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PubMed1979

The Mini-Mental State Test and computerized tomography.

In order to evaluate the clinical usefulness of the Mini-Mental State (MMS) test, the authors had 63 patients complete the test after undergoing computerized tomographic (CT) scans of the brain. Patients with positive CT scans scored significantly lower than those with negative CT scans. Further analysis showed that cerebral atrophy was more closely related to cognitive impairment than focal cerebral lesions only. The authors conclude that the MMS can discriminate organicity in some instances but that further refinement and modification of its subtests are needed for maximum usefulness.

Aged↗
PubMed1983

[Tomodensitometric study of the course of supratentorial malignant glioma after treatment].

Computed tomography now is the primary method for the management of supratentorial malignant gliomas. In this study, analysis of CT scan controls done at 2 or 3 month intervals in 87 treated patients showed that: 1) in most instances, recurrence arose within the initial tumor site; 2) the tumor invades contiguous anatomical structures through intra-and inter-hemispheric association fibers; 3) multicentric gliomas are uncommon (less than 6% of patients). The purpose of this study was to reduce irradiated volumes and thus radiation toxicity. The finding that most patients experience recurrence within the original tumor site is evidence experience recurrence within the original tumor site is evidence that current radiation doses and total brain irradiation are inappropriate. Our results are consistent with those recently reported in the medical literature. Using computed tomography data, it should be possible to restrict the irradiated volume to the tumor site and to presumptive extension pathways. Higher doses may be delivered to this volume.

Adolescent↗
PubMed1995

Role of ventriculoperitoneal shunt in post-tuberculous meningitic hydrocephalous.

Thirty-two patients with post-tuberculous meningitic hydrocephalous were admitted. Thirty were subjected to ventriculoperitoneal shunt. Diagnosis was based on CSF analysis and CT scan. Five patients at a Glasgow Coma Score of 3-7 underwent an external ventricular drainage as an initial procedure followed by shunt in 3 patients when condition improved, 17 patients who were conscious at the time of admission made good recovery as compared to 13 patients with altered consciousness who either died (5 patients), or were disabled (8 patients) even after surgery. A mortality of 22% was noted. An early detection and referral is desired to improve the prognosis.

Adolescent↗
PubMedDate not supplied

[Acute catatonia and neuroleptic malignant syndrome. A case of infantile psychosis].

Similar clinical and biological features in lethal catatonia (LC) and neuroleptic malignant syndrome (NMS) suggest a relationship between both affections and common physiopathologic mechanisms. Pharmacological effects of several drugs--dopaminergic agonists, benzodiazepines, carbamazepine--suggest an impairment of several systems of neurotransmitters. We report the case of a young woman with infantile psychosis who developed catatonic syndrome worsened by neuroleptic treatment, arising the problem of the chronology of both affections. The evolution with treatment may partially explain the physiopathology. A 18-year old woman with an history of infantile psychosis, experienced insomnia, anorexia, paradoxical agitation developed after affective traumatism (mother's hospitalization). Chlorazepate (150 mg) remained inefficient and hospitalization was necessary. The patient was dumb, prostate in bed. She presented negativism, rigidity of the four limbs, catalepsia and hyperpyrexia (38.5 degrees C). Hepatic transaminases were increased (SGOT: 71 UI/l; N < 30). After cumulated dose of levomepromazine (100 mg) profuse sudation, thermic and cardiovascular instability, alteration of consciousness, major rigidity of limbs appeared. (Blood) hepatic transaminases and muscular enzymes increased. Bacteriological samples, cerebrospinal fluid analysis, CT-scan and EEG were normal. Within 48 hours after rehydratation and bromocriptine (30 mg per day) alteration of consciousness and autonomic disorders decreased but hyperpyrexia (38 degrees C) persisted. Biological parameters were normalized 10 days later. Negativism and psychomotor inertia remained. Lorazepam (3 mg per day) failed to be clinically beneficial. On carbamazepine (600 mg per day) she started speaking and moving spontaneously. Catalepsia disappeared but rigidity and anorexia persisted. Electroconvulsivotherapy (ECT) was necessary. After 2 shocks she started standing up, walking, taking food and speaking fluently.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1993

Considerations in treatment planning for implant-supported auricular prostheses.

Improvements in planning for the provision of silicone auricular prostheses have been achieved with CT scanning. The analysis of information using a computer workstation has enabled preoperative determination of skull thickness and position of implants in relation to the proposed location of the prosthesis. The technique is of particular value in cases of craniofacial microsomia.

Ear, External↗
PubMed1998

[A case report of neoadjuvant intra-arterial injection chemotherapy combined with peripheral blood stem cell reinfusion in an advanced breast cancer patient].

