Multidetector Computed Tomography Research Articles

Forensic age estimation in adults based on multidetector computed tomography analysis of bone density in the medial meta-epiphyseal region of clavicle.

The aim of this study was to investigate the potential of using multidetector computed tomography (MDCT) to measure the bone mineral density (BMD) in the medial meta-epiphyseal region of clavicle (MERC) for adult age estimation. A total of 1064 chest MDCT scans from individuals aged 21 to 102years were utilized to determine the MERC BMD. The Mimics software was used for the BMD measurements, and the average BMD of both MERC was also calculated. Regression analysis was conducted with chronological age as a dependent variable and MERC BMD as an independent variable to establish a mathematical model for age estimation. The mean absolute error (MAE) was calculated to evaluate the accuracy of the regression model using an independent validation sample. Among all the models, the cubic regression model showed the highest correlation between MERC BMD and chronological age and also provided the most accurate age prediction for both males and females (MAE = 9.41 for males, MAE = 10.38 for females). Our study suggests that BMD measured by MERC can be utilized for age estimation in adults when more reliable indicators are not available.

Empiric embolization by vasospasm therapy for acute lower gastrointestinal bleeding: a preliminary report

To report the preliminary result of empiric embolization for angiographycally-negative lower gastrointestinal bleeding (LGIB) by using the pharmaco-induced vasospasm technique with or without the adjunctive use of intra-arterial multi-detector computed tomography (MDCT). 23 LGIB patients with positive MDCT findings but negative angiographic results underwent empiric pharmaco-induced vasospasm therapy. The presumed bleeding artery was semi-selectively catheterized, and a segment of bowel was temporarily spasmed with bolus injection of epinephrine and immediately followed by 4-h’ vasopressin infusion. The rebleeding, primary and overall clinical success rates were reported. MDCT showed 19 bleeders in the SMA territory and 4 bleeders in the IMA territory. Early rebleeding was found in 6 patients (26.1%): 2 local rebleeding, 3 from new-foci bleeding and 1 uncertain. Of the 10 small bowel bleeding patients, only 1 out of the 7 who underwent intra-arterial MDCT showed rebleeding, whereas 2 out of the 3 without intra-arterial MDCT rebled. No patients exhibited procedure-related major complications, including bowel ischemia and cardiopulmonary distress. The overall clinical success rate was 91.3% (21/23) with a 30-day mortality rate of 26.1% (2 of the 6 patients had early rebleeding). Empiric pharmaco-induced vasospasm therapy, when localized with/without adjunctive intra-arterial MDCT, seems to be a safe and effective method to treat angiographically-negative LGIB patients.

Elucidating the mechanism of rapid functional recovery following atrial fibrillation ablation in patients with left ventricular systolic dysfunction

Abstract Introduction Successful sinus rhythm restoration by catheter ablation (CA) of atrial fibrillation (AF) rapidly improves cardiac function in patients with left ventricular (LV) systolic dysfunction. However, the underlying mechanism of this recovery remains unknown. Purpose To elucidate the mechanism of the functional recovery after CA of AF and systolic dysfunction. Methods We retrospectively examined 4001 consecutive patients who underwent first-time CA of AF between 2012 and 2021 at our institution. Of them, 505 patients had baseline LV ejection fraction (LVEF) of <50%. Among them, we enrolled 454 patients who received electrocardiogram-gated contrast-enhanced 256-slice multi-detector computed tomography (MDCT) (Brilliance iCT, Philips Medical Systems, Cleveland, Ohio) both at baseline and 3 months after CA. Changes in LV measures, wall thickness, and LV mass were examined based on MDCT data. Results A reduction of LV end-systolic volume (LVESV) (from 71 ± 37 ml to 46 ± 34 ml, p <0.001) and improvement of LVEF (from 39 ± 9% to 62 ± 14%, p <0.001) were observed after CA. However, there was no significant change in LV end-diastolic volume (LVEDV) (from 118 ± 49 ml to 116 ± 46 ml, p = 0.13). Mean wall thickness during diastole did not change (from 7.1 ± 1.4 mm to 7.1 ± 1.4 mm, p = 0.94), either. However, wall thickness during systole significantly changed after CA (from 10.0 ± 1.7 mm to 12.7 ± 2.8 mm, p <0.001). As a result, there was no significant change in LV mass after CA (from 84.3 ± 28.7 g to 84.4 ± 28.1 g, p = 0.88). A regression analysis revealed a significant inverse correlation between the delta LVEF and delta LVESV (r = -0.59, p <0.001). However, the delta LVEF was not correlated with the delta LVEDV and delta LV mass. Conclusions The rapid improvement of LVEF after CA of AF was attributed to a decrease in the LVESV. Unchanged LV mass indicated that this functional recovery was solely a mechanical issue, without evidence of myocyte regression.

