Results Of Multislice Computed Tomography Research Articles

Oblique projections in the analysis of multislice computed tomography data in gunshot wounds

Background. The purpose is to determine the place and role of oblique projections in the analysis of multislice computed tomography (MSCT) data in gunshot wounds. Materials and me­thods. More than 3,300 MSCT studies performed in wounded and traumatized patients over a certain period in the Military Medical Clinical Center of the Northern Region of the Medical Forces Command were prospectively studied. All the wounded were male, the average age was 42.1 ± 2.4 years. MSCT of the head, thoracic and abdominal organs, pelvis, and limbs was performed. The frequency of using oblique projections and their informativeness were studied. Results. A prospective study demonstrated that coronal, axial, sagittal projections, and 3D modeling were used in 100 % of cases, and in 21.4 % — oblique projections to improve MSCT results. The distribution by localization of MSCT was as follows: head — 32.9 %, neck — 7.6 %, chest organs — 32.2 %, abdominal organs — 22.3 %, limbs — 5.0 %. MSCT in angiomode was performed in 3.5 % of injured and traumatized patients: head — 27.2 %, neck — 18.4 %, chest organs — 28.9 %, abdominal organs — 23.7 %, limbs — 1.8 %. Oblique projections in MSCT data analysis were used when studying the wound channel in 82.3 % of cases, to improve the visualization of vessels during MSCT in angiomode — in 12.6 % and to improve the visualization of bone fracture lines — in 5.1 %. Conclusions. In the structure of MSCT studies, the head, thoracic organs, abdominal organs, neck, and limbs prevail by localization (in descending order). Oblique projections are used is 1/5 of cases and allow to improve the visualization of the direction of the wound channel, vessels during angiography and lines of flat and long tubular bone fractures.

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.

ВАЛИДНОСТЬ ОТРИЦАТЕЛЬНОГО РЕЗУЛЬТАТА КОЖНОГО ТЕСТА С АЛЛЕРГЕНОМ ТУБЕРКУЛЕЗНЫМ РЕКОМБИНАНТНЫМ ДЛЯ ИСКЛЮЧЕНИЯ АКТИВНОГО ТУБЕРКУЛЕЗА У ДЕТЕЙ

Detection of tuberculosis (TB) infection and prophylactic anti-tuberculosis treatment in order to prevent cases of the disease is a current priority in phthisiatry. The effective screening of the TB infection requires the availability of effective tests with high sensitivity and specificity. The purpose of the study was to assess the concordance of a negative result of a recombinant tuberculosis allergen (RTA) test and the absence of specific changes on multi-slice computed tomography (MSCT) of the chest organs in children aged 3 to 14 years old who are not at risk for the TB development in territories with a low incidence of TB. Materials and methods of the study: a multicenter cohort retrospective study of children 3 to 14 years old who do not belong to risk groups for the TB development, without clinical symptoms of any disease and with a negative RTA test result. An analysis of the data of the objective examination of the child, of the general blood test study, of the results of previous immunodiagnostics, and of the results of MSCT of the chest organs (the presence of changes of any nature in the lungs and intrathoracic lymph nodes) was performed. Results: 43 children were included in the study, 65% (28) males. The average age of children was 7.0 [6.0; 11.0] years. Two age groups of children were studied - 3 to 7 and 8 to 14 years old. In the group of children aged 3 to 7 years old, only 68% had information about a previous tuberculinogram, on the basis of which it was possible to judge the presence of a possible active TB infection. In 14 children of this age group, pronounced reactions to tuberculin were noted, which was an indication for the Mantoux test with 2 tuberculin units (2TU) for an in-depth examination and consultation with a phthisiatrician (increase in tuberculin sensitivity). The concordance of the negative result of the RTA test and the negative result of the Mantoux test with 2TU was 50% - the value is random, while in all children according to MSCT of the chest organs, there were no specific changes. The concordance of a negative result of the RTA test and the absence of specific changes on MSCT of the chest organs was 100%. Conclusion: in children who do not belong to the risk group for the TB development, a negative result of the RTA test was accompanied by the absence of changes in the MSCT of the chest organs (100% concordance). The tuberculin diagnostics using the Mantoux test with 2TU has significant limitations for detection of the TB infection in children under 7 years of age. For children aged 3 to 7 years old who have been diagnosed with mycobacterium TB infection and do not need to be re-introduced with BCG vaccine, it is reasonable to screen for TB using the RTA test.

