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Background: Cardiac myxomas (CMs) and thrombi are associated with high morbidity and mortality. These two conditions need totally different treatments. However, they are difficult to distinguish using naked eye. In clinical, misdiagnoses occur now and then. This study aimed to compare the characteristics of CMs and cardiac thrombi and investigate the value of a radiomics signature in distinguishing CMs from cardiac thrombi, based on cardiovascular contrast-enhanced computed tomography (CECT) images., Methods: A total of 109 patients who had CMs (n = 59) and cardiac thrombi (n = 50) were enrolled in this retrospective study from 2009 to 2019. First, the lesion characteristics of cardiovascular CECT images were documented and compared by two radiologists. Then all patients were randomly allotted to either a primary group or a validation group according to a 7:3 ratio. Univariate analysis and the least absolute shrinkage and selection operator were used to select robust features. The best radiomics signature was constructed and validated using multivariate logistic regression. An independent clinical model was created for comparison., Results: The best radiomics signature was developed using eight selected radiomics. The classification accuracies of the radiomics signature were 90.8% and 90.9%, and the area under the receiver operating characteristic curves were 0.969 and 0.926 in the training and testing cohorts, respectively. Cardiovascular CECT images showed that the two diseases had significant differences in location, surface, Hydrothorax, pericardial effusion and heart enlargement. The naked eye findings were used to create the clinical model. All metrics of the radiomics signature were higher than those of clinical model., Conclusions: Compared with clinical model, the radiomics signature based on cardiovascular CECT performed better in differentiating CMs and thrombi, suggesting that it could help improving the diagnostic efficiency.

Objective: Right ventricular function (RVF) is a strong predictor of adverse cardiac events; however, the reference standard for RVF assessment, MRI, is limited in some patients for whom accurate evaluation of RVF is essential, like those with COPD or non-MR compatible metal implants. We conducted this meta-analysis to evaluate whether CT was as accurate as MRI for the assessment of RVF., Method: We conducted a meta-analysis of studies retrieved from PubMed, Embase, and Cochrane Central searches to evaluate the differences and correlations between the following RVF parameters as measured by CT and MRI: end diastole volume (EDV), end systole volume (ESV), right ventricular ejection fraction (RVEF), and stroke volume (SV)., Results: Sixteen studies that used disk summation (637 subjects) and three studies that used three-dimensional reconstruction were included. For the 16 studies, the pooled standard mean differences (95% confidence interval) were 1.04 (- 2.59, 4.67) for EDV, 1.22 (1.50, 3.95) for ESV, - 0.65 (- 2.60, 1.29) for RVEF, and - 0.37 (- 3.64, 2.90) for SV. The overall correlation coefficient (r) values were 0.98 for EDV, 0.95 for ESV, 0.98 for RVEF, and 0.97 for SV. The mean difference between the two methods was not statistically significant (overall effect Z test, p > 0.1)., Conclusion: CT can assess RVF with accuracy comparable to that of MRI. Thus, CT is a valid alternative to MRI., Key Points: • CT could help clinicians to assess RVF as accurately as MRI can, with satisfactory repeatability.

To evaluate the value of dual-source computed tomography (DSCT) compared with transthoracic echocardiography (TTE) in assessing intracardiac and extracardiac anomalies in patients with coarctation of aorta (CoA) and interrupted aortic arch (IAA). Seventy-five patients (63 with CoA and 12 with IAA) who received preoperative DSCT and TTE were retrospectively studied. Intracardiac and extracardiac anomalies were recorded and compared by DSCT and TTE, in reference to surgical or cardiac catheterization findings. A total of 155 associated anomalies were finally found. Collateral circulation (56, 74.70%), patent ductus arteriosus (PDA; 41, 54.67%) were the most common anomalies. PDA, aortopulmonary window, and collateral circulation were more frequently present in patients with IAA than those with CoA (100% vs. 46.03%, 16.67% vs. 0%, and 100% vs. 69.84%, respectively, all p < 0.05). DSCT was superior to TTE in assessing associated extracardiac-vascular anomalies (sensitivity: 100% vs. 39.81%; specificity: 100% vs. 100%; positive predictive value: 100% vs. 100%; negative predictive value: 100% vs. 76.06%). Extracardiac-vascular anomalies, including collateral circulation and PDA, were the most common anomalies in patients with IAA and CoA. Compared with TTE, DSCT is more reliable in providing an overall preoperative evaluation of morphological features and extracardiac anomalies for surgical planning.

Common atrium (CA) is a rare complex congenital heart disease. The studies of CA are mostly case reports, while few have been done regarding its morphological characteristics. We aimed to determine CA characteristics and diagnostic accuracy in assessing associated malformations in these patients with low-dose dual-source computed tomography (DSCT).Twenty-one pediatric and adolescent CA patients underwent low-dose DSCT. Different ventricular types and associated malformations were assessed. The diagnostic accuracy of DSCT and transthoracic echocardiography (TTE) in evaluating associated malformations were assessed. The effective doses of DSCT were calculated.Patients (n = 21) were divided into CA with biventricular physiology (n = 7) and CA with single ventricle (SV) (n = 14). There were 3 types of SV morphology: single left ventricle (n = 5), single right ventricle (n = 6), and undifferentiated ventricle (n = 3). In all, 22 associated malformations were seen in CA and 56 in CA with SV. DSCT was superior to TTE for detecting intracardiac anomalies (sensitivity: DSCT, 92.31% vs TTE, 76.92%), great vessels anomalies (sensitivity: DSCT, 100.00% vs TTE, 77.50%), and of collateral vessels (sensitivity: DSCT, 100% vs TTE, 20.00%). The estimated mean effective dose was 0.95 ± 0.44 mSv (<1 mSv).This study indicated that low-dose DSCT is an ideal alternative for pediatric and adolescent patients with CA, providing morphological details of CA and associated malformations with high accuracy.

