Radiographic evaluation for nasal dysfunction: computed tomography versus plain films.

Sixty-two patients, presenting to the Nasal Dysfunction Clinic at the University of California, San Diego, were radiographically examined with plain sinus x-rays and computed tomographic (CT) scans. The x-rays were evaluated independently, and the reported findings were compared. In maxillary sinuses the CT and plain film observations corresponded poorly with a concordance of 77%. There was a tendency to overread the plain films. In the ethmoid sinuses the lack of concordance between CT scans and plain films was 76%, and a tendency to underread the plain films was noted. In the lower nasal compartment the correspondence between CT and plain film readings was 57%, with a notable tendency to overread the plain films. In the olfactory recess, the CT/plain film concordance was 66%. At our institution, a sinus CT series costs $400; a conventional sinus series costs $102. The CT radiation dose is 5.2 to 6.5 cGY compared with 1.4 cGY for plain films. We conclude that plain films are unreliable and no longer routinely indicated for the evaluation of nasal and paranasal sinus disease. When radiographic evaluation is indicated a limited CT series provides superior information. Exceptions may include children and some cases of sinus disease isolated to a single sinus.

Benefits of Gd-DTPA for MR imaging of intracranial abnormalities.

Forty patients with symptoms of intracranial disease were studied with magnetic resonance before and after intravenous injection of gadolinium-diethylenetriamine pentaacetic acid (Gd-DTPA). The T1- and T2-weighted images were obtained in all patients. Ninety brain lesions were found in 36 patients, including primary (20 patients) and metastatic (six) tumors, hemorrhage (one), progressive multifocal leukoencephalopathy (one), cysticercosis (one), infarction (four), and postoperative changes (four). Postcontrast images revealed lesions not seen on precontrast scans in eight (20%) patients. Also, the postcontrast images showed a change in appearance of the lesions in 20 (50%) that provided helpful information for assessing the abnormality in 20 cases (50%). Gadolinium-DTPA did not obscure any of the lesions seen on precontrast scans. It improved conspicuity, helped characterize and delineate the extent of lesions, and increased the sensitivity for detection of cerebral abnormalities.

Magnetic resonance imaging of hemorrhagic cerebral infarction.

A comparative study between magnetic resonance (MR) and computed tomography (CT) showed MR to be more sensitive than CT for detecting subacute and chronic hemorrhage into cerebral infarction. The hemorrhage appeared as either high signal on T1 weighted images or low signal on T2 weighted images, depending on the age of the hemorrhage. Cortical hemorrhagic infarction showed a characteristic gyral pattern. Methemoglobin and hemosiderin served as markers of previous hemorrhage into cerebral infarcts.

Paramagnetic enhancement of cerebral lesions with gadolinium-DTPA.

Magnetic resonance imaging (MRI) was performed on 30 patients with cerebral symptoms before and after intravenous gadolinium-DTPA (Gd-DTPA) administration. T1 and T2 weighted images were obtained in all patients. Fifty abnormalities were found in 27 patients. The post-contrast images revealed lesions not seen on pre-contrast scans in 6 patients. Also, the post-contrast images showed a change in morphology of the lesions in 15 that provided additional information for assessing the abnormality. The Gd-DTPA did not obscure any of the lesions seen on pre-contrast scans. Gd-DTPA improves conspicuity, helps characterize and delineate the extent of lesions and increases the sensitivity for detection of cerebral abnormalities.

Management of carotid artery transection resulting from a stab wound to the ear.

Emergency treatment of penetrating injury to the internal carotid artery at the skull base and within the temporal bone is difficult due to problems of exposure and control of this vessel. A successful method of management of a patient whose carotid artery was completely transected by a stab wound to the ear is presented. This involved gaining proximal vascular control in the neck and distal control intracranially. Indications for extracranial-intracranial vascular bypass procedures are discussed.

In vitro magnetic relaxation times of the ischemic and reperfused rabbit kidney: concise communication.

