Abnormal Computed Tomography Findings Research Articles

Early Infantile Krabbe Disease: Results of the World-Wide Krabbe Registry

New York State began screening for Krabbe disease in 2006 to identify infants with Krabbe disease before symptom onset. Because neither galactocerebrosidase activity nor most genotypes reliably predict phenotype, the World Wide Registry was developed to determine whether other clinical/neurodiagnostic data could predict early infantile Krabbe disease in the newborn screening population. Data on disease course, galactocerebrosidase activity, DNA mutations, and initial neurodiagnostic studies in 67 symptomatic children with early infantile Krabbe disease were obtained from parent questionnaires and medical records. Initial signs included crying/irritability, cortical fisting, and poor head control. Galactocerebrosidase activity was uniformly low. Eight of 17 manifested novel mutations. Ninety-two percent (n = 25) exhibited elevated cerebrospinal fluid protein; 76% (n = 42) demonstrated abnormal magnetic resonance images; 67% (n = 15) exhibited abnormal computed tomography findings; 43% (n = 28) produced abnormal electroencephalogram findings; 100% (n = 5) demonstrated abnormal nerve conduction velocities; 83% (n = 6) produced abnormal brainstem evoked responses; and 50% (n = 6) exhibited abnormal visual evoked responses. One, 2, and 3 year survivals were 60%, 26%, and 14%, respectively. Although most symptomatic patients with the early infantile phenotype manifested abnormal cerebrospinal fluid protein, magnetic resonance imaging, brainstem evoked responses, and nerve conduction velocities, studies of affected children may be normal. Other biomarkers are needed to predict phenotype in the newborn screening population.

Utility of Abdominal Computed Tomography in Head and Neck Cancer Patients

Objective: Assess the role of abdominal computed tomography (CT) imaging in the staging and surveillance of patients with head and neck squamous cell cancer (HNSCC) for distant metastatic disease (DMD) and second primary tumors (SPT). Method: Retrospective review of 172 HNSCC patients treated at an academic center who underwent abdominal CT imaging from 2003 to 2007. These scans were categorized as suspicious, positive, or negative for DMD or SPT. Charts of patients with suspicious or positive results were reviewed to determine resultant work-up and outcomes. Results: After consideration of exclusion criteria, 165 patients were included in this retrospective study. Normal abdominal CT scans were seen in 139 patients while the remaining 27 patients had abnormal abdominal CT findings. Of these 27, 16 patients (9.7%) were determined to have malignancy. Twelve patients had DMD, and 4 were diagnosed with SPT. Conclusion: Abdominal CT imaging identified DMD or SPT in 9.7% of patients resulting in significant alteration in their comprehensive oncologic care. This rate is not inconsequential and might justify the use of abdominal CT in managing HNSCC patients. Prospective trials might help determine the impact of abdominal CT findings on survival.

CT Findings in Adult Celiac Disease

Celiac disease is now recognized as a common disease, occurring in about one in every 200 Americans. However, less than 10% of cases are currently diagnosed, with a diagnostic delay of more than 10 years from onset of symptoms. In the past, barium examination of the small bowel demonstrated a pattern of abnormal findings caused by the pathophysiologic changes induced by malabsorption, thus leading to diagnosis of celiac disease and other diseases of malabsorption. Although not specific, that pattern prompted further patient evaluation. The number of barium examinations performed and the skill necessary to interpret their results are both in decline. Abdominal pain in celiac disease is a common early complaint that often leads to computed tomography (CT). Improved CT resolution now permits better depiction of the small bowel, colon, and mesenteric lymph nodes, all of which are affected by celiac disease. Detection of celiac disease with CT will allow treatment to be initiated to prevent the significant morbidity and increased mortality associated with a delay in diagnosis. The abnormal CT findings seen over the past decade during review of more than 200 cases of celiac disease demonstrate that CT depicts more features of celiac disease than did barium examination. Pattern recognition for the diagnosis of small bowel diseases that create structural changes in the bowel wall is well accepted. Because it demonstrates features of celiac disease not detected with barium examination, CT may be more sensitive than barium examination for diagnosis of this disease.

