Multidetector Spiral Computed Tomography Research Articles

Anatomic characteristics of the right internal spermatic vein based on imaging analysis: a retrospective study in southwest China.

The specific anatomic characteristics of the right internal spermatic vein (ISV) are pivotal factors in embolism failure. However, the inherent angles and configurations of the right ISV remain incompletely explored. This study aimed to address this gap by conducting a thorough investigation into the specific anatomic characteristics of the right ISV using imaging analysis in southwest China. This retrospective study analyzed the imaging data of 1000 male patients who underwent multidetector spiral computed tomography (MCT). Anatomic characteristics of the right ISV, including position, type, distance, and angle, were also evaluated. The most common anatomic type (87.8%) of the right ISV was direct drainage into the inferior vena cava, with 90% of the angles below 25.7°. There were 22 cases (2.2%) with parallel right spermatic veins. In the axial plane, the right ISV (86.4%) was located in the third and fourth quadrants. The diameter at the entrance of the right ISV ranged from 2.7-3.8 mm. When the right ISV drained into the inferior vena cava, 83% of cases were located within 40 mm distance below the ostium of the right renal vein, while during draining into the right renal vein, the average distance from the main vein was 6.3 mm. This study concluded that MCT can be used to evaluate the anatomical characteristics of the right ISV. The optimal interventional approach was through the jugular vein route to locate the ISV opening and improve the success rate of the embolization.

The clinical application of 18F-FDG PET/CT in pancreatic cancer: a narrative review.

Pancreatic cancer is one of the worst prognoses of all malignant tumors, with an annual incidence near its annual mortality rate. To improve the prognosis of patients with pancreatic cancer, it is essential to diagnose and evaluate pancreatic cancer early. Imaging examinations play an essential role in tumor detection, staging, and surgical resection assessment and can provide reliable evidence for the diagnosis and treatment of pancreatic cancer. Currently, imaging techniques commonly used for pancreatic cancer include endoscopic ultrasound (EUS), conventional ultrasound, magnetic resonance imaging (MRI), multidetector spiral computed tomography (MDCT), positron emission tomography/computed tomography (PET/CT), and others PET/CT is a new imaging device composed of PET and CT. 18F-Fluorodeoxyglucose (18F-FDG) is a commonly used tracer in the clinic. Cancer cells are more robust than other ordinary cells in that they can ingest glucose, and the structure of glucose is similar to the structure of 18F-FDG. Therefore, after the injection of 18F-FDG, 18F-FDG in tumor cells appears very thick during PET scanning. Therefore, PET/CT can determine the metabolic capacity and anatomical position of pancreatic tumor cells in the body accurately diagnose the patient's condition and tumor location. It plays a vital role in early diagnosis and accurate staging, predicts survival, and monitors therapeutic effectiveness and pancreatic cancer recurrence. Although 18F-FDG PET/CT has limitations in identifying inflammatory diseases and tumors, it still has good development potential. This article reviews the clinical application of 18F-FDG PET/CT in pancreatic cancer.

Клінічний випадок «невидимої» гігантської неорганної заочеревинної пухлини

SummaryBackground. The problem of verification of abdominal and retroperitoneal spacegiant tumors deserves special attention. At first glance, such verification should not bedifficult, but real clinical practice suggests otherwise. Often such a tumor can remainundetected for a long time, despite repeated examinations. This is especially true forliposarcomas, which have a heterogeneous structure, can be perceived duringultrasound as the intestine, which worsens visualization due to flatulence. As a result,patients receive treatment for a long time for various pathologies, the size of the tumorincreases, the prognosis of such patients deteriorates.Materials and methods. The case of a patient with giant retroperitonealliposarcoma is presented in order to draw attention to the importance of cancervigilance for timely diagnosis of the tumor.Results. A 77-year-old male patient was treated for a long time for heart failure(HF) and was repeatedly hospitalized for HF decompensation. The main complaintswere an increase in abdominal volume, flatulence, shortness of breath, impaired qualityof life and decreased tolerance to exercise. Ultrasound examination of the abdominalcavity and retroperitoneal space was performed repeatedly, poor visualization wasexplained by severe flatulence. During the last hospitalization, a very large tumor wasdetected by multidetector spiral computed tomography (MSCT). According to theautopsy, the liposarcoma of gigantic size (approximately 8 kg) was found. The diagnosiswas confirmed histologically.Conclusion. Computed tomography and MSCT is a useful diagnostic tool to verifygiant «invisible» tumors in the abdomen.

