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PubMed2000

[Diagnostic and prognostic value of additional neurologic diagnosis in alcohol withdrawal delirium].

A severe course of alcohol withdrawal has been observed in 28% of patients in a neurological intensive care unit due to complicating central nerve system (CNS) diseases. In any atypical alcoholic delirium, especially with focal neurological signs, partial seizures, or decreased level of consciousness, CNS diseases like meningoencephalitis, intracranial hemorrhage, or central pontine myelinolysis must be diagnosed by computed tomography (CT) scan and cerebral spinal fluid (CSF) tap. The diagnostic and prognostic value of CT scan and CSF analysis was examined in 32 persons with alcohol withdrawal syndrome or delirium tremens. Neurological complications and cerebral convulsions at the beginning of delirium tremens appear to predispose the patient to a protracted clinical course and necessary mechanical ventilation. Blood-CSF barrier permeability is increased in 70% of alcohol withdrawal patients and that also seems to be a marker of a prolonged clinical course. Cerebral atrophy as shown in CT scan does not play a role in predicting clinical course. In our experience, CT examination or lumbar puncture is not necessarily recommended if clinical signs are typical for alcohol delirium.

Adult↗
PubMed2004

Identification by CT scan of ischemic stroke patients with high risk of brain death.

The identification of patients with high risk of evolution to brain death is one of the more important tasks of transplant coordination teams. Although most of pool of potential donors come from the group of patients who suffer a head injury or hemorrhagic stroke, the procurement of organs from brain-dead patients suffering an ischemic stroke as the cause of brain damage must also be considered. The main objective of this study was to investigate the radiological signs that in the CT scan of admission to a neurological ICU are more frequently associated with progression to brain death. We studied the CT scans of 15 brain-dead patients after an ischemic stroke versus the scans of 15 recovered patients admitted to ICU with the same diagnosis. The radiological signs included: insular ribbon sign, hyperintensities inside the big arteries of the base of the skull, hemispheric hypodensities, midline shift, and compression of the cerebrospinal fluid spaces. There were two signs significantly associated with brain death: midline shifts and the compression of the ambiens cistern. It may be concluded that analysis of the CT scan at admission of patients with an ischemic stroke in the ICU can predict the risk of evolution to brain death.

Brain Death↗
PubMed1998

[Thoracolumbar fractures. Pathomorphology and indications for treatment].

The indications for conservative and surgical management of fractures of the thoracolumbar spine are reviewed, based upon the morphology of the lesions, which is assessed by meticulous analysis of radiographs, CT scan and in some cases MRI. The author advocates using the AO classification, which considers several subtypes of fractures: compression fractures, distraction fractures and fractures with multidirectional displacement. The indication for treatment is based upon morphological analysis of the lesions, while other factors such as the general condition of the patient or the locally available surgical environment must also be taken into consideration. Up to 50% of thoracolumbar fractures can benefit from surgical management, with posterior or anterior stabilisation, the latter performed through thorascoscopy in selected cases.

Humans↗
PubMed1999

Late radiation toxicity after whole brain radiotherapy: the influence of antiepileptic drugs.

