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PubMed1993

Incomplete interlobar fissures: bronchovascular analysis with CT.

Thin-section computed tomographic scans of both lungs in 154 patients, including seven cadavers, with lung cancer (n = 37), diffuse (n = 32) or inflammatory (n = 30) lung disease, other proved or suspected disease (n = 23), or healthy lungs (n = 32) were analyzed to determine the frequency of incomplete interlobar fissure (IIF). An IIF was defined as a discontinuous linear shadow that remained in contact with the chest wall. An IIF was found in 128 of 154 right lungs (83.1%) and 77 of 154 left lungs (50.0%). Some bronchovascular structures crossed or passed through two contiguous lobes in the fused area. The most common bronchovascular structure associated with an IIF was a pulmonary vein; this association was found in 87 right lungs (56.5%) and 20 left lungs (13.0%). An IIF was traversed by a pulmonary artery in only seven right lungs and 13 left lungs or by a bronchus in only three lungs. It is concluded that recognition of an IIF might improve understanding of the spread of pulmonary disease.

Bronchi↗
PubMed1984

Computed tomography and thin-section tomography in facial trauma.

The efficacy of radiographic methods in detecting and classifying facial fractures was assessed. Thirty-one patients with maxillofacial trauma were studied with plain radiography, coronal and lateral pluridirectional tomography (PT), and axial and direct coronal computed tomography (CT). PT and CT were compared to assess how many fractures each method could demonstrate. In addition, plain films were used in combination with each special study to see how efficacious each combination was at classifying fractures into types, such as blow-out, tripod, etc. To reflect the fact that it is sometimes impossible to obtain lateral PT or direct coronal CT scans at this institution, the same analysis was done using just coronal PT and axial CT. With two projections, CT was better than PT at demonstrating fractured surfaces (168 vs. 156) and in classifying fractures in combination with plain films (48 vs. 43). However, when only one projection from each special study was used, PT surpassed CT in showing fractures (137 vs. 124) and in classifying fractures (42 vs. 40). Failures with each method occurred when the plane of section was parallel or oblique to the plane of the structure being examined, that is, axial CT failed to show the floor of the orbit well and coronal PT failed to show the anterior maxillary sinus wall well. Imaging in two planes, including the coronal plane, is desirable for greatest accuracy in fracture detection, whether by CT, PT, or both. CT is generally better for the display of soft-tissue abnormalities.

Evaluation Studies as Topic↗
PubMed2005

Interobserver reliability of computed tomography-derived primary tumor volume measurement in patients with supraglottic carcinoma.

BACKGROUND: Prior studies have determined that macroscopic ("gross") tumor volume (GTV), as calculated from pretreatment computer tomography (CT), was capable of predicting local control in squamous cell carcinoma arising in different subsites in the head and neck in patients who were treated with nonsurgical organ-preservation therapy. The majority of these studies were single-institution, retrospective investigations. Consequently, there has been concern that GTV measurements may not be reproducible by different readers at different institutions. The objective of the current study was to measure the interobserver reliability for GTV measurements for squamous cell carcinoma of the supraglottic larynx (SGSCCA) performed by different readers at different institutions. METHODS: Eight experienced readers (4 neuroradiologists and 4 radiation oncologists) from different institutions independently measured the pretreatment GTV of 20 patients with SGSCCA. The CT scans were obtained from patients entered into the definitive radiation therapy arm of Radiation Therapy Oncology Group protocol 91-11, who had supraglottic carcinoma and underwent pretreatment CT scans of the neck. Statistical analysis focused on interobserver reliability as measured by the intraclass correlation coefficient. RESULTS: The intraclass correlation coefficient was 0.81 (95% lower confidence bound, 0.71). This value was interpreted as "excellent." CONCLUSIONS: GTV measurements were reliable and reproducible when performed by neuroradiologists and radiation oncologists who were experienced in the interpretation of CT scans of the extracranial head and neck in patients with SGSCCA. The result implied that the correlation between GTV and local control should be reproducible across institutions.

