Abdominal Multidetector Computed Tomography Research Articles

The "cardiac neglect": a gentle reminder to radiologists interpreting contrast-enhanced abdominal MDCT.

Myocardial infarction (MI) may be visible on contrast-enhanced multidetector computed tomography (MDCT) scans of the abdomen. In the previous literature, potentially missed MI in abdominal MDCTs was not perceived as an issue in radiology. This retrospective single-center study assessed the frequency of detectable myocardial hypoperfusion in contrast-enhanced abdominal MDCTs. We identified 107 patients between 2006 and 2022 who had abdominal MDCTs on the same day or the day before a catheter-proven or clinically evident diagnosis of MI. After reviewing the digital patient records and applying the exclusion criteria, we included 38 patients, with 19 showing areas of myocardial hypoperfusion. All MDCT studies were non ECG-gated. The delay between the MDCT examination and MI diagnosis was shorter in studies with myocardial hypoperfusion ( hours and hours) but not statistically significant . Only 2 of 19 (11%) of these pathologies had been noted in the written radiology reports. The most common cardinal symptom was epigastric pain (50%), followed by polytrauma (21%). STEMI was significantly more common in cases of myocardial hypoperfusion . Overall, 16 of 38 (42%) patients died because of acute MI. Based on extrapolations using local MDCT rates, we estimate several thousand radiologically missed MI cases worldwide per year.

Predictive value of sphericity index and other multidetector computed tomography findings in perforated acute appendicitis.

Early radiological prediction and diagnosis of perforated acute appendicitis remain controversial. In the current study, it was aimed to examine the predictive value of multidetector computed tomography (MDCT) findings in perforated acute appendicitis. The patients (n=542) who underwent appendectomy between January 2019 and December 2021 were retrospectively evaluated. The patients were divided into two groups as non-perforated appendicitis and perforated appendicitis. Preoperative abdom-inal MDCT findings, appendix sphericity index (ASI) scores, and laboratory findings were evaluated. The sample consisted of 427 cases in the non-perforated group and 115 cases in the perforated group, with a mean age of 33.88±12.84 years. The mean time until admission was 2.06±1.43 days. Appendicolith, free fluid, wall defect, abscess, free air, and retroperitoneal space (RPS) involvement were all found to be significantly higher in the perforated group (P<0.001). The mean long axis, short axis, and ASI values were found to be higher in the perforated group (P<0.001; P=0.004; and P<0.001, respectively). C-reac-tive protein (CRP) was found to be significantly higher in the perforated group (P=0.008), but the mean white blood count was found to be similar between the groups (P=0.613). Among MDCT findings, free fluid, wall defect, abscess, high CRP, long axis, and ASI were observed to be predictive values for perforation. According to receiver operating characteristic analysis, ASI had a cut-off value of 1.30, a sensitivity of 80.87%, and a specificity of 93.21%. MDCT findings, namely, appendicolith, free fluid, wall defect, abscess, free air, and RPS involvement are significant findings for perforated appendicitis. With a high sensitivity and specificity, the ASI appears to be a key predictive parameter for perfo-rated acute appendicitis.

Clinical outcomes of acute upper gastrointestinal bleeding according to the risk indicated by Glasgow-Blatchford risk score-computed tomography score in the emergency room.

Acute upper gastrointestinal (UGI) bleeding is a significant emergency situation with a mortality rate of 2% to 10%. Therefore, initial risk stratification is important for proper management. We aimed to evaluate the role of contrast-enhanced multidetector computed tomography (MDCT) for risk stratification in patients with acute UGI bleeding in the emergency room (ER). This retrospective study included patients with UGI bleeding in the ER. Glasgow-Blatchford risk score-computed tomography (GBS-CT) was assessed using a combination of GBS and the MDCT scan scoring system. Of the 297 patients with UGI bleeding, 124 (41.8%) underwent abdominal MDCT. Among them, 90.3% were classified as high-risk by GBS, and five patients died (4.0%). Rebleeding occurred in nine patients (7.3%). The high-risk GBS-CT group had significantly higher in-hospital mortality (10.5% in high-risk vs. 1.4% in moderate risk vs. 0% in low-risk, p = 0.049), transfusion amount (p &lt; 0.001), and endoscopic hemostasis (p &lt; 0.001) compared to the moderate- and low-risk groups. Adding MDCT scans to the existing validated prognosis model when predicting the risk of UGI bleeding in patients in the ER plays a significant role in determining in-hospital mortality, transfusions, and the need for endoscopic hemostasis.

