Contrast-enhanced Computed Tomography Findings Research Articles

Retrospective evaluation of venous phase contrast-enhanced computed tomography images in patients who developed pancreatic adenocarcinomas after treatment for nonpancreatic primary cancer.

Objectives:To clarify venous phase contrast-enhanced CT findings in early pancreatic adenocarcinomas by retrospectively evaluating CT images of pancreatic adenocarcinomas that developed during follow-up after treatment for non-pancreatic cancers.Methods:The study cohort comprised six patients who developed pancreatic adenocarcinomas between April 2005 and April 2020 during follow-up after treatment for non-pancreatic primary cancers. Two radiologists retrospectively evaluated CT images and reached consensus on previously reported CT findings that were suggestive of small pancreatic adenocarcinomas; namely pancreatic duct interruption and dilatation, pancreatic parenchymal atrophy, focal hypoattenuated areas, and appearance of cystic lesions. Time intervals between the first CT with these suggestive findings and the latest pre-operative CT were recorded. Doubling times were calculated in patients with hypoattenuated areas on initial CT scans.Results:Small (<10 mm) focal hypoattenuated areas with (n = 2) or without rim enhancement (n = 1) were identified on initial CT images of three patients. Pancreatic duct interruption and dilatation, pancreatic parenchymal atrophy, and cystic lesion were identified in two, one and one patient, respectively. Time intervals between initial and latest preoperative CT examination were 6–19 months (median, 14.5 months). Tumor doubling time according to CT findings was calculated as 46–407 days (median 106 days).Conclusion:Venous phase contrast-enhanced CT can provide findings that are suggestive of early pancreatic adenocarcinoma. Pancreatic phase contrast-enhanced CT should therefore be performed in patients with such findings with the aim of early detection of pancreatic adenocarcinoma.Advances in knowledge:Pancreatic adenocarcinoma can develop subsequently in patients with non-pancreatic malignancies. Patients with non-pancreatic cancers are often followed up with monophasic contrast-enhanced CT in venous phase timing. Venous phase contrast-enhanced CT can provide some findings suggestive of early pancreatic adenocarcinoma. Knowledge of these findings is important for early detection of pancreatic adenocarcinoma.

Ovarian metastases of ileal neuroendocrine tumor

A 55-year-old, menopausal woman with history of breast carcinoma was referred for recurrent abdominal pain without diarrhea. Physical examination, routine biological investigation, and serum CA15-3 were normal. Abdominal contrast-enhanced computed tomography (CT) found a 15-mm ileal hyper-vascularized lesion with mild intestinal dilation and a mesenteric mass of about 20 mm. Both ovaries were moderately enlarged without radiological overt signs of malignancy. CT findings were consistent with ileal neuroendocrine tumor (ileal-NET) with mesenteric invasion. Serum value of chromogranin A was normal. 18F-Fluorodihydroxyphenylalanine (18F-FDOPA) positron emission tomography (PET)/CT was added to the preoperative work-up 1 Addeo P. Poncet G. Goichot B. et al. The added diagnostic value of 18F-fluorodihydroxyphenylalanine PET/CT in the preoperative work-up of small bowel neuroendocrine tumors. J Gastrointest Surg. 2017; 22: 722-730 Crossref PubMed Scopus (7) Google Scholar and distinctly identified the primary ileal-NET with the mesenteric involvement. Moreover, intense and pathological 18F-FDOPA uptake was shown in both ovaries and 1 peritoneal nodule of a few millimeters in the Douglas space (Fig 1, A), suggesting ovarian metastases with peritoneal carcinomatosis. Surgical exploration found the primary tumor and the mesenteric lesion that were removed by a 20-cm ileal resection and mesenteric lymphadenectomy. Intervention was completed by bilateral salpingo-oophorectomy, omentectomy, and multiple peritoneal biopsies (Fig 1, B). Postoperative course was uneventful, and pathology confirmed a 20-mm, well-differentiated grade-2 ileal-NET (Ki-67: 4%) with mesenteric invasion, ovarian bilateral spread, and pelvic peritoneal metastases as small as a few millimeters in size (pT4N2M1, UICC 2016).

