Biomedical subjects
Publications and source records attributed to C Metreweli.
A retrospective analysis of 100 coronal sinus CT scans was performed to investigate the frequency of opacity of the nasolacrimal duct and determine if there was any correlation between the pattern of duct opacity and the presence of inflammatory sinus disease. The study showed that the nasolacrimal ducts are opaque in the majority of normal people and that there is no relationship to inflammatory sinus disease.
The sensitivity and specificity of MIBI breast scintigraphy, conventional mammography and ultrasound in differentiating malignant and benign palpable breast lesions was compared in 48 women. MIBI breast scintigraphy had a sensitivity of 97% a specificity of 69%, a positive predictive value of 87.5% and a negative predictive value of 91.7%. Ultrasound and mammography had comparable results with accuracy rates of approximately 93%. We conclude that MIBI breast scintigraphy may have a complementary role in the evaluation of palpable breast lesions, but is not specific enough to replace current imaging modalities.
Five hundred and twenty-nine women with self-discovered or clinically palpable breast lumps had physical examination followed by high-resolution ultrasonographic examination of the breast. A total of 482 palpable and 146 nonpalpable masses were discovered by ultrasonography. The median values of the breast stromal, premammary, and retromammary fat thickness measurements were 1.3 cm, 0.1 cm, and 0.1 cm, respectively. The median depths of the lesions and the distance of the lesions from the pectoralis muscle were 0.5 cm and 0.2 cm, respectively. The median size of all breast masses was 1.5 cm. These measurements (of the tissue characteristics of the breast, location of the breast mass, and size of the breast lesion) were correlated with palpability or nonpalpability of the breast lesions. Multivariate logistic regression performed for all breast masses showed the only significant factors affecting palpability to be the size (anteroposterior and transverse diameters) and the depth of a breast mass. This is expressed by the following equation: [formula: see text] where z = -0.8759 + 0.9691 (g) + 2.2770 (e)-1.5332 (d), and d represents depth of lesion from the cutaneous surface and e and g represent anteroposterior and transverse diameters of the breast mass, respectively. The nature of the breast tissue (i.e., the premammary fat, retromammary fat, or breast stromal thickness as determined by ultrasonography) does not affect palpability. This study would therefore strongly support the recommendation of breast self-examination, irrespective of breast structure.
Axillary lymph node status is crucial in the evaluation of prognosis and in treatment planning of breast cancer. High-resolution real-time sonographic scans of the breast and both axillae were performed on 114 patients with breast carcinoma, all of whom had axillary lymph node dissection and histologic assessment. The sensitivity of high-resolution ultrasonography in the detection of axillary nodal metastases was 84.1%, with a specificity of 97.1%, accuracy of 92.1%, positive predictive value of 94.9%, and negative predictive value 90.7%. Ultrasonography of the axilla provides good information on anatomy and pathology and may have a potential role in the prognostic work-up of patients who are not surgical candidates.
In 100 normal subjects who had a sonographic examination of the neck, 1211 lymph nodes were detected. In all the subjects, at least five lymph nodes were seen. The distribution, number, echogenicity, shape, presence or absence of echogenic hilus, and the sharpness of nodal borders of normal cervical lymph nodes were determined. The usefulness of these sonographic features in understanding the normal distribution and characteristics of the nodes in the Chinese population is discussed. The relationship between the shape and size of lymph node also was assessed.
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We prospectively assessed the accuracy of high resolution breast ultrasonography in the diagnosis of palpable breast masses in comparison to clinical palpation and x-ray mammography. Four hundred and eight Chinese women with palpable breast lumps had clinical assessment followed by ultrasonography of the breast, mammography (for women over 35 years), and fine needle aspiration cytology. Excisional biopsy or surgery was performed for suggestive lesions. The clinical, mammographic and ultrasound diagnoses were compared with the final pathologic diagnosis. In the determination of whether a lesion was malignant, the sensitivity, specificity, and positive predictive values were 97%, 97%, and 85%, respectively, for ultrasonography; 92%, 94%, and 84%, respectively, for mammography; and 88%, 92%, and 67%, respectively, for clinical evaluation. The specificity for combined clinical palpation and ultrasonography was higher (99%) than that for combined clinical palpation and mammography (96%). Addition of ultrasonography to combined clinical palpation and mammography increased specificity. Mammography in addition to combined clinical palpation and ultrasonography did not significantly improve the sensitivity, specificity, or positive predictive value. This limited usefulness raises the question as to whether it should be eliminated in the workup of a palpable mass in the average Chinese patient. Its main advantage is the detection of extended foci of carcinoma in situ related to a palpable mass, which often is undetected by ultrasonography.
