Accuracy of CT cerebral perfusion in predicting infarct in the emergency department: lesion characterization on CT perfusion based on commercially available software

This study aims to assess the diagnostic accuracy of a single vendor commercially available CT perfusion (CTP) software in predicting stroke. A retrospective analysis on patients presenting with stroke-like symptoms within 6 h with CTP and diffusion-weighted imaging (DWI) was performed. Lesion maps, which overlays areas of computer-detected abnormally elevated mean transit time (MTT) and decreased cerebral blood volume (CBV), were assessed from a commercially available software package and compared to qualitative interpretation of color maps. Using DWI as the gold standard, parameters of diagnostic accuracy were calculated. Point biserial correlation was performed to assess for relationship of lesion size to a true positive result. Sixty-five patients (41 females and 24 males, age range 22–92 years, mean 57) were included in the study. Twenty-two (34 %) had infarcts on DWI. Sensitivity (83 vs. 70 %), specificity (21 vs. 69 %), negative predictive value (77 vs. 84 %), and positive predictive value (29 vs. 50 %) for lesion maps were contrasted to qualitative interpretation of perfusion color maps, respectively. By using the lesion maps to exclude lesions detected qualitatively on color maps, specificity improved (80 %). Point biserial correlation for computer-generated lesions (R _pb?=?0.46, p?<?0.0001) and lesions detected qualitatively (R _pb?=?0.32, p?=?0.0016) demonstrated positive correlation between size and infarction. Seventy-three percent (p?=?0.018) of lesions which demonstrated an increasing size from CBV, cerebral blood flow, to MTT/time to peak were true positive. Used in isolation, computer-generated lesion maps in CTP provide limited diagnostic utility in predicting infarct, due to their inherently low specificity. However, when used in conjunction with qualitative perfusion color map assessment, the lesion maps can help improve specificity.     

Improved lesion detection in MR mammography: three-dimensional segmentation, moving voxel sampling, and normalized maximum intensity-time ratio entropy

RATIONALE AND OBJECTIVES: The objective of this work was to develop a quantitative method for improving lesion detection in dynamic contrast-enhanced magnetic resonance mammography (DCEMRM). For this purpose, we segmented and analyzed suspicious regions according to their contrast enhancement dynamics, generated a normalized maximum intensity-time ratio (nMITR) projection, and explored it to extract important features, to improve accuracy and reproducibility of detection. MATERIALS AND METHODS: A novel automated method is introduced to segment and analyze lesions in three dimensions. It consists of four consecutive stages: volume of interest selection, nMITR projection generation using a voxel sampling method based on a moving 3 x 3 mask, three-dimensional lesion segmentation, and feature extraction. The nMITR projection of the detected lesion is used to extract six features: mean, maximum, standard deviation, kurtosis, skewness, and entropy, and their diagnostic significance is studied in detail. High-resolution MR images of 52 breast masses from 46 women are analyzed using the technique developed. RESULTS: Entropy, standard deviation, and the maximum and mean value features were found to have high significance (P < 0.001) and diagnostic accuracy (0.86-0.97). The kurtosis and skewness were not significant. Automated analysis of DCEMRM using nMITR was shown to be feasible. CONCLUSION: The lesion detection method described is efficient and leads to improved, accurate, reproducible diagnoses. It is reliable in terms of observer variability and may allow for a better standardization of clinical evaluations. The findings demonstrate the usefulness of nMITR based features; nMITR-entropy shows the best performance for quantitative diagnosis.     

数字化小肠气钡造影在小肠病变中的诊断价值

目的 评价数字化小肠气钡造影在诊断小肠病变中的用途。方法 22例经手术病理证实的小肠病变，其中，恶性病变10例，良性病变12例，均经数字化小肠气钡造影。结果 在22例患者中，数字化小肠气钡造影正确诊断19例，1例空肠腺癌被误诊为炎症，2例空肠增殖性结核被误诊为恶性占位性病变。诊断敏感性、特异性、准确率、阳性预测值以及阴性预测值分别为80%，92%，87%，89%以及92%。结论 数字化小肠气钡造影对小肠病变具有较高的诊断与鉴别诊断能力，对临床上疑有小肠病变的患者应作为首选方法。     

Lesions of the menisci of the knee: value of MR imaging criteria for recognition of unstable lesions

