Multidetector Computed Tomography Imaging Research Articles

Safety and efficacy of water pressure endoscopic submucosal dissection for colorectal tumors with submucosal fibrosis (with video)

Colorectal neoplasms with submucosal fibrosis are the most challenging targets of endoscopic resection. Water pressure endoscopic submucosal dissection (WP-ESD) is a recently introduced procedure that has several advantages over conventional endoscopic submucosal dissection (C-ESD). This study aimed to assess the efficacy and safety of WP-ESD for fibrotic colorectal neoplasms. This retrospective observational study investigated 133 colorectal neoplasms expected to have submucosal fibrosis that were resected by WP-ESD or C-ESD between April 2012 and April 2020. Eighty-seven lesions after endoscopic or surgical treatment, 18 with biopsy scar with fold convergence and 28 in patients with ulcerative colitis, were included. The differences in treatment outcomes, including procedure time and adverse event proportions, between the WP-ESD and C-ESD groups were analyzed. The clinical course after perforation using WP-ESD was also evaluated, including postprocedural multidetector CT findings obtained immediately after WP-ESD. Severe submucosal fibrosis was observed in 96 lesions (72.2%). The median procedure time was significantly shorter in the WP-ESD group than in the C-ESD group (43.5 minutes [interquartile range {IQR}, 32.8-73] vs 72 minutes[IQR, 45-105]; P= .0041). The multivariate analysis revealed WP-ESD as an independent factor for a shortprocedure time (odds ratio, 2.90; 95% confidence interval, 1.28-6.55). The proportions of post-ESD electrocoagulation syndrome (11.6% vs 13.1%) and perforation (20.4% vs 22.8%) were similar between the groups. Four of 11 patients withperforation who underwent WP-ESD showed fluid collection on postprocedural multidetector CT images. WP-ESD can shorten procedure time for treating fibrotic colorectal neoplasms.

Estimation of Gender by Using Decision Tree, a Machine Learning Algorithm, With Patellar Measurements Obtained From MDCT Images

Aim: The present study aimed to analyze whether gender could be determined with the decision tree (DT) method, a machine learning algorithm, based on patellar multidetector computed tomography (MDCT) image measurements. Material and Methods: The study was conducted on 219 male and 131 female MDCT images. The patellar anteroposterior (Ap), craniocaudal (Cc), transverse (Trv) length and volume (Vol), adjusted on the orthogonal plane by the radiologist, were calculated. In patellar length measurements, initially linear discriminant outliers were detected to clear the data for gender prediction. Accuracy (Acc), Sensitivity (Sen), Specificity (Spe), F1-Score (F1) and Matthew’s Correlation Coefficient (Mcc) criteria were taken as the performance criteria for DT. Results: It was determined that male Ap, Trv, Cc, and Vol values were higher when compared to the female values and there was a significant difference between these values based on gender (pAp, Trv, Cc, Vol = 0.000). Using the above-mentioned measurements, it was calculated that the prediction rate for male individuals was 98.2% and for female individuals, it was 98.4%. Conclusion: DT analysis based on patella morphometry provided a simple, adequate and highly accurate approach for gender estimation. Furthermore, it was determined that it would provide an advantage for researchers in gender prediction using only branching and cut-off values on the tree structure without the need to use a computer.

MDCT-Based Radiomics Features for the Differentiation of Serous Borderline Ovarian Tumors and Serous Malignant Ovarian Tumors.

ObjectiveTo investigate whether multidetector computed tomography (MDCT)-based radiomics features can discriminate between serous borderline ovarian tumors (SBOTs) and serous malignant ovarian tumors (SMOTs).Patients and MethodsEighty patients with SBOTs and 102 patients with SMOTs, confirmed by pathology (training set: n = 127; validation set: n = 55) from December 2017 to June 2020, were enrolled in this study. The interclass correlation coefficient (ICC) and least absolute shrinkage and selection operator (LASSO) regression were applied to select radiomics parameters derived from MDCT images on the arterial phase (AP), venous phase (VP), and equilibrium phase (EP). Receiver operating characteristic (ROC) analysis of each selected parameter was carried out. Heat maps were created to illustrate the distribution of the radiomics parameters. Three models incorporating selected radiomics parameters generated by support vector machine (SVM) classifiers in each phase were analyzed by ROC and compared using the DeLong test.ResultsThe most predictive features selected by ICC and LASSO regression between SBOTs and SMOTs included 9 radiomics parameters on AP, VP, and EP each. Three models on AP, VP, and EP incorporating the selected features generated by SVM classifiers produced AUCs of 0.80 (accuracy, 0.75; sensitivity, 0.74; specificity, 0.75), 0.86 (accuracy, 0.78; sensitivity, 0.80; specificity, 0.75), and 0.73 (accuracy, 0.69; sensitivity, 0.71; specificity, 0.67), respectively. There were no significant differences in the AUCs among the three models (AP vs. VP, P = 0.199; AP vs. EP, P = 0.260; VP vs. EP, P = 0.793).ConclusionMDCT-based radiomics features could be used as biomarkers for the differentiation of SBOTs and SMOTs.

