Computed coronal tomography

A method for obtaining coronal scans of the cranium is described in which a scanner with a tilting gantry is used. Computed coronal tomography is especially useful in the high convexity area and in the suprasellar and foramen magnum regions.     

Computed tomography in a case of pseudomembranous colitis

Pseudomembranous colitis (PMC) is an infectious colitis usually occurring as a complication of antibiotic therapy. The computed tomography (CT) findings of 10 patients with PMC are reviewed. All patients demonstrated an abnormal large bowel wall with an average thickness of 13 mm (range 7-31 mm). Additional, but less frequent findings included mesenteric inflammation, ascites, pleural effusions, and dilatation of the large or small bowel. Pancolonic involvement was seen in 7 cases, while three patients had focal colitis. Although the CT appearance of PMC is not specific, the diagnosis may be suggested in the proper clinical setting.     

Computed tomography in the elderly

In a chemically defined serum-free culture system, platelet-derived growth factor (PDGF) as the only externally applied growth factor, in concert with corticosterone, 3-isobutyl-1-methylxanthine (IBMX) and low insulin (1nM), stimulates adipose conversion of 3T3-L1 preadipocytes. Omission of PDGF during the induction period results in loss of differentiation competence and apoptotic cell death. Induction of apoptosis is shown to be clearly mediated by PDGF withdrawal, since neither corticosterone nor IBMX affect the apoptotic behaviour of 3T3-L1 cells. Cell viability in the absence of the survival factor PDGF could be achieved by application of high insulin (1 microM) or ectopical expression of the anti-apoptotic proto-oncogene Bcl-2. However, PDGF-independent suppression of cell death does not trigger adipose conversion in the presence of corticosterone and IBMX. Therefore, we conclude that suppression of apoptosis per se is not permissive for differentiation of 3T3-L1 preadipocytes and PDGF might exert some additional differentiation-promoting effect(s).     

Computed tomography in intracerebral hemorrhage

Computed tomography is a practical and simple procedure for diagnosis of acute intracerebral hemorrhage. By this means, operable intracerebral hemorrhage was diagnosed in five patients; four were treated surgically. Computed tomography showed the size and location of the hematomas, making surgical treatment feasible despite occasional large extensions of the lesions.     

Computed tomography and pulmonary measurements

This study examines characteristics of Arbisi and Ben-Porath's (1995) MMPI-2 Infrequency-Psychopathology scale, F(p), in a sample of individuals admitted for inpatient treatment of chemical dependency. The F(p) scale, designed to detect deviant response biases in settings characterized by high base rates of psychopathology, was found by Arbisi and Ben-Porath (1995) to have good construct and incremental validity with psychiatric inpatients. Comparisons of the F(p), Infrequency (F), and Infrequency-Back (Fb) scales' means and relationships to indices of psychopathology in the current study provide evidence supporting the F(p) scale's validity in populations of chemically dependent inpatients with and without concurrent psychiatric diagnoses.     

Computed tomography in Graves' ophthalmopathy

The CT scan with the 160 x 160 matrix demonstrated both the normal orbital anatomy and the abnormal orbital anatomy of Graves' ophthalmopathy in great detail. In Graves' ophthalmopathy, the cardinal pathologic feature of extraocular muscle enlargement was accurately reflected on the CT scan and was a distinctive, diagnostically reliable finding. Enlargement of the medial and lateral rectus muscles and of the apex of the muscle cone were the most consistent findings. The severity of the CT scan abnormalities correlated well with clinical severity. Because muscle cone abnormality was observed characteristically in those patients with sight loss, we suggest that pressure by the extraocular muscles on the optic nerve may contribute to visual acuity loss in this disease.     

Computed tomography of systemic lupus erythematosus

Computed tomographic (CT) findings in 14 patients with systemic lupus erythematosus are correlated with clinical symptomatology. Microinfarction (manifested by perisuical atrophy) large infarcts, and hematomas are the major abnormalities demonstrated by CT. The neuropathology of these changes is discussed.     

Computed tomography in the postoperative patient

Nine cases of patients in whom intracranial infection was suspected after operation are presented. Lesions with ring enhancement were seen in all of these patients. The differentiation of enhancement, seen as a normal postoperative phenomenon, from residual neoplasia and cerebral abscess can be difficult. This can be resolved by serial and sequential-delayed CT, and thus unnecessary re-exploration may be prevented.     

Computed tomography findings in scrotal cystocele

Combined MRI/MRS studies were performed in 9 girls with Rett syndrome of different ages. NAA, as marker of neuronal tissue, was found to decrease with increasing age. There was no evidence for a defective energy metabolism. The data point towards a probably secondary degenerative process in the pathogenesis of Rett syndrome.     

Computed tomography in cerebellar atrophic processes

Forty-six patients with cerebellar atrophy were identified by review of CT scans of 7,500 patients. Independent examination of a separate file of the same group disclosed 49 patients whose history indicated cerebellar degeneration. Forty-three patients were in both groups indicating excellent correlation between CT abnormality and clinical cerebellar signs. Three patients with CT cerebellar atrophy failed to show clinical cerebellar signs, and 6 had clinical signs without evidence of changes on CT. Specific anatomic correlation was suggested in 10 of 13 patients with predominantly midline cerebellar CT abnormalities, and in 3 with olivopontocerebellar degeneration clinically who showed brainstem and cerebellar atrophy.     

