Multidetector Computed Tomography Findings Research Articles

Multidetector CT Findings in the Abdomen and Pelvis after Damage Control Surgery for Acute Traumatic Injuries

After experiencing blunt or penetrating trauma, patients in unstable condition who are more likely to die of uncorrected shock than of incomplete injury repairs undergo emergency limited exploratory laparotomy, which is also known as damage control surgery (DCS). This surgery is part of a series of resuscitation steps, with the goal of stabilizing the patient's condition, with rapid surgical control of hemorrhage followed by supportive measures in the intensive care unit before definitive repair of injuries. These patients often are imaged with multidetector CT within 24-48 hours of the initial surgery. Knowledge of this treatment plan is critical to CT interpretation, because there are anatomic derangements and foreign bodies that would not be present in patients undergoing surgery for other reasons. Patients may have injuries beyond the surgical field that are only identified at imaging, which can alter the care plan. Abnormalities related to the resuscitation period such as the CT hypoperfusion complex and ongoing hemorrhage can be recognized at CT. Familiarity with these imaging and clinical findings is important, because they can be seen not only in trauma patients after DCS but also in other patients in the critical care setting. The interpretation of imaging studies can be helped by an understanding of the diagnostic challenges of grading organ injuries with surgical materials in place and the awareness of potential artifacts on images in these patients. Online supplemental material is available for this article. ©RSNA, 2019 See discussion on this article by LeBedis .

Invited Commentary on "Multidetector CT Findings in the Abdomen and Pelvis after Damage Control Surgery for Acute Traumatic Injuries".

Invited Commentary on "Multidetector CT Findings in the Abdomen and Pelvis after Damage Control Surgery for Acute Traumatic Injuries".

Urgent multidetector computed tomography in colon cancer: Postsurgical changes and early complications

Complications after surgery for colorectal cancer are common in emergency departments. Multidetector computed tomography plays a fundamental role in the follow-up of patients after surgery, because it enables the detection of relapse and complications. Radiologists need to be familiar with different surgical techniques and the normal postsurgical changes so that we can differentiate them from potential complications and relapse.This article reviews the multidetector computed tomography findings that can be considered normal after surgical intervention for colorectal cancer as well as the most common early complications seen in postsurgical colorectal cancer patients presenting at emergency departments.

Utility of biphasic multi-detector computed tomography in suspected acute mesenteric ischemia in the emergency department.

To retrospectively evaluate the utility of biphasic multi-detector computed tomography (MDCT) with arterial and portal venous phases for the detection of suspected acute mesenteric ischemia (AMI) in emergency department (ED) patients compared to limited surgical confirmation. A research ethics board (REB)-approved retrospective review of all consecutive adult patients who underwent an emergency biphasic 64-MDCT examination of the abdomen and pelvis due to clinical suspicion for AMI over a 5-year period at a single tertiary-care institution was performed. Patients who underwent biphasic 64-MDCT scans performed for any clinical concern other than suspected acute mesenteric ischemia were excluded. Specifically, reported vascular and bowel findings were used to establish occlusive arterial, venous, and non-occlusive MDCT findings of AMI. Correlation was made with surgical findings in operatively managed patients and with serum lactate values preceding imaging assessment. Diagnostic yield and positive predictive value calculations were performed. Two hundred and twenty-five patients underwent MDCT for suspected occlusive AMI between 10 Jan 2011 and 31Jul 2016. Of these, 200 patients were negative for AMI and 25 patients (mean age 73.5years; age range 48 to 94years; 13 men and 12 women) had MDCT findings positive for bowel ischemia (yield of 11.1%). On MDCT, 18/25 (72%) had an occlusive arterial etiology for AMI, 2/25 (8%) had an occlusive venous etiology, and 5/25 (20%) had non-occlusive AMI. Twenty of 25 (80%) patients with positive MDCT findings of AMI also had an elevated serum lactate level, including 14/18 (77.8%) patients with arterial occlusive AMI on MDCT, 2/2 (100%) with venous-occlusive AMI on MDCT, and 4/5 (80%) with non-occlusive AMI on MDCT. Correlation with surgical findings led to a positive predictive value (PPV) of biphasic MDCT for surgically proven all-cause occlusive ischemia of 92.9%. Further substratification revealed PPVs of arterial and venous-occlusive ischemia of 85.7% and 7.1%, respectively. Of the 225 patients MDCT-positive for AMI, 213 had pre-imaging serum lactate assessments. Of 188 patients MDCT-negative for AMI, 85 patients had elevated serum lactate (45.2%). Twenty of the 25 patients with positive MDCT findings of AMI (80%) also had an elevated serum lactate level, including 14/18 (77.8%) patients with arterial occlusive AMI on MDCT, 2/2 (100%) with venous-occlusive AMI on MDCT, and 4/5 (80%) with non-occlusive AMI on MDCT. Emergent biphasic MDCT demonstrated low but non-trivial yield (11.1%) for the depiction of suspected acute mesenteric ischemia but was particularly low for occlusive venous AMI (0.9%). The relationship between serum lactate elevation and positive MDCT findings of AMI in our study conforms to prior work and cautiously suggests value in routine serum lactate assessment preceding imaging for patient prioritization.

