Multidetector Computed Tomography Findings Research Articles

Pilomatricoma (calcifying epithelioma): MDCT and MR imaging findings in 31 patients with radiological-pathological correlation

PurposeTo describe the radiological characteristics of pilomatricomas on multi-detector computed tomography (MDCT) and magnetic resonance imaging (MRI), and to correlate the radiological findings and pathological features. Materials and methodsThe radiological findings of 41 pilomatricomas in 31 patients were retrospectively reviewed. The images were evaluated with emphasis on calcifications, reticular and ring-like appearances, enhancement patterns, circular target sign and peritumoral fat stranding, and correlating these with pathological features. ResultsOf the 31 lesions evaluated by MDCT, 25(80.6%) showed different patterns of calcifications which included single in 12(38.7%) lesions and multiple in 13(41.9%) lesions, but peritumoral fat stranding was observed only in 2(6.5%) lesions. MRI scans were performed in 11 patients with 21 lesions, homogeneous and inhomogeneous hypointensities on T1-weighted (T1W) images were showed respectively in 14(66.7%) and 7(33.3%) lesions. On fat-suppressed (FS) T2-weighted (T2W) images, a ring-like hyperintensity was observed in all 21(100%) lesions, reticular hyperintensity, circular target sign, peritumoral fat stranding and secondary anetoderma were seen in 7(33.3%), 4(19%), 4(19%) and 1(4.8%) lesions, respectively; and a significant difference (P < 0.05) was found when comparing the maximum diameter of tumors with (2.3 ± 1.4 mm) and without (1.1 ± 0.3 mm) reticular hyperintensity. On contrast-enhanced T1W images, all 21(100%) lesions were found to have ring-like enhancement and 7(33.3%) of them showed reticular enhancement. The reticular and ring-like appearances on MR images respectively corresponded to the pathological edematous stroma and connective tissue capsule, and the four-layer structures of the circular target sign on FS T2W images also corresponded to pathological calcifications, shadow cells, epithelial cells and connective tissue capsule, respectively. ConclusionsThe characteristic radiological findings associated with pilomatricomas include different patterns of calcifications on MDCT images and ring-like, reticular appearances and circular target sign on MR images. Radiological findings are well correlated with pathological nature.

Role of Multidetector Computed Tomography (MDCT) in Evaluation of Gallbladder Malignancy and its Pathological Correlation in an Indian Rural Center

Clinically or sonographically suspected gallbladder carcinoma was evaluated on multidetector computed tomography. Based on the spectrum of multidetector computed tomography findings, staging of gallbladder carcinoma was done. Multidetector computed tomography diagnosis was compared with pathological diagnosis. This is a prospective study carried out in 100 patients at a rural Indian center between May 2012 and June 2015. Multidetector computed tomography was performed in all the cases and the findings were observed. Based on the radiological spectrum, staging of gallbladder carcinoma was done. The diagnosis was confirmed by ultrasound guided fine needle aspiration cytology/histopathological examination of surgical specimens. The most common multidetector computed tomography findings noted by us were mass replacing gallbladder, followed by diffuse/focal gallbladder wall thickening and polypoidal mass. Other findings noted were cholelithiasis, liver infiltration, intra hepatic biliary dilatation, liver metastases, portal vein invasion, antroduodenal and hepatic flexure involvement. Ultrasonography guided fine needle aspiration cytology done in all cases was positive in 92 cases and inconclusive in eight cases. Surgery was performed in only 22 patients, and histopathological findings were correlated with multidetector computed tomography findings. Multidetector computed tomography is also reliable in detection of extension of tumor and lymph nodes. multidetector computed tomography plays a major role in evaluating and staging of carcinoma gallbladder. It also guides the surgeons for operatibility and resectability of tumour.

Differences in clinicopathological characteristics and computed tomography findings between signet ring cell carcinoma and nonsignet ring cell carcinoma in early and advanced gastric cancer.

