Diagnostic accuracy of non-contrast abdominal CT scans performed as follow-up for patients with an established cancer diagnosis: a retrospective study

Abstract With the development of minimally invasive cardiac surgery, chest and abdominal computed tomography (CT) scans are becoming an integral part of preoperative assessment and planning. Therefore, the number of incidental findings (IFs) detected with CT is rising. We aimed to investigate the frequency of clinically significant IFs on chest and abdominal CT scans performed during the preoperative assessment of patients undergoing adult cardiac surgery in a 2-year period. In a cohort of 401 patients (mean age 67.4 ± 12.3, female gender 28.9%, median logistic EuroSCORE 5.8 [0.9, 90.5]) who underwent chest or abdominal CT imaging during the study period, we identified 75 patients (18.7%) with clinically significant IFs who needed a further treatment or work-up to confirm the diagnosis or postoperative follow-up. Our data indicate that clinically significant IFs in patients referred for cardiac surgery are frequent. It is important to identify clinically significant Ifs, as a clear postoperative follow-up plan should be made.

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Ultrasound Placental Localisation in Early Pregnancy

Scottish Medical Journal ◽

10.1177/003693308703200109 ◽

1987 ◽

Vol 32 (1) ◽

pp. 19-21 ◽

Cited By ~ 5

Author(s):

A. T. Khan ◽

K.S. Stewart

Keyword(s):

Retrospective Study ◽

Diagnostic Accuracy ◽

Clinical Significance ◽

Early Pregnancy ◽

Fetal Development ◽

Placenta Previa ◽

Consecutive Case ◽

Antepartum Haemorrhage

A retrospective study of 400 consecutive case records was made to establish the clinical significance of the low lying placenta found on ultrasound. Diagnostic accuracy is discussed. 30% of the patients had a low lying placenta on early scan. Of these, 73% had a follow up scan. There was a progressive drop in the incidence of low lying placentae through pregancy until at term, in this study, there was no placenta previa. It is considered that a repeat scan is necessary to exclude placenta previa, but not until 34 weeks gestation. Amongst the patients with early low lying placentae the incidence of antepartum haemorrhage of indeterminate type was significantly high (P<0.001). A careful surveillance of these patients is therefore required. Dynamic placental migration may be the cause of this bleeding. Further study is necessary to determine the effect of early placental position on subsequent fetal development.

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Retrospective analysis of unstaged and staged Gamma Knife surgery with and without preceding embolization for the treatment of arteriovenous malformations

Journal of Neurosurgery ◽

10.3171/jns/2008/109/12/s10 ◽

2008 ◽

Vol 109 (Supplement) ◽

pp. 57-64 ◽

Cited By ~ 35

Author(s):

Adam G. Back ◽

Dennis Vollmer ◽

Otto Zeck ◽

Clive Shkedy ◽

Peter M. Shedden

Keyword(s):

