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Biomedical subjects

D M Balfe

Publications and source records attributed to D M Balfe.

At least 73 records · Page 4Linked to original sources
PubMed1990

Ileal J pouch: radiologic evaluation in patients with and without postoperative infectious complications.

The authors studied the ileograms and computed tomographic (CT) examinations of 18 patients who had undergone surgical construction of an ileal J pouch and ileoanal anastomosis; 10 had developed postoperative infectious complications and eight had not. The initial ileograms obtained 4 weeks postoperatively proved to be unhelpful in predicting future infectious complications, showing abnormalities in only two of 10 patients. Ileography and CT performed at the time of the complications showed abnormalities in eight of nine and nine of 10 patients, respectively. Ileographic abnormalities in patients with abscesses included extravasation of contrast material, extraluminal gas collections, thickening of ileal pouch folds, and extrinsic mass effect on the pouch. CT findings included thickening of the pouch and/or rectal walls, streaky areas of soft-tissue attenuation within the ileal pouch mesentery and perirectal fat, and areas of soft-tissue attenuation or fluid attenuation in the peripouch region. CT was more valuable in depicting the site and extent of abscess formation before surgical or percutaneous drainage.

Adenomatous Polyposis Coli↗
PubMed1989

Detection of focal hepatic masses: prospective evaluation with CT, delayed CT, CT during arterial portography, and MR imaging.

The sensitivities of contrast medium-enhanced computed tomography (CT), delayed CT (DCT), CT during arterial portography (CTAP), and magnetic resonance (MR) imaging for detecting focal liver lesions were prospectively evaluated in eight patients who subsequently underwent hepatic lobectomy or transplantation. Pathologic evaluation of the resected liver specimens demonstrated 37 lesions. The sensitivities were 81% (30 of 37 lesions) for CTAP, 57% (21 of 37 lesions) for MR imaging, 52% (12 of 23 lesions) for DCT, and 38% (14 of 37 lesions) for contrast-enhanced CT. The difference between the sensitivity of CTAP and the sensitivities of the other imaging tests was statistically significant (P less than .004). Of the lesions smaller than 1 cm in diameter, CTAP depicted 61% (11 of 18 lesions), MR imaging 17% (three of 18 lesions), CT 0% (zero of 18 lesions), and DCT 0% (zero of nine lesions). It is concluded that for preoperative detection of focal hepatic masses, CTAP is the most accurate technique available to most radiologists. Patients with primary or secondary hepatic neoplasms who are being considered for hepatic resection should undergo CTAP as part of their preoperative examination.

Adult↗
PubMed1989

Biliary carcinoma: CT evaluation of extrahepatic spread.

The authors studied the computed tomographic (CT) images obtained in 56 patients with pathologically proved biliary cancer and 75 patients with no evidence of biliary disease, attempting to define the normal anatomy of the lymphatic system draining the bile ducts and the prevalence of extrahepatic spread of primary biliary cancer into these retroperitoneal planes. Of 20 patients with gallbladder cancer, 14 (70%) had proved adenopathy and nine (45%) had peritoneal spread at presentation, and another three later developed carcinomatosis. Of 22 patients with proximal cholangiocarcinoma, 16 (73%) had nodal involvement at presentation, four later developed adenopathy, and five had peritoneal dissemination. Distal or diffuse cholangiocarcinomas were less associated with metastatic nodes or peritoneal spread. For all biliary cancers, the nodes most commonly involved were the node of the foramen of Winslow, the superior pancreatoduodenal node, and the posterior pancreatoduodenal chain. Extrahepatic tumor spread produced proximal intestinal obstruction in 13 patients (23%). CT reliably demonstrates lymphatic or other extrahepatic spread of biliary cancers, which may have an important bearing on management decisions.

Adenoma, Bile Duct↗
PubMed1989

Large colonic neoplasms missed by endoscopy.

Endoscopy is commonly accepted as the gold standard in the evaluation of neoplastic colonic disease. The procedure is used to confirm or exclude lesions detected on barium enemas, with the assumption that the endoscopist was successful in reaching the appropriate segment of the colon. We collected 18 cases, all with proved colonic neoplasm 2-8 cm in diameter that were detected by barium enema but overlooked on initial endoscopy. All of the lesions were relatively flat with little intraluminal protuberance. Histologic examination showed malignant foci in six of 11 tumors that were resected. In two of the other seven patients, unresected lesions progressed to advanced carcinomas. This experience suggests that a repeat barium enema is indicated when endoscopy fails to detect a colonic tumor suspected on barium enema examination.

