CT Angiography In Diagnosis Research Articles

Retrospective Case Series of Vertebral Artery Injuries Associated with Cervical Spine Trauma

BackgroundVertebral artery injuries (VAI) can occur due to cervical spine trauma. VAI can prove a serious complication and potentially compromise vascular supply to the posterior aspect of the brain. Currently, there is a paucity of evidence with regards to incidence, management, and outcomes for these patients. The purpose of this study is to investigate and elucidate the incidence of VAI associated with cervical trauma at a national tertiary referral centre for spinal pathology, their respective management, and associated outcomes. MethodsA retrospective review was conducted from 2012-2021 to identify patients with VAI secondary to cervical spine trauma. Demographic, clinical, and radiological data was collected to identify common traits in injury characteristics and management. Results1013 spine patients presented to our institution across the 10-year period. 739/1013 (72.9%) were trauma patients. 42/739 (5.7%) were imaged for suspected VAI secondary to trauma. There were 14/739 (1.9%) confirmed VAI. All patients had CT-angiography for diagnosis. Four of the confirmed VAI patients (28.6%) had additional MR-angiography imaging. Right-side was the most common side of VAI injury (7/14; 50%), followed by left (5/14; 35.7%) and bilateral (2/14; 14.3%) injuries. 8/14 (57.1%) patients were prescribed anti-thrombotic therapy. Acute mortality within 3-months was noted to be 2/14 (14.3%) and occurred at 49 days and 57 days respectively. ConclusionVAI associated with cervical spine injury is rare in occurrence. However, it can be associated with high morbidity and mortality. As such, a multi-disciplinary approach to care is integral to ensuring good outcomes in these patients.

Value of CT angiography in diagnosis and classification of spontaneous isolated superior mesenteric artery dissection and evaluation of its clinical symptoms

Value of CT angiography in diagnosis and classification of spontaneous isolated superior mesenteric artery dissection and evaluation of its clinical symptoms

The point-of-care D-dimer test provides a fast and accurate differential diagnosis of Stanford Type A aortic syndrome and ST-elevated myocardial infarction in emergencies

BackgroundThe research of the sensitivity and specificity point-of-care testing (POCT) of D-dimer as a diagnostic protocol for differential diagnosis of Stanford Type A aortic syndrome (hereafter as TAAS) mimicking ST-elevated myocardial infarction (STEMI) with regular STEMI in the emergency department is limited.MethodsFull medical information of 32 patients confirmed TAAS and 527 patients confirmed STEMI from January 1st, 2016 to October 1st, 2021 were retrospectively analyzed in Shanghai Tenth People’s Hospital of Tongji University.ResultsThe baseline characteristics of two groups of patients were well-balanced post propensity score matching (PSM) analysis, and each group had 32 patients enrolled. Patients in the STEMI group had higher positive cardiac troponin I (cTNI) (0.174 ng/ml vs. 0.055 ng/ml, P = 0.008) results but lower D-dimer (0.365μg/ml vs. 31.50μg/ml, P < 0.001) results than the TAAS group. The D-dimer cutoff value of 2.155μg/ml had the best sensitivity of 100% and specificity of 96.9%, and the positive predictive value (PPV) as well as the negative predictive value (NPV) of the cutoff value were 96.9 and 100%, respectively, in total 64 patients, the area under the curve (AUC) values were 0.998 (95% CI:0.992-1.000, P < 0.001) for the D-dimer. No significant correlation between the D-dimer concentration and the time from symptoms onset to first medical contact in both groups (TAAS group: r = − 0.248, P = 0.170; STEMI group: r = − 0.159, P = 0.383) or significant correlation between D-dimer and creatine clearance (TAAS group: r = − 0.065, P = 0.765; STEMI group: r = 0.222, P = 0.221). The total in-hospital mortality for the patients with TAAS presenting as STEMI was 62.5% (20/32). The mortality rate for TAAS patients confirmed by computed tomography angiography (CTA) was significantly lower (40% vs. 82.4%, P = 0.014) than the mortality rate for TAAS patients confirmed by coronary angiography (CAG) and had a longer average survival time (log-rank = 0.015), less peri-surgical complications especially gastrointestinal hemorrhage (0.00% vs. 55.6%, P < 0.001). CTA diagnosis can reduce the mortality rate by 67.5% (95%CI:0.124-0.850, P = 0.16).ConclusionsThe POCT D-dimer with cut-off 2.155μg/ml would be useful to rule-out TAAS mimicking STEMI from regular STEMI prior to reperfusion therapy. CTA diagnosis is effective in reducing the probability of perioperative complications and lowering perioperative mortality than CAG diagnosis in TAAS patients.

