Diagnostic Accuracy Of Multidetector Computed Tomography Research Articles

The Diagnostic Accuracy of a Novel Scoring System Using Multi-Detector Computed Tomography to Diagnose Lung Cancer.

Lung cancer is the leading cause amongst the cancer deaths in the world. Detection of malignancy at an early stage and with precision is the utmost objective of radiological evaluation. The final diagnosis of lung cancer is histopathological evaluation of the mass. The authors hereby have tried to convert the multi-detector CT (MDCT) characteristics and patient demographics into quantitative data to formulate a scoring system that can predict lung malignancy as close to histopathology as possible. After obtaining ethical clearance, 104 cases of suspected lung cancer by history, clinical and radiographic evaluation were enrolled in the study. These patients were undergoing CT thorax (contrast) on 384 slice siemens somatom force. After undergoing the radiological evaluation biopsy of the mass was done either by CT guided or bronchoscopy guided. Radiological and histopathological findings were correlated. Patients aged >50, lymphadenopathy, tumor volume >50 cc, enhancement >15 HU (Hounsfield unit) after contrast injection were given a score of 15 each. History of smoking, bronchus cut off, spiculated/lobulated margins, mediastinal/pleural involvement, and angiogram sign positive were given a score of 20 each. So, a maximum score of 160 can be achieved by history and MDCT evaluation. Sensitivity, specificity, positive predictive values (PPV), negative predictive values (NPV), and diagnostic accuracy of MDCT by using conventional parameters against histopathology was 97.5%, 85%, 96.29%, 89.47%, and 95.0%. The sensitivity and specificity calculated through Receiver-Operating-Characteristic (ROC) for predicting malignancy were found to be 98.8% and 90.0% for a cut-off score of >97.5 out of maximum of 160. Conclusion: MDCT serves as atool for early diagnosis of lung cancer, and it is the utmost important tool for cases where biopsy or fine needle aspiration cytology (FNAC) is not possible. By creating a quantitative criterion to diagnose lung malignancy, the subjective nature of MDCT diagnosis can be converted into an objective based evaluation.

Diagnostic Accuracy of Multidetector Computed Tomography in Detecting Mesorectal Fascia Involvement in Colorectal Carcinoma

Objectives: To determine the diagnostic accuracy of multi detector computed tomography (MDCT) in detecting mesorectal fascia involvement in colorectal carcinoma, taking histopathology as a gold standard.
 Study Design: Cross-sectional study.
 Place and Duration of Study: Department of Radiology, Combined Military Hospital Quetta from Jun to Dec 2019.
 Methodology: A total of 117 suspected patients of colorectal carcinoma, aged 40-80 years of either gender were included. All the patients underwent MDCT and then were looked for mesorectal fascia involvement. After surgical intervention, the his to pathological result of respected specimens was correlated with MDCT findings.
 Results: MDCT showed mesorectal fascia involvement in 66 (56.41%) patients. Histopathology confirmed mesorectal fascia involvement in 62 (52.99%) cases, whereas 55 (47.01%) patients revealed no mesorectal fascia involvement. In MDCT positive patients, 56 patients were true positive, while ten patients were false positive. Among 51 MDCT negative patients, 6 were false-negative while 45 were true negative. Overall results of sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of MDCT in detecting mesorectal fascia involvement, taking histopathology as the gold standard was, 90.32%, 81.82%, 84.85%, 88.24% and 86.32% respectively.
 Conclusion: This study concluded that MDCT is a recommended modality due to its high sensitivity. It is an accurate modality for pre-operative detecting mesorectal fascia involvement in colorectal carcinoma patients.

