Does delayed phase imaging in CT angiography provide additional information in patients with suspected active bleeding?

PURPOSE: We hypothesize that delayed phase imaging does not provide additional diagnostic information in patients who undergo multi-phasic CTA for suspected active bleeding. METHODS: Data on patients who underwent multiphasic CTA (pre-contrast, arterial, porto-venous, and delayed phases) for suspected acute bleed were retrospectively collected between January 2019 and November 2021. CTA images were reviewed by a general radiologist, an interventional radiologist, and a body imaging radiologist independently. Each reader evaluated if delayed phase images provided additional information that would change the final impression of the CTA report. Additional information regarding bleeding location, time needed for delayed image acquisition, and radiation exposure were also obtained. RESULTS: A total of 104 patients with CTAs were analyzed with an average age of 58 years ± 22. Studies rated with absent additional findings on delayed images were 102 (98.1%) by the interventional radiologist, 101 (97.1%) by the body imaging radiologist, and 100 (96.1%) by the general radiologist with percent agreement of 96.15% (kappa 0.54, p < 0.001). All the findings were characterized as unlikely to be clinically significant. Mean time added to complete a delayed phase images was 3.61 ± 3.4 min. The average CT dose length product (DLP) for the total exam was 3621.78 ± 2129.57 mGy.cm with delayed acquisition adding a mean DLP of 847.75 ± 508.8 mGy.cm. CONCLUSION: Delayed phase imaging does not provide significant additional diagnostic information in evaluating patients with suspected active bleeding but is associated with increased examination time and radiation exposure.

Findings of cholangitis in a kidney transplant patient with Caroli disease on FDG PET/CT and MRI.

Caroli disease is a rare congenital disorder of segmental cystic dilatations of the intrahepatic biliary ducts that maintain communication with the rest of the biliary tree. Its typical clinical presentation is recurrent episodes of cholangitis. The diagnosis is usually made using abdominal imaging modalities. We present a patient with Caroli disease showing atypical presentation of acute cholangitis with ambiguous labs and initial negative imaging findings, which was later diagnosed by [18F]-fluorodeoxyglucose positron emission tomography/computed tomography and confirmed by magnetic resonance imaging and tissue pathology. The use of such imaging modalities in moments of doubt or clinical suspicion provide the patient with accurate diagnosis, proper management, and better clinical outcome, thus obviating the need for further invasive investigations.

Diagnostic value of procedural images in CT-guided interventions.

PURPOSE: We hypothesize procedural images of CT-guided interventions may contain diagnostic findings not present in the reference images. METHOD: A retrospective review of CT-guided interventions performed at our hospital, from 01 April 2017 to 08 May 2020. Two radiologists independently reviewed the procedural CT images for presence of diagnostic findings in comparison to the reference images (CT, MRI, or PET/CT). ACR RADPEER score was assigned to all findings. The Findings were categorized into new finding, characterization of prior finding or change of prior finding. The results of biopsy and drainage samples were also reviewed. RESULTS: The prevalence of diagnostic findings in procedural CT images was found to be 6.1% (81/1336); 32 new, 8 characterization, and 41 change findings. Having CT as reference image, procedure in the chest and having drainage were associated with presence of findings (p < 0.05). Increase time interval between the reference image and the procedure increases the odds of having diagnostic findings (p < 0.001). Age, sex, or whether in-patient or out-patient, malignant pathology result or infectious collection were not related to presence of findings (p > 0.05). The majority of findings were likely clinically significant (73%) and the majority were not documented in the procedure report (63%). CONCLUSION: Clinically relevant diagnostic findings in procedural images of CT-guided interventions are not uncommon and are underreported. Time delay between the reference image and the procedure is the most significant factor associated with presence of diagnostic findings.

A Rare Case of Isolated Ureteral Diaphragmatic Herniation: Case Report and Review of Literature.

Diaphragmatic ureteral hernias are rare causes of ipsilateral renal obstruction. Management strategies varies from conservative to ureteral stenting to operative herniorraphy and reduction. We present a case of a 71-year-old man who was found to have an incidental right ureteral diaphragmatic herniation causing an asymptomatic kidney obstruction. He was managed conservatively with no evidence of increased hydronephrosis on serial imaging and no deterioration of biochemical renal function. We review all similar cases published in the literature and discuss the optimal treatment strategies.