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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]

Background: Functional single ventricle (FSV) is a rare and complex cardiac malformation. FSV is a broad term including various cardiac structural anomalies in which one ventricle is severely underdeveloped. We aimed to accurately diagnose FSV and its different subtypes using multidetector computed tomography (MDCT). Methods: Eighteen patients with suspected FSV underwent cardiac computed tomography angiography (CTA), and the results were compared to those of echocardiography. Results: MDCT could accurately diagnose FSV and its different subtypes. It detected FSV of left ventricular morphology in 77.8% with the most common associated subtype is double inlet left ventricle (DILV) and FSV of right ventricular morphology in 22.2% with double outlet right ventricle (DORV) as the commonest variant. MDCT was superior to echocardiography in defining the dominant ventricle in 22.2% of cases and detection of the associated extracardiac anomalies in 38.9% of patients. MDCT could assess the connection and state of palliative shunts in the 4 patients with earlier interventions. Conclusion: MDCT can diagnose FSV and the associated extracardiac malformation and is indispensable in pre and postoperative follow up. [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]

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]

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]

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]

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. A 52-year-old patient with a history of hypertension, type II diabetes mellitus, hyperlipidemia, and stage IIIB chronic kidney disease was referred to our hospital for sustained monomorphic VT. Upon admission, the patient was hemodynamically stable. Laboratory results indicated mild anemia, moderate renal dysfunction, and normal myocardial enzymes. ECG during sinus rhythm showed widespread repolarization abnormalities in the apical and postero-lateral leads. Echocardiography revealed mild left ventricular dysfunction and coronary angiography confirmed significant lesions in multiple coronary arteries that were treated with drug-eluting stents (DES). Cardiac MRI showed relatively limited areas of old myocardial infarctions in the left circumflex artery and left anterior descending artery territories, therefore we decided to perform VT ablation. We used a Carto 3 Biosense Webster electro-anatomical mapping system (EAM) guided by fusion imaging (cardiac MRI and multidetector computed tomography - MDCT) with the aid of ADAS 3D software. The voltage map created during sinus rhythm, was concordant with the lesions identified on LGE-CMR. Radiofrequency (RF) catheter ablation targeted abnormal signals from the EAM, which were identified based on conduction channels (CCs) from the fusion imaging. There was complete VT non-inducibility at programmed ventricular stimulation (PVS). At the 3-month follow-up, echocardiography showed a slight improvement in LVEF and repeated PVS proved persistent ventricular arrhythmia non-inducibility. Substrate-based VT ablation in structural heart disease has greatly improved by high-resolution substrate imaging with detailed anatomy, allowing successful personalized treatment. There is room for further improvement in the near future with the contribution of artificial intelligence, possibly with a more targeted and automated VT ablation. [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]

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]

PURPOSE To explore the utility of four-phase computed tomography (CT) in distinguishing renal oncocytoma with central hypodense areas from clear cell renal cell carcinoma (ccRCC). METHODS Eighteen 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. RESULTS Complete 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. CONCLUSION The combination of enhancement features of the central hypodense areas and the peripheral tumor parenchyma can help distinguish oncocytoma with central hypodense areas from ccRCC. [ABSTRACT FROM AUTHOR]

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.

Transcatheter aortic valve replacement (TAVR) has transformed the treatment of aortic stenosis and pre‐procedure planning relies heavily on advanced imaging. Multidetector computed tomography angiography, the "TAVR CT," facilitates essential planning steps of measuring the aortic root for valve sizing and feasibility and assessment of potential access vessels, making it the guideline gold standard in preprocedural TAVR work up. This Impact of Advanced Imaging Techniques on Cardiac Surgery article will examine the development of TAVR CT, illustrate the current impact and utility, and highlight potential areas of future growth. Clinicians who keep informed of these changes and can become proficient with TAVR CT analyses will offer patients the most optimal results and fuel future therapeutic growth. [ABSTRACT FROM AUTHOR]

To evaluate whether the patient-specific contrast enhancement optimizer simulation software (p-COP) is useful for predicting contrast enhancement during whole-body computed tomography angiography (WBCTA). We randomly divided the patients into two groups using a random number table. We used the contrast material (CM) injection protocol selected by p-COP in group A (n = 52). The p-COP used an algorithm including data on the individual patient's cardiac output. Group B (n = 50) was assigned to the conventional CM injection protocol based on body weight. We compared the CT number in the abdominal aorta at the celiac artery level between the two groups and classified them as acceptable (> 280 HU) and unacceptable (< 279 HU) based on the optimal CT number for the WBCTA scans. To evaluate the difference in both injection protocols, we compared the visual inspection of the images of the artery of Adamkiewicz in both protocols. The CM dosage and injection rate in group A were significantly lower than those in group B (480.8 vs. 501.1 mg I/kg and 3.1 vs. 3.3 ml/s, p < 0.05). The CT number of the abdominal aorta at the celiac level was 382.4 ± 62.3 HU in group A and 363.8 ± 71.3 HU in group B (p = 0.23). CM dosage and injection rate were positively correlated to cardiac output for group A (r = 0.80, p < 0.05) and group B (r = 0.16, p < 0.05). The number of patients with an acceptable CT number was higher in group A [46/6 (86.7%)] than in group B [43/7 (71.4%)], but not significant (p = 0.71). The visualization rate for the Adamkiewicz artery was not significantly different between groups A and B (p = 0.89). The p-COP was useful for predicting contrast enhancement during WBCTA with a lower CM dosage and a lower contrast injection rate than that based on the body weight protocol. In patients with lower cardiac output a reduction in contrast injection rate and CM dosage did not lead to a reduced imaging quality, thus particularly in this group CM dosage can be reduced by p-COP. [ABSTRACT FROM AUTHOR]

