Accuracy of aortic valve calcification volume score for identification of significant aortic stenosis on non-electrocardiographic-gated computed tomography compared to the Agatston scoring system.

BACKGROUND: Considering the absence of reports validating the precision of the volume score and the relationship between the volume and Agatston scores, this study evaluated the accuracy of the volume score compared to the Agatston score for the quantitative measurement of aortic valve calcification (AVC) on non-electrocardiographic-gated computed tomography (CT). METHODS: We retrospectively analysed the AVC scores of 5385 patients who underwent transthoracic echocardiography between March 1, 2013 and December 26, 2019 â€‹at our institution, using non-contrast non-electrocardiographic-gated CT. The thresholds for significant aortic stenosis (AS) were computed using receiver operating characteristic curves based on the AVC scores. The area under the curve (AUC) of the Agatston and volume scores for significant AS were compared to evaluate the accuracy of the scoring method. RESULTS: All sex-specific AVC thresholds of the volume score for significant AS (moderate and high AS severity, moderate and high AS severity without discordance, discordant severe AS, and concordant severe AS) showed high sensitivity and specificity (AUC, 0.978-0.996; sensitivity, 94.2-98.4%; specificity, 90.1-100%). No significant differences in the AUC were observed between the Agatston and volume scores for significant AS in male and female patients. CONCLUSION: All volume score threshold values showed high sensitivity and specificity for identifying significant AS. The accuracy of the test for AVC thresholds of the volume score for significant AS was comparable to that of the Agatston score. Our findings raise questions about the significance of weighting calcium density in the Agatston score for assessing AS severity.

Imaging analysis of dural exposure in cholesteatomas with a skull base defect.

PURPOSE: Dural exposure during cholesteatoma surgery can pose a risk of cerebrospinal fluid leakage or residual disease. Therefore, delicate handling of the area surrounding the bone defect in the cranial fossa is required. However, in small-sized defects, preoperative prediction of dural exposure can be challenging. This study aimed to evaluate the diagnostic value of computed tomography (CT) for preoperative prediction of cholesteatoma-related dural exposure in bone discontinuities in the skull base. METHODS: We evaluated serial high-resolution CT images showing bone density discontinuities in the middle cranial fossa (MCF) requiring mastoidectomy for cholesteatoma. The CT and intraoperative findings were analyzed retrospectively. We evaluated the length between the superior margins of the bone density discontinuities using coronal CT planes. Receiver operating characteristic (ROC) curves were constructed to determine the optimal cut-off values. RESULTS: We extracted data from 107 bone density discontinuities, among which 54 (50.5%) showed dural exposure intraoperatively. Discontinuities with dural exposure (n = 54) had significantly greater lengths than did those without (n = 53) (p < 0.001, Wilcoxon rank-sum test). The area under the curve was 0.9780 according to the ROC analysis, and the optimal cut-off value was determined to be 2.99 mm (sensitivity 92.59%; specificity 94.34%). CONCLUSION: A bone density discontinuity length of > 2.99 mm in the MCF on coronal CT plane is a reliable diagnostic marker for cholesteatoma-related dural exposure. Thus, preoperative high-resolution CT analysis can inform optimal surgical preparation and planning before manipulating the area surrounding the osteolytic lesion in the MCF.

The impact of middle ear aeration on surgical outcome after intact canal wall tympanoplasty for cholesteatoma.

