Detection rate and efficiency of lymph node assessment with axial and coronal image reading based on 16 row multislice CT of the neck.
ABSTRACT Multislice CT (MSCT) has the advantage of isotropic volumetric data acquisition which allows high resolution data reconstruction in the axial and coronal plane. We evaluate the accuracy and efficiency of coronal reconstruction compared to axial reconstructions of a routinely performed CT scan exemplary in neck lymph node assessment performed on a 16 row MSCT.
Contrast enhanced neck MSCT of 24 patients with known lymphoma were evaluated prospectively for lymph node assessment. 4 blinded readers evaluated the axial and coronal reconstructions of the same patient. Neck lymph nodes larger than 10 mm were evaluated by their anatomical region (deep jugular chain, submandibular, nuchal). Time for axial and coronal image evaluation was assessed. Detection rate was compared with consensus reading as gold standard.
In consensus reading 169 enlarged lymph nodes in the deep jugular chain were found. Detection rate for axial image interpretation was 36.1 % with 54.9 % in coronal reading. Assessing the submandibular lymph nodes (n = 45) axial interpretation revealed 53.9 % with 36.1 % in coronal reading. Evaluation time for axial reading was in all but one reader significantly longer (mean 176 seconds) than in coronal reading (mean 129 seconds).
Coronal image reading improves the detection rate of cranio-caudal oriented structures. Considering representatively neck lymph nodes in the deep jugular chain the image interpretation time is significantly reduced. Still axial reading remains necessary for assessing axially oriented structures such as the submandibular region in the neck.
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ABSTRACT: To evaluate prevalence of mesenteric vascular contact at routine computed tomography (CT) and evaluate its value for distinguishing missed mesenteric masses from adjacent bowel. We identified 18 abdominopelvic CT scans of 9 patients in whom mesenteric masses were missed on the prospective CT reports. We recorded the long-axis diameter of the masses, time interval to eventual detection, and presence of vascular contact (fat plane obscuration) with a mesenteric vessel greater than 1 mm in diameter. We also retrospectively identified 129 consecutive abdominopelvic CT scans of nononcology patients and recorded all locations of vascular contact between a mesenteric vessel greater than 1 mm in diameter and adjacent bowel. In the 18 CT examinations where mesenteric masses were missed, the mean long-axis diameter was 2.9 cm, and time between the initial CT scan and first discovery was 12 months. Mesenteric vessels contacted the masses in 17 (94%) of 18 scans. In the 129 nononcology patients, vascular contact was rarely seen with bowel distal to the proximal jejunum (6 had vascular contact with distal jejunum, 5 with ileum, and 0 with colon). However, the third and fourth duodenal portions showed vascular contact with the superior mesenteric vessels in 36 (28%) and 12 patients (9.4%), respectively, and with the inferior mesenteric vessels in 58 patients (48%). At CT, mesenteric vessels greater than 1 mm in diameter rarely contact bowel other than the duodenum and proximal jejunum; however, they often contact mesenteric masses. At CT scan review, inspection of the mesenteric vessels may facilitate mesenteric mass identification.Journal of Computer Assisted Tomography 01/2008; 32(2):185-90. · 1.58 Impact Factor
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ABSTRACT: In order to investigate whether 1-mm thin slices and multiplanar reconstructions (MPRs) of multi-detector computed tomography (CT) datasets interpreted in addition to isotropic 5-mm thick slices in one session improve the detection of peritoneal carcinomatosis. The abdominal CT datasets of 44 patients with histologically proven tumors of the abdomen or pelvis were retrospectively evaluated for peritoneal carcinomatosis by four radiologists with variable experience (radiologist 1: >or=10 years, radiologists 2 and 3: 1.5 years, radiologist 4: 0.5 years). In three successive steps, the radiologists evaluated first the axial 5-mm slices, second the 1-mm slices, and third the MPRs and rated their diagnostic confidence. Specificity was nearly unchanged for all the four radiologists. Sensitivity improved for the most experienced and the least experienced radiologists and was unchanged for the two readers with intermediate skills. Except for the third step of radiologist 4, no statistically significant differences in diagnostic performance were detected. The diagnostic confidence of all the four readers benefited to variable degrees from interpretation of the 1-mm slices and MPRs. While 5-mm slices are sufficient for the detection of peritoneal carcinomatosis, 1-mm slices and MPRs can improve sensitivity and diagnostic confidence.Abdominal Imaging 02/2008; 34(1):49-54. · 1.91 Impact Factor