This retrospective study had the following aims: (a) calculation of actuarial rate of late radiation toxicity after whole-brain radiotherapy (WBRT), (b) correlation of clinical symptoms with changes of computed tomography (CT) scans, and (c) analysis of potentially predictive factors with special regard to concomitant treatment with antiepileptic drugs. We analyzed 49 adult patients, selected from a preexisting data base. Inclusion criteria were as follows: no previous brain irradiation; WBRT without boost; CT, clinical, and neurologic examination before and more than 3 months after completion of WBRT. Uni- and multivariate tests of various patient- and treatment-related parameters as possible predictive factors for clinical symptoms of late radiation toxicity (scored according to the RTOG/EORTC system) as well as cerebral atrophy and white matter abnormalities were performed. Median age was 54 years. Patients were treated for brain metastases (n = 37), primary cerebral lymphoma (n = 2), primary brain tumors (n = 7), or with prophylactic intention (n = 3). Carbamazepine was given to 15 patients, phenytoin to 12, and barbiturate to 7, respectively; 42 patients also received corticosteroids. The median dose of WBRT was 30 Gy (range 27-66 Gy). Median fraction size was 3 Gy (1-3 Gy). Nine patients received two fractions per day. The biologically effective dose (BED) according to the linear-quadratic model ranged between 90 and 141 Gy (median, 120 Gy; alpha/beta value, 1 Gy). Median follow-up was 10 months (range, 4-130 months). In 16 cases, symptoms of late radiation toxicity grade I-III appeared. Actuarial rates were 32% after 1 year, 49% after 2 years, and 83% after 5 years. Actuarial rates of cerebral atrophy were 50% after 1 year and 84% after 2 years (white matter abnormalities: 25% and 85%, respectively). There was a significant correlation between atrophy and white matter abnormalities, but not between CT changes and clinical symptoms. CT changes were dependent on BED, absence of barbiturate use, and preexisting cerebral atrophy. Clinical symptoms usually were dependent on BED too, but treatment with carbamazepine was more important in the multivariate model. Neither other drugs nor other factors influenced late radiation toxicity. A detailed analysis showed that most carbamazepine-treated symptomatic patients took the drug during WBRT as well as during follow-up. Actuarial rates of grade I-III symptoms were 18% versus 50% after 1 year with or without carbamazepine. Even after exclusion of carbamazepine-treated patients, CT changes and clinical symptoms did not correlate. In conclusion, a BED <120 Gy was associated with a lower rate of late radiation toxicity after WBRT. The anticonvulsant drug carbamazepine showed a surprisingly clear influence on clinical symptoms of late radiation toxicity; that might be explained by the fact that the side effects of long-term drug treatment are indistinguishable from mild or moderate true radiation sequelae, rather than that it has a role in the pathogenesis of radiation-induced changes.

Actuarial Analysis↗
PubMed2004

Evaluation of therapeutic potential of heavy ion therapy for patients with locally advanced prostate cancer.

PURPOSE: To investigate the feasibility of raster scanned heavy charged particle therapy in the treatment of prostate cancer (PCa,) with special regard to the influence of internal organ motion on the dose distribution. METHODS AND MATERIALS: The CT data of 8 patients with PCa who underwent three-dimensional conformal radiotherapy (RT) were chosen. In addition to the routine treatment planning scan, three to five additional positioning control CT scans were performed. The organs at risk and the target volumes were defined on all CT scans. Primary and boost carbon ion plans were calculated to deliver 66 Gy to the clinical target volume/planning target volume, with an additional 10 Gy to the gross tumor volume (GTV). To estimate the influence of internal organ motion on plan quality, the dose was recalculated on the basis of the control CT scans. The comparative analysis was based on the dose-volume histogram-derived physical parameters. RESULTS: The average 90% target coverage was 99.1% for the GTV. The maximal dose to the rectum was 71.8 Gy. The average rectal mean dose was 19 Gy. The volume of the rectum receiving 70 and 68 Gy was 0.1 and 0.3 cm3. The average difference in the 90% coverage for the GTV on control CT cubes was 3.6%. The maximal rectal dose increased to 76.2 Gy. The deviation in the mean rectal dose was <1 Gy on average. The rectal volume receiving 70 and 68 Gy increased to 2.5 and 3.3 cm3. CONCLUSION: The investigation demonstrated the feasibility of raster scanned carbon ions for PCa RT. Excellent coverage of the target volume and optimal sparing of the rectum were acquired. The combination of photon intensity-modulated RT and a carbon ion boost to the GTV is the most rational solution for the gain of clinical experience in heavy ion RT for PCa patients.

Carbon↗
PubMed1979

CT scanning in urology.

More efficient patient management, including a decrease in the length of hospital stay and a decrease in patient medical cost, may be achieved in many instances by use of the CT scanner. The clinical efficacy of this noninvasive imaging technique must continue to be judged by comparison with conventional uroradiologic techniques and careful cost analysis, but the CT scan is becoming an accepted means of assessment and diagnosis of urinary tract problems. As the technology continues to improve so will our ability to diagnose and define the extent of disease within the urinary tract.

Abscess↗
PubMed1999

Prospective comparison of axial computed tomography and standard and panoramic radiographs in the diagnosis of mandibular fractures.

