Contrast-enhanced CT Research Articles

Non-enhanced abbreviated MRI as a periodic surveillance protocol for colorectal liver metastases compared with contrast-enhanced CT: a prospective observational study.

Adopting appropriate noninvasive radiological method is crucial for periodic surveillance of liver metastases in colorectal cancer (CRC) patients after surgery, which is closely related to clinical management and prognosis. This study aimed to prospectively enroll stage II-III CRC patients for the surveillance of liver metastases, and compare the diagnostic performance of contrast-enhanced CT (CE-CT) and non-enhanced abbreviated MRI (NE-AMRI) during this process. 587 CRC patients undergoing radical resection of the primary tumor were evaluated by 1 to 3 rounds of surveillance tests, consisting of abdominal CE-CT and contrast-enhanced MRI (CE-MRI) within 7days at 6-month intervals. Subsequently, images of NE-AMRI were extracted from the CE-MRI examination, paired CE-CT and NE-AMRI analysis were performed. The lesion-based detection rates between two protocols were compared and a subgroup analysis was performed in lesions with the size of ≤ 10mm. The patient-based sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, and the areas under the curves (AUCs) of CE-CT and NE-AMRI in each round were evaluated. Finally, the relationship between the diagnostic accuracy of two protocols and characteristics of patients was explored. The lesion-based detection rates of NE-AMRI in three rounds were all significantly higher than that of CE-CT (p < 0.001, p < 0.001, p=0.003, respectively). In the subgroup analysis of lesions ≤ 10mm, NE-AMRI also performed better than CE-CT (p < 0.001, p=0.002, p=0.005, respectively). The patient-based sensitivities, specificities, NPVs, PPVs of NE-AMRI were higher than those of CE-CT in three rounds of surveillance. The AUCs for NE-AMRI were all significantly better than that for CE-CT in each round (p=0.015, p=0.045, p=0.009, respectively). Furthermore, patient BMI and fatty liver disease had impacts on the diagnostic accuracy of CE-CT protocol, but not on NE-AMRI protocol. NE-AMRI may be a promising periodic surveillance tool for CRC patients after surgery to increase diagnostic accuracy of liver metastases, developing personalized clinical management and improving prognosis, simultaneously avoiding side-effects associated with ionizing radiation and contrast agents.

High-resolution 0.25mm Detector CT Has Limited Impact on Right Adrenal Vein Detectability in Preprocedural Contrast Enhanced CT for Adrenal Venous Sampling.

This study aims to identify factors associated with the detectability of the right adrenal vein (RAV) on preoperative contrast-enhanced CT scans of adrenal venous sampling (AVS) in the era of high-resolution CT (HRCT). In this retrospective study, 36 patients (15 men and 21 women; mean age, 56y) who underwent preoperative contrast-enhanced CT [11 patients in HRCT with 0.25mm detector matrix (Cannon Medical Systems) and 25 patients in conventional multidetector CT with 0.5mm matrix] were included. A contrast agent dose of 600mgI/kg was injected, and CT images were acquired at a fixed scan delay of 50 and 80 seconds. Adrenal venography and venous sampling were performed for the diagnosis of suspected primary hyperaldosteronism. The qualitative detectability of RAV on preoperative CT was assessed with adrenal venography as a reference. Clinical and imaging factors associated with a good detectability of RAV were analyzed via regression analysis. Optimal acquisition timing was assessed by analyzing the time-intensity curve and contrast enhancement pattern of the inferior vena cava using CT data from a separate cohort (n=5). The qualitative detectability of RAV was deemed good in 15 patients and poor in 21 patients. Regression analysis revealed that only heterogeneous enhancement of inferior vena cava with bolus high attenuation, corresponding to an optimal acquisition timing from time-intensity curve analysis, was associated with a good detectability of RAV (odds ratio, 5.06). The use of HRCT was not statistically significant. Optimal acquisition timing is a crucial factor for the detectability of RAV in preprocedural CT for AVS, while high-resolution 0.25 detector CT appears to have limited significance.

