Preoperative computed tomography assessment for a deep inferior epigastric perforator (DIEP) flap: a new easy technique from the Bologna experience

Background Deep inferior epigastric perforator (DIEP) flap reconstruction is the gold standard reconstructive technique for women undergoing breast cancer surgery. A preoperative computed tomography angiography (CTA)-dedicated protocol and 3D reconstructions are mandatory for correct surgical planning. Purpose To evaluate the diagnostic performance of a new preoperative CTA protocol and a new reconstruction method in the assessment of DIEP technique. Material and Methods A total of 263 women (median age 49 years, age range 26–73 years) underwent preoperative CTA examination before DIEP flap breast reconstruction. A CTA-dedicated protocol followed by 3D-reconstructions were performed. Identification, branching pattern, and caliber at origin were assessed for each perforator. Intraoperative findings were the standard of reference. The sensitivity, positive predictive value, and diagnostic accuracy of the preoperative CTA protocol were calculated. Results In 255/263 (97%) patients, the dominant perforators assessed by CTA resulted adequate for surgical reconstruction. In 260/263 (99%) cases, the imaging localization of the dominant perforators corresponded with those seen intraoperatively (mean errors ≤1 cm). The preoperative CTA imaging sensitivity, positive predictive value, and diagnostic accuracy in determining the localization of perforators were 99% (95% CI 98–100), 100% and 99% (95% CI 98–100), respectively. No statistically significant differences were found between the CTA findings and the surgical findings for the assessment of branching pattern and caliber of the dominant perforators ( P < 0.001). Conclusion The present protocol has demonstrated high accuracy in the CTA imaging assessment of the perforators before DIEP flap reconstruction with high reproducibility between CT and surgical findings.

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Utility of Apical Lung Assessment on Computed Tomography Angiography as a COVID-19 Screen in Acute Stroke

Stroke ◽

10.1161/strokeaha.120.030959 ◽

2020 ◽

Vol 51 (12) ◽

pp. 3765-3769

Author(s):

Charles Esenwa ◽

Ji-Ae Lee ◽

Taha Nisar ◽

Anna Shmukler ◽

Inessa Goldman ◽

...

Keyword(s):

Computed Tomography ◽

Ischemic Stroke ◽

Positive Predictive Value ◽

Diagnostic Accuracy ◽

Computed Tomography Angiography ◽

Predictive Value ◽

Screening Tool ◽

Clinical Symptoms ◽

Shortness Of Breath ◽

Patient Reported

Background and Purpose: Evaluation of the lung apices using computed tomography angiography of the head and neck during acute ischemic stroke (AIS) can provide the first objective opportunity to screen for coronavirus disease 2019 (COVID-19). Methods: We performed an analysis assessing the utility of apical lung exam on computed tomography angiography for COVID-19–specific lung findings in 57 patients presenting with AIS. We measured the diagnostic accuracy of apical lung assessment alone and in combination with patient-reported symptoms and incorporate both to propose a COVID-19 era AIS algorithm. Results: Apical lung assessment when used in isolation, yielded a sensitivity of 0.67, specificity of 0.93, positive predictive value of 0.19, negative predictive value of 0.99, and accuracy of 0.92 for the diagnosis of COVID-19, in patients presenting to the hospital for AIS. When combined with self-reported clinical symptoms of cough or shortness of breath, sensitivity of apical lung assessment improved to 0.83. Conclusions: Apical lung assessment on computed tomography angiography is an accurate screening tool for COVID-19 and can serve as part of a combined screening approach in AIS.

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Computed Tomography-Aortography Versus Color-Duplex Ultrasound for Surveillance of Endovascular Abdominal Aortic Aneurysm Repair

Circulation Cardiovascular Imaging ◽

10.1161/circimaging.119.009886 ◽

2020 ◽

Vol 13 (6) ◽

Cited By ~ 2

Author(s):

Elixène Jean-Baptiste ◽

Patrick Feugier ◽

Coralie Cruzel ◽

Gabrielle Sarlon-Bartoli ◽

Thierry Reix ◽

...

