Use Of Multislice Computed Tomography Research Articles

A comparative study between high-definition volumetric imaging computed tomography and multi-slice computed tomography in the detection of acute thoraco-lumbar disc extrusions in dogs

Computed tomography (CT) is commonly used to image intervertebral disc extrusion (IVDE) in dogs. The current gold standard for CT imaging is the use of multi-slice CT (MS CT) units. Smaller high-definition volumetric imaging (HDVI) mobile CT has been marketed for veterinary practice. This unit is described as an advanced flat panel. The goal of this manuscript was to evaluate the ability of the HDVI CT in detecting IVDE without the need for CT myelography, compared with the detection of acute disc extrusions with a MS CT without the need for MS CT myelogram. Retrospective blinded analyses of 219 dogs presented for thoraco-lumbar IVDE that had a HDVI CT (n = 123) or MS CT (n = 96) were performed at a single referral hospital. A total of 123 cases had HDVI CT scans with surgically confirmed IVDE. The IVDE was identified in 88/123 (72%) dogs on pre-contrast HDVI CT. The remaining 35/128 (28%) cases required a HDVI CT myelogram to identify the IVDE. Ninety-six cases had MS CT scans with surgically confirmed IVDE. The IVDE was identified in 78/96 (81%) dogs on the pre-contrast MS CT. The remaining 18/96 (19%) cases had a MS CT myelogram to identify the IVDE. Multi-slice CT detected IVDE significantly more than HDVI CT (p = 0.032). This study showed that the ability of HDVI CT for detecting IVDE is lower than that of MS CT. The HDVI CT system may be useful in smaller referral practices, with a lower case load where space is limited.

Usefulness of Multislice Computed Tomography in Percutaneous Coronary Intervention Following Valve-in-Valve Transcatheter Aortic Valve Replacement.

An 88-year-old man with anginal symptoms, referred for percutaneous coronary intervention (PCI), had undergone valve-in-valve transcatheter aortic valve replacement (TAVR) with 23-mm Evolut R transcatheter heart valve (THV) (Medtronic, Dublin, Ireland) 4 years before due to severe aortic

Sex determination from chest measurements in a sample of Egyptian adults using Multislice Computed Tomography

BackgroundIn forensic sciences to determine one's sex is quite important during the identity defining stage. The reliability of sex determination depends on the completeness of the remains and the degree of sexual dimorphism inherent in the population. Computed Tomography is the imaging modality of choice for two- and three-dimensional documentation and analysis of many autopsy findings. ObjectiveThe aim of the present work was to assess the reliability of Three-dimensional Multislice Computed Tomography (3D MSCT) to determine sexual dimorphism from certain chest measurements; sternum and fourth rib using the 3D MSCT and to develop equations for sex determination from these bones among adult Egyptians sample. Subjects and methodsThe present study was performed on 60 adult Egyptians. Their age ranged from 21 up to 74 years and they were equally divided between both sexes. Sixty virtual chests (reconstructed Multislice Computed Tomography 3D images) were examined for detection of Sternal measurements; Manubrium length (ML), Sternal body length (BL), Manubrium width (MW), Sternal body widths(BWa&BWb), Sternal area (SA) [(ML + BL) × (MW + BWa + BWb)/3]and Fourth rib width (FRW). ResultsAll the studied measurements were significantly higher in males than in females. Multiple regression analysis was used to and three significant regression equations were developed for predicting sex using the different studied chest measurements; the sternal measurements, the sternal area and the widths of the right and left fourth ribs with their accuracies 96.67%.95.0%.72.68% respectively. ConclusionSterunm and fourth rib width revealed significant metric sex differences with the use of Multislice Computed Tomography 3D images thus provide a great advantage in the analysis of skeletal remains and badly decomposed bodies.

Computed Tomographic Assessment of Coronary Arteries in Patients Undergoing Stem Cell Therapy Following an Acute Myocardial Infarction

Abstract Despite of numerous treatment strategies developed in the last years, ischemic heart disease remains the leading cause of death around the world. Acute myocardial infarction (MI) causes irreversible destruction to the myocardial tissue, which is replaced by fibroblast cells, leading to the formation of a dense, collagenous scar, a non-contractile tissue, and often to heart failure. Stem cell therapy seems to represent the next therapeutic method for the treatment of heart failure caused by myocardial infarction. Several international trials proved the beneficial outcome of the intracoronary infusion of bone marrow-derived stem cells, improving left ventricular systolic function and clinical symptomatology. Many noninvasive imaging procedures are available to evaluate the beneficial properties of stem cell therapy. Most studies have demonstrated the role of multislice computed tomography (MSCT) in evaluating left ventricular parameters such as end-diastolic and end-systolic volumes and ejection fraction, or to quantify myocardial scar tissue. In this review we will discuss the usefulness of MSCT for the assessment of coronary arteries, new tissue regeneration, and evaluation of tissue changes and their functional consequences in subjects undergoing stem cell treatment following MI.

