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Objective: The purpose of the study was to analyze the anatomy and variations in the origin of the dorsal pancreatic artery, greater pancreatic artery and to study the various types of arterial arcades supplying the pancreas on multidetector CT (MDCT). Methods: A retrospective analysis of 747 MDCT scans was performed in patients who underwent triple phase or dual phase CT abdomen between December 2020 and October 2022. Variations in origin of Dorsal pancreatic artery (DPA), greater pancreatic artery (GPA), uncinate process branch were studied. Intrapancreatic arcade anatomy was classified according to Roman Ramos et al. into 4 types—small arcades (type I), small and large arcades (type II), large arcades (type III) and straight branches (type IV). Results: The DPA was visualized in 65.3% (n = 488) of cases. The most common origin was from the splenic artery in 58.2% (n = 284) cases. The mean calibre of DPA was 2.05 mm (1.0–4.8 mm). The uncinate branch was seen in 21.7% (n = 106) with an average diameter of 1.3 mm. The greater pancreatic artery was seen in 57.3% (n = 428) predominantly seen arising from the splenic artery. The most common arcade anatomy was of Type II in 52.1% (n = 63) cases. Conclusion: Pancreatic arterial variations are not very uncommon in daily practice. Knowledge of these variations before pancreatic surgery and endovascular intervention procedure is important for surgeons and interventional radiologist. [ABSTRACT FROM AUTHOR]

Variant arch anatomy may be seen associated with many congenital heart diseases. Its accurate preoperative identification is of paramount importance in optimal surgical planning of such cases. This case describes one such variant arch anatomy with two vessel right aortic arch, comprising of bicarotid trunk (giving rise to bilateral common carotid arteries) and right subclavian artery with isolation of the left subclavian artery, in a patient with tetralogy of Fallot. Right aortic arch with isolated left subclavian artery has already been described in association with tetralogy of Fallot. However, to the best of our knowledge, present arch pattern consisting of right aortic arch with bicarotid trunk and isolated left subclavian artery has not been reported in literature so far. Moreover, this case highlights the utility of multidetector computed tomography in accurate identification of variant arch anatomy in addition to delineation of cardiac and extracardiac details.

Variant arch anatomy may be seen associated with many congenital heart diseases. Its accurate preoperative identification is of paramount importance in optimal surgical planning of such cases. This case describes one such variant arch anatomy with two vessel right aortic arch, comprising of bicarotid trunk (giving rise to bilateral common carotid arteries) and right subclavian artery with isolation of the left subclavian artery, in a patient with tetralogy of Fallot. Right aortic arch with isolated left subclavian artery has already been described in association with tetralogy of Fallot. However, to the best of our knowledge, present arch pattern consisting of right aortic arch with bicarotid trunk and isolated left subclavian artery has not been reported in literature so far. Moreover, this case highlights the utility of multidetector computed tomography in accurate identification of variant arch anatomy in addition to delineation of cardiac and extracardiac details. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the role of dual-energy computed tomography (DECT) in the management of vertebral compression fractures in clinical practice. Materials and methods: This retrospective IRB-approved study included 497 consecutive patients with suspected acute vertebral fractures, imaged either by DECT (group 1) or MRI (group 2) before vertebroplasty. The site, number and type of fractures at imaging findings, and clinical outcome based on any change in pain (DELTA-VAS), before (VAS-pre) and after treatment (VAS-post), were determined and compared. Two radiologists evaluated DECT and MRI images (15 and 5 years of experience, respectively), and inter-observer and intra-observer agreement were calculated using k statistics. Results: Both in the control group (n = 124) and in the group of patients treated by vertebroplasty (n = 373), the clinical outcome was not influenced by the imaging approach adopted, with a DELTA-VAS of 5.45 and 6.42 in the DECT group and 5.12 and 6.65 in the MRI group (p = 0.326; p = 0.44). In the group of treated patients, sex, age, lumbar fractures, multiple fractures, previous fractures, Genant grade, involvement of anterior apex or superior endplates, and increased spinal curvatures were similar (p = ns); however, dorsal fractures were more prevalent in group 1 (p = 0.0197). Before treatment, the mean VAS-pre was 8.74 in group 1 (DECT) and 8.65 in group 2 (MRI) (p = 0.301), whereas after treatment, the mean VAS-post value was 2.32 in group 1 (p = 0.0001), and 2.00 in group 2 (p = 0.0001). The DELTA-VAS was 6.42 in the group of patients imaged using DECT and 6.65 in the group imaged using MRI (p = 0.326). Inter-observer and intra-observer agreement were 0.85 and 0.89 for DECT, and 0.88 and 0.91 for MRI, respectively. Conclusion: The outcome of vertebral compression fracture management was no different between the two groups of patients studied. [ABSTRACT FROM AUTHOR]

