Biomedical subjects
Publications and source records attributed to M Korobkin.
Large and medium-sized blood vessels can be identified on extracranial computed tomographic (CT) scans when a combination of infusion and bolus injection of conventional contrast material is administered. The cases illustrated in this report show that CT angiography can sometimes offer clinically useful information not present on CT scans obtained without contrast injection.
A retrospective study was made of 29 consecutive patients who were evaluated for suspected abdominal abscess by at least two of three imaging modalities: gallium-67 scanning, ultrasonography, and computed tomography. No statistically significant difference in accuracy of the findings could be demonstrated. Consideration of the advantages and disadvantages of each imaging modality will often indicate which to use in an individual case. Findings from the three imaging techniques sometimes provided complementary rather than identical information.
Computed tomography (CT) was performed in 3 patients and 2 dogs with subcapsular hematoma of the spleen. When fresh blood is in the subcapsular space, the hematoma may have the same attentuation value as the adjacent spleen, making it difficult to identify unless contrast material is injected. As the hematoma ages, the attenuation value decreases. CT appears to be a simple and accurate method of diagnosing a subcapsular splenic hematoma.
The use of computed tomography (CT) in diagnosing disorders affecting the hollow viscera of the alimentary tract has received little attention. The authors reviewed CT scans of 43 patients on which lesions affecting the gastrointestinal tract were demonstrated. All cases were correlated with barium-enema examinations, surgical reports, or autopsy findings. CT can provide valuable information on the extraluminal extent of masses arising in the bowel, mesenteric masses, and can define and characterize extrinsic lesions. The authors's results suggest that CT is a useful adjunct in evaluating intramural or mesenteric lesions of the gastrointestinal tract.
The capability of ultrasonography and computed tomographic body scanning to demonstrate the status of the biliary tract was studied prospectively in 23 jaundiced patients. Ultrasonography correctly indicated the presence or absence of obstruction in 21 of the 23 patients and CT scanning in 20. Both procedures correctly demonstrated no evidence of ductal dilatation in the five patients who had nonobstructive jaundice. Retrospective study of the same material increased the accuracy of CT scanning (22 of 23 patients) because of recognition of common bile duct dilatation in the absence of intrahepatic duct dilatation. The accuracy of ultrasonography was unchanged.
CT body scans of 60 random patients without evidence of adrenal disease were reviewed to determine the location, size, and shape of both normal adrenal glands. Both glands were clearly delineated in 78% of the patients evaluated. The length, width, and thickness of adrenal glands as measured by computed tomography were similar to comparable measurements from surgical and autopsy studies.
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Computed tomographic (CT) body scans from a series of 45 infants and children were reviewed for the indications leading to the examinations, for technical quality of the images, and for diagnostic value of CT scanning. Useful diagnostic information was obtained in 30 of the 39 cases with technically satisfactory images. Individual case reports of CT examinations including findings from other imaging studies demonstrate how CT can interface with other methods to yield additional diagnostic information. Methods of patient preparation and suggested indications for CT body scan examinations of children are presented.
The utility of computed tomography (CT) in evaluation of musculoskeletal disorders was assessed in 55 selected patients. CT provided unique information leading to a correct diagnosis in 45% of cases. In 78% the extent of a lesion was more clearly defined than on conventional imaging procedures, and in the same percentage the CT findings were used to plan optimal therapy. CT was most useful in demonstrating absence of a suspected mass lesion and in defining the full extent of a lesion involving the soft tissues.
Six patients with obstructive jaundice had computed tomography (CT) scans showing a dilated extrahepatic biliary tree in the absence of intrahepatic ductal dilatation. Dilated extrahepatic bile ducts were most easily identified by means of intravenous injection of urographic contrast material, which permitted them to be seen as low density structures. Findings in these patients emphasize that (1) demonstration of dilated intrahepatic bile ducts is not a prerequisite for the CT diagnosis of obstructive jaundice and (2) careful CT evaluation of the extrahepatic biliary tree is necessary to identify patients with isolated dilatation of the common hepatic or common bile duct.
Four cases of tumor thrombosis of the inferior vena cava and renal veins were diagnosed by computed tomography. In two, the thrombus itself was demonstrated within the vascular lumen after intravenous injection of urographic contrast material. The diagnosis was made in the other two patients by identification of massive enlargement of the vascular diameter.
Eleven patients with unilateral ureteral calculus had excretory urography which showed the radiopacity of excreted contrast material to be diminished on the side of the calculus. This finding was of diagnostic importance in nine patients who demonstrated little or no dilatation of the urinary tract proximal to the calculus. Other forms of unilateral renal disease, such as acute pyelonephritis, can produce the same urographic finding.
Fifteen patients with a suspected abdominal abscess were examined by both gallium-67 and computed tomographic scanning. The Ga-67 scan was a useful screening examination, correctly identifying all eight cases of infection, whereas the CT scan missed one case of a pericecal phlegmon. Misdiagnosis of infection by Ga-67 scan occurred in 2/8 cases without infection but the CT scan correctly identified all noninfected patients. While this series is too small to decide whether there is significant difference in the ability of the two procedures to suggest the correct diagnosis, it is felt that Ga-67 and subsequent CT scans may be complementary in that a Ga-67 scan can initially locate the abnormality and thus direct the CT scan, which can confirm the diagnosis or avoid a misinterpretation of the Ga-67 scan. Computed tomography also provides more anatomical detail, better location of the lesion, and demonsrates lesions noninfectious in nature.
The value of computed tomography in the diagnosis and management of lesions of the musculoskeletal system is being determined. Illustrative cases including a lipoma of the thigh, osteochondroma of the hip, simple cyst of the ilium, recurrent liposarcoma of the lumbar spine, desmoid tumor in the gluteal region, and postoperative interspace infection of the lumbar spine are presented to indicate the potential value of this procedure in the diagnosis and planning of treatment of musculoskeletal lesions.
The presence of an intrarenal collateral circulation in pediatric patients with segmental renal artery stenosis has not been stressed. Three patients demonstrating these collateral pathways are presented. The anatomy, pathogenesis, angiographic features, differential diagnosis, and significance of intrarenal collaterals in infants and children are discussed.
Computed tomography (CT) is a useful modality in assessing fatty masses in the mediastinum. A case is presented in which a large mediastinal mass was shown by CT scan to be periesophageal, composed entirely of fat; surgery demonstrated omental herniation without visceral herniation.
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.
Abdominal computed tomography (CT) scans of 151 patients were reviewed for the presence of discrete structures between the vertebra and the diaphragmatic crura. A distinct retrocrural structure larger than 6 mm in diameter was present in 39 patients. In 112 patients the retrocrural space contained discrete structures smaller than 6 mm or showed no definable structures. Of the 39 patients with retrocrural structures larger than 6 mm in diameter, 37 had clinical and other CT evidence as well as biopsy or lymphangiographic evidence of middle to upper abdominal paraaortic adenopathy. Only three of the 112 patients exhibiting retrocrural structures smaller than 6 mm had such evidence of associated retroperitoneal adenopathy. These three were found to have enlarged nodes, but in the lower rather than the middle or upper abdomen. It is concluded that discrete retrocrural structures larger than 6 mm represent enlarged lymph nodes. Smaller retrocrural structures represent azygous veins or normal lymphatic structures.