Noninvasive detection of gallstone acute pancreatitis.
Explore the source record for details and available documents.
Cholangiopancreatography, Endoscopic Retrograde↗
Biomedical subjects
R M Gore
Publications and source records attributed to R M Gore.
Bolus-rapid infusion of contrast medium: simplified technique for optimal computed tomography pancreatography without use of dynamic scanning.
Optimal pancreatic computed tomography demands the use of both narrow beam collimation and high levels of intravascular contrast medium. Dynamic scanning with or without table incrementation has been advocated, but not all patients are amenable to prolonged breath holding, and tube cooling requirements may limit the study. In addition, repeat boluses usually must be administered to adequately image the entire pancreas. Enhancement may also be less than uniform. We describe a simple method of pancreatic scanning using bolus injection and pressurized rapid infusion of contrast medium that yields consistently high-quality scans demonstrating both pancreatic parenchymal and peripancreatic vascular enhancement in most patients. The method eliminates the need for dynamic scans in most cases and improves the speed of examination and quality of patient care in a busy computed tomography department.
Contrast Media↗
A comparative study of computed tomography and ERCP in pancreaticobiliary disease.
Fifty-seven patients with suspected pancreaticobiliary pathology constituting a clinical subset in whom the diagnosis was problematic or nonspecific were evaluated with computed tomography and ERCP. The relative sensitivities, specificities, and accuracies of the two tests were compared. Computed tomography was successful in obtaining a diagnostic examination in 100% and ERCP was technically successful in 75%. Both tests were equally accurate in detecting an abnormality (computed tomography 95.7%; ERCP 95.3%) and offering a correct diagnosis (computed tomography 72%; ERCP 70%). Sensitivity and specificity of the two tests for detection of an abnormality was computed tomography 100% and 91.3%; ERCP 91.7% and 100%. Sensitivity and specificity for the correct diagnosis was computed tomography 59% and 91.3%; ERCP 46% and 100%. Computed tomography was also superior to ERCP in making a correct diagnosis in pancreatic carcinoma (80% versus 63%) and pancreatitis (75% versus 50%). Based on these results we conclude that computed tomography utilizing high doses of intravenous contrast material and thin collimation is the preferred screening examination for pancreaticobiliary disease. ERCP should be reserved for those cases where the pancreaticobiliary disease. ERCP should be reserved for those cases where the diagnosis on computed tomography is obscure or uncertain and/or the pancreatic or biliary ductal anatomy requires direct contrast imaging.
Biliary Tract Diseases↗
Budd-Chiari syndrome: CT observations.
The authors describe four patients with Budd-Chiari syndrome in whom contrast material-enhanced computed tomographic (CT) scans demonstrated low-density venous thrombosis in three sites not, to our knowledge, previously described with this modality. Thrombosis was seen in the portal circulation, the hepatic veins, and the intrahepatic inferior vena cava. It is known that concomitant portal vein thrombosis may be seen in 20% of patients with Budd-Chiari syndrome. Three of the four patients in the current study had this finding, one with extensive thrombosis of portal, mesenteric, and splenic veins and the other two with portal vein branch involvement. In one patient hepatic vein thrombosis was demonstrated with CT, and in three inferior vena cava clot was demonstrated. All four patients had the distinctive hepatic parenchymal contrast enhancement pattern seen in this condition, which the authors think may be at least partially caused by associated portal thrombosis. The presence of portal venous thrombosis should prompt the observer to consider the diagnosis of Budd-Chiari syndrome. Detection of hepatic vein clot confirms the diagnosis and may be seen in this condition in association with inferior vena cava thrombus.
Adult↗
Evaluation of ectopic bone by CT.
