The value of computerized tomography for preoperative staging of stomach cancer

The validity of computed tomography (CT) for the preoperative staging (TNM) of gastric carcinoma was studied in 74 patients, first in a prospective study, then under routine clinical conditions. Comparing CT-staging to intraoperative findings in the study patients showed correct assessment of the T-category in 70%, the N-category in 36%, and of both T and N in 26%. Validity was also low with 27% for both T- and N-staging when the CT was set against pathological-anatomical findings. The results in clinical routine were even more disappointing. The examination is of little value for deciding on operative indication and planning. Computed tomography therefore should not be part of a preoperative routine diagnostic assessment in gastric carcinoma.     

Diagnostic value of whole-body computerized tomography in tumors in children

First experience is reported in the application of computerized tomography to tumorous diseases in childhood, being localized in the mediastinum, lungs, abdomen, bones and soft tissue. In the majority of cases the indication for CT was to identify or exclude tumors. In a little part the method served to determine the extent of the tumor for therapy planing. Despite the known difficulties in abdominal diagnosis encountered with computerized tomography a satisfactory result has been achieved by means of appropriate programs. There were difficulties in diagnosis of tumors in the small pelvic starting from the ovariens or the uterus and in diagnosis of recidivtumors. Using special possibilities of computerized tomography, e.g. measuring absorption values, the kind of disease can be diagnosed in some cases and specific therapeutical measures be planned. The limitations of this technic will be pointed out too.     

The value of ultrasonography and computerized tomography in estimating the histopathological severity of nonalcoholic steatohepatitis

BACKGROUND & AIMS: Liver biopsy is the gold standard for the diagnosis of non-alcoholic steatohepatitis (NASH), but is an invasive method. There is a need for non-invasive methods that can reflect the histopathological severity of NASH. The aim of this study was to compare the ultrasonography and computerized tomography findings with the histopathological severity in patients with NASH. MATERIAL AND METHODS: Twenty-two consecutive patients with biopsy proven NASH and 20 age- and sex-matched healthy individuals were enrolled. Clinical and demographic data were collected at the time of liver biopsy. Histopathological grading and staging were made by an expert pathologist. Each patient underwent ultrasonography and computerized tomography. RESULTS: Liver ultrasonographic findings were not correlated with histopathological grade and stage (r: 0.134, P > 0.05; r: 0.130, P > 0.05). Mean liver densities obtained by computed tomography of NASH patients were lower than that of controls (P < 0.05) and liver/spleen density ratios were lower than that of controls (P < 0.05). These results were significantly correlated with histopathological grade (r: -0.716, P < 0.001; r: -0.663, P: 0.001), but not with the histopathologic stage (r: -0.416, P: 0.05; r: -0.356, P: 0.1). CONCLUSIONS: Ultrasonography findings do not reflect histopathological severity in patients with NASH. Computed tomography attenuation of the liver is significantly correlated with histopathologic grade but not with histopathological stage.     

The lack of prognostic value of computerized tomography imaging examinations in patients with chronic non-progressive back pain

The purpose of the present study was to evaluate the prognostic value of computerized tomography (CT) in the conservative treatment of patients with chronic non-progressive back pain. The study included 73 patients with chronic non-progressive back pain in the lumbar region of at least 3-months duration who were referred to the back clinic because of pain that was non-responsive to physical therapy and analgesics. All patients underwent clinical examination and spinal CT scan. The clinical examination and imaging procedures were followed by a 4-week rehabilitation programme based on a multidisciplinary approach that included a rheumatologist, a pain specialist, back school, Alexander technique, acupuncture, manipulation and psychological intervention. Patients were evaluated by the same physician at the end of the 4-week programme and after 6 months follow-up using parameters of pain rating, pain frequency and analgesic drug consumption. CT examinations were evaluated separately by two radiologists. The patients were divided into three groups according to the CT findings: group 1 — normal imaging: 26 patients; group 2 — spinal stenosis: 20 patients; group 3 — posterior bulging, protrusion, extrusion or sequestration of disc: 27 patients. The clinical improvement was almost the same (=50%) in the three different groups. In spite of the small number of cases, the results were statistically significant. We concluded that, in contrast to the importance of modern spinal-imaging procedures before the performance of surgery, the role of these procedures in the prognosis of the conservative treatment of patients with chronic non-progressive back pain does not seem to be important.     