MDCT prior to median re-sternotomy in cardiovascular surgery: our experiences, infrequent findings and the crucial role of radiological report

Resternotomy (RS) is a common occurrence in cardiac surgical practice. It is associated with an increased risk of injury to old conduits, cardiac structures, catastrophic hemorrhage and subsequent high morbidity and mortality rate in the operating room or during the recovery period. To mitigate this risk, we evaluated the role of multidetector CT (MDCT) in planning repeat cardiac surgery. We evaluated sternal compartment abnormalities, sternal/ascending aorta distance, pre-reoperative assessment of the aorta (wall, diameters, lumen, valve), sternal/right ventricle distance, diaphragm insertion, pericardium and cardiac chambers, sternal/innominate vein distance, connection of the grafts to the predicted median sternotomy cut, graft patency and anatomic course, possible aortic cannulation and cross-clamping sites and additional non-cardiovascular significant findings. Based on the MDCT findings, surgeons employed tailored operative strategies, including no-touch technique, clamping strategy and cardiopulmonary bypass (CPB) via peripheral cannulation assisted resternotomy. Our experience suggests that MDCT provides information which contributes to the safety of re-operative heart surgery reducing operative mortality and adverse outcomes. The radiologist must be aware of potential surgical options, including in the report any findings relevant to possible resternotomy complications.

Infectious pseudoaneurysm of the abdominal aorta caused by adjacent spondylodiscitis. Multidetector computed tomography findings

Infectious pseudoaneurysm of the abdominal aorta caused by adjacent spondylodiscitis. Multidetector computed tomography findings

Foreign body aspiration in children with negative multi-detector Computed Tomography results: Own experience during 2011–2018

ObjectiveThis study sought to summarize the clinical characteristics of foreign body aspiration(FBA) in children with negative multi-detector Computed Tomography(MDCT) results and to explore the essential points which determined the patients to undergo bronchoscopy. MethodsThe medical records of 48 pediatric patients admitted to the department of respiratory medicine in our hospital from January 2011 to October 2018 and diagnosed with foreign body aspiration and negative chest MDCT results were retrospectively analyzed. They were compared with the patients of FBA whose MDCT findings suggested indirect signs, such as atelectasis or emphysema. ResultsOf the 48 patients, 33 were boys (68.8%) and 15 girls (31.2%), with a mean age of 35.3 months(range, 7–156 months). Cough (47 cases, 97.9%), fever (25 cases, 52.1%) and wheezing (23 cases,47.9%)were the main symptoms.39 patients (81.3%) had abnormal physical signs. None of the MDCT or three dimension(3D) images based on MDCT revealed foreign bodies in these children, while the results were: signs of lung infection without atelectasis or emphysema 52.1%(25 cases), increase of lung markings16.7%(8 cases),bronchiectasis 6.3%(3 cases), or normal 27.1%(13 cases). 41 Patients were successfully removed their foreign bodies(A further 5 had the FB removed from the tracheobronchial tree but it was then swallowed before retrieval. The remaining 2 cases had to be referred to another hospital for further management), most of which were organic. The shapes of foreign bodies were small granular (23 cases, 56.1%), sheet or powder (18 cases, 43.9%). The control group was 13 patients of FBA whose MDCT findings suggested indirect signs of atelectasis or emphysema during the same time. The result of comparison showed the clear history of FBA was statistically different between the two groups. ConclusionsForeign body aspiration could not be ruled out with negative MDCT in patients clinically suspected. Typical foreign body aspiration history and ineffective conservative treatment could provide important basis of performing bronchoscopy. Complicated with lung infection and the shape of foreign bodies may affect the false negative results of MDCT.

