Advent Of CT Scanning Research Articles

A study of clinical & radiological outcomes of small single enhancing lesions in CT brain - in a tertiary care hospital

Introduction Small single enhancing lesion in CT (SSECT) scan as an entity came into existence in India in early 1980, with the advent of CT scan. Tandon et al3 labeled them as intracranial tuberculomas. They identified two types of lesions based on the appearance of the lesion in the C T Scan brain. Small ring and disc lesions were called as immature tuberculomas and large lobulated lesions were called as mature tuberculomas. ATT was invariably started in these patients. Sethi et al5 & Bansal et al6 noted that these lesions disappeared spontaneously without treatment. Natarajan and Arjundas et al37 at the Institute of Neurology, Chennai also noted spontaneous disappearance of these lesions without specific treatment. The exact cause of these lesions could not be deciphered because apart from tuberculoma, cysticercus granuloma, pyogenic abscess, metastases, fungal granuloma, and glioma had been reported to cause similar appearance in CT scan brain as more centers acquired C.T. Scan facility. Hence the exact aetiology of these lesions became a subject of speculation. A significant breakthrough came in 1987 at Vellore 8 when stereo tactic biopsy was done on 15 patients with SSECT. Most of the lesions were identified as cysticercus and none were of tuberculous etiology. Bhargava and Tandon in 1988 and Wadia, Makhalle in 19863,4, found evidence of tuberculous lesions in histopathology. However they failed in defining the size of the lesion. Rajshekhar et al8 then defined a small single lesion based on CT appearance as “A solitary, contrast-enhancing lesion of less than 20- mm diameter lesion without severe cerebral edema (no midline shift)”.this definition is often equated to cysticercous granuloma but there is every possibility that these lesions could be a tuberculoma.

Giant Inguinoscrotal hernia -a radiological perspective

Inguinal hernia is a common surgical disease. Giant inguinoscrotal hernias are more unusual and impose significant impact on quality of life including difficulty with mobility, scrotal skin ulceration and bowel obstruction. Besides it is more challenging in terms of surgical management. Diagnosis of giant inguinoscrotal hernia is straight forward on clinical examination. Nevertheless, with the advent of CT scan, pre-operative contrast-enhanced CT scan is useful for ascertaining the hernia contents, its configuration and measuring the neck of hernia. We report a case of a patient with extremely huge irreducible right giant inguinoscrotal hernias.

Primary Results From MATCH: A Randomised Controlled Trial in Primary Aldosteronism

Abstract Primary aldosteronism (PA) is now considered the sole, often curable, cause of hypertension in 5-10% of patients. Yet there has been only one RCT, and practice has changed little since the advent of CT scanning. Adrenal vein sampling (AVS) and adrenalectomy remain the standard, invasive interventions, leading to a 50% reduction in pill count as the average clinical improvement. Study Design In MATCH (Is Metomidate PET-CT superior to Adrenal vein sampling in predicting ouTCome from adrenalectomy in patients with primary Hyperaldosteronism), 142 patients, mean age 52, 32% female, 32% of African ancestry, 46% hypokalemic, had both AVS and 11C-metomidate PET CT (MTO) in random order, and were referred for surgery if aldosterone/cortisol ratio differed >4-fold between adequately cannulated adrenal veins, and/or SUVmax on MTO was >1.25 higher, in a definite tumour, than the opposite adrenal. The primary outcome is the proportion of patients in whom adrenalectomy achieved complete or partial biochemical or clinical cure, analysed hierarchically using PASO criteria.1 Anticipating ~50% incidence of unilateral PA, MATCH is powered to detect 25% superiority of MTO vs AVS, or non-inferiority at a lower-bound CI of -17%. Secondary outcomes include non-randomised comparison of outcomes between unilateral and bilateral PA; prediction of clinical outcome from the home BP (12 readings over 3 days) before and after starting spironolactone 100 mg od for 4 weeks; quality-of-life assessments; and analyses, by RNAseq, of genotype and transcriptomes of 56 of the CYP11B2-positive tumors, correlated with ethnicity and outcomes. Results: The analysis set is 75 patients who, on 31 Dec 2020, had undergone adrenalectomy with > 6 months follow-up. 67 patients (89%) had complete biochemical cure following PASO criteria,1 and 63 (84%) had complete or partial clinical cure. In 39 of the surgical patients, only one of MTO or AVS was scored as high-probability using criteria above. This score was confirmed at the multi-centre, Multi-Disciplinary Team (MDT) meeting which reviewed all MTO scans without knowledge of AVS. In the primary analysis, comparing accuracy of MTO and AVS by McNemar test, the 39 discordant results were allocated as a win to the positive investigation, if the patient was cured, or to the negative investigation, if not cured. 50/56 CYP11B2-positive tumors had a known mutation; the frequency was CACNA1D>KCNJ5>ATP1A1>ATP2B3>CTNNB1>GNAQ>CLCN2, differing between patients whose hypertension was completely or partially cured. Two other tumors had novel gene mutations. Several RNAseq transcripts varied with genotype and outcome, including some encoding measurable, secreted proteins. Full primary and secondary outcomes will be presented. 1. Williams TA, et al. Lancet Diabetes Endocrinol. 2017;5:689-699

