Multidetector Computed Tomography Angiography Research Articles

AB004. S1-3. Biliary imaging in diagnosis and staging

: Preoperative staging is the prime concern when evaluating the possibility of surgical resectability in cholangiocarcinoma. Currently, multidetector computed tomography (MDCT) is the essential primary step to assess the local extension of the tumor and it should be undertaken prior to biliary drainage to prevent modifications of the bile duct wall thickness or enhancement by a drainage catheter mimicking the tumor extension. Tumor invasion of the liver parenchyma, hepatic vein and inferior vena cava (IVC), or intrahepatic metastasis can be assessed by MDCT and magnetic resonance imaging (MRI). In addition, lymph node metastasis is evaluated mainly by MDCT, and fluorodeoxyglucose PET scan is sometimes informative to assess distant and/or lymph node metastasis. In terms of recent advances in imaging techniques, MDCT and 3D CT angiography have replaced conventional angiography to assess the degree of vascular involvement and to delineate the vascular anatomy in each individual cholangiocarcinoma case. The characteristic MR findings include hypointensity on T1-weighted images, hyperintensity on T2-weighted images, the presence or absence of a central scar, ductal dilatation, satellite nodules, portal vein invasion, and lobar atrophy. Magnetic resonance cholangiopancreatography (MRCP) is useful for a comprehensive understanding of the biliary tree as a whole; however, it is still unable to diagnose the intricate local anatomy of the separated intrahepatic segmental ducts and to design an appropriate operative procedure in patients with Bismuth type III or IV cholangiocarcinoma. MRI and MRCP remain mandatory to define resectability of perihilar cholangiocarcinomas. A recent study found gadoxetic acid–enhanced 3-T MR imaging provides high per-lesion sensitivity and PPV for preoperative malignant liver lesion detection overall, although sensitivity for 0.2–0.5 cm malignant lesions is poor. The recently introduced simultaneous PET/MRI combines the metabolic imaging capabilities of PET and the unmatched soft tissue contrast of MRI and appears to be a promising modality for oncologic imaging. Simultaneous acquisition provides better spatial registration compared to the sequential acquisition of PET and CT. PET/MRI is expected not only to improve the diagnostic potential but also holds promise for better delineation of the target volume in staging and surgical planning.

High-Value Multidetector CT Angiography of the Superior Mesenteric Artery: What Emergency Medicine Physicians and Interventional Radiologists Need to Know.

The superior mesenteric artery (SMA) provides vital blood supply to the midgut, and an acute abnormality can rapidly precipitate bowel ischemia and infarction and lead to morbidity and mortality. Vascular diseases that acutely compromise the SMA threaten its tributaries and include occlusion, dissection, aneurysm rupture, pseudoaneurysm, vasculitis, and SMA branch hemorrhage into the bowel. Emergency medicine physicians rely on the radiologist to identify SMA abnormalities, to characterize them, and to detail findings that guide the appropriate triage of these patients. As such, radiologists must be cognizant of the features that influence patient treatment to assist vascular surgeons and interventional radiologists in decision making. Some patients can be treated medically, while clinical and radiographic findings may suggest the need for interventional or surgical repair of the artery. In the latter case, multidetector CT findings aid in determining which of the various surgical and endovascular treatment options is optimal, and both vascular and gastrointestinal sequelae of acute SMA abnormalities contribute to these determinations. The authors review acute life-threatening conditions involving the SMA including acute occlusion, dissection, aneurysm, pseudoaneurysm, and hemorrhage and discuss the vascular and gastrointestinal multidetector CT findings in each of these conditions that help to guide surgical and interventional management. ©RSNA, 2019.

