Use Of Multidetector Computed Tomography Research Articles

Coronary-to-pulmonary artery fistula in adults: Evaluation with thallium-201 myocardial perfusion SPECT.

ObjectivesWith the increasing use of multi-detector CT, the number of detected cases with coronary-to-pulmonary artery fistula (CPAF) has increased. Several previous studies reported severe cases of angina, but no appropriate tests to evaluate myocardial perfusion for patients with CPAF have been established. We evaluated the hemodynamic characteristics of CPAF using thallium-201 (Tl-201) single photon emission computed tomography (SPECT).Materials and methodsTl-201 SPECT was performed in 17 patients with CPAF, but without evidence of coronary artery disease on coronary computed tomography angiography (CCTA) (age, 58.5±13.3 years; 8 men). Quantitative analysis of scintigraphic data was performed. Additionally, perfusion abnormalities were compared with CCTA findings. Medical records were obtained to define clinical data, diagnostic findings, symptoms, management, follow-up data, and major adverse cardiac events (MACE).ResultsSix patients (35.2%) showed perfusion abnormalities on SPECT studies and could be classified as follows: 3 patients, no reversible ischemia (3/17, 17.6%); 1 patient, mild ischemia (1/17, 5.8%); and 2 patients, moderate ischemia (2/17, 11.7%). During the follow-up, ten patients (58.8%) improved under medical management and 5 patients (29.4%) underwent surgical ligation for CPAF with symptomatic improvement in 4 patients. Seven patients performed follow-up myocardial perfusion SPECT, and symptomatic improvement correlated well with scintigraphic perfusion improvement in 6 patients No MACE was observed.Clinical significanceTl-201 myocardial perfusion SPECT might be useful for determining the hemodynamic status and for risk stratification in patients with CPAF.

Usefulness of Multi-Detector Computed Tomography Scanning as a Replacement for Diethylenetriamine Pentaacetic Acid

BackgroundDiethylenetriamine pentaacetic acid (DTPA) and multi-detector computed tomography (MDCT) can predict postoperative estimated glomerular filtration rate (eGFR) in a live kidney donor. Accordingly, we compared predicted eGFR measured by use of DTPA and MDCT. MethodsFrom January 2013 to May 2015, 264 live kidney donors were enrolled. All donors underwent preoperative DTPA and MDCT, and bilateral renal cortex volume was measured by use of MDCT. We estimated DTPA-eGFR [remaining split renal function (%) × preoperative eGFR] and Vol-eGFR [remaining renal volume/total renal volume (%) × preoperative eGFR] and analyzed DTPA-eGFR, Vol-eGFR, and Modification of Diet in Renal Disease (MDRD)-eGFR during week 1 and in months 1, 3, and 6. Additionally, we compared DTPA-eGFR and Vol-eGFR by use of the formula ΔeGFR (maximum eGFR minus minimum eGFR during 6 months). ResultsThe mean DTPA-eGFR and Vol-eGFR values (mL/min/1.73 m2) were 52.97 ± 10.32 and 51.26 ± 10.26, respectively. Predictions of the dominant side did not agree in 113 of 303 (37.3%) cases. Postoperative MDRD-eGFR exhibited a statistically significant correlation with total renal volume, DTPA-eGFR, and Vol-eGFR (P < .0001). A significant correlation was found between ΔeGFR and total renal volume, DTPA-eGFR, and Vol-eGFR (P < .0001). Receiver operating characteristic curves were generated to predict the possibility of eGFR <60 mL/min/1.73 m2 at 6 months, using DTPA-eGFR and Vol-eGFR, which indicated that DTPA-eGFR (area under the curve = 0.858; P < .0001) and Vol-eGFR (area under the curve = 0.878; P < .0001) could predict chronic kidney disease class III at 6 months. ConclusionsMDRD-eGFR, Vol-eGFR, and DTPA-eGFR were significantly correlated. Moreover, Vol-eGFR and DTPA-eGFR exhibited high predictive value for chronic kidney disease class III at 6 months, whereas Vol-eGFR was a good predictor of renal function recovery.

Cone Beam CT of Trauma of Small Bones and Joints.

