Sonographic morphology of the normal menstrual cycle.

Sequential gray-scale sonograms were obtained during 20 menstrual cycles in 16 normal female volunteers. Hormonal and physical parameters of an ovulatory cycle were correlated with morphological changes in the ovaries, uterus, and cul-de-sac as seen on the sonogram. Ovarian cysts of two sizes were observed, corresponding chronologically and morphologically to Graafian follicles and corpora lutea.

Acoustic contrast enhancement: value of several system gain variations in gray scale ultrasonography.

Because of the broad spectrum of echogenicity inherent in the heterogeneous composition of the abdominal viscera, system gain variations may be useful in gray scale ultrasound imaging to improve lesion definition. In general, Anechoic or hypoechoic processes may be accentuated by scanning in the higher gain ranges, while hyperechoic lesions may be better delineated at lower gain levels. Thus adjustments in "acoustic contrast" may supplement and reinforce information derived from an initial standard medium gain scan.

Radiographically guided needle biopsy of abdominal neoplasms--who, how, where, why?

Radiographically guided percutaneous needle biopsy is a safe, accurate, well-tolerated alternative to laparotomy for confirmation of advanced abdominal malignancy. Here we describe the indications and methodology for its performance. Eighty-two percent of 66 patients with proven abdominal neoplasms were successfully biopsied with a fine-caliber needle using a variety of guidance methods.

Mittelschmerz. Sonographic demonstration.

Ultrasonography of the pelvis at mid-menstrual cycle in normal women has demonstrated small quantities of free fluid in 40% of cycles. Two thirds of the cycles associated with pain had ultrasonically demonstrated fluid at ovulation. These sonographic findings at Mittelschmerz confirm the physiological trauma of ovulation.

Nonvisualized gallbladder by cholecystosonography.

To further define the significance of gallbladder nonvisualization by cholecystosonography, we studied follow-up data on 25 consecutive patients in whom the gallbladder could not be identified despite adequate fasting. In one patient, intravenous cholangiography demonstrated a large gallbladder but no gallstones. In the 24 cases for which a pathoanatomic diagnosis was established, all but two had diseased gallbladders with obliteration of the lumen.

Computed tomography of the thorax and standard radiographic evaluation of the chest: a comparative study.

Comparison of standard radiographic evaluation of the chest with computed tomography (CT) was carried out in 109 patients who were examined on a prototype EMI CT5000 scanner. Forty-eight patients had lung problems, and 61 were evaluated because of a mediastinal mass or widening, or for the detection of an occult thymoma in myasthenia gravis. Computed tomography was of value in the staging of bronchogenic carcinoma, particularly in the detection of direct mediastinal and pleural extension, and in evaluating patients with solitary or multiple nodules by detecting additional lesions and calcification.

Gray scale ultrasound in adnexal thickening: correlation with laparoscopy.

A retrospective comparison between ultrasound and subsequent laparoscopy was made in 70 female patients to evaluate the sonographic features of minimal pelvic disease (in particular, adnexal thickening). The overall accuracy of sonography as compared with laparoscopy was 75 percent (53 of 70), with a true positive rate of 72 percent (40 of 51) and a true negative rate of 68 percent (13 of 19). In this study the concept of clinical or sonographic adnexal thickening did not correlate with observations at laparoscopy.

Malignant seeding of the tract after thin-needle aspiration biopsy.

Fine-needle aspiration biopsy is an established technique for cytodiagnosis of malignant neoplasms, yielding a high rate of positive tissue with negligible local sequelae. The authors report the first instance known to them of needle tract seeding following this biopsy technique in a patient with an unresectable pancreatic carcinoma. Because of the rarity of this occurrence, the procedural indications remain unaltered.

Computed body tomography in chronic pancreatitis.

CT of the pancrease permitted correct positive diagnosis in 28/50 or 56% of patients with chronic pancreatitis proved by laparotomy or retrograde ductography. Diagnoses were based on CT identification of one or more specific hallmarks of chronic pancreatitis including calcifications (18/50 or 36%), parenchymal atrophy (7/50 or 14%) and pancreatic duct dilatation (2/50 or 4%), as well as the principal surgical complications, pseudocyst and abscess (15/50 or 30%). In 9 patients, CT disclosed pancreatic calcifications not visible on conventional radiographs.

Bile duct obstruction in hepatocellular carcinoma (hepatoma)--clinical and cholangiographic characteristics. Report of 6 cases and review of the literature.

Direct cholangiography revealed 6 cases of hepatoma where tumor growth within the bile ducts caused obstructive jaundice. Characteristic features included bulky obstructing intraluminal masses in the proximal extrahepatic ducts. Distal common duct defects usually signify hemobilia and clots as tumor complication.

