Lymphangitis carcinomatosa in thin section computed tomography.

High resolution computed tomography is a diagnostic method of choice in the evaluation of lung parenchyma. HRCT enables the evaluation of small interstitial changes, invisible on plain chest radiographs, and their assessment at the level of the lung lobule. The aim of the study was the assessment of typical findings in HRCT in lymphangitis carcinomatosa, enabling differential diagnosis. Material comprises a group of 18 patients with lymphangitic spread of carcinoma, in whom HRCT examination was performed. Nodular thickening of the peribronchovascular interstitium and interlobular septa are typical in lymphangitic spread of carcinoma. Smooth peribronchovascular and septal thickenings are typical in sarcoidosis, and are only seen in some patients in the lymphangitic spread of carcinoma. In lymphangitis carcinomatosa lung architecture remains unchanged, which allows differentiating from sarcoidosis.

Morphological characteristics of malignant solitary pulmonary nodules.

The solitary pulmonary nodule is a common radiologic abnormality, which is often detected incidentally. It is defined as focal, round or oval areas of increased opacity in the lung which are caused by a variety of disorders, including neoplasm, infection, inflammations, and vascular and congenital abnormalities. Most of the solitary pulmonary nodules are benign, but up to 30%-40% of them are malignant. The main goal of the radiologic evaluation of suspected solitary pulmonary nodules is to differentiate benign from malignant lesions as accurately as possible. The aim of the study was the assessment of the morphological characteristics of the malignant solitary pulmonary nodules. Large nodule size, irregular, spiculated margins, inhomogeneous density of nodule thick walls in cavitary nodules suggest the presence of the malignant lesion. Smooth, well-defined margins, homogeneous density or the presence of diffuse, laminated, central or popcorn-like calcifications suggest the benign nodule. Diffuse, irregular amorphous calcifications suggest the malignant process. Unfortunately there is a kind of overlapping, and some benign nodules may show features typical of malignancy, and some malignant lesions may appear benign. Morphologic characteristics in computed tomography is however helpful in differentiation of benign from malignant nodules.

High resolution computed tomography in sarcoidosis: typical findings.

Sarcoidosis is a systemic disorder of unknown cause in which noncaseating granulomas occur. Granulomas are formed in lymphatic or perilymphatic distribution, along lymphatics and in peribronchovascular interstitium. In some cases the granulomas are formed in interlobular septa or subpleural interstitium. Nodular interstitial densities in parahilar lung regions are very typical of sarcoidosis, especially with coexistent hilar lymphadenopathy. In HRCT the appearance of pulmonary sarcoidosis may vary, masquerading many other diffuse interstitiallung diseases. The aim of the study is the evaluation of the typical findings for sarcoidosis in HRCT, and assessment of their value in differential diagnosis. The most typical HRCT finding in patients with sarcoidosis are small nodules. They are predominantly distributed adjacent to peribronchovascular and subpleural interstitium. Thickenings of peribronchovascular and septal interstitium are also often seen in sarcoidosis. Ground glass opacities are seen in early stages of sarcoidosis. Conglomerates of masses and large nodules may also be seen in advanced diseases, with traction bronchiectases and honeycombing as a result of fibrosis.

Typical findings for bronchiolitis in high resolution computed tomography.

High resolution computed tomography is a diagnostic modality of choice in imaging of interstitial lung diseases. HRCT enables visualization of the pathological findings invisible on plain radiographs and their evaluation at the level of the pulmonary lobule. The aim of the study was evaluation of typical HRCT findings in patients with bronchiolitis, and assessment of their usefulness in differential diagnosis. Tree in bud is a typical sign seen on HRCT sections in patients with bronchiolitis, resulting from filling the small centrilobular bronchioles with puss, mucus, granulomas or inflammatory cells. Material filling the bronchioles causes their obstruction resulting in the presence of air-trapping, visible on expiratory sections. Thickening of the bronchiolar walls and dilatation of the small bronchioles is also very often seen. Ground glass opacities and small nodules are also seen in some patients with bronchiolitis.

Limitations in ultrasonographic evaluation of the abdominal aortic aneurysms.

