Biomedical subjects

Vassilios Raptopoulos

Publications and source records attributed to Vassilios Raptopoulos.

At least 19 recordsLinked to original sources

PubMed2006

Recombinant methionyl human leptin therapy in replacement doses improves insulin resistance and metabolic profile in patients with lipoatrophy and metabolic syndrome induced by the highly active antiretroviral therapy.

CONTEXT: Highly active antiretroviral therapy (HAART) for HIV-1 infection has been associated with a metabolic syndrome characterized by insulin resistance, hyperlipidemia, and redistribution of body fat (lipodystrophy). A subset of patients with predominant lipoatrophy has low levels of the adipocyte-secreted hormone leptin. OBJECTIVE: The objective of the study was to assess whether administration of recombinant methionyl human leptin (r-metHuLeptin) improves insulin resistance and other metabolic abnormalities in HIV+ leptin-deficient subjects with HAART-induced lipoatrophy. DESIGN, SETTING, PATIENTS, AND INTERVENTION: We conducted a randomized, placebo-controlled, double-blinded, crossover study from 2002 to 2004 in seven HIV+ men with HAART-induced lipoatrophy, serum leptin level less than 3 ng/ml, and fasting triglyceride level greater than 300 mg/dl, who were administered placebo for 2 months before or after administration of r-metHuLeptin at physiological doses for an additional 2 months. MAIN OUTCOME MEASURES: Insulin resistance, lipid levels, inflammatory markers, body composition, and HIV control were measured. RESULTS: Compared with placebo, r-metHuLeptin therapy improved fasting insulin levels, insulin resistance (as expressed by the homeostasis model assessment index and an insulin suppression test), and high-density lipoprotein. Body weight and fat mass decreased on r-metHuLeptin, mainly due to a decrease in truncal fat but not peripheral fat or lean body mass. r-metHuLeptin was well tolerated, and HIV control was not adversely affected. CONCLUSIONS: r-metHuLeptin replacement at physiological doses in HIV+ leptin-deficient patients with HAART-induced lipoatrophy improves insulin resistance, high-density lipoprotein, and truncal fat mass. Future larger and more long-term studies in HAART-induced lipoatrophy, including patients with more severe metabolic abnormalities, are warranted to evaluate the physiological and potentially therapeutic role of r-metHuLeptin for this condition and to fully clarify the underlying mechanisms of action.

Acquired Immunodeficiency Syndrome↗

PubMed2006

Coronal reformations of the chest on 64-row multi-detector row CT: evaluation of image quality in comparison with 16-, 8- and 4-row multi-detector row CT.

PURPOSE: To evaluate image quality of coronal reformations of chest performed on 64-row MDCT in comparison with 16-, 8- and 4-row MDCT. MATERIALS AND METHODS: Consecutive patients who underwent pulmonary CT angiography using four different MDCT scanners were retrospectively studied with IRB approval: (1) n=30, 64-row MDCT; (2) n=30, 16-row MDCT; (3) n=30, 8-row MDCT; (4) n=30, 4-row MDCT. Coronal reformatted images (2 mm thickness and 2mm intervals for 64-row MDCT; 5 mm thickness and 5 mm intervals for 16-, 8- and 4-row MDCT) were evaluated by consensus reading of two board-certified radiologists who were blinded to scanner type. The image quality of overall chest appearance and individual thoracic structures including heart, aorta and pulmonary arteries was graded using five-point scale. Grades from four different scanners were compared using Kruskal-Wallis test. A second evaluation was performed in 48 randomly selected patients (12 patients for each scanner). Reproducibility was assessed using weighted-kappa analysis. RESULT: Significant reproducibility was observed between the first and second evaluations in 48 patients both for image quality of overall chest (weighted kappa=0.826) and each thoracic structure (mean weighted kappa=0.803; range, 0.729-0.858). Image quality of overall chest and individual thoracic structures differed significantly among four different MDCT groups, with 64-row MDCT having the highest grades, followed by 16-, 8- and 4-row MDCT (mean grades for overall chest in each scanner: 3.9, 3.0, 2.4 and 1.9, respectively) (P<0.0001 for overall chest and each thoracic structure). CONCLUSION: When comparing coronal reformations of chest using four different MDCT scanners, the 64-row MDCT had the highest image quality for overall chest appearance and individual thoracic structures, followed by 16-, 8- and finally 4-row MDCT.