Signet ring cell carcinoma (SRC) of the stomach is a histological type based on microscopic characteristics. SRC's clinicopathological characteristics and prognosis are still controversial. Our study is to describe the clinicopathological features and multidetector computed tomography (MDCT) findings of patients with SRC of the stomach in comparison with nonsignet ring cell adenocarcinoma (NSRC). We retrospectively analyzed data from 241 patients who had undergone curative gastrectomy, including 62 SRC and 179 NSRC. Clinicopathological outcomes and MDCT findings were evaluated, and we investigated whether these variables were correlated with histopathological type. In early gastric carcinoma, patients with SRC were younger (50.2 vs. 60.2 years; P = 0.000) and more likely to be observed in the middle and lower third stomach (P = 0.010). Early SRC had a tendency to be confined to the mucosa (82.1%). There were significant differences in degree of enhancement between early SRC and NSRC on MDCT imaging (P < 0.001). In advanced gastric carcinoma, SRC was more likely to be stage T3‐4 (100%). SRC patients had thicker tumors (P = 0.001) and a higher frequency of diffusely infiltrative gross appearance (P < 0.001). SRC was more likely to have high‐degree contrast enhancement than were NSRC (P = 0.001). The maximal diameter of SRC tumor on MDCT imaging correlated with lymph node metastasis (sensitivity 93.9%, specificity 74.1%) and serosal invasion (sensitivity 89.5%, specificity 78.0%) of SRC. In conclusion, SRC differs significantly from NSRC in clinicopathological features at presentation. MDCT could help differentiate advanced gastric SRC from NSRC based on the thickened stomach wall, high‐degree contrast enhancement, and a higher frequency of diffusely infiltrative gross appearance, particularly in combination.

Multidetector computed tomography has replaced conventional intravenous excretory urography in imaging of the kidneys: A scoping review of multidetector computed tomography findings in renal tuberculosis.

BackgroundTuberculosis (TB) is a worldwide infectious disease burden, especially in non-developed countries, with increased morbidity and mortality among human immunodeficiency virus (HIV)-infected patients. Extrapulmonary TB is rare and renal TB is one of the commonest manifestations. The end result of renal TB is end-stage renal disease; however, this can be avoided if the diagnosis is made early. The diagnosis of renal TB is challenging because of the non-specific presentation and low sensitivity of clinical tests. Although the sequel of TB infection in the kidney causes varying manifestations depending on the stage of the disease, multidetector computed tomography (MDCT) is capable of demonstrating early findings. We performed a 20-year scoping review of MDCT findings in renal TB to promote awareness.AimTo identify specific MDCT imaging characteristics of renal TB, promote early diagnosis and increase awareness of the typical imaging features.Methods and materialWe searched published and unpublished literature from 1997 to 2017 using a combination of search terms on electronic databases. We followed the Joanna Briggs Institute guidelines.ResultsA total of 150 articles were identified, of which 145 were found through electronic search engines and 5 were obtained from grey literature. Seventy-nine articles that fulfilled our inclusion criteria were reviewed. These included original research, case reports, literature review, organisational reports and grey literature.ConclusionMultidetector computed tomography can reproduce images comparable with intravenous excretory urography; together with advantages of being able to better assess the renal parenchyma and surrounding spaces, it is important in suggesting the diagnosis of renal TB and clinicians should consider including MDCT when investigating patients with recurrent urinary tract infection not responding to usual antimicrobial therapy.

Non-contrast MDCT for Ureteral Calculi and Alternative Diagnoses: Yield in Adult Women vs in Adult Men

To determine the yield of non-contrast multi-detector computed tomography (MDCT) of the abdomen and pelvis in diagnosing ureteral calculi as well as other alternative acute conditions in male vs in female adult patients presenting to the emergency department with new onset of symptoms. Our institutional review board approved a retrospective review of the official reports of the non-contrast MDCT examinations of the abdomen and pelvis performed on adults (18 years and older) presenting to our emergency department with a suspected ureteral calculus from October 1, 2011 to October 30, 2013. Patients with recently documented ureteral calculi, known urinary tract infection, malignancy, and trauma were excluded from the study. From a total of 1097 non-contrast MDCT examinations of the abdomen and pelvis over the 2-year period, 400 randomly selected examinations were reviewed (approximately one-third of all the examinations). We compared the prevalence of ureteral calculi between the male and female population. P values and confidence intervals were determined using software Stata 14. Other acute intra-abdominal and intra-pelvic findings amenable to prompt medical care were also documented and analyzed separately. The mean patient age was 55.2 years, with a range of 19-90 years. This included 170 female (mean age 56.8 years) and 230 male patients (mean age 54.2 years). Ureteral calculi were detected in 170 (42.5%) of the patients [111 males (48%) and 59 females (34.7%)] with a prevalence which was statistically significantly higher in the male patients compared to in the female patients (P < 0.01, confidence level of 95% and CI of 13.2-13.4). An alternative diagnosis was made based on the MDCT findings in 49 patient cases (12.25 %), including 26 females (15.29%) and 23 males (10.00%). There was no statistically significant difference in alternative acute findings in male compared to in female patients (P > 0.05). This was with the exception of acute pyelonephritis, which was statistically significantly higher in the female patients (P < 0.01). The likelihood of making the diagnosis of a ureteral calculus on non-contrast MDCT of the abdomen and pelvis was statistically significantly higher in male patients compared with female patients presenting to our emergency department. However, there was no statistically significant difference in the alternative diagnoses, with the exception of pyelonephritis, which was more common in women.

