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1.

Purpose

To investigate the value and highlight the role of multi slice computed tomography (MSCT) angiography in evaluation of extra-cardiac intra thoracic vascular anomalies in children.

Patients and methods

This study included 24 patients (13 males and 11 females) with an age range of 1 month–13 years. All of these patients were clinically diagnosed to have congenital heart disease with suspected extracardiac vascular anomalies. All underwent prospective ECG-gated MSCT angiography after trans-thoracic echocardiography (TTE). Iterative reconstruction techniques were applied to reduce the radiation dose in MSCT angiography with the mean radiation dose of (4 mSv). The diagnostic accuracy and sensitivity of MSCT angiography and TTE were compared in comparison with surgical outcome.

Results

The most common congenital extra cardiac vascular anomalies are PDA (45.8%) and aortic coarctation (37.5%). The major CT angiographic findings missed by TTE were coronary artery anomalies, absence of a pulmonary artery and pulmonary artery stenosis. The overall sensitivity of the MSCT angiography in diagnosis of the extra-cardiac vascular anomalies was 98.1% which was higher than that of TTE 80%.

Conclusion

CG gated MSCT angiography is an accurate modality for demonstrating extra cardiac structures in complex CHD. It provides important complementary information to TTE with regard to extra cardiac vascular structures and coronary artery anatomy. This modality may reduce the need for high radiation dose invasive diagnostic cardiac catheterization.  相似文献   

2.

Objective

The aim of this study was to monitor the incidence of complicated inferior vena cava (IVC) anomalies and evaluate the role of Multidetector Computed Tomographic Venography (MDCTV) in diagnosis and assessment of associated venous collaterals, lower limb deep venous thrombosis (DVT) or varicose veins (VV).

Patients and methods

During two years duration 100 patients with clinical history and complains suggesting of DVT or VV were prospectively evaluated after performance of MDCTV examination. The images obtained were interpreted and reconstructed using dedicated software and work stations. Results were correlated with Color Doppler Ultrasound (CDUS) findings.

Results

Out of 100 cases, 9 cases (9%) were diagnosed to have complicated IVC anomalies while 91 cases (91%) had either well developed IVC or common anatomical variations. 6 cases (66.7%) had complicated IVC anomalies and 3 cases (33.3%) had associated complicated common iliac veins (CIV) anomalies. 8 cases (88.9%) had associated DVT and all cases (100%) had bilateral VV. 2 cases (22.2%) had associated varicocele and 1 case (11.1%) had associated KILT syndrome.

Conclusion

MDCT venography examination has a major role in diagnosis of complicated IVC anomalies and detection of associated venous collaterals, lower limb DVT or VV.  相似文献   

3.

Background

Patients with pulmonary embolism have high mortality and morbidity rate due to right heart failure and circulatory collapse leading to sudden death. Multi-detector computed tomography MDCT can efficiently evaluate the cardiovascular factors related to pulmonary embolism.

Objectives

To evaluate the diagnostic accuracy of multi-detector computed tomography (MDCT) in differentiation of between sever and non-severe pulmonary embolism groups depending on the associated cardiovascular parameters and create a simple reporting system.

Patients & methods

Prospective study contained 145 patients diagnosed clinically pulmonary embolism. All patients were examined by combined electrocardiographically gated computed tomography pulmonary angiography-computed tomography venography (ECG-CTPA-CTV) using certain imaging criteria in a systematic manner.

Results

Our study revealed 95 and 55 non-severe and severe pulmonary embolism groups respectively. Many cardiovascular parameters related to pulmonary embolism shows significant p value and can differentiate between sever and non-severe pulmonary embolism patients include pulmonary artery diameter, intraventricular septum flattening, bowing, superior vena cava and Azygos vein diameters, right and left ventricular diameters.

Conclusion

Multi-detector computed tomography (MDCT) can be valuable to assess the severity of pulmonary embolism using the related cardiovascular parameters and leading the management strategy aim for best outcome.  相似文献   

4.

