101
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Coleman BG, Arger PH, Rosenberg HK, Mulhern CB, Ortega W, Stauffer D. Gray-scale sonographic assessment of pancreatitis in children. Radiology 1983; 146:145-50. [PMID: 6849036 DOI: 10.1148/radiology.146.1.6849036] [Citation(s) in RCA: 29] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
A total of 144 gray-scale sonograms were obtained in 110 children to evaluate the pancreas. The entire gland was adequately visualized in just over 86% of cases. The size, contour, echo pattern, and echo intensity were assessed. Either diffuse or focal enlargement of the pancreas was the most consistent finding in the 25 children with pancreatitis. In contrast to previous reports, decreased echo intensity was not a reliable indicator of inflammation. Numerous complications were detected on the 54 sonograms of these 25 patients. These complications included pseudocysts, lesser sac fluid collections, ascites, biliary obstruction, and hemorrhage. It is recommended that ultrasound be the initial imaging procedure in the evaluation of children with suspected pancreatic disease, and that it be used in conjunction with clinical and biochemical data.
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102
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Arger PH, Coleman BG, Dalinka MK. Computed tomography in orthopedics. Orthop Clin North Am 1983; 14:217-32. [PMID: 6338445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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103
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Weinerman PM, Arger PH, Coleman BG, Pollack HM, Banner MP, Wein AJ. Pelvic adenopathy from bladder and prostate carcinoma: detection by rapid-sequence computed tomography. AJR Am J Roentgenol 1983; 140:95-9. [PMID: 6600330 DOI: 10.2214/ajr.140.1.95] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Diagnostic pelvic lymphadenectomies are used in both bladder and prostate carcinoma. Enhanced rapid-sequence computed tomographic (CT) scanning of the retroperitoneum and pelvis was done prospectively in patients scheduled for lymphadenectomies. The CT results were then compared to the histopathological findings in 32 patients to analyze the ability of dynamic CT to indicate whether a lymphadenectomy is needed. The comparison showed eight true positive, four false negative, 18 true negative, and two false positive. The sensitivity was 66%, specificity 90% and accuracy 81%. The diagnostic considerations of the role of CT based on these findings are illustrated and discussed.
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104
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Mulhern CB, Arger PH, Coleman BG, Pollack HM, Velchik M, Banner MP. Wilms' tumor: diagnostic therapeutic implications. UROLOGIC RADIOLOGY 1982; 4:193-8. [PMID: 6301129 DOI: 10.1007/bf02924047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Twenty-four cases of Wilms' tumor were analyzed. The gray-scale echographic characteristics of the tumors were categorized. Correlation with pathologic characteristics, clinical presentation, prognosis, and therapy response was assessed. Two echographic patterns emerged: (a) hypoechoic solid--3; and (b) hyperechoic solid--21. Necrotic degeneration as well as decrease in tumor size were echographic features correlated with positive response to therapy. The results of this analysis showed no initial correlation between the echographic patterns and the clinical presentation or prognosis. On the other hand, the echographic features of Wilms' tumor seem distinctive enough to help in etiologic differentiation and therapy management.
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105
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Pollack HM, Banner MP, Arger PH, Peters J, Mulhern CB, Coleman BG. The accuracy of gray-scale renal ultrasonography in differentiating cystic neoplasms from benign cysts. Radiology 1982; 143:741-5. [PMID: 7079503 DOI: 10.1148/radiology.143.3.7079503] [Citation(s) in RCA: 65] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
To evaluate the ability of gray-scale renal ultrasonography to distinguish cystic neoplasms from benign cysts, 182 cysts or cyst-like masses were reviewed retrospectively by three radiologists with varying degrees of experience in nephrosonography. All cases were proved by needle puncture or surgery. An unequivocal diagnosis of "cyst" based solely on ultrasonography was 98% accurate, with 2% being due to hematomas, localized hydronephrosis, or septa within the cyst. No cystic neoplasms were mistaken for benign cysts. These results indicate that experienced observers using proper technique will rarely be in error in distinguishing non-neoplastic cystic masses from cystic neoplasms by articulated-arm gray-scale ultrasonography, and that routine needle puncture may be unnecessary in such cases.
