Multidetector Computed Tomography Research Articles

Thoracic Aortic Plaque Burden and Prediction of Cardiovascular Events in Patients Undergoing 320-row Multidetector CT Coronary Angiography.

Wide volume scan (WVS) coronary computed tomography angiography (CCTA) enables aortic arch visualization. This study assessed whether the thoracic aortic plaque burden (TAPB) score can predict major cardiovascular adverse events (MACE) in addition to and independently of other obstructive coronary artery disease (CAD) attributes. This study included patients with suspected CAD who underwent CCTA (n=455). CCTA-WVS was used to assess CAD and the prognostic capacity of TAPB scores. Data analysis included the coronary artery calcification score (CACS), CAD status and extent, and TAPB score, calculated as the sum of plaque thickness and plaque angle at five thoracic aortic segments. The primary endpoint was MACE defined as a composite event comprised of ischemic stroke, acute coronary syndrome, and cardiovascular death. During a mean follow-up period of 2.8±0.9 years, 40 of 455 (8.8%) patients experienced MACE. In the Cox proportional hazards model adjusted for clinical risks (Suita cardiovascular disease risk score), we identified TAPB score (T3) as a predictor of MACE independent of CACS ＞400 (hazards ratio [HR], 2.91; 95% confidence interval [CI], 1.26-6.72; p=0.012) or obstructive CAD (HR, 2.83; 95% CI, 1.30-6.18; p=0.009). The area under the curve for predicting MACE improved from 0.75 to 0.795 (p value=0.008) when TAPB score was added to CACS ＞400 and obstructive CAD. We found that comprehensive non-invasive evaluation of TAPB and CAD has prognostic value in MACE risk stratification for suspected CAD patients undergoing CCTA.

Quantitative assessment of the knee joint from weight bearing computed tomography

In recent years weight bearing computed tomography (WBCT) has been applied to the knee, delivering 3-D imaging in a physiologically loaded stance. Several quantitative approaches have been used to evaluate this data, with the greatest focus on joint space width (JSW) leading to 3-D JSW being potentially sensitive enough as a useful structural biomarker. Studies of JSW and lower limb alignment have been facilitated by novel technologies and have demonstrated significant differences between the non-weight bearing and weight bearing positions. Further work is needed to look at whole lower limb alignment that involves the interplay of all the joints of the lower limb. Steps are being taken to quantify bone parameters from cone beam technology, while there is an opportunity for contrast arthrography to evaluate articular cartilage and the meniscus in a weight bearing position. The concept of weight bearing imaging has also led to the evolution of different technology solutions, including different types of cone beam set up, upright and supine-loaded multidetector CT techniques. This latter approach has included kinematic CT with gating for acquisitions in different angles of flexion. WBCT has also been combined with MRI for finite element analysis of the meniscus. The increasingly varied applications of WBCT at the knee broadens its definition and hold potential for enhancing our understanding of factors in the onset and progression of osteoarthritis. However a consensus on standardized protocols will be required to facilitate these advances.

Frequency of Hemorrhagic and Ischemic Patients of Cerebrovascular Accident (Stroke), Diagnosed on CT-Scan

AIM: To evaluate the frequency of ischemic and haemorrhagic stroke on computed tomography and evaluate clinical manifestation related with HS and IS. Methodology: A retrospective Study was Perform in which 77 patients were taken to get required results. All the patient’s data had been collected from the indoor, outdoor, and emergency department of DHQ Hospital of Okara. After informed consent, data was collected through the Toshiba Aquilion 16 multi detector CT scanner. Results: Total of 77 patients diagnose with stroke are included, 40 patients was male, about 37 patients were female. Most of the patients were of age 50 to 70. My study results concluded that 25 patients were having ischemic stroke in which female patients were10, and 15 patients were male. Furthermore, 17 patients was diagnosed with haemorrhagic stroke, in which 8 patients were female, and 9 male. I excluded 35(45.45%) patients who were classified as stroke from other causes. In stroke, the rate of Ischemic stroke is significantly higher than haemorrhagic stroke (p=0.039). Conclusion: In current study numerous clinical indications of different types of cerebrovascular accident are assessed in order to distinguished haemorrhagic and ischemic stroke. This comparative study was to be in the favor of IS as compared to HS(IS>HS). Though these result provides trustworthy signs for differentiation of stroke types. For the diagnose of stroke imaging modality is still the gold standard

Dual-energy CT Portal Venography: Clinical Application Values and Future Opportunities.

