Roentgenologic Diagnosis Research Articles

Complex radiologic imaging of early breast cancer (literature review)

Clinicoroentgenological diagnosis of early breast cancer - BC (non-invasive or invasive small-sized cancers) is difficult due to the absence of any characteristic clinical symptoms and pathognomonic roentgenological signs of the malignant process. Screening of BC has shown to be one of the most successful projects for early diagnosis of malignancies, but the probability to receive false negative results using screening mammography reaches 12%, and, on the one hand, this is due to interval cancers, and on the other hand - to defects in the primary screening. Among the factors associated with the likelihood of ineffective screening of BC, the most authors highlight such as high breast density, preceding the breast biopsy for a benign process, young age, as well as the use of hormone replacement therapy. The main methods of instrumental BC diagnostics are mammography, ultrasound (US), magnetic resonance imaging (MRI) and positron emission tomography (PET). Mammography is the "gold standard" for both screening and best diagnostics, but is characterized by a high proportion of both false positive and false negative results, and this can be partially solved by the use of digital mammography with tomosynthesis (performing a series of mammography images obtained at different angles and producing the focused 3-D images). Contrast enhanced mammography allows to identify angiogenesis in the area of the predicted malignancy, but is characterized by a high radiation exposure. Breast ultrasound is characterized by low specificity of the method and the high dependence of the result of data interpretation depending on physician qualifications. MRI of the breast for screening is characterized by high sensitivity, but also high cost and high proportion of false positive results. The role of PET/computer tomography in the diagnosis of early BC remains unclear, and the informative value of research in patients with nonpalpable tumors is extremely low. The roentgenological picture of early BC is widely variable; characteristic features include the presence of clustered calcifications, lumps with jagged edges, rough multinodular lumps. However, in a significant proportion of women the only manifestation of early BC is the presence of microcalcinates. Careful analysis of the localization and the shape of microcalcinates and basic characteristics allows correctly interpret the roentgenological diagnosis and helps to choose the optimal diagnostic and treatment algorithm.

Use of PlateletRich Autoplasma in Complex Therapy of Knee Osteoarthrosis

Efficacy of platelet-rich autoplasma (PRA) in treatment of osteoarthrosis was evaluated. Prospective study included 120 patients (83 females, 37 males, mean age 52.8±4.5 years) with clinical and roentgenologic diagnosis of II-IV stage osteoarthrosis by Kellgren-Lawrence classification. The patients from the main group (n=60) were on courses of PRA intraarticular injections (3 injections with 1-2 weeks interval). In the control group the patients received nonsteroidal anti-inflammatory drugs (NSAIDs) and periodically injections of glucocorticoids when indicated. Results were assessed by the verbal efficacy scale, Lequesne index and the pain visual analog scale. Follow up period made up 6 months. Use of PRA enabled to eliminate pain syndrome and improve knee joint function without adverse effects. In 6 months the number of patients who noted the efficacy of treatment was 31% higher in the main group than in the control one. The obtained results allow recommending PRA use for knee osteoarthrosis treatment as an alternative to NSAIDs especially in contraindications to the latter.

Use of PlateletRich Autoplasma in Complex Therapy of Knee Osteoarthrosis

Efficacy of platelet-rich autoplasma (PRA) in treatment of osteoarthrosis was evaluated. Prospective study included 120 patients (83 females, 37 males, mean age 52.8±4.5 years) with clinical and roentgenologic diagnosis of II-IV stage osteoarthrosis by Kellgren-Lawrence classification. The patients from the main group (n=60) were on courses of PRA intraarticular injections (3 injections with 1-2 weeks interval). In the control group the patients received nonsteroidal anti-inflammatory drugs (NSAIDs) and periodically injections of glucocorticoids when indicated. Results were assessed by the verbal efficacy scale, Lequesne index and the pain visual analog scale. Follow up period made up 6 months. Use of PRA enabled to eliminate pain syndrome and improve knee joint function without adverse effects. In 6 months the number of patients who noted the efficacy of treatment was 31% higher in the main group than in the control one. The obtained results allow recommending PRA use for knee osteoarthrosis treatment as an alternative to NSAIDs especially in contraindications to the latter.