Mesenteric ischemia is a broad term encompassing several clinical conditions leading to impaired vascularity of bowel loops. Absence of specific clinical presentation and a definitive laboratory marker often lead to delayed diagnosis with high morbidity and mortality in the acute setting. Imaging plays a crucial role in the diagnosis and management. Multi-detector CT (MDCT) is the first line imaging modality for the evaluation of patients with suspected mesenteric ischemia and plays an important role for assessing its severity and complications. This review article highlights the causes, pathophysiology, imaging features and possible endovascular treatment options of mesenteric ischemia. [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]

This study was carried out to know the frequency of occurrence of common anatomic variants in computed tomography of paranasal sinuses and nasal cavity. Non contrast Computed tomography (CT) of paranasal sinuses of 100 patients referred to Department Of Radiology, Saveetha Medical College were retrospectively studied. The Multi-detector computed tomography (MDCT) scans were evaluated for various anatomical variants of paranasal sinuses and nasal cavity. The frequency of occurrence was calculated in percentage. We found out that deviated nasal septum (DNS) was the most common variant in this study, seen in 86% of cases, followed by Agger nasi cells which was seen in 56% and the third most common was supra-orbital ethmoidal cells seen in 42% of the study population. All the cases included in the study, had minimum of one variant. Most of the study population showed multiple anatomical variations of paranasal sinus and nasal cavity. In conclusion, multidetector Computed tomography plays an important role is the assessment of various anatomical variants of the paranasal sinuses and nasal cavity. Pre-operative MDCT of Paranasal sinuses, gives the surgeons most if not all of the anatomical information they need to tailor surgeries. Considering the relatively high frequency of occurrence of these variants, it is essential for the radiologists to have a precise knowledge of imaging features of normal anatomy and anatomical variants of Paranasal sinuses. [ABSTRACT FROM AUTHOR]

Aims Paravalvular leakage (PVL) after transcatheter aortic valve replacement (TAVR) is a common complication in patients with bicuspid aortic valve (BAV). However, predictors and mechanisms of PVL are not well understood in this subset. The aim of this study was to analyse determinants and mechanisms of PVL in BAV and tricuspid aortic valve (TAV). Methods and results Of the 2394 consecutive patients undergoing transfemoral TAVR using new-generation valves at our centre, we identified 242 cases with BAV. To adjust for baseline differences, we performed 3 : 1 propensity score matching (TAVPS n  = 726). We analysed the aortic root anatomy and calcification as well as the number, circumferential distribution, and predilection sites of PVL using pre-procedural multidetector computed tomography and post-TAVR echocardiography. In the matched cohort, the incidence of PVL ≥mild (BAV 51.9% vs. TAVPS 51.7%; P  = 0.955) and PVL ≥moderate (BAV 5.0% vs. TAVPS 3.7%; P  = 0.393), the circumferential distribution, and independent predictors were similar between BAV and TAVPS. Both the presence of peri-annular calcium chunks or LVOT calcification were highly associated with PVL in BAV and TAVPS patients, whereas in BAV patients neither the presence of a calcium bridge nor the volume of its calcification was related to PVL. Notably, the spatial localization of these lesions did not necessarily match the circumferential leak position. Conclusion The incidence, circumferential distribution, predilection sites, and predictors of PVL were similar in matched population of BAV and TAVPS patients undergoing transfemoral TAVR using new-generation devices. These novel findings suggest a common underlying mechanism of PVL in both entities. [ABSTRACT FROM AUTHOR]

To avoid severe limited-view artifacts in reconstructed CT images, current multi-row detector CT (MDCT) scanners with a single x-ray source-detector assembly need to limit table translation speeds such that the pitch ${p}$ (viz., normalized table translation distance per gantry rotation) is lower than 1.5. When ${p}>{1.5}$ , it remains an open question whether one can reconstruct clinically useful helical CT images without severe artifacts. In this work, we show that a synergistic use of advanced techniques in conventional helical filtered backprojection, compressed sensing, and more recent deep learning methods can be properly integrated to enable accurate reconstruction up to ${p}={4}$ without significant artifacts for single source MDCT scans. [ABSTRACT FROM AUTHOR]

Sonography is the imaging modality of choice for diagnosing diseases of the female genital tract due to its high resolution, easy availability, low cost and lack of radiation. CT is not advocated for the primary evaluation of the female pelvis. However, with the advent of Multidetector CT (MDCT), females of all ages undergo CT scan of the abdomen and pelvis for myriad non-gynaecological diseases, e.g. subacute intestinal obstruction, abdominal lump, abdominal tuberculosis, appendicitis, ureteric colic, pancreatitis, oncological staging, follow-up, etc. Incidental female genital tract disorders were seen on these scans that are a dilemma for both, the radiologists and the clinicians. The objective of this pictorial review is to characterise the incidentally detected lesions of the female genital tract observed on 64-slice MDCT by correlating with sonography, if necessary, and establishing a clinico-radiological diagnosis. Our aim is to emphasise that the radiologist may be the first person to recognise a gynaecologic disorder and hence can play a significant role in patient management. [ABSTRACT FROM AUTHOR]