Diagnostic ability of multi-detector spiral computed tomography for pathological lymph node metastasis of advanced gastric cancer.

BACKGROUNDThe reliability of preoperative nodal diagnosis of advanced gastric cancer by multi-detector spiral computed tomography (MDCT) is still unclear.AIMTo examine the diagnostic ability of MDCT more precisely by using data on intranodal pathological metastatic patterns.METHODSA total of 108 patients with advanced gastric cancer who underwent MDCT and curative gastrectomy at Kanazawa Medical University Hospital were enrolled in this study. The nodal sizes measured on computed tomography (CT) images were compared with the pathology results. A receiver-operating characteristic curve was constructed, from which the critical value (CV) was calculated by using the data of the first 69 patients retrospectively. By using the CV, sensitivity and specificity were calculated with prospectively collected data from 39 consecutive patients. This enabled a more precise one-to-one correspondence of lymph nodes between CT and pathological examination by using the size data of lymph node mapping. The intranodal pathological metastatic patterns were classified into the following four types: Small nodular, peripheral, large nodular, and diffuse.RESULTSAlthough all the cases were clinically suspected as having metastasis, 81 had lymph node metastasis and 27 had no metastasis. The number of dissected, detected on CT, and metastatic nodes were, 4241, 897, and 801, respectively. The CV obtained from the receiver-operating characteristic was 7.6 mm for the long axis. The sensitivity was 91.4% and the specificity was 47.3% in the prospective phase. The large nodular and diffuse metastases were easy to diagnose because metastatic nodes with a large axis often exhibit these forms.CONCLUSIONThe ability of MDCT to contribute to a nodal diagnosis of advanced gastric cancer was examined prospectively with precise size data from node mapping, using a CV of 7.6 mm for the long axis that was calculated from the retrospectively collected data. The sensitivity was as high as 91%, and would be improved when referring to the enhanced patterns. However, its specificity was as low as 47%, because most of metastatic nodes in gastric cancer being small in size. The small nodular or peripheral type metastatic nodes were often small and considered difficult to diagnose.

Optimal tube potential and tube current for radiation dose reduction in routine adult head computed tomography scanning

ABSTRACTWe proposed a new, optimised scanning parameter that can reduce the patient’s radiation dose while maintaining image quality in a head computed tomography (CT) scan. We evaluated the clinical CT scan parameters (tube voltage, tube current, slice thickness pitch, scan range, rotation time, and CT dose index) for brain CT examination in a total of 52 multi-detector row spiral CTs (SOMATOM Definition AS+, Siemens Healthcare, Germany). The data were analysed, and the range of valid scan parameters was determined clinically using quartile distribution within the 95% confidence interval. The American Association of Physicists in Medicine performance evaluation phantom was used to acquire images using these scan parameters, and new, optimised CT scan parameters were proposed by analysing CT number accuracy, noise, uniformity, spatial resolution, and contrast resolution. The new CT scan parameters proposed were determined as tube voltage 100 kVp and tube current 300 mAs. Compared with conventional clinical scan parameters, tube voltage was reduced by 16.7% and tube current was decreased by 33.3%. Loss in imaging accuracy and uniformity of CT number was less than 20%, loss in noise was less than 40%, and no change in resolution was observed. Conversely, the CT dose index and effective dose was 20%–50%. A new systematic method for clinically assessing the optimised CT scan parameters were proposed, and the effective dose was decreased, with changing exposure conditions.

Computed tomography of the chest: I. Basic principles

### Key points The conventional chest radiograph superimposes a three-dimensional image onto a two-dimensional surface, so limiting its clinical usefulness. Since its introduction in 1971, X-ray computed tomography (CT) has rapidly evolved into an essential diagnostic imaging tool that forms a cross-sectional image, avoiding the super-imposition of structures that occurs in conventional chest imaging, with a >10-fold increase in attenuation sensitivity. Although CT imaging is reported by radiologists, it is important for both anaesthetists and intensivists to be able to interpret the scans, as reporting facilities may not be immediately available. Furthermore, the radiologist may not fully report all facets of a detailed scan and further information may be acquired by a physician with the ability to interpret CT scans. This is the first in a series of two articles written for anaesthetists and intensivists covering both thoracic anatomy and pathology as it relates to CT. A CT scanner makes many measurements, from different rotational angles, of X-ray attenuation ( weakening in force or intensity ) through the cross-sectional plane of the thorax. It then uses these data to reconstruct a digital representation of the cross-section with …

