Pulmonary embolism at multi-detector row CT of chest: one-year survival of treated and untreated patients

PURPOSE: To retrospectively assess outcome in patients with clinically unsuspected pulmonary embolism (PE) at chest multi-detector row computed tomography (CT). MATERIALS AND METHODS: Institutional review board approval and informed consent were not required. PE was assessed in consecutive CT scans in 1966 patients (mean age, 60 years; range, 15-96 years; male-female ratio, 1.79) and graded with severity score. Studies with true-positive and false-negative radiologic diagnoses were determined. Coexisting morbidity, anticoagulant therapy (ACT), complications, and 1-year outcome were reviewed. Statistical evaluation included Mann-Whitney U test, chi(2) test, Poisson regression, and Kaplan-Meier statistics. RESULTS: Scans were PE positive in 117 patients. Clinical data review was complete in 96 patients; 63 of 96 patients had malignancy; in 58, PE was not suspected. In 38 of these 58 patients, radiology report findings were false-negative (mean severity score, 20.21 +/- 17.88 [standard deviation] and 9.55 +/- 7.12 for those with true-positive and false-negative findings, respectively; P = .012). Forty-nine patients received therapeutic ACT; 21, prophylactic ACT; and 26, no treatment. PE severity was higher in patients with therapeutic ACT versus those without (P < .001). Bleeding complications were more frequent with therapeutic ACT (two early deaths, five major nonfatal hemorrhages) than without (one minor hemorrhage; P = .037). There were eight early deaths (therapeutic ACT, seven; without ACT, one; P = .037). Positive predictors of early death included severity score >28, use of systemic thrombolytic therapy, occurrence of major hemorrhage, and new-onset cardiac or renal failure (P = .001-.043). Negative predictors were report with false-negative findings and no therapeutic ACT (P = .007-.037). Predictors of late death (n = 25) were older age, malignancy, and renal failure (P = .001-.043). CONCLUSION: Clinically unsuspected PE may remain undetected at routine chest CT; these patients have favorable short-term outcome without therapeutic ACT.     

Pulmonary embolism: radiation dose with multi-detector row CT and digital angiography for diagnosis

PURPOSE: To compare radiation dose delivered at four- and 16-detector row computed tomography (CT) with a dose-modulation program and that delivered at digital angiography for evaluation of pulmonary embolism (PE). MATERIALS AND METHODS: The part of the study involving patients (seven women, four men; mean age, 62 years +/- 16 [standard deviation]; range, 41-85 years) was approved by the institutional review board. Patients gave written informed consent. Exposure was performed with an anthropomorphic phantom with thermoluminescent dosimeters for four-detector row CT without the dose-modulation program and 16-detector row CT without and with the dose-modulation program with standard protocols for pulmonary CT angiography (120 kV, 144 mAs, four and 16 detector rows with 1.00- and 0.75-mm section thickness, respectively). Digital angiograms were acquired with four standard projections at 80 kV. For digital angiography, radiation dose was calculated according to phantom measurements and adapted to acquisition and fluoroscopy times. Distribution of dose was compared for CT and digital angiography. RESULTS: During pulmonary CT angiography, mean radiation dose delivered at middle of chest was 21.5, 19.5, and 18.2 mGy for four-detector row CT and for 16-detector row CT without and with dose-modulation program, respectively. At the same level, a mean dose of 91 mGy was delivered with digital angiography. The dose adjusted to clinical conditions was 139.0 mGy for digital angiography and could be reduced after technical adjustment. Ratios of maximum dose to mean dose were 1.15 and 2.96 for CT and digital angiography, respectively. With application of the dose-modulation program at 16-detector row CT, radiation dose was reduced 15%-20% at the upper chest. CONCLUSION: Multi-detector row CT delivers a lower radiation dose, with better spatial distribution of dose, than does pulmonary CT angiography. With 16-detector row CT and a dose-modulation program, radiation dose is decreased during PE work-up.     

