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Biomedical subjects

J G Murray

Publications and source records attributed to J G Murray.

At least 37 records · Page 2Linked to original sources
PubMed1997

Evaluation of adrenal masses in patients with bronchogenic carcinoma using 18F-fluorodeoxyglucose positron emission tomography.

OBJECTIVE: The purpose of this study was to assess the usefulness of positron emission tomography (PET) with 18F-fluorodeoxyglucose (FDG) when differentiating benign from metastatic adrenal masses in patients with bronchogenic carcinoma. SUBJECTS AND METHODS: For our prospective study, any patient presenting to our institution with pathologically proven bronchogenic carcinoma and an adrenal mass was eligible. Thirty-three adrenal masses (mean size, 3 cm; range, 1-9 cm) in 27 patients were revealed by CT. PET was performed in all 27 patients and interpreted as positive when FDG uptake in the adrenal mass was greater than background activity or negative when FDG uptake in the adrenal mass was equal to or less than background activity. In addition, semiquantitative analysis was performed by computing a standardized uptake ratio. All studies were reviewed independently by three radiologists and then correlated with biopsy and CT findings. Specificity and sensitivity for determining metastatic disease to the adrenal gland were calculated. RESULTS: FDG uptake was positive (abnormally increased) in 25 adrenal masses. Twenty-three (92%) of the 25 masses were metastatic disease. The mean standardized uptake ratio of these was 6.28 (range, 3.22-14.41). The remaining two masses (8%) that had positive FDG uptake showed no tumor at percutaneous biopsy. The standardized uptake ratio values for these two masses were 3.0 and 3.7. FDG uptake was negative (normal) in eight adrenal masses. All these lesions were benign as proven by biopsy (n = 2) and CT attenuation values of less than 10 H (n = 6). The mean standardized uptake ratio value for these eight lesions classified as benign was 1.77 (range, 0.93-3.70). The sensitivity for detecting metastatic disease was 100%, and the specificity was 80%. CONCLUSION: PET with FDG is an accurate, noninvasive way to differentiate benign from metastatic adrenal masses in patients with bronchogenic carcinoma.

Adrenal Gland Diseases↗
PubMed1997

Radiologic issues in lung transplantation for end-stage pulmonary disease.

Lung transplantation has evolved into an effective therapy for end-stage pulmonary disease. The radiologist has an important role in the management of these patients before and after transplantation. Unfortunately, the radiologic findings of the major complications (i.e., reperfusion edema, infection, rejection) that occur after transplantation overlap and are often nonspecific. Clinical correlation, bronchoalveolar lavage, and transbronchial biopsy are usually required for accurate differentiation. The following rules of thumb may be helpful: Radiographic opacities seen during the first week are usually due to reperfusion edema: persistent or progressive opacities beyond the first week suggest infection or acute rejection: infection in the first month is usually bacterial, and opportunistic pneumonia is more common thereafter, nodular opacities are usually due to infection or posttransplantation lymphoproliferative disorders but can also be due to transbronchial lung biopsy; and progressive bronchial dilatation and air trapping seen on expiratory CT are useful signs of BOS.

Humans↗
PubMed1997

CT appearance of the pleural space after talc pleurodesis.

OBJECTIVE: This study describes the CT appearance of the pleural space after talc pleurodesis. CONCLUSION: After talc pleurodesis, the pleural space reveals variable degrees of pleural thickening and nodularity, often with a residual loculated effusion. High-attenuation areas representing talc deposits are expected and should not be confused with other pleural abnormalities.

Adult↗
PubMed1996

Intraocular silicone oil for retinal detachment in AIDS: CT and MR appearances.

