[Show abstract][Hide abstract] ABSTRACT: The purpose of this study was to assess the efficacy and feasibility of ultrasound (US)-guided magnetic resonance (MR) arthrography of the glenohumeral joint via a posterior approach.
Thirty-four patients (18 males and 16 females) who were suspected to have glenohumeral joint pathology were examined using MR arthrography. The patients ranged in age from 21 to 85 years, and the average age was 45±15.9 years. A Toshiba Xario US unit was utilized. Ultrasonography examinations were conducted using a broad-band 5-12 MHz linear array transducer. Gadolinium was injected into the shoulder joint using an 18-20 gauge needle. MR imaging was performed within the first 30 min after the injection.
The injection of gadolinium into the shoulder joint was successfully accomplished in all 34 patients. Major contrast media extravasation outside the joint was depicted in only two patients (5.9%). No major complications were encountered.
Ultrasonography is an effective alternate guidance technique for the injection of gadolinium into the glenohumeral joint for MR arthrography. US-guided arthrography via a posterior approach to the glenohumeral joint is safe, accurate, well tolerated by patients and easy to perform with minimal training.
[Show abstract][Hide abstract] ABSTRACT: Because renal venous variations possess potential hazards during abdominal aortic surgery or laparoscopic donor nephrectomy, the detailed preoperative evaluation of the renal vessels with angiography should be performed to avoid vascular injuries. We present multidetector row computed tomography (MDCT) findings of the retroaortic left renal vein (RLRV) with other vascular variations.
Twenty-two patients with RLRV were evaluated with MDCT using multiplanar images, MIP images, and 3D volume rendering.
The RLRVs with accessory renal vessels and other variant veins draining into the left renal vein were effectively evaluated in all patients.
MDCT angiography is an effective technique for evaluating abdominal vessels, and it presents adequate images of renal vessels and vascular variations, which pose importance before abdominal surgery.
[Show abstract][Hide abstract] ABSTRACT: In this study, we evaluated the utility of 16-slice MDCT (multidetector computed tomography) to assess stent patency after coronary artery stenting.
Retrospective ECG-gated CT-angiography using 16-slice MDCT was performed in 52 consecutive patients with coronary artery stents. Qualitative assessment of 61 coronary stent lumens by MDCT is reported, and the reasons preventing assessment were investigated.
All non-assessable stents were non-assessable due to partial volume effects and metal artifacts. To evaluate instent restenosis, conventional coronary angiography was performed on the 54 assessable stents in 48 patients, and the results were compared with the MDCT results. Based on the results of the conventional coronary angiography, MDCT correctly detected four in-stent restenosis.
Despite some limitations, 16-slice MDCT provides sufficient evaluations of some coronary stents, and can detect in-stent restenosis with high accuracy.
[Show abstract][Hide abstract] ABSTRACT: Depending on the perfusing interventricular septum of the arteries, there are 3 types of circulation dominance: right, left, and balanced. In this study, coronary artery branches supplying the ventricular septum were investigated in vivo in a large group of patients by multidetector computed tomography (MDCT) coronary angiography. In addition, the association of coronary artery variations with coronary arterial disease was investigated.
The study included 325 consecutive patients (214 men and 108 women, with a mean age of 59 +/- 14 years) who underwent MDCT coronary angiography. Multidetector computed tomography was performed with a 16-detector-row computed tomographic scanner. The type of dominance, coronary arterial diseases, and coronary artery variations were recorded.
In our study, the types of coronary circulation were right, left, and balanced in 227 (70%), 40 (12.5%), and 58 (17.5%) patients, respectively. Dominance of right circulation was detected in 150 of 217 (69%) of men and in 77 of 108 (71%) of women; dominance of left circulation was found in 26 of 217(12%) of men and in 14 of 108 (13%) of women; balanced/codominance circulation was found in 41 of 217 (19%) of men and in 17 of 108 (16%) of women. However, no significant differences were detected between the sexes for the type of coronary circulation. Coronary artery disease was determined in 68 patients (20.9%) by MDCT, and coronary artery variations were also determined in 34 patients (10.4%). Both the number and the rate of coronary artery variations were significantly higher among the patients with left artery dominance.
