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

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

Türkiye kalp kapak hastalıkları kayıt çalışması

Amaç: Ülkemizde kalp kapak hastalıkları (KKH) sık görülmesine karşın, bu konuda herhangi bir epidemiyolojik veri bulunmamaktadır. Bu çalışmada, Türkiye’deki KKH’de klinik, laboratuvar bulguları ve önerilen tedavi yöntemlerinin araştırılması amaçlandı. Çalışma planı: Çalışma ileriye dönük olarak, 42 merkezde yapıldı. Haziran 2009-Haziran 2011 arasında bu merkezlere başvuran, daha önce KKH’ye yönelik girişimde bulunulmuş olgular, doğal kapak hastalığı ve/veya endokardit tanısı konulan hastalar çalışmaya alındı. Bulgular: Toplam 1300 hastaya ait veriler kaydedildi. Hastaların yaş ortalaması 57±18 yıl, kadın/erkek oranı 1.5 idi. KKH’nin %84’i doğal kapak, %15’i önceden girişim yapılan ve %1’i de endokarditli olgulardan oluşmaktaydı. En sık görülen doğal KKH mitral yetersizliği (%43) olup bunu çoklu kapak hastalığı (%32) izlemekteydi. Tüm hastalarda romatizmal (%46), aort darlığında ise dejeneratif (%86) etyoloji öne çıkmaktaydı. Yaşla birlikte aort darlığı görülme sıklığının arttığı, mitral darlığının ise azaldığı saptandı. En sık görülen belirti nefes darlığı (%73) idi. Kapak hastalarında tedavi seçimi yapılırken en sık kullanılan yöntemin klinik ve ekokardiyografik değerlendirme (%54) olduğu görüldü. Mitral darlığında perkütan mitral balon valvüloplasti (%76), diğer kapak hastalıklarında ise mekanik protez kapak uygulaması (%74) yeğlenen tedavi yöntemiydi. Sonuç: Türkiye’de kapak hastalıklarının en sık nedeni romatizmal ateştir. Mitral yetersizliği ve çoklu kapak tutulumu en sık görülen kapak hastalıklarıdır. Perkütan balon valvüloplasti ve kapak değişimi en sık başvurulan tedavi yöntemleridir.Objectives: Valvular heart diseases (VHD) occur frequently n Turkey. However, epidemiological studies of VHD have not been completed until now. The aim of this study is to dentify the VHD type, clinical, laboratory characteristics, and treatment methods among VHD patients in Turkey. Study design: The study was conducted prospectively be- tween June 2009 and June 2011 at 42 centers, and included patients with native VHDs, infective endocarditis, and/or pre- vious valve interventions. Results: All medical data from 1300 patients were recorded. Mean age was 57±18 years and the female/male ratio was 1.5. VHD was native in 84% of patients, 15% had previous nterventions, and 1% had infective endocarditis. Among the native VHDs, mitral regurgitation was the most frequent lesion (43%), followed by multiple VHDs (32%). Degenerative etiolo- gy (86%) was more frequent in aortic VHD, and rheumatic ori- gin was the main cause in all VHDs. While the prevalence of aortic stenosis increased with age, mitral stenosis decreased with patient age. The most frequent symptom was shortness of breath (73%). Clinical and echocardiographic examinations (54%) were mostly used as diagnostic techniques for deter- mining treatment course. Percutaneous mitral balloon valvu- oplasty (PMBV) was performed in 76% of the patients with mitral stenosis and mechanical prosthetic valve replacement was performed in 74% of the patients with other lesions. Conclusion: This study showed that the main cause of VHD s rheumatic fever. Mitral regurgitation and multiple valvular esions are the most frequent VHDs in Turkey. PMBV and mechanical prosthetic valve replacement are the preferred treatment methods for VHD