Spectrum of Multi-Detector Computed Tomography Findings that Alter Pulmonary Artery Diameters in Adults

Spectrum of Multi-Detector Computed Tomography Findings that Alter Pulmonary Artery Diameters in Adults

Utility of multi-detector computed tomography scans after colorectal endoscopic submucosal dissection: a prospective study

Several reports have described major adverse events after endoscopic submucosal dissection (ESD), such as perforation or bleeding. However, few studies have discussed the occurrence of post-ESD electrocoagulation syndrome (PEECS) after colorectal ESD. In addition, the occurrence of fever without abdominal pain in patients requires postoperative management similar to that required for PEECS. Therefore, we have defined post-ESD inflammatory syndrome (PEIS) composed of both PEECS and fever without abdominal pain. This study aimed to evaluate the correlation between the findings of multi-detector computed tomography (MDCT) imaging and PEIS in patients. Between January 2015 and October 2015, we performed colorectal ESD in 100 patients; after this, all patients underwent abdominal examinations by MDCT scans. Nine patients who experienced intraoperative perforations or penetrations were excluded; 91 patients were enrolled in our prospective study. MDCT findings in patients were classified according to the amount of extraluminal gas. The patients were divided into 2 groups based on the presence or absence of extraluminal gas and were assessed for co-occurring PEIS. Among the 91 patients, extraluminal gas was observed in 31 (34%); of these, PEIS occurred in 14 (15%) patients. Patients with extraluminal gas had increased incidence of PEIS compared with patients without extraluminal gas (29% vs 8%, P= .014). Extraluminal gas was detected by MDCT in many cases and significantly correlated with the occurrence of PEIS, even in cases without obvious intraoperative perforation or penetration. MDCT findings after ESD may be useful for predicting PEIS and appropriate perioperative management.

Adhesive internal hernia: multidetector CT findings and clinical relevance

To review the clinical and multidetector computed tomography (MDCT) features of adhesive internal hernias (IHs) and to ascertain specific MDCT criteria to assist in the diagnosis of adhesive IHs and the early detection of intestinal strangulation. Medical records and preoperative abdominal MDCT findings of 34 patients with surgically confirmed abdominal adhesive IHs were analysed retrospectively. The specific MDCT features of adhesive IHs included the following: dislocating and clustering of intestinal segments (100%); stretching and crowding of the mesenteric vessels (100%); presence of hernial orifice (88.2%), peritoneal adhesive bands (76.5%); and the fat notch sign (85.3%). In addition, the significant MDCT features indicative of intestinal strangulation compared with those without intestinal strangulation were bowel wall thickening (p=0.009), intramural haemorrhage (p=0.007), and abnormal bowel wall enhancement (p=0.023). Furthermore, bowel obstruction occurred in 17 (50%) patients, and mesenteric whirl was apparent in 8 (23.5%) patients. This article illustrates the specific MDCT criteria of adhesive IHs. Knowledge of MDCT findings in adhesive IHs and their complications is essential for making the correct diagnosis and may help guide early clinical management.

