Imaging In Management Of Patients Research Articles

Evaluation of computed tomography in management of patients with head injury

Background: The primary goal in treating craniocerebral trauma due to any cause is to preserve the patient’s life and remaining neurological function. It has also made the neuroradiologist an indispensable element of the trauma treatment team. The purpose of this study is to evaluate the efficacy of computed tomography (CT) in the diagnosis, treatment, and prognosis of patients with brain trauma. Aims and Objectives: The objectives of this study were to evaluate the efficacy of CT in the diagnosis, treatment, and prognosis of patients with brain trauma. Materials and Methods: The present study was conducted on patients with head injuries who were referred to the Department of Radiodiagnosis over a 2 years. Details were noted down on pro forma either immediately before or after the procedure was carried out, depending on the status of the patient. Few of the patients underwent plain radiography of the skull before conducting the CT scan. Results: In the present study, the most common lesion observed by CT was edema (49%) followed by contusion (48%), whereas least lesion was observed as intraventricular hemorrhage (4%) and intracerebral hemorrhage (8%). In the present study, the patient with low scores (3–5) showed early deterioration as compared to those with higher scores. This could be attributable to the severity of the primary injury. Late deterioration was more common than early deterioration in scores of >8 where mortality within 48 h was virtually nil and the recovery rate was much higher. Conclusion: This simple, affordable, highly successful, and safe imaging modality should be regarded the initial imaging modality of choice in acute head injury, as it serves as the foundation for cornerstone for rapid and effective diagnosis.

A TROJAN HORSE NEVER TO BE MISSED IN ELDERLY – AN INTRESTING CASE OF RIGHT ILIAC FOSSA MASS

We report a case of an elderly patient presenting with the right iliac fossa mass. The provisional diagnosis included an inammatory appendicular mass or abdominal wall mass. Interestingly, initial non-contrast computed tomography (CT) of the abdomen and pelvis, lap parameters and colonoscopy guided biopsy demonstrated the inammatory changes. Follow up imaging by contrast CT threw light on a new path towards the neoplastic etiology. Even after the follow up imaging the subsequent colonoscopy guided biopsy showed features suspicious for malignancy whereas cystoscopy guided biopsy showed benign features. Intra-operatively bowel neoplasm with bladder invasion was seen and right hemicolectomy with partial cystectomy done. Post-operative specimen nally revealed mucinous adenocarcinoma of caecum with urinary the bladder invasion. In the presented case, non-contrast CT ndings and clinico-pathological reports suggestive of a benign etiology were misleading. This could have been prevented if the patient was subjected to contrast study in view of her elderly age. This case highlights the importance of imaging in patient management. Therefore, we feel that it is important to share our experience of the successful management of the presented case.

Pulmonary COVID-19: Multimodality Imaging Examples.

The full digital presentation is available online.

Appropriateness of Emergency CT Utilization During the Initial Peak of the COVID-19 Pandemic.

Appropriateness of Emergency CT Utilization During the Initial Peak of the COVID-19 Pandemic.

The Role of Chest Imaging in Patient Management during the COVID-19 Pandemic: A Multinational Consensus Statement from the Fleischner Society.

With more than 900,000 confirmed cases worldwide and nearly 50,000 deaths during the first three months of 2020, the COVID-19 pandemic has emerged as an unprecedented healthcare crisis. The spread of COVID-19 has been heterogeneous, resulting in some regions having sporadic transmission and relatively few hospitalized patients with COVID-19 and others having community transmission that has led to overwhelming numbers of severe cases. For these regions, healthcare delivery has been disrupted and compromised by critical resource constraints in diagnostic testing, hospital beds, ventilators, and healthcare workers who have fallen ill to the virus exacerbated by shortages of personal protective equipment. While mild cases mimic common upper respiratory viral infections, respiratory dysfunction becomes the principal source of morbidity and mortality as the disease advances. Thoracic imaging with chest radiography (CXR) and computed tomography (CT) are key tools for pulmonary disease diagnosis and management, but their role in the management of COVID-19 has not been considered within the multivariable context of the severity of respiratory disease, pre-test probability, risk factors for disease progression, and critical resource constraints. To address this deficit, a multidisciplinary panel comprised principally of radiologists and pulmonologists from 10 countries with experience managing COVID-19 patients across a spectrum of healthcare environments evaluated the utility of imaging within three scenarios representing varying risk factors, community conditions, and resource constraints. Fourteen key questions, corresponding to 11 decision points within the three scenarios and three additional clinical situations, were rated by the panel based upon the anticipated value of the information that thoracic imaging would be expected to provide. The results were aggregated, resulting in five main and three additional recommendations intended to guide medical practitioners in the use of CXR and CT in the management of COVID-19.

