PURPOSE: To demonstrate the clinical usefulness of ultrasonography for detecting esophageal varices. MATERIALS AND METHODS: In 20 cases of esophaged varix, the authors analysed the transabdominal ultrasono-graphicfindings of the esophagogastric junction and compared mural thickness, the anteroposterior diameter of theesophagus, and the echogenic nature of the esophageal mucosal layer with those of 78 normal patients. RESULTS:The anterior and posterior mural thickeness of normal esophagus was 2.2 +/-0.7 and 2.4 +/-0.8mm re-spectively, butfor variceal esophagus, the corresponding readings were 5.9 +/-1.3 and 5.2 +/-1.3mm respective-ly. Theanteroposterior diameter of normal esophagus was 7.9 +/-2.1mm and that of variceal esophagus was 1 4 . 0 +/-1.8mm.There was a stastically significant difference (p<0.01) in mural thickness and anteroposterior diameter of theesophagus between a normal and variceal patient with regard to change of echogenic nature at the esphagogastricjunction. Normal esophageal mucosa showed a thin and uniform echogenic line, but for variceal mucosa, theechogenic pattern was irregular, tortuous and thick. CONCLUSION: The athors believe that transabdominal US ishelpful for detecting esophageal varices in patients with liver cirrhosis and UGI bleeding. Important clinicallyuseful sonographic findings in diagnosing e-sophageal varix are as follows: 1) mural thickness more than 6mm; 2)anteroposterior diameter of the esopha-gus of more than 15mm; 3) irregular, tortuous and thickened echogenicmucosa.
Esophageal and Gastric Varices* ; Esophagogastric Junction ; Esophagus ; Hemorrhage ; Humans ; Liver Cirrhosis ; Mucous Membrane ; Reading ; Ultrasonography ; Varicose Veins

PURPOSE: In cases of colorectal cancer, to correlate the spiral CT staging with water enema with thepathologic staging according to the new AJCC classification. MATERIALS AND METHODS: Ninety four patients withpathologically proven carcinoma of the colon who had un-dergone spiral CT with water enema were evaluated. CTscans were obtained after enema involving about 600-1,200mL of water. Scanning was performed from thediaphragmatic dome to the symphysis pubis using 10mm collimation thickness, 12mm table feed, and 10mmreconstruction interval. The TNM stage, as seen on spiral CT, was determined without reference to the pathologicresults. Staging was performed according to the new AJCC cancer staging manual(1997). The pathologic T-stage wasT1 in four cases(4.3%), T2 in 11(11.7%), T3 in 72(76.6%), and T4 in seven(7.4%). The pathologic N-stage was N0 in57 cases(60.6%), N1 in 25 cas-es(26.6%), and N2 in 12(12.8%). The pathologic M-stage was M0 in 90 cases(95.7%) andM1 in four(4.3%). RESULTS: The detection rate of colon cancer using spiral CT with water enema was 97.9%. At theT-stage, pathologic correlation was good in 68.1% of cases(64/94). Nine patients(9.6%) were overstaged and21(22.3%) were understaged. At the N-stage, pathologic correlation was good in 54.3% of cases(51/94), with 27pa-tients(28.7%) overstaged and sixteen(17.0%) understaged. At the M-stage, pathologic correlation was good in95.7% of cases(90/94). Four patients(4.3%) were overstaged. CONCLUSION: The accuracy of staging of colorectalcarcinoma by spiral hydro-CT was 68.1% at the T-stage, 54.3% at the N-stage, and 95.7% at the M-stage. As seen onspiral CT with water enema, the T-stage tended to-wards understaging and the N-stage towards overstaging.
Classification* ; Colon ; Colonic Neoplasms ; Colorectal Neoplasms* ; Enema* ; Humans ; Neoplasm Staging ; Tomography, Spiral Computed* ; Water*