Combining Low-energy Images in Dual-energy Spectral CT With Deep Learning Image Reconstruction Algorithm to Improve Inferior Vena Cava Image Quality.

To explore the application of low-energy image in dual-energy spectral CT (DEsCT) combined with deep learning image reconstruction (DLIR) to improve inferior vena cava imaging. Thirty patients with inferior vena cava syndrome underwent contrast-enhanced upper abdominal CT with routine dose, and the 40, 50, 60, 70, and 80keV images in the delayed phase were first reconstructed with the ASiR-V40% algorithm. Image quality was evaluated both quantitatively [CT value, SD, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) for inferior vena cava] and qualitatively to select an optimal energy level with the best image quality. Then, the optimal-energy images were reconstructed again using deep learning image reconstruction medium strength (DLIR-M) and DLIR-H (high strength) algorithms and compared with that of ASiR-V40%. The objective CT value, SD, SNR, and CNR increased with the decrease in energy level, with statistically significant differences (all P<0.05). The 40keV images had the highest CT values, SNR, and CNR and good diagnostic acceptability, and 40keV was selected as the best energy level. Compared with ASiR-V40% and DLIR-M, DLIR-H had the lowest SD, highest SNR and CNR, and subjective score (all P<0.001) with good consistencies between the 2 physicians (all k ≥0.75). The 40keV images with DLIR-H had the highest overall image quality, showing sharper edges of inferior vena cava vessels and clearer lumen in patients with Budd-Chiari syndrome. Compared with the ASiR-V algorithm, DLIR-H significantly reduces image noise and provides the highest CNR and best diagnostic image quality for the 40keV DEsCT images in imaging inferior vena cava.

Anatomical Predictors of Access-Related Vascular Complications Following Transfemoral Transcatheter Aortic Valve Replacement.

Access-related vascular complications (VCs) after percutaneous transfemoral transcatheter aortic valve replacement (TAVR) are associated with poor clinical outcomes and remain a significant challenge despite technological advances. The aim of this study was to identify anatomic predictors of access-related VCs after TAVR on preprocedural contrast-enhanced multidetector computed tomography (MDCT). The aim of this study was to identify anatomical predictors of access-related VCs after TAVR on preprocedural contrast-enhanced MDCT. A total of 348 consecutive patients with symptomatic severe AS who underwent transfemoral TAVR were included retrospectively. The primary endpoint of the study was the composite of minor and major access site complications as defined by the Valve Academic Research Consortium-3 (VARC-3) criteria. The study population was divided into two groups according to the VC including VC (+) and VC (-). A total of 101 patients (29%) developed VC (8.7% major, 20.3% minor) following TAVR. Regression analysis identified severe CFA calcification (p = 0.004), CFA depth (p < 0.001), minimum CFA diameter (p < 0.001), CFA depth-to-diameter ratio ≥ 5.6 (p < 0.001), and sheath-to-femoral artery ratio (SFAR) (p < 0.001) as significant predictors of VC. ROC curves generated for the occurrence of VC, the AUC for the femoral artery depth-to-diameter ratio (0.720) was higher than the AUC for the SFAR and the depth of the femoral artery (0.636, 0.630). Complications related to vascular access sites continue to be a significant concern for patients undergoing TF-TAVR. The CFA depth-to-diameter ratio has demonstrated superior predictive performance for VC compared to SFAR as expressed in the literature. Utilizing this criterion may enhance risk stratification for VC in high-risk patients, potentially reducing associated morbidity and mortality.

A preoperative predictive model based on multi-modal features to predict pathological complete response after neoadjuvant chemoimmunotherapy in esophageal cancer patients