The frequency of the abdominal aortic aneurysms (AAA) increases in older population, especially in men older than 50 years. In most cases the AAAs are revealed occasionally in routine ultrasound examination or in CT performed due to other reasons. The aim of the study was the assessment of the diagnostic value and limitations of ultrasound examination in the evaluation of the abdominal aortic aneurysms. The ultrasound examination is a quick, cheap diagnostic modality in revealing the abdominal aortic aneurysm. It may be useful in mass screening, and control of patients with small aneurysm. But ultrasonographic assessment is not accurate enough in the evaluation of all critical features of the aneurysm and preoperative evaluation. In emergency and obese patients the ultrasound examination may fail in visualizing the abdominal aorta. In long aneurysm in ultrasonography the assessment of the involvement of the thoracic aorta is impossible.

Abdominal aortic aneurysm in ultrasound and CT examination.

About 75% of AAAs are asymptomatic. They come to light as the chance findings of a lump with or without pulsation, noted on self-examination, a routine physical check-up, or during diagnostic investigations. Ultrasonography and CT are two most often used in diagnosing of AAAs. The aim of the study was the assessment of the diagnostic value of computed tomography and ultrasonography in the evaluation of abdominal aortic aneurysm. Material comprises a group of 26 patients with abdominal aortic aneurysm. There were 18 men and 8 women, aged between 48 and 76 years (mean age 62 years). In each patient computed tomography and ultrasound examinations were performed. Computed tomography is more accurate technique than ultrasonography. In obese patients or in the presence of gas in the bowel the abdominal aorta may be invisible in ultrasonography, but is easily and clearly visualized in CT. Measurements of aneurysm diameters are much more reliable in CT than in ultrasonography. In CT it is possible to imagine and measure the length of the aneurysm in various MPR reconstructions. The bifurcation of the aorta and iliac arteries are well imagined in CT. The coexistent aneurysms of thoracic aorta are easily diagnosed just by performing few additional sections of the thoracic aorta. In properly prepared patients ultrasonography provides good imaging modality in performed screening examination, and in controlling patients with small aneurysm because it is widely accessible and cheap. In preoperative assessment the CT examination is necessary.

Diagnostic value of multiplanar CT reconstructions in the assessment of abdominal aortic aneurysms.

The increased use of ultrasonography and computed tomography result in the increased number of detected aneurysms, especially with relatively small diameters so the prevalence of the abdominal aortic aneurysms (AAA) is increasing. The aim of the study was to assess the usefulness of multiplanar (MPR) CT reconstructions in the evaluation of abdominal aortic aneurysms. Material comprises a group of 30 patients with the abdominal aortic aneurysm. There were 22 men and eight women, aged between 54 and 78 years (mean age was 62 years). In all the patients the CT examination of the abdominal aorta was performed. The diameter of the aortic aneurysm, measured using computed tomography scans and the rate of growth are the most important determinants of the risk of rupture, and in determining when elective repair is justified. The exact measurements of the aortic aneurysm are required. The tortuous aorta is clearly visible on MPR reconstruction, which enables choosing the proper axial section to measure the true diameter of the aneurysm. The exact measurement of the aneurysm length, possible on MPR sections is essential in determining the rate of aneurysm growth. The presence and size of thrombus correlate with the risk of aneurysm rupture. The MPR reconstructions enable exact measurements of the thrombus length. The visualization of aortic bifurcation is better on MPR reconstructions in coronal plane. The beginning of the dissection in some patients is visible only on MPR images. An MPR reconstruction provides additional information in CT examination of abdominal aortic aneurysm and should be performed in each CT examination of aortic aneurysms.

Synchronous primary esophageal and gastric cancers.

The diagnosed multiple cancer cases have recently been increasing in number. The frequency of synchronous esophageal and gastric carcinomas is increasing due to development of more sophisticated invasive and non-invasive diagnostic tools and an increase in the number of elderly patients. Four cases of synchronous esophageal and gastric cancers were diagnosed in 2nd Department of Radiology, Medical University of Lublin and in Radiological Department of Hospital in Krosno between the 1996 and 2002. In all cases double-contrast barium examinations of upper gastrointestinal tract were performed. In all cases the two lesions were found, separated by normal mucous membrane. In two cases the irregular tumor masses were localized in the gastric cardia. In two patients coexistent lesions form the oval filling defect, with hazy appearance in the middle of the anterior esophageal wall. In three cases the results of contrast examinations were confirmed with CT. Endoscopy with taking the specimens for histopathological examination supplemented the radiological examination. The results of histopathological examinations confirmed the diagnosis. The possibility of multiple primary cancers should be kept in mind during the preoperative examination. In case of esophageal cancer with severe stricture, when endoscope cannot be passed through the esophagus, the stomach should be carefully examined in a barium meal study.

