home *** CD-ROM | disk | FTP | other *** search
Unknown | 1992-06-06 | 303.8 KB |
open in:
MacOS 8.1
|
Win98
|
DOS
view JSON data
|
view as text
This file was not able to be converted.
This format is not currently supported by dexvert.
Confidence | Program | Detection | Match Type | Support
|
---|
66%
| dexvert
| OS/2 Installation Package (archive/os2InstallPackage)
| ext
| Supported |
1%
| dexvert
| BeOS Installation Package (archive/beOSInstallPackage)
| ext
| Unsupported |
1%
| dexvert
| Newton Package (archive/newtonPackage)
| ext
| Unsupported |
1%
| dexvert
| Independence War 2 mod Package (other/independenceWar2ModPackage)
| ext
| Unsupported |
100%
| file
| data
| default
|
|
hex view+--------+-------------------------+-------------------------+--------+--------+
|00000000| 1a 44 50 31 2e 31 00 00 | 00 00 00 00 00 05 64 00 |.DP1.1..|......d.|
|00000010| 00 00 16 00 00 00 30 30 | 00 00 00 01 9c 05 00 00 |......00|........|
|00000020| d9 11 00 00 30 31 00 00 | 00 01 75 17 00 00 9a 0d |....01..|..u.....|
|00000030| 00 00 30 32 00 00 00 01 | 0f 25 00 00 ab 0f 00 00 |..02....|.%......|
|00000040| 30 33 00 00 00 01 ba 34 | 00 00 86 0f 00 00 30 34 |03.....4|......04|
|00000050| 00 00 00 01 40 44 00 00 | 19 0a 00 00 30 35 00 00 |....@D..|....05..|
|00000060| 00 01 59 4e 00 00 b5 10 | 00 00 30 36 00 00 00 01 |..YN....|..06....|
|00000070| 0e 5f 00 00 9d 0e 00 00 | 30 37 00 00 00 01 ab 6d |._......|07.....m|
|00000080| 00 00 b3 0d 00 00 30 38 | 00 00 00 01 5e 7b 00 00 |......08|....^{..|
|00000090| 97 0d 00 00 30 39 00 00 | 00 01 f5 88 00 00 ab 0d |....09..|........|
|000000a0| 00 00 31 30 00 00 00 01 | a0 96 00 00 45 0c 00 00 |..10....|....E...|
|000000b0| 31 31 00 00 00 01 e5 a2 | 00 00 ce 0e 00 00 31 32 |11......|......12|
|000000c0| 00 00 00 01 b3 b1 00 00 | d0 0c 00 00 31 33 00 00 |........|....13..|
|000000d0| 00 01 83 be 00 00 d8 0c | 00 00 31 34 00 00 00 01 |........|..14....|
|000000e0| 5b cb 00 00 88 0a 00 00 | 31 35 00 00 00 01 e3 d5 |[.......|15......|
|000000f0| 00 00 e2 0c 00 00 31 36 | 00 00 00 01 c5 e2 00 00 |......16|........|
|00000100| 0f 0f 00 00 31 37 00 00 | 00 01 d4 f1 00 00 97 08 |....17..|........|
|00000110| 00 00 31 38 00 00 00 01 | 6b fa 00 00 f1 0b 00 00 |..18....|k.......|
|00000120| 31 39 00 00 00 01 5c 06 | 01 00 f8 0b 00 00 32 30 |19....\.|......20|
|00000130| 00 00 00 01 54 12 01 00 | 99 0e 00 00 32 31 00 00 |....T...|....21..|
|00000140| 00 01 ed 20 01 00 53 0b | 00 00 32 32 00 00 00 01 |... ..S.|..22....|
|00000150| 40 2c 01 00 ab 0a 00 00 | 32 33 00 00 00 01 eb 36 |@,......|23.....6|
|00000160| 01 00 2b 0e 00 00 32 34 | 00 00 00 01 16 45 01 00 |..+...24|.....E..|
|00000170| 95 0d 00 00 32 35 00 00 | 00 01 ab 52 01 00 f2 0b |....25..|...R....|
|00000180| 00 00 32 36 00 00 00 01 | 9d 5e 01 00 22 0e 00 00 |..26....|.^.."...|
|00000190| 32 37 00 00 00 01 bf 6c | 01 00 15 09 00 00 32 38 |27.....l|......28|
|000001a0| 00 00 00 01 d4 75 01 00 | 36 0d 00 00 32 39 00 00 |.....u..|6...29..|
|000001b0| 00 01 0a 83 01 00 c1 0f | 00 00 33 30 00 00 00 01 |........|..30....|
|000001c0| cb 92 01 00 c5 0d 00 00 | 33 31 00 00 00 01 90 a0 |........|31......|
|000001d0| 01 00 51 0b 00 00 33 32 | 00 00 00 01 e1 ab 01 00 |..Q...32|........|
|000001e0| c3 0a 00 00 33 33 00 00 | 00 01 a4 b6 01 00 c6 0b |....33..|........|
|000001f0| 00 00 33 34 00 00 00 01 | 6a c2 01 00 ad 0e 00 00 |..34....|j.......|
|00000200| 33 35 00 00 00 01 17 d1 | 01 00 2d 0d 00 00 33 36 |35......|..-...36|
|00000210| 00 00 00 01 44 de 01 00 | a0 0c 00 00 33 37 00 00 |....D...|....37..|
|00000220| 00 01 e4 ea 01 00 ed 0e | 00 00 33 38 00 00 00 01 |........|..38....|
|00000230| d1 f9 01 00 1e 0d 00 00 | 33 39 00 00 00 01 ef 06 |........|39......|
|00000240| 02 00 38 0a 00 00 34 30 | 00 00 00 01 27 11 02 00 |..8...40|....'...|
|00000250| 21 0e 00 00 34 31 00 00 | 00 01 48 1f 02 00 0f 0d |!...41..|..H.....|
|00000260| 00 00 34 32 00 00 00 01 | 57 2c 02 00 43 0d 00 00 |..42....|W,..C...|
|00000270| 34 33 00 00 00 01 9a 39 | 02 00 8f 08 00 00 34 34 |43.....9|......44|
|00000280| 00 00 00 01 29 42 02 00 | ba 08 00 00 34 35 00 00 |....)B..|....45..|
|00000290| 00 01 e3 4a 02 00 b3 0d | 00 00 34 36 00 00 00 01 |...J....|..46....|
|000002a0| 96 58 02 00 2a 0c 00 00 | 34 37 00 00 00 01 c0 64 |.X..*...|47.....d|
|000002b0| 02 00 9d 0a 00 00 34 38 | 00 00 00 01 5d 6f 02 00 |......48|....]o..|
|000002c0| d0 09 00 00 34 39 00 00 | 00 01 2d 79 02 00 00 0e |....49..|..-y....|
|000002d0| 00 00 35 30 00 00 00 01 | 2d 87 02 00 f4 0d 00 00 |..50....|-.......|
|000002e0| 35 31 00 00 00 01 21 95 | 02 00 81 0b 00 00 35 32 |51....!.|......52|
|000002f0| 00 00 00 01 a2 a0 02 00 | ef 08 00 00 35 33 00 00 |........|....53..|
|00000300| 00 01 91 a9 02 00 85 11 | 00 00 35 34 00 00 00 01 |........|..54....|
|00000310| 16 bb 02 00 6b 0c 00 00 | 35 35 00 00 00 01 81 c7 |....k...|55......|
|00000320| 02 00 2d 0c 00 00 35 36 | 00 00 00 01 ae d3 02 00 |..-...56|........|
|00000330| 84 0a 00 00 35 37 00 00 | 00 01 32 de 02 00 a5 0a |....57..|..2.....|
|00000340| 00 00 35 38 00 00 00 01 | d7 e8 02 00 19 0e 00 00 |..58....|........|
|00000350| 35 39 00 00 00 01 f0 f6 | 02 00 5d 0d 00 00 36 30 |59......|..]...60|
|00000360| 00 00 00 01 4d 04 03 00 | 30 09 00 00 36 31 00 00 |....M...|0...61..|
|00000370| 00 01 7d 0d 03 00 97 0c | 00 00 36 32 00 00 00 01 |..}.....|..62....|
|00000380| 14 1a 03 00 cc 0a 00 00 | 36 33 00 00 00 01 e0 24 |........|63.....$|
|00000390| 03 00 d4 0c 00 00 36 34 | 00 00 00 01 b4 31 03 00 |......64|.....1..|
|000003a0| 9d 0e 00 00 36 35 00 00 | 00 01 51 40 03 00 57 0a |....65..|..Q@..W.|
|000003b0| 00 00 36 36 00 00 00 01 | a8 4a 03 00 6e 0a 00 00 |..66....|.J..n...|
|000003c0| 36 37 00 00 00 01 16 55 | 03 00 7f 0b 00 00 36 38 |67.....U|......68|
|000003d0| 00 00 00 01 95 60 03 00 | 85 09 00 00 36 39 00 00 |.....`..|....69..|
|000003e0| 00 01 1a 6a 03 00 08 0a | 00 00 37 30 00 00 00 01 |...j....|..70....|
|000003f0| 22 74 03 00 30 0c 00 00 | 37 31 00 00 00 01 52 80 |"t..0...|71....R.|
|00000400| 03 00 df 0a 00 00 37 32 | 00 00 00 01 31 8b 03 00 |......72|....1...|
|00000410| 98 0a 00 00 37 33 00 00 | 00 01 c9 95 03 00 2d 09 |....73..|......-.|
|00000420| 00 00 37 34 00 00 00 01 | f6 9e 03 00 e9 09 00 00 |..74....|........|
|00000430| 37 35 00 00 00 01 df a8 | 03 00 0e 0c 00 00 37 36 |75......|......76|
|00000440| 00 00 00 01 ed b4 03 00 | 22 0b 00 00 37 37 00 00 |........|"...77..|
|00000450| 00 01 0f c0 03 00 2f 09 | 00 00 37 38 00 00 00 01 |....../.|..78....|
|00000460| 3e c9 03 00 92 0d 00 00 | 37 39 00 00 00 01 d0 d6 |>.......|79......|
|00000470| 03 00 a3 09 00 00 38 30 | 00 00 00 01 73 e0 03 00 |......80|....s...|
|00000480| 85 09 00 00 38 31 00 00 | 00 01 f8 e9 03 00 95 0a |....81..|........|
|00000490| 00 00 38 32 00 00 00 01 | 8d f4 03 00 7c 0c 00 00 |..82....|....|...|
|000004a0| 38 33 00 00 00 01 09 01 | 04 00 dc 09 00 00 38 34 |83......|......84|
|000004b0| 00 00 00 01 e5 0a 04 00 | 10 0d 00 00 38 35 00 00 |........|....85..|
|000004c0| 00 01 f5 17 04 00 64 0c | 00 00 38 36 00 00 00 01 |......d.|..86....|
|000004d0| 59 24 04 00 97 09 00 00 | 38 37 00 00 00 01 f0 2d |Y$......|87.....-|
|000004e0| 04 00 bc 0c 00 00 38 38 | 00 00 00 01 ac 3a 04 00 |......88|.....:..|
|000004f0| 7f 0d 00 00 38 39 00 00 | 00 01 2b 48 04 00 92 0b |....89..|..+H....|
|00000500| 00 00 39 30 00 00 00 01 | bd 53 04 00 db 08 00 00 |..90....|.S......|
|00000510| 39 31 00 00 00 01 98 5c | 04 00 c6 09 00 00 39 32 |91.....\|......92|
|00000520| 00 00 00 01 5e 66 04 00 | 69 0a 00 00 39 33 00 00 |....^f..|i...93..|
|00000530| 00 01 c7 70 04 00 0b 08 | 00 00 39 34 00 00 00 01 |...p....|..94....|
|00000540| d2 78 04 00 cb 0d 00 00 | 39 35 00 00 00 01 9d 86 |.x......|95......|
|00000550| 04 00 d6 0b 00 00 39 36 | 00 00 00 01 73 92 04 00 |......96|....s...|
|00000560| a6 0c 00 00 39 37 00 00 | 00 01 19 9f 04 00 f9 0b |....97..|........|
|00000570| 00 00 39 38 00 00 00 01 | 12 ab 04 00 3a 09 00 00 |..98....|....:...|
|00000580| 39 39 00 00 00 01 4c b4 | 04 00 ed 0a 00 00 00 00 |99....L.|........|
|00000590| 00 00 00 00 39 bf 04 00 | 00 00 00 00 24 55 6e 69 |....9...|....$Uni|
|000005a0| 71 75 65 5f 49 44 7b 59 | 52 42 30 39 36 30 30 7d |que_ID{Y|RB09600}|
|000005b0| 0d 0a 24 54 69 74 6c 65 | 7b 52 61 64 69 6f 67 72 |..$Title|{Radiogr|
|000005c0| 61 70 68 69 63 20 46 69 | 6e 64 69 6e 67 73 20 69 |aphic Fi|ndings i|
|000005d0| 6e 20 4f 76 65 72 6c 6f | 6f 6b 65 64 20 43 6f 6c |n Overlo|oked Col|
|000005e0| 6f 6e 20 43 61 72 63 69 | 6e 6f 6d 61 73 3a 20 20 |on Carci|nomas: |
|000005f0| 41 20 52 65 74 72 6f 73 | 70 65 63 74 69 76 65 20 |A Retros|pective |
|00000600| 41 6e 61 6c 79 73 69 73 | 7d 0d 0a 24 41 75 74 68 |Analysis|}..$Auth|
|00000610| 6f 72 7b 46 6f 72 6b 2c | 20 46 2d 54 7d 0d 0a 24 |or{Fork,| F-T}..$|
|00000620| 41 66 66 69 6c 69 61 74 | 69 6f 6e 7b 55 6e 69 76 |Affiliat|ion{Univ|
|00000630| 20 6f 66 20 4c 75 6e 64 | 2c 20 4d 61 6c 6d 6f 2c | of Lund|, Malmo,|
|00000640| 20 53 77 65 64 65 6e 7d | 0d 0a 24 4a 6f 75 72 6e | Sweden}|..$Journ|
|00000650| 61 6c 7b 41 63 74 61 20 | 52 61 64 69 6f 6c 7d 0d |al{Acta |Radiol}.|
|00000660| 0a 24 56 6f 6c 75 6d 65 | 7b 32 39 7d 0d 0a 24 50 |.$Volume|{29}..$P|
|00000670| 61 67 65 7b 33 33 31 2d | 33 33 36 7d 0d 0a 24 44 |age{331-|336}..$D|
|00000680| 61 74 65 7b 4d 61 79 2d | 4a 75 6e 65 20 31 39 38 |ate{May-|June 198|
|00000690| 38 7d 0d 0a 24 59 42 56 | 6f 6c 7b 31 39 39 30 20 |8}..$YBV|ol{1990 |
|000006a0| 59 65 61 72 20 42 6f 6f | 6b 20 6f 66 20 44 69 61 |Year Boo|k of Dia|
|000006b0| 67 6e 6f 73 74 69 63 20 | 52 61 64 69 6f 6c 6f 67 |gnostic |Radiolog|
|000006c0| 79 7d 0d 0a 24 43 68 61 | 70 74 65 72 7b 34 2d 37 |y}..$Cha|pter{4-7|
|000006d0| 7d 0d 0a 24 59 42 45 64 | 69 74 6f 72 7b 44 72 73 |}..$YBEd|itor{Drs|
|000006e0| 2e 20 42 72 61 67 67 2c | 20 48 65 6e 64 65 65 2c |. Bragg,| Hendee,|
|000006f0| 20 4b 65 61 74 73 2c 20 | 4b 69 72 6b 70 61 74 72 | Keats, |Kirkpatr|
|00000700| 69 63 6b 2c 20 4d 69 6c | 6c 65 72 2c 20 4f 73 62 |ick, Mil|ler, Osb|
|00000710| 6f 72 6e 2c 20 61 6e 64 | 20 54 68 6f 6d 70 73 6f |orn, and| Thompso|
|00000720| 6e 7d 0d 0a 24 54 61 62 | 6c 65 7b 54 61 62 6c 65 |n}..$Tab|le{Table|
|00000730| 20 4f 6d 69 74 74 65 64 | 7d 0d 0a 24 43 6f 6d 6d | Omitted|}..$Comm|
|00000740| 65 6e 74 61 74 6f 72 7b | 57 2e 4d 2e 20 54 68 6f |entator{|W.M. Tho|
|00000750| 6d 70 73 6f 6e 2c 20 4d | 2e 44 2e 7d 0d 0a 0d 0a |mpson, M|.D.}....|
|00000760| 43 6f 70 79 72 69 67 68 | 74 20 28 63 29 20 59 65 |Copyrigh|t (c) Ye|
|00000770| 61 72 62 6f 6f 6b 20 4d | 65 64 69 63 61 6c 20 50 |arbook M|edical P|
|00000780| 75 62 6c 69 73 68 65 72 | 73 2c 20 49 6e 63 2e 2c |ublisher|s, Inc.,|
|00000790| 20 31 39 39 30 0d 0a 0d | 0a 31 39 39 30 20 59 65 | 1990...|.1990 Ye|
|000007a0| 61 72 20 42 6f 6f 6b 20 | 6f 66 20 44 69 61 67 6e |ar Book |of Diagn|
|000007b0| 6f 73 74 69 63 20 52 61 | 64 69 6f 6c 6f 67 79 20 |ostic Ra|diology |
|000007c0| 28 52 29 0d 0a 0d 0a 43 | 68 61 70 74 65 72 20 34 |(R)....C|hapter 4|
|000007d0| 2d 2d 54 68 65 20 41 62 | 64 6f 6d 65 6e 0d 0a 0d |--The Ab|domen...|
|000007e0| 0a 47 61 73 74 72 6f 69 | 6e 74 65 73 74 69 6e 61 |.Gastroi|ntestina|
|000007f0| 6c 20 54 72 61 63 74 0d | 0a 0d 0a 42 41 52 49 55 |l Tract.|...BARIU|
|00000800| 4d 20 45 4e 45 4d 41 0d | 0a 0d 0a 2d 2d 2d 2d 2d |M ENEMA.|...-----|
|00000810| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00000820| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00000830| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00000840| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00000850| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 0d 0a 52 61 64 69 6f |--------|-..Radio|
|00000860| 67 72 61 70 68 69 63 20 | 46 69 6e 64 69 6e 67 73 |graphic |Findings|
|00000870| 20 69 6e 20 4f 76 65 72 | 6c 6f 6f 6b 65 64 20 43 | in Over|looked C|
|00000880| 6f 6c 6f 6e 20 43 61 72 | 63 69 6e 6f 6d 61 73 3a |olon Car|cinomas:|
|00000890| 20 20 41 20 52 65 74 72 | 6f 73 70 65 63 74 69 76 | A Retr|ospectiv|
|000008a0| 65 0d 0a 41 6e 61 6c 79 | 73 69 73 0d 0a 0d 0a 46 |e..Analy|sis....F|
|000008b0| 6f 72 6b 20 46 2d 54 0d | 0a 28 55 6e 69 76 20 6f |ork F-T.|.(Univ o|
|000008c0| 66 20 4c 75 6e 64 2c 20 | 4d 61 6c 6d 6f 2c 20 53 |f Lund, |Malmo, S|
|000008d0| 77 65 64 65 6e 29 0d 0a | 41 63 74 61 20 52 61 64 |weden)..|Acta Rad|
|000008e0| 69 6f 6c 20 32 39 3a 33 | 33 31 2d 33 33 36 2c 20 |iol 29:3|31-336, |
|000008f0| 4d 61 79 2d 4a 75 6e 65 | 20 31 39 38 38 0d 0a 2d |May-June| 1988..-|
|00000900| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00000910| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00000920| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00000930| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00000940| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 0d 0a 0d |--------|-----...|
|00000950| 0a 41 62 73 74 72 61 63 | 74 0d 0a 0d 0a 20 20 20 |.Abstrac|t.... |
|00000960| 20 20 41 6c 74 68 6f 75 | 67 68 20 68 69 73 74 6f | Althou|gh histo|
|00000970| 6c 6f 67 69 63 61 6c 6c | 79 20 65 61 72 6c 79 20 |logicall|y early |
|00000980| 63 6f 6c 6f 72 65 63 74 | 61 6c 20 63 61 72 63 69 |colorect|al carci|
|00000990| 6e 6f 6d 61 20 63 61 6e | 20 62 65 20 63 75 72 65 |noma can| be cure|
|000009a0| 64 20 62 65 66 6f 72 65 | 0d 0a 69 6e 76 61 73 69 |d before|..invasi|
|000009b0| 6f 6e 20 68 61 73 20 72 | 65 61 63 68 65 64 20 74 |on has r|eached t|
|000009c0| 68 65 20 73 65 72 6f 73 | 61 2c 20 6c 65 73 69 6f |he seros|a, lesio|
|000009d0| 6e 73 20 61 72 65 20 6e | 6f 74 20 75 73 75 61 6c |ns are n|ot usual|
|000009e0| 6c 79 20 64 65 74 65 63 | 74 65 64 20 75 6e 74 69 |ly detec|ted unti|
|000009f0| 6c 0d 0a 62 6c 65 65 64 | 69 6e 67 20 6f 63 63 75 |l..bleed|ing occu|
|00000a00| 72 73 2e 20 20 53 6f 6d | 65 20 70 61 74 69 65 6e |rs. Som|e patien|
|00000a10| 74 73 20 61 72 65 20 66 | 6f 75 6e 64 20 72 65 74 |ts are f|ound ret|
|00000a20| 72 6f 73 70 65 63 74 69 | 76 65 6c 79 20 6f 6e 20 |rospecti|vely on |
|00000a30| 72 65 76 69 65 77 20 6f | 66 20 65 61 72 6c 69 65 |review o|f earlie|
|00000a40| 72 0d 0a 72 61 64 69 6f | 6c 6f 67 69 63 20 63 6f |r..radio|logic co|
|00000a50| 6c 6f 6e 20 65 78 61 6d | 69 6e 61 74 69 6f 6e 73 |lon exam|inations|
|00000a60| 2e 20 20 44 6f 75 62 6c | 65 2d 63 6f 6e 74 72 61 |. Doubl|e-contra|
|00000a70| 73 74 20 62 61 72 69 75 | 6d 20 65 6e 65 6d 61 20 |st bariu|m enema |
|00000a80| 73 74 75 64 69 65 73 20 | 77 69 74 68 0d 0a 70 72 |studies |with..pr|
|00000a90| 69 6d 61 72 69 6c 79 20 | 6d 69 73 73 65 64 20 63 |imarily |missed c|
|00000aa0| 61 72 63 69 6e 6f 6d 61 | 73 20 6f 66 20 74 68 65 |arcinoma|s of the|
|00000ab0| 20 63 6f 6c 6f 6e 20 77 | 65 72 65 20 75 6e 64 65 | colon w|ere unde|
|00000ac0| 72 74 61 6b 65 6e 20 74 | 6f 20 64 65 66 69 6e 65 |rtaken t|o define|
|00000ad0| 20 74 68 65 0d 0a 72 61 | 64 69 6f 67 72 61 70 68 | the..ra|diograph|
|00000ae0| 69 63 20 63 72 69 74 65 | 72 69 61 20 6f 66 20 6f |ic crite|ria of o|
|00000af0| 76 65 72 6c 6f 6f 6b 65 | 64 20 63 6f 6c 6f 6e 20 |verlooke|d colon |
|00000b00| 63 61 6e 63 65 72 73 20 | 61 6e 64 20 74 6f 20 61 |cancers |and to a|
|00000b10| 6e 61 6c 79 7a 65 20 73 | 70 65 63 69 66 69 63 61 |nalyze s|pecifica|
|00000b20| 6c 6c 79 0d 0a 77 68 79 | 20 63 61 6e 63 65 72 73 |lly..why| cancers|
|00000b30| 20 77 65 72 65 20 6e 6f | 74 20 66 6f 75 6e 64 2e | were no|t found.|
|00000b40| 0d 0a 20 20 20 20 20 54 | 77 65 6e 74 79 2d 6f 6e |.. T|wenty-on|
|00000b50| 65 20 63 6f 6c 6f 6e 20 | 63 61 72 63 69 6e 6f 6d |e colon |carcinom|
|00000b60| 61 73 20 77 65 72 65 20 | 6d 69 73 73 65 64 20 70 |as were |missed p|
|00000b70| 72 69 6d 61 72 69 6c 79 | 20 72 61 64 69 6f 67 72 |rimarily| radiogr|
|00000b80| 61 70 68 69 63 61 6c 6c | 79 2d 2d 75 73 69 6e 67 |aphicall|y--using|
|00000b90| 0d 0a 74 68 65 20 64 6f | 75 62 6c 65 2d 63 6f 6e |..the do|uble-con|
|00000ba0| 74 72 61 73 74 20 62 61 | 72 69 75 6d 20 65 6e 65 |trast ba|rium ene|
|00000bb0| 6d 61 20 74 65 63 68 6e | 69 71 75 65 20 28 44 43 |ma techn|ique (DC|
|00000bc0| 45 29 2d 2d 64 75 72 69 | 6e 67 20 61 20 31 32 2d |E)--duri|ng a 12-|
|00000bd0| 79 65 61 72 20 70 65 72 | 69 6f 64 2e 0d 0a 46 6f |year per|iod...Fo|
|00000be0| 72 20 61 6c 6c 20 70 61 | 74 69 65 6e 74 73 2c 20 |r all pa|tients, |
|00000bf0| 74 68 65 20 63 61 72 63 | 69 6e 6f 6d 61 20 77 61 |the carc|inoma wa|
