MDCT angiography in evaluation of pediatric hemangiomas and peripheral vascular malformations

Background: To evaluate the role of MDCT angiography in peripheral hemangiomas and vascular malformations in pediatric patients.Methods: Total of 36 consecutive pediatric patients with clinically suspected peripheral hemangiomas and peripheral malformations were included in the study. MDCT angiography and doppler sonography was done for all patients. Final diagnosis was made by response to treatment and follow up. The statistical significance of various MDCT findings and post processing techniques was calculated. p value of <0.05 was considered significant.Results: Venous malformations were the most common. The MDCTA features which were significant in diagnosing venous malformations were phleboliths (p=0.039), peak enhancement in venous or delayed phase, absence of soft tissue mass, lacy tangle of vessels on maximum intensity projection and volume rendered images. Features significant in diagnosing arteriovenous malformations were tortuous arterial feeders, peak enhancement in arterial phase (0.0001), early draining vein (p=0.0001), venous phase wash out (p=0.0001), tense tangle of vessels on maximum intensity projection and volume rendered images (p=0.0003). Phleboliths (p=0.43) and venous or delayed phase peak enhancement (p=0.69) were overlapping features in congenital hemangiomas and venous malformations. Arterial phase enhancement (p=0.10) and early draining veins (p=0.39) were overlapping features in infantile proliferating hemangiomas and arteriovenous malformations. However, presence of soft tissue mass (p=0.0001) and lack of venous phase wash out (p=0.0003) were differentiating features for hemangiomas.Conclusions: MDCT angiography can be used as a highly accurate modality to diagnose hemangiomas and vascular malformations. It has an advantage over color Doppler in depicting entire extent of deep lesions.

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Case 5.6

Mayo Clinic Body MRI Case Review ◽

10.1093/med/9780199915705.003.0134 ◽

2014 ◽

pp. 253-253

Author(s):

Christine U. Lee ◽

James F. Glockner

Keyword(s):

Abdominal Pain ◽

Equilibrium Phase ◽

Arterial Phase ◽

Recurrent Pancreatitis ◽

Portal Venous Phase ◽

History Of ◽

Venous Phase ◽

Delayed Phase

37-year-old woman with a history of recurrent pancreatitis and abdominal pain Arterial phase (Figure 5.6.1A), portal venous phase (Figure 5.6.1B), equilibrium phase (Figure 5.6.1C), and 8-minute delayed phase (Figure 5.6.1D) postgadolinium 3D SPGR images show multiple splenic lesions that are initially hypoenhancing relative to adjacent spleen and become hyperintense on delayed images....

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Diagnostic Potential of Multidetector Computed Tomography for Characterizing Small Renal Masses

The Scientific World JOURNAL ◽

10.1155/2015/476750 ◽

2015 ◽

Vol 2015 ◽

pp. 1-8

Author(s):

Maria Elisabetta Mancini ◽

Annamaria Albergo ◽

Marco Moschetta ◽

Mariacristina Angelelli ◽

Arnaldo Scardapane ◽

...

Keyword(s):

