Assessing the resectability of pancreatic carcinoma: the value of reinterpreting abdominal CT performed at other institutions.

OBJECTIVE: The purpose of this study was to determine the value of reinterpreting abdominal CT performed at other institutions when assessing the resectability of pancreatic carcinoma. MATERIALS AND METHODS: Fifty-three patients (30 men, 23 women; mean age, 62 years) referred to our tertiary care institution with newly diagnosed pancreatic carcinoma had formally reinterpreted abdominal CT scans and available initial reports. CT was performed at community hospitals (n = 47), university hospitals (n = 4), an outpatient clinic (n = 1), and an imaging center (n = 1); reinterpretation was performed by university radiologists with subspecialty expertise in abdominal imaging. On the basis of the initial and reinterpretation reports, the patients were categorized as having resectable or nonresectable disease. Medicare reimbursement rates were assessed. RESULTS: The initial and reinterpretation reports agreed in 36 (68%) of the 53 patients, with the disease of 16 patients considered resectable and 20 unresectable by both reports. In 17 patients (32%), we found discrepancies between the initial and the reinterpretation reports. All discrepancies involved the initial report indicating resectability and the reinterpretation report consistent with nonresectable disease. Discrepancies were resolved by findings at surgery (n = 9), percutaneous biopsy (n = 3), dedicated pancreatic CT (n = 3), dedicated liver CT (n = 1), and follow-up abdominal CT (n = 1); the reinterpretation reports were correct in 16 (94%) of 17 patients. Reimbursement for outside CT reinterpretation, repeated abdominal CT, and an exploratory laparotomy were estimated at $46.45, $414.47, and $16,996.44, respectively. CONCLUSION: Reinterpretation of outside abdominal CT was valuable for determining pancreatic carcinoma resectability and inexpensive when compared with repeating the CT examination or performing an exploratory laparotomy.

Colouterine fistula: computed tomography and vaginography findings.

Colouterine fistulas are difficult to demonstrate radiologically. The authors present a case in which such a fistula was observed with computed tomography and confirmed by vaginography.

Helical computed tomography at 1.5:1 pitch reconstructed at 15-mm and 7-mm intervals for examination of patients with suspected metastatic disease.

OBJECTIVE: To document the need for overlapped reconstruction when using helical computed tomography (CT) software that reconstructs 10-mm-collimation, 1.5:1-pitch images at 15-mm intervals in follow-up examination of patients with suspected metastatic disease. PATIENTS AND METHODS: Forty consecutive patients with known or suspected metastatic disease were examined with helical CT at 10-mm collimation and 1.5:1 pitch. The studies were examinations of the chest, abdomen and pelvis; the chest and abdomen; or the abdomen and pelvis. Two image sets, one prospectively reconstructed at 15-mm intervals and the other retrospectively reconstructed at 7-mm intervals, were independently reviewed by three radiologists, and the number, size and location of lesions were documented. Differences in interpretation were resolved by consensus. The lesions detected on the two sets of images were classified according to lesion size and location, and the results were analysed by multivariate analysis of variance with repeated measures. RESULTS: Images reconstructed at 7-mm intervals revealed a total of 436 lesions, 127 (41%) more than were revealed by images reconstructed at 15-mm intervals. The number of lesions less than 1 cm in diameter that were visible in the two sets of images was significantly different (p = 0.018). However, there was no significant difference between the two sets of images in terms of lesion location. CONCLUSION: Metastatic lesions may be missed by helical CT at 1.5:1 pitch if overlapped reconstruction is not performed.

Urologic applications of multiplanar and three-dimensional computed tomography.

The introduction of helical computed tomography (CT) has resulted in improved quality of multiplanar reformations and three-dimensional reconstructions in the chest and abdomen and has made CT angiography a clinical reality. These imaging techniques are useful for evaluating the urinary tract, adding a new dimension to its display, resulting in improved diagnosis of renal and perirenal disease. This article reviews the indications and techniques utilized for multiplanar and three-dimensional CT for urology. The advantages and limitations are discussed, and normal and pathologic findings in the urinary tract illustrated.

Sonography of the umbilical cord.

