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1.
Mohamed Ahmed Youssef Mahmoud Abdelaziz Dawoud Aly Aly Elbarbary Mohamed Mohamed Elbedewy Hasan Mohamed Elkhateeb 《The Egyptian Journal of Radiology and Nuclear Medicine》2014
Objective
To evaluate the effectiveness of the multislice CT coronary angiography, as a non-invasive imaging tool in assessment of coronary artery stenosis.Patients and methods
The study included 50 patients who were referred for MSCT coronary angiography followed by catheter coronary angiography. Patients with previous coronary bypass grafts and those with coronary stents were excluded. History of contrast allergy, renal impairment and severe chest conditions were exclusion criteria. The coronary angiographic CT studies were performed using a 320 CT scanner. The catheter coronary angiographic studies were performed via femoral arterial puncture. The results of CT angiography were compared with the gold standard catheter angiography.Results
The positive predictive value and negative predictive value of MSCT coronary angiography in detection of coronary artery stenosis were 94% and 100%, respectively.Conclusion
In conclusion, MSCT coronary angiography is a very helpful and rapid non-invasive coronary imaging modality that was able to detect and grade coronary artery stenosis better than other noninvasive examinations used to detect CAD, such as exercise stress testing. Due to its very high negative predictive value, it may eliminate the need for invasive coronary procedures in the presence of normal coronary imaging. 相似文献2.
I. Helmy A. Nasr A. Ismail A. Ramadan K. Helmy 《The Egyptian Journal of Radiology and Nuclear Medicine》2012
Objective
The purpose of this study is to evaluate the role of MDCT in the depiction of coronary artery anomalies.Patients and methods
Sixteen patients were included in this study. Retrospectively gated coronary CT angiography was performed in 11 patients and prospectively gated CT coronary angiography was performed in 5 patients. Post-processing techniques as maximum-intensity projection, curved multiplanar reconstruction, and volume rendering were applied to assess the origin and course of the coronary vessels.Results
Origin and course anomalies of the central coronary artery segments were seen in 11 patients (67%), anomalies of only coronary artery origin in 2 patients (13%), origin and course anomalies of the peripheral coronary segments in 2 patients (13%) and coronary arterio-venous fistula in one patient (7%). The origin and course anomalies of the central coronary artery segment were more common in the left coronary artery involving 8 patients (73%). Malignant inter-arterial course between aortic root and pulmonary artery or the right ventricle outflow tract was seen in 3 anomalous arteries.Conclusion
MDCT coronary angiography can precisely depict the origin and course coronary artery anomalies and is recommended in young patients and before cardiac intervention or surgery to prevent possible complications. 相似文献3.
Wael Abdulghaffar Fady Elganayni Ahmed H. Abou-Issa Ayman Almorsy 《The Egyptian Journal of Radiology and Nuclear Medicine》2012
Objective
To shed light on coronary artery anomalies among cardiac patients using ECG-gated 64-row MDCTA during assessment of coronary arteries.Patients and methods
Study included 840 patients out of whom twenty-one patients have congenital coronary artery anomalies. Patients were examined using ECG gated 64-row MDCT; 80–100 ml contrast agent, followed by a 50 ml saline chaser injected at 5 ml/s, 350 ms gantry rotation time, 0.65 mm detector collimation, ECG tube current modulation and 100–120 kV. Post-processing was done on second workstation including 3D VR, MPR and CMPR images.Results
Anomalies of the coronary arteries were diagnosed in twenty-one patients. The prevalence of congenital anomalies in this study was 2.5% and included: anomalous origin of right coronary artery in 4 cases (0.48%), anomalous origin of left circumflex artery in 3 cases (0.36%), myocardial bridging of LAD in 12 cases (1.4%) and coronary artery fistula in 2 cases (0.24%).Conclusion
Coronary artery anomalies are not uncommon among cardiac patients. Myocardial bridging is the most common followed by anomalous origin and proximal course and lastly coronary artery fistula. 64-Row MDCTA is an excellent promising modality and should be the first non-invasive diagnostic tool to rule out such anomalies. 相似文献4.
