Accuracy Of Multidetector Computed Tomography Research Articles

Are multi-detector computed tomography and cone-beam computed tomography exams and software accurate to measure the upper airway? A systematic review.

Cone-beam computed tomography (CBCT) has several applications in various fields of dental medicine such as diagnosis and treatment planning. When compared to computed tomography (CT), CBCT's radiation exposure dose is decreased by 3%-20%. However, CBCT produces more scattered signals and may present poorer image quality when compared to medical CT. To review the findings regarding the accuracy of multi-detector computed tomography (MDCT) and CBCT and to compare the different software programs that segment the upper airway. Three databases (PubMed, Medline, and Web of Science) were searched for articles and a manual search was performed. The inclusion criteria were defined following the PICO framework: P-any patient with a CBCT or CT; I-dimensional evaluation of the upper airway using MDCT or CBCT; C-phantoms; O-the primary outcome was MDCT and CBCT accuracy, the secondary outcome was the evaluation and comparison of software programs used to segment the upper airway. Articles that met eligibility criteria were assessed using the Critical Appraisal Skills Program Checklist. Among the 16 eligible studies, 6 articles referred to the accuracy of MDCTs or CBCTs and 10 to the accuracy of the software. Most articles were qualified as high quality. MDCT and CBCT scans' accuracy in upper airway dimensional measurements depends on machine brand, parameters, and segmentation technique. Regarding the segmentation technique, 12 programs were studied. Most either underestimated or overestimated upper airway measurements. In particular, OnDemand3D and INVIVO showed poor accuracy. On the contrary, Invesalius, and MIMICS were accurate in assessing nasal cavities when using an interactive threshold. However, results varied due to methodological differences among the studies. Finally, fully automatic segmentation based on artificial intelligence may represent the future of airway segmentation because it is faster and seems to be accurate. However, further studies are necessary. This study was registered in Prospero (International Prospective Register of Systematic Reviews) with the ID number CRD42022373998.

The Diagnostic Accuracy of a Novel Scoring System Using Multi-Detector Computed Tomography to Diagnose Lung Cancer.

Lung cancer is the leading cause amongst the cancer deaths in the world. Detection of malignancy at an early stage and with precision is the utmost objective of radiological evaluation. The final diagnosis of lung cancer is histopathological evaluation of the mass. The authors hereby have tried to convert the multi-detector CT (MDCT) characteristics and patient demographics into quantitative data to formulate a scoring system that can predict lung malignancy as close to histopathology as possible. After obtaining ethical clearance, 104 cases of suspected lung cancer by history, clinical and radiographic evaluation were enrolled in the study. These patients were undergoing CT thorax (contrast) on 384 slice siemens somatom force. After undergoing the radiological evaluation biopsy of the mass was done either by CT guided or bronchoscopy guided. Radiological and histopathological findings were correlated. Patients aged >50, lymphadenopathy, tumor volume >50 cc, enhancement >15 HU (Hounsfield unit) after contrast injection were given a score of 15 each. History of smoking, bronchus cut off, spiculated/lobulated margins, mediastinal/pleural involvement, and angiogram sign positive were given a score of 20 each. So, a maximum score of 160 can be achieved by history and MDCT evaluation. Sensitivity, specificity, positive predictive values (PPV), negative predictive values (NPV), and diagnostic accuracy of MDCT by using conventional parameters against histopathology was 97.5%, 85%, 96.29%, 89.47%, and 95.0%. The sensitivity and specificity calculated through Receiver-Operating-Characteristic (ROC) for predicting malignancy were found to be 98.8% and 90.0% for a cut-off score of >97.5 out of maximum of 160. Conclusion: MDCT serves as atool for early diagnosis of lung cancer, and it is the utmost important tool for cases where biopsy or fine needle aspiration cytology (FNAC) is not possible. By creating a quantitative criterion to diagnose lung malignancy, the subjective nature of MDCT diagnosis can be converted into an objective based evaluation.