Diagnostic Accuracy of Multi-Detector CT for Evaluation of Renal Masses

Objective: To determine the accuracy of multi-detector computed tomography (MDCT) in differentiation of renal masses taking histopathology as gold standard. Methods: This cross-validation study was conducted from March 2021 to August 2021 at Al Hussain Diagnostic & Medical center Nishtar Road Multan. We included 100 patients presenting with renal masses on clinical and ultrasonography. All patients underwent MDCT for evaluation of renal masses. After MDCT, biopsy specimens were obtained for histopathological diagnosis of renal masses. The MDCT findings were correlated with histopathology diagnosis to determine the accuracy of MDCT. Results: Mean age was 45.8±12.36 years, 67% patients were male and 33% were female. Malignancy was diagnosed in 83% patients and remaining 17% patients were diagnosed of having benign lesions. Out of malignant lesions, 65% patients had RCC, 07% Wilm’s tumor, 6% lymphoma, meta-stasis was diagnosed 04% patients and 01% renal pelvic TCC. Among the benign lesions 11% patients had Angiomyolipoma and oncocytoma was diagnosed in 6.0% patients. The overall sensitivity of CT scan was 97.6%, specificity was 100%, PPV was 100% and NPV was 89.5%. Conclusion: MDCT can be used as the imaging method of choice for initial evaluation and diagnosis of RCC as it is associated with high sensitivity and specificity for differentiating malignant from benign lesions. Keywords: Diagnostic Accuracy, Histopathology, Multi detector CT, Renal Masses

English

BACKGROUND Mediastinal lesions are one of the most common lesions of the chest in children and adults. Multidetector computed tomography (MDCT) is the most common investigation done in patients with suspected abnormalities on X-ray. Crosssectional imaging visualises complex anatomy, helps in predicting the tissue of origin, characterises lesions and depicts the extent of involvement of adjacent structures. Complications of mediastinal lesions and emergent conditions, for example, sealed pneumo-mediastinum, tracheoesophageal / pulmonary fistula, a peri-lesional abscess can be well assessed on CECT. The possibility of the lesion as benign or malignant and can be well predicted. Vascular lesions like aneurysms, dissections, and embolism can be evaluated and stable lesions requiring to follow up and unstable lesions requiring emergent treatment are differentiated using MDCT. The objectives of the study were to characterize and identify features pathognomic of specific mediastinal masses on computed tomography and find out diagnostic accuracy of MDCT in mediastinal masses and compare them with pathological results wherever possible. METHODS A prospective study was done in the Department of Radiodiagnosis, Rohilkhand Medical College and hospital, Bareilly for a span of 1 year from November 2018 to October 2019. Our study included 51 patients. Mediastinal lesions were assessed based on size, compartmental localisation, and attenuation and enhancement patterns. RESULTS In our study with 51 patients, 16 lesions were non-neoplastic and 35 were neoplastic lesions. Anterior mediastinal lesions constituted maximum lesions followed by middle and posterior mediastinal lesions. Lymph nodal masses were the commonest lesions out of which 4 cases were tubercular in origin, 4 were lymphomatous and 4 were metastatic. Neurogenic tumours were most common in the posterior mediastinum consisting of 6 cases. 2 vascular lesions were seen, 1 of aortic aneurysm and 1 aortic dissection. The diagnostic accuracy of MDCT was 93 % compared to histopathological results. Computed tomography (CT) plays a major role in evaluating mediastinal masses by virtue of its excellent multiplanar reconstruction capabilities and demonstration of exact anatomic relationships. However, in many situations, histopathological examination is needed to know the exact tissue of origin and for further management. CONCLUSIONS We conclude that CT has a major role in evaluating mediastinal masses regarding location, extent and tissue characterization. It can display certain features pathognomic for particular masses thus obviates the need for invasive procedures. KEY WORDS Mediastinal Lesions, MDCT, Imaging Modality, Histopathology

Diagnostic Accuracy of MDCT (Multidetector Computed Tomography) for Staging of Renal Cell Carcinoma

Background: The advancement in technology has introduced multi-detector CT scanners and achievement of better spatial resolution with faster acquisition has become a possibility. The three-dimensional reformatted images along with multiplanar reconstructions upgrade the staging capabilities for RCC. Aim: To check accuracy of MDCT (Multi-detector Computed tomography) in staging renal cell carcinoma with histopathology taken as the gold standard. Study design: The study is a descriptive cross sectional study. Settings: Radiology Department, Bahawal Victoria Hospital, Bahawalpur Study duration: 16"' January 2019 to 15"' July 2019. Methods 157 patients (including both genders) were included with age range of 25-60 years, showing features of renal cell carcinoma on ultrasonography. Those Patients with renal mass other than renal cell carcinoma, solitary functioning kidney and pregnant females were eliminated from the study. All the selected patients had Multi-detector CT scan abdomen performed. Results: Mean age was 44.66+9.3 I years. Out of these 157 patients, there were 90(57.32) male patients and 67 (42.68°/c) females with ratio of I.3: I. All the patients had CT scan of abdomen and pelvis. The results showed that 8I of the patients were True Positive and only 08 were False Positive. Out of 68 CT negative patients, 07 (False Negative) showed renal cell carcinoma on histopathology while 6 I True Negative patients had no evidence of RCC on histopathology (p=0.0001). Conclusion: Multi-detector CT scan is a very sensitive yet accurate non - invasive method for staging renal cell ca. Keywords: Renal cell carcinoma, multidetector CT scan, imaging, sensitivity