Purpose
To study the role of multidetector CT angiography in diagnosis, and follow up of venous and arterial pulmonary anomalies in pediatrics.Subjects and methods
Retrospective study was conducted upon 53 consecutive pediatric patients (24 F and 29 M, aged 4 days to 5 years; mean age 11.78 months). CT examinations were done using 16-section CT scanner with a detector collimation of 16 × 0.75 mm, pitch of 0.6, and gantry rotation time of 0.5 s. Anatomic coverage extended from above the thoracic inlet to below the level of the L2 vertebra to include the origin of celiac trunk. Timed injection method was used. Post processing Image reconstruction was done in 3D volume rendering and maximum intensity projection (MIP).Results
The arterial pulmonary anomalies were more common than pulmonary venous anomalies, combined arterial and venous anomalies were seen in five cases and two cases had more than one type of pulmonary artery anomalies. The commonest pulmonary artery anomaly was atresia, followed by stenosis then hypoplasia. The commonest venous pulmonary anomaly was supracardiac total anomalous pulmonary venous return.Conclusion
We concluded that 16-MDCT is an accurate method for the diagnosis of congenital anomalies involving both pulmonary arteries and veins and also for preoperative planning and post operative evaluation. 相似文献5.
Objective
The purpose of this study was to evaluate the role of CT angiography in different encountered congenital vascular anomalies of pediatric age groups using 64 multislice CT scanner.Subjective and methods
Through one year, a total of 15 patients having congenital extracardiac anomalies were encountered from those attending big trauma and emergency center and were studied in this work. Each patient’s parent was thoroughly asked about the detailed clinical history after reviewing the referring imaging request and laboratory findings. Exclusion criteria for CT were as follows: previous allergic reactions to iodine contrast media and severe renal insufficiency. CT examination was performed using 64 multislice CT machine.Results
CTA examination was performed in a total of 15 patients. The age of the patients was ranging from 2 days to 14 yrs and 5 cases were females. Four cases came with cyanosis; one case came with follow up after operation for transposition of great arteries, while the remaining cases were suffering from medical problems such as respiratory distress or hypertension. Aortic arch hypoplasia, right sided aortic arch with mirror image or with aberrant left subclavian artery, hypoplastic left pulmonary artery with left sided aortic arch and aberrant right subclavian artery, hypoplastic left heart chambers, retrotracheal left pulmonary artery with patent ductus arteriosus (PDA), right superior partial anomalous pulmonary venous drainage (PAPVD) with ASD sinus venosum, postoperative assessment of transposition of great arteries (TGA), fibromuscular dysplasia involving the renal and common iliac arteries, and bilateral double renal arteries with ectopic right kidney were the different extracardiac vascular anomalies encountered in this work.Conclusion
CTA provides an excellent means to detect a number of extracardiac vascular anomalies and allows accurate and fast noninvasive characterization of extracardiac vascular anatomy. It is a helpful tool in establishing the primary diagnosis, defining anatomic landmarks and relationships, identifying vascular anomalies and helping in postoperative follow-up. 相似文献6.
CT coronary angiography: Coronary CT-flow quantification supplements morphological stenosis analysis
H. Bovenschulte B. Krug T. Schneider H. Schwabe C. Kabbasch C. Bangard M. Hellmich G. Michels D. Maintz K. Lackner 《European journal of radiology》2013
Background
Our rationale was to evaluate whether a 64-slice CT scanner allows accurate measurement of computed tomographic (CT) changes in coronary artery flow profiles and whether CT flow measurements are suitable for classifying the significance and hemodynamic relevance of a stenosis and thereby supplement as a functional parameter for morphological stenosis analysis.Methods
A total of 50 patients prospectively underwent computed tomography coronary angiography (coronary CTA) in a multidetector CT scanner (Brilliance 64, Philips) ± 1 day before or after invasive coronary angiography (ICA). Immediately thereafter, 2 radiologists reviewed the imaging data to detect any vessel segments with morphology poorly evaluable by coronary CTA. A locally constant cyclical measurement was acquired in these coronary arteries in breath-hold technique during the passage of a 50 ml bolus of contrast media. For analysis, time–density curves of the bolus passage were registered in the coronary artery and the aorta (internal reference), the up-slopes were determined and correlated with each other. The results were compared with the ICA findings.Results
47 of 50 CT flow measurements were evaluable. A good correlation was found between the degrees of stenosis and slope ratios in aorta and coronary artery (R2 = 0.92). The threshold corridor was 0.55–0.77 for distinguishing hemodynamically (≥70%) from non-hemodynamically relevant stenoses.Conclusions
CT-based coronary artery flow measurements (CTFM) correlate well with the angiographically determined degree of stenosis and can elevate by non-invasive means the diagnostic accuracy of coronary CTA. From both a clinically diagnostic and scientific standpoint, CTFM proves a suitable method for quantifying coronary blood flow. 相似文献7.
