Cine computerized tomography

Ultrafast (Cine) CT scanning provides cross-sectional millisecond tomography, and therefore combines digital imaging and high resolution without the need for either cardiac catheterization or any form of ECG gating. Fifty millisecond multilevel scanning at rates of 17 scans per second allows quantitation of left ventricular (LV) function at each tomographic level during a cardiac cycle. Calculations of global and regional ejection fraction can be obtained, and in addition ultrafast CT also has the potential for providing unique data concerning regional wall thickening, mass and even regional myocardial perfusion. Interventional studies with exercise and pharmacological agents have commenced and are currently being evaluated.     

Conventional computerized tomography of the heart

Summary Ungated cardio-CT provides good morphologic information in the case of congenital heart disease, volume or pressure loading, left ventricular aneurysm, tumours, thrombi, cardiac calcifications and pericardial diseases. It allows qualitative assessments of myocardial thickness and perfusion of coronary bypass grafts.ECG-gated cardio-CT allows a quantitative assessment of systolic and diastolic myocardial thickness, volume calculation of cardiac cavities and evaluation of functional parameters. The correlation of the calculated left ventricular ejection fraction comparing laevocardiography and ECG-gated cardio-CT was poor (r=0.7) mainly due to the comparable poor time resolution on the side of cardio-CT (approximately 0.1 s). The quantitative analysis of regional wall motion based on cardio-CT showed for the diagnosis of pathologic wall motion a specificity of 80.5%, sensitivity of 73.9% and accuracy of 75.7%.Side effects must be taken into account following the injection of 200–250 ml hyperosmolar contrast medium during 5–10 minutes which causes intravascular fluid retention and cardiac volume loading. Patients prone to cardiac decompensation should be excluded from cardio-CT examinations.     

Cranial computerized tomography in dihydropteridine reductase deficiency

Dihydropteridine reductase deficiency is a rare cause of hyperphenylalaninaemia, characterized by severe and progressive neurological impairment, despite early and accurate dietary control of plasma phenylalanine. We describe two girls, diagnosed at 17 and 14 months of age, respectively, and immediately treated withl-dopa, 5-hydroxytryptophan and carbidopa. In spite of an adequate dietary and pharmacological treatment, the clinical and neurological pictures progressively worsened. Repeated cranial computerized axial tomography scans showed degeneration of the white matter and, in one case, calcification of the basal ganglia. The possible association of this last finding with folate depletion is discussed.     

Using computerized tomography to identify neurologic problems

Computerized tomography (CT) scanning accurately identifies neurologic abnormalities in many elderly patients, often making it possible to differentiate symptomatic neurologic changes of normal aging from treatable pathologic states such as occult masses and cerebral infarction producing much the same symptoms. The scan also singles out patients in whom further diagnostic measures are necessary. The advantages of CT--low morbidity, noninvasiveness, and high sensitivity--far outweigh its limitations. Concomitant cerebral atrophy and metabolic imbalance do not significantly affect diagnostic accuracy. Risks are minimal, related chiefly to contrast allergy, and occasionally to anesthetics for patients who cannot remain motionless during the procedure.     

FDG positron emission tomography/computerized tomography features of bleomycin-induced pneumonitis

Bleomycin is a widely used chemotherapeutic that has been shown to induce life-threatening interstitial lung disease in a small subset of patients. We report a case of bleomycin-induced pneumonitis in a patient treated for Hodgkin lymphoma with severe clinical respiratory symptoms, a marked restrictive pattern on pulmonary function tests, and FDG avid lymphadenopathy and diffuse increased uptake involving both lungs on imaging. To our knowledge, the in-line computed tomography/18F-fluorodeoxyglucose positron emission tomography of bleomycin induced pneumonitis has not been previously reported in the literature.     

Contrast-enhanced computed tomography of the gallbladder in acute pancreatitis

The gallbladder findings encountered in 59 patients examined because of a first attack of acute, alcohol-induced pancreatitis, are reported. Abdominal contrast-enhanced computed tomography was technically acceptable in 54 patients. In 85% of the patients the gallbladder finding was pathological. The density increase in the gallbladder contents was more than twice normal. Possible reasons for this phenomenon are discussed. Intense contrast enhancement of the gallbladder wall was found in 87% of the cases. Increased wall thickness was observed in 64% of the patients.     

Diagnosis of emphysematous cholecystitis by computerized tomography.

