Pelvic abscess drainage: outcome with factors affecting the clinical success

PURPOSE:We aimed to evaluate the success and complication rates of image-guided pelvic abscess drainage with emphasis on factors affecting the clinical success.METHODS:During a 7-year period, 185 pelvic abscesses were treated in 163 patients under ultrasonography and fluoroscopy (n=140) or computed tomography (n=45) guidance with transabdominal (n=107), transvaginal (n=39), transrectal (n=21) and transgluteal (n=18) approaches. Abscess characteristics (etiology, number, size, intrastructure, microbiological content, presence of fistula), patient demographics (age, sex, presence of malignancy, primary disease, antibiotic treatments), procedure-related factors (guidance method, access route, catheter size) and their effects on clinical success, complications, and duration of catheterization were statistically analyzed. RESULTS:Technical and clinical success rates were 100% and 93.9%, respectively. Procedure-related mortality or major complications were not observed. Minor complications such as catheter dislodgement, obstruction, or kinking were detected in 6.7% of the patients. Clinical failure was observed in 10 patients (6.1%). Fistulization was observed in 14 abscesses. Fistulization extended the duration of catheter use (P < 0.001) and decreased the clinical success rate (P < 0.001). The presence of postoperative malignant, complex-multilocular abscesses, and fungus infection in the cavity extended catheter duration (P < 0.001, P = 0.018, and P = 0.007, respectively), whereas the presence of sterile abscess and endocavitary catheterization reduced the catheter duration (P = 0.009 and P = 0.011, respectively).CONCLUSION:İmage-guided pelvic abscess drainage has high clinical success and low complication rates. The only factor affecting the clinical success rate is the presence of fistula

The association of left atrial mechanics with left ventricular morphology in patients with hypertrophic cardiomyopathy: A cardiac magnetic resonance study

Purpose: Hypertrophic cardiomyopathy (HCM) is related with structural and pathologic changes in the left atrium (LA) and left ventricle (LV). The aim of this study was to explore the association between LA mechanics and LV charac-teristics in patients with HCM using cardiac magnetic resonance feature tracking (CMR-FT). Material and methods: A total of 76 patients with HCM and 26 healthy controls were included in the study. The pa-rameters including the extent of LV late gadolinium enhancement (LGE-%) and the LV early diastolic longitudinal strain rate (edLSR) were assessed for LV. LA conduit, booster, and reservoir functions were assessed by LA fractional volumes and strain analyses using CMR-FT. HCM patients were classified as HCM patients without LGE, with mild LGE-% (0% = 10%), and prominent LGE-% (10% < LGE-%).Results: HCM patients had worse LA functions compared with the controls (p < 0.05). The majority of LA functional indices were more impaired in HCM patients with regard to LGE. LA volumes were higher in HCM patients with prominent LGE-% compared with HCM patients with mild LGE-% (p < 0.05). However, only a minority of LA functional parameters differed between the 2 groups. LA strain parameters showed weak to modest correlations with LV LGE-% and LV edLSR.Conclusions: LV characteristics, to some extent, influence LA mechanics, but they might not be the only factor induc-ing LA dysfunction in patients with HCM

