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To study the distribution and thromboembolic effect of Ultrafluid Lipiodol, 15 surgically removed hepatocellular carcinomas with selective intraarterial Lipiodol injection 7 to 10 days before surgery and 15 noninjected controls were studied radiologically and histologically. Tissue blocks were processed with an en bloc silver impregnation technique for Lipiodol localization in histologic sections. Lipiodol was distributed evenly in tumors measuring less than 5 cm in diameter and peripherally in tumors measuring 10 cm or more. Lipiodol droplets were mainly extracellular. There was no difference in tumor architecture or in hemorrhage and necrosis scores between Lipiodol-injected cases and negative controls (1.18 versus 0.92). Similarly, in injected cases, no differences were observed between Lipiodol-positive and Lipiodol-negative areas (scores of x-ray Lipiodol-positive versus Lipiodol-negative areas: 1.17 versus 1.36; scores of microscopic Lipiodol-positive versus Lipiodol-negative areas: 1.18 versus 1.14). Lipiodol-negative but hypodense areas examined by x-ray proved to be necrosis or fibrosis with or without viable tumor islands. Lipiodol has no thromboembolic effects. The uneven Lipiodol distribution may account for its failure as a carrier for chemotherapeutic agents in large tumors.

This study compares measurements taken by routine clinical means with those taken from computed tomography (CT) images. Ocular and head dimensions were measured. Correlation between techniques was reasonable for all parameters except exophthalmos. The correlation coefficient improved for measurement of exophthalmos when thin (5 mm) axial sections were used, however there were occasional large discrepancies in measured values. In general, measurement from CT scans gave smaller values than direct measurement, though interpupillary values were larger when measured from CT images. The results show the importance of choosing a mid-orbital axial scan plane and avoiding tilt of the scan plane for accurate measurement from CT images. Consistency in measurement techniques is also important for comparative measurements over time.

The histological distribution of lipiodol within hepatocellular carcinoma (HCC) was correlated with that seen on computed tomography (CT), arteriography and high resolution plain films of 15 resected specimens. By means of special stains, the arterially administered lipiodol was shown to be maximally distributed at the periphery of large tumours and nodules. The centre of large lesions often remained unopacified. In multinodular tumours some nodules were heavily stained while others contained little or no contrast medium. In small tumours there was a more uniform distribution. In large tumours, those areas where there are large arteries (and slow flow) contained little or no lipiodol. There was also no consistent match of areas of angiographic blush with lipiodol deposition. The lipiodol patterns were poorly shown by CT when compared with high resolution films taken on a mammography unit. We conclude from this study that lipiodol on its own as an embolic agent or as a chemotherapeutic carrier has great limitations because of its peripheral and otherwise haphazard distribution in large tumours. However, such treatments might be more effective in small tumours where a greater concentration of lipiodol is likely. Nevertheless, lipiodol staining of tumours remains a useful diagnostic aid as small HCC can be difficult to visualize both on arteriography and conventional CT.

Presents a medical image computing system which has been designed to extract and analyze quantitative information from a spatial sequence of CT (computed tomography) images. In particular, it has been applied to the quantitation and 3D reconstruction of the diffuse pattern of a radio-opaque anti-cancer drug, lipiodol-doxorubicin, in hepatocellular carcinoma. The PC-based system computes quantitative measures which can be used to assess the effectiveness of the chemotherapeutic treatment and to study the histology of the tumour. The system can provide a visualization of the tumour volume and quantification of drug absorption using 3D surface reconstruction and graphics techniques. >

Plain radiographs, computed tomographic (CT) scans and clinical records of 100 patients with nasopharyngeal carcinoma were studied. CT scans and plain radiographs provided similar information in 46 patients. There were 54 cases in which the two techniques disagreed. In 45 cases CT demonstrated abnormalities not seen in plain radiographs and in nine cases plain radiographs demonstrated abnormalities not seen with CT scanning. Based on the total information gained from clinical examination, the imaging investigations, biopsies, and subsequent clinical course and investigations it appeared that none of the abnormalities predicted by plain radiographs alone could be substantiated. Conversely the CT abnormalities could be supported as being correct. We conclude that CT alone is the undoubted investigation of choice where this is available. Plain films provide less information, are unreliable and, where CT is available, superfluous.

In a prospective study of 51 cases of lymphadenopathy (44 with cervical metastatic nasopharyngeal carcinoma, NPC) using intravenous contrast and computed tomography (CT), a ring enhancement was observed. A retrospective review of 105 cervical carcinomatous lymph nodes (64 with metastatic NPC) showed a prominent peripheral hypervascular pattern not seen in 48 lymphomas and 60 normal controls. We conclude that in carcinomatous cervical lymphadenopathy, enhancement can be achieved by intravenous contrast and CT; and the peripheral hypervascularity is the anatomical basis for the ring appearances seen radiographically.

