Evaluation of Aortic Disease with Spiral CT Angiography and Multiplanar Reconstructions: Comparison with Catheter Angiography

Purpose: To assess the usefulness of spiral CT angiography (CTA) in the evaluation of aortic aneurysm (AA) or dissection (AD). Methods: Ninety-eight patients with AA (n = 78) or AD (n = 20) were examined with CTA. Imaging results were correlated with angiographic (n = 98) findings in all cases and surgical findings in AA cases (n = 64). The spiral CT angiography were analyzed by an experienced radiologist without knowledge of the result of the catheter angiography, to evaluate the same features. The catheter angiograms were individually interpreted by two experienced radiologists. Results: In AA, all of major aortic branches were depicted on CTA except two of seven accessory renal arteries and six of 26 inferior mesenteric arteries. CTA correctly assessed aneurysm involvement of left subclavian (LSA), renal (RA), and iliac arteries (IA) in all patients. In AD, CTA correctly assessed Stanford classification in all patients, and the relationship between 70 major aortic branches and true/false lumen in all but two branches. CTA showed 23 of 30 intimal tears in double barreled AD. Conclusion: CTA might replace catheter angiography in evaluation of AA and AD except in cases of type A dissection. Index Terms: computed tomography - CT angiography - aorta, aneurysm - aorta, dissection - Catheter angiograph

Multidetector-Row CT in Patients with Suspected Obstructive Jaundice: Comparison with Non-Contrast MRI with MR Cholangiopancreatography

We compared the diagnostic accuracy of multidetector-row computed tomography (MDCT) with multiplanar reconstruction (MPR) images to non-contrast magnetic resonance imaging (MRI) with magnetic resonance cholangiopancreatography (MRCP) (MRI/MRCP) for evaluating obstructive jaundice. MDCT and MRI/MRCP images from 53 patients with suspected obstructive jaundice were interpreted by two radiologists. These readers evaluated the images to determine level of obstruction, to differentiate between benign and malignant lesions, and to state the first-choice diagnosis with degree of confidence. We analyzed the obstruction levels in 50 patients excluding 3 patients who did not undergo direct cholangiography (DC). Both MDCT and MRI/MRCP showed almost perfect agreement with DC in two readers (statistic weighted kappa?0.80) in the determination of obstruction level. The mean area under the receiver operating characteristic curve for differentiating benign from malignant lesions was significantly (p=0.02) larger in MDCT (0.98) than in MRI/MRCP (0.86). We analyzed the first-choice diagnoses for 39 patients excluding 14 patients without final diagnosis confirmed. Readers had, out of 78 interpretations, a high confidence level in their first-choice diagnoses for 44 (56%) and 23 (29%) interpretations using MDCT and MRI/MRCP, respectively. In the interpretations made with high confidence level, 98% (43/44) and 91% (21/23) were correct for MDCT and MRI/MRCP, respectively. In conclusion, MDCT with MPR images is as accurate as MRI/MRCP for evaluating the biliary duct obstruction level, and has high diagnostic accuracy in evaluating the cause of jaundice. MDCT can provide sufficient information on the level of biliary obstruction and cause of obstructive jaundice