Knowledge of the development, normal sonographic appearance, and potential abnormalities of the umbilical cord is important in fetal assessment. The umbilical cord can be visualized throughout most of gestation and is detectable sonographically soon after visualization of the fetal pole. The normal umbilical cord is 50-60 cm long and may coil as many as 40 times, usually to the left. Abnormalities in umbilical cord size, degree of coiling, attachment, and position can have important implications for the outcome of the pregnancy. Structural abnormalities of the umbilical cord such as single umbilical artery, knots, cysts, and tumors may be associated with fetal distress or malformations. Color Doppler ultrasound (US) is useful in the identification and evaluation of structural abnormalities of the cord. By allowing measurement of blood flow velocity in the umbilical artery, duplex Doppler US may provide additional information in the evaluation of intrauterine growth retardation and twin-twin transfusion syndrome.

Directed and random biopsies of the prostate: indications based on combined results of transrectal sonography and prostate-specific antigen density determinations.

OBJECTIVE: We studied the usefulness of transrectal sonography, prostate-specific antigen levels, and prostate-specific antigen density as indications for directed and random biopsies of the prostate in patients with possible prostatic cancer. MATERIALS AND METHODS: A total of 141 patients with increased levels of prostate-specific antigen or abnormal findings on digital rectal examination had transrectal sonography of the prostate and determination of prostate-specific antigen density. Through sonographic visualization, all patients had biopsies of possible cancerous lesions and random biopsies of regions of the prostate that appeared normal. Histologic results were correlated with sonographic findings and determinations of prostate-specific antigen levels and prostate-specific antigen density. RESULTS: Adenocarcinoma was detected in 40 (28%) of the 141 patients. Transrectal sonography showed an abnormality that was determined by directed biopsy to be a carcinoma in 27 (68%) of the 40 patients. Transrectal sonography showed no carcinoma in 13 patients (32%) for whom random biopsy revealed a tumor. The sensitivity of sonography was 68%, and the specificity was 49%. The combination of sonographic findings suggestive of cancer and increased prostate-specific antigen density had a sensitivity of 75% and a specificity of 75%; we calculated a sensitivity of 72% and a specificity of 56% for the combination of sonographic findings suggestive of tumor and increased levels of prostate-specific antigen. Thirty-nine (97%) of 40 patients with cancer had either sonographic findings suggestive of tumor or increased prostate-specific antigen density, and one (3%) had no evidence of tumor on sonography and a normal prostate-specific antigen density. CONCLUSION: Directed and random sonographic biopsies of the prostate are indicated in patients with sonographic findings suggestive of tumor and increased prostate-specific antigen density and in patients with abnormal sonographic findings and normal prostate-specific antigen density. Random biopsies are indicated in patients with normal sonographic findings and increased prostate-specific antigen density. In our series, random biopsies were not indicated in 25 of 26 patients with normal sonographic findings and normal prostate-specific antigen density. Further research on the need for random biopsies when there are no sonographic abnormalities and when prostate-specific antigen densities are not elevated is warranted.

CT of the chest and abdomen in patients on mechanical pulmonary ventilators: quality of images made at 0.6 vs 1.0 sec.

OBJECTIVE: Chest and abdominal CT scans using 1.0-sec scan times are often limited by motion in patients who are unable to hold their breath. With our scanner we can obtain images in 0.6 sec (partial scan) that use data from 225 degrees instead of the 360 degrees used for 1.0-sec scans. The purpose of this study was to assess whether the quality of images of the chest and abdomen in patients on mechanical pulmonary ventilators who could not breath-hold could be improved if images were taken using a scan time of 0.6 sec rather than 1.0 sec. MATERIALS AND METHODS: Thirty patients who were being treated with mechanical pulmonary ventilation with indications for chest or abdominal CT or both were scanned with a scan time of 1.0 sec. At the end of the examination, additional 0.6-sec images were taken at three or four levels. Images obtained with these two scan times were filmed at similar levels and windows, and anatomically matched levels were compared. The images were masked and independently evaluated by three radiologists for motion, noise, artifact, and overall image quality. Each parameter was rated using a scale of 1 to 4. Using Kendall's tau correlation, there was no significant difference between the radiologists in the grading of individual parameters or of overall image quality. Therefore, the average of the scores of the three radiologists was used. Statistical analysis was done using repeated measures multivariate analysis of variance. RESULTS: Images obtained in 0.6 sec had significantly less motion (p < .001) but more noise (p < .001) than those obtained in 1.0 sec. We found no statistically significant difference in artifacts between the two scan times. Overall image quality was judged to be significantly better on scans obtained in 0.6 sec than on scans obtained at 1.0 sec (p < .001), in spite of the greater noise on 0.6-sec images. The higher quality of 0.6-sec images was most noticeable for lung window settings. CONCLUSION: Our results indicate that scans taken in 0.6 sec (partial scans) provide better quality images than those obtained in 1.0 sec in patients being treated with mechanical pulmonary ventilation who cannot breath-hold. This technique may be useful not only in this population but in all patients who are unable to cooperate with breath-holding instructions.