Urinary Tract ◽

Clear Cell ◽

Renal Tumors ◽

Arterial Phase ◽

Renal Masses ◽

Portal Phase ◽

Diagnostic Potential ◽

Peak Enhancement ◽

Density Values ◽

Delayed Phase

Objectives. To assess the potential of CT for characterizing small renal tumors.Methods. 76 patients with <4 cm renal tumors underwent CT examination. The following parameters were assessed: presence of calcifications, densitometry on unenhanced and enhanced scans, washout percentage, urinary tract infiltration, star-shaped scar, and paradoxical effect.Results. Calcifications were found in 7/56 (12.5%) carcinomas. Clear cell carcinomas were as follows: mean density 183.5 HU (arterial phase), 136 HU (portal phase), and 94 HU (delayed phase), washout 34.3%; chromophobe carcinomas were as follows: mean density 135 HU (arterial phase), 161 HU (portal phase), and 148 HU (delayed phase), washout 28%; papillary carcinomas were as follows: mean density 50.3 HU (arterial phase), 60 HU (portal phase), and 58.1 HU (delayed phase), washout 2.7%. In 2/56 (3.6%) cases urinary tract infiltration was found. Oncocytomas were as follows: mean density 126.5 HU (arterial phase), 147.5 HU (portal phase), and 115.5 HU (delayed phase), washout 28.6%. On unenhanced scans, angiomyolipomas were as follows: density values <30 HU in 12/12 (100%) of cases and on enhanced scans: mean density 78 HU (arterial phase), 128 HU (portal phase), and 80 HU (delayed phase), washout 50%.Conclusions. Intralesional calcifications and urinary tract infiltration are suggestive for malignancy, with the evidence of adipose tissue for angiomyolipomas and a modest increase in density with a reduced washout for papillary carcinomas. The intralesional density on enhanced scans, peak enhancement, and washout do not seem significant for differentiating clear cell, chromophobe carcinomas, angiomyolipomas, and oncocytomas.

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Quantitative Analysis of Enhanced Computed Tomography in Differentiating Cystitis Glandularis and Bladder Cancer

BioMed Research International ◽

10.1155/2020/4930621 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7

Author(s):

Hui Hua ◽

Yuanxiang Gao ◽

Jizheng Lin ◽

Feng Hou ◽

Jun wei Wang ◽

...

Keyword(s):

Bladder Cancer ◽

Quantitative Analysis ◽

Sensitivity And Specificity ◽

Arterial Phase ◽

Relative Enhancement ◽

Enhanced Ct ◽

Venous Phase ◽

Enhanced Computed Tomography ◽

Quantitative Indicators ◽

Delayed Phase

Objective. This study was performed to assess the value of quantitative analysis of enhanced computed tomography (CT) values in the differential diagnosis of bladder cancer and cystitis glandularis (CG). Methods. Eighty patients with bladder masses (39 with CG and 41 with bladder cancer) who underwent enhanced CT were retrospectively reviewed. The CT enhancement values of the lesion and normal bladder wall in the arterial phase, venous phase, and delayed phase were measured. The relative enhancement CT values (relative enhancement CT value=enhancement CT value of lesion−enhancement CT value of normal bladder) in the arterial phase, venous phase, and delayed phase were also calculated. The pathological results were used as the gold standard, and the area under the curve (AUC), sensitivity, and specificity were calculated for the six groups of quantitative indicators (enhanced CT values and relative enhanced CT values of CG and bladder cancer in the arterial, venous, and delayed phases). We performed the leave-group-out cross-validation method to validate the accuracy, AUC, sensitivity, and specificity. The differences in accuracy, AUC, sensitivity, and specificity among the six groups of quantitative indicators were compared by the t-test. Results. In a combined analysis of the AUC, sensitivity, and specificity performance, the best indicator was the arterial-phase relative enhancement CT value with a cut-off of 25.85 HU (AUC, 0.966; sensitivity, 95.1%; specificity, 92.3%). We used the 100-times leave-group-out cross-validation method to validate the accuracy, AUC, sensitivity, and specificity. Arterial-phase relative enhancement CT values showed the highest AUC and accuracy among the six groups, with statistical significance (P<0.05). Conclusion. Quantitative analysis of enhanced CT is of great clinical value in the differential diagnosis of CG and bladder cancer.

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Correlation of Small Bowel Gastrointestinal Stromal Tumor Computed Tomography Features with the Grade of Pathological Risk

10.21203/rs.3.rs-934053/v1 ◽

2021 ◽

Author(s):

Yanfen Lan ◽

Lixun Chen ◽

Shaobin Chen ◽

Mingping Ma

Keyword(s):