BackgroundThis study aimed to develop a multi-modality model by incorporating pretreatment computed tomography (CT) radiomics and pathomics features along with clinical variables to predict pathologic complete response (pCR) to neoadjuvant chemoimmunotherapy in patients with locally advanced esophageal cancer (EC).MethodA total of 223 EC patients who underwent neoadjuvant chemoimmunotherapy followed by surgical intervention between August 2021 and December 2023 were included in this study. Radiomics features were extracted from contrast-enhanced CT images using PyrRadiomics, while pathomics features were derived from whole-slide images (WSIs) of pathological specimens using a fine-tuned deep learning model (ResNet-50). After feature selection, three single-modality prediction models and a combined multi-modality model integrating two radiomics features, 11 pathomics features, and two clinicopathological features were constructed using the support vector machine (SVM) algorithm. The performance of the models were evaluated using receiver operating characteristic (ROC) analysis, calibration plots, and decision curve analysis (DCA). Shapley values were also utilized to explain the prediction model.ResultsThe predictive capability of the multi-modality model in predicting pCR yielded an area under the curve (AUC) of 0.89 (95% confidence interval [CI], 0.75-1.00), outperforming the radiomics model (AUC 0.70 [95% CI 0.54-0.85]), pathomics model (AUC 0.77 [95% CI 0.53-1.00]), and clinical model (AUC 0.63 [95% CI 0.46-0.80]). Additionally, both the calibration plot and DCA curves support the clinical utility of the integrated multi-modality model.ConclusionsThe combined multi-modality model we propose can better predict the pCR status of esophageal cancer and help inform clinical treatment decisions.

Abdominopelvic imaging in the follow-up of testicular germ-cell tumors in adults: recommendations of the Scrotal and Penile Imaging Working Group of the European Society of Urogenital Radiology.

The Scrotal and Penile Imaging Working Group (SPIWG) of the European Society of Urogenital Radiology (ESUR) aimed to formulate recommendations on the imaging modalities and minimal technical requirements for abdominopelvic imaging in the follow-up of adult patients treated for testicular germ-cell tumors (TGCT). The SPIWG members performed an extensive literature search, reviewed the current clinical practice, and reached a consensus based on the opinions of experts in the field. Recurrence in patients treated for TGCT mainly occurs in retroperitoneal lymph nodes (LNs). Abdominopelvic CT and MRI are equivalent assessing retroperitoneal LNs. MRI has the advantage of avoiding radiation exposure, and moreover, diffusion-weighted images (DWI) may increase the detection rates without the need for contrast administration. In patients treated for stage I TGCT, the ESUR-SPIWG recommends MRI over CT for the detection of retroperitoneal LNs during the follow-up after treatment. CT, however, remains the follow-up imaging of choice in patients with advanced disease. When MRI is used, the recommended minimal requirements are at least one high-quality anatomical sequence (T1-WI or T2-WI) in axial and coronal planes, and DWI in the same axial plane, ≤ 4 mm contiguous slices from the diaphragm to the perineum. When CT is used, the recommended minimal requirement is a standard-dose contrast-enhanced CT in the portal-venous phase, scanned from the diaphragm to the perineum. In this paper, the ESUR-SPIWG provides recommendations on the imaging modalities and minimal technical requirements for abdominopelvic imaging in the follow-up of adult patients treated for TGCT. Question There are no recommendations on the preferred imaging modality or scan sequences required for abdominopelvic imaging in the follow-up after treatment for testicular cancers. Findings The European Society of Urogenital Radiology Scrotal and Penile Imaging Working Group (ESUR-SPIWG) provides recommendations for abdominopelvic imaging in follow-up after treatment for testicular cancers. Clinical relevance Recurrence of testicular germ-cell tumors mainly occurs in retroperitoneal lymph nodes. Both CT and MRI provide similar morphological assessments, but radiation exposure can be avoided by using MRI instead of CT.

CT and MR Imaging in Colorectal Carcinoma: A Tool for Diagnosis, Staging, Response Evaluation, and Follow-Up

The present review highlights the role of computed tomography (CT), CT colonography (CTC), and magnetic resonance imaging (MRI) in the diagnosis, staging, response evaluation, and follow-up of colorectal cancer. For a CT scan, prior bowel preparation is required. This is done to enhance imaging of the colon with the use of oral or rectal contrast agents. Negative contrast like air or carbon dioxide are helpful in detecting polyps and masses by distending the colon. Virtual colonoscopy offers a lower-radiation alternative for polyp and cancer detection. Intravenous contrast administration with arterial and venous phase CT images is also important in complete staging of a known case of colon cancer and for evaluation of residual/recurrent disease. With respect to MRI, high-resolution T2-weighted images in multiple planes are important, with diffusion-weighted imaging (DWI) sequences being important for restaging. Intravenous contrast is not generally recommended. Contrast-enhanced CT and MRI are used for nodal and distant metastasis staging, with special attention to the pelvic side wall nodes. Positron emission tomography (PET) CT is to be considered for further evaluation if the findings are unclear and recurrence is suspected.

