Non-variceal upper gastrointestinal bleeding(NVUGIB)is a common gastroenterological emergency associated with significant morbidity and mortality.Upper gastrointestinal endoscopy is currently recommended as the gold s...Non-variceal upper gastrointestinal bleeding(NVUGIB)is a common gastroenterological emergency associated with significant morbidity and mortality.Upper gastrointestinal endoscopy is currently recommended as the gold standard modality for both diagnosis and treatment,with computed tomography traditionally playing a limited role in the diagnosis of acute NVUGIB.Following the introduction of multidetector computed tomography(MDCT),this modality is emerging as a promising tool in the diagnosis of NVUGIB.However,to date,evidence concerning the role of MDCT in the NVUGIB diagnosis is still lacking.The aim of our study was to review the current evidence concerning the role of MDCT in the diagnosis of acute NVUGIB.展开更多
AIM:To investigate the attenuation patterns and detectability of common bile duct(CBD) stones by multidetector computed tomography(MDCT).METHODS:Between March 2010 and February 2012,191 patients with suspicion of CBD ...AIM:To investigate the attenuation patterns and detectability of common bile duct(CBD) stones by multidetector computed tomography(MDCT).METHODS:Between March 2010 and February 2012,191 patients with suspicion of CBD stones undergoing both MDCT and endoscopic retrograde cholangiopancreatography(ERCP) were enrolled and reviewed retrospectively.The attenuation patterns of CBD stones on MDCT were classified as heavily calcified,radiopaque,less radiopaque,or undetectable.The association between the attenuation patterns of CBD stones on MDCT and stone type consisting of pure cholesterol,mixed cholesterol,brown pigment,and black pigment and the factors related to the detectability of CBD stones by MDCT were evaluated.RESULTS:MDCT showed CBD stones in 111 of 130 patients in whom the CBD stones were demonstrated by ERCP with 85.4% sensitivity.The attenuation patterns of CBD stones on MDCT were heavily calcified 34(26%),radiopaque 31(24%),less radiopaque 46(35%),and undetectable 19(15%).The radiopacity of CBD stones differed significantly according to stone type(P < 0.001).From the receiver operating characteristic curve,stone size was useful for the determination of CBD stone by MDCT(area under curve 0.779,P < 0.001) and appropriate cut-off stone size on MDCT was 5 mm.The factors related to detectability of CBD stones on MDCT were age,stone type,and stone size on multivariate analysis(P < 0.05).CONCLUSION:The radiopacity of CBD stones on MDCT differed according to stone type.Stone type and stone size were related to the detectability by MDCT,and appropriate cut-off stone size was 5 mm.展开更多
Renal cell carcinoma(RCC) accounts for approximately 90%-95% of kidney tumors. With the widespread use of cross-sectional imaging modalities, more than half of RCCs are detected incidentally, often diagnosed at an ear...Renal cell carcinoma(RCC) accounts for approximately 90%-95% of kidney tumors. With the widespread use of cross-sectional imaging modalities, more than half of RCCs are detected incidentally, often diagnosed at an early stage. This may allow the planning of more conservative treatment strategies. Computed tomography(CT) is considered the examination of choice for thedetection and staging of RCC. Multidetector CT(MDCT) with the improvement of spatial resolution and the ability to obtain multiphase imaging, multiplanar and threedimensional reconstructions in any desired plane brought about further improvement in the evaluation of RCC. Differentiation of RCC from benign renal tumors based on MDCT features is improved. Tumor enhancement characteristics on MDCT have been found closely to correlate with the histologic subtype of RCC, the nuclear grade and the cytogenetic characteristics of clear cell RCC. Important information, including tumor size, localization, and organ involvement, presence and extent of venous thrombus, possible invasion of adjacent organs or lymph nodes, and presence of distant metastases are provided by MDCT examination. The preoperative evaluation of patients with RCC was improved by depicting the presence or absence of renal pseudocapsule and by assessing the possible neoplastic infiltration of the perirenal fat tissue and/or renal sinus fat compartment.展开更多
AIM: To characterize the computed tomography(CT) findings in patients with post-inflammatory esophageal strictures(corrosive and peptic) and reveal the optimal scanning phase protocols for distinguishing postinflammat...AIM: To characterize the computed tomography(CT) findings in patients with post-inflammatory esophageal strictures(corrosive and peptic) and reveal the optimal scanning phase protocols for distinguishing postinflammatory esophageal stricture and esophageal cancer.METHODS: Sixty-five patients with esophageal strictures of different etiology were included in this study: 24 patients with 27 histopathologically confirmed corrosive strictures, 10 patients with 12 peptic strictures and 31 patients with esophageal cancer were evaluated with a two-phase dynamic contrast-enhanced MDCT. Arterial and venous phases at 10 and 35 s after the attenuation of 200 HU were obtained at the descending aorta, with a delayed phase at 6-8 min after the start of injection of contrast media. For qualitative analysis, CT scans of benign strictures were reviewed for the presence/absence of the following features: "target sign", luminal mass, homogeneity of contrast medium uptake, concentric wall thickening, conically shapedsuprastenotic dilatation, smooth boundaries of stenosis and smooth mucous membrane at the transition to stenosis, which were compared with a control group of 31 patients who had esophageal cancer. The quantitative analysis included densitometric parameter acquisition using regions-of-interest measurement of the zone of stenosis and normal esophageal wall and the difference between those measurements(ΔCT) at all phases of bolus contrast enhancement. Esophageal wall thickening, length of esophageal wall thickening and size of the regional lymph nodes were also evaluated. RESULTS: The presence of a concentric esophageal wall, conically shaped suprastenotic dilatation, smooth upper and lower boundaries, "target sign" and smooth mucous membrane at the transition to stenosis were suggestive of a benign cause, with sensitivities of 92.31%, 87.17%, 94.87%, 76.92% and 82.05%, respectively, and specificities of 70.96%, 89.66%, 80.65%, 96.77% and 93.55%, respectively. The features that were most suggestive of a malignant cause were eccentric esophageal wall thickening, tuberous upper and lower boundaries of stenosis, absence of mucous membrane visualization, rupture of the mucous membrane at the upper boundary of stenosis, cup-shaped suprastenotic dilatation, luminal mass and enlarged regional lymph nodes with specificities of 92.31% 94.87%, 67.86%, 100%, 97.44%, 94.87% and 82.86%, respectively and sensitivities of 70.97%, 80.65%, 96.77%, 80.65%, 54.84%, 87.10% and 60%, respectively. The highest tumor attenuation occurred in the arterial phase(mean attenuation 74.13 ± 17.42 HU), and the mean attenuation difference between the tumor and the normal esophageal wall(mean ΔCT) in the arterial phase was 23.86 ± 19.31 HU. Here, 11.5 HU of ΔCT in the arterial phase was the cut-off value used to differentiate esophageal cancer from post-inflammatory stricture(P = 0.000). The highest attenuation of postinflammatory strictures occurred in the delayed phase(mean attenuation 71.66 ± 14.28 HU), and the mean ΔCT in delayed phase was 34.03 ± 15.94 HU. Here, 18.5 HU of ΔCT in delayed phase was the cut-off value used to differentiate post-inflammatory stricture from esophageal cancer(P < 0.0001).CONCLUSION: The described imaging findings reveal high diagnostic significance in the differentiation of benign strictures from esophageal cancer.展开更多
