Cystic fibrosis: CT assessment of lung involvement in children and adults.

PURPOSE: To compare a computed tomographic (CT)-based scoring system with nonimaging indexes of pulmonary status in patients with cystic fibrosis. MATERIALS AND METHODS: Pulmonary CT findings were assessed in 117 patients with cystic fibrosis, with cases classified according to three groups by age; 0-5 years, 6-16 years, and 17 years and older. Images were examined for specific abnormalities, and the severity and anatomic extent of each sign were used to generate a score. Scores in each category and the global score for each patient were correlated with pulmonary function test results, clinical status, serum immunoglobulin levels, and genotype, all obtained within 2 weeks of CT. RESULTS: The most frequent individual CT abnormalities were bronchiectasis in 94 (80.3%), peribronchial wall thickening in 89 (76.1%), mosaic perfusion in 71 (63.9%), and mucous plugging in 56 (51.3%) patients. The percentage of patients with specific CT findings and the overall CT scores increased significantly (P < .05) with progressively increasing age groups. All CT findings and the overall CT scores correlated significantly (P < .05) with the pulmonary function test results, serum immunoglobulin levels, and clinical scores. No relationship was observed between genotype and CT scores. CONCLUSION: Scoring of CT studies in patients with cystic fibrosis seems to offer a reliable way to monitor disease status and progression and may provide a reasonable tool to assess treatment interventions.     

Cystic fibrosis: scoring system with thin-section CT

The progression of lung disease in patients with cystic fibrosis (CF) was evaluated with chest radiography. The severity and extent of the various radiographic changes were scored with the Chrispin or the Birmingham method, which involves the use of imprecise and subjective terms, such as line shadows, large pulmonary shadows, and nodular cystic lesions. Although computed tomography (CT) has been shown to be helpful in the evaluation of lung disease in CF, no scoring system or other objective criteria have been developed for the evaluation of the wide range of pulmonary changes in these patients. A CT scoring system was devised that incorporates all of the changes seen in the lungs of patients with CF. Such a scoring system may facilitate objective evaluation of existing and newly developed therapeutic regimens and may be a valuable tool in the preoperative evaluation of patients being considered for lobectomy or bullectomy and in the selection of patients for lung transplantation.     

急诊胸部创伤CT检查的价值探讨

急诊胸部创伤常见于交通事故、工伤事故、暴力伤等,部分患者可同时合并有复合性的其他急性创伤,如颅脑、腹部、四肢创伤等。因病情急,临床在作体格检查时受限,常规胸片因系被动体位,难以达到优质片要求,加之常规胸片的局限性使其有些征象不易检出。而胸部CT检查不需要变换体位,     

Diagnosis and localization of laceration of the thoracic duct: usefulness of lymphangiography and CT

The usefulness of lymphangiography and CT in the diagnosis and localization of laceration of the thoracic duct was evaluated in 12 patients with chylothorax or chylous ascites after surgery. Bipedal lymphangiography was performed in all 12 patients. The last four patients studied also had CT after lymphangiography. Seven patients had abnormal findings on lymphangiograms; five with leaks from the thoracic duct, one with a lymphocele in a nephrectomy bed, and one with obstructed intestinal lymphatic vessels after thoracotomy. Five patients had no evidence of lymphatic leakage. CT in one patient with evidence of a leak on lymphangiography showed extravasation of contrast medium into the mediastinum and pleural space. CT in three patients with no abnormalities on lymphangiography also showed no abnormalities. Four of the five thoracic duct lacerations and the lymphocele were confirmed surgically. The diagnosis of obstructed intestinal lymphatic vessels was supported clinically. Four of the five patients with normal findings on lymphangiograms had resolution of their pleural effusions and no evidence of recurrence during a follow-up period of 1-27 months. One patient with normal findings on lymphangiography had an alternative diagnosis established at surgery. Laceration of the thoracic duct was accurately diagnosed and localized with lymphangiography, which allowed definitive surgical repair. CT was of little additional value in diagnosing these injuries.     