CORRELATION BETWEEN RADIOLOGICAL (PCIR) AND SURGICAL (PCIS) PERITONEAL CARCINOMATOSIS INDEX (PCI)

Abstract Introduction The Peritoneal Carcinomatosis Index (PCI) is used for the selection of candidates for cytoreductive surgery (CRS)+HIPEC and as a prognostic for resectability. The accuracy of MDCT (Multidetector Computed Tomography) is evaluated by analyzing the degree of correlation between preoperative PCIr and surgical PCIs. Methods We conducted an observational, longitudinal, single-center and retrospective study between May 2014 and 2018 on patients operated upon for peritoneal carcinomatosis. Preoperative TCDM were interpreted by an expert radiologist and PCIs were calculated intraoperatively. Comparison was performed using the Concordance Correlation Coefficient (CCC). The Bland-Altman method was used to represent the difference between observations, with a 95% confidence interval (CI). The sensitivity and specificity of PCIr <20 as a predictor of resectability was also assessed. Results Mean PCIs of the 50 patients undergoing CRS+HIPEC was 11.8 (9.5), and mean PCIr was 11.0 (10.1). The CCC between both was 0.94 (95% CI 0.91–0.97). Sensitivity of PCIr was 0.82 (95%CI 0.68–0.92), being resectable 37/40 patients with PCIr <20. Specificity of PCIr fell to 0.40 (95%CI 0.05–0.85), by failing to achieve complete cytoreduction in 2/10 patients with PCIr ≥20. Positive predictive value was 0.92 (95%CI 0.80–0.98), and negative predictive value was 0.20 (95%CI 0.03–0.56). Conclusions MDCT interpreted by an expert radiologist is an indispensable tool for the selection of patients who are candidates for CRS+HIPEC. A PCIr ≥20 is not synonymous with unresectability.

Preoperative Triple-Phase Three-Dimensional-Multi-Detector Computed Tomography Imaging of the Hepatic Vascular Tree: An Accurate Road Map Prior to Tumor Resection in Hepatoblastoma.

To evaluate the hepatic vasculature/tumor relations in hepatoblastoma patients with three-dimensional (3D) reformatted images after triple-phase multi-detector computed tomography (MDCT) and to compare these with the surgical findings to judge the accuracy of this investigation. The study was carried out in hepatoblastoma patients after appropriate neo-adjuvant chemotherapy, prior to resection. Images were postprocessed at a dedicated workstation for multi-planar reformations, maximum intensity projection, curved planar reformations, and volume-rendered technique reconstructions. The reporting was done as per a specific protocol by both the radiologist and surgeon (per-operative findings) and the accuracy of MDCT ascertained as per concordance between the surgical and imaging findings. Fourteen children (13 boys, 1 girl) underwent surgery. Clinically, relevant information regarding vascular, tumor involvement, and interface with vessels was provided by the study in all cases. Although all tumors were deemed resectable on preoperative imaging, one procedure was abandoned due to an unanticipated portal cavernoma. While a few anatomical variations were unexpectedly encountered during surgery, there was good concordance overall between findings on imaging and surgical exploration. MDCT with 3D reformatting provides accurate virtual representations of the hepatic tumor. This allows simulation of surgical resection with decreased risk of vascular injury and postoperative liver failure.

The Diagnostic Performance of Multi-Detector Computed Tomography (MDCT) in Depiction of Acute Spondylodiscitis in an Emergency Department.

Background: The diagnosis of acute spondylodiscitis can be very difficult because clinical onset symptoms are highly variable. The reference examination is MRI, but very often the first diagnostic investigation performed is CT, given its high availability in the acute setting. CT allows rapid evaluation of other alternative diagnoses (e.g., fractures), but scarce literature is available to evaluate the accuracy of CT, and in particular of multi-detector computed tomography (MDCT), in the diagnosis of suspected spondylodiscitis. The aim of our study was to establish MDCT accuracy and how this diagnostic method could help doctors in the depiction of acute spondylodiscitis in an emergency situation by comparing the diagnostic performance of MDCT with MRI, which is the gold standard. Methods: We searched our radiological archive for all MRI examinations of patients who had been studied for a suspicion of acute spondylodiscitis in the period between January 2017 and January 2021 (n = 162). We included only patients who had undergone MDCT examination prior to MRI examination (n = 25). The overall diagnostic value of MDCT was estimated, using MRI as the gold standard. In particular, the aim of our study was to clarify the effectiveness of CT in radiological cases that require immediate intervention (stage of complications). Therefore, the radiologist, faced with a negative CT finding, can suggest an elective (not urgent) MRI with relative serenity and without therapeutic delays. Results: MDCT allowed identification of the presence of acute spondylodiscitis in 13 of 25 patients. Specificity and positive predictive value were 100% for MDCT, while sensitivity and negative predictive value were 68% and 50%, respectively, achieving an overall accuracy of 76%. In addition, MDCT allowed the identification of paravertebral abscesses (92%), fairly pathognomonic lesions of spondylodiscitis pathology. Conclusions: The MDCT allows identification of the presence of acute spondylodiscitis in the Emergency Department (ED) with a satisfactory accuracy. In the case of a positive CT examination, this allows therapy to be started immediately and reduces complications. However, we suggest performing an elective MRI examination in negative cases in which pathological findings are hard to diagnose with CT alone.

