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ABSTRACT: We present a case of pulmonary vein (PV) stenosis after radio-frequency (RF) ablation, in which a hemodynamic change in the pulmonary artery was similar to that of congenital PV atresia on time-resolved contrast-enhanced magnetic resonance angiography (TR-MRA). A 48-year-old man underwent RF ablation due to atrial fibrillation. The patient subsequently complained of hemoptysis, dyspnea on exertion, and right chest pain. Right PV stenosis after catheter ablation was diagnosed through chest computed tomography and lung perfusion scan. Pulmonary TR-MRA revealed the pulmonary artery via systemic arterial collaterals and draining systemic collateral veins. On a velocity-encoded cine image, the flow direction of the right pulmonary artery was reversed in the diastolic phase and the left pulmonary artery demonstrated continuous forward flow throughout the cardiac cycle. These hemodynamic changes were similar to those seen in congenital unilateral PV atresia.
Korean journal of radiology: official journal of the Korean Radiological Society 11/2012; 13(6):816-9. · 1.32 Impact Factor
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ABSTRACT: PURPOSE:: To evaluate multidetector row computed tomographic indexes to quantify bronchiolitis obliterans syndrome (BOS) after hematopoietic stem cell transplantation by correlation with pulmonary function tests (PFT). MATERIALS AND METHODS:: Eighteen patients with BOS after hematopoietic stem cell transplantation and 18 age-matched healthy volunteers were included. They underwent multidetector row computed tomography including inspiration and expiration scans. The patients also underwent PFTs. Mean lung density (MLD), relative areas (RAs) of lung with attenuation coefficients below specific thresholds, and 9 percentiles of the distribution of attenuation coefficients were computed. These parameters and PFT results were correlated. RESULTS:: Mean MLD on inspiration (MLDin), MLD on expiration (MLDex), and the difference between the 2 (ΔMLD) were -858.5 HU, -788.6 HU, and 69.9, respectively, for the patients and -815.9 HU, -691.8 HU, and 124.1, respectively, for the volunteers. These parameters showed significant differences between the 2 groups (P<0.001) and strongly correlated with patients' residual forced expiratory volume in 1 second (FEV1) (r=0.71, 0.92, and 0.85, P≤0.001, respectively). RA with attenuation coefficients <-800 HU (RA800e) and the 80th percentile (80the) on expiration correlated most highly with the patients' residual FEV1 (r=-0.94, P<0.001). CONCLUSIONS:: RA with attenuation coefficients <-800 HU (RA800e) and the 80th percentile (80the) on expiration are valid indexes of the patients' residual FEV1 in BOS.
Journal of thoracic imaging 10/2012; · 1.42 Impact Factor
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ABSTRACT: We present an unusual case of an intracardiac Eustachian valve cyst observed concurrently with atresia of the coronary sinus ostium, a persistent left superior vena cava (LSVC) and a bicuspid aortic valve. There have been several echocardiographic reports of Eustachian valve cysts; however, there is no report of multidetector computed tomography (MDCT) findings related to a Eustachian valve cyst. Recently, we observed a Eustachian valve cyst diagnosed on MDCT showing a hypodense cyst at the characteristic location of the Eustachian valve (the junction of the right atrium and inferior vena cava). MDCT also demonstrated additional cardiovascular anomalies including atresia of the coronary sinus ostium and a persistent LSVC and bicuspid aortic valve.
