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Journal of Computer Assisted Tomography - Current Issue

Journal of Computer Assisted Tomography - Current Issue
  1. Effects of Percutaneous Coronary Intervention on Viable Myocardium and Heart Function of Diabetic Patients With Chronic Total Occlusion
    imageObjective: The aim of this study was to compare the effects of percutaneous coronary intervention (PCI) on coronary chronic total occlusion patients with (DM) or without (NDM) diabetes mellitus. Methods: A total of 78 patients were divided into DM group and NDM group according to whether the patient has DM. The results of PCI were analyzed using quantitative coronary analysis. In addition, all the patients underwent 99mTc-MIBI (methoxyisobutylisonitrile) single-photon emission computed tomography (SPECT) and ultrasonic cardiogram in the first week and the sixth month after PCI to evaluate PCI results. During the 6-month follow-up, major adverse cardiac event (MACE) was recorded and analyzed as well. Results: The first and second classes of collateral circulation between the 2 groups have significant differences (P < 0.05). Left ventricular end-diastolic volume index and left ventricular end-systolic volume index were decreased at the sixth month compared with those at the first week. Left ventricular ejection fraction was significantly increased. In both groups, the defect size significantly reduced, and percentage of radionuclide scintigraphic count significantly increased between rest and nitroglycerin interventional SPECT. After 6 months, both groups repeated nitroglycerin interventional SPECT, which showed that defect size was significantly reduced, and the percentage of radionuclide scintigraphic count was significantly increased compared with those of the first week. During the 6-month follow-up, the incidence of MACE between the 2 groups had no significant difference. Conclusions: Percutaneous coronary intervention has beneficial effects on heart functions and MACE when performed on chronic total occlusion patients with and without DM.



  2. Usefulness of a Low Tube Voltage: Knowledge-Based Iterative Model Reconstruction Algorithm for Computed Tomography Venography
    imageObjectives: The objective of this study was to evaluate the use of 80-kVp scans with knowledge-based iterative model reconstruction (IMR) for computed tomography venography (CTV). Methods: This prospective study received institutional review board approval; a previous informed consent was obtained from all participants. We enrolled 30 patients with suspected deep venous thrombosis or pulmonary embolism who were to undergo 80-kVp CTV studies. The images were reconstructed with filtered back projection (FBP), hybrid iterative reconstruction (HIR), and IMR. The venous attenuation, image noise, and contrast-to-noise ratio at the iliac, femoral, and popliteal veins were compared on FBP, HIR, and IMR images. We performed qualitative image analysis (image noise, image contrast, image sharpness, streak artifacts, and overall image quality) of the 3 reconstruction methods and measured their reconstruction times. Results: There was no significant difference in venous attenuation among the 3 reconstruction methods (P > 0.05). On IMR images, the image noise was lowest at all 3 venous locations, and the contrast-to-noise ratio was highest. Qualitative evaluation scores were also highest for IMR images. The reconstruction time for FBP, HIR, and IMR imaging was 25.4 ± 1.9 seconds, 43.3 ± 3.3 seconds, and 78.7 ± 6.0 seconds, respectively. Conclusions: At clinically acceptable reconstruction times, 80-kVp CTV using the IMR technique yielded better qualitative and quantitative image quality than HIR and FBP.



