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Helical CT (helical + ct)
Selected AbstractsHP36P DOES NEO-ADJUVANT CHEMOTHERAPY AFFECT THE ACCURACY OF HELICAL CT AND CT PORTOGRAPHY FOR PRE-OPERATIVE PLANNING IN HEPATIC COLORECTAL METASTASES?ANZ JOURNAL OF SURGERY, Issue 2007S. Adie Purpose Pre-operative scanning for hepatic colorectal metastases surgery remains a challenge, especially in the age of neo-adjuvant chemo, which has marked biochemical & physical effects on the liver. We investigated helical CT and CT portography as pre-op planning tools. Methodology All patients who had resection of hepatic colorectal metastases between Jan 2004 and June 2006 were included. Patients were divided into those who received neo-adjuvant chemo and those who did not. The number of malignant hepatic lesions found on each scan was compared with those found on histopathology & intra-op ultrasound/examination. Accurate scans (scan lesions = true lesions), over-estimations (scan lesions > true lesions) and under-estimations (scan lesions < true lesions) were recorded. Results 25 patients had pre-op CT portography with neo-adjuvant chemo and 63 without. Accurate scans on a per-patient basis were 2 (8%) for the chemo group vs. 27 (43%) for the non-chemo group, p < 0.002. Notably, there were 17 (68%) over-estimates in the chemo group vs. 25 (40%) in the non-chemo group. There were 6 (24%) vs. 11 (17%) under-estimates respectively. 23 patients had pre-op helical CT with neo-adjuvant chemo and 64 without. Accurate scans on a per-patient basis were 7 (30%) for the chemo group vs. 26 (41%) in the non-chemo group, p = 0.388. There were 8 (35%) over-estimates in the chemo group vs. 12 (19%) in the non-chemo group. There were 8 (35%) vs. 26 (41%) under-estimates respectively. Conclusion While CT portography is useful for detecting occult hepatic metastases, there is evidence that over-estimation of disease is a problem, particularly when neo-adjuvant chemo was used. Helical CT also shows this trend although to a lesser extent. [source] Impact of Helical Computed Tomography on the Outcomes of Emergency Department Patients with Suspected AppendicitisACADEMIC EMERGENCY MEDICINE, Issue 8 2003Sam S. Torbati MD Abstract Objectives: To assess the impact of an emergency department (ED) guideline employing selective use of helical computed tomography (CT) on clinical outcomes of female patients with suspected appendicitis. Methods: All patients presenting with suspected appendicitis were prospectively enrolled and managed in accordance with a guideline incorporating selective use of helical CT. Although not the objective of this investigation, male patients were included for purposes of comparison. Patients with clinically evident appendicitis were referred to the surgical service, and patients with equivocal presentations were studied with helical CT. Patients were followed to final surgical or clinical outcomes. Outcome measures included time from ED presentation to laparotomy and rate of appendiceal perforation. These measures were compared with those of a historical cohort of patients preceding the use of helical CT. Results: A total of 310 consecutive patients with suspected appendicitis were enrolled; 92 had appendicitis. Sixty patients were referred to the surgical service without helical CT, and 41 had appendicitis (68%). Helical CT was performed on 250 patients; 51 had appendicitis (20%). For males, the mean interval from ED presentation to laparotomy was 559 minutes (95% CI = 444 to 674 minutes) during guideline use and 480 minutes (95% CI = 405 to 555 minutes) before. This interval for females was 433 minutes (95% CI = 326 to 540 minutes) during guideline use and 710 minutes (95% CI = 558 to 862 minutes) before. Appendiceal perforation rate for males was 0.25 (95% CI = 0.14 to 0.36) during guideline use and 0.38 (95% CI = 0.29 to 0.47) before; perforation rate for females was 0.06 (95% CI =,0.05 to 0.17) during guideline use and 0.23 (95% CI = 0.14 to 0.32) before. Helical CT had 92% sensitivity, 97% specificity, and 96% accuracy in diagnosing appendicitis. Conclusions: Helical CT is highly accurate in detecting