Normal or Abnormal? Demystifying Uterine and Cervical Contrast Enhancement at Multidetector CT

Computed tomography (CT) is not generally advocated as the first-line imaging examination for disorders of the female pelvis. However, multidetector CT is often the modality of choice for evaluating nongynecologic pelvic abnormalities, particularly in emergent settings, in which all the pelvic organs are invariably assessed. Incidental findings of uterine and cervical contrast enhancement in such settings may easily be mistaken for abnormalities, given the broad spectrum of anatomic variants and enhancement patterns that may be seen in the normal uterus and cervix. The authors' review of CT and magnetic resonance (MR) imaging enhancement patterns, augmented by case examples from their clinical radiology practice, provides a solid foundation for understanding the spectrum of normal uterine and cervical appearances and avoiding potential pitfalls in the diagnosis of benign cervical lesions, adenomyosis, infection, malignancy, and postpartum effects. This information should help radiologists more confidently differentiate between normal and abnormal CT findings and, when CT findings are not definitive, offer appropriate recommendations for follow-up ultrasonography or MR imaging.

Cranial computed tomography scan findings in head trauma patients in Enugu, Nigeria

Background:The choice of radiological investigations in head trauma in Africa is influenced by factors such as cost. Some patients who require computed tomography (CT) scan elsewhere are either managed blindly or do not present for it at the appropriate time. This paper evaluates the CT scan findings as they are obtained in cases of head trauma in a region of Nigeria.Methods:Prospectively recorded data of all head injury patients who presented for CT scan between January 2009 and April 2010 at Memfys Hospital for Neurosurgery (MHN), Enugu, Nigeria, were analyzed. Mobile CereTom 8-Slice CT was used in all cases. New and follow-up cases were included.Results:There were 204 CT scans for head trauma (171 new, 33 follow-up), accounting for about 34% of all head CT scans performed with this unit. The male to female ratio was 3.5:1. About 33.9% of the patients were in the third and fourth decades of life. In 19.9% cases, CT was unremarkable, while 80.1% cases had abnormal CT findings. The CT diagnosis was not in keeping with the indication of head trauma in 7%, and 13% had more than one finding. The most common CT findings were: subdural hematoma 30%, cerebral contusions and edema 30.7%, skull fractures 23.4% and extradural hematoma 8.0%. About 64% of the CT findings required surgical interventions. The overall mortality was 11.1%, but amongst the 137 patients who had abnormal CT findings, it was 13.9%.Conclusion:The high yield and diversity of CT scan findings in head trauma patients support the indication for the appropriate use of CT in diagnosis and management of head trauma even in developing countries.

Centrilobular Opacities in the Asthmatic Lung Successfully Treated with Inhaled Ciclesonide and Tiotropium: With Assessment of Alveolar Nitric Oxide Levels

Despite the fact that bronchioles are involved in asthma, there have been limited asthmatic cases showing marked centrilobular opacities on computed tomography (CT) chest scans. Systemic corticosteroids have been administered in such cases, but the efficacy of extra-fine particle inhaled corticosteroids has not been assessed. A previously healthy 64-year-old man presented with a four-month history of productive cough and progressive dyspnea despite a combination therapy with inhaled salmeterol (50 μg bid) and fluticasone (500 μg bid), sustained-release theophylline, and pranlukast because of suspicion of asthma. Physical examination revealed wheezing at the end of forced expiration. High resolution CT chest scan showed diffuse centrilobular opacities, bronchiectatic changes, and bronchial wall thickening. Transbronchial lung biopsy, bronchoalveolar lavage fluid, and transbronchial biopsy all showed predominant eosinophil infiltrates, suggesting that eosinophilic inflammation across the entire airway tree caused the abnormal CT findings. Alveolar fraction of exhaled nitric oxide level, a non-invasive marker of eosinophilic peripheral airway inflammation, was also elevated. Because he refused systemic corticosteroids, inhaled ciclesonide (400 μg bid) and inhaled tiotropium were added on to his current medication under careful observation. His symptoms, pulmonary function and CT findings promptly improved, and he had fully recovered at follow-up. Extra-fine particle inhaled corticosteroids could be an alternative approach in centrilobular opacities caused by eosinophilic peripheral airway inflammation.

