Role Of Diagnostic Imaging Research Articles

Coronary artery anomalies: incidence, pathophysiology, clinical relevance and role of diagnostic imaging

Conventional coronary angiography is the gold standard for the diagnosis of coronary artery anomalies. Coronary anomalies are relatively rare findings in patients undergoing conventional coronary angiography for suspected obstructive coronary artery disease. Recently, the increasing performance of diagnostic techniques, such as electron beam tomography (EBT), magnetic resonance (MR) and, more recently, multislice computed tomography (MSCT), has enabled their application to cardiac imaging. MSCT, in particular, has a prominent role in coronary imaging due to its spatial and temporal resolution and three-dimensional capabilities. We report the incidence and pathophysiology of coronary artery anomalies based on the capabilities of recent diagnostic tools with the aim of improving an accurate and noninvasive diagnostic approach.

Posttraumatic bile leaks: role of diagnostic imaging and impact on patient outcome

The aim of this study was to evaluate the impact of bile leaks on patient morbidity and hospital course following blunt and penetrating liver trauma. Forty patients who underwent hepatobiliary scintigraphy after trauma were included. Scintigraphic results were classified as follows: free intraperitoneal bile leak, contained bile leak, and no bile leak. Outcomes measured were length of hospital stay, number of procedures required, and number of subsequent imaging studies. Bile leaks were identified in 25% of patients. Eight percent had free intraperitoneal leaks, 18% contained bile leaks, and 73% had no bile leak. One study was nondiagnostic due to poor hepatic function. Mean hospitalization was as follows: free bile leak group, 53 days; contained bile leak group, 10 days; no bile leak group, 14 days. Patients with free intraperitoneal bile leak had more imaging studies and procedures than patients without free bile leak. Patients with liver injury and free intraperitoneal bile leak have longer hospitalizations and undergo more therapeutic procedures than those without, who respond to conservative management.

Pancréatites chroniques et inflammatoires : apport des techniques d’imagerie en coupe

The role of diagnostic imaging in chronic and inflammatory pancreatitis is to detect structural changes of the ducts and pancreatic parenchyma, to assess the functional integrity of the gland, to detect associated complications, and to assist in management. These goals may be achieved using helical CT and MR imaging with secretin stimulation. In this review, the advantages of each technique are discussed and illustrated.

Cardiac MR and CT: Prime focus for correlative imaging

Cardiac disease is recognized as a major worldwide health problem with significant morbidity and mortality. Early diagnosis and treatment coupled with aggressive preventive measures are essential for positive outcomes. Rapid technological development has focused prime consideration upon the relative and correlative roles of magnetic resonance and computed tomography in the early diagnosis of heart disease, including coronary artery disease. In addition, the research emphasis in biomedicine, with the advent of the National Institute of Biomedical Imaging and Bioengineering and with the current focus at the National Institutes of Health on the Roadmap for Biomedical Research in the next decade, has recognized that imaging does and will play a vital role in diagnostic imaging and in fundamental biomedical research. The accelerating energy and number of program initiatives involved with multimodality molecular imaging provide an added opportunity and responsibility for investigators in the field to describe and evaluate the relative roles of imaging modalities that will interdigitate with the growing capabilities in molecular biology, genomics, and proteomics. These new tools will enable new methodologies, which will be deployed in addressing major worldwide health problems including heart disease, cancer, and stroke. Our special issue on cardiac imaging, comparing and contrasting MR and CT, represents a serious effort to define the state-of-the-art in this field. In addition, this compilation of articles sets forth the model that MRI must increasingly be applied, interpreted, and extended in correlation with other modalities used in healthcare and in biomedical research. We are fortunate to have Pamela K. Woodard, MD, Assistant Professor of Radiology, Cardiovascular Imaging Laboratory, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, and Arthur E. Stillman, MD, PhD, Head, Section of Cardiovascular MRI, Division of Radiology, The Cleveland Clinic Foundation, Cleveland, Ohio, as guest editors of our special issue. The editorial board wishes to express its appreciation to them for a job very well done.

VALVULAR HEART DISEASE

Congenital and acquired valvular disease remains a frequent cause of morbidity and mortality. It presents a diagnostic challenge in all age groups, and often occurs in conjunction with other types of heart disease. Traditional chest radiography provides the earliest opportunity for radiologic diagnosis, hence the need for skill and knowledge in interpreting the radiographic findings. Echocardiography with color flow Doppler measurements is frequently the next modality applied. CT and MR imaging can simultaneously display cardiovascular morphology with greater spatial resolution than ultrasound, and at the same time provide quantitative assessment of cardiac function. The role of diagnostic imaging is therefore crucial, both for primary diagnosis and in the management of valvular heart disease. Furthermore, it is fundamental in evaluating the results of all forms of interventional therapy.

