Multidetector Computed Tomography Findings Research Articles

Imaging findings associated with costoclavicular intervention during lead extraction.

Binding sites in the costoclavicular space are commonly encountered during transvenous lead extraction. Severe adhesions may warrant use of more aggressive rotational cutting tools or surgical intervention. It is not known whether pre-procedural multidetector computed tomography (MDCT) can provide information about the likelihood that a patient will require costoclavicular intervention. The purpose of this study was to determine if there are pre-procedural MDCT findings associated with need for intervention in the costoclavicular space during lead extraction. Patients who underwent lead extraction and required use of stiffer rotational cutting tools (TightRail Sub-C) or surgical intervention in the costoclavicular space were included, as well as age- and sex-matched controls who did not require intervention. Pre-procedural MDCT was evaluated for patterns of lead tethering to bone and adjacent calcification. Overall, 56 patients were included (n=20 Sub-C only, n=8 surgical intervention, and n=28 matched controls). The mean patient age of interventional cases was 65.0 ± 14.7 years, 18% were female, and the mean lead age was 12.3 ± 6.2 years. Four major patterns were identified on imaging: lead surrounded 360° by fat (intervention rate, 5/24 patients); lead tethered to bone by <180° (11/19); no tethering of lead but with associated calcifications (3/4); and lead tethered to bone by >180° (9/9). Tethering of at least one lead to bone by >180° was associated with a 100% rate of costoclavicular intervention, and the highest rate of surgical intervention (56%). Absence of any degree of bone tethering was associated with a 0% rate of surgical intervention. CT captures details of costoclavicular binding that appear to correlate with the need for adjunctive extraction techniques, including surgical intervention. CT may be useful in pre-procedural planning for adhesions in the costoclavicular space.

Empiric embolization by vasospasm therapy for acute lower gastrointestinal bleeding: a preliminary report

To report the preliminary result of empiric embolization for angiographycally-negative lower gastrointestinal bleeding (LGIB) by using the pharmaco-induced vasospasm technique with or without the adjunctive use of intra-arterial multi-detector computed tomography (MDCT). 23 LGIB patients with positive MDCT findings but negative angiographic results underwent empiric pharmaco-induced vasospasm therapy. The presumed bleeding artery was semi-selectively catheterized, and a segment of bowel was temporarily spasmed with bolus injection of epinephrine and immediately followed by 4-h’ vasopressin infusion. The rebleeding, primary and overall clinical success rates were reported. MDCT showed 19 bleeders in the SMA territory and 4 bleeders in the IMA territory. Early rebleeding was found in 6 patients (26.1%): 2 local rebleeding, 3 from new-foci bleeding and 1 uncertain. Of the 10 small bowel bleeding patients, only 1 out of the 7 who underwent intra-arterial MDCT showed rebleeding, whereas 2 out of the 3 without intra-arterial MDCT rebled. No patients exhibited procedure-related major complications, including bowel ischemia and cardiopulmonary distress. The overall clinical success rate was 91.3% (21/23) with a 30-day mortality rate of 26.1% (2 of the 6 patients had early rebleeding). Empiric pharmaco-induced vasospasm therapy, when localized with/without adjunctive intra-arterial MDCT, seems to be a safe and effective method to treat angiographically-negative LGIB patients.

Pixel to Pathology: A Prospective Cross-Sectional Study on the Role of Multidetector Computed Tomography in the Evaluation of Malignant Large Bowel Lesions With Histopathological Correlation.