Nobuo Tomizawa Fumio Suzuki Masaaki Akahane Rumiko Torigoe Shigeru Kiryu Kuni Ohtomo 《European journal of radiology》2013
Objective
To investigate the effect of saline flush on coronary CT angiography of proximal, middle, and distal coronary artery segments, using 320-row CT, and to compare two injection duration protocols as to amount of contrast in the right heart chambers.Methods
This retrospective study was approved by the local ethics committee, and the requirement for informed consent to participate in this study was waived. The final study group included 108 patients who underwent coronary CT angiography. The first 36 patients received contrast medium without saline flush (group 1); the next 36 patients received contrast medium for 14 s and saline flush (group 2); the last 36 patients received contrast medium for 12 s and saline flush (group 3). The CT number, noise, contrast-to-noise ratio (CNR), and number of segments with a CT number greater than 325 Hounsfield units (HU) were recorded for proximal, middle, and distal segments.Results
The CT numbers and the CNR in groups 2 and 3 were significantly higher than that in group 1 (p < 0.005); the difference between groups 2 and 3 was not significant. The proportion of segments greater than 325 HU improved with saline flush (p < 0.05), with a larger improvement in the distal segments.Conclusions
Saline flush improves enhancement and CNR of coronary arteries, particularly of distal segments, in coronary CT angiography using 320-row CT. An average contrast medium injection of 44 mL was feasible using a saline flush. 相似文献8.
Hossam Mansour Abd El-Rahman Tamir A. Hassan Muhammad M. Elfawal Basheir A. Hassan Al shymaa A. Ali Hend M. Abdel-Rahman 《The Egyptian Journal of Radiology and Nuclear Medicine》2017,48(3):581-591
Purpose
To investigate the value and highlight the role of multi slice computed tomography (MSCT) angiography in evaluation of extra-cardiac intra thoracic vascular anomalies in children.Patients and methods
This study included 24 patients (13 males and 11 females) with an age range of 1 month–13 years. All of these patients were clinically diagnosed to have congenital heart disease with suspected extracardiac vascular anomalies. All underwent prospective ECG-gated MSCT angiography after trans-thoracic echocardiography (TTE). Iterative reconstruction techniques were applied to reduce the radiation dose in MSCT angiography with the mean radiation dose of (4 mSv). The diagnostic accuracy and sensitivity of MSCT angiography and TTE were compared in comparison with surgical outcome.Results
The most common congenital extra cardiac vascular anomalies are PDA (45.8%) and aortic coarctation (37.5%). The major CT angiographic findings missed by TTE were coronary artery anomalies, absence of a pulmonary artery and pulmonary artery stenosis. The overall sensitivity of the MSCT angiography in diagnosis of the extra-cardiac vascular anomalies was 98.1% which was higher than that of TTE 80%.Conclusion
CG gated MSCT angiography is an accurate modality for demonstrating extra cardiac structures in complex CHD. It provides important complementary information to TTE with regard to extra cardiac vascular structures and coronary artery anatomy. This modality may reduce the need for high radiation dose invasive diagnostic cardiac catheterization. 相似文献9.
Ruder TD Bauer-Kreutz R Ampanozi G Rosskopf AB Pilgrim TM Weber OM Thali MJ Hatch GM 《European journal of radiology》2012,81(9):2208-2214
Objectives
Minimally invasive or virtual autopsies are being advocated as alternative to traditional autopsy, but have limited abilities to detect coronary artery disease. It was the objective of this study to assess if the occurrence of chemical shift artifacts (CSA) along the coronary arteries on non-contrast, post-mortem cardiac MR may be used to investigate coronary artery disease.Methods
We retrospectively compared autopsy and CT findings of 30 cases with significant (≥75%), insignificant (<75%), or absent coronary artery stenosis to post-mortem cardiac MR findings. The chi-square test was used to investigate if the occurrence of CSA depends on the presence or absence of stenosis. Sensitivity, specificity and predictive values were calculated for each finding.Results
CSA indicates the absence of (significant) stenosis (p < 0.001). The occurrence of paired dark bands in lieu of CSA on post-mortem cardiac MR suggests (significant) coronary arteries stenosis (p < 0.001). Both findings have a high specificity but low sensitivity.Conclusions
CSA is a marker of vessel patency. The presence of paired dark bands indicates stenosis. These criteria improve the ability of minimally invasive or virtual autopsy to detect coronary artery disease related deaths. 相似文献10.