Assessment of Coronary Plaques in Patients With Acute Coronary Syndrome Without Persistent ST-Segment Elevation

to analyze morphological features of atherosclerotic plaques in culprit and non-culprit coronary lesions in patients with non ST-elevation acute coronary syndrome (NSTE-ACS) by multidetector spiral computed tomography (MDCT). RESULTS. In culprit lesions (n = 70) compared to non-culprit lesions (n = 144) frequency of soft plaques (60 vs 43%, p = 0.003), positive remodeling (70.2 vs 54.3%, p = 0.03) and uneven contour (91.7 vs 68.7%, p = 0.0002) were significantly higher. Minimal plaque density was significantly lower and length of plaque was significantly higher in culprit coronary segments (40.1 ± 25.3 vs 74.1 ± 116.8 Hounsfield units [HU], p = 0.02 and 16.8 ± 13.4 vs 13.2 ± 6.9 mm, p = 0.01, respectively). Receiver-operator characteristic curve analysis identified optimal cutoff value of minimum plaque density and length for discrimination between culprit and non-culprit lesion as 40 HU and 13.5 mm, respectively. The combination of soft plaque with a minimal density < 40 HU and uneven contour occurred in one third of culprit lesions and almost two times less in non-culprit (31.67 and 17.91%, respectively, p = 0.04) and was characterized by high specificity (82.1%) and negative predictive value (72.7%). The most specific features of culprit lesions in patients with NSTE-ACS were positive vascular remodeling, length > 13.5 mm, minimal CT-density < 40 HU, soft plaque's type and presence of uneven contour, as well as a combination of the last 3 features.

Pulmonary embolism

Acute pulmonary embolism is an important differential diagnosis of acute chest pain. The clinical signs are often non-specific. However, diagnosis and therapy must be done quickly in order to reduce morbidity and mortality. The new (2014) European guidelines for acute pulmonary embolism (PE) focus on risk-adapted diagnostic algorithms and prognosis adapted therapy concepts. According to the hemodynamic presentation the division in a high-risk group (unstable patient with persistent hypotension or shock) or in non-high-risk groups (hemodynamically stable) was proposed. In the high-risk group the immediate diagnosis is usually done by multidetector spiral computed tomography (MDCT) and primarily the medical therapy of right ventricular dysfunction and thrombolysis is recommended.In the non-high-risk group, this is subdivided into an intermediate-risk group and low-risk group, the diagnosis algorithm based on the PE-pretest probability--determined by validated scores. Moreover, the diagnosis is usually secured by MDCT--the new gold standard in the PE-diagnosis, scores, or it can be primarily ruled out due to the high negative predictive value of D-dimer determination. To improve the prognostic risk stratification in non-high-risk group patients the additional detection of right ventricular dysfunction (MDCT, echocardiography), cardiac biomarkers (troponin, NT proBNP) and validated scores (e.g. Pulmonary Embolism Severity Index) is recommended. Therefore, the intermediate-risk group can be further subdivided. For treatment of non-high-risk group patients, the initial anticoagulation (except those with severe renal insufficiency) using low molecular weight heparin/fondaparinux and conversion to vitamin-K antagonists or alternatively with direct oral anticoagulants (DOAK) is recommended. Hemodynamically stable patients with right ventricular dysfunction and myocardial ischemia (Intermediate-high-risk group patients) but with clinically progressive hemodynamic decompensation may benefit from systemic thrombolysis as well. Due to the high risk of bleeding in the PEITHO study, however, a critical individual risk-benefit evaluation should be done. A dose reduced systemic or local ultrasound-assisted thrombolysis could gain importance in the future. For very selected patients in the low-risk group early outpatient treatment could be considered.The diagnosis and treatment of pulmonary embolism remains complex. Improved algorithms support the diagnosis procedures and therapy decisions. Direct oral anticoagulants are a new first-line therapy alternative for hemodynamically stable non-high-risk patients.

