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We describe the computed tomography (CT) imaging findings in six cases (five males and one female; age range 61-78 years; mean age 67.3 years) with histologically proven hepatoid adenocarcinoma of the stomach (HAS). Five of the six patients had elevated serum alpha-fetoprotein levels. The most common type of gross appearance HAS on CT is a polypoid mass (83%, 5/6). The most common contrast enhancement pattern was heterogeneous. All six patients had a regional lymphadenopathy larger than 6 mm in its short axis. Liver metastases (n = 3) were noted. Venous tumor thrombosis was identified in the portal vein (n = 2) of the regions near primary gastric tumors or metastatic masses. Our findings suggest in an elderly, male patients with a large heterogeneous enhancement tumor, the presence of distant metastases, regional lymphadenopathy and characteristically increased serum alpha-fetoprotein levels indicates a high likelihood of HAS.

Recent clinical reports have indicated that myocardial bridge and mural coronary artery complex (MB-MCA) might cause major adverse cardiac events. 256-slice CT angiography (256-slice CTA) is a newly developed CT system with faster scanning and lower radiation dose compared with other CT systems. The objective of this study is to evaluate the morphological features of MB-MCA and determine its changes from diastole to systole phase using 256-slice CTA. The imaging data of 2462 patients were collected retrospectively. Two independent radiologists reviewed the collected images and the diagnosis of MB-MCA was confirmed when consistency was obtained. The length, diameter, and thickness of MB-MCA in diastole and systole phases were recorded, and changes of MB-MCA were calculated. Our results showed that among the 2462 patients examined, 336 have one or multiple MB-MCA (13.6%). Out of 389 MB-MCA segments, 235 sites were located in LAD2 (60.41%). The average diameter change of MCA in LAD2 from systole phase to diastole phase was 1.1 ± 0.4 mm, and 34.9% of MCA have more than 50% diameter stenosis in systole phase. This study suggested that 256-slice CTA multiple-phase reconstruction technique is a reliable method to determine the changes of MB-MCA from diastole to systole phase.

Objective: To determine the morphological characteristics of myocardial bridge and mural coronary artery (MB-MCA) and initially quantify the changes of MB-MCA in diastole and systole phase with multiple-phase reconstruction technique using 256-slice CT angiography (256-slice CTA)., Methods: We retrospectively collected the coronary artery imaging data of 861 patients undergoing 256-slice CTA with suspected or documented coronary artery disease. The images were reviewed by two independent radiologists, the diagnosis of MB-MCA was confirmed when consistency was obtained. The length, diameter and thickness of MB-MCA in the middle segment of LAD (LAD2) in diastole and systole phase were recorded, and changes of MB-MCA were calculated., Results: Among the 861 patients, 150 MB-MCA were found in 131 patients (15.2%). 99 MB-MCA (66.0%) were located in LAD2, the remaining 51 (34.0%) in the other segments of coronary arteries. The average length and thickness of MB was (17.6 ± 5.7) mm and (2.6 ± 0.7) mm, respectively. The average diameter change of MCA in LAD2 from systole phase to diastole phase was (1.2 ± 0.5) mm, and 41% of MCA have diameter stenosis more than 50% in systole phase., Conclusion: The changes of MB-MCA from diastole to systole phase could be determined to some extent by 256-slice CTA multiple-phase reconstruction technique.