  3. Computed Tomography Pulmonary Angiogram Dynamic Parameter Correlation With Pulmonary Pressure and Pulmonary Hypertension Etiologies
    imageObjective: Pulmonary hypertension (PH) is caused by etiologies that differ in pathophysiology. Patients with undiagnosed PH may have a computed tomography pulmonary angiography (CTPA) scan during workup. Static measurements on computed tomography correlate with PH; however, dynamic parameters have received less attention. We studied the correlation between CTPA dynamic parameters and PH and assessed whether these parameters differ among PH etiologies. We also propose a method for PH screening. Methods: Patients who underwent right-heart catheterization and CTPA within 45 days of each other were included. Charts were reviewed for presence and etiology of PH. The time it took to reach the CTPA trigger threshold during bolus tracking (TT) was recorded and compared with pulmonary pressure measured on pulmonary artery catheterization. The correlation between TT values and pulmonary pressure was studied, as well as the sensitivity and specificity of TT for PH. Results: Twenty-seven patients with 28 examinations were included. A significant correlation was found between pulmonary pressure and TT, as well as TT and right ventricular decreased function, P < 0.01. Left heart failure showed the longest TT among PH subgroups and significantly longer TT in patients with both PH and right ventricular decreased function. Time to trigger demonstrated a sensitivity range of 75% to 92% and specificity between 56% and 88% for pulmonary pressure of 40 mm Hg or greater. Conclusions: Dynamic parameters of flow measured on CTPA significantly correlate with pulmonary pressure and can potentially help screen for PH. Left heart failure seems to have the greatest impact on TT among patients with PH.



  4. Sternal Development and Variations and Anomalies in Patients With Microtia: Evaluation Using 3-Dimensional Computed Tomography
    imageObjective: The objectives of this study were to evaluate sternal development and variations in patients with microtia and to identify the incidence of congenital sternal anomalies and then to investigate the interaction between microtia and sternal anomalies. Methods: A total of 212 consecutive patients received a preoperative 3-dimensional chest computed tomography. A retrospective study was performed with the clinical and imaging data from November 2014 to July 2015. Descriptive statistics, analysis of variance, Spearman analysis, χ2 test, and Fisher χ2 test were performed for statistics analysis. Results: We evaluated the ossification centers and developmental variations in the manubrium and body, as well as the xiphoid process, manubriosternal and sternoxiphoidal fusion, and sternal anomalies. Significant variations were observed from person to person. Sternal foramen was detected in 6 male patients (2.8%). All foramina were located in the inferior part of the body. Sternal cleft was observed in 4 cases (1.9%), of which 2 were accompanied by a foramen in the distal part of the sternum. Conclusions: The development of the different components of the sternum is a process with wide variation among patients with microtia. A different distribution of mesosternal types I to II among our population age range was found, and the incidence of sternal foramina was lower in patients with microtia.



  5. Evaluation and Minimization of the Pseudohepatic Anisotropy Artifact in Liver Intravoxel Incoherent Motion
    imagePurpose: The aim of this study was to evaluate the effect of the pseudohepatic anisotropy artifact on liver intravoxel incoherent motion (IVIM) metrics and whether the use of multiple gradient directions in the IVIM acquisition minimizes the artifact. Materials and Methods: Multiple breath-holding and forced shallow free-breathing IVIM scans were performed on 8 healthy volunteers using 1 and 6 gradient directions. Cluster analysis was carried out to separate motion-contaminated parenchyma from liver parenchyma and vessels. Nonlinear motion analysis was also performed to look for a possible link between IVIM metrics and nonlinear liver motion. Results: On the basis of the resulted clusters, motion-contaminated parenchyma is often noted in the left liver lobe, where the prominent pseudohepatic artifact has previously been identified. A significant reduction in outliers was obtained with the acquisition of 6 noncoplanar gradient directions and when using forced shallow free-breathing. Conclusion: The pseudohepatic anisotropy artifact can be minimized when using multiple diffusion-encoding gradient directions and forced free-breathing during IVIM acquisition.


  6. Assessing Synovitis and Bone Erosion With Apparent Diffusion Coefficient in Early Stage of Rheumatoid Arthritis
    imagePurpose: The aim of this study was to assess the value of apparent diffusion coefficient (ADC) in distinguishing synovitis from joint fluid and bone erosion from cysts. Methods: Twenty-eight patients with suspected rheumatoid arthritis underwent diffusion-weighted imaging and pre– and post–contrast-enhanced magnetic resonance imaging. The mean ADC values were compared between synovitis and joint effusion and between bone erosion and cyst. Results: Mean ADC value of synovitis was significantly lower than that of the joint effusion (2.6 ± 0.37 × 10−3 vs 1.63 ± 0.37 × 10−3 mm2/s, P < 0.001; cutoff value 2.10 × 10−3 mm2/s). Mean ADC value of bone erosion was significantly lower than that of the cysts (1.61 ± 0.39 × 10−3 vs 2.39 ± 0.34 × 10−3 mm2/s, P < 0.001; cutoff value 2.04 × 10−3 mm2/s). Conclusion: Apparent diffusion coefficient can be used in differentiating between synovitis and joint effusion and between bone erosion and cysts.