Roentgenological diagnosis for lumbar spinal canal stenosis—Relationship between IFR and MRI grade—

Roentgenological diagnosis for lumbar spinal canal stenosis—Relationship between IFR and MRI grade—

Radiologic Diagnosis of Shoulder Joint Deforming Arthrosis

The basis of the lecture is complex analysis and systematization of various forms of degenerative-dystrophic lesions of shoulder joint. With regard for the principles of modern clinical and roentgenologic diagnosis six etiologic and morphofunctional groups of shoulder deforming arthrosis are distinguished and characterized. Accurate diagnosis of clinical-roentgenologic type of the pathology will enable a physician to choose a maximum effective treatment technique.

Roentgenological diagnosis of alimentary tract emergencies in the new born

© 2008. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Diagnosis of focal spinal diseases - a critical review

The article offers a critical review of the diagnosis of focal diseases of the vertebral column, based on 200 histological vertebral column examinations. The findings obtained by means of the roentgenological, histological and bacteriological examinations can be subdivided into 6 groups: 1. Non-specific and specific cases of spondylitis (59 patients); 2. Systemic malignant diseases and primarily malignant tumours (23 patients); 3. Metastases (71 patients); 4. Benign tumours (11 patients); 5. Miscellaneous cases (28 patients) and 6. Unclarified cases (8 patients). The authors comment on the following points with specific reference to the results obtained by them: a) Possibilities and limitations of roentgenological diagnosis: roentgenologically, the inflammatory diseases are most easy to identify, but is not always possible to differentiate safely between non-specific, specific and plasmacellular spondylitis. There are clear limitations to the diagnosis of the type of focal diseases of the spinal column; this applies particularly to the benign and malignant types of tumours. b) Necessity of arriving at an accurate diagnosis: it is imperative to aim at an accurate diagnosis before any meaningful therapy can be initiated. The mandatory need for this is explained via examples covered by the present study. c) Closed or open biopsy: it is shown by means of a review of the literature that open biopsy yields more representative material for the histological examination than closed needle biopsy. It goes without saying that this is a true prerequisite for an accurate histological diagnosis. In this connection, the authors go into the details of the difficulties governing any histological examination. d) informative value of further additional examinations: Scintigraphy, tomography and computer tomography may be valuable aids in the discovery and better visualisation of a vertebral focus, but they are not helpful in arriving at a diagnosis regarding the type of focus involved. Laboratory examinations are not very helpful, either. e) Accuracy of the authors' own diagnostic measures: in spite of open biopsy, 177 cases only out of 200 (88%) could be diagnosed on a purely histological basis. In 12 further cases, diagnosis was established after correlation of the histological finding with the x-ray film. 8 cases (4%) could not be clarified. In 7 patients (3.5%) it must be assumed that the focus was not located despite open biopsy.

Lung metastasis in a patient with lymphangioleiomyomatosis

Summary Pulmonary lymphangioleiomyomatosis (PLAM) is a rare disease, which occurs mainly in women of reproductive age, and occasionally in postmenopausal women. We report a small pulmonary metastatic uterine body cancer in a 63-year-old female patient with PLAM. In patients with PLAM, differential diagnostic consideration is proliferation of pneumocytes and PLAM cells in addition to benign tumor as well as primary and metastatic lung cancer. We emphasize difficulties in the clinical and roentgenological diagnosis in this kind of combined pathology. Even if the association we describe is probably fortuitous, not only a primary but also a metastatic tumor is suspected when a solitary pulmonary nodule is detected in a patient that has been previously treated for carcinoma in any organs.

Morphology Predicts Oncology: A Commentary on Vezina and Sutton's Article, “Prolactin-Secreting Pituitary Microadenomas: Roentgenologic Diagnosis”

Morphology Predicts Oncology: A Commentary on Vezina and Sutton's Article, “Prolactin-Secreting Pituitary Microadenomas: Roentgenologic Diagnosis”

Advances concerning the diagnosis and treatment of carpal collapse

最近20年对腕塌陷有系统研究,X线片诊断标准的提出和修正进一步明确了腕塌陷的概念,舟月进行性腕塌陷分期法帮助临床医生更客观地追踪该病的发展和愈后.相关生物力学的研究使对此症病理机制的认识大为加深,并且成为手术方法选择的重要参考依据.以四角融合术为代表的各种部分腕骨融合术和近排腕骨切除术可以有效缓解症状,阻止腕塌陷的继续,成为该病的主要治疗手段,但必须要根据桡腕关节和腕中关节的具体情况灵活使用.硅胶假体置换术由于其明显的并发症基本被淘汰。

