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Aim: To investigate the use of second-generation dual-source high-pitch computed tomography in obtaining confident diagnostic image quality using a low radiation dose in young patients with congenital heart disease (CHD)., Materials and Methods: From July 2014 to June 2016, 50 consecutive children <4 years with complex CHD underwent electrocardiography (ECG)-triggered dual-source computed tomography (CT). The patients were assigned randomly to two groups: high-pitch (pitch 3.4) spiral dual-source CT acquisition (group A) and retrospectively spiral dual-source CT acquisition (group B). The image quality, diagnostic accuracy, coronary artery origin, course demonstration, and radiation exposure were compared between the two groups., Results: Fifty examinations were performed (group A, 25; group B, 25). There were no significant differences in image quality, diagnostic accuracy, coronary artery origin, and course demonstration between the two groups. The image quality scores were 1.3±0.4 in group A and 1.1±0.3 in group B (p=0.2). The diagnostic accuracy was 100% in both groups. The coronary arteries were traceable in 80% in group A and 84% in group B (p=0.7). A single coronary artery was identified in one case in group A and the left anterior descending (LAD) branch originated from the right coronary artery (RCA) in one case in group B. There were significant differences in the effective doses between the two groups (0.40±0.20 mSv in group A and 2.7±1.0 mSv in group B, p<0.05)., Conclusion: Intra-cardiac and extra-cardiac malformation, coronary artery origin, and course malformation can be visualised clearly using a high-pitch ECG-triggered dual-source CT with a low radiation dose and good image quality in patients with CHD., (Copyright © 2017 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.)

Objectives: To evaluate the effective dose and image quality of horizontal CBCT in comparison with multislice spiral CT (MSCT) in scans of the head, cervical spine, ear and dental arches., Methods: A head and neck Alderson-Rando ® phantom (The Phantom Laboratory, Salem, NY) equipped with 74 thermoluminescence dosemeters was exposed according to 5 different scans in CBCT and 4 different scans in MSCT. Spatial and contrast resolutions, in terms of modulation transfer function and contrast-to-noise ratio (CNR), were measured to obtain a quantitative assessment of image quality., Results: The CBCT effective dose was 248, 249, 361, 565 and 688 µSv in the cervical spine, head, ear, dental arches with small field of view and dental arches with medium field of view, respectively. The MSCT effective dose was 3409, 1892, 660 and 812 µSv in the cervical spine, head, ear and dental arches, respectively. The modulation transfer function was 0.895 vs 0.347, 0.895 vs 0.275, 0.875 vs 0.342 and 0.961 vs 0.352 for CBCT vs MSCT in the cervical spine, head, ear and dental arches, respectively. Head and cervical spine MSCT showed greater CNR than CBCT, whereas CNR of the ear and dental arches showed comparable values., Conclusions: CBCT was preferable to MSCT for the ear and dental arches volumetric imaging due to its lower radiation dose and significantly higher spatial resolution. In the case of cervical spine and head imaging, MSCT should be generally recommended if a high contrast resolution is required, despite the greater radiation exposure.

Objective: To discuss the diagnostic value of multislice CT angiography (MSCTA) in acute aortic syndrome (AAS)., Materials and Methods: The clinical and imaging data of 36 cases diagnosed as AAS by MSCTA were collected. The manifestations of the MSCTA images were reviewed retrospectively, and the average x-ray dose was calculated., Results: Among 36 AAS cases, 16 cases had aortic dissection (AD), 8 cases had penetrating atherosclerotic ulcer (PAU), 7 cases had intramural hematoma (IMH), and 5 cases had unstable thoracic aneurysm (UTA). Of 16 cases with AD, type A and type B accounted for 43.7% (7/16) and 56.3% (9/16), respectively. Of 7 cases with IMH, type A and type B accounted for 42.9% (3/7) and 57.1% (4/7), respectively., Conclusion: In spite of the x-ray radiation, MSCTA proves to be a rapid and noninvasive imaging technique for the diagnosis of AAS., (© 2017, Wiley Periodicals, Inc.)

Purpose: The aim was to determine whether the enhanced soft tissue contrast provided by high-dose volumetric CT (HDVCT) can reduce inter-observer variability in delineating prostate compared to helical conventional CT (CCT) scans and 3T MRI scans for patients undergoing radical prostate cancer radiotherapy. Secondly, to quantify the potential PTV reduction with decreased inter-observer variability., Materials and Methods: A 320 slice volumetric CT scanner was used. The wide-detector coverage of 16cm enabled volumetric image acquisition of prostate gland in one rotation. Three imaging studies were performed on ten patients. CCT and HDVCT were performed consecutively at the same coordinate system followed by MRI. Five radiation oncologists delineated the prostate., Results: The inter-observer variability is 2.0±0.6, 1.9±0.4 and 1.8±0.4mm for CCT, HDVCT and MR respectively with the maximum at the apex region. Comparing inter-observer difference variability between CCT and HDVCT with MR indicates that observers have larger variations in contouring using CCT than HDVCT especially at apex. Jaccard index of HDVCT is significantly higher than CCT with a mean difference of 0.03 (p=0.011). Both MRI and HDVCT provide the opportunity for a 2mm PTV margin reduction at the apex compared to CCT., Conclusion: Inter-observer variability in delineation remains an important source of systematic error. HDCTV for treatment planning reduces this error without recourse to MRI and permits a PTV reduction of 2mm at the apex. The margins required to account for residual error with any imaging modality are still greater than are used in typical current practice., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Purpose: Computed tomography (CT)-guided periradicular infiltration has become an accepted procedure for treating radiculopathy-associated low back pain. The purpose of this study is to compare spot scanning and segmental helical planning CT in terms of dose reduction., Materials and Methods: Eighty-five patients underwent CT-guided single-site lumbar periradicular therapy. Prior imaging was not available for planning. Sixty-three patients were examined with a new dedicated spot scanning technique (group I), and twenty-two patients underwent conventional segmental planning CT examinations with helical image acquisition serving as controls (group II). Examinations were reviewed retrospectively for dose-length product (DLP) and number of acquisitions required for intervention. Pain reduction accomplished with the intervention was recorded for quality assurance., Results: Median DLP was 0.80 mGy cm for spot scanning versus 6.50 mGy cm for segmental planning CT. Thus, the contribution of the planning scan to the total interventional dose decreased from 73 to 25%. As a result, the total interventional dose was reduced significantly from a median DLP of 8.90 mGy cm to 3.20 mGy cm (-64%). Acquisitions required during the intervention had a median DLP of 2.40 mGy cm for group I and 2.35 mGy cm for group II, showing no significant difference. Median pain reduction in both groups was two points on the numeric rating scale., Conclusion: Dedicated spot scanning for planning reduced the total median effective dose of the intervention by more than 64% without increasing the number of images required during the interventional procedure. Significant pain reduction was achieved with both approaches. Spot scanning is recommended for dose reduction.

Objectives: The purpose of this study was to assess the efficacy of the renewed dynamic collimator in a third-generation dual source CT (DSCT) scanner and to determine the improvements over the second-generation scanner., Methods: Collimator efficacy is defined as the percentage overranging dose in terms of dose-length product (DLP) that is blocked by the dynamic collimator relative to the total overranging dose in case of a static collimator. Efficacy was assessed at various pitch values and different scan lengths. The number of additional rotations due to overranging and effective scan length were calculated on the basis of reported scanning parameters. On the basis of these values, the efficacy of the collimator was calculated., Results: The second-generation scanner showed decreased performance of the dynamic collimator at increasing pitch. Efficacy dropped to 10% at the highest pitch. For the third-generation scanner the efficacy remained above 50% at higher pitch. Noise was for some pitch values slightly higher at the edge of the imaged volume, indicating a reduced scan range to reduce the overranging dose., Conclusions: The improved dynamic collimator in the third-generation scanner blocks the overranging dose for more than 50% and is more capable of shielding radiation dose, especially in high pitch scan modes., Key Points: • Overranging dose is to a large extent blocked by the dynamic collimator • Efficacy is strongly improved within the third-generation DSCT scanner • Reducing the number of additional rotations can reduce overranging with increased noise.

