Preoperative CT Examination Research Articles

Clinical value of Siemens 64 row CT and 1.5T MRI in the single or combined diagnosis of SNIP

Objective To compare the clinical value of Siemens 64 row CT and 1.5 T MRI in the diagnosis of sinonasal inverted papilloma (SNIP). Methods From June 2008 to June 2017, 200 patients with inverted papilloma of the nasal cavity and paranasal sinuses admitted to Lyuliang People's Hospital were selected.All patients were confirmed by surgery and pathology, and preoperative MRI and CT examination were adopted.Pathological diagnosis was taken as the gold standard for clinical diagnosis, and the coincidence rate of MRI and CT examination with pathological diagnosis was analyzed. Results The detection rate of disease stage and origin site of pathological examination was significantly higher than those of CT examination (13.00%, 35.00%, 45.00%, 7.00%, 100.00% vs.10.00%, 21.00%, 53.00%, 16.00%, 85.00%, χ2=8.273, 15.273, all P 0.05). There was no statistically significant difference in the detection rate of stage and origin site between the two examination methods (13.00%, 35.00%, 45.00%, 7.00%, 100.00% vs.11.00%, 37.00%, 44.00%, 8.00%, 97.00%; χ2=0.384, 2.073, all P>0.05). The malignant detection rate of pathological examination was 100%, which was significantly higher than that of MRI (100.00% vs.25.00%; χ2=9.923, P<0.05). The malignant rate of MRI examination was 25.00%, which was significantly lower than that of CT examination(χ2=4.233, P<0.05). The detection rates of stage and origin site in MRI examination were significantly higher than those in CT examination (11.00%, 37.00%, 44.00%, 8.00%, 97.00% vs.10.00%, 21.00%, 53.00%, 16.00%, 85.00%; χ2=7.384, 8.073, all P<0.05). Conclusion There are advantages and disadvantages in the early diagnosis and treatment of inverted papilloma of nasal cavity and paranasal sinuses by CT and MRI, respectively.Therefore, it is suggested that CT and 1.5T MRI should be used together.The extent of the disease and the boundary between the disease and the surrounding soft tissue are more comprehensive, which is helpful to accurately evaluate the clinical stage and origin of the tumor before operation. Key words: Sinonasal inverted papilloma; Computerized tomography; Magnetic Resonance Imaging; Combined diagnosis; Value

Analysis on CT in diagnosis of lymph node metastasis of thoracic esophageal cancer with minimum diameter greater than 1 cm

Objectives: To evaluate the diagnostic value of CT for lymph node metastasis of thoracic esophageal carcinoma with a diameter of more than 1 cm, and to find the optimal diagnostic index by comparing relevant CT indexes. Methods: Totally 80 patients with pathologically proved thoracic esophageal cancer with preoperative CT examination revealed lymph node diameter greater than 1 cm admitted at Department of Thoracic Surgery, the First Affiliated Hospital of University of Science and Technology of China from January 2016 to January 2018 were enrolled in this study. There were 70 males and 10 females, aging of (60±14) years (range: 40-85 years). According to the pathological result of lymph nodes, all the patients and lymph nodes were divided into two groups (N+group: 47 patients, 62 lymph nodes; N-group: 33 patients, 39 lymph nodes). The average number of dissected lymph nodes were 21±4 and 101 lymph nodes' diameter were greater than 1 cm. The clinicopathologic factors, postoperative complications, lymph node dissection and relevant CT indexes like the minimum diameter of lymph nodes (Min D), the maximum diameter of lymph node (Max D), lymph node axial ratio(LAR), the enhancement of lymph node (ELN) and the boundary of lymph node (BLN) were compared. The clinicopathological data, lymph node dessection and CT parameters of the two groups were compared by t test, χ(2) test or Wilcoxon rank sum test. Receiver operating characteristic (ROC) curve analysis was used to compare the ability to predict lymph node metastasis between Min D, Max D, LAR, ELN and BLN. Multiple Logistic regression analysis were performed to determine the independent variables for prediction of lymph node metastasis. Results: The difference of tumor segmentation, pN stage, pTNM stage, total number of metastatic lymph nodes, total number of abdominal lymph node metastases, Min D, Max D, ELN and BLN between the two groups were statistically significant. The results of univariate and multivariate analyses showed that gender (OR=0.128, 95%CI: 0.019 to 0.858, P=0.034), pTNM stage (OR=1.514, 95%CI: 1.020 to 2.247, P=0.039), Min D (OR=0.102, 95%CI: 0.010 to 0.995, P=0.050) and LAR (OR=0.195, 95%CI: 0.052 to 0.731, P=0.015) were the independent relative factors. The area under the curve of ROC curve analysis of Min D, Max D, LAR, ELN and BLN were 0.679, 0.666, 0.561, 0.650 and 0.820, respectively. BLN was the best CT index to diagnosis lymph node metastasis, while the accuracy of dignosis of lymph node metastasis of BLN was 97.0%. The Youden index of Min D, Max D and LAR were 1.25 cm, 1.64 cm and 0.77, respectively. Combining the BLN and ELN had a higher diagnostic rate (97.0%) of lymph node metastasis. Conclusions: CT has high diagnostic value for lymph node metastasis in thoracic esophagel cancer when the lymph node diameter is greater than 1 cm. BLN is the best diagnostic index for lymph node metastasis.