BACKGROUND Axial and coronal reformations have been a widely used image post-processing protocol for the ordinary multidetector computed tomography(MDCT)examination of patients with small bowel obstruction(SBO) or oth...BACKGROUND Axial and coronal reformations have been a widely used image post-processing protocol for the ordinary multidetector computed tomography(MDCT)examination of patients with small bowel obstruction(SBO) or other abdominal diseases. The diagnostic accuracy of MDCT for assessing SBO is expected to be further improved through the use of multiple post-processing techniques.AIM To systemically evaluate the diagnostic accuracy and efficiency of an optimized protocol using multiple post-processing techniques for MDCT assessment of SBO and secondary bowel ischemia.METHODS This retrospective cross-sectional study included 106 patients with clinically suspected SBO. Two readers applied three protocols to image post-processing and interpretation of patients' MDCT volume data. We compared the three protocols based on time spent, number of images, diagnostic self-confidence,agreement, detection rate, and accuracy of detection of SBO and secondary bowel ischemia.RESULTS Protocol 2 resulted in more time spent and number of images than protocols 1 and 3(P < 0.01), but the results of the two readers using the same protocol were not different(P > 0.05). Using protocol 3, both readers added multiple postprocessing techniques at frequencies of 29.2% and 34.9%, respectively, for obstruction cause, and 32.1% and 30.2%, respectively, for secondary bowel ischemia. Protocols 2 and 3 had higher total detection rates of obstruction cause and secondary bowel ischemia than protocol 1(P < 0.01), but no difference was detected between protocols 2 and 3(P > 0.05). The accuracy, sensitivity,specificity, positive predictive value and negative predictive value of protocols 2 and 3 were superior to those of protocol 1 for evaluating obstruction cause and secondary bowel ischemia.CONCLUSION Our optimized protocol of multiple post-processing techniques can both guarantee efficiency and improve diagnostic accuracy of MDCT for assessing SBO and secondary bowel ischemia.展开更多
Objective:To evaluate the human epidermal growth factor receptor 2(HER2)status in patients with breast cancer using multidetector computed tomography(MDCT)-based handcrafted and deep radiomics features.Methods:This re...Objective:To evaluate the human epidermal growth factor receptor 2(HER2)status in patients with breast cancer using multidetector computed tomography(MDCT)-based handcrafted and deep radiomics features.Methods:This retrospective study enrolled 339 female patients(primary cohort,n=177;validation cohort,n=162)with pathologically confirmed invasive breast cancer.Handcrafted and deep radiomics features were extracted from the MDCT images during the arterial phase.After the feature selection procedures,handcrafted and deep radiomics signatures and the combined model were built using multivariate logistic regression analysis.Performance was assessed by measures of discrimination,calibration,and clinical usefulness in the primary cohort and validated in the validation cohort.Results:The handcrafted radiomics signature had a discriminative ability with a C-index of 0.739[95%confidence interval(95%CI):0.661-0.818]in the primary cohort and 0.695(95%CI:0.609-0.781)in the validation cohort.The deep radiomics signature also had a discriminative ability with a C-index of 0.760(95%CI:0.690-0.831)in the primary cohort and 0.777(95%CI:0.696-0.857)in the validation cohort.The combined model,which incorporated both the handcrafted and deep radiomics signatures,showed good discriminative ability with a C-index of 0.829(95%CI:0.767-0.890)in the primary cohort and 0.809(95%CI:0.740-0.879)in the validation cohort.Conclusions:Handcrafted and deep radiomics features from MDCT images were associated with HER2 status in patients with breast cancer.Thus,these features could provide complementary aid for the radiological evaluation of HER2 status in breast cancer.展开更多
AIM:To distinguish acinar cell carcinoma(ACC)from pancreatic adenocarcinoma(AC)by comparing their computed tomography findings.METHODS:Patients with ACC and AC were identified on the basis of results obtained using su...AIM:To distinguish acinar cell carcinoma(ACC)from pancreatic adenocarcinoma(AC)by comparing their computed tomography findings.METHODS:Patients with ACC and AC were identified on the basis of results obtained using surgically resected pancreatectomy specimens.The preoperative computer tomographic images of 6 acinar cell carcinoma patients and 67 pancreatic adenocarcinoma patients in 4 phases(non-contrast,arterial,portal venous,and delayed phase)were compared.The scan delay times were 40,70,and 120 s for each contrast-enhanced phase.The visual pattern,tomographic attenuation value,and time attenuation curve were assessed and compared between AC and ACC cases using the 2test,Wilcoxon signed-rank test,and Mann Whitney U test.RESULTS:The adenocarcinomas tended to be hypodense in all 4 phases.The acinar cell carcinomas also tended to be hypodense in the 3 contrast-enhancedphases,although their computed tomographic attenuation values were higher.Further,5 of the 6 acinar cell carcinomas(83%)were isodense in the non-contrast phase.The time attenuation curve of the adenocarcinomas showed a gradual increase through the 4 phases,and all adenocarcinomas showed peak enhancement during the delayed phase.The time attenuation curve of the acinar cell carcinomas showed peak enhancement during the portal venous phase in 4 cases and during the arterial phase in 2 cases.None of the 6 acinar cell carcinomas showed peak enhancement during the delayed phase.CONCLUSION:The tumor density in the non-contrast phase and time attenuation curve pattern clearly differ between acinar cell carcinomas and adenocarcinomas,and multidetector-row computed tomography can thus distinguish these tumors.展开更多
AIM: To describe the multidetector computed tomography features of pancreatic metastasis from leiomyosarcoma(LMS).METHODS: Between January 1995 and December 2012, 13 consecutive patients(11 women, 2 men; mean age of 5...AIM: To describe the multidetector computed tomography features of pancreatic metastasis from leiomyosarcoma(LMS).METHODS: Between January 1995 and December 2012, 13 consecutive patients(11 women, 2 men; mean age of 57 years; range, 38-78 years) with pancreatic metastases from LMS were included in our study. Imaging features including location, number, largest dimension, tumor attenuation and enhancement characteristics, presence of necrosis, pancreatic ductal dilatation, common bile duct(CBD) dilatation, presence of pancreatitis, and atrophy were documented.RESULTS: The most common site of origin of the pancreatic metastases from LMS was uterus(38.5%), followed by retroperitoneum(30.8%) and extremity(23.1%). None of the patients in our study had pancreas as the first site of metastasis. All patients developed pancreatic metastases at a median interval of 24 mo. Pancreatic metastases from LMS were solitary in 8/13 patients and multiple in 5/13 patients, had no predilection for any part of the pancreas, were hypovascular on arterial phase in 10/13 patients and associated with pancreatic duct dilatation in 3/13 patients. None had CBD dilatation. None of the pancreatic metastases in LMS cohort caused pancreatitis, and atrophy. Median duration of follow-up was 19 mo for LMS cohort during which two patients underwent resection of metastasis(median survival 45 mo) while the remaining underwent systemic therapy(median survival 13 mo).CONCLUSION: Pancreatic metastases from LMS are often solitary and hypovascular masses and less commonly associated with pancreatic ductal dilatation, CBD dilatation, pancreatitis or pancreatic atrophy. Surgical resection of solitary LMS pancreatic metastasis can be considered due to the long survival of these patients.展开更多
AIM:To investigate the features of abdominal crush injuries resulting from an earthquake using multidetector computed tomography(MDCT). METHODS:Fifty-one survivors with abdominal crush injuries due to the 2008 Sichuan...AIM:To investigate the features of abdominal crush injuries resulting from an earthquake using multidetector computed tomography(MDCT). METHODS:Fifty-one survivors with abdominal crush injuries due to the 2008 Sichuan earthquake underwent emergency non-enhanced scans with 16-row MDCT. Data were reviewed focusing on anatomic regions including lumbar vertebrae,abdominal wall soft tissue, retroperitoneum and intraperitoneal space;and types of traumatic lesions. RESULTS:Fractures of lumbar vertebrae and abdominal wall soft tissue injuries were more common than retro-and intraperitoneal injuries(P【0.05).With regard to the 49 lumbar vertebral fractures in 24 patients,these occurred predominantly in the transverse process(P【0.05),and 66.67%of patients(16/24) had fractures of multiple vertebrae,predominantly two vertebrae in 62.5%of patients(10/16),mainly in L1-3 vertebrae in 81.63%of the vertebrae(40/49). Retroperitoneal injuries occurred more frequently than intraperitoneal injuries(P【0.05),and renal and liver injuries were most often seen in the retroperitoneum and in the intraperitoneal space,respectively(all P【 0.05). CONCLUSION:Transverse process fractures in two vertebrae among L1-3 vertebrae,injury of abdominal wall soft tissue,and renal injury might be features of earthquake-related crush abdominal injury.展开更多
