Tumor pseudopapilar sólido de páncreas, una neoplasia inusual / Solid Pseudopapillary Tumor of the Pancreas, an Unusual Neoplasm

Presentación del caso. Se trata de una mujer de 26 años que presentó dolor en epigastrio e hipocondrio izquierdo, con aumento del perímetro abdominal y pérdida de 5 kg de peso corporal. En el examen físico se detectó una masa de gran tamaño en el epigastrio, con bordes regulares, ligeramente dolorosa al tacto y no móvil. Los estudios de imagen revelaron una neoplasia mixta en el cuerpo y cola pancreática. Intervención terapéutica. Se practicó una esplenopancreatectomía corpo-caudal, con extirpación completa del tumor. Evolución clínica. La paciente recibió cuidados especializados y vigilancia estrecha posquirúrgica en la unidad de cuidados intensivos, sin presentar complicaciones relevantes. Tras el alta hospitalaria, la paciente refirió un buen estado general en los controles de seguimiento, que incluyeron una tomografía realizada a los 12 meses, donde no se evidenciaron restos o recidivas tumorales

Case presentation. A 26-year-old woman who presented with pain in the epigastrium and left hypochondrium, with increased abdominal perimeter and loss of 5 kg of body weight. Physical examination revealed a large mass in the epigastrium, with regular borders, slightly painful to the touch and non-mobile. Imaging studies revealed a mixed neoplasm in the pancreatic body and tail. Treatment. A corpo-caudal splenopancreatectomy was performed, with complete removal of the tumor. Outcome. The patient received specialized care and close postoperative surveillance in the intensive care unit, with no relevant complications. After hospital discharge, the patient reported a good general condition in the follow-up controls, which included a computed tomography scan performed after 12 months, where no tumor remnants or recurrences were evidenced

Low-dose helical CT projection data restoration using noise estimation / 南方医科大学学报

OBJECTIVE@#To build a helical CT projection data restoration model at random low-dose levels.@*METHODS@#We used a noise estimation module to achieve noise estimation and obtained a low-dose projection noise variance map, which was used to guide projection data recovery by the projection data restoration module. A filtering back-projection algorithm (FBP) was finally used to reconstruct the images. The 3D wavelet group residual dense network (3DWGRDN) was adopted to build the network architecture of the noise estimation and projection data restoration module using asymmetric loss and total variational regularization. For validation of the model, 1/10 and 1/15 of normal dose helical CT images were restored using the proposed model and 3 other restoration models (IRLNet, REDCNN and MWResNet), and the results were visually and quantitatively compared.@*RESULTS@#Quantitative comparisons of the restored images showed that the proposed helical CT projection data restoration model increased the structural similarity index by 5.79% to 17.46% compared with the other restoration algorithms (P < 0.05). The image quality scores of the proposed method rated by clinical radiologists ranged from 7.19% to 17.38%, significantly higher than the other restoration algorithms (P < 0.05).@*CONCLUSION@#The proposed method can effectively suppress noises and reduce artifacts in the projection data at different low-dose levels while preserving the integrity of the edges and fine details of the reconstructed CT images.

Progress of Lung Cancer Screening with Low Dose Helical Computed Tomography / 中国肺癌杂志

Lung cancer which represents characteristics of a heavy disease burden, a large proportion of advanced lung cancer and a low five-year survival rate is a threat to human health. It is essential to implement population-based lung cancer screening to improve early detection and early treatment. The National Lung Screening Trial (NLST) demonstrated that screening with low dose helical computed tomography (LDCT) may decrease lung cancer mortality, which brings hope for the early diagnosis and treatment of lung cancer. In recent years, great progresses have been made on research of lung cancer screening with LDCT. However, whether LDCT could be applied to large population-based lung cancer screening projects is still under debate. In this paper, we review the recent progresses on history of lung cancer screening with LDCT, selection of high-risk individuals, management of pulmonary nodules, performance of screening, acceptance of LDCT and cost-effectiveness.
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Determination of subcarinal angle of trachea using computed tomography