Investigation of proper hepatic artery and gastroduodenal artery variations by multidetector computed tomography angiography method

Purpose: The purpose of this study is to evaluate the clinical anatomic variations of the proper hepatic artery (PHA) and the gastroduodenal artery (GDA). For this purpose, angiographic images of patients were evaluated.Materials and methods: We retrospectively reviewed the multiple-detector computed tomography angiography images of 671 patients.Results: In this retrospective study, 35 different types were identified as associated with PHA and GDA. There were 292 patients (43.52%; 175 females and 117 males) included in normal anatomical classification. Different anatomic variations were detected in 300 patients (44.71%; 129 females and 171 males). In 79 patients, arterial branch follow-up failed. These patients were evaluated as an unidentified group.Conclusion: We described different vascular variations in the PHAs and GDAs of our patients.

Value of CT-Angiography in the Emergency Management of Severe Hemoptysis.

Objective To depict imaging anatomy of bronchial artery (BA) using multidetector CT-angiography (MDCTA) and evaluate the value of MDCTA for management of hemoptysis patients requiring admission to emergency room. Methods We retrospectively studied the clinical and radiological data of patients with severe hemoptysis (≥100 ml of expectorated blood in a 24-hour period) requiring admission to emergency room from Jan 1, 2013 to Dec 31, 2015. Patients' images of MDCTA, treatment modalities, and outcome were discussed. Results A total of 108 patients underwent MDCTA scans. Etiology of hemoptysis was mainly bronchiectasis (44%), tuberculosis sequelae (26%) and tumor (18%). MDCTA visualized 197 traceable BAs and also suggested the involvement of 35 nonbronchial systemic arteries. The mean diameter of BAs, measured at the level of the bronchial bifurcation in the mediastinum, was 2.8±1.2 mm. The mean diameter of BAs, for 52 patients who only received conservative treatment, was 2.9±1.1 mm, and was not significantly larger than that of BAs for 56 patients who underwent bronchial artery embolization (BAE) for continued bleeding which did not resolve after conservative treatment (2.7±1.1 mm, P = 0.94). The technical success rate of embolization was 95% (53/56). Clinical success rate during follow-up was achieved in 50 (94%) of 53 patients who had undergone embolization. Conclusions MDCTA provides useful information for identifying the anatomical characteristics of bleeding-related BAs and nonbronchial systemic arteries for the management of patients with severe hemoptysis. However, MDCTA could not determine the individuals who need BAE through measuring diameter of BAs.

A gastrosplenic trunk in association with a replaced common hepatic artery arising independently from the superior mesenteric artery: A case report using multidetector computed tomography angiography

The authors report the case of a 51-year-old male that shown to have, independently of the vascular lesions of the lower limbs, the presence of a gastrosplenic trunk (GST) in association with a replaced common hepatic artery (CHA), arising from the superior mesenteric artery by multidetector computed tomography angiography. The GST with an endoluminal diameter of 5.6 mm at its origin and a length of 18.8 mm arose from the anterior wall of the AA at the level of middle 1/3rd of the L1 vertebral body. The replaced CHA with an endoluminal diameter at the origin of 4.8 mm has a lateral right ascendent path, initial in front of the superior mesenteric vein, in the middle portion penetrating the pancreatic parenchyma, in the terminal portion crossing the anterior aspect of hepatic portal vein, and finally fork in the gastroduodenal artery and hepatic artery proper. The knowledge of the variations of the GST and the replaced CHA is important for planning and performing procedures such as duodenopancreatectomy and liver transplantation.

Case of anomalous origin of right coronary artery from pulmonary artery associated with interrupted aortic arch type A, diagnosed by multidetector computed tomography angiography

Anomalous origin of the right coronary artery from pulmonary artery (ARCAPA) is a rare congenital anomaly of the coronary circulation, which can be easily missed by echocardiography. Interrupted aortic arch (IAA) is another rare congenital cardiac abnormality that typically presents in the first few weeks of life. We present a case of ARCAPA associated with IAA diagnosed with the help of multidetector computed tomography angiography, in a 7-year-old boy.