Adult↗

PubMed2006

Evaluation of thoracic abnormalities on 64-row multi-detector row CT: comparison between axial images versus coronal reformations.

PURPOSE: To evaluate the capability of coronal reformations of chest on 64-row MDCT in demonstrating thoracic abnormalities in comparison with axial images. MATERIALS AND METHODS: Thirty-eight consecutive patients who underwent pulmonary CTA on 64-row MDCT were retrospectively studied with institutional review board (IRB) approval. Contiguous 2 mm axial and coronal images were reviewed independently with a 1-week interval, by consensus reading of two board-certified radiologists. Overall image quality was graded using a five-point scale. Abnormalities in mediastinum, hilum, pulmonary vessels, aorta, heart, esophagus, pleura, chest wall, and lung parenchyma were scored: 1 = definitely absent, 2 = probably absent, 3 = equivocal, 4 = probably present, 5 = definitely present. Scores on axial and coronal images were compared using weighted kappa analysis. RESULTS: Overall image quality was not different with statistical relevance between axial and coronal images (mean/median scores; 3.7/4; 3.6/4, respectively, P = 0.286, Wilcoxon signed-rank test). Significant agreement was observed between axial and coronal scores (mean weighted kappa, 0.661; range, 0.362-1). Agreement was almost perfect for pneumothorax, lung and pleural mass, effusion and consolidation (weighted kappa=0.833-1); substantial for pulmonary embolism, trachea, mediastinal lymphadenopathy and non-skeletal chest wall lesion, heart, esophagus, and emphysema (weighted kappa, 0.618-0.799); moderate for atelectasis, mediastinum, hilar nodes, aorta, other lung lesions, skeletal chest wall lesions, linear scarring, nodules > 1 cm, pulmonary artery abnormalities and pleural thickening (weighted kappa, 0.405-0.592); and fair for nodules < 1 cm (weighted kappa = 0.362). CONCLUSION: Coronal reformations on 64-row MDCT had substantial agreement with axial images for evaluation of the majority of thoracic abnormalities.

Adult↗

PubMed2006

Loss of anteroposterior intralobar attenuation gradient of the lung: Correlation with pulmonary function.

RATIONALE AND OBJECTIVES: Since the initial description of an intralobar attenuation gradient by Webb et al, it has been suggested that departure from the intralobar attenuation gradient could indicate early lung diseases. However, its significance has not been determined in detail. We aimed to quantify the anteroposterior intralobar attenuation gradient on volumetric end-inspiratory and end-expiratory high-resolution computed tomography (CT) in patients with emphysema and to correlate the gradient values with pulmonary function. MATERIALS AND METHODS: The study population consisted of 21 consecutive patients with emphysema evaluated with volumetric expiratory high-resolution CT and 6 patients with normal high-resolution CT findings. The anteroposterior intralobar attenuation gradient values were quantified on end-inspiratory and end-expiratory sagittal reformations using a lung analysis software program and were correlated with pulmonary function tests results. RESULTS: The intralobar attenuation gradient values in patients with forced expiratory volume in 1 second (FEV1) < or =70% were significantly smaller compared with those in patients with FEV1 >70% in bilateral lower lobes at end-expiration (P = .0061, P = .047, respectively, unpaired t-test). The FEV1 values in patients with attenuation gradient values < or =0.02 were significantly lower than in those with attenuation gradient values >0.02 (right lower lobe: P = .024; left lower lobe: P = .0034; chi-squared test). The intralobar attenuation gradient values in bilateral lower lobes at end-expiration were significantly correlated with FEV1 and FEV1/forced vital capacity (right: P = .031, P = .039, respectively; left: P = .036, P = .030, respectively, Pearson correlation). CONCLUSIONS: The quantitative measurement of the anteroposterior intralobar attenuation gradient values of the lung showed that these gradients at end-expiration in both lower lobes correlate with obstructive physiology.