Application of dual-energy CT angiography in diagnosis of arterial erectile dysfunction: new scanning technology, new scanning area

Objectives To explore the value of dual-energy computed tomography (DE-CT) angiography in diagnosis of arteriogenic erectile dysfunction (ED) patients and feasibility of new scanning area that excludes the testis. Materials and methods Ninety-three patients suspected of suffering arterial ED and 40 health volunteers underwent penile duplex Doppler ultrasound and DE-CT angiography (DE-CTA). The scanning range of DE-CTA covered whole arterial system of pelvis and testis was excluded. Two blinded investigators independently evaluated the arterial system that supplies the penis. Results Finally, 1596 segments were evaluated and 470 segments were judged to be abnormal. The distribution was: 2 (0.4%) in common iliac artery, 7 (1.5%) in internal iliac artery, 82 (17.5%) in internal pudendal artery, 89 (18.9%) in penile artery, 120 (25.5%) in dorsal artery, and 170 (36.2%) in cavernosal artery. The specificity, sensitivity, positive predictive value, and negative predictive value of DE-CTA in diagnostic were 86.02%, 87.50%, 94.12%, and 72.92%. Besides, the new scan area allowed for effective evaluation of the arteries while excluding the testis. Conclusion DE-CTA can provide unbiased, safe evaluation of the vascular status of the penile bed in patients with ED.

Artificial Intelligence Algorithm-Based CTA Imaging for Diagnosing Ischemic Type Biliary Lesions after Orthotopic Liver Transplantation.

The study focused on the clinical application value of artificial intelligence-based computed tomography angiography (CTA) in the diagnosis of orthotopic liver transplantation (OLT) after ischemic type biliary lesions (ITBL). A total of 66 patients receiving OLT in hospital were selected. Convolutional neural network (CNN) algorithm was used to denoise and detect the edges of CTA images of patients. At the same time, the quality of the processed image was subjectively evaluated and quantified by Hmax, Ur, Cr, and other indicators. Then, the digital subtraction angiography (DSA) diagnosis and CTA diagnosis based on CNN were compared for the sensitivity, specificity, positive predictive value, negative predictive value, and patient classification results. It was found that CTA can clearly reflect the information of hepatic aorta lesions and thrombosis in patients with ischemic single-duct injury after liver transplantation. After neural network algorithm processing, the image quality is obviously improved, the lesions are more prominent, and the details of lesion parts are also well displayed. ITBL occurred in 40 (71%) of 56 patients with abnormal CTA at early stage. ITBL occurred in only 8 (12.3%) of 65 patients with normal CTA at early stage. Early CTA manifestations had high sensitivity (72.22%), specificity (87.44%), positive predictive value (60.94%), and negative predictive value (92.06%) for the diagnosis of ITBL. It was concluded that artificial intelligence-based CTA had high clinical application value in the diagnosis of ITBL after OLT.

Diagnostic accuracy of a revised computed tomography angiography score for brain death confirmation, combining supra-tentorial arteries and infra-tentorial veins