Rates of colorectal cancer detection in screening colonoscopy post appendicectomy in patients 50 years and over.

IntroductionAcute appendicitis in older adults is relatively uncommon and could be the first presentation of an underlying colorectal carcinoma. Colonoscopy in these individuals affords the opportunity for earlier diagnosis and treatment. The finding of increased rates of colorectal cancer (CRC) with older patients who have had appendicitis was supported by a number of small studies and case reports in the early 1980s.With the advent of CT scanning and laparoscopic appendicectomy, increased ability to visualize the caecum has been achieved.PurposeA retrospective 12-month study of all patients presenting with acute appendicitis aged 50 years and over from 1st May 2017 to 31st May 2018, and review of post operative screening colonoscopy findings.ResultsForty-three patients met inclusion criteria. The patients’ median age was 62 years (range 50–85 years). 47% of the patients were male. 86% of patients had abdominal CT scans prior to surgery with acute appendicitis visualized in 97% of these cases. Acute appendicitis was found in 100% of cases with no clinical suggestion of CRC operatively or pathologically. 46% of patients had pertinent findings on colonoscopy. This included a malignant obstructing tumour at the hepatic flexure and a tubular adenoma in the transverse colon in a second patient. The remaining findings in this cohort of patients included diverticular disease and benign polyps.ConclusionDespite the advancement in visualization of anatomy with CT scan and laparoscopic appendicectomy there is still a role for screening colonoscopy in patients greater than 50 years of age with appendicitis particularly if they have associated bowel symptoms or risk factors for CRC.

Case Report of A Neonate with Congenital Superior Lumbar Hernia

Background: congenital lumbar hernias are rare. It constitutes to 20% of all lumbar hernias which is less than 1.5% of all the abdominal wall hernias. There are no more than 50 cases reported in literature till date. We report a case of congenital lumbar hernia in a preterm female neonate located on the superior lumbar triangle. Case: a preterm female neonate was born, presented with a mass at the right lumbar area with a size of 8x8 cm, round, movable with bluish discoloration, well delineated border, no visible veins, increases in size when the patient cries, and reduces easily. Ultrasonography revealed a right posterolateral abdominal mass measuring 4.2x2.88x1.59 cm. CT scan revealed right posterolateral mid-abdominal wall hernia with protrusion and no intestinal obstruction. The patient underwent exploratory laparotomy, where hernia defect was about 2 cm in diameter in the right posterior abdominal wall, pararenal area, and just below the 12th rib. The ascending colon and parts of the ileum were adherent inside the hernia defect at the right lumbar area. Primary closure of the hernia defect was done by suturing the psoas major and the transversus abdominis and internal oblique muscles. The postoperative, patient had good bowel movement, no abdominal distention or vomiting. Feeding was then started and well tolerated. After two weeks follow-up, there were no signs or symptoms of intestinal obstruction such as nausea and vomiting. Patient is being fed regularly and passes bowel movement almost 2-3 times a day. Conclusion: appropriate diagnosis of the extent of the defect through the advent of CT scan and early detection of other congenital anomalies should be routine in these cases. Open surgery with primary repair is almost always done but we can consider laparoscopic approach in the future with uncomplicated lumbar hernias.