Feasibility and adaptation of three-dimensional model for surgical planning and training: A pilot study

Background: Three dimensional (3D) printing can produce accurate anatomical model of any part of the body. This study is based on reconstruction of models of the affected body part for preoperative planning and to see its usefulness in training of resident doctors and for patient education. Methodology: Thirty-five surgically operated patients were retrospectively reviewed and were divided into the conventional planning group (n = 14) and planning with 3D printing group (n = 16). Pathological structures from clinical cases were identified on multidetector computed tomography images and were then transferred to Dicom to print software and saved in a standard format digital imaging and communication in medicine. Segmented regions were combined to create 3D models. Printout of models was taken after being edited by Geomagic free form plus software. Models prepared using 3D printing technology were used to simulate the real surgical operation. The models were used by surgeons for surgical planning and to train their resident doctors. Surgical duration and blood loss were recorded during operation. A questionnaire was provided to the surgeons and residents to assess the utility of 3D models in pre-surgical planning. Results: The mean surgical time in planning with the 3D printing group and conventional planning group was 129.090 ± 36.79 min and 218 ± 94.932 min (P < 0.05). The intraoperative blood loss in planning with 3D printing group and conventional planning group was 130 ± 69.019 ml and (455 ± 44.122 ml) (P < 0.05). Forty subjects completed the survey. Twenty-nine (96.66%) surgeons gave favorable responses (80% found it to be very helpful and 16% helpful) when asked about the utility of these models in the visualization of abnormal pathological anatomy and preoperative planning. Conclusion: Our study suggests that 3D printing technology is useful to aid to surgical planning and provides teaching materials for residents in learning surgery.

WITHDRAWN: Morphometric Analysis of Cavitas Glenoidalis with Multidedector CT.

Ahead of Print article withdrawn by publisher.

CT Findings of Central Airway Lesions Causing Airway Stenosis-Visualization and Quantification: A Pictorial Essay.

The tracheobronchial tree is a system of airways that allows the passage of air to aerate the lungs and entire body. Several pathological conditions can affect this anatomical region. Multidetector CT (MDCT) helps identify and characterize various large airway diseases. Post-processing tools, such as virtual bronchoscopy and automatic lung analysis, can help enhance the performance of imaging studies. In this pictorial essay review, we provide imaging findings of various bronchial lesions manifested as wall thickening and endoluminal nodules on conventional MDCT and advanced image visualization and analysis.

Two-Dimensional Transesophageal Echocardiography Assessment of the Major Aortic Annulus Diameter in Patients Undergoing Transcatheter Aortic Valve Replacement.

Background:Multidetector computed tomography (MDCT) is the gold standard in annulus sizing before transcatheter aortic valve replacement (TAVR). However, MDCT has limited applicability in specific subgroups of patients, such as those with atrial fibrillation and chronic kidney disease. Two-dimensional transesophageal echocardiography (2DTEE) has traditionally been limited to the long-axis measurement of the anteroposterior diameter of the aortic annulus. We describe a new 2DTEE approach for the measurement of the major diameter of the aortic annulus.Methods:Seventy-six patients with symptomatic severe aortic valve stenosis and high surgical risk underwent MDCT and 2DTEE before TAVR. A modified five-chamber view was used to measure the major aortic annulus diameter. This was obtained starting from a mid-esophageal four chamber and retracting the TEE probe up until the left ventricular outflow tract and the left and noncoronary aortic cusps were visualized: major aortic annulus diameter was measured as the distance between their insertion points in systole.Results:Major aortic annulus diameters measured at 2DTEE showed good correlation with MDCT diameter (r = 0.79; P < 0.001) and perimeter (r = 0.87; P < 0.0001). Using factsheet-derived sizing criteria, 2DTEE alone would have allowed accurate sizing in 75% of patients, with 21% of oversizing predominantly with smaller annuli.Conclusions:We describe a new method for 2DTEE measurement of the major aortic annulus diameter; this approach is simple, correlates with MDCT, and allows adequate TAVR sizing in most patients. These findings may help in the assessment of patients with contraindications to or inadequate MDCT images.

