Acta Radiologica

The anatomy and catheterization techniques of the internal mammary artery (i.m.a.) are described. The diagnostic criteria and importance of i.m.a. angiography in thymoma, lymphoma, carcinoma, parathyroid adenoma, diseases of the breast, and trauma are discussed. The role of i.m.a. catheterization for i.a. infusion therapy in lung carcinoma, mesothelioma and chest wall metastases of breast carcinoma and embolization of i.m.a. in bleeding following trauma or tumour ulceration are described. Transcatheter treatment of mediastinal parathyroid adenoma is also described.

A prospective investigation was performed concerning the clinical value of Doppler examination with a flow velocity profile analysis using the quotient (AR) between the acceleration of velocity in a supposed diseased artery as compared with the acceleration of flow velocity in a healthy artery. Seventy-nine patients with peripheral arterial disease were followed at least one year after angiography which was performed as a preoperative examination. Comparing AR with angiography and blood pressure measurements it was found that AR values were affected favourably by development of good collaterals. AR≤0.25 (Doppler frequency 5 MHz) in the best artery of the foot was found in all patients where amputation had to be performed, and in 36 of 44 legs treated with vascular reconstruction.

Histologically classified benign breast disorder was present in 163 breasts of 158 symptomatic women. The results of diaphanography (DPG) were correlated with those obtained by clinical examination (CE), mammography (M) and cytology (C). A tumour was palapable in 108 cases (66.3%). A false positive diagnosis, i.e. possibly malignant, probably malignant or malignant was made in 15 cases (9.2%) with DPG, and in 33 cases (20.2%) with M. Use of both M and DPG reduced the number of false positives to 1.8 per cent. In 8 cases (4.9%) false positive diagnosis was made with C. During a mean observation time of 58.5 months (range 44–72 months), one case of breast carcinoma was diagnosed.

Microarteriography has demonstrated the anatomy which explains the pathogenesis and radiologic features of adult vertebral osteomyelitis and of childhood discitis. Infarction is caused in the metaphysis by a septic embolus. The intraosseous arteries in children are anastomotic and a small portion of bone is destroyed. In adults a larger portion of bone is destroyed because the intraosseous arteries are end-arteries and septic thrombosis spreads into peripheral intraosseous arteries. The disc is avascular at all ages and is attacked by infection equally. The trans-equatorial spread of osteomyelitis occurs via an artery which is first described here. It joins the metaphyseal anastomoses of the same vertebral body in the midline.

A grading system involving six stages of arthritis from grade 0 = normal joints to grade V = extensive bony ankylosis in the sacro-iliac joints and a scheme applicable for quantitative registration of the radiographic findings of the spine in ankylosing spondylitis (AS) are detailed. These radiographic grading systems were used in a study comprising 48 patients with psoriasis (group A), 19 patients with AS and psoriasis (group B), 103 patients with AS (group C) and 231 first-degree relatives of the patients belonging to groups B and C (group D). Radiographic abnormalities of the spine were found totally in 80 per cent of the patients belonging to groups B and C. In these groups sclerotic anterior borders of vertebrae (SABS) and/or straightened anterior surfaces of vertebrae were seen totally in 66 per cent. SABS were earlier findings than syndesmophyte formation which was found in 60 per cent of the patients belonging to groups B and C. Except for ankylosis of the apophyseal joints and ossified interspinous ligament most frequently found in the lower lumbar region in patients with duration of disease more than 20 years, all abnormalities of the spine were most frequent in the dorsolumbar junction. Grade V sacro-iliitis was associated with ankylosis of two or more segments of the spine. Such spinal changes were infrequently seen in patients with grade IV sacro-iliitis. This finding supports the previous notion that among patients fulfilling the criteria for AS, there is a group with a non-ankylosing disease. Thus two different subgroups of AS could be identified. Except for frequent unilateral sacro-iliitis and slight changes of the spine in group A no radiographic differences were found between the groups A, B and C. Sacro-iliitis was found in 22 (9%) in group D, and 11 of those with sacro-iliitis had abnormalities of the spine compatible with AS.

Five sacral tumors, 2 chordomas, 2 chondro- and/or osteosarcomas and one metastasis were examined with magnetic resonance imaging (MRI). The tumor delineation was excellent in all cases, and in several respects superior to CT. The signal pattern from the chordoma differed considerably from the other tumors suggesting a potential for tumor differentiation with MRI.