Context: Pancreatic masses are routinely encountered on imaging and often present as a diagnostic dilemma. These masses range from benign inflammatory masses, requiring no intervention to malignant masses, which carry grave prognosis and hence require aggressive management. Aims: Compare the diagnostic accuracy of 256 multislice CT and endoscopic ultrasound (EUS) in characterization and assessment of resectability of pancreatic masses and compare the multidetector computed tomography (MDCT) and EUS findings with histopathological findings. Settings and Design: Prospective study. Subjects and Methods: 36 patients with pancreatic masses were included who underwent dual phase CT using pancreatic protocol and EUS using 5–13 MHz transducer. Fine needle aspiration cytology (FNAC) was done wherever feasible. Parameters regarding tumor size, location, imaging morphology, and vessel involvement were recorded. Findings were compared with histopathological/operative diagnosis/clinical follow-up. Statistical Analysis Used: Descriptive statistics with percentages and proportions and Chi-square test. Results: Multidetector computed tomography (MDCT) and EUS established diagnosis consistent with tissue diagnosis in 30 (83%) and 22 (61%) patients, respectively. However, the best results were obtained with the combined use of MDCT and EUS. The number of patients categorized as inconclusive by MDCT were lower compared to EUS. Assessing resectability for pancreatic adenocarcinoma, MDCT showed specificity and positive predictive value (PPV) of 100% compared to EUS, which had specificity and PPV of 75% and 92.3%, respectively. MDCT is the first-line imaging modality in detection, characterization of pancreatic masses, and assessment of resectability in malignant neoplasms. EUS is beneficial in the detection of masses

Objective: The purpose of the study was to investigate the incidence of pancreatic contour variations on multidetector CT (MDCT) for abdominal examinations. Methods: A retrospective analysis of 700 MDCT scans was performed in patients who underwent triple phase CT abdomen between October 2018 and January 2021. After excluding 176 patients, finally total of 524 patients were included in the study. For simplification, we classified the pancreatic contour variations as classified by Ross et al. and Omeri et al. Pancreatic head–neck variations was classified into Type I-anterior, Type II-posterior and Type III-horizontal variety. Pancreatic body–tail variation was divided into Type Ia-anterior projection; Ib-posterior projection and Type IIa-globular, IIb-lobulated, IIc-tapered, and IId-bifid pancreatic tail. Results: The most common type of variation in the head was Type II (n = 112, 21.3%) followed by Type III (n = 37, 7%) and Type I (n = 21, 4%). The most common type of variation in the body of pancreas was Type Ia (n = 33, 6.2%) followed by Type Ib (n = 13, 2.4%). In the tail region of pancreas, the most common variation was Type IIb (n = 21, 4%) followed by Type IIa (n = 19, 3.6%). Conclusion: Pancreatic contour variations are not very uncommon in daily practice. Knowledge of these variations is important for surgeons, radiologists and avoids misjudgement of normal pancreatic tissue as tumor or lymph node especially on unenhanced or single phase MDCT. [ABSTRACT FROM AUTHOR]

Purpose To compare image quality, diagnostic performance, and conspicuity between single-energy and multi-energy images for endoleak detection at CT angiography (CTA) after endovascular aortic repair (EVAR). Materials and Methods In this single-center prospective randomized controlled trial, individuals undergoing CTA after EVAR between August 2020 and May 2022 were allocated to imaging using either low-kilovolt single-energy images (SEI; 80 kV, group A) or low-kiloelectron volt virtual monoenergetic images (VMI) at 40 and 50 keV from multi-energy CT (80/Sn150 kV, group B). Scan protocols were dose matched (volume CT dose index: mean, 4.5 mGy ± 1.8 [SD] vs 4.7 mGy ± 1.3, P = .41). Contrast-to-noise ratio (CNR) was measured. Two expert radiologists established the reference standard for the presence of endoleaks. Detection and conspicuity of endoleaks and subjective image quality were assessed by two different blinded radiologists. Interreader agreement was calculated. Nonparametric statistical tests were used. Results A total of 125 participants (mean age, 76 years ± 8; 103 men) were allocated to groups A ( n = 64) and B ( n = 61). CNR was significantly lower for 40-keV VMI (mean, 19.1; P = .048) and 50-keV VMI (mean, 16.8; P < .001) as compared with SEI (mean, 22.2). In total, 45 endoleaks were present (A: 23 vs B: 22). Sensitivity for endoleak detection was higher for SEI (82.6%, 19 of 23; P = .88) and 50-keV VMI (81.8%, 18 of 22; P = .90) as compared with 40-keV VMI (77.3%, 17 of 22). Specificity was comparable among groups (SEI: 92.7%, 38 of 41; both VMI energies: 92.3%, 35 of 38; P = .99), with an interreader agreement of 1. Conspicuity of endoleaks was comparable between SEI (median, 2.99) and VMI (both energies: median, 2.87; P = .04). Overall subjective image quality was rated significantly higher for SEI (median, 4 [IQR, 4-4) as compared with 40 and 50 keV (both energies: median, 4 [IQR, 3-4]; P < .001). Conclusion SEI demonstrated higher image quality and comparable diagnostic accuracy as compared with 50-keV VMI for endoleak detection at CTA after EVAR. Keywords: Aneurysms, CT, CT Angiography, Vascular, Aorta, Technology Assessment, Multidetector CT, Abdominal Aortic Aneurysms, Endoleaks, Perigraft Leak Supplemental material is available for this article . © RSNA, 2024.