AbstractEvaluation of trauma of small bones or joints is traditionally done by conventional radiographs (CRs). Although multidetector computed tomography (MDCT) has a better sensitivity than CR in fracture detection and evaluation of complex fractures, high doses of radiation prevent systematic use of MDCT in fracture evaluation. Cone beam computed tomography (CBCT) combines a high spatial resolution and relatively low radiation dose and is therefore a very valuable technique to evaluate trauma of small bones and joints in patients with negative or doubtful radiographs and a high clinical suspicion for fractures or when complex fractures are suspected. CBCT may also be useful for the evaluation of chronic trauma or follow-up of fractures.

Multidetector CT appearance of the pelvis after cesarean delivery: normal and abnormal acute findings.

Cesarean section (CS) may have several acute complications that can occur in the early postoperative period. The most common acute complications are hematomas and hemorrhage, infection, ovarian vein thrombosis, uterine dehiscence and rupture. Pelvic hematomas usually occur at specific sites and include bladder flap hematoma (between the lower uterine segment and the bladder) and subfascial or rectus sheath hematoma (rectus sheath or prevescical space). Puerperal hemorrhage can be associated with uterine dehiscence or rupture. Pelvic infections include endometritis, abscess, wound infection, and retained product of conception. Radiologists play an important role in the diagnosis and management of postoperative complications as a result of increasing use of multidetector CT in emergency room. The knowledge of normal and abnormal postsurgical anatomy and findings should facilitate the correct diagnosis so that the best management can be chosen for the patient, avoiding unnecessary surgical interventions and additional treatments. In this article we review the surgical cesarean technique and imaging CT technique followed by description of normal and abnormal post-CS CT findings.

Effect of an Institutional Triaging Algorithm on the Use of Multidetector CT for Patients with Blunt Abdominopelvic Trauma over an 8-year Period.

Purpose To evaluate the effect of an institutional clinical triaging algorithm on the rate of multidetector computed tomography (CT) utilization in blunt abdominopelvic trauma (BAPT) over an 8-year period at an urban level 1 trauma center. Materials and Methods Adult patients (n = 13 096; mean age, 42 years; age range, 15-95 years) admitted with BAPT from January 1, 2006, to December 31, 2013, were included. Patients with BAPT were divided into two groups: those admitted before (referred to as the prealgorithm group, from January 1, 2006, to June 30, 2010) and after (referred to as the postalgorithm group, from July 1, 2010, to December 31, 2013) the implementation of an institutional clinical triaging algorithm. The following parameters were recorded from abdominopelvic CT study reports for the pre- and postalgorithm groups: number of abdominopelvic CT examinations at admission, number of abdominopelvic CT examinations with positive BAPT-related findings, injury severity score, length of hospital stay, and number of mortalities. The unpaired t test and χ2 analysis were used to determine significant differences. Results The percentage of patients admitted for BAPT who underwent an abdominopelvic CT study was 76.7% (5900 of 7688) in the prealgorithm group and 44.6% (2413 of 5408) in the postalgorithm group, a 32.1% decrease in use of CT (P < .001). The mean injury severity score increased from 10.1 ± 9.1 (standard deviation) to 13.3 ± 11.9 after implementation of the algorithm in patients admitted for BAPT who underwent abdominopelvic CT examination (P < .001). The percentage of abdominopelvic CT examinations with BAPT-related findings increased from 17.1% (1007 of 5900) to 19.8% (479 of 2413) (P = .003). There was a significant difference in average length of stay, from 4.8 days ± 7.0 to 4.2 days ± 6.2 (P < .001). Mortality decreased from 3.1% (242 of 7688) to 2.7% (148 of 5408) after implementation of the algorithm (P = .19). Conclusion The implementation of a clinical triaging algorithm resulted in decreased use of multidetector CT in patients who presented with BAPT to the emergency department. © RSNA, 2016.

Multidetector CT of Mandibular Fractures, Reductions, and Complications: A Clinically Relevant Primer for the Radiologist.

