Accuracy Of MDCT Research Articles

Role of computed tomography in non-traumatic acute abdomen in adults

Background: The objective of this study was to study, assess, and diagnose causes of acute abdomen accurately, to determine the accuracy of multidetector computed tomography (CT) for confirmation of negative, diagnosed, or equivocal ultrasonography (USG) cases, and to establish role of CT as the primary imaging modality. Aims and Objective: To study, assess and diagnose causes of acute abdomen accurately, To determine the accuracy of MDCT for confirmation of Negative, diagnosed or equivocal USG cases & To establish role of CT as the primary imaging modality. Materials and Methods: One hundred and twenty random patients were included in this prospective study. USG and CT were done in all patients. Axial, coronal, and sagittal reformatted images were studied. Intravenous and oral contrast were also used depending on the clinical condition. All these patients were followed up diagnosis obtained before and after CT were compared with intraoperative findings or final clinical diagnosis at discharge. Results: Among 120 patients, confirmative CT diagnosis was made in 111 cases and was discordant in seven cases, while two cases could not be followed up. Forty-five cases underwent surgical management and rest of them were managed medically. Conclusion: CT abdomen done in patients presenting with non-traumatic acute abdominal pain which helps to make accurate diagnosis and planning the appropriate treatment.

ROLE OF MULTI-DETECTOR COMPUTED TOMOGRAPHY IN CHARACTERIZATION OF OVARIAN MASSES WITH CYTOHISTOPATHOLOGICAL CORRELATION

Aims & Objectives- To evaluate the diagnostic accuracy of MDCT to differentiate between benign and malignant ovarian masses and to compare the ndings with cytohistopathological results. Material & Methods- This prospective observational study was conducted at SRMS, Institute of Medical Sciences, Bareilly from November 2019 to April 2021. CT imaging ndings of 50 patients with ovarian masses diagnosed clinically or on pelvic sonography were compared with cyto-histopathological results. Ovarian masses were classied as benign or malignant based on scan ndings. Sensitivity, specicity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy of MDCT were calculated. 50 c Results- ases were evaluated by computed tomography, total 60 lesions were found (10 bilateral / 50 unilateral). On the basis of computed tomography 28 patients were found to have benign ovarian lesions whereas malignant ovarian lesions were present in 22 patients. Cyto/histopathological correlation revealed benign lesions in 30 patients and malignant lesions in 20 patients. The sensitivity, specicity, PPV, NPV and diagnostic accuracy of Computed Tomography was found to be 90.0%, 86.6%, 89%, 85% and 90.0%. MDCT imaging offers a safe, accurate and non-invasive modality tdif Conclusion- ferentiate between benign and malignant ovarian masses.

42 The Accuracy of the Multi-Slice Detector CT scan (MDCT) in Staging Borderline Respectable Periampullary Carcinoma

Abstract Aim Assess MDCT accuracy in staging cancers periampullary cancers. Method Periampullary malignancies are highly aggressive with poor outcomes. Surgery is the only curative option. It is crucial to define the patients who can advantage from a Whipple’s resection and who can avoid. RCT investigated randomly 28 patients over 15 months. The patients were sub-divided into 2 groups. Group A, we relied mainly on the MDCT for preoperative staging, while in Group B staging laparoscopy was added before the abdominal exploration. Sensitivity of the MDCT and its accuracy were 100% in defining the signs of irresectability. For borderline staging, the accuracy of the scan was 62.5% and 71%, in groups A and B. The Overall accuracy of MDCT was 75%. It decreased to 68.1% for borderline lesions. The addition of staging laparoscopy to the diagnostic work up, increased the accuracy to 92.5%. The camera test was able to see occult findings which were missed in the images. Liver Mets and malignant peritoneal fluid were localized in 18% and 9% respectively. 3 cases in group A and one in group B underwent unnecessary laparotomy. Thus, the false negative incidences were 21% and 7% in group A and B, with overall incidence 14.2%. Conclusion MDCT is highly sensitive and specific with high stage periampullary cancers. These parameters drop in border tumours with reduced accuracy in detecting the degree of vascular abutment and distant-occult findings. Addition of other adjuncts to decrease the rate of un-indicated laparotomy.