Multidetector Computed Tomography Findings of Splenic Artery Aneurysms Associated With Liver Involvement in Wilson's Disease

PurposeThe purposed of this study was to examine the incidence and multidetector computed tomography (MDCT) findings of splenic artery aneurysms (SAAs) in patients with liver involvement related to Wilson's disease. MethodsEighteen patients with clinically and/or pathologically proven Wilson's disease underwent triphasic MDCT. Arterial, portal, and equilibrium phase images were obtained. The analysis of the CT features included the presence and characteristics of the SAA, splenic artery (SA) diameter, the presence and size of the portosystemic collateral vessels, and spleen volume. ResultsSAAs were detected in 11 patients (61.1%). Eight (72.7%) patients had multiple aneurysms. In 6 (54.5%) patients, the SAAs were located in the distal third of the SA and the intraparenchymal part of the SA. In 3 (27.3%) patients, the SAAs were located only in the distal third of the SA. In 1 (9.1%) patient, the aneurysms were located in the intermediate, distal third, and intraparenchymal part of the SA; in another (9.1%) patient, the aneurysms were located only in the intraparenchymal part of the SA. There were significant differences between the patients with SAA and those without SAA with respect to SA diameter, portosystemic collateral vessel diameter, and spleen volume (P = .007, P < .001, and P = .006, respectively). ConclusionsThe incidence of SAAs seems to be higher in patients with liver involvement related to Wilson's disease compared with patients with other causes of cirrhosis and portal hypertension. Large portosystemic collaterals, increased SA diameter, and spleen volume were significant factors for the presence of SAAs.

MDCT of the temporal bone and audiological findings of pediatric acquired cholesteatoma.

Cholesteatoma is a benign epithelial lesion affecting the middle ear and/or mastoid process, causing otorrhea and hearing loss. Here, we retrospectively evaluated the temporal multidetector computed tomography and audiological findings of acquired cholesteatoma in children. Forty-three patients younger than 18years old with middle ear acquired cholesteatoma were evaluated with regard to their clinical symptoms, temporal multidetector computed tomography findings, and audiometry results. The multidetector computed tomography findings were classified according to the site-ossicle-complication classification, and the relationships between the clinical, radiological, and audiological findings were evaluated. Only one patient had pars tensa cholesteatoma, and the remaining had attic cholesteatoma. The most common site-ossicles-complication classifications were S4 (acquired cholesteatoma involving four sites), O1 (involving one ossicle), and C0 (no complications), and the most common complaint was hearing loss, followed by otorrhea. There were no statistically significant relationships between the site of involvement and ossicle involvement. In addition, there were no statistically significant differences according to the S classification in either the air conduction or air-bone-gap levels; however, these levels differed statistically significantly with increasing ossicle involvement. Early diagnosis and treatment are essential to prevent hearing loss and serious complications in cases of acquired cholesteatoma. Therefore, it is important to evaluate the temporal multidetector computed tomography and audiological findings to accurately diagnose acquired cholesteatoma in children.

Radiologic findings of thoracic trauma.

IntroductionChest trauma may be blunt or penetrating and the chest is the third most common trauma region. It is a significant cause of mortality. Multidetector computed tomography (MDCT) has been an increasingly used method to evaluate chest trauma because of its high success in detecting tissue and organ injuries. Herein, we aimed to present MDCT findings in patients with blunt and penetrating chest trauma admitted to our department.MethodsA total of 240 patients admitted to the emergency department of our hospital between April 2012 and July 2013 with a diagnosis of chest trauma who underwent MDCT evaluations were included. Most of the patients were male (83.3%) and victims of a blunt chest trauma. The images were analyzed with respect to the presence of fractures of bony structures, hemothorax, pneumothorax, mediastinal organ injury, and pulmonary and vascular injuries.ResultsMDCT images of the 240 patients yielded a prevalence of 41.7% rib fractures, 11.2% scapular fractures, and 7.5% clavicle fractures. The prevalence of thoracic vertebral fracture was 13.8% and that of sternal fracture was 3.8%. The prevalence of hemothorax, pneumothorax, pneumomediastinum, and subcutaneous emphysema was 34.6%, 62.1%, 9.6%, and 35.4%, respectively. The prevalence of rib, clavicle, and thoracic vertebral fractures and pulmonary contusion was higher in the blunt trauma group, whereas the prevalence of hemothorax, subcutaneous emphysema, diaphragmatic injury, and other vascular lacerations was significantly higher in the penetrating trauma group than in the blunt trauma group (p<0.05).ConclusionMDCT images may yield a high prevalence of fracture of bony structures, soft tissue lacerations, and vascular lesions, which should be well understood by radiologists dealing with trauma.

