Preoperative computed tomographic diagnosis of an aortocaval fistula associated with aneurysm of the abdominal aorta

Aortocaval fistula is a rare but life-threatening complication of ruptured abdominal aortic aneurysm. We present a case of an aortocaval fistula with acute right heart failure. The condition was accurately diagnosed before operation by physical examination, echo, and especially by computed tomography (CT), thereby enabling proper planning of the operative strategy. At surgery, not only the infrarenal aorta and common iliac arteries on both sides but the inferior vena cava and iliac veins on both sides were also controlled to avoid massive venous bleeding through the fistula. Aortocaval fistula repair was easy, and conventional bifurcated Dacron graft replacement for abdominal aortic aneurysm was successfully performed. Innovative CT images give us prompt preoperative diagnoses and elaborate surgical strategies.     

Cerebellar abscess: the impact of computed tomographic scanning

Thirty-four cases of cerebellar abscess, diagnosed by computed tomographic (CT) scanning, were managed according to a standard protocol during a 4-year period. Triple high dosage intravenous antibiotics were used, open catheter drainage of the abscess was instituted, and external ventricular drainage was added if obvious hydrocephalus was present. Seventeen patients made a good recovery, and five remained minimally disabled. Ten patients died, and two were left severely disabled. A relationship between the level of consciousness on admission and final outcome was established. In addition, two particular CT scan features (viz. the presence of hydrocephalus and the stage of the abscess) were significant adverse prognostic factors.     

Preoperative staging of carcinoma of the bronchus: can computed tomographic scanning reliably identify stage III tumours?

BACKGROUND--The aim of preoperative computed tomographic (CT) assessment of patients with carcinoma of the bronchus is to stage the tumour accurately, and forewarn the surgeon of any possible local extrapulmonary extension of tumour in patients considered to have potentially resectable disease. The ability of CT scanning to differentiate between conventionally resectable lung cancer (TNM stages I and II), locally advanced but resectable lung cancer (TNM stage IIIa), and locally advanced but unresectable lung cancer (TNM stage IIIb) was determined in a group of patients accepted for surgery. METHODS--Computed tomographic scans of 110 patients who underwent thoracotomy for intended resection of carcinoma of the bronchus, including 52 cases with stage III and 58 cases with stage I or II disease, were reviewed and the CT features and radiological interpretations correlated with the surgical and pathological findings. RESULTS--Thirteen CT scans were judged not to have been of diagnostic quality: of the remaining 97 cases 45 had stage III lung cancer, of whom 30 had successful resections, and 52 had stage I or stage II tumours. There was no difference in the frequencies of CT observations--including contiguity of tumour and mediastinum or chest wall, apparent mediastinal or chest wall invasion, proximity of tumour to the carina, mediastinal nodal enlargement, pulmonary collapse or consolidation and pleural effusion--in patients with stage I/II disease and patients with stage III disease. Similar results were found when the same observations were compared in all patients with resected disease and those with unresectable tumour. Sensitivity and specificity of CT was 27% and 96% respectively for tumour unresectability, 50% and 89% for mediastinal invasion, 14% and 99% for chest wall invasion, and 61% and 76% for mediastinal nodal metastases. Only 19 of 45 stage III tumours were correctly identified as being stage III and resectable or unresectable. CONCLUSIONS--In patients being considered for thoracotomy for resection of lung cancer, CT scanning used as the sole method of staging is of limited value for differentiating between stage I/II and stage III tumours. Patients should not be denied the opportunity for curative surgery on the basis of equivocal CT signs.     

