Real-time sonography of the pancreatic duct: application to percutaneous pancreatic ductography

Using a linear-array electronic real-time scanner, ultrasonic pancreatograms were obtained in 21 of 25 normal adults and in 28 of 29 patients with pancreatic disease. The normal pancreatic duct was seen as a thin anechoic tube with echogenic walls and an inner diameter under 0.8 mm. In patients with pancreatic disease, changes in the duct such as dilatation, obstruction, and pancreatic stones could be seen. When ultrasonic pancreatograms were compared with endoscopic pancreatograms in the same patients, there was a good correlation in the patterns of duct dilatation. Using a real-time transducer to guide a thin needle for puncture, both percutaneous pancreatic ductography and percutaneous aspiration biopsy of the pancreas were successfully performed as a single procedure in eight patients with carcinoma of the head of the pancreas. There were no major complications, and the examination provided a definitive diagnosis in all patients.     

Computed tomography of the normal pancreatic uncinate process

The uncinate process of the pancreas has been assessed in 106 consecutive patients without pancreatic disease in order to establish normal features. The process measures approximately 1 X 1.3 cm in size, is frequently inseparable from the superior mesenteric vein without contrast enhancement and can adopt a number of cross-sectional configurations.     

Computed tomography after modified Whipple procedure with pancreatic duct occlusion

Eighty-two CT examinations performed on 28 patients who had undergone a modified Whipple procedure including pancreatic duct occlusion were reviewed. Reduction of the antero-posterior diameter of the body and tail of the pancreatic remnant was observed on consecutive scans in 8 patients (29%). Decreasing liver attenuation was seen in 4 patients (14%) postoperatively, and pseudocysts in the pancreatic remnant in 6 (21%). In 10 examinations performed because of suspected intraabdominal abscess postoperatively, abscess was diagnosed in 2 patients. In 62 routine follow-up CT examinations, significant positive findings were diagnosed in 5 patients: tumor recurrence or metastases in 4, and a large pseudocyst in one. CT is of value in the early postoperative phase to reveal postoperative complications and in the follow-up of patients with specific symptoms indicating tumor recurrence or metastases.     

Computed tomography findings in clinically normal and abnormal thyroid patients

Fifty normal volunteers had unenhanced thyroid computed tomography scans. A range of normal computed tomography densities and volumes was established for each age group. Pre- and postcontrast scans were done on 47 abnormal patients with hemorrhagic cysts, multinodular goiter, thyroiditis, papillary carcinoma, and benign adenomas. The computed tomography characteristics of each of the pathologic groups was noted for both the abnormal areas and the uninvolved part of the gland. Preliminary observations of the computed tomography characteristics of each abnormality are discussed.     

Computed tomography of the abnormal appendix

This report describes the CT features of 29 abnormal appendices visualized during abdominal CT examinations. There were 22 cases of acute appendicitis, five mucoceles, and two mucinous adenocarcinomas of the appendix. The inflammed appendix appeared either as a fluid-filled slightly distended structure or as a collapsed small tubular structure. It was visualized on either cross or longitudinal sections and showed slight circumferential wall thickening. Periappendiceal inflammation was detected in 19 cases and intraluminal appendicoliths in six cases. Mucocele appeared as a larger fluid-filled round, oval, or tubular structure having a thin, sharp wall, low density contents, and no periappendiceal inflammation. Mucinous carcinoma appeared either as a single or as multiloculated, irregular shaped cystic lesion with solid elements. Infiltration of cecum and terminal ileum was seen in one case. In five cases the abnormal appendix was not recognized initially and was identified only after repeat 5 X 5 mm sections were obtained. During CT examination, demonstration of an abnormal appendix establishes the source of the abdominal pathology and helps greatly in the differential diagnosis.     

Computed tomography of pancreatic abscesses

Computed tomography (CT) was used as the primary diagnostic tool in 10 cases of pancreatic abscess and seven cases of infected pseudocyst. Pancreatic gas collections were the only definitive feature of infection and were seen in five cases (29%). An equally common finding was poorly defined nonencapsulated peripancreatic fluid collections or mottled mass density. It was not possible to distinguish infected from noninfected pseudocysts or peripancreatic fluid collections by other CT criteria. Diagnostic percutaneous needle aspiration is indicated in patients with pancreatic pseudocyst or fluid collections with persistent fever or leukocytosis. CT is also useful in the preoperative evaluation of multiple abscesses and of recurrent abscesses after surgery.     