Impact of waist circumference and abdominal fat distribution on coronary artery disease severity stratified by computed tomography-derived SYNTAX score

Abstract Background Waist circumference (WC) is the most convenient anthropometric measure of obesity. Recently, abdominal fat distribution (AFD) has been identified as a more important risk factor for coronary artery disease (CAD) than the absolute amount of adipose tissue. However, studies examining the impact of body composition indicators (BCIs) on CAD severity are lacking. The computed tomography (CT)-derived SYNTAX score (CT-SXscore) is a feasible method for grading CAD severity based on coronary CT angiography (CTA) findings. Purpose This study was aimed to evaluate the association between BCI and CAD severity using the CT-SXscore. Methods We enrolled consecutive patients with suspected CAD who underwent CTA using a 320-row multidetector CT scanner between October 2014 and March 2020. Plain abdominal CT was also performed at the umbilical level to measure the visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) areas. The total adipose tissue (TAT) area was calculated as the sum of VAT and SAT. To assess the AFD, the VAT/SAT (V/S) ratios were also calculated as the VAT area divided by the SAT area in each case. WC was measured by tracing the body contour at the umbilical level in CT images. The severity of coronary artery stenosis was assessed using CTA. Significant stenosis was defined as a stenosis diameter of ≥50%. The CT-SXscore was calculated in patients with more than one significant stenoses. Each stenotic lesion was evaluated to calculate the CT-SXscore in the same manner as the invasive coronary angiography assessment. We assessed the effects of BCI [i.e., WC, body mass index (BMI), each adipose tissue area, and V/S ratios] on the CT-SXscores. Results 308 eligible patients (mean age, 70.9 ± 10.6 years; 69.5% males) were evaluated. The median values of WC, BMI, TAT, SAT, VAT, and V/S ratio were 84.8 cm, 23.6 kg/m2, 198.2 cm2, 111.8 cm2, 81.0 cm2, and 0.67, respectively. Although WC showed a significant correlation with BMI, TAT, SAT, and VAT area, no correlation was observed between WC and V/S ratio (Figure1). The CT-SXscore showed no association with WC, BMI, and TAT area; however, it exhibited a weak negative correlation with the SAT area and a weak positive correlation with the VAT area. Additionally, a strong correlation was observed between the CT-SXscore and V/S ratio. In the multivariate regression analysis, WC, BMI, TAT, SAT, and VAT were no longer associated with the CT-SXscore after adjusting for traditional coronary risk factors, whereas the V/S ratio remained as the only independent predictor of CAD severity based on the CT-SXscore (Figure2). Conclusions WC was strongly correlated with other BCIs, except for the V/S ratio; however, it could not be identified as a predictive factor of CAD severity. Among the BCIs, only the V/S ratio was an independent predictor of CAD severity, indicating that the AFD revealed by the V/S ratio may be a more important risk factor for progression of CAD than other BCIs.Figure1Figure2

CCTA and CTP imaging for detecting clinically suspected in-stent restenosis: a meta-analysis

