Resectability of pancreatic tumors: Correlation of multidetector CT with surgical and pathologic results

Purpose

The purpose of this study is to evaluate the ability of multidetector CT (MDCT) in predicting resectability of pancreatic tumors.

Patients and methods

Thirty-nine patients were included in this study, there were 29 males and 10 females, and their age range was 44–73 years with a mean age of 58.3 years. All the patients were subjected to contrast enhanced biphasic examinations on 64-slice CT machine.

Results

Twenty-one patients (53.8%) were considered inoperable with unresected tumor, the remaining 18 patients (46.2%) were considered suitable for tumor resection according to MDCT criteria. 15 out of the 18 patients (83.3) had a successful tumor resection while the remaining 3 (16.7%) showed unresectable tumor during operation. On the basis of pathology results 12 patients out of the 18 (66.7%) had successful surgery with negative tumor margin, and a positive predictive value of 66.7% and accuracy of 66.7%.

Conclusions

There is better prediction of resectability of pancreatic tumors with the development of MDCT technology. As compared to Helical computed tomography (HCT) studies, there is a rise in the rate of successful surgical resection. The positive predictive value of multidetector computed tomography for resectable pancreatic tumors is decreased when pathologic results are used as a reference standard.     

Acute and chronic mesenteric ischemia: Multidetector CT and CT angiographic findings

Aim of the work

To assess the role of multidetector CT (MDCT) and CT angiography (CTA) in the diagnosis of acute and chronic mesenteric ischemia.

Patients and methods

This prospective study was performed on 57 consecutive patients clinically suspected of having mesenteric ischemia, they were examined with 16-row multidetector CT, MDCT and CTA were evaluated for evidence of bowel wall changes and abnormal mesenteric vascular changes.

Results

Twenty one patients of studied 57 patients had an abnormal CTA finding diagnostic of mesenteric ischemia and they constituted the material of this study, the most prevalent MDCT findings were bowel wall thickening, bowel distension and non-enhanced bowel wall. MDCT and CTA gave an accurate diagnosis of the cause of mesenteric ischemia as proved by the final diagnosis based on surgical exploration, conventional angiography, laboratory investigations and clinical follow up with 100% sensitivity and specificity.

Conclusion

MDCT and CTA are fast, safe, accurate and non-invasive imaging modalities of choice in patients with suspected mesenteric ischemia which are able to evaluate not only mesenteric vascular structures but also evaluate bowel wall changes and adjacent mesentery, thus detecting the primary cause of mesenteric ischemia that can lead to earlier diagnosis and intervention.     

Prediction of vascular involvement and resectability by multidetector-row CT versus MR imaging with MR angiography in patients who underwent surgery for resection of pancreatic ductal adenocarcinoma

Purpose

To compare the diagnostic value of dual-phase multidetector-row CT (MDCT) and MR imaging with dual-phase three-dimensional MR angiography (MRA) in the prediction of vascular involvement and resectability of pancreatic ductal adenocarcinoma.

Methods and materials

116 patients with proven pancreatic adenocarcinoma underwent both MDCT and combined MR imaging prior to surgery. Of 116 patients, 56 who underwent surgery were included. Two radiologists independently attempt to assess detectability, vascular involvement and resectability of pancreatic adenocarcinoma on both images. Results were compared with surgical findings and statistical analysis was performed.

Results

MDCT detected pancreatic mass in 45 of 56 patients (80.3%) and MR imaging in 44 patients (78.6%). In assessment of vascular involvement, sensitivities and specificities of MDCT were 61% and 96% on a vessel-by-vessel basis, respectively. Those of MR imaging were 57% and 98%, respectively. In determining resectability, sensitivities and specificities of MDCT were 90% and 65%, respectively. Those of MR imaging were 90% and 41%, respectively. There was no statistical difference in detecting tumor, assessing vascular involvement and determining resectability between MDCT and MR imaging (p = 0.5).

Conclusion

MDCT and MR imaging with MRA demonstrated an equal ability in detection, predicting vascular involvement, and determining resectability for a pancreatic ductal adenocarcinoma.     

Assessment of vascular invasion in pancreatic carcinoma by MDCT

Background

Pancreatic cancer is one of the aggressive cancers with poor resectability and survival rates. The relationship to adjacent vessels must be assessed before deciding the choice of treatment.

