Radiologia diagnostica最新文献

The results of a comparison of clinical, roentgenological and cytological investigation of circumscribed growing tumours of the breast are reported - 43 carcinomas and 19 intracanalicular fibroadenomas - that are hard to differentiate. A number of diagnostically valuable symptoms are described: Significant for carcinoma are an age over 55, microcalcifications (60 +/- 13% of the cases) and different sizes of the tumour found by palpation and mammography (35 +/- 9% of the cases). The diagnostic accuracy of the methods was: clinical 44 +/- 8%, roentgenological 79 +/- 7%, cytological 89 +/- 3% and for their joint application in a special mammographic cabinet 98 +/- 2%.

CT provides exquisite anatomic detail of normal and pathologic adrenal glands but little specificity as to the nature of adrenal masses. MR reliably distinguishes non-functioning and hyperfunctioning adenomas (adrenal mass/liver ratio less than 1.2) and pheochromocytomas (adrenal mass liver ratio greater than 2.5). Metastases to the adrenal gland and primary adrenocortical carcinomas lie in the intermediate range (adrenal mass/liver ratio 1.4-2.5). Particularly problematic are masses with ratios in the 1.2-1.4 range since some non-functioning adenomas and some metastases will have similar signal intensities and cannot be distinguished.

Pericardial fluid can impair cardiac function. If medication is ineffective, puncture and drainage of the fluid is necessary. Three cases of CT-guided puncture and drainage of pericardial fluid are reported. The described technique is quick, of little risk and effective. It is superior to the conventional puncture of the pericardium from the subxiphoidal direction.

In 62 patients with proven pancreatic tumours in a joint retrospective study the sequence of diagnostic imaging methods was analysed. Their diagnostic value was evaluated according to their contribution to final diagnosis and a diagnostic strategy was derived. A valuable primary investigation is sonography. It should be complemented, according to the specific question, by ERCP, PTC and CT. The investigation with barium meal is a complementing method for the differentiation of epigastric disorders. Biopsy of the tumour for histologic purposes should be done as early as possible. A first guiding diagnosis was obtained with ultrasound in 50% of the cases, in 53% of them already with the first examination. In 23% of the patients, however, the final diagnosis was established not before surgery or dissection.

The arterial supply of the femoral head was studied by Hipp. Superselective angiographies in different positions of the hip joint contribute informations especially about the smaller vessels e.g. rami nutritii capitis. Angiographies in different positions of the hip joint were performed in twenty cases. Furthermore the results of functional stress angiographies of five patients, who underwent the transplantation of pedicle bone graft, are reported. These patients had femoral head necrosis. Especially these postoperative examination demonstrates in one case impressive deterioration of the perfusion of the pedicle bone graft in some positions of the joint.

Four cases of multiple cartilaginous exostoses in a family (mother and three children) are described. In two children the exostoses are combined with enchondromatosis of the large tubular bones. At some phalanges of these children the changes show the roentgenologic signs of solitary enchondromas and ecchondromas and in one of the cases with cartilaginous exostoses osteochondroma-like changes were found. The combination of the described symptoms seems to indicate a close relationship between enchondromatosis and the cartilaginous exostoses, as well as between these chondrodysplasias and the cartilaginous tumours.

In 30 patients the influence of ionic (Amidotrizoate) and non-ionic (Iopromide) contrast agents on the heart parameters contractility, relaxation, perfusion and the rate of extrasystoles was investigated. They were significantly less influenced by Iopromide than by Amidotrizoate. A negative inotropic action was detectable only for Amidotrizoate. It is concluded that non-ionic contrast media should be used especially for critical patients.

From the comparison of conventional radiography, computed tomography and angiography the diagnostic value of each of these methods is evaluated. Conventional radiography will remain the most significant method for detecting primary skeletal tumours even if magnetic resonance imaging is considered. CT is an important additional method for the evaluation of tumour size, but is disappointing for tumour classification. Bone scintigraphy is the most sensitive method for the differentiation of solitary and multiple tumours. Angiography is not necessary, except for the planning of surgery in certain cases.