Of multidetector computed tomography (MDCT) in evaluation of lung nodule with histopathological correlation

Background: Lung cancer is the most common and lethal cancer around the world. Computed tomography (CT) is an integral imaging technique for staging the lung cancer. Aim of this study was to correlate the multidetector CT (MDCT) findings of lung nodule with histopathological examination, as well as to assess the diagnostic accuracy of MDCT in evaluation of suspected lung nodule. Methods: One hundred patients with clinical or radiological suspicion of lung nodule referred for CT scan of thorax were included in the study. Histopathological analysis was performed. The location of the lesion was analysed and nodules were classified. Fine needle aspiration cytology (FNAC) was done with spinal needle under all aseptic precautions. The results obtained by MDCT were analysed and compared with histopathological findings done by CT guided FNAC. Results: Average age of patients was 65 years, 25 % were females and 75 % were males. Among all the patients 66 % of lesions were located in right side lung and 34 % of lesions were left in location. Of all, 2 % patients had lesions less than 3 cm, 11 % patients had lesion between 3-4 cm, 19 % patients had lesion between 4-5 cm, 26 % patients had lesion between 5-7 cm and 42 % patients had lesion greater than 7 cm. Many of these patients also presented with enlarged lymph nodes, most commonly mediastinal (73 %) followed by subcarinal (51 %), hilar (44 %) and supraclavicular (4 %) lymph nodes. The most common histological findings of lung nodules analysis were adenocarcinoma (41 %). Among the 100 patients 58 % had lesions located peripherally while 42 % had central lesions. CT was a highly sensitive (95.45 %) and moderately specific (75 %) test and also had a high positive predictive value (96 %) to diagnose malignant lung nodule. Conclusion: CT guided FNAC of lung nodule is a safe, minimal invasive procedure with a high diagnostic accuracy. The use of CT-guided FNAC in hilar and mediastinal nodules can avoid unnecessary exploratory surgery for staging and also diagnosis could be made with lesser cost.

Diagnostic Accuracy of Multidetector CT in Detection of Early Interstitial Lung Disease With Its Role in Characterization.

BackgroundMultidetector CT (MDCT) has emerged as a useful option for early diagnosis of interstitial lung disease (ILD) with adequate accuracy.MethodsA total of 80 patients with restricted pulmonary functions and clinical suspicion of ILD were enrolled in the study. MDCT evaluation was done using Siemens Somatom Force 384 slice multidetector computer tomography machine. Pattern analysis for reticular opacities, nodules and lung opacities was done to reach at a diagnosis. Final diagnosis was based on correlation of radiological and clinicopathological findings. Diagnostic efficacy of MDCT was evaluated in terms of sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy for detection of ILD.ResultsMean age of patients was 58 ± 8.75 years. Majority were females (51.3%). History of chronic obstructive pulmonary disease (COPD), tuberculosis and bronchial asthma was revealed in 31 (38.8%), 26 (32.5%) and 16 (20%) patients, respectively. There were 30 (37.5%) patients having no history of respiratory diseases. MDCT diagnosed ILD in 45 (56.3%) cases. On final diagnosis, ILD was diagnosed in 35 (43.8%) cases (15 usual interstitial pneumonia [UIP], 9 cryptogenic organizing pneumonia [COP], 8 nonspecific interstitial pneumonia [NSIP] and 3 respiratory bronchiolitis associated interstitial lung disease [RBILD]). The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of MDCT in detection of ILD was 91.4%, 71.1%, 71.1%, 91.4% and 80%, respectively.ConclusionMDCT as a single modality had a high sensitivity for detection of ILD and could be recommended as first line diagnostic imaging technique.

