Multislice CT Research Articles

Role of Multi-slice CT Coronary Angiography and Coronary Arteries Calcium Score in Evaluating Patients with Anginal Pain.

Role of Multi-slice CT Coronary Angiography and Coronary Arteries Calcium Score in Evaluating Patients with Anginal Pain.

Study the variations in radiation doses in different multi-slice CT scan machines

Objectives: This study aimed to measure variations in dose output and patient’s effective dose across the different computed tomography scanners during standard CT examinations of head, chest and abdomen, so as to determine patient, and machine settings that contribute to variations in radiation dose to optimize patient effective dose. Methods: Retrospective, study performed in different hospitals, in Najran province (K.S.A) from October 2022 to June 2023. The study comprise 360 adults CT examinations. The mean values of CT dose index volume (CTDIvol) and dose length product (DLP) were measured. The patient effective dose (ED) were calculated for each protocol and compared among different CT scanners. Results: The mean values of CTDIvol , DLP, and ED, varied across the different CT scanners, Regarding abdomen CT, the CTDIvol mean values were (5.56 mGy to 18.655 mGy) , the DLP (289.78 to 968.241 mGy/cm), and mean effective doses were (4.34 to 14.5 mSv), in chest CTs the mean values of CTDIvol were (5.05 to 14.39mGy), the DLP were (202.84 to 499.098mGy/cm), and median effective doses were (2.85 to 6.97 mSv), in head CTs the mean values of CTDIvol were (42.4to 68.278mGy), the DLP were (781 to 1209.18mGy/cm), and effective doses were (1.636 to 2.528mSv). Conclusion: Regarding selected exams, CTDI, DLP and ED were found to be varied from low variations in head CT scan, to medium in chest CT scan and high variation in abdomen CTs among different CT scanners, The highest values of CTDI and DLP were noted in head CTs followed by abdomen, and the lowest were in chest CTs. The most factors affected the CT dose variations were the technical parameters settings, mainly the number of slices, however the scanner specifications reported some impact. Optimizing dose to a reliable standard for each anatomical part should be adjusting independently by each department according to the scanner characteristics, settings and patient factors.

Coronary Artery Fistula: A Diagnostic Dilemma.

Coronary artery fistula (CAF), although one of the rare coronary anomalies, is becoming increasingly more detectable in the recent years due to advancements in cardiac diagnostic imaging. Its long-term prognostic implications and importance for the cardiovascular system remain a dilemma for cardiologists and patients. Based on a variety of haemodynamic symptoms and complications, cardiologists must be aware of the characteristics of CAF and the diagnostic importance of multi-slice CT in evaluation, pre-procedural management and follow-up. Both surgical and percutaneous options are available for symptomatic patients or those with complications, while management of asymptomatic CAF remains a viable alternative.

The Possibilities of Standard Radiography with the Use Processing Radiographic Images and Multisection Computed Tomography when Planning a Reverse Total Shoulder Arthroplasty

The aim of the study was to compare the informative value of standard radiography of the shoulder joint using computer processing software with the capabilities of multislice computed tomography (MSCT) before surgery in the volume of reverse total shoulder arthroplasty. The radiographs of shoulder joints in standard projections and computed tomograms of 30 patients who were observed with the consequences of shoulder joint injuries before surgery in the volume of reverse total shoulder arthroplasty. It is clearly shown that the use of specialized software provides additional information when choosing the size of the shoulder component of the endoprosthesis, allows for virtual restoration of the anatomy of the proximal humerus with severe post-traumatic deformation and limited mobility of the shoulder joint. However, during the program processing of X-ray images of the shoulder joint, no additional information was obtained when evaluating the geometric parameters of the shoulder blade glenoid. The data on the geometric characteristics of the glenoid, established using specialized software, were comparable with the results of image processing carried out in manual mode. Reliable characteristics, most important for preoperative planning of the positioning of the glenoid component of the endoprosthesis, could be obtained only by the results of MSCT.

