TNM staging of pancreatic carcinoma using helical CT.

OBJECTIVE: The purpose of this study was to determine the accuracy of helical CT scanning in predicting the stage of carcinoma of the exocrine pancreas using TNM staging guidelines and in predicting resectability of carcinoma of the exocrine pancreas. MATERIALS AND METHODS: Twenty-six patients with proven adenocarcinoma of the pancreas underwent uniphasic or biphasic helical CT scanning. Two observers unaware of the patient's surgical stage evaluated the CT examinations using the TNM system (with specific assessment and description of disease sites). In addition, the two observers rated confidence of nonresectability using a 5-point scale (ranging from 1, definitely resectable, to 5, definitely not resectable). Observer results and preoperative interpretations were compared with surgical findings. RESULTS: Nineteen of 26 patients had nonresectable disease. The combined observer scores showed correct determination of T stage in 77% of patients, of N stage in 58%, and of M stage in 79%. The overall accuracy in determining lack of resectability was 96% and 84% for the two observers. All errors in determining resectable versus nonresectable disease occurred when the observer was not maximally confident of his or her diagnosis. CONCLUSION: Helical CT is an effective screening technique for assessing T and M stages of pancreatic carcinoma. However, helical CT is poor at detecting regional lymph node involvement. In patients with equivocal T-stage findings (such as questionable venous involvement), other studies such as endoscopic sonography may be of value.

Helical (spiral) CT of the upper airway with three-dimensional imaging: technique and clinical assessment.

OBJECTIVE: The purpose of this study was to evaluate the application of helical CT-generated three-dimensional images of the upper airway. MATERIALS AND METHODS: Thirty patients, 10 healthy and 20 with upper-airway disease, were studied with helical CT (5-mm collimation). Overlapping images at 2-mm intervals were retrospectively generated. In the group of healthy patients, two radiologists in independently compared overlapping with nonoverlapping images, ranked confidence in identifying small airway structures on a scale of 1-5, and tabulated the number of images demonstrating these structures. In the 20 patients with disease, three-dimensional (3D) surface models were rendered on an independent workstation and were reviewed by two radiologists and one otolaryngologist for image quality, appreciation of lesion morphology, and ability to judge lesion extent, using a similar scale. A phantom was used to optimize parameters for the 3D reconstructions. RESULTS: Viewing of the retrospectively generated overlapping images increased by 122% the number of images in which laryngeal and hypopharyngeal structures could be identified (p < .01). Image confidence scores for the radiologists averaged 3.3 for nonoverlapping and 4.0 for overlapping (p < .05). Radiologists and otolaryngologist rated the quality of the 3D images equally. The otolaryngologist's assessment of the value of the models for understanding the lesion morphology was 3.5 compared with the radiologists assessment of 2.5; and for judging the lesion extent, the otolaryngologist's assessment was 3.8 compared with 2.7 for the radiologist, a statistical significance of p < .01. CONCLUSION: Helical CT with the application of overlapping images and 3D reconstructions significantly assists the understanding of upper-airway disease.

Helical CT of the upper airway: normal and abnormal findings on three-dimensional reconstructed images.

Imaging of the hypopharynx, larynx, and upper airway are effectively achieved with CT and MR imaging. These techniques have proved their diagnostic usefulness in assessing the deep soft tissues not visible with laryngoscopy [1]. However, with axial imaging, large numbers of images often need to be mentally stacked to envision the appearance of the airway. With helical CT, we can create high-quality three-dimensional (3D) reconstructions [2, 3]. Advantages of helical technology include rapid scanning, decreased motion artifact, and minimization of misregistration artifacts. Recent work has suggested a role for multiplanar and 3D reconstructions of helical data for assessing the tracheobronchial tree [3]. The helically derived 3D models illustrate the normal and abnormal findings affecting the airway.

Three-dimensional imaging of the hypopharynx and larynx by means of helical (spiral) computed tomography. Comparison of radiological and otolaryngological evaluation.

A new computed tomography (CT) technology, helical (spiral) CT, allows the entire neck to be imaged in only 30 seconds. Although multiplanar and three-dimensional (3-D) imaging could be performed with conventional CT, the volumetric acquisition provided by helical (spiral) CT allows significantly improved quality and easier reconstruction for more applications. These 3-D models show an airway appearance similar to that obtained with laryngography. Independent review of the 3-D images in 12 patients with lesions by two radiologists and one otolaryngologist was performed to assess 1) image quality, 2) ability to judge lesion extent, and 3) assistance in understanding the lesion compared to that provided by routine axial scans. Rating scores of 1 to 5 were assigned, with 5 representing the best quality or greatest value. The results showed that both groups scored image quality equally: 4.7. Lesion extent for the radiologists was 2.6, while the otolaryngologist's ranking was 3.7 (p < .01). In assisting understanding of lesions versus axial scans, radiologists ranked 3-D images 2.1, while the otolaryngologist ranked them 3.1 (p < .01). In summary, 3-D models provide a complementary imaging technique in understanding upper airway disease.

Routine helical CT of the abdomen: image quality considerations.

PURPOSE: Both helical and nonhelical abdominal computed tomographic (CT) scans were obtained to compare image quality, study the effect of patient size and collimation, and compare the frequency of visualization of normal abdominal structures. MATERIALS AND METHODS: The study group consisted of 60 consecutive patients with clinically suspected metastatic malignancy. RESULTS: Both helical and nonhelical image quality was excellent, with equal mean image quality scores of 4.1 on a 5-point scale. In patients weighing more than 175 lb (79 kg), both helical and nonhelical image quality degraded equally when 5-mm collimation was used; 10-mm collimation resulted in excellent image quality, regardless of patient size. Small in-plane structures (eg, renal arteries, renal veins, pancreatic duct) were seen best on helical scans. With the addition of retrospectively reconstructed overlapping images, improvement in visualization of these structures was statistically significant. CONCLUSION: Helical CT scanning should be the preferred means of acquiring routine abdominal CT images.

Lateralization of complex binaural stimuli: a weighted-image model.

This article describes a new model that predicts the subjective lateral position of bandpass stimuli. It is assumed, as in other models, that stimuli are bandpass filtered and rectified, and that the rectified outputs of filters with matching center frequencies undergo interaural cross correlation. The model specifies and utilizes the shape and location of assumed patterns of neural activity that describe the cross-correlation function. Individual modes of this function receive greater weighting if they are straighter (describing consistent interaural delay over frequency) and/or more central (describing interaural delays of smaller magnitude). This weighting of straightness and centrality is used by the model to predict the perceived laterality of several types of low-frequency bandpass stimuli with interaural time delays and/or phase shifts, including bandpass noise, amplitude-modulated stimuli with time-delayed envelopes, and bandpass-filtered clicks. This model is compared to other theories that describe lateralization in terms of the relative contributions of information in the envelopes and fine structures of binaural stimuli.