Preoperative Multidetector Computed Tomography Research Articles

A Rare Hepatic Arterial Variation Established in Preoperative MDCT Angiography

Preoperative evaluation and exact description of origins and courses of hepatic vasculature is essential to avoid iatrogenic complications and to have effective results in surgical and radiologic procedures of hepatobiliary pancreatic region. Therefore, preoperative visceral angiography is critical. Digital substraction angiography is gold standart for the evaluation of vascular structures but its invasive nature limits its use. In recent years with the introduction of Multidetector CT (MDCT) Angiography, the use of conventional angiography has been reduced. We present a case of hepatic arterial variation in which Common Hepatic Artery (CHA) originates from not Celiac Trunk but from Superior Mesenteric Artery (SMA) which is established in preoperative MDCT Angiography of a patient scheduled for Whipple operation for cancer of pancreatic head.

The role of multidetector CT in local staging and evaluation of retroperitoneal surgical margin involvement in colon cancer.

We aimed to evaluate preoperative T and N staging and retroperitoneal surgical margin (RSM) involvement in colon cancer using multidetector computed tomography (MDCT). In this retrospective study, preoperative MDCTs of 141 patients with colon adenocarcinoma were evaluated in terms of T and N staging and retroperitoneal surgical margin involvement by two observers. Results were compared with histopathology. In determining extramural invasion, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of MDCT were 81%, 50%, 95%, 26%, and 81% for observer 1 and 87%, 75%, 97%, 27%, and 84% for observer 2, respectively. Moderate interobserver agreement was observed (ĸ=0.425). In determining T stage of the tumor, accuracy of MDCT was 55% for observer 1 and 51% for observer 2. In the detection of lymph node metastasis, sensitivity, specificity, PPV, NPV, and accuracy of MDCT were 84%, 46%, 60%, 74% and 64% for observer 1 and 84%, 56%, 65%, 78%, and 70% for observer 2, respectively. Interobserver agreement was substantial (ĸ=0.650). RSM was involved in six cases (4.7%). When only retroperitoneal colon segments were considered, 1.6% of subjects demonstrated RSM involvement. Four of the six RSM-positive tumors were located on sigmoid colon and one tumor was on transverse colon and caecum. Considering all colon tumors, in the detection of RSM involvement, sensitivity and specificity of MDCT were 33% and 81% for observer 1 and 50% and 80% for observer 2. Interobserver agreement was moderate (ĸ=0.518). MDCT is a promising technique with moderate interobserver agreement in detection of extramural invasion, lymph node metastases, and RSM involvement in colon carcinomas.

Extraperitoneal ascending appendicitis: Usefulness of the split interfascial plane sign on MDCT.

To retrospectively evaluate the multidetector computed tomography (MDCT) findings of extraperitoneal ascending appendicitis. The MDCT examinations of 10 patients with extraperitoneal ascending appendicitis confirmed by laparoscopic surgery were retrospectively analyzed. Preoperative MDCT examinations were obtained after intravenous administration of iodinated contrast material in all patients. Transverse and coronal reformatted MDCT images were reviewed in consensus by two radiologists. The presence of the extraperitoneal triangle sign, the split interfascial plane sign, and the other classical findings of appendicitis were evaluated. Luminal dilatation, wall enhancement of the inflamed appendix, and fat infiltration were present in 10/10 patients (100%). The perforation of the inflamed appendix with abscess formation was present in 4/10 patients (40%). The split interfascial plane sign was present in 7/10 patients (70%), and parts of inflamed appendix or periappendiceal abscess were located behind the right extraperitoneal triangle in 8/10 patients (80%). The split interfascial plane sign and the presence of an appendiceal tip or periappendiceal abscess located in the right extraperitoneal triangle are highly suggestive of extraperitoneal ascending appendicitis on MDCT.

Preoperative Diagnosis of Pancreatic Cystic Lesions: The Accuracy of Endoscopic Ultrasound and Cross-Sectional Imaging.

