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Background: Congenital rib deformity is a common thoracic deformity that has a potentially far-reaching impact on the growth and lung function development of young children. Early diagnosis and accurate assessment of congenital rib deformity is of great importance. This study was to retrospectively analyze the number, location, and types of deformities, imaging features as well as clinical symptoms of children with congenital rib deformities. Methods: Children who were diagnosed with congenital rib deformities between October 2019 and October 2021 in our hospital were included in this study. The rib deformities were analyzed according to the imaging results of chest X-ray and 3D volume rendering multidetector computed tomography (MDCT). The data were analyzed using SPSS 22.0. Results: A total of 472 male and 186 female children with rib deformities were detected in this study, with a male to female ratio of approximately 2.54:1. Of the deformed ribs, 417 (63.4%) were located on the right side, usually single and unilateral. The most common type of the detected rib deformity were bifid ribs (95.14%). Rib deformity was most common in the fourth rib (46.62%). The majority (76.16%, n = 428) of rib deformities were incidental findings and asymptomatic. Conclusions: Congenital rib deformities in pediatric patients included in our hospital were more frequently observed in males than females, more frequently detected on the right than on the left side. The most common type of rib deformity is the bifid rib. MDCT examination are of great value in the diagnosis of rib deformity and can help guide clinical treatment. [ABSTRACT FROM AUTHOR]

Introduction: Chronic rhinosinusitis (CRS), with or without nasal polyps, is characterized by the inflammation of the nose and paranasal sinuses. To make the diagnosis of CRS, a patient must exhibit 2 or more of the following symptoms for at least 12 weeks time period: nasal obstruction, nasal blockage, or congestion, and/or nasal discharge (which could be anterior or posterior nasal drip), along with possible facial pain or pressure, and/or a reduction or loss of smell. This diagnosis must be supported by observable disease signs, which can be identified through an endoscopic examination showing nasal polyps, mucopurulent discharge, or edema/mucosal obstruction. Methods: A prospective study will be conducted on all the patients with clinical diagnosis and suspicious of CRS, referred from OPD / wards of ENT and HNS to the department of radiodiagnosis of Muzaffarnagar Medical college, for diagnosis and evaluation of patients. Diagnosis will be made based on clinical and radiological findings. A brief clinical history of the patient will be taken from the patient or by the attendant. Results: In this study involving 40 participants, nasal mass was observed in 42.5%, while nasal bleed occurred in 47.5% of participants. X-ray opacification of sinuses varied, with opacification in all sinuses seen in 22.5% of cases and various bilateral and unilateral patterns in others. Polypoidalmass was present in 12.5% of participants. Bony changes included erosion in5% and sclerosis in 22.5% of cases. Deviated nasal septum was observed, with left deviation noted in 10% and right deviation in 15% of participants. Conclusion: this study of 40 participants revealed a male predominance and a mean age of 39.8 years, with no significant age difference between genders. Common symptoms included nasal obstruction, nasal discharge, sneezing, headache, facial puffiness, and altered smell. Nasal mass and nasal bleed were frequent, while X-ray opacification of sinuses showed diverse patterns. Polypoidal masses were observed in a notable percentage of participants. [ABSTRACT FROM AUTHOR]

Total anomalous pulmonary venous connection (TAPVC) is anomalous drainage of all pulmonary veins into systemic circulation. The intracardiac type typically entails the drainage of all the pulmonary veins into the right atrium, via the coronary sinus. The connection of the pulmonary veins directly into the right atrium is exceptionally rare and has been primarily reported with right atrial isomerism. Herein, we presented a remarkable case of TAPVC in a 10-year-old male child, distinguished by an unconventional drainage of all the pulmonary veins directly into the right atrium, with normal coronary sinus and absent right atrial isomerism. Intriguingly, computed tomography imaging revealed a combination of incredibly rare coexistent pulmonary, vascular, and skeletal anomalies. These anomalies included absence of pulmonary fissures in the right lung, presence of left circumflex aortic arch with bovine branching pattern, bilateral cervical ribs, and C7 vertebral fusion anomalies. To our knowledge, this unique combination of coexistent anomalies has not been previously reported in scientific literature in the background of rare drainage pattern of TAPVC. [ABSTRACT FROM AUTHOR]

Abstract Background Congenital rib deformity is a common thoracic deformity that has a potentially far-reaching impact on the growth and lung function development of young children. Early diagnosis and accurate assessment of congenital rib deformity is of great importance. This study was to retrospectively analyze the number, location, and types of deformities, imaging features as well as clinical symptoms of children with congenital rib deformities. Methods Children who were diagnosed with congenital rib deformities between October 2019 and October 2021 in our hospital were included in this study. The rib deformities were analyzed according to the imaging results of chest X-ray and 3D volume rendering multidetector computed tomography (MDCT). The data were analyzed using SPSS 22.0. Results A total of 472 male and 186 female children with rib deformities were detected in this study, with a male to female ratio of approximately 2.54:1. Of the deformed ribs, 417 (63.4%) were located on the right side, usually single and unilateral. The most common type of the detected rib deformity were bifid ribs (95.14%). Rib deformity was most common in the fourth rib (46.62%). The majority (76.16%, n = 428) of rib deformities were incidental findings and asymptomatic. Conclusions Congenital rib deformities in pediatric patients included in our hospital were more frequently observed in males than females, more frequently detected on the right than on the left side. The most common type of rib deformity is the bifid rib. MDCT examination are of great value in the diagnosis of rib deformity and can help guide clinical treatment.

Total anomalous pulmonary venous connection (TAPVC) is anomalous drainage of all pulmonary veins into systemic circulation. The intracardiac type typically entails the drainage of all the pulmonary veins into the right atrium, via the coronary sinus. The connection of the pulmonary veins directly into the right atrium is exceptionally rare and has been primarily reported with right atrial isomerism. Herein, we presented a remarkable case of TAPVC in a 10-year-old male child, distinguished by an unconventional drainage of all the pulmonary veins directly into the right atrium, with normal coronary sinus and absent right atrial isomerism. Intriguingly, computed tomography imaging revealed a combination of incredibly rare coexistent pulmonary, vascular, and skeletal anomalies. These anomalies included absence of pulmonary fissures in the right lung, presence of left circumflex aortic arch with bovine branching pattern, bilateral cervical ribs, and C7 vertebral fusion anomalies. To our knowledge, this unique combination of coexistent anomalies has not been previously reported in scientific literature in the background of rare drainage pattern of TAPVC.

Abstract Background The posterior ethmoid sinuses have a complex anatomy and a highly variable normal structure. The posterior ethmoid Onodi cell needs careful assessment because of its proximity to the optic nerve and the internal carotid artery canal. Recognising the distinctions is essential for optimal pre-op preparation. Sphenoid sinus surgery can now be performed without worrying about compromising vital structures like the internal carotid artery or optic nerve. Preoperative radiological assessment is a quick and easy way to check for ethmoid cell pneumatisation differences. Aim and objectives To determine the pneumatisation patterns of Onodi cells among the North-East Indian population using 16-slice multidetector computed tomography (MDCT). Results Nine-hundred MDCT paranasal sinuses were analysed over a period of 0–2 years, out of which 220 cases showed the presence of Onodi cell. Type I were 89 cases (40.45%, CI 32.00–48.90), Type II were 128 cases (58.18%, CI 49.72–66.63), and 3 cases with Type III cell (1.36%, CI 0.18–2.54). Conclusion The most prevalent pneumatisation pattern is Type II. The pneumatisation patterns of Onodi cells can be best detected and evaluated by multiplanar MDCT imaging. Sinus surgeons need a firm grasp of pneumatisation patterns to avoid damaging the optic nerve and internal carotid artery canal during operations.

