HSR19-110: Predicting Candidates for Cytoreductive Surgery and HIPEC: The Role of Computed Tomography and Diagnostic Laparoscopy

2019 ◽  
Vol 17 (3.5) ◽  
pp. HSR19-110
Author(s):  
Leigh Selesner ◽  
Gabrielle Gauvin ◽  
Dorotea Mutabdzic ◽  
Eileen O’Halloran ◽  
Maxwell Kilcoyne ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Ct Scan ◽  
Sensitivity And Specificity ◽  
Cytoreductive Surgery ◽  
Diagnostic Laparoscopy ◽  
Preoperative Assessment ◽  
Interval Time ◽  
Final Pathology ◽  
Median Interval

Introduction: Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CS/HIPEC) has led to improved survival in select patients with peritoneal surface malignancies. Predicting the volume of disease and any unresectable disease is important for determining CS candidacy. Computed tomography (CT) scan is the preoperative assessment of choice, and diagnostic laparoscopy (DL) is also supported in the literature but has not been widely adopted. In this study, we report our experience comparing and evaluating the role of imaging and DL in the preoperative assessment of patients being considered for CS/HIPEC. Methods: Patients considered for CS/HIPEC at our tertiary cancer center between January 2012 and December 2017 were included. Diagnostic modality sensitivity and specificity were calculated by comparing findings on CT scan and DL to findings at the time of laparotomy and on final pathology. Specificity and sensitivity of the 2 modalities were compared using the McNemar Chi-square test. Results: Our analysis included 71 patients (60.5% male, mean age of 54.9) seen in consultation for CS/HIPEC. Primary cancer diagnosis was 57.7% colorectal cancer, 25.4% pseudomyxoma peritonei, 8.5% mesothelioma, and 8.5% adenocarcinoma of unknown primary. DL was done in 42.3% of patients (median time of 30 days between CT and DL) and an open procedure was done directly after CT in 39.4% (median interval time of 39 days). Findings of DL identified 70% as being unresectable and hence ineligible for HIPEC. The median interval time between 2 operations was 29 days (range, 16–42). When comparing diagnostic modalities to open surgery and final pathology, CT had a sensitivity and specificity of 48.2% and 76.4% and DL, 68.2% and 88.9%, respectively. DL was significantly more sensitive and specific than CT (χ2=5.54; P<.0186) at predicting ascites, small bowel, omental, liver, and lymph node involvement. Conclusion: Our results support the recommendation for performing DL prior to open exploration in patients considered for CS/HIPEC. In our cohort, DL was significantly more sensitive and specific than CT in predicting disease volume and distribution. While there is obviously greater risk to an invasive modality compared to non-invasive CT scan, routine performance of DL can potentially avoid laparotomy without CS/HIPEC in a large proportion of patients. These results will be used to inform the next phase of our study: a prospective clinical trial.

scholarly journals The role of lumbar puncture in the diagnosis of subarachnoid hemorrhage when computed tomography is unavailable

CJEM ◽  
2002 ◽  
Vol 4 (02) ◽  
pp. 102-105 ◽  
Author(s):  
David Mann
Keyword(s):  
Computed Tomography ◽  
Differential Diagnosis ◽  
Subarachnoid Hemorrhage ◽  
Ct Scan ◽  
Lumbar Puncture ◽  
Uncommon Condition ◽  
Noncontrast Computed Tomography ◽  
Acute Headache ◽  
Interpretation Of Results

ABSTRACTSubarachnoid hemorrhage (SAH) is an important but uncommon condition in the differential diagnosis of acute headache. Most authorities recommend that patients with suspected SAH undergo noncontrast computed tomography (CT) as a first diagnostic intervention. If the results of the CT scan are negative, a lumbar puncture should be performed. Many nonurban Canadian hospitals do not have CT scanners and must either transfer patients or consider performing lumbar puncture prior to CT. In selected patients, performing lumbar puncture first may be an option, but timing of the procedure and the interpretation of results is important.

scholarly journals Role of Radiologic Computed Tomography in Evaluating Coronavirus (COVID-19) Patients

2021 ◽  
pp. 39-44
Author(s):  
Mwahib Sayed Ahmed Aldosh
Keyword(s):  
Computed Tomography ◽  
Ct Scan ◽  
Ct Scanning ◽  
Viral Disease ◽  
Human Beings ◽  
Complementary Method ◽  
High Incidence ◽  
High Incidence Rate ◽  
The Common