To assess the effects of renal ischemia and reperfusion on in vitro magnetic relaxation times (T1 = magnetization recovery, T2 = spin echo), we evaluated the spectroscopic characteristics of the renal cortex from 25 rabbits. Eight served as controls (Group 1), nine had one renal pedicle ligated for 1 hr (Group 2), and eight (Group 3) were occluded for 1 hr and reperfused for 30 min. For intra-animal comparison purposes, % H2O content, T1 (msec), and T2 (msec) of the ischemic (reperfused) kidney were normalized to the values from the normal kidney within the same animal. Renal ischemia consistently increased water content, which was exaggerated by reperfusion. In association with ischemia, T1 fell, and with reperfusion T1 lengthened. T2 increased with ischemia and declined from the peak ischemic effects with reperfusion.

CT of intracranial metastases with skull and scalp involvement.

Twenty-eight persons with contiguous intracranial skull, and often extracranial metastatic disease are reported. These lesions comprised 7.6% of a series of 250 consecutive patients with intracranial metastatic disease. Only three of 28 patients had other intracranial lesions and only seven of 28 patients has other skull lesions demonstrable on computed tomography (CT). Carcinoma of the prostate and breast, multiple myeloma, and neuroblastoma are especially likely to appear in this manner. All metastases enhanced. The bone destruction was so pervasive that in 19 of the patients it was obvious at routine CT settings. In the nine other patients, it could be clearly seen only at bone settings (high window and level). The CT demonstration of an enhancing intracranial mass involving the skull and often the scalp is highly suggestive but not diagnostic of a metastatic lesion.

Needle biopsy under computerized tomographic control: a method for tissue diagnosis in intracranial lesions.

Thirteen patients with intracranial lesions were submitted to a twist drill needle biopsy under computerized tomographic (CT) control, with sedation and local anesthesia. (The patients' ages ranged from 12 to 81 years.) The final diagnoses were glioblastoma in 7 patients and 1 case each of anaplastic astrocytoma, low grade astrocytoma, thrombosed arteriovenous malformation, cerebral infarct, 3rd ventricular epidermoid, and degenerative disease of the brain. Definitive diagnosis was obtained in all but 2 patients with this technique. Appropriate therapy was subsequently instituted in 11 patients without further operation. Transiently increased weakness of the previously affected limbs was the only untoward effect (4 patients). Intracranial hematoma after this procedure was seen in 1 patient in this series, as detected by the postprocedure CT scan, but there was no change in the clinical course. All patients were treated with dexamethasone for 24 to 48 hours before and for several days after the procedure to avoid decompensation of intracranial dynamics because of edema. The procedure, including appropriate level CT scans of the lesion area, was performed in approximately 1 hour in all patients. (Neurosurgery, 5: 671--674, 1979).

CT diagnosis of cerebrovascular disorders--a review.

During the past few years CT has emerged as an unsurpassed diagnostic modality in cerebrovascular disease. CT is of limited value in TIA, but reveals a wide variety of findings in completed infarcts. Ischemic, petechial, and hemorrhagic infarcts can be distinguished. Contrast enhancement, varying with the age of the infarct, is frequent. Also the general density of the infarct varies with time. Differential diagnosis, primarily infarct vs tumor, is made by angiography or by followup CT scans. Saccular aneurysms are directly demonstrable by CT if larger than 0.5 cm in diameter. Sequelae of ruptured aneurysm--hematoma, hydrocephalus, ischemia--are consistently visible. This generally also applies to arteriovenous malformations. Angiography is necessary to clarify anatomical details of aneurysms and vascular malformations, and is often indispensable for differential diagnosis.

Angiographic aspects of experimental nonocclusive intestinal ischemic injury.

An experiment was designed to fulfill the following aims: (1) to develop a model of nonocclusive intestinal ischemic injury compatible with survival for several days; (2) to determine the accuracy of angiography in diagnosing the presence and extent of intestinal ischemic injury; and (3) to determine the therapeutic and diagnostic value of intraarterial papaverine infusion. Experimental shock models were developed in the dog, and efficacy of the hypovolemic and normovolemic models was confirmed by gross and histologic evidence of intestinal injury in surviving dogs. No reliable angiographic signs of intestinal mucosal injury could be elicited. Angiographic abnormalities associated with the experiment were attributable to the shock itself and disappeared with the relief of shock. Infusion of papaverine into the superior mesenteric artery within 2 hr of the onset of shock prevented or ameliorated intestinal injury.