Electromagnetic Navigation Bronchoscopy

OBJECTIVE: Suspicious pulmonary nodules have become a more common finding since the advent of CT scans as a screening method for lung cancer. The challenge is to find a safer, practical and more accurate way to diagnose peripheral nodules and lesions while minimizing harm to the patient. Electromagnetic Navigation Bronchoscopy (ENB) is a cutting edge technology that enables pulmonologists to precisely target small and difficult to reach peripheral pulmonary nodules by using technology similar to a global positioning system (GPS).This study describes our experience in using ENB with Endobronchial ultrasound (EBUS) as a diagnostic tool on patients suspected of lung malignancy. MATERIALS AND METHODS: A retrospective analysis was conducted for 33 patients between November 2014 and November 2015 at our institution. Yield was determined by attaining final diagnosis from tissue analysis of every patient who underwent the ENB and EBUS procedure for suspected lung malignancy. Patients with no definite diagnosis were referred to surgery for further examination. Intraoperative and postoperative complications were recorded. RESULTS: The ENB and EBUS procedure was completed in all 33 subjects on lung nodules measuring from 2 to 108mm. The patients were 67% (22) male, 33% (11) female, 88% (29) Asian, with a mean age of 61 years old. Lung nodules were located in the upper lobe (52%), lower lobe (43%) and middle lobe (5%). Lymph node involvement was present in 33% of cases. Of the patients in the study, 26 cases (79%) were accurately diagnosed using ENB and EBUS, 6 cases (18%) were referred to surgery and 1 patient (3%) refused further investigation. No bleeding or pneumothorax complications were reported. CONCLUSION: ENB is an effective, accurate and a novel method that provides real time directions toward lung lesions and nodules. This tool allows flexibility that aids biopsy of hard to reach areas, and attains adequate tissue samples. This instrument compliments other bronchoscopic methods such as EBUS.

Inferring the properties of the pterosaur wing membrane

Abstract The preservation of the wing membrane of pterosaurs is very poor and the available fossil evidence does not allow its properties to be reconstructed. In contrast, the fossil record for the wing bones is relatively good and the advent of CT scanning has made it possible to build high-fidelity structural models of the wing spar. The bending strength of the wing spar of a 6 m wingspan ornithocheirid pterosaur is used to infer the likely membrane tension. The tensions required to suppress aeroelastic flutter and to minimize ballooning of the membrane under flight loads are also estimated. All three estimates are of similar magnitude and imply that the membrane must have contained high-modulus material, supporting the view that the reinforcing aktinofibrils were keratinous.

Reverse and pseudoreverse cortical sign in thoracolumbar burst fracture: radiologic description and distinction—a propos of three cases

