Multidetector CT Imaging Findings Research Articles

Deciphering normal and anomalous viscero-atrial situs on multidetector CT angiography.

Viscero-atrial situs encompasses the laterality, relative position and configuration of the abdominal viscera, the atria of the heart and the tracheobronchial tree. Determining the situs and cardiac position is the first step in the commonly used sequential, segmental approach to the imaging evaluation of congenital heart defects (CHD). Abnormalities of visceroatrial situs and cardiac position are frequently associated with the presence of complex CHDs and accurate assessment of situs abnormalities can help predict the probability and type of the defect. Multidetector CT (MDCT) angiography, with its multiplanar reformatting and volume rendering techniques, offers accurate information about the morphology and three-dimensional relationships of the various cardiac and extra cardiac structures. In this pictorial essay, we present the MDCT imaging findings of the spectrum of abnormalities of visceroatrial situs and cardiac position, using a third generation dual source CT scanner.

Imaging of anomalous pulmonary venous connections by multidetector CT angiography using third-generation dual source CTscanner.

Abnormal embryological development of the pulmonary veins can manifest as either partial or total anomalous drainage into the systemic venous circulation. Echocardiography does not provide adequate information in all cases as the optimal visualization of anomalous structures is limited by the availability of acoustic window; also it is highly operator dependent. However, multidetector CT angiography, with its multiplanar reformatting and volume rendering techniques, offers precise information about the three-dimensional anatomy and spatial relationships of the cardiovascular structures. With advent of dualsource CT scanners and use of advanced dose reduction techniques, this information can be obtained in a short time with minimal radiation dose. In this pictorial essay, we present the multidetectorCT imaging findings of the spectrum of total and partial anomalous pulmonary venous connections, using a third-generation dual source CT scanner.

Blunt pancreatic trauma: evaluation with MDCT technology

The purpose of this paper is to determine the relative frequency of multi-detector CT (MDCT) findings of pancreatic injury in blunt trauma and to determine their diagnostic accuracy in predicting main pancreatic duct injury. Fifty-three patients (31 male, 22 female; mean 44.1 years) with blunt trauma and admission MDCT findings suspicious for pancreatic injury or who underwent MDCT and had a discharge diagnosis of pancreatic trauma were included in this study. Two radiologists reviewed all images and recorded findings suspicious for pancreatic injury, which were subsequently compared to surgical findings to generate diagnostic accuracy. MDCT imaging findings suggestive of pancreatic injury included low attenuation peripancreatic fluid (n = 51), hyperattenuating peripancreatic fluid (n = 13), pancreatic contusion (n = 7), active hemorrhage (n = 2), and pancreatic laceration (n = 16). Diagnostic accuracy of the various imaging findings varied for diagnosing main duct injury; there were highly sensitive, nonspecific imaging findings such as the presence of low attenuation peripancreatic fluid (sensitivity, 100 %; specificity 4.9 %) as well as insensitive, specific findings such as visualizing a pancreatic laceration involving >50 % of the parenchymal width (sensitivity, 50 %; specificity, 95.1 %). In the setting of blunt abdominal trauma, MDCT imaging findings can be grouped into two categories for determining integrity of the main pancreatic duct: indirect, highly sensitive but nonspecific findings and direct, specific but insensitive findings. Awareness of the clinical implications of the various MDCT imaging findings of pancreatic trauma is useful in interpreting their significance.

Letter to the editor: Blind-ending branch of bifid ureter: multidetector CT imaging findings

Free AccessCorrespondenceLetter to the editor: Blind-ending branch of bifid ureter: multidetector CT imaging findingsP K GuptaP K GuptaSearch for more papers by this authorPublished Online:28 Jan 2014https://doi.org/10.1259/bjr/31163090SectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail AboutThe Editor,I read the case report published in the British Journal of Radiology 2011; 84(998):38–40, on “Blind-ending branch of bifid ureter: multidetector CT imaging findings” by E Chang et al, with academic interest. In the present era of imaging, CT is the modality of choice in patients presenting with microscopic haematuria especially when no other sign or symptom is evident. It is appreciable that the learned authors have presented this appropriately as a rare case of such urinary anomaly on MDCT. However, intravenous urography, a conventional approach, could have also given good diagnostic results for surgical management in such cases. It could be an economical and easily available modality with much less radiation to the patient compared with MDCT. We diagnose cases of renal and ureteric duplication and other urinary anomalies on intravenous urography for proper management of patient and relief of their symptoms. One such male patient of 35-years-old presented with right side uretric colic at our hospital and was diagnosed on intravenous urography as ureteric duplication with blind ending.The authors have very rightly described that bifid ureters with blind ending have ureterouretral reflux with asynchronous peristaltic waves (yo-yo ureteric peristalsis). In such cases the contrast should have not been seen at the most cephalad part of the blind ending ureter, instead the filling of this duplicated ureter must be from the caudal to cephalad part as shown in our case (Figure 1). The cephalic segment of this bifid blind ending ureter, in the presented case, must not have been filled completely in 10 min; however, if we look at the images a contrast track can be seen along the right side of the orthotopic right ureter suggest the filling of ureter from caudal to cephalad part of bifid ureter.Figure 1 (a) Right-side bifid ureter filling from caudal to cephalic section, (b) right-side bifid ureter with blind ending. Download Figure The letter is written with the aim that readers of the BJR can appreciate the diagnostic values of IVU, a state of the art modality in radiodiagnosis. This art of conventional radiology, we are losing fast in the era of imaging.Yours etc., Previous article Next article FiguresReferencesRelatedDetails Volume 84, Issue 1004August 2011Pages: 677-e168 2011 The British Institute of Radiology History ReceivedFebruary 16,2011AcceptedMarch 16,2011Published onlineJanuary 28,2014 Metrics Download PDF