Aim: The aim of this study was to investigate the added value of SPECT/spiral CT versus SPECT or CT alone in the differential diagnosis of solitary skeletal lesions., Methods: This was a retrospective study on a total of 69 patients who had a solitary skeletal "hot spot" that could not be definitively diagnosed using planar scintigraphy. Thus, SPECT/spiral CT was performed on the indeterminate lesions. SPECT, CT and SPECT/spiral CT images were independently interpreted by two experienced doctors who have both identification of CT and nuclear medicine. Each lesion was graded on a 4-point diagnostic scale (1: benign, 2: likely benign, 3: likely malignant, 4: malignant). The final diagnosis of each lesion was based on pathological confirmation after surgery within 3 weeks of the bone scan., Results: Final diagnoses based on the pathological results revealed that 43 of the 69 patients were diagnosed with malignancy, and the remaining 26 patients were diagnosed as having benign lesions. For SPECT and CT scans, both of the reviewers rated 55.1 % (38/69) and 37.7 % (26/69) of lesions as equivocal, with the help of SPECT/CT, 33.3 % (23/69) of lesions were rated as equivocal. The diagnostic accuracies of SPECT, CT alone and SPECT/CT were 66.7 % (46/69) ,82.6 % (57/69) and 85.5 %(59/69), respectively. The kappa scores for the degree of agreement between SPECT, CT alone or SPECT/CT with pathological results were 0.185 (p = 0.054) , 0.612 (p < 0.001) and 0.671 (p < 0.001), respectively., Conclusion: Compared with SPECT or imaging alone, SPECT/spiral CT imaging was more accurate and valuable in the differential diagnosis of solitary skeletal lesions and resulted in significantly fewer equivocal findings.

Objective: To investigate the usefulness and effectiveness of multi-slice spiral computerized tomographic fistulography (MSCTF) in the diagnosis and treatment of congenital fistula of neck. Methods: Thirty-four patients with thyroglossal fistulasor branchial cleft fistulas who were initial treated from July 2008 to August 2015 in Fujian Provincial Hospital were retrospectively analyses. Thirteen males and 21 females patients aging from 3 to 46 years old with a median age of 37 were included. There were thyroglossal fistula in 6 cases, the first branchialcleft fistula in 9 cases, the second branchialcleft fistula in 3 cases, the third branchialcleft fistula in 9 cases, and the fourth branchialcleft fistula in 7 cases. All the patients underwent preopeative MSCTF and the diagnoses were finally confirmed with surgery and histopathology. Multiplanar reconstruction(MPR), maximumintensity projection(MIP)and volume rendering(VR) were completed with AW Volume Share 4.2 image processing software after initial CT scanning.The internal openings, distribution, and neighboring relationship of the fistulas showed by MSCTF were analyzed and the surgical strategies were subsequently made. Results: Except 2 cases, 32 patients had obtained successfully MSCTF image. The presence and location of the fistulas could be showed clearly on MSCTF. Based on the results of MSCTF examination, the surgical planes to treat the fistulas were made. The fistulas in all cases were successfully found and excised. Three cases underwent selective neck dissection. Postoperative infection occurred in 1 case. Unilateral vocal fold paralysis due to surgery recovered 3 months after surgery with follow-up. One case lost follow-up, the remaining 33 cases were followed up for 13-97 months with no the fistula recurrence. Conclusions: MSCTF could provide valuable information and benefit surgical planning by demonstrating the coursesof congenital fistulas of neck in detail.

Background To date, there has been no computed tomography (CT) evaluation of adenovirus pneumonia in a large number of immunocompetent patients. Purpose To describe the thin-section CT findings of immunocompetent patients with adenovirus pneumonia. Material and Methods We prospectively enrolled 104 patients with adenovirus pneumonia from a military hospital. CT scans of each patient were retrospectively and independently assessed by two radiologists for the presence of abnormalities, laterality and zonal predominance of the parenchymal abnormalities, and dominant imaging patterns and their anatomic distributions. Results CT findings included consolidation (n = 92), ground-glass opacity (GGO; n = 82), septal thickening (n = 34), nodules (n = 46), bronchial wall thickening (n = 32), pleural effusion (n = 16), and lymphadenopathy (n = 3). Eighty-four patients (81%) exhibited unilateral parenchymal abnormalities and 57 (57%) exhibited lower lung zone abnormalities. The most frequently dominant CT pattern was consolidation with surrounding GGO (n = 50), with subpleural (70%) and peribronchovascular (94%) distributions. Consolidation-the second-most common pattern (n = 33)-also exhibited subpleural (79%) and peribronchovascular (97%) distributions. The dominant nodule pattern (n = 14) exhibited mixed (64%) and peribronchovascular (100%) distributions. A dominant GGO pattern was only observed in four patients; none had central distribution. Conclusion Although the manifestations of adenovirus pneumonia on CT are varied, we found the most frequent pattern was consolidation with or without surrounding GGO, with subpleural and peribronchovascular distributions. Parenchymal abnormalities were predominantly unilateral and located in the lower lung zone. If dominant consolidation findings are present in immunocompetent patients during the early stages, adenovirus pneumonia should be considered.

Objective: Testing the hypothesis that CT airway measurements could be influenced by total lung capacity (TLC), gender and height in normal individuals., Methods: In this ethics committee-approved prospective trial, 87 healthy never-smoking volunteers who provided written informed consent were included. From a helical CT scan of the chest, the wall thickness (WT) and the lumen area were twice measured in the third- and fourth-generation airways by three readers using a dedicated software. In addition, the TLC was also measured using CT (TLC CT ). The percentage of airway area occupied by the wall (WA%) and the square root of wall area at an internal perimeter of 10 mm (√WAPi10) were calculated. CT airway measurements were compared between genders by using a mixed linear model. The correlations between height, TLC CT and CT airway measurements were tested by using a Pearson correlation analysis. These correlations were arbitrarily considered as significant if there was a significant correlation observed for each of the six measurement sessions., Results: √WAPi10, WT 3rd and WT 4th were significantly different between genders. For both genders, there was no significant correlation between any airway measurements and TLC CT . In females only, WT 3rd and WT 4th were significantly and negatively correlated with height., Conclusion: √WAPi10, WT 3rd and WT 4th are different in males and females. WT 3rd and WT 4th are correlated with height in females only but not with TLC or in males. Advances in knowledge: CT airway measurements are influenced by gender and by height in females only but not by TLC. They should be adjusted according to gender and height in females.