Suspected acute pulmonary embolism: evaluation with multi-detector row CT versus digital subtraction pulmonary arteriography

PURPOSE: To determine diagnostic accuracy of four-channel multi-detector row computed tomography (CT) in emergency room and inpatient populations suspected of having acute pulmonary embolism (PE) who prospectively underwent both CT and pulmonary arteriography (PA). MATERIALS AND METHODS: Patients referred for PA to assess suspected PE were eligible. Institutional review board approval and written informed consent were obtained. All patients underwent CT and PA within a 48-hour period. For CT, 4 x 2.5-mm collimation was used. Three readers independently evaluated each study for PE presence. PE status, vessel level, and lobar location were determined by means of majority rule, and interobserver agreement (kappa) was calculated for PE status, as assessed with each modality. Sensitivity and specificity of CT were calculated by using PA as the reference standard. Two radiologists later reviewed false-positive CT studies. RESULTS: The study group comprised 93 patients (median age, 56 years; range, 19-88 years). Sensitivity, specificity, and accuracy of CT were 100%, 89%, and 91%, respectively. kappa values were 0.71 and 0.83 for CT and PA, respectively, and were not significantly different between modalities. At PA, 18 patients (19%) had PE at 50 vessel levels (five main and/or interlobar, 24 segmental, and 21 subsegmental), 17 (94%) of which had PE at multiple sites. At CT, 26 patients (28%) had PE at 71 vessel levels (24 main and/or interlobar, 33 segmental, and 14 subsegmental). Twenty patients (77%) had PE at multiple sites. Review of eight false-positive CT studies showed an appearance highly suggestive of acute PE in three patients, chronic PE in one, and no PE in three; one study was inconclusive. CT better demonstrated large-level vessel involvement (P < .01), while PA better demonstrated small-level vessel involvement (P < .01). CONCLUSION: Multi-detector row CT has an accuracy of 91% in the depiction of suspected acute PE when conventional PA is used as the reference standard.     

Coronary artery calcium quantification at multi-detector row helical CT versus electron-beam CT

PURPOSE: To compare coronary artery calcium scores from a multi-detector row helical computed tomographic (CT) scanner with those from an electron-beam CT scanner, with emphasis on subjects with calcium scores less than 400. MATERIALS AND METHODS: Seventy-eight asymptomatic subjects (37 women, 41 men; age range, 39-78 years; mean age, 54.2 years) underwent multi-detector row CT and electron-beam CT. Volume and Agatston scores were calculated with a workstation. Statistical analyses included assessment of association between calcium scores from two scanners, calculation of percent absolute difference to assess score variability between scanners, equivalence analysis, construction of Bland-Altman plots to assess agreement between scores, and assessment of changes in score grouping and risk criteria based on score differences between scanners. RESULTS: Electron-beam CT calcium scores were higher than multi-detector row CT scores. Linear association between calcium scores obtained from paired scans was significant (r = 0.96-0.99, P <.001). Mean percent absolute differences were 67.9% and 65.0% for volume and Agatston scores, respectively (48.6% and 46.3% for corresponding natural log-transformed scores). In subjects with a score of 11 or greater, mean percent absolute differences between electron-beam CT and multi-detector row CT scores ranged from 15% to 30% (<10% for natural log-transformed calcium scores). With a 20% equivalence limit, calcium scores from the two scanners were statistically equivalent (P <.05). Score grouping would have been subject to change in 12 (11 increased and one decreased; six with scores of 11 or greater), and possible risk management decisions would have been subject to change in eight (16%) of 51 subjects who underwent electron-beam CT versus multi-detector row CT scanning. CONCLUSION: Multi-detector row CT appears to be comparable to electron-beam CT for coronary calcification screening, except in subjects with a calcium score less than 11.     

