Clinical value of 16-slice multidetector computed tomography in symptomatic patients with suspected coronary artery disease

BACKGROUND

Multidetector computed tomography angiography has emerged as a rapidly developing method for the noninvasive detection of coronary artery disease.

PURPOSE

To investigate the diagnostic accuracy and limitations of multidetector computed tomography (MDCT) in the detection of significantly (> 50%) obstructive coronary artery disease (CAD) using a scanner equipped with 16 x 0.625-mm collimation.

MATERIAL AND METHODS

MDCT angiography was performed in 153 patients (99 male, 54 female; mean age 55 +/- 10 years) with suspected CAD and scheduled for conventional coronary angiography (CCA). Image quality was assessed in terms of artifacts and segment visibility, and the assessable segments were screened for the presence of significant stenoses (> 50% lumen diameter reduction). The diagnostic performance of MDCT for the detection of significant stenosis was compared with the results of CCA.

RESULTS

In all 153 patients, MDCT was carried out without complications. A total of 1989 coronary artery segments were evaluated. After exclusion of 394 non-evaluable segments (19.8%), 1595 segments (80.2%) were included in the analysis. The most frequent causes of poorly assessable segments were motion artifact (36%) and severe calcification (23%). Considering only the segments judged to be evaluable, the sensitivity, specificity, and positive and negative predictive values of 16-slice MDCT were 85%, 97%, 79%, and 98%, respectively. Including all segments in the analysis (evaluable and non-evaluable), the sensitivity was 74%, specificity 96%, positive predictive value 73%, and negative predictive value 97%.

CONCLUSION

When all coronary artery segments are included, 16-slice MDCT has moderate sensitivity and very high specificity and negative predictive value in assessing coronary artery stenoses. High specificity and negative predictive value indicate that 16-slice MDCT may be a useful tool in reliably ruling out significant lesions in patients with a low pretest probability.

Splenic arteriovenous fistula with infarcted spleen

A 25-year-old woman developed epigastralgia and abdominal bruit in the left hypochondrium. Radiologic investigation included Doppler ultrasonography, angiography and computed tomography and revealed splenic artery aneurysm and arteriovenous fistula resulting in an almost totally infarcted spleen.

Presinusoidal portal hypertension does not affect hepatic artery resistance index

We aimed to determine the mean hepatic artery resistance index (RI) in presinusoidal portal hypertension and to compare the values with those in sinusoidal portal hypertension. The hepatic artery RIs of 11 patients with presinusoidal portal hypertension, 12 patients with sinusoidal portal hypertension and 16 healthy subjects were examined with duplex Doppler ultrasound. Mean hepatic artery RIs of three groups were compared. In patients with presinusoidal portal hypertension, mean RI in the hepatic artery (0.63 +/- 0.06) was significantly lower (p < 0.05) than that in the patients with sinusoidal portal hypertension (0.73 +/- 0.03). There was no significant difference (p > 0.05) in the mean RIs of the hepatic artery between the patients with presinusoidal portal hypertension (0.63 +/- 0.06) and the controls (0.67 +/- 0.05). Mean RI value in patients with sinusoidal portal hypertension (0.73 +/- 0.03) was significantly higher (p < 0.05) than the mean values in the control group (0.67 +/- 0.05). Hepatic arterial resistance does not change in presinusoidal portal hypertension, whereas it increases in sinusoidal portal hypertension. However, there are some overlaps in the RI values which raise difficulties in the differentiation of these two forms of portal hypertension.

Marked increase in flow velocities during deep expiration: A duplex Doppler sign of celiac artery compression syndrome

Symptoms of chronic mesenteric ischemia develop when the celiac artery is constricted by the median arcuate ligament of the diaphragm. Lateral aortography is the primary modality for diagnosing ligamentous compression of the celiac artery. However, duplex Doppler sonography performed during deep expiration can cause a marked increase in flow velocities at the compressed region of the celiac artery and suggest the diagnosis of celiac arterial constriction due to the diaphragmatic ligament.

