Diagnostic Accuracy Of CT Scan Research Articles

EGS P42 Prospective diagnostic accuracy of Alvarado score and CT scan in evaluation of suspected appendicitis

Abstract Background Appendicitis is most common general surgical emergency with a life time risk of 7%.Appendicitis is considered as disease of the younger age group with only 5-10% of cases occurring in the elderly population. Ultrasound and CT scan are helpful in diagnosing acute appendicitis.The rationale of this study is to find out the group of patients based on the Alvarado score that will certainly benefit from the use of city scan. As CT is the preferred imaging modality in diagnosing acute appendicitis. Alvarado score is used to stratify patients into a subgroup that will certainly benefit from CT use. Methods Cross-sectional validation study was conducted for six months from (30/03/2017) to (30/09/2017) in Surgical unit-1, holy family hospital, Rawalpindi. Alvarado score was calculated, and the patients then underwent a contrast-enhanced CT scan. For the data of CT scan, patients were divided into two groups Positive and negative of appendicitis. All selected patients underwent an appendectomy. Histological specimens were collected and interpreted. All the collected data was entered and analyzed on SPSS version 19. Results The mean age of the patients was 28.93±10.21 years. The male to female ratio was 1:1.1. The mean Alvarado score was 6.05±0.68. The sensitivity, specificity and diagnostic accuracy of CT scan for diagnosing acute appendicitis was 84.75%, 78.69% & 81.67% respectively taking histopathology as the gold standard. Conclusions According to our study CT scan is a reliable and useful diagnostic tool at Alvarado score of 5-6 in males and 6-7 in females, in predicting acute appendicitis keeping histopathology as a gold standard.

Comparison of the diagnostic accuracy of CT scan with oral and intravenous contrast versus CT scan with intravenous contrast alone in the diagnosis of blunt abdominal trauma

PurposeAbdominal CT scan using oral and intravenous (IV) contrast is helpful in the diagnosis of intra-abdominal injuries. However, the use of oral and IV contrast delays the process of diagnosis and increases the risk of aspiration. It has also been shown that CT scan with IV contrast alone is as helpful as CT scan with oral and IV contrast and rectal CT scan in detecting abdominal injuries. Therefore, the present study aims to prospectively compare the diagnostic value of CT scan with oral and IV contrast versus CT scan with IV contrast alone in the diagnosis of blunt abdominal trauma (BAT). MethodsAltogether 123 BAT patients, 60 (48.8%) women and 63 (51.2%) men with the mean age of (40.4 ± 18.7) years who referred to the emergency department of Imam Khomeini Educational and Medical Center in Sari, Iran (a tertiary trauma center in north of Iran) from November 2014 to March 2017 and underwent abdominal CT scans + laparotomy were investigated. Those with penetrating trauma or hemodynamically unstable patients were excluded. The participants were randomly allocated to two groups: abdominal CT scan with oral and IV contrast (n = 63) and CT scan with IV contrast alone (n = 60). No statistically significant difference was found between two groups regarding the hemodynamic parameters, age, gender, injury mechanisms (all p > 0.05). The results of CT scan were compared with that of laparotomy results. The collected data were recorded in SPSS version 22.0 for Windows. Quantitative data were presented as mean and SD. ResultsThe sensitivity and specificity of CT scan using oral and IV contrast in the diagnosis of BAT were estimated at 96.48 (95% CI: 90.73 – 99.92) and 92.67 (95% CI: 89.65 – 94.88), respectively; while CT scan with IV contrast alone achieved a comparable sensitivity and specificity of 96.6 (95% CI: 87.45 – 99,42 and 92.84 (95% CI: 89.88 – 95.00), respectively. ConclusionCT scan with IV contrast alone can be used to assess visceral injuries in BAT patients with normal hemodynamics to avoid diagnostic delay.

