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Background: Multi-slice computed tomography (MSCT) is the mainstay for preoperative assessment of many complex renal masses in current clinical practice. Benign renal processes may simulate malignant renal tumors and could be defined correctly by CT. MSCT has also an important role in tumor staging. The purpose of this article is to understand the imaging spectrum of renal masses on MSCT and assess the usefulness of CT in surgical planning and management.Methods: Studied 500 patients with suspected renal lesions who underwent MSCT during the period July 2017 to July 2020 at state-of-art imaging center. CT imaging was done in those patients in whom clinical examination and ultrasonography (USG) revealed possibility of diagnosis of renal masses for further detailed evaluation and deciding management.Results: Out of 500 total subjects, the common age group in this study is 51 to 60 years (25%). Male preponderance (59%) was noted. The most common presentation was pain (84%) followed by lump (29.4%) and haematuria (17.8%). Malignant masses (51%) were more common followed by benign (39%) and inflammatory masses (10%) respectively. Renal cell carcinoma has more incidence (30%) followed by simple cyst (20%). Calcification (19.6%), perinephric extension (78%) and vascular invasion (21.5%) are more common in malignant masses. Conclusion: MSCT is the modality of choice for the diagnosis of renal masses and deciding management approach in current practice. Detection of tumoral spread, invasion of surrounding organs and vascular structure are better with CT. MSCT also has a role in postoperative follow-up of renal masses.
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Background: Coronary artery disease (CAD) is one of the leading cause of the morbidity and mortality in India and worldwide and last decade has seen a steep rise in incidence of CAD in India and its treatment as bypass surgery. Direct visualization of the grafts and native coronary arteries by invasive catheterization is now being replaced by non-invasive CT coronary angiography with higher slice machines and newer technology as it has good temporal resolution, high scanning speed as well as low radiation dose. We share our experience of graft imaging on 128 slice CT machine.Methods: This is a retrospective, single-center, observational study. We included 500 symptomatic patients who have undergone CT study between the year 2014 to 2018 post bypass surgery.Results: Arterial grafts have a better patency rate than venous grafts. (88% vs. 64.1%). Amongst the individual arterial grafts RIMA had the best patency rate (100%) followed by LIMA (90.8%), RA (68.7%). LAD was the most commonly involved artery (91%).Conclusions: Significant absolute concordance between CT and catheter angiographic findings have been documented for all arterial and venous grafts patency in the literature. The MSCT with retrospective gating permits an accurate and non-invasive evaluation of patent and diseased arterial and vein grafts and could replace conventional angiography for the follow-up of symptomatic, stable patients. Moreover, an optimal diagnostic accuracy was also documented in the appraisal of native vessels distal to the graft anastomoses.
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Background: Multi-slice computed tomography (MSCT) plays an important role in clinical practice in assessing post-operative patients with complex CHD when echocardiography is not contributory. Despite the great capabilities of MR imaging for anatomic and functional assessment of the heart, it is time-consuming and may require a lengthy period of patient sedation; hence its use in seriously ill or uncooperative patients is often limited. CT has the advantages of widespread availability and short acquisition times. It is imperative for a radiologist to be aware of various palliative as well as corrective procedures and their various imaging findings. Aim of this article is to demonstrate and make one aware of various checklists and imaging findings in paediatric patients who have undergone various shunts and grafts at our tertiary cardiac care centre, their immediate as well as long term complications.Methods: We studied a total of 100 paediatric patients (<12 years old), who had undergone some sort of palliative or corrective shunt or graft placement, on MSCT during the period 2014 to 2018 at our tertiary cardiac care centre.Results: We try to outline details of various shunts and grafts used in congenital heart diseases correction, MSCT technique and imaging appearances and appearances of abnormal post-operative findings.Conclusions: Advances in computed tomography (CT) scanners and electrocardiographic gating techniques have resulted in superior image quality of the aorta and pulmonary arteries for evaluating postoperative congenital heart disease. MSCT is an excellent non-invasive modality for post-operative evaluation of various shunts and grafts.