Decreased Diagnostic Accuracy of Multislice Coronary Computed Tomographic Angiography in Women with Atypical Angina Symptoms.

Background:Multislice computed tomography (MSCT) coronary angiography (CAG) is a noninvasive technique with a reported high diagnostic accuracy for coronary artery disease (CAD). Women, more frequently than men, are known to develop atypical angina symptoms. The purpose of this study was to investigate whether the diagnostic accuracy of MSCT in women with atypical presentation differs from that in men.Methods:We enrolled 396 in-hospital patients (141 women and 255 men) with suspected or proven CAD who successively underwent both MSCT and invasive CAG. CAD was defined as any coronary stenosis of ≥50% on conventional invasive CAG, which was used as the reference standard. The patients were divided into typical and atypical groups based on their symptoms of angina pectoris. The diagnostic accuracy of MSCT, including its sensitivity, specificity, negative predictive value, and positive predictive value (PPV), was calculated to determine the usefulness of MSCT in assessing stenoses. The diagnostic performance of MSCT was also assessed by constructing receiver operating characteristic (ROC) curves.Results:The PPV (91% vs. 97%, χ2 = 5.705, P < 0.05) and diagnostic accuracy (87% vs. 93%, χ2 = 5.093, P < 0.05) of MSCT in detecting CAD were lower in women than in men. Atypical presentation was an independent influencing factor on the diagnostic accuracy of MSCT in women (odds ratio = 4.94, 95% confidence intervals: 1.16–20.92, Walds = 4.69, P < 0.05). Compared with those in the atypical group, women with typical angina pectoris had higher PPV (98% vs. 74%, χ2 = 17.283. P < 0.001), diagnostic accuracy (93% vs. 72%, χ2 = 9.571, P < 0.001), and area under the ROC curve (0.91 vs. 0.64, Z = 2.690, P < 0.01) in MSCT diagnosis.Conclusions:Although MSCT is a reliable diagnostic modality for the exclusion of significant coronary artery stenoses in all patients, gender and atypical symptoms might have some influence on its diagnostic accuracy.

Usefulness of Multislice Computed Tomography for Percutaneous Coronary Intervention in Anomalous Right Coronary Artery from the Left Sinus of Valsalva

Usefulness of Multislice Computed Tomography for Percutaneous Coronary Intervention in Anomalous Right Coronary Artery from the Left Sinus of Valsalva

Patient doses using multidetector computed tomography scanners in Kenya

Assessment of patient dose attributed to multislice computed tomography (CT) examination. A questionnaire method was developed and used in recording the patient dose and scanning parameters for the head, chest, abdomen and lumbar spine examinations. The patient doses due to brain, chest and abdomen examination were above the international diagnostic reference levels (DRLs) by factors of between one and four. The study demonstrated that the use of multislice CT elevates patient radiation dose, justifying the need for local optimised scanning protocols and the use of institutional DRL for dose management without affecting diagnostic image quality.

Novel clinical applications of state-of-the-art multi-slice computed tomography

Recent years have witnessed a rapid development of multi-slice computed tomography (MSCT) technology. The number of detector rows has increased from 4-slices to the current availability of 64-slice and even 320-slice systems. In addition, images are acquired with thinner slices and faster rotation times resulting in substantially improved image quality and diagnostic accuracy. Simultaneously, effective dose reduction acquisition techniques have been developed allowing considerable reduction of the radiation dose. Conceivably, these advancements may allow further expansion of the use of MSCT beyond the visual assessment of the presence or absence of significant coronary artery disease. Indeed, a particular advantage of the technique is that in addition to evaluation of the coronary arteries it also allows assessment of cardiac structures and function. The purpose of the current review is to discuss several novel applications of cardiac MSCT, including stenosis quantification, atherosclerotic plaque imaging and prognostification as well as imaging of left ventricular function, aortic and mitral valve anatomy using state-of-the-art technology.