Absence of the celiac trunk: Definition, classification, multidetector computed tomography angiographic findings, and their probable embryological mechanisms.

This study aims to identify the types and prevalence of absence of the celiac trunk by using multidetector computed tomography (MDCT) angiography, and analyze their probable embryological mechanisms. A retrospective study was carried out on 2500 abdominal MDCT angiography images. The absence of the celiac trunk was defined as that the celiac trunk is not exist, more specifically, there is not such an arterial trunk containing at least two major branches of the celiac trunk. Various types of the absence of the celiac trunk were investigated. Of the 2500 patients, 19 (0.76%) patients were identified as an absence of the celiac trunk. According to its definition and classification, the absence of the celiac trunk could be divided into five types: type I (LGA + CHA + SA + SMA), type II (HM trunk + LGA + SA), type III (SM trunk + LGA + CHA), type IV (GM trunk + CHA + SA), and type V (other type); and these types were observed in 5 patients (0.20%), 9 patients (0.36%), 3 patients (0.12%), 0 patients (0.00%), and 2 (0.08%) patients, respectively. There were more examples of the types I and II than of the types III-V (p = 0.004). We systematically classified the absence of the celiac trunk based on its MDCT angiography findings. Abnormal interruptions and persistence of the longitudinal anastomosis, regression of vascular root, and emergence of replaced artery could all be the embryological mechanisms of various types of the absence of the celiac trunk.

Role of clinical data and multidetector computed tomography findings in acute superior mesenteric artery embolism.

BACKGROUNDSuperior 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.AIMTo 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.METHODSData 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.RESULTSUnivariate 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.CONCLUSIONFor 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.

Anatomical Variations of Vermiform Appendix on Plain MDCT and Its Association with Acute Appendicitis in Adult Urban Population of Karachi, A Tertiary Care Hospital Experience

Objective: To evaluate the anatomical positions of vermiform appendix and its association with acute appendicitis on Multidetector computed tomography (MDCT). Study design and setting: A cross sectional study based on hospital database was carried out in Department of Anatomy in collaboration with Department of Radiology, Liaquat National Hospital. Methodology: A total of three hundred and six 306 adult urban patients CT axial images were evaluated retrospectively over period of 6 months from March 2021 to August 2021 who had abdominal MDCT scan for acute abdomen after getting approval from ethical committee to find out anatomical variations of position of vermiform appendix in a tertiary care hospital among adult urban Karachi population and its association with appendicitis. Data was analyzed using SPSS version 25. All categorical variables were summarized as frequencies and percentages. Result: In present study 159(52%) were males and 147(48%) were females with mean age of 32.97 years. The subcecal anatomical position of vermiform appendix on MDCT was most common n=85(27.8%), followed by postileal n=78(25.5%), pelvic n=61(19.9%), postcecal n= 36(11.8%), preileal n=29(9.5%), ectopic n=17(5.6%). The association between appendicitis with anatomical position of vermiform appendix and age was analyzed by chi- square and was statistically significant (p =0.05). There was no significant association between position of vermiform appendix on MDCT and gender. Conclusion: The subcecal position of vermiform appendix is most common on MDCT and the postileal position was more frequent in the inflamed group of vermiform appendix

Evaluation of the incidence of renal vein anomalies and their relationship with renal stone disease and renal tumors by abdominal multidetector computed tomography