AIM: To describe the CT and MR features of intraocular silicone oil which is used to treat complex retinal detachments in patients with acquired immune deficiency syndrome (AIDS). PATIENTS AND METHODS: Seven male patients with AIDS were treated by pars plana vitrectomy and intraocular silicone oil injection for complex retinal detachments due to biopsy proven cytomegalovirus retinitis. Two patients had bilateral therapy. RESULTS: Silicone oil was hyperdense to muscle on CT with attenuation values of 106-139 HU (mean 115, SD 4.5). On MR, when compared with normal vitreous, intraocular silicone oil appeared hyperintense on T1-, proton density, and T2-weighted spin-echo sequences. A chemical shift artifact was seen on all MR images, being most marked on the T2-weighted images. CONCLUSION: The high attenuation value of silicone oil on CT and its hyperintensity on T1 weighted MR images my cause diagnostic confusion with haemorrhage. These entities can be distinguished at CT by directly measuring the attenuation number (silicone oil > 100 HU; blood < 90 HU), and at MR by the presence of a chemical shift artifact.

Acquired Immunodeficiency Syndrome↗
PubMed1996

Juvenile chronic arthritis of the hip: value of contrast-enhanced MR imaging.

OBJECTIVE: The purpose of this study was to assess the value of contrast-enhancement in MR diagnosis of hip joint disease in patients with juvenile chronic arthritis. PATIENTS AND METHODS: Fourteen hips in seven children (four girls, three boys; mean age, 11 years; range, 7-17 years) with juvenile chronic arthritis for a mean duration of seven years (range, 3-15 years) were imaged on a 0.5T MR unit. One patient had an MR scan repeated after an 8-month interval. Axial and coronal T1-weighted spin-echo, and axial gradient-echo sequences were performed. T1 weighted axial sequences were repeated immediately after 0.1 mmol/kg of intravenous gadopentetate dimeglumine. Patients were assessed clinically for pain in the hip, range of motion at the hip joint, haemoglobin and erythrocyte sedimentation rate. Two radiologists, unaware of the patients symptoms, jointly assessed the unenhanced and contrast-enhanced scans for synovial hypertrophy (pannus), cartilage destruction and joint effusion. RESULTS: Pannus was underestimated on 75% of unenhanced MR scans (95% binomial confidence intervals 54% to 93%). Enhancing pannus was seen in 14 of the 16 hip MR scans. Enhancing pannus was associated with articular cartilage destruction in all cases, and joint pain in 13 of 14 scans. Joint effusions were overestimated on unenhanced scans in all cases. Pannus could only reliably be distinguished from joint effusion after contrast enhancement. Both cases of loculated joint effusion were only seen after contrast enhancement. CONCLUSION: Contrast-enhancement is recommended to aid MR detection of disease activity and extent in children with juvenile chronic arthritis of the hip.

Adolescent↗
PubMed1996

Imaging of acute head injury.

This article reviews the neuroradiological evaluation of acute head injury with an emphasis on CT and MR imaging. Subacute and chronic head injury are not discussed. CT remains the modality of choice in the emergency setting, permitting rapid, comprehensive assessment of the great majority of head injuries. MR is most useful in patients in whom there is a discrepancy between clinical symptoms and CT findings. In addition, MR is the imaging modality of choice in the subacute and chronic setting. The superior contrast resolution of MR permits optimal evaluation of nonhemorrhagic (and hemorrhagic) white matter shearing injuries, and the lack of beam-hardening artifact permits a more thorough evaluation of the brain stem, posterior fossa, and cortical surface.

Acute Disease↗
PubMed1996

Acute rupture of the diaphragm due to blunt trauma: diagnostic sensitivity and specificity of CT.