After the nasal bones, the mandible is the second most common site of facial fractures, and mandibular fractures frequently require open reduction. In the trauma injury setting, multidetector computed tomography (CT) has become the cornerstone imaging modality for determining the most appropriate treatment management, fixation method, and surgical approach. Multidetector CT is also used to assess the adequacy of the reduction and evaluate potential complications in the postoperative period. For successful restoration of the mandible's form and function, as well as management of posttraumatic and postoperative complications, reconstructive surgeons are required to have a detailed understanding of mandibular biomechanics, occlusion, and anatomy. To provide added value in the diagnosis, treatment planning, and follow-up of mandibular fractures, radiologists should be aware of these concepts. Knowledge of the techniques commonly used to achieve occlusal and anatomic reduction and of the rationale behind the range of available treatment options for different injury patterns-from isolated and nondisplaced fractures to multisite and comminuted fractures-also is essential. This article focuses on the use of multidetector CT for pre- and postoperative evaluation of mandibular fractures and outlines fundamental concepts of diagnosis and management-beginning with an explanation of common fracture patterns and their biomechanical underpinnings, and followed by a review of the common postoperative appearances of these fractures after semirigid and rigid fixation procedures. Specific considerations regarding fractures in different regions of the tooth-bearing and non-tooth-bearing mandible and the unique issues pertaining to the edentulous atrophic mandible are reviewed, and key features that distinguish major from minor complications are described. (©)RSNA, 2016.

The utility of multi-detector CT in detection and characterization of mesenteric lymphadenopathy with histopathological confirmation

PurposeTo detect and characterize mesenteric lymphadenopathy using multi-detector CT. Patients and methodsThis prospective study included 100 patients with abdominal pain or mass. MDCT examination of the abdomen was performed for all the patients using 16-detector MDCT scanner (Bright Speed 16; GE medical systems). The axial and MPR images were interpreted for nodal size, morphology, number, distribution, and associated groups of LN. Histopathological examination of the biopsied nodes was performed for confirmation. ResultsBased on nodal size criterion, nodes were classified into two groups: normal in 68% and pathologic in 32%. Most of normal nodes were oval shape (88.2%), multiple (85%) and located at the root of the mesentery (70.6 %). Most of pathologic nodes were well-defined (62.5%), rounded shape (37.5%) with lobulated margins (43.75%). They were multiple (68.7%), located at the root of the mesentery (87.5 %) and enhanced (75%). Central necrosis was detected in 6 patients, calcification in 5 patients and extra-nodal spread in 12 patients. The associated other groups of abdominal lymph node enlargement were detected in 26 patients. ConclusionThe MDCT has a great role in characterization of mesenteric lymph node which helps in differentiation between normal and pathological groups based on many MDCT criteria.

The usefulness of MDCT-myelography for patients with spontaneous intracranial hypotension.

PurposeThe detection and localization of cerebrospinal fluid (CSF) leakage in patients with spontaneous intracranial hypotension (SIH) is important. The aim of this study was to evaluate the usefulness of multidetector CT (MDCT)-myelography in patients with SIH.MethodsA radiologist retrospectively searched the electronic database to find the patients who had undergone MDCT-myelography for SIH between October 2010 and September 2014. In the MDCT-myelographic treatment, the patient’s whole spine was scanned by 64 or 256 channel MDCT scanners after being injected with 20 ml of contrast agent via L3/4 interlaminar space under fluoroscopic guidance. Three radiologists in consensus determined the presence, pattern (“pseudodiverticular sign” or “gray-rim sign”) and level of contrast leakage outside the dural sac.ResultsEighteen patients (M:F = 9:9; mean age, 36.2; age range 17–56) were finally included in this study. CSF leakage was detected in 17 of 18 patients. CSF leakage pattern was described as a “pseudodiverticular sign” in five and “gray-rim sign” in ten patients. Leakage level could be determined in ten patients based on MDCT-myelography.ConclusionsMDCT-myelography was useful to detect CSF leakage and to guess the leakage level in patients with SIH.

MULTIDETECTOR COMPUTED TOMOGRAPHY IN POSTOPERATIVE ASSESSMENT OF CAROTID ARTERIES

Актуальность. Для профилактики нарушений мозгового кровообращения, до 80% которых носят ишемический характер, при наличии выраженного стено-окклюзирующего поражения сонных артерий проводится операция каротидной эндартерэктомии. В литературе нет подробного описания особенностей послеоперационных изменений сонных артерий в зависимости от метода оперативного вмешательства.

Clinical utility of multi-detector cardiac computed tomography in structural heart interventions.