Retrospective Study ◽

Retrospective Analysis ◽

Gamma Knife ◽

Arteriovenous Malformations ◽

Gamma Knife Surgery ◽

Ct Scans ◽

Treatment Modalities ◽

Mr Images ◽

Obliteration Rate

Object The authors conducted a retrospective study to examine data on rates of obliteration of arteriovenous malformations (AVMs) with use of various combinations of treatment modalities based on Gamma Knife surgery (GKS). The authors believe that this study is the first to report on patients treated with embolization followed by staged GKS. Methods The authors identified 150 patients who underwent GKS for treatment of AVMs between 1994 and 2004. In a retrospective study, 4 independent groups emerged based on the various combinations of treatment: 92 patients who underwent unstaged GKS, 28 patients who underwent embolization followed by unstaged GKS, 23 patients who underwent staged GKS, and 7 patients who underwent embolization followed by staged GKS. A minimum of 3 years of follow-up after the last GKS treatment was required for inclusion in the retrospective analysis. Angiograms, MR images, or CT scans at follow-up were required for calculating rates of obliteration of AVMs. Results Fifty-seven of 150 patients (38%) supplied angiograms, and overall obliteration was confirmed in 43 of these 57 patients (75.4%). An additional 37 patients had follow-up MR images or CT scans. The overall obliteration rate, including patients with follow-up angiograms and patients with follow-up MR images or CT scans, was 68 of 94 (72.3%). Patients who underwent unstaged GKS had a follow-up rate of 58.7% (54 of 92) and an obliteration rate of 75.9% (41 of 54). Patients who underwent embolization followed by unstaged GKS had a follow-up rate of 53.5% (15 of 28) and an obliteration rate of 60.0% (9 of 15). Patients who underwent staged GKS had a follow-up rate of 82.6% (19 of 23) and an obliteration rate of 73.7% (14 of 19). Patients who underwent embolization followed by staged GKS had a follow-up rate of 85.7% (6 of 7) and an obliteration rate of 66.7% (4 of 6). Conclusions Gamma Knife surgery is an effective means of treating AVMs. Embolization prior to GKS may reduce AVM obliteration rates. Staged GKS is a promising method for obtaining high obliteration rates when treating larger AVMs in eloquent locations.

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Comparison of subjective evaluation versus objective algorithm in the interpretation of follow-up FDG-PET/CT scans after radiochemotherapy in head and neck cancer patients

Nuklearmedizin ◽

10.1055/a-0859-6518 ◽

2019 ◽

Vol 58 (02) ◽

pp. 93-100 ◽

Cited By ~ 1

Author(s):

Alexander Kohler ◽

Steffen Löck ◽

Steffen Appold ◽

Anna Bandurska-Luque ◽

Sebastian Hoberück ◽

...

Keyword(s):

Diagnostic Accuracy ◽

Head And Neck ◽

Fdg Pet ◽

Distant Metastases ◽

Ct Scans ◽

Experienced Observer ◽

Pet Ct ◽

Objective Classification ◽

Fdg Pet Ct

Abstract Aim Retrospective evaluation of serial FDG-PET/CT scans in head and neck squamous cell cancer (HNSCC) patient’s follow-up after primary radiochemotherapy (RCTx), to assess the diagnostic accuracy of an experienced observer vs. an objective classification compared to standard clinical follow-up examinations. Methods Sixty-nine patients with locally advanced HNSCC were included, who received curative RCTx. Follow-up included serial FDG-PET/CT at the following time intervals t1: ≤ 270 d, t2: 271–540 d, t3: > 540 d after curative RCTx. The likelihood to detect local recurrences, nodal and distant metastases were compared between (i) experienced observer, (ii) an objective classification system by Zundel et al. 25, and (iii) routine clinical follow-up examinations. Results Twenty-two local recurrences, 7 nodal and 17 distant metastases were recorded during the follow-up. The diagnostic accuracy for local recurrence of the experienced observer vs. objective classification was 78 % vs. 77 % for t1, 83 % vs. 79 % for t2 and 100 % vs. 84 % for t3.The classification (ii) and the conventional follow-up (iii) resulted in a relatively high amount of equivocal findings reducing the diagnostic accuracy. Conclusion Evaluation of FDG-PET/CT by an experienced observer in follow-up of HNSCC patients after curative RCTx resulted in the highest diagnostic accuracy in comparison to an objective classification and to routine clinical examination.HNSCC is a malignant tumor with a high likelihood of recurrence, especially in the first two years after curative RCTx. Early detection of recurrence is of high clinical importance, since there are several effective second line therapies that may have curative potential in some patients.

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Strategy for obtaining solid fusion at L5–S1 in adult spinal deformity: risk factor analysis for nonunion at L5–S1

Journal of Neurosurgery Spine ◽

10.3171/2020.2.spine191181 ◽

2020 ◽

Vol 33 (3) ◽

pp. 323-331 ◽

Cited By ~ 1

Author(s):

Ki Young Lee ◽

Jung-Hee Lee ◽

Kyung-Chung Kang ◽

Sung Joon Shin ◽

Won Ju Shin ◽

...