Potential Usefulness of Single Photon Emission Computed Tomography/Computed Tomography in Management of Patients with Failed Back Surgery Syndrome

Potential Usefulness of Single Photon Emission Computed Tomography/Computed Tomography in Management of Patients with Failed Back Surgery Syndrome

The Use of Imaging in Management of Patients with Low Back Pain.

Lower back pain (LBP) is one of the most common chief complaints encountered in primary care. Advanced imaging studies, including computerized tomography (CT) and magnetic resonance imaging (MRI), are frequently ordered in the setting of LBP. Structural abnormalities are commonly identified by CT and MRI in patients complaining of low back pain, however, these findings are also found in asymptomatic patients. In the past decade, multiple guidelines have been published to help providers identify patients in whom the use of advanced imaging is appropriate. In this article, we review common conditions associated with LBP that require advanced imaging along with their clinical and associated imaging findings.

The Use of Cone-Beam Computed Tomography in Management of Patients Requiring Dental Implants: An American Academy of Periodontology Best Evidence Review.

Application of cone-beam computed tomography (CBCT) has grown exponentially across dentistry with a clear impact in implant dentistry. This review aims at providing the scientific context to understand if CBCT imaging should become the standard of care for patients requiring dental implants. A literature search for CBCT applications in implant dentistry was performed using the PubMed database that included studies published between January 1, 2000, and June 24, 2017. Of 559 citations identified and manually screened, 161 were selected as suitable for the purpose of the review. The selected studies belonged to three distinct categories: 1) diagnosis and treatment outcome assessment, 2) implant treatment planning, and 3) anatomic characterization. The current available literature reflects an increased optimization of emerging CBCT imaging protocols and further highlights its diverse applications for dental implant therapy. This technology continues to be considered an advanced point-of-care imaging modality and should be used selectively as an adjunct to two-dimensional dental radiography. As with other ionizing radiation imaging modalities, CBCT imaging should be used only when the potential benefits to the patient outweigh the risks. Dental health care professionals should consider CBCT imaging only when they expect the diagnostic information yielded will lead to better patient care, enhanced patient safety, and ultimately facilitate a more predictable, optimal treatment outcome.

Reply to Verbanck and Vanderhelst: The Respective Roles of Lung Clearance Index and Magnetic Resonance Imaging in the Clinical Management of Patients with Cystic Fibrosis

Reply to Verbanck and Vanderhelst: The Respective Roles of Lung Clearance Index and Magnetic Resonance Imaging in the Clinical Management of Patients with Cystic Fibrosis

The Respective Roles of Lung Clearance Index and Magnetic Resonance Imaging in the Clinical Management of Patients with Cystic Fibrosis.

The Respective Roles of Lung Clearance Index and Magnetic Resonance Imaging in the Clinical Management of Patients with Cystic Fibrosis.

AB005. OS01.05. Early prediction of response to target therapy by FDG-PET in thymic epithelial tumors: a monocentric experience

Background: Recently several data regarding the role of 18F-Fluorodeoxyglucose positron emission tomography (18F-FDG PET) imaging in management of patients with thymic epithelial tumors (TET) have been published. The primary objective of this study was to demonstrate the role of early 18F-FDG-PET in patients with TETs treated with target therapy as surrogate of 12-month progression free survival (PFS) according to Response Evaluation Criteria in Solid Tumors (RECIST).

Imagerie de l’aorte abdominale pathologique

After a review of imaging techniques applicable to the abdominal aorta, this article describes the pathologies involved and the place of imaging in patient management. Aneurysms, the most common abdominal aortic pathology are presented in detail, emphasizing signs of complication (inflammation, rupture), clinical assessment and postoperative follow-up. Then the article successively describes normal and pathological imaging of the operated aorta, inflammatory aortitis (mainly Takayasu's arteritis), aortic infections, histiocytosis aortic stenosis, and thrombosis as well as emboligenic aortitis, dissections situated in an abdominal aneurysm, trauma, birth defects and aortic tumors. Ultrasound, computed tomography and magnetic resonance imaging findings are described since detailed investigations of abdominal aorta pathologies rely heavily on these imaging techniques.

Positron Emission Tomography-Computed Tomography (PET-CT) Versus No PET-CT in the Management of Potentially Resectable Colorectal Cancer Liver Metastases: Cost Implications of a Randomized Controlled Trial.