Knowledge of coronary artery variations and pathologies is important in planning the treatment and in interpretation of findings of cardiovascular diseases. Our study indicated that, although right dominance circulation is more common in general population, both the coronary diseases and coronary artery variations are more common in individuals with left dominance circulation.
[Show abstract][Hide abstract] ABSTRACT: In this study we aimed to investigate the value of contrast enhanced dynamic MR imaging (DMI) in the diagnosis of nodular abdominal endometriosis.
Fourteen patients with surgically and pathologically proven endometriosis were examined with DMI. The patients were 22-54 years old (mean age 30.8 years). The dynamic MR studies of these patients were retrospectively reviewed by two radiologists who were aware of the clinical data. Nodular masses showing enhancement were evaluated for size, margins, and signal intensity on T1- and T2-weighted MR sequences. The protocol was tailored to selectively determine the diagnostic utility of signal intensity time course analysis for the behavior of nodular endometriosis and endometrial tissue, in DMI. Contrast-enhanced DMI was performed and the time-intensity curves of the lesions and the uterine endometrial tissue of each patient were compared. Mean enhancement values were calculated. Each DMI was evaluated for signal intensity value.
In 8 (57%) of 14 patients, we found endometriosis in the abdominal wall. All patients with abdominal wall endometriosis had pelvic surgical operation history. Diameter of nodular endometriosis determined in the abdominus muscle ranged between 3 and 40 mm. Of eight cases, five had only one lesion and three had multiple lesions. Remaining 6 (43%) cases had deep pelvic endometriosis located in the uterosacral ligaments (n = 3), rectosigmoid (n = 2), and rectovaginal septum (n = 1). Diameter of pelvic endometriosis ranged between 9 and 53 mm. Noncontrast mean signal intensity of endometriosis and endometrial tissue were 280 +/- 73 and 216 +/- 20, respectively. The mean values of both endometriosis and normal endometrial tissue were calculated for each patient examined with five-slice DMI. All of the curves showed significant correlation. The lesion showed significant enhancement in the course of time similar to the endometrial tissue in all patients.
Our study was inspired from the fact that endometriosis is the ectopic endometrial tissue and we thought that endometrial tissue and endometriomas should have similar vascularity. In this way imaging with MR, getting the time-intensity curves and experiencing the correlation between the endometriosis and endometrial tissue may support the diagnosis in the cases with suspected endometriosis. This first study shows that the ectopic nodular endometriosis can easily be identified with dynamic MRI. It may be used to differentiate nodular endometriosis from the other pathologic conditions of abdominal wall and pelvis.
[Show abstract][Hide abstract] ABSTRACT: Earlier publications have reported that common carotid artery intima-media thickness (CCA-IMT) was lower on the right side than on the left side and that left-handed patients have a lower risk of sudden death of brain infarction. This study aimed to determine whether there is an asymmetry and the handedness related difference in CCA-IMT. Ultrasonographic examinations were performed with the use of Aplio US system. In total sample, male and female left-handers, CCA-IMT was greater on left side than on right side. In men, both right and left CCA-IMTs, but in women only right IMT, were lower in the left-handers than in the right-handers. Both right and left CCA-IMTs was positively correlated with age in men and in women. Handedness was a significant factor influencing CCA-IMT with adjustment for sex and age. It was greater on left side than on right side, especially in the left-handers. CCA-IMTs were lower in the left-handers than in the right-handers. These results suggest that hemodynamic stress and intimal damage was larger in the left carotid artery, which was larger in the right-handers compared to the left-handers.
International Journal of Neuroscience 05/2007; 117(4):433-41. DOI:10.1080/00207450600592230 · 1.53 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: In this study, our goal is to determine the use of multidetector computed tomography (MDCT) in detection of aorto-ostial lesions.
