Cardiac Computed Tomography of Native Cardiac Valves.

Valvular heart disease (VHD) is a significant clinical problem associated with high morbidity and mortality. Although not being the primary imaging modality in VHD, cardiac computed tomography (CCT) provides relevant information about its morphology, function, severity grading, and adverse cardiac remodeling assessment. Aortic valve calcification quantification is necessary for grading severity in cases of low-flow/low-gradient aortic stenosis. Moreover, CCT details significant information necessary for adequate percutaneous treatment planning. CCT may help to detail the etiology of VHD as well as to depict other less frequent causes of valvular disease, such as infective endocarditis, valvular neoplasms, or other cardiac pseudomasses.

Incidental deep venous thrombosis diagnosed on lower extremity computed tomography is a rare but clinically impactful finding.

BACKGROUND: In the setting of a known thrombotic event, computed tomography (CT) studies provide reasonable sensitivity for the diagnosis of deep venous thrombosis (DVT). However, the incidence and accuracy of a DVT diagnosis on CT studies not targeted for the detection of DVT are not well described. In addition, the clinical impact of DVTs incidentally identified on CT is unknown. METHODS: In this single-institution retrospective study, we queried all contrasted CT studies of the lower extremities performed over a 10-year period. Regular expressions applied to the radiology reports associated with the CT studies identified studies with positive findings associated with DVT. These selected reports were then manually reviewed to confirm the presence of a DVT. Patient demographics and relevant medical and surgical history were obtained through a chart review. Follow-up information was obtained for 1 year after the incident CT and included treatment course, additional imaging, and adverse events. An incidental DVT was one identified in a patient in whom the DVT was not noted in a prior study and for whom the study indication did not include concern for DVT or pulmonary embolism. RESULTS: Of 16,637 lower extremity contrasted CT studies queried, 37 study reports identified a DVT. However, only 13 patients had a finding of an incidental DVT (10-year incidence of 0.08%). Among these 13 patients, 11 underwent additional imaging, including 9 who had a subsequent venous duplex and 2 who had subsequent CT studies. Among those with a subsequent duplex, DVT was not identified in eight cases, whereas in one case, DVT was confirmed. Among those with subsequent CT studies, DVT was not identified in one case and was confirmed in one case. Of the 13 patients with incidental DVTs, 3 were initiated on anticoagulation based on their initial CT findings alone. Among these, two did not experience any complications from their DVT or anticoagulation regimen. One did experience major bleeding complications, requiring additional procedures. CONCLUSIONS: Incidental DVTs are a rare finding in lower extremity CT studies, noted to occur in only 0.08% of studies. Most patients with incidental DVTs receive additional imaging, with negative findings in 80% of cases. This study identified that 23% of patients were initiated on anticoagulation due to the CT findings, with a 33% rate of significant complications. Currently, a CT venogram is not recommended as a first-line modality for the diagnosis of DVT. However, there is no guidance regarding the need for repeat imaging in patients with incidentally diagnosed lower extremity DVTs identified on CT. Additional study is needed to provide evidence for guideline development.

Incidence and outcomes of intraoperative periprosthetic acetabular fractures during cementless total hip arthroplasty: a prospective three-dimensional computer tomography-based study.

PURPOSE: Unlike periprosthetic femoral fractures, periprosthetic acetabular fractures during total hip arthroplasty (THA) have not been evaluated in detail. We prospectively evaluated the incidence, patterns, risk factors, and clinical outcomes of intraoperative periprosthetic acetabular fractures using pre- and postoperative computer tomography (CT). METHODS: In this prospective single-centre study, we evaluated 234 consecutive patients (250 hips) who underwent THA and three-dimensional CT before and after the surgery. We assessed the incidence, pattern of fractures, outcomes for each fracture pattern, reoperation and revision rates, Harris hip score, and visual analog scale (VAS) for pain. Multivariate regression models were used to identify risk factors for periprosthetic acetabular fractures. RESULTS: In total, 43 periprosthetic acetabular fractures (17.2%) were identified via CT. Fractures occurred most frequently at the superolateral wall. Early cup migration occurred in three hips. None of the patients underwent revision surgery for acetabular loosening. Regression modeling showed that rheumatoid arthritis was a significant predictor of periprosthetic acetabular fractures. CONCLUSIONS: Periprosthetic acetabular fractures are not infrequent during cementless THA and are more common in patients with rheumatoid arthritis.

