Biomedical subjects
Publications and source records attributed to M Korobkin.
Chest computed tomography (CT) scans were performed in 50 pediatric patients. The techniques and inherent problems are presented. CT provides detailed anatomic information about the chest wall, mediastinum, and lungs. Pediatric chest CT is particularly valuable in the evaluation of extrapleural masses, parenchymal metastatic disease, and posterior mediastinal tumors.
A calcified thrombus in the inferior vena cava of infants and children may be imaged by computed tomography. The precise location of the calcification within the inferior vena cava may be confirmed by computed tomographic scanning during injection of intravenous contrast material.
Sixty-one consecutive patients suspected of having pancreatic neoplasms had endoscopic retrograde cholangiopancreatography (ERCP) and computed tomography (CT). The ERCP results were 62% accurate, 8% false negative, and 3% failure. The overall accuracy in cases of successful pancreatic duct cannulation was 88%. The results of CT were 76% correct, 5% false positive, 13% false negative, and 6% indeterminate. Excluding ERCP failure, the CT-ERCP diagnosis was identical in 67%. When findings were identical, the accuracy rate was 93%, high than that of either study alone. The ERCP-CT examinations were often complementary and generally led to a more accurate and specific diagnosis.
To determine the accuracy of scintigraphy in distinguishing true renal masses from normal variants, 40 patients with excretory urographic findings indicating a possible, but not definite, mass lesion were studied. Scintigraphy correctly identified 17 true masses and 17 normal variants. Four false positive and two false negative results were obtained.
Renal failure from urographic contrast media is a serious potential hazard of excretory urography and is usually recognized by the clinician 24--48 hr after the procedure. The association of an abnormally increasing nephrogram with development of oliguric renal failure in children was described in 1969, but in 112 subsequent reported cases of contrast-induced renal failure, a persistent nephrographic pattern was described only once. With special attention to the abnormally persistent nephrogram, we were able to detect nine cases of contrast-induced renal failure after excretory urography. Two of these cases are discussed in detail and pertinent data on the other seven are presented.
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Pelvic lipomatosis is a rare, benign disease in which the characteristic roentgenographic findings may mimic those of pelvic malignancy. In the past more than two-thirds of reported cases have been explored surgically for diagnosis. We present 2 cases to demonstrate how the definitive diagnosis of pelvic lipomatosis can be made with the aid of computed tomography to avoid invasive techniques.
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The relation of liver fat content to CT number was studied in 20 rabbits (17 experimental, 3 control), where fatty degeneration was produced by carbon tetrachloride (CCl4) ingestion. Liver scanning was performed before and 2--5 days after CCl4 administration.. Changes (decrease) in CT number were compared with triglyceride (TG), water, and protein content of resected livers. A decrease of 12--20 CT numbers (24--40 H) reflected a TG concentration of 20--40 mg/g.
Hepatic CT scans in 61 consecutive patients with proved liver metastasis performed both before and after administration of contrast medium were subjected to blind analysis by two observers. In 10 patients (16%) hepatic lesions were better defined before CE and focal hepatic lesions were diagnostically visible only before CE in 8 patients (13%). Lesions were better defined following CE in 16 patients (26%) but in only 2 cases (3%) were lesions diagnostically visible only after CE. The majority of lesions [35 (58%)] were equally well visualized before and after CE.
A series of 63 patients with suspected adrenal disease was evaluated by computed tomography (CT). In 15 additional patients CT diagnosed unsuspected adrenal disease. The CT results were correlated with surgical, postmortem, or compelling clinical data. In those patients with adequate visualization of both adrenals, CT correctly identified all adrenal masses subsequently proven at surgery or postmortem examination. CT accurately predicted the presence or absence of a unilateral adrenal neoplasm in patients with Cushing's syndrome and primary aldosteronism. Unsuspected primary or metastatic neoplasms of the adrenals were occasionally detected in patients scanned for other reasons. CT is a safe and accurate method of evaluating patients with suspected adrenal disease.
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Forty patients with suspected abdominal abscess had computed tomography (CT) and plain film examinations; 15 also had ultrasound study. CT was found to be the most consistently accurate examination, both for the detection of abscess and evaluation of its extent. Ultrasound was positive in a high percentage of cases in which it was used. Although plain films correctly suggested the presence of an abscess in over half the proven cases, confirmatory evidence from CT or ultrasound was often required to persuade clinicians of the presence of an abscess and to provide detailed information regarding its extent and configuration.
Thoracoabdominal computed tomography (CT) scanning was performed prior to treatment on 30 patients with proven carcinoma of the esophagus. Operative, bronchoscopic, and/or autopsy data were reviewed and showed that CT correctly identified the extent of medistinal spread in 27 patients and intraabdominal metastases in 22 patients. The ability of CT to reliably predict the extent of disease should help the surgeon and radiation oncologist plan optimal therapy.
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A retrospective review of 12 surgically proved cases of pancreatic pseudocyst was performed. CT correctly demonstrated 6/8 uncomplicated pseudocysts and 4/4 infected pseudocysts. Ultrasound identified 7/8 uncomplicated and 2/4 infected pseudocysts. Errors by one modality are due to limitations not shared by the other method. This suggests a basis for the complementary use of CT scanning and ultrasound in the evaluation of suspected pancreatic pseudocysts.
The diaphragmatic crura have a variable appearance on CT body scans. They can at times appear quite prominent and be easily confused with other anatomical or pathological structures. Analysis of the CT scans of 100 patients revealed certain characteristic features of the diagphragmatic crura that help distinguish them from other structures, especially enlarged para-aortic lymph nodes.
The effect of Gastrografin and glucagon on pancreatic CT scanning was studied in a blind clinical trial. Twenty-five patients had a pancreatic CT scan performed on an 18-second scanner and a repeat pancreatic CT scan following administration of Gastrografin and glucagon. The results were statistically significant: decreased streak artifacts; improved pancreatic head, body and tail delineation; and improved overall pancreatic visualization. Gastrografin-glucagon administration is recommended prior to pancreatic CT scanning if the scanning cycle is 18 seconds or longer.