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To study the distribution and thromboembolic effect of Ultrafluid Lipiodol, 15 surgically removed hepatocellular carcinomas with selective intraarterial Lipiodol injection 7 to 10 days before surgery and 15 noninjected controls were studied radiologically and histologically. Tissue blocks were processed with an en bloc silver impregnation technique for Lipiodol localization in histologic sections. Lipiodol was distributed evenly in tumors measuring less than 5 cm in diameter and peripherally in tumors measuring 10 cm or more. Lipiodol droplets were mainly extracellular. There was no difference in tumor architecture or in hemorrhage and necrosis scores between Lipiodol-injected cases and negative controls (1.18 versus 0.92). Similarly, in injected cases, no differences were observed between Lipiodol-positive and Lipiodol-negative areas (scores of x-ray Lipiodol-positive versus Lipiodol-negative areas: 1.17 versus 1.36; scores of microscopic Lipiodol-positive versus Lipiodol-negative areas: 1.18 versus 1.14). Lipiodol-negative but hypodense areas examined by x-ray proved to be necrosis or fibrosis with or without viable tumor islands. Lipiodol has no thromboembolic effects. The uneven Lipiodol distribution may account for its failure as a carrier for chemotherapeutic agents in large tumors.

This study compares measurements taken by routine clinical means with those taken from computed tomography (CT) images. Ocular and head dimensions were measured. Correlation between techniques was reasonable for all parameters except exophthalmos. The correlation coefficient improved for measurement of exophthalmos when thin (5 mm) axial sections were used, however there were occasional large discrepancies in measured values. In general, measurement from CT scans gave smaller values than direct measurement, though interpupillary values were larger when measured from CT images. The results show the importance of choosing a mid-orbital axial scan plane and avoiding tilt of the scan plane for accurate measurement from CT images. Consistency in measurement techniques is also important for comparative measurements over time.

The histological distribution of lipiodol within hepatocellular carcinoma (HCC) was correlated with that seen on computed tomography (CT), arteriography and high resolution plain films of 15 resected specimens. By means of special stains, the arterially administered lipiodol was shown to be maximally distributed at the periphery of large tumours and nodules. The centre of large lesions often remained unopacified. In multinodular tumours some nodules were heavily stained while others contained little or no contrast medium. In small tumours there was a more uniform distribution. In large tumours, those areas where there are large arteries (and slow flow) contained little or no lipiodol. There was also no consistent match of areas of angiographic blush with lipiodol deposition. The lipiodol patterns were poorly shown by CT when compared with high resolution films taken on a mammography unit. We conclude from this study that lipiodol on its own as an embolic agent or as a chemotherapeutic carrier has great limitations because of its peripheral and otherwise haphazard distribution in large tumours. However, such treatments might be more effective in small tumours where a greater concentration of lipiodol is likely. Nevertheless, lipiodol staining of tumours remains a useful diagnostic aid as small HCC can be difficult to visualize both on arteriography and conventional CT.

Presents a medical image computing system which has been designed to extract and analyze quantitative information from a spatial sequence of CT (computed tomography) images. In particular, it has been applied to the quantitation and 3D reconstruction of the diffuse pattern of a radio-opaque anti-cancer drug, lipiodol-doxorubicin, in hepatocellular carcinoma. The PC-based system computes quantitative measures which can be used to assess the effectiveness of the chemotherapeutic treatment and to study the histology of the tumour. The system can provide a visualization of the tumour volume and quantification of drug absorption using 3D surface reconstruction and graphics techniques. >

Plain radiographs, computed tomographic (CT) scans and clinical records of 100 patients with nasopharyngeal carcinoma were studied. CT scans and plain radiographs provided similar information in 46 patients. There were 54 cases in which the two techniques disagreed. In 45 cases CT demonstrated abnormalities not seen in plain radiographs and in nine cases plain radiographs demonstrated abnormalities not seen with CT scanning. Based on the total information gained from clinical examination, the imaging investigations, biopsies, and subsequent clinical course and investigations it appeared that none of the abnormalities predicted by plain radiographs alone could be substantiated. Conversely the CT abnormalities could be supported as being correct. We conclude that CT alone is the undoubted investigation of choice where this is available. Plain films provide less information, are unreliable and, where CT is available, superfluous.