appendicitis in patients with equivocal ED presentations. The use of a guideline employing selective helical CT was associated with a decline in the time from ED presentation to operative intervention in females. [source] HP36P DOES NEO-ADJUVANT CHEMOTHERAPY AFFECT THE ACCURACY OF HELICAL CT AND CT PORTOGRAPHY FOR PRE-OPERATIVE PLANNING IN HEPATIC COLORECTAL METASTASES?ANZ JOURNAL OF SURGERY, Issue 2007S. Adie Purpose Pre-operative scanning for hepatic colorectal metastases surgery remains a challenge, especially in the age of neo-adjuvant chemo, which has marked biochemical & physical effects on the liver. We investigated helical CT and CT portography as pre-op planning tools. Methodology All patients who had resection of hepatic colorectal metastases between Jan 2004 and June 2006 were included. Patients were divided into those who received neo-adjuvant chemo and those who did not. The number of malignant hepatic lesions found on each scan was compared with those found on histopathology & intra-op ultrasound/examination. Accurate scans (scan lesions = true lesions), over-estimations (scan lesions > true lesions) and under-estimations (scan lesions < true lesions) were recorded. Results 25 patients had pre-op CT portography with neo-adjuvant chemo and 63 without. Accurate scans on a per-patient basis were 2 (8%) for the chemo group vs. 27 (43%) for the non-chemo group, p < 0.002. Notably, there were 17 (68%) over-estimates in the chemo group vs. 25 (40%) in the non-chemo group. There were 6 (24%) vs. 11 (17%) under-estimates respectively. 23 patients had pre-op helical CT with neo-adjuvant chemo and 64 without. Accurate scans on a per-patient basis were 7 (30%) for the chemo group vs. 26 (41%) in the non-chemo group, p = 0.388. There were 8 (35%) over-estimates in the chemo group vs. 12 (19%) in the non-chemo group. There were 8 (35%) vs. 26 (41%) under-estimates respectively. Conclusion While CT portography is useful for detecting occult hepatic metastases, there is evidence that over-estimation of disease is a problem, particularly when neo-adjuvant chemo was used. Helical CT also shows this trend although to a lesser extent. [source] Impact of Helical Computed Tomography on the Outcomes of Emergency Department Patients with Suspected AppendicitisACADEMIC EMERGENCY MEDICINE, Issue 8 2003Sam S. Torbati MD Abstract Objectives: To assess the impact of an emergency department (ED) guideline employing selective use of helical computed tomography (CT) on clinical outcomes of female patients with suspected appendicitis. Methods: All patients presenting with suspected appendicitis were prospectively enrolled and managed in accordance with a guideline incorporating selective use of helical CT. Although not the objective of this investigation, male patients were included for purposes of comparison. Patients with clinically evident appendicitis were referred to the surgical service, and patients with equivocal presentations were studied with helical CT. Patients were followed to final surgical or clinical outcomes. Outcome measures included time from ED presentation to laparotomy and rate of appendiceal perforation. These measures were compared with those of a historical cohort of patients preceding the use of helical CT. Results: A total of 310 consecutive patients with suspected appendicitis were enrolled; 92 had appendicitis. Sixty patients were referred to the surgical service without helical CT, and 41 had appendicitis (68%). Helical CT was performed on 250 patients; 51 had appendicitis (20%). For males, the mean interval from ED presentation to laparotomy was 559 minutes (95% CI = 444 to 674 minutes) during guideline use and 480 minutes (95% CI = 405 to 555 minutes) before. This interval for females was 433 minutes (95% CI = 326 to 540 minutes) during guideline use and 710 minutes (95% CI = 558 to 862 minutes) before. Appendiceal perforation rate for males was 0.25 (95% CI = 0.14 to 0.36) during guideline use and 0.38 (95% CI = 0.29 to 0.47) before; perforation rate for females was 0.06 (95% CI =,0.05 to 0.17) during guideline use and 0.23 (95% CI = 0.14 to 0.32) before. Helical CT had 