Comparative Reproducibility Analysis of Thoracic Aorta Morphometric Parameters According to Computed Tomography and Magnetic Resonance Angiography

Objective: to compare intra- and inter-operator reproducibility of thoracic aorta (ThAo) morphometric parameters, calculated by multislice computed tomography (MSCT) and magnetic resonance imaging (MRI).Material and methods. The prospective study included 20 patients with ascending aorta (AAo) dilatation (≥45 mm). All patients underwent MSCT- and MRI-angiography in electrocardiogram-gated mode. Mean diameter (Dmean) and cross-sectional area (CSA) were measured at different ThAo levels in the systole and diastole along the inner contour of the vessel. All measurements were performed by two radiologists. Each of them took measurements twice at an interval of at least 1 month. The reproducibility of repeated measurements was studied using intraclass correlation coefficient. Results. The analysis of the systolic frame revealed significant differences between the methodsfor measuring Dmean (MRI: 42.5 (41.0–47.8) mm; MSCT: 37.7 (34.7–40.3) mm; p = 0.003) and CSA at the level of the sinotubular junction (MRI: 14.8 (12.7–17.9) cm2; MSCT: 11.4 (10.3–13.3) cm2; p = 0.009), AAo CSA(MRI: 17.6 (14.6–20.8) cm2; MSCT: 19.6 (16.7–21.5) cm2; p = 0.035) and Dmean at the level proximal to left subclavian artery (LSA) (MRI: 31.5 (31.0–34.0) mm; MSCT: 31.7 (27.3–32.9) mm; p = 0.041). For the diastolic frame, significant differences between the methods were observed when measuring AAo CSA (MRI: 17.0 (14.5–19.7) cm2; MSCT: 19.7 (15.3–21.8) cm2; p = 0.025), Dmean (MRI: 30.5 (29.3–32.8) mm; MSCT: 29.8 (27.1–31.3) mm; p = 0.05) and CSA at the level proximal to LSA (MRI: 7.5 (6.9–7.9) cm2; MSCT: 7.4 (5.9–7.8) cm2; p = 0.007), as well as CSA at the left atrium level (MRI: 4.9 (4.2–5.0) cm2; MSCT: 5.1 (4.67–5.5) cm2; p = 0.042). For MSCT-angiography, good intra- and inter-operator reproducibility of measurements at all ThAo levels was obtained. For MRI-angiography, there was a strong intra- and interoperator variability in determining Dmean and CSA at the levels of aortic arch and descending aorta.Conclusion. Aortic cross-sectional area showed the best intra- and inter-operator reproducibility and comparability of measurements between MSCT- and MRI-angiography

Transcatheter Aortic Valve Implantation for Bicuspid Aortic Valve Disease: Procedural Planning and Clinical Outcomes.

Bicuspid aortic valve (BAV) is the most common congenital heart disease, with a prevalence of 1-2% and occurring in >20% of octogenarians referred for aortic valve replacement. However, BAV patients have been systematically excluded from pivotal randomized trials. Since TAVI indications are moving toward low-risk patients, an increase in the number of BAV patients who undergo TAVI is expected. BAV represents a challenge due to its unique morphological features (raphe, extreme asymmetrical valve calcifications, cusp asymmetry and aortopathy) and the lack of consensus about the accurate sizing method. The role of multi-slice computed tomography (MSCT) in the planification of the TAVI procedure is well-established, being useful to define the optimal valve sizing and the implantation strategy. New-generation devices, more experience of the operators and better planification of the procedure have been associated with similar clinical outcomes in bicuspid and tricuspid patients undergoing TAVI.