Diagnostic Accuracy of Multidetector Computed Tomography in Detecting Mesorectal Fascia Involvement in Colorectal Carcinoma

Objectives: To determine the diagnostic accuracy of multi detector computed tomography (MDCT) in detecting mesorectal fascia involvement in colorectal carcinoma, taking histopathology as a gold standard.
 Study Design: Cross-sectional study.
 Place and Duration of Study: Department of Radiology, Combined Military Hospital Quetta from Jun to Dec 2019.
 Methodology: A total of 117 suspected patients of colorectal carcinoma, aged 40-80 years of either gender were included. All the patients underwent MDCT and then were looked for mesorectal fascia involvement. After surgical intervention, the his to pathological result of respected specimens was correlated with MDCT findings.
 Results: MDCT showed mesorectal fascia involvement in 66 (56.41%) patients. Histopathology confirmed mesorectal fascia involvement in 62 (52.99%) cases, whereas 55 (47.01%) patients revealed no mesorectal fascia involvement. In MDCT positive patients, 56 patients were true positive, while ten patients were false positive. Among 51 MDCT negative patients, 6 were false-negative while 45 were true negative. Overall results of sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of MDCT in detecting mesorectal fascia involvement, taking histopathology as the gold standard was, 90.32%, 81.82%, 84.85%, 88.24% and 86.32% respectively.
 Conclusion: This study concluded that MDCT is a recommended modality due to its high sensitivity. It is an accurate modality for pre-operative detecting mesorectal fascia involvement in colorectal carcinoma patients.

Diagnostic Accuracy of Multi-Detector CT for Evaluation of Renal Masses

Objective: To determine the accuracy of multi-detector computed tomography (MDCT) in differentiation of renal masses taking histopathology as gold standard. Methods: This cross-validation study was conducted from March 2021 to August 2021 at Al Hussain Diagnostic & Medical center Nishtar Road Multan. We included 100 patients presenting with renal masses on clinical and ultrasonography. All patients underwent MDCT for evaluation of renal masses. After MDCT, biopsy specimens were obtained for histopathological diagnosis of renal masses. The MDCT findings were correlated with histopathology diagnosis to determine the accuracy of MDCT. Results: Mean age was 45.8±12.36 years, 67% patients were male and 33% were female. Malignancy was diagnosed in 83% patients and remaining 17% patients were diagnosed of having benign lesions. Out of malignant lesions, 65% patients had RCC, 07% Wilm’s tumor, 6% lymphoma, meta-stasis was diagnosed 04% patients and 01% renal pelvic TCC. Among the benign lesions 11% patients had Angiomyolipoma and oncocytoma was diagnosed in 6.0% patients. The overall sensitivity of CT scan was 97.6%, specificity was 100%, PPV was 100% and NPV was 89.5%. Conclusion: MDCT can be used as the imaging method of choice for initial evaluation and diagnosis of RCC as it is associated with high sensitivity and specificity for differentiating malignant from benign lesions. Keywords: Diagnostic Accuracy, Histopathology, Multi detector CT, Renal Masses