Roc Curve ◽

Risk Group ◽

Low Risk ◽

Arterial Phase ◽

Stromal Tumors ◽

Ct Value ◽

Phase Increment ◽

Venous Phase ◽

Small Intestinal ◽

Delayed Phase

Abstract Objectives: The aim of this study was to investigate the diagnostic value of computerized tomography (CT) features of small intestinal stromal tumors in terms of their degree of risk. Methods: The clinical data and CT data of 107 patients with small intestinal stromal tumors confirmed by surgery and pathology in our hospital from June 2012 to October 2020 were selected. According to the results of postoperative pathological risk, the patients were divided into high-risk and low-risk groups, wherein 67 cases were in high-risk group and 40 cases were in the low-risk group The maximum diameter, solid component plain scan, arterial phase CT value, venous phase CT value, and delayed phase CT value of the two groups were measured, and the enhancement degree of arterial phase, venous phase, delayed CT value, and lesion enhancement mode were calculated. The difference between the two groups was compared. An independent sample t-test was used to compare quantitative indices, and the chi-squared test or Fisher’s exact test was used for qualitative index comparison. A receiver operating characteristic (ROC) curve was used to evaluate the diagnostic value of the arterial phase CT value, venous phase CT value, delayed phase CT value, arterial phase enhancement degree, venous phase enhancement degree, delayed phase enhancement degree, and the enhanced net value-added in the risk degree of SBGISTs. The relationship between preoperative imaging findings and tumor risk was retrospectively analyzed. Results: Univariate analysis showed that there were significant differences in the lesion location, growth pattern, lesion ulcer, necrotic cystic degeneration, lobulation, boundary with surrounding tissues, plain scan density and lesion enhancement mode, CT value in arterial phase, increment in arterial phase, CT value in venous phase, increment in venous phase, CT value in delayed phase, increment in delayed phase, and enhancement value in lesion between the two groups (P < 0.05); there were no significant differences in sex, age, calcification, bleeding, clinical symptoms, and CT value (P > 0.05). The ROC curve analysis showed that the area under the curve (AUC) of the long diameter of the lesion was 0.959 (P = 0.000), the optimal critical point of the ROC curve was the lesion ≥ 4.80 cm, the sensitivity was 88.1%, the specificity was 97.5%, and the accuracy was 91.6%; for the low-risk group, the AUC was 0.788 (the largest, P = 0.000), the sensitivity was 77.5%, the specificity was 70.1%, and the accuracy was 72.9%. Multivariate analysis showed that non-uniform density (P = 0.030; odds ratio [OR]: 12.544; 95% confidence interval [CI]: 1.269–123.969), arterial phase CT value (P = 0.024; OR: 10.790; 95% CI: 1.374–84.754), and lesion length (P = 0.000; OR: 648.694; 95% CI: 40.541–10,379.714) were risk factors for SBGISTs. Conclusions: The CT features of small intestinal stromal tumors have certain characteristics, which can help to grade the risk of small intestinal stromal tumors before surgery.

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Secondary Pulmonary Vein Stenosis Due to Total Anomalous Pulmonary Venous Connection Repair in Children: Extravascular MDCT Findings

Children ◽

10.3390/children8090726 ◽

2021 ◽

Vol 8 (9) ◽

pp. 726

Author(s):

Edward Y. Lee ◽

Sara O. Vargas ◽

Kathy J. Jenkins ◽

Ryan Callahan ◽

Halley J. Park ◽

...

Keyword(s):

