CT of pancreatic injuries

Wong, Yon-Cheong MDE; Wang, Li-Jen MD; Fang, Jen-Feng MD; Lin, Being-Chuan MD; Ng, Chip-Jin MD, MHA; Chen, Ray-Jade MD;

Multidetector-Row Computed Tomography (CT) of Blunt Pancreatic Injuries: Can Contrast-Enhanced Multiphasic CT Detect Pancreatic Duct Injuries?

Journal of Trauma-Injury Infection & Critical Care. 64(3):666-672, March 2008.
Abstract
Background: We examined patients of blunt trauma with contrast-enhanced multiphasic computed tomography (CT) and determined if it could detect pancreatic duct injuries.Methods: During a 17-month period, 95 patients of blunt abdominal trauma underwent multiphasic CT examinations. The CT grading scales of pancreatic injuries at parenchymal phase, portal venous phase, and equilibrium phase were recorded and compared with surgery, endoscopic retrograde cholangiopancreatography, or discharged diagnosis. The diagnostic values of multiphasic CT and interobserver agreements at different phases were computed.Results: Of the 95 patients, nine (9.5%) had pancreatic injuries (six with main duct injuries, three without main duct injuries). The interobserver agreement presented in kappa values between two radiologists regarding the integrity or disruption of the main duct were good at parenchymal phase (K = 0.73), portal venous phase (K = 0.64), and equilibrium phase (K = 0.68). The overall accuracies of multiphasic CT in detecting main duct injuries were 97.9% (parenchymal phase), 100.0% (portal venous phase), and 96.8% (equilibrium phase), respectively. The sensitivity (50.0%) and negative predictive value (96.7%) of equilibrium phase CT were the lowest among the three phases of CT scans.Conclusion: The portal venous phase CT was the most accurate scan to detect pancreatic duct injuries. However, equilibrium phase CT might underestimate major pancreatic injuries. Multiphasic CT shows early promise in this clinical application and further multi-institutional studies to verify its accuracy and reveal the optimal CT methodology are needed.

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Cardiac luxation and CT

Leibecke, Thorsten MD; Stoeckelhuber, Beate Maria MD; Gellissen, Joerg MD; Bartels, Claus MD, PhD; Meier, Torsten MD; Eberhardt, Frank MD; Helmberger, Thomas MD, PhD; Rademaker, Juergen MD;

Posttraumatic and Postoperative Cardiac Luxation: Computed Tomography Findings in Nine Patients

Journal of Trauma-Injury Infection & Critical Care. 64(3):721-726, March 2008.
Abstract
Background: Posttraumatic and postoperative cardiac luxation represents a serious complication of pericardial rupture, and early diagnosis is important. The purpose of this study is to determine signs of left cardiac luxation on computed tomography (CT).Methods: CT scans in nine patients with pericardial rupture and cardiac luxation after blunt chest trauma (n = 7) and postoperatively after extended left pneumectomy (n = 2) were reviewed for abnormalities. We analyzed the clinical history, clinical findings, and the imaging findings.Results: Dislocation of the heart to the left and pneumopericardium were seen in nine patients. Five of these nine patients revealed "entrapment" of the left heart between the proximal ascending aorta and the descending aorta. All patients underwent a pneumopericardium. All patients with a history of trauma showed a left-sided pneumothorax but no pericardial effusion.Conclusions: CT plays a key role for early diagnosis of cardiac luxation. Dislodgment of the heart, entrapment of the left atrium and ventricle, and pneumopericardium associated with pneumothorax are the most important CT findings.

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Screening high-risk patients with CTA

Gottlieb, Ilan MD; Lima, Joao A.C. MD;
From the Johns Hopkins Hospital, Baltimore, Md (I.G., J.A.C.L.) and Federal University of Rio de Janeiro, Cardiology Department, Medicine, Rio de Janeiro, Brazil (I.G.).
Screening High-Risk Patients With Computed Tomography Angiography

Circulation. 117(10):1318-1332, March 11, 2008.

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Screening high-risk patients with CTA

Kramer, Christopher M. MD

From the Departments of Medicine and Radiology, University of Virginia Health System, Charlottesville

All High-Risk Patients Should Not Be Screened With Computed Tomographic Angiography
Circulation. 117(10):1333-1339, March 11, 2008.

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MRI for knee osteoarthritis

AAOS study: MRI overused for knee osteoarthritis
SAN FRANCISCO - MRI scans are being overutilized in diagnosing osteoarthritis of the knee, a practice that inflates healthcare costs and sacrifices patient care standards, according to a study presented Wednesday at the American Academy of Orthopaedic Surgeons (AAOS) meeting.

American Cancer Society recognizes virtual colonoscopy screening benefit

Virtual colonoscopy got a major boost today following the decision by the American Cancer Society (ACS) to add the study to its screening guidelines for colorectal cancer. The ACS cited recent data that suggest virtual colonoscopy is comparable to optical colonoscopy for detecting cancer and polyps of significant size. The decision could pave the way for broad acceptance of virtual colonography as a screening tool and widespread reimbursement by third-party payors. Click here to read the rest of the article.

Coronary CT angiography

Sometimes, when assessing the value of a new medical technology, it's easy to get caught up in arcane statistics and lose sight of the ultimate goal: saving lives.
That's especially true with coronary CT angiography (CTA), an exciting new technology that's been generating controversy of late. At issue is whether coronary CTA's ability to detect potentially fatal heart disease before symptoms arise is worth the cost of integrating the technology into the healthcare system.
This week in our Cardiac Imaging Digital Community, we bring you a story that illustrates the lifesaving value of coronary CTA. Jim Pittman, an administrator at a Midwestern U.S. hospital, describes how his life was suddenly changed when he volunteered for a CTA exam originally intended to train technologists on a new 64-slice CT scanner.
Mr. Pittman's story alone isn't statistically significant, and by itself probably won't convince Medicare or any third-party payors to suddenly open the purse strings for coronary CTA reimbursement. But it is yet another example in a growing body of anecdotal evidence in support of the value of coronary CTA.
Learn about Mr. Pittman's story by clicking here, or visit our Cardiac Imaging Digital Community, at cardiac.auntminnie.com.