In recent years, there have been major advances in structural interventional cardiology, which have revolutionized the practice of cardiology. Appropriate selection and follow-up of patients undergoing these structural heart interventions is vital. Multi-detector computed tomography (MDCT) has emerged as a key imaging modality in the peri-procedural assessment of patients undergoing multiple structural cardiac interventions. The purpose of this review is to provide an evidence-based clinical update on the roles of MDCT in both established and evolving structural heart interventions, including transcatheter aortic valve replacement (TAVR) and transcatheter mitral valve implantation (TMVI). The utility of MDCT in the peri-procedural assessment of patients undergoing pulmonary vein isolation (PVI) for atrial fibrillation, cardiac resynchronization therapy (CRT) and left atrial appendage (LAA) closure will also be reviewed.

The validity of investigating occult hip fractures using multidetector CT.

10% of all hip fractures are occult on plain radiography, requiring further investigation to ascertain the diagnosis. MRI is presently the gold standard investigation, but frequently has disadvantages of time delay, resulting in increased hospital stay and mortality. Our aim was to establish whether multidetector CT (MDCT) is an appropriate first-line investigation of occult femoral neck (NOF) fractures. From 2013, we elected to use MDCT as the first-line investigation in patients believed to have an NOF fracture with negative plain films. These were reported by consultant musculoskeletal radiologists. We retrospectively analysed the data of consecutive patients presenting to the University Hospital of Wales, over 30 months with a clinical suspicion of a hip fracture. 1443 patients were admitted during the study period. 209 (14.5%) patients had negative plain films requiring further investigation to exclude an NOF fracture, of which 199 patients had a CT. 93 patients had no fracture and 20 patients had isolated greater trochanter fractures. None of these patients progressed to develop an intracapsular femoral neck fracture at 4-month follow-up, although one patient sustained an extracapsular fracture following a high-energy fall whilst admitted. 26 femoral neck fractures were diagnosed on CT, whilst the remaining 60 patients were diagnosed with other pelvic ring fractures. When interpreted by experienced radiologists, MDCT has both sensitivity and specificity of 100%. We recommend the use of MDCT as a safe and appropriate first-line investigation for NOF fractures.

Clinical Utility of Multidetector Computed Tomography in Redo Valve Procedures

Transesophageal echocardiography (TEE) is recommended for diagnosis in patients suspected of prosthetic valve dysfunction, but could be limited in its ability to identify the etiology of these dysfunctions and to assess extracardiac structures. Our objective is to examine the usefulness of multidetector computed tomography (MDCT) in establishing the etiology of the dysfunctions and its clinical utility in preoperative assessment in these patients. Twenty-two prosthetic heart valves from 20 consecutive patients who had a preoperative MDCT and underwent redo prosthetic valve procedures from December 2008 to February 2013 were examined retrospectively. Results from MDCT and TEE were compared to intraoperative findings. Extravalvular MDCT findings including coronary artery/bypass graft, high-risk features for reoperative cardiac surgery, and extracardiac findings were also assessed. MDCT correctly identified 15 valve regurgitation and seven valve obstructions compared to intraoperative findings. Both TEE and MDCT were able to correctly identify the etiologies in 93% (14/15) of regurgitant valves. However, MDCT was better able to identify the etiology of obstructive valves than TEE (86% [6/7] vs. 43% [3/7]) compared to intraoperative findings. In patients who had preoperative invasive angiography, MDCT correctly identified two patients with significant coronary artery disease (CAD) and ruled out 11 without significant CAD. Furthermore, MDCT detected five high-risk features for postoperative complications and eight clinically relevant extracardiac findings. MDCT displayed comparable or better diagnostic performance than TEE for identifying the type of dysfunction and its etiology, as well as providing additional coronary and other extravalvular evaluations useful for preoperative planning.

