Spiral CT Angiography Research Articles

The effect of angiotensin-2 receptor blocker valsartan on circulating level of endothelial progenitor cells in diabetic patients with asymptomatic coronary artery disease

BackgroundDecreased circulating endothelial progenitor cells (EPCs) are considered as strong and robust biomarkers for the prediction of cardiovascular outcomes in diabetic populations. The perspectives for modulating EPCs levels in T2DM with known coronary artery disease (CAD) with different drugs, affected mechanisms of improving mobilization of EPCs from tissue, are not still understood. AimsTo evaluate an effect of angiotensin-2 receptor blocker valsartan on circulating level of EPCs in diabetic patients with asymptomatic CAD. MethodsThe study population was structured retrospectively after determining the CAD by contrast-enhanced spiral computed tomography angiography in 126 asymptomatic subjects. All subjects were distributed into two cohorts depending on daily doses of valsartan given. Low (80–160mg daily orally) and high doses (240–320mg daily orally) of valsartan were used and they were adjusted depending on achieving BP level less than 140/80mmHg. ResultsThe change from baseline in CD34+ subset cells (frequencies and absolute values) was not significantly different between treatment cohorts. We found a significant increase of circulating level of CD14+CD309+ cells in two patient cohorts. But more prominent change of CD14+CD309+ cells was verified in subjects who were given valsartan in high daily doses when compared with persons who were included into cohort with low daily doses of the drug (1.96% versus 2.59%, respectively; P<0.05). Therefore, both frequencies and absolute values in CD14+CD309+Tie2+ were increased significantly in patients who were treated with high doses of valsartan only. ConclusionWe found positive influence of angiotensin-2 receptor blocker valsartan in escalation doses on bone marrow-derived EPCs phenotyped as CD14+CD309+ and CD14+CD309+Tie2+ in T2DM patients with known asymptomatic CAD.

Management for Carotid Body Tumors: A Single Center Experience

Introduction: The carotid body tumor is a rare neoplasm that has generated much literature over the last century, and for which continued controversy exists regarding natural history, biologic behavior, proper technique of excision, and the risk of morbidity and mortality. Methods: The present study reviewed a 7-year experience of managing carotid body paraganglioma between 2007 and 2013. There were 10 consecutive patients aged between 18 and 50 years, and median follow-up was 5-year. Preoperative information was derived from spiral computed tomography (CT) scanning, magnetic resonance imaging, color Doppler imaging (CDI), and four-vessel digital subtraction arteriography. Results: In five patients, the tumor excision was attempted before they were referred to our tertiary care hospital. Two patients had bilateral tumors. Four patients had preoperative embolization, and blood loss was minimal, and excision was relatively easier in them. There was difficulty in deglutition (nasal and laryngeal regurgitation) in three patients with large tumors. Conclusion: Surgical planning and prediction of peri-operative complications can be obtained by digital subtraction angiography, spiral CT angiography, and CDI. The peri-operative blood loss can be reduced by preoperative embolisation.

Serum uric Acid predicts declining of circulating proangiogenic mononuclear progenitor cells in chronic heart failure patients.