Feasibility of rapid magnetic resonance imaging (rMRI) for the emergency evaluation of suspected pediatric orbital cellulitis

To determine the feasibility of noncontrast rapid magnetic resonance imaging (rMRI), compared with traditional contrast-enhanced computed tomography (CT) in assessing pediatric emergency department patients with suspected orbital cellulitis or orbital abscess. All subjects <19years of age who presented emergently with suspected orbital cellulitis from July 1, 2017, to July 31, 2019, were included. Participants received both the standard contrast orbital CT, if deemed necessary, with the addition of the noncontrast rMRI after informed consent was obtained. No sedation was used for either examination. All clinical decisions were based on CT findings; rMRI was interpreted within 24hours of the visit. Three pediatric radiologists, with 8-21years' experience of pediatric neuroradiology, interpreted the rMRI, masked to the CT and clinical results. Results were analyzed for interobserver bias. A total of 14 patients were enrolled during the study period. Mean age was 5.9years (range, 0.33-13). Of the 14 patients, 13 (93%) were able to complete the rMRI at 1.5 and 3T; 1 patient (1.67years of age) was unable to complete the rMRI (no images obtained). Of the 26 unilateral orbital units assessed, 3 were positive for retroseptal orbital cellulitis by CT and were diagnosed correctly by rMRI. Interobserver agreement was 100% in detecting presence or absence of retroseptal cellulitis. CT and rMRI findings were concordant in 100% of cases in differentiating preseptal vs orbital cellulitis. Kappa statistics for three-category ratings by three raters for right eye/orbit was 0.921 and for left eye/orbit was 0.9288, suggesting almost perfect agreement. Concordance correlation coefficients were 0.938 for the right eye and 0.955 for the left eye. Noncontrast rMRI orbits showed findings concordant in all cases with contrast-enhanced CT for differentiating preseptal cellulitis from orbital cellulitis.

S3070 Severity of Biliary Pancreatitis in Hispanics vs Non-Hispanics: Are There Any Differences?

INTRODUCTION: Biliary pancreatitis manifests as pancreatic inflammation due to ductal obstruction by a stone at the sphincter of Oddi. Often presenting as acute-onset abdominal pain with elevated biochemical markers, it can be a life-threatening disease requiring urgent evaluation. Contrast-enhanced computed tomography (CT) identifies the presence and extent of pancreatitis necrosis, and the CT Severity Index (CTSI) is a reliable predictor of severity and mortality of acute biliary pancreatitis. Mortality due to biliary pancreatitis ranges from 3% in patients with interstitial edematous pancreatitis to 17% in those who develop pancreatic necrosis, demonstrating the need for early identification and intervention. This study compared the severity of disease in Hispanic and non-Hispanic patients based on the CTSI as well as the Revised Atlanta Classification for Acute Pancreatitis. METHODS: A retrospective analysis of 303 biliary pancreatitis cases in patients aged 18-80 years from 2012 to 2019 were reviewed. Initial CT findings were standardized by a single reader. Patients were excluded if they did not have a diagnosis of biliary pancreatitis or an initial CT scan on admission. Data was analyzed with R, using univariate and multivariable logistic regression and Fisher’s exact test. RESULTS: 185 patients (average age 53.5 years) were Hispanic, and 118 (average age 49 years) were non-Hispanic. 21/185 (11.4%) patients in the Hispanic group presented with a fluid collection on initial CT versus 19/118 (16.1%) non-Hispanic patients (P = 0.309). 9/185 (4.9%) Hispanics had an acute necrotic collection (ANC), compared to 6/118 (5.1%) non-Hispanics (P = 0.44). 8/185 (4.3%) Hispanics had an acute peripancreatic fluid collection (APFC) associated with interstitial edematous pancreatitis, compared to 10/118 (8.5%) non-Hispanics. 5 total patients presented with a pancreatic pseudocyst, of which 4 were Hispanic. The average CTSI score was 2.14 +/- 1.96 for non-Hispanics and 1.82 +/- 1.76 (P = 0.132) for Hispanics. CONCLUSION: No statistical differences were noted in severity of biliary pancreatitis based on imaging evaluation among the two groups. The absolute difference of patients with pancreatic pseudocyst suggests that Hispanics may have stayed home longer between the onset of symptoms and hospital admission. This is the first study to classify ethnic differences in severity based on CT imaging. Larger cohort population studies are necessary to determine if statistically significant differences are present or not.Table 1.: Patient DemographicsTable 2.: Presence/Type of Fluid Collection on CT Scan and CTSI in Hispanics versus Non-Hispanics

Contrast-enhanced ultrasound for the preoperative assessment of laryngeal carcinoma: a preliminary study.