Akut Apandisit Bulgularının Dual Enerji Bt İle Değerlendirilmesi

Despite the gradual increase of utilization dual-energy computed tomography (DECT) in the field of abdominal radiology, solid studies of acute appendicitis (AA) regarding this imaging technique have yet to be done. We hereby aimed to assess the utility of DECT in the diagnosis of AA. The DECT scans of consecutive 30 patients (14 male, 16 female) with AA and 30 consecutive patients (14 male, 16 female) with normal appendix vermiformis (AV) were recruited to this study. The maximum diameter of AV as well as the density of most compressed and inflamed site of AV at 80 kVp, 140 kVp, virtual non-contrast (VNC), iodine overlay, mixed, and monoenergetic (40,50,60,70,80,90,100,190 keV) images were quantified. The maximum diameter was 11.5±2.3 mm in AA patients and 5.7±0.5 mm in control group (p<0.001). The attenuation values of inflamed AVs were higher than that of normal AVs at 80 kVp, 140 kVp, VNC, iodine overlay, mixed images and all virtual monochromatic energy levels (p<0.001). The attenuation values of inflamed AVs at 80 kVp, 140 kVp, VNC, iodine overlay, mixed images were 101.5±20.1 HU, 59.5±13.7 HU, 20.7±11.7 HU, 50.6±9.7 HU, 71.9±15.9 HU respectively. The attenuation values of normal AVs at 80 kVp, 140 kVp, VNC, iodine overlay, mixed images were 52.6±12.3 HU, 31.1±13.4 HU, 1.4±16.6 HU, 37.4±13.4 HU, 38.3±11.7 HU respectively. The attenuation values of inflamed AVs at virtual monochromatic images generated from 40 to 100 keV energy levels in 10-keV increments were 204.3±40.2 HU, 136.1±27.4 HU, 103.4±19.2 HU, 79.1±15.5 HU, 64.6±31.6 HU, 55.1±12.6 HU, 48.9±12.9 HU respectively. The attenuation values of normal AVs at virtual monochromatic images generated from 40 to 100 keV energy levels in 10-keV increments were 146±49.7 HU, 97.9±30.3 HU, 69.4±20.4 HU, 46.7±10.8 HU, 38.6±10.2 HU, 31.8±12 HU, 26.3±12.5 HU respectively. The sensitivity and specificity values were calculated for certain cut-off attenuation values as ranging from 73.3% to 96.7% for each. 80 kVp images yielded the highest diagnostic accuracy with AUC of 0.996 following maximum diameter with AUC of 1 (p<0.001). 70 keV and 80 keV energy levels out of the virtual monochoromatic images provided the highest diagnostic accuracies with AUC of 0.958 and 0.934, respectively. In conclusion, AA can be more easily detected in iodine overlay, low kVp and low energy monochromatic images of DECT due to increased attenuation values at certain energy levels. The 80 kVp and virtual energy monochromatic images at 70 keV and 80 keV energy levels yield the highest diagnostic accuracies in the setting of AA.İÇİNDEKİLER Safya TEŞEKKÜR iii ÖZET iv ABSTRACT vi İÇİNDEKİLER viii SİMGELER VE KISALTMALAR xi ŞEKİLLER xii TABLOLAR xiv 1. GİRİŞ VE AMAÇ 1 2. GENEL BİLGİLER 4 2.1. Tarihçe 4 2.2. Embriyoloji, anatomi ve histoloji 5 2.3. Tanım ve fizyopatoloji 6 2.4. Epidemiyoloji 8 2.5. Akut apandisit kliniği 8 2.5.1.Semptomlar 8 2.5.2. Karın ağrısı 9 2.5.2.1. Akut apandisitte ağrının patogenezi 9 2.5.3. İştahsızlık 10 2.5.4. Dışkılama Dürtüsü 11 2.6. Fizik Muayene Bulguları 11 2.7. Laboratuvar bulguları 12 2.8. Alvarado skorlama sistemi 12 2.9. Akut apandisitte görüntüleme 13 2.9.1. Direkt grafi 14 2.9.2. Baryum enema 14 2.9.3.Ultrasonografi 14 2.9.4. Bilgisayarlı tomografi 16 2.9.5. Manyetik rezonans görüntüleme 19 2.10. Ayırıcı Tanı 20 2.11. Akut Apandisit Tedavisi 21 2.11.1. Nonoperatif Tedavi 21 2.11.2. Cerrahi Tedavi 22 2.12. Dual-Enerji BT 22 3. GEREÇ VE YÖNTEM 26 3.1. Hasta popülasyonu 26 3.2. Kontrol grubu 26 3.3. Abdomen BT görüntüleme protokolü 27 3.4. BT Görüntülerinin Analizi 30 3.5. İstatistiksel Değerlendirme 31 4. BULGULAR 37 4.1. Sosyodemografik özelliklerin analizi 37 4.2. Histopatolojik incelemelerin analizi 39 4.3. Maksimum çap ölçümünün analizi 39 4.4. Lenf nodu analizi 41 4.5. Periapendisiyel inflamasyon, komşu barsak duvarında ödem ve serbest sıvı varlığının analizi 41 4.6. Sanal kontrastsız görüntülerin analizi 42 4.7. 