Acta Radiol

Advance in the diagnosis of esophageal carcinoma. A new imaging process by adaptive spatial filtering of computed esophagograms.

Year 1998
Ueyama T. Kawamoto K. Yamada Y. Yoshikawa H. Masuda K.
Department of Radiology, Faculty of Medicine, Kyushu University, Fukuoka, Japan.
PURPOSE: To assess the clinical utility of computed radiographic images processed with adaptive spatial filtering (ASF) in the diagnosis of esophageal carcinoma. MATERIAL AND METHODS: After determining the optimal values for ASF image parameters in double-contrast barium studies, we used ASF to process the esophagograms of 35 patients with 37 esophageal carcinomas (superficial 20, advanced 17). The image quality of each lesion was evaluated independently by four radiologists on the basis of detectability, extent, and surface structure. The scoring was: 1 when the ASF image was superior to the original; -1 when the converse was true; and 0 when quality of images was equal. RESULTS: In superficial carcinoma, the mean scores for image quality with regard to detectability, extent, and surface structure were 0.19, 0.48, and 0.31 respectively. In advanced carcinoma, the scores were 0.00, 0.76, and 0.25 respectively. CONCLUSION: ASF offers an improved image quality which is valuable in the evaluation of esophageal carcinoma, particularly in the detection of superficial carcinomas and in the identification of intraepithelial extension.

Conventional plain-film radiology, ultrasonography and CT in jejuno-ileal perforation.

Year 1998
Grassi R. Pinto A. Rossi G. Rotondo A.
Department of Radiology, Hospital A. Cardarelli, Naples, Italy.
PURPOSE: To evaluate conventional radiography, US and CT in identifying jejuno-ileal perforation. MATERIAL AND METHODS: We retrospectively reviewed the findings of conventional radiography, US and CT in 13 consecutive patients with surgically proven jejuno-ileal perforation. RESULTS: The site of perforation was the ileum in 10 cases and the jejunum in 3 cases. Free gas was identified in 6 cases (46%) while indirect findings of perforation were found in 7 (54%). The jejunal perforations were diagnosed by indirect findings in all 3 cases. The ileal perforations were diagnosed by direct findings in 6 cases and indirect findings in 4 cases. CONCLUSION: Conventional radiology did not detect free gas in 7 (54%) of the 13 patients examined. In the absence of free gas, radiology showed indirect signs in all 7 patients, the most common being intraperitoneal free fluid in 5 (71%) of them. Jejunal perforations were more rare than ileal perforations and more difficult to identify by radiology. US was not useful for detecting free gas but it was useful for identifying intraperitoneal free fluid and intestinal paresis. Abdominal CT was useful when performed 6 h after the symptoms began.

Enteroclysis-guided fine-needle aspiration cytology of focal small-bowel lesions.

Year 1998
Verma V. Nagi B. Rajvanshi A. Kochhar R. Singh K.
Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
PURPOSE: To study the role of enteroclysis-guided percutaneous fine-needle aspiration cytology (FNAC) of focal small-bowel lesions. MATERIAL AND METHODS: Twenty patients with non-palpable circumscribed small-bowel lesions found on enteroclysis underwent FNAC after confirmation of needle position under fluoroscopy. RESULTS: Positive diagnosis was obtained in 18 (90%) of the patients. Thirteen patients with positive FNAC and one with inconclusive cytology underwent surgery. In all, the cytological diagnosis was confirmed by histopathology. No complications were seen. CONCLUSION: Enteroclysis-guided FNAC of focal small-bowel lesions is a safe and accurate diagnostic method.

Spiral CT of the pancreas. The value of small field-of-view targeted reconstruction.

Year 1998
Nishiharu T. Yamashita Y. Ogata I. Sumi S. Mitsuzaki K. Takahashi M.
Department of Radiology, Kumamoto University School of Medicine, Japan.
PURPOSE: To compare the value of a retrospective targeted high-resolution spiral CT to the standard reconstruction technique in the assessment of pancreatic diseases. MATERIAL AND METHODS: Spiral CT pancreatic images of a standard-size reconstruction protocol were compared prospectively with those of a retrospective targeted high-spatial-resolution reconstruction protocol in 30 patients. Prior to clinical evaluation, a phantom study was performed to evaluate the spatial resolution and signal-to-noise ratio of both protocols. RESULTS: The high-resolution protocol achieved a good signal-to-noise ratio with acceptable spatial resolution. Phantom studies revealed increased image noise (+17%) with an increase in spatial resolution (+100%). In patients studied with the high-resolution protocol, the increase in noise was not significant but there was a marked improvement in the definition of small details. CONCLUSION: Images obtained with a targeted high-spatial-resolution reconstruction protocol showed superior lesion definition and vascular opacification compared with those obtained with a standard-size reconstruction protocol. This technique may have potential in the evaluation of small pancreatic abnormalities.

