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R J Steckel

Publications and source records attributed to R J Steckel.

At least 37 records · Page 2Linked to original sources

Current use of imaging in the evaluation of primary mediastinal masses.

A wide variety of lesions occur in the mediastinum in patients of every age. Twenty five to 50 percent of these primary mediastinal masses may be malignant, making early diagnosis and therapy crucial. Since most arise from normal structures in the region, localization of lesions to compartments of the mediastinum may assist in diagnosis. This article reviews imaging techniques for lesions originating in the mediastinum.

Arteriovenous Malformations↗

An integrated approach to the evaluation of metastatic bone disease.

The radionuclide bone scan is the most effective whole body screening test for bone metastases. Conventional radiography, although relatively insensitive to the presence of bone metastases, is the best modality for characterizing them once they are detected in radionuclide scans. When the radionuclide bone scan and appropriate correlative radiographs are analyzed and reported together, false-positive scan findings are reduced, and scan specificity is increased. Valuable information on response to treatment may be obtained by correlating the changes seen in radiographs and radionuclide bone scans. CT or MR imaging may be useful for evaluating suspicious radionuclide bone scan findings that cannot be explained radiographically, and may influence the decision regarding the need for biopsy. CT can also be used to monitor needle-biopsy procedures. The use of CT or MR imaging is helpful in determining the local extent of metastatic disease when planning palliative surgery or radiotherapy. Although a positive diagnosis by needle biopsy is considered definitive, a negative result must be suspect and may eventually necessitate open surgical biopsy. An algorithmic approach to the workup of a possible skeletal metastasis is illustrated in Figure 12.

Bone Neoplasms↗

Mediastinal germ cell tumor in a young woman.

Primary mediastinal germ cell malignancies are uncommon neoplasms, usually presenting in young men. We review a case of a primary mediastinal seminoma occurring in a 23-year-old woman. The differential diagnosis, work-up and therapy for these lesions is discussed with emphasis on the role of magnetic resonance imaging in the evaluation of anterior mediastinal masses.

Adult↗

Evaluation of intrathoracic extent of lung cancer by plain chest radiography, computed tomography, and magnetic resonance imaging.

A comparison was made of the ability of plain chest radiography, computed tomography (CT), and magnetic resonance imaging (MRI) to detect and assess the intrathoracic extent of lung cancer in 46 patients. The chest radiographs (CXR) were obtained with a high kilovoltage phototimed technique. The CT scans were obtained with a GE 9800 machine and the MRI studies with a 0.3 Tesla permanent magnet imaging system. The primary tumor was well demonstrated by all 3 imaging techniques; however, the configuration of lesions was best demonstrated by CT. MRI was superior to CXR and CT for demonstrating hilar involvement in 4 cases. CT and MRI were generally comparable for demonstrating mediastinal involvement but were superior to CXR. In 2 cases, small normal size nodes seen on CT were considered to be a single large abnormal node on MRI. Because of the paucity of signal from flowing blood, compression and displacement of vessels were easier to identify with MRI. In 1 case, a small pleural effusion was better seen with CT than with CXR or with MRI. Direct chest wall involvement in 1 case was not seen by CXR. Vertebral body abnormality in another case was seen only by MRI and not by CXR or CT. At present, MRI, with its long scanning time, motion degradation of the image, and poor spatial resolution, is inferior to CT for imaging lung cancer. For evaluation of intrathoracic extent of lung cancer, CT remains the procedure of choice after performing plain chest radiography.

Adult↗

Retroperitoneal sarcomas: the role of diagnostic imaging and multimodal management.

Retroperitoneal sarcomas are a varied group of malignancies which have a high rate of recurrence following surgery alone. The majority of the initial recurrences are local in nature, and new therapeutic approaches are clearly needed. Diagnostic imaging and "interventional radiology" have important roles to play in the management of these malignancies, as well as in investigational approaches to therapy. Two cases are presented which illustrate some recent advances in diagnosis and staging of this group of tumors which can be attributed to new cross-sectional imaging techniques, when used in concert with "conventional" imaging methods. The latter include arteriography to guide the placement of intra-arterial catheters for local infusion chemotherapy. CT-guided needle biopsies can be performed to secure a preoperative diagnosis and also to obtain viable tissue for in vitro chemosensitivity assays. A judicious combination of local and systemic chemotherapy, radiation, and surgery may hold promise for better control of this malignancy, similar to the therapeutic advances which have already been obtained with limb sarcomas.

Adult↗

Liver mass in a four-year old child: current considerations for diagnosis and treatment.

A case is presented of an embryonal sarcoma of the liver in a young child. The differential diagnosis of liver masses in children is reviewed, as well as the implications of diagnostic imaging studies for diagnosis, prognosis, staging, and the choice of treatment. The use of diagnostic imaging for guiding interventional diagnostic procedures and certain palliative approaches is also discussed.

Antineoplastic Combined Chemotherapy Protocols↗

The NCI's Cancer Centers Program: past, present, and future.

Since passage of the National Cancer Act in 1971, the NCI Centers Program has promoted the establishment and the development of cancer centers of many types throughout the nation. These now include 20 comprehensive cancer centers, as well as a number of clinical and basic science centers that are supported through NCI core grants. Scientific productivity at NCI-supported centers has been high. While cancer center core grants usually represent only a small proportion of the total extramural research support for a given institution, they are essential in providing shared resources and in pulling together the various component research programs of a center into a unified program. The future directions of the NCI centers program as a whole, as well as the role of cancer research centers within their communities and regions, are discussed.

Cancer Care Facilities↗