Coronary Artery Anomalies Detected by Multi-Detector Computed Tomography: A Single Centre Experience

Background: Coronary artery anomalies (CAA) prevalence represents less than 1% of congenital heart diseases. It includes anomalies in origin, course, and termination. Its detection has been easier with advances in imaging techniques using multi-detector computed tomography (MDCT). MDCT helps not only detection of the anomalous origin, but it allows delineation of the course and termination of the arteries, differentiation between benign and malignant courses, and guiding therapeutic interventions. Results: There were consecutive patients with a low-to-intermediate probability of coronary artery disease scanned with 128 MDCT. Each patient underwent a non-contrast prospective gating acquisition for coronary calcium scoring followed by contrast-enhanced helical retrospective gated scans for the detection of coronary artery origin, course, termination, and detection of concomitant atherosclerosis. We scanned 1000 patients with a mean age of 57.5 ± 8.3, and 68% were males. Thirty-two anomalies were noted (3.2%) including;nineteen (1.9%) anomalous origin from the opposite sinus, three (0.3%) anomalous left coronary arteries from the pulmonary artery (ALCAPA), one (0.1%) super dominant left anterior descending artery (LAD) giving origin to the posterior descending artery (PDA), three single coronary arteries (0.3%)in which the left main (LM) and right coronary arteries were originating with a common stem from the right coronary sinus (RCS)and the LM took a pre-pulmonic course. Along with six (0.6%) dual LAD including five (0.5%) patients with type I (short LAD and long diagonal), there was one (0.1%) type 4 with an extra LAD originating from the RCS with a pre-pulmonic course. Conclusions: MDCT allows easy detection of coronary anomalies with high spatial resolution and overcomes limitations in conventional invasive coronary angiography. Based on our study we recommend the use of MDCT as an efficient and feasible modality for the diagnosis of coronary anomalies once this pathology is clinically suspected.

Multi-Detector Row Computed Tomography Urography (MDCTU) in the Evaluation of Microscopic Hematuria in Adults

Multi-detector row computed tomography urography (MDCTU) becomes the imaging modality of choice for evaluation of the kidneys and urinary tract. The aim of this study was to discuss and illustrate the role of MDCTU, on a 32-row CT scanner in the evaluation a variety of entities that were frequently associated with microscopic hematuria in adults. This prospective cohort study was performed in the period of August 2013 to October 2014. Fifty positive participants to microscopic hematuria were examined at the radiology department of Alnilin Diagnostic Medical Center and Antalya Medical Center. Computed tomography urography (CTU) scanning was performed using two powerful performances, high speed multi-detector row on 32-row CT scanners (Siemens Healthcare Global, Somatom Emotion Duo Eco). Statistical analysis was done through the standard Statistical Package for the Social Sciences (SPSS Inc., Chicago, IL, USA) version 15 for windows. MDCTU established the correct cause of microscopic hematuria in (44;88%) of participants. In (6;12%) of participants, no cause of hematuria was identified based on the standard of references. The causes of hematuria in (41;82%) participants were diseases in the upper urinary tract, while urinary bladder neoplasms (2;4%) and diverticulum (1;2%) were the causes of hematuria (3;6%) in the lower urinary tract. Thirty two-row MDCTU scanner demonstrated satisfactory results in the investigation of microscopic hematuria, being able to demonstrate a wide spectrum of diseases affecting the urinary tract is the main advantage of the technique.

Rectal cancer staging: Multidetector-row computed tomography diagnostic accuracy in assessment of mesorectal fascia invasion