Korean journal of radiology: official journal of the Korean Radiological Society 07/2012; 13(4):500-4. · 1.32 Impact Factor
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Skeletal Radiology 04/2012; 38(10):1027-1027. · 1.54 Impact Factor
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ABSTRACT: Our aim was to evaluate the plaque characteristics of coronary arteries related to significant stenosis with coronary CT angiography (CCTA) and to discuss the diagnostic accuracy of CCTA in patients with high calcium scores. After institutional review board approval, 110 patients (63 men; mean age: 67.1 ± 7.9 years) with Agatston scores >400 were retrospectively reviewed. Patients underwent Agatston calcium scoring and 64-slice CCTA, in addition to invasive coronary angiography (CAG). The composition (calcified, mixed, and non-calcified) and configuration (concentric, eccentric) of coronary artery plaques were analyzed on a per-segment basis by CCTA. We analyzed the differences in plaque composition and configuration between significant (≥ 50%) and non-significant (<50%) stenosis. Additionally, the diagnostic accuracy of stenosis according to plaque composition was evaluated by CCTA, using CAG as a reference method. Significant differences in plaque composition and configurations were observed between the two groups. In cases of significant stenosis, the proportions of concentric, mixed, and non-calcified plaques were significantly higher than those of eccentric and calcified plaques (P < 0.001). The sensitivity and positive predictive value of mixed (97.4, 87.6%) and non-calcified plaques (97.8, 95.7%) were significantly higher than those of calcified plaques (87.6, 67.2%). Although CCTA has limited value due to low diagnostic accuracy of calcified plaques, knowledge about the high frequencies of mixed and non-calcified plaques in significant stenosis help to make an accurate assessment of CAD with CCTA in patients with high calcium scores.
The international journal of cardiovascular imaging 11/2011; 27 Suppl 1:43-51. · 2.15 Impact Factor
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ABSTRACT: We report a rare case of the absence of the right superior vena cava and a persistent left superior vena cava in a 46-year-old man. This congenital venous anomaly was incidentally found on low-dose chest computed tomography and was clearly demonstrated by 3-dimensional volume-rendering image of multidetector computed tomography. Prior to computed tomography scanning, the scan range, optimal contrast enhancement, and reconstruction methods should be carefully planned to obtain the best diagnostic image of the venous anomalies using multidetector computed tomography.
Journal of thoracic imaging 08/2011; 26(3):W86-8. · 1.42 Impact Factor
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Sung-Won Jang,
Beom-June Kwon,
Min-Seok Choi,
Dong-Bin Kim,
Woo-Seung Shin,
Eun Joo Cho,
Ji-Hoon Kim,
Yong-Seog Oh,
Man-Young Lee,
Tai-Ho Rho,
Jae-Hyung Kim,
Bae-Young Lee,
Hyo-Lim Kim, Jung-Im Jung,
Kyung-Sup Song
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ABSTRACT: The aim of this study was to investigate the anatomic relationship around the left atrium (LA) and to provide clinical information to help avoid the risk of an atrio-esophageal fistula during atrial fibrillation (AF) ablation.
The multidetector spiral computed tomography images of 77 male patients (mean age, 54 ± 9 years) with drug-refractory AF and 37 male control subjects (mean age, 50 ± 11 years) were analyzed. We measured the following variables: (1) distance between the ostia of the pulmonary veins (PVs) and the ipsilateral esophageal border, (2) presence of a pericardial fat pad around each PV, and (3) contact width/length and presence of a fat pad between the LA and the esophagus.
The distance between the esophagus and the ostia of right superior PV, right inferior PV (RIPV), left superior PV, and left inferior PV (LIPV) was 27.2 ± 9.4 mm, 22.9 ± 10.3 mm, 2.7 ± 9.4 mm, and 7.1 ± 8.8 mm, respectively. A fat pad between the esophagus and the superior PV was present in more than 90% of the subjects in both groups. However, the fat pad around inferior PV was present less frequently in the patients than in the control group (p = 0.011, RIPV; p < 0.001, LIPV). The average length of the LA-esophagus contact in the patients and the control group subjects was 26.2 ± 10.4 and 18.5 ± 5.1 mm, respectively (p < 0.001).
Caution should be exercised when ablating the LIPV because the esophagus is located in close proximity to the left-sided PV and most of the inferior PVs in patients with AF are not covered with fat pads.
Journal of Interventional Cardiac Electrophysiology 06/2011; 32(1):1-6. · 1.17 Impact Factor
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ABSTRACT: Portopulmonary venous anastomosis (PPVA), which has been rarely reported in conventional CT and MR studies, is an unusual collateral pathway in patients with portal hypertension. It has clinical implications related to right-to-left shunt that are different from the clinical implications related to other more usual portosystemic shunts in portal hypertensive patients. Here, we report the dynamic CT and MRA findings of a case of PPVA in a patient with portal hypertension, directly demonstrating the shunt flow from the paraesophageal varix to the left atrium via the right inferior pulmonary vein.
