Purpose:to develop optimal technique of cardiac multidetector computed tomography (MDCT) before noninvasive cardiac mapping before cateter ablation of atrial fibrillation.Materials and methods.94 patients with atrial fibrillation were included in study (60 males, 34 females; mean age = 58.3 ± 10 years; mean body mass index (BMI) = 29.9 ± ± 4.8). The patients were divided into 2 groups: I – 80 patients who underwent computer tomography (CT)-protocol for noninvasive cardiac mapping with standard contrast enhancement (single-bolus protocol); II – 14 patients who underwent CT with modified contrast enhancement technique with preliminary contrast injection (prebolus). To detect thrombotic masses in the left auricle the low-dose delayed phase was performed. The analysis of individual features of pulmonary veins, left atrium and adjacent structures was performed. Contrast enhancement of heart chambers was assessed by mean attenuation and homogeneity measurement.Results and discussion.The typical anatomy of the right pulmonary veins was in 93.6% of cases; right middle pulmonary vein in 5.3%; right segmental veins in 1.1%. The typical anatomy at the left side was in 57.4% of cases; common vestibulum of the left pulmonary veins in 18.1%; common left trunk in 24.5%. Volume enlargement of the left atrium (LA) was in 96.8% of patients. In 6 cases left auricle thrombosis was suspected, low-dose delayed phase was performed. In 2 cases filling defects in left auricle persisted, thrombosis was proved by transesophageal echocardiography. With the single-bolus injection protocol the contrast enhancement of left heart chambers was best (mean attenuation of blood in LA = 296 ± 84 HU, in left ventricle (LV) = 286 ± 83 HU), but the contrast enhancement and homogeneity of the chambers were insufficient (mean attenuation of blood in right atrium (RA) = 179 ± 97 HU, in right ventricle (RV) = 176 ± 80 HU). With prebolus protocol the contrast enhancement and homogeneity of all chambers were optimal (mean attenuation of blood in LA = 259 ± 31 HU, in LV = 286 ± 83 HU, in RA = 270 ± 92 HU, in RV = 253 ± 80 HU). This allowed making more accurate epi-endocardial heart models in the noninvasive cardiac mapping and operation planning.Conclusion.MDCT with standard contrast enhancement protocol provides detailed information about anatomy and size of pulmonary veins, the left atrium volume, the presence of intracardiac masses (including thrombotic masses), the anatomy of adjacent structures. The modified contrast enhancement technique with preliminary contrast injection (prebolus) allows to receive optimal contrast enhancement of all heart chambers and to make high accurate epi-endocardial models of both the right and left sides of the heart in case of noninvasive cardiac mapping.
Purpose. Identification of the possibilities of contrast enhancement computed tomography in evaluated the number of the acinar structures in the pancreatic parenchyma at the preoperative stage to predict the development pancreatic fistula.Material and methods. In 2016–2019, 196 pancreatoduodenectomy were performed. 86 patients were retrospectively selected. Patients were divided into 2 groups: group 1 included 16 observations with the development of clinically significant pancreatic fistula, in 2 – 70 cases without complications. According to preoperative contrast enhancement computed tomography, structure of the pancreas, pancreatic parenchyma thickness, pancreatic duct diameter, the density of the pancreas in the native phase, relative parenchyma enhancement ratio, washout coefficient, pancreas stump volume were evaluated. According histological, the number of acinar and fat cells in the section of the removed pancreas was evaluated.Results. “Soft” structure of the pancreas (r = 0.374, p = 0.000), pancreatic parenchyma thickness (r = 0.549, p = 0.000), the density of the pancreas in the native phase of the scan (r = 0.568, p = 0.000), the values relative parenchyma enhancement ratio (r = 0.63, p = 0.000), pancreas stump volume (r = 0.508, p = 0.000) positively correlated with clinically significant pancreatic fistula and the number of acinar cells. Pancreatic duct diameter (r = −0.339, p = 0.001) negatively correlated with clinically significant pancreatic fistula and the number of acinar cells. Pancreatic fistula risk is 3.09 times higher with the number of acini more than 72.5%, sensitivity 75%, specificity 75.71%. Pancreatic fistula risk is 1.8 times higher with the density of the pancreas in the native phase over 35.5 HU sensitivity 62%, specificity 65%. Pancreatic fistula risk is 2.76 times higher with values parenchyma accumulation coefficient more than 1, sensitivity 75%, specificity 73%.Conclusions. Contrast enhancement computed tomography allows evaluating acinar index in the preoperative period to pick out the high-risk patient group to development of pancreatic fistula.
Purpose. The research goal comprises primary analysis of CT examinations results and their interpretation by comparing with the data already available in the literature.Material and methods. During the period from April 17, 2020 to May 18, 2020, 830 chest CT scans were performed and results of 123 CDs with CT scans made by other institutions were interpreted. Follow-up examinations were carried out every 3–4 days or when clinical presentation changed. At the primary stage, we have analysed in a more detail way a group of 69 patients, who were diagnosed with CT-3 or CT-4 volume of lung damage at least once during hospitalization. The patients underwent PCR analysis three times during hospitalization. Among 69 patients, 34 patients had a positive PCR test at least once, the remaining 35 patients had a clinic, corresponding with this disease.Results. At the initial examination, ground-glass opacity prevailed, as it was observed in 44 cases (64%), and lung tissue consolidation was observed in 25 cases (36%) in a group of 69 patients. When comparing the two groups, the average age of the patients with consolidation changes was statistically significantly lower than one of the group where ground-glass opacity prevailed – 51.7 and 59.4 years, respectively (p = 0.01) In the group of patients with pulmonary tissue consolidation, there were fewer concomitant diseases, fatal outcomes, positive PCR test results, a shorter hospitalization period, and fewer cases of tocilizumab administration were noted. At the initial examination the average percentage of pulmonary parenchyma involvement in the group of patients with lung tissue consolidation was higher (63.3%; p = 0.04), follow-up examinations showed c statistically significantly lower average values of the increase in the percentage of involvement of the parenchyma, which acquired negative values after the third CT scan (8.3 after the 2nd CT and −5.2 after the 3rd CT versus 18.5 and 3 in the GGO glass group; p = 0.02 and 0.03, respectively). No visible differences in CT between the period from the onset of the disease and the predominant symptom in CT were revealed. Meanwhile, on the 5th day (the day of the check-up CT examination) the largest number of patients was determined in both groups.Conclusion. An analysis of our experience during the first month of operation of Covid-19 Hospital is presented. According to our data, the appearance of consolidation at the initial CT examination is probably not related to the period, when the disease has been in progress, and may be associated with a more favorable course of the process.
The number of available methods for hepatic tumor treatment is steadily increasing. Except traditional surgical resection and systemic chemotherapy there are a lot of effective and increasingly used local methods such as Radiofrequency ablation, cryodestruction, transarterial chemoembolization. Radiologist should be able to assess treatment response and evaluate prognosis. We present review of literature on various systems for hepatic tumor treatment response evaluation. WHO, RECIST 1.0, RECIST 1.1, mRECIST and Choi criteria are thoroughly explained in terms of benefits and drawbacks. Also, texture analysis and diffusion-weighted imaging are discussed.
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