AIM: To assess the diagnostic accuracy of multidetectorrow computed tomography(MDCT) as compared with conventional magnetic resonance imaging(MRI), in identifying mesorectal fascia(MRF) invasion in rectal cancer patients.METHODS: Ninety-one patients with biopsy proven rectal adenocarcinoma referred for thoracic and abdominal CT staging were enrolled in this study. The contrast-enhanced MDCT scans were performed on a 256 row scanner(ICT, Philips) with the following acquisition parameters: tube voltage 120 KV, tube current 150-300 m As. Imaging data were reviewed as axial and as multiplanar reconstructions(MPRs) images along the rectal tumor axis. MRI study, performed on 1.5 T with dedicated phased array multicoil, included multiplanar T2 and axial T1 sequences and diffusion weighted images(DWI). Axial and MPR CT images independently were compared to MRI and MRF involvement was determined. Diagnostic accuracy of both modalities was compared and statistically analyzed.RESULTS: According to MRI, the MRF was involved in 51 patients and not involved in 40 patients. DWI allowed to recognize the tumor as a focal mass with high signal intensity on high b-value images, compared with the signal of the normal adjacent rectal wall or with the lower tissue signal intensity background. The number of patients correctly staged by the native axial CT images was 71 out of 91(41 with involved MRF; 30 with not involved MRF), while by using the MPR 80 patients were correctly staged(45 with involved MRF; 35 with not involved MRF). Local tumor staging suggested by MDCT agreed with those of MRI, obtaining for CT axial images sensitivity and specificity of 80.4% and 75%, positive predictive value(PPV) 80.4%, negative predictive value(NPV) 75% and accuracy 78%; while performing MPR the sensitivity and specificity increased to 88% and 87.5%, PPV was 90%, NPV 85.36% and accuracy 88%. MPR images showed higher diagnostic accuracy, in terms of MRF involvement, than native axial images, as compared to the reference magnetic resonance images. The difference in accuracy was statistically significant(P = 0.02). CONCLUSION: New generation CT scanner, using high resolution MPR images, represents a reliable diagnostic tool in assessment of loco-regional and whole body staging of advanced rectal cancer, especially in patients with MRI contraindications.

Imaging features of solid pseudopapillary tumor of the pancreas on multi-detector row computed tomography

AIM:To retrospectively analyze the imaging features of solid-pseudopapillary tumors(SPTs) of the pancreas on multi-detector row computed tomography(MDCT) and define the imaging findings suggestive of malignant potential.METHODS:A total of 24 consecutive cases with surgically and pathologically confirmed SPTs of the pancreas underwent preoperative abdominal MDCT studies in our hospital.All axial CT images,CT angiographic images,and coronally and sagittally reformed images were obtained.The images were retrospectively reviewed at interactive picture archiving and communication system workstations.RESULTS:Of the 24 cases of SPTs,11 cases(45.8%) occurred in the pancreatic head and seven(29.1%) in the tail.Eighteen were pathologically diagnosed as benign and six as malignant.MDCT diagnosis of SPTs was well correlated with the surgical and pathological results(Kappa = 0.6,P < 0.05).The size of SPTs ranged from 3 to 15 cm(mean,5.8 cm).When the size of the tumor was greater than 6 cm(including 6 cm),the possibilities of vascular(8 vs 1) and capsular invasion(9 vs 0) increased significantly(P < 0.05).Two pathologically benign cases with vascular invasion and disrupted capsule on MDCT presented with local recurrence and hepatic metastases during follow-up about 1 year after the resection of the primary tumors.CONCLUSION:Vascular and capsular invasion with superimposed spread into the adjacent pancreatic parenchyma and nearby structures in SPTs of the pancreas can be accurately revealed by MDCT preoperatively.These imaging findings are predictive of the malignant potential associated with the aggressive behavior of the tumor,even in the pathologically benign cases.

Multi-detector computed tomography imaging of large airway pathology:A pictorial review

The tracheobronchial tree is a musculo-cartilagenous framework which acts as a conduit to aerate the lungs and consequently the entire body. A large spectrum of pathological conditions can involve the trachea and bronchial airways. These may be congenital anomalies, infections, post-intubation airway injuries, foreign body aspiration or neoplasms involving the airway. Appropriate management of airway disease requires an early and accurate diagnosis. In this pictorial essay review, we will comprehensively describe the various airway pathologies and their imaging findings by multi-detector computed tomography.