Background: Change in tracheal bifurcation angle (subcarinal angle) is an indirect marker of various cardiac, pulmonary and mediastinal pathologies. Helical computed tomography (CT) allows acquisition of volumetric set of data of the chest and can be used for accurate measurements of subcarinal angle using reconstructed images on a workstation using minimum intensity projection (MinIP).The objective of this study was to estimate normal subcarinal angle (SCA) of trachea by computed tomography and to assess its relationship with gender.Methods: This was an observational study comprising a study cohort of 552 patients comprising of 312 males and 240 females who were subjected to CT chest for various indications in our department. Patients with no underlying cardiac, mediastinal or pulmonary disease were included in the study. Spiral CT scan of chest was performed on 64-slice seimens CT SOMATOM and images were reconstructed with thickness of 1.5mm and the images were viewed in coronal reformatted minimum intensity projection (MinIP) for determination of subcarinal angle using the angle measuring tool provided in the workstationResults: The mean subcarinal angle (SCA) in males was (67.60±14.55). The mean subcarinal angle (SCA) in females was (78.90±11.04). Females had a higher mean SCA compared to males with a statistically significant difference (p-value <0.05).Conclusions: The mean SCA in females was higher compared to males with a statistically significant difference between the two. This study holds practical relevance with regard to the performance of invasive trachea-bronchial procedures like bronchoscopy and tracheal/bronchial intubation.

PET/CT: Técnica, consideraciones e indicaciones en el estudio oncológico de pacientes pediátricos / PET/CT: Technique, considerations and indications in the oncology study of pediatric patients

Resumen El cáncer en la población pediátrica representa la segunda causa de muerte en niños mayores de 5 años en nuestro país, después del trauma. La tomografia por emisión de positrones/tomograña computada (PET/CT) es una técnica hibrida que involucra radiación y que progresivamente se está implementando en niños. Esta técnica permite hacer evaluaciones morfológicas y funcionales del cuerpo con aplicaciones en patología neoplásica y no neoplásica. Su principal rol en la oncología se encuentra en la evaluación y control de linfomas, sarcomas y neuroblastomas, entre otros. La calidad de los resultados depende de la realización de procesos rigurosos para obtener las imágenes. En este artículo se revisan los pasos para la obtención de las imágenes, los aspectos técnicos involucrados, las fuentes de mala interpretación y las principales indicaciones que debe conocer el médico radiólogo y pediatra.

Abstract Pediatric cancer is the second cause of death in children older than 5 years in our country, after trauma. Positron emission tomography/computed tomography (PET/CT) is a hybrid technique that involves radiation, which has been used for some time in adults and is being progressively imple mented in children. This technique allows morphological and functional assessments of the body with applications in neoplastic and non-neoplastic pathology. Its main role in oncology is in the evaluation and control of lymphomas, sarcomas and neuroblastomas, among others. The quality of the results is determined by a number of rigorous processes to obtain the images. In this article we describe the steps in obtaining the images, the technicalities involved, sources of misinterpretation and what the main current indications that must be known by radiologists and pediatricians are.

Prenatal diagnosis of sirenomelia by two-dimensional and three-dimensional skeletal imaging ultrasound / 华中科技大学学报（医学）（英德文版）

This study sought to evaluate the contribution of two-dimensional ultrasound (2D-US) and three-dimensional skeletal imaging ultrasound (3D-SUIS) in the prenatal diagnosis of sirenomelia. Between September 2010 and April 2014, a prospective study was conducted in a single referral center using 3D-SUIS performed after 2D-US in 10 cases of sirenomelia. Diagnostic accuracy and detailed findings were compared with postnatal three-dimensional helical computed tomography (3D-HCT), radiological findings and autopsy. Pregnancy was terminated in all 10 sirenomelia cases, including 9 singletons and 1 conjoined twin pregnancy, for a total of 5 males and 5 females. These cases of sirenomelia were determined by autopsy and/or chromosomal examination. Initial 2D-US showed that there were 10 cases of oligohydramnios, bilateral renal agenesis, bladder agenesis, single umbilical artery, fusion of the lower limbs and spinal abnormalities; 8 cases of dipus or monopus; 2 cases of apus; and 8 cases of cardiac abnormalities. Subsequent 3D-SUIS showed that there were 9 cases of scoliosis, 10 cases of sacrococcygeal vertebra dysplasia, 3 cases of hemivertebra, 1 case of vertebral fusion, 3 cases of spina bifida, and 5 cases of rib abnormalities. 3D-SUIS identified significantly more skeletal abnormalities than did 2D-US, and its accuracy was 79.5% (70/88) compared with 3D-HCT and radiography. 3D-SUIS seems to be a useful complementary method to 2D-US and may improve the accuracy of identifying prenatal skeletal abnormalities related to sirenomelia.