Differential diagnosis of asymmetrical renal cortex thickening and solid renal tumours.

Nowadays the number of asymptomatic, incidental tumors being detected increased as a result of the widespread use of noninvasive abdominal imaging modalities, including ultrasound and computed tomography (CT) and magnetic resonance imaging. The aim of the study is to analyze the atypical, complex morphologic changes and anatomical variants of renal structure, with tumor-like appearance. This is important especially in screening revealing tumors in asymptomatic patients or in patients with atypical symptoms. Material comprises a group of 186 patients in which the US examination was performed between 1996 and 2002, in 2nd Department of Radiology, Medical University of Lublin. In 20 patients the local thickening of renal cortex was found, protruding from the surface of the kidney, so-called "renal gibbus", constituting the anatomical variation. In eight cases the cortex thickening suggesting the presence of the renal gibbus, proved to be renal tumors. Diagnosing of small asymptomatic tumors, less than 3 cm in diameter, was difficult. They have appearance of protruding cortex thickening distorting the renal outlines. The assessment of renal outlines was an important morphologic factor. Small renal tumors showed anatomical anomalies. Regular tumor shape was rarely seen in larger tumors. The normal renal shape was more often seen in small tumors, while the large mass produces irregular distortion of renal outline. In four cases the oblique section of the renal pyramid has within the central part of kidney the appearance of oval pseudo-tumor. The differentiating of oval cortex thickenings protruding from the lateral renal margin--presenting "renal gibbuses"--and small renal tumors is difficult and requires supplementary helical CT examination with spatial reconstructions. Dynamic CT with early bolus of contrast agent and late sections is indicated. The lesion sizes, regularity of its margins, distortion of renal shape, echogenicity similar with the normal renal cortex were important in US examination. MR enhanced with DTPA and CT guided biopsy enables definite diagnosis.

The diagnostic value of different imaging modalities in evaluation of bowel obstruction.

The aim of the study was analysing of the diagnostic value of different imaging modalities in evaluation patients with bowel obstruction. The material comprises a group of 47 patients with diagnosed acute abdomen. Erect radiography, and radiographs in supine and left lateral patients' positions, US and CT examination were performed in those patients. CT examination was performed in 5 mm--and 10-mm thick axial sections before and after administering the contrast agent. In 6 patients small barium enema was performed. In 5 cases water-soluble contrast was administered orally. In 6 cases on plane radiographs the presence of high small bowel obstruction was found. In 3 cases the level of small bowel obstruction was in the distal ileum. In 12 patients the obstruction of large bowel was seen on plain radiographs. In 3 patients intussusception of sigmoid bowel was found. The mesenteric ischemia was found to be a reason of bowel obstruction in 5 cases. On CT section soft tissue mass with irregular contrast enhancement was found, reflecting ischemic intestinal loops. In 2 patients the gall stone small bowel obstruction was found. In one of them the presence of gas in the biliary tree was seen on CT images. The determining of the level of the obstruction is facilitated on plain radiographs, erect and in supine and left lateral patients' position. In small bowel obstruction, normal or equivocal initial radiographs may result in a delayed diagnosis. As the bowel diameter cannot be assessed the plain radiographic diagnosis is difficult or impossible. If there is persistent diagnostic difficulty, follow-up plain radiographs taken a few hours later will often resolve the problem and, if not, a barium study or CT may be performed. Orally administering of water-soluble contrast agent, diluted barium, barium enema are also helpful in differentiating the character and etiology of obstruction.

Imaging of abdominal abscesses.

The aim of the study is presenting own experiences in using different diagnostic modalities in evaluating abdominal abscesses. Material comprises a group of nine patients with diagnosed abdominal abscess aged between 22 and 78 years. The plain abdominal radiograms, ultrasound examinations and computed tomography were performed in those patients. The CT examination was performed in 10-mm thick axial sections, before and after administering contrast agent. The perirenal abscesses were found in two patients. In US have showed various, inhomogeneous echogenicity, depending on the stage of the abscess. The contrast CT reveals enhancing septa, thick walls and oval, central area of lower density. The plane radiograms revealed abscesses in three cases. In two of them abscesses were complications of previouscholecystectomy. The large abscesses dislocated intestinal loops. CT was necessary to assess the extent, depth and shape of retroperitoneal fluid collections. Abdominal abscess is life threatening condition requiring quick diagnosis and proper management. The imaging methods are especially important in diagnosis of abscesses. Abscesses may by recognized on plain abdominal radiograms, but US and especially CT are much more sensitive and accurate. CT is imaging modality of choice in revealing abdominal abscess. CT and US are very useful in nonoperative therapies, including US and CT guided drainage.