囊性纤维化:应用FDGPET/CT检测气道炎症的变化

摘要目的探讨对于囊性纤维化(CF)肺部病情恶化的病人,氟18-氟脱氧葡萄糖(FDG)PET/CT成像能否显示静脉内抗生素的治疗效果。材料与方法该研究经儿童医院制度审查委员会和加拿大卫生部批准。     

Cystic renal masses: usefulness of the Bosniak classification

To determine the usefulness of the Bosniak classification of cystic renal masses, the computed tomographic (CT) and ultrasound findings of 16 pathologically proven cystic renal masses were retrospectively reviewed. All imaging studies were reviewed and categorized utilizing the Bosniak classification without knowledge of the final pathologic diagnosis. There were no category I lesions (classical simple cyst), four category II (minimally complicated), seven category III lesions (more complicated), and five category IV lesions (probable malignant). All category II lesions were benign, all category IV lesions were malignant. Of the seven category III lesions, three were benign and four were malignant. We conclude that the Bosniak classification is extremely useful in the management of cystic renal masses.     

CT检查在FESS术前计划制定中的价值

目的:探讨蝶窦与视神经、颈内动脉等邻近结构的CT影像解剖关系,为经蝶窦手术及诊断提供准确的影像解剖学依据。方法:CT扫描病例128例,年龄20～72岁,平均46.2岁;其中男79例,女49例。使用日本TOSHIBA公司生产的Aquilion 4螺旋CT。后台处理采用Vitrea 1处理系统。测量数据采用x±SD,百分数,t检验。结果:视神经管与蝶窦的关系:隆起型视神经管38例(29.69%),压迹型视神经管73例(57.03%),远离型视神经管17例(13.28%)。视神经走行与蝶窦外侧的关系:全程与蝶窦外侧壁毗邻者71侧(27.73%),全程与后组筛窦毗邻者66侧(25.78%),全程同时与蝶筛外侧壁毗邻者95侧(37.11%),全程穿过骨质者22侧(8.59%)。颈内动脉与蝶窦的关系:隆起型48侧(18.75%),压迹型101侧(39.45%),远离型107侧(41.80%)。结论:CT扫描结合MPR重组,能够清楚显示颈内动脉、视神经等与蝶筛外侧壁的解剖毗邻关系。CT检查有利于FESS手术进路的选择及手术方案的确定,为手术安全提供了保证。     

Cystic hepatocellular carcinoma: CT findings.

Although hepatic lesions can be well characterized by noninvasive imaging modalities, findings are often nonspecific. Considerable diagnostic differential exists even for cystic hepatic lesions. We describe a highly unusual case of multifocal, multilocular cystic hepatocellular carcinoma.     

CT angiography in the examination of patients with aneurysm clips.

The use of CT angiography is described in three patients for the evaluation of intracranial clips after surgery for an aneurysm. A postprocessing technique is described in which shaded-surface-display models were superimposed on maximum intensity projection CT angiograms. CT angiograms showed residual aneurysmal filling adjacent to a clip, patency of a vessel thought to be compromised by recent clip placement, and errant position of a clip, which required repeat surgery.     

Post-lung transplantation bronchiolitis obliterans syndrome: usefulness of expiratory thin-section CT for diagnosis

