Koroner arter çıkış varyasyonlarının çok kesitli bilgisayarlı tomografi ÇKBT ile değerlendirilmesi

Amaç: Koroner arter varyasyonları nadir görülmekle birlikte egzersiz esnasında ani ölüme yol açabilmektedir. Sözkonusu varyasyonların tanımlanması bir takım ciddi komplikasyonları önlemede yol gösterici olabilmektedir. Çalışmamızın amacı koroner arter çıkış varyasyonlarının sıklığını ve klinik açıdan önemini vurgulamak; aynı zamanda son yıllarda gelişen BT teknolojileriyle bu varyasyonların saptanabilirliğini ortaya koymaktır. Gereç ve Yöntem: Çalışmaya risk faktörü nedeniyle veya koroner arter hastalığı düşünülen ve bu nedenle kliniğimizde koroner BT anjiyografi tetkiki yapılan 1256 olgu dahil edildi. Retrospektif olarak planlanan çalışmada olgulardaki koroner arter varyasyonları tespit edilerek tanımlandı.Yüksek çıkımlı sağ koroner arter RCA - sol koroner arter LCA , ayrı ostiumlardan çıkış gösteren sol ön inen arter LAD ve sol sirkumfleks arter Cx , karşı koroner sinüsten çıkış gösteren arterler ve RCA’dan çıkış gösteren Cx arterler değerlendirildi.Bulgular: Toplam 31 olguda % 2.50 koroner arter varyasyonu tespit edildi. Yüksek çıkımlı koroner arter sıklığı RCA ve LCA için sırasıyla % 0.16, % 0.40 olarak tespit edildi. LAD ve Cx arterin ayrıostiumlardan çıkma sıklığı % 0.64 olarak saptandı. Sol sinüs Valsalva’dan köken alan RCA sıklığı % 0.48 oranında görülürken; Cx arter ve LCA’nın sağ sinüs Valsalva’dan köken alma sıklığı sırasıyla %0.16, % 0.24 olarak hesaplandı. RCA’dan çıkış gösteren Cx sıklığı % 0.32 olarak hesaplandı. Tek koroner arter anomalisi sıklığı ise % 0.08 oranında gözlendi.Sonuç: Koroner arter varyasyonları toplumun yaklaşık % 2’sinde görülen ve çeşitlilikleri fazla olan anomalilerdir. Klinik olarak asemptomatik olabilecekleri gibi infarkt veya ani ölümlere yol açabilen anomaliler de bulunmaktadır. Özellikle koroner arterlerin pulmoner arterden köken alması, anormal kökenli koroner arterlerin interarteriyel seyir göstermesi gibi anomalilerin ani ölüme yol açabilme potansiyelleri nedeniyle tanısı ve uygun tedavisi önemlidir. ÇKBT Çok Kesitli Bilgisayarlı Tomografi koroner anjiyografi ile koroner arter varyasyonları yüksek duyarlılıkta saptanabilmektedi

Vascular imaging findings with high-pitch low-dose dual-source CT in atypical Kawasaki disease

PURPOSE:Determining the presence of aneurysms, thrombosis, and stenosis is very important for the diagnosis of atypical Kawasaki disease (AKD) and in the follow-up of AKD patients with aneurysms. We aimed to demonstrate high-pitch low-dose dual-source computed tomography (CT) angiography findings in pediatric patients with AKD.METHODS:Over a 5-year period, high-pitch low-dose CT angiography was performed to determine vascular aneurysms or occlusions in 17 patients who had suspected AKD. The patients ranged from 2 months of age to 11.3 years, with a mean age of 3 years. The American Heart Association’s criteria were used to diagnose AKD.RESULTS:We did not detect any vascular problems in 6 of the patients, and they were not included in our study. Arterial aneurysms were present in 11 patients (aged 2 months to 11.3 years; mean age, 4.2 years; 7 males). In one patient, there was also a thrombus at an arterial aneurysm. Coronary artery aneurysms were detected in 7 patients and systemic artery aneurysms were detected in 7 patients. Three patients had both systemic and coronary aneurysms.CONCLUSION:Our results suggest that high-pitch low-dose dual-source CT can detect all types of aneurysms, stenosis and occlusions of vessels in patients with AKD who were not previously diagnosed. This useful, easy, robust and fast technique may be preferred to diagnose AKD

Long-term lung perfusion changes related to COVID-19: a dual energy computed tomography study

