Diagnosis of acute mesenteric ischemia/infarction in the era of multislice CT

Acute mesenteric ischemia/infarction is a complex and often misdiagnosed syndrome. The availability of new imaging methods, namely multislice computed tomography, has enabled early recognition of signs and symptoms of acute mesenteric ischemia, resulting in timely therapeutic intervention

Role of computed tomography in the diagnosis of acute lung injury/acute respiratory distress syndrome.

7Acute lung injury/acute respiratory distress syndrome (ALI/ARDS) is a complex pulmonary pathology with high mortality rates, manifesting over a wide range of severity. Clinical diagnosis relies on the following 4 criteria stated by the American-European Consensus Conference: acute onset of impaired gas exchange, severe hypoxemia defined as a PaO2 to FiO2 ratio <300 (PaO2 in mmHg), bilateral diffuse infiltration on chest X-ray; pulmonary artery wedge pressure of !18 mmHg to rule out cardiogenic causes of pulmonary edema. The aim of this study was to determine the usefulness of CT in the diagnosis and management of this condition.noneMazzei MA; Guerrini S; Cioffi Squitieri N; Franchi F; Volterrani L; Genovese EA; Macarini LMazzei, Ma; Guerrini, S; Cioffi Squitieri, N; Franchi, F; Volterrani, L; Genovese, EUGENIO ANNIBALE; Macarini, L

Role of computed tomography in the diagnosis of acute lung injury/acute respiratory distress syndrome

Acute lung injury/acute respiratory distress syndrome (ALI/ARDS) is a complex pulmonary pathology with high mortality rates, manifesting over a wide range of severity. Clinical diagnosis relies on the following 4 criteria stated by the American-European Consensus Conference: acute onset of impaired gas exchange, severe hypoxemia defined as a PaO2 to FiO2 ratio <300 (PaO2 in mmHg), bilateral diffuse infiltration on chest X-ray; pulmonary artery wedge pressure of ≤18 mmHg to rule out cardiogenic causes of pulmonary edema. The aim of this study was to determine the usefulness of CT in the diagnosis and management of this condition

Preoperative MDCT assessment for lymphatic gastric cancer spread in the era of neoadjuvant treatment

Purpose: To validate the feasibility and accuracy of MDCT for the preoperative lymphatic gastric cancer spread. Material and Methods: 104 patients with primary gastric cancer (mean age 68.67 years) who consecutively underwent MDCT scan followed by radical surgical treatment were prospectively evaluated. Regional lymph nodes were considered involved when the short-axis diameter was >5mm for the lymph nodes of group 1 and >8mm for the lymph nodes of other group according to the Japanese Classification of Gastric Carcinoma. All patients underwent a radical lymph node dissection (D2-D3) according to Japanese Research Society for Gastric Cancer (JRSGC) guidelines. The removal of nodal stations was always preceded by Indian-ink injection in the lesser and greater curvature of the stomach; after operation, single lymph nodes were retrieved on the fresh specimen by the surgeon, and classified in JRSGC nodal stations for pathological examination. Results: Lymph node invasion was found in 85 cases (81.73%) with a MDCT sensitivity and specificity of 89% and 85%, respectively. The rate of understaging was higher (15%) than that of overstaging (8%). Lymph node status of early forms was correctly staged in all cases. Furthermore, all N3 cases were correctly staged. Conclusion: MDCT is a useful technique in the preoperative assessment of lymphatic cancer spread and could have a positive impact in clinical decision making in the era of neoadjuvant treatment

