Diagnostic Accuracy Of Multidetector-row Computed Tomography Research Articles

Diagnostic accuracy of multi detector-row computed tomography (MDCT) and endoscopic ultrasound (EUS) for clinical N staging in early gastric cancer.

17 Background: An accurate preoperative assessment of potential lymph node metastasis is useful in the decision for the treatment strategy of early gastric cancer. The aim of this study was to retrospectively evaluate the accuracy of preoperative assessment of lymph node status with multi detector-row computed tomography (MDCT) and endoscopic ultrasound (EUS). Methods: We had analyzed 1,104 patients with early gastric cancer who underwent gastrectomy with lymph-node dissection at Seoul National University Bundang Hospital from May 2003 to July 2011. Patients were underwent preoperative MDCT in 1,104 and EUS in 1,028. Lymph nodes were considered positive for metastasis if they were larger than 8mm in the short axis diameter of MDCT. The criteria of EUS for metastatic lymph nodes are rounded nodes larger than 8 mm diameter with hypoechogenicity. The clinical N staging of preoperative MDCT and EUS was compared to the postoperative pathological finding. Results: The overall diagnostic accuracy of MDCT and EUS for determining lymph node metastasis was 89.1% and 90.5%. In MDCT, the rate of overestimation of lymph node metastasis was 8.20% (91/1104) and underestimation was 8.7% (96/1104). Tumor size (>2cm) was significant related with overestimation (p=0.007). Underestimation of clinical N staging was related with female (p=0.025, OR 2.025), lymphovascular invasion (p<0.0001, OR 7.807), positive EGFR (p=0.015, OR 2.566) and tumor size (>2cm) (p=0.009, OR 3.221). In EUS, overestimated lymph node metastasis was 5.40% (56/1028) and underestimation was 9.6% (99/1028). No factor was significantly related with overestimation. Underestimation of lymph node metastasis was related with female (p=0.020, OR 2.049), lymphovascular invasion (p<0.0001, OR 11.716), positive EGFR (p=0.024, OR 2.489) and tumor size (>2cm) (p=0.020, OR 2.774). Conclusions: For preoperative assessment of lymph node metastasis in early gastric cancer, MDCT and EUS showed high diagnostic accuracy. Both MDCT and EUS, female, lymphovascular invasion, positive EGFR, large tumor size (>2cm) were related to underestimation of clinical N staging. We proposed that careful attention is required to choose treatment based on clinical N staging by MDCT and EUS.

The Role of Multidetector Row Computed Tomography in Biliary Tract Malignancy

Early diagnosis of biliary tract tumors is important in accurate staging, to choose the best possible treatment and improve their prognosis. Multidetector row Computed Tomography is an ideal method to evaluate patients with suspected biliary tract obstruction and thereby biliary tract malignancy. Aims and Objective: To evaluate the accuracy of Multidetector row Computed Tomography (MDCT) in evaluation of level of obstruction and to study the imaging features of various causes of biliary tract malignancy. Material and Method: MDCT of 40 patients with clinically suspicion of biliary tract obstruction were prospectively reviewed and only malignant causes were included in the study. Final diagnosis was based on endoscopic retrograde cholangiopancreatography, surgical and histopathological diagnosis. The MDCT diagnosis and final diagnosis was compared for level and imaging features of malignant lesions. Results: The sensitivity, specificity, PPV, NPV and diagnostic accuracy of MDCT in determining the level of malignant obstruction is 100%, 83.33%, 97.77%, 100%, 98%, and cause of malignant obstruction is 97.73%, 83.33%, 97.72%, 83.33%, 96%. MDCT with its high sensitivity and specificity values plays an essential role in the diagnosis of malignant tumors of biliary tract and for the evaluation of therapeutic options. Conclusion: MDCT has a vital role to play in biliary tract malignancy with its high degree of accuracy in establishing the level of obstruction and in defining the imaging features of the malignant lesions.

Multi-detector Row Computed Tomography (MDCT) versus Endorectal Coil Magnetic Resonance Imaging (ECMRI) in Staging of Carcinoma Rectum

BACKGROUND: Rectal cancer is one of the most common tumors in industrialized countries and one of the most common malignant tumors of the gastrointestinal tract.
 OBJECTIVE: To compare the diagnostic accuracy of MDCT and ECMRI in preoperative staging of rectal cancers and correlation with intraoperative and histo-pathologic staging of resected specimen with respect to depth of tumor invasion (T-staging), lymph node metastasis (N- staging), and extra rectal spread (M-staging).
 METHODS: The study was a prospective one and consisted of 68 patients with biopsy proved rectal carcinoma. Patients were randomly selected for either of these two staging modalities (i.e., MDCT or ECMRI) using a random number table. MDCT and ECMRI findings were compared with intraoperative and histopathologic (reference standard) findings. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of each diagnostic modality were assessed.
 RESULTS: The diagnostic accuracies of MDCT and ECMRI for T1/T2 lesions were 75% and 87.5%, respectively, the difference being significant. For T3 lesions, the diagnostic accuracies of MDCT and ECMRI were 85.2% and 100%, respectively. The diagnostic accuracy of both for T4 lesions was found to be 100%. Both ECMRI and MDCT were found to be almost equally accurate and specific in detecting perirectal lymph node involvement.
 CONCLUSION: Endorectal coil MRI is superior to MDCT in local (T) staging of tumor and has overall more diagnostic accuracy, sensitivity and specificity than MDCT. ECMRI has a less tendency to under-stage the disease. However, both ECMRI and MDCT are almost equally accurate and specific in detecting perirectal lymph node involvement. JMS 2012;15(1):32-38.

Stadiazione preoperatoria locoregionale del carcinoma del colon-sigma: colonografia TC multidetettore con aria versus acqua

The authors sought to evaluate the diagnostic accuracy of multidetector-row computed tomography (MDCT) performed with two different hypodense endoluminal contrast agents for the preoperative staging of colosigmoideal cancer. Seventy consecutive patients with an endoscopically and histologically proven diagnosis of colosigmoideal cancer underwent MDCT examination. Thirty-five patients were evaluated with water MDCT colonography and the remaining 35 with air MDCT colonography. Patients were randomly assigned to the air or water groups for staging. Transverse images and multiplanar reconstructions (MPR) were retrospectively examined by two blinded expert radiologists in order to assess T and N parameters, and the results were compared with histological findings. The overall diagnostic accuracy of MDCT was 68.6% for water and 62.8% for air colonography. In the evaluation of the T parameter, the accuracy values were 88.6% for water and 80% for air colonography. In staging of the N parameter, the accuracy values were 77.1% and 74.3% for water and air MDCT colonography, respectively. MDCT examination can be proposed for the local staging of colosigmoideal cancer. Water is more accurate than air in evaluation of the T parameter, whereas the kind of endoluminal contrast material does not influence the definition of the N parameter.