Computed tomography of elephantiasis neuromatosa

A case of an unusually symmetric and grotesque elephantiasis neuromatosa of the trunk is presented. Computed tomography demonstrated the extent of the disease, which is essential if surgery is planned.     

Magnetic resonance imaging of elephantiasis neuromatosa

We present the case of a 43-year-old man with neurofibromatosis type 1 who developed elephantiasis neuromatosa of his left leg. The gross limb enlargement was extremely disfiguring, and resulted in such severe disability that he was only able to walk a very short distance using crutches. Previous debulking procedures had resulted in massive blood loss, and prior to attempting further surgical intervention MRI studies were requested. Taking advantage of the excellent tissue characterisation and multiplanar imaging capabilities of MRI, we were able to assess the extent of soft tissue and osseous involvement. The use of recently developed MR angiographic sequences enabled us to non-invasively provide detailed images to assess the relationship of the lesions to the major vessels, as well as the vascular supply and angiographic features of the lesions themselves. This article describes our MRI-based findings, which precluded debulking surgery in this unusual manifestation of neurofibromatosis.     

The value of computed tomography in cerebral syphilis

Summary The computed tomographic findings of three patients with cerebral syphilis, including cerebral gumma, which regressed completely under penicillin therapy, syphilitic angiitis with cerebral infarction, and syphilitic cerebral atrophy, are reported. CT is unable to provide specific diagnostic data for these conditions. The etiology can be clarified only by taking into consideration the clinical findings and course, the serological results, and the result of therapy.     

The value of computed tomography scanning in chondromalacia patellae

Sixtyseven patients with pain in the knee were studied. A computed tomography (CT) score indicating chondromalacia was devised, based on the results of CT after arthrography. This score takes account of the regularity, the congruity, and the imbibition of contrast material. Thus the patients could be divided into four groups: those who definitely have chondromalacia (++), probably (+), probably not (±), and definitely not (-). These results were compared with the clinical diagnosis based on clinical signs, arthroscopy, or operation. Eighteen patients had clinically proved chondromalacia, CT scored 14++, 3+ and 1±. Twentynine patients had no chondromalacia, CT scored 19-, 8±, and 2+. Twenty patients had an uncertain clinical diagnosis. Arthrography was less accurate in detecting chondromalacia.     

The value of computed tomography in patients with mucopolysaccharidosis

Summary Cranial computed tomography (CT) was performed on 11 cases of mucopolysaccharidosis (MPS) IVA (Morquio syndrome). Our results suggest that although the patients may have normal intelligence CT changes may be seen with increasing age. In two cases white matter low density was found and in a third there was gross dilatation of the ventricles, basal cisterns and subarachnoid space. Nine other patients with various types of mucopolysaccharidosis also had cranial CT performed and in general those types associated with mental retardation showed changes although there was an interesting exception involving a case of MPS IIIA who had a normal CT scan.     

Pheochromocytoma: value of computed tomography

A review of 60 histologically proved pheochromocytomas confirmed the value of computed tomography (CT) in the evaluation of this tumor. CT was found to be an accurate means of locating the tumor in 52 patients presenting for the first time and 8 patients with evidence of recurrence.     

The value of computed tomography for predicting empyema-associated malignancy

OBJECTIVE: To determine the value of computed tomography (CT) scanning in detecting associated malignancy in patients with chronic empyema. METHODS: Two radiologists retrospectively reviewed CT scans of 112 consecutive patients with chronic empyema and arrived at a consensus about the findings. Among these patients, 6 were confirmed by pathology evaluation to have empyema-associated malignancy (EAM), including 4 lymphomas. The CT scans were evaluated for the presence of the following findings: a mass in the empyema sac; mass involvement of the extrapleural fat, chest wall, rib, and lung; bulging of the empyema sac; nodular pleural thickening; empyema involvement of the mediastinal pleura; presence of lung nodules (>1 cm); and mediastinal lymph node enlargement. The association between the CT findings and the EAM was analyzed with the Fisher exact test. A multiple logistic regression analysis was used to determine the predictive variables for EAM. Sensitivity, specificity, and positive predictive value were calculated for each finding. RESULTS: All CT findings, except rib involvement and bulging of empyema sac, were significantly associated with EAM (P<0.05). The finding of the presence of a mass, extrapleural fat, and mediastinal involvement showed relatively high sensitivity (100%, 67%, 67%, respectively) and specificity (81%, 87%, 91%, respectively). A bulging of the empyema sac and nodular pleural thickening showed 100% sensitivity, but low specificity (39% and 44%, respectively). Findings from the multiple logistic regression analysis revealed that the presence of a mass and empyema of the mediastinal pleura were significant variables associated with EAM (P<0.05). CONCLUSIONS: Although many CT findings are associated with EAM, most showed either low positive predictive value or low sensitivity. A variety of CT findings should be considered when evaluating CT image-based detection of EAM.     