PURPOSE: To assess the malignant potential of small(< or =15mm) portal defects seen on CT arterial portography,the findings of CT hepatic arteriography and lipiodol CT CT were reviewed. MATERIALS AND METHODS: In 91 patientswho underwent both CTAP and CTHA, small portal defects were re-viewed for frequency, multiplicity and location. Weprospectively evauluated changes in the size and enhance-ment pattern of malignant lesions on follow up CTaccording to density on CTHA, location, lipiodol deposits on lipiodol CT, and multiplicity. RESULTS: Among the 91patients, 102 small defects were defected in 42 patients(46%). Small portal defects were benign, malignant, and ofundetermined malignant potential in 77%, 20% and 3% of cases, respectively. Small portal defects that werehyperattenuated on CTHA, and lipiodol deposits on lipiodol CT, were malignant in 42% and 70% of cases,respectively. Location and multiplicity did not show statistically significant variation between benign andmalignant defects. CONCLUSION: Small portal defects are common and there is a high probability that portaldefects smaller than 15mm are benign, even in patients with a known hepatic mass and defect that washyperattenuated on CTHA. If a small defect showed lipiodol deposit on lipiodol CT, malignancy must be suspected.
Angiography* ; Ethiodized Oil* ; Follow-Up Studies ; Humans ; Liver* ; Portography*

PURPOSE: To determine the usefulness of magnetic resonance imaging (MRI) after computed tomography (CT) inpatients with focal hepatic lesion. MATERIALS AND METHODS: We evaluated 100 patients with 103 focal hepaticlesions. The diagnosis of each lesion was made pathologically (n=19), or radiologically and clinically (n=84), andthe findings were as follows: he-mangioma (n=53), hepatocellular carcinoma (n=17), metastasis (n=10), cyst (n=5),regenerative nodule (n=3), and adenomatous hyperplasia (n=3). The patients underwent conventional CT (n=25),two-phase spi-ral CT (n=17) or three-phase spiral CT (n=61). MRI was performed using conventional T1- andT2-weighted imaging and dynamic contrast enhancement. The value of MRI after CT was assigned to one of fourgrades, according to the consensus of three radiologists: grade I (decisive), grade II (helpful), grade III (notadditional), or grade IV (confused). RESULTS: The outcome of MRI of 103 lesions was grade I in 14 cases(14%), IIin 34 (33%), III in 49 (48%), and IV in 6 (6%). MRI was not helpful (grade III or IV) in 40% (10/25), 47% (8/17),and 61%(31/61) of lesions after conventional, two-phase spiral, and three-phase spiral CT, respectively. Grade IIIor IV lesions were present in 45% of hemangiomas (24/53), 59% of hepatocellular carcinomas (10/17), and 80% ofcases in which metastasis had occurred(8/10). CONCLUSION: MRI after CT in patients with focal hepatic lesion washelpful in less than half of all cases. It was particularly valuable for patients who did not undergo three-phasespiral CT and in whom hemangioma was suspected.
Carcinoma, Hepatocellular ; Consensus ; Diagnosis ; Hemangioma ; Humans ; Hyperplasia ; Inpatients ; Magnetic Resonance Imaging* ; Neoplasm Metastasis ; Tomography, Spiral Computed

PURPOSE: To assess the clinical and pathologic features of each type of intrahepatic cholangiocarcinoma,which is divided into three types according to gross appearance, and to determine the efficacy of CT in detectingthis tumor. MATERIALS AND METHODS: The pathologic and CT features of 53 surgically proven cases of intrahepaticcholangio-carcinoma were reviewed. On the basis of their gross appearance, the tumors were divided into threetypes, as follows: mass forming (n=33), periductal infiltrating (n=6), and intraductal growth type (n=14). CTscans were analyzed for sensitivity of detection and correlation between a tumors appearance and itshistopathology. RESULTS: The most common histopathologic feature of mass forming and periductal infiltrating typewas tubu-lar adenocarcinoma, while in the intraductal growth type, papillary adenocarcinoma (100%) was common.With regard to pattern of tumor spread, intrahepatic and lymph node metastasis were more common in the massforming and periductal infiltrating type than in the intraductal growth type. CT findings including intra-hepaticmass, ductal wall thickening or intraductal mass associated with segmental dilatation of intrahepataic bile ducts,corresponded with these morphologic types. CONCLUSION: This classification according to gross appearance is ofconsiderable value when interpreting the pathologic features of intrahepatic cholangiocarcinoma. CT seems to be auseful modality for the detection of tumors and may be consistent with their gross morphologic findings.
Adenocarcinoma ; Adenocarcinoma, Papillary ; Bile ; Cholangiocarcinoma* ; Classification ; Dilatation ; Lymph Nodes ; Neoplasm Metastasis

