64-slice Multidetector Computed Tomography Angiography Research Articles

Relationship of cardiovascular risk factors, pericardial fat, and carotid thickness with coronary plaque type in patients with diabetes mellitus.

There is paucity of data on the potential predictors of coronary plaque types among patients with diabetes mellitus(DM). To assess the association of cardiovascular risk factors, pericardial fat volume (PFV) assessed by multi-detector CT(MDCT)angiography, and internal carotid intima media thickness with coronary atherosclerotic plaque types in patients with type 2 DM. Patients with suspected coronary artery disease who underwent 64-slice MDCT angiography were enrolled in this retrospective study. A total of 784 patients were enrolled in this study, 198 of whom had DM and 586 of whom did not. The prevalence of calcified and mixed plaques was significantly higher in the DM group than without DM group, while no significant difference was found in the distribution of non-calcified plaque between groups. There was significant association between smoking [OR(CI) = 4(2-10),P = 0.001] and increased age[OR(CI) = 1.1(1-1.3),P = 0.023] and calcified plaque presence. Regarding mixed and non-calcified plaque, increased PFV[OR(CI) = 1.1(1-1.3),P = 0.001] and positive family history[OR(CI) = 4(2-12),P = 0.049] showed a significant association with coronary mixed plaque presence while no significant association was observed between cardiovascular risk factors, PFV, and internal carotid intima media thickness and non-calcified plaque presence in patients with DM. Increased PFV showed significant and independent association with mixed coronary plaques development, which suggests that PFV may be used as an imaging marker for early detection of increased risk for future coronary events in patients with DM.

Sex-Related Differences in the Association of BMI and Pericardial Fat Volume With Coronary Atherosclerotic Markers in Young.

We assessed sex-related differences in the association of pericardial fat volume (PFV) and obesity measured by body mass index (BMI) with coronary atherosclerotic markers (coronary artery calcium score [CAC], coronary luminal stenosis severity, and coronary plaque) in young patients. Patients (n = 174; age <50 years) with suspected coronary artery disease who underwent 64-slice multidetector computed tomography angiography were enrolled. Females tended to have a younger age and increased BMI, normal coronary arteries (free from luminal stenosis), and increased percentage of absent coronary plaque compared with males. There was a significant independent association between PFV with coronary luminal stenosis and between PFV and BMI with coronary noncalcified plaque presence after adjustment for conventional cardiac risk factors. On the other hand, males showed a more increment in PFV, CAC, percentage of calcified plaque, and percentage of significant coronary luminal stenosis compared with females. There was a significant independent association of PFV with CAC, significant coronary stenosis, and calcified plaque presence, while no association was observed between BMI with coronary markers in young males. In conclusion, PFV, but not BMI, showed a significant independent association with advanced coronary atherosclerosis in young male patients.

Pericardial adiposity versus body adiposity measured by BMI in the assessment of coronary atherosclerosis burden in patients with hypertension

ABSTRACT Objectives The link between obesity and hypertension with coronary atherosclerosis is complex. We aimed to assess the association of cardiac fat deposition measured by pericardial fat volume(PFV) using by multi-detector CT(MDCT) and general obesity measured by BMI with subclinical coronary atherosclerotic markers (coronary artery calcium score (CAC), coronary plaque and stenosis) in patients with hypertension and suspected coronary artery disease. Methods Among 496 patients presenting with chest pain who underwent 64-slice MDCT angiography to exclude occlusive coronary disease, 261 patients with hypertension (age: 57 ± 8 years, 45% males) enrolled in the present study. Results PFV showed a significant association with CAC(r = 0.2,P = .001),coronary stenosis severity(PFV median(IQR) 88(63–161) in patients with coronary stenosis<50% compared to PFV median(IQR) 125(85–140) in patients with coronary stenosis ≥ 50%, P = .001) and coronary plaque presence (PFV median (IQR) 89(65–128) in patients without plaque compared to PFV median (IQR) 115(74–150) in patients with plaque presence = 0.03).the significant association of PFV with CAC[odds ratio(95% confidence interval = 0.5(0.19–0.97),P = .001] and coronary stenosis severity [odds ratio(95% confidence interval = 1.1(1.00–1.01),P = .01]persisted after adjustment for conventional cardiac risk. BMI showed a significant association with significant coronary stenosis presence (P = .02).The association of BMI with significant coronary stenosis presence after adjustment for conventional cardiac risk factors (P = .03).BMI showed no significant association with CAC and coronary plaque presence (P > .05). Conclusion PFV showed a significant independent association with coronary calcification and significant coronary stenosis in patients with hypertension rather than BMI.

