MDCT of the myocardium: a new contribution to ischemic heart disease

RATIONALE AND OBJECTIVES: Despite the progress made in diagnosis and treatment, cardiovascular diseases remain the main cause of death worldwide. MATERIALS AND METHODS: Multidetector row computed tomography (MDCT) provides several diagnostic insights, namely assessment of coronary artery anatomy and measurement of left ventricular volume and function. The ability of CT to show myocardial infarcted areas as an enhanced territory was described in the late 1970s in an animal model. RESULTS: This method found a second wind with the arrival of MDCT technology that led to its clinical application. Several authors describe the ability of MDCT to assess myocardial injury both in animals and humans. The MDCT assessment of myocardial late enhancement is based on the same principle as delayed enhancement MRI. CONCLUSIONS: The aim of this review is to cover the technical aspects of cardiac MDCT in assessing the myocardium and its potential in diagnosing ischemic heart disease.     

多层螺旋CT对肠道Crohn病的诊断价值

目的:探讨多层螺旋CT(MDCT)Crohn病影像特点及诊断价值。方法:对我院经病理证实的14例肠道Crohn病患者的MDCT影像特点进行回顾性分析。结果:所有病例均有跳跃性肠壁增厚,8例表现为肠壁环形增厚,同时伴有粘膜强化和分层形成"靶征"及"双晕征";有11例表现为增厚肠壁分层消失,增强不明显,肠壁厚度多在5～11mm。4例表现为病变段肠管周围肠系膜水肿及增厚,蜂窝织炎,其中并发脓肿1例。7例表现为肠系膜淋巴结肿大。有3例表现为肠系膜血管增多增粗形成"梳征"。其中"靶征"、"双晕征"及"梳征",均提示与病变活动度相关。结论:MDCT不但能准确显示Crohn病病变部位、肠外病变,还能区分活动性与非活动性病变。MDCT可作为Crohn病首选影像学检查方法。     

Cake kidney: MDCT urography for diagnosis

Cake (fused pelvic) kidney is an uncommon congenital anomaly. Early diagnosis and recognition of potential complications that may accompany this anomaly are important to prevent permanent renal impairment. To the best of our knowledge, this is the first report on a case of cake kidney that was diagnosed by multidetector row computed tomographic urography.     

Radiologic diagnosis of different types of pulmonary stenoses

Right ventricular outflow obstructive lesions are among the most prevalent congenital cardiac anomalies with a frequency ranging from 6–10% when considered as isolated anomalies. As part of a more complicated developmental complex, their frequency is undoubtedly higher. The diagnosis can be suspected by the traditional clinical and hemodynamic findings, but a firm diagnosis can only be made by angiography. An exact diagnosis is most important since most of these lesions can be surgically corrected.     

MDCT diagnosis and endovascular management of bullet embolization to the heart

Multidetector computed tomography is a useful imaging modality in diagnosing the path of a bullet and evaluating the extent of injury the bullet has caused in the torso. We present a 21-year-old patient who sustained a single gunshot wound to the right flank without any exit wound. Bullet fragments were embolized to the heart and left pulmonary artery via inferior vena cava. Minimally invasive interventional management was performed successfully to retrieve the intracardiac bullet fragments to prevent further complications.     

Accuracy of MDCT in the diagnosis of choledocholithiasis

OBJECTIVE: Our purpose was to evaluate the diagnostic performance of contrast-enhanced and unenhanced MDCT, performed for various indications, in detecting choledocholithiasis. CONCLUSION: Unenhanced and contrast-enhanced MDCT images, interpreted in PACS workstations with axial images, are moderately sensitive and specific for showing choledocholithiasis.     

MDCT for the diagnosis of acute pulmonary embolism

With the advent of multidetector CT, pulmonary CT angiography (MD-CTPA) has substantially gained in spatial resolution and is the accepted method of choice to diagnose and rule out acute pulmonary embolism down to the subsegmental level. This article reviews means to optimize scanning technique and contrast injection protocols dependent on the scanner type used. It summarizes recent publications on the performance of MD-CTPA with special emphasis on the diagnostic accuracy, interpretation and clinical role of (isolated) peripheral emboli. Diagnostic algorithms are outlined that describe the role of CT in context with the pretest probability, the D-Dimer, lower limb sonography and scintigraphy.     

