Role Of Ct Scan In Staging Of Carcinoma Of Esophagus – A Study Of 100 Cases

Introduction: CT has become a useful diagnostic modality in the evaluation of the stage of oesophageal carcinoma and an integral part of surgical planning. Present study describes various finding of oesophageal carcinoma on CTto aid in its diagnosis and staging. Aim and objectives: The aim of our study is to evaluate and describe the various CT findings of carcinoma oesophagus to evaluate diagnostic accuracy of CT for carcinoma oesophagus and comparision of CT findings with histopathological findings to stage the disease using worldwide accepted criteria of TNM staging system. Materials and Methods: After ethical clearance, a prospective study was carried out in the Gujarat Cancer and Research In statute, Ahmedabad, from August 2015 to November 2017. After obtaining consent, 100 patients presenting with clinical symptoms and signs pertaining to carcinoma of oesophagus were studied. Oral and IV contrast was used. Three dimensional reconstructions were done and various CT findings of oesophageal cancer studied. The diagnosis and staging confirmed by post-operative histopathology. Results: Carcinoma oesophagus was commonly seen in age group between 51 to 60 years (34%) with males (72%) more commonly affected than females (28%). All patients predominantly presented with dysphagia. The middle 1/3rd of oesophagus affected more commonly compare to other parts. The wall thickness in majority of the cases measured between 10-20mm (62%). T3N1M0 was the most common staging found in CT (30%). 16% cases presented with metastasis. Squamous cell carcinoma (84%) was the most common histopathological type presented. 54 patients got operated out of 100 and CT staging was compared with the postoperative histopathological staging. The accuracy of CT-scan for 'T' stage were 83.33 %, in 'N' stage 81.48 % and in 'M' stage being 99 %. Conclusion: CT-scan is excellent in the diagnosis of distant metastasis and lymphadenopathies. Thus, evaluation of various CT findings and preoperative staging of carcinoma oesophagus will help to decide management of these patients. Hence, CT plays an important role in detecting and staging carcinoma oesophagus.

Pielonefritis xantogranulomatosa: estudio retrospectivo de 8 casos / Xanthogranulomatous pyelonephritis: a retrospective study of 8 cases

Hemos revisado las características clínicas, radiológicas y patológicas de la pielonefritis xan-togranulomatosa junto con la evolución de la enfermedad y una revisión bibliográfica de la misma. Se realiza un estudio retrospectivo en nuestro centro, obteniendo una muestra de 8 casos confirmados por anatomía patológica a través de los que describimos las características clínicas y diagnósticas. De los 8 casos (1 varón y 7 mujeres), 6 de ellos debutaron como cólico renal complicado, 1 se presentó con astenia y pérdida de peso y el otro caso fue un hallazgo incidental. El diagnóstico inicial se realizó mediante ecografía en 2 casos y TC en todos los casos, siendo confirmados todos mediante estudio histopatológico.

We have revised the clinical, radiological and pathological characteristics of Xanthogranuloma-tous pyelonephritis (XGP), together with the evolution of the disease and a literature review of the same. A retrospective study was performed at our center, obtaining a sample of 8 pathologically confirmed cases which we used to describe the clinical and diagnostic features. Of the 8 cases (1 male and 7 female), 6 of them presented complicated renal colic, one presented asthenia and weight loss and the other case was an incidental finding. The initial diagnosis was achieved with ultrasonography in 2 of the cases and with CT in all of the cases, all being confirmed by a histopathological study.