Automated detection of traumatic bleeding in CT images using 3D U-Net# and multi-organ segmentation.

Traumatic injury remains a leading cause of death worldwide, with traumatic bleeding being one of its most critical and fatal consequences. The use of whole-body computed tomography (WBCT) in trauma management has rapidly expanded. However, interpreting WBCT images within the limited time available before treatment is particularly challenging for acute care physicians. Our group has previously developed an automated bleeding detection method in WBCT images. However, further reduction of false positives (FPs) is necessary for clinical application. To address this issue, we propose a novel automated detection for traumatic bleeding in CT images using deep learning and multi-organ segmentation; Methods: The proposed method integrates a three-dimensional U-Net# model for bleeding detection with an FP reduction approach based on multi-organ segmentation. The multi-organ segmentation method targets the bone, kidney, and vascular regions, where FPs are primarily found during the bleeding detection process. We evaluated the proposed method using a dataset of delayed-phase contrast-enhanced trauma CT images collected from four institutions; Results: Our method detected 70.0% of bleedings with 76.2 FPs/case. The processing time for our method was 6.3 ± 1.4 min. Compared with our previous ap-proach, the proposed method significantly reduced the number of FPs while maintaining detection sensitivity.

Value of Noncontrast-Enhanced Vessel Wall MRI in Longitudinal Venous System Invasion Before Robot-Assisted Radical Nephrectomy.

Objectives: To explore the value of vessel wall MRI (VW-MRI) in the preoperative assessment of T3 renal-cell carcinoma (RCC) with varying degrees of longitudinal venous system invasion. Materials and Methods: Patients with RCC with pathological T3 stage between January 2016 and December 2023 were included in this retrospective study. All the patients underwent contrast-enhanced CT (CECT), conventional MRI (con-MRI) or VW-MRI. Images were independently and blindly evaluated at 4-week intervals by three readers. The pathological features reported in the pathological report, combined with clinical data, were used as the reference standards. The incremental value was calculated using net reclassification improvement (NRI) and integrated discrimination improvement. Results: Eighty-two T3 RCC patients (median age, 65 years) were enrolled. The accuracy of T staging in CECT (n = 59), con-MRI (n = 49), and VW-MRI (n = 30) was 69.5%, 71.4%, and 93.3%, respectively. VW-MRI had a statistically incremental value for CECT in the preoperative evaluation of T3a-c stages (T3a: NRI = 0.066, p = 0.04. T3b: NRI = 0.085, p = 0.02. T3c: NRI = 0.178, P = 0.02), especially in renal pelvicaliceal invasion (NRI = 0.154, p = 0.04) and vena cava wall invasion (NRI = 0.263, p = 0.01). Besides, statistically significant preoperative incremental effects were obtained in the assessment of T3a-c stages (T3a: NRI = 0.264, p = 0.01. T3b: NRI = 0.373, p = 0.03. T3c: NRI = 0.202, p = 0.045), renal vein invasion (NRI = 0.630, p = 0.03), and vena cava wall invasion (NRI = 0.185, p = 0.02) when added VW-MRI into con-MRI. VW-MRI changed 24% (4/27) of the previous CECT and con-MRI-based surgical plan. Conclusion: VW-MRI added a preoperative value for evaluating T stage of T3 RCC, especially in the evaluation of renal vein invasion and vena cava wall invasion.

18F-FDG PET/CT Versus 18F-FAPI PET/CT in Eosinophilic Liver Infiltration.