Background: The posterior ethmoid sinuses have a complex anatomy and a highly variable normal structure. The posterior ethmoid Onodi cell needs careful assessment because of its proximity to the optic nerve and the internal carotid artery canal. Recognising the distinctions is essential for optimal pre-op preparation. Sphenoid sinus surgery can now be performed without worrying about compromising vital structures like the internal carotid artery or optic nerve. Preoperative radiological assessment is a quick and easy way to check for ethmoid cell pneumatisation differences. Aim and objectives: To determine the pneumatisation patterns of Onodi cells among the North-East Indian population using 16-slice multidetector computed tomography (MDCT). Results: Nine-hundred MDCT paranasal sinuses were analysed over a period of 0–2 years, out of which 220 cases showed the presence of Onodi cell. Type I were 89 cases (40.45%, CI 32.00–48.90), Type II were 128 cases (58.18%, CI 49.72–66.63), and 3 cases with Type III cell (1.36%, CI 0.18–2.54). Conclusion: The most prevalent pneumatisation pattern is Type II. The pneumatisation patterns of Onodi cells can be best detected and evaluated by multiplanar MDCT imaging. Sinus surgeons need a firm grasp of pneumatisation patterns to avoid damaging the optic nerve and internal carotid artery canal during operations. [ABSTRACT FROM AUTHOR]

In present study 200 cases of acute pancreatitis were evaluated and following conclusions were made. MDCT is an excellent imaging modality in diagnosis of acute pancreatitis with depiction of pancreas, peri pancreatic changes and also associated complications. No significant correlation seen between pancreatic enzymes and severity of pancreatitis. Significant correlation with modified CT severity index and length of hospital stay, interventions, organ failure is noted. MCTSI is good indicator for outcome of patient especially with the organ failure and also length of stay. CECT with modified CT severity index shows good correlation with grading of severity of pancreatitis and extent of disease process. CT is the most sensitive and specific imaging modality for the evaluation of acute pancreatitis and its complications. [ABSTRACT FROM AUTHOR]

Mesenteric ischemia diagnosis is challenging, with an overall mortality of up to 50% of cases despite advances in treatment. The main problem that affects the outcome is delayed diagnosis because of non-specific clinical presentation. Multi-Detector CT Angiography (MDCTA) is the first-line investigation for the suspected diagnosis of vascular abdominal pathologies and the diagnostic test of choice in suspected mesenteric bowel ischemia. MDCTA can accurately detect the presence of arterial and venous thrombosis, determine the extent and the gastrointestinal tract involved, and provide detailed information determining the subtype and the stage progression of the diseases, helping clinicians and surgeons with appropriate management. CT (Computed Tomography) can differentiate forms that are still susceptible to pharmacological or interventional treatment (NOM = non-operative management) from advanced disease with transmural necrosis in which a surgical approach is required. Knowledge of CT imaging patterns and corresponding vascular pathways is mandatory in emergency settings to reach a prompt and accurate diagnosis. The aims of this paper are 1. to provide technical information about the optimal CTA (CT Angiography) protocol; 2. to explain the CTA arterial and venous supply to the gastrointestinal tract and the relevant ischemic pattern; and 3. to describe vascular, bowel, and extraintestinal CT findings for the diagnosis of acute mesenteric ischemia. [ABSTRACT FROM AUTHOR]

Background Unicuspid aortic valve (UAV) represents a rare congenital anomaly characterized by two subtypes: acommissural unicuspid aortic valve and unicommissural unicuspid aortic valve. Acommissural UAV is often diagnosed and corrected during the neonatal period due to haemodynamic instability. Unicommissural UAV leads to aortic stenosis (AS) in early adulthood. The diagnostic challenge associated with UAV primarily stems from its eccentric orifice opening and valvular calcification, resulting in difficult visualization of the commissures and localization of the orifice plane. This case report aims to demonstrate the unique morphological features of UAV through a comprehensive analysis using multimodality imaging. Case summary A 61-year-old woman presented to the emergency department for recurrent episodes of dyspnoea. Severe AS was diagnosed on transthoracic echocardiography (TTE) by Doppler haemodynamic measurement. However, follow-up transesophageal echocardiography (TEE) and CT transcatheter aortic valve replacement showed moderate AS by planimetry. Following this, patient was monitored closely, but her dyspnoea kept worsening. Cardiovascular magnetic resonance (CMR) was performed due to persistent dyspnoea, identifying UAV with eccentric loophole orifice with unicommissural attachment and opposite free leaflet edge. The patient was managed medically. Discussion TTE is the test of choice for AS that defines valvular morphology by direct visualization and grades the severity by haemodynamic measurement. However, the accuracy of TTE can be limited by poor acoustic windows and heavy valvular calcification. TEE measures aortic valve area (AVA) by planimetry that requires accurate localization of the AV orifice plane. Similarly, it applies to multi-detector computed tomography (MDCT). While CMR is expensive and mainly available in tertiary centres, it can provide additional information when there is discordance. [ABSTRACT FROM AUTHOR]

Aims. To compare the efficacy of computed tomography from endoscopic examination in diagnosing and staging laryngeal carcinoma. Methods. From February 2019 to July 2020, we conducted a retrospective study on patients with laryngeal carcinoma. After receiving a clinical diagnosis of laryngeal masses, patients underwent indirect laryngoscopy evaluation before being referred for computed tomography (CT) scans. A postimaging biopsy was undertaken via direct laryngoscopy. Imaging features of the tumor, such as size, level of invasion, and tumor staging, were analyzed. Results. The mean age was 61±11, with 90% of male patients. The risk of laryngeal cancer for those patients who were active smokers (93.5%) and alcohol consumers (67.7%). The most common symptom was hoarseness (93.5%). In CT image, more than half of the cancers were carcinoma of the glottis (29%) and two regions, supraglottis and glottis (22.6%), while the less common cancers were the subglottic (3.2%) and all three regions (9.7%) carcinoma, especially true vocal cord (67.7%) is the most common site starting carcinoma. The percentage of tumor spreading to paraglottic space and pre-epiglottic space was 50% and 30.6%, respectively. The most common stage of laryngeal cancer in CT was the T3 stage (35.5%). Compared to laryngoscopy, there is a weak agreement (Kappa=0.518) in staging in laryngeal cancer in CT. Conclusion. MDCT is better in staging of laryngeal cancer in the T3 and T4 stages as compared to laryngoscopy. [ABSTRACT FROM AUTHOR]

ObjectiveTo develop a model that integrates radiomics features and clinical factors to predict upper gastrointestinal bleeding (UGIB) in patients with decompensated cirrhosis.Methods104 decompensated cirrhosis patients with UGIB and 104 decompensated cirrhosis patients without UGIB were randomized according to a 7:3 ratio into a training cohort (n = 145) and a validation cohort (n = 63). Radiomics features of the abdominal skeletal muscle area (SMA) were extracted from the cross-sectional image at the largest level of the third lumbar vertebrae (L3) on the abdominal unenhanced multi-detector computer tomography (MDCT) images. Clinical-radiomics nomogram were constructed by combining a radiomics signature (Rad score) with clinical independent risk factors associated with UGIB. Nomogram performance was evaluated in calibration, discrimination, and clinical utility.ResultsThe radiomics signature was built using 11 features. Plasma prothrombin time (PT), sarcopenia, and Rad score were independent predictors of the risk of UGIB in patients with decompensated cirrhosis. The clinical-radiomics nomogram performed well in both the training cohort (AUC, 0.902; 95% CI, 0.850–0.954) and the validation cohort (AUC, 0.858; 95% CI, 0.762–0.953) compared with the clinical factor model and the radiomics model and displayed excellent calibration in the training cohort. Decision curve analysis (DCA) demonstrated that the predictive efficacy of the clinical-radiomics nomogram model was superior to that of the clinical and radiomics model.ConclusionClinical-radiomics nomogram that combines clinical factors and radiomics features has demonstrated favorable predictive effects in predicting the occurrence of UGIB in patients with decompensated cirrhosis. This helps in early diagnosis and treatment of the disease, warranting further exploration and research.

The persistent challenge of ventricular tachycardia (VT) ablation lies in the elevated morbidity and mortality due to the underlying disease progression and the complexity of the arrhythmogenic substrate. As imaging methods are evolving, substrate-based VT ablation is moving closer to the realm of precision medicine.

