Multidetector-row Computed Tomography Angiography Research Articles

Value of multidetector computed tomography angiography in severe non-variceal upper gastrointestinal bleeding: a retrospective study in a referral bleeding unit.

Non-variceal upper gastrointestinal bleeding is a common gastroenterological emergency associated with significant morbidity and mortality. Upper gastrointestinal endoscopy is currently recommended as the gold standard modality for both diagnosis and treatment. As historically played a limited role in the diagnosis of acute non-variceal upper gastrointestinal bleeding, multidetector-row computed tomography angiography is emerging as a promising tool in the diagnosis of non-variceal upper gastrointestinal bleeding, especially for severe cases. However, to date, evidence concerning the role of multidetector-row computed tomography angiography in the non-variceal upper gastrointestinal bleeding diagnosis is still lacking. The purpose of this study was to retrospectively investigate the diagnostic performance of emergent multidetector-row computed tomography angiography performed prior to any diagnostic modality or following urgent upper endoscopy to identify the status, the site, and the underlying etiology of severe non-variceal upper gastrointestinal bleeding. Institutional databases were reviewed in order to identify severe acute non-variceal upper gastrointestinal bleeding patients who were admitted to our bleeding unit and were referred for emergent multidetector-row computed tomography angiography prior to any hemostatic treatment (< 3h) or following (< 3h) endoscopy, between December 2019 and October 2022. The study aim was to evaluate the diagnostic performance of multidetector-row computed tomography angiography to detect the status, the site, and the etiology of severe non-variceal upper gastrointestinal bleeding with endoscopy, digital subtraction angiography, surgery, pathology, or a combination of them as reference standards. A total of 68 patients (38 men, median age 69years [range 25-96]) were enrolled. The overall multidetector-row computed tomography angiography sensitivity, specificity, and accuracy to diagnose bleeding status were 77.8% (95% CI: 65.5-87.3), 40% (95% CI: 5.3-85.3), and 75% (95% CI: 63.0-84.7), respectively. Finally, the overall multidetector-row computed tomography angiography sensitivity to identify the bleeding site and the bleeding etiology were 92.4% (95% CI: 83.2-97.5) and 79% (95% CI: 66.8-88.3), respectively. Although esophagogastroduodenoscopy is the mainstay in the diagnosis and treatment of most non-variceal upper gastrointestinal bleeding cases, multidetector-row computed tomography angiography seems to be a feasible and effective modality in detecting the site, the status, and the etiology of severe acute non-variceal upper gastrointestinal bleeding. It may play a crucial role in the management of selected cases of non-variceal upper gastrointestinal bleeding, especially those clinically severe and/or secondary to rare and extraordinary rare sources, effectively guiding timing and type of treatment. However, further large prospective studies are needed to clarify the role of multidetector-row computed tomography angiography in the diagnostic process of acute non-variceal upper gastrointestinal bleeding.

Predictive value of imaging manifestations of supratentorial hemorrhage in hematoma enlargement and clinical prognosis

IntroductionIntracerebral hemorrhage (ICH) is an important cause of death and disability. This study aimed to explore the imaging indicators identifying hematoma expansion in primary ICH and to provide a basis for its clinical treatment.Material and methodsHematoma expansion was evaluated by plain computed tomography (CT) scan and multi-detector-row CT angiography (MDCTA).ResultsThis study included a total of 203 patients with intracerebral hemorrhage. The size of the hematoma at the time of admission was 32.5–92.3 mL (average, 45.5 mL). Original or reconstructed MDCTA images with contrast extravasation were available in 35 cases (17.2%). Patients were divided into two groups based on whether or not hematoma expansion had occurred: hematoma expansion group (n = 87) and no hematoma expansion group (n = 116). Patients with spot signs in the two groups were 37.93% and 3.45%, respectively, and those with spot sign ± blend sign ± black hole sign ± island sign (%) were 48.30% and 1.72%, respectively, with significant statistical differences. The sensitivity, specificity, and positive and negative predictive values of hematoma enlargement were 37.93%, 98.27%, and 94.29% and 67.86%, respectively. The sensitivity, specificity, and positive and negative predictive values of blend density sign ± irregular sign in predicting hematoma enlargement in ICH patients were 97.7%, 76.7%, and 75.9% and 97.8%, respectively.ConclusionsBlend density sign ± irregular sign can be used as substitute signs. The more irregular and uneven density the hematoma, the more likely it is that the hematoma will be enlarged.