This study aimed to evaluate the accuracy of endoscopic ultrasound (EUS) and cross-sectional imaging including multidetector computed tomography (MDCT) or magnetic resonance imaging (MRI) as a preoperative diagnostic modality for the pancreatic cystic lesions. Three hundred eighteen patients with surgically proven pancreatic cystic lesions were enrolled as a study cohort from 1998 to 2011. Preoperative radiological, EUS, and final histopathologic diagnosis were correlated to measure several kinds of diagnostic performance. A total of 318 patients underwent preoperative MDCT, with additional imaging modalities such MRI and/or EUS in 215 (67.6%) and 108 (34.0%) patients, respectively. κ Values among the different modalities were as follows: MDCT versus pathology = 0.52 (P < 0.0001), MDCT + MRI versus pathology = 0.674 (P < 0.0001), and EUS versus pathology = 0.558 (P < 0.0001). The sensitivity and specificity in terms of ability to predict neoplastic cysts were as follows: MDCT, 83.1%/70.0%; MDCT + MRI, 94.7%/58.7%; and EUS, 88.5%/52.9%. The diagnostic accuracies of MDCT and MDCT + MRI were 61.4% (62/101) and 80.5% (173/215), respectively, and that of EUS was 70.4% (76/108). Magnetic resonance imaging as an additional diagnostic modality to MDCT increased the accuracy, sensitivity, and specificity, as well in terms of predicting neoplastic cysts.

The diagnostic accuracy of pericolonic fat extension and attenuation for colorectal tumors

ObjectiveTo evaluate the utility of quantitative analysis of the extension and attenuation of pericolonic fat in the local staging of colorectal cancer (CRC) using multi detector computed tomography (MDCT). Materials and methodsThis was a retrospective study of 110 patients who were operated due to pathologically proven CRC from January 2007 to January 2010, and who underwent preoperative MDCT of the abdomen and pelvis with administration of intravenous contrast material and image acquisition during the portal venous phase. The mean age was 69 years (range of 38–90 years). Pathological reports were reviewed for TNM staging. All MDCT studies were reviewed by two certified radiologists for maximal and minimal tumor diameter, extent of the infiltrated pericolonic fat (measured in mm), attenuation of the infiltrated pericolonic fat (measured in Hounsfield units), and attenuation of normally appearing fat next to the tumor. The sensitivity and specificity of these parameters in detecting patients with ≥ T3 CRC were calculated. ResultsThe overall sensitivity, specificity, and accuracy of pericolonic fat infiltration in detecting patients with ≥T3 stage were 95% (95% CI, 89.0–98.7%), 20% (5.8–43.7%), and 81.9% (74.7–89%) respectively. The mean extent and attenuation of the infiltrated pericolonic fat, in addition to the maximal tumor diameter, were higher in the ≥T3 group (p<0.05). By defining threshold values to these parameters, the positive predictive value for detecting ≥T3 stage tumors approaches 100%. ConclusionQuantitative analysis of pericolonic fat increased the accuracy of MDCT in the detection of local tumor spread in CRC.

Abstract 114: The prediction of postoperative renal function from renal cortex volumetry with preoperative multidetector computed tomography