Adult↗
PubMed1982

[Use of the scanner in diagnosis and therapeutic surveillance of brain abscess].

Comparison from 102 cases of brain infections has been done between 2 periods: before and after 1978. The use of CT scan in routine since 1978 has not changed the number of patients diagnosed in acute phase (less than 15 days); but diagnosis was done before 2 days in 37% after 1978 and in 27% before 1978. However frequency of consciousness disorders is equal in both groups: 55%. By a semi-statistical analysis on 40 cases, 10 CT scan datas have been tested according to their sensibility and specificity to the diagnosis of brain abscess; 4 datas have a satisfying sensibility and specificity and are more accurate than the others: regularity of the shape, regularity of the enhanced ring; enhancement after injection, surrounding edema. Survey of 40 cases by CT scan has permitted to determine the average delay of disappearance of mass effect (20 days), of disappearance of the abscess (44 days) and the cicatricial aspects according to the treatment: puncture or excision.

Brain Abscess↗
PubMed1981

Volumetric CT analysis of hepatic tumors.

Current methods of measuring hepatic volume and the percent of hepatic parenchyma replaced by tumor are crude, yet clinical decisions are often based on these imprecise measurements. We describe a new computed tomographic (CT) assisted volume calculatory program to accurately assess hepatic volume and a new computer program to discriminate tumor from normal liver and thus provide tumor volume measurements. The potential usefulness of these techniques is illustrated by an analysis of pre- and post-therapy CT scans and calculation of changes in hepatic volume and in the volume of hepatic tumor. Analysis revealed small changes in liver volume could be accompanied by substantial changes in tumor volume and vice versa. We conclude (a) quantitative CT techniques allow for rapid, reproducible measurements of liver and tumor volume, and (b) small changes in organ volume may be accompanied by substantial changes in tumor volume.

Humans↗
PubMed1982

A prospective study of hepatic imaging in the detection of metastatic disease.

This prospective study of 80 patients compared the results of liver scintiscan, ultrasound, and CT scan to the objective findings recorded at laparotomy. Analysis of these data revealed no significant differences in sensitivity, specificity, or accuracy among these three imaging procedures, although a trend toward increased accuracy of the CT scan was noted. In a composite analysis, the accuracy was not improved by combining two or all three of these examinations. A lesion by lesion analysis revealed the inability of any of the three currently used techniques to accurately detect lesions less than 3 cm in diameter.

Biopsy↗
PubMed1983

[Formation of postoperative hematoma directly under a silastic dural substitute].

Several cases of spontaneous hematoma formation occurred under the Silastic dural substitute were reported with CT-scan and recraniotomy findings. In overall analysis, an incidence of the spontaneous hematoma formation was 35.1% in cases of artificial dural grafting with Silastic sheeting and none with autogenous temporal fascia. On CT-scan the hematoma showed localized high density area severely convex toward underlying brain. At recraniotomy, the hematoma consisted of massive clot presented locally beneath the dural substitute. As it depressed sharply underlying brain, it tends to having shown heavy clinical symptoms in comparison with a volume of clot. Neomembrane formed under the artificial graft seemed the most probable bleeding source.

Adult↗
PubMed2005

Three-dimensional analysis of mandibular growth and tooth eruption.

Normal and abnormal jaw growth and tooth eruption are topics of great importance for several dental and medical disciplines. Thus far, clinical studies on these topics have used two-dimensional (2D) radiographic techniques. The purpose of the present study was to analyse normal mandibular growth and tooth eruption in three dimensions based on computer tomography (CT) scans, extending the principles of mandibular growth analysis proposed by Björk in 1969 from two to three dimensions. As longitudinal CT data from normal children are not available (for ethical reasons), CT data from children with Apert syndrome were employed, because it has been shown that the mandible in Apert syndrome is unaffected by the malformation, and these children often have several craniofacial CT scans performed during childhood for planning of cranial and midface surgery and for follow-up after surgery. A total of 49 datasets from ten children with Apert syndrome were available for study. The number of datasets from each individual ranged from three to seven. The first CT scan in each of the ten series was carried out before 1 year of age, and the ages for the 49 scans ranged from 1 week to 14.5 years. The mandible and the teeth were segmented and iso-surfaces generated. Landmarks were placed on the surface of the mandible, along the mandibular canals, the inner contour of the cortical plate at the lower border of the symphysis menti, and on the teeth. Superimposition of the mandibles in the longitudinal series was performed using the symphysis menti and the mandibular canals as suggested by Björk. The study supported the findings of stability of the symphysis menti and the mandibular canals as seen in profile view previously reported by Björk & Skieller in 1983. However, the mandibular canals were, actually, relocated laterally during growth. Furthermore, the position of tooth buds remained relatively stable inside the jaw until root formation started. Eruption paths of canines and premolars were vertical, whereas molars erupted in a lingual direction. The 3D method would seem to offer new insight into jaw growth and tooth eruption, but further studies are needed.