Keyword(s):

Computed Tomography ◽

Positive Predictive Value ◽

Diagnostic Accuracy ◽

Negative Predictive Value ◽

Predictive Value ◽

Endovascular Aneurysm Repair ◽

Positive Likelihood Ratio ◽

Morphological Abnormality ◽

Aneurysm Repair

Background Color-duplex ultrasonography (DUS) could be an alternative to computed tomography-aortography (CTA) in the lifelong surveillance of patients after endovascular aneurysm repair (EVAR), but there is currently no level 1 evidence. The aim of this study was to assess the diagnostic accuracy of DUS as an alternative to CTA for the follow-up of post-EVAR patients. Methods Between December 16, 2010, and June 12, 2015, we conducted a prospective, blinded, diagnostic-accuracy study, in 15 French university hospitals where EVAR was commonly performed. Participants were followed up using both DUS and CTA in a mutually blinded setup until the end of the study or until any major aneurysm-related morphological abnormality requiring reintervention or an amendment to the follow-up policy was revealed by CTA. Database was locked on October 2, 2017. Our main outcome measures were sensitivity, specificity, positive predictive value, negative predictive value, positive and negative likelihood ratios of DUS against reference standard CTA. CIs are binomial 95% CI. Results This study recruited prospectively 659 post-EVAR patients of whom 539 (82%) were eligible for further analysis. Following the baseline inclusion visit, 940 additional follow-up visits were performed in the 539 patients. Major aneurysm-related morphological abnormalities were revealed by CTA in 103 patients (17.2/100 person-years [95% CI, 13.9–20.5]). DUS accurately identified 40 patients where a major aneurysm-related morphological abnormality was present (sensitivity, 39% [95% CI, 29–48]) and 403 of 436 patients with negative CTA (specificity, 92% [95% CI, 90–95]). The negative predictive value and positive predictive value of DUS were 92% (95% CI, 90–95) and 39% (95% CI, 27–50), respectively. The positive likelihood ratio was 4.87 (95% CI, 2.9–9.6). DUS sensitivity reached 73% (95% CI, 51–96) in patients requiring an effective reintervention. Conclusions DUS had an overall low sensitivity in the follow-up of patients after EVAR, but its performance improved meaningfully when the subset of patients requiring effective reinterventions was considered. Registration URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01230203.

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Diagnostic Accuracy of BISAP Score for Detecting Acute Pancreatitis Keeping Computed Tomography Severity Index as GS

10.53350/pjmhs2115113164 ◽

2021 ◽

Vol 15 (11) ◽

pp. 3164-3165

Author(s):

Mohammad Iltaf ◽

Sana Akhtar ◽

Dilaram Khan

Keyword(s):

Computed Tomography ◽

Acute Pancreatitis ◽

Positive Predictive Value ◽

Diagnostic Accuracy ◽

Negative Predictive Value ◽

Severe Acute Pancreatitis ◽

Predictive Value ◽

Gold Standard ◽

Severity Index ◽

Cross Sectional

Objective: To establish the diagnostic accuracy of BISAP in detecting the severe acute pancreatitis keeping computed tomography severity index as gold standard. Study Design: Cross-sectional study Place and Duration of Study: Department of Gastroenterology, Hayatabad Medical Complex, Peshawar from April 16th 2018 to 16th October 2018. Methodology: One hundred and twenty nine patients of age range of 18-60, of either gender having severe acute pancreatitis were included. While patients already diagnosed as severe acute pancreatitis and having known history of chronic pancreatitis were excluded. Patients were subjected to CT scan to confirm whether the severe acute pancreatitis is present or not. All CT scans were reported by single experiences radiologist. Results: There were 30.3% were males and 69.7% were females with mean age 42±11.03 years. BISAP had sensitivity 92.74%, specificity 80%, positive predictive value 99.13%, negative predictive value 20.76% and the overall diagnostic accuracy was 92.24%. Conclusion: BISAP had sensitivity 93.61%, specificity 100%, positive predictive value 100%, negative predictive value 40% and the overall diagnostic accuracy was 93.87% in severe acute pancreatitis keeping CT severity index as gold standard. Keywords: Accuracy, Severe acute pancreatitis, Computed tomography

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Diagnostic Accuracy of Ultrasound and Plain X-Ray KUB (Kidney, Ureter, Bladder) Compared to Non-Contrast CT (Computed Tomography) in Patients of Ureteric Calculi