Acta Radiologica 06/2011; 52(5):566-9. · 1.37 Impact Factor
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ABSTRACT: Direct comparison of different image reconstruction parameters to detect pulmonary embolism (PE) using 64-slice multidetector-row computed tomography (MDCT) is absent and the most accurate image reconstruction parameters have not yet been proven.
To compare different image reconstruction parameters for detecting PE using 64-slice MDCT in patients suspected of having an acute PE.
Forty patients who underwent pulmonary CT angiography with 64-slice MDCT for a suspected PE were included. Different image reconstruction parameters were used for each patient: axial and coronal images with slice thicknesses of 0.625 mm, 1.3 mm, and 2.5 mm and axial maximum intensity projection (MIP) images with slab thicknesses of 1.3 mm, 2.5 mm, and 5 mm. Four experienced radiologists reviewed the images. The diagnosis of a PE was based on consensus review of axial 0.625 mm slice thickness images by two chest radiologists with allowing multiplanar reconstruction. Accuracy and reproducibility (kappa value) were evaluated.
In 15 of 40 patients, a PE was diagnosed. For detecting lobar PEs, axial images with a slice thickness of 1.25 mm and all coronal re-formatted images showed comparable results to axial images with a slice thickness of 0.625 mm. For detecting segmental PEs, axial images with a slice thickness of 1.25 mm and coronal images with a slice thickness of 0.625 mm re-formatted images showed comparable results to axial images of a slice thickness of 0.625 mm. For detecting subsegmental PEs, axial images with a slice thickness of 0.625 mm showed the highest sensitivity. Better reproducibility was obtained when the thinner slice thickness reconstructions were in axial and coronal images. However, reproducibility of MIP images with slab thicknesses of 2.5 mm and 5 mm was similar for detecting segmental and subsegmental PEs.
Thin-slice reconstruction of less than 1 mm is mandatory for visualization of PE at the subsegmental level.
Acta Radiologica 05/2011; 52(4):417-21. · 1.37 Impact Factor
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ABSTRACT: With the increasing use of multidetector computed tomography (MDCT), the number of incidentally detected ventricular septal aneurysms (VSAs) in adults has increased. However, to date, there are not sufficient well-organized data regarding VSAs in adults on MDCT.
To evaluate the CT findings of ventricular septal aneurysms (VSAs) in adults and correlate the findings with clinical features.
We performed a retrospective review of the cardiac CT reports in our electronic database of 3402 patients who underwent ECG-gated cardiac CT scans using a 64-slice multidetector CT or dual-source CT from October 2006 to December 2009 at our institute. Among them, eight patients were diagnosed with a VSA. We evaluated the location, size, and morphology of VSAs on cardiac CT angiographies (CCTAs) and correlated the findings with the clinical features of the patients.
On CCTAs, all eight patients were found to have VSAs in the membranous portion of the interventricular septum and toward the right ventricle. The VSAs were 10-22 mm at their longest diameter and had wide necks. The VSAs were lobulated along the outer margin and were incidental findings in all patients. Four of the eight patients had a conduction abnormality such as first-degree atrio-ventricular block or incomplete right bundle branch block seen on ECG, whereas the other four patients had normal ECGs.
VSA in adults is usually detected incidentally. It is seen in the membranous portion of the interventricular septum with a lobulated shape on CCTA. It is occasionally associated with a conduction anomaly.
Acta Radiologica 04/2011; 52(6):619-23. · 1.37 Impact Factor
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ABSTRACT: The incidence and findings of tuberculous invasion of the peripheral bronchus have not been fully investigated with MDCT. Purpose To evaluate the prevalence and findings of MDCT abnormalities of small- and medium-sized bronchus (SMB) in active pulmonary tuberculosis (TB).
Using multiplanar reformation, 35 consecutive MDCT scans (follow-up exams available in 14 patients with a mean interval of 8.1 months) were assessed for following abnormalities of SMB: bronchial impaction (BI), wall thickening, dilatation, peribronchial cuff of soft tissue, and bronchocavitary fistula. It was also assessed whether tree-in-buds (TIB) have a tendency to distribute in the territories of diseased SMB, and whether SMB abnormalities are present in patients with relatively mild disease.
