Value of MR imaging in the evaluation of chronic infiltrative lung diseases: comparison with CT.

The value of MR imaging was compared with that of high-resolution CT in assessing chronic infiltrative lung disease in 25 patients. The cases included nine patients with usual interstitial pneumonia, six with sarcoidosis, four with hypersensitivity pneumonitis, and six with miscellaneous conditions. The diagnosis was proved by biopsy (n = 17) or by means of clinical, laboratory, and radiologic criteria (n = 8). All patients had 1.5-T MR imaging and CT of the chest. Cardiac-gated T1-, proton density-, and T2-weighted spin-echo sequences were obtained. Initially, the MR images were assessed independently; later they were compared directly with the corresponding CT scans. In six patients, MR images and CT scans were obtained before open lung biopsy, and the images and scans were assessed prospectively. CT was superior to MR imaging in the anatomic assessment of the lung parenchyma and in showing fibrosis. However, areas of air-space opacification (ground-glass opacities) were seen as well on MR as on high-resolution CT. In the six patients who had open lung biopsy, areas of air-space opacification seen on MR and on CT corresponded to areas of active alveolitis or air-space infiltrates pathologically. Follow-up in six patients showed equal degrees of change in the air-space opacification over time on MR and CT. We conclude that, although MR imaging is inferior to high-resolution CT in the assessment of chronic infiltrative lung diseases, it may play a role in the assessment and follow-up of patients with air-space opacification.     

Solitary pulmonary nodule: high-resolution CT and radiologic-pathologic correlation

Edge and internal characteristics of pulmonary nodules evaluated with high-resolution computed tomography (HRCT) were correlated with the pathologic specimens in 93 patients. Speculation correlated pathologically with irregular fibrosis, localized lymphatic spread of tumor, or an infiltrative tumor growth pattern and was observed in six of 11 benign nodules (55%) and 74 of 85 malignant nodules (87%). Pleural tags were observed in three benign nodules (27%) and 49 malignant lesions (58%); pathologically, these represented fibrotic bands usually associated with juxta-cicatricial pleural retraction. Bubblelike areas of low attenuation within the nodule were observed in 21 malignant lesions (25%) and only one benign nodule (9%). They were observed most commonly in bronchioloalveolar carcinomas (seven of 14) and were due either to patent small bronchi or small, cystic spaces within neoplastic glands. Malignant nodules as a group were larger than benign lesions (P = .02) and more commonly demonstrated a spiculated contour (P less than .05), lobulation (P less than .001), and inhomogeneous attenuation (P less than .05).     

Noncardiogenic pulmonary edema caused by decompression sickness: rapid resolution following hyperbaric therapy

Noncardiogenic pulmonary edema is a recognized but uncommon manifestation of type 2 decompression sickness. It typically occurs within 6 hours of a dive. Because the adult respiratory distress syndrome in this setting is believed to be due to microbubbles in the pulmonary vasculature, recompression in a hyperbaric chamber has been recommended as a form of therapy. A patient developed noncardiogenic pulmonary edema following a seawater dive to 75 feet. There was complete radiologic and clinical resolution within 5 hours of hyperbaric therapy.     

Photodynamic laser therapy to alleviate complete bronchial obstruction: comparison of CT and bronchoscopy to predict outcome

Photodynamic laser therapy is used in the palliation of advanced lung cancer. To minimize the complications of this form of therapy, physicians must evaluate correctly the extent of extraluminal disease. We undertook a study to compare CT and bronchoscopy in the evaluation of extent of disease before laser therapy in 20 patients with complete bronchial obstruction. The relative contribution of intraluminal and extraluminal tumor to the obstruction and its influence on response to therapy was assessed by using both techniques. Adequate response was defined as greater than or equal to 50% relief of the obstruction on bronchoscopy performed within 1 week of therapy and by any improvement of the postobstructive atelectasis and consolidation on follow-up chest radiographs. Nine patients had predominately intraluminal tumor on both CT and bronchoscopy before laser therapy. Eight of these had a bronchoscopic response and radiographic improvement after therapy. Ten patients had predominately extrinsic compression by tumor on CT. Of these, only two had a bronchoscopic response and none had radiographic improvement after treatment. The differences in bronchoscopic and radiographic response between the two groups were significant (p less than .01). In the 10 patients with predominately extraluminal tumor on CT, bronchoscopy agreed with CT in suggesting mainly extrinsic compression in five, but it incorrectly suggested mainly intraluminal tumor in the remaining five. In one patient with a left upper-lobe tumor, the relative intra- and extraluminal components could not be assessed on CT. We conclude that in complete bronchial obstruction, CT is superior to bronchoscopy in evaluating the extent of extrinsic compression by tumor. The presence of predominately extraluminal tumor compression on CT correlates with a poor response to laser therapy.     

