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 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.

Double contrast-enhanced ultrasonography improves diagnostic accuracy of T staging compared with multi-detector computed tomography in gastric cancer patients

BACKGROUND Gastric cancer(GC)is the most common malignant tumor and ranks third for cancer-related deaths among the worldwide.The disease poses a serious public health problem in China,ranking fifth for incidence and third for mortality.Knowledge of the invasive depth of the tumor is vital to treatment decisions.AIM To evaluate the diagnostic performance of double contrast-enhanced ultrasonography(DCEUS)for preoperative T staging in patients with GC by comparing with multi-detector computed tomography(MDCT).METHODS This single prospective study enrolled patients with GC confirmed by preoperative gastroscopy from July 2021 to March 2023.Patients underwent DCEUS,including ultrasonography(US)and intravenous contrast-enhanced ultrasonography(CEUS),and MDCT examinations for the assessment of preoperative T staging.Features of GC were identified on DCEUS and criteria developed to evaluate T staging according to the 8th edition of AJCC cancer staging manual.The diagnostic performance of DCEUS was evaluated by comparing it with that of MDCT and surgical-pathological findings were considered as the gold standard.RESULTS A total of 229 patients with GC(80 T1,33 T2,59 T3 and 57 T4)were included.Overall accuracies were 86.9%for DCEUS and 61.1%for MDCT(P<0.001).DCEUS was superior to MDCT for T1(92.5%vs 70.0%,P<0.001),T2(72.7%vs 51.5%,P=0.041),T3(86.4%vs 45.8%,P<0.001)and T4(87.7%vs 70.2%,P=0.022)staging of GC.CONCLUSION DCEUS improved the diagnostic accuracy of preoperative T staging in patients with GC compared with MDCT,and constitutes a promising imaging modality for preoperative evaluation of GC to aid individualized treatment decision-making.

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.

Utility of multi-detector row computed tomography angiography versus Doppler in localization of perforators of anterolateral thigh flaps

Aim:Anterolateral thigh(ALT)flap is widely used in reconstruction of various defects.Preoperative imaging facilitates perforator mapping,overcoming intraoperative uncertainty.The purpose of this study was to investigate the utility of multi-detector row computed tomography angiography(MDCTA)and a handheld Doppler in locating ALT perforators.Methods:Twenty patients were randomized into two groups.Group 1 patients received MDCTA and Doppler studies whereas Group 2 received only a Doppler study.The number,location,course,and source of all cutaneous and sizable perforators were compared with intraoperative findings.Surgeons’stress levels during flap harvest and flap harvest time were compared.Results:MDCTA findings correlated well with intraoperative findings for perforator type and segmental distribution with 100%concordance.Doppler alone had a 52%rate of concordance.The sensitivity and specificity for MDCTA in demonstrating the presence of perforators were 85.71%and 97.22%,respectively;whereas for Doppler alone the sensitivity and specificity were 80%and 87.91%,respectively.In demonstrating perforator source,MDCTA showed a sensitivity of 100%and specificity of 91.66%,with 100%accuracy.Sensitivity and specificity for sizable perforators were 90%each,with 88.88%accuracy.Doppler studies were unable to provide this information.Comparison of surgeon stress levels showed no differences between the two groups,although the time for flap harvest was significantly shorter in Group 1.Conclusion:MDCTA compared to Doppler is more sensitive,specific,and accurate with respect to location,course,and source of perforators.

Computed tomography diagnosed left ovarian venous thrombophlebitis after vaginal delivery:A case report

BACKGROUND Postpartum ovarian vein thrombophlebitis(POVT)is a rare but serious postpartum complication that affects mostly postpartum women.A high index of suspicion is required when faced with sudden postpartum abdominal pain.CASE SUMMARY A 25-year-old healthy woman who accepted a vaginal delivery procedure suffered fever(temperature 39.6℃)one day after delivery,accompanied with left lower abdominal pain.Physical examination indicated mild tenderness in the left lower abdomen,accompanied with rebound pain.The patient was confirmed to have left ovarian venous thrombosis with inflammation after receiving a multidetector row computed tomography scan.CONCLUSION POVT is a rare and dangerous postpartum complication.A high index of suspicion is required for the occurrence of ovarian venous thrombosis when faced with postpartum abdominal pain and fever.Early application of Doppler ultrasound,computed tomography,magnetic resonance imaging and other auxiliary examinations is conducive to timely and accurate diagnosis of POVT,thus reducing maternal mortality.