Bone measurements at multiple skeletal sites in adolescent idiopathic scoliosis-an in vivo correlation study using DXA, HR-pQCT and QCT.

Low bone mass is an important feature of adolescent idiopathic scoliosis (AIS), which is a complex 3D spinal deformity that affects girls during puberty. However, no clinical imaging modality is suitable for regular monitoring on their spinal bone qualities in rapid growth period. Therefore, we investigated whether bone mineral density (BMD) and bone microstructure at non-spinal sites correlated with BMD and mechanical property in the spine in AIS patients. Thirty-two AIS girls (16.7 ± 3.5years old with mean Cobb angle of 67 ± 11°) who underwent pre-operative spine CT examination for navigation surgery were recruited. Volumetric BMD (vBMD) of lumbar spine (LS) was measured by quantitative computed tomography (QCT), vBMD and bone microstructure of distal radius (DR) by high-resolution peripheral QCT (HR-pQCT) and areal BMDs of total hip (TH) and femoral necks (FN) by dual-energy X-ray absorptiometry (DXA). Biomechanical properties of the DR and LS were estimated by finite element analysis (FEA). Pearson correlation was performed to study the correlation between bone parameters at these three sites. LS vBMD correlated significantly with both FN and TH aBMD (R = 0.663-0.725, both p< 0.01) and with DR microstructural parameters (R = 0.380-0.576, all p < 0.05). Mechanical properties of LS and DR were also correlated (R = 0.398, p= 0.039). Bone measurement at proximal femur and distal radius could provide an additional predictive power in estimating the bone changes at spine, which is the primary site of deformity in AIS patients. Our result indicated that DXA and HR-pQCT could provide a valid surrogate for spine bone measurements in AIS patients.

Combined operation involving tibial tubercle distalization for recurrent patellar dislocation with patella alta

To explore the clinical effects of combined operation involving tibial tubercle distalization for the recurrent patellar dislocation with patella alta. Between April 2010 and May 2016, 14 cases of recurrent patellar dislocation with patella alta were treated with combined operation involving tibial tubercle distalization. There were 5 males and 9 females with an average age of 18.5 years (range, 13-26 years). The left knee was involved in 9 cases and the right knee in 5 cases. The patella had dislocated 3.3 times on average (range, 2-5 times). The interval between the first dislocation and admission was 19.7 months on average (range, 4-60 months), and the main symptoms were knee pain and limited knee movement. Preoperative X-ray films, CT, and MRI examinations of knee joint showed that the epiphyseal plate closed in all patients. Of all patients, 3 patients had avulsion fracture of the inner edge of patella, and 2 patients had free body in articular cavity. The tibial tuberosity-trochlear groove (TT-TG) distance, patellar-trochlear-groove distance, Caton-Deschamps index, knee range of motion (ROM), Lysholm score, International Knee Documentation Committee (IKDC) score, Kujala score, and Tegner score were compared pre- and post-operation. All patients had primary wound healing. All patients were followed up 24-72 months with an average of 34.6 months. X-ray film and CT examination showed that the patellar dislocation was corrected and the osteotomy of the tibial tubercle healed with an average healing time of 3.8 months (range, 3-5 month). At 1 day and 1 year after operation, the TT-TG distance, patellar-trochlear-groove distance, and Caton-Deschamps index showed significant differences when compared with preoperative values ( P<0.05), but there was no significant difference between 1 day and 1 year after operation ( P>0.05). At the 1 year and 2 years after operation, the knee ROM, Lysholm score, IKDC score, Kujala score, and Tegner score showed significant differences when compared with preoperative values ( P<0.05), and there was no significant difference between the 1 year and 2 years after operation ( P>0.05). Combined operation involving tibial tubercle distalization is a safe and reliable method, which has satisfactory short-term effectiveness for the recurrent patellar dislocation with patella alta.