Patricia Carrascosa Carlos Capuñay Marcelo Bettinotti Alejandro Goldsmit Alejandro Deviggiano Jorge Carrascosa Mario J. García 《Journal of Cardiovascular Computed Tomography》2007,1(2):86-94
Background
Multidetector computed tomography (MDCT) has been proposed as a noninvasive method for the diagnosis of obstructive coronary artery disease (CAD). In patients with high risk of iodinated contrast adverse effects such as acute allergic-type reactions, the use of gadolinium could be an alternative.Objective
We sought to evaluate the feasibility of gadolinium-enhanced MDCT for the diagnosis of obstructive CAD.Methods
Twenty patients (mean age, 61 years; range, 50-73 years) referred for X-ray coronary angiography were studied by both gadolinium and iodine-enhanced 16-row MDCT coronary angiography. The degree of enhancement and the accuracy for detection of obstructive CAD (>50% diameter reduction) were evaluated with X-ray coronary angiography as the standard. Renal nephrotoxicity was strictly monitored.Results
Gadolinium- and iodine-enhanced MDCT showed adequate visualization of the coronary arteries in 310 of the 312 coronary artery segments that were available by X-ray angiography, respectively. The average density of the coronary arteries in both iodine and gadolinium CT scans was 253.65 Hounsfield unit (HU) and 135.20 HU, respectively. In a per-coronary segment analysis, gadolinium- and iodine-enhanced MDCT showed sensitivities of 89% vs 84%, specificities of 96% vs 95%, and negative predictive values of 97% vs 96%, respectively. In a per-patient analysis, both gadolinium- and iodine-enhanced MDCT showed sensitivities of 92.85% vs specificities of 83.33%. Intermethod agreement between gadolinium- and iodine-enhanced MDCT (κ) was 0.95 (P < 0.0001).Conclusion
Our preliminary results indicate lower attenuation with gadolinium but similar diagnostic accuracy for the detection of obstructive CAD when compared with iodine-enhanced MDCT. Therefore, gadolinium is a feasible alternative contrast agent for patients with iodine contrast allergy referred for MDCT coronary angiography. 相似文献11.
Maksymilian P. Opolski Jerzy Pregowski Mariusz Kruk Adam D. Staruch Adam Witkowski Marcin Demkow Tomasz Hryniewiecki Piotr Michalek Witold Ruzyllo Cezary Kepka 《European journal of radiology》2014
Objective
To determine the prevalence, radiologic patterns and clinical characteristics of intra-atrial right coronary artery (IARCA) among adult coronary computed tomography angiography (CCTA) population.Methods
We included 9,284 consecutive subjects who underwent CCTA at a single high-volume center. The presence of IARCA including the number, length and diameter of IARCA segments with accompanying atherosclerosis and coronary anomalies were evaluated. Additionally, clinical characteristics and midterm follow-up of IARCA patients were recorded.Results
The IARCA prevalence was 0.15% (14/9,284) with 15 intra-atrial segments. The intra-atrial segment length ranged from 14 to 53 mm, and the mean diameter proximal to the entry site was 3.3 ± 0.7 mm. IARCA was more often associated with intramuscular course of the left anterior descending coronary artery (29% vs. 4%, p = 0.001) and anomalous origin of the left circumflex artery from the right aortic sinus (14% vs. 0.3%, p = 0.001) compared with non-IARCA cases. The majority of IARCA patients were women (86%) presenting with supraventricular arrhythmia (71%). Compared with computed tomographic population without IARCA, IARCA subjects were younger (60 ± 12 vs. 54 ± 14 years, p = 0.037) and more often women (51% vs. 86%, p = 0.013). At a mean of 20 months follow-up of IARCA patients there were no adverse cardiac events except for supraventricular tachycardia episodes occurring in 36% of subjects.Conclusions
IARCA occurs rarely and is often associated with additional coronary anomalies. The clinical profile of IARCA patients is most often represented by middle-aged women with supraventricular arrhythmia showing favorable midterm prognosis. 相似文献12.
