[Computer tomography--indications and technology].
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Biomedical subjects
Publications and source records attributed to A Hemmingsson.
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For staging of Hodgkin's disease 45 patients underwent lymphography and abdominal computed tomography (CT); in 31 of them ultrasound examination was also performed. In cases of retroperitoneal lymph node enlargement lymphography and CT are diagnostically equivalent, whereas the poorer resolution of ultrasound reduces the reliability of this method when the lymph nodes are only slightly enlarged. Theoretically with lymphography also small lymphomatous lesions in normal-sized lymph nodes should be possible to demonstrate, but there is a clear tendency to overdiagnosis. CT is therefore recommended as the initial method and this examination is considered sufficient both in clearly negative and clearly positive cases. In doubtful cases and in those where CT has revealed solitary slightly enlarged lymph nodes, the examination should be supplemented with ultrasonic scanning and lymphography.
In three patients operated on for intermittent claudication in 1953, 1954 and 1956, respectively, the pathology causing the obstruction was localized cystic adventitial degeneration of the popliteal artery. On examination 27 to 30 years postoperatively the grafts were all patient, but showed some widening and irregularity. The vein grafts had thus stood a rather long test of time. There were no signs of relapse of the non-atherosclerotic disease of the femoro-popliteal artery. None of the patients had any history of knee injury or joint swelling.
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A phantom for study of uniformity, artifacts from dense structures, and consistency in pixel values was constructed. On-site studies of eight computed tomographs belonging to the second, third, and fourth generations showed that the phantom was appropriate for such measurements. The results indicate certain inherent shortcomings in some of the present designs.
Occurrence of Takayasu's arteritis (TA) is described in this work in a defined area of Sweden, namely the Uppsala Hospital region (1.3 million inhabitants). During the eight year period 1969-1976 there were 15 cases of TA discharged from the hospitals in this region. The estimated yearly prevalence was 0.64 per 100,000 inhabitants. All subjects underwent angiography of the aorta and the main vessels. The authors point to the necessity of performing a total aortography. The most common lesions in this study were confined to the subclavian arteries in contrast to the commonly reported lesions of the aortic arch. Six of the fifteen subjects died during the study period. Those who died more often had hypertension hypercholesterolemia and were smokers to a greater extent than those who survived. Treatment with corticosteroids and azathioprine seemed to improve the prognosis. At present a total aortography and/or biopsy of the vessel at autopsy or operation is the most accurate way of establishing the diagnosis.
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Lymphographic findings were compared with the results at histopathology in 42 laparotomized patients with malignant lymphoma. Of 12 patients with lymphographically suggested lesions in normal-sized lymph nodes, only one had pathologic changes at histologic examination. Computed tomography gave a better idea of the extent of the disease than lymphography. Moreover, CT had an equal diagnostic accuracy as lymphography for demonstrating enlarged para-aortic lymph nodes. CT should therefore be able to replace lymphography in examination of malignant lymphoma. Ultrasound had the same diagnostic accuracy as CT regarding the upper and middle abdomen but not in the lower abdomen. Ultrasound is of special value in thin patients and when guided needle biopsy is required.
Twenty-four patients with probably resectable carcinoma of the head of the pancreas were examined by means of CT, ERCP and US and supplemented with angiography to assess the resectability. Resection was possible in half of the patients. As the series consisted only of potentially resectable cases, those with obvious liver metastases at CT or US were not included. The 3 patients in whom CT or US revealed a tumour larger than 5 cm were inoperable. A distance less tan 5.5 cm between the hilum of the liver and the proximal margin of the tumour measured in the common bile duct at ERCP also meant inoperability. Invasion of the superior mesenteric or splenic vein at angiography as an indication of non-resectability was confirmed at laparotomy in 12 of 13 cases.
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Computed tomography of the adrenals from 100 selected patients and from adrenal models was used to investigate the morphology, anatomic relations, and transaxial imaging of the normal glands. The recorded data were correlated with the classical anatomy and with the relevant reports in the literature. A system of nomenclature which is felt to be best suited for describing normal and pathologic adrenals, besides being applicable to all specialties, is suggested. Some sources of diagnostic errors were disclosed by reviewing the concepts of the normal axial imaging in the light of pathologic adrenal characteristics.
Model investigations for computerized quantitation of atherosclerotic plaques by a combination of arteriography and microdensitometry were performed. The correlation between real and densitometrically determined plaque volumes was high (r = 0.987) in examinations of randomly distributed plaques. The results indicate that this method can be useful in the clinical examination of patients with atherosclerosis.
Computed tomography, adrenal venous blood sampling, phlebography and arteriography were compared as diagnostic methods in 50 proven cases of adrenal disease. The diagnostic accuracy was 90 per cent for CT, 100 per cent for adrenal venous sampling, 75 per cent for phlebography and 58 per cent for arteriography. It was necessary in some instances to correlate the findings for more than one modality to reach a correct diagnosis. From an analysis of the different examination methods a sequence in the radiologic evaluation of the pathologic adrenal gland is suggested. CT can be used to advantage as the primary imaging method. However, the other modalities, still play an important role.
A number of physiologic movements in the body influence the image at CT scanning. The pulsations of the abdominal aorta result in a motion of the retroperitoneal lymph nodes in the transverse plane. In connection with lymphography, the motion of the lymph nodes was analysed in 10 patients. The maximum motion in the transverse plane was 2.5 mm. In phantom experiments an object with a diameter of 10 mm was scanned during pulsating movements. Based on these experiments it was concluded that the motion of the lymph nodes does not seem to be of any importance for the reproduction of the node size, whereas motion in the CT plane will probably impair the resolution and thus the imaging of the internal structure of the nodes.
The histopathologic findings at retroperitoneal lymph node excision in 29 patients with a non-seminomatous germ cell tumour were compared with the findings at preoperative computed tomography, ultrasound and lymphography. The possibilities of detecting retroperitoneal metastases are somewhat greater with computed tomography than with lymphography. In the present material ultrasound was less reliable than computed tomography for demonstrating small metastases. At postoperative follow-up, in more than half of the patients computed tomography could not discriminate benign postoperative abnormalities from recurrent tumours. Ultrasound seemed to be a more reliable method for postoperative evaluation of the retroperitoneal space.
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