Standard multidetector computed tomography (MDCT) uses a single X-ray tube to emit a mixed energy X-ray beam, which is received by a single detector. The difference is that dual-energy CT (DECT), a new equipment in recent years, employs a single X-ray tube or two X-ray tubes to emit two single-energy X-ray beams, which are received by a single or two detectors. The application of dual-energy technology to portal venography has become one of the research hotspots. This paper will elaborate on the clinical application values of DECT portal venography in improving portal vein image quality, distinguishing the nature of portal vein thrombus, reducing contrast agent dose and radiation dose, and will discuss the possibility of its movement from research to routine practice and future development opportunities.

Florida sleeve procedure for type II aortic regurgitation with aortic root enlargement: a case report.

Florida sleeve procedure is an operative technique for aortic root reconstruction that offers advantages such as reduced bleeding risk, shorter operation time, and improved formation of the atrioventricular junction (AVJ) and sinotubular junction (STJ). In our department, we perform a Florida sleeve procedure for aortic regurgitation (AR) associated with aortic root enlargement of less than 40 mm in diameter of the Valsalva sinus. Here, we present a case of severe type II AR with aortic root enlargement where we successfully performed Florida sleeve procedure and augmented it with autologous pericardium. A 62-year-old male patient was referred for cardiovascular surgery after a transthoracic echocardiogram indicated left ventricular enlargement and severe AR. Preoperative multidetector computed tomography (MDCT) revealed AVJ of 28.2 mm, Valsalva sinus of 38.4 mm, STJ of 36.1 mm, and ascending aorta of 40.1 mm, indicating enlargement from the aortic root to ascending aorta. Preoperative transesophageal echocardiography (TEE) revealed that the main cause of AR was suspected to be the right coronary cusp prolapse (RCC). Intraoperative findings showed that the tricuspid aortic valve had no limitation of motion, but the RCC was subjected to central bending and prolapsed. The leaflet bend was thickened and shortened causing AR (type II). The geometric height (gH) of RCC was short at 14 mm, while the other valve cusps were 20 mm. An augmentation of RCC was performed using autologous pericardium, followed by a Florida sleeve procedure performed using 26-mm Gelweave Valsalva™ grafts. The gH of RCC after augmentation was 23 mm, and the effective height was adjusted to 10 mm by central plication, showing no AR by TEE. Postoperative MDCT revealed AVJ of 22.2 mm, Valsalva sinus of 30.9 mm, and STJ of 21.9 mm. Therefore, the Florida sleeve procedure provided a reduction that preserved the geometry of the aortic root, including AVJ and STJ, as intended. Florida sleeve procedure is a reliable and simple method for ensuring uniform aortic root geometry. A favorable outcome was obtained using the Florida sleeve procedure and augmentation with autologous pericardium in a patient with type II AR and aortic root enlargement.

Clinical Presentations, MDCT Features, and Treatment of Three Types of Adult Intussusceptions Based on the Location.

This study aimed to explore the similarities and differences in clinical presentations, multidetector computed tomographic (MDCT) features, and treatment of three types of adult intussusceptions based on location. We retrospectively reviewed 184 adult patients with 192 intussusceptions. Depending on the location, intussusceptions were classified as enteric, ileocolic, and colonic types. The similarities and differences of clinical presentations, MDCT features, and treatment of three types of adult intussusception were compared. Meanwhile, the three types of intussusceptions were further divided into surgical and conservative groups based on the treatment. Uni- and multivariate logistic analyses were used to identify risk factors for intussusception requiring surgery. Enteric and ileocolic intussusceptions were mainly presented with abdominal pain (78.46% and 85.71%). Hematochezia/melena (64.29%) was the main symptom of colonic intussusception. On MDCT, ileocolic intussusceptions were longer in length and had more signs of intestinal necrosis (hypodense layer, fluid collection and no/poor bowel wall enhancement) than enteric and colonic intussusceptions. Moreover, it was found that 93.88% (46/49) of ileocolic intussusception and 98.59% (70/71) of colonic intussusception belonged to the surgical group, whereas only 43.06% (31/72) of enteric intussusception belonged to the surgical group. Intussusception length (OR=1.171, P=0.028) and discernible lead point on MDCT (OR=21.003, P<0.001) were reliable indicators of enteric intussusception requiring surgery. Ileocolic intussusception may be more prone to intestinal necrosis than enteric and colonic intussusceptions, requiring more attention from clinicians. Surgery remains the treatment of choice for most ileocolic and colonic intussusceptions. Less than half of enteric intussusceptions require surgery, and MDCT features are effective in identifying them.

