Multidetector Computed Tomography Research Articles

Evaluation of the Image Quality of Ultra-Low-Dose Paranasal Sinus Computed Tomography Scans

Objective: We aimed to investigate the image quality of paranasal sinus computed tomography (CT) scans obtained with the “Advanced intelligent Clear-IQ Engine” (AICE) software and ultra-low dose parameters in patients with prediagnosed rhinitis, sinusitis or nasal septum deviation. Methods: The first 50 patients (31 men and 19 women, aged 18-70 years) who agreed to participate in our prospectively planned study were included in the study. Imaging of the patients was performed with a 160-slice multidetector CT device Canon Aquilion Prime SP (Canon Medical Systems, Otawara, Japan). Tube voltage of 80 kV and tube current of 40 mA were chosen. The effective radiation dose (ED) was calculated based on the “dose-length product” (DLP) information of each patient. Evaluation of images was made on reformat images made with “AiCE Bone” filter in the axial and coronal planes. All images were double-blindly evaluated by 2 radiologists out of 5 points (5 = very good; 1 = not diagnostic). The visibility of 17 bilateral important anatomical landmarks examined on paranasal sinus CT was scored (0 = not visible; 2 = completely visible). In the evaluation of images, the agreement between radiologists was evaluated with Kappa statistics. Results: The median ED value of the CT protocol was 0.015±0.001 mSv [range 0.012-0.017 mSv]. The overall image quality of the images in our study was interpreted as 4 (good) or 3 (moderate) for all patients. Inter-research agreement was 92%. Most of the anatomical landmarks evaluated were completely visible. Six (bilateral of three) anatomical landmarks could be partially visible in some patients. Conclusion: Combining the ultra-low dose CT protocol and the AiCE reconstruction algorithm makes it possible to achieve very low ED values ​​in paranasal sinus CT scans and still obtain sufficient image quality in indications such as septum deviation and sinusitis.

Prognostic Nutritional Index (PNI) as a Potential Prognostic Tool for Exacerbation of COPD in Elderly Patients.

In COPD, exacerbation of the disorder causes a deterioration in the quality-of-life and worsens respiratory dysfunction, leading to a poor prognosis. In recent years, nutritional indices have been reported as significant prognostic factors in various chronic diseases. However, the relationship between nutritional indicators and prognosis in elderly subjects with COPD has not been investigated. We enrolled 91 subjects who received COPD assessment tests (CAT), spirometry, blood tests, and multidetector computed tomography (MDCT). We divided the subjects into two groups according to age (<75 years (n=57) and ≥ 75 years (n=34)). The prognostic nutritional index (PNI) was used to assess immune-nutritional status and was calculated as 10 x serum albumin + 0.005 x total lymphocyte count. We then examined the relationship between PNI and clinical parameters, including exacerbation events. There was no significant correlation between the PNI and CAT, the FEV1%pred, or low attenuation volume percentage (LAV%). In the elderly group, there were significant differences between the groups with or without exacerbation in the CAT and PNI (p=0.008, p=0.004, respectively). FEV1%pred, neutrophil-to-lymphocyte ratio (NLR) and LAV% did not differ between the two groups. The analytical model combining CAT and PNI improved the prediction of exacerbations in the elderly subjects (p=0.0068). In elderly subjects with COPD, CAT were associated significantly with the risk of COPD exacerbation, with PNI also a potential predictor. The combined assessment of CAT and PNI may be a useful prognostic tool in subjects with COPD.

Pancreatic morphology/contour variations should be recognized and remembered.

Pancreatic contour variations can be detected incidentally on computed tomography (CT). Recognition and remembering of these variations are important in volumetric measurements and surgery as well as in preventing misdiagnosis. This study aims to evaluate the morphology/contour variations in the pancreas head-neck, body-tail, and uncinate process with multi-detector CT (MDCT) examinations (triple phase CT abdomen). Around 1662 adult age (>18 years old) patients were evaluated retrospectively, and after exclusion criteria, 945 patients were included in the study. Aplasia and hypoplasia of the uncinate process were determined, and pancreatic contour variances were categorized according to the Ross et al. and Omeri et al. classifications. Pancreatic head-neck variants were categorized into Type I-anterior, Type II-posterior, and Type III-horizontal variations. Pancreatic body-tail variants were sectioned into Type Ia-anterior protrusion, Type Ib-posterior protrusion, and Types IIa-globular, IIb-lobulated, IIc-tapered, and IId-bifid pancreatic tail. Of the 945 patients, 481 (50.9%) were female. The mean age was 43.28 ± 10.49 (min. 20-max. 68). In the evaluations made according to the uncinate process morphology variant, hypoplasia was detected in 66 (7%) patients and aplasia in 12 (1.3%) patients. Pancreatic head-neck and body-tail contour variations were observed in 596 (63.1%) patients. The most common head-neck variation was Type II in 233 (24.6%) patients, followed by type III in 96 (10.2%). There were Type Ia in 83 (8.8%) patients and Type Ib in 14 (1.5%) patients. The pancreatic tail configuration was normal in 792 (83.8%) patients; it was Type IIa in 62 (6.6%) patients and IIb in 50 (5.3%) patients. The most common variation was head and tail in 33 (3.5%) patients. Pancreatic variations detected in CT examinations for distinct reasons are not rare; these variations should be recognized and remembered.