PurposeThe 4-point score is the corner stone of brain death (BD) confirmation using computed tomography angiography (CTA). We hypothesized that considering the superior petrosal veins (SPVs) may improve CTA diagnosis performance in BD setting. We aimed at comparing the diagnosis performance of three revised CTA scores including SPVs and the 4-point score in the confirmation of BD. MethodsIn this retrospective study, 69 consecutive adult-patients admitted in a French University Hospital meeting clinical brain death criteria and receiving at least one CTA were included. CTA images were reviewed by two blinded neuroradiologists. A first analysis compared the 4-point score, considered as the reference and three non-opacification scores: a “Toulouse score” including SPVs and middle cerebral arteries, a “venous score” including SPVs and internal cerebral veins and a “7-score” including all these vessels and the basilar artery. Psychometric tools, observer agreement and misclassification rates were assessed. A second analysis considered clinical examination as the reference. ResultsBrain death was confirmed by the 4-score in 59 cases (89.4 %). When compared to the 4-score, the Toulouse score displayed a 100 % positive predictive value, a substantial observer agreement (0.77 [0.53; 1]) and the least misclassification rate (3.03 %). Results were similar in the craniectomy subgroup. The Toulouse score was the only revised test that combined a sensitivity close to that of the 4-score (86.4 % [75.7; 93.6] and 89.4 % [79.4; 95.6], p-value < 0.001, respectively) and a substantial observer agreement. ConclusionsA score including SPVs and middle cerebral arteries is a valid method for BD confirmation using CTA even in patients receiving craniectomy.

Computed tomography angiography evaluation of acute limb ischemia.

Acute limb ischemia (ALI), a subclass of critical limb ischemia, is a medical emergency. The cause of ALI is usually thrombotic or embolic in nature, and the specific etiology often dictates the appropriate therapy. While the diagnosis is a clinical with common presenting symptoms, advances in ultrasound, computed tomography, and magnetic resonance technology have impacted the diagnosis and subsequent therapy. In ALI, the time to revascularization is critical and computed tomography angiography (CTA) provides a highly sensitive and specific technique for rapidly identifying occlusions and precisely defining vascular anatomy prior to interventions. In patients with significant renal disease, magnetic resonance angiography with or without contrast provides effective alternatives at the expense of imaging time. Treatment can include a variety of endovascular or surgical interventions, including thromboembolectomy, angioplasty, or bypass. Proper evaluation of the etiology of the ischemia, affected vasculature, and medical history is critical to select appropriate treatment and improve patient outcomes. Here, we examine the presentation, evaluation, and treatment of ALI and the role of CTA in diagnosis and therapy.

GW29-e1028 Clinical Value of Functional Stenosis Score with Coronary artery CT Angiography in Diagnosis of Coronary Heart Disease: a prospective study

To analyze the clinical value of functional stenosis score (FSS) with coronary CT angiography (CCTA) in diagnosis of coronary heart disease (CHD). A total of 1,200 patients with clinically diagnosed or suspected coronary heart disease were enrolled prospectively from January 2015 to April 2015. 248

Accuracy of Computed Tomographic Perfusion in Diagnosis of Brain Death: A Prospective Cohort Study.

BackgroundThis study was designed to determine diagnostic accuracy of computed tomographic perfusion (CTP) compared to computed tomographic angiography (CTA) for the diagnosis of brain death (BD).Material/MethodsWhole-brain CTP was performed in patients diagnosed with BD and in patients with devastating brain injury with preserved brainstem reflexes. CTA was derived from CTP datasets. Cerebral blood flow (CBF) and volume (CBV) were calculated in all brain regions. CTP findings were interpreted as confirming diagnosis of BD (positive) when CBF and CBV in all ROIs were below 10 mL/100 g/min and 1.0 mL/100 g, respectively. CTA findings were interpreted using a 4-point system.ResultsFifty brain-dead patients and 5 controls were included. In brain-dead patients, CTP results revealed CBF 0.00–9.98 mL/100 g/min and CBV 0.00–0.99 mL/100 g, and were thus interpreted as positive in all patients. CTA results suggested 7 negative cases, providing 86% sensitivity.In the non-brain-dead group, CTP results revealed CBF 2.37–37.59 mL/100 g/min and CBV 0.73–2.34 mL/100 g. The difference between values of CBF and CBV in the brain-dead and non-brain-dead groups was statistically significant (p=0.002 for CBF and p=0.001 for CBV). CTP findings in all non-brain-dead patients were interpreted as negative. This resulted in a specificity of 100% (95% CI, 0.31–1.00) for CTP in the diagnosis of BD. In all non-brain-dead patients, CTA revealed preserved intracranial filling and was interpreted as negative. This resulted in a specificity of 100% (95% CI, 0.31–1.00) for CTA in diagnosis of BD.ConclusionsWhole-brain CTP seems to be a highly sensitive and specific method in diagnosis of BD.

CT angiography for diagnosis and subcategorization of unroofed coronary sinus syndrome.

