Contrast-Enhanced Computed Tomography Does Not Provide More Information about Sarcopenia than Unenhanced Computed Tomography in Patients with Pancreatic Cancer

Objective. The aim of this study was to understand whether enhanced CT can provide more information than unenhanced CT on diagnosis of sarcopenia. Materials and Methods. We reviewed the enhanced CT data of 45 patients of pancreatic cancer. Manual tracing of the psoas muscles was used for measuring the cross-sectional muscle areas and attenuation at umbilicus level; afterwards, PMI, PMD, and Δ PMD were calculated. Results. In the unenhanced scanning, arterial, venous, and parenchymal phases of enhanced CT, PMI values were 6.905 ± 2.170, 6.886 ± 2.195, 6.923 ± 2.239, and 6.866 ± 2.218, respectively, and the difference was not statistically significant. The PMD values at different phases were 34.311 ± 7.535, 37.487 ± 7.118, 40.689 ± 7.116, and 42.989 ± 7.745, respectively, which were gradually increased, and the difference was statistically significant. Meanwhile, the PMD of arterial phase, venous phase, and parenchyma phase showed a linear correlation with PMD of unenhanced scanning phase. 31 patients had low PMD and 14 had normal PMD during the unenhanced scanning phase. With the addition of contrast agent, ΔPMD values increased faster in the low PMD group than in the normal PMD group during the venous and parenchymal phases (7.048 ± 3.067 vs 4.893 ± 2.558; 9.581 ± 3.033 vs 6.679 ± 2.621; p < 0.05 ), which made the gap between PMD after contrast-enhancement vs. unenhanced scanning smaller. Conclusion. The use of contrast agent has no effect on the manually measured PMI values but can change the results of PMD. This change makes the difference of PMD in different enhancement phases smaller than that in plain scan phase and furthermore increases the examination cost; therefore, it is not recommended to use enhanced CT routinely with fixed dose administration of contrast agent for patients’ assessment of PMI and PMD.

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Estimation of nephron number in living humans by combining unenhanced computed tomography with biopsy-based stereology

Scientific Reports ◽

10.1038/s41598-019-50529-x ◽

2019 ◽

Vol 9 (1) ◽

Cited By ~ 7

Author(s):

Takaya Sasaki ◽

Nobuo Tsuboi ◽

Yusuke Okabayashi ◽

Kotaro Haruhara ◽

Go Kanzaki ◽

...

Keyword(s):

Computed Tomography ◽

Arterial Phase ◽

Nephron Number ◽

Living Kidney Donors ◽

Explanatory Variables ◽

Cortical Volume ◽

Unenhanced Ct ◽

Enhanced Ct ◽

Phase Images ◽

Unenhanced Computed Tomography

Abstract Methods for estimating nephron number in a clinical setting may be useful for predicting renal outcomes. This study aimed to establish such a method using unenhanced computed tomography (CT) and biopsy-based stereology. Patients or living kidney donors simultaneously subjected to enhanced and unenhanced CT examinations were randomly assigned to development and validation groups. The enhanced CT-measured arterial phase and the venous phase images of kidneys were regarded as the true values for cortical volume and parenchymal volume, respectively. Linear multiple regression analysis was used to create models for estimating cortical volume using explanatory variables including unenhanced CT-measured parenchymal volume. Nephron number was determined as the product of cortical volume and the glomerular density in biopsies of donors. Five equations for estimating cortical volume were created and verified. In donors, estimated nephron number by unenhanced CT was consistent with that by enhanced CT, with minimal errors in all models (636–655 ± 210–219 vs. 648 ± 224 × 103/kidney). Clinical characteristics combined with parenchymal volume did not improve the equation over parenchymal volume alone. These results support the feasibility of estimating nephron number by a combination of unenhanced CT and biopsy-based stereology, with a possible application for renal disease patients who are often not suitable for contrast media.