Soft Tissue ◽

Pulmonary Vein ◽

Soft Tissue Mass ◽

Ground Glass Opacity ◽

Pulmonary Vein Stenosis ◽

Mdct Angiography ◽

Tissue Mass ◽

Pleural Thickening ◽

Vein Stenosis ◽

Anomalous Pulmonary Venous Connection

Purpose: To evaluate extravascular findings on thoracic MDCT angiography in secondary pulmonary vein stenosis (PVS) due to total anomalous pulmonary venous connection (TAPVC) repair in children. Materials and Methods: All patients aged ≤18 years with a known diagnosis of secondary PVS after TAPVC repair, confirmed by echocardiography, conventional angiography, and/or surgery, who underwent thoracic MDCT angiography studies between July 2008 and April 2021 were included. Two pediatric radiologists independently examined MDCT angiography studies for the presence of extravascular thoracic abnormalities in the lung, pleura, and mediastinum. The location and distribution of each abnormality (in relation to the location of PVS) were also evaluated. Interobserver agreement between the two independent pediatric radiology reviewers was studied using kappa statistics. Results: The study group consisted of 20 consecutive pediatric patients (17 males, 3 females) with secondary PVS due to TAPVC repair. Age ranged from 2 months to 8 years (mean, 16.1 months). In children with secondary PVS due to TAPVC repair, the characteristic extravascular thoracic MDCT angiography findings were ground-glass opacity (19/20; 95%), septal thickening (7/20; 35%), pleural thickening (17/20; 85%), and a poorly defined, mildly heterogeneously enhancing, non-calcified soft tissue mass (17/20; 85%) which followed the contours of affected pulmonary veins outside the lung. There was excellent interobserver kappa agreement between two independent reviewers for detecting extravascular abnormalities on thoracic MDCT angiography studies (k = 0.99). Conclusion: Our study characterizes the extravascular thoracic MDCT angiography findings in secondary pediatric PVS due to TAPVC repair. In the lungs and pleura, ground-glass opacity, interlobular septal thickening, and pleural thickening are common findings. Importantly, the presence of a mildly heterogeneously enhancing, non-calcified mediastinal soft tissue mass in the distribution of the PVS is a novel characteristic thoracic MDCT angiography finding seen in pediatric secondary PVS due to TAPVC repair.

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MDCT angiography of emergent, non-traumatic, upper extremity vascular lesions

British Journal of Radiology ◽

10.1259/bjr.20190731 ◽

2020 ◽

Vol 93 (1116) ◽

pp. 20190731

Author(s):

Sameer Ahmed ◽

Megan H Lee ◽

Hannah Ahn ◽

Elliot K. Fishman

Keyword(s):

Upper Extremity ◽

Multidetector Ct ◽

Vascular Malformations ◽

Maximum Intensity Projection ◽

Vascular Pathology ◽

Vascular Lesions ◽

Emergency Setting ◽

Mdct Angiography ◽

Non Invasive

Timely, accurate diagnosis of upper extremity vascular pathology is critical for successful clinical and surgical management. Although the vast majority of upper extremity vascular injury is due to trauma, physicians in the emergency setting, including radiologists, must be familiar with vascular lesions from iatrogenic injury, thromboembolic disease, vascular malformations, and vasculitis. Non-invasive diagnostic imaging with multidetector CT (MDCT) angiography is often employed in the emergency department to evaluate patients with suspected vascular pathology of the upper extremity. Maximum intensity projection and volume rendering technique are two methods that are useful for evaluating vasculature. In addition, dual-energy MDCT is useful in that it allows for the generation of iodine-selective images and bone subtracted images. These techniques can be used to create images that simulate catheter angiograms. In this article, we will discuss the role of MDCT angiography in the diagnosis and management of emergent non-traumatic vascular lesions of the upper extremity.

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Extravascular MDCT Findings of Pulmonary Vein Stenosis in Children with Cardiac Septal Defect

Children ◽

10.3390/children8080667 ◽

2021 ◽

Vol 8 (8) ◽

pp. 667

Author(s):

Edward Y. Lee ◽

Ryan Callahan ◽

Sara O. Vargas ◽

Kathy J. Jenkins ◽

Halley J. Park ◽

...

Keyword(s):