Türkiye kalp kapak hastalıkları kayıt çalışması

Amaç: Ülkemizde kalp kapak hastalıkları (KKH) sık görülmesine karşın, bu konuda herhangi bir epidemiyolojik veri bulunmamaktadır. Bu çalışmada, Türkiye’deki KKH’de klinik, laboratuvar bulguları ve önerilen tedavi yöntemlerinin araştırılması amaçlandı. Çalışma planı: Çalışma ileriye dönük olarak, 42 merkezde yapıldı. Haziran 2009-Haziran 2011 arasında bu merkezlere başvuran, daha önce KKH’ye yönelik girişimde bulunulmuş olgular, doğal kapak hastalığı ve/veya endokardit tanısı konulan hastalar çalışmaya alındı. Bulgular: Toplam 1300 hastaya ait veriler kaydedildi. Hastaların yaş ortalaması 57±18 yıl, kadın/erkek oranı 1.5 idi. KKH’nin %84’i doğal kapak, %15’i önceden girişim yapılan ve %1’i de endokarditli olgulardan oluşmaktaydı. En sık görülen doğal KKH mitral yetersizliği (%43) olup bunu çoklu kapak hastalığı (%32) izlemekteydi. Tüm hastalarda romatizmal (%46), aort darlığında ise dejeneratif (%86) etyoloji öne çıkmaktaydı. Yaşla birlikte aort darlığı görülme sıklığının arttığı, mitral darlığının ise azaldığı saptandı. En sık görülen belirti nefes darlığı (%73) idi. Kapak hastalarında tedavi seçimi yapılırken en sık kullanılan yöntemin klinik ve ekokardiyografik değerlendirme (%54) olduğu görüldü. Mitral darlığında perkütan mitral balon valvüloplasti (%76), diğer kapak hastalıklarında ise mekanik protez kapak uygulaması (%74) yeğlenen tedavi yöntemiydi. Sonuç: Türkiye’de kapak hastalıklarının en sık nedeni romatizmal ateştir. Mitral yetersizliği ve çoklu kapak tutulumu en sık görülen kapak hastalıklarıdır. Perkütan balon valvüloplasti ve kapak değişimi en sık başvurulan tedavi yöntemleridir.Objectives: Valvular heart diseases (VHD) occur frequently n Turkey. However, epidemiological studies of VHD have not been completed until now. The aim of this study is to dentify the VHD type, clinical, laboratory characteristics, and treatment methods among VHD patients in Turkey. Study design: The study was conducted prospectively be- tween June 2009 and June 2011 at 42 centers, and included patients with native VHDs, infective endocarditis, and/or pre- vious valve interventions. Results: All medical data from 1300 patients were recorded. Mean age was 57±18 years and the female/male ratio was 1.5. VHD was native in 84% of patients, 15% had previous nterventions, and 1% had infective endocarditis. Among the native VHDs, mitral regurgitation was the most frequent lesion (43%), followed by multiple VHDs (32%). Degenerative etiolo- gy (86%) was more frequent in aortic VHD, and rheumatic ori- gin was the main cause in all VHDs. While the prevalence of aortic stenosis increased with age, mitral stenosis decreased with patient age. The most frequent symptom was shortness of breath (73%). Clinical and echocardiographic examinations (54%) were mostly used as diagnostic techniques for deter- mining treatment course. Percutaneous mitral balloon valvu- oplasty (PMBV) was performed in 76% of the patients with mitral stenosis and mechanical prosthetic valve replacement was performed in 74% of the patients with other lesions. Conclusion: This study showed that the main cause of VHD s rheumatic fever. Mitral regurgitation and multiple valvular esions are the most frequent VHDs in Turkey. PMBV and mechanical prosthetic valve replacement are the preferred treatment methods for VHD

The feasibility of dual-energy CT in differentiation of vertebral compression fractures

WOS: 000368418500008PubMed: 26537691Objective: To prospectively evaluate the ability of dual-energy CT (DECT), compared with MRI, to identify vertebral compression fractures in acute trauma patients. Methods: This institutional review board-approved study included 23 consecutive patients with 32 vertebral fractures who underwent both DECT and MRI of the spine between February 2014 and September 2014. A total of 209 vertebrae were evaluated for the presence of abnormal bone marrow attenuation on DECT and signal on MRI by five experienced radiologists. The specificity, sensitivity, predictive values and intraobserver and interobserver agreements were calculated. Results: MRI revealed a total of 47 vertebrae (22.4% of all vertebrae) and DECT revealed 44 vertebrae (21.0% of all vertebrae) with oedema. Using MRI as the reference standard, DECT had sensitivity, specificity, positive-predictive value, negative-predictive value and accuracy of 89.3, 98.7, 95.4, 96.9 and 96.6%, respectively. With respect to establishing the presence of oedema, the interobserver agreement was almost perfect (k=0.82), and the intraobserver agreement was substantial (k=0.80). Conclusion: Compared with MRI, DECT can provide an accurate demonstration of acute vertebral fractures and can be used as an alternative imaging modality for the assessment of vertebral fractures in patients with contraindications for MRI. Advances in knowledge: Distinguishing of acute and chronic vertebral compression fracture is important for treatment choices. DECT is very fast compared with MRI and is an alternative imaging modality for the assessment of vertebral fractures in patients with contraindications for MRI

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

WOS: 000379846300006PubMed: 27328718PURPOSE 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 Polycystic Ovary Syndrome Patients with Strain Echocardiography

Objectives: Polycystic Ovary Syndrome (PCOS) is characterized by several metabolic abnormalities that may lead to insulin resistance, diabetes, and atherosclerosis which are associated with chronic inflammatory processes and oxidative stress. Due to this fact PCOS patients are at increased risk of cardiovascular diseases. We used echocardiographic quantification tools to detect subclinical changes in myocardial functions. Materials and Methods: Echocardiographic, hormonal and metabolic measurements were performed in twenty-six women with PCOS and twenty-three healthy volunteers. The age of the attendants ranged between 20 and 31 years. PCOS was diagnosed by using the Rotterdam criteria. We compared the myocardial functions of PCOS patients without any cardiovascular symptoms with healthy volunteers by using strain echocardiography. Results: No differences were found between the two groups' strain, strain rate and myocardial velocity measurements. Conclusion: According to our study PCOS patients without any clinical cardiovascular symptoms have no impairment in myocardial functions. These results should be further confirmed in larger controlled studies