A 48-year-old man presented with upper abdominal discomfort for 10 days. Abdominal contrast-enhanced CT showed multiple abnormal enhanced masses in liver, suggesting a probability of malignancies. The patient was then enrolled in a clinical trial of comparison of 18F-FDG and 18F-FAPI PET/CT in hepatic lesions. Compared with 18F-FDG PET/CT, 18F-FAPI PET/CT showed higher tracer uptake, more lesions in liver. Meanwhile, peripheral blood eosinophils increased remarkably. The hepatic lesions were highly suspected as eosinophilic liver infiltration. Finally, pathologic analysis confirmed the diagnosis of eosinophilic liver infiltration.

Significantly Elevated FDG Activity in Esophageal Inflammatory Myofibroblastic Tumor of a Pediatric Patient.

A 13-year-old girl presented with dysphagia underwent contrast-enhanced CT and endoscopy. The CT revealed cervical esophageal wall thickening with heterogeneous enhancement. Microscopic examination of the biopsy specimen suggested a possible mesenchymal tumor. She underwent an 18F-FDG PET/CT scan for staging. The scan showed local thickening of the cervical esophageal wall with heterogeneous and significantly elevated FDG activity. Subsequent immunohistochemical staining and fluorescence in situ hybridization confirmed the diagnosis of esophageal inflammatory myofibroblastic tumor.

Segmentation of ADPKD Computed Tomography Images with Deep Learning Approach for Predicting Total Kidney Volume

Background: Total Kidney Volume (TKV) is widely used globally to predict the progressive loss of renal function in patients with Autosomal Dominant Polycystic Kidney Disease (ADPKD). Typically, TKV is calculated using Computed Tomography (CT) images by manually locating, delineating, and segmenting the ADPKD kidneys. However, manual localization and segmentation are tedious, time-consuming tasks and are prone to human error. Specifically, there is a lack of studies that focus on CT modality variation. Methods: In contrast, our work develops a step-by-step framework, which robustly handles both Non-enhanced Computed Tomography (NCCT) and Contrast-enhanced Computed Tomography (CCT) images, ensuring balanced sample utilization and consistent performance across modalities. To achieve this, Artificial Intelligence (AI)-enabled localization and segmentation models are proposed for estimating TKV, which is designed to work robustly on both NCCT and Contrast-Computed Tomography (CCT) images. These AI-based models incorporate various image preprocessing techniques, including dilation and global thresholding, combined with Deep Learning (DL) approaches such as the adapted Single Shot Detector (SSD), Inception V2, and DeepLab V3+. Results: The experimental results demonstrate that the proposed AI-based models outperform other DL architectures, achieving a mean Average Precision (mAP) of 95% for automatic localization, a mean Intersection over Union (mIoU) of 92% for segmentation, and a mean R2 score of 97% for TKV estimation. Conclusions: These results clearly indicate that the proposed AI-based models can robustly localize and segment ADPKD kidneys and estimate TKV using both NCCT and CCT images.

Prognosticating WHO/ISUP grade in clear cell renal cell carcinoma: Insights from amide proton transfer-weighted MRI.

Preoperative prediction of clear cell renal cell carcinoma (ccRCC) grade can support optimal selection of surgical resection strategies. Currently, there is no effective preoperative method for accurately assessing the histologic grade of ccRCC. More precise, non-invasive prediction methods are needed. To investigate the parameter of amide proton transfer-weighted (APTw) MRI for prediction of pathological ccRCC grade and whether the combination of the APTw, Diffusion-Weighted Imaging (DWI), and mDixon MRI techniques can improve the prediction performance. This prospective study included ccRCC patients who underwent multiparametric MRI examinations (including APTw, DWI, and mDixon) along with contrast-enhanced CT or MRI examinations from March 2021 to June 2024. The mean, maximum, minimum, and standard deviation (SD) values from APTw and apparent diffusion coefficient (ADC) imaging of the solid tumor portions and the fat fraction (FF) values from mDixon imaging were measured. The area under the receiver operating characteristic curve (AUC) values for the parameters were calculated to evaluate the diagnostic performance. A total of 48 ccRCC patients (mean age, 65 years; 32 males) were included, of whom 10 had high-grade ccRCC and 38 had low-grade ccRCC. Compared with low-grade ccRCC, high-grade ccRCC exhibited higher APTwmean (2.28 % vs. 4.17 %; P < .05), APTwmax (4.97 % vs. 8.48 %; P < .01), and APTwSD (1.10 vs. 1.75; P < .01) values as well as lower ADCmin values (1.23 × 10-3 mm2/s vs. 0.94 × 10-3 mm2/s; P < .05). The AUC values for the ability of APTwmean, APTwmax, APTwSD, ADCmin, and these factors combined to distinguish between low-grade and high-grade ccRCC were 0.728, 0.786, 0.832, 0.741, and 0.858, respectively. APTwmean, APTwmax, APTwSD, and ADCmin values are potential indicators for preoperative prediction of ccRCC pathologic grade. APTw parameters offer certain advantages for use alone or in combination with other parameters.