The pulmonary findings in patients with acute aortic dissection on multidetector CT / 中国中西医结合急救杂志

10.3969/j.issn.1008-9691.2013.03.018

From pitfall to misdiagnosis and life-threatening treatment / De las trampas de los falsos positivos a los diagnósticos equivocados y los tratamientos que amenazan la vida

Sixty-four-section multidetector computed tomography angiography (64-SMCTA) is increasingly used for screening and surgical planning of ruptured intracranial aneurysms due to its high sensitivity and positivity and it is less invasive than digital subtraction angiography (DSA). Combination of both is the best tool when diagnosis is inconclusive. Sometimes the use of 64-SMCTA alone may cause interpretation pitfall and unnecessary life-threatening treatment. This case report is about 64-SMCTA interpretation pitfall, a false positive result that occasioned surgery for clipping an intracranial aneurysm which was not found during surgical procedure. The patient survived the life-threatening surgery and she has been doing well over the last two years. A perceptual error and lack of conspicuity due to some limitations of the scanner to disclose a normal anatomic variant were responsible for this false positive. When ever 64-SMCTA renders inconspicuous images, this result must be seen as inconclusive and hence a meticulous differential diagnosis and DSA are required before any surgical planning.

La angiografía mediante tomografía axial computadorizada con multidetectores de 64 secciones (64- SMCTA) se usa cada vez más para el tamizaje y el planeamiento quirúrgico de la ruptura de aneurismas intracraneales, debido a su alta sensibilidad y positividad, y a que es menos invasiva que la angiografía de substracción digital (ASD). La combinación de ambas es la mejor herramienta cuando el diagnóstico es inconcluso. A veces el uso de 64-SMCTA solo, puede causar una interpretación falsamente positiva, llevando así a un tratamiento innecesario que ponga en peligro la vida del paciente. Este reporte de caso trata de una trampa de la interpretación con 64-SMCTA - un resultado falsamente positivo que ocasionó una cirugía para pinzar un aneurisma intracraneal que no se encontró durante el procedimiento quirúrgico. La paciente sobrevivió la riesgosa cirugía, y le ha ido bien en los últimos dos años. Un error de percepción y falta de clara visibilidad a causa de algunas limitaciones del escáner para revelar variantes anatómicas normales, fueron los responsables del falso positivo, es decir, de la falsa alarma. Cuando el 64-SMCTA produce imágenes no suficientemente precisas, el resultado debe considerarse inconcluso, y se requiere entonces un meticuloso diagnóstico diferencial y DSA antes de proseguir a una planificación quirúrgica.

Coronary Vasospastic Angina: Assessment by Multidetector CT Coronary Angiography

OBJECTIVE: We aimed to describe the imaging findings of multidetector CT coronary angiography (MDCTA) in cases of vasospastic angina (VA) and to determine the accuracy of MDCTA in the identification of VA as compared with invasive coronary angiography with an ergonovine provocation test (CAG with an EG test). MATERIALS AND METHODS: Fifty-three patients with clinically suspected VA were enrolled in this study. Two radiologists analyzed the stenosis degree, presence or absence of plaque, plaque composition, and a remodeling index of the related-segment in CAG with an EG test, which were used as a gold standard. We evaluated the diagnostic performances of MDCTA by comparing the MDCTA findings with those of CAG with an EG test. RESULTS: Among the 25 patients with positive CAG with an EG test, all 12 patients with significant stenosis showed no definite plaque with the negative arterial remodeling. Of the six patients with insignificant stenosis, three (50%) had non-calcified plaque (NCP), two (33%) had mixed plaque, and one (17%) had calcified plaque. When the criteria for significant stenosis with negative remodeling but no definite evidence of plaque as a characteristic finding of MDCTA were used, results showed sensitivities, specificities, positive predictive values (PPV), and negative predictive values (NPV) of 48%, 100%, 100%, and 68%, respectively. CONCLUSION: Significant stenosis with negative remodeling, but no definite evidence of plaque, is the characteristic finding on MDCTA of VA. Cardiac MDCTA shows good diagnostic performance with high specificity and PPV as compared with CAG with an EG test.