|00000c00| 73 20 64 69 61 67 6e 6f | 73 65 64 20 61 74 20 73 |s diagno|sed at s|
|00000c10| 65 63 6f 6e 64 20 72 65 | 61 64 69 6e 67 2c 20 61 |econd re|ading, a|
|00000c20| 74 0d 0a 63 6f 6c 6f 6e | 6f 73 63 6f 70 79 2c 20 |t..colon|oscopy, |
|00000c30| 61 74 20 73 75 72 67 65 | 72 79 2c 20 6f 72 20 6f |at surge|ry, or o|
|00000c40| 6e 20 72 65 74 72 6f 73 | 70 65 63 74 69 76 65 20 |n retros|pective |
|00000c50| 72 65 76 69 65 77 2e 20 | 20 41 74 20 72 65 74 72 |review. | At retr|
|00000c60| 6f 73 70 65 63 74 69 76 | 65 20 72 65 76 69 65 77 |ospectiv|e review|
|00000c70| 2c 0d 0a 64 69 61 67 6e | 6f 73 74 69 63 20 61 6e |,..diagn|ostic an|
|00000c80| 64 20 74 65 63 68 6e 69 | 63 61 6c 20 70 69 74 66 |d techni|cal pitf|
|00000c90| 61 6c 6c 73 20 77 65 72 | 65 20 72 65 63 6f 72 64 |alls wer|e record|
|00000ca0| 65 64 2c 20 61 6e 64 20 | 73 65 63 6f 6e 64 61 72 |ed, and |secondar|
|00000cb0| 79 20 63 61 72 63 69 6e | 6f 6d 61 0d 0a 66 65 61 |y carcin|oma..fea|
|00000cc0| 74 75 72 65 73 20 77 65 | 72 65 20 69 6e 76 65 73 |tures we|re inves|
|00000cd0| 74 69 67 61 74 65 64 2e | 0d 0a 20 20 20 20 20 54 |tigated.|.. T|
|00000ce0| 68 65 20 6d 65 61 6e 20 | 64 69 61 67 6e 6f 73 74 |he mean |diagnost|
|00000cf0| 69 63 20 64 65 6c 61 79 | 20 77 61 73 20 32 20 79 |ic delay| was 2 y|
|00000d00| 65 61 72 73 20 69 6e 20 | 31 34 20 70 61 74 69 65 |ears in |14 patie|
|00000d10| 6e 74 73 20 61 6e 64 20 | 6c 65 73 73 20 74 68 61 |nts and |less tha|
|00000d20| 6e 20 37 0d 0a 77 65 65 | 6b 73 20 69 6e 20 37 20 |n 7..wee|ks in 7 |
|00000d30| 70 61 74 69 65 6e 74 73 | 2e 20 20 53 69 78 20 63 |patients|. Six c|
|00000d40| 61 72 63 69 6e 6f 6d 61 | 73 20 77 65 72 65 20 6c |arcinoma|s were l|
|00000d50| 6f 63 61 74 65 64 20 69 | 6e 20 74 68 65 20 73 69 |ocated i|n the si|
|00000d60| 67 6d 6f 69 64 2c 20 69 | 6e 20 74 68 65 0d 0a 61 |gmoid, i|n the..a|
|00000d70| 73 63 65 6e 64 69 6e 67 | 20 63 6f 6c 6f 6e 20 69 |scending| colon i|
|00000d80| 6e 63 6c 75 64 69 6e 67 | 20 74 68 65 20 72 69 67 |ncluding| the rig|
|00000d90| 68 74 20 66 6c 65 78 75 | 72 65 2c 20 61 6e 64 20 |ht flexu|re, and |
|00000da0| 69 6e 20 74 68 65 20 63 | 65 63 75 6d 2c 20 72 65 |in the c|ecum, re|
|00000db0| 73 70 65 63 74 69 76 65 | 6c 79 2e 0d 0a 4e 6f 20 |spective|ly...No |
|00000dc0| 74 75 6d 6f 72 20 77 61 | 73 20 66 6f 75 6e 64 20 |tumor wa|s found |
|00000dd0| 69 6e 20 74 68 65 20 72 | 65 63 74 75 6d 2e 20 20 |in the r|ectum. |
|00000de0| 54 77 65 6c 76 65 20 6c | 65 73 69 6f 6e 73 20 77 |Twelve l|esions w|
|00000df0| 65 72 65 20 6c 65 73 73 | 20 74 68 61 6e 20 33 30 |ere less| than 30|
|00000e00| 20 63 6d 20 69 6e 0d 0a | 64 69 61 6d 65 74 65 72 | cm in..|diameter|
|00000e10| 2c 20 61 6e 64 20 36 20 | 77 65 72 65 20 6c 65 73 |, and 6 |were les|
|00000e20| 73 20 74 68 61 6e 20 31 | 35 20 6d 6d 2e 20 20 4f |s than 1|5 mm. O|
|00000e30| 66 20 74 68 65 20 33 20 | 6c 61 72 67 65 72 20 74 |f the 3 |larger t|
|00000e40| 75 6d 6f 72 73 2c 20 32 | 20 77 65 72 65 20 69 6e |umors, 2| were in|
|00000e50| 20 74 68 65 0d 0a 63 65 | 63 75 6d 2e 20 20 49 72 | the..ce|cum. Ir|
|00000e60| 72 65 67 75 6c 61 72 20 | 62 6f 72 64 65 72 73 20 |regular |borders |
|00000e70| 61 6e 64 20 63 6f 6e 63 | 61 76 65 20 61 72 63 73 |and conc|ave arcs|
|00000e80| 20 6f 66 20 62 61 72 69 | 75 6d 20 63 61 75 73 65 | of bari|um cause|
|00000e90| 64 20 62 79 20 74 75 6d | 6f 72 20 6d 61 72 67 69 |d by tum|or margi|
|00000ea0| 6e 73 0d 0a 77 65 72 65 | 20 76 69 73 75 61 6c 69 |ns..were| visuali|
|00000eb0| 7a 65 64 20 69 6e 20 31 | 31 20 70 61 74 69 65 6e |zed in 1|1 patien|
|00000ec0| 74 73 20 28 46 69 67 20 | 34 2d 36 29 2e 20 20 49 |ts (Fig |4-6). I|
|00000ed0| 6e 20 36 20 70 61 74 69 | 65 6e 74 73 2c 20 74 68 |n 6 pati|ents, th|
|00000ee0| 65 72 65 20 77 65 72 65 | 0d 0a 64 69 73 68 61 72 |ere were|..dishar|
|00000ef0| 6d 6f 6e 79 20 61 6e 64 | 20 63 6f 6e 76 65 72 67 |mony and| converg|
|00000f00| 65 6e 63 65 20 6f 66 20 | 69 6e 74 65 72 68 61 75 |ence of |interhau|
|00000f10| 73 74 72 61 6c 20 66 6f | 6c 64 73 2c 20 6d 69 73 |stral fo|lds, mis|
|00000f20| 73 69 6e 67 20 68 61 75 | 73 74 72 61 6c 20 66 6f |sing hau|stral fo|
|00000f30| 6c 64 73 20 28 46 69 67 | 0d 0a 34 2d 37 29 2c 20 |lds (Fig|..4-7), |
|00000f40| 6f 72 20 6c 6f 63 61 6c | 20 72 65 64 75 63 74 69 |or local| reducti|
|00000f50| 6f 6e 73 20 69 6e 20 76 | 6f 6c 75 6d 65 20 6f 66 |ons in v|olume of|
|00000f60| 20 61 69 72 2d 64 69 73 | 74 65 6e 64 65 64 20 6c | air-dis|tended l|
|00000f70| 6f 6f 70 73 2e 20 20 49 | 6e 20 34 20 70 61 74 69 |oops. I|n 4 pati|
|00000f80| 65 6e 74 73 0d 0a 65 61 | 63 68 2c 20 74 68 65 72 |ents..ea|ch, ther|
|00000f90| 65 20 77 65 72 65 20 66 | 69 6c 6c 69 6e 67 20 64 |e were f|illing d|
|00000fa0| 65 66 65 63 74 73 20 69 | 6e 20 62 61 72 69 75 6d |efects i|n barium|
|00000fb0| 20 70 6f 6f 6c 20 63 6f | 6c 6c 65 63 74 69 6f 6e | pool co|llection|
|00000fc0| 73 2c 20 6d 61 73 73 20 | 6c 65 73 69 6f 6e 73 2c |s, mass |lesions,|
|00000fd0| 20 61 6e 64 0d 0a 72 65 | 74 69 63 75 6c 61 72 2c | and..re|ticular,|
|00000fe0| 20 64 65 62 72 69 73 2d | 6c 69 6b 65 20 6d 75 63 | debris-|like muc|
|00000ff0| 6f 73 61 6c 20 70 61 74 | 74 65 72 6e 73 3b 20 61 |osal pat|terns; a|
|00001000| 6e 64 20 69 6e 20 33 20 | 70 61 74 69 65 6e 74 73 |nd in 3 |patients|
|00001010| 2c 20 74 68 65 72 65 20 | 77 65 72 65 20 6c 6f 63 |, there |were loc|
|00001020| 61 6c 0d 0a 63 6f 6e 74 | 72 61 63 74 69 6f 6e 73 |al..cont|ractions|
|00001030| 20 69 6e 20 74 68 65 20 | 74 75 6d 6f 72 20 61 72 | in the |tumor ar|
|00001040| 65 61 2e 20 20 53 65 76 | 65 6e 74 65 65 6e 20 70 |ea. Sev|enteen p|
|00001050| 61 74 69 65 6e 74 73 20 | 68 61 64 20 6e 6f 20 6d |atients |had no m|
|00001060| 61 73 73 20 6c 65 73 69 | 6f 6e 20 28 46 69 67 0d |ass lesi|on (Fig.|
|00001070| 0a 34 2d 38 29 2e 20 20 | 41 6c 6c 20 66 61 69 6c |.4-8). |All fail|
|00001080| 75 72 65 73 20 72 65 73 | 75 6c 74 65 64 20 66 72 |ures res|ulted fr|
|00001090| 6f 6d 20 70 65 72 63 65 | 70 74 69 76 65 20 65 72 |om perce|ptive er|
|000010a0| 72 6f 72 73 20 62 79 20 | 74 68 65 20 72 61 64 69 |rors by |the radi|
|000010b0| 6f 6c 6f 67 69 73 74 2c | 0d 0a 61 6c 74 68 6f 75 |ologist,|..althou|
|000010c0| 67 68 20 34 20 63 6f 75 | 6c 64 20 61 6c 73 6f 20 |gh 4 cou|ld also |
|000010d0| 62 65 20 65 78 70 6c 61 | 69 6e 65 64 20 62 79 20 |be expla|ined by |
|000010e0| 69 6e 74 65 72 70 72 65 | 74 61 74 69 6f 6e 61 6c |interpre|tational|
|000010f0| 20 65 72 72 6f 72 73 2e | 0d 0a 20 20 20 20 20 42 | errors.|.. B|
|00001100| 65 63 61 75 73 65 20 6f | 66 20 70 65 72 63 65 70 |ecause o|f percep|
|00001110| 74 69 76 65 20 65 72 72 | 6f 72 73 2c 20 61 6c 6d |tive err|ors, alm|
|00001120| 6f 73 74 20 31 2e 34 25 | 20 6f 66 20 74 68 65 20 |ost 1.4%| of the |
|00001130| 63 6f 6c 6f 6e 20 63 61 | 72 63 69 6e 6f 6d 61 73 |colon ca|rcinomas|
|00001140| 0d 0a 76 69 73 75 61 6c | 69 7a 65 64 20 6f 6e 20 |..visual|ized on |
|00001150| 44 43 45 20 72 61 64 69 | 6f 67 72 61 70 68 73 20 |DCE radi|ographs |
|00001160| 61 72 65 20 70 72 69 6d | 61 72 69 6c 79 20 6f 76 |are prim|arily ov|
|00001170| 65 72 6c 6f 6f 6b 65 64 | 20 62 79 20 74 68 65 20 |erlooked| by the |
|00001180| 72 61 64 69 6f 6c 6f 67 | 69 73 74 2e 0d 0a 4f 63 |radiolog|ist...Oc|
|00001190| 63 61 73 69 6f 6e 61 6c | 6c 79 2c 20 74 65 63 68 |casional|ly, tech|
|000011a0| 6e 69 63 61 6c 20 73 68 | 6f 72 74 63 6f 6d 69 6e |nical sh|ortcomin|
|000011b0| 67 73 20 63 6f 6e 74 72 | 69 62 75 74 65 20 74 6f |gs contr|ibute to|
|000011c0| 20 74 68 65 20 6d 69 73 | 73 65 64 20 64 69 61 67 | the mis|sed diag|
|000011d0| 6e 6f 73 69 73 2e 20 20 | 4d 6f 73 74 0d 0a 6f 76 |nosis. |Most..ov|
|000011e0| 65 72 6c 6f 6f 6b 65 64 | 20 63 61 6e 63 65 72 73 |erlooked| cancers|
|000011f0| 20 61 72 65 20 66 6c 61 | 74 20 61 6e 64 20 6c 65 | are fla|t and le|
|00001200| 73 73 20 74 68 61 6e 20 | 33 30 20 6d 6d 20 69 6e |ss than |30 mm in|
|00001210| 20 64 69 61 6d 65 74 65 | 72 2e 20 20 41 6e 79 20 | diamete|r. Any |
|00001220| 63 68 61 6e 67 65 20 69 | 6e 0d 0a 6e 6f 72 6d 61 |change i|n..norma|
|00001230| 6c 20 63 6f 6c 6f 6e 20 | 61 6e 61 74 6f 6d 79 2c |l colon |anatomy,|
|00001240| 20 65 73 70 65 63 69 61 | 6c 6c 79 20 63 6f 6e 63 | especia|lly conc|
|00001250| 61 76 65 20 6f 72 20 69 | 72 72 65 67 75 6c 61 72 |ave or i|rregular|
|00001260| 20 6d 75 63 6f 73 61 6c | 20 62 61 72 69 75 6d 20 | mucosal| barium |
|00001270| 6d 61 72 67 69 6e 73 2c | 0d 0a 63 6f 6e 76 65 72 |margins,|..conver|
|00001280| 67 65 6e 63 65 20 6f 66 | 20 69 6e 74 65 72 68 61 |gence of| interha|
|00001290| 75 73 74 72 61 6c 20 66 | 6f 6c 64 73 2c 20 66 6c |ustral f|olds, fl|
|000012a0| 61 74 20 6f 72 20 6d 69 | 73 73 69 6e 67 20 68 61 |at or mi|ssing ha|
|000012b0| 75 73 74 72 61 2c 20 72 | 65 64 75 63 65 64 20 63 |ustra, r|educed c|
|000012c0| 65 63 61 6c 0d 0a 76 6f | 6c 75 6d 65 2c 20 6f 72 |ecal..vo|lume, or|
|000012d0| 20 6c 6f 63 61 6c 6c 79 | 20 66 69 78 65 64 20 64 | locally| fixed d|
|000012e0| 65 62 72 69 73 2d 6c 69 | 6b 65 20 6c 65 73 69 6f |ebris-li|ke lesio|
|000012f0| 6e 73 20 73 68 6f 75 6c | 64 20 62 65 20 63 61 72 |ns shoul|d be car|
|00001300| 65 66 75 6c 6c 79 20 61 | 6e 61 6c 79 7a 65 64 2e |efully a|nalyzed.|
|00001310| 0d 0a 0d 0a 50 6f 73 74 | 2d 43 6f 6d 6d 65 6e 74 |....Post|-Comment|
|00001320| 0d 0a 0d 0a 20 20 20 20 | 20 54 68 69 73 20 65 78 |.... | This ex|
|00001330| 63 65 6c 6c 65 6e 74 20 | 61 72 74 69 63 6c 65 20 |cellent |article |
|00001340| 73 68 6f 75 6c 64 20 62 | 65 20 72 65 76 69 65 77 |should b|e review|
|00001350| 65 64 20 62 79 20 61 6c | 6c 20 72 61 64 69 6f 6c |ed by al|l radiol|
|00001360| 6f 67 69 73 74 73 20 77 | 68 6f 20 70 65 72 66 6f |ogists w|ho perfo|
|00001370| 72 6d 0d 0a 62 61 72 69 | 75 6d 20 65 6e 65 6d 61 |rm..bari|um enema|
|00001380| 73 2c 20 65 73 70 65 63 | 69 61 6c 6c 79 20 66 6f |s, espec|ially fo|
|00001390| 72 20 65 76 61 6c 75 61 | 74 69 6f 6e 20 6f 66 20 |r evalua|tion of |
|000013a0| 74 68 65 20 66 69 67 75 | 72 65 73 2e 20 20 41 6c |the figu|res. Al|
|000013b0| 6c 20 6f 66 20 75 73 20 | 68 61 76 65 20 68 61 64 |l of us |have had|
|000013c0| 0d 0a 74 68 65 20 75 6e | 66 6f 72 74 75 6e 61 74 |..the un|fortunat|
|000013d0| 65 20 65 78 70 65 72 69 | 65 6e 63 65 20 6f 66 20 |e experi|ence of |
|000013e0| 6d 69 73 73 69 6e 67 20 | 63 6f 6c 6f 6e 20 63 61 |missing |colon ca|
|000013f0| 6e 63 65 72 20 61 6e 64 | 20 70 6f 6c 79 70 73 2e |ncer and| polyps.|
|00001400| 20 20 46 6f 72 6b 20 68 | 61 73 0d 0a 6e 69 63 65 | Fork h|as..nice|
|00001410| 6c 79 20 64 65 6d 6f 6e | 73 74 72 61 74 65 64 20 |ly demon|strated |
|00001420| 6d 61 6e 79 20 6f 66 20 | 74 68 65 73 65 20 65 72 |many of |these er|
|00001430| 72 6f 72 73 2e 20 20 41 | 73 20 68 65 20 70 6f 69 |rors. A|s he poi|
|00001440| 6e 74 73 20 6f 75 74 2c | 20 74 68 65 20 76 61 73 |nts out,| the vas|
|00001450| 74 20 6d 61 6a 6f 72 69 | 74 79 0d 0a 6f 66 20 6d |t majori|ty..of m|
|00001460| 69 73 73 65 73 20 61 72 | 65 20 63 61 75 73 65 64 |isses ar|e caused|
|00001470| 20 62 79 20 65 72 72 6f | 72 73 20 69 6e 20 70 65 | by erro|rs in pe|
|00001480| 72 63 65 70 74 69 6f 6e | 20 65 76 65 6e 20 74 68 |rception| even th|
|00001490| 6f 75 67 68 20 4b 65 6c | 76 69 6e 20 61 6e 64 20 |ough Kel|vin and |
|000014a0| 63 6f 2d 77 6f 72 6b 65 | 72 73 0d 0a 28 31 29 20 |co-worke|rs..(1) |
|000014b0| 72 65 70 6f 72 74 65 64 | 20 74 68 61 74 20 74 65 |reported| that te|
|000014c0| 63 68 6e 69 63 61 6c 20 | 65 72 72 6f 72 73 20 77 |chnical |errors w|
|000014d0| 69 6c 6c 20 61 6c 73 6f | 20 61 63 63 6f 75 6e 74 |ill also| account|
|000014e0| 20 66 6f 72 20 61 20 73 | 69 67 6e 69 66 69 63 61 | for a s|ignifica|
|000014f0| 6e 74 0d 0a 70 65 72 63 | 65 6e 74 61 67 65 20 6f |nt..perc|entage o|
|00001500| 66 20 6f 76 65 72 6c 6f | 6f 6b 65 64 20 63 61 6e |f overlo|oked can|
|00001510| 63 65 72 73 2e 20 20 54 | 68 75 73 2c 20 77 65 20 |cers. T|hus, we |
|00001520| 6d 75 73 74 20 62 65 20 | 63 65 72 74 61 69 6e 20 |must be |certain |
|00001530| 74 68 61 74 20 74 68 65 | 20 65 6e 74 69 72 65 0d |that the| entire.|
|00001540| 0a 63 6f 6c 6f 6e 20 69 | 73 20 61 64 65 71 75 61 |.colon i|s adequa|
|00001550| 74 65 6c 79 20 65 76 61 | 6c 75 61 74 65 64 20 62 |tely eva|luated b|
|00001560| 65 66 6f 72 65 20 62 65 | 67 69 6e 6e 69 6e 67 20 |efore be|ginning |
|00001570| 74 6f 20 73 65 61 72 63 | 68 20 66 6f 72 20 74 68 |to searc|h for th|
|00001580| 65 20 69 6e 74 72 61 6c | 75 6d 69 6e 61 6c 0d 0a |e intral|uminal..|
|00001590| 6c 65 73 69 6f 6e 73 2e | 20 20 46 6f 72 6b 20 64 |lesions.| Fork d|
|000015a0| 65 6d 6f 6e 73 74 72 61 | 74 65 73 20 6d 61 6e 79 |emonstra|tes many|
|000015b0| 20 6f 66 20 74 68 65 20 | 73 75 62 74 6c 65 20 61 | of the |subtle a|
|000015c0| 62 6e 6f 72 6d 61 6c 69 | 74 69 65 73 20 63 61 75 |bnormali|ties cau|
|000015d0| 73 65 64 20 62 79 20 63 | 6f 6c 6f 6e 0d 0a 63 61 |sed by c|olon..ca|
|000015e0| 6e 63 65 72 20 74 68 61 | 74 20 61 72 65 20 65 69 |ncer tha|t are ei|
|000015f0| 74 68 65 72 20 6f 76 65 | 72 6c 6f 6f 6b 65 64 20 |ther ove|rlooked |
|00001600| 6f 72 20 6d 69 73 69 6e | 74 65 72 70 72 65 74 65 |or misin|terprete|
|00001610| 64 2e 20 20 41 6c 6c 20 | 73 75 73 70 69 63 69 6f |d. All |suspicio|
|00001620| 75 73 20 72 65 67 69 6f | 6e 73 0d 0a 6d 75 73 74 |us regio|ns..must|
|00001630| 20 62 65 20 63 6f 6d 70 | 75 6c 73 69 76 65 6c 79 | be comp|ulsively|
|00001640| 20 72 65 65 76 61 6c 75 | 61 74 65 64 2c 20 61 6e | reevalu|ated, an|
|00001650| 64 20 69 66 20 6e 65 63 | 65 73 73 61 72 79 2c 20 |d if nec|essary, |
|00001660| 74 68 65 20 63 6f 6c 6f | 6e 20 73 68 6f 75 6c 64 |the colo|n should|
|00001670| 20 62 65 0d 0a 72 65 66 | 69 6c 6c 65 64 20 77 69 | be..ref|illed wi|
|00001680| 74 68 20 62 61 72 69 75 | 6d 20 62 65 66 6f 72 65 |th bariu|m before|
|00001690| 20 74 68 65 20 70 61 74 | 69 65 6e 74 20 6c 65 61 | the pat|ient lea|
|000016a0| 76 65 73 20 74 68 65 20 | 64 65 70 61 72 74 6d 65 |ves the |departme|
|000016b0| 6e 74 20 6f 72 20 72 65 | 73 63 68 65 64 75 6c 65 |nt or re|schedule|
|000016c0| 64 0d 0a 66 6f 72 20 61 | 20 72 65 70 65 61 74 65 |d..for a| repeate|
|000016d0| 64 20 65 78 61 6d 69 6e | 61 74 69 6f 6e 2e 20 20 |d examin|ation. |
|000016e0| 4f 62 76 69 6f 75 73 6c | 79 2c 20 69 74 20 69 73 |Obviousl|y, it is|
|000016f0| 20 6d 6f 72 65 20 65 66 | 66 69 63 69 65 6e 74 20 | more ef|ficient |
|00001700| 61 6e 64 20 62 65 74 74 | 65 72 20 66 6f 72 0d 0a |and bett|er for..|
|00001710| 74 68 65 20 70 61 74 69 | 65 6e 74 20 69 66 20 74 |the pati|ent if t|
|00001720| 68 65 20 65 6e 74 69 72 | 65 20 63 6f 6c 6f 6e 20 |he entir|e colon |
|00001730| 63 61 6e 20 62 65 20 63 | 6f 6d 70 6c 65 74 65 6c |can be c|ompletel|
|00001740| 79 20 65 78 61 6d 69 6e | 65 64 20 77 69 74 68 20 |y examin|ed with |
|00001750| 6f 6e 6c 79 20 31 0d 0a | 73 74 75 64 79 2e 2d 2d |only 1..|study.--|
|00001760| 57 2e 4d 2e 20 54 68 6f | 6d 70 73 6f 6e 2c 20 4d |W.M. Tho|mpson, M|
|00001770| 2e 44 2e 0d 0a 24 55 6e | 69 71 75 65 5f 49 44 7b |.D...$Un|ique_ID{|
|00001780| 59 52 42 30 39 36 30 31 | 7d 0d 0a 24 54 69 74 6c |YRB09601|}..$Titl|
|00001790| 65 7b 43 61 72 63 69 6e | 6f 6d 61 20 6f 66 20 74 |e{Carcin|oma of t|
|000017a0| 68 65 20 43 6f 6c 6f 6e | 20 61 6e 64 20 52 65 63 |he Colon| and Rec|
|000017b0| 74 75 6d 3a 20 20 54 75 | 6d 6f 72 73 20 4d 69 73 |tum: Tu|mors Mis|
|000017c0| 73 65 64 20 62 79 20 52 | 61 64 69 6f 6c 6f 67 69 |sed by R|adiologi|
|000017d0| 63 20 45 78 61 6d 69 6e | 61 74 69 6f 6e 20 69 6e |c Examin|ation in|
|000017e0| 20 36 31 20 50 61 74 69 | 65 6e 74 73 7d 0d 0a 24 | 61 Pati|ents}..$|
|000017f0| 41 75 74 68 6f 72 7b 42 | 6f 6c 69 6e 2c 20 53 0d |Author{B|olin, S.|
|00001800| 0a 46 72 61 6e 7a 65 6e | 2c 20 4c 0d 0a 4e 69 6c |.Franzen|, L..Nil|
|00001810| 73 73 6f 6e 2c 20 45 0d | 0a 53 6a 6f 64 61 68 6c |sson, E.|.Sjodahl|
|00001820| 2c 20 52 7d 0d 0a 24 41 | 66 66 69 6c 69 61 74 69 |, R}..$A|ffiliati|
|00001830| 6f 6e 7b 55 6e 69 76 20 | 6f 66 20 4c 69 6e 6b 6f |on{Univ |of Linko|
|00001840| 70 69 6e 67 2c 20 53 77 | 65 64 65 6e 7d 0d 0a 24 |ping, Sw|eden}..$|
|00001850| 4a 6f 75 72 6e 61 6c 7b | 43 61 6e 63 65 72 7d 0d |Journal{|Cancer}.|
|00001860| 0a 24 56 6f 6c 75 6d 65 | 7b 36 31 7d 0d 0a 24 50 |.$Volume|{61}..$P|
|00001870| 61 67 65 7b 31 39 39 39 | 2d 32 30 30 38 7d 0d 0a |age{1999|-2008}..|