Computed tomography diagnosis of partial anomalous pulmonary venous drainage.

A case of the rarely occurring partial anomalous pulmonary venous drainage of the right upper lobe into the azygos arch is presented. Computed tomography (CT) clearly demonstrated the abnormal vessel coursing through the right upper lobe and draining into the azygos arch.

MR imaging of the brachial plexus.

The brachial plexus is difficult to evaluate with conventional radiologic techniques, including CT. However, it is well shown by MR imaging, which has direct multiplanar imaging capability and superior soft-tissue resolution [1-4]. We present our technique for evaluating the brachial plexus, discuss the anatomy, and illustrate normal and abnormal findings.

Pancreatic plasmacytomas in a patient with multiple myeloma: CT and ultrasound findings.

Extramedullary plasmacytomas are an unusual manifestation of multiple myeloma. They occur most frequently in tissues or organs rich in reticulo-endothelial cells. Pancreatic plasmacytomas are rare, with only a few case reports in the literature. We present the ultrasound (US) and computed tomographic (CT) findings of two pancreatic plasmacytomas in a patient with multiple myeloma.

MR imaging of the female pelvic region.

Magnetic resonance (MR) imaging is a valuable technique for noninvasive evaluation of the female pelvic region. This article presents the normal anatomy and abnormalities of the female pelvis. MR imaging may be more useful than clinical evaluation or other imaging modalities in diagnosing or staging developmental anomalies, leiomyomas, adenomyosis, endometrial or cervical carcinoma, vaginal neoplasms, ovarian cysts, endometriosis, teratomas, polycystic ovaries, or other ovarian masses. It could potentially replace laparoscopy as a more useful tool in the diagnosis of uterine anomalies. MR imaging is generally capable of helping determine whether a pelvic mass is uterine or adnexal in origin and may be used to characterize some adnexal masses. In some cases, MR imaging is used to differentiate recurrent disease from posttreatment fibrosis, which aids in treatment planning.

CT of uterine cervical myeloma: case report.

Myelomatous involvement of the uterine cervix is rare and, to our knowledge, has not been reported previously in the radiologic literature. This report describes the computed tomographic (CT) findings and reviews differential diagnostic considerations.

Ultrasound of the scrotum.

High-resolution real time ultrasound of the scrotum, including gray-scale and color Doppler sonography is presented. The normal anatomy of the scrotum with sonographic correlation is reviewed. The sonographic features of scrotal pathology, including congenital, neoplastic, inflammatory, and traumatic conditions are presented.

Coexistent adenocarcinoma and microcystic adenoma of the pancreas.

A case with coexistent pancreatic adenocarcinoma and microcystic adenoma is presented. These diagnoses were suspected on the basis of their computed tomography (CT) appearances and confirmed with CT-guided fine-needle aspiration.

CT evaluation of congenital and acquired abnormalities of the azygos system.

Congenital and acquired abnormalities may alter the anatomy, size, or position of the azygos system. Computed tomography is often able to depict these abnormalities and in many cases indicate the cause. In this article, the normal anatomy of the azygos system is discussed and examples of congenital and acquired abnormalities are presented.

CT of thoracic aortic aneurysms.

Aneurysms of the thoracic aorta are most often the result of arteriosclerotic disease. Other causes include degeneration of the medial layer of the aortic wall, either idiopathically or due to genetic disorders such as Marfan syndrome; aortic dissection; trauma; syphilis and other bacterial infection; noninfective aortitis; and congenital anomaly. We review normal anatomy of the aorta and discuss our technique and interpretation of computed tomography (CT) in the evaluation of the thoracic aorta. We illustrate the CT appearance of different types of aortic aneurysms as well as discuss the use of CT for assessing complications of aneurysms, for postoperative follow-up, and in the differentiation of aortic aneurysm from a paraaortic mass.