No abstract

A prospective comparison of computed tomography (CT) and magnetic resonance (MR) imaging at 1.5 T was performed in 50 patients with the suspected diagnosis of pancreatic carcinoma. CT scans were obtained before and after administration of contrast material in 41 of 50 patients (82%); 34 of 41 postcontrast scans (83%) were obtained with dynamic CT. MR images were interpreted without knowledge of the results of CT, ultrasound, cholangiography, or endoscopic retrograde cholangiopancreatography in 48 patients (96%). Surgical correlation of findings at CT and MR imaging was performed in 24 patients (48%) at laparotomy and in two patients (4%) at autopsy. On T1-weighted MR images, relatively diminished signal intensity of tumor compared with that of the adjacent pancreas was a consistent finding. MR imaging proved superior to CT in identification of pancreatic carcinoma (particularly in smaller intrapancreatic tumors), peripancreatic extension, vascular and portal vein invasion, and duodenal invasion. These results suggest that MR imaging of the pancreas is superior in many instances to CT in preoperative evaluation of pancreatic carcinoma.

No abstract

For aspergillomas in patients with fibrocavitary lung disease, surgery is often not recommended. Injection or lavage of the cavities with solutions of potassium iodide or antifungal agents has had varying success and requires repeated sessions because of nonretention of the therapeutic agent within the cavity. In three patients with four aspergillomas, the authors used fluoroscopic or computed tomographic (CT) guidance to inject amphotericin in gelatin as a liquid that solidifies within the cavity at body temperature. The patients were followed up with serial chest radiography or CT. The mixture was successfully instilled in every case. Three of the four aspergillomas completely resolved within 3 months or less, with no evidence of recurrence at follow-up of 6-18 months. The remaining aspergilloma decreased in size, but the patient needed pneumonectomy because of recurrent hemoptysis within 6 months of amphotericin injection. Transthoracic instillation of a liquid mixture of amphotericin and gelatin that solidifies rapidly at body temperature may be useful as a one-step treatment for aspergillomas.

The risk of a major complication resulting from peripheral angioplasty in appropriately selected outpatients is no greater than it is for patients admitted for overnight observation.