Radiological findings in Yersinia ileitis.

Bacteriological and clinical studies of patients with acute retional ileitis indicate that numerous patients with this diagnosis have a benign ileitis of short duration, caused by Yersinia enterocolitica, whereas others develop chronic Crohn's disease. Yersinia ileitis has some clinical and radiological features in common with Crohn's disease, but the two conditions are basically separate. In Yersinia ileitis, three stages are apparent: (a) the nodular stage, lasting up to three weeks; (b) the edematous stage (4th-5th week); and (c) resolution, observed during the 5th-8th week. The radiological findings in 25 patients with Yersinia ileitis and their distinction from Crohn's disease are described.

Roentgenology of the colon in Crohn's disease. Air contrast studies of the lesions and their development.

201 patients with Crohn's disease underwent air contrast examination of the colon. The Diagnosis was histologically confirmed in each case. Most of the pathological changes of Crohn's disease of the colon are manifested as alterations of the mucosal surface. These changes are excellently demonstrated by the air contrast technique. The roentgenologic findings in colonic Crohn's disease are being discussed as well as cecal deformities and rectal changes. Some conditions that may mimic colonic Crohn's disease are summarized. Finally the advantages and disadvantages with the air contrast technique are given.

Colonic changes of herpes zoster.

The lesions of herpes zoster of the colon were observed in three cases. Small polygonal mucosal blebs or small ulcerations involving a short segment of the colon and appearing in a reasonable time relationship with the cutaneous manifestations either in a corresponding or noncorresponding dermatome should enable diagnosis of this unusual condition. Recognition of this entity in the presence of these skin lesions should be obvious and therefore helpful in avoiding more aggressive and invasive diagnostic procedures.

Angiography in Crohn's disease revisited.

The diagnostic value of angiography was studied in 116 patients with Crohn's disease. Angiograms showed abnormalities in over 90% of the cases. Many angiographic features were nonspecific; only the "zoning sign" and the presence of paraintestinal mesenteric neovasculature were considered diagnostic. Crohn's colitis could be distinguished from ulcerative colitis in only 30% of the cases. Angiography, as a diagnostic adjunct to barium studies, will reveal the presence of lesions and their extent. This is particularly important in suspected postoperative recurrence of Crohn's disease. Angiography is a potential differential diagnostic aid in doubtful cases of inflammatory and malignant bowel disease.

Perfluoro carbon bromides as contrast media in radiography of the central nervous system. A preliminary experimental report.

A preliminary investigation of the properties of perfluorooctyl bromide in the subarachnoid space revealed this compound to have suitable attenuation capacity and advantageous physical and biologic properties for demonstration of the brain and spinal cord. No acute or chronic neurotoxicity was encountered. Microscopy demonstrated evidence of chronic inflammatory changes subsequent to long term exposure to the compound. It was concluded that the medium was superior to iodophendylate in several respects and that it may provide an alternative to water-soluble contrast media. Perfluorohexyl bromide proved unsuitable for neuroradiologic use because of formation of excessive amounts of non-absorbable gas, leading to high subarachnoid pressure and severe neurologic deficits.

Dynamic aspects of colonic Crohn's disease.

Changing patterns of the lesions in colonic Crohn's disease were studied in 86 patients who underwent multiple consequetive roentgen examinations. Local progression of lesions was seen in 56 out of 86 patients; rapid local advancement from mild to severe lesions was not uncommon. Temporary regression of lesions was only seen in 7%; definitive permanent healing on conservative treatment was not observed. Preoperative extension of lesions was seen in 29%, with ultimate involvement of the rectum in 7% and development of anal fistulae in 17%. Clinical implications of the findings are briefly discussed.

Catheter exchange in tortuous vessels during selective cerebral angiography.

Inability to advance double-curved catheters beyond the origin of tortuous arch vessels in a common problem in femorocerebral angiography in the aged or hypertensive patient. The authors describe a simple technique involving the use of an exchange guide wire and straight catheter which has proved to be safe and successful in such circumstances.