To evaluate whether positron emission tomography (PET) combined with computed tomography (PET-CT) is cost saving, or cost neutral, compared with conventional imaging in management of patients with resectable colorectal cancer liver metastases. Cost evaluation of a randomized trial that compared the effect of PET-CT on surgical management of patients with resectable colorectal cancer liver metastases. Health care use data ≤ 1 year after random assignment was obtained from administrative databases. Cost analysis was undertaken from the perspective of a third-party payer (ie, Ministry of Health). Mean costs with 95% credible intervals (CrI) were estimated by using a Bayesian approach. The estimated mean cost per patient in the 263 patients who underwent PET-CT was $45,454 CAD (range, $1,340 to $181,420) and in the 134 control patients, $40,859 CAD (range, $279 to $293,558), with a net difference of $4,327 CAD (95% CrI, -$2,207 to $10,614). The primary cost driver was hospitalization for liver surgery (difference of $2,997 CAD for PET-CT; 95% CrI, -$2,144 to $8,010), which was mainly a result of a longer length of hospital stay for the PET-CT arm (median, 7 v 6 days; P = .03) and a higher postoperative complication rate (20% v 10%; P = .01). Baseline characteristics were similar between groups, including the number of liver segments involved with cancer, number of segments resected, and type of liver resection performed. No difference in survival was detected between arms. PET-CT was associated with limited clinical benefit and a nonsignificant increased cost. Universal funding of PET-CT in the management of patients with resectable colorectal cancer liver metastases does not seem justified.

The Role of I-123 Metaiodobenzylguanidine Imaging in Management of Patients With Heart Failure

Despite advances in evidence-based treatments, the morbidity and mortality of congestive heart failure remain exceedingly high. In addition, the costs associated with recurrent hospitalizations and advanced therapies, such as implantable cardiac defibrillators (ICDs), left ventricular assist devices, and heart transplantation, place a substantial financial burden on the health care system. The present criteria for risk stratification in patients with heart failure are inadequate and often prevent the allocation of appropriate treatment. Patients who have received ICDs as primary prevention for sudden cardiac death often receive no device therapy in their lifetime, whereas other patients with left ventricular dysfunction die suddenly without meeting criteria for ICD implantation.

Near Infrared Fluorescence Imaging for early detection, monitoring and improved intervention of diseases involving the joint

Joints consist of different tissues, such as bone, cartilage and synovium, which are at risk for multiple diseases. The current imaging modalities, such as magnetic resonance imaging, Doppler ultrasound, X-ray, computed tomography and arthroscopy, lack the ability to detect disease activity before the onset of anatomical and significant irreversible damage. Optical in vivo imaging has recently been introduced as a novel imaging tool to study the joint and has the potential to image all kinds of biological processes. This tool is already exploited in (pre)clinical studies of rheumatoid arthritis, osteoarthritis and cancer. The technique uses fluorescent dyes conjugated to targeting moieties that recognize biomarkers of the disease. This review will focus on these new imaging techniques and especially where Near Infrared (NIR) fluorescence imaging has been used to visualize diseases of the joint. NIR fluorescent imaging is a promising technique which will soon complement established radiological, ultrasound and MRI imaging in the clinical management of patients with respect to early disease detection, monitoring and improved intervention.

The role of magnetic resonance imaging in management of patients with nonlobar hypertensive intracerebral hemorrhage.

Despite the increased use and availability of magnetic resonance imaging (MRI), its role in hypertensive intracerebral hemorrhage (ICH) remains uncertain. In this retrospective study, we assessed the utility of MRI in diagnosis and management of patients with hypertensive ICH. We retrospectively reviewed the charts of patients with ICH presenting to our hospital over an 18-month period. We included patients who presented with hypertensive ICH in typical locations and excluded lobar hemorrhages. We further isolated cases that had undergone MRI. Collected data included mean age, gender, location of hematoma, neuroradiologist's interpretative report of the MRI, and management steps taken in response to the results of the MRI. Logistic regression was used to determine whether the overall yield of MRI in these patients was significant. We found 222 patients with ICH in our database. Forty-eight patients met our inclusion criteria, of which 24 had brain MRI done as a part of their hospital workup. Brain MRI obtained in 2 (8%) of the 24 patients revealed abnormalities that led to a change in management. The diagnostic yield of MRI and the management decisions that followed were both insignificant. The diagnostic yield of brain MRI in patients with nonlobar hypertensive ICH is low and does not result in significant changes in management.

Computed tomography in management of patients with non-localizing headache.