Purpose

Evaluate role of MRI and TRICKS-MR angiography in diagnosis of facial vascular anomalies.

Material and methods

This study included 22 patients (mean age 9?years) with proved facial vascular anomalies on basis of interventional/surgical procedures (n?=?19) or clinical follow up (n?=?3). They underwent MRI examination with TRICKS-MRA. Images were evaluated for lesion location, size, feeding arteries and draining veins.

Results

AVM was diagnosed in 15 patients (68.2%), hemangioma (5) patients (27.7%) and low flow venous malformation (2) patients (9.1%). TRICKS-MRA was accurate in diagnosis of 25 feeding arteries out of total 27 included in the study with 92.6% positive predictive value, 100% negative predictive value and 93.1% accuracy. AVMs were treated with sclerotherapy (26.7%), embolization (40%) and combined embolization and surgery (33.3%). Surgery was done in 2 hemangiomas (40%) while the other three patients (60%) underwent clinical follow up for 2?years with stationary course. The 2 patients with venous malformation underwent successful sclerotherapy.

Conclusion

MRI & TRICKS-MRA provide excellent diagnostic data for assessment of facial vascular anomalies. TRICKS -MRA adds precise delineation of the vascular mapping, regarding feeding arteries and draining veins which helps in planning of therapeutic approach and reduces needing for invasive DSA.  相似文献   

5.

Purpose

The goal of the study was to assess and confirm the role of 64-slice multidetector computed tomography (MDCT) with its new applications for diagnosis and its impact on management of small bowel obstruction.

Patients and methods

Prospective study included 40 patients, referred for radiological assessment of one or more of symptoms of intestinal obstruction or acute abdomen. Patients with clinical suspicion of high grade SBO (30 patients) underwent MDCT, while those with low grade SBO (10 patients) were offered MDCT enterography and the results were compared to the final clinical and surgical diagnosis as well as the histopathology results.

Results

18 patients were found to have intrinsic cause of SBO. 17 patients found to have extrinsic cause of SBO including adhesions and different types of hernia. 1 patient with an intraluminal cause (gall stone ileus) and 4 patients with variety of causes involving ileus, midgut volvulus and Ladd's band compressing duodenum. Those results were compared to final clinical surgical diagnosis with 100% accuracy, sensitivity and specificity.

Conclusion

64-slice MDCT have a very high sensitivity, specificity and accuracy to diagnose and determine the cause of SBO, allowing for better planning of required surgeries.  相似文献   

6.

Abstract aim

To assess role of MDCT in diagnostic evaluation of different renal sinus lesions.

Methods

A prospective study included 40 patients (25 male; 5 female; mean age, ±SD, 54?±?8?years) proven as renal sinus lesions by US& 64-MDCT. MDCT protocoal included unenhanced and contrast enhanced MDCT (CMP & NP & EP). Comparing MDCT findings with histopathological results were calculated. The study was approved by ethics committee.

Results

Our different pathology were: ?3 parapelvic cysts (0.4%); 2 peripelvic cysts (0.8%); 3R.A.A. (1.2%); 1 AVM (0.4%); 2 lipomatosis (0.8%), 2XGP (0.8%); 2 hematomas (0.8%); 1 abscess (0.4%); 2 SCC (0.4%); 7 TCC (2.8%); 1 AML (0.4%); 1 hemangioma (0.4%); 2 AML (0.8%); 1 NHL (04%); 1CPDN (0.4%),1 MCN (0.4%), 6 RCC (2.4%); 1 retroperitoneal NHL (0.4%), 1 retroperitoneal plasmacytoma (0.4%). Statistically significant difference was found between HU in CMP and EP (P?<?0.001) and between NP & EP (P?<?0.001) in cases of RCC, A significant statistical difference was detected among HU in NP and EP in TCC (P value?=?0.03). Presence of pseudo-capsule in RCC (P?<?0.001), MDCT yields sensitivity 95%, specificity 70%, PPV?=?90.2% & NPV?=?77.8% and overall accuracy 87.5%.

