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Factors contributing to the occurrence of an indeterminate lung scan
370
ABSTRACTS
radiography in detection of calcification; and to assess the value of CT in predicting response to non-surgical therapy. Thirty-three patients with gall-stones considered potentially suitable for non-surgical therapy were studied. Compared with CT, the sensitivity of plain abdominal films was 40%, specificity 100%, accuracy 72% and negative predictive value 66% in detection of calcification in these patients. Of 15 patients given bile acid therapy, five showed a response, defined as reduction in gall-stone volume of 20% within 6 months, using a previously validated cholecystographic technique. Median attenuation value in these five responders was 18 HU, compared with 147 H U in the 10 non-responders (P < 0.02). CT detected calcifications ( > 90 HU) in all 10 non-responders and in only one of the five responders. These controlled studies have confirmed that CT is more sensitive than plain films in the detection of gall-stone calcification; and have demonstrated that detection of calcification not shown on plain films is of value in predicting response to bile acid therapy.
C H O L E D O C H O L I T H I A S I S AND MENISCUS SIGN A. K. H. HASAN, B. M O U L E and D. C. CARTER*
Glasgow Royal Infirmary, Glasgow *Present address: Edinburgh Royal lnfirmary The cholangiograms of 43 jaundiced patients who had a final diagnosis of choledocholithiasis based on operative or endoscopic finding of stones were evaluated. The aim of the study was to define cholangiographic abnormalities associated with this condition, in particular the importance of the meniscus sign. The cholangiographic abnormality was a constant filling defect at the lower end of the common bile duct (CBD) in 28 cases (65%). In eight cases the abnormality was a downwardly concave meniscus with complete obstruction to the flow of the contrast. In four patients, the complete obstruction at the lower end of the CBD showed no specific features peculiar to any condition. In two further patients, the cholangiograms showed dilated ducts extending down to the ampulla with no evidence of filling defects or meniscus sign. The features were more in favour of periampullary carcinoma. Finally, the abnormality in one patient was a smooth tapering of the CBD with moderate proximal dilatation, an appearance which is usually regarded as peculiar to chronic pancreatitis. The smooth and downwardly concave meniscus sign which is always regarded as characteristic of stone obstruction was observed in 19% of our patients with choledocholithiasis. Furthermore, the meniscus sign was also observed in patients with metastatic lesions, cholangiocarcinoma and chronic pancreatitis. Therefore, the study concludes that the meniscus sign is highly suggestive of choledocholithiasis but it is neither a common nor pathognomonic cholangiographic sign for stone obstruction.
PROGNOSTIC FEATURES OF HEPATOCELLULAR CARCINOMAS P. A. GAINES and C. METREWELI
Prince of Wales Hospital, Shatin, New Territories, Hong Kong Work from Japan and Taiwan suggests that the biological behaviour of hepatomas may be reflected in their ultrasound appearance. Confirmation of this would enable ultrasound to stage these tumours. We analysed prospectively the effect of 11 ultrasound variables, patient age, sex, serum A F P and treatment on patient survival. Using a univariate model (Kaplan Meirs Life Table Analysis) in 69 patients the following features were found to be associated with a poor prognosis: age < 50 years, high serum AFP, an isoechoic or infiltrative tumour, caudate lobe involvement, hepatic cirrhosis and ascites. Multivariate analysis (Cox Regression) demonstrates that age < 50, the presence of ascites and a focal isoechoic tumour were the most significant features associated with a poor prognosis.
RADIOLOGICAL FEATURES OF THE MODIFIED SCOPINARO PROCEDUREFOR MORBID OBESITY A. G R U N D Y , J. H A D D O C K , J. FRANKS, S. C A W T H O R N E and J-C. GAZET
Twenty patients have undergone a modified, potentially reversible procedure of truncal vagotomy, stapled transverse ~gastric partition and gastro-ileal anastomosis. Radiology is essential to assess anatomical and functional status following surgery. Water soluble studies were performed one week following surgery in all patients. Barium studies were carried out one month and between 3 and 6 months later. At 7 days an intact staple line was seen in all patients, no anastomotic leaks were seen and 19 out of 20 patients had a patent gastro-ileal anastomosis. Follow-up studies revealed marked dilatation of the proximal gastric pouch in all patients. The anastomosis measured between 3 and 8 mm diameter in 17 patients. Three patients had stomal stenosis requiring balloon dilatation. One patient had a late anastomotic leak. No patient developed peptic ulceration and all patients had sustained weight loss. Contrast studies are vital in assessing post-operative anatomy and function and development of complications of all operations for morbid obesity. Normal post-operative appearances of these procedures need to be recognized.