  7. Two-Dimensional Spoiled Gradient-Recalled Echo Magnetic Resonance Imaging of the Liver Using Respiratory Navigator-Gating Techniques
    imageObjective: We assessed the feasibility of T1-weighted 2-dimensional spoiled gradient-recalled (2D SPGR) acquisition in steady-state imaging of the liver with various respiratory navigator gating techniques. Methods: A total of 12 healthy volunteers underwent in-phase and out-of-phase 2D SPGR imaging of the liver during breath-holding and free-breathing. Four techniques for respiratory navigation, 2 conventional navigator techniques and 2 self-navigator techniques, were used for free-breathing imaging. Results: Good navigator waveforms were obtained in conventional navigation, whereas fluctuations were evident in self navigation. All of the 4 navigator-based methods provided better images in terms of background signals and visual image quality compared with images obtained with no respiratory control. However, differences remained in comparison with breath-holding. Superiority of self-navigation to conventional navigation was not shown. Conclusions: Navigator-gating techniques improved 2D SPGR images of the liver acquired during free-breathing, suggesting feasibility and beneficial effects, although navigator-based images were still inferior to breath-hold images.



  8. Relationship of Nonseptal Late Gadolinium Enhancement to Ventricular Tachyarrhythmia in Hypertrophic Cardiomyopathy
    imageObjective: This study aimed to determine the relationship between the extent and the location of late gadolinium enhancement (LGE) and ventricular tachyarrhythmia or implantable cardioverter defibrillator (ICD) in hypertrophic cardiomyopathy (HCM). Methods: We enrolled 115 patients with HCM and LGE. The location of LGE was divided into septal and nonseptal segments. Clinical backgrounds and LGE were compared in patients between with and without the arrhythmia or consequent ICD installation. Results: There were significant differences in the number of risk markers, left ventricular ejection fraction, extent of global LGE, and extent of nonseptal LGE between the groups (P < 0.01). Multivariate analysis revealed that the number of risk markers and extent of nonseptal LGE contributed to ventricular tachyarrhythmia or ICD installation (P < 0.01). Conclusions: The nonseptal LGE is related to ventricular tachyarrhythmia or ICD installation. We should be vigilant for nonseptal LGE when applying LGE to risk stratification for HCM.



  9. Correlation Between Bile Reflux Gastritis and Biliary Excreted Contrast Media in the Stomach
    imageObjective: This study aimed to evaluate the relationship between biliary excreted contrast media in the stomach and the presence of bile reflux gastritis. Methods: Consecutive 111 patients who underwent both gadoxetic acid–enhanced magnetic resonance cholangiography (gadoxetic MRC) and gastric endoscopy were included in this study. We performed a review of the gadoxetic-MRC image sets acquired 60 minutes after intravenous injection of contrast media and endoscopic images. We recorded amount of contrast media in the stomach. The sensitivity, specificity, and accuracy of duodenogastric bile reflux diagnosis were evaluated for the gadoxetic MRC. Statistical analysis was performed using the Fisher exact test and the linear-by-linear association test. Results: Among the 111 patients, 39 had 60-minute delayed images showing the presence of contrast media in the stomach. Of these 39 patients, 13 had bile reflux gastritis and 5 showed bile in the stomach without evidence of erythematous gastritis. Of the 72 patients who did not show contrast media in the stomach, none had bile reflux gastritis and 2 patients showed bile staining in the stomach without evidence of erythematous gastritis. Bile reflux gastritis was significantly more frequent in patients with contrast media in the stomach on gadoxetic MRC than in those without. Patients with high-grade extension of contrast media in the stomach had significantly frequent bile reflux gastritis than did those with low-grade extension. Conclusion: Biliary excreted contrast media in the stomach on 60-minute delayed gadoxetic MRC has a correlation with the presence of bile reflux gastritis on endoscopic examination.



