The American journal of roentgenology, radium therapy, and nuclear medicine最新文献

A method has been evaluated for the quantification of the angiographic severity of pulmonary embolism. There was close agreement between observers especially in the more severely affected cases. The method has been shown to be sensitive enough to demonstrate highly significant differences between treatment regimens and to assist in the selection of treatment at the outset.

Plain orifice-view roentgenograms permit measurement of the area circumscribed by calcium in patients with heavily calcified aortic valves. The measurements relate well to the actual size of the orifice. Therefore, this roentgenographic technique serves in a practical fashion as a non-invasive method for the assessment of the severity of the aortic stenosis in such patients. During the injection of contrast material, orifice-view roentgenograms serve as a useful adjunct to standard aortography. Such views permit assessment of the valvular leaflets, size of the aortic ring, and the degree of stenosis.

Ture pulmonary varices are congenital local dilatations of a pulmonary vein or veins, with normal or collateral transpulmonary drainage into the left atrium. Pulmonary varices do not cause pulmonary venous hypertension, but existing varices can further become dilated by pulmonary venous hypertension due to mitral valve disease. Embryologically, pulmonary varices may represent residual primitive splanchnic venous components incorporated into the pulmonary venous system, or atresia of an individual pulmonary vein which occurred at a time that enable adoption of unobstructed transpulmonary collateral drainage into the left atrium. True pulmonary varices do not produce symptoms, do not change in diameter over the years, and, usually, do not require treatment.

Careful attention to the dimensions and symmetry of the interureteric ridge, when it is visible, aids in interpretation of abnormalities in the bladder and ureters. It is important in evaluating renal agenesis, low ureteral calculi, trauma, and neoplasm.

In a series of 24 cases of acute dissecting aneurysm of the aorta (not including Marfan's disease) the diagnosis was usually suspected on the basis of the clinical picture and plain chest roentgenograms. The most consistent clinical sign was severe pain. Absent pulses and a neurological deficit were each noted in only five patients. In many cases there was no correlation between the clinical picture and the type or the extent of the dissection. Widening of the aortic arch and obliteration of the aortic knob with displacement of the trachea to the right are the most common signs in plain chest roentgenograms. A barium swallow examination in these cases reveals an elongated compression and displacement of the esophagus by the aortic arch. Calcification in the area of the aortic arch is the exception rather than the rule in dissecting aneurysms. Angiography is essential for the definitive diagnosis of dissecting aneurysms. The diagnosis is based on the demonstration of two channels, either by the presence of a linear radiolucency separating the two lumens, or by differences in flow that present as delayed opacification or delayed washout. If only the true lumen is opacified, widening of the outer extraluminal border of the aorta or narrowing of the lumen indicates the presence of a dissection. Abnormal catheter recoil and position were helpful in only two cases, and are not informative when the false lumen is catheterized. Failure to visualize main aortic branches was not always due to involvement by the dissection. It can also be caused by reduced flow due to severe proximal compression of the main lumen. The exact location of the intimal tears is usually not demonstrated unless additional injections are made in the area assumed to contain the tear. If only the false lumen is opacified in the ascending aorta, this can be recognized by the demonstration of a blind end, by failure to visualize the sinuses of Valsalva, from flattening of the medial border of the opacified channel, and from delayed washout in the blind end.

Forty-four patients with operatively created arteriovenous fistulas have been examined angiographically. Widening of the main arteries of the forearm was evident, the most pronounced widening occurring in the artery feeding the fistula. Stenosis of the arteries or veins seldom influenced the flow significantly. Blood from the fistula was often partly or totally directed into the hand. In nine patients filling of deep veins was evident, and in most of these cases big fistulas were present. A rough estimate of the blood supply to the hand indicated poor supply in eight patients of which only one had symptoms of ischemia. Brachial angiography is of value in estimation of the blood flow in fistulas, when cannulation of veins is difficult, when thrombosis is suspected, or when a new fistula is planned after decreased function of an old one.

Successful nonsurgical treatment of gastrointestinal bleeding and arteriovenous malformations by embolization techniques has been previously documented. 1) Compressed Ivalon sponge was found to be a suitable embolic material in animals and in four patients. 2) The material has been extensively used in surgery, and its biocompatibility has been proved. 3) Expansion of the compressed sponge to its original size after embolization makes this material extremely effective. Recanalization did not occur in animals and humans. 4) For the occlusion of larger arteries, Ivalon can be wrapped around the guidewire. Ivalon sponge absorbs blood and serum, unwraps itself allowing withdrawal of the guidewire. 5) Embolization procedures are not without risk since reflux of embolic material may occur. Therefore, these procedures have to be carried out under fluoroscopic control.

Male breast disease, although overshadowed by its female counterpart, is still a problem which often comes to the attention of the radiologist. The major importance of mammography is differentiating unilateral gynecomastia from cancer. We now recognize four xeroradiographic patterns of gynecomastia: (1) increased ducts only; (2) ductal hyperplasia mimicking adenosis; (3) small ducts with stromal proliferation; and (4) fatty replacement only. These reflect the duration of the process. Gynecomastic masses are central, smooth, and most important, extend from the nipple outward, usually bisecting the midplane. Ducts may be visible. Carcinoma is usually central, dense, with irregular spiculated margins and, unlike gynecomastia is rarely in the midplane of the nipple, although it can be retroareolar in location. There may be concomitant skin changes or lymphadenopathy seen on the xerogram and these never occur in gynecomastia. There are numerous etiologies for gynecomastia, and these have been discussed in detail. It is thought that the radiologist should be aware of the pathophysiology of male breast disease and understand its significance.