Search

Following the discovery of X-rays by Roentgen in 1895, it was 70 years later that the specialty of imaging really took off, with ultrasound, CT, Nuclear medicine, and MRI now an integral part of all large departments. The recent progress has been accelerated by advances in computer technology which aided the development of imaging techniques that do not use ionising radiation. Some imaging techniques are replacing other more hazardous diagnostic procedures, (e.g. MRCP v ERCP, and MRA v catheter angiography) while some are able to provide almost perfect anatomical detail e.g. brain MRI. Techniques using radioisotopes provide more functional information which can be used to complement the morphological studies. We have witnessed the birth and maturation of Interventional Radiology. This is a highly skilled subspecialty enabling some surgical procedures to be replaced by minimally invasive methods using image guidance. These range from simple drainage procedures and guided biopsies to complex aortic bifurcation stent graft insertions. The potential for digital storage of all images is already established and the filmless radiology department in the more developed countries could be the norm by 2020.

A comparative study of quantitative hemidiaphragmatic ultrasound with fluoroscopy was undertaken in 30 patients referred for investigation of suspected hemidiaphragmatic movement abnormality. The aim of this study was to determine whether assessment with ultrasound or fluoroscopy differed, and which technique appeared more suitable in the investigation of hemidiaphragmatic movement disorder. There were four technical failures using fluoroscopy (13%), compared with none using ultrasound. Using the normal ranges of right to left ratio of maximal excursion (0.5-2.0 for fluoroscopy and 0.5-1.6 for ultrasound) there was concordance in 21 out of 26 (81%) patients. All cases of abnormality on fluoroscopy were seen on ultrasound. Four of the discordant cases had excursions on the lesser side in the normal range on ultrasound suggesting a milder movement abnormality detected by ultrasound than by fluoroscopy. Sniff testing conferred no advantage over quantitative testing. Ultrasound has technical, qualitative and quantitative advantages over fluoroscopy and should be the method of choice in the investigation of suspected hemidiaphragmatic movement abnormality.

Bilateral parotid gland aplasia is a cause of xerostomia. A case is presented in which the clinical diagnosis was confirmed with the use of 99mTcO-4 salivary gland scintiscanning and computerised tomography. The literature of this rare condition is reviewed and significance to the patient discussed.

A technique of simultaneous computed tomography and sialography of the parotid and submandibular glands is described and the examination of 14 patients reported. Tumours were diagnosed in six cases and in the remaining eight cases inflammatory lesions were found. Sialographic enhancement offered definite advantages in localisation of lesions and examination of the tumour-normal tissue interface compared with either C.T. or sialography alone.

In a prospective study designed to differentiate pheochromocytoma from other forms of hypertension, urinary catecholamines were measured after sleep and clonidine administration in 12 patients with pheochromocytoma, 19 hypertensive patients in whom pheochromocytoma was suspected but later excluded, and 31 hypertensive patients in whom pheochromocytoma was never suspected. The test correctly identified all 12 patients in whom pheochromocytoma was present. Four of these had equivocal plasma levels of both norepinephrine and epinephrine, suggesting that overnight clonidine suppression may be of particular value when tumor secretion is intermittent or low. When pheochromocytoma was not present, urinary norepinephrine and epinephrine levels were suppressed below 60 and 20 nmol/mmol creatinine, respectively, after sleep and clonidine, the two in combination giving better suppression than sleep alone. Since urinary catecholamines can be determined relatively easily by high-pressure liquid chromatography with electrochemical detection, this test may be more widely applicable than suppression tests based on plasma measurements.