Keyword(s):

Risk Factors ◽

Retrospective Study ◽

Spinal Deformity ◽

Sagittal Balance ◽

Interbody Fusion ◽

Adult Spinal Deformity ◽

Ct Scans ◽

Iliac Screws ◽

Iliac Fixation

OBJECTIVEMaintaining lumbosacral (LS) arthrodesis and global sagittal balance after long fusion to the sacrum remains an important issue in the surgical treatment for adult spinal deformity (ASD). The importance and usefulness of LS fixation have been documented, but the optimal surgical long fusion to the sacrum remains a matter for debate. Therefore, the authors performed a retrospective study to evaluate fusion on CT scans and the risk factors for LS pseudarthrosis (nonunion) after long fusion to the sacrum in ASD.METHODSThe authors performed a retrospective study of 59 patients with lumbar degenerative kyphosis (mean age 69.6 years) who underwent surgical correction, including an interbody fusion of the L5–S1, with a minimum 2-year follow-up. Achievement of LS fusion was evaluated by analyzing 3D-CT scans at 3 months, 6 months, 9 months, 1 year, and 2 years after surgery. Patients were classified into a union group (n = 36) and nonunion group (n = 23). Risk factors for nonunion were analyzed, including patient and surgical factors.RESULTSThe overall fusion rate was 61% (36/59). Regarding radiological factors, optimal sagittal balance at the final follow-up significantly differed between two groups. There were no significant differences in terms of patient factors, and no significant differences with respect to the use of pedicle subtraction osteotomy, the number of fused segments, the proportion of anterior versus posterior interbody fusion, S2 alar iliac fixation versus conventional iliac fixation, or loosening of sacral or iliac screws. However, the proportion of metal cages to polyetheretherketone cages and the proportion of sacropelvic fixation were significantly higher in the union group (p = 0.022 and p < 0.05, respectively).CONCLUSIONSLS junction fusion is crucial for global sagittal balance, and the use of iliac screws in addition to LS interbody fusion using a metal cage improves the outcomes of long fusion surgery for ASD patients.

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Undetected Pancreatic Adenocarcinoma on CT: Frequency According to CT Scan Protocol

10.21203/rs.3.rs-737370/v1 ◽

2021 ◽

Author(s):

Moran Drucker Iarovich ◽

Sara Apter ◽

Eli Konen ◽

Yael Inbar ◽

Marrianne Amitai ◽

...

Keyword(s):

Ct Scan ◽

Pancreatic Adenocarcinoma ◽

Cancer Diagnosis ◽

Ct Scans ◽

Abdominal Ct ◽

Diagnostic Modality ◽

Pancreatic Fat ◽

Triphasic Ct ◽

Fat Stranding ◽

Scan Protocol

Abstract Purpose: CT is a main diagnostic modality for detecting pancreatic adenocarcinoma. This study aims to assess the frequency of missed pancreatic adenocarcinoma on CT scans according to different CT protocols.Methods: Consecutive pancreatic adenocarcinoma patients were retrospectively collected (12/2011-12/2015). Patients with abdominal CT scans performed up-to a year prior to cancer diagnosis were included. Two radiologists registered in consensus the presence and radiological signs of missed cancers. The frequency of missed cancers was compared between portal and pancreatic/triphasic CT protocols. Results: Overall, 180 CT scans of pancreatic adenocarcinoma patients were retrieved. 126/180 (70.0%) were pancreatic/triphasic protocols and 54/180 (30.0%) were portal protocols. The overall frequency of missed cancers was 6/180 (3.3%). The frequency of missed cancers was higher in portal CT protocols compared to pancreatic/triphasic protocols: 5/54 (9.3%) vs. 1/126 (0.8%), p=0.01. CT signs of missed cancers included: 3 cases of small hypodense lesions, 2 cases with peri-pancreatic fat stranding, 1 case of dilated pancreatic duct with a cut-off sign.Conclusion: The frequency of missed pancreatic adenocarcinoma is higher on portal CT protocols. Physicians should consider the cancer miss rate on different CT protocols.