Diagnosing Small Hepatic Cysts on Multidetector CT: an Additional Merit of Thinner Coronal Reformations

OBJECTIVE: We wanted to validate the additional merit of the thinner coronal reformation images from multidetector CT (MDCT) for making the diagnosis of hepatic cysts. MATERIALS AND METHODS: For the 90 benign hepatic cysts confirmed on MRI, the transverse (5-mm thickness) and additional coronal (2-mm thickness) reformation images from MDCT were compared with each other in terms of the Hounsfield units (HUs) and the size of each hepatic cyst. RESULTS: The attenuations (mean: 17.2 HUs, standard deviation: +/- 14.4) on the thinner coronal images were significantly lower than those (mean: 40.7 HUs; standard deviation: +/- 20.6) on the thicker transverse images for the small hepatic cysts (< or = 10 mm on the transverse image, p < 0.01). Twenty-three (79%) of the 29 cysts between 5 mm and 10 mm and 21 (51%) of 41 lesions up to 5 mm showed a mean HU value of 20 or less on the coronal reformation images. CONCLUSION: By reducing the partial volume effect, routine coronal reformation of MDCT with a thinner section thickness can provide another merit for making a confidential diagnosis of many small sub-centimeter hepatic cysts, and these small cysts are not easily characterized on the conventional transverse images.

Individual Pulmonary Vein Atresia in Adults: Report of Two Cases

We present two cases of individual pulmonary vein atresia without vestige of an involved pulmonary vein. On CT, we noted the absence or interruption of normal pulmonary venous structures, and the presence of abnormal vascular structures that represented collaterals for the involved lung parenchyma. On angiography, the atretic pulmonary vein was found to drain into the other ipsilateral pulmonary veins through the collaterals.

The Utility of 64 Channel Multidetector CT Angiography for Evaluating the Renal Vascular Anatomy and Possible Variations: a Pictorial Essay

The increased use of laparoscopic nephrectomy and nephron-sparing surgery has prompted the need for a more detailed radiological evaluation of the renal vascular anatomy. Multidetector CT angiography is a fast and accurate modality for assessing the precise anatomy of the renal vessels. In this pictorial review, we present the multidetector CT angiography appearances of the normal renal vascular anatomy and a spectrum of various anomalies that require accurate vascular depiction before undergoing surgical treatment.

Multidetector Computed Tomography Findings of a Papillary Fibroelastoma of the Aortic Valve: A Case Report

Papillary fibroelastoma is a rare benign cardiac tumor that represents 10% of all primary cardiac tumors. Diagnosis is accomplished incidentally by echocardiography that is usually performed for another purpose. Most papillary fibroelastomas are asymptomatic, but the lesions are recognized as a cause of embolisms. To the best of our knowledge, there has been no case report of computed tomography findings of a papillary fibroelastoma. We report a case of a papillary fibroelastoma in a 78-yr-old woman who had dyspnea and chest tightness. Echocardiography revealed a small lobulated mobile echogenic mass attached to the aortic valve, and CT demonstrated a lobulated soft tissue density mass with a thin stalk at the sinotubular junction of the aortic valve.

Clinical Application of Cardiac Hybrid Imaging in Coronary Artery Disease / 영남의대학술지

Constant technological developments in coronary artery disease have contributed to the assessment of both the presence of coronary stenosis and its hemodynamic consequences. Hence, noninvasive imaging helps guide therapeutic decisions by providing complementary information on coronary morphology and on myocardial perfusion and metabolism. This can be done using single photon emission computed tomography(SPECT) or positron emission tomography(PET) and multidetector CT(MDCT). Advances in image-processing software and the advent of SPECT/CT and PET/CT have paved the way for the combination of image datasets from different modalities, giving rise to hybrid imaging. Three dimensional cardiac hybrid imaging helped to confirm hemodynamic significance in many lesions, add new lesions such as left main coronay artery disease, exclude equivocal defects, correct the corresponding arteries to their allocated defects and identify culprit segment. Cardiac hybrid imaging avoids the mental integration of functional and morphologic images and facilitates a comprehensive interpretation of coronary lesions and their pathophysiologic adequacy by three dimensional display of fused images, and allows the best evaluation of myocardial territories and the coronary-artery branches that serve each territory. This integration of functional and morphological information were feasible to intuitively convincing and might facilitate developmnt of a comprehensive non-invasive assessment of coronary artery disease.