Abstract INTRODUCTION: To predict the postoperative total renal function after renal surgery, we measured preserved renal cortex volume and examined the estimation of postoperative eGFR of from preoperative multidetector CT. MATERIALS AND METHODS: From 2011 to 2013, 39 patients with preoperative contrast enhanced multi detector CT were underwent renal removal surgery at Teikyo University Hospital. Preoperative and postoperative renal function were assessed by estimating glomerular filtration rate (eGFR). The renal cortex volume (RCV) was calculated automatically by imaging volumetry computer software. Addition of normal side RCV and disease side RCV that was subtracted by tumor region determined as total RCV. The postoperative RCV was defined as preserved renal cortex volume (RCV preservation), which is normal side RCV. The factors that affected the postoperative renal function were examined by univariate and multivariate analysis. For developing the models to estimate postoperative eGFR, we used stepwise (backward elimination) method for identifying the predictors. To assess of the relative quality of these statistical models, both Akaike information criterion (AIC) and Root mean square error of the cross validation (RMSE CV) were calculated. Then tour model was examined as the external validation with 10 patients in Jyuntendo University Hospital. RESULTS: The postoperative eGFR value was associated with age (P &amp;lt;0.01), preserved Renal Parenchymal Volume, and preserved Renal Cortex Volume (P &amp;lt;0.01, P =0.03, respectively). With univariate analysis, %GFR alternation significant correlated with % RCV preservation (r = 0.58, p &amp;lt;0.01) and with % RPV preservation (r = 0.54, p &amp;lt;0.01). Age and preoperative eGFR show poor statistically significant correlations. The alteration of renal cortex volume is the strongest predictor for the postoperative eGFR alteration rate.From the results, we identified the independent predictors of eGFR. AIC and RMSE CV values were 198.7 and 60.4 respectively. Our developed regression model as follows: postoperative eGFR=57.87 -0.55(Age)-15.01(BSA)+0.30(preoperative eGFR)+52.92(% RCV preservation). A strong correlation was seen between postoperative eGFR and estimation model (R=0.805, p &amp;lt;0.001 and RMSE value was 7.16). The results of external validation cohort, residual sum of squares of our equation was calculated as 647.77, which show better predictive value than the previous reported estimation models. CONCLUSIONS: Preoperative MDCT based RCV measurements are associated with postoperative renal function in patients undergoing renal surgery. Computer aided image analysis system makes this procedure simple and reproducible method. Combining CT renal volumetry and patient data might be the important prediction tool for postoperative renal function and risk assessment tool for the CKD after renal surgery. Citation Format: Shuji Isotani, Hiroshi Shimoyama, Yasuhiro Noma, Keisuke Saito, Satoru Muto, Hisamitsu Ide, Raizo Yamaguchi, Shigeo Horie. The prediction of postoperative renal function from renal cortex volumetry with preoperative multidetector computed tomography. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 114. doi:10.1158/1538-7445.AM2014-114

Assessment of surgical resectability of pancreatic adenocarcinomas with multidetector computed tomography: what are the possibilities and problems?

To investigate the accuracy of multidetector computed tomography (MDCT) in preoperatively determining the surgical resectability of pancreatic adenocarcinomas. Multidetector computed tomography, surgery, and pathological results of 274 patients with pancreatic adenocarcinoma were evaluated retrospectively. MDCT findings were compared with surgical and pathological findings to determine the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of MDCT in determining surgical resectability. A total of 124 of 274 (56%) patients (83 males, mean age: 60 years) underwent laparoscopy and/or laparotomy. The sensitivity, specificity, PPV, NPV, and accuracy of MDCT in determining the surgical resectability of pancreatic adenocarcinomas were 100%, 72%, 78%, 100%, and 86%, respectively. Liver metastases in 9 cases, peritoneal metastases in 3 cases, and vascular invasion in 5 cases, which were determined during surgery, were not reported by MDCT. On re-review of the MDCT images of these 17 patients, no metastatic lesions could be seen in 9 patients with liver metastases and in 2 of 3 patients with peritoneal metastases. In 1 patient, a peritoneal implant of a diameter of 8 mm was missed on MDCT. There was no vascular invasion according to Lu criteria on the MDCT images in the 5 cases that had vascular invasion in the surgical exploration. The accuracy of MDCT is high in the preoperative determination of surgical resectability of pancreatic adenocarcinomas, but the detection of small liver and peritoneal metastases and accurate determination of vascular invasion are still major problems. Surgeons should be aware of the limitations of preoperative MDCT.