Multimodal Visualization of the Left Ventricular Postinfarction Aneurysms: Current State of the Problem and Own Observation Results

Background. Left ventricular aneurysm (LVA) is a complication occurring in 5–10% of acute myocardial infarction (AMI) patients significantly complicating AMI acute stage course and leading to advanced congestive heart failure (CHF) progress. Non-invasive LVA visualization includes echocardiography, cardiac magnetic resonance imaging (MRI), radio-nuclide ventriculography, and multi-slice computed tomography (MSCT). It can also be detected during heart catheteriza-tion by coronary ventriculography (CVG). Each method has its advantages and drawbacks.
 The aim. To analyze multimodal non-invasive LVA visualization methods (echocardiography and MSCT) in order to establish accuracy of these methods compared to CVG regarding the diagnosis of LVA and LVA thrombosis.
 Methods. We examined 60 patients after AMI with LVA admitted for surgical revascularization and left ventricular aneurysm resection (LVAR). Control group included 110 patients after AMI prior to revascularization without history of LVA. All the patients underwent CVG, heart MSCT and echocardiography prior to surgery.
 Results. Mean patients’ age was 60.9±11.4 years (46 [76.7%] men and 14 [23.3%] women, mean LVEF was 42.7±11.1%. Significant CAD according to coronary angiography (CAG) before surgery was proved in 59 (98.3%) pa-tients, and 1 (1.7%) patient had no significant coronary lesions. The majority of patients had anterior LVA localization after AMI in LAD area (57 [95.0%] patients), 2 (3.3%) patients were diagnosed with inferior LVA after AMI in RCA area, and 1 (1.7%) patient had posterior-lateral LVA in Cx area. There was high correlation between LVEF obtained with echo-cardiography and that obtained with MSCT (r=0.955, p<0.0001), although mean LVEF obtained with echocardiography was significantly higher compared to MSCT results (42.7±11.1% vs. 32.7±9.3%, p<0.0001). Comparison of accuracy of the methods in LVA diagnosis showed that MSCT was the most precise method with significantly higher sensitivity compared to CVG and echocardiography (94.9% vs. 75.0%, p=0.002, and 88.0%, p=0.023, respectively), and MSCT significantly ex-ceeded CVG in all diagnostic method accuracy indices. Echocardiography also significantly exceeded CVG in all diagnostic accuracy indices. Comparison of accuracy of the methods in LVA thrombosis diagnosis showed similar results: echocar-diography was much more precise in terms of sensitivity (79.4% vs. 58.8%, p<0.0001) and the rest of indices. MSCT was much more precise in terms of all indices compared to CVG, and also significantly exceeded echocardiography results in terms of sensitivity (97.1% vs. 79.4%, p<0.0001), positive (PPV) (100.0% vs. 93.1%, p=0.0005) and negative predictive value (NPV) (99.1% vs. 93.9%, p=0.0091), integral “area under curve” index (AUC) (0.99 vs. 0.89, p=0.0001) and odds ratio (OR) (3630 vs. 208, p<0.0001).
 Conclusions. High correlation of LVEF according to echocardiography and MSCT results allows to skip CVG as a global LV contractility evaluation method enabling to reduce the procedure time. The lowest accuracy of CVG in the diagnosis of LVA and LVA thrombosis also allows to reduce the duration and volume of the invasive procedure to selective CAG and to reduce radiation exposure for patients and operators in favor of non-invasive and more accurate methods (MSCT and echocardiography). MSCT is the most accurate method for LVA thrombosis diagnosis, but it is completely comparable to echocardiography in LVA diagnosis per se, making echocardiography the method of choice in screening and stratification of patients after AMI regarding myocardial revascularization only or combined surgical revascularization with LVAR due to its rapidness, low cost and absence of patient-related adverse effects.