MDCT diagnosis of the child with posterior plagiocephaly

OBJECTIVE: In this article, we review the normal anatomy and development of the posterior skull base and describe distinguishing imaging features of the two most common causes of posterior plagiocephaly: posterior deformational plagiocephaly and unilateral lambdoid synostosis. We also describe three unusual cases of posterior plagiocephaly, including asymmetric premature fusion of the anterior and posterior intraoccipital synchondroses, with diagnoses enabled by volume-reformatted MDCT. CONCLUSION: Three-dimensional reformatted MDCT enables accurate diagnosis of common and rare causes of posterior plagiocephaly in children.     

MDCT诊断右冠状动脉瘤2例

病例资料患者1男性,78岁,心前区痛不适多年,近2月胸闷不适加重。3年前左室下壁梗死。E C G示左室下壁陈旧性梗死,血脂升高、高血压史。心率68次/m in～70次/m in。患者2女性,50岁,胸闷、心前区偶尔不适一月余。E C G示多源性房性、室性早搏(偶发)。心率59次/m in～64次/m in。血脂偏高,无糖尿病、高血压史。64排-M D C T显示:患者1右冠近段锐缘支开口处局限性瘤样扩张,腔内未见明显充盈缺损。左前降支见多发钙化斑,管腔轻-中度狭窄(见图1、图2)。患者2,右冠远段近后室间沟处管腔瘤样扩张,最大径达10m m,无钙化和血栓形图1,图2患者1VR图…     

MDCT diagnosis of penetrating diaphragm injury

The purpose of the study was to determine the diagnostic sensitivity and specificity of multidetector CT (MDCT) in detection of diaphragmatic injury following penetrating trauma. Chest and abdominal CT examinations performed preoperatively in 136 patients after penetrating trauma to the torso with injury trajectory in close proximity to the diaphragm were reviewed by radiologists unaware of surgical findings. Signs associated with diaphragmatic injuries in penetrating trauma were noted. These signs were correlated with surgical diagnoses, and their sensitivity and specificity in assisting the diagnosis were calculated. CT confirmed diaphragmatic injury in 41 of 47 injuries (sensitivity, 87.2%), and an intact diaphragm in 71 of 98 patients (specificity, 72.4%). The overall accuracy of MDCT was 77%. The most accurate sign helping the diagnosis was contiguous injury on either side of the diaphragm in single-entry penetrating trauma (sensitivity, 88%; specificity, 82%). Thus MDCT has high sensitivity and good specificity in detecting penetrating diaphragmatic injuries.     

MDCT for the diagnosis of acute pulmonary embolism

With the advent of multidetector CT, pulmonary CT angiography (MD-CTPA) has substantially gained in spatial resolution and is the accepted method of choice to diagnose and rule out acute pulmonary embolism down to the subsegmental level. This article reviews means to optimize scanning technique and contrast injection protocols dependent on the scanner type used. It summarizes recent publications on the performance of MD-CTPA with special emphasis on the diagnostic accuracy, interpretation and clinical role of (isolated) peripheral emboli. Diagnostic algorithms are outlined that describe the role of CT in context with the pretest probability, the D-Dimer, lower limb sonography and scintigraphy.     

不同形态类型肝内胆管细胞癌的CT诊断

目的：探讨不同形态类型肝内胆管细胞癌的CT表现。方法：回顾性分析经病理证实的20例肝内胆管细胞癌的形态特点和动态增强CT表现。结果：20例肝内胆管细胞癌中肿块型14例，管周浸润型4例，管内生长型2例。肿块型平扫表现为不规则低密度肿块，动态扫描早期肿瘤周边呈环状强化，中心部分早期呈轻度强化或不强化，延迟期呈现持续性强化为特征性表现；管周浸润型表现为沿胆管树走行的分枝状软组织肿块，边缘不清，远侧胆管扩张，动态扫描肿瘤呈渐进性延迟强化；管内生长型表现为扩张胆管内的乳头状或结节状病变，动态扫描早期呈轻度均匀性强化，延迟期无强化。结论：不同形态类型肝内胆管细胞癌的CT表现不同，术前影像学检查明确ICC的形态学类型，有助于临床选择合理的治疗方案并判断患者预后。     

Biliary dilatation and duodenal intussusception secondary to enteric duplication cyst: MDCT diagnosis

Enteric duplication cysts are rare congenital anomalies that may occur anywhere along the gastrointestinal tract, most commonly involving the small bowel. The distal ileum, jejunum, and duodenum are affected in descending order of frequency. We describe a case of biliary dilatation and duodenal intussusception caused by an enteric duplication cyst in an adult patient. To our knowledge, there are no other reported cases of this entity in an adult in the English literature. Multidetector computed tomography (MDCT) findings are emphasized, and the value of multiplanar reformation (MPR) in forming a correct preoperative differential diagnosis is discussed.