Cholescintigraphic images in a patient with hepatocellular carcinoma and Oriental cholangitis.
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Bile Ducts, Intrahepatic↗
Biomedical subjects
C Metreweli
Publications and source records attributed to C Metreweli.
The detection of occult phlebitis with Tc-99m stannous fluoride colloid labeled white blood cell scintigraphy.
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Adult↗
Simultaneous hot and cold bone scan metastases in hepatocellular carcinoma.
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Bone Neoplasms↗
MRI of intraspinal nerve sheath tumours presenting with sciatica.
The magnetic resonance imaging (MRI) characteristics of 14 intraspinal nerve sheath tumours (NST) presenting with sciatica were reviewed. The group comprised seven schwannomas, six neurofibromas and one perineuroma. The tumours were either iso- or hypointense with respect to spinal cord on T1-weighted (T1W) images; almost all tumours were hyperintense compared with spinal cord on T2-weighted (T2W) images. The tumours were all detectable on unenhanced T1W images. Nine NST were scanned following Gadolinium-Diethylenetriamine penta acetic acid (DTPA) injection and all showed intense enhancement. This aids differentiation from sequestrated disc fragments. Tumours were more likely to show homogeneous enhancement unless they were recurrent tumours. Rim enhancement occurs more commonly in schwannomas and this can be used to differentiate these from neurofibromas. However, on unenhanced images, schwannomas cannot be distinguished from neurofibromas. Four tumours occurred at T11-T12. There was poor correlation of the site of the lesion with the clinical findings. MRI studies in patients with sciatica should include the lower thoracic region especially if no protruded disc was found in the lumbar region.
Adolescent↗
Giant hydronephrosis in adults: the great mimic. Early diagnosis with ultrasound.
Giant hydronephrosis in adults is uncommon and often misdiagnosed clinically. We present three cases of giant hydronephrosis in adults secondary to ureteric calculous obstruction, two of whom presented with an acute abdomen and one with an indirect inguinal hernia. All patients were diagnosed promptly with ultrasound.
Aged↗
Technical note: an evaluation of the routine use of rectal air in computed tomography of the pelvis.
We have performed computed tomographic examinations of the pelvis in 50 patients, using rectally administered air to outline the rectosigmoid colon. Bowel cleansing was not performed and smooth muscle relaxants were not used. The procedure was well tolerated by all patients, and diagnostic images were obtained in all cases. There were no complications. This is a safe, low cost and easily administered form of bowel contrast. We recommend it as the technique of choice in routine pelvic computed tomography.
Colon, Sigmoid↗
Detection and assessment of intracranial aneurysms: value of CT angiography with shaded-surface display.
OBJECTIVE: The purpose of this study was to evaluate the efficacy of circle of Willis CT angiography with shaded-surface display in the detection and assessment of suspected intracranial aneurysms. MATERIALS AND METHODS: Twenty-three patients who had clinical or radiologic suspicion of intracranial aneurysms were studied prospectively with CT angiography and conventional angiography. The images were obtained and interpreted in a double-blind fashion by different radiologists. Conventional angiography, which was the reference standard in this study, diagnosed 17 aneurysms in 15 patients. The usefulness of the two types of images for surgical planning was evaluated by two neurosurgeons. RESULTS: No aneurysms were detected with either technique in eight patients. Both techniques showed 15 aneurysms in 14 patients. The maximum dimensions were less than 3.0 mm in three cases, 3.0-5.0 mm in four cases, and greater than 5.0 mm in eight cases. With conventional angiography used as the reference standard, CT angiography has one false-positive and two false-negative findings, resulting in a sensitivity of 88% (15/17) and a specificity of 89% (8/9). For 12 of 15 aneurysms, CT angiography was rated equal or superior to conventional angiography in depicting all aspects (shape, orientation, neck, and parent vessel) of the aneurysms. CONCLUSION: We were able to detect aneurysms of the circle of Willis as small as 2 mm in size. Using conventional angiography as the reference standard, CT angiography has a sensitivity of 88% and a specificity of 89% for the detection of aneurysms in the circle of Willis. In almost all cases, CT angiography was equal or superior to conventional angiography in characterizing the aneurysms for surgical planning.