Introduction: Serum uric acid (SUA) is considered a marker for natural progression of chronic heart failure (CHF) mediated cardiovascular remodelling. CHF associates with declining of circulating mononuclear progenitor cells (MPCs). The objective of this study was to evaluate the interrelationship between SUA concentrations and proangiogenic MPCs in ischemic CHF patients. Methods: The study population was structured retrospectively after determining the coronary artery disease (CAD) by contrast-enhanced spiral computed tomography angiography in 126 subjects with symptomatic ischemic mild-to-severe CHF and 128 CAD subjects without CHF. Baseline biomarkers were measured in all patients. Cox proportional multivariate hazard ratio was calculated for predictors of MPCs declining in both CHF and non-CHF patient population predictors of MPCs declining in CHF subjects were examined in stepwise logistic regression. C-statistics, integrated discrimination indices (IDI) and net-reclassification improvement were utilized for prediction performance analyses. Results: Cox proportional adjusted hazard ratio analyses for CD14+CD309+ and CD14+CD309+Tie2+ MPCs by SUA has shown that the higher quartiles (Q3 and Q4) of SUA compared to the lower quartiles (Q1 and Q2) are associated with increased risks of depletion of both CD14+CD309+ and CD14+CD309+Tie2+ MPCs. The addition of Q4 SUA to the ABC model improved the relative IDI by 13.8% for depletion of CD14+CD309+ MPCs and by 14.5% for depletion of CD14+CD309+Tie2+ MPCs. Conclusion: Circulating levels of proangiogenic MPCs are declined progressively depending on the levels of SUA in the HF subjects with CHF. We suggest that even mild elevations of SUA might be used to predict of relative depletion of proangiogenic MPCs among chronic HF patients.

Spiral computed tomography angiography in the evaluation of hepatocellular carcinoma vascularity and malignancy degree

Aim. To study the vascularity and malignancy degrees of hepatocellular carcinoma using spiral computed tomography angiography considering its morphological differentiation and tumor size. Methods. A comprehensive clinical and radiological examination of 300 patients (males - 170 (56.6%), females - 130 (43.4%), mean age 52.0±3.2 years) with hepatocellular carcinoma, who were picked out from 2550 patients with malignancies treated in 2005-2013, was performed. Liver cirrhosis was diagnosed in 70 (23.33%) out of 300 patients with hepatocellular carcinoma. The features of tumor bloodflow were assessed using color Doppler ultrasonography and spiral computed tomography angiography (by 4 phases of examination) considering tumor size and tumor morphological differentiation. Results. According to the morphological study results of samples from 123 patients, high-grade differentiated hepatocellular carcinoma was diagnosed in 40 patients, moderately differentiated - in 53, poorly differentiated - in 30 patients. A correlation of tumor vascularity with histological differentiation degree and tumor size was revealed. The difference in high-grade differentiated hepatocellular carcinoma maximal computed tomography density increment gradients at arterial phase compared to liver parenchyma maximal computed tomography density increment was 17 Hounsfield units in tumors sized up to 5 cm and 12 Hounsfield units in 32 (80%) of 40 patients with tumors sized over 5 cm. Thus, high-grade differentiated hepatocellular carcinoma was associated with increased vascularity in 80.0%, normal vascularity - in 8.0%, low vascularity - in 12.0% of cases. The difference in moderately differentiated hepatocellular carcinoma computed tomography density increment gradients compared to liver parenchyma was assessed as 20 and 25 Hounsfield units in tumors with the corresponding size in 45 (89.4%) out of 53 patients. Moderately differentiated hepatocellular carcinoma was associated with increased vascularity in 89.4%, normal vascularity - in 4.0%, low vascularity - in 6.6% of cases. Poorly differentiated hepatocellular carcinoma was associated with increased vascularity only in 7 out of 30 patients. Conclusion. The correlation of tumor vascularity with histological differentiation degree and tumor size was revealed. Increased vascularity was observed in high-grade differentiated and moderately differentiated hepatocellular carcinoma, low vascularity - mainly in poorly differentiated hepatocellular carcinoma.

Application of iterative reconstruction in CT angiography of craniocervical arteries