The value of ultrasound and computerized tomography in detection of cystic changes in chronic pancreatitis]

Intra- or extrapancreatic pseudocysts (PP) are the most common local complication in chronic pancreatitis. Aim of this study was to investigate frequency, localisation and size of pseudocysts in patients with chronic pancreatitis by means of ultrasound (US) and computed tomography (CT). 155 patients (females 35, males 120) with chronic pancreatitis, that underwent simultaneous (within two weeks) CT and US examinations, from January 1982 to June 1989, were included in this study. Cystic lesions were detected in 62% by CT, in 52% by US. Sensitivity in detection of cysts based on intraoperative findings (gold standard) was 98% for CT and 94% for US. 80% of the pseudocysts were smaller than 6 cm. 46% were in the range from 2 to 66 cm and 34% were smaller than 2 cm. The most common localisation was the pancreatic head region (50%), 20 of 102 patients with chronic pancreatitis were found to have a direct communication of a pseudocyst with the ductal system by ERP. No specific clinical or laboratory pattern were associated with the presence of pseudocysts. Increased pancreatic serum amylase concentration was detected in 29% of patients with and in 27% of patients without pseudocysts.     

Diagnostic value of unenhanced computerized tomography urography in the evaluation of acute renal colic

This study prospectively evaluated the diagnostic value of unenhanced computerized tomography (CT) urography in patients with acute renal colic. Fifty-nine patients with clinical manifestations of acute renal colic underwent unenhanced helical CT to evaluate urinary tract abnormalities. Reformatted three-dimensional CT urography was performed in all patients. The findings were correlated with ureteroscopy, surgical findings, histopathologic findings, and clinical course. CT urography detected urinary abnormalities in 57 of 59 patients with the clinical manifestation of acute renal colic, including 45 cases of urolithiasis, three urinary malignancies, one congenital abnormality, and eight ureteral strictures (due to chronic inflammation or fibrosis). CT urography showed negative findings in the urinary system in two patients, and after clinical follow-up, urinary abnormality was excluded in these patients. Incidental findings of extrarenal disease were noted in six patients (pulmonary abnormalities, n = 2; gallstones, n = 4). Only one patient with urolithiasis was misdiagnosed as having a renal tumor by CT urography. The sensitivity and specificity of CT urography in diagnosing urolithiasis was 97.8% (44/45) and 100% (14/14), respectively. Three-dimensional CT urography is a newly developed modality to evaluate anomalies of the urinary tract. The highly accurate diagnostic value of CT urography makes it a suitable alternative or substitutive modality in patients with acute flank pain.     

The value of 68 Ga-PSMA-11 positron emission tomography/computerized tomography in evaluating the lacrimal and salivary glands function

Clinical Rheumatology - To investigate the value of 68&nbsp;Ga-PSMA-11 positron emission tomography/computerized tomography (PET/CT) in evaluating lacrimal and salivary glands function. Ten...     