Preoperative assessment of idiopathic scoliosis in adolescent and young adult with three-dimensional T2-weighted spin-echo MRI.

To compare tridimensional (3D) T2-weighted spin-echo MRI and CT for minimal pedicle width measurements in the preoperative assessment of adolescent idiopathic scoliosis (AIS) in adolescent and young patients. A total of 22 adolescents/young patients suffering from AIS were retrospectively included. There were 18 females and 4 males with a mean age of 15.3±2.3 (SD) years (range: 11-21years). Preoperative lumbar spine MRI and CT examinations of the 22 patients were reviewed by two independent readers who measured the minimal width of 259 pedicles. Inter-reader agreement for CT and MRI was assessed using intra-class correlation coefficient (ICC). Intra-reader agreement and relative differences in measurements between MRI and CT were also assessed for each reader. Inter-reader agreement was excellent (ICC≥0.8) for both CT and MRI. Relative differences in measurements between CT and MRI was 10.3% for reader 1 and 9.4% for reader 2. 3D T2-weighted spin-echo MRI underestimates minimal pedicle width by only 9.4 - 10.3% compared to CT. 3D T2-weighted MRI appears as a valuable alternative to CT for preoperative measurements of vertebral pedicles in AIS.

Outcome following computed tomographic imaging and subsequent surgical removal of keratomas in equids: 32 cases (2005-2016).

OBJECTIVE To describe the use of CT in the diagnosis of and presurgical planning for equids with keratomas treated by hoof wall resection and determine postoperative complications and outcome. DESIGN Retrospective case series. ANIMALS 29 horses and 3 mules with keratomas treated by partial or complete hoof wall resection following CT imaging of the distal portion of the affected extremity from 2005 through 2016. PROCEDURES For each equid, physical examination and lameness evaluation were performed, followed by imaging of the distal portion of the affected extremity. A tentative diagnosis of keratoma was made given results of clinical, radiographic, and CT examination, with the definitive diagnosis made on histologic examination. After CT imaging, each equid was treated with hoof wall resection. RESULTS CT allowed accurate identification of the size and location of 35 keratomas in 33 feet. Thirty equids underwent partial and 2 underwent complete hoof wall resection for keratoma removal. Complications developed in 4 of 31 (13%) equids and included excessive granulation tissue formation at the surgical site (n = 1), excessive granulation tissue formation and worsening lameness (1), incomplete keratoma removal with suspected regrowth (1), and incomplete healing of the surgical site with distal interphalangeal joint sepsis secondary to repeated debridement of abnormal tissue (1). Twenty-eight of 31 (90%) equids returned to their previous activity level. CONCLUSIONS AND CLINICAL RELEVANCE Preoperative CT examination of the feet was useful in the diagnosis of and surgical planning for keratomas in equids. A low complication rate was achieved with the described techniques.

P1.05-15 Benign Lung Nodule Resections in the Era of Advanced Imaging and Clinical Guidelines: Imaging Features and How we can Reduce the Resection Rate