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[Objective]To study the relationship between bridging septa thickening in the perinephric space and split renal function in acute unilateral upper urinary tract obstruction.[Methods]50 patients with acute unilateral upper urinary tract obstruction by calculus were analyzed retrospectively. According to the images of multi-slice spiral CT (MSCT)scanning,all cases were divided into thickened bridging septa group(n=25)and normal bridging septa group (n=25),The CT values of renal cortical in the plain(CTp)and renal cortical enhancing(CTe)phase were measured, the difference of increasement value(CTe-CTp)and the CT value ratio of the ipsilateral and opposite in renal cortical phase was analyzed by independent sample T test.[Results]The CT increasement value of bridging septa thickening and normal group were(103±30)HU and(128±24)HU respectively,the difference between the two groups was statistically significant(P<0.01);and CTac/CTuc were 0.81±0.13 and 0.96±0.06 respectively(P<0.01).[Conclusion]Thickening of bridging septa in the perinephric space with acute unilateral upper urinary tract obstruction will weaken the enhancement of renal cortical,and increased the likelihood of split renal function impairing.
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Objective To analyze the typical imaging features of various internal biliary fistulas by multislice spiral CT (MSCT),and the diagnostic value.Methods the data of 56 cases of internal biliary fistula in Wuxi No.2 Affiliated Hospital of Nanjing Medical University from January 2011 to March 2018 were analyzed retrospectively.All cases were examined by MSCT plain scan and enhanced examination.The imaging features of various biliary fistula were analyzed and studied.Results Among 56 cases of biliary fistula,39 cases were gallbladder duodenum fistula,and the diagnostic sensitivity was 87.2％ (34/39).The total coincidence rate was 85.7％ (48/56).21 cases were fistula formation,and 11 cases of narrow neck syndrome.Gallbladder bile duct fistula,liver-gallbladder fistula,bile duct and duodenal fistula of 6 cases were showed.In 4 cases of complex gallbladder fistulas,3 cases showed fistula clearly including 2 cases of fistula and a "clover" sign.In the indirect CT signs of 56 cases of internal biliary fistula,the common imaging features:atrophy of gallbladder or incarceration,stone incarceration of biliary tract,gallbladder or choledochal duct and cavity viscera.Conclusion MSCT scan can not only distinguish the type of biliary fistula and the structure of fistula,but also display the fistula,shape,atrophy of gallbladder,gallbladder and bile duct gas,stone and surrounding conditions,which have important guiding significance for the formulation of the operation scheme.
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Objective To explore the value of MSCT parameter in evaluating TNM staging of gastric cancer and its correlation with clinicopathological features.Methods Totally 120 cases with T2 gastric cancer in our hospital from December 2014 to December 2016 were selected into the clinical data.Preoperative MSCT parameters were used to evaluate the TNM staging,and the results were compared with the postoperative pathological findings.Logistic stepwise regression was used to analyze the clinicopathological features of the patients.Results The accuracy of T staging was 88.33％ (106/120).Compared with the postoperative pathology,the overall accuracy rate of N staging was 64.17％ (77/120),with Kappa =0.48.The overall accuracy of TNM staging was 68.33％ (82/120),with Kappa =0.51.TNM staging I stage (OR=1.679,95％ CI:1.119-2.519) and Ⅱ stage (0R=1.373,95％ CI:1.054-1.789),Ⅲ stage (OR=1.274,95％ CI:1.013-1.602) and Ⅳ stage (OR=1.510,95％ CI:1.210-1.884) were the protective factors.Conclusion MSCT parameters can better evaluate the TNM staging of gastric cancer,and the diagnosis is accurate.