92% sensitivity, 97% specificity, and 96% accuracy in diagnosing appendicitis. Conclusions: Helical CT is highly accurate in detecting appendicitis in patients with equivocal ED presentations. The use of a guideline employing selective helical CT was associated with a decline in the time from ED presentation to operative intervention in females. [source] Nonoperative imaging techniques in suspected biliary tract obstructionHPB, Issue 6 2006Frances Tse Abstract Evaluation of suspected biliary tract obstruction is a common clinical problem. Clinical data such as history, physical examination, and laboratory tests can accurately identify up to 90% of patients whose jaundice is caused by extrahepatic obstruction. However, complete assessment of extrahepatic obstruction often requires the use of various imaging modalities to confirm the presence, level, and cause of obstruction, and to aid in treatment plan. In the present summary, the literature on competing technologies including endoscopic retrograde cholangiopancreatography (ERCP), percutaneous transhepatic cholangiopancreatography (PTC), endoscopic ultrasound (EUS), intraductal ultrasonography (IDUS), magnetic resonance cholangiopancreatography (MRCP), helical CT (hCT) and helical CT cholangiography (hCTC) with regards to diagnostic performance characteristics, technical success, safety, and cost-effectiveness is reviewed. Patients with obstructive jaundice secondary to choledocholithiasis or pancreaticobiliary malignancies are the primary focus of this review. Algorithms for the management of suspected obstructive jaundice are put forward based on current evidence. Published data suggest an increasing role for EUS and other noninvasive imaging techniques such as MRCP, and hCT following an initial transabdominal ultrasound in the assessment of patients with suspected biliary obstruction to select candidates for surgery or therapeutic ERCP. The management of patients with a suspected pancreaticobiliary condition ultimately is dependent on local expertise, availability, cost, and the multidisciplinary collaboration between radiologists, surgeons, and gastroenterologists. [source] Diagnosis of pancreatic cancerHPB, Issue 5 2006Fumihiko Miura Abstract The ability to diagnose pancreatic carcinoma has been rapidly improving with the recent advances in diagnostic techniques such as contrast-enhanced Doppler ultrasound (US), helical computed tomography (CT), enhanced magnetic resonance imaging (MRI), and endoscopic US (EUS). Each technique has advantages and limitations, making the selection of the proper diagnostic technique, in terms of purpose and characteristics, especially important. Abdominal US is the modality often used first to identify a cause of abdominal pain or jaundice, while the accuracy of conventional US for diagnosing pancreatic tumors is only 50,70%. CT is the most widely used imaging examination for the detection and staging of pancreatic carcinoma. Pancreatic adenocarcinoma is generally depicted as a hypoattenuating area on contrast-enhanced CT. The reported sensitivity of helical CT in revealing pancreatic carcinoma is high, ranging between 89% and 97%. Multi-detector-row (MD) CT may offer an improvement in the early detection and accurate staging of pancreatic carcinoma. It should be taken into consideration that some pancreatic adenocarcinomas are depicted as isoattenuating and that pancreatitis accompanied by pancreatic adenocarcinoma might occasionally result in the overestimation of staging. T1-weighted spin-echo images with fat suppression and dynamic gradient-echo MR images enhanced with gadolinium have been reported to be superior to helical CT for detecting small lesions. However, chronic pancreatitis and pancreatic carcinoma are not distinguished on the basis of degree and time of enhancement on dynamic gadolinium-enhanced MRI. EUS is superior to spiral CT and MRI in the detection of small tumors, and can also localize lymph node metastases or vascular tumor infiltration with high sensitivity. EUS-guided fine-needle aspiration biopsy is a safe and highly accurate method for tissue diagnosis of patients with suspected pancreatic carcinoma. 