Adolescent↗
Ultrasonographic demonstration of normal axillary lymph nodes: a learning curve.
High frequency transducers with near field resolution allow visualization of superficial structures in the axilla, such as the lymph nodes, which could not be visualized with older equipment. We have been able to observe normal axillary nodes in 61.5% of 26 women who had histologic correlation of normal lymph nodes at axillary dissection. We studied 663 women with a clinically palpable breast lump using breast and axillary ultrasonography. They were divided into four groups. The first group consisted of all women who had undergone surgery and had histologic correlation of axillary nodes. The second, third, and fourth groups were made up of three consecutive series of 221 women examined. Women from group one were included in groups two, three, and four. A steep learning curve of 7.1 to 41.9 to 64.7% was observed in the detection of normal axillary nodes, suggesting that these appearances can be recognized easily.
Axilla↗
Determination of tumour vascularity using selective hepatic angiography as compared with intrahepatic-arterial technetium-99m macroaggregated albumin scan in hepatocellular carcinoma.
A total of 51 patients with hepatocellular carcinoma (HCC) were studied to determine the tumour vascularity as determined by selective hepatic angiography (HAG) and by intrahepatic-arterial technetium-99m-labeled macroaggregated albumin (Tc99m-MAA) scan. The tumour vascularity was graded on the HAG films by an interventional radiologist using a scale ranging from 1 (hypovascular) to 4 (extremely hypervascular). The grades of vascularity on HAG were grade 1 in 5 patients, grade 2 in 13 patients, grade 3 in 24 patients and grade 4 in 9 patients. The tumour vascularity on scintigraphy was determined by quantifying the count rates over the tumour and normal liver areas by an analog/digital gamma-camera, and the resultant tumour-to-normal ratio (T/N ratio) gave a quantitative measure of the vascularity. The range of the T/N ratio was 0.9 to 11.1, with a median of 3.7. There was no correlation between the tumour vascularity grading on HAG and the T/N ratio on the Tc99m-MAA scan (Wilcoxon rank test, P = 0.83). Thus, we conclude that HAG cannot reveal the true vascularity nor reflect the T/N ratio in HCC.
Angiography↗
Role of ultrasonography in thyroid metastases.
The ultrasound features in eight cases of metastases to the thyroid are reported. The primary tumours were bronchogenic carcinoma (4 cases), breast carcinoma (2 cases), oesophageal carcinoma (1 case) and carcinoma of the stomach (1 case). In this series, none of the metastases were from malignant melanoma or a renal neoplasm. Malignant cervical lymphadenopathy was seen in four cases, and five patients had evidence of disseminated disease.
Breast Neoplasms↗
Ultrasound imaging in laryngeal cancer: a preliminary study.
High resolution ultrasound is a promising technique in the assessment of laryngeal carcinoma, yet few published studies have appeared concerning its use. We set out to assess if ultrasound could correctly identify the site and size of known lesions, if unsuspected extralaryngeal spread or nodal involvement could be shown and if the results could be used to influence patient management. Fourteen patients with advanced laryngeal cancer (Stage T2 or above) were prospectively evaluated by systematic ultrasound technique, with the sonologist blind to the clinical findings. The results were correlated with clinical assessment and with histopathological findings in six patients who subsequently underwent surgery. Eleven of 14 tumours were visible on ultrasound and the site and size correctly identified in each. Unsuspected extralaryngeal spread was found in four cases increasing the tumour stage to T4; spread to the pre-epiglottic space was also shown in four cases. Nodal staging was correctly raised in two cases and incorrectly in one. Patient management was significantly influenced in 8/14 cases. Ultrasound can identify the majority of laryngeal tumours of Stage T2 and above, and detect extralaryngeal spread. Small tumours may not be visible but in this preliminary study, ultrasound complemented the clinical assessment and was useful in patient management.
Aged↗
Treatment of inoperable hepatocellular carcinoma with intrahepatic arterial yttrium-90 microspheres: a phase I and II study.