Translabial sonography of vaginal fibroids: report of 2 cases and review of the literature.

OBJECTIVE: To determine the role of translabial sonography in the diagnosis of vaginal fibroids. METHODS: Two women with vaginal masses of undetermined origin were examined by various imaging procedures, including translabial sonography. RESULTS: Initial examinations, which included transabdominal sonography, cystoscopy, and cystourethrography, yielded inconclusive findings. Translabial sonography, however, suggested isolated vaginal leiomyomas in both patients, and in both the diagnosis was confirmed histologically after surgery. CONCLUSIONS: Translabial sonography should be considered as an adjunct to transabdominal and transvaginal sonography for patients with suspected vaginal fibroids.     

Imaging of urinary tract infection in the adult

The diagnosis of urinary tract infection (UTI) in the adult is primarily based on typical patient symptomatology and urinary evaluation for the presence of bacteria and white blood cells. Uncomplicated UTI usually does not require radiological evaluation unless it is recurrent. Imaging should, in general, be reserved for those patients in whom conventional treatment has failed or those who have recurrent or unusually severe symptoms. Patients with conditions predisposing to infection, or complications thereof, such as diabetes mellitus or immunocompromised states, may also benefit from early imaging. If pyonephrosis is suspected, early imaging and possible urgent drainage is also warranted. Intravenous urogram and ultrasound have traditionally been used in the assessment of these patients, allowing detection of calculi, obstruction and incomplete bladder emptying. These imaging techniques, while useful, have limitations in the evaluation of renal inflammation and infection in the adult. Computerised tomography has now become accepted as a more sensitive modality for diagnosis and follow-up of complicated renal tract infection. Contrast-enhanced CT allows different phases of excretion to be studied and can define extent of disease and identify significant complications or obstruction. Nuclear medicine has a limited role in the evaluation of urinary tract infection in adults. Its main role is in the assessment of renal function, often prior to surgery. Magnetic resonance imaging has a limited but increasing role. It is particularly useful in those with iodinated contrast allergies, offering an ionising radiation free alternative in the diagnosis of both medical and surgical diseases of the kidney.     

Imaging of urinary tract infection in the adult

The diagnosis of urinary tract infection (UTI) in the adult is primarily based on typical patient symptomatology and urinary evaluation for the presence of bacteria and white blood cells. Uncomplicated UTI usually does not require radiological evaluation unless it is recurrent. Imaging should, in general, be reserved for those patients in whom conventional treatment has failed or those who have recurrent or unusually severe symptoms. Patients with conditions predisposing to infection, or complications thereof, such as diabetes mellitus or immunocompromised states, may also benefit from early imaging. If pyonephrosis is suspected, early imaging and possible urgent drainage is also warranted. Intravenous urogram and ultrasound have traditionally been used in the assessment of these patients, allowing detection of calculi, obstruction and incomplete bladder emptying. These imaging techniques, while useful, have limitations in the evaluation of renal inflammation and infection in the adult. Computerised tomography has now become accepted as a more sensitive modality for diagnosis and follow-up of complicated renal tract infection. Contrast-enhanced CT allows different phases of excretion to be studied and can define extent of disease and identify significant complications or obstruction. Nuclear medicine has a limited role in the evaluation of urinary tract infection in adults. Its main role is in the assessment of renal function, often prior to surgery. Magnetic resonance imaging has a limited but increasing role. It is particularly useful in those with iodinated contrast allergies, offering an ionising radiation free alternative in the diagnosis of both medical and surgical diseases of the kidney.