The role of High resolution multidetector computed tomography chest in the differential diagnosis of ground glass opacity in diffuse lung diseases

The role of High resolution multidetector computed tomography chest in the differential diagnosis of ground glass opacity in diffuse lung diseases

Kırım Kongo kanamalı ateşi hastalarında abdominal vasküler yapıların çokkesitli bilgisayarlı tomografi ile değerlendirilmesi

Aim: This study aims to determine whether Crimean–Congo Hemorrhagic Fever (CCHF) has effects on abdominal vascular structures.&#x0D; Material and Method: The study group included 35 patients diagnosed with CCHF. The control group included 35 patients with symptoms such as dyspepsia, pelvic pain, and abdominal pain who underwent multidetector computed tomography (MDCT) and whose MDCT examinations were reported as completely normal. This is a retrospective study and patients admitted to the hospital between May 2016 and April 2022 were included in the study. The patient group and control group were compared in terms of liver size, splenic size, and portal vein (PV), hepatic artery (HA), splenic vein (SV), splenic artery (SA), superior mesenteric vein (SMV) and superior mesenteric artery (SMA) diameters.&#x0D; Results: The liver size, splenic size, and PV, HA, and SA diameters in the patient group were significantly higher than those in the control group (p0.05).&#x0D; Conclusion: Our study shows that abdominal vascular structures are affected in CCHF patients.

Diagnostic accuracy of Lateral X-Ray of Cervical Spine in detection of fracture in hospitalized patients.

Background: Lateral X-ray of the cervical spine (LCSX) is a common diagnostic tool to detect fractures in hospitalized patients. Its non-invasive nature and cost-effectiveness make it a preferred imaging technique for rapid identification of cervical spine fractures. However, its diagnostic accuracy is still a subject of debate and further research is needed to establish its reliability and validity. This study aimed to determine the diagnostic accuracy of LCSX in detecting fractures in hospitalized patients, using multi-detector computed tomography (MDCT) as the gold standard.&#x0D; Methodology: This cross-sectional retrospective study was conducted at a tertiary care hospital in Karachi. The study included 431 male and female patients aged between 18 to 60 years referred by the primary medical team to the Radiology Department for both LCSX and MDCT to detect cervical spine fractures. Patients with known cases of cervical spine fractures determined by history, examination, and previous radiological modalities like LCSX, MDCT, or MRI at the time of imaging were included.&#x0D; Results: LCSX identified 63 cases (14.6%) as having cervical spine fractures, while 368 cases (85.3%) were reported as not having cervical spine fractures. However, on MDCT, 116 cases (26.9%) out of the 431 cases were found to have cervical spine fractures, while 315 cases (73.08%) were reported as not having cervical spine fractures. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of LCSX were calculated. The sensitivity of LCSX was found to be 58.35%, specificity was 100%, positive predictive value was 100%, negative predictive value was 85.59%, and diagnostic accuracy was 87.70%.&#x0D; Conclusion: LCSX has low sensitivity as a diagnostic tool in detecting cervical spine fractures in trauma patients, resulting in missed diagnoses of critical cervical spine fractures and compromised patient care, which can lead to increased morbidity and mortality.&#x0D;

Testing of Different Scanning Protocols Used for Precise 3D-printing of Mandibular Models.

Multidetector computed tomography (MDCT) is often necessary to manufacture 3D-printed medical models (MMs) required for mandibular restoration due to trauma or malignant tumor. Although cone-beam computed tomography (CBCT) is a preferable method of mandibular imaging, additional scanning is often unjustified. To test whether a single radiologic protocol could be used for mandibular reconstructions, the human mandible was scanned with 6 MDCT and 2 CBCT protocols and later 3D-printed using a fused-deposition modelling technique. Then, we assessed linear measures on the mandible and compared them with MDCT/CBCT digital scans and 3D-printed MMs. Our data revealed that CBCT0.25 was the most precise protocol for manufacturing 3D-printed mandibular MMs, which is expected considering its voxel size. However, we noted that CBCT0.35 and Dental2.0H60s MDCT protocols were of comparable accuracy, indicating that this MDCT protocol could be a single radiologic protocol used to scan both donor and recipient regions required for mandibular reconstruction.