  10. Comparison of 270 Versus 320 mg I/mL of Iodixanol in 1 Image Assessment of Both Renal Arteries and Veins With Dual-Energy Spectral CT Imaging in Late Arterial Phase and Their Influence on Renal Function
    imageObjective: The objective of this study was to compare the image quality of renal arteries and veins with dual-energy spectral computed tomography (CT) imaging in late arterial phase using 270 and 320 mg I/mL of iodixanol and their influence on renal function. Methods: A total of 1062 patients underwent renal CT angiography with 270 or 320 mg I/mL of iodixanol with dual-energy spectral CT imaging in late arterial phase. Image quality and their influence on renal function were compared. Results: There were no significant differences of CT value, signal-to-noise ratio, contrast-to-noise ratio, and subjective score of renal vessels between 2 groups (all P > 0.05). The incidence of contrast-induced nephropathy in patients with abnormal renal function using 320 mg I/mL of iodixanol was significantly higher than using 270 mg I/mL of iodixanol (P = 0.043). Conclusions: The renal arteries and veins can be fully assessed in late arterial phase with 270 mg I/mL of iodixanol using dual-energy spectral CT scan with better preserved renal function.


  11. Preoperative Computed Tomography Assessment for Perinephric Fat Invasion: Comparison With Pathological Staging
    imageObjective: The aim of this study was to assess the accuracy of computed tomography (CT) imaging in diagnosing perinephric fat (PNF) invasion in patients with renal cell carcinoma. Methods: We retrospectively reviewed the medical records and preoperative CT images of 161 patients (105 men and 56 women) for pT1–pT3a renal cell carcinoma. We analyzed the predictive accuracy of CT criteria for PNF invasion stratified by tumor size. We determined the predictive value of CT findings in diagnosing PNF invasion using logistic regression analysis. Results: The overall accuracy of perinephric (PN) soft-tissue stranding, peritumoral vascularity, increased density of the PNF, tumoral margin, and contrast-enhancing soft-tissue nodule to predict PNF invasion were 56%, 59%, 35%, 80%, and 87%, respectively. Perinephric soft-tissue stranding and peritumoral vascularity showed high sensitivity but low specificity regardless of tumor size. A contrast-enhancing soft-tissue nodule showed low sensitivity but high specificity in predicting PNF invasion. Among tumors 4 cm or less, PN soft-tissue stranding showed 100% sensitivity and 70% specificity, and tumor margin showed 100% sensitivity and 98% specificity. Among CT criteria for PNF invasion, PN soft-tissue stranding was chosen as the only significant factor for assessing PNF invasion by logistic regression analysis. Conclusions: Computed tomography does not seem to reliably predict PNF invasion. However, PN soft-tissue stranding was shown to be the only significant factor for predicting PNF invasion, which showed good accuracy with high sensitivity and high specificity in tumors 4 cm or less.



  12. Dynamic Contrast-Enhanced Magnetic Resonance Imaging of Ocular Melanoma as a Tool to Predict Metastatic Potential
    imagePurpose: This study explores the capability of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) to differentiate tumor characteristics of metastatic and nonmetastatic choroidal melanoma as a potential tool for patient management. Materials and Methods: A total of 13 patients (69 ± 9 years) with choroidal melanoma were imaged using DCE-MRI on a 3-T MRI system with a 16-channel head coil. The Tofts 2-compartment model was chosen for quantification, and parameters Ktrans (the transfer constant from the blood plasma to the extracellular space) and Kep (the transfer constant from the extracellular space to the blood plasma) were calculated and compared. Metastasis was excluded by subsequent clinical work-up or confirmed by histology after targeted biopsy. Results: Six patients were diagnosed with metastatic melanoma and 7 without. All orbital tumors were at least larger than 2 mm. A significant difference was identified in Ktrans between patients with (0.73 ± 0.18/min) and without (1.00 ± 0.21/min) metastatic melanoma (P = 0.03), whereas the difference was not significantly shown in Kep (2.58 ± 1.54/min of metastatic patients vs 2.98 ± 1.83/min of nonmetastatic patients, P = 0.67). Conclusions: Dynamic contrast-enhanced magnetic resonance imaging has the potential to differentiate orbital melanomas with metastatic and nonmetastatic spread. Thus, DCE-MRI has the potential to be an in vivo imaging technique to predict early which patients are prone to metastatic disease.