Helical computed tomographic angiography for the diagnosis of traumatic arterial injuries of the extremities

BACKGROUND: The radiologic study of choice for evaluation of traumatic arterial injuries is conventional arteriography, but it poses the risks of an invasive procedure. Computed tomographic arteriography (CTA) is emerging as a new way to study arterial anatomy, with the additional advantages of being noninvasive and a technique that allows evaluation of different body areas simultaneously. Our experience using CTA for evaluation of traumatic arterial injuries is provided in this study. METHODS: A retrospective review over a 22-month period of all adult patients undergoing CTA for evaluation of traumatic injuries to the extremities was performed. RESULTS: A total of 97 CTA studies were performed in the 95 patients. CTA adequately demonstrated the nature and location of all the arterial injuries when compared with conventional arteriography or surgical exploration. Abnormal CTA results included 21 arterial occlusions, 2 intimal flap defects, and 2 pseudoaneurysms. Nine of these 25 injuries were confirmed by surgery only, 10 by surgery and arteriography, and 6 by arteriography only. Normal CTA results were confirmed with arteriography in 10 cases. No missed injuries were encountered in patients with normal CTA results. CONCLUSION: CTA is a reliable technique for the detection and characterization of traumatic extremity arterial injuries. These results suggest CTA may be an alternative to conventional arteriography for the diagnosis of traumatic arterial injuries.     

Functional closure of the femoral canal revealed by computed tomographic scanning

The lacuna vasorum contains, as well as the external iliac vessels, a space called the femoral canal which allows pulsation and other changes in the diameter of the two vessels. The canal is closed by a connective tissue septum which is too weak to prevent a herniation alongside the vessels. The functional closure of the canal was investigated by artificial augmentation of the intraluminal pressure of the vein in five specimens and by computed tomographic (CT) scanning during a Valsalva manoeuvre in ten normal persons. In the abdomen the intraluminal and extraluminal pressures are raised in parallel, with no consequence for the diameter of the vessels. In the area of the lacuna vasorum the intravenous pressure is conveyed down to the first competent valve which is located 0.5 cm distal to the inguinal ligament, while the extraluminal pressure is reduced to normal. At each rise of the intra-abdominal pressure the vein will therefore bulge and exactly fill the empty space of the femoral canal thus preventing herniations by an on-demand mechanism. By CT scanning it was found that the vein in the femoral canal increased its diameter 2.5-3.0 times during the Valsalva manoeuvre.     

Applications of computed tomographic scanning of the cervical spine

Computed tomography is an extremely valuable adjunct to the evaluation of the cervical spine and spinal cord. When combined with intrathecal metrizamide enhancement and with computer reformatted images in sagittal and coronal planes, CT is a thorough diagnostic modality that can be applied to congenital/developmental, degenerative, and trauma-induced abnormalities. Its major deficiency is the potential to miss defects that are oriented in the transverse plane because of partial volume averaging of adjacent surrounding bone. CT scanning of the cervical spine has been used sparingly to date, probably because available scanners are used for higher-priority demands. However, anecdotal information in the literature document the value of CT in evaluations of the cervical spine, intervertebral disks, neural foramina, and spinal cord. In the future, magnetic resonance scanners may shift some of the imaging burden away from x-ray CT. More widespread use of CT for evaluation of cervical radiculopathies and myelopathy may then occur.     

寰椎Jefferson骨折伴横韧带损伤的诊治

目的 分析总结寰椎Jefferson骨折伴横韧带损伤的诊断和治疗。方法 1995年3月-2005年3月收治26例寰椎Jefferson骨折伴横韧带损伤患者。其中新鲜骨折20例，陈旧性骨折6例。所有患者均伴有不同程度的横韧带损伤，23例有神经损害表现。X线检查显示寰椎弓环及侧块不同部位骨折，寰齿间距（ADI）为4．7mm。5例行非手术治疗，其余21例行颈椎后路枕颈融合术或寰枢椎融合术治疗。结果所有患者术后获6～24个月（平均15个月）随访，21例手术治疗患者术后临床症状缓解；5例非手术治疗患者中，4例成功，另1例失败再行颈后路寰枢椎融合术治疗，术后疗效满意。结论 寰椎Jefferson骨折伴横韧带损伤患者的临床表现主要取决于韧带断裂后寰椎前脱位的程度以及是否造成脊髓压迫，诊断以ADI为主、并结合外伤史及临床表现。对于可能存在寰枢椎不稳或已有横韧带损伤且存在典型神经症状的患者，应早期行寰枢椎融合术或枕颈融合术治疗。     