Multidetector CT and MR Imaging of Cardiac Tumors

The purpose of this article is to provide a current review of the spectrum of multidetector CT (MDCT) and MRI findings for a variety of cardiac neoplasms. In the diagnosis of cardiac tumors, the use of MDCT and MRI can help differentiate benign from malignant masses. Especially, the use of MDCT is advantageous in providing anatomical information and MRI is useful for tissue characterization of cardiac masses. Knowledge of the characteristic MRI findings of benign cardiac tumors or thrombi can be helpful to avoid unnecessary surgical procedures. Presurgical assessment of malignant cardiac tumors with the use of MDCT and MRI may allow determination of the resectability of tumors and planning for the reconstruction of cardiac chambers.

Assessment of coronary artery stenosis with 16 slices multidetector CT.

Objective: To investigate the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of noninvasive coronary computer tomography (CT) for assessment of coronary arteries. Methods: The total of 330 patients who were suspected to have coronary artery disease underwent noninvasive coronary CT angiography. The 26 patients (male 14: female 12) had consecutively undergone a 16 slices multi-detector row CT, as well as invasive coronary angiography, within a 3 months period. The coronary CT angiography was retrospectively reviewed by two radiologists. The degree of coronary stenosis was compared with invasive conventional angiography. Results: The coronary CT angiography of 306 segments in 26 patients was evaluated. The 306 segments were divided into proximal 155 branches and distal 151 branches. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of coronary CT angiography for coronary artery stenosis were 76.9%, 91.7%, 65.6%, 95.1%, and 89.2% respectively. The sensitivity and specificity of proximal coronary artery stenosis 155 segments were 85.7%, and 90.8%, respectively. The sensitivity and specificity for 151 distal branches were 58.8% and 92.5%, respectively. Conclusion: Coronary CT angiography using 16 slices multi-detector row CT allows for the reliable detection of coronary artery stenoses with a high diagnostic accuracy.

Aortic Stenosis: Evaluation with Multidetector CT Angiography and MR Imaging

Aortic valvular stenosis (AS) is the most common valve disease which results in the need for a valve replacement. Although a Doppler echocardiography is the current reference imaging method, the multidetector computerized tomograpghy (MDCT) and magnetic resonance imaging (MRI) have recently emerged as a promising method for noninvasive valve imaging. In this study, we briefly describe the usefulness and comparative merits of the MDCT and MRI for the evaluation of AS in terms of valvular morphology (as the causes of AS), quantification of aortic valve area, pressure gradient of flow (for assessment severity of AS), and the evaluation of the ascending aorta and cardiac function (as the secondary effects of AS). The familiarity with the MDCT and MRI features of AS is considered to be helpful for the accurate diagnosis and proper management of patients with a poor acoustic window.

Angiotomografía con multidetectores (TCMD): ¿Nueva prueba de oro para el diagnóstico de lesiones vasculares de las extremidades? / Multidetector CT (MDCT) angiography: new gold standard for the diagnosis of vascular injuries in the extremities?

El enfoque diagnóstico y terapéutico de los pacientes con sospecha de trauma vascular de las extremidades ha cambiado a lo largo del tiempo. La arteriografía de rutina desplazó al tratamiento quirúrgico obligado debido al alto número de exploraciones quirúrgicas no terapéuticas. Posteriormente se adoptó un enfoque selectivo y el análisis juicioso de los hallazgos del examen físico condujo a la disminución del número de arteriografías practicadas. En los últimos años se ha recurrido al uso de la tomografía helicoidal y, más recientemente, al de la angiotomografía con multidetectores (TCMD) para la evaluación de situaciones médicas y quirúrgicas de urgencia y su uso se ha extendido a los pacientes con trauma vascular. La experiencia acumulada en el Hospital Universitario San Vicente de Paúl de Medellín (Colombia) y en otros centros de trauma permite concluir que es un procedimiento seguro, confiable y que por su excelente desempeño se puede constituir en la prueba de oro para el diagnóstico del trauma vascular de las extremidades.