OBJECTIVE: This study aimed to determine the value of four MR imaging criteria for evaluating unstable meniscal lesions. MATERIALS AND METHODS: Criteria for unstable meniscal lesions were the presence of a displaced meniscal fragment, visibility on more than three 3-mm-thick coronal and two 4-mm-thick sagittal images, having more than one orientation plane or more than one pattern (contour irregularity, peripheral separation, tear), and having intrameniscal high signal intensity on T2-weighted spin-echo images. Sensitivity, specificity, and positive and negative predictive values for recognition of instability among all meniscal lesions were determined for the presence of each individual criterion and for the presence of at least one criterion in 50 consecutive patients (mean age, 46 years) who underwent MR imaging and subsequent arthroscopy. RESULTS: Sensitivities and specificities of these four criteria ranged between 18% and 54% and between 94% and 100%, respectively. Positive and negative predictive values ranged between 92% and 100% and between 39% and 52%, respectively. The presence of at least one criterion enabled recognition of unstable lesions with a sensitivity and specificity of 82% and with positive and negative predictive values of 90% and 70%, respectively. CONCLUSION: The four MR imaging criteria have high specificities and positive predictive values and low sensitivities and negative predictive values when evaluating unstable meniscal lesions.     

Low radiation dose multislice CT colonography in children: Experience after 100 studies

The purpose of this study was to determine the sensitivity (S) and specificity (sp) of virtual colonoscopy in the detection of elevated lesions in children, and to compare these results with conventional colonoscopy. Between April 2000 and January 2003, 100 patients (mean: 6 years old) were evaluated with virtual colonoscopy and conventional colonoscopy. All patients presented rectal bleeding and both methods were performed the same day. All patients had received a standard bowel cleansing the day before. Virtual colonoscopies were carried out with 2.5 mm thick slices, 1.3 mm reconstruction intervals, 15 mAs, and 90 kV. The acquisition time ranged from 5-10 s depending on the age of the patient. For each method, two scans were performed in both a supine and a prone position. After the acquisitions, images were reprocessed using two-dimensional, volume rendering, and virtual endoscopy reconstructions. Findings of the two methods were compared blinded. They were classified in two groups: (1) normal studies, and (2) elevated lesions studies. The second group was subdivided according to the diameter of the lesions: (2a) <5 mm, (2b) 5-9 mm, and (2c) >9 mm. All studies were performed without complications. Forty-eight patients were normal. In the other 52 patients, virtual colonoscopy detected 86 lesions, whereas conventional colonoscopy depicted only 80 lesions. There were 70 true-positive findings, 48 true-negative findings, 12 false-positive findings, and 8 false-negative findings. The global S was 89%, sp: 80%, positive predictive value: 85%, and negative predictive value: 85%. In group (2a), sensitivity, specificity, positive predictive value, and negative predictive value were 81, 90, 81, and 90% respectively; in group (2b), 90, 90, 85, and 94%, respectively; and in group (2c), 100, 96, 90, and 100%, respectively. We concluded that virtual colonoscopy is an alternative method for the evaluation of children with elevated lesions. It is fast, has no complications, and uses a low radiation dose.     

Management of high-risk breast lesions found on mammogram or ultrasound: the value of contrast-enhanced MRI to exclude malignancy

PurposeTo evaluate the performance of magnetic resonance imaging (MRI) to exclude malignancy in biopsy-proven high-risk breast lesions prior to surgical excision.Material and methodsBreast MRIs performed after a core needle biopsy (CNB) yielding high-risk pathology were evaluated for the presence of suspicious enhancement. The diagnostic performance of MRI to exclude malignancy was calculated.ResultsThe average reader sensitivity, specificity, negative predictive value, positive predictive value and accuracy of MRI were 92%, 51%, 98%, 22% and 56%, respectively.ConclusionLack of enhancement on MRI at the site of a high-risk lesion was useful for excluding malignancy.     

Radioimmunoassay for carcinoembryonic antigen and alpha 1-fetoprotein in the qualitative evaluation of focal hepatic lesions in Japan

The combined tests of serum alpha 1-fetoprotein (AFP) and carcinoembryonic antigen (CEA) were routinely performed in 210 patients with focal hepatic lesions on a 99mTc-colloid liver scan in order to determine whether these could provide more useful information that AFP test alone in the qualitative evaluation of focal hepatic lesions. The predictive value of hepatoma with positive AFP alone remained 80%. However, when the negative CEA was combined with positive AFP, the predictive value of hepatoma (91%) with both was greatly increased. On the other hand, the predictive value of metastatic liver cancer with positive CEA showed 92%. The combined test of AFP and CEA may be useful for preserving high predictive values of hepatoma and metastatic liver disease.     

