Multidetector Computed Tomography Research Articles

Role of Multidetector Computed Tomography Urography in the Evaluation of Obstructive Uropathy: A Review.

Obstructive uropathy, a prevalent clinical problem, can irreparably harm the kidneys if not treated promptly. As a result, accurate diagnosis is necessary for prompt management. This study examines the utility of multidetector computed tomography (MDCT) urography in identifying obstructive uropathy. PubMed, Google, Embase, Medline, and other electronic databases were used to search the English-language literature. The search phrases were obstructive urinary infections or urinary bladder or kidneys or MDCT. The authors' expertise and experience in the subject area aided in archiving pertinent publications. Even though the dilated upper tract of the ureters can be seen, ultrasonography (USG) has limitations because it cannot show the middle portion of the ureters, even if they are dilated mostly due to bowel gas artifacts. The USG does not emphasize the functioning of the renal tract. To evaluate obstructive uropathy, MDCT urography plays a very important role. For speedy, effective therapy, it provides a quick diagnosis of the source of obstruction.

Application of spectral CT in diagnosis, classification and prognostic monitoring of gastrointestinal cancers: progress, limitations and prospects

Gastrointestinal (GI) cancer is the leading cause of cancer-related deaths worldwide. Computed tomography (CT) is an important auxiliary tool for the diagnosis, evaluation, and prognosis prediction of gastrointestinal tumors. Spectral CT is another major CT revolution after spiral CT and multidetector CT. Compared to traditional CT which only provides single-parameter anatomical diagnostic mode imaging, spectral CT can achieve multi-parameter imaging and provide a wealth of image information to optimize disease diagnosis. In recent years, with the rapid development and application of spectral CT, more and more studies on the application of spectral CT in the characterization of GI tumors have been published. For this review, we obtained a substantial volume of literature, focusing on spectral CT imaging of gastrointestinal cancers, including esophageal, stomach, colorectal, liver, and pancreatic cancers. We found that spectral CT can not only accurately stage gastrointestinal tumors before operation but also distinguish benign and malignant GI tumors with improved image quality, and effectively evaluate the therapeutic response and prognosis of the lesions. In addition, this paper also discusses the limitations and prospects of using spectral CT in GI cancer diagnosis and treatment.

Assessment of CBCT gray value in different regions-of-interest and fields-of-view compared to Hounsfield unit.

Different factors can affect the discrepancy between the gray value (GV) measurements obtained from CBCT and the Hounsfield unit (HU) derived from multidetector CT (MDCT), which is considered the gold-standard density scale. This study aimed to explore the impact of region of interest (ROI) location and field of view (FOV) size on the difference between these two scales as a potential source of error. Three phantoms, each consisting of a water-filled plastic bin containing a dry dentate human skull, were prepared. CBCT scans were conducted using the NewTom VGi evo system, while MDCT scans were performed using Philips system. Three different FOV sizes (8 × 8 cm, 8 × 12 cm, and 12 × 15 cm) were used, and the GVs obtained from eight distinct ROIs were compared with the HUs from the MDCT scans. The ROIs included dental and bony regions within the anterior and posterior areas of both jaws. Statistical analyses were performed using SPSS v. 26. The GVs derived from CBCT images were significantly influenced by both ROI location and FOV size (p < 0.05 for both factors). Following the comparison between GVs and HUs, the anterior mandibular bone ROI represented the minimum error, while the posterior mandibular teeth exhibited the maximum error. Moreover, the 8 × 8 cm and 12 × 15 cm FOVs resulted in the lowest and highest degrees of GV error, respectively. The ROI location and the FOV size can significantly affect the GVs obtained from CBCT images. It is not recommended to use the GV scale within the posterior mandibular teeth region due to the potential for error. Additionally, selecting smaller FOV sizes, such as 8 × 8 cm, can provide GVs closer to the gold-standard numbers.