Accuracy of Multi-Detector Computed Tomography in Detection of Esophageal Varices in Chronic Liver Disease

Background: Patients with chronic liver disease should undergo screening endoscopy, but this approach places a heavy burden upon endoscopy units along with other limitations. The aim of this study was to determine the diagnostic accuracy of multi-detector computed tomography scan in detecting esophageal varices taking endoscopy as gold standard.Material and Methods: This cross-sectional study was done from 1st Jan 2018 to 31st Dec 2018 at Department of Radiology, PIMS Hospital Islamabad. A total of 180 patients of both gender with chronic liver disease for at least 12 months were included in this study with an age range of 25-65 years. Patients with active gastrointestinal hemorrhage, hypersensitivity to iodinated contrast agent, chronic renal failure, claustrophobic and pregnant females were excluded. All the patients underwent endoscopy and computed tomography of lower chest and the upper abdomen before and after intravenous contrast administration. Multi detector computed tomography (MDCT) scan findings for esophageal varices were compared with endoscopy findings.Results: In MDCT positive patients (n=102), 98 were true positive and 04 were false positive. Among 78 MDCT negative patients, 07 were false negative, whereas 71 were true negative. Overall sensitivity and specificity were 93.33%, and 94.67% respectively. The positive and negative predictive values were 96.08% and 91.03% respectively, while diagnostic accuracy of MDCT in detecting esophageal varices in chronic liver disease patients was 93.89%, taking endoscopy as gold standard.Conclusions: Multi-detector computed tomography scan is a highly sensitive and accurate non-invasive modality for detecting esophageal varices in chronic liver disease patients.Key words: Accuracy, Chronic liver disease, Esophageal varices, Multi-detector computed tomography

Diagnostic Accuracy of Multidetector Computed Tomography in Evaluation of Retroperitoneal Traumatic Injuries and Retroperitoneal Hemorrhage

AbstractBackground: Abdominal trauma represents a main daycare activity in radiology.non surgical treatment has become the standard of care in hemodynamically stable abdominal trauma patients as a result of comprehensive assessment of injury by imaging.MDCT is very sensitive method to detect traumatic injuries and determine the grading of this injuries on which the management will be performed.Aim of Study: To assess diagnostic accuracy of multi-detector CT in evaluation of retroperitoneal traumatic injuries and retroperitoneal hemorrhage.Patients and Methods: Prospective study included 60 patients with abdominal trauma (40 male, 20 females), their age ranged from 7 years to 70 years (mean age 34.8 year). Ultrasonography and MDCT were performed for all patients.Results: 30 patients (50% of the total studied patients) had retroperitoneal injuries, 27 patients of them (90%) were secondary to blunt abdominal trauma and 3 patients (10%) suffered from stab trauma. Fifteen patients had renal injuries; 3 of them associated with adrenal injuries, 2 patients had bowel injuries, 5 patients had pancreatic injuries, 3 patients had vascular injuries and 5 patients had retroperitoneal hematoma related to other injuries; 3 of them had psoas muscle injury and the other 2 patients had urinary bladder rupture.Conclusion: MDCT proved to be accurate and sensitive to evaluate retroperitoneal traumatic injuries and determine the grading and severity of these injuries on which the man-agement will be performed. In addition MDCT proved to be highly sensitive in detection of active hemorrhage which is a life threatening condition.

Age- and gender-specific disease distribution and the diagnostic accuracy of CT for resected anterior mediastinal lesions.