Cerebrospinal fluid leaks pose a serious threat to patients as they represent an unchecked communication between the subarachnoid space and the extracranial environment. Accurate localization of the leakage site is essential for treatment planning. We describe the novel utilization of dual-energy computed tomography technology in cisternography in the evaluation of a patient with a cerebrospinal fluid leak.

INTRODUCTION: To evaluate whether or not obtaining low-dose and high quality images in the paranasal sinus CT imaging using 320-row multidetector CT technique on phantom study. METHODS: Twenty phantom examinations were conducted with different settings of the tube voltage (135, 120, 100, 80 kV) and current. Dose measurements were derived from the study protocol as volume CT dose index (CTDIvol) and dose-length product (DLP). Image qualities of all the phantom images were assessed using a five-point scale (1: non-diagnostic to 5: excellent image quality) by observer 1 and 2. RESULTS: We obtained the lowest radiation dose in using 80 kVp and 2.5 mAs (CTDIvol: 0.2 mGy, DLP: 2.5 mGy x cm) phantom CT protocol and the highest radiation dose in using 120 kVp and 75 mAs (CTDIvol: 13.7 mGy, DLP: 191.2 mGy x cm) phantom CT protocol(p

Purpose: To compare the diagnostic performance of multidetector computed tomography (MDCT), magnetic resonance imaging (MRI), and MRI with diffusion-weighted imaging (DWI) in the characterization of focal renal lesions. We also compared MDCT and MRI in the staging of renal cell carcinoma (RCC). Materials and Methods: One hundred and twenty adult patients underwent MDCT (40-row and 128-row scanners), MRI (at 1.5 T), and DWI (at b-values of 0 and 500 s/mm2) for characterization of 225 renal lesions. There were 65 malignant neoplasms (44 RCCs), 25 benign neoplasms, 25 abscesses, 45 pseudotumors, 15 hemorrhagic cysts, and 50 benign cysts. A composite gold standard including histology, typical imaging criteria, and follow-up imaging was employed. To determine the diagnostic performance of imaging modalities, area-under-curve (AUC) was calculated by receiver-operating-characteristic analysis and compared. Fisher’s exact test was used to compare the diagnostic accuracies and confidence levels with MDCT, MRI, and MRI + DWI. Cross-tabulation was used to assess the precision of MDCT and MRI in RCC staging. Results: AUC for MDCT (0.834) and MRI (0.841) in the classification of benign and malignant lesions were within corresponding 95% confidence interval (CI) (P = 0.88) whereas MRI + DWI had significantly better performance (AUC 0.968, P = 0.0002 and 0.0004, respectively). Both CT and MRI had low specificity (66.9% and 68.8%, respectively), which increased substantially with DWI (93.8%) owing to correct diagnosis of pseudotumors. MRI was superior to CT in diagnosing necrotic RCC and hemorrhagic cysts. MRI + DWI had the highest accuracy (94.2%) in assigning the definitive diagnosis and 97.6% lesions were diagnosed with very high confidence, significantly better than CT and MRI. Both CT and MRI had the same accuracy (86.1%) in RCC staging and evaluation of intravascular thrombi. Conclusions: Characterization of renal lesions was most accurate with MRI + DWI. The latter is also the most suitable modality in diagnosing pseudotumors and evaluating patients with renal dysfunction. CT and MRI were equivalent in RCC staging.

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Hemoptysis due to saphenous venous graft (SVG) aneurysm is an extremely rare condition and published literature has described the role of conservative management, surgical resection, and covered stent. Here, we report a successful placement of a covered stent for SVG aneurysm in a 56-year-old male who presented with hemoptysis. He was a known diabetic and had undergone a coronary artery bypass grafting 5 years ago. Computed tomography (CT) chest and fiberoptic bronchoscopy performed in another local hospital had revealed blood in the left lingula with spillover into the left lung parenchyma. Hence, he had received empirical anti-tuberculosis medication for 2 months without any improvement. He was referred to our hospital for further management of hemoptysis. Multidetector CT (MDCT) angiography of the chest covering coronaries performed at our hospital revealed SVG aneurysm that was managed with covered stent placement. [ABSTRACT FROM AUTHOR]

