Evaluation of computed tomography in the detection of pulmonary metastases: a prospective study.

Conventional linear x-ray tomography is often used to search for pulmonary metastases but tends to underestimate extent of disease when compared with operative findings. In a prospective study, operative findings were correlated with computed axial tomography and conventional linear tomography performed on 25 patients with a history of extrathoracic malignancy and pulmonary nodules. Computed tomography detected 69 nodules of which 31 proved to be metastases. Conventional linear tomography detected 38 nodules of which 25 were metastases. Of the 54 resected nodules measuring greater than 3 mm, computed tomography detected 42; whereas conventional tomography detected 32. Only six of the 31 additional nodules (20%) detected by computed tomography and not by conventional tomography proved to be metastases. These results suggest that computed tomography is more sensitive than conventional tomography in detecting small pulmonary nodules; however, there is diminished specificity in identifying metastatic nodules.

Computed tomography in adrenal tumors.

Computed tomography (CT) was used to evaluate 26 patients with a variety of adrenal lesions. Surgical proof was available in 22 patients and clinical confirmation with a variety of other studies in the other four patients. Nine patients ahd aldosterone-producing adrenal adenomas and CT correctly identified seven. Four patients had cortisol-producing adenomas and five patients had cortisol-producing carcinomas; CT identified each of these tumors. Prominent but normal shaped glands were seen in each of the four patients with adrenal hyperplasia. Adrenal metastases from malignant melanoma in two patients were identified. Only one of two pheochromocytomas in two patients could be seen on CT. CT is a noninvasive method of localizing adrenal tumors and may be helpful in distinguishing adenomas from adrenal hyperplasia.

Comparison of computed and conventional whole lung tomography in detecting pulmonary nodules: a prospective radiologic-pathologic study.

Whole lung computed tomography (CT) was performed on 25 patients with clinical diagnoses including osteogenic sarcoma. Ewing's sarcoma, rhabdomyosarcoma, fibrosarcoma, and melanoma in whom conventional tomography had revealed from one to four parenchymal nodules in one lung deemed resectable for either staging or treatment purposes. Thoracotomy was performed within 3 weeks after conventional and computed whole lung tomography. All palpable nodules were resected, measured at the time of surgery, mapped by anatomic segment, and submitted for individual histologic evaluation. CT defined more nodules than conventional tomography in 48% of cases. The additional nodules were usually pleural or subpleural and 3--6 mn in diameter. CT identified 78% of all resected nodules greater than 3 mm in diameter, compared to 59% using conventional tomography. CT was also of value in detecting bilateral nodules earlier than conventional tomography and in documenting small nodule growth on successive examination. However, 60% of the additional nodules defined by CT and resected proved to be benign granulomas and pleural-based nodes at thoracotomy.

Detection of subcutaneous metastases by computed tomography.

Subcutaneous fat provides excellent contrast for water density tissue. Five patients with subcutaneous metastases visualized on computed tomography (CT) scans are presented. In some cases, CT proved to be the optimal diagnostic modality for visualizing these lesions and documenting their response to therapy.

Adrenal cortical tumors with low attenuation coefficients: a pitfall in computed tomography diagnosis.

Four cases of adrenal tumors with unusually low attenuation coefficients are reported. The tumors presented with values ranging from 8 to 17 EMI units (EU: 500 scale) instead of the expected 30 to 40 EU range of the remainder of our adrenal tumors. Two of these patients had primary aldosteronism and two had Cushing's syndrome. An unusually high lipid content may be responsible for the lucent appearance.

Whole body computed tomography in the diagnosis of abdominal and thoracic malignancy: review of 600 cases.

Whole-body computed tomography (CT) was performed on 600 patients with known or suspected malignancy at the National Institutes of Health. This new diagnostic modality utilizes a finely columnated X-ray source mounted opposite a computer-linked detector bank to generate anatomic cross-sectional images of the body part being scanned. CT proved valuable in defining many pathologic processes and was, at times, deemed the only test short of exploratory surgery that yielded diagnostic information. This latter benefit was most acutely emphasized in lesions affecting the retroperitoneum, adrenal glands, pelvis, liver, and immediate subpleural pulmonary parenchyma.

Computed tomography in the diagnosis of subcapsular and perirenal hematoma.

Six patients are described in whom subcapsular and perirenal hematomas were demonstrated by computed tomography. This new diagnostic tool provided a rapid noninvasive means of visualizing the hematoma, its extent, location, and relationship to renal parenchyma. Serial examinations were used to follow progress of the hematomas toward resolution. Correlation is made with conventional rediography, angiography, and gray scale ultrasound.

Computed tomography in the diagnosis, staging, and management of abdominal lymphoma.

Computed tomography (CT) was performed in 30 patients with histologically proven lymphoma within 1 week of bipedal lymphangiography to assess the relative sensitivity of each diagnostic modality in defining the location and extent of lymphomatous involvement. In 11 patients, lymphangiography significantly underestimated the volume of the periaortic nodal mass and its cephalad extent. In 13 additional patients, CT defined significant renal hilar, mesenteric, splenic hilar, and splenic pulp extension not visualized by lymphangiography. Sequential CT scans performed in five patients proved an excellent way to follow therapeutic response. CT scans were also performed in 26 patients with nonlymphomatous intraabdominal malignancy within a week of lymphangiography. It was of value in staging patients with carcinoma of the testis but was not overly helpful in patients with carcinoma of the ovary or pancreas.