Adult↗

PubMed2006

Establishing a cardiac imaging rotation in radiology residency.

RATIONALE AND OBJECTIVE: The advent of new technologies for cardiac imaging such as magnetic resonance imaging (MRI) and cardiac computed tomography (CT) have added new tools in the armamentarium of noninvasive methods for predicting cardiac disease. However, training in cardiac anatomy and physiology is critical if radiology is to meet the demands of this service. MATERIALS AND METHODS: We designed a core rotation in cardiac imaging at the Beth Israel Deaconess Medical Center, Harvard Medical School, to train residents in noninvasive cardiac imaging methods, such as cardiac echocardiography, nuclear cardiac imaging, cardiac MRI, and with special emphasis on cardiac CT. RESULTS: This 1-month block includes cardiac imaging conferences and a lecture series, hands-on training in the use of imaging software, introduction to cardiac catheterization, and clinical cardiology. Residents are provided with a set of research and review articles along with textbooks on coronary imaging to serve as references for this rotation. CONCLUSION: We believe that this educational exercise will establish a core of young, knowledgeable, and capable physicians who will be able to meet the clinical demand for noninvasive cardiac imaging and maintain a major role in this emerging specialty.

Boston↗

PubMed2006

Impact of CT-guided drainage in the treatment of diverticular abscesses: size matters.

OBJECTIVE: Our objective was to determine whether abscess size can be used as a discriminating factor to guide management of patients with diverticular abscesses. MATERIALS AND METHODS: We performed a word search of our CT database between July 2001 and July 2002 for the CT diagnosis of diverticulitis. CTs were retrospectively reviewed as consensus opinion of two reviewers. CTs were evaluated for presence of an abscess, its location, maximum diameter, and feasibility of percutaneous abscess drainage. Abscesses were categorized into smaller than 3 cm and larger than or equal to 3 cm, and the management of these groups was compared. RESULTS: Thirty-one abscesses were noted in 30 (17%) of 181 patients with a CT diagnosis of diverticulitis. Twenty-two (73%) of 30 patients had 23 abscesses, all of which were smaller than 3 cm and were treated and resolved with antibiotics alone (p < 0.001). Eight (36%) of 22 required surgical treatment. Eight (26%) of 31 abscesses had a maximum diameter larger than or equal to 3 cm. Four (50%) of eight patients with abscesses 3.4-4.1 cm were treated with antibiotics alone. Four (50%) of eight abscesses, all larger than 4.1 cm, were treated with CT-guided drainage and one abscess required repeat drainage. After resolution of symptoms, surgery was performed in five (62.5%) of eight of the larger abscesses. CONCLUSION: Patients with abscesses smaller than 3 cm in size can be treated with antibiotics alone and, in some cases, as outpatients, and may not uniformly require surgery. This is also likely true for patients with abscesses 3-4 cm in size, although our results in this group were limited by a small sample size. Patients with abscesses larger than or equal to 4 cm can be managed with CT-guided abscess drainage followed by referral for surgical treatment.

Abdominal Abscess↗

PubMed2006

Cine CT during coughing for assessment of tracheomalacia: preliminary experience with 64-MDCT.

OBJECTIVE: 64-MDCT is advantageous for functional imaging because of its high spatial and temporal resolution combined with its length of coverage. Our purpose is to describe the technical aspects of using 64-MDCT for cine CT during coughing and to share our preliminary clinical experience using this method. CONCLUSION: This method is technically feasible and offers a promising alternative to previous cine CT methods for diagnosing tracheomalacia.

Cough↗

PubMed2005

Lung cancer detected in patients presenting to the Emergency Department studies for suspected pulmonary embolism on computed tomography pulmonary angiography.