Aim

Assessment of the MDCT signs of arterial and venous invasion in pancreatic carcinoma.

Subjects and methods

Total of 179 of the major peripancreatic vessels (CA; CHA; SMA; PV; SMV) in 47 patients who underwent surgery for pancreatic cancer after MDCT were assessed at surgery and compared with CT findings. Statistical analysis of the findings was done using Chi square test.

Results

115 vessels were not invaded at surgery, while the remaining 64 vessels were invaded (22 arteries and 42 veins). There was over all statistically significant difference between arterial and venous invasion regarding stenosis, occlusion, infiltration and circumferential involvement of the vessel wall.

Conclusion

Assessment of vascular invasion is crucial in the evaluation of resectability for pancreatic cancer. MDCT is an accurate diagnostic tool for peripancreatic vascular invasion in cancer pancreas.     

64 Multidetector CT with multiplanar reformation in evaluation of bilateral ovarian masses

Purpose

To evaluate the role of 64 multidetector CT (MDCT) with multiplanar reformation in evaluation of bilateral ovarian masses and to correlate the findings with histopathological results and surgery.

Material and methods

MDCT was performed to 23 patients with sonographically detected bilateral ovarian masses. All scans were performed on a 64 row CT scanner at the oncology center, Mansoura University. The axial and reformatted images were evaluated for lesion characterization and the relationship to adjacent structures. The radiological findings were correlated with operative and pathological findings.

Results

There were 11 bilateral malignant lesions and 9 bilateral similar benign lesions. Three cases showed different benign lesions in both sides.All malignant lesions were read by MDCT as malignant, also all benign lesions were read by MDCT as benign except for one case with endometrioid cyst which was diagnosed as malignant tumor by CT.

Conclusion

64 Multidetector CT with MPR in different planes allows good visualization and characterization of bilateral ovarian masses with greater diagnostic accuracy and improves the detection of peritoneal metastases.     

An evaluation of the accuracy of CT when determining resectability of pancreatic head adenocarcinoma after neoadjuvant treatment

Background

To evaluate the accuracy of MDCT for determination of resectability R0 after neoadjuvant therapy in patients with pancreatic head adenocarcinoma locally advanced.

Methods

From January 2005 to December 2010, 80 patients with pancreatic head adenocarcinoma underwent multidetector CT before surgery. Of these, 38 patients received neoadjuvant therapy because tumor was considered locally advanced on baseline CT scan. We retrospectively correlated imaging interpretations with operative and histological data and compared results in patients without (control group) or with (neoadjuvant group) preoperative treatment.

Results

41/42 patients in control group and 31/38 patients in neoadjuvant group finally had curative resection. While resection R0 is similar in both groups (83% and 81%), CT accuracy in determining resectability R0 was significantly decreased in neoadjuvant group (58% versus 83%; p = 0.039). CT scan specificity was significantly lower after neoadjuvant therapy (52% versus 88% in control group) due to an overestimation of vascular invasion: 12/31 patients with complete resection in neoadjuvant group were evaluated at high risk of incomplete resection on CT scan. Tumor size tends to be underestimated in control group (−2 mm) and overestimated in neoadjuvant group (+10 mm). T-staging accuracy was decreased in neoadjuvant group (39% versus 78% in control group; p = 0.002).

Conclusion

Neoadjuvant therapy significantly decreases the accuracy of CT scan in determining operability, T-staging, and resectability R0 of pancreatic head carcinoma. Overestimation of tumor size and vascular invasion significantly reduces CT scan specificity after preoperative treatment.     

A comparative study of cone-beam CT and multidetector CT in the preoperative assessment of odontogenic cysts and tumors

Aim of the work

To compare the accuracy of cone beam CT (CBCT) and multidetector CT (MDCT) in the preoperative radiological assessment of odontogenic cysts and tumors.

Material and methods

This prospective study included 24 patients (13 males and 11 females) with primary untreated pathologically proven odontogenic cysts and tumors. Their ages ranged from 5–45 years. They underwent (CBCT) and (MDCT). All CBCT and MDCT images were reviewed for morphologic characteristics of the lesions, internal appearance, extension as well as effect on surrounding structures. All patients were scheduled for surgical treatment within one week after clinical and radiological evaluation. Using intra-operative findings as the gold standard, the accuracy of (CBCT) and (MDCT) for radiological assessment of odontogenic cyst and tumors was compared.