Accuracy of maxillofacial prototypes fabricated by different 3-dimensional printing technologies using multi-slice and cone-beam computed tomography.

PurposeThis study aimed to compare the accuracy of 3-dimensional (3D) printed models derived from multidetector computed tomography (MDCT) and cone-beam computed tomography (CBCT) systems with different fields of view (FOVs).Materials and MethodsFive human dry mandibles were used to assess the accuracy of reconstructions of anatomical landmarks, bone defects, and intra-socket dimensions by 3D printers. The measurements were made on dry mandibles using a digital caliper (gold standard). The mandibles then underwent MDCT imaging. In addition, CBCT images were obtained using Cranex 3D and NewTom 3G scanners with 2 different FOVs. The images were transferred to two 3D printers, and the digital light processing (DLP) and fused deposition modeling (FDM) techniques were used to fabricate the 3D models, respectively. The same measurements were also made on the fabricated prototypes. The values measured on the 3D models were compared with the actual values, and the differences were analyzed using the paired t-test.ResultsThe landmarks measured on prototypes fabricated using the FDM and DLP techniques based on all 4 imaging systems showed differences from the gold standard. No significant differences were noted between the FDM and DLP techniques.ConclusionThe 3D printers were reliable systems for maxillofacial reconstruction. In this study, scanners with smaller voxels had the highest precision, and the DLP printer showed higher accuracy in reconstructing the maxillofacial landmarks. It seemed that 3D reconstructions of the anterior region were overestimated, while the reconstructions of intra-socket dimensions and implant holes were slightly underestimated.

Multidetector computed tomography diagnosis of small bowel intussusceptions in adults: observations in a 10-year single-center study.

The etiologies of small bowel intussusception (SBI) in adults are varied. To investigate multidetector computed tomography (MDCT) characteristics in adults with neoplastic and non-neoplastic SBI. Clinical data and MDCT images diagnosed with SBI in adults from January 2010 to May 2020 were retrospectively reviewed. The study included a total of 71 patients. Forty-two patients had a combined total of 55 neoplastic intussusceptions, including 29 patients with benign tumors and 13 patients with malignant tumors. Twenty-nine patients had a combined total of 36 non-neoplastic intussusceptions, of which the condition was idiopathic in 23 patients and cased by non-neoplastic benign lesions in six patients. There were no significant differences in patient age or sex ratio in the neoplastic and non-neoplastic groups. In the non-neoplastic group the intussusceptions were shorter in length (3.6 cm vs. 13.2 cm, P<0.05) and smaller in transverse diameter (2.8 cm vs. 4.2 cm, P<0.05), and less likely to be associated with intestinal obstruction (2 vs. 18, P<0.05). The percentage of patients with multiple intussusceptions was greater in the neoplastic group (10/42, 23.8% vs. 4/29, 13.8%). In the non-neoplastic group only one lead point was detected (in a patient with Meckel's diverticulum), whereas lead points were detected in all 55 intussusceptions in the neoplastic group. There are differences in the clinical and MDCT manifestations of adult neoplastic and non-neoplastic SBIs. Whether a lead point is present or not has implications with regard to deciding on the most appropriate treatment and avoiding unnecessary surgery.