Summary and conclusionsThere is now a wide choice of medical imaging to show both focal and diffuse pathologies in various organs. Conventional radiology with plain films, fluoroscopy and contrast medium have many advantages, being readily available with low-cost apparatus and a familiarity that almost leads to contempt. The use of plain films in chest disease and in trauma does not need emphasizing, yet there are still too many occasions when the answer obtainable from a plain radiograph has not been available. The film may have been mislaid, or the examination was not requested, or the radiograph had been misinterpreted. The converse is also quite common. Examinations are performed that add nothing to patient management, such as skull films when CT will in any case be requested or views of the internal auditory meatus and heal pad thickness in acromegaly, to quote some examples.Other issues are more complicated. Should the patient who clinically has gall-bladder disease have more than a plain film that shows gall-stones? If the answer is yes, then why request a plain film if sonography will in any case be required to ‘exclude’ other pathologies especially of the liver or pancreas? But then should cholecystography, CT or scintigraphy be added for confirmation? Quite clearly there will be individual circumstances to indicate further imaging after sonography but in the vast majority of patients little or no extra information will be added. Statistics on accuracy and specificity will, in the case of gall-bladder pathology, vary widely if adenomyomatosis is considered by some to be a cause of symptoms or if sonographic examinations ‘after fatty meals’ are performed.The arguments for or against routine contrast urography rather than sonography are similar but the possibility of contrast reactions and the need to limit ionizing radiation must be borne in mind. These diagnostic strategies are also being influenced by their cost and availability; purely pragmatic considerations are not infrequently the overriding factor.Non-invasive methods will be preferred, particularly sonography as it is far more acceptable by not being claustrophobic and totally free of any known untoward effects. There is another quite different but unrelated aspect. The imaging methods, apart from limited exceptions, cannot characterize tissues as benign or malignant, granulomatous or neoplastic; cytology or histology usually provides the answer. Sonography is most commonly used to locate the needle tip correctly for percutaneous sampling of tissues. Frequently sonography with fine needle aspiration cytology or biopsy is the least expensive, safest and most direct route to a definitive diagnosis. Abscesses can be similarly diagnosed but with needles or catheters through which the pus can be drained.The versatility and mobility of sonography has spawned other uses, particularly for the very ill and immobile, for the intensive therapy units and for the operating theatre, as well in endosonography. The appointment of more skilled sonographers to the National Health Service could make a substantial contribution to cost-effective management of hospital services.Just when contrast agents and angiography have become safe and are performed rapidly, they are being supplanted by scanning methods. They are now mainly used for interventional procedures or of pre-operative ‘road maps’ and may be required even less in the future as MRI angiography and Doppler techniques progress.MRI will almost certainly extent its role beyond the central nervous system (CNS) should the equipment become more freely available, especially to orthopaedics. Until then plain films, sonography or CT will have to suffice. Even in the CNS there are conditions where CT is more diagnostic, as in showing calculations in cerebral cysticercosis. Then, too, in most cases CT produces results comparable to MRI apart from areas close to bone, structures at the base of the brain, in the posterior fossa and in the spinal cord.Scintigraphy for pulmonary infarcts and bone metastases and in renal disease in children plays a prominent role and its scope has increased with new equipment and radionuclides. Radio-immunoscintigraphy in particular is likely to expand greatly not only in tumour diagnosis but also in metabolic and infective conditions. Whether the therapeutic implications will be realized is more problematic. The value of MRS and NM for metabolic studies in clinical practice is equally problematical, although the data from cerebral activity are extremely interesting.While scanning has replaced many radiographic examinations, endoscopy has had a similar effect on barium meals and to a lesser extent on barium enemas. The combined visual/sonographic endoscope is likely to accelerate this process.There is no doubt that over the last 2 decades medical imaging has changed the diagnostic process, but its influence on the outcome of disease other than infections is less certain and probably indefinable. Data concerning the comparative efficacy in terms of patient outcome for each of the imaging techniques would be of considerable interest and a great help in determining diagnostic strategies.

