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Patients over 50 years old with intrauterine low density on enhanced computed tomography were analyzed. Uterine volume and volume of intrauterine low density were calculated. Intrauterine low density was expressed as a percent of uterine volume. At 1-year follow-up, 23 (63.9%) had uterine malignancy and 13 (36.2%) had benign findings. All patients whose intrauterine low density exceeded 35% of the total uterine volume had a malignancy (p < 0.001). If intrauterine low density exceeds 35% of uterine volume, evaluation of uterine malignancy should be performed regardless of symptoms.

Yersinia enterocolitica is becoming increasingly recognized as a source of abscess formation in patients with numerous underlying disease entities, most notably hepatic and hematologic disorders. Patients ranging in age from infancy to adulthood can become infected with this worldwide pathogen, which seems to be relatively rare in the United States. We present the appearance of a Yersinia abscess on computed tomography in the hope that an increased awareness of this infection will result in earlier diagnosis and improved therapeutic management.

This case report describes a serendipitously diagnosed renal carcinoma in a transplant donor. Computed tomography was instrumental in establishing the true nature of this mass based on its ability to demonstrate pooling of contrast material and staining of discrete septae on dynamic postcontrast scans.

Thirty-six of 119 patients with myasthenia gravis examined by computed tomography for possible thymic mass had a thymectomy. The computed tomographic findings were compared to the findings of chest x-ray and linear tomography and then correlated with the surgical histopathologic results. Computed tomography detected all cases of thymoma or thymic enlargement due to hyperplasia. Chest x-ray correctly demonstrated 50% of thymomas present while linear tomography demonstrated 88%. Computed tomography was not able to distinguish between enlargement due to thymoma or hyperplasia unless calcification was present. The role of computed tomography is detailed and discussed in relationship to the other diagnostic modalities.

CT can be helpful in staging bladder and prostate cancer as described previously. The limitations are significant in certain aspects of staging. It is important for the future to compare state-of-the-art computed tomographic scanning with newer imaging modalities such as magnetic resonance imaging, which is currently being evaluated for staging these particular tumors.

To evaluate the impact of computed tomography (CT) on therapeutic management decisions in solid tumors of the chest and abdomen, 92 examinations on 54 children with 13 histologic tumor types were analyzed. The CT impact on the management decisions was analyzed in relation to other diagnostic procedures of the same body part including sonography, chest films with tomography, abdominal/pelvic films, and excretory urography. Overall, CT provided the essential information of 47% of management decision. By confirming non-CT examination results it helped direct therapeutic decisions in 28%. No additional information was derived from CT in 20%. Technically poor studies in 5% resulted in CT errors. According to the procedural method, CT provided additional information in 42% when compared with sonography, in 38% when compared with chest films and tomography, in 41% when compared with abdominal/pelvic films, and in 27% when compared with intravenous urography. The investigation showed that CT provided information directly affecting the therapeutic management decision in a significant number of patients.

The CT features of endobronchial granular cell myoblastoma are reported in an acknowledged heavy smoker without pulmonary complaints. Computed tomography confirmed the intraluminal location of the mass, demonstrated associated atelectasis, and detected the lack of adenopathy or invasion into the mediastinum, thus contributing significantly to surgical planning.

Thirteen patients with a variety of renal pelvic filling defects were evaluated using computed tomography (CT). Nonopaque calculi and some blood clots can be more accurately differentiated with this modality than has heretofore been possible. In transitional-cell carcinoma of the renal pelvis, the main value of CT appears to be in tumor staging. CT may also be helpful where urography cannot discriminate between extrinsic compression and true intraluminal renal pelvic defects.