Pericardial fat versus BMI in the assessment of coronary atherosclerotic burden in patients with diabetes mellitus.

To investigate the association of obesity measured by body mass index (BMI) versus pericardial fat volume (PFV) measured by multi-detector computed tomography (MDCT) with coronary atherosclerotic markers (coronary artery calcium score (CAC), coronary stenosis severity and coronary plaque presence) in patients with type 2 diabetes mellitus (DM). Among 496 patients with suspected coronary artery disease who underwent 64-slice MDCT angiography to exclude occlusive coronary artery disease, 102 patients with DM were enrolled in the present study. PFV showed a significant association with CAC (r = 0.2, P = 0.01) and significant coronary artery stenosis [PFV median (IQR) = 75 (51-136) in patients with coronary stenosis < 50% versus PFV median (IQR) = 113 (68-140) in patients with coronary stenosis ≥ 50%, P = 0.01] while there was no significant association of PFV with coronary plaque presence (PFV median (IQR) = 84 (56-140) in patients without plaque versus PFV median (IQR) = 109 (70-136) in patients with plaque presence, P = 0.4). The association between PFV with CAC persisted after adjustment for conventional cardiac risk factors. BMI showed no significant association with CAC, coronary stenosis severity and coronary plaque presence (P > 0.05). PFV was independently associated with CAC in diabetic patients. PFV, rather than obesity measured by BMI, could be used as an imaging biomarker for assessing coronary atherosclerotic burden in patients with DM.

Agreement Between 64-Slice Multidetector CT Angiography and Transthoracic Echocardiography in Detection of Extracardiac Findings of Congenital Heart Disease.

To determine the degree of agreement between multi-detector computed tomography angiography and transthoracic echocardiography in diagnostic evaluation of congenital heart disease with extracardiac findings. Descriptive cross-sectional study. Radiology Department, Doctors Hospital and Medical Centre, Lahore, from May to November 2016. Patients with clinical suspicion of cardiovascular malformation were included in the study. All the patients had echocardiography and thoracic computed tomography angiography done to diagnose congenital heart disease. Agreement was labelled in true positive and true negative patients. Computed tomography angiography could detect the extracardiac findings of congenital heart disease in 140 (93.3%) patients, while transthoracic echocardiography in 118 (78.7%) patients. Agreement was detected in 108 (72%) patients. Kappa statistics showed poor agreement (kappa = -0.113). Although transthoracic echocardiography is usually the first line of investigation in evaluation of congenital heart disease; it has its limitations for evaluating congenital heart disease with extracardiac findings, due to intrinsic limitation of the imaged field. Computed tomography angiography has better sensitivity in detecting extracardiac findings of congenital heart disease along with better delineation of anatomy.

Digit ratio and hair color relationships with coronary atherosclerotic markers.

Objective We aimed to investigate the association between body phenotype markers and coronary atherosclerosis markers. Methods Eighty-nine patients (mean age 57 ± 9 years, 50.5% male) who were assessed for coronary artery disease by 64-slice multidetector computed tomography angiography were enrolled in the study. Results A significant positive association was observed between coronary artery calcification and the second to fourth digit ratio ( r = 0.2, p = 0.00); more notably in males compared to females ( p = 0.03 vs. p = 0.08). There was a significant association between coronary artery calcification and pure white hair ( p = 0.00). There was no significant association between pericardial fat volume and second to fourth digit ratio ( p = 0.8). Pericardial fat volume was significantly associated with pure white hair ( p = 0.02). A significant association was observed between coronary plaque and a higher second to fourth digit ratio ( p = 0.01) and this was more notable in males ( p = 0.04). A significant association was observed between pure white hair and coronary plaque ( p = 0.00). After adjustment for conventional cardiac risk factors, the association of coronary artery calcification and coronary plaque with the second to fourth digit ratio did not persist, whereas the association of pericardial fat volume and coronary artery calcification with pure white hair remained significant ( p = 0.01 and p = 0.00, respectively). Conclusion These results suggest a possible predictive value of hair color, rather than digit ratio, in assessing increased risk of coronary atherosclerosis and cardiac fat deposition.