Duodenal pathology is an infrequent cause of acute abdominal pain for which patients present to the emergency department. Critical pathology on multidetector CT (MDCT) may be overlooked if the radiologist does not carefully evaluate the duodenum as part of the search pattern. Optimal MDCT protocols include intravenous contrast with multiplanar reconstructions (MPRs). A variety of etiologies ranging from infection to malignancy can involve the duodenum, for which interrogation with MPRs is most helpful given the anatomy and complex relationship with surrounding structures. The purpose of this review article is to highlight the importance of CT acquisition with multiplanar reconstructions and review the spectrum of emergent duodenal pathology, with the goal of ensuring accurate and timely diagnosis to best guide patient management. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to assess if ultra-low-dose CT is a useful clinical alternative to digital radiographs in the evaluation of acute wrist and ankle fractures.Materials and Methods: An ultra-low-dose protocol was designed on a 256-slice multi-detector CT. Patients from the emergency department were evaluated prospectively. After initial digital radiographs, an ultra-low-dose CT was performed. Two readers independently analyzed the images. Also, the radiation dose, examination time, and time to preliminary report was compared between digital radiographs and CT.Results: In 207 extremities, digital radiography and ultra-low-dose CT detected 73 and 109 fractures, respectively (p < 0.001). The odds ratio for fracture detection with ultra-low-dose CT vs. digital radiography was 2.0 (95% CI, 1.4-3.0). CT detected additional fracture-related findings in 33 cases (15.9%) and confirmed or ruled out suspected fractures in 19 cases (9.2%). The mean effective dose was comparable between ultra-low-dose CT and digital radiography (0.59 ± 0.33 μSv, 95% CI 0.47-0.59 vs. 0.53 ± 0.43 μSv, 95% CI 0.54-0.64). The mean combined examination time plus time to preliminary report was shorter for ultra-low-dose CT compared to digital radiography (7.6 ± 2.5 min, 95% CI 7.1-8.1 vs. 9.8 ± 4.7 min, 95% CI 8.8-10.7) (p = 0.002). The recommended treatment changed in 34 (16.4%) extremities.Conclusions: Ultra-low-dose CT is a useful alternative to digital radiography for imaging the peripheral skeleton in the acute setting as it detects significantly more fractures and provides additional clinically important information, at a comparable radiation dose. It also provides faster combined examination and reporting times. [ABSTRACT FROM AUTHOR]

The purpose of this study was to compare, using the same radiation dose and image quality metrics, flat panel computed tomography (FPCT) to multidetector CT (MDCT) in interventional radiology. A single robotic angiography system with FPCT was compared to a single MDCT system, both installed in a hybrid CT‐angiography laboratory and both operating under automatic exposure control. Radiation dose was measured on the central axis (Dc) of a CT dosimetry phantom 30 cm in diameter and 60 cm in length using default protocols for FPCT and MDCT with the imaged length in MDCT matched to the field of view of FPCT. The noise power spectrum (NPS), modulation transfer function (MTF), and z‐axis resolution were measured using the same phantom. Iodine contrast to noise ratio (CNR) was also measured. Radiation dose (Dc) was 41%–69% lower in MDCT compared to FPCT when default protocols and automatic exposure control were used. While spatial resolution could generally be matched with appropriate choice of kernel in MDCT, MTF dropped more quickly at higher spatial frequency for MDCT than FPCT. Image noise was 49%–120% higher for MDCT compared to FPCT for comparable in‐plane spatial resolution. Z‐axis resolution was slightly better for MDCT than FPCT, while iodine CNR depended on protocol selection. Radiation dose was much lower for MDCT compared to FPCT, but image noise was much higher. Matching image noise in MDCT to FPCT would result in similar radiation doses. Iodine contrast depended on dose modulation settings for MDCT. [ABSTRACT FROM AUTHOR]

Virtual colonoscopy (CTC) is considered investigational or experimental, for patients with inflammatory bowel disease, including Crohn’s, ulcerative colitis, or diverticulitis and cancerous lesions. CTC has several advantages over colonoscopy. It is more comfortable for the patient, does not require sedation (so there is no anesthetic risk like in colonoscopy), and does not disqualify any patients for certain medical reasons, as colonoscopy sometimes does. CTC also requires less time to complete and return to normal activities than colonoscopy, it carries no risk of surgical complications. CT colonography is highly sensitive for colorectal cancer, especially when both cathartic and tagging agents are combined in the bowel preparation. Given the relatively low prevalence of colorectal cancer, primary CT colonography is more suitable than conventional colonography for initial investigation of suspected colorectal cancer, assuming reasonable specificity. [ABSTRACT FROM AUTHOR]

Echocardiography is considered as an initial imaging modality of choice in patients with congenital heart disease (CHD), and magnetic resonance (MR) imaging is preferred for detailed functional information. Multi-detector computed tomography (CT) plays an important role in clinical practice in assessing post-operative morphological and functional information of patients with complex CHD when echocardiography and MR imaging are not contributory. Radiologists should understand and become familiar with the complex morphology and physiology of CHD, as well as with various palliative and corrective surgical procedures performed in these patients, to obtain CT angiograms with diagnostic quality and promptly recognise imaging features of normal post-operative anatomy and complications of these complex surgeries.

The article presents a case study of a 59-year-old male with nose neoplasm. Topics include reporting no previous medical and family history of cardiac disease or trauma; subsequent chest computed tomographic (CT) scan with and without contrast showing a thrombosed aneurysm; and cross-sectional imaging like CT or magnetic resonance imaging(MRI) increasingly carried out for the preoperative evaluation of SVA.