Vertebral erosion due to chronic rupture of aneurismatic abdominal aorta

Introduction. Extremely rarely, the evolution of abdominal aortic aneurysm (AAA) includes the phase when extravasations of the blood from a ruptured aneurysm is contained by the surrounding tissue, referred to as chronic (contained) rupture of the AAA. Our aim was to call attention to this life-threatening condition, which is always challenging for diagnosis. Case outline. A 58-year-old man reported to the Emergency Center for significant abdominal pain. Ultrasound examination showed an infrarenal aneurysm of the abdominal aorta. A computed tomography scan of the thorax, abdomen, and pelvis with iodine contrast in arterial phase was performed. A free gas collection was observed between the liver and the anterior abdominal wall that is traced to a ruptured inflamed diverticulum on the transversal colon. Immediately distal to the branching sites of the renal arteries, the abdominal aorta extended forward and aneurismatically expanded. Posterior left, along the psoas muscle, a rupture of the aortic wall was seen, with an organized hematoma that accompanied the muscle. Between the hematoma and the aortic aneurysm, erosions of the anterior and lateral part of the vertebral bodies L2 and L3 were discovered. The patient underwent endovascular AAA repair (EVAR) and recovered well. Conclusion. Multidetector computed tomography angiography is a reliable, non-invasive, and necessary examination for localization and evaluation of the size of the AAA form, its chronic rupture, and complications such as vertebral body erosion.

Carotid intima-media thickness, 25-OH vitamin D, homocysteine and subclinical coronary artery atherosclerosis in patients with type 1 diabetes mellitus

Individuals with type 1 diabetes have an increased risk of premature atherosclerosis. The aim of this study was to evaluate the possible predictive significance of elevated plasma total homocysteine (tHcy), lower serum 25-hydroxy vitamin D (25(OH)D) concentrations and increased carotid intima-media thickness (CIMT) for the development of coronary atherosclerosis in patients with type 1 diabetes mellitus (T1D) and no previous history of ischemic heart disease. The study included 73 patients previously diagnosed with T1D. The patients were divided into groups with and without non-obstructive moderate coronary artery stenosis. Coronary artery stenosis was examined using coronary multidetector computed tomographic angiography (MDCTA); CIMT was measured by B-mode ultrasound. The patients with moderate stenosis had significantly higher HbA1c (p<0.001), elevated tHcy (p<0.001), increased CIMTmax. (p<0.001) but lower 25(OH)D (p<0.001) in comparison to patients without detectable coronary atherosclerosis. Homocysteine (AUCHcy=0.955; p<0.001), vitamin D (AUCvit D=0.792; p<0.001) and CIMT max (AUCCIMT=0.743; p<0.001) (AUC or area under the curve) appear to be adequate markers for detecting stenosis of coronary arteries using receiver operating characteristic (ROC) curve analysis. Multivariate logistic regression analysis showed that serum homocysteine was the only significant predictor of moderate coronary artery stenosis. Our study implies that tHcy can be used as a reliable predictor of coronary artery atherosclerosis in patients with T1D. 25(OH)D and CIMT can also be used, but with lower diagnostic accuracy.

Complex Coronary Cameral Fistulas Evaluated by Multi-Detector CT Angiography: A Report of Three Rare Cases and a Review of the Literature

Complex Coronary Cameral Fistulas Evaluated by Multi-Detector CT Angiography: A Report of Three Rare Cases and a Review of the Literature

