Use of spiral computerized tomography angiography in patients with subarachnoid hemorrhage in whom subtraction angiography did not reveal cerebral aneurysms

OBJECT: Patients with subarachnoid hemorrhage (SAH) in whom angiography does not demonstrate diagnostic findings sometimes suffer recurrent disease and actually harbor undetected cerebral aneurysms. The management strategy for such cases remains controversial, but technological advances in spiral computerized tomography (CT) angiography are changing the picture. The purpose of this prospective study was to examine how spiral CT angiography can contribute to the detection of cerebral aneurysms that cannot be visualized on angiography. METHODS: In 134 consecutive patients with SAH, a prospective search for the source of bleeding was performed using digital subtraction (DS) and spiral CT angiography. In 21 patients in whom initial DS angiography yielded no diagnostic findings, spiral CT angiography was performed within 3 days. Patients in whom CT angiography provided no diagnostic results underwent second and third DS angiography sessions after approximately 2 weeks and 6 months, respectively. Six patients with perimesencephalic SAH were included in the 21 cases. Six of the other 15 patients had small cerebral aneurysms detectable by spiral CT angiography, five involving the anterior communicating artery and one the middle cerebral artery. Two patients in whom initial angiograms did not demonstrate diagnostic findings proved to have a ruptured dissecting aneurysm of the vertebral artery; in one case this was revealed at autopsy and in the other during the second DS angiography session. A third DS angiography session revealed no diagnostic results in 13 patients. CONCLUSIONS: Spiral CT angiography was useful in the detection of cerebral aneurysms in patients with SAH in whom angiography revealed no diagnostic findings. Anterior communicating artery aneurysms are generally well hidden in these types of SAH cases. A repeated angiography session was warranted in patients with nonperimesencephalic SAH and in whom initial angiography revealed no diagnostic findings, although a third session was thought to be superfluous.     

Transparent box enables three dimensional viewing of CT imaging of the liver

We designed a transparent box to reconstruct cross sectional computed tomography (CT) imagings of the liver into a three dimensional form. The objective was to clearly visualize the area of lesion and to facilitate clinical teaching. This box (31.5×22.0×18.5 cm) is made of acrylic board containing 16 demountable panels layered horizontally at 10-mm intervals. The transparency of the CT film is projected onto these panels at each height of the liver, and findings including location of the tumor, main vessels and adjacent organs are outlined with an erasable marker. After completion of each tracing, the panels are replaced in the box and the total layer forms a completed picture of the CT findings. Since 1981, we have used this tool to assess resectability and/or to select adequate procedures for treating 54 patients with liver tumor. The solid picture gives an definite location of the tumor and its extension. In the clinical work-up, indication for surgery and a procedure of choice can be discussed by the team, using this visual aid.     

Double-contrast CT arthrography of the cruciate ligaments

The value of computed tomography (CT) in evaluating the cruciate ligaments was assessed by studying an amputated knee in order to find the most suitable position for detecting minimal defects of the ligaments. The ACL or PCL, or both, of 60 patients (61 knees) were then examined by CT and the findings were compared with those of arthroscopy. Defects 3mm in length were shown by CT. A sufficient quantity of air and an adequate amount of positive contrast medium were required to obtain an accurate picture of the ligaments. For the ACL, the sensitivity of CT was 96.6%, specificity was 95.5%, and accuracy was 96.1%. For the PCL, sensitivity was 78.6%, specificity was 91.7%, and accuracy was 84.6%. Ruptures of the cruciate ligaments shown by CT were classified into four types. Their CT images coincided significantly with their arthroscopic findings. This study shows double-contrast CT arthrography to be a valuable method for evaluating the cruciate ligaments, and especially the ACL.     

Radiodiagnosis of acute appendicitis

Sixty acute appendicitis suspects with unclear clinical picture were examined with high-frequency ultrasound and native CT. The results of the examinations were compared with clinical data, surgical findings and histological evidence. Acute appendicitis was in 39 patients, other diseases of abdominal cavity and small pelvis--in 21. Sensitivity of CT was 95%, specificity--91.3%, accuracy--96.6%. Sensitivity of US was 92.3%, specificity--100%, accuracy--95%. The above parameters for non-invasive diagnostic methods were similar to ones for laparoscopy. Native CT and US are highly precise methods for diagnosis of acute appendicitis. They are preferable in unclear clinical situations, atypical location of the appendix, in children, elderly and aged patients, and in patients with mental disorders.     