BACKGROUND The role of multidetector computed tomography(MDCT)in patients with acute infectious colitis is still unclear.AIM To examine the usefulness of MDCT in distinguishing the etiology of acute infectious colitis...BACKGROUND The role of multidetector computed tomography(MDCT)in patients with acute infectious colitis is still unclear.AIM To examine the usefulness of MDCT in distinguishing the etiology of acute infectious colitis.METHODS Overall,244 patients who met the criteria for acute infectious colitis and visited the Hospital from February 2015 to 2018 were retrospectively enrolled and divided into two groups(bacterial:204,viral:40)according to causes of acute colitis,based on stool PCR.Eleven MDCT parameters,including wall thickening,submucosal edema,mucosal enhancement,serosa involvement,empty colon sign,small bowel involvement,comb sign,continuous distribution,accordion sign,mucosal thickening,and lymph node enlargement,were constructed in a blinded fashion.RESULTS MDCT parameters of wall thickening(OR:13.60;95%CI:5.80–31.88;P<0.001),submucosal edema(OR:36.08;95%CI:13.54–96.13;P<0.001),mucosal enhancement(OR:22.55;95%CI:9.28–54.81;P<0.001),serosal involvement(OR:14.50;95%CI:3.33–63.23;P<0.001),empty colon sign(OR:6.68;95%CI: 2.44–18.32;P < 0.001), continuous distribution (OR: 24.09;95%CI: 9.38–61.90;P < 0.001), accordionsign (OR: 9.02;95%CI: 1.12–72.35;P = 0.038), mucosal thickening (OR: 46.41;95%CI: 10.38–207.51;P< 0.001), and lymph node enlargement (OR: 4.39;95%CI: 1.22–15.72;P = 0.023) were significantlyassociated with bacterial colitis. At least one positive finding in four CT outcomes (submucosaledema, mucosal enhancement, continuous distribution, mucosal thickening) in summer showed ahigh probability of bacterial colitis (sensitivity, 41.67;specificity, 92.50;OR: 24.95).CONCLUSIONMDCT provides many clues that can be useful in suggesting a specific etiology of acute infectiouscolitis.展开更多
BACKGROUND Superior mesenteric artery embolism(SMAE)has acute onset and fast progression,which seriously threatens the life of patients.Multidetector computed tomography(MDCT)is one of the most important diagnostic me...BACKGROUND Superior mesenteric artery embolism(SMAE)has acute onset and fast progression,which seriously threatens the life of patients.Multidetector computed tomography(MDCT)is one of the most important diagnostic methods for SMAE,which plays an important role in the diagnosis and prognosis of SMAE.AIM To evaluate the value of combined clinical data and MDCT findings in the diagnosis of acute SMAE and predict the risk factors for SMAE-related death.METHODS Data from 53 SMAE patients who received abdominal MDCT multi-phase enhancement and superior mesenteric artery digital subtraction angiography examinations were collected.Univariate cox regression and multivariate cox model were used to analyze the correlation between death risk and clinical and computed tomography features in SMAE patients.RESULTS Univariate Cox regression model showed that intestinal wall thinning,intestinal wall pneumatosis,blood lactate>2.1 mmol/L and blood pH<7.35 increased the risk of death in patients with SMAE.After adjusting for age,sex,embolic involvement length and embolic distribution region,multivariate Cox regression model I showed that blood lactate>2.1 mmol/L(HR=5.26,95%CI:1.04-26.69,P=0.045)and intestinal wall thinning(HR=9.40,95%CI:1.05-83.46,P=0.044)were significantly increases the risk of death in patients with SMAE.CONCLUSION For patients with SAME,increased blood lactate and intestinal wall thinning are the risk factors for death;hence,close monitoring may reduce the mortality rate.Clinical observation combined with MDCT signs can significantly improve SMAE diagnosis.展开更多
Trauma is the leading cause of death in age group less than 45 years. In trauma, time is one of the most crucial factors in predicting prognosis. Outcomes are greatly improved when critical interventions are provided ...Trauma is the leading cause of death in age group less than 45 years. In trauma, time is one of the most crucial factors in predicting prognosis. Outcomes are greatly improved when critical interventions are provided within the golden hour following injury. Whole body multidetector computerised tomography (WBMDCT) can decrease this critical time and increase survival. Emergency CT plays a major role in diagnostic workflow in the evaluation of patients with polytrauma. MDCT scanners are widely used because they rapidly produce high-resolution scans of large areas, offering short examination times for multiple body regions under emergency conditions. Such examinations most often include the head, cervical spine, and thorax to pelvis. Role of MDCT in head trauma remains unparalleled for reasons like its widespread availability and capability to reveal skull fractures, primarily because it is a fast and efficient method to triage the patients with treatable conditions mandating urgent surgical intervention such as extra axial hematomas, mass effect, herniations of brain, hydrocephalus, and midline shift and hence preventing secondary brain injury. MDCT angiography is an important tool to screen patients with suspected vascular injury.展开更多
Background: Radiology plays an essential role in the diagnosis, staging and surveillance of oncology patients. CT is the most sensitive imaging modality in the workup of these patients. Aim of the Study: The aim of th...Background: Radiology plays an essential role in the diagnosis, staging and surveillance of oncology patients. CT is the most sensitive imaging modality in the workup of these patients. Aim of the Study: The aim of this work is to detect the role of MDCT (multidetector computed tomography) in the preoperative investigation of gastric adenocarcinoma patients according to TNM staging. Patients and Methods: This is a prospective study enrolling 20 patients who had histologically proven adenocarcinoma based upon an upper gastrointestinal endoscopic biopsy for MDCT staging of gastric carcinoma during the period from June 2016 to June 2017. The MSCT data were correlated and compared with the histopathological results. The study was conducted in the Radiology Department of Assiut University Hospital using 64-MDCT (Toshiba Aquilion). Results: According to our study results, the sensitivity of determining T1 stage on CT scan can’t be detected as there was only 1 case pathologically proved T1 and overstaged as T2 by MSCT;however, accuracy and specificity are quite high, which was 95% and 100% respectively. For T2 stage tumors (25.0% of cases), accuracy is 95%, sensitivity—100%, and specificity—93.7%. According to our results the accuracy and sensitivity of T3 staging are 75% and 100%, while those of T4 stage were 75% and 44.4% respectively. Tumor was correctly staged in 14 of 20 patients (the valid T staging rate was 70.0%). Tumor was under-staged in 5 of 20 patients (25.0%) (staged as T3, but pathologically proven to be T4a). As regards N staging accuracy found results for N0 (62.5%), N2 (87.5%) and N3 (75%), while N1 accuracy recorded 37.5%. As regards the nodal staging sensitivity which had a range from (0% for N4) to (66% for N2) this wide range of sensitivity demonstrates the problem of CT in nodal staging. As regards sensitivity of M0, accuracy was 100% and 85% respectively. While that of M1 was (62.5%) and (85%) respectively. Conclusion: MSCT can be the first choice for the preoperative evaluation of patients with gastric carcinoma. It presents excellent accuracy in the staging of tumor invasion depth (T) and in the staging of metastatic neoplastic disease (M). Despite the good accuracy in the staging of patients without lymph node disease (N0), the method presents limitations in the staging of lymph node involvement.展开更多