In thoracolumbar burst fracture the "reverse cortical sign" is a known entity that corresponds to a fragment of the posterior wall that has been flipped 180 degrees with the cancellous surface of the fragment facing posteriorly in the canal and the cortical surface (posterior wall) facing anteriorly. The identification of such reverse cortical fragment is crucial as ligamentotaxis is classically contraindicated as the posterior longitudinal ligament is ruptured. Recognition of such a flipped cortical fragment has relied so far on the axial CT. The advent of CT scans with sagittal reconstruction has allowed us to better describe such entities that have received little attention in the literature. The goal of this report was therefore to describe the appearance of the reverse cortical sign and its likes as they can appear on axial CT scans, sagittal reconstructions and MRI. During 1-year practice at our institution we had to treat three patients with thoracolumbar burst fracture associated with what looked like a reverse cortical sign on the axial CT scans. Further analysis of the sagittal reconstruction CT could differentiate the true reverse cortical sign from a new entity that we coined "the pseudoreverse cortical sign" as observed in two out of the three cases. In the pseudo reverse cortical sign what appears to be a flipped piece of posterior vertebral body is actually part of the superior or inferior endplate that is depressed into the comminuted vertebral body. In such cases the posterior longitudinal ligament appears to be in continuity and therefore such fracture can theoretically be treated with posterior ligamentotaxis as evidenced in one of our case. Careful analysis of the CT scan and specifically the sagittal reconstruction and MRI can differentiate two separate entities that may correspond to a different severity injury.

Endoscopic removal of malignant melanoma of the nasal cavity

Mucosal melanoma of the nasal cavity is a rare tumour. With the extended used of nasal endoscopes and advent of CT scan, early diagnosis of nasal melanoma and accurate assessment of its extent is possible. This allows endoscopic excision of tumour, avoiding unnecessary removal of healthy tissue. Here we present a case where endonasal endoscopic excision with postoperative radiotherapy achieved disease free survival till follow up (nearly 2 years).

Endoscopic removal of ethmoidal foreign body

Foreign bodies in the ethmoidal sinuses pose a challenge due to the complex anatomy of these paranasal sinuses and due to the close proximity of important structures like the orbits, the cribriform plate, dura, and adjacent important structures like arteries and nerves. An additional difficulty lies in cases of blast injuries, as they usually cause destruction of soft tissue and bone, thereby distorting the local anatomy. With the advent of CT scans, assessment has improved considerably [1]. Nasal endoscopes have improved in the last two decades with better rod lenses and fibreoptics. These have enabled us to see the intranasal structures better and led to endoscopic guided surgery such as functional endoscopic sinus surgery (FESS). Once familiar with this approach, surgeons could confidently attempt to carry out other procedures endoscopically, like the removal of foreign bodies [2]. Though not yet a common procedure, endoscopic removal has been documented for foreign bodies of the ethmoid [3] and more frequently of the maxillary sinus [4].

Computerised tomography in the staging of Hodgkin's disease and non-Hodgkin's lymphoma.

The last 25 years have seen major changes in the imaging investigation and subsequent management of patients with Hodgkin's disease (HD) and non-Hodgkin's lymphoma (NHL); accurate staging is vital for prognostication and treatment in both, and particularly in HD. The choice of imaging modality for staging depends on its accuracy, impact on clinical decision-making, and availability. Modern CT scanners fulfil most of the desired criteria. The advent of CT scanning, along with the development of ever more effective chemotherapeutic regimens, has resulted in the virtual demise of bipedal lymphangiography (LAG) as a staging tool in patients with lymphoma. It has rendered superfluous a battery of other tests that were in routine use. This contribution reviews the evidence for the use of CT in preference to LAG. CT accurately depicts nodal enlargement above and below the diaphragm, has variable sensitivity for intra-abdominal visceral involvement and is generally outstanding in depicting the extent of disease, especially extranodal extension. Despite the advances in CT technology, there are still areas where CT performs less well (e.g. disease in normal-sized lymph nodes, splenic and bone marrow infiltration). The influence of technical factors, such as the use of intravenous contrast medium, is discussed. In some instances, CT is not the imaging modality of choice and the place of newer techniques such as MRI and endoscopic ultrasound will be reviewed.