Contrast-enhanced ultrasound (CEUS) is considered an attractive imaging technique to evaluate tumor microcirculation. However, the validity of CEUS for assessing laryngeal carcinoma is unclear. To compare the performance of CEUS with conventional US and contrast-enhanced computed tomography (CECT) in the diagnosis and preoperative T-staging of laryngeal carcinoma. Forty-one consecutive patients with laryngeal carcinoma underwent conventional high-frequency US, CEUS, and CECT before surgery. The CEUS characteristics of laryngeal carcinoma were recorded. The imaging findings of CEUS and conventional US were compared with CECT findings and the postoperative pathological examination. CEUS showed hyperenhancement in 38 cases and isoenhancement in three cases. Homogeneous distribution of contrast agent was found in 20 cases and heterogeneous distribution in 21 cases, of which 16 cases showed local perfusion defects. In the enhanced phase, rapid entry was observed in 37 cases, synchronous entry was observed in two cases, and slow entry was observed in two cases. Rapid exit was observed in 25 cases and slow exit was observed in 16 cases. The pretherapeutic T-staging accuracy was not significantly different between conventional US, CEUS, and CECT (P ≥ 0.500). A high sensitivity and specificity were achieved by CEUS in the evaluation of involvement of thyroid cartilage. Compared with conventional US and CECT, CEUS has a reliable initial T-staging accuracy and diagnostic properties for detecting laryngeal cartilage invasion.

Detection of Coalescent Acute Mastoiditis on MRI in Comparison with CT

PurposeCurrent imaging standard for acute mastoiditis (AM) is contrast-enhanced computed tomography (CT), revealing inflammation-induced bone destruction, whereas magnetic resonance imaging (MRI) outperforms CT in detecting intracranial infection. Our aim was to compare the diagnostic performance of MRI with CT in detecting coalescent AM and see to which extent MRI alone would suffice to diagnose or rule out this condition.MethodsThe MR images of 32 patients with AM were retrospectively analyzed. Bone destruction was evaluated from T2 turbo spin echo (TSE) and T1 Gd magnetization-prepared rapid acquisition with gradient echo (MPRAGE) images. Intramastoid enhancement and diffusion restriction were evaluated subjectively and intramastoid apparent diffusion coefficient (ADC) values were measured. The MRI findings were compared with contrast-enhanced CT findings of the same patients within 48 h of the MR scan.ResultsDepending on the anatomical subsite, MRI detected definite bone defects with a sensitivity of 100% and a specificity of 54–82%. Exception was the inner cortical table where sensitivity was only 14% and specificity was 76%. Sensitivity for general coalescent mastoiditis remained 100% due to multiple coexisting lesions. The absence of intense enhancement and non-restricted diffusion had a high negative predictive value for coalescent mastoiditis: an intramastoid ADC above 1.2 × 10−3 mm2/s excluded coalescent mastoiditis with a negative predictive value of 92%.ConclusionThe MRI did not miss coalescent mastoiditis but was inferior to CT in direct estimation of bone defects. When enhancement and diffusion characteristics are also considered, MRI enables dividing patients into low, intermediate and high-risk categories with respect to coalescent mastoiditis, where only the intermediate risk group is likely to benefit from additional CT.