Acute Pancreatitis: The Role of Diagnostic Imaging

In the U.S., acute pancreatitis is usually caused by excessive consumption of ethanol or by biliary stone disease. Major pathologic findings and complications include fluid collections within the organ or the adjacent peripancreatic tissues, pseudocysts, pancreatic necrosis, pseudoaneurysm, and abscess formation. Radiologic imaging, including endoscopic retrograde cholangiopancreatography (ERCP), sonography, and computed tomography (CT), are important in the evaluation of acute pancreatitis and its complications. CT in particular also aids in grading the severity of acute pancreatitis and in predicting complications and mortality; however, CT correlation with Ranson's clinical prognostic factors or with other classification systems is less clear. The imaging and therapeutic aspects of acute pancreatitis are discussed and illustrated and prognostic factors are correlated.

MRI of the ageing and herniating intervertebral disc

The role of diagnostic imaging from the patient’s perspective is to provide answers to four basic questions:—what is wrong?, How bad is it?, Is it clinically relevant?, Can it be treated? In the assessment of spinal disorders, multiple modalities have evolved in an attempt to answer the questions poised. Without doubt, the advent of MRI has given this process significant benefits primarily because of the unparalleled way of depicting normal and abnormal tissues in a non-invasive manner. In particular, MRI is admirably suited to study the intervertebral disc and goes a long way in answering the first two questions, aiding in the accurate analysis of disc morphology, defining pathological states, and delineating the extent and effect of disease. This information however, needs to be equated with the clinical signs and symptoms before any decisions concerning treatment options can be made. At this point one needs to exercise some degree of prudence and remember that MRI as yet does not differentiate abnormal asymptomatic from symptomatic painful disc levels. Enhancement with gadolinium compounds may go some way in providing some answers by defining the tissue response at or around the damaged points within the disco-vertebral unit. Modern MRI scanners and techniques demonstrate exquisitely, the structural status of the disc but the functional impact of these structural alterations cannot as yet be fully determined by MRI—there lies the challenge for the future. This article reviews the current MRI knowledge concerning the ageing and herniating intervertebral disc in a clinical context, and critically appraises its present role in a practical fashion.

Self-expanding metal stents in the management of colorectal carcinoma — a preliminary report

The role of diagnostic imaging in colorectal carcinoma is in the initial diagnosis, staging and detection of complications of the disease. Seven cases of colorectal carcinoma are presented where expandable metallic stents were placed for the management of stenosing lesions in patients with advanced metastatic disease or with serious medical complications which prevented immediate surgery. Seven patients (five male, two female) with an age range of 51-76 years had expandable metallic stents placed over a 9-month period. All stents were placed successfully with no immediate complications. The stents remained in situ for a range of 7-210 days. Expandable metallic stents can be successfully and safely placed in the colon. These stents may be useful in the management of patients with advanced metastatic disease or in those presenting with large bowel obstruction in which decompression by a stent allows treatment of coexisting medical complications to enable surgery to be carried out at a later date.

Acute Pancreatitis: The Role of Diagnostic Imaging

In the U.S., acute pancreatitis is usually caused by excessive consumption of ethanol or by biliary stone disease. Major pathologic finding and complications include fluid collections within the organ or the adjacent peripancreatic tissues, pseudocysts, pancreatic necrosis, pseudoaneurysm, and abscess formation. Radiologic imaging, including endoscopic retrograde cholangiopancreatography (ERCP), sonography, and computed tomography (CT), are important in the evaluation of acute pancreatitis and its complications. CT in particular also aids in grading the severity of acute pancreatitis and in predicting complications and mortality; however, CT correlation with Ranson's clinical prognostic factors or with other classification systems is less clear. The imaging and therapeutic aspects of acute pancreatitis are discussed and illustrated and prognostic factors are correlated.

Value of computerized tomography and magnetic resonance tomography in psychiatric diagnosis

This paper evaluates the role of computed tomography (CT) and magnetic resonance imaging (MRI) in the diagnosis of psychiatric disorders according to the "International Classification of Diseases" (ICD-10). Indications for CT/MRI can be derived from ICD-10 for the identification or exclusion of defined cerebral lesions resp. for the etiology in organic disorders. Due to the lack of specific morphological findings, CT/MRI do not contribute to the classification of all other diagnoses. CT/ MRI can only exclude causal organic factors. However, ICD-10 provides only few guidelines for ruling out cerebral pathology (e.g. tumors in bulimic anorexia). Therefore, recommendations for routine CT/MRI-investigations for the exclusion of organic disorders are required and might be developed by the quality assurance. Application of CT or MRI: CT plays an important role in diagnostic imaging in routine as well as in emergency situations (haemorraghe, hamatoma, infaction, head injury, tumour, vascular malformation). MRI on the other hand, is more sensitive in the diagnosis of inflammatory diseases, skull base lesions, degenerative changes of the white matter and in the imaging of hydrocephalus and epilepsy.