|00001880| 24 44 61 74 65 7b 4d 61 | 79 20 31 35 2c 20 31 39 |$Date{Ma|y 15, 19|
|00001890| 38 38 7d 0d 0a 24 59 42 | 56 6f 6c 7b 31 39 39 30 |88}..$YB|Vol{1990|
|000018a0| 20 59 65 61 72 20 42 6f | 6f 6b 20 6f 66 20 44 69 | Year Bo|ok of Di|
|000018b0| 61 67 6e 6f 73 74 69 63 | 20 52 61 64 69 6f 6c 6f |agnostic| Radiolo|
|000018c0| 67 79 7d 0d 0a 24 43 68 | 61 70 74 65 72 7b 34 2d |gy}..$Ch|apter{4-|
|000018d0| 38 7d 0d 0a 24 59 42 45 | 64 69 74 6f 72 7b 44 72 |8}..$YBE|ditor{Dr|
|000018e0| 73 2e 20 42 72 61 67 67 | 2c 20 48 65 6e 64 65 65 |s. Bragg|, Hendee|
|000018f0| 2c 20 4b 65 61 74 73 2c | 20 4b 69 72 6b 70 61 74 |, Keats,| Kirkpat|
|00001900| 72 69 63 6b 2c 20 4d 69 | 6c 6c 65 72 2c 20 4f 73 |rick, Mi|ller, Os|
|00001910| 62 6f 72 6e 2c 20 61 6e | 64 20 54 68 6f 6d 70 73 |born, an|d Thomps|
|00001920| 6f 6e 7d 0d 0a 24 54 61 | 62 6c 65 7b 54 61 62 6c |on}..$Ta|ble{Tabl|
|00001930| 65 20 4f 6d 69 74 74 65 | 64 7d 0d 0a 24 43 6f 6d |e Omitte|d}..$Com|
|00001940| 6d 65 6e 74 61 74 6f 72 | 7b 57 2e 4d 2e 20 54 68 |mentator|{W.M. Th|
|00001950| 6f 6d 70 73 6f 6e 2c 20 | 4d 2e 44 2e 7d 0d 0a 0d |ompson, |M.D.}...|
|00001960| 0a 43 6f 70 79 72 69 67 | 68 74 20 28 63 29 20 59 |.Copyrig|ht (c) Y|
|00001970| 65 61 72 62 6f 6f 6b 20 | 4d 65 64 69 63 61 6c 20 |earbook |Medical |
|00001980| 50 75 62 6c 69 73 68 65 | 72 73 2c 20 49 6e 63 2e |Publishe|rs, Inc.|
|00001990| 2c 20 31 39 39 30 0d 0a | 0d 0a 31 39 39 30 20 59 |, 1990..|..1990 Y|
|000019a0| 65 61 72 20 42 6f 6f 6b | 20 6f 66 20 44 69 61 67 |ear Book| of Diag|
|000019b0| 6e 6f 73 74 69 63 20 52 | 61 64 69 6f 6c 6f 67 79 |nostic R|adiology|
|000019c0| 20 28 52 29 0d 0a 0d 0a | 43 68 61 70 74 65 72 20 | (R)....|Chapter |
|000019d0| 34 2d 2d 54 68 65 20 41 | 62 64 6f 6d 65 6e 0d 0a |4--The A|bdomen..|
|000019e0| 0d 0a 47 61 73 74 72 6f | 69 6e 74 65 73 74 69 6e |..Gastro|intestin|
|000019f0| 61 6c 20 54 72 61 63 74 | 0d 0a 0d 0a 42 41 52 49 |al Tract|....BARI|
|00001a00| 55 4d 20 45 4e 45 4d 41 | 0d 0a 0d 0a 2d 2d 2d 2d |UM ENEMA|....----|
|00001a10| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00001a20| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00001a30| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00001a40| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00001a50| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 0d 0a 43 61 72 63 |--------|--..Carc|
|00001a60| 69 6e 6f 6d 61 20 6f 66 | 20 74 68 65 20 43 6f 6c |inoma of| the Col|
|00001a70| 6f 6e 20 61 6e 64 20 52 | 65 63 74 75 6d 3a 20 20 |on and R|ectum: |
|00001a80| 54 75 6d 6f 72 73 20 4d | 69 73 73 65 64 20 62 79 |Tumors M|issed by|
|00001a90| 20 52 61 64 69 6f 6c 6f | 67 69 63 20 45 78 61 6d | Radiolo|gic Exam|
|00001aa0| 69 6e 61 74 69 6f 6e 20 | 69 6e 0d 0a 36 31 20 50 |ination |in..61 P|
|00001ab0| 61 74 69 65 6e 74 73 0d | 0a 0d 0a 42 6f 6c 69 6e |atients.|...Bolin|
|00001ac0| 20 53 2c 20 46 72 61 6e | 7a 65 6e 20 4c 2c 20 4e | S, Fran|zen L, N|
|00001ad0| 69 6c 73 73 6f 6e 20 45 | 2c 20 53 6a 6f 64 61 68 |ilsson E|, Sjodah|
|00001ae0| 6c 20 52 0d 0a 28 55 6e | 69 76 20 6f 66 20 4c 69 |l R..(Un|iv of Li|
|00001af0| 6e 6b 6f 70 69 6e 67 2c | 20 53 77 65 64 65 6e 29 |nkoping,| Sweden)|
|00001b00| 0d 0a 43 61 6e 63 65 72 | 20 36 31 3a 31 39 39 39 |..Cancer| 61:1999|
|00001b10| 2d 32 30 30 38 2c 20 4d | 61 79 20 31 35 2c 20 31 |-2008, M|ay 15, 1|
|00001b20| 39 38 38 0d 0a 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |988..---|--------|
|00001b30| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00001b40| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00001b50| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00001b60| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00001b70| 2d 2d 2d 0d 0a 0d 0a 41 | 62 73 74 72 61 63 74 0d |---....A|bstract.|
|00001b80| 0a 0d 0a 20 20 20 20 20 | 42 61 72 69 75 6d 20 65 |... |Barium e|
|00001b90| 6e 65 6d 61 20 65 78 61 | 6d 69 6e 61 74 69 6f 6e |nema exa|mination|
|00001ba0| 20 69 73 20 74 68 65 20 | 70 72 69 6d 61 72 79 20 | is the |primary |
|00001bb0| 6d 65 61 6e 73 20 6f 66 | 20 64 65 74 65 63 74 69 |means of| detecti|
|00001bc0| 6e 67 20 63 6f 6c 6f 72 | 65 63 74 61 6c 0d 0a 63 |ng color|ectal..c|
|00001bd0| 61 6e 63 65 72 73 2e 20 | 20 54 6f 20 64 65 74 65 |ancers. | To dete|
|00001be0| 72 6d 69 6e 65 20 74 68 | 65 20 73 65 6e 73 69 74 |rmine th|e sensit|
|00001bf0| 69 76 69 74 79 20 6f 66 | 20 72 6f 75 74 69 6e 65 |ivity of| routine|
|00001c00| 20 64 69 61 67 6e 6f 73 | 74 69 63 20 6d 65 74 68 | diagnos|tic meth|
|00001c10| 6f 64 73 2c 20 62 6f 74 | 68 0d 0a 73 69 6e 67 6c |ods, bot|h..singl|
|00001c20| 65 20 61 6e 64 20 64 6f | 75 62 6c 65 20 63 6f 6e |e and do|uble con|
|00001c30| 74 72 61 73 74 20 62 61 | 72 69 75 6d 20 65 6e 65 |trast ba|rium ene|
|00001c40| 6d 61 20 73 74 75 64 69 | 65 73 20 6f 66 20 37 30 |ma studi|es of 70|
|00001c50| 38 20 70 61 74 69 65 6e | 74 73 20 77 69 74 68 20 |8 patien|ts with |
|00001c60| 37 33 31 0d 0a 63 6f 6c | 6f 72 65 63 74 61 6c 20 |731..col|orectal |
|00001c70| 63 61 72 63 69 6e 6f 6d | 61 73 20 65 78 61 6d 69 |carcinom|as exami|
|00001c80| 6e 65 64 20 61 20 74 6f | 74 61 6c 20 6f 66 20 37 |ned a to|tal of 7|
|00001c90| 34 31 20 74 69 6d 65 73 | 20 69 6e 20 61 20 31 33 |41 times| in a 13|
|00001ca0| 2d 79 65 61 72 20 70 65 | 72 69 6f 64 20 77 65 72 |-year pe|riod wer|
|00001cb0| 65 0d 0a 72 65 76 69 65 | 77 65 64 2e 0d 0a 20 20 |e..revie|wed... |
|00001cc0| 20 20 20 54 68 65 20 62 | 61 72 69 75 6d 20 65 6e | The b|arium en|
|00001cd0| 65 6d 61 20 68 61 64 20 | 61 6e 20 6f 76 65 72 61 |ema had |an overa|
|00001ce0| 6c 6c 20 73 65 6e 73 69 | 74 69 76 69 74 79 20 6f |ll sensi|tivity o|
|00001cf0| 66 20 39 30 25 2e 20 20 | 53 69 78 74 79 2d 66 6f |f 90%. |Sixty-fo|
|00001d00| 75 72 20 63 61 6e 63 65 | 72 73 0d 0a 77 65 72 65 |ur cance|rs..were|
|00001d10| 20 6d 69 73 73 65 64 20 | 62 79 20 37 34 20 65 78 | missed |by 74 ex|
|00001d20| 61 6d 69 6e 61 74 69 6f | 6e 73 2e 20 20 46 6f 72 |aminatio|ns. For|
|00001d30| 74 79 2d 74 68 72 65 65 | 20 66 61 6c 73 65 2d 6e |ty-three| false-n|
|00001d40| 65 67 61 74 69 76 65 20 | 73 74 75 64 69 65 73 20 |egative |studies |
|00001d50| 77 65 72 65 20 64 6f 6e | 65 0d 0a 62 79 20 74 68 |were don|e..by th|
|00001d60| 65 20 73 69 6e 67 6c 65 | 20 63 6f 6e 74 72 61 73 |e single| contras|
|00001d70| 74 20 6d 65 74 68 6f 64 | 2c 20 61 6e 64 20 32 37 |t method|, and 27|
|00001d80| 20 6f 74 68 65 72 73 2c | 20 62 79 20 74 68 65 20 | others,| by the |
|00001d90| 64 6f 75 62 6c 65 20 63 | 6f 6e 74 72 61 73 74 20 |double c|ontrast |
|00001da0| 6d 65 74 68 6f 64 2e 0d | 0a 41 20 72 65 6c 61 74 |method..|.A relat|
|00001db0| 69 76 65 6c 79 20 6c 61 | 72 67 65 20 6e 75 6d 62 |ively la|rge numb|
|00001dc0| 65 72 20 6f 66 20 6d 69 | 73 73 65 64 20 6c 65 73 |er of mi|ssed les|
|00001dd0| 69 6f 6e 73 20 77 65 72 | 65 20 69 6e 20 74 68 65 |ions wer|e in the|
|00001de0| 20 63 65 63 75 6d 20 61 | 6e 64 20 61 73 63 65 6e | cecum a|nd ascen|
|00001df0| 64 69 6e 67 0d 0a 63 6f | 6c 6f 6e 20 28 54 61 62 |ding..co|lon (Tab|
|00001e00| 6c 65 20 31 29 2e 20 20 | 54 68 65 20 6d 65 64 69 |le 1). |The medi|
|00001e10| 61 6e 20 74 69 6d 65 20 | 66 72 6f 6d 20 61 6e 20 |an time |from an |
|00001e20| 69 6e 69 74 69 61 6c 20 | 66 61 6c 73 65 2d 6e 65 |initial |false-ne|
|00001e30| 67 61 74 69 76 65 20 73 | 74 75 64 79 20 74 6f 0d |gative s|tudy to.|
|00001e40| 0a 64 69 61 67 6e 6f 73 | 69 73 20 77 61 73 20 32 |.diagnos|is was 2|
|00001e50| 30 20 6d 6f 6e 74 68 73 | 2e 20 20 41 62 6f 75 74 |0 months|. About|
|00001e60| 20 68 61 6c 66 20 74 68 | 65 20 65 72 72 6f 72 73 | half th|e errors|
|00001e70| 20 77 65 72 65 20 70 65 | 72 63 65 70 74 69 76 65 | were pe|rceptive|
|00001e80| 20 69 6e 20 6e 61 74 75 | 72 65 2c 20 61 6e 64 0d | in natu|re, and.|
|00001e90| 0a 61 6e 6f 74 68 65 72 | 20 74 68 69 72 64 20 77 |.another| third w|
|00001ea0| 65 72 65 20 62 6f 74 68 | 20 70 65 72 63 65 70 74 |ere both| percept|
|00001eb0| 69 76 65 20 61 6e 64 20 | 74 65 63 68 6e 69 63 61 |ive and |technica|
|00001ec0| 6c 20 28 54 61 62 6c 65 | 20 32 29 2e 20 20 4d 61 |l (Table| 2). Ma|
|00001ed0| 6e 79 20 6f 66 20 74 68 | 65 0d 0a 6c 65 73 69 6f |ny of th|e..lesio|
|00001ee0| 6e 73 20 74 68 61 74 20 | 77 65 72 65 20 6d 69 73 |ns that |were mis|
|00001ef0| 73 65 64 20 68 61 64 20 | 65 6c 75 73 69 76 65 20 |sed had |elusive |
|00001f00| 72 61 64 69 6f 6c 6f 67 | 69 63 20 61 70 70 65 61 |radiolog|ic appea|
|00001f10| 72 61 6e 63 65 73 20 28 | 46 69 67 73 20 34 2d 39 |rances (|Figs 4-9|
|00001f20| 20 61 6e 64 0d 0a 34 2d | 31 30 29 2e 20 20 54 68 | and..4-|10). Th|
|00001f30| 65 72 65 20 77 65 72 65 | 20 6f 6e 6c 79 20 32 20 |ere were| only 2 |
|00001f40| 69 6e 74 65 72 70 72 65 | 74 69 76 65 20 65 72 72 |interpre|tive err|
|00001f50| 6f 72 73 2e 20 20 45 6c | 65 76 65 6e 20 6c 65 73 |ors. El|even les|
|00001f60| 69 6f 6e 73 20 77 65 72 | 65 20 6e 6f 74 0d 0a 64 |ions wer|e not..d|
|00001f70| 65 74 65 63 74 65 64 20 | 65 76 65 6e 20 69 6e 20 |etected |even in |
|00001f80| 72 65 74 72 6f 73 70 65 | 63 74 2e 0d 0a 20 20 20 |retrospe|ct... |
|00001f90| 20 20 54 68 65 20 62 61 | 72 69 75 6d 20 65 6e 65 | The ba|rium ene|
|00001fa0| 6d 61 20 65 78 61 6d 69 | 6e 61 74 69 6f 6e 20 72 |ma exami|nation r|
|00001fb0| 65 6d 61 69 6e 73 20 61 | 6e 20 65 78 63 65 6c 6c |emains a|n excell|
|00001fc0| 65 6e 74 20 6d 65 74 68 | 6f 64 20 66 6f 72 20 64 |ent meth|od for d|
|00001fd0| 65 74 65 63 74 69 6e 67 | 0d 0a 63 6f 6c 6f 72 65 |etecting|..colore|
|00001fe0| 63 74 61 6c 20 63 61 6e | 63 65 72 73 20 61 73 20 |ctal can|cers as |
|00001ff0| 6c 6f 6e 67 20 61 73 20 | 70 65 72 63 65 70 74 69 |long as |percepti|
|00002000| 76 65 20 65 72 72 6f 72 | 73 20 61 72 65 20 6d 69 |ve error|s are mi|
|00002010| 6e 69 6d 69 7a 65 64 2e | 20 20 45 6e 64 6f 73 63 |nimized.| Endosc|
|00002020| 6f 70 79 20 61 6e 64 0d | 0a 62 61 72 69 75 6d 20 |opy and.|.barium |
|00002030| 65 6e 65 6d 61 20 65 78 | 61 6d 73 20 61 72 65 20 |enema ex|ams are |
|00002040| 63 6f 6d 70 6c 65 6d 65 | 6e 74 61 72 79 20 6d 65 |compleme|ntary me|
|00002050| 74 68 6f 64 73 20 69 6e | 20 74 68 65 20 64 65 74 |thods in| the det|
|00002060| 65 63 74 69 6f 6e 20 6f | 66 20 63 6f 6c 6f 72 65 |ection o|f colore|
|00002070| 63 74 61 6c 0d 0a 63 61 | 6e 63 65 72 73 2e 0d 0a |ctal..ca|ncers...|
|00002080| 0d 0a 50 6f 73 74 2d 43 | 6f 6d 6d 65 6e 74 0d 0a |..Post-C|omment..|
|00002090| 0d 0a 20 20 20 20 20 54 | 68 65 72 65 20 61 72 65 |.. T|here are|
|000020a0| 20 61 20 6e 75 6d 62 65 | 72 20 6f 66 20 69 6d 70 | a numbe|r of imp|
|000020b0| 6f 72 74 61 6e 74 20 70 | 6f 69 6e 74 73 20 69 6e |ortant p|oints in|
|000020c0| 20 74 68 69 73 20 70 61 | 70 65 72 2e 20 20 4d 69 | this pa|per. Mi|
|000020d0| 73 73 65 64 20 6c 65 73 | 69 6f 6e 73 0d 0a 77 65 |ssed les|ions..we|
|000020e0| 72 65 20 6d 6f 72 65 20 | 63 6f 6d 6d 6f 6e 20 69 |re more |common i|
|000020f0| 6e 20 74 68 65 20 72 69 | 67 68 74 20 63 6f 6c 6f |n the ri|ght colo|
|00002100| 6e 2c 20 70 61 72 74 69 | 63 75 6c 61 72 6c 79 20 |n, parti|cularly |
|00002110| 74 68 65 20 63 65 63 75 | 6d 2e 20 20 45 69 67 68 |the cecu|m. Eigh|
|00002120| 74 65 65 6e 20 70 65 72 | 63 65 6e 74 0d 0a 6f 66 |teen per|cent..of|
|00002130| 20 74 68 65 20 70 61 74 | 69 65 6e 74 73 20 68 61 | the pat|ients ha|
|00002140| 64 20 6d 75 6c 74 69 70 | 6c 65 20 74 75 6d 6f 72 |d multip|le tumor|
|00002150| 73 2c 20 63 6f 6d 70 61 | 72 65 64 20 77 69 74 68 |s, compa|red with|
|00002160| 20 61 6e 20 65 78 70 65 | 63 74 65 64 20 69 6e 63 | an expe|cted inc|
|00002170| 69 64 65 6e 63 65 20 6f | 66 0d 0a 33 2e 36 25 20 |idence o|f..3.6% |
|00002180| 69 6e 20 61 20 70 6f 70 | 75 6c 61 74 69 6f 6e 20 |in a pop|ulation |
|00002190| 6f 66 20 38 37 39 20 63 | 6f 6c 6f 6e 20 61 6e 64 |of 879 c|olon and|
|000021a0| 20 72 65 63 74 61 6c 20 | 63 61 6e 63 65 72 73 20 | rectal |cancers |
|000021b0| 65 76 61 6c 75 61 74 65 | 64 20 62 79 20 74 68 65 |evaluate|d by the|
|000021c0| 20 73 61 6d 65 0d 0a 67 | 72 6f 75 70 2e 20 20 45 | same..g|roup. E|
|000021d0| 69 67 68 74 79 2d 74 77 | 6f 20 70 65 72 63 65 6e |ighty-tw|o percen|
|000021e0| 74 20 6f 66 20 74 68 65 | 20 65 72 72 6f 72 73 20 |t of the| errors |
|000021f0| 77 65 72 65 20 70 65 72 | 63 65 70 74 69 76 65 20 |were per|ceptive |
|00002200| 77 69 74 68 20 6f 72 20 | 77 69 74 68 6f 75 74 0d |with or |without.|
|00002210| 0a 63 6f 6e 74 72 69 62 | 75 74 69 6e 67 20 74 65 |.contrib|uting te|
|00002220| 63 68 6e 69 63 61 6c 20 | 64 69 66 66 69 63 75 6c |chnical |difficul|
|00002230| 74 79 2c 20 61 6e 64 20 | 33 25 20 6f 66 20 74 68 |ty, and |3% of th|
|00002240| 65 20 65 72 72 6f 72 73 | 20 77 65 72 65 20 69 6e |e errors| were in|
|00002250| 74 65 72 70 72 65 74 69 | 76 65 2e 20 20 49 74 0d |terpreti|ve. It.|
|00002260| 0a 69 73 20 69 6d 70 6f | 72 74 61 6e 74 20 74 6f |.is impo|rtant to|
|00002270| 20 73 74 72 65 73 73 20 | 74 68 61 74 20 6f 6e 6c | stress |that onl|
|00002280| 79 20 31 35 25 20 6f 66 | 20 74 68 65 20 6d 69 73 |y 15% of| the mis|
|00002290| 73 65 64 20 6c 65 73 69 | 6f 6e 73 20 77 65 72 65 |sed lesi|ons were|
|000022a0| 20 63 61 75 73 65 64 20 | 62 79 0d 0a 74 65 63 68 | caused |by..tech|
|000022b0| 6e 69 63 61 6c 20 65 72 | 72 6f 72 73 2e 20 20 41 |nical er|rors. A|
|000022c0| 20 6c 65 73 69 6f 6e 20 | 77 61 73 20 69 64 65 6e | lesion |was iden|
|000022d0| 74 69 66 69 65 64 20 65 | 69 74 68 65 72 20 61 74 |tified e|ither at|
|000022e0| 20 74 68 65 20 69 6e 69 | 74 69 61 6c 20 65 78 61 | the ini|tial exa|
|000022f0| 6d 20 6f 72 0d 0a 72 65 | 74 72 6f 73 70 65 63 74 |m or..re|trospect|
|00002300| 69 76 65 6c 79 20 69 6e | 20 37 33 30 20 6f 66 20 |ively in| 730 of |
|00002310| 37 34 30 20 63 61 73 65 | 73 2c 20 77 69 74 68 20 |740 case|s, with |
|00002320| 61 20 70 6f 74 65 6e 74 | 69 61 6c 20 73 65 6e 73 |a potent|ial sens|
|00002330| 69 74 69 76 69 74 79 20 | 66 6f 72 20 74 68 65 0d |itivity |for the.|
|00002340| 0a 62 61 72 69 75 6d 20 | 65 6e 65 6d 61 20 62 65 |.barium |enema be|
|00002350| 69 6e 67 20 39 39 25 2e | 20 20 44 72 2e 20 42 6f |ing 99%.| Dr. Bo|
|00002360| 6c 69 6e 20 61 6e 64 20 | 68 69 73 20 63 6f 2d 61 |lin and |his co-a|
|00002370| 75 74 68 6f 72 73 20 69 | 6e 64 69 63 61 74 65 20 |uthors i|ndicate |
|00002380| 74 68 61 74 20 6e 6f 0d | 0a 63 6f 6e 63 6c 75 73 |that no.|.conclus|
|00002390| 69 6f 6e 20 63 6f 75 6c | 64 20 62 65 20 64 72 61 |ion coul|d be dra|
|000023a0| 77 6e 20 63 6f 6e 63 65 | 72 6e 69 6e 67 20 74 68 |wn conce|rning th|
|000023b0| 65 20 72 65 6c 61 74 69 | 76 65 20 6d 65 72 69 74 |e relati|ve merit|
|000023c0| 73 20 6f 66 20 73 69 6e | 67 6c 65 20 6f 72 20 64 |s of sin|gle or d|
|000023d0| 6f 75 62 6c 65 0d 0a 63 | 6f 6e 74 72 61 73 74 20 |ouble..c|ontrast |
|000023e0| 62 61 72 69 75 6d 20 65 | 6e 65 6d 61 73 2c 20 61 |barium e|nemas, a|
|000023f0| 73 20 62 6f 74 68 20 77 | 65 72 65 20 75 73 65 64 |s both w|ere used|
|00002400| 20 69 6e 20 74 68 65 20 | 73 74 75 64 79 20 61 6e | in the |study an|
|00002410| 64 20 74 68 65 20 65 72 | 72 6f 72 73 20 77 65 72 |d the er|rors wer|
|00002420| 65 20 6e 6f 74 0d 0a 70 | 72 65 73 65 6e 74 20 69 |e not..p|resent i|
|00002430| 6e 20 73 75 66 66 69 63 | 69 65 6e 74 20 6e 75 6d |n suffic|ient num|
|00002440| 62 65 72 73 20 74 6f 20 | 64 72 61 77 20 61 6e 79 |bers to |draw any|
|00002450| 20 63 6f 6e 63 6c 75 73 | 69 6f 6e 73 2e 20 20 54 | conclus|ions. T|
|00002460| 68 65 20 6d 61 6a 6f 72 | 69 74 79 20 6f 66 0d 0a |he major|ity of..|
|00002470| 67 61 73 74 72 6f 69 6e | 74 65 73 74 69 6e 61 6c |gastroin|testinal|
|00002480| 20 72 61 64 69 6f 6c 6f | 67 69 73 74 73 2c 20 68 | radiolo|gists, h|
|00002490| 6f 77 65 76 65 72 2c 20 | 64 6f 20 70 72 65 66 65 |owever, |do prefe|
|000024a0| 72 20 74 68 65 20 64 6f | 75 62 6c 65 20 63 6f 6e |r the do|uble con|
|000024b0| 74 72 61 73 74 0d 0a 65 | 78 61 6d 69 6e 61 74 69 |trast..e|xaminati|
|000024c0| 6f 6e 2e 20 20 49 74 20 | 69 73 20 74 68 65 20 72 |on. It |is the r|
|000024d0| 6f 75 74 69 6e 65 20 65 | 78 61 6d 69 6e 61 74 69 |outine e|xaminati|
|000024e0| 6f 6e 20 69 6e 20 6d 6f | 73 74 20 64 65 70 61 72 |on in mo|st depar|
|000024f0| 74 6d 65 6e 74 73 2e 2d | 2d 57 2e 4d 2e 0d 0a 54 |tments.-|-W.M...T|
|00002500| 68 6f 6d 70 73 6f 6e 2c | 20 4d 2e 44 2e 0d 0a 24 |hompson,| M.D...$|