Summary While investigating the radiological appearances of globus pallidus calcification in an autopsy case, cortical-pia mater calcification was detected. There was no documentation of its existence in the literature of radiology, neurology and neuropathology. To establish its incidence and clinical significance, 20 consecutive autopsy brains (15 males, 5 females, age 32–73 years, mean age 56.7) were studied with high resolution radiography and histology. Clinical records, autopsy findings, in-life plain skull films and computed tomography of the brain (if available) were reviewed. Radiologically, the calcifications appeared as 1–2 mm irregular spots or tiny pin-point opacities in the pia mater and subcortical regions, either unilaterally or bilaterally in the frontal (15 cases), temporal (15), parietal (3) and occipital lobes (1). Similar calcification was detected in 1 of the 3 in-life computed tomographic scans available. Histologically, these cortical-pia mater calcifications were extracellular amorphous calcified masses of various sizes in necrotic neural tissue, frequently associated with microscopic haemorrhage and hypoxic neuronal changes in the adjacent brain tissue. Blood vessels in the region were not hyalinized or calcified. The occurrence was not related to age. Hospital stay was < 7 days in 14 and < 30 days in 2; 50% of patients died within 48 hours after admission. None of the patients had records of long term cytotoxic chemotherapy, radiotherapy or central nervous system infection. Two had stroke, one had cerebellar atrophy and one mild hypercalcaemia. The high incidence of calcifications in the temporal lobes, while asymptomatic, suggests that cortical calcification may be a pointer to the aetiology of idiopathic epilepsies in the elderly.

We analyzed the serum concentrations of lipids and lipoproteins and the prevalence of other risk factors in a case-control study of 304 consecutive Chinese patients with acute stroke (classified as cerebral infarction, lacunar infarction, or intracerebral hemorrhage) and 304 age- and sex-matched controls. For all strokes we identified the following risk factors: a history of ischemic heart disease, diabetes mellitus, or hypertension; the presence of atrial fibrillation or left ventricular hypertrophy; a glycosylated hemoglobin A1 concentration of greater than 9.1%; a fasting plasma glucose concentration 3 months after stroke of greater than 6.0 mmol/l; a serum triglyceride concentration 3 months after stroke of greater than 2.1 mmol/l; and a serum lipoprotein(a) concentration of greater than 29.2 mg/dl. We found the following protective factors: a serum high density lipoprotein-cholesterol concentration of greater than 1.59 mmol/l and a serum apolipoprotein A-I concentration of greater than or equal to 106 mg/dl. The patterns of risk factors differed among the three stroke subtypes. When significant risk factors were entered into a multiple logistic regression model, we found a history of hypertension, a high serum lipoprotein(a) concentration, and a low apolipoprotein A-I concentration to be independent risk factors for all strokes. The attributable risk for hypertension was estimated to be 24% in patients aged greater than or equal to 60 years. In this population, in which cerebrovascular diseases are the third commonest cause of mortality, identification of risk factors will allow further studies in risk factor modification for the prevention of stroke.

To demonstrate postangiographic Lipiodol (LIP) in hepatocellular carcinoma (HCC) in paraffin sections, direct impregnation of formalin-fixed tissue blocks with silver nitrate (AgNO3) was followed by routine processing. LIP appeared as black globules in the sinusoids. Ninety-four tissue blocks from 13 postangiographic LIP HCCs and 69 from 8 non-LIP HCCs and 4 fatty livers were studied. Seventy-two of 73 negative controls and all positive blocks as seen on soft tissue radiographs (STRs) were correctly coded (specificity 98.6%, sensitivity 100%). Twenty-six of the 44 LIP-negative areas on STRs from LIP cases contained scanty globules of less than 10 microns in diameter. Fatty change gave no positive readings. Thus, modified AgNO3 impregnation is a simple, accurate means of detecting LIP in high-quality paraffin sections suitable for tumor diagnosis and, if applied to postangiographic LIP, ultrasonographically guided liver biopsy, can verify that a biopsy has reached a suspected tumor focus.