BACKGROUND No qualitative or quantitative analysis of contrast-enhanced computed tomography(CT)images has been reported for the differentiation between ameloblastomas and central giant cell granulomas(CGCGs).AIM To de...BACKGROUND No qualitative or quantitative analysis of contrast-enhanced computed tomography(CT)images has been reported for the differentiation between ameloblastomas and central giant cell granulomas(CGCGs).AIM To describe differentiating multidetector CT(MDCT)features in CGCGs and ameloblastomas and to compare differences in enhancement of these lesions qualitatively and using histogram analysis.METHODS MDCT of CGCGs and ameloblastomas was retrospectively reviewed to evaluate qualitative imaging descriptors.Histogram analysis was used to compare the extent of enhancement of the soft tissue.Fisher’s exact tests and Mann–Whitney U test were used for statistical analysis(P<0.05).RESULTS Twelve CGCGs and 33 ameloblastomas were reviewed.Ameloblastomas had a predilection for the posterior mandible with none of the CGCGs involving the angle.CGCGs were multilocular(58.3%),with a mixed lytic sclerotic appearance(75%).Soft tissue component was present in 91%of CGCGs,which showed hyperenhancement(compared to surrounding muscles)in 50%of cases,while the remaining showed isoenhancement.Matrix mineralization was present in 83.3%of cases.Ameloblastomas presented as a unilocular(66.7%),lytic(60.6%)masses with solid components present in 81.8%of cases.However,the solid component showed isoenhancement in 63%.No matrix mineralization was present in 69.7%of cases.Quantitatively,the enhancement of soft tissue in CGCG was significantly higher than in ameloblastoma on histogram analysis(P<0.05),with a minimum enhancement of>49.05 HU in the tumour providing 100%sensitivity and 85%specificity in identifying a CGCG.CONCLUSION A multilocular,lytic sclerotic lesion with significant hyperenhancement in soft tissue,which spares the angle of the mandible and has matrix mineralization,should indicate prospective diagnosis of CGCG.展开更多
We report a case of left pulmonary artery sling associated with patent ductus arteriosus and atrial septal defect in a 21-month-old child. 256-slice MDCT provides valuable information, such as abnormal origin of the l...We report a case of left pulmonary artery sling associated with patent ductus arteriosus and atrial septal defect in a 21-month-old child. 256-slice MDCT provides valuable information, such as abnormal origin of the left pulmonary artery, the relationship between pulmonary artery and airway, the diameter of the patent ductus artery and atrial septal defect. The information is helpful in diagnosis, pre-operative evaluation and post-operative follow-up of LPS.展开更多
<strong>Background</strong>: Redo aortic valve replacement for prosthetic valve endocarditis is a challenge for surgeons. Echocardiography is occasionally not an effective modality for the detection of inf...<strong>Background</strong>: Redo aortic valve replacement for prosthetic valve endocarditis is a challenge for surgeons. Echocardiography is occasionally not an effective modality for the detection of infectious signs in prosthetic valve endocarditis. <strong>Case presentation</strong>: Herein, we report the case of a patient whose prosthetic valve endocarditis was detected by multidetector computed tomography and who successfully underwent redo aortic valve replacement. Preoperative echocardiography revealed no remarkable findings related to endocarditis such as perivalvular leakage or vegetation;however, multidetector computed tomography revealed a thickened right coronary cusp. Intraoperatively, the right coronary cusp was confirmed to be covered with thick infected tissue. The pathological findings revealed broad destruction due to infection of the right coronary cusp. <strong>Conclusion</strong>: Multidetector computed tomography was useful in detecting infectious signs in prosthetic valves.展开更多
AIM:To evaluate the use of three-dimensional imaging of pancreatic carcinoma using multidetector computed tomography(CT)in a prospective study.METHODS:Ten patients with suspected pancreatic tumors were examined prospe...AIM:To evaluate the use of three-dimensional imaging of pancreatic carcinoma using multidetector computed tomography(CT)in a prospective study.METHODS:Ten patients with suspected pancreatic tumors were examined prospectively using multidetec-tor CT(Somatom Sensation 16,Siemens,Erlangen,Germany).The images were evaluated for the pres-ence of a pancreatic carcinoma and invasion of the peripancreatic vessels and surrounding organs.Using the isotropic CT data sets,a three-dimensional image was created with automatic vascular analysis and semi-automatic segmentation of the organs and pancreatic tumor by a radiologist.The CT examinations and the three-dimensional images were presented to the sur-geon directly before and during the patient's operation using the Medical Imaging Interaction Toolkit-based software "ReLiver".Immediately after surgery,the value of the two images was judged by the surgeon.The operation and the histological results served as the gold standard.RESULTS:Nine patients had a pancreatic carcinoma(all pT3),and one patient had a serous cystadenoma.One tumor inf iltrated the superior mesenteric vein.The inf iltration was correctly evaluated.All carcinomas were resectable.In comparison to the CT image with axial and coronal reconstructions,the three-dimensional image was judged by the surgeons as better for operation planning and consistently described as useful.CONCLUSION:A 3D-image of the pancreas repre-sents an invaluable aid to the surgeon.However,the 3D-software must be further developed in order to be integrated into daily clinical routine.展开更多
AIM:To evaluate the clinical impact of multidetector computed tomography (MDCT) before double-balloon endoscopy (DBE) for patients with obscure gastrointestinal bleeding (OGIB).METHODS:A retrospective analysis of pros...AIM:To evaluate the clinical impact of multidetector computed tomography (MDCT) before double-balloon endoscopy (DBE) for patients with obscure gastrointestinal bleeding (OGIB).METHODS:A retrospective analysis of prospectively collected cases with DBE and MDCT for overt OGIB was conducted from April 2004 to April 2010 at Changhua Christian Hospital.We evaluated the clinical impact of MDCT on the subsequent DBE examinations and the diagnostic yields of both MDCT and DBE respectively.RESULTS:From April 2004 to April 2010,a total of 75 patients underwent DBE for overt OGIB.Thirty one cases received MDCT followed by DBE for OGIB.The overall diagnostic yields of DBE and MDCT was 93.5% and 45.2%.The MDCT had a high diagnostic yield of tumor vs non-tumor etiology of OGIB (85.7% vs 33.3%,P=0.014).Additionally,the choice of initial route of DBE was correct in those with a positive MDCT vs negative MDCT (100% vs 52.9%,P=0.003).CONCLUSION:This study suggests MDCT as a triage tool may identify patients who will benefit from DBE and aid the endoscopist in choosing the most efficient route.展开更多
Objective To evaluate the diagnostic value of three-dimensional multidetector-row computed tomography(MDCT) in detecting acquired renal arteriovenous malformation(RAVM) and to compare its performance with that of ultr...Objective To evaluate the diagnostic value of three-dimensional multidetector-row computed tomography(MDCT) in detecting acquired renal arteriovenous malformation(RAVM) and to compare its performance with that of ultrasonography and digital subtraction angiography(DSA). Methods The institutional review board approved this retrospective study and written informed consent was obtained from all patients before examination. All 14 patients with acquired RAVM underwent MDCT, including cortical and medullary phase enhancement angiography and three-dimensional(3D) reconstruction. Five and nine patients were further examined and their diagnoses confirmed by DSA and surgery, respectively. The MDCT images, including 3D reconstructions, were analyzed for RAVM independently and in consensus by two observers using a workstation.Results Among the 14 patients with acquired RAVM, 12 with maximum lesion diameter ≥ 10 mm, and one with a maximum lesion diameter between 5 and 10 mm, were correctly diagnosed with MDCT angiography. Among these patients, four diagnoses were confirmed by DSA. One patient with a lesion 5–10 mm in diameter was misdiagnosed with a renal aneurysm by MDCT angiography. The other one with the maximum diameter of the lesion between 5 mm and 10 mm was misdiagnosed as renal aneurysm with MDCT angiography, which was diagnosed as renal arteriovenous malformation with DSA. Among 14 lesions in 14 patients, eight and six originated in the left and right kidney, respectively.Conclusion MDCT angiography can accurately diagnose RAVM and improve our understanding of the disease, which will allow clinicians to provide better care.展开更多
文摘Non-variceal upper gastrointestinal bleeding(NVUGIB)is a common gastroenterological emergency associated with significant morbidity and mortality.Upper gastrointestinal endoscopy is currently recommended as the gold standard modality for both diagnosis and treatment,with computed tomography traditionally playing a limited role in the diagnosis of acute NVUGIB.Following the introduction of multidetector computed tomography(MDCT),this modality is emerging as a promising tool in the diagnosis of NVUGIB.However,to date,evidence concerning the role of MDCT in the NVUGIB diagnosis is still lacking.The aim of our study was to review the current evidence concerning the role of MDCT in the diagnosis of acute NVUGIB.