Dobutamine stress echocardiography remains indispensable for the diagnosis of low-flow low-gradient severe aortic stenosis

Abstract Background In patients with low-gradient aortic stenosis (AS) and low transvalvular flow, current guidelines recommend dobutamine stress echocardiography (DSE) to determine valve stenosis severity. Additionally, aortic valve calcification (AVC) scores are also used with this intent. Previous studies have determined cut-off values of ≥2000AU for men and ≥1200AU for women to distinguish between true severe AS and pseudosevere AS. Purpose To assess the relationship between AVC and DSE in low-flow low-gradient aortic stenosis. Methods We performed a multicenter international registry study including patients that underwent DSE to determine AS severity and multi-slice computed tomography (MSCT) of sufficient quality to determine AVC scores. Severe AS was diagnosed when resting peak aortic valve velocity was ≥4.0 m/s, or stress aortic valve area (AVA) remained <1.0cm2 at peak dobutamine stress levels; moderate AS was diagnosed when resting AVA was ≥1.0cm2 and peak velocity was < 4.0m/s or stress AVA exceeded 1.0cm² at peak stress. Using the previous cut-off values, MSCT-AVC scores were compared to DSE-derived AS diagnoses to determine sensitivity and specificity of AVC, and the positive and negative predictive values of high and low scores. Subsequently, we performed a receiver-operating characteristics (ROC)-curve analysis for men and women separately. Results We included 271 patients from 8 centers, of which 231 patients had sufficiently interpretable DSE and MSCT. Median age was 79 years (Interquartile range (IQR): 71-84), median BMI was 26.4 kg/m2 (IQR: 24.1-30.0) and median BSA was 1.9 m2(IQR: 1.8-2.1). Left ventricular ejection fraction was reduced (<50%) in 209 (90.5%) patients. Bicuspid valve morphology was present in 20 patients (8.7%). DSE confirmed severe AS in 103 patients, 4 of whom already had resting peak aortic valve velocity ≥4.0m/s. Moderate AS was diagnosed in 128 patients, of which 76 had a resting AVA ≥ 1.0cm2. Characteristics of these patients are summarized the table. Of the patients with severe AS, 49 (47.6%) had a high AVC score (≥2000 for men or ≥1200 for women) and of patients with moderate AS, 75 (58.6%) had an AVC score below those cut-off values. This corresponds to a sensitivity of 47.6%, a specificity of 58.4% and positive and negative predictive values of 53.5% and 51.6%, respectively. The ROC-curves are shown in the figure; the area under the curve was 0.55 for men and 0.52 for women, signifying poor discriminative performance. Conclusion In this multicenter international registry we found that aortic valve calcification scores correlated poorly with AS severity and therefore DSE remains the preferred technique to assess borderline AS severity.Table.Patient characteristicsFigure.ROC curve

Impact of platelet reactivity on subclinical valve thrombosis in patients treated with TAVR

Abstract Background and introduction High residual platelet reactivity (HPR) in patients undergoing percutaneous coronary intervention with dual antiplatelet therapy (DAPT) is associated with an increased risk of thrombotic events. The relationship between HPR and the presence of subclinical valve thrombosis (SVT) following transcatheter aortic valve replacement (TAVR) is unknown. Purpose The aim of this study was to determine whether HPR is associated with the occurrence of SVT in patients undergoing TAVR treated with DAPT and to determine independent predictors of SVT. Methods This is a prospective, multicentre study. Patients with symptomatic aortic stenosis successfully treated with TAVR followed by DAPT (aspirin + clopidogrel) for 3 months were included. Patients with monotherapy, oral anticoagulation, or severe renal impairment were excluded. For the purpose of the study, platelet reactivity was measured either with Multiplate analyzer or VerifyNow point-of-care assay at baseline, at 1-2 days post, and 1-3 months post-TAVR. HPR was defined as ≥ 468AU, or ≥208PRU, respectively. The primary endpoint was the incidence of SVT measured by multi-slice CT at 3-months post TAVR in relation to HPR. Secondary objectives included the relationship between HPR following TAVR and the incidence of major adverse cardiac and cerebral clinical events (MACCE), to determine whether a pro-thrombotic inflammatory response is associated with the appearance of SVT and to evaluate factors associated with the occurrence of SVT. Results A total of 169 patients were included, the mean age was 81.5±5 and 51% were female. The overall rate of SVT was 22%. Patients with HPR demonstrated a similar incidence of SVT to those without (23,7% vs 33,6%: p=0,29). The overall bleeding rate was 4,9%. No differences in the rate of stroke at 1-year follow-up were observed (no SVT group 1.5% vs SVT group 2.6%: p=0.6). Independent predictors of SVT, were: dyslipemia OR 0,38 (0,15-0,96) p=0,039, creatinine clearance 0.98 (0.96.1.0, p=0.04), self-expandable valve OR 3,57 (1,40-9,06); p=0,006 and prosthesis size 0,78 (0,64-0,96): p=0,009. Patients with SVT expressed increased inflammatory parameters at 6 months compared to those without SVT CD14+ CD16-: 76,6±9,9 vs 70,7±13,9: p=0.02. Conclusion In contrast to coronary interventions, for the first time we have demonstrated that HPR does not appear to be associated with the development of SVT in TAVR patients treated with DAPT.