Acrocephalosyndactylia↗
PubMed2000

Aggressive non-Hodgkin lymphoma: early prediction of outcome with 67Ga scintigraphy.

PURPOSE: To evaluate use of gallium 67 scintigraphy early during chemotherapy to predict the outcome in patients with aggressive non-Hodgkin lymphoma. MATERIALS AND METHODS: Among 118 patients, 67Ga scintigraphy was performed after one cycle of chemotherapy in 51 patients, after a median of 3.5 cycles in 97 patients, and both in 30 patients. Computed tomography (CT) was performed after a median of 3.5 cycles of treatment in 87 patients. The failure-free survival was compared between patients with positive or negative 67Ga or CT scans by using the log-rank test. Multivariate analysis helped determine the relation between 67Ga scintigraphic and CT findings and the outcome. RESULTS: The differences in failure-free survival between patients with positive versus negative 67Ga scans after one cycle of treatment (P < .001) and at midtreatment (P < .001) were significant. There was no statistically significant difference in failure-free survival between patients with positive versus negative CT findings during treatment. In multivariate analysis, 67Ga scintigraphy after one cycle (P < .045) and at midtreatment (P < .006) was an independent factor associated with outcome. CONCLUSION: Gallium 67 scintigraphic findings after one cycle of chemotherapy and at midtreatment are predictive of outcome in patients with aggressive non-Hodgkin lymphoma. CT findings are not predictive. Early 67Ga scintigraphy during chemotherapy is a good indicator of patients who may benefit from a change to a more aggressive treatment. A future study is necessary to investigate the potential effect of early change of treatment.

Adolescent↗
PubMed2003

Computed tomographic parameters predicting fatal outcome in large middle cerebral artery infarction.

BACKGROUND: Large middle cerebral artery (MCA) ischaemic stroke when associated with extensive mass effect can result in brain herniation and neurological death. As yet there are few guidelines to aid the selection of patients for aggressive interventional therapies, such as decompression hemicraniectomy and/or hypothermia. METHODS: We studied a cohort of patients from seven centres with large MCA infarction requiring neurocritical care. The purpose of this analysis was to assess the use of early radiological signs on follow-up computed tomographic (CT) signs performed within 48 h of stroke onset for predicting mortality at 30 days. The CT parameters assessed included horizontal displacement of the septum pellucidum, pineal shift, complete or partial infarction of the temporal lobe, involvement of additional vascular territories, and the presence of hydrocephalus. The primary outcome measure was in-hospital death within 30 days. RESULTS: One hundred and thirty-five patients who had follow-up CT scans within 48 h were identified from a total of 201 patients with large MCA infarction that received conventional medical therapy alone. The median age was 68 (range 29-99), 56% were female, and the median NIHSS category was 26-30 at 48 h. Among CT variables in univariable analysis, anteroseptal shift >/=5 mm, pineal shift >/=2 mm, complete temporal lobe infarction, involvement beyond the MCA territory, and moderate or severe hydrocephalus were equally predictive of death. Multivariable analysis adjusting for time to CT scan revealed the following predictors of fatal outcome: anteroseptal shift >/=5 mm (OR 10.9; 95% CI 3.2-37.6), NIHSS within 48 h >20 (OR 6.6; 95% CI 2.3-19.3), and infarction beyond the MCA territory (OR 4.9; 95% CI 1.6-15.0). CONCLUSIONS: We identified the role of early CT signs in predicting death following massive MCA infarction. The CT parameters anteroseptal shift (>5 versus </=5 mm), pineal shift >/=2 mm, hydrocephalus, temporal lobe infarction, and other vascular territory infarction if present were predictive of fatal outcome. These CT parameters require prospective validation before they should be considered reliable markers for decision-making.