Relation between Epicardial Adipose Tissue Thickness Assessed by Multidetector Computed Tomography and Significance of Coronary Artery Disease

Objective: To evaluate the relation between epicardial adipose tissue (EAT) thickness and also pericoronary fat assessed by Multidetector Computed Tomography (MDCT) with both calcium score and significance of coronary artery disease. Background: Epicardial adipose tissue (the visceral fat of the heart present under the visceral layer of the pericardium) has the same origin of abdominal visceral fat, which is known to be strongly related to the development of coronary artery atherosclerosis. Multidetector CT (MDCT) provides an accurate and reproducible quantification of EAT due to its high spatial and temporal resolution. Patients and Methods: The current study included 70 patients with low-intermediate probability of coronary artery disease. All patients were subjected to 256 Multidetectors CT to assess EAT thickness, the mean thickness of the pericoronary fat surrounding the three coronary arteries and coronary calcium score. Also coronary CT angiography was done and patients were then divided into 3 groups according to significance of coronary atherosclerosis: Group 1: No atherosclerosis (20 patients), Group 2: Non obstructive atherosclerosis (luminal narrowing less than 50% in diameter) (25 patients), Group3: Obstructive atherosclerosis (luminal narrowing ≥ 50%) (25 patients). Results: The mean EAT thickness and the mean pericoronary fat thickness were significantly higher in patients with obstructive coronary artery disease (CAD) with stenosis > 50% (group 3) compared to other groups with normal coronaries or non obstructive (CAD). ROC curve was used to define the best cut off value of the thickness of both EAT and pericoronary fat in predicting the obstructive CAD group which was ≥7.2 and 12.6 mm for epicardial and pericoronary fat respectively. Also there is a positive correlation between both epicardial adipose tissue and pericoronary fat thickness and the coronary calcium score. Conclusion: EAT thickness and pericoronary fat thickness can be used in predicting the significance of coronary artery disease.

Magnetic resonance imaging and multi-detector computed tomography assessment of extracellular compartment in ischemic and non-ischemic myocardial pathologies

Myocardial pathologies are major causes of morbidity and mortality worldwide. Early detection of loss of cellular integrity and expansion in extracellular volume(ECV) in myocardium is critical to initiate effective treatment. The three compartments in healthy myocardium are: intravascular(approximately 10% of tissue volume), interstitium(approximately 15%) and intracellular(approximately 75%). Myocardial cells, fibroblasts and vascular endothelial/smooth muscle cells represent intracellular compartment and the main proteins in the interstitium are types Ⅰ/Ⅲ collagens. Microscopic studies have shown that expansion of ECV is an important feature of diffuse physiologic fibrosis(e.g., aging and obesity) and pathologic fibrosis [heart failure, aortic valve disease, hypertrophic cardiomyopathy, myocarditis, dilated cardiomyopathy, amyloidosis, congenital heart disease, aortic stenosis, restrictive cardiomyopathy(hypereosinophilic and idiopathic types), arrythmogenic right ventricular dysplasia and hypertension]. This review addresses recent advances in measuring of ECV in ischemic and non-ischemic myocardial pathologies. Magnetic resonance imaging(MRI) has the ability to characterize tissue proton relaxation times(T1, T2, and T2*). Proton relaxation times reflect the physical and chemical environments of water protons in myocardium. Delayed contrast enhanced-MRI(DE-MRI) and multi-detector computed tomography(DE-MDCT) demonstrated hyper-enhanced infarct, hypo-enhanced microvascular obstruction zone and moderately enhanced peri-infarct zone, but are limited for visualizing diffuse fibrosis and patchy microinfarct despite the increase in ECV. ECV can be measured on equilibrium contrast enhanced MRI/MDCT and MRI longitudinal relaxation time mapping. Equilibrium contrast enhanced MRI/MDCT and MRI T1 mapping is currently used, but at a lower scale, as an alternative to invasive sub-endomyocardial biopsies to eliminate the need for anesthesia, coronary catheterization and possibility of tissue sampling error. Similar to delayed contrast enhancement, equilibrium contrast enhanced MRI/MDCT and T1 mapping is completely noninvasive and may play a specialized role in diagnosis of subclinical and other myocardial pathologies. DE-MRI and when T1-mapping demonstrated sub-epicardium, sub-endocardial and patchy mid-myocardial enhancement in myocarditis, Behcet's disease and sarcoidosis, respectively. Furthermore, recent studies showed that the combined technique of cine, T2-weighted and DE-MRI technique has high diagnostic accuracy for detecting myocarditis. When the tomographic techniques are coupled with myocardial perfusion and left ventricular function they can provide valuable information on the progression of myocardial pathologies and effectiveness of new therapies.