BackgroundAnterior mediastinal lesions account for approximately half of all mediastinal masses and computed tomography (CT) is known to exhibit limited differentiating performance. Our aim was to evaluate the age‐ and gender‐specific distribution of anterior mediastinal lesions and the diagnostic accuracy of multi‐detector CT (MDCT).MethodsThis retrospective study included 549 consecutive patients with proven anterior mediastinal lesions and diagnostic MDCT scans. The age‐ and gender‐specific distribution of proven diagnoses and diagnostic accuracy were reviewed. The CT features of malignant and benign diseases having the lowest accuracy were compared with those of the most commonly misdiagnosed diseases.ResultsThe proportion of malignancy showed a V‐shape relationship with age (lowest, 52.7% [50s]). The most prevalent malignancies were lymphoma (20s), lymphoma/thymoma (30s), thymoma (40s–50s), and thymoma/thymic carcinoma (≥60s). The most prevalent benign diseases were thymic remnant/hyperplasia (20s–30s), and thymic bed cyst (≥40s). The first‐choice diagnostic accuracy of MDCT decreased with age regardless of gender: 75.4% (20s), 75.0% (30s), 67.8% (40s), 58.5% (50s), and 53.4% (≥60s), primarily due to incorrect diagnoses of thymic bed cyst and thymic carcinoma (accuracy, 42.3% and 30.5%), which were prevalent in older patients and mostly misdiagnosed as thymoma. The most powerful differentiating MDCT features were water attenuation (≤20 HU) (OR, 42.7 [95%CI, 8.8–‐208.3], P < 0.001) for thymic bed cyst and mediastinal lymphadenopathy (6.8 [1.7–27.2], P = 0.006) for thymic carcinoma, but both showed low sensitivity (34.5% and 18.6%, respectively).ConclusionsMDCT accuracy depended on age, owing to the age‐specific distribution of thymic carcinoma and thymic bed cyst, which frequently lacks distinguishable CT features from thymoma.

Diagnostic accuracy of MDCT in differentiating gallbladder cancer from acute and xanthogranulomatous cholecystitis

ObjectiveTo determine the diagnostic accuracy of multi-detector CT (MDCT) for differentiating gallbladder cancer from acute and xanthogranulomatous cholecystitis using previously described imaging features. MethodsIn this IRB approved HIPAA-compliant retrospective cohort study, contrast-enhanced MDCT of histologically confirmed acute cholecystitis (n = 17), xanthogranulomatous cholecystitis (n = 25), and gallbladder cancer (n = 18) were reviewed independently by three abdominal radiologists blinded to outcome. The primary outcome was the diagnostic accuracy of MDCT for the differentiation of gallbladder cancer from cholecystitis (acute and xanthogranulomatous) using various imaging parameters. Kappa (κ) statistics and two-way mixed-model single-measure intra-class correlation statistics (ICC) were calculated for each imaging feature and the final radiologic diagnosis. ResultsInter-rater agreement was moderate to substantial (κ = 0.43–0.70), sensitivity 0.67–0.78, specificity 0.22–0.33 and the positive likelihood ratio was 4.28–8.56 for the differentiation of gallbladder cancer from benign gallbladder pathology. Only three imaging findings: disrupted gallbladder mucosa (κ = 0.68), intraluminal gallstones (κ = 0.66), and gallbladder wall thickness (ICC = 0.63) had substantial inter-rater agreement. The following had slight or no agreement: intramural hypoattenuating nodules (κ = 0.17), transient hepatic attenuation differences (κ = 0.14), gallbladder wall calcification (κ = −0.01), gallbladder wall enhancement (κ = 0.18), and omental or mesenteric invasion (κ = 0.08). In the final multivariate model, the following were significant predictors useful in making or excluding diagnosis of gallbladder cancer: focal gallbladder wall thickening (p = 0.003, OR: 13.09 [95% CI: 2.40–71.48]), pericholecystic “fat stranding” (p = 0.018, OR: 0.10 [95% CI: 0.01–0.66]), and maximum short axis lymph node diameter (p = 0.043, OR: 1.18 [95% CI: 1.00–1.38]). ConclusionMDCT has moderate sensitivity, poor specificity, and moderate-to-substantial inter-rater repeatability for the differentiation of gallbladder cancer from acute and xanthogranulomatous cholecystitis.

Multidetector CT for Restaging Locally Advanced Esophageal Squamous Cell Carcinoma and Assessing Therapeutic Response to Neoadjuvant Chemotherapy.