Purpose: This study aimed to evaluate the types and incidence of renal vein anomaly (RVA) and their relationship with renal stone disease and renal tumors with multidetector computed tomography (MDCT). &#x0D; Materials and Methods: We evaluated retrospectively 10124 patients abdominal MDCT images. After the exclusion criteria, the final study population consisted of 9294 patients. The demographic characteristics of the patients, the presence of RVA, the presence of renal stone disease and renal tumor were recorded. RVAs were separated into three subgroups: retroaortic left renal vein (RLRV), circumaortic left renal vein (CLRV), and double right renal vein (DRRV). The presence of renal stone disease and renal tumors were recorded in patients with RVAs.&#x0D; Results: 1389 cases had RVA (14.9%). RVA was higher in males than females. The prevalence of DRRV, RLRV, and CLRV were 9.5%, 3.9%, and 1.9%, respectively. Renal tumors was detected in 20, and renal stone disease was detected in 243 of 1389 RVA cases, there was no statistically significant correlation. However, a statistically significant correlation was found between left renal stone disease with RLRV and CRLV.&#x0D; Conclusion: Contrary to popular belief, RVAs are not uncommon. It is very important to know the presence of RVA before retroperitoneal surgery to prevent possible complications. In addition, RLRV and CLRV are thought to be factors that predispose to the development of left renal stone disease.

Clinical utility of abdominal multidetector CT in 85 goats with suspected abdominal disease.

Diagnosing the cause of abdominal disease in goats can be challenging. Clinical history, physical investigation, and laboratory findings do not always allow definitive identification of intra-abdominal disease or the underlying cause. Multidetector CT (MDCT) has become more readily available and now often replaces or augments other abdominal imaging techniques. The objective of this retrospective, observational, descriptive study was to investigate the clinical utility of MDCT for evaluation of the abdomen in goats with suspected abdominal disease involving the urinary, gastrointestinal, reproductive tracts and abdominal wall. Medical records (1/2009-12/2017) were reviewed for all goats undergoing an abdominal MDCT. Signalment, clinical history, examination and MDCT findings and outcome were recorded and categorized by abdominal organ system and wall lesion. Clinical problems and MDCT findings were compared in the various abdominal categories. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic odds ratio (OR) were calculated for MDCT, using clinical examination findings as the reference standard. A total of 85 goats underwent an abdominal MDCT examination. The sensitivity of MDCT for detecting urinary, gastrointestinal, reproductive tract, and abdominal wall abnormalities in goats with clinical problems related to these body systems was high at 94.7 %, 78.3%, 94.1%, and 100%, and the specificity was high at 95.6%, 96.7%, 93.9%, and 100%, respectively. The PPV was 94.7%, 90.0 %, 80.0%, and 100.0%, the NPV was 95.6%, 92.1%, 98.4%, and 100%, and the OR were 387.0, 104.4, 248.0, and infinite. In conclusion, findings supported the use of MDCT as an adjunct diagnostic test for assessing goats with abdominal disease.

Deep learning image reconstruction algorithm for abdominal multidetector CT at different tube voltages: assessment of image quality and radiation dose in a phantom study

To compare the image quality and radiation dose of a deep learning image reconstruction (DLIR) algorithm compared with iterative reconstruction (IR) and filtered back projection (FBP) at different tube voltages and tube currents. A customized body phantom was scanned at different tube voltages (120, 100, and 80 kVp) with different tube currents (200, 100, and 60mA). The CT datasets were reconstructed with FBP, hybrid IR (30% and 50%), and DLIR (low, medium, and high levels). The reference image was set as an image taken with FBP at 120 kVp/200mA. The image noise, contrast-to-noise ratio (CNR), sharpness, artifacts, and overall image quality were assessed in each scan both qualitatively and quantitatively. The radiation dose was also evaluated with the volume CT dose index (CTDIvol) for each dose scan. In qualitative and quantitative analyses, compared with reference images, low-dose CT with DLIR significantly reduced the noise and artifacts and improved the overall image quality, even with decreased sharpness (p < 0.05). Despite the reduction of image sharpness, low-dose CT with DLIR could maintain the image quality comparable to routine-dose CT with FBP, especially when using the medium strength level. The new DLIR algorithm reduced noise and artifacts and improved overall image quality, compared to FBP and hybrid IR. Despite reduced image sharpness in CT images of DLIR algorithms, low-dose CT with DLIR seems to have an overall greater potential for dose optimization. • Using deep learning image reconstruction (DLIR) algorithms, image quality was maintained even with a radiation dose reduced by approximately 70%. • DLIR algorithms yielded lower image noise, higher contrast-to-noise ratios, and higher overall image quality than FBP and hybrid IR, both subjectively and objectively. • DLIR algorithms can provide a better image quality, much better than FBP and even better than hybrid IR, while facilitating a reduction in radiation dose.