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2020/567 ◽

2020 ◽

Vol 7 (47) ◽

pp. 2762-2766

Author(s):

N. Imdad Ali ◽

Noor Elahi Pasha ◽

Ravishankar T.H.S

Keyword(s):

Computed Tomography ◽

Positive Predictive Value ◽

Diagnostic Accuracy ◽

Negative Predictive Value ◽

Predictive Value ◽

X Ray ◽

Ureteric Calculus ◽

Ureteric Calculi ◽

Ureteric Colic ◽

Contrast Ct

BACKGROUND Imaging plays a major role in the diagnosis and management of patients with urolithiasis. Non-Contrast Computed Tomography (NCCT) is generally accepted as the gold standard, but there are concerns over higher radiation exposure from NCCT to the patient population. Our prospective study compared the diagnostic accuracy of plain X-ray KUB (Kidney, Ureter, Bladder) and USG (Ultrasonography) with NCCT in the evaluation of patients with ureteric colic. METHODS This study conducted from December 2018 to January 2020 in the Department of Urology, Vijayanagar Institute of Medical Sciences, and attached Hospital. 230 patients with ureteric colic were evaluated for ureteric calculi with x-ray KUB, USG (Ultrasonography) abdomen and pelvis and NCCT (Non-Contrast Computed Tomography) KUB region. RESULTS Out of 230 patients, 168 (73 %) were males and 62 (26.9 %) were females. Ages of the study population ranged from 18 to 55 yrs. 198 of the 230 patients were confirmed to have ureteric calculus, with lower ureteric calculus 97 (48.9 %), upper ureteric 65 (32.8 %), middle ureteric 29 (14.6 %), and multiple 7 (3.5 %). X-ray and USG (Ultrasonography) group yielded a sensitivity of 86.3 %, a specificity of 87.5 %, positive predictive value 97 %, and negative predictive value 51 %. While On NCCT (Non-Contrast Computed Tomography), a total of 192 patients (96 %) demonstrated ureterolithiasis of the 198 patients confirmed to have ureteric calculi (Table 2). X-ray and USG group yielded a sensitivity of 96.9 %, specificity of 93.6 %, positive predictive value 98.9 %, and negative predictive value 83 %. CONCLUSIONS Combination of x-ray KUB and USG, and NCCT were found to be excellent imaging modalities for the detection of ureteric calculi. X-ray KUB and USG can be used as the first investigation of choice for patients with ureteric colic and for follow up of patients after treatment. KEYWORDS Ureteric Colic, Ureterolithiasis, Ultrasonography

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Noninvasive Evaluation of Coronary Artery Bypass Grafts with 16-Slice Multidetector Computed Tomography

The Heart Surgery Forum ◽

10.1532/hsf98.20111075 ◽

2012 ◽

Vol 15 (1) ◽

pp. 12 ◽

Cited By ~ 1

Author(s):

Levent Sahiner ◽

Ali Oto ◽

Kudret Aytemir ◽

Tuncay Hazirolan ◽

Musturay Karcaaltincaba ◽

...

Keyword(s):

Computed Tomography ◽

Coronary Artery ◽

Diagnostic Accuracy ◽

Multidetector Computed Tomography ◽

Coronary Artery Bypass ◽

Predictive Value ◽

Artery Bypass ◽

Time Interval ◽

Mdct Angiography ◽

Sensitivity Specificity

Background: The aim of this study was to investigate the diagnostic accuracy of 16-slice multislice, multidetector computed tomography (MDCT) angiography for the evaluation of grafts in patients with coronary artery bypass grafting (CABG).Methods: Fifty-eight consecutive patients with CABG who underwent both MDCT and conventional invasive coronary angiography were included. The median time interval between the 2 procedures was 10 days (range, 1-32 days). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of MDCT for the detection of occluded grafts were calculated. The accuracy of MDCT angiography for detecting significant stenoses in patent grafts and the evaluability of proximal and distal anastomoses were also investigated.Results: Optimal diagnostic images could not be obtained for only 3 (2%) of 153 grafts. Evaluation of the remaining 150 grafts revealed values for sensitivity, specificity, PPV, NPV, and diagnostic accuracy of the MDCT angiography procedure for the diagnosis of occluded grafts of 87%, 97%, 94%, 93%, and 92%, respectively. All of the proximal anastomoses were optimally visualized. In 4 (8%) of 50 patent arterial grafts, however, the distal anastomotic region could not be evaluated because of motion and surgical-clip artifacts. The accuracy of MDCT angiography for the detection of significant stenotic lesions was relatively low (the sensitivity, specificity, PPV, and NPV were 67%, 98%, 50%, and 99%, respectively). The number of significant lesions was insufficient to reach a reliable conclusion, however.Conclusion: Our study showed that MDCT angiography with 16-slice systems has acceptable diagnostic performance for the evaluation of coronary artery bypass graft patency.