Colorectal lesions can present as a mass or as focal or diffuse thickening of the colon wall and may also be associated with abnormalities in the perienteric region. Multidetector computed tomography (MDCT) enables simultaneous imaging of both extracolonic structures and the gut wall. It is instrumental in assessing tumor extent, detecting pericolic dissemination, including lymph node involvement, and identifying metastases. This study aims to evaluate the role of MDCT in diagnosing large bowel lesions in patients referred from the surgery department with suspected large bowel pathology and to correlate MDCT findings with histopathological results. In the Department of Radiodiagnosis at Mahatma Gandhi Medical College and Research Institute (MGMCRI), Pondicherry, this study was carried out from February 2023 to January 2024 over a one-year span. CT imaging was carried out utilizing a GE Optima 128 Slice MDCT scanner for instances of clinically suspected large bowel pathology. IV contrast, rectal, oral (positive), and plain CT were the imaging protocols that were used. Thirty of the 45 patients were female, and 15 were male; most of the patients were in the 46-60 age range. Twenty-three of the 24 instances with a CT diagnosis of malignancy had a histological confirmation. On CT, all 21 benign lesions were correctly detected. Benign lesions showed homogenous attenuation, mild symmetric wall thickening, and diffuse bowel involvement. Heterogeneous attenuation, pronounced asymmetric wall thickening, and localized bowel involvement were observed in malignant lesions. For the diagnosis and differentiation of benign from malignant colon and rectum lesions,MDCThas shown itself to be an excellent technique. MDCT provides additional information about related pericolic abnormalities, lymph node presence, neighboring organ infiltration, and distant metastases in addition to identifying the lesions.

Double contrast-enhanced ultrasonography improves diagnostic accuracy of T staging compared with multi-detector computed tomography in gastric cancer patients.

Gastric cancer (GC) is the most common malignant tumor and ranks third for cancer-related deaths among the worldwide. The disease poses a serious public health problem in China, ranking fifth for incidence and third for mortality. Knowledge of the invasive depth of the tumor is vital to treatment decisions. To evaluate the diagnostic performance of double contrast-enhanced ultrasonography (DCEUS) for preoperative T staging in patients with GC by comparing with multi-detector computed tomography (MDCT). This single prospective study enrolled patients with GC confirmed by preoperative gastroscopy from July 2021 to March 2023. Patients underwent DCEUS, including ultrasonography (US) and intravenous contrast-enhanced ultrasonography (CEUS), and MDCT examinations for the assessment of preoperative T staging. Features of GC were identified on DCEUS and criteria developed to evaluate T staging according to the 8th edition of AJCC cancer staging manual. The diagnostic performance of DCEUS was evaluated by comparing it with that of MDCT and surgical-pathological findings were considered as the gold standard. A total of 229 patients with GC (80 T1, 33 T2, 59 T3 and 57 T4) were included. Overall accuracies were 86.9% for DCEUS and 61.1% for MDCT (P < 0.001). DCEUS was superior to MDCT for T1 (92.5% vs 70.0%, P < 0.001), T2 (72.7% vs 51.5%, P = 0.041), T3 (86.4% vs 45.8%, P < 0.001) and T4 (87.7% vs 70.2%, P = 0.022) staging of GC. DCEUS improved the diagnostic accuracy of preoperative T staging in patients with GC compared with MDCT, and constitutes a promising imaging modality for preoperative evaluation of GC to aid individualized treatment decision-making.

Progression of subclinical cardiovascular disease in patients with HIV.

Human immunodeficiency virus (HIV) infected patients are at increased risk of cardiovascular disease (CVD). Multidetector computed tomography (MDCT) stratifies cardiovascular risk in asymptomatic patients with subclinical atherosclerosis. The aim of this study was to determine the ability of MCTD and clinical and laboratory parameters to assess subclinical CVD progression in HIV patients. Prospective longitudinal cohort study of patients with at least 10 years of HIV infection and 5 years of antiretroviral therapy history, low cardiovascular risk and monitored for 6 years (2015-2021). All patients underwent clinical assessment, blood analysis, carotid ultrasound, and gated MDCT in 2015 and 2021. Sixty-three patients (63.5% male) with a mean age of 49.9 years (standard deviation [SD], 10.5) were included in 2015; 63 of them were followed until 2021. Comparing the results from 2015 with those from 2021, Systematic Coronary Risk Estimation-2 (SCORE2) was 2.9% (SD, 2.1) vs. 4.4% (SD,3.1); Multi-Ethnic Study of Atherosclerosis score (MESA risk) was 3.4 (SD 5.8) vs. 6.0 (SD 8.6); coronary artery calcification CAC) score >100 was 11.1% vs. 25.4% (P < 0.05); and 11% vs. 27% had carotid plaques (P = 0.03). After six years of follow-up, an increase in SCORE2, carotid plaques, CAC scoring and MESA risk was observed. MDCT findings, along with other clinical and laboratory parameters, could play an important role as a marker of CVD progression in the evaluation of patients with HIV and low cardiovascular risk.