High Incidence Rate of Computed Tomography-Measured Steatotic Liver Disease in Men With and Without HIV Infection.

INTRODUCTION: We determined steatotic liver disease (SLD) incidence in a prospective cohort of men with HIV (MWH) and men without HIV (MWOH). METHODS: Incident SLD was defined using paired noncontrast computed tomography scans performed during 2010-2013 and repeated during 2015-2017. RESULTS: Of 268 men, 173 MWH and 95 MWOH, 33 had incident SLD (11.1%, incidence rate 2.4 and 2.7/100 person-years for MWH and MWOH, respectively). Overall, higher abdominal visceral adipose tissue was independently associated with increased SLD risk. In MWH, increased visceral adipose tissue, insulin resistance, chronic hepatitis B, and cumulative etravirine use were associated with SLD. DISCUSSION: Metabolic factors, but not HIV, were associated with incident SLD. The high incidence rate suggests that SLD will continue to increase in PWH.

Pattern of Endothelialization in Left Atrial Appendage Occluder by Optic Coherence Tomography: A Pilot Study.

BACKGROUND: Implantation of the left atrial appendage occluder (LAAO) has been proven to prevent stroke effectively in patients with atrial fibrillation who cannot tolerate anticoagulants. Incomplete endothelization of LAAO may cause device-related thrombus, and currently no good image modality exists to clearly see LAAO endothelialization. We aimed to use coronary optic coherence tomography (OCT) to visualize LAAO endothelialization. METHODS AND RESULTS: We enrolled 14 patients (72.8±9.4 years old) undergoing pulmonary vein isolation with a preexisting LAAO implanted more than 1 year ago (5 Watchman and 9 Amulet). After pulmonary vein isolation, we did OCT via steerable sheath and coronary guiding catheter to adjust OCT probe location and injected contrast medium to visualize the LAAO surface. In vitro testing was also performed to see the bare occluder. In vitro OCT showed the surface of the bare device as an interrupted granule pattern, which included the Watchman surface polytetrafluoroethylene membrane string, Amulet disc metal strut, and inner polytetrafluoroethylene membrane string. In the implanted Watchman, OCT showed endothelialization as a smooth surface layer with noninterrupted coarser granules. In the implanted Amulet, OCT showed endothelialization as thin (early) or thick (late) endothelialization layer covering struts with OCT shadows. Among patients with Watchman, 2 showed no, 2 early, and 1 complete endothelialization. Among patients with Amulet, 2 showed no, 3 early, and 4 late endothelialization. CONCLUSIONS: We demonstrated the feasibility of OCT to visualize LAAO endothelization with high resolution. Further studies are needed to determine antithrombotic regimens if incomplete endothelization is detected. A new OCT catheter may be designed specifically for LAAO.

Advanced flexible transvaginal mesh with high visibility under computerized tomography (CT) scan.

Pelvic floor disorders, including pelvic organ prolapse (POP) and stress urinary incontinence (SUI), are serious and very common. Surgery is commonly undertaken to restore the strength of the vaginal wall using transvaginal surgical mesh (TVM). However, up to 15% of TVM implants result in long-term complications, including pain, recurrent symptoms, and infection.Clinical Relevance- In this study, a new bioengineered TVM has been developed to address these issues. The TVM is visible using noninvasive imaging techniques such as computed tomography (CT); it has a highly similar structural profile to human tissue and potential to reduce pain and inflammation. These combined technological advances have the potential to revolutionize women's health.

Radiopacity of Sodium Zirconium Cyclosilicate in Computed Tomography: a case of a patient with Hyperkalemia and kidney disease.

