Sensitivity Of High Resolution Computed Tomography Research Articles

Cochlear implantation for post-meningitis deafness with cochlear ossification: diagnosis and surgical strategy

Background Cochlear ossification (CO) after meningitis can cause profound sensorineural hearing loss (SNHL). Cochlear implantation (CI) is the ideal treatment strategy for CO. Aims To explore the strategy for CI in patients with CO after meningitis. Materials and Methods In this retrospective study, the medical records of patients diagnosed with profound SNHL due to CO after meningitis and who underwent CI in our department between September 2010 and September 2021 were collected and reviewed. Their imaging and surgical findings were analyzed. Results The data of 26 patients with unilateral CI were reviewed. All patients underwent preoperative temporal high-resolution computed tomography (HRCT) and 22 patients magnetic resonance imaging (MRI). The sensitivity of HRCT was 61.5% (10/26), whereas that of MRI was 81.8% (18/22). Combined HRCT and MRI achieved a detection rate of 92.3% (24/26). Twenty-two and four patients underwent complete and partial electrode implantations, respectively. Conclusions and Significance Preoperative temporal bone HRCT and MRI are essential for determining whether a patient is suitable for CI and surgical planning. A false-negative diagnosis is possible when diagnosing CO, but combined HRCT and MRI can improve the positive rate of preoperative diagnosis of CO post meningitis. Early CI is recommended.

Diagnostic Accuracy of High-Resolution CT in Early Diagnosis of COVID-19 Patients with Comparison to Reverse Transcriptase-PCR

Objective: To determine the accuracy of high-resolution CT (HRCT) in early diagnosis of COVID-19 in comparison to Reverse-Transcription Polymerase Chain Reaction (RT-PCR). Study Design and Setting: This was a retrospective study, conducted in Department of Radiology, PNS Shifa Hospital, Karachi from April 2020 to June 2020. Methodology: A total of 115 patients were included in the study who presented with symptoms. Patient’s data such as demographic details, clinical presentations, RT-PCR reports and HRCT reports were collected from the record of the hospital. Data was entered and analyzed using SPSS-25. Results: Out of 115 study participants, 98(85.2%) were male and 17(14.8%) were female with the average age of 50.53 (±18.64) years. Fever along with cough was the most common clinical presentation, presented by 91(79.1%) subjects. In comparison to RT-PCR, sensitivity of HRCT was 96.2%, its specificity standing at 60% with the overall accuracy of 93.19%. Moreover, mortality Rate of these symptomatic patients was 11.30% (13 out of 115). The average age of the expired patients was 67.07 (±11.45) years and the age of discharged patients was 48.31 (±17.92) years. The difference in age was statistically significant (p-value <0.001). Conclusion: Highly specific and sensitive diagnostic tests for COVID-19 have not yet been developed. High resolution CT chest has high sensitivity for early diagnosis of COVID-19, hence HRCT should be incorporated as a primary tool in assessment criteria of hospitalized patients for early diagnosis of COVID-19.

Role of HRCT Temporal Bone in Predicting Surgical Difficulties Encountered in Fenestral Otosclerosis Surgery.

To study spectrum of high resolution computed tomography (HRCT) imaging findings in otosclerosis, to predict approximate length of prosthesis required from pre-operative HRCT measurements and to correlate between oval window niche (OWN) height preoperatively and difficulty in introducing foot plate perforator during surgery. A cross sectional study was conducted on 23 patients with a clinical diagnosis of otosclerosis from September 2018 to July 2020. Sensitivity of HRCT in detecting otosclerosis, correlation between pre-operative incudo-stapedial length (ISL) and intra operative prosthesis length, and correlation between OWN height and difficulty in introducing perforator were sought. The mean age of 23 patients studied was 39.9years with a female preponderance of 56.5%. 17 out of 19 patients with foci of otosclerosis during surgery had HRCT findings of otosclerosis providing a sensitivity of 89.5%. Mean OWN height obtained was 1.29mm preoperatively and a cut off value of 1.325mm found using receiver operating characteristic curve method classifying OWN height as narrow or normal. Mean ISL measured pre operatively was 4.25mm and mean length of prosthesis used was 4.56mm with significant positive correlation using intraclass correlation coefficient method with correlation coefficient = 0.879. HRCT is an invaluable modality aiding the surgeon to detect otosclerotic foci with high sensitivity, identify thick obliterative otosclerotic foci requiring additional drilling, to predict the length of prosthesis used and to predict difficulties in approaching footplate when OWN height is below 1.325mm.

