The mission of the Tropical Medicine Central Resource (TMCR) at USUHS, under whose umbrella the International Registry of Tropical Imaging (IRTI) was developed with funding from TATRC, is to serve as a worldwide archiving and retrieval source for imaging studies involved in the diagnosis of over 70 parasitic and infectious, neoplastic and miscellaneous diseases affecting over 2 billion people in the tropical and subtropical regions of the globe. This archive has as its core the 10,000 images collected over the past 40 years by Drs. Maurice Reeder and Philip Palmer with the cooperation of radiologists and clinicians from over 30 countries. The most important of these images are to be found in the 1700 page, 2 volume text "The Imaging of Tropical Diseases, with Epidemiological, Pathological and Clinical Correlation", 2nd edition, by Palmer and Reeder published in 2001 by Springer-Verlag, Heidelberg. The publishers graciously agreed to license the illustrations and pertinent text to be incorporated into the Registry's files in 2003, and these were used as the basis for this DVD after the copyright was reverted to the authors in 2008.

Every effort will be made to correlate imaging examinations with whatever corresponding epidemiological, gross and microscopic pathological, and clinical information may be available for each case and each disease entity. In so doing, it may be possible to illustrate the commonalties and differences in imaging and disease patterns regarding tropical diseases of identical etiology seen in varying parts of the world. For example, why should schistosomiasis mansoni cause inflammatory fibroid polyps in the colon in Africa and Arabia but present a Crohn-like pattern of narrowing and mucosal effacement in the Western hemisphere? Why should Chagas' disease cause myocarditis in virtually all patients in Central and South America, but cause, in addition, megaesophagus and megacolon almost exclusively in Brazilians? Why are certain malignancies present in a great percentage of the population in certain African villages and countries, while being almost unknown in adjacent areas? Perhaps a multidisciplinary approach can shed new light on these and dozens of other puzzles throughout the tropical world!

The advent of new imaging techniques such as CT, MRI and Ultrasound in the past 35 years, with refinements continuing to the present, has permitted a vastly more sophisticated approach to the diagnosis and understanding of the pathophysiology of these diseases than ever before, yet most clinicians and even many radiologists are still unaware of the potential of these imaging modalities in the diagnosis, treatment planning and research of these ageless maladies. One has only to study the exquisite detail available on an MRI scan of a patient with neurocysticercosis, wherein the 2 mm scolex of the Cysticercus cyst is plainly identified, surrounded by contrast-induced ring enhancement of the capsule and edema of the surrounding brain parenchyma, to realize the enormous potential of modern-day diagnostic imaging. Similarly, the stunning experimental studies being performed on humans and animals with paragonimiasis by Korean investigators using high resolution CT scanning have served to elucidate the pathophysiology of the various stages of worm evolution within the lungs. Gadolinium-enhanced MRI studies and sophisticated radioisotope examinations are shedding new light on the pathophysiology of Chagas' myocarditis patients in Brazil. Biliary duct studies have enabled the surgical and/or catheter removal of Clonorchis, Ascaris and other biliary parasites and accompanying stones from infected patients.

Ultrasound, CT, and MRI, wherever available in the more sophisticated areas of the tropics, have had an enormous impact on the diagnosis and treatment planning of amebiasis and hydatid disease by showing the true extent of liver and other organ involvement in these potentially devastating, yet usually curable, diseases. In Saudi Arabia and other developed countries, CT and MRI have illuminated a host of new diagnostic signs for both intact and rupturing hydatid cysts and the introduction of the PAIR procedure by radiologists has proven to be a reliable alternative to the surgical removal of hydatids in thousands of patients. It will be one of the goals of IRTI to assimilate data on new procedures and imaging studies, depending on the interest and generosity of contributors from around the globe, and disseminate this information widely via DVDs and the Internet.


Copyright: Palmer and Reeder
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