Specificity Of Multidetector Computed Tomography Research Articles

Role of Multidetector Computed Tomography in the Detection and Characterisation of Benign and Malignant Non Lymphoid Masses of the Neck and its Concordance with Fine Needle Aspiration Cytology

Introduction: Computed Tomography (CT) enables the evaluation of both osseous and soft tissue details and has become an important imaging modality in the evaluation of patients presenting with a neck mass. The study was conducted to justify the usefulness of Multidetector CT (MDCT) in patients presenting with neck lesions. Aim: To detect benign and malignant non lymphoid lesions of the neck using MDCT imaging features and compare it with Fine Needle Aspiration Cytology (FNAC). Materials and Methods: This cross-sectional study undertaken in a Government Stanley Medical College, Chennai, India, the duration of the study, from June 2021 to May 2022. Contrast Enhanced CT (CECT) was performed with a 16 slice MDCT scanner pre and postcontrast administration. The benign and malignant lesions were evaluated by their enhancement patterns, necrosis, bony and vascular invasion and extension to adjacent neck space. The results were compared with FNAC being considered the gold standard, sensitivity and accuracy of CT was determined. The collected data was analysed with International Business Machines (IBM) Statistical Package for Social Sciences (SPSS) Version 23.0. Results: Of the total 95 patients who were enrolled in to the study, 38 patients were females and 57 patients were males, the mean age of the subjects studied were 45.1±17.4 years, 67 cases were benign lesions and 28 cases were malignant lesions by FNA. The sensitivity and specificity of MDCT was found to be 78.6% and 95.5%, respectively with a Positive Predictive Value (PPV) of 88.0% and Negative Predictive Value (NPV) 0f 91.4%. Conclusion: MDCT is precise in differentiating malignant from benign lesions of the neck and defining the extent of the lesions and involvement of adjacent structures.

Role of Multidetector Computed Tomography in the Assessment of Malignant Large-Bowel Lesions

Abstract Background and Objective: Intestinal disease can be examined with computed tomography (CT), which also allows for an assessment of extraintestinal pathology. In addition, CT enhances diagnostic specificity (SP) and offers an exceptional evaluation of the perienteric anomalies that typically accompany bowel disorders. The preoperative grading accuracy was found unappealing, varying between 48% and 77%. The bowel wall thickening among individuals with colorectal cancer is classified as benign or malignant depending on the extent of thickening, symmetrical and asymmetrical thickening, focal, segmental, or diffuse involvement, and related perienteric anomalies. The current study used a cohort of patients with colorectal cancers. The study aimed to find out sensitivity (SN) and SP of multidetector CT (MDCT) in detecting malignant pathologies of the large bowel by comparing the MDCT diagnosis with findings of histopathological examination. Materials and Methods: The study was an observational study, done from December 2019 to December 2021 in the Department of Radiodiagnosis, MES Medical College, Perinthalmanna, Kerala. The patients included were clinically and radiologically indicative of bowel lesions, who were referred with clinical suspicion of large-bowel diseases. The 16-slice Philips ACCESS MDCT scanner was used for MDCT. Oral, rectal, and IV contrast were used after plain CT imaging. Results: The study consisted of 63 patients, of which 53 lesions were found to be malignant on MDCT. However, only 51 patients had cancer verified by histology. Histopathology indicated that the two instances, which the MDCT had identified as malignant, were actually inflammatory. Therefore, for the diagnosis of malignant tumors, MDCT had a SN of 98.10%, SP of 81.80%, a positive predictive value of 96.20%, and a negative predictive value of 90.00% in the present study. On histology, a case that was first identified as benign on MDCT turned out to be malignant. Benign abnormalities on CT showed broad intestinal involvement and modest, symmetric wall thickening. The CT characteristics of malignant tumors included localized intestinal involvement and pronounced asymmetric wall thickening. Conclusion: MDCT has shown to be a trustworthy method for the purpose of evaluating and discriminating benign from malignant colon and rectum tumors. In addition to merely identifying a tumor, MDCT also offers additional information on any perienteric anomalies that may be present around the lesion, the presence of lymph node enlargement, invasion of adjacent viscera, the existence of intestinal obstruction, and metastatic tumors.

Diagnostic Accuracy of a 64-Slice Multi-Detector CT Scan in the Preoperative Evaluation of Periampullary Neoplasms.