OBJECTIVE: The purpose of this study was to determine the diagnostic sensitivity and specificity of CT in detecting acute rupture of the diaphragm after blunt trauma. MATERIALS AND METHODS: Abdominal CT scans taken before surgery of 11 patients with diaphragmatic rupture (eight left and three right) and 21 patients with intact diaphragms after major acute blunt abdominal trauma were independently reviewed by three observers who were unaware of surgical findings. Retrospective note was made of diaphragmatic discontinuity, intrathoracic herniation of abdominal contents, waistlike constriction of bowel ("collar sign"), and associated findings. Right and left hemidiaphragms were graded as intact or ruptured, and these findings were correlated with surgical findings. Individual and average observer sensitivity and specificity in detecting acute diaphragmatic rupture were calculated. RESULTS: Of the 11 cases of diaphragmatic rupture, diaphragmatic discontinuity was seen in eight, visceral herniation was seen in six, and the "collar sign" was seen in four cases. Hemoperitoneum of hemothorax completely obscured visualization of the ruptured diaphragm in three cases. Individual diagnostic sensitivity for detecting diaphragmatic rupture was 54-73% and specificity was 86-90%. Average sensitivity for the three observers was 61% (95% confidence interval, 41-81%), and average specificity was 87% (95% confidence interval, 76-99%). CONCLUSION: CT is highly specific in diagnosing acute diaphragmatic rupture and detects approximately two thirds of acute diaphragmatic ruptures after blunt trauma.

Abdominal Injuries↗
PubMed1996

Complications of lung transplantation: radiologic findings.

The first clinically successful lung transplantation was performed in 1983. Since that time, more than 2700 transplants have been recorded by the International Lung Transplant Registry [1]. Lung transplantation is currently limited to patients with endstage lung disease and a life expectancy of less than 18 months [1]. Unilateral lung transplantation is the most commonly performed procedure. Bilateral transplantation generally is reserved for patients with pulmonary sepsis. One-year survival after transplantation is currently 80-90%, and 5-year survival is estimated at 50% [1]. Early detection and treatment of the complications of lung transplantation are critical to decrease patient morbidity and mortality [2-4]. This article reviews the radiologic findings of the most common complications of lung transplantation, using our experience with 85 patients.

Adult↗
PubMed1995

Digital subtraction in Gd-DTPA enhanced imaging of the breast.

PURPOSE: This study examines the role of digital subtraction magnetic resonance imaging (MRI) of the breast in the interpretation of the morphology and characteristics of breast disease. METHODS: Thirty-one patients with an abnormal mammogram or clinically palpable abnormality underwent MRI of the breast prior to surgical excision of the lesion. FLASH 3-D images of the breast were acquired before and after IV contrast injection of Gd-DTPA. Digital subtraction was performed on selected images. The images were independently assessed by two radiologists experienced in both mammography and MRI. RESULTS: Accurate diagnosis was possible in 29 out of 31 patients using the subtraction technique compared to 23 cases using the pre-subtraction images alone. The actual extent of disease and multicentricity were also better appreciated on the subtracted image. Subtraction also provided better identification of tumour recurrence in the post-operative and post-radiotherapy breast. Chest wall and lymph node involvement were more easily appreciated on the subtraction images. CONCLUSION: Digital subtraction is a simple, effective and relatively cheap technique which can aid in the interpretation of magnetic resonance imaging of the breast.

Adult↗
PubMed1995

Mediastinal lymph node enlargement and splenomegaly in primary hypogammaglobulinaemia.

The computed tomography (CT) scans of 37 patients with primary hypogammaglobulinaemia were reviewed to determine the frequency of enlarged mediastinal lymph nodes and splenomegaly in this group. None of the 10 X-linked Agammaglobulinaemia (XLA) patients had enlarged nodes and only one had splenomegaly. Eleven of the 27 Common Variable Immunodeficiency (CVID) group had enlarged nodes (41%) and 13 had splenomegaly (48%). There was no significant correlation between the presence of enlarged nodes and splenic enlargement. Twenty-two patients had bronchiectasis but the presence of bronchiectasis did not correlate with the presence of either splenomegaly or lymphadenopathy. Three to 6 years follow-up is available for 36 of the 37 patients and none of this group have developed lymphoma or other malignancy. Enlarged mediastinal nodes and/or splenomegaly are frequently found in patients with CVID and are usually due to a benign, non-neoplastic, process. Mediastinal lymph node enlargement is not a feature of XLA and splenomegaly is unusual in this condition.