Influence of preoperative MDCT analysis by a dedicated software on aortic insufficiency and outcome in patients after TAVI

Background: Multidetector computed tomography (MDCT) has been increasingly employed for valve sizing before TAVI as it enables a 3-dimensional analysis of the aortic annulus. Therefore, the aim of this study was to retrospectively analyze if image analysis has an influence on outcomes of patients undergoing TAVI. Methods: A total of 186 consecutive pre-TAVI-MDCTs of patients treated in 2010 and 2011 at our institution when the minimum/maximum diameter of the aortic annulus as determined by MDCT was used for valve sizing, were retrospectively analyzed with the image analysis software (3-mensio Medical Imaging) in a blinded fashion. Parameters used for calculation of the aortic annulus size included annulus area, diameter and perimeter. Valve sizes were determined as recommended by the respective manufacturer based on these parameters. Results: Patients either received the Edwards Sapien (n = 91), the Medtronic Corevalve (n = 84) or the Medtronic Engager (n = 11). In 130 patients (69.9%/Group A) image analysis recommended the same valve size that was actually implanted. However, in 29 patients (15.6%/Group B) image analysis revealed a larger valve size and in 27 patients (14.5%/Group C) a smaller size was suggested. Patients of group B showed a seven-fold higher rate of aortic regurgitation (AR)≥2 (n = 6/29) compared to group A (n = 4/130;p = 0.001) whereas group C did not show a higher incidence of conduction disorders (p = 0.5). Interestingly, there was no difference in 30 day mortality (4.6%(A), 3.4%(B), 7.4%(C) p = 0.76) and 1-year mortality between all three groups (27.5%(A), 17.2%(B), 30.4%(C); p = 0.21). Conclusion: Retrospective image analysis of pre-TAVI-MDCTs by a dedicated software revealed a different valve size in about one third of the patient cohort. Patients with an undersized valve had a seven fold higher risk for moderate AR but this did not translate into a reduced 1 year survival of the respective patients.

Gastric cancer-can we rely only on endoscopic ultrasonography?

Endoscopic ultrasonography (EUS) is considered to be the most precise method for locoregional staging, was commonly used for differentiating mucosal lesions from submucosal lesions. By contrast, computed tomography (CT) was used to detect the presence of distant metastasis. Both are valuable tools for the pre-operative evaluation of gastric cancer. With the introduction of new therapeutic options and the recent improvements in CT technology, further evaluation of the diagnostic accuracy of EUS and multidetector CT (MDCT) is needed. The present study was conducted to compare the staging accuracy of EUS with that of MDCT in series of patients and to evaluate their usefulness in association with the clinicopathological factors. In total, 277 patients with gastric lesions who underwent EUS and CT, hospitalized at Department of Gastroenterology and Hepatology, Clinical Center, University of Sarajevo. The results from the pre-operative EUS and MDCT were compared with the post-operative pathological findings. Among the 277 patients, the overall accuracy of EUS and MDCT for T staging was 74.7% and 76.9%, respectively. Among the 141 patients with visualized primary lesions on MDCT, the overall accuracy of EUS and MDCT for T staging was 61.7% and 63.8%, respectively. The overall accuracy for N staging was 66% and 62.8%, respectively. The performance of EUS and MDCT for large lesions and lesions at the cardia and angle had significantly lower accuracy than that of other groups. For EUS, the early gastric cancer lesions with ulcerative changes had significantly lower accuracy than those without ulcerative changes. For the pre-operative assessment of individual T and N staging in patients with gastric cancer, the accuracy of MDCT was close to that of EUS. Both EUS and MDCT are useful complementary modalities for the locoregional staging of gastric cancer.

Value of multidetector computed tomography in the diagnosis of mucosa-associated lymphoid tissue-lymphomas in the parotid gland: A case report and review of the literature

The present study aimed to review the multidetector computed tomography (MDCT) imaging features of eight mucosa-associated lymphoid tissue (MALT)-lymphoma cases of the parotid gland and to explore the diagnostic value of MDCT. A total of eight patients with pathologically confirmed MALT-lymphomas of the parotid gland underwent pre-operative MDCT plain and dual-phase scans. The changes in the CT values and enhancement patterns of the tumors were assessed. Quantitative analysis was performed to determine the CT value changes of the tumors in the various enhanced phases compared with the plain scan. The MALT-lymphomas of the parotid gland exhibited even density isodense or hyperdense nodules, with occasional calcification and necrosis. The dual-phase scan of the MALT-lymphomas revealed a pattern of lower or moderate enhancement, circumambient enhancement or delayed enhancement. The MALT-lymphomas were closely associated with Sjögre’s syndrome and demonstrated malignant features and isodense or hyperdense nodules and lower or moderate enhancement on the CT scans.

