Accuracy Of Multidetector-row Computed Tomography Research Articles

The Impact of MDCT and Endoscopic Transpapillary Mapping Biopsy to Predict Longitudinal Spread of Extrahepatic Cholangiocarcinoma

BackgroundsWe aimed to investigate the diagnostic accuracy of multidetector-row computed tomography (MDCT), mapping biopsy, and other imaging modalities to predict the longitudinal extension and depth of invasion of extrahepatic cholangiocarcinoma at possible surgical ductal margins. MethodsOf 102 patients with surgical resection of extrahepatic cholangiocarcinoma between January 2010 and October 2015, 32 evaluated by multidetector-row computed tomography (MDCT) performed before biliary drainage and mapping biopsy were enrolled. Mapping biopsies were performed at 74 sites to determine the resection point of the bile duct (at 74 possible surgical ductal margins). Diagnostic accuracy was evaluated by histopathology. ResultsThe diagnostic accuracy of MDCT for longitudinal cancer spread was 79.7%, that of biopsy was 73.0%, and combining the two modalities showed highest accuracy (83.8%). The depth of tumor invasion could be predicted by combination of the ductal wall thickness and contrast enhancement on MDCT, that is, at 11 of 13 sites (84.6%) with submucosal invasion, ductal wall thickness was > 2.5mm with high contrast enhancement. ConclusionsMDCT demonstrated highest accuracy of diagnosing longitudinal extension at possible surgical ductal margins in patients with extrahepatic cholangiocarcinoma. The depth of tumor invasion could be predicted by ductal wall thickness and contrast enhancement of MDCT.

Diagnostic performance of CT, gadoxetate disodium-enhanced MRI, and PET/CT for the diagnosis of colorectal liver metastasis: Systematic review and meta-analysis.

Imaging studies, including computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET), have an essential role in the detection and localization of colorectal liver metastasis (CRLM). To systematically determine the diagnostic accuracy of multidetector row CT (MDCT), gadoxetate disodium-enhanced MRI, and PET/CT for diagnosing CRLM and the sources of heterogeneity between the reported results. Systematic review and meta-analysis. In all, 2151 lesions in CT studies, 2301 lesions in MRI studies, 1846 lesions in PET/CT studies, FIELD STRENGTH: 1.5T and 3.0T. We identified research studies that investigated MDCT, gadoxetate disodium-enhanced MRI, and PET/CT to diagnose CRLM by performing a systematic search of PubMed MEDLINE and EMBASE. Study quality was assessed using Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2). According to the types of imaging tests, study heterogeneity and the threshold effect were analyzed and the meta-analytic summary of sensitivity and specificity were estimated. Meta-regression analysis was performed to further investigate study heterogeneity. Of the 860 articles screened, we found 36 studies from 24 articles reporting a diagnosis of CRLM (11 CT studies, 12 MRI studies, and 13 PET/CT studies). The meta-analytic summary sensitivity for CT, MRI, and PET/CT were 82.1% (95% confidence interval [CI], 74.0-88.1%), 93.1% (95% CI, 88.4-96.0%), and 74.1% (95% CI, 62.1-83.3%), respectively. The meta-analytic summary specificity for CT, MRI, and PET/CT were 73.5% (95% CI, 53.7-86.9%), 87.3% (95% CI, 77.5-93.2%), and 93.9% (95% CI, 83.9-97.8%), respectively. There was no threshold effect in any of the imaging tests. Neoadjuvant chemotherapy significantly decreased the sensitivity of CT and MRI (P < 0.01), although it did not significantly affect the sensitivity of PET/CT. The study design, type of reference standard, and study quality also affected the diagnostic performances of imaging studies. Despite the heterogeneous accuracy between studies, gadoxetate disodium-enhanced MRI showed the highest sensitivity, and gadoxetate disodium-enhanced MRI and PET/CT had similar specificities for diagnosing CRLM. 3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018;47:1237-1250.

Accuracy of MDCT and CBCT in three-dimensional evaluation of the oropharynx morphology.

