Application of CT pulmonary angiography and echocardiography in acute pulmonary embolism: A cross‐sectional study

Abstract Background Pulmonary Embolism (PE) is an acute and potentially fatal condition defined as the blockage of pulmonary arteries by an embolism that can be from various origins. Objective The present study aimed to investigate the findings of computed tomography pulmonary angiography (CTPA) and echocardiography in patients with acute PE. Methods The present cross‐sectional study included some patients with clinical manifestations of PE who underwent CTPA and echocardiography. The radiologic findings, PE severity, and outcome of the patients were recorded. Moreover, echocardiography was performed by an expert cardiologist using a high‐resolution device, while CTPA was performed by an expert radiologist using a 16‐slice device and a two‐step selective test bolus method. Results According to our findings, a total number of 147 patients were diagnosed with PE, including 44 (29.93%), 44 (29.93%), and 59 (40.14%) cases of mild, moderate, and severe PE, respectively. Moreover, 25 patients (17%) finally expired due to PE. Regarding the CTPA findings, 31 patients (21.1%) had septum flattening, while 35 (23.8%) had a septum deviation toward the left ventricle. Also, there were significant correlations between mortality and some CTPA findings, including severe PE (p < 0.001), the presence of septal deviation (p = 0.007), and higher diameters of the main pulmonary artery (p < 0.001) and right ventricle (p = 0.008). Conclusion CTPA is a valid and accessible modality for diagnosing and evaluating PE in suspected patients. Moreover, several findings in CTPA could predict adverse outcomes, such as death, in patients with PE

Evaluation of vertebral artery variations and arterial dominance in cervical CT angiographic images in Iranian population

Purpose: The aim of the present study was to determine the characteristics and variations in the origin of vertebral arteries (VA), its level of entry into the transverse foramen, VA diameter, Length of VA, and VA dominance. Methods: A total of 250 adult patients (143 males and 107 females) were enrolled (Mean age: 60.92±13.44) and scanned with Computerized Tomography angiography (CTA). Results: The VA entered the C6 transverse foramen in 97.8% of specimens. Abnormal entrance of VA was observed in 4.4% of specimens. The mean length of prevertebral (V1) right and left VA was 81.38±14.38 mm and 82.49±14.16 mm. The mean length of the intraforaminal segment (V2) of the right and left VA was 81.38±14.375mm and 82.49±14.162mm and showed sexual dimorphism. The mean diameter of the right and left VA was 3.297±0.85 and 3.676±0.88, respectively. We found 1(0.4%) left and 1(0.4%) right VA emerging from the aortic arch. The mean right and left VA diameters were 3.28 ± 0.83 mm and 3.6±0.88mm, respectively. A total of 90(0.36) patients were right dominant and 160(0.64) patients were left-dominant. The right VA of aortic arch origin entered the 4th cervical transverse foramina, whereas the left VA entered the 7th cervical transverse foramina. We found that 22(8.8%) of the right and 1 (0.4%) of the left vertebral arteries had distal origin. The results did not show any relationship between gender and origin of VA, diameter of VA, and level of entry. A significant relationship was observed between gender and VA length (P=0.0001). Discussion: The present study confirms the presence of anomalous in the VA route. Knowledge of such anatomical variations is important in interpreting CTA and may reduce the risk of intraoperative VA injury

Distribution of modic changes and its relation with age, sex and body mass index in Iranian population

Background: Suspected as a cause of low back pain (LBP), Modic changes (MCs) have received increasing attention in spine research and care. Knowledge of MCs based on the general population, which may provide an important clinical reference is limited. Moreover, fewer studies have examined whether MCs are related to other structural features of LBP, such as age, gender and body mass index (BMI). The aim of present study was to determine the prevalence and clinical distribution of MCs in patients with LBP and to explore the related factors such as age, gender and BMI. Method: A total of 159 adult subjects (74 males [46.2%] and 85 females [53.5%]) were enrolled in the study (Mean age: 46.15 ± 10.36) and scanned with 1.5 T Magnetic Resonance Scanner. Age, gender, disk degeneration, herniation, involved segments, Lumbar lordosis (LL) angle, Sacral sloop (SS), MCs, and endplate concave angle (ECA) were recorded. Disk degeneration was graded using a Pfirrmann scale. MCs were classified into Type I (MCI), type II (MC II), type III (MCIII). Results: There were a total of 13 patients (8.2%) with MCI, 145 patients (91.2%) with MC II, and 1 patient (0.6%) with MCIII. Among all patients, the L4/L5 lumbar level was most likely to suffer MCs (56.0%). Greater age [odds ratio (OR) = 2.44 for each 10-year increase] and BMI (OR = 1.07) were associated with the presence of MCs. Logistic regression showed that age, LL, L5/S1 segment lordosis angle, and L5 upper and lower ECA were related with different types of MCs. The OR values were A = 1.08, L = 0.88, D = 1.12, E = 0.88, O = 1.10, respectively (A means age, L means L5/S1 segment lordosis angle, D and E means L5 upper and lower ECA and O means Lumbar lordosis). Conclusion: Type II MCs are predominant, mostly occur in lower lumbar region. Age, LL, and L5 ECA were associated with type II MCs. L5 Lower concave angle and LL were the most relevant factors for different types