Adaptive Statistical Iterative Reconstruction Technique for Pulmonary CT: Image Quality of the Cadaveric Lung on Standard- and Reduced-Dose CT

To evaluate thin-section computed tomography (CT) images of the lung reconstructed using adaptive statistical iterative reconstruction (ASIR) on standard- and reduced-dose CT. Eleven cadaveric lungs were scanned by multidetector-row CT with two different tube currents (standard dose, 400 mA; reduced dose, 10 mA). The degree of ASIR was classified into six different levels: 0% (non-ASIR), 20%, 40%, 60%, 80%, and 100% (maximum-ASIR). The ASIR (20%, 60%, and 100%) images were compared with the ASIR (0%) images and assessed visually by three independent observers for image quality using a 7-point scale. The evaluation items included abnormal CT findings, normal lung structures, and subjective visual noise. The median scores assigned by the three observers were analyzed statistically. Quantitative noise was calculated by measuring the standard deviation in a circular region of interest on each selected image of ASIR (0%-100%). On standard-dose CT, the overall image quality significantly improved with increasing degree of ASIR (P ≤ .009, Wilcoxon signed-ranks test with Bonferroni correction). As ASIR increased, however, intralobular reticular opacities and peripheral vessels tended to be obscure. On reduced-dose CT, the overall image quality of ASIR (100%) was significantly better than that of ASIR (20%) (P ≤ .009). As ASIR increased, however, intralobular reticular opacities tended to be obscure. Using ASIR significantly reduced subjective and quantitative image noise on both standard- and reduced-dose CT (P < .001, Bonferroni/Dunn's method). ASIR improves the image quality by decreasing image noise. Maximum-ASIR may be needed for improving image quality on highly reduced-dose CT. However, excessive ASIR may obscure subtle shadows.

The Efficacy of Motor-evoked Potentials on Cerebral Aneurysm Surgery and New-onset Postoperative Motor Deficits

Surgical clipping may cause stenosis of parent arteries or occlusion of perforating arteries in cerebral aneurysm surgery. To prevent postoperative motor deficits, motor-evoked potentials (MEPs) have been used. This enables to detect cerebral ischemia. However, the rate of false negatives (motor deficits with preserved MEP) has been relatively higher than in aortic surgery. We hypothesized that postoperative motor deficits with preserved intraoperative MEP do not always represent false negatives. We reviewed medical records of patients for cerebral aneurysms surgery with transcranial MEP monitoring from September 2003 to March 2009. We reviewed aneurysm location and size, abnormal computed tomography findings, and clinical outcome. Motor status was evaluated immediately after extubation and anytime when the symptom of motor deficits was found. One hundred and eleven patients underwent cerebral aneurysm clipping with transcranial MEP. Ninety-eight patients manifested no intraoperative MEP changes and no postoperative motor deficits. Six patients showed intraoperative MEP changes, resulting in no motor deficits in 4 patients with MEP recovery and hemiparesis in 2 without MEP recovery. Four patients of 6 had aneurysm in anterior choroidal artery (AchA). Other 6 patients showed postoperative motor deficits despite preserved intraoperative MEP. Two of 6 patients showed no motor deficits just after extubation, but developed deficits 5 hours after coming out of anesthesia. Only 1 of the 6 patients had aneurysm in AchA. In AchA aneurysm surgery, intraoperative MEP monitoring seems to be useful. False negative in MEP monitoring may include new-onset hemiparesis despite preserved intraoperative MEP.

Serum Glial Fibrillary Acidic Protein Is a Highly Specific Biomarker for Traumatic Brain Injury in Humans Compared With S-100B and Neuron-Specific Enolase