SMB abnormalities were observed in 23 (65.7%) patients with active TB. The most frequent finding was wall thickening (n = 18, 51.4%), followed by BI (n = 13, 37.1%; zigzag-shaped in four), dilatation (n = 11, 31.4%), amputated appearance of air column (n = 11, 31.4%), peribronchial cuff of soft tissue (n = 10, 28.6%), and bronchocavitary fistula (n =8, 22.9%). TIB (n = 29; absent in two patients with SMB) was mainly within (n = 14) or close to (n = 4) the territory of diseased SMB. Follow-up CT frequently showed improvement of wall thickening (11/12) and persistence of bronchial dilatation (11/13). SMB abnormality was present in all of six patients with mild disease.
MDCT shows that tuberculous invasion of the peripheral bronchus may be more frequent than previously thought, of which findings include wall thickening, BI, dilatation, amputated appearance of air column, peribronchial cuff of soft tissue and bronchocavitary fistula.
Acta Radiologica 03/2011; 52(2):167-72. · 1.37 Impact Factor
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ABSTRACT: To assess the functional differences among the three anatomic compartments of the left atrium (LA) using 64-multislice cardiac CT in controls and patients with atrial fibrillation (AF).
We examined 144 individuals (105 males, mean age 56.42 ± 12.04 years) undergoing 64-multislice cardiac CT and divided them into 48 control, 53 paroxysmal AF (PAF), and 43 persistent AF (PeAF) patients. The LA was divided into three anatomic compartments according to their embryologic origins: venous LA (VLA), anterior LA (ALA), and LA appendage (LAA). Each volume was calculated using a threshold-based, three-dimensional segmentation. The LA parameters were defined as maximum and minimum LA volume indices, emptying volume, and ejection fraction. We compared the LA parameters of each compartment in controls, PAF patients, and PeAF patients.
In each of the three LA compartments, the maximum LA volume index was lowest in controls (LAA, 4.8 ml/m(2); VLA, 18.3 ml/m(2); ALA, 37.1 ml/m(2)) and highest in PeAF patients (LAA, 9.8 ml/m(2); VLA, 30.0 ml/m(2); ALA, 67.3 ml/m(2)). Regarding the three LA compartments, the ejection fraction was highest in the LAA and lowest in the VLA in controls (LAA, 58.3%; VLA, 29.0%; ALA, 47.4%) and in PAF patients (LAA, 47.3%; VLA, 18.3%; ALA, 39.2%). In PeAF patients, the emptying volumes and ejection fractions of the VLA were approximately zero.
The anatomic compartments of the LA play different roles in AF patients. The LAA has both highest contractility and independent function, and the VLA is the most severely affected by LA dysfunction. Our results may be helpful in understanding the pathophysiology of AF and predicting treatment responses to radiofrequency ablation in the future.
International journal of cardiology 03/2011; 159(3):181-6. · 7.08 Impact Factor
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ABSTRACT: Left ventricle-coronary sinus fistula and left ventricular pseudoaneurysm are unusual and frightening complications after mitral valve replacement. A 27-year-old female patient underwent mitral valve replacement 5 years previously and trans-thoracic echocardiography showed an outpouching lesion at the atrioventricular groove. It was difficult to differentiate whether the lesion was a left ventricle-coronary sinus fistula or a left ventricular pseudoaneurysm by two-dimensional echocardiography. Cardiac computed tomography confirmed a left ventricular pseudoaneurysm compressing the coronary sinus.
Journal of cardiovascular ultrasound 12/2010; 18(4):157-60.
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ABSTRACT: The aim of this study was to determine the computed tomography (CT)-pathological correlation of malignant solitary fibrous tumors of the pleura (MSFP) and to compare these findings with CT findings of benign solitary fibrous tumors of the pleura (BSFTP).
We retrospectively identified the clinical, CT, and pathological findings in seven cases of MSFP. There was a CT-pathological correlation for the MSFPs. Additionally, 12 cases of BSFTP from case files were compared with the clinical and CT features of the MSFPs.
On CT, the MSFP appeared as a heterogeneously enhancing mass >10 cm (100%). Pleural metastasis (57.1%) and lung metastasis (14.3%) were associated. In the CT-pathological correlation, the enhancing area was mixed cellular and collagenous tissue with hypercellularity, mitosis, and pleomorphism. Hemorrhage, necrosis, cystic, or myxoid degeneration produced areas of intratumoral low attenuation. MSFPs showed a higher incidence of intratumoral low-attenuation areas (P = 0.034) and pleural metastasis (P = 0.009); and on CT, MSFPs tended to be larger than BSFTPs (P = 0.076).
