Multidetector computed tomography of diaphragm: Anatomic variants and diagnostic problems in adult population

AbstractObjectiveAssess the multidetector computed tomography (MDCT) in the anatomic appearance of the diaphragm, its variants and defects.Materials and methodsRetrospective study of 142 scans of patients in their 20s–80s using 64 rows MDCT from January 2010 to March 2011. According to Gale (1986), anterior diaphragm appearance on axial image is classified into type 1: continuous, type 2: discontinuous, and type 3: broad. Sagittal reformatted image is classified into type A: downward slope, type B: upward slope, and type C: flat. According to Caskey et al. (1989), posterior diaphragm defects are classified into type 1: localized defect with maintenance of its continuity, type 2: defect in parallel layers with maintenance of its continuity and type 3: loss of diaphragmatic continuity.ResultsAnterior diaphragm was assessed in 141 cases. On axial images, types 1, 2, and 3 were found in 36.9%, 41.1%, and 22.0% respectively. On sagittal reformatted images, types A, B, and C were found in 32.6%, 41.1%, and 26.2% respectively. One case had Morgagni hernia. Significant relationship between the types at the axial and sagittal images was found (r=0.205, P<0.05). 2.8% Posterior diaphragmatic defects. High significant relationship between the age and diameter of oesphageal hiatus was found (P<0.05).ConclusionThe multiplanar capability of MDCT is adding a new scope of assessment of diaphragm and its variants

The diagnostic role of MDCT enterography in small bowel lesions

AbstractPurposeTo evaluate the role of MDCT enterography in the diagnosis of small bowel diseases.Patient and methodsThirty nine patients suspected to have small bowel diseases were examined with 64 MDCT enterography.ResultMDCT enterography easily diagnosed small intestinal diseases which confirmed with histopathological results, operative data and follow up.ConclusionsMDCT can be used as a front-line imaging and one stop imaging modality for the detection of small bowel diseases. However, biopsy is still the confirmatory diagnostic method

Quantitative validation of the severity of emphysema by multi-detector CT

Objectives: To determine whether MDCT reflects the severity of chronic obstructive pulmonary disease (COPD) compared to the pulmonary function tests (PFTs). Patients and methods: A prospective study included 63 COPD patients. Spirometry was done and included forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC) and the ratio of forced expiratory volume in 1 s over forced vital capacity (FEV1/FVC). Patients were grouped according to GOLD guidelines. MDCT examinations were obtained during full inspiration. The extent of emphysema was quantified by using dedicated software. −950 Hounsfield units (HU) used as the percentage of low-attenuation (%LA) emphysematous areas. Statistical study between PFTs, and CT emphysema extent was performed. Results: The study included 26 females and 37 males with a mean age of 53 years. A moderate significant relationship was found between lung volume less than −950 HU and FVC, FEV1, and FEV1/FVC (p < 0.001). Pulmonary function tests revealed that 23.8% had mild restrictive defect, 14.3% had moderate obstructive defect and 61.9% had severe obstructive defect. A good correlation was observed between the quantitative assessments for the lower lung regions with −950 HU (%LA) and pulmonary function variables (p < 0.001). Conclusion: MDCT results are significantly related to the data of PFTs for defining the severity of emphysema

Reliability of multidetector CT in the diagnosis of cerebrospinal fluid rhinorrhea with operative correlation

Purpose: To evaluate the role of non-contrast multidetector CT (MDCT) reliability in localizing CSF leaks and skull base defects in correlation to operative findings. Materials and methods: Twenty patients clinically diagnosed to have CSF rhinorrhea; 8 spontaneous and 12 post-traumatic patients were evaluated using 64-rows MDCT with slice section 0.6 mm. CT is considered accurate if correctly determine the site and size of bony defect as matched with operative findings. Results: MDCT accurately detected the site of presumed CSF leak in 19 out of 20 cases with sensitivity 95%. Cribriform plate defect is the most common site of defect in 40% of cases with 75% of cases categorized as Keros type II. The consensus image with fair agreement (K = 0.38) shows that coronal reformat has the highest diagnostic performance in 75% of cases while the least diagnostic value is encountered with the axial plane in 15% of cases (p = 0.095). There is almost a perfect agreement (K = 0.810) between the MDCT measurements and operative size of bony defect with minimal difference in 10% of patients (P < 0.001). Conclusion: Non-contrast MDCT is an accurate reliable non-invasive imaging modality for preoperative evaluation of CSF rhinorrhea

Evaluation of acute pulmonary embolism by sixty-four slice multidetector CT angiography: Correlation between obstruction index, right ventricular dysfunction and clinical presentation

Introduction: MDCT pulmonary angiography is the method of choice for the detection of pulmonary embolism (PE). The severity of PE as estimated by the obstruction index (OI) and right ventricular dysfunction (RVD) can be evaluated with MDCT. Objective: To investigate the correlation between the OI, RVD and clinical presentation in patients with acute PE. Methods: Among 70 patients with suspected PE, 35 patients proved to have PE with MDCT. The CT OI and the RV/LV diameter (RVD-ratio) using the four-chamber view of the heart were calculated for PE patients. The cut-off for the OI to detect RVD was constructed using ROC curve. Results: Dyspnea and RVD (RVD-ratio >1) were significantly more common in patients with central pulmonary emboli. The mean OI (35% ± 19%) was significantly higher in patients with dyspnea, tachycardia and obesity. A positive correlation was found between the OI and both the CT pulmonary artery diameter (r = 0.66, p  43% identified more than 90% of patients with RVD (area under the curve on ROC analysis: 0.825; p < 0.001). Conclusion: The mean OI correlated linearly with PA diameter and RVD-ratio. OI > 43% proved to be an independent predictor of RVD