Thirty-three patients suspected to have aorto-ostial lesion by either catheter angiography (CA) or MDCT coronary angiography comprised our study population. In 19 patients (group 1), aorto-ostial lesion was suspected based on CA, then MDCT coronary angiography was performed. In the remaining 14 patients (group 2), aorto-ostial lesion diagnosis was made by MDCT coronary angiography, and then afterward, CA was performed. A cardiologist and a radiologist reevaluated both the CA and MDCT coronary angiography recordings of all patients and their consensus formed the diagnosis. We accepted this consensus diagnosis as our criterion standard because a universal criterion standard to compare CA and MDCT findings with is not available. Then, the previous diagnoses by CA and MDCT coronary angiography were compared with the consensus diagnoses.
Finally, 26 patients were diagnosed with aorto-ostial lesion, whereas 5 patients were found not to have aorto-ostial lesions. Two patients were diagnosed with abnormal origination of a coronary artery. When the results were evaluated in terms of the presence of aorto-ostial lesion, MDCT coronary angiography correctly diagnosed all 26 patients, and in the 5 patients with normal ostium, MDCT coronary angiography finding was also normal. However, 7 of 26 patients with aorto-ostial lesion were reported to be normal by CA, and also 5 patients with normal ostia were reported to have aorto-ostial lesion by CA. That is, 12 of 33 patients were misdiagnosed by CA. Moreover, CA missed the abnormal origination of the coronary arteries in 2 patients. When the results were evaluated in terms of the degree of stenosis in 26 patients with aorto-ostial lesion; MDCT coronary angiography predicted the final diagnosis in all 26 patients correctly. However, CA predicted the final degree of stenosis only in 12 patients. Catheter angiography underestimated the degree of the stenosis in 2 patients, overestimated in 5 patients and missed the lesion in 7 patients.
Our findings suggest that MDCT is a reliable tool for diagnosing the presence and severity of aorto-ostial lesions. In addition, MDCT might be useful in preventing the false diagnosis due to the catheter-induced spasms in patients who were diagnosed with aorto-ostial lesion by CA. Moreover, if MDCT coronary angiography detects a lesion in aorto-ostial region, there is no need to perform CA to merely verify this pathology.
[Show abstract][Hide abstract] ABSTRACT: Conjoined twins are a rare and often catastrophic obstetrical event. Although ultrasonography is widely used in the diagnosis of conjoined twins, it may fail to demonstrate the details in fetuses with complex anomalies, especially during late pregnancy. We present an omphalopagus conjoined twins case evaluated by HASTE magnetic resonance imaging, which showed the conjunction site and cranial anomalies, and aided antenatal counseling and neonatal surgical planning.
[Show abstract][Hide abstract] ABSTRACT: An anomalous origin and course of the coronary arteries can be benign or life threatening. Recently, because of new advances in computed tomography technology, radiologists have begun to interpret the diseases of coronary arteries. We aimed to demonstrate some remarkable anomalies of coronary arteries, some of which were not shown by multidetector computed tomography (MDCT) coronary angiography previously, and to discuss the clinical importance of these anomalies.
Seven hundred twenty-five consequent patients referred to Florence Nightingale Hospital and Atatürk University Hospital for MDCT coronary angiography were included in this study. The patients were between the ages of 33 and 78 years (mean +/- SD, 59 +/- 13.86 years). Four hundred ninety-seven patients (68.6%) were men, and 228 (31.4%) were women. All the examinations were evaluated by both a radiologist and a cardiologist.
The incidence of anomalous anatomical origin and course of the coronaries found in our study group was 5.79% (n = 42). The anomalies found in our study are absence of the right coronary artery (RCA; n = 1, 0.13%), ectopic origin of RCA from the left anterior descending (LAD) artery (n = 1, 0.13%), absence of the left main coronary artery (n = 4, 0.52%), ectopic origin of the left main coronary artery from the right sinus of Valsalva (n = 1, 0.13%), double LAD and ectopic origin of LAD from RCA (n = 1, 0.13%), ectopic origin of the left circumflex artery from the right sinus of Valsalva (n = 3, 0.39%), ectopic origin of the left circumflex artery from RCA (n = 2, 0.26%), and myocardial bridging (n = 29, 4%).