Thirty-six consecutive patients either with primary or recurrent carcinoma of the cervix were evaluated by computed tomography (CT) to assess CT's ability to screen patients prior to radical surgery. Overall accuracy when compared to surgical findings or skinny needle biopsies was 80%. In accuracies by CT were the results of inability to assess minimally enlarged lymph nodes, inability to distinguish fibrosis from recurrent tumors, and difficulty in delineating actual tumor invasion versus contiguity of adjacent pelvic organs. Computed tomography proved to be a sensitive indicator in delineating actual tumor bulk and sidewall extension. Information gained by CT compared favorably with that obtained by intravenous urography, barium enemas, lymphangiography, and nuclear medicine bone scans. This comparison indicates that CT can serve as a sensitive imaging modality to assess the surgical candidacy of patients either with initial or recurrent carcinoma of the cervix. An algorithm of studies is proposed based on this preliminary investigation.

Breast cancer is sometimes treated with an excisional biopsy and a radiation portal limited to the breast and the adjacent chest wall, especially in patients with negative lymph node dissections. The beam passes through this portion of the chest wall tangentially. Such radiation can result in changes in the included lung parenchyma that are pleural-based and sharply demarcated from the normal lung on CT lung windows. In our experience CT lung windows were more sensitive than chest radiography in showing these changes. Such changes must be recognized and differentiated from pleural metastases. Computed tomography also resulted in a more specific diagnosis than chest radiography because it better localized the abnormality to the radiation portal.

After pelvic exenteration for cancer, the gracilis muscles, skin, and subcutaneous fat from the inner aspect of both thighs may be raised as a pedicle flap and tunneled under the skin into the pelvic space to create a neovagina. We reviewed nine pelvic CT examinations in six patients to evaluate the CT appearance of this procedure and its complications. Five patients are alive and without complications. One patient died 6 months after surgery and had a small-bowel fistula to the neovagina. Normal CT findings included air in the vaginal canal in six of nine examinations, gracilis muscle atrophy in two patients who had early and late CT studies, and early separation of the anterior and posterior approximation of the flaps in one patient. Abnormal findings were seen in two patients: one had an abscess near the vaginal apex that was drained per vagina; the other had extraluminal air in the retropubic and subcutaneous fatty tissues due to a small-bowel fistula into the vagina.

The sixteenth case of bilateral ureteral obstruction with anuria secondary to an abdominal aortic aneurysm with perianeurysmal fibrosis is presented. The details of this case clearly indicate the need for a combined vascular and urologic approach to patients with this disorder. A complete preoperative evaluation, including excretory urography, retrograde pyeloureterography, aortography and, when indicated, venacavography, may determine renal and vascular abnormalities that will allow a more definitive and successful management of this difficult problem. Furthermore, we believe that the use of computed tomography is an invaluable tool to define this retroperitoneal disease process and its precise relationship to the ureters.

Neurofibromatosis is a relatively common disorder that often involves many organ systems. One of the least understood aspects of this malady is a well documented potential for sarcomatous degeneration of neurofibromas. The inability to identify patients at risk and the lack of noninvasive screening methods for symptomatic patients often leads to late diagnosis. In six of seven subsequently proven neurofibrosarcomas, CT demonstrated low-density areas that histopathologically appeared to be due to necrosis, hemorrhage, and/or cystic degeneration. The density differences within these sarcomas were enhanced by the intravenous administration of iodinated contrast agents.

An unusual case of a cervical mucocele (focal hydrometra) was diagnosed only after correlation of ultrasonic, CT, and physical examination findings.

CT scanning was performed on 29 consecutive patients with clinically localized prostatic carcinoma (stage A or B). Bipedal lymphangiography was performed in 12 cases. Histologic confirmation was obtained in 15 cases (pelvic lymphadenectomy in 12 and positive percutaneous needle biopsy in three). In these 15 proven cases, the overall accuracy of CT was 93% with one false positive and no false negatives. Lymphangiography was far less accurate (55%) with two false positives and three false negatives in 11 proven cases. The greater accuracy of CT resulted primarily from its ability to detect abnormal nodes in the pelvis, particularly hypogastric nodes, which are rarely opacified by lymphangiography. Preliminary experience suggests that CT is superior to lymphangiography in detecting early lymphatic spread from prostatic carcinoma in the pelvis. In the future, CT-guided percutaneous needle biopsy should be useful for documenting metastases in these patients.