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106
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Arger PH, Mulhern CB, Coleman BG, Pollack HM, Wein A, Koss J, Arenson R, Banner M. Prospective analysis of the value of scrotal ultrasound. Radiology 1981; 141:763-6. [PMID: 7302233 DOI: 10.1148/radiology.141.3.7302233] [Citation(s) in RCA: 53] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Ultrasound was evaluated in 69 patients for its usefulness in distinguishing scrotal abnormalities requiring surgery from those that may have clinical follow-up only. Distinction was possible in the majority of cases. On imaging, tumor showed decreased echogenicity within the testicle, which was usually enlarged. Epididymal enlargement, marked increase in peritesticular fluid, and skin thickening suggest a non tumorous condition. The ultrasound characteristics of various scrotal abnormalities are described.
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107
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Metzger RA, Mulhern CB, Arger PH, Coleman BG, Epstein DM, Gefter WB. CT differentiation of solitary from diffuse bronchioloalveolar carcinoma. J Comput Assist Tomogr 1981; 5:830-3. [PMID: 6274932 DOI: 10.1097/00004728-198112000-00008] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The therapy and prognosis of bronchioloalveolar carcinoma vary greatly with the solitary versus the diffuse form of the disease. Solitary disease demonstrates a high resectability rate with good long term prognosis. This contrasts with the rapidly fatal course associated with the diffuse form. To date, categorization of patients into either the solitary or the diffuse form has been based solely on conventional radiography. Multiple authors have reported cases of disease not demonstrated radiographically but discovered at surgery or autopsy. With the superiority of chest computed tomography (CT) for demonstrating parenchymal abnormalities, we propose that preoperative CT may be crucial in the workup of patients with presumed solitary bronchioloalveolar cell carcinoma. Early identification of diffuse disease or confirmation of the presence of solitary disease by CT may allow the institution of proper therapy and better evaluation of patient prognosis.
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108
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Koss JC, Coleman BG, Mulhern CB, Arger PH, Tuchman DN. Mucocutaneous lymph node syndrome with hydrops of the gallbladder diagnosed by ultrasound. JOURNAL OF CLINICAL ULTRASOUND : JCU 1981; 9:477-479. [PMID: 6796607 DOI: 10.1002/jcu.1870090904] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
One of the complications of the mucocutaneous lymph node syndrome is acute hydrops of the gallbladder. Although surgery may be required occasionally, spontaneous resolution of gallbladder hydrops in patients is common. Ultrasound is the optimal method for evaluating these patients.
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109
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Arger PH, Mulhern CB, Littman PS, Meadows AT, Coleman BG, Jarrett PT. Management of solid tumors in children: contribution of computed tomography. AJR Am J Roentgenol 1981; 137:251-5. [PMID: 6789630 DOI: 10.2214/ajr.137.2.251] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
To evaluate the impact of computed tomography (CT) on therapeutic management decisions in solid tumors of the chest and abdomen, 92 examinations on 54 children with 13 histologic tumor types were analyzed. The CT impact on the management decisions was analyzed in relation to other diagnostic procedures of the same body part including sonography, chest films with tomography, abdominal/pelvic films, and excretory urography. Overall, CT provided the essential information of 47% of management decision. By confirming non-CT examination results it helped direct therapeutic decisions in 28%. No additional information was derived from CT in 20%. Technically poor studies in 5% resulted in CT errors. According to the procedural method, CT provided additional information in 42% when compared with sonography, in 38% when compared with chest films and tomography, in 41% when compared with abdominal/pelvic films, and in 27% when compared with intravenous urography. The investigation showed that CT provided information directly affecting the therapeutic management decision in a significant number of patients.