Sodium Zirconium Cyclosilicate (SZC) is commonly used for treating hyperkalemia because it sequesters gastrointestinal potassium ions, thereby reducing serum potassium levels. However, a less-discussed aspect of SZC is its radiopacity on x-ray-based imaging techniques. The European Medicines Agency (EMA) has only vaguely addressed this issue. Radiopaque substances like SZC can interfere with diagnostic imaging, creating challenges for clinicians and radiologists. We present the case of a 34-year-old Italian male to illustrate these concerns.

Postoperative Pharyngeal Fistula Diagnosed by Prone Position Computed Tomography With Oral Contrast Agent: A Case Report.

BACKGROUND/AIM: A pharyngeal fistula is the most common complication of total laryngectomy; thus, accurate diagnosis and treatment are important. Diagnosis is usually made by the finding of leakage of the contrast agent outside the pharynx during swallowing contrast examination. Herein, we encountered a case in which fine leaks not detected on contrast examination during swallowing were visualized and diagnosed by computed tomography (CT) imaging with oral contrast media with the patient in a prone position. CASE REPORT: During imaging in a prone position, the contrast agent entered the sutures on the cephalocaudal and ventral sides of the surgical site, which were particularly prone to leaks due to gravity, and it was possible to diagnose minute leaks. When there is a high risk of postoperative pharyngeal fistula, such as in reconstructive cases with a pedunculated flap or with overlapping risk factors such as preoperative irradiation, CT imaging with contrast medium in a prone position is considered useful when swallowing contrast examination does not provide a clear diagnosis. However, suture failure is possible, and this should be evaluated. CONCLUSION: This case suggests that routine prone CT may lead to the early detection of postoperative pharyngeal fistula in high-risk cases. Further accumulation of cases is required to confirm our findings.

Different computed tomography parameters for defining myosteatosis in patients with advanced non-small cell lung cancer.

BACKGROUND & AIMS: Myosteatosis, excess muscle fat infiltration, is a novel prognostic factor in cancer patients. To define myosteatosis, skeletal muscle radiodensity (SMD) is most commonly used, while intramuscular adipose tissue (IMAT) is newly introduced. We aimed to compare SMD-defined and IMAT-defined myosteatosis for predicting overall survival (OS) in patients with advanced non-small cell lung cancer (NSCLC) and to explore whether patients with both low SMD and high IMAT had a shorter OS than patients with low SMD or high IMAT alone. METHODS: We consecutively and prospectively recruited adult patients with stage IIIB or IV NSCLC at a teaching hospital. The mean SMD of all skeletal muscle areas and the area of IMAT on the unenhanced chest computed tomography (CT) images at the 12th thoracic vertebral level were segmented using Mimics version 21.0. Myosteatosis was defined by either low SMD (SMD-defined myosteatosis) or high IMAT (IMAT-defined myosteatosis). The optimal cutoffs for low SMD and high IMAT were also determined using the maximally selected rank statistics method. We calculated hazard ratios (HRs) and the corresponding confidence intervals (CIs) to evaluate the associations of OS with low SMD, high IMAT, and a combination of them. RESULTS: We included 565 patients (345 men and 220 women; mean age 58.5 ± 9.0 years). Lower IMAT exhibited a tendency toward a favorable prognosis in men (p = 0.0015) and women (p < 0.0001); whereas higher SMD tended to have a favorable prognosis in men (p = 0.0006) and women (p < 0.0001). At baseline, 423 (74.9 %) participants had high IMAT, 432 (76.5 %) participants had low SMD and 370 (65.5 %) participants had both high IMAT and low SMD. Compared to those without either high IMAT or low SMD, the participants with either high IMAT or low SMD had a shorter OS, while the participants with both High IMAT and Low SMD had the shortest OS (log-rank p < 0.0001). After adjustment for the same confounders, high IMAT (HR, 1.44; 95 % CI, 1.10-1.87) and low SMD (HR, 1.92; 95 % CI, 1.36-2.43) were separately associated with poor prognosis. Moreover, the combination of high IMAT and low SMD indicated a higher risk of poor prognosis (HR, 2.43; 95 % CI, 1.62-3.66). CONCLUSIONS: Both SMD-defined and IMAT-defined myosteatosis are highly prevalent in patients with advanced NSCLC and may serve as independent prognostic factors for OS. The diagnosis of myosteatosis might consider a combination of low SMD and high IMAT because this would help identify patients at a higher risk of mortality.