Nomogram prediction model based on non-enhanced computed tomography for adnexal torsion: A retrospective multicenter study.

To develop and validate an individualized nomogram for predicting adnexal torsion in women with abdominal pain and an adnexal mass based on preoperative non-contrast computed tomography (CT) findings. This retrospective study included 200 women with surgically resected ovarian lesions who underwent preoperative non-contrast CT for abdominal pain from January 2017 to September 2023 in seven hospitals. The 200 patients were randomly divided into a development group (140 cases) and a validation group (60 cases). The independent risk factors for adnexal torsion from non-contrast CT signs were screened using univariate and multivariate logistic regression analyses. The corresponding nomogram prediction model was drawn according to the regression coefficients. The areas under the receiver operating characteristic curves (AUC) and the calibration plots were used to estimate the discrimination and calibration of the prediction model, respectively. The most common lesion causing adnexal torsion was ovarian cyst (30.1%), followed by mature cystic teratoma (25.7%), whereas malignant tumors and tubo-ovarian abscesses were more common in non-torsioned patients. Multivariable regression analysis showed that navel sign (odds ratio [OR] 14.78; P = 0.005), whirl sign (OR 38.05; P = 0.002), and peri-adnexal fat haziness (OR 0.20; P = 0.012) were independent significant parameters predicting adnexal torsion. The AUC of the development group and validation group were 0.903 and 0.861, respectively, and the calibration curve suggested good agreement between the predictive probability and the actual probability. Navel sign, whirl sign, and peri-adnexal fat haziness, and an integrated nomogram derived from these non-contrast CT findings, can be useful for predicting adnexal torsion, especially when ultrasound and contrast-enhanced CT cannot be used.

Transmission-Based Monitoring of Dual-Applicator Microwave Ablation Discriminates Discontiguous from Contiguous Ablation Zones in an In Vivo Porcine Liver Model.

To determine the technical feasibility of discriminating discontiguous from contiguous ablation zones between a pair of microwave ablation (MWA) applicators using broadband microwave transmission signal measurements in an in vivo porcine liver model. Dual applicator 2.45GHz MWA was performed using one directional and one omnidirectional applicator, spaced 3cm apart, under imaging guidance. The study involved 15 hepatic MWAs across four swine, with ablation durations of 200s (n=8) for discontiguous ablation and 600s (n=7), each at 60W; these ablation durations and applied power combinations were selected with the intent of creating discontiguous (200s) and contiguous (600s) ablation zones. A custom software periodically measured transmission signals between the applicators at 46-second intervals. Contrast-enhanced CT, gross pathology, and histopathologic analyses were used to assess the processed transmission signal (PTS). Statistical analyses revealed significant differences between contiguous and discontiguous ablation zones on CECT imaging (volume: 16.9±5.2cm3 vs. 3.9±1.5cm3, p=0.0002), gross tissue sections and histology (area: 10±3.3cm2 and 6.5±1.3cm2, p=0.001 and PTS datasets showed values of 85.1±11% and 37.3±12.9% (p=0.02). PTS values functioned well as predictors of complete vs incomplete ablation (area under curve of the receiver operating characteristic curve = 0.90), with a PTS threshold of 53% being optimal for indicating ablation zone contiguity. Ablation zone contiguity was strongly correlated with PTS (Spearman correlation coefficient 0.86, p<0.0001). This study demonstrated that PTS between dual MWA applicators can distinguish between contiguous and discontiguous ablation zones.