Tailored versus fixed scan delay in contrast-enhanced abdominal multi-detector CT: An intra-patient comparison of image quality

PurposeTo perform anintra-patient comparison betweena single-pass protocol (SP) and a portal venous phase (PVP) by means ofboth quantitative and qualitative analysis of image quality. MethodsForty patients (31 M; 9F; aged 20–77 years; BMI 23 ± 4 Kg/m2) underwent both a SP and a PVP using a 64-rows multi-detector CT with a median interval time of 56 days (range5–903). All patients underwent i.v. bolus injection (2.0 cc/sec) of 1.7 cc/Kg of a non ionic iodinated contrast-media (370 mgI/ml) with scan delays of 67 ± 8 and 90 s for the SP and the PVP, respectively. Signal- (SNR) and contrast-to-noise ratios (CNR) were calculated for most visceral organs and for both abdominal aorta (AA) and main portal vein (MPV). For qualitative analysis, reproduction of abdominal viscera and vascular structures was blindly evaluated and inter-observer agreement calculated by the weighted Cohen k-analysis. ResultsAttenuation values (H.U.) of AA (232 ± 53vs180 ± 36) and MPV (215 ± 39vs187 ± 42) were significantly (p < 0.001) higher in the SP than in PVP, respectively. At qualitative analysis, reproduction of mostabdominal viscerawas also significantly sharper (p < 0.001) with the SP than the PVPwith inter-observer agreement scores (k)ranging from 0.60 to 0.88 for all but one imaging criteria. ConclusionsAs the SP resulted in a significantly higher vascular enhancement and in a sharper reproduction of most abdominal viscera, it may be better suited than a PVP for the CT evaluation of non traumatic acute abdomen.

Accuracy of the Chula's formula for calculation of standard liver volume in Thai population

Background: Standard liver volume (SLV) is an important concept in living donor liver transplantation for treatment of end-stage liver disease. Accurate estimation of the SLV of living donor and recipient is crucial to ensure optimal graft function and avoid complications. Objective: 1) to assess the proposed formula for calculation of SLV in Thai population, using computed tomography (CT) volumetric measurement as a gold standard. 2) to evaluate the factors (e.g. age, sex, body weight and body surface area) related to differences between SLV calculated from the proposed formula and CT volumetric measurement. Materials and methods: We evaluated 497 patients underwent contrast-enhanced abdominal multi-detector CT for conditions unrelated to hepatobiliary system with normal liver radiology between October 1, 2014 and August 31, 2015 were included. Calculated SLV by the proposed formula (SLV = 20.76 x body weight) were compared to the total liver volume (TLV) measured from multi-detector CT by using computerized tool automatically. Factors related to the difference between SLV and TLV were evaluated. Result: The aforementioned formula showed a high accuracy in estimating the liver volume with some limitations in overweight or underwent patients. The mean difference between SLV and TLV is 3.36 cm3 with SD of 224.65 cm3. Conclusion: We proposed a new formula ("Chula's standard liver volume") that demonstrates a high accuracy for calculation of SLV in Thai population. Keywords: Liver volume; MDCT; standard liver volume; Thai population

Relationship of superior mesenteric artery thrombus density with transmural intestinal necrosis on multidetector computed tomography in acute mesenteric ischemia.