A seventy-one year-old woman suffered from Stage IIIb advanced breast cancer complicated with direct thoracic invasion and skin eruption. An indwelling intra-arterial catheter was inserted into the subclavian artery for the administration of anti tumor agents. After three courses of neoadjuvant chemotherapy combined with G-CSF and/or PBSCT reinfusion, the breast cancer revealed a remarkable size reduction and was absent from direct thoracic and pectoral muscle, invasion within the physical status and visual analysis by CT scan. Thereafter, the patient underwent a radical mastectomy. In the pathological findings of the operation specimen, despite a remarkable tumor collapse, the microscopic invasion remained in the shallow layer of the pectoral muscle. Thus, the patient should be given additional postoperative irradiation. The patients has had six months of stable tumor-free survival since the mastectomy.

Aged↗
PubMed1999

A dynamic model for the estimation of optimum timing of computed tomography scan for dose evaluation of 125I or 103Pd seed implant of prostate.

PURPOSE/OBJECTIVE: The dosimetric evaluation of permanent 125I or 103Pd prostate implant is based on the assumption that both prostate and seeds are static throughout the entire treatment time which lasts months. However, the prostate is often edematous after the surgical implantation of seeds. Therefore, both the volume of the prostate and the seed locations change dynamically as the edema resolves. This effect has impact on the validity of postimplant analysis based upon a CT scan. If a CT scan is taken too early after implantation while there is edema in the prostate, the dose delivered by the implant may be underestimated. If the imaging is delayed too long, the dose may be overestimated. The magnitude of this effect depends on both of the half-life of the isotope used and the half-life and magnitude of the edema. This study describes a dynamic biomathematical model which takes edema into account in calculating the dose delivered by the implant and is used to investigate the optimum time to obtain the postimplant CT scan. MATERIALS AND METHODS: The dynamic biomathematical model is a numerical integration of the accumulated dose in which the prostate dimensions, the seed locations, and the source strength are all functions of time. The function which describes the change in prostate dimensions and seed locations as a function of time was determined in a separate study by analysis of serial postimplant CT scans. Dose-volume histograms (DVH) of the prostate for the total dose generated by the dynamic model are compared to DVHs generated by CT scans simulated for postimplant intervals ranging from 0 to 300 days after the implantation for 30 different combinations of the magnitude and duration of edema. RESULTS: DVHs of the prostate calculated by taking edema into account show that the time of obtaining a CT scan for postimplant analysis is critical to the accuracy of dose evaluations. The comparison of the DVHs generated by the dynamic model to those generated by the CT scans simulated for a range of postimplant intervals show that obtaining the CT scan too early tends to underestimate the total dose while obtaining the CT scan after the edema is resolved tends to overestimate it. The results show that the optimum timing of the CT scan depends upon the duration of the edema and the half-life of the radioisotope used. It is almost independent of the magnitude of the edema. Thus, a unique optimum time window for the imaging study cannot be defined for either 125I or 103Pd implants. However, an optimum time window can be identified for which the calculated dose, on the average, will generally differ from the actual dose by less than 5%, with a maximum error not exceeding 15%. Such a window is 4 to 10 weeks after the implantation for an 125I implant, and 2 to 4 weeks for a 103Pd implant. CONCLUSIONS: A dynamic biomathematical model to correct for the effects of edema in calculating the total dose delivered by an 125I or 103Pd seed implant has been developed. The model has been used to investigate the optimum time window during which the postimplant CT scans for analysis should be obtained.

Brachytherapy↗
PubMed1994

[A case of bronchiolitis obliterans organizing pneumonia: diagnostic utility of bronchoalveolar lavage and CT scan].

A 54-year-old female was admitted to our hospital because of abnormal shadows on chest X-ray at annual checkup. She complained of dyspnea on exertion. Chest X-ray findings showed an increase in density at the bilateral lower lung fields and unclearness of the silhouette of the heart and the diaphragm. CT scan findings revealed irregular opacities of various density with many small cystic changes and air bronchograms and air bronchiolograms. The pulmonary function test showed restrictive ventilatory disturbance and reduced diffusing capacity. BALF findings revealed an increase in the total cell count, an increase in the percentage of lymphocytes and a decrease in the OKT4+/OKT8+ ratio. TBLB specimen showed infiltration of mononuclear cells in alveolar septa and organizing exudate in alveolar ducts. These findings suggested a diagnosis of BOOP rather than IPF, and an open lung biopsy was performed. Open lung biopsy specimen showed obstructive bronchiolitis with polypoid granulation tissue and thickening of alveolar septa with infiltration of mononuclear cells, and she was diagnosed as having BOOP. She responded well to corticosteroid and is free from any abnormalities on chest X-ray, CT scan and pulmonary function test at present. Analysis of BALF and CT scan findings are useful for the differential diagnosis of BOOP and IPF.