Comparison of Diagnostic Accuracy of CT scan and USG in Right Upper Quadrant Pain: A Review Analysis

Purpose: Acute right upper quadrant (RUQ) pain is a common presenting symptom in emergency departments and outpatient medical practices, and is most commonly attributable to biliary and hepatic pathology. The main objective of the study is to systematically analyse the comparison of diagnostic accuracy of ultrasound and computed tomography in right upper quadrant pain. Material and methods: This study was conducted using a systematic search on Google scholar, Pubmed and Web of science published until 20th June 2020. The cited references of retrieved articles and previous reviews were also manually checked to identify any additional eligible studies with indexed search terms for cholecystitis, US, cholescintigraphy, CT, and MR imaging. Results: After excluding duplicates and articles that did not meet the inclusion criteria, we obtained 30 articles with full-texts which were read for further evaluation, where another 60 were excluded as irrelevant. Overall, we included 30 articles that directly match on the inclusion criteria. Conclusion: It is concluded that RUQ pain were not as good as sensitivities reported in prior studies. CT was statistically significantly better for the diagnosis of RUQ pain than US, most likely because of an unclear clinical picture, the patient population, and a high proportion of poor-quality US examinations. However, US is still our first test of choice if RUQ pain is suspected clinically, whereas CT is performed when the clinical picture is unclear.

A wolf in sheep’s clothing: concomitant appendicitis with occult cecal adenocarcinoma

We present the case of an 89-years-old female with an atypical presentation of an obstructive acute appendicitis secondary to a cecal carcinoma. The physical exam revealed a distended abdomen with bilateral lower quadrants tenderness without rebound or rigidity. CT scan demonstrated distal small bowel obstruction and ruptured acute appendicitis. Patient was treated conservatively with nasogastric decompression, intravenous fluids, and antibiotics. She later underwent CT guided drainage of a rim-enhancing fluid collection and her symptoms eventually resolved. She returned a week later and a CT imaging showed high grade distal small bowel obstruction, and findings were a 4.5 cm diameter cecal mass. She underwent an exploratory laparotomy and modified right hemicolectomy with ileostomy for. She had an uneventful postoperative course. Pathology revealed poorly differentiated adenocarcinoma of the cecum stage III T4N1Mx. Appendectomy for appendicitis is the most commonly performed emergency operation in the world. Appendicitis are often rare in elderly, with atypical or delayed presentation and expanded differential diagnosis, making preoperative diagnosis challenging. With the increase overall risk of cancer in this age group, occult colonic carcinoma should be high in the differential diagnosis. Three mechanisms potentially leading to obstruction of the appendiceal lumen by the tumor includes: immediate proximity to the lumen, inflammatory changes from the tumor, back pressure on the cecum causing obstruction of the appendix. Despite advances in imaging, local inflammation, collections, and masses may be misleading. The diagnostic accuracy of CT scan reportedly can be as low as 54% for cecal tumors.

Diagnosis of diaphragm injuries using modern 256-slice CT scanners: too early to abandon operative exploration

BackgroundMissed injury of the diaphragm may result in hernia formation, enteric strangulation, and death. Compounding the problem, diaphragmatic injuries are rare and difficult to diagnose with standard imaging. As such,...

A Large Spontaneous Esophageal Perforation Treated With Endoscopic Stent Placement