Validity of computed tomography defined body composition as a prognostic factor for functional outcome after kidney transplantation.

BACKGROUND: The prevalence of sarcopenia is markedly higher in kidney transplant candidates than in the general population. It is a syndrome characterized by progressive and generalized loss of skeletal muscle mass and strength, which increases the risk of adverse postoperative outcomes. METHODS: We studied the impact of computed tomography defined preoperative sarcopenia, defined as a skeletal muscle index below age and gender specific cut-off values, on postoperative physical functional outcomes (grip strength, 4-m walking test, timed up and go, and sit to stand) at 6 months follow up. RESULTS: A total of 107 patients transplanted between 2015 and 2019 were included in this single-centre study. Mean age was 60.3 (±13.1), and 68.2% of patients were male. Ten patients (9.4%) were identified as sarcopenic. Sarcopenic patients were younger (55.6 (±15.1) vs. 60.8 (±12.9) years), more likely to be female (60.0% vs. 28.9%), and had an increased dialysis vintage (19 [2.5-32.8] vs. 9 [0.0-21.0] months) in comparison with their non-sarcopenic counterparts. In univariate analysis, they had a significantly lower body mass index and skeletal muscle area (P ≤ 0.001). In multivariate regression analysis, skeletal muscle index was significantly associated with grip strength (ß = 0.690, R2  = 0.232) and timed up and go performance (ß = -0.070, R2  = 0.154). CONCLUSIONS: We identified a significant association between sarcopenia existing pre-transplantation and poorer 6 months post-transplantation physical functioning with respect to hand grip strength and timed up and go tests in kidney transplant recipients. These results could be used to preoperatively identify patients with an increased risk of poor postoperative physical functional outcome, allowing for preoperative interventions to mitigate these risks.

Computed tomography-defined sarcopenia as a risk factor for short-term postoperative complications in oral cancer patients with free flap reconstruction: A retrospective population-based cohort study.

BACKGROUND: Postoperative complications after free flap reconstruction for oral cancer can increase cost and prolong hospitalization. This study explored risk factors for complications, focusing on sarcopenia. METHODS: The study explored the associations between computed tomography-defined sarcopenia and the occurrence of postoperative complications, adjusted for age, gender, smoking, alcohol, ASA scoring, clinical stage of tumor, tumor site, type of free flap used, presence of tracheotomy, and blood test parameters. RESULTS: Of 253 patients, 17.39% (44/253) of oral cancer patients had comorbid sarcopenia. Univariate analysis showed an overall postoperative complication rate of 65.90% in the sarcopenia group and 51.67% in the non-sarcopenia group. Multivariate modeling showed sarcopenia and smoking were major risk factors for total and respiratory complications, increasing the risks by over two-fold. No factors significantly impacted surgery-specific complications. CONCLUSIONS: This study identified sarcopenia as a risk factor for postoperative complications in oral cancer patients undergoing flap reconstruction.

Usefulness of cardiac computed tomography in prosthetic heart valve dysfunction.