Pokazatelji markera inflamacije, oštećenja organa, oksidativnog oštećenja makromolekula i promena na CT toraksa pacijenata sa COVID-19 pneumonijom

Coronavirus disease 2019 (COVID-19) is a multi-systemic disease caused by Severe acute respiratory syndrome coronavirus 2, SARS-CoV-2. Since the onset of the pandemic, understanding the pathophysiological mechanisms of this disease has posed a significant challenge, with the intent to determine its progression and implement appropriate treatment strategies. The heightened severity and mortality associated with SARS-CoV-2 infection can be attributed, in part, to a phenomenon known as cytokine storm. This refers to an uncontrolled systemic inflammatory response characterized by elevated proinflammatory cytokines and chemokines, leading to an overproduction of free radicals. The aforementioned cytokine storm is accompanied by the excessive generation of reactive oxygen species and affects the virus and directly damages the host's cells. Given that the SARS-CoV-2 virus primarily targets respiratory cells, pneumonia is a common manifestation of the disease. Consequently, chest multidetector computed tomography (MDCT) plays a crucial role in evaluating lung tissue inflammation, determining disease severity, making decisions regarding hospitalization, and assessing the necessity of intensive care unit treatment. Assessing the level of oxidative stress can be accomplished by measuring the products resulting from damage to lipids, proteins, and DNA - whereas the inflammatory and multiorgan impairment biomarkers can be procured from routine laboratory practice. Due to the established association of a cytokine storm with a free radical storm, it might be postulated that during the acute phase of COVID-19 pneumonia the redox biomarkers might correlate with inflammatory and multiorgan impairment biomarkers, as well as chest MDCT findings.

Evaluation of Acute Abdomen by Multidetector Computed Tomography: A Prospective Study in a Tertiary Care Hospital in Andhra Pradesh, India

Abstract Background and Objective: Evidence on the efficiency of multidetector computed tomography (MDCT) in diagnosing acute abdomen in the Indian setting is lacking. This study was conducted to estimate the incidence of various causes of acute abdomen, correlate MDCT observations with postoperative findings, and estimate the sensitivity and specificity of MDCT findings. Methods: In this prospective study, 54 patients with acute abdomen were recruited in the emergency department (ED) of a tertiary care hospital in Chittoor, India. In these patients, MDCT observations were compared with postoperative findings, and the sensitivity and specificity of MDCT findings were estimated. Results: The majority of the patients presented with pain in epigastrium (n = 13, 24.1%), and 46 (85.2%) had nontraumatic acute abdomen. Pancreatitis was the major cause of nontraumatic acute abdomen. MDCT had failed to detect one case of acute appendicitis, one calculous cholecystitis, Meckel’s diverticulum, stricture ureter, and degloving injury of the colon. Overall, MDCT was positive for 57 out of a total of 63 conditions (eight patients had two different diagnoses) and it could rule out acute abdomen accurately in one patient. The sensitivity of MDCT in diagnosing acute abdomen was 92% and specificity was 100%. Conclusion: MDCT is a valuable diagnostic radiological investigation for patients with acute abdomen presenting to the EDs. Its multiple advantages put it ahead of the other traditional radiological investigations.