Right ventricular function in patients with acute pulmonary embolism: analysis with electrocardiography-synchronized multi-detector row CT

PURPOSE: To prospectively assess electrocardiography (ECG)-synchronized multi-detector row computed tomography (CT) for the evaluation of right ventricular (RV) function in patients suspected of having pulmonary embolism (PE). MATERIALS AND METHODS: All patients gave informed consent after the study details, including radiation exposure, were explained; institutional ethical committee approval was obtained. Nonsynchronized multi-detector row CT of the chest was performed in 66 consecutive patients (29 men, 37 women; mean age, 58 years+/-15 [standard deviation]) who were suspected of having PE. ECG-synchronized cardiac multi-detector row CT was performed to assess cardiac function. Dimension ratios for the RV and left ventricle (LV) were measured on nonsynchronized transverse and angulated four-chamber views. Furthermore, the RV end-diastolic and end-systolic volumes were measured on ECG-synchronized multi-detector row CT scans. An independent samples t test was performed to compare the mean value of different groups. An analysis of variance post hoc test was performed to investigate whether the values of the variables varied between groups. RESULTS: PE was detected in 29 of 66 patients. The location of PE was categorized as central (n=17) or peripheral (n=12). The RV/LV dimension ratio was larger on the four-chamber view (P=.002), and RV end-systolic volume was larger (P=.01) and ejection fraction was lower (P=.01) in patients with PE. The RV end-systolic volumes and RV/LV volume ratios, as assessed by using ECG-synchronized multi-detector row CT, showed significant differences (P<.005) between patients with central PE and those with peripheral PE. However, the RV/LV dimensions on nonsynchronized images revealed no significant differences. CONCLUSION: Retrospective ECG-synchronized multi-detector row CT facilitates detection of RV dysfunction, depending on pulmonary embolus location.     

CT dose optimization when changing to CT multi-detector row technology

The purpose of this article was to review the strategies to control patient dose in adult and pediatric computed tomography (CT), taking into account the change of technology from single-detector row CT to multi-detector row CT. First the relationships between computed tomography dose index, dose length product, and effective dose in adult and pediatric CT are revised, along with the diagnostic reference level concept. Then the effect of image noise as a function of volume computed tomography dose index, reconstructed slice thickness, and the size of the patient are described. Finally, the potential of tube current modulation CT is discussed.     

门静脉栓塞的MSCT诊断价值

目的:探讨门静脉栓塞的MSCT诊断价值。方法:回顾性分析29例经临床/手术病理证实的门静脉栓塞患者的MSCT表现和临床资料,29例中门静脉血栓(PVT)13例(PVT组),门静脉瘤栓(PTT)16例(PTT组)。结果:29例栓子的部位、范围均清晰显示;13例PVT中9例继发于肝硬化门静脉高压;CT平扫呈等或稍高密度,动态增强呈不同形态、无强化的低密度充盈缺损;7例呈典型的"靶征",5例呈"线样征"。16例PTT均继发于肝癌;CT平扫表现为等或稍低密度,动态增强呈形态各异、不均匀强化的充盈缺损;PVT组与PTT组间CT强化差异具有统计学意义(P=0.000);PVT组完全阻塞3例(3/13),PTT组12例(12/16),PTT组完全阻塞率高于PVT组(P=0.040);PVT组管腔局部扩张2例(2/13),PTT组12例(12/16),PTT组管腔局部扩张高于PVT组(P=0.030);PVT组管壁局部不光整1例(1/13),PTT组14例(14/16),PTT组管壁局部不光整率高于PVT组(P=0.000)。结论:MSCT能显示门静脉栓塞的影像特征,准确判断栓子的部位、范围及性质,对该病的诊断具有重要价值。     

Prediction of short term outcome of pulmonary embolism: Parameters at 16 multi-detector CT pulmonary angiography

Purpose

To evaluate the accuracy of computed tomography pulmonary angiography (CTPA) parameters, for predicting short-term mortality in patients with acute pulmonary embolism (PE).