Objective: This study aimed to evaluate easily available computed tomography (CT)-based parameters for assessing the presence and severity of cirrhosis and predicting complications in Chinese patients with cirrhosis., Methods: CT-based morphological indices were determined in 167 patients with cirrhosis and 244 healthy volunteers. The correlation of morphological indices with Child-Pugh score and cirrhotic complications was analyzed using Spearman's correlation analysis. The area under the receiver operating characteristic curve (AUROC) was used to analyze the diagnostic performance of the indices. Sensitivity and specificity were determined., Results: Patients with cirrhosis had a lower total liver volume (TLV) and a larger total splenic volume (SV) than healthy individuals. There was a significant difference in the portal venous diameter, splenic venous diameter and portal venous cross-sectional area between the two groups. A low TLV/SV ratio was strongly associated with liver cirrhosis; with a cut-off value of 4.27 for the diagnosis of cirrhosis TLV/SV had a sensitivity of 87.7% and a specificity of 84.9%, and AUROC of 0.921. Further analysis showed that TLV/SV was accurate in discriminating between mild and moderate/severe cirrhosis and could be used for predicting complications of cirrhosis., Conclusion: The easily available parameters of CT can accurately evaluate the severity of cirrhosis in Chinese patients., (© 2017 Chinese Medical Association Shanghai Branch, Chinese Society of Gastroenterology, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine and John Wiley & Sons Australia, Ltd.)

Objective: The aim of this project was to study the imaging characteristics of multi-detector CT (MDCT) in different types of malignant tumor in the common bile duct ampulla., Patients and Methods: We examined 30 cases of pancreatic head cancer, 35 of terminal cholangiocarcinoma, 26 of ampullary carcinoma, and 40 of benign lesions, all confirmed by pathology. We used 64-slice spiral CT plain scan and multi-phase enhanced scan with multi-planar reconstruction (MPR) and curved planar reconstruction (CPR) post-processing to obtain three-dimensional images. From these images, we analyzed intrahepatic and extrahepatic bile ducts, gallbladder and common bile duct dilation, and morphology and enhancement pattern of lesions and surrounding tissue., Results: The dilatation rate of intrahepatic, extrahepatic bile duct and gallbladder in terminal cholangiocarcinoma was the highest. The double duct sign was most evident in pancreatic head cancer. Ampullary carcinoma fell in between, and the benign lesions had no intrahepatic or extrahepatic bile duct and pancreatic duct dilation. Pancreatic cancer had a larger diameter, a higher internal rate of necrosis, and the surrounding tissues had a higher vulnerability to invasion. Terminal cholangiocarcinoma had a smaller diameter and a thicker wall. Benign lesions showed isodensity and hyperdensity shadow in the lumen, but no other significant changes were observed. Pancreatic head carcinoma had lower enhancement degree than normal pancreatic tissue, no enhancement in the internal necrotic area, and the borderline was unclear. Thickened ductal wall of the terminal cholangiocarcinoma showed equal density, enhancement and commonly delayed enhancement. The enhancement degree was higher than in the cancer of the pancreatic head and slightly lower than in ampullary cancer. Ampullary cancer had a regular margin and a significant enhancement, with enhancement degree higher than in pancreatic cancer and lower than in common bile duct cancer. Arterial and venous phases showed enhancement, but benign lesions did not show enhancement., Conclusions: MDCT imaging and post-processing techniques have significant application in the diagnosis of benign and malignant lesions, as well as a malignant tumor of the common bile duct ampulla.

Recent studies demonstrated that sinogram affirmed iterative reconstructions (SAFIRE) can produce higher-resolution images with greater robustness for the reduction of various imaging artefacts. Eighty-five patients were prospectively evaluated and underwent a high-pitch spiral acquisition CT scan. In-stent noise, signal-to-noise ratio(SNR), stent-lumen attenuation increase ratio (SAIR), and subjective image quality score were measured and compared between the SAFIRE and Filter back projection (FBP) reconstructions. Conventional coronary angiography served as the standard of reference. In 159 evaluated stents, SAFIRE was superior to FBP with regards to in-stent noise, SNR, SAIR, and image quality score. On per-stent analysis, SAFIRE vs. FBP reconstruction yielded 85% vs. 85%sensitivity, 89% vs. 78%specificity, 73% vs. 57%positive predictive value, 95% vs. 94%negative predictive value, and 0.87 vs. 0.82 area under curve, although these improvements did not reach statistical significance (P > 0.05). However, in the subgroup of small diameter stents (≤3 mm; n = 95), specificity(82% vs. 62%), positive predictive value(66% vs. 50%) and area under curve (0.81 vs. 0.70) improved significantly (P < 0.05) with SAFIRE. SAFIRE image reconstruction can thus improve the evaluation for ISR, especially in smaller stents.

Background: Respiration-correlated CT (4D CT) is the basis of radiotherapy treatment planning of thoracic and abdominal tumors. Current clinical 4D CT images suffer, however, from artifacts due to unfulfilled assumptions concerning breathing pattern regularity. We propose and evaluate modifications to existing low-pitch spiral 4D CT reconstruction protocols to counteract respective artifacts., Methods: The proposed advanced reconstruction (AR) approach consists of two steps that build on each other: (1) statistical analysis of the breathing signal recorded during CT data acquisition and extraction of a patient-specific reference breathing cycle for projection binning; (2) incorporation of an artifact measure into the reconstruction. 4D CT data of 30 patients were reconstructed by standard phase- and local amplitude-based reconstruction (PB, LAB) and compared with images obtained by AR. The number of artifacts was evaluated and artifact statistics correlated to breathing curve characteristics., Results: AR reduced the number of 4D CT artifacts by 31% and 27% compared to PB and LAB; the reduction was most pronounced for irregular breathing curves., Conclusions: We described a two-step optimization of low-pitch spiral 4D CT reconstruction to reduce artifacts in the presence of breathing irregularity and illustrated that the modifications to existing reconstruction solutions are effective in terms of artifact reduction.

Objectives: To determine whether washout characteristics of dynamic contrast-enhanced computed tomography (CT) could predict survival in patients with extrahepatic cholangiocarcinoma (EHC)., Methods: This study collected 46 resected cases. All cases were examined by dynamic contrast study on multidetector-row CT. Region-of-interest measurements were obtained at the non-enhanced, portal venous phase and delayed phase in the tumour and were used to calculate the washout ratio as follows: [(attenuation value at portal venous phase CT - attenuation value at delayed enhanced CT)/(attenuation value at portal venous phase CT - attenuation value at unenhanced CT)] × 100. On the basis of the median washout ratio, we classified the cases into two groups, a high-washout group and low-washout group. Associations between overall survival and various factors including washout rates were analysed., Results: The median washout ratio was 29.4 %. Univariate analysis revealed that a lower washout ratio, venous invasion, lymphatic permeation and lymph node metastasis were associated with shorter survival. Multivariate analysis identified the lower washout ratio as an independent prognostic factor (hazard ratio, 3.768; p value, 0.027)., Conclusions: The washout ratio obtained from the contrast-enhanced CT may be a useful imaging biomarker for the prediction of survival of patients with EHC., Key Points: • Dynamic contrast study can evaluate the aggressiveness of extrahepatic cholangiocarcinoma. • A lower washout ratio was an independent prognostic factor for overall survival. • CT can predict survival and inform decisions on surgical options or chemotherapy.

Purpose The purpose of this article is to assess the diagnostic performance of computed tomography (CT) reformatted images for detection of superior semicircular canal (SSC) dehiscence. Material and methods Forty-two patients, with sound- and/or pressure-induced vestibular symptoms, and 42 control participants underwent helical CT examination with a highly collimated beam (0.5 mm). Reformatted images of the vestibular labyrinth were obtained in the standard axial and coronal planes (group A images), and in a plane parallel and perpendicular to the SSC (group B images). Diagnostic performance obtained by evaluating the group A images alone and the group B images alone was analyzed by using the area under the receiver operating characteristic curve (AUC). Results The diagnostic performance of group A images was AUC = 0.929 with an overall accuracy of 92.9%. The diagnostic performance of group B images was AUC = 0.988 with an overall accuracy of 98.8%. The evaluation of group B images alone showed an improved diagnostic performance over the group A images alone. Conclusion Thin-section 0.5-mm collimation CT with reformatted images oriented in the plane parallel and perpendicular to the SSC improves diagnostic accuracy in assessing for SSC dehiscence in comparison to CT images with reconstructions limited to traditional axial and coronal planes.