Multidetector computed tomography findings in patients with abdominal crush trauma due to Kahramanmaraş centered earthquakes

Purpose: This study aimed to investigate the characteristics of abdominal crush injuries using multidetector computed tomography (MDCT) in survivors of earthquakes centered in Kahramanmaraş.&#x0D; Materials and Methods: Retrospective evaluation was conducted on 255 patients who sustained injuries due to an earthquake centered in Kahramanmaraş and were treated at our hospital. Patients clinically suspected of having abdominal crush trauma underwent MDCT examinations. The presence of abdominal wall injuries, solid organ injuries, free fluid in the abdomen, pneumoperitoneum, and subcutaneous emphysema findings were examined.&#x0D; Results: The median time between injury and MDCT examination was 3 days, ranging from 4 hours to 8 days. Among pediatric and adult age groups, males constituted 42.6% (52/122) and 47.4% (63/133), while females were 57.4% (70/122) and 52.6% (70/133), respectively. The mortality rates for pediatric and adult age groups were 0.4% (1/122) and 4.3% (11/133), respectively. Among patients with fatal outcomes, rates of acute kidney injury, subcutaneous emphysema, spleen injuries, and renal/perirenal injuries were 8.3% (1/12), liver and abdominal wall injuries were 16.7% (2/12), and free fluid in the abdomen was observed at a rate of 33.3% (4/12).&#x0D; Conclusion: Abdominal wall injuries were the most frequently observed manifestations of crush injuries, with renal/perirenal injuries being the most common among solid organs, and liver injuries being commonly seen among intraperitoneal organs. These findings underscore important characteristics of abdominal crush trauma related to earthquakes.

Prognostic impact of highly solid component in early-stage solid lung adenocarcinoma.

Based on computed tomography (CT) findings of lung cancer, solid nodules have a much worse prognosis than subsolid nodules, even if the nodules are subcentimeter in size. There is, however, no systematic method for determining the prognosis of solid tumors on CT. This study aimed to discover the prognostic factor of early-stage solid lung adenocarcinoma using three-dimensional CT volumetry. Patients with pathological stage I solid lung adenocarcinoma who underwent complete resection between 2007 and 2012 were selected in this retrospective study. Clinicopathological data and preoperative multidetector CT findings, such as tumor size on the two-dimensional axial image, three-dimensional tumor volume between -600 and 199 HU, and three-dimensional solid volume between 0 and 199 HU, which corresponded to highly solid components, were compared between recurrence and non-recurrence. Furthermore, these radiological values were compared to pathological invasive volume (PIV). During this time, 709 patients had their lung cancer completely removed. From this cohort, 90 patients with pathological stage I solid lung adenocarcinoma were selected. In addition, recurrence was found in 26 patients (28.9%). Although two-dimensional axial image, serum carcinoembryonic antigen (CEA) level, and SUVmax on 18F fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) did not differ statistically between recurrent and non-recurrent patients, three-dimensional tumor and solid tumor volume did. Multivariate analysis indicated that three-dimensional solid tumor volume [hazard ratio: 2.440; 95% confidence interval (CI): 1.110-5.361, P=0.026] and epidermal growth factor receptor (EGFR) mutation (hazard ratio: 4.307; 95% CI: 1.328-13.977, P=0.015) were significantly associated with disease-free survival (DFS). When three-dimensional tumor and solid tumor volume were compared to PIV, three-dimensional solid tumor volume (3,091 mm3 on average) showed a highly similar value with PIV (2,930 mm3 on average), whereas three-dimensional tumor volume (6,175 mm3 on average) was significantly larger than PIV (P<0.001). In patients with early-stage solid lung adenocarcinoma, the measurement of three-dimensional solid tumor volume, which is correlated with PIV, accurately predicted the postoperative outcome.

Grading Abdominal Trauma: Changes in and Implications of the Revised 2018 AAST-OIS for the Spleen, Liver, and Kidney.