|00002510| 55 6e 69 71 75 65 5f 49 | 44 7b 59 52 42 30 39 36 |Unique_I|D{YRB096|
|00002520| 30 32 7d 0d 0a 24 54 69 | 74 6c 65 7b 4e 65 75 74 |02}..$Ti|tle{Neut|
|00002530| 72 6f 70 65 6e 69 63 20 | 43 6f 6c 69 74 69 73 3a |ropenic |Colitis:|
|00002540| 20 20 45 76 61 6c 75 61 | 74 69 6f 6e 20 57 69 74 | Evalua|tion Wit|
|00002550| 68 20 43 6f 6d 70 75 74 | 65 64 20 54 6f 6d 6f 67 |h Comput|ed Tomog|
|00002560| 72 61 70 68 79 7d 0d 0a | 24 41 75 74 68 6f 72 7b |raphy}..|$Author{|
|00002570| 56 61 73 2c 20 57 47 0d | 0a 53 65 65 6c 69 67 2c |Vas, WG.|.Seelig,|
|00002580| 20 52 0d 0a 4d 61 68 61 | 6e 74 61 2c 20 42 0d 0a | R..Maha|nta, B..|
|00002590| 50 61 74 65 6c 2c 20 42 | 0d 0a 53 61 6c 69 6d 69 |Patel, B|..Salimi|
|000025a0| 2c 20 5a 0d 0a 4d 61 72 | 6b 69 76 65 65 2c 20 43 |, Z..Mar|kivee, C|
|000025b0| 0d 0a 53 75 6e 64 61 72 | 61 6d 2c 20 4d 7d 0d 0a |..Sundar|am, M}..|
|000025c0| 24 41 66 66 69 6c 69 61 | 74 69 6f 6e 7b 56 41 20 |$Affilia|tion{VA |
|000025d0| 4d 65 64 20 43 74 72 2c | 20 53 74 20 4c 6f 75 69 |Med Ctr,| St Loui|
|000025e0| 73 3b 20 53 74 20 4c 6f | 75 69 73 20 55 6e 69 76 |s; St Lo|uis Univ|
|000025f0| 7d 0d 0a 24 4a 6f 75 72 | 6e 61 6c 7b 4a 20 43 6f |}..$Jour|nal{J Co|
|00002600| 6d 70 75 74 20 54 6f 6d | 6f 67 72 7d 0d 0a 24 56 |mput Tom|ogr}..$V|
|00002610| 6f 6c 75 6d 65 7b 31 32 | 7d 0d 0a 24 50 61 67 65 |olume{12|}..$Page|
|00002620| 7b 32 31 31 2d 32 31 35 | 7d 0d 0a 24 44 61 74 65 |{211-215|}..$Date|
|00002630| 7b 4a 75 6c 79 20 31 39 | 38 38 7d 0d 0a 24 59 42 |{July 19|88}..$YB|
|00002640| 56 6f 6c 7b 31 39 39 30 | 20 59 65 61 72 20 42 6f |Vol{1990| Year Bo|
|00002650| 6f 6b 20 6f 66 20 44 69 | 61 67 6e 6f 73 74 69 63 |ok of Di|agnostic|
|00002660| 20 52 61 64 69 6f 6c 6f | 67 79 7d 0d 0a 24 43 68 | Radiolo|gy}..$Ch|
|00002670| 61 70 74 65 72 7b 34 2d | 39 7d 0d 0a 24 59 42 45 |apter{4-|9}..$YBE|
|00002680| 64 69 74 6f 72 7b 44 72 | 73 2e 20 42 72 61 67 67 |ditor{Dr|s. Bragg|
|00002690| 2c 20 48 65 6e 64 65 65 | 2c 20 4b 65 61 74 73 2c |, Hendee|, Keats,|
|000026a0| 20 4b 69 72 6b 70 61 74 | 72 69 63 6b 2c 20 4d 69 | Kirkpat|rick, Mi|
|000026b0| 6c 6c 65 72 2c 20 4f 73 | 62 6f 72 6e 2c 20 61 6e |ller, Os|born, an|
|000026c0| 64 20 54 68 6f 6d 70 73 | 6f 6e 7d 0d 0a 24 54 61 |d Thomps|on}..$Ta|
|000026d0| 62 6c 65 7b 54 61 62 6c | 65 20 4f 6d 69 74 74 65 |ble{Tabl|e Omitte|
|000026e0| 64 7d 0d 0a 24 43 6f 6d | 6d 65 6e 74 61 74 6f 72 |d}..$Com|mentator|
|000026f0| 7b 57 2e 4d 2e 20 54 68 | 6f 6d 70 73 6f 6e 2c 20 |{W.M. Th|ompson, |
|00002700| 4d 2e 44 2e 7d 0d 0a 0d | 0a 43 6f 70 79 72 69 67 |M.D.}...|.Copyrig|
|00002710| 68 74 20 28 63 29 20 59 | 65 61 72 62 6f 6f 6b 20 |ht (c) Y|earbook |
|00002720| 4d 65 64 69 63 61 6c 20 | 50 75 62 6c 69 73 68 65 |Medical |Publishe|
|00002730| 72 73 2c 20 49 6e 63 2e | 2c 20 31 39 39 30 0d 0a |rs, Inc.|, 1990..|
|00002740| 0d 0a 31 39 39 30 20 59 | 65 61 72 20 42 6f 6f 6b |..1990 Y|ear Book|
|00002750| 20 6f 66 20 44 69 61 67 | 6e 6f 73 74 69 63 20 52 | of Diag|nostic R|
|00002760| 61 64 69 6f 6c 6f 67 79 | 20 28 52 29 0d 0a 0d 0a |adiology| (R)....|
|00002770| 43 68 61 70 74 65 72 20 | 34 2d 2d 54 68 65 20 41 |Chapter |4--The A|
|00002780| 62 64 6f 6d 65 6e 0d 0a | 0d 0a 47 61 73 74 72 6f |bdomen..|..Gastro|
|00002790| 69 6e 74 65 73 74 69 6e | 61 6c 20 54 72 61 63 74 |intestin|al Tract|
|000027a0| 0d 0a 0d 0a 49 4d 41 47 | 49 4e 47 20 54 45 43 48 |....IMAG|ING TECH|
|000027b0| 4e 49 51 55 45 53 0d 0a | 0d 0a 2d 2d 2d 2d 2d 2d |NIQUES..|..------|
|000027c0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000027d0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000027e0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000027f0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002800| 2d 2d 2d 2d 2d 2d 2d 2d | 0d 0a 4e 65 75 74 72 6f |--------|..Neutro|
|00002810| 70 65 6e 69 63 20 43 6f | 6c 69 74 69 73 3a 20 20 |penic Co|litis: |
|00002820| 45 76 61 6c 75 61 74 69 | 6f 6e 20 57 69 74 68 20 |Evaluati|on With |
|00002830| 43 6f 6d 70 75 74 65 64 | 20 54 6f 6d 6f 67 72 61 |Computed| Tomogra|
|00002840| 70 68 79 0d 0a 0d 0a 56 | 61 73 20 57 47 2c 20 53 |phy....V|as WG, S|
|00002850| 65 65 6c 69 67 20 52 2c | 20 4d 61 68 61 6e 74 61 |eelig R,| Mahanta|
|00002860| 20 42 2c 20 50 61 74 65 | 6c 20 42 2c 20 53 61 6c | B, Pate|l B, Sal|
|00002870| 69 6d 69 20 5a 2c 20 4d | 61 72 6b 69 76 65 65 20 |imi Z, M|arkivee |
|00002880| 43 2c 20 53 75 6e 64 61 | 72 61 6d 20 4d 0d 0a 28 |C, Sunda|ram M..(|
|00002890| 56 41 20 4d 65 64 20 43 | 74 72 2c 20 53 74 20 4c |VA Med C|tr, St L|
|000028a0| 6f 75 69 73 3b 20 53 74 | 20 4c 6f 75 69 73 20 55 |ouis; St| Louis U|
|000028b0| 6e 69 76 29 0d 0a 4a 20 | 43 6f 6d 70 75 74 20 54 |niv)..J |Comput T|
|000028c0| 6f 6d 6f 67 72 20 31 32 | 3a 32 31 31 2d 32 31 35 |omogr 12|:211-215|
|000028d0| 2c 20 4a 75 6c 79 20 31 | 39 38 38 0d 0a 2d 2d 2d |, July 1|988..---|
|000028e0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000028f0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002900| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002910| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002920| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 0d 0a 0d 0a 41 |--------|---....A|
|00002930| 62 73 74 72 61 63 74 0d | 0a 0d 0a 20 20 20 20 20 |bstract.|... |
|00002940| 4e 65 75 74 72 6f 70 65 | 6e 69 63 20 63 6f 6c 69 |Neutrope|nic coli|
|00002950| 74 69 73 20 64 65 76 65 | 6c 6f 70 73 20 6d 6f 73 |tis deve|lops mos|
|00002960| 74 20 6f 66 74 65 6e 20 | 69 6e 20 70 61 74 69 65 |t often |in patie|
|00002970| 6e 74 73 20 77 69 74 68 | 20 61 63 75 74 65 20 6c |nts with| acute l|
|00002980| 65 75 6b 65 6d 69 61 0d | 0a 77 68 6f 20 61 72 65 |eukemia.|.who are|
|00002990| 20 75 6e 64 65 72 67 6f | 69 6e 67 20 63 68 65 6d | undergo|ing chem|
|000029a0| 6f 74 68 65 72 61 70 79 | 2e 20 20 54 68 65 20 63 |otherapy|. The c|
|000029b0| 6f 6e 64 69 74 69 6f 6e | 20 69 73 20 64 69 66 66 |ondition| is diff|
|000029c0| 69 63 75 6c 74 20 74 6f | 20 72 65 63 6f 67 6e 69 |icult to| recogni|
|000029d0| 7a 65 0d 0a 63 6c 69 6e | 69 63 61 6c 6c 79 20 61 |ze..clin|ically a|
|000029e0| 6e 64 20 69 73 20 73 65 | 6c 64 6f 6d 20 64 69 61 |nd is se|ldom dia|
|000029f0| 67 6e 6f 73 65 64 20 62 | 65 66 6f 72 65 20 64 65 |gnosed b|efore de|
|00002a00| 61 74 68 2e 20 20 49 66 | 20 6c 65 66 74 20 75 6e |ath. If| left un|
|00002a10| 74 72 65 61 74 65 64 2c | 0d 0a 6e 65 75 74 72 6f |treated,|..neutro|
|00002a20| 70 65 6e 69 63 20 63 6f | 6c 69 74 69 73 20 70 72 |penic co|litis pr|
|00002a30| 6f 67 72 65 73 73 65 73 | 20 74 6f 20 74 72 61 6e |ogresses| to tran|
|00002a40| 73 6d 75 72 61 6c 20 6e | 65 63 72 6f 73 69 73 20 |smural n|ecrosis |
|00002a50| 61 6e 64 20 63 6f 6c 6f | 6e 20 70 65 72 66 6f 72 |and colo|n perfor|
|00002a60| 61 74 69 6f 6e 2c 0d 0a | 6c 65 61 64 69 6e 67 20 |ation,..|leading |
|00002a70| 74 6f 20 73 65 70 74 69 | 63 65 6d 69 61 20 61 6e |to septi|cemia an|
|00002a80| 64 20 64 65 61 74 68 2e | 20 20 43 6f 6d 70 75 74 |d death.| Comput|
|00002a90| 65 64 20 74 6f 6d 6f 67 | 72 61 70 68 79 20 61 70 |ed tomog|raphy ap|
|00002aa0| 70 65 61 72 73 20 74 6f | 20 62 65 20 75 73 65 66 |pears to| be usef|
|00002ab0| 75 6c 20 69 6e 0d 0a 74 | 68 65 20 64 69 61 67 6e |ul in..t|he diagn|
|00002ac0| 6f 73 69 73 20 6f 66 20 | 74 68 69 73 20 70 6f 74 |osis of |this pot|
|00002ad0| 65 6e 74 69 61 6c 6c 79 | 20 6c 65 74 68 61 6c 20 |entially| lethal |
|00002ae0| 63 6f 6e 64 69 74 69 6f | 6e 2e 0d 0a 20 20 20 20 |conditio|n... |
|00002af0| 20 43 6f 6d 70 75 74 65 | 64 20 74 6f 6d 6f 67 72 | Compute|d tomogr|
|00002b00| 61 70 68 79 20 77 61 73 | 20 70 65 72 66 6f 72 6d |aphy was| perform|
|00002b10| 65 64 20 69 6e 20 36 20 | 6d 65 6e 20 61 6e 64 20 |ed in 6 |men and |
|00002b20| 34 20 77 6f 6d 65 6e 20 | 61 67 65 64 20 32 34 2d |4 women |aged 24-|
|00002b30| 37 37 20 79 65 61 72 73 | 3b 0d 0a 34 20 68 61 64 |77 years|;..4 had|
|00002b40| 20 61 63 75 74 65 20 6d | 79 65 6c 6f 69 64 20 6c | acute m|yeloid l|
|00002b50| 65 75 6b 65 6d 69 61 2c | 20 33 20 68 61 64 20 61 |eukemia,| 3 had a|
|00002b60| 63 75 74 65 20 6c 79 6d | 70 68 6f 63 79 74 69 63 |cute lym|phocytic|
|00002b70| 20 6c 65 75 6b 65 6d 69 | 61 2c 20 31 20 68 61 64 | leukemi|a, 1 had|
|00002b80| 20 70 6f 6f 72 6c 79 0d | 0a 64 69 66 66 65 72 65 | poorly.|.differe|
|00002b90| 6e 74 69 61 74 65 64 20 | 6c 79 6d 70 68 6f 63 79 |ntiated |lymphocy|
|00002ba0| 74 69 63 20 6c 79 6d 70 | 68 6f 6d 61 2c 20 61 6e |tic lymp|homa, an|
|00002bb0| 64 20 32 20 68 61 64 20 | 73 79 73 74 65 6d 69 63 |d 2 had |systemic|
|00002bc0| 20 6c 75 70 75 73 20 65 | 72 79 74 68 65 6d 61 74 | lupus e|rythemat|
|00002bd0| 6f 73 75 73 2e 0d 0a 54 | 68 65 20 64 69 61 67 6e |osus...T|he diagn|
|00002be0| 6f 73 69 73 20 6f 66 20 | 6e 65 75 74 72 6f 70 65 |osis of |neutrope|
|00002bf0| 6e 69 63 20 63 6f 6c 69 | 74 69 73 20 77 61 73 20 |nic coli|tis was |
|00002c00| 63 6f 6e 66 69 72 6d 65 | 64 20 62 79 20 73 75 72 |confirme|d by sur|
|00002c10| 67 65 72 79 20 6f 72 20 | 61 75 74 6f 70 73 79 20 |gery or |autopsy |
|00002c20| 69 6e 20 36 0d 0a 70 61 | 74 69 65 6e 74 73 20 61 |in 6..pa|tients a|
|00002c30| 6e 64 20 62 79 20 63 6c | 69 6e 69 63 61 6c 20 63 |nd by cl|inical c|
|00002c40| 6f 75 72 73 65 2c 20 6c | 61 62 6f 72 61 74 6f 72 |ourse, l|aborator|
|00002c50| 79 20 73 74 75 64 79 2c | 20 61 6e 64 20 43 54 20 |y study,| and CT |
|00002c60| 66 69 6e 64 69 6e 67 73 | 20 69 6e 20 74 68 65 0d |findings| in the.|
|00002c70| 0a 6f 74 68 65 72 20 34 | 2e 20 20 41 6c 6c 20 31 |.other 4|. All 1|
|00002c80| 30 20 70 61 74 69 65 6e | 74 73 20 65 78 70 65 72 |0 patien|ts exper|
|00002c90| 69 65 6e 63 65 64 20 6d | 61 6c 61 69 73 65 20 77 |ienced m|alaise w|
|00002ca0| 69 74 68 20 61 62 64 6f | 6d 69 6e 61 6c 20 64 69 |ith abdo|minal di|
|00002cb0| 73 63 6f 6d 66 6f 72 74 | 20 6f 72 0d 0a 70 61 69 |scomfort| or..pai|
|00002cc0| 6e 2c 20 61 6e 64 20 61 | 6c 6c 20 31 30 20 68 61 |n, and a|ll 10 ha|
|00002cd0| 64 20 73 65 76 65 72 65 | 20 6e 65 75 74 72 6f 70 |d severe| neutrop|
|00002ce0| 65 6e 69 61 2e 20 20 43 | 6f 6d 70 75 74 65 64 20 |enia. C|omputed |
|00002cf0| 74 6f 6d 6f 67 72 61 70 | 68 69 63 20 73 63 61 6e |tomograp|hic scan|
|00002d00| 73 20 77 65 72 65 0d 0a | 65 76 61 6c 75 61 74 65 |s were..|evaluate|
|00002d10| 64 20 74 6f 20 64 65 74 | 65 72 6d 69 6e 65 20 74 |d to det|ermine t|
|00002d20| 68 65 20 70 72 65 73 65 | 6e 63 65 20 6f 66 20 62 |he prese|nce of b|
|00002d30| 6f 77 65 6c 20 77 61 6c | 6c 20 74 68 69 63 6b 65 |owel wal|l thicke|
|00002d40| 6e 69 6e 67 2c 20 67 61 | 73 20 69 6e 20 74 68 65 |ning, ga|s in the|
|00002d50| 20 62 6f 77 65 6c 0d 0a | 77 61 6c 6c 2c 20 70 65 | bowel..|wall, pe|
|00002d60| 72 69 63 6f 6c 6f 6e 69 | 63 20 66 6c 75 69 64 2c |ricoloni|c fluid,|
|00002d70| 20 61 6e 64 20 65 64 65 | 6d 61 20 6f 66 20 74 68 | and ede|ma of th|
|00002d80| 65 20 61 64 6a 61 63 65 | 6e 74 20 6d 65 73 65 6e |e adjace|nt mesen|
|00002d90| 74 65 72 79 2e 0d 0a 20 | 20 20 20 20 43 6f 6d 70 |tery... | Comp|
|00002da0| 75 74 65 64 20 74 6f 6d | 6f 67 72 61 70 68 79 20 |uted tom|ography |
|00002db0| 72 65 76 65 61 6c 65 64 | 20 65 69 74 68 65 72 20 |revealed| either |
|00002dc0| 63 69 72 63 75 6d 66 65 | 72 65 6e 74 69 61 6c 20 |circumfe|rential |
|00002dd0| 28 46 69 67 20 34 2d 31 | 31 29 20 6f 72 0d 0a 65 |(Fig 4-1|1) or..e|
|00002de0| 63 63 65 6e 74 72 69 63 | 20 62 6f 77 65 6c 20 77 |ccentric| bowel w|
|00002df0| 61 6c 6c 20 74 68 69 63 | 6b 65 6e 69 6e 67 20 69 |all thic|kening i|
|00002e00| 6e 20 61 6c 6c 20 70 61 | 74 69 65 6e 74 73 2e 20 |n all pa|tients. |
|00002e10| 20 54 68 65 20 74 68 69 | 63 6b 65 6e 65 64 20 62 | The thi|ckened b|
|00002e20| 6f 77 65 6c 20 77 61 6c | 6c 20 77 61 73 0d 0a 69 |owel wal|l was..i|
|00002e30| 73 6f 64 65 6e 73 65 20 | 74 6f 20 74 68 65 20 73 |sodense |to the s|
|00002e40| 75 72 72 6f 75 6e 64 69 | 6e 67 20 6e 6f 72 6d 61 |urroundi|ng norma|
|00002e50| 6c 20 62 6f 77 65 6c 20 | 74 69 73 73 75 65 20 69 |l bowel |tissue i|
|00002e60| 6e 20 36 20 70 61 74 69 | 65 6e 74 73 20 61 6e 64 |n 6 pati|ents and|
|00002e70| 20 73 68 6f 77 65 64 0d | 0a 69 6e 74 72 61 6d 75 | showed.|.intramu|
|00002e80| 72 61 6c 20 61 72 65 61 | 73 20 6f 66 20 6c 6f 77 |ral area|s of low|
|00002e90| 20 64 65 6e 73 69 74 79 | 20 69 6e 20 34 2e 20 20 | density| in 4. |
|00002ea0| 57 61 6c 6c 20 74 68 69 | 63 6b 65 6e 69 6e 67 20 |Wall thi|ckening |
|00002eb0| 69 6e 76 6f 6c 76 65 64 | 20 74 68 65 20 65 6e 74 |involved| the ent|
|00002ec0| 69 72 65 0d 0a 61 73 63 | 65 6e 64 69 6e 67 20 61 |ire..asc|ending a|
|00002ed0| 6e 64 20 70 72 6f 78 69 | 6d 61 6c 20 70 6f 72 74 |nd proxi|mal port|
|00002ee0| 69 6f 6e 20 6f 66 20 74 | 68 65 20 74 72 61 6e 73 |ion of t|he trans|
|00002ef0| 76 65 72 73 65 20 63 6f | 6c 6f 6e 20 69 6e 20 33 |verse co|lon in 3|
|00002f00| 20 70 61 74 69 65 6e 74 | 73 2e 20 20 53 63 61 6e | patient|s. Scan|
|00002f10| 73 0d 0a 6f 66 20 36 20 | 70 61 74 69 65 6e 74 73 |s..of 6 |patients|
|00002f20| 20 73 68 6f 77 65 64 20 | 67 61 73 20 62 75 62 62 | showed |gas bubb|
|00002f30| 6c 65 73 20 77 69 74 68 | 69 6e 20 74 68 65 20 74 |les with|in the t|
|00002f40| 68 69 63 6b 65 6e 65 64 | 20 62 6f 77 65 6c 20 77 |hickened| bowel w|
|00002f50| 61 6c 6c 2c 20 69 6e 64 | 69 63 61 74 69 76 65 0d |all, ind|icative.|
|00002f60| 0a 6f 66 20 70 6e 65 75 | 6d 61 74 6f 73 69 73 20 |.of pneu|matosis |
|00002f70| 63 6f 6c 69 20 28 46 69 | 67 20 34 2d 31 32 29 2e |coli (Fi|g 4-12).|
|00002f80| 20 20 49 6e 20 31 20 70 | 61 74 69 65 6e 74 20 67 | In 1 p|atient g|
|00002f90| 61 73 20 62 75 62 62 6c | 65 73 20 65 78 74 65 6e |as bubbl|es exten|
|00002fa0| 64 65 64 20 69 6e 74 6f | 20 74 68 65 0d 0a 61 64 |ded into| the..ad|
|00002fb0| 6a 61 63 65 6e 74 20 6d | 65 73 65 6e 74 65 72 79 |jacent m|esentery|
|00002fc0| 2e 20 20 49 6e 20 33 20 | 70 61 74 69 65 6e 74 73 |. In 3 |patients|
|00002fd0| 20 77 68 6f 20 72 65 63 | 6f 76 65 72 65 64 20 66 | who rec|overed f|
|00002fe0| 72 6f 6d 20 6e 65 75 74 | 72 6f 70 65 6e 69 63 20 |rom neut|ropenic |
|00002ff0| 63 6f 6c 69 74 69 73 2c | 20 43 54 0d 0a 73 68 6f |colitis,| CT..sho|
|00003000| 77 65 64 20 64 65 63 72 | 65 61 73 65 64 20 62 6f |wed decr|eased bo|
|00003010| 77 65 6c 20 77 61 6c 6c | 20 74 68 69 63 6b 65 6e |wel wall| thicken|
|00003020| 69 6e 67 20 61 6e 64 20 | 61 20 72 65 64 75 63 74 |ing and |a reduct|
|00003030| 69 6f 6e 20 6f 66 20 70 | 6e 65 75 6d 61 74 6f 73 |ion of p|neumatos|
|00003040| 69 73 20 63 6f 6c 69 2e | 0d 0a 41 6c 6c 20 70 61 |is coli.|..All pa|
|00003050| 74 69 65 6e 74 73 20 68 | 61 64 20 65 69 74 68 65 |tients h|ad eithe|
|00003060| 72 20 6c 6f 63 61 6c 69 | 7a 65 64 20 6f 72 20 67 |r locali|zed or g|
|00003070| 65 6e 65 72 61 6c 69 7a | 65 64 20 69 6c 65 75 73 |eneraliz|ed ileus|
|00003080| 2c 20 61 6e 64 20 33 20 | 68 61 64 20 70 65 72 69 |, and 3 |had peri|
|00003090| 63 6f 6c 6f 6e 69 63 0d | 0a 66 6c 75 69 64 2e 20 |colonic.|.fluid. |
|000030a0| 20 50 6c 61 69 6e 20 72 | 61 64 69 6f 67 72 61 70 | Plain r|adiograp|
|000030b0| 68 73 20 73 68 6f 77 65 | 64 20 6f 6e 6c 79 20 6e |hs showe|d only n|
|000030c0| 6f 6e 73 70 65 63 69 66 | 69 63 20 69 6c 65 75 73 |onspecif|ic ileus|
|000030d0| 20 69 6e 20 61 6c 6c 20 | 31 30 20 70 61 74 69 65 | in all |10 patie|
|000030e0| 6e 74 73 3b 0d 0a 70 6e | 65 75 6d 61 74 6f 73 69 |nts;..pn|eumatosi|
|000030f0| 73 20 63 6f 6c 69 20 77 | 61 73 20 6e 6f 74 20 69 |s coli w|as not i|
|00003100| 64 65 6e 74 69 66 69 65 | 64 20 6f 6e 20 61 6e 79 |dentifie|d on any|
|00003110| 20 6f 66 20 74 68 65 20 | 70 6c 61 69 6e 20 72 61 | of the |plain ra|
|00003120| 64 69 6f 67 72 61 70 68 | 73 2e 20 20 42 61 72 69 |diograph|s. Bari|
|00003130| 75 6d 0d 0a 65 6e 65 6d | 61 73 20 70 65 72 66 6f |um..enem|as perfo|
|00003140| 72 6d 65 64 20 69 6e 20 | 33 20 70 61 74 69 65 6e |rmed in |3 patien|
|00003150| 74 73 20 73 68 6f 77 65 | 64 20 6f 6e 6c 79 20 61 |ts showe|d only a|
|00003160| 20 74 68 69 63 6b 2d 77 | 61 6c 6c 65 64 20 63 65 | thick-w|alled ce|
|00003170| 63 75 6d 20 77 69 74 68 | 0d 0a 22 74 68 75 6d 62 |cum with|.."thumb|
|00003180| 70 72 69 6e 74 69 6e 67 | 22 20 61 6e 64 20 69 72 |printing|" and ir|
|00003190| 72 65 67 75 6c 61 72 20 | 6d 75 63 6f 73 61 6c 20 |regular |mucosal |
|000031a0| 6d 61 72 6b 69 6e 67 73 | 2e 20 20 46 69 76 65 20 |markings|. Five |
