MDCT imaging findings for characterization pancreatic cystic lesion: differentiation between benign and malignant pattern.

OBJECTIVE: The purpose of the present study was to determine the characteristic imaging findings for diagnosis of the benign or malignant nature of pancreatic cystic lesions by 64 slice multidetector computed tomography (MDCT) for further investigation or treatment. MATERIAL AND METHOD: A retrospective study was performed in 33 patients with pancreatic cystic lesion who underwent 64 slice MDCT to characterize and establish the diagnosis. The patients were enrolled between January 2004 and March 2009. The MDCT scan of abdomen from patients with pancreatic cystic lesion was retrospectively evaluated by two gastrointestinal radiologists without knowledge of the patient's history, clinical data, and final diagnosis. Sensitivity, specificity, accuracy, PPV, and NPV of CT scan for discriminate benign and malignant pancreatic cystic lesion were calculated. Weighted-kappa statistics were used to estimate agreement between readers. RESULTS: Thirty-three patients with pancreatic cystic lesion were included in the present study. Benign pancreatic cystic lesion are pancreatic pseudocyst (n = 16), serous cystadenoma (n = 4) and benign intraductal papillary mucinous neoplasms IPMN (n = 2). Premalignant and malignant pancreatic cystic tumor are mucinous cystic tumor (n = 5) and include solid pseudopapillary epithelial neoplasm of pancreas (n = 3) and malignant intraductal papillary mucinous neoplasms IPMN (n = 3). The final diagnosis was established either by pathological diagnosis (20 patients), EUS with FNA (11 patients) or F/U clinical and imaging findings (2 patients). Pseudopod sign is a helpful finding for diagnosis pancreatic pseudocyst (3/16) and not observed in other types pancreatic cystic lesions. Type of cyst (unilocular, multilocular microcystic, multilocular macrocystic and solid component) is the only finding that has statistical significance for differentiating between the benign and malignant groups (p < 0.005). The overall sensitivity, specificity and accuracy of 64-slice MDCT to discriminate benign and malignant pancreatic cystic lesion were 36.3%, 100% and 78.8%, respectively. In addition, the PPV and NPV were 100% and 75.9%, respectively. CONCLUSION: The 64 sliced MDCT is a noninvasive method that can be used for discriminating between benign and malignant pancreatic cystic lesions, which is an important finding for further investigation and proper treatment.

Diagnostic performance of CT findings in differentiation of perforated from nonperforated appendicitis.

OBJECTIVE: To assess performance of CT finding in differentiation of perforated from non-perforated appendicitis in Siriraj hospital, Bangkok, Thailand and evaluate accuracy of each finding by using multidetector row computer tomography (MDCT). MATERIAL AND METHOD: Between June 2006 and May 2009, all adult patients (age more than 15 years) who had a diagnosis of acute appendicitis in Siriraj Hospital that was confirmed by pathology or surgical records and received a CT scan whole abdomen or lower abdomen with contrast administration before surgical or medical treatment were included in this study. The 48 consecutive CTs of whole or lower abdomen examinations were retrospectively reviewed by two radiologists. Sensitivity specificity, and accuracy of CT compared with pathologic or surgical findings. RESULTS: In 48 patients, 21 patients of non-perforated appendicitis and 27 patients of perforated appendicitis were enrolled. The CT findings of abscess, extraluminal appendicolith, and extraluminal air had the highest specificities for perforated appendicitis, 95.24%, 100%, 95.24%, respectively. The best accurate finding was defect in enhancing appendiceal wall. The CT findings of enlarged mesenteric lymph nodes at right lower quadrant region and defect in enhancing appendiceal wall had the highest sensitivities, 88.88% and 88.46%, respectively. Group 3 of combined specific findings had the best sensitivity (92.59%) and accuracy (83.3%). CONCLUSION: Multi-detector CT can help to differentiate perforated from non-perforated appendicitis.

Radiographic chest findings and clinical correlations in leptospirosis.

OBJECTIVE: To determine the clinical presentations, radiographic chest findings, and their correlation in patients with leptospirosis. DESIGN: A cross sectional study. SETTING: Between July 2001- December 2002 at 3 hospitals in North Eastern Thailand. MATERIAL AND METHOD: Two hundred and forty patients with laboratory confirmed leptospirosis. RESULTS: Two hundred and nine (87.1%) patients were males. The mean age was 37.53 years (range 13-76). The median duration of fever was 3 days (range 1-13). Overall, 154 patients (64.2%) had respiratory symptoms and 26 (10.8%) patients had hemoptysis. Jaundice was detected in 76 (31.7%) patients, hypotension in 50 (20.8%), renal dysfunction in 80 (30%), and multiorgan dysfunction in 62 (25.8%) on admission. One hundred and fifty-four (64.17%) patients had abnormal chest radiographs on admission (classified as cardiovascular, pulmonary, and mixed cardio-pulmonary involvement in 40 (25.97%), 41 (26.62%), and 73 (47.4%) patients, respectively). Jaundice was significantly associated with the likelihood of having abnormal chest radiography on admission. Air- space nodules detected on the chest radiograph were significantly more common in patients with renal dysfunction and patients who required mechanical ventilation. CONCLUSION: Pulmonary and cardiovascular involvements are common in leptospirosis. Air-space nodules detected by chest radiography may indicate severe leptospirosis.

HRCT of pulmonary tuberculosis mimics malignancy: a preliminary report.

OBJECTIVE: To evaluate potential predictors of high resolution CT (HRCT) findings of pulmonary mass caused by tuberculosis (Tbc). MATERIAL AND METHOD: A retrospective study of chest HRCT was performed in 10 patients diagnosed as pulmonary Tbc. The size, characteristics of lesions, enhancement and mediastinal lymphadenopathy were interpreted. The final diagnosis was reached by laboratory and pathological specimens or clinical improvement from treatment of the Tbc. RESULTS: Of 10 patients, 6 were males and 4 were females. The mean age was 53.5 years old. There were 13 masses analyzed. The mean size of the lesions was 2.3 cm and 53.8% had diameters more than 2 cm. The locations of lesions were right upper lobe (30.8%), right middle lobe (7.7%), right lower lobe (38.5%) and left upper lobe (23.1%). Calcification was found in two lesions. The HRCT findings were spiculated margin (76.9%), lobulated margin (23.1%), smooth margin (7.7%), ground-glass opacity (23.1%), concave border (61.5%), polygonal shape (53.8%), air bronchogram (38.5%), pseudocavity (15.4%), pleural tag (30.8%), distortion of vessels (23.1%), satellite lesions (38.5%), and peripheral subpleural lesion (46.2%). Only 7 cases of enhanced study were available and two cases showed enhancement. Of the 10 cases, mediastinal lymphadenopathy was found in 8(80%) cases. The size of the lymph nodes was less than 2 cm in 6 cases and larger than 2 cm in 2 cases. Other associated findings were pleural thickening or effusion (60%), evidence of volume loss (20%), emphysema (40%), and infiltrations (50%). CONCLUSION: Many characteristics of Tbc lesion on HRCT mimic reported malignant lesions. Re-evaluation of value of HRCT for controversial lesions is needed