Magnetic resonance imaging of the spinal cord in spinal dysraphisms

Magnetic resonance imaging (MRI) was performed 49 times in 42 patients with spinal dysraphism. Scoliosis and a changing neurological picture were the primary indications. Spinal cord anomalies included hydromyelia, diastematomyelia, lipoma, thickened filum terminali, and spinal cord atrophy. All but one patient exhibited Arnold-Chiari malformation. Twenty-two of the 42 patients had computed tomography (CT) scans, myelograms, or operations that corroborated the 41 MRI findings. Three false-positive MRI findings of hydromyelia and no false-negative studies were observed. MRI is a noninvasive investigative technique that provides more information than myelography or CT in defining spinal cord anatomy in spinal dysraphism.     

Colonic wall thickening on computed tomography scan and clinical correlation. Does it suggest the presence of an underlying neoplasia?

The widespread use of computed tomography (CT) scanning technology frequently leads to the incidental discovery of thickened bowel wall. The clinical significance of such a CT scan finding is largely under-investigated. The purpose of our study was to determine the incidence of significant clinical pathology and, particularly, neoplasia in patients with abnormally thickened bowel on CT scan examination. This is a single institution retrospective analysis of patients that underwent CT scanning of their abdomen. The radiological picture was correlated with colonoscopic findings. A total of 40 consecutive patients with thickened bowel on CT scan that also underwent colonoscopy were identified and their records were reviewed. Thirty-five patients had no history of previous gastrointestinal disorder and form our study group. The median age of the patients was 69 years (range, 24-97 years). There were 26 female and 9 male patients. The incidental CT finding of bowel wall thickening was the only reason for the colonoscopy in 14 (35%) out of the 40 patients. Eight (23%) patients with thick bowel had colonic neoplasia based on pathology. Five (14%) patients had invasive adenocarcinoma of the colon. Four (11%) of the 5 patients with colon adenocarcinoma did not have any associated gastrointestinal symptoms or signs. One (3%) patient had lymphoma of the colon and two (6%) had benign polyps. Colonoscopy was unremarkable in 10 (28%) patients. The incidental finding of colonic thickening on CT imaging could be associated with underlying colonic malignancy and, more importantly, represent the initial disease presentation. Therefore, we propose that these patients should undergo colonoscopy.     

Intraoperative ultrasound (US) imaging. Comparison of pathomorphological findings in US and CT

Summary Experience with the use of intraoperative ultrasound (US) imaging in over 300 patients are presented in this paper and discussed with special reference to various pathomorphologies as well as their identifiability within the brain/intracranium. In 201 of these patients, the pathomorphological peculiarities in US could be compared with preoperative CT findings.As a general result, all investigated lesions could be identified during intraoperative US investigations with the exception of small aneurysms. Most of the lesions gave at least partly higher echosignals than normal brain tissue, except arachnoid cysts. Size and shape of lesions were comparable in US and CT with the exception of some gliomas; in the latter group, the diffuse image in US was more akin to the situation likely to be found by the surgeon during operation, wheras CT used to give a misleading picture of a more or less clearly delineated tumour. US allowed more accurate differentiation between intratumoural necrosis and cysts than CT: the latter was misleading in many instances.At the present state of development, real time US imaging does not allow a histopathological diagnosis. The ease of handling and the high quality of morphological imaging, however, warrant a number of practical applications in daily neurosurgical practice.     

Ventricular dilatation and communicating hydrocephalus following spontaneous subarachnoid hemorrhage.

Ventricular dilatation following spontaneous subarachnoid hemorrhage (SAH) is a well recognized phenomenon. Its clinical significance, however, remains controversial. Two phases are distinguished, the acute or early, occurring soon after the ictus, and the chronic or late, developing after the second week. The authors studied the ventricular size in 210 patients with spontaneous SAH through the course of their illness and convalescence by means of serial computerized tomography (CT) scans. Their findings suggest that ventricular dilatation soon after SAH is not always clinically significant and does not necessarily require shunting before definitive surgery. Delayed symptomatic ventricular enlargement (communicating hydrocephalus) occurs in 7% of the patients and can be safely diagnosed on the basis of the clinical picture and CT scan appearances. Treatment with a ventricular shunting system is almost invariably rewarding.     