Evaluation of the anatomic sinus after transcatheter aortic valve replacement

BackgroundFollowing transcatheter aortic valve replacement (TAVI), the newly formed ‘anatomic sinus’.may contribute to the formation of subclinical leaflet thrombosis (SLT).The evaluation of root geometry after TAVI is generally performed using multi-detector computed tomography (MDCT), and the role of transthoracic echocardiography (2D TTE) requires further validation. Thus, we aimed to test the reproducibility of 2D TTE assessment of the anatomic sinus with MDCT as a reference and its association with SLT. Methods2D TTE was performed in 90 patients, and the echocardiograms were analyzed offline. Both sinus of Valsalva (SOV) and prosthesis diameters were assessed in the long- and short-axis parasternal views (PLAX/PSAX), and the anatomic sinus area was calculated. Inter- and intra-observer reproducibility were assessed using the interclass correlation coefficient (ICC). MDCT was performed in 50 individuals to evaluate concordance with 2D TTE and to detect SLT. ResultsThere was excellent correlation regarding the diameter of the SOV and the prosthesis in PLAX (ICC: 0.93 (95% CI: 0.76,0.97); ICC: 0.80 (95% CI: 0.63,0.96)) and PSAX view (ICC: 0.90 (95% CI: 0.68,0.97); ICC: 0.88 (95% CI: 0.63,0.96)). Bland–Altman analysis of 2D TTE and MDCT anatomic sinus areas indicated a high level of agreement. SLT was detected in 8 individuals (16%); 3 patients had severe SLT at the level of 1 cusp. Conclusions2D TTE might play a role in the evaluation of the anatomic sinus after TAVI. The importance of this space and its effects on the SLT remain uncertain.

Diagnostic Challenges of Vascular Rings: Insights from a Case Report

The vascular ring (VR) is a rare congenital anomaly that can cause compression of the trachea or esophagus, resulting in respiratory and/or gastrointestinal symptoms. The severity of symptoms depends on the type of VR, with patients who have anatomically complete VRs typically presenting earlier in life. The diagnosis of VR has advanced with the availability of improved imaging modalities. Prenatal diagnosis is possible with fetal echocardiogram, while non-invasive multidetector CT and MRA can be utilized for later diagnosis. These imaging modalities allow for the delimitation of the defect and the identification of the anatomy for treatment planning. This case report presents the evaluation and management of a male neonate who was diagnosed with VR after initially presenting with respiratory and gastrointestinal symptoms that were suspected to be related to gastroesophageal reflux. This case highlights the importance of considering VR in the differential diagnosis of patients presenting with these symptomatologies.

Multi Detector Computed Tomography and Ultrasound Evaluation of Neck Masses with Pathological Correlation

Introduction: Neck imaging has always been a diagnostic challenge. High-resolution sonography being inexpensive and safe has become the initial investigation of choice for neck pathologies; it provides information regarding the origin and extent of the lesion. Computed tomography (CT) has a unique capacity for displaying soft tissue, bone and airway details and provides critical anatomical information about lesions involving the neck. This study aims to determine the role of USG and CT in neck masses for pre-operative characterization based on location, extent, morphological characteristics and enhancement pattern and to compare USG and CT findings with histopathological diagnosis.&#x0D; Material and Methods: A total number of 60 adult patients with suspected neck masses were studied in the department of Radiodiagnosis, SSIMS&amp;RC, Davanagere and inputs from Dr. B. R. Ambedkar Medical College, Bengaluru over a period of 24 months. Ultrasound was done using GE Voluson E6 machine &amp; Contrast enhanced CT was done using GE Revolution Multidetector CT scan machine. Post processing techniques (like volume rendered techniques) were applied wherever useful.&#x0D; Results: The findings on USG and CT were conclusive in nearly 90% of cases. Enhancement patterns and presence/absence of bony invasion were found to be more specific in differentiating benign/malignant nature.&#x0D; Conclusion: High-resolution sonography can be used as the first-line modality for evaluating cervical soft tissue masses, it helps the clinicians to characterize the lesion. Multi-detector computed tomography is a sensitive diagnostic tool for diagnosing neck masses and differentiating between benign and malignant lesions with high accuracy. The extent of pathology with local/ contiguous spread predicted by CT examination was conclusive. The overall findings suggest that MDCT and Ultrasound, when used in conjunction with pathological correlation, can be effective tools for accurately characterizing and diagnosing the neck masses.

Radiographic alveolar bone assessment in correlation with primary implant stability: A systematic review and meta-analysis.

