Intracerebral metastatic melanoma: CT evaluation.
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Biomedical subjects
Publications and source records attributed to K R Davis.
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Computed tomography of a case of hemorrhage from a dural arteriovenous malformation depicts an occipital varix with dilated venous channels, an intracerebral hematoma, a subdural hematoma and a subfacial hernation. The angiographic and surgical findings are described.
Use of the CT scanner as an instrument for foreign body detection and localization was explored under experimental conditions. The results show that a sufficiently dense radiopaque foreign body as small as 0.7mm3 can be detected and localized by presently available scanners.
Review of computed tomographic (CT) scans of 49 consecutive patients with surgically excised acoustic neuromas revealed positive scans in 80% following contrast enhancement, with 20% false negative scans. All tumors over 2 cm in diameter were shown by optimal scans with contrast enhancement. The positive scans were evaluated to determine the accuracy of the size of the lesions as predicted by the scan. A radiological approach to the evaluation of suspected acoustic neuromas is suggested.
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An analysis has been made of the clinical manifestations in 18 cases of hypertensive thalamic hemorrhage diagnosed by computed tomography (CT). CT scans permitted accurate determination of the site, size, and extension of the hemorrhages. A sensorimotor hemiplegia or hemiparesis was present in all cases. Diagnostic clinical features included limitation of vertical gaze, downward deviation of the eyes, and small unreactive or sluggish pupils. All hemorrhages larger than 3.3 cm in diameter were fatal.
Enhancement of CT attenuation values of the CSF cisterns by the lumbar injection of metrizamide has been shown to be of value in demonstrating the anatomy of the cisterns. Tumors involving the cisterns, such as acoustic neurinomas and pituitary adenomas, are clearly defined. Coronal scanning was superior to horizontal views in many cases.
CT scanning has proven efficacy for the demonstration of normal and altered anatomy of the soft tissues of the head, providing information not available with any other modality. The introduction of total body CT has enabled us to study the entire spine and its contents. This new modality is extremely useful in diagnosing a variety of abnormalities of the spine, including diastematomyelia. A case is presented and the application of CT scanning to the spine is discussed.
Although a probable initial diagnosis may be suggested by computed cranial tomography, the diagnostic accuracy is often increased by the complementary use of other neuroradiologic studies. The use of CT scanning is conjunction with other more invasive neuroradiological studies results in improved diagnosis and patient management in almost the entire spectrum of neurosurgical diseases-- subarachnoid hemorrhage due to aneurysm, stroke, trauma, normal pressure hydrocephalus, and especially neoplasms.
The diagnostic contribution of contrast enhancement by intravenous injection of meglumine diatrizoate was assessed in 121 patients who received both plain and contrast enhanced cranial CT scans. The use of contrast enhancement was found to provide both an increased sensitivity in detection of lesions and some improvement in pathological differentiation of lesions. The use of contrast enhancement in addition to plain CT scans increases the reliability of CT scans in excluding such conditions as neoplasms, abscesses, and vascular malformations. Because the use of contrast medium is associated with morbidity (and significantly extends the length of the total study), the decision to employ contrast enhancement must be based upon a careful evaluation of the clinical, other radiological, and plain CT findings in the individual patient.
Infusion of intravenous contrast medium with computed cranial tomography must be utilized judiciously. It is indicated to improve the detectability of lesions and to assist in differntial diagnosis.
Two cases of extradural epidermoid cyst and one case of xanthoma are reported in order to describe the computed tomographic and other radiographic findings. Contrast enhancement of the margin was seen in all of the cases. Absorption values almost as low as those found with cerebrospinal fluid were present in the central region of the lesions.
In cases with radiation necrosis of the brain, conventional neuroradiological examinations usually demonstrate only an avascular mass lesion impossible to differentiate from intracerebral tumor or hemorrhage. Computed tomography, performed in addition to angiography in three cases, consistently demonstrated the radiation necrosis as a low density area exhibiting enhancement following infusion of contrast medium. The importance of recognizing radiation necrosis as a differential diagnosis to brain neoplasm is emphasized.
Swollen orbital extraocular muscles may mimic an orbital apex tumor on computed tomography. In five of our patients, in spite of highly suggestive findings on CT scanning, indicating the presence of an orbital apex lesion, the correct diagnosis proved to be endocrine exophthalmos. The value of complementary CT projections and of orbital ultrasonography to assist in the differential diagnosis is discussed, and the additional contribution of orbital phlebography for the confirmation of lesions in the orbital apex is emphasized.
Primary intracranial intradural extraventricular epidermoid tumor may be suggested by the findings on computed tomography (CT), which is also useful during the follow-up period. Epidermoid tumors may exhibit minimal symptoms and have usually spread far beyond their original site by the time they are found. Early detection, delineation, and characterization are possible with CT.
Computed tomography (CT) scans of 9 surgically proved cases of cerebral abscess were reviewed. The CT characteristics were studied, as were the postoperative scans. Also assessed were the contributions to the diagnosis of the clinical features, plain radiographic examinations, radionuclide imaging, and angiography. The accuracy and information content of CT scans of cerebral abscesses should lead to a significant reduction in morbidity and mortality.
Computer assisted axial tomography and the venous phase of carotid angiography provide complementary assessments of the ventricular and paraventricular structures. The computer assisted tomography more readily defines the ventricular system, but can prove weak in differentiating paraventricular gliomas, solitary metastasis and infarcts. Angiography plays a major role in differentiating between these three conditions, but is poor in accurately localizing and identifying intra- and paraventricular hemorrhage which is characteristically and expeditiously uncovered by C.T. scanning.
Some of the limitations of CT in the diagnosis of neurologic disease are reported. Problem areas include small lesions; lesions obscured by adjoining structures; small vascular structures and detail of large vessels; cases in which the diagnosis is made but information is incomplete for treatment; cases of incorrect diagnosis; non-nenoplastic lesions mistaken for neoplasms; some subdural hematomas; occasional false negative findings; and misinterpretation due to technical errors. Knowledge and use of the clinical presentation, the performance of other complementary diagnostic procedures, repeat CT scans tailored to the region of interest, and repeat serial scans may assist in reaching the proper diagnosis and diminishing potential error.