Diagnostic Performance of MDCT for Predicting Important Prognostic Factors in Pancreatic Cancer

Tumor stage, node metastasis, tumor size, vascular invasion, and perineural invasion are the most important prognostic factors that might be determined by preoperative multidetector computed tomography (MDCT) in pancreatic cancer. The purpose of our study is to investigate diagnostic accuracy of MDCT for determining these prognostic factors. For 6 years, 111 patients with surgically resected pancreatic cancer underwent preoperative MDCT. Two radiologists retrospectively assessed tumor stage, node metastasis, tumor size, and vascular invasion. They also graded perineural invasion using a 3-point scale focused on 5 routes. Statistical analyses were performed using the receiver operating characteristic analysis, McNemar test, and paired t test. Statistically, tumor size on specimens (3.4 ± 1.46 cm) is larger than tumor size on MDCT (3.2 ± 1.41 cm; P = 0.001). The diagnostic accuracy rates for tumor stage were 82.9% and 77.5%, with moderate agreement (κ = 0.732). The accuracy rates for node metastasis were 59.5% and 55.0%, with fair agreement (κ = 0.597). The diagnostic accuracy rates for vascular invasion were 94% and 92%. The areas under the curve for perineural invasion were 0.733 and 0.66 (P = 0.069), with moderate agreement (κ = 0.77). Multidetector computed tomography is very useful for the preoperative evaluation of tumor stage, perineural invasion, and vascular invasion of pancreatic cancer, but it has limited evaluation of node metastasis and tumor size.

Variable Procedural Strategies Adapted to Anatomical Characteristics in Catheter Ablation of the Cavotricuspid Isthmus Using a Preoperative Multidetector Computed Tomography Analysis

Variable Strategies for CTI AblationObjectivesThis study aimed to investigate the anatomical characteristics complicating cavotricuspid isthmus (CTI) ablation and the effectiveness of various procedural strategies.Methods and ResultsThis study included 446 consecutive patients (362 males; mean age 60.5 ± 10.4 years) in whom CTI ablation was performed. A total of 80 consecutive patients were evaluated in a preliminary study. The anatomy of the CTI was evaluated by multidetector row-computed tomography (MDCT) prior to the procedure. A multivariate logistic regression analysis revealed that the angle and mean wall thickness of the CTI, a concave CTI morphology, and a prominent Eustachian ridge, were associated with a difficult CTI ablation (P < 0.01). In the main study, 366 consecutive patients were divided into 2 groups: a modulation group (catheter inversion technique for a concave aspect, prominent Eustachian ridge, and steep angle of the CTI or increased output for a thicker CTI) and nonmodulation group (conventional strategy). The duration and total amount of radiofrequency energy delivered were significantly shorter and smaller in the modulation group than those in the nonmodulation group (162.2 ± 153.5 vs 222.7 ± 191.9 seconds, P < 0.01, and 16,962.4 ± 11,545.6 vs 24,908.5 ± 22,804.2 J, P < 0.01, respectively). The recurrence rate of type 1 atrial flutter after the CTI ablation in the nonmodulation group was significantly higher than that in the modulation group (6.3 vs 1.7%, P = 0.02).ConclusionChanging the procedural strategies by adaptating them to the anatomical characteristics improved the outcomes of the CTI ablation.