To better understand the morphologic appearance of avascular necrosis (AVN) of the femoral head on magnetic resonance (MR) images (1.5 T) and computed tomographic (CT) scans, the records of 21 lesions were reviewed retrospectively. All MR imaging studies included T1-weighted images (T1WI) (repetition times [TR] of 400-1,000 msec, and echo times [TE] of 20-25 msec), and 15 included T2-weighted images (T2WI) (TR = 2,000-2,500 msec; TE = 60-80 msec). MR signal features of the lesions were compared with features on the corresponding CT scans. Abnormalities in the superoanterior aspect of the femoral head were noted on both image types in all 21 lesions but were more obvious on MR images in two. A characteristic margin of peripheral sclerosis seen on CT scans in 95% (20 of 21) of lesions corresponded to a line of low intensity on MR images. Fractures complicating AVN were seen in eight lesions at CT scanning. On T1WI, fractures were not clearly delineated. On T2WI, fractures were of high intensity but were depicted less clearly than on CT scans. Central signal intensity of the lesions on T1WI correlated with the presence or absence of fracture: 88% (seven of eight) of the lesions with fractures appeared less intense than fat, compared with only 8% (one of 13) of lesions without fractures (P less than .005). While MR imaging is a sensitive method for early diagnosis of AVN, CT scanning can more accurately identify fractures and is thus important for staging.

Rarely do pancreatic pseudocysts extend into the mediastinum. We recently evaluated a case exemplifying this phenomenon. Although ultrasonography demonstrated the nature of the mass, computed tomography (CT) allowed better definition of various anatomic relationships and afforded improved definition of the superior aspect of the pancreatic pseudocyst. The role of CT and its advantages over ultrasonography in the diagnosis and management of pancreatic pseudocyst are discussed.

High-density renal masses are atypical lesions that represent a diagnostic dilemma for computed tomography (CT). The differential diagnosis includes mainly complicated benign cysts and malignant neoplasms. This report analyzes the CT findings in 17 cases of discrete, sharply marginated masses that initially exceeded the density of the uninvolved renal parenchyma, averaging 50 H or more. The subsequently proven pathologic entities responsible for these high attenuation values included primary malignancies in six patients, one of whom also had multiple retention cysts containing highly proteinaceous, gelatinous material; a hemorrhagic cysts with an associated desmoplastic, fibrotic reaction in one patient; and single or multiple hemorrhagic cysts in four patients. No histologic proof was obtained in six patients, three with neoplastic disease and one mentally retarded youth who underwent renal aspiration without sufficient material obtained for analysis. Two patients with presumed hemorrhagic cysts have had serial CT scans without interval change in 8-12 months. An approach to the therapeutic management of affected patients is described.

Duplication of the inferior vena cava and azygos continuation of the inferior vena cava arise from separate embryologic anlage. The former arises from persistence of both supracardinal veins and the latter from arrested development of the right subcardinal vein. Individually these entities are uncommon, but their occurrence together in one patient is exceedingly rare. A patient with both these anomalies of the venous system concurrently is described. This combination has been reported only once before in the radiologic literature.

An intrathoracic meningocele is a protrusion of spinal meninges through an intervertebral foramen into the thoracic cavity. The majority occur in association with neurofibromatosis, and bilateral or multiple lesions are rarely seen. In conventional radiography, small meningoceles may be hidden behind other mediastinal structures. To investigate paraspinal masses, computed tomography (CT) with intrathecal contrast material is likely to result in more frequent detection of unsuspected lateral meningoceles. This report details our experience with CT metrizamide myelography in a case of multiple bilateral intrathoracic meningoceles.

