Detection of cerebral aneurysms in nontraumatic subarachnoid haemorrhage: role of multislice CT angiography in 130 consecutive patients.

PURPOSE: The leading cause of a nontraumatic subarachnoid haemorrhage is rupture of an intracranial aneurysm. The aim of this study was to assess the usefulness of multislice computed tomography angiography (CTA) in identifying and evaluating cerebral aneurysms by comparing it with intra-arterial digital subtraction angiography (DSA) and intraoperative findings. MATERIALS AND METHODS: During a 20-month period (June 2004 and February 2006), 130 patients with a CT diagnosis of nontraumatic acute subarachnoid haemorrhage were prospectively recruited to this study and underwent 16-detector CTA and DSA (57 men, 73 women; mean age 59.5 years). Twenty-five patients who underwent DSA alone postclipping were excluded. CTA and DSA were evaluated by the performing radiologist to assess the presence of one or more aneurysms and their morphological characteristics. RESULTS: CTA detected 133 aneurysms, whereas DSA identified 134: the aneurysm missed by CTA was 2 mm in size. CONCLUSIONS: CTA is fast and relatively noninvasive, and its sensitivity appears similar to that of DSA in detecting and evaluating intracranial aneurysms, even those smaller than 3 mm. This study confirms the value of CTA as the primary imaging technique in subarachnoid haemorrhage, with DSA reserved for selected patients.

Autoimmune pancreatitis: possibilities of CT characterization.

BACKGROUND: Pancreatitis is defined as an inflammatory disease of the pancreas, leading to morphological and pathological changes. Recently, an autoimmune pathogenesis of this disease has been proposed. This type of pancreatitis should be differentiated from other pancreatic diseases, since appropriate therapy is effective and morphological changes and pancreatic function can recover to normal levels. AIM OF THE STUDY: To assess the possibility of distinguishing autoimmune pancreatitis from other pancreatic diseases with an analogous clinical presentation on the basis of CT findings alone. METHODS: The CT images of 7 patients with proven autoimmune pancreatitis, along with those of 20 patients with other pancreatic diseases, but with an analogous clinical presentation, were retrospectively evaluated in a blinded fashion by 2 radiologists. In particular, the radiologists had to search for the typical signs of autoimmune pancreatitis. Discordant cases were further analyzed in the presence of a 3rd radiologist. The final diagnosis was acquired by means of a majority or overall consensus. The sensitivity, specificity, positive and negative predictive values of CT were calculated against each of the diseases (autoimmune pancreatitis; other pancreatic diseases), in order to evaluate the diagnostic value of the scan. RESULTS: After the consensus evaluation, the correct diagnosis was reached in 25/27 (92.5%) cases, with only 2/27 wrong diagnoses (autoimmune pancreatitis diagnosed as another pancreatic disease and vice versa). The sensitivity and specificity of CT against autoimmune pancreatitis were 86 and 95%, respectively. The positive and negative predictive values were 89 and 93%, respectively. CONCLUSION: Patients with autoimmune pancreatitis demonstrate imaging findings that enable the correct diagnosis by dynamic CT, even in the presence of nonspecific clinical symptoms. The precise classification of the disease is extremely important, since simple steroid therapy then represents the correct treatment, and leads to complete recovery.

Afferent loop syndrome presenting as enterolith after Billroth II subtotal gastrectomy: a case report.

We present a rare late-onset (after 24 years) complication of gastric surgery with a combination of afferent loop syndrome associated with a large duodenal stone. The patient, who had undergone Billroth II partial gastrectomy for benign ulcer 24 years before, developed abdominal pain in the right upper quadrant, associated with nausea, vomiting, and high grade fever. Abnormal laboratory values included elevated liver function test, suggesting a pressure-related phenomenon. Leukocytosis and a high level of platelets were also found. Only computed tomography and endoscopy of the upper gastrointestinal tract confirmed the diagnosis of a huge stone in the dilated duodenal afferent loop. To our knowledge, a case like this has not been reported previously in the literature.