Critical reviews in diagnostic imaging最新文献

Malignant testicular tumors are an important clinical problem, and ultrasound is the most frequently ordered imaging modality once a palpable scrotal mass is discovered. Numerous articles discussing the role of ultrasound in the evaluation of testicular pathology have confirmed the value of preoperative imaging. This article presents a review of imaging literature regarding testicular neoplasms, with an emphasis on correlation of gross and microscopic tumor pathology and imaging findings. Also included are sections on anatomy, epidemiology, histogenesis, and tumor markers.

The incidence of ductal carcinoma in situ (DCIS) has increased significantly in the last 2 decades, due to the diagnosis of asymptomatic cancers by screening mammography. These cancers are usually diagnosed by the presence of calcification on mammography. Histologic classification of these tumors is controversial, and established and proposed classification systems are reviewed. The role of breast conservation in the treatment of many of these lesions is generally accepted, although areas of debate regarding its application in these patients persists.

While the plain film and nuclear medicine bone scan are still the traditional imaging modalities used in the evaluation of musculoskeletal infection, the cross-sectional imaging modalities, computed tomography (CT) and magnetic resonance imaging (MRI), have become critical in the delineation of many types of musculoskeletal infection. In particular, the evaluation of soft tissue infections, including cellulitus, myositis, fasciitis, abscess, and septic arthritis are often best evaluated by MRI or CT due to their excellent anatomic resolution and soft tissue contrast. Even in osseous infection, CT and MRI can give better anatomic delineation of the extent of infection. In cases where the plain film and nuclear medicine bone scan findings are complicated due to previous surgery, trauma, or underlying illness, the anatomic resolution and soft tissue contrast provided by MRI and CT are often necessary to determine if underlying infection exists. MRI's visualization of the bone marrow allows for the sensitive detection of osteomyelitis, although specificity for the diagnosis of osteomyelitis is aided by other findings, including cortical destruction. The CT and MRI findings in the spectrum of musculoskeletal infections are discussed and contrasted, and pitfalls in their evaluation of musculoskeletal infection are described.

Objective: To review the changing manifestations of PTLD in patients with renal transplants.

Methods: Review of 1954 records of the renal transplantation clinic from 1971 to 1993 produced 17 patients with the diagnosis of PTLD.

Results: With changes in immunosuppression, the sites of involvement of PTLD have changed. Central nervous system involvement was the predominant site of disease prior to the use of cyclosporine. With the institution of cyclosporine, thoracic, and abdominal presentations became more common. PTLD isolated to the renal transplant is a new manifestation of disease that may be a result of immunosuppression with OKT3. Monomorphous PTLD was associated with a 78% PTLD related mortality. Polymorphous PTLD had a 0% PTLD related mortality. In patients with cross-sectional imaging abnormalities, PTLD presented as solitary or multiple masses in 78%. This is the finding most suggestive of PTLD in a transplant population.

Conclusion: Posttransplantation lymphoproliferative disorder is a heterogeneous grouping of lymphoid proliferation with variable clinical and radiographic manifestations. An understanding of the range of manifestations may lead to improved diagnosis of this unusual disorder.

Computed tomography (CT) plays a significant role in establishing the diagnosis in clinically equivocal cases of renal infection, determining the extent of the disease process, and assessing its complications. Gas, calculi, renal parenchymal calcifications, hemorrhage, and masses can be revealed with unenhanced CT. A subsequent study with contrast enhancement is crucial for the complete evaluation of patients with renal infection in order to demonstrate the areas of altered nephrogram that occur as a result of the inflammatory process and to identify complications. In this article we review a spectrum of renal inflammatory disease, with illustrations of the CT findings in representative cases. We also review the role and potential pitfalls of fast scanning techniques that can image a particular phase of the nephrogram in a renal infection. In acute pyelonephritis, enhanced CT scans obtained during the cortical nephrographic phase typically demonstrate solitary or multifocal hypodense areas with obliteration of the corticomedullary differentiation. Delayed images obtained during the excretory phase are frequently more helpful in defining the extent of the disease process, identifying the complications such as renal abscess, and confirming the presence of urinary obstruction than are early images.