Lumbar Disc Herniation, Spinal Stenosis and Segmental Instability: Role of Diagnostic Imaging

Lumbar Disc Herniation, Spinal Stenosis and Segmental Instability: Role of Diagnostic Imaging

Role of diagnostic imaging in evaluation of the dental implant patient.

Dental implants have become an accepted form of permanent tooth replacement. Nearly all implants currently being placed are of the osseointegrated type. These typically consist of three parts: a fixture, an abutment, and a screw or threaded rod. The fixture, usually composed of titanium, can be placed in either a surgically created site in the alveolar ridge or a fresh extraction socket. Diagnostic imaging can play an important role in evaluating patients with such implants. Useful imaging studies include plain panoramic radiography, computed tomography, and computer-reformatted cross-sectional, panoramic, and three-dimensional imaging. Advanced imaging studies can be used to determine the suitability of implant placement, appropriate sites for implant placement, the size of the implant that can be placed, and the need for preimplantation ridge surgery. Postoperatively, advanced imaging studies can show failure of an endosseous implant to osseointegrate, improper placement of an implant, and violation of important structures.

Role of Diagnostic Imaging in the Evaluation and Treatment of Post‐operative Complications of the Urinary Tract

Role of Diagnostic Imaging in the Evaluation and Treatment of Post‐operative Complications of the Urinary Tract

Urinary tract infection in paediatrics: the role of diagnostic imaging

Infection of the urinary tract (UTI) has several clinical subgroups, each requiring different degrees of investigation. The most severe, acute pyelonephritis, is characterized by ill health, anorexia, pyrexia (>38.5°C), an erythrocyte sedimentation rate greater than 20 mra/h or C-reactive protein greater than 10mg/l, pyuria, bacteruria and possible septicaemia. The child may well require hospitalization and parenteral antibiotics. The term cystitis is used to refer to children with lower urinary tract symptoms but without systemic illness who have more than 100000 bacteria per ml in the urine. They should be distinguished from children who are asymptomatic but nevertheless have positive urine cultures, i.e. asymptomatic bacteruria. This last group usually consists of girls over 5 years old and do not require much investigation. Clinically these three groups overlap to some extent, but nevertheless the presentation should be a guide to the choice of the appropriate imaging. Urinary tract infection is common: the imaging that children undergo is important in terms of resource utilization as well as discomfort and radiation exposure. A conscious effort must be made not to over-investigate the child or to overburden the radiology department, yet treatable disorders or potential long-term complications must be detected (Saxena et al, 1975; Asscher, 1980). A prospective study by Dickson (1979) found 3.1/ 1000 girls and 1.7/1000 boys presented annually with a first symptomatic UTI. The incidence of end-stage renal failure due to pyelonephritis in Europe in individuals under 40 years of age is 4–5 per million per year (Broyer et al, 1984).

Diagnostic imaging of fertility disorders

It is estimated that as many as 15% of married couples are affected by fertility disorders. The number of such couples seeking medical help has increased dramatically in the past 10 years due to both relative and absolute factors. The increase in population, the rising rate of sexually transmitted diseases, and the reduced availability of adoptable infants all contribute to the magnitude of this problem. The role of diagnostic imaging in the effective and compassionate care of couples desiring offspring is the subject of this review. Infertility is a disorder of a couple, not of two individuals. The diagnostic evaluation, therefore, must include both partners. Hysterosalpingography and ultrasound constitute the mainstay of the evaluation of the female member. The various techniques and complications of hysterosalpingography are reviewed. The normal appearance of the uterine cavity together with a review of the numerous anomalies and variations that might be encountered are presented. Along similar lines, the possible filling defects, synechiae, postoperative changes, and other alterations that may be encountered in imaging the uterine cavity are described. Evaluation of the fallopian tubes is of paramount importance, primarily to assess patency but also to assess the possibility of patent but diseased salpinges or disease of the surrounding peritubal tissue. Recently, interventional techniques using radiographic and sonographic control have been developed and are beginning to demonstrate promising results in the management of fallopian tube obstruction. These procedures, adapted from previously established radiographic interventive techniques, are discussed. The role of diagnostic imaging of the male partner is of lesser magnitude. Clinical assessment and semen evaluation generally permit adequate assessment of the male factor. Occasionally, however, vasography and seminal vesiculography are called into play. More frequently, sonographic evaluation to establish the presence of varicoceles is necessary. Such techniques are reviewed, as well as the interventional approaches for ablating varicoceles. The application of conventional and transvaginal sonography in the management of gynecologic fertility disorders is reviewed. Follicular monitoring, guided follicle aspiration, assessment of the status of the endometrium, guided embryo transfer and tubal cannulation, and evaluation of other pelvic disorders are significant factors in the appropriate management of the infertile couple. The advent of transvaginal techniques has greatly facilitated these procedures. This presentation is intended to provide an improved understanding of the role of diagnostic imaging, thus increasing the capabilities of radiologists involved in the care and management of the infertile or subfertile couple.

