Detection of focal hepatic lesions with spiral CT: comparison of 4- and 8-mm interscan spacing.B A Urban, E K Fishman, J E Kuhlman, A Kawashima, J G Hennessey and S S SiegelmanAudio Available | Share
To evaluate the utility of helical computed tomographic (CT) angiography for depiction of thrombi in the portal venous system in patients under consideration for transjugular intrahepatic portosystemic shunt (TIPS) creation.Contrast material-enhanced helical CT was performed before TIPS creation in 25 patients. Axial, multiplanar, and three-dimensional images were evaluated to determine whether thrombus was present in the portal system and whether TIPS creation was contraindicated. CT findings were confirmed at visceral angiography (n = 3), direct portography (n = 20), or duplex ultrasonography (n = 2).Ten (40%) of 25 patients, including 10 (56%) of 18 patients with refractory variceal hemorrhage, had thrombus in the portal venous system. Helical CT scans depicted thrombus in nine (90%) of 10 patients (95% confidence interval = 0.71, 1.00) and in 16 (94%) of 17 vessels (95% confidence interval = 0.83, 1.00), including the portal vein (eight of eight patients), splenic vein (three of four patients), and superior mesenteric vein (five of five patients). TIPS creation was canceled in four (16%) patients on the basis of CT findings.Thrombi in the portal venous system are common in patients with refractory variceal hemorrhage. Helical CT angiography is sensitive and specific for portal venous system thrombosis and can provide information that alters treatment in these patients.
The traditional gold standard for the evaluation of vascular pathology of the thoracic aorta has been conventional catheter-based angiography. In 1992, Costello et al. [1] illustrated the utility of spiral computed tomography (CT) for the noninvasive assessment of the thoracic aorta. Other authors subsequently further defined the role of spiral CT in the diagnosis of vascular pathology [2-6]. Because it decreases data acquisition time and obtains a volumetric data set during breath-holding, spiral CT minimizes or eliminates motion degradation and has been found to be well suited for the assessment of the thoracic vasculature [3-6]. More recent improvements in spiral CT technology, including subsecond scanning, combined with advances in computer software and hardware, have made possible the creation of 3-dimensional (3-D) images of the aorta that can be interactively displayed [6-8]. This pictorial essay illustrates the assessment of the thoracic aorta with real-time 3-D volumetric rendering of data acquired by spiral CT, depicting the value of this technique which, by allowing the viewer to interactively define the plane or perspective, allows for the viewing of anatomy from an infinite number of successive vantage points. This technique is ideal for the appreciation of the internal architecture of vessels, for the enhanced visualization of abnormalities such as intimal flaps, and for the more precise definition of the extent of disease.
Spiral computed tomographic angiography (CTA) coupled with three-dimensional volume-rendering image processing is a less invasive alternative to conventional catheter angiography. The technique has been used successfully in a variety of vascular diseases. In this pictorial essay, we review the CTA findings in selected cases of vasculitis. Technical considerations and the potential clinical value of this method are discussed.
Hepatic tumors treated by cryosurgery: normal CT appearance.B S Kuszyk, M A Choti, B A Urban, T P Chambers, D A Bluemke, J V Sitzmann and E K FishmanAudio Available | Share
Abstract Cases of full and mosaic trisomy 18 and a body of an infant with the 18p‐syndrome were dissected in detail to compare the anatomical variations associated with these 3 chromosome imbalances involving autosome 18. The types and numbers of morphologic variations present in both the full and mosaic trisomy 18 bodies were similar to the types and numbers of variations seen in all other cases of full trisomy 18 that have been sudied by gross dissection. Apart from an atrial septal defect, the body of the infant with the 18p– imbalance showed only 2 striking defects: (1) deficiencies of the levator palpebrae superioris muscle of the upper eyelid, and (2) absence of the ligament of the head of the femur. The first variation provedes a morphologic basis to explain the ptosis which is observed frequently in effected individual. Absence of the ligament of the head of the femur may be a factor contributing to congenital dislocation of the hip, which is reported occasionally in affecte individual. In addition to providing more detailed information about the phenotype of individual aneuploidy syndromes, studies of cases of single autosomes may provide additional insights about the genotype/phenotype relationships of specific chromosome segmeents.
Postpartum patients rarely develop complications that require radiologic evaluation. When indicated, CT can provide a rapid and reliable examination of the major pelvic organs and enable diagnosis of a multitude of postpartum complications, including abscesses, endometritis, thrombophlebitis, as well as more serious and potentially life-threatening sequelae of toxemia, DIC, and HELLP syndrome. This pictorial essay illustrates the utility of CT in the postpartum patient and demonstrates the spectrum of complications evaluated with CT.