To assess the role of 1.5-T magnetic resonance (MR) imaging in evaluation of the adnexa, 43 consecutive examinations that revealed 61 adnexal masses were retrospectively reviewed. T1- and T2-weighted images in coronal, axial, and/or sagittal planes were included. Available ultrasound (US) (n = 30) and/or computed tomographic (CT) (n = 9) scans were then correlated with the MR images. On T2-weighted images at least part of all adnexal masses was of higher signal intensity than surrounding muscle and adipose tissue, and therefore the adnexal masses were best seen with these sequences. T1-weighted imaging improved tissue characterization by revealing signal characteristics of fat in teratomas and characteristics of blood in endometriomas or hemorrhagic cysts, pelvic inflammatory disease, ovarian carcinomas, serous cystadenomas, and teratomas. MR imaging provided additional information or increased diagnostic confidence in 25 of 30 patients who underwent US or CT. MR imaging is a promising problem-solving modality after US in the study of adnexal abnormalities.

Computed tomography examinations were performed on 74 patients who presented to the Children's Hospital of Philadelphia and the Hospital of the University of Pennsylvania with a known or suspected diagnosis of primary or secondary soft tissue sarcoma. Focal masses were detected on computed tomography study in 59 patients. These masses were classified into three broad categories: centrally necrotic masses with a large predominantly liquefactive center and higher density periphery (29); multilocular, septated masses with distinct linear bands or striations (21); and miscellaneous masses (9). The miscellaneous category included six inhomogeneous and three homogeneous masses. The apparent density differences within these sarcomas were best appreciated on dynamic postcontrast scans. The computed tomography appearance of these sarcomas may be explained by the pathologic findings of cystic degeneration, extensive necrosis, central cavitation, focal hemorrhage, and myxoid changes.

The therapy and prognosis of bronchioloalveolar carcinoma vary greatly with the solitary versus the diffuse form of the disease. Solitary disease demonstrates a high resectability rate with good long term prognosis. This contrasts with the rapidly fatal course associated with the diffuse form. To date, categorization of patients into either the solitary or the diffuse form has been based solely on conventional radiography. Multiple authors have reported cases of disease not demonstrated radiographically but discovered at surgery or autopsy. With the superiority of chest computed tomography (CT) for demonstrating parenchymal abnormalities, we propose that preoperative CT may be crucial in the workup of patients with presumed solitary bronchioloalveolar cell carcinoma. Early identification of diffuse disease or confirmation of the presence of solitary disease by CT may allow the institution of proper therapy and better evaluation of patient prognosis.

The role of computed tomography in the preoperative staging of bladder and prostate tumors is discussed and illustrated. The accuracy of judging perivesical tumor extent, various techniques of CT examination, and the clinical significance of evaluating local bladder extension are discussed. The CT evaluation of local periprostatic extension of tumor is examined in relationship to the type of planned therapy. A dynamic technique for lymphadenopathy evaluation is detailed. The accuracy of demonstrating lymphadenopathy by CT and its therapeutic impact on the surgical treatment of bladder and prostate malignancies are discussed.

This small series reports on the computed tomography appearance of hyperdense iliac, inguinal, and femoral lymph nodes in four cases of lymphoma and one case each of ovarian and breast carcinoma. The mean attenuation value of the lymph nodes was 93.8 Hounsfield units (HU), compared to 61 HU for adjacent muscle and 110.7 HU for blood vessels. A relatively homogeneous enhancement pattern was noted, which could not be directly related to hypervascularity, inflammation, or previous treatment with drugs or radiation.

Soft tissue calcification occurs in a variety of disorders. When it is associated with an abnormal calcium phosphorous product, it may present as large, periarticular masses that demonstrate layering on horizontal beam radiographs or computed tomography (CT). Previous reports have shown this phenomenon in idiopathic tumoral calcinosis. We report two patients with metastatic calcification of different etiologies: one patient with tumoral calcinosis and one with secondary hyperparathyroidism complicating chronic renal failure. Both showed layering on CT. The pathology of this phenomenon as well as therapeutic implications are discussed.