Left omental artery bleeding in two patients with segmental arterial mediolysis successfully isolated with coil embolization

BackgroundSegmental arterial mediolysis (SAM) is a rare, nonatherosclerotic, noninflammatory arteriopathy of unknown etiology, rarely involving omental artery (OA). No case reports have described left OA bleeding successfully treated with transarterial embolization (TAE) with coils. This report describes two cases of SAM-affected left OA bleeding successfully embolized using isolation technique with coils, recognizing the potential for the greater omentum to have arterial collateral network between OAs.Case presentationCase 1.A 55-year-old male with no significant past medical history presented with an acute abdomen. Contrast-enhanced computed tomography (CT) revealed possible hemorrhagic ascites involving the left portion of the greater omentum and dilated, stenotic change of the left OA with a possible hematoma. SAM-associated left OA bleeding was suspected. Given its acute-angled branching from a splenic artery or branch and long, tortuous catheter-trajectory, we used a triaxial catheter system. Left OA angiography revealed the proximal dilated, stenotic change and a distal pseudoaneurysm. Isolation was successfully performed with coils. Because he had no abdominal pain or progressive anemia, he was discharged on hospital day 5. Neither recurrence nor new SAM-associated findings were observed during two-years of follow-up.Case 2.A 60-year-old-man with no significant past medical history presented with an acute abdomen. CT revealed similar finding as Case 1. SAM-associated left OA bleeding was suspected. Left OA angiography revealed proximal dilated, stenotic change with distal occlusion. Despite having no signs of active bleeding, review of the CT and angiography findings suggested the left OA as the bleeding site. Given proximal embolization at this point could lead to incomplete hemostasis or rebleeding via the arterial collateral network between OAs, an attempt was made to navigate the microcatheter into the distal side beyond the occlusion. Distal left OA angiography confirmed that the distal OA over the occlusion was intact and directly communicated with a right OA arising from right gastroepiploic artery. The SAM-associated lesion was successfully isolated with coils. Because he had no abdominal pain or progressive anemia, he was transported to another hospital on hospital day 3. Neither recurrence nor new SAM-associated findings were observed during two-years follow-up.ConclusionSAM can involve left OA and be controlled using an isolation technique with coils.

Glomus Tumor of the Duodenum

Glomus tumor is a benign tumor derived from the vascular wall of the arteriovenous anastomosis complex. Glomus tumors in the gastrointestinal tract are rare, especially those in the duodenum. Most gastrointestinal glomus tumors are found incidentally on endoscopy during routine health checkup and sometimes because of bleeding. We experienced a case of duodenal glomus tumor diagnosed after surgical resection of an incidental subepithelial tumor in the duodenum. Herein, we report the characteristic endoscopic ultrasonography, contrast-enhanced CT, and histopathological findings of duodenal glomus tumor.

Dynamic Contrast-Enhanced Computed Tomography Findings that may Predict Poorly-Differentiated Hepatocellular Carcinoma Prior to Treatment

Objective: To identify CT findings that predict poorly-differentiated hepatocellular carcinoma (p-HCC).Methods: This retrospective study included pathologically proven HCC patients during January 2010 to December 2017 who underwent dynamic contrast-enhanced computed tomography (CT) imaging within 12 weeks before the pathological diagnosis. CT findings were reviewed and graded by consensus opinion of two abdominal radiologists. The relationship between imaging findings and histological differentiation of HCC was analyzed using chi-square test. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy for diagnosis of p-HCC were calculated.Results: Of 200 HCCs during the study period, 18 were well-differentiated, 170 were moderately-differentiated, and 12 were poorly differentiated. Irregular rim enhancement in arterial phase (p&lt;0.001) and presence of lymphadenopathy (p=0.003) were both statistically significantly different among the three types of histological differentiation of HCC. Sensitivity, specificity, PPV, NPV, and accuracy for prediction of p-HCC by the presence of irregular rim enhancement in arterial phase and lymphadenopathy were 58.3%, 97.3%, 58.3%, 97.3%, and 95%, and 50%, 88.8%, 22.2%, 96.5%, and 86.5% - all respectively.Conclusion: The presence of irregular rim enhancement in arterial phase and lymphadenopathy are potentially useful CT findings for prediction of p-HCC prior to treatment.

Transthoracic echocardiography-monitored CO2-insufflation esophageal endoscopy for diagnosis of Atrioesophageal fistula and prevention of iatrogenic air embolism: a case report

BackgroundAtrioesophageal fistula (AEF) is the most fatal complication associated with catheter ablation for atrial fibrillation and cannot be easily detected when thoracic contrast-enhanced computed tomography (CT) is normal.Case presentationIn this report, we described a diagnostic tool for detecting AEF with doubtful chest CT in which we introduced CO2-insufflation esophageal endoscopy with transthoracic echocardiography monitoring. Using this modified esophageal endoscopy, AEF was established due to the presence of both esophageal lesions and bubbles into the left atrium. That way, our patient accepted to be operated in time with good clinical prognosis.ConclusionsThis modified esophageal endoscopy is an alternative tool for early detection of AEF when normal or doubtful CT findings present.

