RSNA News - August 2005

Journal Highlights

The following are highlights from the current issues of RSNA's two peer-reviewed journals.

American College of Radiology Imaging Network Digital Mammographic Imaging Screening Trial: Objectives and Methodology

Given the controversial climate surrounding the value of screening mammography in saving women's lives, the results of the Digital Mammographic Imaging Screening Trial (DMIST) will be important.

In a special report in the August issue of Radiology (RSNA.org/radiologyjnl), Etta D. Pisano, M.D., from the University of North Carolina School of Medicine in Chapel Hill, and colleagues describe the objectives and methodology of DMIST, including:

• Digital technology
• Screen-film technology
• Acceptance testing and quality control for the equipment
• Training for protocol compliance
• Imaging protocol
• Image interpretation
• Work-up after an abnormal mammogram
• Determination of truth regarding breast cancer status
• Data collection and management
• S tatistical considerations for primary aim
• Quality of life substudy
• Cost-effectiveness analysis
• Reader studies using the DMIST image archive

(Radiology 2005;236:404-412)

CT of Internal Hernias

CT plays an important role in the diagnosis of acute intestinal obstruction and planning of surgical treatment. Although internal hernias are uncommon, they may be included in the differential diagnosis in cases of intestinal obstruction, especially in the absence of a history of abdominal surgery or trauma. Knowledge of the anatomy of the peritoneal cavity, the characteristic anatomic location and CT findings of each type of internal hernia may assist in their identification.

In an article in the July-August issue of RadioGraphics (RSNA.org/radiographics), Nobuyuki Takeyama, M.D., and colleagues from the Showa University School of Medicine in Tokyo describe their clinical experience with internal hernias, the imaging technique and diagnosis with CT.

They also:

• Describe the normal anatomy of the peritoneal cavity
• Describe the characteristic anatomic location of each type of internal hernia
• Identify the characteristic CT appearances of various types of internal hernias
• Discuss the clinical findings and appropriate management of internal hernias

This article meets the criteria for 1.0 CME credit.

( RadioGraphics 2005;25:997-1015)

    

Hernia through a defect of the right perirectal fossa in a 28-year-old woman with continuous lower abdominal pain of 34 hours duration.

(a, b) Contrast-enhanced CT scans of the pelvis (b obtained 10 mm below a) show dilated and fluid-filled small bowel loops (S). A cluster of dilated bowel loops (arrow) is located to the right of the rectum (R) and behind the uterine cervix (U). Laparotomy was performed four hours after CT.

(c) Drawing (superior view) of the surgical findings shows that the antimesenteric wall of an ileal loop (I), located 50 cm from the ileocecal valve, was herniated (Richter hernia) through a defect (arrow) in the anterior peritoneal layer of the right perirectal fossa (arrowheads). When withdrawn manually, the incarcerated bowel loop was viable and nongangrenous.

© 2005 RSNA. All rights reserved. Printed with permission.