The diagnostic and therapeutic approaches to patients with suspected vascular injuries in the extremities haschanged throughout time. Routine arteriography replaced mandatory surgical treatment due to the high number of non-therapeutic explorations. Later on, a more selective approach was adopted, and thestrict analysis of physical examination findings led toa reduced number of arteriographies. In recent yearsthe use of Helical CT arteriography and then Multidetector CT angiography have become useful tools in the evaluation of some medical and surgicalconditions, which now include vascular trauma. With the accumulated experience at Hospital Universitario San Vicente de Paúl, in Medellín (Colombia) as well as in other trauma centers, it can be now stated that this procedure is safe, reliable and that, due to its excellent performance, it can be considered the Gold-Standard Test for the diagnosis of vascular traumain the extremities.

MDCT Application for Coronary Artery Intervention

Multidetector computed tomography (MDCT) has recently been used as a diagnostic tool for the evaluation of coronary artery morphology and stenosis. The accuracy of MDCT has improved as the number of detectors of MDCT has increased. A 64-MDCT reliably detects significant coronary artery stenosis with a sensitivity and specificity higher than 90%. With its high negative predictive value near 100%, 64-MDCT is very practical for excluding significant coronary artery disease and avoiding unnecessary invasive coronary angiography. Furthermore, preprocedural MDCT coronary angiography is useful to provide additional information and predict the procedural outcomes particularly in patients who have chronic total occlusion and those referred for percutaneous coronary intervention. Postprocedural MDCT coronary angiography usually involves evaluation of in-stent restenosis. Recently, drug-eluting stents are widely used and has notably reduced the rate of in-stent restenosis. However, the rate of in-stent restenosis of drug-eluting stents are still 5~10%. Considering the large number of patients who receive coronary artery stents, MDCT would be clinically useful as a noninvasive tool for the reliable detection of in-stent restenosis. Even with 64-MDCT, 30~40% of stents are not evaluable because the spatial and temporal resolutions are not sufficient for the detection of in-stent restenosis. With the 64-MDCT technology, the accessibility of in-stent restenosis mainly depends on stent size and severity of metal artifact of stents. Although the current MDCT does not permit reliable detection of in-stent restenosis, MDCT can be accepted as a first-line alternative to coronary angiography for the evaluation of stents, especially those with a large diameter such as left main coronary artery stents.

Myocardial Contractility, Perfusion, and Viability Analysis Using Multidetector CT in Patients with Ischemic Heart Disease

The imaging technique that can provide detailed information on the left ventricular function, myocardial perfusion and viability at the same time will not only be helpful for the prognostic assessment of patients with ischemic heart disease but also be valuable in choosing appropriate therapeutic strategies. In recent years, multidetector CT (MDCT) has been proposed as a useful non-invasive imaging method of evaluating both coronary artery stenoses and cardiac morphology at the same time. MDCT has proved to be in excellent agreement with echocardiography and magnetic resonance imaging in the assessment of the left ventricular function. In addition, MDCT can provide information on myocardial viability, which can be assessed from the left ventricular wall thickness, myocardial perfusion, and a delayed contrast enhancement pattern. Despite several shortcomings to be the first-line modality for the assessment of ischemic heart disease, MDCT can provide valuable additional dynamic information in patients undergoing MDCT coronary angiography.

Technical aspect of CT angiography of lower extremities.

