Multislice CT angiography assessment of left coronary artery: Correlation between bifurcation angle, dimensions and development of coronary artery disease

Purpose: To investigate the relationship between left coronary bifurcation and dimensional changes and development of coronary artery disease using multislice CT angiography. Materials and Methods: 30 patients (18 men, 12 women, mean age, 56 years plus or equal to 8) suspected of coronary artery disease undergoing 64- and 256-slice CT angiography were included in the study. Left bifurcation angle and left coronary diameter were measured to determine the relationship between angulation and plaque formation and subsequent dimensional changes. Results: Plaques were present in the left coronary artery in 22 patients with variable angulations and dimensional changes. The mean bifurcation angle between left anterior descending and left circumflex arteries was measured 89.1 plus or equal to 13.1 (range, 55.3, 134.5) among all patients. The mean bifurcation angle measured in patients with normal and diseased left coronary artery was 75.5 plus or equal to 19.8 (range, 60, 96.1), and 94 plus or equal to 19.7 (range, 55.3, 134.5), respectively, with significant difference between these two groups (p=0.02). Similarly, there is a significant difference in the mean diameters of left anterior descending and circumflex between patients with normal and diseased left coronary artery (p less than 0.001), which were measured 2.8 plus or equal to 0.3 mm (range, 2.2, 3.2 mm) and 2.1 plus or equal to 0.4 mm (range, 1.9, 2.9 mm) for the normal left coronary arteries, 4.0 plus or equal to 0.8 mm (range, 2.5, 6.1 mm) and 2.9 plus or equal to 0.5 mm (range, 1.6, 3.9 mm) for the diseased left coronary arteries, respectively. Conclusion: There is a direct correlation between left bifurcation angle and dimensional changes and formation of plaques. Multislice CT angiography can be used to provide relevant features of left coronary atherosclerosis

Use of coronary CT angiography in the diagnosis of patients with suspected coronary artery disease: findings and clinical indications

Objective: To investigate the clinical applications of coronary CT angiography in patients with suspected coronary artery disease and identify factors that affect CT findings. Methods: Medical records of patients suspected of coronary artery disease over a period of 12 months from a tertiary teaching hospital were retrospectively reviewed. Patient age, sex (male/female), duration of symptoms and abnormal rates of coronary CT angiography scans were analysed to investigate the relationship among these parameters. The patients by age were characterized into five groups: under 36 years, 36–45 years, 46–55 years, 56–65 years and more than 66 years, respectively; while the duration of symptoms was also classified into five groups: less than one week, one week to one month, one to three months, three to six months and more than six months. Results: Of the 880 patient records reviewed, 800 met the above study criteria. Five hundred and forty nine patients demonstrated abnormal CT findings (68.6%). There was no significant difference in the percentage of abnormal CT findings based on patient sex and the duration of symptoms (P = 0.14). The abnormal rates of coronary CT angiography, however, increased significantly with increasing age (P < 0.001); with patients over 65 years of age 2.5 times more likely to have an abnormal CT scan relative to a patient under 45 years. A significant difference was found between abnormal coronary CT angiography and the duration of symptoms (P = 0.012). Conclusions: Our results indicate coronary CT angiography findings are significantly related to the patient age group and duration of symptoms. Clinical referral for coronary CT angiography of patients with suspected coronary artery disease needs to be justified with regard to the judicious use of this imaging modality

CT angiography in the diagnosis of cardiovascular disease: A transformation in cardiovascular CT practice.

Computed tomography (CT) angiography represents the most important technical development in CT imaging and it has challenged invasive angiography in the diagnostic evaluation of cardiovascular abnormalities. Over the last decades, technological evolution in CT imaging has enabled CT angiography to become a first-line imaging modality in the diagnosis of cardiovascular disease. This review provides an overview of the diagnostic applications of CT angiography in cardiovascular disease, with a focus on selected clinical challenges in some common cardiovascular abnormalities, which include abdominal aortic aneurysm, aortic dissection, pulmonary embolism and coronary artery disease. An evidence-based review is conducted to demonstrate how CT angiography has changed our approach in the diagnosis and management of cardiovascular disease. Radiation dose reduction strategies are also discussed to show how CT angiography can be performed in a low-dose protocol in the current clinical practice

Personalized Three-Dimensional Printed Models in Congenital Heart Disease

Patient-specific three-dimensional (3D) printed models have been increasingly used in cardiology and cardiac surgery, in particular, showing great value in the domain of congenital heart disease (CHD). CHD is characterized by complex cardiac anomalies with disease variations between individuals; thus, it is difficult to obtain comprehensive spatial conceptualization of the cardiac structures based on the current imaging visualizations. 3D printed models derived from patient’s cardiac imaging data overcome this limitation by creating personalized 3D heart models, which not only improve spatial visualization, but also assist preoperative planning and simulation of cardiac procedures, serve as a useful tool in medical education and training, and improve doctor–patient communication. This review article provides an overall view of the clinical applications and usefulness of 3D printed models in CHD. Current limitations and future research directions of 3D printed heart models are highlighted

Optimization of chest radiographic imaging parameters: a comparison of image quality and entrance skin dose for digital chest radiography systems

We studied the performance of three computed radiography and three direct radiography systems with regard to the image noise and entrance skin dose based on a chest phantom. Images were obtained with kVp of 100, 110, and 120 and mA settings of 1, 2, 4, 8, and 10. Significant differences of image noise were found in these digital chest radiography systems (Pb<0001). Standard deviation was significantly different when the mAs were changed (Pb<001), but it was independent of the kVp values (P=.08–.85). Up to 44% of radiation dose could be saved when kVp was reduced from 120 to 100 kVp without compromising image quality

Ochrobactrum anthropi induced retropharyngeal abscess with mediastinal extension complicating airway obstruction: A case report.

Retropharyngeal abscess with involvement of mediastinal abscess represents an uncommon complication of upper respiratory tract infections. We report a case presenting with a large retropharyngeal abscess with airway obstruction as the primary presenting symptom. Contrast-enhanced CT showed a large retropharyngeal abscess in the neck with extension to the upper and posterior mediastinal spaces. The abscess was surgically excised with 200 cc pus drained from the neck and mediastinal regions. We describe this case to assist physicians in making the difficult diagnosis when confronting a patient with airway obstruction, as early recognition of retropharyngeal abscess permits emergent airway management

3D CT Angiography of Infrarenal Abdominal Aortic Aneurysm with Associated Ectopic Pelvic Kidney: A Case Report of Rare Concomitance

The abdominal aortic aneurysm (AAA) associated with congenital pelvic kidney is a rare clinical finding. We present a case of an infrarenal AAA with associated congenital left pelvic kidney followed up for 5 years, which was managed by regular surveillance. We describe this case to assist physicians and radiologists to recognize small aneurysmsby computed tomography angiography (CTA) with low radiation dose and low iodine dose. To the best of our knowledge,this case is the first report by using CTA with the combination of low-concentration contrast medium, low radiation doseand iterative reconstruction