Wasim Memon

Stones: Impact of dose reduction on CT detection of urolithiasis

Patients undergoing CT for the evaluation of stone disease are likely to receive high levels of radiation over time. Although the results from small studies using simulation software suggest that using a reduced radiation dose has little effect on calculi detection, larger prospective randomized studies are required to produce clinically applicable results.

MDCT of Small Bowel Obstruction: How Reliable Are Oblique Reformatted Images in Localizing Point of Transition?

The goal of this study is to prospectively assess the additional value of oblique reformatted images for localizing POT, having surgery as a reference standard. Materials and Methods. 102 consecutive patients with suspected small bowel obstruction (SBO) underwent 64-slice multidetector row CT (MDCT) using surgical findings as reference standard. Two independent GI radiologists reviewed the CT scans to localize the exact POT by evaluating axial images (data set A) followed by axial, coronal, and oblique MPR images. CT findings were compared to surgical findings in terms of diagnostic performance. McNemars test was used to detect any statistical difference in POT evaluation between datasets A and B. Kappa statistics were applied for measuring agreement between two readers. Results. There was a diagnostic improvement of 9.9% in the case of the less experienced radiologist in localizing POT by using oblique reformatted images. The more experienced radiologist showed diagnostic improvement by 12.9%.

Risk of appendicitis in patients with incidentally discovered appendicoliths

BACKGROUNDnAn appendicolith-related appendiceal obstruction leading to appendicitis is a commonly encountered surgical emergency that has clear evidence-based management plans. However, there is no consensus on management of asymptomatic patients when appendicoliths are found incidentally. The objective of this study was to determine the risk of appendicitis in patients with an incidental finding of the appendicolith.nnnMETHODSnA retrospective matched cohort study of patients with appendicolith discovered incidentally on computed tomographic scan from January 2008 to December 2014 at our institution was completed. The size and position of the appendicolith were ascertained. The study group was matched by age and gender to a control group. Both groups were contacted and interviewed regarding development of appendicitis.nnnRESULTSnIn total, 111 patients with appendicolith were successfully contacted and included in the study. Mean age was found to be 38xa0±xa015xa0y with 36 (32%) of the study population being females. Mean length of appendix was 66xa0±xa016xa0mm, and mean width was 5.8xa0±xa00.9xa0mm. Mean size of the appendicolith was 3.6xa0±xa01.1xa0mm (1.4-7.8xa0mm). Fifty-eight percent of appendicoliths was located at the proximal end or whole of appendix, 31% at mid area, and 11% at the distal end of appendix. All patients of the study and control groups were contacted, and at a mean follow-up of 4.0xa0±xa01.7xa0y, there was no occurrence of acute appendicitis in either group.nnnCONCLUSIONSnPatients with incidentally discovered appendicolith on radiological imaging did not develop appendicitis. Hence, the risk of developing acute appendicitis for these patients does not seem higher than the general population.

Paracaval pseudolipoma mimicking intracaval mass lesion and thrombus

A 53-year-old man presented with moderate dull non-radiating right upper quadrant pain for the past 1u2009month. There were no exacerbating or relieving factors or associated symptoms. His medical history was positive for hepatocellular carcinoma for which segmentectomy was performed 6 months ago. On physical examination, he was vitally stable and all systemic examinations were unremarkable. Contrast-enhanced abdominal CT scan showed an enhancing lesion at the surgical bed, representing recurrence of hepatocellular carcinoma (figure 1 and 2). There was also an apparently intracaval fat-density lesion in …