Objectives: Computer tomography (CT) is the most widely used diagnostic modality in the routine evaluation of distant metastatic disease. We aimed to evaluate the role of Multidetector CT (MDCT) in local staging of cervical malignancies. Patients and methods: In this prospective study 26 patients with pathologically proven cervical malignancies performed postcontrast MDCT of the abdomen and pelvis for local staging. Reconstruction of images was performed in the workstation. In a sample of 12 patients an extended study in which delayed images were obtained for more accurate ureteric evaluation. Data were analyzed using SPSS and McNemar test was used to calculate accuracy. Results: The overall accuracy of CT was 61.5% excluding the discrepancy in staging between CT and examination under anesthesia (EUA) due to distant metastases (three cases had distant metastases in CT which was not evaluated in EUA). This value was raised to 77% if vagina was assessed clinically rather than by CT. Conclusion: In cervical cancer; CT gave better results in staging of advanced cases than in early staged ones. Local staging was improved by acquisition of delayed scans.

Background: PTPE is a significant complication and te main cause for 2–10% of victims. MDCT is increasingly used. Our study is an analysis focused on the anatomy of pleura, principles behind fluid formation/reabsorption and imaging approach to assessing pleural effusion and PTPE under-CT evacuation. Material and methods: The study is conducted on eight (8) patients with PTPE at University Hospital of Trauma, University Hospital– “Mother Theresa”, University Hospital “ Shefqet Ndroqi” in Tirana, during the period, January 2015 – June 2018, by using a MDCT of 128 slice – 64 detector – dual source, SIEMENS, German machine. Results and conclusions: The frequency of post-traumatic pleural injuries with presence of Hydrothorax is 75.6 % in total; second after that of Chest wall injuries (94.2 %). Among the variable forms are reported Hemothorax – 17.4 % and Pneumothorax – 7.3 %. Empyema is rare – 2 %. MDCT is the most sensitive, specific, and accurate imaging modality in the assessment of PTPE and management of patients: • demonstrates the significant disorder in patients with normal initial radiographs, • indicates changing of management in up to 20% of cases with abnormal initial radiographs, • assists several micro-invasive procedures in order to prevents development of empyema, • enables early prediction of respiratory compromise and limits the severe invasive interventions.

Purpose: The aim of this study was to develop and validate a computational clinical decision support system (DSS) on the basis of CT radiomics features for the prediction of lymph node (LN) metastasis in gastric cancer (GC) using machine learning-based analysis.Methods: Clinicopathologic and CT imaging data were retrospectively collected from 490 patients who were diagnosed with GC between January 2002 and December 2016. Radiomics features were extracted from venous-phase CT images. Relevant features were selected, ranked, and modeled using a support vector machine classifier in 326 training and validation data sets. A model test was performed independently in a test set (n = 164). Finally, a head-to-head comparison of the diagnostic performance of the DSS and that of the conventional staging criterion was performed.Results: Two hundred ninety-seven of the 490 patients examined had histopathologic evidence of LN metastasis, yielding a 60.6% metastatic rate. The area under the curve for predicting LN+ was 0.824 (95% confidence interval, 0.804-0.847) for the DSS in the training and validation data and 0.764 (95% confidence interval, 0.699-0.833) in the test data. The calibration plots showed good concordance between the predicted and observed probability of LN+ using the DSS approach. The DSS was better able to predict LN metastasis than the conventional staging criterion in the training and validation data (accuracy 76.4% versus 63.5%) and in the test data (accuracy 71.3% versus 63.2%) CONCLUSIONS: A DSS based on 13 "worrisome" radiomics features appears to be a promising tool for the preoperative prediction of LN status in patients with GC. [ABSTRACT FROM AUTHOR]

It is obligatory in terms of the law and social reforms to establish post-mortem identity. The study of anthropometric characteristics aids in solving the problems related to identification. It has been reported that maxillary sinuses remain intact and well protected. That is the reason that maxillary sinuses can be used for identification. Best part of investigating maxillary sinuses is that the width, length, and height of maxillary sinus together can be used for sex determination when the whole skeleton is not available. The data used in this study was obtained from patients who underwent CT scan examination of PNS in the radiology department of EKO Imaging Institute .The data consists of 50 individuals from 17 years age to 73 years age. The sample consisted of 35 males and 15 females. Discriminant function analysis was used. Df=0.199 right antero posterior -0.044 left antero posterior -0.291 right transverse +0.105 left transverse +0.406 right cephalocaudal -0.125 left cephalocaudal +0.295 right sag -0.277left sag -13.264 (Constant). The classification characteristics show that 82% of original cases were correctly classified; It is possible to predict sex with 80% accuracy cases in contemporary Bengali adult population from the measurements of maxillary sinus. Accuracy rate in prediction was more in females. Age however could not be estimated from this preliminary study. This database built on radiological data can be used by extrapolation for use in fragmentary remains in mutilated or decomposed bodies. [ABSTRACT FROM AUTHOR]