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Assessment Of Third Ventricular Parameters in Computed Tomography of Head: A Pilot Study in Tertiary Level Hospital

Journal of Institute of Medicine ◽

10.3126/jiom.v42i3.37594 ◽

2020 ◽

Vol 42 (3) ◽

pp. 82-86

Author(s):

Umesh P Khanal ◽

Keshav Sah ◽

Ram B Chand

Keyword(s):

Computed Tomography ◽

Third Ventricle ◽

Cross Sectional Study ◽

University Teaching ◽

Cross Sectional ◽

Contrast Enhanced Ct ◽

Contrast Enhanced ◽

Upper Limits ◽

Gender And Age ◽

Enhanced Ct

Introduction Measurement of ventricles of the brain is important for evaluating changes due to growth, ageing, intrinsic and extrinsic pathologies. The aim of this study was to determine the various parameters of the third ventricle and to assess their association with gender and age using computed tomography (CT) scans of head. MethodsThis retrospective, quantitative, cross sectional study was performed in the Department of Radiology and Imaging, Tribhuvan University Teaching Hospital from July to October 2019 (4 months) on images of 100 patients (50 males and 50 females) whose age group were 18-87 years, who underwent non-contrast and contrast enhanced CT scan of head. ResultsThe total mean of width of third ventricle was found to be 0.33±0.09 cm, 0.35±0.10 cm in male and 0.31±0.06 cm in female. Third ventricle width (TVW) showed statistically significant correlation with male and also with Age. Mean of third ventricle sylvian fissure distance index was 0.41±0.67 cm, 0.42±0.65 cm in male and 0.39±0.06 cm in female respectively. Mean of third ventricle ratio was 0.03±0.09 cm, 0.03±0.09 cm in male and 0.02±0.09 in female respectively. The value were slightly higher in male. ConclusionThe third ventricle width in CT in this study was 0.33±0.09 cm. CT was very useful to determine the upper limits of normal value and its variation with age.

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Intravenous Contrast Agent in Abdominal CT: Is It Really Needed to Identify the Cause of Bowel Obstruction? Proof of Concept

Gastroenterology Research and Practice ◽

10.1155/2019/2350948 ◽

2019 ◽

Vol 2019 ◽

pp. 1-6

Author(s):

Federica Vernuccio ◽

Dario Picone ◽

Gregorio Scerrino ◽

Massimo Midiri ◽

Giuseppe Lo Re ◽

...

Keyword(s):

Small Bowel ◽

Contrast Agent ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Large Bowel ◽

Large Bowel Obstruction ◽

Intravenous Contrast ◽

Unenhanced Ct ◽

Enhanced Ct ◽

Intravenous Contrast Agent

Background. To compare sensitivity of unenhanced computed tomography (CT) and contrast-enhanced CT for the identification of the etiology of bowel obstruction. Materials and Methods. We retrospectively evaluated abdominal CT scans of patients operated for bowel obstruction from March 2013 to October 2017. Two radiologists evaluated CT scans before and after contrast agent in two reading sessions. Then, we calculated sensitivity of CT in the diagnosis of bowel obstruction and determined in which cases the etiology of bowel obstruction was detected on both unenhanced and enhanced CT or on enhanced CT only. The reference standard was defined as the final diagnosis obtained after surgery. Results. Eighteen patients (mean age 72±15 years, age range 37-88 years) were included in the study. Sensitivity of unenhanced CT and enhanced CT was not significantly different in either small bowel obstruction (64%, 7/11 patients vs. 73%, 8/11 patients; P=0.6547) or large bowel obstruction (71%, 5/7 patients vs. 100%, 7/7 patients; P=0.1410). Adhesions were identified on unenhanced CT as the etiology of small bowel obstruction in 80% (4/5) of patients. Tumors were identified on unenhanced CT as the etiology of large bowel obstruction in 67% (4/6) of patients. Conclusion. In the diagnosis of small bowel obstruction due to adhesions with normal bowel wall thickening and when a neoplasm is identified as the etiology of large bowel obstruction on unenhanced CT, an intravenous contrast agent may be avoided for the identification of the etiology. In remaining cases, contrast agent is still recommended.