Background/Aim: Lung cancer is the most common and lethal cancer around the world. Computed tomography (CT) is an integral imaging technique for staging the lung cancer. Aim of this study was to correlate the multidetector CT (MDCT) findings of lung nodule with histopathological examination, as well as to assess the diagnostic accuracy of MDCT in evaluation of suspected lung nodule. Methods: One hundred patients with clinical or radiological suspicion of lung nodule referred for CT scan of thorax were included in the study. Histopathological analysis was performed. The location of the lesion was analysed and nodules were classified. Fine needle aspiration cytology (FNAC) was done with spinal needle under all aseptic precautions. The results obtained by MDCT were analysed and compared with histopathological findings done by CT guided FNAC. Results: Average age of patients was 65 years, 25 % were females and 75 % were males. Among all the patients 66 % of lesions were located in right side lung and 34 % of lesions were left in location. Of all, 2 % patients had lesions less than 3 cm, 11 % patients had lesion between 3-4 cm, 19 % patients had lesion between 4–5 cm, 26 % patients had lesion between 5-7 cm and 42 % patients had lesion greater than 7 cm. Many of these patients also presented with enlarged lymph nodes, most commonly mediastinal (73 %) followed by subcarinal (51 %), hilar (44 %) and supraclavicular (4 %) lymph nodes. The most common histological findings of lung nodules analysis were adenocarcinoma (41 %). Among the 100 patients 58 % had lesions located peripherally while 42 % had central lesions. CT was a highly sensitive (95.45 %) and moderately specific (75 %) test and also had a high positive predictive value (96 %) to diagnose malignant lung nodule. Conclusion: CT guided FNAC of lung nodule is a safe, minimal invasive procedure with a high diagnostic accuracy. The use of CT – guided FNAC in hilar and mediastinal nodules can avoid unnecessary exploratory surgery for staging and also diagnosis could be made with lesser cost. [ABSTRACT FROM AUTHOR]

Introduction: Craniovertebral junction is the "zone of transition" between the skull and cervical spine so its detailed discussion is lacking in so many standard textbooks addressing these regions. These anomalies are especially common in the Indian subcontinent. Accurate diagnosis, probable aetiology and pre-treatment evaluation considerably affect the prognosis of patients. The aim of this study was to classify various Craniovertebral junction disorders according to their aetiology and to correlate the imaging findings with the clinical profile of the patients and histopathology whenever possible. Methods: This prospective observational study was done in our department over the period of one year from August 2016 to July 2017. 57 North Indian patients from all age groups and both sex, who had imaging features suggesting craniovertebral junction pathology were selected for the study. Results: Our study group comprised 34 males and 23 females with a male to female ratio of 1.47: 1. The most common age group was 11-20 years and the most common aetiology being developmental followed by infective, autoimmune and inflammatory disorders. Conclusions: CVJ abnormalities are a group of treatable neurological disorders, and are approached with much caution by clinicians. Thus, it is crucial that radiologists should be able to make a precise diagnosis, categorize them into etiological groups, and give precise anatomical information on MDCT and/or MRI, as this information ultimately helps determine the management of such abnormalities and their prognosis. [ABSTRACT FROM AUTHOR]

Background: Diffuse interstitial lung disease have been described in Neurofibromatosis type 1 (NF1), but its diversity and prevalence remain unknown. The aim of this study was to assess the prevalence and characteristics of (NF1)-associated lung manifestations in a large single-center study using multidetector computed tomography (MDCT) and to evaluate the smoking history, patients' age, genetics, and the presence of malignant peripheral nerve sheath tumors (MPNST) as potential influencing factors for lung pathologies.Methods: In this retrospective study, 71 patients with NF1 were evaluated for the presence of distinctive lung manifestations like reticulations, consolidations, type of emphysema, pulmonary nodules and cysts. All patients underwent F-18-FDG PET/CT scans, which were reviewed by two experienced radiologists in consensus. Patients' subgroups were formed based on their smoking history (current smokers/previous smokers/never smokers), age (< 12 years, 12-18 years, > 18 years), and presence of MPNST (MPNST/no MPNST). In 57 patients (80%), genetic analysis of sequences coding for the neurofibromin on chromosome 17 was performed, which was correlated with different lung pathologies.Results: Among all NF1 patients (33 ± 14 years, 56% females), 17 patients (24%) were current smokers and 62 patients (87%) were > 18 years old. Pulmonary cysts, nodules, and paraseptal emphysema were the most common pulmonary findings (35%, 32%, 30%). The presence of pulmonary metastases, MPNST and centrilobular emphysema was associated with smoking. Cysts were observed only in adults, whereas no significant correlation between age and all other pulmonary findings was found (p > 0.05). Presence of MPNST was accompanied by higher rates of intrapulmonary nodules and pulmonary metastasis. Neither the presence nor absence of any of the specific gene mutations was associated with any particular lung pathology (p > 0.05).Conclusions: All pulmonary findings in NF1 patients occurred independently from specific mutation subtypes, suggesting that many NF1 mutations can cause various pulmonary pathologies. The presence of pulmonary metastases, MPNST and centrilobular emphysema was associated with smoking, indicating the value of smoking secession or the advice not to start smoking in NF1 patients as preventive strategy for clinicians. For screening of pulmonary manifestations in NF1 patients, an MDCT besides medical history and physical examination is mandatory in clinical routine. [ABSTRACT FROM AUTHOR]