Severe aortic regurgitation with intimal intussusception secondary to Debakey type I aortic dissection.

Aortic regurgitation (AR) with intimal intussusception, secondary to aortic dissection, is relatively rare and the images are interesting findings. We report a typical case of severe AR with intimal intussusception, secondary to DeBakey type I aortic dissection, detected by contrast-enhanced computed tomography (CECT) and transesophageal echocardiography (TEE). Since there are three types of aortic regurgitation with aortic dissection, it is imperative to consider the most appropriate intervention for AR. The combination of CECT, TEE, and surgical findings may play an important role in determining the optimum surgical procedure for AR with aortic dissection.

Acute cholecystitis: predictive clinico-radiological assessment for conversion of laparoscopic cholecystectomy.

Previous studies evaluating predictive factors for the conversion from laparoscopic to open cholecystectomy have reported conflicting conclusions. To create a risk assessment model to predict the conversion from laparoscopic to open cholecystectomy in patients with acute calculous cholecystitis. A retrospective review of patients with acute calculous cholecystitis with available preoperative contrast-enhanced computed tomography (CT) findings who underwent laparoscopic cholecystectomy was performed. Forty-four parameters-including demographics, clinical history, laboratory data, and CT findings-were analyzed. Among the included 581 patients, conversion occurred in 113 (19%) cases. Multivariate analysis identified obesity (odd ratio [OR] 2.58, P = 0.04), history of abdominal surgery (OR 1.78, P = 0.03), and prolonged prothrombin time (OR 1.98, P = 0.03) as predictors of conversion. In preoperative CT findings, the absence of gallbladder wall enhancement (OR 3.15, P = 0.03), presence of a gallstone in the gallbladder infundibulum (OR 2.11, P = 0.04), and inflammation of the hepatic pedicle (OR 1.71, P = 0.04) were associated with conversion. Inter-observer agreement for CT study interpretation was very good (range 0.81-1.00). A model was created to calculate the risk for conversion, with an area under the receiver operating characteristic curve of 0.87. The risk for conversion, estimated based on the number of factors identified, was in the range of 5.3% (with one factor) to 86.4% (with six factors). Obesity, history of abdominal surgery, prolonged prothrombin time, absence of gallbladder wall enhancement, presence of a gallstone in the gallbladder infundibulum, and inflammation of the hepatic pedicle are associated with conversion of laparoscopic to open cholecystectomy.

An Unusual Case of Isolated Cryptococcal Osteomyelitis of Mastoid: An Enigma!

AbstractCryptococcosis is a disseminated fungal infection commonly affecting the lungs and the central nervous system in immunocompromised patients. Herein we report a rare case of isolated mastoid osteomyelitis due to Cryptococcus neoformans which was initially not recognized due to its uncommon presentation akin to a Betzold’s abscess. A 61-year-old male presented with complaints of left ear discharge for a 1-month duration associated with a swelling in the left side of the neck for which he underwent incision and drainage without any significant improvement. a contrast-enhanced computed tomography (CT) scan revealed extensive erosion of the left mastoid cavity with a collection. Intraoperatively, red friable granulation tissue was seen within the antrum, histopathology of which revealed capsulated yeast forms. The patient underwent left canal wall down mastoidectomy along with antifungal treatment. Bone involvement is rare in patients with cryptococcal infection with vertebrae being the most common site of cryptococcal osteomyelitis. The clinical presentation is nonspecific and can pose a diagnostic dilemma, as the condition can mimic both Betzold’s abscess as well as malignancy. CT findings and the use of specific fungal stains in histopathology will aid in diagnosing this condition. The purpose of this case report is to establish the first case of isolated cryptococcal mastoid osteomyelitis in the database of fungal osteomyelitis. The confirmation of fungal osteomyelitis should be based on histopathological examination. The possibility of fungal osteomyelitis should be borne in mind in any case of insidiously increasing mass with unclear etiology so that prompt antifungal therapy with surgical debridement is initiated.