Assessment of Non-Calcified Coronary Plaques Using 64-Slice Computed Tomography: Comparison With Intravascular Ultrasound

Background and ObjectivesNon-invasive detection and characterization of plaque composition may constitute an important step in risk stratification and monitoring of the progression of coronary atherosclerosis. Multislice computed tomography (MSCT) allows for accurate, non-invasive detection and characterization of atherosclerotic plaques, as well as determination of coronary artery stenosis. The aim of this study was to determine the usefulness of MSCT for characterizing non-calcified coronary plaques previously classified by intravascular ultrasound (IVUS).Subjects and MethodsSeventy-one plaques were evaluated in 42 patients undergoing MSCT and IVUS. Coronary plaques were classified as hypoechoic or hyperechoic based on IVUS echogenicity. On MSCT, CT attenuation was measured using circular regions of interest (ROI) and represented as Hounsfield units (HU).ResultsMSCT attenuation in hypoechoic plaques was significantly lower than it was in hyperechoic plaques (52.9±24.6 HU vs. 98.6±34.9 HU, respectively, p<0.001). When comparing CT attenuation between hypoechoic and hyperechoic plaques, 60.2 HU was the cut-off value for differentiating between the two, with a 90.7% sensitivity and a 78.6% specificity.ConclusionMSCT might be a useful tool for non-invasively evaluating the characteristics of coronary artery plaques.

Characterization of carotid plaques with a new CT technique

Characterization of atherosclerotic plaques in the coronary, carotid or peripheral arteries in vivo is clinically highly relevant. In particular, identification of vulnerable plaques is of utmost importance because of the high risk to precipitate acute thrombotic occlusion [1, 2]. Several techniques are being used nowadays to define the pathology of coronary plaques such as cardiovascular magnetic resonance imaging (CMR) [3–6], intravascular ultrasound (IVUS) [7], optical coherence tomography [8], and multi-slice computed tomography (MSCT) [9–11]. The latter technique combines a number of advantages, such as noninvasiveness and rapid testing, but the downside is that patients are exposed to high levels of radiation. However, recent MSCT systems that have become available, operate at high speed thereby limiting the radiation burden. When looking at the algorithms for dose reduction, the use of ECG pulsing, a reduced tube voltage of 100 kV, and the sequential scan mode are independent predictors for a reduced dose. The effect of the sequential scan mode is largest, followed by the reduced tube voltage of 100 kV. In the paper recently published by de Weert and colleagues [12], the human atherosclerotic carotid plaque is recorded in vivo by MSCT, and analyzed off-line to determine plaque volume and composition. Secondly, the inter-observer variability has been determined. Four patient groups were included in the study, categorized by their carotid artery stenosis grade: 0–29%, 30–49%, 50–69%, and 70–99%. By manually drawing regions of interest (ROI) the pixel intensities within a ROI were divided into three categories: lipid core 130 HU. Before consensus was reached with regard to the lesion length, location of bifurcation and lumen attenuation, inter-observer differences and coefficients of variation (COV) were quite high and interclass correlation coefficients (ICC) were quite low. But if consensus was reached with regard to the lesion length, location of bifurcation and lumen attenuation, inter-observer differences and COV decreased, and ICC increased, to reach values almost similar to those observed after analysis of intra-observer differences. The problems encountered with this technique are: (1) how to differentiate between a normal arterial wall and a slightly thickened arterial wall, (2) how to outline reliably the outer border of the artery where adventitial fat should not be confused with atheromatous lipid in the plaque, and (3) how to differentiate the contrast-enhanced lumen from atherosclerotic plaque. Although the present study lacks validation with histopathological techniques, previous studies of the same group have shown a good correlation between area measurements of arteries recorded by MSCT and histology [13, 14]. The use of MSCT for quantitative assessment of atherosclerotic lesion severity of large arteries in terms of fibrous tissue, lipid, and calcifications will contribute to the rapidly increasing popularity of examinations with MSCT.

Use of multislice CT for the evaluation of emergency room patients with chest pain: The so‐called “Triple rule‐out”

Recent advances in computed tomography (CT) technology have made high resolution noninvasive coronary angiograms possible. Multiple studies involving over 2,000 patients have established that coronary CT angiography (CCTA) is highly accurate for delineation of the presence and severity of coronary atherosclerosis. The high negative predictive value (>95%) found in these studies suggests that CCTA is an attractive option for exclusion of coronary artery disease in properly selected emergency department patients with acute chest pain. CT is also a well established and accurate tool for the diagnosis of acute aortic dissection and pulmonary embolism. Recent technical developments now permit acquisition of well-opacified images of the coronary arteries, thoracic aorta and pulmonary arteries from a single CT scan. While this so called "triple-rule out" scan protocol can potentially exclude fatal causes of chest pain in all three vascular beds, the attendant higher radiation dose of this method precludes its routine use except when there is sufficient support for the diagnosis of either aortic dissection or pulmonary embolism. This article provides an overview of CCTA, and reviews the clinical evidence supporting the use of this technique for triage of patients with acute chest pain.

