A rare localization of cerebral venous sinus thrombosis. Case report

In this work the Authors report their experience on the treatment of a case of cavernous venous sinus thrombosis.The diagnosis is clinical and neuroradiological, CT, MRN, cerebral angiography and orbital venography have aided in establishing the diagnosis during life.Very interesting is the therapeutic approach.     

Computerized tomography in vascular malformations of the brain

Summary Computerized tomography scans of 166 patients — 99 cases with 117 aneurysms, and 67 cases with angiomatous malformations — were reviewed and correlated with angiographic and clinical findings. An intracranial hemorrhage was identified by CT scan in 103 patients, in 60 cases with aneurysms (17 only subarachnoid, 43 intracerebral), and in 43 cases with angiomas (6 only subarachnoid, 37 intracerebral). The source of hemorrhage was diagnosed with varying degrees of certainty with CT scan in 12 (12%) cases with aneurysms and in 27 (40%) cases with angiomas. Further CT findings were low density lesions in 18 cases indicating vasogenic edema, and calcifications in 10 angiomas. Intravenous infusion of contrast material was necessary to distinguish smaller aneurysms and angiomas. CT scan demonstrated the presence and location of thrombosed portions of giant aneurysms; these findings were less apparent with angiography. In 29 angiomas of medium or large size (macroangiomas) the malformation was demonstrated with CT scan in 25 (86%) cases and with angiography in 26 cases. 3 angiographically occult angiomas were diagnosed with CT as low density lesions and misinterpreted as gliomas. In all 36 microangiomas only the hemorrhage was precisely diagnosed with CT. The microangioma was identified angiographically in 24 cases and histologically in 21. In Sturge-Weber's disease the calcifications may be seen earlier with CT than with skull x-ray.Dedicated to Professor Dr. K. J. Zülch on the occasion of his 70th birthday.     

Computerized tomography cystography for the diagnosis of traumatic bladder rupture

PURPOSE: We present our experience with computerized tomography (CT) cystography for diagnosing bladder rupture in patients with blunt abdominal and pelvic trauma, and compare the results of CT cystography with those of surgical exploration. MATERIALS AND METHODS: We identified all patients with blunt trauma diagnosed with bladder rupture from 1992 to September 1998. We reviewed the radiology computerized information system for all CT cystography performed to evaluate blunt trauma during the same period. We also reviewed the medical records and pertinent radiographic studies of patients with bladder rupture who underwent CT cystography as part of the hospital admission evaluation. Operative and radiographic findings were compared. RESULTS: CT cystography was performed in 316 patients as part of the initial evaluation of blunt trauma. Of the 44 patients with the ultimate diagnosis of bladder rupture CT cystography revealed bladder rupture in 42, while 23 of the 28 (82%) who underwent formal bladder exploration had operative findings that exactly matched the CT cystography interpretation in terms of the presence and type of rupture. In the 316 patients CT cystography detected bladder rupture with an overall sensitivity and specificity of 95% and 100%, respectively. For intraperitoneal rupture sensitivity was 78% and specificity was 99%. CONCLUSIONS: CT cystography provides expedient evaluation of bladder rupture due to blunt trauma and has accuracy comparable to that reported for plain film cystography. We recommend CT cystography over plain film cystography in patients undergoing CT for other injuries associated with blunt trauma.     

Usefulness of axial planes of helical computed tomography for diagnosis of pancreaticobiliary maljunction in early infants with negative findings on magnetic resonance cholangiopancreatography

Purpose

Magnetic resonance cholangiopancreatography (MRCP) is not sufficient to detect pancreaticobiliary maljunction (PBM) in young infants because the main pancreatic duct is not visualized and respiratory artifacts occur. To our knowledge, there are no reports highlighting the diagnostic accuracy of evaluation using the axial planes of helical computed tomographic (CT) scanning with contrast medium instead of 3-dimensional (3D) reconstruction. The aim of this study was to describe our experience and the characteristics of 3 children with PBM diagnosed using the axial planes of helical CT with contrast medium, although they showed negative findings of PBM by MRCP, instead of 3D reconstruction.

Methods

Three patients aged from 1 month to 3 years were diagnosed with PBM using the axial planes of helical CT with contrast medium though MRCP could not show the common channel and/or the entrance of the common channel into the duodenum.

Results

In all 3 patients, PBM of the common channel was not revealed by MRCP. On the other hand, axial planes of contrast-enhanced helical CT scans showed PBM clearly.

Conclusions

Our experience suggests that axial planes of the contrast-enhanced helical CT scan comprise an accurate tool for the diagnosis of fusiform-type PBM and could replace MRCP in younger children. Further studies are necessary for better assessment of the potential advantages and pitfalls of this modality.     