文摘AIM:To investigate the attenuation patterns and detectability of common bile duct(CBD) stones by multidetector computed tomography(MDCT).METHODS:Between March 2010 and February 2012,191 patients with suspicion of CBD stones undergoing both MDCT and endoscopic retrograde cholangiopancreatography(ERCP) were enrolled and reviewed retrospectively.The attenuation patterns of CBD stones on MDCT were classified as heavily calcified,radiopaque,less radiopaque,or undetectable.The association between the attenuation patterns of CBD stones on MDCT and stone type consisting of pure cholesterol,mixed cholesterol,brown pigment,and black pigment and the factors related to the detectability of CBD stones by MDCT were evaluated.RESULTS:MDCT showed CBD stones in 111 of 130 patients in whom the CBD stones were demonstrated by ERCP with 85.4% sensitivity.The attenuation patterns of CBD stones on MDCT were heavily calcified 34(26%),radiopaque 31(24%),less radiopaque 46(35%),and undetectable 19(15%).The radiopacity of CBD stones differed significantly according to stone type(P < 0.001).From the receiver operating characteristic curve,stone size was useful for the determination of CBD stone by MDCT(area under curve 0.779,P < 0.001) and appropriate cut-off stone size on MDCT was 5 mm.The factors related to detectability of CBD stones on MDCT were age,stone type,and stone size on multivariate analysis(P < 0.05).CONCLUSION:The radiopacity of CBD stones on MDCT differed according to stone type.Stone type and stone size were related to the detectability by MDCT,and appropriate cut-off stone size was 5 mm.
文摘Renal cell carcinoma(RCC) accounts for approximately 90%-95% of kidney tumors. With the widespread use of cross-sectional imaging modalities, more than half of RCCs are detected incidentally, often diagnosed at an early stage. This may allow the planning of more conservative treatment strategies. Computed tomography(CT) is considered the examination of choice for thedetection and staging of RCC. Multidetector CT(MDCT) with the improvement of spatial resolution and the ability to obtain multiphase imaging, multiplanar and threedimensional reconstructions in any desired plane brought about further improvement in the evaluation of RCC. Differentiation of RCC from benign renal tumors based on MDCT features is improved. Tumor enhancement characteristics on MDCT have been found closely to correlate with the histologic subtype of RCC, the nuclear grade and the cytogenetic characteristics of clear cell RCC. Important information, including tumor size, localization, and organ involvement, presence and extent of venous thrombus, possible invasion of adjacent organs or lymph nodes, and presence of distant metastases are provided by MDCT examination. The preoperative evaluation of patients with RCC was improved by depicting the presence or absence of renal pseudocapsule and by assessing the possible neoplastic infiltration of the perirenal fat tissue and/or renal sinus fat compartment.
文摘AIM: To characterize the computed tomography(CT) findings in patients with post-inflammatory esophageal strictures(corrosive and peptic) and reveal the optimal scanning phase protocols for distinguishing postinflammatory esophageal stricture and esophageal cancer.METHODS: Sixty-five patients with esophageal strictures of different etiology were included in this study: 24 patients with 27 histopathologically confirmed corrosive strictures, 10 patients with 12 peptic strictures and 31 patients with esophageal cancer were evaluated with a two-phase dynamic contrast-enhanced MDCT. Arterial and venous phases at 10 and 35 s after the attenuation of 200 HU were obtained at the descending aorta, with a delayed phase at 6-8 min after the start of injection of contrast media. For qualitative analysis, CT scans of benign strictures were reviewed for the presence/absence of the following features: "target sign", luminal mass, homogeneity of contrast medium uptake, concentric wall thickening, conically shapedsuprastenotic dilatation, smooth boundaries of stenosis and smooth mucous membrane at the transition to stenosis, which were compared with a control group of 31 patients who had esophageal cancer. The quantitative analysis included densitometric parameter acquisition using regions-of-interest measurement of the zone of stenosis and normal esophageal wall and the difference between those measurements(ΔCT) at all phases of bolus contrast enhancement. Esophageal wall thickening, length of esophageal wall thickening and size of the regional lymph nodes were also evaluated. RESULTS: The presence of a concentric esophageal wall, conically shaped suprastenotic dilatation, smooth upper and lower boundaries, "target sign" and smooth mucous membrane at the transition to stenosis were suggestive of a benign cause, with sensitivities of 92.31%, 87.17%, 94.87%, 76.92% and 82.05%, respectively, and specificities of 70.96%, 89.66%, 80.65%, 96.77% and 93.55%, respectively. The features that were most suggestive of a malignant cause were eccentric esophageal wall thickening, tuberous upper and lower boundaries of stenosis, absence of mucous membrane visualization, rupture of the mucous membrane at the upper boundary of stenosis, cup-shaped suprastenotic dilatation, luminal mass and enlarged regional lymph nodes with specificities of 92.31% 94.87%, 67.86%, 100%, 97.44%, 94.87% and 82.86%, respectively and sensitivities of 70.97%, 80.65%, 96.77%, 80.65%, 54.84%, 87.10% and 60%, respectively. The highest tumor attenuation occurred in the arterial phase(mean attenuation 74.13 ± 17.42 HU), and the mean attenuation difference between the tumor and the normal esophageal wall(mean ΔCT) in the arterial phase was 23.86 ± 19.31 HU. Here, 11.5 HU of ΔCT in the arterial phase was the cut-off value used to differentiate esophageal cancer from post-inflammatory stricture(P = 0.000). The highest attenuation of postinflammatory strictures occurred in the delayed phase(mean attenuation 71.66 ± 14.28 HU), and the mean ΔCT in delayed phase was 34.03 ± 15.94 HU. Here, 18.5 HU of ΔCT in delayed phase was the cut-off value used to differentiate post-inflammatory stricture from esophageal cancer(P < 0.0001).CONCLUSION: The described imaging findings reveal high diagnostic significance in the differentiation of benign strictures from esophageal cancer.
