Introduction: Cancer, internal medicine and new imaging

Abstract

The true revolution in medical practice as a result of modern imaging over the last 20 years has primarily been concerned with the diagnosis and management of cancers, imaging playing a major role in the detection of a tumor and often raising the suspicion of its malignant nature. The combination of ultrasound, CT and more recently MRI in clinical practice has occurred so quickly and impressively that these investigations have become part of our daily routine and seem to have always existed. The best way of measuring the major impact of these techniques on our practice is to take a quick look into the past with the help of a few examples. Is a first epileptic fit the presenting feature of a cerebral tumor? In situations such as this, only the neurologist could even attempt to consult the oracle in order to unravel the secrets hidden within the skull vault which was opaque to x-rays. Although the investigation of pulmonary or mediastinal masses was aided by tomography, the abdominal contents and retroperitoneal space remained areas where the clinician was at a loss. Morphological assessment of the pancreas also depended on indirect tests, radiological investigation of the kidney was essentially reduced to visualization of the renal tracts, and the performance of lymphography was too selective for visualizing the retroperitoneal space. Certainly arteriography, performed secondarily, was contributive for large tumor masses, but had definite limitations. The creation of an artificial air contrast (air encephalogram, pneumoretroperitoneogram) could resolve some diagnostic problems but the painful experience of these examinations is certainly more deeply ingrained in the memories of patients than of the medical profession. Younger doctors might say that this is a walk into a medical museum from an other age: a museum certainly, but a contemporary one