Adult↗
PubMed1984

An analysis of the decision-making process in the management of malignant gliomas.

The decision to offer surgery or deep X-ray therapy to patients diagnosed as having malignant gliomas on CT scans is often problematical. Decision-tree analysis is used to make the underlying assumptions explicit in either strategy. Using biopsy and CT data obtained from our own experience, and survival figures from the literature, we are able to demonstrate that the decision is to a large extent related to value judgement. Specifically this relates to the assessment of the utility of long-term survival versus the immediate mortality and morbidity of biopsy in addition to possible difficulties in accepting long-term uncertainty of diagnosis if a biopsy is not performed.

Biopsy↗
PubMed2003

Selection of patients for lung volume reduction surgery using a power law analysis of the computed tomographic scan.

BACKGROUND: A study was undertaken to test the hypothesis that patients respond better to lung volume reduction surgery (LVRS) if their emphysema is confluent and predominantly located in the upper lobes. METHODS: A density mask analysis was used to identify voxels inflated beyond 10.2 ml gas/g tissue (-910 HU) on preoperative and postoperative CT scans from patients receiving LVRS. These hyperinflated regions were considered to represent emphysematous lesions. A power law analysis was used to determine the relationship between the number (K) and size (A) of the emphysematous lesions in the whole lung and two anatomical regions using the power law equation Y=KA(-D). RESULTS: The analysis showed a positive correlation between the change in the power law exponent (D) and the change in exercise (Watts) after surgery (r=0.47, p=0.03). There was also a negative correlation between the power law exponent D in the upper region of the lung preoperatively and the change in exercise following surgery (r=-0.60, p<0.05). CONCLUSIONS: These results confirm that patients with large upper lobe lesions respond better to LVRS than patients with small uniformly distributed disease. Power law analysis of lung CT scans provides a quantitative method for determining the extent and location of emphysema within the lungs of patients with COPD.

Exercise Tolerance↗
PubMedDate not supplied

[Adrenal gland myelolipoma: radiological view].

OBJECTIVE: To report a case of adrenal myelolipoma in a female patient with a history of arterial hypertension and increased plasma aldosterone levels. METHODS: Evaluation by CT and ultrasound, and anatomopathological analysis were performed. RESULTS: The CT and ultrasound scans showed a fat-containing adrenal mass. The patient underwent surgery. Histological analysis of the surgical specimen demonstrated a myelolipoma, a benign tumor composed in varying proportions of adipose and hematopoietic tissue. CONCLUSIONS: A diagnosis of adrenal myelolipoma must be considered when a fat-containing adrenal mass is demonstrated by ultrasound, CT or MRI.

Adrenal Gland Neoplasms↗
PubMed1996

Prognosis of tuberculous meningitis: a multivariate analysis.

Twenty-six clinical, laboratory and CT scan features in 49 patients with tuberculous meningitis (TBM) were analysed to identify the parameters of prognostic significance. Employing univariate analysis, seven variables were found to correlate with three month outcome; these variables included the stage of TBM on admission, focal weakness, Glasgow coma scale (GCS), incontinence, infarction, hydrocephalus and shunt surgery. Analysing all 26 variables, a conditional logistic regression model was derived. In this model stage of TBM, age, focal weakness, cranial nerve palsy and hydrocephalus were found to be contributing to the three month outcome of TBM patients as assessed by the Barthel index.

Adolescent↗
PubMed1996

[Correlation analysis of the changes of EEG mapping and the changes of CT scan in patients with senile dementia].