PURPOSE: To study the frequency and demographics of lung cancer on CT pulmonary angiography in patients with suspected pulmonary embolism referred from the Emergency Department. MATERIALS AND METHODS: Retrospective review of the medical records and radiology reports, clinical and imaging follow-up studies and pathological reports revealed 1106 CT pulmonary angiography studies referred from our Emergency Department during the 15-month period between March 2003 and June 2004. RESULTS: Five incidental lung cancer cases were found in 1106 studies from 1081 patients (0.47%). Pulmonary embolism was found in 95 patients (8.5%). Among the five incidental cases three patients were female and two were male (62-81 years old; mean 73 years, 17-130 packs year; mean 51 packs year). Tumor size ranged from 1.8 to 4.5 cm (mean 3.3 cm). The stagings of the lung cancers were IIIB in one patient and IV in four patients. CONCLUSION: Previously undiagnosed lung cancer was detected in 0.45% of patients among 1081 patients referred from Emergency Department, one of whom had coexistent pulmonary embolism. All five patients presented at advanced lung cancer stages of IIIB and IV.

Aged↗

PubMed2004

Sagittal reformations of volumetric inspiratory and expiratory high-resolution CT of the lung.

RATIONALE AND OBJECTIVES: The purpose of this study is to determine whether sagittal reformations of volumetric high-resolution computed tomography (CT) provide additional information in evaluating lung abnormalities compared to axial high-resolution CT images. MATERIALS AND METHODS: Twenty-two consecutive patients who underwent combined inspiratory and expiratory volumetric high-resolution CT from May to July 2003 were studied. Using end-inspiratory and end-expiratory sagittal reformatted images, respiratory motion artifacts were evaluated at upper, middle, and lower lung areas bilaterally. Diaphragmatic motion artifacts were evaluated bilaterally. The detection of major and minor fissures was assessed. Additional findings on sagittal reformations were graded using a three-point scale: grade 1 = no additional findings; grade 2 = additional findings of no diagnostic significance; grade 3 = additional findings of diagnostic significance. RESULTS: Respiratory motion artifacts were either imperceptible or present but not diagnostically limiting except for one case, in which diagnostically limiting image degradation was noted in the bilateral lower lung areas. Diaphragmatic motion artifacts were frequently present: 95% (21/22) at end-inspiration, and 86% (19/22) at end-expiration; however, diagnostically limiting artifacts were observed in only two cases. The grading of additional findings on sagittal reformatted images was statistically significant (grade 1, n = 13; grade 2, n = 7; grade 3, n = 2; median, 1; P = .004) compared to axial images. Additional findings included relationship between mass/nodules and fissure/pleura/pericardium (grade 2, n = 4; grade 3, n = 2), distribution of interstitial abnormalities of the lung (grade 2, n = 2), and diaphragmatic eventration (grade 2, n = 1). CONCLUSION: Sagittal reformatted images of volumetric high-resolution CT provided additional information compared to volumetric axial images alone with statistical significance.

Adult↗

PubMed2004

Insulin resistance and vascular dysfunction in nondiabetic Asian Indians.