English

BACKGROUND Mediastinal lesions are one of the most common lesions of the chest in children and adults. Multidetector computed tomography (MDCT) is the most common investigation done in patients with suspected abnormalities on X-ray. Crosssectional imaging visualises complex anatomy, helps in predicting the tissue of origin, characterises lesions and depicts the extent of involvement of adjacent structures. Complications of mediastinal lesions and emergent conditions, for example, sealed pneumo-mediastinum, tracheoesophageal / pulmonary fistula, a peri-lesional abscess can be well assessed on CECT. The possibility of the lesion as benign or malignant and can be well predicted. Vascular lesions like aneurysms, dissections, and embolism can be evaluated and stable lesions requiring to follow up and unstable lesions requiring emergent treatment are differentiated using MDCT. The objectives of the study were to characterize and identify features pathognomic of specific mediastinal masses on computed tomography and find out diagnostic accuracy of MDCT in mediastinal masses and compare them with pathological results wherever possible. METHODS A prospective study was done in the Department of Radiodiagnosis, Rohilkhand Medical College and hospital, Bareilly for a span of 1 year from November 2018 to October 2019. Our study included 51 patients. Mediastinal lesions were assessed based on size, compartmental localisation, and attenuation and enhancement patterns. RESULTS In our study with 51 patients, 16 lesions were non-neoplastic and 35 were neoplastic lesions. Anterior mediastinal lesions constituted maximum lesions followed by middle and posterior mediastinal lesions. Lymph nodal masses were the commonest lesions out of which 4 cases were tubercular in origin, 4 were lymphomatous and 4 were metastatic. Neurogenic tumours were most common in the posterior mediastinum consisting of 6 cases. 2 vascular lesions were seen, 1 of aortic aneurysm and 1 aortic dissection. The diagnostic accuracy of MDCT was 93 % compared to histopathological results. Computed tomography (CT) plays a major role in evaluating mediastinal masses by virtue of its excellent multiplanar reconstruction capabilities and demonstration of exact anatomic relationships. However, in many situations, histopathological examination is needed to know the exact tissue of origin and for further management. CONCLUSIONS We conclude that CT has a major role in evaluating mediastinal masses regarding location, extent and tissue characterization. It can display certain features pathognomic for particular masses thus obviates the need for invasive procedures. KEY WORDS Mediastinal Lesions, MDCT, Imaging Modality, Histopathology

Diagnostic Accuracy of MDCT (Multidetector Computed Tomography) for Staging of Renal Cell Carcinoma

Background: The advancement in technology has introduced multi-detector CT scanners and achievement of better spatial resolution with faster acquisition has become a possibility. The three-dimensional reformatted images along with multiplanar reconstructions upgrade the staging capabilities for RCC. Aim: To check accuracy of MDCT (Multi-detector Computed tomography) in staging renal cell carcinoma with histopathology taken as the gold standard. Study design: The study is a descriptive cross sectional study. Settings: Radiology Department, Bahawal Victoria Hospital, Bahawalpur Study duration: 16"' January 2019 to 15"' July 2019. Methods 157 patients (including both genders) were included with age range of 25-60 years, showing features of renal cell carcinoma on ultrasonography. Those Patients with renal mass other than renal cell carcinoma, solitary functioning kidney and pregnant females were eliminated from the study. All the selected patients had Multi-detector CT scan abdomen performed. Results: Mean age was 44.66+9.3 I years. Out of these 157 patients, there were 90(57.32) male patients and 67 (42.68°/c) females with ratio of I.3: I. All the patients had CT scan of abdomen and pelvis. The results showed that 8I of the patients were True Positive and only 08 were False Positive. Out of 68 CT negative patients, 07 (False Negative) showed renal cell carcinoma on histopathology while 6 I True Negative patients had no evidence of RCC on histopathology (p=0.0001). Conclusion: Multi-detector CT scan is a very sensitive yet accurate non - invasive method for staging renal cell ca. Keywords: Renal cell carcinoma, multidetector CT scan, imaging, sensitivity

Diagnostic value of MDCT in determining the perinephric fat tissue and renal sinus invasion in patients with clear cell renal cell carcinoma.

To investigate the accuracy of multidetector computed tomography (MDCT) findings, and the effect of tumor volume in determining the perinephric and renal sinus invasion in clear cell renal cell carcinomas (ccRCCs). Fifty patients with ccRCCs underwent non-contrast and nephrographic-phase contrast-enhanced MDCT examination before total nephrectomy. The following MDCT features were used to diagnose perinephric fat tissue invasion: perinephric stranding, perinephric vascularity, and irregular contour. The following MDCT features were used to diagnose renal sinus fat invasion: elongation of tumor into renal sinus, invasion, or compression of pelvicalyceal system. Histopathologic examinations were used as a gold standard. Fourteen out of 50 ccRCCs patients (28%) had histopathological-proven perinephric fat tissue invasion. The sensitivity, specificity, PPV, NPV, and accuracy of MDCT in the detection of perinephric fat tissue invasion were found 64%, 58%, 38%, 80%, and 60%, respectively. Seven out of 50 ccRCCs patient (14%) had histopathological-proven renal sinus invasion. The sensitivity, specificity, PPV, NPV, and accuracy of MDCT in the detection of renal sinus invasion were found 85%, 65%, 28%, 96%, and 68%, respectively. The area under of curve (AUC) value of tumor volume in the detection of perinephric fat invasion was 0.631. The AUC value of tumor volume in the detection of renal sinus invasion was 0.803. MDCT has a good sensitivity for detection of renal sinus fat invasion, but low PPV and specificity in patients with ccRCC. Tumor volume, and invasion into the pelvicalyceal structures can aid in the diagnosis of renal sinus fat invasion preoperatively.