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110
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Koss JC, Arger PH, Coleman BG, Mulhern CB, Pollack HM, Wein AJ. CT staging of bladder carcinoma. AJR Am J Roentgenol 1981; 137:359-62. [PMID: 6821587 DOI: 10.2214/ajr.137.2.359] [Citation(s) in RCA: 60] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
CT staging was performed in 49 consecutive patients with known carcinoma of the bladder. The overall accuracy of CT staging in 25 patients with surgically confirmed disease stage was 64%. Most diagnostic errors in this series were related to the determination of perivesical fat involvement by tumor. The overall accuracy of CT in predicting lymph node metastasis was 92%. The sensitivity was 60% and the specificity ws 100%. Because of the current management of bladder carcinoma, the major role of CT is in the evaluation of lymph nodes for metastatic disease. Since CT cannot detect metastasis to nonenlarged lymph nodes, it has only a limited role in the staging of bladder carcinoma at this time.
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111
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Levine MS, Arger PH, Coleman BG, Mulhern CB, Pollack HM, Wein AJ. Detecting lymphatic metastases from prostatic carcinoma: superiority of CT. AJR Am J Roentgenol 1981; 137:207-11. [PMID: 6789623 DOI: 10.2214/ajr.137.2.207] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
CT scanning was performed on 29 consecutive patients with clinically localized prostatic carcinoma (stage A or B). Bipedal lymphangiography was performed in 12 cases. Histologic confirmation was obtained in 15 cases (pelvic lymphadenectomy in 12 and positive percutaneous needle biopsy in three). In these 15 proven cases, the overall accuracy of CT was 93% with one false positive and no false negatives. Lymphangiography was far less accurate (55%) with two false positives and three false negatives in 11 proven cases. The greater accuracy of CT resulted primarily from its ability to detect abnormal nodes in the pelvis, particularly hypogastric nodes, which are rarely opacified by lymphangiography. Preliminary experience suggests that CT is superior to lymphangiography in detecting early lymphatic spread from prostatic carcinoma in the pelvis. In the future, CT-guided percutaneous needle biopsy should be useful for documenting metastases in these patients.
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112
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Kilcheski TS, Arger PH, Mulhern CB, Coleman BG, Kressel HY, Mikuta JI. Role of computed tomography in the presurgical evaluation of carcinoma of the cervix. J Comput Assist Tomogr 1981; 5:378-83. [PMID: 7240515 DOI: 10.1097/00004728-198106000-00013] [Citation(s) in RCA: 33] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Thirty-six consecutive patients either with primary or recurrent carcinoma of the cervix were evaluated by computed tomography (CT) to assess CT's ability to screen patients prior to radical surgery. Overall accuracy when compared to surgical findings or skinny needle biopsies was 80%. In accuracies by CT were the results of inability to assess minimally enlarged lymph nodes, inability to distinguish fibrosis from recurrent tumors, and difficulty in delineating actual tumor invasion versus contiguity of adjacent pelvic organs. Computed tomography proved to be a sensitive indicator in delineating actual tumor bulk and sidewall extension. Information gained by CT compared favorably with that obtained by intravenous urography, barium enemas, lymphangiography, and nuclear medicine bone scans. This comparison indicates that CT can serve as a sensitive imaging modality to assess the surgical candidacy of patients either with initial or recurrent carcinoma of the cervix. An algorithm of studies is proposed based on this preliminary investigation.
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113
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Pollack HM, Arger PH, Banner MP, Mulhern CB, Coleman BG. Computed tomography of renal pelvic filling defects. Radiology 1981; 138:645-51. [PMID: 7465841 DOI: 10.1148/radiology.138.3.7465841] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Thirteen patients with a variety of renal pelvic filling defects were evaluated using computed tomography (CT). Nonopaque calculi and some blood clots can be more accurately differentiated with this modality than has heretofore been possible. In transitional-cell carcinoma of the renal pelvis, the main value of CT appears to be in tumor staging. CT may also be helpful where urography cannot discriminate between extrinsic compression and true intraluminal renal pelvic defects.
