Brachiocephalic Veins ; surgery ; Decision Making ; Heart Atria ; Humans ; Male ; Middle Aged ; Prosthesis Failure ; Stents ; Tomography, X-Ray Computed ; Treatment Outcome

Adult ; Animals ; Anthelmintics ; administration & dosage ; Antibodies, Helminth ; blood ; Benzimidazoles ; administration & dosage ; Fasciola hepatica ; drug effects ; immunology ; Fascioliasis ; blood ; diagnosis ; drug therapy ; physiopathology ; Humans ; Magnetic Resonance Imaging ; methods ; Male ; Tomography, X-Ray Computed ; methods ; Treatment Outcome

Adult ; Ascites ; diagnosis ; etiology ; Biopsy ; Diagnosis, Differential ; Duodenal Obstruction ; diagnosis ; etiology ; Endoscopy, Gastrointestinal ; Enteritis ; complications ; drug therapy ; Eosinophilia ; complications ; drug therapy ; Gastritis ; complications ; drug therapy ; Humans ; Intestinal Mucosa ; pathology ; Male ; Tomography, X-Ray Computed

Recent advances in the noninvasive imaging of chronic liver disease have led to improvements in diagnosis, particularly with magnetic resonance imaging (MRI). A comprehensive evaluation of the liver may be performed with the quantification of the degree of hepatic steatosis, liver iron concentration, and liver fibrosis. In addition, MRI of the liver may be used to identify complications of cirrhosis, including portal hypertension, ascites, and the development of hepatocellular carcinoma. In this review article, we discuss the state of the art techniques in liver MRI, namely, magnetic resonance elastography, hepatobiliary phase MRI, and liver fat and iron quantification MRI. The use of these advanced techniques in the management of chronic liver diseases, including non-alcoholic fatty liver disease, will be elaborated.
Ascites ; Carcinoma, Hepatocellular ; Diagnosis ; Elasticity Imaging Techniques* ; Fatty Liver ; Fibrosis ; Hypertension, Portal ; Iron ; Liver Cirrhosis ; Liver Diseases* ; Liver* ; Magnetic Resonance Imaging* ; Non-alcoholic Fatty Liver Disease

UNLABELLEDWe hypothesise that correct interpretation of other diagnostic tests could reduce the use of computerised tomographic pulmonary angiogram (CTPA) examinations in patients with suspected pulmonary embolism (PE).

MATERIALS AND METHODSWe carried out a retrospective analysis of 158 patients in a 928-bed university hospital. These consecutive patients were investigated for suspected PE from May 2001 to February 2002 using CTPA.

RESULTSThere were 74 men and 84 women with a mean (+/-SD) age of 57 (+/-19) years. Overall, 56% of patients (89/158) showed clinically significant abnormalities on the CTPA examination. The overall prevalence of PE was 15% (24/158). The D-dimers were assayed in 40% (63/158) and lower limbs were scanned with Doppler ultrasound (US) in 22% (35/158) of patients. None of the 19 patients with negative D-dimer assays had PE. Of the patients who were positively tested on Doppler US, 4 were positive and 1 was negative for PE on the CTPA. None of the patients with positive Doppler US had negative D-dimer test. In retrospect, patient management based on negative D-dimer assays and positive lower extremity Doppler US studies could have reduced the need for further investigation with CTPA by 15% (24/158).

CONCLUSIONIn patients with suspected PE, correct interpretation of D-dimer and leg Doppler US tests may reduce the demand for CTPAs.

Adult ; Aged ; Angiography ; methods ; Female ; Fibrin Fibrinogen Degradation Products ; analysis ; Humans ; Leg ; diagnostic imaging ; Male ; Middle Aged ; Predictive Value of Tests ; Pulmonary Artery ; diagnostic imaging ; Pulmonary Embolism ; diagnosis ; Retrospective Studies ; Sensitivity and Specificity ; Tomography, Spiral Computed ; Tomography, X-Ray Computed ; Ultrasonography, Doppler

Diagnosis, Differential ; Endocarditis ; etiology ; physiopathology ; Foreign Bodies ; complications ; Heart ; physiopathology ; Humans ; Male ; Needles ; adverse effects

INTRODUCTIONThe severity of acute pulmonary embolism can be assessed with computed tomography (CT) using clot burden estimation. We compared the existing CT obstruction scores with an in-house developed central clot score for the prediction of 30-day pulmonary embolism (PE)-related mortality.

