BACKGROUND & AIMS: :We performed successful surgery for lung cancer after confirming the anatomical abnormality of a tracheal bronchus by three-dimensional multidetector-row computed tomography (3D-MDCT) bronchography and angiography. Tracheal bronchus is unusual, and right upper lobectomy for lung cancer would rarely be performed in a patient with a tracheal bronchus. Most clinicians are unfamiliar with the anatomy of a right upper lobe that includes a tracheal bronchus. Preoperative 3D imaging of the tracheal bronchus and its related vessels familiarized us with the anatomy of this patient before the operation. Thus, we recommend preoperative 3DMDCT bronchography and angiography, especially for patients with a possible bronchial anomaly.

背景与目标： : 通过三维多探测器行计算机断层扫描 (3D-MDCT) 支气管造影和血管造影证实了气管支气管的解剖异常后，我们成功进行了肺癌手术。气管支气管是不常见的，对于患有气管支气管的患者，很少进行右上叶切除术治疗肺癌。大多数临床医生不熟悉包括气管支气管在内的右上叶的解剖结构。术前气管支气管及其相关血管的3D成像使我们在手术前熟悉了该患者的解剖结构。因此，我们建议术前进行3DMDCT支气管造影和血管造影，尤其是对于可能出现支气管异常的患者。

BACKGROUND & AIMS: PURPOSE:To assess the usefulness of MRI and determine which MR sequence is most effective for diagnosing the mild forms of acute pancreatitis. MATERIALS AND METHODS:Forty subjects (20 normal volunteers and 20 patients with a mild form of acute pancreatitis) underwent MRI with fat-suppressed T1-weighted fast low-angle shot (FLASH), half-Fourier acquisition single-shot turbo spin-echo (HASTE), and TSE short TI inversion recovery (TSE-STIR) sequences. The 20 patients with a mild form of acute pancreatitis underwent multidetector CT (MDCT) and MRI within a 24-hour interval. We qualitatively analyzed all of the images by assessing inflammatory changes in the pancreas and peripancreatic fat. We quantitatively compared differences in pancreas-liver contrast between the control and patient groups for each MR sequence by measuring the signal intensities of the pancreas and liver. RESULTS:TSE-STIR was the best of the four modalities for delineating peripancreatic and pancreatic inflammation (P < 0.01). TSE-STIR depicted definitive peripancreatic and pancreatic inflammation in 18 and 15 patients, respectively. MDCT depicted only three cases of peripancreatic inflammation. TSE-STIR was also produced the best the best quantitative results of the MR sequences (P = 0.09). CONCLUSION:MRI is helpful for diagnosing the mild forms of acute pancreatitis. We recommend the use of TSE-STIR imaging as part of the routine protocol for evaluating pancreatitis.

背景与目标：

BACKGROUND & AIMS: OBJECTIVE:Current risk stratification of patients with acute chest pain but normal initial cardiac enzymes and nondiagnostic ECG is inefficient. We sought to determine whether contrast-enhanced MDCT-based detection of stenosis is feasible and improves early and accurate triage of patients with acute chest pain. SUBJECTS AND METHODS:We studied 40 patients (53% men; mean age, 57 +/- 13 years) with chest pain who were awaiting hospital admission to rule out an acute coronary syndrome (ACS) despite the absence of diagnostic ECG changes and normal cardiac enzymes on emergency department presentation. Patients underwent contrast-enhanced MDCT before hospital admission. Afterward, patients received standard clinical care. All physicians involved in the patients' care were blinded to the results of MDCT. An expert panel established the presence or absence of ACS based on American Heart Association (AHA) guidelines. The MDCT images were evaluated for the presence of significant coronary artery stenosis (diameter reduction > 50%) and were used to make a triage decision. RESULTS:All five patients (12.5%) with ACS (one with non-ST elevation myocardial infarction, four with unstable angina pectoris) had at least one significant coronary stenosis on MDCT (sensitivity, 100% [95% CI, 49-100%)]. ACS was ruled out in 35 patients (87.5%). Significant coronary stenosis was excluded in 26 of the 35 patients without ACS by MDCT (specificity, 74% [CI, 75-88%]), potentially saving 70% of unnecessary hospital admissions. CONCLUSION:MDCT-based detection of significant coronary stenoses has tremendous potential to decrease the number of unnecessary hospital admissions, without reducing appropriate admission rates, in patients with chest pain who have nondiagnostic ECG results and normal cardiac enzymes. These results are likely to further improve with advances in MDCT technology.