Diagnosis of Peritonsillar Abscess-A Prospective Study Comparing Clinical with CT Findings in 133 Consecutive Patients.

Background: Peritonsillar abscess (PTA) is relatively common but challenging to diagnose clinically. Several clinical signs may be used, with unknown performances. We evaluated and compared the diagnostic performance of individual and combined clinical signs (trismus, edema, pharynx immobility, uvula deviation, hot potato voice, and overall clinical impression) assessed by an otolaryngologist and of contrast-enhanced computed tomography (CT) to detect acute PTA. Methods: Prospective study in 133 consecutive adult patients (77 males, mean age = 33 years) with suspected clinical PTA and CT obtained in the emergency setting of a tertiary care hospital between November 2020 and October 2022. The standard of reference consisted of surgically proven pus within 24 h of CT or a favorable clinical evolution at 48 h without surgical intervention. Results: PTA was present in 117/133 (88%) patients, with no difference between mean age or sex distribution between the groups with and without PTA. None of the evaluated clinical signs were associated with PTA (OR = 1.26-5.43, p > 0.05), whereas the CT finding "abscess" was significantly associated with PTA (OR = 67.2, p < 0.0001). The sensitivity of individual clinical signs varied between 19.7% and 73.5%, and the sensitivity of CT was significantly higher for all clinical signs (95.7%, p < 0.0001) except for overall clinical impression (97.4%, p = 0.7266). The specificity of clinical signs varied between 12.5% and 93.8%, and the specificity of CT was significantly higher (75%, p < 0.05) for overall clinical impression and edema. All clinical signs together yielded an area under the curve (AUC) = 0.677. Conclusions: In adults, clinical assessment alone using independent clinical signs and overall clinical impression does not allow a reliable diagnosis of PTA, even when performed by an otolaryngologist. CT is reliable in diagnosing PTA and, whenever available, should be the examination method of choice for diagnosing PTA, especially by a non-specialist.

Spleno-Mesenteric Venous Blood Flow Dynamics in Adult Patients with Chronic Portal Vein Thrombosis Analyzed by Sequential CT-Spleno- and Mesenterico-Portography.

Portal vein thrombosis (PVT) leads to portal hypertension (PH) with its sequelae. Computed tomography spleno-mesenterico-portography (CT-SMPG) combines sequential CT spleno-portography and CT mesenterico-portography. CT-SMPG comprehensively illustrates the venous hemodynamic changes due to PH. To assess the effects of PV confluence thrombosis (PVCT) and liver cirrhosis on venous blood flow characteristics of patients with PVT. CT-SMPG was performed in 21 patients with chronic PVT. CT-SMPG was compared to standard contrast-enhanced CT (CECT) and gastroscopy concerning the patency of splanchnic veins, varices and venous congestion. PVCT had a significant effect on perfusion patterns: in patients without PVCT, esophageal varices (EV) and gastric varices were supplied by either the splenic vein (SV), the superior mesenteric vein (SMV), or both. In patients with PVCT, EV and gastric varices were mostly supplied by the SV (p = 0.021, p = 0.016). In patients without PVCT, small bowel varices were fed by both systems or the SMV, while in patients with PVCT they were fed by the SMV (p = 0.031). No statistically significant changes were detected regarding gastropathy, colorectal varices and small bowel congestion. Liver cirrhosis had no statistically relevant effect on hemodynamics. In CT-SMPG, patients with PVCT showed different venous hemodynamics to patients without PVCT, and this can serve as a basis for selecting therapy options.