Clinically, early diagnosis and treatment is important for survival of pediatric with vascular ring (VR) associated with congenital heart disease (CHD), and accurate evaluation of VR is a prerequisite for repair surgical. The study aimed to assess the quantitative characteristics of tracheal compression in pediatrics with VR and CHD using dual-source computed tomography (DSCT), and further provided effective information for surgical decisions. A total of 49 VR patients with CHD and 56 controls were enrolled. The tracheal quantitative measurements (short diameter, long diameter, tracheal area and tracheal length) were obtained, and the degree of tracheal compression was assessed. Our results indicated that VR associated with CHD may cause more serious and complex symptoms, and the greater tracheal compression were found on DSCT when more severe symptoms were present (r = 0.84). The degree of tracheal compression was significantly different within the VR group between those with and without surgery (P = 0.002). Finally, there were good agreement among (1-long diameter ratio), (1-short diameter ratio) and (1-area ratio) in patients and controls, respectively. This study indicated that DSCT enables provides accurate quantitative tracheal compression information for VR pediatrics associated with CHD, and evaluation of the degree of tracheal compression by 1-area ratio may contribute to the repair surgical of VR.

Background: To investigate the diagnostic value of dual-source computed tomography (DSCT) in the evaluation of tetralogy of Fallot (TOF)-associated extracardiac vascular abnormalities in pediatric patients compared with transthoracic echocardiography (TTE)., Methods: One hundred and twenty-three pediatric patients diagnosed with TOF were included in this retrospective study. All patients underwent DSCT and TTE preoperatively. All associated extracardiac vascular abnormalities and their percentages were recorded. The diagnostic performances of DSCT and TTE were compared based on the surgical results. The image quality of DSCT was rated, and the effective radiation dose (ED) was calculated., Results: A total of 159 associated extracardiac vascular deformities were confirmed by surgery. Patent ductus arteriosus (36, 22.64%), right-sided aortic arch (29, 18.24%), and pulmonary valve stenosis (23, 14.47%) were the most common associated extracardiac vascular abnormalities. DSCT was superior to TTE in demonstrating associated extracardiac anomalies (diagnostic accuracy: 99.13% vs. 97.39%; sensitivity: 92.45% vs. 77.07%; specificity: 99.81% vs. 99.42%). The agreement on grading the image quality of DSCT was excellent (κ = 0.80), and the mean score of the image quality was 3.39 ± 0.50. The mean ED of DSCT was 0.86 ± 0.47 mSv., Conclusions: Compared to TTE, low-dose DSCT has high diagnostic accuracy in the depiction of associated extracardiac vascular anomalies in pediatric patients with TOF, and could provide more morphological details for surgeons.

To explore the accuracy of main pulmonary artery (MPA) and ascending aorta (AAO) image evaluation in pediatric patients with single ventricle (SV) by comparing dual-source computed tomography (DSCT) with echocardiography. Thirty-one children with SV were retrospectively enrolled. The stenosis, dilation, and location of MPA and AAO were independently evaluated by DSCT and echocardiography. The accompanying arterial malformations were also assessed by DSCT. For 17 patients undergoing cardiac catheterization, the DSCT-based diameters of MPA and AAO were correlated with their pressures as measured by catheterization. Referring to the surgical and catheterization findings, DSCT had better diagnostic performance in detecting the stenosis, dilation, and location of MPA and AAO with higher sensitivity than echocardiography (sensitivity, MPA: 88.0% vs. 80.0%, AAO: 100% vs. 66.7%, great arteries location: 95.7% vs. 95.2%). The correlations between diameters of MPA and AAO with their pressures were 0.399 (p = 0.04) and 0.611 (p = 0.01), respectively. In addition, DSCT detected 23 cases with patent ductus arteriosus, 26 systemic-to-pulmonary collaterals, 9 branch pulmonary distortions, and 4 coronary artery anomalies. DSCT is reliable for assessing the anatomic features of pulmonary artery and aorta in SV children, and provides comprehensive information for surgical strategy-making.