背景与目标：

BACKGROUND & AIMS: Nucleotides have diverse effects on water and electrolyte reabsorption within the distal tubule of the nephron. As the distal tubule is important in control of renal Mg(2+) balance, we determined the effects of ATP on cellular Mg(2+) uptake in this segment. The effects of ATP on immortalized mouse distal convoluted tubule (MDCT) cells were studied by measuring Mg(2+) uptake with fluorescence techniques. The mean basal Mg(2+) uptake rate was 165 +/- 6 nM/s. ATP inhibited basal Mg(2+) uptake and hormone-stimulated Mg(2+) entry by 40%. Both P2X (P2X1-P2X5 subtypes) and P2Y2 receptor subtypes were identified in MDCT cells using differential RT-PCR. Activation of both receptor subtypes with selective agonists increased intracellular Ca(2+) concentration, P2X purinoceptors by ionotropic-gated channels, and P2Y receptors via G protein-mediated intracellular Ca(2+) release. The more relatively selective P2X agonists [beta,gamma-methylene ATP (beta,gamma-Me-ATP) and 2'- and -3'-O-(4-benzoyl-benzoyl)-ATP] inhibited arginine vasopressin (AVP)- and parathyroid hormone (PTH)-mediated Mg(2+) uptake whereas agonists more selective for P2Y purinoceptors (UTP, ADP, and 2-methylthio-ATP) were without effect. Removal of extracellular Ca(2+) diminished beta,gamma-Me-ATP-mediated increase in intracellular Ca(2+) and inhibition of AVP-stimulated Mg(2+) entry. We conclude from this information that ATP inhibited Mg(2+) uptake in MDCT cells through P2X purinoceptors expressed in this distal convoluted tubule cell line.

背景与目标： 核苷酸对肾单位远端小管内的水和电解质重吸收有多种影响。由于远端小管在控制肾脏Mg(2) 平衡方面很重要，因此我们确定了ATP对该节段中细胞Mg(2) 摄取的影响。通过荧光技术测量Mg(2) 的摄取，研究了ATP对永生化小鼠远曲小管 (MDCT) 细胞的影响。平均基础Mg(2 +) 摄取速率为165 +/- 6 nM/s。ATP通过40% 抑制基础Mg(2 +) 摄取和激素刺激的Mg(2 +) 进入。使用差异rt-pcr在MDCT细胞中鉴定出P2X (P2X1-P2X5亚型) 和P2Y2受体亚型。选择性激动剂激活两种受体亚型均增加了细胞内Ca(2) 的浓度，离子型门控通道的P2X嘌呤受体以及通过g蛋白介导的细胞内Ca(2) 释放的P2Y受体。比较选择性的P2X激动剂 [β，γ-亚甲基ATP (β，Γ-Me-ATP) 和2 '-和-3'-O-(4-苯甲酰基)-ATP] 抑制精氨酸加压素 (AVP)-和甲状旁腺激素 (PTH) 介导的Mg(2) 摄取，而激动剂对P2Y嘌呤受体更具选择性 (UTP，ADP，和2-甲硫基-atp) 没有作用。去除细胞外Ca(2) 可减少 β，γ-Me-ATP介导的细胞内Ca(2) 的增加，并抑制AVP刺激的Mg(2) 进入。我们从该信息得出结论，ATP通过在该远端曲小管细胞系中表达的P2X嘌呤受体抑制了MDCT细胞中Mg(2) 的摄取。