EP.TH.528The Accuracy of the Multi-slice detector CT Scan (MDCT) in staging borderline resectable periampullary carcinoma

Abstract Objectives Assess MDCT accuracy in staging cancers periampullary cancers. Introduction Periampullary malignancies are highly aggressive with poor outcomes. Surgery is the only curative option. It is crucial to define the patients who can advantage from a Whipple’s resection and who can avoid. Methodology and Results RCT investigated randomly 28 patients over 15 months. The patients were sub-divided into 2 groups. Group A, we relied mainly on the MDCT for preoperative staging, while in Group B staging laparoscopy was added before the abdominal exploration. Sensitivity of the MDCT and its accuracy were 100% in defining the signs of irresectability. For borderline staging, the accuracy of the scan was 62.5% and 71%, in groups A and B. The Overall accuracy of MDCT was 75%. It decreased to 68.1% for borderline lesions. The addition of staging laparoscopy to the diagnostic work up, increased the accuracy to 92.5%. The camera test was able to see occult findings which were missed in the images. liver Mets and malignant peritoneal fluid were localized in 18% and 9% respectively. 3 cases in group A and one in group B underwent unnecessary laparotomy. Thus, the false negative incidences were 21% and 7% in group A and B, with overall incidence 14.2%. Conclusion MDCT is highly sensitive and specific with high stage periampullary cancers. These parameters drop in border tumors with reduced accuracy in detecting the degree of vascular abutment and distant-occult findings. Addition of other adjuncts to decrease the rate of un-indicated laparotomy is advised.

Abdominal Ultrasound Compared to MDCT in Assessment of Colorectal Cancer

Background and Aim: Colorectal cancer is the third most common cancer and the fourth most frequent cause of cancer deaths worldwide. The aim of this study to compare the diagnostic performance of abdominal ultrasound and multidetector CT in detection of colorectal cancer. Methods: this study included fifty patients were presented to surgical department of Mit Ghamr oncology center. All patients were examined on MDCT to show presence of the cancer. then examined by abdominal ultrasound to evaluate ability of ultrasound to detect the cancer. Results: fifty patients were included (28 men and 22 women) had a mean age of 47.5years (range 28-70years). Our study results suggested that abdominal ultrasound had sensitivity and specificity in diagnosis of cancer colon were 82.4% and 87.5 % respectively. The accuracy of US was 84%. For MDCT, sensitivity and specificity of cancer colon were 100% and 93.8 respectively. The accuracy of MDCT was 98%. Conclusion: ultrasonography is a useful initial screening tool for colorectal cancer in patients presenting with abdominal distension. Compared with MDCT scanning and other modalities. Ultrasonography is easily available; does not involve radiation, bowel preparation, or sedation; carries no risk of colonic perforation; and is less expensive. Further studies to confirm the usefulness of ultrasonography for diagnosis of colorectal cancer are warranted. CT is valuable in preoperative assessment and staging of colorectal cancer as well as in postoperative surveillance for recurrence. Rapid advances in technology will likely continue to improve the accuracy and usefulness of CT.

Urothelial-phase thin-section MDCT of the bladder in patients with hematuria: added value of multiplanar reformatted images.

To evaluate the diagnostic performance of MDCT with axial images and multiplanar reformatted (MPR) images from the urothelial phase of the bladder in patients with hematuria using cystoscopy as the reference standard. Our IRB for human investigation approved this study, and informed consent was waived. We included 192 patients (121 men, 71 women; age range 17-90years; mean age ± SD: 60 ± 14years) who underwent contrast-enhanced MDCT (scan delay: 70s; section thickness: 2mm) and conventional cystoscopy examination for painless gross hematuria or recurrent microscopic hematuria. Two radiologists in consensus interpreted the images for the presence or absence of bladder lesions. Using the kappa statistic, the patient-based agreement was determined between the CT and cystoscopic findings. We compared the diagnostic performance of axial images to those with coronal and sagittal reformations to detect bladder lesions. MDCT showed excellent agreement between cystoscopy-axial scans (κ = 0.896) and axial with reformatted images (κ = 0.948). The sensitivity, specificity, and accuracy of MDCT were 94%, 96%, and 95% in the axial scans and 98%, 97%, and 97% in the axial with reformatted images, respectively. All statistical parameters of diagnostic performance were similar between the axial and the reformatted images (p > .05). Axial MDCT imaging demonstrates high diagnostic performance in detecting bladder lesions, but additional reformatted images can improve diagnostic accuracy.

Diagnostic Accuracy of Multidetector CT in Detection of Early Interstitial Lung Disease With Its Role in Characterization.

