Acute kidney injury (AKI) is closely associated with the mortality of hospitalized patients and long-term development of chronic kidney disease, especially in children. The purpose of our study was to assess the evidence of contrast-induced AKI after cardiac catheterization in children with heart disease and evaluate the clinical usefulness of candidate biomarkers in AKI. A total of 26 children undergoing cardiac catheterization due to various heart diseases were selected and urine and blood samples were taken at 0 hr, 6 hr, 24 hr, and 48 hr after cardiac catheterization. Until 48 hr after cardiac catheterization, there was no significant increase in serum creatinine level in all patients. Unlike urine kidney injury molecule-1, IL-18 and neutrophil gelatinase-associated lipocalin, urine liver-type fatty acid-binding protein (L-FABP) level showed biphasic pattern and the significant difference in the levels of urine L-FABP between 24 and 48 hr. We suggest that urine L-FABP can be one of the useful biomarkers to detect subclinical AKI developed by the contrast before cardiac surgery.
Acute Kidney Injury/blood/*chemically induced/*urine ; Biological Markers/urine ; Cardiac Catheterization/*adverse effects ; Child ; Contrast Media/adverse effects/diagnostic use ; Fatty Acid-Binding Proteins/*urine ; Female ; Heart Defects, Congenital/complications/*radiography ; Humans ; Iohexol/adverse effects/*analogs & derivatives/diagnostic use ; Male ; Radiography, Interventional/adverse effects ; Reproducibility of Results ; Sensitivity and Specificity

OBJECTIVE: To investigate the value of 3-dimensional (3D) CT virtual anatomy imaging (VAI) in the complex foreign body (FB) retrieval of the soft tissues. MATERIALS AND METHODS: Four hundred and seventy-five patients with radiopaque FB(s) diagnosed by radiograph underwent contrast-enhanced 3D CT examination. VAI was reconstructed by volume-rendering opacity software, by sliding down the lowest threshold from -600 to 100 HU. The imaging was grouped into three groups: A (axial and multi-planar reformation [MPR] images), B (standard 3D imaging with axial and MPR images), and C (VAI with axial and MPR images). They were analyzed to reveal the type, size, number, location, complications, and the interventional removability of the object, with the comparisons in the management and clinical outcomes on the patient follow-up studies. The data were subjected to chi-square tests, with p value < 0.05 indicating significant statistical difference. RESULTS: The FB shape, size, number, site distribution and vessels around FB, as well as the FB-associated vascular complications and the FB interventional removability were assessed more accurately in Group C than in Group B or Group A (p < 0.005). There was no significant difference in disclosing the type and depth of the FB among the three groups (p > 0.75). On the basis of the 3D CT, especially the enhanced 3D CT VAI, the followings were processed: the recommendation of interventional removal in 286 (60.47%) and non-intervention in 187 (39.53%) of the 473 patients with soft-tissue FB(s); in 352 (56.50%) of the 623 radiopaque FBs patients, 258 (54.55%) patients accurately detected on 3D CT and the successful removal by intervention (343 FBs) or surgery (9 FBs) without any sequela; and 215 (45.45%) patients with 271 FBs lost in the follow-up, with their departure from the hospital. CONCLUSION: The 3D CT, especially 3D enhanced CT VAI, has great incremental value in further diagnosis and management of complex FB extraction from soft tissues.
Adolescent ; Adult ; Aged ; Contrast Media/diagnostic use ; Female ; Foreign Bodies/*radiography/surgery ; Humans ; *Imaging, Three-Dimensional ; Iohexol/diagnostic use ; Male ; Middle Aged ; Radiographic Image Interpretation, Computer-Assisted ; Tomography, X-Ray Computed/*methods ; Treatment Outcome ; User-Computer Interface