MSFPs showed a >10 cm pleural mass with low-attenuation regions on CT, which corresponded to hemorrhage, necrosis, cystic, or myxoid degeneration. MSFPs had a higher incidence of intratumoral low-attenuation areas and pleural metastasis, and on CT they tended to be larger than BSFTPs.
Japanese journal of radiology 10/2010; 28(8):602-8. · 0.65 Impact Factor
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ABSTRACT: The objective of this study is to evaluate the incidence and morphologic features of coronary-pulmonary artery fistulas (CPAF) by multidetector computed tomography (MDCT). From 2006 to 2008, 5,372 patients underwent ECG-gated cardiac CT scans using 64-slice MDCT at our institute. Among them, 17 cases of CPAF were detected (M:F = 14:3, mean age = 63 years). Chief complaints of patients were chest pain (n = 12), abnormal cardiac test (n = 3), known coronary artery disease (n = 1), and known CPAF (n = 1). We retrospectively analyzed the morphologic features of CPAF, such as origin vessels, draining site, fistula size, and aneurysmal sac. Five cases underwent coronary angiography (CAG) and correlated with MDCT findings. Incidence of CPAF was 0.32% by MDCT. The origin of CPAF was the left coronary artery in five (29.4%), the right coronary artery in two (11.8%) and both coronary arteries in ten cases (58.8%). In regard to the diameter of the detected fistula, the diameter of the largest vessel excluding aneurysm was variable from less than 2 to 5.7 mm. Five patients (29.4%) had a fistula that was shown as one vessel that could be traced, one patient (5.9%) was shown as two vessels, and eleven patients (64.7%) were shown as innumerable multiple vessel networks. Five cases were associated with aneurysm (29.4%). Fistulas were located primarily in the left anterolateral aspect of the pulmonary trunk (82.3%) and mostly the drainage site was the left lateral side of the pulmonary trunk (82.3%). CAG was performed in five cases and revealed identical findings to MDCT. In conclusion, coronary-pulmonary artery fistula is more frequently found than anticipated on MDCT. CPAF is supplied by either single or both coronary arteries and drains to the left side of the pulmonary trunk. It is typically located in the anterolateral aspect of the pulmonary trunk. Sometimes CPAF is associated with aneurysms.
The international journal of cardiovascular imaging 09/2010; 26(Suppl 2):273-80. · 2.15 Impact Factor
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ABSTRACT: We aimed to assess the usefulness of a threshold-based, 3-dimensional (3D) segmentation in comparison with the traditional 2-dimensional (2D) short axis-based method for measurement of epicardial fat volume with 64-slice multidetector computed tomography (MDCT).
One hundred patients (52 males; mean age, 58.36+/-11.0 years) who underwent coronary CT angiography were enrolled in this study. The epicardial fat volume was measured using the two methods. The existing method was the 2D short axis-based method and the new method was the threshold-based 3D segmentation. Pearson's correlation was used to compare the two measurement methods. We also assessed the relationship between the epicardial fat volume and coronary artery disease (CAD).
There were a strong correlation between the epicardial fat volumes determined using the two methods (r=0.956, p<0.001). The mean overestimation of epicardial fat volume by the threshold-based 3D method was 59.89+/-12.00% compared to the 2D short-axis based method. Using the 3D method, the epicardial fat volume was significantly higher in the CAD group than in the controls (165.07+/-48.22 cm(3) vs. 108.39+/-48.03 cm(3), p<0.001).
Threshold-based 3D segmentation is another easy and useful tool for measuring the epicardial fat volume.
Korean Circulation Journal 07/2010; 40(7):328-33.
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Dong-Hyeon Lee,
Ho-Joong Youn,
Sung-Bo Shim,
Sun-Hee Lee, Jung-Im Jung,
Seung-Eun Jung,
Yun-Seok Choi,
Chul-Soo Park,
Yong-Seog Oh,
Wook-Sung Chung,
Jae-Hyung Kim
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ABSTRACT: The aim of this study was to assess mechanical valve function using 64-slice multidetector computed tomography (MDCT).