A tumour score with multidetector spiral CT for venous infiltration in pancreatic cancer: influence on borderline resectable

A tumour score for venous invasion in patients with pancreatic adenocarcinoma was evaluated by means of computed tomography (CT), in order to improve the assessment of medical treatment and clinical outcome with special attention to borderline resectable disease. Fifty-six consecutive patients who underwent curative surgical resection for pancreatic cancer were analysed. On the basis of CT criteria, tumour involvement of the portal vein (PV) and superior mesenteric vein (SMV) was graded according to an adapted 4-point scale: score 1, definite absence of invasion; score 2, probable absence of invasion; score 3, probable presence of invasion; score 4, definite presence of invasion. Correlations between the venous infiltration scores and the patients' clinical features were also evaluated. After radiological evaluation of PV and SMV grades of infiltration, 21/56 (37%) and 37/56 (66%) patients, respectively, were found to have borderline resectable disease. The 4-point scale achieved a sensitivity of 80%, a specificity of 96% and an accuracy of 93% in the evaluation of the PV, and a sensitivity of 100%, a specificity of 94% and an accuracy of 95% in the evaluation of the SMV. Analysis of the distribution of clinical characteristics by PV and SMV infiltration showed that both scores correlated with the presence of distal metastasis (p=0.016 and p=0.028, respectively), and resection margins status (p=0.015 and p=0.006, respectively). This adapted tumour score is reliable for assessing venous invasion and might improve preoperative staging in patients with borderline resectable pancreatic cancer.

Addenda Required

The radiation dose of an investigation using multidetector spiral computed tomography (MDCT) with contrast medium is 5–8 mS, which equates to a risk of radiation cancer of 1:103–1:104 (1). The article does not mention that when using MDCT, a pulmonary embolism is actually found in only 20–32% of patients in whom this is suspected.

Assessment of right ventricular dysfunction and the metergasis before and after therapy of thrombolysis with electrocardiography gated multi-detector spiral CT in acute pulmonary embolism

Objective To prospectively assess right ventricular dysfunction and the metergasis before and after therapy of thrombolysis with ECG gated multi-detector spiral computed tomography (MSCT)in patients with acute pulmonary embolism. Methods Triple rule-out ECG gated MSCT examination was performed in 96 consecutive patients suspected of PE. 25 patients with central PE were confirmed. 25 agematched subjects without cardiac and pulmonary disease were recruited as control group. Triple rule-out ECG gated MSCT were performed again to assess cardiac function after therapy of thrombolysis. Dimension ratios for the right ventricle (RV) and left ventricle ( LV), main pulmonary artery and aorta were measured.Furthermore, the RV and LV end-diastolic volumes (EDV), end-systolic volume (ESV) and ejection fraction (EF) were also measured. The mean values were compared with analysis of variance (ANOVA) and Newman-Keuls test before and after thrombolysis. Results The mean values of RVEDV, RVESV, RVEF,RV/LV ESV volume ratio, RV/LV dimension ratio and main pulmonary artery/aorta dimension ratio in control group were (150.5±24.1) ml,(71.5 ±18.5) ml, (53.5 ±4.2)%, 1.08 ±0.04, 1.01 ±0.04 and 0. 99 ±0. 02, respectively. While those in PE group were ( 190. 3 ± 16. 2) ml, ( 128. 1 ± 13.2) ml,(32.7 ± 3.6 ) %, 2.00 ± 0.26, 1.30 ± 0. 09 and 1.34 ± 0. 11, respectively. Those after therapy of thrombolysis were ( 159. 2 ± 21.5 ) ml, ( 80. 7 ± 9.4) ml, (49. 2 ± 5.9) %, 1.22 ± 0.25, 1.02 ± 0.02 and 1.02±0.11,respectively. ESV and EDV of RV were larger (q= 6.28, P<0.01; q=7.59, P<0.01),EF value was lower (q = 4. 82, P < 0.01 ) in PE group than those in control group. RV/LV ESV volume ratio, the RV/LV dimension ratio and main pulmonary artery/aorta dimension ratio were larger ( q = 6. 04,P <0. 01; q =4. 43, P <0. 01; q =4. 36, P <0. 01 ) and EDV of LV was lower in PE group than those in control group. However, ESV and EDV of RV and RV/LV ESV volume ratio were lower (q = 5.03, P <0.01;q=6. 11,P<0.01;q=4.74,P<0.01), EF value was larger (q=6.29, P<0.01) and EDV of LV was larger(q =4.01 ,P <0.01 ) after therapy of thrombolysis than before. Conclusion Retrospective triple rule-out ECG-gated MSCT can show pulmonary embolism, measure the function of RV and LV and evaluate curative effect of thrombolysis. Key words: Pulmonary embolism; Ventricular function, right; Embolization, therapeutic; Tomography, X-ray computed