The value of ultrasound harmonic imaging in the diagnostics of gall bladder cholesterol polyps.

The aim of the study was to assess the value of harmonic imaging in US evaluation of gall bladder cholesterol polyps. Material comprises 40 patients with pathology of gall bladder diagnosed in US examination. 10 patients from this group with gall bladder cholesterol polyps diagnosed in US were included into the study. In each patient supplementary US examination in the harmonic mode was performed. The quality of images in the harmonic mode was better. The walls of the gall bladder were more distinct. The polyps were more evident on harmonic images. THI enable more precise measurements of the polyps. In three cases in the standard mode the inspissated bile was found in gall bladder, and in those patients polyps were difficult to assess. Examination of those patients in the harmonic mode excluded the presence of the bile sludge, and facilitates the assessment of the polyps. In four patients on harmonic images more polyps were found than in the standard mode. In the harmonic mode the level of artifacts generated by the body wall is reduced and contrast resolution is increased due to reduction in noise level. The visualization of gallbladder is improved in the harmonic mode. The assessment of gallbladder polyps in the harmonic mode is easier. The polyps are easily seen, assessment of their margins and size is facilitated by harmonic imaging. The number of polyps revealed in US examination is larger in the harmonic mode.

Fibrotic changes in high-resolution computed tomography in patients with sarcoidosis.

The aim of the study is presenting the typical findings of fibrotic changes in high-resolution computed tomography in patients with sarcoidosis. Material comprises a group of 18 patients with sarcoidosis, in whom HRCT examination was performed. The scanning was performed from lung apices to the level of diaphragm, at full inspiration with patients in supine position. The presence and character of HRCT findings were noted and analyzed. Additional expiratory scans were performed to diagnose air-trapping, and in case of subpleural densities in posterior, dependent lung areas additional scans were obtaining in prone patients positions. Fibrotic changes were found in the area of confluent nodular lesions in five patients. In these fibrotic areas the bronchiectasis, as well as parenchymal bands and fibrotic masses were seen. In six patients the reticular pattern was the predominant pathology. Thickened lobular septa did not resolve during the remission of the diseases, suggesting the presence of irreversible, reticular fibrotic changes. Intensive fibrosis led towards destruction of the lung parenchyma, with honeycombing involving large lung areas. In the areas of active disease fibrotic changes with traction bronchiectasis were accompanied by the confluent nodular changes and presence of consolidation. After resolving of active reversible changes the intensive fibrosis with large bronchiectasis forming the honeycombing pattern with reticular changes were seen in five patients. In three cases the most intensive changes both fibrotic and productive (granuloma) changes were localized in the lower lobe, mimicking the idiopathic pulmonary fibrosis. The classical HRCT findings in sarcoidosis are well known. But most of them, nodules, ground glass opacities, peribronchovascular thickening or hilar adenopathy are reversible. The irreversible fibrotic changes develop in about 25% of patients. In the early stage they are subtle and invisible on plain radiographs or even on normal CT sections. So the HRCT is necessary to reveal fibrotic changes in patients with sarcoidosis and to monitor the progression of the diseases. Therefore, the good knowledge of HRCT signs of fibrosis is essential.

Ruptured abdominal aortic aneurysm in computed tomography.