Serum glial fibrillary acidic protein (GFAP) is a specific predictor of brain damage and neurologic outcome in patients with traumatic brain injury (TBI). In this study, serum GFAP, S-100B, and neuron-specific enolase (NSE) were compared in the same samples from severe trauma patients to assess their ability to predict abnormalities detectable on head computed tomography (CT). This study was a retrospective analysis at a single university emergency center. Thirty-four trauma patients were included. Serum samples were collected from the patients for 3 days. Serum GFAP, S-100B, and NSE concentrations were measured with enzyme-linked immunosorbent assays and compared in patients with and without TBI, as evaluated by head CT. Serum GFAP, S-100B, and NSE were significantly higher in the TBI patients than in the non-TBI patients (p < 0.05 for each protein). The receiver operating characteristic curves for TBI were compared for the three biomarkers for 3 days. Serum GFAP on day 1 had the largest area under the receiver operating characteristic curve (0.983), with 88.9% sensitivity and 100% specificity. Serum GFAP has remarkable diagnostic value for TBI, defined by abnormal head CT findings, in prehospital-triaged patients with severe trauma.

Molecular Analysis of Plasma DNA for the Early Detection of Lung Cancer by Quantitative Methylation-Specific PCR

Aberrant promoter hypermethylation of tumor suppressor genes is a promising marker for lung cancer detection. We investigated the likelihood of detecting aberrant DNA methylation of tumor suppressor genes in plasma samples of patients with abnormalities of the lung detected upon computed tomography (CT) scan. In a small evaluation cohort, four gene promoters (DCC, Kif1a, NISCH, and Rarb) were found to be methylated with increased frequency in samples from cancer patients specifically. We then examined DNA from 93 plasma samples from patients with abnormal findings in the lung detected upon CT scan for aberrant methylation of these four gene promoters by quantitative fluorogenic real-time PCR. The patients were divided into two groups, ground glass opacity (n = 23) and cancerous tumors (n = 70). Plasma DNA from age-matched nodule-free individuals were used as controls (n = 80). In plasma, 73% of patients with cancerous tumors showed methylation of at least one gene with a specificity of 71% (P = 0.0001). Only 22% patients with ground glass opacity exhibited methylation of at least one gene. When smoking history was taken into account, 72% of cancer patients with no smoking history or those who smoked <20 pack-years showed methylation of at least one gene with 100% specificity (P = 0.05) when compared with matched controls. Among heavy smokers with 20+ pack-years of smoking history, 30% of the control group and 73% of the patients with cancerous tumors showed methylation (P = 0.0001). These biomarkers can distinguish between cancerous and noncancerous abnormal CT findings.

Multidetector CT of the Lung: Image Quality with Garnet-based Detectors

To evaluate the image quality of both standard- and reduced-dose computed tomography (CT) by comparing multidetector CT with garnet-based detectors with multidetector CT with conventional detectors. The study was approved by the internal ethics review board. Informed consent was obtained. Eleven cadaveric lungs inflated and fixed by using the Heitzman method were scanned by using both CT with garnet-based detectors and CT with conventional detectors. Tube current was 400 mA for standard-dose and 10 mA for reduced-dose CT, and voltage was 120 kVp. Either normal scan mode with 984 views (conventional and garnet-based detectors) or high-resolution mode with 2496 views was used. Image quality at conventional-detector CT and garnet-based-detector CT in all modes was graded by two independent observers with a five-point scale. The evaluation items included normal lung structures, subjective visual noise, and abnormal CT findings. Quantitative image noise measurements were calculated by measuring the standard deviations in a circular region of interest on each selected image. At standard-dose CT, image quality at CT with garnet-based detectors (high-resolution mode) was significantly improved (P < .001, Tukey-Kramer). However, there was no significant difference between quantitative image noise measurements (P > or = .24). At reduced-dose CT, only noise differed significantly, with both subjective visual noise and quantitative image noise measurements significantly greater at CT with garnet-based detectors (high-resolution mode) (P < or = .01). There was no significant difference in image quality except for noise between conventional-detector CT and garnet-based-detector CT (P > or = .06). The image quality of standard-dose garnet-based-detector CT (high-resolution) was significantly improved. Although highly reduced-dose garnet-based-detector CT (high-resolution mode) provided more image noise, overall image quality was not different between conventional-detector CT and garnet-based-detector CT.