Conclusion

MDCT accurately evaluated different renal sinus lesions and differentiating between benign and malignant lesions as well as clear cell subtype and unclassified subtype of RCC.  相似文献   

7.

Objective

We evaluated multidetector computed tomography (MDCT) accuracy for the prediction of the optimal prosthetic aortic valve deployment angle in trans-catheter aortic valve implantation (TAVI) with the different variables.

Methods

Sixty-six patients underwent contrast-enhanced MDCT before TAVI. From the three-dimensional aortic root reconstructions, we get the appropriate perpendicular aortic valve projection at which the bases of the aortic valve cusps were on a straight line. The predicted angles by MDCT were compared to the perpendicular fluoroscopic angles of the prosthetic valve. The degree of MDCT accuracy was defined as accurate, suitable or inaccurate according to the difference between the predicted angles and the perpendicular prosthetic valve projections. The degree of aortic cusp calcification, annular ellipticity, the type of aortic valve (to be tricuspid or bicuspid), were compared in patients with accurate, suitable and inaccurate prediction. The radiation exposure and volume of the used contrast agent were also considered in the comparison.

Results

MDCT prediction was accurate in 84.8% of cases, suitable in 9.1% and inaccurate in 6.1% of cases. There was a significant association between MDCT accuracy and the valve type with higher rates of accurate prediction with tricuspid aortic valves than bicuspid valves (93.1% versus 25%, respectively). The mean number of aortograms and the volume of contrast agent used for TAVI procedure were significantly less in patients with accurate CT prediction (p < 0.001).

Conclusion

MDCT allows accurate prediction of the proper deployment angle for TAVI. Bicuspid aortic valve is significantly associated with fewer rates of accurate prediction.  相似文献   

8.

Purpose

To evaluate the role of non-contrast multidetector CT (MDCT) reliability in localizing CSF leaks and skull base defects in correlation to operative findings.

Materials and methods

Twenty patients clinically diagnosed to have CSF rhinorrhea; 8 spontaneous and 12 post-traumatic patients were evaluated using 64-rows MDCT with slice section 0.6 mm. CT is considered accurate if correctly determine the site and size of bony defect as matched with operative findings.

Results

MDCT accurately detected the site of presumed CSF leak in 19 out of 20 cases with sensitivity 95%. Cribriform plate defect is the most common site of defect in 40% of cases with 75% of cases categorized as Keros type II. The consensus image with fair agreement (K = 0.38) shows that coronal reformat has the highest diagnostic performance in 75% of cases while the least diagnostic value is encountered with the axial plane in 15% of cases (p = 0.095). There is almost a perfect agreement (K = 0.810) between the MDCT measurements and operative size of bony defect with minimal difference in 10% of patients (P < 0.001).

Conclusion

Non-contrast MDCT is an accurate reliable non-invasive imaging modality for preoperative evaluation of CSF rhinorrhea.  相似文献   

9.

Purpose

To highlight the relationship between coraco-humeral distance and subscapularis tendon tear.

Material and methods

Sixty-two shoulder MRI studies were examined. Twenty-two patients had partial or complete tear of subscapularis tendon and forty shoulder as a control group. Axial and oblique sagittal MR images were examined to measure the coraco-humeral distance followed by statistical analysis to correlate the distance with tendon tear.

Results

A cut-off value of 8.25?mm for the coraco-humeral distance gave a sensitivity of 77.5% and specificity of 72.7% for subscapularis tendon tear.

Conclusion

There is a well-known relationship between the coraco-humeral distance and the subscapularis tendon tear and its meticulous assessment in subjects with pain in the anterior shoulder region increases the diagnosis of subcoracoid impingement.  相似文献   

10.

Background

Characterization of tendo-ligamentous pathologies of wrist remains problematic, despite advances in imaging. By using clinical history and imaging appearance, one can determine the diagnosis. USG is used as first imaging modality whereas MRI aids in making a specific diagnosis of few of the lesions.