Introduction-Coronary artery anomalies (CAA) are the genetic abnormalities which are generally asymptomatic. However, these anomalies can cause chest pain, syncope, arrhythmias, MI (myocardial infarction) or unexpected death. Multidetector row-computed tomography (MDCT) has been introduced as the best modality for coronary imaging. In the current study, we tried to evaluate the CAV including anomalies using 64-Slice MDCT coronary angiography in selected population. Material and Method-The current study was a cross-sectional and observational in nature, carried out at Biyani Diagnostic Centre, Dhule, Maharashtra from December 2022 to November 2023. A total of 106 patients were included in the study after applying inclusion and exclusion criteria. Philips Brilliance 64-slice MDCT was used for imaging modality. Data were restructured by retrospective gating in end-diastolic phase or end-systolic phase to clearly figure the 'right coronary artery (RCA)'. For evaluation of CAA, CAV and coronary artery stenosis (CAS), the 3D radiological image of complex anatomy of the coronary artery tree was axially projected. CAV was considered based on American Heart Association (AHA) scheme. All the collected data were statistically analyzed by descriptive statistics using Microsoft excel 2010. Result- The study included 106 patients with age range of 22-74 years and mean age of 52.9±9.5years. in the current study, Right dominance was seen in 90(84.90%), left dominance in 12(11.32%), and co-dominance was observed in 4(3.77%) patients. Smaller branches like conus artery, sinus node artery and septal branches were seen in most of the patients in our study. Type II (partially supplying apex) LAD variation was found to be the commonest among study subjects. As far as coronary anomalies are concerned, it showed prevalence of 15.09% in our study. The most common was the coronary arteries running within the myocardium i.e. myocardial bridging. The present study found 2(1.88%) cases of malignant anomalies. Conclusion- In the current study, CAV was present in most of the patients. Although, prevalence rate of CAA was found to be 15.09%, with the left coronary artery anomalies to be more common than right coronary artery anomalies. MDCT modality is tremendously helpful in indicating the presence CAV and CAA and it gives complete and exact information about the anatomy of coronary artery. This information can be vital for correct diagnosis and treatment plan of the patients as in case of interventional procedures. [ABSTRACT FROM AUTHOR]

Extracorporeal membrane oxygenation (ECMO) was established as a treatment for severe cardiac or respiratory disease. Intra-device clot formation is a common risk. This is based on complex coagulation phenomena which are not yet sufficiently understood. The objective was the development and validation of a methodology to capture the key properties of clots deposed in membrane lungs (MLs), such as clot size, distribution, burden, and composition. One end-of-therapy PLS ML was examined. Clot detection was performed using multidetector computed tomography (MDCT), microcomputed tomography (μCT), and photography of fiber mats (fiber mat imaging, FMI). Histological staining was conducted for von Willebrand factor (vWF), platelets (CD42b, CD62P), fibrin, and nucleated cells (4′, 6-diamidino-2-phenylindole, DAPI). The three imaging methods showed similar clot distribution inside the ML. Independent of the imaging method, clot loading was detected predominantly in the inlet chamber of the ML. The μCT had the highest accuracy. However, it was more expensive and time consuming than MDCT or FMI. The MDCT detected the clots with low scanning time. Due to its lower resolution, it only showed clotted areas but not the exact shape of clot structures. FMI represented the simplest variant, requiring little effort and resources. FMI allowed clot localization and calculation of clot volume. Histological evaluation indicated omnipresent immunological deposits throughout the ML. Visually clot-free areas were covered with leukocytes and platelets forming platelet-leukocyte aggregates (PLAs). Cells were embedded in vWF cobwebs, while vWF fibers were negligible. In conclusion, the presented methodology allowed adequate clot identification and histological classification of possible thrombosis markers such as PLAs.

Introduction: Variations in the branching pattern of the Arch of Aorta (AoA) are common in patients undergoing contrast-enhanced Multidetector Computed Tomography, the identification of which is crucial in managing patients undergoing cardiovascular/neck surgeries and interventions. Methods: This prospective cross-sectional study involved 513 patients who were sent to the Department of Radiology for evaluation of various pathologies of chest and neck between August 2018 and July 2019. After approval from the Institutional Review Committee {Reference No: 11(6-11) E2/075/076}, contrast-enhanced computed tomography images were evaluated with variations in branches of the left-sided arch of the aorta and symptoms associated. Results: Variations in branches of the arch of aorta were seen in 69 (13.45%; 95% CI: 10.60%-16.71%) of cases, left common carotid artery and brachiocephalic trunk having common origin or common trunk was 51(9.94%). The mean age was 52.4±20 years (Range 3 months to 92 years) with male to female ratio of 1.3:1. Conclusions: Contrast-enhanced computed tomography is the modality of choice for the detection of the variations in branches of AoA, recognition of which is crucial in vascular intervention and surgical procedures to reduce the postoperative morbidity and mortality of the patients.

Background: Jaw lesions comprise a broad spectrum of odontogenic and nonodontogenic lesions. They may be cysts, tumors, or tumor-like lesions. Clinical presentation of this vast spectrum of pathology is nonspecific. On imaging, they may be classified as radiolucent, mixed, or radioopaque. Based on this broad categorization of imaging appearances and few specific imaging characteristics if present, it may be possible to diagnose a particular jaw lesion or at least reach a narrow differential diagnosis. Aim & Objective:1. Comparative evaluation of MDCT and 1.5T MRI in radiographically detected jaw lesions.2. Study roll of MDCT and 1.5T MRI in diagnosis of jaw lesions Methodology: Study design: A Prospective Study. Study setting: Radio diagnosis department of Basaveshwara Medical College and Hospital, Chitradurga. Study duration: from July 2022 to June 2023. Study population: The study population included all the cases with jaw lesions patients admitted at a tertiary care center Sample size: 50 Results: Majority of cases found in 46-65 years age group 17 (34%) followed by above 65 years age group 15 (30%), 31-45 years 13 cases (26%) and 5 cases in 18-30 years age group. Most of cases were males 30 (60%) and 20 females (40%). MDCT shows most of cases were Ameloblastoma 12 followed by Keratocysticodontogenic tumor 10, Periapical cyst 7, Osteomyelitis 6, Dentigerous cyst 4, Odontoma 4, Cementoblatsoma 2, Osteogenic Sarcoma 2, Osteochondroma 2. 1.5T MRI shows majority of cases were Ameloblastoma 12 followed by Keratocysticodontogenic tumor 9, Periapical cyst 8, Osteomyelitis 6, Odontoma 5, Dentigerous cyst 4, Cementoblatsoma 2, Osteogenic Sarcoma 2, Osteochondroma 2. Conclusion: MRI could be effectively useful to the typing of different expansive lesion, and to evaluate the possible infiltration of the soft tissue. This information is decisive in the differential diagnosis between the benign lesions and major aggressive odontogenic tumours and in the surgical planning. [ABSTRACT FROM AUTHOR]

Introduction: Small bowel obstruction accounts for 60%-85% of cases of intestinal obstruction. MDCT is now readily available and has advantages over classic helical CT in the imaging of the mesenteric vasculature and of the bowel. Multidetector CT provides good spatial and contrast resolution, multiplanar reconstructions and more efficient scanning with few or no artifacts. Aims and objectives: To assess the role of MDCT in evaluation of clinically suspected acute small bowel obstruction. Methodology: This was a prospective study conducted on 50 patients suffering from clinically suspected acute small bowel obstruction in Department of Radiodiagnosis and Imaging, Govt. Medical College, Amritsar. The final diagnosis was confirmed by pathological correlation, post-operative data and clinical response to medical treatment. Multi Detector Computed Tomography imaging was performed for each patient. The data was tabulated and subjected to statistical analysis. Results: Majority of participants (40%) belonged to age group 41 to 60 years. There were 60% males and 40% females. The most common frequent cause of intestinal obstruction among the examined patients was adhesive bowel obstruction, followed by obstructed hernia, intussusception and gall stone ileus. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of MDCT on diagnosis of small intestinal obstruction was found to be 100%, 95.65%, 66.67%, 100% and 96.00% respectively. Conclusion: MDCT has high sensitivity and specificity to diagnose and determine the causes of bowel obstruction. It can be used in clinical practice as a modality for detecting intestinal obstruction which can aid in reducing the morbidity and mortality of patients with small intestine obstruction. [ABSTRACT FROM AUTHOR]

Background: This study was conducted to evaluate the role of solid organ and hollow viscous injury in blunt abdominal trauma patients using multi-detector computerized tomography, accurately diagnose the type of injury at the earliest and help the clinician in management, study the grades or severity of solid organ injuries, and correlate CT findings in trauma patients with management strategies followed either operatively or conservatively. Methods: This was a hospital-based prospective study conducted among 69 patients who underwent CT evaluation in the Department of Radio Diagnosis, S.C.B. Medical College, Cuttack, over a period of two years from November 2020 to October 2022, after obtaining clearance from the institutional ethics committee and written informed consent from the study participants. Results: Hemoperitoneum (85.5%) was the most common finding in blunt abdominal trauma. Pain in the abdomen was the most common clinical symptom, followed by guarding and rigidity. Among solid organ injuries, the spleen was the most frequently injured organ. Among splenic injuries, intraparenchymal hematoma was the most common type of splenic injury, followed by subcapsular hematoma. Among hepatic injuries, liver laceration was the commonest lesion. The right lobe of the liver involves 70% of cases. Renal injury is noted in 17.39% of cases of BAT; subcapsular hematoma and contusion contribute 25 each, and renal laceration occurs in 50% of cases. 7.49% of patients had pancreatic injuries, of which 40% were pancreatic contusions and 60% were pancreatic lacerations. The most common associated injury was fractures, followed by head and chest injuries, which were found more often with blunt trauma. Conclusion: The sensitivity of a CT scan in determining the type of lesion is 100%. MDCT imaging gives accurate diagnostic pathology of the various intraabdominal organ injuries in BAT, thereby helping the clinicians undertake conservative or surgical management. [ABSTRACT FROM AUTHOR]