Objective: Coronavirus (Covid 19) is a dangerous viral disease that principally targets the respiratory system of human beings. The main objective of this study is to evaluate the significant effects resulting from Covid19 using radiologic CT scanning technology. Methods: The recent study was conducted in order to evaluate covid19 among the local public. The sample size for this study consisted of two hundred and thirty (230) patients diagnosed with coronavirus and underwent a chest computed tomography scan. The study was conducted at Najran city, between the period from September to December 2020. Results: The results showed that it is possible to diagnose the complications of coronavirus that affects the respiratory tract in an accurate manner using chest CT imaging and the main results revealed that coronavirus COVID-19 affected all, but males more than female. (50-60) Age group was the big distribution while acute respiratory failure is the most common clinical etiology. The CT scan findings revealed that bilateral pneumonia was the common complication with a high incidence rate of 32% percent and blood coagulation achieved 5% percent as the minimum distribution result. Conclusion: The sensitivity of the CT scans in assessing COVID-19 was significantly high, it has the efficiency to assess complications of COVID-19 in an accurate manner, and therefore it has been proposed to use CT scan as a complementary method in covid-19 diagnosis. More studies on coronavirus disease were recommended by the author.

scholarly journals Role of Ultrasound and Computed Tomography in the Evaluation of Gallbladder Malignancy

2017 ◽  
Vol 8 (2) ◽  
pp. 105-111
Author(s):  
Nusrat Ghafoor ◽  
Naffisa Abedin ◽  
AS Mohiuddin
Keyword(s):  
Computed Tomography ◽  
Gall Bladder ◽  
Ct Scan ◽  
Sensitivity And Specificity ◽  
Gallbladder Carcinoma ◽  
Bladder Carcinoma ◽  
Biliary Surgery ◽  
Gall Bladder Carcinoma ◽  
Additional Advantage ◽  
Thickened Wall

Background & objective: Ultrasonogram (USG) and computed tomography (CT) are often used in the evaluation of gall-bladder carcinoma. Thepresent study was conducted to determine the usefulness of USG and CT scan in diagnosing gallbladder carcinoma.Materials & Methods: This cross-sectional observational study was conducted at Department of Radiology and Imaging, BIRDEM in collaboration with the Departments of Hepato-biliary Surgery, and Histopathology of the same institute over a period of 3 years fromJuly 2004 to June 2006. A total of 42 patients (ranging from 40-80 years) were initially included on the basis of signs and symptoms of gallbladder carcinoma and underwent USG and CT scan for preoperative radiological diagnosis, its extension and operability. Following operation all the resected specimens were sent for histopathological evaluation. The diagnostic accuracies of USG and CT scan were then compared against histopathological diagnoses by using Kappa statistics.Result: In the present study, the mean age of the patients was 60 (range: 40-80) years with female preponderance. About 40% of the gall-bladder were contracted and reduced in size and 32.5% large and distended on USG examination, while 45% of the gall-bladder were contracted and reduced in size and 25% distended and large on CT examination. Approximately 40% had irregularly thickened wall and 21.2% diffusely thickened wall on USG and 30% of gallbladder wall were diffusely thickened and 45% irregularly thickened on CT scan. The present study showed hepatic parenchymal invasion to be 22.5% on USG and 42.5% on CT scan. The sensitivity and specificity of USG in diagnosing GB carcinoma were 93.9 and 71.4% respectively. Similarly, the sensitivity and specificity of CT scan in detecting GB carcinoma were 97.1 and 83.3% respectively. The test of agreement (Kappa test) revealed an almost 90% agreement between the two procedures meaning that the two diagnostic modalities are almost comparable in diagnosing gall bladder carcinoma (p<0.001).Conclusion: The study findings indicate that both USG and CT scan are ideal,non-invasive, safe imaging modalities for diagnosis of gallbladder carcinoma. CT scan has an additional advantage in defining the extension of the disease and involvement of surrounding structures including lymph nodes and hepatoduodenal ligament.Anwer Khan Modern Medical College Journal Vol. 8, No. 2: Jul 2017, P 105-111

scholarly journals ULTRASOUND, CT-SCAN, AND LAPAROSCOPY

2008 ◽  
Vol 15 (01) ◽  
pp. 171-174
Author(s):  
SUMAIRA KANWAL ◽  
MUHAMMAD ZUBAIR ◽  
SULTAN MEHMOOD ◽  
Riaz Hussain Dab
Keyword(s):  
Diagnostic Accuracy ◽  
Ct Scan ◽  
Sensitivity And Specificity ◽  
Diagnostic Laparoscopy ◽  
Pediatric Patients ◽  
Undescended Testes ◽  
Diagnostic Efficacy ◽  
Surgical Department ◽  
One Year ◽  
Cardiovascular Anomalies