Hepatitis B virus‐induced liver fibrosis and cirrhosis: The value of liver and spleen volumetry with multi‐detector spiral computed tomography

To study the correlation of liver and spleen volume with the degree of liver fibrosis and cirrhosis induced by hepatitis B virus infection. 128 participants who had undergone liver and spleen volumetry were enrolled. The control group consisted of 41 participants who were potential living liver donors. The liver fibrosis group consisted of 63 histologically proved liver fibrosis patients who were further divided into two subgroups: 44 patients with slight liver fibrosis, and 19 patients with advanced liver fibrosis. The liver cirrhosis group consisted of 24 patients. The following parameters were determined by multi-detector spiral computed tomography (MSCT) examination: total liver volume (TLV), right liver lobe volume (RV), left lateral liver segment volume (LLV), left medial liver segment volume (LMV), caudate lobe volume (CV), and spleen volume (SV). The ratios of CV to TLV (C/T), RV to TLV (R/T), LLV to TLV (LL/T), LMV to TLV (LM/T), and SV to TLV (S/T) were calculated. TLV, RV, LMV tended to decrease and SV, C/T, S/T tended to increase gradually with the increased degree of fibrosis. C/T >or= 3.34% and S/T >or= 47.36% were identified as the cut-off values of fibrosis >or=F3 (advanced liver fibrosis) and cirrhosis, respectively. Their sensitivities were 68.4% and 87.5% and their specificities were 59.1% and 89.5%, respectively. Variations in liver and spleen volume correlated with the degree of liver fibrosis and cirrhosis and could be used in the non-invasive follow-up of the development of liver fibrosis.

Multidetector-Row Computed Tomography in the Evaluation of Transjugular Intrahepatic Portosystemic Shunt Performed with Expanded-Polytetrafluoroethylene-Covered Stent-Graft

We assessed, in a prospective study, the efficacy of multidetector spiral computed tomography (MDCT) in the evaluation of transjugular intrahepatic portosystemic shunt (TIPS) patency in patients treated with the Viatorr (Gore, Flagstaff, AZ) expanded-polytetrafluoroethylene (e-PTFE)-covered stent-graft. Eighty patients who underwent TIPS procedure using the Viatorr self-expanding e-PTFE stent-graft were evaluated at follow-up of 1, 3, 6, and 12months with clinical and laboratory tests as well as ultrasound-color Doppler (USCD) imaging. In case of varices, upper gastrointestinal endoscopy was also performed. In addition, the shunt was evaluated using MDCT at 6 and 12months. In all cases of abnormal findings and discrepancy between MDCT and USCD, invasive control venography was performed. MDCT images were acquired before and after injection of intravenous contrast media on the axial plane and after three-dimensional reconstruction using different algorithms. MDCT was successfully performed in all patients. No artefacts correlated to the Viatorr stent-graft were observed. A missing correlation between UCSD and MDCT was noticed in 20 of 80 (25%) patients. Invasive control venography confirmed shunt patency in 16 (80%) cases and shunt malfunction in 4 (20%) cases. According to these data, MDCT sensitivity was 95.2%; specificity was 96.6%; and positive (PPV) and negative predictive values (NPV) were 90.9 and 98.2%, respectively. USCD sensitivity was 90%; specificity was 75%; and PPV and NPV were 54.5 and 95.7%, respectively. A high correlation (K value=0.85) between MDCT and invasive control venography was observed. On the basis of these results, MDCT shows superior sensitivity and specificity compared with USCD in those patients in whom TIPS was performed with the Viatorr stent-graft. MDCT can be considered a valid tool in the follow-up of these patients.