Decoding calcific mitral valve disease: a novel deep learning model uncovers the role of calcium burden

Abstract Background Mitral annular calcification (MAC) is a common degenerative disease that affects older adults and causes calcium deposition in the mitral annulus, increasing the risk of mitral valve (MV) dysfunction, cardiovascular events, conduction abnormalities, and mortality. While the primary imaging modality recommended for the clinical evaluation of MAC is echocardiography, it has been reported to be found incidentally in approximately 8% of routine thoracic computed tomography (CT) scans. CT scan is a sensitive imaging modality for assessing MAC, providing the resolution necessary to understand the anatomical involvement of calcification. Research has shown that the MAC burden is associated with disease activity and progression. Still, the exact correlation between the quantitative calcium burden and the degree of severity of mitral valve disease is unclear. Purpose Our study aimed to determine the association between MAC, as assessed on CT, and significant mitral stenosis (MS) or mitral regurgitation (MR), as visualised on echocardiography. In addition, we sought to determine the quantitative MAC cutoffs that would optimally predict significant MS or MR on echocardiography. Methods A retrospective cohort study was conducted at our academic centre. Inclusion criteria were: age≥60 years, resting transthoracic echocardiogram performed between 2013-2022, non-gated chest CT performed within one year before echocardiography, and any degree of MAC documented on the echocardiography report. CT scans were requested for clinical indications unrelated to mitral valve disease. Exclusion criteria were: prior mitral valve intervention, endocarditis, and congenital mitral valve disease. Significant calcific mitral valve disease was defined as ≥moderate MR and ≥mild MS on the echocardiography report, ascertained by expert readers based on multiparametric ASE criteria. MAC volume was quantified on the multi-slice CT DICOM images using a 3D U-Net deep neural network previously trained by our group on an independent cohort. Results The cohort consisted of 1,560 unique patients with a mean age of 79 years and 61% females. The echocardiographic prevalence of significant MR and MS was 10% and 4%, respectively, for 211 affected patients. The CT-based mean MAC volume was 949 mm³ in patients with significant MR or MS, as opposed to 334 mm³ in those without (P<0.001). MAC volume >1000 mm³ was the optimal cutoff to predict significant MS (specificity 90%, sensitivity 51%, area under ROC curve 0.79) and significant MR (specificity 89%, sensitivity 21%, area under ROC curve 0.60). Adjusting for age, sex, and comorbid conditions did not affect the observed association between MAC volume and mitral valvulopathy. Conclusion A novel deep learning model for quantifying MAC volume from non-cardiac clinical CT scans was efficient in screening for calcific mitral valve disease, particularly MS, and identifying patients who may benefit from further evaluation.

Quality improvement of images with metal artifact reduction using a noise recovery technique in computed tomography.