Diagnostic ability of multi-detector spiral computed tomography for pathological lymph node metastasis of advanced gastric cancer

BACKGROUND The reliability of preoperative nodal diagnosis of advanced gastric cancer by multi-detector spiral computed tomography(MDCT)is still unclear.AIM To examine the diagnostic ability of MDCT more precisely by using data on intranodal pathological metastatic patterns.METHODS A total of 108 patients with advanced gastric cancer who underwent MDCT and curative gastrectomy at Kanazawa Medical University Hospital were enrolled in this study.The nodal sizes measured on computed tomography(CT)images were compared with the pathology results.A receiver-operating characteristic curve was constructed,from which the critical value(CV)was calculated by using the data of the first 69 patients retrospectively.By using the CV,sensitivity and specificity were calculated with prospectively collected data from 39 consecutive patients.This enabled a more precise one-to-one correspondence of lymph nodes between CT and pathological examination by using the size data of lymph node mapping.The intranodal pathological metastatic patterns were classified into the following four types:Small nodular,peripheral,large nodular,and diffuse.RESULTS Although all the cases were clinically suspected as having metastasis,81 had lymph node metastasis and 27 had no metastasis.The number of dissected,detected on CT,and metastatic nodes were,4241,897,and 801,respectively.The CV obtained from the receiver-operating characteristic was 7.6 mm for the long axis.The sensitivity was 91.4%and the specificity was 47.3%in the prospective phase.The large nodular and diffuse metastases were easy to diagnose becausemetastatic nodes with a large axis often exhibit these forms.CONCLUSION The ability of MDCT to contribute to a nodal diagnosis of advanced gastric cancer was examined prospectively with precise size data from node mapping,using a CV of 7.6 mm for the long axis that was calculated from the retrospectively collected data.The sensitivity was as high as 91%,and would be improved when referring to the enhanced patterns.However,its specificity was as low as 47%,because most of metastatic nodes in gastric cancer being small in size.The small nodular or peripheral type metastatic nodes were often small and considered difficult to diagnose.

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.

Comparison of pancreatic acinar cell carcinoma and adenocarcinoma using multidetector-row computed tomography

AIM:To distinguish acinar cell carcinoma(ACC)from pancreatic adenocarcinoma(AC)by comparing their computed tomography findings.METHODS:Patients with ACC and AC were identified on the basis of results obtained using surgically resected pancreatectomy specimens.The preoperative computer tomographic images of 6 acinar cell carcinoma patients and 67 pancreatic adenocarcinoma patients in 4 phases(non-contrast,arterial,portal venous,and delayed phase)were compared.The scan delay times were 40,70,and 120 s for each contrast-enhanced phase.The visual pattern,tomographic attenuation value,and time attenuation curve were assessed and compared between AC and ACC cases using the 2test,Wilcoxon signed-rank test,and Mann Whitney U test.RESULTS:The adenocarcinomas tended to be hypodense in all 4 phases.The acinar cell carcinomas also tended to be hypodense in the 3 contrast-enhancedphases,although their computed tomographic attenuation values were higher.Further,5 of the 6 acinar cell carcinomas(83%)were isodense in the non-contrast phase.The time attenuation curve of the adenocarcinomas showed a gradual increase through the 4 phases,and all adenocarcinomas showed peak enhancement during the delayed phase.The time attenuation curve of the acinar cell carcinomas showed peak enhancement during the portal venous phase in 4 cases and during the arterial phase in 2 cases.None of the 6 acinar cell carcinomas showed peak enhancement during the delayed phase.CONCLUSION:The tumor density in the non-contrast phase and time attenuation curve pattern clearly differ between acinar cell carcinomas and adenocarcinomas,and multidetector-row computed tomography can thus distinguish these tumors.

