Computed tomography in the diagnosis of pathological states of the lumbar diaphragm. 1: general data. Developmental defects and traumatic disorders]

CT was employed for investigation of 94 patients with pathological changes of the diaphragm. Congenital defects and unilateral aplasia of the diaphragm were observed in 5 of them. A new symptom of a pathological line of the diaphragm was recognized, characteristic for this type of patients. Teratodermoid formations with a typical CT picture were found in 3 patients. A tumor growth source was undetectable by CT. The results of investigation of 5 patients with traumatic diaphragmatic hernia have shown no particular advantages of CT over traditional radiation methods. In one case, a traumatic diaphragmatic cyst was correctly diagnosed by CT. CT was shown to be a method of choice in the diagnosis of congenital and traumatic diaphragmatic lesions.     

Computed tomography in the diagnosis of head and neck diseases]

A total of 106 patients suffering from tumors and inflammatory diseases of the head and neck were investigated. CT was performed in axial and frontal projections using a method of intravenous contrast image enhancement. The purpose of CT was to reveal an abnormal lesion, to detect its initial site, spreading, to make differential diagnosis, and to evaluate therapeutic results. Some limitations of CT in differential diagnosis of small-size tumors were observed. CT can be used for differential diagnosis of tumors and inflammatory processes in the accessory nasal sinuses. CT results were important for a choice of therapeutic methods, radiation therapy design, assessment of efficacy of surgical and radiation therapy, and the detection of tumor recurrences.     

Computed tomography in the differential diagnosis of biliary, duodenal and pancreatic diseases]

The paper is concerned with analysis of CT-investigation of 150 patients with diseases of the bilio-pancreatoduodenal area, whose diagnosis was verified histologically or by clinical observation over time, using other methods (USI, RCPG, etc.). The authors have arrived at a conclusion that for increasing the informative value of CT one should use various methods of a contrast study of the duodenum and biliary tract, electron reconstruction of CT images in different projections. They have pointed out the most significant differential-diagnostic CT signs, proposed a table to facilitate the identification of causes and a level of obturation of the bile ducts, the table playing an important role in a choice of adequate therapy.     

Computed tomography in the diagnosis of degenerative diseases of the spine

CT and roentgenography were used for the investigation of 78 patients with the radicular syndrome. The state of the intervertebral disks, intervertebral joints and cerebrospinal canal in degenerative vertebral diseases was assessed. CT permits the detection of hernia, protrusion of the intervertebral disks, deformity of the intervertebral joints, and the narrowing of the cerebrospinal canal as a result of degenerative changes, as well as establishing the cause of the affection of neural structures in the cerebrospinal canal, radicular holes. CT possesses some advantages over roentgenography in the diagnosis of degenerative vertebral diseases and can be recommended as the principal method together with roentgenography for investigation of patients with lumbar pains.     

Computed tomography in the diagnosis of diffuse diseases of the liver

Methods of CT, echotomography and scintigraphy of the liver were used to investigate 95 patients with diffuse liver diseases (fatty dystrophy, hepatitis, cirrhosis, hemosiderosis and amyloidosis). CT changes in these diseases were described. A high efficacy of CT was established in the detection of diffuse liver lesions and portal hypertension permitting one to give up in some cases invasive puncture biopsy of the organ.     

Computed tomography in the comprehensive diagnosis of acute diseases and injuries

The author presents the results of a CT use during combined investigation on 2500 patients and the wounded who were admitted to hospital on emergency as well as patients who developed serious complications during treatment, especially in the postoperative period. CT findings were verified during operation, at autopsy or during a follow-up. They were indicative of a high effectiveness of emergency CT of different organs and systems in the diagnosis of lesions, acute diseases and their complications. The use of CT permitted considerable reduction of a diagnostic (preoperative) period, a decrease in use of routine invasive x-ray and surgical methods, and the improvement of therapeutic results.     

Computed tomography in the diagnosis of asymptomatic renal cysts]

The authors analyzed CT-data on 1732 patients aged 21 to 83 to detect symptom-free renal cysts which were found in 30% of the patients. The rates and prevalence of symptom-free renal cysts were studied. A high resolution was noted. A majority of cysts was detected in patients over 50. The rates and prevalence of renal cysts testified to their low clinical significance (in the authors' opinion).     

Computed tomography in the diagnosis of mechanic jaundice complicated with diseases of the distal common bile duct]

Computerized tomography (CT) is a noninvasive indirect method of instrumental investigation for imaging the liver, bile ducts and the adjacent organs. CT enables one to confirm objectively the mechanical nature of jaundice, to assess a degree and level of involvement of the biliary tract, to assess the nature and spreading of disease. CT sensitivity for the diagnosis of pancreatic head cancer was 78.8%, specificity-91.3%, that for choledocholithiasis--84.6%, specificity--96.7%. CT in jaundice made it possible to establish diagnosis at various levels of accuracy: from differentiation of mechanical and parenchymatous jaundices to preliminary assessment of malignant tumor resectability facilitating a choice of surgical tactics.     