The diagnostic accuracy of the DCBM and of endoscopy were compared in 50 consecutive patients. Examinations were conducted in comparable circumstances, without any cross information. A percentage score method was evolved to allow a numerically more significant assessment. The potential accuracy of the DCBM was calculated to be 96% of that accorded to fibre-endoscopy.

A densely echogenic line is seen connecting the right portal vein and the neck of the gallbladder on longitudinal views in at least 70% of sonograms. The origin of the line has been taken to be the fissure between the right and left lobes of the liver, but no documentation has been provided. Intact liver specimens were studied in a water bath; metallic markers were placed to coincide with the line under real-time guidance. The line does, indeed, correspond to the interlobar fissure. Factors affecting visualization include position of the gallbladder neck and orientation of the fissure as well as fat deposition within the fissure.

Six patients with radiographic evidence of diffuse pleural thickening after industrial asbestos exposure are described. Five had computed tomography of the thorax. All the scans showed marked circumferential pleural thickening often with calcification, and four showed no significant evidence of intrapulmonary fibrosis (asbestosis). Lung function testing showed reduction of the inspiratory capacity and the single-breath carbon monoxide transfer factor (TLCO). The transfer coefficient, calculated as the TLCO divided by the alveolar volume determined by helium dilution during the measurement of TLCO, was increased. Pseudo-static compliance curves showed markedly more negative intrapleural pressures at all lung volumes than found in normal people. These results suggest that the circumferential pleural thickening was preventing normal lung expansion despite abnormally great distending pressures. The pattern of lung function tests is sufficiently distinctive for it to be recognised in clinical practice, and suggests that the lungs are held rigidly within an abnormal pleura. The pleural thickening in our patients may have been related to the condition described as "benign asbestos pleurisy" rather than the interstitial fibrosis of asbestosis.

The anatomy and radiology of the areae gastricae were studied in human and pig specimens and it was shown that the double contrast barium meal demonstrates a true picture of the undulating gastric mucosa, which is distinctive in appearance in the antrum body and fundus of the pig stomach. The importance of the type of barium used and the thickness of barrier mucus in the demonstration of the areae pattern is emphasised and the high incidence of duodenal ulcer in the grade 4 pattern and the low incidence in the non-coater is described. A knowledge of the anatomy and radiology of the areae gastricae pattern is central to the interpretation of the double contrast barium meal.

Summary A case is presented of a glomangioma with typical history and clinical findings, proven by operation and histology. Unique radiographic features are demonstrated including visualization of the tumour on a soft tissue radiograph and associated hyperaemic bone changes, continuous wave Doppler results indicating hyperaemia and an arterio-venous malformation, and the clear demonstration of the tumour in both frontal and lateral views was possible by intra-arterial digital subtraction angiography (DSA) under local anaesthesia. Fibrous dysplasia of a femur was an incidental finding.

Seven patients with idiopathic pulmonary haemosiderosis were investigated with chest radiographs, pulmonary function tests, computed axial tomograms, and isotope ventilation and perfusion scans. Three of the patients had coeliac disease (CD) and a fourth an abnormal small bowel mucosa under the dissecting microscope which was normal histologically. Five patients showed airflow limitation with a low transfer coefficient. Three of these had air trapping, two of whom had hyperinflation of the lungs, and the third a total lung capacity at the upper limit of normal. Two patients showed a central distribution of radiographic opacities, and the other five had changes throughout the lung fields. The presence or absence of CD showed no relationship to these findings.