New imaging techniques in ventricular tachycardia ablation: integration of myocardial thickness analysis software in computed tomography with omnipolar mapping

Abstract Funding Acknowledgements Type of funding sources: None. Background/Introduction Magnetic resonance imaging (MRI) is very useful for planning the ablation of ventricular tachycardias (VT) related to scar, since it allows identification of anatomy, scar dense/border zone (DZ/BZ) and conduction channels (CC). However, access to this test is limited in many centres and, in addition, artefacts generated by pacing/defibrillation devices (ICDs) can often make it uninterpretable. Multidetector cardiac computed tomography (MDCT) offers the advantages of greater accessibility, better anatomical characterisation and less device artefacts, although there is little experience of its use. Purpose The objective is to evaluate the effectiveness of integrating myocardial thickness analysis software with MDCT and omnipolar electroanatomical mapping for VT ablation procedures in patients with cardiomyopathy. Methods Single-centre, descriptive study of a serie of patients, ICD carriers, that underwent VT ablation: - Patient 1- 72-year-old male with ischaemic heart disease. - Patient 2- 46-year-old male with left arrhythmogenic cardiomyopathy. - Patient 3- 60-year-old male with biventricular arrhythmogenic cardiomyopathy. - Patient 4- 28-year-old female with right arrhythmogenic cardiomyopathy. MDCT was performed on all patients and the images were post-processed using myocardial thickness analysis software. A 3D colour map was created with identification of the DZ, BZ and CC. This map was fused with the electroanatomical map created during the electrophysiological study with omnipolar technology. Results In all cases there was a high anatomical correlation between DZ, BZ and CC detected on postprocessed MDCT and the area of pathological voltage and late electrograms of the omnipolar map. In patient-1, the CC detected on CT coincides with the diastolic corridor of clinical VT (image 1A). In patient 2, CT analysis identified the direct relationship of the circumflex artery with the superior region of the DZ (image 1B). In patients 3 and 4, the CT scan identified the relationship of the DZ/BZ in the right ventricular outflow tract with the coronary arteries and phrenic nerve (image 1 C and D). Conclusions The computed tomography myocardial thickness analysis software is positioned as an alternative to MRI in VT ablation, as it localises critical anatomical structures and identifies the scar dense/border zone and conduction channels accurately.

Multidetector computed tomography-derived left atrial wall thickness maps of patients undergoing persistent atrial fibrillation ablation

Abstract Funding Acknowledgements Type of funding sources: None. Background Pulmonary vein isolation (PVI) has proven to be effective in treating persistent atrial fibrillation (PeAF), although long-term ablation outcomes have been significantly less favorable than in paroxysmal AF. Purpose We sought to analyze multidetector computed tomography (MDCT)-derived left atrial wall thickness (LAWT) maps of patients undergoing PeAF radiofrequency ablation with a personalized approach aimed for adapting the ablation index (AI) of contiguous lesions to the local LAWT. Methods PeAF was defined in the presence of at least one AF episode sustained beyond 7 days, long-standing PeAF was defined as continuous AF of &amp;gt;12 months duration when decided to adopt a rhythm control strategy. For each patient included in the analysis, LAWT three-dimensional map were obtained from MDCT. LAWT was categorized into 1 mm layers and AI was titrated according to the LAWT. Results One hundred twenty-one patients (79.4% male, age 64.5±9.5 years) were included. Procedure time was 67 minutes (IQR 50-67), fluoroscopy time was 43 seconds (IQR 20-71), and radiofrequency time was 16.5 minutes (IQR 14.3-18.4). LAWT of the circumferential PV line was thicker in the LPVs as compared to the RPVs (1.64 mm [1.5-1.81] vs. 1.29 mm [1.16-1.57], p&amp;lt;0.01). More specifically, anterior wall segments were thicker in the LPVs as compared to the RPVs (2.1 mm [1.9-2.4] vs. 1.4 mm [1.1-1.9], p&amp;lt;0.01), while posterior wall segments had similar WT. Ablation index applied according to local LAWT was 387 (IQR 360-410) for the anterior wall and 335 (IQR 300-375) for the posterior wall. Overall first pass rate was 73.6%; median LAWT values were higher for PVs with no first pass during radiofrequency ablation with respect to the whole cohort (1.73 mm [1.57-1.98] vs. 1.64 mm [1.50-1.81] p=0.02 for LPVs; 1.46 mm [1.21-1.65] vs. 1.29 mm [1.16-1.57] p=0.03, for RPVs). LAWT values for each PV segment are represented in Figure 1. At a 12 months of follow-up the rate of recurrence-free survival was 79%. Recurrence-free survival rate was significantly higher in patients with PeAF with respect to those with long-standing PeAF diagnosis (p=0.044). A second ablation was performed in 18 patients out of those with AT/AF recurrence. Median LAWT values were higher for PVs with reconnection found in the redo procedures comparing to the median LAWT of the corresponding PVs of the whole cohort (1.77 mm [1.65-2.14] vs. 1.64 mm [1.50-1.81] p=0.01 for LPVs; 1.43 mm [1.25-1.61] vs. 1.29 mm [1.16-1.57] p=0.05, for RPVs). Methods and results are summarized in Figure 2. Conclusion This proof-of-concept study proves that personalized local LAWT-guided PVI ablation for PeAF is efficient and have good long-term outcomes. No first-pass segments during first procedure and reconnection sites within redo procedures were mostly found in thickest regions. A randomized trial comparing the LAWT-guided PVI with the standard of practice is in progress.

