Multidetector row helical computed tomography enteroclysis findings in ileal endometriosis

Ileal endometriosis is a rare condition, which, most of the time, is found incidentally in women who have had abdominal or pelvic surgery. In general, ileal endometriosis is asymptomatic and is responsible for small bowel obstruction in only 0.5% of the cases. In addition, in most published cases, the diagnosis was established postoperatively. We report herein two cases of ileal endometriosis, which were responsible for small bowel occlusion. The diagnosis was considered preoperatively owing to the presence of a constellation of findings, including those obtained on multidetector row helical CT enteroclysis images. Multidetector row helical CT enteroclysis demonstrated dilated small bowel up to a stenosis due to circumferential parietal thickening in the distal ileum in one case and an ileal parietal solid nodule in the other one. Although multidetector row helical CT enteroclysis does not show specific findings, it may help to suggest the diagnosis of ileal endometriosis in the proper clinical setting.     

Multidetector computed tomography findings of the sternoclavicular joint in patients with rheumatoid arthritis

We evaluated the multidetector computed tomography (MDCT) findings of the sternoclavicular joint in patients with rheumatoid arthritis (RA) and compare them with general population. Chest MDCT scans of RA patients were reviewed. The control group was formed from age and sex-matched individuals. The most common CT findings were cortical irregularity, joint space narrowing, and osteophytes in study group. There were no statistically significant differences in the MDCT findings between the two groups except that osteophytes were observed more often in the control group. It is difficult to distinguish between the involvement of RA and age-related degenerative changes at the sternoclavicular joint.     

Unusual computed tomography findings in hepatic amyloidosis

An unusual pattern of delayed enhancement in a patient with a focal hepatic defect due to amyloidosis is presented. Without the aid of region-of-interest density measurements, the lesion was not appreciated on unenhanced computed tomography scans.     

Multidetector computed tomography in acute abdomen

MDCT has become a fundamental tool for determining the causes of acute abdomen. CT is considered the imaging technique of choice in the diagnostic workup of both localized and diffuse acute abdomen, except in patients in whom acute cholecystitis or acute gynecological disease is suspected and in children, adolescents, and pregnant patients, in whom ultrasonography is the imaging technique of choice. Plain-film X-ray examination has been relegated to the initial management of renal colic, suspected foreign bodies, and intestinal obstruction. One of the drawbacks of MDCT is its use of ionizing radiation, which makes it necessary to filter and direct the examinations as well as to ensure that the most appropriate protocols are used. For this reason, low dose protocols have been developed so that diagnostic studies can be performed with doses of radiation between 2 and 3 mSv; these are normally used in the diagnosis of renal colic and can also be used in selected patients with suspected appendicitis and acute diverticulitis.     

Multidetector computed tomography in acute joint fractures

Conventional radiography plays an essential diagnostic role in the primary evaluation of acute joint trauma. In complex fractures, however, computed tomography (CT) is an imaging modality often used second to radiography. As a result of technical breakthroughs in the field, multidetector CT (MDCT) allows faster imaging and better temporal, spatial, and contrast resolution compared with conventional single-slice spiral CT. MDCT with multiplanar reformation is helpful in disclosing fracture patterns, particularly in complex joint fractures, where they reveal occult fractures and show the exact number of fracture components and their degree of displacement.     

Multidetector row computed tomography findings from ischemia to infarction of the large bowel

OBJECTIVE: MDCT is performed as first imaging examination for patients with acute abdomen in most Emergency Departments. Clinical suspicion of ischemic colitis and infarction is related to specific findings, however, differential diagnosis as well as the staging for a confirmed ischemic affection may be critical. The individual signs from ischemia to infarction of large bowel is a captivating topic. In this study, we report our experience of the MDCT assessment of acute colonic disease from vascular mesenteric disorders. MATERIALS AND METHODS: We retrospectively reviewed the MDCT findings of 71 patients admitted to our attention for acute abdomen, with final proven diagnosis of colonic ischemia and/or infarction made by surgery and/or endoscopy. CT-scanning of the abdomen and pelvis was performed after i.v. contrast medium administration, using a multidetector row CT equipment. We correlated the presence of parietal disease, the evidence of mesenteric arterial or venous vessels occlusion, the parietal features as well as others findings, such as free fluid and/or air in peritoneal recess or in retroperitoneum, with the surgical and/or endoscopic findings. RESULTS: Analysis of our data showed a segmental (84%) or complete (16%) involvement of the colon; 57 cases were related to ischemia, 14 to infarction. Inferior mesenteric vessels defect of opacification was noted in 10 cases. Various degree of wall thickening and parietal enhancement, peritoneal fluid, mural or portal-mesenteric pneumatosis were compared to evidence of mesenteric arterial or vein occlusion and to final proven diagnosis. A classification in a multi-stage grading for both decreased of arterial supply or impaired venous drainage disorders was done. CONCLUSIONS: A grading scale from ischemia to infarction affecting the large bowel from arterial or venous mesenteric vessels origin has been not previously reported in a series at our knowledge. MDCT findings may support the clinical evaluation of patients affected by acute colon from vascular disorders. In particular, it seems to provide effective and valuable information's in differentiating etiology and stage of disease.     