Usefulness of multidetector computed tomography before and after pulmonary vein isolation

ObjectiveTo analyze the usefulness of multidetector computed tomography (MDCT) in the preprocedural evaluation and follow-up of patients undergoing radiofrequency ablation of pulmonary veins and the impact of the MDCT findings on the approach to treatment. MethodWe retrospectively analyzed 92 consecutive MDCT studies done in 80 patients between January 2011 and June 2013; 70 (76%) studies were done before a first ablation procedure and 22 (24%) were done in patients who had undergone an ablation procedure. ResultsFindings were useful in 34% of the patients who underwent MDCT before the first ablation procedure and in 68% of the studies done after a procedure. The incidence of stroke associated with the ablation procedure was 3%, similar to the incidence recorded in our center before we started to use MDCT to evaluate the anatomy of the left atrium. All symptomatic patients had some pulmonary vein stenosis, and 80% had significant stenosis. Furthermore, the stenoses progressed very rapidly; treatment with balloon angioplasty was associated with early restenosis. Stenting was an alternative in cases of failed angioplasty. ConclusionIn the preprocedural evaluation and postprocedural follow-up of patients undergoing pulmonary vein isolation, MDCT is useful for guiding treatment and detecting complications.

Acute post traumatic portal venous thrombosis associated with shattered spleen: A case report

Post-traumatic portal venous thrombosis is a rare event, and is usually seen in association with penetrating injuries. Portal venous thrombosis following blunt abdominal trauma is extremely rare with only few reports in the literature, some associated with underlying coagulation disorders. We report multidetector computed tomography findings in a case of blunt abdominal trauma with otherwise normal coagulation profile, which showed shattered spleen and MDCT evidence of acute thrombosis in the right branch of the portal vein. To the best of our knowledge, this is the first documented report of acute portal venous thrombosis in association with shattered spleen.

Utilidad de la tomografía computarizada multidetector en la evaluación previa y el seguimiento de los pacientes sometidos a ablación de venas pulmonares

ObjectiveTo analyze the usefulness of multidetector computed tomography (MDCT) in the preprocedural evaluation and follow-up of patients undergoing radiofrequency ablation of pulmonary veins and the impact of the MDCT findings on the approach to treatment. MethodWe retrospectively analyzed 92 consecutive MDCT studies done in 80 patients between January 2011 and June 2013; 70 (76%) studies were done before a first ablation procedure and 22 (24%) were done in patients who had undergone an ablation procedure. ResultsFindings were useful in 34% of the patients who underwent MDCT before the first ablation procedure and in 68% of the studies done after a procedure. The incidence of stroke associated with the ablation procedure was 3%, similar to the incidence recorded in our center before we started to use MDCT to evaluate the anatomy of the left atrium. All symptomatic patients had some pulmonary vein stenosis, and 80% had significant stenosis. Furthermore, the stenoses progressed very rapidly; treatment with balloon angioplasty was associated with early restenosis. Stenting was an alternative in cases of failed angioplasty. ConclusionIn the preprocedural evaluation and postprocedural follow-up of patients undergoing pulmonary vein isolation, MDCT is useful for guiding treatment and detecting complications.

MDCT and US of intrathoracic extrapleural space soft tissue-containing lesions: US extrapleural fat sign and MDCT fat ghost ribs sign.

The purpose of this study was to review the normal anatomy of the extrapleural space, its soft tissue-containing lesions, and to illustrate the extrapleural fat sign with Multidetector Computed Tomography (MDCT) and Ultrasound (US), which was never described so far. The study includes 28 patients. 24 with histologically or surgically proven extrapleural soft tissue-containing lesions and 4 pleural lesions. Six patients underwent unenhanced MDCT of the chest, while 22 patients had a contrast-enhanced chest MDCT. Furthermore, 9/28 patients underwent Thoracic Ultrasound after MDCT. The lesions included 12 extrapleural hematomas (8 post-traumatic and 4 from other causes), 3 extrapleural lesions from pleural infection extension, 9 extrapleural lesions from metastases. MDCT multiplanar Minimum Intensity Projection (MinIP) reconstructions were always obtained; T-US and MDCT findings were correlated. Among 9 patients who underwent T-US 4/9 showed the "UltraSonography fat extrapleural sign". Among 24 patients who underwent chest MDCT all show the well-known computed tomography (CT) extrapleural fat sign and new auxiliary (MDCT) findings that serve to "strengthen" the diagnosis of correct intrathoracic extrapleural space attribution of lesion. MDCT with its multiplanar capabilities and post-processing MinIP reconstructions and Thoracic US play a prominent role in the identification and characterization of abnormalities of the frequently overlooked extrapleural space. In conjunction with main CT thoracic findings they provides relevant information in the diagnostic process and correct management.