Abstract Background The evaluation of coronary artery stents via Coronary Computed Tomography Angiography (CCTA) can be compromised by artefacts, potentially undermining its diagnostic accuracy. The integration of CT Perfusion (CTP) with CCTA (CCTA+CTP) has been proposed to enhance the diagnostic yield in detecting in-stent restenosis (ISR). Purpose This meta-analysis aims to assess the diagnostic performance of CCTA and combined CCTA+CTP in detecting ISR. Methods A comprehensive literature search of studies from 2005 to 2022 identified 13,747 articles. Inclusion criteria comprised the utilization of multidetector CT scanners with ≥64 slices and invasive coronary angiography as the reference standard. Studies that systematically evaluated stent patency in asymptomatic patients as part of their protocol were excluded. Results After removing duplicates, screening titles and abstracts, and conducting full-text reviews, 20 studies met the inclusion criteria (17 CCTA, 3 CCTA+CTP). Data on 2,674 CCTA-assessed stents and 752 CCTA+CTP-assessed stents were analyzed. The meta-analysis revealed that CCTA alone achieved a sensitivity of 90% (95% CI; 84-94%) and a specificity of 89% (95% CI; 86-92%)(Figure 1). CCTA+CTP exhibited comparable diagnostic performance, with a per-stent sensitivity of 88% (95% CI; 80-94%) and a specificity of 88% (95% CI; 84-93%) (Figure 2). The summary Receiver Operating Characteristic (sROC) Area Under the Curve (AUC) was 0.96 (95% CI; 0.94-0.97) for CCTA and 0.96 (95% CI; 0.89-1.00) for CCTA+CTP, indicating a high overall performance for both diagnostic modalities. Conclusion Utilizing contemporary imaging hardware, both CCTA and CCTA+CTP demonstrate high diagnostic performance in evaluating ISR. The findings suggest that the presence of coronary artery stents should not preclude the use of these non-invasive diagnostic tests in clinical practice.Figure 1Figure 2

Analysis of imaging features and clinical manifestations in children with congenital rib deformities: a retrospective study

BackgroundCongenital rib deformity is a common thoracic deformity that has a potentially far-reaching impact on the growth and lung function development of young children. Early diagnosis and accurate assessment of congenital rib deformity is of great importance. This study was to retrospectively analyze the number, location, and types of deformities, imaging features as well as clinical symptoms of children with congenital rib deformities.MethodsChildren who were diagnosed with congenital rib deformities between October 2019 and October 2021 in our hospital were included in this study. The rib deformities were analyzed according to the imaging results of chest X-ray and 3D volume rendering multidetector computed tomography (MDCT). The data were analyzed using SPSS 22.0.ResultsA total of 472 male and 186 female children with rib deformities were detected in this study, with a male to female ratio of approximately 2.54:1. Of the deformed ribs, 417 (63.4%) were located on the right side, usually single and unilateral. The most common type of the detected rib deformity were bifid ribs (95.14%). Rib deformity was most common in the fourth rib (46.62%). The majority (76.16%, n = 428) of rib deformities were incidental findings and asymptomatic.ConclusionsCongenital rib deformities in pediatric patients included in our hospital were more frequently observed in males than females, more frequently detected on the right than on the left side. The most common type of rib deformity is the bifid rib. MDCT examination are of great value in the diagnosis of rib deformity and can help guide clinical treatment.

Comparative Assessment of Aortic Annulus Diameters between 3D Transesophageal Echocardiography and Cardiac MDCT in Patient with Sclerocalcific Aortic Stenosis

Comparative Assessment of Aortic Annulus Diameters between 3D Transesophageal Echocardiography and Cardiac MDCT in Patient with Sclerocalcific Aortic Stenosis

Cone-beam CT volumetry: a new method for evaluating osteotomy healing - a clinical evaluation and MDCT comparison.