Evaluating the diagnostic value of multi-detector brain CT angiography in diagnosing acute cerebral venous thrombosis

Cerebral venous sinus thrombosis (CVST) is a rare type of venous thromboembolism mostly affecting young adults. Despite improved imaging studies, the diagnosis is usually delayed by several days. An average diagnostic delay of seven days from the onset of symptoms is still reported for this condition, and it is crucial for radiologists to detect this potentially lethal condition in routine imaging studies. In this study we aimed to investigate the diagnostic value of multi-detector brain CTA in diagnosing acute CVT. We searched our Picture Archiving and Communicating System (PACS) of our tertiary-level academic hospital between March 2016 and March 2019, and collected all patients for whom both contrast-enhanced MRV and brain CTA were acquired at the same admission. A total of 242 patients were found on our PACS database who met our criteria. In the blinded multidetector-row computed tomographic angiography (MDCTA) evaluation, there was a sensitivity of 96.1%, specificity of 98.6% and accuracy of 98.3% for MDCTA in detecting CVST. In the emergency settings, and in centers in which MRI scanners are not available, MDCTA can be used instead of CE-MRV for diagnosis of CSVT with a good sensitivity and specificity.

Effective Dose Measurements of the Latest-Generation Angiographic System in Patients with Acute Stroke: A Comparison with the Newest Multidetector CT Generation.

Patients with acute ischemic stroke are increasingly triaged with one-stop management approaches, resulting in baseline imaging with a flat detector CT scanner. This study aimed to estimate the effective dose to a patient of a novel cervical and intracranial flat detector CT angiography and a flat detector CT perfusion protocol and to compare it with the effective dose of analogous multidetector row CT protocols. We estimated the effective dose to the patient according to the International Commission on Radiological Protection 103 using an anthropomorphic phantom with metal oxide semiconductor field effect transistor dosimeters. Placement was according to the organ map provided by the phantom manufacturer. We used 100 measurement points within the phantom, and 18 metal oxide semiconductor field effect transistor dosimeters were placed on the surface of the phantom. All protocols followed the manufacturer's specifications, and patient positioning and collimation were performed as in routine clinical practice. Measurements were obtained on the latest-generation angiography and multidetector row CT systems with identical placement of the metal oxide semiconductor field effect transistor dosimeters. The estimated effective doses of the investigated perfusion protocols were 4.52 mSv (flat detector CT perfusion without collimation), 2.88 mSv (flat detector CT perfusion with collimation), and 2.17 mSv (multidetector row CT perfusion). A novel protocol called portrait flat detector CT angiography that has a z-axis coverage area comparable with that of multidetector row CT angiography had an estimated effective dose of 0.91 mSv, while the dose from multidetector row CT was 1.35 mSv. The estimated effective dose to the patient for flat detector CT perfusion and angiography on a modern biplane angiography system does not deviate substantially from that of analogous multidetector row CT protocols.

Sex Differences in Plaque Composition and Morphology Among Symptomatic Patients With Mild-to-Moderate Carotid Artery Stenosis.