The value of computed tomography in the diagnosis of grating scapula

Snapping or grating scapula is a condition of the shoulder girdle in which the patient complains of pain and an audible snapping sound which may be associated with pain. We evaluated the diagnostic value of the computed tomography (CT) scans using the clinical diagnosis of a grating scapula as the gold standard. This retrospective study reports the sensitivity, specificity, likelihood ratio and receiver operator characteristic curve for the CT scans and the κ value as a measure of the interobserver agreement. None of the parameters validated the examination. We therefore concluded that CT scans are inappropriate for differentiation between a grating scapula and a normally functioning shoulder except in cases where bony abnormalities are present.     

The value of computed tomography in the localization of undescended testes

Eight patients with unilateral and four with bilateral (4) unpalpable testes were evaluated with CT for localization. All patients were later submitted to laparascopy and/or surgery and 13 cryptorchid testes and 3 atrophic or agenesic testes were found. CT detected correctly 11 of the cryptorchid testes - (85%) with one false positive and one false negative finding. In the three atrophic or agenesic testes, CT did not identify any image suspicious of being a testis, so there three were no false positive studies here. It is concluded that CT is an accurate noninvasive method for the preoperative detection of cryptorchid testes.     

Diagnostic value of computed tomography in parotid tumours

In 18 cases of parotid tumours, CT demonstrated their primary site, extent and invasion of surrounding tissue precisely. It was valuable in the majority of cases in differentiating benign from malignant tumours and could distinguish accurately intrinsic from extrinsic. CT sialography was superior in equivocal cases when it made the tumour easier to identify and the diagnosis more accurate.     

The spleen in non-Hodgkin lymphoma. Diagnostic value of computed tomography

Computed tomography of the spleen was correlated with histologic examination or clinical data in 53 selected patients with non-Hodgkin lymphoma. Calculation of the splenic index with CT by multiplying spleen length, width and thickness is a simple and rapid procedure for defining splenic size in vivo. A good correlation was found between size of the spleen, as estimated by splenic index calculation, and the proven or probable histologic state of the spleen.     

The value of computed tomography in evaluating patients with prolactinomas.

The use of computed tomography (CT) in 28 patients with surgically proved prolactinomas is described. The authors' experience suggests that in evaluating patients with galactorrhea-amenorrhea syndrome, CT in combination with pluridirectional tomography usually provides sufficient information to make further invasive studies unnecessary. In selected cases with low-density areas within the sella as seen on CT, pneumoencephalography is still advisable to distinguish between the empty sella and the necrotic tumor. Angiography is still necessary to exclude vascular causes for suprasellar and parasellar masses such as aneurysms and meningiomas.     

单光子发射计算机断层显像在低氧预适应中的应用价值

目的:采用单光子发射计算机断层显像(single photon emission computed tomography,SPECT)观察缺血性卒中患者低氧预适应组及对照组治疗前后脑血流灌注变化,了解SPECT在低氧预适应中的应用价值。方法:选择我院门诊患者26例根据治疗方案不同将患者分为两组,低氧预适应组17例,对照组9例。经颅多普勒超声(transcranialDoppler,TCD)检查证实患单侧颅内动脉中、重度狭窄或闭塞。磁共振成像(magnetic resonance imaging,MRI)检查除外脑占位病变及脑出血性病变。分别对两组缺血性卒中患者治疗前后脑血流灌注显像结果进行对比分析。结果:①17例预适应组患者额、颞、顶、枕叶皮层病变侧与对侧相应区域放射性计数比值治疗前后无统计学差异(P>0.05),而基底节及丘脑治疗前后有统计学差异(P<0.05);②9例对照组患者额、颞、顶、枕叶皮层及基底节和丘脑病变侧与对侧相应区域放射性计数比值治疗前后无统计学差异(P>0.05)。结论:低氧预适应可提高缺血脑组织对缺血的耐受性,通过SPECT检查发现经低氧预适应治疗的患者基底节和丘脑血流灌注改善明显,借助SPECT可为临床判断疗效提供客观的影像学依据。     

Cysticercosis of the brain. The value of computed tomography

Incidence and radiologic findings of neurocysticercosis were investigated in a series of 23,800 consecutive head examinations using computed tomography (CT). The condition was diagnosed in 168 cases (0.7%). The parenchymatous form was the most common presentation (96.3%), while the meningeal form corresponded to only 11.9 per cent of cases. These two forms coexisted in some cases. These findings reversed the knowledge on the condition based on conventional radiography. The different CT appearances in the brain are described and a new radiologic protocol for the CT evaluation of the condition is advocated, which includes a follow-up after a trial cure with Praziquantel in the presence of cysts not associated with suggestive brain calcifications. CT was more sensitive than conventional radiography in the differentiation between dead and living larvae, thus having an impact on the therapeutic management of the patients.