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Objective To explore the correlation of EGFR and Ki-67 expressions in lung adenocarcino-ma with MSCT features and general clinical characteristics. Methods According to the differences in EGFR 19/21 gene mutation in the tumor tissues ,120 patients with lung adenocarcinoma were divided into positive group or wild type group. And Ki-67 expression in the tumor tissues was also detected. The test results were analyzed ,and the clinical data and theMSCT imaging features were examined by using the SPSS 19.0. Results The expression of EGFR differed statistically with lymphatic metastasis ,organ metastasis ,pleural indentation ,andnodule types (P < 0.05),but had no statistical significance with age ,sex ,degree of differentiation ,tumor size ,tumor-lung boundary ,burr ,lobulated sign ,vacuole sign and pleural effusion.The high expression of Ki-67 had statistical sig-nificance with lymphatic metastasis and tumor size(P < 0.05)while had no statistical significance with other in-dicators.Ki-67 expression was significantly positively correlated with EGFR(P < 0.05). Conclusions Tumor size ,pleural indentation ,lymphatic metastasis ,organ metastasis and nodular types of lung adenocarcinoma have guiding significance in judging EGFR mutation , proliferation activity ,prognosis and therapy.
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Objective To analyze multislice CT (MSCT) multiphase multiphase enhancement scanning in the atypical hemangiomas. Methods During February 2013 from January 2014, chosing125 cases of patients with atypical hemangiomas in our hospital were retrospectively analyzed. Results There was a total of 240 lesions in 125 patients, multiple (2 or higher) in a total of 70 cases, 55 cases of single. A total of 170 were located in the right lobe, 70 were located in the left lobe, lesions was 0.8 to 4.5 cm in diameter, the average was (2.53±0.21) cm. A total of 205 lesions were circular, a total of 35 as lobulated or irregular. CT scan, a total of 155 were low density, 85 in equal density. A total of 120 state clearly, realm for part of the fuzzy and parts out of a total of 35, 85 was fuzzy. A total of 45 lesions density uneven, a total of 195 was lesions density uniformity. In 240 intrahepatic lesions, a total of 145 lesions present performance1, 80 lesions belong to 2 kinds of forms, 15 lesions characterized by 3 kinds of forms. Conclusion Although a few hemangiomas reinforcement is not typical, by the mutiperiodic enhanced MSCT scanning remain their respective characteristics, in identification of its pathological changes has important diagnostic value.
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Objective To investigate the image quality and radiation dosage of the prospective ECG-triggered 256 multi-slice computer tomography (MSCT) angiography in accessing coronary artery (CA) on children.Methods Coronary arteries of ninety-three children were evaluated using prospective ECG-triggered 256-MSCT with the same system setting.Seventy-four patients had the heart rate records and a four-point scoring system was applied to study the capability of MSCT in detecting CA.The signal,noise and contrast-to-noise ratio (CNR) were analyzed to investigate the association of image quality with age (n =74).Then volumetric CT dose index (CTDIvol),dose-length product (DLP) and effective dose (E) were utilized to study the association of radiation dosage with age (n =93).Results On 74 patients with heart records,the detection rate for original,proximal,middle,distal and all 11 segments of CA was 100％,97％,92％,78％ and 91％,respectively.No influence of age was found on their detection (all P＞0.05).E of group A,B,C and D were 1.8,1.3,0.8 and 0.7 mSv,respectively.A strong negative correlation was found between E and age (r =-0.803,P ＜ 0.01).Higher DLP was found on elder patients,though no correlation was found between ages vs.DLP(r =0.124,P ＞ 0.05).No correlation was found between noise vs.age (r =0.041,P ＞ 0.05).Significantly larger signals,CNR and E(t =3.386,2.073,3.825,P ＜ 0.05) were found on younger patients (age ＜ 3 years).Conclusions Prospective ECG-triggered 256-MSCT has considerable performance for the evaluation of coronary arteries on children.However,children under the age of 3 are not recommended for this examinary,but for examination on children ≥ 8-year old,the tube current could be further needed.