Comparison of Image Quality of Low Voltage 64-slice Multidetector CT Angiography with the Standard Condition in Patients Suspected of Pulmonary Embolism

Introduction: Reduction of peak kilovoltage (kV) setting has been a useful approach to d creating radiation dose; however, it may have varied effects on noise and the accuracy of diagnosis. Thus, we compared image quality between low (80 kV) and standard kilovoltage (100 kV) protocols. Material and Methods: This triple blind non-randomized parallel quasi-experimental study was conducted on 140 cases of questionable pulmonary embolism. Results: Image quality was twice as high as the standard protocol in the 80-kV group (odds ratio=2.08). Main, segmental, and subsegmental arteries showed significantly higher vascular enhancement (P<0.001) in the 80-kV group. Similarly, the mean number of measurable segmental arteries was significantly greater in the 80-kV group relative to the standard group. On the other hand, the mean of image noise was significantly higher in the 80-kV group in comparison with the 100-kV group (mean: 68.4 vs. 43.1; P<0.001). Finally, the mean of radiation dose received in the 80-kV group was significantly lower than that in the 100-kV group (mean: 0.94 vs. 2.43 mSv; P<0.001). Conclusion: Lower radiation dose received and higher image quality, but worse image noise, in the 80-kV group compared to the 100-kV group present acceptable evidence in support of reduction of voltage in cases with the suspicion of pulmonary embolism. In these patients, therefore, it is recommended as a good strategy to be adopted in computed tomography angiography.

ECG markers of arrythmogenic risk relationships with pericardial fat volume and BMI in patients with coronary atherosclerosis

BackgroundSeveral novel ECG markers are proposed to predict the risk of sudden cardiac death in several clinical conditions in the recent years. However, little is known about the association of pericardial fat or obesity with these markers. ObjectivesTo assess the possible relationship between pericardial fat volume (PFV) and body mass index (BMI) with novel ECG markers (Tp-e, Tp-e/QT, Tp-e/QTc*QRS and QTc/QRS) in patients with coronary atherosclerosis. Patients and methodsWe enrolled 100 patients with suspected coronary artery disease who underwent 64-slice multi-detector CT angiography. ResultsHigher values of Tp-e/QTc*QRS and QTc/QRS were observed among high PFV group in comparison to low PFV group particularly in patient with coronary atherosclerosis and these relationships persisted after adjustment for cardiac risk factors and coronary calcium score (CAC) while no significant differences in QTc, Tp-e, Tp-e/QTc and Tp-e/QRS values were observed between the PFV groups in patients without coronary atherosclerosis. There was no significant difference in QTc, Tp-e/QTc, Tp-e/QRS, Tp-e/QTc*QRS and QTc/QRS observed between the BMI groups either in patients with and without coronary atherosclerosis. ConclusionPFV and not obesity measured by BMI is significantly associated with novel ECG markers of arrhythmia risk in patients with coronary atherosclerosis. These results could suggest the potential role of PFV in cardiac arrhythmogenesis through depolarization–repolarization conduction abnormalities.

Index of cardiac electrophysiological balance and transmural dispersion of the repolarization index relationships with pericardial fat volume and coronary calcification.