Double-contrast CT arthrography of the cartilage of the patellofemoral joint

For assessment of the value of computed tomography (CT) as a method for evaluating the cartilage of the patellofemoral joint, 100 knees were examined in 91 patients. With the patient in a supine position with the knee flexed at a 30 degree angle, a sufficient quantity of air and positive contrast material was required to obtain an accurate CT picture of the cartilage. Normal cartilage images of 53 knees and abnormal images of 47 knees were obtained by use of CT. The latter group was classified into eight types. When the CT findings of 70 knees were compared with arthroscopy and/or arthrotomy, the results showed that CT diagnosis was accurate in 68 of 70 knees, with a coincidence rate of 97.1%. Cartilage thickness at an arbitrary site and the extent of the ulcer within the deep layers were observed easily by CT. Although examination exclusively with arthroscopy had distinct disadvantages (e.g., the inability to assess either the specific thickness of the cartilage or the extent of the ulcers within deep layers), the combined use of arthroscopy with CT provided a precise three-dimensional image of the cartilage. CT was found to be a valuable noninvasive imaging method for patellofemoral joint cartilage evaluation.     

Computed tomography in thoracoabdominal trauma

This study evaluates our experience with CT scanning in thoracic and abdominal trauma. It was designed to analyze the accuracy and usefulness of CT with regard to: a) type of trauma, b) location of injury, c) timing of scanning, d) timing of operative intervention, e) confirmatory findings, and f) ultimate patient outcome. Between 1978 and 1983, 2,069 CT scans were performed for trauma in our institution, of which 122 were abdominal and ten thoracic, in 98 patients. Thirty-one of these patients had operation or autopsy confirmation of the findings; for 11 patients subsequent CT was available. Abdominal scanning was positive in 48 patients. The organs most commonly injured were spleen (17 patients), pancreas (nine), kidney (11), and liver (eight). Two pancreatic scans were initially interpreted as negative, but in retrospect definite abnormalities were present. Conclusions: 1) Thoraco-abdominal CT scanning documents injury to the liver, spleen, kidney, and retroperitoneum with a high degree of accuracy. 2) CT is most useful in stable trauma patients without obvious indications for laparotomy but with abnormal findings requiring explanation. 3) CT scanning is useful in evaluating patients for delayed complications following trauma. 4) Attention to details of technique and clinical correlation are essential to avoid misinterpretation of thoracoabdominal CT scans, especially of the pancreas. 5) Use of CT scans may assist in the safe, nonoperative management of selected patients with injury limited to solid organs.     

A comparison of unenhanced helical computerized tomography findings and renal obstruction determined by furosemide 99m technetium mercaptoacetyltriglycine diuretic scintirenography for patients with acute renal colic

PURPOSE: We assessed unenhanced helical computerized tomography (CT) secondary findings as predictors of renal obstruction as determined by diuretic scintirenography, and determined their reproducibility. MATERIALS AND METHODS: We performed a retrospective review of the records of 77 consecutive patients with unenhanced helical CT findings (stones and secondary findings, including renal parenchymal edema, hydronephrosis, hydroureter, perinephric fat stranding, periureteral fat stranding and extravasation) of urinary lithiasis who had also undergone concomitant diuretic scintirenography during the initial emergency room evaluation during a 1-year period. Unenhanced helical CT films were independently reviewed by 2 attending radiologists (blinded to clinical outcome) to determine interobserver variability. The results were compared to those of diuretic scintirenography. RESULTS: Considerable interobserver variability, as evidenced by kappa values ranging from 0.26 to 0.60, existed for the diagnosis of secondary findings associated with urinary lithiasis on unenhanced helical CT. There was no significant difference in terms of CT findings between patients diagnosed by diuretic scintirenography as having high grade/complete obstruction and those with partial obstruction (p values 0.24 to 0.85 for the 6 unenhanced helical CT findings analyzed). Analyses of variance followed by Tukey's pairwise comparisons showed no significant difference in average number of unenhanced helical CT findings between patients with high grade/complete obstruction (mean plus or minus standard deviation 4.4 +/- 1.31), partial obstruction (4.4 +/- 1.30), and decompression/no obstruction (4.2 +/- 1.16). However, the mean number of unenhanced helical CT findings for patients with normal scintirenography/no obstruction (1.9 +/- 1.41) was significantly different from each of the other 3 diuretic scintirenography groups. Separate logistic regression analyses showed that each unenhanced helical CT finding, except for renal parenchymal edema and urinary extravasation, was a significant predictor of "any degree of obstruction" (high grade and partial obstruction groups) compared to "no obstruction" (decompressed and no obstruction groups). Odds ratios (95% confidence interval) ranged from 6.15 (2.25, 16.82) for perinephric fat stranding to 3.41 (1.30, 8.97) for hydroureter. When these analyses were repeated after exclusion of 8 patients with bladder/passed stones, only perinephric fat stranding and periureteral fat stranding remained significant predictors of "any degree of obstruction," with respective odds ratios of 4.21 (1.49, 11.91) and 4.08 (1.31, 12.65). CONCLUSIONS: Measures of agreement between trained, independent radiologists with respect to unenhanced helical CT secondary findings show considerable variability. The average number of CT consensus findings is not helpful in differentiating patients with variable degrees of obstruction, except for those with normal scintirenography/no obstruction. Unenhanced helical CT findings, except for renal parenchymal edema and urinary extravasation, are significant predictors of "any degree of obstruction" (high grade or partial obstruction) compared to "no obstruction" (decompressed or no obstruction). Therefore, unenhanced helical CT findings may be useful for identifying patients with any degree of obstruction but do not differentiate between those with high grade and partial obstruction.     