Detecting isolated superior mesenteric artery dissection with computed tomography

Aim: Isolated superior mesenteric artery (SMA) dissection without associated aortic dissection is a rare entity. The aim of the study is to evaluate its incidence, and multidetector computed tomography (MDCT) and computed tomography angiography (CTA) findings, as well as show the clinical importance of this condition, which should be diagnosed and treated urgently. Methods: Images of all patients who underwent contrast enhanced CTA or MDCT scan from July 2017 to July 2020 at our radiology department were examined retrospectively. A total of 600 CTA and 14000 contrast enhanced MDCT scans (14600 CT) were evaluated. Only the cases with isolated SMA dissections without aortic involvement, who had arterial phases on contrast enhanced MDCT images, were included. Aortic dissection cases with SMA involvement, and non-contrast MDCT images were excluded. Age, gender, symptoms, presence of thrombosis or bowel ischemia were noted. Average extension of dissection and distance from origin were measured. Results: Ten patients (7 M, 3 F), aged between 48-66 years (mean: 57 years), had isolated SMA dissection. The mean distance of dissection from origin and mean extension were 1.9 cm and 3.4 cm, respectively. Patients were treated with conservative anticoagulation therapy. Follow-up CTA or MDCT showed normal SMA without evidence of dissection in 5 patients, decreased extension and length of dissection in 3 patients and no significant difference in 2 patients. Conclusion: Isolated SMA dissection is a rare but important cause of abdominal pain. Early diagnosis allows correct treatment. CT is a useful noninvasive method for diagnosis and anticoagulation therapy is successful.

Three-dimensional modelling and morphometric investigation of computed tomography images of brown bear's (Ursus arctos) ossa cruris (Zeugopodium).

This study was aimed to examine the detailed morphometrical and morphological characteristics of the bone by creating three-dimensional images through multidetector computed tomography images of ossa cruris in brown bears. Four brown bear ossa cruris were used in the study. It was observed that tibia and fibula articulated at proximal and distal epiphysis and they combined, and ossa cruris were shaped in this way. Cochlea tibiae were determined to be sagittally oriented. The length of the tibia was determined to be 268.97 mm and 266.32 mm at right and left sides, respectively. The length of the fibula was determined to be 249.16 mm and 250.19 mm on average at the right and left sides, respectively. In consequence of the correlation analysis, statistical relationships at different rates were detected between the measured values. Detailed anatomical examinations are very important in terms of determining the similarities and differences of bear bones with those of the other species in the order Carnivora. Therefore, it is thought that this study will reveal detailed characteristics of ossa cruris of bears and provide data for further studies on archaeological and forensic sciences.

Prediction of bowel obstruction caused by obturator hernia using risk factor categories on clinical characteristics and multidetectorcomputed tomographic findings.

To detect risk factors on clinical characteristics and multidetectorcomputed tomographic (MDCT) findings for predicting bowel obstruction in patients with obturator hernia. We retrospectively reviewed 47 patients who had an obturator hernia diagnosed by MDCT and/or surgery. The patients were divided into obstruction and non-obstruction group based on the presence or absence of bowel obstruction on MDCT images. Uni- and multivariate analyses were performed to identify risk factors for predicting bowel obstruction. There were 26 patients (55.32%) in the obstruction group and 21 patients (44.68%) in the non-obstruction group. Patients in the obstruction group were older (P = 0.002) and had more women (P = 0.033) and lower body mass index (BMI) (P = 0.0001) than patients in the non-obstruction group. The non-obstruction group suffered fewer bowel obstruction symptoms (P = 0.0001), Howship-Romberg (HR) sign (P = 0.012), deaths (P = 0.008) and major postoperative complications (P = 0.047). The hernia sac in the obstruction group had greater mean major diameter (P = 0.0001) and volume (P = 0.001) than those in the non-obstruction group. Multivariate analysis showed that age [odds ratio (OR) 1.18, 95% confidence interval (CI) 1.00-1.39, P = 0.046] and major diameter of hernia sac (OR 68.17, 95% CI 4.52-1027.70, P = 0.002) were independent risk factors associated with bowel obstruction in patients with obturator hernia. Patient's age and major diameter of hernia sac are independent risk factors resulting in bowel obstruction in patients with obturator hernia. Obturator hernia repair before bowel obstruction development may result in better outcomes and fewer postoperative complications.