Barium Sulfate↗
PubMed1989

Blunt renal and ureteral trauma in childhood: CT patterns of fluid collections.

The CT scans of 25 children with blunt renal and ureteral trauma were analyzed to determine the severity of injury, the appearance of retroperitoneal fluid collections, and whether the extent of these collections correlated with the severity of injury. CT showed renal parenchymal injuries in 23 patients and ureteral injuries in two patients. Retroperitoneal fluid was detected in 19 (76%) of 25 patients. Perirenal fluid collections were present in all 19, periureteral fluid in 12, interfascial fluid in eight, anterior pararenal fluid in four, and psoas hemorrhage in three. The presence of perirenal and periureteral fluid was not a good predictor of the extent of renal injury. Fluid collections in the interfascial or anterior pararenal spaces and psoas muscle appeared to correlate with the severity of injury. Patients with these fluid patterns usually had renal fractures, arterial injuries, or ureteral disruptions. The presence of perirenal and periureteral fluid did not correlate with the extent of renal injury, while the presence of interfascial, anterior pararenal, and psoas muscle fluid correlated somewhat with renal fractures and renal pedicle disruption.

Child↗
PubMed1988

Small bowel disease in children: diagnosis with CT.

The computed tomographic (CT) scans of 22 children with small bowel disease and those of 110 children with no small bowel disease were analyzed by two observers who were blinded with respect to clinical history and final diagnoses in order to determine which CT findings reliably indicated neoplastic, inflammatory, or noninflammatory processes. Bowel-wall thickening was the most reliable sign of disease. Five of six patients (83%) with bowel-wall thickness greater than 1 cm had neoplastic disease. Nine of ten patients (90%) with bowel-wall thickness between 3 mm and 1 cm had inflammatory disease, while four of six patients (66%) with wall thickness less than 1 cm and increased attenuation of mesenteric fat or an increase in the number of mesenteric vessels had noninflammatory edema. The presence of mesenteric masses was not a helpful sign for differentiating various disease processes. The results of this retrospective study suggest that the identification and classification of small bowel disease in children is possible from the objective analysis of CT findings.

Child↗
PubMed1987

Neck evaluation with barium-enhanced radiographs and CT scans after supraglottic subtotal laryngectomy.

Supraglottic subtotal laryngectomy (SSL) is a radical, yet voice-conserving, surgical procedure commonly performed for carcinoma of the supraglottic larynx. The pharyngograms and computed tomographic (CT) scans of 35 patients obtained after SSL were evaluated retrospectively. These examinations reliably demonstrated the changes in anatomy caused by removal of the epiglottis, aryepiglottic folds, and false vocal cords. Fourteen patients had documented recurrence of cancer; five mucosal, nine extramucosal. Three of five macroscopic mucosal recurrences in the larynx/pharynx were detected on the barium pharyngograms; the two mucosal lesions not seen were in the base of the tongue and tonsillar fossa. CT enabled detection of five of five recurrences and was superior to pharyngography in demonstrating the soft-tissue extent of disease. CT findings mimicking recurrence were seen in two patients: one with diffuse histiocytic lymphoma; the second, with benign hyperkeratosis. Barium and CT examinations are useful adjuncts to the clinical examination in detecting recurrent squamous cell carcinoma in patients following SSL.

Adult↗
PubMed1987

Suprapancreatic biliary obstruction: CT evaluation.

In a 5-year period, 92 patients with biliary obstruction proximal to the pancreatic segment were evaluated with computed tomography (CT). Seventy-three were judged to have technically optimal studies. Observations of the level of obstruction were compared with data from 50 percutaneous transhepatic cholangiograms; CT data enabled the level of obstruction to be correctly predicted in 46. CT enabled correct prediction of the distribution of obstructing lesions in all 18 patients with intrahepatic obstruction. Forty-four of the 73 patients had pathologic examination of the porta hepatitis. CT findings of obstructing mass and lesser omental nodes resulted in correct prediction of malignancy in 25 (92%) of 27 patients; the absence of such findings enabled correct prediction of benign disease in 13 (77%) of 17 individuals. CT is most valuable as a noninvasive means of planning surgical or radiologic drainage procedures in patients with biliary obstruction.