Evaluation of Temporal Bone Cholesteatoma and the Correlation between High Resolution Computed Tomography and Surgical Finding

BackgroundAcquired cholesteatomas are commonly seen in patients less than 30 years. There is a typical history of recurrent middle ear infections with tympanic membrane perforation. The diagnosis of cholesteatoma is usually made on otologic examination.ObjectiveThe aim of the work was to study the role of high resolution computed tomography (HRCT) in detecting, evaluating, and diagnosing middle ear cholesteatoma.Patients and methodsThis was a prospective study that included 56 consecutive patients with chronic suppurative otitis media, unsafe type cholesteatomas. Each patient was subjected to full clinical evaluation, and HRCT examination. Intravenous contrast media was used in some patients with suspected intracranial complication. Preoperative radiological data were correlated with data related to surgical findings.ResultsThe study showed that a high incidence of cholesteatoma in the third decade of life. The scutum and lateral attic wall were the most common bony erosions in the middle ear bony wall (64.3%), and the incus was the most eroded ossicle in the middle ear (88.2%). Sclerosing of mastoid air cells were encountered in 60.7% of patients and the lateral semicircular canal was affected in 9%, while facial canal erosion was found in 21.4%. Temporal bone complications are more common than intracranial complications.HRCT findings were compared with operative features; the comparative study included the accuracy and sensitivity of HRCT in detecting cholesteatoma (92.8%), its location and extension (96.4%), ossicular chain erosion (98%), labyrinthine fistula and intracranial complications (100%).ConclusionThe important role of HRCT scannig lies on the early detection of cholesteatoma, and more conservative surgical procedures can be used to eradicate the disease.

Imaging Evaluation in Otosclerosis: Single Photon Emission Computed Tomography and Computed Tomography

The aim of our study was to demonstrate the utility of diphosphonate bone single photon emission computed tomography (SPECT) in diagnosing otosclerosis and to correlate the findings from SPECT with age, gender, and sensorineural hearing loss. We also evaluated the ability of high-resolution computed tomography (HR-CT) in detecting otospongiotic and otosclerotic foci and correlated the HR-CT findings with the SPECT results. Seventy-three subjects with surgically confirmed otosclerosis underwent SPECT, and 45 of the 73 patients also underwent HR-CT of the petrous bones. In the patient sample examined in this study, SPECT demonstrated a sensitivity of 95.2% and a specificity of about 96.7%. By correlating the SPECT findings, we found an inverse relationship between bone radioactivity and age (i.e., greater disease activity in younger patients) and a direct relationship between bone radioactivity and the severity of sensorineural impairment in younger patients. In the 45 patients who also underwent HR-CT, the sensitivity of HR-CT (58%) was lower than that of SPECT, and the comparison between SPECT activity and the HR-CT findings (fenestral or retrofenestral type) demonstrated a statistically significant correlation between the morphological finding of bone demineralization (pericochlear foci) and a high uptake index. The use of SPECT seems to be highly effective in differentiating normal from pathological petrous bone. It also provides a quantitative evaluation of disease activity and shows a significant correlation with bone demineralization revealed by HR-CT.

Primary graft dysfunction; possible evaluation by high resolution computed tomography, and suggestions for a scoring system☆

We have reviewed and discussed current knowledge on existing scoring systems regarding high resolution computed tomography (HRCT) images for the assessment of primary graft dysfunction (PGD) after lung transplantation. Adult respiratory distress syndrome (ARDS) has been more widely studied and appears to have many morphological features similar to what is found in PGD, and might, therefore, be usefully extrapolated to PGD. Principles of HRCT, scoring systems based on HRCT and various terms describing PGD were reviewed and summarized. The sensitivity, inter-intra observer variability, and reproducibility of these systems were discussed. Lastly, the future perspectives for 64-multi-slice computed tomography (MSCT) in relation to PGD were discussed. Few studies on scoring systems of lung tissue by HRCT in ARDS patients and idiopathic pulmonary fibrosis (IPF) patients were found. Most studies were performed on patients with cystic fibrosis (CF). Sensitivity of HRCT for the detection of parenchymal changes is superior to other imaging methods. High levels of reproducibility are achievable amongst observers who score HRCT lung images. Development of standardized criteria that specify the inclusion/exclusion criteria of patients, pilot testing, and training investigators through review of disagreements, were possibilities suggested for decreasing inter/intra observer variability. Factors affecting the image attenuation (Hounsfield numbers) and thus, the reproducibility of CT densitometric measurements were of minimal influence. Studies have reported on how lung tissue images, derived by HRCT, can be scored and graded. There does not seem to be a golden standard for evaluating these images, which makes comparison between methods challenging. These scoring systems assess the presence, severity, and extent of parenchymal change in the lung. HRCT is considered relevant and superior in evaluating disease severity, disease progression, and in evaluating the effects of therapy regimes in the lung. It is, however, not clear to what extent these scoring methods may be implemented for grading PGD. Further efforts could be made to standardize scoring methods for lung tissue with regards to PGD.

Pictorial Essay: Multinodular Disease

The evaluation of patients presenting with multinodular pulmonary disease provides an important clinical challenge for physicians. The differential diagnosis includes an extensive list of benign and malignant processes making the management of these cases frequently problematic. With the introduction of high-resolution CT (HRCT) scanning, the ability to assess various patterns of diffuse multinodular disease has evolved into an essential part of the diagnostic process. The purpose of this article is to develop an approach to the diagnosis of multinodular parenchymal disease using HRCT scan pattern recognition as a point of departure.