Mesenteric ischemia diagnosis is challenging, with an overall mortality of up to 50% of cases despite advances in treatment. The main problem that affects the outcome is delayed diagnosis because of non-specific clinical presentation. Multi-Detector CT Angiography (MDCTA) is the first-line investigation for the suspected diagnosis of vascular abdominal pathologies and the diagnostic test of choice in suspected mesenteric bowel ischemia. MDCTA can accurately detect the presence of arterial and venous thrombosis, determine the extent and the gastrointestinal tract involved, and provide detailed information determining the subtype and the stage progression of the diseases, helping clinicians and surgeons with appropriate management. CT (Computed Tomography) can differentiate forms that are still susceptible to pharmacological or interventional treatment (NOM = non-operative management) from advanced disease with transmural necrosis in which a surgical approach is required. Knowledge of CT imaging patterns and corresponding vascular pathways is mandatory in emergency settings to reach a prompt and accurate diagnosis. The aims of this paper are 1. to provide technical information about the optimal CTA (CT Angiography) protocol; 2. to explain the CTA arterial and venous supply to the gastrointestinal tract and the relevant ischemic pattern; and 3. to describe vascular, bowel, and extraintestinal CT findings for the diagnosis of acute mesenteric ischemia.

Aims and objectives: 1) To study the role of MDCT in the evaluation of clinically suspected bowel pathologies. 2) To study the imaging characteristics of various bowel pathologies and narrow down the differential diagnosis using MDCT. 3) To correlate the imaging findings with operative findings/ cytohistopathology/ clinical outcomes if any. 4) To determine the sensitivity, specificity and accuracy of MDCT in the evaluation of bowel pathologies. Material and Methods: 50 patients with suspected bowel pathologies who were referred to the Department of Radiodiagnosis were included in this study. Results: The study had 60% males and 40% females This study showed male predominance. All the 50 patients in the study presented with abdominal pain. Weight loss, fever, vomiting and diarrhoea/constipation were the other complaints by the patients. The predominant wall enhancement pattern was homogenous. We observed that mucosa was affected in maximum number of cases. Based on the length of the bowel maximum cases in our study showed focal involvement. The cases in our study showed equal proportion of the large and small bowel involvement. Maximum cases in our study showed moderate mural thickness. Ascites was present in 88% cases in the present study. Necrotic and non-necrotic nodes were observed in 42% and 38% cases respectively. Pulmonary tuberculosis, liver microabscesses, metastases, peritoneal abscess, diverticulae and ovarian malignancy were the associated abnormalities in our study. On MDCT, tuberculosis followed by the malignancy were the maximum number of cases reported. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of MDCT on diagnosis of tuberculosis was found to be 91.67%, 92.11%, 78.57%, 97.22% and 92.00% respectively. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of MDCT on diagnosis of malignancy found to be 66.67%, 97.56%, 85.71%, 93.02% and 92.00% respectively. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of MDCT on diagnosis of other cases was found to be 100% each. Conclusion: The present study confirms the high diagnostic accuracy of MDCT in bowel diseases. MDCT is a powerful diagnostic tool for the study of bowel disorders, including inflammatory disease, neoplasms, and mechanical obstruction. MDCT enterography is a dedicated technique that allows proper visualization of the entire bowel wall to detect abnormal mural thickening and analyse its type, length, and pattern of enhancement. [ABSTRACT FROM AUTHOR]

PURPOSETo explore the utility of four-phase computed tomography (CT) in distinguishing renal oncocytoma with central hypodense areas from clear cell renal cell carcinoma (ccRCC).METHODSEighteen patients with oncocytoma and 63 patients with ccRCC presenting with central hypodense areas were included in this study. All patients underwent four-phase CT imaging including the excretory phases later than 20 min after contrast injection. Two blinded experienced radiologists visually reviewed the enhancement features of the central hypodense areas in the excretory phase images and selected the area demonstrating the greatest degree of enhancement of the tumor in the corticomedullary phase images. Regions of interest (ROIs) were placed in the same location in each of the three contrast-enhanced imaging phases. Additionally, ROIs were placed in the adjacent normal renal cortex for normalization. The ratio of the lesion to cortex attenuation (L/C) for the three contrast-enhanced imaging phases and absolute de-enhancement were calculated. The receiver operating characteristic curve was used to obtain the cut-off values.RESULTSComplete enhancement inversion of the central areas was observed in 12 oncocytomas (66.67%) and 16 ccRCCs (25.40%) (P = 0.003). Complete enhancement inversion combined with L/C in the corticomedullary phase lower than 1.0 (P < 0.001) or absolute de-enhancement lower than 42.5 HU (P < 0.001) provided 86.42% and 85.19% accuracy, 61.11% and 55.56% sensitivity, 93.65% and 93.65% specificity, 73.33% and 71.43% positive predictive value (PPV), and 89.39% and 88.06% negative predictive value (NPV), respectively, for the diagnosis of oncocytomas. Combined with complete enhancement inversion, L/C in the corticomedullary phase lower than 1.0 and absolute de-enhancement lower than 42.5 HU provided 87.65%, 55.56%, 96.83%, 83.33%, and 88.41% of accuracy, sensitivity, specificity, PPV, and NPV, respectively, for the diagnosis of oncocytomas.CONCLUSIONThe combination of enhancement features of the central hypodense areas and the peripheral tumor parenchyma can help distinguish oncocytoma with central hypodense areas from ccRCC.

Wide array of anatomical variations and pathologies affect the inferior vena cava (IVC). Multidetector computed tomography remains the most important modality to diagnose and evaluate the extent of involvement. The congenital variations such as duplication, anomalous course of renal veins, azygos continuation of IVC, etc., remain clinically indolent and are detected incidentally in abdominal imaging. This article describes the various congenital variants which include abnormalities in drainage, failure of development, and regression of the IVC. This article also highlights the important pathological conditions such as Budd–Chiari syndrome, primary and secondary neoplasms of the IVC, bland thrombosis, and retrograde opacification of the IVC.

Purpose: This study was conducted to evaluate the results of conservative management of blunt splenic trauma according to the American Association for the Surgery of Trauma-Organ Injury Scale (AAST-OIS) in 2018 by embolization. Methods: This observational study included 50 patients (42 men and 8 women) with splenic injury who underwent multidetector computed tomography (MDCT) and embolization. Results: According to the 2018 AAST-OIS, 27 cases had higher grades than they did according to the 1994 AAST-OIS. The grades of two cases of grade II increased to grade IV; those of 15 cases of grade III increased to grade IV; and four cases of grade IV increased to grade V. As a result, all patients underwent successful splenic embolization and were stable at discharge. No patients required re-embolization or conversion to splenectomy. The mean hospital stay was 11.8± 7 days (range, 6– 44 days), with no difference in length of hospital stay among grades of splenic injury (p > 0.05). Conclusion: Compared with the AAST-OIS 1994, the AAST-OIS 2018 classification is useful in making embolization decisions, regardless of the degree of blunt splenic injury with vascular lacerations visible on MDCT. [ABSTRACT FROM AUTHOR]

In the transition from the operative to the conservative approach for the polytraumatized patients who undergo blunt trauma, diagnostic imaging has assumed a pivotal role, currently offering various opportunities, particularly in the follow-up of these patients. The choice of the most suitable imaging method in this setting mainly depends on the injury complications we are looking for, the patient conditions (mobilization, cooperation, medications, allergies and age), the biological invasiveness, and the availability of each imaging method. Computed Tomography (CT) represents the "standard" imaging technique in the polytraumatized patient due to the high diagnostic performance when a correct imaging protocol is adopted, despite suffering from invasiveness due to radiation dose and intravenous contrast agent administration. Ultrasound (US) is a readily available technology, cheap, bedside performable and integrable with intravenous contrast agent (Contrast enhanced US—CEUS) to enhance the diagnostic performance, but it may suffer particularly from limited panoramicity and operator dependance. Magnetic Resonance (MR), until now, has been adopted in specific contexts, such as biliopancreatic injuries, but in recent experiences, it showed a great potential in the follow-up of polytraumatized patients; however, its availability may be limited in some context, and there are specific contraindications, such as as claustrophobia and the presence non-MR compatible devices. In this article, the role of each imaging method in the body-imaging follow-up of adult polytraumatized patients will be reviewed, enhancing the value of integrated imaging, as shown in several cases from our experience. [ABSTRACT FROM AUTHOR]

