Multidetector Computed Tomography Angiography Research Articles

Role of Multi Detector Computerized Tomography Angiography (MDCTA) in evaluation of renal vascular anomalies

Role of Multi Detector Computerized Tomography Angiography (MDCTA) in evaluation of renal vascular anomalies

Evaluation of Prevalence and Features of Coronary Artery Anomalies using Multidetector-row Computed Tomography

Aim: To evaluate the course, origin and termination of coronary artery anomalies in subjects demonstrating various symptoms and undergoing multidetector CT coronary angiography for evaluation of coronary disease. Study Design: Retrospective study Place and duration: Ch.Pervaiz Elahi Institute of Cardiology Multan from January 2021 to January 2022. Methodology: The study included patients who were referred to the radiology department because of suspicion of coronary artery disease. The data of these patients were reviewed for the course and origin of coronary artery anomalies. A 64-slice scanner was used for MDCT coronary angiography. At the start of acquisition contrast arriving coronary arteries were synchronised using the bolus tracking technique. The whole heart was imaged during apnea using 80-90ml iodinated contrast material administered intravenously. Coronary arteries were evaluated using 3-D and multiplanar reformatted images Results: Total of 600 patients who were referred for MDCT coronary angiography. The subjects underwent screening because of various risk factors, chest pain, or similar symptoms. Coronary artery anomalies were diagnosed in 21 out of 600 (3.5%) patients, whose mean age was 52.6±10.8 years and 504 (84%) were male. 3(14%) patients had high take-off of RCA (right coronary right) and 4(19%) of LMCA (left main coronary artery). In 5(24%) patients left circumflex artery (LCx) and left anterior descending artery (LAD) originated separately from the left sinus of Valsalva (LSV). In 3(14%) patients RCA originated from the opposite sinus of Valsalva.RCA anomaly in 1 patient had a malignant course. Conclusion: The study shows that evaluation of coronary artery anomalies can viably be done using CT. Right diagnosis and treatment planning are based upon an understanding of the clinical significance and CT characteristics of different CAAs. Keywords: Coronary artery angiography, MDCT, prevalence

Intralobular pulmonary sequestration in the middle lobe supplied by a right internal mammary artery: a case report

BackgroundPulmonary sequestration (PS) is a rare congenital malformation that is more common in the left lower lobe, and the thoracic aorta is the most common arterial supply.Case presentationWe describe a case of a 67-year-old man with a chief complaint of intermittent cough and hemoptysis who had been diagnosed by multidetector computed tomography angiography with right middle lobe intralobular pulmonary sequestration supplied by a right internal mammary artery. Finally, he underwent middle pulmonary lobectomy with normal postoperative recovery.DiscussionThis is a rare intralobular pulmonary sequestration case for a feeding artery from the right internal mammary. Multidetector computed tomography angiography should be performed for diagnosis and preoperative evaluation once pulmonary sequestration is suspected.

Aortic arch plaque morphology in patients with coronary artery disease undergoing coronary computed tomography angiography with wide-volume scan.

BackgroundWide-volume scanning with 320-row multidetector computed tomography coronary angiography (CTCA-WVS) enables the assessment of the aortic arch plaque (AAP) morphology and coronary arteries without requiring additional contrast volume. This study aimed to investigate the prevalence of AAPs and their association with coronary artery disease (CAD) and major adverse cardiovascular events (MACEs) in patients who underwent CTCA-WVS.MethodsThis study included 204 patients without known CAD (mean age, 65 years; 53% men) who underwent CTCA-WVS. We evaluated the presence of aortic plaques in the ascending aorta, aortic arch, and thoracic descending aorta using CTCA-WVS. Large aortic plaques were defined as plaques of at least 4 mm in thickness. A complex aortic plaque was defined as a plaque with ulceration or protrusion. MACEs were defined as composite events of cardiovascular (CV) death, nonfatal myocardial infarction, and ischemic stroke.ResultsAAPs and large/complex AAPs were identified in 51% (n = 105) and 18% (n = 36) of the study patients, respectively. The prevalence of AAPs with large/complex morphology increased with CAD severity (2.1% in no CAD, 12% in nonobstructive CAD, and 39% in obstructive CAD). The univariate Cox hazard model demonstrated that the predictors associated with MACEs were diabetes, obstructive CAD, and large/complex AAPs. Independent factors associated with large/complex AAPs were male sex [odds ratio (OR), 2.90; P = 0.025], stroke history (OR, 3.48; P = 0.026), obstructive CAD (OR, 3.35; P = 0.011), and thoracic aortic calcification (OR, 1.77; P = 0.005).ConclusionCTCA-WVS provides a comprehensive assessment of coronary atherosclerosis and thoracic aortic plaques in patients with CAD, which may improve the stratification of patients at risk for CV events.

