CT In Evaluation Of Patients Research Articles

Comparison between Trans-Abdominal Ultrasound and Multislice CT in Evaluation of Patients with Suspected Intestinal Obstruction

Comparison between Trans-Abdominal Ultrasound and Multislice CT in Evaluation of Patients with Suspected Intestinal Obstruction

Low-dose CT for diagnosing intestinal obstruction and pneumoperitoneum; need for retakes and diagnostic accuracy.

BackgroundOne of the main concerns using low-dose (LD) CT for evaluation of patients with suspected intestinal obstruction or pneumoperitoneum is the potential need to make an additional standard-dose (SD) CT scan (retake) due to insufficient diagnostic accuracy of the LD CT.PurposeTo determine the frequency of retakes and evaluate the diagnostic accuracy of LD CT for the assessment of intestinal obstruction and pneumoperitoneum.Material and MethodsThis retrospective study registered all LD CT scans over a one-year period at Aarhus University Hospital, Denmark in patients with suspected intestinal obstruction or perforation, comprising a total of 643 LD CT scans. A retake was defined as a SD CT scan of the abdomen and pelvis performed with or without intravenous contrast within 72 h after the initial LD CT due to either continued suspicion of intestinal obstruction or perforation or due to unclarified secondary findings. The sensitivity and specificity of LD CT for diagnosing intestinal obstruction and pneumoperitoneum compared to the discharge diagnoses of the scanned patients were determined.ResultsThe frequency of retakes was 3%. The overall LD CT sensitivity and specificity for assessment of patients with suspected intestinal obstruction and pneumoperitoneum was 83% and 99%, respectively, but higher in certain subgroups.ConclusionsLD CT led to few retakes and had a high diagnostic accuracy for diagnosing intestinal obstruction and pneumoperitoneum. Thus, LD CT can be recommended as the examination of choice in patients with suspected intestinal obstruction or perforation in order to reduce radiation dose.

Survey on practice patterns in imaging utilization in patients with Crohn's disease

PurposeTo perform a survey-based assessment of imaging practice preferences in Crohn's disease (CD). MethodsAn internet-based questionnaire was sent to physicians involved in CD care. The questionnaire addressed the experience, practice patterns, choice of modality, and recent trends in imaging utilization. ResultsThe response rate was 7.57% (122/1598) with 43.8% of respondents involved in care of CD for ≥10 years. CT was mostly preferred by ED physicians, internists and primary care physicians, while MRI by gastroenterologists and pediatricians. Practitioners from non-teaching facilities had higher preference for CT (CT:42% andMR:27%), compared to teaching/academic hospitals (MR:45% and CT: 40%) (p = 0.06). MR was preferred by pediatric practitioners compared to physicians serving older age group of patients (>16 yrs) (p = 0.01). CT was preferred by physicians taking care of <50 patients/year (CT:37, MR:27, No preference = 19) and MR preferred by physicians serving ≥50 patients/year (CT:12, MR:21, No preference:3)(p = 0.02). CT/CT enterography was the most widely used exam (93.3%) and preferred modality for evaluation of acute CD exacerbation (87.7%), followed by assessment for new symptoms (73.7%) and extra-intestinal manifestations (61.3%). MR/MR enterography (58%) was more preferred for asymptomatic CD patients for disease surveillance.Nearly 80% of respondents reported a change in imaging preferences, 46.5% respondents indicating growing preference for MRI while 33.3% reported increasing preference for CT. 29.6% physicians reported a patient preference for MRI over CT (13%) with the most common factor for choice of MRI being fear of harmful effects of radiation (60.2%). ConclusionPhysician practices reported continued preference for CT in evaluation of patients with CD, particularly for evaluation of acute exacerbation, new symptoms or extra-intestinal manifestations. Physician providers with large practice volume, younger patient population and GI sub-specialty expertise report growing MRI utilization.

Role of EPI-FLAIR in Patients with Acute Stroke: A Comparative Analysis with FLAIR