Electrical impedance tomography is clinically used to trace ventilation related changes in electrical conductivity of lung tissue. Estimating regional pulmonary perfusion using electrical impedance tomography is still a matter of research. To support clinical decision making, reliable bedside information of pulmonary perfusion is needed. We introduce a method to robustly detect pulmonary perfusion based on indicator-enhanced electrical impedance tomography and validate it by dynamic multidetector computed tomography in two experimental models of acute respiratory distress syndrome. The acute injury was induced in a sublobar segment of the right lung by saline lavage or endotoxin instillation in eight anesthetized mechanically ventilated pigs. For electrical impedance tomography measurements, a conductive bolus (10% saline solution) was injected into the right ventricle during breath hold. Electrical impedance tomography perfusion images were reconstructed by linear and normalized Gauss-Newton reconstruction on a finite element mesh with subsequent element-wise signal and feature analysis. An iodinated contrast agent was used to compute pulmonary blood flow via dynamic multidetector computed tomography. Spatial perfusion was estimated based on first-pass indicator dilution for both electrical impedance and multidetector computed tomography and compared by Pearson correlation and Bland-Altman analysis. Strong correlation was found in dorsoventral (r = 0.92) and in right-to-left directions (r = 0.85) with good limits of agreement of 8.74% in eight lung segments. With a robust electrical impedance tomography perfusion estimation method, we found strong agreement between multidetector computed and electrical impedance tomography perfusion in healthy and regionally injured lungs and demonstrated feasibility of electrical impedance tomography perfusion imaging. [ABSTRACT FROM AUTHOR]

Background: Non-occlusive mesenteric ischemia (NOMI) is a mesenteric ischemic disease with considerably high mortality rate, although little has been known about what factors affect the patients' prognosis. The purpose of this study was to investigate prognostic factors of clinical data and computed tomography (CT) findings in patients with NOMI.Methods: This was a single institutional, retrospective study, reviewing 21 consecutive patients diagnosed with NOMI on angiography. Patients were divided into either ''survivor'' group or ''non-survivor'' group based on their clinical courses 1 month after diagnosis. Clinical information such as laboratory data, Charlson Comorbidity Index, and time from CT to injecting vasodilator was obtained from patients' medical records. Contrast-enhanced CT images were assessed in following items: defect of mural enhancement, pneumatosis intestinalis, hepatic portal venous gas, paralytic bowel dilatation, bowel wall thinning, and diameters of the relevant vessels.Results: Eight patients belonged to ''survivor'' group, whereas eleven were allocated to ''non-survivor'' group. None of CT findings showed significant difference between survivor group and non-survivor group [defect of mural enhancement: 75% and 100% (p = 0.16), pneumatosis intestinalis: 50% and 45.5% (p = 1.00), hepatic portal venous gas: 37.5% and 45.5% (p = 1.00), paralytic bowel dilatation: 12.5% and 63.6% (p = 0.06), and bowel wall thinning: 50% and 45.5% (p = 1.00)]. The diameters of the relevant vessels did not have significant difference either. Time from CT to injecting vasodilator was revealed to be significantly shorter in survivor group [187.5 (122.5-294) min and 310 (187-925.5)] (p = 0.048). None of the other clinical information had significant difference between each group.Conclusion: Prompt angiography may be a key to improve the prognosis of NOMI patients. [ABSTRACT FROM AUTHOR]

The objective of the present study was to model in 3D the detailed morphometric features of the thoracic and pelvic limb bones of the gazelle (Gazella subgutturosa), whose natural habitat is only in the Sanliurfa province, by using multidetector computerized tomography (MDCT) images. Materials from 14 (7 male and 7 female) dead gazelles were collected from the Harran University Veterinary Medicine Faculty clinics during or after treatment. MDCT images of the gazelles were taken and saved as DICOM (Digital Imaging and Communications in Medicine) files. MIMICS 20.1 software was used to generate a 3D reconstruction of the data, and morphological and morphometrical evaluation was performed. In respect of morphological features, the combined metacarpus (Mc) III and metacarpus Mc IV were the main weight‐bearing metacarpal bone, while Mc II and Mc V were rudimentary. On the femur, the lateral condyle was bigger than the medial condyle at the caudodistal end and the medial wing of the trochlea femoris was larger than the lateral. As with the thoracic limb, the combined metatarsus (Mt) III and metatarsus Mt IV were the main weight‐bearing metacarpal bone and they displayed a synostosis structure. There was no secondary metatarsus in the gazelles' pelvic limb. Based on digital measurements, the tibia was the longest bone of the gazelles' skeletal system, and there was a statistically significant sexual dimorphism throughout the skeleton at the levels of p <.05, p <.01 and p <.001. As a result, the present study's findings are useful as reference data for further studies on anatomy, surgery and archaezoology, while also being useful for classifying species and for forensic sciences. [ABSTRACT FROM AUTHOR]

Background: Left atrial appendage (LAA) has different shapes, sizes, and relations to different adjacent structures, all of these may be extremely important when interventional procedures related to left atrium are done. There is a growing data about variations in LAA morphology in relation to gender and in different populations. Objective: So in our study we evaluated LAA morphologies and identified the proportion of its different subtypes in Egyptians. Patients and methods: We analyzed retrospectively the data of 101 consecutive Egyptian patients who underwent multidetector computed tomography (MDCT) in our university specialized hospital from August 2019 to February 2020. Results: All images were evaluated for LAA morphology and volume. Windsock morphology existed in 32% of patients followed by chicken wing in 25% of patients. Cauliflower morphology was reported in 23% of patients whereas 20% of patients had cactus morphology. There was a significant gender difference, as female patients had predominantly cauliflower and cactus morphologies (P<0.05). Left atrial appendage volume showed a statistically significant positive correlation with advanced age and significant negative correlation with left ventricular ejection fraction. Conclusion: Egyptians had LAA predominantly windsock morphology in males and cactus morphology in females. [ABSTRACT FROM AUTHOR]