BACKGROUND & AIMS: UNLABELLED:Six hundred sixty-one participants who had at least one cardiac risk factor but were without known coronary heart disease underwent low-dose multidetector computed tomography coronary angiography (MDCT-CA) and dual-energy X-ray absorptiometry. The association between presence of subclinical coronary calcified plaque and low bone mineral density for the middle-aged individual was not significant after multivariate adjustment. INTRODUCTION:Results of previous clinical studies assessing the relationship between osteoporosis and coronary calcification are inconsistent. This study aimed to evaluate the association between subclinical coronary calcification and osteoporosis in middle-aged men, premenopausal women, and postmenopausal women by using low-dose MDCT-CA and bone mineral density (BMD). METHODS:This study enrolled 661 participants with at least one cardiac risk factor but without known coronary artery disease (CAD). All subjects underwent low-dose MDCT-CA and dual-energy X-ray absorptiometry on the same day. RESULTS:The mean age was 52.2 years for men, 44.8 years for premenopausal women, and 59.1 years for postmenopausal women. The prevalence of calcified plaques between men with normal BMD and low BMD at lumbar spine were significantly different (P=0.042). The prevalence of mixed plaque and calcified plaque between pre- and postmenopausal women with normal BMD and low BMD at lumbar spine and femoral neck were not significantly different (P>0.05). Possible association between lumbar spine, femoral neck, and total proximal femur BMD and the presence of CAP was evaluated for men, premenopausal women, and postmenopausal women using multivariate logistic regression analysis: results were not significant (P>0.05). CONCLUSION:Our study demonstrates that the association between the presence of subclinical coronary calcification and low BMD among middle-aged men and women was not significant after controlling for age and other risk factors for CAD and osteoporosis.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:To evaluate feasibility and reproducibility of quantification of perinephric hematoma volume on multidetector-row CT (MDCT). METHODS:Perinephric hematomas in 63 patients (42 males, 21 females, median age: 49 years) imaged with contrast-enhanced MDCT of the abdomen were evaluated. A semi-automated segmentation software was applied to quantify hematoma volume. Reproducibility for quantification of hematoma volume was evaluated by repeated measurements in 20 patients. Statistical analyses were performed by using Student's t test. Interobserver and intraobserver variability was evaluated by Bland-Altman plots. P < 0.05 denoted statistical significance RESULTS:Quantification of hematoma volume was feasible in all cases. One step, direct quantification of volume was possible in 21 patients (33.33%) with small hematomas that did not reach upper and lower renal poles (range: 3.12-183.98 mL; mean: 39.92 mL). Quantification of hematoma size was performed indirectly in 42 patients (66.67%) with larger hematomas that extended beyond the renal poles by subtracting the ipsilateral renal volume from the combined kidney and hematoma volumes (range: 27.08-2431.3 mL; mean: 435.31 mL). Mean quantification time was 45 and 71 s for small and large hematomas, respectively (P < 0.05). Mean intraobserver and interobserver variability for determination of hematoma volume was 0.14% (95% CI, -1.57% to 1.85%) and 2.04% (95% CI, -1.77% to 5.85%), respectively. There was no significant difference in renal volume between ipsilateral and contralateral kidneys (P > 0.05). CONCLUSION:Quantification of perinephric hematoma was feasible from MDCT data in all patients and was reproducible.

背景与目标：

BACKGROUND & AIMS: :Calcinosis is a typical feature of systemic sclerosis (SSc) and can be found in many different tissues including the superficial soft tissues, periarticular structures, muscles, and tendons. It can also provoke erosive changes on bones. Investigation is conducted most often with plain radiographs. However, when a more detailed assessment is necessary, multidetector computed tomography (MDCT) is helpful owing to its multiplanar reformat (MPR) ability. The purpose of this review is to provide an overview of the various appearances of calcinosis in SSc patients as visualized at MDCT.