Objective To assess the diagnostic accuracy of multidetector CT (MDCT) for restaging of patients with esophageal squamous cell carcinoma (SCC) after neoadjuvant chemotherapy and determine the feasibility of CT for assessing the treatment response and evaluating the prognosis. Methods Totally 135 patients with esophageal SCC who had received neoadjuvant treatment and surgery in Beijing Cancer Hospital from September 2005 to December 2011 were enrolled in this study. TN staging was performed using CT for lesions before and after neoadjuvant treatment by two radiologists,and the tumor regression grade (TRG) and pathological TRG were also assessed. Based on preoperative CT TN restaging results,the patients were defined as responders with T0-2N0 after therapy,non-responders with T3-4N+,and patients with undefined response (T3-4N0 or T0-2NN+). Results The accuracy of T and N restaging using CT was 50%,54% (κ=0.718,P <0.001) and 59%,56% (κ=0.753,P <0.001) by two radiologists,respectively. TRG from CT was predicted correctly in 27% of patients. Pathological TRG was an accurate predictor of survival (χ 2=8.13,P=0.04). There was no significant trend toward better survival for lower CT TRG (χ 2=1.17,P=0.286). Among 135 patients with esophageal cancer,19 patients(14.07%) were responders ,46 patients(34.07%) were non-responders,and 70 patients (50.37%)were patients with undefined response . The overall survival rates of responders,non-responders and patients with undefined response were 71.5%,47.3%,and 18.5%,respectively. The overall survival of responders was better than that of patients with undefined response (χ2=1.518,P=0.63) and non-responders(χ2=12.04,P=0.0016),but the overall survival of patients with undefined response was better than that of non-responders (χ2=14.468,P=0.0003). Conclusion sMDCT restaging after neoadjuvant treatment can not accurately predict pathological stage in esophageal SCC. The CT T and N restaging has certain clinical value in assessing the response to neoadjuvant chemotherapy in patients with esophageal cancer and predicting the prognosis.

Comparative study of multidetector computed tomography and magnetic resonance cholangiopancreatography in obstructive jaundice

Background: Accurate diagnosis of the cause is crucial in the management of obstructive jaundice. Multidetector computed tomography (MDCT) and magnetic resonance cholangiopancreatography (MRCP) play the pivotal roles in the diagnosis. Objective: The objective of this study is to evaluate the diagnostic accuracy of MDCT in determining the level and cause of biliary obstruction in patients with obstructive jaundice and correlates MDCT findings with that of MRCP. Materials and Methods: This cross-sectional study was conducted in the Department of Radiodiagnosis of a tertiary hospital in Manipur after obtaining the Institutional Ethical Committee approval. Fifty-seven patients with obstructive jaundice, age ranging 20–80 years, were subjected to MDCT and MRCP. Final definite diagnosis was made from operative or histopathological findings. Data and findings of MDCT and MRCP were correlated and statistically analyzed. Results: Maximum numbers of cases were seen to occur in the fourth to sixth decades. The female-to-male ratio was 1.4:1. Both MDCT and MRCP could correctly determine the level of obstruction in all the cases. The most common level of obstruction was at the suprapancreatic level. The most common cause of obstruction was choledocholithiasis (45.61%). Benign causes constituted 68% and malignant causes constituted 32%. MDCT could correctly determine the cause in 85.96% of cases, compared to 75.44% by MRCP. Kappa statistics showed fair agreement between MDCT and MRCP in diagnosing the cause of biliary obstruction. MDCT showed comparable sensitivity, specificity, and positive and negative predictive value, in diagnosing the causes of obstruction. Conclusion: Overall performance of the MDCT was comparable or better than that of MRCP.

Role of MDCT in the detection of early abdominal complications after orthotopic liver transplantation

PurposeThis study aims to assess the role of multidetector computed tomography (MDCT) for detecting early abdominal complications after orthotopic liver transplantation. Materials and methodsWe retrospectively enrolled 170 subjects with clinical laboratory and/or echo-color Doppler abnormalities who underwent MDCT within the first 90 days after transplantation. All images were reviewed by two radiologists in conference and imaging results were correlated with digital subtraction angiography, conventional cholangiography, surgery, clinical laboratory, and/or imaging follow-up. ResultsNo significant complication was found in 142 patients, while vascular complications (hepatic artery thrombosis, n=5 and stenosis, n=5; portal vein thrombosis, n=4; cava vein thrombosis, n=1; arterial bleeding, n=1), biliary complications (anastomotic leak with biloma, n=6), parenchymal complications (abscess, n=1; extended areas of impaired perfusion, n=3), adrenal hemorrhage (n=1), and bowel perforation (n=1) were identified in the remaining 28 cases. Four false-positive cases (three hepatic artery stenoses and one hepatic artery dissection) and one false-negative case (biloma) were diagnosed on MDCT. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of MDCT in the identification of various complications were 96%, 97%, 87%, 99%, and 97%, respectively. ConclusionMDCT is a reliable diagnostic technique in the identification of early abdominal complications of liver recipients.