Bile Duct Diseases↗
PubMed1987

Diagnosis and staging of renal cell carcinoma: a comparison of MR imaging and CT.

MR studies were performed in 36 patients with proven renal cell carcinoma. In 27 patients in whom a radical nephrectomy was performed, MR studies were reviewed and compared with CT and pathologic findings. Renal cell carcinomas had a varied MR signal with the most common appearance being a mass with an intensity intermediate between the renal cortex and the medulla on T1-weighted images and hyperintense on T2-weighted images. MR was similar to CT in staging renal cell carcinomas (74% for MR vs 67% for CT). Neither CT nor MR was reliable in differentiating stage I from stage II lesions. MR clearly showed venous invasion without the use of IV contrast medium and was superior to CT in differentiating lymphadenopathy from small vascular structures. Because of the limited availability, longer imaging time, and more stringent patient requirements (patients with pacemakers, intracranial aneurysm clips, life-supporting systems, and severe claustrophobia need to be excluded), the authors recommend MR only for patients with known contraindications to iodinated contrast medium, patients with prior suboptimal bolus-contrast CT studies, or patients in whom the CT findings are equivocal.

Adult↗
PubMed1987

Small-bowel disease: categorization by CT examination.

Fifty patients with no small-bowel disease were evaluated by CT to determine the normal appearance of the small bowel and mesentery. Subsequently, the CT findings in 95 patients with proven small-bowel disease were analyzed to determine which CT observations correlated with neoplastic, inflammatory, or edema-producing processes. Thirty-three (83%) of 40 patients with wall thickening or mesenteric masses greater than 1.5 cm had a neoplastic process. Twenty-eight (82%) of 34 patients with normal mesenteric fat attenuation, wall thickening less than 1.5 cm, or mesenteric masses less than 1.5 cm had inflammatory disease. Fourteen (67%) of 21 patients with no mesenteric mass, increased mesenteric fat attenuation, and wall thickening less than 1.5 cm had noninflammatory edema. Overall, CT assigned 75 (79%) of 95 patients into appropriate categories; use of ancillary CT findings led to correct categorization in 83 (87%). CT is helpful in correctly assigning a disease category to patients with small-bowel wall thickening.

Diagnosis, Differential↗
PubMed1986

Prostatic carcinoma and benign prostatic hyperplasia: inability of MR imaging to distinguish between the two diseases.

Forty patients with prostatic carcinoma or benign prostatic hyperplasia (BPH) underwent magnetic resonance (MR) imaging of the prostate. In vitro MR images of six prostate specimens were also obtained. The prostatic parenchyma was best evaluated by a T2-weighted spin-echo pulse sequence. The prostate both in patients with prostatic carcinoma and patients with BPH often had an inhomogeneous and nodular appearance on T2-weighted images. While most of the prostatic carcinomas appeared hyperintense relative to muscle and adjacent prostatic parenchyma, some of the hyperplastic nodules had a signal intensity similar to carcinoma. With current imaging techniques, MR imaging cannot differentiate prostatic carcinoma from BPH with certainty.

Adult↗
PubMed1986

Uterine neoplasms: MR imaging.

Magnetic resonance (MR) studies were performed on 20 healthy volunteers and 41 patients with proved cervical and uterine neoplasms. MR imaging demonstrated normal uterine landmarks in all patients. On T2-weighted images, the normal uterine wall could be differentiated into three distinct layers: a central high-intensity zone, a junctional low-intensity band, and a peripheral medium-intensity area. While most of the normal cervices had only two distinct zones (central high-intensity zone and peripheral low-intensity zone), a small percentage had three layers of signal intensity, similar to the uterine body. Primary cervical and uterine neoplasms could be identified on MR images. In 18 of 22 patients with proved carcinoma, a mass with a signal intensity higher than that of normal cervical lips was seen on T2-weighted images. Endometrial carcinoma was most often identified as expansion of the central high-intensity area; discrete tumor nodules were visible in nine of 15 patients. Mixed müllerian sarcoma appeared as a large pelvic mass with complete obliteration of normal uterine landmarks. MR imaging delineates primary cervical and endometrial carcinoma better than computed tomography does.