Radiation Dose Comparison between Intravenous Urography (IVU) and Unenhanced Helical Computed Tomography (UHCT) Urography / Jurnal Sains Kesihatan Malaysia

Intravenous urography (IVU) and unenhanced helical computed tomography (UHCT) urography are the two main procedures performed in the radiological investigation for urolithiasis (urinary stone). However, exposure to ionizing radiation is the main concern in both procedures. Therefore, a dose comparison study was conducted between IVU and UHCT urography procedures to determine the optimum exposure parameters in this study. An anthropomorphic whole body phantom was used following the exact procedure of UHCT urography and series of imaging for IVU with an administration of contrast media. Three different exposure parameters were used for IVU with 75 kVp, 80 kVp and 85 kVp while 100 kVp, 120 kVp and 140 kVp for UHCT urography respectively. As a result, the radiation doses for IVU were 1.40 mSv, 2.10 mSv and 2.79 mSv corresponding to 75 kVp, 80 kVp and 85 kVp. On the other hand, the radiation doses for UHCT urography were 0.76 mSv, 1.32 mSv and 1.82 mSv for 100 kVp, 120 kVp and 140 kVp, respectively. However the optimum image was obtained at 85 kVp for IVU and 120 kVp for UHCT urography. In conclusion, the doses obtained from IVU were consistently higher than UHCT urography but not signifi cantly different

Densitometria óssea em gatos hígidos por tomografia computadorizada quantitativa / Bone densitometry in healthy cats by quantitative computed tomography

Estabeleceram-se valores de média radiodensidade do osso trabecular das vértebras lombares de 16 gatos adultos, hígidos, por meio da tomografia computadorizada quantitativa (TCQ). O valor médio de radiodensidade do osso trabecular da segunda vértebra lombar foi de 436,1±42,1 unidades Hounsfield, com distribuição não homogênea da radiodensidade no corpo vertebral.

The radiodensity of the trabecular bone of the lumbar vertebrae in 16 healthy adult cats was studied using quantitative computed tomography (QCT). The average radiodensity of the trabecular bone of the second lumbar vertebra was 436.1±42.1 Hounsfield units. However, there was a nonhomogeneous radiodensity distribution of the vertebral body.

Estudio de las venas de la fosa cubital a través de la tomografía computada helicoidal y su aplicación clínica / Study of the veins of the cubital fossa by helical computed tomography and its clinical application

Las venas superficiales de la fosa cubital, constituyen uno de los sitios más importantes de punción venosa. La disposición de estas venas presenta numerosas variaciones. Su anatomía no ha sido estudiada aplicando los avances tecnológicos en el campo de la medicina, como la tomografía computada helicoidal. Fueron analizadas mediante tomografía axial computada helicoidal, las formaciones venosas de la fosa cubital en 60 individuos chilenos de ambos sexos, de edades entre 10 y 86 años, de la IX Región de La Araucanía, Chile. El estudio fue realizado en un tomógrafo General Electric, modelo CT/e, perteneciente al Centro de Imagenología del Hospital del Trabajador, Temuco, Chile, en individuos ambulatorios. Basados en la clasificación de del Sol et al. (1988) para las formaciones venosas de la fosa cubital, se obtuvo los siguientes resultados: Tipo I (46,7 por ciento), la vena cefálica del antebrazo (VCA), se divide en vena mediana basílica (VMB) y vena mediana cefálica (VMC), las que se unen a la vena basílica del antebrazo (VBA) y vena cefálica del accesoria del antebrazo (VCAA), respectivamente. Tipo II (13,3 por ciento), la VCA originó la vena mediana del codo (VMCo), que se une a la VBA. Tipo III (20 por ciento), no existe comunicación entre la VBA y VCA a nivel de la fosa cubital. Tipo IV (8,3 por ciento), la VCA drenaba en la VBA. Tipo V (11,7 por ciento). Otras disposiciones, donde se incluye la "M" clásica, que resulta de la división de la vena mediana del antebrazo. La utilización de la VMC o de la VCA, se recomienda ya que previene los riesgos de punción de otras estructuras anatómicas importantes como el ramo anterior del nervio cutáneo antebraquial medial.