Esophageal perforations are extremely rare, with an incidence of 3.1 per 1,000,000 annually. About 15% are spontaneous, usually referred to as Boerhaave's syndrome, which occurs due to increased intraluminal pressure with inability of upper esophageal sphincter to relax during retching. However, a spontaneous perforation without such an inciting event is even more infrequent. An 88 year-old male with no prior medical history presented with chest pain, dyspnea and worsening acid reflux. Preliminary workup was concerning for a cardiac event, for which he underwent a cardiac catherization with stent placement. However, he continued to have chest pain, thus a CTA chest/abdomen/pelvis was performed, and revealed a likely hiatal hernia with significant reflux, however otherwise normal. Three days later a CXR showed a left pleural effusion, and eventually a CT chest revealed oral contrast in the left thorax with significant pneumomediastinum, suspicious for an esophageal perforation. He was transferred to the surgical ICU, kept NPO, started on empiric antibiotic, antifungal, and acid suppression therapy. The cardiothoracic surgical team placed two chest tubes. He then had an esophagram, showing a large esophageal defect with free extravasation of contrast into the mediastinum. Given that he was deemed a poor surgical candidate, he was taken to the OR for endoscopic stent placement. EGD revealed a large, 5cm perforation in the distal esophagus. No esophagitis or tumor was seen. Successful placement of two fully covered metal stents achieved adequate closure of the defect. Taking into account the lack of typical symptoms, typical inciting events, and overall patient tolerance of such a large perforation, this is a highly unusual case and suggests a possibly chronic underlying defect. Diagnosis of spontaneous esophageal perforation is often delayed as the classic triad of vomiting, chest pain and subcutaneous or mediastinal air, is only described in 50% of cases. Esophageal stents are an alternative to surgical treatment of perforations. Although esophageal stent placement successfully sealed the majority of our patients' perforation, a defect of this size will likely require surgical repair. This case emphasizes the importance of prompt recognition of a suspected esophageal perforation, the importance and diagnostic accuracy of CT scan with PO contrast and the potential role of fully covered metal stents as a therapeutic alternative to emergent surgery. Watch the video: https://goo.gl/fhkDGTFigure: CT chest/abdomen with IV and PO contrast demonstrating pneumomediastinum and oral contrast in the mediastinum.Figure: Fluoroscopic images from gastrograffin esophagram revealing large area of extravasation into the left mediastinum.

Diagnostic Accuracy of CT Scan in Diagnosing Paranasal Fungal Infection.

To assess the diagnostic accuracy of CTscan in detecting paranasal sinus fungal infections. Cross-sectional, observational study. Department of Radiology, Ziauddin University Hospital, Karachi, from April to September 2014. Patients with clinical suspicion of fungal sinusitis were included in this study. Patients with already diagnosed or history of recurrent fungal infections were excluded. All these patients underwent CTscan examination of paranasal sinuses. Findings were recorded. Final diagnosis was based on smear analysis for fungal culture. Accuracy analysis was conducted for CTdiagnosis using smear analysis as the gold standard. Kappa analysis was conducted to determine agreement. Out of the 120 patients, 71 (59%) were male. The sensitivity, specificity, positive predictive value and negative predictive value of CTwere 96.19%, 93.33%, 99.01%, 77.77%, respectively. The diagnostic accuracy was 95.83%. Kappa statistics showed 82% agreement beyond chance. CTscan is highly accurate in diagnosing and characterizing fungal infection of paranasal sinuses. It also determines the extent of disease which eventually aids in deciding the surgical approach to be used.

Role of Computed Tomography in the Pre operative Diagnosis of Clear Cell Renal Carcinoma

Background: Renal cell carcinoma (RCC) accounts for 3% of all human malignant tumors. The behavior of RCC apparently depends on its subtype. CT scan can provide detailed information about the tumor itself and regarding its precise extension. The pre-histological diagnosis of clear cell renal carcinoma could be made with more precision on the basis of CT scan features and would ultimately play a major role in the prognosis and management of the disease. Objective: To determine the diagnostic accuracy of computed tomography in the diagnosis of clear cell renal carcinoma taking histopathological findings as gold standard. Methods: Total 100 patients had renal mass were included. All patients underwent contrast enhanced CT scan. On the basis of CT scan features a pre-surgical diagnosis of histological subtype of RCC, clear cell renal carcinoma was made. The patients were followed by nephrectomy. The diagnostic accuracy of CT scan was determined. Results: The male to female ratio was 3.2:1.0. Out of total study subjects 85.0% patients turned out to be renal cell carcinomas and among these 40 (47%) were right sided and 45 (53%) were left sided. The mean size of tumor was 12.75 cm. The sensitivity, specificity, and diagnostic accuracy of CT scan were 89.0%, 72.7%, and 86.0% respectively. Conclusion: The CT scan was helpful in diagnosing clear cell renal carcinoma. The most valuable parameter was the degree of enhancement of clear cell renal carcinoma with other parameters playing supplemental role.