OBJECTIVE: To compare the ancillary CT findings between superior mesenteric artery thromboembolism (SMAT) and superior mesenteric vein thrombosis (SMVT), and to determine the independent CT findings of life-threatening mesenteric occlusion. MATERIALS AND METHODS: Our study was approved by the institution review board. We included 43 patients (21 SMAT and 22 SMVT between 1999 and 2008) of their median age of 60.0 years, and retrospectively analyzed their CT scans. Medical records were reviewed for demographics, management, surgical pathology diagnosis, and outcome. We compared CT findings between SMAT and SMVT groups. Multivariate analysis was conducted to determine the independent CT findings of life-threatening mesenteric occlusion. RESULTS: Of 43 patients, 24 had life-threatening mesenteric occlusion. Death related to mesenteric occlusion was 32.6%. A thick bowel wall (p < 0.001), mesenteric edema (p < 0.001), and ascites (p = 0.009) were more frequently associated with SMVT, whereas diminished bowel enhancement (p = 0.003) and paralytic ileus (p = 0.039) were more frequent in SMAT. Diminished bowel enhancement (OR = 20; p = 0.007) and paralytic ileus (OR = 16; p = 0.033) were independent findings suggesting life-threatening mesenteric occlusion. CONCLUSION: The ancillary CT findings occur with different frequencies in SMAT and SMVT. However, the independent findings indicating life-threatening mesenteric occlusion are diminished bowel wall enhancement and paralytic ileus.
Arteries ; Contrast Media/diagnostic use ; Female ; Humans ; Iohexol/diagnostic use ; Male ; Mesenteric Vascular Occlusion/mortality/pathology/*radiography ; Middle Aged ; Multivariate Analysis ; Retrospective Studies ; Risk Factors ; Tomography, X-Ray Computed/*methods ; Veins

We describe a case of new-onset heart failure in a patient in whom cardiac CT enabled the non-invasive diagnosis of isolated non-compaction and associated functional abnormalities of the left ventricle with the concomitant evaluation of coronary arteries. This case highlights the utility of cardiac CT for the morphological and functional evaluation of the heart as a single imaging modality.
Aged ; Cardiac-Gated Imaging Techniques ; Contrast Media/diagnostic use ; Diagnosis, Differential ; Disease Progression ; Echocardiography ; Electrocardiography ; Heart Failure/*diagnosis ; Humans ; Image Interpretation, Computer-Assisted ; Iohexol/analogs & derivatives/diagnostic use ; Isolated Noncompaction of the Ventricular Myocardium/*diagnosis ; Magnetic Resonance Imaging ; Male ; *Tomography, X-Ray Computed

OBJECTIVE: To investigate whether the low-tube-voltage (80-kVp), intermediate-tube-current (340-mAs) MDCT using the Iterative Reconstruction in Image Space (IRIS) algorithm improves lesion-to-liver contrast at reduced radiation dosage while maintaining acceptable image noise in the detection of hepatocellular carcinomas (HCC) in thin (mean body mass index, 24 +/- 0.4 kg/m2) adults. SUBJECTS AND METHODS: A phantom simulating the liver with HCC was scanned at 50-400 mAs for 80, 100, 120 and 140-kVp. In addition, fifty patients with HCC who underwent multiphasic liver CT using dual-energy (80-kVp and 140-kVp) arterial scans were enrolled. Virtual 120-kVP scans (protocol A) and 80-kVp scans (protocol B) of the late arterial phase were reconstructed with filtered back-projection (FBP), while corresponding 80-kVp scans were reconstructed with IRIS (protocol C). Contrast-to-noise ratio (CNR) of HCCs and abdominal organs were assessed quantitatively, whereas lesion conspicuity, image noise, and overall image quality were assessed qualitatively. RESULTS: IRIS effectively reduced image noise, and yielded 29% higher CNR than the FBP at equivalent tube voltage and current in the phantom study. In the quantitative patient study, protocol C helped improve CNR by 51% and 172% than protocols A and B (p < 0.001), respectively, at equivalent radiation dosage. In the qualitative study, protocol C acquired the highest score for lesion conspicuity albeit with an inferior score to protocol A for overall image quality (p < 0.001). Mean effective dose was 2.63-mSv with protocol A and 1.12-mSv with protocols B and C. CONCLUSION: CT using the low-tube-voltage, intermediate-tube-current and IRIS help improve lesion-to-liver CNR of HCC in thin adults during the arterial phase at a lower radiation dose when compared with the standard technique using 120-kVp and FBP.
*Algorithms ; Analysis of Variance ; Carcinoma, Hepatocellular/*blood supply/*radiography ; Contrast Media/diagnostic use ; Female ; Humans ; Iohexol/analogs & derivatives/diagnostic use ; Liver Neoplasms/*blood supply/*radiography ; Male ; Middle Aged ; Phantoms, Imaging ; Radiographic Image Interpretation, Computer-Assisted/*methods ; Regression Analysis ; Retrospective Studies ; Tomography, X-Ray Computed/*methods