Purpose: To evaluate the image features and diagnostic agreement for anomalous pulmonary venous connection (APVC) by dual-source computed tomography (DSCT) before surgery when compared with trans-thoracic echocardiography (TTE)., Materials and Methods: A total of one hundred and twenty-three patients were enrolled in this study. The associated malformation was analyzed between 39 total anomalous pulmonary venous connections (TAPVC) and 84 partial anomalous pulmonary venous connections (PAPVC). For 75 patients who received surgical treatment, the diagnostic agreement between the surgical findings of DSCT and TTE was evaluated. The dimensions of the four chambers of the heart were also measured by DSCT and TTE., Results: Atrial septal defect is the most common anomaly associated with APVC (86/123, 69.9%), which has a higher incidence in TAPVC compared to that in PAPVC (100% vs. 56.0%, p<0.001). Of 75 operative patients, discrepancies in diagnostic sensitivity existed between DSCT and TTE for different drainage sites, supracardiac (94.4% vs. 82.2%, p=0.001), cardiac (98.7% vs. 91.1%, p=0.089), and infracardiac (100% vs. 57.1%, p=0.096), respectively, and for different venous origins, right superior pulmonary vein (98.4% vs. 87.1%, p=0.871), right inferior pulmonary vein (100% vs. 87.3%, p=0.006), left superior pulmonary vein (100% vs. 93.1%, p=0.246), left inferior pulmonary vein (100% vs. 95.7%, p=0.500), and atypical pulmonary vein (66.7% vs. 44.4%, p=0.011), respectively. Good agreement was obtained between DSCT and TTE for measurements of left atrium, left ventricle, right atrium, and right ventricle sizes (bias 0.3±5.05mm, -0.3±4.50mm, 5.8±14.15mm, and 1.1±5.95mm, respectively)., Conclusions: DSCT can provide optimal and accurate anatomy details for patients with APVC, and serves as a promising accessary imaging modality after TTE to achieve a better and comprehensive preoperative imaging evaluation., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Multimodality imaging revealed a left circumflex coronary artery-left ventricle fistula in a 4-year-old boy. MRI tissue tracking revealed a slight abnormality in the left ventricular myocardial strain. Early surgery was suggested to avoid serious complications.

Objectives: To evaluate the efficacy of dual-source computed tomography (DSCT) in assessing the morphological features, quantitative features, and associated coronary artery lesions among patients with coronary artery fistula (CAF) before surgery., Methods: We enrolled 34 patients with CAF that were morphologically and quantitatively analyzed by DSCT and compared the analyses with surgical results (reference standard). The associated coronary artery lesions were also assessed., Results: By DSCT, we identified 15 patients (44.1%) with left-sided CAF, 9 (26.5%) with right-sided CAF, and 10 (29.4%) with bilateral CAF; the left anterior descending coronary artery (50.0%) was most frequently involved. Drainage was most commonly in the main pulmonary artery (41.2%), and those with right-sided CAF had larger feeding coronary arteries and drainage sites than those with left-sided or bilateral CAF (p<0.05). All the morphological features presented by DSCT were confirmed at surgery. In the quantitative analysis of CAF, DSCT was as accurate as surgery (r=0.95-0.98, p<0.001), and it was able to evaluate associated lesions accurately, including arteriosclerotic plaques, coronary artery aneurysms, and myocardial bridges. The evaluation could be completed in a single scan, without requiring an increased radiation dose (mean ED=2.27±1.92mSv)., Conclusions: DSCT is an alternative noninvasive imaging method that enables accurate assessment of morphological features, quantitative features, and associated coronary artery lesions in patients with CAF. It can be used to provide comprehensive information for determining surgical strategies., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Objectives: To provide a road map of pulmonary vein (PV) and left atrial (LA) variants in patients with atrial fibrillation (AF) before catheter ablation procedure using cardiac CT., Methods: Cardiac CT was performed in 1420 subjects for accurate anatomical information, including 710 patients with AF and 710 matched controls without AF. PV variants, PV ostia and spatial orientation, LA enlargement, and left atrial diverticulum (LAD) were measured, respectively. Differences between these two groups were also respectively compared. Some risk factors for the occurrence of LAD were analyzed., Results: In total, PV variants were observed in 202 (28.5 %) patients with AF patients and 206 (29.0 %) controls without AF (p = 0.8153). The ostial sizes of all accessory veins were generally smaller than those of the typical four PVs (p = 0.0153 to 0.3958). There was a significant difference of LA enlargement between the AF and control groups (36.3 % vs. 12.5 %, p < 0.0001), while the prevalence of LAD was similar in these two groups (43.2 % vs. 41.9 %, p = 0.6293)., Conclusion: PV variants are common. Detailed knowledge of PVs and LA variants are helpful for providing anatomical road map to determine ablation strategy., Key Points: • PVs variants are helpful for providing anatomical road map to ablation. • PV variants are common. • DSCT could recognize these anatomic features before ablation as a non-invasive imaging.

Purpose: To evaluate the quantitative accuracy of dual-source computed tomography (DSCT) on measurements of pulmonary artery in pediatric patients with cyanotic congenital heart diseases (CCHDs) when compared with transthoracic echocardiography (TTE)., Methods: Thirty-five patients (mean age: 27.88 ± 28.27 months) with CCHDs underwent DSCT and TTE for evaluating the diameter of the main pulmonary artery (MPA), right pulmonary artery (RPA), and left pulmonary artery (LPA). Surgical measurements were obtained and served as the reference standard. The agreement was tested by linear regression analysis, Pearson's correlation coefficient, and Bland-Altman analysis. The intra- and extracardiac malformations were also observed., Results: There was a markedly positive correlation between DSCT and surgical measurements of the MPA, RPA, and LPA (r=0.95-0.97; all p<0.001), although the overestimation of the measurements of MPA, RPA, and LPA (bias 0.15 ± 0.95, 0.31 ± 0.63 and 0.35 ± 0.68 mm, respectively) was observed. However, there was a moderate correlation between TTE and surgical measurements of MPA, RPA, and LPA (r=0.61-0.84; all p<0.001), and the underestimation of the measurements of MPA, RPA, and LPA (bias-1.20 ± 1.69, -1.80 ± 1.77, and -1.50 ± 2.30 mm, respectively) was observed. In addition, DSCT was more efficient in finding associated malformations than TTE (40/40 vs. 33/40)., Conclusions: As a reliable, noninvasive and radiation-save imaging modality, DSCT can provide more accurate pulmonary artery measurements than TTE in cardiac surgical procedures., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