367 Acute Care Diagnostic Collaboration: Bayesian Comparative Assessment of Diagnostic Accuracy of CT Scan and Ultrasonography in the Diagnosis of Urolithiasis After the Application of the STONE Score

367 Acute Care Diagnostic Collaboration: Bayesian Comparative Assessment of Diagnostic Accuracy of CT Scan and Ultrasonography in the Diagnosis of Urolithiasis After the Application of the STONE Score

CARCINOMA OF LARYNX

Objectives: The objective of this study was to determine the diagnosticaccuracy of CT scan in detecting thyroid cartilage invasion by carcinoma of larynx keepinghistopathological findings as a gold standard. Study Design: Cross sectional and descriptivestudy. Setting: Department of Radiology of LUMHS, And Karachi Institute of Radiotherapy &Nuclear Medicine. Period: February 2013 to August 2015. Subjects and Methods: Overall 86patients were incorporated in this study. All these patients subsequently had their histopathology.The CT outcomes were then contrasted with histopathological results & measures of variablescalculated, were based on the results. Results: Fifty patients were men & 36 patients werewomen. The ages varied from 31 to 65yrs with mean age of 50yrs. The specificity & sensitivityof CT in diagnosing thyroid cartilage invasion was 84.5% and 93.3% respectively. Accuratenessof CT in diagnosing thyroid cartilage invasion was 86.05%. Conclusion: The study establishedthe specificity, sensitivity, negative as well as positive predictive value and accuracy of CTscan for the detection of thyroid cartilage invasion as 84.5%, 93.3%, 98.4%, 56% and 86.05%respectively. Very low negative predictive value was found in patients of age more than 50 years.

English

Objectives: The objective of this study was to determine the diagnostic accuracy of CT scan in detecting thyroid cartilage invasion by carcinoma of larynx keeping histopathological findings as a gold standard. Study Design: Cross sectional and descriptive study. Setting: Department of Radiology of LUMHS, And Karachi Institute of Radiotherapy & Nuclear Medicine. Period: February 2013 to August 2015. Subjects and Methods: Overall 86 patients were incorporated in this study. All these patients subsequently had their histopathology. The CT outcomes were then contrasted with histopathological results & measures of variables calculated, were based on the results. Results: Fifty patients were men & 36 patients were women. The ages varied from 31 to 65yrs with mean age of 50yrs. The specificity & sensitivity of CT in diagnosing thyroid cartilage invasion was 84.5% and 93.3% respectively. Accurateness of CT in diagnosing thyroid cartilage invasion was 86.05%. Conclusion: The study established the specificity, sensitivity, negative as well as positive predictive value and accuracy of CT scan for the detection of thyroid cartilage invasion as 84.5%, 93.3%, 98.4%, 56% and 86.05% respectively. Very low negative predictive value was found in patients of age more than 50 years.

The Alvarado score versus computed tomography in the diagnosis of acute appendicitis: A prospective study

BackgroundTo assess and compare performance of the Alvarado score and computed tomography scan in the diagnosis of acute appendicitis at King Hussein Medical Center. MethodsA total of 320 patients with suspected acute appendicitis were included in this study over a period of 2 years. The Alvarado score was calculated for all of these patients and 112 CT scans were requested selectively by surgeons caring for the patients. The histopathology diagnosis was used as the gold standard against which diagnostic performance of Alvarado score and CT scan were compared. ResultsThe complete data of 196 males and 124 females were analyzed at the end of the study period. The mean age was 26.1±11.3 years. Appendectomy was performed in 263 patients with a negative appendectomy rate of 14.83% overall (12.28 in males and 19.56 in females). The remaining 57 patients were assumed to have no appendicitis. The diagnostic performance of CT scan was superior to that of Alvarado score with sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio of 94.2 versus 85.4%, 90 versus 65%, 9.42 versus 2.44, and 0.065 versus 0.224, respectively (p-value<0.05). The overall diagnostic accuracy of CT scan was 92.6% compared to 77.5% for Alvarado score. ConclusionThe Alvarado score was far from good and CT scan is more accurate in diagnosis of acute appendicitis in our patient population.