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Clinical data and radiological findings of 78 patients with distal radial fractures,who underwent plain X-ray film and muhislice CT (MSCT) examinations,were retrospectively analyzed.Twenty nine associated carpal bone factures were detected on X-ray film in 21 cases;while 47 associated carpal bone fractures were detected on MSCT in 29 cases (P ＜ 0.05).The missed diagnosis rate of X-ray was 38％.Results indicate that MSCT can significantly improve the detect rate,which should be recommended for diagnosis of associated carpal bone fractures in distal radial fractures.
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Objective To evaluate the diagnostic value of multi-slice spiral CT (MSCT)for traumatic spleen and liver rupture.Methods We made a retrospective analysis of 140 cases of liver and spleen injury with clinical manifestations confirmed by operation.MSCT examination results and clinical data were compared.Results Of the 140 cases,male patients outnumbered female ones,and the peak age was 10 - 30 years old.The injuries were most commonly attributed to traffic accident and falling.There were 69 (49%)cases of spleen injury,5 1 (36%) cases of liver injury,and 20 (14%)cases of both.Liver and spleen injuries showed on MSCT examination were liver and spleen laceration, hematoma within the liver and spleen as well as hematoma beneath the envelop. Conclusion MSCT has an important diagnostic value for traumatic liver and spleen rupture and thus can guide clinical treatment choice.
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Objective:To examine the features of multislice spiral computed tomography (MSCT) in micropapillary-predominant lung adenocarcinomas to improve the understanding of this type of lung cancer. Methods:The MSCT features of 18 cases with micro-papillary-predominant lung adenocarcinoma (micropapillary component>50%) confirmed by histopathology were analyzed retrospec-tively. Results:Among the 18 cases of lung cancer, 1 was diffuse, 3 were central, and 14 were peripheral lung cancer (PLC). The size of the adenocarcinomas in the 14 PLC cases ranged from 1.3 cm to 8.5 cm, with an average of 3.56 cm, including the size of 8 cases greater than or equal to 3 cm. Among the 18 cases, 13 were lobulated, 9 showed spicule signs, 7 showed pleural indentation signs, 5 had pleural adhesions, 1 had bronchial truncation (i.e., cut-off sign), and 4 were surrounded by obstructive inflammation. In addition, calcifi-cation was observed in one case, uneven density in two large lesions, air bronchus sign in four, and solid and ground-glass mixed densi-ty in two. Among the total number of cases, a variety of the measurable enhanced CT values (ΔCT) of lesions were found in 16, ranging from 13 HU to 80 HU, with an average of 47.5 HU, of which 15 were cases ofΔCT≥15 HU and 15 were cases ofΔCT≥20 HU. Pleu-ral thickening was observed in two cases with pleural effusion, and pleural metastasis in one case was confirmed by histopathology. One case with pleural effusion suffering pleural metastasis was confirmed. Ground-glass density nodules in both lungs were observed in one case, with a few bilateral pleural and pericardial effusions. Eight cases had mediastinal or hilar enlarged lymph nodes with uneven density enhancement, and lymph node metastasis was pathologically confirmed in six cases. Lymph node metastasis was found in four cases, but no apparent enlargement of lymph nodes in MSCT was observed. Conclusion:Micropapillary-predominant lung adenocarci-nomas were common in non-smoking elderly female patients, whose lung cancer cases were mostly PLC. The typical features of PLC include lobulation, spicule, and pleural indentation signs. Solid density ranked first in the PLC cases, with evident enhancement and high rate of lymph node metastasis.