Background: Benign nephrectomy to treat patients with renal inflammatory disease in cases of severe urinary infection represents a diagnostic and management challenge because of significant inflammatory, fibrotic, and infectious components. Among renal inflammatory diseases, fistulization and invasiveness to adjacent structures are some of the hallmarks of xanthogranulomatous pyelonephritis (XGP). The aims of this study were as follows 1. to retrospectively determine key demographic and clinical features of XGP among benign nephrectomies; 2. to assess the CT preoperative diagnostic accuracy; and 3. to define the imaging characteristics of the CT stage. Material and Methods: A retrospective review of clinical, laboratory, and radiological features and operative methods of patients who underwent benign nephrectomy with histologically proven XGP was performed. Results: XPG was diagnosed in 18 patients over a 4-year (2018–2022) period. XGP represented 43.90% among benign nephrectomies. The mean age of the patients was 63 years, and the sex prevalence was higher in women (72.22%). Symptoms were vague and not specifically referrable to urinary tract disorders and unilateral (100%), with the left kidney affected in 61.11% of cases. Staghorn calculi and stone disease were the most common underlying cause (72.22%). All patients underwent CT. The preoperative CT imaging accuracy for renal inflammatory disease was 94.44% and indeterminate in 5.56%. A suspected diagnosis of XGP was formulated in 66.67% (12/18; 2 stage II/10 stage III), meanwhile, in 33.33% (6 patients with stage I), a non-specific diagnosis of renal inflammatory disease was formulated. CT was reported according to the Malek and Elder classification and staged in the stage I nephric form (33.33%), stage II perinephric form (11.11%), stage III paranephric form (55.56%). Conclusions: The CT diagnostic accuracy for kidney inflammatory disease was extremely high, whereas the suspected diagnosis of XGP was formulated preoperatively in only 66.67% of high-stage disease, where the hallmarks of invasiveness and fistulization of the pathology increased the diagnostic confidence. [ABSTRACT FROM AUTHOR]

Knowledge of anatomical variations of the hepatic artery from its origin to intrahepatic segmentation is of utmost importance for planning upper abdominal surgeries including liver transplantation, pancreatoduodenectomy, and biliary reconstruction. The origin and branching pattern of the hepatic artery was thoroughly described by the classification of Michels and Hiatt. Some rare variations of the hepatic artery were classified by Kobayashi and Koops. By the use of the multidetector computed tomography (MDCT) technique, the branching pattern of the hepatic artery can be visualized quite accurately. Unawareness of these arterial variations may lead to intraoperative injuries such as necrosis, abscess, and failure of the liver and pancreas. The origin and course of the aberrant hepatic arteries are crucial in the surgical planning of carcinoma of the head of the pancreas and hepatobiliary surgeries. In liver transplant surgeries, to minimize intraoperative bleeding complications and postoperative thrombosis, exact anatomy of the branching of the hepatic artery, its variations and intrahepatic course is of utmost importance. This review discusses variations in the anatomy of the hepatic artery from its origin to branching by the use of advanced imaging techniques and its effect on the liver, pancreatic, biliary and gastric surgeries. [ABSTRACT FROM AUTHOR]

Wide array of anatomical variations and pathologies affect the inferior vena cava (IVC). Multidetector computed tomography remains the most important modality to diagnose and evaluate the extent of involvement. The congenital variations such as duplication, anomalous course of renal veins, azygos continuation of IVC, etc., remain clinically indolent and are detected incidentally in abdominal imaging. This article describes the various congenital variants which include abnormalities in drainage, failure of development, and regression of the IVC. This article also highlights the important pathological conditions such as Budd–Chiari syndrome, primary and secondary neoplasms of the IVC, bland thrombosis, and retrograde opacification of the IVC. [ABSTRACT FROM AUTHOR]

Abstract Background The importance of thymic CT-grading and presence of thymic rebound hyperplasia during COVID-19 infection were only investigated in a few studies. This multivariate study aims to evaluate the relation between thymus CT-grading and rebound during COVID-19 infection and the following: (1) the patients' age, (2) the patients' blood lymphocytic count, (3) the CT-volumetry of the diseased lung parenchyma, (4) the patient's clinical course and prognosis, and finally (5) the final radiological diagnosis. Results Multicenter retrospective analyses were conducted between March and June 2021 on 325 adult COVID-19 patients with positive PCR results and negative history of malignant or autoimmune diseases. They included 186 males and 139 females (57.2%:42.8%). Their mean age was 40.42 years ± 14.531 SD. Three consulting radiologists performed CT-grading of the thymus gland (grade 0–3) and CT-severity scoring (CT-SS) of the pathological lung changes in consensus. Two consulting pulmonologists correlated the clinical severity and blood lymphocytic count. Pearson correlation coefficient (r) and linear regression analyses were statistically utilized. Sub-involuted thymus (with CT-grade 0:2) was detected in 42/325 patients (12.9%); all of them had a mild clinical course and low CT-SS (0–1). Thymic rebound hyperplasia was the only positive CT-finding in 15/325 patients (4.6%) without pathological lung changes. A weak positive significant correlation was proved between thymic grade and patient's age, clinical course, and CT-SS (r = 0.217, 0.163, and 0.352 with p ≤ 0.0001,

Background: Gastrointestinal perforations are a frequent cause of acute abdominal symptomatology for patients in the emergency department. The aim of this study was to investigate the findings of multidetector-row computed tomography of gastrointestinal perforations and analyze the impact of any imaging signs on the presurgical identification of the perforation site. Methods: We retrospectively reviewed emergency MDCT findings of 93 patients submitted to surgery for gastrointestinal perforation at two different institutions. Two radiologists separately reviewed the emergency MDCT examinations performed on each patient, before and after knowing the surgical diagnosis of the perforation site. A list of findings was considered. Positive predictive values were estimated for each finding with respect to each perforation site, and correspondence analysis (CA) was used to investigate the relationship between the findings and each of the perforation types. Results: We did not find inframesocolic free air in sigmoid colorectal perforations, and in rare cases, only supramesocolic free fluid in gastroduodenal perforations was found. A high PPV of perivisceral fat stranding due to colonic perforation and general distension of upstream loops and collapse of downstream loops were evident in most patients. Conclusions: Our data could offer additional information on the perforation site in the case of doubtful findings to support surgeons, especially in planning a laparoscopic approach.

This study presents a rare clinical case of encapsulated necrotic pancreatitis, which was a complication of acute pancreatitis that arose against the background of alimentary disorders. The aspects of the semiotics of radiation diagnostic methods in the follow-up control of these pathologies were presented. This case is notable for the manifestation of diseases upon hospital admission, as in the classical edematous form of acute pancreatitis, with a further increase in negative dynamics. This demonstrated the possible stepwise disease development, accompanied by a series of follow-up computed tomography between the clinical and morphological phases of acute pancreatitis and before the formation of pancreatic necrosis, which was complicated by sequestration of the pancreatic body with peripancreatic abscess formation. Afterward, the therapeutic paradigm was changed, and the place of the conservative approach was taken by active surgical tactics, followed by repeated manipulations and follow-up computed tomography and magnetic resonance until the improvement of the patients condition.

Abstract Background Tetralogy of Fallot is the most common cyanotic congenital heart disease encountering a large spectrum of anatomical presentations with differing surgical approaches, and long-term outcomes ranging from ventricular septal defect with limited aortic overriding and mild pulmonary obstruction to a critical form of VSD and pulmonary atresia. TOF variants include PA/VSD, TOF/CAVC, TOF/DORV and TOF with absent pulmonary valve. Also, it may be accompanied with many associated intracardiac and extracardiac anomalies that may be of value when imaging and planning the surgical procedure. Results Our study included 22 cases of classic TOF, 18 with PA/VSD (12 were of type A, 5 were of type B and 1 was of type C), 3 with TOF/CAVC and 7 TOF/DORV. Sub-valvular RVOTO was detected in 94% of patients. A statistically significant difference was depicted between Echocardiography and MDCT in detecting supravalvular RVOTO, however no statistically significant difference was found in sub-valvular and valvular RVOTO detection. MDCT could efficiently characterize pulmonary arterial tree with statistically significant difference between both Echocardiography and MDCT in assessment of main, right and left pulmonary arteries with P value = 0.036,0.014 and 0.023 respectively. With calculation of Mc-Goon ratio in all patients, it was favorable (> 1.2) in 33 patients (66%). MDCT entailed 19 patients with PDA versus 15 depicted by Echocardiography and 25 MAPCAs per 11patients compared 8 MAPCAs per 7 patients detected by Echocardiography. Right sided aortic arch was found in 10 patients and 24 patients showed abnormal branching pattern. Coronary artery abnormalities were identified in eight patients. MDCT showed 100% sensitivity and 100% specificity in depicting aortic, coronary and other associated extracardiac vascular anomalies. Conclusion MDCT offers comprehensive anatomical assessment of TOF, and its variants providing superiority over echocardiography and comparable results to cardiac catherization with 100% sensitivity and specificity in evaluation of associated extracardiac vascular anomalies as well as pulmonary arteries characterization. It is worth using MDCT routinely in combination with echocardiography for the preoperative assessment of TOF and its variants representing a less invasive option than conventional catherization with lower radiation exposure.

