Multidetector-row Computed Tomography In Patients Research Articles

Differences in airway structural changes assessed by 3-dimensional computed tomography in asthma and asthma–chronic obstructive pulmonary disease overlap

BackgroundAsthma–chronic obstructive pulmonary disease (COPD) overlap (ACO) is a clinical phenotype sharing features of asthma and COPD. Multidetector row computed tomography (MDCT) can be used to evaluate the airway structure; however, differences between asthma and ACO seen on MDCT are poorly understood. ObjectiveTo investigate the difference in airway structural between asthma and ACO, using MDCT in patients with clinical asthma. MethodsSixty-four patients with asthma were allocated to an asthma group (never smokers and ex-smokers with a smoking history of < 10 pack-years) or an ACO group (patients with a ≥10-pack-year smoking history and forced expiratory volume in 1 second [FEV1]/forced vital capacity [FVC] < 0.7). The asthma group was further divided into patients with airflow limitation (AL; FEV1/FVC < 0.7) and those without AL. Wall thickness (WT) and airway inner luminal area in the third-generation to fifth-generation bronchi were evaluated using MDCT in both study groups and in 29 healthy controls. ResultsForty-three patients were included in the asthma group (20 with AL, 23 without AL) and 16 in the ACO group. Patients with asthma and ACO had significantly greater WT than the healthy controls. WT in the third-generation bronchi was significantly greater in the ACO group than in the asthma group. The ACO group and the asthma with AL group were matched for age, disease duration, and FEV1/FVC. The WT in the third-generation bronchi was still greater in the ACO group than in the asthma with AL group. ConclusionPatients with ACO have a thicker airway wall than those with asthma, suggesting that airway remodeling is more prominent in ACO than in asthma.UMIN Clinical Trials Registry (UMIN-CTR) system (http://www.umin.ac.jp/ctr/UMIN000028913).

Systematic evaluation of collateral pathways to the artery of Adamkiewicz using computed tomography.

Preoperative identification of the artery of Adamkiewicz can help prevent postoperative spinal cord injury in patients undergoing thoracic and thoraco-abdominal aortic aneurysm repair. Although several studies have shown the feasibility of evaluating the artery of Adamkiewicz using multidetector row computed tomography (MDCT), no detailed investigations regarding the collateral circulation to the artery of Adamkiewicz have been performed. The purpose of this study was to investigate the collateral circulation to the artery of Adamkiewicz using MDCT in patients with thoracic and thoraco-abdominal aortic aneurysms. Our institutional review board approved this study. Sixty-four patients with descending thoracic and thoraco-abdominal aortic aneurysms associated with the occlusion of the segmental artery from which the artery of Adamkiewicz originated were scanned using 64- or 320-detector row computed tomography. Two independent observers evaluated the MDCT images based on the degree of visualization of the artery of Adamkiewicz and its collateral circulation using a 4-point scale. The average visualization score was 2.8 ± 0.6. In 53 of the 64 (83%) patients, image quality was judged to be diagnostic. MDCT demonstrated 75 collateral pathways to the artery of Adamkiewicz in these 53 patients. Sixty-four of the 75 (85%) pathways were collaterals around the spinal column, and the remaining 11 (15%) pathways were collateral arteries in the thoracic wall. MDCT revealed the collateral pathways to the artery of Adamkiewicz around the spinal column and in the thoracic wall in 83% of our patients with thoracic and thoraco-abdominal aortic aneurysms.

Evaluation of myocardial infarction patients after coronary revasculation by dual-phase multi-detector computed tomography: Now and in future

Multidetector-row computed tomography (MDCT) has become one of the major tools in diagnosing and evaluating patients with coronary artery disease in recent years. In selected patients, MDCT has been shown to provide more reliable accuracy in detection of stent patency than invasive coronary angiography. Chiou et al reported a delicate infarcted myocardium at-risk score. According to their results, the MDCT-based myocardium at-risk score had a good correlation with the thallium 201 ST-segment elevation myocardial infarction-based summed difference score (r = 0.841, P < 0.001). They claimed that dual-phase MDCT is useful in detecting different patterns of obstructive lesions and the extent of myocardium at risk. In this commentary, we discuss the current status of the clinical application of MDCT in patients with myocardial infarction in relation to evaluating the myocardial perfusion defect, detecting reversible myocardial ischemia, assessing myocardial viability, estimating target lesion restenosis, and calculating of fractional flow reserve from MDCT.

Detection of pulmonary embolism using 64-slice multidetector-row computed tomography: accuracy and reproducibility on different image reconstruction parameters

Direct comparison of different image reconstruction parameters to detect pulmonary embolism (PE) using 64-slice multidetector-row computed tomography (MDCT) is absent and the most accurate image reconstruction parameters have not yet been proven. To compare different image reconstruction parameters for detecting PE using 64-slice MDCT in patients suspected of having an acute PE. Forty patients who underwent pulmonary CT angiography with 64-slice MDCT for a suspected PE were included. Different image reconstruction parameters were used for each patient: axial and coronal images with slice thicknesses of 0.625 mm, 1.3 mm, and 2.5 mm and axial maximum intensity projection (MIP) images with slab thicknesses of 1.3 mm, 2.5 mm, and 5 mm. Four experienced radiologists reviewed the images. The diagnosis of a PE was based on consensus review of axial 0.625 mm slice thickness images by two chest radiologists with allowing multiplanar reconstruction. Accuracy and reproducibility (kappa value) were evaluated. In 15 of 40 patients, a PE was diagnosed. For detecting lobar PEs, axial images with a slice thickness of 1.25 mm and all coronal re-formatted images showed comparable results to axial images with a slice thickness of 0.625 mm. For detecting segmental PEs, axial images with a slice thickness of 1.25 mm and coronal images with a slice thickness of 0.625 mm re-formatted images showed comparable results to axial images of a slice thickness of 0.625 mm. For detecting subsegmental PEs, axial images with a slice thickness of 0.625 mm showed the highest sensitivity. Better reproducibility was obtained when the thinner slice thickness reconstructions were in axial and coronal images. However, reproducibility of MIP images with slab thicknesses of 2.5 mm and 5 mm was similar for detecting segmental and subsegmental PEs. Thin-slice reconstruction of less than 1 mm is mandatory for visualization of PE at the subsegmental level.