Results

Histopathologic examination established that of the 24 tumors; 10 were radicular cyst, five dentigerous cyst, three amelobalstoma, three odontogenic keratocyst, one buccal bifurcation cyst, one nasopalatine cyst, and one lateral periodontal cyst. Both CBCT and MDCT were identical in detecting location, borders and internal structure of examined lesions. Concerning linear measurements of the lesions, MDCT underestimated mean depth by 1.7 mm and CBCT underestimated it by 0.9 mm. MDCT underestimated the mean width by 0.9 mm, and CBCT underestimated it by 0.7 mm. MDCT overestimated the mean height by 1.7 mm and CBCT overestimated it by 1 mm. CBCT was superior than MDCT in detecting thinning and perforation of buccal cortical plate and displacement of teeth.

Conclusion

In the overall assessment of odontogenic cysts and tumors, CBCT was comparable with MDCT with no significant statistical difference (P < 0.05). However, CBCT was more accurate in linear measurements and identification of tooth displacement and buccal bone defect. It is an optimal radiological modality for preoperative radiological assessment of odontogenic tumors.     

Gastrointestinal stromal tumors (GISTs): Diagnostic value of multi-detector computed tomography

Background

GISTs are considered the commonest mesenchymal neoplasms of the GIT originating from the gastrointestinal tract, mesentery, omentum, or retroperitoneum. They arise within the gut musculosa having exophytic growth pattern. They characteristically have hemorrhage, necrosis, or cyst formation that appears as focal areas of low attenuation on computed tomographic images.With multidetector CT (MDCT) capabilities, the exact origin of the GIST can be easily confirmed to differentiate it from other mesenchymal origin tumors.

Materials and methods

Retrospective search for GIST cases in the digital archives of our institute, during a 15 months duration (April 2010 to July 2011). Workstation reviewing of their imaging features.

Results

This study included 24 pathologically proved GISTs (12 gastric, 8 small intestinal, two colonic, one mesenteric and one anorectal) demonstrating the radiologic features of GISTs depending on tumor size and organ of origin.

Conclusion

MDCT with its multiplanar capabilities and isotropic z-axis resolution allows the radiologist to examine the detailed relation of the mass to the surrounding bowel wall, vessels and other structures. It also helps to map the vascular pedicle in cases of hypervascular GIST’s, which may be crucial for trans-catheter embolization in cases presenting with acute gastrointestinal bleeding.     

Preoperative assessment of vascular invasion in exocrine pancreatic cancer by multidetector CT

Purpose

To evaluate multidetector CT (MDCT) signs of vascular invasion in pancreatic carcinoma.

Patients and methods

Retrospective review of preoperative dynamic MDCT of 42 patients with pathologically proven pancreatic carcinoma.

Results

Surgically confirmed invaded vessels were 19 arteries and 33 veins. Multiple signs of vascular invasion were assessed.

Conclusion

Significant advances have been made in the ability of MDCT to visualize pancreatic cancer and to stage disease when close attention is paid to technique with special attention to multiple signs of vascular invasion.     

CT presentations of colorectal cancer with chronic schistosomiasis: A comparative study with pathological findings

Objective

To clarify pathological basis of computed tomography (CT) presentations of colorectal cancer (CRC) with schistosomiasis for the purpose of improving the accuracy of CT diagnosis and differential diagnosis of the condition.

Materials and methods

130 patients (87 male and 43 female; age range 49–86 years, mean 71.1) were selected whose diagnoses were pathologically confirmed as CRC with schistosomiasis. All the patients underwent abdominal plain CT and contrast enhanced scanning. The location, morphology, size, calcification features and enhancement modalities (patterns) were evaluated and compared with the pathological findings by two radiologists in a blind way.

Results

CT showed that in 130 patients, the tumors occurred in the large intestine, among which 109 (83.9%) were solitary and 21 (16.1%) were multifocal. The intestinal wall was irregularly thickened in 123 patients, with soft tissue masses in 7 patients. Linear, spotty and small patchy calcifications were seen in 104 (80.0%) patients, with unclear margins in 96 patients. The tumors were markedly unevenly enhanced in 92 patients. Pathological examination revealed adenocarcinoma in 114 patients and in 104 patients, calcified Shistosoma japonicum (S. japonicum) ova inside the tumors, 15 patients were mucinous adenocarcinoma, and one patient was that of adenosquamous carcinoma.