Recurrent respiratory papillomatosis (RRP) is a benign disease of the upper aero-digestive tract caused by human papillomavirus (HPV) infection, which affects children and young adults. The aim of this review is to describe the main etiological, epidemiological, clinical, diagnostic, and treatment aspects of RRP. Most infections in children occur at birth, during passage through the birth canals of contaminated mothers. In adults, HPV is transmitted sexually. Papillomas usually appear as exophytic nodules, primarily in the larynx, but occasionally involving the nasopharynx, tracheobronchial tree, and pulmonary parenchyma. The disease course is unpredictable, ranging from spontaneous remission to aggressive persistent or recurrent disease. Although it occurs rarely, RRP has the potential for malignant transformation to squamous cell carcinoma. Clinically, RRP usually presents with nonspecific symptoms of airway involvement, including chronic cough, hoarseness, wheezing, voice change, stridor, and chronic dyspnea. Helical computed tomography (CT) is highly accurate for the identification and characterization of focal or diffuse airway narrowing caused by nodular vegetant lesions. The typical CT pattern of lung papillomatosis consists of numerous multilobulated nodular lesions of various sizes, frequently cavitated, scattered throughout the lungs. Bronchoscopy is the most reliable method for the diagnosis of RRP; it enables direct visualization of lesions in the central airways and collection of biopsy samples for histopathological diagnosis, and is also useful for therapeutic planning. The definitive diagnosis of RRP is based on histopathological analysis. Currently, no definitive curative treatment for RRP is available; despite the availability of adjunctive treatments, surgery remains the mainstay of treatment., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Objectives: To evaluate the effectiveness of CT before TAVI using variable helical pitch (VHP) scanning and its diagnostic performance for coronary artery disease (CAD)., Methods: Sixty patients (84.4 ± 4.6 years) scheduled for TAVI underwent CT using VHP scanning with the contrast material (CM) volume calculated as scanning time × weight [kg] × 0.06 mL. Retrospective electrocardiography (ECG)-gated scanning was utilized to examine the thorax, and non-ECG-gated scanning of the abdomen immediately followed. We analyzed CT attenuation values of the coronary arteries, aorta, iliac and femoral arteries. The coronary CT angiography images were evaluated for the presence of stenosis (≥50 %); invasive coronary angiography served as a reference standard., Results: The average attenuations of all of the arteries were greater than 400 HU. We could evaluate the peripheral access vessels and dimensions of the ascending aorta, aortic root, and aortic annulus in all patients. The average volume of CM was 38.7 ± 8.5 mL. On per-patient and vessel analysis, CT showed 91.7 % and 89.5 % sensitivity, and 91.3 % and 97.4 % negative predictive value (NPV)., Conclusions: CT using VHP scanning with an average CM volume of 38.7 mL is useful before TAVI and had a high sensitivity and NPV in excluding obstructive CAD., Key Points: • TAVI-planning CT using variable helical pitch (VHP) scanning is useful. • The average volume of contrast material was 38.7 ± 8.5 mL. • The average attenuations of all the arteries were >400 HU. • This CT had a high sensitivity and NPV for excluding obstructive CAD.

Rationale and Objectives: Intraductal papillary mucinous neoplasms (IPMNs) are precancerous lesions of the pancreas. Computed tomography (CT) has been recommended to screen the malignant potential of IPMNs. However, data evaluating the use of CT to differentiate categories of IPMN based on disease progression are limited. This study aimed to explore the correlation between CT characteristics and pathology in IPMN associated with invasive carcinoma., Materials and Methods: A total of 31 patients with intraductal papillary mucinous carcinoma (IPMC) treated at one local regional hospital in Shanghai, China, were enrolled in this study. Patients were divided into two groups based on invasion component and characterized as follows: group A, an invasive component of less than 50% (IPMC-I); and group B, with invasion of 50% or greater and defined as pancreatic ductal adenocarcinoma associated with IPMN (PDAC-IPMN). First, we analyzed the imaging information of the 31 patients retrospectively. Then, we compared the imaging differences between the two groups., Results: Fifteen patients with IPMC-1 and 16 patients with PDAC-IPMN were identified. There was no statistically significant difference in sex, age, lesion location, radiologic type, tumor size, mural nodule size, and lymphatic metastasis between the two groups. However, the arterial increased CT values were significantly different between the two groups (P < .01), with values of 29.2 ± 12.4 HU for group A and 14.2 ± 8.8 HU for group B. The venous increased CT values were 44.6 ± 12.0 HU for group A and 28.4 ± 12.3 HU for group B, and these were significantly different between the two groups (P < .01). In group A, 13 cases (86.7%) were classified as T1 or T2 stage, and in group B, eight cases (50.0%) were classified as T1 and T2 stage. There was a statistically significant difference in tumor classification between group A and group B patients (P < .05)., Conclusions: IPMC-I and PDAC-IPMN have different characteristics in CT imaging, and we demonstrated that CT scans based on blood supply and lymphatic metastasis could be used to evaluate and potentially screen for variation in IPMC disease outcomes., (Copyright © 2017 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.)

Purpose: To investigate the feasibility of perfusion-CT (p-CT) measurements in quantitative assessment of hemodynamic changes related to sorafenib in patients with advanced hepatocellular carcinoma (HCC)., Materials and Methods: Twenty-two patients with advanced HCC underwent p-CT study (256-MDCT scanner) before and 2 months after sorafenib administration. Dedicated perfusion software generated a quantitative map of arterial and portal perfusion and calculated the following perfusion parameters in target liver lesion: hepatic perfusion (HP), time-to-peak (TTP), blood volume (BV), arterial perfusion (AP), and hepatic perfusion index (HPI). After the follow-up scan, patients were categorized as responders and non-responders, according to mRECIST. Perfusion values were analyzed and compared in HCC lesions and in the cirrhotic parenchyma (n=22), such as between baseline and follow-up in progressors and non-progressors., Results: Before treatment, all mean perfusion values were significantly higher in HCC lesions than in the cirrhotic parenchyma (HP 47.8±17.2 vs 13.3±6.3mL/s per 100g; AP 47.9±18.1 vs 12.9±10.7mL/s; p<0.001). The group that responded to sorafenib (n=17) showed a significant reduction of values in HCC target lesions after therapy (HP 29.2±23.3 vs 48.1±15.1; AP 29.4±24.6 vs 49.2±17.4; p<0.01), in comparison with the non-responder group (n=5) that demonstrated no significant variation before and after treatment of HP (46.9±25.1 vs 46.7±24.1) and AP (43.4±21.7 vs 43.5±24.6). Among the responder group, HP percentage variation (Δ) in target lesions, during treatment, showed a significantly different (p=0.04) ΔHP in the group with complete response (79%) compared to the group with partial response or stable disease (16%)., Conclusions: p-CT technique can be used for HCC quantitative assessment of changes related to anti-angiogenic therapy. Identification of response predictors might help clinicians in selection of patients who may benefit from targeted-therapy allowing for optimization of individualized treatment., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Objective To define relationships between the frontal sinus opening, ostia of other frontal recess cells, and endoscopic landmarks and to develop a clinically useful framework to guide frontal sinus surgery. Study Design Retrospective review. Setting Tertiary care academic referral center. Methods Adult patients with computed tomography (CT) without sinonasal pathology were included. Virtual endoscopy (using OsiriX) and corresponding CT reconstructions were used to identify all visible ostia in the frontal recess and characterize their positions in spaces between the uncinate/agger nasi (U), bulla ethmoidalis (EB), and middle turbinate (MT). Results Two hundred sides in 100 patients (median age 51 years, 62% female) were analyzed. The "center" of each map was defined as the intersection of spaces between U, EB, and MT. The frontal sinus opening was in the "center" in 53% of frontal recesses, lateral to this position in 29%, and anterior in 11%. When the frontal sinus opening was at the "center," anterior ostia drained frontal Kuhn T cells in 51% and intersinus septal cells in 23%. The skull base attachment of the apical strut of the uncinate process demarcated medial and lateral within the space between U and EB, with the opening to the frontal sinus medial in 68% and lateral in 31%. Left-right asymmetry in frontal sinus openings was noted in 46% of patients. Conclusion Combining preoperative imaging and knowledge of these anatomic relationships may facilitate more efficient frontal outflow tract identification and instrumentation. This represents the first and largest description of ostial configurations relative to endoscopic structural landmarks., Level of Evidence: 4.