Improving the accuracy of bone mineral density using a multisource CBCT

Multisource cone beam computed tomography CBCT (ms-CBCT) has been shown to overcome some of the inherent limitations of a conventional CBCT. The purpose of this study was to evaluate the accuracy of ms-CBCT for measuring the bone mineral density (BMD) of mandible and maxilla compared to the conventional CBCT. The values measured from a multi-detector CT (MDCT) were used as substitutes for the ground truth. An anthropomorphic adult skull and tissue equivalent head phantom and a homemade calibration phantom containing inserts with varying densities of calcium hydroxyapatite were imaged using the ms-CBCT, the ms-CBCT operating in the conventional single source CBCT mode, and two clinical CBCT scanners at similar imaging doses; and a clinical MDCT. The images of the anthropomorphic head phantom were reconstructed and registered, and the cortical and cancellous bones of the mandible and the maxilla were segmented. The measured CT Hounsfield Unit (HU) and Greyscale Value (GV) at multiple region-of-interests were converted to the BMD using scanner-specific calibration functions. The results from the various CBCT scanners were compared to that from the MDCT. Statistical analysis showed a significant improvement in the agreement between the ms-CBCT and MDCT compared to that between the CBCT and MDCT.

Biomechanical analysis of complications following T10-Pelvis spinal fusion: A population based computational study

Proximal junctional kyphosis (PJK) and proximal junctional failure (PJF) are challenging complications of long fusion constructs for the treatment of adult spinal deformity. The objective of this study is to understand the biomechanical stresses proximal to the upper instrumentation of a T10-pelvis fusion in a large patient cohort. The pre-fusion models were subject-specific thoracolumbar spine models that incorporate the height, weight, spine curvature, and muscle morphology of 250 individuals from the Framingham Heart Study Multidetector CT Study. To create post-fusion models, the subject-specific models were further modified to eliminate motion between the intervertebral joints from T10 to the pelvis. OpenSim analysis tools were used to calculate the medial lateral shear force, anterior posterior shear force, and compressive force on the T9 vertebra during the static postures. Differences between pre-fusion and post-fusion T9 biomechanics were consistent between increased segmental mobility and unchanged segmental mobility conditions.For all static postures, compression decreased (p < 0. 0005). Anterior-posterior shear force significantly increased (p < 0. 0005) during axial twist and significantly increased (p < 0. 0005) during trunk flexion. Medial lateral shear force significantly increased (p < 0. 0005) during axial twist. This computational study provided the first use of subject-specific models to investigate the biomechanics of long spinal fusions. Patients undergoing T10-Pelvis fusion were predicted to have increased shear forces and decreased compressive force at the T9 vertebra, independent of change in segmental mobility. The computational model shows potential for the investigation of spinal fusion biomechanics to reduce the risk of PJK or PJF.

Objective image quality assurance in cone-beam CT: Test methods, analysis, and workflow in longitudinal studies.