  13. Computed Tomography Perfusion Following Transarterial Chemoembolization of Hepatocellular Carcinoma: A Feasibility Study in the Early Period
    imageObjectives: The aim of this study was to assess the feasibility of computed tomography (CT) perfusion in early follow-up after transarterial chemoembolization (TACE) of hepatocellular carcinoma (HCC). Methods: Fifteen patients with a total of 16 HCC who were referred to our institution for TACE were included in the study. Computed tomography perfusion was performed within 1 to 3 days before and 4 to 7 days after TACE. Multiphase contrast-enhanced CT was performed 35 (SD, 20) days after TACE. Hepatic arterial blood flow and portal venous blood flow, as well as the perfusion index (PI), were calculated for each HCC using the dual input maximum slope method. Visual grading of the PI and visual grading of the amount of deposition of embolic material within the HCC were performed using a 6-step scale. Differences in perfusion before and after TACE and correlation of perfusion before TACE with the amount of embolization material depositions 1 week and 1 month after TACE were tested. Results: No statistically significant correlation was found between pre-TACE perfusion parameters and the amount of embolization material deposition in the post-TACE studies. There was no statistically significant difference between pre- and post-TACE arterial blood flow and portal venous blood flow, whereas PI was significantly lower after TACE. Congruently, visual grading of PI was statistically significantly lower after TACE. There was no statistically significant difference in quantitative pre-TACE and post-TACE PI between tumors, which showed hypervascularization in the multiphase follow-up CT and tumors that did not show hypervascularization. However, tumors that showed hypervascularization in the multiphase follow-up CT had significantly higher visual grading of PI after TACE than tumors that did not show hypervascularization. Conclusions: Our findings indicate that visual interpretation of the PI of HCC derived from dual-input maximum slope CT perfusion may be an early predictor of response to TACE.



  14. Gastric Heterotopic Pancreas: Computed Tomography With Clinicopathologic Correlation
    imageAbstract: Asymptomatic heterotopic pancreas (HP) is benign and can be monitored long term without further intervention. Heterotopic pancreas is sometimes surgically resected because it can be difficult to distinguish HP from neoplastic submucosal masses such as gastrointestinal stromal tumors. Although it is not very common, HP should be considered in the differential diagnosis when diagnosing extramucosal gastric masses to avoid unnecessary intervention. We review gastric HP with pathologic correlation to help with diagnosing HP on computed tomography.



  15. Intraluminal Uterine Hypodensity in CT Scans of Postmenopausal Women: Recommendations for Interpretation
    imageObjective: This study aims to investigate the association between intraluminal uterine hypodensity and uterine malignancy and establish thresholds that would minimize routine gynecological evaluation. Methods: Two groups were recruited retrospectively: cancer group, which comprised 32 sequential endometrial cancer patients, and postmenopausal group, which comprised 63 women, with no known gynecologic malignancy. Two radiologists independently measured hypodensity, transversely in the axial plane and anterioposteriorly in the sagittal plane. The association between cancer and hypodensity was evaluated. Receiver operating characteristic curves were evaluated diameters predictive of cancer. Results: Hypodensity was associated with cancer (cancer group, 93.8% vs. postmenopausal group, 38.1%; P < 0.0001). Hypodensity diameters correlated highly with prediction of cancer (transverse area under the curve, 0.899; anteroposterior area under the curve, 0.892). Diameters of 19.5 mm transverse and 6.0 mm anteroposterior yielded a sensitivity of 87% and 83% and specificity of 91% and 83%, respectively. Conclusions: Intrauterine hypodensity is a common finding in computed tomography scans of postmenopausal women. A transverse diameter of 19.5 mm and an anteroposterior diameter of 6.0 mm are suggested as thresholds for further gynecological sonographic evaluation.