Objective: To measure the inner diameter of tracheal(TD) in Chinese adults by multi-slice spiral CT(MSCT), multi-planar reconstruction(MPR) with special window technique and analyze its influencing factors. Methods: A total of 824 normal adults(male 435, female 389) and 16 patients with small peripheral pulmonary nodules(SPN) receiving chest multi-slice spiral CT (MSCT) in the physical examination at the First Affiliated Hospital of Guangzhou Medical University between January, 2014 and December, 2015 were included and their records were retrospectively analyzed. The 16 patients with SPN received bronchoscopy and the images were recorded followed by measurement of tracheal diameter using software. MSCT and MPR images were obtained by the 3Dview software, and the inner diameter of the trachea at 4 horizontal positions were measured by special window technique (window width 500 Hu, window level 100 Hu): thoracic entrance (TD(1)), aortic arch (TD(2)), 2 cm higher than the carina of trachea (TD(3)) and the narrowest trachea (TD(4)). Results: The results of bronchoscopy and software measurement in 16 patients were consistent with those of MSCT and MPR combined with special window technique ( P >0.05). The TD at 4 positions in adult males were larger than those of adult females ( P <0.01). The TD values at each position for males and females were as follows: (18.9±1.7) and (15.6±1.3) mm ( t =30.9, P <0.01) for TD(1), (18.8±1.6) and (16.1±1.2) mm ( t =28.0, P <0.01) for TD(2), (19.0±1.6) and (16.3±1.3) mm ( t =26.5, P <0.01) for TD(3), (18.4±1.5) and (15.5±1.1) mm ( t =31.3, P <0.01) for TD(4), respectively. The age, weight and BMI were not significantly correlated with the tracheal diameter ( P >0.05). The height was linearly correlated with the tracheal diameter: for males, TD(1)=0.071× height (cm) + 6.964 ( r =0.249, P <0.05), TD(2)=0.064 × height (cm) + 7.898 ( r =0.246, P <0.05), TD(3)=0.074 × height (cm) + 6.533 ( r =0.279, P <0.05), TD(4)=0.056 × height(cm) + 8.811( r =0.226, P <0.05); while for females, TD(1)= 0.046× height (cm) + 8.331 ( r =0.183, P <0.05), TD(2) = 0.058 × height (cm)+ 6.950( r =0.248, P <0.05), TD(3)=0.059 × height (cm)+ 7.052 ( r =0.235, P <0.05), TD(4) =0.044× height (cm) + 8.520 ( r =0.208, P <0.05). Conclusion: MSCT and MPR combined with special window technique are accurate and feasible for the measurement of adult tracheal diameter. The diameter of the trachea in males is larger than that in females, and it is positively correlated with height, but not with age, body weight and BMI. The tracheal diameter can be evaluated by linear regression equation.

Purpose: The aim of this study was to measure and characterize breathing-induced motion artifacts in fast helical free-breathing CT scans., Methods: Ten lung cancer patients were scanned using fast helical CT during free breathing. In each case, 25 low-dose CT scans were acquired in alternating craniocaudal and caudocranial directions. A bellow-based breathing surrogate was simultaneously acquired. A published breathing motion model was used to estimate the diaphragm craniodaudal velocity at each CT scan. The Hounsfield unit (HU) profiles passing through a small square (7 × 7 mm 2 ) portion of the diaphragm were examined and fit to error functions, which were used to characterize the motion blur. The HU profiles that intersected diaphragm-adjacent non-parenchymal tissue were excluded from analysis. The five profiles for each scan that were best isolated from non-parenchymal tissue were used to determine the amount of blurring. A convolution-based blurring model was also employed to compare against the human data., Results: There was a distinct relationship between blurring and diaphragm speed. The convolution model well described the blurring behavior in the patients. Most of the CT scans were acquired at tissue velocities less than 20 mm s -1 , which was the threshold where blurring exceeded 1 mm (corresponding to the slice spacing in this study)., Conclusions: Breathing motion-induced blurring occurs even for relatively fast modern helical CT scans. Measurable motion-induced blurring occurs for velocities greater than 15 mm s -1 and greater than 1 mm for velocities greater than 20 mm s -1 . Methods to manage the residual blurring artifacts will need to be developed to maximize the image quality for free-breathing CT protocols., (© 2017 American Association of Physicists in Medicine.)

Objective: Images of temporal bone are obtained on Siemens 64 slices spiral CT scanner with high resolution scanning to describe the course of facial nerve for better preoperative evaluation of CAEMA. Method: To describe the course of facial nerve on rectangular coordinate system from three silce on HRCT, 29 patients(35 ears) are enrolled in our study in ENT department from November 2005 to March 2007 in the second affiliated hospital of sun yan sen university, who are all diagnosed not acquired deformity but CAEME, associated with no congenital deformity syndromes and no middle ear or mastoid operations before. Patients with bilateral ears deformity are 6, and unilateral ears deformity are 23 (13 right and 10 left) in the study group. The control group is the normal ears of unilateral ear deformity. Result: In the study group, the shortest distance from FN tympanic segment to oval window is shorter than that of the normal group ( P < 0.05). In CAEME of unilateral ears the FN mastoid segment displaces anteriorly about 2.7 mm, and in CAEME of bilateral ears displaces 3.0mm, compared with the normal ears ( P < 0.05). The deformity degree of auricle has correlations with anteriorly displacement of facial nerve mastoid segment ( P < 0.05). Conclusion: The FN mastoid segment is anteriorly displacement in both bilateral and unilateral ear deformity. The deformity degree of auricle has correlations with anteriorly displacement of facial nerve mastoid segment. The lateral displacement of facial nerve doesn't occur usually in CAEME. The shortest distance between oval window and tympanic segment of FN become shorter than normal ears., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.)