Background: Right ventricular (RV) function is very important for those patients with respiratory and cardiovascular disorders that can result in RV impairments. Because of complex geometry of the chamber, it is difficult to accurately measure the RV volumetric parameters with conventional imaging modalities. The purpose of this study was to evaluate whether the 64-MDCT can assess RV function with high accuracy and reproducibility when compared to the results with those of MRI., Methods: Forty-seven consecutive subjects underwent retrospectively ECG-gated 64-MDCT and MRI for assessing the ventricular function. Right ventricular end diastolic and end-systolic volume, stroke volume, and ejection fraction were measured with dedicated cardiac analysis software on 64-MDCT and compared with values measured on MRI which served as the reference standard. Agreement between two modalities was assessed with Bland and Altman analysis and linear regression analysis. Repeated measurements were performed to determine intraobserver and interobserver variability., Results: No significant differences were revealed in calculated RV volumes and EF between the two modalities. Agreement and correlation were similar for RV-EDV (0.4 ± 8.2 ml; r=0.95), RV-ESV (-0.6 ± 4.8; r=0.95), RV-SV (1.1 ± 6.7 ml; r=0.93), and RV-EF (0.9 ± 4.4; r=0.88). The difference of SV of right and left ventricle with 64-MDCT was not statistically significant (p=0.40) and good correlation was obtained (r=0.96). The variability in 64-MDCT measurements was lower than those in MRI., Conclusions: ECG-gated 64-MDCT can assess the RV function with high accuracy and reproducibility without geometric assumptions about right ventricle., (Copyright © 2008 Elsevier Ireland Ltd. All rights reserved.)

Objective: To determine the accuracy of 64-slice computed tomography angiography (CTA) in the diagnosis of coronary artery lesions., Methods: We retrospectively collected the coronary artery imaging data of 49 patients who underwent 64-slice CTA and conventional catheter-based selective coronary angiography (SCA) during July 2006 and May 2007. The CTA and SCA diagnosis were compared., Results: The 64-slice CTA enabled the visualization of the entire coronary tree with diagnostic image quality in 46 of the 49 patients. The CTA had a sensitivity of 54.88%, 47.50% and 93.15%, and a specificity of 99.42%, 95.68% and 97.13% for detecting less than 50% stenosis, 50%-75% stenosis, and greater than 75% stenosis, respectively. The overall Pearson's correlation coefficient between the degree of stenosis detected by quantitative SCA and 64-slice CTA was 0.941., Conclusion: 64-slice CTA is a good instrument for assessing coronary artery lesions.

Objective: To study the clinical value of coronary artery calcification score with 64-slice MDCT in the diagnosis of coronary artery disease (CAD)., Methods: 96 subjects including 49 with confirmed CAD (CAD group) and 47 asymptomatic people as control group were recruited between May 2006 and December 2006 by the department of radiology in our hospital. The selective coronary angiography was also performed in 30 subjects including 25 with CAD and 5 asymptomatic people and subsequently divided into three groups (< 50%, 50%-75% and > 75% of maximum degree of vessel occlusion). We investigated the correlation of calcification score (CS) and the maximum degree of vessel occlusion measured by coronary angiography were investigated., Results: The larger CS and more numbers of regions of interest of calcification in the right coronary artery and left anterior descending artery in 96 subjects were observed. The total mean CS of CAD (462 +/- 314) was higher than that of control group (83 +/- 52) (P < 0.001). There was a moderate correlation between degree of vessel stenosis and CS for individual vessels in patients with positive calcium scan(r = 0. 445, P < 0.01)., Conclusion: Although CS measured by MDCT is not an accurate marker of the degree of vessel stenosis in CAD, it can be applied as a screening tool for high risk CAD patients and could greatly reduce the expense on coronary angiography.

Objective: To evaluate the influence of cardiac rhythm on 64-slice multi-detector row CT coronary angiography and clinic value of imaged post-processing technology., Methods: 687 patients with suspected coronary heart disease who underwent 64-slice multi-detector row CT coronary angiography were retrospectively analyzed with their CT images. Four group images of patients were analyzed and compared according to the fluctuation of cardiac rhythm. Multi-phase reconstruction (n = 76) and the ECG-edit software (n = 21) were performed in those patients with arrhythmia., Results: The statistical differences were found among the imaging quality of each group (chi2 = 225.040, P < 0.001). As the fluctuation of cardiac rhythm increased, the quality of CT images dropped down concomitantly. After images processed with ECG-edit software, the quality of CT coronary angiography images got improved (Z = - 3.385, P = 0.001). In 76 patients with multi-phase reconstruction, the image quality of right coronary artery got improved in 40% R-R interval when high quality images couldn't be obtained in 75% R-R interval (Z = - 4.209, P < 0.001)., Conclusion: Cardiac rhythm is an important factor to affect the CT coronary angiography, but post-processing technology may be useful for improving the imaging quality.