Evaluation of multislice computed tomographic perfusion imaging and computed tomographic angiography on traumatic cerebral infarction

Objective： To evaluate the application value of multislice computed tomographic perfusion imaging （MSCTPI） and multislice computed tomographic angiography （MSCTA） on traumatic cerebral infarction.
Methods： MSCTA was performed on 10 patients who were initiailly diagnosed as traumatic cerebral infarction by normal conventional computed tomography （NCCT）, among whom, 3 patients were examined by MSCTPI simultaneously. Reconstructed images of the intracranial artery were made with techniques of maximum intensity projection （MIP） and volume rendering （VR） from MSCTA scanning data. Then the graph of function of four parameters, regional cerebral blood flow （rCBF）, regional cerebral blood volume （rCBV）, mean transit time （MTT）, and time to peak （TTP）, acquired by the perfusing analysis software was obtained.
Results： Among the 10 patients with traumatic cerebral infarction, 6 showed complex type on NCCT, which depicted abnormality on MSCTA, and 4 showed simple type on NCCT, which had negative results on MSCTA. Among the 4 patients with abnormal great vessels, 2 suffered from stenosis or occlusion of the middle cerebral artery, 1 from spasm of the anterior cerebral artery, and 1 from spasm of the vertebral-basal artery. The image of MSCTPI of 1 patient with massive cerebral infarction on the right cerebral hemisphere confirmed by CT was smaller than those of the other patients, which showed occlusion of the ipsilateral middle cerebral artery on MSCTA, Among the 6 patients whose MSCTA showed no abnormality, 4 showed simple infarction and 2 showed complex infarction. The infarction focus of 5 patients occurred in the basal ganglia and 1 in the splenium of corpus callosum. Among the 2 cases of small cerebral infarction volume on NCCT, one was normal, the other showed hypoperfusion on MSCTPI and was normal on MSCTA.
Conclusion： The combination of MSCTPI and MSCTA is very useful for evaluating the change of intracranial artery in ischemic regions and assessing the cerebral h     

Morphologic assessment of abdominal aortic aneurysms by spiral computed tomographic scanning

Purpose: The aim of this study was to seek a relationship between the morphologic features of abdominal aortic aneurysms and the feasibility of endoaortic grafting.Methods: Between June 1995 and January 1996, 86 patients were prospectively studied with contrast-enhanced spiral computed tomographic scans, which provided 35 parameters concerning the aorta and iliac arteries. Four groups were established according to the diameter of abdominal aortic aneurysms: group A, 40 to 49 mm, 36 patients; group B, 50 to 59 mm, 26 patients; group C, 60 to 69 mm, 10 patients; and group D, greater than 70 mm, 14 patients.Results: There was a correlation between the diameter and length of the aneurysm (p < 0.0001) and between aneurysm diameter and length of the proximal neck (p < 0.001). Presence of a proximal neck or a distal neck was more frequent in groups A and B than in groups C and D (p < 0.01). The feasibility of endovascular grafting was estimated at between 50% and 61.6% and was higher in groups A and B than in groups C and D (p < 0.01).Conclusions: This study has shown an inverse relationship between the diameter of the aneurysm and the length of the aortic neck (correlation coefficient, –0.3640, p < 0.001). The diameter of an aneurysm was the most useful of the 31 parameters measured in predicting the feasibility of endoaortic grafting, estimated at 71% for aneurysms less than 60 mm in diameter and 37.5% for aneurysms greater than 60 mm in diameter (p < 0.01). (J Vasc Surg 1997 26:238-46.)     