Objectives: Radiographs are often performed to assess pelvic and hip parameters, but results depend upon correct pelvis positioning. Three-dimensional (3D) reconstruction from biplanar-radiographs should provide parameters that are less sensitive to pelvic orientation, but this remained to be evaluated., Methods: Computerized-tomographic scans of six patients were used both as a reference and for generating simulated frontal and lateral radiographs. These simulated radiographs were generated while introducing axial rotations of the pelvis ranging from 0° to 20°. Simulated biplanar-radiographs were utilized by four operators, three times each, to perform pelvic 3D-reconstructions. These reconstructions were used to assess the trueness, precision and global uncertainty of radiological pelvic and hip parameters for each position., Results: In the neutral position, global uncertainty ranged between ± 2° for pelvic tilt and ± 9° for acetabular posterior sector angle and was mainly related to precision errors (ranging from 1.5° to 7°). With increasing axial rotation, global uncertainty increased and ranged between ± 5° for pelvic tilt and ± 11° for pelvic incidence, sacral slope and acetabular anterior sector angle, mainly due to precision errors., Conclusion: Radiological parameters obtained from 3D-reconstructions, based on biplanar-radiographs, are less sensitive to axial rotation compared to plain radiographs. However, the axial rotation should nonetheless not exceed 10°., Key Points: • Pelvic radiological parameters could be affected by patient malpositioning. • Biplanar radiograph-based 3D reconstructions were performed at increments of axial rotation. • Trueness, precision and global uncertainty were evaluated for pelvic and hip radiological parameters. • Hip parameters were less affected by rotation compared to pelvic parameters. • Maintaining the pelvis close to the neutral position is recommended to ensure the highest possible accuracy.

Objective: This study aims to use perfusion computed tomography to compare pancreatic perfusion in mild acute pancreatitis (MAP) versus normal pancreas., Methods: This observational study included 39 patients with MAP and 18 patients with normal pancreatic function. Perfusion computed tomography parameters, including blood flow (BF), blood volume (BV), mean transit time, and permeability surface area product, were compared., Results: Both serum and urinary amylase levels were significantly higher in patients with MAP than in controls (all Ps < 0.05). Patients with MAP showed significantly lower BF and BV and higher mean transit time and permeability surface area product than the controls (all Ps < 0.05). Correlation analysis on the 39 patients with MAP revealed negative coefficients between serum amylase level and BF and BV values., Conclusions: Pancreatic perfusion seems to be poorer, and pancreatic vascular leakage may increase in MAP compared with normally functioned pancreas.

Objective: The aim of this study was to investigate the efficacy of lesion-oriented whole-liver computed tomography (CT) perfusion for predicting transarterial chemoembolization early treatment response in patients with hepatocellular carcinoma (HCC)., Methods: Volume helical shuttle CT perfusion imaging on the whole liver was prospectively performed on 39 patients with 46 independent HCC lesions before target-selected chemoembolization. The therapeutic effects were assessed: responder group included lesions with a complete and partial response, whereas the nonresponder group contained stable and progressive disease. The perfusion parameter value comparison between 2 groups and receiver operating characteristic analyses were performed., Results: The responders demonstrated higher hepatic arterial perfusion (HAP) and hepatic arterial perfusion index (HAPI) and lower hepatic portal perfusion (HPP) compared with the nonresponders among the 34 lesions without Vp3 or Vp4 portal vein thrombosis. In addition, HAP and HAPI had good prognostic values., Conclusions: Whole-liver CT perfusion allows for hemodynamic evaluation of HCC lesions. The HAP, HAPI, and hepatic portal perfusion values may be useful predictors of short-term therapeutic response after transarterial chemoembolization.

Objective: To evaluate treatment outcomes and patterns of CT lung injury after hypofractionated image-guided radiotherapy delivered with helical tomotherapy (HHT) in a series of inoperable lung lesions., Methods: 68 patients who were medically inoperable (69 lesions) without evidence of viable extrathoracic disease were included. Dose prescription was driven by tumour location (hilar/pericentral vs peripheral) and/or target volume. 52% of the lesions received a biological equivalent dose (BED 10 ) ≥100 Gy. Assessment of tumour response was based on the Response Evaluation Criteria in Solid Tumours 1.1 criteria coupled with fluorine-18 fludeoxyglucose/positron emission tomography-CT. Toxicity monitoring was focused on treatment-related pulmonary adverse events according to the Common Terminology Criteria for Adverse Events v. 4.0. Acute and late events were classified as radiation pneumonitis (RP) and radiation fibrosis (RF), respectively. Survival curves were calculated using the Kaplan-Meier method. Univariate and multivariate analyses of survival were performed using the Cox proportional hazards model., Results: After a median follow-up of 12 months (range, 3-31 months), no instances of ≥Grade 4 RP was documented, and clinically severe (Grade 3) RP occurred in 5.8% of the patients. 2 (3%) patients developed a late severe (≥Grade 3) symptomatic RF. No specific pattern of CT lung injury was demonstrated, in both acute and late settings. Median overall survival (OS) and progression-free survival (PFS) for the entire population were 30.8 and 14.1 months, respectively. At multivariate analysis (MVA), BED 10  ≥ 100 Gy and KPS ≥ 90 emerged as significant prognostic factors for OS (p = 0.01 and p = 0.001, respectively), and BED 10  ≥ 100 Gy for PFS (p = 0.02)., Conclusion: Our findings show that HHT adjusted for tumour location and/or target volume is an effective treatment with an acceptable toxicity profile in patients who are medically inoperable with lung tumours and is not associated with a specific pattern of lung injury. Therefore, it can represent a viable option when conventional stereotactic ablative radiotherapy facilities are not available. Advances in knowledge: The present study is among the largest series addressing the role of HHT for inoperable lung tumours. This technique is safe and effective and is not associated with a specific pattern of lung injury, at least at early and average time points.

Competing Interests: Conflicts of Interest: None declared.

Objective: To analyze the possibilities of standard and additional methods for X-ray mammography (MG) in the comprehensive diagnosis of nonpalpable breast masses and preclinical cancers; to identify the important radiological signs of malignancy as predictors for the application of multislice spiral computed tomography/ magnetic resonance imaging (MSCT/MRI-MG), as well as invasive studies in premenopausal women., Material and Methods: The investigation enrolled 423 pre-menopausal patients with nonpalpable breast masses; 129 women were found to have breast cancer. The diagnosis was verified by comprehensive clinical and instrumental examination using standard and additional methods for X-ray mammography, ultra-sonography, MRI, MSCT of the breast and biopsy. Significant radiological signs of malignancy of the lesions were detected and their diagnostic value was identified., Results: The use of additional diagnostic techniques for mammography contributes to the confident visualization of important radiological criteria for malignancy, enhances the informative value of by 5%, and promotes a decline in the number of unjustified biopsies by 11%., Conclusion: Problems in visualizing and categorizing nonpalpable breast masses necessitate additional diagnostic techniques for X-ray mammography. The identification and confident interpretation of important radiological criteria for benign or malignant lesions increase the diagnostic value of X-ray mammography: the sensitivity from 91% to 98%, specificity from 61% to 75%. MSCT-MG and MRI-MG demonstrate even higher efficiency: contrast-enhanced (CE) MSCT–MG (100% sensitivity, 99% specificity) and CE MRI–MG (100% sensitivity, 98% specificity). Sequential radiological and morphological studies improve the quality and efficiency of diagnosis of nonpalpable breast cancer.