Conclusion

Irregular thickening of the intestinal wall, soft tissue masses, multiple S. japonicum ova calcifications inside the tumor with obscured margins and multiple intestinal masses in some patients are important CT features of CRC with schistosomiasis.     

Omental vascular pedicle sign: multidetector CT finding useful for diagnosis of an omental mass

Objective

To describe multidetector CT findings of “omental vascular pedicle” sign.

Materials and methods

“Omental vascular pedicle” sign was defined as dilated omental vein associated with a mass located in omentum and was observed in 7 patients (5 women, 2 men). Mean age was 45 years. CT examinations and patient records were retrospectively reviewed. CT images were obtained by 16-MDCT (n = 1) and 64-dual source MDCT (n = 6). Curved planar and volume rendered images were reconstructed from axial images. Diameter of omental vein and drainage site were recorded. Images were evaluated by 2 radiologists in consensus.

Results

Pathologic diagnosis of patients with “omental vascular pedicle sign” was omental angiosarcoma (n = 1), endometrial adenocarcinoma (n = 2), ovarian serous adenocarcinoma (n = 2), mixed gonadal tumor (n = 1), malignant peripheral sheath tumor (n = 1). In 5 patients, omental vein drained into splenic vein and in 2 patients it drained into right gastroepiploic vein. Mean size of omental masses associated with omental vascular pedicle was 7.1 × 4.5 cm (range 15 × 11 cm to 2.7 × 1.6 cm). Mean diameter of omental vein was 3.1 mm (range 6–1.5 mm). Diameter of the omental vein increased with the increasing size of omental masses and Pearson's correlation coefficient was 0.99.

Conclusion

“Omental vascular pedicle sign” can be helpful to objectively diagnose omental masses in patients with primary and metastatic omental tumors.     

Acute right lower quadrant pain beyond acute appendicitis: MDCT in evaluation of benign and malignant gastrointestinal causes

Purpose

To evaluate the role of MDCT in identification of various GIT pathologies beyond appendicitis that cause acute right lower quadrant abdominal pain and characterization of various distinguishing CT features as well as their predictive values in differentiating benign from malignant pathologies.

Materials and methods

This retrospective study included a total of 64 patients (34 females and 30 males with age ranges from 21 to 78 years) who presented with ARLQP (acute right lower quadrant pain). MDCT was done for all the patients; inclusion criteria included the presence of clinical, laboratory, and radiological evidence of the pathologic process. Pathological confirmation was obtained in 44 cases. All cases proved pathologically to be appendicitis were eventually excluded from the study cohort. Various CT morphologic parameters were recorded including the location of bowel wall involvement, the extent of involvement, the thickness of bowel wall and pattern of bowel wall thickening, the presence of stratified enhancement pattern, the transition from normal to abnormal wall, the degree of mesenteric fat stranding relative to the degree of wall thickening, the presence of excavating masses, and associated findings. A multivariate analysis was performed using covariates among the variable morphologic CT features.

Results

A stratified enhancement pattern of the bowel wall was the most reliable to indicate a benign active inflammatory process with the highest −ve predictive value of 91% and an abrupt zone of transition also proved to be the most significant in indicating a malignant process with a +ve PV of 74%.

Conclusion

Using a systematic pattern approach MDCT has proved to be an extremely useful noninvasive method for evaluation of patients with acute RLQP, allowing diagnosis and management of not only the most common conditions such as appendicitis but also less common conditions.     

Detection of histologically proven peritoneal carcinomatosis with fused 18F-FDG-PET/MDCT

Objective

To evaluate peritoneal carcinomatosis in patients with gastrointestinal and gynecologic malignancies and to assess the diagnostic role for 18-FDG-PET and MDCT alone in comparison to the diagnostic accuracy of fused 18F-FDG-PET/MDCT by using surgical and histopathological findings as the standard of reference.

Methods and subjects

Sixty-two patients (13 males, 49 females; age range 43–81; mean age, 62 years with suspected peritoneal carcinomatosis were reviewed for the presence of peritoneal lesions on 18F-FDG-PET/MDCT scans (Discovery LS, GE Medical Systems). The results were compared with the histological findings at laparatomy. Thirty-one patients had peritoneal metastases, while 31 patients had negative histological findings at laparotomy.

