Journal of the Canadian Association of Radiologists最新文献

There were 23 patients who had revisions of their failed hip arthroplasties and a prior radiophosphate assessment of the joint components. In this selected group of patients the true positive incidence of abnormal scintigraphic findings for femoral component loosening was 19 out of 20 (95%) and the true negative incidence was two out of two by the criteria adopted. The true positive incidence of such findings, indicating acetabular component loosening, was seven out of seven, and the true negative was nine out of 10. Some of these patients also had contrast arthrography and the incidences of true positive and true negative findings for femoral component loosening were seven out of 15 (47%) and one out of one, respectively. Prediction of the status of the acetabulum was poorer using this technique with true positive and true negative incidences of four out of nine and two out of five, respectively.

We have performed therapeutic embolization of the hepatic artery and its branches in 15 patients, 14 with metastatic neoplasm and one with postoperative hepatobiliary hemorrhage. In the latter patient, bleeding ceased on embolization of the right hepatic artery and did not recur. The median survival time of the 14 patients who had hepatic embolization was six months. The mean survival time in our three patients with metastatic gastric leiomyosarcoma was 24 months, whereas our five patients with metastases from carcinoma of the colon had a mean survival time of only five months. On the basis of this experience we conclude that hepatic artery embolization is advisable in patients with hormonal effects of metastatic disease and in patients with massive hepatomegaly related to metastases from gastric leiomyosarcomas, and may be indicated in patients with hepatic artery hemorrhage.

We report the radiographic appearances of urinary tract complications in 11 patients with Crohn's disease, which included ureteric obstruction, displacement of ureters, renal calculi, bladder involvement with a pseudotumor appearance, and enterovesical fistulae.

Duplex ultrasonography and intravenous digital subtraction angiography (IV-DSA) were used as the initial diagnostic studies in 124 patients referred for evaluation of neurological disorders possibly related to carotid bifurcation disease in the neck. Conventional angiograms were subsequently performed in 29 patients. Diagnostic images were obtained in 100% of the angiograms, 94% of the duplex ultrasonograms and 89% of the IV-DSA studies. Using the angiogram as the reference standard for plaque detection, duplex ultrasonography had a sensitivity of 0.93 and specificity of 0.83. Doppler velocity ratio alone was used to detect all patients with angiographically demonstrated disease but demonstrated a specificity of only 0.35. IV-DSA showed a sensitivity of 0.93 and specificity of 0.91. IV-DSA and duplex ultrasonography agreed in the assessment of degree stenosis in over 90% of cases and we conclude that these two modalities have approximately the same sensitivity and specificity for detecting atherosclerotic disease at the carotid bifurcations.

We review the technique of double-contrast arthrotomography (DCAT) including reference to a new, superficial and bevel-oriented puncture and the use of a special density compensation filter. We have found it possible to demonstrate the varieties, size and exact location of rotator cuff tears in the coronal and sagittal planes. Adaptation of the method to studies of the glenoid labrum also yields excellent results. DCAT is now the best technique of shoulder arthrography.

Osteochondritis dissecans is a disorder which rarely involves the patella. It must be differentiated from chondromalacia, lateral marginal fracture due to direct injury, medial facet osteochondral fracture secondary to traumatic lateral dislocation and a dorsal defect of the patella. I report a patient in whom computed tomography (CT) helped confirm the diagnosis. Although usually diagnosable from plain films, in difficult patients CT should be considered.

The diagnosis of diffuse malignant infiltration of lung is often made with certainty only by open lung biopsy or at autopsy. However, the clinical presentation and radiological examination are often sufficiently characteristic to suggest the diagnosis. Percutaneous fine-needle aspiration biopsy (PFNAB) has been reserved mainly for the diagnosis of focal lesions of lung and has been reported not to be useful in the diagnosis of diffuse lung disease, especially when the latter is mainly interstitial. We report 15 patients with radiologically diagnosed diffuse interstitial infiltration of lung, 13 of whom had lymphangitic carcinomatosis either on clinical follow-up, cytological or pathological examination. Cytology by percutaneous fine-needle aspiration biopsy was positive for malignant cells in 11 of the 13 patients. We propose that PFNAB be used early in investigation when the clinical and radiological findings suggest that a patient has diffuse malignant interstitial lung infiltration.

The presence of tibio-talar slant is reported in an adult patient with Down syndrome. No previous description of this deformity in connection with Down syndrome has been found.

Plain radiographs and wrist arthrography of 11 patients with non-united fractures of the scaphoid were retrospectively studied. The arthrographic feature of non-union was found to be opacification of the fracture line and, secondly, of the midcarpal compartment, whereas in patients with fibrous or cartilaginous union no opacification of the fracture line was obtained. There was no single plain radiographic feature that could distinguish non-union from fibrous or cartilaginous union.

An osteoid osteoma is a benign bone lesion which may involve the femoral neck. The lesions are distinctively osteoblastic, containing a central fibrovascular and osteoid nidus which often evokes substantial periosteal reaction occasionally making the diagnosis by conventional radiography very difficult. Computed tomographic evaluation of these lesions at other sites has been previously reported. I wish to emphasize the unique value of CT multiplanar reformatting in a patient with an osteoid osteoma of the femoral neck.