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Fifty oncologic patients with suspected hepatic metastases were prospectively evaluated by dynamic sequential hepatic computed tomography (DSHCT) and by delayed iodine hepatic computed tomography (DICT) scanning. DICT scanning was performed 4-6 hours following administration of 60 g of intravenous iodine. Both techniques were evaluated for lesion definition relative to the adjacent hepatic parenchyma and for numbers of metastases detected. Metastases were detected by both techniques in 26 patients. Fifteen patients (58%) had lesions better defined by DICT. DICT scanning detected more metastases in seven of these 15 patients. In eight patients (31%), there was no difference between the two techniques in numbers of masses detected or lesion definition. In three cases (11%), metastases were more confidently identified on the initial or DSHCT scan. DICT scanning, as described, is useful in defining and detecting hepatic metastases, especially where there is questionable hepatic involvement or better quantification of size is necessary.

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Results of percutaneous needle biopsies were evaluated retrospectively in 58 patients in whom a diagnosis of lymphoma was suspected. The biopsy specimen was diagnostic in 94% of the 36 patients with lymphoma, 20 of whom had recurrent disease and 16 of whom had newly diagnosed lymphoma. Sufficient tissue was obtained in 94% of these positive biopsy specimens to allow histologic subtyping of the lymphoma. Immunohistochemical studies performed on seven of the biopsy specimens allowed immunologic subclassification into B-cell and T-cell types of lymphoma. Our results suggest that the percutaneous needle biopsy is a useful and reliable tool in the diagnosis and classification of lymphoma.

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During the 3-year period from May 1981 to June 1984, 145 patients with hepatic abnormalities demonstrated by computed tomography (CT) or ultrasonography (US) underwent 151 imaging guided percutaneous hepatic biopsies. These biopsies were performed with needles ranging in size from 21-gauge aspiration to 14-gauge cutting type. Histologic and cytologic results were correlated with subsequent surgical, autopsy, and clinical follow-ups ranging from 2 months to 3 years. The overall accuracy for imaging-guided biopsies was 92.1% and 98% for diagnosis of malignant lesions. Our complication rate of 1.3% is comparable to that reported in other studies. We discuss indications, techniques, and risks for imaging-guided percutaneous hepatic biopsy.

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Forty-five percutaneous needle biopsies of pancreatic masses were performed in 41 patients in whom there was clinical or radiological concern for the diagnosis of cancer. Computed tomography (CT) was the imaging technique used in 41 of the 45 biopsies. An overall sensitivity of 85%, specificity of 100%, and accuracy rate of 88% were achieved, with serious complications in three of the 45 attempts (6.7%). These figures show that percutaneous pancreatic biopsies have the potential for greater accuracy than has been previously reported and are relatively safe when compared with surgery.

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One hundred twenty infants ranging in weight from 600 to 4,000 grams were entered into a prospective sonographic study to establish normal renal growth parameters. Renal cortical echogenicity was demonstrated to decrease with increasing infant weight. Observations on the use of Doppler analysis for assessing renal vascular flow are presented.

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Sixty patients underwent CT scanning of the liver prior to, immediately after, and four hours after intravenous administration of 60% meglumine diatrizoate. Twenty patients received a 50 ml bolus of contrast material (14.6 g of iodine), 20 received 100 ml (29.2 g of iodine), and 20 received 200 ml (58.4 g of iodine). In each group, delayed CT scanning safely raised the inherent density of the liver significantly (increase of 14.3% using 50 ml; 23.9% using 100 ml; and 40.7% using 200 ml). Thus, delayed scanning with doses presently used in abdominal and neurological CT examinations may be helpful in detecting hepatic lesions.

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Various techniques for contrast enhanced CT scanning have been proposed to maximize detection of hepatic abnormalities. A new method that uses the secondary excretion of water-soluble contrast media by the liver is described, and an example is provided.

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We document a case of acute nonobstructive appendicitis and critically evaluate the pertinent literature. Although undoubtedly a rare entity, nonobstructive appendicitis may occur and should be differentiated from a normal appendix by barium enema examination. Mucosal and intramural inflammatory abnormalities are described which permit the diagnosis of nonobstructive appendicitis.

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Fifty-eight percutaneous needle biopsies of adrenal masses were performed in 53 patients. The technique was initially successful in 44 (83%) of 53 patients. Five patients had second procedures because of initial failure or the possibility of sampling error. Fourteen biopsies were performed in nononcologic patients and 39 in patients with a known malignancy. None of the adrenal masses in nononcologic patients were malignant. Only 18 (46.1%) of the 39 masses in oncologic patients were metastases; the rest represented a variety of nonneoplastic conditions. Seven minor complications occurred in six patients. Two of these patients required transfusions for hypotension or decreases in hematocrit. No correlation was noted between needle size and complications. There were no pneumothoraces. The procedure is an accurate and safe alternative to surgical biopsy.

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A prospective sonographic study of 21 patients with suspected renal colic was undertaken to detect the presence or absence of urinary tract calculi. The presence of calculi was diagnosed sonographically by visualization of the calculus and/or unilateral hydronephrosis in all 18 cases in which presence of a calculus was subsequently proved by surgery, spontaneous passage and recovery, or intravenous urography. In the two cases in which the sonographic examination demonstrated neither calculi nor unilateral obstruction, further evaluation confirmed the absence of calculi. There was one false-positive examination in which unilateral hydronephrosis was detected secondary to a retroperitoneal tumor. There were no false-negative examinations. The results of this study support the use of ultrasound in the initial evaluation of renal colic.

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