Fluid collections developing after pancreatic transplantation: radiologic evaluation and intervention.

The usefulness of real-time sonography, duplex sonography, computed tomography (CT), cystography, diagnostic aspiration, and percutaneous drainage in the diagnosis and treatment of peri-pancreatic-transplant fluid collections was retrospectively assessed in 46 recipients of extraperitoneal pancreatic transplants. Forty-four abnormalities were identified in the extraperitoneal space at sonography, including four pancreatic pseudocysts associated with malfunction of the pancreatic duct, seven abscesses, six hematomas, nine urinomas, six early postoperative fluid collections that spontaneously resolved, six cases of pancreatitis, and six cases of vascular occlusion. Sonography (including pulsed Doppler sonography) was the procedure of choice in detecting fluid collections and diagnosing pancreatitis, rejection, vascular thrombosis, and pancreatic duct malfunction. CT was diagnostic in four of six hematomas; cystography was diagnostic in seven of nine urinomas. Sonographically guided percutaneous intervention enabled three patients to avoid surgery and allowed optimal surgical planning for six patients.

Teleradiology image transmission system: diagnostic accuracy at three matrix sizes for various types of images.

The interpretability of transmitted digitized radiographic images is an important factor in the operation and use of teleradiology systems. Matrix size may influence diagnostic accuracy of the interpretation. Commercially available equipment has certain built-in image enhancement controls that may increase the interpretability of the image received. Evaluation of the effect of varying the matrix size and other factors on diagnostic accuracy are described.

X-File: a program for maintaining a radiographic teaching file.

Software designed for entry, retrieval, and maintenance of radiographic case-file data on a microcomputer offers considerable help in maintaining such records in a radiology department. The case files are based on the Index for Roentgen Diagnoses, published by the AmericanCollege of Radiology. The terms and code numbers of the index are included in the software, so that the user need only enter the diagnostic term desired; the code numbers and exact terminology are assigned automatically. The software is written for an IBM-compatible microcomputer. Residents and staff radiologists have been using the program for the past two years to store and find both confirmed cases and other interesting cases. The system's capacity exceeds 70,000 entries on a 20-megabyte had disk. The program has five features not found in previous similar programs and not attainable with manual methods.

Diagnostic accuracy of a teleradiology image transmission system.

Teleradiology is the remote interpretation of digitized radiographic images by physicians. The images are usually transmitted over telephone lines, but satellite communication has also been used. The interpretability of the transmitted image is an important factor in the operation and use of teleradiology systems. Commercially available equipment has certain built-in functions that may enhance the interpretability of the image received. These functions and their usefulness in diagnosis are described. It is also possible to enhance the image for transmission, prior to digitizing, by certain manual techniques. These may be of value in situations where the first transmission is lacking in some quality. A test of these functions and techniques is reported.

Innocuous gas collections in pancreatic allografts demonstrated by computed tomography.

Over a 4-year period, 6 pancreatic abscesses were found in 37 patients who had combined renal and segmental pancreatic transplants. An additional 4 patients who were nontoxic at the time of their computed tomographic (CT) examinations had innocuous gas collections, either in the pancreatic allograft or the surrounding peripancreatic tissue. The possible etiology of this gas formation is discussed. These collections do not have the same ominous clinical significance as would be expected in abscess formation. Radiological evaluation should include examination of the gastrointestinal tract and voiding cystograms to detect fistula formation. Simultaneous percutaneous aspiration of this area should be performed to rule out an infective process. If this is negative in a nontoxic transplant patient, the radiologist will be in a position to obviate unnecessary surgical intervention.

Computed tomography of omental liver packs.

Hypodense liver lesions with attenuation coefficients indicative of fat density were seen on CT of three patients followed up for suspected metastatic spread of gastrointestinal malignancy. Knowledge of previous hepatic surgery using omental packing for hemostasis in the setting of liver trauma or lobectomy was useful in preventing a false-positive interpretation of postoperative complications.

Neutropenic colitis: evaluation with computed tomography.

The computed tomography findings of 10 patients with neutropenic colitis are described and illustrated. Seven of these patients had leukemia, one had lymphocytic lymphoma, and two had systemic lupus erythematosus. All patients had colon wall thickening which was either isodense with the normal bowel tissue or showed areas of intramural low density. Air in the thickened bowel wall was seen in six patients. These computed tomography findings in neutropenic patients with fever, abdominal pain, and diarrhea should suggest the diagnosis in most instances, resulting in prompt treatment of this usually life-threatening entity.

Pancreatic transplantation: scintigraphy, US, and CT.

Twenty-one patients with insulin-dependent diabetes mellitus received simultaneous renal and segmental pancreatic transplants. A retrospective analysis of 112 real-time ultrasound (US) images, 108 technetium-99m glucoheptonate scinti-scans, 55 computed tomography (CT) scans, and 11 cystograms was performed. Complications that were observed included pancreatic transplant rejection, pancreatitis, arteriovenous occlusions, hemorrhage, abscesses, and extravasation at the pancreaticocystostomy site. Scintigraphy is a sensitive indicator of normal transplant function but is non-specific when findings are abnormal. Real-time US aids in the differentiation of acute rejection from pancreatitis and arteriovenous occlusion. CT is helpful for evaluation of postoperative complications. Imaging may play an important role in the noninvasive management of pancreatic transplants.

Male pelvic hemangiopericytoma on computed tomography.

A case of hemangiopericytoma in the male pelvis is presented in which computed tomography demonstrated a well-circumscribed, homogeneous enhancing mass with feeding vessels.

Networking of microcomputers in the radiology department.

A microcomputer may be installed in any of several areas in a radiology department or office to automate data processing. Such areas include the reception desk, the transcription office, the quality-control station, and remote or satellite radiography rooms. Independent microcomputers can be interconnected by networking, using small hardware and software packages and cables, to effect communication between them, afford access to a common data base, and share peripheral devices such as hard disks and printers. A network of microcomputers can perform many of the functions of a larger minicomputer system at lower cost and can be assembled in small modules as budgetary constraints allow.

Gated cardiac tomographic visualization of coronary artery calcification.

Coronary artery calcification (CAC) is usually detected by fluoroscopy or on cine films during coronary angiography, but measurement of the calcification is not possible. Gated tomography of the heart provides a full sized image with high contrast spatial resolution of 0.1 mm and low contrast spatial resolution of 0.76 mm. The radiation exposure to the heart is between 1-5% of that experienced with coronary cinefluorography . Measurement of the diameter of calcium deposits is possible and calcium that could be related to arterial stenosis may be identified.

Missouri Automated Radiology System: a dynamic, interactive diagnostic and management system for radiant images.

Missouri Automated Radiology System has functioned in full support of the Department of Radiology for more than 7 years. For the past 5 years, MARS has functioned as a minicomputer system on a DEC (Digital Equipment Corporation) PDP-15 computer. While continuing to effectively support the department, in daily use by 20 staff and 15 resident physicians, MARS has continued to function in a research and development mode. With the continuous development of new applications, MARS is now essential to the function of the department and has again proven the point that physicians and computers can function symbiotically in the medical environment.