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ABSTRACT: The objective of our study was to evaluate the diagnostic impact of slice thickness on the detection of endoleaks at MDCT.
Fifty patients with abdominal aortic aneurysm treated with endovascular repair who had undergone follow-up MDCT were enrolled in this study. Contrast-enhanced images were obtained with a 4-MDCT scanner (1-mm collimation). Images were reconstructed using a 1-mm (set A), 3-mm (set B), or 5-mm (set C) slice width. Each image set was interpreted by two independent readers for the presence of endoleaks and for image quality on a dedicated workstation. Sensitivity, specificity, and positive predictive values of each reading session were compared.
The statistical values obtained with sets A and B were significantly higher (p < 0.001) than those obtained with set C. No statistically significant differences were found between the values obtained with sets A and B.
For the detection of endoleaks at MDCT, the sensitivity of 1- and 3-mm-thick images was significantly higher than that of 5-mm-thick slices. However, no statistically significant differences were found between the 1- and 3-mm image sets; moreover, the use of thinner reconstruction images (1 mm) has the disadvantage of increasing the number of images that must be interpreted and archived.
American Journal of Roentgenology 12/2007; 189(6):1414-20. · 2.78 Impact Factor
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ABSTRACT: To retrospectively determine the sensitivity and specificity of unenhanced, delayed enhanced phase (DEP), and arterial enhanced phase (AEP) multi-detector row computed tomography (CT) for depicting endoleaks during follow-up of endovascular aneurysm repair.
Fifty patients (two women, 48 men; mean age, 72 years) underwent follow-up multi-detector row CT 1, 6, and 12 months after endovascular aneurysm repair. Unenhanced CT was performed with 2.5-mm collimation; 1-mm collimation was used with AEP and DEP examinations. Two independent readers assessed the presence of endoleak in three reading sessions: AEP (session A), unenhanced and AEP (session B), and AEP and DEP (session C). At 6- and 12-month follow-up, a fourth set was included: 1-month unenhanced and AEP (session D). Sensitivity, specificity, and positive predictive value of each session were calculated. Triple-phase multi-detector row CT was the reference standard.
At 1 month, sensitivity, specificity, and positive predictive value, respectively, were 79%, 75%, and 55% for session A; 93%, 97%, and 93% for session B; and 93%, 78%, and 62% for session C. At 6 months, sensitivity, specificity, and positive predictive value, respectively, were 92%, 68%, and 48% for session A; 92%, 100%, and 100% for session B; and 100%, 84%, and 67% for session C. At 12 months, sensitivity, specificity, and positive predictive value, respectively, were 80%, 80%, and 50% for session A; 90%, 98%, and 90% for session B; and 100%, 80%, and 56% for session C. Sensitivity did not significantly differ (P > .05) among reading sessions A, B, and C, whereas specificity and positive predictive values in session B were significantly higher (P < .001). For 6- and 12-month follow-up, no significant differences (P > .05) were found between sessions D and B.
The combination of AEP and unenhanced imaging performed at 1-month follow-up offers improved specificity and positive predictive values compared with AEP alone. DEP imaging does not significantly increase sensitivity for detection of endoleaks, but it does depict low-flow endoleaks not seen at AEP.
Radiology 01/2007; 241(3):915-21. · 5.73 Impact Factor
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12/2004: pages 119-135;
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ABSTRACT: Acute chest pain may represent the initial and/or accompanying symptom in a variety of disease processes that may occur in the cardiovascular system, respiratory system, gastrointestinal tract, or musculoskeletal system. Although clinical history, risk factors, and physical examination are important factors in establishing the etiology of symptoms in patients presenting with acute chest pain, imaging modalities are frequently utilized. Noncardiac causes of acute chest pain are reviewed in this paper with special reference to the most recently published literature and emphasis on acute aortic diseases. Imaging modalities with indication of appropriateness, optimal technique and practical keys for interpretation are discussed.
European Radiology 09/2002; 12(8):1872-85. · 3.22 Impact Factor
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ABSTRACT: Acute chest pain may represent the initial and/or accompanying symptom in a variety of disease processes that may occur in
the cardiovascular system, respiratory system, gastrointestinal tract, or musculoskeletal system. Although clinical history,
risk factors, and physical examination are important factors in establishing the etiology of symptoms in patients presenting
with acute chest pain, imaging modalities are frequently utilized. Noncardiac causes of acute chest pain are reviewed in this
paper with special reference to the most recently published literature and emphasis on acute aortic diseases. Imaging modalities
with indication of appropriateness, optimal technique and practical keys for interpretation are discussed.