Evaluation of lung nodules is a long standing clinical problem. Despite advances in diagnostics, many nodules are still resected that are benign. Although certain imaging characteristic can distinguish benign from malignant lung nodules on CT and PET/CT, overlap exists. Our purpose is to understand the benign resection rate with use of PET and PET/CT, and to review the patient and imaging characteristics of benign resected nodules in the PET-PET/CT era. We reviewed all 557 surgically resected lung nodules from 2001-2012. Patient demographics, smoking and cancer history, diagnostic tests prior to surgery, and pathology results were collected. All preoperative CT examinations were reviewed for nodule location, size, shape, border and attenuation, and PET/CTs for FDG-avidity. Of 557 resected nodules in 541 patients, 39 nodules in 38 patients were benign (15 females, 23 male) for a benign resection rate of 7% (39/557). There was no significant difference between benign and malignant groups across sex, race, nodule size or attenuation. Patients with benign nodules were younger (mean age 59 vs. 65 years in the malignant group; p=0.005). 75% of patients with benign nodules were smokers versus 80% in the malignant group (p=0.04). In the benign nodule group, 14 patients (36%) had a cancer history. Benign pathology results were: 15 granuloma, 6 chronic inflammation, 5 hamartoma, 5 abscesses, 2 inflammatory pseudotumor, 2 organizing pneumonia and 1 case each of bronchogenic cyst, fibrous tumor, lipoid pneumonia and lymphoepithelioma. 62% of were in the right lung, and 46% were in an upper lobe. Nodule size was 10-95 mm (mean 29). CT nodule morphology was round/ovoid in 16, and triangular/angular in 3. Nodule border was lobulated in 4, smooth in 7 and spiculated in 8. Cavitation was present in 4 nodules, 14 were exclusively soft tissue attenuation and one contained fat. By attenuation, 18 were solid, and 1 was non solid (ground glass). Of the 18/38 (47%) patients who underwent preoperative PET/CT scan, nodule FDG uptake was: 5 intense, 10 mild, 3 none. Our benign resection rate for lung nodules is 7%. While in many cases the imaging characteristics of surgically proven benign lung nodules and their clinical management are appropriate, following clinical guidelines for nodule management may further reduce the benign resection rate. The use of PET/CT and follow up low dose chest CT for PET/CT negative or mild uptake lesions to confirm nodule stability over time is a pathway for management that requires reinforcement.

Utility of radiopaque urinary catheter placement before computed tomographic examination in two dogs with multiple pelvic fractures

Pelvic fractures are a common sequel to traumatic injuries in dogs, often caused by vehicular collisions. Urethral injury is a recognised complication of pelvic trauma. Retrograde positive contrast urethrography is...

CT Radiogenomic Characterization of the Alternative Lengthening of Telomeres Phenotype in Pancreatic Neuroendocrine Tumors.

The objective of this study was to identify imaging characteristics in patients with known pancreatic neuroendocrine tumors (PanNETs) that predict the alternative lengthening of telomeres (ALT) phenotype by blinded retrospective review of preoperative multiphasic CT scans. For this retrospective study of 121 preoperative CT examinations of patients with resected PanNETs, two radiologists independently reviewed the CT examinations for tumor characteristics including size, shape, cystic or necrotic elements, calcifications, invasion of adjacent organs and vessels, biliary duct dilatation, pancreatic duct dilatation, and hepatic metastases. Univariate analysis of association of CT characteristics with ALT phenotype was performed with Fisher exact tests or t tests, and multivariate analysis was assessed by multiple logistic regression. Univariate analysis showed that the following CT features were significantly associated with the ALT phenotype: lobulated or irregular tumor shape (p = 0.001), tumor necrosis (p = 0.002), vascular invasion (p < 0.001), pancreatic duct dilatation (p < 0.001), and hepatic metastasis (p < 0.001). Multivariate analysis found that the combination of pancreatic duct dilatation, hepatic metastasis, and size of tumor ≥ 3 cm was a strong predictor of ALT phenotype (odds ratio = 20.3; 95% CI = 2.3-176.3; AUC = 0.58; p = 0.006). This study showed that several preoperative CT features of PanNETs are associated with the ALT phenotype, which is known to predict poor prognosis. Additionally, CT findings of intratumoral calcifications and metastases predicted poor survival independent of the ALT status.

Extraskeletal Myxoid Chondrosarcoma: A Comparative Study of Imaging and Pathology.

The purpose of this study was to achieve better understanding of extraskeletal myxoid chondrosarcoma (EMC). 13 cases of EMC confirmed by surgery biopsy were retrospectively studied. All patients underwent preoperative CT or/and MRI examinations. Among six patients who underwent preoperative CT examinations, six cases of lesions exhibited hypodensity on unenhanced image, three cases of tumor showed funicular spots or patchy calcification, and four cases of tumor did not show any obvious enhancement after enhanced CT scan. Among ten patients who underwent preoperative MRI examination, 8 cases of tumor revealed uniform or slight hyposignal intensity on T1WI, 10 cases of tumor demonstrated lobulated hypersignal intensity with multiple low signal intensity of interval septa on T2WI, and 5 cases of lesions indicated characteristic appearance: septa enhancement with tumor stroma between interval septa being unenhanced. EMC usually occurred at older men and at certain location such as limbs, trunk, and subcutaneous tissues. EMC usually exhibited low density mass (mostly 20-40HU) with calcification and in a portion of the cases showed light or no enhancement on CT. On MRI, EMC showed lobulated hypersignal intensity on T2WI with characteristic arc, septa, or interval septa enhancement.