Background: To evaluate and compare preoperatively multi-detector computed tomography and digital panoramic radiography of jaw bones in patients submitted to dental implant restoration. Patients and methods: We conducted a diagnostic test accuracy study, Al-Azhar University Hospital Assuit. Thirty patients, with partial edentulous areas, were enrolled in the study and they were 11 females and 19 males with mean age of 37 years. Patients were included if they were systemically healthy, at least 18 years old, missing a single or multiple teeth, and their crestal residual ridge width ranging from 3 to 5 mm. Results: A higher Cronbach's alpha for the multi-detector computed tomography (MDCT) modality, as well as a lower reliability of error were found. Moreover, unlike digital panorama radiography, MDCT obtained length and width could predict the implant length and diameter. These results highlight the superiority of MDCT to digital panorama radiography in the preoperative assessment before dental implantation. Conclusion: Superiority of MDCT to digital panorama radiography in determining the implant site parameters before dental implantation. Future studies should consider reducing the cost of MDCT and improving its accessibility in low-resource settings. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to examine the main branches of abdominal aortae (AA) and to make evaluation by carrying out some measurements by considering gender difference. Materials and Methods: This study was designed as a retrospective research subjecting multi-detector computed tomography (MDCT) angiography images of 200 individuals (61 women, 139 men). Coeliac trunk (CT), superior mesenteric artery (SMA), right renal artery (RRA), left renal artery (LRA), inferior mesenteric artery (IMA) were examined by abdominal aortae and its branches. The cases of these arteries with anatomical variation were classified, and vertebral outflow levels originated from AA and the mean of distance measurements with each other were recorded. In addition, sagittal and transverse diameter measurements at the level of the main branches of AA were conducted, all examined data were compared according to gender. Results: While normal CT anatomy was observed in 91% of 2 00 cases, the rate of CT variations was 9 %. The replaced right hepatic artery originated from SMA was found only in one patient. No variation was observed in IMA. No significant difference was determined between genders in most of the vertebral outflow levels of the arteries examined. Conclusion: Diagnosing mesenteric and renal arterial variations is of vital importance in colon, hepatobiliary and renal transplantations, and vertebra levels of these arteries, diameter and distance measurements provide convenience for clinical staff and cadaver dissection in anatomy. [ABSTRACT FROM AUTHOR]

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Objective: To investigate the diagnostic value of digital tomosynthesis in urolithiasis compared with multidetector computed tomography (MDCT). Subjects and Methods: This study received the approval of institutional review board and obtained the informed consents of all subjects. Fifty patients with acute renal colic and hematuria from February 2014 to February 2015 were enrolled. They underwent both MDCT and digital tomosynthesis. Images were interpreted by two experienced radiologists, and inter-reader agreement was assessed. The diagnostic performance of urinary stones with digital tomosynthesis and MDCT was compared. The entrance surface dose (ESD) in MDCT and digital tomosynthesis for patients was measured and compared. Results: No significant difference was found between digital tomosynthesis and MDCT in the diagnosis of urinary stones (X2 = 1.357, p > 0.05). The ESD in digital tomosynthesis was lower than that in both routine-dose and low-dose MDCT for patients (p < 0.05). Conclusions: Digital tomosynthesis has great diagnostic value in urolithiasis. Compared with MDCT, digital tomosynthesis can significantly decrease ESD for patients and financial loan with a similar detection rate. [ABSTRACT FROM AUTHOR]

Our study's objective is to discuss and illustrate imaging methods used for a complete diagnosis of renal tumoral lesions associated to the most common renal fusion anomalies - horseshoe kidney. We reviewed our database for a period of ten years (between January 2010 and January 2020) using as keywords "horseshoe kidney" and "renal tumor", looking for cases associating both pathologic conditions. Most of the patients have been investigated by ultrasound first, but all of them had sectional imaging investigations (CT-urography or MRI), multidetector computed tomography (MDCT) being the main imaging method for this segment of pathology. We found five cases of renal tumoral lesions developed on the most frequent type of fusion anomalies (horseshoe kidney), three males and two females. Unfortunately, the malformative pathology was ubiquitary discovered during the imaging investigation realized for neoplastic disease. All cases have been investigated by MDCT, CT-urography remaining the best imaging tool in these cases. Imaging investigations in patients with associated tumoral and malformative conditions are essential for staging neoplastic disease, malformative conditions like horseshoe kidney representing predisposing factors for lithiasis, urinary tract obstruction, infections and, in rare cases, tumoral lesions. MDCT is an excellent diagnostic tool, but for associated genital anomalies, MRI is a better method. [ABSTRACT FROM AUTHOR]

