Indium-111 tropolonate leucocyte scanning in the detection of intra-abdominal abscesses

Indium-111 leucocyte scanning is established as an accurate method for localising intra-abdominal abscesses. With the currently available cell labelling techniques there is a variable and significant delay in localisation of abscesses which is a major disadvantage in comparison with ultrasound or computed tomography. We have examined the speed and accuracy of localisation of leucocytes labelled in plasma with a new chelating agent, indium-111 tropolonate, in 90 patients with suspected intra-abdominal abscess. In 50 patients a comparison with ultrasound was made. Nineteen patients had abscesses. The sensitivity and specificity of labelled leucocytes were 95% and 99%, respectively. Comparative results for ultrasound were 60% and 83%. In nine out of 10 patients with abscesses scanned sequentially from 40 min after return of the labelled cells, activity corresponding to the abscess was already visible on the 40 min scan. These results demonstrate that indium-111 plasma labelled leucocyte scanning is both rapid and an accurate method of detecting abscesses.     

Outpatient therapy of intra-abdominal abscesses following early discharge from the hospital

Although percutaneous aspiration and drainage of abdominal abscesses will frequently avert an open surgical procedure, patients remain hospitalized during drainage. The authors treated 9 patients for abscesses using percutaneous drainage catheters and sent them home with the catheter in place. All had an uneventful recovery. An average of $12,050 was saved in each case. The authors suggest that outpatient drainage of abdominal abscesses is significantly less expensive than inpatient treatment, yet does not jeopardize patient care.     

Specific enhancement of intra-abdominal abscesses with perfluoroctylbromide for CT imaging

Perfluoroctylbromide (PFOB), a radiopaque reticuloendothelial system contrast media for computed tomography, has been shown to accumulate in macrophages. In the current study PFOB was tested in rabbits as an abscess imaging agent. Two abscesses were induced in each of 24 rabbits, one in the liver and the other in the peritoneal cavity. CT of the rabbit abdomen was performed four days later, two days after the administration of 5 gm/Kg of PFOB to 12 of these rabbits. The average enhancement of the wall of liver abscesses was by 140 Hounsfield units (HU) relative to the enhanced liver and peritoneal abscesses by 135 HU relative to the control group. This enhancement was secondary to the intense accumulation of PFOB filled macrophages in the abscess wall. In those rabbits where the liver abscess ruptured, the edges of the peritoneal collections enhanced by 147 HU. Regions of inflammation prior to liquifaction enhanced considerably. These areas could not be detected in the animals not receiving PFOB. Though the liquified center of liver abscesses could be seen in the absence of PFOB, none of the peritoneal abscesses could be detected in the animals not receiving PFOB. In contradistinction, all peritoneal abscesses enhanced considerably following PFOB allowing their prospective localization. In conclusion, PFOB accumulates in abscess walls and areas of inflammation producing marked CT enhancement of liver and peritoneal abscess collections. This enhancement allowed the differentiation of peritoneal abscess collections from adjacent bowel.     

Structured radiologic diagnosis in polytrauma

Purpose. Development of a concept for structured diagnostic imaging in patients with multiple trauma. Material and methods. Evaluation of data from a prospective trial with over 2400 documented patients with multiple trauma. All diagnostic and therapeutic steps, primary and secondary death and the 90 days lethality were documented. Structured diagnostic imaging of multiple injured patients requires the integration of an experienced radiologist in an interdisciplinary trauma team consisting of anesthesia, radiology and trauma surgery. Radiology itself deserves standardized concepts for equipment, personnel and logistics to perform diagnostic imaging for a 24-h-coverage with constant quality. Results. This paper describes criteria for initiation of a shock room or emergency room treatment, strategies for documentation and interdisciplinary algorithms for the early clinical care coordinating diagnostic imaging and therapeutic procedures following standardized guidelines. Diagnostic imaging consists of basic diagnosis, radiological ABC-rule, radiological follow-up and structured organ diagnosis using CT. Radiological trauma scoring allows improved quality control of diagnosis and therapy of multiple injured patients. Conclusion. Structured diagnostic imaging of multiple injured patients leads to a standardization of diagnosis and therapy and ensures constant process quality.     