The CT appearance of ectopic bone and its maturation in 25 patients were correlated with the findings on radiographs and bone scans. Ossification progressed from an early appearance of soft-tissue density of lower attenuation than muscle to a calcific density paralleling radiographic and scintigraphic evidence of bone formation. Persistent unossified, low-density soft tissue was detected adjacent to mineralized areas of ectopic bone in 14 patients up to 16 years after neurologic injury, often with bone-scan evidence of maturity of the ectopic bone. This soft tissue most likely corresponds to immature, unossified connective tissue, which may have a potential for ossification. Detection of areas of soft-tissue density by CT and their avoidance during surgical resection of an ankylosing mass of ectopic bone may reduce intraoperative hemorrhage and postoperative ectopic bone recurrence.
Adolescent↗
Cross-sectional imaging of inflammatory bowel disease.
The cross-sectional imaging modalities provide an important diagnostic perspective in patients with inflammatory bowel disease that often has a profound influence on the therapeutic decision-making process. They can directly and noninvasively image infectious and inflammatory complications involving the bowel wall, serosa, and mesentery that can only be assessed indirectly by colonoscopy and barium studies. At the present time, CT is superior to ultrasound and MR in diagnosing these extramucosal complications.
Colitis, Ulcerative↗
Duodenal manifestations of nontropical sprue.
Barium studies of the upper gastrointestinal tract and small bowel were performed in 16 adult patients with biopsy-proven nontropical sprue. Commercially available contrast media containing micropulverized barium sulfate, suspending agents, and various other additives were used. Radiographs were analyzed for the incidence and pattern of duodenal vs. small-bowel changes associated with celiac disease. Thirteen of 16 patients (81%) demonstrated abnormalities of the duodenum which ranged from focal erosions to diffusely thickened and nodular folds. A nonspecific, mild dilatation pattern was present on the small-bowel series of 11 patients (69%). The classic radiographic signs of malabsorption, such as flocculation and segmentation, however, occurred in less than 20% of cases, apparently because of the stability of new barium suspensions. The pathogenesis of duodenal changes in sprue and its diagnostic implications are emphasized.
Adult↗
Ultrasound demonstration of bile duct thickening in primary sclerosing cholangitis.
Explore the source record for details and available documents.
Adult↗
Crohn's disease of the upper gastrointestinal tract.
The transmural granulomatous inflammation of chronic nature which characterizes the Crohn's disease involves primarily the terminal ileum and colon. However, the upper gastrointestinal tract may also be affected by the same histopathological process, usually co-existent with or following Crohn's disease of the ileocecal region. Such cases can present a formidable diagnostic challenge if the clinical, endoscopic and radiographic findings are not correlated. This article describes and illustrates the spectrum of radiological manifestations of Crohn's disease and its associated complications involving the esophagus, stomach and duodenum.
Biliary Tract Diseases↗
Value of computed tomography in the detection of complications of Crohn's disease.
Abdominal and pelvic computed tomography (CT) scans were performed on 17 patients with suspected complications of Crohn's disease. CT was superior to conventional barium studies and colonoscopy in demonstrating mural, serosal, and mesenteric pathology such as bowel wall thickening (100%), abscess (59%) and phlegmon (6%) formation, and fibro-fatty proliferation of the mesentery (41%). While not advocated as the primary means of evaluating Crohn's disease, CT can provide information vital to the management of complications of this disease.
Abscess↗
Computed tomography in the evaluation of cirrhosis and portal hypertension.
Patients with cirrhosis present a continuing diagnostic and therapeutic challenge. The status of their disease frequently changes, necessitating intensive serial evaluation. CT is an invaluable tool in the management of these patients because it can noninvasively provide vital information concerning liver size, contour, and occasionally hepatic parenchyma. More importantly, CT can demonstrate superficial and deep varices, assess the patency of the extrahepatic portal system, and detect other complications including ascites, hepatic steatosis, hemochromatosis, and hepatocellular carcinoma.
Ascites↗
Brain edema: ultrasound examination.
Sonographic examination of the brain in 10 patients who had cortical mass lesions was performed. Results were compared with findings of CT. In each case, brain edema surrounded the lesion, and the adjacent white matter had a diffusely echo-genic appearance that corresponded to the area of brain edema seen on CT.