Computed tomography in the emergency department

We report a neonatal case of severe, life-threatening Kasabach-Merritt syndrome that was successfully treated with interferon-alpha: This patient had a huge hemangioma of the right leg and a general bleeding tendency. Although the condition initially responded to steroid and radiation therapy, after a relapse, no therapy including steroids, radiation, aspirin, and dipyridamole was effective. Because of severe thrombocytopenia and extension of the hemangioma to the pelvic region, surgical intervention was not indicated. Interferon-alpha therapy was started on day 61 of life. During the therapy the platelet counts increased by more than tenfold and reached the normal level in a month. The size of the hemangioma dramatically decreased. The administration of interferon-alpha might be indicated as a therapy for severe, life-threatening Kasabach-Merritt syndrome, especially when there is resistance to steroid or radiation therapy.     

Computed tomography in partial carpal arthrodesis

We carried out X-rays and computed tomography in 59 wrists in patients who had previous surgical intercarpal fusions. 1.2 mm thick axial images were obtained perpendicular to the axis of the joint. CT showed whether or not the carpal fusions were united. Compared with CT, plain radiography yielded a 25% false negative and 6% false positive rate. We conclude that CT is more useful than plain X-rays for evaluating partial carpal arthrodesis.     

Computed tomography in evaluation of patients with stage III melanoma

BACKGROUND: Metastatic disease is detected infrequently by computed tomography (CT) in early stage melanoma. The diagnostic yield of routine CT for stage III melanoma is less established, despite extensive use in clinical practice. METHODS: Charts from 347 asymptomatic patients with stage III melanoma were reviewed. Findings suggestive of metastatic melanoma identified by head or body CT, chest radiography, bone scan, or liver function studies were confirmed histologically or by progression of disease. RESULTS: Individual CT scans identified 33/788 (4.2%) instances of metastatic melanoma, with 66/788 (8.4%) false positive studies. No metastases were identified among 104 head CT scans. Chest CT had the highest yield in patients with cervical adenopathy (7/35, 20%), and the lowest yield with groin adenopathy (1/50, 2%). Pelvic CT diagnosed metastases in 7/94 (7.4%) patients with groin adenopathy, but no patients with palpable axillary (n = 76) or cervical (n = 21) nodes. Metastatic melanoma was diagnosed in 11/136 (8.1%) patients having complete body CT imaging (chest, abdomen, and pelvis), including six patients (4.4%) identified by CT alone. CONCLUSIONS: Routine CT in patients with clinical stage III melanoma infrequently identifies metastatic disease. Head CT in the asymptomatic patient, chest CT in patients with groin adenopathy, and pelvic CT in the presence of axillary or cervical adenopathy are not indicated. Selective use of chest CT in patients with cervical adenopathy or pelvic CT in the presence of groin disease may be useful.     

Computed tomography findings in convergent strabismus fixus

X-ray computed tomography (CT) of the eyeball and orbit revealed the cause of eye movement disorder in convergent strabismus fixus. The findings suggest that the disease can be diagnosed and treated at an early stage. Twelve cases of progressive esotropia with high myopia and 20 cases with normal visual acuity served as subjects in this study. The CT slice was parallel to the German horizontal plane, and the lens and medial and lateral rectus muscles were scanned. The average axial length of the affected eyes was significantly longer than in normal eyes. In progressive esotropia, the characteristic CT findings are an elongated eyeball, mechanical contact between the eyeball and lateral wall of the orbit, and a downward displacement of the lateral rectus muscle. Thus, it is reasonable to conclude that eye movement disorder in convergent strabismus fixus results from weakness of the lateral rectus muscle which has been displaced downward due to compression of the eyeball against the orbital wall.     

Surgical treatment of craniopharyngiomas: experience with 168 patients

OBJECT: The goal of this study was to assess the outcome of surgical management in 168 consecutive patients harboring craniopharyngiomas treated between January 1983 and April 1997. METHODS: In 148 patients undergoing initial (primary) surgery, the pterional approach was most frequently used (39.2%), followed by the transsphenoidal approach (23.6%). For large retrochiasmatic craniopharyngiomas, the bifrontal interhemispheric approach was used increasingly over the pterional approach and led to improved surgical results. Total tumor removal was accomplished in 45.7% of transcranial and 85.7% of transsphenoidal procedures. The main reasons for incomplete removal were attachment to and/or infiltration of the hypothalamus, major calcifications, and attachment to vascular structures. The success rate in total tumor removal was inferior in the cases of tumor recurrence. The operative mortality rate in transcranial surgery was 1.1% in primary cases and 10.5% in cases of tumor recurrence. No patient died in the group that underwent transsphenoidal surgery. The rate of recurrence-free survival after total removal was 86.9% at 5 years and 81.3% at 10 years. In contrast, the 5-year recurrence-free survival rate was only 48.8% after subtotal removal and 41.5% after partial removal. Following primary surgery, the actuarial survival rate was 92.7% at 10 years, with the best results after complete tumor removal. At last follow up, 117 (79%) of 148 patients who underwent primary surgery were independent and without impairment. CONCLUSIONS: Total tumor removal while avoiding hazardous intraoperative manipulation provides favorable early results and a high rate of long-term control in craniopharyngiomas.     

Computed tomography of intracranial epidermoid tumours with special reference to atypical features

Intracranial intradural epidermoid tumours have been known to show characteristic CT features consisting of non-enhancing lucent lesions with sharply defined margins that are often irregular and scalloped. Since the epidermoid tumours are benign, potentially curable lesions, it should be also noted that they may occasionally show atypical CT features such as dense lesion, definite marginal enhancement following contrast medium injection, or tumour associated with large, heavy calcifications. Four such atypical cases are reported, and the literature is reviewed.