Tomografía computarizada multidetector urgente de la cirugía del cáncer colorrectal: Cambios posquirúrgicos y complicaciones tempranas

Complications after surgery for colorectal cancer are common in emergency departments. Multidetector computed tomography plays a fundamental role in the follow-up of patients after surgery, because it enables the detection of relapse and complications. Radiologists need to be familiar with different surgical techniques and the normal postsurgical changes so that we can differentiate them from potential complications and relapse.This article reviews the multidetector computed tomography findings that can be considered normal after surgical intervention for colorectal cancer as well as the most common early complications seen in postsurgical colorectal cancer patients presenting at emergency departments.

Multidetector CT of Laryngeal Injuries: Principles of Injury Recognition.

Blunt laryngeal trauma is associated with high morbidity and mortality. However, owing to their relatively rare occurrence, laryngeal injuries may be missed or underdiagnosed. Even subtle abnormalities at multidetector CT may correspond to significant functional abnormalities. It is important to understand normal CT laryngeal anatomy and develop a systematic review of the cervical soft tissues and laryngeal skeleton in patients who undergo screening CT cervical spine or other neck examinations in the setting of trauma, such as CT angiography. Multidetector CT findings of the normal larynx are reviewed, and blunt laryngeal injuries including soft-tissue edema, hematoma, mucosal lacerations, cartilage fracture, cricoarytenoid dislocation, and vocal fold paralysis are presented. The radiologist plays an important role in diagnosis and may be the first to identify laryngeal injuries that are not evident at physical examination. This article reviews normal laryngeal anatomy, presents various blunt laryngeal injuries at multidetector CT with case examples, discusses the role of multidetector CT in acute management, and describes pitfalls of diagnosis. ©RSNA, 2019.

Tomografía computarizada del divertículo de Meckel complicado en adultos

ObjectiveTo review the embryology, the clinical findings and the appearance in multidetector computed tomography (MDCT) of complicated Meckel's diverticulum (DM) in adults. ConclusionThe presence of an MD in a MDCT should be suspected when a blind tubular structure connected to the terminal ileum by a neck of variable size is observed. Multiplanar 2D reconstructions images and CT enterography can help in the diagnosis. In patients with symptoms of obstruction or intestinal inflammation, the possibility of a complication secondary to a MD should be considered, especially when the terminal ileum and the vermiform appendix are normal. MDCT angiography, in cases of acute gastrointestinal bleeding, can identify contrast extravasation and accumulation of blood in the MD, and could demonstrate the persistent omphalomesenteric artery, which is diagnostic of MD. Other MDCT findings such as the presence of enteroliths or associated inflammatory changes around the MD can facilitate the preoperative diagnosis of MD complications.

Mitral annular calcification: Can CMR be useful in identifying caseous necrosis?

Mitral annular calcification (MAC) can resemble an intracardiac mass and it is defined as a chronic degeneration of the mitral annulus. Often reported is caseous mitral annulus calcification (CMAC), a periannular, extensive calcification resembling a tumor. We report the case of a 68-year-old woman who had been hospitalized for palpitations and dyspnea. The transthoracic and transesophageal echocardiography revealed a non-homogeneous, slightly mobile, round mass, attached to the ventricular side of posterior mitral leaflet, with central echo-lucent area and without acoustic shadowing. Therefore, a cardiac magnetic resonance (CMR) was performed; delayed enhancement sequences showed a non-enhanced central core surrounded by a hyperenhanced rim (fibrous cap). To confirm the diagnosis, a multidetector computed tomography (MDCT) was performed; the MDCT showed a hyperdense mass with a hypodense center and a calcified peripheral rim. The central content had heterogeneous fluid density without significant contrast enhancement. The MDCT findings were considered highly suggestive of CMAC. CMR may be useful for the identification and definition of pericardial and myocardial masses and CMAC.