Standards for image quality evaluation in multi-detector CT (MDCT) and cone-beam CT (CBCT) are evolving to keep pace with technological advances. A clear need is emerging for methods that facilitate rigorous quality assurance (QA) with up-to-date metrology and streamlined workflow suitable to a range of MDCT and CBCT systems. To evaluate the feasibility and workflow associated with image quality (IQ) assessment in longitudinal studies for MDCT and CBCT with a single test phantom and semiautomated analysis of objective, quantitative IQ metrology. A test phantom (CorgiTM Phantom, The Phantom Lab, Greenwich, New York, USA) was used in monthly IQ testing over the course of 1 year for three MDCT scanners (one of which presented helical and volumetric scan modes) and four CBCT scanners. Semiautomated software analyzed image uniformity, linearity, contrast, noise, contrast-to-noise ratio (CNR), 3D noise-power spectrum (NPS), modulation transfer function (MTF) in axial and oblique directions, and cone-beam artifact magnitude. The workflow was evaluated using methods adapted from systems/industrial engineering, including value stream process modeling (VSPM), standard work layout (SWL), and standard work control charts (SWCT) to quantify and optimize test methodology in routine practice. The completeness and consistency of DICOM data from each system was also evaluated. Quantitative IQ metrology provided valuable insight in longitudinal quality assurance (QA), with metrics such as NPS and MTF providing insight on root cause for various forms of system failure-for example, detector calibration and geometric calibration. Monthly constancy testing showed variations in IQ test metrics owing to system performance as well as phantom setup and provided initial estimates of upper and lower control limits appropriate to QA action levels. Rigorous evaluation of QA workflow identified methods to reduce total cycle time to ∼10min for each system-viz., use of a single phantom configuration appropriate to all scanners and Head or Body scan protocols. Numerous gaps in the completeness and consistency of DICOM data were observed for CBCT systems. An IQ phantom and test methodology was found to be suitable to QA of MDCT and CBCT systems with streamlined workflow appropriate to busy clinical settings.

External validation of the RSNA 2020 pulmonary embolism detection challenge winning deep learning algorithm

PurposeTo evaluate the diagnostic performance and generalizability of the winning DL algorithm of the RSNA 2020 PE detection challenge to a local population using CTPA data from two hospitals. Materials and MethodsConsecutive CTPA images from patients referred for suspected PE were retrospectively analysed. The winning RSNA 2020 DL algorithm was retrained on the RSNA-STR Pulmonary Embolism CT (RSPECT) dataset. The algorithm was tested in hospital A on multidetector CT (MDCT) images of 238 patients and in hospital B on spectral detector CT (SDCT) and virtual monochromatic images (VMI) of 114 patients. The output of the DL algorithm was compared with a reference standard, which included a consensus reading by at least two experienced cardiothoracic radiologists for both hospitals. Areas under the receiver operating characteristic curve (AUCs) were calculated. Sensitivity and specificity were determined using the maximum Youden index. ResultsAccording to the reference standard, PE was present in 73 patients (30.7%) in hospital A and 33 patients (29.0%) in hospital B. For the DL algorithm the AUC was 0.96 (95% CI 0.92–0.98) in hospital A, 0.89 (95% CI 0.81–0.94) for conventional reconstruction in hospital B and 0.87 (95% CI 0.80–0.93) for VMI. ConclusionThe RSNA 2020 pulmonary embolism detection on CTPA challenge winning DL algorithm, retrained on the RSPECT dataset, showed high diagnostic accuracy on MDCT images. A somewhat lower performance was observed on SDCT images, which suggest additional training on novel CT technology may improve generalizability of this DL algorithm.

Exploring the Complex Interplay: Fatty Liver Severity, Epicardial Fat Volume, and Coronary Artery Calcification

Background and Objective: Cardiovascular diseases and nonalcoholic fatty liver disease are the most common non-communicable diseases in most developed countries, and due to lifestyle changes, their incidence is increasing day by day. The present study aimed to assess the correlation of fatty liver with epicardial fat volume and coronary artery calcium score. Materials and Methods: This cross-sectional study was conducted on 136 patients referred to Hamadan Farshchian Cardiovascular Hospital for computed tomography (CT) angiography. They were selected using a consecutive sampling method. Using a 128-slice multidetector CT scanner, the coronary artery calcium score based on the Agatston criteria and epicardial fat volume were measured. A liver ultrasound was performed using a GE voluson E6 and a 3-5 MHz depth probe, and the severity of the fatty liver was determined based on the echogenicity of the liver on the ultrasound. Data analysis was conducted using the SPSS software (version 26). Results: The mean age scores of patients were 52.90±12.10 years. Regarding gender, 50.5% and 49.5% of cases were male and female, respectively. In terms of fatty liver grade, 64 (47.1%), 48 (35.3%), 21 (15.4%), and 3 (2.2%) cases had grades zero, I, II, and III, respectively. The mean calcium score was 30.76±35.40, and epicardial fat volume was 86.84±36.56. The severity of fatty liver demonstrated no significant relationship with calcium score and epicardial fat (P&gt;0.05). Conclusion: As evidenced by the obtained results, the severity of fatty liver had no relationship with the amount of coronary epicardial fat and coronary artery calcium.