To assess the accuracy of five different computed tomography (CT) scanners for the evaluation of the oropharynx morphology. An existing cone-beam computed tomography (CBCT) data set was used to fabricate an anthropomorphic phantom of the upper airway volume that extended from the uvula to the epiglottis (oropharynx) with known dimensions (gold standard). This phantom was scanned using two multi-detector row computed tomography (MDCT) scanners (GE Discovery CT750 HD, Siemens Somatom Sensation) and three CBCT scanners (NewTom 5G, 3D Accuitomo 170, Vatech PaX Zenith 3D). All CT images were segmented by two observers and converted into standard tessellation language (STL) models. The volume and the cross-sectional area of the oropharynx were measured on the acquired STL models. Finally, all STL models were registered and compared with the gold standard. The intra- and inter-observer reliability of the oropharynx segmentation was fair to excellent. The most accurate volume measurements were acquired using the Siemens MDCT (98.4%; 14.3 cm3) and Vatech CBCT (98.9%; 14.4 cm3) scanners. The GE MDCT, NewTom 5G CBCT, and Accuitomo CBCT scanners resulted in smaller volumes, viz., 92.1% (13.4 cm3), 91.5% (13.3 cm3), and 94.6% (13.8 cm3), respectively. The most accurate cross-sectional area measurements were acquired using the Siemens MDCT (94.6%; 282.4 mm2), Accuitomo CBCT (95.1%; 283.8 mm2), and Vatech CBCT (95.3%; 284.5 mm2) scanners. The GE MDCT and NewTom 5G CBCT scanners resulted in smaller areas, viz., 89.3% (266.5 mm2) and 89.8% (268.0 mm2), respectively. Images of the phantom were acquired using the vendor-supplied default airway scanning protocol for each scanner. Significant differences were observed in the volume and cross-sectional area measurements of the oropharynx acquired using different MDCT and CBCT scanners. The Siemens MDCT and the Vatech CBCT scanners were more accurate than the GE MDCT, NewTom 5G, and Accuitomo CBCT scanners. In clinical settings, CBCT scanners offer an alternative to MDCT scanners in the assessment of the oropharynx morphology.

Diagnostic accuracy of indocyanine green fluorescence imaging and multidetector row computed tomography for identifying hepatocellular carcinoma with liver explant correlation.

Indocyanine green (ICG)-fluorescence imaging is useful for detecting hepatocellular carcinoma (HCC) during surgery, but its accuracy has not been compared to that of multidetector row computed tomography (MDCT) with liver explant correlation. The aim of the present study was to clarify the precise diagnostic accuracy of ICG-fluorescence imaging for detecting HCC in a whole explant liver survey. Thirty-three patients with end-stage liver disease (mean age, 53years) were prospectively enrolled in the present study. The mean Model for End-stage Liver Disease score was 14.6. One month before and 1week prior to living donor liver transplantation, all patients underwent MDCT and administration of ICG. Following whole liver resection, the explanted liver was sliced. Gross examination and ICG-fluorescence imaging of both sides of the cut specimen was carried out and all focal liver lesions were recorded. Pathologic examination diagnosed 18 of 84 focal liver lesions as HCC. Of those, MDCT and ICG-fluorescence imaging diagnosed 12 and 13 HCCs, respectively. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of MDCT were 66.7%, 92.4%, 70.6%, 91.0%, and 86.9%, respectively, compared with those of ICG-fluorescence imaging at 72.2%, 31.8%, 22.4%, 80.8%, and 40.5%, respectively. The sensitivity of ICG-fluorescence imaging for detecting HCC with liver explant correlation was similar to that of MDCT. However, ICG-fluorescence imaging had low specificity in the setting of decompensated cirrhotic explant liver correlation.