In metal artifact reduction (MAR) in computed tomography (CT) based on projection data inpainting, X-ray photon noise has not been considered in the inpainting process. This study aims to assess the effectiveness of a MAR technique incorporating noise recovery in such projection data regions, compared with existing MAR techniques based on projection data normalization (NMAR), including one with frequency splitting (FSNMAR). Phantoms simulating hip prostheses and dental fillings were scanned using a 64-row multi slice CT scanner. The projection data was processed by NMAR and NMAR with noise recovery (NRNMAR); the processed data was sent back to the CT system for reconstruction. For the phantoms and clinical cases with hip prostheses and dental fillings, images were reconstructed without MAR, and with NMAR, NRNMAR, and FSNMAR (incorporated in the CT system). To validate the efficacy of noise recovery, noise power spectra (NPSs) were measured from the images of the hip prosthesis phantom with and without metals. The artifact index (AI) was compared between NRNMAR and FSNMAR. The resultant NPSs of NRNMAR were very similar to those of phantom images with no metals, endorsing the efficacy of noise recovery. The NMAR images had unnatural noise textures and FSNMAR caused additional streaks. NRNMAR exhibited some significant improvements in these respects: It reduced the AI by as much as 66.2-88.6% compared to FSNMAR, except for the case of a unilateral prosthesis. In conclusion, NRNMAR, which simply adds white noise to the projection data, would be effective in improving the quality of CT images with metal artifacts reduction.

Quantitative analysis of zirconia and titanium implant artefacts in three-dimensional virtual models of multi-slice CT and cone beam CT: does scan protocol matter?

Artefacts from dental implants in three-dimensional (3D) imaging may lead to incorrect representation of anatomical dimensions and impede virtual planning in navigated implantology. The aim of this study was quantitative assessment of artefacts in 3D STL models from cone beam CT (CBCT) and multislice CT (MSCT) using different scanning protocols and titanium-zirconium (Ti-Zr) and zirconium (ZrO2) implant materials. Three ZrO2 and three Ti-Zr implants were respectively placed in the mandibles of two fresh human specimens. Before (baseline) and after implant placement, 3D digital imaging scans were performed (10 repetitions per timepoint: voxel size 0.2 mm³ and 0.3 mm³ for CBCT; 80 and 140 kV in MSCT). DICOM data were converted into 3D STL models and evaluated in computer-aided design software. After precise merging of the baseline and post-op models, the surface deviation was calculated, representing the extent of artefacts in the 3D models. Compared with baseline, ZrO2 emitted 36.5-37.3% (±0.6-0.8) artefacts in the CBCT and 39.2-50.2% (±0.5-1.2) in the MSCT models. Ti-Zr implants produced 4.1-7.1% (±0.3-3.0) artefacts in CBCT and 5.4-15.7% (±0.5-1.3) in MSCT. Significantly more artefacts were found in the MSCT vs CBCT models for both implant materials (p < 0.05). Significantly fewer artefacts were visible in the 3D models from scans with higher kilovolts in MSCT and smaller voxel size in CBCT. Among the four applied protocols, the lowest artefact proportion of ZrO2 and Ti-Zr implants in STL models was observed with CBCT and the 0.3 mm³ voxel size.

TCT-292 Regional Disparity of the Bypass Strategy and Graft Patent Rate in the First-in-Man Trial of Coronary Surgical Revascularization Solely Guided on Multislice Computed Tomography

TCT-292 Regional Disparity of the Bypass Strategy and Graft Patent Rate in the First-in-Man Trial of Coronary Surgical Revascularization Solely Guided on Multislice Computed Tomography

The Effect of Using Black Tea as an Alternative Diuretic on Multislice Computed Tomography (MSCT) Urography Examination