To assess the usefulness of a computed tomography scan in patients with non-localized headache. One-hundred and forty-two patients with non-localized headache were included in a retrospective study after reviewing the medical records of 896 patients at the Radiology Department, Sultan Qaboos University Hospital. Patients with neurological deficits, head injury, previous intracranial intervention, or malignancy were excluded. Radiological findings of all patients were reviewed and results were divided into 3 groups: 1) no intracranial abnormality; 2) with clinically significant intracranial abnormality; and 3) positive without clinical significance or with extracranial abnormality. All patient history records were reviewed for a period of six months following their initial computed tomography scan to assess their clinical outcomes. The cost of computed tomography examination and patient radiation dose were calculated. Of the 142 patients, 64% were females and 36% males (7% pediatric) with an age range of 4-87 years (mean: 36.2 years). Among the patients, 70% demonstrated negative computed tomography findings (grade 1), only 4% showed clinically significant findings (grade 2), and 26% demonstrated incidental positive findings with no clinical significance (grade 3). The average cost of computed tomography head examination was approximately 60 Omani Riyal ($156). The clinically significant positive cases were fewer than expected. The average estimated radiation dose for these patients was calculated and found to be around 5 times the radiation from computed tomography of the sinuses (approximately 1.84 mSv). Computed tomography head imaging in patients with non-localized headache has a low likelihood for any significant intracranial lesion. Therefore, it is essential to develop local standard operating procedures to promote better utilization of this type of imaging service.

AB0744 A retrospective analysis of the diagnostic utility of positron emission tomography (pet) in the diagnosis and management of large vessel vasculitis

BackgroundTo assess the role of (18F)FDG-PET/CT imaging in management of patients suspected to have large vessel vasculitis (LVV) with systemic and/or GCA/PMR features with or without history of large vessel...

18F-Fluorodeoxyglucose Positron Emission Tomography in the Management of Patients with Thymic Epithelial Tumors

There are limited data regarding the role of (18)F-fluorodeoxyglucose positron emission tomography ([(18)F]-FDG PET) imaging in management of patients with thymic epithelial tumors (TET). The primary objective of this study was to assess the usefulness of early [(18)F]-FDG PET to monitor treatment efficacy and its correlation with Response Evaluation Criteria in Solid Tumors (RECIST) in patients with TETs. [(18)F]-FDG PET/computed tomographic (CT) scans were conducted at baseline and after 6 weeks of treatment in patients enrolled in two phase II and one phase I/II clinical trials. On the basis of data from other solid tumors, metabolic response was defined as a reduction of [(18)F]-FDG uptake by more than 30% as assessed by average standardized uptake values (SUV) of up to five most metabolically active lesions. Fifty-six patients with unresectable Masaoka stage III or IV TETs were included. There was a close correlation between early metabolic response and subsequent best response using RECIST (P < 0.0001-0.0003): sensitivity and specificity for prediction of best response were 95% and 100%, respectively. Metabolic responders had significantly longer progression-free survival (median, 11.5 vs. 4.6 months; P = 0.044) and a trend toward longer overall survival (median, 31.8 vs. 18.4 months; P = 0.14) than nonresponders. [(18)F]-FDG uptake was significantly higher in thymic carcinoma than in thymoma (P = 0.0004-0.0010). In patients with advanced TETs, early metabolic response closely correlates with outcome of therapy. [(18)F]-FDG PET may be used to monitor treatment efficacy and assess histologic differences in patients with advanced TETs.

Experience with cardiac magnetic resonance imaging in patient management at the Markusovszky Hospital, County Vas, Hungary

At the Markusovszky Hospital, Vas County, Hungary, cardiac magnetic resonance imaging has been routinely used since July, 2009. In the majority of cases this method has been applied for the assessment of myocardial viability in patients with chronic ischemic heart disease and, in a smaller number of cases, for the evaluation of patients with myocarditis, cardiomyopathy and syncope with uncertain etiology in young athletes. The aim of the study was to analyze the clinical value of cardiac magnetic resonance imaging in assessing the viability of affected myocardial regions due to chronic occlusion of major coronary arteries. Delayed-enhancement cardiac magnetic resonance examination was performed in 88 patients who had 103 myocardial regions affected with chronic occlusion of the coronary arteries. The number of affected myocardial regions which proved to be treatable with coronary artery intervention and the number of regions where revascularization strategy was based on cardiac magnetic resonance imaging findings were analyzed. Based on findings from cardiac magnetic resonance imaging, revascularization strategy was set up in 88 myocardial regions corresponding to 83.5% of all affected myocardial regions included in this study. Delayed-enhancement cardiac magnetic resonance imaging appears to be a powerful tool to choose the optimal reperfusion strategy in patients with chronic coronary occlusion. Although this diagnostic method is relatively expensive, its accuracy regarding the features of myocardial viability such as transmural extension of the lesion within the affected region is higher than that of other methods (e.g. myocardium scintigraphy or stress echocardiography).