Bronchoalveolar Lavage Fluid↗
PubMed2002

A model to simulate day-to-day variations in rectum shape.

PURPOSE: To develop a model that predicts possible rectum configurations that can occur during radiotherapy of prostate cancer on the basis of a planning CT scan and patient group data. MATERIALS AND METHODS: We used a stochastic shape description model with a limited number of parameters (area, area difference, and curvature) on a slice-by-slice basis to simulate rectum motion. The probability distributions of the chosen parameters were obtained from a group of 9 reference patients, who each received 15-17 repeat CT scans. We used a Monte Carlo technique to generate different rectum configurations from the probability distributions. We verified the model by comparing dose-wall histograms (DWHs) of the originally delineated rectal contours and simulated rectums for a three-field treatment technique with a prescription dose of 78 Gy. The 15-17 sets of rectal contours of each patient are regarded as the golden standard and provide a good estimate of the actual dose received during the treatment. We determined the equivalent uniform dose (EUD) for a quantitative comparison between the actual dose, the dose predicted on the basis of the simulations, and the dose predicted on the basis of a single planning CT scan. RESULTS: The simulated rectum configurations yield a better estimate of the actual dose in the rectal wall than the rectum in the planning CT scan alone. The differences between the EUD based on the planning CT scan and the actual EUD ranged between -1.1 Gy and 2.1 Gy, with respect to a mean actual EUD of 69.8 Gy. This range is smaller for the EUD based on the simulated rectums, namely -0.4 Gy to 0.6 Gy. Furthermore, the simulation generates a set of rectum configurations that provides an estimate of the variation in DWHs during the course of the treatment. This estimate can be used in addition to the DWH of the planning CT scan in the analysis of gastrointestinal toxicity. CONCLUSIONS: To simulate rectum shapes, we have developed a model that can be used in addition to the information available in the planning CT scan in the analysis of the received dose to the rectal wall during radiotherapy of prostate cancer.

Algorithms↗
PubMedDate not supplied

Cost analysis in the diagnosis of chronic rhinosinusitis.

BACKGROUND: The present treatment regimen for a diagnosis of chronic rhinosinusitis involves a prolonged course of antibiotic therapy along with other adjunctive therapy. The decision to start treatment is made after diagnosis of chronic rhinosinusitis, which is based on subjective symptoms. The working hypothesis of this study is that the diagnosis based on subjective symptoms is inaccurate, leading to inappropriate antibiotic therapy and unnecessary health care expense. METHODS: One hundred patients were evaluated prospectively to determine which patients qualified for this study. Seventy-eight patients satisfied current criteria for a diagnosis of rhinosinusitis. RESULTS: Fifty-three percent (41 patients) of the 78 patients did not have a diagnosis of chronic sinusitis based on same-day computed tomography (CT) scanning. A charge analysis comparing treatment after diagnosis with medical therapy alone and CT scan for failures versus CT scanning with medical treatment for positive scans was performed. Although the most economical method of treatment was initiating medical therapy, it was also the least sensitive and specific in that 52% of patients didn't require the treatment. Endoscopy and/or CT screening with medical therapy were much better at appropriate diagnosis and targeted therapy but charge analysis indicated a much higher cost. CONCLUSION: Presently, the current subjective diagnostic paradigm for chronic rhinosinusitis is most cost-effective but least accurate. Objective evaluations (endoscopy and CT scanning) to aid in diagnosis are more accurate but more costly. Where cost constraints are important, careful considerations of alternatives are important.

Anti-Bacterial Agents↗
PubMed1988

Multiple sclerosis: diagnostic value of computerized tomography with delayed scanning after a double-dose of contrast medium in comparison with other diagnostic tests.

In 63 cases of clinical definite or suspected MS we compared the results of CSF analysis, VEP, BAEP, CT scanning without and after double dose contrast, in 17 cases also those of MRT. We found that CSF analysis had the highest rate of abnormal findings, followed by MRT. VEP and CT with double dose contrast showed similar sensitivity, while BAEP and CT without contrast had disappointing results. We think that CT with delayed scanning after double dose contrast can be a very useful investigation in early and doubtful cases of MS, until MRT will become a more widespread and less expensive investigation.

Adult↗
PubMed2001

[Gross tumor volume and clinical target volume in radiotherapy. Tumors of the buccal cavity].

