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Biomedical subjects

R L Bree

Publications and source records attributed to R L Bree.

At least 73 records · Page 4Linked to original sources
PubMed1989

Computed tomography of chest wall masses.

The authors argue that CT is superior to other imaging techniques for the examination of the bones and soft tissues of the chest wall. They also note the importance of CT in planning therapy for lesions involving these structures. In support of these theses they present computed tomograms showing 26 different types of lesion involving the chest wall ranging from sternal fracture to malignant fibrous histiocytoma. Malignant neoplasms involving the chest wall by metastasis or direct extension from the breast, lung or mediastinum are emphasized.

Humans↗
PubMed1989

Transvaginal sonography in the evaluation of normal early pregnancy: correlation with HCG level.

Transvaginal sonography (TVS) is the procedure of choice in evaluating the viability of embryos early in pregnancy. However, viability based on TVS can be assessed more accurately when the exact gestational age from the last menstrual period is known or when the findings are correlated with beta human chorionic gonadotropin (HCG) levels. No large series has been reported with correlative data between early pregnancy findings, HCG, and gestational age. We performed 75 transvaginal examinations in 53 patients with proved normal pregnancy in the fifth through seventh weeks of gestation. The presence and size of the gestational sac, presence of a yolk sac, and identification of embryonic heart activity were correlated with the level of HCG. Sac size was correlated with yolk sac and heart activity and the three parameters correlated with gestational age in days. When the level of HCG reached 1000 mIU/ml by using the first International Reference Preparation, a gestational sac was seen sonographically in each patient. When the HCG level reached 7200 mIU/ml, a yolk sac was seen in every patient. Ten of 22 patients with HCG between 1000 and 7200 mIU/ml had a visible yolk sac. Every patient with an HCG level greater than 10,800 mIU/ml had a visible embryo with a heartbeat. A discriminatory level of 32 days was found for the presence of a gestational sac. A yolk sac was first seen in every patient between 36 and 40 days. Every patient with accurate dates greater than 40 days had an embryo with a heartbeat identified. When correlating sac size with structures within the sac, a yolk sac was first seen in a gestational sac between 6 and 9 mm and a heartbeat seen in every patient with a 9-mm or greater gestational sac diameter. These data allow identification of normal intrauterine pregnancy and distinction of normal from ectopic gestation at least 1 week earlier than is possible with transabdominal techniques.

Chorionic Gonadotropin↗
PubMed1988

Small renal cell carcinomas: resolving a diagnostic dilemma.

Thirty-nine patients with pathologically proved renal cell carcinomas 3 cm or les in diameter were examined. Results of intravenous urography (n = 30) were true positive in 20 patients and false negative in ten (sensitivity, 67%). Renal ultrasound (US) (n = 29) had true-positive results in 23 patients and false-negative results in six (sensitivity, 79%); computed tomography (CT) (n = 36) had true-positive results in 34 and false-negative results in two (sensitivity, 94%). For selective renal angiography (n = 35%), the results were true positive in 26 and false negative in nine (sensitivity, 74%), with typical hypervascular renal cell carcinomas demonstrated in 17. Finally, the findings of percutaneous fine-needle aspiration biopsy were true positive in one of five patients when US guidance was used (sensitivity, 20%) and in five of eight when CT guidance was used (sensitivity, 62%). Small renal cell carcinomas are more frequently encountered in clinical practice than heretofore realized, and they are best imaged by CT.

Adult↗
PubMed1987

MR imaging of hepatic focal nodular hyperplasia: characterization and distinction from primary malignant hepatic tumors.

Spin-echo MR imaging at 0.35 T was used to image hepatic focal nodular hyperplasia (FNH) and to attempt to distinguish it from primary malignant hepatic tumors. There were six FNH and 10 malignant tumors including seven hepatocellular carcinomas, two cholangiocarcinomas, and one hepatoblastoma. Our results show that FNH has a fairly consistent appearance, dissimilar from that of malignant primary hepatic tumors. Four of six FNH lesions were isointense (except for a central scar in three) and indistinguishable from normal hepatic parenchyma on all pulse sequences, whereas two of six were homogeneous but slightly hyperintense on T2-weighted sequences. Furthermore, a central hyperintense scar was seen in three of six lesions on T2-weighted sequences. In contrast, each of the malignant primary hepatic tumors was hyperintense on T2-weighted sequences and seven of 10 were hypointense on T1-weighted sequences; in nine of 10, heterogeneous areas of intensity were noted. In two fibrolamellar hepatocellular carcinomas a central scar was seen that was hypointense on all pulse sequences. By using quantitative data, the best characterization was obtained by using lesion/normal-liver intensity ratios from a T2-weighted sequence; all FNH had a ratio less than 1.33, while in nine of 10 primary malignant tumors it was greater than 1.41. We conclude that focal nodular hyperplasia may have a consistent appearance on spin-echo MR imaging and probably can be distinguished from primary malignant lesions in most instances.