Feasibility of pulmonary MRI for nodule detection in comparison to computed tomography

BackgroundTo assess the feasibility of various magnetic resonance imaging (MRI) sequences for the detection of pulmonary nodules by comparing the detection rate of computed tomography (CT).MethodsForty-two patients with pulmonary nodules detected by multi-slice CT (MSCT) were prospectively enrolled in the present study between November 2016 and February 2017. Chest MRI was acquired within 24 h of CT. The MRI protocol included free-breathing radial VIBE (r-VIBE) and a conventional breathhold T1-weighted VIBE (C-VIBE) were analyzed by two independent radiologists. Both detection and morphology results of each MRI image were recorded. Subjective image evaluation in terms of overall nodule morphology on the MRI images was carried out using the 4-point scoring criteria. The MRI results were compared with those from CT, with the results of MSCT serving as the reference standard.ResultsTwo hundred and fifty-eight solid pulmonary nodules in 42 patients were detected by CT. The r-VIBE correctly detected 94% of the pulmonary nodules as compared with CT. The detection rate increased to 100% for lesions ≥6 mm. The C-VIBE had a lower overall detection rate (64.3%) of pulmonary nodules. The difference in the subjective image evaluation scores between the two sequences was statistically significant (p < 0.001).ConclusionSignificantly increased detection rates were obtained with free-breathing r-VIBE as compared with C-VIBE for the detection of pulmonary nodules and also provided more information when evaluating the nodules as compared with C-VIBE.

Differential diagnosis of pancreatic diseases: new approaches in laboratory and radiologic diagnosis

Aim. To assess significance of serum fibronectin (FN) and new approaches of processing computed tomography (CT) results for pancreatic cancer (PC) and chronic pancreatitis (CP) differential diagnosis.&#x0D; Materials and methods. Data of 49 patients with pancreatic lesions who underwent multislice computed tomography (MSCT) with intravenous contrast enhancement and FN evaluation in 2018 were analyzed. There were 29 (59.2%) males and 20 (40.8%) females, mean age 51.9±13.9 (30–82). All patients were divided in 3 groups: 1 — PC (17 patients, 34.6%) — morphologically verified, 2 — chronic pancreatitis with previous pancreonecrosis (CPPN) — 16 patients, 32.7%, 3 — chronic calcifying pancreatitis (CCP) — 16 patients, 32.7%. We calculated median of enhancement gradient between region of interest and intact parenchyma (Мgrad) based on MSCT results. Pearson’s correlation coefficient (rp) was calculated for correlation assessment.&#x0D; Results. We assessed mean Мgrad and mean serum FN rate in all three groups: PC — 28.1±2.6, р=0.0001, CPPN — 14.9±2.4, р=0.07, CCP — 13.3±0.7, р=0.08 for Мgrad, and 239.8±30.1, p=0.8, 243.5±33.8, p=0.7, 227.2±34.3, p=0.8 for serum FN rate, respectively. There was statistically significant strong correlation of Мgrad in patients with PC (rp=0.63, p=0.0001). We revealed cut-off point of Мgrad value for PC that was 20 (p=0.001). There were no statistically significant correlations of serum FN rate in all groups (PC rp=0.04, p=0.8; CPPN rp=0.06, p=0.7; CCP rp=-0.03, p=0.8).&#x0D; Conclusions. Mgrad evaluation based on MSCT is an informative marker for differential diagnosis between PC and chronic pancreatitis, high rates of Мgrad positively correlate with PC existence. There was no correlation between serum FN rate and existence of PC, CPPN or CCP.