To assess the possible relationship between coronary atherosclerosis markers, pericardial fat volume (PFV) and coronary artery calcification, with ECG markers of index of the cardiac electrophysiological balance (iCEB) and transmural dispersion of the repolarization in patients with suspected coronary artery disease. One hundred patients who underwent 64-slice multidetector computed tomography angiography were found to be eligible and were enrolled in the study. Patients with high iCEB levels tended to have a higher PFV values compared with patients with low iCEB levels (median [interquartile range]) (152 [29-206] vs 96 [14-177]; p=0.03). No significant differences in coronary artery calcification values were observed between iCEB and transmural dispersion of the repolarization groups. A higher PFV value was observed in patients with high iCEB. Larger prospective studies are required to confirm the results.

Clinical Applications of Three-Dimensional Visualization Model of Arteries Supplying the Extrahepatic Bile Duct for Patients with Biliary Obstruction

This study aimed to assess distribution characteristics and digital typing of arteries supplying the extrahepatic bile duct for patients with biliary obstruction, and evaluate the three-dimensional (3D) model in surgical decision-making. Forty-one patients with biliary obstruction were retrospectively evaluated. Clinical data obtained by 64-slice multidetector CT angiography scanning were introduced into Medical Image Three-Dimensional Visualization System; then, 3D model of extrahepatic bile duct and its supplying arteries were reconstructed. Based on the 3D model, the origination and bifurcations of the bile duct artery were observed, and the digital types established. Afterwards, plans for preoperative procedures were formulated. Finally, postoperative observations were performed and the biliary complications recorded in detail. The 3D model clearly displayed the origin, course, and distribution of individualized arteries supplying the extrahepatic bile duct, as well as variations. According to 3D model characteristics, the digital types were established. Blood supply to the superior segment of the extrahepatic bile duct encompassed 6 (14.6%), 17 (41.5%), 12 (29.3%), and 6 (14.6%) cases of Types IA, IB, IC, and II, respectively; meanwhile, blood supply to the inferior segment comprised 13 (31.7%), 13 (31.7%), 4 (9.8%), 7 (17.0%), and 4 (9.8%) cases of Types IA, IB, IC, II, and III, respectively. This classification helped in preoperative surgical planning and corroborated intraoperative findings. No postoperative biliary complications were recorded. The 3D model reconstructed using Medical Image Three-Dimensional Visualization System displayed individualized anatomical structures of the extrahepatic bile duct and associated blood supplying arteries, and could contribute to preoperative surgical planning.

The relationship of socioeconomic status with coronary artery calcification and pericardial fat.

Little data currently exist supporting the correlation of socioeconomic status (SES) to markers of subclinical coronary atherosclerosis. The main aim was to investigate the relationship of SES measured by economic status and educational level with coronary artery calcification (CAC) and pericardial fat volume (PFV) assessed by multi-detector computed tomography (MDCT). A total of 220 consecutive patients with suspected coronary artery disease, who underwent 64-slice MDCT angiography for assessment of coronary atherosclerosis, were recruited between January 2014 and March 2015. Of these, 186 patients were enrolled in this cross sectional study. Low economic status patients showed higher PFV values; median (inter-quartile range [IQR] was 94 [50-140] cm3, p = 0.00001 and r = 0.37, compared to patients with high economic status, and this association persisted even after multiple logistic regression to conventional cardiac risk factors (p = 0.004, CI 7.3-30.4), while patients with low economic status reported a higher calcium score (but statistically non significant) (p = 0.12) compared to high economic status patients. Pa-tients with no formal education showed higher PFV (median [IQR] was 93 [48-140] cm3, p = 0.01) compared to patients with bachelor's degree (median [IQR] was 56 [28-92] cm3), but this association was attenuated after further adjustment for conventional cardiac risk factors (p = 0.1, CI -9.52-10.88), while CAC showed no significant correlation with educational level (p = 0.2, r = 0.117). Socioeconomic status, particularly economic status measure, reported a significant inverse relationship with PFV independent of conventional cardiac risk factors.

Investigated geometrical characteristics and image density of left ventricle of multi-detector computed tomography in early coronary artery disease patients.