PURPOSEAlthough the findings of acute new coronavirus disease (COVID-19) infection on dual-energy computed tomography (DECT) have recently been defined, the long-term changes in lung perfusion associated with COVID-19 pneumonia have not yet been clarified. We aimed to examine the longterm course of lung perfusion in COVID-19 pneumonia cases using DECT and to compare changes in lung perfusion to clinical and laboratory findings.METHODSOn initial and follow-up DECT scans, the presence and extent of perfusion deficit (PD) and parenchymal changes were assessed. The associations between PD presence and laboratory parameters, initial DECT severity score, and symptoms were evaluated.RESULTSThe study population included 18 females and 26 males with an average age of 61.32 ± 11.3 years. Follow-up DECT examinations were performed after the mean of 83.12 ± 7.1 (80–94 days) days. PDs were detected on the follow-up DECT scans of 16 (36.3%) patients. These 16 patients also had ground-glass parenchymal lesions on the follow-up DECT scans. Patients with persistent lung PDs had significantly higher mean initial D-dimer, fibrinogen, and C-reactive protein values than patients without PDs. Patients with persistent PDs also had significantly higher rates of persistent symptoms.CONCLUSIONGround-glass opacities and lung PDs associated with COVID-19 pneumonia can persist for up to 80–90 days. Dual-energy computed tomography can be used to reveal long-term parenchymal and perfusion changes. Persistent PDs are commonly seen together with persistent COVID-19 symptoms

Quantitative evaluation of ischemic myocardial scar tissue by unenhanced T1 mapping using 3.0 Tesla MR scanner

PURPOSEWe aimed to use a noninvasive method for quantifying T1 values of chronic myocardial infarction scar by cardiac magnetic resonance imaging (MRI), and determine its diagnostic performance.MATERIALS AND METHODSWe performed cardiac MRI on 29 consecutive patients with known coronary artery disease (CAD) on 3.0 Tesla MRI scanner. An unenhanced T1 mapping technique was used to calculate T1 relaxation time of myocardial scar tissue, and its diagnostic performance was evaluated. Chronic scar tissue was identified by delayed contrast-enhancement (DE) MRI and T2-weighted images. Sensitivity, specificity, and accuracy values were calculated for T1 mapping using DE images as the gold standard.RESULTSFour hundred and forty-two segments were analyzed in 26 patients. While myocardial chronic scar was demonstrated in 45 segments on DE images, T1 mapping MRI showed a chronic scar area in 54 segments. T1 relaxation time was higher in chronic scar tissue, compared with remote areas (1314±98 ms vs. 1099±90 ms, P < 0.001). Therefore, increased T1 values were shown in areas of myocardium colocalized with areas of DE and normal signal on T2-weighted images. There was a significant correlation between T1 mapping and DE images in evaluation of myocardial wall injury extent (P < 0.05). We calculated sensitivity, specificity, and accuracy as 95.5%, 97%, and 96%, respectively.CONCLUSIONThe results of the present study reveal that T1 mapping MRI combined with T2-weighted images might be a feasible imaging modality for detecting chronic myocardial infarction scar tissue

The value of dual-energy computed tomography in the evaluation of myocarditis

PURPOSEThe inflammation of the heart muscle is referred to as acute myocarditis. Cardiac magnetic resonance imaging (CMR) has become the primary method for a non-invasive assessment of myocardial inflammation. However, there are several drawbacks of CMR. During the last decade, dual energy computed tomography (DECT) has been used in cardiac imaging. The current study aims to assess the efficacy and feasibility of DECT in acute myocarditis and compare the results to CMR.METHODSThis prospective study included patients who had myocarditis but no coronary artery pathology. Two observers evaluated the patients for acute myocarditis using DECT and CMR. CMR was performed on 22 patients within 24 hours of DECT, which was administered within 12 hours following the onset of chest pain. Inter-observer agreement was tested with Cohen’s Kappa coefficient, and Spearman’s correlation was used to examine the possible correlations. A P value of <0.050 was accepted as statistically significant.RESULTSThe DECT and CMR agreement was significant for transmural diagnoses, excellent for subepicardial and intramyocardial diagnoses, and perfect for nodular and band-like patterns.CONCLUSIONThe findings of this study showed that the dark areas on the color-coded iodine map created with DECT were strongly correlated with CMR in acute cases of myocarditis. In addition, DECT is a robust imaging method that can also be used in the diagnosis of acute myocarditis. Furthermore, it provides information about coronary arteries faster and more reliably than magnetic resonance imaging without any limitations

Coronary lesion complexity assessed by SYNTAX score in 256-slice dual-source MDCT angiography