Asian Indians are at higher risk for diabetes and cardiovascular disease than European Caucasians. To examine the pathophysiology of this increased risk, we measured insulin sensitivity, cardiovascular risk factors, fat distribution, and endothelium-dependent (reactive hyperemia) and -independent (nitroglycerin) vasodilation before and after a 2-h hyperinsulinemic clamp (40 mU/m(2).min) in 25 nondiabetic Asian Indians and 15 Caucasians with similar age and body mass index. Asian Indians had higher fasting insulin than Caucasians (6.7 +/- 0.8 vs. 3.7 +/- 0.3 microU/ml, P = 0.007) but similar FPG (90 +/- 2 vs. 88 +/- 2 mg/dl). Glucose uptake during the clamp was markedly reduced in Asian Indians vs. Caucasians (4.5 +/- 0.3 vs. 7.5 +/- 0.4 mg/kg x min, P < 0.0001). During the clamp, basal brachial artery diameter increased less in Asian Indians vs. Caucasians (2.6 +/- 1.0 vs. 5.7 +/- 1.0%, P = 0.04), and the reduction was correlated with the impairment in insulin sensitivity (r = 0.38, P = 0.04). In contrast, vasodilatory responses to reactive hyperemia and nitroglycerin were similar in Asian Indians and Caucasians both before and during hyperinsulinemia. Plasminogen activator inhibitor-1 and FFA were significantly elevated and adiponectin was significantly lower in Asian Indians vs. Caucasians, and there were trends toward higher low-density lipoprotein and triglycerides, lower high-density lipoprotein, and increased total, sc, and visceral fat. These risk factors were all significantly correlated with insulin sensitivity. Thus, apparently healthy Asian Indians have severe insulin resistance, dyslipidemia, elevated plasminogen activator inhibitor-1, impaired insulin-mediated vasodilation, and trends toward altered body fat distribution. These abnormalities may contribute to the increased risk of diabetes and cardiovascular disease in this population.

Abdomen↗

PubMed2004

Coronal reformations of volumetric expiratory high-resolution CT of the lung.

OBJECTIVE: The purposes of this study were to evaluate the quality of coronal reformatted images obtained from volumetric expiratory high-resolution CT imaging and to compare coronal and axial images with regard to their usefulness in detecting and characterizing air trapping. SUBJECTS AND METHODS. We studied 40 consecutive patients with known or suspected diffuse lung diseases with airway abnormalities who underwent volumetric expiratory high-resolution CT between May and July 2003. Respiratory motion artifacts were evaluated at upper, middle, and lower lung areas. Cardiac motion, beam-hardening, and other artifacts were evaluated throughout the lung fields. Detectability, clarity of borders, size, distribution, and extent of air trapping were compared on axial versus coronal end-expiratory high-resolution CT images. RESULTS: Respiratory motion artifacts were either imperceptible or not diagnostically limiting in all patients except three (7%) with diagnostically limiting image degradation at lower lung areas. Other diagnostically limiting image degradation was caused by beam-hardening artifacts in two patients (5%) and by quantum noise in two other patients (5%). The borders of air trapping were more clearly identified on coronal images than on axial images (grade 1 [vague], nine vs three; grade 2 [partially clear], 23 vs 21; grade 3 [completely clear], eight vs 16; median, two vs two; p = 0.001). The coronal reformatted images were as informative as axial images for detecting and assessing the classification and extent of air trapping. CONCLUSION: Coronal reformations of volumetric expiratory high-resolution CT scans were acceptable in image quality and provided additional value by affording clearer visualization of the borders of air trapping than was found in contiguous axial images.

Adult↗

PubMed2004

A simple method for extracting DICOM images from a magnetooptic disk.

OBJECTIVE: Our objective was to develop a simple and easy-to-use method to extract DICOM images from magnetooptic (MO) disks to the computer desktop for research purposes. CONCLUSION: The method we developed allows users to extract DICOM images directly from MO disks to a PC desktop. The hardware component that we used is commercially available and is plug-and-play. The system is lower in cost than a clinical workstation. Users do not need to have special computer skills to use our method. DICOM images can be transferred directly from the MO disks to computer desktop folders using drag-and-drop. In our implementation, we store the DICOM files in a shared folder in our hospital network, so users can access the data from their office or research computers.

Humans↗

PubMed2003

Reproducibility of linear tumor measurements using PACS: comparison of caliper method with edge-tracing method.