Acute arterial occlusive mesenteric ischemia with transmural intestinal necrosis (TIN) is a fatal disease, which is difficult to diagnose on multidetector computed tomography (MDCT). The aim of the present study was to determine the relationship of superior mesenteric artery (SMA) thrombus density with TIN on MDCT in patients with acute mesenteric ischemia (AMI) due to SMA thromboembolism. In this retrospective study, 33 patients who underwent abdominal MDCT and angiography for AMI due to SMA thromboembolism were divided into two groups: the AMI with TIN group and the AMI without TIN group. We analyzed the relationships of clinical characteristics, qualitative MDCT signs, and SMA thrombus density with TIN. The SMA thrombus density was measured on non-contrast MDCT. Univariate and multivariate analyses were performed to determine the risk factors for predicting TIN. The diagnostic performances of risk factors were evaluated by receiver-operating characteristic (ROC) curve analysis. Of the patients with AMI enrolled in this study, 33.3% (11/33) were diagnosed with TIN. Peritonitis (P=0.042), bowel wall thinning (P=0.033), and pneumatosis/portomesenteric gas (P=0.010) were significantly associated with TIN. AMI patients with TIN exhibited a higher SMA thrombus density than AMI patients without TIN [41.2±6.1 vs. 34.2±3.0 Hounsfield unit (HU), P=0.003]. Multivariate analysis showed that SMA thrombus density was an independent predictor of TIN [P=0.044, hazard ratio (HR): 1.82, 95% confidence interval (CI): 1.02-3.25]. For diagnosing AMI with TIN, the area under the ROC curve (AUC) of SMA thrombus density (0.83) was larger than those of peritonitis (0.68), bowel wall thinning (0.66), and pneumatosis/portomesenteric gas (0.71). In patients with AMI, erythrocyte-rich thrombus blocking the SMA trunk which has a higher density on MDCT is prone to the occurrence of TIN compared with erythrocyte-scarce thrombus with a lower density. SMA thrombus density could be an independent risk factor for TIN in patients with AMI due to SMA thromboembolism.

Prediction of Incidental Osteoporotic Fractures at Vertebral-Specific Level Using 3D Non-Linear Finite Element Parameters Derived from Routine Abdominal MDCT.

To investigate whether finite element (FE) analysis of the spine in routine thoracic/abdominal multi-detector computed tomography (MDCT) can predict incidental osteoporotic fractures at vertebral-specific level; Baseline routine thoracic/abdominal MDCT scans of 16 subjects (8(m), mean age: 66.1 ± 8.2 years and 8(f), mean age: 64.3 ± 9.5 years) who sustained incidental osteoporotic vertebral fractures as confirmed in follow-up MDCTs were included in the current study. Thoracic and lumbar vertebrae (T5-L5) were automatically segmented, and bone mineral density (BMD), finite element (FE)-based failure-load, and failure-displacement were determined. These values of individual vertebrae were normalized globally (g), by dividing the absolute value with the average of L1-3 and locally by dividing the absolute value with the average of T5-12 and L1-5 for thoracic and lumbar vertebrae, respectively. Mean-BMD of L1-3 was determined as reference. Receiver operating characteristics (ROC) and area under the curve (AUC) were calculated for different normalized FE (Kload, Kdisplacement,K(load)g, and K(displacement)g) and BMD (KBMD, and K(BMD)g) ratio parameter combinations for identifying incidental fractures. Kload, K(load)g, KBMD, and K(BMD)g showed significantly higher discriminative power compared to standard mean BMD of L1-3 (BMDStandard) (AUC = 0.67 for Kload; 0.64 for K(load)g; 0.64 for KBMD; 0.61 for K(BMD)g vs. 0.54 for BMDStandard). The combination of Kload, Kdisplacement, and KBMD increased the AUC further up to 0.77 (p < 0.001). The combination of FE with BMD measurements derived from routine thoracic/abdominal MDCT allowed an improved prediction of incidental fractures at vertebral-specific level.

Predicting Vertebral Bone Strength Using Finite Element Analysis for Opportunistic Osteoporosis Screening in Routine Multidetector Computed Tomography Scans-A Feasibility Study.