Causes for recurrence after personalized radiofrequency catheter ablation for paroxysmal atrial fibrillation and pulmonary vein reconnection site characteristics

Abstract Funding Acknowledgements Type of funding sources: None. Background Personalized pulmonary vein isolation (PVI) for paroxysmal atrial fibrillation (PAF), tailoring the ablation index (AI) to the left atrial wall thickness (LAWT), has proven to be a highly efficient method with excellent arrhythmia free survival rates. However, the number and location of pulmonary vein (PV) reconnection sites in patients with arrhythmic recurrences after personalized PVI is not known. Purpose We aimed to analyze the PV reconnection sites and the probable causes responsible for these PV reconnections during REDO procedures after personalized atrial fibrillation (AF) ablation. Methods Consecutive patients referred for a REDO procedure, after a personalized ablation protocol for PAF, were included in the analysis. During the index procedure and using ADAS 3DTM imaging platform for segmentation, the LAWT maps were obtained from multidetector computerized tomography (MDCT) and, thereafter, imported into CARTO 3 navigation system. If reconnection of a PV was confirmed, the LAWT of the reconnection site was analyzed. Patients who lost follow-up were excluded. Results Among 251 consecutive patients who underwent personalized PVI from April 2019 to July 2021, 45 (17,9%) had recurrence of atrial tachyarrhythmias after a mean follow-up of 1,4 ± 0,8 years. Of them, 28 underwent a REDO AF ablation procedure. 26 patients (93%) had PV reconnections [17 (60%) had both right and left reconnected PVs, 5 (18%) isolated right PV reconnection and 4 (14%) isolated left PV reconnection]. Overall, there were 76 reconnection points (40 in right PVs and 36 in left PVs). Mean LAWT in right and left PV reconnection sites was 2 ± 0,8 mm and 3,1 ± 1,2 mm, respectively. Most frequent sites of PV reconnections were anterosuperior and anterior carina for RPV (accounting for 55% of reconnection points) and anterosuperior, anterior ridge and anteroinferior for LPV (75%). Only 2 PV reconnections (3%) occurred in areas with LAWT &amp;lt; 1 mm. Analyzing the possible causes for PV reconnections, we found a causal relationship in 20 reconnected points (26%): gaps in the ablation line (distance between two adjacent VISITAG™ &amp;gt; 6 mm) in 5, lower ablation index than pre-specified in the personalized ablation protocol at a given point in 15, and absence of right carina ablation line in 5 cases. Catheter instability and misinterpretation of the color-coded LAWT were the main causes of these suboptimal (under target RF dosing) ablation lesions. Conversely, among 6 patients with no gaps and optimal ablation lesions according to the pre-specified protocol, only 1 had PVs isolated during the REDO procedure. Conclusion Most of the patients with AF recurrence after a personalized AF ablation had PV reconnections. Reconnection points were more frequently present in thicker segments of both PVs. GAPS in the ablation line, suboptimal ablation lesions and catheter instability are associated with PV reconnections.