Comparison of preoperative Borrmann classification in advanced gastric carcinoma with double contrast-enhanced ultrasound and multi-detector row CT: correlation with surgical and histologic results

Objective To compare the accuracy of double contrast-enhanced ultrasound (DCEUS) and multi-detector row CT (MDCT) in determining the Borrmann classification in advanced gastric carcinoma (AGC) preoperatively. Methods Two hundred and nine patients with AGC proved by endoscopic biopsy were included. DCEUS (intravenous microbubbles combined with oral contrast-enhanced ultrasound) and MDCT were performed preoperatively. The diagnostic accuracy of DCEUS and MDCT in determining Borrmann classification was calculated and compared. Additionally, intra- and inter- observer reliability of DCEUS and MDCT were assessed using Kappa analysis and a well reliability was set as Kappa value large than 0.75. Results The overall accuracy of DCEUS in determining the Borrmann classification of AGC was 87.9%, the accuracy of DCEUS in determining Borrmann Ⅰ, Ⅱ, Ⅲ and Ⅳ was 90.3%, 86.5%, 87.1% and 88.2%, respectively. The overall accuracy of MDCT in determining the Borrmann classification of AGC was 80.9%, the accuracy of MDCT in determining Borrmann Ⅰ, Ⅱ, Ⅲ and Ⅳ was 87.1%, 78.4%, 78.6% and 85.3%, respectively.There was no significant difference in accuracy between DCEUS and MDCT for Borrmann Ⅰ and Ⅳ classification of AGC (chi-square test, P=0.349 for Borramnn Ⅰ type, P=0.094 for Borrmann Ⅳ type). The accuracy of DCEUS for Borrmann Ⅱ and Ⅲ classification of AGC was higher than the accuracy of MDCT (chi-square test, P=0.000 for Borrmann Ⅱ type, P=0.000 for Borrmann Ⅲ type). The intra- and inter-observe reproducibility were both almost perfect for assessing the Borrmann classification of AGC with a Kappa value of 0.891(P=0.000) for intra-observer and 0.860(P=0.000) for inter-observer by DCEUS. The intra- and inter-observe reproducibility were both almost perfect for assessing the Borrmann classification of AGC with a Kappa value of 0.884 (P=0.000) for intra-observer and 0.852 (P=0.000) for inter-observer by MDCT. Conclusions DCEUS could be considered as a new, reliable and noninvasive method for preoperative the Borrmann classification in AGC. Key words: Ultrasonography; Microbubbles; Tomography, X-ray computed; Stomach neoplasms; Borrmann classification

Diagnostic accuracy of multi detector-row computed tomography (MDCT) and endoscopic ultrasound (EUS) for clinical N staging in early gastric cancer.

17 Background: An accurate preoperative assessment of potential lymph node metastasis is useful in the decision for the treatment strategy of early gastric cancer. The aim of this study was to retrospectively evaluate the accuracy of preoperative assessment of lymph node status with multi detector-row computed tomography (MDCT) and endoscopic ultrasound (EUS). Methods: We had analyzed 1,104 patients with early gastric cancer who underwent gastrectomy with lymph-node dissection at Seoul National University Bundang Hospital from May 2003 to July 2011. Patients were underwent preoperative MDCT in 1,104 and EUS in 1,028. Lymph nodes were considered positive for metastasis if they were larger than 8mm in the short axis diameter of MDCT. The criteria of EUS for metastatic lymph nodes are rounded nodes larger than 8 mm diameter with hypoechogenicity. The clinical N staging of preoperative MDCT and EUS was compared to the postoperative pathological finding. Results: The overall diagnostic accuracy of MDCT and EUS for determining lymph node metastasis was 89.1% and 90.5%. In MDCT, the rate of overestimation of lymph node metastasis was 8.20% (91/1104) and underestimation was 8.7% (96/1104). Tumor size (&gt;2cm) was significant related with overestimation (p=0.007). Underestimation of clinical N staging was related with female (p=0.025, OR 2.025), lymphovascular invasion (p&lt;0.0001, OR 7.807), positive EGFR (p=0.015, OR 2.566) and tumor size (&gt;2cm) (p=0.009, OR 3.221). In EUS, overestimated lymph node metastasis was 5.40% (56/1028) and underestimation was 9.6% (99/1028). No factor was significantly related with overestimation. Underestimation of lymph node metastasis was related with female (p=0.020, OR 2.049), lymphovascular invasion (p&lt;0.0001, OR 11.716), positive EGFR (p=0.024, OR 2.489) and tumor size (&gt;2cm) (p=0.020, OR 2.774). Conclusions: For preoperative assessment of lymph node metastasis in early gastric cancer, MDCT and EUS showed high diagnostic accuracy. Both MDCT and EUS, female, lymphovascular invasion, positive EGFR, large tumor size (&gt;2cm) were related to underestimation of clinical N staging. We proposed that careful attention is required to choose treatment based on clinical N staging by MDCT and EUS.