BackgroundMultidetector CT (MDCT) has emerged as a useful option for early diagnosis of interstitial lung disease (ILD) with adequate accuracy.MethodsA total of 80 patients with restricted pulmonary functions and clinical suspicion of ILD were enrolled in the study. MDCT evaluation was done using Siemens Somatom Force 384 slice multidetector computer tomography machine. Pattern analysis for reticular opacities, nodules and lung opacities was done to reach at a diagnosis. Final diagnosis was based on correlation of radiological and clinicopathological findings. Diagnostic efficacy of MDCT was evaluated in terms of sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy for detection of ILD.ResultsMean age of patients was 58 ± 8.75 years. Majority were females (51.3%). History of chronic obstructive pulmonary disease (COPD), tuberculosis and bronchial asthma was revealed in 31 (38.8%), 26 (32.5%) and 16 (20%) patients, respectively. There were 30 (37.5%) patients having no history of respiratory diseases. MDCT diagnosed ILD in 45 (56.3%) cases. On final diagnosis, ILD was diagnosed in 35 (43.8%) cases (15 usual interstitial pneumonia [UIP], 9 cryptogenic organizing pneumonia [COP], 8 nonspecific interstitial pneumonia [NSIP] and 3 respiratory bronchiolitis associated interstitial lung disease [RBILD]). The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of MDCT in detection of ILD was 91.4%, 71.1%, 71.1%, 91.4% and 80%, respectively.ConclusionMDCT as a single modality had a high sensitivity for detection of ILD and could be recommended as first line diagnostic imaging technique.

MDCT in the Setting of Suspected Colonic Diverticulitis: Prevalence and Diagnostic Yield for Diverticulitis and Alternative Diagnoses.

OBJECTIVE. The purpose of this study was to determine the prevalence and demographic distribution of colonic diverticulitis (CD) and alternative diagnoses (AD), as well as the diagnostic accuracy of MDCT in patients with suspected CD. MATERIALS AND METHODS. This study retrospectively included 1069 patients (560 women) undergoing MDCT for the evaluation of suspected CD. The prevalence of CD and AD was determined and the diagnostic accuracy of MDCT calculated. The final clinical diagnosis derived from the discharge report served as the standard of reference. Prevalence of diagnoses by age, sex, and admission status were compared using Cochran-Armitage, chi-square, and Fisher exact tests. RESULTS. Prevalence of CD was 52.5% (561/1069) and of AD was 39.9% (427/1069). In the remaining 7.6% (81/1069) no final clinical diagnosis was established. The most frequent AD were appendicitis (12.6%, 54/427), infectious colitis (10.5%, 45/427), infectious gastroenteritis (8.2%, 35/427), urolithiasis (6.1%, 26/427), and pyelonephritis (4.9%, 21/427). The prevalence of diverticulitis and AD varied statistically significantly according to both age (p < 0.001) and admission status (p < 0.001). Also, the prevalence of the 10 most frequent specific AD varied statistically significantly according to sex (p = 0.022). CT had a sensitivity and specificity of 99.1% and 99.8% for diagnosing CD and 92.7% and 98.8% for AD, respectively. CONCLUSION. In about 40% of patients with suspected diverticulitis a broad spectrum of AD is causative for symptoms. MDCT provides high diagnostic accuracy in the diagnosis of diverticulitis and AD. The prevalence of diagnoses is related to admission status and demographic data; in particular age-related AD have to be considered in patients with clinically suspected diverticulitis.

MDCT planning of trans catheter aortic valve implantation (TAVI): determination of optimal c-arm angulation.

A fluoroscopic view perpendicular to the aortic valve annulus is required during transcatheter aortic valve implantation (TAVI) for obtaining an optimal deployment of the bioprosthesis. By predicting c-arm angulation, pre-procedural MDCT could decrease the number of aortograms, shorten the time of the procedure and reduce the amount of intra-arterial contrast agent. The aim of our study was to assess the accuracy of MDCT in predicting c-arm angulation at the cath. lab. In this single center study, we investigated MDCT prediction of c-arm angulation in patients having undergone a TAVI procedure using SAPIEN 3® (Edwards Lifesciences, USA). Prior to the procedure, an experienced radiologist had reported the angulation using dedicated software (CTreport). After the procedure, a blinded experienced radiologist retrospectively measured the angles using the same method (CTstudy). Interobserver variability was drawn from the comparison between CTreport and CTstudy. Then, the mean angular difference between the predicted MDCT angles (CTstudy) was compared to the working view recorded at the cath. lab. Seventy-nine patients (M/F = 0.65; mean age: 85.2years ± 5.3) were included. Interobserver variability was 5.9 ± 6.1°. The mean absolute difference between MDCT and fluoroscopy was 8.8 ± 7.1°. The present study showed that MDCT could predict the coplanar fluoroscopic angles prior to TAVI using a balloon-expandable bioprosthesis Sapien 3® placed via a transfemoral approach with a mean angular difference of 8.8 ± 7.1°. Reproducibility was considered good as the mean difference between two independent measures was 5.9 ± 6.1°.