External validation of the clinical indications of computed tomography (CT) of the head in patients with low-energy geriatric hip fractures

IntroductionOn evaluation of the clinical indications of computed tomography (CT) scan of head in the patients with low-energy geriatric hip fractures, Maniar et al. identified physical evidence of head injury, new onset confusion, and Glasgow Coma Scale (GCS) < 15 as predictive risk factors for acute findings on CT scan. The goal of the present study was to validate these three criteria as predictive risk factors for a larger population in a wider geographical distribution.Patients and methodsPatients ≥65 years of age with low-energy hip fractures from 6 trauma centers in a wide geographical distribution in the United States were included in this study. In addition to the relevant patient demographic findings, the above mentioned three criteria and acute findings on head CT scan were gathered as categorical variables.ResultsIn total 799 patients from 6 centers were included in the study. There were 67 patients (8.3%) with positive acute findings on head CT scan. All of these patients (100%) had at least one criteria positive. There were 732 patients who had negative acute findings on head CT scan with 376 patients (51%) having at least one criteria positive and 356 patients (49%) having no criteria positive. Sensitivity of 100% and negative predictive value of 100% was observed to predict negative acute findings on head CT scan when all the three criteria were negative.ConclusionWith the observed 100% sensitivity and 100% negative predictive value, physical evidence of acute head injury, acute retrograde amnesia, and GCS < 15 can be recommended as a clinical decision guide for the selective use of head CT scans in geriatric patients with low energy hip fractures. All the patients with positive acute head CT findings can be predicted in the presence of at least one positive criterion. In addition, if these criteria are used as a pre-requisite to order the head CT, around 50% of the unnecessary head CT scans can be avoided.     

Incidental findings on computed tomography scans for acute appendicitis: prevalence, costs, and outcome

CT scan is increasingly being used to diagnose appendicitis due to its specificity and literature suggesting its cost-effectiveness. CT scans are associated with incidental findings. We sought to investigate the rates of incidental findings identified on CT scans, the follow-up of these findings, and the added cost associated with this follow-up. A retrospective review of patients who underwent appendectomies for acute appendicitis between 2003 and 2005 was completed at Elmhurst Hospital Center (Elmhurst, NY). Incidental findings were grouped into low and high significance, based on workup or follow-up needed. The diagnostic workup and cost of each incidental finding was ascertained. For patients who did not receive a workup due to lack of follow-up, an estimate of the minimum workup was calculated. Of 1142 patients with acute appendicitis, 876 (77%) had a CT scan. This rate increased over time (from 66% in 2003 to 85% in 2005, P < 0.01) and with age (70% in patients under 20 and 98% in patients over 50, P < 0.001). Incidental findings were common and increased with age (23% in the youngest group vs 78% in patients older than 50, P < 0.001). The cost associated with workup of these incidental findings increased with age as well. The increased use of CT scans is associated with a high rate of incidental findings. These findings are usually of low clinical significance but may require further workup and follow-up. Physicians need to be aware of the high rate of incidental findings, the need for further workup, and the associated costs.     