Can Preoperative Examination Help Choose the Best Surgical Procedure in Gastric Cancer?

Aim Gastrectomy with lymph node dissection is standard treatment in gastric cancer. This study aimed to explore whether preoperative investigation finds could predict lymph node metastatic scope in gastric carcinoma so that the optimal surgical procedure could be selected. Materials and Methods Radical gastrectomy patients (n = 378) were separated into two groups according to the lymph node metastatic scope. Univariate and multivariate analyses of preoperative examination results were performed to identify the predictors of metastatic scope. ROC curves were constructed, and the area under the curve (AUC) was calculated to estimate diagnostic values. Results Serum CEA (OR: 3.73; 95% CI: 1.84–7.56; P ≤ 0.001), tumor size (OR: 2.07; 95% CI: 1.08–3.98; P = 0.03), and CT examination results (OR: 17.81; 95% CI: 9.18–34.55; P ≤ 0.001) were identified as independent predictors. The AUC proved that they possessed significant diagnostic value. When CT examination was negative, the combination of serum CEA and tumor size showed high specificity (95.3%; 164/172), negative predictive value (92.7%; 164/177), and accuracy (89.0%; 170/191). Conclusions Preoperative serum CEA, tumor size, and CT examination are independent predictors of lymph node metastatic scope and can be used for selecting the appropriate lymphadenectomy pattern in gastric cancer patients.

Mobile C-arm CT scan in surgery for thoracolumbar burst fractures of type A3

Objective To discuss the application of mobile C-arm CT scan in the operations for thora-columbar burst fractures of type A3. Methods From January 2012 to December 2014, 21 patients with sin-gle-segment thoracolumbar burst fracture (AO type A3) were treated. They were 15 males and 6 females, aged from 17 to 68 years (average, 43.6 years). By the American Spinal Injury Association (ASIA) grading, one was grade A, 2 were grade B, 12 grade C, 4 grade D and 2 grade E. Preoperative CT examination was conducted. Mobile C-arm CT scan was performed to evaluate reduction of the fragments after the fracture was reset by posterior pedicle screwing. Laminotomy for canal decompression or reduction of the fragments would be performed if it was indicated by the results of mobile C-arm CT scan. CT examination was conducted postoperatively to assess the fracture re-duction and recovery of the canal calibre. Results All the patients were followed up for an average of 15.5 months (from 10 to 18 months). Their cobb angle, vertebral anterior margin compression rate, spinal occupancy rate, vertebral translocation rate and visual analogue score at postoperation and final follow-up were significantly improved compared with their preoperative values (P 0.05). Postoperative ASIA grading showed that the spinal function was improved from grade B to grade C in one, from grade C to grade D in 4 cases, from grade C to grade E in 5 cases, and from grade D to grade E in 3 cases. Conclusion Since intraoperative C-arm CT scan can help decide whether laminectomy for canal decompression is conducted or not in the surgery of thoracolumbar burst fractures, it enhances the surgical safety and reliability. Key words: Thoracic vertebrae; Lumbar vertebrae; Fractures,bone; Fracture fixation,internal; C-arm CT

Discussion on imaging examination method and preoperative follow-up for gastric duplication in children

Objective To report the clinical and imaging characteristics of 9 cases of gastric duplication in children, as well as to probe into all kinds of imaging examination methods, with an aim to improve preoperative diagnostic accuracy. Methods Nine cases of children with gastric duplication that received surgical resection and were pathologically confirmed in our hospital from January 2009 to November 2016 were retrospectively analyzed. The clinical manifestations, complications, complicated malformation and imaging findings of the cases were summarized. Three asymptomatic cases were carried out regular ultrasound examination follows-up preoperatively. Results Gastric duplication in children varied in terms of clinical manifestations. All the 9 cases were performed ultrasonography preoperatively, and 5 of them were accurately diagnosed. Meanwhile, 7 cases received preoperative CT examination, with 2 cases being confirmed. Three cases received magnetic resonance imaging (MRI) examination, with 2 cases being confirmed. And 2 cases had upper abdominal gastrointestinal imaging (GI) examination, but no definite diagnosis was made. Three cases of asymptomatic children with enlarged lesion can be seen in follow-up. Conclusions Gastric duplication is a rare congenital malformation, ultrasound allows to clearly display the capsule wall structure and the relation between gastric duplication with gastric wall, which is associated with high utilization rate and diagnosis rate, and it can be served as the preferred imaging examination method for gastric duplication in children. Key words: Ultrasonography; Gastric duplication