The superficial veins of the cubital fossa, is one of the most important sites of venipunctures. There are many variations in the arrangement of these veins. Their anatomy has not been studied using technology available in the field of medicine such, as helical computed tomography. The vein formation of the cubital fossa in 60 Chilean subjects of both sexes, between 10 and 86 years of age of the IX Region of Araucania, Chile, were analyzed by helical computed tomography. The study was realized on a General Electric scanner, model CT / e, belonging to the Imaging Center of the Hospital del Trabajador, Temuco, Chile, in ambulatory subjects. Based on the classification of del Sol et al. (1988) for the vein formation of the cubital fossa, we obtained the following results: Type I (46.7 percent), the cephalic vein of forearm (CVF), is divided into median basilic vein (MBV) and median cephalic vein (MCV), then anastomosis the basilic vein of forearm (BVF) and cephalic vein accessory (CVA), respectively. Type II (13.3 percent), the CVA originates at the median cubital vein (MCuV), which anastomoses to the BVF. Type III (20 percent), there is no communication between BVF and CVF at the cubital fossa. Type IV (8.3 percent), CVF drains into the BVF. Type V (11.7 percent) - Other disposition, which include the "M" classical, resulting from the division of the median antebrachial vein. Using the MCV or CVF, is recommended, since there are risks of puncture of other important anatomical structures such as the anterior branch of the medial antebrachial cutaneous nerve.

Tomografia computadorizada no diagnóstico de hepatopatia esteroidal em cão: relato de caso / Computed tomography in the diagnosis of steroidal hepatopathy in a dog: case report

It is reported a case of an eight-year-old Yorkshire Terrier dog, with a history of prolonged use of prednisone in a dosage of 1mg/kg of body weight each 24 hours during two years. The helical computed tomography revealed hepatomegaly associated to a hyperattenuation of the parenchyma, with a radiodensity value of 82.55 Hounsfield units (HU). The spleen presented a mean radiodensity of 57.17HU, and a radiodensity difference of 25.38HU was observed between the two organs. Based on the history and findings of imaging technique, it was determined the presumptive diagnosis of steroidal hepatopathy compatible with accumulation of hepatic glycogen. It was concluded that computed tomography enabled the characterization of hepatic injury and the presumed diagnosis of steroidal hepatopathy.

Relata-se o caso de um cão da raça Yorkshire, de oito anos de idade, com histórico de tratamento com prednisona na dose de 1mg/kg de peso, a cada 24 horas, por dois anos. A tomografia computadorizada helicoidal revelou hepatomegalia associada à hiperatenuação, com radiodensidade de 82,55 unidades Hounsfield (HU). O baço apresentava radiodensidade média de 57,17HU, sendo observada diferença de radiodensidade de 25,38HU entre os dois órgãos. Por meio do histórico e dos achados da técnica de imagem, foi possível determinar o diagnóstico presuntivo de hepatopatia esteroidal compatível com acúmulo de glicogênio hepático. Concluiu-se que a tomografia computadorizada possibilitou caracterizar a lesão hepática e presumir o diagnóstico de hepatopatia esteroidal.

O papel dos exames de imagem no diagnóstico de trombose das veias esplâncnicas: relato de dois casos / The role of imaging exams in the diagnosis of thrombosis of the splanchnic veins: Report of two cases

Objetivos: apresentar dois casos de trombose de veias esplâncnicas, que é considerada uma causa potencialmente fatal de isquemia intestinal, sendo as veias porta e mesentérica superior as mais acometidas. Discutir as possíveis etiologias e realçar a importância do uso de exames de imagem no diagnóstico dessa afecção.Descrição dos Casos: duas pacientes com trombose venosa esplâncnica apresentaram manifestações clínicas inespecíficas. No primeiro caso as principais manifestações foram dor abdominal, diarréia sanguinolenta, distensão abdominal e náuseas. No segundo caso, a paciente apresentava dor abdominal vaga, inapetência e hipotensão arterial. Nos dois casos o diagnóstico foi firmado por tomografia computadorizada.Conclusões: considerando as manifestações clínicas vagas da trombose de veias esplâncnicas, os exames de imagem, em especial a tomografia computadorizada, apresentam papel fundamental no seu diagnóstico.