Evaluation of Sacrum Measurements in Healthy Individuals and Patients with L5-S1 Spondylolisthesis

Objective: In recent studies, the relationship between sacrum morphology and orientation and spondylolisthesis has gained importance. The present study aimed to compare the morphometry of the sacrum between patients with L5-S1 spondylolisthesis and healthy subjects on multidetector computed tomography (MDCT) images. Methods: In this study, abdominopelvic MDCT images of 191 individuals (age range 20-92 years; 101 males and 90 females; 56 patients diagnosed with L5-S1 spondylolisthesis and 135 healthy individuals) were retrospectively evaluated. In this study, the sacrum parameters (Intercornual distance (ICD), sacral hiatus length (LHS), anteroposterior diameter of hiatus at the apex of sacral hiatus(APCWHSA), sacral height (SH), sacral table angle (STA), sacral table index (STI), S1 superior angle (S1A), sacral slope(SS)) evaluated morphometric and morphological in healthy individuals and patients with L5-S1 spondylolisthesis. Kolmogorov–Smirnov test was used to test the normality, which is one of the parametric test assumptions, of the data. Results: Age parameter was found statistically significant higher in the patient group (p&lt;0.001). STA, S1A, SH, LHS and APCWHSA measurements were found to be significantly higher in the healthy group. (p&lt;0.001, p&lt;0.001, p=.008, p=.005, and p=.002, respectively). STI and ICD were found to be significantly higher in women in the healthy group (p=.031, p=.010), while SH parameter was found statistically significant higher in men in the healthy group (p=.007). SS was found statistically significant lower in the healthy group (p&lt;0.001). S1A, L5-S1 spondylolisthesis was found statistically significant higher than Grade 1, Grade 2 according to the degree of slippage (p=.045). Conclusion: The results of this study showed that sacral morphology is important in the development or at least progression of spondylolisthesis.

Utility of CT Scan in Detecting Bladder Involvement Among Patients With Cervical Carcinoma.

Background Cervical cancer is a widespread health issue in India, particularly affecting women as the second most common cancer. The burden of cervical cancer in the country necessitates accurate staging for treatment optimization. The revised International Federation of Gynecology and Obstetrics (FIGO) staging system is vital for this purpose, emphasizing the extent of parametrial and pelvic sidewall involvement. Cervical cancer's propensity to infiltrate neighboring pelvic organs, including the bladder, necessitates precise staging. In India, traditional methods like cystoscopy have been relied upon, but they have limitations. Recent advancements in medical imaging, notably the increased use of computed tomography (CT) scans, provide a non-invasive alternative for staging and evaluating bladder involvement. This study aimed to evaluate the utility and accuracy of CT scans in assessing bladder involvement. Methods This cross-sectional study examined 127 newly diagnosed cervical carcinoma cases in women over a two-year period from August 2021 to July 2023. Patients underwent CT scans (plain) and cystoscopy, and bladder involvement was determined following the revised FIGO staging. Data collected comprised patient demographics, medical history, clinical symptoms, and FIGO staging. Cystoscopy was performed using an Olympus CYF-5 flexible cystoscope, and CT scans utilized a 64-slice multidetector CT scanner. Radiological reports detailed primary tumor characteristics and proximity to the bladder. Statistical analysis encompassed descriptive statistics, and calculation of sensitivity, specificity, positive predictive value, and negative predictive value for CT scans in comparison to cystoscopy. Statistical significance was considered at p < 0.05. Results In our study, the mean participant age was 45.3 years, with 61.4% falling in the 40-60 years age group. Socioeconomic status (SES) varied, with 37.8% classified as low SES, 48.8% as middle SES, and 13.4% as high SES. Parity data showed that 76.4% had three or more pregnancies. Among presenting symptoms, abnormal vaginal bleeding (65.4%) was the most prevalent, and squamous cell carcinoma (78.7%) was the predominant histological type. The prevalence of bladder involvement was 9.4% by cystoscopy and 30.7% by CT scans. CT scan demonstrated a high sensitivity (100%) but lower specificity (76.52%), with 78.80% overall accuracy. Conclusion A combined approach, using CT scans as a screening tool and cystoscopy as a confirmatory method, could provide the most comprehensive and reliable assessment of bladder involvement in cervical carcinoma patients, ultimately contributing to improved patient care and management.