Objective: To assess the less invasive technique of CT angiography for evaluation of lower extremity arteries with nonionic water soluble iodinated contrast medium. Methods: One hundred thirty patients underwent a CT angiography of lower extremity using smart prep technique above the iliac creast 1 inch. and the following parameters: Helical, Rotation time : 0.8 seconds, Rotation length : full, Detector configuration : 16X1.25 mm, Helical thickness : 1.25, Pitch : 1.375:1, Speed : 27.50 mm/rotation, Beam collimation : 20 mm, Image interval : 1.0 mm, Gantry tilt : 0.0, SFOV : large, X-ray energy 140 kV, 260 mA. Results: The data of CT Acquisition and Contrast Medium Parameters were Scanning coverage (mm): 1040 ฑ 88, Scanning duration (sec): 33+ 5, Number of transverse sections: 1063+ 348 iodine dose (g): 89.8+ 5.3, Concentration of contrast medium(mg/ml): 356.7+ 24.4, Volume of contrast medium (ml): 120+ 0, Contrast medium injector rate (ml/sec): 4+ 0, Injection duration (sec): 30+ 0, Scanning -to-injection duration ratio: 1.08+ 0.2, Delay between contrast medium initiation and scanning (sec): 26+ 5.3. Conclusion: The conventional study for lower extremity arteries is conventional angiography which is invasive method. This method required admission and absolute bed rest at least 8-12 hours after procedure. The CT angiography takes advantage over conventional angiography, including 3D volumetric analysis, minimally invasive vascular opacification and depiction of mural calcium. The fastest and more slices of current generation of 16 slices multidetector CT scanner is possible to study entire length of lower extremities.

Multidetector CT and high magnetic field MRI in evaluation of small cystic-solid renal mass / 上海第二医科大学学报

Objective To evaluate the role of multidetector CT(MDCT) and high magnetic field MRI in diagnosis of small cystic-solid renal mass. Methods Fifty-two cases with small renal cystic-solid mass(≤3 cm) were consecutively collected,including small cystic-solid renal cell carcinoma(n=25),carcinoid(n=1),complex cysts(n=16),small angiomyolipoma(n=7) and benign cystic nephroma(n=3).All were examined by both 1.5T MRI and multidetector CT at intervals between 3 days and 2 months. Results All cases were proved by pathology.Multi-planar reconstruction techniques were useful for MDCT in differentiating small cystic-solid renal mass,with the sensitivity of 98.1%,which was as high as MRI.However,the accuracy for MDCT was 71.2%,significantly lower than that of MRI(90.4%)(P=0.001).MRI helped to identify the components and structure of renal masses,and behaved better in the detection of pseudo-capsule of renal cell carcinoma(57.7%).Conclusion High magnetic field MRI may play an important role in the diagnosis of small renal cystic-solid masses,and it may be feasible as a noninvasive examination when CT can not make the ultimate determination.

Familial Isolated Noncompaction of the Ventricular Myocardium in Asymptomatic Phase

Isolated noncompaction of the ventricular myocardium (INVM) is a rare cardiomyopathy resulting from a failure of normal endomyocardial embryogenesis and it has been categorized as a form of unclassified cardiomyopathy. The disorder is characterized by an excessively prominent trabecular meshwork with deep intertrabecular recesses. Although the disorder is sporadic, familial incidence may occur. Clinical symptoms and prognosis of INVM may differ markedly, and range from an asymptomatic course to a severe cardiac disability. The diagnostic method of choice for IVNM is echocardiography, which reveals multiple prominent trabeculations with deep intertrabecular spaces communicating with the left ventricular cavity in the middle and apical segments of the left ventricle. The authors report a case of INVM in a family in which three adult members (a brother and two sisters) were found to be affected by this disorder. They were all asymptomatic. The diagnosis of the disorder was made first in the 36-year-old brother by transthoracic echocardiography (TTE) and multidetector CT (MD CT), during the process of preoperative evaluation for surgical treatment of low back intervertebral herniated disc. TTE and MD CT showed similar and peculiar findings of INVM. Echocardiographic screening in all first-degree relatives of this patient, in order to identify asymptomatic patients, demonstrated INVM in two elder sisters.

Multidetector CT Urography in Imaging of the Urinary Tract in Patients with Hematuria

This review article comprehensively discusses multidetector CT urography protocols and their role in imaging of the urinary tract in patients with hematuria.