Clinical presentation and surgical management of intra-abdominal abscesses: a retrospective study

BackgroundIntra-abdominal abscesses pose a significant challenge due to their complex nature, potential complications, and diagnostic difficulties. This retrospective study aims to assess the etiological factors, clinical presentations, diagnostic methods, and treatment outcomes associated with intra-abdominal abscesses.MethodsThis cross-sectional, retrospective study reviewed medical records of 47 patients diagnosed with intra-abdominal abscesses at Babol University of Medical Sciences, Iran, between 2011 and 2020. Data collected included demographic details, clinical and laboratory findings, imaging results, treatment methods, and patient outcomes.ResultsThe study included 47 patients, with a mean age of 47 years, comprising 20 females and 27 males. The most common symptoms were abdominal pain (85.1%), fever (61.7%), and anorexia (59.57%). Contrast-enhanced CT scan was the predominant diagnostic tool used (55.31%), followed by ultrasound (34.04%). Most abscesses were intraperitoneal (70.21%) and of gastrointestinal origin (61.7%), with appendicitis being the leading cause. Open surgery was the most common treatment method (65.95%), with a higher complication rate observed in surgical cases. There was a significant association between previous surgical history and the development of gastrointestinal abscesses (P = 0.004). No significant differences were found between abscess origin and demographic factors, treatment methods, or complications (p > 0.05).ConclusionIntra-abdominal abscesses are commonly associated with non-specific symptoms and are most frequently intraperitoneal, originating from gastrointestinal pathology. CT scan remains the gold standard for diagnosis, and open surgery is often required for treatment. The findings underscore the importance of timely diagnosis and individualized treatment strategies, to minimize complications and improve outcomes.

Successful Management of Pseudo-Ludwig Angina from Supratherapeutic Warfarin Use: A Case Report

Introduction: Ludwig angina is a potentially fatal condition characterized by soft tissue infection of the submandibular, sublingual, and submental compartments. Pseudo-Ludwig angina is a rare condition characterized by sublingual swelling of non-infectious etiology, typically in the setting of supratherapeutic anticoagulation. However, other etiologies, such as angioedema and trauma, have been described. Case Report: We present the case of a 59-year-old female with pseudo-Ludwig angina that developed in the setting of warfarin therapy and supratherapeutic international normalized ratio. She presented with sublingual swelling and dysphagia. She was successfully treated with dexamethasone, vitamin K, and fresh frozen plasma. The most appropriate imaging modalities in these cases are contrast-enhanced computed tomography (CT) and CT angiogram. If a hematoma is present, antibiotics for anaerobic coverage are also appropriate. Conclusion: We hope this case sheds light upon this rare pathology and ultimately hastens recognition and proper intervention.

Effectiveness of single-energy metal artifact reduction algorithm in CT: application to contrast-enhanced CT with EVAR and coil embolization.

This study aimed to evaluate the efficacy of the single-energy metal artifact reduction (SEMAR) algorithm in reducing metal artifacts and enhancing image quality in contrast-enhanced computed tomography (CT) for patients undergoing endovascular aneurysm repair (EVAR) with coil embolization. Thirty-eight patients (mean age 81.0 ± 6 years; 31 men, 7 women) who underwent contrast-enhanced CT following EVAR and internal iliac artery coil embolization between September 2022 and May 2023 were retrospectively analyzed. The Artifact Index (AI) quantified metallic artifacts from internal iliac artery aneurysm coils in CT images, calculated from the standard deviation of the artifact-containing region relative to a reference region. CT values of the external iliac artery at the same slice were also evaluated and compared. Two radiologists independently performed qualitative assessments of SEMAR and non-SEMAR images. SEMAR significantly reduced metal artifacts, decreasing the AI from 171.9 ± 74.5 HU to 35.8 ± 16.9 HU (p < 0.001). The mean CT values of the external iliac artery were similar for SEMAR (259.4 ± 63.7 HU) and non-SEMAR (257.1 ± 63.6 HU, indicating no significant difference. Qualitative assessment scores improved significantly with SEMAR (from 1.0 ± 0.0 to 2.5 ± 0.5; p < 0.001), enhancing visualization of internal iliac artery aneurysms. Interobserver agreement was high (κ = 0.83). The SEMAR algorithm effectively reduces metal artifacts in contrast-enhanced CT, significantly enhancing image quality without altering adjacent artery CT values. These improvements enhance the image quality of post-operative assessments in patients undergoing EVAR with coil embolization.