The Diagnostic Accuracy of CT Scan in Evaluation of Gallbladder Carcinoma

Objective: To determine the diagnostic accuracy of CT scan in evaluation of Gallbladder Carcinoma (GBC) taking histopathology as gold standard. Study Design: Cross sectional, Descriptive study. The study was conducted at Department of Radiology, Dow Medical Collage and Civil Hospital, Karachi from 1st January 2014 to 31st December 2014. Materials and Methods: This study comprises 434 patients of either gender, age between 30 to 70 years, with history of jaundice, pain in right hypochondrium / epigastrium and weight loss with suspicion of carcinoma gall bladder, referred to the Radiology Department of Civil Hospital Karachi over a period of 12 months. Post operated cases without CT scan and patients allergic to the contrast material were excluded from the study. Patients who fulfilled the above mentioned criteria, followed to CT scan with intravenous contrast and findings were documented. Patients were referred for surgery. During surgery sample for histopathology was taken which was used as gold standard. Data were entered and analyzed using computer program SPSS- 21. Descriptive statistics were applied to calculate mean and standard deviation for the quantitative variables. The sensitivity, specificity; positive predictive value, negative predictive value, and diagnostic accuracy of CT scan were calculated. Results: Out of 434 patients there were 183(42%) male and 251(58%) female patients in this study. The overall mean age was 53.37±7.18 years with range 28 (38–66) years. With histopathological findings gallbladder carcinoma (GBC) was found positive in 292 patients and with CT scan findings gallbladder carcinoma (GBC) was found positive in 285 patients. The mean age of patients with positive histopathological findings for gallbladder carcinoma (GBC) was 54.36±6.95 years and the mean age of patients with positive CT scan findings for gallbladder carcinoma was 53.51±7.28 years. 274 patients were true positive and 132 patients were true negative. Sensitivity, specificity, PPV, NPV and accuracy were 94.2%, 92.3%, 96.1%, 88.6%, and 93.5% respectively. Conclusion: The use of computed tomography can help early diagnosis of GBC. Contrast enhanced MDCT was effective in identifying the criteria for resectabilityof the tumor and in disease staging. The histopathological diagnosis of the present study correlated well with CT scan in diagnosis of gallbladder malignancy.

Evaluation of the diagnostic accuracy of CT scan of the abdomen and thorax compared with DXA as the standard reference in patients with suspected osteoporosis