The Value of 320-Row Multidetector CT Bronchial Arteriography in Recurrent Hemoptysis after Failed Transcatheter Arterial Embolization

PurposeTo retrospectively assess the value of computed tomographic (CT) bronchial arteriography (BA) with 320-row multidetector CT in the management of patients with recurrent hemoptysis immediately after bronchial artery embolization (BAE). Materials and MethodsAmong 135 consecutive patients treated with BAE between April 2014 and March 2016, recurrent hemoptysis developed in 15, and 10 subsequently underwent multidetector CT. Vascular abnormalities and associated anatomy were evaluated to determine the potential cause of BAE failure, and the clinical impacts of CT BA were analyzed. ResultsCT BA revealed an additional 22 abnormal vessels in the qualified 10 patients, and 8 patients were treated again within 24 hours after the first BAE based on multidetector CT findings. Of the 22 abnormal vessels, 16 were embolized, including 4 orthotopic arteries, 8 ectopic arteries, and 4 nonbronchial systemic arteries (NBSAs); the remaining 6 abnormal arteries were not embolized because of normal BA (n = 1), anatomic inaccessibility (n = 2), or cessation of hemoptysis with conservative therapy (n = 3). There were no further cases of recurrent hemoptysis after the second intervention, with a mean follow-up of 7.7 months ± 6.7. Overall, initial conventional BA missed 65% of potential bleeding arteries (22 of 34). After CT BA, 73% of the newly identified vessels (16 of 22) were embolized. ConclusionsMultiple unrecognized abnormal ectopic bronchial arteries and NBSAs are the major causes of failure of initial BAE. Multidetector CT BA can precisely identify a large number of feeding vessels that are missed on conventional BA, allowing for repeat embolization with a high success rate.

Spread of odontogenic infections in the elderly: Prevalence and characteristic multidetector CT findings

Purpose: To analyze spread of odontogenic infections in the elderly, especially the prevalence and characteristic multidetectorcomputed tomography (MDCT) findings.Materials and methods: Ninety-seven patients with odontogenic infection who underwent 64-row MDCT were evaluated inthis study. The study patients comprised 31 elderly patients (60 years) and 66 adults (&lt; 60 years). Age, gender, location ofcausal tooth, and spread of odontogenic infections with MDCT were analyzed.Results: The elderly patients (74.2%) had higher ratio with female compared to the adults (57.6%). The buccal space (93.5%)was the most common spread of odontogenic infections for the elderly patients, followed by the masticator space (54.8%) andsubmandibular space (45.2%), whereas the buccal space (97.0%) was the most common spread of odontogenic infections for theadults, followed by submandibular space (65.2%) and masticator space (51.5%). Logistic multivariate regression analysis forodontogenic infections in the elderly demonstrated that the gender (odds ratio = 3.462, P = .024) and submandibular space (oddsratio = 0.168, P = .013) were significant variable.Conclusions: The study showed the prevalence and characteristic MDCT findings of spread of odontogenic infections in theelderly.

Multidetector CT findings of histopathologically proven peritoneal tuberculous cold abscesses.