Materials and methods

Thirty-two patients with proven PE had CT pulmonary angiography were included in the study. The clot burden using the Qanadli score (QS), and the right ventricular dysfunction (RVD) parameters were assessed on CT by calculating right ventricular/left ventricular (RV/LV) diameter ratios, interventricular septum abnormality, inferior vena cava contrast reflux, azygous vein and superior vena cava measures. Contrast density in pulmonary artery and descending aorta was evaluated for all patients. Patients were followed up for 30 days and then classified as survivors or non survivors.

Results

Thirty-two patients were included in the study, 23 (71.8%) of them were classified as survivors, and the other nine (28.1%) patients died within the first month (non survivors). There was a positive, but weak correlation between the Qanadli score and the short term mortality (P value = 0.05). There was a statistically significant relationship between the RV/LV ratio and PE-related mortality, with a P value < 0.001. Also, there was a good correlation between degree of IVC reflux and PE outcome (P < 0.001). The PA/AO diameter ratio, SVC diameter and azygous vein diameter showed no statistically significant difference between survivors and non survivors.

Conclusions

CTPA findings that may predict short term mortality are the high grades of inferior vena cava reflux, RV/LV diameter ratio more than 1.2, and clot burden >18 according to the Qanadli score and to a lesser degree the interventricular septum abnormality.     

Isoattenuating pancreatic adenocarcinoma at multi-detector row CT: secondary signs

PURPOSE: To assess the frequency of isoattenuating pancreatic adenocarcinoma with multi-detector row computed tomography (CT) and determine whether there are specific secondary signs that aid in detection. MATERIALS AND METHODS: Fifty-three patients with pancreatic adenocarcinoma underwent contrast material-enhanced biphasic multi-detector row CT with curved planar reformation. Tumors were initially deemed isoattenuating or hypoattenuating to normal pancreatic parenchyma on the basis of visual inspection, and the degree of attenuation was confirmed by calculating the mean attenuation differences between normal pancreatic parenchyma and tumor (tumor-pancreas contrast) during the pancreatic phase. Indirect signs of pancreatic tumor were tabulated in patients with an isoattenuating tumor. RESULTS: Of the 53 patients, six (11%) had isoattenuating tumors with a mean tumor-pancreas contrast of 9.25 HU +/- 11.3 during the pancreatic phase and 4.15 HU +/- 8.5 during the portal venous phase. The secondary signs of pancreatic tumor in these six patients included an interrupted pancreatic duct (n = 5), dilated biliary and pancreatic ducts (n = 1), atrophic distal pancreatic parenchyma (n = 3), and mass effect and/or convex contour abnormality (n = 3). The mean tumor-pancreas contrast for the remaining 47 patients was 74.76 HU +/- 35.61 during the pancreatic phase. CONCLUSION: With no visible tumor-pancreas contrast for isoattenuating tumors, indirect signs such as mass effect, atrophic distal parenchyma, and an interrupted duct sign are important indicators for the presence of tumor.     

多排螺旋CT诊断肺动脉栓塞的新进展

肺动脉栓塞是一种常见的心血管疾病。由于临床症状和体征无特异性,影像诊断起了重要的作用。MDCT扫描速度快,敏感,无创,应该成为肺动脉栓塞的首选检查方式。本文探讨了MDCT诊断肺动脉栓塞时的扫描技术、影像征象、同其他影像技术的比较,以及存在的问题及展望。     

Diagnosis of acute pulmonary embolism in outpatients: comparison of thin-collimation multi-detector row spiral CT and planar ventilation-perfusion scintigraphy