Gastroduodenal artery pseudoaneurysm hemorrhage 1 year after laparoscopic distal gastrectomy: a case report

BackgroundPostoperative bleeding originating from pseudoaneurysms after radical gastrectomy is not common, but it can be fatal. In particular, delayed bleeding that occurs after the seventh postoperative day is rare.Case presentationA 54-year-old man underwent laparoscopic distal gastrectomy, D2 lymph node dissection, and Roux en-Y reconstruction for duodenal neuroendocrine tumors. Drainage was performed for a postoperative pancreatic fistula and abdominal abscess. On the 28th postoperative day, he passed a large amount of bloody stool; therefore, emergency esophagogastroduodenoscopy (EGD) and angiography were performed. However, neither examination demonstrated any bleeding foci or pseudoaneurysm. He was conservatively observed and discharged on the 50th postoperative day. Approximately 1 year after the surgery, he passed a bloody stool and experienced hemorrhagic shock. An EGD revealed exposed blood vessels at the duodenal blind end. His condition was diagnosed as a pseudoaneurysm arising from gastroduodenal artery, which ruptured into the duodenum, based on abdominal contrast-enhanced computed tomography findings. Emergency angiography was performed, and the pseudoaneurysm and artery were successfully embolized.ConclusionsThis case illustrates that there is a possibility of delayed bleeding even 1 year after gastrectomy. Such cases may be serious and require immediate and careful management.

Contrast-Enhanced Ultrasound in the Short-Term Evaluation of Hepatocellular Carcinoma after Locoregional Treatment

Background: Contrast-enhanced ultrasound (CEUS) with second-generation contrast agents performed 1 month after hepatocellular carcinoma (HCC) treatment is almost as sensitive as contrast-enhanced computed tomography (CECT) in depicting the residual tumor. However, the efficacy of CEUS performed early after the procedure is still debated. Aim: We evaluated the diagnostic accuracy (DA) of CEUS for the assessment of tumor response shortly after locoregional therapy in patients with unresectable HCC. Methods: Ninety-four patients with 104 HCC lesions who were scheduled to receive percutaneous ethanol injection, radiofrequency ablation, transcatheter arterial chemoembolization, or combined treatment were enrolled in this study. With CECT at 1-month as the reference standard, the DA of CEUS performed 48-h after the procedure was evaluated. Patients were followed-up to look for tumor or disease progression. Results: Based on CECT findings, 43/104 lesions were diagnosed as having residual viability after 1 month. CEUS performed 48 h after treatment detected residual tumor in 34/43 nodules with treatment failure at CECT with a sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 79.1, 96.7, 94.4, 86.8, and 89%, respectively. There was a high degree of concordance between CEUS and CECT (kappa coefficient = 0.78). A hyperemic halo was detectable in 35 lesions without a statistically significant difference between concordant and discordant cases. In patients with uninodular disease responders according to 48 h CEUS had a significantly longer mean overall survival and time to progression compared to nonresponders. Conclusion: CEUS performed 48 h after treatment can be considered a reliable modality for the evaluation of the real extent of necrosis and has prognostic value in the assessment of HCC.

Comparison of Different Scoring Systems in Predicting the Severity of Acute Pancreatitis: A Prospective Observational Study.