PurposeTo investigate the feasibility of using routine clinical multidetector computed tomography (MDCT) scans for conducting finite element (FE) analysis to predict vertebral bone strength for opportunistic osteoporosis screening.MethodsRoutine abdominal MDCT with and without intravenous contrast medium (IVCM) of seven subjects (five male; two female; mean age: 71.86 ± 7.40 years) without any bone disease were used. FE analysis was performed on individual vertebrae (T11, T12, L1, and L2) including the posterior elements to investigate the effect of IVCM and slice thickness (1 and 3 mm) on vertebral bone strength. Another subset of data from subjects with vs. without osteoporotic vertebral fractures (n = 9 age and gender-matched pairs) was analyzed for investigating the ability of FE-analysis to differentiate the two cohorts. Bland-Altman plots, box plots, and coefficient of correlation (R2) were calculated to determine the variations in FE-predicted failure loads for different conditions.ResultsThe FE-predicted failure loads obtained from routine MDCT scans were strongly correlated with those from without IVCM (R2 = 0.91 for 1mm; R2 = 0.92 for 3mm slice thickness, respectively) and different slice thicknesses (R2 = 0.93 for 1mm vs. 3mm with IVCM). Furthermore, a good correlation was observed for 3mm slice thickness with IVCM vs. 1mm without IVCM (R2 = 0.87). Significant difference between FE-predicted failure loads of healthy and fractured patients was observed (4,705 ± 1,238 vs. 4,010 ± 1,297 N; p=0.026).ConclusionRoutine clinical MDCT scans could be reliably used for assessment of fracture risk based on FE analysis and may be beneficial for patients who are at increased risk for osteoporotic fractures.

Kontrastlı çok dedektörlü bilgisayarlı tomografi ile akut spontan izole renal arter diseksiyonunun saptanması

Purpose: Spontaneous isolated renal artery dissection is a very rare but threatening condition that can be difficult to diagnose early due to nonspecific symptoms. The goal of this study is to evaluate the incidence and multidetector computed tomography (MDCT) findings of this rare and important condition. Materials and methods: We retrospectively examined the images of all patients who underwent contrast enhanced abdominal MDCT scans due to various abdominal complaints between July 2017- July 2020. 14000 contrast enhanced MDCT scans were evaluated. Only the isolated renal artery dissections without aortic involvement were included. Age, gender, symptoms, presence of thrombosis or renal parenchymal ischemia-infarct were noted. Average extension of dissection and distance from origin were measured. Results: 8(0,054%) patients had spontaneous isolated renal artery dissection (5M, 3F, age range 43-61 years). The mean distance from origin was 3.7 cm and the average extension was 3.8 cm. 3 patients had kidney infarct with a focal area of decreased perfusion. Only 1 patient underwent digital subtraction angiography. Patients were started on an anticoagulation therapy. No surgical or interventional therapy was deemed necessary. Dissections completely disappeared in patients who could undergo follow-up MDCT. Conclusion: Spontaneous isolated renal artery dissection is a very rare condition. The etiology is not well known. The initial symptoms are generally nonspecific such as severe upper abdomen or flank pain. There are several treatment options available such as medical, surgical or interventional managements. Early diagnose is important to prevent complications. It should be considered in patients with new-onset flank or abdominal pain.

Evaluating incidence and clinical importance of renal vein anomalies with routine abdominal multidetector computed tomography.

