Biomedical subjects
J R Haaga
Publications and source records attributed to J R Haaga.
Computed tomographic guided liver biopsy using the Menghini needle.
CT guided biopsies of the liver using the Menghini needle were performed in 42 patients. The recovery of diagnostic tissue was successful in 86% of focal lesions. Advantages over the blind liver technique include better recovery of diagnostic specimens, while advantages over the ultrasonic guided techniques include greater amount of tissue obtained and better occuracy in guidance. This technique is indicated in those patients with a small number of focal defects in the liver in whom a diagnostic histologic specimen is desired.
Percutaneous CT-guided pancreatography and pseudocystography.
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New techniques for CT-guided biopsies.
Two new recently instituted techniques have eliminated the shortcomings associated with computed tomography-guided biopsy procedures. By using the bolus biopsy technique, it has been possible to assess the vascular anatomy and vascularity of abnormalities so that cutting-type needles can be used on a routine basis. In a series of 47 cases, this method was used to select cases for cutting biopsies. In 29 cases in which the cutting biopsy was performed, tissue was successfully recovered in 25 cases. Advantages of large specimens obtained by such large needles are discussed. Secondly, the fourth generation scanning devices permit scanning at low radiation doses that provide slightly noisier but suitable images to perform the biopsy procedures. This eliminates the possibility of objectionably high radiation dose if more than one scan is required.
Clinical comparison of computed tomography and lymphangiography for detection of retroperitoneal lymphadenopathy.
The advantages of CT scan over lymphangiography are numerous and significant. The accuracy of CT scan was virtually identical to lymphogram for the detection of para-aortic lymph node involvement; however, CT provides a better means of assessing the true extent of disease. In such cases it is possible to determine whether the neoplastic process involves retroperitoneal structures such as the kidneys, ureters, pancreatic region, hilum of the liver, or the major vessels. Moreover, this excellent definition permits accurate follow-up assessment of therapy. Finally, CT is a noninvasive examination and does not require significant technical expertise, and the examination is easily reproducible following any time period from the initial examination. Finally, although we have not specifically discussed biopsy procedures, the CT scan is an excellent means for guiding biopsy procedures even for retroperitoneal abnormalities, perhaps precluding the necessity for laparotomy in order to provide histologic diagnosis of disease (Fig. 11). The disadvantages of CT are several. Of course, the acquisition of CT equipment is expensive and the cost effectiveness has not yet been proven. The most significant disadvantage is its inability to resolve or detect neoplastic disease within normal-sized lymph nodes. This was not a significant problem in our series, because our series contained only a few cases of suspected metastatic disease as opposed to lymph node neoplasms. The advantages of lymphography have been discussed by other authors. Because of the better spatial resolution of lymphograms, it is possible by proper interpretation to distinguish between neoplastic disease and lipogranulomatous changes. In a few cases in our series, this did not prove to be true; however, this may have been due to deficiencies in our interpretations (two cases of lymphoma were called positive for neoplasm, but proved to be lipogranulomatous changes by biopsy). Secondly, surveillance films may be easily and cheaply obtained to detect recurrences of disease. In addition, lymphography also provides the opportunity for biopsy of lymphoma masses, but to date this has only been accomplished by skinny-needle biopsy aspirations and not by large core biopsy techniques. After reviewing the literature and evaluating our data, we believe that several recommendations are appropriate with respect to the roles of computed tomography and lymphography. We agree with the previously stated concept that CT should be used for screening for lymphoma; however, we disagree that lymphograms have a greater advantage over CT in the biopsy-proven cases of lymphoma. Rather we believe that CT is better suited than lymphography for those cases with biopsy proven lymphoma. CT is better able to accurately localize the lymph node masses for surgeons if the surgical approach is desired and better able to define the extent of the disease throughout the abdomen. As a result of this it is capable of providing a better follow-up for therapy...
New interventional techniques in the diagnosis and management of inflammatory disease within the abdomen.
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Foreign body localization and removal utilizing computerized axial tomography.
In this preliminary report, computerized tomography guidance was instrumental in allowing the safe and rapid removal of a metallic foreign body from paravesical soft tissues deep within the male pelvis. Hopefully, expanded future experience with this technique will further clarify its value in the management of retained foreign bodies.
Computed tomography-guided biopsy. I. Overview.