OBJECTIVE: To observe the changes of EEG mapping and CT scan and analyse the correlation between the changes of the function presented by EEG mapping and morphology presented by CT. METHODS: The absolute power of EEG mapping and 9 parameters of CT in 30 normal controls and 31 patients with senile dementia were measured. The correlation was analysed quantitatively with multiple stepwise regression method. RESULTS: The EEG mapping of senile dementia revealed a diffuse increase in delta, theta power and decreased alpha power in most areas. CT scan showed cortical and subcortical atrophy in brain. There were positive correlations between the increase of delta power and lateral fissure, and between the increase of delta power and average cerebral sulcus. There was a negative correlation between the decrease of alpha power and the increase of lateral fissure. CONCLUSION: The EEG mapping and CT in patients with senile dementia are different from those in normal elderly. There is a correlation between the changes of EEG mapping and CT scan.

Aged↗
PubMed2002

Fate of the transpedicular intervertebral bone graft after posterior stabilisation of thoracolumbar fractures.

The authors present a retrospective clinical and radiological study addressing the outcome after posterior stabilisation of thoracolumbar fractures with intervertebral fusion via transpedicular bone grafting. The study included computed tomographic (CT) scan after implant removal for analysis of the intervertebral fusion and incorporation of the intervertebral bone graft and its influence on postoperative re-kyphosing. Twenty-nine patients with acute fractures of the thoracolumbar spine, treated between 1988 and 1995 at the Department of Trauma Surgery, Hannover Medical School, underwent posterior stabilisation and interbody fusion with transpedicular cancellous bone grafting. This study group was followed clinically and radiologically for a mean of 3.5 years. All patients underwent spiral CT scan with sagittal reconstruction after implant removal. Twenty-four type A, four type B, and one type C lesion were posteriorly stabilised and transpedicular intervertebral bone grafting was performed. The operative time averaged 2 h 50 min, the intraoperative fluoroscopy time 4 min 7 s, and the mean intraoperative blood loss was 376 ml. Four patients out of six with an incomplete neurologic lesion (Frankel/ASIA D) improved to Frankel/ASIA grade E. Two complications were observed: one delayed wound healing and one venous thrombosis with secondary pulmonary embolism. Compared to the preoperative status, our follow-up examinations demonstrated permanent social sequelae: the percentage of individuals able to do physical labor was reduced, whereas the proportion of unemployed or retired patients increased. The assessment of complaints and functional outcome with the Hannover Spine Score reflected a significant difference ( P<0.001) between the status before injury (96.6/100 points) and at follow-up (64.4/100 points). The radiographic follow-up revealed a mean loss of correction of 7.8 degrees ( P<0.005). CT scans after implant removal showed an interbody fusion and incorporation of the transpedicular bone graft in ten patients (34%). In another ten patients (34%), the CT scans demonstrated the interbody fusion at the anterior and posterior walls of the vertebral body via direct contact due to collapse of the disc space. In these patients, the bone graft was not incorporated and no central interbody fusion could be found. In nine patients (31%) neither interbody fusion nor incorporation of the transpedicular graft was achieved. A frequent and reliable intervertebral fusion could not be achieved with the described technique of transpedicular bone grafting. The ineffectiveness of the intervertebral graft was found to be a reason for postoperative re-kyphosing.

Adult↗
PubMed2002

Dose, volume, and tumor control prediction in primary radiotherapy of non-small-cell lung cancer.