Letter to the editor: Blind-ending branch of a bifid ureter: multidetector CT imaging findings

Author's reply The Editor, We appreciate your feedback to our case. We acknowledge and agree that conventional intravenous urography (IVU) could have been used to make the diagnosis, as prior reports indicate. Our institution reflects the general trend and unfortunately the valuable IVU has become under used. The effectiveness of IVU has been proven over time, both in regards to cost and radiation dose to the patient. Often the finding of a blind-ending bifid ureter is noted incidentally and primary pathologies that clinicians are assessing include calculi and neoplasms. Clearly, MDCT has an important role for evaluation of these diseases and has been demonstrated to be far more sensitive. Regarding the asynchronous peristaltic waves that the ureter demonstrates, we believe that contrast was initially seen most cephalad in the blind-ending ureter because one or more cycles of retrograde-antegrade peristalsis had already occurred prior to the imaging at 10 min. It is possible that some portion of the blind-ending ureter was dyskinetic or minimally extrinsically compressed leading to residual contrast remaining at the cephalad-most portion after antegrade peristalsis. Again we appreciate your comments. Yours etc.,

Isolated complete congenital sternal cleft in an adult: MDCT imaging findings

Sternal cleft is a very rare midline defect. Incomplete forms are more common than complete ones. In this challenging anomaly, the underlying mediastinal structures (especially the heart and great vessels) can easily be injured by external trauma. In addition, the deformity is cosmetically unpleasant and quite alarming to the young patient and the patient's family. In this report, we describe the multidetector CT (MDCT) images that demonstrate the complete sternal cleft.

MDCT evaluation of pulmonary embolism in children and young adults following a lateral tunnel Fontan procedure: optimizing contrast-enhancement techniques

Pulmonary embolism (PE) is a life-threatening thromboembolic complication in patients who have undergone a Fontan procedure for augmenting pulmonary blood flow in the setting of single-ventricle physiology. In patients following a Fontan procedure, lack of proper contrast agent mixing in the right atrium and sluggish, low-velocity blood flow within the Fontan circulation often results in suboptimal contrast enhancement within the pulmonary artery for evaluating PE. Unfortunately, there is a paucity of information describing the optimal contrast-enhancement technique with multidetector CT (MDCT) for evaluating PE in children and young adults following a Fontan procedure. We illustrate the MDCT imaging findings of suboptimal contrast enhancement within the pulmonary artery, which can be mistaken for PE, in patients following a lateral Fontan procedure, and we discuss MDCT techniques to optimize contrast enhancement within the pulmonary artery in these patients for evaluating PE. The MDCT imaging findings in pediatric and young adult patients following a lateral Fontan procedure and with clinically suspected PE are illustrated. We describe intravenous contrast agent injection techniques that can be used to optimize the contrast enhancement in the pulmonary artery in patients following a lateral Fontan procedure. The use of a suboptimal contrast-enhancement technique led to initial misdiagnosis and incomplete evaluation of PE in the three patients following a lateral Fontan procedure. Imaging in two patients showed that optimal evaluation of thrombosis in the Fontan pathway and PE in the pulmonary arteries can be successfully achieved with simultaneous upper- and lower-limb injections of contrast agent. This series demonstrates that suboptimal contrast enhancement can result in misdiagnosis or incomplete evaluation of PE in children and young adults following a lateral Fontan procedure. Careful attention to optimizing contrast enhancement during MDCT examination for evaluation of PE in these patients is essential to prevent misdiagnosis and incomplete evaluation.