BACKGROUND: Prosthetic heart valve (PHV) dysfunction is a serious complication. Echocardiography remains the first-line imaging investigation to assess PHV dysfunction. However, the role of Computed Tomography (CT) scanning in this type of case has not been thoroughly studied yet. The objective of our study was to determine if cardiac Computed Tomography (CT) had a potentially complementary role to play alongside echocardiography in diagnosing the mechanism of prosthetic valve dysfunction. METHODS AND RESULTS: This prospective cohort study was conducted on 54 patients with suspected PHV dysfunction. All patients underwent routine diagnosis work-up (transthoracic and transesophageal echocardiography) and additional cardiac CT. Cardiac CT showed findings that were not detected by echocardiography in seven patients (12%) namely aortic pannus (5) and pseudoaneurysm (2). An underlying thrombus was detected by echocardiography and missed by cardiac CT in 15 patients (27%). However, in these thrombotic cases, cardiac CT contributed to the functional evaluation of leaflets. CONCLUSION: This study demonstrates that an integrated approach including transthoracic, transesophageal echocardiography and computed tomography is useful in patients with suspected PHV dysfunction. While computed tomography is more accurate in the diagnosis of pannus formation and periannular complications, echocardiography is superior at detecting thrombus.

A strategy to reduce the false-positive rate after low-dose computed tomography in lung cancer screening: A multicenter prospective cohort study.

BACKGROUND: The ability of lung cancer screening to manage pulmonary nodules was limited because of the high false-positive rate in the current mainstream screening method, low-dose computed tomography (LDCT). We aimed to reduce overdiagnosis in Chinese population. METHODS: Lung cancer risk prediction models were constructed using data from a population-based cohort in China. Independent clinical data from two programs performed in Beijing and Shandong, respectively, were used as the external validation set. Multivariable logistic regression models were used to estimate the probability of lung cancer incidence in the whole population and in smokers and nonsmokers. RESULTS: In our cohort, 1,016,740 participants were enrolled between 2013 and 2018. Of 79,581 who received LDCT screening, 5165 participants with suspected pulmonary nodules were allocated into the training set, of which, 149 lung cancer cases were diagnosed. In the validation set, 1815 patients were included, and 800 developed lung cancer. The ages of patients and radiologic factors of nodules (calcification, density, mean diameter, edge, and pleural involvement) were included in our model. The area under the curve (AUC) values of the model were 0.868 (95% CI: 0.839-0.894) in the training set and 0.751 (95% CI: 0.727-0.774) in the validation set. The sensitivity and specificity were 70.5% and 70.9%, respectively, which could reduce the 68.8% false-positive rate in simulated LDCT screening. There was no substantial difference between smokers' and nonsmokers' prediction models. CONCLUSION: Our models could facilitate the diagnosis of suspected pulmonary nodules, effectively reducing the false-positive rate of LDCT for lung cancer screening.

Computed tomography values of pericardial effusion may predict chylopericardium: a case report.

BACKGROUND: Idiopathic chylopericardium is a rare disease characterized by filling of the pericardial cavity with chylous fluid and has no evident cause. Secondary chylopericardium usually results from injury or damage to the thoracic duct. The most common causes of secondary chylopericardium are trauma, thoracic or cardiac surgery, and congenital lymphangiomatosis. Conservative or surgical treatment can be pursued; however, surgical treatment is required if conservative treatment is unsuccessful. Pericardiocentesis plays a crucial role in the definitive diagnosis of chylopericardium. However, although a serious complication, its occurrence is infrequent. Non-invasive methods, such as computed tomography (CT), could be useful in predicting the color or characteristics of pericardial effusion. CASE PRESENTATION: A 37-year-old Japanese woman presented to our hospital with a cough that persisted for 1 week. Echocardiography revealed pericardial effusion, which was diagnosed as acute pericarditis and treated with loxoprofen. However, pericardial effusion increased, and the patient presented to the emergency room with cardiac tamponade 1 month later. Pericardiocentesis was performed, which confirmed that the pericardial effusion was chylopericardium. Lymphatic scintigraphy did not show any connection between the thoracic duct and pericardial cavity, and the patient was diagnosed with idiopathic chylopericardium. The patient underwent continuous drainage for 11 days. After completion of cardiac drainage, the patient was discharged from the hospital without any exacerbation. The CT attenuation value of the pericardial fluid was 11.00 Hounsfield units (HU). Compared with the other causes of pericardial effusions encountered at our hospital, the HU on CT scan of pericardial effusion was low in our study and similar to the values on CT scan of chylous ascites reported in previous studies. CONCLUSIONS: Although idiopathic chylopericardium is rare, it should be considered an important cause of pericardial effusion. Pericardiocentesis is necessary for definitive diagnosis; however, the CT findings of pericardial effusion may help predict the presence of chylous fluid.