Appendiceal Diverticulitis

We report the case of a 56-year-old man with episodic right lower quadrant abdominal pain. Preoperative evaluation included computed tomography (CT) showing a right lower quadrant phlegmon consistent with cecal diverticulitis or appendicitis. The patient was treated with a short course of bowel rest and antibiotics. Four weeks later, he had an appendectomy. The patient was found to have chronic appendiceal diverticulitis and recovered uneventfully. Histopathologic studies revealed herniated mucosa through the muscular layer associated with chronic inflammation and marked fibrosis. These findings represent appendiceal diverticulitis. Diverticulosis of the appendix is believed to be uncommon and roentgenologic diagnosis of appendiceal diverticular disease is rarely made. We discuss the diagnosis and CT findings of appendiceal diverticulitis and present a thorough review of the literature.

Intensification roentgenologic and endoscopic diagnosis of stomach diseases

The diagnostic possibilities of roentgenologic and endoscopic methods using proper estimation criteria in various stomach diseases including rare pathologies like submucous tumors are determined. It is established that for diagnosis the endoscopic investigation for the most part is sufficient. A list of the indications to obligatory roentgenologic examination after endoscopy is given.

Acute torticollis in children due to atlanto-axial rotary fixation

Acute, painful torticollis in a child is not uncommon. When no local changes can explain the disease, atlanto-axial rotary fixation should be considered. The position of the head is typical but the roentgenological diagnosis is difficult, and as early treatment is mandatory, it should be initiated even if the roentgenogram is "normal". We present a review of nine patients.

Zur Wertigkeit der kombinierten computerunterstützten Perfusionsszintigraphie und Renographie bei Oligurie/Anurie von nierentransplantierten Patienten

Combined computer-aided perfusion scintigraphy and renography (computer renography) is used for the differential diagnosis of the etiology of transplant malfunctions in kidney-transplant patients. This article describes semiquantitative computer renography evaluation methods which have been used in 99 examinations of 58 oligo/anuric graft recipients. The accuracy of these methods was confirmed by patho-anatomical and roentgenological diagnosis. From the constellation of qualitative and semiquantitative scintigraphic perfusion, function and excretion parameters it was possible, by means of a flow chart, to draw conclusions regarding the location of the malfunctions (prerenal, renal or postrenal). Using the new methods, all patients could be correctly classified. With respect to more detailed differential diagnosis of renal malfunctions the accuracy was 82%. The comparison between perfusion measurements based on a perfusion index defined with the help of a planimeter on the one hand and an angiography graduation on the other hand, resulted in a correlation coefficient of 0.90 (p < 0.001). As a non-invasive examination which can also be carried out in emergency cases, combined computer-aided perfusion scintigraphy and renography should become part of standard diagnostic procedures for oligo/anuric graft recipients.

Radiology of the pancreas: two decades of progress in imaging and intervention.

The preceding article, “Roentgenologic Diagnosis of Pancreatic Disease,” was published in 1967 by Josef ROSCh in volume 1 00 of the AJA [1]. It presented the current status of pancreatic radiology and began “The pancreas is difficult to examine roentgenologically since it is small and situated deep in the retropentoneal space. . . . The roentgenologic diagnosis of pancreatic disease, therefore, mainly relies on the changes caused by pathologic processes in surrounding organs.” The pancreas was indeed the “hidden organ” in 1967. ROSCh concluded his article by stating that the radiologic evaluation of pancreatic diseases was still too limited and new methods of examination were needed, along with improvements in the performance and interpretation of current techniques. His main hope for the future was for the discovery of an agent that could be administered by mouth or IV and that would permit direct visualization of the pancreas or its excretory passages, similar to the way the kidney and bile ducts were then being studied. Two decades later, a variety of sophisticated, high-technology techniques have been developed that allow radiologists to image the pancreas directly, thus enabling diagnosis to be based on specific changes in the pancreatic parenchyma, ductal system, and vascular network, as well as on changes in surrounding organs or structures. This article presents the status of pancreatic radiology in 1988 and offers some hopes for the future.