Purpose: We compared and analyzed the detectability performance pertaining to an abdominal phantom including a region of interest (ROI) according to a computed tomography (CT) reconstruction algorithm. Methods: Three types of reconstruction algorithms (FBP, SAFIRE, and ADMIRE) were used to evaluate the detectability performance using the abdominal phantom (phantom size: 25 × 18 × 28 cm3). The vendor default settings for routine multi‐detector computed tomography abdominal scans were used. As the quantitative evaluation method, the contrast‐to‐noise ratio (CNR), difference in coefficient of variation (COV) with the normalization based on the FBP data, and the noise power spectrum (NPS) were measured. Results: The characteristic of the ADMIRE‐3 reconstructed image was higher than those of the FBP and SAFIRE‐3 reconstructed images. The CNR values of the SAFIRE and ADMIRE images were much higher than the corresponding values of the FBP images. The difference in COV values for the ADMIRE images was ~1.2 times lower than the corresponding values of the SAFIRE images. Conclusion: The comparative analysis of the abdominal phantom low‐contrast resolution differences for each CT exposure parameters showed that ADMIRE demonstrated better results than SAFIRE and FBP in terms of contrast, CNR, COV difference, and 1D NPS. This indicates that ADMIRE can provide a clearer observation even with the same number of contrast objects as compared to SAFIRE and FBP owing to its better contrast resolution in the central part of the contrast hole at low kV. [ABSTRACT FROM AUTHOR]

Objectives: In the context of a joint Mummy Research Project of the National Archaeological Museum, the Hellenic Institute of Egyptology and the Athens Medical Centre, an Egyptian mummy of the mid-Ptolemaic Period was transferred to our hospital and was thoroughly investigated with Computed Tomography. Methods: The mummy was carefully removed from its coffin and scanned in a 64-detector row computed tomographic scanner. Multiplanar and anthropometric measurements were obtained using advanced software. Results: The mummy appeared to be well-preserved and belonged to a young male adult. Among the findings, the most interesting and uncommon one was the asymmetry of the maxillary sinuses and the orbits. There were no signs of trauma. Conclusions: Computed Tomography revealed in a non-destructive way a rare, based on the published data, facial deformity in an Egyptian mummy attributed to chronic maxillary atelectasis. [ABSTRACT FROM AUTHOR]

Part of the group of socially significant diseases are the cardiovascular pathologies. The earliest signs are the arterial hypertension and lipid balance changes. Multidetector computed tomography angiography is a noninvasive exam to visualize the blood vessels and to detect any pathological processes. Having more accurate information about the patient condition can help in planning treatment and improve the overall therapy results. [ABSTRACT FROM AUTHOR]

Cardiovascular disease (CVD) is the leading cause of death worldwide and is particularly frequent among those with severe renal impairment. Early diagnosis and therapeutic intervention may help alleviate the burden of cardiovascular complication within this population. In the last years, advances have been made toward developing noninvasive imaging techniques that could offer better insight into the cardiac involvement in end‐stage renal disease (ESRD). Conventional transthoracic echocardiography remains the first‐line investigation used to assess cardiac function, but encompassing in our daily practice, the newer approaches such as speckle‐tracking imaging, cardiac computed tomography, or cardiac magnetic resonance can guide us to a more comprehensive understanding of CVD in ESRD. Given that patients with chronic kidney disease may not present with typical CVD symptoms, the amount of information brought by newer imaging techniques is crucial for an accurate diagnosis, risk stratification, and further management. The purpose of this review is to briefly summarize the specific applications of standard cardiac imaging techniques in patients with ESRD and to offer insight into the novel imaging modalities, highlighting the newest research in this field. By doing so, we aim to identify the most important imaging predictors of clinical outcomes in this population. [ABSTRACT FROM AUTHOR]

Abstract Background This study aimed to demonstrate the diagnostic ability of 64-row multidetector computed tomography (64-row MDCT) for longitudinal superficial extension of distal cholangiocarcinoma (LSEDC). Methods Twenty-seven patients with distal cholangiocarcinoma (DC) underwent preoperative 64-row MDCT without drainage tubes. LSEDC was diagnosed using curved planar reconstruction images reconstructed from 64-row MDCT, which were compared with pathologic findings. Results LSEDC was observed in 13 patients (48%). Ten patients (37%) had enhancing nonthickened bile ducts extending continuously from the main tumor (type 1). These coincided with pathologic findings of high-grade dysplasia (HGD) in 90.0% of cases; that is, a positive predictive value (9/10). Fourteen patients (52%) had only wall thickening of the main tumor with or without enhancement (type 2). Four patients with HGD in this group were difficult to diagnose. Three patients (11%) had enhancing nonthickened bile ducts not in continuity with the main tumor (type 3). This finding revealed an inflammatory change instead of a carcinoma in the pathologic findings. The sensitivity and specificity of detecting HGD were 75% and 93% on the liver side, 33% and 100% on the duodenal side, respectively. Four patients (67%) with HGD on the liver side were overdiagnosed, and one patient (17%) was underdiagnosed. Most of the patients overdiagnosed on the liver side (3/4 or 75%) had drainage tubes inserted before the MDCT. Conclusions For DC patients without drainage tubes, the 64-row MDCT technique may be useful for diagnosing HGD depicted as LSEDC on the liver side but not as useful on the duodenal side. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of our study was to determine contrast-enhanced MDCT features to differentiate nonhypervascular pancreatic neuroendocrine tumors (PNETs) from pancreatic ductal adenocarcinomas (PDACs).Methods: and materials: We included 74 patients with PNETs and 80 patients with PDACs who underwent preoperative MDCT. Two radiologists evaluated the morphologic characteristic and enhancement patterns of the tumors. Quantitative and qualitative analysis was performed, including evaluation of tumor size, homogeneity, contrast enhancement pattern, presence of pancreatic duct dilatation and tumor invasion to the adjacent vessels and peripancreatic infiltration. Tumor-to-pancreas enhancement ratio was defined as the Hounsfield units (HU) value of the tumor divided by the HU value of the pancreas. the first group was hypervascular PNETs showing hyperenhancement on arterial phase images and nonhypervascular PNETs, showing iso- or hypoenhancement on arterial phase images. After that, two radiologists estimated the possibilities of PNET or PDAC were for nonhypervascular PNETs.Results: On the basis of arterial enhancement, 43 PNETs were hypervascular and 31 were nonhypervascular. When compared to PDAC, nonhypervascular PNETs more frequently had well-defined tumor margins, intratumoral cystic components, calcifications and blood vessels and less frequently had main pancreatic duct dilatation, peripancreatic infiltration and vascular invasion (p < 0.01 for all). Nonhypervascular PNETs had higher tumor-to-pancreas enhancement ratio in venous phase (1.02 vs. 0.78, p = 0.012). Nonhypervascular PNETs more often had portal-venous hyperenhancement or persistent isoenhancement, while PDAC more often had persistent hypoenhancement or gradual delayed enhancement (p < 0.001). The absence of pancreatic duct dilatation and portal-venous hyperenhancement or persistent isoenhancement were the independent predictors for nonhypervascular PNETs. (The most accurate MDCT-findings to predict nonhypervascular PNET were the absence of pancreatic duct dilatation and peripancreatic infiltration (79% and 92% accuracy), portal-venous phase hyperenhancement or persistent isoenhancement (77%), the presence of intratumoral blood vessels (77%) and relative enhancement intensity in venous phase >0.9 (76%). Using these criteria, the area under curve for differentiation of PNET from PDAC was 0.906-0.846.Conclusion: Combined assessment of the enhancement and morphologic characteristics can improve the differentiation between nonhypervascular PNETs and PDAC at contrast-enhanced MDCT. [ABSTRACT FROM AUTHOR]