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) has been suggested as a promising modality for noninvasive differentiation between benign and malignant lesions. Previous studies reported the sensitivity and specificity of FDG-PET for detecting malignant pancreatic tumors as being 71,100% and 64,90%, respectively. FDG-PET does not replace, but is complementary to morphologic imaging, and therefore, in doubtful cases, the method must be combined with other imaging modalities. [source] Detection and differential diagnosis of hepatic masses using pulse inversion harmonic imaging during the liver-specific late phase of contrast enhancement with levovistJOURNAL OF CLINICAL ULTRASOUND, Issue 4 2002Cem Yücel MD Abstract Purpose The purpose of this study was to investigate whether late-phase pulse inversion harmonic imaging (PIHI) increases conspicuity in hepatic masses, helps to differentiate benign from malignant lesions, and demonstrates a greater number of and smaller metastatic lesions than do conventional (fundamental) sonography and helical CT. Methods Thirty patients (17 women and 13 men; age range, 35,77 years; mean age, 54 years) with known or suspected liver masses were evaluated using both fundamental sonography and contrast-enhanced PIHI during the liver-specific late phase of Levovist. The patients also underwent contrast-enhanced triphasic helical CT examinations within 1 week after sonography. In 4 of the patients, gadolinium-enhanced MRI was also performed as a part of their clinical work-up. Results The increase in the lesions' conspicuity on PIHI compared with fundamental sonography was significantly greater in malignant lesions than in benign lesions (p< 0.001). An echogenic rim was observed on PIHI in 8 (53%) of 15 malignant lesions. The mean number of metastatic lesions visualized on PIHI (5.5 ± 5.3) was significantly higher than the mean number visualized on fundamental sonography (2.5 ± 2.1, p < 0.05). Although lesions as small as 3 mm were observed on PIHI, the mean sizes of the smallest lesions demonstrated using fundamental sonography, PIHI, and helical CT were not significantly different. Conclusions Late-phase PIHI is a useful technique for characterizing hepatic lesions and demonstrating both a greater number of and smaller metastases. It may help to differentiate benign from malignant liver masses and may obviate unnecessary and expensive further imaging. © 2002 Wiley Periodicals, Inc. J Clin Ultrasound 30:203,212, 2002; Published online in Wiley InterScience (www.interscience. wiley.com). DOI: 10.1002/jcu.10053 [source] Western Australian cigarette smokers have fewer small lung nodules than North Americans on CT screening for lung cancerJOURNAL OF MEDICAL IMAGING AND RADIATION ONCOLOGY, Issue 4 2009CP Murray Summary To determine the prevalence of small lung nodules on low-dose helical computed tomography (CT) in a Western Australian cohort of asymptomatic long-term cigarette smokers and to compare this with a large, similarly derived cohort of North Americans from the Mayo Clinic Lung Cancer Screening Trial. Forty-nine asymptomatic long-term cigarette smokers of minimum age 50 years underwent a low-dose 64-slice helical CT of the lungs. Images were viewed on a soft copy reporting station with thin section axial and coronal images, maximum intensity projection images, and advanced image manipulation tools. The prevalence of all nodules was 39%, significantly lower than the Mayo Clinic cohort prevalence of 51% (P < 0.01, Fisher's exact test), despite the use of more advanced imaging technology and image manipulation designed to increase the sensitivity for nodules. The prevalence of small nodules in asymptomatic long-term cigarette smokers in Western Australia is high, though significantly less than that found in a large study in North America. The authors postulate this is due to the relatively low rates of mycobacterium tuberculosis and soil-derived fungal pulmonary infections in Western Australia, as well as a lower degree of urban air pollution. [source] Spontaneous coeliac artery dissectionJOURNAL OF MEDICAL IMAGING AND RADIATION