Background: In 2010, the International Atomic Energy Agency launched the “3A’s campaign” as an effective tool for primary cancer prevention. In 2011, the American Association of Physicists in Medicine recommended t...Background: In 2010, the International Atomic Energy Agency launched the “3A’s campaign” as an effective tool for primary cancer prevention. In 2011, the American Association of Physicists in Medicine recommended the size specific dose estimate (SSDE). Objectives: To audit doses of Coronary CT Angiography (Coronary CTA) in tertiary care referral center. Methods: We reviewed 998 consecutive Coronary CTA (from 2007 to 2012). Doses (CTDIvol mGy), DLP (mGy*cm), effective dose (DLP*0.014, mSv) were on-line archived. SSDE was estimated retrospectively. Appropriateness score was evaluated for exams performed from the 2010. Results: Overall median dose per Coronary CTA was 49.7 mGy for CTDIvol, 55.5 mGy for SSDE, 994.96 mGy*cm for DLP, 13.9 mSv for effective dose. Median DLP decreased over time (1452.94 in 2007, 1605.56 in 2008, 1113.49 in 2009, 759.99 in 2010, 448.61 in 2011 and 497.88 mGy*cm in 2012, p < 0.0001). SSDE was proportional to the size dependent factor (SDF);in patients with SDF > 1 (88%) CTDIvol underestimated SSDE (48.49 vs 57.19 mGy), whilst in patients with SDF < 1 (12%) CTDIvol overestimated SSDE (56.46 vs 50.3 mGy). Scans were appropriate in 58%, uncertain in 24%, and inappropriate in 18% of cases. Doses were similar in appropriate, uncertain or inappropriate examinations and in excellent-to-good (81%) vs. sufficient-to-poor (19%) image quality exams. Conclusions: Coronary CTA reference doses can be very misleading. SSDE can allow individual technique optimization. The dose is similar in appropriate and inappropriate examinations, and unrelated to image quality. The rate of inappropriate examinations is still too high even after dissemination of guidelines.展开更多
Objectives To compare the different patterns of coronary artery calcification (CAC) in acute and chronic coronary syndromes utilizing electron beam computed tomography. Background Pathologic, angiographic, and intraco...Objectives To compare the different patterns of coronary artery calcification (CAC) in acute and chronic coronary syndromes utilizing electron beam computed tomography. Background Pathologic, angiographic, and intracoronary ultrasound studies revealed sharp differences in the plaque morphology between patients with acute versus chronic coronary syndromes. Whether there are different patterns of coronary artery calcification in patients with stable angina pectoris (SAP) and in those with unstable angina pectoris (UAP) or acute myocardial infarction (AMI), however, remains unclear. Methods Two hundred and sixty - four patients, including 67 with SAP, 94 with UAP and 103 with AMI were studied with electron beam computed tomography for analysis of coronary artery calcification and with selective coronary angiography for determination of atherosclerotic lesions. CAC prevalence and calcium score were compared among three groups, and relation of CAC to the severity of atherosclerotic disease in the SAP and UAP patients was separately analyzed. Results Prevalence of CAC was 100 % in the SAP patients, significantly higher than the 87. 23 % in UAP patients and 86. 41 % among the patients with AMI ( P < 0. 05) . More patients and arteries in the SAP group had severe forms of calcium than those in the UAP and AMI group ( P < 0. 01), and the mean LN [CS + 1] (natural logarithm transformation of calcium score) of the SAP patients was much greater than that of the UAP and AMI patients (P < 0.001). The distribution of vessels with various CAC by luminal stenosis was different between SAP and UAP patients. The average CAC extent of the infarct - related arteries was less severe than that of the noninfarct - related arteries. Conclusions U-tilizing electron beam computed tomography, we demonstrated that there exist different patterns of coronary artery calcification in patients with acute versus chronic coronary syndromes, which may provide insight into the differences observed in the clinical and pathologic development between these two types of coronary artery disease.展开更多