The radiographic examination of alveolar bone using 3D radiographic examination is essential in dental implant treatment planning. Our study aimed to systematically review and quantitatively analyze the correlation between alveolar bone parameters, specifically bone density and cortical bone thickness, assessed using cone beam computed tomography (CBCT) and/or multidetector computed tomography (MDCT); and primary implant stability (PIS) determined using implant stability quotient (ISQ), Periotest® value (PTV), and insertion torque value (ITV). This review was registered in the PROSPERO database (registration number CRD42022307245). An electronic literature search was conducted on the PubMed, SCOPUS, and Web of Science databases for papers published until February 2022. The Quality Assessment in Prognostic Studies (QUIPS) tool was used to assess risk of bias. Meta-analyses were conducted to calculate the estimated average correlation coefficient based on a multilevel random-effects model, followed by subgroup analysis. Twenty-six studies were included in this review, consisting of 17 prospective cohort studies, eight retrospective cohort studies, and one nonrandomized controlled trial. A total of 3109 implants placed in 1171 subjects were analyzed. Twenty-three studies were evaluated using meta-analysis. The alveolar bone condition was significantly correlated with ISQ (r = 0.60; p < .001), IT (r = 0.52; p < .001), and PTV (r = -0.42; p < .05). Alveolar bone condition is significantly associated with PIS. Low bone density and thin cortical bone can lead to low PIS; therefore, modification of treatment planning and surgical procedures might be needed to avoid poor osseointegration.

Multidetector Computed Tomography in Patients Who Underwent Transcatheter Mitral Edge-to-Edge Repair

Multidetector computed tomography (MDCT) can provide valuable information for mitral assessment, but its role in transcatheter mitral edge-to-edge repair (TEER) planning has been poorly elucidated. We aimed to compare MDCT with 3-dimensional transesophageal echocardiography (3D-TEE) for TEER preprocedural evaluation. We analyzed the preprocedural MDCT and 3D-TEE of 108 consecutive patients with mitral regurgitation (MR) who underwent MitraClip implantation. The levels of agreement for the etiology and mechanism of MR, mitral calcification, mitral annulus, and mitral valve orifice area (MVOA) measurements were compared between MDCT and 3D-TEE data. Receiver-operating-characteristic curves were generated for mitral annulus area and MVOA using a low mean transmitral pressure gradient at discharge (<5mm Hg) as the state variable, and the primary outcome of all-cause mortality or rehospitalization for heart failure at 1 year was compared between MDCT's and 3D-TEE's MVOA <4-cm2 cutoff. Good levels of agreement between MDCT and 3D-TEE were observed for determining the etiology (κ=0.81) and mechanism (κ=0.62) of MR but not for grading mitral calcification (κ=0.31 to 0.35). The correlations between MDCT and 3D-TEE measurements were strong for mitral annulus area (r=0.90) and good for MVOA (r=0.73). Furthermore, no significant differences in the area under the receiver-operating-characteristic curve to predict low transmitral pressure gradient at discharge or the primary outcome at 1 year were detected between MDCT- and 3D-TEE-derived parameters (all p >0.05). In conclusion, in patients who underwent TEER with MitraClip, a high degree of agreement for comprehensive evaluation of MR and prediction of clinical outcomes between MDCT and 3D-TEE was observed.

Accuracy of Multi-Detector Computed Tomography In the Diagnoses of Adnexal Masses

Background: Ovarian cancer is the 5th common cause of death in women. patients older than 30 years are high malignant potential group. The lifetime risk of dying from invasive ovarian cancer is about 1 in 95. Modern imaging techniques have demonstrated significant accuracy in the diagnosis and staging of adnexal masses that help the clinician in surgical and post-surgical treatment planning. Objective: To determine the accuracy of multidetector computed tomography (MDCT) in diagnoses of benign and malignant adnexal masses, compare it with histopathological diagnoses and find out the sensitivity, specificity, positive predictive value, negative predictive value of MDCT in diagnoses of benign and malignant adnexal masses. Materials and Methods: This cross-sectional observational study was carried out between January 2013 to December 2014 with 45 patients referred for an MDCT scan of the pelvic organ with a suspicion of adnexal mass in Dhaka Medical College, Dhaka. All the patients were evaluated by detailed history and clinical examination. CT scan of the pelvic organ was performed in all cases and the report was checked by the radiologists of DMCH. Operated patients were followed up after surgery up to histopathological diagnosis and correlated with CT scan findings. Results: CT diagnosis for evaluation of benign adnexal mass, sensitivity was 90.0%, specificity 92.0%, accuracy 91.1%, PPV was 90.0% and NPV 92.0%. In the case of malignant mass, sensitivity is 92.0%, specificity 90.0%, accuracy 91.1%, PPV 92.0% and NPV 90.0%. Conclusion: MDCT is a valuable modality in the diagnosis of benign and malignant adnexal masses.KYAMC Journal Vol. 14, No. 02, July 2023: 74-78.