According to the Centers for Disease Control and Prevention, trauma is the leading cause of fatal injuries for Americans aged 1-44 years old and the fourth leading overall cause of death. Accurate and early diagnosis, including grading of solid organ injuries after blunt abdominal trauma (BAT), is crucial to guide management and improve outcomes. The American Association for the Surgery of Trauma (AAST) Organ Injury Scale (OIS) is the most widely accepted BAT scoring system at CT both within the United States and internationally, and its uses include stratification of injury severity, thereby guiding management, and facilitation of clinical research, billing, and coding. Furthermore, this system also plays a role in the credentialing process for trauma centers in the United States. The newly revised 2018 OIS provides criteria for grading solid organ damage into three groups: imaging, operation, and pathology. The final grade is based on the highest of the three criteria. If multiple lower-grade (I or II) injuries are present in a single organ, one grade is advanced to grade III. The most substantial change in the revised 2018 AAST-OIS is incorporation of multidetector CT findings of vascular injury, including pseudoaneurysm and arteriovenous fistula. The authors outline the main revised aspects of grading organ injury using the AAST-OIS for the spleen, liver, and kidney after BAT, particularly the role of multidetector CT and alternative imaging in organ injury detection, the importance of vascular injuries in grade change, and the impact of these changes on patient management and in prediction of operative treatment success and in-hospital mortality. ©RSNA, 2023 Supplemental material and the slide presentation from the RSNA Annual Meeting are available for this article. Quiz questions for this article are available through the Online Learning Center.

Left Bronchial Isomerism with Right-Sided Tracheal Bronchus: A Rare Case Report

The tracheal bronchus is a congenital bronchial branching anomaly defined as an aberrant bronchus arising in either the trachea or a main bronchus. Left bronchial isomerism is characterized by two bilobed lungs, bilateral long main bronchi, and both pulmonary arteries passing superiorly to their respective upper lobe bronchi. Left bronchial isomerism with a right-sided tracheal bronchus is a very rare combination of tracheobronchial anomalies. It has not been previously reported. We present multi-detector CT findings of a left bronchial isomerism with a right-sided tracheal bronchus of a 74 year old man.

Predictive value of sphericity index and other multidetector computed tomography findings in perforated acute appendicitis.

Early radiological prediction and diagnosis of perforated acute appendicitis remain controversial. In the current study, it was aimed to examine the predictive value of multidetector computed tomography (MDCT) findings in perforated acute appendicitis. The patients (n=542) who underwent appendectomy between January 2019 and December 2021 were retrospectively evaluated. The patients were divided into two groups as non-perforated appendicitis and perforated appendicitis. Preoperative abdom-inal MDCT findings, appendix sphericity index (ASI) scores, and laboratory findings were evaluated. The sample consisted of 427 cases in the non-perforated group and 115 cases in the perforated group, with a mean age of 33.88±12.84 years. The mean time until admission was 2.06±1.43 days. Appendicolith, free fluid, wall defect, abscess, free air, and retroperitoneal space (RPS) involvement were all found to be significantly higher in the perforated group (P<0.001). The mean long axis, short axis, and ASI values were found to be higher in the perforated group (P<0.001; P=0.004; and P<0.001, respectively). C-reac-tive protein (CRP) was found to be significantly higher in the perforated group (P=0.008), but the mean white blood count was found to be similar between the groups (P=0.613). Among MDCT findings, free fluid, wall defect, abscess, high CRP, long axis, and ASI were observed to be predictive values for perforation. According to receiver operating characteristic analysis, ASI had a cut-off value of 1.30, a sensitivity of 80.87%, and a specificity of 93.21%. MDCT findings, namely, appendicolith, free fluid, wall defect, abscess, free air, and RPS involvement are significant findings for perforated appendicitis. With a high sensitivity and specificity, the ASI appears to be a key predictive parameter for perfo-rated acute appendicitis.