CT血管造影和磁共振血管成像在颅内动脉瘤诊治中的价值

目的 评价CT血管造影(CTA)、磁共振血管成像(MRA)在颅内动脉瘤诊断及治疗中的临床应用价值。方法 运用CTA、MRA和数字减影血管造影(DSA)影像学方法，对302例颅内动脉瘤患者及18例非动脉瘤自发性蛛网膜下腔出血患者进行了单独或联合检查。单独检查CTA、MRA或DSA的患者分别为203例、12例及88例，CTA DSA联合检查为11例，CTA MRA联合检查为4例，检测出的颅内动脉瘤均经手术证实；对18例非动脉瘤自发性蛛网膜下腔出血患者进行CTA DSA联合检查，并对CTA、MRA、DSA检查结果进行回顾性分析，结果 通过CTA、DSA检查单独确诊的动脉瘤分别为203个和88个，与术中结果相一致。仅行MRA检查的12例患者，其中10例与手术结果完全一致，1例术前MRA诊断为右侧大脑中动脉瘤，术中证实为右侧颈内后交通动脉瘤，1例术前MRA正常，术中证实为巨大前交通动脉瘤。10例先行CTA检查，怀疑为动脉瘤，后经DSA检查确诊，并经手术证实，1例DSA检查正常，后行CTA检查确诊并经手术证实。4例行MRA检查，怀疑为动脉瘤，后行CTA检查确诊，并经手术证实。另有18例自发性蛛网膜下腔出血患者，行CTA DSA检查均未见动脉瘤及其他脑血管病征象。CTA、MRA和DSA对颅内动脉瘤的检出率(与手术相比较)分别为100％、87．5％、98．9％。结论 CTA可以作为检查颅内动脉瘤的首选方法，MRA可以用于诊断颅内动脉瘤，但其检出率低于CTA、DSA。     

胸部CT在多发性骨髓瘤骨病变及临床预后评价中的价值

目的 探讨胸部CT在多发性骨髓瘤骨病评价中的价值以及在预后判断中的作用.方法 回顾性分析北京协和医院2010年6月至2012年8月新诊断的多发性骨髓瘤患者46例临床资料,分析其胸部CT和相应范围X线片检查、临床分期[包括Durie-Salmon (DS)分期和国际分期系统(ISS)]及其荧光原位杂交结果(显示染色体异常).结果 (1)CT和X线片对骨髓瘤骨病骨折的诊断阳性率相近,分别为41.3％ (19/46)和30.4％(14/46),差异无统计学意义(P=0.29).(2) CT较X线片对5 ～10 mm和＞10 mm溶骨性病变病例的检出率均显著提高[60.9％ (28/46)比13.0％(6/46);50.0％(23/46)比10.9％(5/46);P均＜0.001].(3)各病例中CT检出的溶骨性病变数目显著多于X线片[5 ～ 10 mm病变:5(0 ～21)处比0(0 ～4)处;＞10 mm病变:2(0 ～14)处比0(0 ～2)处;P均＜0.001].(4)CT诊断溶骨性病变阳性的患者较阴性患者的RB1基因缺失、D13s319基因缺失和高危细胞遗传学特征发生率更高[46.7％(14/30)和18.8％ (3/16);43.3％(13/30)和18.8％(3/16);50.0％(15/30)和25.0％(4/16);P均＜0.001].结论 胸部CT对评价多发性骨髓瘤溶骨病变较X线片敏感,且溶骨性病变与DS分期和RB1基因缺失、D13s319基因缺失及高危细胞遗传学特征相关,对预后判断具有一定临床意义.     

Conventional computerized tomography of the heart

Summary Ungated cardio-CT provides good morphologic information in the case of congenital heart disease, volume or pressure loading, left ventricular aneurysm, tumours, thrombi, cardiac calcifications and pericardial diseases. It allows qualitative assessments of myocardial thickness and perfusion of coronary bypass grafts.ECG-gated cardio-CT allows a quantitative assessment of systolic and diastolic myocardial thickness, volume calculation of cardiac cavities and evaluation of functional parameters. The correlation of the calculated left ventricular ejection fraction comparing laevocardiography and ECG-gated cardio-CT was poor (r=0.7) mainly due to the comparable poor time resolution on the side of cardio-CT (approximately 0.1 s). The quantitative analysis of regional wall motion based on cardio-CT showed for the diagnosis of pathologic wall motion a specificity of 80.5%, sensitivity of 73.9% and accuracy of 75.7%.Side effects must be taken into account following the injection of 200–250 ml hyperosmolar contrast medium during 5–10 minutes which causes intravascular fluid retention and cardiac volume loading. Patients prone to cardiac decompensation should be excluded from cardio-CT examinations.     