Coronary artery disease (CAD) remains the leading cause of death worldwide. Currently, cardiac multi-detector computed tomography (MDCT) is widely used to diagnose CAD. The purpose in this study is to identify informative and useful predictors from left ventricular (LV) in the early CAD patients using cardiac MDCT images. Study groups comprised 42 subjects who underwent a screening health examination, including laboratory testing and cardiac angiography by 64-slice MDCT angiography. Two geometrical characteristics and one image density were defined as shape, size and stiffness on MDCT image. The t-test, logistic regression, and receiver operating characteristic curve were applied to assess and identify the significant predictors. The Kappa statistics was used to exam the agreements with physician's judgments (i.e., Golden of True, GOT). The proposed three characteristics of LV MDCT images are important predictors and risk factors for the early CAD patients. These predictors present over 80% of AUC and higher odds ratio. The Kappa statistics was 0.68 for the combinations of shape and stiffness into logistic regression. The shape, size and stiffness of the left ventricular on MDCT can be used to be the effective indicators in the early CAD patients. Besides, the combinations of shape and stiffness into logistic regression could provide substantial agreement with physician's judgments.

Economic Outcomes With Anatomical Versus Functional Diagnostic Testing for Coronary Artery Disease.

PROMISE (PROspective Multicenter Imaging Study for Evaluation of Chest Pain) found that initial use of at least 64-slice multidetector computed tomography angiography (CTA) versus functional diagnostic testing strategies did not improve clinical outcomes in stable symptomatic patients with suspected coronary artery disease (CAD) requiring noninvasive testing. To conduct an economic analysis for PROMISE (a major secondary aim of the study). Prospective economic study from the U.S. perspective. Comparisons were made according to the intention-to-treat principle, and CIs were calculated using bootstrap methods. (ClinicalTrials.gov: NCT01174550). 190 U.S. centers. 9649 U.S. patients enrolled in PROMISE between July 2010 and September 2013. Median follow-up was 25 months. Technical costs of the initial (outpatient) testing strategy were estimated from Premier Research Database data. Hospital-based costs were estimated using hospital bills and Medicare cost-charge ratios. Physician fees were taken from the Medicare Physician Fee Schedule. Costs were expressed in 2014 U.S. dollars, discounted at 3% annually, and estimated out to 3 years using inverse probability weighting methods. The mean initial testing costs were $174 for exercise electrocardiography; $404 for CTA; $501 to $514 for pharmacologic and exercise stress echocardiography, respectively; and $946 to $1132 for exercise and pharmacologic stress nuclear testing, respectively. Mean costs at 90 days were $2494 for the CTA strategy versus $2240 for the functional strategy (mean difference, $254 [95% CI, -$634 to $906]). The difference was associated with more revascularizations and catheterizations (4.25 per 100 patients) with CTA use. After 90 days, the mean cost difference between the groups out to 3 years remained small. Cost weights for test strategies were obtained from sources outside PROMISE. Computed tomography angiography and functional diagnostic testing strategies in patients with suspected CAD have similar costs through 3 years of follow-up. National Heart, Lung, and Blood Institute.

Correlations Between Aortic Root Calcification and Coronary Artery Atherosclerotic Markers Assessed Using Multidetector Computed Tomography

Atherosclerosis is a systemic process associated with arterial calcification in multiple vascular beds. This study investigated correlations between aortic root calcification (ARC) quantified using Agatston and volumetric scoring methods with coronary atherosclerotic markers (coronary artery calcification [CAC], calcified plaques, and luminal stenosis). This cross-sectional study was carried out between January and December 2013. One hundred ninety-six consecutive patients with intermediate pretest probability of ischemic heart disease who underwent 64-slice multidetector computed tomography angiography were recruited, with 175 patients being eligible to enroll in the study. A significant correlation was observed between ARC and total CAC using the Agatston and volumetric scoring methods (r=0.225; P=.003 and r=0.243; P=.001, respectively). With regard to individual coronary vessel calcification and ARC, a significant correlation was observed between ARC and left main stem artery calcification calculated using the volumetric and Agatston scoring methods (P<.05). A significant correlation was observed between high ARC and presence of coronary calcified plaque measured using the Agatston and volumetric scoring methods. A strong correlation was also observed between ARC and number of coronary stenotic vessels measured using the Agatston and volumetric scoring methods (r=0.67; P<.001 and r=0.63; P<.001, respectively). ARC can be used as an additional marker to assess coronary atherosclerosis and may have a complementary role with CAC for detection of coronary artery disease.