OBJECTIVE: To identify the CT features that help differentiate gastric schwannomas (GS) from small (5 cm or smaller) gastrointestinal stromal tumors (GIST) and to assess the growth rates of both tumors. MATERIALS AND METHODS: We included 16 small GSs and 56 GISTs located in the stomach. We evaluated the CT features including size, contour, surface pattern, margins, growth pattern, pattern and degree of contrast enhancement, and the presence of intralesional low attenuation area, hemorrhage, calcification, surface dimpling, fistula, perilesional lymph nodes (LNs), invasion to other organs, metastasis, ascites, and peritoneal seeding. We also estimated the tumor volume doubling time. RESULTS: Compared with GISTs, GSs more frequently demonstrated a homogeneous enhancement pattern, exophytic or mixed growth pattern, and the presence of perilesional LNs (each p < 0.05). The intralesional low attenuation area was more common in GISTs than GSs (p < 0.05). Multivariate analyses indicated that a homogeneous enhancement pattern, exophytic or mixed growth pattern, and the presence of perilesional LNs were statistically significant (p < 0.05). Tumor volume doubling times for GSs (mean, 1685.4 days) were significantly longer than that of GISTs (mean, 377.6 days) (p = 0.004). CONCLUSION: Although small GSs and GISTs show similar imaging findings, GSs more frequently show an exophytic or mixed growth pattern, homogeneous enhancement pattern, perilesional LNs and grow slower than GISTs.
Adult ; Aged ; Aged, 80 and over ; Contrast Media/diagnostic use ; Diagnosis, Differential ; Endoscopy, Gastrointestinal ; Female ; Gastrointestinal Stromal Tumors/pathology/*radiography ; Humans ; Iohexol/analogs & derivatives/diagnostic use ; Logistic Models ; Male ; Middle Aged ; Neurilemmoma/pathology/*radiography ; Retrospective Studies ; Statistics, Nonparametric ; Stomach Neoplasms/pathology/*radiography ; Tomography, X-Ray Computed/*methods