European Radiology 07/2002; 12(8):1872-1885. · 3.22 Impact Factor
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ABSTRACT: To compare the diagnostic performance of axial and coronal views in multidetector-row computed tomography (MDCT) of patients with small-bowel obstruction (SBO) or large-bowel obstruction (LBO).
Among 157 patients with clinical and radiographic findings of BO, 73 patients, who underwent MDCT and were found to have surgically proven SBO (49/73) or LBO (24/73), were retrospectively evaluated. Portal-enhanced MDCT was performed using 4 x 2.5-mm collimation; 3-mm-thick axial images were reconstructed with 2 mm of increment. Coronal views were reformatted using 3-mm-thick sections with 1 mm of increment. Three radiologists analyzed axial (session A), coronal (session B), and axial plus coronal images (session C) to identify the site, cause, and type of BO. To correlate surgical findings and MDCT results, the bowel was divided into duodenum, oral jejunum, aboral jejunum, oral ileum, aboral ileum, cecum/ascending colon, transverse colon, descending colon, and sigmoid colon/rectum. The mean diagnostic accuracy and the mean confidence score of each reader and each reading session were calculated.
The diagnostic accuracy of axial images was higher than that of coronal views (P = 0.014) in SBO, whereas no significant differences were found in LBO. The definition of the SBO cause was correctly assessed in 45 of 49 patients during session A, in 40 of 49 during session B, and in 45 of 49 during session C. In patients with LBO, the cause was correctly assessed in 21 of 24 patients during session A and in 22 of 24 patients during sessions B and C. All readers interpreted axial plus coronal images with a significantly higher confidence level than axial or coronal views alone, either for the detection of the site (P = 0.002) or for the identification of the cause (P < 0.001) of SBO and LBO.
The MDCT allowed accurate detection of the site and the cause of obstruction. In SBO, axial images yielded a higher diagnostic accuracy than coronal views, whereas in LBO, no differences were found between axial and coronal planes. The reading of axial plus coronal views significantly improved diagnostic confidence.
Journal of Computer Assisted Tomography 31(4):499-507. · 1.22 Impact Factor
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ABSTRACT: To assess serial changes in liver tumors after percutaneous radiofrequency ablation at follow-up multidetector-row computed tomography.
Forty patients with 65 malignant lesions underwent multidetector-row computed tomography immediately, 1 month and every 3 months, up to a maximum of 15 months after radiofrequency ablation. The computed tomography (CT) appearance of the treated lesions (non-enhanced attenuation, enhancement pattern, shape and size) was assessed at each follow-up. The relationship between each CT finding and the treatment outcome was evaluated by chi2 test (P < 0.05).
No significant differences were found in lesion shape and in non-enhanced CT attenuation between successfully and unsuccessfully treated lesions, whereas over time change of lesion size was significantly different. The no enhancement and nodular enhancement pattern prevalence was significantly (P < 0.0001) different between successfully and unsuccessfully treated lesions, whereas non-nodular enhancement pattern did not show any relationship with the treatment outcome.
Lesion size increase and nodular enhancement pattern resulted significantly related to the treatment failure.
Journal of Computer Assisted Tomography 31(1):42-52. · 1.22 Impact Factor
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ABSTRACT: To assess the frequency and clinical impact of extravascular incidental findings on routine CT angiography of abdominal aorta or lower extremity arteries.
From January 2002 to July 2004, a total of 692 patients underwent CT angiography of abdominal aorta and lower extremity arteries. Two radiologists retrospectively reviewed by consensus cross-sectional images for the presence and clinical impact definition of extravascular findings. The revision of hospital charts, medical records, and all procedures' reports performed before and after CT angiography represented the standard of reference (SOR).
Only 373 out of 605 patients in whom extravascular findings were found had a SOR; in these patients CT angiography obtained a true-positive incidental rate of 98.9% (369/373). For the clinical impact definition of CT-angiography incidental findings, a concordance with SOR was obtained in 56.3% of patients, whereas a subsequent investigation was required in 183 patients (183/369, 49.6%). Among clinically relevant incidental findings, a total of 35 malignancies (35/894, 3.9%) were detected in 20 patients (20/423, 4.7%); in 15 patients (15/423, 3.5%) malignancy was unknown before CT-angiography exam.
A careful observation of cross-sectional images, even if "time consuming", is mandatory not only to assess vascular findings but also to avoid a misdiagnosis of clinical relevant extravascular findings.
Abdominal Imaging 32(4):489-94. · 1.73 Impact Factor