Multidetector computed tomography imaging of the spine

This article discusses applications of multidetector computed tomography imaging of the spine as they were presented at the "Advances in Multidetector CT" meeting held in Washington, DC, September 13-14, 2003. These include imaging the spine in the setting of trauma, postoperative fusion, chronic pain, radiculopathy, or bony lesions and performing image-guided biopsies.     

Multidetector computed tomography and neuroendocrine pancreaticoduodenal tumors

Purpose: To investigate the accuracy of dedicated pancreatic multidetector computed tomography (MDCT) in the diagnosis of neuroendocrine pancreaticoduodenal tumors (NPTs).

Material and Methods: MDCT and other imaging studies in patients with suspected NPTs were identified. Thirty dedicated MDCT studies were done in 23 patients. Fourteen patients (16 operations) subsequently had surgery. Imaging reports were reviewed and findings compared with surgical findings and findings in other imaging studies.

Results: Patients with surgery: 19 NPTs (16 extrapancreatic gastrinomas and 3 pancreatic NPTs) were identified at surgery. MDCT identified 16 and somatostatin receptor scintigraphy (SRS) 11 out of 19 tumors. Endoscopic ultrasound detected 11 out of 14 NPTs. Patients without surgery: In 4 out of 9 patients, no NPTs were identified at MDCT.

Conclusion: Dedicated MDCT of the pancreas can identify many NPTs, including small duodenal and periduodenal tumors, and the detection rate is better than reported in the older literature on CT.     

Multidetector computed tomography imaging of aortoenteric fistula

Three case reports illustrating multidetector computed tomography (CT) imaging findings of secondary aortoenteric fistula (AEF) are described and presented in axial sections, multiplanar reformats, and 3-dimensional reconstruction. Fistulae occurred in the early and late postgrafting period and involved both end-to-end and end-to-side aortic graft anastomoses. Multidetector CT is quick and accurate in the diagnosis of bleeding AEF.     

Multidetector computed tomography and blunt thoracoabdominal trauma

Computed tomography has had an increasing role in the evaluation of patients after blunt trauma. Important findings in thoracic trauma include acute traumatic aortic injury, pneumothorax, hemothorax, pulmonary contusions and lacerations, mediastinal hematoma, and diaphragmatic rupture. The solid abdominal viscera may lacerate; infarct; or suffer vascular, ductal, or pyelocalyceal disruption. The bladder and intestines may rupture. In abdominal pelvic trauma, the direction of applied force often results in an identifiable constellation of injuries. This article reviews how multidetector computed tomography (MDCT) is used in the trauma patient. Technical advances of increased cephalocaudad coverage speed and improved z-axis resolution intrinsic to MDCT, together with effective contrast utilization, make MDCT invaluable in the setting of trauma.     

Multidetector computed tomography angiography of the abdomen

Multidetector computed tomography (MDCT) angiography has provided excellent opportunities for advancement of computed tomography (CT) technology and clinical applications. It has a wide range of applications in the abdomen including vascular pathologies either occlusive or aneurysmal; enables the radiologist to produce vascular mapping that clearly show tumor invasion of vasculature and the relationship of vessels to mass lesions. MDCTA can be used in preoperative planning for hepatic resection, preoperative evaluation and planning for liver transplantation. MDCTA can also provide extremely valuable information in the evaluation of ischemic bowel disease, active Crohn disease, the extent and location of collateral vessels in cirrhosis.     

Multidetector computed tomography findings of abdominal aortic aneurysm and its complications: a pictorial review

Abdominal aortic aneurysms (AAAs) are defined as abnormal dilatation of the abdominal aorta and are potential to catastrophic complications. With the advent of multidetector computed tomography (MDCT), this diagnostic modality has virtually replaced conventional angiography in many circumstances and has become an integral part of the evaluation of AAA. Its ability to assess the peri-aortic soft tissue and the exact extension of aneurysm as well as its excellent vascular opacification and multiplanar reconstruction make computed tomography angiography the best suited imaging modality for not only detecting AAA but also evaluating its various complications. In this pictorial essay, we intend to demonstrate the spectrum of MDCT findings in AAA and its various consequences including impending rupture, contained rupture, rupture, aorto-caval fistula, aorto-left renal vein fistula, aorto-enteric fistula, and infection. Familiarity with the characteristic imaging features of AAA is essential for clinical radiologists and also referring physicians for the prompt diagnosis of life-threatening complications.