Diagnostic accuracy of 64-slice multidetector CT angiography for detection of in-stent restenosis of vertebral artery ostium stents: comparison with conventional angiography

There are very few reports assessing in-stent restenosis (ISR) after vertebral artery ostium (VAO) stents using multidetector computed tomography (MDCT). To compare the diagnostic accuracy of computed tomography angiography (CTA) using 64-slice MDCT with digital subtraction angiography (DSA) for detection of significant ISR after VAO stenting. The study evaluated 57 VAO stents in 57 patients (39 men, 18 women; mean age 64 years [range, 48-90 years]). All stents were scanned with a 64-slice MDCT scanner. Three sets of images were reconstructed with three different convolution kernels. Two observers who were blinded to the results of DSA assessed the diagnostic accuracy of CTA for detecting significant ISR (≥50% diameter narrowing) of VAO stents in comparison with DSA as the reference standard. The sensitivity, specificity, positive and negative predictive values, and accuracy were calculated. Of the 57 stents, 46 (81%) were assessable using CTA, while 11 (19%) were not. No stents with diameters ≤2.75 mm were assessable. DSA revealed 13 cases of significant ISR in all stents. The respective sensitivity, specificity, positive and negative predictive values, and accuracy were 92%, 82%, 60%, 97%, and 84% for all stents. On excluding the 11 non-assessable stents, the respective values were 88%, 95%, 78%, 97%, and 93%. Of the 46 CTA assessable stents, eight significant ISRs were diagnosed on DSA. Seven of eight patients with significant ISR by DSA were diagnosed correctly with CTA. The area under the receiver-operating characteristic curve (AUC) was 0.87 for all stents and 0.91 for assessable stents, indicating good to excellent agreement between CTA and DSA for detecting significant ISR after VAO stenting. Sixty-four-slice MDCT is a promising non-invasive method of assessing stent patency and can exclude significant ISR with high diagnostic values after VAO stenting.

To assess the benefits of medical image three-dimensional visualization system assisted pancreaticoduodenctomy for patients with hepatic artery variance

Our main aim was to evaluate the value of medical image three-dimensional visualization system (MI-3DVS) in pancreaticoduodenctomy patients with hepatic artery variance. 114 patients who had undergone pancreatoduodenectomy were retrospectively summarized and analyzed. Clinical data of 64-slice multidetector CT angiography (64-MDCTA) scanning was introduced into MI-3DVS for procedural segmentation, registration and 3-dimensional (3D) reconstruction. The findings were compared with those found during the operation and by postoperative digital subtraction angiography (DSA) of coeliac artery. The 3D model demonstrated the origination and bifurcations of blood vessels, and the relationships among neoplasms, organs and blood vessels efficiently. About (14/114 cases, 12.3%) had variant. The sensitivity, specificity and accuracy of MI-3DVS in variant hepatic artery diagnosis were 100%. It assisted in preoperative procedural planning that was consistent with intraoperative findings. MI-3DVS can be applied for accurate diagnosis of hepatic artery variance. It also provides detailed preoperative guidance for individualized procedural planning.

Comparison of Image Quality of Low Voltage 64-Slice Multidetector CT Angiography (80 Kilovoltage) With Standard Condition (100 Kilovoltage) in Patients Suspected of Pulmonary Emboli

Background/Objectives: Comparing quality of images at 80 kV versus 100 kV Patients and Methods: In a non-randomized triple blind parallel quasi-experimental study, we evaluated 140 suspicious cases of pulmonary emboli by either 80 or 100 kV CT angiography. Results: Quality of images was better in 80 kV group (OR, 2.08). Vascular enhancement was significantly higher in all main, segmental and subsegmental arteries (P < 0.001 in all) in 80 kV group as well. Mean number of measurable segmental arteries was also significantly higher among 80 voltage group. On the other hand, mean of image noise was higher (68.4 vs. 43.1) among images with 80 kV (P < 0.001). Received radiation dosage in the group with 80 kV and the group with100 kV were 0.94 and 2.43 mSv, respectively (P < 0.001). Conclusions: Despite worse image noise, received radiation dosage was lower, and image quality was better in cases with 80 kV in comparison with 100 kV.

