Diagnosis of extracerebral fluid collections by computed tomography.

The computed tomography scans of 90 patients with extracerebral fluid collections were reviewed. Epidural hematomas, acute, subacute, and chronic subdural hematomas, convexity subarachnoid hemorrhages, subdural hygromas, and one epidural empyema were seen. The CT findings were analyzed and correlated with the time elapsed since injury (when known) and the results of radionuclide scans (when available). The overall accuracy of CT in detecting extracerebral fluid was 90% with no acute hemorrhages missed. In subacute and chronic subdural collections, six CT scans were false negative in whole or in part. Three false positive interpretations were made and are discussed.     

Consecutive bilateral cranial subdural fluid collections in misdiagnosed SIH

European Radiology -     

Statistical detection of nonvisible isodense subdural fluid collections.

An analytic method for detecting isodense subdural fluid collections from computed tomography (CT) scan pixel attenuation data is presented. Analysis of 44 CT scan levels from 8 patients with isodense subdural hematomas (ISDH) and 50 CT scan levels from 15 patients without ISDH indicates 6% false positive and 3% false negative errors if the analysis is restricted to noncontrast CT scans that demonstrate subcalvarial bilateral cortical attenuation symmetry in the pictorial display.     

The value of computed tomography in cerebral syphilis

Summary The computed tomographic findings of three patients with cerebral syphilis, including cerebral gumma, which regressed completely under penicillin therapy, syphilitic angiitis with cerebral infarction, and syphilitic cerebral atrophy, are reported. CT is unable to provide specific diagnostic data for these conditions. The etiology can be clarified only by taking into consideration the clinical findings and course, the serological results, and the result of therapy.     

The predictive value of computed tomography in the detection of reflux esophagitis in patients undergoing upper endoscopy

BackgroundReflux esophagitis (RE) may mimic symptoms requiring cross-sectional imaging.MethodsFrom 565 patients who had CT and esophagogastroduodenoscopy within four days apart, CT scans of 72 patients with RE confirmed by esophagogastroduodenoscopy and 108 matched patients without RE were evaluated for distal esophageal wall characteristics.ResultsIn RE patients the distal esophageal wall thickness was greater (5.2 ± 2.0 mm) compared to patients without RE (3.5 ± 1.2 mm, p < 0.0001) with AUC of 0.78 and 56% sensitivity, 88% specificity for a 5.0 mm cut-off.ConclusionsThere is a moderate association between distal esophageal wall thickness on CT and RE diagnosed by esophagogastroduodenoscopy as the reference standard.     

Computed tomography of pararenal fluid collections in acute pancreatitis

Acute pancreatitis is a serious condition with severe and, sometimes, fatal complications. In recent years, both computed tomography (CT) and ultrasound have improved the diagnosis of certain complications, particularly pseudocysts, extrapancreatic exudates and abscesses. A frequent site for extrapancreatic exudates is the pararenal space. Reports in the CT literature have suggested that pararenal exudates are rare on the right but common on the left in acute pancreatitis. A series is presented here of nine patients with acute pancreatitis, seven of whom had right pararenal exudates demonstrated on CT examination. Patients with diffuse pancreatitis had bilateral pararenal exudates whilst those with inflammation confined either to the head and neck or to the tail of the pancreas had appropriate unilateral exudates. The detection and drainage of extrapancreatic exudates in acute pancreatitis may significantly influence morbidity.     

The value of computed tomography scanning in chondromalacia patellae

Sixtyseven patients with pain in the knee were studied. A computed tomography (CT) score indicating chondromalacia was devised, based on the results of CT after arthrography. This score takes account of the regularity, the congruity, and the imbibition of contrast material. Thus the patients could be divided into four groups: those who definitely have chondromalacia (++), probably (+), probably not (±), and definitely not (-). These results were compared with the clinical diagnosis based on clinical signs, arthroscopy, or operation. Eighteen patients had clinically proved chondromalacia, CT scored 14++, 3+ and 1±. Twentynine patients had no chondromalacia, CT scored 19-, 8±, and 2+. Twenty patients had an uncertain clinical diagnosis. Arthrography was less accurate in detecting chondromalacia.     

Diagnosis of isodense subdural hematomas by computed tomography.

