[Tomodensitometry in oculo-orbital pathology. Principles, technics, basis of interpretation, dosimetry].
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Biomedical subjects
Publications and source records attributed to F Guibert-Tranier.
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The performance of the c.a.t. scanner in the diagnosis and supervision of malignant hemispheric astrocytomas in adults is analysed on the basis of four series (Kendall, Steinhoff, Castandet, Caillé). The sensibility of the examination varies between 95% and 65% depending on the series and the level of diagnosis sought. The specificity is in the range of 80%. Certain limits of the c.a.t. scanner examination are pointed out, preoperatively (grade, volume, tumor contents); postoperatively (radionecrosis, relapse).
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In a series of 25 cases of primary malignant tumours of the nasopharynx the authors the advantages of CT which provides.--positive diagnoses,--assistance in the performance of biopsy in cases with primary malignant cervical adenopathies,--the possibility of personalising radiotherapy protocols,--valuable technique for long-term supervision.
100 cases of orbital syndromes, primary or secondary, are reviewed after CT analysis and compared with the results of plain and angiographic conventional examinations. First, the technique and normal results are described. Primary orbital syndromes (45 cases) originating in the orbit form three subgroups--tumors of the eyeball, tumors limited to the orbit and tumors of the orbit with bone lesions, with or without extra-orbital extension. Secondary orbital syndromes (55 cases) spreading to the orbit contain malignant tumors (36 cases) of which 25 are epitheliomas and benign tumors, the most frequent being meningiomas. For ocular and orbital tumors, CT allows the diagnosis of a mass and sometimes the pathological diagnosis (endocrine exophtalmos, inflammatory pseudotumors, varicose ophthalmic veins). For all other orbital tumors CT is important in determining the volume, relationships and extension, and does so better than carotid angiography or orbital phlebography. In secondary orbital syndromes, and particularly in facial malignant tumors and in meningiomas, CT is of great interest in the pretherapeutic evaluation of a tumor. It shows its volume and extension toward the face and orbital cavities, the pterygo-maxillary fossa (so important in determining the operability), the infra-temporal fossa and the endocranium, often without resorting to complementary investigational procedures which are much more aggressive. After histological diagnosis, CT allows the establishment of a therapeutic program.
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After analysis of the results of 142 CT brains scans performed from 1976 to 1982 on children with acute lymphoblastic leukemia, we can propose indications for this exam in relation with the different clinical stages and evolution of the disease. An exam is carried out as soon as possible at the start of the disease without injection of contrast media for use as a reference point. Excepting complications or neurological localisations, a scan will be performed at the end of the third year of treatment, without injection of contrast media, in screening for possible iatrogenic lesions. Neurological complications of unknown origin and leucoblastic meningitis seems to require a scan with injection of contrast media firstly as a mean of diagnosis, and secondly, in case of a cerebro meningeal localisation, in order to judge the efficiency of treatment and to screen for early complications. Computerized tomography however has its limits, particularly in case of purely meningeal leucoblastic infiltration.
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