Application of three-dimensional visualization technology in pancreaticoduodenctomy for patients with variant hepatic artery

To explore the application value of the MI-3DVS in patients with hepatic artery variation receiving duodenopancreatectomy. A total of 114 patients who had undergone pancreatoduodenectomy were retrospectively summarized and analyzed during January 2010 to July 2012. The clinical data of 64-slice multidetector CT angiography (64-MDCTA) scanning was introduced into MI-3DVS for procedural segmentation, registration and 3-dimensional reconstruction. Based on the reconstructed 3-dimensional model, the origination and bifurcations of variant hepatic artery was observed. And its anatomical relationships with abdominal organs and vessels were also observed. Thereafter, preoperative procedures planning was formulated. The findings were compared to those found during the operation and by postoperative digital subtraction angiography (DSA) of coeliac artery. The abdominal 3D models can clearly display the size and shape of tumor, the origin and course of the blood vessels, as well as the 3D anatomic relationship between tumors and organs, blood vessels. A total of 14 cases (12.3%, 14/114) were found with variant, including 9 cases (7.9%) with replaced right hepatic artery arising from superior mesenteric artery, 3 cases (2.6%) with replaced common hepatic artery arising from superior mesenteric artery, 2 cases (1.8%) with replaced left hepatic artery arising from left gastric artery. The 14 patients all received standard procedures of duodenopancreatectomy. Compared to the intraoperative findings and postoperative DSA examination, the sensitivity, specificity and accuracy of MI-3DVS to variant hepatic artery is 100%. The preoperative planning guided by MI-3DVS is in line with the intraoperative findings.No postoperative complications occurred in all 14 patients, including hepatic abscesses, biliary fistula and liver failure. MI-3DVS can accurately diagnose hepatic artery variation before duodenopancreatectomy. Therefore, it contributes to the formulation of preoperative surgical plans.It also increases the success rate of the surgical operations and decreases the occurrence of postoperative complications.

Coronary artery fistulas in children

There are various types of coronary artery fistulas (CAF) with complex shapes. Therefore, it is important to make a correct diagnosis and to understand the relationship of the CAF to the adjacent structures before transcatheter occlusion or surgery. This study evaluated the feasibility of using 64-slice multidetector computed tomography (MDCT) angiography in diagnosing CAF. Two readers who were blinded to the results of echocardiography, intervention, or surgery retrospectively evaluated the coronary MDCT appearances of CAF in 10patients (4boys and 6girls; mean age, 2.9years; range, 1-6years). The origin, course, and distal entry site of the fistula were determined. The diameters of the origin and the distal entry site were measured and compared with those seen during intervention or surgery. The origin, course, and distal vessel entry site of the CAF were clearly outlined in all patients by MDCT. The distal vessel draining site involved a single entry vessel in all patients. Seven fistulas involved the right coronary artery, and three involved the left coronary artery. Four fistulas drained into the right ventricle, four into the right atrium, and two into the left ventricle. The diagnosis of CAF using MDCT was in accordance with diagnoses made during intervention or surgery. There was an excellent correlation between MDCT and transcatheter occlusion in quantifying the diameters of the origin and distal entry site (R = 0.90 and 0.92, respectively, P < 0.05). Coronary 64-slice MDCT angiography depicted the whole shape and course of the CAF as well as of the surrounding structures. It may serve as a noninvasive diagnostic tool when planning a therapeutic strategy.

Test Bolus Technique for Detection of Pulmonary Emboli at 64-Slice Multidetector Computed Tomography Angiography

Test Bolus Technique for Detection of Pulmonary Emboli at 64-Slice Multidetector Computed Tomography Angiography