Subdural hematomas, whose absorption values approximate those of adjacent brain, are not visualized in routine computed tomography. Two clues indicating the presence of such "isodense" subdural hematomas are: (1) unilateral effacement of cerebral sulci on the convexities, and (2) midline shift or mass effect on the ventricles in the absence of abnormal areas of diminished or increased density in the brain. Nine cases were detected on pre- and postcontrast studies in 2,500 CT scans of the brain over a 10 month period. Delayed CT scanning 4-6 hr after intravenous contrast injection showed enhancement of the subdural hematoma in three of seven cases.     

The value of computed tomography in patients with mucopolysaccharidosis

Summary Cranial computed tomography (CT) was performed on 11 cases of mucopolysaccharidosis (MPS) IVA (Morquio syndrome). Our results suggest that although the patients may have normal intelligence CT changes may be seen with increasing age. In two cases white matter low density was found and in a third there was gross dilatation of the ventricles, basal cisterns and subarachnoid space. Nine other patients with various types of mucopolysaccharidosis also had cranial CT performed and in general those types associated with mental retardation showed changes although there was an interesting exception involving a case of MPS IIIA who had a normal CT scan.     

Association between postmortem computed tomography value of cerebrospinal fluid and time after death: A longitudinal study of antemortem and postmortem computed tomography

This study was designed to examine the antemortem factors affecting cerebrospinal fluid (CSF) Hounsfield Units (HU) on postmortem computed tomography (PMCT) compared to the antemortem CT (AMCT). Fifty-five participants without brain lesions who died at a university hospital and underwent AMCT, PMCT, and an autopsy were enrolled. We recorded age, sex, time after death, the CSF HU on AMCT and PMCT at multiple measuring points, 4-point-scale brain atrophy grade on AMCT, and the cella media index. We tested the effects of CSF HU factors observed on PMCT. No significant differences were observed between CSF HUs at any of the PMCT measurement points. The average CSF HU on PMCT was positively correlated with the natural logarithm of the time after death (Pearson's correlation coefficient, 0.81; p < 0.001). No other factors showed correlative relationships. Up until approximately 12 h after death, the CSF HU on PMCT depended only on the time since death.     

Negative predictive value of stress myocardial perfusion imaging and coronary computed tomography angiography: A meta-analysis

Background

Comparing the prognostic value of a negative finding by stress single-photon emission computed tomography myocardial perfusion imaging (MPI) and coronary computed tomography angiography (CCTA) may be useful to evaluate how better identify low-risk patients. We performed a meta-analysis to compare the long-term negative predictive value (NPV) of normal stress MPI and normal CCTA in subjects with suspected coronary artery disease (CAD).

Methods and Results

Studies published between January 2000 and November 2016 were identified by database search. We included MPI and CCTA studies that followed-up ≥100 subjects for ≥5 years and providing data on clinical outcome for patients with negative tests. Summary risk estimates for normal perfusion at MPI or <50% coronary stenosis at CCTA were derived in random effect regression analysis, and causes of heterogeneity were determined in meta-regression analysis. We identified 12 eligible articles (6 MPI and 6 CCTA) including 33,129 patients (26,757 in MPI and 6372 in CCTA studies) with suspected CAD. The pooled annualized event rate (AER) for occurrence of hard events (death and nonfatal myocardial infarction) was 1.06 (95% confidence interval, CI 0.49-1.64) in MPI and 0.61 (95% CI 0.35-0.86) in CCTA studies. The pooled NPV was 91% (95% CI 86-96) in MPI and 96 (95% CI 95-98) in CCTA studies. The summary rates between MPI and CCTA were not statistically different. At meta-regression analysis, no significant association between AER and clinical and demographical variables considered was found for overall studies.

Conclusions

Stress MPI and CCTA have a similar ability to identify low-risk patients with suspected CAD.

     

Pheochromocytoma: value of computed tomography

A review of 60 histologically proved pheochromocytomas confirmed the value of computed tomography (CT) in the evaluation of this tumor. CT was found to be an accurate means of locating the tumor in 52 patients presenting for the first time and 8 patients with evidence of recurrence.     