Computed tomography of pancreatic carcinoma

The ductal adenocarcinoma is the most frequent tumour of the pancreas. So far, imaging methods did not enable early diagnosis of the tumour, since in most cases it cannot be detected before it has grown to a size of 2-3 cm diameter. CT findings of the carcinoma of the pancreas as well as problems connected with the diagnosis and with staging of the tumour are presented in a concise review.     

Computed tomography of the calcaneus: normal anatomy

The normal sectional anatomy of the calcaneus was studied as the background for interpretation of computed tomography (CT) of fractures. Multiplanar CT examination of the normal calcaneus was obtained, and sections were matched with a simplified anatomic model. Sectional anatomy in the four most important planes is described. This facilitates three-dimensional understanding of the calcaneus from sections and interpretation of CT sections obtained in any atypical plane.     

Computed tomography of the normal mesentery

Thirty patients were studied to evaluate the CT appearance of the normal mesentery and its vasculature. Mesenteric vessels were identified by determining their relations to segments of the small bowel and colon in the 30 patients. Jejunal and ileal branches supplying small bowel were identified in all patients. The ileocolic and right colic branches of the ascending colon were identified in 27 and 26 patients, respectively; middle colic vessels were identified in 29 patients. Left colic branches were identified in only 14 patients; sigmoid branches were identified in 23 patients. The vessels showed a characteristic wavy appearance as they coursed through mesenteric fat. The average attenuation of the mesenteric fat was -117.4 +/- 7.9 H. Normal lymph nodes were not routinely identified within the mesentery. Various pathologic processes altered the normal appearance of the components of the mesentery.     

Computed tomography in pancreatic disease

Computed tomography (CT) of the pancreas has been evaluated in 50 patients with established exocrine pancreatic disease and 20 patients without pancreatic disease. Increase in size, irregularity in outline and heterogeneity of composition of the pancreas implied disease but were in no way specific to any particular disease entity. In acute pancreatitis, following complete resolution, the pancreas appeared normal whereas incomplete resolution was associated with non-specific swelling and heterogeneity of density. The extent and location of pseudocysts could be accurately delineated. In chronic pancreatitis, duct calculi, duct dilatation and large intrapancreatic cysts aided the differentiation between focal enlargement due to chronic pancreatitis and expansion due to cancer. Hepatic metastases and abnormalities of the biliary system seen in association with cancer further aided this differentiation.     

Computed tomography of the pulmonary hila: 2. abnormal anatomy

Computed tomography can be used to evaluate abnormal pulmonary hila. A series of cases is presented that illustrate the appearance of dilated pulmonary arteries, absent pulmonary artery, hilar adenopathy, and hilar masses.     

Computed tomography of the normal and traumatized elbow

To study the role of CT in the radiographic evaluation of the elbow, a technique was developed for producing axial scans of the elbow in flexed and extended positions. Computed tomography was performed on a total of 75 patients with acute or subacute elbow injuries. All scans were compared to their respective plain radiographs, and results correlated with each patient's clinical management. Based on these observations, six radiographic criteria were developed which, when present, should prompt further study of the elbow by CT. Under these six conditions, the information provided by CT may change the diagnosis and subsequent management of a patient's injuries.     

Computed tomography of the normal sternoclavicular joint

 Objective. The objective of this work was to establish a reference population for the study of the sternoclavicular joint (SCJ). Design. A prospective study of the SCJ was carried out by high-resolution computed tomography (CT). CT images were read by two radiologists and two rheumatologists using a preestablished grid (27 elementary signs). Patients. Sixty healthy subjects, homogeneously distributed by sex and decade of life, from 20 to 80 years old, were studied. Results and conclusions. The main results were the following: 98% of healthy subjects presented at least one sign; mean number of signs per subject was 2.4±1.9; mean number of signs was higher (P<0.005) in men (mean=3.1±2.1) than in women (mean=1.7±1.3); number of signs increased with age (P<0.001). Some signs were very frequent: ”ossification of the first costal cartilage” (88%), ”surrounded subchondral clavicular erosion” (27%). Some signs were significantly more frequent in the elderly: ”sternal osteophyte” after the age of 70 (P<0.01) and ”meniscal calcification” (P<0.01) and ”sternal subchondral sclerosis” (P<0.05) after the age of 60. The number of clavicular signs was greater than that of sternal signs (P<0.001). These results can be used as references for the study of the SCJ.