Accuracy for diagnosis of patients presented with painless hematuria by MDCT urography.

Background: Computed tomography urography (CTU) is a relatively new diagnostic imaging examination providing comprehensive evaluation of the upper and lower urinary tract. CTU is justified as a first-line test for patients with macroscopic hematuria, at high-risk for urothelial cancer. Objective: To assess the role of multi-detector row CT (MDCT) urography, using a MDCT for evaluation of patients presenting with painless hematuria, in Siriraj Hospital, Bangkok, Thailand. Methods: Between 2006 and 2008, 16 consecutive MDCT urography examinations were retrospectively reviewed by two radiologists. Sensitivity, specificity, PPV, NPV and accuracy of MDCT urography compared with surgical, histopathological findings and other imaging modalities were calculated. Results: In 11 out of 16 patients, the causes of painless hematuria were identified on MDCT urography. The most common cause was benign urothelial lesions in 5 cases. About uroepithelial malignancies, a detectable smallest lesion was about 0.8 cm in diameter. Conclusion: Sixty-four row MDCT urography provided satisfactory results in detection of urinary tract lesions with high accuracy in painless hematuria patients.

Accuracy of multi-detector CT scan in pre-operative staging of renal cell carcinoma: Comparison of radiological and histopathological findings.

Objective: To evaluate the accuracy of pre-operative multi-detector CT scan (MDCT) compared to histopathology findings in tumor staging of renal cell carcinoma. Methods: Retrospective review of 29 renal cell carcinomas at Siriraj Hospital from 2004-2007. Two blinded radiologists evaluated the pre-operative MDCT images independently. Imaging findings were compared with surgical specimens and pathological findings. Results: A total of 29 renal cell carcinomas were proven on histopathology. The respective accuracy for overall staging of reader 1 and 2 were 0.75 and 0.65. The reader 1 and 2 reached a sensitivity of 75% and 87%, a specificity of 70% and 50% for perinephric involvement, and a sensitivity of 100% and 100%, a specificity of 63% and 54% for renal pelvis involvement. The kappa interobserver agreements for perinephric involvement and renal pelvis involvement were 0.67 and 0.83, respectively. Conclusion: False positive finding of perinephric involvement causes overstaging of Robson stage I disease or in T1-T2 disease of TNM classification. Perinephric stranding may not be reliable or specific findings, and a result of perinephric involvement in CT scan is still limited. MDCT is accurate in the pre-operative evaluation of renal cell carcinoma in Robson stage II-IV disease.

Computed tomographic findings in differentiating between diverticulitis and colon cancer.

Objective: To determine the computed tomographic (CT) findings associated with diverticulitis or colonic cancer, and to evaluate the CT signs that may help in distinguishing between these two diseases. Methods: Fifty-five CT scans of patients with colonic diverticulitis (n=17) or colonic cancer (n=38) between January 2002 to October 2005 were retrospectively and independently evaluated by two abdominal radiologists who were blinded to the proved diagnosis. Discrepancies of each CT finding were resolved by consensus opinion. CT findings were assessed as follows: location of involved colon, length of involved segment, degree of pericolonic inflammation, pericolonic lymph nodes, thickness and pattern of bowel wall thickening, presence or absence of simple diverticula at the involved colonic segment, inflamed diverticula, intramural sinus tract, fistula, muscular wall hypertrophy, “arrowhead” sign, extraluminal air and bowel obstruction. The inter-observer agreement was assessed with the kappa statistic. The association of consensus opinion of each CT findings with the final diagnosis of colonic diverticulitis or colon cancer were evaluated by using chi-square test and odds ratios. Results: Bowel wall thickness less than 1 cm ( p < 0.0001, odds ratio 32.89, 95% CI 3.31,798.5), presence of simple diverticula at involved segment ( p < 0.001, odds ratio 28.13, 95% CI 4.56, 266.11), presence of inflamed diverticula ( p = 0.003, odds ratio 15.42, 95% CI 1.46, 386.32) and symmetrical pattern of bowel wall thickening( p < 0.0001, odds ratio 13.07, 95% CI 2.66, 73.36) were the statistically significant CT findings which are found more frequently in colonic diverticulitis than in colon cancer. On the other hand, bowel wall thickness 1 cm or greater, eccentric pattern of bowel wall thickening without evidence of simple diverticula or inflamed diverticula at the involved colonic segment were the statistically significant CT findings seen more frequently in colon cancer than in diverticulitis. Conclusion: Bowel wall thickness less than 1 cm, presence of simple diverticula at the involved segment, presence of inflamed diverticula and symmetrical pattern of bowel wall thickening were the helpful CT findings in distinguishing colonic diverticulitis from colon cancer. Bowel wall thickness 1 cm or greater, eccentric pattern of bowel wall thickening without evidence of simple diverticula or inflamed diverticula at the involved colonic segment were the useful CT findings in distinguishing colon cancer from colonic diverticulitis.

Correlation between serum creatinine levels and underlying risk factors for renal disorders in a group of patient undergoing computed tomography using intravenous iodinated radiographic contrast medium.

Intravenous administration of iodinated radiographic contrast media has been known to have nephrotoxic side effects especially patients with renal disorders. Ideally, each patient should have serum creatinine measured before administering the contrast media. This is costly in termed of time and finance and is not practical in our situation here at Siriraj Hospital. The aim of this study is to determine whether serum creatinine levels correlate with the patient's underlying risk factors. The data were collected from 81 patients who were sent for computed tomographic examination. 63 patients (77.78%) were found to have underlying risk factors. These included hypertension 21 cases (33.33%), diabetes mellitus 18 cases (28.57%), administration of chemotoxic drugs 13 cases (20.64%), renal disease 4 cases (6.35%), high serum uric acid 4 cases (6.35%), AIDS 2 cases (3.17%), and ACEI 1 case (1.59%). Of these, only 5 cases (6.17%) were found to have abnormally high serum creatinine levels (over 2 mg/dl), all had underlying risk factors and were over 60 years old.

Differential diagnosis between neonatal hepatitis and biliary atresia using 99mTc DISIDA scintigraphy.

99mTc DISIDA Scintigrams of intants being investigated for proliged jaundice grom May 1983. to December 1987 were studied in order to determine the accuracy and usefulness of the test in differentiating extrahepatic biliary atresia (EHBA) from neonatal hepatitis. The patients were divided into 2 groups, group A consisting of those done from May 1983 to December 1986 and Group B consisting of those done from January to December 1987. The sensitivity, specificity, accuracy, positive and negative perdictive value of the test in each group were 62, 57, 58, 35, and 90, 77, 83, 75, 91%, respectively. With more experience and improved technique, today 99mTc-DISIDA scintigraphy has become an accurate test foe differentiating EHBA from neonatal hepatitis. When radiotracer is demonstrated in the intestine, EHBA can virtually be excluded. When no bowcl excretion is seen upto 24 hours, EHBA is probable and further invasive procedures are justified.