Role of Multidetector Computed Tomography in Patients of Acute Mesenteric Ischaemia and its Comparison with Clinicosurgical Outcome: A Cross-sectional Study

Introduction: Acute mesenteric ischaemia is an abdominal emergency occurring in nearly 1% of patients presenting with acute abdomen. Early diagnosis is very important for the improved survival of the patient. Acute mesenteric ischaemia frequently presents with non specific features such as vomiting, loose stools and abdominal distension. The classical triad of fever, haematochezia and abdominal pain is seen in only 30% of the patients so, it is difficult to diagnose clinically. Multidetector Computed Tomography (MDCT) is gold standard and first line test to diagnose intestinal ischaemia. Aim: To assess the efficacy of MDCT in the diagnosis of acute mesenteric ischaemia and to compare its outcome with surgical and/or clinical findings. Materials and Methods: In this cross-sectional descriptive study conducted from 1st November 2018 to 31st May 2020, MDCT was performed on 40 patients (23 male; 17 female, age range: 28-93 years). Axial and reconstructed images of each patient were evaluated for evidence of bowel wall thickening, bowel wall attenuation, abnormal wall enhancement, bowel dilatation, mesenteric stranding, ascites, solid organ infarcts, pneumatosis intestinalis or portomesenteric gas, and mesenteric arterial or venous thrombosis. Multidetector CT findings were compared with the surgical findings and clinical outcome. Results were expressed in terms of frequency and percentages. Results: Out of 40 patients, most common cause of acute mesenteric ischaemia was arterial thrombosis, seen in 20 patients (50%) while 13 patients (32.5%) had portomesenteric venous thrombosis and 7 (17.5%) patients were diagnosed with non occlusive mesenteric ischaemia. CT finding of bowel wall thickening and bowel dilatation however non specific were seen in majority of patients (62.5% and 70%, respectively). Mesenteric fat stranding and ascites were seen in 95% and 77.5% cases respectively. Specific signs of acute mesenteric ischaemia includes hypoenhancing and non enhancing bowel walls seen in 27 patients (67.5%). Pneumatosis intestinalis and portomesenteric pneumatosis in 20% patients. A total of 27 patients underwent surgery and 13 patients were managed conservatively. On comparing the CT findings with intraoperative/ histopathological findings, accuracy of MDCT in the diagnosis of acute mesenteric ischaemia in this study was 96.39%. Conclusion: MDCT should be the first line imaging modality to diagnose acute mesenteric ischaemia and to exclude other causes of acute abdomen. It is an excellent and fast modality to diagnose bowel ischaemia, as it can visualise both the bowel and mesenteric changes as well as accurately depict the mesenteric vasculature.

Diagnostic Accuracy of Multi-Detector Computed Tomography in the Evaluation of Mediastinal Masses- A Prospective Observational Study

Introduction: The introduction of Multi-Detector Computed Tomography (MDCT) has revolutionised clinical practice. Mediastinal lesions represent challenging problems faced by the radiologist and often a chest radiograph is inadequate for answering the queries of clinicians. MDCT is employed to diagnose various causes of mediastinal widening and often correct diagnosis is obtained using CT alone, thus obviating invasive diagnostic procedures. Aim: To assess the diagnostic accuracy of MDCT in mediastinal mass lesions compared to histopathology. Materials and Methods: A prospective observational study comprised of 52 patients who underwent MDCT examination for evaluation of mediastinal masses. All these patients subsequently underwent histopathological examination either by CT-guided biopsy, transthoracic needle aspiration, endoscopic biopsy or by surgical resection. Sensitivity, specificity and accuracy of each type of lesion was calculated and tabulated. Results: The study population comprised of 52 patients out of whom 43 cases (83%) were predicted correctly by CT when compared with histopathology diagnosis. The sensitivity of detecting malignancy was 100% and specificity was 92.6%. The present study had accuracy of 96.2% in differentiating malignant mediastinal masses from benign lesions. Conclusion: MDCT is useful in evaluating the distribution of mediastinal masses and their relationship to adjacent structures and differentiating between malignant mediastinal masses from benign lesions.