MATERIALS AND METHODSIn 125 consecutive patients [47 men, 78 women; mean age +/- standard deviation (SD, 60.4 years +/- 16.6] with acute PE, 2 readers in consensus assessed the severity of PE with 2 existing clot scoring systems (Mastora and Qanadli) and central clot score. The right ventricular dysfunction was assessed by right ventricular diameter (RVD), left ventricular diameter (LVD), ventricular ratio (VR) and septal deviation. Univariate and multivariate regression analysis were performed to correlate these parameters and 30-day PE-related mortality.

RESULTSTen patients (8%) died of PE within 30 days following CT and 115 patients did not have PE-related death outcome. There was a significant difference in all 3 clot scores, LVD and VR between patients with 30-day PE-related death and those without (P < or =0.001-0.02). Univariate regression analysis showed that all three clot scores and LVD were predictors of PE death, however with multivariate analysis, only central clot score showed significant correlation with 30-day PE death [Odds ratio (OR), 1.1; 96% CI, 1-1.16; P <0.003]. A central clot index of 53% had 100% sensitivity, 76.5% specificity, 23.5% positive predictive value and 98% negative predictive value for 30-day PE death.

CONCLUSIONCentral clot score is a strong predictor of 30-day PE death and may therefore allow therapy and risk stratification in patients with acute PE.

Acute Disease ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Blood Coagulation ; Female ; Forecasting ; Humans ; Male ; Middle Aged ; Pulmonary Embolism ; mortality ; Severity of Illness Index ; Tomography, X-Ray Computed ; Young Adult

Aged, 80 and over ; Brain ; Breast Neoplasms ; complications ; drug therapy ; physiopathology ; radiotherapy ; Cranial Fossa, Posterior ; diagnostic imaging ; physiopathology ; Female ; Humans ; Magnetic Resonance Imaging ; Neoplasm Metastasis ; diagnosis ; radiotherapy ; Ophthalmoplegia ; complications ; diagnosis ; physiopathology ; radiotherapy ; Radiography

INTRODUCTIONEnteric fever is a common infection in endemic areas; however, there are few reports describing the computed tomography (CT) manifestations of enteric fever. We aim to describe and illustrate CT findings in enteric fever in this study.

MATERIALS AND METHODSA retrospective search of medical records in our institute for patients with positive blood cultures for Salmonella typhi, and Salmonella paratyphi organisms yielded 39 cases. Among these patients, 12 had undergone a CT study of the abdomen. The CT images, laboratory and clinical findings of these 12 patients were reviewed.

RESULTSThe most common clinical presentation was fever (100%). Typical features of gastroenteritis were present in only over half of the patients. Liver function tests were abnormal in all patients. The most common abdominal manifestations on CT were the presence of mesenteric lymphadenopathy and splenomegaly (75%). Other features were circumferential small bowel wall thickening (58.3%) and free intraperitoneal fluid (50%). Three patients were found to have complications; one with bleeding from terminal ileal ulceration, another with an ileal perforation and the third with renal abscess formation.

CONCLUSIONCT is useful in evaluating enteric fever in patients with severe forms of presentation, a longer clinical course or less specific symptoms. Although the imaging features overlap with other abdominal infections, when combined with clinical features, travel history to endemic areas and presence of transaminitis, the diagnosis of enteric fever should be considered. CT in particular, is useful for the detection of complications such as perforation, bleeding and abscess formation.

Abscess ; diagnostic imaging ; Adolescent ; Adult ; Aged ; Ascitic Fluid ; diagnostic imaging ; Child ; Child, Preschool ; Female ; Humans ; Intestine, Small ; diagnostic imaging ; Lymphatic Diseases ; diagnostic imaging ; Male ; Middle Aged ; Paratyphoid Fever ; diagnostic imaging ; Radiography, Abdominal ; Retrospective Studies ; Salmonella paratyphi A ; Salmonella paratyphi B ; Salmonella typhi ; Splenomegaly ; diagnostic imaging ; Tomography, X-Ray Computed ; Typhoid Fever ; diagnostic imaging

Spontaneous cerebrospinal fluid rhinorrhoea is a rare clinical entity. The accurate localisation of the leakage site is essential for surgical planning. Imaging techniques such as high-resolution computed tomography (CT), CT cisternography and magnetic resonance cisternography in variable combinations are performed for this purpose. This pictorial essay aims to present the spectrum of imaging findings in cases of spontaneous cerebrospinal fluid rhinorrhoea, which may be useful for radiologists in the determination of the site of cerebrospinal fluid leakage.
Adult ; Cerebrospinal Fluid Rhinorrhea ; diagnostic imaging ; pathology ; surgery ; Humans ; Magnetic Resonance Imaging ; Male ; Posture ; Tomography, X-Ray Computed