|000031b0| 70 61 74 69 65 6e 74 73 | 20 72 65 63 6f 76 65 72 |patients| recover|
|000031c0| 65 64 20 66 72 6f 6d 0d | 0a 74 68 65 69 72 20 6e |ed from.|.their n|
|000031d0| 65 75 74 72 6f 70 65 6e | 69 61 20 61 6e 64 20 6e |eutropen|ia and n|
|000031e0| 65 75 74 72 6f 70 65 6e | 69 63 20 63 6f 6c 69 74 |eutropen|ic colit|
|000031f0| 69 73 3b 20 74 68 65 20 | 6f 74 68 65 72 20 35 20 |is; the |other 5 |
|00003200| 64 69 65 64 2e 0d 0a 20 | 20 20 20 20 43 6f 6d 70 |died... | Comp|
|00003210| 75 74 65 64 20 74 6f 6d | 6f 67 72 61 70 68 69 63 |uted tom|ographic|
|00003220| 20 66 69 6e 64 69 6e 67 | 73 20 6f 66 20 64 69 66 | finding|s of dif|
|00003230| 66 75 73 65 20 63 65 63 | 61 6c 20 77 61 6c 6c 20 |fuse cec|al wall |
|00003240| 74 68 69 63 6b 65 6e 69 | 6e 67 2c 20 73 6f 6d 65 |thickeni|ng, some|
|00003250| 74 69 6d 65 73 0d 0a 69 | 6e 20 61 73 73 6f 63 69 |times..i|n associ|
|00003260| 61 74 69 6f 6e 20 77 69 | 74 68 20 69 6e 74 72 61 |ation wi|th intra|
|00003270| 6d 75 72 61 6c 20 61 69 | 72 20 69 6e 20 70 61 74 |mural ai|r in pat|
|00003280| 69 65 6e 74 73 20 77 69 | 74 68 20 66 65 76 65 72 |ients wi|th fever|
|00003290| 2c 20 61 62 64 6f 6d 69 | 6e 61 6c 20 70 61 69 6e |, abdomi|nal pain|
|000032a0| 2c 0d 0a 64 69 61 72 72 | 68 65 61 2c 20 61 6e 64 |,..diarr|hea, and|
|000032b0| 20 6e 65 75 74 72 6f 70 | 65 6e 69 61 2c 20 73 75 | neutrop|enia, su|
|000032c0| 67 67 65 73 74 20 61 20 | 64 69 61 67 6e 6f 73 69 |ggest a |diagnosi|
|000032d0| 73 20 6f 66 20 6e 65 75 | 74 72 6f 70 65 6e 69 63 |s of neu|tropenic|
|000032e0| 20 63 6f 6c 69 74 69 73 | 2c 20 77 68 69 63 68 0d | colitis|, which.|
|000032f0| 0a 77 61 72 72 61 6e 74 | 73 20 70 72 6f 6d 70 74 |.warrant|s prompt|
|00003300| 20 6d 65 64 69 63 61 6c | 20 6f 72 20 73 75 72 67 | medical| or surg|
|00003310| 69 63 61 6c 20 74 72 65 | 61 74 6d 65 6e 74 2e 0d |ical tre|atment..|
|00003320| 0a 0d 0a 50 6f 73 74 2d | 43 6f 6d 6d 65 6e 74 0d |...Post-|Comment.|
|00003330| 0a 0d 0a 20 20 20 20 20 | 54 68 69 73 20 69 73 20 |... |This is |
|00003340| 61 20 75 73 65 66 75 6c | 20 61 72 74 69 63 6c 65 |a useful| article|
|00003350| 2c 20 65 73 70 65 63 69 | 61 6c 6c 79 20 62 65 63 |, especi|ally bec|
|00003360| 61 75 73 65 20 43 54 20 | 69 73 20 62 65 69 6e 67 |ause CT |is being|
|00003370| 20 75 73 65 64 20 6d 6f | 72 65 0d 0a 66 72 65 71 | used mo|re..freq|
|00003380| 75 65 6e 74 6c 79 20 69 | 6e 20 70 61 74 69 65 6e |uently i|n patien|
|00003390| 74 73 20 77 69 74 68 20 | 6e 6f 6e 73 70 65 63 69 |ts with |nonspeci|
|000033a0| 66 69 63 20 61 62 64 6f | 6d 69 6e 61 6c 20 73 79 |fic abdo|minal sy|
|000033b0| 6d 70 74 6f 6d 73 2e 20 | 20 54 68 69 73 20 69 73 |mptoms. | This is|
|000033c0| 0d 0a 65 73 70 65 63 69 | 61 6c 6c 79 20 74 72 75 |..especi|ally tru|
|000033d0| 65 20 69 6e 20 74 68 65 | 20 69 6d 6d 75 6e 6f 63 |e in the| immunoc|
|000033e0| 6f 6d 70 72 6f 6d 69 73 | 65 64 20 70 61 74 69 65 |ompromis|ed patie|
|000033f0| 6e 74 2e 20 20 52 61 64 | 69 6f 6c 6f 67 69 73 74 |nt. Rad|iologist|
|00003400| 73 20 61 72 65 20 74 68 | 75 73 20 69 6e 20 61 0d |s are th|us in a.|
|00003410| 0a 70 6f 73 69 74 69 6f | 6e 20 74 6f 20 63 6f 6e |.positio|n to con|
|00003420| 66 69 72 6d 20 73 75 73 | 70 65 63 74 65 64 20 61 |firm sus|pected a|
|00003430| 62 6e 6f 72 6d 61 6c 69 | 74 69 65 73 20 61 6e 64 |bnormali|ties and|
|00003440| 20 64 69 61 67 6e 6f 73 | 65 20 75 6e 73 75 73 70 | diagnos|e unsusp|
|00003450| 65 63 74 65 64 0d 0a 67 | 61 73 74 72 6f 69 6e 74 |ected..g|astroint|
|00003460| 65 73 74 69 6e 61 6c 20 | 61 62 6e 6f 72 6d 61 6c |estinal |abnormal|
|00003470| 69 74 69 65 73 20 73 75 | 63 68 20 61 73 20 70 72 |ities su|ch as pr|
|00003480| 65 73 65 6e 74 65 64 20 | 62 79 20 56 61 73 20 61 |esented |by Vas a|
|00003490| 6e 64 20 68 69 73 0d 0a | 61 73 73 6f 63 69 61 74 |nd his..|associat|
|000034a0| 65 73 2e 2d 2d 57 2e 4d | 2e 20 54 68 6f 6d 70 73 |es.--W.M|. Thomps|
|000034b0| 6f 6e 2c 20 4d 2e 44 2e | 0d 0a 24 55 6e 69 71 75 |on, M.D.|..$Uniqu|
|000034c0| 65 5f 49 44 7b 59 52 42 | 30 39 36 30 33 7d 0d 0a |e_ID{YRB|09603}..|
|000034d0| 24 54 69 74 6c 65 7b 45 | 76 61 6c 75 61 74 69 6f |$Title{E|valuatio|
|000034e0| 6e 20 6f 66 20 45 6e 64 | 6f 72 65 63 74 61 6c 20 |n of End|orectal |
|000034f0| 55 6c 74 72 61 73 6f 75 | 6e 64 20 66 6f 72 20 74 |Ultrasou|nd for t|
|00003500| 68 65 20 41 73 73 65 73 | 73 6d 65 6e 74 20 6f 66 |he Asses|sment of|
|00003510| 20 57 61 6c 6c 20 49 6e | 76 61 73 69 6f 6e 20 6f | Wall In|vasion o|
|00003520| 66 20 52 65 63 74 61 6c | 20 43 61 6e 63 65 72 3a |f Rectal| Cancer:|
|00003530| 20 20 52 65 70 6f 72 74 | 20 6f 66 20 61 20 43 61 | Report| of a Ca|
|00003540| 73 65 7d 0d 0a 24 41 75 | 74 68 6f 72 7b 59 61 6d |se}..$Au|thor{Yam|
|00003550| 61 73 68 69 74 61 2c 20 | 59 0d 0a 4d 61 63 68 69 |ashita, |Y..Machi|
|00003560| 2c 20 4a 0d 0a 53 68 69 | 72 6f 75 7a 75 2c 20 4b |, J..Shi|rouzu, K|
|00003570| 0d 0a 4d 6f 72 6f 74 6f | 6d 69 2c 20 54 0d 0a 49 |..Moroto|mi, T..I|
|00003580| 73 6f 6d 6f 74 6f 2c 20 | 48 0d 0a 4b 61 6b 65 67 |somoto, |H..Kakeg|
|00003590| 61 77 61 2c 20 54 7d 0d | 0a 24 41 66 66 69 6c 69 |awa, T}.|.$Affili|
|000035a0| 61 74 69 6f 6e 7b 4b 75 | 72 75 6d 65 20 55 6e 69 |ation{Ku|rume Uni|
|000035b0| 76 2c 20 46 75 6b 75 6f | 6b 61 2c 20 4a 61 70 61 |v, Fukuo|ka, Japa|
|000035c0| 6e 7d 0d 0a 24 4a 6f 75 | 72 6e 61 6c 7b 44 69 73 |n}..$Jou|rnal{Dis|
|000035d0| 20 43 6f 6c 6f 6e 20 52 | 65 63 74 75 6d 7d 0d 0a | Colon R|ectum}..|
|000035e0| 24 56 6f 6c 75 6d 65 7b | 33 31 7d 0d 0a 24 50 61 |$Volume{|31}..$Pa|
|000035f0| 67 65 7b 36 31 37 2d 36 | 32 33 7d 0d 0a 24 44 61 |ge{617-6|23}..$Da|
|00003600| 74 65 7b 41 75 67 75 73 | 74 20 31 39 38 38 7d 0d |te{Augus|t 1988}.|
|00003610| 0a 24 59 42 56 6f 6c 7b | 31 39 39 30 20 59 65 61 |.$YBVol{|1990 Yea|
|00003620| 72 20 42 6f 6f 6b 20 6f | 66 20 44 69 61 67 6e 6f |r Book o|f Diagno|
|00003630| 73 74 69 63 20 52 61 64 | 69 6f 6c 6f 67 79 7d 0d |stic Rad|iology}.|
|00003640| 0a 24 43 68 61 70 74 65 | 72 7b 34 2d 31 30 7d 0d |.$Chapte|r{4-10}.|
|00003650| 0a 24 59 42 45 64 69 74 | 6f 72 7b 44 72 73 2e 20 |.$YBEdit|or{Drs. |
|00003660| 42 72 61 67 67 2c 20 48 | 65 6e 64 65 65 2c 20 4b |Bragg, H|endee, K|
|00003670| 65 61 74 73 2c 20 4b 69 | 72 6b 70 61 74 72 69 63 |eats, Ki|rkpatric|
|00003680| 6b 2c 20 4d 69 6c 6c 65 | 72 2c 20 4f 73 62 6f 72 |k, Mille|r, Osbor|
|00003690| 6e 2c 20 61 6e 64 20 54 | 68 6f 6d 70 73 6f 6e 7d |n, and T|hompson}|
|000036a0| 0d 0a 24 54 61 62 6c 65 | 7b 54 61 62 6c 65 20 4f |..$Table|{Table O|
|000036b0| 6d 69 74 74 65 64 7d 0d | 0a 24 43 6f 6d 6d 65 6e |mitted}.|.$Commen|
|000036c0| 74 61 74 6f 72 7b 57 2e | 4d 2e 20 54 68 6f 6d 70 |tator{W.|M. Thomp|
|000036d0| 73 6f 6e 2c 20 4d 2e 44 | 2e 7d 0d 0a 0d 0a 43 6f |son, M.D|.}....Co|
|000036e0| 70 79 72 69 67 68 74 20 | 28 63 29 20 59 65 61 72 |pyright |(c) Year|
|000036f0| 62 6f 6f 6b 20 4d 65 64 | 69 63 61 6c 20 50 75 62 |book Med|ical Pub|
|00003700| 6c 69 73 68 65 72 73 2c | 20 49 6e 63 2e 2c 20 31 |lishers,| Inc., 1|
|00003710| 39 39 30 0d 0a 0d 0a 31 | 39 39 30 20 59 65 61 72 |990....1|990 Year|
|00003720| 20 42 6f 6f 6b 20 6f 66 | 20 44 69 61 67 6e 6f 73 | Book of| Diagnos|
|00003730| 74 69 63 20 52 61 64 69 | 6f 6c 6f 67 79 20 28 52 |tic Radi|ology (R|
|00003740| 29 0d 0a 0d 0a 43 68 61 | 70 74 65 72 20 34 2d 2d |)....Cha|pter 4--|
|00003750| 54 68 65 20 41 62 64 6f | 6d 65 6e 0d 0a 0d 0a 47 |The Abdo|men....G|
|00003760| 61 73 74 72 6f 69 6e 74 | 65 73 74 69 6e 61 6c 20 |astroint|estinal |
|00003770| 54 72 61 63 74 0d 0a 0d | 0a 49 4d 41 47 49 4e 47 |Tract...|.IMAGING|
|00003780| 20 54 45 43 48 4e 49 51 | 55 45 53 0d 0a 0d 0a 2d | TECHNIQ|UES....-|
|00003790| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000037a0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000037b0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000037c0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000037d0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 0d 0a 45 |--------|-----..E|
|000037e0| 76 61 6c 75 61 74 69 6f | 6e 20 6f 66 20 45 6e 64 |valuatio|n of End|
|000037f0| 6f 72 65 63 74 61 6c 20 | 55 6c 74 72 61 73 6f 75 |orectal |Ultrasou|
|00003800| 6e 64 20 66 6f 72 20 74 | 68 65 20 41 73 73 65 73 |nd for t|he Asses|
|00003810| 73 6d 65 6e 74 20 6f 66 | 20 57 61 6c 6c 20 49 6e |sment of| Wall In|
|00003820| 76 61 73 69 6f 6e 20 6f | 66 0d 0a 52 65 63 74 61 |vasion o|f..Recta|
|00003830| 6c 20 43 61 6e 63 65 72 | 3a 20 20 52 65 70 6f 72 |l Cancer|: Repor|
|00003840| 74 20 6f 66 20 61 20 43 | 61 73 65 0d 0a 0d 0a 59 |t of a C|ase....Y|
|00003850| 61 6d 61 73 68 69 74 61 | 20 59 2c 20 4d 61 63 68 |amashita| Y, Mach|
|00003860| 69 20 4a 2c 20 53 68 69 | 72 6f 75 7a 75 20 4b 2c |i J, Shi|rouzu K,|
|00003870| 20 4d 6f 72 6f 74 6f 6d | 69 20 54 2c 20 49 73 6f | Morotom|i T, Iso|
|00003880| 6d 6f 74 6f 20 48 2c 20 | 4b 61 6b 65 67 61 77 61 |moto H, |Kakegawa|
|00003890| 20 54 0d 0a 28 4b 75 72 | 75 6d 65 20 55 6e 69 76 | T..(Kur|ume Univ|
|000038a0| 2c 20 46 75 6b 75 6f 6b | 61 2c 20 4a 61 70 61 6e |, Fukuok|a, Japan|
|000038b0| 29 0d 0a 44 69 73 20 43 | 6f 6c 6f 6e 20 52 65 63 |)..Dis C|olon Rec|
|000038c0| 74 75 6d 20 33 31 3a 36 | 31 37 2d 36 32 33 2c 20 |tum 31:6|17-623, |
|000038d0| 41 75 67 75 73 74 20 31 | 39 38 38 0d 0a 2d 2d 2d |August 1|988..---|
|000038e0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000038f0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003900| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003910| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003920| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 0d 0a 0d 0a 41 |--------|---....A|
|00003930| 62 73 74 72 61 63 74 0d | 0a 0d 0a 20 20 20 20 20 |bstract.|... |
|00003940| 57 69 74 68 20 63 75 72 | 72 65 6e 74 6c 79 20 61 |With cur|rently a|
|00003950| 76 61 69 6c 61 62 6c 65 | 20 74 65 63 68 6e 69 71 |vailable| techniq|
|00003960| 75 65 73 20 66 6f 72 20 | 74 68 65 20 70 72 65 6f |ues for |the preo|
|00003970| 70 65 72 61 74 69 76 65 | 20 64 69 61 67 6e 6f 73 |perative| diagnos|
|00003980| 69 73 20 6f 66 0d 0a 72 | 65 63 74 61 6c 20 63 61 |is of..r|ectal ca|
|00003990| 6e 63 65 72 2c 20 69 74 | 20 69 73 20 6e 6f 74 20 |ncer, it| is not |
|000039a0| 70 6f 73 73 69 62 6c 65 | 20 74 6f 20 64 65 74 65 |possible| to dete|
|000039b0| 72 6d 69 6e 65 20 77 68 | 65 74 68 65 72 20 61 20 |rmine wh|ether a |
|000039c0| 74 75 6d 6f 72 20 69 73 | 20 6c 69 6d 69 74 65 64 |tumor is| limited|
|000039d0| 20 74 6f 0d 0a 74 68 65 | 20 72 65 63 74 61 6c 20 | to..the| rectal |
|000039e0| 77 61 6c 6c 20 6f 72 20 | 69 73 20 65 78 74 65 6e |wall or |is exten|
|000039f0| 64 69 6e 67 20 69 6e 74 | 6f 20 74 68 65 20 73 75 |ding int|o the su|
|00003a00| 72 72 6f 75 6e 64 69 6e | 67 20 74 69 73 73 75 65 |rroundin|g tissue|
|00003a10| 2e 20 20 48 6f 77 65 76 | 65 72 2c 20 74 6f 0d 0a |. Howev|er, to..|
|00003a20| 73 65 6c 65 63 74 20 74 | 68 65 20 61 70 70 72 6f |select t|he appro|
|00003a30| 70 72 69 61 74 65 20 74 | 79 70 65 20 6f 66 20 73 |priate t|ype of s|
|00003a40| 75 72 67 69 63 61 6c 20 | 70 72 6f 63 65 64 75 72 |urgical |procedur|
|00003a50| 65 20 66 6f 72 20 74 72 | 65 61 74 69 6e 67 20 74 |e for tr|eating t|
|00003a60| 68 65 20 70 61 74 69 65 | 6e 74 2c 20 61 6e 0d 0a |he patie|nt, an..|
|00003a70| 61 63 63 75 72 61 74 65 | 20 61 73 73 65 73 73 6d |accurate| assessm|
|00003a80| 65 6e 74 20 6f 66 20 74 | 68 65 20 74 75 6d 6f 72 |ent of t|he tumor|
|00003a90| 20 65 78 74 65 6e 73 69 | 6f 6e 20 69 73 20 65 73 | extensi|on is es|
|00003aa0| 73 65 6e 74 69 61 6c 2e | 20 20 41 6c 74 68 6f 75 |sential.| Althou|
|00003ab0| 67 68 20 43 54 20 68 61 | 73 0d 0a 69 6d 70 72 6f |gh CT ha|s..impro|
|00003ac0| 76 65 64 20 74 68 65 20 | 64 69 61 67 6e 6f 73 69 |ved the |diagnosi|
|00003ad0| 73 20 6f 66 20 74 68 65 | 20 64 65 70 74 68 20 6f |s of the| depth o|
|00003ae0| 66 20 77 61 6c 6c 20 69 | 6e 76 61 73 69 6f 6e 2c |f wall i|nvasion,|
|00003af0| 20 69 74 20 63 61 6e 6e | 6f 74 20 64 65 6c 69 6e | it cann|ot delin|
|00003b00| 65 61 74 65 0d 0a 6c 61 | 79 65 72 20 73 74 72 75 |eate..la|yer stru|
|00003b10| 63 74 75 72 65 73 20 6f | 66 20 74 68 65 20 72 65 |ctures o|f the re|
|00003b20| 63 74 61 6c 20 77 61 6c | 6c 2e 20 20 48 69 67 68 |ctal wal|l. High|
|00003b30| 2d 72 65 73 6f 6c 75 74 | 69 6f 6e 20 65 6e 64 6f |-resolut|ion endo|
|00003b40| 72 65 63 74 61 6c 0d 0a | 75 6c 74 72 61 73 6f 6e |rectal..|ultrason|
|00003b50| 6f 67 72 61 70 68 79 20 | 75 73 69 6e 67 20 61 20 |ography |using a |
|00003b60| 72 61 64 69 61 6c 20 73 | 63 61 6e 6e 65 72 20 77 |radial s|canner w|
|00003b70| 61 73 20 75 73 65 64 20 | 74 6f 20 61 73 73 65 73 |as used |to asses|
|00003b80| 73 20 74 68 65 20 64 65 | 70 74 68 20 6f 66 20 72 |s the de|pth of r|
|00003b90| 65 63 74 61 6c 0d 0a 63 | 61 6e 63 65 72 20 69 6e |ectal..c|ancer in|
|00003ba0| 76 61 73 69 6f 6e 2e 0d | 0a 20 20 20 20 20 49 6e |vasion..|. In|
|00003bb0| 20 31 32 32 20 70 61 74 | 69 65 6e 74 73 20 72 65 | 122 pat|ients re|
|00003bc0| 63 74 61 6c 20 63 61 6e | 63 65 72 20 77 61 73 20 |ctal can|cer was |
|00003bd0| 63 6f 6e 66 69 72 6d 65 | 64 20 62 79 20 65 6e 64 |confirme|d by end|
|00003be0| 6f 73 63 6f 70 69 63 20 | 62 69 6f 70 73 79 2e 20 |oscopic |biopsy. |
|00003bf0| 20 41 6c 6c 0d 0a 70 61 | 74 69 65 6e 74 73 20 75 | All..pa|tients u|
|00003c00| 6e 64 65 72 77 65 6e 74 | 20 73 75 72 67 69 63 61 |nderwent| surgica|
|00003c10| 6c 20 72 65 73 65 63 74 | 69 6f 6e 20 69 6d 6d 65 |l resect|ion imme|
|00003c20| 64 69 61 74 65 6c 79 20 | 61 66 74 65 72 20 75 6c |diately |after ul|
|00003c30| 74 72 61 73 6f 75 6e 64 | 20 65 76 61 6c 75 61 74 |trasound| evaluat|
|00003c40| 69 6f 6e 2e 0d 0a 54 68 | 65 20 66 69 6e 64 69 6e |ion...Th|e findin|
|00003c50| 67 73 20 6f 6e 20 68 69 | 73 74 6f 6c 6f 67 69 63 |gs on hi|stologic|
|00003c60| 20 65 78 61 6d 69 6e 61 | 74 69 6f 6e 20 6f 66 20 | examina|tion of |
|00003c70| 74 68 65 20 73 75 72 67 | 69 63 61 6c 6c 79 20 72 |the surg|ically r|
|00003c80| 65 6d 6f 76 65 64 20 73 | 70 65 63 69 6d 65 6e 73 |emoved s|pecimens|
|00003c90| 0d 0a 77 65 72 65 20 63 | 6f 6d 70 61 72 65 64 20 |..were c|ompared |
|00003ca0| 77 69 74 68 20 74 68 65 | 20 75 6c 74 72 61 73 6f |with the| ultraso|
|00003cb0| 75 6e 64 20 66 69 6e 64 | 69 6e 67 73 2c 20 77 69 |und find|ings, wi|
|00003cc0| 74 68 20 70 61 72 74 69 | 63 75 6c 61 72 20 61 74 |th parti|cular at|
|00003cd0| 74 65 6e 74 69 6f 6e 20 | 74 6f 20 74 68 65 0d 0a |tention |to the..|
|00003ce0| 64 65 70 74 68 20 6f 66 | 20 74 75 6d 6f 72 20 69 |depth of| tumor i|
|00003cf0| 6e 76 61 73 69 6f 6e 2c | 20 64 65 67 72 65 65 20 |nvasion,| degree |
|00003d00| 6f 66 20 69 6e 66 6c 61 | 6d 6d 61 74 6f 72 79 20 |of infla|mmatory |
|00003d10| 63 65 6c 6c 20 69 6e 66 | 69 6c 74 72 61 74 69 6f |cell inf|iltratio|
|00003d20| 6e 2c 20 61 6e 64 20 74 | 68 65 0d 0a 74 75 6d 6f |n, and t|he..tumo|
|00003d30| 72 27 73 20 69 6e 74 72 | 61 6d 75 72 61 6c 20 61 |r's intr|amural a|
|00003d40| 6e 64 20 65 78 74 72 61 | 6d 75 72 61 6c 20 67 72 |nd extra|mural gr|
|00003d50| 6f 77 74 68 20 70 61 74 | 74 65 72 6e 2e 0d 0a 20 |owth pat|tern... |
|00003d60| 20 20 20 20 45 6e 64 6f | 72 65 63 74 61 6c 20 75 | Endo|rectal u|
|00003d70| 6c 74 72 61 73 6f 75 6e | 64 20 63 6c 65 61 72 6c |ltrasoun|d clearl|
|00003d80| 79 20 64 65 70 69 63 74 | 65 64 20 74 68 65 20 35 |y depict|ed the 5|
|00003d90| 2d 6c 61 79 65 72 20 65 | 63 68 6f 67 72 61 70 68 |-layer e|chograph|
|00003da0| 69 63 0d 0a 73 74 72 75 | 63 74 75 72 65 73 2c 20 |ic..stru|ctures, |
|00003db0| 61 6e 64 20 69 6e 20 73 | 6f 6d 65 20 70 61 74 69 |and in s|ome pati|
|00003dc0| 65 6e 74 73 2c 20 37 2d | 6c 61 79 65 72 20 73 74 |ents, 7-|layer st|
|00003dd0| 72 75 63 74 75 72 65 73 | 20 69 6e 20 74 68 65 20 |ructures| in the |
|00003de0| 6e 6f 72 6d 61 6c 20 70 | 6f 72 74 69 6f 6e 20 6f |normal p|ortion o|
|00003df0| 66 0d 0a 74 68 65 20 72 | 65 63 74 61 6c 20 77 61 |f..the r|ectal wa|
|00003e00| 6c 6c 20 28 46 69 67 20 | 34 2d 31 33 29 2e 20 20 |ll (Fig |4-13). |
|00003e10| 43 61 6e 63 65 72 73 20 | 77 65 72 65 20 64 65 6d |Cancers |were dem|
|00003e20| 6f 6e 73 74 72 61 74 65 | 64 20 61 73 20 68 79 70 |onstrate|d as hyp|
|00003e30| 6f 65 63 68 6f 69 63 20 | 6c 65 73 69 6f 6e 73 0d |oechoic |lesions.|
