CT-guided cutting-needle biopsies of selected chest lesions.

In an effort to improve on our diagnostic yield from percutaneous transthoracic biopsy, we used 14-gauge cutting needles in 56 selected patients. These biopsies were preceded by 18-, 20-, or 22-gauge aspirations in 42 patients, allowing a direct comparison of the efficacy of the needle types. Specific diagnoses were made by cutting-needle biopsy in 78% (25/32) of patients with nonlymphoproliferative malignancies, in 73% (8/11) with lymphoma or thymoma, and in 54% (7/13) of patients with benign diseases. In those in whom both aspiration and cutting needles were employed, a higher percentage of specific diagnoses was achieved by cutting-needle biopsy than by aspiration biopsy: 72% vs 64% in nonlymphoproliferative malignancies, 62% vs 12% in the lymphoproliferative group, and 55% vs 22% in benign disorders. Complications were encountered in 20% of all patients studied. This study shows that, for selected chest lesions, CT-guided cutting-needle biopsies can be performed safely and are useful, especially in the diagnosis of lymphoproliferative or benign disease.

Transverse relaxation time values in MR imaging of normal breast during menstrual cycle.

Magnetic resonance (MR) imaging of the breast has shown promise in the diagnosis of breast lesions. In prior studies the time of MR examination in the menstrual cycle was not taken into account. If alterations in transverse relaxation time (T2) values of ductal tissue did occur during the menstrual cycle, they would have a significant bearing on the timing of MR studies of the breast. This study demonstrated no apparent alteration in T2 values during the menstrual cycle of normal young volunteers.

Benign and malignant breast disease: magnetic resonance and radiofrequency pulse sequences.

Thirty patients with suspected abnormality of the breasts on mammography were evaluated with magnetic resonance imaging (MRI) in a blind fashion. Spin-echo (SE) 250/30 msec scans were used to screen the examined breast. At the location of the suspected abnormality, inversion recovery (IR) 1000/30/300, SE 1000/30, and SE 1000/120 scans were performed. On the basis of these magnetic resonance images and experience with 70 previously studied patients, abnormalities of the breasts were grouped into five patterns. Ten malignant lesions exceeded 1 cm in diameter and were all correctly diagnosed by mammography and MRI. Of the remaining 20 benign conditions, four were suspicious for malignancy on MRI compared to eight with mammography. The shape of the lesion and the change in its signal intensity with different MR radiofrequency pulse sequences allows differentiation between a benign and a malignant process. On the basis of this preliminary experience, it seems MRI may have an adjunctive role to screening mammography. SE 1000/120 scans show higher signal intensity from carcinoma than from normal duct tissue, fibrocystic disease, and fibroadenoma. In this respect, it may allow some tissue specification in the breast.

Magnetic resonance imaging of the human breast: a Phase I trial.

A preliminary comparative evaluation of mammography and magnetic resonance imaging (MRI) of the human breast in a variety of benign and malignant conditions is presented. Although the accuracy of MRI in the evaluation of the human breast is not yet established, it appears to be as sensitive as mammography in the detection of breast abnormalities.

Percutaneous nephrostomy in neonates and infants.

A total of 8 patients between 2 days and 2 years old underwent 13 percutaneous nephrostomies for treatment of hydronephrosis. No significant complications were encountered.

CT-guided liver biopsies: eight years' experience. Work in progress.

In the past eight years 180 patients with liver abnormalities demonstrated on computed tomography (CT) underwent CT-guided biopsies with 22-guage Madayag, 14-gauge Travenol, or 18-gauge Menghini needles used singly or in combination. Cytologic and pathologic results were tabulated and correlated with the subsequent surgical or autopsy findings and with clinical follow-up ranging from three months to three years. Complications of the procedures were also recorded. It is concluded that cutting needle biopsies provide a higher yield of diagnostic tissue compared with aspiration biopsies (89.9% versus 65%) without a significant increase in complications (1.44% versus 0.83%). The techniques utilized, risk of complications, and the indications for biopsy are discussed.

Magnetic resonance imaging of the breast. Work in progress.