Objective To assess the effect of iDose4 in image quality and radiation dosage in CT angiography of craniocervical arteries. Methods Imaging data of 50 patients with 256-slice spiral CT angiography of craniocervical arteries were randomly divided into two groups: (A) 120 k V,250 m As (25 patients),(B) iDose4 100 k V,180 m As (25 patients).Dose length product (DLP) of the two groups were compared.Objective image noise was compared by two blinded readers,t test and nonparametric tests were used for statistical analysis. Results The overall image quality score of group A (3 points=1 patient,4 points=6 patients and 5 points=18 patients) and group B (4 points=5 patients and 5 points=20 patients) were shown.The image noise of group A (1 point=1 patient,2 points=5 patients and 3 points=19 patients) and group B (2 points=4 patients,3 points=21 patients) were also evaluated.There was no statistical difference in revealing rate of image quality scores and objective noise between the two groups (Z=-0.334,-0.218,P>0.05).The estimated effective radiation dose was reduced by 56% in group B than in group A.DLP was significantly lower in group B[ (642.4±36.6) mGy·cm]than in group A[ (1462.1±64.3) mGy·cm]. Conclusion Low dose contrast medium of CT angiography can display craniocervical arteries and the intracranial arteries very well with high image quality. Key words: Tomography,X-ray computed; Angiography; Radiation dosage

Application of prospectively electrocardiograph-gated 128-slice spiral CT angiography in children with complex congenital heart disease

Objective To evaluate the prospective electrocardiograph (ECG) -gated 128-slice spiral CT angiography in the diagnosis of complex congenital heart disease and airway abnormality in children. Methods Eighty children with congenital heart disease received prospective (n=40) or retrospective ECG-gated 128-slice spiral CT angiography (n=40).All of the patients underwent ultrasound cardiogram (UCG) within one week before CTA exmination.The image quality and the effective radiation dose were statistically analyzed using independent samples t test andχ2test.The surgical results were taken as the diagnostic standards,and the preoperative prospective and retrospective CT angiography data were compared with UCG results usingχ2test. Results The effective dose of prospective ECG-gated CT angiography[ (1.00±0.26) mSv] was reduced by 86% as compared with the retrospective ECG-gated CT angiography[ (7.37±0.52) mSv] (t=69.296,P 0.05).The definitive diagnosis of extracardiac vascular anomalies was made in 98.3% (59/60) of patients by using prospective and retrospective ECG-gated CT angiography,which were significantly superior to UCG results[ (76.7% (46/60),76.7% (45/59),respectively] (χ2=13.144,12.644,P 0.05).The definitive diagnosis of the cardiac/large-vessel malformations was made in 100% of the patients by both prospective and retrospective ECG-gated CT angiography,and there was no significant difference between 128-slice spiral CT angiography results and UCG results[97.2% (35/36),97.3% (36/37),respectively] (χ2=1.014,0.001,P>0.05).In the cardiac malformations,the definitive diagnosis by prospective and retrospective ECG-gated CT angiography was 88.7% (47/53) and 92.5% (49/53),and there was no significant difference between 128-slice spiral CT angiography results and UCG results[98.1% (52/53),98.1% (52/53),respectively] (χ2=3.824,1.889,P>0.05),and no significant difference in the definitive diagnosis was observed between prospective and retrospective ECG-gated CT angiography (χ2=0.442,P>0.05).In addition,the 128-slice spiral CT angiography detected airway abnormality in 9 cases who underwent prospective or retrospective ECG-gated CT angiography. Conclusion The prospective ECG-gated 128-slice spiral CT angiography exhibits great application value in the preoperative diagnosis of complex congenital heart disease,which helps to develop surgical program and evaluate surgical risks. Key words: Heart defects,congenital; Tomography,X-ray computed; Child; Infant; Radiation dosage

