Acta Radiologica

Consecutive chest radiographs (n = 2 303) in 601 patients in the intensive care units (ICU) were analyzed with regard to main disease and indication. Two thirds of the patients were transferred for routine post-operative treatment, 14 per cent mainly for cardiopulmonary insufficiency. The remainder were referred because of various clinical conditions. The main indications for chest radiography were routine radiographic follow-up and/or control of the position of catheters, tubes, drainages etc. (50%). Obvious clinical indications appeared in only about 1/4 of the patients. When the patients were discharged from the ICU all chest radiographs were analyzed with regard to their predicted future value. Films considered not worth storing were removed and stored in a separate archive (57%). During a 15-month follow-up period none of the removed films were requested, indicating that a substantial number of films can be sorted out continuously. The possibility to reduce and to ‘clinically compress’ the amount of data in a future digital picture archive is emphasized.

Polar presentations of selective coronary angiography and myocardial ²⁰¹T1 SPECT were compared in 141 patients with multiple vessel disease, 80 with 3-vessel disease, 34 with 2-vessel disease and 27 post-bypass patients. Perfusion defects were present in 125/141 patients (89%) and were located within the area supplied by 194/359 stenotic arteries (54%) and 9 non-stenotic arteries. The type and extent of disease was correctly indicated by ²⁰¹T1 SPECT in 16/80 patients (20%) with 3-vessel disease, 5/34 patients (15%) with 2-vessel disease and 8/27 post-bypass patients (30%). Perfusion defects indicated the artery with the most severe lesion in 107/125 patients (86%). False negative isotope studies were present in 15 patients (11%).

Regular, wave-like constriction in medium-sized arteries, arterial segmental vasoconstriction (ASV), has been observed at arteriography and described by many authors. We found ASV in arteriograms of the superficial femoral artery in 13 of 107 hypercholesterolaemic patients, enrolled in the Probucol Quantitative Regression Swedish Trial (PQRST). The arteriograms were digitized and studied with a quantitative computer-assisted technique. The frequency of ASV was higher than has been reported earlier in clinical materials, possibly because of an increased vasoreactivity in hypercholesterolaemia, as recently observed experimentally. The ASV patients were, on average, younger, had lower blood pressure and less atherosclerosis, than the non-ASV patients. ASV was not found in any of the 19 patients in the material who either had symptoms of peripheral vascular disease or arteriographically verified arterial occlusions. No significant correlations with smoking habits or serum cholesterol levels were found. A computer-based index of ASV and measurement of ASV wavelength are discussed.

Thirty-four patients with portal hypertension of various etiologies were operated upon with an interposition mesocaval Goretex graft. During a period of 6 years 84 angiographic and ultrasonographic (US) examinations (53 B-mode, and 31 Doppler Duplex) were performed, with few exceptions within 3 days. Angiography served as the ‘gold standard’. Shunt patency was correctly interpreted as normal in B-mode US in 38 examinations. Shunt occlusion, definite or probable, was seen in 12 B-mode examinations, where angiography demonstrated occlusion in 6 and patency in the remaining 6 shunts. Shunt occlusion was not observed sonographically in one examination. US was technically inadequate on two occasions. Doppler Duplex showed shunt patency in all 31 examinations, which was correct according to angiography. Both B-mode US, in 6 out of 6 examinations, and Doppler Duplex, in 7 out of 9 examinations failed to reveal shunt stenosis. Five patients with abundant venous collaterals (in one case with aberrant vascular anatomy) were not possible to evaluate even after the introduction of Doppler Duplex, which otherwise facilitated the evaluation. We suggest that US including Doppler should be the primary modality for follow-up in patients with interposition mesocaval Goretex grafts.