To evaluate the characteristic multidetector CT findings of peritoneal tuberculous (TB) cold abscesses. The morphological characteristics of 48 peritoneal TB cold abscesses in 29 patients (male:female=13:16; age range 16-75years) were retrospectively evaluated. TB infection was histologically proven by acid fast bacilli (AFB) smear or culture, TB-polymerase chain reaction (PCR), or histopathological specimen diagnosis. Seventeen abscesses (35.4%) were present in the right perihepatic space, 10 (20.8%) in the left subphrenic space, 6 (12.5%) in the right subphrenic space, 4 (8.3%) in the pelvic cavity, 3 (6.3%) in the left perihepatic space, 3 (6.3%) in the right lower quadrant, and so on. The abscess contents ranged from 10.4 to 61.4 Hounsfield units. Internal septa (64.6%), central necrotic lymphadenopathy (55.2%), and TB coinfections in other organs (65.5%) were observed. TB infection was histopathologically confirmed from the surgical specimens in 17 patients and other 4 patients revealed the positive TB-PCR results from the peritoneal fluid. Ten patients (34.5%) had a recent history of TB peritonitis with ascites. Peritoneal TB cold abscesses were commonly found in the right perihepatic and subphrenic spaces and revealed higher density of internal content, frequent internal septa, central necrotic lymphadenopathy, and high TB coinfections in other organs.

Impact of Subclinical Vascular Complications Detected by Systematic Postprocedural Multidetector Computed Tomography After Transcatheter Aortic Valve Implantation Using Balloon-Expandable Edwards SAPIEN XT Heart Valve

Complications after transcatheter aortic valve implantation (TAVI) remain an important issue. This study aimed to evaluate the impact of systematic postprocedural multidetector computed tomography (MDCT) to detect subclinical complications after TAVI. From October 2013 to August 2015, a total of 135 patients who underwent transfemoral TAVI (n= 116) or transapical TAVI (n= 19) with Sapien XT and MDCT preprocedure and postprocedure were enrolled. Postprocedural MDCT findings were compared with the preprocedural MDCT findings. Cardiovascular complications were observed in 25.9% of patients, including 6 cases (4.5%) with major complications. Of those, clinically apparent major complications were reported in 2 cases including rupture of the sinus of Valsalva and iliac rupture. The complications in the remaining 4 cases (3.0%) included aortic dissection, aortic intramural hematoma, and left ventricular apical pseudoaneurysm, which were totally asymptomatic and only detected by MDCT. The apical pseudoaneurysm required surgical repair. Minor complications were observed in 21.5% of patients, 50% of which were subclinical. Only 1 case with femoral pseudoaneurysm required an additional procedure. Noncardiovascular findings were detected in 27.4% of patients; the most frequent were pleural effusions and atelectasis, which were predominantly observed in those treated through a transapical approach. Contrast-induced acute kidney injury after postprocedural MDCT was reported in 1 patient whose clinical course was complicated by sepsis. Inconclusion, postprocedural MDCT was useful in detecting important subclinical complications that may affect the clinical course without deterioration of renal function.

Comparative study of multidetector computed tomography and magnetic resonance cholangiopancreatography in obstructive jaundice

Background: Accurate diagnosis of the cause is crucial in the management of obstructive jaundice. Multidetector computed tomography (MDCT) and magnetic resonance cholangiopancreatography (MRCP) play the pivotal roles in the diagnosis. Objective: The objective of this study is to evaluate the diagnostic accuracy of MDCT in determining the level and cause of biliary obstruction in patients with obstructive jaundice and correlates MDCT findings with that of MRCP. Materials and Methods: This cross-sectional study was conducted in the Department of Radiodiagnosis of a tertiary hospital in Manipur after obtaining the Institutional Ethical Committee approval. Fifty-seven patients with obstructive jaundice, age ranging 20–80 years, were subjected to MDCT and MRCP. Final definite diagnosis was made from operative or histopathological findings. Data and findings of MDCT and MRCP were correlated and statistically analyzed. Results: Maximum numbers of cases were seen to occur in the fourth to sixth decades. The female-to-male ratio was 1.4:1. Both MDCT and MRCP could correctly determine the level of obstruction in all the cases. The most common level of obstruction was at the suprapancreatic level. The most common cause of obstruction was choledocholithiasis (45.61%). Benign causes constituted 68% and malignant causes constituted 32%. MDCT could correctly determine the cause in 85.96% of cases, compared to 75.44% by MRCP. Kappa statistics showed fair agreement between MDCT and MRCP in diagnosing the cause of biliary obstruction. MDCT showed comparable sensitivity, specificity, and positive and negative predictive value, in diagnosing the causes of obstruction. Conclusion: Overall performance of the MDCT was comparable or better than that of MRCP.