Roentgenologic diagnosis of pancreatic disease. By Josef Rösch, 1967.

On the basis of his own experience and of literary sources, the author reports the present situation of the roentgenologic diagnosis of the pancreas. He evaluates the various examination methods and gives a general description of the typical characteristics of the diseases of the pancreas. In conclusion, he suggests ways for further improvements.

Talo-calcaneal coalition treated with resection.

Three cases of symptomatic talocalcaneal coalition (medial or posterior) have been treated successfully with resection of the connecting bar and fat interposition without fusion. At follow-up (ranging from 1 1/2 to 14 years), the patients had no pain, good function, good range of joint motion, and no regeneration of the bar. Computed tomography scanning was the method of choice for roentgenological diagnosis of talocalcaneal coalition.

Diagnosis of Asbestosis and Asbestos-Related Pleural Disease by Imaging Methods: Asbestos Related Disease

Four types of roentgenographic changes occur in the pleura-plaque formation, diffuse pleural thickening, calcification, and pleural effusion-each ofwhich may occur alone or in combination with the others. These pleural manifestations dominate the picture roentgenographically in the majority of series. Pleural thickening or pleural plaques usually are bilateral, more prominent in the middle third of the thorax, and tend to follow the rib contours. Pleural plaques are fibrotic processes that begin in the deepest part of the parietal pleura and morphologically are ivory white in color. They may be smooth or nodular in contour and may measure up to 1 cm in thickness, although they are usually thinner. They occur most commonly on the aponeurotic portion of the diaphragm, on the posterolateral chest wall between the 7th and 10th ribs, and on the lateral chest wall between the 6th and 9th ribs. Their origin in the parietal pleura is in contrast to the visceral pleural involvement that characterizes previous hemothorax or empyema. They may be very difficult to visualize, particularly when viewed en f ace, and tangential roentgenograms may be necessary. Although pleural thickening posteriorly may be difficult to recognize roentgenographically, its presence may be detected by CT or ultrasonic examination. The greatest problem in the roentgenologic diagnosis ofearly plaque formation lies in distinguishing them from normal companion shadows of the chest wall, and, in fact, distinction sometimes is impossible with conviction. Despite these difficulties, it is clear that noncalcified plaques occur often enough to be regarded as virtually diagnostic of asbestos-related disease. Although uncalcified pleural plaque formation is probably the most common roentgenographic manifestation of asbestos-related disease, the most striking abnormality is calcification of pleural plaques. Calcified plaques vary from small linear or circular shadows commonly situated over the diaphragmatic domes to complete encirclement of the lower portion of the lungs. When calcification is minimal, a roentgenogram overexposed at maximal inspiration facilitates visibility. No portion of the pleura is immune to calcification, although the most common site is the diaphragm.

Use of secretin in the roentgenologic and biochemical diagnosis of duodenal gastrinoma

The use of secretin in the biochemical and roentgenologic diagnoses of a duodenal gastrinoma has been described. Preoperatively, the secretin test indicated that a gastrinoma and not a retained antrum was the cause of hypergastrinemia in a patient who had previously undergone Billroth II gastrectomy. Intravenous infusion of secretin during selective angiography resulted in greatly enhanced visualization of the tumor which allowed it to be localized to the duodenal stump. Several months postoperatively, the secretin test result had become negative, which presumably suggested that the tumor had been excised completely. Our experience has revealed that intravenous secretin might improve the diagnostic usefulness of selective angiography.

Long-term results of the treatment of juvenile bone cysts

38 children between 5 and 14 years of age with juvenile bone cysts were followed up to a maximum of 20 years. In two-thirds of the cases the diagnosis was made on the occasion of a fracture in the cyst region. One child received conservative treatment, 37 children were operated on. The roentgenological diagnosis of all children operated on was confirmed histologically. The operative procedure consisted in milling out the cysts and filling the cavities with autogenous, allogenous or xenogenous spongiosa. Because of the high recurrence rate (10-40% in the literature and 19% from our own experience) we suggest a modified surgical procedure assuring complete recovery. Subtotal diaphysectomy with interposition of a corticospongious splinter and allogenous spongiosa using a stable osteosynthesis in the case of large primary cysts in metadiaphyseal position is discussed.