Quantification of calcium burden by coronary CT angiography compared to optical coherence tomography.

Coronary artery calcifications (CAC) are frequently observed in patients referred for coronary CT angiography (CTA). Calcification volume (in mm3) can accurately be assessed during catheterization by optical coherence tomography (OCT). The aim of the present study was to investigate the accuracy of CTA-derived assessment of calcification volume as compared with OCT. 66 calcified plaques (32 vessels) from 31 patients undergoing OCT-guided PCI with coronary CT acquired as a standard of care were included. Coronary CT and OCT images were matched using fiduciary points. Calcified plaques were reconstructed in three dimensions to calculate calcium volume. A Passing-Bablok regression analysis and the Bland-Altman method were used to assess the agreement between imaging modalities. Twenty-seven left anterior descending arteries and 5 right coronary arteries were analyzed. Median calcium volume by CTA and OCT were 18.23 mm3 [IQR 8.09, 36.48] and 10.03 mm3 [IQR 3.6, 22.88] respectively; the Passing-Bablok analysis showed a proportional without a systematic difference (Coefficient A 0.08, 95% CI - 1.37 to 1.21, Coefficient B 1.61, 95% CI 1.45 to 1.84) and the mean difference was 9.69 mm3 (LOA - 10.2 to 29.6 mm3). No differences were observed for minimal lumen area (Coefficient A 0.07, 95% CI - 0.46 to 0.15, Coefficient B 0.85, 95% CI 0.64 to 1.2). CTA volumetric calcium evaluation overestimates calcium volume by 60% compared to OCT. This may allow for an appropriate interpretation of calcific burden in the non-invasive setting. Even in presence of calcific plaques, a good agreement in the MLA assessment was found. Coronary CT may emerge as a tool to quantify calcium burden for invasive procedural planning.

Cost effectiveness of multi detector CT angiography of the coronary arteries for the diagnosis of suspected non-ST elevation acute coronary syndrome (NSTE-ACS) in the emergency department. Mathematical analysis with a decision model.

The purpose of our study is to model cost-effectiveness of MDCTA for the diagnosis of NSTE-ACS with initially negative enzymes, in the emergency department. In Belgium, the use of multi-detector computed tomography (MDCTA) is probably cost-effective in the diagnosis of NSTE-ACS in the acute setting A decision tree model was developed and a mathematical study was performed that included two hypothetical strategies: MDCTA and admission with classic clinical follow-up and treatment. Cost-effectiveness for the Belgian situation was simulated with sensitivity analysis using known values for diagnostic performance and known costs for the different strategies or components of strategies.

Isolated noncompaction of ventricular myocardium. Diagnosis with multidetector computed tomography.

Noncompaction of the ventricular myocardium is a cardiomyopathy thought to be caused by arrest of normal embryogenesis of the endocardium and myocardium. Non-compaction presents as an isolated form or in association with other congenital anomalies, such as obstruction of the right or left ventricular outflow tracts, complex cyanotic congenital heart disease and coronary artery anomalies. Contrast-enhanced CT is capable of showing the abnormal architecture of the left ventricular wall in non-compaction but is also able to evaluate the coronary arteries to exclude anomalies or significant stenosis, which is usually not possible with MRI or echocardiography.

Acute calcific prevertebral tendinitis.

Acute calcific prevertebral tendinitis, also known as retropharyngeal calcific tendinitis and longus colli tendinitis, is an uncommon benign condition presenting as acute neck pain.Typical characteristics of this entity are calcifications at the superior insertion of the longus colli tendons at C1-C2 level and a fluid collection in the retropharyngeal space. Differential diagnosis consists of retropharyngeal abscess, traumatic injury or infectious spondylitis. Knowledge of the clinical and imaging findings can prevent misdiagnosis with inappropriate attempts at surgical drainage.

Additional value of CT-fluoroscopic biopsy of pulmonary lesions: a retrospective study of 69 patients.

The purpose of this retrospective study was to evaluate the diagnostic accuracy of CT-fluoroscopic transthoracic biopsy of pulmonary lesions related to their localization and size. The complication rate was also evaluated. Between January 2003 and June 2004, we performed seventy-two CT-fluoroscopic transthoracic biopsies in sixty-nine patients. Lesions were subdivided in subpleural, peripheral and central lesions. The lesions were also subdivided concerning their diameter. Fifty three lesions (77%) had a final diagnosis of malignancy and 13 lesions (19%) had a final benign diagnosis. CT-fluoroscopic transthoracic biopsy had an overall diagnostic accuracy of 84.4%, sensitivity of 80.7%, specificity of 100%, positive predictive value of 100% and negative predictive value of 54.5%. For lesions between 1 and 3 cm the accuracy was 78.5% for lesions greater than 3 cm 87%. Only one lesion was smaller than 1 cm, this lesion was true positive. There were no false-positive findings. Pneumothoraces were observed in only 7 patients (10%) and there was only 1 small postpuncture hemothorax (1.7%). CT-fluoroscopic biopsy of pulmonary lesions has a good diagnostic accuracy with a very low complication rate. The accuracy is higher for larger lesions, but there is no significant difference for subpleural and peripheral lesions.

Spigelian hernia with unusual content.

We present a case of a primary tumor of the peritoneum that manifested as a spigelian hernia in a 74-year-old woman. Multidetector computed tomography showed a large heterogeneous mass located subcutaneously on the right spigelian line connected to the abdominal cavity. We found no previous report describing a primary peritoneal tumor in a spigelian hernia.

Multiple vertebral fluid-fluid levels.

We present a case of multiple vertebral metastases, with multiple fluid-fluid levels, from a moderately to poorly differentiated carcinoma of unknown origin. We suggest that fluid-fluid levels in multiple vertebral lesions are highly suggestive of bone metastases.