Hepatocellular carcinoma was treated with slow injection of an emulsion containing 40 to 60 mg of adriamycin and 3.5 to 12 ml of Lipiodol into the portal vein via a segmental hepatic artery. During and after the injection, the portal branches of the segment were demonstrated. Six patients with resectable hepatocellular carcinoma received this treatment, which in 3 of them was followed by embolization with Gelfoam of the segmental artery. In these 3, all main tumors and daughter nodules became completely necrotic, but some infarction developed in the non-tumorous area. Those without Gelfoam had complete necrosis of all daughter nodules, but incomplete response of the main tumor. This combined treatment may be recommended for patients with localized lesions which are non-resectable due to cirrhosis, or for other reasons.

Twelve patients with intrahepatic abscesses were examined with computed tomography and ultrasonography between 1979 and 1988. The median size of the lesions was 7 (1–12) cm. They were in 8 patients located only in the right liver lobe and in 3 in both liver lobes. On ultrasonography the echogenicity of the abscesses varied from hypo- to hyperechoic which is consistent with tumours. The final diagnosis of abscess was achieved by fine needle puncture and aspiration for bacterial culture. Nine patients were treated with percutaneous drainage, 3 of them with two catheters, and all received systemic antibiotic treatment. All patients survived the treatment.

Double contrast small bowel enema in a patient with selective amyloidosis of the duodenum and jejunum revealed an unusual radiologic pattern, mimicking multiple polyposis. Many submucosal polypoid lesions, sessile or pedunculated, were scattered throughout the duodenum and proximal jejunum. The lesions had smooth borders and did not show any retraction at the base. Other typical radiologic patterns of intestinal amyloidosis described in the literature were not observed in the present case. Differential diagnosis from multiple polyposis and diffuse lymphoproliferative neoplastic diseases is discussed.

Ten women treated for gynecologic neoplasms (8 cervical carcinomas, one vaginal and one endometrial carcinoma) were found at computed tomography (CT) to have a fistula although only 5 patients had symptoms that could be related to a fistula. Five women had vesico-vaginal fistulae, 2 recto-vaginal, 2 entero-cervical and one a vulvo-pubical fistula. Three patients had recurrent malignancy at the CT examination. We regard CT as the ragiologic method of choice in diagnosing gynecologic fistulae.

Twenty-seven patients with acute leukemia were examined at the time of diagnosis with MR imaging and in vivo T1 relaxation time measurements of the hemopoietic bone marrow. A 1.5 T whole body magnetic resonance scanner was used. Twenty of the patients had follow-up examinations in relation to chemotherapy. Bone marrow biopsies from the posterior iliac crest were obtained within a short time interval of all MR examinations. At the time of diagnosis, T1 relaxation times were increased significantly in all the leukemic patients, compared with 24 age-matched controls. A decrease in T1 relaxation time towards or into the normal range was observed in 10 patients who obtained remission. The T1 relaxation time remained prolonged in 6 patients who failed to obtain remission during chemotherapy. Four patients, who obtained remission with concomitant decrease of T1 values towards or into the normal range, also showed prolongation of T1 relaxation time in relation to leukemic relapse. The results indicate that changes observed in T1 relaxation times of the hemopoietic bone marrow in patients with acute leukemia reflect changes in disease activity, and, that serial measurements of T1 values may provide clinically useful information with the possibility for identification of residual disease in regions inaccessible for biopsy.

A method for quantitative evaluation of hyaline cartilage signal intensities has been developed in an experimental study of 6 swine knees with different types of arthritis. A FLASH sequence with TR 50 ms, TE 10 ms and flip angles of 5, 10, 20, 25, 30, 35, 50 and 90° was employed. Two parameters of the signal intensity flip angle curves proved to be useful for tissue characterisation: The initial increase (A) and the maximum (M).

In a prospective clinical study 24 normal volunteers and 106 patients with acute and chronic arthritis, osteoarthritis and post-traumatic alterations of the knee joints were examined. Using the parameters A and M 98 per cent of the pathologic cartilages and 74 per cent of the normal cartilages could be identified. In addition 78.5 per cent were correctly categorized in 5 cartilage classes. The A/M classification proved to be a fast and specific method for evaluation of cartilage disorders with special promise for follow-up examinations during therapy.