Low-Osmolality Contrast Media: A Current Perspective

Intravascular radiographic contrast media play a major role in diagnostic imaging. Recently, low-osmolality contrast media (LOCM) have become available in the United States. Because of their lower osmolality, these new agents cause fewer undesirable physiologic effects and fewer adverse reactions than do conventional agents after intravascular administration. Unfortunately, the cost of LOCM is substantially higher than the cost of conventional contrast media. Appropriate use of these newer, more expensive contrast agents must be based on a thorough knowledge and understanding of their chemistry, physiologic features, and relative safety. Some questions remain about these new agents. Further studies are needed to determine the nephrotoxicity of LOCM relative to that of conventional agents. In addition, LOCM have less anticoagulant capacity than do the conventional media; therefore, clotting may occur when the LOCM and blood mix in syringes and small catheters. This potential decrease in anticoagulation and its clinical implications should be further investigated. Finally, the mortality rate associated with use of LOCM needs to be determined in future studies in large numbers of patients.

Radiologic Evaluation of Intraabdomenal Masses in Childhood

The abdominal tumors in children are different from those of adult. These tumors are the third most common one, preceded by leukemia and brain tumors, in children under 15 years. X-ray examination is the most important method among diagnostic approaches. The role of diagnostic imaging is to identify the precise anatomic location and extent of pathologic process with the minimal number of imaging procedures. 23 cases of abdominal tumors were reviewed in respect of age incidence, site of origin, radiologic findings. The results are briefly summarized as follows : 1. Neuroblastoma was the most common(6 cases) and wi1m's tumor(5 cases), choledocal cyst(4 cases), ovarian mass(3 cases), hydronephrosis(2 cases), were descending order in frequency. 2. The most common site was retroperitoneum(60%). Kidney was the single most common site of origin. 3. Radiologic findings. The most common findings of plain radiography was ill defined soft tissue mass and this method was helpful in the presence of calcification especially in neuroblastoma. Ultrasonographic pattern was anechoic(cystic), echoic or mixed pattern, but this method provide less precise anatomical details, nevertheless ultrasonography wes paticullary useful imaging modality for the pediatric abdominal tumors. IVP findings were renal displacement, caliceopelvic system distortion or nonvisualization of kidney, these information was helpful in determining the location of tumors. CT scan showed homogenous or inhomogenous, cystic or solid, mass with their anatomic location. 4. Ultrasonography was the most widely used specific diagnostic method, but had limited value in detecting the anatomic location of tumors. CT scan was superior to ultrasound for determining the extent of tumors.

Staging of genitourinary cancers. The role of diagnostic imaging.

Computed tomography (CT) is currently the standard modality for staging of urologic cancer in most institutions. It is used for demonstrating nodal involvement, and for demonstrating invasion of the primary lesion into surrounding fat, muscle, or other tissues or organs. It is also useful for demonstrating hepatic metastases in renal and vesical carcinomas. The problem with computed tomography, however, is that it can only show whether the nodes are large or not; neither can it show the nodal architecture, nor can it detect metastases in normal-sized nodes. Intravesical sonography has been helpful for staging papillary bladder cancer. Transrectal sonography has been somewhat helpful for demonstrating seminal vesicle invasion in patients with prostatic carcinoma. Inferior vena cavography and renal venography can be helpful for demonstrating whether a renal, renal pelvic, or adrenal carcinoma has extended into either vein. Lymphography can show nodal architecture and metastases in normal-sized nodes, and can make possible needle biopsy of abnormal-appearing nodes even if they are normal sized. The examination cannot show very small or microscopic nodal metastases, and it can miss abnormal nodes totally if they have been completely replaced by metastases. It yields false positives when fatty or fibrous infiltration of the nodes has occurred. It is used primarily for staging patients with testis or prostatic carcinoma. Bone scans are essential for staging prostatic carcinoma. Magnetic resonance imaging (MRI) is helpful in some cases of renal cell carcinoma. Multiplanar imaging prevents overstaging. It is also accurate for showing whether the renal vein or inferior vena cava are involved. Enlarged lymph nodes are easily distinguished from vessels. For staging bladder carcinoma involving the fundus or base of the bladder, MRI is better than CT. Microscopic nodal metastases, such as are common in carcinoma of the prostate, currently are not detected by any imaging modality.