Osteoporosis is the most widespread metabolic bone diseases, which can reduce bone strength and increases risk of bone fracture. Diagnostic methods have been improved in recent decades in a way that the disease are diagnosed prior to the fracture. The basis of diagnosis is BoneMineral Densitometry (BMD) measurement, which is defined by WHO Committee. A small number of studies have been carried out on BMD using findings of MDCT. This study intends to examine BMD of persons over 50 years old of age, by using abdomen and thoracic CT scan and DEXA as a standard reference. This analytic epidemiologic study examines 105 persons aged over 50 years old who referred to magnetic resource imaging center of Imam Khomeini Hospital (Ahwaz, Iran) for thoracic CT scanning (2014-1015). Abdomen and thoracic CT scan is performed by using MDCT (16 slices) in Imam Khomeini Hospital through daily calibration for ensuring precision of spinal CT attenuation, which is an indication of grounded BMD. Hounsfield number of the first lumbar spine (L1 of HU) and spines of L1-L4 are measured in thoracic images and abdominopelvic images by mapping Region of Interest (1cm2) in trabecular bone of middle level of spine and avoiding spinal venous level. DEXA of the first lumbar spine is performed by using Osteosys DEXAMUTT. Then, HU findings of CT scan are compared with DEXA results and are statistically analyzed. Present study patients are 40 normal persons, 48 Osteopenia patients, and 17 Osteoporosis patients. ROC analysis indicates in a case that L1 of Hu is greater than 159.5, the persons are diagnosed as normal. Otherwise, they are Osteopenia and/or Osteoporosis. Where L1 of Hu is greater than 101.5, the persons are diagnosed as normal or Osteopenia. Conversely, they are viewed as Osteoporosis. This result is also true for L2-L4. HU and DXA can e replaced with each other in clinical conditions. Generally, CT scan can effectively diagnose Osteopenia and Osteoporosis especially in females. Risky persons should be studied for preventing unsatisfied consequences such as fracture.

The Diagnostic Accuracy of CT Scan in Evaluation of Gallbladder Carcinoma

The Diagnostic Accuracy of CT Scan in Evaluation of Gallbladder Carcinoma

Sa1498 Diagnostic Accuracy of CT Scan in Predicting Endoscopic GI Pathology

Incidental CT scan findings, such as bowel wall thickening or mass lesions, are common radiological findings on CT scans performed in the ER. Abnormal findings on CT scan often prompt further evaluation with esophagogastroduodenoscopy (EGD), small bowel enteroscopy (SBE) or colonoscopy. The clinical significance of such findings is debatable with conflicting results. Previous studies have shown a correlation of abnormal CT scan with colonoscopic findings of 55-74%. Currently, there are no evidenced-based guidelines on follow-up of patients with abnormal CT scan findings.

Surgery in adhesive small bowel obstruction on basis of computed tomography: A prospective analysis

Background: Adhesive small bowel obstruction (ASBO) is the commonest form of small bowel obstruction. The treatment regime for ASBO is not universal. Contrast-enhanced computed tomography (CECT) has been advocated as a valuable procedure to evaluate ASBO. The aim of the present study was to evaluate the contribution of CECT in decision making in the management of patients with ASBO due to postoperative adhesions. Materials and Methods: The duration of this study was 2 years. All patients clinically diagnosed as ASBO with history of clinical symptoms for more than 24 h and any abdominal operation more than a month ago were included in this study. They underwent CECT, which was evaluated for the presence of dilated bowel loops proximal to the transition zone and collapsed distal small bowel loop, presence of complication viz. strangulation and closed loop/volvulus. Results: A total of 30 patients was evaluated. Based on CT findings, the level of obstruction was determined in all the 30 patients. The level of obstruction could be confirmed in nine patients, in which laparotomy was performed, and was same. Complicated small bowel obstruction was predicted in ten patients. The diagnostic accuracy of CT scan was excellent having sensitivity of 100%, specificity of 95.3%, and accuracy of 96.7%. Conclusion: Contrast-enhanced computed tomography abdomen appears to be a safe, quick to perform, and reliable adjunct to clinical examination in the management of patients with ASBO. It is sensitive, specific, and accurate for diagnosis of obstruction, detection of level of obstruction, and complication of obstruction. CT scan appears to be able to sort patients of complicated ASBO, who will require immediate surgical management.