The Role of Multidetector Row Computed Tomography in Biliary Tract Malignancy

Early diagnosis of biliary tract tumors is important in accurate staging, to choose the best possible treatment and improve their prognosis. Multidetector row Computed Tomography is an ideal method to evaluate patients with suspected biliary tract obstruction and thereby biliary tract malignancy. Aims and Objective: To evaluate the accuracy of Multidetector row Computed Tomography (MDCT) in evaluation of level of obstruction and to study the imaging features of various causes of biliary tract malignancy. Material and Method: MDCT of 40 patients with clinically suspicion of biliary tract obstruction were prospectively reviewed and only malignant causes were included in the study. Final diagnosis was based on endoscopic retrograde cholangiopancreatography, surgical and histopathological diagnosis. The MDCT diagnosis and final diagnosis was compared for level and imaging features of malignant lesions. Results: The sensitivity, specificity, PPV, NPV and diagnostic accuracy of MDCT in determining the level of malignant obstruction is 100%, 83.33%, 97.77%, 100%, 98%, and cause of malignant obstruction is 97.73%, 83.33%, 97.72%, 83.33%, 96%. MDCT with its high sensitivity and specificity values plays an essential role in the diagnosis of malignant tumors of biliary tract and for the evaluation of therapeutic options. Conclusion: MDCT has a vital role to play in biliary tract malignancy with its high degree of accuracy in establishing the level of obstruction and in defining the imaging features of the malignant lesions.

Diagnostic Performance of Multidetector Row Computed Tomography for Assessment of Lymph Node Metastasis in Patients with Distal Rectal Cancer

The accurate preoperative diagnosis of depth of tumor invasion and nodal status in distal rectal cancer is important because neoadjuvant chemotherapy or lateral pelvic lymph node dissection is indicated for patients with T3-T4 tumor or nodal involvement. This study aimed to determine the optimal cutoff value for predicting lymph node metastasis in patients with distal rectal cancer using multidetector row computed tomography (MDCT). The study investigated 77 patients who had undergone surgery for distal rectal cancer at a single institution between 2008 and 2011. Diagnostic performance for depth of tumor invasion and mesorectal and lateral pelvic lymph node metastases was evaluated. The optimal cutoff value was determined by receiver operating characteristic curve analysis. For predicting mesorectal and lateral pelvic lymph node metastasis, MDCT had a sensitivity of 0.36 and 0.89 and a specificity of 0.78 and 0.97, respectively. The optimal cutoff values of major and minor axes lengths for predicting mesorectal lymph node metastasis were 6.5 mm and 5.7 mm, respectively. The areas under the curve (AUCs) were 0.82 and 0.88, respectively. For predicting lateral lymph node metastasis, the optimal cutoff values were 9 mm for the major axis and 6 mm for the minor axis. Both AUCs were 1. Using MDCT, the optimal cutoff value of minor axis length for predicting mesorectal and lateral pelvic lymph node metastases in patients with distal rectal cancer was 6 mm. The accuracy of MDCT was satisfactory for predicting lateral pelvic lymph node metastasis.

The role of enhanced multi‐detector‐row computed tomography before urgent endoscopy in acute upper gastrointestinal bleeding

Multi-detector-row computed tomography (MDCT) has been reported to be a potentially useful modality for detection of the bleeding origin in patients with acute upper massive gastrointestinal (GI) bleeding. The purpose of this study is to investigate the efficacy of MDCT as a routine method for detecting the origin of acute upper GI bleeding prior to urgent endoscopy. Five hundred seventy-seven patients with acute upper GI bleeding (514 nonvariceal patients, 63 variceal patients) who underwent urgent upper GI endoscopy were retrospectively analyzed. Patients were divided into three groups: enhanced MDCT, unenhanced MDCT, and no MDCT before endoscopy. The diagnostic accuracy of MDCT for detection of the bleeding origin was evaluated, and the average procedure times needed to endoscopically identify the bleeding origin were compared between groups. Diagnostic accuracy among endoscopists was 55.3% and 14.7% for the enhanced MDCT and unenhanced MDCT groups, respectively. Among nonvariceal patients, accuracy was 50.2% in the enhanced MDCT group, which was significantly better than that in the unenhanced MDCT group (16.5%). In variceal patients, accuracy was significantly better in the enhanced MDCT group (96.4%) than in the unenhanced MDCT group (0.0%). These accuracies were similar to those achieved by expert radiologists. The average procedure time to endoscopic detection of the bleeding origin in the enhanced MDCT group was significantly faster than that in the unenhanced MDCT and no-MDCT groups. Enhanced MDCT preceding urgent endoscopy may be an effective modality for the detection of bleeding origin in patients with acute upper GI bleeding.