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An Adrenal Incidentaloma: How Often Is It Detected and What Are the Consequences?

ISRN Radiology ◽

10.5402/2013/871959 ◽

2013 ◽

Vol 2013 ◽

pp. 1-4 ◽

Cited By ~ 4

Author(s):

E. M. Minnaar ◽

K. E. Human ◽

D. Henneman ◽

C. Y. Nio ◽

P. H. Bisschop ◽

...

Keyword(s):

Adrenal Incidentaloma ◽

National Institutes Of Health ◽

Ct Scans ◽

Adrenal Incidentalomas ◽

Radiology Report ◽

Abdominal Ct ◽

Radiology Reports ◽

Expert Radiologist ◽

Additional Imaging

Objectives. The aim of this study was to investigate the detection rate of adrenal incidentalomas and subsequent workup. Design. Retrospective cohort study. Methods. Two investigators evaluated the adrenals on abdominal CT scans. Abnormalities were compared to the original radiology reports and an experienced abdominal radiologist reviewed the CT scans. All additional imaging and laboratory tests were assessed. Results. The investigators detected 44/356 adrenal incidentalomas (12%). In 25 patients an adrenal incidentaloma had been noted in the radiology report. The expert radiologist agreed on 19 incidentalomas in 17 patients, two with bilateral incidentalomas. Of the 25 incidentaloma patients, 4 (16%) patients were screened for hormonal overproduction and 2 (8%) patients had follow-up imaging studies. Conclusions. 12% of the patients had an adrenal incidentaloma (42 of 356). 17 (40%) had initially not been reported by the radiologist. When diagnosed with an adrenal incidentaloma, only a small percentage of patients (16%) is screened or undergoes repeated imaging (8%) as proposed in the National Institutes of Health (NIH) guidelines on adrenal incidentalomas.

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Osseous Healing With Non-Rigid Suture Fixation Offers a Compelling Alternative to Conventional Latarjet Procedure

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119s00314 ◽

2019 ◽

Vol 7 (7_suppl5) ◽

pp. 2325967119S0031

Author(s):

Vivek Kalia ◽

Emily G. Pacheco ◽

Michael T. Freehill

Keyword(s):

Retrospective Study ◽

Ct Scan ◽

Ct Scans ◽

Rigid Fixation ◽

Suture Fixation ◽

Latarjet Procedure ◽

Cortical Button ◽

The Mean ◽

Fixation System

Objectives: The Latarjet procedure, both open and arthroscopically, is a popular means to surgically address anterior glenohumeral (GH) joint instability. Though the arthroscopic approach to the Latarjet is becoming increasingly common, challenges persist: (1) technical difficulty positioning the bone block flush with the glenoid and the screws parallel to the glenoid surface (2) postoperative complications secondary to the two bicortical fixation screws, and (3) considerable risk of neurological injury. Recently, a novel surgical technique has been described which uses a guided surgical approach for graft positioning with non-rigid fixation via a suture suspensory system. The objective of our retrospective study was to evaluate healing rates and long-term stability of shoulders who underwent this new technique of anterior glenoid augmentation. The specific aims of our study were to assess (1) if this non-rigid suture fixation system is stable enough to allow the autograft bone to heal onto the native glenoid appropriately and (2) if the autograft bone could be reliably placed without migration of the graft. Methods: In this retrospective study, we gathered anonymized DICOM computed tomography (CT) datasets from a total of 107 patients who underwent non-rigid suture fixation with a cortical button fixation device in lieu of the traditional bicortical screws during arthroscopic Latarjet procedure. Of the 107 patients, only 75 patients had at least two CT scans performed at two different time periods which could be compared in terms of osseous healing and potential migration. The first CT scan for each patient was 2 weeks postoperative. Each patient’s CT scans were compared side-by-side by the same fellowship-trained musculoskeletal radiologist on a diagnostic workstation. Data recorded included the age, gender, date of each scan, initial graft position on the glenoid, presence and degree of graft migration on delayed follow-up scan (minimum 3 months), and the percentage of osseous healing (as assessed by osseous bridging) on the delayed follow-up scan. A minority of patients had several delayed timepoint scans (several years out), and those were evaluated as well. Descriptive statistics were calculated evaluating the average migration and average percent healing at both timepoints. Results: Our population (n=75) consisted of 61 men (81.3%) and 14 women (18.7%). The mean age of was 27.3 ± 1.1 years. The mean time period between initial CT scan (2 weeks postoperative) and follow-up CT scan to assess for healing and migration was 27 ± 2 weeks. At delayed follow-up scan, the average percent healing on follow-up scan was 78% ± 4%. A total of 61 out of 75 (81%) patients had greater than 75% healing on follow-up scan. The average migration of the coracoid graft in our study was 1.45 ± 0.23 mm, ranging from 0 mm to 8.75 mm. A total of 37/75 (49.3%) of the patients had no migration at all on follow-up scan, and 63/75 (84%) had migration of < 2 mm. Conclusion: Based on these findings, non-rigid suture fixation with a cortical button device offers a safe alternative to traditional screw fixation for the Latarjet procedure. Though a non-rigid fixation system, osseous healing with minimal migration of the graft can be predicted. [Figure: see text]