Considerations in diagnosing brain abscess with computerized axial tomography

Four studies with computerized axial tomography (CT scan) were performed in a 20-year-old man in whom multiple brain abscesses developed while hospitalized for complications of regional enteritis. A large frontal lobe abscess appeared as a nonspecific region of decreased density on the initial CT scans. When iodine was used to enhance the diagnostic sensitivity of the CT scan, this areas was identifiable as an abscess. However, a 1-cm lesion in the right parietal area that extended into the choroid plexus was not delineated. Radionuclide scans detected both lesions, but did not allow pathological identification. We conclude that CT scans should be performed with iodine enhancement whenever brain abscesses are suspected, and that some abscesses that are undetected by CT scans even with iodine enhancment may be delineated but not identified by sodium pertechnetate Tc 99m imaging.     

The role of spiral computerized tomography in the diagnosis of pulmonary embolism

The diagnostic strategy of pulmonary embolism has changed in the last few years with the use of the pulmonary spiral angio-scan. It has become the investigation of first intention for the positive diagnosis of pulmonary embolism. Its limitations are known, essentially the difficulties in visualisation of distal pulmonary embolism. However, the introduction of new 64-slice scanners has considerably improved the resolution. The indications of the spiral angioscanner have recently increased with the study of pulmonary artery vascularisation and the calculation of Qanadli's obstruction index, the study of the peripheral venous system and the evaluation of right ventricular dysfunction by the calculation of the ratio of surfaces (or diameters) of RV/LV.     

The predictive value of computed tomography calcium scores: a comparison with quantitative volumetric intravascular ultrasound

ObjectiveTo evaluate the relationship between coronary artery calcium scoring (CACS) and intravascular ultrasound (IVUS) calcification and disease severity.MethodsForty-five angina patients who underwent CACS 18±23 days before IVUS were studied. The CACS was recorded for each lesion matched to a specific IVUS lesion. Cross-sectional area measurements of the external elastic membrane, lumen area, plaque and media, and plaque burden were performed. The arc and length of calcification were measured.ResultsThere were 106 calcified lesions detected by IVUS. Eighty-five of those lesions (80%) were detected by CACS, but 21 calcified lesions (20%) were missed. Fourteen (50%) out of 28 of the lesions with an IVUS-calcium arc below the 25th percentile (51.4°) were detected by CACS vs. 91% of lesions with an IVUS-calcium arc >51.4° (P<.05). Similarly, 21 (58%) of 36 lesions ≤3 mm in length were detected vs. 91% of lesions >3 mm (P<.05). We divided IVUS-calcified lesions into CACS ≤10 and >10. Mean plaque burden, calcified length, and arc of calcium increased significantly, while minimum lumen area decreased with increasing CACS. There was the same tendency in culprit and nonculprit calcified lesions, respectively. Multivariate analysis showed a calcified length (regression coefficient=8.718, 95% CI 4.668–12.77, P<.001) and an arc of calcium (regression coefficient=2.789, 95% CI 1.419–4.119, P<.001) were significant predictors for CACS.ConclusionsThis study suggests that a CACS could evaluate coronary calcium burden noninvasively through the accurate estimation of calcium-arc and length.     

Confirming a mediastinal lipoma with cardiac computerized tomography

It is reported on an at present 32-year-old male patient, in whom at the age of 30 years an excessive mediastinal lipoma was excised. For 12 years the cardiological diagnosis was not clear and could completely be clarified only with the help of the computed tomography of the heart.     