Incidence of ischemic stroke differs between men and women, with substantially higher rates in men. The underlying mechanism of this difference remains poorly understood but may be because of differences in carotid atherosclerosis. Using an in-depth imaging-based approach, we investigated differences between carotid plaque composition and morphology in male and female patients with stroke, taking into account differences in total plaque burden. Additionally, we investigated all possible within-artery combinations of plaque characteristics to explore differences between various plaque phenotypes. We included 156 men and 68 women from the PARISK (Plaque At Risk) study, a prospective cohort study of patients with recent ischemic cerebrovascular symptoms and <70% ipsilateral carotid stenosis. Plaque characteristics (intraplaque hemorrhage [IPH], lipid-rich necrotic core [LRNC], calcifications, thin-or-ruptured fibrous cap, ulcerations, total plaque volume) were assessed with magnetic resonance imaging and multidetector-row computed tomography angiography. We used multivariable logistic and linear regression analyses to assess sex differences in plaque characteristics. We found significant difference in total plaque volume between men and women (β=22.9 mm3 [95% CI, 15.4-30.5]; mean volume in men 1399±425 mm3, in women 1011±242 mm3). Additionally, men were more likely to have IPH (odds ratio [OR]=2.8 [95% CI, 1.3-6.3]; IPH proportion in men 49%, in women 16%) and LRNC (OR=2.4 [95% CI, 1.2-4.7]; LRNC proportion in men 73%, in women 41%) even after adjustment for total plaque volume. We found no sex-specific differences in plaque volume-corrected volumes of IPH, LRNC, and calcifications. In terms of coexistence of plaque characteristics, we found that men had more often a plaque with coexistence of calcifications, LRNC, and IPH (OR=2.7 [95% CI, 1.2-7.0]), with coexistence of thin-or-ruptured fibrous cap/ulcerations, LRNC, and IPH (OR=2.4 [95% CI, 1.1-5.9]), and with coexistence of all plaque characteristics (OR=3.0 [95% CI, 1.2-8.6]). In symptomatic patients with mild-to-moderate carotid stenosis, men are more likely to have a high-risk carotid plaque with IPH and LRNC than women, regardless of total plaque burden. Men also have more often a plaque with multiple vulnerable plaque components, which could comprise an even higher stroke risk. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01208025.

ROLE OF MULTIDETECTOR ROW COMPUTED TOMOGRAPHY ANGIOGRAPHY IN IDENTIFICATION OF THE VASCULAR SOURCE OF BLEEDING IN THE PATIENTS WITH HEMOPTYSIS

We aimed to report our experience with the use of multidetector row computed tomography (MDCT), with angiography in the evaluation of patients with hemoptysis. Role of multidetector row computed tomography angiography in OBJECTIVE: identication of the vascular source of bleeding in the patients with hemoptysis. A prospective study was carried out on 50 patients METHODS: suffering from hemoptysis. They underwent MDCT using a 128-detector row scanner with bronchial and pulmonary angiographic techniques. MDCT identied the RESULTS: cause of hemoptysis in 92% of patients. MDCT angiography was able to detect the site and vascular source of bleeding in 86% of patients. A total of 86 bronchial arteries were detected in 76% of patients; 33% of these arteries (40.74%) were abnormally dilated. Our results CONCLUSION: conrm that MDCT angiography is a useful method to identify and depict the bronchial arteries and to predict the presence of nonbronchial systemic vessels that supply a parenchymal lesion. MDCT angiography allows a rapid and detailed identication of abnormal vasculature and provides a precise road map which can be used to guide therapeutic arterial embolization.

Role of computed tomography angiography in the evaluation of haemoptysis in children: Decoding the abnormal vessels.