Purpose: To evaluate the feasibility and diagnostic accuracy of retrospective electrocardiographically (ECG)-gated dual-source computed tomography (DSCT) for the assessment of double outlet right ventricle (DORV) and associated multiple malformations in pediatric patients., Materials and Methods: Forty-seven patients <10 years of age with DORV underwent retrospective ECG-gated DSCT. The location of the ventricular septal defect (VSD), alignment of the two great arteries, and associated malformations were assessed. The feasibility of retrospective ECG-gated DSCT in pediatric patients was assessed, the image quality of DSCT and the agreement of the diagnosis of associated malformations between DSCT and transthoracic echocardiography (TTE) were evaluated, the diagnostic accuracies of DSCT and TTE were referred to surgical results, and the effective doses were calculated., Results: Apart from DORV, 109 associated malformations were confirmed postoperatively. There was excellent agreement (κ = 0.90) for the diagnosis of associated malformations between DSCT and TTE. However, DSCT was superior to TTE in demonstrating paracardiac anomalies (sensitivity, coronary artery anomalies: 100% vs. 80.00%, anomalies of great vessels: 100% vs. 88.57%, separate thoracic and abdominal anomalies: 100% vs. 76.92%, respectively). Combined with TTE, DSCT can achieve excellent diagnostic performance in intracardiac anomalies (sensitivity, 91.30% vs. 100%). The mean image quality score was 3.70 ± 0.46 (κ = 0.76). The estimated mean effective dose was < 1 mSv (0.88 ± 0.34 mSv)., Conclusions: Retrospective ECG-gated DSCT is a better diagnostic tool than TTE for pediatric patients with complex congenital heart disease such as DORV. Combined with TTE, it may reduce or even obviate the use of invasive cardiac catheterization, and thus expose the patients to a much lower radiation dose.

Aims: To retrospectively evaluate coronary anomalies and coronary wall atheromatous changes by using dual-source computed tomography angiography (DSCTA) for preoperative assessment of patients with thoraco-abdominal and noncoronary cardiovascular disease., Materials and Methods: One hundred and eighty-one patients scheduled for elective noncoronary cardiovascular surgery (heart valve disease group, HVD; arrhythmia group, Arrhy; or aortic aneurysm group, AA) underwent a DSCTA examination for preoperative preparation. Anomalous origin of coronary arteries, myocardial bridge (MB), coronary wall atheromatous changes, luminal stenosis, and types of plaques were evaluated and compared among the three groups., Results: Anomalous origin of coronary arteries and MB were observed in 5.1% and 21.5% of patients. Anomalous origin of the coronary artery from the opposite sinus was most common (55.6%). MB was most frequently detected in the distal segment of the left anterior descending artery (LAD) (1.2%). Plaques were most common in the proximal segment of the LAD (16.4%) and LAD branches (42.2%). Diseased vessels and segments were more common in AA group, followed by Arrhy patients and finally HVD groups (p < 0.001 for each group). Multivessel involvement and significant stenosis of AA group were significantly more common than the other two groups. Noncalcified plaque and all grades of stenosis were more common in AA patients., Conclusion: DSCTA is useful for preoperative assessment of coronary arteries in patients undergoing thoraco-abdominal and noncoronary cardiovascular surgery. DSCTA detected higher prevalence of coronary artery disease in AA patients than in the other two groups of patients., (© 2013 Wiley Periodicals, Inc.)

Objective: To evaluate the accuracy of results of heart functions determined by 64-slice multidetector row computed tomography (64-MDCT) in patients with single valvular insufficiency leision in left ventricle., Methods: 58 patients with single valvular insufficiency leision in left ventricle were enrolled in this study. Their heart functions were assessed by magnetic resonance imaging (MRI), 64-MDCT and echocardiography (Echo) respectively. The assessed parameters included left ventricular end-diastolic and end-systolic volume (LVEDV, LVESV), stroke volume (LVSV), ejection fraction (LVEF), and effective ejection fraction (eLVEF). The correlations between eLVEF and some clinical indicators, such as cardiopulmonary bypass time (CPBT), ventilation time (VT), vasoactive drug used time (VDUT), and length of ICU stay (ICUST) were analyzed., Results: No significant differences were found in the parameters measured by 64-MDCT, Echo and MRI. A strong correlation between 64-MDCT and MRI (r: 0.79-0. 92) was found with all of the parameters. The eLVEF measured by 64-MDCT and MRI correlated with CPBT, VT, VDUT and ICUST well (r: 0.56-0. 84)., Conclusion: 64-MDCT is a rapid, accurate and cheap choice for assessing heart functions of patients with single valvular insufficiency leision in left ventricle. eLVEF is a good predictor for the outcomes of operations.