|00003e40| 0a 28 46 69 67 20 34 2d | 31 34 29 2e 20 20 55 6c |.(Fig 4-|14). Ul|
|00003e50| 74 72 61 73 6f 6e 6f 67 | 72 61 70 68 79 20 63 6f |trasonog|raphy co|
|00003e60| 72 72 65 63 74 6c 79 20 | 69 64 65 6e 74 69 66 69 |rrectly |identifi|
|00003e70| 65 64 20 74 68 65 20 64 | 65 70 74 68 20 6f 66 20 |ed the d|epth of |
|00003e80| 63 61 6e 63 65 72 20 69 | 6e 76 61 73 69 6f 6e 0d |cancer i|nvasion.|
|00003e90| 0a 69 6e 20 39 35 20 70 | 61 74 69 65 6e 74 73 20 |.in 95 p|atients |
|00003ea0| 28 37 38 25 29 2c 20 6f | 76 65 72 65 73 74 69 6d |(78%), o|verestim|
|00003eb0| 61 74 65 64 20 74 68 65 | 20 64 65 70 74 68 20 69 |ated the| depth i|
|00003ec0| 6e 20 32 31 20 70 61 74 | 69 65 6e 74 73 2c 20 61 |n 21 pat|ients, a|
|00003ed0| 6e 64 0d 0a 75 6e 64 65 | 72 65 73 74 69 6d 61 74 |nd..unde|restimat|
|00003ee0| 65 64 20 74 68 65 20 64 | 65 70 74 68 20 69 6e 20 |ed the d|epth in |
|00003ef0| 36 2e 20 20 49 6e 66 6c | 61 6d 6d 61 74 6f 72 79 |6. Infl|ammatory|
|00003f00| 20 63 65 6c 6c 20 69 6e | 66 69 6c 74 72 61 74 69 | cell in|filtrati|
|00003f10| 6f 6e 20 61 72 6f 75 6e | 64 20 74 68 65 0d 0a 63 |on aroun|d the..c|
|00003f20| 61 6e 63 65 72 20 77 61 | 73 20 72 65 73 70 6f 6e |ancer wa|s respon|
|00003f30| 73 69 62 6c 65 20 66 6f | 72 20 74 68 65 20 6f 76 |sible fo|r the ov|
|00003f40| 65 72 65 73 74 69 6d 61 | 74 69 6f 6e 73 2e 20 20 |erestima|tions. |
|00003f50| 4d 69 63 72 6f 73 63 6f | 70 69 63 61 6c 6c 79 20 |Microsco|pically |
|00003f60| 6d 69 6e 69 6d 61 6c 0d | 0a 69 6e 76 61 73 69 6f |minimal.|.invasio|
|00003f70| 6e 20 6f 66 20 74 68 65 | 20 74 75 6d 6f 72 20 77 |n of the| tumor w|
|00003f80| 61 73 20 70 72 6f 62 61 | 62 6c 79 20 72 65 73 70 |as proba|bly resp|
|00003f90| 6f 6e 73 69 62 6c 65 20 | 66 6f 72 20 74 68 65 20 |onsible |for the |
|00003fa0| 75 6e 64 65 72 65 73 74 | 69 6d 61 74 69 6f 6e 73 |underest|imations|
|00003fb0| 2e 20 20 49 6e 20 31 0d | 0a 70 61 74 69 65 6e 74 |. In 1.|.patient|
|00003fc0| 20 77 69 74 68 20 72 65 | 63 75 72 72 65 6e 63 65 | with re|currence|
|00003fd0| 20 6f 66 20 61 20 70 72 | 65 76 69 6f 75 73 6c 79 | of a pr|eviously|
|00003fe0| 20 6f 70 65 72 61 74 65 | 64 20 6f 6e 20 65 6e 64 | operate|d on end|
|00003ff0| 6f 72 65 63 74 61 6c 20 | 63 61 6e 63 65 72 2c 0d |orectal |cancer,.|
|00004000| 0a 65 6e 64 6f 72 65 63 | 74 61 6c 20 75 6c 74 72 |.endorec|tal ultr|
|00004010| 61 73 6f 75 6e 64 20 73 | 68 6f 77 65 64 20 61 20 |asound s|howed a |
|00004020| 68 79 70 6f 65 63 68 6f | 69 63 20 6c 65 73 69 6f |hypoecho|ic lesio|
|00004030| 6e 20 69 6e 20 63 6f 6e | 74 61 63 74 20 77 69 74 |n in con|tact wit|
|00004040| 68 20 74 68 65 0d 0a 6d | 75 73 63 75 6c 61 72 69 |h the..m|usculari|
|00004050| 73 20 70 72 6f 70 72 69 | 61 20 28 46 69 67 20 34 |s propri|a (Fig 4|
|00004060| 2d 31 35 29 2c 20 77 68 | 69 63 68 20 77 61 73 20 |-15), wh|ich was |
|00004070| 63 6f 6e 66 69 72 6d 65 | 64 20 61 74 20 6f 70 65 |confirme|d at ope|
|00004080| 72 61 74 69 6f 6e 2e 0d | 0a 20 20 20 20 20 41 6c |ration..|. Al|
|00004090| 74 68 6f 75 67 68 20 65 | 6e 64 6f 72 65 63 74 61 |though e|ndorecta|
|000040a0| 6c 20 75 6c 74 72 61 73 | 6f 75 6e 64 20 73 74 69 |l ultras|ound sti|
|000040b0| 6c 6c 20 68 61 73 20 63 | 65 72 74 61 69 6e 20 6c |ll has c|ertain l|
|000040c0| 69 6d 69 74 61 74 69 6f | 6e 73 2c 20 74 68 69 73 |imitatio|ns, this|
|000040d0| 0d 0a 64 69 61 67 6e 6f | 73 74 69 63 20 6d 6f 64 |..diagno|stic mod|
|000040e0| 61 6c 69 74 79 20 70 72 | 6f 76 69 64 65 73 20 76 |ality pr|ovides v|
|000040f0| 61 6c 75 61 62 6c 65 20 | 61 64 64 69 74 69 6f 6e |aluable |addition|
|00004100| 61 6c 20 69 6e 66 6f 72 | 6d 61 74 69 6f 6e 20 69 |al infor|mation i|
|00004110| 6e 20 74 68 65 0d 0a 70 | 72 65 6f 70 65 72 61 74 |n the..p|reoperat|
|00004120| 69 76 65 20 73 74 61 67 | 69 6e 67 20 6f 66 20 72 |ive stag|ing of r|
|00004130| 65 63 74 61 6c 20 63 61 | 6e 63 65 72 2e 0d 0a 0d |ectal ca|ncer....|
|00004140| 0a 50 6f 73 74 2d 43 6f | 6d 6d 65 6e 74 0d 0a 0d |.Post-Co|mment...|
|00004150| 0a 20 20 20 20 20 54 68 | 65 73 65 20 4a 61 70 61 |. Th|ese Japa|
|00004160| 6e 65 73 65 20 61 75 74 | 68 6f 72 73 20 68 61 76 |nese aut|hors hav|
|00004170| 65 20 70 65 72 66 6f 72 | 6d 65 64 20 61 6e 20 65 |e perfor|med an e|
|00004180| 78 63 65 6c 6c 65 6e 74 | 20 73 74 75 64 79 20 77 |xcellent| study w|
|00004190| 69 74 68 20 76 65 72 79 | 20 67 6f 6f 64 0d 0a 70 |ith very| good..p|
|000041a0| 61 74 68 6f 6c 6f 67 69 | 63 20 63 6f 72 72 65 6c |athologi|c correl|
|000041b0| 61 74 69 6f 6e 2e 20 20 | 41 20 6e 75 6d 62 65 72 |ation. |A number|
|000041c0| 20 6f 66 20 72 65 70 6f | 72 74 73 20 68 61 76 65 | of repo|rts have|
|000041d0| 20 69 6e 64 69 63 61 74 | 65 64 20 74 68 61 74 20 | indicat|ed that |
|000041e0| 74 68 69 73 20 69 73 20 | 61 0d 0a 62 65 74 74 65 |this is |a..bette|
|000041f0| 72 20 73 74 61 67 69 6e | 67 20 74 65 63 68 6e 69 |r stagin|g techni|
|00004200| 71 75 65 20 74 68 61 6e | 20 65 69 74 68 65 72 20 |que than| either |
|00004210| 43 54 20 6f 72 20 4d 52 | 49 2e 20 20 4e 65 69 74 |CT or MR|I. Neit|
|00004220| 68 65 72 20 6f 66 20 74 | 68 65 73 65 20 74 65 63 |her of t|hese tec|
|00004230| 68 6e 69 71 75 65 73 0d | 0a 63 61 6e 20 64 65 74 |hniques.|.can det|
|00004240| 65 72 6d 69 6e 65 20 74 | 68 65 20 64 65 70 74 68 |ermine t|he depth|
|00004250| 20 6f 66 20 74 75 6d 6f | 72 20 65 78 74 65 6e 73 | of tumo|r extens|
|00004260| 69 6f 6e 20 77 69 74 68 | 69 6e 20 74 68 65 20 62 |ion with|in the b|
|00004270| 6f 77 65 6c 20 77 61 6c | 6c 2e 20 20 42 6f 74 68 |owel wal|l. Both|
|00004280| 20 61 72 65 2c 0d 0a 68 | 6f 77 65 76 65 72 2c 20 | are,..h|owever, |
|00004290| 65 66 66 65 63 74 69 76 | 65 20 69 6e 20 64 65 74 |effectiv|e in det|
|000042a0| 65 63 74 69 6e 67 20 74 | 75 6d 6f 72 20 65 78 74 |ecting t|umor ext|
|000042b0| 65 6e 73 69 6f 6e 20 74 | 6f 20 74 68 65 20 70 65 |ension t|o the pe|
|000042c0| 6c 76 69 63 20 73 69 64 | 65 20 77 61 6c 6c 20 61 |lvic sid|e wall a|
|000042d0| 6e 64 0d 0a 6f 74 68 65 | 72 20 63 6f 6e 74 69 67 |nd..othe|r contig|
|000042e0| 75 6f 75 73 20 73 74 72 | 75 63 74 75 72 65 73 2e |uous str|uctures.|
|000042f0| 20 20 54 68 65 79 20 63 | 61 6e 20 61 6c 73 6f 20 | They c|an also |
|00004300| 64 65 74 65 63 74 20 64 | 69 73 74 61 6e 74 20 6d |detect d|istant m|
|00004310| 65 74 61 73 74 61 73 65 | 73 2c 20 62 75 74 0d 0a |etastase|s, but..|
|00004320| 6e 65 69 74 68 65 72 20 | 63 61 6e 20 64 65 74 65 |neither |can dete|
|00004330| 63 74 20 74 75 6d 6f 72 | 20 69 6e 20 6e 6f 72 6d |ct tumor| in norm|
|00004340| 61 6c 20 73 69 7a 65 20 | 6e 6f 64 65 73 2e 20 20 |al size |nodes. |
|00004350| 41 6c 74 68 6f 75 67 68 | 20 65 6e 64 6f 72 65 63 |Although| endorec|
|00004360| 74 61 6c 20 75 6c 74 72 | 61 73 6f 75 6e 64 0d 0a |tal ultr|asound..|
|00004370| 6d 61 79 20 70 72 6f 76 | 65 20 65 66 66 69 63 61 |may prov|e effica|
|00004380| 63 69 6f 75 73 20 66 6f | 72 20 64 69 73 74 69 6e |cious fo|r distin|
|00004390| 67 75 69 73 68 69 6e 67 | 20 61 20 44 75 6b 65 73 |guishing| a Dukes|
|000043a0| 20 41 20 66 72 6f 6d 20 | 61 20 44 75 6b 65 73 20 | A from |a Dukes |
|000043b0| 42 20 6c 65 73 69 6f 6e | 2c 20 49 0d 0a 68 61 76 |B lesion|, I..hav|
|000043c0| 65 20 72 65 73 65 72 76 | 61 74 69 6f 6e 73 20 63 |e reserv|ations c|
|000043d0| 6f 6e 63 65 72 6e 69 6e | 67 20 74 68 65 20 61 62 |oncernin|g the ab|
|000043e0| 69 6c 69 74 79 20 6f 66 | 20 74 68 65 20 74 65 63 |ility of| the tec|
|000043f0| 68 6e 69 71 75 65 20 74 | 6f 20 64 69 66 66 65 72 |hnique t|o differ|
|00004400| 65 6e 74 69 61 74 65 20 | 61 0d 0a 44 75 6b 65 73 |entiate |a..Dukes|
|00004410| 20 42 20 66 72 6f 6d 20 | 61 20 44 75 6b 65 73 20 | B from |a Dukes |
|00004420| 43 20 6c 65 73 69 6f 6e | 2e 2d 2d 57 2e 4d 2e 20 |C lesion|.--W.M. |
|00004430| 54 68 6f 6d 70 73 6f 6e | 2c 20 4d 2e 44 2e 0d 0a |Thompson|, M.D...|
|00004440| 24 55 6e 69 71 75 65 5f | 49 44 7b 59 52 42 30 39 |$Unique_|ID{YRB09|
|00004450| 36 30 34 7d 0d 0a 24 54 | 69 74 6c 65 7b 53 75 73 |604}..$T|itle{Sus|
|00004460| 70 65 63 74 65 64 20 52 | 65 63 75 72 72 65 6e 74 |pected R|ecurrent|
|00004470| 20 52 65 63 74 6f 73 69 | 67 6d 6f 69 64 20 43 61 | Rectosi|gmoid Ca|
|00004480| 72 63 69 6e 6f 6d 61 20 | 41 66 74 65 72 20 41 62 |rcinoma |After Ab|
|00004490| 64 6f 6d 69 6e 6f 70 65 | 72 69 6e 65 61 6c 20 52 |dominope|rineal R|
|000044a0| 65 73 65 63 74 69 6f 6e | 3a 20 20 4d 52 20 49 6d |esection|: MR Im|
|000044b0| 61 67 69 6e 67 20 61 6e | 64 20 48 69 73 74 6f 70 |aging an|d Histop|
|000044c0| 61 74 68 6f 6c 6f 67 69 | 63 20 46 69 6e 64 69 6e |athologi|c Findin|
|000044d0| 67 73 7d 0d 0a 24 41 75 | 74 68 6f 72 7b 64 65 20 |gs}..$Au|thor{de |
|000044e0| 4c 61 6e 67 65 2c 20 45 | 45 0d 0a 46 65 63 68 6e |Lange, E|E..Fechn|
|000044f0| 65 72 2c 20 52 45 0d 0a | 57 61 6e 65 62 6f 2c 20 |er, RE..|Wanebo, |
|00004500| 48 4a 7d 0d 0a 24 41 66 | 66 69 6c 69 61 74 69 6f |HJ}..$Af|filiatio|
|00004510| 6e 7b 55 6e 69 76 20 6f | 66 20 56 69 72 67 69 6e |n{Univ o|f Virgin|
|00004520| 69 61 7d 0d 0a 24 4a 6f | 75 72 6e 61 6c 7b 52 61 |ia}..$Jo|urnal{Ra|
|00004530| 64 69 6f 6c 6f 67 79 7d | 0d 0a 24 56 6f 6c 75 6d |diology}|..$Volum|
|00004540| 65 7b 31 37 30 7d 0d 0a | 24 50 61 67 65 7b 33 32 |e{170}..|$Page{32|
|00004550| 33 2d 33 32 38 7d 0d 0a | 24 44 61 74 65 7b 46 65 |3-328}..|$Date{Fe|
|00004560| 62 72 75 61 72 79 20 31 | 39 38 39 7d 0d 0a 24 59 |bruary 1|989}..$Y|
|00004570| 42 56 6f 6c 7b 31 39 39 | 30 20 59 65 61 72 20 42 |BVol{199|0 Year B|
|00004580| 6f 6f 6b 20 6f 66 20 44 | 69 61 67 6e 6f 73 74 69 |ook of D|iagnosti|
|00004590| 63 20 52 61 64 69 6f 6c | 6f 67 79 7d 0d 0a 24 43 |c Radiol|ogy}..$C|
|000045a0| 68 61 70 74 65 72 7b 34 | 2d 31 31 7d 0d 0a 24 59 |hapter{4|-11}..$Y|
|000045b0| 42 45 64 69 74 6f 72 7b | 44 72 73 2e 20 42 72 61 |BEditor{|Drs. Bra|
|000045c0| 67 67 2c 20 48 65 6e 64 | 65 65 2c 20 4b 65 61 74 |gg, Hend|ee, Keat|
|000045d0| 73 2c 20 4b 69 72 6b 70 | 61 74 72 69 63 6b 2c 20 |s, Kirkp|atrick, |
|000045e0| 4d 69 6c 6c 65 72 2c 20 | 4f 73 62 6f 72 6e 2c 20 |Miller, |Osborn, |
|000045f0| 61 6e 64 20 54 68 6f 6d | 70 73 6f 6e 7d 0d 0a 24 |and Thom|pson}..$|
|00004600| 54 61 62 6c 65 7b 54 61 | 62 6c 65 20 4f 6d 69 74 |Table{Ta|ble Omit|
|00004610| 74 65 64 7d 0d 0a 24 43 | 6f 6d 6d 65 6e 74 61 74 |ted}..$C|ommentat|
|00004620| 6f 72 7b 57 2e 4d 2e 20 | 54 68 6f 6d 70 73 6f 6e |or{W.M. |Thompson|
|00004630| 2c 20 4d 2e 44 2e 7d 0d | 0a 0d 0a 43 6f 70 79 72 |, M.D.}.|...Copyr|
|00004640| 69 67 68 74 20 28 63 29 | 20 59 65 61 72 62 6f 6f |ight (c)| Yearboo|
|00004650| 6b 20 4d 65 64 69 63 61 | 6c 20 50 75 62 6c 69 73 |k Medica|l Publis|
|00004660| 68 65 72 73 2c 20 49 6e | 63 2e 2c 20 31 39 39 30 |hers, In|c., 1990|
|00004670| 0d 0a 0d 0a 31 39 39 30 | 20 59 65 61 72 20 42 6f |....1990| Year Bo|
|00004680| 6f 6b 20 6f 66 20 44 69 | 61 67 6e 6f 73 74 69 63 |ok of Di|agnostic|
|00004690| 20 52 61 64 69 6f 6c 6f | 67 79 20 28 52 29 0d 0a | Radiolo|gy (R)..|
|000046a0| 0d 0a 43 68 61 70 74 65 | 72 20 34 2d 2d 54 68 65 |..Chapte|r 4--The|
|000046b0| 20 41 62 64 6f 6d 65 6e | 0d 0a 0d 0a 47 61 73 74 | Abdomen|....Gast|
|000046c0| 72 6f 69 6e 74 65 73 74 | 69 6e 61 6c 20 54 72 61 |rointest|inal Tra|
|000046d0| 63 74 0d 0a 0d 0a 49 4d | 41 47 49 4e 47 20 54 45 |ct....IM|AGING TE|
|000046e0| 43 48 4e 49 51 55 45 53 | 0d 0a 0d 0a 2d 2d 2d 2d |CHNIQUES|....----|
|000046f0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004700| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004710| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004720| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004730| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 0d 0a 53 75 73 70 |--------|--..Susp|
|00004740| 65 63 74 65 64 20 52 65 | 63 75 72 72 65 6e 74 20 |ected Re|current |
|00004750| 52 65 63 74 6f 73 69 67 | 6d 6f 69 64 20 43 61 72 |Rectosig|moid Car|
|00004760| 63 69 6e 6f 6d 61 20 41 | 66 74 65 72 20 41 62 64 |cinoma A|fter Abd|
|00004770| 6f 6d 69 6e 6f 70 65 72 | 69 6e 65 61 6c 20 52 65 |ominoper|ineal Re|
|00004780| 73 65 63 74 69 6f 6e 3a | 0d 0a 4d 52 20 49 6d 61 |section:|..MR Ima|
|00004790| 67 69 6e 67 20 61 6e 64 | 20 48 69 73 74 6f 70 61 |ging and| Histopa|
|000047a0| 74 68 6f 6c 6f 67 69 63 | 20 46 69 6e 64 69 6e 67 |thologic| Finding|
|000047b0| 73 0d 0a 0d 0a 64 65 20 | 4c 61 6e 67 65 20 45 45 |s....de |Lange EE|
|000047c0| 2c 20 46 65 63 68 6e 65 | 72 20 52 45 2c 20 57 61 |, Fechne|r RE, Wa|
|000047d0| 6e 65 62 6f 20 48 4a 0d | 0a 28 55 6e 69 76 20 6f |nebo HJ.|.(Univ o|
|000047e0| 66 20 56 69 72 67 69 6e | 69 61 29 0d 0a 52 61 64 |f Virgin|ia)..Rad|
|000047f0| 69 6f 6c 6f 67 79 20 31 | 37 30 3a 33 32 33 2d 33 |iology 1|70:323-3|
|00004800| 32 38 2c 20 46 65 62 72 | 75 61 72 79 20 31 39 38 |28, Febr|uary 198|
|00004810| 39 0d 0a 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |9..-----|--------|
|00004820| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004830| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004840| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004850| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004860| 2d 0d 0a 0d 0a 41 62 73 | 74 72 61 63 74 0d 0a 0d |-....Abs|tract...|
|00004870| 0a 20 20 20 20 20 4d 61 | 67 6e 65 74 69 63 20 72 |. Ma|gnetic r|
|00004880| 65 73 6f 6e 61 6e 63 65 | 20 69 6d 61 67 69 6e 67 |esonance| imaging|
|00004890| 20 77 61 73 20 63 61 72 | 72 69 65 64 20 6f 75 74 | was car|ried out|
|000048a0| 20 74 6f 20 64 65 74 65 | 63 74 20 72 65 63 75 72 | to dete|ct recur|
|000048b0| 72 65 6e 74 20 74 75 6d | 6f 72 20 69 6e 0d 0a 31 |rent tum|or in..1|
|000048c0| 31 20 70 61 74 69 65 6e | 74 73 20 77 68 6f 20 68 |1 patien|ts who h|
|000048d0| 61 64 20 61 62 64 6f 6d | 69 6e 6f 70 65 72 69 6e |ad abdom|inoperin|
|000048e0| 65 61 6c 20 72 65 73 65 | 63 74 69 6f 6e 20 6f 66 |eal rese|ction of|
|000048f0| 20 72 65 63 74 6f 73 69 | 67 6d 6f 69 64 20 63 61 | rectosi|gmoid ca|
|00004900| 72 63 69 6e 6f 6d 61 2e | 0d 0a 54 77 65 6c 76 65 |rcinoma.|..Twelve|
|00004910| 20 73 75 73 70 65 63 74 | 20 6d 61 73 73 65 73 20 | suspect| masses |
|00004920| 69 6e 20 74 68 65 20 70 | 72 65 73 61 63 72 61 6c |in the p|resacral|
|00004930| 20 73 70 61 63 65 20 77 | 65 72 65 20 64 69 61 67 | space w|ere diag|
|00004940| 6e 6f 73 65 64 20 77 69 | 74 68 20 43 54 20 6f 72 |nosed wi|th CT or|
|00004950| 20 61 6e 0d 0a 65 6c 65 | 76 61 74 65 64 20 6c 65 | an..ele|vated le|
|00004960| 76 65 6c 20 6f 66 20 63 | 61 72 63 69 6e 6f 65 6d |vel of c|arcinoem|
|00004970| 62 72 79 6f 6e 69 63 20 | 61 6e 74 69 67 65 6e 2e |bryonic |antigen.|
|00004980| 20 20 54 68 65 20 6d 65 | 61 6e 20 69 6e 74 65 72 | The me|an inter|
|00004990| 76 61 6c 20 66 72 6f 6d | 20 70 72 65 76 69 6f 75 |val from| previou|
|000049a0| 73 0d 0a 73 75 72 67 65 | 72 79 20 77 61 73 20 38 |s..surge|ry was 8|
|000049b0| 20 6d 6f 6e 74 68 73 2e | 20 20 45 69 67 68 74 20 | months.| Eight |
|000049c0| 70 61 74 69 65 6e 74 73 | 20 68 61 64 20 68 61 64 |patients| had had|
|000049d0| 20 72 61 64 69 61 74 69 | 6f 6e 20 74 68 65 72 61 | radiati|on thera|
|000049e0| 70 79 20 69 6d 6d 65 64 | 69 61 74 65 6c 79 0d 0a |py immed|iately..|
|000049f0| 61 66 74 65 72 20 72 65 | 73 65 63 74 69 6f 6e 20 |after re|section |
|00004a00| 6f 66 20 74 68 65 20 70 | 72 69 6d 61 72 79 20 74 |of the p|rimary t|
|00004a10| 75 6d 6f 72 2e 0d 0a 20 | 20 20 20 20 49 6e 20 36 |umor... | In 6|
|00004a20| 20 70 61 74 69 65 6e 74 | 73 20 74 68 65 20 6d 61 | patient|s the ma|
|00004a30| 73 73 20 65 78 74 65 6e | 64 65 64 20 62 65 79 6f |ss exten|ded beyo|
|00004a40| 6e 64 20 74 68 65 20 70 | 72 65 73 61 63 72 61 6c |nd the p|resacral|
|00004a50| 20 72 65 67 69 6f 6e 20 | 28 46 69 67 20 34 2d 31 | region |(Fig 4-1|
|00004a60| 36 29 2e 0d 0a 54 65 6e | 20 6c 65 73 69 6f 6e 73 |6)...Ten| lesions|
|00004a70| 20 77 65 72 65 20 6d 61 | 6c 69 67 6e 61 6e 74 2c | were ma|lignant,|
|00004a80| 20 61 6e 64 20 32 20 77 | 65 72 65 20 6d 61 64 65 | and 2 w|ere made|
|00004a90| 20 75 70 20 6f 66 20 6e | 6f 6e 6e 65 6f 70 6c 61 | up of n|onneopla|
|00004aa0| 73 74 69 63 20 69 6e 66 | 6c 61 6d 6d 61 74 6f 72 |stic inf|lammator|
|00004ab0| 79 0d 0a 74 69 73 73 75 | 65 2e 20 20 53 69 67 6e |y..tissu|e. Sign|
|00004ac0| 61 6c 20 69 6e 74 65 6e | 73 69 74 69 65 73 20 77 |al inten|sities w|
|00004ad0| 65 72 65 20 63 6f 6d 70 | 61 72 61 62 6c 65 20 69 |ere comp|arable i|