PURPOSE: To describe the CT findings of portal vein aneurysm in eight patients. MATERIALS AND METHODS: Allpatients included in this study (two men and six women) under went CT examinations between October 1996 and June1998. Of these eight, three were suffering from hepatic disease and portal hypertension. We determined thelocation, shape, size, and characteristics of the lesions, and the presence or ab-sence of portal vein anomaly. RESULTS: S even patients had intrahepatic portal vein aneurysm (at the umbilical por-tion of the left portal veinin five patients, between the transverse and umbilical por-tion of the left portal vein in one, and at thebifurcation of the anterior and posterior branch of the right portal vein in one), while extrahepatic portal veinaneurysm, at the confluence of the superior mesenteric and splenic vein was found in only one. Lesions werecyst-shaped in seven cases and saccular in one, and showed well - circum scribed, markedly enhanced mass, whichcommunicated with the portal vein and/or gives off major branches. Portal vein anomaly, in which the rightanterior segmental portal vein originated from the umbilical portion of the left portal vein, was seen in threepatients. In all three, intrahepatic portal vein aneurysm was present at the umbilical portion of the left portalvein, and in one, the umbilical portion of the left portal vein was located to the right of the Cantlie line. CONCLUSION: CT examination can help reveal portal vein aneurysm by detectinga well - circumscribed, markedlyenhanced mass which communicates with the portal vein and/or gives off major branches.
Aneurysm* ; Humans ; Hypertension, Portal ; Male ; Portal Vein* ; Splenic Vein

PURPOSE: The purpose of this study was to evaluate the frequency, location, and appearance of increasedattenuation of the liver adjacent to a mass during arterial-phase spiral CT in patients with hemangioma. Thecharacteristics of the mass associated with these findings were also evaluated. MATERIALS AND METHODS: Usingspiral CT, 153 lesions in 114 hepatic hemangioma patients were retrospectively reviewed. We evaluated thefrequency, location, and appearance of increased hepatic attenuation adjacent to the hemangioma, and determinedwhether lesion size varied according to whether or not there was increased hepatic attenuation. RESULTS: Areas ofincreased hepatic attenuation adjacent to the hemangioma were identified in 10.5% of cas-es(16/153) and seen inmasses which showed a homogeneously hyperdense (11/16, 69%) or peripherally hy-perdense pattern (5/16, 31%). Thelocation of increased hepatic attenuation was commonly the peripheral por-tion (9/16, 56%), and increased hepaticattenuation was frequently wedge shaped of the mass (11/16, 69%). Lesion size did not vary according to whether ornot there was increased hepatic attenuation. CONCLUSION: Increased hepatic attenuation adjacent to a hemangiomais not rare, and is usually located periph-eral to the mass. It is common in a mass showing a homogeneouslyhyperdense pattern.
Hemangioma* ; Humans ; Liver* ; Retrospective Studies ; Tomography, Spiral Computed

Primary pulmonary plasmacytoma (PPP) is extremly rare. Because of its rarity, PPP may present a diagnos-ticchallenge to the radiologists and there is a little information on the diagnosis and treatment of this condi-tion.We report on a patient with PPP presenting with a left hilar mass on chest radiograph and CT scan. The diagnosiswas confirmed by immunohistochemical study of the resected specimen.
Diagnosis ; Humans ; Plasmacytoma ; Radiography, Thoracic ; Tomography, X-Ray Computed