Renal vein anomalies are usually asymptomatic embryological developmental disorders. If unidentified, they can lead to significant morbidity during surgical explorations. This study aims to evaluate the type, frequency, clinical importance of renal vein anomalies in patients scanned with Multidetector Computed Tomography (MDCT). It was also investigated whether renal vein anomalies are associated with malignancies or their types. Abdominal MDCT images of 8517 patients were examined retrospectively. Renal vein anomaly types, gender, age, and symptoms were recorded. Renal vein anomalies were divided into three subgroups as retroaortic left renal vein (RLRV), circumaortic left renal vein (CLRV), and double right renal vein (DRRV). The presence of malignancy and their types in patients with renal vein anomalies were noted. Malignancies were divided into five subgroups as lung, gastrointestinal system (GIS), genitourinary system, breast, and others. 156 patients had renal vein anomaly (1.8%). The prevalence of RLRV, CLRV, and DRRV were 1.1%, 0.3%, and 0.2%, respectively. Renal vein anomalies were more frequent in females. Malignancy was present in 89 (57.1%) out of 156 renal vein anomaly patients. Among these 89 patients, RLRV was found in 52 (58.4%), CLRV in 22 (24.7%), and DRRV in 15 (16.8%) patients. The presence of malignancy was present in more than half of the renal vein anomaly patients but there was no significant correlation (p = 0.1). This high ratio is probably due to the high number of cancer patients undergoing CT scan in our radiology department. Renal vein anomalies are rare conditions, however, coexistence of renal vein anomalies and malignancies is not. An awareness of this entity before retroperitoneal surgeries is very important in order to avoid complications such as hemorrhage, transfusion, death, or conversion to open surgery.

Risk factors of geriatrics index of comorbidity and MDCT findings for predicting mortality in patients with acute mesenteric ischemia due to superior mesenteric artery thromboembolism.

To identify risk factors of geriatrics index of comorbidity (GIC) and multidetector CT (MDCT) findings for predicting mortality in patients with acute mesenteric ischemia (AMI) due to superior mesenteric artery (SMA) thromboembolism. 33 patients with AMI due to SMA thromboembolism underwent abdominal MDCT and angiography. Patients' comorbidities and MDCT findings of ischemic bowel/mesenteric injuries, regions of SMA involved by thromboembolism, and degrees of SMA stenosis were retrospectively reviewed. The comorbidities were classified into 1-4 levels according to GIC. The association of MDCT signs and GIC classification with mortality were analyzed. Diagnostic performances of risk factors associated with mortality were evaluated by receiver operating characteristic (ROC) curve analyses. Eighteen patients (54.5%) died during hospitalization or follow-up, including one patient with class 1, two patients with class 2, eight patients with class 3, and seven patients with class 4 according to GIC. Three risk factors significantly associated with mortality were identified, including pneumatosis and/or portomesenteric venous gas (PPMVG) (p = 0.017), four regions of SMA involved by thromboembolism (region I + II + III + IV) (p = 0.036), and class 3 + 4 of comorbidities (p = 0.001). The sensitivity and specificity of PPMVG, region I + II + III + IV, class 3 + 4 of comorbidities, and the three risk factors combined for diagnosing mortality were 33.3 and 100%, 27.8 and 100%, 83.3 and 73.3%, and 88.9 and 73.3%, respectively. The areas under the ROC curve (AUC) of the three risk factors combined (0.88) and class 3 + 4 of comorbidities (0.78) were larger than that of PPMVG (0.67) and region I + II + III + IV (0.64). The mortality rate rose from 15.4% in patients without risk factor to 66.7%, 100%, and 100% in patients with one, two, and three factors, respectively. Three risk factors for mortality were identified in patients with AMI due to SMA thromboembolism, including PPMVG and four regions of SMA involved by thromboembolism on MDCT images, and class 3 + 4 of comorbidities. Close monitoring of these risk factors could possibly lower the mortality. Risk factors based on GIC and MDCT findings may be used to predict mortality in patients with AMI. Close monitoring of these risk factors could possibly lower the mortality.

Cystic and Syndromic Disorders of the Pancreas

Several clinically significant cystic diseases and syndromes are known to afflict the pancreas. They are often incidentally encountered in radiologic studies obtained for unrelated indications. Cystic pancreatic lesions are encountered in about 2.6% of abdominal multidetector CT studies and in about 20% of MRI studies.1 The imaging findings of these cystic lesions and syndromes often appear overwhelming to inexperienced radiologists, including radiologists in training, and may result in misdiagnosis. We review the CT and MRI appearance of various cystic and syndrome-related disorders of the pancreas.