Multidetector computerized tomography in acute abdomen

Background: Acute abdominal pain is a common chief complaint in patients examined reporting to emergency department. The sensitivity of CT is 96% in acute abdomen. In order to decrease the mortality and morbidity rate, an efficient and correct diagnosis should be given for these patients. When investigations, like USG examinations are inconclusive, in such cases, multi-detector computer tomography is a widely accepted primary investigation of choice in patients coming with intense abdominal pain. The aim of the study was to evaluate the accuracy of MDCT in diagnosis of acute abdomen; document the sensitivity and specificity of MDCT; the incidence of different pathologies presenting as acute abdomen.Methods: Prospective study on 64 subjects with acute pain abdomen was subjected to MDCT in GMC Srinagar. The duration of this study was from January to May 2019.Results: About 36 patients were females and 28 were males. Youngest patient had an age of 7 years to eldest patient having age of 79 years. Most common causes of acute abdomen were acute pancreatitis in 21.8, acute appendicitis in 15.6% and bowel obstruction in12.5%. In our study the sensitivity, specificity and positive and negative predictable values of MDCT were 95.0%, 75%%, 98.3% and 60% respectively.Conclusions: We conclude that MDCT has high sensitivity and accuracy rate. In inconclusive cases, MDCT is recommended to arrive at a definitive diagnosis. The results obtained in the study were comparable to pioneer studies conducted worldwide.

The accuracy of multi-detector computed tomography and laparoscopy in the prediction of peritoneal carcinomatosis index score in primary ovarian cancer

The purpose of this study was to compare the accuracy of MDCT and laparoscopy in the prediction of peritoneal carcinomatosis index score. Reproducibility of MDCT interpretation was also assessed. This prospective study included 85 ovarian cancer patients underwent MDCT and diagnostic laparoscopy before cytoreductive surgery. We calculated the accuracy of diagnostic modalities in the calculation of the peritoneal cancer index score (PCI). Radiologist interobserver agreement was calculated using kappa statistics. Nine hundred-thirty (84.2%) of the 1105 regions had peritoneal deposits at exploratory laparotomy. Computed tomography (CT) and laparoscopy sensitivity were 94.9%, 98.3%, specificity 86.7%, 80.4%, PPV 97.9 %, 96.8%, NPV 72.2%, 88.8 %, and accuracy 93.8 %, 95.7%, respectively. However, computed tomography (CT) diagnostic performance is less accurate than laparoscopy in pelvic and small intestinal regions; no statistically significant differences were evident regarding total PCI score compared to surgery (p> 0.05). CT and laparoscopy correctly depicted peritoneal carcinomatosis in 88.2%, 90.6% of patients, respectively. Optimal cytoreduction was achieved in 68 (80%) patients. Both CT and laparoscopy seems to be effective tools for assessment of peritoneal carcinomatosis using the PCI score. Dedicated MDCT protocol with routine use of a standardized PCI form may provide better comprehensive multi-regional analysis that may help surgeons referring patients to the best treatment option. Laparoscopy is a valuable tool in cases with a high risk of suboptimal cytoreduction related to disease extent.

Diagnostic accuracy of 256 slices computed tomography coronary angiography in post coronary artery bypass graft Egyptian patients