Fracture healing complications remain a major problem in trauma monitoring. An open wedge osteotomy of the distal radius provides a unique way of evaluating fracture healing. Since the introduction of cone-beam computed tomography (CBCT) at our institution, it has become the method of choice for assessing hand and wrist bones. To date, CT volumetry has been validated for multidetector CT (MDCT) but not for CBCT. To assess osteotomy healing using CBCT volumetry and to evaluate two different segmentation techniques. A total of 36 patients were surgically treated for malunited distal radius fractures with open-wedge osteotomy either leaving the void empty (open wedge empty [OWE]) or filled with bone graft substitutes (BGS). They were scanned using CBCT and MDCT postoperatively and after 3, 6, and 12 months. Segmentation was performed both manually and semi-automatically for volumetric measurement. Inter- and intra-observer reliability were assessed using intraclass correlation (ICC). The median osteotomy volume in the OWE group postoperatively was 0.87 cm3 (range=0.42-2.72). At 3 months, all but one of the OWE volumes had diminished to half or less of their initial volume. In the BGS group, the median postoperative volume was 1.30 cm3 (range=0.73-1.81) and at 12 months, 76% of the initial volume remained. Reliability between CBCT and MDCT volumetry expressed as ICC was ≥0.96. ICC for the two segmentation techniques was ≥0.99 and ICC for inter-observer reliability ≥0.97. CBCT volumetry is a reliable tool and comparable to MDCT to quantify bone healing of an osteotomy.

Puffed-Cheek CT Improved Evaluation of Buccal Mucosal Neoplasm in Contest to Conventional CT Scan

Background: Oral cancer is a frequent cancer in our country, most people are affected by this cancer are older age. Accurate evaluation of this cancer difficult due to close proximity of bones and soft tissue. So for improve diagnostic accuracy Puffed cheek maneuver should be used with traditional Multidetector Computed Tomography (MDCT).Objective: To determine the improved diagnostic accuracy of Puffed cheek Computed Tomography (PCCT) in evaluation of buccal mucosa tumors in contest to non puffed cheek Computed Tomography.Materials and Methods: This descriptive cross sectional study was carried out in Radiology and Imaging department of Khwaja Yunus Ali Medical College and Hospital from 2022(January) to 2023(July). Cases were referred from different department. After meeting the inclusion criteria patients were subjected for CT scan. Imaging was performed from paranasal sinus and neck region with axial sections from pituitary fossa to arch of aorta, after injection of intravenous iodinated contrast media, multiplanar sagittal, coronal reformation images were obtained. Puffed cheek manoeuvre was performed to separate gingival and oral buccal mucosa in all the cases for improved detailed evaluation. The CT result were then compared with non puffed cheek scans results. Results: Among 30 patients 7 cases were missed by conventional CT scan, thirteen patients showed a mass in the oral cavity that were inseparable from 2 mucosal surfaces. Puffed-cheek images clearly showed the mass and surface of tumor involvement. Other 10 patients in conventional CT showed mass in the margins of tongue, oral cavity but extension and infiltration of surrounding structures by the lesion could not be well delineated, puffed-cheek images clearly showed the specific location, extension, adjacent muscles and other structures infiltration. Conclusion: Puffed cheek CT gives better performance to diagnosis the small buccal mucosal tumors, any irregularity, thickening, more detailing of mucosal surface of oral cavity than conventional CT scan, so can helps in choosing the management & surgical approach also. KYAMC Journal Volume: 15, No: 01, April 2024: 29-32.

Diagnostic Performance of Computed Tomography in Laryngeal Carcinoma and its Extension