Combined HRCT and MRI in the Detection of CSF Rhinorrhea

Cerebrospinal fluid (CSF) rhinorrhea is a potentially dangerous problem. Accurate preoperative localization of the site of leakage is mandatory. The standard diagnostic technique is computed tomography (CT) cisternography. Because of its related risks, however, various alternatives have been suggested. High-resolution CT (HRCT) provides good bony details, but fluid is poorly detected. In contrast, T2-weighted magnetic resonance imaging (MRI) shows CSF as a bright signal, but spatial resolution is poor as is the depiction of bony details. To overcome the shortcomings of both techniques, we superimposed the images obtained from each modality and used the result to plan surgical explorations. The sensitivity of HRCT was 88.25%. Fat-suppressed T2-weighted MRI detected a CSF-like density in 18 cases (90%) with a sensitivity of 88.88%. Superimposing the CTs and MRIs accurately localized the site of CSF leakage in 17 of 19 cases with a sensitivity of 89.74%. This finding compares favorably with the results of other techniques. We thus recommend this technique as the primary diagnostic method of choice for the investigation of patients with CSF rhinorrhea.

High-resolution CT in the evaluation of clinically suspected Pneumocystis carinii pneumonia in AIDS patients with normal, equivocal, or nonspecific radiographic findings.

We prospectively studied AIDS patients with a high clinical pretest probability of Pneumocystis carinii pneumonia (PCP) in whom chest radiographic findings were normal, equivocal, or nonspecific with high-resolution CT (HRCT) to determine the incidence of PCP in these patients, to assess the diagnostic accuracy of HRCT for the presence or absence of PCP, to evaluate the role of HRCT in patient management, and to determine the clinical outcome of all patients 1 month after evaluation. All patients were referred to the Division of Pulmonary and Critical Care Medicine for diagnosis of clinically suspected PCP. Thirty-three patients were prospectively evaluated with HRCT within 24 hr of diagnostic bronchoalveolar lavage; 18 other patients who underwent HRCT were managed according to the HRCT interpretation and followed up clinically. All HRCT scans were independently reviewed by three chest radiologists; patchy or nodular ground-glass attenuation was considered to indicate "possible PCP." The incidence of PCP was 12% (6/51). The sensitivity of HRCT was 100%; specificity, 89%; and accuracy, 90% (p < .005). We had five false-positive and no false-negative interpretations. Some form of "airways disease" (n = 23) was the single most common HRCT interpretation. HRCT may allow exclusion of PCP in patients with findings that are normal, equivocal, or nonspecific on chest radiographs. Empiric therapy or immediate bronchoscopy can be avoided in many patients on the basis of the HRCT findings.

The Sensitivity of High-Resolution CT in Detecting Idiopathic Pulmonary Fibrosis Proved by Open Lung Biopsy: A Prospective Study

To assess the sensitivity of high-resolution chest computed tomography (HRCT) in detecting idiopathic pulmonary fibrosis proved by biopsy specimen. To determine the degree of physiologic and pathologic abnormalities in patients with idiopathic pulmonary fibrosis who have a false-negative HRCT. Prospective 2-year study. Tertiary care university hospital. All patients with dyspnea and suspected interstitial lung disease referred to the University of Michigan for enrollment in the Idiopathic Pulmonary Fibrosis Specialized Center of Research (SCOR) protocol were included; 25 underwent open lung biopsy and formed the final study group. All patients underwent physiologic (pulmonary function, gas exchange, and exercise testing), radiologic (chest x-ray film and HRCT), and pathologic assessments (bronchoscopic and open lung biopsy). The results of HRCT were prospectively compared with results of standard pulmonary function tests, cardiopulmonary exercise testing, and open lung biopsy. Of 25 patients who had both HRCT and open lung biopsy, 3 patients (12%) had HRCTs that demonstrated no evidence of interstitial lung disease. These three patients had less severe disease based on clinical, radiographic, and physiologic (CRP) scores, gas exchange abnormalities, and pathologic scoring of open lung biopsy specimens, compared with those with an abnormal HRCT. We conclude that in the evaluation of patients with dyspnea and abnormal results of pulmonary function studies, a normal HRCT does not exclude early and clinically significant interstitial lung disease. In our patient population, physiologic testing was more sensitive than HRCT in detecting mild abnormalities in patients with idiopathic pulmonary fibrosis proved by biopsy specimen.

The airway

The term bronchiectasis refers to chronic irreversible dilatation of diseased bronchi. There are many causes of bronchiectasis and the entity should be considered as the final outcome of a number of mechanisms, rather than as a simple diagnostic label.6 Because the definition of bronchiectasis is a morphologic one, imaging has a key role in its identification. Over the years, imaging tests have become increasingly accurate in depicting the features of early bronchiectasis. The sensitivity of high-resolution CT (HRCT) contrasts starkly with the limited ability of plain chest radiography to detect even advanced bronchiectasis. HRCT represents a great improvement over previous imaging techniques, but problems with specificity and observer variation remain. New insights into the functional consequences of bronchiectasis are now being provided by HRCT. It seems probable that HRCT will remain the imaging test of choice for the detection of bronchiectasis over the next few years. This article covers the clinical, pathologic, and functional features of bronchiectasis, HRCT technique, the signs of bronchiectasis on chest radiography and HRCT, and causes of misdiagnosis of bronchiectasis.