The aim of the study is presentation the usefulness of CT examination in evaluation of ruptured abdominal aortic aneurysms. Material comprises a group of six patients (two women and four men) aged 52-79 years, examined in the 2nd Department of Radiology, Medical University of Lublin between the year 1997 and 2002. In all patients US examination and CT was performed. USG was performed with a Hitachi EUB 410 apparatus. CT was performed with Somatom AR. T scanner by Siemens, with two matrixes, 512 x 512 and 320 x 320 pixels. High resolution reconstruction algorithm was used with the possibility of performing spatial reformations. Five- and 10 mm-axial sections were performed before and after administering of contrast agents. Delayed scans were performed to reveal extravasations of the contrast agent. In three cases axial sections and MPR reconstructions revealed the presence of the periaortic haematoma with active extravasation of the contrasted blood. The ruptured aneurysm in two cases was associated with extensive retroperitoneal haematoma. The periaortic haematoma extended along the wall of the aneurysm. In one case the haematoma was localized mainly in front of aorta. In one case of aneurysm of abdominal aorta and iliac arteries, the rupture or left iliac artery with large retroperitoneal haematoma in the pelvis and intensive extravasation of contrasted blood was seen. The US examination with Power Doppler and Duplex facilitate in three cases evaluation of aneurysm localization. The rupture of abdominal aortic aneurysm is life-threatening condition, in vast majority of cases resulting in patient's death. In cases of acute rupture the clinical symptoms and CT examination of stable patients are essential. In chronic rupture the early diagnosis is very important. The main role plays CT examination, which enables revealing of the aneurysm, precise evaluation of the leakage, retroperitoneal haematoma, vertebral destruction and dislocation of aorta and kidneys.

Imaging diagnostics of renal trauma.

The aim of the study is presenting the diagnostic value of different imaging modalities in the evaluation of patients with renal injury. The material comprises a group of 16 patients with blunt abdominal trauma. Six of them were treated surgically. Plain abdominal radiography was performed in 9 patients, urography in 7, US examination in 16 patients and CT in 12 cases. The renal injuries in US were found in 16 cases, 7 of them were isolated and in 9 patients multi-organ injuries were found, with liver injury in 2 of them. The minor injuries were found in 8 cases. In other 8 cases severe renal injuries were found. The perirenal haematomas were visible as non-enhancing areas adjacent to kidney. The parenchymal laceration appeared as linear non-enhancing areas in the renal parenchyma. In the group of minor renal lesion in 3 cases the renal contusion was found and small parenchymal and subcapsular haematomas in 2 cases appearing as hyperdense subcapsular areas, without evident contrast enhancement. In 2 cases CT revealed perirenal extravasations of blood, appearing as perirenal masses (density of 50 HU), and not revealing contrast enhancement. In 2 cases in CT retroperitoneal haematomas were found. The absence of excretion was found in 2 cases, representing severe injury of the renal pedicle. In 3 cases the injury of ureteropelvic system with extravasations of the contrasted urine into perinephric area was found in CT and in urography. That was the most frequent urographic sign of renal laceration. In 3 cases axial sections revealed injuries of renal collecting system, with subtle extravasation of contrasted urine. In 2 other cases of extensive parenchymal injuries US examination revealed irregular areas of inhomogeneous reflectivity. Radiological evaluation of kidney in patients which sustained abdominal trauma is generally indicated in patients with hypotension < 90 mm Hg and hematuria. CT is preferred image method, enabling evaluation of the injury category. CT is essential in qualifying of patients for conservative or surgical management. USG is also useful in initial diagnosis, but usually precise renal evaluation requires additional CT examination.

The value of ultrasound harmonic imaging in the diagnostics of gall bladder concrements.

The aim of the study was to assess the value of harmonic imaging in US evaluation of gall bladder concrements. The material comprised 40 patients with pathology of gall bladder diagnosed in US examination. 21 patients from this group with gall bladder concrements diagnosed in US was included into the study. In each patient supplementary US examination in the harmonic mode was performed. In three patients the deposits were localized in the cervix of the gallbladder. In two of them the acoustic shadow was seen only on THI images. In one patient the fibrotic gall bladder was found. In seven cases the concrements were sharper and more distinctly visible on harmonic images and acoustic shadow was more evident in eight. In five cases in the standard mode the presence of inspissated bile was found in gall bladder, but examination in the harmonic mode excluded the diagnosis in four of them. In the harmonic mode the level of artifacts generated by the body wall is reduced and contrast resolution is increased due to reduction in the noise level. The visualization of gallbladder is improved in the harmonic mode. The assessment of gallbladder stones in the harmonic mode is easier because: 1) images of the gall bladder lumen are clearer due to the reduced level of artifacts; 2) the resolution and contrast between the concrements and the bile are increased; 3) the acoustic shadow is more evident on harmonic images. Diagnosis of concrements localized in the gall bladder cervix is especially improved in the harmonic mode. Differentiation of solitary and multiple concernments is also facilitated by harmonic imaging.