Said A. Monem Ahmed M.S. Nasr Ahmed M.W. Algebalay Ibrahim Mostafa Helmy Moataz Salah Eldin 《The Egyptian Journal of Radiology and Nuclear Medicine》2012
Objective
To assess the accuracy of coronary CTA in detection of coronary artery bypass graft patency, occlusion and stenosis.Patients and methods
Twenty-four patients with past history of coronary bypass surgery were included in this study and underwent MDCT coronary angiography. Invasive coronary angiography was done within 2 weeks of MDCT coronary angiography. All grafts considered patent were then evaluated for the presence of significant stenosis. Significant stenosis was defined as reduction in diameter of more than 50%.Results
All the MDCT scans were interpretable and a total number of 78 CABG conduits were analyzed. At MDCT angiography 4 (5.2%) grafts were classified as occluded and 74 (94.8%) grafts were patent. Significant stenosis was detected in 7 (9.4%) out of the 74 patent grafts. At invasive coronary angiography; when occlusion and significant stenosis pooled together they were 9 grafts; 4 arterial and 5 venous. All these 9 grafts were detected at MSCT (sensitivity is 100%). In 67 out of 69 grafts occlusion or significant stenosis was correctly ruled out (specificity 97.1%). The diagnostic accuracy of MDCT angiography when compared with invasive angiography was 97.4%. The negative predictive value was 100% and positive predictive value was 81.8%.Conclusion
MDCT coronary angiography is an accurate imaging technique for the evaluation of CABG patency and in detection of graft stenosis and confirms of previous studies using 64 MDCT. 相似文献13.
U?ur Bozlar Mehmet ?ahin U?urel Sebahattin Sar? Veysel Akgün Fatih ?rs Mustafa Ta?ar 《Diagnostic and interventional radiology (Ankara, Turkey)》2015,21(1):34-41
PURPOSE
We aimed to evaluate the frequency and features of dual left anterior descending artery (LAD) variants using computed tomography (CT) angiography.METHODS
A total of 1337 consecutive coronary CT angiography examinations performed between April 2010 and December 2013 were retrospectively evaluated for the presence of dual LAD. CT examinations were performed with either 64- or 320-row multidetector CT scanners. All CT angiography images were evaluated for the presence and morphologic features of dual LAD subtypes.RESULTS
Fifty-six dual LAD variations (4%) were identified in this study population. Type 1 was the most common type of dual LAD (n=48), while Type 3 (n=3) and Type 4 (n=2) were infrequent and Type 2 was not detected. Additionally, we detected previously unclassified dual LAD variations in three cases.CONCLUSION
Dual LAD may be a relatively more common variant than described in the medical literature, which is mostly based on catheter angiography studies. Coronary CT angiography seems markedly efficacious for detecting and documenting the anatomical details of dual LAD subtypes, as well as showing other associated cardiocoronary anomalies.Dual left anterior descending (LAD) coronary artery is a rare congenital anomaly (1), basically defined as the existence of two distinct segments of the vessel occupying the anterior interventricular sulcus (AIS) of the heart.First study classifying dual LAD anomalies based on coronary catheter angiography was published in 1983 by Spindola-Franco et al. (2), which has served as a primary classification system. However, individual reports further described previously unclassified LAD variants (3, 4). Most of the recent publications about dual LAD anomalies involve case reports and there is a paucity of large series using coronary computed tomography (CT) angiography (3–8).At present, quite a large number of coronary CT angiography examinations are being performed and recognition of dual LAD variations by CT angiography requires familiarity. Being aware of dual LAD anomalies could be critical for coronary bypass surgery and interventions. Surely, sound knowledge on dual LAD anomalies is a prerequisite for proper management of patients with coronary artery disease.In this study, we aimed to identify the frequency of dual LAD variations, and define the morphoanatomical features based on Spindola-Franco classification, using CT angiography. Appendageal subtypes of this variation were also documented and discussed. 相似文献14.