Aims

To investigate the etiological spectrum of tendo-ligamentous pathologies of wrist on USG & MRI with statistical correlation.

Patients and methods

80 patients (male/female = 46/34) with complaint of swelling or pain in wrist were included and underwent USG and MRI of both the wrists.

Results

The spectrum included ganglion cysts, vascular malformations, tenosynovitis, tendinopathy, ligament tears and fibrosis. The analysis was done using kappa coefficient and spearman's rho correlation coefficient. The strength of agreement between USG and MRI for the diagnosis of ganglion cysts, vascular malformations, tenosynovitis and tendinopathy was found to be very good.

Conclusion

USG provides detailed depiction of superficial structures, is less expensive, and allows dynamic examinations of the wrist. It should be the first choice of investigation for majority of the cystic, tendinous, vascular, and fibrotic pathologies of the wrist. However, less promising results were observed for ligamentous pathologies on USG in our study.  相似文献   

11.

Background

Urinary tract injuries occur in 3–10% of abdominal trauma. Early recognition and diagnosis of ruptured bladder is essential to lower this mortality rate. CT is the method of choice for the evaluation of patients with blunt or penetrating abdominal and/or pelvic trauma. Imaging in patients with suspected bladder injury with CT cystography may be performed using either an intravenous or retrograde technique.

Aim of work

The aim was to evaluate the role of CT in diagnosing traumatic urinary bladder injuries.

Materials and methods

The study was carried out on 32 patients with suspected traumatic urinary bladder injury. All patients were subjected to contrast-enhanced CT study and classified according to Sandler et al. classification of urinary bladder injuries.

Results

All patients were classified according to the type of the encountered urinary bladder trauma. Type I injury was diagnosed in 3.1% of patients, type II in 18.8%, type III in 3.1%, type IVa in 12.5%, type IVb in 43.7% and type V in 18.8%. 21.8% of patients were managed conservatively, while 78.2% of patients underwent surgical repair.

Conclusion

CECT well demonstrated traumatic urinary bladder injuries.  相似文献   

12.

Objective

Vaginal or uterine outlet obstruction leads to hematocolpos or hematometra. Detection of the etiology of this entity is important to guide adequate surgical management and thereby avoid complications and to preserve fertility. The aim of this study was to evaluate obstructing vaginal malformations in adolescent girls presenting with hematocolpos or hematometra with MR imaging.

Materials and methods

A hospital based prospective study was conducted in a tertiary care centre from September 2015 to October 2016. The study included 17 adolescent females who were evaluated with MRI.

Result

Of 17 adolescent female with vaginal or uterine outflow obstructive anomalies with hematocolpos or hematometra, where 6 patients (35.3%) had HWWS, 6 patients (35.3%) had imperforate hymen, 2 patients (11.8%) had transverse vaginal septum, 1 patient each (5.9%) had cervico-vaginal atresia, unicornuate uterus and communicating rudimentary Uterine horn. MRI revealed hematocolpos in 15 patients (88.2%), hematometra in 13 patients (76.5%), endometriotic ovarian cysts in 6 patients (35.3%) and hematosalpnix in 3 patients (17.6%).

Conclusion

Early radiological diagnosis of the cause of vaginal or uterine outflow obstruction is important to guide adequate surgical management which if undertaken promptly helps to avoid complications due to reflux from vaginal or uterine outflow obstruction.  相似文献   

13.

Objectives

To assess the clinical utility of PET-CT in assessment of thoracic involvement in lymphoma patients prior to, during and after finishing treatment and comparing it to contrast enhanced CT (CECT).

Patients and methods

PET-CT was performed for 30 patients with lymphoma. Thoracic nodal and extranodal involvement was assessed and compared to contrast enhanced CT.

Results

Comparison of CECT and PET-CT in staging and assessment of treatment response reveals significant statistical difference (P?=?.0001 & .04 respectively). CECT shows sensitivity?=?83.3% and specificity?=?75% in evaluation of patients after finishing chemotherapy.