Computed tomography and magnetic resonance imaging for pulmonary embolus evaluation in children: up-to-date review on practical imaging protocols.

Pulmonary embolism (PE) is a potentially life-threatening condition that requires immediate medical intervention. Although PE was previously thought to occur infrequently in the pediatric population, recent studies have found a higher-than-expected prevalence of PE in the pediatric population of up to 15.5%. The imaging modality of choice for detecting PE in the pediatric population is multi-detector CT angiography, although MRI is assuming a growing and more important role as a potential alternative modality. Given the recent advances in both computed tomography pulmonary angiography (CTPA) and MRI techniques, a growing population of pediatric patients with complex comorbidities (such as children with a history of surgeries for congenital heart disease repair), and the recent waves of coronavirus disease 2019 (COVID-19) and multisystem inflammatory syndrome in children (MIS-C), which are associated with increased risk of PE, there is new and increased need for an up-to-date review of practical CT and MRI protocols for PE evaluation in children. This article provides guidance for up-to-date CT and MR imaging techniques, reviews key recent studies on the imaging of pediatric PE, and discusses relevant pediatric PE imaging pearls and pitfalls, in hopes of providing readers with up-to-date and accurate practice for imaging evaluation of PE in children.

Ultrasound Evaluation of Subclavian Artery and Internal Thoracic Artery Before Coronary Artery Bypass Grafting as Part of Preoperative Vascular Assessment

Noninvasive diagnostic imaging of subclavian artery (SCA) and internal thoracic artery (ITA) is crucial to the patients planning to use ITA for coronary artery bypass grafting (CABG). The guidelines have not yet provided guidance on screening high-risk groups. The present study aimed to evaluate the contribution of ultrasonography in the assessment of SCA and ITA, especially for the patients referred for CABG who planned to use ITA graft. Patients diagnosed with multivessel coronary heart disease were enrolled and some of them planned CABG. Bilateral SCAs and ITAs were routinely evaluated by color Doppler ultrasound (CDUS) before operation. The luminal diameter and the peak systolic velocity of the proximal and distal parts of SCA and ITA were measured. Depending on the Doppler waveform, the lumen narrowing rate was calculated. The final analysis was carried out in 572 patients. Thirty-five patients had moderate (50%-69%), severe (70%-99%) stenosis or occlusion in the SCA (left-sided in 21 and right-sided in 14). One patient had severe proximal stenosis in left ITA and one patient had no flow in left ITA due to the occlusion in left SCA. One patient had anatomic variation of isolated right aortic arch with aberrant left SCA. All of those cases were confirmed with multidetector computed tomography angiography. CDUS could be used for the evaluation of SCA and ITA before CABG as part of presurgical vascular assessment and provide an import basis for the imaging diagnosis and surgical plan.

