Demonstration of normal and dilated testicular veins by multidetector computed tomography

Recent advances in multidetector computed tomography (MDCT) technology enabled better visualization of testicular (gonadal) vein using submillimeter slice thickness and three-dimensional images. Normally, the testicular vein measures 1–3 mm and drains into the inferior vena cava and left renal vein on the right and left sides, respectively. They can be seen in most patients during MDCT studies. Curved planar and volume-rendered images can be used to display testicular veins. We aim to demonstrate MDCT findings of normal testicular vein and its pathologies including varicocele, varices, the testicular vascular pedicle sign, and phlebolith. The testicular vein can be dilated owing to varicocele or portal hypertension and in patients with intraabdominal seminomas arising from undescended testis. The testicular vein can also cause ureteral compression at the crossing point. Understanding MDCT findings of the normal testicular vein and its various pathologies can allow a correct diagnosis, thereby avoiding further diagnostic tests.     

Diagnosis of spinal dural arteriovenous fistula with multidetector row computed tomography: a case report

Spinal dural arteriovenous fistulas are a rare cause of myelopathy. Nonspecific symptoms may delay the diagnosis. Magnetic resonance imaging and spinal angiography are routinely used to establish the diagnosis. In our case abnormalities on magnetic resonance imaging only suggested spinal dural arteriovenous fistulas. Multidetector row computed tomography (MRCT) led to the diagnosis which was confirmed by angiography.     

Pseudocoarction of the aorta and crossed fused ectopic kidney assessed by multidetector computed tomography

Aortic pseudocoarctation is a congenital abnormality consisting of an elongated aortic arch with a kink at level of the isthmus. However, unlike coarctation, significant flow obstruction is not associated with pseudocoarctation, although there is an increased incidence other cardiovascular anomalies. This case demonstrates the use of multidetector CT as part of the clinical evaluation of a 49-year-old male with suspected aortic coarctation, leading to the final diagnosis of pseudocoarctation, as well as the incidental discovery of a crossed fused ectopic kidney.     

ECG-gated multidetector computed tomography for the assessment of the postoperative ascending aorta

Purpose

This study was undertaken to define the role of electrocardiographically (ECG)-gated multidetector computed tomography (MDCT) in the assessment of the postoperative ascending aorta.

Materials and methods

From November 2006 to June 2007, 21 patients, [11 men, ten women; age ± standard deviation (SD): 62.7±10.8 years] with a history of ascending aorta replacement underwent ECG-gated MDCT and were prospectively included in our study. Ascending aorta replacement had been performed with different surgical techniques: Bentall-De Bono (four patients, 19%), Tirone-David (five patients, 23%), and modified Tirone-David with creation of aortic neosinuses (12 patients, 57%). Two patients were excluded from MDCT evaluation because they failed to fulfil the inclusion criteria. Transthoracic echocardiography was used as the reference standard. All patients provided informed consent.

Results

In all patients, ECG-gated MDCT provided a clear depiction of the aortic annulus, aortic root and ascending aorta, enabling accurate measurements in all cases. The aortic valve area (3.4±0.2 cm²), the diameter of the sinotubular junction (31.6±1.8 mm), the diameter of the neosinuses in the case of modified Tirone-David procedures (37.3±2.1 mm) and the distance between the cusps and the graft wall during systole (3.1±0.7 mm) fell within standard ranges and showed a good correlation (r=0.89) with the values obtained with transthoracic echocardiography.

Conclusions

MDCT is currently considered a compulsory diagnostic step in patients with suspected or known aortic pathology. MDCT is a reliable technique for anatomical and functional assessment of the postoperative aortic root and provides cardiac surgeons with new and detailed information, enabling them to formulate a prognostic opinion regarding the outcome of the surgical procedure.     

Evaluation of normal appendix vermiformis in adults with multidetector computed tomography

To determine the utility of different contrast enhancement phases (unenhanced, arterial, and venous), slice thicknesses (0.5, 3, and 5 mm), and planes (axial and coronal) in the evaluation of appendix vermiformis (AV) on multidetector computed tomography (MDCT), CT examinations of 600 patients were obtained. No significant difference was found between the different imaging planes, slice thicknesses, and contrast enhancement phases in terms of detection rates of AV. The mean diameter of AV in the axial plane (5.93±0.06 mm) was significantly lower than that in the coronal plane (6.18±0.06 mm). Evaluation of AV on MDCT is enhanced by combined interpretation on axial and coronal planes.     