CT biopsy of abdominal tumors: aids for lesion localization.

Computed tomographic guided fine needle aspiration biopsy of 25 consecutive patients with a variety of confirmed malignant abdominal and plevic neoplasms resulted in a 100% yield of positive tissue diagnosed, without significant complications. The principal advantage of CT guidance is the continuous direct observation of the needle tip position in relation to the target volume. Simultaneous insertion of 2 fine caliber biopsy needles (tandem needle maneuver) is a new technique developed for rapid, accurate needle repositioning for repeated aspiration attempts.

Computed tomographic diagnosis of pseudoascites (floating viscera syndrome).

Two cases of excessive fat deposition in the abdomen, confused clinically as massive ascites, are reported. Computed tomography (CT) has proven useful in making a definitive diagnosis of fat deposition in the abdominal and retroperitoneal space and has made further clinical studies unnecessary. No prior cases of pseudoascites (floating viscera syndrome) have been reported in the radiologic literature despite the specificity of CT diagnosis.

Gas in the bile ducts (pneumobilia) in emphysematous cholecystitis.

Gas in the biliary ducts (pneumobilia) was demonstrated in three cases of emphysematous cholecystitis. Pneumobilia is usually secondary to a spontaneous internal biliary fistula or incompetent sphincter of Oddi, and is rarely considered a manifestation of emphysematous cholecystitis. The presence of gas in the biliary ducts in these cases suggests that the cystic duct is patent, allowing gas to escape from the gallbladder lumen.

Clinical efficacy of computed body tomography.

A method for assessing the effect of computed body tomography on diagnostic understanding and therapeutic decision making is described and the results in the first 184 patients are presented. The patients' referring physicians provided the primary data used for the evaluation. CT improved diagnostic understanding in 41% of patients, reassured the physician about previously planned therapy in 43%, contributed to a change in therapy in 17%, and improved precision of previously planned treatment in an additional 10%.

Scanning techniques in computed body tomography.

Clinical examinations with the whole body CT scanner require considerable individualization of examination technique in relation to specific organs, anatomic areas, and clinical problems. Careful selection of radiographic factors, patient position, contrast agents, and pharmacologic adjuncts will optimize diagnostic results and patient throughput.

New cholangiographic sign of common bile duct obstruction: initial opacification of intrahepatic ducts.

A previously undescribed sign of common bile duct obstruction during intravenous cholangiography - initial visualization of proximal intrahepatic ducts - was observed in 26 patients with surgically proven obstructive disease of the distal common duct. In all cases, opacification of intrahepatic biliary radicles occurred on standard interval films prior to visualization of the extrahepatic common bile duct, the reverse of the normal sequence. The abnormal opacification pattern reflects stasis of bile flow in the presence of distal obstruction and seems analogous to the urographic finding of opacified intra-renal calyces as the initial manifestation of distal ureteral obstruction.

Radiologic treatment of esophageal food impaction using intravenous glucagon.

Obstructing esophageal food impaction was successfully relieved in 3 patients by the administration of intravenous glucagon. Since proteolytic enzyme digestion of bolus impaction carries a clear risk of fatal esophageal perforation, early therapeutic administration of glucagon during initial esophagography affords a safe and effective acute-care radiologic adjunct. Advantages include immediate diagnosis and therapy, effectiveness in meat and vegetable impactions, and safety for repeated doses.

Refinements in Chiba needle trans hepatic cholangiography.

The recent wide acceptance of Chiba needle transhepatic cholangiography prompted this elaboration of present techniques, intraprocedure observations, and special interpretive considerations based on a series of 100 consecutive examinations. The established safety margin of this technique now permits up to 15 needle passes to obtain a cholangiogram; thus success rates of duct opacification presently approach 100%. Special phenomena related to the small caliber of the needle include duct filling from "invisible" radicles, perivenous or periductal dissection of contrast, and pseudolesions in an incompletely decompressed stagnant bile column.

Computerized tomography of in vitro abdominal organs--effect of preservation methods on attenuation coefficient.

The effect of formalin, freezing, and refigeration on the attenuation coefficient of fresh abdominal tissue of rhesus monkeys and dogs was investigated over a 1-week period. These techniques were used individually and in combinations designed to simulate circumstances involved in future in vitro investigations of human specimens. Statistically significant alterations of attenuation coefficients were found to occur at all scanning times within the first week except for the first 48 hr of formalin storage.

Radiology of the pancreas, 1976: sonography and ductography.

In recent years ultrasonography and endoscopic retrograde cholangiopancreatography (ERCP) have assumed pre-eminent roles in the radiographic evaluation of patients with pancreatic disease. This article survays the present status of these techniques based on clinical experience at the Massachusetts General Hospital and a review of the literature.