Spectrum of Multidetector Computed Tomography Imaging Findings in Iatrogenic Abdominopelvic Injuries: A Comprehensive Pictorial Review.

Iatrogenic injuries are unavoidable complications of surgeries and minimally invasive procedures. They are generally classified into vascular and nonvascular injuries and based on the time of injury into early and late injuries. Iatrogenic injuries, particularly vascular injuries, increase the mortality and morbidity, with prolongation of hospital-stay. Multidetector computed tomography (MDCT) is a highly sensitive, and often the first imaging modality in suspected iatrogenic injuries. This pictorial review elucidates the imaging considerations and appearances of iatrogenic injuries of the abdominopelvic organs on MDCT.

Main Portal Vein Diameter Changes in Patients Undergoing Gastric Surgery for Malignancy: An Observational CT Study

Abstract Background In the follow-up computed tomography (CT) examinations of patients who had undergone gastrectomy for gastric malignancy in our center, we noticed by chance that there was an isolated increase in the diameter of the main portal vein (MPV) without other radiological findings of portal hypertension. Objectives In this study, we aimed to evaluate whether the MPV diameter of patients who had gastric surgery for malignancy differed in the preoperative and postoperative periods and its change over time in patients who underwent postoperative follow-up examinations. Materials and Methods The CT images of 240 patients who underwent abdomen CT for staging and follow-up gastric malignancy between January 2017 and September 2021 were evaluated retrospectively. The CT scans of the remaining 149 patients after the exclusion criteria were included in the study. All CT imaging was performed using multidetector CT (64 or 128 slice) in portal venous phases. The images were evaluated by two radiologists based on consensus. Maximum MPV diameter were measured outer wall to outer wall with calipers on axial images at the level of 1 cm distal to the portosplenic confluence. Results One hundred forty-nine patients included in the study had preoperative CT examination. Eighty-three patients had follow-up CT examination at third month, 89 patients at sixth month, and 99 patients at first year. The MPV diameters differed significantly between preoperative CT and postoperative third month, sixth month, and first year CT (p = 0.001, p = 0.001, and p = 0.001, respectively). There was no difference in MPV diameter between postoperative third month CT and postoperative 6th month and 1st year CT (p = 0.514 and p = 0.078, respectively). Conclusion There is an increase in MPV diameter in the first 3 months postoperatively in patients undergoing gastric surgery for malignancy. This enlargement continues unchanged in the first 1 year follow-up. The radiologists' awareness of this situation may prevent the wrong diagnosis of portal hypertension, unnecessary concern, and further investigation.

Volumetric computed tomography with carbon nanotube X-ray source array for improved image quality and accuracy

Cone beam computed tomography (CBCT) is widely used in medical and dental imaging. Compared to a multidetector CT, it provides volumetric images with high isotropic resolution at a reduced radiation dose, cost and footprint without the need for patient translation. The current CBCT has several intrinsic limitations including reduced soft tissue contrast, inaccurate quantification of X-ray attenuation, image distortions and artefacts, which have limited its clinical applications primarily to imaging hard tissues and made quantitative analysis challenging. Here we report a multisource CBCT (ms-CBCT) which overcomes the shortcomings of the conventional CBCT by using multiple narrowly collimated and rapidly scanning X-ray beams from a carbon nanotube field emission source array. Phantom imaging studies show that, the ms-CBCT increases the accuracy of the Hounsfield unit values by 60%, eliminates the cone beam artefacts, extends the axial coverage, and improves the soft tissue contrast-to-noise ratio by 30–50%, compared to the CBCT configuration.