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114
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Coleman BG, Arger PH, Mulhern CB, Pollack HM, Banner MP, Arenson RL. Gray-scale sonographic spectrum of hypernephromas. Radiology 1980; 137:757-65. [PMID: 7444059 DOI: 10.1148/radiology.137.3.7444059] [Citation(s) in RCA: 29] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The sonographic appearances of 43 proved hypernephromas was characterized and correlated with the angiographic and pathologic features. This report details the findings and emphasizes the criteria for recognizing poorly echogenic tumors, which may be confused with cysts. A diagnostic dilemma may be posed by these tumors, particularly if angiography shows no evidence of tumor neovascularity. The end point in diagnostic work-up of these tumors must be based upon a correlative approach utilizing the clinical, urographic, sonographic, and angiographic data.
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115
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Mulhern CB, Arger PH, Coleman BG. Ultrasonic diagnosis of placental abnormalities in situ. JAMA 1980; 244:2339-41. [PMID: 7431560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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116
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Peters JC, Coleman BG, Turner ML, Arger PH, Mulhern CB, Dalinka MK, Allan DA, Schumacher HR. CT evaluation of enlarged lliopsoas bursa. AJR Am J Roentgenol 1980; 135:392-4. [PMID: 6773351 DOI: 10.2214/ajr.135.2.392] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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117
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Abstract
Rarely do pancreatic pseudocysts extend into the mediastinum. We recently evaluated a case exemplifying this phenomenon. Although ultrasonography demonstrated the nature of the mass, computed tomography (CT) allowed better definition of various anatomic relationships and afforded improved definition of the superior aspect of the pancreatic pseudocyst. The role of CT and its advantages over ultrasonography in the diagnosis and management of pancreatic pseudocyst are discussed.
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118
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Mandell GA, Dalinka MK, Coleman BG. Fibrous lesions in the lower extremities in neurofibromatosis. AJR Am J Roentgenol 1979; 133:1135-8. [PMID: 116506 DOI: 10.2214/ajr.133.6.1135] [Citation(s) in RCA: 40] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Multiple fibrous lesions have been noted in the lower extremities of patients with neurofibromatosis (Recklinghausen's disease). These lesions are probably a combination of fibrous cortical defects, nonossifying fibromas, and intraosseous neurofibromas. When several fibrocystic lesions frequent the knee areas in an adolescent, neurofibromatosis should be suspected.
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119
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Mulhern CB, Arger PH, Coleman BG, Stein GN. Nonuniform attenuation in computed tomography study of the cirrhotic liver. Radiology 1979; 132:399-402. [PMID: 461799 DOI: 10.1148/132.2.399] [Citation(s) in RCA: 52] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Diffuse hepatocellular processes are not well imaged by most radiologic modalities. At present, CT has not added significantly to the evaluation of hepatocellular disease, particularly in the cirrhotic liver. The CT patterns of cirrhosis previously described are reviewed, and the pathophysiology of cirrhosis is discussed. In 3 cases, a pattern was seen in cirrhotic livers characterized by nonuniform attenuation with varied response to administration of intravenous contrast agents. With further evaluation of fatty infiltration and cirrhosis, CT may prove helpful in understanding these disease processes.
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120
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Coleman BG, Arger PH, Mulhern CB. Endometriosis: clinical and ultrasonic correlation. AJR Am J Roentgenol 1979; 132:747-9. [PMID: 107739 DOI: 10.2214/ajr.132.5.747] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Thirteen patients with surgically proven endometriosis underwent ultrasonography as part of their diagnostic evaluation. An attempt was made to assess the sonographic characteristics of endometriosis to determine if a characteristic pattern would emerge when the clinical presentations and physical findings were coupled with the ultrasonic picture. Ultrasound showed pelvic masses in all patients. Most masses appeared spherical and separate from the uterus and were cystic or predominantly cystic with scattered peripheral echoes. This retrospective study suggests a more useful role for ultrasound than previously recognized in the clinical management of patients with endometriosis.
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