Pre-operative staging of rectal cancer using multi-detector row computed tomography with multiplanar reformations: single center experience.

Technical advancement in imaging has helped to stage and plan treatment modality for carcinoma rectum with still some objectives controversial. The aim of our study was to evaluate the accuracy of multidetector row computed tomography (MDCT) with multiplanar reformations in the pre-operative staging of rectal carcinoma and correlation with intraoperative and histopathologic staging of retrieved specimen with respect to the depth of tumor invasion (T-staging), lymph node metastasis (N-staging) and mesorectal fascia (MRF) involvement. The study was a prospective one and consisted of 52 patients with biopsy proved rectal carcinoma. MDCT studies were performed on a 64-slice computed tomography system. Images were reconstructed in axial, coronal and sagittal planes. MDCT findings were compared with intraoperative and pathologic (reference standard) findings. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy were assessed. The diagnostic accuracy of MDCT for T1/T2, T3 and T4 lesions was 77%, 86.5% and 100%, respectively. For perirectal lymph node metastasis (N+), the diagnostic accuracy of MDCT was 84.1%. The diagnostic accuracy of MDCT for MRF involvement was 91%. MDCT is a reliable radiological tool for local staging of rectal cancer with excellent accuracy rates for T and N-staging of rectal cancer.

A Prospective Validation Study to Diagnose Serosal Invasion and Nodal Metastases of Gastric Cancer by Multidetector-row CT

Multidetector-row CT (MDCT) may provide accurate preoperative staging of resectable gastric cancer. However, the standard methods and criteria to diagnose the T and N stages to select the patients who are good candidates for neoadjuvant chemotherapy have not been established yet. The aim of this prospective study was to evaluate the accuracy of MDCT to diagnose the serosal invasion and nodal metastases of gastric cancer. Patients who had gastric adenocarcinoma underwent MDCT scanning using a standardized method. The T and N stage were diagnosed by prespecified criteria. The analyses were performed in the patients who had cN0-2 and M0 tumors and underwent curative gastrectomy as a primary treatment. The accuracy was calculated by comparing the results of MDCT with the histopathological findings. A total of 315 patients were analyzed. The overall diagnostic accuracy (95 % confidence interval) of T staging was 71.4 % (225 of 315, 66.2-76.1). The accuracy, sensitivity, and specificity for serosal invasion were 85.7 % (81.4-89.1), 54.5 % (42.6-66.0), and 94.0 % (90.3-96.3), respectively. The false-positive rate for serosal invasion was 6.0 % (2.9-7.7). The overall diagnostic accuracy of N staging was 75.9 % (239 of 315, 70.9-80.3). The accuracy, sensitivity, and specificity for nodal metastases were 81.3 % (76.6-85.2), 46.4 % (36.8-56.3), and 96.8 % (93.5-98.4), respectively. The false-positive rate for nodal metastases was 3.2 % (1.6-6.5 %). These results suggest that MDCT provides an accurate diagnosis with high specificity and a low false-positive rate and can be used to select the patients who are candidates for preoperative chemotherapy.

