Use of intra-arterial multi-detector row CT angiography for the evaluation of an ischaemic limb in a patient with renal impairment.

The vastly improved scanning speed and z-axis resolution afforded by multi-detector technology has allowed CT to refine its traditional roles and to explore many new applications in imaging. We present a case report of a patient with renal failure and an ischaemic leg, which illustrates a useful new CT vascular imaging application. By carrying out 16-channel multi-detector row CT angiography through a sheath introduced into the common femoral artery, we obtained a high-quality angiographic image of the affected leg, using only 30 mL of iodinated contrast material. The examination definitively showed the number, distribution and patency of the tibial run-off arteries, with significant influence on the patient's subsequent clinical management. This simple and relatively minimally invasive technique is useful in peripheral vascular imaging, when conventional CT angiography using a large volume of i.v. contrast and MR angiography are unsuitable or unavailable.

Interpreting urgent brain CT scans: Does review by a radiology trainee make a difference in accuracy?

An urgent brain CT scan is now commonly performed on patients presenting to hospital emergency departments for a wide variety of indications. At most institutions in Australia, such scans are reviewed immediately by an on-call radiologist, who is usually an accredited registrar. The value of the trainee radiologist in such a setting is unclear. In the present study, the rate of abnormal findings in a random sample of 100 brain CT scans performed on hospital patients is reviewed and the accuracy of detection of potentially urgent lesions is compared between three junior clinicians, an accredited radiology registrar and a junior radiographer, using the final radiological report as the standard of reference. At least one potentially urgent abnormality in 25% of the patients scanned was found. The RANZCR trainee recorded a significantly higher sensitivity compared to the other readers. It is concluded that an urgent brain CT is of greater value as a screening test if a contemporaneous radiological review is made available, and the implications this may have on current imaging practices are briefly considered.