Adenocarcinoma↗
PubMed1986

Neck neoplasms: MR imaging. Part I. Initial evaluation.

Untreated neoplasms of the neck (tumors of the oropharynx, supraglottic area, carotid body, and thyroid, in addition to malignant lymphadenopathy) were evaluated in 23 patients with magnetic resonance (MR) imaging. The results were compared with computed tomographic (CT) scans in 20 patients. Contrast between tumor and fat was best on relatively T1-weighted images (500/30-35 [TR msec/TE msec]), whereas separation of tumor and muscle was best with relatively T2-weighted pulse sequences (1,500/90). Balanced images (1,500/30-35) provided best overall image quality and best demonstrated vascular anatomy. MR imaging was usually superior to CT in showing the relationship of tumor mass to muscle. MR imaging and contrast material-enhanced CT were equivalent in most patients in defining vascular anatomy, but MR imaging was superior when intravenous contrast material was not administered. However, CT was more helpful in showing bone and cartilage anatomy, and in some patients CT also was better in showing airway abnormalities. Despite these limitations, MR imaging is a promising imaging technique for studying neoplasms of the neck.

Adult↗
PubMed1986

Neck neoplasms: MR imaging. Part II. Posttreatment evaluation.

Thirty-three patients who had undergone prior surgery and/or radiation therapy for malignant neoplasms of the neck were studied with magnetic resonance (MR) imaging. Twenty-seven of these patients were also evaluated with computed tomography (CT). Ten patients were healthy posttreatment volunteers, and 23 had documented tumor recurrence. MR images better demonstrated normal muscular landmarks, especially in patients with obliterated fat planes. Areas of posttreatment fibrosis or scarring were low in signal intensity with all MR pulse sequences. However, in three patients, high signal intensity from postradiation edema of the supraglottic area mimicked neoplasm. In patients with recurrent tumor, MR imaging was superior to CT in defining the relationship of tumor and muscle and in demonstrating vascular anatomy when no intravenous contrast material was given during the CT examination. In two patients tumor and fibrosis were separated on MR images because of signal intensity differences. CT scans, however, showed adjacent bone and cartilage anatomy better. Our data indicate that an MR examination may be helpful in patients in whom CT is indeterminate either because of anatomical distortion or suboptimal demonstration of vascular anatomy.

Head and Neck Neoplasms↗
PubMed1985

Ulcerative and granulomatous colitis in children. Comparison of double- and single-contrast studies.

The authors reviewed 49 double-contrast and 27 single-contrast barium-enema examinations (BE) in 71 children with suspected inflammatory bowel disease. The diagnosis was proved in 41 patients, of whom 36 underwent proctoscopy and 5 had advanced disease which was treated surgically within 3 to 30 days after BE; the other 30 children served as controls. BE and proctoscopy were compared with regard to sensitivity (detection of disease) and accuracy (categorization as ulcerative or granulomatous colitis). Sensitivity was 93% for double-contrast and 82% for single-contrast BE. Both detected all cases of advanced disease; in early disease, double-contrast BE detected 91% of cases and single-contrast BE 70%. Colitis was correctly categorized as ulcerative or granulomatous in 93% with double-contrast BE and 86% with single-contrast BE. Specificity within the control group was 100% with both techniques. The authors conclude that both types of BE exhibit similar sensitivity in advanced disease, but the double-contrast technique is more accurate in detecting early disease.

Adolescent↗
PubMed1985

Radiation fibrosis: differentiation from recurrent tumor by MR imaging.

Magnetic resonance (MR) images of 21 patients who had undergone radiation therapy were analyzed and compared with those of 15 patients who had untreated tumors. T2-weighted images (TR = 1,500 msec, TE = 90 msec) were most helpful in distinguishing recurrent tumor from radiation fibrosis. Radiation fibrosis, like muscle, usually remained low in signal intensity on T2-weighted images, while tumor demonstrated higher signal intensity. In no patient was the signal intensity of tumor the same or less than muscle on the T2-weighted images. However, relatively high signal intensity on T2-weighted images is not specific for tumor recurrence and may be seen in acute radiation pneumonitis, infection, hemorrhage, and even pulmonary radiation fibrosis.

Adult↗