Predictors of Inaccurate Coronary Arterial Stenosis Assessment by CT Angiography

This study sought to investigate the clinical and imaging characteristics associated with diagnostic inaccuracy of computed tomography angiography (CTA) for detecting obstructive coronary artery disease (CAD) defined by quantitative coronary angiography (QCA). Although diagnostic performance metrics of CTA have been reported, there are sparse data on predictors of diagnostic inaccuracy by CTA. The clinical characteristics of 291 patients (mean age: 59 ± 10 years; female: 25.8%) enrolled in the multicenter CorE-64 (Coronary Artery Evaluation Using 64-Row Multi-detector Computed Tomography Angiography) study were examined. Pre-defined CTA segment-level characteristics of all true-positive (N = 237), false-positive (N = 115), false-negative (FN) (N = 159), and a random subset of true-negative segments (N = 511) for ≥50% stenosis with QCA as the reference standard were blindly abstracted in a central core laboratory. Factors independently associated with corresponding levels of CTA diagnostic inaccuracies on a patient level and coronary artery segment level were determined using multivariable logistic regression models and generalized estimating equations, respectively. An Agatston calcium score of ≥1 per patient (odds ratio [OR]: 5.2; 95% confidence interval [CI]: 1.1 to 24.6) and the presence of within-segment calcification (OR: 10.2; 95% CI: 5.2 to 19.8) predicted false-positive diagnoses. Conversely, absence of within-segment calcification was an independent predictor of an FN diagnosis (OR: 2.0; 95% CI: 1.2 to 3.5). Prior percutaneous revascularization was independently associated with patient-level misdiagnosis of obstructive CAD (OR: 4.2; 95% CI: 1.6 to 11.2). Specific segment characteristics on CTA, notably segment tortuosity (OR: 3.5; 95% CI: 2.4 to 5.1), smaller luminal caliber (OR: 0.48; 95% CI: 0.36 to 0.63 per 1-mm increment), and juxta-arterial vein conspicuity (OR: 2.1; 95% CI: 1.4 to 3.2), were independently associated with segment-level misdiagnoses. Attaining greater intraluminal contrast enhancement independently lowered the risk of an FN diagnosis (OR: 0.96; 95% CI: 0.94 to 0.99 per 10-Hounsfield unit increment). We identified clinical and readily discernible imaging characteristics on CTA predicting inaccurate CTA diagnosis of obstructive CAD defined by QCA. Knowledge and appropriate considerations of these features may improve the diagnostic accuracy in clinical CTA interpretation. (Diagnostic Accuracy of Multi-Detector Spiral Computed Tomography Angiography Using 64 Detectors [CORE-64]; NCT00738218).

Optimization of scanning protocols in low-dose, prospectively ECG-triggered, high-pitch spiral coronary CT angiography

Optimization of scanning protocols in low-dose, prospectively ECG-triggered, high-pitch spiral coronary CT angiography

Detection of coronary artery stenosis with sub-milliSievert radiation dose by prospectively ECG-triggered high-pitch spiral CT angiography and iterative reconstruction

To evaluate the diagnostic accuracy of sub-milliSievert (mSv) coronary CT angiography (cCTA) using prospectively ECG-triggered high-pitch spiral CT acquisition combined with iterative image reconstruction. Forty consecutive patients (52.9 ± 8.7 years; 30 men) underwent dual-source cCTA using prospectively ECG-triggered high-pitch spiral acquisition. The tube current-time product was set to 50 % of standard-of-care CT examinations. Images were reconstructed with sinogram-affirmed iterative reconstruction. Image quality was scored and diagnostic performance for detection of ≥50 % stenosis was determined with catheter coronary angiography (CCA) as the reference standard. CT was successfully performed in all 40 patients. Of the 601 assessable coronary segments, 543 (90.3 %) had diagnostic image quality. Per-patient sensitivity for detection of ≥50 % stenosis was 95.7 % [95 % confidence interval (CI), 76.0-99.8 %] and specificity was 94.1 % (95 % CI, 69.2-99.7 %). Per-vessel sensitivity was 89.5 % (95 % CI, 77.8-95.6 %) with 93.2 % specificity (95 % CI, 86.0-97.0 %). The area under the receiver-operating characteristic curve on per-patient and per-vessel levels was 0.949 and 0.913. Mean effective dose was 0.58 ± 0.17 mSv. Mean size-specific dose estimate was 3.14 ± 1.15 mGy. High-pitch prospectively ECG-triggered cCTA combined with iterative image reconstruction provides high diagnostic accuracy with a radiation dose below 1 mSv for detection of coronary artery stenosis. • Cardiac CT with sub-milliSievert radiation dose is feasible in many patients • High-pitch spiral CT acquisition with iterative reconstruction detects coronary stenosis accurately. • Iterative reconstruction increases who can benefit from low-radiation cardiac CT.