Objective: We prospectively evaluate multidetector computed tomography (MDCT) criteria of internal hernia, and related complication as intestinal strangulation. Methods: 27 patients presented to emergency department with acute small bowel obstruction (ASBO) and diagnosed with MDCT as IH were included. Validity of different MDCT criteria in diagnosing IH was compared with surgical diagnosis. Results: Surgical diagnosis was 22 patients with IH (14 paraduodenal and 8 transmesenteric hernia) and 5 false positive cases. There was excellent agreement between MDCT and surgery in diagnosing paraduodenal hernia (k = 1), and good agreement in diagnosing transmesenteric hernia (k = 0.624). Significant MDCT criteria include the following: cluster of small-bowel (p

Background: Recurrent ischemic symptoms after coronary stenting require imaging assessment to rule-out in-stent restenosis or occlusion. Aim: To evaluate role of multi-detector computed tomography in assessment of coronary artery stents. Patients and methods: Twenty-four patients were referred to assess coronary stents. All were subjected to history taking, clinical examination and computed tomography angiography of coronary arteries using 320-row multi-detector computed tomography. Results: There were totally sixty-three coronary artery stents. Only six stents were non-interpretable. Where forty-eight patent, while nine stents showed in-stent restenosis of significant degree (⩾50%), most stents 3.0 mm diameter. Conclusion: Multi-detector computed tomography is considered convenient and reliably non-invasive imaging modality for assessment of suspected coronary stents with large diameter.

Objective: To assess the accuracy of MDCT in diagnosis and preoperative evaluation of alternatives of acute appendicitis causing RLQP and associated complications. Patients and methods: 350 consecutive patients (250 males and 100 females) with ARLQP underwent MDCT examinations with contrast. Each scan was evaluated independently for the presence of inflammatory process (appendicitis), associated complications and for the detection of other findings rather than acute appendicitis causing RLQP. The radiological findings were compared with histopathological results for operated cases. Results: 146 typical cases out of 350 patients received CT diagnosis of acute appendicitis, 62 with complications such as appendicular abscess (n = 32), appendicolith (n = 7), mucocele (n = 15), retrocecal appendix (n = 5), and retroileal appendix (n = 3); 63 patients received nonappendicular GIT causes, and 79 patients received alternative diagnosis of extra-GIT causes; patients who were operated upon based on either clinical diagnosis or US findings or both, with negative CT findings and pregnant women were excluded from the study. Conclusion: MDCT can be used effectively in the preoperative evaluation of appendicitis, provides high accuracy for detecting complications, detects other findings causing RLQP, and better guides physicians for proper management of these patients.

Purpose: This study aimed to assess the role of MDCT in evaluation and management of blunt splenic injury. Patients and methods: We retrospectively traced clinical data of patients who underwent MDCT for suspected blunt traumatic intra-abdominal injuries and were admitted in general surgery department of Nizwa Hospital, Oman, during period from March 2012 to February 2013. 44 patients were found to have splenic injuries that were verified either during laparotomy or with clinical notes during hospital stay. The initial MDCT findings were correlated with the final diagnosis and management of the patients. Results: The 44 splenic injuries were classified according to American Association for Surgery of Trauma (AAST) grading scales, and 32 of them (72.7%) underwent non-operative management. Of the 7 patients with contrast material extravasation (CME), all underwent spleen-related laparotomy (100%) and demonstrated active bleeding during surgery. Only 5 of the remaining 37 patients without CME (13.5%) required spleen-related laparotomy. The difference was statistically significant (p

Introduction: MDCT pulmonary angiography is the method of choice for the detection of pulmonary embolism (PE). The severity of PE as estimated by the obstruction index (OI) and right ventricular dysfunction (RVD) can be evaluated with MDCT. Objective: To investigate the correlation between the OI, RVD and clinical presentation in patients with acute PE. Methods: Among 70 patients with suspected PE, 35 patients proved to have PE with MDCT. The CT OI and the RV/LV diameter (RVD-ratio) using the four-chamber view of the heart were calculated for PE patients. The cut-off for the OI to detect RVD was constructed using ROC curve. Results: Dyspnea and RVD (RVD-ratio >1) were significantly more common in patients with central pulmonary emboli. The mean OI (35% ± 19%) was significantly higher in patients with dyspnea, tachycardia and obesity. A positive correlation was found between the OI and both the CT pulmonary artery diameter (r = 0.66, p 43% identified more than 90% of patients with RVD (area under the curve on ROC analysis: 0.825; p 43% proved to be an independent predictor of RVD.