背景与目标： : 钙质沉着症是系统性硬化症 (SSc) 的典型特征，可在许多不同的组织中发现，包括浅表软组织，关节周围结构，肌肉和肌腱。它还会引起骨骼的侵蚀变化。调查最常使用x线平片进行。但是，当需要更详细的评估时，多探测器计算机断层扫描 (MDCT) 由于其多平面重新格式化 (MPR) 能力而很有帮助。这篇综述的目的是概述在MDCT中可见的SSc患者中钙化沉病的各种表现。

BACKGROUND & AIMS: OBJECTIVE:The purpose of this study was to evaluate the performance of MRI and a combination of MDCT arthrography and MR arthrography in the diagnosis of tears and cartilage abnormalities of the wrist ligaments. SUBJECTS AND METHODS:The feasibility of combining MDCT arthrography and MR arthrography and performing them with an optimized contrast solution was evaluated in vitro and in vivo. Forty-five consecutively enrolled subjects with suspected wrist ligament tears underwent MRI and a combined MDCT and MR arthrographic procedure. Two observers reviewed the images for evidence of tears and cartilage abnormalities of the scapholunate and lunotriquetral ligaments and triangular fibrocartilaginous complex. Interobserver agreement was determined with kappa statistics, and the diagnostic accuracy of each technique was calculated. RESULTS:A 1:1 solution of 2.5 mmol/L tetraazacyclododecanetetraacetic acid (DOTA)-gadolinium and 300 mg I/mL iopamidol provided adequate contrast enhancement for both in vitro and in vivo MDCT arthrographic and MR arthrographic images. Interobserver agreement was substantial for MRI (kappa = 0.61) and MR arthrography (kappa = 0.71) and almost perfect for MDCT arthrography (kappa = 0.93). The sensitivity and specificity of MRI, MDCT arthrography, and MR arthrography for tears of the scapholunate ligament were 59% and 70%, 95% and 96%, and 68% and 87% for the first observer and 77% and 83%, 95% and 100%, and 77% and 87% for the second observer. For tears of the lunotriquetral ligament, these values were 30% and 94%, 100% and 94%, and 60% and 97% for the first observer and 50% and 97%, 90% and 100%, and 50% and 94% for the second observer. The three techniques appeared equivalent for complete tears of the scapholunate and lunotriquetral ligaments, but partial tears were significantly better visualized with MDCT arthrography. The sensitivity and specificity of MRI, MDCT arthrography, and MR arthrography for triangular fibrocartilaginous complex tears were 27% and 100%, 100% and 100%, and 82% and 100% for the first observer and 45% and 100%, 100% and 100%, and 82% and 100% for the second observer. For cartilage abnormalities, these values were 30% and 100%, 100% and 100%, and 30% and 100% for the first observer and 10% and 100%, 100% and 100%, and 40% and 100% for the second observer. CONCLUSION:MDCT arthrography appears more accurate than MRI and MR arthrography, particularly for discerning partial tears of the scapholunate and lunotriquetral ligaments that do not necessitate surgical therapy.

背景与目标：

BACKGROUND & AIMS: PURPOSE:The aim of the study was to compare the influence of different reconstruction algorithms on quantitative emphysema analysis in patients with severe emphysema. MATERIAL AND METHODS:Twenty-five patients suffering from severe emphysema were included in the study. All patients underwent inspiratory MDCT (Aquilion-16, slice thickness 1/0.8mm). The raw data were reconstructed using six different algorithms: bone kernel with beam hardening correction (BHC), soft tissue kernel with BHC; standard soft tissue kernel, smooth soft tissue kernel (internal reference standard), standard lung kernel, and high-convolution kernel. The only difference between image data sets was the algorithm employed to reconstruct the raw data, no additional radiation was required. CT data were analysed using self-written emphysema detection and quantification software providing lung volume, emphysema volume (EV), emphysema index (EI) and mean lung density (MLD). RESULTS:The use of kernels with BHC led to a significant decrease in MLD (5%) and EI (61-79%) in comparison with kernels without BHC. The absolute difference (from smooth soft tissue kernel) in MLD ranged from -0.6 to -6.1 HU and were significant different for all kernels. The EV showed absolute differences between -0.05 and -0.4 L and was significantly different for all kernels. The EI showed absolute differences between -0.8 and -5.1 and was significantly different for all kernels. CONCLUSION:The use of kernels with BHC led to a significant decrease in MLD and EI. The absolute differences between different kernels without BHC were small but they were larger than the known interscan variation in patients. Thus, for follow-up examinations the same reconstruction algorithm has to be used and use of BHC has to be avoided.