Multi-Detector CT Findings of Typical and Atypical Appendicitis: A Pictorial Essay

Multi-detector CT (MDCT) is a highly accurate diagnostic tool that is commonly used to evaluate appendicitis and its complications. The diagnosis of appendicitis based on MDCT findings can be difficult and challenging when the observed findings are inconsistent with the typical features. Atypical appendicitis includes a wide spectrum of features, such as variable positions of the appendix and cecum, complications, and unusual pathological findings of secondary appendicitis that mimic or induce appendicitis. Our pictorial essay describes the diverse spectrum of atypical appendicitis and appendicitis-like conditions in terms of location abnormalities, complications, and uncommon pathologies, including related tumors, reactive appendicitis, appendiceal diverticulitis, and IgG4-related disease. Through this essay, the readers can become more familiar with MDCT findings of atypical appendicitis.

Role of Computed Tomography Scan in the Assessment and Management of Blunt Splenic Trauma in a Tertiary Care Hospital, Assam, India

Introduction: Trauma is the most common cause of mortality and morbidity in young individuals. Penetrating splenic injuries are more common than blunt injuries. The management of blunt splenic trauma has substantially evolved over the last few decades, moving from routine splenectomy to preserving the spleen wherever feasible. Aim: To determine the role of Multidetector Computed Tomography (MDCT) in the diagnosis and treatment of blunt splenic trauma. Materials and Methods: This hospital-based retrospective study was conducted in Department of General Surgery, Tezpur Medical College and Hospital, Tezpur, Assam, India. During the study period, there were 132 cases of blunt trauma abdomen. Among them, 122 patients had undergone MDCT of the abdomen. Clinical details of those 122 patients who did MDCT for possible blunt trauma of the abdomen were traced and were admitted to the Department of General Surgery, Tezpur Medical College and Hospital, Tezpur, Assam, India during the period from 1st October 2021 to 31st August 2022 retrospectively. The clinical data of these 122 patients were recorded. Of these 122 patients who underwent MDCT, 21 had splenic injuries. The patients who were treated conservatively were traced and the outcome of the treatment on follow-up, from the clinical notes. The preliminary MDCT findings of the patients were correlated with the final diagnosis and treatment. Fisher’s-exact tests and Chi-square were used for statistical analysis. Results: The 21 splenic injuries in this study were classified based on the American Association for the Surgery of Trauma (AAST) grading scales for organ injury, and 14 (66.67%) had Non Operative Management (NOM). Of the four patients with Contrast Material Extravasation (CME), all of them had undergone laparotomy related to the spleen (100%) and demonstrated active bleeding during surgery, but only three of the remaining 17 patients without CME (17.65%) required laparotomy related to the spleen; the difference was statistically found to be significant (p&lt;0.01). Conclusion: The accurate diagnosis provided by MDCT evaluation of blunt splenic injuries helps in formulating the right approach for better management.

Added value of a chest multidetector computed tomography scoring system in the assessment of chronic lung disease among pediatric patients

BackgroundPediatric chronic lung disease (CLD) represents a heterogeneous group of several distinct clinical entities, with its prevalence increasing over the last decade. The current study aimed to identify the role of chest multidetector computed tomography (MDCT) using modified Bhalla scoring for the early diagnosis of CLD in pediatric patients and determine the most common chest MDCT findings. This prospective study involved 45 pediatric patients with chronic respiratory symptoms, all of whom underwent MDCT. Thereafter, data were analyzed using the modified Bhalla score.ResultsChronic lung diseases were classified according to their radiological and clinical criteria. The total CT score, which was the most significant factor for chronic inhalation and chronic recurrent inflammatory lung diseases, varied between 2 and 21 points, with those having autoimmune diseases exhibiting the largest value for the mean CT score. The clinical severity of symptoms was not correlated with CT score.ConclusionOur findings showed that MDCT was a useful tool for diagnosing pediatric CLD and assessing disease extent, severity, and superimposed complications. The modified Bhalla CT scoring system allowed for systematic primary and follow-up assessments of various lung lesions in cases with varying CLD etiologies.