基于磁共振表观扩散系数图的影像组学模型对前列腺癌Gleason分级的诊断价值

目的:探讨基于磁共振ADC图的影像组学模型对诊断前列腺癌侵袭度的价值。方法:回顾性分析2018年1月至2019年5月在建湖医院,经手术病理证实且能确定Gleason分级的42例患者的ADC图像,将癌灶分为高危组(Gleason评分≥8)和低中危组(Gleason评分≤7)2组。其中中低危21例、高危21例。应用ITK-SNAP软件勾化感兴趣区(ROI),将ADC图像导人Analysis-Kinetics分析软件,进行影像特征提取。采用Lasso回归分析进行特征降维。通过LASSO降维筛选出的特征和相应加权系数乘积的线性组合来建立鉴别中低危、高危前列腺癌的模型,绘制ROC曲线评价模型鉴别中低危、高危前列腺癌的预测效能。结果:共提取396个影像组学特征,通过特征筛选后最后筛选出7个影像组学特征。建模后影像组学特征对鉴别中低危、高危前列腺癌具有较好的预测效能,预测模型在训练组中鉴别效能的曲线下面积、准确度、敏感度、特异度、阳性预测值和阴性预测值分别为0.97、93.3%、93.3%、93.3%、0.93和0.93;在验证组中的曲线下面积、准确度、敏感度、特异度、阳性预测值和阴性预测值分别为0.97、91.7%、83.3%、100.0%、1和0.86;结论:基于磁共振ADC图的影像组学模型对前列腺癌Gleason分级具有诊断价值。     

Can unenhanced multiparametric MRI substitute gadolinium-enhanced MRI in the characterization of vertebral marrow infiltrative lesions?

Purpose

To assess the diagnostic effectiveness of unenhanced-multiparametric magnetic resonance imaging (mp MRI) as an alternative to gadolinium (Gad)-enhanced MRI in the characterization of vertebral marrow infiltrative lesions.

Patients and methods

A prospective evaluation of fifty-six patients with suspected or untreated vertebral metastases undergoing MRI of the spine at 1.5 T was carried out. Two groups of sequences were assigned and compared for the characterization of marrow infiltrative lesions: group [A] unenhanced-mp MRI (including T1-weighted, T2-weighted, short time inversion recovery (STIR), diffusion weighted imaging (DWI) and in/opposed phase sequences) and group [B] gadolinium-enhanced MRI (including T1-weighted, T2-weighted, STIR and T1-weighted fat-suppressed gadolinium-enhanced sequence). Qualitative and quantitative image analysis was performed and compared. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy for both imaging techniques were calculated.

Results

There was no statistical significant difference between unenhanced-multiparametric MRI and gadolinium-enhanced MRI as regards their diagnostic performance in differentiating benign from malignant vertebral marrow infiltrative lesions (p > 0.05) with calculated sensitivity (94% vs. 97%), specificity (92% vs. 88%), positive predictive value (94% vs. 91%), negative predictive value (92% vs. 95%) and (93% vs. 93%) accuracy.

Conclusion

Unenhanced-multiparametric MRI is compatible with gadolinium-enhanced MRI in reliable characterization of marrow infiltrative lesions. The routine MRI protocol of cancer patients should be altered to accommodate the evolving MRI technology and cost effectively substitute the need for a gadolinium enhanced scan.     

Radioimmunoassay for carcinoembryonic antigen and alpha1-fetoprotein in the qualitative evaluation of focal hepatic lesions in Japan

The combined tests of serum alpha₁-fetoprotein (AFP) and carcinoembryonic antigen (CEA) were routinely performed in 210 patients with focal hepatic lesions on a ^99mTc-colloid liver scan in order to determine whether these could provide more useful information that AFP test alone in the qualitative evaluation of focal hepatic lesions. The predictive value of hepatoma with positive AFP alone remained 80%. However, when the negative CEA was combined with positive AFP, the predictive value of hepatoma (91%) with both was greatly increased. On the other hand, the predictive value of metastatic liver cancer with positive CEA showed 92%.The combined test of AFP and CEA may be useful for preserving high predictive values of hepatoma and metastatic liver disease.     