Aims: To present two cases of thrombosis of the splanchnic veins, which is considered a possible fatal cause of intestinal ischemia, with the portal and superior mesenteric veins being the most affected. To discuss the etiological possibilities and emphasize the importance of using imaging exams for the definitive diagnosis.Case Description: Two women with splanchnic venous thrombosis showed nonspecific clinical manifestations. In the first case, the main symptoms were abdominal pain, bloody diarrhea, abdominal distension and nausea. In the second case, the patient presented with vague abdominal pain, anorexia and hypotension. In both cases the diagnosis was established by computed tomography. Conclusion: Considering the nonspecific clinical manifestations of splanchnic veins thrombosis, the imaging exams, especially the computed tomography, play a major role in its definitive diagnosis.

O valor dos critérios de indicação da angiotomografia no diagnóstico de lesões das artérias carótidas e vertebrais no trauma contuso / Value of the criteria for indication of angiography in the diagnosis of carotid and vertebral arterial injuries in blunt trauma

Introdução: As lesões contusas de artérias carótidas e vertebrais (LCCV) não são muito frequentes, porém podem apresentar repercussões graves. A incidência desse tipo de lesão é difícil de ser avaliada porque os doentes podem estar neurologicamente assintomáticos quando atendidos no pronto socorro ou podem apresentar sintomas que são atribuídos ao trauma de crânio ou a outras lesões associadas. Estatísticas recentes apontam uma incidência de 0,24% a 0,33% em doentes traumatizados portadores de algum sintoma neurológico. No Brasil não existem trabalhos de nosso conhecimento que tenham estudado a incidência das LCCV. Por outro lado, a real morbidade e mortalidade das LCCV não estão claramente determinadas, nem mesmo na literatura internacional. Os objetivos deste estudo foram: a) avaliar a incidência de LCCV em 100 doentes vítimas de trauma contuso submetidos à angiotomografia cervical, utilizando parâmetros obtidos da avaliação clínica inicial e das tomografias de crânio e da região cervical e b) verificar quais os critérios de indicação da angiotomografia cervical que mais se correlacionam com a presença de LCCV no serviço de trauma de hospital quaternário brasileiro. Material e Método: Durante o período de trinta meses a partir de julho de 2006, todos os doentes admitidos no Pronto-Socorro do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, com trauma cervical fechado, com potencial risco de lesão dos vasos cervicais apresentando défice neurológico não justificado pela tomografia computadorizada de crânio, infarto cerebral, hematoma cervical estável, epistaxe volumosa, anisocoria/sinal de Horner, escore na escala de coma de Glasgow abaixo de 8 sem achados justificativos pela tomografia, fratura de coluna cervical, fratura de base de crânio, fratura de face (Le Forte II ou III), sinal do cinto de segurança acima da clavícula, frêmito ou sopro cervical, foram incluídos no estudo...

Background: Blunt trauma of the carotid and vertebral arteries (LCCV) are infrequent, but may have serious repercussions. The incidence of this type of injury is difficult to evaluate as many patients are neurologically asymptomatic when assisted in emergency rooms, or with symptoms attributed to cranium trauma or to other associated injuries. Recent statistical data show an incidence of 0.24% to 0.33% traumatized patients that carry some neurological symptom, we are not aware of any papers in Brazil that have studied the occurrence of LCCV. On the other hand, the real morbidity and mortality are not clearly determined, not even in the international literature. The objectives of the current study were: a) to evaluate the incidence of carotid and vertebral artery injuries in 100 patients with blunt trauma subjected to cervical angiography, using parameters obtained from the initial clinical evaluation and tomography of the patients and b) to verify which criteria for recommending cervical angiography are most related to the presence of LCCV in the trauma services section in a Brazilian quaternary care hospital. Method: During thirty months, starting in July 2006, all patients admitted in the emergency room of Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, with blunt cervical trauma, with potential risk of injuries to cervical vessels that presented neurological deficit unexplained after cranial CT scan, cerebral infarction, stable cervical haematomas, severe epistaxis, anisocoria/sign of Horner`s syndrome, Glasgow coma scores bellow 8 that are not explained by CT scan, cervical spine fracture, basilar skull fracture, facial fracture (Le Forte II or III), seatbelt signals above the clavicle, cervical hum or bruit were included in the study. The patients were subjected to cervical angiography in order to diagnose LCCV. There were analyzed the mechanisms of injuries, gender, age, severity of LCCV, type of treatment and outcome...

