Myocardial bridging and coronary artery anomalies detected by ECG-gated 64-row multidetector computed tomography angiography in symptomatic patients

Advances in 64-row multidetector computed tomography have provided noninvasive imaging of coronary arteries. The aim of this study was to evaluate the prevalence of coronary artery anomalies in Iranian symptomatic patients and to determine the presence of anomalies resulting in myocardial ischaemia without atherosclerotic plaque. This study was carried out in Tabriz University of medical sciences on 534 patients with suggestive symptoms for coronary artery diseases. Original slices were reconstructed from data achieved by using a ECG-gated multidetector computed tomography scanner, and reconstructed 3-dimentional images of the heart were reviewed. Congenital angiography was performed in 36.3% of patients. The prevalence of myocardial bridging in symptomatic patients was 6.0% by multidetector computed tomography while conventional angiography could detect 20% of them. The most prevalent site was the middle portion of the left anterior descending artery. Anomalous origin or course of coronary arteries and AV fistula was detected by multidetector computed tomography coronary angiography in 2.6% of cases while conventional angiography could detect 44.4% of these anomalies. The prevalence of atherosclerotic plaques in patients with myocardial bridging was 53.1%. In 46.9% of these patients, myocardial bridging was held responsible for signs and symptoms of myocardial ischaemia as no atherosclerotic plaque was evident. This rate was 64.3% in symptomatic patients with other anomalies in origin or course of coronary arteries. This study gives the prevalence of coronary artery anomalies and myocardial bridging in the Iranian population. The results suggest multidetector computed tomography coronary angiography as the preferred utility for diagnosing such anomalies

Anatomical differences in the right and left renal arterial patterns

The aim of this study was to determine the pattern and character of the renal arteries in patients referred for preoperative or diagnostic evaluation of the renal or abdominal arteries by multi-detector computed tomography and, by comparing the arterial anatomy of the right and left kidneys, to evaluate the effect of differences in their anatomical position on the characteristics of the arteries. During a cross-sectional study from August 2005 to October 2007, 117 patients underwent contrast-enhanced 64-slice multi-detector computed tomography renal angiography in Tabriz Imam Khomeini Hospital (Parsian Centre). The number of arteries, the number of branches and the presence of accessory arteries and early branching were assessed in the renal arteries on both sides. In all, the data for 117 patients data were analysed, 76 (65%) of whom were male and 41 (35%) female. The mean of age of the patients was 39.26 ± ± 17.03 years. The mean diameters of the aorta and renal artery were 2.62 ± ± 1.55 mm and 0.62 ± 0.11 mm respectively and the distance to branching was 3.39 ± 1.59 mm. There was no significant difference in diameter between the left and right renal arteries or in the distance to branching (0.62 ± 0.11 vs. 0.61 ± 0.12 mm; p = 0.35; 3.24 ± 1.2 vs. 3.56 ± 1.77 mm; p = 0.11). An accessory artery was presented in 58 kidneys and this significantly more often occurred on the right side than on the left side: 38 of 117 (32.47%) right kidneys vs. 20 of 117 (17.09%) left kidneys (p = 0.01). There was early branching in 42 subjects (35.89%). In a comparison of early branching of the arteries of the right and left kidneys, no significant difference was found, despite the higher incidence of branching on the right side. The diameters of the right and left renal arteries and the distances to branching did not differ. Apart from width, there was no difference in kidney size. An accessory artery occurred more frequently in the right renal artery than in the left. (Folia Morphol 2008; 67: 104-110

Diagnostic accuracy of twinkling artifact sign seen in color doppler ultrasonography in detecting microlithiasis of kidney

Background: Ultrasonography (US) is a safe and cost-efficient modality which is used to assess patients with urinary tract lithiasis. Objectives: In this study, we aimed to evaluate the accuracy of the twinkling artifact of color Doppler sonography in detecting renal stones smaller than 4 mm in diameter. Methods: Of all patients referring to a tertiary medical center with a probable diagnosis of urolithiasis during April 2019 to Septem-ber 2019, 99 patients with a renal stone smaller than 4 mm in non-contrast computed tomography (CT) scan entered our study. Both gray scale and color Doppler US were performed to assess the presence of any renal stones, the accompanying posterior shadowing, and the twinkling artifact for all patients. Results: Of 99 patients with confirmed renal stone on non-contrast CT scan, 91 patients had an echogenic focus on grayscale (sensi-tivity = 91.9), 70 patients had posterior shadowing sign (sensitivity = 70.7), and 76 patients had twinkling artifact on color Doppler US. The sensitivity, specificity, positive predictive value, and negative predictive value of this imaging finding for detecting renal stones smaller than 4 mm were 76.8, 100, 100, and 32.4, respectively. Conclusions: Our study revealed that twinkling artifact on color Doppler US is a reliable sign for detecting renal stones smaller than 4 mm. However, the sensitivity of this sign could be increased in combination with gray scale findings (echogenic focus and posterior shadowing). © 2020, Author(s)

La risonanza magnetica nelle complicanze del rene trapiantato

Kidney transplantation is currently the treatment of choice in most patients with end-stage chronic renal failure owing to the excellent results in terms of both graft and patient survival. However, surgical complications are still very frequent. Although urological (stricture, urinary fistulas, vesico-ureteral reflux) and lymphatic complications (lymphocoele) have a high incidence, they only rarely lead to graft loss. By contrast, vascular complications (stenosis, arterial and venous thrombosis, arterio-venous fistulas, pseudoaneurysms) are relatively rare, but potentially serious and may affect graft survival. Finally, medical complications such as acute tubular necrosis (ATN), rejection and de novo neoplasms may also arise in kidney transplantation. The purpose of this pictorial review is to illustrate the increasingly significant contribution of magnetic resonance angiography (MRA) in the management of complications of kidney transplantation, and emphasise how this method should now be considered a mandatory step in the diagnostic workup of selected cases. Moreover, the application and role in this setting of new magnetic resonance imaging (MRI) techniques, such as diffusion-weighted and blood oxygen level-dependent (BOLD) MRI, are also discussed