Evaluation of myocardial infarction patients after coronary revasculation by dual-phase multi-detector computed tomography:Now and in future

Multidetector-row computed tomography(MDCT) has become one of the major tools in diagnosing and evaluating patients with coronary artery disease in recent years.In selected patients,MDCT has been shown to provide more reliable accuracy in detection of stent patency than invasive coronary angiography.Chiou et al reported a delicate infarcted myocardium at-risk score.According to their results,the MDCT-based myocardium at-risk score had a good correlation with the thallium 201 ST-segment elevation myocardial infarction-based summed difference score(r = 0.841,P < 0.001).They claimed that dual-phase MDCT is useful in detecting different patterns of obstructive lesions and the extent of myocardium at risk.In this commentary,we discuss the current status of the clinical application of MDCT in patients with myocardial infarction in relation to evaluating the myocardial perfusion defect,detecting reversible myocardial ischemia,assessing myocardial viability,estimating target lesion restenosis,and calculating of fractional flow reserve from MDCT.

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.

Coronary arterial bypass graft patency evaluated by multi-detector computed tomography and magnetic resonance imaging

The progression of atherosclerosis of the coronary artery does not stop after coronary arterial bypass grafting (CABG) surgery.……

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.

Acquired renal arteriovenous malformation:the diagnostic value of three-dimensional multidetector-row computed tomography

Objective To evaluate the diagnostic value of three-dimensional multidetector-row computed tomography(MDCT) in detecting acquired renal arteriovenous malformation(RAVM) and to compare its performance with that of ultrasonography and digital subtraction angiography(DSA). Methods The institutional review board approved this retrospective study and written informed consent was obtained from all patients before examination. All 14 patients with acquired RAVM underwent MDCT, including cortical and medullary phase enhancement angiography and three-dimensional(3D) reconstruction. Five and nine patients were further examined and their diagnoses confirmed by DSA and surgery, respectively. The MDCT images, including 3D reconstructions, were analyzed for RAVM independently and in consensus by two observers using a workstation.Results Among the 14 patients with acquired RAVM, 12 with maximum lesion diameter ≥ 10 mm, and one with a maximum lesion diameter between 5 and 10 mm, were correctly diagnosed with MDCT angiography. Among these patients, four diagnoses were confirmed by DSA. One patient with a lesion 5–10 mm in diameter was misdiagnosed with a renal aneurysm by MDCT angiography. The other one with the maximum diameter of the lesion between 5 mm and 10 mm was misdiagnosed as renal aneurysm with MDCT angiography, which was diagnosed as renal arteriovenous malformation with DSA. Among 14 lesions in 14 patients, eight and six originated in the left and right kidney, respectively.Conclusion MDCT angiography can accurately diagnose RAVM and improve our understanding of the disease, which will allow clinicians to provide better care.

Gd-EOB-DTPA-enhanced magnetic resonance imaging features of hepatic hemangioma compared with enhanced computed tomography