Evaluation of renal vasculature and its variants by CT angiography

Background: Kidneys are a pair of retroperitoneal organs supplied by a single renal artery and vein. However, the classic illustration of the renal vasculature, formed by one renal artery and one renal vein, occurs in ≤25% of cases. MDCT angiography is presently the most preferred investigation for assessing prospective renal donors. Aims and Objectives: This study aims to familiarize urologists with the variations found in the renal vascular system, emphasizing prevalence, the adequate, appropriate terms, and the clinical and surgical implications involved. Materials and Methods: A cross-sectional study in 50 patients clinically indicated to undergo CT Renal angiographic study over 2 years is included in the study. This study was carried out to look for any anatomical variants in renal vasculature. CT examination was performed on a multidetector 16 slice CT Siemens scanner in the department of radiodiagnosis. Once conventional CT is done, the data obtained can produce 3D post-processing images that simulate conventional angiograms. Results: Out of 50 patients, single renal arteries are present in 27, and multiple renal arteries are present in 23 patients. Out of 27 patients with single renal arteries, 22.2 % has perihilar arterial branching. The most common variant was accessory renal arteries, which are found in 56% of individuals, followed by aberrant renal arteries found in 30% of individuals. Double renal arteries are found in 8.7% and triple renal arteries in 4.3% of cases. Out of 50 patients, 48 patients have a single renal vein, whereas two patients have supernumerary veins. The present study found right renal vein duplication in only 2% of patients. Conclusion: Renal arteries and veins show numerous variations in their origin sites, numbers, course, and division patterns. These variants exist in the population with high prevalence and are thus crucial in preoperative and intra-operative analysis for better prognosis and reduced complications. Preoperative CT evaluation of renal vasculature using MDCT angiography helps depict the presence or absence of renal arterial and venous variants.

Ectopic vascularization of the right kidney arising from contralateral common iliac artery

Variant renal arteries have been reported in 20~30% of the entire population. The anatomic variations among advanced patients should be investigated when performing surgery or interventional procedures on the kidney. Most variant renal arteries originated from various level of the abdominal aorta. Very rarely, this case shows renal artery originated from the contralateral common iliac artery with other accessory arteries. MDCT angiography revealed several anatomical variants of the right kidney. There were four right renal arteries. The main renal artery originated from the left proximal common iliac artery and other renal artery originated from the aortic bifurcation. The other two renal arteries arose from the abdominal aorta, lower thoracic T12 level and lower lumbar L4 level. The right kidney was located at the level of the third to fifth lumbar vertebra. And renal pelvis of the right kidney was laterally rotated. This case documented a rare anatomic variant, involving multiple accessory renal arteries, including the main artery originating from the contralateral iliac artery, caused by a specific renal embryological condition. These variants should be analysed to effectively perform surgical and interventional procedures.

Diagnostic value of multi-detector computed tomography angiography (MDCTA) in assessment of vascular invasion and resectability of pancreatic head cancer

Introduction: pancreatic carcinoma is a common gastrointestinal malignancy. Accurate preoperative imaging helps to avoid unnecessary or unsuccessful surgical procedures and reduce the number of aborted pancreatic resections. MDCT is the most widely available and best validated tool for imaging patients with pancreatic adenocarcinoma. Objective: to evaluate the diagnostic value of resectability and local staging of Pancreatic Head Cancer by MDCTA. Materials and methods: This cross-sectional study was conducted on 20 patients referred to the Diagnostic Radiology and Medical Imaging Department at Tanta University Hospitals presenting with pancreatic head cancer. Results: Patients underwent exploratory laparoscopy or laparatomy with progression to a pancreaticoduodenectomy as deemed resectable in 7 (35%) patients, and 6 (30%) of patients underwent exploratory laparoscopy or laparatomy with progression to Gasterojejunostomy, 4 (20%) of patients underwent ERCP for biliary stenting and 3 (15 %) of patients were inoperable. In the studied patients, 15.4% of resectable by MDCTA found to be unresectable at laparoscopy exploratory with true positive was 100%. The MDCTA imaging sensitivity was 100%, specificity was 71%, NPV was 100% and PPV was 87% with accuracy of 90% to assess for resectability.