Summary While investigating the radiological appearances of globus pallidus calcification in an autopsy case, cortical-pia mater calcification was detected. There was no documentation of its existence in the literature of radiology, neurology and neuropathology. To establish its incidence and clinical significance, 20 consecutive autopsy brains (15 males, 5 females, age 32–73 years, mean age 56.7) were studied with high resolution radiography and histology. Clinical records, autopsy findings, in-life plain skull films and computed tomography of the brain (if available) were reviewed. Radiologically, the calcifications appeared as 1–2 mm irregular spots or tiny pin-point opacities in the pia mater and subcortical regions, either unilaterally or bilaterally in the frontal (15 cases), temporal (15), parietal (3) and occipital lobes (1). Similar calcification was detected in 1 of the 3 in-life computed tomographic scans available. Histologically, these cortical-pia mater calcifications were extracellular amorphous calcified masses of various sizes in necrotic neural tissue, frequently associated with microscopic haemorrhage and hypoxic neuronal changes in the adjacent brain tissue. Blood vessels in the region were not hyalinized or calcified. The occurrence was not related to age. Hospital stay was < 7 days in 14 and < 30 days in 2; 50% of patients died within 48 hours after admission. None of the patients had records of long term cytotoxic chemotherapy, radiotherapy or central nervous system infection. Two had stroke, one had cerebellar atrophy and one mild hypercalcaemia. The high incidence of calcifications in the temporal lobes, while asymptomatic, suggests that cortical calcification may be a pointer to the aetiology of idiopathic epilepsies in the elderly.

We analyzed the serum concentrations of lipids and lipoproteins and the prevalence of other risk factors in a case-control study of 304 consecutive Chinese patients with acute stroke (classified as cerebral infarction, lacunar infarction, or intracerebral hemorrhage) and 304 age- and sex-matched controls. For all strokes we identified the following risk factors: a history of ischemic heart disease, diabetes mellitus, or hypertension; the presence of atrial fibrillation or left ventricular hypertrophy; a glycosylated hemoglobin A1 concentration of greater than 9.1%; a fasting plasma glucose concentration 3 months after stroke of greater than 6.0 mmol/l; a serum triglyceride concentration 3 months after stroke of greater than 2.1 mmol/l; and a serum lipoprotein(a) concentration of greater than 29.2 mg/dl. We found the following protective factors: a serum high density lipoprotein-cholesterol concentration of greater than 1.59 mmol/l and a serum apolipoprotein A-I concentration of greater than or equal to 106 mg/dl. The patterns of risk factors differed among the three stroke subtypes. When significant risk factors were entered into a multiple logistic regression model, we found a history of hypertension, a high serum lipoprotein(a) concentration, and a low apolipoprotein A-I concentration to be independent risk factors for all strokes. The attributable risk for hypertension was estimated to be 24% in patients aged greater than or equal to 60 years. In this population, in which cerebrovascular diseases are the third commonest cause of mortality, identification of risk factors will allow further studies in risk factor modification for the prevention of stroke.

To demonstrate postangiographic Lipiodol (LIP) in hepatocellular carcinoma (HCC) in paraffin sections, direct impregnation of formalin-fixed tissue blocks with silver nitrate (AgNO3) was followed by routine processing. LIP appeared as black globules in the sinusoids. Ninety-four tissue blocks from 13 postangiographic LIP HCCs and 69 from 8 non-LIP HCCs and 4 fatty livers were studied. Seventy-two of 73 negative controls and all positive blocks as seen on soft tissue radiographs (STRs) were correctly coded (specificity 98.6%, sensitivity 100%). Twenty-six of the 44 LIP-negative areas on STRs from LIP cases contained scanty globules of less than 10 microns in diameter. Fatty change gave no positive readings. Thus, modified AgNO3 impregnation is a simple, accurate means of detecting LIP in high-quality paraffin sections suitable for tumor diagnosis and, if applied to postangiographic LIP, ultrasonographically guided liver biopsy, can verify that a biopsy has reached a suspected tumor focus.

Plain film radiography and pluridirectional tomography have been displaced by CT and MRI for imaging NPC. The latter techniques are to some extent complementary, since MRI is particularly useful for defining soft-tissue components and CT accurately delineates bone erosion. CT, however, also provides good soft-tissue definition in conjunction with contrast enhancement. Nuclear isotope scanning is valuable in detecting bone metastases. These imaging techniques are of particular value in detecting submucosal tumors not visible clinically and are also essential to accurate tumor staging.

The diagnostic accuracy of the DCBM and of endoscopy were compared in 50 consecutive patients. Examinations were conducted in comparable circumstances, without any cross information. A percentage score method was evolved to allow a numerically more significant assessment. The potential accuracy of the DCBM was calculated to be 96% of that accorded to fibre-endoscopy.

A densely echogenic line is seen connecting the right portal vein and the neck of the gallbladder on longitudinal views in at least 70% of sonograms. The origin of the line has been taken to be the fissure between the right and left lobes of the liver, but no documentation has been provided. Intact liver specimens were studied in a water bath; metallic markers were placed to coincide with the line under real-time guidance. The line does, indeed, correspond to the interlobar fissure. Factors affecting visualization include position of the gallbladder neck and orientation of the fissure as well as fat deposition within the fissure.