PURPOSE: To compare multi-detector row computed tomography (CT) and ventilation-perfusion (V-P) scintigraphy in the diagnosis of acute pulmonary embolism (PE) in outpatients who were cared for in the emergency department. MATERIALS AND METHODS: Ninety-four nonconsecutive patients, in whom acute PE was suspected, underwent thin-collimation multi-detector row CT (collimation, 4 x 1 mm; pitch, 1.25; scanning time, 0.5 second) and V-P scintigraphy. Concordance between CT and scintigraphic images was used in the diagnosis of PE. Pulmonary angiography was performed within 24 hours if interpretations of V-P and spiral CT images were inconclusive or discordant. Sensitivity and specificity values were calculated for V-P scintigrams and CT scans of the lungs. The rates of conclusive results for scintigraphy and CT were compared. RESULTS: The sensitivity of thin-collimation multi-detector row CT and V-P scintigraphy for the detection of PE was 96% (27 of 28; CI: 82%, 99%) and 98% (65 of 66; CI: 92%, 99%), respectively. The specificity of CT and V-P scintigraphy was 86% (24 of 28; CI: 67%, 96%) and 88% (58 of 66; CI: 77%, 94%), respectively. Seven V-P scintigrams were of intermediate probability, and one spiral CT study was indeterminate. Examinations with spiral CT yielded conclusive results more often than examinations with planar V-P scintigraphy (P <.05). Five V-P scintigrams and spiral CT scans were discordant. Twelve pulmonary angiographic examinations were performed. Angiographic findings were concordant in 10 (91%) of 11 patients with conclusive CT scans in whom pulmonary angiography was attempted. CT was used to establish an alternative diagnosis in 19 (29%) of 66 patients in whom PE was excluded. CONCLUSION: Thin-collimation multi-detector row CT is more accurate than V-P scintigraphy in the diagnosis of acute PE in outpatients. Furthermore, CT provides alternative diagnoses for patients without PE on high-quality transverse or near-isotropic reformatted images.     

Subsegmental pulmonary emboli: improved detection with thin-collimation multi-detector row spiral CT

PURPOSE: To compare different reconstruction thicknesses of thin-collimation multi-detector row spiral computed tomographic (CT) data sets of the chest for the detection of subsegmental pulmonary emboli. MATERIALS AND METHODS: A multi-detector row spiral CT protocol for the diagnosis of pulmonary embolism was used that consisted of scanning the entire chest with 1-mm collimation within one breath hold. In 17 patients with central pulmonary embolism, the raw data were used to perform reconstructions with 1-mm, 2-mm, and 3-mm section thicknesses. For each set of images, each subsegmental artery was independently graded by three radiologists as open, containing emboli, or indeterminate. RESULTS: For the rate of detection of emboli in subsegmental pulmonary arteries, use of the 1-mm section width yielded an average increase of 40% when compared with the use of 3-mm-thick sections (P <.001) and of 14% when compared with the use of 2-mm-thick sections (P =.001). With the use of 1-mm sections versus 3-mm sections, the number of indeterminate cases decreased by 70% (P =.001). Interrater agreement was substantially better with the use of 1-mm and 2-mm sections than with the use of 3-mm sections. CONCLUSION: For the diagnosis of subsegmental pulmonary emboli at multi-detector row CT, the use of 1-mm section widths results in substantially higher detection rates and greater agreement between different readers than the use of thicker sections.     

Solitary pulmonary nodule: characterization with combined wash-in and washout features at dynamic multi-detector row CT