Morphological Investigation of Deep Femoral Artery Variations using Multidetector Computed Tomography Angiography

Purpose The deep femoral artery (DFA) is the largest and thickest branch of the femoral artery (FA), separated from the posterior lateral surface of the FA. This study aimed to analyze the anatomy of DFA using multidetector computed tomography (MDCT) angiography images to improve for its clinical applications. Materials and methods Eight hundred right and left DFA MDCT angiography images from 400 individuals, 302 males (75.5%) and 98 females (24.5%), were included. Results It was determined that the DFA originates from six different aspects of the FA. The DFA was found to most commonly originate from the posterolateral aspect of the FA, with an incidence of 53%. The DFA originated from the posterior, lateral, medial, anterolateral, and posteromedial aspects at an incidence of 35.3%, 9.8%, 1%, %0.5, and 0.37%, respectively. The average distance between the DFA’s origin and the midpoint of the inguinal ligament (IL) was 43.07 mm across both genders. The average distance between the DFA’s origin and the midpoint of the IL was 43.07 mm. The average diameters of the DFA, medial circumflex femoral artery (MCFA), and lateral circumflex femoral artery (LCFA) were 5.62 mm, 3.01 mm, and 3.44 mm, respectively. The average distance between the DFA and MCFA was 14.64 mm, while between the DFA and LCFA, it was 19.05 mm. Conclusion Knowledge regarding the anatomical variants and morphology of the DFA will enhance the accuracy of decision-making during interventional procedures and operations in the femoral region, as well as aid in the prevention of iatrogenic injuries.

Investigation of the Frequency of Coronary Artery Anomalies in MDCT Coronary Angiography and Comparison of Atherosclerotic Involvement between Anomaly Types.

Coronary artery anomalies (CAAs) are rare anatomical variations characterized by abnormal origin, course, or termination of the coronary arteries. This study aims to identify incidental CAAs in patients who underwent multidetector computed tomography coronary angiography (MDCTCA) to determine their incidence and to evaluate whether there is a difference between CAA types in terms of coronary atherosclerotic involvement. For this purpose, patients who underwent MDCTCA between December 2018 and January 2022 were retrospectively assessed. Of the 5200 MDCTCAs analyzed, CAAs were detected in 136 patients (2.61%). Of these 136 patients, 37 (27.2%) patients had an origin anomaly, 97 (71.3%) had a course anomaly, and 2 (1.5%) had a termination anomaly. There was no statistically significant difference between CAA types in terms of atherosclerotic involvement (p = 0.220). However, atherosclerotic involvement was high in vessels with anomalies when normal vessels with and without anomalies were compared (p = 0.005). Accurate detection of CAAs is vital for endovascular treatment or surgical intervention. MDCTCA is helpful both in the diagnosis of CAA and in the early detection and development of prevention strategies for coronary atherosclerosis.

Fenestration of the vertebrobasilar junction detected with multidetector computed tomography angiography.

The complex embryonic origin of the vertebrobasilar system may result in a wide range of anatomical variations. It has been hypothesized that the formation of fenestrations are likely to occur due to the failure of regression of the bridging arteries that connect the longitudinal neural arteries during embryogenesis. Fenestration of the vertebrobasilar system is a rare anatomical variation that involves a luminal division of the artery, that has a single origin into two separate and parallel channels which are rejoined distally. Fenestrations are important anatomical variants in patients undergoing endovascular and invasive intracranial interventions. Vascular fenestration has been associated with aneurysms, arteriovenous malformations, neuralgia, and vertebrobasilar ischaemia. We report on 3 cases of fenestration at the vertebrobasilar junction in 1 female and 2 male patients, respectively, using multidetector computed tomography angiography. The length of the fenestrated segment of the artery measured 4.41 mm, 3.90 mm, and 5.90 mm, respectively in the patients. Our report is clinically important as the presence of this anatomical variation may influence the management of cervical and intracranial pathologies. Increased awareness of the prevalence of anatomic variations contributes to the advancement of noninvasive imaging capabilities.