The role of US examination in the management of acute abdomen

Acute abdomen is a medical emergency, in which there is sudden and severe pain in abdomen of recent onset with accompanying signs and symptoms that focus on an abdominal involvement. It can represent a wide spectrum of conditions, ranging from a benign and self-limiting disease to a surgical emergency. Nevertheless, only one quarter of patients who have previously been classified with an acute abdomen actually receive surgical treatment, so the clinical dilemma is if the patients need surgical treatment or not and, furthermore, in which cases the surgical option needs to be urgently adopted. Due to this reason a thorough and logical approach to the diagnosis of abdominal pain is necessary. Some Authors assert that the location of pain is a useful starting point and will guide a further evaluation. However some causes are more frequent in the paediatric population (like appendicitis or adenomesenteritis) or are strictly related to the gender (i.e. gynaechologic causes). It is also important to consider special populations such as the elderly or oncologic patients, who may present with atypical symptoms of a disease. These considerations also reflect a different diagnostic approach. Today, surely the integrated imaging, and in particular the use of multidetector Computed Tomography (MDCT) has revolutionised the clinical approach to this condition, simplyfing the diagnosis but burdening the radiologists with the problems related to the clinical management. However although CT emerging as a modality of choice for evaluation of the acute abdomen, ultrasonography (US) remains the primary imaging technique in the majority of cases, especially in young and female patients, when the limitation of the radiation exposure should be mandatory, limiting the use of CT in cases of nondiagnostic US and in all cases where there is a discrepancy between the clinical symptoms and negative imaging at US

Accuracy of MDCT in preoperative definition of maximum tumor diameter in patients with gastric cancer

purpose: The maximum tumor diameter (Dmax) is a prognostic factor in patients with gastric cancer, considering its dependance on the depth of invasion. The aim of our work has been to evaluate the accuracy of MDCT in the preoperative definition of Dmax in patients with gastric cancer, assuming surgical specimen measurements as gold standard, in order to obtain a pre- surgery prognostic evaluation. material and methods: Pre-surgery CT examinations of 47 patients (mean age 53.5, range 48-71) with diagnosis of gastric cancer were evaluated retrospectively and in a blind fashion by a radiologist with expertise in the oncologic field. The Dmax measured was obtained through 2D multiplanar curved reconstruction (ADW 4.6 GE Healthcare). The results were compared with macroscopic data after surgery.results: The mean value of Dmax obtained by surgical specimen was 50 mm (range 30-60) versus 63 mm (range 46-92) of Dmax measured through MDCT. If the Dmax values were stratified in three groups (group 1 smaller than 40 mm, group 2 between 40 and 80 mm, group 3 bigger than 80 mm), a correlation with MDCT results of 25%, 62% and 71%, respectively, was found. Conclusion: MDCT is an accurate technique to obtain an appropriate preoperative definition of Dmax, within the limits of tumor bigger than 40 mm. The revaluation of each case with Dmax smaller than 40 mm will supply additional information about the discrepancy (retraction of the stomach following immersion into formalin, diffusion in the submucosal layer)

Quantitative CT perfusion measurements in characterization of solitary pulmonary nodules: new insights and limitations

Although computed tomography (CT) scans remain the basis of morphologic evaluation in the characterization of solitary pulmonary nodules (SPNs), perfusion CT can represent an additional feasible technique offering reproducible measurements, at least in SPNs with a diameter >10 mm. In particular, CT perfusion could reduce the number of SPNs, diagnosed as undetermined at morphologic CT, avoiding long term follow-up CT, FDG-PET studies, biopsy or unnecessary surgery with a significant reduction in healthcare costs. In order to reduce the radiation dose, an optimization of the CT perfusion protocol could be obtained using axial mode acquisition, using shorter acquisition time and adaptative statistical iterative reconstruction algorith

Restaging patients with N2 non-small cell lung cancer after neoadjuvant therapy: TCMS accuracy using a multi-criteria approach

An appropriate staging of lung cancer is critical, because stage dictates treatment and treatment regimens vary considerably according to the stage. The involvement of mediastinal lymph nodes has long been recognized as the most important prognostic factor in non-metastatic non-small cell lung cancer (NSCLC). It is very important to correctly identify preoperative patients with N2 disease (stage IIIA), because for these patients surgery should be avoided offering instead a multimodality approach [4]. Computed tomography (CT) is the method of choice in the preoperative staging of patients with NSCLC. In the CT assessment of mediastinal lymph nodes the majority of the studies use the size of the node as the only criterion suggestive of malignancy, thus limiting the usefulness of such method in comparison with PET. Considering our previous study on this topic, the aim of this work has been to evaluate the accuracy of MDCT in restaging patients with N2 NSCLC, after neoadjuvant chemotherapy using a multi-criteria approach