  16. CT Attenuation of Pericoronary Adipose Tissue in Normal Versus Atherosclerotic Coronary Segments as Defined by Intravascular Ultrasound
    imageBackground: The factors influencing genesis of atherosclerosis at specific regions within the coronary arterial system are currently uncertain. Local mechanical factors such as shear stress as well as metabolic factors, including inflammatory mediators released from epicardial fat, have been proposed. We analyzed computed tomographic (CT) attenuation of pericoronary adipose tissue in normal versus atherosclerotic coronary segments as defined by intravascular ultrasound (IVUS). Patients and Methods: We evaluated the data sets of 29 patients who were referred for invasive coronary angiography and in whom IVUS of 1 coronary vessel was performed for clinical reasons. Coronary CT angiography was performed within 24 hours from invasive coronary angiography. Computed tomographic angiography was performed using dual-source CT (Siemens Healthcare; Forchheim, Germany). A contrast-enhanced volume data set was acquired (120 kV, 400 mA/rot, collimation 2 × 64 × 0.6 mm, 60–80 mL intravenous contrast agent). Intravascular ultrasound was performed using a 40-MHz IVUS catheter (Atlantis; Boston Scientific Corporation, Natick, Mass) and motorized pullback at 0.5 mm/s. Sixty corresponding coronary artery segments within the coronary artery system were identified in both dual source computed tomography and IVUS using bifurcation points as fiducial markers. In dual source computed tomography data sets, 8 serial parallel cross sections (2-mm slice thickness) were rendered orthogonal to the center line of the coronary artery for each segment. For each cross section, pericoronary adipose tissue within a radius of 3 mm from the coronary artery and enclosed within the epicardium (excluding coronary veins and myocardium) was manually traced and mean CT attenuation values were obtained. Intravascular ultrasound was used to define coronary segments as follows: presence of predominantly fibrous atherosclerotic plaque (hyperechoic), presence of predominantly lipid-rich atherosclerotic plaque (hypoechoic), and absence of atherosclerotic plaque. Results: In IVUS, 20 coronary segments with fibrous plaque, 20 segments with lipid-rich plaque, and 20 coronary segments without plaque were identified. The mean CT attenuation of pericoronary adipose tissue for segments with any coronary atherosclerotic plaque was −34 ± 14 Hounsfield units (HU), as compared with −56 ± 16 HU for segments without plaque (P = 0.005). The density of pericoronary fat in segments with fibrous versus lipid-rich plaque as defined by IVUS was not significantly different (−35 ± 19 HU vs −36 ± 16 HU, P = 0.8). Conclusions: Mean CT attenuation of pericoronary adipose tissue is significantly lower for normal versus atherosclerotic coronary segments. This supports a hypothesis of different types of pericoronary adipose tissue, the more metabolically active of which might exert local effects on the coronary vessels, thus contributing to atherogenesis.



  17. Application and Indication of Carcinoembryonic Antigen Triggered 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Scanning in the Detection of Relapse of Colorectal Cancer Patients After Curative Therapy
    imageObjective: This study aimed to explore the characteristics of patients with colorectal cancer (CRC) following curative therapy that may benefit from fluorine-18-2-uoro-2-deoxy-D-glucose positron emission tomography/computed tomography (18F-FDG PET/CT) scanning, evaluate the application of carcinoembryonic antigen (CEA)–triggered 18F-FDG PET/CT scanning, and provide referential indicators. Methods: This retrospective study included 56 CRC patients who received a PET/CT scan as a primary examination because of rising CEA levels after curative therapy and who had not received any other radiological examinations previously. Results: The rate of recurrence or metastasis was 75.0% by PET/CT scan but was 69.6% with follow-up treatment. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were 94.9%, 70.6%, 87.5%, 88.1%, and 85.7%, respectively. TNM (tumor, node, metastasis) stage, body mass index, and CEA level were significant prognostic factors. Conclusions: Positron emission tomography/CT can be selectively applied as a primary examination in CRC patients with asymptomatic elevation of CEA. High CEA levels, increased body mass index, and advanced TNM staging are risk factors for relapse.