Pseudoaneurysm of the abdominal aorta diagnosed by color duplex Doppler sonography

A pseudoaneurysm of the abdominal aorta is rare, accounting for only 1% of all abdominal aneurysms. More than 1 imaging method may be needed to demonstrate an abdominal aortic pseudoaneurysm. We report a case in which the presence of continuous bidirectional flow in the neck of a pseudoaneurysm on color duplex Doppler sonography confirmed the diagnosis.

A case report of congenital intrahepatic arterioportal fistula

We report a case of congenital arterioportal fistula presenting with upper gastrointestinal bleeding from oesophageal varices. The fistula was successfully treated with surgical ligation of the left hepatic artery.

Carotid disease in patients scheduled for coronary artery bypass: analysis of 678 patients

The purpose of this article is to investigate the frequency of carotid disease and to identify high-risk groups among patients scheduled for isolated coronary artery bypass grafting (CABG) procedures under nonemergent conditions. A total of 678 consecutive patients underwent preoperative carotid artery duplex scanning (CADS) before CABG procedures. Morphology of carotid artery was determined and five groups were formed. Age, sex, cervical bruit, diabetes mellitus (DM), hypertension, smoking, history of cerebrovascular event (CVE), peripheral vascular disease (PVD), and severity of coronary artery disease were investigated to describe the high-risk group for carotid artery disease. In 41% of patients carotid examination produced normal findings; 46.2% had less than 60% luminal stenoses, 7.1% had 60-79% stenoses, 4.6% had 80-99% stenoses, and 1.2% had total occlusion. Previous cerebral ischemic events (CVE) (p<0.05), hypertension (p < 0.01), smoking (p < 0.01), advanced age (p < 0.01), and female sex (p < 0.01) were identified as high-risk factors for carotid artery stenoses. There was a linear association between carotid disease and coronary disease (p < 0.05). Documentation of previous CVE, hypertension, smoking, advanced age, female sex, and severe coronary artery disease may be helpful in identifying patients at high risk for carotid artery stenoses.

Doppler waveforms of the normal and collateralized inferior mesenteric artery

OBJECTIVE

Our purpose was to analyze Doppler waveform changes and the caliber of the inferior mesenteric artery as a collateral vessel in occlusive disease of the abdominal aorta or its main branches.

SUBJECTS AND METHODS

Thirty-three patients were examined in three groups according to the location of their occlusive disease (group 1 [n = 5], occlusion of the celiac and superior mesenteric arteries; group 2 [n = 9], occlusion of the iliac artery; and group 3 [n = 19], occlusion of the abdominal aorta distal to the renal arteries). The main truncus of the inferior mesenteric artery was evaluated along its longitudinal axis using color duplex Doppler sonography. Peak systolic velocity, end-diastolic velocity, mean velocity, resistive index, and pulsatility index were determined from the Doppler spectrum. The inner diameter and cross-sectional area of the inferior mesenteric artery were measured, and blood flow volume was calculated. The data obtained from the three groups were compared with data from a control group (n = 24).

RESULTS

In all three patient groups, the mean blood flow volume and the mean flow velocities were significantly higher, the mean pulsatility index was significantly lower, and the mean diameter of the vessel was significantly larger than in the control group. The blood flow volume in patients with aortic occlusion was significantly lower than that in patients with superior mesenteric artery occlusion. In the patients with iliac artery occlusion, the mean resistive index was not significantly different from that in the control group.

CONCLUSION

An increase in blood flow volume and the presence of a monophasic waveform indicate increased collateral function of the inferior mesenteric artery. However, blood flow volume in patients with aortic occlusion does not increase as high as in patients with superior mesenteric artery occlusion, and a monophasic waveform is not a distinctive finding in iliac artery occlusion.

Superior mesenteric artery blood flow in patients with small bowel diseases: evaluation with duplex Doppler sonography

PURPOSE

This study was conducted to determine how the hemodynamic parameters of the superior mesenteric artery are affected in small bowel diseases.

METHODS

One hundred thirty-seven patients whose clinical symptoms suggested an intestinal abnormality were evaluated with duplex Doppler sonography. The control group comprised 42 subjects recruited from the medical staff or from patients referred for renal sonography.