Multi-detector Row Computed Tomography (MDCT) versus Endorectal Coil Magnetic Resonance Imaging (ECMRI) in Staging of Carcinoma Rectum

BACKGROUND: Rectal cancer is one of the most common tumors in industrialized countries and one of the most common malignant tumors of the gastrointestinal tract.&#x0D; OBJECTIVE: To compare the diagnostic accuracy of MDCT and ECMRI in preoperative staging of rectal cancers and correlation with intraoperative and histo-pathologic staging of resected specimen with respect to depth of tumor invasion (T-staging), lymph node metastasis (N- staging), and extra rectal spread (M-staging).&#x0D; METHODS: The study was a prospective one and consisted of 68 patients with biopsy proved rectal carcinoma. Patients were randomly selected for either of these two staging modalities (i.e., MDCT or ECMRI) using a random number table. MDCT and ECMRI findings were compared with intraoperative and histopathologic (reference standard) findings. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of each diagnostic modality were assessed.&#x0D; RESULTS: The diagnostic accuracies of MDCT and ECMRI for T1/T2 lesions were 75% and 87.5%, respectively, the difference being significant. For T3 lesions, the diagnostic accuracies of MDCT and ECMRI were 85.2% and 100%, respectively. The diagnostic accuracy of both for T4 lesions was found to be 100%. Both ECMRI and MDCT were found to be almost equally accurate and specific in detecting perirectal lymph node involvement.&#x0D; CONCLUSION: Endorectal coil MRI is superior to MDCT in local (T) staging of tumor and has overall more diagnostic accuracy, sensitivity and specificity than MDCT. ECMRI has a less tendency to under-stage the disease. However, both ECMRI and MDCT are almost equally accurate and specific in detecting perirectal lymph node involvement. JMS 2012;15(1):32-38.

Stadiazione preoperatoria locoregionale del carcinoma del colon-sigma: colonografia TC multidetettore con aria versus acqua

The authors sought to evaluate the diagnostic accuracy of multidetector-row computed tomography (MDCT) performed with two different hypodense endoluminal contrast agents for the preoperative staging of colosigmoideal cancer. Seventy consecutive patients with an endoscopically and histologically proven diagnosis of colosigmoideal cancer underwent MDCT examination. Thirty-five patients were evaluated with water MDCT colonography and the remaining 35 with air MDCT colonography. Patients were randomly assigned to the air or water groups for staging. Transverse images and multiplanar reconstructions (MPR) were retrospectively examined by two blinded expert radiologists in order to assess T and N parameters, and the results were compared with histological findings. The overall diagnostic accuracy of MDCT was 68.6% for water and 62.8% for air colonography. In the evaluation of the T parameter, the accuracy values were 88.6% for water and 80% for air colonography. In staging of the N parameter, the accuracy values were 77.1% and 74.3% for water and air MDCT colonography, respectively. MDCT examination can be proposed for the local staging of colosigmoideal cancer. Water is more accurate than air in evaluation of the T parameter, whereas the kind of endoluminal contrast material does not influence the definition of the N parameter.

Evaluation of coronary allograft vasculopathy using multi-detector row computed tomography: a systematic review

Coronary allograft vasculopathy (CAV) is a significant cause of morbidity and mortality after cardiac transplantation and requires frequent surveillance with catheter-based coronary angiography (CCA). Multi-detector row computed tomography (MDCT) has been shown to be effective in assessing atherosclerosis in native coronary arteries. This article systematically reviews the literature to determine the accuracy of MDCT in CAV assessment. An English-language literature search was performed using EMBASE, OVID, PubMed, and Cochrane Library databases. Studies that directly compared MDCT with CCA and/or IVUS for the detection of coronary artery stenosis or significant intimal thickening in cardiac transplant patients were analyzed. Data were pooled to obtain weighted sensitivities, specificities, and diagnostic accuracies. Negative and positive predictive values (NPV/PPV) were calculated. A total of seven studies with a sum of 272 patients were included in this review. There were three studies examining 16-slice MDCT and four studies looking at 64-slice MDCT in CAV. Using per-segment analysis, MDCT assessed between 91% and 96% of all coronary segments when evaluating for stenosis. Pooled estimates for sensitivity and specificity for MDCT ranged from 82% to 89% and 89% to 99%, respectively, while NPV was 99%. Per-patient analysis revealed a sensitivity of 87-100% and NPV of 96-100%. PPV was less than 50% for 64-slice MDCT in both per-segment and per-patient analysis. When compared with IVUS, MDCT had a sensitivity of 74-96% and specificity of 88-92% in assessment of intimal thickening. NPV and PPV were 80-81% and 84-98%, respectively. The high sensitivity and NPV of MDCT suggest that it may be a useful, noninvasive screening tool to rule out CAV.