Spiral CT localization of the point where superior epigastric artery perforates rectus abdominis muscle

Objective To locate the points where the superior epigastric artery perforates the rectus abdominis muscle by using the spiral CT,in order to evaluate its control on abdominal complications after breast reconstruction.Methods Fifty cases had received abdominal spiral CT angiography,respectively.Then the coordinate system was established,with the umbilicus as the origin,the umbilicus horizontal line as X axis,vertical umbilical level line as Y axis.The point where superior epigastric artery perforates the rectus abdominis muscle in the coordinate system was located as described above.Results There were 392 perforating points in the rectus abdominis muscle in all 50 cases,with a mean of 7.84 perforators per patient.In the first quadrant,the points where superior epigastric artery perforate the rectus abdominis muscle were located in the range from 1.45 cm to 5.47 cm on the X axis,and in the range from 2.52 cm to 16.38 cm on the Y axis,respectively.In the second quadrant,the points where superior epigastric artery perforates the rectus abdominis muscle were located in the range from 2.02 cm to 6.80 cm on the X axis,and in the range from 2.30 cm to 14.46 cm on the Y axis,respectively.Conclusions The spiral CT angiography has high sensitivity and specificity,it can locate the point where the superior epigastric artery perforates the rectus abdominis muscle,which can avoid to cut extra rectus abdominis muscle.It is significant to reach best postoperative effect with the lowest donor site complications. Key words: Spiral CT angiography; Mammaplasty; Superior epigastric artery; TRAM flap

Clinical features in patients with pulmonary embolism at a community hospital: analysis of 4 years of data

The aim of this study is to assess the various clinical features, risk factors, and electrocardiographic (EKG) findings associated with acute pulmonary embolism (PE). Knowledge gained from the study may enable health care providers in diagnosis of PE, thus allowing them to carry out appropriate diagnostic testing and treatment after recognition of this potentially lethal disease. PE is common but frequently under-diagnosed clinical problem, associated with potentially fatal outcomes. Clinical presentation is highly variable, non-specific and most patients have an underlying identifiable risk factor. The presentation of PE can easily be confused with other cardio-pulmonary or systemic disorders. Prompt diagnosis of this potentially deadly disease is of utmost importance. Knowledge of salient features associated with PE may enable health care providers in diagnosis of PE, thus allowing them to carry out appropriate diagnostic testing and treatment after its recognition. We performed a single-center, cross-sectional descriptive study including all inpatient and emergency department encounters ≥18years of age diagnosed with PE at our institution, a 300-bed inner city community hospital, during the dates January 2007 to December 2010. All patients were diagnosed with multi-detector 64-slice spiral computed tomography angiography. Using a standardized form, we performed simultaneous retrospective chart review to collect the necessary data required for the study. PE was confirmed in 334 patients during the 4years study period. Mean age of subjects was 65.8years (±16.4, range 22-98). Females represented 54% of study subjects. Dyspnea, chest pain, and cough were present in 72, 38, and 19% of the patients, respectively. Dyspnea was the only presenting symptom in 29%. Tachypnea, hypoxia, tachycardia, and signs of DVT were present in 39, 35, 33, and 29%, respectively. Cancer was most common risk factor present in 27%, followed by prior history of venous thromboembolism (DVT or PE), immobilization, and surgery in 19, 15, and 15, respectively. EKG interpretation revealed normal sinus rhythm in 53%, sinus tachycardia in 31%, S1Q3T3 pattern in 6%, and atrial fibrillation (AF) in 6%.We also noted that 8% of elderly patients had new onset AF at the time of diagnosis of PE. Diagnosis of PE remains a challenging task due to its variable presentation. Many of the classical features associated with this potentially fatal disease are often missing. This data re-emphasizes a wide spectrum of clinical presentation and non-specificity of symptoms of PE. Clinical suspicion of PE is a critical step and of paramount importance for further objective investigations, which would assist in the diagnosis and appropriate timely management of PE.