Ten normal volunteers and 45 patients with breast abnormalities were examined with magnetic resonance (MR), utilizing a 0.3-tesla superconducting magnet. In all patients, MR detected an abnormality that corresponded to the area of pathology seen on either a mammogram or computed tomographic (CT) scan. An appreciable advantage of MR over mammography was observed in patients with cysts and in those with areas of asymmetric dysplastic breast tissue. Abnormalities on MR images appeared as areas of low signal intensity relative to adjacent normal ductal and fatty tissue. The configuration of a lesion on MR permitted distinction between a benign and a malignant process.

Head trauma evaluated by magnetic resonance and computed tomography: a comparison.

Magnetic resonance (MR) images and computed tomograms of 25 patients with head trauma were compared. MR proved to be superior in many ways for demonstrating extracerebral as well as intracerebral traumatic lesions. Isodense subdural hematomas, which present a diagnostic dilemma on CT images were clearly seen on MR, regardless of their varying CT densities. In a case of epidural hematoma, the dura mater was shown directly as nearly devoid of signal on MR. Direct coronal images provided excellent visualization of extracerebral collections along the peritentorial space and subtemporal area. In a patient with intracerebral hematoma, CT failed to demonstrate residual parenchymal changes in a 3-month follow-up study, but MR clearly depicted the abnormalities. The superiority of MR over CT was also well illustrated in a patient with post-traumatic osteomyelitis of the calvarium.

NMR imaging of the spine.

The usefulness of nuclear magnetic resonance (NMR) images in the evaluation of spinal disorders below the craniocervical junction was studied. Six normal subjects and 41 patients with various spinal abnormalities were examined. NMR proved capable of demonstrating important normal and pathologic anatomic structures; it was useful in the evaluation of syringohydromyelia and cystic spinal cord tumors, and the bright signal intensity of lipoma was quite impressive. In the evaluation of herniated disk, NMR images offered a new perspective by visualizing abnormal degradation of the signal intensity of the nucleus pulposus itself. NMR images were least valuable in the evaluation of spondylosis and spinal stenosis. Although NMR imaging of the spine is still in a very early developmental stage, the absence of both ionizing radiation and risks associated with contrast material makes it especially attractive as a new diagnostic method. This limited experience with currently available equipment suggests that, with technical refinement, the efficacy of NMR of the spine will increase.

NMR scanning of the pelvis: initial experience with a 0.3 T system.

Pelvic NMR scans were obtained on 29 patients using a 0.3 T superconducting magnet system. Pathologies studied included four bladder carcinomas, four prostatic carcinomas, four ovarian dermoid cysts, three ovarian cysts, three endometrial carcinomas, two endometriomas, and one each of serous cystadenoma of the ovary, benign prostatic hypertrophy, pelvic hematoma, and undifferentiated sarcoma. NMR is a very promising method for characterizing pelvic masses and in staging pelvic malignancies. It can show primary tumors of the prostate, bladder, and uterus and reveals tumor extension into pelvic fat. The pelvis is particularly well suited to NMR scanning because of the abundant natural contrast provided by pelvic fat and by urine in the bladder and gas in the bowel. There is also less motion blurring than in the upper abdomen and chest because there is relatively little respiratory motion of pelvic organs. Various pulse sequences were used in scanning the pelvis; their relative merits are discussed.

Initial experience with nuclear magnetic resonance (NMR) imaging of the human breast.

Two patients with breast abnormalities, one malignant and one benign, were studied with nuclear magnetic resonance (NMR) imaging utilizing a cryogenic superconducting magnet. Three-dimensional NMR images were obtained in one case and single slice planar images were obtained in the other. The NMR images correlated well with the corresponding mammograms. Although both conditions exhibited a different signal intensity for the area of abnormality compared to adjacent ductal and fatty tissue, the configuration of the abnormal areas allowed distinction between benign and malignant process.

Preliminary experimental results in humans and animals with a superconducting, whole-body, nuclear magnetic resonance scanner.

In order to determine the clinical usefulness of nuclear magnetic resonance (NMR) imaging, the investigators examined a variety of normal volunteers, patients with neoplastic lesions, and experimental animals. Preliminary results were obtained with the use of potential contrast agents. It was found that imaging applications of NMR in the vascular system, spine, brain, lung, and mediastinum offer certain advantages over other modalities. The absence of biological hazard as well as the ability to obtain unenhanced, noninvasive, gated images of the vascular system, as demonstrated in this study, make NMR particularly attractive. In addition to single-section capability, NMR makes it possible to obtain volume images of the spine and other organs which can be displayed in any desired plane or section thickness.