A comparison of computed tomography and myelography in the diagnosis of lumbar disc herniation

Summary Ninety patients suspected to have a herniated lumbar disc were examined by myelography and computed tomography (CT). Of these, 37 were subjected to surgery. The surgical findings were in agreement in 21 patients (57%) with the myelograms and in 28 patients (76%) with the CT examinations. False-positive CT examinations were found in only one patient. CT is as reliable as myelography in the primary diagnosis of disc herniation.     

Use of computed tomography in diagnosis of major postoperative gastrointestinal complications of laparoscopic Roux-en-Y gastric bypass surgery

Laparoscopic Roux-en-Y gastric bypass (LRYGB) is becoming a frequently performed procedure for the treatment of morbid obesity. It is important for all general surgeons to be able to diagnose correctly and treat its complications. It is the purpose of this study to determine whether computed tomography (CT) is useful in correctly diagnosing these complications. The medical records of all patients that underwent LRYGB between March 2000 and December 2002 (n = 574) at Huntington Memorial Hospital were reviewed. Major abdominal complications defined as anastomotic leaks or small bowel obstruction were noted. Results of CT scans in these patients were reviewed by both a radiologist and an attending surgeon. CT scan findings were then compared to intraoperative findings. Postoperatively, 18 patients were found to have small bowel obstruction/herniation and anastomotic leaks. CT scan correctly diagnosed anastomotic leaks and small bowel obstruction in 71 per cent and 100 per cent of patients, respectively. Complication following LRYGB are rare but potentially life-threatening. CT scans are helpful in predicting the pathology and directing the surgical management of these patients. CT scan findings, however, can be subtle and therefore be missed by those not intimately familiar with post gastric bypass anatomy.     

A comparison of computed tomography and myelography in the diagnosis of lumbar disc herniation

Ninety patients suspected to have a herniated lumbar disc were examined by myelography and computed tomography (CT). Of these, 37 were subjected to surgery. The surgical findings were in agreement in 21 patients (57%) with the myelograms and in 28 patients (76%) with the CT examinations. False-positive CT examinations were found in only one patient. CT is as reliable as myelography in the primary diagnosis of disc herniation.     

A comparative study between Marshall and Rotterdam CT scores in predicting early deaths in patients with traumatic brain injury in a major tertiary care hospital in Nepal

Purpose: CT plays a crucial role in the early assessment of patients with traumatic brain injury (TBI). Marshall and Rotterdam are the mostly used scoring systems, in which CT findings are grouped differently. We sought to determine the values of the scoring system and initial CT findings in predicting the death at hospital discharge (early death) in patients with TBI. Methods: There were consecutive 634 traumatic neurosurgical patients with mild-to-severe TBI admitted to the emergency department of College of Medical Sciences. Their initial CT and status at hospital discharge (dead or alive) were reviewed, and both CT scores were calculated. We examined whether each score is related to early death; compared the two scoring systems'' performance in predicting early death, and identified the CT findings that are independent predictors for early death. Results: Both imaging score (Marshall) and clinical score (Rotterdam) can be used to reliably predict mortality in patients with acute traumatic brain injury with high prognostic accuracy. Other specific CT characteristics that can be used to predict early mortality are traumatic subarachnoid hemorrhage, midline shift and status of the peri-mesencephalic cisterns. Conclusions: Marshall CT classification has strong predictive power, but greater discrimination can be obtained if the individual CT parameters underlying the CT classification are included in a prognostic model as in Rotterdam score. Consequently, for prognostic purposes, we recommend the use of individual characteristics rather than the CT classification. Performance of CT models for predicting outcome in TBI can be significantly improved by including more details of variables and by adding other variables to the models.     

Current Experience with Computed Tomographic Cystography and Blunt Trauma

We present our experience with computed tomographic (CT) cystography for the diagnosis of bladder rupture in patients with blunt abdominal and pelvic trauma and compare the results of CT cystography to operative exploration. We identified all blunt trauma patients diagnosed with bladder rupture from January 1992 to September 1998. We also reviewed the radiology computerized information system (RIS) for all CT cystograms performed for the evaluation of blunt trauma during the same time period. The medical records and pertinent radiographs of the patients with bladder rupture who underwent CT cystography as part of their admission evaluation were reviewed. Operative findings were compared to radiographic findings. Altogether, 316 patients had CT cystograms as part of an initial evaluation for blunt trauma. Of these patients, 44 had an ultimate diagnosis of bladder rupture; 42 patients had CT cystograms indicating bladder rupture. A total of 28 patients underwent formal bladder exploration; 23 (82%) had operative findings that exactly (i.e., presence and type of rupture) matched the CT cystogram interpretation. The overall sensitivity and specificity of CT cystography for detection of bladder rupture were 95% and 100%, respectively. For intraperitoneal rupture, the sensitivity and specificity were 78% and 99%, respectively. CT cystography provides an expedient evaluation for bladder rupture caused by blunt trauma and has an accuracy comparable to that reported for plain film cystography. We recommend CT cystography over plain film cystography for patients undergoing CT evaluation for other blunt trauma-related injuries.     