The aim of this study was to evaluate inter- and intra-observer reproducibility when making electronic caliper linear tumor measurements on picture archiving and communications systems (PACS) and compare them with linear measurements obtained from circumferential tracing of tumor perimeter. Three radiologists measured 64 masses from 30 patients on body CT scans in two separate settings. Long axis and perpendicular short axis were measured using electronic calipers. The edge of each tumor was traced electronically and the long and short axes were calculated by computer software. The reproducibility of a measurement was evaluated by computing and comparing the absolute value of the mean difference between initial and subsequent measurements. The mean differences +/-95% confidence interval (CI) between two measurements of the long by short axis were 3.8+/-2.6x3.1+/-1.8 mm when the caliper method was used and 3.5+/-2.0x3.2+/-1.5 mm when the tumor tracing method was used. There was no statistically significant difference in individual intra-observer reproducibility of tumor axes measurements. Neither long- nor short-axis single-dimension measurements resulted in significantly greater or lesser intra-observer reproducibility. When comparing caliper and tracing measurements, the overall mean difference (3.42+/-1.8 vs 3.38+/-1.4 mm) was not statistically significant. There was close correlation between the individual measurements made by each observer whether these were made by electronic calipers and when these were calculated from electronic tracings (Pearson correlations between 0.79 and 0.949). Current PACS systems allow reproducible linear, long or short axis, tumor measurements. There is no significant difference in reproducibility of measurements whether these are made directly with electronic calipers or calculated from tumor edge tracings.

Humans↗

PubMed2003

Detection of pulmonary embolism: comparison of paddlewheel and coronal CT reformations--initial experience.

In five patients with acute multilobar pulmonary embolism (PE) who were imaged with multi-detector row CT angiography, maximum intensity projection images were reformatted from axial images into rotated paddlewheel and coronal planes with three slab thicknesses and were reviewed for evidence of PE on a per-vessel basis with consensus of two readers. Paddlewheel reformations had a significantly higher percentage of overall detection of PE than did coronal reformations obtained with equivalent slab thickness (P <.0001). Paddlewheel reformations with 5.0-mm slab thickness had no significantly different percentage of overall detection of PE compared with that of axial images obtained with 2.5-mm collimation.

Adult↗

PubMed2003

Colorectal neoplasms: role of intravenous contrast-enhanced CT colonography.

PURPOSE: To evaluate whether computed tomographic (CT) colonography with intravenously administered contrast material can help predict malignant differentiation of colorectal neoplasms (> or =10 mm in diameter). MATERIALS AND METHODS: Enhancement of 29 consecutive colorectal neoplasms on pre- and postcontrast CT colonographic images was retrospectively measured. The neoplasms were subsequently resected. Enhancement was calculated by subtraction of attenuation values (in Hounsfield units) obtained with precontrast and postcontrast 45-second-delay prone CT colonographic sequences. The neoplasms were graded as follows: grade 1, adenoma; grade 2, adenoma with high-grade dysplasia; grade 3, well-differentiated adenocarcinoma; grade 4, moderately differentiated adenocarcinoma; and grade 5, poorly differentiated adenocarcinoma. Correlation among size, histologic grade, and degree of enhancement was made with Pearson and Spearman coefficients. The ability of the degree of enhancement to help predict adenocarcinoma (histologic grade, > or =3) was calculated. RESULTS: Histologic-CT colonographic correlation was performed in 29 neoplasms (mean diameter, 27.9 mm; range, 10-65 mm). There was no correlation between size and degree of enhancement, size and histologic grade (R = -0.17, P =.33), or histologic grade and degree of enhancement (R = 0.23, P =.23). However, increasing enhancement was noted between grades 2 and 5. When an enhancement threshold of 40 HU was used for the diagnosis of adenocarcinoma (grades 3-5), sensitivity was 92%, specificity was 20%, positive predictive value was 50%, and negative predictive value was 75%. CONCLUSION: The degree of contrast enhancement on a 45-second-delay CT colonographic image does not correlate with size or degree of histologic differentiation, although increasing enhancement with lesser degrees of differentiation was noted.

Adenocarcinoma↗

PubMed2003

Multislice CT angiography.