Diagnosis of Congenital Aortic Arch Anomalies in Chinese Children by Multi-Detector Computed Tomography Angiography

Summary： The purpose of this study was to evaluate the value of multi-detector computed tomography （MDCT） angiography for the diagnosis of congenital aortic arch anomalies and present the radiological images of congenital aortic arch anomalies in Chinese children. MDCT angiography and transthoracic echocardiography （TTE） were applied for the diagnosis of congenital aortic arch anomalies in 362 Chi- nese children between May 2006 and December 2011 （age ranges from 5 days to 12 years; mean age, 3.3 years）. Surgery and/or catheter angiography （CA） were conducted in all patients to confirm the final diagnosis. In the 362 Chinese children with congenital heart anomalies, congenital aortic arch anomalies were definitely diagnosed in 198 children and 164 children ruled out by operation and/or （CA）. Among the 198 children with anomalies, coarctation of aorta （CoA）, interruption of aortic arch （IAA）, fight aor- tic arch, aberrant right subclavian artery and double aortic arch were diagnosed in 134, 32, 20, 10 and 2 children respectively, and there were 6 cases with uncommon congenital aortic arch anomalies： 2 had double aortic arch including 1 with five branches of the aortic arch, 2 had isolation of the right sub- clavian artery with two patent ductus arteriosus （PDA）, 1 had an isolation of the common carotid artery with a PDA, and 1 had double PDA with a single ventricle and pulmonary artery atresia. Among the 32 children with IAA, 28 were of type A, and 4 were of type B. The diagnostic sensitivity, specificity and accuracy of MDCT angiography for congenital aortic arch anomaiies were 100% （198/198）, 98% （161/164） and 99% （359/362）, respectively. The diagnostic sensitivity, specificity and accuracy of TTE were 92% （182/198）, 81% （133/164） and 87% （315/362）, respectively. In conclusion, MDCT angiogra- phy is a reliable, noninvasive imaging technique for the diagnosis of congenital aortic arch anomalies in children. Sometimes, even more information can be obtained from this technique than from conven- tional angiography.

Colonic perforation by a transmural and transvalvular migrated retained sponge:Multi-detector computed tomography findings

Transmural migrated retained sponges usually impact at the level of the ileo-cecal valve leading to a small bowel obstruction.Once passed through the ileo-cecal valve,a retained sponge can be propelled forward by peristaltic activity and eliminated with feces.We report the case of a 52-year-old female with a past surgical history and recurrent episodes of abdominal pain and constipation.On physical examination,a generalized resistance was observed with tenderness in the right flank.Contrast-enhanced multi-detector computed tomography findings were consistent with a perforated right colonic diverticulitis with several out-pouchings at the level of the ascending colon and evidence of free air in the right parieto-colic gutter along with an air-fluid collection within the mesentery.In addition,a ring-shaped hyperdense intraluminal material was also noted.At surgery,the ascending colon appeared irregularly thickened and folded with a focal wall interruption and a peri-visceral abscess at the level of the hepatic flexure,but no diverticula were found.A right hemi-colectomy was performed and on dissection of the surgical specimen a retained laparotomy sponge was found in the bowel lumen.

A spontaneous strangulated transomental hernia: Prospective and retrospective multi-detector computed tomography findings

Transomental hernias are among the rarest type of all internal hernias which overall account for less than 6% of small bowel obstructions. Most transomental hernias occurring in adults are either iatrogenic or post-traumatic. More rarely, a spontaneous herniation of small bowel loops may result from senile atrophy of the omentum. We report a case of an 86-year-old male who presented with signs and symptoms of small bowel obstruction but had no past surgical or traumatic abdominal history. At contrast-enhanced multi-detector row computed tomography(CT), a cluster of fluid-filled dilated small bowel loops could be appreciated in the left flank, with associated signs of bowel wall ischemia. Swirling of the mesenteric vessels could also be appreciated and CT findings were prospectively considered consistent with a strangulated small bowel volvulus. At laparotomy, no derotation had to be performed but up to 100 cm of gangrenous small bowel loops had to be resected because of a transomental hernia through a small defect in the left part of the greater omentum. Retrospective reading of CT images was performed and findings suggestive of transomental herniation could then be appreciated.