Adult↗
Intraoperative sonography of the pancreas.
Intraoperative sonography (IOS) of the pancreas was performed in 12 patients, eight with known or suspected inflammatory disease and four with known or suspected malignancy, in order to assess its utility in aiding pancreatic surgery. In all eight patients with inflammatory disease, IOS provided additional information, aided in resection or biopsy, or identified structures that could not be evaluated by surgical dissection. IOS was particularly useful in these patients in determining the size and appearance of the pancreatic duct before dissection or ductography, thus allowing planning of appropriate pancreatic decompression or resection. It also was extremely helpful in locating and characterizing pseudocysts, including measurement of cyst wall thickness, and in directing needle aspiration of cyst contents. Adequate drainage of all cysts in multiple cystic masses was easily monitored. Finally, impalpable peripancreatic fluid collections and abscesses were often localized. In the four patients with probable malignancy, IOS was somewhat helpful in two, allowing exclusion of tumor in one and guiding biopsy in another. In the other two patients, IOS provided no information due to obvious local invasion and nonresectability. Results indicate a significant adjunctive role for IOS in surgery for inflammatory disease of the pancreas. It seems to be less helpful in patients with malignancy, probably because of the advanced stage of pancreatic carcinoma at the time of surgery.
Adult↗
Inferior vena cava CT pseudothrombus produced by rapid arm-vein contrast infusion.
Laminar flow within the inferior vena cava can cause artifacts that may simulate thrombus if a foot-vein infusion is used. A "pseudothrombus" artifact within the suprarenal inferior vena cava produced by rapid infusion of contrast material through an arm vein is reported. This artifact was noted in 25 patients in a 6 month period and was believed to be from laminar flow of renal venous effluent of increased opacity around less opacified infrarenal caval contents. Differentiation from true thrombus can be made by the use of delayed scans as well as the increased density and relatively poor margination of the artifact.
Humans↗
Diverging gastro-esophageal folds: an useful sign for detecting small hiatal hernias in the erect position.
Upright, double contrast films of the gastro-esophageal junction were reviewed in 30 patients with hiatal hernias and 30 normal controls. Patients with hiatal hernias demonstrated gastro-esophageal folds that converged above the diaphragm and diverged at or beneath the diaphragm on double contrast films of the esophagus. In the normal situation these folds were found to converge at or beneath the diaphragm. The origin and significance of this sign for the diagnosis of hiatal hernias in the upright position is discussed.
Esophagogastric Junction↗
Superior mesenteric artery syndrome. Diagnostic criteria and therapeutic approaches.
The hospital records and radiographs of 44 patients diagnosed as having superior mesenteric artery syndrome were reviewed using strict clinical and radiographic criteria. Only six (14.6 percent) of the patients fulfilled these criteria, suggesting over-diagnosis of the disorder. An acute change in clinical status, such as an operation or complication of a medical disease, appeared to precipitate the superior mesenteric artery syndrome in these patients, all of whom had chronic debilitating diseases. In four of the six patients conservative therapy failed, and they required surgical decompression.
Adolescent↗
Accessory hemiazygos continuation of left inferior vena cava: CT demonstration.
The first CT description of accessory hemiazygos continuation of a left-sided inferior vena cava is presented. This venous anomaly appears as a mediastinal mass on plain chest films and may simulate an aortic dissection on CT or angiography. Careful attention to the various abnormal vascular pathways will obviate the need for further invasive testing.
Aortic Dissection↗
CT diagnosis of a mycotic aneurysm of the thoracoabdominal aorta.
The CT appearance of a mycotic aneurysm involving the thoracoabdominal aorta with adjacent vertebral osteomyelitis is presented. Specific CT features of the aneurysm, such as lack of intimal calcification and adjacent bone destruction or abscess, may allow the diagnosis to be made in the appropriate clinical setting.
Aneurysm, Infected↗