Evaluation of inferior mesenteric vein drainage patterns in the Turkish population: A multidetector computed tomography study

Background/Aim: The inferior mesenteric vein (IMV) plays a crucial role in the venous system as it joins the superior mesenteric vein (SMV) and splenic vein to form the portal vein. The widespread adoption of multidetector computed tomography (MDCT) has greatly enhanced our ability to assess abdominal vascular structures. This study aimed to investigate the IMV drainage patterns in a Turkish population using MDCT. Methods: This descriptive, single-center, retrospective study included patients who had undergone abdominal computed tomography (CT) in the portal phase at our hospital for various clinical indications. Excluded from the study were patients who did not undergo imaging in the portal venous phase, those with incomplete evaluation of all IMV segments, and individuals who had undergone pancreaticoduodenal or intestinal surgery for any reason. We retrospectively analyzed a total of 877 contrast-enhanced MDCT examinations performed at our hospital between March 2022 and March 2023. Patients were classified based on their IMV drainage patterns into the following categories: type 1 (drainage into the splenic vein), type 2 (drainage into the SMV), type 3 (drainage at the junction level), type 4 (drainage into the branches of the SMV), and type 5 (patients in whom IMV assessment was not possible). Results: The mean age of the patients was 48.7 years (range: 24–92 years), with 449 (51.2%) being male and 428 (48.8%) female. The distribution of patients according to IMV drainage patterns was as follows: type 1, n=379 (43.2%); type 2, n=398 (45.4%); type 3, n=71 (8.1%); type 4, n=15 (1.7%); and type 5, n=14 (1.6%). Conclusion: Our study findings indicate that in the Turkish population, the IMV predominantly drains into the SMV before joining the splenic vein. This disparity from certain studies in the literature underscores the variability in IMV drainage patterns, emphasizing the importance of individualized patient evaluation in this regard.

Are multi-detector computed tomography and cone-beam computed tomography exams and software accurate to measure the upper airway? A systematic review.

Cone-beam computed tomography (CBCT) has several applications in various fields of dental medicine such as diagnosis and treatment planning. When compared to computed tomography (CT), CBCT's radiation exposure dose is decreased by 3%-20%. However, CBCT produces more scattered signals and may present poorer image quality when compared to medical CT. To review the findings regarding the accuracy of multi-detector computed tomography (MDCT) and CBCT and to compare the different software programs that segment the upper airway. Three databases (PubMed, Medline, and Web of Science) were searched for articles and a manual search was performed. The inclusion criteria were defined following the PICO framework: P-any patient with a CBCT or CT; I-dimensional evaluation of the upper airway using MDCT or CBCT; C-phantoms; O-the primary outcome was MDCT and CBCT accuracy, the secondary outcome was the evaluation and comparison of software programs used to segment the upper airway. Articles that met eligibility criteria were assessed using the Critical Appraisal Skills Program Checklist. Among the 16 eligible studies, 6 articles referred to the accuracy of MDCTs or CBCTs and 10 to the accuracy of the software. Most articles were qualified as high quality. MDCT and CBCT scans' accuracy in upper airway dimensional measurements depends on machine brand, parameters, and segmentation technique. Regarding the segmentation technique, 12 programs were studied. Most either underestimated or overestimated upper airway measurements. In particular, OnDemand3D and INVIVO showed poor accuracy. On the contrary, Invesalius, and MIMICS were accurate in assessing nasal cavities when using an interactive threshold. However, results varied due to methodological differences among the studies. Finally, fully automatic segmentation based on artificial intelligence may represent the future of airway segmentation because it is faster and seems to be accurate. However, further studies are necessary. This study was registered in Prospero (International Prospective Register of Systematic Reviews) with the ID number CRD42022373998.

Angiographic challenges of spinal dural and epidural arteriovenous fistulas: report on 45 cases.

The localization of the fistula level in spinal dural arteriovenous fistulas (dAVFs) and epidural arteriovenous fistulas (edAVFs) remains a diagnostic challenge. Consecutive patients with spinal dAVFs and edAVFs in the thoracic, lumbar, and sacral regions were included. The primary endpoint was to describe the characteristics of patients who required angiography with multiple catheterizations of segmental arteries (10 or more). Forty-five patients (median age 69years; male 89%; dAVFs, n = 31; edAVFs, n = 14) were included. Spinal dAVFs commonly developed in the thoracic region and edAVFs in the lumbosacral region. Fistulas were predicted at the correct level or plus/minus 2 level in less invasive examinations using multi-detector CT angiography (n = 28/36, 78%) and/or contrast-enhanced MR angiography (n = 9/14, 64%). We encountered diagnostic challenges in the localization of fistulas in 6 patients. They underwent angiography a median of 2 times. In each patient, spinal levels were examined at a median of 25 levels with a median radiation exposure of 3971mGy and 257ml of contrast. Fistulas were finally localized at the high thoracic region (T4-6) in 3 patients, the sacral region (S1-2) in 2, and the lumbar region (L3) in 1. Four patients were diagnosed with edAVFs and 2 with dAVFs. The correlation coefficient between the fistula level and the rostral end of the intramedullary T2 high-signal intensity on MRI was interpreted as none. In patients in whom less invasive examinations failed for fistula localization, high thoracic or sacral AVFs need to be considered.