Environmental Tobacco Smoke Exposure Estimated Using the SHSES Scale, and Feature Tracking Computed Tomography-Derived Left Ventricular Global Longitudinal Strain in Hypertensive Patients.

Aim of the study was to assess the relationship between environmental tobacco smoke (ETS) and computed tomography-derived left ventricular global longitudinal strain (LV GLS) in patients with arterial hypertension. 103 non-smokers with AH were included in the study (age 67.73 ± 8.84 years). ETS exposure was assessed with the Second-Hand Smoke Exposure Scale (SHSES). LV GLS was measured on computed tomography using feature tracking technology. In accordance with SHSES scale patients were divided into subgroups: subgroup A-no ETS exposure, subgroup B-low ETS exposure, subgroup C-medium ETS exposure, and subgroup D-high ETS exposure. Peak of LV GLS was statistically significantly lower in subgroup D than in subgroup A. There was a negative correlation between the exposure to ETS expressed by the SHSES scale and peak of LV GLS (r = - 0.35, p < 0.05). Regression analysis showed that higher SHSES score, higher age, left ventricular hypertrophy, left ventricular diastolic dysfunction, and higher CAD-RADS are independent risk factors for lower peak of LV GLS values. On the contrary, the effective blood pressure control appeared to be independent protecting factor against lower peak of LV GLS values. In summary, there is an unfavorable weak relationship between ETS exposure estimated using the SHSES scale and LV GLS in hypertensive patients.

Evaluation of nonalcoholic fatty liver disease in Japanese patients with psoriasis: Chest CT imaging for screening purposes.

Psoriasis patients have been reported to have a higher prevalence of nonalcoholic fatty liver disease (NAFLD), therefore detection at an early stage is important since it may progress to hepatic cirrhosis or hepatocellular carcinoma. We evaluated liver fat accumulation in patients with moderate to severe psoriasis by chest computed tomography (CT). The images were taken for screening purposes prior to the start of any biologics. The prevalence of NAFLD in patients with psoriasis vulgaris, psoriatic arthritis, and control subjects was 19.4%, 33.3% and 9.8%, respectively (P = 0.004). The mean CT score in psoriasis patients was significantly lower (51.684 ± 12.778) than that in control subjects (61.204 ± 9.498, P < 0.001). Multivariate logistic regression analysis showed that only CT scores were associated with the presence of psoriasis (P = 0.001). No significant relationship was observed between the Psoriasis Activity and Severity Index scores and CT scores of psoriasis patients (P = 0.055), suggesting that the presence of psoriasis may contribute to the pathogenesis of NAFLD. By analysis of chest CT imaging, our study successfully assessed liver fat accumulation. Chest CT is a useful diagnostic tool for the quantitative measurement of fat accumulated in the liver, enabling the early noninvasive detection of NAFLD and early therapeutic intervention.

Routine Early Computed Tomography Scanner After Laparoscopic Sleeve Gastrectomy in High-Risk Severely Obese Patients Is Effective for Bleeding or Hematoma Diagnosis but not for Staple-Line Leak Detection: a Prospective Study.