Predicting the Success of Emergency Surgical Treatment of Acute Massive Pulmonary Embolism Based on the Results of Multislice Computed Tomography

Objective – to assess the informativeness of multisclice computed tomography (MSCT) angiopulmonography in the assessment of peripheral blood flow and to determine the prognostic role of angiographic massiveness and volume of preserved peripheral blood flow as predictors of success of emergency surgical treatment of acute massive pulmonary embolism (PE). Material and methods. The article presents the results of 7-year work for the period from March 2012 to September 2019, which included a pilot retrospective stage (analysis of the results of 264 MSCT procedures with contrast enhancement for acute PE in patients aged 32 to 69 years for the period 2012–2013) and prognostic practical work (the second stage, analysis of the results of 974 MSCT procedures with contrast enhancement in patients aged 25 to 78 years for the period 2013–2019).Results. The obtained results and statistical dependences proved the influence of the saved volume of peripheral arterial pulmonary blood flow on the outcome of surgical treatment. The use of this indicator as an MSCT predictor reduced the hospital mortality rate from 7.2% to 3.5%. The analysis of the influence of the initial angiographic massiveness of PE on the outcome of surgical treatment has not been confirmed.Conclusion. According to the results of the study, we recommend the inclusion of segmental arterial pulmonary blood flow analysis by MSCT with contrast enhancement in the algorithm of preoperative examination of patients with acute massive pulmonary embolism in case of emergency surgical treatment.

Multislice Computed Tomography Assessment of Tracheobronchial Patterns in Partial Anomalous Left Pulmonary Artery.

The aim of this study was to present relationship between partial anomalous left pulmonary artery (PALPA) and the tracheobronchial tree and patterns of the tracheobronchial tree assessed by multislice computed tomography (MSCT). Nine patients were assessed by MSCT. The relationships between the tracheobronchial tree and PALPA and different tracheobronchial patterns, location of tracheobronchial stenosis, severity of stenosis, and associated cardiac defects were evaluated. The results of MSCT for these patients were compared with the operative findings. The anatomy of PALPA was clearly identified by MSCT in all 9 patients. Three relationships between PALPA and the tracheobronchial tree were noted. In addition, 3 patterns of tracheobronchial tree anatomy were also demonstrated. The PALPA arose from the right pulmonary artery, forming a pulmonary sling (n = 2). The PALPA, which arose from the proximal right pulmonary artery, went below the tracheal bifurcation and passed anterior (n = 1) or inferior-anterior (n = 6) to the proximal left main bronchus. Three patterns of the tracheobronchial tree were presented with normal (n = 5), normal pattern with right tracheal bronchus (n = 3), and bridging bronchus (n = 1). The rate of tracheobronchial stenosis was 56% (5/9).Five patients underwent operation, and at that time, the relationship between PALPA and the tracheobronchial tree defined on MSCT was confirmed. The PALPA can be associated with tracheobronchial anomalies and airway compression depending on its orientation to the airway. Noninvasive imaging modalities such as MSCT will be helpful for making further management decisions.

Cone Beam Computed Tomography vs Multislice Computed Tomography in Computer-Aided Design/Computer-Assisted Manufacture Guided Implant Surgery Based on Three-Dimensional Optical Scanning and Stereolithographic Guides: Does Image Modality Matter?

Cone beam computed tomography (CBCT) is increasingly overtaking multislice computed tomography (MSCT) for implant planning and computer-aided design/computer-assisted manufacturing (CAD/CAM) surgical guide fabrication. The purpose of this study was to evaluate whether the image modality has a significant influence on the accuracy of image-fusion stereolithographic guides. A total of 240 implants were placed in 30 polymer models using surgical guides fabricated using CBCT or MSCT and optical scanning of dental casts and diagnostic wax-up. Postsurgical image data were fused with the planning data for evaluation of the following errors: total error (Euclidean error), mesiodistal and buccolingual error, depth error, and angular error. The CBCT and MSCT results were statistically compared using a t test (P = .05). CBCT showed a statistically significantly higher total error with mean (± SD) of 0.36 ± 0.13 mm vs 0.27 ± 0.13 mm (P = .000), mesiodistal error with 0.20 ± 0.14 mm vs 0.16 ± 0.11 mm (P = .018), and depth error with 0.17 ± 0.12 mm vs 0.07 ± 0.07 mm (P = .000). Buccolingual and angular errors did not statistically significantly differ with 0.16 ± 0.11 mm vs 0.15 ± 0.12 mm (P = .613), and 0.96 ± 0.47 degrees vs 0.85 ± 0.59 degrees (P = .111). Using CBCT for image-fusion stereolithographic guides may provide lower accuracy than MSCT. The results should be confirmed on alternative CBCT scanners. Due to the total volume of tissues, image artifacts, and patient movements, the advantages seen using MSCT on models could be nonexistent or exacerbated on patients. Patient studies are required to demonstrate clinical relevance.