The value of computed tomography for predicting empyema-associated malignancy

OBJECTIVE: To determine the value of computed tomography (CT) scanning in detecting associated malignancy in patients with chronic empyema. METHODS: Two radiologists retrospectively reviewed CT scans of 112 consecutive patients with chronic empyema and arrived at a consensus about the findings. Among these patients, 6 were confirmed by pathology evaluation to have empyema-associated malignancy (EAM), including 4 lymphomas. The CT scans were evaluated for the presence of the following findings: a mass in the empyema sac; mass involvement of the extrapleural fat, chest wall, rib, and lung; bulging of the empyema sac; nodular pleural thickening; empyema involvement of the mediastinal pleura; presence of lung nodules (>1 cm); and mediastinal lymph node enlargement. The association between the CT findings and the EAM was analyzed with the Fisher exact test. A multiple logistic regression analysis was used to determine the predictive variables for EAM. Sensitivity, specificity, and positive predictive value were calculated for each finding. RESULTS: All CT findings, except rib involvement and bulging of empyema sac, were significantly associated with EAM (P<0.05). The finding of the presence of a mass, extrapleural fat, and mediastinal involvement showed relatively high sensitivity (100%, 67%, 67%, respectively) and specificity (81%, 87%, 91%, respectively). A bulging of the empyema sac and nodular pleural thickening showed 100% sensitivity, but low specificity (39% and 44%, respectively). Findings from the multiple logistic regression analysis revealed that the presence of a mass and empyema of the mediastinal pleura were significant variables associated with EAM (P<0.05). CONCLUSIONS: Although many CT findings are associated with EAM, most showed either low positive predictive value or low sensitivity. A variety of CT findings should be considered when evaluating CT image-based detection of EAM.     

The value of F-18 fluorodeoxyglucose positron emission tomography/computed tomography in asymptomatic examinees with unexplained elevated blood carcinoembryonic antigen levels

Purpose

Cancer is still a clinical challenge, with many efforts invested in order to achieve timely detection. Unexplained elevated blood carcinoembryonic antigen levels are occasionally observed in an asymptomatic population and considered as a risk factor of cancers. The purpose of this study was to determine the validity of 18 F-fluorodeoxyglucose-positron emission tomography/computed tomography (F-18 FDG-PET/CT) for detecting cancer in an asymptomatic population with an unexplained elevation in blood carcinoembryonic antigen (CEA) levels.

Methods

This retrospective study included a total of 1920 asymptomatic examinees conducted from August 2011 through September 2013. The participants underwent CEA assay and conventional medical imaging (CEA-conventional), or CEA assay and F-18 FDG-PET/CT (CEA-PET/CT). The validity of conventional medical imaging and CEA-PET/CT scanning for detecting cancer and early-stage cancer in an asymptomatic population with an unexplained elevation in blood CEA levels were evaluated.

Results

Sensitivity, specificity, cancer detection rate, missed cancer detection rate, early-stage cancer detection rate, and early-stage cancer ratio using the CEA-PET/CT scanning were 96.6 %, 100 %, 10.4 %, 0.4 %, 3.7 %, and 34.5 %, respectively. In contrast, the corresponding values obtained using the conventional medical imaging were 50.6 % (P?<?0.0001), 100 % (P?>?0.9999), 50.6 % (P?<?0.0001), 99.9 % (P?=?0.055), 2.6 % (P?<?0.0001), 2.5 % (P?=?0.04), 0.7 % (P?=?0.0004), and 14.5 % (P?=?0.002), respectively.

Conclusion

The F-18 FDG-PET/CT scanning significantly improved the validity of the cancer detection program in the asymptomatic population with an unexplained elevation in CEA levels.

     

Multidetector-row computed tomography of the coronary arteries: predictive value and quantitative assessment of non-calcified vessel-wall changes

The aim of this study was to quantitatively assess non-calcified coronary artery plaques and to determine their predictive value for the detection of coronary artery disease (CAD). A total of 179 patients underwent a calcium screening examination and a contrast-enhanced multidetector-row computed tomography angiography (MDCT) of the coronary arteries for various indications. The traditional calcium scores were evaluated and all examinations were reviewed for the presence of non-calcified plaques with an attenuation of 0–130 Hounsfield units (HU). The number, mean attenuation, and volume of these non-calcified plaques were recorded. All patients also underwent conventional catheter angiography. Coronary calcium was detected in 73% (131 of 179) of the patients. Overall incidence of purely non-calcified plaques was 30% (53 of 179). In 27% of the patients (48 of 179) no calcium was detected; however, 15% of these patients without calcifications showed non-calcified plaques (7 of 48). Significant correlations were found between the volume of calcified plaques, volume of non-calcified plaques, and total plaque volume. There were significant differences in plaque composition comparing different risk factor profiles and different stages of CAD. Volumetric assessment of non-calcified coronary artery plaques is feasible using contrast-enhanced MDCT. Screening for non-calcified plaques identifies patients with signs of CAD that are missed in a calcium screening examination.