Imaging in blunt cardiac injury: Computed tomographic findings in cardiac contusion and associated injuries

BackgroundBlunt cardiac injury (BCI) may manifest as cardiac contusion or, more rarely, as pericardial or myocardial rupture. Computed tomography (CT) is performed in the vast majority of blunt trauma patients, but the imaging features of cardiac contusion are not well described.PurposeTo evaluate CT findings and associated injuries in patients with clinically diagnosed BCI.Materials and methodsWe identified 42 patients with blunt cardiac injury from our institution's electronic medical record. Clinical parameters, echocardiography results, and laboratory tests were recorded. Two blinded reviewers analyzed chest CTs performed in these patients for myocardial hypoenhancement and associated injuries.ResultsCT findings of severe thoracic trauma are commonly present in patients with severe BCI; 82% of patients with ECG, cardiac enzyme, and echocardiographic evidence of BCI had abnormalities of the heart or pericardium on CT; 73% had anterior rib fractures, and 64% had pulmonary contusions. Sternal fractures were only seen in 36% of such patients. However, myocardial hypoenhancement on CT is poorly sensitive for those patients with cardiac contusion: 0% of right ventricular contusions and 22% of left ventricular contusions seen on echocardiography were identified on CT.ConclusionCT signs of severe thoracic trauma are frequently present in patients with severe BCI and should be regarded as indirect evidence of potential BCI. Direct CT findings of myocardial contusion, i.e. myocardial hypoenhancement, are poorly sensitive and should not be used as a screening tool. However, some left ventricular contusions can be seen on CT, and these patients could undergo echocardiography or cardiac MRI to evaluate for wall motion abnormalities.     

Improved Staging With Pretreatment Positron Emission Tomography/Computed Tomography in Low Rectal Cancer

Background ¹⁸F-Fluorodeoxyglucose (FDG)-positron emission tomography (PET) and computed tomography (CT) are widely accepted in the evaluation for metastatic or recurrent rectal cancer. Only spiral CT and transrectal ultrasonography (TRUS) are routinely used in the initial evaluation of primary rectal cancer. We wished to determine whether PET/CT could provide additional information in patients undergoing standard evaluation for primary rectal cancer. Methods Thirty-seven patients (mean age, 58 years; range, 26–90 years) with a previously untreated rectal cancer underwent TRUS or magnetic resonance imaging, spiral CT, and FDG-PET/CT. The tumor location (low, ≤6 cm; mid, 7–10 cm; or high, ≥10 cm) and carcinoembryonic antigen level were recorded. Discordant findings between spiral CT and FDG-PET/CT were confirmed by histological analysis or imaging follow-up. Results FDG-PET/CT identified discordant findings in 14 patients (38%), and this resulted in upstaging of 7 patients (50%) and downstaging of 3 patients (21%). Although node-positive disease on TRUS/magnetic resonance imaging was associated with discordant FDG-PET/CT findings, this was not statistically significant. Discordant PET/CT findings were significantly more common in patients with a low rectal cancer than in those with mid or high rectal cancer (13 vs. 1; P = .0027). The most common discordant finding was lymph node metastasis (n = 7; 50%). Histological confirmation of discordant FDG-PET/CT findings was performed in seven patients, and in no case did FDG-PET/CT prove to be inaccurate. Discordant PET/CT findings resulted in a deviation in the proposed treatment plan in 27% of patients (n = 10). Conclusions FDG-PET/CT frequently yields additional staging information in patients with low rectal cancer. Improved accuracy of pretreatment imaging with FDG-PET/CT will allow for more appropriate stage-specific therapy. Presented at the Annual Meeting of the Society of Surgical Oncology, Atlanta, Georgia, March 3–6, 2005.