AIM To clarify the association of malignancy with mesenteric panniculitis-like changes on computed tomography(CT).METHODS All abdominal CT scans performed at North Shore University HealthS ystem showing mesenteric pan...AIM To clarify the association of malignancy with mesenteric panniculitis-like changes on computed tomography(CT).METHODS All abdominal CT scans performed at North Shore University HealthS ystem showing mesenteric panniculitis from January 2005 to August 2010 were identified in the Radnet(Rad Net Corporation, Los Angeles, CA) database. Patients with a new or known diagnosis of a malignancy were included for this analysis. Longitudinal clinical histories were obtained from electronic medical records.RESULTS In total, 147794 abdominal CT scans were performed during the study period. Three hundred and fiftynine patients had mesenteric panniculitis(MP)-like abnormalities on their abdominal CT. Of these patients, 81 patients(22.6%) had a known history of cancer at the time of their CT scan. Nineteen(5.3%) had a new diagnosis of cancer in concurrence with their CT, but the majority of these(14/19, 74%) were undergoing CT as part of a malignancy evaluation. Lymphomas were the most common cancers associated with MPlike findings on CT(36 cases, 36%), with follicular lymphoma being the most frequent subtype(17/36). A variety of solid tumors, most commonly prostate(7) and renal cell cancers(6) also were seen. CT follow up was obtained in 56 patients. Findings in the mesentery were unchanged in 45(80%), worsened in 6(11%), and improved in 5 patients(9%). Positron emission tomography(PET) scans performed in 44 patients only showed a positive uptake in the mesenteric mass in 2 patients(5%). CONCLUSION A new diagnosis of cancer is uncommon in patients with CT findings suggestive of MP. MP-like mesenteric abnormalities on CT generally remain stable in patients with associated malignancies. PET scanning is not recommended in the evaluation of patients with mesenteric panniculitis-like findings on CT.展开更多
随着鼻窦CT诊断和鼻内镜诊疗技术的发展，大量鼻部疾病导致的头痛得以治愈。根据2004年国际头痛协会的分类，鼻源性头痛的第二种类型——黏膜接触点性头痛（mucosa contact point headache），因为缺少典型的鼻部症状，而分散就诊于其...随着鼻窦CT诊断和鼻内镜诊疗技术的发展，大量鼻部疾病导致的头痛得以治愈。根据2004年国际头痛协会的分类，鼻源性头痛的第二种类型——黏膜接触点性头痛（mucosa contact point headache），因为缺少典型的鼻部症状，而分散就诊于其他学科，长期得不到合理诊疗。我们近期总结了多例临床上没有典型的鼻部症状，而是以各种类型的头痛为主诉就诊于神经内科等专科的患者，经过会诊筛查，确诊为鼻源性黏膜接触点性头痛，通过鼻内镜手术治愈。其中包括1组女性患者，长期被误认为是月经前期头痛，通过治疗证明是黏膜接触点性头痛的一种特殊存在形式，撰文总结如下。展开更多
文摘Background: In 2010, the International Atomic Energy Agency launched the “3A’s campaign” as an effective tool for primary cancer prevention. In 2011, the American Association of Physicists in Medicine recommended the size specific dose estimate (SSDE). Objectives: To audit doses of Coronary CT Angiography (Coronary CTA) in tertiary care referral center. Methods: We reviewed 998 consecutive Coronary CTA (from 2007 to 2012). Doses (CTDIvol mGy), DLP (mGy*cm), effective dose (DLP*0.014, mSv) were on-line archived. SSDE was estimated retrospectively. Appropriateness score was evaluated for exams performed from the 2010. Results: Overall median dose per Coronary CTA was 49.7 mGy for CTDIvol, 55.5 mGy for SSDE, 994.96 mGy*cm for DLP, 13.9 mSv for effective dose. Median DLP decreased over time (1452.94 in 2007, 1605.56 in 2008, 1113.49 in 2009, 759.99 in 2010, 448.61 in 2011 and 497.88 mGy*cm in 2012, p < 0.0001). SSDE was proportional to the size dependent factor (SDF);in patients with SDF > 1 (88%) CTDIvol underestimated SSDE (48.49 vs 57.19 mGy), whilst in patients with SDF < 1 (12%) CTDIvol overestimated SSDE (56.46 vs 50.3 mGy). Scans were appropriate in 58%, uncertain in 24%, and inappropriate in 18% of cases. Doses were similar in appropriate, uncertain or inappropriate examinations and in excellent-to-good (81%) vs. sufficient-to-poor (19%) image quality exams. Conclusions: Coronary CTA reference doses can be very misleading. SSDE can allow individual technique optimization. The dose is similar in appropriate and inappropriate examinations, and unrelated to image quality. The rate of inappropriate examinations is still too high even after dissemination of guidelines.