Objective: Evaluate the diagnostic accuracy of 256 slices computed tomography (CT) coronary angiography (CA) (multidetector CT [MDCT]) in the assessment of native coronary arteries and grafts in post-coronary artery bypass graft (CABG) surgery Egyptian patients. Patients and Methods: It included 70 patients with a history of isolated CABG with recurrent chest pain. We excluded patients with a history of redo CABG or other open-heart surgeries, renal impairment, severe claustrophobia, chronic liver disease, dye allergy, tachycardia with contraindication to beta blockers (BB), pregnancy. All patients were subjected MDCT and CA. Both examinations were done within 3 months. Results: In our study, 161 grafts evaluated (63 left internal mammary artery [LIMA] in situ grafts, 5 right internal mammary artery (RIMA) and 2 radial grafts, and 91 venous grafts). CA failed to detect 3 LIMA and 7 venous grafts. All were seen only by MDCT. For grafts CT compared to CA has sensitivity (91.5%, 84.8%), specificity (98%, 100%), accuracy (95.65%, 96.9%), positive predictive value (PPV) (96.43%, 100%), and negative predictive value (NPV) (95.24%, 96.2%) in the assessment of significant stenosis and total occlusion of grafts, respectively. For grafted vessels CT has sensitivity (94%, 100%), specificity (98%, 100%), accuracy (96.94%, 100%), PPV (95.92%, 100%), and NPV (97%, 100%) in the assessment of significant stenosis and total occlusion of grafted vessel, respectively. For native vessels CT has sensitivity (100%, 97.7%), specificity (84.2%, 98.4%), accuracy (97.14%, 98.1%), PPV (96.6%, 97.7%), and NPV (100%, 98.37%) in the assessment of significant stenosis and total occlusion of native vessels, respectively. Conclusion: Our study demonstrated a high diagnostic accuracy of MDCT for the assessment of bypass grafts and grafted or native coronary arteries compared with CA. Detection of grafts or native vessels occlusion was better than detection of substantial stenosis. MDCT is a good negative test for native vessels as it has a high sensitivity since it tends to overestimate stenosis degree, so patients with negative MDCT angiographic results mostly have patent vessels.

Diagnostic Performance of Multidetector Computerized Tomography in the Detection of Abdominal Complications Early and Late After Liver Transplantation: A 10-Year Experience

BackgroundMultidetector computerized tomography (MDCT) is considered to be a fast noninvasive diagnostic technique for the evaluation of postoperative complications in patients with liver transplantation (LT). However, its role has not been fully established in the diagnosis for detecting complications after liver transplantation. The aim of this work was to evaluate the diagnostic performance of MDCT for detecting abdominal complications in the early and late periods after LT. MethodsWe retrospectively enrolled 75 patients who had undergone LT from March 2006 to January 2010, followed by MDCT from March 2006 to November 2017. Patients were divided into 2 groups according to the timing after LT: within the first 3 months (early period) or ≥3 months after LT (late period). We evaluated vascular, biliary, and other complications on MDCT. Angiography, endoscopic retrograde cholangiography, and percutaneous transhepatic cholangiography were used as reference standards. ResultsWe initially found 77 complications in 45 patients (60.0%) with the use of MDCT. After comparison with the reference standards, 83 complications were diagnosed in 49 patients (65.3%). Forty-seven complications (34 vascular, 10 biliary, 3 other complications) were diagnosed in 33 patients (44.0%) during the early period, and 36 complications (6 vascular, 20 biliary, 10 other complications) were detected in 27 patients (36.0%) in the late period. The sensitivity, specificity, and diagnostic accuracy of MDCT for diagnosing overall complications were, respectively, 93.6%, 90.2%, and 92.0% in the early period (for vascular complications: 97.1%, 92.6%, and 94.3%,; for biliary complications: 80.0%, 100%, and 97.7%) and 77.8%, 98.1%, and 89.8% in the late period (for vascular complications: 83.3%, 100%, and 98.9%; for biliary complications: 65.0%, 98.6%, and 90.9%). ConclusionsAlthough MDCT in the late period should be interpreted with caution in patients with suspected biliary complication, MDCT is a reliable diagnostic technique for the identification of early and late abdominal complications after LT.

The Role of Preoperative 64 MDCT in the Evaluation of Tumor Stage for Advanced Gastric Carcinoma

To evaluate the accuracy of preoperative 64–detector row computer tomography (MDCT) enhanced scanner in tumor stage prediction for advanced gastric carcinoma, the data of 62 patients with advanced gastric cancer who underwent preoperative 64 MDCT were retrospectively analyzed. Pathological tumor stage was based on international TNM stage of Gastric Carcinoma Association. All MDCT results were compared with surgical and postoperative pathologic results. Results showed that the prediction accuracy of MDCT for T2, T3 and T4 stage evaluation is 42.8% (9/21), 80.7% (21/26) and 60.0% (9/15) respectively. The prediction sensitivity for N2 metastasis is 75%, sensitivity is 92%, and accuracy is 88.7%. It is concluded that preoperative 64 MDCT can provide relatively higher accuracy for detection of T3 and T4 layer invasion of gastric carcinoma, and help to predict the N2 lymph node metastasis for AGC.