Computerized axial tomography of the esophagus to determine the suitability for blunt esophagectomy.

Computerized axial tomographic (CT) scans were performed on 16 patients over an 18-month period to determine which patients were candidates for removal of their esophageal tumors by blunt esophagectomy. Blunt esophagectomy was offered only to those patients whose tumors were confined to the esophageal wall on CT scan. Thirteen patients were able to undergo blunt esophagectomy, with only one complication, a tracheal injury, which was repaired. Three patients had extensive mediastinal invasion requiring standard thoracotomy to perform a palliative resection. The operative blood loss in the group of patients with blunt esophagectomy was 500 ml, and there was only one operative death related to chronic aspiration. The CT scan is a valuable adjunct in determining which patients are candidates for esophagectomy without thoractomy.     

Computerized tomography in the diagnosis of intramedullary metastases

Summary The authors describe two cases in which computerized tomography (CT) revealed the presence of cervical intramedullary metastases in the form of increased density areas.     

自控腰椎纵轴加压器诊断隐匿性腰椎退行性变

目的探讨自控腰椎纵轴加压器对隐匿性腰椎退行性变的诊断价值。方法采用自制"自控腰椎纵轴加压器"对120例腰腿痛(98例坐骨神经痛、22例腰痛)患者行腰椎纵轴加压CT/MR检查,所加压力不超过患者体质量的50%,并与常规腰椎CT/MR检查进行比较,硬膜囊面积减小(>15mm2)并降至75mm2以下、侧隐窝狭窄、椎间盘突出或程度增加等异常征像为腰椎纵轴加压检查的附加有效信息(AVI)。结果 120例中43例存在AVI,包括硬膜囊面积减小33例,椎间盘突出11例和突出程度增加15例,侧隐窝或椎间孔狭窄12例。98例坐骨神经痛患者中40例(40/98,40.82%)出现AVI,22例腰痛患者中仅3例(3/22,13.64%)出现AVI(P<0.05)。结论腰椎纵轴加压CT/MR检查对显示腰椎及椎管的隐匿性退行性变具有重要临床价值。     

Computerized axial tomography in the diagnosis of multiple brain tumors-correlation with angiography and nuclear scanning (author's transl)]

Results of Computerized Axial Tomography with and without intravenous contrast (60% Conray) in 24 patients with multiple brain tumors were analyzed. Of the 24 patients, 19 had metastatic brain tumors, 4 multiple gliomas and 1 patient had multiple meningiomas. Data obtained by C.T. scan were compared to results obtained by angiography and nuclear scanning. In the diagnosis of multiple metastatic brain tumors. C.T. scans were superior to the other two procedures. however, C.T. scanning detected 4 lesions in the case of multiple meningiomas, while angiography disclosed 11 tumors in the same patient. In one patient having multiple gliomas, one (vascular) lesion only was demonstrated by angiography. Many other evaluations of Computerized Axial Tomography have been reported and the advent of this unique non-invasive radiologic technique has resulted in marked changes in the neuro-radiological diagnostic approach to brain tumors. However, it is important to recognize the weak as well as the strong points of each diagnostic procedure including the C.T. scan. At present, in our opinion, even with a positive demonstration of a brain tumor by C.T.scanning, cerebal angiography should be carried out prior to surgical intervention.     

Follow-up computerized tomography (CT) scans in moderate and severe head injuries: Correlation with Glasgow coma scores (GCS), and complication rate

Summary Background: The wide availability of computerized tomography (CT) scan has popularized its use in initial and follow-up evaluations of head trauma patients. Follow-up CT scans of clinically stable patients, however, may not provide additional information, but could potentially subject the patients to secondary injuries. The authors investigated the correlation between CT scans and Glasgow coma score (GCS), and complication rate during follow-up CT scans in an attempt to dissuade clinicians from obtaining unnecessary follow-up CT scans. Methods: The medical records of 180 patients with blunt head trauma were retrospectively reviewed. Only patients (117) with moderate and severe head injuries were included in the study. A total of 319 follow-up brain CT's for 94 patients were obtained. Results: The change in CT scans was compared to the GCS the day of the scan. These two variables were found to be positively correlated by Chi-square analysis (²=81.2; < 0.001). CPP trend was found also be correlated with CT scan evolution by the Chisquare analysis ( < 0.001). When patients had unchanged or improved GCS, 73.1% had improved or the same CT appearance. When patients had a worse GCS, the CT was worse in 77.9%. A 16.9% (54/319) complication rate was documented during the follow-up scans (hemodynamic instability, increased intracranial pressure, desaturation, and agitation). This rate was higher in severe head trauma (GCS 3–8) patients than in moderate head injury (GCS 9–12) patients. Hemodynamic instability was the most common complication, which comprises 42.6% (23/54) of all complications. Conclusion: Because of the correlation between the CT scan appearance and the clinical status, as well as the detrimental effect of mobilizing critically ill patients, the authors urge the use of follow-up CT scans only in patients with clinical deterioration unexplained by ICP changes alone.     