Combined Imaging with Multi-Detector Row Computed Tomography and Diffusion-Weighted Imaging in the Detection of Pancreatic Cancer

Pancreatic cancer is one of the most aggressive malignant tumor types. Its prognosis is extremely poor without early detection, and an accurate diagnosis with imaging techniques is vital for any chance of long-term survival after treatment. Despite the great technical advances that have been made with various kinds of imaging equipment, detection of pancreatic cancer is unsatisfactory, and new modalities are required. Diffusion-weighted imaging (DWI) on magnetic resonance imaging (MRI) has high sensitivity and specificity for the detection of pancreatic cancer; however, it does not provide anatomic information. Quite often, the necessary spatial correlation of a high-intensity area with anatomic structures is constrained. If it becomes possible to combine the imaging technique of DWI with multi-detector row computed tomography (MDCT), such as is done with positron emission tomography (PET) and computed tomography (CT), it is expected that the early diagnostic capability will improve. The objective of this study was to introduce combined imaging with DWI and CT into clinical practice to improve the diagnosis of pancreatic cancer. In the current report, we demonstrate a clinical attempt to combine DWI on MRI with the anatomical accuracy of MDCT for two patients of pancreatic adenocarcinoma. Analysis of these two patients revealed that the combined images corresponded precisely to the operative findings. Thus, the combined imaging with DWI and MDCT is useful for the detection of the pancreatic cancer.

Diagnostic accuracy of multidetector‐row computed tomography for hilar cholangiocarcinoma

The aim of this study was to investigate the diagnostic reliability of multidetector-row computed tomography (MDCT) for the evaluation of tumor spread in hilar cholangiocarcinoma. Images obtained from a 16-detector row scanner of 22 patients were interpreted. The diagnostic accuracy of longitudinal ductal spread, vertical invasion (including hepatic parenchyma), and lymph node metastasis was assessed with reference to histopathological findings. The location of the tumor was correctly diagnosed in 95% of cases (21/22), but in five of these cases, the cut end of the intrahepatic bile duct was positive, resulting in 77% diagnostic accuracy for longitudinal spread. Among the patients with a negative bile duct surgical margin, there was a significant difference in the measurement of tumor spread between MDCT and microscopic investigation (P < 0.001). For vertical invasion, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of MDCT were 69%, 100%, 100%, and 69% for the liver parenchyma, respectively. The sensitivity, specificity, PPV, and NPV of MDCT for lymph node metastasis were 50%, 75%, 43%, and 80%, respectively. The diagnostic accuracy of MDCT for tumor location and vertical invasion was satisfactory, but ductal spread was underestimated in comparison with microscopic measurements.

Preoperative staging of gastric cancer by endoscopic ultrasonography and multidetector‐row computed tomography

The aim of this study was to determine the accuracy of endoscopic ultrasonography (EUS) and multidetector-row computed tomography (MDCT) for the locoregional staging of gastric cancer. EUS and computed tomography (CT) are valuable tools for the preoperative evaluation of gastric cancer. With the introduction of new therapeutic options and the recent improvements in CT technology, further evaluation of the diagnostic accuracy of EUS and MDCT is needed. In total, 277 patients who underwent EUS and MDCT, followed by gastrectomy or endoscopic resection at Bundang Hospital, Seoul National University, from July 2006 to April 2008, were analyzed. The results from the preoperative EUS and MDCT were compared to the postoperative pathological findings. Among the 277 patients, the overall accuracy of EUS and MDCT for T staging was 74.7% and 76.9%, respectively. Among the 141 patients with visualized primary lesions on MDCT, the overall accuracy of EUS and MDCT for T staging was 61.7% and 63.8%, respectively. The overall accuracy for N staging was 66% and 62.8%, respectively. The performance of EUS and MDCT for large lesions and lesions at the cardia and angle had significantly lower accuracy than that of other groups. For EUS, the early gastric cancer lesions with ulcerative changes had significantly lower accuracy than those without ulcerative changes. For the preoperative assessment of individual T and N staging in patients with gastric cancer, the accuracy of MDCT was close to that of EUS. Both EUS and MDCT are useful complementary modalities for the locoregional staging of gastric cancer.

