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Recent Posts

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92
CT Assessment of Pancreatic Cancer: What Are the Gaps in Predicting Surgical Outcomes?

Fowler KJ1.

Excerpt

Pancreatic cancer outcomes remain poor, often despite aggressive surgical management. While surgery is the only option for cure and long-term survival, only about 10% of patients who undergo resection achieve 5-year overall survival in the absence of adjuvant therapy (1,2). The reason for the poor oncologic outcome is likely multifactorial and includes lymph node involvement, micro- or occult metastatic disease, positive surgical margins, or potentially lymphatic or hematogenous spread of tumor after surgical manipulation. Ultimately, these poor oncologic outcomes also indicate a significant gap in the performance of preoperative staging and determination of surgical suitability of these patients. Within this gap, the question of surgical resectability is addressed by Hong et al in this issue of Radiology (3).

DOI: https://doi.org/10.1148/radiol.2018181912

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What are your thoughts?  Any comments?
93
Should contrast CT urography replace non-contrast CT as an investigation for ureteric colic in the emergency department in those aged 65 and over?

Batura D1, Hashemzehi T2, Gayed W3.

Abstract

PURPOSE:
Elderly patients with upper tract urothelial cancer (UTUC) may present with colic and microscopic haematuria, mimicking urolithiasis. Patients presenting to emergency departments with acute ureteric colic are investigated with a CT KUB. CT urography (CTU) identifies UTUC better than a CT KUB. Thus, there is a possibility that a CT KUB may miss UTUC.

METHODS:
We studied patients aged 65 years or over presenting to the emergency department with ureteric colic and microscopic haematuria who had a CT KUB between January 2014 and October 2016. Patients who had both CT KUB and CTU were then compared to determine if CT KUB had missed a UTUC and if the diagnoses were concordant by the two tests. A radiologist independent from the reporting radiologists reviewed images as well as their reports. According to the Health Research Authority, England regulations, we did not obtain an ethical review on a voluntary basis for this retrospective study.

RESULTS:
Four hundred eighty-five patients [228 (47.01%) male and 257 (52.99%) female] had a CT KUB scan over the 34-month period. Their mean age was 74 (SD 6.97) [males 73 (SD 6.42), females 75 (SD 7.42)] years. One hundred eighty-seven scans were normal. Ureteric calculi (167), renal calculi (58) and renal cysts (28) were most frequent diagnoses. The diagnosis was uncertain in 33 patients (6.8%) [16 (48.49%) males and 17 (51.51%) females]. The mean age of this group of patients was 74 (SD 6.64) [males 73 (SD4.43), females 74 (SD7.64)] years. These patients had a CTU for clarity. CTU identified one UTUC not identified by CT KUB (0.2%), corroborated the diagnosis of a ureteric tumour in one patient and excluded UTUC in two others. CTU diagnosed two new bladder tumours and an endometrial tumour. Diagnoses were concordant between CT KUB and CTU in 17 of 33 patients (51.5%).

CONCLUSIONS:
CT KUB scans for patients 65 years and over presenting with ureteric colic is justified. Only a small proportion of patients will subsequently require the higher radiation dose CTU as the probability of missing UTUC is low.

DOI: https://doi.org/10.1007/s10140-018-1620-0

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What are your thoughts? Any comments?
94
Soft-Tissue Imaging in a Human Mummy: Propagation-based Phase-Contrast CT.

Romell J1, Vågberg W1, Romell M1, Häggman S1, Ikram S1, Hertz HM1.

Abstract

Purpose: To evaluate phase-contrast CT as a noninvasive alternative to histology in the study of ancient soft tissue.

Materials and Methods: The imaging was performed between May 8 and June 13, 2017. A mummified human hand from ancient Egypt was imaged in a laboratory phase-contrast CT arrangement with propagation-based imaging. The experimental arrangement for propagation-based imaging included a microfocus x-ray source, a rotation stage for the sample, and an x-ray detector. The mummified hand was imaged in two different modes. First, a CT scan of the whole hand was performed in an overview arrangement. Then, a detailed scan of the tip of the middle finger was performed. With imaging distances tailored for a large magnification and to maximize the phase-contrast signal, the estimated resolution in the final images was 6-9 µm.

Results: The overview CT allowed identification of the tendons of the hand, as well as identification of arteries and nerves in the dehydrated soft tissue. In the detailed phase-contrast setting, virtual histology of the soft tissues of the fingertip could be performed. Blood vessels in the nail bed and the microanatomy of the bone marrow and hypodermis were imaged, and the layers of the skin could be distinguished. Round structures in the adipose tissue were identified as the remains of adipocytes.