Adolescent↗
PubMed1995

Long-segment (> or = 10 cm) femoropopliteal angioplasty: improved technical success and long-term patency.

PURPOSE: To assess angioplasty as a treatment for symptomatic long-segment (> or = 10 cm) femoropopliteal atherosclerotic disease. MATERIALS AND METHODS: Angioplasty performed on 44 lesions that measured 10-40 cm (mean, 24.3 cm) were assessed for technical success and 12-24-month patency. Disease severity was assessed with the Doppler ankle-brachial index (ABI) and clinical evaluation before angioplasty and at follow-up examinations 1 month and 12-24 months (mean, 18 months) later. Technical success was defined as a restoration of vessel lumen (< 30% residual stenosis) and a rise in ABI values of at least 0.2. Arterial patency (< 50% residual stenosis) was determined with color duplex sonography. RESULTS: Angioplasty was technically successful at 41 of 44 sites (93%). There was no mortality related to the procedure or emergency surgical referral. At 18-month follow-up, mean ABI values had risen from 0.53 to 0.80. Cumulative primary patency was 69%. Clinical symptoms had improved in 83% of patients. CONCLUSION: Angioplasty is useful in the treatment of long-segment femoropopliteal atherosclerotic disease.

Aged↗
PubMed1995

Microabscesses of the liver and spleen in AIDS: detection with 5-MHz sonography.

PURPOSE: To determine whether sonograms of the liver and spleen, obtained with 5-MHz linear-array transducers, aid in detection of hepatosplenic microabscesses in patients with acquired immunodeficiency syndrome (AIDS). MATERIALS AND METHODS: Abdominal sonographic examinations (n = 111) were performed in 102 consecutive patients with AIDS. A 3.5-MHz sector transducer was used in each study, with additional images of the hepatic and splenic parenchyma obtained with a 5-MHz linear-array transducer. Each study was reviewed without benefit of the 5-MHz images, and categories of the hepatic and splenic parenchyma were as follows: 1, lesions definitely present; 2, lesions possibly present; and 3, lesions absent. The 5-MHz images were subsequently reviewed, and studies were recategorized. Findings were correlated with results of pathologic examination. RESULTS: The 5-MHz scans enabled identification of focal hepatic or splenic lesions in 14 of 96 studies placed in category 2 or 3 on the basis of the 3.5-MHz sector scans. CONCLUSION: In patients with AIDS, 5-MHz sonograms of the liver and spleen enable detection of microabscesses not confidently identified on 3.5-MHz scans.

AIDS-Related Opportunistic Infections↗
PubMed1995

Mediastinal lymph node size in an Asian population.

There is a high incidence of respiratory tuberculosis in the British population of Indian subcontinent (Asian) ethnic origin. Granulomatous diseases can cause long term lymph node enlargement. Separate computed tomography (CT) criteria for normal nodal size could therefore be necessary when staging thoracic malignancy in Asian patients. The objective of this study was to measure mediastinal lymph node size in an Asian population, and to correlate nodal size with previous tuberculosis. Chest CT scans on all Asian patients over a 5 year period were reviewed and those with pulmonary disease, malignancy or grossly distorted anatomy were excluded. The study group consisted of 48 patients (26 male, 22 female) aged 10-75 years (mean 47 years). All nodes were measured and the site of those greater than 7 mm was recorded using the American Thoracic Society (ATS) lymph node map. 81.3% of patients had nodes less than or equal to 7 mm at all ATS stations, 10.4% had nodes of 8-10 mm and 8.3% had nodes greater than 10 mm. All nodes measuring more than 7 mm were in regions 4R, 10R and 7. Fourteen patients had signs of previous tuberculosis, and in this group 50% had nodes greater than 7 mm as compared with 6% in the group with no signs of previous tuberculosis (p < 0.001, X2 test). Despite these differences only four of the 48 patients (8.3%) had nodes greater than 10 mm, which is in keeping with other general population studies. Thus the generally accepted size criteria for mediastinal lymph node enlargement (greater than 10 mm) can reasonably be applied to all Asian patients when staging lymphoma or bronchogenic carcinoma.