Soft Tissue ◽

Pulmonary Vein ◽

Pediatric Patients ◽

Septal Defect ◽

Soft Tissue Mass ◽

Pulmonary Vein Stenosis ◽

Mdct Angiography ◽

Tissue Mass ◽

Pleural Thickening ◽

Vein Stenosis

To retrospectively investigate the extravascular thoracic MDCT angiography findings of pulmonary vein stenosis (PVS) in children with a cardiac septal defect. Materials and Methods: Pediatric patients (age ≤ 18 years) with cardiac septal defect and PVS, confirmed by echocardiogram and/or conventional angiography, who underwent thoracic MDCT angiography studies from April 2009 to April 2021 were included. Two pediatric radiologists independently evaluated thoracic MDCT angiography studies for the presence of extravascular thoracic abnormalities in: (1) lung and airway (ground-glass opacity (GGO), consolidation, pulmonary nodule, mass, cyst, septal thickening, fibrosis, and bronchiectasis); (2) pleura (pleural thickening, pleural effusion, and pneumothorax); and (3) mediastinum (mass and lymphadenopathy). Interobserver agreement between the two independent pediatric radiology reviewers was evaluated with kappa statistics. Results: The final study group consisted of 20 thoracic MDCT angiography studies from 20 consecutive individual pediatric patients (13 males (65%) and 7 females (35%); mean age: 7.5 months; SD: 12.7; range: 2 days to 7 months) with cardiac septal defect and PVS. The characteristic extravascular thoracic MDCT angiography findings were GGO (18/20; 90%), septal thickening (9/20; 45%), pleural thickening (16/20; 80%), and ill-defined, mildly heterogeneously enhancing, non-calcified soft tissue mass (9/20; 45%) following the contours of PVS in the mediastinum. There was a high interobserver kappa agreement between two independent reviewers for detecting extravascular abnormalities on thoracic MDCT angiography studies (k = 0.99). Conclusion: PVS in children with a cardiac septal defect has a characteristic extravascular thoracic MDCT angiography finding. In the lungs and pleura, GGO, septal thickening, and pleural thickening are frequently seen in children with cardiac septal defect and PVS. In the mediastinum, a mildly heterogeneously enhancing, non-calcified soft tissue mass in the distribution of PVS in the mediastinum is seen in close to half of the pediatric patients with cardiac septal defect and PVS.

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Radiological differentiation of phaeochromocytoma from other malignant adrenal masses: importance of wash-in characteristics on multiphase CECT

Endocrine Connections ◽

10.1530/ec-19-0198 ◽

2019 ◽

Vol 8 (7) ◽

pp. 898-905 ◽

Cited By ~ 4

Author(s):

Manjunath Goroshi ◽

Swati S Jadhav ◽

Vijaya Sarathi ◽

Anurag R Lila ◽

Virendra A Patil ◽

...

Keyword(s):

High Specificity ◽

Arterial Phase ◽

Study Cohort ◽

Western India ◽

Imaging Data ◽

Peak Enhancement ◽

Adrenal Lymphoma ◽

Venous Phase ◽

Adrenal Masses ◽

Venous Enhancement

Rationale and introduction To evaluate the computerised tomography (CT) characteristics of phaeochromocytoma (PCC) that differentiate them from other non-benign adrenal masses such as adrenocortical carcinoma (ACC), primary adrenal lymphoma (PAL) and adrenal metastases (AM). Methods This retrospective study was conducted at a tertiary health care institute from Western India. Patients presented between January 2013 and August 2016 with histological diagnosis of PCC or other non-benign adrenal mass having adequate reviewable imaging data comprising all four CECT phases were included. Results The study cohort consisted of 72 adrenal masses from 66 patients (33 PCC, 22 ACC, 4 PAL, 13 AM). Unlike other masses, majority of PCC (25/33) showed peak enhancement in early arterial phase (EAP). PCC had significantly higher attenuation in EAP and early venous phase (EVP), and higher calculated percentage arterial enhancement (PAE) and percentage venous enhancement (PVE) than other adrenal masses (P < 0.001). For diagnosis of PCC with 100% specificity, PAE value ≥100% and EAP attenuation ≥100 HU had 78.8 and 63.6% sensitivity respectively. ACC were significantly larger in size as compared to PCC and metastasis. The adreniform shape was exclusively found in PAL (two out of four) and AM (4 out of 13). None of the enhancement, wash-in or washout characteristics were discriminatory among ACC, PAL and AM. Conclusion Peak enhancement in EAP, PAE value ≥100% and EAP attenuation ≥100 HU differentiate PCC from other malignant adrenal masses with high specificity.

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Can Enhancement Pattern and Enhancement Level on Biphasic Enhanced CT Distinguish Homogeneous Pheochromocytomas From Adenomas Without Lipid

10.21203/rs.3.rs-92153/v1 ◽

2020 ◽

Author(s):

Yongyu An ◽

Fengjuan Tian ◽

Bin Lin ◽

Meihua Shao ◽

Fangmei Zhu ◽

...