Imaging of Electrode Position after Cochlear Implantation with Flat Panel CT

Background. Postoperative imaging after cochlear implantation is usually performed by conventional cochlear view (X-ray) or by multislice computed tomography (MSCT). MSCT after cochlear implantation often provides multiple metal artefacts; thus, a more detailed view of the implant considering the given anatomy is desirable. A quite new method is flat panel volume computed tomography. The aim of the study was to evaluate the method's clinical use. Material and Methods. After cochlear implantation with different implant types, flat panel CT scan (Philips Allura) was performed in 31 adult patients. Anatomical details, positioning, and resolution of the different electrode types (MedEL, Advanced Bionics, and Cochlear) were evaluated interdisciplinary (ENT/Neuroradiology). Results. In all 31 patients cochlear implant electrode array and topographical position could be distinguished exactly. Spatial resolution and the high degree of accuracy were superior to reported results of MSCT. Differentiation of cochlear scalae by identification of the osseous spiral lamina was possible in some cases. Scanning artefacts were low. Conclusion. Flat panel CT scan allows exact imaging independent of implant type. This is mandatory for detailed information on cochlear electrode position. It enables us to perform optimal auditory nerve stimulation and allows feed back on surgical quality concerning the method of electrode insertion.

Glenoid bone lesions: Comparison between 3D VIBE images in MR arthrography and nonarthrographic MSCT

To evaluate the feasibility of using a fat-suppressed 3D volumetric interpolated breath-hold examination (VIBE) sequence in magnetic resonance (MR) arthrography as a substitute for nonarthrographic multislice computed tomography (MSCT) in detecting glenoid bone lesions. Fat-suppressed 3D VIBE MR arthrography and MSCT were performed in 56 patients (46 male, 10 female; age range, 14-51 years; mean age, 26 years). Based on the results of MSCT, the sensitivity and specificity of fat-suppressed 3D VIBE images for detection of bony Bankart lesion and glenoid bone loss were determined. Statistical significance of the percentages of glenoid bone loss between these two methods was calculated. Bony Bankart lesions were noted in 23 (41.1%) of 56 glenohumeral joints, and glenoid bone loss was found in 40 (71.4%) of 56 patients at nonarthrographic MSCT. Compared with MSCT, the sensitivity and specificity of fat-suppressed 3D VIBE images in detecting bony Bankart lesions were 95.7%-100% and 93.9%-97.0%, respectively (kappa value = 0.926), and those in predicting glenoid bone loss were 95.0% and 93.8%, respectively. For quantification of glenoid bone loss, there was a high correlation between fat-suppressed 3D VIBE and MSCT (r = 0.921, P < 0.001). Fat-suppressed 3D VIBE MR arthrography is a promising substitute for MSCT as a reliable method for evaluating bony Bankart lesion and glenoid bone loss.

Evaluation of effective regurgitant orifice area of mitral valvular regurgitation by multislice cardiac computed tomography

The purpose of our study was to assess the diagnostic accuracy of multislice computed tomography (MSCT) for the identification and quantification of mitral valve regurgitation in comparison with transthoracic echocardiography (TTE). Twenty-six patients (15 females, 11 males with a mean age of 44.6±14.1 years) who were in follow-up with the diagnosis of mitral regurgitation and those who were referred for MSCT were enrolled. MSCT results were compared with TTE measurements. The mean effective mitral regurgitant orifice area at MSCT was 23.1±13.0 mm² and at echocardiography was 24.4±16.0 mm². Bland-Altman analysis showed good agreement between the two imaging methods. MSCT provides reliable and good results for the evaluation of mitral regurgitation.