An anomalous origin of the coronary anatomy must be present in the interpretations because of its importance for patients, cardiologists, and surgeons. As a conclusion, our study showed that MDCT, especially volume rendering and maximum intensity projection techniques, may be useful for assessment of complex variations, when the conventional angiography may not be sufficient.
[Show abstract][Hide abstract] ABSTRACT: The superior vena cava (SVC) obstruction by malignant diseases is either by direct invasion and compression or by tumour thrombus of the SVC. Whatever is its cause, obstruction of the SVC causes elevated pressure in the veins draining into the SVC and increased or reversed blood flow through collateral vessels. Severity of the syndrome depends on the collateral vascular system development. Therefore, imaging of the collateral veins with variable location and connection is important in determining the extension and management of the disease. Our aims are to describe collateral vessels of the superior vena cava syndrome (SVCS) related with the malignant diseases and to assess the ability of multi-detector row CT with multiplanar and 3D volume rendering techniques in determining and describing collateral circulations.
We present CT angiography findings of seven patients with small cell carcinoma of the lung (n = 2), squamous cell carcinoma of the lung (n = 3), Hodgkin disease of the thorax (n = 1), and squamous cell carcinoma of the oesophagus (n = 1). The patients received contrast-enhanced CT scans of the chest and abdomen on a multi-detector row CT during breath holding at suspended inspiration.
CT images revealed the cause and level of the SVC obstruction in all patients with axial and multiplanar reconstructed images. The SVC showed total obstruction in five patients and partial obstruction in two patients. The most common experienced collateral vessels were azygos vein (6), intercostal veins (6), mediastinal veins (6), paravertebral veins (5), hemiazygos vein (5), thoracoepigastric vein (5), internal mammary vein (5), thoracoacromioclavicular venous plexus (5), and anterior chest wall veins (5). While one case showed the portal-systemic shunt, V. cordis media and sinus coronarius with phrenic veins were enlarged in two cases, and the left adrenal vein was enlarged in a patient. In one case, the azygos vein with reversed blood flow was drained into both inferior vena cava and hemiazygos vein with the left renal vein.
Multi-detector row CT with multiplanar and 3D imaging is an effective tool in evaluation of the SVCS and has a greater advantage than the other imaging techniques. 3D volume rendering is a useful technique in determining and describing collateral circulations in addition to the primary disease process.
European Journal of Radiology 08/2006; 59(1):93-103. DOI:10.1016/j.ejrad.2006.01.003 · 2.16 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The aim of this work was to study the handedness differences in the height of the right and left ethmoid roofs. Hand preference was assessed using the Edinburgh Handedness Inventory. The height of the right and left ethmoid roofs was measured with computerised tomography (CT). The incidence of persons who had a lower ethmoid roof on the right side was significantly greater among right-handers than among left-handers; the incidence of persons who had a lower ethmoid roof on the left side was significantly greater among left-handers than among right-handers; and right and left ethmoid roofs were equal in all ambidextrous subjects. The relationship between the asymmetric ethmoid roofs and handedness may result from the right or left embryonic craniofacial region being smaller in the right- or left-handed subjects. This is particularly important in the light of the high degree of variability in the ethmoid roof, and even between the right and left sides in a given individual. Preoperative awareness of a patient's unique sinus anatomy may help prevent iatrogenic injury to the surrounding vital structures during ethmoid sinus surgery (ESS).
[Show abstract][Hide abstract] ABSTRACT: Dysphagia lusoria (DL) is described in the literature as difficulty in swallowing caused by vascular abnormalities. The most common cause is an aberrant right subclavian artery (SCA) which passes behind the esophagus and is also called arteria lusoria (AL). Our aim was to demonstrate the use of multidetector computed tomography (MDCT) in the diagnosis of AL, as there is no comprehensive study investigating the role of MDCT in such cases.