Role of Multidetecter CT in Diagnosis of Mediastinal Masses

Background: The mediastinum is a vital sector of the thorax that contains vital intrathoracic structures such as the heart and great vessels, trachea and main bronchi, esophagus, thymus, venous and lymphatic structures, and nerve tissue. CT is the imaging modality of choice in diagnosis of mediastinal masses. The multiplanar capability of multidetector computed tomography (MDCT) is extremely helpful in delineating the full extent and source of vascularity thus helping in pre-operative planning of these patients. Objective: Detection of the role of multidetector CT in diagnosis and differentiation of mediastinal masses. Patients and methods: Forty patients were included in this study (20 females and 20 males), who presented with signs and symptoms suggestive for mediastinal masses. All patients were subjected to detailed history taking, clinical examination, laboratory studies, chest xray and MDCT examination. The correlation was done between the MDCT findings and the final diagnosis. The final diagnosis was made by operative procedures, CT guided biopsy, histopathological results and conservative management Results: Lymphoma was the commonest mediastinal mass forming 20% of cases , followed by neurogenic tumors (neuroblastoma, , neurofibroma , ganglioneuroma and schwannomatosis) forming about 17.5 % , then retrosternal thyroid (10%), teratoma (5%), thymoma (5%), metastatic lymphadenopathy (5%), esophageal carcinoma (5%), aortic aneurysm (5%), Bochdalek hernia (5%), hiatus hernia (5%), morgagni hernia (5%), esophageal achalasia (5%), esophageal leiomyoma (5%) and paraspinal abscess (2.5%). MDCT sensitivity was 92.86% & MDCT specificity was 100%. Conclusion: MDCT has a major and reliable role to play in the evaluation and assessment of the mediastinal masses; regarding the organ of origin, its density and mass effect upon adjacent structures, distribution pattern and extent of the lesion.

Role of Multidetecter CT in Diagnosis of Mediastinal Masses

Background: The mediastinum is a vital sector of the thorax that contains vital intrathoracic structures such as the heart and great vessels, trachea and main bronchi, esophagus, thymus, venous and lymphatic structures, and nerve tissue. CT is the imaging modality of choice in diagnosis of mediastinal masses. The multiplanar capability of multidetector computed tomography (MDCT) is extremely helpful in delineating the full extent and source of vascularity thus helping in pre-operative planning of these patients. Objective: Detection of the role of multidetector CT in diagnosis and differentiation of mediastinal masses. Patients and methods: Forty patients were included in this study (20 females and 20 males), who presented with signs and symptoms suggestive for mediastinal masses. All patients were subjected to detailed history taking, clinical examination, laboratory studies, chest xray and MDCT examination. The correlation was done between the MDCT findings and the final diagnosis. The final diagnosis was made by operative procedures, CT guided biopsy, histopathological results and conservative management Results: Lymphoma was the commonest mediastinal mass forming 20% of cases , followed by neurogenic tumors (neuroblastoma, , neurofibroma , ganglioneuroma and schwannomatosis) forming about 17.5 % , then retrosternal thyroid (10%), teratoma (5%), thymoma (5%), metastatic lymphadenopathy (5%), esophageal carcinoma (5%), aortic aneurysm (5%), Bochdalek hernia (5%), hiatus hernia (5%), morgagni hernia (5%), esophageal achalasia (5%), esophageal leiomyoma (5%) and paraspinal abscess (2.5%). MDCT sensitivity was 92.86% & MDCT specificity was 100%. Conclusion: MDCT has a major and reliable role to play in the evaluation and assessment of the mediastinal masses; regarding the organ of origin, its density and mass effect upon adjacent structures, distribution pattern and extent of the lesion.

High-Value Multidetector CT Angiography of the Superior Mesenteric Artery: What Emergency Medicine Physicians and Interventional Radiologists Need to Know.