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Deep learning-based muscle segmentation and quantification at abdominal CT: application to a longitudinal adult screening cohort for sarcopenia assessment

British Journal of Radiology ◽

10.1259/bjr.20190327 ◽

2019 ◽

Vol 92 (1100) ◽

pp. 20190327 ◽

Cited By ~ 20

Author(s):

Peter M. Graffy ◽

Jiamin Liu ◽

Perry J. Pickhardt ◽

Joseph E. Burns ◽

Jianhua Yao ◽

...

Keyword(s):

Ct Scans ◽

Abdominal Ct ◽

Muscle Area ◽

Mean Values ◽

Muscle Density ◽

Age Related ◽

Muscle Attenuation ◽

Attenuation Loss ◽

Muscle Segmentation

Objective: To investigate a fully automated abdominal CT-based muscle tool in a large adult screening population. Methods: A fully automated validated muscle segmentation algorithm was applied to 9310 non-contrast CT scans, including a primary screening cohort of 8037 consecutive asymptomatic adults (mean age, 57.1±7.8 years; 3555M/4482F). Sequential follow-up scans were available in a subset of 1171 individuals (mean interval, 5.1 years). Muscle tissue cross-sectional area and attenuation (Hounsfield unit, HU) at the L3 level were assessed, including change over time. Results: Mean values were significantly higher in males for both muscle area (190.6±33.6 vs 133.3±24.1 cm2, p<0.001) and density (34.3±11.1 HU vs 27.3±11.7 HU, p<0.001). Age-related losses were observed, with mean muscle area reduction of -1.5 cm2/year and attenuation reduction of -1.5 HU/year. Overall age-related muscle density (attenuation) loss was steeper than for muscle area for both sexes up to the age of 70 years. Between ages 50 and 70, relative muscle attenuation decreased significantly more in females (-30.6% vs -18.0%, p<0.001), whereas relative rates of muscle area loss were similar (-8%). Between ages 70 and 90, males lost more density (-22.4% vs -7.5%) and area (-13.4% vs -6.9%, p<0.001). Of the 1171 patients with longitudinal follow-up, 1013 (86.5%) showed a decrease in muscle attenuation, 739 (63.1%) showed a decrease in area, and 1119 (95.6%) showed a decrease in at least one of these measures. Conclusion: This fully automated CT muscle tool allows for both individualized and population-based assessment. Such data could be automatically derived at abdominal CT regardless of study indication, allowing for opportunistic sarcopenia detection. Advances in knowledge: This fully automated tool can be applied to routine abdominal CT scans for prospective or retrospective opportunistic sarcopenia assessment, regardless of the original clinical indication. Mean values were significantly higher in males for both muscle area and muscle density. Overall age-related muscle density (attenuation) loss was steeper than for muscle area for both sexes, and therefore may be a more valuable predictor of adverse outcomes.

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