Malpractice considerations in endoscopic sinus surgery

Operations on the nose and sinuses result in the largest number of malpractice lawsuits and the highest indemnity payouts for otolaryngologic procedures. The advent of CT scanning and endoscopic technology has increased the number of such operations performed. Directly related to this has been an in

Lipomas colorretais: correlação anatomoclínica de 29 casos

To evaluate the incidence of colorectal lipomas, its diagnostic methodology and therapeutic management.The reviewed necropsies performed in a six years period and the patients' records from colorectal lipomas cases treated up to 1965 until 1993 were studied enhancing the clinical presentation, their diagnosis and therapy. The 29 cases of submucosal intestinal lipomas were disposed in three groups. The first group with ten patients lipomas were detected at necropsies. The second group with 11 symptomatic patients and group three with 8 asymptomatic patients which lipomas were discovered accidentally in surgical specimens resected due to neoplasm or in the course of diagnostical procedure.0.56% of patients who were submitted to necropsy disclosed colorectal lipomas situated preferentially in right colon and in female. Enterourhage was the most often symptom (54.5%) in the group two, followed by cramp abdominal pain. Intussusception appeared in three patients (27.3%). Contrary to the medical literature, the symptomatic lipomas were preferentially situated in left colon and its mean size was 6.1 cm. The diagnosis were performed through opaque enema and more recently by colofibroscopy and CT scan. Resections were performed in all patients: five were enlarged, three were local and other three were endoscopic resections. Multiple lipomas were detected in 30% of patients who were submitted to necropsy and in 25% of asymptomatic group. In both groups no tumor was larger than 2.0 cm of diameter.Colorectal lipomas are rare in both clinical presentation and necropsy. Before the advent of CT scan and colofibroscopy the majority of the patients were submitted to wide resections, in the assumption of malignancy. Afterwards the endoscopic polipectomy and local resection became our preferential management.

Since the advent of CT scanning, what role does the contrast enema examination play in the diagnosis of acute diverticulitis?

Since the advent of CT scanning, what role does the contrast enema examination play in the diagnosis of acute diverticulitis?S W Trenkner and W M ThompsonAudio Available | Share

Patterns of early treatment failure in non-metastatic nasopharyngeal carcinoma: A study based on CT scanning

Six hundred and twenty-eight patients with non-metastatic nasopharyngeal carcinoma were staged by CT scanning and treated with radical locoregional radiotherapy. Parapharyngeal boost radiation for bulky parapharyngeal involvement, neoadjuvant chemotherapy for bulky nodal metastases, and intracavitary 192Ir treatment for local persistence of tumour after external radiotherapy were also used as appropriate. Forty-eight patients had Ho's (1978) Stage I disease (7.6%), 167 Stage II (26.6%), 312 Stage III (49.7%) and 101 Stage IV (16.1%). At 2 years after treatment, 185 patients (29.5%) had developed recurrence; 112 had distant metastases (60.5%), and 75 had local failure (40.5%). Eighty-three patients had developed distant metastases alone, 73 patients locoregional failure alone and 29 patients had both locoregional and metastatic failure The overall 2-year actuarial distant and local failure rates were 18.4% and 12.7% respectively. Distant metastasis is the major form of treatment failure which limits early survival. Seventy-four per cent of distant metastases were not associated with locoregional recurrence and had probably arisen from pre-existing occult foci. Our data also suggest that the advent of CT scanning has improved local tumour delineation and radiotherapy planning, and hence local control.

Brain tumours in infants. Preferred treatment options.

Since the advent of CT scan and MRI, the diagnosis of neonatal infantile brain tumours and related diseases is more easily accomplished; their rarity is reflected in the small number of cases reported. Astrocytomas and teratomas are the most common oncotypes in infants and particularly in neonates. Surgical mortality rates are not high and have decreased because of the advances of diagnosis and improvements in treatment. However, the survival rates are disappointing. Follow-up shows little improvement in last 2 decades. Adjuvant therapy is still a problem; radiotherapy gives a small percentage of favourable later neuropsychological results. Postoperative chemotherapy added to maximal surgical resection and delayed irradiation may prolong survival with only minimal short term neurotoxicity in very young children with malignant tumours. Different protocols of chemotherapy are suggested but still not definitely accepted. Radical surgery seems to have a higher chance of success in neonates than infants and remains the less aggressive means; in low grade gliomas after total removal it may be preferable to perform a second operation if the tumour recurs and withhold irradiation and chemotherapy until after 3 years of age.