Haemoptysis in children is potentially life-threatening. In most cases, the bleeding arises from the systemic circulation, and in 5-10 per cent of cases, it arises from the pulmonary circulation. The role of computed tomography angiography (CTA) in this setting is important. This study was undertaken (i) to study the role of single-phase split-bolus dual energy contrast-enhanced multidetector row CTA (DECTA) in the evaluation of haemoptysis in children; (ii) to analyze the patterns of abnormal vascular supply in the various aetiologies encountered. A retrospective study of 86 patients who underwent split bolus DECTA for the evaluation of haemoptysis was performed. Final diagnoses were categorized as normal computed tomography, active tuberculosis (TB), post-infectious sequelae, non-TB active infection, cystic fibrosis (CF), non-CF bronchiectasis, congenital heart disease (CHD), interstitial lung disease, vasculitis, pulmonary thromboembolism and idiopathic pulmonary haemosiderosis. Abnormal bronchial arteries (BAs) and non-bronchial systemic collateral arteries (NBSCs) were assessed for number and site and their correlation with underlying aetiologies. A total of 86 patients (45 males, age from 0.3 to 18 yr, mean 13.88 yr) were included in the study; among these only two patients were less than five years of age. The most common cause of haemoptysis was active infection (n=30), followed by bronchiectasis (n=18), post-infectious sequelae (n=17) and CHD (n=7). One hundred and sixty five abnormal arteries were identified (108 BA and 57 NBSC), and were more marked in bronchiectasis group. Active infections and bronchiectasis are the most common causes of haemoptysis in children. While post-infectious sequelae are less common, in patients with haemoptysis, the presence of any abnormal arteries correlates with a more frequent diagnosis of bronchiectasis. NBSCs are more common in post-infectious sequelae and CHD.

Anatomy of the arterial and venous systems of the superficial inferior epigastric artery flap: A retrospective study based on computed tomographic angiography

This study was performed to investigate the arterial and venous anatomy of superficial inferior epigastric artery (SIEA) flaps using multidetector-row computed tomography angiography (MDCTA). We hypothesized that applicability of the SIEA flap has been underestimated in previous studies. We retrospectively analyzed the results of preoperative MDCTA of the bilateral lower abdominal walls in 72 consecutive patients. We assessed the presence and branching pattern of the superficial inferior epigastric artery, superficial inferior epigastric vein (SIEV), superficial circumflex iliac vein, and venae comitantes (VC) of the superficial inferior epigastric artery. We also assessed the internal diameter of the SIEA at its origin. The SIEA was present on 133 sides (92.4%), and the mean internal diameter was 2.0 mm. The internal diameter of the SIEA was ≥2.0 mm on 102 sides (70.8%). The VC drained into the superficial circumflex iliac vein on 68 sides (47.2%) and to the SIEV on 30 sides (20.8%). An internal diameter of the SIEA of ≥2.0 mm at its origin on preoperative imaging can be a good criterion for exploring the artery during lower abdominal flap harvest. The VC is the dominant drainage vein over the SIEV in some patients, and it communicates with the superficial circumflex iliac vein in almost half of patients. These findings can increase the safety of breast reconstruction with an SIEA flap.

Role of Multidetector Computed Tomography in the Diagnosis of Congenital Thoracic Vascular Anomalies

Background: multidetector row computed tomography (MDCT) provides reliable diagnostic information on the normal anatomy of the aorta, pulmonary arteries & veins and vena cava, as well as congenital anomalies in pediatric and adult patients. Objective: in this study, we assess the role of multidetector CT scan in the evaluation and its ability to diagnose congenital thoracic vascular anomalies as well as it is importance to recognize these anomalies early for proper treatment and follow up, and also to prevent morbidities and mortalities. Patients and Methods: the study was done in National Heart Institute, Ministry of health Egypt. It included a total of 80 patients (50 males and 30 females, their age ranged between, 2 days to 64 years and the mean age was 11.6±18 years), who underwent MDCT (using GE 16/64- multislice CT) angiography from December 2018 to June 2019 and had diagnosed of congenital thoracic vascular anomalies, or asymptomatic (incidentally discovered). Results: a total of 80 patients had done 16/64-MDCT angiograms were considered to be of adequate diagnostic image quality. Twenty-seven patients diagnosed as systemic arterial (aortic) anomalies corresponding to 33.7% in all cases, the right aortic arch anomalies (9 cases) are represented the most frequent cases (11.2 %). Conclusion: The ability to diagnose congenital vascular thoracic anomalies has evolved tremendously in the past 20 years. Traditional methods of plain radiographs and barium swallow studies as well as invasive angiography have now been supplanted with MR imaging and MDCT, minimally invasive methods that provide superb resolution and a large field of view.