Background: Laryngeal carcinoma is a common malignant neoplasm of the head and neck with high incidence of new malignancies worldwide every year. Several imaging techniques including magnetic resonance imaging (MRI) and computed tomography (CT) scans are widely used to detect laryngeal carcinoma. Of them, CT scan is relatively cheaper, easily available and sensitive in the evaluation of laryngeal carcinoma. Objective: To find out the diagnostic performance of CT scan in laryngeal carcinoma and its extensions. Methodology: This cross-sectional study was carried out in the department of Radiology and Imaging, Dhaka Medical CollegeHospital, Dhaka, during the period of July, 2016 to June, 2018 for a period of 2(two) years. A total of 50 samples were included purposively. The enrolled patients were attending outpatient department (OPD) or admitted in indoor and referred to the Radiology and Imaging department for CT scan. All the enrolled cases had laryngectomy and resected tissues were sent for histopathological examination. Data collection was done by the principal investigator and a preformed questionnaire was used during data collection. Following completion of data collection, it was analyzed by SPSS 20.0. Results: Age range of the patients was from 18 to 84 years, with the mean age of 61.2 years + 13.4 years standard deviation and a male-female ratio of about 7.3:1. By multidetector CT scan, majority (32, 64.00%) of the tumours were found confined in a specific area with no extension, followed by 12 (24.00%) involving both supraglottic and glottic region. On the other hand, by histopathology, almost all (47, 94.00%) of the cases were found malignant and majority of the malignant cases (31, 65.96%) were found without nodal metastasis. Validity tests of CT in the diagnosis of laryngeal carcinoma revealed sensitivity, specificity, accuracy and positive predictive values of 97.9%, 66.7%, 96% and 97.9% respectively. In case of nodal metastases, the sensitivity, specificity, accuracy and positive predictive value were 93.8%, 97%, 96% and 93.8% respectively. Conclusion: Contrast enhanced CT scan has good role in detecting nodal metastases, but had complementary role in detecting laryngeal carcinoma. Journal of Monno Medical College December, 2023; 9 (2): 63-67

Anthropological and forensic significance of facial soft tissue thickness in Montenegrin population

A lack of soft tissue leads to difficulties in facial reconstruction and further identification in the absence of DNA (deoxyribonucleic acid), finger print and dental data. If these data are not available, then identification based on facial soft tissue thickness (FSTT) is the next reliable method. There is no data in the literature about facial soft tissue thickness in Montenegrin population. Once the measurement is performed, a software algorithm based on the multidetector computerized tomography (MDCT) imaged bone structures and use of FSTT would be able to provide a useful picture of the face for identification purposes. This prospective research was performed by MDCT head examinations of 83 adults aged 18–85, living in Montenegro. The FSTT was measured at eight central points (glabella (GL), nasion (NA), rhinion (RHI), mid-philtrum (MID), upper lip (UL), lower lip (LL), mental eminence (ME), and the point beneath the chin (BC)), and five bilateral points (frontal tubers (FT), supraorbital (SO), external orbital marginal point (EX), zygomatic arch (ZY), and middle masseter (MST)). It was observed that the points RHI, MID, UL, LL, ME, FT, SO and MST are thicker in men compared to women. With an increase in BMI, FSTT in the central points also increases, as well as bilaterally at the ZY, FT, SO and MST points. With aging, there is an increase of the thickness of the FSTT at the RHI and bilaterally at the EX and ZY, while at the MID, LL and MST, the thickness decreases with aging, in both sexes.

Pixel to Pathology: A Prospective Cross-Sectional Study on the Role of Multidetector Computed Tomography in the Evaluation of Malignant Large Bowel Lesions With Histopathological Correlation

Pixel to Pathology: A Prospective Cross-Sectional Study on the Role of Multidetector Computed Tomography in the Evaluation of Malignant Large Bowel Lesions With Histopathological Correlation

Role of Multi-Detector Computed Tomography in Evaluating Traumatic Brain Injuries in Taif City, Kingdom of Saudi Arabia