A comparison of high resolution computerized tomography and magnetic resonance imaging in the evaluation of allergic bronchopulmonary aspergillosis

Apart from serologic markers structural changes of bronchi and adjacent lung tissue are key factors determining the diagnosis and course of allergic bronchopulmonary aspergillosis (ABPA). Due to problems relating to procedural hazards and radiation exposure using bronchography and computerized tomography we evaluated the efficacy of magnetic resonance imaging of the lung in ABPA. Direct comparison of high resolution computerized tomography (HR-CT) and magnetic resonance imaging (MR) in 5 patients with ABPA revealed that image resolution and data acquisition of present MR technique are insufficient to accurately delineate the extent and activity of structural damage of bronchi and adjacent lung tissue. Although major bronchiectasis may be identified, MR was unable to demonstrate even extensive patchy infiltrates seen in high resolution computerized tomography. At present, magnetic resonance imaging cannot be recommended for determining diagnosis or course of ABPA.     

Prognostic value of the computerized ECG in Hispanics

BACKGROUND: The prevalence and prognostic values of electrocardiogram (ECG) abnormalities in Hispanics have not been compared to other ethnicities in a large population. Despite a worse cardiovascular risk profile, the prevalence of cardiovascular disease is lower in Hispanics compared to non-Hispanics. HYPOTHESIS: We hypothesized that ECG abnormalities were less common in Hispanics and were not as strongly associated with cardiovascular mortality. METHODS: 45,563 ECGs ordered for usual clinical indications in a Veteran's hospital were available for analysis. 1,392 patients who died within one week of the ECG were excluded. Demographic characteristics were recorded and the population was followed for an average of 7.5 years using the California Death Index. The presence of baseline ECG characteristics were recorded and analyzed using the GE/Marquette computerized ECG system. Age, sex and heart rate adjusted Cox hazard ratio analyses were performed. RESULTS: Being Hispanic was associated with lower cardiovascular death, with a hazard ratio (HR) of 0.76 (95% CI 0.65-0.89). Findings such as atrial fibrillation, presence of Q-waves, left ventricular hypertrophy (LVH), upright T-waves in aortic valve replacement (aVR) and cardiac Infarction Injury Scores > 6 were significantly less prevalent in Hispanics than in non-Hispanics. These findings were similarly associated with increased cardiovascular mortality in both groups, each with a HR of approximately 2. CONCLUSION: The lower prevalence of ECG characteristics associated with coronary heart disease, atrial fibrillation and left ventricular hypertrophy support prior observations that cardiovascular disease is less prevalent in the Hispanic population. These findings, however, are similarly associated with increased mortality compared to non-Hispanics.     

Diagnostic and prognostic value of 18-fluorodeoxyglucose positron emission tomography in adrenocortical carcinoma: a prospective comparison with computed tomography

OBJECTIVE: Patients with adrenocortical cancer are submitted to multiple imaging procedures for diagnosis of recurrence and staging. The aim of this prospective study was to evaluate the diagnostic and prognostic values of fluorodeoxyglucose (FDG) using a combined positron emission tomography and computed tomography (PET/CT) modality, compared with thoracoabdominopelvic computed tomography (TAP-CT). METHODS: Twenty-eight consecutive patients with adrenocortical cancer referred from November 2003 to December 2004 to the Institut Gustave Roussy were included. Mean time between PET/CT and TAP-CT was 16 d. Independent readers analyzed images of each modality. The gold standard was progression on follow-up TAP-CT or pathology. RESULTS: A total of 269 lesions in 57 organs were depicted in 22 patients. The sensitivities for the detection of distinct lesions and the diagnosis of metastatic organs were 90 and 93% for PET/CT and 88 and 82% for TAP-CT, respectively. Twelve percent of the lesions were seen on PET/CT only and 10% on TAP-CT only. Eighteen percent of the metastatic organs were diagnosed with PET/CT only and 7% with TAP-CT only. Thirty-eight percent of the local relapses were seen only with PET/CT. PET/CT depicted three false-positive lesions. Treatment modalities were modified by PET/CT findings in five cases among which one was falsely positive. Tumor size and mitotic rate were significantly associated with FDG uptake. The intensity of FDG uptake (maximum standardized uptake value > 10) and the volume of FDG uptake (>150 ml) were significant prognostic factors for survival. CONCLUSIONS: We show that FDG-PET/CT is complementary to TAP-CT and of special interest in the diagnosis of local relapses.