Accuracy of Alvarado Scoring System and Selective Computed Tomography in Diagnosis of Suspected Cases of Acute Appendicitis

Objective: To evaluate the diagnostic accuracy of combined Alvarado scoring system and selective computed tomography (CT) in the diagnosis of suspected cases of acute appendicitis. Material and methods: This study was conducted during the period March 2018 to January 2020 at Prince Mohammed bin Abdul-Aziz hospital (NGHA) in Al Madinah, KSA. It is a prospective study involving 100 consecutive patients attending the emergency department with right iliac fossa pain, excluding children below the age of 14 years and pregnant women. All patients were initially assessed by the Alvarado scoring system, and the result of each patient was recorded in a separate predesigned data sheath. Based on the patient's calculated Alvarado scores, patients were stratified into three groups: Group A (score ≤ 4), Group B (score 5-6), and group C (score ≥ 7). All patients in group A were discharged from the emergency department with instruction to return if their symptoms persist or get worse while all patients in group B had an abdominal multidetector CT scan (MDCT) with IV contrast and no oral contrast to help the diagnosis. Group C patients had surgery without further investigation. Alvarado scores were compared to intraoperative findings and histopathological examination of the removed appendix in those who were operated. The sensitivity, specificity, positive and negative predictive values of the scoring system in each group were calculated with special reference to the role of CT scan in improving the diagnostic accuracy of the scoring system in the middle group (group B). Result: 58 patients were male and 42 were female. Age range between 14 and 43 years with median age 24 years. Out of the 100 patients, 14 (8 males, 6 females) belonged to Group A, 23 (11 males, 12 females) to Group B and 63 (39 males, 24 females) to group C. Two patients from group A (one male and one female) were returned with worsening symptoms and subsequently operated for acute appendicitis. CT scan established the diagnosis of acute appendicitis in 16 out of the patients of group B with subsequent histological confirmation of acute appendicitis in 15 of them. Histopathology confirmed the diagnosis of acute appendicitis in 32 out of 63 patients of group C. Conclusion: Alvarado score has a high accuracy of ruling in and out acute appendicitis at the extremes of the score (≤7 and ≥4), however, the accuracy of the score to confirm or rule out acute appendicitis in the middle group (5 -6) is significantly low. Selective utilization of CT scan in patients in the middle of the score improves the diagnostic accuracy of the score and limits overutilization of CT scan in the other patients at the extremes of the score saving patients unnecessary exposure to radiation and health authorities’ time and cost without increasing the rate of negative appendectomy.

Assessment of paraspinal muscle characteristics, lumbar BMD, and their associations in routine multi-detector CT of patients with and without osteoporotic vertebral fractures

PurposeTo investigate paraspinal muscle characteristics and lumbar bone mineral density (BMD) and their associations in routine abdominal multi-detector computed tomography (MDCT) as well as the impact of osteoporotic vertebral fractures on such associations. Method116 patients (69.7 ± 8.1 years, 72 males) who underwent routine abdominal MDCT (oncological staging and/or follow-up for tumor recurrence) were retrospectively included and assigned to a fracture and control group (age- and gender-matched), depending on the presence or absence of lumbar osteoporotic vertebral fractures. BMD was derived from lumbar vertebrae using a conversion equation, and the cross-sectional area (CSA), CSA ratio (CSA psoas muscles divided by CSA erector spinae muscles), and muscle attenuation were measured for the psoas and erector spinae muscles at the levels L2 and L4/5 without dedicated software. ResultsMales showed significantly higher BMD, CSA, and CSA ratios at the levels L2 and L4/5, while females had decreased erector spinae muscle attenuation at L4/5 (p < 0.05). No significant differences between patients with versus without fractures were observed except for BMD (68.5 ± 37.2 mg/ml vs. 91.4 ± 26.8 mg/ml; p < 0.01). Age-adjusted partial correlation testing revealed significant correlations of BMD and the CSA ratio at level L4/5 (r = 0.20; p = 0.03), but not with muscle attenuation (p > 0.05). ConclusionsParaspinal muscle characteristics and lumbar BMD can be assessed seamlessly in routine abdominal MDCT without dedicated software. There are level-dependent interactions between paraspinal muscle characteristics as well as lumbar BMD. Vertebral fracture status was independent of paraspinal muscle characteristics.