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PubMed1984

Magnetic resonance. Principles and applications.

Magnetic resonance is a unique, noninvasive imaging modality which allows direct, multiplanar imaging and the possibility of obtaining biochemical information in vivo. Presently, MR appears most applicable to the evaluation of central nervous system abnormalities. The high sensitivity of MR in the evaluation of intracranial pathology suggests that it may eventually replace CT for many suspected diseases, if future investigations are able to improve its specificity. As previously noted, MR may be more diagnostic than other radiologic studies in the evaluation of suspected Chiari malformation, syringomyelia, congenital abnormalities, tumors of the spinal axis, and disc space infection. In the chest, MR appears to be more accurate than CT in the determination of the extent of mediastinal tumor, but at present cannot replace CT because of the lack of experience in imaging parenchymal nodules and benign diseases. MR of the breast is promising, but the size of the lesion may prove to be a limiting factor with magnetic field strengths commonly being utilized. There are inherent difficulties in the evaluation of cardiac disease with MR, but it offers a noninvasive method of investigating congenital heart disease and may provide valuable information in suspected myocardial ischemia and altered cardiac function. MR provides a new method of evaluating the vascular system, both in terms of providing anatomic information on large and medium-sized vessels and flow analysis. In the abdomen, MR appears to be most sensitive in the evaluation of suspected hepatic masses, but as with the brain, greater specificity will be needed to replace CT. At the present time, MR offers no distinct advantage over conventional imaging modalities in the evaluation of pancreatic disease, it maybe more accurate than CT in the staging of renal cell carcinoma. Larger studies are needed to determine the role of MR in the investigation of retroperitoneal adenopathy and adrenal abnormalities. In the pelvis, MR offers the hope of earlier diagnosis of prostatic carcinoma and may replace CT for staging of prostatic carcinoma and transitional cell carcinoma of the bladder. Limited MR experience with benign disease of the female pelvis suggests that it is currently more accurately evaluated with ultrasound. MR appears to be highly sensitive and specific for the diagnosis of avascular necrosis and may provide an early clue in suspected osteomyelitis. Finally, in vivo MR spectroscopy may provide unique metabolic information that was unobtainable prior to the advent of magnetic resonance, if this proves to be technically feasible.

Bone Diseases↗
PubMed1985

Magnetic resonance imaging in pediatrics.

Magnetic resonance imaging has potentially broad applications in pediatric practice. Although further studies are needed to determine its exact role in comparison with the other imaging modalities, magnetic resonance has shown increased sensitivity in lesion detection in many disease processes. Since MR does not use ionizing radiation and does not require intravenous contrast to identify vascular structures, it becomes an ever more attractive imaging tool for pediatric diagnosis. Thus, the early results of MR imaging have shown promise and the future of MR appears exciting.

Abdominal Neoplasms↗
PubMed2005

[Emergency pediatric thoracic radiology].

Pediatric thoracic emergencies are frequent and may be due to a large spectrum of lesions including traumatic and non traumatic pathologies, such as foreign bodies, mediastinal tumors, pulmonary infections, asthma, pneumothorax and delayed manifestations of congenital chest malformations. Emergencies require rapid diagnosis to make a treatment plan and in most cases, radiology plays an essential role. Plain chest radiographs remain the initial study with inspiratory films. In certain circumstances, the use of expiratory films is absolutely necessary. Ultrasonogragraphy is the primary modality for evaluation of pleural effusions. Computed tomography (CT), with volume acquisition and more rapid scanning, is a technique capable of imaging the lungs and mediastinum with excellent spatial resolution in the pediatric population. CT provides more information than chest radiographs. This explains the increasing indications of CT in the evaluation of pediatric thoracic emergencies, more particularly traumatic emergencies.

Child↗
PubMed1999

Interventional techniques in the thorax.

Transthoracic needle biopsy (TNB) has become the diagnostic procedure of choice in evaluation of focal chest lesions. Both advances in cross-sectional image guidance and cytopathologic techniques allow TNB to accurately diagnose malignancy and characterize a spectrum of benign conditions. Image-guided percutaneous drainage of intrathoracic collections has developed as an extension of similar procedures in the abdomen and pelvis. The ability of CT and ultrasound to accurately detect and characterize parenchymal and pleural collections, and advances in interventional techniques and catheter design, have made percutaneous catheter drainage the treatment of choice for a variety of intrathoracic collections. This article provides an updated review of the spectrum of image-guided diagnostic and therapeutic procedures in the thorax.

Biopsy, Needle↗
PubMed1996

Carcinoma arising in ectopic hamartomatous thymoma. An ultrastructural study.

We present the ultrastructural features of a case of adenocarcinoma arising in ectopic hamartomatous thymoma in a 31 year old man, in the supraclavicular location. The tumor had a cribriform adenomatous component with a granular cell quality and mimicked a metastatic carcinoma. Ultrastructurally, the spindle cell component revealed clusters of tonofilaments and the tumor cells were attached by well developed desmosomes. The cytoplasm of adenocarcinoma cells contained peculiar cup-shaped bodies derived from the endoplasmic reticulum wrapped around the mitochondria.

Adenocarcinoma↗
PubMed1996

Is preoperative percutaneous fine-needle aspiration cytology of intrathoracic lesions advisable in resectable patients?