Results

CT detected peritoneal seeding in 26/31 patients, 18F-FDG-PET in 25/31 patients, and 18F-FDG-PET/MDCT in 30/31 patients, for a sensitivity of 88%, 88%, and 100%, respectively. False-positive findings were seen in MDCT in one patient, in 18F-FDG-PET in two patients, and in 18F-MDCT-PET/MDCT in one patient, for a specificity of 97%, 94%, and 97%, respectively.

Conclusion

Fused 18F-FDG-PET/MDCT is superior to MDCT and 18F-FDG-PET alone for the detection of peritoneal carcinomatosis especially in small lesions and it offers exact anatomic information for surgical treatment.     

Comparison between multislice CT and MR imaging in the diagnostic evaluation of patients with pancreatic masses

Purpose

This study compared the results of multislice computed tomography (MSCT) and high-field magnetic resonance imaging (MRI) in the diagnostic evaluation of pancreatic masses.

Materials and methods

Forty patients with clinical and ultrasonographic evidence of pancreatic masses underwent MSCT and MRI. The majority of patients (31/40, 78%) had proven malignant pancreatic tumours (24 ductal adenocarcinoma, six mucinous cystadenocarcinoma, one intraductal papillary mucinous carcinoma), whereas the remaining patients (9/40, 22%) were found to have benign lesions (eight chronic pancreatitis, one serous cystadenoma). Results of the imaging studies were compared with biopsy (n=33) and/or histology (n=7) findings to calculate sensitivity, specificity, accuracy and positive (PPV) and negative (NPV) predictive value for correct identification of tumours and evaluation of resectability of malignancies.

Results

Both for tumour identification and resectability, MSCT and MRI had comparable diagnostic accuracy, with no statistically significant differences between them. Tumour identification CT/MRI: accuracy 98/98%, sensitivity 100/100%, specificity 88/88%, PPV 97/97%, NPV 100/100%; tumour resectability CT/MRI: accuracy 94/90%, sensitivity 92/88%, specificity 100/100%, PPV 100/100%, NPV 78/70%.

Conclusions

MRI represents a valid diagnostic alternative to CT in the evaluation of patients with pancreatic masses, both for correct identification and characterisation of primary lesions and to establish resectability in the case of malignancies. New high-field MRI equipment allows optimal imaging quality with good contrast resolution in evaluating the upper abdomen.     

Comparison of F-18-FDG PET/CT findings between pancreatic solid pseudopapillary tumor and pancreatic ductal adenocarcinoma

Objective

Pancreatic solid pseudopapillary tumor (SPT) is a rare benign tumor. Little data are available on positron emission tomographic/computed tomographic (PET/CT) characteristics of this tumor. Therefore, we analyzed the metabolic characteristics of SPT using F-18-FDG PET/CT and compared the results with those of pancreatic ductal adenocarcinoma.

Methods

We retrospectively reviewed the records of 11 SPT patients and 46 patients with ductal adenocarcinoma. Ten SPT patients had primary tumors and 1 patient had metastatic SPT. Maximum standardized uptake value (max SUV), mean SUV, metabolic tumor volume (MTV), total lesion glycolysis (TLG), and tumor-to-background ratio (TBR) were evaluated. Mann–Whitney U test between pancreatic SPT and ductal adenocarcinoma was performed. In addition, age, gender and tumor size-adjusted analysis of covariance (ANCOVA) was done between pancreatic SPT and ductal adenocarcinoma.

Results

Compared with pancreatic ductal adenocarcinomas, SPTs had significantly higher tumor size-adjusted MTV and TLG. MTV and TLG values were significantly correlated with T-stage of the SPTs. In 1 SPT patient, metastases in the liver and mesentery were revealed by intense uptake of FDG on F-18-FDG PET/CT, and after PET/CT had suggested the presence of pancreatic SPT.

Conclusion

We recommend that SPT be considered when a solid pancreatic mass with increased FDG metabolism is encountered on PET/CT. F-18-FDG PET/CT may be useful in detecting subtle metastases of SPT.     

Perfusion CT can predict tumoral grading of pancreatic adenocarcinoma

Objectives

To describe perfusion CT features of locally advanced pancreatic ductal adenocarcinoma and to evaluate correlation with tumor grading.