Low dose multidetector computed tomography in localizing the transition zone of Hirschsprung’s Disease: A novel study

Objectives: The objectives of this study were the evaluation of low dose multidetector computed tomography (MDCT) in localizing the site of the transition zone (TZ) of Hirschsprung’s Disease (HD) for preoperative planning. Patients and methods: Twenty-two infants were recruited from pediatric and surgical clinics in Assiut University Hospital and Sohag University Hospital. The recruited patients were sedated before examination. Examinations were done using 64-rows MDCT. Each MDCT examination was reviewed to determine the location and length of the TZ and compared with operative and pathological results. Results were analyzed by chi square test and interobserver agreement using Kappa test. P < 0.05 was considered statistically significant. Results: According to operative and pathological data, the site of the TZ: 17 (77.27%) were of short-segment disease (rectosigmoid HD), 2 (9%) were of long segment (above sigmoid colon), and 3 (13.63%) were of ultrashort segment. A correct diagnosis of TZ by MDCT was made in 19 out of 22 with 82.4% sensitivity and 80% specificity. The site of TZ was concordant in 17. Results yielded a moderate strength of inter-observer agreement in localizing the site of TZ (k = 0.546) and ( P= 0.009). Conclusion: Low-dose MDCT has a good role in localizing the site of TZ of HD in infants

The impact of cyclooxygenase-2 gene polymorphism 899G/C and certain indices on hepatitis C related liver fibrosis

The link between cyclooxygenase-2 (COX-2) gene polymorphisms and liver diseases has been widely reported. Early and precise estimation and staging of hepatic fibrosis are crucial for prognosis and treatment decisions in those patients. We aimed in this study to clarify role of -899G/C polymorphism of COX-2 gene, alteration of CA 19-9 and CA 125 levels, and plasma protein pattern in staging of liver fibrosis comparing them to METAVIR stages of liver fibrosis. We recruited 103 patients with post-hepatitis C liver fibrosis and 42 healthy controls. COX-2 gene polymorphism was detected by PCR- TaqMan probes, while CA19-9, CA125 levels were estimated using quantitative ELISA. Plasma proteins were detected by the capillary electrophoresis method. The results revealed that the frequency of COX-2 -899G/C genotypes GG, GC, and CC were 68.0%, 28.2% and 3.9% in the fibrotic group; 97.06%, 2.4%, and 0.0% in healthy control group respectively. The percent of COX-2 expression for the fibrotic group and the healthy group were 32% and 2.3% respectively. COX-2 expression scores on mild- vs. sever-fibrosis stages (METAVIR stages 1, 2 vs. stages 3,4) were 18.2 %and 81.8% respectively (OR=48.00, 95%CI). The serum level of tested tumor markers were significantly higher in fibrotic patients than in control group (69.40 ±51.82, 13.41 ± 6.49 respectively for CA 19.9 and 59.16 ± 47.23, 10.90 ± 8.36 for CA 125) and in GC/CC genotypes than GG one (116.96 ± 55.00, 33.64 ± 28.39 respectively for CA 19.9 and 101.62 ± 51.29, 27.89 ± 25.51 respectively for CA 125). In conclusion, COX-2 -899 C allele carriers are more vulnerable to develop hepatitis C- related hepatic fibrosis. The combined estimation of CA 19-9 and CA 125 levels are useful for identifying and staging patients with liver fibrosis.Keywords: COX-2 gene polymorphisms, CA 19-9, CA 125, protein electrophoresis, liver fibrosi

Impact of direct-acting antivirals on neuropsychiatric and neurocognitive dysfunction in chronic hepatitis C patients

Abstract Background Hepatitis C virus (HCV) infection is associated with psychiatric and cognitive dysfunctions. We aimed to investigate depression, anxiety, and cognitive function of chronic hepatitis C (CHC) patients before and after treatment with direct-acting antivirals (DAAs). Forty CHC patients (20 non-cirrhotic and 20 cirrhotic) who had undergone DAA treatment in our outpatient clinic and ten controls. We administered the Hospital Anxiety and Depression questionnaires to measure the anxiety and depression symptoms and the Cognitive Abilities Screening Instruments (CASI) to measure the cognitive function at the beginning and 3 months after the end of the treatment. Results Sustained virological response (SVR) was achieved in all patients. Post-treatment anxiety and depression scores showed a significant improvement than pre-treatment ones in CHC patients. Regarding CASI, before and after the treatment, a statistical significance was found in short-term memory (P = 0.001), concentration (P = 0.033), abstract thinking and judgment (P = 0.024), total (P = 0.001) in non-cirrhotic, Also, an improvement was seen in long-term memory (P = 0.015), short-term memory (P < 0.001), concentration (P = 0.024) and total (P = 0.01) in cirrhotic. However, these changes were still impaired in post-treated cirrhotic compared to controls. Conclusions CHC patients' anxiety, depression, and cognitive function partially improved after DAA therapy. Besides, improving the status of CHC, reversibility of cognitive dysfunction in non-cirrhotic patients may indicate the importance of treatment in early stages of liver disease