80 kVp görüntülerin analizi 44 4.8. 140 kVp görüntülerin analizi 46 4.9. Overlay (iodine content) görüntülerin analizi 48 4.10. Mix (sanal kontrastsız + iodine content) görüntülerin analizi 49 4.11. 40 keV sanal monokromatik görüntülerin analizi 51 4.12. 50 keV sanal monokromatik görüntülerin analizi 52 4.13. 60 keV sanal monokromatik görüntülerin analizi 54 4.14. 70 keV sanal monokromatik görüntülerin analizi 55 4.15. 80 keV sanal monokromatik görüntülerin analizi 57 4.16. 90 keV sanal monokromatik görüntülerin analizi 59 4.17. 100 keV sanal monokromatik görüntülerin analizi 60 4.18. Apandisit tanısında kullanılan parametrelerin etki büyüklüklerinin analizi 63 5. TARTIŞMA 65 6. SONUÇ 77 7. KAYNAKLAR 78 EKLER EK 1: Etik kurul onay belgesi 90Abdominal radyolojide dual-enerji bilgisayarlı tomografinin (DEBT) artan kullanım alanına rağmen, akut apandisit (AA) tanısındaki yerine ilişkin yeterli çalışma bulunmamaktadır. Bu çalışmada akut apandisit tanısında DEBT bulgularının değerlendirilmesi amaçlanmıştır. Radyolojik olarak akut apandisit tanısı alan ardışık 30 hasta ile (14 erkek, 16 kadın) apendiksi normal olan 30 hastanın (14 erkek, 16 kadın) DEBT görüntüleri çalışma kapsamında değerlendirilmiştir. Apendiksin maksimum çapı; 80 kVp, 140 kVp, sanal kontrastsız, iyot haritası ve mikst görüntüler ile 40-100 keV enerji düzeylerinde her 10 keV aralığında oluşturulan sanal monokromatik görüntülerdeki dansite ölçülmüştür. AA hastalarında maksimum çap 11.5±2.3 mm, kontrol grubunda ise 5.7±0.5 mm bulunmuştur (p<0.001). 80 kVp, 140 kVp, sanal kontrastsız, iyot haritası ve mikst görüntüler ile 40-100 keV enerji düzeylerinde her 10 keV aralığında oluşturulan sanal monokromatik görüntülerde inflame apendiksin dansitesi, normal apendiks dansitesine göre yüksek bulunmuştur (p<0.001). İnflame apendiksin dansite değerleri 80 kVp, 140 kVp, sanal kontrastsız, iyot haritası ve mikst görüntülerde sırasıyla 101.5±20.1 HU, 59.5±13.7 HU, 20.7±11.7 HU, 50.6±9.7 HU, 71.9±15.9 HU; normal apendiksin dansite değerleri sırasıyla 52.6±12.3 HU, 31.1±13.4 HU, 1.4±16.6 HU, 37.4±13.4 HU, 38.3±11.7 HU olarak saptanmıştır. İnflame apendiksin dansite değerleri 40-100 keV enerji düzeylerinde her 10 keV aralığında oluşturulan sanal monokromatik görüntülerde sırasıyla 204.3±40.2 HU, 136.1±27.4 HU, 103.4±19.2 HU, 79.1±15.5 HU, 64.6±31.6 HU, 55.1±12.6 HU, 48.9±12.9; normal apendiksin dansite değerleri sırasıyla 146±49.7 HU, 97.9±30.3 HU, 69.4±20.4 HU, 46.7±10.8 HU, 38.6±10.2 HU, 31.8±12 HU, 26.3±12.5 HU olarak saptanmıştır. Görüntü setlerinde belirlenen eşik değeri dansiteler için sensitivite değerleri %73.3 - 96.7; spesifisite değerleri %73.3 - 96,7 arasında bulunmuştur. Maksimum çapı takiben (AUC=1) en yüksek tanı değerine 80 kVp görüntü setinde ulaşılmıştır (AUC=0.996, p<0.001). Sanal monokromatik götüntülerde ise 70 keV ve 80 keV görüntü setinin en yüksek tanı değeri sağladığı görülmüştür (sırasıyla AUC 0.958 ve 0.934, p<0.001). Özetle iyot haritası, düşük kVp ve düşük enerji düzeylerinde oluşturulan sanal monokromatik görüntülerde akut apandisit, standart BT’ ye göre daha kolay saptanabilir. Bu hastalarda tanıya ulaşmada, 80 kVp görüntü seti ile 70 keV ve 80 keV enerji düzeylerinde oluşturulan sanal monokromatik görüntüler en yüksek etki değerine sahiptir