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Objective To explore the clinical value of 256-slice CT whole hepatic perfusion imaging in transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC).Methods Twenty-three patients with hepatocellular carcinoma underwent whole hepatic perfusion with the JOG technique one week before TACE.The scanning data of cancer and liver tissues were analyzed using the perfusion software.The cancer tissue perfusion was repeated 4 to 6 weeks after treatment and was compared with that before treatment.Results (1) Before TACE,the HCC lesions were shown on the hepatic arterial perfusion (HAP) map as homogeneous hyper-perfusion lesions in 8 patients and as inhomogeneous hyper-perfusion lesions in 15 patients.The HAP and hepatic arterial perfusion index (HAPI) values of the tumor were higher than those of the liver tissues,while the hepatic portal perfusion (HPP) values of the tumor was lower than that of the liver tissues.The differences were all significant (P ＜ 0.05).(2) Mter TACE,the tumors were totally filled with lipiodol in 3 patients,partially filled with lipiodol in 13 patients,and sparsely filled with lipiodol in the remaining 3 patients.There was no blood perfusion in the lipiodol-filled areas and in the cancer necrotic tissues,but in the sparsely or partially lipiodol-filled areas blood perfusion could still be seen.21 patients received another session of TACE 6 to 8 weeks later.The results between the hepatic arterial digital subtraction angiography (DSA) and the CT perfusion were 100％ matching.The HAP and HAPI values of the tumor decreased when compared with before treatment,and the difference was significant (both P ＜0.05).The HPP values decreased slightly with no significant difference (P ＞ 0.05),while higher HAP and HPI and lower HPP were observed in the active cancer tissues when compared with the liver tissues after treatment (P ＜ 0.05).Conclusion 256-slice MSCT whole liver perfusion imaging can quantitatively reflect abnormal perfusion of hepatocellular carcinoma tissues and postoperative active tissues,and has important guiding significance in the preoperative evaluation,and the postoperative follow up of patients treated with TACE.
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To evaluate multi-slice computer tomography (MSCT) in mediastinal lymph node metastasis of T1 and T2 non-small cell lung cancer (NSCLC). Methods:A total of 32 patients with T1 and T2 NSCLC from February 2004 to October 2012 were selected. Preoperative MSCT assessment of mediastinal lymph nodes was performed on basis of the pathological results. Results:Lymph nodes with diameters of≥10 mm were evaluated, and the sensitivity and specificity of the MSCT mediastinal lymph node me-tastases were 82.4%and 92.4%, respectively. Lymph node size, primary tumor location, and visceral pleural invasion showed statistical significance in forecasting mediastinal lymph node metastases (P<0.05). Conclusion:MSCT can be used for the effective evaluation of mediastinal lymph node metastasis, lymph node size, and position of primary tumor. and visceral pleural invasion of the tumor had a higher risk of mediastinal lymph node metastasis.
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Objective To discuss the correlation between MSCT morphological index of emphysema and pulmonary function test (PFT) indexes. Methods We randomly selected 33 cases with chronic obstructive pulmonary disease (COPD),and conducted CT and PFT in a week. The whole lung was scanned by MSCT at the end of deep aspiration,and the post-processing workstation was used for quantitative determination of a total of 12 morphological indexes,including the density of lung, pulmonary diameter line,lung volume,and etc,then their correlation with lung function index was analyzed.Results FEV1.0%had correlation with upper right lung density ( =0.391, =0.391), lower right lung density ( =0.465, =0.038),the mean lung density ( =0.576,=0.576), and total lung capacity (=0.471, =0.471),upper right lung volume ( =0.413, =0.049) . FEV1.0/FVC had correlation with left lower lung density ( =0.392, =0.024), the mean lung density ( =0.703, = 0.000), total lung transverse diameter ( = 0.521, = 0.521), upper right lung maximum transverse diameter ( =0.627, =0.627), and total lung capacity ( =0.549, =0.549) correlation. FVC had correlation with upper right lung maximum transverse diameter ( = 0.378, = 0.378), characterized by maximum transverse diameter (=0.349, =0.037) . TLC had correlation with mean lung density (=0.523,=0.523), upper right lung maximum transverse diameter ( =0.454, =0.454), and total lung capacity (= 0.001), the right lung volume ( = 0.492, = 0.492) . Conclusion MSCT lung morphology quantitative indicators have good clinical application value in the diagnosis and assessment of emphysema patients.