Diagnostic value of multidetector computed tomography in differentiation of benign and malignant omental lesions

ObjectiveTo assess the diagnostic value of multidetector computed tomography (MDCT) in differentiation of benign and malignant omental lesions. Patients and methodsMDCT scan was performed for 37 patients with omental lesions after administration of oral and intravenous contrast. The CT diagnosis was compared with the final histopathological findings. Sensitivity, specificity, and diagnostic accuracy of MDCT were calculated using surgical and histopathological findings as the gold standard. ResultsMDCT findings of all cases with omental torsion, cystic lymphangioma, and loculated fluid in the greater omentum correlated with the surgical and histopathological findings with 100% diagnostic accuracy. However, the diagnosis was missed in two patients from seven (2/7) with tuberculous peritonitis and in two patients from 21 (2/21) with peritoneal carcinomatosis with sensitivity, specificity and diagnostic accuracy of 73%, 92%, 85% and 90%, 95%, 93%, respectively. ConclusionMDCT is an excellent diagnostic tool for evaluating omental lesions, especially those present with nonspecific clinical manifestations.

Role of coronary angiography MDCT in the clinical setting: changes in diagnostic workup in the real world

The authors sought to evaluate the incremental value of introducing coronary angiography with multidetector computed tomography (MDCT-CA) compared with the conventional diagnostic workup in managing patients with suspected coronary artery disease (CAD) workup. A total of 531 consecutive patients underwent MDCT-CA between April 2008 and August 2010. For each patient the pretest probability of CAD was obtained by using the Morise score as well as the diagnostic performance of the exercise test and of MDCT-CA, considering conventional coronary angiography (CCA) as the gold standard. Based on these results, we calculated the posttest likelihood of CAD after stress testing, comparing the incremental diagnostic value for each category of cardiovascular risk with data obtained with MDCT-CA. The conventional diagnostic workup (without MDCT-CA) was then compared with the modified workup (including MDCT-CA). The diagnostic performance of the exercise test for identifying patients with significant lesions had a sensitivity and specificity of 20% and 88%, respectively, with positive (PPV) and negative (NPV) predictive value of 41% and 72%, respectively. Taking CA as the gold standard, MDCT-CA had 93% sensitivity, 89% specificity, 88% PPV and 93% NPV compared with CCA in evaluating significant stenoses in the per-patient analysis. The overall diagnostic accuracy of MDCT-CA was 91%. The exercise tests provided no significant incremental diagnostic value compared with cardiovascular history in patients with a low to intermediate risk. Comparison of the diagnostic accuracy of these protocols showed improved performance results for the modified protocol. MDCT-CA is the reference modality for the noninvasive exclusion of critical CAD. It provides a very high incremental diagnostic value compared with exercise testing in patients with a low to intermediate risk of CAD. The use of diagnostic protocols based on MDCT-CA ensures improved diagnostic performance compared with those involving conventional exercise electrocardiograms.

Role of multidetector computed tomography (MDCT) in patients with ovarian masses

Objective:To evaluate the diagnostic accuracy of multidetector 64-slice computed tomography (MDCT) in the diagnosis and differentiation of benign and malignant ovarian masses using histopathology and surgical findings as the gold standard.Material and methods:This study was conducted in Aga Khan University Hospital, Karachi, Pakistan. Data was reviewed retrospectively from 1 November 2008 to 12 December 2009. One hundred patients found to have ovarian masses on CT scan were included in the study. CT scan was performed in all these patients after administration of oral and IV contrast. Ovarian masses were classified as benign and malignant on scan findings. Imaging findings were compared with histopathologic results and surgical findings. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy of MDCT were calculated.Results:MDCT was found to have 97% sensitivity, 91% specificity, and an accuracy of 96% in the differentiation of benign and malignant ovarian masses, while PPV and NPV were 97% and 91%, respectively.Conclusion:MDCT imaging offers a safe, accurate and noninvasive modality to differentiate between benign and malignant ovarian masses.