Of multidetector computed tomography (MDCT) in evaluation of lung nodule with histopathological correlation

Background: Lung cancer is the most common and lethal cancer around the world. Computed tomography (CT) is an integral imaging technique for staging the lung cancer. Aim of this study was to correlate the multidetector CT (MDCT) findings of lung nodule with histopathological examination, as well as to assess the diagnostic accuracy of MDCT in evaluation of suspected lung nodule. Methods: One hundred patients with clinical or radiological suspicion of lung nodule referred for CT scan of thorax were included in the study. Histopathological analysis was performed. The location of the lesion was analysed and nodules were classified. Fine needle aspiration cytology (FNAC) was done with spinal needle under all aseptic precautions. The results obtained by MDCT were analysed and compared with histopathological findings done by CT guided FNAC. Results: Average age of patients was 65 years, 25 % were females and 75 % were males. Among all the patients 66 % of lesions were located in right side lung and 34 % of lesions were left in location. Of all, 2 % patients had lesions less than 3 cm, 11 % patients had lesion between 3-4 cm, 19 % patients had lesion between 4-5 cm, 26 % patients had lesion between 5-7 cm and 42 % patients had lesion greater than 7 cm. Many of these patients also presented with enlarged lymph nodes, most commonly mediastinal (73 %) followed by subcarinal (51 %), hilar (44 %) and supraclavicular (4 %) lymph nodes. The most common histological findings of lung nodules analysis were adenocarcinoma (41 %). Among the 100 patients 58 % had lesions located peripherally while 42 % had central lesions. CT was a highly sensitive (95.45 %) and moderately specific (75 %) test and also had a high positive predictive value (96 %) to diagnose malignant lung nodule. Conclusion: CT guided FNAC of lung nodule is a safe, minimal invasive procedure with a high diagnostic accuracy. The use of CT-guided FNAC in hilar and mediastinal nodules can avoid unnecessary exploratory surgery for staging and also diagnosis could be made with lesser cost.

Accuracy of preoperative staging with multidetector computed tomography in colon cancer.

Multidetector computed tomography (MDCT) is the main preoperative decision-making tool in colon cancer treatment, thus the validation of daily clinical practice is warranted. The only published study validating the accuracy of MDCT in a national cohort was performed more than a decade ago. With neoadjuvant chemotherapy for patients with preoperatively assessed locally advanced cancer and the emergence of other personalized treatments we aimed to validate the accuracy of MDCT in a national cohort. The study is based on the Danish Colorectal Cancer Group (DCCG) database and included all Danish patients diagnosed with primary colon adenocarcinoma between January 2015 and December 2018. The primary study outcome was the accuracy of MDCT in identifying patients with locally advanced disease. The secondary outcomes were the accuracy of predicting UICC Stage I based on predicting the tumour category (pT3-T4 versus pT1-T2) and lymph node metastasis. A total 3465 patients were included in the analyses regarding locally advanced colon cancer. The sensitivity and specificity were 0.61 (0.58-0.64) and 0.85 (0.83-0.86), respectively, for CT to predict locally advanced disease. The sensitivity and specificity were 0.63 (0.59-0.66) and 0.80 (0.78-0.81), respectively, for predicting UICC Stage I in 4496 patients. Thirty six per cent of the patients assessed as having locally advanced disease and 58% assessed as Stage I were misclassified by MDCT. The present standard in Denmark questions whether the implementation of personalized medicine such as neoadjuvant adjuvant chemotherapy and tailor-made resections based on MDCT is justified.

Preoperative Staging of Gastric Cancer Using Computed Tomography and Its Correlation with Histopathology with Emphasis on Multi-planar Reformations and Virtual Gastroscopy.

Gastric cancer is the fifth most common cancer in the world. Preoperative staging of gastric cancer has assumed pivotal role in deciding appropriate management of gastric cancer with multi-detector computed tomography (MDCT) using hydro- and gaseous distension of stomach superseding endoscopic ultrasound in tumor (T) and nodal (N) staging. We undertook this study to evaluate the diagnostic accuracy of MDCT in the T and N staging of gastric cancer with an attempt to differentiate between early and advanced gastric carcinomas. A total of 160 patients with endoscopically diagnosed and biopsy-proven gastric cancer were subjected to MDCT after adequate gaseous and hydro-distention of stomach. Multi-planar reformatted (MPR) as well as virtual gastroscopy images were also obtained. Gastric lesions were categorized into T1 to T4 stages with N staging from N0 to N3. Preoperative CT findings were correlated with histopathological findings. Overall diagnostic accuracy of T staging in our study was 82.5% (132/160) with an accuracy of 75% (120/160) for N staging. The diagnostic accuracy of CT for early gastric carcinoma in our study was 93.75% with high specificity of 96% but low sensitivity of 66.7%. MDCT using gaseous and hydro-distension of stomach is an excellent modality for near accurate preoperative T staging of gastric cancer. However, CT has a limited role in the N staging of gastric cancer. This study also suggested that the combined use of virtual gastroscopy and MPR images helps in better detection of early gastric cancers.