To evaluate the role of CT angiography (CTA) in the diagnosis and subcategorization of unroofed coronary sinus syndrome (URCS). We retrospectively analyzed 46 URCS patients diagnosed by CTA. Based on the defect location and size of coronary sinus (CS), URCS was divided into four types: complete defect as type I, partial defect of proximal CS as type II, partial defect of distal CS as type III, partial defect in which a communication occurs between CS and left atrial as type IV. According to presence of left superior vena cava (LSVC), all types were divided into 2 subtypes as a and b. All 46 patients underwent echocardiography. According to subcategorization of URCS by CTA, type I was observed in 23 cases (Ia 7, Ib 16), type II in 10 cases (IIa 3, IIb 7), type III in 12 cases (IIIa 3, IIIb 9), and type IV in 1 case classified as IVb subtype. In these 46 cases, 21 were detected by echocardiography as URCS (46%). The sensitivity of echocardiography in detecting URCS was significantly lower compared with cardiac CTA (P<0.05). In type I patients, the mean CS diameter indexed to body surface area (CS index) was larger than other types (P<0.05). Thirty patients were successfully treated by surgery and the diagnosis of URCS was confirmed by operative findings. Among them, data were available in 22 cases for analysis; and patients with types I, II and IIIa differ significantly from those with types IIIb and IV (P<0.05) with respect to surgical repair. CTA and imaging reconstruction can provide excellent anatomical delineation of the heart, great vessels, and CS, and allows for precise diagnosis of URCS. This CTA classification scheme of URCS is simple and easy to use, and has important clinical implications for diagnosis and treatment.

Efficacy of color doppler imaging over CT angiography in peripheral arterial disease

Introduction : PAD is an atherosclerotic occlusive condition in which plaque builds up in the distal arteries. Until 10 years ago, conventional angiography and digital subtraction angiography were the only angiographic techniques used in peripheral vascular disease and are considered gold standard. However, the complications and patient discomfort associated with these techniques have prompted the need of less invasive means of assessing the peripheral arterial system. Aim of the study was to compare efficacy of USG and MDCT angiography for investigating the lower limb arterial disease. Method: 40 patients suspected of lower limb PAD were included. Patients with previous amputation surgery were excluded. In all patients color Doppler sonography and multi-detector CT angiography was done. A comparative study of multi-detector CT angiography and color Doppler sonography was undertaken. Result: 50% patients had complaints in left lower limb and 25% in right lower limb. 22% had bilateral lower limb pain which was more on the left side (12%). Three patients examined by angiography showed irregularity of arterial wall on both sides, which appeared as calcifications on CT angiography (sensitivity 100%) while only 2 of them appeared on color coded Doppler examination (sensitivity 75%). Conclusions: Color Doppler USG is the initial modality of choice in PAD. CT Angiography is a better for segmental length assessment, collateral circulation along with a road map reproduction of the arterial system. USG is better than CT angiography in diagnosis of Grade 1 &2 cases, with better assessment of soft plaques, segmental flow and recanalization in PAD.

MR pulmonary angiography: Can it be used as an alternative for CT angiography in diagnosis of major pulmonary thrombosis?

ObjectiveA comparative study between the non contrast Magnetic Resonance pulmonary Angiography (MR-PA) and the Computed Tomography Angiography (CTA) in diagnosis of pulmonary embolism (PE). Patients and methodsFifty patients were included in our study. All patients were admitted and/or referred to Chest Department with moderate to high clinical suspicious of PE. All patients underwent CTA and non contrast MR-PA in the same day or within two consecutive days. The radiological examinations were interpreted by two different radiologists. The results were compared and statistically analyzed. ResultsThe mean age of the selected patients was about 55years old. Thirty-one cases showed positive PE in both MR-PA and CTA. Four cases showed positive PE only in CTA with 2 cases showing positive PE only in MR-PA. The rest cases showed negative results in both. The sensitivity of MR-PA was 88.5% with 86.6% specificity. The sensitivity and specificity were also calculated per vessel and were 87.2% and 99.3% respectively. ConclusionThe non contrast MR-PA has a reasonable sensitivity and specificity in the diagnosis of PE especially in major branches. So, it can be used as an alternative to the CTA especially when the CTA and the use of gadolinium are contraindicated.

