Inflammation of the neck

Summary In the evaluation of a large series of infectious processes in the cervical region, certain diagnostic sonographic patterns have been established, which prove very helpful in differentiating the various stages and the extension of inflammatory processes. The advantages of sonographic imaging are demonstrated.     

Calcifications simulating sialolithiasis of the major salivary glands

Calcifications found in routine and normal radiographs of the oral and facial region may turn out to be an interesting diagnosis. Although most of the radiopacities may be sialoliths, other differential diagnoses must not be exempted, such as calcified lymph nodes, phleboliths and other vascular calcifications, tuberculosis of lymph nodes or of the salivary gland itself. Several cases are presented which simulated pathological calcifications of the orofacial region and were diagnosed primarily as sialoliths, but further examinations revealed other pathology. These cases together with several suggested diagnostic modalities are discussed in this paper.     

Double contrast examination in disease of the anorectal region.

Patients with symptoms from the anorectal region will not always be rectoscopically examined and sometimes lesions of the ano-rectal region are overlooked by the rectoscopist. In order to increase the overall diagnostic accuracy and make possible an early diagnosis of pathological changes in the ano-rectal region, the radiologist should take responsibility also for this part of the bowel. Minor lesions are often difficult to demonstrate by the conventional barium enema, but they are readily seen on an adequately performed double contrast examination. Of special importance is the diagnosis of small polypoid tumors which may become malignant. An early diagnosis and subsequent surgical removal of these tumors prevent spread and minimizes the surgical procedure.     

Normal anatomy of the brain in the nuclear spin tomogram as a basis for therapeutic intervention

Anatomical relationships interesting for diagnosis and therapy are demonstrated in clinical NMR-tomograms of the normal brain of a 30 year old woman. Critical structures of the brainstem and of the periventricular region are better visualised with NMR than with any previous system. It is planned to introduce this excellent diagnostic system which is practically innocuous and non-aggressive, in the patient's therapy planning.     

CT-guided biopsy. Comments on the puncture technique

Computed tomography is an universally applied method of controlling diagnostic puncture of unrecognized processes in practically any region of the human body. The conditions required, the puncture technique, the various pathways and the types of needles used are discussed.     

Extrapineal abnormalities of the tectal region: MR imaging findings.

This essay illustrates the imaging spectrum of extrapineal lesions that involve the tectal region, with emphasis on intrinsic tectal abnormalities. The superb sensitivity of MR and its multiplanar imaging capability permit unparalleled diagnostic accuracy in this region. The sagittal and axial planes are ideal for evaluating the tectum. CT remains important in the detection of acute hemorrhage and calcification. Grouping of abnormalities on the basis of anatomic boundaries (tectum, aqueduct, and quadrigeminal plate cistern) is useful in establishing the correct diagnosis.     

Differential diagnosis of contrast medium recesses of the renal pelvis or the renal calyx system (author's transl)]

Contrast medium recesses in the renal pelvis and calyx system of a retrograde pyelogram or urogram are due to many widely different pathologico-anatomical changes in the renal region. It is the aim of the present study to show up this multitude of differential diagnostic possibilities which lead to contrast medium recesses in the renal pelvis and renal calyx system of a pyelogram.     

Role of radiology in the treatment of malignant hilar biliary strictures 1: review of the literature

Malignant strictures of the biliary tree are an uncommon cause of obstructive jaundice. There are a number of pathological subtypes, but tumours in this region tend to have similar clinical and diagnostic features and therapeutic and prognostic implications. We review the published literature on this topic discussing diagnostic modalities and treatment options with a focus on radiological intervention. Diagnosis currently is best achieved using a range of procedures. Direct cholangiography remains the gold standard in delineating anatomy, but the invasiveness of this procedure limits its use as a purely diagnostic tool. Magnetic resonance technology, in particular magnetic resonance cholangiopancreatography, has an increasing role as accessibility is improved. Treatment of these tumours is difficult. Surgical resection and palliative biliary enteric bypass are the most common methods used with endoscopic and percutaneous therapies reserved for palliating patients not fit for surgery. There is little firm evidence to suggest that any one palliative modality is superior. Interventional radiology is particularly suitable for palliative management of difficult and expansive lesions as the anatomy can preclude easy access by surgical or endoscopic techniques. Good palliative results with minimal mortality and morbidity can be achieved with percutaneous stenting.     