Accuracy of Multi-Detector Computed Tomography in Detection of Esophageal Varices in Chronic Liver Disease

Background: Patients with chronic liver disease should undergo screening endoscopy, but this approach places a heavy burden upon endoscopy units along with other limitations. The aim of this study was to determine the diagnostic accuracy of multi-detector computed tomography scan in detecting esophageal varices taking endoscopy as gold standard.Material and Methods: This cross-sectional study was done from 1st Jan 2018 to 31st Dec 2018 at Department of Radiology, PIMS Hospital Islamabad. A total of 180 patients of both gender with chronic liver disease for at least 12 months were included in this study with an age range of 25-65 years. Patients with active gastrointestinal hemorrhage, hypersensitivity to iodinated contrast agent, chronic renal failure, claustrophobic and pregnant females were excluded. All the patients underwent endoscopy and computed tomography of lower chest and the upper abdomen before and after intravenous contrast administration. Multi detector computed tomography (MDCT) scan findings for esophageal varices were compared with endoscopy findings.Results: In MDCT positive patients (n=102), 98 were true positive and 04 were false positive. Among 78 MDCT negative patients, 07 were false negative, whereas 71 were true negative. Overall sensitivity and specificity were 93.33%, and 94.67% respectively. The positive and negative predictive values were 96.08% and 91.03% respectively, while diagnostic accuracy of MDCT in detecting esophageal varices in chronic liver disease patients was 93.89%, taking endoscopy as gold standard.Conclusions: Multi-detector computed tomography scan is a highly sensitive and accurate non-invasive modality for detecting esophageal varices in chronic liver disease patients.Key words: Accuracy, Chronic liver disease, Esophageal varices, Multi-detector computed tomography

Diagnostic Accuracy of Multidetector Computed Tomography in Evaluation of Retroperitoneal Traumatic Injuries and Retroperitoneal Hemorrhage

AbstractBackground: Abdominal trauma represents a main daycare activity in radiology.non surgical treatment has become the standard of care in hemodynamically stable abdominal trauma patients as a result of comprehensive assessment of injury by imaging.MDCT is very sensitive method to detect traumatic injuries and determine the grading of this injuries on which the management will be performed.Aim of Study: To assess diagnostic accuracy of multi-detector CT in evaluation of retroperitoneal traumatic injuries and retroperitoneal hemorrhage.Patients and Methods: Prospective study included 60 patients with abdominal trauma (40 male, 20 females), their age ranged from 7 years to 70 years (mean age 34.8 year). Ultrasonography and MDCT were performed for all patients.Results: 30 patients (50% of the total studied patients) had retroperitoneal injuries, 27 patients of them (90%) were secondary to blunt abdominal trauma and 3 patients (10%) suffered from stab trauma. Fifteen patients had renal injuries; 3 of them associated with adrenal injuries, 2 patients had bowel injuries, 5 patients had pancreatic injuries, 3 patients had vascular injuries and 5 patients had retroperitoneal hematoma related to other injuries; 3 of them had psoas muscle injury and the other 2 patients had urinary bladder rupture.Conclusion: MDCT proved to be accurate and sensitive to evaluate retroperitoneal traumatic injuries and determine the grading and severity of these injuries on which the man-agement will be performed. In addition MDCT proved to be highly sensitive in detection of active hemorrhage which is a life threatening condition.

Age- and gender-specific disease distribution and the diagnostic accuracy of CT for resected anterior mediastinal lesions.

