Ceskoslovenska radiologie最新文献

The paper verified literature data assuming that the heart damage caused by irradiation of thorax may be scintigraphically detected by means of 99mTc-pyrophosphate. Three dogs underwent a single irradiation of thorax with a gamma cobalt source by the Dose 40 Gy. The myocardium scan was performed 24 hours, 20 days, 50 days, 80 days and 93 days after the irradiation. The scintigraphic examination proved to be negative at all the intervals observed. A comparison of the scan with morphological findings and with radioactivity of tissue samples after the dogs were sacrificed 93 days after the irradiation proved that the negativity of the pyrophosphate scintigraphy was caused by a minimum damage of the myocardium and not by an inability of 99mTc-pyrophosphate to be incorporated into radiation lesions. The data in literature on myocardium damage by irradiation appear to be considerably exaggerated.

The authors performed, in the period from February to May 1989 seven recanalization interventions on occlusions of femoral artery with a laser angioplasty. In six cases the dilatation of the formed primary canal was made by subsequent balloon angioplasty. In all patients the intervention was followed by a significant clinical improvement and increased doppler index. No significant clinical complications occurred during the interventions.

Thallium scintigraphy of myocardium is a diagnostic method of nuclear medicine which enables visualization of well perfused and vital tissue of myocardium by means of 201thallium absorbed by its cells. In the first part of the review the authors present various radiopharmaceuticals having been used in this area. Physical properties are described in greater detail as well as preparation and pharmacokinetics of 201thallium. The method of examination is described in its basic form, but also some special cases of detection and evaluation are presented, such as ECG-synchronised thallium scintigraphy of myocardium and one-photon transaxial tomography.

The author describes the observation of nervus ulnaris neurinoma in a 10-year boy, who manifested the tumour clinically as a palpation -sensitive resistance. It was represented in the ultrasonographic picture as a sharply demarcated ovoid lesion of strongly hypo-echogenic character, homogenous echo-structure, while distal enhancement was mildly expressed behind the tumour. Based on the analysis of literature data the author discusses in detail ultrasonographic picture of tumours of peripheral nerves.

The authors review the modern concept of liver anatomy, related to the needs of surgeons in segmental resections. Important anatomical structures are described participating in division of the liver into four basic segments. The ultrasound anatomy of portal system, hepatic veins, hepatic fissures and liver hilus are dealt with in detail. Criteria for perfect examination of the liver by ultrasound are defined and representability of key anatomical structure under optimal conditions is analyzed in a group of 100 patients. The only non-constantly represented structure was fissura interlobaris (44%). Hepatic veins proved to be the most variable structures (17%). The results show that segmental anatomy of the liver may be very well represented by ultrasound. The authors discuss the importance of perfect knowledge of anatomy for quality examination.

Ultrasonography is a direct method of representation, giving various advantages over other methods in the examination of parathyroid glands: it is rapid, non-radiation and economically undemanding. Dynamic examination by means of the linear electronic transducer of 3.5 MHz and the use of water path was used in 37 patients. In 7 patients with primary hyperparathyroidism was the examination rapid and the pictures of the adenomas were persuasive. In 30 patients with secondary hyperparathyroidism were found characteristic pictures, if the glands were enlarged to 8 mm or more. For the diagnosis of smaller glands a high resolution transducer will be necessary. Histological finding was available in 21 patients undergoing operation, and easily available method and it is therefore the procedure of the first choice.

The author presents case histories of his patients and draws attention to the most frequently occurring developmental anomalies of truncus coeliacus. In addition to variations in the division and course of vessels of Tripus Halleri, there are also frequent hypoplasies of vessels and orificial compressions, caused by anomalous course of ligamentum arcuatum. The author also draws attention to the evaluation of the importance of vascular anomalies from the point of view of hemocirculation changes detected by angiography, used also in clinical practice until recently. In the last years the digital subtraction angiography and ultrasonography modified by the method of duplex scanning--exercise Doppler, substitute the classical abdominal angiography and materialize regional hypoperfusion of organs in clinically uncertain abdominal symptomatology.

A total of 42 patients with clinically suspect acute appendicitis or equivocal clinical finding indicating this diagnosis were examined by means of high resolution ultrasonography. The sensitivity reached in a group of 14 patients with acute appendicitis confirmed by surgery was 92.8%. The finding was considered positive if the appendix was visualized and, at the same time, its wall was wider than 3 mm or if there was an anechogenic lumen. In this way the specificity for the diagnosis reached 100%, overall accuracy reaching 95.2%. In this study there were two non-diagnostic cases and one false-negative case. In one subject without clinical signs of acute appendicitis there was a picture of normal appendix. A detailed attention was also paid to eight patients (from the total of 26 who were indeed negative), where ultrasonography contributed to the detection of another organic origin of the patients' complaints. The results have shown that ultrasonography may significantly contribute in conditions, where the surgeon is reluctant whether to operate on or not. This method appears to be a contribution also for differential diagnosis in this area.

The author detected a traumatic prolapse of stomach into thorax cavity. The X-ray examination was made only after ultrasonography. Two days after the operation, which confirmed the sonographic finding, symptoms of ileus became evident. The following ultrasonographic finding proved to be very similar to that made before the operation. A relapse of the prolapse was assumed to have occurred, but was not confirmed by a new operation. Since the X-ray examination of the stomach two months after the operation revealed a hiatus hernia, the author is of the opinion that a sliding hernia may have been cause of the erroneous diagnosis of the prolapse relapse.