Assessment of Microvascular Density in the Neuroendocrine Tumors of the Pancreas: a Correlation with Multidetector Computed Tomography (MDCT) Features and Tumor Grade

Introduction/ Background The biologic course of pancreatic neuroendocrine tumors (NET) can be accurately predicted on the basis of pathology parameters which, unfortunately, cannot be fully assessed until the entire tumor has been resected. When obvious landmarks of malignancy (metastases, vascular invasion) are lacking, tumour size is the only reliable preoperative parameter used to differentiate between presumably benign and malignant pancreatic NETs. It is generally accepted that pancreatic NETs exceeding 2 cm in their diameter may have borderline pathology or even malignancy. Anyway, up to 10% of tumors with diameter less than 2 cm are although malignant. That is why there is need in studies focusing on additional imaging characteristics, such as contrast-enhanced MDCT, useful for the aggressiveness assessment. Aims To determine whether it is possible to predict pancreatic NET Grade and microvascular density (MVD) according to contrast-enhanced MDCT findings. Methods A retrospective study was conducted and 70 patients with pancreatic NETs were retrieved from the institutional archives. Twenty eight of them had met the including criteria (a - patients underwent surgery in our Institution and b - patients underwent preoperative dynamic abdominal CT within 30 days prior surgery) and comprised the study population. Thus, research included 15 patients with functioning and non-functioning pancreatic NETs Grade 1 and 13 of patients with Grade 2 (according to the WHO classification of 2010). Radiology All preoperative CT examinations were performed by a 256-slice CT scanner. Dynamic CT images, including non-enhanced, arterial, portal venous and delay phase images, were obtained for all patients. For contrast-enhanced CT, 90–120 mL of high concentration contrast mediaiomeprol 400 (Iomeron 400; Bracco Imaging SpA, Milan, Italy). CT images were reconstructed with a section thickness of 1-2 mm. Pathology For identification of vessels, regardless lymphatic or venous, immunohistochemistry with CD34 (clone QBEnd/10, CellMarque) was performed on formalin-fixed paraffin-embedded (FFPE) tumor blocks. Image analysis Density of vessels was defined on 3 fields at x 200 (~ 1,8 mm2). The choice of fields of vision was carried out among sites with visually greatest density of vessels (“hot spots”). Determined total number of the pixels belonging to vessels by the Color Threshold tool (ImageJ) and divided this number into total of pixels in the image. Results The median of density of vessels at patients with NET Grade 1 made 8% ± 2% whereas in group of patients with NET Grade 2 this indicator made 5 ± 4%. The difference was statistically significant (p <0,05). Mean arterial enhancement ratio was 1.66(0.42) in Grade 1 and 1.04(0.39) in Grade 2 pancreatic NET (p<0.01); and correlated with intratumoral MVD (r=0.61, p<0.005) and tumor grade (p<0.01). Vascular invasion, metastases and pancreatic duct dilatation were observed in two cases, both in G2 tumors. Arterial enhancement ratio <1.1, size≥20 mm, ill-defined borders and tumor non-homogeneity showed 83%, 74%, 70% and 56% accuracy in diagnosing G2 tumor respectively, while the accuracy of two of these criteria used in combination was 91%. Contrast-enhanced MDCT-features of pancreatic NET correlate with MVD and can predict tumor grade during preoperative staging.

Nasal endoscopy: an adjunct to patient selection for preoperative low-dose CT examination in chronic rhinosinusitis.