The superior mesenteric artery (SMA) provides vital blood supply to the midgut, and an acute abnormality can rapidly precipitate bowel ischemia and infarction and lead to morbidity and mortality. Vascular diseases that acutely compromise the SMA threaten its tributaries and include occlusion, dissection, aneurysm rupture, pseudoaneurysm, vasculitis, and SMA branch hemorrhage into the bowel. Emergency medicine physicians rely on the radiologist to identify SMA abnormalities, to characterize them, and to detail findings that guide the appropriate triage of these patients. As such, radiologists must be cognizant of the features that influence patient treatment to assist vascular surgeons and interventional radiologists in decision making. Some patients can be treated medically, while clinical and radiographic findings may suggest the need for interventional or surgical repair of the artery. In the latter case, multidetector CT findings aid in determining which of the various surgical and endovascular treatment options is optimal, and both vascular and gastrointestinal sequelae of acute SMA abnormalities contribute to these determinations. The authors review acute life-threatening conditions involving the SMA including acute occlusion, dissection, aneurysm, pseudoaneurysm, and hemorrhage and discuss the vascular and gastrointestinal multidetector CT findings in each of these conditions that help to guide surgical and interventional management. ©RSNA, 2019.

Multidetector CT findings differ between surgical grades of pancreatic fistula after pancreaticoduodenectomy.

To define and correlate multidetector CT (MDCT) findings of pancreatic fistula after pancreaticoduodenectomy with surgical grading based on the 2016 Revised International Study Group of Pancreatic Fistula (ISGPF) classification. Between May 2011 and December 2016, 235 patients with periampullary tumor underwent pancreaticoduodenectomy and postoperative MDCT. Patients were classified into three groups (clinically no pancreatic fistula (cNo-PF), grade B, and grade C) according to the ISGPF classification. MDCT images were retrospectively evaluated by two radiologists in consensus for the presence of pancreaticojejunostomy (PJ) dehiscence, PJ dehiscence diameter, PJ defect, acute necrotic collection (ANC), peripancreatic fluid collection, and imaging findings of complications. Categorical MDCT findings were compared among the three groups using Pearson's chi-square test, and PJ dehiscence diameter was compared using the Kruskal-Wallis test. There was no significant difference in patient demographics among the groups (cNo-PF = 133, grade B = 68, and grade C = 34), but the MDCT findings were significantly different regarding the presence of PJ dehiscence (p < 0.001), PJ defect (p < 0.001), ANC (p = 0.002), and imaging findings of total complications (p < 0.001). The diameters of PJ dehiscence were significantly different among the groups (cNo-PF [0.42 ± 1.54mm], grade B [1.47 ± 2.33mm], and grade C [5.38 ± 6.45mm]) (p < 0.001). With respect to the presence of PF, postoperative MDCT findings may differ between surgical grading based on the ISGPF classification. • Regarding the presence of pancreatic fistula, the postoperative multidetector CT findings correlate well with surgical grading based on the International Study Group of Pancreatic Fistula classification. • Multidetector CT may provide reliable information to suggest pancreatic fistula after pancreaticoduodenectomy.

The investigation of incidence and multidetector computed tomography findings of median arcuate ligament syndrome

This study aims to evaluate the incidence and multidetector computed tomography (MDCT) findings of median arcuate ligament syndrome (MALS). Between January 2010 and September 2016 a total of 4028 patients who underwent angiography for MDCT based on the clinical indications for abdominal pain were retrospectively analyzed. The typical signs of MALS were identified in a total of 141 (3.5%) patients. Among all patients, 84 (59%) were male and 57 (41%) were female. The mean age was 42 years (range: 24 to 71 years). The incidence of celiac artery stenosis was 30% to 50% in 45 patients (32%) and 51% to 90% in 96 patients (68%). Poststenotic dilatation was reported in 74 patients (52%). Collateral vascular structures from the superior mesenteric artery were observed in 5 patients (3.5%). Twenty-one patients (14.9%) underwent laparoscopic surgery with significant stenosis. MALS is a rare vascular pathology. It is especially important to recognize the presence of MALS with an epigastric pain that increases with expiration in adults and also its etiology before interventional procedures. MDCT visualization made the diagnosis of MALS easy.

Role of Multi-Detector Computed Tomography in Diagnosis and Staging of Cholesteatoma