Early esophageal carcinoma. Evaluation of the depth of invasion based on double-contrast esophagography.

Year 1998
Ueyama T. Kawamoto K. Yamada Y. Masuda K.
Department of Radiology, Faculty of Medicine, Kyushu University, Fukuoka, Japan.
PURPOSE: The aim of this study was to assess the depth of invasion of early esophageal carcinoma (EEC) by means of double-contrast esophagography. MATERIAL AND METHODS: The radiological findings of 46 EECs were retrospectively analyzed for the following factors that might be related to the depth of invasion: in depressed lesions (n = 30): maximum size, surface appearance, sharpness of contour, and wall rigidity; and in elevated lesions (n = 16): maximum size, height, shape, and wall rigidity. All lesions were surgically or endoscopically resected and the radiological findings were compared with the histological appearance. RESULTS: In depressed lesions, the size of the surface granules correlated very strongly with the depth of invasion (rs = 0.8147). In both depressed and elevated lesions, wall rigidity correlated strongly with the depth of invasion (rs = 0.7540 and rs = 0.6702 respectively). In depressed lesions, sharpness of contour also correlated strongly with the depth of invasion (rs = 0.6731). The other factors did not correlate with the depth of invasion. CONCLUSION: Double-contrast esophagography could provide useful information for assessing the depth of invasion of EECs.

Spiral CT during pharmacoangiography with angiotensin II in patients with pancreatic disease. Technique and diagnostic efficacy.

Year 1998
Kuroda C. Mihara N. Hosomi N. Inoue E. Fujita M. Ohigashi H. Ishikawa O. Nakaizumi A. Ishiguro S.
Department of Diagnostic Radiology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Japan.
PURPOSE: To compare the diagnostic efficacy of pancreatic pharmacoangiographic CT using angiotensin II with conventional angiographic CT. MATERIAL and Methods: Eighteen patients with space-occupying pancreatic disease were examined in this study. Pharmacoangiographic CT was performed with a 1-3 micrograms/6-ml solution of angiotensin II injected through a catheter into the celiac artery during spiral CT. RESULTS: In 17 of the 18 (94%) patients, the area of pancreatic parenchymal enhancement was the same or larger at pharmacoangiographic CT than at conventional angiographic CT. The attenuation value of the pancreatic parenchyma was significantly increased at pharmacoangiographic CT (p = 0.0010). Although the attenuation value of tumors was also increased on images obtained after the injection of angiotensin II, the tumor-to-pancreas contrast was significantly greater at pharmacoangiographic CT (p = 0.0479). The mean differences in attenuation between tumor and pancreas at angiographic CT with and without angiotensin II were respectively 182 HU and 115 HU. CONCLUSION: Pharmacoangiographic CT with angiotensin II proved superior to conventional angiographic CT in the diagnosis of pancreatic disease. We therefore recommend it as a supplementary technique at the angiographic examination of patients with suspected pancreatic tumor.

Sensitivity in detection of hypervascular hepatocellular carcinoma by helical CT with intra-arterial injection of contrast medium, and by helical CT and MR imaging with intravenous injection of contrast medium.

Year 1998
Hori M. Murakami T. Oi H. Kim T. Takahashi S. Matsushita M. Tomoda K. Narumi Y. Kadowaki K. Nakamura H.
Department of Radiology: Osaka University Medical School, Japan.
PURPOSE: To determine the effectiveness of i.a. contrast-enhanced helical CT and of i.v. contrast-enhanced helical CT and MR imaging, in detecting hypervascular hepatocellular carcinoma (HCC). MATERIAL AND METHODS: Fifty patients with 125 hypervascular HCC nodules underwent helical CT both during arterial portography (CTAP) and during hepatic arteriography (CTHA). Helical CT and MR imaging of the entire liver with i.v. administration of contrast medium were also performed. Helical CT images were obtained at 30-33 s (arterial-phase CT) and at 5 min (equilibrium-phase CT) after the initiation of an i.v. bolus injection of contrast medium. After T1- and T2-weighted spin-echo MR imaging, gradient-echo images during breath-holding were obtained prior to and 20 s, 1 min, and 2 min after the bolus administration of 0.1 mmol/kg of gadopentetate dimeglumine (dynamic MR). The sensitivity and positive predictive value of the various techniques were evaluated and compared. RESULTS: In terms of sensitivity for hypervascular HCC nodules of less than 1 cm in diameter, CTAP (90%) and CTHA (88%) were significantly superior to dynamic MR imaging (44%), arterial-phase CT (39%), spin-echo MR imaging (20%), and equilibrium-phase CT (7%) (p < 0.001). However, there was no significant difference in the techniques with regard to the detection of lesions equal to or more than 2 cm in diameter. CONCLUSION: For detecting small hypervascular HCCs, helical CT with i.a. contrast enhancement is superior to helical CT and MR imaging with i.v. enhancement.