Background/Aim: To retrospectively assess the accuracy of intravenous (IV) contrast-enhanced multidetector CT (MDCT) in choledocholithiasis detectability, in the presence and absence of positive intraduodenal contrast. Patients and Methods: Over a 3-year period, patients in whom endoscopic retrograde cholangiopancreatography (ERCP) was performed within a week from a portovenous (PV)-enhanced abdominal CT were identified. The final cohort consisted of 48 CT studies in which the entire common bile duct (CBD) length was visualized (19 males, 29 females; mean age, 68 years). We identified two groups according to the absence (n = 31) or presence (n = 17) of positive intraduodenal contrast. CT section thickness ranged from 1.25 to 5 mm. Two radiologists, blinded to clinical information and ERCP results, independently evaluated the CT images. Direct CBD stone visualization was assessed according to previously predefined criteria, correlating with original electronic CT reports and using ERCP findings as the reference standard. A third reader retrospectively reviewed all discordant results. The diagnostic performances of both observers and interobserver agreement were calculated for both groups. Results: 77%–88% sensitivity, 50%–71% specificity, and 71%–74% accuracy were obtained in the group without positive intraduodenal contrast, versus 50%–80% sensitivity, 57%–71% specificity, and 59%–71% accuracy in the group with positive intraduodenal contrast. With the exception of the positive predictive value (PPV), all diagnostic performance parameters decreased in the positive intraduodenal contrast group, mostly affecting the negative predictive value (NPV) (71%–78% vs 50%–67%). Conclusion: PV-enhanced MDCT has moderate diagnostic performance in choledocholithiasis detection. A trend of decreasing accuracy was noted in the presence of positive intraduodenal contrast.

Multiphasic multidetector computed tomographic angiography is a standard diagnostic test for canine abdominal vascular disorders. Three imaging protocols have been previously described. The test‐bolus protocol allows precise timing but can be time consuming to perform. Bolus‐tracking software is fast and easy to use but can be problematic for exact timing of vascular phases. A recently described fixed‐injection‐duration protocol is not influenced by body weight and provides a wider temporal window for arterial acquisitions. Objectives of this retrospective and prospective, multicentric, method comparison study were to determine which of the three multidetector computed tomographic angiography protocols allows best vascular conspicuity of the canine abdomen and to assess the influence of different multidetector computed tomography (CT) scanners on study quality. Triple‐phase multidetector computed tomographic angiography canine abdominal studies from 30 dogs were retrospectively retrieved from three different institutions. Each institution performed one of the three computed tomographic angiography protocols (4‐row and 16‐row multidetector CT). Prospectively, the three protocols were also acquired with similar conditions on a 64‐row MDCT in 21 dogs. Main abdominal vessels were scored by blinded readers for each phase. The fixed‐injection‐duration protocol had the best combined arterial and portal vascular conspicuity on scanners of limited speed, while the test‐bolus protocol provided the best overall vascular conspicuity on 64‐row multidetector CT scanner. The quality of arterial studies performed on 64‐row MDCT scanner was improved compared to the ones performed on four‐ to 16‐row multidetector CT scanners. Findings supported the fixed‐injection‐duration protocol as the best compromise between an ideal portal vascular enhancement and an easily reproducible protocol on scanners with low and high number of detector rows. [ABSTRACT FROM AUTHOR]

Purpose: In the clinic, computed tomography (CT) has evolved into an essential modality for diagnostic imaging by multidetector row CT (MDCT) and image guided intervention by cone beam CT (CBCT). Recognizing the increasing importance of axial MDCT/CBCT in clinical and preclinical applications, and the existence of CB artifacts in MDCT/CBCT images, we provide a review of CB artifacts’ root causes, rendering mechanisms and morphology, and possible solutions for elimination and/or reduction of the artifacts. Methods: By examining the null space in Radon and Fourier domain, the root cause of CB artifacts (i.e., data insufficiency) in axial MDCT/CBCT is analytically investigated, followed by a review of the data sufficiency conditions and the “circle +” source trajectories. The rendering mechanisms and morphology of CB artifacts in axial MDCT/CBCT and their special cases (e.g., half/short scan and full scan with latitudinally displaced detector) are then analyzed, followed by a survey of the potential solutions to suppress the artifacts. The phenomenon of imaged zone indention and its variation over FBP, BPF/DBPF, two‐pass and iterative CB reconstruction algorithms and/or schemes are discussed in detail. Results: An interdomain examination of the null space provides an insightful understanding of the root cause of CB artifacts in axial MDCT/CBCT. The decomposition of CB artifacts rendering mechanisms facilitates understanding of the artifacts’ behavior under different conditions and the potential solutions to suppress them. An inspection of the imaged zone intention phenomenon provides guidance on the design and implementation of CB image reconstruction algorithms and schemes for CB artifacts suppression in axial MDCT/CBCT. Conclusions: With increasing importance of axial MDCT/CBCT in clinical and preclinical applications, this review article can update the community with in‐depth information and clarification on the latest progress in dealing with CB artifacts and thus increase clinical/preclinical confidence. [ABSTRACT FROM AUTHOR]