Diagnostic value of physical tests for isolated chronic acromioclavicular lesions

PURPOSE: Chronic acromioclavicular joint lesions are a common source of pain and disability in the shoulder. The goal of this study was to evaluate diagnostic values of physical tests for isolated, chronic acromioclavicular joint lesions. STUDY DESIGN: A retrospective case-control study. METHODS: Between 1994 and 2002, 35 patients underwent a distal clavicle excision for isolated acromioclavicular joint lesions. The results of 3 commonly used examinations for acromioclavicular joint lesions were calculated for sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy. RESULTS: The cross body adduction stress test showed the greatest sensitivity (77%), followed by the acromioclavicular resisted extension test (72%) and active compression test (41%). The active compression test had the greatest specificity (95%). All tests had a negative predictive value of greater than 94%, but the positive predictive value was less than 30% for all tests. The active compression test had the highest overall accuracy (92%), followed by the acromioclavicular resisted extension test (84%) and the cross arm adduction stress test (79%). Combinations of the tests increased the diagnostic values for chronic acromioclavicular joint lesions. CONCLUSIONS: These tests have utility in evaluating patients with acromioclavicular joint pathologic lesions, and a combination of these physical tests is more helpful than isolated tests.     

18F-FDG PET/CT in the characterization and surgical decision concerning adrenal masses: a prospective multicentre evaluation

Purpose

This prospective multicentre study assesses the usefulness of FDG PET/CT in characterizing and making the therapeutic decision concerning adrenal tumours that are suspicious or indeterminate in nature after conventional examinations (CE).

Methods

Seventy-eight patients (37 men, 41 women, 81 adrenal lesions) underwent FDG PET/CT after CE including CT scan, biological tests and optionally ¹³¹I-metaiodobenzylguanidine (MIBG) and/or ¹³¹I-norcholesterol scans. FDG adrenal uptake exceeding that of the liver was considered positive. PET results were not decisive. Surgery was discussed when at least one of the following criteria was found during CE: size >3 cm, spontaneous attenuation value >10 HU, heterogeneous aspect, abnormal MIBG or norcholesterol scan or hormonal hypersecretion.

Results

Following the gold standard (histology analysis or ≥9 months follow-up), 49 lesions potentially qualified for surgery (malignant = 27, benign secreting = 22) and 32 benign non-secreting lesions did not. PET was negative in 97% of non-surgical lesions and positive in 73% of potentially surgical ones which included all the malignant lesions, except 3 renal cell metastases, and 12 of 22 benign secreting lesions. The negative predictive value for malignancy was 93% (41/44) and positive predictive value for detecting surgical lesions was 97% (36/37). A high FDG uptake (maximum standardized uptake value?≥?10) was highly predictive of malignancy.

Conclusion

Adrenal FDG uptake is a good indicator of malignancy and/or of secreting lesions and should lead one to discuss surgery. If there is no prior history of poorly FDG-avid cancer, the absence of FDG uptake should avoid unnecessary removal of benign adrenal lesions.     

正电子发射计算机体层-CT成像鉴别心脏及心包良恶性病变的初步研究

目的 探讨氟代脱氧葡萄糖(18F-FDG)PET-CT鉴别诊断心脏、心包病变良恶性的可行性.方法 对23例经病理或临床证实的心脏、心包良恶性病变进行18F-FDG PET-CT扫描,其中恶性病变13例,良性病变10例.测得病灶、心腔(血本底)的最高标准摄取值(SUVmax)及SUVmax病灶/SUVmax心腔比值(lesion/blood),并观察病灶的内部密度及与周围组织关系.采用两独立样本非参数检验(Mann-Whitney)分析SUVmax及SUVmax lesion/blood良恶性病灶中有无统计学差异.同时分别计算出CT、PET-CT鉴别诊断心脏、心包病变良恶性的敏感度、特异度、阳性预测值和阴性预测值.结果 良性病变及恶性病变SUVmax中位数分别为1.5和6.5,两者之间差异有统计学意义(Z=-3.601,P＜0.01).良性、恶性病变的SUVmax lesion/blood分别为0.9和3.4,两者之间差异有统计学意义(Z=-3.600,P＜0.01).病灶SUVmax值以3.5～4.0或SUVmax lesion/blood值以1.3～2.0为PET-CT鉴别心脏、心包病变良、恶性的最佳临界值.单独CT及PET-CT鉴别诊断心脏、心包病变良恶性的敏感度、特异度、准确度、阳性预测值、阴性预测值分别为76.9%(10/13)、100.0%(10/10)、87.0%(20/23)、100.0%(10/10)、76.9%(10/13)和100.0%(13/13)、90.0%(9/10)、95.7%(22/23)、92.9%(13/14)、100.0%(9/9).结论 18F-FDG PET-CT可用于鉴别诊断心脏、心包病变的良、恶性,并为较为准确的鉴别诊断手段.     