Dissecting aortic aneurysm in computed tomography.

The dissecting aortic aneurysm (DAA) is an emergency, and because of that it requires urgent diagnosis and treatment. Many methods may by used to diagnose dissection, including aortography, CT, MRI, traditional and transesophageal ultrasonography. The computed tomography is often used in diagnostic of DAA, thus the knowledge of morphological characteristic of dissection is very important. The most important features of dissection in CT are presence of dissection of intima and two lumens, true and false. Nevertheless, the CT pictures of dissection not always appears like this, and sometimes the two lumens are identified only by their different rates of opacification with contrast material.

The value of ultrasound in the monitoring of patients after operations on the pancreas.

The aim of the study is to assess the value of ultrasound examination in the postoperative assessment of the pancreas. The material comprises 16 patients after operation with Whipple's method, 3 patients after operation with Puestow's method, 4 patients after the operation with Jurasz's method, 11 patients after surgical treatment of acute hemorrhagic-necrotic pancreatitis and 4 patients after palliative interventions. In 2 patients after operation with Whipple's method the presence of the abscess was observed due to bile discharge that requires drainage. In 4 cases edematous inflammation changes surrounded by a liquid streak were found. 6 patients had features of chronic pancreatitis. The segmental pancreatic duct widening was found in 4 patients, and 2 of them were after operation with Jurasz's method. In patients drained due to hemorrhagic-necrotic pancreatitis, US apart from liquid areas, reveals the localization of the drain end. In patients after palliative procedures the grade of intrahepatic bile ducts and choledochus dilatation were assessed. In 5 patients recurrence was found. US examination is a valuable diagnostic method in postoperative monitoring of patients after surgical treatment of pancreatic diseases.

3D CT imaging of the lumbo-sacral spine after surgical treatment of L5-S1 spondylolisthesis by postero-lateral spondylodesis.

Background. The aim of the study is the evaluation of the spatial imaging computed tomography (3D CT) of lumbo-sacral spine after surgically treated spondylolistesis L5-S1 with the postero-lateral spondylodesis using autogenic bone grafts.
Material and methods. Material comprises 9 patients treated surgically due to I degrees spondylolistesis caused by the L5 vertebra spondylolysis. In all cases postero-lateral spondylodesis was performed using autogenic bone grafts, taken from the iliac crest, placed on the transverse processes of the L5 vertebra and the sacral bone. The CT examination was performed in the period between 6 months up to 2 years after operation due to overloading lumbar pain.
Results. The bone grafts was localized correctly in 8 patients. In 1 person the upper side of the one bone graft was localized incorrectly, on the prominent transverse processus of the S1 vertebra, instead of the L5 one. The spatial reconstruction reveal the presence of osteophytes surrounding the ends of the bone grafts or the localization the fissure of the arch. In 2 cases the bone grafts were bigger on the left side, and the wide lower ends were connected with the dorsal surface of the sacral bone and were connected with the shorten due to surgery iliac crest
Conclusions. The CT examination with the use of the spatial option is very valuable in the lumbo-sacral spine imaging in patients treated with the postero-lateral spondylodesis due to spondylolisthesis L5-S1. The spatial images 3D CT are especially useful in imaging of the localization of the bone grafts, assessment of the wide of spinal canal and intervertebral foramens. The use of spatial imaging 3D is valuable supplement of standard CT examination in diagnosis of the patients complaining of the lumbar pain, treated surgically due to spondylolistesis.

Role of CT examination in assessing the response of oesophageal carcinoma to neoadjuvant chemotherapy.

The oesophageal carcinoma is a devastating disease with very poor prognosis. In many cases surgery with previous radiation or chemotherapy are used in treatment. The assessment of the oesophageal tumour response to chemotherapy is very important, because early detection of tumour response to antineoplastic therapy may improve the value of such an approach by allowing continuation of treatment in those likely to benefit while preventing the administration of ineffective and potentially harmful therapy in non-responders. The CT evaluation is a reliable method of monitoring patients during chemotherapy due to oesophageal carcinoma. It can detect reduction of the infiltration thickness, size of enlarged lymph nodes as well as reduction of the angle of aortic infiltration. Unlike in oesophageal ultrasonography, even highly stenotic tumours can be fully assessed in CT.