Prenatal diagnosis of right aortic arch with mirror‐image branching without associated anomalies

A pregnant woman at 32 weeks of gestation was referred because of untypical visualization of a three-vessel tracheal view. Detailed ultrasound examination demonstrated an abnormal position of descending aorta, positioned at the right-front side of the spine at the level of four-chamber view. The descending aorta was connected with left pulmonary artery through ductus arteriosus, which configured a vascular ring. Right aortic arch with mirror-image branching without any associated anomaly was suspected prenatally. Amniocentesis showed no chromosomal abnormality. A male, 2440-g infant was delivered vaginally at 37 weeks and 4 days of gestation. Echocardiography confirmed no associated congenital heart defect. Three-dimensional reconstruction using 64-slice spiral computed tomography angiography at 2-months old confirmed the diagnosis of right aortic arch with mirror-image branching. The infant is now 1 year old and well developed without any symptoms.

Clinical significance of hepatic artery variations originating from the superior mesenteric artery in abdominal tumor surgery

Background Hepatic artery variations are frequent clinical occurrences. The aim of this study was to investigate the characteristic course of variant hepatic arteries originating from the superior mesenteric artery for the purpose of providing instructions for abdominal tumor surgery. Methods The course of variant hepatic arteries originating from the superior mesenteric artery was studied in 400 patients with liver cancer confirmed by digital subtraction angiography (DSA) and multi-slice spiral computed tomography angiography (MSCTA), and 86 patients with gastric cancer confirmed by preoperative MSCTA between June 2008 and June 2010 in the First Affiliated Hospital of Guangxi Medical University. Results Hepatic artery variations originating from the superior mesenteric artery were noticed in 49 liver cancer patients and 14 gastric cancer patients (total 63 cases), with a variation rate of 12.96%, including two cases (3.17%) where the hepatic arteries ran along the anterior pancreas, and 61 cases (96.83%) where the hepatic arteries ran along the posterior pancreas. Conclusions Hepatic artery variations originating from the superior mesenteric artery present as two types: the pre-pancreas type and the post-pancreas type with the latter predominating. This finding is of clinical significance in abdominal tumor surgeries where clearance of portal lymph nodes is needed.

Value of multi-slice spiral CT angiography in diagnosis and treatment of cerebral arteriovenous malformations

Objective To evaluate the manifestation of cerebral arteriovenous malformations (CAVM) on multi-slice spiral CT (MSCT) angiography and the clinical value of this examinaion.Methods The data on 36 patients with CAVM undergoing MSCT angiography were collected.Vascular reconstruction were performed by volume rendering and AV.The manifestations of feeding arteries and draining veins were then analyzed.Results Among these 36 patients with cerebral arteriovenous malformations,ten patients had the lesion in occipital lobe,nine in temporal lobe,two in frontal lobe,three in parietal lobe,seven in occipital lobe and cerebellar hemisphere,three in occipital and temporal lobe,and two in frontal and parietal lobe,with a clear display of masses of deformed vessels,feeding arteries and draining veins; 4 patients were complicated by intra-aneurysm of CAVM,2 were complicated by extra-aneurysm of CAVM,3 concurred with subarachnoid hemorrhage,and 6 concurred with cerebral hemorrhage.Conclusions Multi-slice spiral angiography can clearly detect masses of deformed vessels,feeding arteries,draining veins,and coexisting aneurysms. Key words: Cerebral arteriovenous malformations; CT angiography