Keyword(s):

Arterial Phase ◽

Inclusion Criteria ◽

Enhancement Pattern ◽

Unenhanced Ct ◽

Peak Enhancement ◽

Enhanced Ct ◽

Cystic Changes ◽

Venous Phase ◽

The Mean ◽

Attenuation Values

Abstract Objective The purpose of our study was to evaluate whether enhancement pattern and enhancement level on biphasic enhanced CT can distinguish homogeneous pheochromocytomas from adenomas without lipid and explore the value of percentage of peak enhancement (PPE) in differentiating the two entities.Methods We retrospectively analysed pathologically proven 17 pheochromocytomas and 34 adenomas. Both tumors were homogeneous without necro-cystic changes and hemorrhage. The inclusion criteria for adenomas without lipid in our study was that the mean attenuation values were greater than 10 HU and the minimum values were greater than 0 HU on unenhanced CT. Biphasic CT scan protocol consisted of unenhanced phase, arterial phase (25-35 seconds) and venous phase (60-80 seconds). The enhancement pattern, attenuation values on unenhanced and enhanced phases and PPE were compared between the two groups.Results Enhancement pattern was similar between the two groups (p>0.99), persistent enhancement pattern on venous phase was the most common in both tumors. The precontrast CT values of pheochromocytomas were significantly higher than that of adenomas without lipid (41 HU vs 37 HU, p=0.006). The enhancement level on arterial and venous phase of pheochromocytomas was greater than that of adenomas without lipid, but no significant differences were found (100 HU vs 85 HU, p=0.223; 103 HU vs 96 HU, p=0.905, respectively). The distribution of PPE of two entities was different. A range of 100%-240% of PPE can discriminate adenomas without lipid from pheochromocytomas, with sensitivity of 88.2%, specificity of 47.1%. Conclusion The enhancement pattern and enhancement level on biphasic enhanced CT could not distinguish homogeneous pheochromocytomas from adenomas without lipid. Further studies are needed to prove the potential value of PPE due to its low specificity.

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Analisis Informasi Citra Anatomi Vaskular dengan Multi Planar Reformating (MPR) dan Maximum Intensity Projection (MIP) pada Fase Early Arteri Pemeriksaan MSCT Abdomen

Jurnal Imejing Diagnostik (JImeD) ◽

10.31983/jimed.v3i2.3192 ◽

2017 ◽

Vol 3 (2) ◽

pp. 240-244

Author(s):

Ratna Istiningrum ◽

Fatimah Fatimah ◽

Tri Wulanhandarini

Keyword(s):

Maximum Intensity Projection ◽

Arterial Phase ◽

P Value ◽

Post Processing ◽

Test Analysis ◽

Vascular Abnormalities ◽

Kappa Test ◽

Anatomical Image ◽

Parametric Statistical Test ◽

Early Arterial Phase

Background: The development in the field of image reconstruction is growing rapidly along with the development of CT Scan. In the early stages of MSCT abdominal artery is usually found various kinds of vascular abnormalities such as stenosis, aneurism and others. Post processing image techniques commonly used include MPR and MIP. The purpose of this study is to determine whether there is a difference between MPR and MIP techniques and to know which one is better between the two.Methods: This research was quantitative study with experimental approach. The study was conducted at Bhakti Dharma Husada Surabaya Hospital with 15 samples by performing reconstruction on vascular anatomical image of coronal examination of abdominal MSCT. Assessment of anatomical information data is done by 2 respondents. Data analysis was done by kappa test followed by Wilcoxon sign rank test.Result : The results showed the difference between the post-processing of MIP and MPR on the coronal stages of the early arterial phase of the abdominal MSCT examination, based on the results of non-parametric statistical test analysis (Wilcoxon) showed a significant value of p value = 0.001. The result of MIP mean rank value (8,46) is higher than the mean rank value of MPR (1,50), it can be known that post proceeding MIP technique on coronal phase cuts early arterial examination of abdominal MSCT produces better anatomical image information.Conclusion: On examination of abdominal MSCT in the early arterial phase should be at the time of processing the image is also done by using post-processing MIP because more clearly than the MPR.

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