Purpose
The aim of this study was to perform a systematic review of the diagnostic accuracy of multi-detector row computed tomography angiography (MDCT) for detection of coronary in-stent restenosis in patients treated with coronary stenting when compared to invasive catheter angiography.Materials and methods
A search of PUBMED and MEDLINE databases for English literature was performed. Only studies with at least 10 patients comparing 16- or more detector rows MDCT angiography with invasive catheter angiography in the detection of coronary in-stent restenosis (more than 50% stenosis) were included for analysis. Sensitivity and specificity estimates pooled across studies were tested using a fixed effects model.Results
15 studies met selection criteria for inclusion in the analysis. There were eight studies performed with 16-detector row CT scanners, and five studies with 64-detector row scanners and one study with a 40-detector scanner. The remaining study was performed with a mixture of 16-and 64-detector row scanners. Prevalence of in-stent restenosis following coronary stenting was 18% (95% CI: 13, 24%). Pooled estimates of the sensitivity and specificity of overall MDCT angiography for the detection of coronary in-stent restenosis was 85% (95% CI: 78, 90%) and 97% (95% CI: 95, 98%), respectively. No significant difference was found between 16- and 64-detector row scanners regarding the sensitivity and specificity of MDCT for assessment of in-stent restenosis (p > 0.05).Conclusion
The results showed that MDCT angiography (with 16 or more detector rows) has moderate sensitivity and high specificity for the detection of coronary in-stent restenosis when compared to invasive catheter angiography. A high specificity value of MDCT may be most valuable as a non-invasive technique of excluding coronary stent restenosis or occlusion. The main factors affecting visualization are stent diameters and stent materials. 相似文献15.
Purpose and aim
To assess the role of MSCT angiography in evaluation of extra-cardiac vascular abnormalities in pulmonary venous anomalies and compare it with echocardiography.Materials and methods
This study included 26 patients with an age range of 15 days–25 years. All of these patients underwent MSCT angiography and echocardiography. Only 10 patients underwent cardiac catheterization.Results
Our initial experience showed that MSCT is capable of complementing echocardiography and replacing diagnostic cardiac catheterization for anatomical delineation if performed with an optimum technique.MSCT angiography proved to be a worthy primary investigation tool in patients whom ECHO has been able to clearly identify the intracardiac anatomy, but not the extra-cardiac vascular anatomy.Conclusion
MDCT correctly depicted the TAPVR (Total anomalous pulmonary venous return) and PAPVR (Partial anomalous pulmonary venous return) types of pulmonary venous anomalies with sensitivity 100%, and specificity 100%. The specificity of echocardiography was 50% for both findings. Inspite of the risk of ionizing radiation and contrast medium injection the adoption of our minimal invasive, low radiation, non-ECG gated protocol greatly reduces the time, radiation dose, and contrast medium volume needed to perform an optimum CT angiographic technique. Thus, paving a clear road map for pre and post operative assessment of patients with pulmonary venous anomalies. 相似文献16.
Joachim Gruettner Christian Fink Thomas Walter Mathias Meyer Paul Apfaltrer U. Joseph Schoepf Joachim Saur Tim Sueselbeck Dominik Traunwieser Richard Takx Stefan Kralev Martin Borggrefe Stefan O. Schoenberg Thomas Henzler 《European journal of radiology》2013
Objective
To evaluate the impact of coronary CT angiography (coronary CTA) or “triple-rule-out” CT angiography (TRO-CTA) on patient management in the work-up of patients with acute chest pain and an intermediate cardiac risk profile.Materials and methods
100 patients with acute chest pain and an intermediate cardiac risk for acute coronary syndrome (ACS) underwent coronary CTA or TRO-CTA for the evaluation of chest pain. Patients with a high and low cardiac risk profile were not included in this study. All patients with significant coronary stenosis >50% on coronary CTA underwent invasive coronary catheterization (ICC). Important other pathological findings were recorded. All patients had a 90-day follow-up period for major adverse cardiac events (MACE).Results
Based on a negative coronary CTA 60 of 100 patients were discharged on the same day. None of the discharged patients showed MACE during the 90-day follow-up. Coronary CTA revealed a coronary stenosis >50% in 19 of 100 patients. ICC confirmed significant coronary stenosis in 17/19 patients. Among the 17 true positive patients, 9 underwent percutaneous coronary intervention with stent implantation, 7 were received intensified medical therapy, and 1 patient underwent coronary artery bypass surgery.A TRO-CTA protocol was performed in 36/100 patients due to elevated d-dimer levels. Pulmonary embolism was present in 5 patients, pleural effusion of unknown etiology in 3 patients, severe right ventricular dysfunction with pericardial effusion in 1 patient, and an incidental bronchial carcinoma was diagnosed in 1 patient.Conclusion
Coronary CTA and TRO-CTA allow a rapid and safe discharge in the majority of patients presenting with acute chest pain and an intermediate risk for ACS while at the same time identifies those with significant coronary artery stenosis. 相似文献17.