Introduction: To evaluate the effects of the multiple burr hole (MBH) revascularization on ischemic type adult Moyamoya disease (MMD) by computed tomography perfusion (CTP)., Methods: Eighty-six ischemic MMD patients received CTP 1 week before and 3 weeks after MBH operation. Fifty-seven patients received it again at 6 month and underwent digital subtraction angiography (DSA) and mRS follow-up. Cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT), time to peak (TTP), and relative values of ischemic symptomatic hemispheres were measured. Differences in pre- and post-surgery perfusion CT values were assessed., Results: There were significant differences of CBF, TTP, and relative time to peak (rTTP) in ischemic hemisphere between 1 week before and 3 weeks after surgery, and no significant difference in relative cerebral blood flow (rCBF), CBV, relative cerebral blood volume (rCBV), MTT, relative mean transit time (rMTT). According to whether there was symptom improvement or not on 3 weeks after MBH, the rTTP value was not statistically significant in the patients whose symptoms were not improved at all on 3 weeks after operation. Six-month follow-up showed that CBF, rCBF, and rCBV values were significantly higher than those before operation. Postoperative MTT, TTP, rMTT, and rTTP values were significantly lower than those before operation., Conclusion: CTP is a sensitive method to obtain functional imaging of cerebral microcirculation, which can be a noninvasive assessment of the abnormalities of intracranial arteries and cerebral perfusion changes in MMD before and after surgery. CBF and TTP map, especially the relative values of TTP, seems to have the capability of being quite sensitive to the presence of altered brain perfusion at early time after indirect revascularization.

Aim: To illustrate the MDCT features of hepatic paragonimiasis and correlate the results with clinicopathological findings., Materials and Methods: Eighteen patients (8 male, 10 female; mean age 37years) with hepatic paragonimiasis were included in this study. MDCT features of their hepatic lesions were retrospectively reviewed and correlated with clinicopathological findings., Results: All patients were lifelong residents in endemic areas of paragonimiasis, especially Paragonimiasis skrjabini variety. Abdominal pain or discomfort, fever and high eosinophil percentage were the predominant clinical features. In total, 21 lesions were detected on MDCT images, 18 (85.7%) directly contacted the hepatic capsule and 3 (14.3%) were adjacent to the capsule. Segment V (26%), VIII (26%) and VI (18.5%) were the most commonly involved sites. Sixteen lesions (76%) were conglomerated cystic or multilocular and 5 (24%) were solid. On plain MDCT scan, the margin and internal detail of the lesions were not clear except for one cystic variety, while they were clearly demonstrated on enhanced images. Single or multiple cysts with different diameters were commonly detected in the non-solid lesions, and some of them were mutually connected with tortuous tract formation. Among the solid lesions, 2 and 3 showed tubular and homogeneous enhancement, respectively., Conclusion: Peripherally distributed lesions, mutually connected cysts with tortuous tract formation, and tubular enhancement, which may be closely associated with the infection route and migration of the worm, could be seen as the main MDCT features of hepatic paragonimiasis., (Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.)

Since the introduction of computed tomography (CT), detection of small lung cancer, especially small peripheral adenocarcinoma, is common. Recently, the morphological characteristics, including thin-section CT and pathologic findings, and prognosis of small peripheral lung adenocarcinomas have been studied extensively. The radiologic and microscopic findings correlate well with each other and are closely associated with tumour prognosis. Most importantly, some subtypes of small lung adenocarcinomas with specific CT or pathologic features are curable. Therefore, all defining characteristics (CT, pathologic and prognostic) of this kind of tumour should be integrated to improve our understanding, provide guidelines for management and accurately assess its prognosis.

Purpose: To clarify the differences of the carotid and cerebrovascular disease between patients with and without type 2 diabetes using dual-source CT angiography., Materials and Methods: Dual-source CT angiography of the carotid and cerebrovascular arteries was performed in 79 type 2 diabetic patients and 207 non-diabetic patients. The type, extent and distribution of plaques, and luminal stenosis were compared., Results: Compared with non-diabetic patients, diabetic patients had a higher overall incidence of plaque (p<0.05) and cerebral infarction (p<0.05). Among these plaques, no differences were observed in the subtype of plaques between these two cohorts (all p>0.05), as well as for the number of diseased segments and the distribution of plaques; both mainly involved the bilateral cavernous segment of the internal carotid artery. As for the stenosis, non-obstructive lesions were more common in diabetic patients (p<0.05). There was no difference in the segment number of stenosis (≥30% and ≥70%) between these two groups (all p>0.05)., Conclusion: Diabetes is associated with a higher incidence of plaque and non-obstructive stenosis. However, no significant differences were observed in the type, extent and distribution of involved plaques between diabetic and non-diabetic patients., (Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.)

Objective: In a massive earthquake, cranio-maxillofacial trauma was common. The present study was to determine the features of cranio-maxillofacial trauma sustained in the massive Sichuan earthquake by multi-detector row computed tomography (MDCT)., Methods: The study included 221 consecutive patients (123 males and 98 females; age range, 1-83 years; median age, 35 years) with cranio-maxillofacial trauma in the Sichuan earthquake, who underwent cranio-maxillofacial MDCT scans. The image data were retrospectively reviewed focusing on the injuries of the cranio-maxillofacial soft tissue, facial bones and cranium., Results: All patients had soft tissue injuries frequently with foreign bodies. Ninety-seven (43.9%) patients had fractures (1.5 involved sites per patient, range from 1 to 8) including single cranial fractures in 36 (37.1%) cases, single maxillofacial fractures were seen in 48 (49.5%) and cranio-maxillofacial fractures in 13 (13.4%). Single bone fracture was more common than multiple bone fractures (p<0.05). Nasal, ethmoid bones and the orbits were the most commonly involved sites of the craniofacial region. Thirty-eight (17.2%) patients had intracranial injuries, the commonest being subarachnoid haemorrhage and the commonest sites were the temporal and frontal regions. Coexisting intracranial injuries were more common in patients with cranial fractures than in patients with maxillofacial fractures (p<0.05)., Conclusion: Our results indicate that the cranio-maxillofacial trauma arising from the massive Sichuan earthquake had some characteristic features, and a significant number of individuals had the potential for combined cranial and maxillofacial injuries, successful management of which required a multidisciplinary approach., (Crown Copyright © 2010. Published by Elsevier Ltd. All rights reserved.)