Six patients with radiographic evidence of diffuse pleural thickening after industrial asbestos exposure are described. Five had computed tomography of the thorax. All the scans showed marked circumferential pleural thickening often with calcification, and four showed no significant evidence of intrapulmonary fibrosis (asbestosis). Lung function testing showed reduction of the inspiratory capacity and the single-breath carbon monoxide transfer factor (TLCO). The transfer coefficient, calculated as the TLCO divided by the alveolar volume determined by helium dilution during the measurement of TLCO, was increased. Pseudo-static compliance curves showed markedly more negative intrapleural pressures at all lung volumes than found in normal people. These results suggest that the circumferential pleural thickening was preventing normal lung expansion despite abnormally great distending pressures. The pattern of lung function tests is sufficiently distinctive for it to be recognised in clinical practice, and suggests that the lungs are held rigidly within an abnormal pleura. The pleural thickening in our patients may have been related to the condition described as "benign asbestos pleurisy" rather than the interstitial fibrosis of asbestosis.

The anatomy and radiology of the areae gastricae were studied in human and pig specimens and it was shown that the double contrast barium meal demonstrates a true picture of the undulating gastric mucosa, which is distinctive in appearance in the antrum body and fundus of the pig stomach. The importance of the type of barium used and the thickness of barrier mucus in the demonstration of the areae pattern is emphasised and the high incidence of duodenal ulcer in the grade 4 pattern and the low incidence in the non-coater is described. A knowledge of the anatomy and radiology of the areae gastricae pattern is central to the interpretation of the double contrast barium meal.

Summary A case is presented of a glomangioma with typical history and clinical findings, proven by operation and histology. Unique radiographic features are demonstrated including visualization of the tumour on a soft tissue radiograph and associated hyperaemic bone changes, continuous wave Doppler results indicating hyperaemia and an arterio-venous malformation, and the clear demonstration of the tumour in both frontal and lateral views was possible by intra-arterial digital subtraction angiography (DSA) under local anaesthesia. Fibrous dysplasia of a femur was an incidental finding.

Seven patients with idiopathic pulmonary haemosiderosis were investigated with chest radiographs, pulmonary function tests, computed axial tomograms, and isotope ventilation and perfusion scans. Three of the patients had coeliac disease (CD) and a fourth an abnormal small bowel mucosa under the dissecting microscope which was normal histologically. Five patients showed airflow limitation with a low transfer coefficient. Three of these had air trapping, two of whom had hyperinflation of the lungs, and the third a total lung capacity at the upper limit of normal. Two patients showed a central distribution of radiographic opacities, and the other five had changes throughout the lung fields. The presence or absence of CD showed no relationship to these findings.

Summary 1. Of 285 lymphoma cases, 167 were selected for study. Of these there were forty-seven with radio-logically demonstrable mediastinal gland enlargement. 2. In fifteen cases (8 per cent of 167) appearances suggesting pericardial effusion were present. 3. All fifteen cases occurred among the group showing mediastinal gland enlargement. 4. In twelve of the forty-seven cases with mediastinal glandular enlargement (25·5 per cent) as there was no other detectable cause for the pericardial effusion, it is assumed that is was due to lymphomatous involvement. 5. Anaemia was prominent in three of these fifteen cases. Anaemia was also a probable cause of the cardiac enlargement in one other case not included in these fifteen.

The material and methods of arteriography and scintillation scanning upon which this study is based are briefly considered and representative cases are presented. The findings on hepatic arteriography and scintillation scanning are compared and correlated in cases of liver disease with special reference to space-occupying lesions. Both examinations can detect these lesions in many cases. However, scintillation scanning usually gives no clue as to the aetiology or vascularity of the lesion and cannot detect tumours smaller than 2 cm in diameter. Arteriography can show whether the defect is vascular or not and may thus distinguish malignant tumours from cysts. Where lesions are vascular they may be shown even if only 0·5–1 cm in diameter. On the other hand, where a filling defect has been shown on scintillation scanning, the vascular pattern in the area can be more accurately evaluated. In cirrhosis and the Budd-Chiari syndrome, with macro-nodular transformation, “splayed” vascular arches may be de...

We have described three cases of crico-pharyngeal web not associated with iron deficiency, discovered on routine barium swallows in the thyroid clinic. It is suggested that there is an association between cricopharyngeal web and thyroid disease. An association which, as far as we know, has not previously been commented upon. We are unable, at the present time, to explain this association.

A technique has been developed which allows the position of the upper gastrointestinal tract, as determined radiographically, to be superimposed on the pancreatic photoscan, performed after an injection of (75)Se-selenomethionine. Results of the technique applied to 27 ;abnormal' and 23 ;normal' subjects are described. The importance of the additional information gained by the combined technique is discussed in terms of normal variation and increased diagnostic yield, and the situations in which it was found most useful are described. The addition of correlated duodenography rendered scan reporting more objective in 50% of cases.