Computerized axial tomography (CT) as an aid in the diagnosis of hepatic portal venous gas: a case report

The radiologic finding of hepatic portal venous gas and its surgical implications have been documented previously in the literature. More than 67 cases have been reported. Branching tubular lucencies that extend from the porta hepatis to the edge of the liver are characteristic. In general, air in the biliary tree is central in location, but the distinction may not always be clear. We present a case in which computerized axial tomography was extremely helpful in localizing extraluminal gas to the liver and differentiating between air in the biliary tree and hepatic portal venous gas.     

彩色多普勒影像技术设计腹部轴型皮瓣修复上肢深部创面

目的 报道利用彩色多普勒影像技术（CDFI）设计腹部轴型皮瓣修复上肢深部创面的方法和产疗效。方法 根据上肢创面特点，选用髂腰皮瓣、下腹部皮瓣和胸脐皮瓣共3个部位8个皮瓣，术前传统方法设计皮瓣后，应用CDFI检测轴型皮瓣供血动脉的起止点和长度等，根据检测结果再次设计皮瓣并转移覆盖上肢创面。结果 CDFI检测结果与术中所见相符，8例皮瓣完全成活。结论 CDFI对腹部轴型皮瓣血管判断具有简单、直观和无创的特点，为确定腹部轴型皮瓣移植提供更准确的依据。     

CT对腹壁子宫内膜异位症诊断的临床研究

目的 探讨CT对腹壁子宫内膜异位症的临床诊断价值。方法 回顾性分析2011年6月至2013年12月,河北省玉田县医院收治的腹壁子宫内膜异位患者23例。通过术前的CT检查,辅助手术切除治疗。结果 CT扫描发现,本组23例患者,单个肿块14例,多个肿块9例。肿块最小0．9cm×1．6cm,最大5．1cm×3．0cm。肿块均位于腹壁切口瘢痕下方,位于皮下脂肪层12例,腹壁切口肌层内7例,肌层与壁层腹膜4例。实块型肿块3个,囊肿型肿块14个,囊实混合性6个。手术后23例患者症状基本消失。手术时间35—70min,平均住院时间（6±2）d,预后较好,切口均甲级愈合。结论 CT对子宫内膜异位症的准确位置以及对周围组织的浸润情况具有较高的临床诊断价值,有助于子宫内膜异位症手术的顺利进行,值得临床推广。     

Decompressive craniectomy for massive cerebral infarction with enlarged cruciate duraplasty

Summary The use of decompressive craniectomy for massive cerebral infarction is attracting renewed interest because conventional medical treatment is associated with high mortality. The technique of duraplasty may be important. We have developed a 4 step volume-enlarged cruciate duraplasty and report its use in 12 patients with massive cerebral infarction. None of the patients needed an additional anterior temporal lobectomy to reduce intraoperative intracranial pressure and none suffered epilepsy after the operation. This initial experience suggests that the use of a stepwise cruciate duraplasty during a decompression may promote clinical outcomes and further evaluation is merited.     

Endoscope-assisted biopsy for the diagnosis of neurosarcoidosis

A 56-year-old woman was followed in the neurological department for febrile mental confusion. The diagnosis of sarcoidosis was suggested on the ground of associated abdominal lymphadenopathy, elevated serum angiotensin-converting enzyme level, aseptic meningitis and intracranial hypothalamic lesion. Nevertheless, radiological, biological and histological analyses could not assert the diagnosis of systemic sarcoidosis. Six months later, cerebral MRI showed a recent enhanced nodule, located near the right choroid plexus, inducing a dilatation of the right temporal ventricular horn. A surgical endoscope-assisted biopsy of that lesion was decided. The endoscope was introduced in the right trapped temporal ventricle. The limits between normal and pathological tissues were clearly identified. The biopsy was thus accurately performed. Histological analysis definitely confirmed the diagnosis of neurosarcoidosis. No postoperative complication was noted. We report a case of neurosarcoidosis which was diagnosed by ventricular endoscope-assisted biopsy. The discussion stresses the potential advantages of endoscopy for the diagnosis of small periventricular lesions when ventricular dilatation is associated.     