Multidetector computed tomography of temporomandibular joint: A road less travelled

This article reviews the imaging anatomy of temporomandibular joint(TMJ), describes the technique of multi-detector computed tomography(MDCT) of the TMJ, and describes in detail various osseous pathologic afflictions affecting the joint. Traumatic injuries affecting the mandibular condyle are most common, followed by joint ankylosis as a sequel to arthritis. The congenital anomalies are less frequent, hemifacial microsomia being the most commonly encountered anomaly involving the TMJ. Neoplastic afflictions of TMJ are distinctly uncommon, osteochondroma being one of the most common lesions. MDCT enables comprehensive evaluation of osseous afflictions of TMJ, and is a valuable tool for surgical planning. Sagittal, coronal and 3D reformatted images well depict osseous TMJ lesions, and their relationship to adjacent structures.

Predictive Factors of the Presence and Number of Noncalcified Coronary Plaque in Japanese Patients with Zero Coronary Artery Calcium Score Using 64-Slice Multi-Detector Computed Tomography

Background: Factors that can predict the presence and number of noncalcified coronary plaques (NCP) in Japanese patients with zero coronary artery calcium scores (CACS) essentially remain undefined. Methods and Results: We assessed independent predictors of the presence and number of segments with NCP in 111 Japanese patients with zero CACS who underwent 64-slice multi-detector computed tomography at our hospital. Thirty five patients (32%) had NCP, and 24 patients (22%) had ≥ 2 NCPs. Multiple logistic regression analysis revealed that significant predictors for the presence of NCP were age (odds ratio [OR]: 1.06, 95% confidence interval [CI] 1.01 - 1.11, p = 0.021), male (OR: 3.61, 95% CI 1.40 - 9.35, p = 0.008) and diabetes mellitus (OR: 3.10, 95% CI 1.02 - 9.45, p = 0.046), and those for the presence of ≥ 2 NCPs were age (OR: 1.08, 95% CI 1.02 - 1.15, p = 0.007) and a current smoking habit (OR: 5.09, 95% CI 1.00 - 25.74, p = 0.049). Multiple linear regression analysis identified advanced age, male gender and diabetes mellitus as independent predictors of the number of NCPs. A novel score calculated from the above four predictors showed moderate accuracy for a diagnosis of NCP and ≥ 2 NCPs, with areas under receiver operating curves of 0.738 and 0.736, respectively. Conclusions: Male Japanese patients with zero CACS, advanced age, diabetes mellitus and a current smoking habit might have NCPs.

High-resolution computed tomography in patients with atypical 'cardiac' chest pain: a study investigating patients at 10-year cardiovascular risks defined by the Framingham and PROCAM scores

Background and objective Atypical 'cardiac' chest pain (ACCP) is not usually caused by myocardial ischaemia. Current noninvasive investigations for these symptoms are not yet as accurate as invasive coronary angiography. The latest 64-row multi-detector computed tomography (MDCT) technology is non-invasive, has high specificity and negative predictive values for the detection of significant coronary disease. Our aim was to investigate if this modality can provide more information in the assessment of outpatients with ACCP in addition to established cardiovascular risk scores. Methods Seventy consecutive patients presenting to the outpatient clinic with ACCP underwent 64-row MDCT scan of the coronary arteries. They were categorized into low, medium or high risk groups based upon the Framingham and PROCAM scores. We defined a clinically abnormal MDCT scan as coronary stenosis =50% or calcium score ＞400 Agatston. Results Fifty-three (75.7%) patients did not have clinically abnormal scans. Framingham score classified 43 patients as low-risk while PROCAM classified 59 patients as low-risk. MDCT scans were abnormal for 18.6% and 22.0% of the respective low-risk group of patients. For patients with medium-to-high risk, 33.3% and 36.4% of Framingham and PROCAM patient groups respectively had abnormal MDCT scans. Conclusion MDCT adds valuable information in the assessment of patients with ACCP by identifying a significant proportion of patients categorized as low-risk to have underlying significant coronary stenosis and coronary calcification by established cardiovascular risk scores.

