Resurgence of the Role of Computed-Tomography Myelogram in the Era of MRI for Surgical Decision-Making of Lumbar Degenerative Disc Disorder.

BACKGROUND: Since the introduction of magnetic resonance imaging (MRI) into clinical practice in the mid-1980s, the role of computed tomography myelography (CTM) has become less important in spinal diagnostics but remains a method that is probably even superior to MRI for special clinical issues. The study aims to report the diagnostic utility of CTM as an adjunct to MRI in lumbar degenerative disc disorder (DDD). METHODS: Included were 20 patients who presented with symptomatic DDD but with MRI findings that did not correlate with the clinical features. These patients underwent CTM as an additional imaging technique to aid preoperative surgical decision-making. Both imaging modalities were compared for the identification of the impinging pathology as well as the number of levels of compression. RESULTS: MRI revealed compression and/or impingement at 38 levels, whereas CTM revealed these at 29 levels. Of 20 patients, 18 underwent surgery, and a total of 29 levels were decompressed as localized in the CTM. The visual analog scale (VAS) score for back pain and leg pain at baseline were 6 ± 0.7 and 7 ± 0.4, respectively, and at 6 months postintervention (surgical/conservative) were 2 ± 0.8 and 0.3 ± 0.1, respectively. The Oswestry Disability Index scores at baseline and 6 months postintervention were 56 ± 6.9 and 18 ± 4.2, respectively (P < .0001). There was agreement on the number of levels between MRI and CTM in 10 patients (50%). MRI overestimated the number of involved levels in 9 patients (45%), whereas in the remaining 1 patient (5%), MRI underestimated the number of involved levels. The weighted κ value for agreement between MRI and CTM on the number of levels involved necessitating decompression was 0.4 (95% CI, 0.18-0.77; P = .0009). CONCLUSIONS: CTM has a role as an adjunct imaging modality to formulate an effective management plan in patients presenting with symptomatic lumbar DDD in cases where MRI findings are inconclusive and ambiguous. LEVEL OF EVIDENCE: 4.

Incidental chest computed tomography findings in asymptomatic Covid-19 patients. A multicentre Indian perspective.

In December 2019, an unprecedented outbreak of pneumonia of unknown etiology emerged called COVID-19. A vast number of people affected by this disease are asymptomatic and yet contagious with up to 79% of COVID-19 infections reportedly caused by undocumented infections. Surprisingly, these asymptomatic subjects are also known to quietly harbor pneumonia changes on CT scans. RT-PCR, the definitive test for COVID-19, maybe false negative in patients with COVID-19 pneumonia on CT. Incidental findings highly suspicious of COVID-19 pneumonia on CT chest of asymptomatic patients may increase as the community transmission of the virus rises and isolation restrictions are released. It is advisable to be aware of its appearances and the challenges associated with it.

Differentiation of peritoneal tuberculosis from peritoneal carcinomatosis by the Omental Rim sign. A new sign on contrast enhanced multidetector computed tomography.

INTRODUCTION: Peritoneal TB (PTB) is the commonest presentation of abdominal TB. One of its close mimics is peritoneal carcinomatosis (PC). We present a new sign of PTB on contrast enhanced multidetector computed tomography (CT) called the Omental Rim (CT-OR) sign which helps to accurately differentiate PTB from PC. MATERIALS AND METHODS: A prospective study was performed from 2014 to 2018 on patients referred for CT at a tertiary referral hospital. The study group consisted of consecutive 85 patients, 52 men and 33women, with PTB. The control group consisted of 168 consecutive patients, 96 men and 72 women, with PC. The images were analysed for omental thickening and enhancement, peritoneal thickening and nodules, mesenteric thickening and nodules, presence, quantity, loculation and density of ascites, presence of nodes, bowel and other organ involvement as well as a new sign called the CT-OR sign. RESULTS: The CT-OR sign could identify 85% of patients with PTB. It was absent in 96% of patients with PC and was effective in ruling out PC (p < 0.001). The sign had a sensitivity of 85%, specificity of 96%, positive predictive value of 92%, negative predictive value of 93% and accuracy of 92%. CONCLUSION: The new CT-OR sign is a sensitive and specific sign for PTB. It helps to rule out majority of PC.