Computed tomography (CT) of the temporomandibular joint (TMJ) was compared with hypocycloidal tomography in 30 joints of 15 adults with rheumatic disease. CT included 1.5 mm thick axial scans (at 1.0 mm intervals) with reformatted oblique sagittal and oblique coronal sections. Multisection (at 2.0 mm intervals) tomography included oblique sagittal and occasionally, oblique coronal sections. CT demonstrated bone abnormalities in 21 and tomography in 20 joints, indicating high agreement between the imaging modalities regarding number of abnormal TMJs. Bone structures were, however, better visualized by multiplanar CT due to superior contrast and spatial resolution particularly in the most lateral and medial parts of the joint, indicating superiority of CT for depicting subtle bony TMJ abnormalities in patients with rheumatic disease.

In a study of 40 young adults the pelvic inclination measured by a specially constructed inclinometer was found to be the same in the supine and standing positions when related to the horizontal and frontal planes, respectively. Consequently supine CT measurements of the hip are also representative of corresponding standing angles. The variations of the acetabular anteversion and the sector angles on CT of the hips in 5 adult corpses were measured by angulating the gantry in increments of 5° to ±20°. An approximate linear relationship was found for all parameters, the acetabular anteversion varied 0.5° with 1° pelvic rotation, and the sector angles 0.7°. A theoretic mathematical model for the variation of the acetabular anteversion outside the measured range employing a sine curve is introduced.

The central, peripheral and renal haemodynamic effects after intravenous infusion (1 ml/s) of high doses (4 mg I/kg) of two low osmolar, chemically and physically similar non-ionic contrast media (iohexol and iopentol) were investigated in 16 pigs. Both contrast media induced a significant increase of mean arterial, mean right atrial, mean pulmonary arterial and mean pulmonary arterial occlusion pressure along with an increase in cardiac output. The systemic vascular and pulmonary vascular resistances were decreased. Renal venous blood flow and renal vascular resistance were not significantly changed after infusion of contrast media. There were no differences in haemodynamic effects between the two media studied.

Urine profiles were followed for 3 or 9 days after intravenous injection of diatrizoate, iohexol or saline in 30 rats, where a tubulointerstitial nephropathy was induced by gentamicin given over a 14-day period. Another 10 rats who had an injection of saline served as controls. Iohexol increased the excretion of lactate dehydrogenase significantly more than both saline and diatrizoate for the first 3 days, whereas diatrizoate had no effect. Both media caused significantly increased excretion of L-gamma-glutamyltransferase compared with saline, but iohexol significantly more than diatrizoate. Compared with saline S-creatinine was significantly increased following iohexol at 24 h, 3 and 9 days, and following diatrizoate only at 9 days. Among rats having gentamicin light microscopy revealed more severe changes in kidneys exposed to iohexol than to either diatrizoate or saline 3 days after their injection. Six days later no obvious differences were found between the 3 groups. In conclusion, iohexol induced more renal dysfunction than diatrizoate in this animal model of gentamicin induced nephropathy.

Negative gastrointestinal contrast enhancement can be achieved by oral administration of superparamagnetic particles. Their feasibility for the MR imaging of the female pelvis and lower abdomen was evaluated in studies on 32 follow-up patients with treated gynaecologic cancer. All the applied doses (0.2–1.0 mg particles/ml given in a volume of 600–800 ml) of contrast medium decreased the intraluminal signal. However, there was unpredictable individual variation in segmental distribution, and in some cases only a limited contrast effect was obtained. Image distortion was detected when the applied particle concentration exceeded 0.5 mg/ml, especially of the sagittal sections.

Guided by ultrasonography percutaneous needle biopsy of skeletal muscle was performed in 24 patients, using the one hand held Biopty system and a 2 mm Tru-Cut needle. The specimens were graded with regard to diagnostic quality and utility and almost all specimens (96%) were of highest quality. The use of ultrasonography was helpful in selecting a suitable area for the biopsy and vascular structures could be avoided. The procedure was well tolerated and easy to perform, and no complications were recorded.