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Diagnostic imaging techniques have an important role in supplementing the clinical evaluation of the diabetic. These are discussed in relation to the pathophysiologic changes: vascular degeneration, neurologic and infective changes, and maternal-fetal influences during pregnancy.
Newer forms of radiologic diagnostic imaging now include non-roentgenographic modalities such as ultrasound, nuclear medicin, and thermography, all of which can be applied to otolaryngology. It is the purpose of this presentation to demonstrate these modalities, and indicate their clinical application, yet in its earliest stages, to otolaryngology.
The respective diagnostic value each of diagnostic radiology and nuclear medicine in the detection of early rheumatoid arthritis is being demonstrated--with close correlation to its clinical presentation and course. Diagnostic radiology is found to be specific and nuclear medicine to be highly sensitive, with the latter giving better diagnostic information at an earlier time about the activity of the disease than the former--including soft tissue technique. Nuclear medicine further--more will be helpful for appropriate timing of diagnostic radiology evaluations of this disease.
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Conventional radiography is now complemented by a large range of newer radiologic diagnostic techniques, involving both roentgenographic and non-roentgenographic modalities. It is the purpose of this presentation to present these new roentgenographic modalities in graphic form, and demonstrate their application to otolaryngic diagnosis. The major roentgenographic modalities which will be stressed are: xeroradiography, angiography, and computerized tomographic scanning.
The results of 100 consecutive pancreatic arteriograms performed in concert with a combination of other diagnostic procedures (gray scale ultrasonography, computed tomography, endoscopic retrograde cholangiopancreatography, percutaneous transhepatic cholangiography) were evaluated to determine the value of angiography in diagnosis and management of patients with known or suspected pancreatic disease. Angiography was found to be valuable for diagnosis in 68% (68/100) of cases and was considered helpful for management in 81% (57/70) of patients with pancreatic neoplasm, pancreatitis, or a nonpancreatic abnormality.
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To evaluate the role of intravenous cholangiography (IVC), ultrasound andoral cholecystography in the diagnosis of gallstone pancreatitis, 20 patients with acute pancreatitis were studied during the first three days of an attack. The IVC successfully demonstrated the common bile duct and gallbladder in 17 (85%) 20 patients. The ultrasound studies showed the gallbladder in all 18 patients in whom the gallbladder was present. The common duct was not seen by ultrasound in any patient and the pancreas was abnormal in all patients. In the three patients with gallbladder stones these were identified on both IVC and ultrasound. Common duct stones in three patients were seen only by IVC (two of these patients had concurrent gallbladder stones and one after cholecystectomy). Oral cholecystography was of limited usefulness, although the 50% visualization rate was higher than the literature suggests.
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Individuals with hereditary cancer syndromes are born with germline genetic variants that significantly increase their lifetime risk of developing multiple cancers. Cancer rates and overall mortality can be reduced with intensive surveillance to facilitate early cancer detection. However, participating in diagnostic imaging and endoscopy surveillance programs is often time-consuming, overwhelming, inconvenient, and anxiety-inducing. To improve this, multi-cancer early detection tests are being developed using cell-free DNA (cfDNA) sequencing analysis to detect cancers with more sensitivity than conventional screening methods. Our community (the CHARM consortium: Cell-free DNA in Hereditary And high-Risk Malignancies) has been exploring the use of cfDNA sequencing in hereditary cancer, and has launched the CHARM2 prospective randomized controlled trial, which is enrolling 1000 participants with Hereditary Breast and Ovarian Cancer, Lynch syndrome, Li-Fraumeni syndrome, Neurofibromatosis type 1 and Hereditary Diffuse Gastric Cancer to improve equitable access, early detection and surveillance for high-risk individuals. All participants will have screening as per conventional syndrome-specific surveillance recommendations. Half the participants (experimental cohort) will also have cfDNA analysis at least three times a year, with abnormal results triggering dedicated clinical imaging and diagnostic evaluation, and heightened surveillance. Vetted by our patient advisors, validated patient-reported outcome and experience measures assessing participant psychosocial outcomes, engagement, and test preferences will be administered to both arms. Our goal is to inform if and how cfDNA analysis could be implemented into routine clinical care and offer a path to equitable and more convenient cancer screening for all high-risk Canadians.
The effect of rare-earth phosphor intensifying screens on diagnostic image quality was examined. Five observers were asked to identify ten landmarks on each of fifteen cephalometric images having varying screen-film-kvp combinations. The most sensitive screens were found to significantly affect diagnostic image quality and thereby the reliability of landmarks identification. This finding was, however, only established for those landmarks having the lowest standard deviations and the clinical significance is thus questionable. There would appear to be other more important factors than physical image quality involved in the reliability of landmark identification. High intensifying screens are, therefore, recommended for use in cephalometric analyses since they help to reduce patient dose and do not appear to sacrifice diagnostic image quality to the extent that the reliability of cephalometric measurements is significantly affected.
Technical and diagnostic image quality are distinguished and the limitations of three methods currently used for assessing diagnostic image quality are discussed. They are evaluations based on individual clinical experience, measurement of diagnostic performance, and physical measurements made on images or imaging systems. Finally, a psychophysical approach to image quality evaluation is presented and its potential value discussed.
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Gray scale ultrasonography (US) and computed tomography (CT) have enhanced the role of various imaging modalities in the evaluation of patients with suspected pancreatic disease. When these anatomical studies are normal or equivocal, a functional, radionuclide pancreas scan may be useful. Pancreatic imaging can be achieved using ultrasound, transmission CT, single photon radionuclide imaging, and positron emission CT. A diagnostic imaging decision chart for the evaluation of patients with possible pancreatic disease is useful in choosing the correct imaging modality in a specific situation. Such a chart and its theoretic basis are described in this review. The need to optimize the pancreatic work-up with respect to cost-benefit decisions and diagnostic accuracy, sensitivity, and specificity are of particular concern to the physician. Of all the potential areas for disease, the pancreas has been and remains a particularly difficult diagnostic problem.