Clinical research in individual information of celiac artery CT imaging and gastric cancer surgery

The objective of this study is to acquire CT images of the celiac artery by 64-multi-slice spiral CT angiography (64-MSCTA) in gastric cancer patients to facilitate gastric cancer surgery. Preoperative 64-MSCTA was performed to observe the origin, course and anatomical variations of the celiac artery and vascular calcifications in 102 gastric cancer patients. (1) The celiac trunk mostly arose at the level between the 12th thoracic vertebra and the 1st lumbar vertebra; the mean inferior angle with the abdominal aorta was 63.5° (14°-159°), the mean length was 36.29 mm (5.80-73.58 mm), and its course showed many styles. (2) Of 102 gastric cancer patients, 34 patients (33.33 %) were observed with celiac artery variations of whom there were 27 patients with anatomical variations of the hepatic artery, 3 patients with anatomical variation of the left gastric artery and 1 patient with anatomical variation of the splenic artery; in 1 patient, the celiac trunk and the superior mesenteric artery originated from a common trunk. In other cases, it was observed with another variation. (3) The abdominal aortic calcified plaque was observed in 48 patients (47.1 %), and among them, 34 patients were more than 60 years old, and the existence of the abdominal aortic calcified plaque was related to age, significantly (P < 0.01). The 64-MSCTA largely improves our understanding of the origin, course and anatomical variations of the celiac artery and vascular calcifications in individual patient with gastric cancer. It is recommended that the 64-MSCTA of the celiac artery should be classified as a routine preoperative procedure in gastric cancer patients.

High-pitch dual-source CT angiography of supra-aortic arteries: assessment of image quality and radiation dose

High-pitch CT angiography (CTA) is a recent innovation that allows significant shortening of scan time with volume coverage of 43 mm per second. The aim of our study was to assess this technique in CTA of the head and neck. CTA of supra-aortic arteries was performed in 50 patients using two acquisition protocols: conventional single-source 64-slice (pitch 1.2) and high-pitch dual-source 128-slice CT (pitch 3.2). Subjective and objective image quality of supra-aortic vessel ostia as well as intra- and extra-cranial segments was retrospectively assessed by blinded readers and radiation dose compared between the two protocols. Conventional and high-pitch CTA achieved comparable signal-to-noise ratios in arterial (54.3 ± 16.5 versus 57.3 ± 14.8; p = 0.50) and venous segments (15.8 ± 6.7 versus 18.9 ± 8.9; p = 0.21). High-pitch scanning was, however, associated with sharper delineation of vessel contours and image quality significantly improved at the level of supra-aortic vessel ostia (p < 0.0001) as well as along the brachiocephalic trunk (p < 0.0001), the subclavian arteries (p < 0.0001), proximal common carotid arteries (p = 0.01), and vertebral V1 segments (p < 0.0001). Using the high-pitch mode, the dose-length product was reduced by about 35% (218.2 ± 30 versus 141.8 ± 20 mGy × cm). Due to elimination of transmitted cardiac motion, high-pitch CTA of the neck improves image quality in the proximity of the aortic arch while significantly lowering radiation dose. The technique thus qualifies as a promising alternative to conventional spiral CTA and may be particularly useful for identification of ostial stenosis.

AB 8. Pulmonary embolism severity index, based on spiral CT angiography and V/Q scan, in correlation with d-dimers and P(A-a)O2. A retrospective study

Background Aim of the study was to apply new, established severity indexes of pulmonary embolism based on spiral CT angiography and V/Q scan and correlate them with the d-dimers levels and P(A-a)O2 upon admission.