BackgroundAcute pancreatitis (AP) is an inflammatory condition of the pancreas mostly due to alcohol or gallstones. Various scoring systems were involved in identifying the severity of the disease. The standard single score to identifying the severity remains uncertain.MethodologyThis prospective observational study was carried out for two years in a tertiary care center from South India. The diagnosis of AP was made based on Atlanta criteria, and a total of 164 patients were included. All patients were assessed by acute physiology and chronic health evaluation ll (APACHE II), bedside index for severity in AP (BISAP), modified Glasgow score (MGS), and Ranson score on admission and 48 hours after admission scores. Procalcitonin was done in all patients with AP. Contrast-enhanced computed tomography (CT) of the abdomen was done in 69 patients who had features of severe acute pancreatitis (SAP). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy were calculated for each score, and procalcitonin for CT documented severe patients and organ failure patients together.ResultsA total of 164 patients were included in this study. CT abdomen showed a modified CT severity index (MCSI) ≥8 in all 69 (100%) patients. APACHE II score could predict SAP based on CT findings in 44 patients (63.76%), BISAP score in 22 patients (31.88%), MGS in 55 patients (79.71%), Ranson score at admission in 31 patients (44.92%), Ranson score 48 hours after admission in 44 patients (63.76%), and procalcitonin on admission in 69 patients (100%) when cut-off used as per the literature. APACHE II score could predict SAP in cases of AP (n=164) in 52 patients (50%), BISAP score in 27 patients (26%), MGS in 79 patients (76%), Ranson score at admission in 34 patients (33%), and Ranson score 48 hours after admission in 61 (59%) patients when cut-off was used as per the literature. This study demonstrated that Ranson score on admission had a good area under the curve (AUC). AUC (0.8483), APACHE II (AUC 0.7708), and Ranson score 48 hours after admission (AUC 0.8167) had a fair accuracy. BISAP (AUC 0.6399) and MGS (AUC 0.6486) had poor accuracy for the prediction of severity in AP based on receiver operator characteristic (ROC) curves.ConclusionAmong the scoring system compared, MGS had the highest sensitivity for predicting the severity of AP. However, Ranson score on admission had better diagnostic accuracy for predicting severity, organ failure, and mortality based on ROC curves. Procalcitonin had the best sensitivity, specificity, PPV, NPV, and diagnostic accuracy for association with severity in AP.

Role of MSCT in the diagnosis of perforated gall bladder (a retrospective study)

BackgroundAlthough gall bladder perforation (GBP) is not common, it is considered a life-threating condition, and the possibility of occurrence in cases of acute cholecystitis must be considered. The aim of this study was to assess the role of multi-slice computed tomography (MSCT) in the assessment of GBP.ResultsIt is a retrospective study including 19 patients that had GBP out of 147, there were 11 females (57.8%) and 8 males (42.1%), aged 42 to 79 year (mean age 60) presented with acute abdomen or acute cholecystitis. All patients were examined with abdominal ultrasonography and contrast-enhanced abdominal MSCT after written informed consent was obtained from the patients. This study was between January and December 2018. Patients with contraindications to contrast-enhanced computed tomography (CT) (pregnancy, acute kidney failure, or allergy to iodinated contrast agents) who underwent US only were excluded. Patients with other diagnoses, such as acute diverticulitis of the right-sided colon or acute appendicitis, were excluded. The radiological findings were evaluated such as GB distention; stones; wall thickening, enhancement, and defect; pericholecystic free fluid or collection; enhancement of liver parenchyma; and air in the wall or lumen. All CT findings are compared with the surgical results. Our results revealed that the most important and diagnostic MSCT finding in GBP is a mural defect. Nineteen patients were proved surgically to have GBP.ConclusionGBP is a rare but very serious condition and should be diagnosed and treated as soon as possible to decrease morbidity and mortality. The most accurate diagnostic tool is the CT, MSCT findings most specific and sensitive for the detection of GBP and its complications.

Aftermath of pulmonary tuberculosis: computed tomography assessment

PurposePulmonary tuberculosis (PTB) has clinically significant sequelae, even after recommended treatment completion. It is important to recognise these sequelae for accurate assessment of severity and treatment planning, if indicated.Material and methodsWe retrospectively analysed contrast-enhanced computed tomography (CT) scans of chest of 100 patients with previous history of treated pulmonary tuberculosis, excluding those with active pulmonary disease. CT findings were analysed based on parenchymal, airway, pleural, mediastinal, and vascular sequelae of PTB.ResultsParenchymal sequelae included fibrosis with architectural distortion and volume loss (90%), cavities (21%) (with aspergillomas noted in 19% of these cases), and tuberculomas (54%). Airway involvement was noted as bronchiectasis (77%) and bronchial stenosis (4%) but none with broncholithiasis. Mediastinal sequelae included lymph node calcification (74%), fibrosing mediastinitis (1%), and pericardial tuberculosis (2%). Pleural sequelae included pleural thickening (22%), with 40.9% of these patients showing calcifications, and one patient with chronic chylous pleural effusion. Vascular sequelae included Rasmussen aneurysms (4%), enlarged bronchial arteries (3%), and systemic bronchial collaterals in 1% of our patients.ConclusionsPTB has multiple appalling sequelae, which require due attention and appropriate treatment in symptomatic cases. Radiological evaluation forms an integral part in patient assessment and decision making.