The introduction of multislice CT into clinical radiology constitutes a quantum leap that significantly widens the scope of vascular CT imaging. The advances over conventional spiral CT have been quantitative, mainly in terms of increased image acquisition speed which provides unprecedented volume coverage and spatial resolution. Moreover, significant technical innovations, such as cardiac scanning capabilities, have brought about a qualitative shift towards applications that were thought to be beyond the scope of CT imaging. This way multislice CT offers a wealth of new opportunities for quickly and accurately diagnosing suspected vascular disease in all organ systems; however, as we move towards faster and faster image acquisition techniques, we are also facing new challenges that require development of novel strategies in order to take full advantage of the increased capabilities of multislice CT in its current form and future generations of CT scanners.

Angiography↗

PubMed2003

Increased prevalence of coronary artery calcification in patients with suspected pulmonary embolism.

RATIONALE AND OBJECTIVES: The authors explored the possibility that patients with suspected pulmonary embolism are at high risk for coronary artery disease. To this purpose, they compared the presence of coronary artery calcification on computed tomography (CT) in patients suspected of pulmonary embolism with age- and gender-matched controls. MATERIALS AND METHODS: The CT scans of 214 patients were reviewed. Of those, 107 consecutive patients (50%) had pulmonary CT angiography for suspected pulmonary embolism (PE group). The remaining 107 age- and gender-matched patients were scanned for reasons other than pulmonary embolism (non-PE group). All CT scans were performed with the same 8-detector-row multislice scanner. Two radiologists reviewed scans of 5-mm slices using a five-grade modified coronary calcium scoring system: 1 = no calcification; 2 = minimal calcification; 3 = mild calcification; 4 = moderate calcification; and 5 = severe calcification. The Marginal Homogeneity test was used to compare the distribution and severity of calcification in the two groups. RESULTS: Of 107 patients in the PE group, seven (6.54%) had pulmonary embolism detected on CT. Coronary artery calcification was detected in 61 patients (57%) in the PE group compared with 42 patients (39%) in the non-PE group. The Marginal Homogeneity test showed that patients with pulmonary embolism symptoms were 2.9 times more likely to have calcification detected compared with those patients who had chest CT for some other reason (P = .0034). However, in patients in whom coronary artery calcification was detected, the distribution of severity of calcification was the same in both groups. CONCLUSION: Assuming coronary artery calcification indicated coronary atherosclerosis, patients undergoing CT for suspected pulmonary embolism may be at high risk for coronary artery disease.

Adolescent↗

PubMed2003

Acute appendicitis: effect of increased use of CT on selecting patients earlier.

PURPOSE: To explore the possibility of a relationship between increased use of computed tomography (CT) for diagnosis of appendicitis and increased occurrence of minimal or subtle CT and surgical findings. MATERIALS AND METHODS: Two groups, each with 50 consecutive patients who underwent CT before appendectomy in 1997 and 2000, were compared. CT scans and surgery-pathology reports were evaluated on a six-grade scale from normal to abscess or inflammatory mass. The demographics, surgical techniques, hospital stay, and grade distribution for the two groups were compared, and the CT results were correlated with surgical findings. RESULTS: In 1997, CT was performed in 33% (50 of 152) of patients undergoing appendectomy, as compared with 59% (50 of 85) 3 years later (P <.001). There was excellent correlation between surgical-pathologic and CT grades (weighted kappa, 0.75; P <.001; Spearman rank correlation, 0.83). There was no significant difference in demographics, rate of surgery, or surgical techniques used, but there was a significant decrease in the median surgical-pathologic grades, from 3.0 to 2.5 (P =.05) for all patients and from 3.5 to 2.6 (P =.003) for patients who underwent CT. Similarly, the median CT grade decreased from 4 to 3 (P <.001). Seven patients had subtle CT findings in 1997 compared with 16 in 2000 (P =.004), and there was a significant decrease in mean hospital stay, from 2.8 days +/- 4 (SD) to 1.5 days +/- 2 (P =.008). CONCLUSION: With increased CT use, there were less severe imaging findings, including absence of periappendiceal stranding, and a significant decrease in surgical-pathologic severity of appendiceal disease and hospital stay.

Acute Disease↗