The value of CT angiography in diagnosis of intracranial aneurysms

Objective To study the application value of multislice spiral CT angiography(MSCTA)in diag-nosis of intracranial aneurysms. Methods MSCTA was used to diagnose intracranial aneurysms in 40 patients with subarachnoid hemorrhage. Subtraction angiography digital（DSA）was used as the gold standard to evaluate the sensi-tivity，specificity and accuracy of MSCTA for diagnosis of intracranial aneurysms. Results In 40 patients,34 aneu-rysms were detected in 32 patients and they were all confirmed by incarceration of aneurysm. The aneurysms were detected in 33 cases by MSCTA, and the aneurysms were 34.Most of them were single(31 cases),1 case was multiple and 1 case was false positive. DSA was detected in 32 patients with 34 aneurysms, but single in 30 cases and multiple in 2 cases. DSA as the gold standard, the sensitivity, specificity and accuracy of MSCTA in diagnosis of intracranial aneurysms were 100%,87.50% and 97.50% respectively. MSCTA detected aneurysm neck width 1.85-4.33mm, average aneurysm neck width was(3.65±1.85)mm.DSA detected aneurysm neck width 1.52-4.48mm, average aneurysm neck width was(3.41±1.96)mm. The average tumor neck width detected by the two methods had no sta-tistically significant difference(t＝0.78,P＞0.05). But from the minimum of the detection, DSA still had certain advantages. Conclusion The sensitivity of MSCTA for intracranial aneurysmswas high. It can be used as a method for surgical treatment of intracranial aneurysms, but it still can not completely replace the DSA. Key words: CT angiography angiography; Digital subtraction angiography; Intracranial aneurysms

The value of 64-slice spiral CT angiography in diagnosis of the origin of abdominal large masses

Objective To investigate the value of 64-slice spiral CT angiography in diagnosis of the origin of abdominal large masses. Methods Twenty patients who were proven by operation and pathology to be abdominal massive tumor were collected in this study, tumor diameter average 17.8cm.All patients accepted plain and enhanced CT scanning, and their data were transferred to Philips IntelliSpace Portal.The tumor vessel were reconstructed with multiplanar reformation(MPR), maximum intensity projection(MlP), and volume rendering(VR). The origin of tumor were judged according to the feeding arteries by 2 attending physician, and the results were compared with pathology. Results Of these 20 cases,15 cases were malignant tumor,5 benign. Blood supply arteries were found in 19 patients,36 vessels. Lateral branch vessels in 6 cases and arteriovenous fistula in 4 cases. MSCTA findings were consistent with operation and pathology, with the accuracy of 90%. One case had no tumor vessel,one was misdiagnosed. Conclusion MSCT could be taken good use in diagnosis of large abdominal masses by tracking down the nourishing artery of masses. Key words: Abdomen; Large mass; Tomography, X-ray computed; Angiography

Abstract No. 364 - Celiac artery compression syndrome: review of causes and appearances

No. 364 Celiac artery compression syndrome: review of causes and appearances R. Florek, E.K. Lang, Dr, D. Beary, R. Tanenbaum, D. Casey, J. Gomez; Radiology, Lourdes Regional Medical Center, Lafayette, LA; Radiology, West Jefferson Medical Center, Marrero, LA; Radiology, SUNY Downstate Medical Center, New York, NY; Radiology, North Oaks Medical Center, Hammond, LA; Radiology, Tulane Univ. Medical Center, New Orleans, LA Purpose: To review the causes of celiac artery compression syndrome (CACS) with diagnostic CT angio appearance. Materials and Methods: Symptomatic and asymptomatic cases of celiac artery compression are reviewed to demonstrate the cause and extent of celiac narrowing and/or encasement. Recruitment of collateral flow channels can render CACS asymptomatic (1), depending on the amount of the collaterization, usually by the gastroduodenal artery (GDA) arcade, less commonly via the arcade of Roland, or from the left gastric artery. Results: Computed tomography angiography (CTA) of celiac artery compression syndrome can demonstrate a variety of causes: athersclerosis being the most common; followed by median arcuate ligament syndrome (MALS); mass effect by tumor, aneurism, or lymph nodes, and rarely by retroperitoneal fibrosis (RPF). Treatment options vary, depending on the cause; stenting is used for athersclerotic narrowing of the proximal lumen, surgical release of the median arcuate ligament is usually done laparoscopically (2), and tumor debulking can be done either surgically or by radiotherapy. Doppler ultrasound can be used to document the increase in flow after stenting or surgical release (3). RPF remains problematic as retroperitoneal encasement affect multiple organs. Conclusion: 1. CACS remains a clinical diagnosis, with flow deficits ranging from asymptomatic to debilitating, depending on development of collateral flow pathways. 2. CTA diagnosis of CACS is the most accurate way to demonstrate the etiology of CACS, visualizing both intraluminal and extrinsic causes, as well as collateralization of flow to the liver and proximal small bowel.