Absence of the celiac trunk: Definition, classification, multidetector computed tomography angiographic findings, and their probable embryological mechanisms.

This study aims to identify the types and prevalence of absence of the celiac trunk by using multidetector computed tomography (MDCT) angiography, and analyze their probable embryological mechanisms. A retrospective study was carried out on 2500 abdominal MDCT angiography images. The absence of the celiac trunk was defined as that the celiac trunk is not exist, more specifically, there is not such an arterial trunk containing at least two major branches of the celiac trunk. Various types of the absence of the celiac trunk were investigated. Of the 2500 patients, 19 (0.76%) patients were identified as an absence of the celiac trunk. According to its definition and classification, the absence of the celiac trunk could be divided into five types: type I (LGA + CHA + SA + SMA), type II (HM trunk + LGA + SA), type III (SM trunk + LGA + CHA), type IV (GM trunk + CHA + SA), and type V (other type); and these types were observed in 5 patients (0.20%), 9 patients (0.36%), 3 patients (0.12%), 0 patients (0.00%), and 2 (0.08%) patients, respectively. There were more examples of the types I and II than of the types III-V (p = 0.004). We systematically classified the absence of the celiac trunk based on its MDCT angiography findings. Abnormal interruptions and persistence of the longitudinal anastomosis, regression of vascular root, and emergence of replaced artery could all be the embryological mechanisms of various types of the absence of the celiac trunk.

Radiological anatomy of the vertebrobasilar artery in a select South African population

IntroductionThe vertebrobasilar artery is the combination of the bilateral vertebral artery and the basilar artery. The basilar artery extends from the confluence of the bilateral vertebral arteries at the pontomedullary junction, terminating at the ponto-mesencephalic junction. Depending on the geometry of the intracranial vertebral arteries and the incidence of arterial tortuosity, the basilar artery may exhibit variable course patterns. This morphologic deformation has negative implications on the hemodynamic of blood flow in the posterior circulatory territory by inducing the development of infarcts and thus increasing the risk of vascular pathologies. Lateral displacement of the basilar artery has been associated with migraines and frequent headaches. The present study aimed to investigate the radiological anatomy of the basilar artery within a select South African cohort of patients in terms of the course patterns and morphometry. Materials and methodThe study is an observational retrospective chart review of 100 radiographic images (Average age: 59; Males: 60%; Females: 40%) of multidetector computed tomography angiography, of the vertebrobasilar artery to establish the course pattern of the basilar artery. ResultsAsymmetry of the intracranial vertebral artery as well as lateral displacement of the basilar artery have been reported with varying course patterns. The average length and diameter of the basilar artery were reported as 25.41 ± 6.44 mm 2.72 ± 0.85 mm, respectively. ConclusionThe geometric characteristics of the vertebrobasilar system in the population studied can predispose to some cerebrovascular diseases in the posterior circulatory territory and influence the build-up of atherosclerotic plaque. Knowledge of this variant anatomy is imperative to the clinician in the diagnosis of many vascular-related pathologies.

Evaluation of cardiovascular morphology and associated anomalies in patients with crossed pulmonary arteries on multidetector computed tomography angiography.

The present study sought to study morphology and associated cardiovascular anomalies in patients with crossed pulmonary arteries on multidetector computed tomography (CT) angiography. We retrospectively evaluated all CT angiography studies performed at a tertiary medical center from January2014 to December2021 to identify patients with crossed pulmonary arteries. The associated cardiovascular anomalies as identified on CT angiography were evaluated. Out of 4773 patients who had undergone CT angiography for evaluation of congenital heart diseases, we identified 24 (0.5%) patients (18 males; mean age: 7.7 years) with crossed pulmonary arteries. Tetralogy of Fallot was associated in seven (29.17%) patients, double outlet right ventricle in one (4.17%) patient, and common arterial trunk in four (16.67%) patients. An aortopulmonary window was seen in three (12.5%) patients while atrial septal defect and ventricular septal defect were seen in two (8.33%) and 16 (66.67%) patients, respectively. Aortic arch anomalies were present in 16 (66.67%) patients including interrupted aortic arch and coarctation of aorta with hypoplastic aortic arch seen in two (8.33%) patients each. A double aortic arch with an atretic left arch was seen in one (4.17%) patient. Coronary artery anomalies were seen in three (12.5%) patients. Crossed pulmonary arteries are a rare anomaly and their presence suggests the coexistence of a variety of cardiovascular anomalies, including aortic arch anomalies and outflow tract malformations. Comprehensive CT angiography-based evaluation of cardiovascular morphology is imperative in the presence of crossed pulmonary arteries to facilitate presurgical planning.