Multi-detector CT features of acute intestinal ischemia and their prognostic correlations

Acute intestinal ischemia is an abdominal emergency occurring in nearly 1% of patients presenting with acute abdomen. The causes can be occlusive or non occlusive. Early diagnosis is important to improve survival rates. In most cases of late or missed diagnosis, the mortality rate from intestinal infarction is very high, with a reported value ranging from 60% to 90%. Multidetector computed tomography(MDCT) is a fundamental imaging technique that must be promptly performed in all patients with suspected bowel ischemia. Thanks to the new dedicated reconstruction program, its diagnostic potential is much improved compared to the past and currently it is superior to that of any other noninvasive technique. The increased spatial and temporal resolution, high-quality multi-planar reconstructions, maximum intensity projections, vessel probe, surface-shaded volume rending and tissue transition projections make MDCT the gold standard for the diagnosis of intestinal ischemia, with reported sensitivity, specificity, positive and negative predictive values of 64%-93%, 92%-100%, 90%-100% and 94%-98%, respectively. MDCT contributes to appropriate treatment planning and provides important prognostic informationthanks to its ability to define the nature and extent of the disease. The purpose of this review is to examine the diagnostic and prognostic role of MDCT in bowel ischemia with special regard to the state of art new reconstruction software.

Current status of low dose multi-detector CT in the urinary tract

Over the past several years,advances in the technical domain of computed tomography(CT) have influenced the trend of imaging modalities used in the clinical evaluation of the urinary system.Renal collecting systems can be illustrated more precisely with the advent of multi-detector row CT through thinner slices,high speed acquisitions,and enhanced longitudinal spatial resolution resulting in improved reformatted coronal images.On the other hand,a significant increase in exposure to ionizing radiation,especially in the radiosensitive organs,such as the gonads,is a concern with the increased utilization of urinary tract CT.In this article,we discuss the strategies and techniques availablefor reducing radiation dose for a variety of urinary tractCT protocols with metabolic clinical examples.We also reviewed CT for hematuria evaluation and related scan parameter optimization such as,reducing the number of acquisition phases,CT angiography of renal donors and lowering tube potential,when possible.

Contrast enhanced multi-detector CT and MR findings of a well-differentiated pancreatic vipoma

Pancreatic vipoma is an extremely rare tumor accounting for less than 2% of endocrine pancreatic neoplasms with a reported incidence of 0.1-0.6 per million. While cross-sectional imaging findings are usually not specific, exact localization of the tumor by means of either computed tomography(CT) or magnetic resonance(MR) is pivotal for surgical planning. However, cross-sectional imaging findings are usually not specific and further characterization of the tumor may only be achieved bysomatostatin-receptor scintigraphy(SRS). We report the case of a 70 years old female with a two years history of watery diarrhoea who was found to have a solid, inhomogeneously enhancing lesion at the level of the pancreatic tail at Gadolinium-enhanced MR(Somatom Trio 3T, Siemens, Germany). The tumor had been prospectively overlooked at a contrast-enhanced multi-detector CT(Aquilion 64, Toshiba, Japan) performed after i.v. bolus injection of only 100 cc of iodinated non ionic contrast media because of a chronic renal failure(3.4 mg/mL) but it was subsequently confirmed by SRS. The patient first underwent a successful symptomatic treatment with somatostatin analogues and was then submitted to a distal pancreasectomy with splenectomy to remove a capsulated whitish tumor which turned out to be a well-differentiated vipoma at histological and immuno-histochemical analysis.

MDCT增强联合CTA复合多维技术在舌鳞状细胞癌评估中的诊断价值

目的:验证多排螺旋CT(MDCT)增强联合CT血管成像(CTA)多维技术在舌鳞状细胞癌诊断中的应用价值。方法:回顾性分析从2011年11月~2022年7月的44例舌鳞状细胞癌患者的影像学特征及指标,以病理检查结果作为诊断金标准,评价CT平扫及MDCT增强联合CTA多维技术对舌鳞状细胞癌定性、定量诊断的评估效能。结果:CT平扫对评估原发性舌鳞状细胞癌淋巴结转移的灵敏度及特异度分别为63.16%和55.56%,MDCT增强联合CTA多维技术的灵敏度及特异度分别为94.74%和55.56%。CT平扫对评估复发性舌鳞状细胞癌淋巴结转移的灵敏度及特异度均为50%,MDCT增强联合CTA多维技术的灵敏度及特异度分别为71.43%和66.67%。平扫时肿瘤面积及动、静脉期肿瘤面积与舌鳞状细胞癌淋巴结转移无显著相关。结论:MDCT增强联合CTA多维技术可用于舌鳞状细胞癌术前诊断与分期,对临床治疗方案制定具有一定指导意义。

