MRI appearances of the axilla in treated breast cancer.

Differentiation between recurrent axillary disease and changes due to radiotherapy or surgery has major implications for management in patients following breast cancer treatment, but clinical examination of the axilla may be difficult. This study was undertaken to correlate the MRI appearances of the axilla following breast cancer treatment with clinical outcome. 74 women with treated breast cancer were evaluated by MRI (0.5 T) and the appearances defined by consensus. Outcome was assessed by long-term clinical follow-up. 62 women had symptoms related to the axilla while 12 were scanned to stage the axilla. None of the axillary staging group had abnormal MRI appearances and none of these subsequently developed recurrence. The 62 symptomatic women were subdivided according to MRI appearances. 22 had normal axillary appearances, 18 had an axillary mass and 22 women had abnormal axillary appearances (rated mild, moderate and severe) in the absence of a mass. Normal axillary appearances on MRI excluded recurrent disease as the cause of symptoms with a specificity of 94.7% and a positive predictive value (PPV) of 95.5%. The presence of an axillary mass was commonly but not exclusively due to recurrent disease (sensitivity 68.4%, specificity 88.4%, PPV 72.2%). Sensitivity for diagnosis of axillary recurrence was increased to 89.5% with a specificity of 76.7% if the criteria for recurrent disease were taken as either the presence of an axillary mass or severe axillary changes in the absence of a mass lesion.

Correlation between spiral computed tomography, endoscopic ultrasonography and findings at operation in pancreatic and ampullary tumours.

BACKGROUND: Spiral computed tomography (CT) allows high-resolution examination of the pancreas, surrounding vascular structures, lymph nodes and liver. Endoscopic ultrasonography (EUS) also allows high-resolution imaging of the pancreas and adjacent structures but is an invasive procedure. With the availability of spiral CT, the role of EUS in the investigation of patients with suspected pancreatic or ampullary tumours is unclear. METHODS: Forty-eight patients with clinical suspicion of a pancreatic or ampullary tumour underwent both spiral CT and EUS. Thirty-four patients had surgical exploration, of whom 17 underwent pancreatic resection and 17 had biliary and gastric bypass. The results of spiral CT and EUS were compared with the operative findings. RESULTS: The final histological diagnosis was ductal adenocarcinoma (24 patients), ampullary carcinoma (six), serous cystadenoma (two) and chronic pancreatitis (two). EUS demonstrated 33 and spiral CT 26 of the 34 primary lesions. EUS was particularly useful in the assessment of small resectable tumours missed by spiral CT. The sensitivity and specificity of EUS and spiral CT for detecting involvement by the tumour of the superior mesenteric vein, portal vein and lymph nodes were similar, but EUS was less effective at evaluating the superior mesenteric artery. CONCLUSION: EUS is an important additional investigation after spiral CT in patients with a suspected pancreatic or ampullary tumour.

MR pelvimetry--a practical alternative.

Pelvimetry remains a useful technique as part of the assessment of the term breech pregnancy where vaginal delivery is planned. MR pelvimetry is accurate, well tolerated and shows soft-tissue structures as well as bone. It avoids the potentially carcinogenic effects of ionising radiation and is thought to be completely safe for mother and fetus. A technique of MR pelvimetry is described which uses gradient-echo sequences. This quick, practical method makes minimal inroads into valuable scanning time, and may therefore be considered a potentially cost-effective alternative to conventional pelvimetry.

MR and CT in the assessment of Poland syndrome.

Seven cases of Poland syndrome were investigated with CT and/or MR to assess the extent of the muscle abnormalities of the shoulder girdle. In all cases the absence of the sternocostal head of the pectoralis major was clearly shown, as were any associated abnormalities of the pectoralis minor, serratus anterior, and latissimus dorsi. The latissimus dorsi muscle has an important role in reconstructive surgery and can be difficult to assess clinically. Cross-sectional imaging with CT or MR will give useful information in patients with Poland syndrome requesting anterior axillary reconstruction and breast mound formation.

Case report: CT and angiographic appearances of intrasplenic mycotic aneurysm.

A 67-year-old man developed intrasplenic mycotic aneurysms secondary to bacterial endocarditis. The computed tomography (CT) appearances showing enhancing lesions within the spleen are correlated with the angiographic appearances.

Comparative study of the sodium salts of iodamide and iothalamate in clinical urography.

In a comparative urographic study of the sodium salts of iodamide (Uromiro 300 Sodium) and iothalamate (Conray 420) the following conclusions have been made. (i) In subjects with radiologically normal kidneys and a creatinine clearance greater than 70 ml/min, nephrogram scores were significantly higher with iodamide (P less than 0.02). There were differences between the media in respect of total urogram scores and pyelogram scores but they were not statistically significant. (ii) In patients with radiologically normal kidneys and a spectrum of normal and abnormal renal function, performance scores for iothalamate showed no significant relationship with creatinine clearance. Results for iodamide, however, showed some relationship with creatinine clearance (nephrogram score r = 0.46, pyelogram score r = 0.38, total urogram score r = 0.49). A possible mechanism for this is proposed. (iii) Side-effects encountered in the study were mild and there were no significant differences between the contrast media in either the incidence or severity of the side-effects. (iv) Blood-pressure and pulse-rate profiles following iodamide were not significantly different from those following iothalamate. (v) Cardiac arrhythmias were mild and uncommon.

Comparative study of the methylglucamine salts of iodamide and iothalamate in clinical urography.

In a comparative urographic study of the methylglucamine salts of iodamide (Uromiro 300) and iothalamate (Conray 280) the following conclusions have been made: (i) In subjects with radiologically normal kidneys and a creatinine clearance greater than 70 ml/min total urogram scores and nephrogram scores were higher with iodamide (not statistically significant). The improvement in performance was more marked in the nephrographic phase. (ii) In patients with radiologically normal kidneys and a spectrum of normal and abnormal renal function, total urogram scores and nephrogram scores showed no significant dependance on creatinine clearance. (iii) No correlations of note were observed between urographic performance and physical or biochemical parameters for either contrast medium. (iv) Side effects encountered in the study were mild and there were no significant differences between the contrast media in either the incidence or severity of the side effects. (v) Post-injection blood pressure profiles showed no significant differences between the media. (vi) Induced electrocardiographic abnormalities were uncommon and mild occurring in seven patients following iothalamate and three patients following iodamide.