The purpose of this report is to review the CT findings of cardiac hydatid disease and to emphasize the role of multidetector CT scan in diagnosing cardiac hydatidosis. The most common locations of cardiac hydatid cysts are left ventricle (LV), interventricular septum and right ventricle respectively. We reported three cases of cardiac hydatid disease, in which one patient had extensive lesions in pericardium and cardiac walls. Second patient had single lesion in the interventricular septum while third patient had lesion in wall of LV. The diagnosis was not definite on echocardiography, but MDCT was utilized to assess cysts and extent of disease. We present the CT imaging details and review of literature in cardiac hydatidosis. [ABSTRACT FROM AUTHOR]

Background: Lower limb peripheral arterial disease (PAD) is a common disease that affects about two hundred million peoples per year. It is the third leading cause of cardiovascular morbidity. We plan to evaluate the diagnostic performance of 64-section computed tomographic (CT) angiography in the assessment of steno-occlusive disease in patients with PAD, with conventional digital subtraction angiography (DSA) as the reference standard. Aim of study: is to compare the diagnostic accuracy of multidetector computed tomographic (MDCT) angiography in diagnosis of PAD compared to the DSA as pre-operative evaluation of lower limb peripheral arterial diseases. Patients and methods: The study included 20 patients clinically presented with symptomatic PAD from February 2018 to July 2018. The study protocol was approved, and written informed consent was obtained from all patients. The patients underwent CT angiography and subsequent DSA. For stenosis analysis (≥70% stenosis), the arterial bed was divided into 35 segments and evaluated by three readers. Inter observer agreement was determined with generalized κ statistics. Accuracy, sensitivity, specificity, was calculated. Mc Nemar test was used to prove significant differences between CT angiographic and DSA findings. Results: A total of 700 arterial segments were evaluated, with excellent agreement between readers (κ ≥ 0.928). On a segmental basis, both sensitivity and specificity for stenosis of 70% or more were at least 96% (386 of 400 segments and 290 of 300 segments, respectively), with an accuracy of 98% (686 of 7oo segments).There was no significant difference between CT angiographic and DSA findings (P = .62-.87). Conclusion: The diagnostic performance of 64-section CT angiography is excellent in patients with clinical symptoms of PAD. [ABSTRACT FROM AUTHOR]

Cystic duct calculus could either be due to the retained stone during the cholecystectomy or recurrence of stone in the actual remnant of the cystic duct and causes common duct obstruction by extrinsic compression - Mirizzi syndrome. We report a rare case of post cholecystectomy Mirizzi's syndrome that developed one year after laparoscopic cholecystectomy and our case reminds usefulness of CT scanning, after already inconclusive ultrasound and invasive diagnostic modality ERCP. Stone removal was achieved successfully by traditional laparotomy after the CT scan. [ABSTRACT FROM AUTHOR]