Significance of Serum High-Density Lipoprotein Cholesterol Levels for Diagnosis of Coronary Stenosis as Determined by MDCT in Patients with Suspected Coronary Artery Disease

Since we previously reported that lower levels of HDL-C may be most useful for predicting coronary artery disease (CAD) as assessed by multi-detector row computed tomography (MDCT), we sought to confirm, among the levels of LDL-C, HDL-C, non-HDL-C (total cholesterol minus HDL-C) and the ratio of LDL-C to HDL-C (LDL-C/HDL-C), which is most closely related to the presence of CAD. The subjects consisted of 506 consecutive patients with suspected CAD who underwent MDCT with (+) or without (-) statin treatment. The levels of LDL-C in the statin (-) group were similar in categories I, II and III according to the Japan Atherosclerosis Society (JAS) Guidelines 2007, whereas the levels of HDL-C significantly decreased and LDL-C/HDL-C significantly increased as the category number increased. In the statin (-) group, the prevalence of CAD in categories I, II and III was 0, 16 and 33%, respectively (p=0.0018 for trend), in patients with good control of LDL-C levels according to the Guidelines. Multivariate logistic regression analysis was per-formed to examine the association between the presence of CAD and 11 possible factors. Age and HDL-C in the statin (-) group, and HDL-C in the statin (+) group were identified as significant independent variables that correlated with the presence of CAD. Receiver-operating characteristic curve analysis in the statin (-) and statin (+) groups showed a higher area under the curve for HDL-C than for LDL-C, non-HDL-C or LDL-C/HDL-C. In particular, the cut-off levels of HDL-C with the greatest sensitivity and specificity for the diagnosis of CAD in the statin (+) group were 55 mg/dL (sensitivity 0.816, specificity 0.510). HDL-C levels are most closely associated with the presence of CAD. In particular, we need to perform coronary CT for suspected CAD patients with lower HDL-C levels under statin treatment.

Comparison of preoperative whole‐body positron emission tomography with MDCT in patients with primary colorectal cancer

Preoperative use of emission tomography with(18)F-fluorodeoxyglucose (FDG-PET) in patients with primary colorectal cancer remains controversial. This study evaluated the additional value of FDG-PET in comparison with routine multidetector row computed tomography (MDCT) in patients with primary colorectal cancer. Retrospective analysis was performed in 65 patients with colorectal cancer who underwent whole-body FDG-PET. Results of FDG-PET were compared with routine preoperative evaluation by MDCT regarding detection of primary tumour, lymph node involvement and distant metastases. All images were evaluated before surgery. Tumour detection rate was 100% (63/63) for MDCT and 98% (62/63) for FDG-PET. Lymph node involvement was pathologically confirmed in 35 patients. MDCT and FDG-PET displayed sensitivities of 89% (31/35; 95% CI: 73-97%) and 43% (15/35; 95% CI: 26-61%) and specificities of 52% (11/21; 95% CI: 30-74%) and 95% (20/21; 95% CI: 76-100%), respectively. Liver metastases were present in 22 patients. MDCT and FDG-PET showed accuracies of 98% (64/65; 95% CI: 92-100%) and 97% (63/65; 95% CI: 89-100%), respectively. FDG-PET detected additional extrahepatic metastatic lesions and affected treatment plan compared with MDCT in 10 patients. Preoperative FDG-PET is not superior to MDCT for detection of primary tumour, lymph node involvement or liver metastases, but may have potential clinical value in patients with advanced colorectal cancer by detecting extrahepatic distant metastases.

Assessment of Coronary Stenosis by a 16-Slice MDCT Scanner in Asymptomatic Diabetic Patients Starting Dialysis Therapy

Background: The accuracy for the detection of coronary stenosis by multidetector row computed tomography (MDCT) has been getting more recognition. However, the usefulness of MDCT in patients with chronic kidney disease (CKD) has not been confirmed. Methods: Weanalyzed 19 consecutive patients with asymptomatic diabetic CKD who underwent both MDCT and coronary angiography (CAG) at the initiation of dialysis. The definition of stenosis in this study was lesions with ≧50% stenosis by CAG. Results: CAG revealed stenosis in 35 of 76 branches in 19 patients. Vessel diameter could not be evaluated by MDCT in 11 (14%) major vessels because of motion artifacts, pericardial effusion, pleural effusion, and severe calcification. Almost all of such lesions were located in the right coronary (4/11; 36%) or left circumflex (5/11; 45%) artery. The sensitivity, specificity, positive and negative predictive values of MDCT for a diagnosis of stenosis in the 65 evaluable major vessels were 86, 81, 78, and 88%, respectively. The severity of vessel calcification was increased in a stepwise manner with increments in the proportion of major vessels with ≧50% stenosis (p = 0.004 for trend). Conclusion: MDCT seemed to be an effective non-invasive method of screening patients with diabetic CKD for CAD.