Anatomical Variants and Anomalies of Coronary Artery Tree as Seen in Slice Multidetector Computed Tomography (MDCT)

Anatomical Variants and Anomalies of Coronary Artery Tree as Seen in Slice Multidetector Computed Tomography (MDCT)

Sine Spin flat detector CT can improve cerebral soft tissue imaging: a retrospective in vivo study

BackgroundFlat detector computed tomography (FDCT) is frequently applied for periinterventional brain imaging within the angiography suite. Novel technical developments such as the Sine Spin FDCT (S-FDCT) may provide an improved cerebral soft tissue contrast. This study investigates the effect of S-FDCT on the differentiation between gray and white matter compared to conventional FDCT (C-FDCT) and multidetector computed tomography (MDCT).MethodsA retrospective analysis of a prospectively maintained patient database was performed, including patients who underwent mechanical thrombectomy in our institution and received S-FDCT or C-FDCT as well as MDCT. Differentiation between gray and white matter on the contralateral hemisphere to the ischemic stroke was analyzed quantitatively by contrast-to-noise ratio (CNR) and qualitatively (5-point ordinal scale).ResultsIn a cohort of 109 patients, MDCT demonstrated the best differentiation between gray and white matter compared to both FDCT techniques (p ≤ 0.001). Comparing both generations of FDCT, S-FDCT provided better visibility of the basal ganglia (p = 0.045) and the supratentorial cortex (p = 0.044) compared to C-FDCT both in quantitative and qualitative analyses. Median CNR were as follows: S-FDCT 2.41 (interquartile range [IQR] 1.66–3.21), C-FDCT 0.96 (0.46–1.70), MDCT 3.43 (2.83–4.17). For basal ganglia, median score and IQR were as follows: S-FDCT 2.00 (2.00–3.00), C-FDCT 1.50 (1.00–2.00), MDCT 5.00 (4.00–5.00).ConclusionsThe novel S-FDCT improves the periinterventional imaging quality of cerebral soft tissue compared to C-FDCT. Thus, it may improve the diagnosis of complications within the angiography suite. MDCT provides the best option for x-ray-based imaging of the brain tissue.Relevance statementFlat detector computed tomography is a promising technique for cerebral soft tissue imaging, while the novel Sine Spin flat detector computed tomography technique improves imaging quality compared to conventional flat detector computed tomography and thus may facilitate periinterventional diagnosis of gray and white matter.Key points• Flat detector computed tomography (FDCT) is frequently applied for periinterventional brain imaging.• The potential of novel Sine Spin FDCT (S-FDCT) is unknown so far.• S-FDCT improves the visibility of cerebral soft tissue compared to conventional FDCT.• Multidetector computed tomography is superior to both FDCT techniques.• S-FDCT may facilitate the evaluation of brain parenchyma within the angiography suite.Graphical

Signal Quantification of Intravenous Contrast Agents Enhancement from Biphase Liver CT Scan Procedures

In multi-detector computed tomography (MDCT) abdominal and pelvic CT treatments with intravenous (IV) contrast media (CM), automated bolus monitoring with a fixed contrast enhancement delay was examined. Statistics assess all contrast enhancement variables, including patient data like body weight, cardiac output, and contrast injection settings. This study comprised 100 retrospective and 43 prospective patients. In the first group, the Hounsfield unit (HU) was measured before, 30 seconds, and 70 seconds after CM. The second group measured age, weight, heart rate, systolic and diastolic blood pressure, and creatinine. The radiographer computed CM time based on HU values around 120. The differences in HU levels across groups were used to create an equation for imaging time prediction utilizing auto-mated bolus monitoring. The Bolus Time Equation’s predictors included patient weight, heart rate, creatinine level, and systolic blood pressure, with 34.9% dependency and 59.1% influence on each variable. The equation is trustworthy since the ANOVA test indicated p = 0.002. The computation and study gave the same Bolus Time value with a p-value of (0.992 > 0.05). The first and second groups exhibited very different HU rates (p-value 0.00). The research found that fixed-time improved more than bolus monitoring, which performed better.