Coronary Artery Anomalies by Multidetector Computed Tomography

The prevalence of coronary artery anomalies (CAAs) is reported to be 0.3% to 2% of the general population. Asymptomatic CAAs are more common and have a better prognosis. Nevertheless, some of these anomalies are linked with symptoms such as syncope, chest pain, and sudden cardiac death. The aim of the study was to determine the prevalence and describe the coronary congenital anomalies and their variations using coronary CT angiography. MD (320) CT angiography was used to prospectively examine 630 patients with either myocardial ischemic symptoms or suspected coronary anomalies by echocardiography or invasive coronary angiography. Contrast injection with ultra-thin cardiac scanning were then carried out. Images were analyzed with multiplanar reformations (MPR), curved multiplanar reformations (cMPR), maximum intensity projections (MIP) & volume rendering techniques (VR). Coronary artery anomalies were found in 217/630 patients (34.44% incidence), 69 (10.95%) anomalies were of vessel origin with good agreement between CTA and ICA results (K= 0.630), 140 (22.22%) were of vessel course and intrinsic vessel anomalies with moderate agreement between CTA and ICA results (K= 0.448), and 8 (1.27%) were of vessel termination with very good agreement between CTA and ICA results (K= 1.000). from this study we conclude that the prevalence of coronary anomalies is substantially higher with coronary CTA than with invasive coronary angiography and ECG gated multidetector coronary CT angiography allows accurate anatomical assessment of coronary artery anomalies.

Carotid artery calcification score and its association with cognitive impairment.

PurposeTo retrospectively investigate the possible association between carotid artery calcification score (CS) and cognitive impairment in carotid artery stenosis (CAS) patients.Patients and methodsCarotid artery was measured in 102 patients with cervical carotid arteries using Color Doppler ultrasound, multi-detector row spiral CT angiography and MRI scanning. Correlation analysis between CSs obtained by MD CT and cognitive scores was performed, and the correlation between CSs and vascular stenosis degree and MRI-measured plaque histological (lipid-rich necrotic nucleus [LRNC], intraplaque hemorrhage and fibrous cap surface rupture) and morphological parameters (lumen area [LA], wall area [WA], total area of blood vessels [TVA], plaque burden [PB]) was analyzed. Follow-up review analysis was conducted on 38 postoperative patients.ResultsSignificant negative correlation was discovered between CS value and cognitive scores in CAS patients (R=−0.359, P<0.001), which did not exist in postoperative patients (P=0.348); CS value also showed significant correlation with WA (R=0.521, P=0.042), TVA (R=0.215, P=0.017) and PB (R=0.237, P=0.003) and had a certain predictive value for the occurrence probability of carotid plaque LRNC (P=0.029, AUC =0.780) in preoperative patients.ConclusionCarotid artery CSs have significant correlation with cognitive scores, which could be used as risk factor for early screening of cognitive impairment in CAS patients. The possible mechanism may be related to the calcification impact on the plaque burden.

Role of MDCT Coronary Angiography with 64-Slice Technology to Detect the Coronary Artery Diseases

Role of MDCT Coronary Angiography with 64-Slice Technology to Detect the Coronary Artery Diseases

Mesenteric ischemia: can multidetector computed tomography angiography be a one-stop diagnostic solution?

Background Mesenteric ischemia is a medical condition in which inflammation and injury of the small intestine result from inadequate blood supply. Mesenteric ischemia is caused by a reduction in intestinal blood flow and is classified as acute (sudden onset of intestinal hypoperfusion) or chronic depending on the time course of symptoms. Multi Detector Computed Tomography MDCT has high sensitivity and specificity for diagnosing acute primary mesenteric ischemia. Aim and objectives Our objective was to evaluate the role of MDCT angiography in evaluation of patients with suspected mesenteric ischemia as regards vascular and intestinal abnormalities. Patients and methods This prospective study was performed on 60 patients clinically suspected of having mesenteric ischemia, referred to the radiology department of Cairo University hospitals from the emergency hospital and the out-patient clinics and in-patient departments of general surgery and of Endemic Infectious diseases and Hepatogastroenterology. Patients suspected clinically to have mesenteric ischemia were initially examined by Doppler and if showed mesenteric vascular suspicious findings by Doppler, they were referred to CT angiography examination. Results In our study we found that 40 patients (66.7%) out of 60 patients showed abnormal MDCT findings which explained the cause of mesenteric ischemia in these patients. The most prevalent CT findings in 40 patients with positive CT angiographic findings in acute mesenteric ischemia (AMI) were bowel wall thickening in 12 patients (30%), bowel distension in 8 patients (20%) and lack of mural enhancement in 10 patients (25%). Computed tomography angiography (CTA) detected accurately the cause of AMI where arterial thrombo-embolism was common cause of AMI (62.5%) and the SMA was the most frequent site in patients with AMI than mesenteric venous thrombosis with AMI (37.5%). 50% of patients with AMI showed pneumatosis intestinalis and surgical exploration revealed bowel infarction and resection anastomosis was done. Conclusion MDCT is fast, safe, accurate and non-invasive imaging modality of choice in patients with suspected mesenteric ischemia which is able to evaluate not only mesenteric vascular structures but also evaluate bowel wall changes and adjacent mesentery, thus detecting the primary cause of mesenteric ischemia that can lead to earlier diagnosis and intervention, also confirmation or exclusion of various other differential diagnoses of acute abdominal conditions.