Retroperitoneoscopic Renal Pedicle Lymphatic Disconnection for Chyluria in Presence of Complex Renal Vasculature

To evaluate retroperitoneoscopic renal pedicle lymphatic disconnection (RRPLD) for chyluria in the setting of complex renal vasculature and compare those outcomes with the RRPLD outcomes of patients with normal renal vasculature. From December 2002 to December 2011, RRPLD was performed in 14 patients with complex renal vasculature and 64 patients with normal renal vasculature. Preoperative multislice spiral computed tomography angiography for renal vessels was done on 5 patients with complex vasculature. The demographic and perioperative data were collected to assess critical outcomes. The abnormal vasculature was identified using preoperative multislice spiral computed tomography angiography in 5 patients and surgical exploration in 9 patients. RRPLD was successfully completed in all patients without conversion to open surgery or vascular injury. The mean operative time was significantly longer in those with complex renal vasculature than those with normal renal vasculature (105.4 ± 18.7 vs 84.5 ± 15.6 minutes; P = .000). The outcomes were similar in the 2 groups in terms of intraoperative blood loss (P = .060), mean hospital stay (P = .478), and intraoperative complications (P = .660). The occurrence of postoperative gross hematuria was significantly greater in those with complex renal vasculature than in those with normal renal vasculature (4 of 14 vs 2 of 64; P = .008). The event was resolved uneventfully. Although it is technically challenging, RRPLD is feasible and safe for patients in the presence of complex renal vasculature. Preoperative evaluation of the renal vasculature with multislice spiral computed tomography angiography is beneficial for managing abnormal renal vessels.

Is it necessary to dissect the lymph nodes around an abnormal hepatic artery in D2 lymphadenectomy for gastric cancer?

Surgical resection remains the principal treatment for advanced gastric cancer. However, one of the difficulties in radical D2 lymphadenectomy is the identification of the vascular abnormalities around the stomach, especially abnormal hepatic artery. The hepatic artery arising from the superior mesenteric artery shows great variations, and whether or not the lymphatic tissues around the abnormal artery should be dissected is still controversial. Eighty-six gastric cancer patients who underwent radical D2 lymphadenectomy by the same surgeon in our department in the past 2 years were included in this study. All patients underwent multislice spiral computed tomography angiography for preoperative evaluation of the abnormal hepatic artery arising from the superior mesenteric artery. Postoperative immunohistochemistry of the lymphoid tissues around the abnormal hepatic artery was performed using CK20 and CEA antibodies to determine the occurrence of lymph node micrometastasis around the abnormal artery. In our study, we found 14 cases with an abnormal hepatic artery arising from the superior mesenteric artery. The hepatic artery ran in front of the pancreas in 1 case and behind the pancreas in 13 cases. Immunohistochemical analyses revealed no micrometastasis in the lymphoid tissues surrounding the abnormal artery. Abnormal hepatic arteries arising from the superior mesenteric artery can be classified into pre-pancreas and post-pancreas types. Lymph nodes around the abnormal artery may not need to be dissected in radical D2 lymphadenectomy.

Clinical value of 256-slice spiral CT and selective coronary angiography for the diagnosis of coronary artery disease

Objective To explore the clinical value of 256-slice CT and coronary angiography in the diagnosis of coronary artery disease.Methods 46 patients with coronary heart disease,who underwent coronary angiography and 256-slice spiral CT were selected.Compare two methods for the detection of coronary artery disease.Results ( 1 ) All 256-slice CT and coronary angiography achieved a satisfactory image,in the diagnosis of coronary artery stenosis and occlusion,the two methods had no statistically significant difference ( P ＞ 0.05 ).(2) according to standard coronary angiography,256-slice spiral CT for the diagnosis of coronary artery stenosis sensitivity was 93.0％ (132/142),specificity was 91.6％ (142/155),positive predictive rate was 91.0％ (132/145),negative predictive rate was 93.4％ (142/152).Conclusion 256-slice spiral CT has a high time resolution,spatial resolution,the display of the coronary artery disease has high sensitivity,specificity,positive predictive value and negative predictive value. Key words: Tomography, Spiral computed; Coronary angiography; Coronary disease; Diagnosis