PURPOSE: To analyze the causes of delayed detection of lung cancer on chest radiographs. MATERIALS AND METHODS: We retrospectively reviewed 105 cases in which an initial diagnosis of lung cancer, based on anexamination of plain radiographs, had been missed or misinterpreted. All occurred between October 1993 and April1997. We reviewed the initial chest radiographs and compared the features noted with those seen on later chestradiographs and computed tomographic (CT) images. RESULTS: Undetected lung cancer was identified in 56 patients(56/105, 53.3%) It had been hidden by superim-posed structures (41, 73.2%), overlapped by combined benign diseases(12, 21.4%), or the nodules were subtle(3, 5.4%). Of the 41 lung cancers hidden by a superimposed structure, thecentral type accounted for 29 (70.7%) and the peripheral type for 12 (29.3%). The 29 central type had been hiddenby the left hilum (n=15), the right hilum (n=10), the heart (n=3), or a rib (n=1). The twelve peripheral type werehidden by a rib (n=7), the heart (n=2), the diaphragm (n=2), or the left hilum (n=1). Of the 12 lung cancersoverlapped by combined benign diseases, pulmonary tuberculosis (n=6), pleural effusion (n=4), congestive heartfailure (n=1), and dif-fuse interstitial lung disease (n=1) were present at the time of interpretation. Themisinterpreted lung cancers were identified in 49 patients (49/105, 46.7%) and were seen to be combined withbenign disease (16, 32.6%), or as obstructive pneumonia without a central mass (15, 30.6%), air-spaceconsolidation (7, 14.3%), cavity (7, 14.3%), double lesion (2, 4.1%), or young age below 26 years (2, 4.1%). Ofthe 16 lung cancers misinterpreted as combined disease, pulmonary tuberculosis (n=14) and pleural disease (n=2)had been initially diagnosed. CONCLUSION: Most commonly, lung cancer was missed or misinterpreted because it washidden by a normal structure or combined with a benign disease. Perceptual errors can be reduced by appropriatetechniques and the scrutiny of trouble spots such as the parahilar, retrocardiac, retrodiaphragmatic and costalregions. Errors in the analysis of lung cancer can be reduced by increased awareness of growth patterns anduncommon man-ifestations of the disease.
Diagnosis ; Diaphragm ; Estrogens, Conjugated (USP) ; Heart ; Humans ; Lung Diseases ; Lung Diseases, Interstitial ; Lung Neoplasms* ; Lung* ; Pleural Diseases ; Pleural Effusion ; Pneumonia ; Radiography, Thoracic* ; Retrospective Studies ; Ribs ; Thorax* ; Tuberculosis

PURPOSE: The aim of this study was to assess the diagnostic accuracy of chest comput-ed radiography for thedetection of bronchiectasis diagnosed by high-resolution CT. MATERIALS AND METHODS: Our study included 100consecutive patients with bronchiec-tasis and 20 normal subjects, all seen on high-resolution CT. Two independentobservers analyzed chest computed radiographs and recorded the presence and type of bronchiectasis, and the invo lved lobe. RESULTS: On high-resolution CT, bronchiectasis was seen in one lobe in 29 patients, two lobes in 29,three lobes in 16, four lobes in 14, five lobes in 10, and six lobes in t wo. The bronchiectasis was tubular in 55patients, mixed tubular and cystic in 29, and cystic in 16. For observer 1, the sensitivity, specificity, andaccuracy of chest com-puted radiography was 95%, 85%, and 93%, respective l y, while for observer 2, thecorresponding figures were 93%, 85%, and 92%. Sensitivity and specificity for observ-er 1 were 33% and 96% for theright upper lobe (46% and 95% for observer 2), 68% and 86% for the right middle lobe (76% and 86%), 70% and 78%for the right lower lobe (48% and 83%), 50% and 100% for the left upper lobe (50% and 97%), 63% and 90% for thelingular segment (49% and 93%), and 87% and 75% for the left lower lobe (75% and 90%), respective l y. Tubularbronchiectasis involving a single lobe was the most common source of false negative readings based on the findingsof chest com-puted radiography. CONCLUSION: Because chest computed radiography is not inferior to high-resolutionCT for the detection of bronchiectasis, the routine use of chest computed radiography in screening forbronchiectasis is feasible. Howeve r, due to its low sensitivity in detect-ing bronchiectasis in a specific lobe,preoperative high-resolution CT examination may be needed.
Bronchiectasis* ; Humans ; Mass Screening ; Radiography* ; Reading ; Sensitivity and Specificity ; Thorax*