BACKGROUND: To evaluate the influence of total dose and tumor volume on local control and survival in primary radiotherapy of non-small-cell lung cancer (NSCLC). METHODS AND MATERIALS: We retrospectively analyzed the clinical course and CT-derived pre- and post-therapeutic tumor volume data of 135 patients with NSCLC undergoing primary radiotherapy at our department between 1989 and 1996. Among these, a total of 192 spatially separated tumor volumes (135 primary tumors, 1 additional intrapulmonary tumor, and 56 involved lymph nodes) were available for analysis. In all patients, treatment was planned using CT-based three-dimensional treatment planning. The dose to each tumor volume was derived from the individual dose plans. Mean total dose was 59.9 Gy (range: 30-80 Gy). All but 3 patients were followed until death. For local control analysis, each tumor was analyzed separately, and its remission status was determined in serial follow-up CT scans. A total of 784 CT scans were analyzed. Actuarial local control analysis was performed for the 192 separated tumor volumes, and survival analysis was performed for the 135 patients. Tumor control probability was calculated using a Poisson statistical model. RESULTS: Overall 1- and 2-year local control rate was 50% and 37%, respectively. The 2-year local control rate for tumors <50 ccm, 50-200 ccm, and >200 ccm was 51%, 22%, and 10%, respectively (p = 0.02). The 2-year local control rate for dose levels < or = 60 Gy and >60 Gy was 28% and 43% (p < 0.001). For the subgroup of 147 tumors smaller than 100 ccm, the local control rate increased up to 70% (1 year) and 51% (2 years) with doses of more than 60 Gy. For tumors larger than 100 ccm, no dose effect was seen. Only 2 of 45 tumors >100 ccm were controlled more than 2 years. Multivariate analysis revealed tumor volume, total dose, histopathologic type, and grading as significant and independent prognostic factors for local control. The number of delay days by split course (if used) and application of chemotherapy was not found to influence local control. Overall 1- and 2-year survival rate was 42% and 13%. Total radiation dose, chemotherapy, and T and N stage---but not tumor volume---were found to be independent and significant prognostic factors for survival in multivariate analysis. CONCLUSION: Tumor volume is an important predictor of local control in NSCLC. We found a clear dose effect for local control and survival in NSCLC. Long-term local control for a significant proportion of patients seems possible for small tumors only (<100 ccm, i.e., maximum diameter 6 cm) with doses of 70 Gy and more. Tumors of > or = 100 ccm are unlikely to be controlled long term by conventional doses up to 70 Gy. These results support dose escalation in patients with NSCLC.

Adenocarcinoma↗
PubMed2002

The relationship of chronic sputum expectoration to physiologic, radiologic, and health status characteristics in alpha(1)-antitrypsin deficiency (PiZ).

STUDY OBJECTIVES: First, to determine the relationships among chronic sputum expectoration (CSE), exacerbations, airflow obstruction, and emphysema in patients with alpha(1)-antitrypsin deficiency (alpha(1)-ATD) [PiZ]. Second, to use multivariate analysis to determine how these factors influence health status. DESIGN: Cross-sectional, single-center. SETTING: UK center for alpha(1)-ATD, university teaching hospital. PATIENTS: One hundred seventeen nonsmoking patients underwent lung function testing, high-resolution CT (HRCT) scanning with density mask analysis, and health status assessment using the St. George's Respiratory Questionnaire (SGRQ) and short form 36 (SF-36) health survey questionnaire. RESULTS: Patients with CSE (n = 50) had worse postbronchodilator airflow obstruction than those who did not (p = 0.03), with a median FEV(1) of 1.15 L (interquartile range [IQR], 0.76 to 1.82) vs 1.44 L (IQR, 0.99 to 2.93), respectively, and higher HRCT scan voxel index (VI) values indicating more extensive emphysema (patients with CSE: median lower zone VI, 50; IQR, 28 to 61; patients without CSE: median lower zone VI, 41; IQR, 5 to 53; p = 0.04). Patients with CSE also had worse health status, as assessed by the SGRQ (p < 0.01 for all domains) and SF-36 questionnaire (p < 0.05 for seven of nine domains). Exacerbation frequency was greater in those patients with CSE (p < 0.001), with a median of two episodes per year (IQR, 1 to 3) vs 0.66 episodes per year (IQR, 0 to 2) for those without CSE. Stepwise linear regression analysis revealed FEV(1), exacerbation frequency, and lower zone VI to be the most important predictors of health status. CONCLUSIONS: Among patients with alpha(1)-ATD, those with CSE expectoration exhibit greater physiologic impairment and more extensive emphysema than those without. This is reflected in an inferior health status, which is also influenced independently by an increased exacerbation frequency in those with CSE.

Adult↗