Portal and splanchnic haemodynamics in patients with advanced post-hepatitic cirrhosis and in healthy adults. Assessment with duplex Doppler ultrasound.

Year 1998
Dinc H. Sari A. Resit Gumele H. Cihanyurdu N. Baki A.
Department of Radiology, KTU Medical Faculty, Trabzon, Turkey.
PURPOSE: To assess portal and splanchnic haemodynamics, and splanchnic vascular resistance in patients with advanced post-hepatitic cirrhosis and in healthy volunteers, by means of duplex Doppler ultrasound (US). MATERIAL AND METHODS: The duplex Doppler US examination was performed in 16 patients with cirrhosis and in 24 healthy volunteers. We investigated vessel diameters, mean flow velocities, and mean blood flows in the portal vein, the superior mesenteric artery (SMA), and the splenic artery (SA), and measured the resistive index values of SMA and SA. RESULTS: The mean portal venous blood flow in patients with cirrhosis (829 +/- 264 ml/min) was not statistically different from those in the volunteers (734 +/- 194 ml/min). The ratio of the SMA and SA blood flows (621 ml/min) to the portal venous blood flow (734 ml/min) was 0.85 in the control subjects. The mean portal venous blood flow (1261 ml/min) and the portal venous velocity (14.6 cm/s) were higher in the patients with recanalized para-umbilical veins than in the volunteers and in the patients without recanalized para-umbilical veins. The SMA and SA blood flows were significantly increased in patients with cirrhosis compared with volunteers. Splanchnic inflow (the sum of the SMA and SA blood flows) was higher than the portal blood flow in patients with cirrhosis except in the subjects with recanalized para-umbilical veins. SMA and SA resistive index values were significantly higher in these patients than in the volunteers. CONCLUSION: Splanchnic blood flow and splanchnic vascular impedance increased significantly in patients with advanced post-hepatitic cirrhosis. Splanchnic inflow must not exceed portal venous blood flow in patients with recanalized para-umbilical veins. Portal vein velocity and portal venous blood flow measurements alone are not useful parameters for discriminating patients with cirrhosis from healthy subjects.

Peritoneocele and enterocele. Formation and transformation during rectal evacuation as studied by means of defaeco-peritoneography.

Year 1998
Bremmer S. Mellgren A. Holmstrom B. Uden R.
Department of Diagnostic Radiology, Karolinska Institute, Danderyd Hospital, Stockholm, Sweden.
PURPOSE: To study, by means of defaeco-peritoneography, the formation and transformation of the peritoneocele, with and without an enterocele, during rectal evacuation. MATERIAL AND METHODS: Forty-six patients with a peritoneocele at defaeco-peritoneography were selected for the study, and examined at three different stages: 1) at the start with a contrast-filled rectum; 2) at maximum straining; and 3) at rest after rectal evacuation. RESULTS: Fourteen patients had a peritoneocele at the start. These peritoneoceles were largest at maximum straining and were all still present at rest after rectal evacuation. In 32 patients defaeco-peritoneography was regarded as normal at the start. At maximum straining these patients developed a peritoneocele and 20 of these were still present after rectal evacuation. No enterocele was seen at the start. At maximum straining 21 patients developed an enterocele and 15 of these were still present after rectal evacuation. Liquid in varying amounts was found in the peritoneoceles. CONCLUSION: The present study demonstrated that peritoneoceles were present at different stages of the defaeco-peritoneographic investigations. Peritoneoceles were most frequent and largest at maximum straining. An enterocele was present in half of the peritoneoceles at maximum straining, but never at the start. Liquid was often present in the peritoneoceles.

Hepatic parenchymal perfusion abnormalities after pancreaticobiliary surgery. Evaluation with dynamic helical CT.