Controversies in the radiologic diagnosis of pelvic malignancies

Although vast differences exist among the many pelvic malignancies, several unifying concepts emerge from this discussion. First, there is a different role for diagnostic imaging for each type of pelvic malignancy. The radiologist should be aware that although the radiographic findings may be similar, the clinical impact varies greatly with a particular tumor. Second, although clinical staging is notoriously inaccurate, nevertheless diagnostic imaging techniques only improve upon but do not replace it because of false-positive and false-negative results. Third, because of the high false-negative rates of most of the modalities in use, negative studies do not in fact rule out the presence of disease. A surgical procedure may still be needed. Finally, several new techniques, including MRI and transrectal or transurethral ultrasound, may improve the accuracy rates. These developments will probably further enliven the controversies surrounding the radiologic evaluation of pelvic malignancies.     

Value of iopamidol in radiologic diagnosis

The effect of the contrast medium Iopamidol/Iopamiro, Bracco (Milano) was studied in 31 patients via intravascular or intraarticular injection, as well as in experiments on dogs with 32 kidneys, employing selective angiography and histological examination. In all cases, we obtained good x-ray films showing plenty of detail, the patient tolerance being good. Blood pressure, pulse rate and UN, SGOT, and SeBi values did not show any significant change. In some cases we noticed a moderate proteinuria. In the animal experiments, the kidneys showed histological changes in two cases only which could be ascribed to the action of the contrast medium; however, even these changes were of a minimal nature and degree, and were reversible. Iopamidol was found to be a very favourable contrast medium as far as the kidneys are concerned.     

Requirements in radiologic diagnosis from the internist-cardiology viewpoint

The article discusses the demands to be made on the various radiological methods in thoracic diagnostics in respect of their informative value for therapeutic consequences, as seen from the viewpoint of internal-cardiological intensive-care medicine. The importance of x-ray thoracic film in one or two planes is emphasised, with special reference to routine imaging. In consideration of the demonstration of essential pathological findings, routine chest x-ray film would be mandatory only the 40th year of age onwards and lateral projection from the 50th year. At any rate, about 50% of routine thorax x-rays in intensive-care wards show changes, the percentage being higher if there is a clinical suspicion of changes. Mention must be made of a so-called time phase lag between the x-ray thoracic findings and changed pulmonary arterial pressure. In diagnosis of pulmonary artery embolism the nuclear medicine methods are compared with pulmonary arterial angiography, taking sensitivity and specificity into account. 90% of pulmonary embolism show only non-specific changes in the chest x-ray. Together with these and perfusion scintigraphy a sensitivity of 98% can be attained, albeit with lower specificity, since perfusion angiography and angiography agree in only about 87% of the cases. The demands to be made on radiological diagnostics must be determined from case to case by the diagnostic effectivity in relation to the technical setup and cost. The cost aspect of the individual methods is of major importance when installing equipment in hospitals.     

Interventional radiologic procedures in the investigation of lesions of the breast

The interventional radiologist who performs mammography does far more than read films; he examines every patient, punctures cysts, and localizes other breast lesions for precise excisional biopsy. With specimen radiography, he can confirm that suspicious lesions are completely removed by the surgeon and that the tissue in question is selected by the pathologist for examination. Pneumocystography can save the patient the unnecessary, disfiguring surgical removal of benign cysts. Those patients requiring biopsy may be scheduled for the procedure at once, and close cooperation with the surgeon greatly reduces the time the patient must wait to find out whether or not she has breast cancer. Thus, the interventional radiologist can improve the accuracy and speed of diagnosis of breast lesions, establish a definitive diagnosis and expedite the therapeutic management of benign cysts, and save the patient much of the anxiety commonly experienced in waiting for diagnostic results. The end result is better care at a lower cost to the patient and to society.