基金the National Natural Science Foundation of China,No.81671943
文摘BACKGROUND Axial and coronal reformations have been a widely used image post-processing protocol for the ordinary multidetector computed tomography(MDCT)examination of patients with small bowel obstruction(SBO) or other abdominal diseases. The diagnostic accuracy of MDCT for assessing SBO is expected to be further improved through the use of multiple post-processing techniques.AIM To systemically evaluate the diagnostic accuracy and efficiency of an optimized protocol using multiple post-processing techniques for MDCT assessment of SBO and secondary bowel ischemia.METHODS This retrospective cross-sectional study included 106 patients with clinically suspected SBO. Two readers applied three protocols to image post-processing and interpretation of patients' MDCT volume data. We compared the three protocols based on time spent, number of images, diagnostic self-confidence,agreement, detection rate, and accuracy of detection of SBO and secondary bowel ischemia.RESULTS Protocol 2 resulted in more time spent and number of images than protocols 1 and 3(P < 0.01), but the results of the two readers using the same protocol were not different(P > 0.05). Using protocol 3, both readers added multiple postprocessing techniques at frequencies of 29.2% and 34.9%, respectively, for obstruction cause, and 32.1% and 30.2%, respectively, for secondary bowel ischemia. Protocols 2 and 3 had higher total detection rates of obstruction cause and secondary bowel ischemia than protocol 1(P < 0.01), but no difference was detected between protocols 2 and 3(P > 0.05). The accuracy, sensitivity,specificity, positive predictive value and negative predictive value of protocols 2 and 3 were superior to those of protocol 1 for evaluating obstruction cause and secondary bowel ischemia.CONCLUSION Our optimized protocol of multiple post-processing techniques can both guarantee efficiency and improve diagnostic accuracy of MDCT for assessing SBO and secondary bowel ischemia.
基金supported by the National Key R&D Program of China(No.2017YFC1309100)the National Science Fund for Distinguished Young Scholars(No.81925023)+1 种基金the National Natural Science Foundation of China(No.81771912,81701662,81701782,81601469,and 81702322)Science and Technology Planning Project of Guangdong Province(No.2017B020227012)。
文摘Objective:To evaluate the human epidermal growth factor receptor 2(HER2)status in patients with breast cancer using multidetector computed tomography(MDCT)-based handcrafted and deep radiomics features.Methods:This retrospective study enrolled 339 female patients(primary cohort,n=177;validation cohort,n=162)with pathologically confirmed invasive breast cancer.Handcrafted and deep radiomics features were extracted from the MDCT images during the arterial phase.After the feature selection procedures,handcrafted and deep radiomics signatures and the combined model were built using multivariate logistic regression analysis.Performance was assessed by measures of discrimination,calibration,and clinical usefulness in the primary cohort and validated in the validation cohort.Results:The handcrafted radiomics signature had a discriminative ability with a C-index of 0.739[95%confidence interval(95%CI):0.661-0.818]in the primary cohort and 0.695(95%CI:0.609-0.781)in the validation cohort.The deep radiomics signature also had a discriminative ability with a C-index of 0.760(95%CI:0.690-0.831)in the primary cohort and 0.777(95%CI:0.696-0.857)in the validation cohort.The combined model,which incorporated both the handcrafted and deep radiomics signatures,showed good discriminative ability with a C-index of 0.829(95%CI:0.767-0.890)in the primary cohort and 0.809(95%CI:0.740-0.879)in the validation cohort.Conclusions:Handcrafted and deep radiomics features from MDCT images were associated with HER2 status in patients with breast cancer.Thus,these features could provide complementary aid for the radiological evaluation of HER2 status in breast cancer.
文摘AIM:To distinguish acinar cell carcinoma(ACC)from pancreatic adenocarcinoma(AC)by comparing their computed tomography findings.METHODS:Patients with ACC and AC were identified on the basis of results obtained using surgically resected pancreatectomy specimens.The preoperative computer tomographic images of 6 acinar cell carcinoma patients and 67 pancreatic adenocarcinoma patients in 4 phases(non-contrast,arterial,portal venous,and delayed phase)were compared.The scan delay times were 40,70,and 120 s for each contrast-enhanced phase.The visual pattern,tomographic attenuation value,and time attenuation curve were assessed and compared between AC and ACC cases using the 2test,Wilcoxon signed-rank test,and Mann Whitney U test.RESULTS:The adenocarcinomas tended to be hypodense in all 4 phases.The acinar cell carcinomas also tended to be hypodense in the 3 contrast-enhancedphases,although their computed tomographic attenuation values were higher.Further,5 of the 6 acinar cell carcinomas(83%)were isodense in the non-contrast phase.The time attenuation curve of the adenocarcinomas showed a gradual increase through the 4 phases,and all adenocarcinomas showed peak enhancement during the delayed phase.The time attenuation curve of the acinar cell carcinomas showed peak enhancement during the portal venous phase in 4 cases and during the arterial phase in 2 cases.None of the 6 acinar cell carcinomas showed peak enhancement during the delayed phase.CONCLUSION:The tumor density in the non-contrast phase and time attenuation curve pattern clearly differ between acinar cell carcinomas and adenocarcinomas,and multidetector-row computed tomography can thus distinguish these tumors.
文摘AIM: To describe the multidetector computed tomography features of pancreatic metastasis from leiomyosarcoma(LMS).METHODS: Between January 1995 and December 2012, 13 consecutive patients(11 women, 2 men; mean age of 57 years; range, 38-78 years) with pancreatic metastases from LMS were included in our study. Imaging features including location, number, largest dimension, tumor attenuation and enhancement characteristics, presence of necrosis, pancreatic ductal dilatation, common bile duct(CBD) dilatation, presence of pancreatitis, and atrophy were documented.RESULTS: The most common site of origin of the pancreatic metastases from LMS was uterus(38.5%), followed by retroperitoneum(30.8%) and extremity(23.1%). None of the patients in our study had pancreas as the first site of metastasis. All patients developed pancreatic metastases at a median interval of 24 mo. Pancreatic metastases from LMS were solitary in 8/13 patients and multiple in 5/13 patients, had no predilection for any part of the pancreas, were hypovascular on arterial phase in 10/13 patients and associated with pancreatic duct dilatation in 3/13 patients. None had CBD dilatation. None of the pancreatic metastases in LMS cohort caused pancreatitis, and atrophy. Median duration of follow-up was 19 mo for LMS cohort during which two patients underwent resection of metastasis(median survival 45 mo) while the remaining underwent systemic therapy(median survival 13 mo).CONCLUSION: Pancreatic metastases from LMS are often solitary and hypovascular masses and less commonly associated with pancreatic ductal dilatation, CBD dilatation, pancreatitis or pancreatic atrophy. Surgical resection of solitary LMS pancreatic metastasis can be considered due to the long survival of these patients.