Utilidad de la Tomografía Computada helicoidal en la diverticulitis aguda / Usefulness of helical computed tomography in the acute diverticulitis

Objetivo: Evaluar la utilidad de la tomografía computada helicoidal (TCH) en el diagnóstico y manejo terapéutico de la diverticulitis aguda. Materiales y métodos: Estudio de cohorte retrospectivo realizado sobre un periodo de 6 meses que incluyó a 100 pacientes con sospecha clínica de diverticulitis. Se efectuó TCH con contraste oral y endovenoso, salvo contraindicación. Los estudios se correlacionaron con la respuesta terapéutica y el seguimiento clínico y con cirugía e histopatología cuando fue necesario tratamiento quirúrgico. Resultados: De 100 pacientes estudiados, 62 tuvieron diagnóstico tomográfico de diverticulitis; de ellas, 41 fueron diverticulitis simples y 21, complicadas (absceso, flemón, plastrón, perforación libre, fístula vésicocolónica y obstrucción intestinal); en 24 pacientes se realizó diagnóstico alternativo (apendicitis, apendagitis, colitis inespecífica, colitis isquémica, pielonefritis, litiasis ureteral, pancreatitis, salpingitis, quiste de uraco complicado, obstrucción colónica mecánica y perforación colónica por cuerpo extraño) y en 14, diagnóstico de ausencia de diverticulitis aguda, sin diagnóstico alternativo, siendo dos de ellos falsos negativos por clínica y respuesta al tratamiento. La TCH para la diverticulitis demostró: sensibilidad: 96,87%; especificidad: 100%; valor predictivo positivo: 100%; valor predictivo negativo: 94,7%; certeza: 98%. De los 41 pacientes con diagnóstico tomográfico de diverticulitis no complicada, 37 recibieron tratamiento médico ambulatorio y 4, tratamiento médico con internación; de los 21 pacientes con diagnóstico de diverticulitis complicada, 18 realizaron un tratamiento médico con internación y en 3 se tomó una conducta quirúrgica; de los 14 pacientes con ausencia de hallazgos tomográficos de diverticulitis, en 12 se adoptó una conducta expectante ambulatoria y 2 recibieron tratamiento médico ambulatorio. Conclusión: La tomografía es muy útil y eficaz para el diagnóstico, evaluación y manejo de los pacientes con sospecha clínica de diverticulitis.

Objective: The evaluation of the usefulness of helical computed tomography (HCT) in the diagnosis and therapeutic management of the acute diverticulitis. Materials and methods: Six months retrospective cohort study of 100 patient population clinically suspected of diverticulitis was carried out. The exams were made with oral and intravenous contrast unless the patient presented contraindications. A correlation of these studies with the therapeutic response and clinical follow up was done with surgery and histopathology. Results: From a total of 100 patients studied, 62 presented tomographic diagnosis of diverticulitis, 41 were classified as simple diverticulitis and 21 were complicated cases (abscess, phlegmon, plastron, free perforation, vesicocolonic fistula and intestinal obstruction). In 24 patients an alternative diagnosis was made (appendicitis, appendagitis, uretheral litiasis, colitis, salpingitis, pancreatitis, uraco cyst complication, colonic mecanical obstruction, colonic perforation with foreign body): 14 patients did not present tomographic findings to support the clinical symptoms, two of them were false-negative by the clinic and by the response to treatment. These data represented a sensibility of 96,87%, specificity of 100%, PPV of 100% and NPV of 94,7% and a certainty of 98 for the tomography diagnosis of acute diverticulitis. Of the 41 patients with tomographic diagnostic of not complicated diverticulitis, 37 received medical outpatient treatment and only 4 medical treatment with placement; of the 21 patients diagnosed with complicated diverticulitis, 18 were hospitalised with medical treatment and the other 3 patients needed surgery; of the 14 patients without tomographic findings of diverticulitis, in 12 outpatients an expectant conduct was followed and the other 2 received medical outpatient treatment. Conclusion: HCT is very useful and effective in diagnosis, evaluation and management of patients with clinical suspicion of diverticulitis.

Is 3D-CT reformation using free software applicable to diagnosis of bone changes in mandibular condyles?

