Aim: To quantify the incidence of unsuspected pulmonary emboli (PE) in an unselected inpatient population undergoing contrast enhanced multidetector CT (MDCT) scanning of the thorax and to assess aetiological factors in their development. Methods: All inpatients undergoing MDCT scanning of the thorax over a 10 month period were prospectively identified. Patients with previous or suspected current PE were excluded. CT scans were reviewed and the degree of contrast enhancement and presence of PE recorded. Where PE was found, the level of the most proximal thrombus was identified. Patient age, length of admission, slice scan thickness and clinical indication were noted. Results: 547 inpatients who had undergone MDCT scanning were identified. Following exclusions 487 remained, 28 of whom (5.7%) had PE. Unsuspected PE was more common with increasing age, occurring in 9.2% (20/218) of all patients over 70 years and 16.7% (11/66) of those over 80 years (p,0.001). Eighteen of the 28 positive scans (64.3%) were at the segmental or subsegmental level. No other aetiological factor was identified which significantly increased the incidence of unsuspected PE. No significant difference was noted between 4-slice and 16-slice MDCT. Nine of the cases of incidental PE (32.1%) were not identified by the original reporting radiologists. Conclusion: PE is an unsuspected finding on contrast enhanced MDCT scanning of the thorax in 5.7% of all inpatients. The incidence is higher in older patients. Most are peripheral and .30% are missed on initial review. PE should be routinely sought in all contrast enhanced MDCT scans of the chest, irrespective of the indication for the CT scan.
The aim of this study was to determine whether there is superior diagnostic accuracy for the detection and exclusion of bronchiectasis using 16-slice CT of the chest (1 mm) compared with conventional high-resolution CT (HRCT) of the chest (10 mm). A prospective study was carried out in patients who were referred for chest CT by a chest physician for the investigation of bronchiectasis over a 1-year period. All scans were performed using a 16-slice CT scanner. In addition to contiguous 1 mm slices, conventional HRCT images (1 mm slice every 10 mm) were prepared. Both datasets were dual read. There were 53 patients with a median age of 62 years (range, 51.5-71.5 years), comprising 14 males and 39 females. 10 of 53 scans had no bronchiectasis in either dataset. 36 patients had bronchiectasis diagnosed on both HRCT and 1 mm scans. Two patients had tubular bronchiectasis on the HRCT scans, which was not confirmed on the 1 mm scans. Five patients had confirmed tubular bronchiectasis on the 1 mm scans, which was not identified on HRCT scans. 40 extra lobes demonstrated bronchiectasis on the 1 mm vs the HRCT scans; of these, half were labelled as definite bronchiectasis on the 1 mm scan. There was a 32% increased confidence with the 1 mm scans compared with conventional HRCT of the chest in the diagnosis of bronchiectasis (p < 0.001). In conclusion, there is improved diagnostic accuracy and confidence for diagnosis and exclusion of bronchiectasis using 16-slice chest CT (1 mm cuts) compared with conventional HRCT of the chest.
If a 99mTc-MAG3 study has been performed then a 99mTc-DMSA study is unnecessary provided DRF is normal on the 99mTc-MAG3 study and there is no scarring. A change in practice would lead to considerable savings in time, cost and radiation burden.
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