Anomalies of the Portal Venous System in Dogs and Cats as Seen on Multidetector-Row Computed Tomography: An Overview and Systematization Proposal

This article offers an overview of congenital and acquired vascular anomalies involving the portal venous system in dogs and cats, as determined by multidetector-row computed tomography angiography. Congenital absence of the portal vein, portal vein hypoplasia, portal vein thrombosis and portal collaterals are described. Portal collaterals are further discussed as high- and low-flow connections and categorized in hepatic arterioportal malformation, arteriovenous fistula, end-to-side and side-to-side congenital portosystemic shunts, acquired portosystemic shunts, cavoportal and porto-portal collaterals. Knowledge of different portal system anomalies helps understand the underlying physiopathological mechanism and is essential for surgical and interventional approaches.

Celiacomesenteric trunk: a rare case

We present a case of celiacomesenteric trunk that was incidentally detected on routine multi-detector row computed tomography angiography of lower extremities. A 59-year-old patient had intermittent claudication. The celiacomesenteric trunk is a rare vascular variation that is important to be detected before surgical and interventional procedures. Multi-detector row computed tomography angiography is excellent on showing vascular anatomy, pathology and variations.

Electrocardiography-Gated Computed Tomography of the Bronchial Arteries With Iterative Image Reconstruction: Clinical Evaluation and Image Quality.

The aim of this study was to apply electrocardiography (ECG)-gated prospective-triggered multidetector row computed tomography angiography with iterative model reconstruction (IMR) to optimize imaging of the bronchial arteries in patients with the chief complaint of hemoptysis. This was a prospective observational study. Between August 2015 and June 2016, we enrolled 31 consecutive patients with the chief complaint of hemoptysis who were scheduled to undergo computed tomography of the bronchial artery. Patients were randomly divided into 3 groups: group A, with filtered back-projection reconstruction; group B, with iDose reconstruction; and group C, with ECG-gated prospective-triggered multidetector row computed tomography angiography with IMR. Image quality, visibility, and traceability were compared. Image quality, including signal-to-noise and contrast-to-noise ratios, visibility, and traceability, was best in group C. With the help of IMR and ECG-synchronized prospective-triggered technology, the bronchial artery anatomy can be accurately depicted in patients with massive hemoptysis.

Assessment of left ventricular volume and function in healthy dogs by use of one-, two-, and three-dimensional echocardiography versus multidetector computed tomography.

OBJECTIVE To compare left ventricle (LV) volume and function variables obtained by use of 1-D, 2-D, and real-time 3-D echocardiography versus ECG-gated multidetector row CT (MDCT) angiography, which was considered the criterion-referenced standard. ANIMALS 6 healthy, purpose-bred dogs. PROCEDURES Dogs were anesthetized and administered a constant rate infusion of esmolol, and 1-D, 2-D, and 3-D echocardiography and ECG-gated, contrast-enhanced MDCT were performed. End-diastolic volume (EDV), end-systolic volume (ESV), stroke volume, and ejection fraction (EF) were calculated by use of the Teichholz method for 1-D echocardiography, single-plane and biplane modified Simpson method of disks (MOD) and area-length method for 2-D echocardiography, and real-time biplane echocardiography (RTBPE) and real-time 3-D echocardiography (RT3DE) for 3-D echocardiography. Volumes were indexed to body surface area and body weight. Median values, correlations, and limits of agreement were compared between echocardiographic modalities and MDCT. RESULTS EDV and ESV measured by use of RTBPE and RT3DE had the strongest correlations with results for MDCT. Values obtained for EDV, ESV, stroke volume, and EF did not differ significantly between echocardiographic methods and MDCT. Use of RT3DE and RTBPE slightly underestimated EDV, ESV, and EF, compared with values for MDCT, as determined with Bland-Altman analysis. CONCLUSIONS AND CLINICAL RELEVANCE Values for EDV and ESV obtained by use of 3-D echocardiography, including RTBPE and RT3DE, had the highest correlation with slight underestimation, compared with values obtained by use of MDCT. This was similar to results for 3-D echocardiography in human medicine.