Sonoanatomy of the foot

Summary To show the possibilities of imaging diagnostic procedures using high and extremely high resolution ultrasonic probes we investigated the anatomic structures of the foot. We examinated 10 cadaver foots of the anatomic institute and in a clinical trial 20 healthy patients with 10 to 20-MHz-probes and could identify correctly single tendons and ligaments even in the toe region. Especially the possibility of dynamic examination had to be mentioned beside the other advantages of ultrasound diagnostic (saving of expenses, lack of radiation, side-to-side comparison).      

Computed tomography in the evaluation of sarcomatous tumors of the thigh.

CT examination of a soft tissue mass in the lower extremity adds substantially to a more precise preoperative histologic diagnosis and anatomic localization of the lesion. An appreciation of the normal cross-sectional anatomy of this region is essential for adequate evaluation of the information provided by the CT scan. Four patients with sarcomatous tumors involving the soft tissues of the thigh are described and the diagnostic information provided by CT is discussed. In two of these cases anatomic cross sections are correlated with the CT scan.     

Neoplasias of the scapula--rare causes of chronic shoulder-arm syndrome

The diseases most frequently resulting in a chronic shoulder-hand syndrome are definitely of a post-traumatic nature and are later - after a varying period - often combined with degenerative changes. The tendency to injury is enhanced by the particularly great mobility of the shoulder joint. Inflammatory changes - e.g. of bacterial, rheumatic origin - are much rarer. The authors present two patients with rare neoplastic lesions in the region of the shoulder-blade and show how the disease was identified via various differential diagnostic methods.     

胸腔出入口区CT解剖及其临床应用评价

目的探讨胸腔出入口区的正常CT解剖和CT对该区病变的诊断及鉴别诊断价值。方法回顾性分析经病理及临床证实的127例胸腔出入口区病变的CT表现,对60例正常对照组在CT上分为5个解剖区:1区(甲状腺区);2区(甲状腺内侧区);3区(甲状腺外侧区);4区(甲状腺后区);5区(甲状腺前区)。结果在127例中,病变位于1区18例(12.40%),2区8例(6.84%),3区75例(61.54%),4区1例(0.85%),5区3例(2.56%),跨1、3、5区15例(12.8%),跨1、2、3区7例(5.98%)。病变主要分布在3区,其中以淋巴结病变最为多见(60例);甲状腺病变(33例)主要分布在1区和跨区生长。结论在CT上对胸腔出入口解剖区域的合理分区,有利于病变的定位和定性诊断,具有重要的临床应用价值。     

Ultrasonics in the diagnosis and monitoring of cryptorchism in children

The diagnostic reliability of US was investigated in the study of cryptorchidism during a 9-month clinical and US trial performed on 52 children (mean age 4.3 years). Cryptorchidism was unilateral in 44 cases (24 on the left side and 20 on the right side), and bilateral in 8 cases. Of 60 cryptorchid testes, 53--belonging to 45 of 52 patients--were located in the inguinal region (18 along the canal, 20 at the external ring, and 15 at the internal one); the others 7--belonging to the remaining 7 subjects--were found in an extra-inguinal region (4 in paravesical location and 3 in the inferior abdomen). US confirmed 29 undescended testes with clinical evidence in the inguinal region and identified, in the same area, 24 other testes which had been missed at clinical examination. In addition, US provided useful information as to both structure and volumetry of the gonads. On the other hand, US failed to provide reliable diagnostic results in the rare cases of pelvic and abdominal cryptorchidism, where precise testes localization was achieved by CT. US is the diagnostic technique of choice in the study of cryptorchidism (after clinical examination): the method is non-invasive and simple, has low cost and its use is widespread; moreover, US does not administer ionizing radiations. According to our experience, US had 88.3% diagnostic sensitivity as for undescended testes (53 of 60), and 100% specificity. In addition, US monitoring allowed clinical efficacy of therapeutic trials to be verified in 25 patients (17 sensitive to therapy): 16 of them were treated with human Chorionic Gonadotropin (hCG) and 9 with Luteinizing Hormone-Releasing Hormone (LH-RH).     