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.

Morphometric and volumetric analysis of lacrimal glands in patients with thyroid eye disease

Assessment of morphometric and volumetric changes in lacrimal glands in thyroid eye disease, its clinical manifestations in relation of disease progression. Retrospective volumetric analysis included both genders and was performed on total of 183 patients - 91 patients with diagnosed Grave’s disease and thyroid eye disease and 92 patients without Grave’s disease and thyroid eye disease who underwent multidetector computed tomography (MDCT) examination in routine daily work according to other medical indications. In the group of females, there was statistical significance between patients with thyroid eye disease and controls who were smoking and had body weight gain. We found statistical significance in volumetric enlargements for both orbits in both genders for the patients group when compared to controls. There was also statistical significance in morphometric characteristics for the lacrimal gland diameters measured. Determination planimetric morphometric parameters of importance were coronary height of lacrimal gland of the right eye, coronary height of lacrimal gland of the left eye and coronary width of lacrimal gland of the left eye for the group of males. In a group of females the established determination parameters of importance were the coronary height of lacrimal gland of the left eye, the axial width of lacrimal gland of the left eye, volume of lacrimal gland of the right eye and the volume of lacrimal gland of the left eye. When we compared the displaced lacrimal gland coming forward (proptosis) in time progressing disease between group of patients and controls, we also found statistical significant connection. Evaluation of lacrimal gland volumetric and morphometric data may increase validity of defining this anatomical substrate and its morphology disruption as liable tool for thyroid eye disease progression follow up and treatment planning and outcome.

Bone mineral density radiopaque templates for cone beam computed tomography and multidetector computed tomography

BACKGROUND: Cone beam computed tomography is widely applied for diagnostics and planning various manipulations in the maxillofacial region, for example, dental implantation. Its advantages include high spatial resolution, low radiation exposure, and cost-effectiveness. However, it has a significant drawback: the inability to determine the density of the jaw bone in Hounsfield Units (HU).&#x0D; AIMS: This study aimed to develop radiopaque templates with sets of X-ray density based on potassium hydrophosphate and beta-tricalcium phosphate, to study templates on various cone beam computed tomography and multidetector computed tomography devices, and to determine a cross-calibration algorithm for assessing the bone mineral density of the jaw in HU.&#x0D; MATERIALS AND METHODS: The bone mineral density template comprised microtubes (0.25 ml) with potassium hydrophosphate concentrations of 49.96, 99.98, 174.99, 349.99, and 549.98 mg/ml, and a suspension of beta-tricalcium phosphate with an equivalent concentration of potassium hydrophosphate 1,506 mg/ml, designed to simulate the types of bone density according to C. Mish. The study was carried out on two multidetector computed tomography and four cone beam computed tomography machines. Cross-calibration was referred on the standard multidetector computed tomography 1 mode 120 kV, 200 mA.&#x0D; RESULTS: There was a significant scatter of the X-ray values (HU for multidetector computed tomography and GV for cone beam computed tomography) vs. bone mineral density, with varying slopes, bias, and curve shapes. After cross-calibration, good comparability corresponding to the multidetector computed tomography 1 mode was shown. The median of the differences before cross-calibration was 160 relative units (HU, GV), after decreased by 10 times and amounted to 16 rel. units (p=0.000). The mean difference for cone beam computed tomography was significantly higher (30 rel. units) than for multidetector computed tomography (8 rel. units) (p=0.024, MannWhitney U test).&#x0D; CONCLUSION: The developed radiopaque template enables the standardization of densitometric indicators for cone beam computed tomography and various multidetector computed tomography modes. On average, the spread after cross-calibration is reduced by 10 times, which makes it possible to classify bone tissue in HU according to C. Mish.