Periampullary tumors are highly malignant masses with poor prognosis. Surgical resection is the only treatment for patients with this disease. The preoperative evaluation of masses is essential to determine the tumor resectability and vascular invasion. The aim of this study was to determine the diagnostic accuracy of 64-slice multi-detector computed tomography (MDCT) in detecting the resectability of periampullary masses. A cross-sectional study was conducted on patients with a definite diagnosis of periampullary cancer. All the participants underwent an MDCT scan before the surgical pancreaticoduodenectomy. The preoperative results were compared to the intraoperative findings and the diagnostic accuracy was determined based on the sensitivity and specificity of the MDCT. From June 2015 until June 2016, 32 patients with periampullary carcinoma were enrolled in the study. Of 32 masses, one of them considered nonresectable because of the gross vascular invasion in th CT images. After the operation, the overall resectability rate was 81.3%. The sensitivity and specificity of MDCT for tumor resectability was 100% and 16.7%, respectively, with an overall accuracy of 84.4%. To sum up, MDCT had high sensitivity but low specificity in the preoperative evaluation of preampullary carcinomas. The low specificity resulted from the low accuracy of the CT scan in detecting vascular involvement.

Thyroid cartilage invasion in laryngeal and hypopharyngeal squamous cell carcinoma treated with total laryngectomy

The objective of this study is to analyze the accuracy of computed tomography in detecting malignant thyroid cartilage invasion. In a retrospective chart review, 120 patients with carcinoma of the larynx and hypopharynx underwent computed tomography before total laryngectomy. These data were compared with the histological specimens. Multidetector computed tomography (MDCT) scan had a positive predictive value (PPV) of 76% and a negative predictive value (NPV) of 69%. The specificity of MDCT was 89% and sensitivity was 46%. Comparison between radiologic suspected cartilage invasion and histologic results showed a significant correlation (p<0.02). We found no significant impact of cartilage invasion concerning survival rates (5-year overall survival p=0.683; 5-year disease-free survival p=0.711). Preoperative CT scan is an important instrument in detecting neoplastic cartilage invasion.

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.

The Application of MDCT in the Diagnosis of Chest Trauma

Traumas are the third most common cause of death worldwide, after cardiovascular diseases and neoplasms, and the main cause of death of patients under 40 years of age. Contemporary image diagnosis of chest trauma uses chest X-ray (CXR), multidetector computed tomography (MDCT), transthoracic and transoesophageal ultrasound (USG), X-ray angiography and magnetic resonance. The aim of the present study was to evaluate MDCT results in the examination of posttraumatic chest injuries and to compare the results of CXR and MDCT in chosen chest traumatic injuries. The sixty patients with chest trauma included in the study were diagnosed at the Department of Radiology of the Institute of Tuberculosis and Lung Diseases between May 2004 and October 2007. MDCT was performed in all patients. Two groups with different types of injury (blunt or penetrating chest trauma) were distinguished. The analysis of injuries in both groups was conducted depending on the mechanism of trauma. The detection of 20 selected injuries at CXR and MDCT was compared. Moreover, the compatibility of MDCT with the results of intraoperative assessment and bronchoscopy was analysed. The influence of MDCT on the treatment modality was also assessed. History of blunt chest trauma was found in 51 patients (group 1) and of penetrating trauma in 9 patients (group 2). The most frequent injuries among group 1 were lung contusion and rib fractures, and among group 2 it was pericardial hematoma. Compared to MDCT, the sensitivity and specificity of CXR were 66.7 and 58%, respectively. Change of treatment modality was observed after MDCT in 83% of patients. The sensitivity and specificity of MDCT in diagnosing tracheobronchial injury, compared to bronchoscopy, were 72.7% and 100%, respectively. Compatibility of MDCT results and intraoperative assessment was observed in 43% of patients, and the main reason for discrepancy was underdiagnosis of diaphragm injury in MDCT. MDCT was a valuable diagnostic method in recognition of chest trauma, characterized by high sensitivity and specificity in the assessment of life-threatening injures and for depicting tracheal and bronchial injuries. The diagnostic value of CXR was low. The compatibility of MCTD and intraoperative assessment was confirmed, with the exception of diaphragm injures and lung laceration. Change of treatment modality was certified after MDCT in 83% of patients.