Evaluation of portal vein variations in multidetector CT

Aim: It is important for surgeons to have a comprehensive knowledge of vascular anatomy when performing liver interventions. For example, liver transplantation requires a vast understanding of vascular anatomy and variations. This study aimed to evaluate the intrahepatic branching pattern of the portal vein to find out unknown variations. Methods: Multidetector computed tomography images of the abdomen region were used from the PACS archives of Selcuk University Medical Faculty Hospital. Images of 838 patients (464 females and 374 males) who had no hepatic pathologies were examined. Images were evaluated in terms of the presence of variations, and the cases were divided into groups, all of which were compared in terms of gender. Results: A previously unknown variation of the portal vein was detected in 4.9% of the patients: The left portal vein curved reversely after its origination from the main portal vein, supplying liver segments II and IV, after which it branched to supply segment III. In addition, four types of previously known variations of the portal vein were detected. Normal anatomic branching of portal vein was detected in 82.6% of the patients. Conclusion: A previously unknown variation was detected. Awareness of this variation and other known variations is significant in hepatic transplantation, surgery, and interventions.

Recovery of Renal Function following Kidney-Specific VEGF Therapy in Experimental Renovascular Disease

Background: Chronic renovascular disease (RVD) can lead to a progressive loss of renal function, and current treatments are inefficient. We designed a fusion of vascular endothelial growth factor (VEGF) conjugated to an elastin-like polypeptide (ELP) carrier protein with an N-terminal kidney-targeting peptide (KTP). We tested the hypothesis that KTP-ELP-VEGF therapy will effectively recover renal function with an improved targeting profile. Further, we aimed to elucidate potential mechanisms driving renal recovery. Methods: Unilateral RVD was induced in 14 pigs. Six weeks later, renal blood flow (RBF) and glomerular filtration rate (GFR) were quantified by multidetector CT imaging. Pigs then received a single intrarenal injection of KTP-ELP-VEGF or vehicle. CT quantification of renal hemodynamics was repeated 4 weeks later, and then pigs were euthanized. Ex vivo renal microvascular (MV) density and media-to-lumen ratio, macrophage infiltration, and fibrosis were quantified. In parallel, THP-1 human monocytes were differentiated into naïve macrophages (M0) or inflammatory macrophages (M1) and incubated with VEGF, KTP-ELP, KTP-ELP-VEGF, or control media. The mRNA expression of macrophage polarization and angiogenic markers was quantified (qPCR). Results: Intrarenal KTP-ELP-VEGF improved RBF, GFR, and MV density and attenuated MV media-to-lumen ratio and renal fibrosis compared to placebo, accompanied by augmented renal M2 macrophages. In vitro, exposure to VEGF/KTP-ELP-VEGF shifted M0 macrophages to a proangiogenic M2 phenotype while M1s were nonresponsive to VEGF treatment. Conclusions: Our results support the efficacy of a new renal-specific biologic construct in recovering renal function and suggest that VEGF may directly influence macrophage phenotype as a possible mechanism to improve MV integrity and function in the stenotic kidney.

Association of Bioprosthetic Aortic Valve Leaflet Calcification on Hemodynamic and Clinical Outcomes

BackgroundThe prognostic value of aortic valve calcification (AVC) measured by using multidetector computed tomography imaging has been well validated in native aortic stenosis, and sex-specific thresholds have been proposed. However, few data are available regarding the impact of leaflet calcification on outcomes after biological aortic valve replacement (AVR). ObjectivesThe goal of this study was to analyze the association of quantitative bioprosthetic leaflet AVC with hemodynamic and clinical outcomes, as well as its possible interaction with sex. MethodsFrom 2008 to 2010, a total of 204 patients were prospectively enrolled with a median of 7.0 years (interquartile range: 5.1 to 9.2 years) after biological surgical AVR. AVC measured by using the Agatston method was indexed to the cross-sectional area of aortic annulus measured by echocardiography to calculate the AVC density (AVCd). Presence of hemodynamic valve deterioration (HVD; increase in mean gradient [MG] ≥10 mm Hg and/or increase in transprosthetic regurgitation ≥1) was assessed by echocardiography in 137 patients at the 3-year follow-up. The primary clinical endpoint was mortality or aortic valve re-intervention. ResultsThere was no significant sex-related difference in the relationship between bioprosthetic AVCd and the progression of MG. Baseline AVCd showed an independent association with HVD at 3 years. During follow-up, there were 134 (65.7%) deaths (n = 100) or valve re-interventions (n = 47). AVCd ≥58 AU/cm2 was independently associated with an increased risk of mortality or aortic valve re-intervention (adjusted hazard ratio: 2.23; 95% confidence interval: 1.44 to 3.35; p < 0.001). The AVCd threshold combined with an MG progression threshold of 10 mm Hg amplified the stratification of patients at risk (log-rank, p < 0.001). The addition of AVCd threshold into the prediction model including traditional risk factors improved outcome prediction (net classification improvement: 0.25, p = 0.04; likelihood ratio test, p < 0.001). ConclusionsAortic bioprosthetic leaflet calcification is strongly and independently associated with HVD and the risk of death or aortic valve re-intervention. As opposed to native aortic stenosis, there is no sex-related differences in the relationship between AVCd and hemodynamic or clinical outcomes.