Evaluation of Coronary Atherosclerosis in Patients with Coronary Artery Aneurysm With CAD-RADS Scoring System Using MDCT Angiography

Aim: This article aims to investigate the degree and frequency of atherosclerosis using the “Coronary Artery Disease Reporting and Data System” (CAD-RADS) classification in patients who underwent coronary Multidetector Computed Tomography (MDCT) Angiography with a preliminary diagnosis of coronary artery disease and were found to have coronary artery aneurysm (CAA) and also to discuss the predisposing factors, prevalence, diagnostic criteria and complications in CAA with CT images.Material and Methods: We retrospectively evaluated the examinations of 3694 patients who underwent coronary MDCT angiography. We evaluated a total of 69 patients including 23 patients with CAA and 46 patients without CAA, in terms of atherosclerotic involvement using the CAD-RADS classification system and compared the findings.Results: CAA was most frequently found in the right coronary artery (RCA), followed by the left anterior descending artery (LAD), left circumflex (LCX), left main coronary artery (LMCA), and posterolateral branch (PLB). In patients with CAA, the most frequently atherosclerosis observed vessels were LAD, LCX, RCA, and LMCA, respectively, while LAD, RCA, LCX, LMCA, PLD, and PDA were detected in patients without an aneurysm. No atherosclerosis was detected in 5 patients (21.7 %) with CAA and 15 patients (32.6 %) without CAA (p>0.05). Conclusion: The number of atherosclerotic vessels and the degree of stenosis calculated using the CAD-RADS scoring in patients with CAA are similar to patients without an aneurysm. The fact that atherosclerosis is an important factor in the etiology of aneurysms may explain this situation.

CT angiographic study of hepatic arteries variants in Iranian subjects

This retrospective study aimed to assess the anatomical variations of hepatic arteries (HAs) in Iranian subjects referred to the Baqiyatallah Hospital (Tehran, Iran) as a reference medical center. The presence of anatomical variations such as hepatic arteries (HA) is approved among different societies. Classification of common patterns and probable variants of HA seems necessary in preoperative precautions of hepatosurgeries. Multidetector computed tomography angiography scans were prepared from the patients referred to the Baqiyatallah Hospital from January 2019 to January 2020. Inclusion and exclusion criteria were assessed, and all patterns of hepatic arterial supply were evaluated in 240 cases based on Michels’ classification of HA. Following the assessment of 240 patients, HA variants with aberrant origin (types of II-VIII) were detected in 55 cases (22.92%). Besides, no patients were reported as types of XI and X variants (n=0). Also, no relationship was found between the HA and gender. Detection of common patterns along with abnormal variations of HA variants is necessary for hepatosurgical procedures. We found that 22.92% of Iranian patients referred to the Baqiyatallah hospital represented HA variation which must be considered in hepatic surgeries.