In 20 patients (mean age, 50+/-12 years; male-to-female ratio, 10:10), 30 St. Jude bileaflet mechanical valves (15 aortic and 15 mitral valves) were evaluated using MDCT. We selected images vertical and parallel to the mechanical valve. The valve orifice area (OA) and valve length were determined by manual tracing and the opening and closing angles were measured using a protractor. The OA and length of the mechanical valves were compared with the manufacturer's values.
The geometric orifice areas (GOAs) based on the manufacturer's values and the OAs determined by MDCT were 3.4+/-0.2 cm(2) and 3.4+/-0.3 cm(2) for the mitral valves and 2.1+/-0.3 cm(2) and 2.1+/-0.4 cm(2) for the aortic valves, respectively. The correlation coefficients between the OA measures were 0.433 for the mitral valves and 0.874 for the aortic valves (both p<0.001). The lengths based on the manufacturer's values and determined by MDCT were 29.3+/-1.99 mm and 29.6+/-1.65 mm for the mitral valves and 21.5+/-2.1 mm and 20.7+/-2.3 mm for the aortic valves, respectively. The correlation coefficients between the measures were 0.651 for the mitral valve and 0.846 for the aortic valve (both p<0.001). The opening and closing angles determined by MDCT were 10.9+/-0.6 degrees and 131.1+/-3.2 degrees for the mitral valves and 11.1+/-0.9 degrees and 120.6+/-1.7 degrees for the aortic valves, respectively.
MDCT is an accurate modality with which to assess the function and morphology of bileaflet mechanical valves.
Korean Circulation Journal 04/2009; 39(4):157-62.
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ABSTRACT: To determine the radiologic features of pulmonary tuberculosis in hematopoietic stem cell transplant (HSCT) recipients.
Between January 1996 and December 2005, 10 patients with pulmonary tuberculosis were analyzed. Chest radiographs were available in all of these patients and chest computed tomography (CT) scans were available in 7 patients. We retrospectively analyzed each patient's chest radiographic and CT findings.
On chest radiography (n=10), the most common abnormalities were air-space consolidation (100%) and nodules (80%). Parenchymal lesions appeared mixed with other findings (80%). The most common mixed pattern was nodules with consolidations (80%). Parenchymal lesions were multilobar (80%), patchy (70%), or bilateral (80%). Evidence of a zonal predominance was not seen. On chest CT scans (n=7), the most common parenchymal lesions were consolidation (100%), nodules (71%), tree-in-bud appearance (43%), and ground-glass opacity (43%). Parenchymal lesions seen on CT scans also appeared mixed (86%) and multilobar in distribution (100%). Significant zonal predominance was not noted on CT scans. Cavity was noted in 14% of the study patients and lymphadenopathy was noted in 71% of these patients on CT scans.
The radiologic features of pulmonary tuberculosis in HSCT recipients were nodules or air-space consolidation. Most of the abnormalities were mixed with other findings and had multilobar distribution, however, a lobar predilection was not seen. Awareness of radiologic findings of pulmonary tuberculosis in HSCT recipients may help the diagnosis of pulmonary tuberculosis.
Journal of thoracic imaging 03/2009; 24(1):10-6. · 1.42 Impact Factor
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Jung Im Jung
American Journal of Roentgenology 10/2008; 191(3):637-8. · 2.78 Impact Factor
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ABSTRACT: OBJECTIVE: The purpose of this essay is to illustrate the CT findings of variable benign tumors of the tracheobronchial tree and to correlate the CT and pathologic findings in 17 patients. CONCLUSION: The tracheal tumors were eccentric, well-defined, polypoid masses in all cases. The endobronchial tumors were masses confined within the bronchus in all cases, and atelectasis or pneumonia of the distal parenchyma was frequently associated. Of the six hamartomas, one was a fatty mass, and two were nodules with calcification. The others were soft-tissue-density nodules. The lipomas manifested as fat density on CT scans in both cases. The other benign tumors were low-attenuating, soft-tissue-density masses without characteristic findings on CT scans.
American Journal of Roentgenology 06/2006; 186(5):1304-13. · 2.78 Impact Factor