The role of multi-detector CT (MDCT) in patients presented with non-traumatic acute abdominal conditions

Background: Acute abdominal pain classically refers to pain within the abdomen that has been present for less than 7 days from the time of presentation. The use of CT scan in the evaluation of acute abdominal pain has increased to a large extent due to high accuracy of CT in the diagnosis of specific diseases like appendicitis and diverticulitis, especially with the use of multidetector CT scanners. It has been shown that the use of intravenous contrast media increases the diagnostic accuracy of CT scan examination, with a positive predictive value of 95% in the cases of acute appendicitis. The accuracy of CT scan imaging in patients with acute abdominal pain was not affected by the lack of entral contrast material.Objectives: To evaluate the real usefulness of multi-detector CT( MDCT) in non-traumatic acute abdomen, to determine the cause of acute abdomen in those with uncertain pathological diagnosis.Patients and methods: This prospective study had been conducted at Al-Sader medical city from the first of January to the first of September 2015. Our study includes all patients presented to the emergency department with non-traumatic acute abdominal conditions with uncertain underlying cause inspite of detailed history and physical examination with negative or non-conclusive U/S, plain abdominal XR finding and the surgeon failed to identify the exact underlying pathology. This study included (80) patients, (44 male and 36 female) . Non-enhanced CT scan was done first for all patients which was sufficient to reach the diagnosis in (22) patients, contrast material were not used because blood urea was elevated in (6) patients . In (8) patients, CT angiography protocol was performed for patients with suspected mesenteric vessels pathology. In the remaining (44) patients, intravenous contrast was given manually via a wide bore cannula ( gauge 18) and post contrast scan done in the portal phase (delay time 45-50 second).Results: In this study, which was performed on (80) patients with undiagnosed nontraumatic acute abdominal conditions. We found that acute pancreatitis (20 patients)(25%) was the most common cause of undiagnosed acute abdominal pain, followed by intestinal obstruction (12 patients)(15%).While acute cholecystitis (8 patients)(10%) , portal or mesenteric vein thrombosis (8 patients ) (10%) , perforated viscus ,(6 patients)(7.5%), mesenteric arterial thrombosis (4 patients) (5%) ,left gastric artery aneurysm (2patient))(2.5%) , acute appendicitis(2 patient ) (2.5%)diverticulitis (2patient) (2.5%) and ectopic pregnancy (2patient) (2.5%). In (14 patients) (17.5%), no specific pathology could be detected.Conclusion: The role of multi-detector CT (MDCT) has an important role in the management undiagnosed acute abdominal conditions in the emergency department. Acute pancreatitis is one of the main cause of undiagnosed acute abdominal conditions.

Influence of radiation dose and reconstruction algorithm in MDCT assessment of airway wall thickness: A phantom study.

Wall thickness (WT) is an airway feature of great interest for the assessment of morphological changes in the lung parenchyma. Multidetector computed tomography (MDCT) has recently been used to evaluate airway WT, but the potential risk of radiation-induced carcinogenesis-particularly in younger patients-might limit a wider use of this imaging method in clinical practice. The recent commercial implementation of the statistical model-based iterative reconstruction (MBIR) algorithm, instead of the conventional filtered back projection (FBP) algorithm, has enabled considerable radiation dose reduction in many other clinical applications of MDCT. The purpose of this work was to study the impact of radiation dose and MBIR in the MDCT assessment of airway WT. An airway phantom was scanned using a clinical MDCT system (Discovery CT750 HD, GE Healthcare) at 4 kV levels and 5 mAs levels. Both FBP and a commercial implementation of MBIR (Veo(TM), GE Healthcare) were used to reconstruct CT images of the airways. For each kV-mAs combination and each reconstruction algorithm, the contrast-to-noise ratio (CNR) of the airways was measured, and the WT of each airway was measured and compared with the nominal value; the relative bias and the angular standard deviation in the measured WT were calculated. For each airway and reconstruction algorithm, the overall performance of WT quantification across all of the 20 kV-mAs combinations was quantified by the sum of squares (SSQs) of the difference between the measured and nominal WT values. Finally, the particular kV-mAs combination and reconstruction algorithm that minimized radiation dose while still achieving a reference WT quantification accuracy level was chosen as the optimal acquisition and reconstruction settings. The wall thicknesses of seven airways of different sizes were analyzed in the study. Compared with FBP, MBIR improved the CNR of the airways, particularly at low radiation dose levels. For FBP, the relative bias and the angular standard deviation of the measured WT increased steeply with decreasing radiation dose. Except for the smallest airway, MBIR enabled significant reduction in both the relative bias and angular standard deviation of the WT, particularly at low radiation dose levels; the SSQ was reduced by 50%-96% by using MBIR. The optimal reconstruction algorithm was found to be MBIR for the seven airways being assessed, and the combined use of MBIR and optimal kV-mAs selection resulted in a radiation dose reduction of 37%-83% compared with a reference scan protocol with a dose level of 1 mGy. The quantification accuracy of airway WT is strongly influenced by radiation dose and reconstruction algorithm. The MBIR algorithm potentially allows the desired WT quantification accuracy to be achieved with reduced radiation dose, which may enable a wider clinical use of MDCT for the assessment of airway WT, particularly for younger patients who may be more sensitive to exposures with ionizing radiation.