Adolescent↗
PubMed1995

Widening of the tracheal bifurcation on chest radiographs: value as a sign of left atrial enlargement.

OBJECTIVE: This study evaluated widening of the tracheal bifurcation (subcarinal and interbronchial) angle on posteroanterior chest radiographs as a sign of left atrial enlargement. The purpose was to determine the diagnostic sensitivity and specificity of the sign. MATERIALS AND METHODS: The chest radiographs and echocardiograms of 122 clinically stable patients were retrospectively reviewed. The mean interval between examinations was 10 days (range, 0-30 days). The left atrial dimension was measured on the two-dimensional echocardiograms. Sixty-five patients had a normal left atrial dimension (mean, 34 mm), and 45 patients had an enlarged atrium (mean, 47 mm) on echocardiography. Subcarinal and interbronchial angles were jointly measured by two observers who were unaware of the echocardiographic findings. Correlation analysis was used to determine which angle measurement best predicted the left atrial size. Discriminant analysis was used to derive a threshold angle that predicted left atrial enlargement. RESULTS: The carina was inadequately seen on 14 radiographs. Left atrial size correlated poorly with both the interbronchial (r = .33) and the subcarinal (r = .25) angel values. An interbronchial angle of 76.4 degrees and a subcarinal angle of 65.4 degrees were the best discriminators between patients with normal and those with enlarged left atrial dimensions (sensitivities, 61% and 51%, respectively; specificities, 63% and 66%). CONCLUSION: Our findings show that widening of the tracheal bifurcation angle on chest radiographs is an insensitive and nonspecific sign of left atrial enlargement. This sign is of little value in diagnosing left atrial enlargement.

Adult↗
PubMed1995

Cytomegalovirus colitis in AIDS: CT features.

OBJECTIVE: The purpose of this study was to determine the CT features of cytomegalovirus colitis in patients with AIDS. MATERIALS AND METHODS: Abdominal CT scans of 24 patients with biopsy-proved cytomegalovirus colitis (colonoscopy, n = 14; sigmoidoscopy, n = 8; surgery, n = 2) were jointly reviewed by two observers. Patients were men 26-68 years old (mean age, 39 years; SD, 9 years) with CD4 counts of 3-129 mm3 (mean, 32 mm3; SD, 34 mm3). The mean interval between CT and biopsy was 6 days (range, 0-20 days; SD, 6 days). Scans were assessed for colonic wall thickening (> or = 4 mm), ulceration, mural edema, pericolonic stranding, ascites, lymphadenopathy, and thickening of the small-bowel wall. Mural involvement was recorded as asymmetric or circumferential. Disease location was recorded as ascending colon, transverse colon, descending colon, rectosigmoid colon, or pancolonic. RESULTS: Colonic wall thickening of 8 to 33 mm (mean, 15 mm; SD, 6 mm) was seen in 22 patients. One patient had pancolonic involvement. The ascending colon was involved in 13, the transverse colon in five, the descending colon in 10, and the rectosigmoid colon in 16. Circumferential colonic thickening was seen in 17 patients. Deep mural ulceration was seen in 15 patients, mural edema in 15, pericolonic stranding in 23, ascites in 10, lymphadenopathy in four, and small-bowel involvement in 10. Two patients had appendicitis. Three patients had perforations (two rectal, one cecal). One patient had a giant rectal ulcer. CONCLUSION: Although many of the CT features of cytomegalovirus colitis are nonspecific, the diagnosis should be suggested when CT shows colonic wall thickening, particularly if the thickening is associated with mural ulceration in patients with AIDS and CD4 counts of less than 200 mm3.

AIDS-Related Opportunistic Infections↗