|00004ae0| 6e 20 74 68 65 20 6d 61 | 6c 69 67 6e 61 6e 74 20 |n the ma|lignant |
|00004af0| 61 6e 64 20 62 65 6e 69 | 67 6e 0d 0a 6d 61 73 73 |and beni|gn..mass|
|00004b00| 65 73 2e 20 20 41 72 65 | 61 73 20 6f 66 20 68 69 |es. Are|as of hi|
|00004b10| 67 68 20 73 69 67 6e 61 | 6c 20 69 6e 74 65 6e 73 |gh signa|l intens|
|00004b20| 69 74 79 20 63 6f 72 72 | 65 6c 61 74 65 64 20 77 |ity corr|elated w|
|00004b30| 69 74 68 20 74 75 6d 6f | 72 2c 20 74 75 6d 6f 72 |ith tumo|r, tumor|
|00004b40| 20 6e 65 63 72 6f 73 69 | 73 2c 0d 0a 61 6e 64 20 | necrosi|s,..and |
|00004b50| 6e 6f 6e 74 75 6d 6f 72 | 6f 75 73 20 69 6e 66 6c |nontumor|ous infl|
|00004b60| 61 6d 6d 61 74 69 6f 6e | 20 61 6e 64 20 65 64 65 |ammation| and ede|
|00004b70| 6d 61 2e 20 20 4c 6f 77 | 20 73 69 67 6e 61 6c 20 |ma. Low| signal |
|00004b80| 69 6e 74 65 6e 73 69 74 | 79 20 63 6f 72 72 65 73 |intensit|y corres|
|00004b90| 70 6f 6e 64 65 64 20 74 | 6f 0d 0a 66 69 62 72 6f |ponded t|o..fibro|
|00004ba0| 73 69 73 20 69 6e 20 62 | 6f 74 68 20 6d 61 6c 69 |sis in b|oth mali|
|00004bb0| 67 6e 61 6e 74 20 61 6e | 64 20 62 65 6e 69 67 6e |gnant an|d benign|
|00004bc0| 20 6c 65 73 69 6f 6e 73 | 2e 0d 0a 20 20 20 20 20 | lesions|... |
|00004bd0| 54 68 65 20 65 78 74 65 | 6e 74 20 62 75 74 20 6e |The exte|nt but n|
|00004be0| 6f 74 20 74 68 65 20 6e | 61 74 75 72 65 20 6f 66 |ot the n|ature of|
|00004bf0| 20 61 20 70 72 65 73 61 | 63 72 61 6c 20 6d 61 73 | a presa|cral mas|
|00004c00| 73 20 63 61 6e 20 62 65 | 20 61 70 70 72 65 63 69 |s can be| appreci|
|00004c10| 61 74 65 64 20 6f 6e 0d | 0a 4d 52 20 69 6d 61 67 |ated on.|.MR imag|
|00004c20| 65 73 2e 0d 0a 0d 0a 50 | 6f 73 74 2d 43 6f 6d 6d |es.....P|ost-Comm|
|00004c30| 65 6e 74 0d 0a 0d 0a 20 | 20 20 20 20 41 20 6e 75 |ent.... | A nu|
|00004c40| 6d 62 65 72 20 6f 66 20 | 72 65 70 6f 72 74 73 20 |mber of |reports |
|00004c50| 68 61 76 65 20 73 75 67 | 67 65 73 74 65 64 20 74 |have sug|gested t|
|00004c60| 68 61 74 20 4d 52 49 20 | 77 69 6c 6c 20 62 65 20 |hat MRI |will be |
|00004c70| 61 62 6c 65 20 74 6f 20 | 64 69 66 66 65 72 65 6e |able to |differen|
|00004c80| 74 69 61 74 65 0d 0a 72 | 65 63 75 72 72 65 6e 74 |tiate..r|ecurrent|
|00004c90| 20 72 65 63 74 61 6c 20 | 63 61 72 63 69 6e 6f 6d | rectal |carcinom|
|00004ca0| 61 20 66 72 6f 6d 20 70 | 6f 73 74 6f 70 65 72 61 |a from p|ostopera|
|00004cb0| 74 69 76 65 20 66 69 62 | 72 6f 73 69 73 2e 20 20 |tive fib|rosis. |
|00004cc0| 44 65 20 4c 61 6e 67 65 | 20 61 6e 64 20 68 69 73 |De Lange| and his|
|00004cd0| 0d 0a 63 6f 6c 6c 65 61 | 67 75 65 73 20 68 61 76 |..collea|gues hav|
|00004ce0| 65 20 63 6f 6e 66 69 72 | 6d 65 64 20 77 68 61 74 |e confir|med what|
|00004cf0| 20 6d 61 6e 79 20 6f 66 | 20 75 73 20 69 6e 74 65 | many of| us inte|
|00004d00| 72 65 73 74 65 64 20 69 | 6e 20 67 61 73 74 72 6f |rested i|n gastro|
|00004d10| 69 6e 74 65 73 74 69 6e | 61 6c 0d 0a 6d 61 6c 69 |intestin|al..mali|
|00004d20| 67 6e 61 6e 63 79 20 68 | 61 76 65 20 73 75 73 70 |gnancy h|ave susp|
|00004d30| 65 63 74 65 64 3a 20 20 | 4d 52 49 20 77 69 6c 6c |ected: |MRI will|
|00004d40| 20 6e 6f 74 20 62 65 20 | 61 62 6c 65 20 74 6f 20 | not be |able to |
|00004d50| 64 65 74 65 63 74 20 73 | 75 62 74 6c 65 20 72 65 |detect s|ubtle re|
|00004d60| 63 75 72 72 65 6e 74 0d | 0a 74 75 6d 6f 72 20 69 |current.|.tumor i|
|00004d70| 6e 20 74 68 65 20 70 6f | 73 74 6f 70 65 72 61 74 |n the po|stoperat|
|00004d80| 69 76 65 20 62 65 64 2e | 20 20 49 74 20 61 70 70 |ive bed.| It app|
|00004d90| 65 61 72 73 20 74 68 61 | 74 20 62 69 6f 70 73 79 |ears tha|t biopsy|
|00004da0| 20 77 69 6c 6c 20 73 74 | 69 6c 6c 20 62 65 20 6e | will st|ill be n|
|00004db0| 65 65 64 65 64 0d 0a 74 | 6f 20 64 69 66 66 65 72 |eeded..t|o differ|
|00004dc0| 65 6e 74 69 61 74 65 20 | 72 65 63 75 72 72 65 6e |entiate |recurren|
|00004dd0| 63 65 20 66 72 6f 6d 20 | 70 6f 73 74 6f 70 65 72 |ce from |postoper|
|00004de0| 61 74 69 76 65 20 63 68 | 61 6e 67 65 2e 20 20 54 |ative ch|ange. T|
|00004df0| 68 69 73 20 73 75 67 67 | 65 73 74 73 20 74 68 61 |his sugg|ests tha|
|00004e00| 74 20 43 54 0d 0a 77 69 | 6c 6c 20 62 65 20 74 68 |t CT..wi|ll be th|
|00004e10| 65 20 6d 6f 64 61 6c 69 | 74 79 20 6f 66 20 63 68 |e modali|ty of ch|
|00004e20| 6f 69 63 65 20 74 6f 20 | 66 6f 6c 6c 6f 77 20 75 |oice to |follow u|
|00004e30| 70 20 74 68 65 73 65 20 | 70 61 74 69 65 6e 74 73 |p these |patients|
|00004e40| 2e 2d 2d 57 2e 4d 2e 20 | 54 68 6f 6d 70 73 6f 6e |.--W.M. |Thompson|
|00004e50| 2c 0d 0a 4d 2e 44 2e 0d | 0a 24 55 6e 69 71 75 65 |,..M.D..|.$Unique|
|00004e60| 5f 49 44 7b 59 52 42 30 | 39 36 30 35 7d 0d 0a 24 |_ID{YRB0|9605}..$|
|00004e70| 54 69 74 6c 65 7b 43 6c | 69 6e 69 63 61 6c 20 53 |Title{Cl|inical S|
|00004e80| 69 67 6e 69 66 69 63 61 | 6e 63 65 20 6f 66 20 41 |ignifica|nce of A|
|00004e90| 62 6e 6f 72 6d 61 6c 69 | 74 69 65 73 20 6f 66 20 |bnormali|ties of |
|00004ea0| 74 68 65 20 47 61 73 74 | 72 6f 69 6e 74 65 73 74 |the Gast|rointest|
|00004eb0| 69 6e 61 6c 20 54 72 61 | 63 74 20 44 65 74 65 63 |inal Tra|ct Detec|
|00004ec0| 74 65 64 20 62 79 20 41 | 62 64 6f 6d 69 6e 61 6c |ted by A|bdominal|
|00004ed0| 20 55 6c 74 72 61 73 6f | 75 6e 64 7d 0d 0a 24 41 | Ultraso|und}..$A|
|00004ee0| 75 74 68 6f 72 7b 53 63 | 68 6f 65 6c 6d 65 72 69 |uthor{Sc|hoelmeri|
|00004ef0| 63 68 2c 20 4a 0d 0a 44 | 69 61 7a 2c 20 41 0d 0a |ch, J..D|iaz, A..|
|00004f00| 56 6f 6c 6b 2c 20 42 41 | 0d 0a 53 70 61 6d 65 72 |Volk, BA|..Spamer|
|00004f10| 2c 20 43 0d 0a 42 72 61 | 6d 62 73 2c 20 48 4a 0d |, C..Bra|mbs, HJ.|
|00004f20| 0a 47 65 72 6f 6b 2c 20 | 57 7d 0d 0a 24 41 66 66 |.Gerok, |W}..$Aff|
|00004f30| 69 6c 69 61 74 69 6f 6e | 7b 55 6e 69 76 20 6f 66 |iliation|{Univ of|
|00004f40| 20 46 72 65 69 62 75 72 | 67 2c 20 57 65 73 74 20 | Freibur|g, West |
|00004f50| 47 65 72 6d 61 6e 79 7d | 0d 0a 24 4a 6f 75 72 6e |Germany}|..$Journ|
|00004f60| 61 6c 7b 44 69 67 20 44 | 69 73 20 53 63 69 7d 0d |al{Dig D|is Sci}.|
|00004f70| 0a 24 56 6f 6c 75 6d 65 | 7b 33 33 7d 0d 0a 24 50 |.$Volume|{33}..$P|
|00004f80| 61 67 65 7b 32 35 37 2d | 32 36 32 7d 0d 0a 24 44 |age{257-|262}..$D|
|00004f90| 61 74 65 7b 4d 61 72 63 | 68 20 31 39 38 38 7d 0d |ate{Marc|h 1988}.|
|00004fa0| 0a 24 59 42 56 6f 6c 7b | 31 39 39 30 20 59 65 61 |.$YBVol{|1990 Yea|
|00004fb0| 72 20 42 6f 6f 6b 20 6f | 66 20 44 69 61 67 6e 6f |r Book o|f Diagno|
|00004fc0| 73 74 69 63 20 52 61 64 | 69 6f 6c 6f 67 79 7d 0d |stic Rad|iology}.|
|00004fd0| 0a 24 43 68 61 70 74 65 | 72 7b 34 2d 31 32 7d 0d |.$Chapte|r{4-12}.|
|00004fe0| 0a 24 59 42 45 64 69 74 | 6f 72 7b 44 72 73 2e 20 |.$YBEdit|or{Drs. |
|00004ff0| 42 72 61 67 67 2c 20 48 | 65 6e 64 65 65 2c 20 4b |Bragg, H|endee, K|
|00005000| 65 61 74 73 2c 20 4b 69 | 72 6b 70 61 74 72 69 63 |eats, Ki|rkpatric|
|00005010| 6b 2c 20 4d 69 6c 6c 65 | 72 2c 20 4f 73 62 6f 72 |k, Mille|r, Osbor|
|00005020| 6e 2c 20 61 6e 64 20 54 | 68 6f 6d 70 73 6f 6e 7d |n, and T|hompson}|
|00005030| 0d 0a 24 54 61 62 6c 65 | 7b 7d 0d 0a 24 43 6f 6d |..$Table|{}..$Com|
|00005040| 6d 65 6e 74 61 74 6f 72 | 7b 57 2e 4d 2e 20 54 68 |mentator|{W.M. Th|
|00005050| 6f 6d 70 73 6f 6e 2c 20 | 4d 2e 44 2e 7d 0d 0a 0d |ompson, |M.D.}...|
|00005060| 0a 43 6f 70 79 72 69 67 | 68 74 20 28 63 29 20 59 |.Copyrig|ht (c) Y|
|00005070| 65 61 72 62 6f 6f 6b 20 | 4d 65 64 69 63 61 6c 20 |earbook |Medical |
|00005080| 50 75 62 6c 69 73 68 65 | 72 73 2c 20 49 6e 63 2e |Publishe|rs, Inc.|
|00005090| 2c 20 31 39 39 30 0d 0a | 0d 0a 31 39 39 30 20 59 |, 1990..|..1990 Y|
|000050a0| 65 61 72 20 42 6f 6f 6b | 20 6f 66 20 44 69 61 67 |ear Book| of Diag|
|000050b0| 6e 6f 73 74 69 63 20 52 | 61 64 69 6f 6c 6f 67 79 |nostic R|adiology|
|000050c0| 20 28 52 29 0d 0a 0d 0a | 43 68 61 70 74 65 72 20 | (R)....|Chapter |
|000050d0| 34 2d 2d 54 68 65 20 41 | 62 64 6f 6d 65 6e 0d 0a |4--The A|bdomen..|
|000050e0| 0d 0a 47 61 73 74 72 6f | 69 6e 74 65 73 74 69 6e |..Gastro|intestin|
|000050f0| 61 6c 20 54 72 61 63 74 | 0d 0a 0d 0a 49 4d 41 47 |al Tract|....IMAG|
|00005100| 49 4e 47 20 54 45 43 48 | 4e 49 51 55 45 53 0d 0a |ING TECH|NIQUES..|
|00005110| 0d 0a 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |..------|--------|
|00005120| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005130| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005140| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005150| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005160| 0d 0a 43 6c 69 6e 69 63 | 61 6c 20 53 69 67 6e 69 |..Clinic|al Signi|
|00005170| 66 69 63 61 6e 63 65 20 | 6f 66 20 41 62 6e 6f 72 |ficance |of Abnor|
|00005180| 6d 61 6c 69 74 69 65 73 | 20 6f 66 20 74 68 65 20 |malities| of the |
|00005190| 47 61 73 74 72 6f 69 6e | 74 65 73 74 69 6e 61 6c |Gastroin|testinal|
|000051a0| 20 54 72 61 63 74 20 44 | 65 74 65 63 74 65 64 0d | Tract D|etected.|
|000051b0| 0a 62 79 20 41 62 64 6f | 6d 69 6e 61 6c 20 55 6c |.by Abdo|minal Ul|
|000051c0| 74 72 61 73 6f 75 6e 64 | 0d 0a 0d 0a 53 63 68 6f |trasound|....Scho|
|000051d0| 65 6c 6d 65 72 69 63 68 | 20 4a 2c 20 44 69 61 7a |elmerich| J, Diaz|
|000051e0| 20 41 2c 20 56 6f 6c 6b | 20 42 41 2c 20 53 70 61 | A, Volk| BA, Spa|
|000051f0| 6d 65 72 20 43 2c 20 42 | 72 61 6d 62 73 20 48 4a |mer C, B|rambs HJ|
|00005200| 2c 20 47 65 72 6f 6b 20 | 57 0d 0a 28 55 6e 69 76 |, Gerok |W..(Univ|
|00005210| 20 6f 66 20 46 72 65 69 | 62 75 72 67 2c 20 57 65 | of Frei|burg, We|
|00005220| 73 74 20 47 65 72 6d 61 | 6e 79 29 0d 0a 44 69 67 |st Germa|ny)..Dig|
|00005230| 20 44 69 73 20 53 63 69 | 20 33 33 3a 32 35 37 2d | Dis Sci| 33:257-|
|00005240| 32 36 32 2c 20 4d 61 72 | 63 68 20 31 39 38 38 0d |262, Mar|ch 1988.|
|00005250| 0a 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |.-------|--------|
|00005260| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005270| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005280| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005290| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 0d |--------|-------.|
|000052a0| 0a 0d 0a 41 62 73 74 72 | 61 63 74 0d 0a 0d 0a 20 |...Abstr|act.... |
|000052b0| 20 20 20 20 53 65 76 65 | 72 61 6c 20 70 72 65 76 | Seve|ral prev|
|000052c0| 69 6f 75 73 20 73 74 75 | 64 69 65 73 20 68 61 76 |ious stu|dies hav|
|000052d0| 65 20 64 65 73 63 72 69 | 62 65 64 20 74 68 65 20 |e descri|bed the |
|000052e0| 75 6c 74 72 61 73 6f 75 | 6e 64 20 70 61 74 74 65 |ultrasou|nd patte|
|000052f0| 72 6e 73 20 61 6e 64 20 | 61 0d 0a 6e 75 6d 62 65 |rns and |a..numbe|
|00005300| 72 20 6f 66 20 61 74 79 | 70 69 63 61 6c 20 74 61 |r of aty|pical ta|
|00005310| 72 67 65 74 20 73 69 67 | 6e 73 20 6f 66 20 64 69 |rget sig|ns of di|
|00005320| 73 6f 72 64 65 72 73 20 | 74 68 61 74 20 61 66 66 |sorders |that aff|
|00005330| 65 63 74 20 74 68 65 20 | 67 61 73 74 72 6f 69 6e |ect the |gastroin|
|00005340| 74 65 73 74 69 6e 61 6c | 0d 0a 28 47 49 29 20 74 |testinal|..(GI) t|
|00005350| 72 61 63 74 2e 20 20 48 | 6f 77 65 76 65 72 2c 20 |ract. H|owever, |
|00005360| 74 68 65 20 63 6c 69 6e | 69 63 61 6c 20 73 69 67 |the clin|ical sig|
|00005370| 6e 69 66 69 63 61 6e 63 | 65 20 61 6e 64 20 74 68 |nificanc|e and th|
|00005380| 65 20 6e 65 65 64 20 66 | 6f 72 20 61 20 66 75 72 |e need f|or a fur|
|00005390| 74 68 65 72 0d 0a 64 69 | 61 67 6e 6f 73 74 69 63 |ther..di|agnostic|
|000053a0| 20 77 6f 72 6b 2d 75 70 | 20 77 68 65 6e 20 73 75 | work-up| when su|
|000053b0| 63 68 20 66 65 61 74 75 | 72 65 73 20 61 72 65 20 |ch featu|res are |
|000053c0| 66 6f 75 6e 64 20 68 61 | 76 65 20 6e 6f 74 20 79 |found ha|ve not y|
|000053d0| 65 74 20 62 65 65 6e 0d | 0a 73 79 73 74 65 6d 61 |et been.|.systema|
|000053e0| 74 69 63 61 6c 6c 79 20 | 73 74 75 64 69 65 64 2e |tically |studied.|
|000053f0| 20 20 41 20 70 72 6f 73 | 70 65 63 74 69 76 65 20 | A pros|pective |
|00005400| 73 74 75 64 79 20 77 61 | 73 20 69 6e 69 74 69 61 |study wa|s initia|
|00005410| 74 65 64 20 74 6f 20 66 | 75 72 74 68 65 72 20 64 |ted to f|urther d|
|00005420| 65 66 69 6e 65 0d 0a 74 | 68 65 20 73 69 67 6e 69 |efine..t|he signi|
|00005430| 66 69 63 61 6e 63 65 20 | 6f 66 20 73 75 63 68 20 |ficance |of such |
|00005440| 75 6c 74 72 61 73 6f 75 | 6e 64 20 66 69 6e 64 69 |ultrasou|nd findi|
|00005450| 6e 67 73 2e 0d 0a 20 20 | 20 20 20 54 68 65 20 73 |ngs... | The s|
|00005460| 74 75 64 79 20 70 6f 70 | 75 6c 61 74 69 6f 6e 20 |tudy pop|ulation |
|00005470| 63 6f 6e 73 69 73 74 65 | 64 20 6f 66 20 31 30 30 |consiste|d of 100|
|00005480| 20 70 61 74 69 65 6e 74 | 73 20 77 69 74 68 20 61 | patient|s with a|
|00005490| 62 6e 6f 72 6d 61 6c 69 | 74 69 65 73 20 6f 66 20 |bnormali|ties of |
|000054a0| 74 68 65 0d 0a 47 49 20 | 74 72 61 63 74 20 64 65 |the..GI |tract de|
|000054b0| 74 65 63 74 65 64 20 62 | 79 20 72 6f 75 74 69 6e |tected b|y routin|
|000054c0| 65 20 75 6c 74 72 61 73 | 6f 75 6e 64 20 65 78 61 |e ultras|ound exa|
|000054d0| 6d 69 6e 61 74 69 6f 6e | 2e 20 20 42 61 73 65 64 |mination|. Based|
|000054e0| 20 6f 6e 20 74 68 65 73 | 65 20 66 69 6e 64 69 6e | on thes|e findin|
|000054f0| 67 73 2c 0d 0a 70 61 74 | 69 65 6e 74 73 20 77 65 |gs,..pat|ients we|
|00005500| 72 65 20 64 69 76 69 64 | 65 64 20 69 6e 74 6f 20 |re divid|ed into |
|00005510| 34 20 67 72 6f 75 70 73 | 2c 20 69 6e 63 6c 75 64 |4 groups|, includ|
|00005520| 69 6e 67 20 32 30 20 77 | 69 74 68 20 73 74 6f 6d |ing 20 w|ith stom|
|00005530| 61 63 68 2d 72 65 6c 61 | 74 65 64 20 74 61 72 67 |ach-rela|ted targ|
|00005540| 65 74 0d 0a 73 69 67 6e | 73 2c 20 35 31 20 77 69 |et..sign|s, 51 wi|
|00005550| 74 68 20 62 6f 77 65 6c | 2d 72 65 6c 61 74 65 64 |th bowel|-related|
|00005560| 20 74 61 72 67 65 74 20 | 73 69 67 6e 73 2c 20 31 | target |signs, 1|
|00005570| 30 20 77 69 74 68 20 62 | 6f 77 65 6c 20 63 6f 6e |0 with b|owel con|
|00005580| 67 6c 6f 6d 65 72 61 74 | 65 73 2c 20 61 6e 64 20 |glomerat|es, and |
|00005590| 31 39 0d 0a 77 69 74 68 | 20 73 6f 6c 69 64 2d 6d |19..with| solid-m|
|000055a0| 61 73 73 20 6c 65 73 69 | 6f 6e 73 2e 20 20 41 20 |ass lesi|ons. A |
|000055b0| 66 69 6e 64 69 6e 67 20 | 77 61 73 20 63 6f 6e 73 |finding |was cons|
|000055c0| 69 64 65 72 65 64 20 66 | 61 6c 73 65 6c 79 20 70 |idered f|alsely p|
|000055d0| 6f 73 69 74 69 76 65 20 | 69 66 20 61 0d 0a 63 6f |ositive |if a..co|
|000055e0| 6d 70 6c 65 74 65 20 77 | 6f 72 6b 2d 75 70 20 66 |mplete w|ork-up f|
|000055f0| 61 69 6c 65 64 20 74 6f | 20 63 6f 6e 66 69 72 6d |ailed to| confirm|
|00005600| 20 61 20 72 65 6c 61 74 | 65 64 20 64 69 73 6f 72 | a relat|ed disor|
|00005610| 64 65 72 2e 0d 0a 20 20 | 20 20 20 53 65 76 65 6e |der... | Seven|
|00005620| 20 6f 66 20 74 68 65 20 | 32 30 20 70 61 74 69 65 | of the |20 patie|
|00005630| 6e 74 73 20 77 69 74 68 | 20 73 74 6f 6d 61 63 68 |nts with| stomach|
|00005640| 2d 72 65 6c 61 74 65 64 | 20 74 61 72 67 65 74 20 |-related| target |
|00005650| 73 69 67 6e 73 20 77 65 | 72 65 20 6c 61 74 65 72 |signs we|re later|
|00005660| 0d 0a 66 6f 75 6e 64 20 | 74 6f 20 68 61 76 65 20 |..found |to have |
|00005670| 63 61 72 63 69 6e 6f 6d | 61 20 6f 66 20 74 68 65 |carcinom|a of the|
|00005680| 20 73 74 6f 6d 61 63 68 | 2c 20 32 20 68 61 64 20 | stomach|, 2 had |
|00005690| 6c 79 6d 70 68 6f 6d 61 | 20 6f 66 20 74 68 65 20 |lymphoma| of the |
|000056a0| 73 74 6f 6d 61 63 68 2c | 20 32 20 68 61 64 0d 0a |stomach,| 2 had..|
|000056b0| 70 79 6c 6f 72 69 63 20 | 73 74 65 6e 6f 73 69 73 |pyloric |stenosis|
|000056c0| 2c 20 61 6e 64 20 31 20 | 68 61 64 20 73 61 72 63 |, and 1 |had sarc|
|000056d0| 6f 69 64 6f 73 69 73 20 | 77 69 74 68 20 67 61 73 |oidosis |with gas|
|000056e0| 74 72 69 63 20 69 6e 76 | 6f 6c 76 65 6d 65 6e 74 |tric inv|olvement|
|000056f0| 2e 20 20 54 68 65 0d 0a | 70 6f 73 69 74 69 76 65 |. The..|positive|
|00005700| 20 70 72 65 64 69 63 74 | 69 76 65 20 76 61 6c 75 | predict|ive valu|
|00005710| 65 20 28 50 50 56 29 20 | 6f 66 20 74 68 65 20 75 |e (PPV) |of the u|
|00005720| 6c 74 72 61 73 6f 75 6e | 64 20 66 69 6e 64 69 6e |ltrasoun|d findin|
|00005730| 67 73 20 66 6f 72 20 74 | 68 69 73 20 67 72 6f 75 |gs for t|his grou|
|00005740| 70 20 77 61 73 0d 0a 38 | 30 25 2e 20 20 54 77 65 |p was..8|0%. Twe|
|00005750| 6e 74 79 2d 66 69 76 65 | 20 28 34 39 25 29 20 6f |nty-five| (49%) o|
|00005760| 66 20 74 68 65 20 35 31 | 20 70 61 74 69 65 6e 74 |f the 51| patient|
|00005770| 73 20 77 69 74 68 20 62 | 6f 77 65 6c 2d 72 65 6c |s with b|owel-rel|
