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Purpose: Evaluation of the impact, indications, and therapeutic efficiency of chest CT in intensive-care and emergency patients., Materials and Methods: Retrospective assessment of 741 consecutive chest CT, or which 74% were acquired in the spiral technique, in intensive-care and emergency patients. Chest CT scans and respective clinical data were compared., Results: 16% of all examinations were indicated to resolve questions arising from the chest radiogram, 10% to confirm or exclude pulmonary embolisms and 10% to confirm or exclude aortic dissection. In 10% a focus of infection was sought. 57% of all CT examinations had an impact on therapy, in 7% further diagnostic tests were prompted. Among a total of 588 clinical decisions based upon chest CT, the most frequent therapeutic conclusions consisted in: minimally invasive CT guided interventions in 17%. A new drug was administered in 13%, surgical intervention was performed in 13%, bed-side interventions such as insertion of a drainage tube in 13%, and a given pharmacological therapy was continued in 11%., Conclusion: Chest CT has a strong impact on patient management in emergency and critical-care medicine. CT guided interventions are frequently used in critically-ill patients. The introduction of the spiral technique has led to important new CT indications in the field of non-invasive vascular diagnosis, namely the assessment of pulmonary embolism and aortic dissection.

CT-Dose-Index of Standard-CT corresponds to CT-Dose-Effect-Index of Spiral-CT. Spiral-CT provides a continuous data acquisition with well balanced dose profiles. Increasing pitch reduces radiation dose and nevertheless an unbroken reconstruction of scanned volume is possible. In contrast to Standard-CT, small parts at both ends of the volume scan are not reconstructed. Volume-Dose-Index therefore is elevated in short scan times but corresponds to that of Standard-CT in long scan times. 1 mm slices cause more radiation exposure due to their broadened dose profiles.

To evaluate the diagnostic accuracy of CT and MRI in the diagnosis of malignant peripheral neuroectodermal tumors (MPNT), the imaging data of nine patients with immunehistochemically proven MPNT were retrospectively analyzed. The average age was 24 years (ranging from 5 to 63 years). MRI and CT of all patients showed large tumors with direct infiltration of the surrounding structures. Intratumoral calcifications were not identified. All tumors showed equal to less high signal intensity in T1- and high signal intensity in T2-weighted images. Because of its high soft-tissue contrast, MRI is the most capable imaging modality in the diagnosis and therapy-monitoring in these tumors.

Iliopsoas abscesses originating from bacterial lumbar spondylodiscitis were successfully treated by CT-guided percutaneous abscess drainage, antibiotics, and immobilization in two patients. Vertebral fusion of the affected segments was observed in both patients in the follow-up period (1 and 6 years, respectively). Percutaneous abscess drainage can replace surgery for iliopsoas abscesses following vertebral osteomyelitis.

Jejunogastric intussusception is a rare complication after gastric surgery and when its diagnosis is delayed a high mortality rate can be expected. This paper reports on the characteristic findings of this entity at ultrasound and CT examination. Both diagnostic procedures have a high sensitivity. Sonography is the method of first choice because the diagnosis can be made with a high grade of certainty. CT allows the differentiation of the distinct stages of the disease and the views given by CT are often more easily accepted by the surgeons.