Extracranial internal carotid artery occlusive dissection - multimodality presentation in a case series.

Background: Carotid dissection is a rare disease, mainly affecting young and middle-aged patients potentially ending up in stroke. Multimodality imaging plays an essential role, both in terms of prompt and accurate diagnosis and follow-up of this entity. Patients and methods: We herein present a case series of patients with internal carotid artery dissection and compare the various imaging findings of ultrasonography, multidetector computed tomography angiography and magnetic resonance angiography, with a purpose to illustrate the value of multimodality imaging in the diagnosis of carotid dissection. Results: Ultrasound represents the first-line imaging modality for the evaluation of a suspected carotid pathology. Digital subtraction angiography is considered the gold standard method for evaluation of carotid luminal abnormalities and is currently reserved for those patients selected for endovascular surgery. Nevertheless, the widespread availability of modern cross-sectional techniques such as multi-detector computed tomography angiography and magnetic resonance angiography has made angiography marginalised. Computed tomography and magnetic resonance angiography offered accurate delineation of vascular lumen and providing valuable information for the vascular wall composition. Conclusions: Careful interpretation of imaging findings on various imaging modalities can lead to early and accurate diagnosis of carotid dissection.

Coronary Artery Atherosclerosis Assessment Using Multi Detector Computed Tomography and its Correlation with Framingham Risk Score Among Symptomatic Patients with Chest Pain

AbstractBackground: A non-invasive assessment of coronary atherosclerosis by means of Framingham risk scoring (FRS) and multi-slice computed tomography coronary angiography (MSCT) could improve patients' risk stratification. However, the data is still limited on the strong association between FRS and imaging modality in the form of MSCT coronary angiog-raphy.Aim of Work: To study the relationship between the extent of atherosclerotic affection among symptomatic patients with chest pain assessed by MDCT & the CAD risk as assessed by FRS.Patients and Methods: This prospective cross sectional study took place between September 2017 and September 2018, at Kobry El-Kobba Military Hospital, and enrolled 150 patients who presented with chest pain. All patients were subjected to clinical assessment with FRS, after which they had undergone MDCT coronary angiography to diagnose the type of vessels affected, number of stenotic segments, as well as the volume of plaques obstructing the vessels.Results: Most of our studied patients were males (70.7%) with mean±SD age 54.9±9.1 years. The mean ± SD FRS score was 15.6±11.3 with median value of 13.2. The majority of the patients were classified as low risk score. The patients with higher FRS showed more than 2 segments of stenosis and correlated strongly with the number of affected segments as well as the volume of detected plaques. Subjects who were in the higher risk group were significantly older, had disturbed lipid profile and showed the highest systolic blood pressure compared to the low and intermediate risk groups.Conclusion: Framingham risk score is a well validated clinical score being moderately correlated with number of affected segments and volume of plagues detected in MDCT coronary angiography. Higher group of FRS was significantly associated with male gender, older subjects and disturbed lipid profile.