Pulmonary CT findings in relapsing polychondritis

Relapsing polychondritis (RPC) is a rare rheumatic disease characterized by recurrent inflammation of cartilaginous structures, with airway involvement a major cause of morbidity and mortality. To retrospectively evaluate airway and lung abnormalities in RPC with computed tomography (CT). From January 2004 to May 2009, 21 patients with RPC (12 men, 9 women; 13-65 years old) underwent chest CT examinations. Two chest radiologists evaluated the CT images retrospectively. Abnormal findings, including airway stenosis, airway malacia, air trapping, and airway wall thickening with or without calcifications, were observed and noted. Major abnormal CT findings were observed in eight patients (38.1%), which included airway wall thickening (n=7), airway stenosis (n=6), airway malacia (n=6), airway wall calcification (n=8), and air trapping (n=3). Mediastinal lymph nodes were found in 12 patients. Lung infection was identified in four patients and interstitial lung disease in six patients. The CT findings in patients with RPC consisted mainly of airway wall thickening, airway stenosis, airway malacia, airway wall calcification, and air trapping.

Identification of Occult Parechymal Disease Such as Emphysema or Airway Disease Using Screening Computed Tomography

ABSTRACTRationale: Chronic obstructive pulmonary disease (COPD) is a major public health problem. This study was performed to determine whether the low attenuation area (LAA) and visual score provided by low-dose computed tomography (CT) can be used to detect occult parenchymal disease, such as insidious COPD. Methods: Each participant underwent low-dose CT scan and pulmonary function tests. The LAA% of the corresponding lung area was calculated. The cut-off level between the normal lung density area and LAA was defined as –960 HU, and the severity of emphysematous change (visual score) and LAA% were evaluated on three same chest CT slices obtained at full inspiration. Results: Forty-eight of 2,247 individuals including 1058 non-smokers and 1189 smokers were diagnosed with COPD. Chest CT findings in individuals diagnosed with COPD showed centrilobular emphysema (50%), however, 17 of the subjects diagnosed with COPD had normal screening CT findings. Thirty-one subjects diagnosed with COPD showed a positive visual score, and 27 individuals with COPD showed LAA% of more than 30. Nine of 17 subjects with a negative visual score showed LAA% of more than 30. The visual score in smokers was significantly higher than that of non-smokers. The lung function in smokers was lower than that of non-smokers. Smokers also showed higher frequencies of chest CT abnormalities. Conclusion: Low-dose CT scans detected LAA and a positive visual score before COPD associated with an impaired lung function develops. Smokers with normal spirometry had a potential to develop an airflow obstruction accompanied with abnormal CT findings.

Smoking Behavior 1 Year after Computed Tomography Screening for Lung Cancer: Effect of Physician Referral for Abnormal CT Findings

Computed tomography (CT) lung cancer screening offers a unique clinical setting in which to promote smoking cessation. Focusing on outcomes related to the reporting of CT abnormality, we examined the natural history of smoking in the Pittsburgh Lung Screening Study. Pittsburgh Lung Screening Study recruited 50- to 79-year-old current and former cigarette smokers living in the Pittsburgh area. We examined self-reported smoking outcomes 1 year after study entry in a subgroup that contained 2,094 active cigarette smokers without interval lung cancer diagnosis (50.7% women; median age, 57 years; 40-year median duration of cigarette smoking; and 65.2% > or =20 cigarettes/d). Analyses compared efforts to quit in relation to physician referral for abnormal CT. Since study entry, 58.5% [95% confidence interval (95% CI), 56.3-60.6%] reported any quit attempt and 27.2% (95% CI, 25.3-29.1%) reported any quit interval >30 days. One year after study entry, 15.5% (95% CI, 14.0-17.1%) reported not smoking for >30 days. Comparing persons referred because of CT abnormalities creating moderate or high lung cancer suspicion (n = 156; 7.4%) to persons not referred for any reason (n = 1145; 54.7%), propensity score-adjusted fractions with any quit attempt and with any quit interval >30 days increased 18.8% (95% CI, 11.1-26.5%) and 17.7% (95% CI, 9.4-26.0%), respectively. The fraction quit >30 days at 1 year increased 12.2% (95% CI, 4.9-19.5%). Persons who experienced referral because of abnormal CT reported more smoking cessation.