Surgical experiences with giant intracranial aneurysms.

The common method of presentation of intracranial aneurysms is at the time of their rupture (with subarachnoid haemorrhage) or on the occasion of their compression of neighbouring structures. While giant aneurysms may occasionally present with subarachnoid haemorrhage, their more common methods of presentation are due to their space occupying and neighbourhood effects. Giant aneurysms are commonly defined as those with a diameter larger than 2.5 cm. Previously this diameter was assessed either by arteriography, so that size meant internal diameter, or by the displacement of surrounding structures, as for example, small perforating vessels, which could be attributed positively to the presence of a larger mass. Before CT scanning however, the factor of a very considerable larger aneurysm, partly occluded by clot could occasionally cause unexpected operative difficulty. The advent of CT scan and now especially MR imaging has made the prediction of the size of the aneurysm much easier and the extent of the intra-aneurysmal clot also clearly definable. This paper describes one surgeon's experience with 64 giant cerebral aneurysms operated on in the last 10 years (Table 1). It has emerged from this experience that the most satisfactory method of handling the lesion is to remove the intra-aneurysmal clot and clip the neck of the aneurysm, and the steps necessary to secure this laudable design from the burden of the paper.

Renal Angiomyolipoma: Report of 24 Cases

A series of 24 patients with renal angiomyolipoma was reviewed. Their ages ranged from 10 to 70 years (average 41). Four cases were associated with tuberous sclerosis, 1 with spinal neurilemmoma, 1 with transitional cell carcinoma and another with renal tuberculosis. The presenting symptoms in decreasing frequencies were flank pain, mass, haematuria, fever, syncope and respiratory distress. Although it has often been said that angiomyolipomas associated with tuberous sclerosis are small and asymptomatic, all 4 such patients in this study had large symptomatic tumours. Before the advent of CT scan and ultrasonography, the pre-operative diagnostic rate for cases unassociated with tuberous sclerosis was 10% (1/10). With the combined use of these 2 modalities, the diagnostic rate increased to 60% (6/10). Most patients in this series were treated with nephrectomy. However, equally good outcomes occurred in 2 patients who received partial nephrectomies. Pre-operative diagnosis now makes it possible to consider more conservative management.

SUBDURAL FLUID COLLECTION

Since the advent of CT scan, the investigation of intracranial lesions has been easy and accurate. With the improvement of diagnostic ability, subdural fluid collection (SFC) has also been detected frequently after head injuries and neurosurgical operations.The clinical symptoms caused by SFC are mild in most patients and most cases of SFC disappear spontaneously as shown by repeated CT scan. Therefore the indications for surgical treatment of SFC should be limited.CT scan has newly revealed that some cases of SFC develop to chronic subdural hematoma (CSH). The clinical significance of SFC is that it can be a precursor of CSH. The factors related to development of CSH from SFC are not sufficiently known. Further studies are thus needed to clarify these factors and moreover to prevent progression to CSH from SFC.

CT demonstration of optic canal fractures.

Traumatic blindness is a well recognized entity with a guarded prognosis. Previous studies have variously reported the incidence of concomitant optic canal fractures and response to surgical therapy. With the advent of CT scanning, a new technique for study of these severely injured patients has become available. Over a period of 20 months, optic foramen fractures were demonstrated in 10 such patients using finely collimated, high-resolution CT scans. Fractures were easily classified by location, relation to the optic nerve assessed, and associated facial injuries imaged. The technique is easy, rapid, and superior to polytomography in this setting. Possible implications for therapy are discussed.