To determine the impact of reduced hard-copy size on diagnostic performance of digital radiography, screen-film chest radiographs were compared with isodose digital storage phosphor radiographs in the detection of simulated nodules, fine pulmonary lines, and micronodular opacities superimposed on the chests of 10 healthy volunteers. Digital radiographs were laser-printed in a full-size conventional format and in image lengths of two-thirds, one-half, and five-elevenths of the conventional format. Eighteen thousand observations by eight radiologists were analyzed by use of receiver operating characteristics. The detectability of lines and micronodular opacities decreased with declining image format size. In the detection of micronodular opacities, only the nearly full-size digital images were equivalent to conventional images. In the detection of linear opacities, reduction of image length by one-half or more reduced performance (analysis of variance, P less than .05). Only for the detection of nodules was no major difference found.
SUMMARY To determine the value of nondynamic computed tomography (CT) in assessing aortocoronary bypass graft patency, we studied 67 patients with 125 grafts by CT and by coronary angiography at close time intervals. CT scans were performed before and after one to three (average 1.98 + 0.65) 50-ml i.v. bolus injections of contrast material. Eighty-four of 92 grafts patent at angiography were also visualized by CT (sensitivity 91.3%); 29 of 33 grafts closed at angiography were considered to be occluded by CT (specificity 87.9%). Eleven of 13 grafts demonstrating one or more severe obstructions at angiography were considered to be patent by CT. Interobserver disagreement existed in four of 125 grafts (3.2%) and intraobserver variability was 1.6%. Although nondynamic CT allows a correct assessment of graft patency in many cases, it does not provide sufficient information on graft stenosis and function to replace angiography in patients who are symptomatic after surgery. ACCURATE determination of aortocoronary bypass graft patency requires angiography. Noninvasive methods for analyzing bypass grafts function, such as the directional Doppler flow technique,' thallium-201 myocardial perfusion scintigraphy2' and echocardiographic analysis of regional ventricular function,5 are of limited value because they indirectly assess bypass graft patency. A noninvasive method easily performed, repeatable and without special risks, visualizing the anatomy and providing direct information on graft patency, would be very useful in the postoperative evaluation of patients after bypass graft surgery. Computed tomography (CT) provides a high-resolution, cross-sectional image of the chest and may be an
In 32 cases pancreatic cysts were diagnosed by endoscopic pancreatocholangiography (ERPC) all confirmed by subsequent surgery. From the X-ray findings, we can enumerate the following symptoms as being typical of or at least suspicious for pancreatic cysts: I. Direct filling of cyst cavity. 2. Filling defect in the pancreatic branches and parenchyma. 3. Obstruction of the main pancreatic duct as a strict or as a tapering type abruption. 4. Displacement and compressions of the common bile duct. Pancreatic cysts were located in the head region in 17 cases and in 15 cases in the tail region. Single cysts are seen more often than multiple cysts. If a pancreatic cyst is diagnosed or suspected by ERPC, surgery is indicated. The time of operation depends on the X-ray findings. Filled cysts without discharge into the main duct must be operated on immediately, at least within 10 hours of ERPC, due to the danger of purulent infection.Key-Words: Endoscopic pancreatocholangiography (ERPC), pancreatic cysts, X-ray findings in the pancreatic duct system, X-ray findings in the common bile duct, localization of the cysts.Until recently, pancreatic cysts could be diagnosed only by indirect methods prior to surgery. X-ray of stomach and duodenum, including hypotonic duodenography, and Endoscopy 6 (1974) 77-83 Röntgenbefunde bei Pankreaszysten dwelt endoskopische Pankreatocholangiographie Bei 32 Patienten wurden Pankreaszysten durch die Methode der retrograden Pankreatocholangiographie (ERPC) diagnostiziert und nachfolgend operativ bestatigt. Nach den Röntgenbefunden sind die folgenden Zeichen typisch oder weitgehend verdachtig auf das Vorliegen von Pankreaszysten: 1. Direkte Auffilllung eines zystischen Hohlraumes. 2. Fiillungsdefekt in den Seitengangen und im Parenchym des Pankreas. 3. Abbruch des Pankreashauptganges, entweder scharf oder allmahlich verdammernd. Verlagerung und Einengung des Ductus choledochus. In 17 Fallen waren die Pankreaszysten in der Kopfund in 15 Fallen in der Schwanzregion lokalisiert. Einzelzysten waren häufiger als multiple Zysten. Wenn mittels ERPC eine Pankreaszyste nachgewiesen wird oder der dringende Verdacht besteht, ist ein chirurgisches Vorgehen angezeigt. Der Zeitpunkt der Operation hangt dabei vom röntgenologischen Bild ab. Gefüllte Zysten ohne freien Abfluß in den Ductus Wirsungianus sollten wegen der Gefahr einer Superinfektion umgehend, spatestens aber innerhalb von 10 Stunden nach durchgeführter ERPC operiert werden. intravenous cholangiography displacements, compression, obstructions and impressions may indicate a pancreatic cyst. Also, selective angiography of the arteria coeliaca and the
The accuracy of radiology in the diagnosis of gastric carcinomas was checked on 232 cases, including 24 early examples. Accuracy depends most of all on the experience of the radiologist. Amongst 146 patients, using a satisfactory technique, a carcinoma was diagnosed in 131 patients (90%) and suspected in eight (6%). In five (3%) the changes were misinterpreted as being benign and the lesion was missed in two (1%). Of 120 gastric carcinomas submitted to operation a correct diagnosis had been made radiologically in 88% and suspected in 4%; endoscopically, the diagnosis was made in 92% and suspected in 2%. Of the 24 early carcinomas, both methods suggested the presence of a malignant lesion in 80%. The combination of radiology, endoscopy, hitology and cytology increases accuracy to 95%. These results indicated that localised changes in the gastric mucosa and the wall of the stomach can be demonstrated only by using refined radiological techniques; each lesion should be confirmed by endoscopy and histology.
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