Postmortem-computed tomography and postmortem-computed tomography-angiography: a focused update.

The use of multidetector CT (MDCT) represents a reality routinely used in several forensic institutes, for the numerous advantages that this diagnostic tool can provide; costs are becoming increasingly lower; data acquisition is always faster and once acquired may be revalued at any time. However, there are also some diagnostic limitations, for example, the visualization of the vascular system or a limited soft tissue contrast. In order to overcome these limitations, in recent years, contrast medium has been introduced in postmortem cases, with the development of several techniques of PMCT angiography (PMCTA) and standardized protocols to make them easily reproducible. The aim of this review is to highlight the advantages and pitfalls of PMCT and PMCTA in forensic investigation, taking into consideration the broad spectrum of applications both for natural and unnatural deaths and the numerous methods currently used. Secondly, in the light of the considerable progress in this field and the attempt to develop standardized protocols of PMCTA, the authors aim to evaluate the diagnostic value of PMCTA in comparison both to PMCT and conventional autopsy.

Preoperative CT evaluation of potential donors in living donor liver transplantation.

Living donor liver transplantation is an effective, life sustaining surgical treatment in patients with end-stage liver disease and a successful liver transplant requires a close working relationship between the radiologist and the transplant surgeon. There is extreme variability in hepatic vascular anatomy; therefore, preoperative imaging of potential liver donors is crucial not only in donor selection but also helps the surgeons in planning their surgical approach. In this article, we elaborate important aspects in evaluation of potential liver donors on multi-detector computed tomography (MDCT) and the utility of MDCT in presurgical assessment of the hepatic parenchyma, relevant hepatic vascular anatomy and segmental liver volumes.

Use of multidetector computed tomography in the assessment of dogs with pericardial effusion.

BackgroundContrast‐enhanced multidetector computed tomography (MDCT) allows high spatial and temporal resolution imaging of cardiac, thoracic, and abdominal structures. Accurate determination of the cause of pericardial effusion (PE) is essential to providing appropriate treatment and prognosis. Echocardiography and pericardial fluid analysis may not differentiate between causes of PE and cannot identify extracardiac metastasis.Hypothesis/ObjectivesDescribe the thoracic and abdominal MDCT findings and evaluate the utility of MDCT to differentiate between neoplastic and nonneoplastic causes of PE in dogs.AnimalsEleven client‐owned dogs with PE diagnosed by echocardiography.MethodsProspective observational study. Transthoracic echocardiography (TTE), 3‐view thoracic radiography, and contrast‐enhanced thoracic and abdominal MDCT images were evaluated for the presence of cardiac masses, pulmonary metastases, and abdominal masses. Histopathology in 5 dogs and survival analysis in all dogs were evaluated.ResultsA neoplastic cause was identified in 6/11 dogs and a nonneoplastic cause was identified in 5/11. Cardiac MDCT findings were consistent with TTE findings in all dogs with right atrial (5/5) and heart base masses (1/1). Pulmonary metastases were identified in 1/11 dogs by thoracic radiography and in 2/11 dogs by MDCT. MDCT identified splenic or hepatic lesions consistent with neoplasia in 6/11 and 5/11 dogs, respectively. Focal MDCT pericardial changes at the pericardiocentesis site were noted in 3/11 dogs.Conclusions and Clinical ImportanceMultidetector computed tomography did not improve the detection of cardiac masses in dogs with PE over echocardiography. The benefit of MDCT was primarily in the detection of pulmonary metastases and extracardiac lesions using a single imaging modality.