Case report: A case of an anomalous right coronary artery arising from the left coronary cusp.

Abstract&#x0D; An anomalous origin of the right coronary artery is usually asymptomatic. It is mostly found incidentally on an invasive diagnostic angiogram. It does lead to an increased risk of sudden cardiac death, especially in younger patients. We present a case of a 41-year-old who had presented to the hospital with complaints of chest pain. The patient was evaluated by cardiology who performed an angiography that identified an anomalous origin of the right coronary artery arising from the left coronary cusp but no evidence of coronary artery disease. Once identified, these anomalous vessels should be corrected surgically, as these conditions increase the risk of sudden cardiac death arrhythmia and ischemic events.&#x0D; &#x0D; INTRODUCTION&#x0D; Anomalous aortic origin of the right coronary artery (AAORCA) is an uncommon congenital malformation with varying clinical presentations ranging from asymptomatic to sudden cardiac death (SCD). Those with symptoms or high-risk lesions are usually managed by unroofing or reimplantation, coronary artery bypass graft (CABG), AAORCA treated with right internal memory artery graft with proximal RCA ligation.&#x0D; &#x0D; CASE DESCRIPTION&#x0D; A 41-year-old female patient with obesity and hypertension presented with a 1-year history of intermittent exertional substernal pressure radiating to left shoulder and back. The pain, which lasted about 10 minutes per episode, had been more frequent and intense over the past week.Upon initial evaluation, she was hypertensive at 150/90 mmHg and heart rate 60 bpm. Blood work was unremarkable, including negative serial troponin levels. Electrocardiography showed sinus bradycardia without ischaemic changes. Anomalous origin of RCA was incidentally discovered from computed tomography (CT) of the chest. Coronary angiography and ascending aortography were then performed, which revealed a patent RCA originating from the left coronary cusp (Fig. 1A). CT heart angiography with reconstruction revealed the RCA ostium in the left coronary cusp with a malignant course between the aorta and pulmonary artery and without an obvious intramural segment&#x0D; Discussion:&#x0D; &#x0D; An anomalous origin of the right coronary artery (RCA) is a rare congenital anomaly that was first described in 1948 by White and Edwards. After carrying out angiography in 126,595 patients, Yamanaka and Hobbs reported the incidence of anomalous origin of the right and left coronary arteries as 136 (0.107%) and 22 (0.017%), respectively. The prevalence of an anomalous origin of RCA (ARCA) arising from the left coronary cusp with an inter-arterial course varies between 0.026% and 0.25%. An ARCA is more common than the anomalous origin of the left coronary artery (ALCA), but the latter is shown to be responsible for up to 85% of sudden cardiac deaths (SCD) related to the anomalous origins of arteries. Most coronary anomalies are detected incidentally on diagnostic angiography and are clinically insignificant; some, however, have been associated with an increased risk of SCD. It is second only to hypertrophic cardiomyopathy as a leading cause of SCD in young athletes. Mechanical compression of the RCA by the great vessels, which dilate and compress the RCA during periods of increased stroke volume, is the usual explanation for coronary ischemia. Patients usually have no ischemic changes on an electrocardiogram (ECG) at rest; however, multi-detector computed tomography (MDCT) is being used to evaluate the course of anomalous vessels outlying their relative positions to the aorta and the pulmonary artery. It also gives additional information regarding any stenotic lesion in these anomalous vessels. Echocardiography (Echo), magnetic resonance angiography (MRA), MCDT, and cardiac catheterization are all complementary diagnostic tools for evaluating anomalous coronary arteries [10]. While it is agreed that surgical correction is the standard of care for ALCA, when found, the management for right ARCA is more complicated. Treatment options for these patients include observation with medical therapy, percutaneous intervention (stenting), or surgery. Early diagnosis of coronary artery anomalies based on the patients’ symptoms can help decrease the incidence of sudden cardiac deaths, fatal arrhythmias, and ischemic events in the high-risk population.&#x0D; &#x0D; Conclusions &#x0D; &#x0D; Coronary anomalies should be suspected in symptomatic young patients with a normal cardiac workup. Non-invasive imaging modalities such as a CTCA can help establish the diagnosis

Study on the diagnostic value of MDCT extramural vascular invasion in preoperative N staging of gastric cancer patients

