COMPARISON OF 128-SLICE SPIRAL COMPUTED TOMOGRAPHY PULMONARY ANGIOGRAPHY (CTPA) FINDINGS WITH PLASMA D-DIMER LEVELS IN PATIENTS WITH CLINICAL SUSPICION OF PULMONARY EMBOLISM

Objective: To compare the effectiveness of plasma D-dimer levels with findings of 128-slice spiral computed tomography pulmonary angiography (CTPA) in patients with clinical suspicion of pulmonary embolism. Study Design: Retrospective observational study Place and Duration of Study: Department of Computed Tomography, Armed Forces Institute of Radiology & Imaging, Pak Emirates Military Hospital Rawalpindi, from Jan 2018 to Dec 2018. Methodology: A total of 59 patients were inducted who presented in Emergency Department, Pak Emirates Military Hospital Rawalpindi with clinical suspicion of Pulmonary Embolism. The main symptoms were shortness of breath and chest pain. Plasma D-dimer levels of all patients were sent to laboratory and CTPA was performed at Computed Tomography department, Armed Forces Institute of Radiology & Imaging using 128-slice spiral computed tomography. Results: 36 patients (61%) were males and 23 (39%) were females with an average age of 48.03 ± 18.06 years (range 23-85 years). Out of 59 patients, D-dimer levels were raised in 28 cases (47.4%) while 31 patients (52.6%) showed normal levels. Pulmonary Embolism was detected by CTPA in 30 cases (50.8%) while 29 patients (49.2%) were without obvious abnormality. Conclusion: Plasma D-Dimer levels show low sensitivity, specificity and negative predictive value and cannot exclude Pulmonary Embolism without CTPA. Computed Tomography Pulmonary Angiography (CTPA) remains diagnostic modality of choice for definitive assessment of Pulmonary Embolism in patients reporting at the emergency reception.

Multislice Spiral Computed Tomography Postprocessing Technology in the Imaging Diagnosis of Extremities and Joints

Objective. To improve the clinical detection rate of bone and joint fractures of the extremities and to explore the value and significance of the application of multislice spiral computed tomography (MSCT) postprocessing technology in diagnosis. Methods. 80 patients with bone and joint fractures of the extremities admitted to the hospital were selected as the research objects. The patients received X-ray digital radiography (DR) plain film examination and then MSCT examination. At the same time, multiplane reconstruction (MPR) and surface shadow display (SSD) and volume rendering three-dimensional imaging (VRT) technology and other postprocessing technologies compare the differences in the detection rate of limbs and joint fractures between the two inspection methods. Results. A total of 100 fractures were found in 80 patients. The detection rate of X-ray DR was 69%. After MSCT postprocessing technology, the detection rates of MPR, SSD, and VRT were 96%, 98%, and 99%, respectively. The accuracy of MSCT postprocessing technology in diagnosing extremity bone and joint fractures was significantly higher than that of DR, and the difference between groups was statistically significant. Conclusion. MSCT postprocessing technology for patients with extremity bone and joint fractures has a good effect. It is not only noninvasive but also has a high detection rate. It can significantly reduce the missed and misdiagnosed rate and provide detailed imaging data for the formulation of clinical treatment plans.

Morphometry of the shoulder joint and justification of new modular reverse shoulder endoprosthesis sizes using computed tomography data