AbstractBackground: Pathology of the middle ear is the third most common reason of visiting a general practitioner or a family doctor. In children and teenagers, inflammatory conditions of the middle ear are the most frequent reasons to prescribe antibiotics and perform surgery.In the majority of these cases, proper diagnosis is made by clinical examination alone and patients will not benefit from additional diagnostic imaging studies. However, the prevalence of ear infections increased significantly and this may suggest that the current approach to preventing and treating middle ear inflammation is not adequate. Therefore, especially in complicated and recurrent conditions, imaging plays an important role; imaging findings may fundamentally influence the treatment. Also, in non-inflammatory conditions of external and middle ear Computed Tomography (CT) or Magnetic Resonance Imaging (MRI) would provide a diagnosis and/or necessary information for surgery in a significant number of cases.Aim of Work: Evaluation the role of Multi-Detector Computed Tomography (MDCT) in diagnosis Chronic Sup-purative Otitis Media (CSOM) with or without cholesteatoma and staging of middle ear Cholesteatoma and assess its impact on the selection of the surgical procedure.Patients and Methods: A prospective study included 30 patients with mean age 30.4 years with CSOM with or without cholesteatoma. They were evaluated regarding to their clinical symptoms, temporal multidetector computed tomography findings, and postoperative results. MDCT staging classified cholesteatoma according to its site in the tympanic cavity (S); erosion of the ossicular chain (O); and associated complications (C).Results: MDCT imaging of these patients showed opaci-fication of middle ear cavity with integrity of the ossicular chain with 100% accuracy. Nondependent soft tissue masses in the middle ear, eroded scutum (n=20), eroded ossicles (n= 20), intact tegmen tympani (n=30), lateral mastoid fistula (n=2) and labyrinthine fistula (n=1) were observed in CSOM with cholesteatoma. All these patients underwent surgical intervention that confirmed the diagnosis of the presence of cholesteatoma in all these patients. But it also added the presence of lateral mastoid fistula and labyrinthine fistula in 1 other patient and discovered the presence of facial nerve injury in 1 patient.Conclusion: MDCT scanning has limitations, but it is a useful in diagnosis, staging and surgic

Multidetector Computed Tomography Findings of Auto-Evacuated Secondary Acquired Cholesteatoma: A Morphologic and Quantitative Analysis

Multidetector Computed Tomography Findings of Auto-Evacuated Secondary Acquired Cholesteatoma: A Morphologic and Quantitative Analysis

Klatskin Tumor (Hilar Cholangiocarcinoma)

Klatskin tumor is a term that was given to a hilar cholangiocarcinoma, occurring at the bifurcation of the common hepatic duct. Typically, these tumors are small, poorly differentiated, exhibit aggressive biologic behavior, and tend to obstruct the intrahepatic bile ducts. Here, we present the multidetector computed tomography findings in a case of hilar cholangiocarcinoma.

Comparison between groove carcinoma and groove pancreatitis

Background/objectivesThe pancreatoduodenal groove (anatomical groove) is a potential space bordered by the head of the pancreas, duodenum, and common bile duct. Discerning between groove carcinoma (GC) and groove pancreatitis (GP) is often difficult, but clinically important. We retrospectively analyzed and compared the findings of computed tomography (CT), laboratory tests, and endoscopic ultrasound-fine needle aspiration (EUS-FNA) for GC and GP. MethodsGC (n = 36) and GP (n = 44) patients at Asan Medical Center from January 1, 2000, to May 31, 2017 were retrospectively reviewed. MDCT findings, baseline characteristics, laboratory test results, and EUS and EUS-FNA findings of GC and GP patients were compared. ResultsCT showed no significant difference in groove enhancement between the groups. Mass-like lesions, cystic groove lesions, and calcification were observed in 86.1% and 15.9%, 38.9% and 75%, and 2.8% and 29.5% of GC and GP patients, respectively. Patients were tested for total bilirubin (GC: 2.0 vs. GP: 0.6 mg/dL), cancer antigen 19-9 (CA19-9) (GC: 76 vs. GP: 12.5 U/mL), and carcinoembryonic antigen (GC: 2.4 vs. GP: 2 ng/mL). Three GP patients died, and one GP patient was diagnosed with GC. However, among 30 GC patients with at least 1-year follow-up, 20 died. In multivariate logistic regression, CA19-9, and mass-like lesion on multidetector CT (MDCT) were discriminating factors between GC and GP. Among 23 (10 GC, 13 GP) patients who underwent EUS-FNA, the diagnostic sensitivity, specificity, positive predictive value, negative predictive value, accuracy of EUS-FNA were 90%, 100%, 100%, 92.86%, and 95.65%, respectively. ConclusionsSeveral MDCT and laboratory findings favor GC over GP. EUS-FNA should be considered in patients with elevated CA19-9 levels and mass-like lesions on MDCT.