A total of 38 consecutive patients, comprising of 23 females (61%) and 15 males (39%), who had extrinsic compression were included in the study. These patients are selected from the cases who were admitted due to their gastrointestinal symptoms, such as dysphagia, epigastric pain, chronic nausea, vomiting, etc. The mean age of patients was 40 +/- 25 years (range 15-65). Following barium esophagogram and then endoscopy performed, MDCT angiography was carried out on the same or the following few days. MDCT sections were examined to determine the following: presence of vascular abnormality; the diameter and angle of that vascular structure; and the compressed area of esophagus. Radiological findings and dysphagia scores were also compared.
In each of 15 cases, there was a compression due to vascular abnormality which were all located between the esophagus and the spine. There was an esophageal compression in each of 12 cases, due to right aberrant SCA, in one case due to right superior aortic arch and in two cases due to both right aortic arch and left SCA with Kommerell's diverticulum. The mean diameter and the angle of AL were 16.4 mm and 48.8 degrees , respectively, and the mean area of pressured esophagus was 194.7 mm2. Dysphagia scores of the cases was 1 in thirteen cases and 2 in two cases. However, dysphagia scores were not correlated with these parameters.
MDCT angiography is a useful diagnostic tool for evaluation of patients with dysphagia, especially caused by a vascular abnormality.
European Journal of Radiology 08/2006; 59(1):82-7. DOI:10.1016/j.ejrad.2006.01.013 · 2.16 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Traumatic rupture of the diaphragm usually results from blunt or penetrating injuries, or iatrogenic causes. Most cases are initially overlooked in the acute phase because they present with variable clinical and radiological signs. An overlooked diaphragmatic injury presents as a hernia many years later with potentially serious complications, therefore selection of the most appropriate radiological technique and accurate diagnosis of traumatic diaphragmatic hernias (DH) on the first admission is important. Although the diagnosis of diaphragmatic injuries is problematic, various investigations may be used for diagnosis. We describe the imaging findings of 19 traumatic DH cases with various imaging techniques. The patients were acute trauma cases or cases with prior trauma or thoraco-abdominal surgery with clinical suspicion of DH. An evaluation of the imaging techniques used in the diagnosis of DH is presented.
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to evaluate the incidence of myocardial bridging in 626 patients examined with MDCT angiography of the coronary arteries.
Six hundred twenty-six patients who were referred to Florence Nightingale and Atatürk University Hospitals were involved in this study. These patients had atypical chest pain, symptoms suggestive of coronary artery disease, or no significant cardiac complaint. Patients were in sinus rhythm and were premedicated with metoprolol tartrate (5 mg/mL IV bolus) to decrease the heart rate and nitroglycerin (5 mg sublingual 1 min before the examination) to dilate the coronary arteries. MDCT was performed on two different 16-MDCT scanners.
Among the 626 patients, 22 cases (3.5%) of myocardial bridging were detected. Fifteen cases of myocardial bridging (2.4%) were located at the middle third of the left anterior descending coronary artery (LAD), five (0.8%) were at the distal third of the LAD, and two (0.3%) were at the proximal third of the LAD. In these patients, the length of tunneled artery was between 6 and 22 mm, with a mean of 17 mm, and the depth of tunneled artery was between 1.2 and 3.3 mm, with a mean of 2.5 mm.
We found the incidence of myocardial bridging in this patient group to be 3.5%. This result is in agreement with some of the angiographic studies in the literature. Our study showed that MDCT is a reliable and noninvasive tool for diagnosing coronary myocardial bridging. After evaluating resource axial images, it is necessary to also evaluate the sagittal multiplanar reconstruction images for myocardial bridging.
American Journal of Roentgenology 07/2006; 186(6 Suppl 2):S391-4. DOI:10.2214/AJR.05.0307 · 2.74 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Interrupted aortic arch (IAA) is a rare severe congenital heart defect defined as complete luminal and anatomic discontinuity between ascending and descending aorta. Although its association with various congenital heart defects has been reported, absence of left common carotid artery (CCA) in patients with IAA has not been reported previously. We report a case of IAA associated with the absence of left CCA which was clearly shown on multidetector-row spiral CT.