Usefulness of scintimammography as an adjunct to mammography and ultrasound in the diagnosis of breast diseases

This study was undertaken to evaluate the diagnostic efficacy of 99mtechnetium methoxyisobutylisonitrile scintimammography (SM) and combined use of mammography and ultrasound in the detection of the breast lesions in the symptomatic breast. Histopathological findings were the gold standard. Eighty patients with symptomatic breasts underwent mammography and/or ultrasound breast followed by SM. In 25 patients there were 27 lesions that were malignant and 55 patients had 65 lesions that were benign. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of SM were found to be 92, 72, 58, 96 and 78%, respectively, as compared with the combined use of mammography and ultrasound, which showed these parameters to be 89, 94, 86, 95 and 92%, respectively. In this study, SM showed slightly better sensitivity than combined mammography and ultrasound, whereas the specificity was clearly shown as higher in the latter.     

Dual energy CT for the assessment of lung perfusion--correlation to scintigraphy

Purpose of this study was to determine the diagnostic value of dual energy CT in the assessment of pulmonary perfusion with reference to pulmonary perfusion scintigraphy. Thirteen patients received both dual energy CT (DECT) angiography (Somatom Definition, Siemens) and ventilation/perfusion scintigraphy. Median time between scans was 3 days (range, 0-90). DECT perfusion maps were generated based on the spectral properties of iodine. Two blinded observes assessed DECT angiograms, perfusion maps and scintigrams for presence and location of perfusion defects. The results were compared by patient and by segment, and diagnostic accuracy of DECT perfusion imaging was calculated regarding scintigraphy as standard of reference. Diagnostic accuracy per patient showed 75% sensitivity, 80% specificity and a negative predictive value of 66%. Sensitivity per segment amounted to 83% with 99% specificity, with 93% negative predictive value. Peripheral parts of the lungs were not completely covered by the 80 kVp detector in 85% of patients. CTA identified corresponding emboli in 66% of patients with concordant perfusion defects in DECT and scintigraphy. Dual energy CT perfusion imaging is able to display pulmonary perfusion defects with good agreement to scintigraphic findings. DECT can provide a pulmonary CT angiogram, high-resolution morphology of the lung parenchyma and perfusion information in one single exam.     

Value of modern sonography in the assessment of meniscal lesions

The aim of this prospective study was to assess the accuracy of modern ultrasonography in diagnostic imaging of meniscal tears. One hundred and sixty menisci were evaluated in 80 patients (42 females, 38 males, mean age=36.2 years, range=16-70 years). Inclusion criteria for the study were twofold: clinical suspicion of meniscal injury and clinical indication for arthroscopy. Knee examination was performed with the Voluson 730 Expert ultrasound system (General Electric). After sonographic examination, all patients underwent arthroscopic procedures within 1-4 days. The final diagnosis of meniscal tears was taken from surgical reports. The overall sensitivity, specificity, positive predictive value and negative predictive value of sonographic examination in the assessment of meniscal tears amounted to 85.4%, 85.7%, 67.3% and 94.4%, respectively. The statistical parameters were not statistically different in medial and lateral menisci. Age, sex, body mass index (BMI), weight, physical activity, mechanism on injury, and time lapse from injury did not have a statistically significant impact on the usefulness of ultrasonography. The highest sensitivity (>90%) was obtained in medial menisci and in patients with a BMI>25. The highest specificity (>90%) was obtained in lateral menisci, in patients after twisting injuries, in sports injuries, and in recent injuries (time lapse from the injury <1 month). The positive predictive value (PPV) of sonographic examination was higher than 90% only in recent injuries (<1 month), however, the negative predictive value of ultrasound is high, being less than 90% in males with lesions of lateral menisci and in sequelae of sports injuries.     