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Objective To study the feasibility of reducing radiation dose in aorto-iliac and lower extremity arteries CT angiography (CTA) with low tube voltage (100 kV) and automatic tube current modulation(ATCM).Methods Totally 61 patients requiting aorto-iliac and lower extremity arteries CTA for clinical reasons were prospectively enrolled in study.The patients were randomly assigned to 3 groups:Group A(120 kV),Group B (100 kV) and Group C (100 kV with automatic tube current modulation).Both quantitative and qualitative analysis were included in this research.Group C was divided into obese group(BMI≥ 24.9 kg/m2) and normal group(BMI ＜ 24.9 kg/m2).The radiation doses were analyzed respectively among two groups.Results The subjective evaluations of image quality for axial,MIP and VR were good.There were no significant differences among group A,B and C in SNR and CNR (P ＞0.05).The effective dose of group A,B and C was 8.20 mSv,5.36 mSv,and was 7.48 mSv,respectively Group B was 34.6％ less than group A.Group C was 39.5％ more than group B,and there was no significant differences between group A and C (P ＞ 0.05).The effective dose of group C1 was 7.11mSv,group C2 was 9.69 mSv,the E with group C1 were significantly less than group C2 (t =-3.163,P ＜0.05),the effective dose of group C1 was 13.3％ less than group A (Z =-2.822,P ＜ 0.05),but the group C2 was more than group A (P ＞ 0.05) and group B (Z =-3.426,P ＜ 0.05).Conclusions Lowkilovoltage (100 kV) CT scanning protocol is feasible in multi-detector CT angiography for aortoiliac and lower extremity arteries.Automatic low tube voltage (100 kV) with automatic tube current modulation (ATCM) scanning protocol can be used for someone with BMI less than 24.9 kg/m2.
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Introducción: En la actualidad la enfermedad coronaria obstructiva (obstrucción mayor de 50%) puede ser fácilmente evaluada por medio de la tomografía coronaria multicorte. Sin embargo, aún no se define si ésta puede reemplazar a la angiografía coronaria invasiva, en pacientes que van a cirugía cardiaca no coronaria. Objetivo: Conocer si la tomografía coronaria multicorte puede sustituir a la angiografía coronaria invasiva en la detección de enfermedad coronaria en pacientes que van a ser operados de cirugía cardiaca no coronaria; comparando entre si la sensibilidad y especificidad de ambos métodos en la detección de enfermedad coronaria. Método: Se incluyeron consecutivamente 64 pacientes con edades de 55.17 ± 12.73 años, en Clase I de las guías del Colegio Americano de Cardiología/Asociación Americana de Corazón para realizar angiografía coronaria en el preoperatorio de cirugía cardiaca no coronaria. Se excluyeron enfermos con angina de pecho, alergia al medio de contraste, creatinina sérica por arriba de 2.0 mg/dL, que tuvieran previamente cirugía cardiaca o angioplastia coronaria y arritmias supra-ventriculares. Se analizó la anatomía coronaria y se cuantificó la cantidad de calcio coronario. Resultados: La prevalencia de obstrucción coronaria mayor de 50% fue 12.5%. La tomografía coronaria multicorte mostró sensibilidad de 87.5%, especificidad de 92.8%, valor predictivo negativo de 98.1% y área bajo la curva de 0.90, para predecir obstrucción coronaria. Ningún paciente con valvulopatía reumática tuvo obstrucción coronaria mayor de 50% o score de calcio > 400 U A (RR = 0.80, IC 95% 0.69-0.94). La estenosis valvular aórtica degenerativa tuvo mayor probabilidad de obstrucción coronaria mayor de 50% (RR = 9.0: IC 95% 1.64-49.8). Con análisis multivariado usando regresión logística, el score de calcio mayor de 400 UA (Coef ß 0.342, t = 4.297, p = 0.000) y sexo masculino (Coef ß 0.174, t = 2.214, p = 0.031), fueron las variables predictoras de más peso. Este estudio muestra poblaciones diferentes en el grupo de pacientes que van a cirugía cardiaca no coronaria. Conclusiones: El género masculino, el calcio coronario mayor de 400 UA y el tipo de enfermedad cardiaca previa a la cirugía cardiaca no coronaria pueden ser variables útiles para realizar la selección de pacientes que pueden evaluarse con tomografía coronaria multicorte o con angiografía coronaria invasiva. La angiografía coronaria invasiva puede indicarse necesariamente en algunos pacientes que van a cirugía cardiaca no coronaria, pero no es absolutamente necesaria en todos los enfermos como hasta hoy se recomienda en las guías del Colegio Americano de Cardiología y la Asociación Americana de Corazón.