Radiation therapy, either alone or combined with surgery is a cornerstone in the treatment of oral cavity tumors. Target volumes to be treated with external beam radiation must take under consideration the initial tumor location, providing information on satellites lymph nodes to be irradiated as well. Modern imaging, with emphasis on CT scan with injection, is now mandatory for a better analysis of initial lesions including both tumor location and invaded lymph nodes. Tumor volumes based on clinical examination and CT scan analysis might be divided in two groups. First, volumes susceptible to receive a prophylactic irradiation for an hypothetical microscopic spread (CTV) to be treated with a prophylactic dose; second, volumes including lesions visible clinically or on CT scan that should receive a higher radiation dose (GTV). Clinical tolerance will largely be depending upon radiation-induced mucositis, impairing food intake. Radiation techniques aiming at normal tissues preservation should be used, including devices allowing keeping an open mouth during radiation delivery.

Contrast Media↗
PubMed2005

Ventilation-perfusion scanning and helical CT in suspected pulmonary embolism: meta-analysis of diagnostic performance.

PURPOSE: To perform meta-analysis of literature about the role of helical computed tomography (CT) and ventilation-perfusion (V-P) scanning in detection of acute pulmonary embolism (PE) by using summary receiver operating characteristic (ROC) curve analysis. MATERIALS AND METHODS: V-P scanning articles published from January 1985 to March 2003 and helical CT articles published from January 1990 to March 2003 in MEDLINE and EMBASE databases were included if (a) tests were performed for evaluation of acute PE, (b) conventional angiography was the reference standard, and (c) absolute numbers of true-positive, false-negative, true-negative, and false-positive results were available. Sensitivity analysis was conducted by excluding articles published before 1995. RESULTS: A total of 12 articles discussing helical CT and/or V-P scanning were included. With a random-effects model, pooled sensitivity for helical CT was 86.0% (95% confidence interval [CI]: 80.2%, 92.1%), and specificity was 93.7% (95% CI: 91.1%, 96.3%). V-P scanning yielded low sensitivity of 39.0% (95% CI: 37.3%, 40.8%) but high specificity of 97.1% (95% CI: 96.0%, 98.3%) with high probability threshold. V-P scanning yielded high sensitivity of 98.3% (95% CI: 97.2%, 99.5%) and low specificity of 4.8% (95% CI: 4.7%, 4.9%) with normal threshold. Regression coefficients for helical CT angiography were 0.588 (95% CI: -1.55, 2.74) and 4.14 (95% CI: -0.002, 8.28) versus V-P scanning with high and normal thresholds, respectively. Regression coefficients for helical CT angiography were 0.588 (95% CI: -1.55, 2.74) and 4.14 (95% CI: -0.002, 8.28) versus V-P scanning with high and normal thresholds, respectively. CONCLUSION: Helical CT has greater discriminatory power than V-P scanning with normal and/or near-normal threshold to exclude PE, while helical CT and V-P scanning with high probability threshold had similar discriminatory power in the diagnosis of PE.

Humans↗
PubMed2005

Cervical spine evaluation in urban trauma centers: lowering institutional costs and complications through helical CT scan.

BACKGROUND: In the evaluation of the cervical spine (c-spine), helical CT scan has higher sensitivity and specificity than plain radiographs in the moderate- and high-risk trauma population, but is more costly. We hypothesize that institutional costs associated with missed injuries make helical CT scan the least costly approach. STUDY DESIGN: A cost-minimization study was performed using decision analysis examining helical CT scan versus radiographic evaluation of the c-spine. Parameter estimates were obtained from the literature for probability of c-spine injury, probability of paralysis after missed injury, plain film sensitivity and specificity, CT scan sensitivity and specificity, and settlement cost of missed injuries resulting in paralysis. Institutional costs of CT scan and plain radiography were used. Sensitivity analyses tested robustness of strategy preference, accounted for parameter variability, and determined threshold values for individual parameters on strategy preference. RESULTS: C-spine evaluation with helical CT scan has an expected cost of US 554 dollars per patient compared with US 2,142 dollars for plain films. CT scan is the least costly alternative if threshold values exceed US 58,180 dollars for institutional settlement costs, 0.9% for probability of c-spine fracture, and 1.7% for probability of paralysis. Plain films are least costly if CT scan costs surpass US 1,918 dollars or plain film sensitivity exceeds 90%. CONCLUSIONS: Helical CT scan is the preferred initial screening test for detection of cervical spine fractures among moderate- to high-risk patients seen in urban trauma centers, reducing the incidence of paralysis resulting from false-negative imaging studies and institutional costs, when settlement costs are taken into account.