AIM:To clarify features of hepatic hemangiomas on gadolinium-ethoxybenzyl-diethylenetriaminpentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) compared with enhanced computed tomography (CT). METHODS:Twenty-six patients with 61 hepatic hem- angiomas who underwent both Gd-EOB-DTPA-enhanced MRI and enhanced CT were retrospectively reviewed. Hemangioma appearances (presence of peripheral nodular enhancement, central nodular enhancement, diffuse homogenous enhancement, and arterioportal shunt during the arterial phase, fill-in enhancement during the portal venous phase, and prolonged enhancement during the equilibrium phase) on Gd-EOB-DTPA-enhanced MRI and enhanced CT were evaluated.The degree of contrast enhancement at the enhancing portion within the hemangioma was visually assessed using a five-point scale during each phase. For quantitative analysis, the tumor-muscle signal intensity ratio (SIR), the liver-muscle SIR, and the attenuation value of the tumor and liver parenchyma were calculated. The McNemar test and the Wilcoxon's signed rank test were used to assess the significance of differences in the appearances of hemangiomas and in the visual grade of tumor contrast enhancement between Gd-EOB-DTPA-enhanced MRI and enhanced CT. RESULTS:There was no significant difference between Gd-EOB-DTPA-enhanced MRI and enhanced CT in the presence of peripheral nodular enhancement (85% vs 82%), central nodular enhancement (3% vs 3%), diffuse enhancement (11% vs 16%), or arterioportal shunt (23% vs 34%) during arterial phase, or fill-in enhancement (79% vs 80%) during portal venous phase. Prolonged enhancement during equilibrium phase was observed less frequently on Gd-EOB-DTPA-enhanced MRI than on enhanced CT (52% vs 100%, P < 0.001). On visual inspection, there was significantly less contrast enhancement of the enhancing portion on Gd-EOB-DTPA-enhanced MRI than on enhanced CT during the arterial (3.94 ± 0.98 vs 4.57 ± 0.64, respectively, P < 0.001), portal venous (3.72 ± 0.82 vs 4.36 ± 0.53, respectively, P < 0.001), and equilibrium phases (2.01 ± 0.95 vs 4.04 ± 0.51, respectively, P < 0.001). In the quantitative analysis, the tumor-muscle SIR and the liver-muscle SIR observed with Gd-EOB-DTPA-enhanced MRI were 0.80 ± 0.24 and 1.28 ± 0.33 precontrast, 1.92 ± 0.58 and 1.57 ± 0.55 during the arterial phase, 1.87 ± 0.44 and 1.73 ± 0.39 during the portal venous phase, 1.63 ± 0.41 and 1.78 ± 0.39 during the equilibrium phase, and 1.10 ± 0.43 and 1.92 ± 0.50 during the hepatobiliary phase, respectively. The attenuation values in the tumor and liver parenchyma observed with enhanced CT were 40.60 ± 8.78 and 53.78 ± 7.37 precontrast, 172.66 ± 73.89 and 92.76 ± 17.92 during the arterial phase, 152.76 ± 35.73 and 120.12 ± 18.02 during the portal venous phase, and 108.74 ± 18.70 and 89.04 ± 7.25 during the equilibrium phase, respectively. Hemangiomas demonstrated peak enhancement during the arterial phase, and both the SIR with Gd-EOB-DTPA-enhanced MRI and the attenuation value with enhanced CT decreased with time. The SIR of hemangiomas was lower than that of liver parenchyma during the equilibrium and hepatobiliary phases on Gd-EOB-DTPA-enhanced MRI. However, the attenuation of hemangiomas after contrast injection was higher than that of liver parenchyma during all phases of enhanced CT. CONCLUSION:Prolonged enhancement during the equilibrium phase was observed less frequently on Gd-EOB-DTPA-enhanced MRI than enhanced CT, which may exacerbate differentiating between hemangiomas and malignant tumors.

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.

Improvement of distension and mural visualization of bowel loops using neutral oral contrasts in abdominal computed tomography

AIM: To assess and compare the image quality of 4% sorbitol and diluted iodine 2%(positive oral contrast agent) in abdomino-pelvic multi-detector computed tomography.METHODS: Two-hundred patients, referred to the Radiology Department of a central educational hospital for multi-detector row abdominal-pelvic computed tomography, were randomly divided into two groups: the first group received 1500 m L of 4% sorbitol solution as a neutral contrast agent, while in the second group 1500 m L of meglumin solution as a positive contrast agent was administered in a one-way randomized prospective study. The results were independently reviewed by two radiologists. Luminal distension and mural thickness and mucosal enhancement were compared between the two groups. Statistical analysis of the results was performed by Statistical Package for the Social Sciences software version 16 and the Mann-Whitney test at a confidence level of 95%. RESULTS: Use of neutral oral contrast agent significantly improved visualization of the small bowel wall thickness and mural appearance in comparison with administration of positive contrast agent(P < 0.01). In patients who received sorbitol, the small bowel showed better distention compared with those who received iodine solution as a positive contrast agent(P < 0.05). CONCLUSION: The results of the study demonstrated that oral administration of sorbitol solution allows better luminal distention and visualization of mural features than iodine solution as a positive contrast agent.

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.

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.

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.