Abstract Background The term of Double-outlet right ventricle (DORV) is used to describe a spectrum of complex congenital cardiac malformations where anomalies of the ventriculo-arterial alignment are noted where both great arteries (pulmonary artery and aorta) originate completely or predominantly from the right ventricle. The purpose of this study is to evaluate the diagnostic accuracy of electrocardiography (ECG) gated multidetector computed tomography (MDCT) in preoperative assessment of DORV and its associated malformations, providing key anatomic parameters that affect surgical planning. Results A total of 50 patients diagnosed by echocardiography with DORV referred from our institute between September 2018 and August 2020 were enrolled. The location of the ventricular septal defect (VSD) to the great vessels and the alignment of the great vessels to each other as well as other associated malformations that affect the surgical planning were assessed by MDCT. The patients were retrospectively classified into subgroups according to the relative positions of the great arteries, the relationship between the great arteries and the VSD, and the presence of associated malformations according to the classification of Society of Thoracic Surgeons database. The diagnostic value of MDCT and transthoracic echocardiography (TTE) in evaluation of associated cardiac malformations apart from double outlet right ventricle was compared in 20 patients, whom surgeries were performed and surgical results were obtained. Fallot type of DORV was the most common clinical type which represented 48% of the patients in which the VSD is committed to the aorta. The second most common clinical type was Taussig–Bing anomaly which represented 30% of the patients and the VSD was seen committed to the pulmonary artery. The atrio-ventricular septal defect (AVSD)/uni-ventricular type represented 16% of the patients in the current study, with pulmonary and systemic venous anomalies, heterotaxy syndrome and situs anomalies were commonly associated. A total of 53 malformations apart from DORV were found in 20 patients whom performed surgical interventions. MDCT detected different vascular and situs anomalies in those patients with 100% sensitivity and 100% positive predictive value compared to 71.4% and 94% respectively in TTE. On the other hand, in our study TTE was superior to MDCT for detection of intracardiac anomalies with 100% sensitivity and 100% accuracy compared to 87.5% and 95% respectively in MDCT. Conclusions Our study suggested that ECG gated MDCT serves as a rapid, noninvasive imaging modality with good spatial resolution and provides excellent diagnostic image quality and has satisfactory diagnostic accuracy in the preoperative assessment of DORV. It is superior to echocardiography in providing a comprehensive mapping of the anatomy of complex anomalies especially that of extra-cardiac structures such as aorta, systemic veins, pulmonary veins, and pulmonary arteries. However, it can miss tiny intracardiac malformations. So combining the results of MDCT and echocardiography would be beneficial to guarantee the accuracy of diagnosis of DORV.

BackgroundCT SQUEEZ is a new automated technique to evaluate regional endocardial strain by tracking features on the endocardium from 4D cine CT data. The objective of this study was to measure the range of endocardial regional strain (RSCT) values obtained with CT SQUEEZ in the normal human left ventricle (LV) from standard clinical 4D coronary CTA exams.MethodsRSCT was measured over the heart cycle in 25 humans with normal LV function using cine CT from three vendors. Mean and standard deviation of RSCT values were computed in 16 AHA LV segments to estimate the range of values expected in the normal LV.ResultsCurves describing RSCT vs. time were consistent between subjects. There was a slight gradient of decreasing minimum RSCT value (increased shortening) from the base to the apex of the heart. Mean RSCT values at end-systole were: base = -32% ± 1%, mid = -33% ± 1%, apex = -36% ± 1%. The standard deviation of the minimum systolic RSCT in each segment over all subjects was 5%. The average time to reach maximum shortening was 34% of the RR interval.ConclusionsRegional strain (RSCT) can be rapidly obtained from standard gated coronary CCTA protocols using 4DCT SQUEEZ processing. We estimate that 95% of normal LV end-systolic RSCT values will fall between -23% and -43%; therefore, we hypothesize that an RSCT value higher than -23% will indicate a hypokinetic segment in the human heart.

The highest incidence of death in systemic sclerosis due to pulmonary disease raises the need for early detection and treatment. The study aim is the assessment of interstitial pulmonary disease by Multi Detector High Resolution CT (MDCT) and finds its relationship with the other disease parameters and the Pulmonary Function tests (PFT). A prospective cross-sectional study was performed in Assiut University Hospitals from May 2018 to January 2020 and included 62 consecutive SSc female patients. Demographic, clinical, Laboratory, PFT and MDCT assessment were conducted for all participants. The coarseness of fibrosis was 8.32 (range 0.0–17), the average proportion of ground-glass opacification was 28.3% (range, 0.0%–75%). Honey-comb pattern was seen in (52.5%). Mean Extent of disease was 46.25 ± 3.7 (range 5–81). Restrictive deficit found in 42 patients. Significant relation was found between the extent of disease and the percentage predicted FVC (r = 0.373, p 0.018) and FEV1/FVC (r = 0.593, p 0.000) and coarseness of fibrosis and proportion of ground glass opacification correlated inversely with VC (r = −0.385, p = 0.014, r = −0.376, p = 0.017 respectively), Rayanud's phenomena, modified Rodnan Skin Score and Medsger's general are positively correlated with MDCT disease extent. Scoring of systemic sclerosis (SSc) related interstitial lung disease (SSc-ILD) could be applicable as one of the important tools for disease assessment. [ABSTRACT FROM AUTHOR]

Background and Objectives: Colorectal lesions can present as a mass or as focal or diffuse thickening of the colon wall and may also be associated with abnormalities in the perienteric region. Multidetector computed tomography (MDCT) enables simultaneous imaging of both extracolonic structures and the gut wall. It is instrumental in assessing tumor extent, detecting pericolic dissemination, including lymph node involvement, and identifying metastases. This study aims to evaluate the role of MDCT in diagnosing large bowel lesions in patients referred from the surgery department with suspected large bowel pathology and to correlate MDCT findings with histopathological results., Materials and Methods: In the Department of Radiodiagnosis at Mahatma Gandhi Medical College and Research Institute (MGMCRI), Pondicherry, this study was carried out from February 2023 to January 2024 over a one-year span. CT imaging was carried out utilizing a GE Optima 128 Slice MDCT scanner for instances of clinically suspected large bowel pathology. IV contrast, rectal, oral (positive), and plain CT were the imaging protocols that were used., Results: Thirty of the 45 patients were female, and 15 were male; most of the patients were in the 46-60 age range. Twenty-three of the 24 instances with a CT diagnosis of malignancy had a histological confirmation. On CT, all 21 benign lesions were correctly detected. Benign lesions showed homogenous attenuation, mild symmetric wall thickening, and diffuse bowel involvement. Heterogeneous attenuation, pronounced asymmetric wall thickening, and localized bowel involvement were observed in malignant lesions., Conclusion: For the diagnosis and differentiation of benign from malignant colon and rectum lesions, MDCT has shown itself to be an excellent technique. MDCT provides additional information about related pericolic abnormalities, lymph node presence, neighboring organ infiltration, and distant metastases in addition to identifying the lesions., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Institutional Human Ethics Committee of Mahatma Gandhi Medical College and Research Institute issued approval MGMCRI/Res/01/2021/110/IHEC/147. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Prathapan et al.)

Abstract Background Enhancement washout technique in solid renal masses using multidetector computed tomography (MDCT) can differentiate different type of lesions. 99 Patients who are presenting with suspected renal masses or renal tumour for staging are included in this study. CT examination are carried out at urology and nephrology centre using MDCT. The attenuation values (Hounsfield Unit) will be assesed for each lesion on the pre enhanced, corticomedullary, nephrographic and delayed phases. Washout ratio will be calculated for each phase of enhancement in comparison to the unenhanced attenuation value. The characteristics of enhancement-washout will be correlated with the final histopathological diagnosis. Results Early enhancement and washout pattern was noted in 54 renal lesions (54.5%) representing 4 types of renal lesions; Oncocytoma (n = 13), clear cell renal cell carcinoma (n = 16), Chromophobe renal cell carcinoma (n = 15) and unclassified renal cell carcinoma (n = 10).Prolonged enhancement pattern was noted 45 lesions (45.4%); PRCC (n = 14), 10 case of lipid poor AML (n = 10), metanephric adenoma (n = 10) and Xp11 RCC (n = 11). High pre-contrast attenuation was noted in Xp 11RCC showing attenuation value 41.7 ± 6.823HU. The highest CMP values were noted in CCRCC (151.9 ± 20.4) followed by oncocytomas (137.6 ± 19.15HU) and then CHRCC (123.6 ± 16.6 HU)while the lowest values were noted in Metanephric adenoma)57.1 ± 17.4HU)and followed by PRCC (59.9 ± 4.8)and followed by lipid poor AML (79.17 ± 13.666) and RCC unclassified (89.06 ± 18.1). Conclusions Four-phase MDCT (the unenhanced, corticomedullary, nephrographic, and excretory phases) evaluate role of MDCT in differentiation of solid renal masses.