Reliability of Preoperative Multidetector Computed Tomography Scan in Patients With Chronic Otitis Media

The objectives of this study were to specify the objective criteria of existence of cholesteatoma in chronic otitis media on the preoperative multidetector computed tomography (MDCT) and to evaluate the complications of disease. We compared the results of preoperative MDCT scan with intraoperative findings in 71 patients (22 women, 49 men; mean age, 16-73 years) who had mastoidectomy operation between January 2008 and May 2012. Multidetector computed tomography evaluations of temporal bone were performed on a workstation using high-spatial-resolution magnified images with intended angle and plane. We observed cholesteatoma formation in all patients with scutum erosion (n = 11), dural exposure (n = 6), and lateral semicircular canal fistula (n = 5). Computed tomography revealed these findings with 100% sensitivity. Distortion of ossicular integrity (n = 11) and facial canal dehiscence (n = 5) was significantly higher in cholesteatoma patients. Using the criteria of osteolysis, the sensitivity, specificity, and the accuracy rates of MDCT in detecting cholesteatoma were 71%, 93%, and 88%, respectively. The best diagnostic clue of a cholesteatoma was a mass-like soft tissue located in a retraction pocket in the posterosuperior quadrant of the Shrapnell membrane, causing widening of Prussak space and scutum erosion. Evaluation of computed tomography scan showed nearly 100% sensitivity in detecting tympanic opacification, dural height, dehiscence of lateral semicircular canal, tegmen tympani erosion, and deformation of malleoincudal articulation. However, its contribution to detecting minor ossicular erosion, facial canal dehiscence, and incudostapedial joint evaluation was limited. Preoperative assessment of chronic otitis media via MDCT with intended angle and plane produces important guidance to understand the extent of disease and to prevent possible intraoperative complications.

Preoperative assessment of vascular invasion in exocrine pancreatic cancer by multidetector CT

PurposeTo evaluate multidetector CT (MDCT) signs of vascular invasion in pancreatic carcinoma. Patients and methodsRetrospective review of preoperative dynamic MDCT of 42 patients with pathologically proven pancreatic carcinoma. ResultsSurgically confirmed invaded vessels were 19 arteries and 33 veins. Multiple signs of vascular invasion were assessed. ConclusionSignificant advances have been made in the ability of MDCT to visualize pancreatic cancer and to stage disease when close attention is paid to technique with special attention to multiple signs of vascular invasion.

The Accuracy of Multidetector Row CT Angiography in the Evaluation of Living Kidney Donors

Purpose: To assess the value of MDCT in evaluation of the anatomy of living kidney donors and in revealing the prevalence of renal vascular variations.&#x0D; Materials and Methods: This retrospective study was approved by the Ethics committee of Rajavithi hospital(NO.172/2555). The accuracy of the images of vessel structures obtained by using 64-row multidetector computed tomography (MDCT) angiography in comparison with the actual vessel structures observed during surgery was analyzed retrospectively. We analyzed 20 patients who had undergone donor nephrectomy from 2008 to 2012. Preoperative MDCT angiography was performed, and the surgeons themselves subsequently recorded the operative findings.&#x0D; Results: Nephrectomy was performed on the left side in all 20 patients. The accuracy levels of MDCT for the artery and the vein were 90% and 95% respectively.&#x0D; Conclusions: MDCT angiography is a good investigative technique for the preoperative evaluation of the anatomy of vessels.

Preoperative Multidetector CT Manifestations of Perigastric Lymph Nodes in Patients with Early Gastric Cancer and pN0

Preoperative Multidetector CT Manifestations of Perigastric Lymph Nodes in Patients with Early Gastric Cancer and pN0

Early regeneration of the remnant liver volume after right hepatectomy for living donation: A multiple regression analysis

