PURPOSE: To determine the optimal imaging modality for diagnosis and staging of ovarian cancer. MATERIALS AND METHODS: Two hundred eighty women suspected to have ovarian cancer were enrolled in a prospective study before surgery. Doppler ultrasonography (US), computed tomography (CT), and magnetic resonance (MR) imaging were used to evaluate the mass; conventional US, CT, and MR imaging were used to stage spread. RESULTS: All three modalities had high accuracy (0.91) for the overall diagnosis of malignancy. In the ovaries, the accuracy of MR imaging (0.91) was higher than that of CT and significantly higher than that of Doppler US (0.78). In the extraovarian pelvis and in the abdomen, conventional US, CT, and MR imaging had similar accuracies (0.87-0.95). In differentiation of disease confined to the pelvis from abdominal spread, the specificity of conventional US (96%) was higher than that of CT and significantly higher than that of MR imaging (88%), whereas the sensitivities of MR imaging (98%) and CT (92%) were significantly higher than that of conventional US (75%). CONCLUSION: MR imaging is superior to Doppler US and CT in diagnosis of malignant ovarian masses. There is little variation among conventional US, CT, and MR imaging as regards staging.

Adult↗

PubMed1998

Turf battles in radiology: how individual radiologists can respond to the challenge.

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Diagnostic Imaging↗

PubMed1998

CT appearance of primary papillary serous carcinoma of the peritoneum.

OBJECTIVE: Our objective was to describe the CT characteristics of primary papillary serous carcinoma of the peritoneum. CONCLUSION: The presence of peritoneal masses, extensive omental calcification, and the absence of an ovarian mass on CT--particularly in postmenopausal women--is highly suggestive of primary papillary serous carcinoma of the peritoneum and should alert the radiologist to the possibility of this diagnosis.

Contrast Media↗

PubMed1997

The role of color Doppler and staging biopsies in prostate cancer detection.

OBJECTIVES: To review the current published data on the role of color Doppler sonography and sonographically-guided staging biopsies in the detection and staging of prostate cancer. This article also discusses the role of color Doppler sonography in defining the ideal patients for neoadjuvant chemotherapy. METHODS: Peer-reviewed reports in the radiologic, urologic, and medical literature were reviewed. Data from our own institution served as illustrative material. RESULTS: Color Doppler sonography using state of the art ultrasound equipment produced from the mid 1990s onward can define areas of hypervascularity in the prostate. When located in the peripheral zone and associated with definable lesions, these areas likely represent carcinoma. More importantly, when isoechoic areas contain hypervascular foci with chaotic flow, cancer is also likely. In 93% of sites that contain normal vascularity, prostate cancer was not detected by biopsy. Staging biopsies are not frequently performed in current clinical practice. A positive seminal vesicle biopsy is associated with capsular penetration in 100% and positive lymph nodes in 50% of patients with prostate cancer. CONCLUSIONS: Color Doppler sonography and staging biopsies may have a more significant role as newer alternative therapies for prostate cancer become popular. These two techniques show promise for increasing the accuracy of pretreatment staging over current algorithms, which are less than adequate.

Biopsy↗

PubMed1996

Effect of mandatory radiology consultation on inpatient imaging use. A randomized controlled trial.

OBJECTIVE: To determine if a mandatory radiology consultation service can decrease radiology resource use on inpatient internal medicine services. DESIGN AND SETTING: Randomized controlled trial on 4 internal medicine services at a university hospital. PATIENTS AND OTHER PARTICIPANTS: Six radiologists performed the intervention on 2 internal medicine services over a 12-month period. A total of 1022 patients were admitted to the 2 intervention services and 1178 patients were admitted to the 2 control services. Each was staffed by an attending internist and 3 house officers. INTERVENTION: Each radiology examination required approval by the attending radiologist before it was performed. MAIN OUTCOME MEASURE: Relative resource costs (relative value units [RVUs]), number of examinations per patient, proportion of patients with 1 or more tests, and mean length of stay (LOS). RESULTS: Mean RVUs for the intervention group were 356.1, and for the control group, 336.0 (P=.5). Mean examinations per patient for both groups was 4.4. Mean LOS for the intervention group was 6.0 days, and for the control group, 6.1 days (P=.8). CONCLUSIONS: An inpatient radiology consultation service, with a goal to reduce resource use, did not achieve its goal. A more appropriate use of time and expense for radiology utilization management may be in the outpatient setting.

Female↗

PubMed1996

Genitourinary radiology.

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Adrenal Glands↗

PubMed1996

Tumorous intrahepatic lymphoproliferative disorder in transplanted livers.

OBJECTIVE: We describe the radiologic findings of lymphoproliferative disorder manifesting as an intrahepatic mass in hepatic transplant recipients. Three patients with focal intrahepatic masses due to lymphoproliferative disorder after transplantation were retrospectively identified. Clinical features and radiologic findings in these patients were reviewed in conjunction with pertinent cases from the literature. (Reports of lymphoproliferative disorder confined to the transplanted liver have been sporadic.) CONCLUSION: Factors supporting the diagnosis of tumorous intrahepatic lymphoproliferative disorder include presentation 4-12 months after transplantation; portal or periportal location; poorly defined extrahepatic periportal soft tissue; encasement or narrowing of the biliary ducts, hepatic artery, or portal vein; and serologic evidence of exposure to Epstein-Barr virus.

Aged↗

PubMed1996

Scrotal ultrasound.

Scrotal ultrasound is now the first and only imaging examination necessary to evaluate the scrotal contents. This article first discusses normal scrotal anatomy, and then examines the imaging findings of various malignant and benign scrotal masses. Other topics include cryptorchidism, extratesticular abnormalities, and acute scrotum.

Adolescent↗

PubMed1995

Automated localization of the prostate at the time of treatment using implanted radiopaque markers: technical feasibility.

PURPOSE: Prostate movement is a major consideration in the formation of target volumes for conformal radiation therapy of prostate cancer. The goal of this study was to determine the technical feasibility of using implanted radiopaque markers and digital imaging to localize the prostate at the time of treatment, thus allowing for reduction of the margin required for uncertainty in target position. METHODS AND MATERIALS: Radiopaque markers implanted around the prostate prior to treatment are visible on electronic radiographs generated with a portal imager or diagnostic imaging device. The locations of the images of these markers on the digital radiographs were automatically determined by a template-matching algorithm. The coordinates of the markers were found by projecting rays through the marker locations on orthogonal radiographs using a three-dimensional (3D) point-matching algorithm. Prostate and/or patient movement was inferred from the marker displacements. Images generated from known movements of a phantom with implanted markers were tested with this algorithm. Locations of markers from daily images of patients with implanted markers were determined by both manual and automatic techniques to determine the efficacy of automated localization on typical clinical images. RESULTS: Prostate movements can be automatically detected in a phantom using low-energy photons within 30 s after image acquisition and with a precision of better than 1 mm in translation and 1 degree in rotation (indistinguishable from the uncertainty in measuring precision). CONCLUSION: The studies show that on-line repositioning of the patient based on localization of the markers at the time of treatment is feasible, and may reduce the uncertainty in prostate location when combined with practical on-line repositioning techniques.

Feasibility Studies↗