Computed tomography in the diagnosis of malignant renal neoplasms and their dissemination]

CT, performed in 66 patients with suspected renal tumors, showed renal cell carcinoma in 36. Tumor spreading was correctly established in 80.6%. Accurate diagnosis was made in 64 of 66 cases. The authors regard CT as an effective method for the recognition of sizable processes and differential diagnosis of solid tumors. Among the visual methods of investigation, used to define a tumor stage, CT turned out to be the most effective one.     

Computed tomography in the x-ray diagnosis of pneumonia

Experience in the use of CT in combined radiodiagnosis of pneumonia was analysed. It has been concluded that CT objectively reflects morphological inflammatory pulmonary changes and permits their all-round assessment over time. The diagnosis of pneumonia in CT is based on classical x-ray symptoms. As compared to survey radiography CT reveals symptoms of pneumonia to the full at earlier stages. CT is an important additional method of investigation of inflammatory pulmonary diseases, but it should not be used separately without survey radiography. In a majority of cases when CT is performed there is no need in x-ray tomography.     

Computed tomography in the diagnosis of soft tissue neoplasms of the trunk and extremities]

Analysis of CT data on 213 patients with soft tissue and trunk tumors has shown that a majority of malignant and benign tumors have a similar picture (except lipoma). Features of the contours of a tumor and its inner structure do not permit the assessment of its nature. The only significant differential-diagnostic sign of malignant soft tissue tumors is destruction of an adjacent bone, noted in 17.6%. The majority of malignant and benign soft tissue tumors (70.9%) on CT scans look like a single node; recurrent tumors look multinodular (78.2%). Verification of soft tissue tumors, revealed by CT, should be done using morphological methods.     

Computed tomography in the diagnosis of stomach cancer and the assessment of its spread]

CAT was carried out in 110 patients with gastric carcinoma and its findings compared with the intraoperative findings. CAT involved a polypositional scanning (depending on the tumor site) against the background of oral contrast label of the stomach and intestine. CAT potentialities in the diagnosis of gastric carcinoma, assessment of the tumor size and involvement of the adjacent organs and structures, detection of the metastases were studied. Use of CAT in complex with other methods will help choose the optimal treatment strategy and determine the volume of supposed surgical intervention.     

Computed tomography in the diagnosis of exudative otitis media

Temporal bone computed tomography (CT) was used to examine 37 patients aged 2 to 55 years who had exudative otitis media; in 27 patients of them, a pathological process was bilateral. An analysis of 58 temporal bone CT scans identified the CT signs of chronic exudative otitis media. These included a partial or complete block of the osseous foramen of the auditory tube; impaired pneumatization of the tympanic cavity, mastoid process fenestrae, and antrum; pathological drawing-in of the tympanic membrane. The preservation of the auditory ossicles and the absence of destructive changes in the walls of the cavities of the middle ear were observed in most cases. Repeated temporal bone CT study was performed in 10 patients (14 temporal bones) in different periods (from 2 months to 3 years) after surgery. The results of tympanostomy were visually assessed. These included recovered pneumatization of middle ear cavities (7 temporal bones), a cicatricial process in the tympanic cavity (5 temporal bones), recurrence of the CT manifestations of exudative otitis media (2 temporal bones).     

Computed tomography before lumbar puncture in acute meningitis: a review of the risks and benefits.

OBJECTIVE: To determine the indications, if any, for routine computed tomography (CT) of the brain before lumbar puncture in the management of acute meningitis. DATA SOURCES: Original research papers, reviews and editorials published in English from 1965 to 1991 were retrieved from MEDLINE. The bibliographies of these articles and of numerous standard texts were examined for pertinent references. A survey of local neurologists was conducted, and legal opinion was sought from the Canadian Medical Protective Association. DATA EXTRACTION: There were no studies directly assessing the risks of lumbar puncture in meningitis; however, all sources were culled for other pertinent information. RESULTS: No cases could be found of patients with acute meningitis deteriorating as a result of lumbar puncture. The neurologic consensus refuted the need for CT in typical acute meningitis. All sources stressed speedy lumbar puncture and the early institution of appropriate antibiotic therapy to minimize the severity of the illness and the risk of death. CONCLUSIONS: (a) There is no evidence to recommend CT of the brain before lumbar puncture in acute meningitis unless the patient shows atypical features, (b) for patients with papilledema the risks associated with lumbar puncture are 10 to 20 times lower than the risks associated with acute bacterial meningitis alone, (c) CT may be necessary if there is no prompt response to therapy for meningitis or if complications are suspected, (d) the inability to visualize the optic fundi because of cataracts or senile miosis is not an indication for CT and (e) there are no Canadian legal precedents suggesting liability if physicians fail to perform CT in cases of meningitis.