Early liver regeneration was studied in a series of 70 patients who underwent right hepatectomy for living donation between November 2004 and January 2010. Liver regeneration was evaluated with multidetector computed tomography (MDCT) at a mean of 61.07 days after surgery. Presurgical variables [eg, age, weight, height, body mass index (BMI), liver function tests, creatinine levels, platelet counts, international normalized ratio, and glucose levels] and variables detected with preoperative MDCT imaging [eg, main portal vein diameter, steatosis, original liver volume, and spleen volume (SV)] were investigated as potential predictors of liver regeneration. The future remnant liver volume (FRLV) was preoperatively calculated with a virtual surgical cut. Liver function tests and creatinine levels were recorded on the 30th postoperative day. In addition, the onset of postoperative complications occurring within 90 days of surgery was analyzed, and the complications were codified according to the 5 tiers of the Clavien-Dindo classification. In 26 of the 70 patients (37.14%), 100% or greater hepatic regeneration had occurred at 2 months. There was no association between the clinical outcome and the liver regeneration rate. A stepwise multiple regression analysis showed that a higher BMI (coefficient = 0.035, P < 0.0001) and preoperative parameters such as a smaller FRLV (coefficient = -0.002, P < 0.0001) and a greater SV/FRLV ratio (coefficient = 1.196, P < 0.0001) were predictors of greater liver regeneration.

Time-resolved cardiac interventional cone-beam CT reconstruction from fully truncated projections using the prior image constrained compressed sensing (PICCS) algorithm

C-arm cone-beam CT could replace preoperative multi-detector CT scans in the cardiac interventional setting. However, cardiac gating results in view angle undersampling and the small size of the detector results in projection data truncation. These problems are incompatible with conventional tomographic reconstruction algorithms. In this paper, the prior image constrained compressed sensing (PICCS) reconstruction method was adapted to solve these issues. The performance of the proposed method was compared to that of FDK, FDK with extrapolated projection data (E-FDK), and total variation-based compressed sensing. A canine projection dataset acquired using a clinical C-arm imaging system supplied realistic cardiac motion and anatomy for this evaluation. Three different levels of truncation were simulated. The relative root mean squared error and the universal image quality index were used to quantify the reconstruction accuracy. Three main conclusions were reached. (1) The adapted version of the PICCS algorithm offered the highest image quality and reconstruction accuracy. (2) No meaningful variation in performance was observed when the amount of truncation was changed. (3) This study showed evidence that accurate interior tomography with an undersampled acquisition is possible for realistic objects if a prior image with minimal artifacts is available.

Small bowel obstruction secondary to internal hernia through a defect of the broad ligament: preoperative multi-detector CT diagnosis

We report a case of small bowel obstruction secondary to internal hernia through a defect in the broad ligament diagnosed by MDCT and confirmed at surgery. The CT findings that allow the diagnosis of this very rare cause of SBO are presented here.

Accuracy of hepatocellular carcinoma detection on multidetector CT in a transplant liver population with explant liver correlation

To evaluate the diagnostic accuracy of multidetector computed tomography (MDCT) for hepatocellular carcinoma (HCC) in cirrhotic patients undergoing liver transplantation. Secondary aims were to examine the effect of radiologist experience and lesion size on diagnostic accuracy. Thirty-nine patients (72% male with a mean age of 56.5 years) underwent liver transplantation following preoperative triple-phase MDCT examination of the liver. MDCT examinations were retrospectively independently reviewed by three radiologists for the presence and location of suspected HCCs, with the diagnostic confidence recorded using a five-point confidence scale. MDCT examinations were compared with explant specimens for histopathological correlation. Histopathological results demonstrated 46 HCCs in 29 of the 39 patients. Analysis demonstrated a sensitivity of 65-75% and specificity of 47-88% for detection of HCC lesions. The sensitivity dropped to 48-57% for lesions of size ≤20mm. As the diagnostic confidence increased, there was a further decrease in the sensitivity (4-26%). The radiologist with the greatest number of years experience was found to have a significantly higher accuracy of detection of HCC lesions compared with the least experienced radiologist. Larger lesion size of HCC and greater number of years experience of the radiologist resulted in significantly higher accuracy of HCC lesion detection. The overall sensitivity and specificity results for MDCT detection of HCC are comparable to previous helical CT imaging.