Exanthem Subitum-Associated Encephalitis: Nationwide Survey in Japan

We sought to clarify clinical features of exanthem subitum associated-encephalitis/encephalopathy, generally caused by primary human herpesvirus-6 infection in Japan. A two-part questionnaire was sent to hospitals between January 2003-December 2004. Of 3357 questionnaires, 2357 (70.2%) were returned, and 2293 (68.3%) were eligible for analysis. Eighty-six cases of exanthem subitum-associated encephalitis/encephalopathy were reported. Seventy-seven (89.5%) of 86 patients were diagnosed with human herpesvirus-6 infection by virologic examination. Although 41 (50.6%) of 81 patients had no sequelae, 38 (46.9%) had neurologic sequelae. Moreover, two fatal cases (2.5%) were reported. Pleocytosis was evident in only 4 (7.5%) of 53 patients, and cerebrospinal fluid protein levels were within normal range (23.4 +/- 14.6 mg/dL S.D.) in all patients. Human herpesvirus-6 DNA was detected in 21 (53.8%) of 39 patients. Abnormal computed tomography findings were a predictor of neurologic sequelae (P = 0.0097). As a consequence of this survey, we estimate that 61.9 cases of exanthem subitum-associated encephalitis occur every year. The disease prognosis was unexpectedly poor.

Factors predictive of abnormal results for computed tomography of the head in horses affected by neurologic disorders: 57 cases (2001–2007)

To determine neurologic indications associated with abnormal results for computed tomography (CT) imaging of the head of horses affected by neurologic disorders. Retrospective case series. 57 horses. Signalment, history, clinical abnormalities, and clinicopathologic findings were obtained from medical records of horses examined because of neurologic disorders, and precontrast and postcontrast CT images of the head were reviewed. Data were analyzed by use of univariate and multivariate logistic regression. For a horse with abnormal mentation, odds of having abnormal results for CT imaging of the head was 30 times (95% confidence interval [CI], 2.36 to 374.63) the odds for a similar horse without abnormal mentation. For a horse with cranial nerve deficits, odds of having abnormal results for CT imaging of the head was 11 times (95% CI, 1.00 to 127.96) the odds for a similar horse without cranial nerve deficits. For a horse with seizure-like activity, odds of having abnormal results for CT imaging of the head was 0.05 times (95% CI, 0 to 0.90) the odds for a similar horse without seizures. These results suggested that alterations in consciousness and cranial nerve deficits were strong predictors of abnormal CT findings for the head of affected horses. Thus, CT can be a useful complementary diagnostic test in horses with these neurologic deficits. In contrast, alternative diagnostic tests (eg, electroencephalography and magnetic resonance imaging) should be considered in horses with seizure-like activity that do not have head trauma or cranial nerve deficits.

Clinical Utility of Computed Tomography Screening of Chest, Abdomen, and Sinuses before Hematopoietic Stem Cell Transplantation: The St. Jude Experience

All allogeneic (allo) and autologous (auto) hematopoietic stem cell transplantation (HSCT) recipients at St. Jude Children's Research Hospital undergo pre-HSCT computed tomography (CT) of the sinuses, chest, and abdomen because they are at significant risk for opportunistic infections. We studied whether this extensive routine imaging is warranted to detect infection despite the risk of additional radiation exposure. We reviewed the medical records of all children receiving allo- and auto-HSCT at St. Jude in 2004 and 2005. Of the 184 eligible patients who received 187 transplants, 131 received allografts and 56 autografts. Solid tumors and lymphomas were removed from the final analysis of the chest and abdomen CT as this imaging is typically warranted as part of disease restaging; thus, 111 allogeneic participants were included in this analysis. Both auto- and allo-recipients were evaluated by sinus CT and included in this final analysis. Most allo- and auto-HSCT recipients (≥80%) did not have sinus, pulmonary, cardiac, or gastrointestinal symptoms; >85% of the evaluable allo-recipients had no prior fungal infection. Eighty-eight allo- and 31 auto-HSCT recipients had abnormal sinus CT findings, all unrelated to the underlying disease. Sixty-two (55.9%) of the allo-recipients had normal chest CT and 85 (76.6%) had normal abdominal CT. Of the 18 allo-recipients who began new therapy based on these findings, only 2 (11.1%) were related to chest CT findings and the other 16 were related to sinus findings. Our findings suggest that pre-HSCT routine CT imaging of the abdomen may not be warranted in a subset of allogeneic recipients who are asymptomatic and without previous infectious findings. Thus, these patients may be spared unnecessary radiation exposure. Recipients undergoing auto-HSCT or allo-HSCT for lymphomas or solid tumors will routinely undergo chest and abdominal CT imaging as part of their disease evaluation. The decision to perform chest CT should be made judiciously based on a careful history and physical examination. Sinus imaging, which was frequently abnormal, may be justified in all patients to plan post-HSCT care.