Bone scintigraphy and the added value of SPECT (single photon emission tomography) in detecting skeletal lesions.

Skeletal metastases are one of the major clinical problems for the oncologist. Over the last several decades bone scintigraphy has been used extensively in detecting bone involvement since it can provide information about disease location, prognosis and the effectiveness of treatment. Bone scan offers the advantage of total body examination, and images bone lesions earlier than other techniques. In this paper the main clinical problems related to the most common applications of bone scan in breast, prostate, lung cancer and other tumours are discussed. The experience carried out at the National Cancer Institute of Milan by using bone SPECT to detect single bone metastases is reported. One hundred and eighteen patients with bone metastases (from different tumour types: breast, lung, prostate, lymphomas, etc.) were studied by planar scintigraphy, SPECT and other radiological modalities (CT, MRI or X-rays). The overall performances of bone SPECT were sensitivity: 90.5% (19/21), specificity 92.8% (90/97), positive predictive value 73% (19/26), negative predictive value 97.8% (90/92), accuracy 92.4% (109/118). Considering breast cancer, the most frequent pathology in our series, and the lumbar spinal tract, the most common skeletal segment involved, the figures of merit of SPECT were: sensitivity 100% (4/4), specificity 95.3% (41/43), positive predictive value 66.7% (4/6), negative predictive value 100% (41/41), accuracy 95.7% (45/47). In conclusion bone SPECT showed very good performances, in particular improving the predictive value of planar scan in the diagnosis of vertebral metastases.     

肝脏局灶性小病灶MRI定量指标与病灶性质的相关研究

目的　探讨T1、T2 值及T2 指数 (T2 index)在区分肝脏局灶性小占位性质方面的价值。资料与方法　随机选择经确诊的肝细胞癌、肝转移瘤、肝海绵状血管瘤和肝囊肿患者共 92例 (14 8个病灶 ) ,行前瞻性MRI(0 .5T)研究 ,计算病变的T1、T2 值及T2 指数 ,并进行统计学分析。结果　恶性病变的T1值显著低于良性病变 (t =4 .0 2 4 ,P <0 .0 0 1) ,但由于数值重叠较多 ,对诊断无实际应用价值 ;良性病变的T2 值显著高于恶性病变 (t =10 .92 9,P <0 .0 0 1) ,第一个双回波 (TR 2 5 0 0ms,TE 30、90ms)以 84ms为界区分良、恶性病变 ,诊断正确率为 92 %。第二个双回波 (TR 2 5 0 0ms,TE 6 0、12 0ms)以 80ms为界 ,诊断正确率为 93% ;良性病变的T2 指数均显著高于恶性肿瘤 (t =13.6 97,P <0 .0 0 1) ,TE 30、90ms时 ,以 1.89为界 ,诊断正确率为 92 % ,TE 6 0、12 0ms时 ,以 2 .0 1为界 ,诊断正确率亦为92 %。结论　T2 值和T2 指数在区分肝脏良、恶性占位性病变方面有肯定的价值     

Multi-detector CT features of acute intestinal ischemia and their prognostic correlations

Acute intestinal ischemia is an abdominal emergency occurring in nearly 1% of patients presenting with acute abdomen. The causes can be occlusive or non occlusive. Early diagnosis is important to improve survival rates. In most cases of late or missed diagnosis, the mortality rate from intestinal infarction is very high, with a reported value ranging from 60% to 90%. Multi-detector computed tomography (MDCT) is a fundamental imaging technique that must be promptly performed in all patients with suspected bowel ischemia. Thanks to the new dedicated reconstruction program, its diagnostic potential is much improved compared to the past and currently it is superior to that of any other noninvasive technique. The increased spatial and temporal resolution, high-quality multi-planar reconstructions, maximum intensity projections, vessel probe, surface-shaded volume rending and tissue transition projections make MDCT the gold standard for the diagnosis of intestinal ischemia, with reported sensitivity, specificity, positive and negative predictive values of 64%-93%, 92%-100%, 90%-100% and 94%-98%, respectively. MDCT contributes to appropriate treatment planning and provides important prognostic information thanks to its ability to define the nature and extent of the disease. The purpose of this review is to examine the diagnostic and prognostic role of MDCT in bowel ischemia with special regard to the state of art new reconstruction software.