Sherif A. Khedr Mohamed A. Hassaan Mohamed H. Allam 《The Egyptian Journal of Radiology and Nuclear Medicine》2013
Purpose
To evaluate the diagnostic value of MDCT angiography in assessment of coronary bypass grafts. We studied 51 patients from April 2008 to October 2011. All patients gave written informed consent, and the study protocol was approved by the Institutional Review Board. 96 grafts including 35 left internal mammary artery (LIMA) grafts, 5 radial artery grafts, and 56 saphenous vein grafts (SVG) were assessed by 64-MDCT and the results were compared with conventional coronary angiography as reference standard.Results
The diagnostic value of multi-detector computed tomography for graft occlusion was: 100% sensitivity, 100% specificity, 100% positive predictive value, and 100% negative predictive value. The diagnostic power of multi-detector computed tomography for stenosis of the graft anastomosis was: 100% sensitivity, 96% specificity, 87.5% positive predictive value, and 100% negative predictive value, and 96.4% accuracy.Conclusion
Multi-detector computed tomography has become an alternative to coronary angiography to diagnose graft occlusion and stenosis after coronary artery bypass. In addition, multidetector CT has the added advantage over traditional angiographic evaluation of simultaneously allowing evaluation for alternate postoperative complications that may also manifest with chest pain and dyspnea, thereby mimicking recurrent angina. 相似文献18.
Schmitt R Froehner S Brunn J Wagner M Brunner H Cherevatyy O Gietzen F Christopoulos G Kerber S Fellner F 《European radiology》2005,15(6):1110-1121
The objective of this study is to evaluate multidetector CT (MDCT) in detecting and characterizing anomalous coronary arteries. Forty-four patients with anomalies of the coronaries were selected from a total of 1758 individuals examined with ECG-gated 4- and 16-row MDCT including thinMIP, MPR and VRT post-processing. Twenty-eight patients showed origin and course anomalies of the central coronary segments, and in this subgroup 13 were judged as malignant because of interarterial courses between the aortic root and the pulmonary trunk, either of the right coronary artery (n=11) or the left coronary artery (n=2). Twelve non-hemodynamic anomalies were found, affecting the coronary origins only (n=10) or the peripheral vessels courses (n=2). Four arteriovenous fistulas were present, all of them with complex arterial feeders. Regardless of vessel anatomy, coronary opacification was always possible by means of the systemic contrast agent, and the aberrant coronary arteries were visualized synoptically in direct relation to the great mediastinal vessels. In contrast to MDCT, selective cannulation and final diagnosis was possible in only 11 of the 20 catheter angiograms performed (accuracy of 55.0%). In conclusion, its non-invasiveness and precise visualization makes MDCT the standard of reference for evaluating anomalous coronary arteries. 相似文献
19.
Seeger A Hennemuth A Klumpp B Fenchel M Kramer U Bretschneider C Mangold S May AE Claussen CD Peitgen HO Miller S 《European journal of radiology》2012,81(1):71-76
Purpose
To investigate the feasibility of image fusion of MR-coronary angiography (MRCA) and delayed gadolinium enhancement imaging (LGE) and to assign areas of myocardial infarction to the corresponding supplying coronary arteries.Materials and methods
An interactive segmentation of the coronary arteries was performed in MRCA data sets (n = 25). The LGE slices were matched onto the vessel segmentation to perform a fused analysis of coronary artery anatomy and LGE. The results were compared to the segmental model recommended by the American Heart Association (AHA). Standard of reference was the identification of the culprit lesion in the invasive coronary angiography (CA) (n = 20).Results
The fused analysis allowed the assignment of MI to the supplying coronary artery in 13/20 patients. The sensitivities/specificities for the assignment of MI to the three main vessels were: LAD 63%/100%, LCX 75%/100%, and RCA 56%/100%, respectively.Using the AHA segmental model the sensitivities/specificities for the correct assignment of MI to the three main vessels were: LAD 88%/58%, LCX 94%/75%, and RCA 77%/73%, respectively.Conclusion
Fusion images of MRCA and LGE provides added diagnostic information in the effort to determine the epicardial vessels responsible for the postischemic myocardial injury and therefore might be helpful to establish appropriate future therapeutic steps. 相似文献20.
Mohamad Zakaryia Al-Azzazy Mohamad Sanad Nasr Mohamad A. Shoura 《The Egyptian Journal of Radiology and Nuclear Medicine》2014