背景与目标：

BACKGROUND & AIMS: CONCLUSION:Three-dimensional multi-detector computed tomography (3D MDCT) analysis of the upper airway suggested that the lengthening of the upper airway in the absence of volumetric change may independently contribute to the severity of obstructive sleep apnea syndrome (OSAS) in adults. OBJECTIVES:We sought to investigate the relationships among the length and volume of the upper airway to the severity of OSAS. METHODS:A total of 73 subjects underwent 3D MDCT scanning and standard polysomnography. We measured the upper airway length (UAL), which was defined as the vertical distance from the hard palate to the hyoid in the mid-sagittal plane. We also used the height-adjusted UAL for analyses. Upper airway volume was measured using a 3D reconstruction of the cross-sectional area from the hard palate to the hyoid. RESULTS:The adjusted UAL showed a significant positive correlation with the apnea hypopnea index (AHI, r = 0.523, p < 0.000) and was a significant variable for predicting the AHI of OSAS patients in multiple stepwise regression analysis. Although the severe OSAS group had a greater adjusted UAL compared with that of other groups (p = 0.001), the volume of the upper airway did not show differences among groups.

背景与目标：

BACKGROUND & AIMS: OBJECTIVE:Determination of left ventricular (LV) volumes and global function parameters from MDCT data sets is usually based on short-axis reformations from primarily reconstructed axial images, which prolong postprocessing time. The aim of this study was to evaluate the feasibility of LV volumetry and global LV function assessment from axial images in comparison with short-axis image reformations. SUBJECTS AND METHODS:This study consisted of 20 patients with either coronary artery disease or dilated cardiomyopathy. We evaluated MDCT results using cine MRI as the reference technique. RESULTS:LV end-diastolic volume (LVEDV) and end-systolic volume (LVESV) were significantly overestimated by the axial MDCT approach in comparison with volume measurements from short-axis CT image reformations. The mean LV ejection fraction (LVEF) was not significantly different (41.2% vs 42.7%). Short-axis and axial MDCT determination of LVEF revealed a systematic underestimation by a mean +/- SD of -2.1% +/- 3.6% versus -3.6% +/- 8.2%, respectively, when compared with LVEF values based on cine MRI. The interobserver variability for volume and function measurements from axial images (LVEDV = 8.5%, LVESV = 10.8%, LVEF = 9.6%) was slightly higher than those measurements from short-axis reformations (LVEDV = 7.2%, LVESV = 9.5%, LVEF = 8.7%). The mean total evaluation time was significantly shorter using axial images (14.1 +/- 3.9 min) compared with short-axis reformations (16.9 +/- 5.2 min) (p < 0.05). CONCLUSION:Determination of LV volumes and assessment of global LV function from axial MDCT image reformations is feasible and time efficient. This approach might be a clinically useful alternative to established short-axis-based measurements in patients with normal or near-normal LV function. A progressive underestimation of LVEF with increasing LV volumes may limit the clinical applicability of the axial approach in patients with dilated cardiomyopathy.