OBJECTIVE: To measure the intra-fraction displacements of the mediastinal metastatic lymph nodes by using four-dimensional CT (4D-CT) in non-small cell lung cancer (NSCLC). MATERIALS AND METHODS: Twenty-four patients with NSCLC, who were to be treated by using three dimensional conformal radiation therapy (3D-CRT), underwent a 4D-CT simulation during free breathing. The mediastinal metastatic lymph nodes were delineated on the CT images of 10 phases of the breath cycle. The lymph nodes were grouped as the upper, middle and lower mediastinal groups depending on the mediastinal regions. The displacements of the center of the lymph node in the left-right (LR), anterior-posterior (AP), and superior-inferior (SI) directions were measured. RESULTS: The mean displacements of the center of the mediastinal lymph node in the LR, AP, and SI directions were 2.24 mm, 1.87 mm, and 3.28 mm, respectively. There were statistically significant differences between the displacements in the SI and LR, and the SI and AP directions (p < 0.05). For the middle and lower mediastinal lymph nodes, the displacement difference between the AP and SI was statistically significant (p = 0.005; p = 0.015), while there was no significant difference between the LR and AP directions (p < 0.05). CONCLUSION: The metastatic mediastinal lymph node movements are different in the LR, AP, and SI directions in patients with NSCLC, particularly for the middle and lower mediastinal lymph nodes. The spatial non-uniform margins should be considered for the metastatic mediastinal lymph nodes in involved-field radiotherapy.
Adult ; Aged ; Aged, 80 and over ; Carcinoma, Non-Small-Cell Lung/*radiography/radiotherapy ; Contrast Media/diagnostic use ; Female ; Four-Dimensional Computed Tomography/*methods ; Humans ; Iohexol/analogs & derivatives/diagnostic use ; Lung Neoplasms/*radiography/radiotherapy ; Lymphatic Metastasis/*radiography ; Male ; Mediastinum/radiography ; Middle Aged ; Radiographic Image Interpretation, Computer-Assisted ; Statistics, Nonparametric

OBJECTIVE: To retrospectively define which histologic characteristics of small-sized hepatocellular carcinomas (HCCs) are related to atypical dynamic enhancement on multi-detector computed tomography (MDCT) imaging. MATERIALS AND METHODS: Seventy-three patients with 83 HCCs (3 cm or less in diameter) were included in this study. All patients underwent 4-phase MDCT imaging and subsequent surgery within eight weeks. Two independent radiologists blinded to the histologic findings retrospectively classified the HCCs as either typical (showing increased enhancement on arterial phase images followed by washout in late phase images) or atypical lesions demonstrating any other enhancement pattern. From the original pathologic reports, various histologic characteristics including gross morphology, nuclear histologic grades, presence of capsule formation, and capsule infiltration when a capsule was present, were compared among the two groups. RESULTS: An atypical enhancement pattern was seen in 30 (36.2%) of the 83 HCCs. The mean size of atypical HCCs (1.71 +/- 0.764) was significantly smaller than that of typical HCCs (2.31 +/- 0.598, p < 0.001). Atypical HCCs were frequently found to be vaguely nodular in gross morphology (n = 13, 43.3%) and to have grade I nuclear grades (n = 17, 56.7%). Capsule formation was significantly more common in typical HCCs (p < 0.001). Capsular infiltration was also more common in typical HCCs (p = 0.001). CONCLUSION: HCCs showing atypical dynamic enhancement on MDCT imaging are usually smaller than typical HCCs, vaguely nodular type in gross morphology in most cases, and well-differentiated in nuclear grades, and they lack of capsule formation or capsular infiltration.
Adult ; Carcinoma, Hepatocellular/pathology/*radiography/surgery ; Chi-Square Distribution ; Contrast Media/diagnostic use ; Diagnosis, Differential ; Female ; Humans ; Image Enhancement ; Iohexol/analogs & derivatives/diagnostic use ; Liver Neoplasms/pathology/*radiography/surgery ; Male ; Middle Aged ; Radiographic Image Interpretation, Computer-Assisted ; Retrospective Studies ; Tomography, X-Ray Computed/*methods