基金Supported by The National Natural Science Foundation of China,No.30870688The Science Foundation for Distinguished Young Scholars of Sichuan Province,No.2010JQ0039
文摘AIM:To investigate the features of abdominal crush injuries resulting from an earthquake using multidetector computed tomography(MDCT). METHODS:Fifty-one survivors with abdominal crush injuries due to the 2008 Sichuan earthquake underwent emergency non-enhanced scans with 16-row MDCT. Data were reviewed focusing on anatomic regions including lumbar vertebrae,abdominal wall soft tissue, retroperitoneum and intraperitoneal space;and types of traumatic lesions. RESULTS:Fractures of lumbar vertebrae and abdominal wall soft tissue injuries were more common than retro-and intraperitoneal injuries(P【0.05).With regard to the 49 lumbar vertebral fractures in 24 patients,these occurred predominantly in the transverse process(P【0.05),and 66.67%of patients(16/24) had fractures of multiple vertebrae,predominantly two vertebrae in 62.5%of patients(10/16),mainly in L1-3 vertebrae in 81.63%of the vertebrae(40/49). Retroperitoneal injuries occurred more frequently than intraperitoneal injuries(P【0.05),and renal and liver injuries were most often seen in the retroperitoneum and in the intraperitoneal space,respectively(all P【 0.05). CONCLUSION:Transverse process fractures in two vertebrae among L1-3 vertebrae,injury of abdominal wall soft tissue,and renal injury might be features of earthquake-related crush abdominal injury.
基金Supported by the 2019 Inje University research grant
文摘BACKGROUND The role of multidetector computed tomography(MDCT)in patients with acute infectious colitis is still unclear.AIM To examine the usefulness of MDCT in distinguishing the etiology of acute infectious colitis.METHODS Overall,244 patients who met the criteria for acute infectious colitis and visited the Hospital from February 2015 to 2018 were retrospectively enrolled and divided into two groups(bacterial:204,viral:40)according to causes of acute colitis,based on stool PCR.Eleven MDCT parameters,including wall thickening,submucosal edema,mucosal enhancement,serosa involvement,empty colon sign,small bowel involvement,comb sign,continuous distribution,accordion sign,mucosal thickening,and lymph node enlargement,were constructed in a blinded fashion.RESULTS MDCT parameters of wall thickening(OR:13.60;95%CI:5.80–31.88;P<0.001),submucosal edema(OR:36.08;95%CI:13.54–96.13;P<0.001),mucosal enhancement(OR:22.55;95%CI:9.28–54.81;P<0.001),serosal involvement(OR:14.50;95%CI:3.33–63.23;P<0.001),empty colon sign(OR:6.68;95%CI: 2.44–18.32;P < 0.001), continuous distribution (OR: 24.09;95%CI: 9.38–61.90;P < 0.001), accordionsign (OR: 9.02;95%CI: 1.12–72.35;P = 0.038), mucosal thickening (OR: 46.41;95%CI: 10.38–207.51;P< 0.001), and lymph node enlargement (OR: 4.39;95%CI: 1.22–15.72;P = 0.023) were significantlyassociated with bacterial colitis. At least one positive finding in four CT outcomes (submucosaledema, mucosal enhancement, continuous distribution, mucosal thickening) in summer showed ahigh probability of bacterial colitis (sensitivity, 41.67;specificity, 92.50;OR: 24.95).CONCLUSIONMDCT provides many clues that can be useful in suggesting a specific etiology of acute infectiouscolitis.
基金Supported by The"333"Talent Funding Project of Jiangsu Province,No.BRA2020198Nantong City Social Development Project-Standardized Diagnosis and Treatment of Key Diseases No.HS2019002The Youth Project of Nantong City Health Committee,No.QA2019006 and QA2020002.
文摘BACKGROUND Superior mesenteric artery embolism(SMAE)has acute onset and fast progression,which seriously threatens the life of patients.Multidetector computed tomography(MDCT)is one of the most important diagnostic methods for SMAE,which plays an important role in the diagnosis and prognosis of SMAE.AIM To evaluate the value of combined clinical data and MDCT findings in the diagnosis of acute SMAE and predict the risk factors for SMAE-related death.METHODS Data from 53 SMAE patients who received abdominal MDCT multi-phase enhancement and superior mesenteric artery digital subtraction angiography examinations were collected.Univariate cox regression and multivariate cox model were used to analyze the correlation between death risk and clinical and computed tomography features in SMAE patients.RESULTS Univariate Cox regression model showed that intestinal wall thinning,intestinal wall pneumatosis,blood lactate>2.1 mmol/L and blood pH<7.35 increased the risk of death in patients with SMAE.After adjusting for age,sex,embolic involvement length and embolic distribution region,multivariate Cox regression model I showed that blood lactate>2.1 mmol/L(HR=5.26,95%CI:1.04-26.69,P=0.045)and intestinal wall thinning(HR=9.40,95%CI:1.05-83.46,P=0.044)were significantly increases the risk of death in patients with SMAE.CONCLUSION For patients with SAME,increased blood lactate and intestinal wall thinning are the risk factors for death;hence,close monitoring may reduce the mortality rate.Clinical observation combined with MDCT signs can significantly improve SMAE diagnosis.
文摘Trauma is the leading cause of death in age group less than 45 years. In trauma, time is one of the most crucial factors in predicting prognosis. Outcomes are greatly improved when critical interventions are provided within the golden hour following injury. Whole body multidetector computerised tomography (WBMDCT) can decrease this critical time and increase survival. Emergency CT plays a major role in diagnostic workflow in the evaluation of patients with polytrauma. MDCT scanners are widely used because they rapidly produce high-resolution scans of large areas, offering short examination times for multiple body regions under emergency conditions. Such examinations most often include the head, cervical spine, and thorax to pelvis. Role of MDCT in head trauma remains unparalleled for reasons like its widespread availability and capability to reveal skull fractures, primarily because it is a fast and efficient method to triage the patients with treatable conditions mandating urgent surgical intervention such as extra axial hematomas, mass effect, herniations of brain, hydrocephalus, and midline shift and hence preventing secondary brain injury. MDCT angiography is an important tool to screen patients with suspected vascular injury.
文摘Background: Radiology plays an essential role in the diagnosis, staging and surveillance of oncology patients. CT is the most sensitive imaging modality in the workup of these patients. Aim of the Study: The aim of this work is to detect the role of MDCT (multidetector computed tomography) in the preoperative investigation of gastric adenocarcinoma patients according to TNM staging. Patients and Methods: This is a prospective study enrolling 20 patients who had histologically proven adenocarcinoma based upon an upper gastrointestinal endoscopic biopsy for MDCT staging of gastric carcinoma during the period from June 2016 to June 2017. The MSCT data were correlated and compared with the histopathological results. The study was conducted in the Radiology Department of Assiut University Hospital using 64-MDCT (Toshiba Aquilion). Results: According to our study results, the sensitivity of determining T1 stage on CT scan can’t be detected as there was only 1 case pathologically proved T1 and overstaged as T2 by MSCT;however, accuracy and specificity are quite high, which was 95% and 100% respectively. For T2 stage tumors (25.0% of cases), accuracy is 95%, sensitivity—100%, and specificity—93.7%. According to our results the accuracy and sensitivity of T3 staging are 75% and 100%, while those of T4 stage were 75% and 44.4% respectively. Tumor was correctly staged in 14 of 20 patients (the valid T staging rate was 70.0%). Tumor was under-staged in 5 of 20 patients (25.0%) (staged as T3, but pathologically proven to be T4a). As regards N staging accuracy found results for N0 (62.5%), N2 (87.5%) and N3 (75%), while N1 accuracy recorded 37.5%. As regards the nodal staging sensitivity which had a range from (0% for N4) to (66% for N2) this wide range of sensitivity demonstrates the problem of CT in nodal staging. As regards sensitivity of M0, accuracy was 100% and 85% respectively. While that of M1 was (62.5%) and (85%) respectively. Conclusion: MSCT can be the first choice for the preoperative evaluation of patients with gastric carcinoma. It presents excellent accuracy in the staging of tumor invasion depth (T) and in the staging of metastatic neoplastic disease (M). Despite the good accuracy in the staging of patients without lymph node disease (N0), the method presents limitations in the staging of lymph node involvement.