Mesenteric CT angiography for diagnosis of primary small intestinal space-occupying lesions

Mesenteric CT angiography for diagnosis of primary small intestinal space-occupying lesions

Diagnostic accuracy of contrast enhancement MRI versus CTA in diagnosis of intracranial aneurysm in patients with non-traumatic subarachnoid hemorrhage

Aim of the studyThe most common cause of spontaneous SAH is the rupture of cerebral aneurysm. So it is very important to exclude it from circulation as soon as possible using endovascular therapy. The aim was to determine whether contrast enhancement magnetic resonance angiography (CEMRA) is preferable to computed tomography angiography (CTA) in detection of intracranial aneurysm in patients presenting with non-traumatic subarachnoid hemorrhage (SAH). Patients and methodsTwenty-five patients who presented with non-traumatic SAH underwent CEMRA and CTA for detection of aneurysms. Digital subtraction angiography (DSA) was used as standard of reference. ResultsCEMRA and CTA were done for all patients. A total of 22 aneurysms were detected in 25 patients. 15 patients with single aneurysm, 2 patients with two aneurysms, one patient with 3 aneurysms and in 7 patients no aneurysm was found. CEMRA and CTA angiograms were interpreted for the detection of aneurysms, site and size. ConclusionThe diagnostic performance of CEMRA does not significantly differ from that of CTA in patients presenting with SAH.

Clinical utility and cost-effectiveness of CT-angiography in the diagnosis of nontraumatic subarachnoid hemorrhage.

CT-angiography gains an increasing role in the initial diagnosis of patients with nontraumatic subarachnoid hemorrhage (SAH). However, the implementation of CT-angiography does not always exclude the necessity of conventional angiography. Our objective was to determine the practical utility and cost-effectiveness of CT-angiography. All patients with nontraumatic subarachnoid hemorrhage admitted to our university hospital after implementation of CT-angiography between June 1, 2011 and June 30, 2012 were retrospectively analyzed in regard to factors of treatment flow, radiation exposure, harms of contrast medium loading, and diagnostic costs. A control group of the same size was assembled from previously admitted SAH patients, who did not undergo pretreatment CT-angiography. Furthermore, cost-effectiveness analysis was performed. The final analysis consisted of 93 patients in each group. Of 93 patients with pretreatment CT-angiography, 74 had to undergo conventional angiography for diagnostic and/or therapeutic purposes. CT-angiography had significant impact on the reduction of collective effective radiation dose by 4.419mSv per person (p = 0.0002) and was not associated with additional harms. Despite the significantly earlier detection of aneurysms with CT-angiography (p < 0.0001), there were no significant differences in the timing of aneurysm repair and duration of ICU and general hospital stay. There was an increase of diagnostic costs-the cost-effectiveness analysis showed, however, that benefits of CT-angiography in respect to radiation exposure and risk of conventional angiography-related complications justify the additional costs of CT-angiography. Although the implementation of CT-angiography in SAH diagnosis cannot completely replace conventional angiography, it can be approved in regard to radiation hygiene and cost-effectiveness.