Objective data comparing sensitivity and accuracy between traditional and computed imaging techniques used for diagnosing mandibular fractures is sparse. To address the paucity of information the authors studied prospectively 33 mandibular fractures in 21 consecutive patients with standard mandibular series, panoramic tomography, axial computed tomography (CT), and coronal CT. Differences in diagnostic accuracy and sensitivity as compiled by four blinded reviewers were calculated. Although overall sensitivities of mandibular fracture detection were not statistically significant between the imaging studies, a distinction between the four methods did exist. Coronal CT was the most accurate imaging method, followed by mandibular series, panoramic topography, and axial CT. Excluding technically inadequate studies, panoramic tomography was 100% accurate and sensitive. Diagnostic accuracy and sensitivity did not correlate measurably with reviewers' impressions of the quality of a particular exam. Axial CT detected significantly fewer angle fractures than standard radiographs (60% vs. 98%, p = 0.006) and coronal CT (60% vs. 100%, p = 0.008). False-positives were unusual except for plain mandibular radiographs. The clear definition of both coronal and axial CT scans made their analysis simpler than the plain radiographs. Lack of fracture displacement was the single most important factor in missed fractures with all modalities. Despite reviewer concerns about the quality of the plain mandibular series, the high accuracy and sensitivity of this imaging technique and applicability in all patients, coupled with its low cost, make it an excellent screening exam for all patients with suspected mandibular fractures. In clinically stable and cooperative patients with mandibular trauma, panoramic radiography and coronal CT are recommended to confirm clinical suspicions when the mandibular series is equivocal. To supplement the mandibular series in the uncooperative or multisystem trauma patient, axial CT scans have not been beneficial. These diagnostic modalities do not obviate the need for a careful physical exam.

Algorithms↗
PubMed2001

Appendicitis masquerading as tumor: a case of two diagnoses.

Acute appendicitis remains one of the most difficult diagnoses to make in the Emergency Department. We present a puzzling and unusual case. A 47-year-old man had several hours of acute abdominal pain in the right upper quadrant, point tenderness in the right midquadrant on examination, and normal chemistries. Early appendicitis was suspected and a computed tomography (CT) scan of the abdomen was obtained. Appendicitis was not seen. What was evident was a retroperitoneal lipoma estimated to weigh 10 pounds. The general surgeon was consulted who believed that operation was necessary in light of the patient's continuing abdominal pain and the presence of the mass. Masses this large could cause pain from local compression of structures, or ischemia of the mass from outgrowing its blood supply. In surgery, a lipoma was observed that filled most of the retroperitoneum and displaced all the contents of the abdomen, including the cecum and its appendix. Also present was an acute appendicitis. On retrospective analysis of the CT scan, the appendicitis was evident but atypically located in the epigastrium. This case illustrates once again that the CT scan is a useful diagnostic adjunct for the diagnosis of new onset abdominal pain and specifically for appendicitis.

Acute Disease↗
PubMedDate not supplied

Bullae, bronchiectasis and nutritional emphysema in severe anorexia nervosa.

STUDY OBJECTIVES: Pulmonary complications of anorexia nervosa are rarely documented. The case of a patient with anorexia nervosa and pulmonary disease is presented, a new quantitative computed tomography (CT) method for the detection of emphysema is employed, the literature is reviewed and the concept of 'nutritional' emphysema is discussed. RESULTS: The case of a 34-year-old, nonsmoking woman with long-standing severe anorexia nervosa who was evaluated for cough and progressive shortness of breath is reported. Pulmonary function testing showed a predominant restrictive pattern with a marked reduction in carbon monoxide transfer and respiratory muscle strength, and an elevated residual volume. Imaging revealed bullae and bronchiectasis, and quantitative analysis of the CT scan was consistent with mild, generalized emphysema. Bronchial washings grew Pseudomonas aeruginosa. Known causes for bronchiectasis were excluded. A literature review disclosed few reported noninfectious pulmonary complications of anorexia nervosa. CONCLUSIONS: To the authors' knowledge, this is the first report of bullae and bronchiectasis in a patient with anorexia nervosa, and the CT analysis was consistent with mild emphysema. Malnutrition has been associated with emphysematous changes in animals and may be the primary insult in the development of emphysema, bullae and bronchiectasis in the present patient.