Purpose: To directly compare the capability of dynamic first-pass contrast-enhanced (CE-) perfusion area-detector CT (ADCT) and PET/CT for early prediction of treatment response, disease progression and overall survival of non-small cell carcinoma (NSCLC) patients treated with chemoradiotherapy., Materials and Methods: Fifty-three consecutive Stage IIIB NSCLC patients who had undergone PET/CT, dynamic first-pass CE-perfusion ADCT, chemoradiotherapy, and follow-up examination were enrolled in this study. They were divided into two groups: 1) complete or partial response (CR+PR) and 2) stable or progressive disease (SD+PD). Pulmonary arterial and systemic arterial perfusions and total perfusion were assessed at targeted lesions with the dual-input maximum slope method, permeability surface and distribution volume with the Patlak plot method, tumor perfusion with the single-input maximum slope method, and SUV max , and results were averaged to determine final values for each patient. Next, step-wise regression analysis was used to determine which indices were the most useful for predicting therapeutic effect. Finally, overall survival of responders and non-responders assessed by using the indices that had a significant effect on prediction of therapeutic outcome was statistically compared., Results: The step-wise regression test showed that therapeutic effect (r 2 =0.63, p=0.01) was significantly affected by the following three factors in order of magnitude of impact: systemic arterial perfusion, total perfusion, and SUV max . Mean overall survival showed a significant difference for total perfusion (p=0.003) and systemic arterial perfusion (p=0.04)., Conclusion: Dynamic first-pass CE-perfusion ADCT as well as PET/CT are useful for treatment response prediction in NSCLC patients treated with chemoradiotherapy., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

The authors consider in brief epidemiology, diagnostics, and variants of the surgical treatment of the rare clinical condition pneumocele and pneumoencephalocele of the temporal bone. Diagnostic and surgical modalities for the management of multiple pneumocele associated with temporal bone hyperpneumatization are discussed.

Objective of this study is to present and test a new method for metal artifact reduction (MAR) by segmenting raw CT data (sinogram). The artifact suppression technique incorporates two steps namely, metal projection segmentation in the sinogram and replacement of segmented regions by new values using an interpolation method. The proposed segmentation algorithm uses the sinogram instead of reconstructed CT slices. First, one of the best and newest region-based geometric active contour models is used to detect projection data affected by metal objects (missing projections). Then, the Hough-transform method is applied to detect all sinusoidal-like curves belonging to metal objects. Finally, a post image processing technique is used aiming to increase accuracy of the segmentation process. To provide a proof of performance, CT data of two patients with metallic teeth filling and pelvis prosthesis were included in the study as well as CT data of a phantom with metallic teeth inserts. Accuracy was determined by comparing mean, variance, mean squared error (MSE) and, peak signal to noise ratio (PSNR) as evaluation measurements of distortion in phantom images with respect to metallic teeth (original and suppressed) and without metallic teeth inserts. Quantitative results showed an average improvement of 12 dB in terms of PSNR and 517 in terms of MSE when the new MAR method was applied to remove metal artifacts. Qualitative improvement was also assessed by comparing uncorrected clinical images with artifact suppressed images. Moreover, qualitative comparison of the results of the proposed new method with the existing methods of MAR showed the superiority of the new method tested in this study.

Objective: To compare a radiation dose obtained during standard digital radiography, tomosynthesis, and multislice spiral computed tomography (MSCT)., Material and Methods: Life-size full body pediatric anthropomorphic mannequin phantom was examined with a Fujifilm FDR Ac Selerate 200 X-ray diagnostic apparatus and a Toshiba Aquilion Prime 64 computed scanner using the Piranha dosimetry equipment, as well as Gammex planar target, for comparison of the resolution of the apparatus. The effective radiation doses were calculated for different anatomical regions with the formulas specified in the methodical instructions, using the coefficients K and Kd., Results: The tables and graphs comparing the radiation dose when using different radiation diagnostic techniques were presented. The resolution of standard digital radiography versus that of tomosynthesis was analyzed. Fluctuations of the doses obtained were associated with the difference in the volume of irradiated tissue and in the presence of the doses in the irradiated volume of organs with high radiosensitivity. Optimal physical and technical parameters of photography were proposed, which could reduce a dose load on the patient, without significantly losing the quality of films., Conclusion: The effective doses of tomosynthesis were significantly higher than those of standard digital radiography (p < 0.05) while those of (MSCT) were above those of both X-ray and tomosynthesis, and the resolution of the latter was slightly lower.

After the discovery of skeletonized human remains, the estimation of stature is an important element of the so-called "biological profile". Typically, long bone lengths are used in regression formulas. If long bones are not available, predictions of stature cannot be made. Human skulls are often the subject of forensic osteological examination, sometimes even detached. Therefore, it seems reasonable to search for skull measurements that have a sufficiently good correlation to stature. The aim of the study presented was to measure odonto-stomatological parameters using post-mortem CT data to check whether the esti- mation of stature was possible on this basis. Three classic tooth dimensions (MD, BL, ZL), two diagonal tooth dimensions (MBDL, DBML) first described by Lund and Mörnstad in 1999, two tooth dimensions defined for the first time in this study (MKDO, DKMO), the mesiodistal index (MDS) and also the palatal arch dimensions (arch length, arch width, molar length and dental length) - each at maxilla and mandible - were digitally measured on a total of 799 teeth of 48 virtual 3-D-reconstructed skulls (33 males and 15 females). For most of the aforementioned measurements no statistically significant relation to stature was found. There were positive correlations by Pearson at a significance level of 99 % (2-sided) at three measurements: ZL 15, MKDO 14 and MKDO 15. Positive correlations by Pearson at a significance level of 95 % (2-sided) could be determined for eight measurements, but an applicable regression formula could not be calculated for any of the parameters. Despite a statistical correlation of a few teeth parameters with body length, they must be considered unsuitable for estimating stature.

The paper considers the main provisions of the 2009 RECIST guidelines (version 1.1.) criteria for a standard approach to measuring lung tumor lesions and assessing the dynamics of the tumor process during treatment. This paper contains a list of conditions for carrying out multislice spiral computed tomography, under which the latter becomes maximally reproducible for the same patient, as well as an assessment of the course of the disease does optimal.

This article reports a rare observation of the development of chronic polypous pansinusitis with deformation of the external nose in a 8 year-old child presenting with primary ciliary dyskinesia syndrome. The patient underwent multiple surgical interventions in the preceding period. The key argument in favour of the definitive diagnosis was the results of investigation of ciliated epithelium biopsy taken from the nasal cavity and bronchi in combination with the data obtained by diagnostic endoscopy of the nasal cavity and nasopharynx supplemented by computed tomography. The proposed treatment strategy including endoscopic endonasal pansinusotomy, antibacterial therapy taking into consideration the sensitivity of the seeded microorganism, and hormonal therapy proved optimal for the management of the given patient.