文摘BACKGROUND No qualitative or quantitative analysis of contrast-enhanced computed tomography(CT)images has been reported for the differentiation between ameloblastomas and central giant cell granulomas(CGCGs).AIM To describe differentiating multidetector CT(MDCT)features in CGCGs and ameloblastomas and to compare differences in enhancement of these lesions qualitatively and using histogram analysis.METHODS MDCT of CGCGs and ameloblastomas was retrospectively reviewed to evaluate qualitative imaging descriptors.Histogram analysis was used to compare the extent of enhancement of the soft tissue.Fisher’s exact tests and Mann–Whitney U test were used for statistical analysis(P<0.05).RESULTS Twelve CGCGs and 33 ameloblastomas were reviewed.Ameloblastomas had a predilection for the posterior mandible with none of the CGCGs involving the angle.CGCGs were multilocular(58.3%),with a mixed lytic sclerotic appearance(75%).Soft tissue component was present in 91%of CGCGs,which showed hyperenhancement(compared to surrounding muscles)in 50%of cases,while the remaining showed isoenhancement.Matrix mineralization was present in 83.3%of cases.Ameloblastomas presented as a unilocular(66.7%),lytic(60.6%)masses with solid components present in 81.8%of cases.However,the solid component showed isoenhancement in 63%.No matrix mineralization was present in 69.7%of cases.Quantitatively,the enhancement of soft tissue in CGCG was significantly higher than in ameloblastoma on histogram analysis(P<0.05),with a minimum enhancement of>49.05 HU in the tumour providing 100%sensitivity and 85%specificity in identifying a CGCG.CONCLUSION A multilocular,lytic sclerotic lesion with significant hyperenhancement in soft tissue,which spares the angle of the mandible and has matrix mineralization,should indicate prospective diagnosis of CGCG.
文摘We report a case of left pulmonary artery sling associated with patent ductus arteriosus and atrial septal defect in a 21-month-old child. 256-slice MDCT provides valuable information, such as abnormal origin of the left pulmonary artery, the relationship between pulmonary artery and airway, the diameter of the patent ductus artery and atrial septal defect. The information is helpful in diagnosis, pre-operative evaluation and post-operative follow-up of LPS.
文摘<strong>Background</strong>: Redo aortic valve replacement for prosthetic valve endocarditis is a challenge for surgeons. Echocardiography is occasionally not an effective modality for the detection of infectious signs in prosthetic valve endocarditis. <strong>Case presentation</strong>: Herein, we report the case of a patient whose prosthetic valve endocarditis was detected by multidetector computed tomography and who successfully underwent redo aortic valve replacement. Preoperative echocardiography revealed no remarkable findings related to endocarditis such as perivalvular leakage or vegetation;however, multidetector computed tomography revealed a thickened right coronary cusp. Intraoperatively, the right coronary cusp was confirmed to be covered with thick infected tissue. The pathological findings revealed broad destruction due to infection of the right coronary cusp. <strong>Conclusion</strong>: Multidetector computed tomography was useful in detecting infectious signs in prosthetic valves.
文摘AIM:To evaluate the use of three-dimensional imaging of pancreatic carcinoma using multidetector computed tomography(CT)in a prospective study.METHODS:Ten patients with suspected pancreatic tumors were examined prospectively using multidetec-tor CT(Somatom Sensation 16,Siemens,Erlangen,Germany).The images were evaluated for the pres-ence of a pancreatic carcinoma and invasion of the peripancreatic vessels and surrounding organs.Using the isotropic CT data sets,a three-dimensional image was created with automatic vascular analysis and semi-automatic segmentation of the organs and pancreatic tumor by a radiologist.The CT examinations and the three-dimensional images were presented to the sur-geon directly before and during the patient's operation using the Medical Imaging Interaction Toolkit-based software "ReLiver".Immediately after surgery,the value of the two images was judged by the surgeon.The operation and the histological results served as the gold standard.RESULTS:Nine patients had a pancreatic carcinoma(all pT3),and one patient had a serous cystadenoma.One tumor inf iltrated the superior mesenteric vein.The inf iltration was correctly evaluated.All carcinomas were resectable.In comparison to the CT image with axial and coronal reconstructions,the three-dimensional image was judged by the surgeons as better for operation planning and consistently described as useful.CONCLUSION:A 3D-image of the pancreas repre-sents an invaluable aid to the surgeon.However,the 3D-software must be further developed in order to be integrated into daily clinical routine.
文摘AIM:To evaluate the clinical impact of multidetector computed tomography (MDCT) before double-balloon endoscopy (DBE) for patients with obscure gastrointestinal bleeding (OGIB).METHODS:A retrospective analysis of prospectively collected cases with DBE and MDCT for overt OGIB was conducted from April 2004 to April 2010 at Changhua Christian Hospital.We evaluated the clinical impact of MDCT on the subsequent DBE examinations and the diagnostic yields of both MDCT and DBE respectively.RESULTS:From April 2004 to April 2010,a total of 75 patients underwent DBE for overt OGIB.Thirty one cases received MDCT followed by DBE for OGIB.The overall diagnostic yields of DBE and MDCT was 93.5% and 45.2%.The MDCT had a high diagnostic yield of tumor vs non-tumor etiology of OGIB (85.7% vs 33.3%,P=0.014).Additionally,the choice of initial route of DBE was correct in those with a positive MDCT vs negative MDCT (100% vs 52.9%,P=0.003).CONCLUSION:This study suggests MDCT as a triage tool may identify patients who will benefit from DBE and aid the endoscopist in choosing the most efficient route.
基金Supported by grants from the National Natural Science Foundation of China(No.81271529)the Natural Science Foundation of Hubei Province(No.2014CFB298)the Health and Family Planning Research of Hubei Province(No.WJ2015MB066)
文摘Objective To evaluate the diagnostic value of three-dimensional multidetector-row computed tomography(MDCT) in detecting acquired renal arteriovenous malformation(RAVM) and to compare its performance with that of ultrasonography and digital subtraction angiography(DSA). Methods The institutional review board approved this retrospective study and written informed consent was obtained from all patients before examination. All 14 patients with acquired RAVM underwent MDCT, including cortical and medullary phase enhancement angiography and three-dimensional(3D) reconstruction. Five and nine patients were further examined and their diagnoses confirmed by DSA and surgery, respectively. The MDCT images, including 3D reconstructions, were analyzed for RAVM independently and in consensus by two observers using a workstation.Results Among the 14 patients with acquired RAVM, 12 with maximum lesion diameter ≥ 10 mm, and one with a maximum lesion diameter between 5 and 10 mm, were correctly diagnosed with MDCT angiography. Among these patients, four diagnoses were confirmed by DSA. One patient with a lesion 5–10 mm in diameter was misdiagnosed with a renal aneurysm by MDCT angiography. The other one with the maximum diameter of the lesion between 5 mm and 10 mm was misdiagnosed as renal aneurysm with MDCT angiography, which was diagnosed as renal arteriovenous malformation with DSA. Among 14 lesions in 14 patients, eight and six originated in the left and right kidney, respectively.Conclusion MDCT angiography can accurately diagnose RAVM and improve our understanding of the disease, which will allow clinicians to provide better care.