Introduction: CT is the gold standard for visualizing renal and ureteral calculi. CT three-dimensional reformatting allows for automatic, accurate, and reliable measurement of stone size, volume, density, and location. In this study, we aimed to develop and test a software platform capable of calculating a battery of clinically important urinary stone parameters at the point-of-care (POC). Methods: The syngo Calcium Scoring (Siemens Corporation) algorithm was modified to identify calcium-based stones using an attenuation threshold (250 HU) within a region of interest. Information automatically obtained after reconstruction included voxel sum and calculated volume, maximum diameter, largest diameter in the x, y, and z planes, cumulative diameter, distribution of attenuation in HU, and position relative to the skin for calculation of the skin-to-stone distance (SSD). This algorithm was packaged into a stand-alone application (MATLAB 9.1). From April 2017 to May 2017, all patients undergoing a noncontrast CT of the abdomen or the abdomen and pelvis at the Johns Hopkins Hospital were eligible for inclusion in this validation cohort. Results: A total of 55 index renal stones were included. The mean volume calculated by voxel sum was 216.53mm3 (standard deviation [SD] -616.19, range 1.50-4060.13). The mean volume calculated using the Ackermann's formula and for a sphere was 232.96mm3 (SD±702.65, range 1.24-4074.04) and 1214.63mm3 (SD±4233.41, range 1.77-25,246.40), respectively. The mean largest diameter in any one direction was 6.95mm (SD±7.31, range 1.50-36.40). The maximum density of the stones ranged from 164 to 1725 HU. The mean SSD at the shortest possible point was 14.19 cm (SD±6.13, range 6.67-31.28). Conclusions: We developed a stand-alone platform with a simple easy-to-use interface, which will allow any user the ability to calculate a battery of clinically important urinary stone parameters from CT imaging at the POC. This program is now freely available online. [ABSTRACT FROM AUTHOR]

Background: virtual hysterosalpingography is a novel, noninvasive modality that combines the capabilities of multidetector CT with the established technique of hysterosalpingography to allow a simultaneous non-invasive evaluation of the entire uterine wall, uterine cavity, cervix and Fallopian tubes. The evaluation of the para-uterine pelvic structures is considered as a great advantage of the procedure that can be an alternative diagnostic technique in the infertility workup algorithm. Virtual hysterosalpingography with the reconstruction of twodimensional, three-dimensional, and virtual endoscopic views allows a comprehensive evaluation of the female reproductive system with a single imaging test, it gives well-appointed anatomic information and a detailed characterization of the different pathologic processes. In comparison with HSG, US and MR imaging techniques that have been used for the diagnostic work-up of female infertility; virtual hysterosalpingography provides more detailed information about abnormalities of the cervix, uterus, Fallopian tubes and other pelvic structures and it may allow a more accurate evaluation of tubal patency. However, the resultant exposure of the patient to ionizing radiation is a relative disadvantage that must be weighed against the clinical purpose. Aim of the work: this study aimed to evaluate the role of virtual CT hysterosalpingography as a new noninvasive modality for the assessment of the uterus and the Fallopian tubes abnormalities. Conclusion: VHSG has the ability to integrate most of the advantages of the diagnostic studies methods in the diagnosis and evaluation of the infertile female. Whether it should completely replace the use of standard conventional HSG among the infertile females, or be used as a back up to HSG and indicated when questionable or abnormal findings are encountered. [ABSTRACT FROM AUTHOR]

Purpose: To compare the diagnostic performance of multidetector computed tomography (MDCT), magnetic resonance imaging (MRI), and MRI with diffusion-weighted imaging (DWI) in the characterization of focal renal lesions. We also compared MDCT and MRI in the staging of renal cell carcinoma (RCC). Materials and Methods: One hundred and twenty adult patients underwent MDCT (40-row and 128-row scanners), MRI (at 1.5 T), and DWI (at b-values of 0 and 500 s/mm2) for characterization of 225 renal lesions. There were 65 malignant neoplasms (44 RCCs), 25 benign neoplasms, 25 abscesses, 45 pseudotumors, 15 hemorrhagic cysts, and 50 benign cysts. A composite gold standard including histology, typical imaging criteria, and follow-up imaging was employed. To determine the diagnostic performance of imaging modalities, area-under-curve (AUC) was calculated by receiver-operating-characteristic analysis and compared. Fisher's exact test was used to compare the diagnostic accuracies and confidence levels with MDCT, MRI, and MRI + DWI. Cross-tabulation was used to assess the precision of MDCT and MRI in RCC staging. Results: AUC for MDCT (0.834) and MRI (0.841) in the classification of benign and malignant lesions were within corresponding 95% confidence interval (CI) (P = 0.88) whereas MRI + DWI had significantly better performance (AUC 0.968, P = 0.0002 and 0.0004, respectively). Both CT and MRI had low specificity (66.9% and 68.8%, respectively), which increased substantially with DWI (93.8%) owing to correct diagnosis of pseudotumors. MRI was superior to CT in diagnosing necrotic RCC and hemorrhagic cysts. MRI + DWI had the highest accuracy (94.2%) in assigning the definitive diagnosis and 97.6% lesions were diagnosed with very high confidence, significantly better than CT and MRI. Both CT and MRI had the same accuracy (86.1%) in RCC staging and evaluation of intravascular thrombi. Conclusions: Characterization of renal lesions was most accurate with MRI + DWI. The latter is also the most suitable modality in diagnosing pseudotumors and evaluating patients with renal dysfunction. CT and MRI were equivalent in RCC staging. [ABSTRACT FROM AUTHOR]