Background: Traumatic brain injury (TBI) represents a major percentage of admissions to hospital due to frequent trauma to this region and is considered a life-threatening situation because of that, MDCT is necessary to provide rapid diagnosis and best management that leads to successful treatment. Multi-detector Computed Tomography (MDCT) has a critical and significant rule for early evaluation and patient triage. Aim: This study aimed to evaluate the findings that occur due to head injuries using MDCT. Material and Method: An analytical retrospective study of 200 patients with head injuries were examined by CT, the study extended from January 2024 to September 2024. 128 slice CT systems (Siemens Medical system) were applied to investigate patients with head trauma at King Abdul-Aziz Specialist Hospital (KAASH )in Ta'if City, Saudi Arabia. Results: A total of 200 head trauma 136 (68%) males and 64(32%) females, were examined via head CT and presented with various types of trauma. The findings have noticed that brain injuries were significantly higher in the male population (68%) than in the female population (32%). Based on age groups, the incidence percentage of TBI was 34%, occurring in the age group 18-27 years. The most common cause of injury in patients presenting with head trauma was road traffic accidents, comprising 63% of cases. The isolated skull fracture was most frequently seen 35% of cases. Our study reveals that Subdural hematoma (52%) was the most frequent lesion noted in traumatic patients. Conclusion: Non-enhanced computed tomography( NECT) is considered the gold standard and the most informative diagnostic modality in the evaluation of Traumatic brain injuries and it is essentially to triage patients to observation, surgical, or medical management.

Evolving capabilities of computed tomography imaging for transcatheter valvular heart interventions - new opportunities for precision medicine.

The last decade has witnessed a substantial growth in percutaneous treatment options for heart valve disease. The development in these innovative therapies has been mirrored by advances in multi-detector computed tomography (MDCT). MDCT plays a central role in obtaining detailed pre-procedural anatomical information, helping to inform clinical decisions surrounding procedural planning, improve clinical outcomes and prevent potential complications. Improvements in MDCT image acquisition and processing techniques have led to increased application of advanced analytics in routine clinical care. Workflow implementation of patient-specific computational modeling, fluid dynamics, 3D printing, extended reality, extracellular volume mapping and artificial intelligence are shaping the landscape for delivering patient-specific care. This review will provide an insight of key innovations in the field of MDCT for planning transcatheter heart valve interventions.

Reliability assessment of craniofacial and airway measurements: a comparative study between multidetector computed tomography and cone-beam computed tomography.

To compare the intra- and inter-examiner reliability of multidetector computed tomography (MDCT) and cone-beam computed tomography (CBCT) using Amira and Dolphin software analyses for craniofacial/airway measurements by six examiners. Five adults and one dry skull with CBCT and MDCT scan files were duplicated and randomly numbered. Six orthodontic residents imported these files into two software programs, oriented the images, set thresholds, and performed 26 measurements. Intra- and inter-examiner reliabilities were determined by using intraclass correlation coefficient (ICC) and presented with scatterplots. Variables including anterior nasal width, posterior nasal width, frontomaxillary suture right-to-left, inner nasal contour point right-to-left, and minimum cross-sectional area in the oropharynx showed "moderate" to "substantial" intra- or inter-examiner agreement. Amira provided relatively reliable airway assessment, while Dolphin showed standard deviations 10 to 30 times larger for volumetric airway measurements. MDCT scans significantly reduced airway volume/area measurements compared to CBCT, except for intraoral airway volume. Unreliable skeletal measurements and low reliability of Dolphin for airway analysis discourage using CT to quantitatively correlate changes in craniofacial structures with airway dimensions.

Prevalence of pneumatisation patterns of Onodi cells among the North-East Indian population

BackgroundThe posterior ethmoid sinuses have a complex anatomy and a highly variable normal structure. The posterior ethmoid Onodi cell needs careful assessment because of its proximity to the optic nerve and the internal carotid artery canal. Recognising the distinctions is essential for optimal pre-op preparation. Sphenoid sinus surgery can now be performed without worrying about compromising vital structures like the internal carotid artery or optic nerve. Preoperative radiological assessment is a quick and easy way to check for ethmoid cell pneumatisation differences.Aim and objectivesTo determine the pneumatisation patterns of Onodi cells among the North-East Indian population using 16-slice multidetector computed tomography (MDCT).ResultsNine-hundred MDCT paranasal sinuses were analysed over a period of 0–2 years, out of which 220 cases showed the presence of Onodi cell. Type I were 89 cases (40.45%, CI 32.00–48.90), Type II were 128 cases (58.18%, CI 49.72–66.63), and 3 cases with Type III cell (1.36%, CI 0.18–2.54).ConclusionThe most prevalent pneumatisation pattern is Type II. The pneumatisation patterns of Onodi cells can be best detected and evaluated by multiplanar MDCT imaging. Sinus surgeons need a firm grasp of pneumatisation patterns to avoid damaging the optic nerve and internal carotid artery canal during operations.