Value of mesenteric CT angiography in diagnosis of small intestinal neoplasms

Objective To investigate the value of mesenteric vascular CTA in the diagnosis of small intestinal neoplasms.Methods A retrospective analysis of mesenteric CTA from January 2008 to April 2013 was conducted in 51 patients with pathologically proven small intestinal neoplasms.Features of intestinal neoplasms CTA signs including neoplasm feeding artery,draining vein,mesangial side vasa recta and the formed neoplasm vessels,were observed.Two radiologists individually used two methods,namely intestinal tumor feeding artery positioning method and Cole fractionation method,for diagnosis and localization diagnosis of tumor,and also for comparing the results with those of surgical pathology.McNemar Chi-square test was adopted to evaluate the diagnosis differences between the two physicians and between the two methods by the same physician.Kappa value was used to assess the consistency of the results.Results Features of intestinal tumors CTA signs:12 cases of enlarged neoplasm feeding artery,9 cases of early displayed draining vein,22 cases of enlarged mesangial side vasa recta,and 11 cases of vessels formed inside and around the neoplasm,single lesion for all and the largest lesion diameter≥ 5 cm for 37 cases.The accuracy of Cole fractionation method positioning and the feeding artery positioning were 84.31％(43/51) and 98.03％(50/51) respectively.Moderate consistency(Kappa=0.49,P＜0.01) was seen with Cole fractionation method by the two physicians and high consistency(Kappa=1.00,P＜0.01) with feeding artery positioning method.McNemar Chi-square test showed no significant difference between the two methods by the same physician and the consistency of the results from the two methods was passable(P were 0.062 and 0.125).Conclusion Mesenteric CTA can display the intestinal tumor feeding arteries and draining veins,and is helpful in identification of the relationship between the tumor and its surrounding blood vessels,which can improve the accuracy of pre-operative localization and qualitative diagnosis for small intestinal tumor. Key words: Mesentereric; Tomography, X-ray computed; Angiography

Predictors of Inaccurate Coronary Arterial Stenosis Assessment by CT Angiography

This study sought to investigate the clinical and imaging characteristics associated with diagnostic inaccuracy of computed tomography angiography (CTA) for detecting obstructive coronary artery disease (CAD) defined by quantitative coronary angiography (QCA). Although diagnostic performance metrics of CTA have been reported, there are sparse data on predictors of diagnostic inaccuracy by CTA. The clinical characteristics of 291 patients (mean age: 59 ± 10 years; female: 25.8%) enrolled in the multicenter CorE-64 (Coronary Artery Evaluation Using 64-Row Multi-detector Computed Tomography Angiography) study were examined. Pre-defined CTA segment-level characteristics of all true-positive (N = 237), false-positive (N = 115), false-negative (FN) (N = 159), and a random subset of true-negative segments (N = 511) for ≥50% stenosis with QCA as the reference standard were blindly abstracted in a central core laboratory. Factors independently associated with corresponding levels of CTA diagnostic inaccuracies on a patient level and coronary artery segment level were determined using multivariable logistic regression models and generalized estimating equations, respectively. An Agatston calcium score of ≥1 per patient (odds ratio [OR]: 5.2; 95% confidence interval [CI]: 1.1 to 24.6) and the presence of within-segment calcification (OR: 10.2; 95% CI: 5.2 to 19.8) predicted false-positive diagnoses. Conversely, absence of within-segment calcification was an independent predictor of an FN diagnosis (OR: 2.0; 95% CI: 1.2 to 3.5). Prior percutaneous revascularization was independently associated with patient-level misdiagnosis of obstructive CAD (OR: 4.2; 95% CI: 1.6 to 11.2). Specific segment characteristics on CTA, notably segment tortuosity (OR: 3.5; 95% CI: 2.4 to 5.1), smaller luminal caliber (OR: 0.48; 95% CI: 0.36 to 0.63 per 1-mm increment), and juxta-arterial vein conspicuity (OR: 2.1; 95% CI: 1.4 to 3.2), were independently associated with segment-level misdiagnoses. Attaining greater intraluminal contrast enhancement independently lowered the risk of an FN diagnosis (OR: 0.96; 95% CI: 0.94 to 0.99 per 10-Hounsfield unit increment). We identified clinical and readily discernible imaging characteristics on CTA predicting inaccurate CTA diagnosis of obstructive CAD defined by QCA. Knowledge and appropriate considerations of these features may improve the diagnostic accuracy in clinical CTA interpretation. (Diagnostic Accuracy of Multi-Detector Spiral Computed Tomography Angiography Using 64 Detectors [CORE-64]; NCT00738218).