Diagnostic Utility of Computed Tomographic Angiography in Giant-Cell Arteritis.

Background and Purpose- The diagnosis of giant-cell arteritis (GCA) is challenging. Superficial temporal artery biopsy and ultrasound are positive in only 50%. We evaluated computed tomographic angiography (CTA) of the head in GCA. Methods- This case-control study was performed using a prospective GCA registry. Cases presented with stroke symptoms, had a CTA, and were subsequently diagnosed with GCA. Age- and sex-matched controls presented with stroke symptoms, had a CTA, and were not diagnosed with GCA. CTAs were evaluated for the presence of superficial temporal artery abnormalities. Results- Fourteen cases met the inclusion criteria and were matched with 14 controls. Blurred vessel wall margins and perivascular enhancement was found in 10 cases (71.4%) and 2 controls (14.3%). CTA has an accuracy of 78.6%, sensitivity of 71.4%, and a specificity of 85.7% for GCA. Conclusions- CTA detects superficial temporal artery abnormalities in GCA. This may facilitate early diagnosis and prompt implementation of potentially sight-saving and stroke-preventing treatment.

Prostate MRI using an external phased array wearable pelvic coil at 3T: comparison with an endorectal coil.

PURPOSE: To evaluate T2w and DWI image quality using a wearable pelvic coil (WPC) compared with an endorectal coil (ERC). METHODS: Twenty men consecutively presenting to our prostate cancer MRI clinic were prospectively consented to be scanned using a wearable pelvic coil then an endorectal coil and pelvic phased array coil at 3T. Eighteen patients were suitable for inclusion. Axial T2w images were obtained using the WPC and ERC, and DWI images were obtained using the WPC, ERC, and PPA. Analysis was performed in consensus by two readers with experience in prostate MRI. The readers scored the T2w images using six qualitative criteria and the DWI images using five criteria. Signal-to-noise ratio (SNR) was also measured. RESULTS: T2w artifact severity was greater for an ERC than a WPC (p = 0.003). There was no significant difference in T2w qualititatve image quality by other measures. The distinction of zonal anatomy on DWI was superior for an ERC compared with both a WPC and a PPA (p = 0.018 and p < 0.001 respectively), and there was no significant difference in DWI image quality by other measures. SNR was significantly higher for ERC imaging for both T2w and DWI. CONCLUSION: WPC imaging provides comparable image quality to that of an ERC, potentially reducing the need for an ERC. WPC imaging shows reduced T2w artifact severity and inferior DWI zonal anatomy distinction compared with an ERC. Imaging with a WPC produces a lower SNR than an ERC.

C-arm cone-beam CT parenchymal blood volume imaging for transarterial chemoembolization of hepatocellular carcinoma: implications for treatment planning and response.

We report on the feasibility of C-arm cone-beam computed tomography (CBCT) parenchymal blood volume imaging (PBVI) performed immediately following transarterial chemoembolization (TACE) of hepatocellular carcinoma (HCC) to assess the need for repeat treatment. Eighteen TACE procedures were included. A retrospective assessment was made for the presence or absence of residual disease requiring treatment on immediate post-TACE PBVI and on interval follow-up multidetector computed tomography (MDCT) or magnetic resonance imaging (MRI). In 9/18 cases, both PBVI and MDCT/MRI showed that no further treatment was required. In 6/18 cases, further treatment was required on both PBVI and MDCT/MRI. In three cases, PBVI showed that further treatment was not required but MDCT/MRI showed residual disease requiring repeat treatment. There were no cases with PBVI showing residual disease not detected on follow-up MDCT/MRI. The PBVI sensitivity for detecting disease requiring repeat TACE was 67% (95% confidence interval [CI] 30-93%), and specificity was 100% (95% CI 66-100%). The use of C-arm CBCT PBVI for the detection of residual viable tumor within a treated lesion immediately after TACE is feasible. It may allow repeat TACE to be planned without performing interval imaging with MDCT or MRI.

Diagnostic accuracy of standard axial 64-slice chest CT compared to cardiac MRI for the detection of cardiomyopathies.

OBJECTIVE: To assess the diagnostic accuracy of standard axial chest CT compared with cardiac MRI for cardiomyopathies. METHODS: The standard axial 64-slice chest CTs of 49 patients with cardiomyopathies and 27 controls were blindly assessed for the presence of a cardiomyopathy by two independent readers. Qualitative and quantitative analysis included assessment of: (i) interatrial septal thickness, (ii) left atrial diameter, (iii) myocardial hypertrophy, thinning or fat, (iv) myocardial and papillary muscle calcification, (v) papillary muscle thickness, (vi) calcified coronary artery segments, (vii) left ventricular (LV) diameter, (viii) interventricular septal thickness and (ix) right ventricular diameters. Cardiac MRI was the gold standard. RESULTS: There were 21 (42.9%) dilated, 16 (32.7%) hypertrophic, 8 (16.3%) ischaemic and 4 other (8.2%) (LV non-compaction × 2, amyloid, idiopathic restrictive) patients with cardiomyopathies. An LV diameter of 47 mm, interventricular septal thickness of 14 mm and coronary artery/papillary muscle calcification on axial chest CT best distinguished dilated, hypertrophic and ischaemic cardiomyopathies from controls, respectively; kappa = 0.45 (moderate interobserver agreement). The sensitivity (95% confidence interval), specificity, positive- and negative-predictive values (95% confidence interval) and diagnostic accuracy of chest CT in diagnosing cardiomyopathies were 68% (52-83), 100%, 100%, 66% (55-85) and 80%, respectively. CONCLUSION: Cardiomyopathies may be detected on standard chest CT with good sensitivity and high specificity. ADVANCES IN KNOWLEDGE: It is useful to assess for an underlying cardiomyopathy on standard chest CT, especially in a patient with unexplained dyspnoea.