The authors are preparing a series of communications on CT-guided biopsy procedures to be published in future issues of this journal. The present article, which previously appeared in the Cleveland Clinic Quarterly, is intended to serve as an introduction to the concept of CT-guided biopsies. Because the principles of the biopsy procedure remain the same, we do not believe that a "rewrite" of the previously published article would be required. We hope that by presenting this article and subsequent articles concerning the use of CT-guided biopsies, the reader will acquire an appreciation of the proper role of this exciting new technique in comparison to the available imaging modalities. We believe that as individuals become more experienced with the imaging capabilities of these CT devices, they will want to develop the technique of obtaining biopsy confirmation of the imaging diagnosis.
Computerized axial tomography of an abdominal lymphoma.
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Optimal diagnostic management of suspected pancreatic carcinoma.
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Computed tomography of the gallbladder.
Computed tomography (CT) was used to study 79 patients with suspected gallbladder disease. First and second generation scanners were used to determine the efficacy of CT in detecting cholecystitis or cholelithiasis. Manifestations of gallbladder disease such as hydrops, opaque and nonopaque gallstones, chronic cholecystitis with thickened inflammatory walls, and secondary liver abscesses can be easily detected. It is a useful technique for individuals in whom the gallbladder has failed to opacity on oral cholecystography. The scanning method is described, and estimates of reliability are given including its accuracy, limitations, and place in the management of gallbladder disease, especially cholelithiasis. When conventional radiographic examinations or ultrasound fail to give definitive diagnostic information, CT can be a useful alternative with an overall diagnostic accuracy greater than 80%.
CT detection of infected synthetic grafts: preliminary report of a new sign.
The diagnosis of infected synthetic grafts is difficult using traditional radiographic techniques. In four cases, computed tomography demonstrated small pockets of gas in the clot around the grafts, a distinctive finding for an infected prosthesis. Further experience is required to determine whether this will prove to be a reliable diagnostic sign. The gas collections in infected grafts differ from normal gas in their multiplicity and occurrence more than 10 days after surgery.
Computed tomography: an aid to the abdominal surgeon.
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Body computed tomography: a clinically important and efficacious radiologic procedure.
In the institutions represented by the authors, more than 7,500 body CT examinations have been performed. Body CT has been found to be particularly useful in solving specific problems, especially when other diagnostic procedures yield confusiing results. Radiologists and their collegues, and not governmental agencies and insurance companies, should define the experimental, research and clinical usefulness of computed tomography.
Definitive role of CT scanning of the pancreas. The second year's experience.
In a group of 188 patients, 192 computed tomographic (CT) scans of the pancreas were done, and the diagnostic accuracy of CT determined relative to other modalities. CT was the most effective method of detecting neoplastic and inflammatory diseases. The full extent of the disease process, including involvement of the retroperitoneum and metastasis to the liver, was visualized with one examination. Calcification and cystic collections associated with pancreatitis were also clearly seen.
CT detection and aspiration of abdominal abscesses.
Computed tomography (CT) is effective in detecting intraabdominal abscesses. Loculations of fluid and extraluminal gas are clearly localized in relation to other organs. Of 22 abscess in this series, CT successfully detected 20; comparative information with gallium, techneticum, and ultrasound scans is presented. In addition to localizing these collections, CT can be used to guide needle aspiration and drainage procedures. Three sizes of needles were used to aspirate specimens and/or provide drainage. This was accomplished successfully in 12 of 14 CT-guided procedures.
CT-guided antegrade pyelography and percutaneous nephrostomy.
Percutaneous antegrade pyelography and percutaneous nephrostomy can be easily performed using CT guidance. CT provides cross-sectional images which facilitate accurate needle placement into the renal pelvis. CT is capable of detecting subtle density differences within the tissues so that even renal pelvises which do not contain contrast material and are not dilated can be accurately punctured. In addition to these procedures, CT accurately displays the perinephric space so that assessment of complications is possible. Four of five attempted percutaneous nephrostomies and two antegrade pyelograms were successfully performed using CT gudance.
Computed tomography and obstructive biliary disease.
Forty-four patients with confirmed biliary diseases were studied to determine the value of computed tomography (CT) in the diagnosis of biliary pathology. The results indicate that CT is useful and highly accurate in differentiating between obstructive (surgical) and nonobstructive (medical) disease entities. Of the cases with proved obstruction, 88% were correctly identified. All of the nonobstructive cases had positive CT correlation. In addition, the underlying cause of the occlusion was determined in the majority of cases.