PERITONEAL MESOTHELIOMA: THE ROLE OF C O M P U T E D T O M O G R A P H Y IN DIAGNOSIS AND FOLLOW-UP P. J. GUEST, R.H. REZNEK, D. SELLESLAG, R. GERAGHTY and M. SLEVIN
St Bartholomew's Hospital, London To date the computed tomography (CT) description of malignant peritoneal mesothelioma has been in isolated case reports or in series of very few patients. We have reviewed our experience of the CT appearance of 15 new patients with peritoneal mesothelioma. Eight patients have had follow-up scans after treatment (total 23 scans) Our findings conflict substantially with the reports and reviews of other authors. Unlike previous reviews only 3/15 of our patients showed discrete masses, whereas 10/15 had a moderate or extensive amount of ascites. The patterns of mesenteric ( 11/ 15), omental (10/15) and bowel (5/15) involvement, and the criteria for peritoneal involvement (11/15) will be discussed and illustrated. Recent reports suggest that a significant response to treatment can be achieved in patients with mesothelioma. The absence of discrete measurable masses has particular importance in follow-up after therapy (8/15). The use of CT and its possible role in the management of peritoneal mesothetioma will be presented.
FACTORS CONTRIBUTING TO THE OCCURRENCE OF AN INDETERMINATE LUNG SCAN P. R. G O D D A R D , A. M I T C H E L M O R E , T. C O O P E R and M. H A R T O G
Bristol Royal Infirmary and Southmead Hospital, Bristol In about one-third of cases ventilation/perfusion lung scanning (V/Q) results in an indeterminate outcome - a report of intermediate probability for pulmonary thrombo-embolism. In a study of 260 patients with suspected pulmonary embolism multivariate analysis was used to assess factors most likely to contribute to an indeterminate lung scan outcome. The patients were studied consecutively and prospectively. All patients had VQ scans and chest radiographs; spirometry was performed in 95%. Patients with conditions that are included in the differential diagnosis of pulmonary embolism were also studied. These included myocardial ischaemia (36), cardiac failure (37) and chest infection (39). Discriminant analysis suggested that of the factors studied, congestive cardiac failure was the condition most likely to give an indeterminate result from V/Q scanning. Chest infection was also a major factor but chronic airflow obstructive disease (CAO) was a less important factor than is usually expected. Delay in scanning should be avoided since there was a significantly greater delay period in the indeterminate group compared with other groups.
St George's Hospital, London
UK SURVEY OF THE RADIOLOGICAL INVESTIGATION OF SUSPECTED PULMONARY E M B O L I S M M. W. J. H A Y W A R D , T. J. COOPER A N D V. M. HARTOG
Scopinaro (1986) described partial gastrectomy with pancreaticobiliary by-pass for morbid obesity, combining the advantages of gastric reduction and small intestinal by-pass without having the metabolic effects of jejuno-ileal by-pass.
A survey of 360 acute hospitals in the U K was undertaken to assess the current usage of pulmonary angiography and radionuclide lung scala"
University of Bristol and University of Wales College of Medicine, Cardiff
ABSTRACTS
radiography in detection of calcification; and to assess the value of CT in predicting response to non-surgical therapy. Thirty-three patients with gall-stones considered potentially suitable for non-surgical therapy were studied. Compared with CT, the sensitivity of plain abdominal films was 40%, specificity 100%, accuracy 72% and negative predictive value 66% in detection of calcification in these patients. Of 15 patients given bile acid therapy, five showed a response, defined as reduction in gall-stone volume of 20% within 6 months, using a previously validated cholecystographic technique. Median attenuation value in these five responders was 18 HU, compared with 147 H U in the 10 non-responders (P < 0.02). CT detected calcifications ( > 90 HU) in all 10 non-responders and in only one of the five responders. These controlled studies have confirmed that CT is more sensitive than plain films in the detection of gall-stone calcification; and have demonstrated that detection of calcification not shown on plain films is of value in predicting response to bile acid therapy.
C H O L E D O C H O L I T H I A S I S AND MENISCUS SIGN A. K. H. HASAN, B. M O U L E and D. C. CARTER*
Glasgow Royal Infirmary, Glasgow *Present address: Edinburgh Royal lnfirmary The cholangiograms of 43 jaundiced patients who had a final diagnosis of choledocholithiasis based on operative or endoscopic finding of stones were evaluated. The aim of the study was to define cholangiographic abnormalities associated with this condition, in particular the importance of the meniscus sign. The cholangiographic abnormality was a constant filling defect at the lower end of the common bile duct (CBD) in 28 cases (65%). In eight cases the abnormality was a downwardly concave meniscus with complete obstruction to the flow of the contrast. In four patients, the complete obstruction at the lower end of the CBD showed no specific features peculiar to any condition. In two further patients, the cholangiograms showed dilated ducts extending down to the ampulla with no evidence of filling defects or meniscus sign. The features were more in favour of periampullary carcinoma. Finally, the abnormality in one patient was a smooth tapering of the CBD with moderate proximal dilatation, an appearance which is usually regarded as peculiar to chronic pancreatitis. The smooth and downwardly concave meniscus sign which is always regarded as characteristic of stone obstruction was observed in 19% of our patients with choledocholithiasis. Furthermore, the meniscus sign was also observed in patients with metastatic lesions, cholangiocarcinoma and chronic pancreatitis. Therefore, the study concludes that the meniscus sign is highly suggestive of choledocholithiasis but it is neither a common nor pathognomonic cholangiographic sign for stone obstruction.