The critical isthmus of left atrial anterior wall flutter is mostly circumscribed into a small area immediately behind the aortic root. Implications for catheter ablation

Abstract Funding Acknowledgements Type of funding sources: None. Background Left atrial flutters (LAFL) are typically observed in patients with previous ablation lines or surgery in the left atrium (LA). Less frequently, scar-related left atrial anterior wall (LAAW) flutters may occur. Although the presence of low-voltage areas (LVAs, a surrogate of scar) in the LA is considered an arrhythmogenic substrate and a marker of atrial cardiomyopathy, the pathophysiologic factors responsible for its formation remain unclear. We hypothesized that compression of the LAAW by the aortic root could be responsible of LVAs found in the LAAW, and therefore, be the substrate for the development of LAAW flutter. Purpose We aimed to describe: 1) the relationship between the aortic root and the presence of LVAs in the LAAW, which is the substrate for reentry; and 2) the clinical and electrophysiological characteristics of LAAW atrial flutter. Methods Consecutive patients referred for LAFL ablation between April 2019 and September 2022 in a single center were retrospectively collected. Among 55 patients with LAFL, 10 (18%) demonstrated a macroreentrant circuit with a critical isthmus identified in the LAAW, in the absence of previous ablation lines or surgery, and were included in the analysis. Previous pulmonary vein isolation (PVI) was not an exclusion criterion. All patients underwent a multidetector computerized tomography (MDCT) prior to the procedure and the images were analyzed using ADAS 3DTM imaging platform. Activation mapping was performed in all patients using a multielectrode mapping catheter and CARTO 3 navigation system. Results 9 of 10 patients were male (mean age 74,3 ± 6,3 years). LA enlargement was present in all patients (48,3 ± 4,7 mm) and the mean aortic root diameter was 34,8 ± 3,4 mm. The mean LAAW flutter cycle length was 293,4 ± 68,3 ms. In 9 of the patients (90%), the LAAW flutter critical isthmus was just behind the aortic root, separated by &amp;lt; 1 mm according to the LA-aortic root fingerprinted isodistance map (mean fingerprinted isodistance area was 5,8 ± 2,5 cm2). The remaining patient had the critical isthmus just below the aortic root, between the area in contact with the latter and the mitral annulus. Furthermore, in all cases, the critical isthmus was immersed in LVAs. All but 1 LAAW flutter terminated during radiofrequency (RF) energy applications and rendered it non-inducible. After a median follow-up of 13,6 months (IQ range 5,3-21,6), 7 patients (70%) remained without recurrences. Conclusion In patients with LAAW atrial flutter, the presence of LVAs and the critical isthmus of the tachycardia are mostly circumscribed into small areas immediately behind the aortic root. Knowledge of this close relationship and the use of the isodistance map could be useful when mapping and ablating LAAW flutter, helping to straightforward the ablation procedure.

Radiopaque properties of polyetheretherketone crown at laboratory study

ObjectivesThere have been no reports on the radiopaque properties of new polyetheretherketone (PEEK) crowns for locating crowns during accidental ingestion or aspiration and detection of secondary caries, which is essential information for clinical application. This study aimed to investigate whether the radiopaque properties of PEEK crowns could be used to identify the site of accidental ingestion or aspiration and detect secondary caries. MethodsFour types of crowns were fabricated: three non-metal crowns (PEEK, hybrid resin, and zirconia) and one full metal cast crown (gold-silver-palladium alloy). Initially, the images for these crowns were compared using intraoral radiography, chest radiography, cone-beam computed tomography (CBCT), and multi-detector computed tomography (MDCT); computed tomography (CT) values were calculated. Subsequently, the images for the crowns placed on the secondary caries model with two artificial cavities were compared using intraoral radiography. ResultsThe PEEK crowns displayed the lowest radiopaque properties on radiography and very few artifacts were observed on CBCT and MDCT. On the other hand, the CT values of the PEEK crowns were a little lower than those of the hybrid resin crowns and considerably lower than the zirconia and full metal cast crowns. The cavity could be detected in the PEEK crown-placed secondary caries model through intraoral radiography. ConclusionsThis simulated study of radiopaque properties with four types of crowns suggested that a radiographic imaging system can be used to identify the site of accidental ingestion and aspiration of PEEK crowns and to detect secondary caries of the abutment tooth within a PEEK crown.

Multidetector computed tomography evaluation of origin, V2 segment variations and morphology of vertebral artery.

