ECG-gated multi-detector row spiral CT in the assessment of myocardial infarction: correlation with non-invasive angiographic findings.

Our objective was to retrospectively evaluate the ability of multidetector-row computed tomography (MDCT) to detect previous myocardial infarctions (MIs) and to correlate necrosis with the status of coronary arteries supplying the infarcted territory. After having clinically evaluated 187 patients referred for ECG-gated MDCT of the coronary arteries, 30 previous MIs were identified in 29 patients (9 recent and 21 chronic). MDCT data were evaluated qualitatively and quantitatively by measuring attenuation values and wall thickness within the infarcted region and normal adjacent myocardium. Each MI was also assigned to the distribution territory of a coronary vessel, and morphological data were combined with MDCT angiographic findings. MDCT was able to detect 25/30 MIs showing an overall sensitivity and specificity of 83 and 91%, respectively. Quantitative analysis revealed a statistically significant difference in attenuation values between normal and infarcted regions (38.9+/-14 HU vs. 104.0+/-16 HU). Regional wall thinning was observed in chronic MIs (4.1+/-2 mm vs. 10.5+/-3.8 mm), and not in patients with recent event (7.9+/-1.6 mm vs 9.1+/-4 mm). In 22/25 cases, MDCT angiographic findings showed the presence of suspicious critical lumen narrowing (n=3), previous coronary stenting (n=14) and surgical revascularization (n=5) in the infarct-related coronary. During a single examination, MDCT might provide comprehensive imaging of MI offering a combined morphological and angiographic assessment.

Multislice computed tomography in the preoperative assessment of adult-to-adult living donor liver transplantation: personal results.

PURPOSE: To evaluate the possible role of multislice spiral computed tomography (MSCT) as the sole imaging examination in the preoperative assessment of potential donors undergoing adult-to-adult living donor liver transplantation (LDLT). MATERIALS AND METHODS: Fifteen patients underwent MSCT with 0.5-second gantry rotation time. Pre- (4 X 2.5 mm collimation) and post-contrast (4 X 1 mm collimation) acquisitions during arterial and portal venous phases were performed after intravenous administration of 140 ml of non ionic contrast agent at 4-5 ml/s, with a delay time of 25 and 60 seconds, respectively. Pre-contrast scans with 80 and 140 kVp were acquired at the same level used to assess liver density. Real-time interaction with the post-contrast 3D data set was performed on a dedicated workstation to determine total and lobar liver volume, and to assess arterial and venous vascular anatomy. RESULTS: Steatosis was found in three patients, who as a consequence were excluded as possible candidates. MSCT correctly identified five cases of arterial anatomical variations: two cases of the right hepatic artery arising from the superior mesenteric artery, two cases of the common hepatic artery arising from the superior mesenteric artery and one case of the left hepatic artery arising from left gastric artery. In two cases portal trifurcation was considered a criterion for exclusion. A 4% error in the liver volume calculation was found at surgery, in no case considered significant. Two patients underwent surgery and three have been short-listed. CONCLUSIONS: MSCT enables complete preoperative evaluation of potential donors undergoing LDLT. Total and lobar volume determination provided accurate and reproducible information. MSCT enabled correct surgical planning without intra-operative complications. One of the limits of the technique was the poor visualization of the biliary anatomy with the need to perform an intraoperative cholangiography in all the patients.

Pancreatic carcinoma: the role of high-resolution multislice spiral CT in the diagnosis and assessment of resectability.

The purpose of our study was to evaluate multislice computed tomography (MSCT) in the assessment of patients with clinical, laboratory, and US suspicion of pancreatic neoplasm, and to evaluate resectability status. Forty-six patients with a suspected pancreatic tumor underwent MSCT. After a preliminary precontrast survey, a postcontrast scan was performed in the arterial and portal venous phase with the following protocol: 4 x 1-mm collimation; 1.25- and 5-mm slice thickness width, respectively, and 1- and 5-mm reconstruction interval. In all patients pathological correlation was obtained. The evaluation of all images provided a diagnosis in 44 patients, with a sensitivity, specificity, and accuracy of 97, 80, and 96%, respectively. The MSCT correctly provided a diagnosis of unresectability with sensitivity of 96%, specificity of 86%, and accuracy of 93%. Evaluation of 1-mm slices demonstrated 83 of the 91 liver metastases found at surgery; conversely, the 5-mm slices detected only 76 of these lesions. Infiltration of peripancreatic major vessels was demonstrated, and was confirmed at surgery in 18 patients. High-resolution MSCT improves prediction of resectability in patients with suspected pancreatic carcinoma. Parenchymal and vascular information can be achieved with a single MSCT examination.