Opportunistic osteoporosis screening in multi-detector CT images using deep convolutional neural networks.

To explore the application of deep learning in patients with primary osteoporosis, and to develop a fully automatic method based on deep convolutional neural network (DCNN) for vertebral body segmentation and bone mineral density (BMD) calculation in CT images. A total of 1449 patients were used for experiments and analysis in this retrospective study, who underwent spinal or abdominal CT scans for other indications between March 2018 and May 2020. All data was gathered from three different CT vendors. Among them, 586 cases were used for training, and other 863 cases were used for testing. A fully convolutional neural network, called U-Net, was employed for automated vertebral body segmentation. The manually sketched region of vertebral body was used as the ground truth for comparison. A convolutional neural network, called DenseNet-121, was applied for BMD calculation. The values post-processed by quantitative computed tomography (QCT) were identified as the standards for analysis. Based on the diversity of CT vendors, all testing cases were split into three testing cohorts: Test set 1 (n = 463), test set 2 (n = 200), and test set 3 (n = 200). Automated segmentation correlated well with manual segmentation regarding four lumbar vertebral bodies (L1-L4): the minimum average dice coefficients for three testing sets were 0.823, 0.786, and 0.782, respectively. For testing sets from different vendors, the average BMDs calculated by automated regression showed high correlation (r > 0.98) and agreement with those derived from QCT. A deep learning-based method could achieve fully automatic identification of osteoporosis, osteopenia, and normal bone mineral density in CT images. • Deep learning can perform accurate fully automated segmentation of lumbar vertebral body in CT images. • The average BMDs obtained by deep learning highly correlates with ones derived from QCT. • The deep learning-based method could be helpful for clinicians in opportunistic osteoporosis screening in spinal or abdominal CT scans.

Preoperative multidetector computed tomography for isolated surgical aortic valve replacement: Planning for future transcatheter options.

Valve-in-valve (ViV) transcatheter aortic valve replacement (TAVR) has become a valuable option in patients with bioprosthetic failure. However, potential issues with ViV TAVR may occur in patients with high-risk anatomy for coronary obstruction and patients with baseline smaller bioprosthetic valves at risk for patient prosthesis mismatch. The purpose of this study was, therefore, to use preoperative electrocardiography-gated, multidetector computed tomography (MDCT) in patients undergoing isolated surgical aortic valve replacement (SAVR) to (1) identify which would be high risk for coronary occlusion with ViV TAVR, and (2) predict intraoperative SAVR sizing. Among 223 patients from our institutions' database that underwent SAVR for aortic insufficiency (AI) or aortic stenosis (AS) between January 2012 and January 2020, 48 patients had MDCT imaging before surgery (AI; n = 31, AS; n = 17). Of all patients, 67% (n = 32) were bicuspid morphology. With the use of virtual valve implantation, all patients with AI and bicuspid AS had feasible anatomy for ViV TAVR, while 38% of patients with tricuspid AS were high risk for coronary obstruction. There was a strong correlation between actual valve size implanted and preoperative MDCT measurements using annulus average diameter, area, and/or perimeter. Preoperative MDCT in patients undergoing SAVR is a useful tool for lifetime management, particularly in patients with tricuspid AS. Decisions for surgical management may change based on MDCT's ability to predict intraoperative SAVR size and determine which patients may be high-risk candidates for future ViV TAVR due to coronary artery obstruction.

Evaluating incidence and clinical importance of renal vein anomalies with routine abdominal multidetector computed tomography.

