Ileocolic vascular curvature: a new CT finding of cecal volvulus.
Abdominal radiology (New York)
Wong, M., Brooke Jeffrey, R., Rucker, A. N., Olcott, E. W.
2020
Abstract
PURPOSE: To evaluate the diagnostic performance of a proposed new CT observation in cecal volvulus, marked hook-like curvature of ileocolic vessels termed "ileocolic vascular curvature."METHODS: Contrast-enhanced CT scans of 14 patients with diagnoses of cecal volvulus on original CT reports were compared with scans of 40 control patients with dilated cecum but no cecal volvulus on original CT reports, accrued consecutively from January, 2006 through July, 2017. Two independent blinded readers retrospectively evaluated scans for cecal dilatation, ileocolic vascular curvature and seven previously reported CT features of cecal volvulus. Statistical methods included the exact binomial distribution to define 95% confidence intervals (95% CIs), logistic regression, receiver operating characteristic analysis, and the exact McNemar test. Pathology reports and clinical records served as reference standards.RESULTS: All patients had abdominal pain and cecal distension. All 14 patients with CT diagnoses of cecal volvulus, and no control patients, had cecal volvulus by reference standards. Ileocolic vascular curvature and ectopic cecal location were the only features independently and significantly associated with cecal volvulus in multivariable regression (odds ratio 178, p=0.014, and 63, p=0.013, respectively) and also the only features with both sensitivity (12/14 [85.7%, 95% CI 57.2-98.2%] and 13/14 [92.9%, 95% CI 66.1-99.8%], respectively) and specificity (40/40 [100.0%, 95% CI 91.2-100.0%] and 38/40 [95.0%, 95% CI 83.1-99.4%], respectively) that differed significantly from 50.0%.CONCLUSIONS: Ileocolic vascular curvature was independently and significantly associated with cecal volvulus and exhibited both substantial sensitivity and substantial specificity for cecal volvulus, and thus is potentially a valuable new CT finding of cecal volvulus.
View details for DOI 10.1007/s00261-020-02491-w
View details for PubMedID 32221671
Abstract
The introduction of spectral CT imaging in the form of fast clinical dual-energy CT enabled contrast material to be differentiated from other radiodense materials, improved lesion detection in contrast-enhanced scans, and changed the way that existing iodine and barium contrast materials are used in clinical practice. More profoundly, spectral CT can differentiate between individual contrast materials that have different reporter elements such that high-resolution CT imaging of multiple contrast agents can be obtained in a single pass of the CT scanner. These spectral CT capabilities would be even more impactful with the development of contrast materials designed to complement the existing clinical iodine- and barium-based agents. New biocompatible high-atomic number contrast materials with different biodistribution and X-ray attenuation properties than existing agents will expand the diagnostic power of spectral CT imaging without penalties in radiation dose or scan time.
View details for DOI 10.1016/j.addr.2016.09.001
View details for PubMedID 27620496
View details for PubMedCentralID PMC5344792
Abstract
To compare the incidence of contrast-induced nephropathy (CIN) for intravenous vs. intra-arterial administration of iodixanol, compared to non-administration.We retrospectively identified 650 patients who had intravenous iodixanol-enhanced CT, 695 with intra-arterial iodixanol cardiac catheterization, 651 with unenhanced CT, and those who also had baseline and follow-up serum creatinine within 5 days of the exam. From the medical records, we recorded the gender, age, baseline and follow-up serum creatinine/eGFR; underlying renal injury risk factors; indication for imaging; contrast material administration volume, concentration, and route of administration; and use of pre-imaging prophylactic measures for CIN. Univariate and multivariate models were used to determine predictors of CIN.Baseline eGFR was lower for patients undergoing unenhanced CT than intravenous or intra-arterial patients (68 vs. 74.6 and 72.2, respectively, p < 0.01) and not different between intravenous and intra-arterial patients (p = 0.735). Simple logistic regression did not show a difference in the rate of CIN in patients who received intravenous vs. intra-arterial iodixanol (28 of 650, 4%, vs. 28 of 695, 4%, respectively, p = 0.798), nor a higher rate of CIN than seen with unenhanced CT (45 of 651, 7%, p = 0.99 and p = 0.98 by one-sided t test). Multivariate regression modeling showed that only elevated baseline creatinine or decreased eGFR and low hematocrit/hemoglobin were associated with CIN incidence (odds ratio 1.28 and 2.5; p < 0.023 and <0.006, respectively).Elevation in serum creatinine due to intravenous and intra-arterial iodixanol administration is infrequent and is not more common than after unenhanced CT scans.
View details for DOI 10.1007/s00261-015-0611-9
View details for Web of Science ID 000374109400012
View details for PubMedID 26830615
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