A novel quantitative model based on gross tumor volume corresponding to anatomical distribution measured with multidetector computed tomography to determine the resectability of non‑distant metastatic esophageal squamous cell carcinoma.

It is important to accurately determine the resectability of thoracic esophageal squamous cell carcinoma (ESCC) for treatment decision-making. Previous studies have revealed that the CT-derived gross tumor volume (GTV) is associated with the staging of ESCC. The present study aimed to explore whether the anatomical distribution-based GTV of non-distant metastatic thoracic ESCC measured using multidetector computed tomography (MDCT) could quantitatively determine the resectability. For this purpose, 473 consecutive patients with biopsy-confirmed non-distant metastatic thoracic ESCC who underwent contrast-enhanced CT were randomly divided into a training cohort (TC; 376 patients) and validation cohort (VC; 97 patients). GTV was retrospectively measured using MDCT. Univariate and multivariate analyses were performed to identify the determinants of the resectability of ESCC in the TC. Receiver operating characteristic (ROC) analysis was performed to clarify whether anatomical distribution-based GTV could help quantitatively determinate resectability. Unweighted Cohen's Kappa tests in VC were used to assess the performance of the previous models. Univariate analysis demonstrated that sex, anatomic distribution, cT stage, cN stage and GTV were related to the resectability of ESCC in the TC (all P<0.05). Multivariate analysis revealed that GTV [P<0.001; odds ratio (OR) 1.158] and anatomic distribution (P=0.027; OR, 1.924) were independent determinants of resectability. ROC analysis revealed that the GTV cut-offs for the determination of the resectability of the upper, middle and lower thoracic portions were 23.57, 22.89 and 22.58 cm3, respectively, with areas under the ROC curves of >0.9. Unweighted Cohen's Kappa tests revealed an excellent performance of the ROC models in the upper, middle and lower thoracic portions with Cohen k-values of 0.913, 0.879 and 0.871, respectively. On the whole, the present study demonstrated that GTV and the anatomic distribution of non-distant metastatic thoracic ESCC may be independent determinants of resectability, and anatomical distribution-based GTV can effectively be used to quantitatively determine resectability.

Different prognostic significance of coronary artery and aortic valve calcium in patients with chest pain.

Coronary artery calcification (CorCa) identifies high cardiovascular risk in the general population. In this setting, aortic valve calcification (AoCa) showed contradictory results. Our goal has been to assess the prognostic power of CorCa and AoCa in patients with chest pain who underwent an ECG-gated cardiac multidetector CT (cardiac-MDCT). A total of 528 patients without previous known coronary artery disease, with chest pain who underwent a cardiac-MDCT multidetector, were retrospectively recruited. The primary endpoint included death, acute coronary syndrome, stroke, and heart failure. A total of 61 patients (11.6%) had an event during a mean follow-up of almost 6years (5.95 ± 2.98). The most frequent event was acute coronary syndrome (6.4%). Total mortality was 4.5%. Patients with CorCa > 0 had more events than those without CorCa (17.3% versus 4.3%; p < 0.001). Likewise, when only patients without AoCa were considered (n = 118), clinical events were more frequent in those with CorCa (12.7% versus 3.6%; p = 0.004). After excluding patients with coronary artery disease, events were more frequent in those with CorCa (12.6% versus 4.3%; p = 0.004). The higher the Agatston score, the more frequent the events. Patients with AoCa > 0 had more events than those without (16.5% versus 7.3%; p < 0.001), but in patients without CorCa, no difference in events was seen (6.2% versus 3.6%; p = 0.471). A Cox regression analysis showed age, smoking, prior stroke, and CorCa but not AoCa to be independently related to events. In summary, CorCa, but not AoCa, is related to cardiovascular events in patients with chest pain who undergo a cardiac-MDCT. We show that coronary artery calcification, but not aortic valve calcification, detected in a coronary CT scan is tightly related to cardiovascular events. Although this is a message already shown by other groups in the general population, we do believe that this work is unique because it is restricted to patients with chest pain sent to coronary CT. In other words, our work deals with what we face in our routine everyday practice. • The presence and the amount of coronary artery calcification are associated with cardiovascular events in patients with chest pain. • Aortic valve calcification is not associated with cardiovascular events in patients with chest pain.