High resolution computed tomography in asthma

High-resolution computed tomography [HRCT] can detect the structural abnormalities in asthma. This study attempts to correlate these abnormalities with clinical and pulmonary function test [PFT] data. Consecutive stable asthma patients attending Mubarak Al Kabeer Hospital, Kuwait, were subjected to HRCT during a six month period from July 2004 to December 2004, after initial evaluation and PFT. Of the 28 cases, sixteen [57.1%] had moderate, 6 [21.4%] had mild and 6 [21.4%] had severe persistent asthma. Thirteen [46.4%] patients had asthma for 1 to 5 years and 12 [42.9%] were having asthma for >10 years. Bronchial wall thickening [57.1%], bronchiectasis [28.6%], mucoid impaction [17.9%], mosaic attenuation [10.7%], air trapping [78.6%] and plate like atelectasis [21.4%] were noted. Bronchial wall thickening [p=0.044] and bronchiectasis [p=0.063] were most prevalent in males. Ten [35.7%] patients exhibited mild, 9 [32.1%] had moderate and 3 [10.7%] had severe air trapping. The difference in Hounsfield units between expiratory and inspiratory slices [air trapping] when correlated with percent-predicted FEV1 in right upper [r=0.25; p=0.30], left upper [r=0.20; p=0.41], right mid [r=0.15; p=0.53], left mid [r=-0.04; p=0.60], right lower [r=0.04; p=0.86] and left lower zones [r=-0.13; p=0.58] showed no relation. The same when correlated as above with the percent predicted FEF 25-75 did not show any significant association. The presence of air trapping was compared with sex [p=0.640], nationality [p=1.000], disease duration [p=1.000] and severity of symptoms [p=0.581]. Abnormal HRCT findings are common in asthma; however, air trapping when present was not related to the duration or severity of the illness or to the FEV1

Accuracy of 64-multidetector-row computed tomography in the diagnosis of coronary artery disease

The aim of this prospective study was to assess the accuracy of 64-multidetector-row computed tomography coronary angiography [CTA] in the diagnosis of coronary artery disease [CAD Ninety-two patients suspected of having CAD underwent CTA using a 64-slice CT scanner before a scheduled, conventional coronary angiogram [CCA]. Blinded assessment of CTA to detect CAD was performed. The accuracy of CTA in detecting significant stenoses [>/= 50%] was compared to CCA. Data analysis was performed on 73 patients because the scans were nondiagnostic in 5 patients and 14 refused to undergo coronary angiography The CTAs of 21 of these 73 patients were considered as normal; 19 were confirmed on CCA. For the remaining 52 diagnosed as abnormal, 51 were confirmed on CCA. For patient-based analysis, CTA had a sensitivity of 95%, a specificity of 96%, a positive predictive value of 98% and a negative predictive value of 90%. For the whole vessel, the sensitivity of CTA was 60-100%, for all vessels and the specificity was 82-100%. Pooled sensitivity was 92% and pooled specificity was 98%. For the segments, the sensitivity of CTA was 64% or above for all vessels except for the distal left anterior descending artery [40%], mid circumflex artery [50%] and posterior descending artery [60%]; the pooled sensitivity was 79%. The specificity for the segments was 82-100% for all vessels and pooled specificity was 94%. The sensitivity and specificity for patient-based analysis and for the main coronary vessels were high whereas for the segments, the sensitivity was moderately good, but the specificity was high, confirming that a negative CTA is useful to rule out significant CAD. A coordinated classification system between radiologists and cardiologists is required to eliminate errors in segment classification

Spinal tuberculosis: CT and MRI features

Spinal tuberculosis [TB] is perhaps the most clinically important extrapulmonary form of the disease. Early recognition is therefore necessary to minimize residual spinal deformity and/or permanent neurological deficit. We defined the CT and MRI image morphology of spinal TB and correlated the imaging features of these two modalities. CT [29 patients] and MRI [11 patients] images were retrospectively analyzed in 30 patients with proved spinal TB. CT and MRI findings were compared in cases with both imaging tests [10 cases]. The parameters assessed were the type and extent of bone and soft tissue involvement. The majority of the 30 patients were males [n=18] in the 30-49 year age group [43%]. The most common clinical presentation was backache [73.3%] followed by fever [63.3%] and malaise [36.6%]. The lumbar spine was the commonest site of the disease [43.3%] followed by the thoracic region [36.6%]. A fragmentary type of bone destruction was the most frequent CT feature of the disease [48.2%] followed by the lytic type [24.1%]. Intervertebral disc destruction [72%] and paravertebral mass/abscess [65.5%] were other features. Of the 11 patients who had an MRI, contiguous vertebral disease with disc destruction was seen in 10 cases. In 4 patients, there was distant vertebral disease in addition to the disease at the symptomatic site. MRI offers excellent visualization of the bone and soft tissue components of spinal tuberculosis and helps to identify disease at distant asymptomatic sites. CT is useful in assessing bone destruction, but is less accurate in defining the epidural extension of the disease and therefore its effect on neural structures. MR imaging clearly demonstrated the extent of soft tissue disease and its effect on the theca/cord and foramen in cases with doubtful CT findings