PURPOSE: To prospectively assess the accuracy of combined wash-in and washout characteristics at dynamic contrast material-enhanced multi-detector row computed tomography (CT) in distinguishing benign from malignant solitary pulmonary nodules. MATERIALS AND METHODS: Institutional review board approval and informed consent were obtained. The study included 107 patients (62 men, 45 women; mean age, 55 years; range, 22-81 years) with a solitary pulmonary nodule. After unenhanced CT (2.5-mm collimation) scans were obtained, dynamic CT was performed by using a helical technique (series of images obtained throughout the nodule, with 2.5-mm collimation, at 30, 60, 90, and 120 seconds and 4, 5, 9, 12, and 15 minutes) after intravenous injection of contrast medium (120 mL). Tissue diagnosis was made in 70 nodules, and follow-up images showed benignancy in the remaining 37 (no change in size, n = 32; decrease in size, n = 5). CT findings were analyzed in terms of wash-in and washout of contrast medium. Sensitivity, specificity, and accuracy for malignant nodules were calculated by considering both the wash-in and washout characteristics at dynamic CT. RESULTS: There were 49 malignant and 58 benign nodules. When diagnostic criteria for malignancy of both wash-in of 25 HU or greater and washout of 5-31 HU were applied, sensitivity, specificity, and accuracy for malignancy were 94% (46 of 49 nodules), 90% (52 of 58 nodules), and 92% (98 of 107 nodules), respectively. Of 58 benign nodules, 27 showed less than 25 HU wash-in, 14 showed persistent contrast enhancement without washout and with wash-in of 25 HU or greater, and 11 showed washout greater than 31 HU and wash-in of 25 HU or greater. CONCLUSION: Evaluation of solitary pulmonary nodules by analyzing combined wash-in and washout characteristics at dynamic contrast-enhanced multi-detector row CT showed 92% accuracy for distinguishing benign nodules from malignant nodules.     

Anterior spinal artery and artery of Adamkiewicz detected by using multi-detector row CT

BACKGROUND AND PURPOSE: Our purpose was to evaluate the visualization of the artery of Adamkiewicz (AKA) and the anterior spinal artery (ASA) by using multi-detector row CT. Preoperative detection of the AKA and ASA is important for prevention of ischemic complications of thoracoabdominal aortic surgery. METHODS: Data from contrast-enhanced CT of the abdomen of 19 consecutive patients with known or suspected liver disease were evaluated. The scanning range was set from the level of the diaphragm to the lower edge of the liver. After bolus injection of contrast material (100 mL of iohexol, 350 mgI/mL, 5 mL/s), arterial phase scans were obtained by using a four-channel multi-detector row CT scanner. The scanning parameters included a detector row configuration of 4 x 2 mm, a pitch of 5:1, a gantry rotation speed of 0.5 s, 120 kVp, and 150 mAs. Arterial phase coronal multiplanar reconstruction scans obtained parallel to the spinal cord were evaluated by two neuroradiologists. The detectability of ASA and AKA was analyzed. RESULTS: The AKA was visualized on the scans of 13 of 19 patients (68%). The segmental level of AKA origin ranged from T10 to L2. The AKA originated from the left side in nine patients (69%) and the right side in four patients (31%). The ASA was visualized on the scans of all patients (100%). For 16 of the 19 patients, the ASA was detected in its full length from the cranial edge of the scan range. However, the ascending branch of the ASA distal to the junction of the AKA was not detected for the remaining three patients. CONCLUSION: The AKA and ASA can be visualized by using multi-detector row CT with the use of IV administered contrast material. Multi-detector row CT could be a useful tool in the evaluation of spinal vascular structures.     

Radiation exposure during cardiac CT: effective doses at multi-detector row CT and electron-beam CT

PURPOSE: To measure the effective radiation doses delivered at electron-beam computed tomography (CT) and multi-detector row spiral CT of coronary arteries and to compare these doses with those delivered at catheter coronary angiography. MATERIALS AND METHODS: An anthropomorphic phantom equipped with 66 thermoluminescent dosimeters was imaged at cardiac CT. Four protocols for unenhanced coronary artery calcium scoring were simulated: one with electron-beam CT and three with multi-detector row CT. Four similar protocols for coronary CT angiography were simulated. All multi-detector row spiral CT protocols were performed with retrospective electrocardiographic triggering. Biplane catheter coronary angiography also was simulated. Radiation doses to organs were measured, and effective doses were calculated according to guidelines published in International Commission on Radiological Protection Publication 60. RESULTS: Coronary artery calcium scoring with electron-beam CT yielded effective radiation doses of 1.0 and 1.3 mSv for male and female patients, respectively. The radiation doses at calcium scoring with multi-detector row CT were 1.5-5.2 mSv for male patients and 1.8-6.2 mSv for female patients. Electron-beam CT coronary angiography yielded effective doses of 1.5 and 2.0 mSv for male and female patients, respectively. The highest effective doses were delivered at multi-detector row CT angiography: 6.7-10.9 mSv for male patients and 8.1-13.0 mSv for female patients. Catheter coronary angiography yielded effective doses of 2.1 and 2.5 mSv for male and female patients, respectively. CONCLUSION: Higher radiation doses are delivered at multi-detector row cardiac CT compared with the doses delivered at electron-beam CT and catheter coronary angiography.     