PURPOSE: To assess the usefulness of thin-section expiratory computed tomography (CT), as compared with that of thin-section inspiratory CT, in detecting airway obstruction and air trapping in pediatric lung transplant recipients with bronchiolitis obliterans syndrome (BOS). MATERIALS AND METHODS: Thin-section CT scans were obtained at full inspiration and end expiration in 21 pediatric lung transplant recipients with proved BOS and in 41 transplant recipients with normal airways. True diagnosis was based on pulmonary function test results. Inspiration CT scans were scored for extent of decreased attenuation of the lung parenchyma; expiration CT scans were scored for extent of air trapping. RESULTS: The sensitivity of inspiratory CT for enabling diagnosis of BOS was 71%; the specificity, 78%; the positive predictive value, 62%; and the negative predictive value, 84%. The sensitivity of expiratory CT for enabling diagnosis of BOS was 100%; the specificity, 71%; the positive predictive value, 64%; and the negative predictive value, 100%. Expiratory CT scores correlated more strongly (rho = 0.75, P <.01) with pulmonary function test-based scores than did inspiratory CT scores (rho = 0.48, P <.01). Nominal logistic regression analysis revealed that expiratory CT was a more powerful predictor of true diagnosis (P <.01) than was inspiratory CT (P =.10). CONCLUSION: Expiratory CT is sensitive for depicting BOS-related airway abnormalities and may be more useful than inspiratory CT for diagnosis of small airway obstruction.     

Evolution of CT findings in patients with cystic fibrosis.

OBJECTIVE: The aim of our study was to assess the evolution of pulmonary CT findings in cystic fibrosis patients. MATERIALS AND METHODS: Serial CT examinations were performed in four different follow-up periods on 107 patients with cystic fibrosis. Lung images of the initial and follow-up CT were reviewed and scored for specific morphologic findings. CT findings were correlated with the results of the pulmonary function tests and clinical (Shwachman-Kulczycki) scores. RESULTS: Morphologic changes were minor within the first 18 months of follow-up compared with the period after 18 months. The increase of the overall score was significantly higher in groups with follow-up periods longer than 18 months compared with groups with follow-up periods shorter than 18 months. Various components of morphologic changes contributed to the sequential changes seen on the CT scans. All morphologic changes and the CT scores correlated significantly (p < .0001) with pulmonary function tests and clinical score. CONCLUSION. Serial CT scans allow assessment of the evolution of pulmonary abnormalities in patients with cystic fibrosis. CT seems to have advantages over pulmonary function tests and clinical scoring in the depiction of pulmonary changes over time.     

Cystic fibrosis: MR imaging of the pancreas

The appearance of the pancreas in 17 adult patients with cystic fibrosis was evaluated with magnetic resonance (MR) imaging. The pancreas was abnormal in 15 patients. Three patterns were observed: (a) lobulated enlarged pancreas with complete replacement by fatty tissue (n = 9), (b) small atrophic pancreas with partial replacement by fat tissue (n = 5), and (c) diffuse atrophy of the pancreas without fatty replacement (n = 1). Replacement of the pancreas by fat tissue was seen on T1-weighted images with, characteristically, a very high signal intensity. The sensitivity of MR imaging in depicting pancreatic abnormality in cystic fibrosis is 94%, which is comparable to that of computed tomography.     

Clinical usefulness of the cardiac multi-detector-row CT.

Along with improvement of the temporal and special resolution, multi-detector-row CT has become able to generate artifact-less heart images. We discuss the potential benefits of the newly developed cardiac application, demonstrating informative cases.Two- and three-dimensional (2D and 3D) cardiac images were produced throughout one cardiac cycle. By paging 2D and 3D images in cardiac cycle order, animated movies were generated.Cardiac imaging with multi-detector-row CT, acquired during a single breath hold, provides information about: (1) clear morphology of heart chambers and myocardium, (2) wall motion and systolic thickening, (3) myocardial perfusion, (4) volume assessment, and (5) coronary anatomy and pathophysiology.     

Cystic fibrosis in images: the Bhalla scoring system for computed tomography in paediatric patients

To monitor the course of lung damage in patients with cystic fibrosis (CF) using the different chest X-ray and high resolution computed tomography (HRCT) scoring systems that have been developed. The HRCT technique is more sensitive than chest radiography to evaluate the anatomy. However, in paediatric patients, the use of CT should be kept to a minimum, and guidelines for radiation protection and dose reduction should be applied. One of the most used classification systems for HRCT is the one proposed by Bhalla in 1991, which helps in the assessment of the severity and course of the disease in these patients depending on the different imaging findings. We present various examples of these criteria for HRCT, observed while reviewing a group of 48 paediatric patients.