What is the Optimal Range of Medial Pocket Dissection in Breast Augmentation? An Anatomical Study of Chinese Women.

The range of the medial dissection forbidden zone, defined as the no-touch zone in this study, is of great importance in breast augmentation. Currently, 30mm of the no-touch zone is marked and the pocket dissection does not pass medial to this zone, which lacks anatomical evidence. This study aimed to determine the optimal range of the no-touch zone in breast augmentation by precisely locating relevant anatomical structures. Preoperative multidetector-row CT angiography (MDCTA) was performed in 36 Chinese female patients who were to receive breast reconstruction. The MDCTA data were used to measure the healthy side's horizontal distance from the cutaneous perforators of the internal thoracic artery to the midline, from the sternal origin of the pectoralis major to the midline, from the sternal border to the midline, at the 2nd to 5th intercostal spaces in the subpectoral plane. All the target tissues were identified in MDCTA data. Mean distances from cutaneous perforators of the internal thoracic artery to the midline of the 2nd to 5th intercostal spaces were 19.66±4.08, 20.37±3.88, 21.00±3.63, and 21.35±4.80mm; and that from the sternal origin of pectoralis major to midline were 5.00±4.01, 4.83±2.85, 11.67±5.35, and 19.19±7.10mm; and that from the sternal border to the midline were 12.48±1.70, 14.02±2.05, 13.52±2.91, and 4.68±4.44mm. Most of perforators of the internal thoracic arteries are disrupted in the current surgical process, indicating that the restrictive factor that affects the range of the no-touch zone is the sternal origin of the pectoralis major, rather than the cutaneous perforators. The range of the no-touch zone can be minimized to 20mm in the 2nd and 3rd intercostal spaces, and can be 30mm in the 4th intercostal space. However, surgeons should be more cautious to avoid disrupting the origin of the pectoralis major when dissecting the pocket of the 4th and 5th intercostal spaces. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Abstract: Principles and Algorithm for the Microsurgical Treatment of Unstable Keloids on the Trunk after Burn Injury