Year 1998
Mitsuzaki K. Yamashita Y. Ogata I. Nishiharu T. Urata J. Takahashi M.
Department of Radiology, Kumamoto University School of Medicine, Japan.
PURPOSE: To evaluate perfusion abnormalities of the liver after pancreaticobiliary surgery. MATERIAL AND METHODS: We retrospectively evaluated 128 patients with pancreaticobiliary malignant tumors who had been examined both before and after surgery by means of helical CT of the liver. An infusion of 3 ml/s of 60% nonionic contrast material was followed by helical CT of the liver in a sequential arterial phase, portal venous phase, and equilibrium phase. RESULTS: Of 128 patients, we followed 97. In 21 patients (22%) we found 47 lesions with perfusion abnormalities that were detected 1-33 months (mean 6.6 months) after the operation. All patients were asymptomatic. The shape of each perfusion abnormality was characterized as geographic (n = 23, 47%), wedge-shaped (n = 21, 45%), or round (n = 3, 8%). The abnormalities were seen in the arterial phase in 46 lesions (98%), in the portal venous phase in 18 lesions (38%), and in the equilibrium phase in 1 lesion (0.2%). In all lesions, the size either decreased spontaneously, or it remained unchanged for more than one year. CONCLUSION: Perfusion abnormalities of the liver may occur in patients who undergo pancreaticobiliary surgery. This findings should not be confused with hypervascular metastases.

Relationship of 31P MR spectroscopy to the histopathological grading of chronic hepatitis and response to therapy.

Year 1998
Kiyono K. Shibata A. Sone S. Watanabe T. Oguchi M. Shikama N. Ichijo T. Kiyosawa K. Sodeyama T.
Department of Radiology, Shinshu University School of Medicine, Matsumoto, Japan.
PURPOSE: In vivo phosphorus-31 MR spectroscopy (31P MRS) was performed in the human liver in order to investigate the relation between: the ratios of phosphorus metabolites in the liver; the histopathological grading of chronic hepatitis; and the response to therapy. MATERIAL AND METHODS: Hepatic 31P MRS using the DRESS method (depth-resolved surface-coil spectroscopy) was carried out in 45 patients with chronic viral hepatitis or autoimmune hepatitis, and in 16 control subjects. We measured the ratios of the peak areas of phosphomonoesters (PME), inorganic phosphate (Pi), or phosphodiesters (PDE) to the peak area of beta-adenosine triphosphate (ATP). RESULTS: The PDE/ATP ratio of patients with chronic hepatitis or liver cirrhosis was lower than that of control subjects (liver cirrhosis = 0.74; chronic active hepatitis = 1.13-1.21; normal = 1.43); only a small difference was found in the PME/ATP and Pi/ATP ratios. There was no correlation between the spectra and histopathological grading or response to therapy, but the response to therapy was poor when a reduced PDE/ATP ratio was present. CONCLUSION: The PDE/ATP ratio measured by 31P MRS makes it possible to identify the transition of chronic active hepatitis into liver cirrhosis with a poor response to therapy.

Diagnosis of acute left-sided colonic diverticulitis by three radiological modalities.

Year 1998
Eggesbo HB. Jacobsen T. Kolmannskog F. Bay D. Nygaard K.
Department of Radiology, Aker University Hospital, Norway.
PURPOSE: To compare the findings at US, CT and contrast enema (CE) with the clinical, biochemical, and surgical findings in patients with suspected acute left-sided colonic diverticulitis (ALCD). MATERIAL AND METHODS: The study comprised 32 consecutive patients hospitalized with clinically diagnosed ALCD. During the first 3 days of hospitalization, they were examined by US and CT of the pelvis and abdomen, and CE. RESULTS: Of the 32 patients, 21 had ALCD according to the combined radiological, clinical, biochemical and surgical findings. Findings compatible with ALCD were verified by radiological examination alone in 12 patients (4 patients at US, 10 at CT, and 6 at CE). In 9 patients, only diverticula or tethering was found at either CE or CT, and the diagnoses were then supported by clinical and biochemical findings and clinical follow-up. The most common clinical symptoms and signs associated with ALCD were left lower quadrant pain, left-sided tenderness, and fever. Most patients showed elevations of the white blood-cell count, erythrocyte sedimentation rate, and C-reactive protein, but there was no statistical difference in the stages of severity of ALCD, or between ALCD and other abdominal disorders. CONCLUSION: Radiological examination is valuable in confirming the diagnosis of ALCD. CT was the radiological modality that best demonstrated ALCD and revealed complications (e.g. pericolic abscesses) during the course of the illness.