BackgroundAnterior mediastinal lesions account for approximately half of all mediastinal masses and computed tomography (CT) is known to exhibit limited differentiating performance. Our aim was to evaluate the age‐ and gender‐specific distribution of anterior mediastinal lesions and the diagnostic accuracy of multi‐detector CT (MDCT).MethodsThis retrospective study included 549 consecutive patients with proven anterior mediastinal lesions and diagnostic MDCT scans. The age‐ and gender‐specific distribution of proven diagnoses and diagnostic accuracy were reviewed. The CT features of malignant and benign diseases having the lowest accuracy were compared with those of the most commonly misdiagnosed diseases.ResultsThe proportion of malignancy showed a V‐shape relationship with age (lowest, 52.7% [50s]). The most prevalent malignancies were lymphoma (20s), lymphoma/thymoma (30s), thymoma (40s–50s), and thymoma/thymic carcinoma (≥60s). The most prevalent benign diseases were thymic remnant/hyperplasia (20s–30s), and thymic bed cyst (≥40s). The first‐choice diagnostic accuracy of MDCT decreased with age regardless of gender: 75.4% (20s), 75.0% (30s), 67.8% (40s), 58.5% (50s), and 53.4% (≥60s), primarily due to incorrect diagnoses of thymic bed cyst and thymic carcinoma (accuracy, 42.3% and 30.5%), which were prevalent in older patients and mostly misdiagnosed as thymoma. The most powerful differentiating MDCT features were water attenuation (≤20 HU) (OR, 42.7 [95%CI, 8.8–‐208.3], P < 0.001) for thymic bed cyst and mediastinal lymphadenopathy (6.8 [1.7–27.2], P = 0.006) for thymic carcinoma, but both showed low sensitivity (34.5% and 18.6%, respectively).ConclusionsMDCT accuracy depended on age, owing to the age‐specific distribution of thymic carcinoma and thymic bed cyst, which frequently lacks distinguishable CT features from thymoma.

Diagnostic Accuracy of Multidetector Computed Tomography in Detection of Esophageal Varices.

ObjectiveTo determine the diagnostic accuracy of multidetector computed tomography (MDCT) in the detection of esophageal varices by taking endoscopy as the reference standard.Materials and methodsThis was a cross-sectional prospective study conducted at the Department of Radiology, Aga Khan University Hospital, (AKUH) Karachi, for the duration of 12 months from August 1, 2014 to July 31, 2015. One hundred ninety-six patients with a suspicion of chronic liver disease/cirrhosis undergoing 64 slice MDCT were enrolled in our study and underwent computed tomography (CT) scanning in the Department of Radiology at AKUH. Biphasic CT was performed with images obtained during the hepatic arterial phase (30-second delay) and the portal venous phase (65-second delay) after the intravenous (IV) injection of 120 mL of nonionic contrast material at a rate of 3.5 mL/s. The presence of esophageal varices was evaluated on MDCT with endoscopy as gold standard. The sensitivity, specificity, negative predictive value and positive predictive value, and accuracy of MDCT were assessed against the gold standard.ResultsOur results yielded an MDCT sensitivity of 98.96%, specificity of 100%, positive predictive value (PPV) of 100%, negative predictive value (NPV) of 66.67%, and diagnostic accuracy of 98.97% for esophageal varices in chronic liver disease (CLD) patients.ConclusionThe rate of detection of esophageal varices in patients with chronic liver disease on MDCT in our country is comparable to the international data and we advocate that MDCT should be used as a screening tool in patients with chronic liver disease to exclude esophageal varices.

Role of multidetector computed tomography imaging in the management of patients with blunt chest trauma

Objectives To demonstrate the capabilities of multidetector computed tomography (MDCT), in revealing injuries and guiding management of patients with blunt chest trauma. Background MDCT has become a cornerstone tool for evaluating blunt chest trauma owing to quick scanning, identification of concealed injuries, viewing images in many planes, providing three-dimensional images, ability to clarify tracheobronchial or vascular injuries, usage of contrast media, and detection of coexisting nonthoracic injuries. Patients and methods This study included 40 patients referred from Emergency Department with blunt chest trauma presented mainly with chest pain and dyspnea. All were subjected to clinical history, general and local examination, chest radiography (CXR), and MDCT studies for diagnostic evaluation and received intravenous water-soluble contrast. Results MDCT showed superior sensitivity, detecting more injuries than CXR and detecting other injuries that were totally missed such as sternal, dorsal spinal fractures, lung lacerations, herniation, and trachea-bronchial injuries. CXR sensitivity was low regarding detection of many injuries such as chest wall, pleural, parenchymal, and mediastinal injuries. Accuracy of MDCT was superior to CXR for positive findings providing more details about them with subsequent changes in the management plans. Conclusion Our results support that MDCT is the imaging modality of choice for blunt thoracic trauma in hemodynamically stable patients, being more sensitive and accurate, being rapid, showing injuries that are well clarified with contrast media, and enabling postprocessing reformatted images with subsequent more diagnostic findings that would change patient management plan.