Digital forensic osteology—Possibilities in cooperation with the Virtopsy ® project

The present study was carried out to check whether classic osteometric parameters can be determined from the 3D reconstructions of MSCT (multislice computed tomography) scans acquired in the context of the Virtopsy ® project. To this end, four isolated and macerated skulls were examined by six examiners. First the skulls were conventionally (manually) measured using 32 internationally accepted linear measurements. Then the skulls were scanned by the use of MSCT with slice thicknesses of 1.25 mm and 0.63 mm, and the 33 measurements were virtually determined on the digital 3D reconstructions of the skulls. The results of the traditional and the digital measurements were compared for each examiner to figure out variations. Furthermore, several parameters were measured on the cranium and postcranium during an autopsy and compared to the values that had been measured on a 3D reconstruction from a previously acquired postmortem MSCT scan. The results indicate that equivalent osteometric values can be obtained from digital 3D reconstructions from MSCT scans using a slice thickness of 1.25 mm, and from conventional manual examinations. The measurements taken from a corpse during an autopsy could also be validated with the methods used for the digital 3D reconstructions in the context of the Virtopsy ® project. Future aims are the assessment and biostatistical evaluation in respect to sex, age and stature of all data sets stored in the Virtopsy ® project so far, as well as of future data sets. Furthermore, a definition of new parameters, only measurable with the aid of MSCT data would be conceivable.

Contrast CT in Localization of Acute Lower Gastrointestinal Bleeding

Localization of the source of acute lower gastrointestinal bleeding is of paramount importance in its management as it allows for planned segmental resection rather than a "blind" abdominal total colectomy. Various methods of localization with radionuclide scan, mesenteric angiography and colonoscopy have been utilized, but none has been shown to be superior to others. The recent use of contrast-enhanced multislice computed tomography (MSCT) has generated much interest as it is rapid, noninvasive and readily accessible, and allows for excellent reformation on different planes. These are clear advantages in an emergency setting for accurate localization prior to surgery. We report a case where the use of MSCT resulted in prompt and accurate localization in a patient who presented acutely with massive lower gastrointestinal bleed. We believe that contrast-enhanced MSCT has the potential of accurately localizing the source of bleeding in an emergency setting, and should be part of the algorithm in the management of acute lower gastrointestinal bleeding.

Integrated multislice CT and Tc–99m Sestamibi SPECT–CT evaluation of solitary pulmonary nodules

The purpose of this study was to evaluate efficacy of multislice computed tomography (MSCT) and single photon emission computed tomography (SPECT)-CT with Tc-99m Sestamibi in the assessment of solitary pulmonary nodules of uncertain significance. Scintigraphy was performed using a 'hybrid' g-camera that allows simultaneous acquisition of SPECT and CT images, with interesting results in diagnostic oncology. Between September 2003 and August 2004, 23 patients with a solitary pulmonary nodule detected on CT underwent SPECT-CT using Tc-99m Sestamibi as a radiotracer. Nodules with positive scintigraphy were immediately subjected to biopsy or surgical resection. Nodules with negative scintigraphy were followed up after 3-4 months by MSCT with automatic segmentation software (Advanced Lung Analysis, ALA) and histological characterisation. Of the 23 nodules (size range 0.8-2 cm) discovered with MSCT, 11 showed intense uptake of Tc-99m Sestamibi. Ten lesions were true positive: seven adenocarcinomas, one squamous cell carcinoma, one large cell carcinoma and one metastasis. The only false positive was histologically classified as a large cell granuloma. Twelve lesions had negative scintigraphy: five fibrous lesions, three hamartomas, three granulomas and one adenocarcinoma (false negative). Benign nodules without tracer uptake underwent another CT scan 3-4 months later, which confirmed stability of the nodule size. Correlation of Sestamibi SPECT with histology showed sensitivity (Se) of 90.9 %, specificity (Sp) of 91.6 %, diagnostic accuracy of 91.3 %, positive predictive value (PPV) of 90.9% and negative predictive value (NPV) of 91.6 %. The integrated use of MSCT and Tc-99m Sestamibi SPECT-CT could be very useful in the management of solitary pulmonary nodules (SPNs). In particular, in our preliminary study, scintigraphy provided significant diagnostic information to differentiate benign from suspicious pulmonary nodules. The use of scintigraphy could be helpful to anticipate histological assessment and surgical treatment of SPNs identified at CT.