Diagnostic Value of 64-Slice Multi Detector Computed Tomographic Angiography in Assessment of Complicated Coronary Artery Bypass Graft

AbstractBackground: Coronary Artery Bypass Grafting (CABG) is to replace occluded or stenosed coronary arteries with patent venous or arterial conduits. Long-term sequelae after CABG include native coronary artery disease progression and de novo arthrosclerosis in grafts, resulting in recurrent ischemic symptoms and mortality.Aim of Study: This study was undertaken to form the basis of review on the role of 64 Multi-Detector Computed Tom-ography (MDCT) in detecting possible complications in post coronary artery graft (CABG) patients.Material and Methods: During the period from November 2015 to August 2017, a prospective evaluation of 50 patients with suspected post-CABG complications underwent MDCT coronary angiography in radiology department of International Medical Center in Egypt. Informed consent was obtained from all patients and the study had institutional review board approval. Descriptive statistics were used to analyze the data.Results: There were 40 males and 10 females, their mean age ± (SD) of 59±3.9 years. A total of 129 grafts were available for evaluation. From the total 129 graft 25 grafts were occluded as 24 of them showing the occlusion at the proximal anasto-mosis and the remaining one at the distal anastomosis. 8 grafts showed significant stenosis. Two showing ulceration at anas-tomotic site and 6 showing kinking course while one was showing competitive flow distally and one showing retrograde felling. Four grafts show stent placement. From the total evaluated 50 patients four patients were underwent redu operation. One patient had partial thrombosis in left subclavian artery encroaching upon LIMA origin. Three patients were suffering from fever one had pneumonia and the other two had chest wall infection with retrosternal extension and associated mediastinal involvement. Four patients show sternal dehiscence. One patient showed localized pericardial hemato-ma. Sex patients showed ascending aortic aneurysm and two showed main pulmonary artery aneurysm. All these compli-cations occurred from 6 menthes to 13 years post CABG surgery.Conclusion: MDCT is an easy non-invasive technique which showed to be effective in diagnosis of post-operative CABG related and non-related complications and is very informitive in difficult clinical situations.

Радіологічні та патогістологічні методи оцінки периферичного сегмента артеріального русла для об’єктивізації синдрому діабетичної стопи

Мета. Підвищення інформативності мультидетекторної комп’ютерно-томографічної ангіографії (МДКТА) та гістоморфометрії судин нижніх кінцівок (НК) шляхом їх порівняння та визначення клінічної цінності кожного зокрема у пацієнтів із синдромом діабетичної стопи (СДС).&#x0D; Матеріали і методи. Обстежено 80 хворих (усі чоловіки) із СДС, яким проведено передопераційну МДКТА НК та гістоморфометрію судинних структур післяопераційного біоматеріалу.&#x0D; Результати. МДКТА мала нижчу чутливість (31,3%) щодо визначення виду атеросклеротичної бляшки порівняно з гістологічним дослідженням, за даними якого навіть у певній вказаній стадії чітко встановлювали початок чи зрілість названого патоморфологічного процесу. І за допомогою МДКТА, і за допомогою прямої морфометрії отримали високоінформативну кількісну оцінку анатомічних розмірів досліджуваних артерій (площа під ROC-кривою дорівнювала 0,994 та 0,875 відповідно), якщо зважати на статистично достовірні результати якості діагностичних тестів згідно з експертною шкалою класифікаторів.&#x0D; Висновки. МДКТА має високу клінічну значущість у виявленні власне атеросклеротичних бляшок, але її не можна вважати «золотим стандартом» щодо диференціації стадій атеросклерозу у пацієнтів з діабетичною макроангіопатією. Пряма морфометрія артеріальних структур діабетичної стопи поступалась щодо операційних характеристик МДКТА через складність штучного відтворення гомеостазу артеріального русла, що вплинуло на стан досліджуваних анатомічних структур.