Primary pan-computed tomography for blunt multiple trauma: can the whole be better than its parts?

Single-pass, whole-body computed tomography (pan-CT) was proposed in the late 1990 s as a new concept for the diagnostic work-up of severely injured patients. Since its introduction, it has led to considerable debate among clinicians and scientists, triggered by concerns about its immediate safety, questionable therapeutic advantages and exposure to radiation. However, it was recently shown that pan-CT scanning may be associated with a reduction in trauma mortality. In this article, we provide an overview of current knowledge of the value of this compelling concept. The diagnostic accuracy of multidetector row CT (MDCT) for clearing various anatomical regions in trauma patients is, at best, unclear. Little is known about the accuracy of pan-CT as a whole, which weakens statements about its effectiveness and prevents inferences about survival advantages. This last point may be explained by a stage-migration or “Will Rogers” phenomenon: Pan-CT increases injury severity by detecting lesions that would not have been recognized by conventional methods but still do not affect treatment decisions, thus artificially lowering the ratio of observed to expected deaths. In order to maintain the credibility of pan-CT technology for trauma, a rigorous, large-scale evaluation of its accuracy is required. Such an evaluation requires consensus about the definition of true and false positive and negative findings in the setting of blunt multiple trauma. In addition, triage criteria need to be refined to increase specificity and reduce the number of unnecessary scans.

Multidetector-row computed tomography (MDCT) for the diagnosis of hepatocellular carcinoma in cirrhotic candidates for liver transplantation: prevalence of radiological vascular patterns and histological correlation with liver explants

To define the prevalence of different multidetector-row computed tomography (MDCT) vascular patterns and their histopathological correlation with liver explants, and to evaluate the accuracy of MDCT for the diagnosis of hepatocellular carcinoma (HCC). We retrospectively reviewed 125 cirrhotic patients imaged by MDCT before liver transplantation. Three main vascular patterns were identified: hypervascular lesion with washout (Hyper-L-Wo), hypervascular lesion without washout (Hyper-L) and non-hypervascular lesion (Hypo-L). Radiological findings were matched with histopathology of explants. Positive predictive value (PPV) and likelihood ratio (LR) were 95% and 18.66, respectively, for Hyper-L-Wo; 45% and 0.82 for Hyper-L; and 75% and 3 for Hypo-L of 20 mm or larger. Overall accuracy of MDCT for detection and characterisation of HCC was 89% and 43%, respectively. Sensitivity of MDCT for detection and characterisation was related to the lesion size, ranging from 78% (lesion smaller than 10 mm) to 98% (larger than 20 mm) and from 9% to 64%, respectively. MDCT established the accurate stage of disease in 46% of the patients, underestimated in 52% and overestimated in 2%. In cirrhotic patients, any Hyper-L-Wo detected by MDCT can be confidently considered to be HCC. Hyper-L larger than 10 mm and Hypo-L of 20 mm or larger are at high risk of HCC. However, even using MDCT and the newest imaging protocols, imaging underestimated the diagnosis of small HCC.

Determining gastric cancer resectability by dynamic MDCT

Multi-detector row CT (MDCT) has been widely used to detect primary lesions and to evaluate TNM staging. In this study we evaluated the accuracy of dynamic MDCT in the preoperative determination of the resectability of gastric cancer. MDCT was used to image 350 cases of gastric cancer diagnosed by biopsy before surgery. MDCT findings regarding TNM staging and resectability were correlated with surgical and pathological findings. The accuracy of MDCT for staging gastric cancer was high, especially for tumour stage T1 (94.3%), lymph node stage N2 (87.3%), and for predicting distant metastases (>96.6%). When resectability was considered to be the outcome, the total accuracy of MDCT was 87.4%, sensitivity was 89.7% and specificity was 76.7%. Results showed high sensitivity for identifying peritoneal seeding (90.0%) and for predicting liver metastasis (80.0%). Dynamic enhanced MDCT is useful for TNM staging of gastric cancers and for predicting tumour respectability preoperatively.