Choledochocele demonstrated by computed tomographic cholangiography: Report of a case

(Received for publication on Nov. 2. 1998; accepted on July 13, 1999)     

Prospective computed tomographic scanning in the staging of bronchogenic cancer

One hundred eight-five patients with potentially operable lung cancer were prospectively evaluated by computed tomographic scanning of the mediastinum and upper part of the abdomen. Mediastinal lymph node size was correlated with operative and pathologic findings. There was close agreement between computed tomographic estimate of size and operative measurements. Mediastinal lymph nodes that were larger than 2.0 cm were positive for tumor in 69.6%, nodes between 1.1 and 1.9 cm contained metastases in 31.8%, and nodes less than 1.0 cm were positive in only 2.7%. The cell type, T status, and location of the primary tumor did not influence these findings: A node less than 1.0 cm with a T3 lesion had the same probability of being abnormal as with a T1 lesion, although predictably, those patients with T3 and central tumors had a greater likelihood of having nodes larger than 2.0 cm. The presence of pneumonitis did not increase the prevalence of enlarged, histologically normal nodes. Asymptomatic adrenal metastases were present in 3.2% of patients with otherwise operable disease and were suggested only by the computed tomographic scan. Patients with mediastinal nodes less than 1.0 cm probably do not need preresection mediastinal exploration. Those with nodes larger than 2.0 cm should not be considered unresectable without pathologic confirmation, even in large tumors, in view of the 30.4% negativity rate. The computed tomographic scan is useful in depicting and localizing enlarged mediastinal nodes but cannot be used as a substitute for pathologic examination.     

Thoracic disc herniation. Improved diagnosis with computed tomographic scanning and a review of the literature

Thoracic disc herniation is uncommon. One of the main problems in the treatment of thoracic disc herniation has been the lack of accuracy of diagnostic tests. Now, with the use of computed tomographic scanning with and without metrizamide in the subarachnoid space, this accuracy has greatly improved. Computed tomography scanning can demonstrate the type and level of the lesion even when the myelographic study is negative. We have reviewed 280 cases; a peak incidence was noted in the fourth decade with 75% of the protruded discs occurring below T-8. Back pain was the most common presenting symptom followed by sensory disturbances. By the time of diagnosis, 70% of the patients had signs of spinal cord compression. A small group of patients could be identified that invariably had a good prognosis. They had a history of trauma, symptoms lasting less than a month, and soft disc herniation. Regarding the results of surgical treatment, there was a success rate ranging from 57% for decompressive laminectomy to over 80% for the posterolateral, lateral, and transthoracic approaches.     

外伤性寰椎横韧带断裂的治疗策略

目的探讨外伤性寰椎横韧带断裂治疗策略。方法回顾性分析一组24例寰椎横韧带断裂病例,其中单纯横韧带断裂15例,合并有寰椎骨折7例,合并齿状突骨折2例。急性损伤20例,陈旧性损伤4例。手术行寰枢椎融合术14例,枕颈融合6例,非手术治疗3例,入院后当天死亡1例。结果23例获得随访,平均随访时间为46个月。20例手术治疗患者中15例完全恢复正常,3例仍有局部症状,2例颈脊髓神经损害改善,无术后神经损害加重病例。3例接受非手术治疗患者中有2例出现寰枢椎不稳及迟发性脊髓损害。结论寰椎横韧带是维持寰枢椎正常解剖关系不可或缺的重要结构,横韧带断裂必然导致寰枢椎不稳定。无论是急性或陈旧性损伤,一旦诊断明确即应在早期行寰枢椎或枕颈融合术。     

Pitfalls in the computed tomographic diagnosis of toruloma

A case of multiple intracerebral mass lesions is presented in which significant "improvement" in the computed tomographic appearance was noted following steroid and radiation therapies. Nonetheless, the patient's clinical course was one of rapid deterioration, and an autopsy revealed multiple torulomas. It seems that the computed tomographic appearance of torulomas can mimic those of other intracranial mass lesions and can be greatly altered by steroid and radiation therapies, either singly or in combination.     

Superior sensitivity of computed tomographic scanning to magnetic resonance imaging in metastatic neoplasia: two case reports

A case of carcinoma of the breast and a case of melanoma metastatic to the brain were evaluated by both magnetic resonance imaging (MRI) and enhanced computed tomography (CT). In these two cases, enhanced CT was more sensitive and more clearly delineated the extent of disease. Does diagnostic imaging of central nervous system metastatic disease require both MRI and enhanced CT?