PURPOSE: Laparoscopic sleeve gastrectomy (LSG) is the most frequently performed bariatric procedure worldwide. Postoperative staple-line leak and intraabdominal hemorrhage can increase associated morbidity and mortality. The value of routine early computed tomography (CT) scanner examination in the early diagnosis of complications in high-risk severely obese patients undergoing LSG is studied. METHODS: This was a prospective, non-randomized study including all patients undergoing LSG in our department from 2014 to 2020. Patients presenting at least one potential risk factor for postoperative gastric leak and bleeding (as defined by the current literature) were included. Primary endpoint was the efficacy of postoperative day (POD) 2 CT-scanner examination in diagnosing these complications. RESULTS: One thousand fifty-one high-risk patients were included. Median age was 44 years. Early postoperative surgical complications occurred in 48 patients (4.5%): 25 (2.3%) intraabdominal hemorrhage and 23 (2.2%) staple-line leak. Early CT-scanner detected intraabdominal bleeding or hematoma in 22/25 patients, with 95.6% sensitivity (Youden's index = 0.95), while specificity was 100%, positive predictive value (PPV) 100%, and negative predictive value (NPV) 99.9%. Sensitivity of early postoperative CT-scanner was 43.4% (10/23 patients; Youden's index = 0.43) for staple-line leak detection, with specificity of 100%, PPV 100%, and NPV 98.7%. CONCLUSION: POD 2 CT-scanner in high-risk severely obese patients undergoing LSG is an excellent tool for early diagnosis of intraabdominal hemorrhage, but sensitivity remains low for staple-line leak detection. Close postoperative clinical follow-up of these patients is essential and any suspicion of postoperative surgical complication should motivate the performance of a CT-scanner.

The Development of Acute Kidney Injury in Burn Patients Undergoing Computed Tomography With Intravenous Contrast.

Acute kidney injury (AKI) is a major complication of significant burn injuries and a significant cause of patient morbidity and mortality. Patients that sustain traumatic burn injuries may require computed tomography (CT) imaging as part of their initial trauma management. This multicenter retrospective chart review of patients admitted to two level I trauma centers with ≥10% TBSA burns between 2014 and 2017 aims to determine if patients with greater than 10% TBSA burns that received CT imaging with intravenous contrast were more likely to develop acute kidney injury during their admission. A total of 439 patients were included in the study. The average age was 45.3 years and average TBSA was 23.2%. Sixty-seven of the 439 patients underwent CT scans with IV contrast on admission. The rate of AKI between patients who did or did not receive CT scans was not statistically significant (9.1 vs 6.0%, P = 0.40). Patients who developed an AKI had higher TBSA (45.6 vs 21.1%, P < .01), amount of fluids per TBSA given within the first 24 hours (457.4 vs 321.6, P < .01), and mortality (71.1 vs 6.2%, P < .01) than those who did not develop an AKI. There was no significant difference in the development of acute kidney injury in burn patients who received CT scans with IV contrast on admission. Although there is a risk of contrast induced nephropathy, the risk is not increased in burn patients and this should not prevent a thorough evaluation to rule out additional life-threatening injuries in the burn trauma patient.

Can computed tomography-antral wall thickness predict response to endoscopic balloon dilation in patients with caustic-induced gastric outlet obstruction?

BACKGROUND: Caustic-induced gastric outlet obstruction (GOO) remains one of the important causes of long-term morbidity in patients with caustic ingestion. Though endoscopic balloon dilation is an effective modality, response to caustic GOO is poorer as compared to peptic stricture. Computed tomography (CT)-antral wall thickness (AWT) has not been previously explored to predict the procedural success in patients with caustic GOO. METHODS: In a retrospective single-center study of prospectively maintained database, all patients with symptomatic caustic GOO who underwent CT scan prior to endoscopic balloon dilation were included. Gastric AWT was measured at the site of maximum visible thickness on CT scan. Details regarding caustic ingestion and endoscopic dilation were retrieved. Patients were divided into two groups, based on CT-AWT (< or ≥9 mm) and compared for outcome measures. RESULTS: Mean age of included patients (n=35) was 33.51 ± 13.65 years and 22 were male. Procedural success was achieved in 29 (82.85%) patients. Number of mean dilation sessions required were 5.28 ± 2.96 for achieving procedural success. The mean CT-AWT was 10.73 ± 2.80 mm (range 4-18 mm). There was no significant association between the CT-AWT and the number of dilations and procedural success. On univariate analysis, size of the first balloon used was a predictor of refractory stricture (p=0.011). However, no other factors predicted either refractory stricture or procedural success. CONCLUSION: There is no additional role of CT-AWT in predicting response to endoscopic balloon dilation or to predict refractory stricture in patients with caustic GOO.