Introduction: Significant Coronary Artery Disease (CAD>50%) it can easily detected with Multislice Computed Tomography (MSCT), nevertheless if MSCT may replace Invasive Coronary Angiography (ICA) in the preoperative assessment of the patient undergoing to non-coronary cardiac surgery is not well defined. The objective of this study was to know if the MSCT can replace ICA in the preoperative valuation of patients who go to cardiac surgery Method: 64 consecutive patients in Class I recommendation of American College of Cardiology / American Heart Association (ACC/AHA) guidelines for preoperative ICA were evaluated. Patients with angina, contrast medium allergy, serum creatinine up to 2.0 mg/dL, previous coronary cardiac surgery or coronary angioplasty and supraventricular arrhythmias were excluded. Both, Coronary artery calcium (CAC) and coronary angiography were evaluated. Results: The prevalence of significant (>50%) CAD was 12.5%. The Sensitivity of MSCT to detect significant CAD was 87.5%, its Specificity of 92.8%, Predictive Negative Value was 98.1% and Area Under the Curve (ROC analysis) = 0.90. Anyone with Rheumatic Valvular Disease had significant CAD or CAC>400 UA (RR = 0.80, IC95% 0.69-0.94). Degenerative Aortic Valve Stenosis had a major probability of significant CAD (RR of 9.0; IC 95% 1.64-49.80). Logistic Regression Analysis showed than CAC>400 UA (Coef ß 0,351, t = 4.402 p = 0.000) and male gender (Coef ß 0,179, t = 2.445, p = 0.017), were the best predicting variables of CAD. This study shows different populations in patients undergoing to non-coronary cardiac surgery. Conclusions: Gender, CAC> 400 UA and type of cardiac disease previously surgery may be useful for triage to MSCT or ICA in the preoperative assessment. This study shows that ICA may be necessarily indicated in some patients in assessment of non-coronary cardiac surgery but not absolutely indicated in all patients that Guidelines of ACC/AHA have recommended.
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Female , Humans , Male , Middle Aged , Cardiac Surgical Procedures , Coronary Artery Disease , Multidetector Computed Tomography , Preoperative Care , Coronary Angiography/methods , Predictive Value of TestsABSTRACT
Introducción. El stroke isquémico en pacientes jóvenes (entre 15 y 45 años) es un evento inesperado, cuyas causas incluyen patologías diversas y poco frecuentes en la población adulta. Objetivo. Destacar el creciente rol de las neuroimágenes en el diagnóstico, la terapéutica y el pronóstico del accidente cerebrovascular isquémico (ACV) en pacientes jóvenes. Materiales y Métodos. Se incluyeron retrospectivamente 30 pacientes entre 15 y 45 años con stroke isquémico agudo estudiados en nuestra institución en el último año. Resultados. De los 30 pacientes, la mitad de ellos fueron hombres con una edad media de 35 años. En el 86% de los casos (n=26) se estableció la causa del ACV: el 7% (n=2) presentó ateroesclerosis de grandes vasos, el 10% (n=3) se relacionó a cardioembolismo, en el 27% (n=8) las disecciones arteriales fueron la causa y en el 43% (n=13) las etiologías fueron misceláneas. En el 13% (n=4) no se estableció la causa. Conclusiones. El rol de las neuroimágenes en el desafiante estudio de pacientes jóvenes con ACV incluye la confirmación de la naturaleza isquémica de la lesión, la determinación de su localización y extensión, y el estudio en forma rápida y no invasiva de los vasos extra e intracraneanos. En estos aspectos la tomografía multicorte (TCMS) y la resonancia magnética (RM) de alto campo ofrecen alta sensibilidad y especificidad.
