Severe chest allodynia as an unusual first presentation of hydatid disease. A case report

Background: Cystic echinococcosis (CE) is a worldwide zoonosis and the liver is the most commonly affected organ. Clinical manifestations range from completely asymptomatic cysts to a potential lethal cyst rupture and anaphylaxis. Case presentation: Severe chest allodynia was an unusual clinical presentation of hepatic cyst rupture in the retroperitoneal space, without any other specific symptoms. CE diagnosis was confirmed by computed tomography scan and magnetic resonance. The patient underwent hepatectomy with complete resolution of the neuropathic pain. Conclusions: Retroperitoneal hydatid cyst rupture is a rare event and its clinical manifestation may mimic other chest neuropathies

Lean body weight-tailored Iodinated contrast Injection in obese patient. boer versus James Formula

Purpose. To prospectively compare the performance of James and Boer formula in contrast media (CM) administration, in terms of image quality and parenchymal enhancement in obese patients undergoing CT of the abdomen. Materials and Methods. Fifty-five patients with a body mass index (BMI) greater than 35 kg/m2were prospectively included in the study. All patients underwent 64-row CT examination and were randomly divided in two groups: 26 patients in Group A and 29 patients in Group B. The amount of injected CM was computed according to the patient's lean body weight (LBW), estimated using either Boer formula (Group A) or James formula (Group B). Patient's characteristics, CM volume, contrast-to-noise ratio (CNR) of liver, aorta and portal vein, and liver contrast enhancement index (CEI) were compared between the two groups. For subjective image analysis readers were asked to rate the enhancement of liver, kidneys, and pancreas based on a 5-point Likert scale. Results. Liver CNR, aortic CNR, and portal vein CNR showed no significant difference between Group A and Group B (all P ≥ 0.177). Group A provided significantly higher CEI compared to Group B (P = 0.007). Group A and Group B returned comparable overall subjective enhancement values (3.54 and vs 3.20, all P ≥ 0.199). Conclusions. Boer formula should be the method of choice for LBW estimation in obese patients, leading to an accurate CM amount calculation and an optimal liver contrast enhancement in CT

Half-dose coronary artery calcium scoring. impact of Iterative reconstruction

Purpose: The purpose of this study was to assess the impact of adaptive statistical iterative reconstruction (ASiR) on half-dose coronary artery calcium scoring (CACS) acquisition protocol. Materials and Methods: Between September 2016 and October 2017, 89 patients (54 male patients, mean age 64.6±10.7 y) with a clinically indicated coronary computed tomography angiography were prospectively enrolled. On a 64-row computed tomography scanner, patients underwent a standard CACS protocol (120 kVp, 170 mAs) reconstructed by filtered-back projection, and a half-dose CACS protocol (120 kVp, 85 mAs) reconstructed by ASiR at different percentages, from 10% to 100%, in 10% increments. CACS determinants (Agatston score, number of plaques, volume, and mass), signal-to-noise ratio, contrast-to-noise ratio, and radiation dose of both protocols were calculated. Patient risk categories based on CACS were determined for each protocol, and analysis of risk reclassification of half-dose protocol was performed. Depending on their body mass index (BMI), patients were divided into nonobese (BMI<30 kg/m2) and obese (BMI≥30 kg/m2) groups to investigate the influence of BMI on CACS determinants and risk reclassification. Results: Half-dose protocol reconstructed with ASiR 70% showed no significant differences in any CACS determinant compared with the standard protocol for both nonobese and obese patients (all P≥0.070 and ≥0.066, respectively) and reclassified 1 (1.7%) and 6 (20.0%) patients, respectively, with excellent (κ=0.91) and good (κ=0.74) agreement with standard protocol, respectively. ASiR 70% also resulted in a higher signal-to-noise ratio (1.88±0.78) and contrast-to-noise ratio (7.10±2.73) compared with standard protocol (all P≤0.001). Half-dose protocol provided 52% less radiation dose than standard acquisition (0.31±0.06 vs. 0.64±0.10 mSv; P<0.001). Conclusions: ASIR 70% coupled with reduction of tube current by 50% allowed for significant dose reduction and no detrimental effects on image quality, with minimal patient reclassification in nonobese patients. In obese patients, excessive noise may lead to a clinically significant reclassification rate