Abdominal polytrauma and parenchymal organs

The acute radiological diagnostics of polytrauma patients has become an essential part of the interdisciplinary treatment in the emergency room. The incidence of polytrauma patients with an injury severity score (ISS) >16 is approximately 450 cases/million inhabitants/year in Europe. Injuries of the parenchymal organs are of utmost importance for the prognosis and treatment of these patients. The injury patterns are complex and a great deal of experience is necessary to be able to obtain the correct diagnosis within minutes. This review article deals with the radiological diagnostics and grading of the severity of injuries to the spleen, liver, pancreas and kidneys. The use of ultrasound for the evaluation of polytraumatized patients will be discussed. The most important trauma-associated findings for the above mentioned organs using multidetector computed tomography (MDCT) will be described and illustrated by dedicated case findings. Ultrasound contrast agents can supply valuable, additional diagnostic information in the evaluation of polytraumatized patients. Computed tomography has become established as the most relevant imaging modality in severe trauma. Innovative organ-adapted and contrast application protocols improve the diagnostic performance of MDCT. The use of focused assessment sonography for trauma (FAST) scanning as a screening tool is in agreement with the other clinical disciplines of the trauma team. The use of MDCT is trauma-dependent and the classification of the severity of the different parenchymal organ injuries is ultimately decisive for further treatment and prognosis of trauma victims.

Jejunum and ileum blunt trauma: what has changed with the implementation of multislice computed tomography?

to evaluate the impact of the new technology of multidetector computed tomography (MDCT) in improving the accuracy and early diagnosis of BSBI. patients with blunt small bowel injuries (BSBI) grade> I were identified retrospectively and their CT scans reviewed by an experienced radiologist. Clinical and tomographic findings were analyzed and patients grouped as "pre-MDCT" and "post-MDCT", according to the time of implementation of a 64-slice MDCT. of the 26 patients with BSBI 16 had CT scans. Motor vehicle collision (62.5%) was the most frequent mechanism of injury. In the pre-MDCT period, five of the 13 patients (38.5%) had abdominal CT, and in the post-MDCT, 11 of 13 patients (84.6%) had the exam. During pre-MDCT, all CT scans were abnormal with findings of pneumoperitoneum (60%), free fluid (40%) and bowel wall enhancement (20%). In the post-MDCT group, all exams but one were abnormal and the most frequent findings were free fluid (90.9%), bowel wall enhancement (72.7%), and pneumoperitoneum (54.5%). However, the rate of delayed laparotomy did not change. The mortality rate in both groups were similar, with 20% during pre-MDCT and 18.2% during post-MDCT. the use of MDCT in abdominal trauma in our service has increased the sensibility of the diagnosis, but has had no impact on outcome so far.

Pulmonary Nodules CT Scan

: Pulmonary nodules are a common incidental finding on imaging studies, particularly multidetector computed tomography (MDCT). Advances in CT have improved characterization of nodules, helping to differentiate benign from malignant lesions noninvasively. Many nodules, however, remain indeterminate and require either temporal characterization to confirm stability or invasive assessment for a definitive diagnosis. A pulmonary nodule is defined as a round opacity, at least moderately well marginated and no greater than 3 cm in maximum diameter. Solitary pulmonary nodules (SPNs) may be caused by a variety of benign and malignant disorders. CT is significantly more sensitive than standard radiography for nodule detection, and with the increasing use of MDCT, small nodules of less than 1 cm are detected with increasing frequency. As a result, small benign lesions that would have otherwise been invisible on radiographs are now being detected. Low-dose CT has proved to be 3 times more sensitive than chest radiography for detection of non-calcified nodules. Of those patients with nodules, 11% were eventually diagnosed with lung cancer, the majority of whom at stage I of the disease. The introduction of MDCT has minimized misregistration artifacts and improved spatial and temporal resolution, thereby, improving nodule detection and characterization. Intravenous contrast administration is not routinely required. However, it may prove useful in cases in which the suspected nodule is located adjacent to the mediastinum or hilum or if there is a suspicion for an arteriovenous malformation. Routine reconstructions typically are composed of 5-mm sections with a non-targeted field of view. A targeted field of view with thin sections (11.5 mm) through an area of interest, however, greatly improves spatial resolution and hence nodule assessment.