Adenoma, Bile Duct↗
PubMed1987

The accuracy of CT in the staging of carcinoma of the prostate.

Previous studies have reported the accuracy of CT in distinguishing stages of prostatic carcinoma, but they lack uniform surgical proof of histopathologic stage. We evaluated CT scans in 32 patients who underwent radical prostatectomy to assess its role in the preoperative staging of prostatic carcinoma. Two experienced radiologists blindly interpreted CT scans of the pelvis; they looked for evidence of tumor beyond the prostatic capsule and involvement of the seminal vesicles (stage C) or involvement of pelvic lymph nodes (stage D). Sixty-four interpretations in 32 patients yielded a specificity of 75% for predicting stages A or B disease (local disease), a sensitivity of 50% for the prediction of stages C or D, and an overall accuracy of staging of 67%. Interpretation errors were due to an inability to detect lymph node metastases, errors in evaluating the seminal vesicles, and errors in interpreting densities surrounding the prostate gland. Our data suggest that CT should not be used to influence decisions concerning surgical vs nonsurgical treatment in patients with clinically staged local disease and is only useful when unsuspected metastatic nodal disease is detected.

Diagnostic Errors↗
PubMed1986

Adrenal tissue characterization using MR imaging.

Using a superconducting magnet operating at 0.35 T, the authors investigated the adrenal tissue characterization potential of magnetic resonance (MR) in 28 patients with 33 adrenal masses. There were 13 adrenal adenomas (12 non-hyperfunctioning, one aldosteronoma), nine adrenal metastases, four pheochromocytomas, two neuroblastomas, two adrenal lymphomas, two myelolipomas, and one adrenal cortical carcinoma. Spin-echo pulse sequences were obtained at TR 0.5, 2.0 sec and TE 28, 56 msec. Both qualitative (visual assessment) and quantitative (absolute signal intensity, intensity ratios, T1, T2) data were used for tissue characterization. The results suggest that non-hyperfunctioning adrenal adenomas can be distinguished from non-adenomas using both qualitative and quantitative data: 16/19 non-adenomas were visually hyperintense compared with liver at TR 2.0 sec, TE 56 msec, while none of the non-hyperfunctioning adenomas was relatively hyperintense at any pulse sequence used. Of the quantitative data, the intensity ratios of adrenal lesion/liver at TR 0.5 sec, TE 56 msec were most useful in diagnosis: all adenomas had ratios less than 0.83, while 19/20 non-adenomas had ratios exceeding this value. It is concluded that MR has considerable promise in adrenal tissue characterization.

Adenoma↗
PubMed1986

Further observations in the ultrasound evaluation of renal allograft rejection.

In order to determine whether sonographic parenchymal changes and volume changes are reliable predictors of acute transplant rejection, 36 recipients of renal allografts were studied. The significance of graft volume changes was evaluated, since most previous studies have not utilized routine immediate postoperative baseline scans for comparison to follow-up scans. All patients had baseline scans within 24 hours of the transplant. All 24 acute rejection patients had biopsy proof of rejection within three days of the follow-up scans. Seven clinically normal and five clinically designated acute tubular necrosis (ATN) patients were studied for comparison. A retrospective blind review utilizing three sonologists and previously described criteria combined with calculated volume changes demonstrated an overall sensitivity of 85 per cent and specificity of 94 per cent for the detection of acute rejection. The kidneys with acute rejection had an average volume increase of 73 per cent vs. 27 per cent for ATN patients and 24 per cent for normal patients, a statistically significant difference.

Acute Disease↗
PubMed1985

The sensitivity of hepatobiliary imaging and real-time ultrasonography in the detection of acute cholecystitis.

To determine the sensitivity of hepatobiliary imaging (HBI) and strict- and liberal-criteria real-time ultrasonography (RTUS), we retrospectively analyzed 100 cases of pathologically proved acute cholecystitis (AC). A positive HBI was one in which there was nonvisualization of the gallbladder up to four hours after the administration of technetium Tc 99m-disofenin. In the absence of hypoalbuminemia, cirrhosis, or ascites, pathognomonic RTUS findings (strict criteria) for AC were wall edema and/or pericholecystic fluid. Findings indicative of AC (liberal criteria) included the demonstration of stones, a thick gallbladder wall, nonshadowing echoes, or the ultrasonographic Murphy's sign. Of the 100 cases of AC, 91 were calculous, and nine were acalculous. Four of 100 patients had associated choledocholithiasis. The sensitivities in detecting calculous AC were as follows: HBI, 97%; liberal-criteria RTUS, 86%; and strict-criteria RTUS, 24%. The sensitivities in detecting acalculous AC were as follows: HBI, 100%; liberal-criteria RTUS, 89%; and strict-criteria RTUS, 44%.

Acute Disease↗
PubMed1985

Computed tomographic studies of the painful abdomen.