OBJECTIVES: This study evaluated the agreement of computed tomography (CT) imaging using 3D reformations (3DR) with shaded surface display (SSD) and maximum intensity projection (MIP) in the diagnosis of bone changes in mandibular condyles of patients with rheumatoid arthritis (RA), and compared findings with multiplanar reformation (MPR) images, used as the criterion standard. MATERIAL AND METHODS: Axial CT images of 44 temporomandibular joints (TMJs) of 22 patients with RA were used. Images were recorded in DICOM format and assessed using free software (ImageJ). Each sample had its 3DR-SSD and 3DR-MIP results compared in pairs with the MPR results. RESULTS: Slight agreement (k = 0.0374) was found in almost all comparisons. The level of agreement showed that 3DR-SSD and 3DR-MIP yielded a number of false-negative results that was statistically significant when compared with MPR. CONCLUSIONS: 3DR-SSD or 3DR-MIP should only be used as adjuvant techniques to MPR in the diagnosis of bone changes in mandibular condyles.

Tomografia computadorizada de abdome normal: estudo retrospectivo das angulações dos hilos renais / Normal abdominal computed tomography: a retrospective study of renal hila angles

OBJETIVO: Obter valores da angulação média dos hilos renais em relação ao plano horizontal, traçado sobre músculos eretores da espinha direito e esquerdo, considerando como parâmetro de referência para as medidas das angulações o centro da coluna vertebral lombar. MATERIAIS E MÉTODOS: Foram analisados 250 exames de tomografia computadorizada de abdomes considerados normais de indivíduos de ambos os sexos, sendo 128 masculinos (idade média de 52,45 ± 17,42 anos) e 122 femininos (idade média de 54,39 ± 18,27 anos), totalizando 500 hilos renais estudados. A angulação média de cada hilo renal em relação ao plano horizontal foi obtida, sendo considerados sempre os ângulos agudos. RESULTADOS: O estudo comparativo entre os sexos mostrou que não houve diferença estatisticamente significante em relação aos ângulos agudos dos hilos renais. A análise estatística mostrou, com intervalo de confiança de 95 por cento, para média do ângulo direito os limites de 40,40° e 44,54° e para o hilo renal esquerdo os limites de 39,91° e 43,23°. CONCLUSÃO: Os hilos renais, independentemente do sexo, apresentam angulações semelhantes. Valores angulares maiores terão anomalia de hiper-rotação ou hiper-rotação exagerada e valores menores terão anomalia de rotação incompleta ou rotação invertida.

OBJECTIVE: To obtain mean angulation values for renal hila in relation to the horizontal plane traced over the right and left spinal erector muscles, considering the center of the lumbar vertebral spine as a parameter for measuring the renal hila angles. MATERIALS AND METHODS: The authors have analyzed 250 abdominal computed tomography studies of both male and female healthy individuals (128 men with mean age 52.45 ± 17.42 years, and 122 women with mean age 54.39 ± 18.27 years), corresponding to 500 renal hila evaluated. The mean angulation of each hilum in relation to the horizontal plane was obtained taking acute angles into consideration. RESULTS: The comparative study have not found any statistically significant difference in acute angles of renal hila between male and female individuals. The statistical analysis demonstrated limits of 40.40° and 44.54° for mean right hilum angulation and 39.91° and 43.23° for mean left hilum angulation, with a confidence interval of 95 percent. CONCLUSION: Renal hila present similar angulation independently of sex. Higher angulation values correspond to hyper-rotation or excessive rotation, and lower angulation values, to incomplete or reverse rotation.

Value of helical computed tomography and color doppler flowing imaging in assessing the resectability of pancreatic cancer / 中华消化外科杂志