Conclusion

PET-CT plays an important role in staging, detection of response to treatment and restaging of lymphoma after finishing chemotherapy.  相似文献   

14.

Background

Ninety percent of hepatic cancers are hepatocellular carcinomas (HCC) which have an unfavorable prognosis. HCC is a hypervascular tumor supplied mainly by the hepatic artery. It has a higher blood supply than the surrounding hepatic tissue due to neovascularization. Computed tomography with perfusion imaging (CTP) is a non invasive tool which quantifies the blood flow parameters of HCC and compares it to the surrounding tissue.

Purpose

To prove that CTP is a valuable diagnostic tool in diagnosis of HCC and posttherapeutic assessment.

Patients and methods

One hundred and twenty-six HCC patients with 150 focal lesions are enrolled this study. Perfusion parameters are quantified and results are compared to those of triphasic CT.

Results

CTP detected 141 lesions with 94% sensitivity and 40% specificity with elevated arterial perfusion (AP) and perfusion index (PI) with low portal flow (PF). It missed 5 lesions because of their hypovascularity and 4 lesions following radiofrequency ablation (RFA) and trans arterial chemo embolization (TACE).

Conclusion

CTP is a safe and specific imaging tool for diagnosis and assessment of therapeutic interventional procedures in HCC.  相似文献   

15.

Background

The knee menisci are compound anatomical structures with important purposes within the knee. In the long term, meniscal losing results in high risk of developing degenerative osteoarthritis. MRI is an accurate and non-invasive diagnostic method for the knee injuries providing satisfactory guide for conservative treatment and guarding the patients from uncritical arthroscopy.

Objective

This study aimed to detect the MRI accuracy in diagnosis of meniscal lesions compared to arthroscopy.

Patients & methods

This study included 13 females and 17 males presented by pain, swelling, limitation of movement, in the duration from April 2015 to June 2016. All patients were subjected to MRI followed by arthroscopy.

Results

The study revealed that specificity, sensitivity, NPV, PPV and accuracy, in MRI diagnosis of medial meniscal abnormal signals were 50%, 95.8%, 88.4%, 86.6%, and 90% respectively, whereas those for lateral meniscus signals were 84.6% 88.2%, 84.6%, 88.2% and 86.7% respectively.

Conclusion

MRI of the knee will give the orthopedic surgeons ability to select suitable treatment and arthroscopic interference for their patients. MRI has high accuracy in meniscal tears diagnosis allowing accurate grading of them.  相似文献   

16.

Aim of the study

Our study is a prospective study aiming to assess congenital bicuspid aortic valve using cardiac MRI and to detect a relationship between the leaflet fusion pattern and other functional parameters including valvular regurge, stenosis and pressure gradient.

Patients and methods

This prospective study included 114 cases 104 of them had bicuspid aortic valve, diagnosed by echocardiography while the rest (10 cases) were normal control cases. All functional and morphological cardiovascular abnormalities were recorded as well as any associated congenital diseases. Two different radiologists read the MRI blindly to each other.

Results

Patients age ranged from 40?days up to 20?years with 62 patients being in the pediatric age group (<12?years). They were 78males and 26 females.We found 54 cases (53.8%) of 1-RL morphology, 34 cases (32.7%) of 1-RN morphology, 8 cases (7.7%) of 0-AP and 6 cases (5.8%) of 0-Lateral. Aortic stenosis and regurgitation were found in 80.75% of cases. Aortic stenosis was the most common valvular lesion being more evident in the 1-RN valve type. Aortic regurge was more predominant in the pediatric age group with no predilection for a specific valve phenotype. Left ventricular function was normal in most of our cases with only 10 cases showing impairment due to long standing valvular lesion.Thirty-eight cases (36.5%) had associated aortic dilatation. Twenty-six patients (25%) showed associated aortic coarctation. Intra cardiac shunts (24 patients 23%) were the second most common associated anomaly after coarctation. Most of the associated congenital anomalies were found with the 1-RL valve morphology type. Other associated congenital anomalies were detected in 44 patients (42.3%).