Multi-detector computed tomography evaluation of tracheobronchial anomaly in pediatric patients with left pulmonary artery sling

The left pulmonary artery sling （LPAS） is a rare vascular anomaly causing respiratory distress in which theleft pulmonary artery arises from the posterior aspect of the right pulmonary artery, courses posteriorly to the right of the bronchus and passes between the trachea and oesophagus to reach the hilum of the left lung. The LPAS is frequently associated with tracheobronchial tree anomalies and congenital cardiac defects. Proper assessment of the tracheobronchial and cardiovascular anomaly is essential in LPAS for planning management of the patient. Currently,

MDCT小肠造影技术在小肠疾病中的临床应用研究

目的:探讨多排螺旋CT小肠造影(MDCTE)扫描技术在小肠疾病诊断中的临床应用价值。方法:对181例临床怀疑小肠病变患者术前行MDCTE平扫及多期增强扫描,图像行后处理,并与手术结果相对照。结果:本组181例患者中,58例MDCTE诊断为小肠病变,并与最终临床诊断相符。123例患者MDCTE诊断为阴性,108例符合,9例漏诊,6例误诊。MDCTE诊断小肠疾病的敏感性为79.45%,特异性为100%,诊断正确率为91.71%,阳性预测值为100%,阴性预测值为87.80%。本组资料中小肠肿瘤15例,其中腺癌5例,间质瘤3例,淋巴瘤1例,平滑肌瘤1例,肠系膜转移5例。小肠炎症性病变27例,其中克罗恩病16例,溃疡性结肠炎2例,小肠结核1例,病毒性肠炎1例,小肠黏膜一般炎症7例。肠梗阻22例,其中腹内外疝9例,小肠扭转6例,小肠粘连性梗阻2例,幽门梗阻2例,胆石症2例,因克罗恩病肠壁增厚引起不全性小肠梗阻1例。小肠憩室2例,其中Meckel憩室1例,盲肠憩室伴慢性阑尾炎、阑尾结石1例。血管性病变3例,其中肠系膜上动脉栓塞1例,肠系膜上静脉血栓形成1例,肠道血管畸形1例。其他病变包括腹茧症2例,肠息肉1例,过敏性紫癜(腹型)1例。结论:小肠肿瘤、炎症、肠梗阻等病变在MDCTE上具有特征性的表现,MDCTE能全景式、多方位展示小肠肠道、肠系膜和系膜血管,对小肠疾病的诊断具有重要价值。

MDCT增强扫描加多平面重建技术诊断腹膜癌的影像学研究

目的:研究多层螺旋CT(Multi-detector row computed tomography,MDCT)增强扫描加多平面重建(Multiplanar reconstruction,MPR)技术对腹膜转移癌(Peritoneal carcinomatosis,PC)的诊断效能,分析PC的典型CT征象。方法:对54例PC患者术前进行MDCT多期增强扫描,分析MDCT横断位图像及MPR图像,与术中探查结果进行比较。结果:54例PC患者MDCT增强扫描检测出356个病灶,在1～13分区中每例患者检测出病灶平均数为(6.5±3.4)个。常见转移部位是大网膜、左半膈、脾包膜、盆腔、右半膈、胃周韧带等。转移病灶密度以实性为主,病灶直径为0.5～13 cm。总体敏感度为78.1%(356/456),特异度为92.3%(277/300);病灶≥0.5 cm时,敏感度为90.0%(307/341),病灶<0.5cm时,敏感度为42.6%(49/115)。CT-腹膜癌指数(Peritoneal carcinomatosis index,PCI)与术中PCI的吻合度为0.384～0.640(P<0.05)。结论:MDCT增强扫描加MPR技术可较准确评估CT-PCI,与术中PCI有较高的吻合度,可为临床制定治疗计划提供依据。