|00005780| 61 74 65 64 20 74 61 72 | 67 65 74 20 73 69 67 6e |ated tar|get sign|
|00005790| 73 20 68 61 64 0d 0a 74 | 72 75 65 20 70 6f 73 69 |s had..t|rue posi|
|000057a0| 74 69 76 65 20 66 69 6e | 64 69 6e 67 73 20 6f 6e |tive fin|dings on|
|000057b0| 20 75 6c 74 72 61 73 6f | 75 6e 64 20 61 73 20 63 | ultraso|und as c|
|000057c0| 6f 6e 66 69 72 6d 65 64 | 20 62 79 20 72 61 64 69 |onfirmed| by radi|
|000057d0| 6f 6c 6f 67 69 63 20 6f | 72 20 65 6e 64 6f 73 63 |ologic o|r endosc|
|000057e0| 6f 70 69 63 0d 0a 70 72 | 6f 63 65 64 75 72 65 73 |opic..pr|ocedures|
|000057f0| 2e 20 20 54 68 65 20 50 | 50 56 20 69 6e 20 74 68 |. The P|PV in th|
|00005800| 69 73 20 67 72 6f 75 70 | 20 77 61 73 20 37 35 25 |is group| was 75%|
|00005810| 2e 20 20 45 69 67 68 74 | 20 28 38 30 25 29 20 6f |. Eight| (80%) o|
|00005820| 66 20 74 68 65 20 31 30 | 20 70 61 74 69 65 6e 74 |f the 10| patient|
|00005830| 73 0d 0a 77 69 74 68 20 | 62 6f 77 65 6c 20 63 6f |s..with |bowel co|
|00005840| 6e 67 6c 6f 6d 65 72 61 | 74 65 73 20 6f 6e 20 75 |nglomera|tes on u|
|00005850| 6c 74 72 61 73 6f 75 6e | 64 20 77 65 72 65 20 66 |ltrasoun|d were f|
|00005860| 6f 75 6e 64 20 74 6f 20 | 68 61 76 65 20 74 72 75 |ound to |have tru|
|00005870| 65 20 6d 61 6c 69 67 6e | 61 6e 74 0d 0a 64 69 73 |e malign|ant..dis|
|00005880| 65 61 73 65 3b 20 74 68 | 65 20 50 50 56 20 6f 66 |ease; th|e PPV of|
|00005890| 20 74 68 65 20 75 6c 74 | 72 61 73 6f 75 6e 64 20 | the ult|rasound |
|000058a0| 66 69 6e 64 69 6e 67 73 | 20 69 6e 20 74 68 65 73 |findings| in thes|
|000058b0| 65 20 70 61 74 69 65 6e | 74 73 20 77 61 73 20 31 |e patien|ts was 1|
|000058c0| 30 30 25 2e 20 20 4e 69 | 6e 65 0d 0a 6f 66 20 74 |00%. Ni|ne..of t|
|000058d0| 68 65 20 31 39 20 70 61 | 74 69 65 6e 74 73 20 77 |he 19 pa|tients w|
|000058e0| 69 74 68 20 73 6f 6c 69 | 64 2d 6d 61 73 73 20 6c |ith soli|d-mass l|
|000058f0| 65 73 69 6f 6e 73 20 68 | 61 64 20 6d 61 6c 69 67 |esions h|ad malig|
|00005900| 6e 61 6e 74 20 74 75 6d | 6f 72 73 2c 20 61 6e 64 |nant tum|ors, and|
|00005910| 20 33 20 68 61 64 0d 0a | 43 72 6f 68 6e 27 73 20 | 3 had..|Crohn's |
|00005920| 64 69 73 65 61 73 65 20 | 77 69 74 68 20 62 6f 77 |disease |with bow|
|00005930| 65 6c 20 63 6f 6e 67 6c | 6f 6d 65 72 61 74 65 73 |el congl|omerates|
|00005940| 2e 20 20 54 68 65 20 50 | 50 56 20 69 6e 20 74 68 |. The P|PV in th|
|00005950| 69 73 20 67 72 6f 75 70 | 20 77 61 73 20 38 33 25 |is group| was 83%|
|00005960| 2e 0d 0a 20 20 20 20 20 | 49 6e 20 61 6c 6c 2c 20 |... |In all, |
|00005970| 6e 6f 20 64 69 61 67 6e | 6f 73 69 73 20 77 61 73 |no diagn|osis was|
|00005980| 20 6d 61 64 65 20 69 6e | 20 39 20 70 61 74 69 65 | made in| 9 patie|
|00005990| 6e 74 73 2c 20 61 20 66 | 61 6c 73 65 20 70 6f 73 |nts, a f|alse pos|
|000059a0| 69 74 69 76 65 20 66 69 | 6e 64 69 6e 67 20 77 61 |itive fi|nding wa|
|000059b0| 73 0d 0a 6f 62 74 61 69 | 6e 65 64 20 6f 6e 20 75 |s..obtai|ned on u|
|000059c0| 6c 74 72 61 73 6f 75 6e | 64 20 69 6e 20 31 38 3b |ltrasoun|d in 18;|
|000059d0| 20 61 20 70 72 6f 62 61 | 62 6c 79 20 74 72 75 65 | a proba|bly true|
|000059e0| 20 70 6f 73 69 74 69 76 | 65 20 66 69 6e 64 69 6e | positiv|e findin|
|000059f0| 67 2c 20 69 6e 20 31 38 | 3b 20 61 6e 64 20 61 0d |g, in 18|; and a.|
|00005a00| 0a 64 69 73 65 61 73 65 | 20 64 65 66 69 6e 69 74 |.disease| definit|
|00005a10| 69 76 65 6c 79 20 72 65 | 6c 61 74 65 64 20 74 6f |ively re|lated to|
|00005a20| 20 74 68 65 20 61 62 6e | 6f 72 6d 61 6c 20 66 69 | the abn|ormal fi|
|00005a30| 6e 64 69 6e 67 73 20 6f | 6e 20 75 6c 74 72 61 73 |ndings o|n ultras|
|00005a40| 6f 75 6e 64 2c 20 69 6e | 20 35 35 0d 0a 70 61 74 |ound, in| 55..pat|
|00005a50| 69 65 6e 74 73 2e 20 20 | 54 68 65 20 6f 76 65 72 |ients. |The over|
|00005a60| 61 6c 6c 20 50 50 56 20 | 66 6f 72 20 75 6c 74 72 |all PPV |for ultr|
|00005a70| 61 73 6f 75 6e 64 20 66 | 69 6e 64 69 6e 67 73 20 |asound f|indings |
|00005a80| 69 6e 20 74 68 69 73 20 | 73 74 75 64 79 20 70 6f |in this |study po|
|00005a90| 70 75 6c 61 74 69 6f 6e | 0d 0a 77 61 73 20 38 30 |pulation|..was 80|
|00005aa0| 25 20 61 6e 64 20 77 61 | 73 20 37 33 25 20 77 68 |% and wa|s 73% wh|
|00005ab0| 65 6e 20 74 68 65 20 70 | 61 74 69 65 6e 74 73 20 |en the p|atients |
|00005ac0| 77 69 74 68 6f 75 74 20 | 64 69 61 67 6e 6f 73 69 |without |diagnosi|
|00005ad0| 73 20 77 65 72 65 20 69 | 6e 63 6c 75 64 65 64 2e |s were i|ncluded.|
|00005ae0| 20 20 54 68 65 0d 0a 72 | 65 73 75 6c 74 73 20 6f | The..r|esults o|
|00005af0| 66 20 74 68 69 73 20 61 | 6e 61 6c 79 73 69 73 20 |f this a|nalysis |
|00005b00| 69 6e 64 69 63 61 74 65 | 20 74 68 61 74 20 61 20 |indicate| that a |
|00005b10| 66 69 6e 64 69 6e 67 20 | 6f 6e 20 75 6c 74 72 61 |finding |on ultra|
|00005b20| 73 6f 75 6e 64 20 6f 66 | 20 61 0d 0a 73 74 6f 6d |sound of| a..stom|
|00005b30| 61 63 68 2d 72 65 6c 61 | 74 65 64 20 6f 72 20 62 |ach-rela|ted or b|
|00005b40| 6f 77 65 6c 2d 72 65 6c | 61 74 65 64 20 74 61 72 |owel-rel|ated tar|
|00005b50| 67 65 74 20 73 69 67 6e | 20 6f 72 20 6d 61 73 73 |get sign| or mass|
|00005b60| 20 68 61 73 20 61 20 68 | 69 67 68 20 63 6c 69 6e | has a h|igh clin|
|00005b70| 69 63 61 6c 0d 0a 72 65 | 6c 65 76 61 6e 63 65 20 |ical..re|levance |
|00005b80| 61 6e 64 20 73 68 6f 75 | 6c 64 20 62 65 20 66 75 |and shou|ld be fu|
|00005b90| 72 74 68 65 72 20 69 6e | 76 65 73 74 69 67 61 74 |rther in|vestigat|
|00005ba0| 65 64 2e 0d 0a 0d 0a 50 | 6f 73 74 2d 43 6f 6d 6d |ed.....P|ost-Comm|
|00005bb0| 65 6e 74 0d 0a 0d 0a 20 | 20 20 20 20 54 68 65 20 |ent.... | The |
|00005bc0| 73 69 67 6e 69 66 69 63 | 61 6e 63 65 20 6f 66 20 |signific|ance of |
|00005bd0| 74 68 69 73 20 61 72 74 | 69 63 6c 65 20 69 73 20 |this art|icle is |
|00005be0| 74 68 61 74 20 75 6c 74 | 72 61 73 6f 6e 6f 67 72 |that ult|rasonogr|
|00005bf0| 61 70 68 79 20 63 61 6e | 20 64 65 74 65 63 74 0d |aphy can| detect.|
|00005c00| 0a 67 61 73 74 72 6f 69 | 6e 74 65 73 74 69 6e 61 |.gastroi|ntestina|
|00005c10| 6c 20 61 62 6e 6f 72 6d | 61 6c 69 74 69 65 73 2e |l abnorm|alities.|
|00005c20| 20 20 54 68 75 73 2c 20 | 72 61 64 69 6f 6c 6f 67 | Thus, |radiolog|
|00005c30| 69 73 74 73 20 73 68 6f | 75 6c 64 20 62 65 20 66 |ists sho|uld be f|
|00005c40| 61 6d 69 6c 69 61 72 20 | 77 69 74 68 0d 0a 74 68 |amiliar |with..th|
|00005c50| 65 20 75 6c 74 72 61 73 | 6f 6e 6f 67 72 61 70 68 |e ultras|onograph|
|00005c60| 69 63 20 66 69 6e 64 69 | 6e 67 73 20 74 68 61 74 |ic findi|ngs that|
|00005c70| 20 63 61 6e 20 72 65 66 | 6c 65 63 74 20 67 61 73 | can ref|lect gas|
|00005c80| 74 72 6f 69 6e 74 65 73 | 74 69 6e 61 6c 20 70 61 |trointes|tinal pa|
|00005c90| 74 68 6f 6c 6f 67 79 2c | 20 62 75 74 0d 0a 77 65 |thology,| but..we|
|00005ca0| 20 73 68 6f 75 6c 64 20 | 6e 6f 74 20 62 65 20 64 | should |not be d|
|00005cb0| 65 6c 75 64 65 64 20 74 | 68 61 74 20 73 70 65 63 |eluded t|hat spec|
|00005cc0| 69 66 69 63 20 64 69 61 | 67 6e 6f 73 65 73 20 63 |ific dia|gnoses c|
|00005cd0| 61 6e 20 62 65 20 6d 61 | 64 65 20 66 72 6f 6d 20 |an be ma|de from |
|00005ce0| 74 68 65 0d 0a 75 6c 74 | 72 61 73 6f 75 6e 64 20 |the..ult|rasound |
|00005cf0| 66 69 6e 64 69 6e 67 73 | 2e 20 20 49 20 64 69 73 |findings|. I dis|
|00005d00| 61 67 72 65 65 20 77 69 | 74 68 20 74 68 65 20 63 |agree wi|th the c|
|00005d10| 6f 6e 63 6c 75 73 69 6f | 6e 20 74 68 61 74 20 61 |onclusio|n that a|
|00005d20| 6c 6c 20 70 61 74 69 65 | 6e 74 73 20 77 69 74 68 |ll patie|nts with|
|00005d30| 0d 0a 61 62 64 6f 6d 69 | 6e 61 6c 20 63 6f 6d 70 |..abdomi|nal comp|
|00005d40| 6c 61 69 6e 74 73 20 73 | 68 6f 75 6c 64 20 68 61 |laints s|hould ha|
|00005d50| 76 65 20 61 6e 20 75 6c | 74 72 61 73 6f 75 6e 64 |ve an ul|trasound|
|00005d60| 20 65 78 61 6d 69 6e 61 | 74 69 6f 6e 20 61 73 20 | examina|tion as |
|00005d70| 61 6e 20 69 6e 69 74 69 | 61 6c 0d 0a 69 6e 76 65 |an initi|al..inve|
|00005d80| 73 74 69 67 61 74 69 6f | 6e 2e 20 20 54 6f 20 6d |stigatio|n. To m|
|00005d90| 65 2c 20 74 68 69 73 20 | 6d 61 6b 65 73 20 61 73 |e, this |makes as|
|00005da0| 20 6d 75 63 68 20 73 65 | 6e 73 65 20 61 73 20 73 | much se|nse as s|
|00005db0| 75 67 67 65 73 74 69 6e | 67 20 74 68 61 74 20 65 |uggestin|g that e|
|00005dc0| 6e 64 6f 73 63 6f 70 79 | 0d 0a 73 68 6f 75 6c 64 |ndoscopy|..should|
|00005dd0| 20 62 65 20 70 65 72 66 | 6f 72 6d 65 64 20 69 6e | be perf|ormed in|
|00005de0| 20 61 6c 6c 20 70 61 74 | 69 65 6e 74 73 20 77 69 | all pat|ients wi|
|00005df0| 74 68 20 61 62 64 6f 6d | 69 6e 61 6c 20 70 61 69 |th abdom|inal pai|
|00005e00| 6e 2e 20 20 55 6e 66 6f | 72 74 75 6e 61 74 65 6c |n. Unfo|rtunatel|
|00005e10| 79 2c 20 74 68 69 73 0d | 0a 77 6f 72 6b 20 77 61 |y, this.|.work wa|
|00005e20| 73 20 70 65 72 66 6f 72 | 6d 65 64 20 62 79 20 67 |s perfor|med by g|
|00005e30| 61 73 74 72 6f 65 6e 74 | 65 72 6f 6c 6f 67 69 73 |astroent|erologis|
|00005e40| 74 73 20 77 69 74 68 6f | 75 74 20 72 61 64 69 6f |ts witho|ut radio|
|00005e50| 6c 6f 67 79 20 69 6e 70 | 75 74 2e 20 20 41 6c 74 |logy inp|ut. Alt|
|00005e60| 68 6f 75 67 68 0d 0a 74 | 68 65 72 65 20 61 72 65 |hough..t|here are|
|00005e70| 20 73 6f 6d 65 20 67 6f | 6f 64 20 70 6f 69 6e 74 | some go|od point|
|00005e80| 73 20 69 6e 20 74 68 65 | 20 61 72 74 69 63 6c 65 |s in the| article|
|00005e90| 2c 20 74 68 65 20 63 6f | 6e 63 6c 75 73 69 6f 6e |, the co|nclusion|
|00005ea0| 73 20 61 72 65 20 6e 6f | 74 20 6a 75 73 74 69 66 |s are no|t justif|
|00005eb0| 69 65 64 0d 0a 6e 6f 72 | 20 74 65 6d 70 65 72 65 |ied..nor| tempere|
|00005ec0| 64 20 77 69 74 68 20 72 | 61 64 69 6f 6c 6f 67 69 |d with r|adiologi|
|00005ed0| 63 20 69 6e 70 75 74 2c | 20 75 6e 64 65 72 73 74 |c input,| underst|
|00005ee0| 61 6e 64 69 6e 67 2c 20 | 61 6e 64 20 65 78 70 65 |anding, |and expe|
|00005ef0| 72 74 69 73 65 2e 2d 2d | 57 2e 4d 2e 0d 0a 54 68 |rtise.--|W.M...Th|
|00005f00| 6f 6d 70 73 6f 6e 2c 20 | 4d 2e 44 2e 0d 0a 24 55 |ompson, |M.D...$U|
|00005f10| 6e 69 71 75 65 5f 49 44 | 7b 59 52 42 30 39 36 30 |nique_ID|{YRB0960|
|00005f20| 36 7d 0d 0a 24 54 69 74 | 6c 65 7b 44 65 74 65 63 |6}..$Tit|le{Detec|
|00005f30| 74 69 6f 6e 20 6f 66 20 | 48 65 70 61 74 69 63 20 |tion of |Hepatic |
|00005f40| 4d 65 74 61 73 74 61 73 | 65 73 20 69 6e 20 44 69 |Metastas|es in Di|
|00005f50| 66 66 75 73 65 20 46 61 | 74 74 79 20 49 6e 66 69 |ffuse Fa|tty Infi|
|00005f60| 6c 74 72 61 74 69 6f 6e | 20 62 79 20 43 54 3a 20 |ltration| by CT: |
|00005f70| 20 54 68 65 20 43 6f 6d | 70 6c 65 6d 65 6e 74 61 | The Com|plementa|
|00005f80| 72 79 20 52 6f 6c 65 20 | 6f 66 20 49 6d 61 67 69 |ry Role |of Imagi|
|00005f90| 6e 67 7d 0d 0a 24 41 75 | 74 68 6f 72 7b 4c 69 70 |ng}..$Au|thor{Lip|
|00005fa0| 6d 61 6e 2c 20 4a 43 0d | 0a 53 74 6f 6d 70 65 72 |man, JC.|.Stomper|
|00005fb0| 2c 20 50 43 0d 0a 4b 61 | 70 6c 61 6e 2c 20 57 44 |, PC..Ka|plan, WD|
|00005fc0| 0d 0a 54 75 6d 65 68 2c | 20 53 53 7d 0d 0a 24 41 |..Tumeh,| SS}..$A|
|00005fd0| 66 66 69 6c 69 61 74 69 | 6f 6e 7b 42 72 69 67 68 |ffiliati|on{Brigh|
|00005fe0| 61 6d 20 61 6e 64 20 57 | 6f 6d 65 6e 27 73 20 48 |am and W|omen's H|
|00005ff0| 6f 73 70 2c 20 42 6f 73 | 74 6f 6e 3b 20 48 61 72 |osp, Bos|ton; Har|
|00006000| 76 61 72 64 20 4d 65 64 | 20 53 63 68 6f 6f 6c 7d |vard Med| School}|
|00006010| 0d 0a 24 4a 6f 75 72 6e | 61 6c 7b 43 6c 69 6e 20 |..$Journ|al{Clin |
|00006020| 4e 75 63 6c 20 4d 65 64 | 7d 0d 0a 24 56 6f 6c 75 |Nucl Med|}..$Volu|
|00006030| 6d 65 7b 31 33 7d 0d 0a | 24 50 61 67 65 7b 36 30 |me{13}..|$Page{60|
|00006040| 32 2d 36 30 35 7d 0d 0a | 24 44 61 74 65 7b 41 75 |2-605}..|$Date{Au|
|00006050| 67 75 73 74 20 31 39 38 | 38 7d 0d 0a 24 59 42 56 |gust 198|8}..$YBV|
|00006060| 6f 6c 7b 31 39 39 30 20 | 59 65 61 72 20 42 6f 6f |ol{1990 |Year Boo|
|00006070| 6b 20 6f 66 20 44 69 61 | 67 6e 6f 73 74 69 63 20 |k of Dia|gnostic |
|00006080| 52 61 64 69 6f 6c 6f 67 | 79 7d 0d 0a 24 43 68 61 |Radiolog|y}..$Cha|
|00006090| 70 74 65 72 7b 34 2d 31 | 33 7d 0d 0a 24 59 42 45 |pter{4-1|3}..$YBE|
|000060a0| 64 69 74 6f 72 7b 44 72 | 73 2e 20 42 72 61 67 67 |ditor{Dr|s. Bragg|
|000060b0| 2c 20 48 65 6e 64 65 65 | 2c 20 4b 65 61 74 73 2c |, Hendee|, Keats,|
|000060c0| 20 4b 69 72 6b 70 61 74 | 72 69 63 6b 2c 20 4d 69 | Kirkpat|rick, Mi|
|000060d0| 6c 6c 65 72 2c 20 4f 73 | 62 6f 72 6e 2c 20 61 6e |ller, Os|born, an|
|000060e0| 64 20 54 68 6f 6d 70 73 | 6f 6e 7d 0d 0a 24 54 61 |d Thomps|on}..$Ta|
|000060f0| 62 6c 65 7b 54 61 62 6c | 65 20 4f 6d 69 74 74 65 |ble{Tabl|e Omitte|
|00006100| 64 7d 0d 0a 24 43 6f 6d | 6d 65 6e 74 61 74 6f 72 |d}..$Com|mentator|
|00006110| 7b 57 2e 4d 2e 20 54 68 | 6f 6d 70 73 6f 6e 2c 20 |{W.M. Th|ompson, |
|00006120| 4d 2e 44 2e 7d 0d 0a 0d | 0a 43 6f 70 79 72 69 67 |M.D.}...|.Copyrig|
|00006130| 68 74 20 28 63 29 20 59 | 65 61 72 62 6f 6f 6b 20 |ht (c) Y|earbook |
|00006140| 4d 65 64 69 63 61 6c 20 | 50 75 62 6c 69 73 68 65 |Medical |Publishe|
|00006150| 72 73 2c 20 49 6e 63 2e | 2c 20 31 39 39 30 0d 0a |rs, Inc.|, 1990..|
|00006160| 0d 0a 31 39 39 30 20 59 | 65 61 72 20 42 6f 6f 6b |..1990 Y|ear Book|
|00006170| 20 6f 66 20 44 69 61 67 | 6e 6f 73 74 69 63 20 52 | of Diag|nostic R|
|00006180| 61 64 69 6f 6c 6f 67 79 | 20 28 52 29 0d 0a 0d 0a |adiology| (R)....|
|00006190| 43 68 61 70 74 65 72 20 | 34 2d 2d 54 68 65 20 41 |Chapter |4--The A|
|000061a0| 62 64 6f 6d 65 6e 0d 0a | 0d 0a 47 61 73 74 72 6f |bdomen..|..Gastro|
|000061b0| 69 6e 74 65 73 74 69 6e | 61 6c 20 54 72 61 63 74 |intestin|al Tract|
|000061c0| 0d 0a 0d 0a 4c 49 56 45 | 52 20 4d 45 54 41 53 54 |....LIVE|R METAST|
|000061d0| 41 53 45 53 20 49 4d 41 | 47 49 4e 47 0d 0a 0d 0a |ASES IMA|GING....|
|000061e0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000061f0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00006200| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00006210| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00006220| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 0d 0a |--------|------..|
|00006230| 44 65 74 65 63 74 69 6f | 6e 20 6f 66 20 48 65 70 |Detectio|n of Hep|
|00006240| 61 74 69 63 20 4d 65 74 | 61 73 74 61 73 65 73 20 |atic Met|astases |
|00006250| 69 6e 20 44 69 66 66 75 | 73 65 20 46 61 74 74 79 |in Diffu|se Fatty|
|00006260| 20 49 6e 66 69 6c 74 72 | 61 74 69 6f 6e 20 62 79 | Infiltr|ation by|
|00006270| 20 43 54 3a 20 20 54 68 | 65 0d 0a 43 6f 6d 70 6c | CT: Th|e..Compl|
|00006280| 65 6d 65 6e 74 61 72 79 | 20 52 6f 6c 65 20 6f 66 |ementary| Role of|
|00006290| 20 49 6d 61 67 69 6e 67 | 0d 0a 0d 0a 4c 69 70 6d | Imaging|....Lipm|
|000062a0| 61 6e 20 4a 43 2c 20 53 | 74 6f 6d 70 65 72 20 50 |an JC, S|tomper P|
|000062b0| 43 2c 20 4b 61 70 6c 61 | 6e 20 57 44 2c 20 54 75 |C, Kapla|n WD, Tu|
|000062c0| 6d 65 68 20 53 53 0d 0a | 28 42 72 69 67 68 61 6d |meh SS..|(Brigham|
|000062d0| 20 61 6e 64 20 57 6f 6d | 65 6e 27 73 20 48 6f 73 | and Wom|en's Hos|
|000062e0| 70 2c 20 42 6f 73 74 6f | 6e 3b 20 48 61 72 76 61 |p, Bosto|n; Harva|
|000062f0| 72 64 20 4d 65 64 20 53 | 63 68 6f 6f 6c 29 0d 0a |rd Med S|chool)..|
|00006300| 43 6c 69 6e 20 4e 75 63 | 6c 20 4d 65 64 20 31 33 |Clin Nuc|l Med 13|
|00006310| 3a 36 30 32 2d 36 30 35 | 2c 20 41 75 67 75 73 74 |:602-605|, August|
|00006320| 20 31 39 38 38 0d 0a 2d | 2d 2d 2d 2d 2d 2d 2d 2d | 1988..-|--------|
|00006330| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00006340| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00006350| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00006360| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00006370| 2d 2d 2d 2d 2d 0d 0a 0d | 0a 41 62 73 74 72 61 63 |-----...|.Abstrac|
|00006380| 74 0d 0a 0d 0a 20 20 20 | 20 20 41 73 20 61 20 72 |t.... | As a r|
|00006390| 65 73 75 6c 74 20 6f 66 | 20 63 68 61 6e 67 65 73 |esult of| changes|
|000063a0| 20 69 6e 20 68 65 70 61 | 74 69 63 20 64 65 6e 73 | in hepa|tic dens|
|000063b0| 69 74 79 20 69 6e 20 64 | 69 66 66 75 73 65 20 66 |ity in d|iffuse f|
|000063c0| 61 74 74 79 20 69 6e 66 | 69 6c 74 72 61 74 69 6f |atty inf|iltratio|
|000063d0| 6e 2c 0d 0a 74 68 65 20 | 64 65 74 65 63 74 69 6f |n,..the |detectio|
|000063e0| 6e 20 77 69 74 68 20 43 | 54 20 6f 66 20 6c 6f 77 |n with C|T of low|
|000063f0| 2d 20 6f 72 20 68 69 67 | 68 2d 64 65 6e 73 69 74 |- or hig|h-densit|
+--------+-------------------------+-------------------------+--------+--------+
Only 25.0 KB of data is shown above.