[Show abstract][Hide abstract] ABSTRACT: To determine brainstem volumes, number of plaques, and surface areas in the occipital lobes of patients with relapsing remitting multiple sclerosis (RRMS) and secondary progressive multiple sclerosis (SPMS), and to investigate whether there is any correlation between brainstem volume and the number/surface areas of plaque in the occipital lobes.
Magnetic resonance imaging was obtained on 14 relapsing-remitting (RR) and 13 secondary progressive (SP) MS patients and 26 female control subjects. The Cavalieri method was used by modern design stereology to measure brainstem volume. The point-counting grid was used to evaluate sclerotic plaque surface areas in the occipital lobe. The number of plaques in the imaging section was calculated.
Brainstem volumes for RR and SP with multiple sclerosis and control subjects were 3647 mm3, 3515 mm3, and 4517 mm3, respectively. Mean number of plaques in the right-left occipital lobe was found to be 2.7-3.4 in RR-MS and 5.2-2.8 in SP-MS. Mean plaque surface area in the right-left occipital lobe was determined to be 58.52-88.24 mm2 in RR MS and 124.3-64.82 mm2 in SP MS. Brainstem volumes were significantly reduced in both groups of patients with MS compared to controls (P < 0.01).
Magnetic-resonance-estimated volume and surface area values in multiple sclerosis may facilitate our understanding of the clinical situation of patients and provide a simple index for evaluating therapeutic efficiency.
[Show abstract][Hide abstract] ABSTRACT: To evaluate whether images obtained during the reconstruction window responding to the isovolumic relaxation period could be used for rapid and easy postprocessing.
One hundred ten consecutive patients with suspected coronary artery disease who had previously had a multidetector computed tomography (MDCT) scan for imaging coronary arteries were enrolled in this study. The age of the patients was 59 +/- 13 years (range: 33-78 years), and 77 (70%) were male. Multidetector computed tomography was performed on a 16-detector-row computed tomography scanner during 1 breath hold (16-24 seconds). Seven different sets of images reconstructed at every 10% of the R-R interval from 30% to 90% for contrast-enhanced scans at levels containing the first several centimeters of the left and right coronary arteries were analyzed. The best of these reconstruction windows were then compared with the images reconstructed at the isovolumic relaxation period, which is the last portion of the T wave at the end of the systole, where there is not any change in ventricular volume, which causes stepladder artifacts. The step artifact was classified as excellent, good, or poor. Image quality was assessed by 2 radiologists who were not aware of each other's interpretation.
According to the routinely used reconstructions, there were 76 patients with excellent image quality, 28 with good image quality, and 6 with poor image quality. For the period of isovolumic relaxation, there were 74 patients with excellent image quality, 25 with good image quality, and 11 with poor image quality.
If one begins image analysis with the isovolumic relaxation period reconstruction window, spending less time for postprocessing analyses, good image quality can be obtained such as with other good reconstruction windows.
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to assess the accuracy of multidetector computed tomography (MDCT), including virtual endoscopy (VE) for detection, precise localization, preoperative evaluation and staging of esophageal cancer (EC) by comparison with surgical and histopathological findings.
Between September 2003 and April 2005, 44 patients with histologically proven EC underwent MDCT and VE. Among 44 patients, the findings were confirmed in 24 at surgery. The accuracy of three-dimensional MDCT for detection, localization, and staging of EC was determined, and compared with surgical finding and histopathology.
The overall accuracy of three-dimensional multidetector row CT for detection of EC was 100% (24/24). MDCT staging was correct in 20 patients (83.3%). The T parameter was correctly assessed in 22 (91.7%) cases (understaged in 1 and overstaged in 1). The N parameter was correctly evaluated in 20 (83.4%) patients (understaged in 2 and overstaged in 2). The overall accuracy of VE for the morphologic classification of EC was 81.5%.
Three-dimensional MDCT, along with VE is a promising method for preoperative evaluation and staging of EC. Although accuracy in N staging remains low in comparison to PET, it provides a larger amount of diagnostic and staging information.
European Journal of Radiology 02/2006; 57(1):90-5. DOI:10.1016/j.ejrad.2005.07.012 · 2.16 Impact Factor