The current study aimed to determine the origin of vertebral artery (VA) on both sides and the levels of entry into respective foramen transversarium (FT), to evaluate possible effects of sex on the entry levels, and to investigate the frequency of VA dominance and VA hypoplasia based on the VA V2 segment. For this study, archived images of patients undergoing multidetector computed tomography (MDCT) examination of the chest and headneck for various reasons at Gaziantep University Medical Faculty Hospital were reviewed retrospectively. Three-dimensional reconstructions were performed for a total of 644 VA images from 322 patients using Horos software, and VA origin, the level of entry to FT and transverse diameters of both VA and FT were measured at the point of entry. It was found that, among males, the VA originated from the truncus brachiocephalicus on the right side in only 1 patient and from the aortic arch in 2 patients on the left side. Left VA emerging from the aortic arch was observed in 2 females. The right VA was found to enter the FT at C3 in 1 male, at C4 in 6 patients (5 males, 1 female), at C5 in 19 patients (3 males, 16 females), and at C6 in 300 patients (141 males, 159 females). The left artery entered the FT at C5 in 23 patients (9 males, 14 females) and at C6 in 298 patients (141 males, 157 females). Looking at the relationship between variations of VA origin and the levels of entry to the FT, it was observed that only one of the left VAs originating from the arcus aorta entered the FT at C6 and at C5 in all others. On the right side, there was only one VA originating from the truncus brachiocephalicus, which entered the FT at C3. Of the remaining 248 VAs originating from the subclavian artery, 5 VAs entered the FT at C4, 14 VAs at C5 and 229 VAs at C6. The measurements of VA diameters showed right VA hypoplasia in 14 patients and left VA hypoplasia in 17 patients. Also, the right VA dominance was found in 110 patients and the left VA dominance in 128 patients. A moderate, positive correlation was observed between VA and FT diameters in both sides. A regression analysis showed that a 1 mm change in the right VA diameter was associated with a 75% change in the FT diameter and a 1 mm change in the left VA diameter caused a 72% change in the FT diameter. An understanding of VA variations and FT morphometry is crucial for informed clinical practice. This will clearly affect the success rates of physicians in the diagnosis and treatment of pathologies involving cervical region. The presence of any VA variation in a patient should be investigated on computed tomography or magnetic resonance imaging images prior to surgery.

Imaging Based Detection of Acute Ischemic Stroke Via Multidetector Computed Tomography

Objectives: The current study was designed to capture comprehensive imaging of acute ischemic stroke (AIS) using multidetector computed tomography (MDCT). The study also evaluated the accessibility and potential use of computed tomography angiography (CTA) and sought to determine stroke subtypes in patients with AIS. Methods: The presence of ischemic lesions was detected by the MDCT, transesophageal echocardiography (TEE), and non-contrast flat detector computed tomography (FDCT). The study selected the AIS patients with hyperacute stroke for less than 6 hours from July 2021 to August 2022. The CTA of cervical arteries was performed in order to determine stroke subtypes. Results: The MDCT-based detection of ischemic lesions in 110 studied ischemic stroke patients showed 34% had extensive intracranial artery damage, 86% detected a partial territorial infarct, while 52% patients had detected artery-to-artery embolization. These percentages of detected ischemic lesions overlapped in all studied AIS patients. The findings showed significant susceptible plaques and arterial stenosis. Conclusion: The findings of the study clearly indicated that AIS patients admitted within less than 6 hours of a hyperacute stroke showed multiple types of ischemic lesions. The findings also concluded that the MDCT technique is highly useful for the detection of multiple patterns of brain infarction and for the determination of the causative mechanisms in patients with acute ischemic stroke.

Children’s interstitial lung disease: Multidetector computed tomography patterns and correlations between imaging and histopathology

PurposeChildhood interstitial lung disease (chILD) is an umbrella concept covering a wide range of rare lung diseases, many of which are unique to childhood. The diagnosis is based on clinical presentation, multidetector computed tomography (MDCT), genetic testing, lung-function testing, and lung biopsy. Because knowledge of the usefulness of MDCT pattern recognition in ChILD is at present limited, we examined the occurrence of MDCT patterns in children with histologically confirmed interstitial lung disease. MethodWe searched the biopsy, MDCT, and clinical information database of a single national paediatric referral hospital for 2004–2020. Data were from affected children under age 18. MDCT images we reanalysed while blinded to the identity and referral information. ResultsWe included 90 patients, of whom 63 (70 %) were male. The median age at biopsy was 1.3 years (interquartile range 0.1–16.8). Biopsy findings fell into 26 histological classes covering all nine chILD classification categories. We recognized six distinct MDCT patterns: neuroendocrine cell hyperplasia of infancy (23), organizing pneumonia (5), non-specific interstitial pneumonia (4), bronchiolitis obliterans (3), pulmonary alveolar proteinosis (2), and bronchopulmonary dysplasia (n = 2). Of the total 90, in 51 (57 %) children, none of these six MDCT patterns appeared. Of those 39 children with a recognizable MDCT pattern, in 34 (87 %), that pattern predicted their final diagnosis. ConclusionsAmong cases of chILD, we identified a specific predefined MDCT pattern in only 43 %. However, when such a recognizable pattern occurred, it was predictive of the final chILD diagnosis.