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Unenhanced computed tomography as a diagnostic tool in suspected pulmonary hypertension: a retrospective cross-sectional pilot study

Wellcome Open Research ◽

10.12688/wellcomeopenres.16853.1 ◽

2021 ◽

Vol 6 ◽

pp. 249

Author(s):

Ze Ming Goh ◽

Christopher S. Johns ◽

Tarik Julius ◽

Samual Barnes ◽

Krit Dwivedi ◽

...

Keyword(s):

Computed Tomography ◽

Pulmonary Hypertension ◽

Characteristic Curve ◽

Right Atrial ◽

Heart Catheterization ◽

Great Vessel ◽

Cross Sectional ◽

Specialist Registrar ◽

Unenhanced Ct ◽

Unenhanced Computed Tomography

Background: Computed tomography pulmonary angiography (CTPA) has been proposed to be diagnostic for pulmonary hypertension (PH) in multiple studies. However, the utility of the unenhanced CT measurements diagnosing PH has not been fully assessed. This study aimed to assess the diagnostic utility and reproducibility of cardiac and great vessel parameters on unenhanced computed tomography (CT) in suspected pulmonary hypertension (PH). Methods: In total, 42 patients with suspected PH who underwent unenhanced CT thorax and right heart catheterization (RHC) were included in the study. Three observers (a consultant radiologist, a specialist registrar in radiology, and a medical student) measured the parameters by using unenhanced CT. Diagnostic accuracy of the parameters was assessed by area under the receiver operating characteristic curve (AUC). Inter-observer variability between the consultant radiologist (primary observer) and the two secondary observers was determined by intra-class correlation analysis (ICC). Results: Overall, 35 patients were diagnosed with PH by RHC while 7 patients were not. Main pulmonary arterial (MPA) diameter was the strongest (AUC 0.79 to 0.87) and the most reproducible great vessel parameter. ICC comparing the MPA diameter measurement of the consultant radiologist to the specialist registrar’s and the medical student’s were 0.96 and 0.92, respectively. Right atrial area was the cardiac measurement with highest accuracy and reproducibility (AUC 0.76 to 0.79; ICC 0.980, 0.950) followed by tricuspid annulus diameter (AUC 0.76 to 0.79; ICC 0.790, 0.800). Conclusions: MPA diameter and right atrial areas showed high reproducibility. Diagnostic accuracies of these were within the range of acceptable to excellent, and might have clinical value. Tricuspid annular diameter was less reliable and less diagnostic and was therefore not a recommended diagnostic measurement.

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Evaluation of chronic headache by computed tomography: a retrospective study

Journal of Nobel Medical College ◽

10.3126/jonmc.v1i2.7301 ◽

2012 ◽

Vol 1 (2) ◽

pp. 64-71 ◽

Cited By ~ 3

Author(s):

Anish Subedee

Keyword(s):