Assessment of cardiac volumes by multidetector computed tomography

Quantitative evaluation of cardiac ventricular and atrial chamber sizes, ventricular function, and left ventricular mass is important for prognosis and management. The most common methods for quantitative evaluation have been echocardiography and cardiac magnetic resonance imaging. Recently, multidetector cardiac computed tomography (CCT) technology has evolved to permit imaging of cardiac structure, function, volume, and mass. Potential advantages of CCT over existing methods include 3-dimensional volumetric assessment of cardiac chambers which are free of geometric assumptions and the ability to obtain true, on-axis imaging planes with double-oblique orientations.     

Myocardial hypoenhancement in a case of acute coronary syndrome with normal coronary arteries: demonstration by 64-slice multidetector computed tomography

A 48-year-old man presented with severe chest pain that had started 2 h before and ST elevation on the electrocardiogram. Cardiac computed tomography (CT) was performed using a 64-slice multidetector scanner (MDCT) to assess coronary artery stenosis at 3 h after the onset. Coronary CT angiography showed no significant stenosis at the coronary arteries, but CT myocardial images at systole demonstrated predominantly subendocardial hypoenhancement in the anterior wall. Cardiac CT that combined coronary angiography and myocardial imaging demonstrated myocardial hypoenhancement in a case of acute coronary syndrome with normal coronary arteries, which may be related to microvascular dysfunction caused by vasospastic angina or microvascular angina.     

Evaluation of traumatic rupture of descending aorta by aortography and computed tomography: case report with follow-up

Small aortic injuries are difficult to detect by computed tomography. We report a patient with a traumatic aortic injury that was not demonstrated on two high-resolution computed tomography scans 1 month apart despite prior angiographic demonstration of the lesion.     

Multislice computed tomography of pneumoparotid: a case report

Pneumoparotid is a rare cause of parotid gland swelling that is often misdiagnosed and therefore incorrectly treated. It is the result of an increase in intraoral pressure and the subsequent forced entry of air through Stensen's duct. We report a case of a 15-year-old boy with a history of recurrent swelling of both parotid glands. The final diagnosis of pneumoparotid was established by multislice computed tomography (CT). The clinical presentation, pathogenesis, and radiographic findings are discussed.     

Pulmonary cryptococcosis misdiagnosed as lung cancer in a man with normal immune function: A case report

Pulmonary cryptococcosis is an opportunistic infection of cryptococcus both in immunocompetent and immunocompromised patients, who suffered from HIV infection, organ transplantation, diabetes mellitus, corticosteroid or immunosuppressive therapy, and malignancy. Pulmonary cryptococcosis is the commonest location of non-central nervous system cryptococcosis and usually presents with nonspecific symptoms. It often shows shadows on the lung, which makes it difficult to distinguish it from lung cancer. Here we report a case of a 52-year-old man with pulmonary cryptococcosis, who was misdiagnosed as lung cancer. Clinicians need to consider the possibility of pulmonary cryptococcosis and the importance of lung biopsy when treating a patient with a normal immune function that has isolated pulmonary nodules. This case also indirectly illustrates the importance of percutaneous lung biopsy in patients with isolated pulmonary nodules.     

痛风性关节炎的超声研究进展

痛风性关节炎是临床常见疾病,由单钠尿酸盐结晶沉积在软骨、关节和周围软组织引发。超声不仅能用于痛风性关节炎的诊断和疗效评估,还可以引导细针穿刺获得诊断所需的组织样本。介绍痛风性关节炎的实用超声检查方法（六分钟检查法）,以及超声在痛风性关节炎不同时期（无症状高尿酸血症期、急性期、发作间期和慢性期）中的诊断应用。在痛风性关节炎的诊治上,超声比X线、CT和MRI更有效,而且无辐射、检查费用低。     

Measurement of coronary artery bifurcation angles by multidetector computed tomography