Background: Perfusion CT is an attractive technique to assess tumor vascularity, and no studies have addressed the relationship between CT perfusion imaging and gastric tumor angiogenesis with volume-based technique. This study aims to assess the correlation between perfusion CT parameters using a volume-based technique and immunohistochemical markers of angiogenesis in gastric adenocarcinoma., Methods: 37 patients with gastric adenocarcinoma who completed whole tumor CT perfusion examination with volume-based technique were studied. Post surgical specimens were stained using a polyclonal antibody to VEGF and CD34. Perfusion measurements were correlated with microvessel density (MVD) and VEGF by using Pearson or Spearman rank correlation analysis, in which a P value < 0.05 was considered statistically significant., Results: The mean MVD of all 37 tumors was 108.9 ± 38.2 vessels/0.723 mm². 70.3% (26 of 37) of tumors expressed VEGF positively. MVD of gastric adenocarcinoma was significantly correlated with blood volume (the Pearson correlation coefficient being 0.420, P = 0.001). No correlations were found between VEGF expression and perfusion CT parameters. There were no significant differences in the parameters between the high and low MVD groups, and between the positive and negative VEGF groups., Conclusions: Blood volume was significantly correlated with MVD. It could reflect the angiogenesis in gastric adenocarcinoma.

Background: Plaque morphology directly correlates with risk of embolism and the recently developed dual-source computed tomography angiography (DSCTA) may help to detect plaques more precisely. The aim of our study was to evaluate the prevalence and morphology of carotid and cerebrovascular atherosclerotic plaques in patients with symptomatic type 2 diabetes mellitus (DM) by DSCTA., Methods: From July 2009 to August 2010, DSCTA was prospectively performed in 125 consecutive patients with symptomatic type 2 DM. We retrospectively analyzed plaque type, distribution, and extensive and obstructive natures were determined for each segment for all patients., Results: Atherosclerotic plaques were detected in 114 (91.2%) patients. Relatively more noncalcified (45%) and calcified (39%) plaques and less mixed (16%) plaques were observed (p < 0.001). Noncalcified plaques were found mainly in the intracranial arteries (81.8%), mixed plaques in the intracranial arteries (25.2%) and intracranial internal carotid artery (ICA) (56.1%). Calcified plaques were found mainly in the intracranial ICA (65.9%) and extracranial arteries (28.2%) (for all, p < 0.001). Extension of plaques from the 1(st) to 5(th) segments was observed in 67 (58.8%) patients and from the 6(th) to 10(th) segments in 35 (30.7%) patients. The most common site of all detected plaques was the cavernous segment. Regarding stenosis, there were significantly more nonobstructive than obstructive stenosis (91% vs. 9%, p < 0.001)., Conclusion: DSCTA detected a high prevalence of plaques in patients with symptomatic type 2 DM. A relatively high proportion of plaques were noncalcified, as well as with nonobstructive stenosis. The distribution of plaques was extensive, with the cavernous portion of ICA being the most common site.

Background: Coronary artery disease (CAD) is a common and severe complication of type 2 diabetes mellitus (DM). The aim of this study is to identify the features of CAD in diabetic patients using coronary CT angiography (CTA)., Methods: From 1 July 2009 to 20 March 2010, 113 consecutive patients (70 men, 43 women; mean age, 68 ± 10 years) with type 2 DM were found to have coronary plaques on coronary CTA. Their CTA data were reviewed, and extent, distribution and types of plaques and luminal narrowing were evaluated and compared between different sexes., Results: In total, 287 coronary vessels (2.5 ± 1.1 per patient) and 470 segments (4.2 ± 2.8 per patient) were found to have plaques, respectively. Multi-vessel disease was more common than single vessel disease (p < 0.001), and the left anterior descending (LAD) artery (35.8%) and its proximal segment (19.1%) were most frequently involved (all p < 0.001). Calcified plaques (48.8%) were the most common type (p < 0.001) followed by mixed plaques (38.1%). Regarding the different degrees of stenosis, mild narrowing (36.9%) was most common (p < 0.001); however, a significant difference was not observed between non-obstructive and obstructive stenosis (50.4% vs. 49.6%, p = 0.855). Extent of CAD, types of plaques and luminal narrowing were not significantly different between male and female diabetic patients., Conclusions: Coronary CTA depicted a high plaque burden in patients with type 2 DM. Plaques, which were mainly calcified, were more frequently detected in the proximal segment of the LAD artery, and increased attention should be paid to the significant prevalence of obstructive stenosis. In addition, DM reduced the sex differential in CT findings of CAD.