The MSCT urography examination requires patient preparation, such as fasting and drinking water.In addition,some hospitals use water,furosemide to accelerate the increase in urine volume.However,Furosemide is a chemical diuretic that is feared to increase the workload of the kidneys. So a natural alternative is needed, namely black tea.This study aims to determine the effect of black tea as an alternative diuretic on the urography MSCT examination. This is quasi-experimental research conducted at RSUD by Dr. Soehadi Prijonegoro Sragen,Central Java. Respondents in this study consisted of 18 outpatients with an MSCT urography examination. These respondents were divided into three groups, namely the group of mineral water, furosemide,and black tea, and three radiology doctors. The scanning process uses MSCT 128 Slice and then tracks MSCT urography with the Curved Multiplanar Reconstruction (MPR) application.Data obtained from observations,questionnaires,and interviews with radiologists was then processed and analyzed using quantitative methods.Normal distributed data was analyzed using the ANOVA test. The results showed a significant difference from the assessment of kidney HU,liver HU, and ureteral dilatation in the mineral water, furosemide, and black tea test groups with sig values.&lt;0.05.Black tea increases Hounsfield Unit (HU) values in the kidneys,lungs,liver,and ureteral dilation, as a tracking picture shown in the Curved Multiplanar Reconstruction(MPR) application. This confirms that black tea can be used as a natural diuretic alternative for some reasons:effective, fast, easy, and inexpensive.It makes it easier to track kidney stones.The operation of curved multiplanar reconstruction(MPR) applications during reconstruction can display more optimal image results to support more accurate diagnostic information.

Osimertinib as First-Line Therapy of Patients with Lung Adenocarcinoma EGFR TKI Mutation from Pleural Fluid Samples: A Case Report

Introduction: Lung cancer is still a major contributor to cancer mortality worldwide. More than 80–85% of cases are constituted by Non-Small Cell Lung Cancer (NSCLC), consisting of approximately 40% adenocarcinomas. The prevalence of T790M mutation also accounts for 30%–50% of resistance to first- and second-generation tyrosine kinase inhibitors (TKI) after 9-12 months of therapy. To overcome this health condition, osimertinib has emerged as a first-line target therapy for lung adenocarcinoma with Epidermal Growth Factor Receptor (EGFR) mutation. Therefore, this study aimed to determine the effectiveness of osimertinib administration as first-line therapy in adenocarcinoma patients with EGFR TKI mutation. Case Presentation: This study presented a case of 60-year-old woman with shortness of breath and cough accompanied by weight loss ± 10 kg in 3 months. Contrast chest MSCT (multislice computed tomography) scan showed a mass in the right lung accompanied by pleural and pericardial effusion. The results of the cytological examination of pleural fluid found a picture of adenocarcinoma. Furthermore, the diagnosis was continued by molecular examination of pleural fluid, and the results of the EGFR Exon 19 mutation were obtained. Based on the results of physical examination and several laboratory tests, a diagnosis of right pleural effusion and EGFR mutation lung adenocarcinoma was established.Conclusions: In this case, there was a clinical improvement after 8 months of osimertinib administration, along with enhancement in the control CT-SCAN. Osimertinib also showed the potential to extend progression-free survival by approximately 18.9 months compared to other generations of tyrosine kinase inhibitor therapy. This result was supported by the improvement of the clinical and performance status of patients in this case during osimertinib administration.

Three-Dimensional Volumetric Investigation of Onodi Cells: A Multi-Slice Computed Tomography Study.

Introduction Onodi cells (OCs) are posterior ethmoid cells that are located above the sphenoid sinus, close to or even surrounding the carotid artery and optic nerve. Objective To investigate and evaluate the volumetric variation of OCs through multi-slice computed tomography (MSCT) scans. Methods We performed a retrospective review of MSCT scans of 79 subjects, 40 male and 39 female patients, Whose age ranged from 18 to 83 (mean: 39.6) years. The volumes of the OCs on the right and left sides were measured using the ITK-SNAP software (open-source) with semiautomatic segmentation. The possible relationships involving age, gender, contact with the optic nerve, extension of the pneumatization of the posterior ethmoid cells into the clinoid processes, mucous thickening in the anterior and posterior ethmoid cells, and obliteration of the sphenoethmoidal complex were analyzed with the Pearson correlation and Chi-squared tests according to the type of data compared and logistic regression models ( p < 0.05). Results We observed that an increase of one unit in the volume of OCs also increases the chance of extension of pneumatization into the clinoid processes by 0.15% ( p = 0.001). No significant correlations were identified regarding age, gender, and volume of the OCs. Conclusion The volume of the OCs has effects on the extension of pneumatization into the clinoid processes.