Further improvement in acquisition speed is needed, if MR imaging is to compete with CT for evaluation of patients with acute ischemic stroke. The purpose of this study was to evaluate the feasibility of implementing an echo-planar fluid-attenuated inversion recovery (EPI-FLAIR) sequence into an acute MR stroke protocol with potential reduction in scan time and to compare the results with conventional FLAIR images. Fifty-two patients (28 men and 24 women; age range, 32-96 years) with acute ischemic stroke were prospectively evaluated with an acute stroke MR protocol, which included both conventional FLAIR and EPI-FLAIR imaging with integration of parallel acquisition. The image acquisition time was 52 seconds for EPI-FLAIR and 3 minutes for conventional FLAIR. FLAIR and EPI-FLAIR studies were assessed by 2 observers independently for image quality and conspicuity of hyperintensity in correlation with DWI and were rated as concordant or discordant. Coregistered FLAIR and EPI-FLAIR images were evaluated for signal intensity ratio of the DWI-positive lesion to contralateral normal white matter. An estimated 96% of all FLAIR and EPI-FLAIR studies were rated of diagnostic image quality by both observers, with interobserver agreements of κ = 0.82 and κ = 0.63 for FLAIR and EPI-FLAIR, respectively. In 36 (95%) of 38 patients with acute infarction, FLAIR and EPI-FLAIR were rated concordant regarding DWI lesion. The mean ± standard deviation of the signal intensity ratio values on EPI-FLAIR and FLAIR for DWI-positive lesions were 1.28 ± 0.16 and 1.25 ± 0.17, respectively (P = .47), and demonstrated significant correlation (r = 0.899, z value = 8.677, P < .0001). In patients with acute stroke, EPI-FLAIR is feasible with comparable qualitative and quantitative results to conventional FLAIR and results in reduced acquisition time.

Assessing the use of routine abdominal CT in staging evaluation of patients with primary breast cancer.

3 Background: The purpose of this study was to determine the utility of routine abdominal CT in the staging evaluation of women with newly diagnosed primary breast cancer given no detectable disease beyond the ipsilateral axillary nodes on chest CT. Methods: The chest and abdominal CT scans from 440 patients over a 10-year period were reviewed. The presence of definite or possible metastatic disease in the axillary nodes, chest wall, internal mammary nodes, mediastinal nodes, lungs, liver and adrenals were recorded for each patient. Cross tabulation bivariate analysis as well as a chi-square test were performed to characterize the relationship between detection of disease in the chest and disease in the abdomen. Results: Of the 440 patients reviewed, the following were found to have detectable metastatic disease by CT scan: axillary nodes 258 of 440 (56.46%), chest wall 40 of 440 (9.10%), internalmammary nodes 8 of 440 (1.82%), mediastinal nodes 29 of 440 (6.59%), lung 25 of 440 (5.68%), liver 12 of 437 (2.73%), and adrenals 8 of 440 (1.82%). In total, 81 patients had disease detectable in the chest beyond the ipsilateral axillary nodes, and only 12 patients had detectable disease spread in the abdomen. Of the 359 patients who had a negative chest CT, only 1 patient had detectable or possible metastatic disease spread on abdominal CT, resulting in a 99.70% negative predictive value (p &lt; 0.001). Conclusions: The routine use of abdominal CT in women with newly diagnosed primary breast cancer and no detectable disease beyond the ipsilateral axillary nodes on staging chest CT scan has little value with a 99.70% negative predictive value. We recommend that if a negative CT scan of the patient’s chest yields no detectable disease beyond the axillary nodes, then further CT imaging of the abdomen is of no additional benefit to the patient. [Table: see text]

Comparison between multislice CT and MR imaging in the diagnostic evaluation of patients with pancreatic masses

This study compared the results of multislice computed tomography (MSCT) and high-field magnetic resonance imaging (MRI) in the diagnostic evaluation of pancreatic masses. Forty patients with clinical and ultrasonographic evidence of pancreatic masses underwent MSCT and MRI. The majority of patients (31/40, 78%) had proven malignant pancreatic tumours (24 ductal adenocarcinoma, six mucinous cystadenocarcinoma, one intraductal papillary mucinous carcinoma), whereas the remaining patients (9/40, 22%) were found to have benign lesions (eight chronic pancreatitis, one serous cystadenoma). Results of the imaging studies were compared with biopsy (n=33) and/or histology (n=7) findings to calculate sensitivity, specificity, accuracy and positive (PPV) and negative (NPV) predictive value for correct identification of tumours and evaluation of resectability of malignancies. Both for tumour identification and resectability, MSCT and MRI had comparable diagnostic accuracy, with no statistically significant differences between them. Tumour identification CT/MRI: accuracy 98/98%, sensitivity 100/100%, specificity 88/88%, PPV 97/97%, NPV 100/100%; tumour resectability CT/MRI: accuracy 94/90%, sensitivity 92/88%, specificity 100/100%, PPV 100/100%, NPV 78/70%. MRI represents a valid diagnostic alternative to CT in the evaluation of patients with pancreatic masses, both for correct identification and characterisation of primary lesions and to establish resectability in the case of malignancies. New high-field MRI equipment allows optimal imaging quality with good contrast resolution in evaluating the upper abdomen.