The accuracy of multidetector Computed Tomography for preoperative staging of renal cell carcinoma

The purpose of this study was to evaluate the accuracy of multidetector computed tomography (MDCT) in the preoperative staging of renal cell carcinoma (RCC). We retrospectively reviewed the clinical and pathological records of 312 patients with RCC who underwent staging MDCT before surgery. Radiographic findings were compared to the findings at surgery and pathological examination. All staging used 2009 updated TNM classification. The difference in tumor size between radiographic and pathological findings was 0.21 cm. In T1a group, the difference was 0.33 cm. Agreement between MDCT and histopathological findings was moderate for T staging (Kappa = 0.469), fair for N staging (Kappa = 0.322), and excellent for M staging (Kappa = 0.932). The sensitivity and specificity of MDCT in detecting perinephric fat invasion were 32.26% and 85.87%, in detecting tumor thrombosis were 84% and 100%, in detecting adrenal gland invasion were 60% and 95.79%, in detecting lymph node involvement were 50% and 96.36%, in detecting distant metastasis were 100% and 99.67%, respectively. In regard to stage grouping, 237 of 314 patients were correctly staged by MDCT, with an overall accuracy of 75.48%. MDCT with a dynamic contrast protocol is able to delineate RCC with high accuracy. However, a great portion of tumors were overstaged by MDCT because of overestimation of tumor size and poor visualization of infiltration of the perinephric fat. In addition, nodal metastatic lesion evaluation relies on node size only and remains a difficult task.

Accuracy of 64-multidetector computed tomography in diagnosis of adnexal tumors

BackgroundAdnexal cancers are in fifth place among the tumors with the highest mortality in the female population. The aim of the present study was to evaluate the accuracy of Multi-detector computed tomography (MDCT) on a 64-multislice CT scanner in the detection and differentiation of adnexal masses stages.MethodsDuring the present prospective study, 95 women with a primary diagnosis of ovarian mass in base of clinical examination and ultrasonographic findings underwent preoperative evaluation by a 64-slice MDCT with a section thickness of 0.6 mm, 50% overlap and reconstructed images. Afterward, results of MDCT were compared with surgical and histopathological findings, and the sensitivity, specificity, positive and negative predictive value and accuracy were determined.ResultsThe mean age of patients was 48.63 ± 13.93 years. MDCT diagnosed 25 (26.3%) masses to be benign and 70 (73.7%) to be malignant (sensitivity, specificity, positive and negative predictive value and accuracy were 92.8%, 88.0%, 95.5%, 81.4% and 91.5% respectively). The sensitivity and specificity of MDCT in determining local extension was 72.2% and 93.4% respectively. And the sensitivity and specificity of MDCT in determining peritoneal seeding and liver extension was 81.8% and 93% respectively. Estimated stage was significantly agreed with the surgical (Cohen's Kappa (κ) = 0.891) and histopathological findings (κ = 0.858).ConclusionMDCT is a highly sensitive and specific diagnostic method in evaluation of adnexal masses and successfully stage the tumor in consistent with surgery and histopathology.

Detection of left atrial thrombus during routine diagnostic work-up prior to pulmonary vein isolation for atrial fibrillation: Role of transesophageal echocardiography and multidetector computed tomography

BackgroundTransesophageal echocardiography (TEE) and multidetector computed tomography (MDCT) are frequently used imaging modalities prior to pulmonary vein isolation (PVI) in order to exclude left atrial (LA) and left atrial appendage (LAA) thrombus and to visualize the anatomy of LA and pulmonary veins. This study aimed to identify predictors of LA/LAA thrombus and to analyze the diagnostic yield of routine pre-procedural TEE and MDCT. Methods329 patients with drug-refractory atrial fibrillation (AF) (age 62±10years; 65% males; 247 paroxysmal AF) referred for pulmonary PVI were included. Prior to the procedure, all patients underwent 64-slice MDCT and TEE, which was used as the gold standard. Risk parameters for thrombus formation were determined, including the CHADS2 and CHA2DS2-VASc scores. ResultsMDCT identified 10 LA/LAA thrombi (3.0%) (8 false positive, 2 true positive), whereas 7 actual thrombi (2.1%) were detected by TEE (5 false negative by MDCT). Sensitivity and specificity of MDCT was 29% and 98%, respectively, with a negative predictive value of 98% and a positive predictive value of 20%. All patients with thrombus were on effective anticoagulation. In multivariate analysis, diabetes mellitus, CHADS2 score ≥3, and CHA2DS2-VASc score ≥4 were significantly associated with LA/LAA thrombus. No thrombus was seen in patients without risk factors. ConclusionsIn patients presenting for PVI, MDCT does not reliably exclude LA/LAA thrombus. Our study revealed a small but significant prevalence of thrombus despite effective anticoagulation. Diabetes mellitus, CHADS2 score ≥3, and CHA2DS2-VASc score ≥4 were independent risk predictors of LA/LAA thrombus.