文摘Objectives To compare the different patterns of coronary artery calcification (CAC) in acute and chronic coronary syndromes utilizing electron beam computed tomography. Background Pathologic, angiographic, and intracoronary ultrasound studies revealed sharp differences in the plaque morphology between patients with acute versus chronic coronary syndromes. Whether there are different patterns of coronary artery calcification in patients with stable angina pectoris (SAP) and in those with unstable angina pectoris (UAP) or acute myocardial infarction (AMI), however, remains unclear. Methods Two hundred and sixty - four patients, including 67 with SAP, 94 with UAP and 103 with AMI were studied with electron beam computed tomography for analysis of coronary artery calcification and with selective coronary angiography for determination of atherosclerotic lesions. CAC prevalence and calcium score were compared among three groups, and relation of CAC to the severity of atherosclerotic disease in the SAP and UAP patients was separately analyzed. Results Prevalence of CAC was 100 % in the SAP patients, significantly higher than the 87. 23 % in UAP patients and 86. 41 % among the patients with AMI ( P < 0. 05) . More patients and arteries in the SAP group had severe forms of calcium than those in the UAP and AMI group ( P < 0. 01), and the mean LN [CS + 1] (natural logarithm transformation of calcium score) of the SAP patients was much greater than that of the UAP and AMI patients (P < 0.001). The distribution of vessels with various CAC by luminal stenosis was different between SAP and UAP patients. The average CAC extent of the infarct - related arteries was less severe than that of the noninfarct - related arteries. Conclusions U-tilizing electron beam computed tomography, we demonstrated that there exist different patterns of coronary artery calcification in patients with acute versus chronic coronary syndromes, which may provide insight into the differences observed in the clinical and pathologic development between these two types of coronary artery disease.
基金Supported by An unrestricted grant from the Keyser Family Fund(partly)
文摘AIM To clarify the association of malignancy with mesenteric panniculitis-like changes on computed tomography(CT).METHODS All abdominal CT scans performed at North Shore University HealthS ystem showing mesenteric panniculitis from January 2005 to August 2010 were identified in the Radnet(Rad Net Corporation, Los Angeles, CA) database. Patients with a new or known diagnosis of a malignancy were included for this analysis. Longitudinal clinical histories were obtained from electronic medical records.RESULTS In total, 147794 abdominal CT scans were performed during the study period. Three hundred and fiftynine patients had mesenteric panniculitis(MP)-like abnormalities on their abdominal CT. Of these patients, 81 patients(22.6%) had a known history of cancer at the time of their CT scan. Nineteen(5.3%) had a new diagnosis of cancer in concurrence with their CT, but the majority of these(14/19, 74%) were undergoing CT as part of a malignancy evaluation. Lymphomas were the most common cancers associated with MPlike findings on CT(36 cases, 36%), with follicular lymphoma being the most frequent subtype(17/36). A variety of solid tumors, most commonly prostate(7) and renal cell cancers(6) also were seen. CT follow up was obtained in 56 patients. Findings in the mesentery were unchanged in 45(80%), worsened in 6(11%), and improved in 5 patients(9%). Positron emission tomography(PET) scans performed in 44 patients only showed a positive uptake in the mesenteric mass in 2 patients(5%). CONCLUSION A new diagnosis of cancer is uncommon in patients with CT findings suggestive of MP. MP-like mesenteric abnormalities on CT generally remain stable in patients with associated malignancies. PET scanning is not recommended in the evaluation of patients with mesenteric panniculitis-like findings on CT.
文摘随着鼻窦CT诊断和鼻内镜诊疗技术的发展，大量鼻部疾病导致的头痛得以治愈。根据2004年国际头痛协会的分类，鼻源性头痛的第二种类型——黏膜接触点性头痛（mucosa contact point headache），因为缺少典型的鼻部症状，而分散就诊于其他学科，长期得不到合理诊疗。我们近期总结了多例临床上没有典型的鼻部症状，而是以各种类型的头痛为主诉就诊于神经内科等专科的患者，经过会诊筛查，确诊为鼻源性黏膜接触点性头痛，通过鼻内镜手术治愈。其中包括1组女性患者，长期被误认为是月经前期头痛，通过治疗证明是黏膜接触点性头痛的一种特殊存在形式，撰文总结如下。