INTRODUCTION: Unstable keloids are one of the most frustrating clinical problems in wound healing and the pathogeneses remains largely unknown.1 To date, little is known in the literature about the microsurgical management of unstable and middle-sized keloids on the trunk, and a clear consensus is lacking.2 Perforator flaps are thin and pliable, have a robust blood supply, potentially release the scar-site tension effectively and may provide an outcome with well-matched color, thickness, and texture.3,4 In this study, we provide a versatile algorithm by using various pedicled and free perforator flaps for the treatment of keloids on the trunk. MATERIALS AND METHODS: Patients with a history of multiple treatments of middle-sized keloids on various regions of the trunk were included. Color Doppler ultrasound (CDU) and multidetector-row computed tomographic angiography (MDCTA) were performed preoperatively. Depending on the location of the keloid, the following flaps were used: superficial circumflex iliac artery perforator (SCIP) flap, internal mammary artery perforator (IMAP) flap, superior epigastric artery perforator (SEAP) flap, anterior intercostal artery perforator (AICAP) flap, deep inferior epigastric artery perforator (DIEP) flap and anterolateral thigh (ALT) flap. RESULTS: Between June 2013 to June 2015, 29 patients (15 male and 14 females) with a mean age of 41 ± 15years were treated. Totally, we performed 5 free SCIP flaps, 2 pedicled SCIP flaps, 8 IMAP flaps, 6 SEAP flaps, 3 AICAP flaps, 4 DIEP flaps and 1 ALT flap. The mean flap size was 83 ± 36cm2 and the mean flap thickness was 14.8 ± 5mm. One partial distal necrosis occurred after a pedicled AICAP reconstruction, which healed conservatively. After a mean follow-up of 5 ± 3months, all surviving flaps showed excellent thickness, texture and color match. Importantly, there was no need for secondary debulking surgery. The donor site healed well after primary closure in all patients. CONCLUSION: We successfully applied various free and pedicled perforator flaps for the treatment of unstable keloids on the trunk. Based on our experience, we provide a useful and reliable algorithm in order to achieve the best possible outcome. No disclosures REFERENCES: 1. Ogawa R, Chin MS. Animal models of keloids and hypertrophic scars. J Burn Care Res 2008;29(6):1016–1017 2. Wang J, Min P, Grassetti L, et al. Preliminary Outcomes of Distal IMAP and SEAP Flaps for the Treatment of Unstable Keloids Subject to Recurrent Inflammation and Infections in the Lower Sternal and Upper Abdominal Areas. J Reconstr Microsurg 2015 3. Hong JP, Choi DH, Suh H, et al. A new plane of elevation: the superficial fascial plane for perforator flap elevation. J Reconstr Microsurg 2014;30(7):491–496 4. Koshima I, Soeda S. Inferior epigastric artery skin flaps without rectus abdominis muscle. Br J Plast Surg 1989;42(6):645–648

Preoperative and Follow up Multi-Detector Row CT Angiography (MDCTA) in the Evaluation of Interrupted Aortic Arch (IAA)

Purpose: The aim of our study is to investigate the ability of preoperative and follow-up multi-detector row CT angiography (MDCTA) in evaluating interrupted aortic arch (IAA). Materials and Methods: MDCTA and echocardiography (ECHO) were performed preoperatively and postoperatively in nine patients (6 males and 3 females, average age: 4.7 years) with surgically confirmed IAA. The preoperative and follow-up images were analyzed retrospectively and compared with operative findings. Results: Of the nine IAA cases, eight were type A, and one was type B. All cases were diagnosed correctly by MDCTA with 100% sensitivity. The MDCTA findings were highly concordant with the operative findings as well as with the various combined cardiac anomalies, including patent ductus arteriosus (PDA) (N=7); ventricular septal defect (VSD) (N=6); double outlet right ventricle and atrial septal defect (ASD) (N=1); aortopulmonary window and right pulmonary artery arising from the ascending aorta (N=1); and abnormal enlarged collateral vessels connecting with the descending aorta and enlarged internal mammary artery without PDA, ASD or VSD (N=2; ages 15 and 13 years old). Only five patients correctly diagnosed by ECHO with 56% sensitivity, two were misdiagnosed with coarctation of the aorta (CoA), and the remaining two were missed diagnoses. In the follow-up period, descending aorta saccular aneurysm combining thrombus at the distal end of the stoma was found in one case by MDCTA but missed by ECHO, and this MDCTA finding was further confirmed by operative findings. No postoperative complications were found in the other cases. Conclusions: MDCTA can display the pathological anatomy of IAA and its combined malformations in a reliable manner. With an improved detection rate of malformations compared with that of ECHO, MDCTA may have high diagnostic value in detecting IAA and its postoperative complications. Keywords: Echocardiography, interrupted aortic arch, multi-detector row CT angiography.