Methods

Thirty-two patients with locally advanced pancreatic adenocarcinoma were included in this study. Lesions were evaluated by P-CT and biopsy after patient's informed consent. P-CT parameters have been assessed on a large single and on 6 small intratumoral ROIs. Values obtained have been compared and related to the tumor grading using Mann–Whitney U test. Sensibility, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy in predicting tumor grading have been calculated for cut-off values chosen by using ROC curves.

Results

Out of 32 lesions, 12 were classified as low grade and 20 as high grade. A statistically significant difference between high and low grade neoplasms were demonstrated for PEI and BV parameters. PEI and BV cut-off values were respectively 17.8 HU and 14.8 ml/100 g. PEI identified high grade neoplasms with a 65% sensitivity, 92% specificity, 93% PPV, 61% NPV and 75% accuracy. BV identified high grade neoplasms with a 80% sensitivity, 75% specificity, 84% PPV, 69% NPV, 78% accuracy. Considering both PEI and BV, P-CT identified high grade lesions with a 60% sensitivity, 100% specificity, 100% PPV, 60% NPV and 75% accuracy.

Conclusions

PEI and BV perfusion CT parameters proved their efficiency in identifying high grade pancreatic adenocarcinoma.     

Dual energy spectral CT imaging of insulinoma-Value in preoperative diagnosis compared with conventional multi-detector CT

Objective

The aim of this study was to investigate the value of dual energy spectral CT (DEsCT) imaging in preoperative diagnosis of insulinomas in comparison with conventional multi-detector CT (MDCT).

Materials and methods

Thirty-five patients were included in this study with 14 underwent the conventional dual-phase CT imaging (from March 2009 to January 2010) and 21 underwent the dual-phase DEsCT imaging (from February 2010 to May 2011). CT images were interpreted prospectively by two radiologists in consensus before operation. All the patients had diagnosis confirmed pathologically. The accuracy of preoperative diagnosis of insulinomas between DEsCT imaging and conventional MDCT, and between different kinds of images of DEsCT was compared.

Results

There were 39 confirmed lesions among the 35 patients (23 and 16 tumors in the spectral CT group and MDCT group, respectively). MDCT detected 11 of 16 tumors. DEsCT imaging detected 20 of 23 tumors separately with the monochromatic image or the iodine density image, and 22 of 23 tumors with the combination of the two kinds of images. The sensitivity for the preoperative diagnosis of insulinoma was 95.7% with the combination of monochromatic and iodine density images in DEsCT imaging, statistically higher than that with the conventional MDCT (68.8%) (p = 0.033).

Conclusion

Dual energy spectral CT imaging has higher sensitivity in preoperative diagnosis of insulinomas compared with conventional MDCT. The combination of monochromatic image and iodine density image can improve the diagnostic sensitivity of insulinomas.     

Cystic pancreatic lesions; CT characterization and pathological evaluation

Objective

The aim of this study was to assess the ability of CT to predict the pathological nature of pancreatic cystic lesions if it is benign, malignant or premalignant.

Multidetector CT and CT angiography in mesenteric ischemia

Purpose

To evaluate the role of 64-multidetector CT in assessment of mesenteric vascular ischemia in clinically suspected patients.

Patients and methods

This study included 38 patients during period from October 2009 to October 2011. The patients age ranged from 38 to 72 year old (mean age was 57 ± 11.2 years). All cases met the criteria of acute non traumatic (28 patients) or chronic abdominal pain (10 patients) and suspected mesenteric vascular ischemia. All 38 cases were evaluated in surgery department, then underwent CT of the abdomen and pelvis & CTA by using 64 multislice GE light speed VCT. MDCT& CT angiographic findings were correlated with surgical findings in acute mesenteric ischemia (AMI) cases & conventional angiography in chronic mesenteric ischemia (CMI) cases.

Results

MDCT findings alone were nonspecific for detection of MI. The sensitivity, specificity& accuracy of CTA in diagnosis of AMI after surgical confirmation were 96%, 66.6% & 92.8% respectively, while in CMI the sensitivity, specificity & accuracy were 88.8%, 100%, 90% respectively, after confirmation by conventional angiography.

Conclusion

CTA scan appears to be an excellent tool to find out and localize cases of AMI rather than in CMI cases.