Comparative diagnostic evaluation with MR cholangiopancreatography, ultrasonography and CT in patients with pancreatobiliary disease

The aim of this study was to directly compare the results of magnetic resonance cholangiopancreatography (MRCP) with those of ultrasonography (US) and multislice computed tomography (MSCT) in the diagnosis of pancreaticobiliary diseases. A total of 70 patients (41 men, 29 women) aged 22-89 years were studied either before (n=59) or after cholecystectomy (n=11) for biliary lithiasis. Clinical signs and symptoms were jaundice (n=15), abdominal pain (n=37) and proven biliary lithiasis (n=18). MRCP was performed in all patients, whereas abdominal US was performed in 55 (group 1) and MSCT in 37 (group 2) patients. A regional evaluation of the main structures of the pancreaticobiliary system was performed: gallbladder and cystic duct, intra- and extrahepatic bile ducts and main pancreatic duct. Histology (n=27), biopsy (n=5), endoscopic retrograde cholangiopancreatography (ERCP) (n=28) and/or clinical-imaging follow-up (n=10) were considered standards of reference. In particular, patients were classified as showing benign (n=47) or malignant (n=12) lesions or normal biliary anatomy (n=11). In group 1, the results of MRCP and US were concordant in the majority (92%) of cases; however, statistically significant discordance (p<0.01) was found in the evaluation of the extrahepatic ducts, with nine cases (16%) of middle-distal common bile duct stones being detected on MRCP only. In group 2, the results of MRCP and MSCT were also concordant in most cases (87%). However, findings were significantly discordant when the intra- and extrahepatic ducts were analysed, with seven (19%) and six (16%) cases, respectively, of lithiasis being detected on MRCP only (p<0.01 for both). The results of our study confirm the diagnostic potential of MRCP in the study of the pancreaticobiliary duct system. In particular, the comparison between MRCP and US and MSCT indicates the superiority of MRCP in evaluating bile ducts and detecting stones in the common bile duct.

Reclassification of Patients for Aggressive Cholesterol Treatment: Additive Value of Multislice Coronary Angiography to the National Cholesterol Education Program Guidelines

National Cholesterol Education Program (NCEP) guidelines have been used to define treatment goals in patients with hypercholesterolemia. However, epidemiology-based guidelines are unable to identify all subjects with coronary artery disease for aggressive lipid intervention. We sought to evaluate the additive value of multislice computed tomography (MSCT) angiography to the NCEP guideline classification for lipid treatment. Multislice computed tomography was performed in 114 consecutive patients (mean age 57+/-14 y; 59% male) without known coronary artery disease. Subjects were classified into 3 categories (low-, intermediate-, and high-risk) according to their Framingham risk scores (FRS). Traditional cardiac risk factors were common: hypertension 59%, diabetes 13%, and smoking 22%. On the basis of the FRS, 11% (n=12/114) of the patients met high-risk criteria requiring aggressive cholesterol reduction. Of those in the low- and intermediate-risk groups, MSCT found coronary plaque in 76% (n=77/102), with moderate or severe plaque in 38% (n=39/102), thus reclassifying them in the high-risk category. Use of statin drugs increased from 32% at baseline to 53% (p=0.002) based on MSCT results; statin dose was increased in 31% of the patients who were already on a statin. The mean low-density lipoprotein cholesterol (LDL-c) decreased from 114 mg/dL to 91 mg/dL after MSCT (p<0.001). Multislice computed tomography reclassifies a high percentage of patients considered to be low- to intermediate-risk into the high-risk category based on their coronary artery lesions. Thus, the rise in MSCT use at present may have a large impact on clinician practice patterns in lipid-lowering therapy.