Ischemic Stroke: Etiologic Work-up with Multidetector CT of Heart and Extra- and Intracranial Arteries

To assess the potential of a single-session multidetector computed tomography (CT) protocol, as compared with established methods, for the etiologic work-up of acute ischemic stroke. Patients found to have recently experienced an ischemic stroke were recruited for this prospective study after institutional review board approval was obtained. Each patient was scheduled for two evaluation strategies: (a) a standard approach involving transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE), duplex ultrasonography (US) of the neck vessels, and magnetic resonance (MR) angiography of the neck and brain vessels; and (b) a protocol involving single-session multidetector CT of the heart, neck, and brain vessels. The authors sought to determine the major etiologic factors of stroke, including cardiac sources of embolism and atheroma of the aortic arch and the extra- and intracranial vessels, by using both strategies. Multidetector CT, MR imaging, and duplex US were performed in 46 patients, 39 of whom also underwent TEE. The sensitivity and specificity of multidetector CT were 72% (18 of 25 cases) and 95% (20 of 21 cases), respectively, for detection of cardiac sources and 100% (24 of 24 cases) and 91% (20 of 22 cases), respectively, for detection of major arterial atheroma. For the 46 cases of stroke, the final etiologic classifications determined by using the standard combination approach were cardiac sources in 20 (44%) cases, major arterial atheroma in nine (20%), multiple sources in four (9%), and cryptogenic sources in 13 (28%). Multidetector CT facilitated correct etiologic classification for 38 (83%) of the 46 patients. Multidetector CT is a promising tool for etiologic assessment of ischemic stroke, although the identification of minor cardiac sources with this examination requires the establishment of robust criteria.

Abstract 2750: Multi-detector Computed Tomography Is An Accurate Screening Imaging Modality For Detection Of Thrombus In Patients Undergoing Catheter Ablation Of Atrial Fibrillation

Introduction Multi-detector computed tomography (MDCT) is commonly used to identify pulmonary vein and left atrial anatomy prior to catheter ablation for atrial fibrillation (CAAF). Additionally, transesophageal echocardiography (TEE) is utilized to exclude left atrial/left atrial appendage thrombus (ICT). Whether MDCT alone can be used to exclude thrombus obviating the need for TEE is unknown. Methods All Pts referred for CAAF at Mayo Clinic between March 2004 and October 2006 were included. Clinical data (including CHADS score), 64 slice MDCT (non-ECG gated), TEE and intra-cardiac echocardiograph (ICE) were all performed and recorded. Image data was reviewed independently and blinded. The left atrial appendage (LAA) was defined as fully opacified or underfilled. An underfilled LAA was further interrogated using a region of interest over the filling defect and mean attenuation in Hounsfield Units (HU) were recorded. Results In total 400 Pts (mean age 56 ± 10 yrs; 76% male; EF 56 ± 10 % ) were included. 362 had no ICT by TEE nor filling defect by MDCT. 38 patients had an underfilled LAA in whom ICT was confirmed by TEE in 7. Sensitivity and specificity of MDCT for ICT was 100% and 92% respectively with a NPV of 100%. In 19 Pts with underfilled LAA’s, a mean LAA emptying velocity was found to be significantly reduced at 26 cm/s (6 – 61 cm/s). Those with a thrombus had a mean attenuation value below 70 HU. CHADS2 score was higher (2.0 versus 1.0) in Pts with LAA filling defect versus those without LAA filling defect. All Pts with confirmed thrombus were taking Warfarin. ICT was not seen in any Pts aged &lt;52 yrs with CHADS score ≤1. Conclusions Sensitivity and specificity of MDCT for detection of LAA thrombus is high. LAA filling defects on MDCT correlate with low emptying velocities by TEE and low attenuation value in HU. These data would suggest that in the absence of MDCT filling defect, no further imaging is required. TEE should be utilized prior to CAAF to investigate MDCT filling defects. Multidetector Computed Tomography for the Detection of LAA Thrombus