Accuracy of diagnosis on CT scan of Surgicel® Fibrillar: results of a prospective blind reading study

ObjectiveOxidized regenerated cellulose is a hemostatic agent used in surgery to control bleeding. Some case reports have suggested that it could lead to a mistaken diagnosis of abscess on postoperative CT scan. The objective of this study was to evaluate the diagnostic accuracy of CT scan for Surgicel® Fibrillar. Study designWe prospectively registered all patients who had Surgicel® Fibrillar left in the operative site during one year. Patients who had a CT scan for medical reasons (e.g. fever, pain, or occlusive syndrome) were evaluated and we compared the radiologists’ conclusions with or without information about the use of Surgicel® (two different radiologists, one blinded to the use of Surgicel®). Results18 patients who underwent pelvic laparotomy had Surgicel® Fibrillar left in the operative site. On first interpretation, the radiologist's conclusion was an abscess in 11% of cases, hematoma in 28%, collections with hydro-aeric levels in 33%, lymphocele in 6% and no conclusion in 11% of cases. For only 2 patients (11%) was the conclusion Surgicel® Fibrillar. After second interpretation by a radiologist aware of the presence of Surgicel® Fibrillar, Surgicel® Fibrillar was the main conclusion on 15 CT scans (83%). ConclusionOxidized regenerated cellulose is a differential diagnosis for abscess or collection. The radiologist should be informed about its presence to increase appropriate evaluation of CT scans and avoid inappropriate treatment.

Diagnostic Accuracy of CT in Paediatric Intracranial Neoplastic Lesions – Radiologic and Pathologic Correlation

Background: The frequency of paediatric tumours in developing countries could be attributed to the incre-ased percentage (39% of total population of children) in the overall population. Therefore, extensive resear-ches should be under taken in the field of Paediatric Oncology in the third world. Objective: This study was conducted to determine the diagnostic accuracy of CT by comparing the pre-ope-rative radiological findings of paediatric brain tumours with post-operative histopathological findings on the basis of characteristic radiological features of various tumours. Materials and Methods: This was a hospital based prospective, cross-sectional and descriptive study car-ried out in Radiology Dept, KEMU / Mayo Hospital, Lahore. Study was conducted over a period of 3 years from June 2005 till June 2008 and comprised of 100 cases of paediatric brain tumours up to 12 years of age. Cases were also collected from Mayo and Children Hospital, Lahore. Results: Topographically, supratentorial tumours were found more than infratentorial 55 : 45. Low grade were more common than high grade 73 : 27. The most common tumour was astrocytoma with 52 cases. Medulloblastoma ranked the second with 16 cases fol-lowed by craniopharyngioma with 12 cases. Conclusion: The diagnostic accuracy of CT scan was found to be 83% when correlated with histopathology. CT proved fairly accurate in detection of paediatric intracranial neoplastic lesions. As CT is relatively commonly available inexpensive modality than MRI so it can be used as non invasive imaging modality. Key words: Paediatric brain tumour, Characteristic CT features, Diagnostic accuracy.

The value of chest CT scan and tumor markers detection in sputum for early diagnosis of peripheral lung cancer.

To investigate the diagnostic value of chest CT scan combined with telomerase activity and p16 gene methylation from exfoliated cells of sputum in 55 cases of solitary pulmonary nodules (SPN; ≤30 mm)suspected early peripheral lung cancer. The sputum specimens from 34 cases of cancer nodules and 21 cases of benign lesion were detected for telomerase activity by TRAP-PCR-ELISA and p16 gene methylation by PCR-based methylation analysis. The qualitative diagnostic accuracy of CT scan was 61.8%(34/55) for SPN provided by pathology. Cytology analysis of sputum was positive in 13 cases (38.2%). Telomerase activity was positive in 29 cases: sensitivity was 79.4%, specificity was 90.5%, accuracy was 83.6%; p16 gene methylation was found in 11 cases: sensitivity was 32.4%, specificity was 100.0%, and accuracy was 58.2%. The sensitivity was increased to 86.1% by combination of telomerase activity and p16 gene methylation. Compared with nodules without malignant CT signs, expression of telomerase activity and p16 methylation of SPN with malignant CT signs (lobulation or spiculate protuberance or spicule sign) had a significant difference (P < 0.01). The results suggest that chest CT scan combined with telomerase activity and p16 gene methylation detection in sputum for patients with peripheral lung cancer may enhance the diagnostic value of radiology and conventional cytology.