多层螺旋CT检查在结直肠肿瘤诊断中的应用

Colorectal neoplasms always present with thickness of the intestinal wall or a soft tissue mass in the enteric cavity. Multi-slice computed tomography (MSCT) with high spatial resolution and advanced post-processing techniques can demonstrate the above signs of the tumor, and the invasive signs of adjacent structures and lymph node metastasis. Combined with three dimensional reformation images, MSCT shows a higher sensitivity than that of double contrast barium enema and electronic colonoscope. MSCT is promising in the diagnosis and preoperative evaluation of colorectal neoplasms.     

The value of different neuro-imaging methods in the diagnosis of a congenital,spinal, epidural meningeal cyst

Congenital, spinal, epidural cysts are rare causes of transverse or radicular spinal lesions. Usually these cysts are located in the thoracal region, are oblong-shaped, and extend over several segments dorsally to the cord. Frequently, they cause no symptoms for years. They are fairly accessible to diagnostics by modern neuro-imaging methods.We report on a 15 year old girl with paraparesis, which showed a slow progression over two years, short-term remissions, and finally impairment of bladder function.Myelogram, computer-assisted tomography and nuclear magnetic resonance tomography showed a large spaceoccupying mass from D8 to L1 epidural and dorsal of the myelon. Operation disclosed an epidural cyst from D10 to L2. Histologically, the removed material was classified as a meningeal cyst. Post-operatively the girl's condition improved under intensive physio-therapy.For the diagnosis of this spinal dysrhapic disorder CT scanning after intrathecal application of contrast medium and magnetic resonance imaging were most valuable.     

Percutaneous CT-guided lung biopsy for the diagnosis of persistent pulmonary consolidation

PurposeThe primary objective of this study was to determine the diagnostic accuracy of percutaneous computed tomography (CT)-guided biopsy of persistent pulmonary consolidations. The secondary objective was to determine the complication rate and identify factors affecting diagnostic yield.Materials and methodsTwo radiologists retrospectively reviewed 98 percutaneous CT-guided biopsies performed in 93 patients (60 men, 33 women; mean age, 62 ± 14.0 (SD) years; range: 18–88 years) with persistent pulmonary consolidations. Final diagnoses were based on surgical outcomes or 12 months clinical follow-up findings. Biopsy results were compared to the final diagnosis to estimate diagnostic yield.ResultsA final diagnosis was obtained for all patients: 51/93 (54.8%) had malignant lesions, 12/93 (12.9%) specific definite benign lesions (including 9 infections, two pneumoconiosis and one lipoid pneumonia) and 30/93 (32.3%) non-specific benign lesions. CT-guided biopsy had an overall diagnostic yield of 60% (59/98) with a correct diagnosis for 50/51 malignant lesions (diagnostic yield of 98% for malignancy) and for 9/47 benign lesions (diagnostic yield of 19% for benign conditions). Major complications occurred in 4/98 (4%) of lung biopsies (four pneumothoraxes requiring chest tube placement).ConclusionPercutaneous CT-guided biopsy is an alternative to endoscopic or surgical biopsy for the diagnosis of persistent consolidation with a low risk of severe complication.     

The use of computed tomography in the prediction of delayed cerebral infarction following acute aneurysm surgery for subarachnoid haemorrhage

Summary In order to predict the occurrence of cerebral infarction after aneurysmal surgery in patients with subarachnoid haemorrhage, we measured the amount of subarachnoid blood on initial and on post-operative computed tomograms. We used a reliable grading method to estimate the amount of blood on computed tomograms in 24 patients with infarction due to vasospasm and 45 patients without cerebral infarction, all of whom underwent aneurysmal surgery within 48 hours after the ictus.The total amount of subarachnoid blood on admission and on the day after operation was more in the cerebral infarction group than in the non-infarction group. The clearance rate of subarachnoid blood by surgery was lower in patients with cerebral infarction than in patients without infarction and the predominant site of subarachnoid blood corresponded with the site of the infarct. Of 24 patients with cerebral infarction, 22 (92%) belonged to the group whose initial total blood score was more than 10 on admission and whose clearance rate by surgery was less than 50%.Therefore, we propose this range to be an indication for the occurrence of cerebral infarction in postoperative patients due to cerebral vasospasm.The presence of intracerebral haematoma and the amount of ventricular blood and their clearance by surgery were also estimated for the prediction of delayed cerebral infarction after aneurysmal surgery. However, they had no relation to the occurrence of cerebral infarction due to vasospasm.