Importance of 18F-FDG-PET/CT in Detection of Early Colorectal Cancer Relapse and its Effect on Therapy Plan.

Introduction: Colorectal cancer (CRC) is the 7th commonest cancer in Egypt, representing 3.5% of male and 3% of female cancers. About 40% of patients with CRC develop early recurrence within the first two years after completion of their treatment. Aim of the work: To evaluate the importance of 18F-FDG-PET/CT in detection of early relapse and to assess its effect on management in patients with CRC and equivocal CECT findings. Patients and Methods: Forty eight patients with treated colorectal cancer, under follow up were subjected to full clinical and laboratory assessment, CECT and PET/CT imaging plus histopathological examination of the biopsied sites of suspected recurrence.Results: Among 48 patients with CRC, PET/CT and histopathology were concordant in 41 patients (31 patients positive & 10 patients negative) and discordant in 7 patients (6 false positive & one false negative). Overall SN, SP, PPV, NPV and accuracy of PET/CT were 96.9%, 62.5%, 83.8%, 90.9% and 75.6% respectively. PET/CT and CECT findings exhibit significant association in detection of local recurrence, hepatic lesions, loco-regional LNs and distant lesions (p value 0.001, 0.001, 0.004 and 0.003 respectively). PET/CT led to overall changes in the therapy plan for 26/48 patients (54.2%), 12/48 patients (25%) from negative to be positive for recurrence and recommended for therapy.One patient (2.1%) from false positive to be negative and continue under follow up and 13/48 patients (27.1%) underwent modification in their plan either by addition or withdrawal of other therapy lines. 22/48 patients (45.8%) didn’t show changes in their proposed plan. The changes in follow up, chemotherapy and radiofrequency strategies before and after PET/CT were significant (p value < 0.001, 0.004 & 0.038). Conclusions: PET/CT is efficient than CECT in detection of early CRC relapse. PET/CT has also a significant impact on directing management through improving the accuracy and decreasing the failure rate of the suggested therapy plan.

Prognostic Predicting Role of Contrast-Enhanced Computed Tomography for Locally Advanced Pancreatic Adenocarcinoma.

Introduction Contrast-enhanced computed tomography (CECT) imaging is commonly used to assess pancreatic adenocarcinoma (PAC). However, the value of semiquantitative and quantitative assessments of CECT parameters used to predict survival in PAC remains unknown. This study aims to investigate the prognostic role of pretreatment CECT imaging in patients with locally advanced pancreatic adenocarcinoma (LAPAC). Materials and Methods From June 2013 to May 2017, eighty-six newly diagnosed patients with pathologically and radiologically confirmed LAPAC were retrospectively recruited. All patients were evaluated by CECT and experienced gemcitabine-based chemotherapy. The relationship between overall survival (OS) and clinical factors including age, sex, serum carbohydrate antigen 19-9 value, and CECT findings (including tumour location, tumour volume, peripancreatic involvement, blood vessel involvement, tumour enhanced rate, and distance liver metastasis) was determined using Cox proportional hazard regression models, and a nomogram was constructed for the prediction of 1- and 1.5-year survival rates of patients with LAPAC. Results On univariate analysis, patients who had a tumour enhanced rate (TER) less than 80.465% and those who had a TER ≥ 80.465% are with a 3.587-fold increase in OS (p < 0.001). After multivariate Cox regression, a nomogram was established based on a new model containing the predictive variables of high Ca19-9 level, higher clinical stages, larger tumour volume, the presence of peripancreatic involvement, and liver metastases. The model displayed good accuracy in predicting OS with a C-index of 0.614. The calibration plots also showed a good discrimination and calibration of the nomogram between the predicted and observed survival probabilities. Conclusion Our results showed that TER can be used to predict survival in LAPAC, and we developed a nomogram for determining the prognosis of patients with LAPAC. However, the purposed nomogram still requires external data verification in future applications.