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Diagnosis of cerebral hemorrhage before the era of computed tomography

Orvosi Hetilap ◽

10.1556/oh.2013.29739 ◽

2013 ◽

Vol 154 (44) ◽

pp. 1743-1746

Author(s):

Gergely Hofgárt ◽

Rita Szepesi ◽

Bertalan Vámosi ◽

László Csiba

Keyword(s):

Computed Tomography ◽

Cerebrospinal Fluid ◽

Positive Predictive Value ◽

Predictive Value ◽

Hemorrhagic Stroke ◽

Cranial Computed Tomography ◽

Cerebral Stroke ◽

Daily Routine ◽

Stroke Patients ◽

The Difference

Introduction: During the past decades there has been a great progress in neuroimaging methods. Cranial computed tomography is part of the daily routine now and its use allows a fast diagnosis of parenchymal hemorrhage. However, before the availability of computed tomography the differentiation between ischemic and hemorrhagic stroke was based on patient history, physical examination, percutan angiography and cerebrospinal fluid sampling, and the clinical utility could be evaluated by autopsy of deceased patients. Aim: The authors explored the diagnostic performance of cerebrospinal fluid examination for the diagnosis of ischemic and hemorrhagic stroke. Method: Data of 200 deceased stroke patients were retrospectively evaluated. All patients had liquor sampling at admission and all of them had brain autopsy. Results: Bloody or yellowish cerebrospinal fluid at admission had a positive predictive value of 87.5% for hemorrhagic stroke confirmed by autopsy, while clear cerebrospinal fluid had positive predictive value of 90.7% for ischemic stroke. Patients who had clear liquor, but autopsy revealed hemorrhagic stroke had higher protein level in the cerebrospinal fluid, but the difference was not statistically significant (p = 0.09). Conclusions: The results confirm the importance of pathological evaluation of the brain in cases deceased from cerebral stroke. With this article the authors wanted to salute for those who contributed to the development of the Hungarian neuropathology. In this year we remember the 110th anniversary of the birth, and the 60th anniversary of the death of professor Kálmán Sántha. Professor László Molnár would be 90 years old in 2013. Orv. Hetil., 154 (44), 1743–1746.

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Accuracy of MSCT Coronary Angiography with 64 Row CT Scanner—Facing the Facts

Clinical Medicine Insights Cardiology ◽

10.4137/cmc.s3864 ◽

2010 ◽

Vol 4 ◽

pp. CMC.S3864 ◽

Cited By ~ 3

Author(s):

M. Wehrschuetz ◽

E. Wehrschuetz ◽

H. Schuchlenz ◽

G. Schaffler

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Coronary Angiography ◽

Positive Predictive Value ◽

Diagnostic Accuracy ◽

Predictive Value ◽

Diagnostic Potential ◽

Coronary Artery Stenoses ◽

Artery Disease ◽

Msct Angiography

Improvements in multislice computed tomography (MSCT) angiography of the coronary vessels have enabled the minimally invasive detection of coronary artery stenoses, while quantitative coronary angiography (QCA) is the accepted reference standard for evaluation thereof. Sixteen-slice MSCT showed promising diagnostic accuracy in detecting coronary artery stenoses haemodynamically and the subsequent introduction of 64-slice scanners promised excellent and fast results for coronary artery studies. This prompted us to evaluate the diagnostic accuracy, sensitivity, specificity, and the negative und positive predictive value of 64-slice MSCT in the detection of haemodynamically significant coronary artery stenoses. Thirty-seven consecutive subjects with suspected coronary artery disease were evaluated with MSCT angiography and the results compared with QCA. All vessels were considered for the assessment of significant coronary artery stenosis (diameter reduction ≥ 50%). Thirteen patients (35%) were identified as having significant coronary artery stenoses on QCA with 6.3% (35/555) affected segments. None of the coronary segments were excluded from analysis. Overall sensitivity for classifying stenoses of 64-slice MSCT was 69%, specificity was 92%, positive predictive value was 38% and negative predictive value was 98%. The interobserver variability for detection of significant lesions had a κ-value of 0.43. Sixty-four-slice MSCT offers the diagnostic potential to detect coronary artery disease, to quantify haemodynamically significant coronary artery stenoses and to avoid unnecessary invasive coronary artery examinations.