PURPOSE:The SYNTAX Score (SS) has an important role in grading the complexity of coronary artery disease (CAD) in patients undergoing revascularization. Noninvasive determination of SS prior to invasive coronary angiography (ICA) might optimize patient management. We aimed to evaluate the agreement between ICA and multidetector computed tomography (MDCT) while testing the diagnostic effectiveness of SS-MDCT.METHODS:Our study included 108 consecutive patients who underwent both MDCT angiography with a 256-slice dual-source MDCT system and ICA within 14±3 days. SS was calculated for both ICA and MDCT coronary angiography. Spearman’s rank correlation coefficient was used to evaluate the association of SS-MDCT with SS-ICA, and Bland-Altman analysis was performed.RESULTS:The degree of agreement between SS-ICA and SS-MDCT was moderate. The mean SS-MDCT was 14.5, whereas the mean SS-ICA was 15.9. After dividing SS into three groups (high [≥33], intermediate [23–32], and low [≤22] subgroups), agreement analysis was repeated. There was a significant correlation between SS-MDCT and SS-ICA in the low SS group (r=0.63, P = 0.043) but no significant correlation in the high SS group (r=0.036, P = 0.677). The inter-test agreement analysis showed at least moderate agreement, whereas thrombotic lesions and the type of bifurcation lesion showed fair agreement.CONCLUSION:The calculation of SS-MDCT by adapting SS-ICA parameters achieved nearly the same degree of precision as SS-ICA and was better than SS-ICA, especially in the low SS group

Evaluation of coronary arteries by multidetector computed tomography

Koroner arter hastalığının değerlendirilmesinde kateter anjiyografi altın standart olarak kabul edilmekle birlikte, asemptomatik ve hafif semptomatik fazdaki koroner arter hastalığının takibi ve değerlendirilmesinde invaziv olmayan görüntüleme yöntemlerine ihtiyaç duyulmaktadır. Bu açıdan, çokkesitli bilgisayarlı tomografi (BT) teknolojisinin gelişmesiyle, koroner BT anjiyografi koroner arterlerin görüntülenmesinde yüksek potansiyele sahip bir yöntem olarak kullanılmaya başlanmıştır. Bu derlemede koroner BT teknolojisi, klinik uygulama alanları, endikasyonları ve bu konuda yapılmış çalışmalar gözden geçirildi.Although coronary angiography is recognized as the gold standard in the evaluation of coronary artery disease, there is still need for noninvasive imaging methods to detect and monitor asymptomatic or minimally symptomatic coronary artery disease. With technological improvements in multidetector computed tomography (CT), coronary CT angiography proved to be a potential noninvasive method in this field. This article reviews technological aspects, clinical applications, and indications of coronary CT angiography in the light of the most recent literature

Stereological evaluation of liver volume in living donor liver transplantation using MDCT via the Cavalieri method.

İstanbul Bilim Üniversitesi, Tıp Fakültesi.In living donor liver transplantation (LDLT), obtaining the precise volume of the graft is very important to decrease volume-related postoperative complications, especially in cases with suspected small-for size grafts. We used stereology based on the Cavalieri method (CM), a new method to measure liver graft volume, and compared the results with those obtained through intraoperative measurement (IOM) and through multidetector computed tomography (MDCT) measurement. Liver volumes estimated using the 3 methods were well-correlated with each other (r2 = 0.94 and P < 0.001 for IOM and CM; r2 = 0.91 and P < 0.001 for IOM and MDCT, and r2 = 0.95 and P < 0.001 for CM and MDCT); however, they were different from each other (in descending order, 908 ± 124 cm2, 861 ± 121 cm2, and 777 ± 168 cm2 for MDCT, CM, and IOM, respectively). Although MDCT and CM overestimated the volumes, the results of CM were almost similar to those obtained via IOM. In conclusion, our results suggest that CM measured the liver graft volume more reliably. Thus, its use, particularly in cases with suspected small-for-size graft, may prove useful

Clinical situations in which coronary CT angiography confers superior diagnostic information compared with coronary angiography.

In this review, we aimed to outline the clinical and pathological conditions for which multidetector computed tomography coronary angiography (MDCT-CA) should be the preferred method because of its advantages over conventional coronary angiography (CCA). A consistent body of literature suggests that MDCT-CA is more than just complementary to CCA and that it provides more valuable diagnostic information in certain clinical situations, such as complex coronary artery variations, aorto-ostial lesions, follow-up of bypass grafts, myocardial bridging, coronary artery fistulas, aortic and coronary artery dissections, and cases in which the coronary ostia cannot be cannulated by a catheter because of massive atherosclerosis or extremely tortuous vascular structures

Diagn Interv Radiol DOI 10.5152/dir.2014.13396 © Turkish Society of Radiology 2014 ABDOMINAL IMAGING REVIEW Perfusion CT imaging of the liver: review of clinical applications

Perfusion computed tomography (CT) has a great potential for determining hepatic and portal blood flow; it offers the advantages of quantitative determination of lesion hemodynamics, distinguishing malignant and benign processes, as well as providing morphological data. Many studies have reported the use of this method in the assessment of hepatic tumors, hepatic fibrosis associated with chronic liver disease, treatment response following radiotherapy and chemotherapy, and hepatic perfusion changes after radiological or surgical interventions. The main goal of liver perfusion imaging is to improve the accuracy in the characterization of liver disorders. In this study, we reviewed the clinical application of perfusion CT in various hepatic diseases