Compatibility of Local Staging (T) Colorectal Cancer in Multi-Slice Computed Tomography (MSCT) with Histopathology: a Retrospective Study

Compatibility of Local Staging (T) Colorectal Cancer in Multi-Slice Computed Tomography (MSCT) with Histopathology: a Retrospective Study

Studi Kasus Pemeriksaan MSCT Urografi Multiphase dengan Klinis Tumor Ginjal

Background: The procedure for examining multi-slice computed tomography (MSCT) multiphase urography with clinical kidney tumors in the Radiology Installation of the Banyumas General Hospital differs from the literature in the use of scans in the corticomedullary phase and the post-contrast scanning phase. This study aims to determine the procedure for MSCT Urography Multiphase examination with clinical kidney tumors, to find out the reasons for using a scan of the corticomedullary phase area from the diaphragm to the pubic symphysis and to find out the reasons for using four phases of post-contrast scanning.Methods: This type of research is qualitative research with a case study approach. Data was collected at the radiology installation at the Banyumas Hospital from January to May 2023, the study respondents consisted of three radiographers, one radiologist, one sending doctor and one radiology nurse. Methods of data collection by observation, in-depth interviews, documentation. Data analysis was carried out through the stages of data collection, data reduction, data presentation and drawing conclusions.Results: MSCT Urography Multiphase examination procedure with clinical kidney tumors in the radiology installation of Banyumas Hospital includes, the patient's supine feet first position, scanning area from the diaphragm to the symphysis pubis, using 50 ml of contrast media with 40 ml of saline flush. Scanning technique by taking the pre-contrast phase, corticomedullary phase, nephrography phase, equilibrium phase and delay phase. Scan the area of the corticomedullary phase from the diaphragm to the symphysis pubis to to simplify the scanning process because the tool protocol has already made full abdominal scan area settings and to evaluate the pattern of abdominal organ enhancement if there is a metastatic urothelial lesion other than the kidney. The use of four phases of post-contrast scanning is because the goals and functions of each scanning phase are different so that the maximum diagnostic information is obtained.Conclusions: The MSCT Urography Multiphase examination procedure with clinical kidney tumors in the radiology installation of Banyumas can provide optimal diagnostic information.

RELATIONSHIP BETWEEN CAROTID ARTERY DISEASE EVALUATED BY ULTRASOUND AND CORONARY ARTERY DISEASE EVALUATED BY CORONARY COMPUTED TOMOGRAPHY

The prospective study was conducted in the Department of Cardiology, Nishtar Medical &amp; Institute of Cardiology Hospital from June 2022 to June 2023 to evaluate the association between the severity of CAD and carotid IMT through multi-slice computed tomography (MSCT) scan in symptomatic or asymptomatic patients. Patients with dyspnea, chest pain, or asymptomatic patients with low to moderate pre-test probability of CAD detected by MSCT were included in the study. Mean IMT, presence or absence of plaque, CACS, and any evidence of atherosclerosis were recorded. Of 250 patients, 8% had dyspnea, 14.8% had chest pain, 10.8% had dizziness, 6.4% had palpitations, and 62% were asymptomatic. Corid plaque and higher CAC score (P&lt;0 .0001) had a significant association. 48% (50 of 105) patients with CACS 0 had carotid plaque, while 87.5% (127 of 145) patients with CACS &gt;0 had carotid plaque, which shows the association between higher CACS and carotid plaque (P=0.0001). Similarly, 52.3% (55 of 105) patients without atherosclerosis had carotid plaque, and 85% (119 of 140) patients with atherosclerosis had carotid plaque (P &lt; 0.0001). It is concluded that plaque and carotid IMT are associated with the degree and presence of coronary disease and calcification on CTA. Due to modest correlation, imaging modality should be selected based on the pattern of atherosclerosis and methodological considerations.