Computed Tomography ◽

Chronic Headache ◽

Patient Management ◽

Alter Patient ◽

Contrast Enhanced Ct ◽

Contrast Enhanced ◽

Enhanced Ct ◽

Minor Abnormality ◽

The Difference ◽

Clinically Significant

Objective: To find out the proportion of intracranial abnormalities in patients with chronic headache without neurologic abnormality with the use of computed tomography (CT) and to compare the results with similar studies done previously. Materials and methods: CT images of 56 patients with chronic/recurrent headache and normal neurological findings were reviewed retrospectively. In 38 of 56 patients, both plain and contrast enhanced CT were done. Patients were divided into three groups according to the CT findings: those with no abnormality, those with minor abnormality (that did not alter patient management) and those with clinically significant abnormality. Proportion of patients in each group was found out and results were compared with previous studies with similar study design. Z test was used to evaluate whether the difference in proportions of patients in our study and previous study was statistically significant or not. Results: Of the 56 patients, 50 had normal CT (89.28 %), four had minor abnormality (7.14%) that did not alter patient management and two had significant lesions (3.57%). Contrast enhanced CT did not improve lesion detection. The minor findings detected were sub-ependymal calcifications of Tuberous sclerosis, calcified neurocysticercosis and old lacunar infarctions in external capsule. Clinically significant lesions detected were small ring enhancing lesion (neurocysticercosis or tuberculoma) and pineal cyst. Results of this study were compared with previous study with similar study design. The Z test showed that the difference in proportions in these studies was not statistically significant (p =0.0708 for minor findings and p =0.2033 for significant findings). Conclusion: The proportion of intracranial abnormalities detected by CT in this study was similar to that of previous studies. The use of intravenous contrast material administration did not improve its yield. This corroborates the evidence that the ability of CT scan in detecting significant intracranial pathology is poor in patients with chronic headache without neurologic abnormality.DOI: http://dx.doi.org/10.3126/jonmc.v1i2.7301 Journal of Nobel Medical College (2012), Vol.1 No.2 p.57-63

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A New Outlook on the Ability to Accumulate an Iodine Contrast Agent in Solid Lung Tumors Based on Virtual Monochromatic Images in Dual Energy Computed Tomography (DECT): Analysis in Two Phases of Contrast Enhancement

Journal of Clinical Medicine ◽

10.3390/jcm10091870 ◽

2021 ◽

Vol 10 (9) ◽

pp. 1870

Author(s):

Arkadiusz Zegadło ◽

Magdalena Żabicka ◽

Aleksandra Różyk ◽

Ewa Więsik-Szewczyk

Keyword(s):

Computed Tomography ◽

Contrast Agent ◽

Energy Range ◽

Contrast Enhancement ◽

Lung Tumors ◽

Dual Energy ◽

Arterial Phase ◽

X Ray ◽

Dual Energy Computed Tomography ◽

X Ray Absorption

For some time, dual energy computed tomography (DECT) has been an established method used in a vast array of clinical applications, including lung nodule assessment. The aim of this study was to analyze (using monochromatic DECT images) how the X-ray absorption of solitary pulmonary nodules (SPNs) depends on the iodine contrast agent and when X-ray absorption is no longer dependent on the accumulated contrast agent. Sixty-six patients with diagnosed solid lung tumors underwent DECT scans in the late arterial phase (AP) and venous phase (VP) between January 2017 and June 2018. Statistically significant correlations (p ≤ 0.001) of the iodine contrast concentration were found in the energy range of 40–90 keV in the AP phase and in the range of 40–80 keV in the VP phase. The strongest correlation was found between the concentrations of the contrast agent and the scanning energy of 40 keV. At the higher scanning energy, no significant correlations were found. We concluded that it is most useful to evaluate lung lesions in DECT virtual monochromatic images (VMIs) in the energy range of 40–80 keV. We recommend assessing SPNs in only one phase of contrast enhancement to reduce the absorbed radiation dose.

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Preoperative CT texture features predict prognosis after curative resection in pancreatic cancer

Scientific Reports ◽

10.1038/s41598-019-53831-w ◽

2019 ◽

Vol 9 (1) ◽

Cited By ~ 7

Author(s):

Hyung Sun Kim ◽

Young Jae Kim ◽

Kwang Gi Kim ◽

Joon Seong Park

Keyword(s):