Progression of coronary calcification in pediatric chronic kidney disease stage 5

Coronary artery calcification (CAC) is common in adults with chronic kidney disease (CKD) and progresses with time. However, data are limited for younger patients. We have previously reported CAC in eight of 53 children with CKD. After 2 years, CAC evaluation was repeated in 48 patients. The median CAC score (CACS) increased from 101.3 (1473.6 +/- 1978.6, range 8.5-4332) to 1759.2 (2236.4 +/- 2463.3, range 0-5858) Agatston units (AU). When the individual changes in CACS were evaluated one by one, we showed a mild decrease in two patients on hemodialysis (HD) and in one transplant (Tx) recipient, a moderate increase in one patient on HD, one on peritoneal dialysis (PD) and one Tx recipient, and a large increase in one HD patient. Also, CAC disappeared in one HD patient. All patients with no calcification at baseline remained calcification-free at follow-up. To obtain the individual cumulative exposure, we calculated time-averaged mean values, using the laboratory values from the beginning of dialysis to the first and second multidetector spiral computed tomography (MDCT) scans (baseline and final values, respectively). Final CACS was positively related to final calcium-phosphorus (CaxP) product, while CAC progression was inversely associated with final serum albumin level. This report is the first study with the largest number and the youngest cohort to document the natural history of coronary calcification.

Clinical Significance of Calcification in Ascending Aorta as a Marker for the Requirement of Coronary Revascularization

Vascular or valvular calcification is a manifestation of atherosclerosis. The aim of this study was to clarify the association between calcification in the vascular or valvular area and significant coronary stenosis; that is, the requirements of coronary revascularization (CR), and to analyze the most associated marker among those valuables. A total of 253 consecutive patients underwent multi-detector spiral computed tomography (MDCT) to diagnose coronary artery stenosis. We quantitatively and qualitatively analyzed calcification in vascular (coronary artery, thoracic ascending and descending aorta) and valvular (mitral and aortic valve) areas. Of 253 patients, 56 with suspected coronary artery stenosis or who had heavy calcification that precluded a diagnosis of lumen stenosis underwent selective coronary angiography. Coronary artery stenosis was significant in 47 patients, of whom 40 underwent CR. The calcification score revealed a significant association between any two sites. Univariate analysis revealed that CR patients showed significantly more calcification at sites other than the aortic valve and a significantly higher calcium score at 3 vascular beds. Multivariate analysis revealed that the presence of calcification in the ascending aorta and a calcium score > 103.8, a cut-off value determined by receiver-operating characteristics (ROC) curve analysis, for the coronary artery were independent factors for CR. Calcification at sites other than the aortic valve was significantly related to CR (+). The presences of calcification in the ascending aorta and a calcium score > 103.8 for the coronary artery were independently associated with CR.

Functional imaging in the assessment of myocardial infarction: MR imaging vs. MDCT vs. SPECT

Purpose To intraindividually compare magnetic resonance (MR) imaging, ECG-gated multi-detector spiral computed tomography (MDCT) and gated single photon emission computed tomography (SPECT) for the evaluation of global and regional myocardial function and the identification of myocardial perfusion abnormalities. Materials and methods Nine patients (8 men; 55.1 ± 8.9 years) with a history of myocardial infarction (MI) were included in this retrospective study. All patients had undergone segmented k-space steady state free precession MR imaging, 99mTc-MIBI gated myocardial perfusion SPECT and contrast enhanced ECG-gated 16-MDCT. Ventricular volumes and ejection fraction (EF) were calculated. Left ventricular (LV) wall motion at rest was analyzed. For SPECT and arterial phase MDCT perfusion abnormalities were assessed. Data was compared with Lin's concordance–correlation coefficient ( ρ c), Bland–Altman plots and kappa statistics. Results For EF, there was an excellent concordance and correlation ( ρ c = 0.99) between SPECT (EF = 41.7 ± 10.4%), MDCT (EF = 42.2 ± 11.1%), and MR imaging (EF = 41.9 ± 11.4%). Considering MR imaging as standard of reference, MDCT ( κ = 0.86) is superior to SPECT ( κ = 0.51) for the assessment of the regional wall motion at rest. There was a good agreement between SPECT and MDCT regarding the detection of perfusion abnormalities ( κ = 0.62). Conclusion MDCT, MR imaging, and SPECT allow for the reliable assessment of global and regional left ventricular function in patients with a history of MI. MDCT also allows to some extent for the detection of perfusion abnormalities. With its potential to assess both, the coronary arteries as well as the myocardium, MDCT a promising modality for the comprehensive diagnostic work-up in patients with suspected myocardial ischemia.