Introduction. Ischemic stroke in patients between the ages of 15 and 45 is an unexpected event. Its causes involve diverse pathologies which are not frequent in the older population. Purpose. To highlight the important role of neuroimaging in the diagnosis, prognosis, and therapeutical approach of these patients. Materials and Methods. 30 young adult patients between the ages of 15 and 45 with diagnosis of acute ischemic stroke were retrospectively studied. Results. Of these 30 patients, half of them were men with a mean age of 35 years. Stroke etiology was established in 86% of the cases (n=26), 7% (n=2) due to atherosclerosis, 10% (n=3) due to cardioembolism, 27% (n=8) because of arterial dissection, and 43% (n=13) due to miscellaneous diseases. In 13% (n=4) of the cases the cause was undetermined. Conclusions. Neuroimages play a comprehensive role in the neuroradiological work-up which include: the confirmation of the presence of an acute ischemic lesion, determination of its topography, extension and evaluation of extracranial and intracranial arteries. In this sense, Magnetic Resonance Imaging (MRI) and Multislice Computed Tomography (MSCT) offer high sensitivity and resolution.
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Objective To evaluate the validity and reliability of multi-slice spiral CT (MSCT) in preoperative TNM staging judgment of rectal carcinoma. Methods Three hundred and one patients with rectal carcinoma were diagnosed and treated consecutively in Colorectal and Anal Surgery Department of Shanxi Province Tumor Hospital from January 2009 to December 2009. The clinical data of these patients were analyzed retrospectively. The diagnosis results were compared between the preoperative MSCT staging and the postoperative pathological staging,the ROC curve and the diagnostic concordance test were analyzed by software Medcalc 11.2. Results The sensitivity, specificity, Kappa value, area under the curve of TNM staging were 64.7% ,96. 8% ,0. 667,0. 808 for T2 staging tumors; 93.8% ,75.0% ,0.709,0.844 for T3 staging tumors;87. 8% ,98. 1% ,0. 859,0. 929 for T4 staging tumors; 72. 0% ,91.2% ,0. 619,0. 816 for N staging tumors;92. 7%, 99. 7%, 0. 925,0. 963 for M staging tumors respectively. Conclusion The diagnostic value of independent use of MSCT in estimating the infiltration degree and lymph node metastasis of rectal cancer is very poor and cannot be used in preoperative staging judgment.
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Objective Evaluate the diagnostic value of PET/CT in the preoperative advanced gastric carcinoma comparing with mult;-slice spiral computed tomography. Methods Thirty-nine advanced gastric carcinoma patients taking PET/CT and abstract 40 advanced gastric carcinoma patients performing MSCT before operation,were done the TNM staging, and the Results were compared with the operation histopathology. Results For diagnosing primary lesions, regional lymph nodes, N3 lymph nodes ,PET/CT was accurate in 92.3% , 66.7% and 100.0%.Instead, MSCT was accurate in 82.0% , 50.0% and 62.5%. Conclusions (1) PET/CT and MSCT have high accuracy in diagnosing primary lesions and regional lymph nodes. But for detecting the N3 lymph nodes and distant metastasis, PET/CT has higher accuracy than MSCT. PET/CT combining abdominoscopy may decrease or avoid exploratory laparotomy.