Goals: With substantially increased number of detector rows in multidetector CT (MDCT), axial scan with projection data acquired along a circular source trajectory has become the method-of-choice in increasing clinical applications. Recognizing the practical relevance of image reconstruction directly from the projection data acquired in the native cone beam (CB) geometry, especially in scenarios wherein the most achievable in-plane resolution is desirable, we present a three-dimensional (3-D) weighted CB-FBP algorithm in such geometry in this paper. Methods: We start the algorithm's derivation in the cone-parallel geometry. Via changing of variables, taking the Jacobian into account and making heuristic and empirical assumptions, we arrive at the formulas for 3-D weighted image reconstruction in the native CB geometry. Results: Using the projection data simulated by computer and acquired by an MDCT scanner, we evaluate and verify performance of the proposed algorithm for image reconstruction directly from projection data acquired in the native CB geometry. Conclusion: The preliminary data show that the proposed algorithm performs as well as the 3-D weighted CB-FBP algorithm in the cone-parallel geometry. Significance: The proposed algorithm is anticipated to find its utility in extensive clinical and preclinical applications wherein the reconstruction of images in the native CB geometry, i.e., the geometry for data acquisition, is of relevance. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to evaluate and compare the diagnostic role of radiography and multi-detector computed tomography (MDCT) in acute traumatic wrist injuries.Patients and Methods: One hundred sixty-eight patients with acute wrist trauma were enrolled in our study. All patients had submitted to radiography and MDCT within 24 h after wrist trauma. The diagnostic role of radiography and MDCT was evaluated and compared. The effective radiation dose of the two techniques was calculated.Results: One hundred four (61.9%) and 84 (50%) out of 168 patients had acute wrist injuries on MDCT and radiographic examinations, respectively. Using MDCT results as a reference standard, the sensitivity, specificity, and accuracy of radiography in the diagnosis of distal radius fracture were 85.7, 96, and 92.3%, respectively, and in the diagnosis of scaphoid fracture were 62.5, 97.3, and 88.5%, respectively. As regards detection of acute traumatic wrist injuries, we observed no significant difference between the two modalities (P = 0.1347); in addition, both modalities had high consistency (κ = 0.8359). The mean effective radiation dose of radiography was 0.01 mSv and of MDCT was 0.1 mSv.Conclusion: Radiography still remains as the first screening tool in acute traumatic wrist injuries and MDCT is complementary to it and used as a problem-solving tool or for preoperative planning. [ABSTRACT FROM AUTHOR]

Introduction Although many radiologists invoke the surgical classification of renal injury proposed by the American Association for Surgery in Trauma (AAST), there has been only limited work on the role of the AAST system as an imaging stratification. The aim was to determine the inter-rater reliability (IRR) amongst radiologists and urologists using the AAST system. Methods: A 1-year retrospective study of consecutive patients with computed tomography (CT) evidence of renal trauma managed at a Level 1 trauma center. Three radiologists and three urologists independently stratified the presentation CT findings according to the AAST renal trauma classification. Agreement between independent raters and mutually exclusive groups was determined utilizing weighted kappa coefficients. Results: One hundred and one patients were included. Individual inter-observer agreements ranged from 54/101 (53.4%) to 62/101 (61.4%), with corresponding weighted kappa values from 0.61 to 0.69, constituting substantial agreement. Urologists achieved intra-disciplinary agreement in 49 cases (48.5%) and radiologists in 36 cases (35.6%). Six-reader agreement was achieved in 24 cases (23.7%). The AAST grade I injuries had the highest level of agreement, overall. Conclusion: The finding of substantial IRR amongst radiologists and urologists utilizing the AAST system supports continued use of the broad parameters of the AAST system, with some modification in specific categories with lower agreement. [ABSTRACT FROM AUTHOR]

Multi-detector computed tomography (MDCT) scanners that can quickly acquire volumetric datasets composed of isotropic voxels laid the groundwork for the widespread clinical implementation of 3D MDCT reconstructions, with maximum intensity projection (MIP) and volumetric rendering (VR) becoming important parts of the imaging evaluation of patients with a wide variety of pathologic conditions. Recently, a new 3D reconstruction technique known as cinematic rendering (CR) has become available and is now U.S. FDA approved. CR bears fundamental similarities to VR, but utilizes a more complex lighting model to bring about photorealistic reconstructions. While a tremendous amount of work remains to be done in order to understand the advantages and disadvantages of CR in comparison to traditional 3D reconstruction methods, the images themselves are strikingly detailed and can be interactively manipulated to highlight a variety of different tissue types and anatomic structures. In the following pictorial essay, we provide a number of clinical examples of the use of CR in musculoskeletal imaging, including the evaluation of complex fractures, the delineation of the relationship of fractures to adjacent vasculature and overlying soft tissues, and the visualization of vascular and soft tissue injuries. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the value of CT with inclusion of smaller lymph node (LN) sizes and axial ratio to improve the sensitivity in diagnosis of regional lymph node metastases in oesophageal squamous cell carcinoma (OSCC).Methods: The contrast-enhanced multidetector row spiral CT (MDCT) multiplanar reconstruction images of 204 patients with OSCC were retrospectively analysed. The long-axis and short-axis diameters of the regional LNs were measured and axial ratios were calculated (short-axis/long-axis diameters). Nodes were considered round if the axial ratio exceeded the optimal LN axial ratio, which was determined by receiver operating characteristic analysis.Results: A positive predictive value (PPV) exceeding 50% is needed. This was achieved only with LNs larger than 9 mm in short-axis diameter, but nodes of this size were rare (sensitivity 37.3%, specificity 96.4%, accuracy 85.8%). If those round nodes (axial ratio exceeding 0.66 ) between 7 mm and 9 mm in size were considered metastases as well, it might improve the sensitivity to 67.2% with a PPV of 63.9% (specificity 91.6%, accuracy 87.2%).Conclusion: Combination of a smaller size and axial ratio for LNs in MDCT as criteria improves the detection sensitivity for LN metastases in OSCC.Key Points: • CT is widely used to assess metastatic lymph nodes. • CT has low sensitivity in detecting metastases using conventional criteria. • Diagnostic sensitivity of CT was improved by using lymph node axial ratio. • New diagnostic criteria provide greater diagnostic confidence with PPVs exceeding 50%. • New diagnostic criteria may help clinicians assess patients with oesophageal cancer. [ABSTRACT FROM AUTHOR]