Detection of High-grade Stenoses With Multislice Computed Tomography in Heart Transplant Patients

Post-transplant follow-up of heart transplant patients consists of repeated coronary angiography, which is associated with high costs, discomfort and risk. We sought to determine whether multislice computed tomography (MSCT) permits the exclusion or progression of coronary artery disease in heart transplant patients. MSCT scanning (Philips CT MX 8000 IDT) and invasive coronary angiography were performed on 66 consecutive heart transplant patients. One hundred milliliters of non-ionic iodinated contrast medium was applied for CT angiography. For MSCT analysis, coronary arteries and side branches with a diameter > or =1.5 mm were assessed for the presence of luminal narrowing of >70%. MSCT results were compared with those of quantitative coronary angiography analysis. Ten patients (17%) had one significant stenosis, whereas 3 patients (5%) had 2-vessel disease and none had 3-vessel disease. MSCT was performed successfully on 60 patients enrolled in our analysis. Forty-two of 44 patients (95%) who were estimated to be fully evaluable for MSCT were correctly classified. On per-segment-based analysis, sensitivity, specificity and positive and negative predictive values were 59%, 94%, 91% and 99.43%, respectively. After exclusion of unevaluable segments, sensitivity and specificity increased to 71% and 99.86%, respectively. On per-patient-based analysis, sensitivity, specificity and positive and negative predictive values were 88%, 97%, 88% and 97%, respectively, in evaluable transplant recipients. MSCT with its high specificity and high negative predictive value allows the exclusion of significant coronary artery vasculopathy in evaluable patients. From the clinical point of view, this might spare additional invasive coronary angiography in heart transplant patients.

Post-mortem changes of the middle ear: Multislice computed tomography study

Six dry skulls were studied by multislice computed tomography (MSCT). They had not previously been prepared, and were natural skeletonized remains. All had been found in the soil. Examination focused on the temporal bones and the ear structures. In all cases, either disruption of the ossicular chain or absence of some ossicular bones were noted. The authors concluded that the fragile ossicles were disrupted in the post-mortem state, and were not indicative of ante-mortem pathology. These observations illustrate the ability of MSCT to visualize taphonomic changes. To further illustrate these findings, we present the results of MSCT performed on an exhumed body. The left ossicular bones were missing and the right ossicular chain was disrupted. With the development of forensic radiology, structures as tiny as the ossicles can be examined. However, the radiologist who performs post-mortem imaging must be familiar with taphonomic changes to avoid interpretation as ante-mortem or peri-mortem traumatic injuries. This could potentially have considerable judicial impact, especially in the study of exhumed bodies.

Diagnostic accuracy of multislice computed tomography for the detection of coronary artery disease in diabetic patients

Background Diabetes mellitus is an important risk factor for coronary artery disease. Cardiac multislice computed tomography (MSCT) permits visualization of the coronary arteries with good sensitivity and specificity. However, at present, there are no data whether MSCT allows an accurate assessment of coronary arteries of diabetic patients, in comparison to nondiabetic patients. Thus, we compared the catheter-controlled MSCT results from diabetic and nondiabetic patients in a cohort of 116 patients with regard to sensitivity, specificity, positive predictive value, and negative predictive value, as well as image quality. Methods and Materials Twenty-two diabetic patients (age, 64.6±8.5 years; number of risk factors, 3.4±1.1) and 94 nondiabetic patients (age, 64.2±9.2 years; number of risk factors, 2.4±1.0) were examined by MSCT (Sensation 16 Speed 4 D, Siemens, Forchheim, Germany; gantry rotation time, 375 ms) and invasive coronary angiography. MSCT results were compared, blinded to the results of the coronary angiography with regard to the presence or absence of a significant stenosis (>50%) in a modified American Heart Association 13-segment model. Image quality was assessed on a qualitative scale between 1 (very good) and 5 (invisible) for each segment. Results Sensitivity, specificity, positive predictive value, and negative predictive value were statistically not different in diabetic and nondiabetic patients (0.85/0.98/0.92/0.96 vs. 0.84/0.97/0.91/0.95). One diabetic and three nondiabetic patients had to be excluded from analysis. Diabetic patients had relevantly more risk factors ( P < .05), but calcium scoring was not different in both groups (Agatston score 1090±1278 vs. 798±1033). The image quality in both cohorts was comparable. Conclusions MSCT allows the assessment of the coronary arteries noninvasively in diabetic patients with a good sensitivity and specificity, and diabetes does not have an impact on the number of evaluable segments. Thus, MSCT is a noninvasive tool in the care of these patients.