Objective: To investigate the profile of pelvic crush fractures in earthquake victims on digital radiography (DR) and multidetector computed tomography (MDCT)., Materials and Methods: One hundred and sixty-seven consecutive survivors of the 2008 Sichuan earthquake with pelvic crush fractures classified into types according to the Tile classification system, entered our study. One hundred and thirty-nine, and 28 patients underwent DR and MDCT scans, respectively. Data were reviewed retrospectively focusing on anatomical sites, numbers, and classification of pelvic ring fractures., Results: Pelvic fractures occurred in the pubis in 88 patients (52.7%), in other pelvic bones in 32 (19.16%), and in both the pubis and other pelvic bones in 47 (28.14%). Pubic fractures were more common than fractures of other pelvic bones, and involvement of bilateral pubis was more common than that of the left or right pubis (all p < 0.05). As for the numbers of pelvic bones involved, multiple fractures occurred in 48.52% patients (81 out of 167) composed predominantly of fractures of two bones in 58.02% (47 out of 81), and were seen more often in bilateral pubis than in any other pelvic bones (p < 0.05). Regarding classifications of pelvic ring fractures, they were Type A in 31 patients (18.56%); Type B in 72 (43.11%), predominantly Type B2 in 26 (15.58%) and Type B3 in 28 (16.77%); and Type C in 64 (38.32%), predominantly Type C3 in 40 (23.95%)., Conclusion: Pelvic crush fractures particularly including multiple pelvic fractures, occurring predominantly in bilateral pubis, and composed of Type C3 followed by Type B3 and Type B2, could be considered to be the profile of pelvic crush fractures in an earthquake.

Background: Perfusion CT has been applied in many clinical areas, but few studies have addressed gastric cancer. This study is to investigate the feasibility of first-pass perfusion CT with volume-based technique to assess microcirculation of gastric adenocarcinoma., Methods: Perfusion CT of gastric adenocarcinoma was performed with 64-section MDCT in 58 patients, which were subdivided into three subgroups according to the location of the tumor. Perfusion, peak enhancement, time to peak, and blood volume were computed in the tumor and in normal gastric wall. Mean values of perfusion parameters were compared between the tumor and normal stomach, between tumors with and without lymph node metastases, and between different stages., Results: Blood volume was significantly increased in gastric adenocarcinoma compared with normal stomach (19.75 +/- 14.74 vs. 13.59 +/- 11.46 mL/100 g, in total stomach, P = 0.004). A total of 10.55 mL/100 g of blood volume was employed as the cut-off value to discriminate the microcirculation of the tumor from that of the normal stomach. There were no significant differences of any perfusion parameters between the subgroups with and without lymph node metastases, or between early and advanced cancer., Conclusions: The first-pass perfusion CT with whole tumor acquisition technique is a feasible technique for quantifying tumor vascularity and angiogenesis in gastric adenocarcinoma.

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.)

Background: There are no reports regarding entire gastric fundic and esophageal varices evaluated with 64-row multidetector CT (MDCT). We attempt to clarify the feasibility of portal venography with this scanner in evaluation of these varices., Methods: A total of 33 patients, with clinically confirmed gastric fundic and esophageal varices secondary to posthepatitic cirrhosis, underwent thoracicoabdominal triphasic enhancement scans using 64-row MDCT along with conventional angiographic portography. CT portography and conventional portography were compared by statistical agreement to determine whether CT maximum intensity projection (CT-MIP) portography is useful in evaluation of entire gastric fundic and esophageal varices., Results: CT-MIP portography demonstrated gastric fundic and esophageal varices, and the inflowing and outflowing vessels of the varices. Gastric fundic varices were shown in 32 cases (97.0%), and esophageal varices were in 27 (81.8%). The inflowing vessels including the left gastric vein and posterior gastric vein/short gastric vein were illustrated in 31 (94.0%) and 17 (51.5%) cases, respectively. The outflowing vessels including the azygos vein, hemiazygos vein, and gastro-renal shunts were seen in 30 (90.9%), 8 (24.2%), and 12 (36.4%) cases, respectively. Findings of CT-MIP portography and conventional angiographic portography were in close agreement (Kappa value ranged from 0.621 to 1.000)., Conclusion: CT-MIP venography with 64-row MDCT could be considered as a method for detecting entire gastric fundic and esophageal varices developed from posthepatitic cirrhosis.

Introduction: In recent years, several massive earthquakes have occurred across the globe. Multidetector computed tomography (MDCT) is reliable in detecting spinal injuries. The purpose of this study was to compare the features of spinal injuries resulting from the Sichuan earthquake with those of non-earthquake-related spinal trauma using MDCT., Methods: Features of spinal injuries of 223 Sichuan earthquake-exposed patients and 223 non-earthquake-related spinal injury patients were retrospectively compared using MDCT. The date of non-earthquake-related spinal injury patients was collected from 1 May 2009 to 22 July 2009 to avoid the confounding effects of seasonal activity and clothing. We focused on anatomic sites, injury types and neurologic deficits related to spinal injuries. Major injuries were classified according to the grid 3-3-3 scheme of the Magerl (AO) classification system., Results: A total of 185 patients (82.96%) in the earthquake-exposed cohort experienced crush injuries. In the earthquake and control groups, 65 and 92 patients, respectively, had neurologic deficits. The anatomic distribution of these two cohorts was significantly different (P < 0.001). Cervical spinal injuries were more common in the control group (risk ratio (RR) = 2.12, P < 0.001), whereas lumbar spinal injuries were more common in the earthquake-related spinal injuries group (277 of 501 injured vertebrae; 55.29%). The major types of injuries were significantly different between these cohorts (P = 0.002). Magerl AO type A lesions composed most of the lesions seen in both of these cohorts. Type B lesions were more frequently seen in earthquake-related spinal injuries (RR = 1.27), while we observed type C lesions more frequently in subjects with non-earthquake-related spinal injuries (RR = 1.98, P = 0.0029)., Conclusions: Spinal injuries sustained in the Sichuan earthquake were located mainly in the lumbar spine, with a peak prevalence of type A lesions and a high occurrence of neurologic deficits. The anatomic distribution and type of spinal injuries that varied between earthquake-related and non-earthquake-related spinal injury groups were perhaps due to the different mechanism of injury.

