Detection of gastric erosions: comparison of biphasic radiography with fiberoptic endoscopy

Biphasic radiography was compared with fiberoptic endoscopy in detecting gastric erosions in a prospective, blinded study of 385 patients with dyspepsia. Because no absolute standard was available for the comparison, since histologic confirmation of all erosions was not possible, the kappa statistic was used to compare results from both modalities. Flat (incomplete) erosions were detected with endoscopy only and were considered to be present in 42 patients (11.2%). Varioliform (complete) erosions were identified with both radiography and endoscopy in 12 patients (3.2%). For the detection of varioliform erosions, a substantial agreement beyond chance between both modalities was found (kappa = 0.73; standard error, 0.12). Thus, flat erosions were detected with endoscopy only, whereas state-of-the-art radiography and endoscopy were equally sensitive for detecting varioliform erosions. Histologic confirmation of erosions was obtained in only 75% of the patients. It is unknown whether the demonstration of erosions with radiography and/or endoscopy correlates with dyspepsia.     

Scirrhous gastric carcinoma: endoscopy versus upper gastrointestinal radiography

PURPOSE: To compare the accuracy of upper gastrointestinal (UGI) series and endoscopic examination in the diagnosis and localization of scirrhous gastric carcinoma. MATERIALS AND METHODS: Seventy-two patients with pathologically proved scirrhous gastric carcinoma in surgical specimens were included. Preoperative reports at UGI series and endoscopic examination, which included impressions on the location and extent of the tumor, were compared with pathology reports, and the accuracy of the preoperative reports was calculated. Two gastrointestinal radiologists retrospectively reviewed the appearance of mucosa at UGI series. RESULTS: Preoperative diagnoses at endoscopy were Borrmann type IV carcinoma in 28 patients (39%), type III carcinoma in 29 (40%), early gastric carcinoma in seven (10%), lymphoma in six (8%), atrophic gastritis in one (3%), and type II carcinoma in one (3%). Preoperative diagnoses at UGI series were type IV carcinoma in 44 patients (61%), type III carcinoma in 25 (35%), lymphoma in two (3%), and early gastric carcinoma in one (1%). Pathology reports were compared with the preoperative reports, and tumor location and extent were correct in the endoscopic examination reports of 24 patients (33%) and the UGI series reports of 49 patients (68%). In 68 patients, UGI series revealed thickened and irregular folds in 62 (91%), ulceration in 42 (62%), and nodularity in 22 (32%) at consensus review. Endoscopic biopsy samples were positive for malignancy in 66 patients (93%). CONCLUSION: UGI series is superior to endoscopic examination in the diagnosis and localization of scirrhous gastric carcinoma.     

Benign gastric ulcers: diagnosis and follow-up with double-contrast radiography

Double-contrast upper gastrointestinal examinations revealed 108 gastric ulcers at the authors' hospital during a recent 1-year period. With use of current double-contrast examination criteria for differentiating benign and malignant ulcers, the radiographic appearance was unequivocally benign in 68 patients, probably benign in 25, probably malignant in 12, and unequivocally malignant in three. Fifty-six patients with benign, probably benign, or probably malignant ulcers underwent endoscopy and biopsy. All 56 had benign ulcers. Another three patients with unequivocally malignant ulcers had endoscopically proved carcinomas. Thus, most suspicious ulcers were benign, but no benign-appearing ulcers were malignant. Follow-up double-contrast studies for 87 ulcers revealed complete ulcer healing in 68 (78%). A residual ulcer scar was observed in 61 of those 68 cases (90%). This experience suggests that double-contrast radiography is a valuable technique for diagnosing benign gastric ulcers and that once diagnosed, typically benign ulcers can be followed up radiographically until completely healed, without need for endoscopic intervention.     