Comparative Evaluation of Multidetector Computed Tomography and Dual-Energy Computed Tomography Findings in Gastrointestinal Tuberculosis.

To compare multidetector computed tomography (MDCT) and dual-energy computed tomography (DECT) imaging findings in gastrointestinal (GI) tuberculosis. To study imaging findings of MDCT and DECT in GI tuberculosis. All the patients falling in the sampling frame and fulfilling the eligibility criteria were clinically examined and demographic details, presenting complaints, medical history, history of anti-tubercular treatment (ATT) intake, personal habits,and family history of tuberculosis were noted. All the patients underwent sputum acid-fast bacilli (AFB) assessment. Outcomes of investigations like bronchoscopy and fine-needle aspiration cytology (FNAC)/biopsy were also noted wherever available. Ascitic fluid AFB and culture assessments were also performed wherever feasible. All CT scans were performed on a 384-slice dual-energy CT scanner (Somaton Force, Siemens Healthcare) and all the images were post-processed on a workstation using syngo.via software that allows the analysis of images using three material decompositions. Features like peritonitis, lymph node involvement, GI wall thickening, and solid organ involvement were focused on. Subjective assessment of images of both MDCT and DECT were assessed by two experienced radiologists to prepare the CT diagnosis. The mutual agreement of the two observers was considered final. The findings of the study showed that both MDCT, as well as DECT, were useful in the diagnosis of GI tuberculosis. On the basis of these findings, DECT could be considered to have an edge over MDCT in the diagnosis of GI tuberculosis. Keeping in view the small sample size and high prevalence, further studies on a larger sample size with relaxed sampling criteria are recommended to validate the findings of the present study.

Role of multi detector computed tomography (MDCT) in evaluation and management of blunt abdominal trauma

Background: The majority of all blunt and penetrating body injuries are abdominal injuries. Computed tomography is a significant and quick technology that provides information on the kind of abdominal damage quickly and aids in patient care in accordance with that information. The current study's objectives were to assess the value of Multidetector Computed Tomography (MDCT) in identifying intra-abdominal injuries in patients with acute abdominal trauma and to give knowledge that might precisely guide therapy decisions (non- operative versus operative). and to compare the computed tomography (CT) results to either clinical observation, a further CT scan (if necessary), or the results of surgery (wherever applicable). Objectives: To examine the utility of multidetector computed tomography (MDCT) in detecting intra-abdominal injuries in patients with blunt abdominal trauma and providing information to define the role of therapy (operative versus conservative). Materials and Methods: This two-year prospective study looked at 50 patients who had suffered blunt abdominal trauma. The MDCT findings were compared to clinical outcomes, follow-up CT scans (if needed), and surgical outcomes (whichever applicable). Results: Motor vehicular accidents were the commonest cause of abdomen blunt injury (68%). Abdominal injury was present in 38 (76%) patients and hemoperitoneum was seen on CT scan in 33 patients (85.8%). In 27 patients, hemoperitoneum was associated with solid organ injury. The commonest injury was splenic injury. In 6 patients (15.8%) who underwent surgery, CT findings of hemoperitoneum and solid organ injury were verified, and bowel injury was shown to be the origin of isolated hemoperitoneum in two cases. The CT scan was 100% accurate in detecting hemoperitoneum. During the follow-up period, all conservatively handled cases recovered without incident. As a result, OIS grading appeared to predict care methods in the majority of patients in this study's overall analysis of solid organ injuries, with the exception of those with bowel and mesenteric injuries. Conclusion: In the diagnosis and management of blunt abdominal trauma, CT is the imaging modality of choice. Keywords: Computed tomography; Blunt Abdominal Trauma; Organ Injury Scaling (OIS); splenic injury; liver injury, road traffic accidents.

