cholangitis/diagnosis , Magnetic Resonance Imaging/methods , Pancreas/pathology , Afferent Loop Syndrome/surgery , Aged , Anastomosis, Surgical/methods , Cholangiopancreatography, Endoscopic Retrograde , Diagnosis, Differential , Female , Humans , Jejunostomy/methodsABSTRACT
Sixteen patients with known neoplastic liver disease underwent 20 ultrasound examinations by two separate teams to determine the level of agreement in the measurement of lesion size and sonographic characteristics. The intraclass correlation coefficient for the observations on lesion size was r = 0.97 (95% lower confidence limit r = 0.96). We conclude that sonographic estimation of the size of neoplastic liver lesions in highly reproducible and that the measurements obtained may be safely incorporated into the criteria of response for cancer clinical trials.
Subject(s)
Liver Neoplasms/diagnosis , Liver/pathology , Humans , Liver Neoplasms/secondary , Observer Variation , Reproducibility of Results , UltrasonographySubject(s)
Bile Duct Neoplasms/diagnosis , Bile Ducts, Intrahepatic , Hamartoma/diagnosis , Bile Duct Diseases/diagnosis , Bile Duct Diseases/diagnostic imaging , Bile Duct Neoplasms/diagnostic imaging , Bile Duct Neoplasms/pathology , Bile Ducts, Intrahepatic/diagnostic imaging , Diagnosis, Differential , Hamartoma/diagnostic imaging , Hamartoma/pathology , Humans , Male , Middle Aged , Tomography, X-Ray Computed , UltrasonographyABSTRACT
Pancreatic and liver ultrasound examinations of twenty-five patients without evidence of liver or pancreatic disease and who had been on Prednisone (greater than 7.5 mg per day for longer than six months) were compared with corresponding age- and sex-matched normal controls. Statistical analysis enabled effects of known variables that determine pancreatic echogenicity to be taken into account and showed that steroid ingestion had a statistically significant effect on pancreatic echogenicity, a previous unreported observation.
Subject(s)
Pancreas/drug effects , Prednisone/administration & dosage , Ultrasonography , Administration, Oral , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Pancreas/pathology , Pancreatitis/diagnosis , Pancreatitis/etiology , Pancreatitis/pathology , Prednisone/adverse effects , Time FactorsABSTRACT
This prospective trial compares abdominopelvic computerized tomography and open peritoneal lavage in the diagnosis of blunt abdominal trauma. Fifteen patients (group 1) were evaluated by both methods. Another 15 patients (group 2) had only computerized tomography. Criteria for a "positive" scan were hemoperitoneum and evidence of solid organ injury. Criteria for "positive" lavage were a grossly bloody return, erythrocyte count greater than 20.0 X 10(9)/L and leukocyte count greater than 0.5 X 10(9)/L. At laparotomy, only injuries requiring repair or excision were considered "true positive". Patients who did not have laparotomy and had an uncomplicated clinical course were considered "true negative". With tomographic criteria alone for diagnosis there would have been one false-positive and three false-negative results, compared with three false positive and no false negatives for open peritoneal lavage alone. None of the three patients who had negative findings on laparotomy suffered any morbidity or died. Results of computerized tomography and open peritoneal lavage agreed in 8 of 15 patients (kappa value = 0.52), indicating a low level of agreement between the two. The authors believe that open peritoneal lavage remains the diagnostic procedure of choice in blunt abdominal trauma.
Subject(s)
Abdominal Injuries/diagnosis , Peritoneal Cavity , Therapeutic Irrigation , Tomography, X-Ray Computed , Wounds, Nonpenetrating/diagnosis , Abdominal Injuries/diagnostic imaging , Erythrocyte Count , Evaluation Studies as Topic , False Negative Reactions , False Positive Reactions , Hemoperitoneum/diagnosis , Humans , Laparotomy , Leukocyte Count , Prospective Studies , Wounds, Nonpenetrating/diagnostic imagingSubject(s)
Aneurysm, Infected/diagnosis , Stomach/blood supply , Ultrasonography , Aged , Angiography , Autopsy , Hematoma/diagnosis , Humans , Stomach Diseases/diagnosisABSTRACT
We describe a patient who developed a subcutaneous lymphocele in the chest wall following traumatic chylothorax. The diagnosis was suggested clinically and confirmed by computed tomography and lymphangiography.
Subject(s)
Chylothorax/diagnostic imaging , Lymph Nodes/injuries , Lymphatic Diseases/diagnostic imaging , Wounds, Nonpenetrating/complications , Adult , Chylothorax/etiology , Hernia/diagnostic imaging , Humans , Lymphatic Diseases/etiology , Male , Radiography , RuptureABSTRACT
Within the right lobe of the liver a linear echogenic band with two parallel sonolucencies within it (accessory fissure) was noted on both real time and static scans of 11 patients over a one-year period. Examination of 27 cadavers was performed to ascertain the etiology of this band and demonstrated three with diaphragmatic bands. In two cadavers the band occurred in a location compatible with the echogenic line noted on ultrasound. The embryonic origin of the diaphragmatic band is presumed to be the anterior edge of the foramen of Bochdalek.
Subject(s)
Liver/anatomy & histology , Ultrasonography , Adult , Aged , Cadaver , Diaphragm/pathology , Female , Humans , Hypertrophy , Male , Middle AgedABSTRACT
Twenty patients with ultrasonographic evidence of disease involving the psoas compartment were analysed retrospectively. The abnormality found was a mass lesion in the psoas muscle with increased or decreased echogenicity and a characteristic loss of the normal appearance of striated homogeneous bundles. Those examined included eight patients with abscesses, six with hematomas and six with tumor infiltration. All the abscesses were echopoor and showed absence of the normal appearance of the muscle. Such findings are non-specific because of the similar appearance of non-organized hematomas or lymphomatous infiltration. Organized hematomas and primary retroperitoneal tumors were echogenic but with loss of the normal appearance. Ultrasound guided needle aspiration is sometimes necessary to complete the diagnosis and may be a definitive strategy. We recommend ultrasonography for use in detecting psoas disease when appropriate clinical signs are present.