Diagnostic role of aortic valve calcium scoring in various etiologies of aortic stenosis

Most of the studies about aortic valve calcium (AVC) score in aortic stenosis (AS) were based on degenerative or bicuspid AS but not rheumatic AS. We aimed to study the diagnostic accuracy of AVC score to determine severe AS in various etiologies. Adult patients diagnosed with mild to severe AS were enrolled. AVC score were identified from multi-detector computed tomography (MDCT) scan. The AVC score was highest in bicuspid AS (3211.9 (IQR (1100.0–4562.4) AU) compared to degenerative AS (1803.7 (IQR (1073.6–2550.6) AU)), and rheumatic AS (875.6 (IQR 453.3–1594.0) AU), p < 0.001. For the ROC curve to identify severe AS, the AVC score performed well in degenerative and bicuspid AS with the area under the ROC curve (AuROC) 0.834 (95% CI, 0.730, 0.938) in degenerative group; and 0.820 (95% CI, 0.687, 0.953) in bicuspid AS. Whereas AVC score had non-significant diagnostic accuracy with AuROC 0.667 (95% CI, 0.357, 0.976) for male and 0.60(95% CI, 0.243, 0.957) for female in rheumatic AS. The cut-off AVC score values to identify severe AS were AVCS > 2028.9AU (male) and > 1082.5AU (female) for degenerative AS, and > 2431.8AU (male) and > 1293.5AU (female) for bicuspid AS. In conclusions, AVC score is the accurate test for assessing severity in patients with degenerative and bicuspid AS but performs poorly in rheumatic AS group.

The importance of chest CT severity score and lung CT patterns in risk assessment in COVID-19-associated pneumonia: a comparative study.

Chest computed tomography (CT) is suitable to assess morphological changes in the lungs. Chest CT scoring systems (CCTS) have been developed and use in order to quantify the severity of pulmonary involvement in COVID-19. CCTS has also been correlated with clinical outcomes. Here we wished to use a validated, relatively simple CTSS to assess chest CT patterns and to correlate CTSS with clinical outcomes in COVID-19. Altogether 227 COVID-19 cases underwent chest CT scanning using a 128 multi-detector CT scanner (SOMATOM Go Top, Siemens Healthineers, Germany). Specific pathological features, such as ground-glass opacity (GGO), crazy-paving pattern, consolidation, fibrosis, subpleural lines, pleural effusion, lymphadenopathy and pulmonary embolism were evaluated. CTSS developed by Pan et al. (CTSS-Pan) was applied. CTSS and specific pathologies were correlated with demographic, clinical and laboratory data, A-DROP scores, as well as outcome measures. We compared CTSS-Pan to two other CT scoring systems. The mean CTSS-Pan in the 227 COVID-19 patients was 14.6 ± 6.7. The need for ICU admission (p < 0.001) and death (p < 0.001) were significantly associated with higher CTSS. With respect to chest CT patterns, crazy-paving pattern was significantly associated with ICU admission. Subpleural lines exerted significant inverse associations with ICU admission and ventilation. Lymphadenopathy was associated with all three outcome parameters. Pulmonary embolism led to ICU admission. In the ROC analysis, CTSS>18.5 significantly predicted admission to ICU (p = 0.026) and CTSS>19.5 was the cutoff for increased mortality (p < 0.001). CTSS-Pan and the two other CTSS systems exerted similar performance. With respect to clinical outcomes, CTSS-Pan might have the best performance. CTSS may be suitable to assess severity and prognosis of COVID-19-associated pneumonia. CTSS and specific chest CT patterns may predict the need for ventilation, as well as mortality in COVID-19. This can help the physician to guide treatment strategies in COVID-19, as well as other pulmonary infections.

AI-based CT Body Composition Identifies Myosteatosis as Key Mortality Predictor in Asymptomatic Adults.