PROGNOSTIC FEATURES OF HEPATOCELLULAR CARCINOMAS P. A. GAINES and C. METREWELI
Prince of Wales Hospital, Shatin, New Territories, Hong Kong Work from Japan and Taiwan suggests that the biological behaviour of hepatomas may be reflected in their ultrasound appearance. Confirmation of this would enable ultrasound to stage these tumours. We analysed prospectively the effect of 11 ultrasound variables, patient age, sex, serum A F P and treatment on patient survival. Using a univariate model (Kaplan Meirs Life Table Analysis) in 69 patients the following features were found to be associated with a poor prognosis: age < 50 years, high serum AFP, an isoechoic or infiltrative tumour, caudate lobe involvement, hepatic cirrhosis and ascites. Multivariate analysis (Cox Regression) demonstrates that age < 50, the presence of ascites and a focal isoechoic tumour were the most significant features associated with a poor prognosis.
RADIOLOGICAL FEATURES OF THE MODIFIED SCOPINARO PROCEDUREFOR MORBID OBESITY A. G R U N D Y , J. H A D D O C K , J. FRANKS, S. C A W T H O R N E and J-C. GAZET
Twenty patients have undergone a modified, potentially reversible procedure of truncal vagotomy, stapled transverse ~gastric partition and gastro-ileal anastomosis. Radiology is essential to assess anatomical and functional status following surgery. Water soluble studies were performed one week following surgery in all patients. Barium studies were carried out one month and between 3 and 6 months later. At 7 days an intact staple line was seen in all patients, no anastomotic leaks were seen and 19 out of 20 patients had a patent gastro-ileal anastomosis. Follow-up studies revealed marked dilatation of the proximal gastric pouch in all patients. The anastomosis measured between 3 and 8 mm diameter in 17 patients. Three patients had stomal stenosis requiring balloon dilatation. One patient had a late anastomotic leak. No patient developed peptic ulceration and all patients had sustained weight loss. Contrast studies are vital in assessing post-operative anatomy and function and development of complications of all operations for morbid obesity. Normal post-operative appearances of these procedures need to be recognized.
PERITONEAL MESOTHELIOMA: THE ROLE OF C O M P U T E D T O M O G R A P H Y IN DIAGNOSIS AND FOLLOW-UP P. J. GUEST, R.H. REZNEK, D. SELLESLAG, R. GERAGHTY and M. SLEVIN
St Bartholomew's Hospital, London To date the computed tomography (CT) description of malignant peritoneal mesothelioma has been in isolated case reports or in series of very few patients. We have reviewed our experience of the CT appearance of 15 new patients with peritoneal mesothelioma. Eight patients have had follow-up scans after treatment (total 23 scans) Our findings conflict substantially with the reports and reviews of other authors. Unlike previous reviews only 3/15 of our patients showed discrete masses, whereas 10/15 had a moderate or extensive amount of ascites. The patterns of mesenteric ( 11/ 15), omental (10/15) and bowel (5/15) involvement, and the criteria for peritoneal involvement (11/15) will be discussed and illustrated. Recent reports suggest that a significant response to treatment can be achieved in patients with mesothelioma. The absence of discrete measurable masses has particular importance in follow-up after therapy (8/15). The use of CT and its possible role in the management of peritoneal mesothetioma will be presented.
FACTORS CONTRIBUTING TO THE OCCURRENCE OF AN INDETERMINATE LUNG SCAN P. R. G O D D A R D , A. M I T C H E L M O R E , T. C O O P E R and M. H A R T O G
Bristol Royal Infirmary and Southmead Hospital, Bristol In about one-third of cases ventilation/perfusion lung scanning (V/Q) results in an indeterminate outcome - a report of intermediate probability for pulmonary thrombo-embolism. In a study of 260 patients with suspected pulmonary embolism multivariate analysis was used to assess factors most likely to contribute to an indeterminate lung scan outcome. The patients were studied consecutively and prospectively. All patients had VQ scans and chest radiographs; spirometry was performed in 95%. Patients with conditions that are included in the differential diagnosis of pulmonary embolism were also studied. These included myocardial ischaemia (36), cardiac failure (37) and chest infection (39). Discriminant analysis suggested that of the factors studied, congestive cardiac failure was the condition most likely to give an indeterminate result from V/Q scanning. Chest infection was also a major factor but chronic airflow obstructive disease (CAO) was a less important factor than is usually expected. Delay in scanning should be avoided since there was a significantly greater delay period in the indeterminate group compared with other groups.
St George's Hospital, London
UK SURVEY OF THE RADIOLOGICAL INVESTIGATION OF SUSPECTED PULMONARY E M B O L I S M M. W. J. H A Y W A R D , T. J. COOPER A N D V. M. HARTOG
Scopinaro (1986) described partial gastrectomy with pancreaticobiliary by-pass for morbid obesity, combining the advantages of gastric reduction and small intestinal by-pass without having the metabolic effects of jejuno-ileal by-pass.
A survey of 360 acute hospitals in the U K was undertaken to assess the current usage of pulmonary angiography and radionuclide lung scala"
University of Bristol and University of Wales College of Medicine, Cardiff