Conclusion: Laboratory phase-contrast CT enables imaging of the anatomy and microanatomy of mummified soft tissue with sub-10-µm resolution and may serve as a complement or alternative to the classic invasive histologic methods used in soft-tissue paleopathology.

DOI: https://doi.org/10.1148/radiol.2018180945

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What are your thoughts? Any comments?
95
Journal Club / 3D CT cinematic rendering of mycotic aneurysms.
« Last post by Lilly Kauffman on December 28, 2018, 11:43:06 am »
3D CT cinematic rendering of mycotic aneurysms.

Rowe SP1,2, Chu LC3, Zimmerman SL3, Fishman EK3.

Abstract

Mycotic aneurysms are uncommon but emergent conditions in which infection of a vessel leads to a contained rupture. Progression to frank rupture, thrombosis, distal embolization, and death can occur. The widespread availability of computed tomography (CT) and its ability to obtain high-resolution, contrast-enhanced, volumetric images rapidly has made it the modality of choice for evaluating mycotic aneurysms. Three-dimensional CT visualizations can provide important information to surgeons and interventionalists prior to attempting repair of these lesions. In this case series, we demonstrate the appearance of mycotic aneurysms with the novel 3D CT visualization methodology known as cinematic rendering (CR). CR makes use of a more complex lighting model than has previously been utilized with other 3D CT techniques, allowing for enhanced surface detail and realistic shadowing effects. These features of CR may have utility in evaluating mycotic aneurysms and in pre-procedural/pre-operative planning, although a prospective study definitively evaluating this has not yet been performed.

DOI: https://doi.org/10.1007/s10140-018-1643-6

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What are your thoughts? Any comments?
96
Preoperative Assessment of Coronary Arteries by Cardiac Computed Tomography in Patients with Lung Cancer.

Zhang F1, Chen J2, Yang ZG3, Liu H1.

Abstract
BACKGROUND:
 To retrospectively evaluate characteristics of coronary artery disease (CAD) in patients undergoing lung resection for cancer by using dual-source computed tomography (DSCT), thus increasing our understanding of perioperative evaluation.

METHODS:
 DSCT coronary angiography was performed for perioperative evaluation in 145 patients with non-small cell lung cancer (NSCLC) due to suspected CAD. The imaging characteristics of CAD including extent, distribution and types of plaques, and luminal stenosis and congenial anomalous including origin of coronary arteries and myocardial bridge (MB) were evaluated and compared by sex, smoking behavior, and pathological types.

RESULTS:
 In total, coronary artery plaques were observed in 130 (89.7%) patients. A total of 205 coronary vessels (1.7 ± 1.3 per patient) and 278 segments (2.4 ± 2.3 per patient) were found to have plaques, respectively. The most frequently involved segment were the left anterior descending (LAD) artery (45.4%) and its proximal segment (24.1%) (p < 0.05). Mild narrowing (61.7%) and calcified plaques (52.9%) were most found (all p < 0.001). Types of plaques, luminal narrowing and extent were not significantly different by sex, smoking behavior, or pathological type. Anomalous origination of the right coronary ostium from left sinus was observed in 0.7% of patients. MB was observed in 16.6% of patients.

CONCLUSION:
 Dual-source CT is a useful preoperative noninvasive test for CAD in patients planning to undergo lung resection for cancer.

DOI: https://doi.org/10.1055/s-0038-1668166

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What are your thoughts? Any comments?
97
!! Please Read - About the Board / FAQs
« Last post by Ask the Fish Support on December 05, 2018, 11:48:49 am »
Q. Can I use your image for my publication?
A. Due to the complexity of copyright, we are unable to allow anyone to use our images for any publications.

Q. Will you be making apps for Android devices?
A. We will not be doing so in the near future.
98
!! Please Read - About the Board / Rules
« Last post by Ask the Fish Support on December 05, 2018, 11:47:39 am »
Please follow the rules of this board to ensure that everyone has a great experience.

1. Please post in the appropriate boards.
If your question has to do with CT Scanning, Scan Protocols, or anything that Dr. Fishman should respond to, it should go somewhere under "Ask the Fish Forum".
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2. For all questions relating to a particular case, please post an image or link so that we can see what you're referring to.  If you have a question about a case Dr. Fishman has posted, please make sure to include the link to that case.
3. Everything posted should have to do with CT scanning and general radiology discussion.

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