Case report: periosteal osteosarcoma of the clavicle

Periosteal osteosarcomas are rare and usually affect the meta-diaphyseal region of long bones. We present a case of a periosteal osteosarcoma of the clavicle, a highly unusual site and representing one of only two such cases documented in the English literature. This case illustrates the diagnostic dilemmas in the classification of such tumors, particularly in small biopsy specimens from unusual locations. It emphasizes the importance of radiological and pathological correlation.     

Pitfalls in establishing the diagnosis of deep venous thrombophlebitis by indium-111 platelet scintigraphy

Forty-seven 111In-platelet scintigraphs (In-PS) were analyzed retrospectively to identify sources of diagnostic error and to optimize the diagnostic criteria for active deep venous thrombophlebitis (DVT). The results of In-PS were compared with contrast venography, additional diagnostic studies, and clinical outcome. Three patterns of platelet localization emerged as the best predictors of active DVT: (a) focal or (b) linear 4-hr localization, or (c) an asymmetric blood-pool pattern on 4-hr imaging that evolved into a focal or linear pattern by 16 to 24 hr. All false-positive studies had abnormal patterns confined to the inguinal region at 24 hr. All patients with false-negative studies had received heparin between 4 and 24 hr. The potential pitfalls encountered in the evaluation of the iliac, femoral, and popliteal veins are reviewed and the importance of delayed imaging in selected cases is emphasized.     

Diseases of the aerodigestive tract and of the soft tissues of the neck. Comparison of MRI and CT

CT and MRT are compared with each other in examinations of the aerodigestive tract in 250 patients. MRT was found to be the method of highest sensitivity and specificity after intravenous administration of the contrast medium Gd-DTPA. Magnetic resonance tomography was found to be clearly superior to computed tomography on account of the 3-dimensional imaging possibilities, improved contrasting of soft parts, and freedom from artifacts. In space-occupying growths of the nasopharynx, oropharynx and hypopharynx, the primary use of MRT must be considered mandatory in diagnostic strategy planning. CT occupies the second rank and can be used for optimised visualisation of small osseous lesions and for digital subtraction angiography (DSA). The latter plays an important role in the analysis of selective vascular supply and in diagnosis before intraarterial chemotherapy. In respect of processed in the soft tissues of the neck, pathological lesions of the lymph nodes, vessels, soft parts and cervical processes are differentiated (n = 139). For the diagnosis of the entire neck region, magnetic resonance tomography with the additional use of the contrast medium Gd-DTPA proves to be the method with the highest rate of accuracy. In processes of the soft tissues, sonography can also be employed as a primary diagnostic tool. However, in certain localisations and lesions this method can only be used with certain restrictions. According to the present state of the art, computed tomography must be considered as a secondary procedure in the diagnosis of the neck region.     

Digital projection radiography of the chest

Direct and film-based radiographic systems are undergoing evaluation by observer performance studies for use in digital imaging of the chest. Many issues intrinsic to digital imaging are not settled, including the minimal pixel size necessary for images of accurate diagnostic quality, the characteristics of the display console, and the usefulness of digital imaging processing techniques. The chest is a particularly difficult anatomic region for examination by digital radiography because of the broad spectrum of disease findings encountered. These issues are discussed in reference to four reports that use observer performance tests for evaluating various facets of chest diagnosis using digital radiography.     

A diagnostic dilemma of the mass in the parotid region (2006: 12a)

Interpretation Corner

A diagnostic dilemma of the mass in the parotid region (2006: 12a)     

Comparing the accuracy of panoramic and intraoral radiography in the diagnosis of proximal caries

OBJECTIVES: The purpose of this study was to compare the diagnostic accuracy of panoramic and intraoral radiographic surveys in the diagnosis of proximal caries according to the different dental regions (maxillary and mandibular incisor, canine, premolar and molar). METHODS: In this study, full mouth series and panoramic radiographs of 79 patients were used. The radiographs were evaluated for proximal caries by three observers. The diagnostic accuracy of radiographic surveys for each dental region was assessed by means of receiver operating characteristic (ROC) curve analysis. RESULTS: Full mouth series was the most efficient method in the diagnosis of caries for incisor and canine teeth. However, full mouth series and combination of panoramic plus bitewings had similar diagnostic accuracy for premolar and molar teeth. CONCLUSIONS: Panoramic survey alone was not sufficient for the diagnosis of proximal caries for the entire dentition. The combination of panoramic plus bitewing plus anterior periapical survey exhibited a diagnostic accuracy for proximal caries that was comparable with full mouth series.