Eighteen patients with inoperable hepatocellular carcinoma (HCC) were treated with intrahepatic arterial yttrium-90 microspheres. All these patients showed a lung shunting below 15% and a tumour-to-normal ratio higher than 2 as determined by diagnostic technetium-99m macroaggregated albumin (Tc-MAA) gamma scintigraphy. The treatment was given through an arterial port placed during laparotomy. The radiation doses to the liver and tumour were determined intraoperatively with a beta probe and liquid scintillation counting of multiple liver biopsies. The treatment was well tolerated without major complications. In all patients the tumour marker fell to a level which ranged from 41% to 0.2% of the pretreatment level. Tumour regression was found to be dose related. Progressive or static disease occurred in a higher proportion of patients whose tumours received < 120 Gy (P = 0.005). Survival was better in those whose tumours received > 120 Gy (median survival = 55.9 weeks) than those whose tumours received lower doses (median survival = 26.2 weeks). This difference is statistically significant with P = 0.005. We conclude that yttrium-90 microsphere therapy is safe and that tumour response is dose related. A tumour dose of > 120 Gy is recommended.
Adolescent↗
Diagnostic pharmaco-scintigraphy with hepatic intra-arterial technetium-99m macroaggregated albumin in the determination of tumour to non-tumour uptake ratio in hepatocellular carcinoma.
Between October 1990 and March 1993, 124 patients who had hepatocellular carcinoma (HCC) underwent diagnostic pharmaco-scintigraphy with hepatic intraarterial technetium-99m macroaggregated albumin (TcMAA) to determine the tumourous to non-tumourous liver tissue uptake ratio (T/N ratio). There were 110 males and 14 females. Ages ranged from 16 to 73 with a median of 55 years. The range of T/N ratio was 0.7 to 19.3 with a median of 3.8. 12 patients with inoperable HCC were subsequently selected by predetermined criteria to undergo treatment with hepatic intraarterial yttrium-90 microspheres and the T/N ratios in these patients were validated by beta probe dosimetry and liquid scintillation count of multiple liver biopsies. The T/N ratio determined by preoperative diagnostic TcMAA scan correlated well with intraoperative beta probe dosimetry, with coefficient of correlation r = 0.82. Preoperative TcMAA scan also correlated well with liquid scintillation count of biopsy specimens, with r = 0.96. We conclude that TcMAA scan can be used to determine the T/N ratio in patients with HCC, thus allowing better selection of patients with inoperable tumours for loco-regional therapy.
Adolescent↗
Comparison of technetium-99m nanocolloid and indium-111 leucocytes in the diagnosis of orthopaedic infections.
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Bacterial Infections↗
Selective internal radiation therapy with intra-arterial iodine-131-Lipiodol in inoperable hepatocellular carcinoma.
UNLABELLED: From August 1990 to June 1993, 26 patients with inoperable hepatocellular carcinoma were treated with intra-arterial iodine-131-Lipiodol (131I-L). METHODS: Iodine-131-Lipiodol was given through either an implantable arterial port (9 patients) or during hepatic angiography (17 patients). All 26 patients had multiple lesions, 3 had involved resection margin after surgical resection and 1 had diffuse infiltrative lesions. The median size of the largest tumor among 22 patients with a measurable lesion was 4.5 cm (2-9.5 cm). The end points are tumor response in terms of tumor size, change in serum alpha-fetoprotein level, toxicity of treatment and overall survival. RESULTS: Twenty-three patients received a single treatment of 1.11-2.22 GBq (30-60 mCi)131I-L. Three patients received 2.22-4.44 GBq (60-120 mCi)131I-L in three fractions. Considering both radiological regression and reduction in serum alpha-fetoprotein level as objective response criteria, the overall response rate was 52% (13 out of 25 patients with evaluable disease). Ten out of 15 patients who had raised alpha-fetoprotein levels had more than 50% reduction and 8 patients had more than 90% reduction in alpha-fetoprotein level. Since analysis, 19 patients have died and 7 remain alive, giving a minimum median survival of 6 mo (range 1.2-16.6 mo), with 4 surviving more than 1 yr calculated from the day of treatment. There was only one patient who had late deterioration of liver function compatible with radiation hepatitis. There was no bone marrow toxicity documented in any patients. CONCLUSION: Treatment with intra-arterial 131I-L was well tolerated in patients with inoperable hepatocellular carcinoma and produced an objective response of 52% with median survival of 6 mo. A fractionated dose of 131I-L was feasible and the radiation dose could be escalated safely.