Computed Tomography ◽

Pancreatic Cancer ◽

Cancer Patients ◽

Curative Resection ◽

Arterial Phase ◽

Normal Pancreas ◽

Grey Level ◽

Tumour Heterogeneity ◽

Run Length ◽

Computed Tomography Scans

AbstractPancreatic cancer is a lethal disease, and resistance to chemotherapy is a critical factor influencing the postoperative prognosis. Tumour heterogeneity is an important indicator of chemoresistance. Therefore, we analysed tumour heterogeneity in preoperative computed tomography scans by performing texture analysis using the grey-level run-length matrix and analysed the correlation of survival with the value obtained in these analyses. We analysed 116 consecutive patients who underwent curative resection and had preoperative contrast-enhanced computed tomography data available for analysis. A region of interest was drawn on all slices with a visible tumour and normal pancreas on the arterial phase computed tomography scans; the correlation of pathological characteristics with grey-level run-length matrix features was analysed. We then performed Kaplan–Meier survival curve analysis among pancreatic cancer patients. The grey-level non-uniformity values in grey-level run-length matrix features for tumours were higher than those for normal pancreas. High grey-level non-uniformity values represent a non-uniform texture, i.e., heterogeneity. Grey-level run-length matrix features showed that recurrence-free survival was shorter in the group with high grey-level non-uniformity 135 values (p = 0.025). Our analyses of the correlation between pathological outcomes and grey-level run-length matrix features in pancreatic cancer patients showed that grey-level non-uniformity values were powerful prognostic indicators.

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Identifying communication-related predictors of patient satisfaction in a briefing prior to contrast-enhanced computed tomography

Insights into Imaging ◽

10.1186/s13244-019-0778-7 ◽

2019 ◽

Vol 10 (1) ◽

Author(s):

Valentina Scholz ◽

Sandra Lange ◽

Britta Rosenberg ◽

Marie-Luise Kromrey ◽

Annika Syperek ◽

...

Keyword(s):

Computed Tomography ◽

Patient Satisfaction ◽

Cross Sectional Study ◽

Hierarchical Regression ◽

Cross Sectional ◽

Patients Satisfaction ◽

Physician Characteristics ◽

Contrast Enhanced Ct ◽

Contrast Enhanced ◽

Enhanced Ct

Abstract Background This study aimed to prospectively investigate patients’ satisfaction with briefings before computed tomography (CT) examinations, determine feasibility, and identify factors influencing patient satisfaction independent of patient and physician characteristics. Methods One hundred sixty patients received information by a radiologist prior to contrast-enhanced CT examinations in an open, prospective, two-center, cross-sectional study (including the introduction of the radiologist, procedure, radiation exposure, possible side effects, and alternatives). Afterwards, patients and radiologists evaluated the briefing using a standardized questionnaire. Additionally, factors such as age, socioeconomic status, inpatient/outpatient status, length of the radiologist’s professional experience, duration of the briefing, clarity of the radiologist’s explanations as perceived by patients, and the duration of communication were obtained in this questionnaire. Subsequently, three classes of influencing factors were defined and entered stepwise into a hierarchical regression. Results Patient satisfaction ratings differed significantly by type of hospitalization, perceived type of communication, and patient gender. Hierarchical regression analysis revealed that perceived clarity was the strongest predictor of patients’ satisfaction when controlling for the patient and physician characteristics. Conclusions Patients appeared to be satisfied with the briefing prior to CT examination. The mean briefing time (2 min 35 s) seemed feasible. Patients’ demographics influenced satisfaction. To improve patients’ satisfaction with briefings before contrast-enhanced CT, radiologists should aim to clarify their communication.

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Liver Enhancement on Computed Tomography Is Suboptimal in Patients with Liver Steatosis

Journal of Personalized Medicine ◽

10.3390/jpm11121255 ◽

2021 ◽

Vol 11 (12) ◽

pp. 1255

Author(s):

Véronique V. van Cooten ◽

Daan J. de Jong ◽

Frank J. Wessels ◽

Pim A. de Jong ◽

Madeleine Kok

Keyword(s):