Reverse shoulder arthroplasty is effective surgery because most of patients have positive long-term results. However, the search for the «perfect» endoprosthesis continues. Objective. To justify the dimensions of a new modular reverse shoulder endoprosthesis using additive technologies based on spiral computed tomography data. Methods. Two data sets of healthy shoulder joints (right — R, left — L) of 100 patients obtained on a spiral computed tomography AQUILION 128 sections (Toshiba, Japan) were processed. Each set consisted of 11 morphometric parameters — linear and angular values. For each of them, three data samples (combined, R and L) are calculated: minimum, maximum, mode, median, mean, standard deviation, distribution asymmetry coefficient. Pearson’s correlation coefficient was calculated, cluster analysis was performed. Results. It is proved that most of the parameters of R and L data sets can be considered homogeneous and can be analyzed as a combined group of 200 cases. It was found that the width and height of the glenoid are more homogeneous data sets, and the value of the endosteal diameter of the humerus decreases in the distal direction. The cervical-diaphyseal angle averages 137.4° ± 4.66°. The correlation between different parameters is more pronounced within most clusters than in the sample as a whole. Conclusions. It is necessary to create different sizes of the distal part of the conical stem, to which securely fix a wide proximal part, as well as in different sizes, in the form of a cup for fixing the liner. The height of the proximal part of the reverse shoulder endoprosthesis should be not less than 20 mm, the diameter of the base of the proximal parts of the stem — 38, 40, 42 mm. It is proposed to use a conical stem of the implant with a wider proximal part, to create the angle 135° between the cup of the proximal part and the stem. Three standard sizes of basic glenoid plates with a diameter of 26, 30, 32 mm are defined. Key words. 3D-printing, arthroplasty of the shoulder joint, glenoid, cluster analysis, correlation analysis.

Relationship Between Pulmonary Hamartoma and Bronchus: Multislice Spiral Computed Tomography Findings

Objective The aim of the present study is to investigate the relationship between pulmonary hamartomas (PHs) and bronchi on multislice spiral computed tomography (MSCT) images. Methods The MSCT scans of 218 PHs from 216 pathologically confirmed patients were reviewed. The PHs were divided into two groups, namely, the central endobronchial and intraparenchymal groups, in accordance with location. Multiplanar reconstruction was used to demonstrate PH–bronchus relationship patterns. The PH–bronchus relationships in the intraparenchymal group were classified into five patterns: type I, the bronchus was cut off by the tumor; type II, the bronchus was contained within the tumor (air bronchogram sign); type III, the bronchus ran at the tumor periphery or was compressed by the tumor; and type IV, no tumor–bronchus relationship was observed. Results Nine (4.1%) PHs were assigned to the central endobronchial group and 209 (95.9%) PHs were assigned to the intraparenchymal group. In the endobronchial group, 1 (11.1%) PH was located in the trachea with the partial stenosis of the trachea, whereas the remaining 8 (88.9%) PHs were located in the lobar or segmental bronchus with the complete occlusion of the corresponding bronchus. In the intraparenchymal group, type IV (147, 70.3%) was most common pattern, followed by type III (54, 25.8%). Type I (8, 3.8%) was rare, and type II was not observed. Conclusion Central endobronchial PHs often obstructed bronchi, whereas only a few intraparenchymal PHs cut off bronchi. No air bronchogram sign was observed.

What is the difference in pedicle morphology of the fifth lumbar vertebra between isthmic and degenerative L5-S1 spondylolisthesis? An anatomic study of 328 patients via multi-slice spiral computed tomography

Purpose The purpose of this study was to investigate and determine whether there are differences in L5 pedicles morphology between isthmic and degenerative L5-S1 spondylolisthesis. Methods One hundred and nineteen patients with isthmic spondylolisthesis and 45 patients with degenerative spondylolisthesis at L5-S1 were enrolled in the IS group and DS group, respectively, and 164 lumbar disc herniation patients without spondylolysis or spondylolisthesis were classified into the normal (NL) group. A series of pedicle parameters of the fifth lumbar vertebra, including pedicle length (PL), pedicle width (PW), pedicle screw trajectory length (PSTL), pedicle height (PH), and the pedicle camber angle (PCA) were measured using multi-slice spiral computed tomography (MSCT). The slip distance of the L5 vertebra was measured on radiography, and the percentage of slip was also recorded. Results The pedicles of the fifth lumbar vertebra were shorter and wider, and the PCA was larger in the IS group compared to the DS group and NL group. On the contrary, the pedicles in the DS group were elongated and thinner, and the PCA was smaller. The pedicle parameters of PL were significantly positively correlated with the percentage of slip in the DS group, but PW and PCA were negatively correlated with the percentage of slip. There was no correlation between the percentage of slip and L5 pedicle parameters in the IS group. Conclusions The L5 pedicles morphology in L5-S1 isthmic spondylolisthesis shows abduction, shortness, and width, while that in the degenerative spondylolisthesis shows adduction, lengthening, and thinning compared with the normal populations. The morphology changes may be the result of pedicle stress remodeling in the development of spondylolisthesis, which should be taken into consideration when placing at the insertion of pedicle screws.