Adult↗
PubMed2004

Anterior lumbar interbody fusion with carbon fiber cage loaded with bioceramics and platelet-rich plasma. An experimental study on pigs.

Platelet-rich plasma (PRP) is an autogenous source of growth factor and has been shown to enhance bone healing both in clinical and experimental studies. PRP in combination with porous hydroxyapatite has been shown to increase the bone ingrowth in a bone chamber rat model. The present study investigated whether the combination of beta tricalcium phosphate (beta-TCP) and PRP may enhance spinal fusion in a controlled animal study. Ten Danish Landrace pigs were used as a spinal fusion model. Immediately prior to the surgery, 55 ml blood was collected from each pig for processing PRP. Three-level anterior lumbar interbody fusion was performed with carbon fiber cages and staples on each pig. Autogenous bone graft, beta-TCP, and beta-TCP loaded with PRP were randomly assigned to each level. Pigs were killed at the end of the third month. Fusion was evaluated by radiographs, CT scanning, and histomorphometric analysis. All ten pigs survived the surgery. Platelet concentration increased 4.4-fold after processing. Radiograph examination showed 70% (7/10) fusion rate in the autograft level. All the levels with beta-TCP+PRP showed partial fusion, while beta-TCP alone levels had six partial fusions and four non-fusions ( P=0.08). CT evaluation of fusion rate demonstrated fusion in 50% (5/10) of the autograft levels. Only partial fusion was seen at beta-TCP levels and beta-TCP+PRP levels. Histomorphometric evaluation found no difference between beta-TCP and beta-TCP+PRP levels on new bone volume, remaining beta-TCP particles, and bone marrow and fibrous tissue volume, while the same parameters differ significantly when compared with autogenous bone graft levels. We concluded from our results in pigs that the PRP of the concentration we used did not improve the bone-forming capacity of beta-TCP biomaterial in anterior spine fusion. Both beta-TCP and beta-TCP+PRP had poorer radiological and histological outcomes than that of autograft after 3 months.

Animals↗
PubMed2004

How should nasal symptoms be investigated in asthma? A comparison of radiologic and endoscopic findings.

BACKGROUND: To improve asthma control, the management of rhinosinusitis often leads the physician to perform sinonasal imaging and/or nasal endoscopy, but their respective contributions are still insufficiently understood. OBJECTIVE: To evaluate the potential contribution of a symptoms questionnaire, sinus radiography (SR) and computed tomography (CT) scan to the diagnosis of nasal diseases in asthmatic patients when compared with ENT examination. METHODS: A total of 124 patients completed a questionnaire on nasal symptoms administered by the chest physician. Then, they underwent ENT examination. On the same day, SR and CT scans were performed independently. RESULTS: Patients (80.3%) had nasal symptoms during the month preceding the consultation. The ENT examination was normal in 8.1% (n = 10) and revealed rhinitis in 57.3% (n = 71), rhinosinusitis in 14.5% (n = 18) and nasal polyposis in 20.2% (n = 25). For rhinitis, the negative predictive value of bilateral nasal obstruction was 87.8%. Both SR and CT had low sensitivity and specificity. For rhinosinusitis, the negative predictive value of nasal symptoms varied from 85.4 to 95.2%. Sinus CT was at least as accurate as SR for the diagnosis of rhinosinusitis. In a multivariate analysis, only the CT scan (score > or =12) appeared to be significantly associated with the diagnosis of nasal polyposis. CONCLUSION: In asthmatic patients, physicians need to enquire systematically about the existence of nasal symptoms by using this simple questionnaire which is sensitive for rhinitis, and has good negative predictive value for excluding rhinosinusitis and nasal polyposis.

Adult↗
PubMed1999

A quantification of the lung surface area in emphysema using computed tomography.

Quantitative analysis of computed tomography (CT) has been combined with a stereologically based histologic analysis of lung structure to assess regional lung inflation and the structural features of the lung parenchyma. In this study, CT measurements of lung inflation were compared with histologic estimates of surface area in order to develop prediction equations that allow lung surface to volume ratio and surface area to be predicted from an analysis of the CT scan. The results show that mild emphysema is associated with an increase in lung volume and a reduction in surface to volume ratio, whereas surface area and tissue weight were only decreased in severe disease. The CT predicted surface to volume ratio correlated with histology, and both predicted and measured surface areas correlated with the diffusing capacity. We conclude that this CT analysis can be used to monitor the progression of emphysematous lung destruction in individual patients, and to assess the impact of both surgical and medical treatments for emphysema.