Computed Tomography ◽

Liver Steatosis ◽

Total Body Weight ◽

Control Group ◽

Portal Venous Phase ◽

Portal Phase ◽

Unenhanced Ct ◽

Venous Phase ◽

The Difference ◽

Total Body

This study’s aim was twofold. Firstly, to assess liver enhancement quantitatively and qualitatively in steatotic livers compared to non-steatotic livers on portal venous computed tomography (CT). Secondly, to determine the injection volume of contrast medium in patients with severe hepatic steatosis to improve the image quality of the portal venous phase. We retrospectively included patients with non-steatotic (n = 70), the control group, and steatotic livers (n = 35) who underwent multiphase computed tomography between March 2016 and September 2020. Liver enhancement was determined by the difference in attenuation in Hounsfield units (HU) between the pre-contrast and the portal venous phase, using region of interests during in three different segments. Liver steatosis was determined by a mean attenuation of ≤40 HU on unenhanced CT. Adequate enhancement was objectively defined as ≥50 ΔHU and subjectively using a three-point Likert scale. Enhancement of non-steatotic and steatotic livers were compared and associations between enhancement and patient- and scan characteristics were analysed. Enhancement was significantly higher among the control group (mean 51.9 ± standard deviation 11.5 HU) compared to the steatosis group (40.6 ± 8.4 HU p for difference < 0.001). Qualitative analysis indicated less adequate enhancement in the steatosis group: 65.7% of the control group was rated as good vs. 8.6% of the steatosis group. We observed a significant correlation between enhancement, and presence/absence of steatosis and grams of iodine per total body weight (TBW) (p < 0.001; adjusted R2 = 0.303). Deduced from this correlation, theoretical contrast dosing in grams of Iodine (g I) can be calculated: g I = 0.502 × TBW for non-steatotic livers and g I = 0.658 × TBW for steatotic livers. Objective and subjective enhancement during CT portal phase were significantly lower in steatotic livers compared to non-steatotic livers, which may have consequences for detectability and contrast dosing.

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Tomografia Computadorizada de Abdome na Urgência: o Uso Exagerado das Tecnologias Médicas e a Desvalorização do Diagnóstico Clínico

Revista Brasileira de Educação Médica ◽

10.1590/1981-5271v43suplemento1-20190022 ◽

2019 ◽

Vol 43 (1 suppl 1) ◽

pp. 498-504

Author(s):

Henrique Soares Silva ◽

Fernanda Kelly Fraga Oliveira ◽

Lourivania Oliveira Melo Prado ◽

Marcos Almeida-Santos ◽

Francisco Prado Reis

Keyword(s):

Computed Tomography ◽

Abdominal Pain ◽

Clinical Diagnosis ◽

Obstructive Uropathy ◽

Hospital Costs ◽

Diagnostic Errors ◽

Cross Sectional Study ◽

Urgent Care ◽

Cross Sectional ◽

The Difference

ABSTRACT The number of computed tomography (CT) examinations performed in urgent care has been increasing since its introduction in the emergency room (ER). This has led to a substantial increase in hospital costs and patient’s exposure to ionizing radiation, which has led to the need for more judicious use of CT in the ER. The aim of this study is to show the difference between clinical (pre-CT), tomographic (post-CT) and definitive diagnoses in patients with abdominal CT in the ER. This is a cross-sectional study, with retrospective data collection through electronic medical records. A total of 834 patients with acute abdominal pain (AAP) lasting less than 7 days, submitted to abdominal computed tomography between January 1, 2016 and December 31, 2017 were selected. Clinical, tomographic and final diagnoses were recorded and submitted to a concordance analysis by calculating the Kappa coefficient, considering p <0.05 as significant. CT scans were considered unnecessary when the clinical diagnosis was concordant when both final and post-CT diagnosis were also concordant. The most frequent diagnoses were nonspecific abdominal pain (NSAP), obstructive uropathy (OU) and appendicitis (AP), corresponding to 73.6%, 58.5% and 61.3% of all diagnoses, respectively. Data analysis showed a moderate Concordance for NSAP (kappa: 0.41, p ¬<0.001) and for OU (kappa: 0.46, p <0.001) and excellent for AP (kappa:0.87, p <0.001). In total, 52.6% of computed tomography were considered unnecessary for NSAP, 82.4% for OU and 91.7% for AP. It was concluded that there are high rates of CT that may be considered unnecessary for the diagnosis of the main emergency conditions, especially appendicitis. The study warns to the exaggerated use of CT in the ER and raise discussions over the possible causes, such as lack of confidence in the clinical diagnosis, fear of diagnostic errors and fear of malpractice lawsuits, of which possible solutions may be more effective when applied since the medical education basis.

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