Objective: To evaluate the comparative diagnostic efficacy of Ultrasound,CT-Scan, and Laparoscopy in the diagnosis of non-palpable undescended testes in pediatric patients. Design:Comparative study.Setting: Surgical and pediatric surgical department of B V Hospital (QAMC) Bahawalpur and AlliedHospital Faisalabad. Period: From April 2006 to April 2007. Materials & Method: A total forty boys with non palpabletestis were subjected to Ultrasound, CT-Scan and diagnostic laparoscopy in a period of one year. The patients above12 years and with cardiovascular anomalies were excluded from the study. Laparoscopy was performed under generalanesthesia and findings were compared with Ultrasound and CT-Scan. Sensitivity and specificity of each werecalculated. Results: Diagnostic accuracy of Ultrasound was 25%, CT-Scan was 64% and Laparoscopy was 100%.Sensitivity was found to be 20%, 63% and 100% and specificity was 10%. 50%and 100%forUltrasound, CT-Scan andLaparoscopy, respectively. Conclusion: Diagnostic laparoscopy is far more superior as compared to Ultrasound andCT-Scan in the diagnosis of non palpable testis.

scholarly journals An Experimental Pre-Post Study on the Efficacy of Respiratory Physiotherapy in Severe Critically III COVID-19 Patients

2021 ◽  
Vol 10 (10) ◽  
pp. 2139
Author(s):  
Denise Battaglini ◽  
Salvatore Caiffa ◽  
Giovanni Gasti ◽  
Elena Ciaravolo ◽  
Chiara Robba ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Ct Scan ◽  
Critically Ill ◽  
Lung Ultrasound ◽  
Quantitative Computed Tomography ◽  
Icu Patients ◽  
Lung Aeration ◽  
Before And After ◽  
Respiratory Physiotherapy

Background: Respiratory physiotherapy (RPT) is considered essential in patients’ management during intensive care unit (ICU) stay. The role of RPT in critically ill COVID-19 patients is poorly described. We aimed to investigate the effects of RPT on oxygenation and lung aeration in critically ill COVID-19 patients admitted to the ICU. Methods: Observational pre-post study. Patients with severe COVID-19 admitted to the ICU, who received a protocolized CPT session and for which a pre-and post-RPT lung ultrasound (LUS) was performed, were included. A subgroup of patients had an available quantitative computed tomography (CT) scan performed within 4 days from RPT. The primary aim was to evaluate whether RPT improved oxygenation; secondary aims included correlations between LUS, CT and response to RPT. Results: Twenty patients were included. The median (1st–3rd quartile) PaO2/FiO2 was 181 (105–456), 244 (137–497) and 246 (137–482) at baseline (T0), after RPT (T1), and after 6 h (T2), respectively. PaO2/FiO2 improved throughout the study (p = 0.042); particularly, PaO2/FiO2 improved at T1 in respect to T0 (p = 0.011), remaining higher at T2 (p = 0.007) compared to T0. Correlations between LUS, volume of gas (rho = 0.58, 95%CI 0.05–0.85, p = 0.033) and hyper-aerated mass at CT scan (rho = 0.54, 95% CI 0.00–0.84, p = 0.045) were detected. No significant changes in LUS score were observed before and after RPT. Conclusions: RPT improved oxygenation and the improvement persisted after 6 h. Oxygenation improvement was not reflected by aeration changes assessed with LUS. Further studies are warranted to assess the efficacy of RPT in COVID-19 ICU patients.

Intracerebellar Hemorrhage in a Premature Newborn: Diagnosis by Real-Time Ultrasound and Correlation with Autopsy Findings

PEDIATRICS ◽  
1983 ◽  
Vol 71 (2) ◽  
pp. 159-162 ◽  
Author(s):  
Jeffrey M. Perlman ◽  
James S. Nelson ◽  
William H. McAlister ◽  
Joseph J. Volpe
Keyword(s):  
Computed Tomography ◽  
Ct Scan ◽  
Premature Infant ◽  
Brain Imaging ◽  
Real Time ◽  
Critically Ill ◽  
Ultrasound Scan ◽  
Ultrasound Scanning ◽  
Ct Scanner

The identification of intracerebellar hemorrhage in a living premature infant by real-time ultrasound scan and confirmation of the findings at autopsy are described. This represents the first demonstration of the value of this noninvasive, convenient, and safe means of brain imaging in diagnosis of this lesion. Previous studies have described the role of the computed tomography (CT) scan in identification of intracerebellar hemorrhage in the newborn. Because infants with intracerebellar hemorrhage are usually critically ill, a means of identification of the lesion that could be utilized at the bedside rather than an approach that requires transport to a CT scanner is needed. This study indicates that portable real-time ultrasound scanning can satisfy that need.