RESULTS

In 38 patients with diverse small bowel diseases, mean blood flow volume to the superior mesenteric artery territory (1.115+/-0.470 l/min) was significantly greater (p < 0.01) and the mean resistance index (0.82+/-0.06) was significantly lower (p < 0.05) than the mean values in the control group (0.692+/-0.250 l/min and 0.85+/-0.04, respectively). The mean peak systolic velocity and end-diastolic velocity in bowel disease patients were higher than the mean values in the control group.

CONCLUSIONS

Various intestinal abnormalities share common Doppler findings, eg, increase in blood flow volume, increase in both peak systolic and end-diastolic velocities, and decrease in resistance index. However, the absence of these findings does not exclude the possibility of small intestinal disease because of the overlap of the measurements in diseased and healthy subjects.

Budd-Chiari syndrome in a child secondary to membranous obstruction of the hepatic vein treated by percutaneous transluminal angioplasty. Report of a case

Budd-Chiari syndrome (BCS) due to membranous obstruction of the hepatic vein and the inferior vena cava is rare in children. We report a child with BCS that had a membranous obstruction at the level of the hepatic veins. The web was successfully dilated percutaneously by balloon catheters. Symptoms and signs of obstruction improved without any complication. As percutaneous catheterization is an effective, safe and repatable procedure, we recommend this technique for treatment of children and adults with BCS due to membranous obstruction of the hepatic veins.

Superior mesenteric artery Doppler waveform changes in response to inflammation of the ileocecal region

In the present study, we determined how Doppler waveforms of the superior mesenteric artery (SMA) are affected by inflammatory processes in the ileocecal region. Twenty-two patients (aged 20-69 years) with ileocecal region inflammation (ICRI) were examined with duplex Doppler Ultrasonography to establish whether any significant changes were present in the mean blood flow parameters of peak systolic velocity (PSV), end-diastolic velocity (EDV), resistive index, pulsatility index, blood flow volume, and diameter of the SMA. The findings were compared with those of 22 volunteer controls. Mean blood flow volume in the SMA in patients with ICRI (1.128 +/- 0. 43 L/min) was significantly greater (p < 0.001) than that in the control group (0.643 +/- 0.19 L/min). The mean PSV (1.87 +/- 0.44 m/s) and the mean EDV (0.31 +/- 0.18 m/s) were also significantly (p < 0.01) higher than those of the means in healthy subjects (mean PSV = 1.44 +/- 0.26 m/s and mean EDV = 0.20 +/- 0.05 m/s). ICRI, regardless of cause, increases both the flow velocities in the SMA and the flow volume to the SMA territory.

Hepatic vein Doppler waveform changes in early stage (Child-Pugh A) chronic parenchymal liver disease

Doppler waveform changes can be found in chronic parenchymal liver disease, especially in the late stages. We investigated the contribution of Doppler ultrasound in diagnosing early-stage chronic parenchymal liver disease. In this prospective study, 30 patients who had been diagnosed with chronic liver disease (Child-Pugh class A) and 30 healthy subjects were studied. The diagnosis was confirmed with histopathologic examinations of biopsy specimens in 17 patients. The Doppler US examination of hepatic veins was performed in all the patients and healthy subjects. The Doppler US pattern was classified into three groups according to the Doppler signal characteristics: (1) type 0, triphasic waveform, the presence of a short phase of reversed flow, (2) type I, decreased amplitude of the phasic oscillations without the short phase of reversed flow, and (3) type II, complete flat waveform. Normal hepatic vein waveforms (type 0) were found in 8 patients (26.66%) and abnormal hepatic waveforms (type I + type II) in 22 patients (73.33%). The results of Doppler ultrasonography were correlated with the diagnosis of early-stage chronic parenchymal liver disease (Child-Pugh class A). In all the subjects of the control group, the Doppler waveform of hepatic veins showed the triphasic pattern (type 0). In the statistical evaluation using Fisher's exact test we observed that there was a significant difference (p < 0.05) between the control group and the patient group with respect to the presence of abnormal (type I + type II) Doppler waveform. The diagnostic accuracy in the patients who had biopsy was 76.47% and that in the patients who did not was 69.23%.