背景与目标：

BACKGROUND & AIMS: OBJECTIVE:The purposes of this study were to determine the reproducibility of quantitative colorectal cancer perfusion measurements using dynamic contrast-enhanced MDCT, and to compare this with measurements from skeletal muscle. SUBJECTS AND METHODS:Ten patients (mean age, 67 years; six men, four women) with histologically proven colorectal cancer were examined prospectively using 4-MDCT. Perfusion studies (cine mode; 4 x 5 mm collimation; 1 acquisition/s; 65 seconds total) were performed through the tumor epicenter after IV bolus contrast administration (iopamidol 340, 100 mL; 5 mL/s) and repeated within 48 hours. Quantitative values for blood volume, blood flow, mean transit time, and permeability were determined using commercial software. Two regions of interest were studied on the axial image: one within the tumor and another within the left gluteal muscle. Measurement reproducibility was assessed using Bland-Altman statistics. RESULTS:For the tumor, the mean difference (95% limits of agreement) was -0.04 mL/100 g tissue (-2.50, 2.42); 8.80 (-50.5, 68.0) mL/100 g tissue/min; -0.99 (-8.19, 6.20) seconds; and 1.20 (-5.42, 7.83) mL/100 g tissue/min for blood volume, blood flow, mean transit time, and permeability, respectively. For muscle, the mean difference (95% limits of agreement) was 0.02 (-1.40, 1.43), 6.60 (-11.2, 24.3), -3.76 (-16.87, 9.35), and 1.30 (-4.68, 7.28), respectively. CONCLUSION:Quantitative perfusion measurements are reproducible. Measurements from tumor are less variable than from skeletal muscle.

背景与目标：

BACKGROUND & AIMS: OBJECTIVE:High reproducibility on coronary artery calcium (CAC) scoring is a key requirement in monitoring the progression of coronary atherosclerosis. Retrospective ECG-gated helical CT has been shown to be superior to prospective gating helical CT in the reproducibility of CAC measurements. However, it brings with it a high level of radiation exposure. The purpose of this study was to compare low- and standard-dose protocols in the variability of CAC scores and in image quality, thereby assessing the feasibility of low-dose retrospective ECG-gated helical CT in CAC measurements. SUBJECTS AND METHODS:Eighty-six patients with CAC were scanned using a tube current setting of 100 mA once and then a tube current setting equivalent to the patient's body weight twice. CAC scores (Agatston and volume) and interscan variability were evaluated. The mean and SD of the CT attenuation values in regions of interest in the aorta were measured, and the value (mean + 2 x SD) was obtained. RESULTS:A high correlation of log(10) (Agatston score + 1) was observed between sequential helical CT scans (r = 0.998). The variability in CAC measurements ranged from 11% to 12% for both the Agatston and volume scores. With the tube current equivalent to body weight, the value (mean + 2 x SD) did not exceed a CT attenuation value of 130 H. CONCLUSION:Low-dose retrospective ECG-gated helical CT-yielding low variability and achieving the level of image quality needed to measure CAC-can be used to monitor patients with coronary atherosclerosis.

背景与目标：

BACKGROUND & AIMS: OBJECTIVE:This article illustrates the MDCT postmortem imaging features that have the potential to enhance forensic investigation and conventional autopsy. CONCLUSION:MDCT may guide, direct, or limit forensic autopsy in projectile injury cases, thereby eliminating the need for a complete invasive autopsy.

背景与目标：

BACKGROUND & AIMS: :Scimitar syndrome with bilateral abnormal venous drainage and horseshoe lung is extremely rare. These rare complex anomalies were diagnosed in a 5-year-old boy by 64-slice multidetector CT (MDCT). This technique provides high-quality visualization of vascular, bronchial and parenchymal structures in a single session, such that no further invasive techniques are required. One obvious disadvantage of MDCT is the radiation exposure, especially in paediatric patients. The use of a single phase of contrast material administration reduces radiation exposure. The workstation platforms of MDCT systems allow multiplanar 2-D and 3-D postprocessing. As a result, various complex pathologies, such as that discussed here, can be diagnosed following a single imaging session with a certain precision.

背景与目标： : 双侧静脉引流和马蹄肺异常的弯刀综合征极为罕见。这些罕见的复杂异常是通过64层多探测器CT (MDCT) 在5岁男孩中诊断出来的。该技术可在一次会议中提供高质量的血管，支气管和实质结构可视化，因此不需要进一步的侵入性技术。MDCT的一个明显缺点是辐射暴露，尤其是在儿科患者中。使用单相造影剂给药可减少辐射暴露。MDCT系统的工作站平台允许多平面2-D和3-D后处理。结果，可以在单个成像会话之后以一定的精度诊断出各种复杂的病理，例如这里讨论的病理。