The Role of Carcinoembryonic Antigen as a Predictor of the Need for Preoperative Computed Tomography in Colon Cancer Patients

2006 ◽  
Vol 72 (10) ◽  
pp. 897-901
Author(s):  
Alicia D. Holt ◽  
Justin T. Kim ◽  
Zuri Murrell ◽  
Richard Huynh ◽  
Michael J. Stamos ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Colon Cancer ◽  
Ct Scan ◽  
Carcinoembryonic Antigen ◽  
Cancer Patients ◽  
Clinical Utility ◽  
Stage Iv ◽  
Stage Iv Disease ◽  
Preoperative Ct

A retrospective study of 117 patients with the diagnosis of colon cancer was performed to evaluate the clinical utility of the preoperative computed tomography (CT) scan and to assess the role of carcinoembryonic antigen (CEA) as a predictor of the need for CT scan in colon cancer patients. Forty-nine patients had a CT scan that altered their treatment. One hundred per cent of stage IV patients versus only 26.5 per cent of stage I, II, and III patients had their operative and/or treatment planning altered by the preoperative CT. The sensitivity of CT scan in predicting metastatic disease was 90.3 per cent. All patients with stage IV disease had an abnormal CEA (>3 ng/mL). There was 89.7 per cent of stage IV patients who had a CEA twice that of normal or above. By using a CEA level of 3.1 ng/mL or above as a prerequisite for preoperative tomography, 34 nonmetastatic patients would not have had preoperative CT scans. Using a prerequisite of 6.1 ng/mL or above, 49 nonmetastatic patients would not have had a preoperative CT scan, and 90 per cent of the stage IV patients would have been imaged. We recommend obtaining a preoperative CT scan on those patients with a CEA value twice that of normal or greater.

scholarly journals The role of computed tomography in the preoperative assessment of gastrointestinal causes of acute abdomen in elderly patients

2014 ◽  
Vol 12 ◽  
pp. S181-S186 ◽  
Author(s):  
Alfonso Reginelli ◽  
Anna Russo ◽  
Antonio Pinto ◽  
Francesco Stanzione ◽  
Ciro Martiniello ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Elderly Patients ◽  
Acute Abdomen ◽  
Preoperative Assessment

scholarly journals Role of Computed Tomography in Staging and Management of Gastrointestinal Lymphoma

1979 ◽  
Vol 72 (11) ◽  
pp. 818-822 ◽  
Author(s):  
George Blackledge ◽  
Jonathan K Best ◽  
Derek Crowther
Keyword(s):  
Computed Tomography ◽  
Ct Scan ◽  
Good Prognosis ◽  
Initial Presentation ◽  
Gastrointestinal Lymphoma ◽  
Planning Treatment ◽  
Gastrointestinal Lymphomas

Twenty-six computed tomography (CT) examinations in 18patients with histologically proven gastrointestinal lymphomas are reported. Fourteen CT examinations were performed at the time of initial presentation, the others being performed during the course of the disease. CT did not help in the diagnosis of the disease but it is effective in assessing the extent and thus the stage of the disease. A normal CT scan during follow up is associated with good prognosis. CT may be of help in planning treatment, especially radiotherapy. It is an investigation easily tolerated by patients and can be used in circumstances where other investigations would be impossible.

scholarly journals Role of Computed Tomography Scan in Evaluating Children with Seizures

2016 ◽  
Vol 02 (01) ◽  
pp. 015-018
Author(s):  
Vasudha Sipayya ◽  
Shivali Kashikar
Keyword(s):  
Computed Tomography ◽  
Developing Countries ◽  
Ct Scan ◽  
Intravenous Contrast ◽  
Number Of Patients ◽  
Computed Tomography Scans ◽  
The Cost ◽  
Developed World ◽  
Posttraumatic Seizures

Abstract Introduction: Seizures are a common cause of morbidity and mortality in childhood. It is important to establish the cause of seizures to appropriately manage such patients. The etiology of seizures is different in developing countries as compared to the developed world. Computed tomography (CT) scan is easily available, is less sensitive to patient motion, and does not generally require sedation. Also the cost is less as compared to MRI, and this makes it an important screening tool in developing countries like India. Aims: To determine the diagnostic ability of CT to determine the cause of seizures in children. Settings and design: A prospective analytical study. Materials and methods: Computed tomography scans of 84 children presenting with seizures during the period of September 2014 to August 2015 were analyzed. The study was done using 16-slice CT scan. Intravenous contrast was administered as needed. Uncooperative patients were sedated for the scan. Results: Out of 84 scans, 40 scans (47.65%) were found to be abnormal. Maximum number of patients were found to have congenital anomalies (10), followed by hydrocephalus which was found in nine children. Five children had posttraumatic seizures. Four presented with tumors. Four children showed features of hypoxic ischemic encephalopathy. Three each had granuloma and calcification. Two children with seizures had infectious causes, which were clinically diagnosed to be meningitis. Conclusion: Our study indicates that CT is an extremely useful tool for screening the patients of seizures. It is also useful in identifying the treatable causes and monitoring the progression. It is recommended that all children with seizures should be evaluated with CT scan.

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