Detection of AAD at the level of T12 vertebrae by using three Dimensional (MDCT) Angiography in subset of Karachi Population

Objective: To determine the diameter of abdominal aorta at T12 vertebral level by the use of Multidetector Computer Tomography Angiography (MDCTA). Study Design: It is a Cross-sectional study. Place and Duration of Study: This study was executed in Ziauddin University (Hospital) Clifton campus Karachi, at Radiology Department, from March 2017 to August 2017. Materials and Methods: Total 160 individuals were enrolled, 75 (46.9%) were females and 85 (53.1%) were males who do not have any abdominal and arterial or venous problems, approach to Radiology Department, for Abdominal 3D Computed Tomography Angiography. Patients who were enrolled in current study were referred to department of Radiology for different indications like adrenal and renal pathologies altered bowel habits and abdominal aches. In current study abdominal aortic dimension (diameter) was analyzed at T12 vertebral levels in both sexes. The SPSS version used in current study was 20 for statistical analysis. Pearson correlation was applied to check the relationship between variables, Independent sample T test was applied. P-value is less than or equal to 0.05 was considered significant. Result: The results of current study revealed that the mean diameter of the abdominal aorta, measured at T12 vertebral level was 20.402±2.54 mm in total 160 individuals. It was observed that male having diameter with 21.47±2.25 and female have 19.18±2.31mm. It clearly showed that male having greater diameter with highly significant values P=0.001. it was also found that there was a high positive correlation was evident in between diameter of abdominal aorta & age with highly significant difference P=0.001 and r =0.713. This correlation showed that as the age increases the thickness of abdominal aorta also increases. Conclusion: It is the first study conducted in Pakistan on detection of abdominal aortic diameter at T12 vertebral level by Multidetector computed tomography angiography. The current study showed that male having greater aortic diameter than in females it also revealed that the age have a great impact on the diameter of abdominal aorta. Keywords: Multidetector computed tomography, aorta, abdominal, heart, tunica Intima.

Imaging in extremity vascular trauma: can MDCT angiography predict the nature of injury?

This study aims to evaluate the utility of computed tomography angiography (CTA) signs of vascular injury in the differentiation of vessel transection from pure thrombosis with intact vessel wall. Retrospective analysis was done on 146 consecutive patients who had undergone CTA and surgical exploration from January 2015 to September 2019. Twelve imaging parameters were assessed. Chi-square was used to test the difference between groups. In addition, a scoring system was devised where one point each was added for the presence of 5 signs and absence of 3 signs. ROC analysis was done for the variables which had shown significant difference between groups and for the composite score. On surgical exploration, 87 patients had transection of vessel, while 59 had thrombosis. Significant difference was found among the two groups in non-opacification, pseudoaneurysm, extravasation (p = 0.04 each), thrombosed cord (p < 0.001), collaterals (p = 0.001) and hematoma (p = 0.002), while other signs did not show significant difference. The AUC value for each of these variables was < 0.650, while for the score, AUC was .843(.773-.913). A cut-off value of ≥ 1.5 gave 83.1% sensitivity and 70% specificity for diagnosing transection. CTA is a useful tool to classify the nature of vascular injury. It is advisable to use a composite score for maximum diagnostic value.

Usefulness of Computed Tomography Angiography in the Preoperative Workup of Patients With Colorectal Cancer.

The objective of this study is to analyze the main patterns of branching of the inferior mesenteric artery (IMA) and to determine if your knowledge changes the surgical strategy in the colorectal cancer. This retrospective study included 63 patients with cancer of the sigmoid or rectum. We assessed the patterns of IMA in 3 subtypes: type A (independent left colic artery [LCA]), type B (LCA and sigmoid artery arising in a common trunk) and type C (LCA, sigmoid artery, and superior rectal artery with a common origin). Colorectal surgeons evaluated how the vascular map changed the type of IMA ligation. Inferior mesenteric artery branching was classified as type A in 55.6% patients, type B in 23.8%, and type C in 20.6%. Knowledge of the vascular map changed the type of ligation from high to low in 20 of the 50 patients who were candidates for surgery. The change was possible in tumors located in the sigmoid colon and the rectosigmoid junction with the type A or B branching. Preoperative Multidetector Computed Tomography angiography can define the pattern of IMA branching. Based on this information, a low ligation can be performed in tumors located in sigmoid colon and rectosigmoid junction with IMA branching types A and B.