Cervical Vertebrae↗
PubMed1978

Computer analysis of periventricular lucency on the CT scan.

Of 53 patients with periventricular lucency, 70% revealed obstructive hydrocephalus, mainly due to infratentorial tumors, and the remainder were cases of communicating hydrocephalus, usually secondary to subarachnoid hemorrhage. Of the patients with PVL, 95% had hypertensive hydrocephalus and 60% showed slightly dilated ventricles. Computer analysis was helpful in displaying PVL objectively and clarifying its nature. In experimentally induced obstructive hydrocephalus, PVL was observed at the acute hypertensive stage. We concluded that the pathogenesis of PVL might be the passive diffusion or acute extravasation of CSF into white matter through the disrupted ventricular wall, rather than transependymal absorption of CSF.

Animals↗
PubMed1997

Cryptogenic fibrosing alveolitis and the fibrosing alveolitis of systemic sclerosis: morphological differences on computed tomographic scans.

BACKGROUND: The purpose of this study was to identify morphological differences on the computed tomographic (CT) scan between cryptogenic fibrosing alveolitis (CFA) and the fibrosing alveolitis associated with systemic sclerosis (FASSc), and to examine their biological relevance. METHODS: One hundred and seven patients with CFA (n = 55) or FASSc (n = 52) who had undergone thin section CT scanning were included. Multivariate analysis was used to identify morphological differences on the CT scans between lone CFA and FASSc, and to determine whether the pattern and distribution of disease on the CT scans were functionally significant (as judged by the lung transfer factor (TLCO), forced vital capacity (FVC), and arterial oxygen tension (PaO2)) or predictive of survival (independent of the type and extent of fibrosing alveolitis, age, sex, and smoking history). RESULTS: Increasingly extensive disease on CT scans was associated with a coarser reticular pattern (increase in reticular score per percentage increase in disease extent = 0.06, 95% confidence interval (CI) 0.03 to 0.09, p < 0.0005) and increasing upper zone involvement (increase in ratio of upper zone to total disease per percentage increase in disease extent = 0.002, 95% CI 0.000 to 0.003, p < 0.04). Patients with CFA were characterised by a higher upper zone ratio (difference = 0.08, 95% CI 0.02 to 0.13, p < 0.004) and a weak trend towards a coarser reticular pattern (p = 0.09), independent of disease extent. Smokers with CFA had more upper zone involvement (difference = 0.11, 95% CI 0.05 to 0.16, p < 0.0005) and a coarser reticular pattern (difference in reticular score = 1.92, 95% CI 0.27 to 3.55, p < 0.02) than smokers with FASSc. The extent of disease on the CT scan was predictive of lung function impairment and survival but the pattern and distribution of disease were not. CONCLUSIONS: Patients with CFA have relatively more upper zone involvement than those with FASSc independent of the extent of disease on the CT scan. This finding may result from smoking related damage but is not functionally significant.

Diagnosis, Differential↗
PubMed1996

Regeneration of a transplanted liver after right hepatic lobectomy.

Liver regeneration has been described after heterotopic liver transplantation, small-for-size orthotopic liver transplantation and reduced-size liver transplantation. In this report, we document the regenerative response of a whole liver transplant to major resection for the first time. A right hepatic lobectomy for liver ischemia was performed in a 30-year-old female after transplantation for autoimmune disease of the liver. Volumetric analysis of computed tomography (CT) scans revealed a preoperative liver volume of 1,961 mL, whereas analysis of the 6-week posthepatectomy CT scan showed a volume of 1,820 mL. Factors influencing regeneration in the setting of a liver transplant include rejection, ischemia/thrombosis, infection, or cyclosporine hepatotrophic/hepatotoxic effects. These factors, balanced with the intrinsic ability of hepatocytes to achieve a standard liver volume, determine the extent of regeneration.

Adult↗
PubMed2003

[Research of the puncture depth in treatment of trigeminal neuralgia (TN) by radiofrequency thermocoagulation(RFT) under CT location].

OBJECTIVE: To control the puncture depth properly and avoid the complications, CT scan was used to measure the depth as the puncture needle perforated through the foramen ovale. METHODS: Analysis of the CT scan diagrams of 121 cases suffering from TN cured by RFT, and measuring the puncture depth. RESULTS: The average puncture depth was 0.88 cm, the maximum was 1.6 cm, and the minimum was 0.4 cm. CONCLUSION: The puncture depth can be manipulated correctly by CT location, the second and third branches can be avoided to be damaged within 0.8 cm, and the first branch can be avoided to be injured between 1.2 cm and 1.5 cm.

Adult↗