A case of emphysematous cholecystitis is presented in which computerized tomography helped to confirm the diagnosis and the extent of disease preoperatively. This unusual disorder is briefly reviewed and the clinical and radiographic findings are discussed.     

Confirming a mediastinal lipoma with cardiac computerized tomography

It is reported on an at present 32-year-old male patient, in whom at the age of 30 years an excessive mediastinal lipoma was excised. For 12 years the cardiological diagnosis was not clear and could completely be clarified only with the help of the computed tomography of the heart.     

Endoscopic ultrasound,positron emission tomography,and computerized tomography for lung cancer

Staging of patients with lung cancer to determine operability is intended to efficiently limit futile thoracotomies without denying possibly curative surgery. Currently available staging tests are imperfect alone and in combination. Imaged suspected metastases often require tissue confirmation before surgery can be denied. Endoscopic ultrasound (EUS) may help identify inoperable patients by providing tissue proof of inoperability in a single staging test, with similar sensitivity for identifying inoperable patients as other staging tests. Therefore, we compared computed tomography, positron emission tomography (PET), and EUS with fine-needle aspiration under conscious sedation, each test interpreted blinded with respect to the other tests, for identifying inoperable patients in a consecutive cohort of 79 potentially operable patients with suspected or proven lung cancer. An economic analysis was also performed. Thirty-nine patients were found inoperable (a 40th patient's inoperability was missed by all preoperative staging tests). The sensitivity of computerized tomography was 43%. PET and EUS each had similar sensitivities (68 and 63%, respectively) and similar negative predictive values (64 and 68%, respectively), but EUS's superior specificity (100 vs. 72% for PET) and considerably lower expense means it may be preferred to PET early in staging to identify inoperable patients.     

Estimation of computerized tomography derived abdominal fat distribution.

Measurements of intra-abdominal fat (IAF) may be important since it is associated with numerous metabolic disorders. The relationship between computerized tomography (CT) measured fat distribution and densitometry measures was investigated in a sample of 61 male Caucasian subjects, aged 18 to 30 years with varying adiposity. Regression models were developed for estimating CT-derived fat of 40 men to estimate IAF. Two equations were developed to estimate IAF. The first used only anthropometric measures. Waist circumference and log chest ratio entered the equation and accounted for 67% of the variance. The second model included densitometry-measured percentage fat with the centred product of waist and hip circumferences, accounting for 73% of the variance. Regression equations were also developed to estimate subcutaneous fat area so that the ratio of IAF to subcutaneous fat might be estimated. Although subcutaneous fat could be estimated, the ratio between IAF and subcutaneous fat could not be estimated accurately. A validation of all regression equations developed for male subjects who also completed using a separate validation sample (n = 21). Only the studies with sample characteristics similar to those found in the validation sample validated satisfactorily. Results indicate that anthropometric and densitometry measures cannot be used to estimate CT-derived abdominal fat with precision, however they may be of value in health risk screening of individuals with high levels of IAF. Proper selection procedures with regard to age, adiposity, and morbidity must be used.     

Pelvic lipomatosis: diagnosis by computerized tomography scan.

Pelvic lipomatosis is a rare, relatively self-limiting disease characterized by the overgrowth of unencapsulated lipomatous tissue within the pelvis. The diagnosis is suggested, but not substantiated, by the striking roentgenographic changes noted on barium enema and intravenous pyelogram. Previously, pelvic laparotomy with tissue diagnosis was essential for documenting the disease. We report three cases in which computerized tomography was utilized as a safe, noninvasive and accurate method of diagnosis. The role played by partial venous obstruction is discussed in addition to rectal bleeding as a mode of presentation.     

The scimitar syndrome confirmed by 320-slice computerized tomography

Scimitar syndrome is a relatively rare variety of congenital heart disease characterized by partial or complete anomalous pulmonary venous connection of the right lung into the inferior vena cava. There are virtually no reports of the use of 320-slice computed tomography in establishing the diagnosis. The investigators present a case of scimitar syndrome confirmed by 320-slice computed tomography.     

Diagnosis of miliary tuberculosis by cerebral computerized tomography.

We report a case of miliary tuberculosis with symptoms and signs of an intracranial mass. These were found to be multiple tuberculomas by computerized axial tomography (CT scan). We review the pathophysiologic features of intracranial tuberculomas. The CT scan allows a rapid and sensitive diagnosis of intracranial tuberculosis without utilizing invasive neurodiagnostic techniques. The value of using CT scans following treatment was confirmed.