BackgroundTo explore the diagnostic value of multidetector computed tomography (MDCT) extramural vascular invasion (EMVI) in preoperative N Staging of gastric cancer patients.MethodsAccording to the MR-defined EMVI scoring standard of rectal cancer, we developed a 5-point scale scoring system to evaluate the status of CT-detected extramural vascular invasion(ctEMVI), 0–2 points were ctEMVI-negative status, and 3–4 points were positive status for ctEMVI. Patients were divided into ctEMVI positive group and ctEMVI negative group. The correlation between ctEMVI and clinical features was analyzed. Receiver operating characteristic (ROC) curve was used to evaluate the diagnostic efficacy of ctEMVI for pathological metastatic lymph nodes and N staging, The sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) of pathological N staging using ctEMVI and short-axis diameter were generated and compared.ResultsThe occurrence rate of lymphovascular invasion (LVI) and proportion of tumors with a greatest diameter > 6 cm in the ctEMVI positive group was higher than that in the ctEMVI negative group (P < 0.05). Spearman correlation analysis showed a positive correlation between ctEMVI and LVI, N stage, and tumor size (P < 0.05). For ctEMVI scores ≥ 3,The AUC of ctEMVI for diagnosing lymph node metastasis, N stage ≥ N2, and N3 stage were 0.857, 0.802, and 0.758, respectively. The sensitivity, NPV and accuracy of ctEMVI for diagnosing N stage ≥ N2 were superior to those of short-axis diameter (P < 0.05), while sensitivity, specificity, PPV, NPV, and accuracy of ctEMVI for diagnosing N3 stage were superior to those of short-axis diameter (P < 0.05).ConclusionctEMVI has important value in diagnosing metastatic lymph nodes and advanced N staging. As an important imaging marker, ctEMVI can be included in the preoperative imaging evaluation of patients, providing important assistance for clinical guidance and treatment.

Tracheobronchial variations in Pneumoconiosis cases: multidetector computed tomography diagnosis.

Tracheobronchial variations (TBVs) are more common than previously believed due to the increasing use of multi-detector computed tomography (MDCT). This study aimed to assess TBVs in cases of pneumoconiosis, one of the oldest occupational diseases that still poses a threat to public health. This was a descriptive study that involved reviewing chest MDCT images of 34 cases of pneumoconiosis and 34 control cases retrospectively from January 2020 to April 2022. Variations in the trachea, right main bronchus, left main bronchus, lobar and segmental branches of the cases in the patient and control groups were evaluated according to Boyden's nomenclature. The frequency of TBV was 32.4% in pneumoconiosis cases. Although the frequency of TBV was higher in the patient group than in the control group, the difference was not statistically significant (p=0.086). Furthermore, there was no significant difference in terms of TBV classification between the patient and control groups (p=0.407). Additionally, the presence of TBV did not affect the distribution of International Labour Organization categories in pneumoconiosis cases (p=0.360). Although our study provides initial insights into the occurrence of TBVs in pneumoconiosis cases, further research is needed to clarify the relationship between these variations and the disease.

Visualization of anatomical structures in the fetlock region of the horse using cone beam computed tomography in comparison with conventional multidetector computed tomography.

Cone-beam computed tomography (CBCT) is regarded as a convenient and suitable alternative to conventional computed tomography. However, in the horse, the quality of obtained data sets needs to be evaluated. Therefore, the aim of this study was to compare the visibility and accessibility of clinically relevant anatomical structures displayed in CBCT and conventional multidetector computed tomography (MDCT). Twenty-nine limbs from horses euthanized for reasons unrelated to this study were used. Native and intraarticular contrast scans of the fetlock (CBCT vs. MDCT) were performed. The visibility and accessibility of selected anatomical structures were blindly scored by three independent experienced observers using a scoring system previously reported and adapted to the fetlock joint. Only minor differences between CBCT and MDCT were identified concerning the diagnostic quality of images for osseous structures. Soft tissue structures were better evaluated on MDCT images. In CBCT as well as in MDCT articular cartilage could only be visualized after intraarticular injection of contrast medium. Cone beam computed tomography of the fetlock is a useful and reliable diagnostic tool when evaluating osseous structures and delineating articular cartilage with contrast medium. However, this modality is limited for assessing soft tissues structures.