Comparison of MR-arthrography and CT-arthrography in hyaline cartilage-thickness measurement in radiographically normal cadaver hips with anatomy as gold standard

To compare magnetic resonance (MR)-arthrography and multidetector-spiral-computed-tomography (MDSCT)-arthrography in cartilage-thickness measurement, in hips without cartilage loss, with coronal anatomic slices as gold standard. Institutional review board permission to study cadavers of individuals who willed their bodies to science was obtained. Two independent observers measured femoral and acetabular cartilage thicknesses of 12 radiographically normal hips (six women, five men; age range, 52-98 years; mean age, 76.5 years), on MDSCT-arthrographic and MR-arthrographic reformations, and on coronal anatomic slices, excluding regions of cartilage loss. Inter- and intraobserver reproducibilities were determined. Analysis of variance (ANOVA) was used to test differences between MR-arthrographic and MDSCT-arthrographic measurement errors compared to anatomy. By MR-arthrography, cartilage was not measurable at approximately 50% of points on sagittal and transverse sections, compared to 0-6% of the points by MDSCT-arthrography. In the coronal plane, the difference between MDSCT-arthrographic and MR-arthrographic measurement errors was not significant (P=0.93). In the coronal plane, MR-arthrography and MDSCT-arthrography were similarly accurate for measuring hip cartilage thickness.

Efficacy of culprit plaque assessment by 64-slice multidetector computed tomography to predict transient no-reflow phenomenon during percutaneous coronary intervention

It has been reported that multidetector spiral computed tomography (MDCT) allows the classification of coronary plaques by measuring computed tomography (CT) density values. However, the impact of CT density values in culprit lesions on the occurrence of transient no-reflow during percutaneous coronary intervention (PCI) has not been investigated. The study population consisted of 51 consecutive patients who were diagnosed as having coronary artery disease by 64-slice MDCT before PCI. The CT density values were measured in multiple cross-sectional images along the plaque by 5-pixel regions of interest at multiple sites in the culprit plaque. The measurements were performed by 2 physicians who were unaware of the outcome of PCI. In addition, we describe a new observation noted on MDCT: from the formal resemblance to a ring, we dubbed these images as showing a "signet ring-like appearance." Of the total 51 patients, 9 had transient no-reflow during the procedure. There was a significant difference in CT density of the culprit plaque between patients with transient no-reflow and those without (67.0 +/- 10.1 vs 97.8 +/- 37.2 Hounsfield units, P = .018). In addition, a signet ring-like appearance was observed more frequently in patients with transient no-reflow (55.6% vs 16.7%, P = .013). By multivariate analysis, low CT density value and ejection fraction were identified as independent predictors of transient no-reflow. The assessment of plaque characteristics by MDCT might be useful for the prediction of transient no-reflow during PCI.

Multidetector spiral CT venography in the diagnosis of upper extremity deep venous thrombosis

Upper extremity deep vein thrombosis is a rare thrombotic disorder (1-4% of all DVT) which has the potential for considerable morbidity. We present a case which demonstrates the limitations in diagnostic accuracy of ultrasonography in the diagnosis of upper extremity deep venous thrombosis. Multidetector spiral computed tomography (CT) continues to evolve as a state of the art imaging modality and our case demonstrates the role and value of multidetector spiral CT venography (CTV) in the diagnosis of upper extremity deep venous thrombosis.

Coronary artery disease cannot be reliably evaluated by 16-slice multidetector spiral computed tomography

Objectives. Angiography by selective catheterization is the standard method for coronary artery imaging but carries a risk of rare, but serious complications. We investigated whether 16-slice multidetector spiral computed tomography (MDCT) could substitute for selective angiography for evaluation of coronary artery disease in surgically revascularized patients. Design. In a setting closely resembling routine clinical practice, 45 patients who had been operated with coronary artery bypass grafting 508–1135 (mean 811) days before were examined with MDCT and conventional selective angiography on the same day. The interpreters were blinded to the results of the parallel imaging modality. Results. Significant pathology (stenosis ≥50% or occlusion) in the larger coronary artery segments was detected by MDCT with a sensitivity of 70–98% (mean 87%) and a specificity of 0–37% (mean 21%). MDCT failed to identify three of ten left main stem stenoses. Conclusion. Sixteen-slice MDCT cannot routinely replace selective angiography for evaluation of coronary artery disease.