Impacto de la puntuación de calcio en la concordancia entre la tomografía computarizada con multidetectores y la coronariografía invasiva

Introduction and objectivesMultidetector computed tomography (MDCT) has been demonstrated as a feasible alternative to invasive coronary angiography (ICA). However, contradictory results have been reported regarding the effect of coronary artery calcium score (CS) on the diagnostic accuracy of MDCT. Our aim was to assess the agreement of MDCT and ICA and to evaluate the influence of CS on this agreement. MethodsWe enrolled 266 consecutive patients who underwent evaluation with 64-slice MDCT and ICA. Standard CS software tools were used to calculate the Agatston score. Stenosis was qualitatively classified as mild, moderate, or severe by 1 blinded observer and the results were compared with those of ICA, which was used as the gold standard. ResultsThe mean age of the patients was 65.4 ± 11.2 years, and 188 patients (70.3%) were men. A total of 484 segments with coronary stenosis ≥ mild were qualitatively evaluated and quantified with MDCT. Noninvasive measurements were concordant with ICA in 402 stenoses (83.05%; Kappa, 0.684), with no significant differences between vessels and with no statistically significant influence of CS on this agreement (OR, 0.93; 95%CI, 0.76-1.09; P = .21). Multidetector computed tomography had high sensitivity, specificity, positive predictive value, and negative predictive value on a per-segment, per-vessel, and per-patient basis. ConclusionsNon-ICA using MDCT showed good agreement with ICA in the qualitative quantification coronary stenosis and CS had no significant impact on this agreement.Full English text available from: www.revespcardiol.org/en

Preoperative tumor restaging and resectability assessment of gastric cancers after chemotherapy: diagnostic accuracy of MDCT using new staging criteria.

To evaluate the diagnostic performance of preoperative MDCT for tumor restaging and determination of resectability in gastric cancers after chemotherapy using new staging criteria. This retrospective study was approved by our institutional review board and the requirement for informed consent was waived. Thirty-seven patients with initially unresectable gastric cancers who had received chemotherapy followed by surgery were included. Two independent radiologists reviewed preoperative MDCT images to determine the TNM staging and rate the overall likelihood of resectability using a 5-point scale (5: definitely unresectable, 1: definitely resectable). New post-chemotherapy MDCT criteria do not use non-enhancing perigastric infiltrations, non-enhancing lymph nodes (LNs), and subtle remaining infiltrations after marked decrease in the size of distant metastases for T, N, and M upstaging, respectively. Discrepancies in TNM staging were resolved by a third reviewer. The diagnostic performances of MDCT were assessed using pathologic results or operation records as reference standards. For predicting resectability, the areas under the ROC curve were 0.885 and 0.882 (95% CIs 0.737-0.966 and 0.733-0.964) in reviewers 1 and 2, respectively, with substantial inter-reader agreement (weighted κ=0.689). Sensitivities and specificities of MDCT for tumor restaging on a consensus review were 80.0% (4/5) and 100% (29/29) for T4b, 35.3% (6/17) and 81.3% (13/16) for N-positive, and 63.6% (7/11) and 100% (26/26) for M1, respectively. For gastric cancers after chemotherapy, new MDCT criteria demonstrated high specificities for T4b and M-staging and good performances to predict resectability before conversion surgery.

Impact of Calcium Score on Agreement Between Multidetector Computed Tomography and Invasive Coronary Angiography

Introduction and objectivesMultidetector computed tomography (MDCT) has been demonstrated as a feasible alternative to invasive coronary angiography (ICA). However, contradictory results have been reported regarding the effect of coronary artery calcium score (CS) on the diagnostic accuracy of MDCT. Our aim was to assess the agreement of MDCT and ICA and to evaluate the influence of CS on this agreement. MethodsWe enrolled 266 consecutive patients who underwent evaluation with 64-slice MDCT and ICA. Standard CS software tools were used to calculate the Agatston score. Stenosis was qualitatively classified as mild, moderate, or severe by 1 blinded observer and the results were compared with those of ICA, which was used as the gold standard. ResultsThe mean age of the patients was 65.4 ± 11.2 years, and 188 patients (70.3%) were men. A total of 484 segments with coronary stenosis ≥ mild were qualitatively evaluated and quantified with MDCT. Noninvasive measurements were concordant with ICA in 402 stenoses (83.05%; Kappa, 0.684), with no significant differences between vessels and with no statistically significant influence of CS on this agreement (OR, 0.93; 95%CI, 0.76-1.09; P = .21). Multidetector computed tomography had high sensitivity, specificity, positive predictive value, and negative predictive value on a per-segment, per-vessel, and per-patient basis. ConclusionsNon-ICA using MDCT showed good agreement with ICA in the qualitative quantification coronary stenosis and CS had no significant impact on this agreement.