Conclusion

Cardiac Magnetic resonance should be performed for patients with bicuspid aortic valve to determine the valve phenotype, function and aortopathy for risk stratification and surgical management. Patients with RL type should be properly imaged to detect associated congenital anomalies.  相似文献   

17.
Perianal fistula is a common disorder with high tendency to recur in spite of satisfactory surgery. Pelvic MRI is the preferable imaging modality for recognition and assessment of perianal fistulas.

Aim of the work

To evaluate the effectiveness of MRI in grading of primary perianal fistula and verification of its associated findings in correlation with surgical outcome.

Subjects and methods

This prospective study included 30 patients with age range 14–44 years. Preoperative MR grading was correlated with surgical outcome.

Results

The sensitivity, specificity, PPV, NPV and weighted Kappa of MR grading in correlation with surgery was 95.8%, 83.3%, 95.8%, 83.3% and 0.79 respectively with P value = 0.000

Conclusion

MRI is a valuable modality for grading of primary perianal fistula and its complications. Accurate pre-operative grading may reduce the surgical complications and possibility of recurrence.  相似文献   

18.

Objective

To assess the diagnostic accuracy of diffusion weighted imaging (DWI-MRI) being a non-contrast based MR sequence versus dynamic contrast enhanced MRI (DCE-MRI) in the preoperative loco-regional staging of the cervical carcinoma.

Methodology

Fifty cases of proved cancer cervix prior staging subjected to dynamic post contrast technique: one pre-and six post contrast phases (40?s each). DWI was scanned using different b values and ADC values were measured.

Results

DWI was the most accurate in staging operable cases (93.3%).Parametrial infiltration was overestimated in 3 cases versus 4 cases in DCE-MR. DWI showed 100% sensitivity, positive predictive value and accuracy in the assessment of locally advanced carcinomas. In metastatic lymph nodes, DCE-MR showed the least accuracy of 86%.

Conclusion

DWI is helpful in discriminating local from locally advanced cervical carcinomas. DCE-MR can delineate cervical carcinomas confined to the uterus and exclude bladder/rectal invasion.  相似文献   

19.

Aim of the work

To evaluate the role of diffusion weighted imaging (DWI) in the planning for CT guided biopsy of lung and mediastinal lesions.

Subjects and methods

This cross sectional study included 23 patients with mean age was 42.7?years came with clinical and imaging suspicion of chest malignancy, referred for CT guided transthoracic biopsy. DWI and apparent diffusion coefficient (ADC) were evaluated for all patients to choose the area of maximum restriction.

Results

The study showed that with DWI guidance; all the biopsy specimens were diagnostic and provide adequate material for analysis.

Conclusion

DWI and measurement of ADC value has a very helpful role in the pre-procedural planning of transthoracic biopsies.  相似文献   

20.

Background

The ankle is frequently injured in trauma, overuse syndrome and inflammatory processes. Different imaging modalities assess the ankle, including plain radiography, computed tomography (CT), magnetic resonance imaging (MRI), and ultrasonography (US).

Purpose

Our objective is to assess the role of high resolution US as a valuable tool in the depiction of causes of ankle joint pain.

Patients and methods

The study included 28 patients presented with ankle pain ranging in age from 17 to 60 years. They were examined by US and findings were correlated with MRI.

Results

US was capable to detect various lesions (synovitis, arthritis, plantar fasciitis, tendon and ligamentous lesions). It had a sensitivity of 95.4%, a specificity of 83.3% and an overall accuracy of 92.8%. US had a limited value in detection of avascular necrosis (AVN), bone marrow oedema and fractures.

Conclusion

US can be used as a first step diagnostic tool in cases of ankle pain. MRI should be spared to cases with negative or equivocal US findings.  相似文献   

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