Multislice CT for Evaluation of Acute Chest Pain in the ED

How should we initially evaluate low-risk patients with acute chest pain? In this randomized study, researchers compared a strategy using multislice computed tomography (MSCT) —followed by nuclear stress testing if MSCT results were equivocal — with a standard diagnostic approach of nuclear stress testing. Patients with symptoms of ischemia within 12 hours of presentation and a low risk for infarction or complications were eligible; …

Non-invasive evaluation of coronary artery bypass grafts using 16-row multi-slice computed tomography with 188 ms temporal resolution

Background Cardiac multi-slice computed tomography (MSCT) scanners permit visualization of the coronary arteries and coronary artery bypass grafts. The latest MSCT generation with true 16-detector slices (Sensation 16 Speed 4 D®, Siemens, Forchheim, Germany) provides improved temporal and spatial resolution, as well as significantly reduced scan time. To assess, whether this technical improvement has also an impact on image quality and accuracy of MSCT diagnosis in patients with previous coronary artery bypass graft (CABG) surgery the following study was conducted. Methods and material Thirteen consecutive patients (pts) (10 male, 3 female, mean age 62 ± 6.4 [55–73] years, heart rate 68 ± 11 [52–88] bpm) and a total number of 43 coronary bypass grafts (11 arterial, 32 venous grafts) were examined by MSCT (gantry rotation time 375 ms). In addition to the analysis of coronary bypass grafts, 13 coronary segments (sgts) were evaluated in each patient ( n = 169 sgts). MSCT results were compared with coronary angiography. Results Forty-one of 43 bypass grafts (95%) were analyzable by MSCT. In conventional angiography 16 of 43 (37%) grafts were occluded. Sixteen of them were correctly diagnosed by MSCT (sensitivity 100%). One graft showed a 50% anastomosis stenosis which was also detected. Twenty-five of 27 grafts without severe lesion showed no significant stenosis in MSCT (specificity 93%, positive predictive value (PPV) 89%, negative predictive value (NPV) 100%). Ninety of 108 (83%) high-grade stenosis (> 70%) of the native coronary vessels were correctly detected (sensitivity 83%, PPV 78%). From the 61 sgts without high grade stenosis 36 were correctly classified (specificity 59%, NPV 67%). If sgts number 8, 9 and 10, which are normally not target for revascularization, are excluded sensitivity rises to 89%, specificity to 71%, PPV to 87% and NPV to 75%. The correct clinical diagnosis (absence or presence of a high grade stenosis of at least one bypass graft) was achieved in all patients. Conclusions True 16-slice MSCT with faster gantry rotation time allows detection of lesions in coronary artery bypass grafts with high sensitivity and specificity. The evaluation of native vessels in pts with known CAD remains a diagnostic challenge. However, the correct clinical diagnosis was achieved in all pts. MSCT is a non-invasive tool to assess coronary artery bypass grafts.

Virtopsy—Fatal Motor Vehicle Accident with Head Injury

A man wearing no protective helmet was struck by a motor vehicle while riding a bicycle. He was loaded on his left side, and the impact point of his head was his occiput on the car roof girder. He was immediately transported to the general hospital, where he passed away. Postmortem examination using multi-slice computed tomography (MSCT) revealed an extensively comminuted fracture of the posterior part and the base of the skull. Observed were deep direct and contrecoup brain bruises, with the independent fractures of the roof of the both orbits. Massive subdural and subarachnoidal hemorrhage with cerebral edema and shifting of the mid-line towards left side were also detected. MSCT and autopsy results were compared and the body injuries were correlated to vehicle damages. In conclusion, postmortem imaging is a good forensic visualization tool with great potential for documentation and examination of body injuries and pathology.