Multislice computer tomography in detection of pseudocapsule of renal cell carcinoma

In order to evaluate the diagnostic efficiency of MDCT with bolus contrast enhancement in the visualization of renal cancer pseudocapsule a retrospective study, included 74 patients with histologically confirmed renal-cell cancer, was performed. Images were acquired in native, arterial, portal and nephrographic - excretory phase on a 64-detector CT scanner. The accuracy of MDCT in detecting pseudocapsule was determined by comparison with histological findings. Native axial images and multiplanar reformations were analyzed. According to the results of the study there was obtained high diagnostic efficiency of MDCT in detecting of the tumor pseudocapsule, that allows to use this method for the preoperative evaluation, assessment of the possibility ofperforming organ-saving surgery.

Multidetector CT evaluation of alternative diagnosis of clinically suspected acute appendicitis, appendicular and nonappendicular lesions

ObjectiveTo assess the accuracy of MDCT in diagnosis and preoperative evaluation of alternatives of acute appendicitis causing RLQP and associated complications. Patients and methods350 consecutive patients (250 males and 100 females) with ARLQP underwent MDCT examinations with contrast. Each scan was evaluated independently for the presence of inflammatory process (appendicitis), associated complications and for the detection of other findings rather than acute appendicitis causing RLQP. The radiological findings were compared with histopathological results for operated cases. Results146 typical cases out of 350 patients received CT diagnosis of acute appendicitis, 62 with complications such as appendicular abscess (n=32), appendicolith (n=7), mucocele (n=15), retrocecal appendix (n=5), and retroileal appendix (n=3); 63 patients received nonappendicular GIT causes, and 79 patients received alternative diagnosis of extra-GIT causes; patients who were operated upon based on either clinical diagnosis or US findings or both, with negative CT findings and pregnant women were excluded from the study. ConclusionMDCT can be used effectively in the preoperative evaluation of appendicitis, provides high accuracy for detecting complications, detects other findings causing RLQP, and better guides physicians for proper management of these patients.

Accuracy of percutaneous soft-tissue interventions using a multi-axis, C-arm CT system and 3D laser guidance

IntroductionPurpose of this phantom study was to compare the accuracy of needle placement using a multi-axis, C-arm-based, flat-panel, cone-beam computed tomography system (CBCT guidance) with that under multi-detector computed tomography guidance (MDCT guidance). Materials and methodsIn an abdominal phantom, eight lesions (six lesions in the liver and two in the renal pelvises, respectively) were each punctured in-plane and off-plane with a 20G needle under CBCT and MDCT guidance. Access paths were initially defined and reproduced identically on the two systems. In total, 32 interventions were conducted. CBCT and MDCT guidance was compared prospectively with respect to technical success, accuracy, and overall procedural time. ResultsAll 32 interventions were technically successful in that it was possible to hit the respective lesion in each procedure. When comparing the accuracy of MDCT to CBCT guidance there was no significant difference in absolute, angular, and longitudinal deviation for either in- or off-plane interventions. Overall procedural duration was significantly longer under CBCT guidance for in-plane interventions (888 vs 527s, p=0.00005), whereas, for off-plane procedures there was no significant difference between CBCT and MDCT guidance (920 vs 701s, p=0.08). Off-plane interventions took significantly longer than in-plane interventions under MDCT guidance (701 vs 527s, p=0.03), whereas under CBCT guidance no significant difference could be found between off- and in-plane procedures (920 vs. 888s, p=0.2). ConclusionsIn this phantom study, we could show that percutaneous soft-tissue interventions under CBCT guidance can be conducted with an accuracy comparable to that under MDCT guidance. Although overall procedural duration is in general shorter using MDCT guidance, CBCT-guided interventions offer the advantage of more degrees of freedom, which is of particular importance for off-plane procedures.