ONCOLOGY, Issue 4 2006B McGuinness Summary A patient with spontaneous coeliac artery dissection that presented as upper abdominal pain is reported. This was diagnosed on contrast-enhanced multislice helical CT. The patient was treated conservatively and follow-up CT showed mild aneurysmal change of the splenic artery and a small splenic infarct. Isolated dissection of the visceral arteries (and, in particular, the coeliac artery) is extremely rare. With such limited evidence, decisions over best management are difficult, but depend on initial severity and progression at follow up. [source] Observation of three cases of temporomandibular joint osteoarthritis and mandibular morphology during adolescence using helical CTJOURNAL OF ORAL REHABILITATION, Issue 4 2004K. Yamada summary, Temporomandibular joint (TMJ) osteoarthritis (OA) is a potential cause of craniofacial deformity. If TMJ OA appears during orthodontic treatment, the mandible usually rotates posteriorly, resulting in an unsatisfactory profile, especially in patients with pre-treatment mandibular retrusion. Although it is important to confirm the kind of TMJ pathosis at the start of orthodontic treatment, the relationship between TMJ OA, condylar remodelling and changes in craniofacial morphology remains unclear because of a lack of longitudinal studies. Elucidating this relationship might allow better prediction of post-treatment craniofacial morphology. In the present case reports, helical computed tomography and cephalometry were used to analyse relationships between the pattern and location of condylar remodelling and the changes in craniofacial morphology in three patients with TMJ OA. [source] Histological diagnosis of mediastinal lymph node metastases from renal cell carcinoma by endobronchial ultrasound-guided transbronchial needle aspirationRESPIROLOGY, Issue 2 2007Takahiro NAKAJIMA Abstract: Evaluation of mediastinal lymphadenopathy in patients with an intrathoracic nodule post malignancy is crucial for the determination of further treatment. Different radiological modalities are available for the detection of mediastinal lymph node metastases such as multidetector helical CT, PET-scan and PET-CT. However, tissue sampling is required for a firm diagnosis. A minimally invasive method of tissue sampling of mediastinal and hilar lymph nodes using direct real-time endobronchial ultrasound-guided transbronchial needle aspiration has been reported. This method is appropriate not only for cytodiagnosis but also for histological diagnosis. This current study reports a case of mediastinal lymph node metastases from renal cell carcinoma successfully diagnosed histologically by endobronchial ultrasound-guided transbronchial needle aspiration. [source] Computed Tomography (CT) of the Lungs of the Dog Using a Helical CT Scanner, Intravenous Iodine Contrast Medium and Different CT WindowsANATOMIA, HISTOLOGIA, EMBRYOLOGIA, Issue 5 2007L. Cardoso Summary The aim of this study was to determine the accuracy of helical computed tomography (CT) for visualizing pulmonary parenchyma and associated formations in normal dogs. CT scan was performed by using intravenous contrast medium and by applying different types of CT windows: soft tissue and lung windows, and high-resolution computed tomography of the lung. This technique allowed, especially with lung window types, a good view of the parenchyma, bronchial tree, vascular structures and pleural cavity. The selected images, with high anatomical quality and tissue contrast, may be a reference for future clinical studies of this organ. Thus, helical CT is a promising non-invasive method of diagnosing a wide variety of pulmonary diseases in dogs. [source] HP36P DOES NEO-ADJUVANT CHEMOTHERAPY AFFECT THE ACCURACY OF HELICAL CT AND CT PORTOGRAPHY FOR PRE-OPERATIVE PLANNING IN HEPATIC COLORECTAL METASTASES?ANZ JOURNAL OF SURGERY, Issue 2007S. Adie Purpose Pre-operative scanning for hepatic colorectal metastases surgery remains a challenge, especially in the age of neo-adjuvant chemo, which has marked biochemical & physical effects on the liver. We investigated helical CT and CT portography as pre-op planning