Carotid artery wall thickness: comparison between sonography and multi-detector row CT angiography

Introduction  

Prospective studies have shown that an increased thickness of the carotid wall is a significant predictor of coronary and cerebrovascular complications. Our purpose was to assess the agreement between multi-detector row computed tomography (CT) angiography (MDCTA) and colour Doppler ultrasound (CD-US) in measuring carotid artery wall thickness (CAWT) and the intima–media thickness (IMT).     

Pancreas divisum: depiction with multi-detector row CT

PURPOSE: To retrospectively evaluate contrast material-enhanced multi-detector row computed tomography (CT) in the depiction of pancreas divisum. MATERIALS AND METHODS: This study was approved by the investigational review board. Seventy-seven patients (46 men and 31 women; mean age, 51 years) underwent CT with a four-detector row scanner and endoscopic retrograde pancreatography (ERP). Section thickness was 3.2 mm, and the reconstruction interval was 3 mm. Two radiologists independently evaluated the CT data sets with picture archiving and communication system (PACS) workstations equipped with software for two- and three-dimensional postprocessing reformations; the radiologists were blinded to the clinical and ERP data. Pancreas divisum was diagnosed at CT if what the authors termed the "dominant dorsal duct sign" (the caliber of the dorsal duct was larger than that of the ventral duct) was present and if the dorsal and ventral ducts did not appear to communicate with each other at cine review of images. ERP findings were used as the standard of reference for determining the performance (sensitivity, specificity, positive and negative predictive values) of the radiologists' CT interpretations. Interobserver agreement was measured by using kappa statistics. RESULTS: For four of the 77 patients (5%), both radiologists considered that depiction of the pancreatic duct on CT images was not sufficient to enable evaluation of ductal anatomy. These patients were excluded from further analysis. In the remaining 73 patients, ERP demonstrated pancreas divisum in 10 (14%); both observers made the correct diagnosis in nine of these patients. In addition, one radiologist had one false-positive interpretation, whereas the other radiologist had two false-positive interpretations. Thus, for observer 1, the calculated sensitivity was 90% (95% confidence interval [CI], 60%-98%) and the specificity was 98% (95% CI, 91%-100%). For observer 2, sensitivity was 90% (95% CI, 60%-98%) and specificity was 97% (95% CI, 89%-99%). Interobserver agreement was excellent (kappa = 0.93). CONCLUSION: CT scans obtained with multi-detector row scanners and interpreted with PACS workstations enable depiction of pancreas divisum. This assessment is possible only when the pancreatic duct is visualized.     

64 Slice multi-detector row cardiac CT

Cardiac imaging is feasible with multi-detector row (MDCT) scanners. Coronary arterial anatomy and both non-calcified and calcified plaques are depicted at CT coronary angiography. Vessel wall pathology and luminal diameter are depicted, and secondary myocardial changes may also be seen. Diagnostic capacity has increased with technological advancement, and preliminary investigations confirm the utility of 64-MDCT in low- and intermediate-risk patients who present to the emergency department with acute chest pain. The clinical indications, 64-MDCT technique, and MDCT findings in coronary artery disease are reviewed.