The growing awareness of increased X-ray exposure to the public has led to the propagation of several methods for reducing the radiation dose during CT examination. Low-dose CT protocols do not, however, have an established role in pre-operative evaluation. The aim of this article was to assess the usefulness of nasal endoscopy in the selection of patients under pre-operative care for low-dose CT examination. A cadaver head was used to discover institutional minimum acceptable CT image quality and scanning settings. Then, 134 adult patients with chronic rhinosinusitis (CRS) were enrolled into the study and divided randomly into standard dose (120 kVp, 100 mAs) or low-dose CT groups (120 kVp, 45 mAs). Subjective assessment of the diagnostic image quality of the surgically relevant anatomical structures was compared using a five-point scale (from excellent to unacceptable) by a radiologist and sinus surgeon independently. Pathologic states of the nose were quantified according to the Lund-Kennedy endoscopic system (LKES) and Lildholdt's scale. Image quality was similar in low-dose and standard dose groups in patients without polyps. The quality of 13% of scans from patients with polyps from the low-dose group and 4% from the standard dose group was in the range from moderate to poor. The quality of scans obtained with low milliamperes second (mAs) values worsened in patients with polyps in the middle meatus, but the difference was particularly pronounced compared with standard dose among subjects with Lildholdt's score above 2 (p < 0.001). Correlation with LKES revealed that changes other than polyps (i.e. discharge, oedema, scaring or crusting) in the nasal cavity alone do not affect the image quality. Interobserver agreement in both groups was very high. Low-dose scanning should be promoted as the screening imaging method of choice in patients with suspected CRS. Furthermore, low mAs value examination can be performed pre-operatively without fear of significant image quality deterioration in uncomplicated CRS patients without polyps, or with minor changes in nasal endoscopy. Standard dose CT, which provides a better identification of bony landmarks, minimizes diagnostic errors and risk to patients, so it might be considered in those with polyps below the middle turbinate.

Sonographic Features of Thyroidal Fatty Lesions in the Thyroid Gland: A Preliminary Study.

To my knowledge, no previous study has evaluated the sonographic features of thyroidal fatty lesions. The present study aims to assess the features of thyroidal fatty lesions as seen on ultrasound images and to determine the frequency of such lesions. From January 2013 to December 2014, a total of 940 patients underwent preoperative ultrasound and CT examinations of the neck before undergoing thyroid surgery. The criterion for the diagnosis of thyroidal fatty lesions was the presence of intraglandular fatty tissue on CT images, regardless of lesion size. One radiologist retrospectively analyzed all the ultrasound and CT images of these patients. Of the 940 patients whose images were reviewed, 20 (2.1%) had thyroidal fatty lesions noted on neck CT and 17 of these 20 patients had thyroidal fatty lesions (mean of largest diameter, 6.3 mm; range, 4.8-9.2 mm) noted on ultrasound. The 20 involved sites included the right lobe (n = 11), the left lobe (n = 9), and the isthmus (n = 0). For 17 of these 20 cases (85%), continuity with the adjacent thyroid capsule or perithyroidal fatty tissue was seen on ultrasound or CT. All thyroidal fatty lesions showed hyperechogenicity, no calcification, no posterior shadowing or enhancement, and an ovoid shape, and most thyroidal fatty lesions had inhomogeneous echogenicity and a smooth margin. On ultrasound images, thyroidal fatty lesions characteristically appear as ovoid inhomogeneously hyperechoic thyroid nodules with no calcification, no posterior shadowing or enhancement, a smooth margin, and continuity with the adjacent thyroid capsule or perithyroidal fatty tissue.

Markers of sarcopenia quantified by computed tomography predict adverse long-term outcome in patients with resected oesophageal or gastro-oesophageal junction cancer.

To assess the impact of sarcopenia and alterations in body composition parameters (BCPs) on survival after surgery for oesophageal and gastro-oesophageal junction cancer (OC). 200 consecutive patients who underwent resection for OC between 2006 and 2013 were selected. Preoperative CTs were used to assess markers of sarcopenia and body composition (total muscle area [TMA], fat-free mass index [FFMi], fat mass index [FMi], subcutaneous, visceral and retrorenal fat [RRF], muscle attenuation). Cox regression was used to assess the primary outcome parameter of overall survival (OS) after surgery. 130 patients (65%) had sarcopenia based on preoperative CT examinations. Sarcopenic patients showed impaired survival compared to non-sarcopenic individuals (hazard ratio [HR] 1.87, 95% confidence interval [CI] 1.15-3.03, p = 0.011). Furthermore, low skeletal muscle attenuation (HR 1.91, 95% CI 1.12-3.28, p = 0.019) and increased FMi (HR 3.47, 95% CI 1.27-9.50, p = 0.016) were associated with impaired outcome. In the multivariate analysis, including a composite score (CSS) of those three parameters and clinical variables, only CSS, T-stage and surgical resection margin remained significant predictors of OS. Patients who show signs of sarcopenia and alterations in BCPs on preoperative CT images have impaired long-term outcome after surgery for OC. • Sarcopenia is associated with impaired OS after surgery for oesophageal cancer. • Other body composition parameters are also associated with impaired survival. • This influence on survival is independent of established clinical parameters. • Sarcopenia provides a better estimation of cachexia than BMI. • Sarcopenia assessment could be considered in risk/benefit stratification before oesophagectomy.

