The incidence and significance of acute post-hysterectomy pelvic collections

In a prospective study, 32 consecutive patients underwent endovaginal pelvic scanning in the first post-operative week following hysterectomy. Twenty-four attended for a further scan at clinical follow up. Vaginal vault fluid collections were identified in 19 women (59%) on the first post-operative scan. Fifteen of the 19 with collections had no significant pyrexia. Out of the entire sample of 32 subjects, six patients (19%) had significant post-operative pyrexia of whom four were in the group with post-hysterectomy vaginal vault collection and two had no collection on their early post-operative scans. All collections detected on the early scans had resolved or were smaller on follow-up scan but two asymptomatic patients who had no collection on the early scan had developed vaginal vault fluid collections on the late follow-up scan. No statistically significant association was demonstrated between the presence of a collection and post-operative pyrexia, surgical approach or operative blood loss The results of this study indicate that the demonstration of vaginal vault collection following hysterectomy is a frequent finding in both febrile and afebrile subjects and does not indicate the need for drainage.

Computed tomography interpretations with a low-cost workstation: a timing study

An ergonomically simple prototype workstation with two 900 x 1,100-pixel monitors capable of displaying eight full-resolution computed tomography (CT) images in 0.2 seconds, was compared with film for interpretation of computed tomographic images of the chest and abdomen. The hardware platform for this workstation cost less than $11,500 in 1993. A repeated-measures experiment was used to generate average interpretation times of 6.17 minutes for the workstation and 6.03 minutes for the film, including loading and unloading films, with three of the four subjects averaging about a minute longer for each workstation interpretation. All dictated reports were of clinically acceptable accuracy. All radiologists stated that workstations based on this design would be an acceptable clinical tool. However, observation suggested human working-memory strain among infrequent CT readers that could indicate the need for additional training. These data suggest that low-cost workstations can have practical application in interpretation of digital medical images such as CT, with the possibility of small increases in interpretation time.

Variations in liver-colon anatomic relationship: relevance to interventional radiology

PURPOSE

To determine the prevalence of significant variations in liver-colon anatomy in an unselected patient population and evaluate the potential effect of these variations on liver-related interventional procedures.

PATIENTS AND METHODS

All abdominal computed tomographic (CT) scans were reviewed prospectively over a 4-month period. Cases that revealed variant hepatocolic anatomy were selected and analyzed for the position of the colon, gallbladder, and duodenum; liver morphology; and the anatomic relations of the right portal vein.

RESULTS

Seventeen (3.3%) of 517 abdominal CT scans demonstrated variant hepatocolic anatomic relations. In seven cases, liver lobar morphology was normal, but the colon was interposed between the chest wall and the liver. The remaining 10 cases were characterized by hypoplasia or aplasia of one or both segments of the left lobe. In these cases the right portal vein was anteriorly exposed and was close to the gallbladder and transverse colon. In all 17 cases it was qualitatively judged that technical modifications might be needed in the performance of various interventional procedures, including percutaneous biliary drainage, biopsies, and transjugular intrahepatic portosystemic shunt creation.

CONCLUSION

Variations in liver-colon anatomic relations in isolation or secondary to hepatic developmental anomalies may have a significant potential impact on the performance of various fluoroscopically guided hepatobiliary interventional procedures.

Real-time radiologist review of remote ultrasound using low-cost video and voice

RATIONALE AND OBJECTIVES

A radiologist practicing remote ultrasound occasionally needs to review a case in real time before releasing the patient. The authors conducted a pilot study to evaluate one solution in which the radiologist views real-time images on a video monitor while conversing with the technologist via a headset telephone.

METHODS

Two experienced ultrasonographers and five technologies participated in a 5-week pilot study in adjacent rooms.

RESULTS

Subjective assessment indicated that the system could function well enough for use at a remote site.

CONCLUSIONS

Although this technology appears effective, an ongoing training environment is recommended.

US guidance for vascular access. Technical note

Real-time ultrasonography (US) is frequently used to access the biliary tree, urinary system, and pleural cavity, as well as abscesses and other fluid collections, but is rarely used to access blood vessels. This article describes the clinically indicated circumstances and technical aspects of US-guided access to veins and arteries. The authors' experience suggests that appropriate use of this modality significantly simplifies vascular access difficulties, reduces procedure time and morbidity, and is cost-effective.

Intrahepatic hepatic artery aneurysm: computed tomography and color-flow Doppler ultrasound findings

An unusual case of intrahepatic hepatic artery aneurysm (IHAA) is presented, in which the diagnosis was initially suspected on computed tomography (CT) and confirmed on color-flow Doppler ultrasound (US). The literature regarding this entity, as well as the utility of color-flow Doppler US in this setting are discussed.

Comparison of the digital rectal examination, endorectal ultrasound, and body coil magnetic resonance imaging in the staging of adenocarcinoma of the prostate

A series of 25 patients with biopsy proven adenocarcinoma of the prostate underwent preoperative staging evaluation with a digital rectal examination, endorectal ultrasound, and body coil magnetic resonance imaging (MRI) before their radical retropubic prostatectomy. The sensitivity and specificity of the digital rectal examination for the detection of extracapsular disease were 17 and 100%, respectively. The sensitivity and specificity of endorectal ultrasound for the detection of extracapsular disease were 35 and 89%, respectively. The sensitivity and specificity of body coil MRI for the detection of extracapsular disease by adenocarcinoma of the prostate were 47 and 63%, respectively. Microscopic disease of the capsule and seminal vesicles was the principle reason for understaging by both imaging modalities. This small series suggests that both imaging modalities are marginally more sensitive, albeit less specific, for extracapsular disease of the prostate than the digital rectal examination, with ultrasound having a slight edge in specificity and MRI having a slight edge in sensitivity.