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The PAP Flap Breast Reconstruction: A Practical Option for Slim Patients

Journal of Reconstructive Microsurgery ◽

10.1055/s-0041-1727200 ◽

2021 ◽

Author(s):

Taehee Jo ◽

Dong Nyeok Jeon ◽

Hyun Ho Han

Keyword(s):

Donor Site ◽

Wound Dehiscence ◽

Diep Flap ◽

Separate Analysis ◽

Flap Reconstruction ◽

Average Body Mass Index ◽

Deep Inferior Epigastric Perforator ◽

Average Body Mass ◽

Artery Perforator ◽

Average Body

Abstract Background The posterior thigh-based profunda artery perforator (PAP) flap has been an emerging option as a secondary choice in breast reconstructions. However, whether a PAP flap could consistently serve as the secondary option in slim patients has not been investigated. Methods Records of immediate unilateral breast reconstructions performed from May 2017 to June 2019 were reviewed. PAP flap breast reconstructions were compared with standard deep inferior epigastric perforator (DIEP) flap breast reconstructions, and were grouped into single or stacked PAP flaps for further analysis. Results Overall, 43 PAP flaps were performed to reconstruct 32 breasts. Eleven patients underwent stacked PAP flap reconstruction, while 17 patients underwent 21 single PAP flap reconstruction. The average body mass index (BMI) of the patients was 22.2 ± 0.5 kg/m2. The results were as follows: no total loss, one case of venous congestion (2.3%), two donor site wound dehiscence cases (4.7%), and one case of fat necrosis from partial flap loss (2.3%). When compared with 192 DIEP flap reconstructions, the final DIEP flap supplied 98.1 ± 1.7% of mastectomy weight, while the final PAP flap supplied 114.1 ± 6.2% of mastectomy weight (p < 0.005), demonstrating that PAP flaps can successfully supply final reconstruction volume. In a separate analysis, single PAP flaps successfully supplied 104.2% (84.2-144.4%) of mastectomy weights, while stacked PAP flaps supplied 103.7% (98.8-115.2%) of mastectomy weights. Conclusion In our series of PAP flap reconstructions performed in low-to-normal BMI patients, we found that PAP flaps, as single or stacked flaps, provide sufficient volume to reconstruct mastectomy defects.

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Influence of lesion location on the accuracy of CT derived FFR: head-to-head comparison with invasive FFR

European Heart Journal ◽

10.1093/ehjci/ehaa946.0158 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

M Moshage ◽

S Smolka ◽

S Achenbach ◽

F Ammon ◽

P Ferstl ◽

...

Keyword(s):