Multi-detector Coronary CT Angiography in Comparison with Invasive Coronary Angiography in the evaluation of Significant Coronary Artery Stenosis

Background: Multi-detector CT angiography (MDCTA) allows detection of coronary artery calcium (CAC) and after contrast injection, visualization of the coronary artery lumen. It is commonly assumed that the absence of coronary calcification makes the presence of obstructive coronary lesions highly unlikely. Coronary computed tomographic angiography (CCTA) is a promising way for diagnosis of coronary artery lesion; however, image quality is still impaired by motion artifacts and calcifications. Objectives: To compare the ability of multi-slice coronary CT angiography (MSCCTA) with invasive coronary angiography (ICA) for detection of significant coronary artery stenosis. Patients and methods: It is hospital-based cross sectional study, enrolled 65 patients who attended to Iraqi Center for Heart Disease (Baghdad) and Shaheed Al-Mehrab Cardiac Center (Babylon) from June-2012 to March-2015 complaining from chest pain and fulfill the appropriate use criteria (AUC) for CCTA. Patients who underwent MSCCTA, with lesions causing ? 50% stenosis were subsequently studied by ICA. A total of 450 native main vessels and secondary branches were analyzed by single blind observer. Results: CCTA demonstrated a sensitivity, specificity, positive predictive value (PPV) and a negative predictive value (NPV), when compare with ICA, of 71.5%, 69.5%, 82.4%,67.12%; respectively for primary coronary arteries; and 56.25%, 97%, 62.5%, 95.25%, respectively for secondary coronary arteries. Overall sensitivity and specificity for all coronary arteries and their branches were 64% and 83.3% respectively; with a positive predictive value of 72.5%, and a negative predictive value of 81.1%. Conclusions: The sensitivity, specificity, PPV and NPV of MSCCTA in the evaluation of significant coronary artery disease (CAD) were low compared with ICA.

Protocolo diagnóstico y tratamiento de la hemoptisis

Hemoptysis is the expectoration of blood. The identification of life-threatening hemoptysis is a challenge to clinicians. The keys for etiological diagnosis are both careful history and directed physical examination, and test selection. The cornstone diagnostic test is the multidetector computed tomography angiography (MDCT angiography). Flexible bronchoscopy plays a pivotal role in the diagnosis of hemoptysis of any origin or amount. Embolization is indicated in all patients with life-threatening or recurrent hemoptysis in whom MDCT angiography shows artery disease. Bronchoscopy is the procedure of choice in hemodynamically unstable patients with life-threatening hemoptysis. By the isolation of not affected bronchial tree from the bleeding area, this procedure allows to achieve the control of bleeding and the clearance of airways. Surgery is reserved for selected cases.

MDCT angiography and coronary catheter angiography in patients with chest pain which is first

Back groundIn some patients suffering from chest pain, we must start by non-invasive coronary CT angiography (CCTA) to protect these patients from unnecessary invasive coronary catheter angiography (CCA). ObjectiveValue of CCTA as the first diagnostic imaging modality in patient suffering from chest pain. Patients and methodsA total number of 100 patients were included in this study with mean age of 53.51 ± 11.6 years. Our patients were divided into two groups, group (A) included 60 patients underwent both CCTA and CCA and group (B) included 40 patients underwent CCTA only. Then Framingham Risk Score was applied for 68 cases (68%) after exclusion of cases with previous coronary artery intervention as CABG or stent (32 cases). ResultsWe were calculated a cutoff point of Framingham Risk Score at which p value <0.001, sensitivity 85.7%, specificity 51.5%, PPV 65.2%, NPV 77.3% and accuracy 69.1%, it was 7.5%. The diagnostic statistics of MDCT for CABG with sensitivity (100%) and specificity (100%). ConclusionIt is reasonable to start with CCTA in patients with Ferminghaim Risk Score less than 7.5%, filtering the patients to avoid unnecessary CCA. CCTA should be the first imaging modality in patients with CABG suffering from chest pain.