Aim: To investigate whether intravenous contrast-enhanced multislice spiral computed tomography (computed tomography) (MSCT) versus myocardial morphological examination can diagnose myocarditis and the non-inflammatory causes of dilated cardiomyopathy (DCM) and evaluate prognosis in patients with the latter., Subjects and Methods: A study group consisted of 130 patients, including 95 men (46.8±11.9 years), with DCM (mean left ventricular (LV) end-diastolic dimension (EDD), 6.6±0.8 cm; mean LV ejection fraction (EF), 29.8±9.3%; NYHA functional class (FC) III (II; III)). All the patients underwent intravenous contrast-enhanced 320-slice CT of the heart; myocardial morphological examination was made in 48 patients (endomyocardial biopsy in 29 patients, intraoperative biopsy in 7, and autopsy in 9, and study of the explanted heart in 3). In addition, cardiotropic viral DNA in the blood and myocardium and the level of anticardiolipin antibodies were determined; echocardiography (in all the patients), scintigraphy (n = 45), magnetic resonance imaging (MRI) (n = 21), and coronary angiography (CG) (n = 46), and a genetic consultation were performed. A comparison group comprised 20 patients, including 14 men (69.3±9.2 years), with coronary atherosclerosis (40% or more stenoses) according to MSCT findings in the absence of criteria for DCM (mean LV EDD, 4.8±0.5 cm; mean LV EF, 59.4±4.6%)., Results: Morphological/comprehensive examination showed that myocarditis as a cause of DCM was diagnosed in 76 (65%) patients; its concurrence with genetic cardiomyopathies was in 17 more patients (17%). MSCT of the heart revealed lower accumulation areas in 2 (1.5%) patients (type 1 based on the proposed rating scale), delayed myocardial contrast agent accumulation (DMCAA) in 81 (62.3%): subendocardial accumulation (type 2) in 8, intramyocardial accumulation in 4 (type 3), subepicardial accumulation in 52 (type 4), and transmural accumulation in 15 (type 5); DMCAA was not noted in 49 patients. DMCAA was not found in the comparison group. As compared with biopsy, the sensitivity, specificity, predictive value of positive and negative results of the tests in detecting active myocarditis for all the types of DMCAA were 77.4, 47.1, 72.7, and 53.3%, respectively; those for types 3-5 of DMCAA were 77.4, 52.9, 75.0, and 56.3%; those in detecting all the morphological types of myocarditis were 68.3, 28.6, 84.8, and 13.3%, and those for types 3-5 were 65.9, 28.6, 84.4, and 12.5%, respectively. Comparison of the data of MSCT and those of comprehensive examination in all the patients with DCM, the diagnostic significance in detecting myocarditis for all the types of DMCAA was 70.6, 67.9, 88.9 and 38.8%, respectively; that for DMCAA types 3-5 was 60.8, 67.9, 87.3, and 32.3%. In the study group, MSCT also identified the non-compacted myocardium (n = 31 (23.8%)), coronary atherosclerosis (n = 31 (23%)), which is confirmed by CG findings in 15 patients. The patients with DMCAA significantly more frequently showed a relationship with previous infection, acute onset, significantly higher NYHA FCs, end-diastolic and end-systolic LV volumes, and insignificantly lower LV EF. During a mean follow-up periods of 12 (6; 37.25) months, the overall mortality rate was 17.7% (23 deaths); the death + transplantation index was 20% (n = 26). All the types of DMCAA were found to be significantly related to prognosis: in the DMCAA group, the mortality rate was 21.5% versus 7.8% in the non-DMCAA group (odds ratio 3.22; 95% confidence interval, 1.02 to 10.21; p < 0.05)., Conclusion: MSCT with the assessment of delayed contrast enhancement (and simultaneous CT coronary angiography) can be used for the non-invasive diagnosis of myocarditis in patients with DCM, including that in the presence of contraindications to MRI. DMCAA correlates with the presence of myocarditis, its activity, the degree of functional disorders, and prognosis.

Objective: The aim of this study was to compare image quality of anatomical cardiac details without electrocardiography triggering, sedation, or heart rate-regulating drugs in contrast-enhanced pediatric chest computed tomography (CT), using high-pitch CT (HPCT) versus conventional pitch-mode technique (multidetector CT [MDCT])., Methods: After written informed consent, 55 patients (median age, 11 years; range, 3-17 years) were prospectively included in this institutional review board-approved study. Patients underwent clinically indicated, contrast-enhanced MDCT or HPCT of the chest.Image quality was assessed evaluating morphological criteria on a 3-point scale (from 1, high, to 3, low detail) and summed up in a global score (from 4, best, to 12, poor image quality). Artifacts were analyzed correspondingly (from 3, low, to 9, severe artifacts). Effective dose and size-specific dose estimate were calculated for all scans., Results: Cardiac image quality was higher in HPCT than in MDCT (7.1 [1.6] vs 8.8 [1.9], P < 0.001). Nevertheless, HPCT showed limitations in image quality, especially concerning the heart valves (2.5 [0.6] and 1.7 [0.5]) and coronary arteries (1.8 [0.6). Artifact score (3.4 [0.6 vs 5.1 [0.9, P < 0.001), effective dose (1.6 [1.3] vs 2.3 [1.6] mSv, P = 0.047), and size-specific dose estimate (2.5 [1.7] vs 4.1 [2.3] mGy, P = 0.002) were lower in HPCT compared with those in MDCT., Conclusions: In pediatric patients, contrast-enhanced HPCT of the chest provides high image quality without electrocardiography triggering or sedation, although image quality is somewhat limited for a detailed depiction of cardiac anatomy.

The authors report a clinical case of successful elimination of a recurrent juvenile angiofibroma at the base of the skull (JAFBS) with the application of the optical navigation system and a cold plasma scalpel in the absence of preoperative embolization. It has been demonstrated using the proposed transperygoid approach to the extirpation of the tumour that a recurrent juvenile angiofibroma at the base of the skull can be efficiently removed by means of a modern minimally invasive and at the same time radical surgical method.

The objective of the present study was the analysis of the health status of 20 patients presenting with histologically verified paranasal sinuses mycetomas (fungus balls) with special reference to CT-semiotics characteristic of the fungal ball as early as during the pre-verification period. The surgical strategy for the management of this condition has been substantiated. It is concluded that the final verification of the pathological process in question is possible only based on the results of the histological studies.

RaySearch RayStation Fallback (FB) planning module can generate an equivalent backup radiotherapy treatment plan facilitating treatment on other linear accelerators. FB plans were generated from the RayStation FB module by simulating the original plan target and organ at risk (OAR) dose distribution and delivered in various backup linear accelerators. In this study, helical tomotherapy (HT) backup plans used in Varian TrueBeam linear accelerator were generated with the RayStation FB module. About 30 patients, 10 with lung cancer, 10 with head and neck (HN) cancer, and 10 with prostate cancer, who were treated with HT, were included in this study. Intensity-modulated radiotherapy Fallback plans (FB-IMRT) were generated for all patients, and three-dimensional conformal radiotherapy Fallback plans (FB-3D) were only generated for lung cancer patients. Dosimetric comparison study evaluated FB plans based on dose coverage to 95% of the PTV volume (R 95 ), PTV mean dose (D mean ), Paddick's conformity index (CI), and dose homogeneity index (HI). The evaluation results showed that all IMRT plans were statistically comparable between HT and FB-IMRT plans except that PTV HI was worse in prostate, and PTV R 95 and HI were worse in HN multitarget plans for FB-IMRT plans. For 3D lung cancer plans, only the PTV R 95 was statistically comparable between HT and FB-3D plans, PTV D mean was higher, and CI and HI were worse compared to HT plans. The FB plans using a TrueBeam linear accelerator generally offer better OAR sparing compared to HT plans for all the patients. In this study, all cases of FB-IMRT plans and 9/10 cases of FB-3D plans were clinically acceptable without further modification and optimization once the FB plans were generated. However, the statistical differences between HT and FB-IMRT/3D plans might not be of any clinically significant. One FB-3D plan failed to simulate the original plan without further optimization., (© 2017 The Authors. Journal of Applied Clinical Medical Physics published by Wiley Periodicals, Inc. on behalf of American Association of Physicists in Medicine.)

The present article reports the clinical cases of the surgical intervention on 20 patients presenting with petrous bone cholesteatoma. We have identified several clinical variants of petrous bone cholesteatoma based on the results of multispiral computed tomography (MSCT) of the temporal bones and categorized them into the following types in accordance with the classification proposed by Moffat-Smith an M. Sanna for this pathological condition: supralabyrinthine (n=8), supralabyrinthine-apical (n=2), infralabyrinthine (n=3), infralabyrinthine-apical (n=5), massive (n=1), and massive - apical (n=1). The surgical sanation of petrous bone cholesteatoma was performed in all the 20 patients in the absence of the pronounced bone destruction in the walls of the temporal bone pyramid and of the subdural expansion of cholesteatoma. In all the cases, the trepanation cavity remained open till its complete epidermization. The follow up period was around 3 years in duration on the average. The post-surgical analysis of the clinical conditions of each of the 20 patients was performed with special reference to the surgical technique applied for the removal of petrous bone cholesteatoma and the final outcome of the radical treatment.