Abdominal CT scans were reviewed in a series of 53 patients who had abdominal pain without objective physical, radiographic, or laboratory abnormalities. Forty patients presented with abdominal pain alone, while the remaining patients had abdominal pain associated with nausea, vomiting, or mild weight loss. Abdominal CT scans in all patients were interpreted as normal. In all but one patient, the final diagnosis was an insignificant benign condition. One patient had a pancreatic carcinoma discovered at surgery one month after the CT scan was obtained. The patients were followed up for 6 to 12 months to confirm absence of significant disease. Our analysis suggests a very low yield from abdominal CT in patients with abdominal pain and no other objective findings.

Adolescent↗
PubMed1985

A nonoperative approach to the adult ruptured spleen sustained from blunt trauma.

From 1978 to 1983, 53 consecutive adult patients with ruptured spleens documented by radionuclide studies, computerized axial tomography, or surgery, were evaluated at William Beaumont Hospital. Thirty-four patients (64%) underwent an exploratory laparotomy; 33 resulted in a splenectomy and one patient had an attempted splenorraphy which failed. Nineteen patients (36%) were hemodynamically stable on admission, or had transient episodes of hypotension readily reversed by intravenous fluids. They were placed at strict bedrest under intensive monitoring. Two patients deteriorated clinically and were taken to surgery, resulting in a splenectomy on the fourth and sixth hospital day, respectively. Seventeen patients (32%) were successfully treated nonoperatively, representing an 89 per cent success rate. The average admitting hemoglobin in the nonoperative group was 13.2 gm/dl, with an average drop of 1.6 gm/dl, and an average total blood transfusion of 1.2 units. These patients were followed for an average of 19.2 months, with no sequelae from their splenic injury. In a hemodynamically stable adult patient with a splenic injury sustained from blunt trauma, a nonoperative approach is a viable alternative when close intensive monitoring is available.

Adolescent↗
PubMed1984

Fetal ovarian cysts: sonographic detection and association with hypothyroidism.

Three cases of ovarian cysts diagnosed antenatally by sonography are analyzed. Two patients also had congenital hypothyroidism, and one of these also had hypertrophic pyloric stenosis. The significance of fetal ovarian cysts is discussed, with emphasis on the implications for clinical management of the baby. In instances where screening thyroid function tests are not routinely performed on all newborns, prenatal identification of ovarian cysts should be considered as an indication to evaluate thyroid status.

Female↗
PubMed1984

Sonography of pelvoabdominal cystic masses in children and adolescents.

A series of large pelvoabdominal cystic masses in young females is presented. Ultrasound examination is the procedure of choice for the initial evaluation of these uncommon masses. Ultrasound can characterize internal structure and relationship to contiguous organs and tissues, and the examination can often suggest the etiology. In two cases, multiple pathologic entities were encountered.

Adolescent↗
PubMed1983

CT detection of adrenal lymphoma.

We present 7 patients with lymphomatous involvement of the adrenal glands detected by computed tomography (CT). In all patients the adrenal glands were diffusely enlarged resulting in oval, round, or triangular shaped glands. In 6 of the 7 patients retroperitoneal adenopathy was present. Adrenal involvement previously occult using conventional radiography should be detected more frequently using CT.

Adrenal Gland Neoplasms↗
PubMed1983

Computed tomography and ultrasound findings in Klippel-Trenaunay syndrome.

Computed tomography (CT) and ultrasound were used to evaluate two patients with Klippel-Trenaunay (K-T) syndrome. Bowel and bladder hemangiomas were demonstrated in these cases. Computed tomography demonstrated multiple low attenuation areas in the liver and spleen in one case. Computed tomography is capable of noninvasively demonstrating bowel and bladder wall hemangiomas in K-T syndrome. Both CT and ultrasound may reveal silent lesions in the upper abdominal viscera, such as liver and spleen.

Adult↗
PubMed1983

Inflammatory pseudotumor from sclerosing cholangitis.

We report the computed tomographic (CT) findings in a case of primary sclerosing cholangitis. A "mass" demonstrated on CT and ultrasound examination in the region of the common bile duct and extending into the head of the pancreas was shown to be diffuse fibrosis and thickening of the common bile duct at surgery.

Adult↗
PubMed1983

A comparison of radionuclide hepatobiliary imaging and real-time ultrasound for the detection of acute cholecystitis.

The relative value of hepatobiliary scintigraphy vs. real-time ultrasound for the identification of acute cholecystitis was evaluated. No significant difference in sensitivity (97% vs. 97%) existed between the two modalities. Scintigraphy demonstrated better specificity (93% vs. 64%) and predictive value (77% vs. 40%). Although real-time ultrasound provided improved sensitivity over static gray-scale imaging for identification of gallbladder disease, hepatobiliary scintigraphy remains the procedure of choice for acute cholecystitis detection.

Acute Disease↗