OBJECTIVE: To assess the technical feasibility and local efficacy of biplane fluoroscopy plus US-guided percutaneous radiofrequency ablation (RFA) for viable hepatocellular carcinoma (HCC) around retained iodized oil after transcatheter arterial chemoembolization (TACE). MATERIALS AND METHODS: Our prospective study was approved by our institutional review board and informed consent was obtained from all participating patients. For patients with viable HCC around retained iodized oil after TACE, biplane fluoroscopy plus US-guided RFA was performed. We evaluated the rate of technical success and major complications on a post-RFA CT examination and local tumor progression with a follow-up CT. RESULTS: Among 40 consecutive patients, 19 were excluded due to one of the following reasons: poorly visible HCC on fluoroscopy (n = 13), high risk location (n = 2), RFA performed under monoplane fluoroscopy and US guidance (n = 2), and poorly identifiable new HCCs on US (n = 2). The remaining 21 patients with 21 viable HCCs were included. The size of total tumors ranged from 1.4 to 5.0 cm (mean: 3.2 cm) in the longest diameter. Technical success was achieved for all 21 HCCs, and major complications were observed in none of the patients. During the follow-up period (mean, 20.3 months; range, 6.5-29.9 months), local tumor progression was found in two patients (2/21, 9.5%). Distant intrahepatic metastasis developed in 76.2% (16/21) of patients. CONCLUSION: When retained iodized oil around the tumor after TACE hampers the targeting of the viable tumor for RFA, biplane fluoroscopy plus US-guided RFA may be performed owing to its technical feasibility and effective treatment for viable HCCs.
Aged ; Aged, 80 and over ; Carcinoma, Hepatocellular/radiography/*surgery/therapy ; *Catheter Ablation ; *Chemoembolization, Therapeutic ; Complex Mixtures ; *Contrast Media ; Female ; *Fluoroscopy/methods ; Humans ; Iodized Oil/*administration & dosage ; Iohexol/analogs & derivatives/diagnostic use ; Liver Neoplasms/radiography/*surgery/therapy ; Male ; Middle Aged ; *Ultrasonography, Interventional

OBJECTIVE: The purpose of this study was to prospectively compare pre-operative computed tomography (CT) perfusion parameters with tumor grade from colorectal adenocarcinoma (CRC) and to correlate pre-operative CT perfusion parameters with microvessel density (MVD) to evaluate angiogenesis in CRC. MATERIALS AND METHODS: Pre-operative perfusion CTs were performed with a 64-channel multidetector row CT in 27 patients (17 women and 10 men; age range 32-82 years) who were diagnosed with CRC involving the sigmoid and rectum between August 2006 and November 2007. All patients underwent surgery without pre-operative chemotherapy or radiation therapy. Dynamic perfusion CTs were performed for 65 seconds after intravenous injection of contrast medium (100 mL, 300 mg of iodine per mL, 5 mL/sec). Before surgery, blood flow (BF), blood volume, mean transit time (MTT), and permeability-surface area product were measured in the tumor. After surgery, one gastrointestinal pathologist evaluated tumor grade and performed immunohistochemical staining using CD 34 to determine MVD in each tumor. The Kruskal-Wallis test was used to compare CT perfusion parameters with tumor grade, and Pearson's correlation analysis was used to correlate CT perfusion parameters with MVD. RESULTS: In 27 patients with CRC, tumor grading was as follows: well differentiated (n = 8); moderately differentiated (n = 15); and poorly differentiated (n = 4). BF was higher in moderately differentiated CRC than well differentiated and poorly differentiated CRCs (p = 0.14). MTT was shorter in moderately differentiated than well differentiated and poorly differentiated CRCs (p = 0.039). The MVD was greater in poorly differentiated than well differentiated and moderately differentiated CRCs (p = 0.034). There was no significant correlation between other perfusion parameters and tumor grade. There was no significant correlation between CT perfusion parameters and MVD. CONCLUSION: BF and MTT measurement by perfusion CT is effective in predicting moderately differentiated CRCs. However, perfusion CT is limited in distinguishing well differentiated and poorly differentiated CRCs. Pre-operative perfusion CT does not reflect the MVD of CRCs.
Adenocarcinoma/pathology/*radiography ; Adult ; Aged ; Aged, 80 and over ; Colorectal Neoplasms/pathology/*radiography ; Contrast Media/diagnostic use ; Female ; Humans ; Iohexol/analogs & derivatives/diagnostic use ; Male ; Microcirculation ; Middle Aged ; Neoplasm Grading ; Neovascularization, Pathologic/*radiography ; Prospective Studies ; Statistics, Nonparametric ; Tomography, X-Ray Computed/*methods