Posterior malleolar fractures of the ankle.

Despite an increasing awareness of injuries to PM in ankle fracture-dislocations, there are still many open questions. The mere presence of a posterior fragment leads to significantly poorer outcomes. Adequate diagnosis, classification and treatment require preoperative CT examination, preferably with 3D reconstructions. The indication for surgical treatment is made individually on the basis of comprehensive assessment of the three-dimensional outline of the PM fracture and all associated injuries to the ankle including syndesmotic instability. Anatomic fixation of the avulsed posterior tibiofibular ligament will contribute to syndesmotic stability and restore the integrity of the incisura tibiae thus facilitating anatomic reduction of the distal fibula. A necessary prerequisite is mastering of posterolateral and posteromedial approaches and the technique of direct reduction and internal fixation. Further clinical studies with higher numbers of patients treated by similar methods and evaluation of pre- and postoperative CT scans will be necessary to determine reliable prognostic factors associated with certain types of PM fractures and associated injuries to the ankle.

Pancreatic neuroendocrine tumors: Correlation between the contrast-enhanced computed tomography features and the pathological tumor grade

ObjectiveTo determine whether CT features can predict the pathological tumor grades of pancreatic neuroendocrine tumors (PanNETs) according to the recent WHO classification. Materials and methodsIn all, 28 patients with histologically confirmed PanNETs underwent preoperative contrast CT examinations. Thirteen tumors were classified as G1 and 15 as G2. Two radiologists independently evaluated the CT features (tumor delineation, peripancreatic vascular involvement, upstream pancreatic duct dilatation, N (regional lymph node metastasis) and M (distant metastasis) grades, tumor homogeneity, cystic or necrotic change, and tumor conspicuity). The tumor sizes and Hounsfield unit values of all PanNETs during each phase on CT were measured by one radiologist. We compared the CT features between pathological tumor grades using Fisher's exact test for nominal scales and Mann–Whitney U test for ordinal scales or continuous variables. Additionally, we evaluated the performances of the CT findings and their combinations to diagnose G2 tumors. ResultsG2 tumors showed significantly larger in tumor size than G1 tumors (p=0.029). All 4 tumors with hepatic metastases were G2. Non-hyperattenuation compared with pancreatic parenchyma during portal venous phase (PVP) was significantly associated with G2 (p=0.016). The accuracy for G2 diagnosis of tumor size (≥20mm), M grade (M1), and tumor conspicuity (non-hyperattenuation during PVP) were 71%, 61%, and 71%, respectively, while the accuracy of their combination was 82%. ConclusionContrast-enhanced CT features (tumor size, M grade, and tumor conspicuity during PVP) can predict the pathological tumor grades of PanNETs.

Intracranial volume is normal in infants with sagittal synostosis

Premature sagittal synostosis results in an elongated, narrow skull shape, scaphocephaly. It has been unclear whether the intracranial volume (ICV) of these children is different from that of normal children. The aim of the present study was to precisely determine the ICV in a large cohort of children with premature sagittal synostosis and to compare it to the ICV of a sex- and age-matched control group. All patients (n = 143) with isolated sagittal synostosis registered in the Göteborg Craniofacial Registry until the end of 2012 with a preoperative CT examination were identified. For each case, a sex- and age- (±30 days) matched control was identified from children who had undergone CT for post-traumatic or neurological reasons. The ICV was measured in a semi-automatic MATLAB program with functions such as region growing, watershed, and thresholding in axial CT slices. The ICV was calculated using the Cavalieri principle. The mean (± SEM) values of ICV for children with sagittal synostosis and for corresponding controls were 866 ± 13 ml and 870 ± 15 ml, respectively. The mean ages of these groups were 173 ± 8 days and 172 ± 8 days, respectively. Subgroup analysis of sex and age at CT (≤180 days and >180 days) did not reveal any differences in ICV between cases and controls. Precise determination of ICV in addition to the use of adequate controls has made it possible to conclude that children with premature isolated sagittal synostosis have a normal ICV.