Informasi Anatomi dan Dosis Radiasi pada MSCT Brain Pediatric Menggunakan Adaptive Statistical Iterative Reconstruction (ASiR)-V

Background: Multislice CT Scan (MSCT) brain examination in pediatric cases should pay attention to the lowest possible dose but still provide optimal anatomical information. Pediatric has a higher risk of developing cancer compared to adults who receive the same dose. The purpose of this study is to obtain the optimal value of the use of the Adaptive Statistical Iterative Reconstruction (ASIR)-V technique with variations in tube current strength and Iterative Reconstruction value which is implemented in pediatric patients under the age of 5 (five) years. Methods: This research was experimental with brain image samples of pediatric patients at the Radiology Installation of RSUD dr. Moewardi Surakarta. The variations of the tube currents selected were 80, 100, and 165 mA with a combination of AR20, AR40, AR60, and AR80 variations. Anatomical information processed descriptively sourced from the assessment of 3 (three) radiologists who were experienced in assessing MSCT images. Meanwhile, the effect of tube current variation on radiation dose was tested using linear regression. Results: The results showed differences in anatomical information between the combinations of 165 mA-AR60 and 165 mA-AR80 "very clear", 165 mA-AR20 "clear", 80 mA-AR20 "fairly clear" and 100 mA-AR80 "less clear". There was an effect of strong variation of tube current on radiation dose with a regression coefficient value of 0.690. The estimated effective doses of the three tube current values were still below the national Dose Reference Level (DRL). Conclusions: It was concluded that there were differences in anatomical information on the MSCT brain pediatric examination with variations in tube current and ASiR-V, there was an effect of variations in mA on radiation dose and mA values and the optimal value of the combination of techniques studied is 80 mA and 20% Iterative Reconstruction.

Risk factor analysis for major mediastinal vessel invasion in thymic epithelial tumors based on multi-slice CT Imaging.

To explore the characteristics and risk factors for major mediastinal vessel invasion in different risk grades of thymic epithelial tumors (TETs) based on computed tomography (CT) imaging, and to develop prediction models of major mediastinal artery and vein invasion. One hundred and twenty-two TET patients confirmed by histopathological analysis who underwent thorax CT were enrolled in this study. Clinical and CT data were retrospectively reviewed for these patients. According to the abutment degree between the tumor and major mediastinal vessels, the arterial invasion was divided into grade I, II, and III (< 25%, 25 - 49%, and ≥ 50%, respectively); the venous invasion was divided into grade I and II (< 50% and ≥ 50%). The degree of vessel invasion was compared among different defined subtypes or stages of TETs using the chi-square tests. The risk factors associated with TET vascular invasion were identified using multivariate logistic regression analysis. Based on logistic regression analysis, male patients (β = 1.549; odds ratio, 4.824) and the pericardium or pleural invasion (β = 2.209; odds ratio, 9.110) were independent predictors of 25% artery invasion, and the midline location (β = 2.504; odds ratio, 12.234) and mediastinal lymphadenopathy (β = 2.490; odds ratio, 12.06) were independent predictors of 50% artery invasion. As for 50% venous invasion, the risk factors include midline location (β = 2.303; odds ratio, 10.0), maximum tumor diameter larger than 5.9 cm (β = 4.038; odds ratio, 56.736), and pericardial or pleural effusion (β = 1.460; odds ratio, 4.306). The multivariate logistic model obtained relatively high predicting efficacy, and the area under the curve (AUC), sensitivity, and specificity were 0.944, 84.6%, and 91.7% for predicting 50% artery invasion, and 0.913, 81.8%, and 86.0% for 50% venous invasion in TET patients, respectively. Several CT features can be used as independent predictors of ≥50% artery or venous invasion. A multivariate logistic regression model based on CT features is helpful in predicting the vascular invasion grades in patients with TET.