OBJECTIVE: Optimal stent deployment in coronary artery bifurcations requires information about the angle between main vessel and side branch. We evaluated the accuracy and interobserver variability of bifurcation angle measurements by contrast-enhanced 16-slice multidetector computed tomography (MDCT) in comparison with invasive angiography and examined the average angles of 4 main coronary bifurcations. METHODS: To determine the accuracy of MDCT for measurement of bifurcation angles, we scanned a coronary artery phantom containing 6 bifurcations (2-mm metal rods with angles between 25 degrees and 90 degrees ) using MDCT, and angles determined in the MDCT data set were compared with the true values. To assess interobserver variability of angle measurements in comparison to invasive angiography, the angles of 3 bifurcation sites (left anterior descending and left circumflex coronary artery [LAD/LCX], LAD and first diagonal branch [LAD/Diag 1], and posterior descending coronary artery and right posterolateral branch [PDA/Rpld]) were determined in 15 patients both in 16-detector row MDCT data sets and invasive coronary angiograms by 2 independent observers each. To assess the natural distribution of the 4 main coronary artery bifurcation angles (LAD and LCX, LAD and Diag 1, LCX and OM1, PDA and Rpld), the average angles of these bifurcations were determined in 16-slice MDCT data sets acquired for coronary artery visalization in a group of 100 consecutive patients with suspected coronary artery disease. RESULTS: The phantom study revealed a mean difference between measured and true angles of 0.7 +/- 0.5 degrees . In the comparison MDCT versus invasive angiography, the 45 angles were significantly lager in MDCT (mean: 66 +/- 20 degrees vs. 56 +/- 24 degrees , P = 0.027). Interobserver variability was significantly lower in MDCT (r = 0.91) than invasive angiography (r = 0.62). Analysis of the natural distribution of bifurcation angles by MDCT revealed average values of 80 +/- 27 degrees (LAD/LCX), 46 +/- 19 degrees (LAD/Diag1), 48 +/- 24 degrees (LCX/OM1), and 53 +/- 27 degrees (PDA/Rpld), respectively. CONCLUSION: MDCT allows assessment of coronary bifurcation angles with high accuracy, which may be of future potential for planning interventional treatment.     

Anomalous origin of a posterior descending artery from the right pulmonary artery: report of a rare case diagnosed by multidetector computed tomography angiography

The case of a mildly symptomatic 43-year-old man with evidence of reversible inferior wall ischemia by radioisotope stress testing is described. Invasive catheterization showed abnormal connections between the coronary arteries and the pulmonary circulation. Multidetector computed tomography elucidated the previously undescribed finding of a posterior descending artery originating from the right pulmonary artery.     

坏死性脑炎误诊为胶质瘤1例

患者 男，32岁。因间歇性癫痫发作伴头痛3个月来诊。体检；神智清，四肢活动自如，肌力、肌张力正常，病理反射阴性。否认有发热病史，临床及实验室检查末发现异常。     

Visualization rate and pattern of normal appendix on multidetector computed tomography by using multiplanar reformation display

OBJECTIVE: To evaluate the visualization rate and describe the morphologic pattern of the normal appendix on multidetector CT (MDCT) by using multiplanar reformation display. METHODS: We conducted a retrospective evaluation of the normal appendix with MDCT in 108 consecutive patients. A radiologist blinded to patient surgery history reviewed multiplanar reformation images at the workstation. The coronal and sagittal reformation images were reviewed in addition to the axial images. The visualization rate and morphologic pattern (including location, diameter, and lumen content) of normal appendices were recorded. RESULTS: The prevalence of appendectomy was 9% (10 of 108 patients). The appendix was recorded as definitely visualized in 91 of 98 patients who denied a history of appendectomy, definitely not visualized in 13 patients, and unsure in 4 patients. For statistical analysis, the definitely not visualized and unsure cases were summed and categorized as not visualized. The sensitivity, specificity, positive and negative predictive values, and accuracy of visualization of the normal appendix by MDCT were 93%, 100%, 100%, 59%, and 94%, respectively. All the patients in the unsure group had ascites or inadequate pericecal fat, or both. The mean outer diameter of the appendix was 5.6 +/- 1.3 mm (SD) (range: 3.0-11.0 mm). CONCLUSION: We verify a high visualization rate (93%) of normal appendices on MDCT by using multiplanar reformation display.     

Closed-loop small-bowel obstruction: diagnostic patterns by multidetector computed tomography

ABSTRACT: Multidetector computed tomography is a highly accurate method in evaluating high-grade intestinal obstruction. Closed-loop obstruction is a relatively uncommon subcategory of small-bowel obstruction; however, it is associated with a high risk of vascular impairment and is, therefore, important to diagnose accurately. Closed-loop obstruction is often caused by conditions such as internal hernias, congenital bands, postoperative adhesions, and malrotation. The purpose of this article is to review the imaging features of closed-loop bowel obstruction and various underlying conditions. Special emphasis will be placed on the technique of multidetector computed tomography and its role in diagnosing this entity.