Carcinoma, Hepatocellular↗
Measuring lung shunting in hepatocellular carcinoma with intrahepatic-arterial technetium-99m macroaggregated albumin.
UNLABELLED: With increased use of intraarterial administration of chemotherapeutic and radioactive particulate agents, it is necessary to assess agent delivery in the lung. METHODS: Technetium-99m-labeled macroaggregated albumin (99mTc-MAA) delivered through the hepatic artery was used to determine the degree of lung shunting in 125 patients with hepatocellular carcinoma (HCC). RESULTS: The percentage of lung shunting varied among patients and it ranged from less than 1% to 67.2%, with a median of 8.1%. The degree of shunting depended on the vascularity of the tumors but not on the tumor size. The effect of angiotensin II on lung shunting was tested on six patients and there was no significant difference found between those patients who were pre-treated with angiotensin II and those who were not. One patient who underwent a liver resection, had a significant decrease in lung shunting from 28.5% to less than 1% after surgery. CONCLUSION: The lack of effect of angiotensin II together with the almost complete ablation of lung shunting by tumor resection suggested neoplastic blood vessels were responsible for the shunting.
Angiotensin II↗
Hepatic intra-arterial lipiodol ultrasound guided biopsy in the management of hepatocellular carcinoma.
One hundred and fifty-one consecutive new patients with suspected hepatocellular carcinoma (HCC) were investigated from 1989 to 1990. Ultrasound showed the tumours to be inoperable in 111 patients. Selective hepatic angiography revealed 17 more patients with inoperable HCC. Hepatic intra-arterial lipiodol (HIAL) was injected in the remaining 23 patients. In 16 of them, a clinical decision could be reached basing on the radiological findings. Hepatic intra-arterial lipiodol ultrasound (HIAL/USG) guided biopsy was done in seven patients with suspicious lesions. Histology obtained with this method revealed hyperplastic cirrhotic nodules in four patients (two with suspected HCC and two with suspected secondaries). In another two patients, the suspected lesions were confirmed to be malignant. In the last patient who had received chemotherapy for extensive HCC, HIAL/USG guided biopsy revealed necrotic tissue only. At laparotomy, diffuse infiltrative abnormality was found and repeated biopsy confirmed residual malignancy in the necrotic tumour. We conclude that when there is radiological uncertainty as to the nature and extent of the HCC, HIAL/USG guided biopsy can help the clinician to make important decisions.
Adult↗
Ultrasound in the diagnosis of gall-bladder carcinoma in Chinese patients.
A review of the ultrasound (US) findings with clinical and pathological correlation in 18 Chinese patients with gall-bladder carcinoma (GBCa) showed that the most frequent appearance was that of diffuse infiltration and thickening of the GB wall (8/18 patients, 44%). Polypoid protrusion into the GB lumen (5/18 patients, 28%) and massive replacement of the entire GB (5/18 patients, 28%) accounted for the remainder. The infiltrating type of tumour was poorly-detected by US (1/8) and was more frequently seen than has been reported in the Western population. Frequent associations with GB calculi (13/18) and synchronous presentation of biliary sepsis (6/18) also contributed to a modest overall US detection rate of 50% (9/18) in this series. Most tumours detected by US were hyperechoic in appearance (6/9). Biliary obstruction was detected by US in 5/6 patients, but only thought to be malignant in 3/6. It most often occurred due to spread of tumour to peripancreatic lymph nodes. Hepatic metastases were seen by US in 4/5 patients. Discontinuous GB wall calcification and non-dependent stones due to elevation by tumour (the 'elevated stone' sign) were infrequent but reliable signs of GBCa, seen in 5/18 and 3/18 respectively. This study suggests that GBCa is as difficult to detect sonographically in Chinese patients as in the Western population. GBCa must be included in the differential diagnosis of causes of both the acutely-presenting 'hot' gall-bladder and lymph node masses in the peripancreatic region if the US detection rate of this important biliary malignancy is to be improved.
Aged↗