Background Body composition data have been limited to adults with disease or older age. The prognostic impact in otherwise asymptomatic adults is unclear. Purpose To use artificial intelligence-based body composition metrics from routine abdominal CT scans in asymptomatic adults to clarify the association between obesity, liver steatosis, myopenia, and myosteatosis and the risk of mortality. Materials and Methods In this retrospective single-center study, consecutive adult outpatients undergoing routine colorectal cancer screening from April 2004 to December 2016 were included. Using a U-Net algorithm, the following body composition metrics were extracted from low-dose, noncontrast, supine multidetector abdominal CT scans: total muscle area, muscle density, subcutaneous and visceral fat area, and volumetric liver density. Abnormal body composition was defined by the presence of liver steatosis, obesity, muscle fatty infiltration (myosteatosis), and/or low muscle mass (myopenia). The incidence of death and major adverse cardiovascular events were recorded during a median follow-up of 8.8 years. Multivariable analyses were performed accounting for age, sex, smoking status, myosteatosis, liver steatosis, myopenia, type 2 diabetes, obesity, visceral fat, and history of cardiovascular events. Results Overall, 8982 consecutive outpatients (mean age, 57 years ± 8 [SD]; 5008 female, 3974 male) were included. Abnormal body composition was found in 86% (434 of 507) of patients who died during follow-up. Myosteatosis was found in 278 of 507 patients (55%) who died (15.5% absolute risk at 10 years). Myosteatosis, obesity, liver steatosis, and myopenia were associated with increased mortality risk (hazard ratio [HR]: 4.33 [95% CI: 3.63, 5.16], 1.27 [95% CI: 1.06, 1.53], 1.86 [95% CI: 1.56, 2.21], and 1.75 [95% CI: 1.43, 2.14], respectively). In 8303 patients (excluding 679 patients without complete data), after multivariable adjustment, myosteatosis remained associated with increased mortality risk (HR, 1.89 [95% CI: 1.52, 2.35]; P < .001). Conclusion Artificial intelligence-based profiling of body composition from routine abdominal CT scans identified myosteatosis as a key predictor of mortality risk in asymptomatic adults. © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Tong and Magudia in this issue.

COMPUTED TOMOGRAPHY IN DIFFERENTIATION BETWEEN SMALL CELL AND NON SMALL CELL CARCINOMA LUNG

Background :- Lung carcinoma is common in the developed world as well as developing world with high morbidity and mortality. It is broadly classified into two categories as small cell and non small cell carcinoma, in which radiological imaging plays a critical role in diagnosing and staging of cancer. Multi Detector computed tomography (MDCT) is the investigation of choice for evaluation of lung carcinomas. - The objectives of our study is radiologi Objectives: cal assessment of difference in size and location of primary and metastatic spread at presentation in histologically proven cases of small cell vs non small cell carcinoma of lung. This study comprised of patients who Material And Methods: presented to the department of radiodiagnosis Shri Ram Murti Smarak Institute Of Medical Science a tertiary care center of west Uttar Pradesh, for CT scan of thorax, with clinical symptomsand / or radiographic suspicion of lung cancer and cytohistopathological diagnosis of lung cancer over the period of two years. : In the present Observations And Results study a total of 84 patients were included. The non small cell carcinoma patients were 66(78.5%) which included Squamous cell carcinoma(40%) and adenocarcinoma (38%) and 18(21.4%) patients were of small cell carcinoma. On CT imaging non small cell carcinoma had larger size at presentation as compared to small cell carcinoma. Small cell carcinoma was more frequently associated with distant metastasis (77% cases) and mediastinal lymphadenopathy (100% cases) as compared to non small cell carcinoma

Clinical Consideration of Anatomical Variations in the Common Hepatic Arteries: An Analysis Using MDCT Angiography.

The purpose of this study was to determine the prevalence of normal hepatic vascularization and variations in the common hepatic arteries using multidetector computer tomography angiography. These variants should be acknowledged before any surgery of the upper abdomen. The aim of our work was to analyze the variations in the hepatic arteries and their possible clinical and surgical implications. This study was carried out on 4192 patients who underwent 64-slice MDCT angiography, from August 2015 to December 2021. We used surface and volume-rendering techniques in order to post-process images of the vascular components in the desired area. We highlighted 76 cases with replaced common hepatic arteries, which are characterized by the origin of the common hepatic artery trunk located outside the classical composition of the celiac trunk. We identified three levels of origin: the abdominal aorta, the superior mesenteric artery and the left gastric artery. We observed six different aspects of the morphological variability of the celiac trunk and the superior mesenteric artery. The trajectory of the artery trunk, between the aortic origin and the hepatic pedicle portion of the hepatic portal vein, is variable and we analyzed the pancreatic trajectory accordingly. The prevalence of hepatic arterial variants found during this study was similar to that in other specialized studies. We came across variants that have not been described in the well-known classification of Michels and even described extremely rare variations. The study of abnormal hepatic vascularization plays an important role in the surgical planning of hepatic transplantation, liver and pancreatic resection and extrahepatic upper abdominal surgeries.