高场强MRI与X线钡餐造影、胃镜诊断胃癌术后复发的对比分析

目的 通过高场强MRI与X线钡餐造影、胃镜检查的对比研究,探讨MRI在胃癌术后复发诊断中的应用价值.方法 收集临床拟诊胃癌术后复发患者53例,所有患者均接受MRI、X线钡餐造影、胃镜检查,以手术或穿刺活检病理结果为金标准,用卡方检验对上述检查方法进行统计分析.结果 53例胃癌术后患者经于术或穿刺活检病理证实:术后吻合口复发者30例,吻合口正常但发生周围及远处转移者10例,无复发者13例.MRI、X线钡餐造影和胃镜检查3种方法诊断胃癌术后吻合口复发的灵敏度、特异度、准确率、阳性预测值、阴性预测值分别为96.6％、86.9％、92.4％、90.6％、95.2％,70.0％、86.9％、77.3％、87.5％、68.9％,96.6％、91.3％、94.3％、93.5％、95.4％;诊断胃癌术后复发(包括胃外组织浸润、转移)的灵敏度、特异度、准确率、阳性预测值、阴性预测值分别为97.5％、76.9％、92.4％、92.8％、90.9％,52.5％、76.9％、58.4％、87.5％、34.4％,72.5％、84.6％、75.4％、93.5％、50.0％.诊断吻合口复发:MRI显著优于X线钡餐造影(x2=4.90,P＜0.05),MRI与胃镜检查结果比较,差异无统计学意义(x2=0.03,P＞0.05);诊断胃癌术后复发(包括胃外组织浸润、转移):MRI显著优于X线钡餐造影(x2=12.46,P＜0.05)和胃镜检查(x2=5.26,P＜0.05).结论 在评价胃癌术后复发(包括胃外组织浸润、转移)中,MRI优于X线钡餐造影、胃镜检查;MRI对指导临床治疗方案,提高胃癌术后生存率具有重要的临床意义.     

Peptic ulcer disease: CT evaluation

The authors retrospectively describe the computed tomographic (CT) findings in 35 patients with peptic ulcer disease. Three of eight patients with gastritis or duodenitis had bowel-wall thickening. Ten of the remaining 27 patients had CT evidence of ulcer perforation (n = 2) or penetration (n = 8), four cases of which were unsuspected clinically. Both patients with acute free perforation had pneumoperitoneum, and one showed free extravasation of orally administered contrast material. The precise site of perforation could not be established in either case with CT. The eight patients with ulcer penetration had CT evidence of bowel-wall thickening (n = 3) and inflammatory changes in adjacent soft tissues and organs (n = 8), including the pancreas (n = 4), liver (n = 1), and lesser omentum (n = 1). Ulcer craters were seen in only two. The CT findings of penetration can mimic other disease processes. CT was not useful in detecting uncomplicated peptic ulcer disease.     

Conventional sinus radiography compared with CT in the diagnosis of acute sinusitis

OBJECTIVES: To evaluate the value of plain film radiography in a prospective investigation of patients with clinical suspicion of acute sinusitis, using standard CT as a gold standard. METHODS: 47 consecutive patients were examined. Each patient underwent conventional X-ray and standard dose CT examinations on the same day. The sensitivity and specificity of the plain film examination were calculated. RESULTS: The specificity of the plain film examination was high, but the sensitivity was low except for the maxillary sinus (sensitivity 80%). Thus, for maxillary sinusitis, plain film examination was reasonably accurate. A negative finding in the other sinuses could not be relied upon. CONCLUSIONS: The sensitivity of plain film radiography for detecting sinus opacifications was unacceptably low for the ethmoid, frontal and sphenoid sinuses. The specificity was high.     

Photostimulable phosphor digital radiography of the extremities: diagnostic accuracy compared with conventional radiography

A direct comparison was made between digital and conventional radiographs to assess the relative accuracy of a photostimulable phosphor digital imaging system in detecting and localizing minor trauma in the extremities. Matched sets of images were obtained on 103 patients who came to the emergency department for radiographs of the hand, wrist, foot, or ankle. One set was obtained with a conventional screen/film system. The other set was obtained with photostimulable phosphor digital cassettes. The two sets of images of each patient were independently interpreted by three radiologists in a blinded fashion. The findings of each of these three readers were compared with the consensus opinion of two different radiologists. Receiver-operating-characteristic (ROC) curves were plotted for each of the three readers, areas under the curves were calculated, and true-positive fractions were determined at false-positive fractions of 0.1. Although no significant differences in the areas under the ROC curves for the two imaging systems were detected, conventional radiography showed a slight advantage. However, when true-positive fractions for fracture detection were compared at false-positive fractions of 0.1 a statistically significant difference was shown, with conventional screen/film radiography being more sensitive. This study raises questions about the use of currently available photostimulable phosphor systems for imaging trauma of the extremities and suggests that those systems should not be used exclusively.     