Renal vein anomalies are usually asymptomatic embryological developmental disorders. If unidentified, they can lead to significant morbidity during surgical explorations. This study aims to evaluate the type, frequency, clinical importance of renal vein anomalies in patients scanned with Multidetector Computed Tomography (MDCT). It was also investigated whether renal vein anomalies are associated with malignancies or their types. Abdominal MDCT images of 8517 patients were examined retrospectively. Renal vein anomaly types, gender, age, and symptoms were recorded. Renal vein anomalies were divided into three subgroups as retroaortic left renal vein (RLRV), circumaortic left renal vein (CLRV), and double right renal vein (DRRV). The presence of malignancy and their types in patients with renal vein anomalies were noted. Malignancies were divided into five subgroups as lung, gastrointestinal system (GIS), genitourinary system, breast, and others. 156 patients had renal vein anomaly (1.8%). The prevalence of RLRV, CLRV, and DRRV were 1.1%, 0.3%, and 0.2%, respectively. Renal vein anomalies were more frequent in females. Malignancy was present in 89 (57.1%) out of 156 renal vein anomaly patients. Among these 89 patients, RLRV was found in 52 (58.4%), CLRV in 22 (24.7%), and DRRV in 15 (16.8%) patients. The presence of malignancy was present in more than half of the renal vein anomaly patients but there was no significant correlation (p = 0.1). This high ratio is probably due to the high number of cancer patients undergoing CT scan in our radiology department. Renal vein anomalies are rare conditions, however, coexistence of renal vein anomalies and malignancies is not. An awareness of this entity before retroperitoneal surgeries is very important in order to avoid complications such as hemorrhage, transfusion, death, or conversion to open surgery.

3D cone-beam CT with a twin robotic x-ray system in elbow imaging: comparison of image quality to high-resolution multidetector CT

BackgroundElbow imaging is challenging with conventional multidetector computed tomography (MDCT), while cone-beam CT (CBCT) provides superior options. We compared intra-individually CBCT versus MDCT image quality in cadaveric elbows.MethodsA twin robotic x-ray system with new CBCT mode and a high-resolution clinical MDCT were compared in 16 cadaveric elbows. Both systems were operated with a dedicated low-dose (LD) protocol (equivalent volume CT dose index [CTDIvol(16 cm)] = 3.3 mGy) and a regular clinical scan dose (RD) protocol (CTDIvol(16 cm) = 13.8 mGy). Image quality was evaluated by two radiologists (R1 and R2) on a seven-point Likert scale, and estimation of signal intensity in cancellous bone was conducted. Wilcoxon signed-rank tests and intraclass correlation coefficient (ICC) statistics were used.ResultsThe CBCT prototype provided superior subjective image quality compared to MDCT scans (for RD, p ≤ 0.004; for LD, p ≤ 0.001). Image quality was rated very good or excellent in 100% of the cases by both readers for RD CBCT, 100% (R1) and 93.8% (R2) for LD CBCT, 62.6% and 43.8% for RD MDCT, and 0.0% and 0.0% for LD MDCT. Single-measure ICC was 0.95 (95% confidence interval 0.91–0.97; p < 0.001). Software-based assessment supported subjective findings with less “undecided” pixels in CBCT than dose-equivalent MDCT (p < 0.001). No significant difference was found between LD CBCT and RD MDCT.ConclusionsIn cadaveric elbow studies, the tested cone-beam CT prototype delivered superior image quality compared to high-end multidetector CT and showed a potential for considerable dose reduction.

Virtual endoluminal aortic root views determined at coronary CT angiography - an important tool for improving anomalous coronary artery visualization and surgical planning.

Anomalous origin of the coronary arteries, though uncommon, is of great clinical concern. It can be the cause of sudden cardiac death and abnormal cardiac hemodynamics. Advances in electrocardiographically (ECG)-gated multi-detector CT have increased diagnostic accuracy in detecting anomalous origin of coronary arteries and their interarterial and intramural courses. Recent advances in multi-detector CT image processing software have allowed the creation of virtual endoluminal views of the aortic root and improved assessment of the intramural course (the length and relationship to the intercoronary commissure) of the coronary artery, which is of considerable surgical importance. We review our experience with virtual endoluminal imaging in our first 19 cases of interarterial coronary artery anomalies (17 cases of interarterial with intramural segment and 2 cases of purely interarterial course) diagnosed preoperatively and proven surgically.