OBJECTIVE: To evaluate pre-operative tumour-node-metastasis staging (TNM) staging, metastases status and detection of role of multidetector-row computed tomography (MDCT) in gastric carcinoma patients in Pakistan. METHODS: This cross-sectional study, spanned over 14 months (January 2018-February 2019), was conducted at Radiology Department of Kuwait Teaching Hospital. Sample size was 173. Patients, selected through non-probability consecutive sampling technique, irrespective of gender, aged over 18 years and having clinically and histopathologically diagnosed with gastric carcinoma were included in the study. MDCT of patients was done. SPSS Version-24 was utilized for data analysis. Chi-square test was applied with p-value ≤0.05 was considered significant. RESULTS: Out of total 173 patients with gastric carcinoma, 121 (69.9%) were males and 52 (30.1%) were females. Mean age of patients was 48.5±1.2 years. Majority of patients were in T4a stage (n=64; 37%) followed T4b, T3, T0, T1 & T2 (24.9%, 17.3%, 11% and 9.8%) respectively. N0 stage with no nodal metastases was 40.5% followed by N1 stage (1-2 lymph nodes), N2 stage (3-6 lymph nodes), N3a stage (7-15 lymph nodes) and N3b stage (more than 15 lymph nodes) with 25.4%, 19.7%, 5.8% and 8.7% respectively. M1 stage with distant metastases was in 76 (43.9%) patients. Age and gender had insignificant association with TNM system (p>0.05). CONCLUSION: Multi detector row computed tomography was effective in pre-operative evaluation and TNM staging of gastric carcinoma. Lymph node detection on MDCT can further be utilized for fine needle biopsies if required.

Abstract Background, The context A prospective study was conducted involving 81 patients (mean age, 20.79 years) with abdominal trauma who underwent ultrasonography and post-contrast CT on MDCT scanner. The total DLP for each patient was reviewed, and the effective dose was calculated. Purpose of the study to: explore the role of MDCT in assessing traumatic abdominal lesions, demonstrate radiation dose delivered by MDCT, and describe specific CT technical features to minimize radiation. Results The spleen was the most commonly injured organ (49.4%) followed by liver (39.5%) and kidney (24.7%). Pancreatic injury occurred in seven patients, whereas only two patients had intestinal injuries. One patient had adrenal injury. Minimal, mild and moderate free intra-peritoneal fluid collection was detected in 21 (25.9%), 47 (58%) and 10 (12.3%) patients, respectively. Only three (3.7%) patients had no collection. One patient had active uncontrolled bleeding and died. Radiation dose was below the detrimental level (calculated effective dose), with optimal image quality. Conclusions MDCT is sensitive to all types of traumatic abdominal lesions. Not only in determining the injury, but also in its grading. MDCT has affected the treatment directions, spotting a focus on conservative treatment by raising the diagnostic confidence. FAST cannot be the sole imaging modality. The individual radiation risk is small but real. Advancements in medical imaging reduce radiation risk.

Abstract Background Hepatic steatosis has been shown to worsen the course of liver disease in chronic hepatitis C (CHC) patients, and it may reduce the efficacy of antiviral therapy and accelerate disease progression. In this cross-sectional study, we aimed to evaluate the role of multidetector computed tomography and magnetic resonance imaging (MRI) in the quantitative assessment and grading of hepatic steatosis to evaluate the association between hepatic steatosis and fibrosis in Egyptian genotype 4-CHC (G4-CHC) patients. Results Histopathological hepatic steatosis was found in 70.3% of 155 patients. No correlation was found between the CT ratio and pathological hepatic steatosis. Proton density fat fraction, T1-fat fraction, and fat percentage correlated with histological steatosis grading (r = 0.953, p 4.95 for a proton density fat fraction (AUC = 0.958) with 95.8% sensitivity, 90% specificity, 78.5% positive predictive value, and 96.1% negative predictive value. Conclusion 1H-MRS had good diagnostic performance in predicting hepatic steatosis in G4-CHC patients, and hence, it may offer a useful noninvasive quantitative modality for grading steatosis with clinical applicability, especially in those where a liver biopsy cannot be done.

Wei Xi,1,&ast; Qinxuan Tan,2,&ast; Yingyong Hou,3,&ast; Xiaoyi Hu,1 Hang Wang,1 Li Liu,1 Yu Xia,1 Qi Bai,1 Jiajun Wang,1 Jianjun Zhou,2 Jianming Guo1 1Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, 200032, People’s Republic of China; 2Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, People’s Republic of China; 3Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, 200032, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Jianming GuoDepartment of Urology, Zhongshan Hospital, Fudan University, Shanghai, 200032, People’s Republic of ChinaEmail guo.jianming@zs-hospital.sh.cnJianjun ZhouDepartment of Radiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, People’s Republic of ChinaEmail zhou.jianjun@zs-hospital.sh.cnObjective: Pseudocapsule (PS) of tumor-parenchyma interface (TPI) can be detected by MDCT (ctPS) in renal cell carcinoma (RCC) with exceptions. We aim to study the prognostic implications and histological reflections of no detection of ctPS in RCC.Patients and Methods: A total of 210 RCC patients who had MDCT examination and received nephrectomy in our institution were included in the analysis. Absence or presence of ctPS was recognized, and its associations with overall survival (OS) and progression-free survival (PFS), pathological PS (pPS) and vasculature were studied.Results: A total of 172 (81.9%) patients were recognized to have a ctPS and 38 (18.1%) had no detection of it. They had comparable histology, stage, grade, and necrosis. Patients without a ctPS had significantly shortened overall survival (OS, p = 0.001) and progression-free survival (PFS, p < 0.001), the significance of which persisted in multivariable analysis (OS, HR 3.104, p = 0.003; PFS, HR 3.313, p = 0.001). Nearly all tumors (34/38, 89.4%) without a ctPS actually had a pPS being detected and incompleteness of pPS was also irrelevant (p = 0.739). Compared with ctPS presence, those without a ctPS had significantly thinned pPS (0.36 vs 0.43 mm, p = 0.005). In clear-cell histology, those without a ctPS also contained increased vascular density and cross-sectional area of vessels with long diameter ≥ 200 um in the pPS layer (p = 0.005 and 0.011) and increased vascular density in the 500 um layer outside pPS (p = 0.017).Conclusion: Absence of ctPS on MDCT significantly increases the risk of adverse clinical outcome in RCC. It is the reflection of a thinner pPS and enriched vasculature of TPI rather than absence of pPS itself.Keywords: renal cancer, pseudocapsule, MDCT, prognosis, histological reflection

PurposeBone fracture risk assessed ancillary to positron emission tomography with computed tomography co-registration (PET/CT) could provide substantial clinical value to oncology patients with elevated fracture risk without introducing additional radiation dose. The purpose of our study was to investigate the feasibility of obtaining valid measurements of bone mineral density (BMD) and finite element analysis-derived bone strength of the hip and spine using PET/CT examinations of prostate cancer patients by comparing against values obtained using routine multidetector-row computed tomography (MDCT) scans-as validated in previous studies-as a reference standard.Materials and methodsMen with prostate cancer (n=82, 71.6±8.3 years) underwent Fluorine-18 NaF PET/CT and routine MDCT within three months. Femoral neck and total hip areal BMD, vertebral trabecular BMD and femur and vertebral strength based on finite element analysis were assessed in 63 paired PET/CT and MDCT examinations using phantomless calibration and Biomechanical-CT analysis. Men with osteoporosis or fragile bone strength identified at either the hip or spine (vertebral trabecular BMD ≤80mg/cm3, femoral neck or total hip T-score ≤-2.5, vertebral strength ≤6500N and femoral strength ≤3500N, respectively) were considered to be at high risk of fracture. PET/CT- versus MDCT-based BMD and strength measurements were compared using paired t-tests, linear regression and by generating Bland-Altman plots. Agreement in fracture-risk classification was assessed in a contingency table.ResultsAll measurements from PET/CT versus MDCT were strongly correlated (R2=0.93-0.97; P0.05 for all), whereas the mean difference in femoral neck areal BMD measurements was small but significant (-0.018g/cm2; -2.5%; P=0.007). The agreement between PET/CT and MDCT for fracture-risk classification was 97% (0.89 kappa for repeatability).ConclusionAncillary analyses of BMD, bone strength, and fracture risk agreed well between PET/CT and MDCT, suggesting that PET/CT can be used opportunistically to comprehensively assess bone integrity. In subjects with high fracture risk such as cancer patients this may serve as an additional clinical tool to guide therapy planning and prevention of fractures.