A More Detailed Classification of Mild Head Injury in Adults and Treatment Guidelines

The purpose of this study was to analyze risk factors that are associated with intracranial lesion, and to propose criteria for classification of mild head injury (MHI), and appropriate treatment guidelines. The study was based on 898 patients who were admitted to our hospital with Glasgow Coma Scale (GCS) score of 13 to 15 between 2003 and 2007. The patients' initial computerized tomography (CT) findings were reviewed and clinical findings that were associated with intracranial lesions were analyzed. GCS score, loss of consciousness (LOC), age and skull fracture were identified as independent risk factors for intracranial lesions. Based on the data analysed in this study, MHI patients were divided into four subgroups : very low risk MHI patients are those with a GCS score of 15 and without a history of LOC or headache; low risk MHI patients have a GCS score of 15 and with LOC and/or headache; medium risk MHI patients are those with a GCS score of 15 and with a skull fracture, neurological deficits or with one or more of the risk factors; high risk MHI patients are those with a GCS score of 15 with abnormal CT findings and GCS score of 14 and 13. A more detailed classification of MHI based on brain CT scan findings and clinical risk factors can potentially improve patient diagnosis. In light of our findings, high risk MHI patients should be admitted and treated in same manner as those with moderate head injury.

Abnormal Computed Tomography Findings Among Children With Viral Gastroenteritis and Symptoms Mimicking Acute Appendicitis

To evaluate computed tomography (CT) findings in pediatric patients with viral gastroenteritis who presented with clinical features of acute abdomen. During 2 seasons of viral gastroenteritis from 2005 to 2007, 302 children with acute gastrointestinal symptoms were admitted to our center for treatment of dehydration and associated complications. Stool specimens obtained from 130 of the 302 were tested for norovirus with the reverse transcriptase-polymerase chain reaction method. Among the 130 patients, 44 tested positive for norovirus, 34 for rotavirus, and 1 for adenovirus. In the remaining 51, except one with Campylobacter jejuni, no viral or bacterial pathogen was detectable. An abdominal CT scan was performed in 4 patients with norovirus and in 1 with rotavirus for suspected acute abdomen including acute appendicitis. Computed tomography (CT) findings were similar among the 5 patients, including thickening of the bowel wall and fluid-filled bowel loops in the small intestine with no pathological findings in the stomach, appendix, or colon. Anatomical changes in the small intestine were shown by CT in 5 children with viral gastroenteritis who presented with acute abdomen. These imaging features of viral gastroenteritis may be useful in differential diagnosis of acute abdomen to avoid unnecessary surgery.

Prevalence of abnormal CT findings in patients with proven ovarian torsion and a proposed triage schema

Many women with ovarian torsion present with nonspecific abdominal/pelvic pain and initially receive computed tomography (CT). We hypothesize that the CT scans preformed on these women will all show abnormalities of the involved ovary. Our purpose is to review cases of surgically proven ovarian torsion at our institution over the last 20 years, assessing CT findings in women with ovarian torsion. A retrospective review of all patients at our institution with surgically proven ovarian torsion from 1985-2005 was conducted. Two physicians reviewed available CT reports, and a radiologist reviewed all available images. CT was obtained in 33% of the 167 patients. Dictated reports were available for 28 studies; all described an enlarged ovary, ovarian cyst, or adnexal mass of the involved ovary. Radiologist review of the available CT images confirmed these findings. This series supports the claim that a CT scan with well-visualized normal appearing ovaries rules out ovarian torsion, while abnormal pelvic findings or failure to visualize the ovaries in women with pelvic pain necessitates further evaluation of torsion.