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ABSTRACT: We evaluated the diagnostic value of high-resolution computed tomography (HRCT) images generated from 64 detector multi-slice CT scanners (HRCT(64-MSCT) imaging) in relation to primary graft dysfunction (PGD) after lung-transplantation (LUTX) in a pilot study. PGD has mortality rates ranging from 17 to 50% over a 90-day period. Detailed HRCT lung images, reconstructed using 64-MSCT, may aid diagnostic and therapeutic efforts in PGD. Thirty-two patients were scanned four times within a year post-LUTX, in a single-centre prospective study. HRCT lung images were reviewed, evaluated and scored by two observers, for ground-glass (GG) opacities, consolidation, septal thickening (ST) and pulmonary embolism. Image and PGD scores were compared in each patient. GG and consolidation changes were largely present up until 2 weeks post-LUTX, and markedly reduced by the 12th week. ST was predominantly found in patients with PGD. There were no vascular changes found at CT angiographies. The most severe cases of GG opacities and consolidation were found in patients with PGD. ST seems to be an important indicator of PGD. HRCT(64-MSCT) imaging may be a useful tool for the identification of pathological features of PGD not detected by classical evaluation in patients undergoing LUTX.
Interactive cardiovascular and thoracic surgery 02/2012; 14(6):785-91.
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ABSTRACT: To evaluate contrast-enhanced ultrasound (CEUS) and compare it to ultrasound (US) and 64-slice-CT (64-CT) for diagnosing, staging and evaluation of resectability of pancreatic cancer.
US, CEUS and 64-CT were performed in 49 consecutive patients with pancreatic head tumors and with suspected cancer. After evaluation 44 patients had pancreatic head adenocarcinoma and 5 had chronic pancreatitis, all confirmed by histology.
The sensitivity of US, CEUS and 64-CT for diagnosing malignant pancreatic head tumors was 89%, 86% and 93%, respectively, and the overall accuracy was 82%, 86% and 88% respectively. There was no significant difference in the malignant tumor size measurement between US and CEUS (p = 0.3619) or between US and 64-CT (p = 0.2129), but a significant difference was seen in the size measured by CEUS and 64-CT (p = 0.0197). The CEUS measurements on the tumor size were smaller. The overall accuracy for M staging of the patients who had surgery for adenocarcinoma was 86% and 90% for US + CEUS and 64-CT, respectively. By performing the CEUS and 64-CT we additionally found, respectively, 35% and 45% non-resectable patients of a group of patients, who were considered resectable on the primary radiological image material.
CEUS may be a useful diagnostic tool in the diagnosis and staging of pancreatic head tumors. For the assessment of resectability CEUS did not prove useful. However, CEUS seemed very useful as an additional instrument in the detection of non-resectable patients already considered resectable on primary radiological image material.
Scandinavian journal of gastroenterology 05/2010; 45(7-8):917-24. · 2.08 Impact Factor
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ABSTRACT: Planar ventilation/perfusion (V/Q) scintigraphy is currently the standard method for the diagnosis of pulmonary embolism (PE) in most nuclear medicine centers. However, recent studies have shown a superior sensitivity and specificity when applying V/Q single photon emission computed tomography (SPECT) in diagnosing PE. This study evaluated the diagnostic performance of three-dimensional V/Q SPECT in comparison with planar V/Q scintigraphy.
Consecutive patients suspected of acute PE from June 2006 to February 2008 were referred to the Department of Nuclear Medicine at Frederiksberg Hospital, Denmark to a V/Q SPECT, as the first-line imaging procedure. Patients with positive D-dimer (>0.5 mg/l) or after clinical assessment with a Wells score of more than 2 were included and had a V/Q SPECT, low-dose CT, planar V/Q scintigraphy, and pulmonary multidetector computer tomography angiography performed the same day. Ventilation studies were performed using Kr. Patient follow-up was at least 6 months.
A total of 36 patient studies were available for analysis, of which 11 (31%) had PE. V/Q SPECT had a sensitivity of 100% and a specificity of 87%. Planar V/Q scintigraphy had a sensitivity of 64% and a specificity of 72%.
We conclude that V/Q SPECT has a superior diagnostic performance compared with planar V/Q scintigraphy and should be preferred when diagnosing PE.
Nuclear Medicine Communications 11/2009; 31(1):82-6. · 1.40 Impact Factor
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ABSTRACT: We have reviewed and discussed current knowledge on existing scoring systems regarding high resolution computed tomography (HRCT) images for the assessment of primary graft dysfunction (PGD) after lung transplantation. Adult respiratory distress syndrome (ARDS) has been more widely studied and appears to have many morphological features similar to what is found in PGD, and might, therefore, be usefully extrapolated to PGD. Principles of HRCT, scoring systems based on HRCT and various terms describing PGD were reviewed and summarized. The sensitivity, inter-intra observer variability, and reproducibility of these systems were discussed. Lastly, the future perspectives for 64-multi-slice computed tomography (MSCT) in relation to PGD were discussed. Few studies on scoring systems of lung tissue by HRCT in ARDS patients and idiopathic pulmonary fibrosis (IPF) patients were found. Most studies were performed on patients with cystic fibrosis (CF). Sensitivity of HRCT for the detection of parenchymal changes is superior to other imaging methods. High levels of reproducibility are achievable amongst observers who score HRCT lung images. Development of standardized criteria that specify the inclusion/exclusion criteria of patients, pilot testing, and training investigators through review of disagreements, were possibilities suggested for decreasing inter/intra observer variability. Factors affecting the image attenuation (Hounsfield numbers) and thus, the reproducibility of CT densitometric measurements were of minimal influence. Studies have reported on how lung tissue images, derived by HRCT, can be scored and graded. There does not seem to be a golden standard for evaluating these images, which makes comparison between methods challenging. These scoring systems assess the presence, severity, and extent of parenchymal change in the lung. HRCT is considered relevant and superior in evaluating disease severity, disease progression, and in evaluating the effects of therapy regimes in the lung. It is, however, not clear to what extent these scoring methods may be implemented for grading PGD. Further efforts could be made to standardize scoring methods for lung tissue with regards to PGD.
Interactive cardiovascular and thoracic surgery 09/2009; 9(5):859-67.
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The Clinical Respiratory Journal 07/2007; 1(1):52-5. · 1.06 Impact Factor
