A retrospective review of chest radiographs from 205 patients with blunt chest trauma who also underwent aortography was performed. Forty-one of the 205 had aortographically proved aortic rupture. Discriminant analysis of 16 radiographic signs indicated that the most discriminating signs were loss of the aorticopulmonary window, abnormality of the aortic arch, rightward tracheal shift, and widening of the left paraspinal line without associated fracture. No single or combination of radiographic signs demonstrated sufficient sensitivity to indicate all cases of traumatic aortic rupture on plain chest radiographs without the performance of a large number of aortographically negative studies. The bedside anteroposterior "erect" view of the chest proved far more valuable than the supine view in detecting true-negative studies. Despite significant reader variability in the interpretation of the various radiographic signs, in general the analysis confirmed the role of chest radiography in this clinical situation, but suggests that its most beneficial use is in excluding the diagnosis and eliminating unwarranted aortography rather than in predicting aortic rupture.

Computed tomography (CT) scanning techniques designed to visualize the beating heart utilize the electrocardiogram (ECG) waveform to gate or select the phase of the cardiac cycle being imaged. Most such methods require that each slice to be imaged be scanned many times to obtain the usual number of projections in a single phase interval of the cardiac cycle. We are studying a new method in which only a single scan of 20 s should be required per imaged slice. The central problem in the proposed technique is to test the diagnostic utility of images reconstructed from a very limited number (about 25) of projections. An essential part of the proposed algorithm is the elimination of all material outside a circle chosen to contain only the heart and the structures immediately surrounding it. Experiments are reported here on scans of calf's heart in an 11-cm container of water, with most views deleted so as to simulate the results from this type of gated scan. The results show that if no high-contrast objects are within the chosen circle, then image quality is satisfactory and could be clinically useful.

To assess the accuracy of computed tomography (CT) in staging advanced carcinoma of the cervix, 18 staging evaluations were performed in 16 patients with locally advanced (FIGO Stage IB-IVA) cervical carcinoma. CT staging results were compared with the results of clinical staging and postoperative staging. CT was accurate in 12/18 (66%) cases, clinical staging was accurate in 10/18 (55%) cases, and clinical staging with cystoscopy was accurate in 14/18 (78%) cases. CT staging failed to detect microscopic pelvic sidewall involvement and bladder involvement when there was no contrast material in the bladder. In the detection of para-aortic lymph node involvement by tumor, there were 12 true-negative, 4 true-positive, 1 false-positive, and 1 false-negative study (sensitivity = 80%, specificity = 92%). It is concluded that CT is equal in accuracy to other clinical staging techniques and offers the advantage of visualizing the tumor, which allows for more accurate determination of radiation portals.

The mesentery consists of two layers of peritoneum enclosing the small bowel and containing the jejunal and iliac branches of the superior mesenteric artery with their accompanying veins, nerve plexuses, lymph vessels, lymph nodes, connective tissue and fat (Figure 1).TABLE I 210 RadioGraphics May 1982 Volume 2, Number 2 Whitley, et at.

Modern computed tomographic (CT) scanners allow reasonably high-resolution cross-sectional visualization of most viscera and masses. To determine the accuracy of CT volume estimation, CT volumes of inanimate objects, cadaver kidneys and spleens, and in vivo balloons were performed. Regions of interest were outlined by a hand-operated cursor, and the computer program calculated the cross-sectional area in square millimeters and in pixels. A second computer program used Simpson's rule to calculate the volume from these multiple cross-sectional area. Calculated CT volumes were within +/-10% of directly measured volumes. Tumor masses being treated by chemotherapy were followed up clinically and by CT. Volume changes determined by CT are believed to be equal to and frequently more sensitive than clinical examination. From our experimental CT and clinical experiences, accuracy can be affected by (1) respiratory movement; (2) rapid changes in in vivo blood volume; (3) low CT number-gradient at the objects' periphery; (4) observer error in cursor tracing of the desired structure; and (5) mathematical errors inherent in Simpson's rule. We conclude that CT can estimate volumes of CT definable masses and can be useful in following tumor response to therapy.