Aged↗
PubMed1998

Evaluation of computed tomographic methods to measure vertebral rotation in adolescent idiopathic scoliosis: an intraobserver and interobserver analysis.

The purpose of this study was to compare three computed tomography (CT) measurement methods that have been described by Aaro-Dahlborn, Ho, and Krismer et al. The methods were based on clinical, intraobserver, and interobserver analysis. Twenty-five patients with adolescent idiopathic scoliosis were studied for clinical reliability of these methods. There was a significant correlation between Aaro-Dahlborn and Ho's methods (p < 0.02), and there was no correlation between Krismer's method and the other two (p > 0.05). Intraobserver analysis was performed by one observer at 20 different times, and interobserver analysis was performed by 20 orthopedic surgeons on the same CT scan. Intraobserver and interobserver analysis has shown that the method described by Ho is the most reliable one. Consequently, Ho's method is the most reliable and clinically the most useful method for measuring the vertebral rotation in adolescent idiopathic scoliosis.

Adolescent↗
PubMed1983

[Histographic analysis of computed tomography of cerebral hemispheric tumors].

The aim of this report is to assess the possibility of digital processing of computed tomography for histological diagnosis of brain tumors. For this purpose, percent histograms of x-ray attenuation value of lesions were analysed in 113 cases of histologically verified hemispheric tumors. Sixteen histograms obtained from normal brain parenchyma served as controls. Histograms were made from the same slices before and after contrast enhancement. The result were as follows; Histograms of benign tumors such as meningiomas and low grade astrocytomas characteristically showed similar pattern with normal subjects, whereas histographic patterns of the more malignant tumors such as malignant astrocytomas, metastases and glioblastomas were more heterogeneous with lower peak and wider curve. Displacement of the histogram to the higher density following contrast material administration was important clue in histographic analysis. The most prominent displacement was observed in meningiomas, followed by metastases with nodular type enhancement and malignant astrocytomas. Displacement in low grade astrocytomas and oligodendrogliomas was very slight and less than that of normal brain. Tumors showing ring enhancement such as glioblastomas and brain abscesses had wide histogram curve with twin peaks. Conclusively, it is possible to detect histological nature of cerebral tumors through CT scanning, using histographic analysis of the digital data.

Astrocytoma↗
PubMed2006

CT histogram analysis in pathologically proven adrenal masses.

OBJECTIVE: The purpose of this article is to evaluate a histogram analysis method for distinguishing adrenal adenomas from metastases, pheochromocytomas, and adrenocortical carcinomas on CT. MATERIALS AND METHODS: A pathology database was searched, and 335 adrenalectomies from 1995 to 2002 were identified. CT images were available for retrospective review in 187 patients (93 males, 94 females; age range, 15-84 years; mean age, 55.2 years) with 208 adrenal masses. This included 112 adenomas in 104 patients, 48 metastases in 39 patients, 40 pheochromocytomas in 36 patients, and eight adrenocortical carcinomas in eight patients. Histogram analysis was performed using a circular region of interest for mean attenuation, number of pixels, number of negative pixels (< 0 H), and percentage of negative pixels by two interpreters. Areas of necrosis were excluded from measurements. Observer agreement was calculated. RESULTS: In 72 of 76 (94.7%) and 63 of 72 (87.5%) adenomas, respectively, interpreters found attenuation values greater than 10 H contained negative pixels on unenhanced CT scans. None of the enhanced adenomas had mean attenuation less than or equal to 10 H, but 24 (38.7%) and 28 (45.2%), respectively, had negative pixels. Negative pixels were present in unenhanced and enhanced metastases, pheochromocytomas, and carcinomas. Using a 5% or 10% negative pixel threshold value to diagnose adenoma improved specificity but diminished sensitivity. Specificity for a 10% negative pixel threshold was approximately 88% for unenhanced CT scans and 99% for enhanced CT scans, with sensitivities of 71% and 12%, respectively. CONCLUSION: Although specificity for the diagnosis of adenomas on enhanced CT scans with histogram analysis was high when a 10% negative pixel threshold was used, low sensitivity likely limits clinical usefulness.