Transpharyngeal examination of the mandibular condyle was compared with transcranial and transmaxillary examinations in 22 patients with mandibular pain/dysfunction. All projections were supplementary and a combination of at least two methods seemed preferable. When a single examination was used, underestimation of abnormalities was evident. In demonstrating condylar destruction, the transpharyngeal examination seemed to be superior to the more commonly used transcranial, but inferior to the transmaxillary examination.

In conventional sinus films in occipitofrontal projection, the atlas is superimposed on the maxillary alveolar processes. If destruction of the alveolar process is present, the atlas-half on the affected side may be unusually clearly demonstrated. The value of this ‘unilateral demonstration of the atlas’ was confirmed by comparing a group of 20 patients with alveolar process destruction with two groups of 50 patients, one reported as normal and another with mucosal thickening, fluid levels or entirely dense sinuses.

The accuracy of the Dunlap method, as modified by Rippstein, for measuring the femoral neck angles was evaluated using adult bodies. The results were correlated to measurements on the dissected femurs. The Dunlap/Rippstein mehtod correlated well with the determinations made in the specimens. The accuracy of the method was within ±7 degrees for the anteversion angle and within −5 to +9 degrees for the head-neck-shaft angle.

Radiographic appearances claimed to be typical of shrinking pleuritis with atelectasis (SPA) were tested by mingling chest films from 6 SPA patients with those from 56 cancer cases. Two radiologists were asked to interpret the films independently, make a diagnosis, and state what abnormalities could be distinguished. No single abnormality or combination of abnormalities was found to be pathognomonic and the wish to diagnose the SPA cases led to misdiagnosis of cancer in one of 56 cases by each radiologist. To prevent underdiagnosis of cancer, further examinations are required. Careful follow-up of SPA cases, if they are not operated upon, is recommended.

CT was performed before and after lymphadenectomy in 105 patients with early stage non-seminomatous testicular tumor. Retroperitoneal blurring and retracted bowel were the most common findings and might cause interpretation problems. A reference CT making future comparison possible should be routinely performed two months after the operation.

A patient with renal cell carcinoma, first presenting because of symptoms from an osseous metastasis, was examined with CT and magnetic resonance imaging (MRI). Both the primary tumor and the metastasis were well demonstrated by both methods. MRI tissue characterization showed that the T1 values in the kidney and the metatasis were the same, as were the T2 values. This may mean a potential for the MRI to define primary tumors when a metastasis is found.

Malignant disease frequently manifests with symptoms from metastatic spread. This presents the diagnostic challenge of detection of the primary tumor site. In this search, radiologic methods are important tools. The radiologic arsenal recently has been strengthened with a new modality, magnetic resonance imaging (MRI), and we now present the first case that seems to be reported of MRI depiction and tissue characterization of a renal cell carcinoma, first presenting as an osseous metastasis.

A new type of balloon catheter for rapid nephrostomy track dilatation from 3 to 10 mm is described. The balloon has a length of 10 cm, which means that the tract can be dilated in its entire length in one step. The catheter system is recommended for use, especially in patients previously not operated upon.

Ultrasonography for detection of postoperative intrarenal dilatation following surgical intervention for vesicoureteral reflux was investigated in 102 children (0–14 years, mean age 4 years and 9 months) over a period of 5 years and was compared with urography. Ultrasonography had a high accuracy for demonstration of even slight intrarenal dilatation caused by postrenal obstruction, while slight and moderate non-obstructive dilatation often was overlooked. The results support the application of sonography for repeated controls of postrenal obstructive dilatation in children with a known medical record in order to diminish their exposure to radiation. The high accuracy does not apply to single sonograms in examination of possible obstruction of unknown origin where some alternative method should be added.

During routine retrograde pyelography in a recently transplanted kidney filling of the central intrarenal veins was observed. This unique radiologic picture was due to renal vein thrombosis. The case is discussed in relation to previous experimental findings.

The new non-ionic contrast medium iohexol 350 mg I/ml was compared with the ionic contrast medium metrizoate 350 mg I/ml in a double blind, two-group urographic study performed on 20 patients with stable, impaired renal function. A dose of contrast medium of 500 mg I/kg body weight was given to each patient. Iohexol resulted in significantly fewer subjective adverse reactions than metrizoate. A similar image quality was obtained with the two contrast media. No clinically significant difference existed between the two contrast media with respect to influence on blood pressure, pulse or clinical chemical parameters. A tendency to deterioration of renal function after urography was found in both groups, but no difference of statistical significance existed between the two contrast media with respect to possible nephrotoxicity. Inadequate hydration may have been partly responsible for the nephrotoxic effect of the urographic procedure.