OBJECTIVE: The study addresses the clinical significance of percutaneous fine-needle aspiration (FNA) cytology in patients with intrathoracic lesions. METHODS: The diagnoses based on cytology in 101 patients (73 male, 28 female; age 21-78 years) with intrathoracic lesions were compared with a definitive histological diagnosis obtained by thoracotomy. Sixty-one lesions were localized in the right and 31 in the left lung, 5 bilaterally and 4 paramediastinally (maximum diameters: 0.8-12 cm; median: 3.5 cm). RESULTS: Upon FNA, 69 cases were graded malignant and 17 benign. In the remaining 15 cases the pathologists felt unable to define clearly the cell type or the biological properties, though the material was found representative. Histology yielded 80 malignant and 21 benign lesions, consistent with the cytological diagnosis in 70 cases. In 60 patients accordance between the cellular subtypes suspected after FNA and those found histologically was present. A significantly higher rate of correct FNA diagnoses was made in malignant lesions (chi-square test: p<0.05). The overall diagnostic accuracy of FNA was 0.77, the sensitivity 0.79 and the specificity 0.91 From the surgical point of view, nine resectable lung cancers, three metastases, three other malignancies and three tuberculomas would have been missed by relying on the FNA diagnoses. Eighteen pneumothoraces (nine requiring suction drainage) occurred after FNA. CONCLUSION: The indication for FNA in otherwise resectable patients should be made carefully, keeping in mind the rate of diagnostic errors and of complications, as well as the possibility for diagnostic VATS of peripheral lesions.

Adult↗
PubMed1997

Comparison of two preoperative indices to predict perioperative mortality in non-cardiac thoracic surgery.

OBJECTIVE: The preoperative classifications: physical status of the American Society of Anesthesiologists (ASA-PS) and/or cardiac risk index (CRI) of Goldman are widely used to estimate the perioperative risk in patients undergoing noncardiac throacic surgery. We tried to determine the validity of both methods in predicting the perioperative mortality in 845 consecutive patients scheduled for major elective noncardiac thoracic surgery. METHODS: Preoperatively, each patient was assigned 2 independent estimations of risk according to the ASA-score (ASA grade, I-IV) and CRI score (CRI grade, I-IV), respectively. RESULTS: Twenty-five patients died within 4 weeks after the operation, the others survived the perioperative period. The grading according to ASA as well as to the CRI score showed a direct correlation with the outcome: The higher the preoperative score, the higher was the mortality rate. When various combinations of ASA and CRI were tested, the lowest mortality rate was found in presence of ASA < or = III and CRI = I. Multivariate regression analysis showed that the ASA score had an independent correlation with perioperative mortality, whereas such a relationship was absent for CRI. CONCLUSIONS: The subjective assessment by an experienced anesthesiologist as expressed by the ASA-score is a valid method in the determination of the perioperative risk. CRI does not contribute additional information for the general perioperative risk.

Adult↗
PubMed2004

Normal volume and cellular contents of pleural fluid.

Because of the technical difficulties in obtaining a-traumatical access to the normal pleural space, the exact volume and cellular content of normal pleural fluid in humans were still unknown until very recently, and animal-derived extrapolation data had to be used. After having developed a minimally invasive thoracoscopic technique for performing sympathectomy in patients suffering from essential hyperhidrosis, but with otherwise absence of thoracic disease, we have been able to achieve minimally traumatic access to normal pleural spaces. Using pleural lavage, a technique consisting of injection and immediate aspiration of 150 mL of prewarmed saline into the pleural space, we were able to determine the total and differential cell content of the few milliliters of original pleural fluid. The exact volume of this original pleural fluid could be measured using urea as an endogenous marker of dilution. Expressed per kilogram of body mass, total pleural fluid volume in healthy, non-smoking humans was 0.26+/-0.1 mL kg(-1). Total white blood cell count (after correction for dilution) was 1.716 x 10(3) cells mL(-1). Differential cell counts yielded median 75% (IR 16%) macrophages, 23% (IR 18%) lymphocytes, and marginally present mesothelial cells (1%, IR 2%), neutrophils (0%, IR 1%) and eosinophils (0%, IR 0%). There was no significant correlation between age and pleural lavage results in a study population aged 17 to 54 years old, which suggests that these results may be extrapolated to the situation in children and adolescents.

Adolescent↗
PubMed1999

Treatment of small cell lung cancer patients.

Small cell lung cancers, comprising approximately 20% of lung cancers, are rapidly growing and disseminating carcinomas which are initially chemosensitive but acquire drug resistance during the course of disease. Thus, outcome is poor with median survival of 10-16 months for patients with limited and 7-11 months for patients with extensive disease. Polychemotherapy with established drugs (platins, etoposide, anthracyclines, cyclophosphamide, ifosfamide and Vinca alkaloids) plays the major role in the treatment of this disease and results in overall response rates between 80%-95% for limited disease and 60%-80% for extensive disease. Dose-intensified chemotherapy and high-dose chemotherapy with peripheral blood progenitor cell support were tested in several trials but their exact impact on outcome remains to be determined. New drugs including the taxanes (paclitaxel, docetaxel), the topoisomerase I inhibitors (topotecan, irinotecan), vinorelbine and gemcitabine are currently evaluated in clinical trials. In limited disease, thoracic radiotherapy improves survival and prophylactic cranial irradiation should be administered to those with a reasonable chance of cure.

Antineoplastic Agents↗