tools. Methodology All patients who had resection of hepatic colorectal metastases between Jan 2004 and June 2006 were included. Patients were divided into those who received neo-adjuvant chemo and those who did not. The number of malignant hepatic lesions found on each scan was compared with those found on histopathology & intra-op ultrasound/examination. Accurate scans (scan lesions = true lesions), over-estimations (scan lesions > true lesions) and under-estimations (scan lesions < true lesions) were recorded. Results 25 patients had pre-op CT portography with neo-adjuvant chemo and 63 without. Accurate scans on a per-patient basis were 2 (8%) for the chemo group vs. 27 (43%) for the non-chemo group, p < 0.002. Notably, there were 17 (68%) over-estimates in the chemo group vs. 25 (40%) in the non-chemo group. There were 6 (24%) vs. 11 (17%) under-estimates respectively. 23 patients had pre-op helical CT with neo-adjuvant chemo and 64 without. Accurate scans on a per-patient basis were 7 (30%) for the chemo group vs. 26 (41%) in the non-chemo group, p = 0.388. There were 8 (35%) over-estimates in the chemo group vs. 12 (19%) in the non-chemo group. There were 8 (35%) vs. 26 (41%) under-estimates respectively. Conclusion While CT portography is useful for detecting occult hepatic metastases, there is evidence that over-estimation of disease is a problem, particularly when neo-adjuvant chemo was used. Helical CT also shows this trend although to a lesser extent. [source] Surgical validation of unenhanced helical computed tomography in acute appendicitis,BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 12 2004K. H. in't Hof Background: Surgery for pain in the right lower quadrant of the abdomen remains a clinical dilemma. This prospective study assessed the accuracy of preoperative unenhanced helical computed tomography (CT) in the evaluation of patients with suspected acute appendicitis. Methods: One hundred and three adult patients with suspected acute appendicitis underwent unenhanced helical CT of the abdomen. Subsequently, all patients underwent laparoscopic inspection of the abdominal cavity by a surgeon who was blinded to the diagnosis suggested by CT. Patients underwent appropriate surgical therapy accordingly. Follow-up was at least 6 weeks. Results: Appendicitis was diagnosed by CT in 83 patients (80·6 per cent). Acute appendicitis was identified during laparoscopy in 87 patients (84·5 per cent). Prospective interpretation of CT images yielded a sensitivity of 95·4 per cent and a specificity of 100 per cent for the diagnosis of acute appendicitis. There were four false-negative scans. In 12 of 20 patients without signs of appendicitis on CT, the scan established the presence of other pathology. At operation no additional pathology was observed in this group and all other diagnoses proved to be correct. Conclusion: Plain helical CT in patients with suspected acute appendicitis provides an accurate diagnosis without the disadvantages of contrast enhancement. Copyright © 2004 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source] Diffuse liver diseases in neonatal and pediatric liver transplant candidates: a pictorial essayCLINICAL TRANSPLANTATION, Issue 4 2010Settimo Caruso Caruso S, Mamone G, Marrone G, Milazzo M, Carollo V, Miraglia R, Maruzzelli L, Minervini MI, Spada M, Riva S, Luca A, Gridelli B. Diffuse liver diseases in neonatal and pediatric liver transplant candidates: a pictorial essay. Clin Transplant 2010: 24: 450,458. © 2009 John Wiley & Sons A/S. Abstract:, A wide spectrum of common and uncommon diffuse liver diseases affecting neonatal and pediatric liver transplant candidates is presented and analyzed using 16 and 64 multi-detector row helical CT (MDCT) and 1.5 T MRI fast imaging. Correlation of imaging findings and explanted liver or histology is illustrated in representative cases. Associated uncommon congenital anomalies are shown. In conclusion, in pediatric liver transplant candidates, 16-MDCT and 1.5 T fast MRI are useful for diagnosis and staging of liver disease, as well as for the evaluation of associated congenital anomalies. [source] | ||||||||||