Evaluation of isolated abdominal visceral artery dissection with multi-scale spiral computed tomography: a retrospective case series

Background To evaluate the role of multi-slice spiral computed tomography (MSCT) angiography in the diagnosis of spontaneous isolated visceral artery dissection (SIVAD). Methods Twenty-seven patients with abdominal SIVAD were included in the study. The MSCT scans of the patients were subjected to various post-processing techniques to visualize the visceral artery wall. Clinical features including arterial dissection, thrombosis, dissection length, true/false lumen, and complications were recorded. Results Type I, IIa, and IIb SIVADs were observed in 11, 6, and 10 patients, respectively. Superior mesenteric artery (SMA) dissection was the most common (n = 16), followed by abdominal aortic dissection (n = 6), splenic artery dissection (n = 2), renal artery dissection (n = 2), and splenic artery dissection (n = 1). One patient with SMA dissection suffered small intestine ischemia, 1 with splenic artery dissection had splenic infarction, and 1 patient with left renal artery dissection experienced renal infarction. The false lumen was bigger than the true lumen in 20 patients, with 9 patients having thrombus. The true lumen was bigger than the false lumen in 7 patients. Conclusions MSCT angiography is a valuable technique in the diagnosis and treatment of patients with SIVAD. Patients with abdominal pain suspected due to SIVAD should be examined with MSCT angiography for early detection of SIVAD.

The role of computed tomography in optimizing the surgical treatment of ventral hernias

In spite of a high informative value, spiral computed tomography is currently an additional optional examination and it is not included in domestic and foreign preoperative examination protocols. Purpose – assessing the feasibility of spiral computed tomography in the complex of presurgery examination of patients with ventral hernias. Materials and methods. The paper deals with analyzing the diagnostic findings of 35 patients with ventral hernias treated at Surgery Department of Municipal Non-Commercial Enterprise of Kharkiv Regional Council “Regional Clinical Hospital” during 2018–2019 period. All patients were operated on after compulsory and additional examinations according to the existing guidelines. Spiral computed tomography was an additional examination for all patients. The frequency of symptoms detected by means of computed tomography and confirmed during surgery was analyzed. Results. Most of the signs revealed during tomography and associated with the combined abdominal pathology, were completely confirmed by laparoscopic exploration of the abdominal cavity and pelvis. Spiral computed tomography was of particular value in patients clinically diagnosed with chronic appendicitis. When assessing the ventral hernia, it was possible not only to clearly determine its content and location towards the abdominal line, but also, before surgery, to calculate the width and length of the hernia gate and the volume of the organs in hernia sac. Unlike ultrasonography, computed tomography makes it possible to thoroughly evaluate the dimensions of the hernia gate and the state of the muscular aponeurotic layer of the anterior abdominal wall. Not least important is diagnosing the combined abdominal pathology, including the oncological one, which has no clinical manifestations but still has to be exposed to surgery. Conclusions. In the complex of preoperative examination of patients with ventral hernias, spiral computed tomography provides useful information on the anatomical features of ventral hernia and the combined abdominal pathology that requires surgical intervention. These data aid in planning a favorable type of hernioplasty of ventral hernia and simultaneous surgery. Spiral computed tomography is recommended to be added to the standard protocol of presurgery examination of patients with ventral hernias.