Summary 1. Of 285 lymphoma cases, 167 were selected for study. Of these there were forty-seven with radio-logically demonstrable mediastinal gland enlargement. 2. In fifteen cases (8 per cent of 167) appearances suggesting pericardial effusion were present. 3. All fifteen cases occurred among the group showing mediastinal gland enlargement. 4. In twelve of the forty-seven cases with mediastinal glandular enlargement (25·5 per cent) as there was no other detectable cause for the pericardial effusion, it is assumed that is was due to lymphomatous involvement. 5. Anaemia was prominent in three of these fifteen cases. Anaemia was also a probable cause of the cardiac enlargement in one other case not included in these fifteen.

The material and methods of arteriography and scintillation scanning upon which this study is based are briefly considered and representative cases are presented. The findings on hepatic arteriography and scintillation scanning are compared and correlated in cases of liver disease with special reference to space-occupying lesions. Both examinations can detect these lesions in many cases. However, scintillation scanning usually gives no clue as to the aetiology or vascularity of the lesion and cannot detect tumours smaller than 2 cm in diameter. Arteriography can show whether the defect is vascular or not and may thus distinguish malignant tumours from cysts. Where lesions are vascular they may be shown even if only 0·5–1 cm in diameter. On the other hand, where a filling defect has been shown on scintillation scanning, the vascular pattern in the area can be more accurately evaluated. In cirrhosis and the Budd-Chiari syndrome, with macro-nodular transformation, “splayed” vascular arches may be de...

We have described three cases of crico-pharyngeal web not associated with iron deficiency, discovered on routine barium swallows in the thyroid clinic. It is suggested that there is an association between cricopharyngeal web and thyroid disease. An association which, as far as we know, has not previously been commented upon. We are unable, at the present time, to explain this association.

A technique has been developed which allows the position of the upper gastrointestinal tract, as determined radiographically, to be superimposed on the pancreatic photoscan, performed after an injection of (75)Se-selenomethionine. Results of the technique applied to 27 ;abnormal' and 23 ;normal' subjects are described. The importance of the additional information gained by the combined technique is discussed in terms of normal variation and increased diagnostic yield, and the situations in which it was found most useful are described. The addition of correlated duodenography rendered scan reporting more objective in 50% of cases.

Studies on 1,476 intravenous urographic examinations done in a 15-month period showed that the proportion of abnormal results varied widely-from 20% in patients with abdominal pain other than renal colic to 92% of those in prostatism. Patients with the strongest clinical evidence of haematuria were the most likely to have abnormal urograms, and to undergo cystoscopy with abnormal findings on this examination. All six patients with renal hypertension showed abnormalities other than on the urogram. Prior use of other tests may increase the effectiveness of urography.

In choosing between various scanning techniques the factors to be considered include availability, cost, the type of equipment, the expertise of the medical and technical staff, and the inherent capabilities of the system. Although it is difficult to state dogmatically which scanning technique is best for each patient and condition, one or other technique is clearly preferable in some areas of medicine. Ultrasound, for example, should be used in obstetrics, while computerized tomography has revolutionised neuroradiological diagnosis. Nevertheless, there is still no substitute for good history taking and a thorough physical examination. The most important factor determining the choice of technique is the system's ability to answer the specific question required for the management of the patient.

Summary A woman aged 35 years from the Philippines presented with epigastric discomfort associated with an epigastric mass. On examination the liver was markedly enlarged.

This paper evaluates the use of metoclopramide (Maxolon) in emptying human stomach contents into the duodenum and beyond. A method of quantitative assessment of content by barium swallow radiography is used in the study, and the method is recommended as a diagnostic manoeuvre in patients presenting for emergency surgery in whom the stomach content is in doubt. Oral metoclopramide was found effective in emptying stomachs challenged by water load, and the intravenous route has been found effective in emptying semisolid contents in emergency clinical situations. A radiographic scan of the resting stomach was made on patients waiting for routine surgery who had received a variety of common premedication; it was shown that significant residues occur. We believe that metoclopramide deserves further investigation in order to exploit its potential in reducing the hazard of regurgitation and vomiting in patients requiring emergency anaesthesia and surgery.