Background: The incidence of abdominal tuberculous lymphadenopathy never appears low. In addition to infecting the abdominal lymph nodes through the digestive tract, the tuberculosis bacteria can also infect the abdominal lymph nodes and extra-nodal organs through hematogenous dissemination. This study investigated contrast-enhanced CT features and anatomic locations of hematogenous disseminated tuberculosis involving abdominal organs., Methods: Thirteen patients with documented hematogenous disseminated tuberculosis involving abdominal organs were recruited. Contrast-enhanced CT scanning was carried out in the abdomen of all patients. CT images were retrospectively analyzed for the size, attenuation, enhancement patterns, and anatomic distribution of the foci in infected lymph node, liver, spleen, and kidney., Results: Hematogenous disseminated tuberculosis dominantly affected lymph nodes in the hepatoduodenal ligament (84.6%), the portacaval space (84.6%), the root of the mesentery (84.6%), the peripancreatic region (84.6%), the periceliac region (76.9%), the hepatogastric ligament (69.2%), and the upper and lower paraaortic region (both were 69.2%). Out of the 13 cases studied, 12 (92.3%) had lymphadenopathy with peripheral enhancement accompanied by multilocular appearance; 10 (76.9%) had homogeneous hepatomegaly; 13 (100%) had inhomogeneous splenomegaly accompanied by scattered low-density lesions with peripheral enhancement; and 8 (61.5%) had low-density lesions in the kidney with peripheral enhancement., Conclusion: Anatomically, peritoneal and retroperitoneal lymph nodes are most susceptible to hematogenous disseminated tuberculosis. The hepatomegaly manifested to be homogeneous in most cases while the splenomegaly is of frequently inhomogeneous attenuation. All these characteristics are closely related to the infection routes and pathologic features of abdominal hematogenous disseminated tuberculosis.

Adrenal glands are common sites of diseases. With dramatically increased use of computed tomography (CT) and magnetic resonance (MR) imaging, more and more uncommon adrenal masses have been detected incidentally at abdominal examinations performed for other purposes. In this article, uncommon adrenal masses are classified as cystic masses (endothelial cysts, epithelial cysts, parasitic cysts, and pseudocysts), solid masses (ganglioneuroma, ganglioneuroblastoma, extramedullary plasmacytoma (EMP), neurilemmoma, and lymphoma), fat-containing masses (myelolipoma, teratoma), and infectious masses (tuberculoma), and the imaging features of these uncommon masses are demonstrated. Although most of these lesions do not have specific imaging features, some fat-containing masses and cystic lesions present with characteristic appearances, such as myelolipoma, teratoma, and hydatid. Combination with histopathologic characteristic of these uncommon masses of adrenal gland, radiological features of these lesions on CT and MR imaging can be accurately understood with more confidences. Moreover, CT and MRI are highly accurate in localization of uncommon adrenal masses, and useful to guide surgical treatments.