Intrarenal varices in portal hypertension: demonstration by color Doppler imaging

The gray-scale ultrasonographic appearances of dilated intrarenal vascular structures may mimic peripelvic cysts or hydronephrosis. We report a patient with portal hypertension in whom color Doppler ultrasound was found to be a very practical imaging technique in demonstrating varices of the renal segmental veins.

Isthmus hypertrophy mimics tumour in horseshoe kidney: a case report

We present a case of horseshoe kidney. He was operated because of nephrolithiasis, and was found to have a tumour-like mass in the isthmic localization 2 years after the operation. The tumour-like mass was proven to be an isthmus hypertrophy after detailed research.

Endoscopic treatment of bronchobiliary fistula: report on 11 cases

BACKGROUND/AIMS

There are reports of treatment of biliary cutaneous fistulae by endoscopically placed nasobiliary drains. We report our fistulae treatment results from this method.

MATERIALS AND METHODS

We treated 11 patients with bronchobiliary fistulas (BBFs) endoscopically during the last 6 years. In most cases, the BBF's were the result of Hydatid cyst operations. Six patients had simultaneous biliocutaneous fistula (BCF).

RESULTS

All BBFs and BCFs closed after the nasobiliary drain placement without any complication. Three patients who developed fistula recurrence healed with endoscopic treatment.

CONCLUSION

Endoscopic treatment is a viable alternative to surgical treatment.

Agenesis of the celiac trunk: an angiographic case

In the angiography performed for a clinical diagnosis, a unique case of "agenesis of the celiac trunk" was encountered in a 42-year-old Turkish male. There was instead an artery which arose from the aorta at the level of the first lumbar vertebra, and supplied blood to the territory of both the celiac and superior mesenteric arteries by giving rise to the splenic, the jejunal, the ileal, the pancreaticoduodenal, the proper hepatic and the left gastric arteries, consecutively.

Wandering accessory spleen

A patient with an excessively mobile accessory spleen detected on ultrasound examination is reported in whom a normally located spleen was also found. Sonographic and colour Doppler imaging criteria were used for making the specific diagnosis. The large accessory spleen has been demonstrated at different sites within the abdomen on subsequent follow-up sonographic examinations. The splanchnic flow pattern obtained from the long vascular pedicle of the accessory spleen indicated normal perfusion. Since the perfusion of the wandering accessory spleen was not compromised by torsion, and the patient refused surgical intervention, a conservative approach was considered to be appropriate.

Irregularity of the left hemidiaphragmatic contour caused by the dilatated left inferior phrenic vein. A case report

A patient with segmental narrowing of the inferior vena cava in whom the dilatated and tortuous left inferior phrenic vein was apparent on a plain chest radiogram as an irregu larity of the left hemidiaphragmatic contour is described.

Clavicular horn: another bony projection in nail-patella syndrome

Nail-patella syndrome is an uncommon inherited disorder characterized by nail dysplasia, iliac horns, and knee and elbow abnormalities. We report a patient with nail-patella syndrome in whom calvicular horn, shoulder girdle dysplasias, and pelvic abnormalities were demonstrated, along with the classical tetrad.

Retroperitoneal fibrosis: evaluation by ultrasonography and color Doppler imaging

Delay in diagnosis is common in retroperitoneal fibrosis because of the non-specific clinical presentation. Ultrasonography combined with color Doppler imaging is a rapid and practical method in the early diagnosis and during follow-up. We describe 3 cases with retroperitoneal fibrosis, emphasizing the ultrasonographic and color Doppler features of the disease.

The mechanism of cholestasis from hepatic hydatid cysts

Cholestasis is a common complication of hepatic hydatid cyst. We describe the various mechanisms of cholestasis in hepatic hydatid cyst as demonstrated by percutaneous transhepatic cholangiography (PTC) and endoscopic retrograde cholangiopancreatography (ERCP) in 16 patients. In our patients, cholestasis was the result of rupture or mechanical pressure of the cyst on the biliary system. Direct visualization of the bile duct, especially by PTC, provided precise definitions of the pathology, and aided the surgeon in his approach. There were no adverse reactions. All preoperative diagnoses were confirmed at operation.