Adenoma↗
PubMed1996

Single-photon emission computed tomography gallium imaging versus computed tomography: predictive value in patients undergoing high-dose chemotherapy and autologous stem-cell transplantation for non-Hodgkin's lymphoma.

PURPOSE: To evaluate the predictive value of computed tomography (CT) scanning and single-photon emission computed tomography (SPECT) gallium (Ga) scanning in the disease-free survival of patients receiving high-dose chemotherapy and autologous stem-cell transplantation for non-Hodgkin's lymphoma (NHL). PATIENTS AND METHODS: One hundred forty-three patients undergoing transplant for NHL underwent CT scanning of chest, abdomen, and pelvis, and a SPECT Ga scan before transplantation and at day + 100 after transplant. The failure-free survival (FFS) by scan result was analyzed. RESULTS: In the diffuse aggressive lymphoma patients, the 1-year FFS for patients having a positive SPECT Ga scan at day + 100 was 15% compared with a 3-year FFS of 47% for those with a negative scan (P < .001). Patients with a positive CT scan at day + 100 had a 36% 3-year FFS, and those with a negative CT scan had a 39% 3-year FFS (P = not significant [NS]). An analysis of the combination of CT scan and SPECT Ga scan results at day + 100 posttransplant demonstrated a 3-year FFS of 14% if they were both abnormal; if the CT was positive and Ga was negative, the 3-year FFS was 68%; positive Ga with a negative CT was 25%; and both negative was 34% (P = .0015). For the patients with follicular NHL, those with a positive SPECT Ga at day + 100 had a 14% 1-year FFS compared with those with a negative scan, who had a 45% 3-year FFS (P < .001). In the follicular NHL patients, the 3-year FFS of those with a positive CT was 17% compared with a 64% 3-year FFS for patients with a negative CT scan (P < .001). CONCLUSION: The use of SPECT Ga scan at day + 100 posttransplant for evaluation of disease activity in patients with diffuse aggressive NHL was highly predictive of eventual outcome and was more predictive than the CT scan results. However, for patients with follicular NHL, the addition of SPECT Ga scanning to CT scanning did not add substantially to the evaluation of transplant outcome.

Adolescent↗
PubMed1999

Effect of post-implant edema on the rectal dose in prostate brachytherapy.

PURPOSE: To characterize the effect of prostate edema on the determination of the dose delivered to the rectum following the implantation of 125I or 103Pd seeds into the prostate. METHODS AND MATERIALS: From 3 to 5 post-implant computed tomography (CT) scans were obtained on 9 patients who received either 125I or 103Pd seed implants. None of the patients received hormone therapy. The outer surface of the rectum was outlined on each axial CT image from the base to the apex of the prostate. The D10 rectal surface dose, defined as the dose which encompasses only 10% of the surface area of the rectum, was determined from each CT scan by compiling a dose-surface histogram (DSH) of the rectal surface. The magnitude and half-life of the post-implant edema in each of these implants is known from the results of a previously published study based on the analysis of the serial CT scans. RESULTS: As the prostate edema resolved, the distance between the most posterior implanted seeds and the anterior surface of the rectum decreased. As a result, the D10 rectal surface dose increased with each successive post-implant CT scan until the edema resolved. The dose increased exponentially at approximately the same rate the prostate volume decreased. The D10 rectal surface dose at 30 days post-implant ranged from 16% to 190% (mean 68 +/- 50%) greater than on day 0. The dose on day 30 was at least 50% greater in 6 of 9 cases. CONCLUSION: The rectal surface dose determined by analysis of a post-implant CT scan of an 125I or 103Pd prostate seed implant depends upon the timing of the CT scan. The dose indicated by the CT scan on day 30 is typically at least 50% greater than that indicated by the CT scan on day 0. Because of this difference, it is important to keep the timing of the post-implant CT in mind when specifying dose thresholds for rectal morbidity.

Brachytherapy↗