Objective: To determine the characteristics of tuberculous Addison's disease on the axial and multiplanar reformatted (MPR) images of the multidetector-row computed tomography (MDCT)., Materials and Methods: The unenhanced and contrast-enhanced MDCT features in 19 patients with tuberculous Addison's disease were retrospectively assessed for the location, contour, size, calcification, attenuation, and enhancement patterns. The correlation between the duration of Addison's disease and the percentage of calcification presence was evaluated., Results: The adrenal glands were infected bilaterally in all of the 19 cases (100%, 38 glands). Enlargement of the glands appeared in 18 cases (94.7%, 36 glands) and the remaining one case (5.3%, two glands) showed atrophy bilaterally. Of the 36 enlarged adrenals, 13 (36.1%) had preserved contours, and the other 23 (63.9%) were mass-like. The size of the adrenals ranged from 0.6 to 4.8 cm (mean 1.92+/-0.96 cm). Calcification was revealed in 16 adrenals (16/38, 42.1%), increasing in incidence with disease progression. Fourteen of the 36 (38.9%) enlarged adrenals showed peripheral enhancement while the remaining 22 (61.1%) demonstrated heterogeneous enhancement. The DeltaCT value, the attenuation measurement of mass-like lesions, was less in the central area (7+/-4 HU) than that in the peripheral area (32+/-14 HU) (P<0.01) between the unenhanced and contrast-enhanced scan., Conclusion: MDCT can reveal the characteristic morphology and CT attenuation in the tuberculous Addison's disease. Combined with its clinical presentations and biochemical findings, we can diagnose and stage adrenal tuberculosis with high specificity and accuracy on MDCT.

Purpose: To describe CT morphology of untreated adrenal tuberculosis during the different stages of the natural history of the disease and to evaluate the diagnostic implications of CT features., Materials and Methods: We retrospectively evaluated CT features in 42 patients with documented adrenal tuberculosis for the location, size, morphology, and enhancement patterns shown on CT images. The clinical duration were correlated with the CT features., Results: Of the 42 patients with untreated adrenal tuberculosis, bilaterally enlarged adrenal glands were revealed in 38 cases (91%), unilaterally enlarged in 3 cases (7%), and normal size in 1 case (2%). Of the 41 cases (98%) with enlargement, mass-like enlargement was seen in 20 cases (49%) and enlargement with preserved contours in 21 cases (51%). Peripheral rim enhancement presented in 22 cases (52%) on contrast-enhanced CT. Non-enhanced CT scan revealed calcification in 21 cases (50%). As the duration of Addison's disease increased, the presence of calcification and contour preservation increased concomitantly (p<0.001), whereas peripheral rim enhancement and mass-like enlargement decreased concomitantly on CT images (p<0.001)., Conclusion: CT may be helpful in diagnosing adrenal tuberculosis when clinically suspected, and CT features are correlated to the clinical duration of Addison's disease.

The aim of the present study is to determine imaging criteria for differentiating tuberculosis from primary tumors in the adrenal gland on contrast-enhanced CT. Non-contrast and contrast-enhanced CT features in 108 patients with adrenal tuberculosis (n = 34) and primary tumor (n = 74) were retrospectively assessed for the location, size, calcification and enhancement patterns. The primary tumors included 41 adenomas, 11 pheochromocytomas, 4 carcinomas, 3 lymphomas, 6 myelolipomas, 6 ganglioneuromas, 2 neurilemmomas and 1 ganglioneuroblastoma. Biochemical investigation was performed for all patients. Of the tuberculosis cases, 31 (91%) invaded with bilateral involvement, while 7 (9%) of the primary tumors invaded with bilateral involvement (P < 0.001). Tuberculosis often showed calcification (20 of 34; 59%), whereas primary tumors infrequently showed calcification (6 of 74; 8%; P < 0.001). Low attenuation in the center with peripheral rim enhancement was more commonly seen in tuberculosis (16 of 34; 47%) than in primary tumors (7 of 74; 9%; P < 0.001). In the determination of tuberculosis, the highest sensitivity (91%) and accuracy (91%) were obtained with bilateral involvement, and the highest specificity (99%) was obtained with the contour preserved. In the determination of primary tumors using a combination of having unilateral involvement and being mass-like, the outcome was a sensitivity of 91%, specificity of 94% and accuracy of 92%. CT findings can differentiate tuberculosis from a primary tumor of the adrenal glands with high sensitivity and an acceptable specificity when combined with the endocrinological examination.