Objective To determine the value of helical computed tomography (HCT) and color doppler flowing imaging (CDPI) in evaluating the resectability of pancreatic cancer. Methods The clinical data of 114 patients with pancreatic cancer who had been admitted to the Affiliated Hospital of North Sichuan Medical College from January 1995 to December 2002 were retrospectively analyzed. The values of HCT and CDPI in assessing the resectability of pancreatic cancer were determined according to the results of operation and pathological examina-tion. All the data were analyzed by chi-square test and Fisher exact probability. Results Of all patients, 109 were examined by HCT, 97 by CDPI and 96 by HCT+CDPI. For patients examined by HCT, the resection rates of pancreatic head cancer, pancreatic body and tail cancer and total pancreatic cancer were 45.3% (39/86), 26.3% (5/19) and 0 (0/9), respectively. The resection rate of pancreatic head cancer was higher than that of pancreatic body and tail cancer (χ2=8.965, P<0.05). With the increase of tumor size, the invasion rate and metastasis rate were increased and the resection rate was decreased (z=6.15, 5.35, 7.18, P<0.01). The sensitivity rate and specificity rate were 77.8% and 82.2% of HCT, 73.3% and 80.6% of CDPI, 90.6% and 92.4% of HCT+CDPI in assessing the resectability of pancreatic cancer. The values of Kappa identity test of HCT, CDPI and HCT+CDPI were 0.58, 0.52 and 0.82, respectively. Conclusions Combined application of HCT and CDPI can further improve the accuracy in assessing the resectability of pancreatic cancer.

Conventional Angiogram versus Multi-detector Row Helical Computed Tomography Angiogram for Preoperative Diagnostic Imaging in Low Extremity Arterial Surgery

PURPOSE: We performed this study to assess the suitability of conventional angiography (CA) vs. multi-detector row helical CT angiogram (MD-CTA) as a method of preoperative diagnostic imaging for low extremity arterial surgery. METHODS: From February 2004 to September 2006, 23 patients (4 claudicants, 19 limb-threatening ischemia) were studied with CA and MD-CTA preoperatively. The site and degree of stenotic or occlusive lesions in arterial segments from the renal artery to the dorsalis pedis artery were compared with both methods. We also compared the surgical inflow and outflow site changes in preoperative planning based on CA and MD-CTA and the final outcome. Additional diagnostic value and test-related complications were also analyzed. RESULTS: The median age of patients was 68 years old (range: 43~89 years), with a male to female ratio of 1.3:1. Twenty-three patients had CA after an MD-CTA scan. One hundred fifty lesions were detected in these patients. The total ratio of consistency for occlusion in CA vs. MD-CTA was 69.6%. Three patients received amputation treatment and eleven patients received a bypass operation. The agreement between the preoperative plan based on MD-CTA and the final operation was 100%, even in critical limb ischemia. There were no serious complications related to the tests. CONCLUSION: These findings suggest that MD-CTA is an adequate preoperative imaging study of infrainguinal arterial surgery and may be substituted for conventional angiography without any serious complications.

Predicting Factors for Spontaneous Passage of Ureteral Calculi Based on Unenhanced Helical CT Findings / 대한비뇨기과학회지

PURPOSE: We performed a prospective study to determine whether unenhanced helical computed tomography(UHCT) findings predict the spontaneous passage of ureteral calculi. MATERIALS AND METHODS: Between April 2006 and June 2007, 175 patients with a single ureteral calculus <1cm in diameter were enrolled in this study, and a UHCT was performed. All of the patients were managed conservatively for 2 weeks. Patients without spontaneous passage of ureteral calculi within 2 weeks were treated by ureteroscopy or extracorporeal shock wave lithotripsy(ESWL). The secondary signs (hydronephrosis, perinephric edema, and the tissue rim sign) were graded on a scale of 0-3. We evaluated whether spontaneous passage of ureteral calculi was associated with stone diameter, location, Hounsfield units(HU), and the degree of secondary signs. RESULTS: Ninety-two patients(52.6%) had spontaneous passage of ureteral calculi. The mean stone diameter was significantly smaller in the passage group than the non-passage group(4.28mm vs. 6.73mm, p=0.002). The rate of spontaneous passage was significantly higher involving distal ureteral calculi(66.1%) than proximal ureteral calculi(30.3%, p<0.001). The incidences of hydronephrosis and perinephric edema were significantly lower in the spontaneous passage group than the non-passage group(8.7% vs. 73.5% and 5.4% vs. 69.9%, respectively). The grades of hydronephrosis and perinephric edema were significantly lower in the spontaneous passage group than the non-passage group(p=0.001). Although there was a tendency toward increasing grades of hydronephrosis and perinephric edema with increasing stone size, the grades were more frequent and severe in the non-passage group in patients with similarly sized stones. CONCLUSIONS: The degree of hydronephrosis and perinephric edema are useful ancillary signs in predicting the likelihood of spontaneous passage of ureteral calculi.