Preoperative prediction of pathological tumor volume and stage in clinically localized prostate cancer: comparison of digital rectal examination, transrectal ultrasonography and magnetic resonance imaging

Accurate preoperative staging is important for proper selection of patients for radical retropubic prostatectomy. Preoperative staging by digital rectal examination, transrectal ultrasound, magnetic resonance imaging (MRI), Gleason grade and prostate specific antigen was compared to pathological stage for 25 patients who underwent radical retropubic prostatectomy. The predictive value for tumor confinement was 36% by rectal examination, 37% by ultrasound and 30% by MRI. The predictive value for extracapsular disease was 100% by rectal examination, 83% by ultrasound and 66% by MRI. Preoperative determinations of tumor volume by any modality did not correlate with pathological tumor volume. Digital rectal examination, ultrasound and MRI clinically understage the disease in most patients but they may be reliable to predict extracapsular disease.

Diverticula of the female urethra: diagnosis by endovaginal and transperineal sonography

Diverticula of the female urethra can be difficult to diagnose. Invasive contrast studies (voiding cystourethrography or double-balloon urethrography) or urethroscopy are frequently required for definitive diagnosis. Although transabdominal sonography has been able to visualize large diverticula, this technique has not proved useful in routine screening. In this study, we examined the use of higher frequency (5 MHz) near-focus endovaginal or transperineal sonography for the diagnosis of urethral diverticula. Five patients with radiographically proved (three with double-balloon urethrography and two with voiding cystourethrography) urethral diverticula were examined with endovaginal (two cases) or transperineal (four cases) sonography. In all five cases, sonography showed the diverticula previously demonstrated on the contrast study. The spatial relationship of the diverticula to the urethra, an important consideration at surgery, was shown more clearly by sonography than by contrast radiography. These findings suggest that sonography may be useful as a noninvasive screening technique for urethral diverticula.

Ectopic pregnancy: features at transvaginal sonography

A retrospective review of the transvaginal sonograms of 50 women with laparoscopically confirmed ectopic pregnancy was performed to determine whether certain sonographic findings can be detected to confirm the diagnosis. Forty-seven of the 50 pregnancies were tubal. A tubal ring (a 1-3-cm mass consisting of a 2-4-mm concentric, echogenic rim of tissue surrounding a hypoechoic center) was seen in 23 of 34 (68%) ectopic pregnancies in which the fallopian tube had not ruptured, and the tubal ring could be distinguished from a corpus luteum cyst in most cases. Transvaginal sonography also depicted simple (n = 22) or particulate (bloody) (n = 13) peritoneal fluid associated with ectopic pregnancy. In each case in the series, at least one abnormal uterine, adnexal, or peritoneal finding was detected at transvaginal sonography. Because of its improved resolution of uterine and adnexal structures, transvaginal sonography is recommended as a means for detailed evaluation of patients suspected of having an ectopic pregnancy.

Infertility: imaging of the female

The current status of both clinical and imaging evaluation of the infertile female will be discussed. The various pathologic processes will be reviewed.

The value of CT in rectal villous tumors

Computed tomography of 13 patients with villous rectal tumors was reviewed. Five tumors were benign, eight were malignant. All five benign lesions demonstrated homogeneous focal colonic wall thickening of less than 2 cm. Seven of the eight malignant lesions demonstrated focal colonic wall thickening greater than 2 cm. "Fronds," characterized by contrast within the interstices of the lesion, were seen in three malignant lesions. In the remaining five malignant lesions, three had a polypoid appearance, one had low attenuation regions, and one had focal rectal wall thickening. Computed tomography upstaged two carcinomas, downstaged two carcinomas, and accurately staged four carcinomas. Our experience shows (a) CT can demonstrate the classic fronds of villous tumors; (b) benign villous tumors tend to be less than 2 cm and are nonspecific in appearance; (c) biopsy is necessary to differentiate small malignant lesions from benign lesions; and (d) CT is inaccurate in staging local invasion of malignant villous tumors.

On the relationship of hemispheric specialization and developmental dyslexia

Hemispheric specialization for linguistic material was compared for normal and dyslexic subjects under dichotic listening (Experiment 1) and hemi-retinal presentation (Experiment 2) conditions. In both experiments, group data indicated that dyslexic subjects were, overall, less accurate in their performance than normals but that both groups showed similar right ear/visual field superiority. However, examination of individual subjects scores in both experiments indicated that the distribution of lateralization scores for dyslexic subjects was bimodal, whereas that for normal subjects was unimodal. These results suggest that the dyslexic 'population' is heterogeneous with regard to cerebral lateralization and that previous work treating it as homogeneous is most likely misleading. It appears important to both carefully examine individual subject data in such studies and to consider the consequences of there being different types of cerebral lateralization etiologies for what has been typically considered to be a homogeneous dyslexic population.