Role of MDCT in Patients with Abdominal Trauma

Objectives: To assess the role of abdominal imaging for precise identification of the injuries for early surgical exploration by using Multidetector Computed Tomography (MDCT) and to assess those patients that can be managed conservatively. Study Design: Prospective cross-sectional observational study. Place and Duration of the Study: Pakistan Air Force Hospital Islamabad, November, 2022-November, 2023. Methodology: The study was carried out on 120 cases of abdominal trauma. MDCT scan with contrast was performed after the initial resuscitation and stability of the patients in the emergency room being done by the respective medical and paramedical staff. Results: In clinically stable patients, the use of multi-detector CT as initial triage of abdominal trauma resulted in a reduction in the number of laparotomies by 91% and an increase in number of conservatively managed with a better outcome of around 95% and 92% respectively. Conclusion: The current study assessed and showed the better role of MDCT in evaluation of the blunt trauma patients in early detection and timely surgical exploration. MDCT imaging test helps the clinicians in making an early and right choice of intervention. The high-resolution MPR, MIP, and 3-D volume reconstruction images assisted in displaying complex injuries, increasing diagnostic capacity, accuracy, associated vascular and bony pathologies, and reduced reporting time.

Comprehensive Evaluation of Pulmonary Masses Using Multi-detector CT: Correlating Morphological Features With CT-Guided Histopathological Findings for Enhanced Diagnostic Accuracy.

Lung masses pose a significant diagnostic challenge due to their diverse causes, from benign hamartomas to malignant bronchogenic carcinoma. Multi-detector CT (MDCT) is essential in evaluating these masses, offering detailed morphological insights to help differentiate between benign and malignant lesions. However, a definitive diagnosis often requires histopathological confirmation. CT-guided biopsy is crucial, providing a minimally invasive method to obtain tissue samples and thus guiding clinical management and treatment decisions. The primary objective of this study was to assess the diagnostic accuracy of MDCT in differentiating between benign and malignant lung mass lesions. The study focused on evaluating the characteristic features of lung masses on MDCT that aid in this differentiation, correlating imaging findings with histopathological results from CT-guided biopsies, and determining the overall diagnostic utility of MDCT in thoracic lesions. This hospital-based observational study was conducted over a period of 17 months. The study included 52 patients with thoracic lesions, identified through imaging techniques such as chest radiographs and CT scans. These patients underwent CT-guided biopsy, with tissue samples sent for histopathological examination. Inclusion criteria involved patients with clinically and radiographically diagnosed lung masses, while exclusion criteria included those who did not consent, had contraindications to contrast media, or had conditions such as severe respiratory distress or coagulopathy. The data were analyzed using descriptive statistics, with efficacy measures such as yield and failure rates of CT-guided biopsies and validation measures like sensitivity, specificity, positive predictive value, and negative predictive value for MDCT. The study included 52 patients (50% male, 50% female), aged 16-80, with the most common age group being 51-60 years. Lesions were mainly in the lung parenchyma (65.38%), followed by the mediastinum (15.38%), hilar region (11.54%), and pleura (7.69%). MDCT evaluation classified 84.44% of the lesions as malignant, characterized by irregular contours, inhomogeneous texture, and contrast enhancement, while 15.55% were benign. Histopathology confirmed 42 malignant lesions, with squamous cell carcinoma being the most prevalent. Benign lesions included abscesses, tuberculosis, and pneumonitis. The study achieved a 100% success rate for CT-guided biopsy, with one minor complication (pneumothorax). The diagnostic accuracy of MDCT was notable, with a sensitivity of 100% for detecting malignancies, a specificity of 77.78%, a positive predictive value of 87.50%, and a negative predictive value of 100%, emphasizing its effectiveness in thoracic lesion evaluation. MDCT is a highly effective tool in the evaluation of lung masses, providing critical information that aids in distinguishing between benign and malignant lesions. When combined with CT-guided biopsy, it offers a reliable method for obtaining diagnostic tissue samples, with a high degree of accuracy and a low complication rate. The study underscores the importance of integrating imaging and histopathological findings in the management of thoracic lesions, ultimately enhancing diagnostic precision and informing appropriate clinical interventions.