Fifty normal volunteers had unenhanced thyroid computed tomography scans. A range of normal computed tomography densities and volumes was established for each age group. Pre- and postcontrast scans were done on 47 abnormal patients with hemorrhagic cysts, multinodular goiter, thyroiditis, papillary carcinoma, and benign adenomas. The computed tomography characteristics of each of the pathologic groups was noted for both the abnormal areas and the uninvolved part of the gland. Preliminary observations of the computed tomography characteristics of each abnormality are discussed.

Diffuse hepatocellular processes are not well imaged by most radiologic modalities. At present, CT has not added significantly to the evaluation of hepatocellular disease, particularly in the cirrhotic liver. The CT patterns of cirrhosis previously described are reviewed, and the pathophysiology of cirrhosis is discussed. In 3 cases, a pattern was seen in cirrhotic livers characterized by nonuniform attenuation with varied response to administration of intravenous contrast agents. With further evaluation of fatty infiltration and cirrhosis, CT may prove helpful in understanding these disease processes.

The use of computed tomography (CT) in diagnosing disorders affecting the hollow viscera of the alimentary tract has received little attention. The authors reviewed CT scans of 43 patients on which lesions affecting the gastrointestinal tract were demonstrated. All cases were correlated with barium-enema examinations, surgical reports, or autopsy findings. CT can provide valuable information on the extraluminal extent of masses arising in the bowel, mesenteric masses, and can define and characterize extrinsic lesions. The authors's results suggest that CT is a useful adjunct in evaluating intramural or mesenteric lesions of the gastrointestinal tract.

High-resolution real-time ultrasound (US) and computed tomography (CT) were compared in 48 patients with a clinical diagnosis of thyroid abnormality and also correlated with biopsy or surgery. The modalities were considered comparable in 38 cases (79%), while CT was superior in 5 and US in 5. CT illustrated substernal extension of a goiter, demonstrated a 5-mm nodule not seen in US, showed 2 cases of thyroiditis better than US, and diagnosed a suspected thyroid mass as a lipoma anterior to the thyroid. US detected 4 nodules not seen on CT and resolved contiguous nodules that appeared to be a single nodule on CT. Both techniques lacked histopathological specificity. CT appears to be advantageous in detecting substernal thyroid extension and confirming thyroiditis, while the ability of US to detect small nodules makes it the procedure of choice in evaluating suspected intrinsic thyroid abnormalities.

If the initial evaluation of the urinary tract raises the possibility of renal mass, one must decide what study or studies to perform to confirm or deny its presence. Radionuclide imaging has been the study of choice in this situation. Six cases are presented in which computed tomography definitively demonstrated that a suspicious renal mass represented normal renal parenchyma. Comparison with other renal imaging modalities is discussed.

Diagnostic pelvic lymphadenectomies are used in both bladder and prostate carcinoma. Enhanced rapid-sequence computed tomographic (CT) scanning of the retroperitoneum and pelvis was done prospectively in patients scheduled for lymphadenectomies. The CT results were then compared to the histopathological findings in 32 patients to analyze the ability of dynamic CT to indicate whether a lymphadenectomy is needed. The comparison showed eight true positive, four false negative, 18 true negative, and two false positive. The sensitivity was 66%, specificity 90% and accuracy 81%. The diagnostic considerations of the role of CT based on these findings are illustrated and discussed.

Villous adenoma may have a specific appearance on barium enema examination but specific CT findings of villous adenoma have not been previously described. Two recently encountered cases of villous adenoma in the rectum had a distinctive pattern on CT. Suggested criteria for CT diagnosis of villous adenoma include a homogeneous water density component of less than 10 HU, occupying more than half the lesion and eccentric on the luminal side of the mass. This low density component interfaces with the majority of the luminal surface of the lesion. No air-fluid level is seen and the lesion should not have a round cystic configuration. A description of these findings is illustrated and discussed.