  18. Lung Cancer in Patients With Tuberculous Fibrothorax and Empyema: Computed Tomography and 18F-Fluorodeoxyglucose Positron Emission Tomography Findings
    imageObjective: The aim of this study was to describe the characteristics of lung cancers in patients with tuberculous fibrothorax or empyema. Methods: We retrospectively evaluated 138 consecutive patients with a diagnosis of lung cancer combined with fibrothorax (n = 127) or empyema (n = 11) from January 2005 to May 2015. All patients underwent computed tomography, and 105 underwent 18F-fluorodeoxyglucose positron emission tomography. Clinical, pathologic, and computed tomography characteristics and maximum standardized uptake values on positron emission tomography of 76 cancers ipsilateral to the fibrothorax or empyema (group 1) were compared with those of 62 contralateral cancers (group 2). Results: The median age at diagnosis of patients was 70 years, with a male-to-female ratio of 8.9:1. The most common type was squamous cell carcinoma (41.3%) followed by adenocarcinoma (39.1%). Most were in the peripheral lung (70.3%), and half abutted the pleura. The median maximum standardized uptake value was 8.9. Tumors in group 1 were larger (median, 48.5 vs 42.8 mm, P = 0.036) and more advanced (T3 or T4) (P = 0.014) than those in group 2. Conclusions: Lung cancers ipsilateral to tuberculous fibrothorax or empyema presented larger and advanced T stages, and the diagnosis could be delayed. The most common type cancer was squamous cell carcinoma.



  19. Diaphragmatic Hernia After Living-Donor Right Hepatectomy: An Important Late Donor Complication
    imageObjective: This study was performed to evaluate the incidence and clinical outcome of diaphragmatic hernia after living-donor right hepatectomy. Methods: Three hundred thirty-six patients (202 men, 134 women; mean age, 37.6 years) who underwent abdominal computed tomography (CT) after right donor hepatectomy were enrolled in this study. The CT images and the electronic medical records were reviewed. We evaluated the associations between diaphragmatic hernia and patient characteristics. Results: Diaphragmatic hernia developed in 9 (2.7%) of 336 patients at a median time interval of 173 days (range, 98–488 days) after hepatectomy. In all 6 patients with available follow-up CT images, diaphragmatic hernia increased in size. Three patients presented with abdominal pain and underwent diaphragmatic repair. Diaphragmatic hernia was associated with older age but not with body mass index or sex. Conclusions: Clinicians and radiologists should not overlook the possibility of diaphragmatic hernia after living-donor right hepatectomy, especially in old liver donors.



  20. Left Atrium Measurements via Computed Tomography Pulmonary Angiogram as a Predictor of Diastolic Dysfunction
    imagePurpose: Left atrium (LA) enlargement on echocardiography may be an indicator of diastolic dysfunction (DD). It is not well known if computed tomography pulmonary angiography (CTPA) can detect DD. Methods: A total of 127 patients who underwent both CTPA and echo within 48 hours were analyzed retrospectively. Left atrium diameters from CTPA were correlated with echo and evaluated against degrees of DD. Computed tomography pulmonary angiography pulmonary artery (PA)/aorta ratio was analyzed as a tool to detect pulmonary hypertension. Results: There were 42% of patients who had DD. There was a strong correlation between LA size on CTPA and echo (r = 0.78). An LA greater than 4.0 cm gave a sensitivity of 68.1% and specificity of 73.9% for DD detection. A PA/aorta cutoff greater than 0.84 yielded a sensitivity of 84% and specificity of 33% for pulmonary hypertension. Conclusions: Computed tomography pulmonary angiography measurements of LA and PA/aorta ratio correlate strongly with equivalent findings on echo. We suggest that LA and PA/aorta measurements be included on chest CTPA reports.


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