Objective: To investigate features of crush extremity fractures associated with massive earthquake on digital radiography (DR) and multidetector computed tomography (MDCT)., Materials and Methods: Six hundred and twenty-three consecutive patients with clinically confirmed crush extremity fractures arising from the 2008 Sichuan earthquake were enrolled into our study. Six hundred and eleven patients with suggested extremity fractures underwent DR, and 12 patients with possible knee fractures underwent MDCT. Image data were retrospectively reviewed, with the focus on anatomic sites, numbers, and status of the fractures., Results: Extremity fractures occurred in lower extremities in 428 patients, upper extremities in 151, and both lower and upper extremities in 44. Lower extremity fractures were more common than upper extremity fractures (P < 0.05), and the commonly involved bones were the tibia and fibula in 141 patients, femur in 102, tibia in 52, and fibula in 40. According to the numbers of bones involved, multiple bone fractures occurred in 336 patients and included lower extremity fractures in 231, upper extremity fractures in 61, and both lower and upper fractures in 44. Multiple fractures in lower extremities were seen more often than in upper extremities (P < 0.05). As for status of the extremity fractures, comminuted fractures occurred in 324 patients and included lower extremity fractures in 248, upper extremity fractures in 51, and both lower and upper extremity fractures in 25. Comminuted fractures were more common in lower extremities than in upper extremities (P < 0.05)., Conclusion: Multiple and comminuted fractures, predominantly in the lower extremities, could be considered as features of crush extremity fractures associated with the massive Sichuan earthquake.

Quantitative values of left ventricular (LV) function and muscle mass in patients with mitral regurgitation are independent predictors of cardiac morbidity and mortality. The aim of this study was to prospectively evaluate whether 64-MDCT can assess the LV function in patients with mitral regurgitation with high accuracy when compared with the MRI and echocardiography results. Fifty-one patients with mitral regurgitation underwent retrospectively ECG-gated 64-MDCT, echocardiography, and MRI for assessing the global ventricular function. End-diastolic and end-systolic volume, stroke volume, ejection fraction, and mass were measured on 64-MDCT and echocardiography, and compared with the results measured on MRI which served as the reference standard. Intertechnique agreement was tested by using Pearson's correlation and Bland-Altman analyses. No significant differences were revealed in calculated LV function and mass between the 64-MDCT and MRI (paired t test, p = 0.07-0.53). Pearson's correlation analysis showed the functional parameters and mass correlated closely between the 64-MDCT and MRI (r = 0.89-0.96, p < 0.001). When compared with MRI, echocardiography underestimated the volumetric parameters of LV (paired t test, p = 0.0003-0.004), but significantly overestimated the EF values (p = 0.003), and moderate correlations of functional parameters were obtained (r = 0.78, 0.60, 0.81, and 0.62, respectively). ECG-gated 64-MDCT allows for accurate and reliable assessment of LV function in patients with mitral regurgitation, whereas LV volumes measured by two-dimensional echocardiography were underestimated and the ejection fraction was overestimated when compared with those achieved by using MRI.

Purpose: To evaluate the accuracy of 64-section multidetector computed tomography (CT) for the assessment of the severity of isolated mitral regurgitation by measuring ventricular volumetrics compared with those at magnetic resonance (MR) imaging and echocardiography., Materials and Methods: This study was approved by an institutional review board; patient informed consent was obtained. Forty-nine patients (22 men, 27 women; mean age, 39 years +/- 11 [standard deviation]) with isolated mitral regurgitation underwent retrospective electrocardiographically (ECG) gated 64-section CT, echocardiography, and MR imaging for the assessment of the severity of mitral regurgitation. Stroke volumes of the left and right ventricles were measured at 64-section CT and MR imaging. With these measurements, regurgitant volumes (RVs) and regurgitant fractions (RFs) were calculated and compared. The agreement between CT and MR imaging was tested by using linear regression and Bland-Altman analyses. RFs were compared with corresponding echocardiographic grades (grades I-IV) based on the absolute area of the regurgitation jet and in relation to the size of the left atrium by using Spearman rank order correlation and a weighted kappa test., Results: No significant differences were found in calculated RV and RF between 64-section CT and MR imaging (P = .56 and .87, respectively; paired t test). Regression analysis showed that 64-section CT correlated well with MR imaging for the measurement of RV (r = 0.89; 95% confidence interval [CI]: 0.81, 0.94) and for calculating the RF (r = 0.91; 95% CI: 0.84, 0.95). Bland-Altman analysis showed no significant differences in RV (bias, -1.0 mL) and RF (bias, 0.2%) between 64-section CT and MR imaging. The severity of regurgitation estimated by using echocardiography correlated well with that estimated by using 64-section CT (r = 0.95; 95% CI: 0.92, 0.97) and MR imaging (r = 0.94; 95% CI: 0.91, 0.96)., Conclusion: ECG-gated 64-section CT helps provide quantitative information with high accuracy for determining the severity of isolated mitral regurgitation.

Myopericytoma is a newly proposed subgroup of perivascular tumors in the World Health Organization classification of soft tissue tumors. In this study, we report a case of a benign myopericytoma with detailed multidetector CT (MDCT) findings in the parotid gland, a location that has not been described for this type of tumor previously. The clinical presentation, imaging features, histopathological and immunohistochemical findings, and the differential diagnosis with other tumors in the parotid gland are described and reviewed.

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.

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.

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.

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.

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.