胃溃疡B超诊断150例研究

报告了经手术、胃镜和病理证实的１５０例胃溃疡的Ｂ超检查结果。总检出符合率为８２％，其中溃疡直径＜０．５ｃｍ及≤１．５ｃｍ者良性溃疡分别占９１％和８１．８％；＞１．５ｃｍ者恶性溃疡为７９．２％。提出了小凹陷增厚型和大凹陷增厚型两种声像图类型。认为，Ｂ超诊断本病具有无创、无痛、简便、易行，且结果可靠的特点，值得推广应用。另外，作者对漏误诊原因进行了分析。对溃疡的性质，可根据凹陷的大小、形态、胃壁增厚的范围、胃蠕动变化程度及胃周有无淋巴结肿大和其它脏器有无浸润转移进行鉴别。     

胃恶性溃疡双重造影与标本涂钡X线照片对比分析

胃恶性溃疡是消化道常见疾病之一,术前正确诊断对治疗方法的选择与预后关系重大,术前诊断大多依靠纤维胃镜,但X线检查(气钡双重造影)[1,2]仍是一种重要检查方法。笔者采集术后标本涂钡后进行X线照片,选取质量优良、资料完整、经病理证实的20例胃恶性溃疡患者的双重造影片和标本     

Accuracy of radiologic and endoscopic diagnosis of gastric ulcer

Patients with upper abdominal pain are often examined with both double contrast study of the stomach and endoscopy. On the basis of the results of the two examinations four diagnostic criteria of an ulcer can be formed: 1) radiography reveals an ulcer, 2) endoscopy reveals an ulcer, 3) both radiography and endoscopy reveal an ulcer, and 4) radiography and/or endoscopy reveals an ulcer. In a prospective study the accuracy of each of the four diagnostic criteria was examined. Eighty-two randomly selected outpatients had a double contrast barium examination and an upper gastrointestinal endoscopy performed by staff personnel. The diagnosis of a specialist in upper gastrointestinal endoscopy was used as the standard. For the four diagnostic criteria the overall accuracy ranged from 0.80 to 0.88. The predictive value of a positive test result was around 0.70 and the predictive value of a negative test result ranged from 0.81 to 0.96. The specificity ranged from 0.87 to 0.95, and the sensitivity from 0.38 to 0.90. It is concluded that from a clinical point of view, the accuracy of the four diagnostic criteria does not differ to an extent that justifies recommendation of one diagnostic criterion of gastric ulcer rather than the other.     

早期胃癌气-钡双对比造影检查与胃镜对照分析

目的:对于早期胃癌的检查,通过气钡双对比造影图像与胃镜检查图像对照观察,分析气钡双对比造影在检出早期胃癌中的价值。方法:42例经病理证实早期胃癌病例,采用低张气钡双对比造影方法,辅以充盈法、黏膜法及加压法观察胃壁改变,并实时点片。常规胃镜检查。结果:Ⅰ型6例,Ⅱa型4例,Ⅱb型2例,Ⅱc型11例,Ⅲ型4例,混合型15例。结论:气钡双对比钡餐检查能够较好显示早期胃癌病变。     

Mediastinal tumors: sensitivity of detection with sonography compared with CT and radiography

The purpose of this prospective study was to evaluate the sensitivity of mediastinal sonography compared with computed tomography (CT) and chest radiography in the detection of mediastinal tumors. The sonograms, CT scans, and chest radiographs of 182 patients were interpreted blindly by three observers, and the results were compared. The proportion of diagnostic sonographic examinations varied for the different mediastinal compartments from 85% (subcarinal region) to 96% (supraaortic region). The sensitivities of sonography and chest radiography, respectively, for each compartment, with CT as the reference method, were as follows: supraaortic region, 98% and 67%; paratracheal region, 89% and 69%; aorticopulmonary window, 81% and 62%; prevascular region, 92% and 46%; subcarinal region, 69% and 31%; pericardial region, 100% and 67%; posterior mediastinum, 6% and 6%; and paravertebral region, 11% and 44%. These results show that sonography is superior to chest radiography in the diagnosis of mediastinal tumors. In certain mediastinal regions (supraaortic, pericardial, prevascular, and paratracheal), sonography is so sensitive that CT and magnetic resonance examinations may be obviated in patients with equivocal radiographic findings.     

胃癌的CT诊断

胃癌是一种常见病,临床上通过消化道气钡造影、胃镜及病理活检都能够作出准确诊断。但消化道气钡造影和胃镜只能观察到胃腔内的病变,而无法了解胃癌对周围组织器官是否有侵犯以及有无肝脏、淋巴结等脏器的转移。随着CT在临床上的广泛应用，胃癌术前CT检查能够弥补上述不足，这对胃癌能否手术治疗及判断预后有重要意义，本文主要分析22例进展期胃癌的检查结果，评价CT检查胃癌的价值。