Coronary Angiography ◽

Positive Predictive Value ◽

Diagnostic Accuracy ◽

Negative Predictive Value ◽

Predictive Value ◽

Invasive Coronary Angiography ◽

Roc Curve Analysis ◽

Jude Medical ◽

Lesion Location ◽

Distal Vessel

Abstract Background The accuracy of CT-derived FFR (FFRCT) has been repeatedly reported. However, the influence of lesion location on accuracy is unknown. Therefore, we evaluated the diagnostic accuracy of FFRCT to detect lesion-specific ischemia and determined the influence of lesion location (proximal vs. distal vessel segments) compared to invasively measured FFR in patients with suspected CAD. Methods A total of 136 vessels in which “Dual-Source”-CT coronary angiography had been performed due to suspected CAD and who were further referred for invasive coronary angiography with invasive FFR measurement within three months of the index CT examination were retrospectively identified and screened for inclusion in this analysis. Patients with either left main coronary artery stenoses, bifurcation or ostial stenoses were excluded. Invasive FFR was measured using a pressure wire (CERTUS®, St. Jude Medical, Minnesota, USA or Verrata®, Volcano, San Diego, USA). FFRCT was calculated using an on-site prototype (cFFR Version 3.0, Siemens Healthineers, Forchheim, Germany). All vessels were analyzed by an experienced observer blinded to the results of invasive FFR. Stenoses with invasively measured FFR ≤0.80 were classified as hemodynamically significant. We evaluated the diagnostic accuracy of FFRCT in proximal vs. non-proximal vessel segments. Proximal lesions included stenoses located in segment one, six, eleven and twelve. All other stenoses were categorized as distal lesions. Results Out of 136 coronary stenoses, 47 (35%) were located in proximal segments and 89 (65%) lesions were located in distal segments. Compared to invasive FFR, the sensitivity of FFRCT to correctly identify/exclude hemodynamically significant stenoses in proximal vessel segments was 93% (95% CI: 68–99.8%) and the specificity was 100% (95% CI: 89–100%), compared to a sensitivity of 72% (95% CI: 46.5–90%) and a specificity of 87% (95% CI: 77–94%) for FFRCT in distal lesions. The positive predictive value was 100% and the negative predictive value was 97% (95% CI: 82.8–99.5%) compared to a positive predictive value of 59% (95% CI: 42–93.9%) and a negative predictive value of 93% (95% CI: 85.4–96.3%) for proximal vs. distal vessel segment, respectively. This corresponds to an accuracy of 98% vs. 84%, respectively (p=0.02). ROC-Curve analysis showed a slightly higher – albeit non-significant – area under the curve for FFRCT to detect hemodynamic relevance in proximal lesions compared to distal lesions (AUC 0.95, p<0.001 vs. AUC: 0.86, p<0.001, respectively, p=0.2). Conclusion FFRCT obtained using an on-site prototype shows overall a high diagnostic accuracy for detecting lesions causing ischemia as compared to invasive FFR with a trend towards better diagnostic performance in proximal vessel segments. Funding Acknowledgement Type of funding source: None

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Serum D-dimer level as a biomarker for identifying patients with isolated injury to prevent unnecessary whole-body computed tomography in blunt trauma care

Scandinavian Journal of Trauma Resuscitation and Emergency Medicine ◽

10.1186/s13049-020-00815-9 ◽

2021 ◽

Vol 29 (1) ◽

Author(s):

Rakuhei Nakama ◽

Ryo Yamamoto ◽

Yoshimitsu Izawa ◽

Keiichi Tanimura ◽

Takashi Mato

Keyword(s):

Computed Tomography ◽

Positive Predictive Value ◽

Predictive Value ◽

High Specificity ◽

Whole Body ◽

Cutoff Value ◽

Whole Body Ct ◽

Isolated Injury ◽

D Dimer ◽

Body Ct

Abstract Background Unnecessary whole-body computed tomography (CT) may lead to excess radiation exposure. Serum D-dimer levels have been reported to correlate with injury severity. We examined the predictive value of serum D-dimer level for identifying patients with isolated injury that can be diagnosed with selected-region CT rather than whole-body CT. Methods This single-center retrospective cohort study included patients with blunt trauma (2014–2017). We included patients whose serum D-dimer levels were measured before they underwent whole-body CT. “Isolated” injury was defined as injury with Abbreviated Injury Scale (AIS) score ≤ 5 to any of five regions of interest or with AIS score ≤ 1 to other regions, as revealed by a CT scan. A receiver operating characteristic curve (ROC) was drawn for D-dimer levels corresponding to isolated injury; the area under the ROC (AUROC) was evaluated. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated for several candidate cut-off values for serum D-dimer levels. Results Isolated injury was detected in 212 patients. AUROC was 0.861 (95% confidence interval [CI]: 0.815–0.907) for isolated injury prediction. Serum D-dimer level ≤ 2.5 μg/mL was an optimal cutoff value for predicting isolated injury with high specificity (100.0%) and positive predictive value (100.0%). Approximately 30% of patients had serum D-dimer levels below this cutoff value. Conclusion D-dimer level ≤ 2.5 μg/mL had high specificity and high positive predictive value in cases of isolated injury, which could be diagnosed with selected-region CT, reducing exposure to radiation associated with whole-body CT.

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