Patient radiation dose from computed tomography angiography and digital subtraction angiography of the brain

The 64-row multidetector computed tomography angiography (64-MDCTA) provides vascular image quality of the brain similar to digital subtraction angiography (DSA), but the effective dose of CTA is lower than DSA studied in phantom. The purpose of this study is to evaluate the effective dose from 64-MDCTA and DSA. Effective dose (according to ICRP 103) from 64-MDCTA and DSA flat panel detector for cerebral vessels examination of the brain using standard protocols as recommended by the manufacturer was calculated for 30 cases of MDCTA (15 male and 15 female).The mean patient age was 49.5 (23-89) yrs. 30 cases of DSA (14 male and 16 female), the mean patient age was 46.8 (21-81) yrs. For CTA, the mean effective dose was 3.7 (2.82- 5.19) mSv. For DSA, the mean effective dose was 5.78 (3.3-10.06) mSv. The effective dose of CTA depends on the scanning protocol and scan length. Low tube current can reduce patient dose whereas the number of exposures and number of series in 3D rotational angiography (3D RA) resulted in increasing effective dose in DSA patients.

Utility of multi-detector row computed tomography angiography versus Doppler in localization of perforators of anterolateral thigh flaps

Aim: Anterolateral thigh (ALT) flap is widely used in reconstruction of various defects. Preoperative imaging facilitates perforator mapping, overcoming intraoperative uncertainty. The purpose of this study was to investigate the utility of multi-detector row computed tomography angiography (MDCTA) and a handheld Doppler in locating ALT perforators.

Utility of multidetector row computed tomography in the management of hemoptysis: An experience from Upper Egypt

BackgroundWe aimed to report our experience with the use of multidetector row computed tomography (MDCT), with angiography in the evaluation of patients with hemoptysis. MethodsA prospective study was carried out on 52 patients suffering from hemoptysis, from May 2011 to August 2014. They underwent MDCT using a 16-detector row scanner with bronchial and pulmonary angiographic techniques. ResultsMDCT identified the cause of hemoptysis in 92% of patients. MDCT angiography was able to detect the site and vascular source of bleeding in 85% of patients. A total of 92 bronchial arteries were detected in 65% of patients; 29 of these arteries (31%) were abnormally dilated. ConclusionOur results confirm that MDCT angiography is a useful method to identify and depict the bronchial arteries and to predict the presence of nonbronchial systemic vessels that supply a parenchymal lesion. MDCT angiography allows a rapid and detailed identification of abnormal vasculature and provides a precise road map which can be used to guide therapeutic arterial embolization.

Acquired renal arteriovenous malformation: the diagnostic value of three-dimensional multidetector-row computed tomography ⁎

Abstract Objective To evaluate the diagnostic value of three-dimensional multidetector-row computed tomography (MDCT) in detecting acquired renal arteriovenous malformation (RAVM) and to compare its performance with that of ultrasonography and digital subtraction angiography (DSA). Methods The institutional review board approved this retrospective study and written informed consent was obtained from all patients before examination. All 14 patients with acquired RAVM underwent MDCT, including cortical and medullary phase enhancement angiography and three-dimensional (3D) reconstruction. Five and nine patients were further examined and their diagnoses confirmed by DSA and surgery, respectively. The MDCT images, including 3D reconstructions, were analyzed for RAVM independently and in consensus by two observers using a workstation. Results Among the 14 patients with acquired RAVM, 12 with maximum lesion diameter ≥ 10 mm, and one with a maximum lesion diameter between 5 and 10 mm, were correctly diagnosed with MDCT angiography. Among these patients, four diagnoses were confirmed by DSA. One patient with a lesion 5-10 mm in diameter was misdiagnosed with a renal aneurysm by MDCT angiography. The other one with the maximum diameter of the lesion between 5 mm and 10 mm was misdiagnosed as renal aneurysm with MDCT angiography, which was diagnosed as renal arteriovenous malformation with DSA. Among 14 lesions in 14 patients, eight and six originated in the left and right kidney, respectively. Conclusion MDCT angiography can accurately diagnose RAVM and improve our understanding of the disease, which will allow clinicians to provide better care.