THE COMPARATIVE STUDY OF USG AND MDCT IN THE EVALUATION OF PELVIC MASSES IN FEMALES

Introduction: Pelvic masses in females of all ages are a routine gynaecological issue for which healthcare is sought, and in a populous country like India, these masses form a significant part of the disease burden. The evaluation of the female pelvis is a radiological necessity and a challenge. The foremost aim for any imaging modality in this scenario is to rule out malignancy in the mass, and further to characterise and define the mass so as to guide appropriate management of the patient. Of the wide range of imaging modalities available, ultrasonography and computed tomography are commonly available and extensively used for the evaluation of the varied female pelvic masses. We studied the ultrasonography and multi detector computed tomography findings and their usefulness in the diagnosis and characterization of various pelvic masses in females. Methodology: It was a prospective observational study, ranging over the duration of one and a half years,of 100 female patients fulfilling inclusion criteria, who underwent ultrasonography and multidetector computed tomography scanning in the Department of Radiodiagnosis at RNT medical college, Udaipur. Pelvic masses were evaluated for origin, size, margins, composition, vascularity, ascites, lymphadenopathy and other features to characterise as benign or malignant. Final diagnosis was by histopathological correlation. Results: The most common age group belonged to 35-45 years group (22%) followed by 55-65 years group (21%). Mean age for benign masses was 35.84 years and for malignant masses was 51.64 years. Ovarian origin was the commonest followed by uterine origin. Features like solid areas, ill-defined margins, lymphadenopathy and ascites favoured malignancy. Most common pathologies were adenocarcinoma ovary, carcinoma cervix, benign ovarian cysts and uterine fibroids. Conclusion: Ultrasonography is often the first imaging study performed in patients with symptoms related to the pelvis. Results indicated higher diagnostic capability of CT as a problem-solving tool. Overall diagnostic accuracy of CT was higher than USG in characterising both benign and malignant pelvic masses.

Surgical importance of the tympanic bone: multidetector computed tomography findings.

ObjectivesTo measure tympanic bone thickness (anterior-superior, anterior-inferior, and inferior wall), external ear canal length, and tympanomandibular distance that can be useful in cases that undergo tympanic bone resection.Materials and MethodsThe temporal computed tomography (CT) images of 349 patients were retrospectively evaluated. The anterior-inferior, anterior-superior, and inferior wall thicknesses; tympanomandibular distance; and external auditory canal (EAC) bone canal length were measured from the narrowest part of the canal. The shapes of the EAC in the coronal and sagittal planes were also examined.ResultsThe numbers of female and male patients were similar, and the mean age was 49.45±13.95 years. The anterior-superior, anterior-inferior, and inferior wall thicknesses were 1.92±0.60, 2.54±0.74, and 9.16±2.20 mm, respectively. The anterior-superior and anterior-inferior wall thicknesses and canal lengths were greater on the right side (P<0.001). All measurement values were higher in males, except right tympanomandibular distance (P<0.05). A non-significant negative correlation was found between the age of the participants and the left anterior-inferior wall and tympanomandibular distance on both sides. Intra-observer agreement was high for all measurements. We observed four main shapes in the external ear canal in the coronal plane Type 3, Type 2, Type 1, and Type 4 in order of frequency on the right, and Type 2, Type 3, Type 1, and Type 4 on the left. In the sagittal plane, we detected three shapes oval (74.4%), triangular (16.3%), and round (9.4%).ConclusionThe anterior wall thicknesses and tympanomandibular distance should be measured on preoperative temporal bone CT to safely perform tympanic bone anterior resection, which is required in some otological procedures, and also to prevent temporomandibular joint damage.

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.&#x0D; Study Design: Cross-sectional study.&#x0D; Place and Duration of Study: Department of Radiology, Combined Military Hospital Quetta from Jun to Dec 2019.&#x0D; 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.&#x0D; 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.&#x0D; 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.