Left Atrial Wall Thickness Estimated by Cardiac CT: Implications for Catheter Ablation of Atrial Fibrillation.

Atrial wall thickness (AWT) is a significant factor in understanding the pathological physiological substrate of atrial fibrillation, with a potentially substantial impact on the outcomes of catheter ablation procedures. Precise measurements of the AWT may provide valuable insights for categorising patients with AF and planning targeted interventions. Objectives: The purpose of this study was to evaluate the characteristics of the left atrium (LA) using non-invasive multidetector computed tomography (MDCT) scans and subsequent three-dimensional (3D) image post-processing using novel software designed to calculate atrial thickness dimensions and mass. Methods: We retrospectively analysed 128 consecutive patients (33.6% females; mean age 55.6 ± 11.2 years) referred for AF ablation (37 with persistent AF and 91 with paroxysmal AF) who underwent preprocedural MDCT. The images were post-processed and analysed using the ADAS software (Galgo Medical), automatically calculating the LA volume and regional wall thickness. In addition, the software employed a regional semi-automatic LA parcellation feature that divided the atrial wall into 12 segments, generating atrial wall thickness (AWT) maps per segment for each patient. Results: This study demonstrated considerable variability in the average thickness of LA walls, with the anterior segments being the thickest across the cohort. Distinct sex-specific differences were observed, with males exhibiting greater anterior and septal wall thickness than females. No significant associations were identified between the average AWT and body mass index, LA volume, or sphericity. Survival analysis conducted over 24 months revealed a meaningful relationship between mean anterior wall thickness and recurrence-free survival, with increased thickness associated with a lower likelihood of AF-free survival. No such relationship was observed for the indexed LA volume. Conclusions: The variability in AWT and its association with recurrence-free survival following AF ablation suggest that AWT should be considered when stratifying patients for AF management and ablation strategies. These findings underscore the need for personalised treatment approaches and further research on the interplay of the structural properties of the left atrium as factors that can serve as important prognostic markers in AF treatment.

Possibility to measure the volume of coronary sinus in contrast-enhanced computed tomography.

Modern imaging techniques such as computed tomography (CT) can help in the assessment of coronary sinus volume in a vitro manner, but there is no comprehensive research on this topic so far. Hence, we decided to develop a methodology for measuring the volume of the coronary sinus in multi-detector CT and to try to apply it in practice. Forty-nine patients (22 men) were included in this research, with a mean age of 70.08 ± 13.6 years. Scanning with retrospective ECG-gating was performed using a Toshiba Aquilion 64 (slice: 0.5 mm; helical pitch: 12.8; rotation time: 0.4 s). 80 ± 20 cm3 of non-ionic contrast was administered to each patient. The volume of coronary sinus and other data measurements were performed using Vitrea 2 workstations. The organ volume measurement function was used to measure volume objects in CT scans. To standardise the measurements, they were all performed to the place where the vein of Marshall reaches the coronary sinus. In cases of loss of vein of Marshall, the first lateral vein was used as the junction between the coronary sinus and the great cardiac vein. The coronary sinus volume varied from 0.96 cm3 to 8.52 cm3. The average volume was 3.71 ± 1.64 cm3. There was a significant correlation between end diastolic volume and coronary sinus volume (r = 0.33, p = 0.02). In most cases the quality of visualisation was good - the average was calculated as 4.16 ± 0.87. The Thebesian valve was present in 22 cases (44.9%); however, no statistical relationship between the presence of the Thebesian valve and coronary sinus was observed. It is possible to visualise and calculate the volume of the coronary sinus in cardiac CT.