Diagnostic Accuracy of Multidetector CT in Acute Mesenteric Ischemia: Systematic Review and Meta-Analysis

To use meta-analysis to determine the diagnostic accuracy of contrast agent-enhanced multidetector computed tomography (CT) in primary acute mesenteric ischemia (AMI). The PubMed search engine and five other electronic databases were searched for "mesenteric ischemia," "computed tomography," and related terms in articles published between January 1996 and September 2009, without language restrictions. Reference lists of retrieved articles were also searched. Two reviewers independently selected six studies that reported 2 x 2 contingency data on the diagnostic accuracy of multidetector CT in primary AMI in at least 10 patients with disease and 10 patients without disease and that used surgery or clinical outcome as the reference standard. Study data were independently extracted by the two reviewers, and disagreement was resolved by consensus. The study quality was assessed by using items from the Quality Assessment of Diagnostic Accuracy Studies tool. The primary 2 x 2 count data were investigated with a bivariate random-effects meta-analysis of sensitivity and specificity. Three studies were prospective, and three were retrospective. All studies were of high quality. The CT scanners used in the included studies had between four and 40 rows. The between-study heterogeneity was low to moderate. Overall, AMI was found in 142 of 619 studied cases. The meta-analysis showed a pooled sensitivity of 93.3% (95% confidence interval: 82.8%, 97.6%) and a pooled specificity of 95.9% (95% confidence interval: 91.2%, 98.2%). On the basis of a thorough clinical examination, contrast-enhanced multidetector CT allows the diagnosis of primary AMI with high sensitivity and specificity. Thus, it may be used as the first-line imaging method.

Preoperative evaluation of the longitudinal spread of extrahepatic bile duct cancer using multidetector computed tomography

The aim of this study was to compare the diagnostic accuracy of multidetector computed tomography (MDCT) and direct cholangiography in evaluating the longitudinal spread of extrahepatic bile duct cancer. Images obtained from a 16-detector row scanner (MDCT) and from direct cholangiography (via either endoscopic naso-biliary drainage or percutaneous transhepatic biliary drainage) of 47 patients with histopathologically proven extrahepatic bile duct cancer were retrospectively interpreted. Differences between measures of longitudinal tumor spread determined by each modality and measures of macroscopic spread in resected specimens were assessed and compared. Assessments carried out using MDCT differed significantly less from the macroscopic measurements than those made using direct cholangiography (P < 0.0001). Provided the diagnosis was defined as being accurate, based on a diagnostic difference of within +/-5 mm, the diagnostic accuracy of MDCT (96%) was significantly higher than that of direct cholangiography (70%) (P = 0.028). Preoperative evaluation with direct cholangiography resulted in a 30% underestimation of the incidence. MDCT is superior to direct cholangiography for evaluating the preoperative longitudinal extent of bile duct cancer. Consequently, the utility of MDCT for preoperative evaluation of extrahepatic bile duct cancer warrants further examination.

Noninvasive coronary angiography with 64-channel multidetector computed tomography in patients with acute coronary syndrome

Advances in computer tomography (CT) imaging technology in recent years have facilitated the possibility of noninvasive coronary angiography. To compare the diagnostic accuracy of 64-channel multidetector computed tomography (MDCT) with conventional invasive coronary angiography (ICA) for the detection of significant coronary stenosis in patients with acute coronary syndrome (ACS). MDCT was performed in 60 patients classified with non-ST-elevation infarction (NSTEMI) or unstable angina and scheduled for ICA within 3 days. The diagnostic accuracy of MDCT was evaluated using quantitative coronary angiography (QCA) as the gold standard. 48 out of 60 patients had interpretable scans by both MDCT and ICA. On a segment-based analysis, 488 out of 665 segments with a diameter of > or =1.5 mm, as defined by QCA, were interpretable by MDCT. Sensitivity was 78%, specificity 87%, positive predictive value 47%, and negative predictive value 97% in detecting and excluding significant coronary stenosis, as defined with MDCT. On a per patient-based analysis, sensitivity was 89%, specificity 50%, positive predictive value 84%, and negative predictive value 60%. Limited diagnostic accuracy restricts the usefulness of coronary MDCT in patient groups with a high pretest probability of disease, such as in acute coronary syndrome.