Low Tube Voltage Increases The Diagnostic Performance Of Dual-Energy Computed Tomography In Patients With Acute Appendicitis

PURPOSE We aimed to assess the utility of dual-energy computed tomography (DECT) imaging in diagnosing acute appendicitis (AA) with density measurements of the appendix vermiformis. METHODS A total of 210 consecutive patients presenting with acute abdominal pain were scanned using DECT between January and October 2016. Twenty-six patients had pathologically confirmed AA, while 30 had normal appendices. Appendiceal densities were measured in the true axial section of the appendix vermiformis at 80 kVp, 140 kVp, virtual noncontrast, iodine overlay, mixed, and monoenergetic (40, 50, 60, 70, 80, 90, 100 keV) images. RESULTS Comparison of the appendix at different kVp and keV energy levels, virtual noncontrast, iodine overlay, and mixed images yielded significant differences between patients with appendicitis and those with a normal appendix (P < 0.001 for all). Receiver operating characteristic (ROC) curve analysis revealed that the 80 kVp image set yielded the best diagnostic performance among all image sets (area under the ROC curve [AUC], 0.996; P < 0.001), while 70 keV images yielded the highest diagnostic performance among the virtual monoenergetic image sets (AUC, 0.958; P < 0.001). Inter-rater agreement was good at 80 kVp images (intraclass correlation coefficient [ICC], 0.78, P < 0.001). CONCLUSION Evaluation of DECT image reconstructions suggested that low tube voltage with 80 kVp demonstrated accurate diagnostic performance for AA. This finding suggests that low kVp CT may be useful for diagnosing AA with reduced patient radiation exposure.PubMedWoSScopu

Usefulness of membranous septum length in the prediction of major conduction disturbances in patients undergoing transcatheter aortic valve replacement with different devices

Background: Conduction disturbances (CD) are one of the most common adverse events after transcatheter aortic valve replacement (TAVR), and seem to be dependent on the device used as well as anatomical factors. Aims: The aim of this study was to evaluate whether the length of the membranous septum (MS) could provide useful information about the risk of CD and to examine the impact of the MS on CD after TAVR using different devices. Methods: This study included 140 patients undergoing TAVR with a balloon‑expandable valve or self‑‑expanding valve. The length of the MS was assessed by preoperative computed tomography. ΔMSID was calculated as the length of the MS minus implantation depth. Results: A total of 24 patients (17%) received a permanent pacemaker (PPM), 53 (38%) developed new‑‑onset left bundle‑branch block (LBBB) following TAVR. The MS length was shown to be the strongest independent predictor of new‑onset LBBB (odds ratio [OR], 3.05; 95% CI, 1.96–4.77; P &lt; 0.001) and PPM implantation (OR, 3.76; 95% CI, 2.01–7.06; P &lt; 0.001). ΔMSID was also inversely associated with the development of LBBB and the need for PPM. In a head‑to‑head comparison, ΔMSID values were found to be statistically lower in the self‑expanding valve group (–0.8 mm vs 0.7 mm; P &lt; 0.001). Conclusions: A short MS and ΔMSID with a negative value increase the risk of CD. Assessment of the MS length prior to TAVR might serve as an additional tool to guide clinical decision‑making and appropriate device selection to reduce the the risk of CD