OBJECTIVE: The aeration status of the middle ear is presumed to be one of the factors affecting the outcome in acquired cholesteatoma. The present study investigated the impact of postoperative middle ear aeration on hearing and recurrence after intact canal wall tympanoplasty. METHODS: We conducted a retrospective chart review of 127 pars flaccida cholesteatoma patients who underwent primary intact canal wall tympanoplasty at a tertiary academic medical center. We collected data on clinical characteristics, including extent of cholesteatoma, surgical procedure, pre- and postoperative middle ear aeration, hearing level, and recurrence. The aeration was measured before and at one year after operation on two axial computed tomography (CT) planes: at the lateral semicircular canal (mastoid cavity) and at the oval window (tympanic cavity). Based on the postoperative air-bone gap (ABG), patients were categorized into two groups: the successful hearing (ABG ≤15 dB) group and the unsuccessful hearing (ABG >15 dB) group. We used aeration ratio to assess the relationship between postoperative aeration improvement and hearing outcome or recurrence. Multivariate logistic regression analysis was used to identify the factors associated with hearing outcome. RESULTS: At one year after operation, aeration ratio in both mastoid and tympanic cavities was significantly improved than the preoperative status (p < 0.001, p < 0.001, respectively, Wilcoxon signed-rank test). The positive correlation was found between postoperative aeration ratios of mastoid cavity and tympanic cavity (r = 0.348, p < 0.001, Spearman's rank-correlation coefficient). In mastoid and tympanic cavities, the postoperative aeration ratio in successful hearing group (n = 57) was significantly higher than that in the unsuccessful hearing group (n = 45) at one year after operation (p < 0.001, p = 0.028, respectively, Mann-Whitney U test). Multivariate logistic regression analysis demonstrated that postoperative aeration ratio in mastoid cavity and preoperative ABG were significant independent prognostic factors for successful hearing (odds ratio [95% confidence interval]: 2.630 [0.985 - 7.024], p = 0.045; 0.891[0.840 - 0.944], p < 0.001, respectively). However, postoperative aeration ratios did not significantly differ between with (n = 14) and without recurrence (n = 113) groups in both cavities. CONCLUSION: Our results suggest that better postoperative aeration in mastoid cavity is independently associated with satisfactory hearing outcome after intact canal wall tympanoplasty in pars flaccida cholesteatoma. However, no significant differences were observed between middle ear aeration at one year after operation and recurrence.

External beam radiotherapy for angiographically diagnosed arteriovenous malformation involving the entire pancreas.

Ultrasonography of a 66-year-old man with abdominal discomfort detected an abnormality of the pancreas. Multiphase contrast-enhanced computed tomography (CT) and angiography revealed arteriovenous malformation (AVM) involving the entire pancreas. The large number of dilated and tortuous feeding arteries contraindicated surgical resection or transcatheter embolization. Hemorrhage into the main pancreatic duct occurred 1 month after diagnosis. The patient underwent external radiotherapy with a total dose of 44 Gy following a conventional fractionation schedule of 2 Gy daily for 22 days administered 5 days per week. Contrast-enhanced CT after treatment confirmed disappearance of feeding vessels and nidi with no complication. Evidence of recurrence was not detected on contrast-enhanced CT 6 months after irradiation.

Diffusion-weighted imaging with relative signal intensity statistical thresholding for delineating prostate cancer tumors.

PURPOSE: We assessed the utility of diffusion-weighted imaging (DWI) with relative signal intensity (rSI) statistical thresholding for delineating prostate cancer tumors. MATERIALS AND METHODS: Seventeen patients with prostate cancer underwent DWI before total prostatectomy. We measured standard deviation (SD) of the signal intensity (SI) of the lesser pelvic space at DWI, created rSI maps, displaying signal intensities with SDs of only > +3, > +3.5, > +4, or > +5, and assessed correlation between the proportion of cancerous area on the 4 different rSI maps and that on pathological slices. RESULTS: We could detect prostate cancer on rSI maps for all cases with SD > +3, but not 2 cases with SD > +3.5, five with SD > +4, and eight with SD > +5. The correlation coefficients (R) between the proportion of cancerous area on pathological examination and rSI maps were 0.7464 for SD > +3 (P = 0.0006); 0.6469 for SD > +3.5 (P = 0.0050); 0.6459 for SD > +4 (P = 0.0051), and 0.4540 for SD > +5 (P = 0.0671). CONCLUSION: DWI-based rSI mapping may be used to delineate the extent of prostate cancer. We achieved best correlation between ratio of cancerous area of the lesser pelvic space on pathological examination and on rSI map using a threshold with SD > +3 of the SI.