Background:There is a lack of information regarding the correlation between multi-detector computed tomography [MDCT] findings and clinical activity of Chron’s disease. The aim of the work: In this study, we aimed to investigate the correlation between MDCT and the degree of activity of Chron’s disease [CD]. Patients and Methods: In this prospective study, a total of 50 patients with CD were recruited The disease activity was assessed using the Crohn's Disease Activity Index [CDAI]. For MDCT evaluation, we used 256 Multislice CT scanners [Toshiba Medical System, Tochigi-ken, Japan]. Results: Forty-five patients [90%] showed signs of activity, while the other five patients [10%] were in the remission state [showed no signs of activity]. The most common sign of activity was mucosal hyper enhancement [93.3%], followed by mucosal thickening [91%], mesenteric congestion [64.4%], and mesenteric lymphadenopathy [33.3%]. The association analysis showed that there was a statistically significant association between CDAI and signs of activity in MDCT [360 ±64.5 in patients with signs of activity vs. 206.9 ±145.6 in patients with no signs of activity; p 0.05]. Conclusion: Our study showed that the findings of MDCT are significantly correlated with clinical activity score. Clinical and radiological predictors of sever disease need to be assessed as predictors in future studies

In the transition from the operative to the conservative approach for the polytraumatized patients who undergo blunt trauma, diagnostic imaging has assumed a pivotal role, currently offering various opportunities, particularly in the follow-up of these patients. The choice of the most suitable imaging method in this setting mainly depends on the injury complications we are looking for, the patient conditions (mobilization, cooperation, medications, allergies and age), the biological invasiveness, and the availability of each imaging method. Computed Tomography (CT) represents the “standard” imaging technique in the polytraumatized patient due to the high diagnostic performance when a correct imaging protocol is adopted, despite suffering from invasiveness due to radiation dose and intravenous contrast agent administration. Ultrasound (US) is a readily available technology, cheap, bedside performable and integrable with intravenous contrast agent (Contrast enhanced US—CEUS) to enhance the diagnostic performance, but it may suffer particularly from limited panoramicity and operator dependance. Magnetic Resonance (MR), until now, has been adopted in specific contexts, such as biliopancreatic injuries, but in recent experiences, it showed a great potential in the follow-up of polytraumatized patients; however, its availability may be limited in some context, and there are specific contraindications, such as as claustrophobia and the presence non-MR compatible devices. In this article, the role of each imaging method in the body-imaging follow-up of adult polytraumatized patients will be reviewed, enhancing the value of integrated imaging, as shown in several cases from our experience.

Transcatheter aortic valve replacement (TAVR) is a well-established treatment option for patients with severe symptomatic aortic stenosis (AS) whose procedural efficacy and safety have been continuously improving. Appropriate preprocedural planning, including aortic valve annulus measurements, transcatheter heart valve choice, and possible procedural complication anticipation is mandatory to a successful procedure. The gold standard for preoperative planning is still to perform a multi-detector computed angiotomography (MDCT), which provides all the information required. Nonetheless, 3D echocardiography and magnet resonance imaging (MRI) are great alternatives for some patients. In this article, we provide an updated comprehensive review, focusing on preoperative TAVR planning and the standard steps required to do it properly. [ABSTRACT FROM AUTHOR]

With the rapid development of smart medical care, copyright security for medical images is becoming increasingly important. To improve medical images storage and transmission safety, this paper proposes a robust zero-watermarking algorithm for medical images by fusing Dual-Tree Complex Wavelet Transform (DTCWT), Hessenberg decomposition, and Multi-level Discrete Cosine Transform (MDCT). First, the low-frequency sub-band of the medical image is obtained through the DTCWT and MDCT. Then Hessenberg decomposition is used to construct the visual feature vector. Meanwhile, the encryption of the watermarking image by combining cryptographic algorithms, third-party concepts, and chaotic sequences enhances the algorithm's security. In the proposed algorithm, zero-watermarking technology is utilized to assure the medical images' completeness. Compared with the existing algorithms, the proposed algorithm has good robustness and invisibility and can efficiently extract the watermarking image and resist different attacks. [ABSTRACT FROM AUTHOR]

Pancreatic neuroendocrine tumors (PNETs) are uncommon pancreatic neoplasms with malignant potential, heterogeneous clinical behavior, as well as imaging appearance. These tumors represent less than 3% of all pancreatic neoplasms with typical CT presentation as solid, well-circumscribed, hypervascular lesions. Cystic PNET is a rare pancreatic tumor which is nowadays more often detected due to the widespread use of high-resolution cross-sectional imaging. They are mainly solitary lesions most commonly localized in the body and the tail of the pancreas. Due to cystic presentation these lesions often present a diagnostic challenge to both experienced radiologists and pathologists. Herein, we present a rare case of synchronous, multiple cystic and solid pancreatic neuroendocrine tumors, which due to their extensiveness required total dudenopancreatectomy with splenectomy. Histopathological findings confirmed microscopic and macroscopic cystic components as well as typical solid variants of neuroendocrine tumors along the entire pancreas. [ABSTRACT FROM AUTHOR]

Background: Gastrointestinal perforations are a frequent cause of acute abdominal symptomatology for patients in the emergency department. The aim of this study was to investigate the findings of multidetector-row computed tomography of gastrointestinal perforations and analyze the impact of any imaging signs on the presurgical identification of the perforation site. Methods: We retrospectively reviewed emergency MDCT findings of 93 patients submitted to surgery for gastrointestinal perforation at two different institutions. Two radiologists separately reviewed the emergency MDCT examinations performed on each patient, before and after knowing the surgical diagnosis of the perforation site. A list of findings was considered. Positive predictive values were estimated for each finding with respect to each perforation site, and correspondence analysis (CA) was used to investigate the relationship between the findings and each of the perforation types. Results: We did not find inframesocolic free air in sigmoid colorectal perforations, and in rare cases, only supramesocolic free fluid in gastroduodenal perforations was found. A high PPV of perivisceral fat stranding due to colonic perforation and general distension of upstream loops and collapse of downstream loops were evident in most patients. Conclusions: Our data could offer additional information on the perforation site in the case of doubtful findings to support surgeons, especially in planning a laparoscopic approach. [ABSTRACT FROM AUTHOR]

Abstract Background Tetralogy of Fallot (TOF) is considered the most common form of cyanotic congenital heart diseases (CHD), accounting for about 10% of cases. It includes four main cardiac defects, in addition to various extra-cardiac anomalies. Aim This study aimed to evaluate cardiac and extra-cardiac vascular defects associated with TOF among Egyptian children, regarding frequency and types with assessment of multi-slice or multi-detector computed tomography (MDCT) role in their diagnosis. Definitely, full detection of these vascular anomalies has utmost importance when evaluating such patients particularly before surgical intervention. Methods This study included 60 pediatric patients diagnosed as TOF, who underwent MDCT examination in our institute during period of 6 months from (March to September 2020), to confirm their trans-thoracic echocardiography (TTE) findings and detect other vascular abnormalities which cannot be precisely detected with TTE before their surgical interventions. Results The incidence of different extra-cardiac vascular defects diagnosed by MDCT among our patients was 85% which was significantly higher than that detected by TTE (55%). Moreover, MDCT was superior to TTE assessment as regards its diagnostic accuracy (96.6% vs. 80%), sensitivity (98% vs. 76.9%), and specificity (88.9% vs. 85.7%), in addition to both positive and negative predictive values. The most common anomalies detected were affecting the pulmonary artery (80%), followed by aorto-pulmonary vessels (45%), then aortic artery (40%), coronary arteries (20%), and lastly vena cava connection (6.7%). Patients’ demographic characteristics and clinical presentations were also presented. Conclusion This study confirmed that many extra-cardiac vascular defects are commonly associating cardiac lesions in TOF and emphasizing the great value of MDCT in their diagnosis. Certainly, proper detection of these anomalies will help decision-making during preoperative evaluation, corrective interventions, and further management of these cases.