PURPOSE: To investigate the clinical, histopathological, and radiological features of radiation pneumonitis arising as a complication of selective internal radiation treatment for liver tumors. To correlate the development of radiation pneumonitis with the degree of lung shunting as assessed by 99mTechnetium-labeled macroaggregated albumin (Tc-MAA) scan. METHODS AND MATERIALS: Five out of 80 patients who had inoperable hepatic tumors and underwent treatment with intraarterial 90Yttrium- (90Y)-microspheres, developed progressive restrictive ventilatory dysfunction without an infective or cardiovascular cause. Histopathological evidence of a pneumonitis and the presence of microspheres in the lung tissue suggested a diagnosis of radiation pneumonitis. The clinical course, radiological and histopathological findings, percentage tumor shunting to the lungs (lung shunting, as predicted by gamma camera scanning after intraarterial Tc-MAA), and the estimated radiation dose to the lungs were analyzed. In an attempt to reduce pulmonary shunting of the microspheres, three patients received partial hepatic embolization with inert particles before selective internal radiation therapy. RESULTS: In the five patients who developed radiation pneumonitis, lung shunting percentages (as predicted by Tc-MAA scan) ranged from 13.1 to 45.6% (median 23.7%). The estimated whole lung radiation dose ranged from 10.43 Gy to 36.44 Gy (median 25.04 Gy). Among 75 patients who did not develop radiation pneumonitis, the percentage lung shunting ranged from less than 1% to 15% (median 6%). Nine patients had lung shunting greater than 13% and five of them developed radiation pneumonitis, whereas this developed in none of those in whom shunting was below 13%. The onset of radiation pneumonitis ranged from 1 to 6 months after internal radiation treatment. All five patients exhibited characteristic plain radiographic and computerized tomographic changes comprising extensive consolidation with well-defined lateral margins. Clinical improvement after corticosteroid treatment was seen in two patients. Three patients died from respiratory failure and two from other causes. Partial hepatic arterial embolization reduced the degree of lung shunting to less than 13%, but did not prevent the development of radiation pneumonitis. CONCLUSION: Radiation pneumonitis may become a complication after intraarterial 90Y-microspheres treatment when lung shunting, as assessed by Tc-MAA scan, is high (above 13%). Prescribed activity of 90Y and lung shunting of Tc-MAA should be considered together before giving selective internal radiation (SIR) therapy for hepatic tumors, and preferably avoided if the lung shunting is above 13%.
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Thallium-201 has been shown to be useful in predicting tumour viability in patients undergoing neoadjuvant chemotherapy for osteogenic sarcoma. Early studies relied upon qualitative assessment of analog images to obtain predictive results. Recently, the lesion to normal tissue uptake ratio of 201Tl has been used in evaluating bone and soft tissue sarcomas. This study attempts to quantitate changes in tumour to normal tissue ratio following chemotherapy. Eight consecutive patients with classical osteosarcoma received standard preoperative chemotherapy with a combination of cisplatin, adriamycin and high-dose methotrexate. 201Tl gamma scintigraphic images were obtained both before and after chemotherapy. The average counts taken over the tumour divided by that from the contralateral normal tissue area yielded a tumour-to-normal tissue (T/N) ratio. The percentage change in the T/N ratio before and after preoperative chemotherapy was correlated with the percentage of tumour necrosis from pathological section. The median post-chemotherapy T/N ratio was 1.85 (range 0.5-7.7). The median percentage change in T/N ratio after chemotherapy was -58% (range +26% to -83%). The median percentage of necrosis from pathological section was 80% (range 0%-95%). There was a good correlation between the percentage of tumour necrosis and the percentage change in T/N ratio (rank correlation coefficient r = 0.84, P = 0.0085). Quantitative assessment of changes in 201Tl uptake by osteosarcoma correlates well with tumour necrosis after preoperative chemotherapy. This method may be used to predict response to chemotherapy at an earlier stage, enabling the clinician to consider alternative chemotherapeutic regimens or salvage surgery.
We describe the ultrasound appearances of lymph nodes in the hepatoduodenal ligament ('Daisy Chain Nodes') in normal subjects. Nodes were identified in 69 of 116 patients referred for abdominal ultrasound, who had no underlying reason for lymphadenopathy. Patients with primary malignancy or inflammatory pathologies were excluded from the sample. In 26 patients, the hepatoduodenal ligament (HDL) was not visualized. Therefore Daisy Chain nodes were visualized in 77% of patients where the HDL was visualized. Nodes were seen more frequently in younger patients; this was attributed to more homogeneous hyperechoic perinodal fat in the younger age group and the larger size of nodes in young patients. Study of normal lymph nodes will help to determine criteria for the appearances of pathological nodes in the abdomen.
Acute scrotal swelling resulting from remote intra-abdominal pathology is a well recognized but rare entity. The present report relates to such a case in a neonate who presented with an acute right scrotal haematoma, adrenal haemorrhage not being suspected clinically, but detected ultrasonographically. In the imaging of neonatal scrotal swellings, abdominal ultrasound is important in excluding a primary intra-abdominal event.
Kimura's disease is found almost exclusively in Orientals. It commonly affects the head and neck region and mainly involves the major salivary glands and regional lymph nodes. Its appearances can be mistaken for malignant disease. We present two patients with Kimura's disease. In one patient the disease involved the soft tissues and parotid gland, and in another the submandibular gland. Both patients demonstrated lymphadenopathy in the submandibular, submental areas and upper cervical region. Both patients had ultrasound examination of the salivary glands and neck. One of the patients also had contrast-enhanced CT and MRI. The clinical, pathological and imaging findings of Kimura's disease are discussed.
Tuberculous adenitis and metastatic nodes from Nasopharyngeal carcinoma may have a similar clinical presentation. Clinical examination and laboratory tests alone are unable to differentiate the two. However, ultrasound is a useful initial investigation in differentiating these two conditions. We present ultrasound appearances in 33 patients with proven tuberculous cervical adenitis and 32 patients with proven metastatic nasopharyngeal carcinoma. The ultrasound features we found useful were the distribution of the nodes, cystic change, matting and surrounding soft tissue oedema. The size, shape and internal architecture of the nodes, previously described criteria in differentiating benign from malignant nodes, did not help.
The ultrasound appearances and histological correlation of metastatic cervical lymph nodes in 20 patients with papillary carcinoma of the thyroid are presented. The majority of the malignant nodes were homogeneous (81.2%), hyperechoic (87.5%) compared to adjacent sternomastoid muscle and 68.7% showed peripheral punctate calcification on US and histology. Histology revealed that the peripheral echogenic foci seen within the nodes on US correlated with psammoma bodies which are characteristic for papillary carcinomas, highlighting the importance of recognizing peripheral punctate calcification in the cervical nodes as a useful sign for the diagnosis of metastatic papillary carcinoma of the thyroid.
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